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Chen Liangfu stated: The Chong (Penetrating) and Ren (Conception) vessels in women are the sea of the twelve meridians, circulating externally along the meridians and nourishing internally the Zang-Fu organs. If Yin and Yang are in harmony, menstruation occurs on schedule. However, if labor and injury impair their restraining function, sudden profuse bleeding may occur, potentially leading to syncope or confusion. If the Cun (inch) pulse is faint and slow, it indicates cold in the Upper Jiao (Upper Burner), manifesting as hematemesis (vomiting blood) or epistaxis (nosebleed). If the Chi (cubit) pulse is faint and slow, it indicates cold in the Lower Jiao (Lower Burner), manifesting as metrorrhagia (uterine bleeding) or hematochezia (blood in stool); the treatment principle should primarily focus on regulating and tonifying the Spleen and Stomach.

Li Dongyuan stated: The sages treat diseases based on the principles of ascending, descending, floating, and sinking according to the four seasons. Persistent dripping of menstrual blood indicates that Qi and Blood from the anterior orifice are descending and escaping. Persistent watery diarrhea indicates that Qi and Blood from the posterior orifice are further sinking. The posterior orifice primarily excretes tangible matter, while the anterior orifice is the gateway for Essence and Qi. When Qi and Blood from both orifices sink downward, it signifies that the patient's whole-body Qi mechanism follows the autumnal and wintery commands of肃杀 (desolation) and storage. In a healthy body, Yang Qi ascends and floats, and Grain Qi moves upward, resulting in the generation of Yang and growth of Yin, characteristic of spring and summer. Once diseased, whole-body Qi and Blood cease to grow, and Grain Qi fails to ascend. Although the initial presentation may involve heat, prolonged loss from the Lower Jiao transforms into cold. With long-term sinking and descending, Cold-Dampness becomes predominant, requiring urgent rescue. Heat should be dispelled with hot herbs, Dampness removed with drying methods, and vigorous lifting and raising employed to assist growth, tonifying Qi and Blood to prevent flaccidity or atrophy. The sage established the treatment method: when Dampness is excessive, use Wind-Wood energy to promote ascent; this aligns with the classic saying "Wind overcomes Dampness," meaning using the overcoming element to pacify it. One must harmonize Stomach Qi to nourish Yuan Qi. If bleeding persists, wind herbs should be used to overcome dampness.

Xue Lizhai stated: A female patient suffered from metrorrhagia due to excessive consumption of cold-natured medicines, leading to chronic deficiency of the Spleen and Stomach. The original illness remained unresolved, and cold pathology re-emerged, presenting with irritability, thirst with desire to drink, inability to eat even a grain of rice, intermittent coma, and a洪大 (surging-large) pulse that felt weak upon deep pressure. This represents rootless fire, where internal deficiency-cold manifests as external false-heat. Treatment with Shiquan Dabu Tang (Ten Significant Decoction) plus Fuzi (Prepared Aconite Root) reduced the bleeding; daily administration of Bawei Wan (Eight-Ingredient Pill) led to recovery. Another case involved a patient with long-standing metrorrhagia who took Siwu Tang (Four Substance Decoction) and other cooling-blood formulas, resulting in intermittent symptoms. Some advocated clearing fire. However, if abdominal pain and cold limbs occurred, this indicated Spleen-Stomach deficiency-cold. Initial treatment with Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) followed by Jisheng Guipi Tang (Jisheng Restore the Spleen Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) resulted in immediate cessation of bleeding. Adhering rigidly to the rule "pain has no tonification method" would be an error.

Shenzhen commented: The above three cases describe metrorrhagia caused by deficiency-cold. While most cases of metrorrhagia are caused by heat, prolonged bleeding transforms heat into cold. Additionally, excessive intake of cold-cooling agents can induce internal cold in the Middle Jiao. The therapeutic approaches in the cases of Li Dongyuan and Xue Lizhai require careful attention. Metrorrhagia and leukorrhea with blood (Benglou) present as excess or deficiency, heat or cold. Only by clearly distinguishing between cold/heat and excess/deficiency can treatment methods be applied without error.