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(Jing Lou, also known as Menstrual Dripping)

Chen Liangfu stated: Some cases arise because Qi deficiency fails to control the blood; others occur when sexual intercourse takes place during menstruation, allowing external pathogens to invade the interior of the uterus.

Wang Mengying added in commentary: There are also cases caused by Blood Heat failing to follow its normal course.

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states that at age forty-nine (seven times seven), Tian Gui (Heavenly Water, referring to reproductive essence/fluids) ceases. For those over fifty whose menstruation does not stop: Xu Shuwei advocated that this is due to an excess of Blood and should not be forcibly stopped, recommending Danggui San (Angelica Powder); the *Chanbao* (Treasures of Childbirth) attributed it to excessive labor injury and irregular emotions of joy and anger; Li Shizhen proposed a theory of "Decayed Blood." These three theories differ, so one must refer to the pulse and symptoms for differentiation.

Li Shizhen said: Menstruation occurring once a month is the norm. Occurring early or late, freely or obstructed, constitutes pathology. If only hematemesis (vomiting blood) or epistaxis (nosebleed) occurs during the menstrual period, or bleeding from the eyes or ears, this is called Dao Jing (Reverse Menstruation). If it occurs once every three months, it is called Ju Jing (Resident Menstruation). If once a year, Bi Nian (Avoidance Year). If a woman never menstruates but can conceive, it is called An Jing (Hidden Menstruation). If she continues to menstruate monthly after conception and delivers a child, it is called Tai Sheng (Fetal Abundance), commonly known as Tai Gou (Fetal Filth). If heavy bleeding occurs several months into pregnancy without fetal loss, it is called Lou Tai (Leaking Fetus). Although these can be explained by excess or deficiency of Qi and Blood, they are all considered abnormal conditions.

Wang Mengying added in commentary: There are cases where menstruation begins before age fourteen (two times seven); there are cases where menstruation continues past age sixty (one hundred years cycle); there are healthy women who occasionally stop menstruating for several months; there are women in their prime whose menstruation ceases abruptly; there are cases where excessive leukorrhea prevents menstruation; there are cases where menstruation occurs only once every few months; there are postpartum women who breastfeed yet still menstruate monthly; there are women who stop menstruating for one or two years after a single childbirth. Due to varying constitutional endowments, one cannot generalize using standard rules.

(When blood volume is extremely large, it is termed Beng [Catastrophic Bleeding], which is an acute condition.)

The *Suwen* (Basic Questions) states: Yin deficiency with Yang pulse striking forcefully is termed Beng.

Xu Shuwei said: The *Neijing* says, "When heaven is hot and earth is dry, the menstrual water boils over." It also states, "In Yin deficiency, the Chi (cun-chi) pulse is deficient and floating; in Yang striking, the Cun (inch) pulse is wiry and urgent." This indicates insufficient Yin Blood and excess Yang pathogenic factors, leading to internal hemorrhage and catastrophic bleeding. Qixiao Siwu Tang (Miraculous Effect Four Substances Decoction) is appropriate, or Siwu Tang (Four Substances Decoction) with added Huanglian (Coptis Rhizome).

Qixiao Siwu Tang
Danggui (washed with wine) Chuanxiong Baishao (fried) Shudihuang (Prepared Rehmannia Root) Ejiao (Donkey-hide Gelatin) Aiye (Mugwort Leaf) Huangqin (Scutellaria Root, fried, each 1 qian)

Xu Shuwei further stated: Women suffer from disordered Qi first, causing unsmooth blood vessels, resulting in syndromes such as Beng and Dai (leukorrhea). Xiangfu (Cyperus Rhizome) is a miraculous herb for women. When stir-fried with vinegar and made into powder, long-term use is beneficial. Take 2 qian per dose, mixed with clear rice water. The wife of Xu Chaofeng tried many medicines without effect but found relief with this remedy.

Xu Hui noted: Xu Shuwei’s emphasis on "regulating Qi" specifically targets liver injury caused by anger and Qi stagnation. Therefore, Xiangfu is used to regulate Qi and harmonize the Liver. One must strictly avoid herbs that break Qi.

