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Zhu Danxi said: Menstrual blood is Yin blood. Yin must follow Yang; therefore, its color is red, inheriting the hue of Fire. Blood is the companion of Qi; if Qi is hot, blood becomes hot; if Qi is cold, blood becomes cold; if Qi is stagnant, blood becomes stagnant. As the companion of Qi, blood moves with Qi. The presence of clots indicates stagnation of Qi. Pain occurring just before menstruation indicates stagnation of Qi mechanism. Pain occurring after menstruation indicates deficiency of both Qi and Blood. Irregular or erratic menstrual flow indicates chaos in Qi mechanism. Pale color indicates deficiency mixed with dampness. Purple color indicates heat in Qi. Black color indicates extreme heat. Nowadays, when people see purple-black clots accompanied by pain, they generally attribute it to invasion by wind-cold and use warm-tonic formulas, leading to immediate disaster. The *Classic of Medicine* states: "When things reach an extreme, they become harmful; only through control can balance be maintained." Extreme heat inevitably involves transformation into Water characteristics; thus, heat results in purple color, and extreme heat results in black color. Moreover, women often have tendencies toward anger and depression, and their desires are doubled. The fire of Jue-Yang (Defiant Yang) in the Zang-Fu organs exists every day; how could this not be a Heat syndrome? If it were wind-cold, it must be due to external contraction. Even if such cases exist, they occur in only one or two out of a thousand.

Ye Shi said: Black menstrual blood belongs to Heat; Danxi's discussion is excellent. However, there are cases of external wind-cold invasion, which I encounter once or twice in ten. Generally, Cold governs contraction and pulling, so the lower abdomen must always feel cold and painful. During menstruation, hands and feet may be cold, lips cyanotic, and face pale. The Chi pulse at the cun-kou position may be slow (Chi), faint, or weak and deficient, or large but forceless. In Heat syndromes, the Chi pulse is surging (Hong) and rapid (Shu), or solid and forceful. One must refer to both pulse and symptoms for an accurate diagnosis.

*Zhunsheng* commentary: When a Cold syndrome is initially contracted from external pathogens, invasion into the meridians causes pain. If there is no pain initially, prolonged stagnation will transform into Heat. Furthermore, Cold Blood coagulates; since the blood has been discharged and appears purple-black, it does not belong to Cold.

Zhu Danxi said: For irregular menstruation with pale-white blood color, it is Qi deficiency, suitable for herbs such as Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Huangqi (Astragalus Root), and Xiangfu (Cyperus Rhizome). For delayed menstruation with purple-black clots, it is Excess Heat in Blood, necessarily accompanied by pain, suitable for Siwu Tang (Four Substances Decoction) added with Huanglian (Coptis Rhizome) and Xiangfu (Cyperus Rhizome). For excessive menstruation with pale color, it is due to abundant Phlegm, suitable for Erchen Tang (Two Aged Ingredients Decoction) added with Chuanxiong (Ligusticum Rhizome) and Danggui (Angelica Sinensis Root).

Xue Lizhai commentary: Delayed menstruation may be caused by Blood deficiency in the Spleen Meridian, suitable for Renshen Yangrong Tang (Ginseng Nourishing Ying Decoction). It may be caused by Blood insufficiency in the Liver Meridian, suitable for Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). It may be caused by Qi deficiency and Blood weakness, suitable for Bazhen Tang (Eight Treasures Decoction).