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Women whose menstruation is irregular due to emotional desires or improper sexual activity, the pathology lies in the Kidney Meridian. This syndrome is very common and must be differentiated and treated accordingly.

Whenever desires are unfulfilled, leading to deep contemplation and accumulated depression, causing Qi stagnation in the Heart and Spleen, the source of the Chong and Ren vessels is damaged, and Kidney Qi gradually diminishes. Mild cases may present with early or delayed menstruation, while severe cases may gradually develop into amenorrhea (absence of menstruation) due to depletion. In such cases, it is appropriate to treat the Heart, Spleen, and Kidney simultaneously, primarily using formulas such as Xiaoyao Yin (Free and Easy Wanderer Decoction) or Miyuan Jian (Secret Origin Decoction). If desire fire is blazing, causing daily erosion of True Yin, Baoyin Jian (Preserve Yin Decoction) or Ziyin Bawei Wan (Nourish Yin Eight-Ingredient Pill) should be used. If sexual activity is unrestrained and careless, it inevitably damages the flow of the Chong and Ren vessels, causing Kidney Qi to fail to hold fast. Treatment must secure the Gate of Life (Mingmen), primarily using Guyin Jian (Secure Yin Decoction) or Miyuan Jian. If True Yin of the Left Kidney is insufficient, leading to menstrual irregularity, Zuogui Yin (Left Return Decoction), Zuogui Wan (Left Return Pill), or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) are appropriate. If True Yang of the Right Kidney is insufficient, leading to menstrual irregularity, Yougui Yin (Right Return Decoction), Yougui Wan (Right Return Pill), or Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) are appropriate. For diseases caused by unresolved mental depression, unless emotional constraints are lifted and wishes fulfilled, efficacy is difficult to achieve; for diseases caused by careless sexual behavior, unless one courageously restricts sexual desire, reliance on medicinal herbs alone is unlikely to succeed.

Abdominal pain during menstruation presents as either Deficiency (Xu) or Excess (Shi). Excess patterns may result from Cold stagnation, Blood stasis, Qi stagnation, or Heat stagnation; Deficiency patterns may result from Blood deficiency or Qi deficiency. Generally, Excess pain occurs before menstruation begins and subsides once the flow is established; Deficiency pain occurs after menstruation has started, persisting despite blood loss, or even intensifying after blood loss. Broadly speaking, pain that can be relieved by pressure or massage indicates Deficiency, whereas pain that rejects pressure or massage indicates Excess. The presence or absence of stagnation can be observed through this method. However, Excess may contain Deficiency, and Deficiency may contain Excess; these must be differentiated by considering the patient's physical constitution and innate endowment, requiring careful observation beyond mere words.

For women experiencing abdominal pain during menstruation due to Qi reversal, where there is complete stagnation without Deficiency, Qi must be regulated, primarily using Tiaojing Yin (Regulate Menstruation Decoction); for severe cases, Paixi Jian (Expel Gas Decoction) may also be used. If Blood stasis prevents flow, with complete stagnation and no Deficiency, only blood-breaking methods are needed, primarily using Tongyu Jian (Unblock Stasis Decoction). If both Qi and Blood are stagnant, Shixiao San (Laughing Without Pain Powder) is appropriate. If Cold stagnates in the meridians, whether due to external Cold invasion or habitual exposure to cold/dampness, leading to coagulation and stagnation causing pain without Deficiency, Cold must be dispelled, primarily using Tiaojing Yin added with Shengjiang (Fresh Ginger), Rougui (Cinnamon Bark), and Wuzhuyu (Evodia Fruit); Hewei Yin (Harmonize Stomach Decoction) may also be considered. If Blood Heat and dryness cause stagnation and pain, Jiawei Siwu Tang (Modified Four Substances Decoction) or Baoyin Jian minus Xuduan (Dioscorea Hypoglauca) with modifications should be used. For the above five Excess patterns, only when stagnation is confirmed without Deficiency is it a true Excess pattern; if Deficiency is present, harsh purgative or attacking methods must not be used indiscriminately.

In general, menstrual abdominal pain involves Deficiency more often than pure Excess. Although distinguishing Deficiency and Excess via tenderness to pressure and timing (pre- vs. post-menstruation) is a fundamental rule, there are cases where innate Qi and Blood are deficient, yet Blood has not yet flowed smoothly, resulting in rejection of pressure even before menstruation. This is due to Qi deficiency and Blood stagnation, lacking the power to circulate freely. By observing physical signs, symptoms, and pulse, if weakness is evident and pain is associated with menstrual stagnation, Juejin Jian (Resolve Vessel Decoction) or Wuwu Jian (Five Elements Decoction) with modifications should be used, yielding miraculous results; Sishen San (Four Divine Powder) may also be used. If pain occurs after menstruation, it is mostly due to Blood deficiency; Daying Jian (Great Camp Decoction) or Xiaoying Jian (Small Camp Decoction) should be used with modifications, or Siwu Tang (Four Substances Decoction) and Bazhen Tang (Eight Treasures Decoction) may be employed, provided that Cold/Heat and Deficiency/Excess are assessed to select appropriate adjuvant herbs, ensuring efficacy. For residual stagnation, Juejin Jian is particularly effective. For women who invariably experience pain during menstruation, accompanied by vomiting after eating, limb fatigue, or alternating chills and fever, this indicates innate insufficiency of Qi and Blood; only Bazhen Tang or Daying Jian should be used. For Deficiency with severe Cold, Liyin Jian (Regulate Yin Decoction) should be used to gradually tonify and nourish, leading to spontaneous recovery over time. For Deficiency pain associated with excessive leukorrhea, Daying Jian or Xiaoying Jian should be used, adding adjuvant herbs based on Cold/Heat differentiation.

Xue Lizai stated: For the aforementioned conditions, if Wind-Cold damages the Spleen, use Liujunzi Tang plus Paojiang (Roasted Ginger); if Overthinking damages Blood, use Siwu Tang plus Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala); if Overthinking damages Qi, use Guipi Tang plus Chaihu (Bupleurum) and Zhizi (Gardenia); if Frustration/Anger damages Blood, combine Guipi Tang with Xiaoyao San.