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Fever during menstruation or tidal fever: Fever before menstruation is due to blood heat, while fever after menstruation is due to blood deficiency. Fever without a fixed time should be examined for external pathogenic heat; tidal fever in the afternoon should be assessed for yin deficiency heat.

[Note] Fevers occurring during menstruation, whether intermittent or tidal, if they occur before menstruation, are fevers caused by blood heat; if they occur after menstruation, they are fevers caused by blood deficiency. Fevers that occur at irregular times are mostly due to external contraction and require careful differentiation of the heat from external pathogens. Tidal fevers in the afternoon mostly belong to interior heat and should be assessed as yin deficiency heat.

Chills and fever with body pain upon onset of menstruation: Differentiate between Ying-Wei disharmony and deficiency/excess patterns. Sweating without abdominal distension indicates Wei Qi insufficiency; no sweating with abdominal distension indicates Ying Blood excess.

[Note] When chills, fever, and body pain occur during menstruation, one must differentiate between Ying-Wei conditions and deficiency/excess: If there is fever, chills, body pain without distension, and sweating, it belongs to Wei Qi deficiency and Ying Blood insufficiency; if there is fever, chills, painful distension of the body, and no sweating, it belongs to Ying excess and Wei Qi surplus.

Abdominal pain after menstruation indicates Qi and Blood weakness; abdominal pain before menstruation indicates Qi and Blood stagnation. Qi stagnation primarily causes abdominal distension, while Blood stasis primarily causes pain. One must further examine whether the pattern is deficiency, excess, cold, or heat.

[Note] For abdominal pain during menstruation, pain occurring after menstruation ends is due to Qi and Blood deficiency; pain occurring before menstruation begins is due to Qi and Blood stagnation. If Qi stagnation leads to Blood stasis, abdominal distension predominates; if Blood stasis impedes Qi movement, pain predominates. One must further investigate the cause of the distension and pain, treating according to whether it is due to deficiency, excess, cold, or heat.

Diarrhea during menstruation is due to Spleen deficiency; duck-like loose stools with cold pain indicate Cold-Dampness. Weak Stomach Qi or injury from drinking fluids often causes vomiting; food injury inevitably causes pain and vomiting of undigested food.

[Note] Diarrhea during menstruation is a manifestation of Spleen deficiency. If the stool resembles duck feces and is accompanied by cold pain, it indicates Cold-Dampness. Vomiting during menstruation indicates weak Stomach Qi. If vomitus consists of saliva and phlegm-fluids, it indicates injury from fluid retention. If vomitus consists of food, it indicates food injury. However, those injured by food usually experience pain and vomit food, while those injured by fluids do not experience pain but only vomit phlegm-fluids.

Retrograde menstruation causing hematemesis or aberrant flow causing metrorrhagia is due to heat damaging Yin or Yang collaterals, causing blood to move recklessly. If blood loss is excessive and heat dissipates with the blood, tonification should be used. If blood loss is minimal but heat persists, despite deficiency, clearing heat should remain the primary treatment.

[Note] Retrograde menstrual blood manifesting upward as hematemesis or epistaxis, or downward as metrorrhagia due to aberrant flow, is all caused by excessive heat. Damage to Yin collaterals leads to downward bleeding forming metrorrhagia; damage to Yang collaterals leads to upward bleeding forming hematemesis and epistaxis. If blood loss is excessive, heat dissipates along with the blood, so treatment should focus on tonification. If blood volume is low but heat has not yet subsided, even though there is deficiency, treatment should still prioritize clearing heat.