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In women suffering from cold damage (Shanghan), or due to overexertion, or anger causing qi stagnation, if fever occurs coinciding with menstruation, heat may enter the blood chamber (the uterus and Chong and Ren meridians). This results in either continuous bleeding or cessation of menstrual flow. Such conditions manifest as clear consciousness and calmness during the day, but delirium and hallucinations resembling seeing ghosts at night. If the heat is caused by external pathogenic factors entering from the exterior, Yi Chaihu Yin (One Bupleurum Decoction), San Chaihu Yin (Three Bupleurum Decoction), Si Chaihu Yin (Four Bupleurum Decoction), or Huanglong Tang (Yellow Dragon Decoction) from *Liangfang* added with Shengdi Huang (Rehmanniae Radix) should be selected and used according to the specific situation. If the fire arises internally due to anger or exertion, and the patient sweats profusely without exterior signs (such as aversion to cold or headache), Baoyin Jian (Protect the Yin Decoction), Qinghua Yin (Clear and Transform Decoction), or Danggui Liu Huang Tang (Angelica Hexa-Yellow Decoction) should be used with modifications. If the illness is gradually improving but the patient has always had weak yuan qi (primordial qi), and the heat has not fully subsided nor the bleeding stopped, Buyin Yiqi Jian (Tonify Yin and Augment Qi Decoction) or Buzhong Yiqi Tang (Regulate the Middle and Augment Qi Decoction) is appropriate. If the spleen qi is inherently weak, Guipi Tang (Restore the Spleen Decoction) is suitable; if both qi and blood are weak, Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) is indicated, thus avoiding errors. If there is blood heat with significant stasis, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Mudan Pi (Moutan Cortex), Honghua (Carthami Flos), and Danggui (Angelicae Sinensis Radix) is recommended.

Observing the color of blood allows one to distinguish between deficiency and excess syndromes, as well as cold and heat syndromes. Thick and abundant blood indicates an abundance of blood; pale and scanty blood indicates a deficiency of blood. These are generally easy to understand. However, the distinction between purple and black colors is critical, as their pathological natures are opposite (like ice and charcoal), yet many fail to comprehend this, leading to frequent misdiagnoses. Purple and black are similar; nowadays, people often see purple blood and, regardless of deficiency or excess, assume it indicates severe internal heat. They do not realize that bright red or purplish-red blood, which is thick and forms clots or strips, represents new blood flowing recklessly, usually due to internal heat. Conversely, blood that is purple mixed with black, or scattered and thin, appearing dark and necrotic, indicates damage to true qi internally and definitely belongs to deficiency-cold syndromes. If the condition worsens from this, the blood may resemble leaking roof water or putrid old blood; these are variations of purple and black manifestations. This signifies severe damage to the liver and spleen and a collapse of yang qi. One should promptly use sweet-warm herbs, such as Liyin Jian (Regulate the Yin Decoction), Lizhong Tang (Regulate the Middle Decoction), Guipi Tang (Restore the Spleen Decoction), Siwei Huiyang Yin (Four-Ingredient Return Yang Infusion), or Buzhong Yiqi Tang (Regulate the Middle and Augment Qi Decoction), to specifically tonify spleen earth. In this way, collapsed qi will be raised, and lost essence will be secured; as yuan qi gradually recovers, the disease will surely heal. If all purple blood is treated as a heat syndrome, death will inevitably follow the administration of medicine. This applies equally to conditions such as intestinal wind and hematochezia. Students of medicine must not neglect this point.