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Zhao Yangkui stated: The Chong and Ren meridians store essence and connect to the uterus, relying on a spark of Mingmen Fire (Fire of the Gate of Life) as their master. When fire is vigorous, the menstrual blood is red; when fire is deficient, it is pale; when fire is excessively vigorous, it is purple; when fire is excessively deficient, it is white. Therefore, nourishing Yin water should also involve nurturing fire. In cases of dryness leading to amenorrhea, although it may be described as extreme fire excess, one should not use bitter-cold herbs to descend fire, but rather greatly tonify Yin water, starting from the source of Tianyi (First Heaven/Pre-heaven), to nourish until fullness is achieved. He further stated: Purple and black colors mostly belong to fire excess, but there are also cases of black color due to deficiency-cold, which must be carefully distinguished. If the color is pale white, it is clearly devoid of fire.

Shen Yaofeng said: Wang Yutai believed that cold causes stagnation; since purple-black appears after menstruation, it is definitely not a cold syndrome. However, using hot herbs succeeds only occasionally, perhaps one or two times out of ten. The idea that pale color indicates lack of fire is also reasonable, yet there are occasional cases unsuitable for warming fire. I once observed a woman in Yuanhe whose menstruation was delayed by ten days and was pale. A midwife, based on this, administered several doses of Cinnamon Twig (Rougui). Consequently, her menstrual flow became profuse, her whole body turned yellow, she lost her appetite, developed fever and rapid pulse, eventually becoming critical. This is the syndrome Zhu Danxi referred to as pale-white menstrual blood belonging to Qi deficiency. In summary, during clinical practice, one must carefully examine the pulse and refer to accompanying symptoms to identify deficiency/excess and cold/heat. If there are doubtful cases with conflicting interpretations, first use mild formulas. For instance, in the case of pale color, if Qi-tonifying methods fail, then employ fire-warming methods, thus minimizing errors. I record Ye's statement below. Ye stated: Black blood belongs to heat, which is the norm, but there are also cases caused by external wind-cold constraint, occurring occasionally, perhaps one or two times out of ten. Since cold governs contraction, the lower abdomen will often feel cold and painful; during menstruation, hands and feet may be cold, lips cyanotic, and face pale; the Chi pulse at both wrists may be slow, or fine and deficient, or large and powerless. Heat syndromes present with a surging and rapid Chi pulse, or solid and forceful. Referencing pulse and symptoms confirms the diagnosis.

Wang Mengying added in commentary: Pale menstrual color can indeed belong to heat, a point never mentioned by ancients. One must deduce this through mutual verification of pulse and symptoms, but one must not treat it as excess-heat and purge it with bitter-cold herbs. There is an even more unusual case: Mrs. Fang’s menstrual color gradually lightened after childbirth, and years later completely lacked redness, accompanied by clots. She had no leukorrhea normally and grew increasingly emaciated. Upon examination, her pulse was soft and rapid, she had a bitter taste in her mouth, and experienced alternating chills and fever. I prescribed Qinghao (Artemisiae Annuae Herba), Baiwei (Cynanchi Atrati Radix), Huangbai (Phellodendri Cortex), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Biejia (Testudinis Carapax et Plastrum), Guiban (Testudinis Carapax et Plastrum), Shaoyao (Paeoniae Radix), Wugu (Sepiae Endoconcha), Gouqi (Lycii Fructus), Digupi (Lycii Cortex), etc., modifying the formula as needed. After taking one hundred doses, she recovered. This is merely a rare syndrome.

Hua Borun stated: Before menstruation, colicky pain in the umbilical and abdominal region occurs with alternating chills and fever, and discharge resembles black bean juice. The Chi pulses are choppy, while others are wiry and urgent. This is cold-dampness contending in the Chong and Ren meridians. Cold-dampness generates turbidity, descending like bean juice, contending with blood, hence the pain. It is suitable to use acrid-dispersing and bitter-warm blood-invigorating herbs.

