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Menstrual blood is the essence and qi transformed from food and drink. It is harmonized within the five Zang organs, distributed to the six Fu organs, and only then can it enter the vessels. The continuous flow of menstrual blood originates in its generation from the Spleen, is controlled by the Heart, stored and received by the Liver, disseminated by the Lung, and excreted by the Kidney, thereby irrigating the whole body. In men, it transforms into essence (Jing); in women, it ascends as breast milk and descends into the Sea of Blood (Chong and Ren meridians) to become menstruation. As long as essence and qi are not depleted, emotions are harmonious, and diet is appropriate, Yang generates and Yin grows, filling all vessels; how could there be irregularity? If one fails to exercise caution, injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) is most severe, followed by fatigue and overexertion. Alternatively, imprudence in sexual activity, where weakness is overcome by strength, leads to failure of the Chong and Ren meridians to maintain control, which is also common. Furthermore, external contractions and internal injuries, or medical errors that damage Ying Qi (Nutritive Qi), invariably cause such disorders. Individuals who are weak, prone to illness, intolerant of cold and heat, and unable to bear physical labor often have congenital deficiency. However, some suffer depletion due to indulgence during youth when Qi and Blood are growing, or premature exhaustion before Jing and Blood are fully mature, damaging the source of transformation and generation, resulting in lifelong harm. This is what must be carefully observed and regulated before disease occurs. To regulate established disease, the key lies in distinguishing Deficiency, Excess, Yin, and Yang. Zhu Danxi stated: Menstruation arriving early indicates Blood Heat; arriving late indicates Blood Deficiency. Wang Ziheng stated: Excessive Yang causes early arrival; insufficient Yin causes late arrival. Cases of fluctuating volume, cessation, metrorrhagia, or metrorrhagia with flooding are all caused by the rise and fall of Yin and Yang; this constitutes the general overview of menstrual irregularities. Although early arrival is often attributed to Fire, if it is a Deficiency pattern accompanied by Fire, the focus should be on Deficiency, primarily nourishing Ying Qi and stabilizing Blood. Moreover, there are cases of early arrival without Fire, where tonifying Middle Qi or securing the Gate of Vitality (Mingmen) is required, avoiding excessive use of Cold-Cooling herbs. Late arrival is fundamentally Blood Deficiency, but may also involve Dryness and Stasis due to Blood Heat, requiring Clearing and Tonification; or Blood Rebellion and stagnation, requiring Dispersion and Purging. In summary, the method of regulating menstruation seeks harmony, relying on detailed observation of pulse and symptoms. Only when both constitution and pulse indicate Excess should Clearing and Purging methods be used. Since Deficiency is very common and Excess is rare, the essence of regulating menstruation lies in tonifying the Spleen and Stomach to nourish the source of Blood, and nurturing Kidney Qi to secure the residence of Blood. Understanding these two aspects achieves perfection. If Ying Qi is inherently deficient and not cultivated, it will inevitably wither and exhaust itself; this must be carefully noted. During menstruation, Cold-Cooling medicines and foods are strictly contraindicated.

Chu Yushi said: Menstruation arrives monthly according to a fixed rhythm. Deviations in amount or timing are considered pathological. If Ying Blood is depleted and cannot nourish the bones and limbs, it manifests as hair loss, sallow complexion, emaciation, and dry heat. When Dryness is prevalent, Metal (Lung) is attacked by pathogens, leading to cough, expectoration, lung abscess (Fei Yong), or lung flaccidity (Fei Wei). Strengthening Stomach Qi and boosting Qi will generate Ying Blood and normalize menstruation. If amenorrhea is caused by rebellious Qi from anger, formulas that move Qi and break Blood stasis should be used.

The "Essence and Blood Chapter" of *Chu Shi's Remnant Books* states: If men engage in intercourse before their essence is fully developed, their bodies will remain incomplete, leading to unnamable diseases later in life. If one engages in intercourse while impotent, the essence remains inside and rots, causing painful urination resembling strangury (Lin syndrome). If essence is already exhausted and further drained, it causes pain in defecation and urination; the more painful, the more frequent the urge, and vice versa. For women, if ten years pass after the arrival of Tian Gui (Menstrual Essence) without intercourse, menstruation becomes irregular. Even within ten years, longing for intercourse can cause irregularity. Irregularity prevents old blood from exiting and causes new blood to flow erratically, potentially seeping into bones or causing swelling. Subsequent intercourse may fail to produce offspring. Excessive intercourse depletes essence and weakens the person; multiple births deplete blood and can be fatal. Observing the relationship between essence and blood reveals half the truth.

