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Shen Yaofeng stated: Regarding the syndrome of hoarseness during menstruation. The eldest daughter of Xun Hengda, who married into the Ni family in Xietang and became a widow early, had a weak constitution. Every time she menstruated, her voice would become hoarse. I used herbs such as Asparagi Radix (Tian Dong), Rehmanniae Radix (Di Huang), Cistanches Herba (Rong Rong), and Angelicae Sinensis Radix (Gui Shen) for treatment, but the condition worsened; she opened her mouth and gestured, unable to articulate any words. By adding a small amount of Lignei Saposhnikoviae Radix (Xi Xin) to this prescription to unblock the collaterals of the Shaoyin channel, her voice recovered immediately after taking the medicine. After more than ten doses, she was regulated with Gui Fu Ba Wei Wan (Cinnamon Twig and Aconite Pill), and the condition never recurred.

The summary states: Blurred vision after menstruation belongs to Blood deficiency.

Wang Shishan said: Diarrhea during menstruation belongs to Spleen deficiency with dampness; Shen Ling Bai Zhu San is appropriate.

Wang Mengying noted: There are also cases where Liver Wood overacts on Earth (Spleen).

Miao Shi said: Leukorrhea during menstruation belongs to Yang deficiency with sinking; herbs that assist Yang, such as Ginseng Radix (Ren Shen) and Atractylodis Macrocephalae Rhizoma (Bai Zhu), should be used.

Wang Mengying noted: There are also cases where internal stagnant fire is abundant.

Su Wen states: Diseases of the Two Yangs originate from the Heart and Spleen. If there are hidden difficulties or emotional constraints, women will not menstruate. If it transmits to Feng Xiao (wasting syndrome resembling wind-drying), or to Xi Ben (accumulated Qi causing shortness of breath), it is a death case and untreatable.

Shen Yaofeng stated: "Two Yangs" refers to the Yangming Channel, not the Zang-Fu organs. "Diseases of the Two Yangs originating from the Heart and Spleen": The Yangming Channel is a channel abundant in Blood. Blood is formed from the essence of water and grain, refined by Heart Fire. Worry and anxiety damage the Heart, which then affects its child organ (Liver/Spleen context implies Spleen as source of blood, though text says "child", traditionally Heart generates Spleen/Earth, or Heart Fire warms Spleen; here Shen interprets it as affecting digestion/blood generation). This leads to loss of appetite, and since Blood has no source to be generated, the Yangming Channel becomes diseased. The classic text says, the anterior yin is the convergence of all sinews, converging at Qichuan, and the Yangming Channel governs it. Therefore, when the Yangming Channel is diseased, sexual function declines and hidden difficulties arise. Taichong is the Sea of Blood, running alongside the Yangming Channel. Therefore, when the Yangming Channel is diseased, the Chong Mai (Penetrating Vessel) declines, and women do not menstruate.

Wang Mengying noted: Although regular monthly menstruation is normal, those with Yin deficiency often have excessive fire, causing menstruation to occur early. The more deficient the Yin, the faster the flow, sometimes occurring every ten days or half a month. Even worse, when blood volume is already low, forcing a monthly cycle indicates imminent exhaustion. If blood is deficient but fire is not intense, menstruation will be delayed. This reflects the principle of containment (Kun trigram's attribute of frugality/concealment); even if menstruation stops for one or two years or ceases entirely, as long as the pulse is not rapid, there is no need to worry. Ignorant people do not understand this principle; they judge disease severity solely by menstrual status. Upon hearing of amenorrhea, they rush to promote flow, draining the pond to catch fish, which is extremely inhumane.

Jingui Yaolue states: Women's diseases caused by deficiency, accumulated cold, and constrained Qi lead to the cessation of menstruation.

Zhang Jingyue stated: Amenorrhea differs between Blood obstruction (Xue Ge) and Blood depletion (Xue Ku). Obstruction is temporary; promoting flow cures it. Depletion develops gradually; nourishment and tonification restore it.