Xu Aihui stated: Acrid-dispersing blood herbs refer to things like Chuanxiong (Chuanxiong Rhizoma); bitter-warm blood herbs refer to things like Aiye (Artemisiae Argyi Folium).

Li Shi stated: Menstrual blood mixed with yellow turbidity is due to damp-phlegm.

Zhu Danxi stated: Pain before menstruation begins is due to Qi stagnation. Use Xiangfu (Cyperi Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Taoren (Persicae Semen), Huanglian (Coptidis Rhizoma); or use Yi Qi San (Suppress Qi Powder), which is Si Wu Tang (Four Substances Decoction) plus Yanzhu (Corydalis Rhizoma), Danpi (Moutan Cortex), and Tiaoqin (Scutellariae Radix). He also stated: Intermittent abdominal pain just before menstruation, appearing and disappearing, is due to blood-heat and Qi excess. Use Si Wu Tang plus Chuanlian (Coptidis Rhizoma - *Note: Text says Chuanlian but context implies Huanglian/Coptis or similar bitter cold herb, usually Huanglian in this context, but strictly translating text as Chuanlian/Coptis*) and Danpi.

Xu Aihui stated: Yi Qi San originates from Yan Shi. It consists of Xiangfu (Cyperi Rhizoma) four liang, Chenpi (Citri Reticulatae Pericarpium) one liang, Fushen (Poria cum Radix Pini) and Zhi Gancao (Prepared Glycyrrhizae Radix) one and a half liang. Pulverized, take two qian per dose. It treats women where Qi exceeds Blood, generating various syndromes such as dizziness and chest fullness, drawing on the meaning from *Neijing*: "For those high up, suppress them." Wang Ang considered this formula peaceful and usable; tonifying Blood to calm Yang fire is also a correct treatment method.

Zhu Danxi further stated: Pain after menstruation is due to joint deficiency of Qi and Blood, suitable for Ba Zhen Tang (Eight Treasures Decoction).

Zhu Danxi further stated: Clots indicate Qi condensation.

Shen Yaofeng stated: Abdominal pain before menstruation must involve some stagnation. Qi stagnation presents with a deep pulse; cold stagnation with a tight pulse; damp stagnation with a soggy pulse. If combined with cold and heat, refer to accompanying symptoms. Furthermore, Wind pathogen entering the vessels from the lower part can also cause pain, with a pulse that fluctuates between large and small, sometimes rising. Ye used Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Jiegeng (Platycodonis Radix), and Gancao (Glycyrrhizae Radix). For deficiency, add Renshen (Ginseng Radix et Rhizoma). Each herb roasted until black, one qian, ground into powder and taken with wine, yields miraculous effects.

Yaofeng further stated: Pain both before and after menstruation mostly stems from the Liver meridian, though differences exist. A wiry and fine pulse indicates Wood Qi depression, suitable for Xiao Yao San (Free and Easy Wanderer Powder) and herbs like Chuanlianzi (Toosendan Fructus), Xiaohuixiang (Foeniculi Fructus), and Juhe (Aurantii Fructus). A large pulse indicates internal stirring of Liver Wind. Red patches on the body indicate outward floating of Liver Yang. All these require warm-moistening methods. Dai Liting’s wife suffered from abdominal pain before and after menstruation radiating to the right leg, with red patches on the body, a large pulse especially prominent at the Right Guan and Chi positions. In autumn of the Ji Mao year, I treated her for internal stirring of Liver Wind. Using Shengdi (Rehmanniae Radix Preparata) four qian, fried Gouqi (Lycii Fructus) one qian, Xi Shihu (Dendrobii Caulis) two qian, Duzhong (Eucommiae Cortex) two qian, Gan Dansongrong (Cynomorii Rubri Caulis) one qian, Maidong (Ophiopogonis Radix) one qian, Niuxi (Achyranthis Bidentatae Radix) one qian, Guishen (Angelicae Sinensis Radix) one and a half qian, fried Baishao (Paeoniae Radix Alba) one qian. Pain ceased after administration. Later, taking several doses before and after menstruation resulted in smooth menses; without medication, pain returned, so pills were made. This formula has proven effective repeatedly.