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Wang Shishan stated: There was a woman who experienced diarrhea for two or three days prior to the onset of menstruation, after which the menses would flow. Her pulse was diagnosed as soft and weak (floating and fine, indicating deficiency or dampness), which points to Spleen deficiency. The Spleen governs blood and is associated with dampness. When menstruation is about to commence, Spleen blood first flows into the Sea of Blood (Chong Mai, the reservoir of Qi and Blood from the twelve meridians) and then descends to become menstrual blood. Since the Spleen blood has been depleted, it becomes too deficient to transform and transport internal dampness. By administering Shen Ling Bai Zhu San (a decoction composed of Ginseng, Poria, Atractodes Rhizome, etc., with functions of benefiting Qi, strengthening the Spleen, draining dampness, and stopping diarrhea), after more than a month, she no longer experienced diarrhea during her menses.

Miao Zhongchun stated: In cases where menstrual flow is excessive, leukorrhea occurs intermittently, symptoms are lighter during the day and heavier at night, and diarrhea occurs without fixed timing, this also belongs to the category of Yin depletion due to loss of blood from the lower jiao. It should be treated as Blood deficiency. Initially, administering Si Wu Tang (a decoction composed of Rehmannia Root, Angelica Sinensis, White Peony Root, and Ligusticum Chuanxiong, with functions of nourishing Blood and regulating menstruation) aggravated the condition. Only then did I realize that this disease perfectly aligns with Zhang Zhongjing's principle of "Yang generating Yin" (when Yang Qi is vigorous, Yin Blood is generated). Excessive menstruation, intermittent leukorrhea, and accompanying diarrhea are all caused by Yang deficiency leading to sinking and prolapse, termed Yang collapse (extreme exhaustion and outward floating of Yang Qi). Symptoms are lighter during the day because Yang Qi is vigorous; aided by Yang, the Spleen restores its function of transformation and transportation, so there is no stagnation of Blood, hence the lighter daytime symptoms. At night, Yin Qi is vigorous, but Yang Qi cannot perform its duties, losing its normal function of transformation and transportation; consequently, Blood stagnates, resulting in heavier nighttime symptoms. Treatment should involve administering herbs that assist Yang, such as Ginseng and Atractodes Rhizome.

Shenzhai commented: The above two entries list concurrent syndromes accompanying menstruation, such as diarrhea and leukorrhea. Concurrent syndromes during menstruation are not limited to one type, but abdominal pain, fever, diarrhea, and leukorrhea are common. The occurrence of any one of these four syndromes is sufficient to cause irregular menstruation; therefore, they are listed after the section on irregular menstruation. However, if irregular menstruation is not carefully diagnosed and treated, it will inevitably progress to amenorrhea (cessation of menstruation) and signs of Blood exhaustion (depletion of essence and blood). Therefore, various discussions regarding amenorrhea, closed menses, and Blood exhaustion in women are collected below. This is the rationale behind the book's arrangement, which readers must understand.

The *Su Wen* states: The reason for absent menstruation is the closure of the Bao Mai (uterine vessels). The Bao Mai belongs to the Heart and connects to the uterus. Currently, Qi forces upward against the Lung, preventing Heart Qi from descending and communicating downward, thus causing the absence of menstruation.

The *Su Wen* states: Diseases of the Yang Ming (the meridians of the Stomach and Large Intestine) originate in the Heart and Spleen. If there are unspoken grievances or sorrows, women will experience amenorrhea. If the condition transmits and develops into "wind wasting" (emaciation as if dried by wind) or "panting rush" (rapid breathing and running sensation), it is a fatal and untreatable condition.

Shenzhai commented: The above two citations from classical texts explain the causes of amenorrhea in women: one belongs to the closure of the Bao Mai, and the other belongs to diseases of the Yang Ming meridians.