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Any variation in the color of menstrual blood can be distinguished, serving not only to differentiate deficiency (Xu) and excess (Shi) patterns but also cold (Han) and heat (Re) patterns. If the blood is thick and abundant, it indicates an abundance of blood; if the blood is pale and scanty, it indicates a depletion of blood. These are generally obvious principles. However, regarding the distinction between purple and black colors, the pathological mechanisms are as contradictory as ice and charcoal, yet most people fail to understand this, leading to frequent misdiagnoses. Since purple and black are similar, nowadays people see purple blood and, without distinguishing between deficiency and excess, immediately attribute it to extreme internal heat. They do not realize that bright red or purplish-red blood that is thick and forms clots or strips represents new blood flowing recklessly, mostly caused by internal heat. Conversely, blood that is purple mixed with black, or is scattered and thin, appearing dark and decayed, is mostly due to damage to the true Qi internally and must belong to a deficiency-cold pattern. If this condition worsens, the blood may appear like dripping water from a leaking roof or like rotten old blood; these are all variations of purple-black blood manifestations. This syndrome represents severe damage to the Liver and Spleen and a sinking of Yang Qi. One should promptly use sweet-warm formulas, such as Li Yin Jian (Cinnamon Twig and Rehmannia Decoction), Li Zhong Tang (Regulate the Middle Decoction), Gui Pi Tang (Restore the Spleen Decoction), Si Wei Hui Yang Yin (Four-Ingredient Decoction to Restore Yang), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). By solely rescuing the Earth element (Spleen), the sunken Qi will be lifted, and the escaping Qi will be secured. As the Yuan Qi gradually recovers, the disease will surely heal. If one treats all purple-colored blood as a heat syndrome, death will inevitably follow the medication. This principle applies equally to conditions such as intestinal wind and hematochezia. Students of medicine must not overlook this point.

Li Yin Jian (See "Blood Cold and Delayed Menses")
Li Zhong Tang (See "Blood Deficiency and Menstrual Disorder")
Gui Pi Tang (See "Irregular Menses")
Si Wei Hui Yang Yin (See *Xin Fang Ba Zhen · Re Zhen*), used for critical cases of primordial Yang deficiency and collapse occurring suddenly.
Ren Shen (Ginseng Radix et Rhizoma) (1–2 liang), Zhi Fu Zi (Prepared Aconiti Lateralis Radix) (2–3 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (1–2 qian), Pao Gan Jiang (Roasted Zingiberis Rhizoma) (2–3 qian).
Boil two zhong of water over strong fire until reduced to seven or eight fen. Take warm, drinking slowly.
Bu Zhong Yi Qi Tang (See "Irregular Menses")

The *Ping Re Bing Lun* states: "When menstruation ceases, it is due to the closure of the Bao Mai (Uterine Vessels). The Bao Mai connects to the Heart and networks into the Bao Zhong (Uterus). Now, if Qi forces upward against the Lung, the Qi of the Heart cannot descend smoothly, thus menstruation ceases."
The *Yin Yang Bie Lun* states: "Diseases of the Two Yang meridians originate in the Heart and Spleen. There is a hidden distress that cannot be voiced; in women, this leads to amenorrhea. If it transmits to become 'Feng Xiao' (wasting away like dried leaves blown by wind) or 'Xi Ben' (rushing breath/palpitations), it is a fatal and untreatable condition."
The *Xie Qi Zang Fu Bing Xing Pian* states: "A faint and choppy Kidney pulse indicates amenorrhea."

Blood Ku (Depletion) and Blood Ge (Obstruction) are fundamentally different. "Ge" means obstruction; "Ku" means exhaustion. Obstruction arises from pathogenic factors blocking stagnation, causing blood to flow retrograde. Exhaustion arises from the failure of the Chong and Ren meridians, where the source of flow is cut off. For any woman suffering from chronic illness lasting months or half a year, amenorrhea is inevitable. Precisely because Yin is exhausted, blood becomes depleted. The meaning of "Ku" implies a state of having no blood. Thus, symptoms may include emaciation, fatigue, cough, night fever, reduced appetite, history of blood loss, or simply prolonged absence of menstruation without distension, pain, blockage, or obstruction—all constitute signs of Blood Ku Amenorrhea. To prevent depletion, nothing is better than nourishing Ying (Nutritive) Qi; to restore flow, nothing is better than [nourishing to allow natural flow]. Just as snow melts and spring water flows naturally, when blood is abundant, the meridians will open spontaneously. With a surging source, who could possibly obstruct it? Yet, contemporary practitioners, regardless of whether there is stagnation or not, often add herbs to guide and unblock. In severe cases, they rely exclusively on promoting circulation with herbs like Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos). Do they not know that while blood stasis can be unblocked, blood depletion cannot? If blood is already depleted and one forcibly unblocks it, the depletion will worsen. What difference is there from squeezing dry juice from a dried fruit? This harm stems from ignorance of the meaning of "Ku." One must avoid this error. The treatment method here should be examined in conjunction with the preceding sections on Blood Deficiency and Kidney Deficiency.