Xue Lizhai stated: For Wind-Heat in the Liver Meridian or Liver Fire stirred by anger, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is suitable.

Jiawei Xiaoyao San
Danggui Baishao Chaihu Gancao Fuling Baizhu Danpi Heishanzhi Add Bohe (Mint), Shengjiang (Fresh Ginger), and Zaoju (Jujube) for decoction.

Li Taisu stated: Treatment for Beng should involve regulating Qi, descending Fire, and lifting.

The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: A Cun Kou pulse that is faint and slow indicates that faintness represents loose Wei Qi (Defensive Qi), leading to empty skin; slowness indicates weak Stomach Qi lacking substance, causing food digestion and water transformation abnormalities. When grain enters the Stomach, the vessel pathways operate; when water enters the meridians, Blood forms. When Ying Qi (Nutritive Qi) is abundant, the skin becomes loose. When the Three Jiao (Triple Burner) meridians are severed, it is named Blood Beng.

Zhao Yangkui stated: Qi belongs to Yang and governs ascending; Blood belongs to Yin and governs descending. If Yang is in excess, the ascending force prevails, and blood exits from upper orifices; if Yang is deficient, the descending force prevails, and blood exits from lower orifices. Those with Qi deficiency will have a pale complexion and a large, deficient Chi pulse.

Li Dongyuan stated: For syndromes of lower bleeding, one must use Sizijunzi Tang (Four Gentlemen Decoction) to tonify Qi to conclude treatment.

Li Dongyuan further stated: When dietary injury occurs, physicians often recklessly use purgatives. Clear Qi sinks downward, turbid Qi fails to descend, leading to distension. Thus, the Yang of the Epigastrium cannot rise and lift; Qi sinking downward causes Beng. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is appropriate.

Zhu Danxi stated: Phlegm-fluids stagnating in the chest prevent Clear Qi from rising, causing meridian obstruction and downward flow. Without resolving phlegm, Qi cannot move; without Qi ascending, Blood cannot return to its vessels. Symptoms may include abdominal fullness resembling pregnancy; stabbing pain around the umbilicus and abdomen; blood clotted into pieces; feeling relieved when blood flows but stifled when it stops; or pulsation above the umbilicus. Treatment should focus on resolving phlegm nodules, moving stagnant Qi, and eliminating foul blood.

Shen Yaofeng stated: The Chong Mai (Penetrating Vessel) is the Sea of Blood and travels alongside the Yangming Meridian. Thus, both Li Dongyuan and Zhu Danxi emphasized the failure of Epigastric Yang to rise. However, their etiologies differed: Li attributed it to reckless purging, while Zhu attributed it to Phlegm stagnation. Symptoms like abdominal fullness resembling pregnancy, relief upon bleeding, and stifling upon cessation help distinguish them. Such symptoms would not exist if caused by reckless purging; inquiry is necessary to determine this.

Dai Yuanli stated: Massive bleeding is termed Beng. It may be clear or turbid, or purely dark purple blood, with unstoppable momentum. In severe Beng accompanied by abdominal pain, people often suspect that evil blood remains and, seeing dark purple color, believe it is evil blood, daring not to stop the bleeding. Whenever blood is pathological, if it stays in the abdomen before fully exiting, it turns purple. Assuming purple blood must be expelled, how do we know it isn't due to Deficiency-Cold? Stasis causes abdominal pain, which stops when blood flows; Beng causes abdominal pain, which stops when bleeding ceases. Xiongui Tang (Cyperi and Angelica Decoction) with Shengjiang (Fresh Ginger) and Fuzi (Aconite Root) stops the blood, and the pain naturally subsides.

Xue Lizhai stated: A woman suffering from Beng took too many cold-natured medicines, causing long-term Spleen-Stomach deficiency. The original illness persisted, and Cold pathology re-emerged with irritability, thirst, inability to eat, occasional coma, and a洪大 (Surging-Large) pulse that felt weak upon deep pressure. This is Rootless Fire, with internal Deficiency-Cold and external False-Heat. Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) with added Fuzi reduced the bleeding; daily consumption of Bawei Wan (Eight-Ingredient Pill) led to recovery. Another case involved chronic Beng treated with cooling agents like Siwu Tang; episodes came and went. Some advocated descending Fire. With added abdominal pain and cold limbs, this indicated Spleen-Stomach Deficiency-Cold. First treat with Fuzi Lizhong Tang (Aconite Center-Regulating Decoction), then use Jisheng Guipi Tang (Sagecraft Return-to-Spleen Decoction) and Buzhong Yiqi Tang. The bleeding stopped immediately. Clinging to the rule "pain has no tonification method" is erroneous.