Shen Yaofeng stated: In Jingui Yaolue, accumulated cold and constrained Qi cause blood stasis, which Zhang Jingyue calls Blood obstruction. Accumulated cold should be treated with large acrid-hot herbs like Cinnamomi Cortex (Rou Gui) to guide blood downward, followed by Ying Rong (Nourishing Glory) herbs for regulation. Constrained Qi should be diffused, using formulas like Xiao Yao San or Qi-moving herbs like Linderae Radix (Wu Yao) and Cyperi Rhizoma (Xiang Fu). Deficiency means there is no blood to move, which Zhang Jingyue calls Blood depletion, requiring tonification. Zhao Yangkui’s three methods—tonifying Water, tonifying Fire, and tonifying Middle Qi—are most essential.

Wang Mengying noted: When tonifying Water, do not stick rigidly to Liu Wei Di Huang Wan; when tonifying Fire, do not stick rigidly to Ba Wei Di Huang Wan; when tonifying Middle Qi, do not stick rigidly to Gui Pi Tang.

Appendix: Yi Guan Jian Formula by Wei Yuhuang. Treats Liver-Kidney Yin deficiency with Qi stagnation and failure of movement, presenting with attacking pain in the hypochondrium, chest and abdominal distension, pulse appearing fine and weak or empty and wiry, tongue lacking fluids, and dry throat.
Sha Shen, Mai Dong, Sheng Di, Dang Gui Shen, Gou Qi Zi, Chuan Lian Zi.
For bitter taste and dryness, add wine-fried Huang Lian.

Appendix: Ji Ling Gao (from Wang Bingheng's *Chongqing Tang Sui Bi*). At age fifty, Yin Qi declines first; many elderly people suffer from Yin deficiency. This formula nourishes True Yin and softens sinews and bones.
Xi Yang Shen (select robust rhizomes, peel, steam nine times over rice, sun-dry nine times), Gan Gou Qi Zi, Huai Niu Xi (wine-steamed), Tian Dong, Mai Dong, Huai Sheng Di, Huai Shu Di, Xian Ling Pi. Equal parts of these eight ingredients, decocted into a paste, taken with warm water or warm wine.

Appendix: Zi Shui Qing Gan Yin Formula (Gao Gufeng). Treats Yin deficiency with Liver Qi depression and obstruction, epigastric pain, hypochondriac pain, pulse empty-wiry or fine-soft, tongue coating smooth and bright red.
This formula is Liu Wei Di Huang Tang plus Dang Gui Shen, Bai Shao, Chai Hu, Shan Zhi, and Da Zao.

Appendix: Zi Yang Ying Ye Gao by Xue Yipiao.
Nu Zhen Zi, Han Lian Cao, Shuang Sang Ye, Hei Zhi Ma, Huang Gan Ju, Gou Qi Zi, Dang Gui Shen, Bai Shao Yao, Shu Di Huang, Hei Da Dou, Nan Zhu Ye, Bai Fu Shen, Wei Rui, Ju Hong, Sha Yuan Ji Li, Zhi Gan Cao.
Decoct with spring water to make a thick juice, add Black Donkey-Hide Gelatin (E Jiao), and refine with white honey.

Appendix: Xin Pi Shuang Bu Wan by Xue Yipiao.
Xi Yang Shen (steamed through), Bai Zhu (steamed cooked), Fu Shen, Gan Cao, Sheng Di Huang, Dan Shen, Zao Ren, Yuan Zhi Rou, Bei Wu Wei Zi, Mai Men Dong, Xuan Shen, Bai Zi Ren, Huang Lian, Xiang Fu (processed), Chuan Bei Mu, Jie Geng, Long Yan Rou.

