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Wen Jing Tang (Cinnamon Twig Decoction, from *Furen Liang Fang* Vol. 3, treating cold-type abdominal pain) Jiao Jia San (Intermingling Powder, from *Furen Liang Fang* Vol. 100, treating pain due to qi and blood stagnation) Cu Fu Wan (Vinegar-Processed Aconite Pill, from *Furen Liang Fang* Vol. 7, treating qi stagnation and pain relief) Niu Xi San (Achyranthes Root Powder, from *Furen Liang Fang* Vol. 99, treating menstrual obstruction and pain relief) Jiang Huang San (Turmeric Powder, from *Furen Liang Fang* Vol. 101, treating blood stasis removal and pain relief) Dang Gui Moyao Wan (Angelica Sinensis and Myrrh Pill, from *Furen Liang Fang* Vol. 6, treating pain due to blood stasis) Xuan Hu Dang Gui San (Corydalis and Angelica Sinensis Powder, from *Furen Liang Fang* Vol. 98, treating pain due to rebellious blood) Hu Po Wan (Amber Pill, from *Furen Liang Fang* Vol. 134)

Incessant metrorrhagia and metrostaxis represent the most severe form of menstrual irregularity. "Irregularity" refers to menstruation occurring either early or late; "metrostaxis" refers to intermittent bleeding outside the menstrual period. Metrostaxis progresses to dripping discharge, which in turn progresses to metrorrhagia with massive bleeding. Fundamentally, these are all disorders of blood, differing only in severity. The *Su Wen: Yin Yang Bie Lun* states: "Yin deficiency with vigorous yang pulse is termed metrorrhagia." The *Su Wen: Bai Bing Shi Sheng Pian* states: "Injury to yang collaterals causes external blood overflow; injury to yin collaterals causes internal blood overflow." Therefore, a vigorous yang pulse necessarily indicates yin deficiency; collateral injury inevitably leads to blood overflow. Understanding these two principles allows one to grasp more than half of the meaning of metrorrhagia and metrostaxis, as well as their treatment methods. Regarding the concept of yin deficiency, it is not merely an injury to Ying Qi (nutritive energy); rather, the yin of all five Zang organs can be affected. Thus, if Shen (spirit) is injured, blood has no master, indicating disease in the Heart; if Qi is injured, blood has no source, indicating disease in the Lung; if Yi (intellect) is injured, it cannot control and secure blood, indicating disease in the Spleen; if Hun (ethereal soul) is injured, it cannot store and hide blood, indicating disease in the Liver; if Zhi (will) is injured, it cannot secure true yin, indicating disease in the Kidney. Hence, all five Zang organs can suffer from yin deficiency and yang vigor. Therefore, in cases of yin deficiency disease, it is due to injury of Zang Qi, causing blood to lose its residence; in cases of yang vigor, it is because fire resides in the yin portion, causing blood to act recklessly due to heat. In general, the treatment for this should examine Zang Qi and observe yin and yang. If there is no fire, seek the injured Zang and tonify it; if there is fire, examine the meridian and clear and nourish it. This is an unchangeable excellent method. However, although cases with fire must be cleared, since Yuan Qi (original energy) is often deficient, false heat is very common. If one fails to distinguish between true and false heat and mistakenly uses cold-cooling herbs, it will further damage the Spleen and Stomach, causing the generating Qi to become increasingly precarious. Ancient sages said: "For all lower body bleeding syndromes, one must use formulas like Si Jun Zi Tang (Four Gentlemen Decoction) to conclude treatment." They also said: "After massive hematemesis, do not rely solely on pulse diagnosis; urgently use Du Shen Tang (Single Ginseng Decoction) to rescue." The purport here is profound. Therefore, whenever signs of blood depletion are seen, one must first use sweet-natured herbs to tonify the Spleen and Stomach, thereby benefiting the generating Qi. Sweet flavors generate blood and nourish Ying Qi. As long as Spleen and Stomach Qi is strong, Yang generates and Yin grows, and blood naturally returns to its vessels. Thus, it is said that the Spleen controls blood.