The Preface to *Chan Bao Fang* states: Women are based on Blood. With careful regulation, Qi and Blood circulate freely, spirit remains clear, menstruation is regular, and conception occurs through blood coagulation. If Spleen and Stomach are weak, appetite is poor, Ying and Wei Qi are insufficient, menstruation ceases, skin is yellow and dry, face lacks luster, there is alternating chills and fever, abdominal pain, difficulty conceiving, leukorrhea, flooding, or stagnant blood forming masses (Jia Zheng).

Xue Lizhai said: The Classics state: Diseases of the Two Yang meridians originate in the Heart and Spleen; hidden difficulties lead to amenorrhea in women. Thus, when Heart and Spleen are harmonious, the body and five Zang organs are moistened, and menstruation is normal. If Heart and Spleen are injured, Blood lacks nourishment and control, leading to irregular menstruation. Therefore, regulating menstruation should focus on regulating Heart and Spleen. Mr. Danxi also stated: Early arrival indicates Blood Heat; late arrival indicates Blood Deficiency. I believe early arrival may result from Spleen channel Blood dryness, Spleen channel depressed Fire, Liver channel angry Fire, Heat in the Blood level, or Fire stirred by labor. Late arrival may result from Spleen channel Blood Deficiency, Liver channel Blood Deficiency, or Qi Deficiency with weak Blood. Treatment methods: For Spleen channel Blood dryness, use Modified Xiao Yao San; for Spleen channel depression, use Gui Pi Tang; for Liver channel angry Fire, use Modified Xiao Chai Hu Tang; for Heat in the Blood level, use Modified Si Wu Tang; for Fire stirred by labor, use Bu Zhong Yi Qi Tang. For late arrival due to Spleen channel Blood Deficiency, use Ren Shen Yang Rong Tang; for Liver channel Blood insufficiency, use Liu Wei Di Huang Wan; for Qi Deficiency and weak Blood, use Ba Zhen Tang. Since Blood is generated by the Spleen, it is said that the Spleen controls Blood. Blood diseases require Bitter-Sweet formulas to assist Yang Qi and generate Yin Blood, as they are generally Deficiency patterns. Generally, for Liver-Spleen Blood dryness, Si Wu Tang is primary; for Liver-Spleen Blood weakness, Bu Zhong Yi Qi Tang is primary; for Liver-Spleen depression, Gui Pi Tang is primary; for Liver channel angry Fire, Modified Xiao Yao San is primary.

He also stated: The Stomach is the source of Wei Qi (Defensive Qi); the Spleen is the root of Ying Qi (Nutritive Qi). Ying Qi arises from the Middle Jiao, and Wei Qi from the Upper Jiao. Insufficient Wei Qi requires Pungent herbs for supplementation; insufficient Ying Qi requires Sweet herbs for tonification. The combination of Sweet and Pungent strengthens the Spleen and Stomach, generating Ying and Wei Qi, thus ensuring abundant Qi and Blood. If mental exertion causes erratic movement of Deficient Fire and menstrual disorder, calming the mind, nourishing Blood, and clearing Fire is indicated, following Mr. Dongyuan’s method.

He further stated: Premature aging, intolerance to cold and heat, inability to bear labor, and seasonal illnesses often stem from mental strain during youth when Qi and Blood are developing, or premature depletion before Jing and Blood are mature. Consequently, symptoms are difficult to describe. A weak or fine-rapid pulse at the Left Chi position indicates insufficiency of True Yin in the Left Kidney; treat with Liu Wei Wan. A slow-soft or deep-fine-rapid-almost-absent pulse at the Right Chi position indicates insufficiency of Ministerial Fire in the Mingmen; treat with Ba Wei Wan. A weak pulse at both Chi positions indicates dual deficiency of Yin and Yang; treat with Shi Bu Wan. These methods nourish the source of transformation. Do not lightly use herbs like Huang Bo (Phellodendron Bark) or Zhi Mu (Anemarrhena Rhizome). Even if Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) invade externally, it is because internal Qi is deficient allowing external pathogens to gather; thus, the aforementioned medicines are particularly suitable.