Appendix: Kan Li Wan Theory by Lu Jiuzhi.
Lu Jiuzhi's ancestor, Shibu Zhai, wrote: Kan Li Wan is the premier fertility formula taken by Observer Yan Chengzhai from Shanxi. It is easiest, simplest, and safest. The formula consists of Red Dates and Black Beans in equal proportions. Red dates are red and enter the Heart; select thick-fleshed ones, steam until cooked, remove skin and pits. Black beans are black and enter the Kidneys; use large black beans, not horse feed beans. Soak them in Mulberry Juice until saturated, then steam in a rice steamer. Steam, soak, and steam again. Mash the two ingredients into a paste, bind with starch to form pills or cakes. Take as desired; it can darken hair and strengthen sinews and bones. Using this to "plant jade," the fetus will naturally stabilize, and children will live long. In the summer of Renwu year, this formula was presented to Vice Minister Xu Songge and included in his collection of effective prescriptions. Those who specialize in tonifying Yang using Sulfur and Aconite should beware. If there is indeed erectile dysfunction, inability to maintain hardness, thin semen, and infertility, Deer Antler (Lu Rong) is still a product of flesh and blood with vital energy. However, it must be combined with Tian Dong, Mai Dong, Sheng Di, Shu Di, and Huang Bo to greatly tonify Yin, making it suitable for both men and women. This is also Chengzhai's view.

Kou Zongshi said: Early awakening of sexual desire in childhood, with persistent thoughts in the mind, causes early closure of menstruation. Worry and anxiety damage the Heart; Heart damage leads to blood exhaustion, thus closing the menses. Since Fire is diseased, it cannot nourish its child (Spleen), leading to poor appetite. Spleen deficiency leads to Lung Qi deficiency, causing cough. Once coughing occurs, Kidney Water Qi is exhausted, leading to dry limbs. Liver Wood Qi is insufficient, leading to irritability, scorched hair/temples, and flaccid sinews. The Five Zang organs transmit sequentially; thus, sudden death does not occur, but eventual death follows. Compared to other consumptive diseases, this is the most difficult to treat.

Shen Yaofeng stated: This section is derived from the "deficiency" aspect of Jingui Yaolue, and such syndromes do exist. However, in cases of unfulfilled desires, Ministerial Fire (Xiang Huo) becomes intense; without tonifying Water, it cannot be controlled. Liu Wei Di Huang Tang, which tonifies Yin and drains Yang, is indeed a wonderful method. However, for Spleen deficiency with reduced appetite, if Rehmannia is considered too cloying, it can be stir-fried until loose; otherwise, replace it with Nu Zhen Zi, which, by name and nature, also drains Ministerial Fire.

Wang Mengying noted: This syndrome is the most difficult to treat. Liu Wei Di Huang Wan hinders the Spleen; Gui Pi Tang aids Fire. Only Xue Yipiao’s Zi Yang Ying Ye Gao added with Xiao Mai, Da Zao, and Yuan Zhi is likely to conform to the correct principles. Yipiao also has Xin Pi Shuang Bu Wan, which can be considered.

Lou Quanshan stated: Amenorrhea includes a syndrome of turbid blood stagnating in the uterine gate. Luo Qianfu’s Xue Ji Gao consists of a single herb, Da Huang powder, boiled with vinegar into a paste. Taking it promotes one or two bowel movements, allowing menstrual blood to flow naturally; it is a fairy medicine for gynecology.

Shen Yaofeng stated: Jingui Yaolue discusses amenorrhea focusing only on Cold, not Heat, not due to missing text. Generally, when heaven is hot and earth is warm, menstrual water boils and overflows; how could it instead stagnate and fail to come? The theories of Jiegu and Dongyuan regarding descending Heart Fire and draining the Triple Burner cannot be fully trusted. Even bone-steaming internal heat belongs to Yin deficiency, not excess Heat that can be cured with cold herbs.

Wang Mengying noted: Wang Ziheng’s *Quansheng Zhimi Fang* contains Di Huang Jian. Use eight taels of fresh Rehmannia juice, boil down by half, add one tael of Rhubarb powder, and boil together until pillable. Form pills the size of mulberry seeds. Take five pills with cooked water; increase to ten if ineffective. It treats women with Qi exhaustion and Liver injury, amenorrhea, named Blood Depletion. Essentially, if stasis is not removed, new blood dries up. This aligns with the meaning of Wutou Luru Wan in Neijing and Dahuang Zhechong Wan in Shanghan Lun. Later generations only know that this type of Blood Depletion is Blood deficiency, not realizing that Heat causes stasis. Instead, they use warm tonics, which cannot cure this Blood Depletion. Yaofeng also held this view, which may lack thorough examination.

Zhu Danxi said: In obese individuals, Phlegm obstructs the uterine gate; Nong Po Er Chen Tang is appropriate.