Treatment methods for metrorrhagia, metrostaxis, and leukorrhea:
If caused by yin deficiency and blood heat acting recklessly, use Bao Yin Jian (Protect the Yin Decoction) or Jia Jian Yi Yin Jian (Modified One Yin Decoction).
If caused by excessive fire forcing blood to act recklessly without deficiency signs, use Xi Xin Yin (Extinguish Fire Drink), Huang Qin San (Scutellaria Powder) plus Xu Duan (Dipsacus Root) and Dan Shen (Salvia Root).
If accompanied by blood heat and a slippery pulse, use Bao Yin Jian, Huai Yu San (Huai Hua and Zong Lu San Powder), or Sheng Di Huang Tang (Rehmannia Decoction).
If caused by liver fire moving blood, use Jia Wei Si Wu Tang (Modified Four Substances Decoction).
If caused by liver fire moving blood with unresolved rebellious Qi, use Hua Gan Jian (Transform the Liver Decoction) or modify Bao Yin Jian.
If blood is stagnant and acting recklessly due to rebellion, use Si Wu Tang (Four Substances Decoction) or Dan Shen San (Salvia Powder).
If Ying Qi is insufficient and blood cannot be regulated, leading to reckless action, choose among Wu Fu Yin (Five Blessings Drink), Si Wu Tang, Si Jun Zi Tang (Four Gentlemen Decoction), or Ba Zhen Tang (Eight Treasures Decoction) according to suitability.
If Spleen Qi is deficient and sinking, unable to secure blood leading to hemorrhage, use Shou Pi Jian (Longevity Spleen Decoction), Gui Pi Tang (Restore the Spleen Decoction), or Si Jun Zi Tang plus Chuan Xiong (Ligusticum Rhizome) and Dang Gui (Angelica Sinensis). For more severe cases, use Ju Yuan Jian (Raise the Origin Decoction).
If Spleen and Kidney are deficient and cold, accompanied by vomiting, diarrhea, and aversion to cold, use Li Yin Jian (Regulate the Yin Decoction), Wu Jun Zi Jian (Five Gentlemen Decoction), or Li Zhong Tang (Regulate the Middle Decoction).
If Yang Qi is severely deficient and collapsing, use Si Wei San (Four Cornered Powder).
If Spleen and Kidney Yin Qi is insecure, use Gu Yin Jian (Secure the Yin Decoction), Wu Yin Jian (Five Yins Decoction), or Mi Yuan Jian (Secret Origin Decoction).
If Liver and Gallbladder Qi is deficient and unable to store blood, there will likely be much fear and timidity; use Wu Fu Yin, Qi Fu Yin (Seven Blessings Drink), or Ba Zhen Tang. If accompanied by Yang deficiency, add Sheng Jiang (Fresh Ginger) and Rou Gui (Cinnamon Bark).
If blood loss is excessive, leading to blood depletion and Qi exhaustion, urgently use Du Shen Tang to grasp the Qi to prevent collapse, or use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction).
If metrorrhagia/metrostaxis has persisted for a long time, with slippery blood that cannot be controlled, requiring astringency and securing, use Long Gu San (Dragon Bone Powder), Ru Sheng San (Like Sage Powder), or Qi Hui San (Seven Ashes Powder), used concurrently with Ren Shen (Ginseng).
Generally, the treatment for blood metrostaxis is roughly as described above. However, foul odor and a slippery pulse indicate excess fire, requiring cooling methods; whereas fishy odor, coldness, and a fine pulse indicate cold, requiring warming and tonification. If chronic illness leads to endless loss of essence and easy depletion of the Weilu (tailgate/lower back region), massive tonification is necessary; Gu Yin Jian and Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) are suitable.

First, metrorrhagia and metrostaxis diseases include sudden metrorrhagia and chronic metrorrhagia. Sudden metrorrhagia arises abruptly and is easier to treat; chronic metrorrhagia involves deep pathology and is difficult to treat. Furthermore, when blood is lost through metrorrhagia, heat gradually diminishes. If it persists without stopping, it becomes metrostaxis. Such syndromes invariably originate from worry, thought, depression, and anger, first damaging the Spleen and Stomach, then affecting the Chong and Ren meridians. Chronic metrorrhagia and metrostaxis cause daily depletion of true Yin, often leading to alternating chills and fever, coughing, and pulses that are wiry-rapid or hollow-large. These are pulses of Yuan Qi deficiency and false heat due to Yin deficiency. One must especially use sweet-warm herbs like Ren Shen, Di Huang (Rehmannia), Dang Gui, and Bai Zhu (Atractylodes Macrocephala) to vigorously tonify the root source, so that survival may be hoped for. As long as Stomach Qi is not exhausted and can accept tonification, cure is possible; if one cannot accept tonification but continues with cooling methods to prolong life temporarily, it is ultimately an ill omen.