Shen Yaofeng stated: Beng syndromes are mostly Heat with little Cold. If the massive bleeding is bright red, it is Heat, not Cold. If the color is dark purple, it is coagulated after leaving the collaterals, indicating a possible Yang Deficiency syndrome. The *Neijing* states: "Yang Qi guards the exterior and secures." Ying Qi moves within the vessels, Wei Qi moves outside. If exterior Yang is deficient and loses its guarding function, Ying Blood inside the vessels leaks out. Once exiting the collaterals, it coagulates and stops flowing, gradually turning purple and black. However, warming formulas should only be administered if there is cold intolerance in the lower abdomen.

Highly Effective Formula for Beng
Di Yu (Sanguisorba Root) Sheng Muli (Raw Oyster Shell, each 2 qian) Sheng Di Huang (Raw Rehmannia Root, 4 qian) Sheng Baishao (Raw White Peony Root, 3 qian) Huang Qin (Scutellaria Root) Dan Pi (Moutan Cortex, each 1.5 qian) Chuan Lian (Coptis Rhizome, 0.5 qian)
Gancao (Licorice Root, fried, 0.8 fen) Lianxu (Lotus Stamens) Heizhi (Black Gardenia Fruit, each 1 qian) Decoct in water and take orally.

Shen Yaofeng stated: A woman taking Ginseng and Ejiao daily continued to bleed. Upon administering this formula, she responded immediately. Because she had excessive leukorrhea, she accidentally substituted Kushen (Sophora Root) for Huangqin, and bleeding resumed. Using Huangqin stopped it; removing Chuanlian caused bleeding again; adding Chuanlian stopped it.

Yaofeng further stated: A woman suffered from Beng for over a month. When I examined her, she was nearly syncope due to severe bleeding. Adding 1 qian of Renshen (Ginseng Root) to this formula brought immediate improvement; ten doses resulted in stability.

Yaofeng further stated: A woman over fifty suffered from this condition. Renshen and Ejiao were ineffective. One day, she took 0.5 qian of Huanglian and felt very uncomfortable. A physician diagnosed it as a Qi disorder. He prescribed Jiuchao Xiangfu (Vinegar-fried Cyperus), Danggui, Baishao, Danpi, Huangqin, Muli, Zaoren (Ziziphus Seed), Hei Jingjie (Black Schizonepeta), each 2 qian; Yujin (Curcuma Radix), 1.5 qian; Chenpi (Tangerine Peel), 1 qian; Shang Chenxiang (Agarwood), 0.3 qian ground and mixed; Chaihu (Bupleurum Root), 0.5 qian; Zonglutan (Palmae Fructus Carbonisatum), 0.8 fen. Decoct and take orally. The bleeding stopped after one dose. Removing Chaihu, Jingjie, and Zonglutan, and taking several more doses improved appetite. Adding Baizhu (Atractylodes Macrocephala Rhizome) as a powder caused distension; reducing the dose brought comfort.

Yaofeng further stated: In a case of Beng with cold intolerance in the lower abdomen, Fugui Bawei Wan (Aconite and Cinnamon Eight-Ingredient Pill) achieved complete recovery.

Wang Mengying added in commentary: Jing Lou (Menstrual Dripping) and Beng Lin (Catastrophic Bleeding with Dribbling) exit through the Jing Qiao (Reproductive Orifice). Only Niao Xue (Blood in Urine) exits through the Niao Qiao (Urinary Orifice). Although women are aware of this, they are shy to describe it in detail. Physicians who fail to differentiate often misdiagnose. Furthermore, in cases of delayed menstruation, Chong Mai blood may redirect to exit via the Large Intestine. People generally mistake this for Bian Xue (Blood in Stool). Clinical examination must be meticulous.