Kou Zongshi stated: "Human life is based on Blood and Qi. Diseases invariably begin by damaging Blood and Qi. For unmarried men and women, persistent thoughts and excessive worry often lead to consumptive disorders. In men, spirit and luster dissipate; in women, menstruation closes first. Worry and anxiety injure the Heart, causing blood rebellion and Qi exhaustion, leading to dissipated spirit and closed menstruation. Furthermore, Heart disease fails to nourish the Spleen, resulting in poor appetite. Spleen deficiency leads to Lung Metal deficiency, causing cough. When Kidney Water is exhausted, Liver Wood loses its nourishment, leading to dry and flaccid limbs, irritability, scorched hair, and weak sinews and bones. If the disease spreads through all five Zang organs, death is certain. This type of disorder is among the most difficult to treat among consumptive diseases. Because the pathology originates within the five Zang organs, there is no clear endpoint, and medicinal force cannot reach it. If the patient can change their mindset, followed by medicinal support, there is still a chance of survival out of ten. Taking this as an example, other prescriptions can be applied according to pulse and syndrome differentiation."

Zhang Shi stated: "For unmarried girls with long-standing amenorrhea, Qing Hao (Artemisiae Annuae Herba) and other cooling herbs must strictly be avoided. Many physicians assume unmarried girls have blood heat and use cooling herbs to resolve it, failing to realize that blood moves with heat and coagulates with cold. *Yang Sheng Bi Yong Fang* explains this in detail. This theory is highly reasonable and must be understood. If menses become scanty and gradually cease, accompanied by restlessness and pain in the hands, feet, bones, and muscles, progressive emaciation, and tidal fever, with a faint and rapid pulse, this is due to Yin deficiency and blood weakness, allowing Yang to invade. Little water cannot extinguish a raging fire; the fire逼 (forces) the water to dry up, consuming body fluids. Treatment should focus on nourishing blood and benefiting Yin. Do not use toxic drugs to force flow. Bai Zi Ren Wan (Biota Seed Pill) or Ze Lan Tang (Lycopus Decoction) are appropriate."

Bai Zi Ren Wan (See *Fu Ren Gui Ancient Formulas*), used for blood deficiency with fire, where menstruation is gradually consumed and ceases, accompanied by progressive emaciation and tidal fever. Do not use toxic drugs to force flow; Bai Zi Ren Wan is suitable.
Bai Zi Ren (Biotae Semen, stir-fried and ground), Niu Xi (Achyranthis Bidentatae Radix, soaked in wine), Juan Bai (Selaginellae Herba) (each 0.5 liang), Ze Lan Ye (Lycopi Herba), Xu Duan (Dipsaci Radix) (each 2 liang), Shu Di Huang (Rehmanniae Radix Praeparata, 3 liang, steamed with wine until soft and mashed into paste).
Grind the above into powder, mix with the Rehmannia paste and refined honey, and form pills the size of tung tree seeds. Take over 100 pills per dose, swallowed with rice water on an empty stomach.

Ze Lan Tang (See *Fu Ren Gui Ancient Formulas*), used for amenorrhea due to consumption and debility.
Ze Lan Ye (Lycopi Herba) (2 qian), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba, stir-fried) (each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) (0.5 qian).
Decoct in water and take orally.

Xue Li-zhai stated: "Menstrual blood is Yin blood, governed by the Chong and Ren meridians. It transforms upward into milk and downward into menstruation. Its disorders arise from various causes: those caused by Spleen-Stomach deficiency failing to generate blood require regulation and tonification; those caused by Spleen depression injuring blood and causing depletion require resolution and tonification; those caused by Stomach fire consuming blood require clearing and tonification; those caused by labor injuring Heart blood and reducing volume require quietude and tonification; those caused by Kidney Water deficiency failing to generate Liver blood and causing closure require tonifying the Spleen and Lung; those caused by Lung Qi deficiency failing to move blood and causing closure require tonifying the Spleen and Stomach.
The Classics state: 'For lung injury, augment Qi; for heart injury, harmonize Ying and Wei; for spleen injury, regulate diet and adapt to temperature; for liver injury, soothe the interior; for kidney injury, benefit Essence.' Carefully examine and treat accordingly, and errors will be avoided.
The five grains enter the Stomach and transform into blood, nourishing the four extremities and internally supporting the five Zang and six Fu organs. If bitter-cold agents are taken, further damaging Stomach Qi, recovery will be impossible."