Second, the treatment of metrorrhagia and metrostaxis distinguishes among the five Zang organs, but some aspects are distinguishable and others are not. Distinguishable aspects: Heart and Lung reside above the diaphragm and belong to the Two Yang organs; Liver, Spleen, and Kidney reside below the diaphragm and belong to the Three Yin organs. Treating Yang organs focuses on Qi; treating Yin organs focuses on Essence. This is what is meant by distinguishable. However, the five Zang organs transfer pathogenic factors to one another, and Essence and Qi intermingle; this is the indistinguishable aspect. For example, if the disease originates in the Heart, injuring Ministerial Fire, it will inevitably burden the Spleen Earth; thus, treating the Spleen is treating the Heart. If the disease originates in the Lung, failing its regulatory function, it will inevitably damage Kidney Water; thus, treating the Kidney is treating the Lung. The Spleen is the official of the Central Plain, managing water and grain. If the supply route is not supported, all five pathways will be diseased. Without investigating the mother organ, treating the Spleen alone is not a good strategy. The Liver is the general officer; depression and anger cause disease. If victorious, it attacks the Spleen; if defeated, it traps itself. Without knowing strength and weakness, attacking and tonifying may be reversed. Moreover, the five Zang organs and five Qi are all interconnected. Thus, within each Zang organ, there is Shen Qi, Lung Qi, Stomach Qi, Liver Qi, and Kidney Qi. Their interactions, benefits, and harms have subtle mutual dependencies. Therefore, one must comprehend the root of Zang Qi: Where lies its strength? Where lies the leverage of life and death? What is the key to Essence and Qi growth and decline? What is the principle of attack and tonification sequence? Only then can one be called wisely enlightened. To say that the Heart uses Suan Zao Ren (Ziziphus Seed) and Yuan Zhi (Polygala Root), the Lung uses Jie Geng (Platycodon Root) and Mai Dong (Ophiopogon Tuber), the Spleen uses Bai Zhu and Gan Cao (Licorice Root), the Liver uses Qing Pi (Citrus Peel) and Bai Shao (White Peony Root), and the Kidney uses Du Huo (Angelica Pubescens) and Xuan Shen (Scrophularia Root)—this is merely superficial knowledge. How can one know the Way of Life and Nature? All syndromes are like this, not just metrorrhagia.

Third, women beyond forty years of age, in the years when menstruation is about to cease, often experience gradual obstruction and missed periods. At this time, vigilance is essential. If Qi and Blood are harmonious and there are no other chronic illnesses, this is simply the natural cessation of menstruation and need not be worried about. However, if the patient usually suffers from depression and irregular menstruation, and now experiences delayed obstruction, it signals impending metrorrhagia. If the obstruction is slight, the metrorrhagia will be mild; if prolonged, the metrorrhagia will be severe. This is metrorrhagia caused by obstruction. One should preemptively administer Si Wu Tang or Ba Zhen Tang to regulate it; otherwise, fearing prolonged stagnation will lead to rupture, causing greater harm. After metrorrhagia occurs, one must distinguish between presence or absence of fire. If fire is present, driven by heat forcing blood, use Bao Yin Jian. If fire is absent, caused by rupture due to obstruction or stagnation, remove the old and nourish the new; use Tiao Jing Yin (Regulate Menstruation Drink) first to regulate, then tailor the treatment: if nourishment is needed, use Xiao Ying Jian (Small Nourishing Decoction); if securing is needed, use Gu Yin Jian.

Wang Shuhe said: What are the Five Metrorrhagias? Answer: White metrorrhagia resembles mucus; Red metrorrhagia resembles dark red fluid; Yellow metrorrhagia resembles rotten melon; Blue metrorrhagia resembles blue color; Black metrorrhagia resembles clotted blood.

Li Jieyu (Lizhai) said: For the aforementioned syndromes, if treated due to Spleen and Stomach deficiency failing to secure blood to return to its source, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Chuan Xiong, Dang Gui, and Chai Hu (Bupleurum Root). If due to Liver Fire causing blood to descend, use Qi Xiao Si Wu Tang (Miraculous Efficacy Four Substances Decoction) or Si Wu Tang plus Chai Hu, Zhi Zi (Gardenia Fruit), Fu Ling (Poria), and Bai Zhu. If due to Liver Wind-Heat causing reckless blood flow, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Zhi Zi, Bai Shao, and Mu Dan Pi (Moutan Cortex). If anger moves Liver Fire causing blood to boil, use the previous prescriptions. If Spleen depression causes blood to leave its vessels, use Gui Pi Tang plus Chai Hu, Zhi Zi, and Mu Dan Pi. If grief injures the Pericardium Collateral causing lower metrorrhagia, use Si Jun Zi Tang plus Chai Hu, Zhi Zi, and Sheng Ma (Cimicifuga Rhizome).

Attached Note: The wife of Dayin Wang Tiancheng suffered from chronic metrorrhagia. She self-administered cooling-blood agents like Si Wu Tang, resulting in intermittent remission and recurrence. Due to anger and fever, her bleeding did not stop. Previous prescriptions were ineffective. The physician then advocated clearing fire, which resulted in severe hypochondriac and abdominal pain and cold extremities. I stated: This is caused by Spleen and Stomach deficiency-cold. First, use Fu Zi Li Zhong Tang (Aconite Regulate Middle Decoction); after fever subsided and pain stopped, use *Ji Sheng Fang* Gui Pi Tang and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction), resulting in immediate cessation of bleeding. If one sticks to the notion that pain has no tonification method, one errs.