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The *Mai Jing* (Pulse Classic) states: If the Chi pulse (Cubit position, reflecting Kidney and lower jiao) is slippery, blood and qi are substantial, yet women suffer from irregular menstruation (a slippery pulse indicates an excess of blood and qi, hence termed "substantial"). If the Shaoyin pulse (reflecting Heart and Kidney) is weak and faint, a faint pulse indicates blood deficiency (weakness indicates insufficient blood; floating and weakness also indicate this). If the Cun pulse (Inch position, reflecting Lung and Heart) is floating and weak, floating indicates deficiency, and weakness indicates lack of blood. A pulse that comes like a zither string causes bitter lower abdominal pain and primarily indicates irregular menstruation and sores in orifices. A Liver pulse that is deep primarily indicates irregular menstruation accompanied by waist and abdominal pain. A Chi pulse that comes intermittently indicates irregular menstruation, likely suffering from lower abdominal pain radiating to the waist, qi stagnation, and upward attacking of the chest and epigastrium. (String-taut, deep, and intermittent pulses all indicate pain, irregular menstruation, sores in orifices, and upward attacking of the chest; these must be distinguished).

If menstruation is blocked, with cold hernia pain around the navel, and the pulse is deep and tight, this is due to cold pathogen lodging in the Blood Chamber, causing blood coagulation and stasis, forming accumulations. Blood is rushed by Qi, and new blood battles old blood, thus causing pain. (Deep and tight pulses indicate cold in the blood level).

**Si Wu Tang** (Four Substances Decoction) treats deficiency and damage to the Chong and Ren vessels in women, irregular menstruation, menstrual disorders occurring early or late, with excessive or scanty flow, umbilical or abdominal pain, waist and leg pain, metrorrhagia and metrostaxis, as well as various conditions before and after childbirth. Regular consumption nourishes Ying and Wei, and tonifies blood and qi. If other diseases exist, modify according to symptoms.
Dang Gui (Angelicae Sinensis Radix) harmonizes blood. If blood stasis causes stabbing pain like knife cuts, this herb is essential.
Chuan Xiong (Ligustici Chuanxiong Rhizoma) treats wind dispersing Liver wood. If blood deficiency causes headache, this herb is essential.
Bai Shao (Paeoniae Radix Alba) harmonizes blood and regulates Spleen. If deficiency-cold causes abdominal pain, this herb is essential. (Stir-fried with wine).
Shu Di Huang (Rehmanniae Radix Preparata) tonifies blood. If umbilical pain occurs, this herb is essential. (Washed with wine).
Crush the above herbs, use equal parts. Take 4 qian per dose, decoct in water and drink. In Spring, double Chuan Xiong; in Summer, double Bai Shao; in Autumn, double Di Huang; in Winter, double Dang Gui. (Spring generates, Summer grows, Autumn harvests, Winter stores; this is the function of the four seasons in nurturing life. As things follow the four seasons for growth, so do human blood and qi follow the four seasons for ascending and descending. Does Si Wu Tang not have profound intent within it? For instance, Dang Gui's sweet, pungent, warm, and moistening nature resembles the harmony of spring; Chuan Xiong's pungent, warm, and dispersing nature resembles the flourishing of summer; this is the function of growth. But if there is only growth without storage, how can things be accomplished? Hence, Bai Shao's sour astringency achieves autumn, and Shu Di Huang's rich flavor achieves winter; this is the wonder of storage. However, among the four seasons, sweetness corresponds to the virtue of Earth, so the sweetness of Dang Gui and Di Huang harmonizes them; this is the Five Elements' inseparability from Earth. Previously, Haicang said: When using blood-tonifying herbs, one should select one or two from Si Wu Tang; this too has meaning. Thus, to move blood, use Chuan Xiong and Dang Gui to execute the commands of Spring and Summer; to stop bleeding, use Di Huang and Shao Yao to execute the commands of Autumn and Winter; this is the way of ascending and descending. Observing Fo Shou San and Xi Jiao Di Huang Tang, which use only two substances from Si Wu Tang, one can understand this. Nevertheless, substances are merely substances; without a master within, they lose their substance, so what is the purpose of Si Wu Tang? Therefore, Yuan Shen (Primordial Spirit) and Wei Qi (Stomach Qi) are particularly critical.) In Spring, add Fang Feng; Si Wu Tang plus Fang Feng, doubling Chuan Xiong. In Summer, add Huang Qin; Si Wu Tang plus Huang Qin, doubling Bai Shao. In Autumn, add Tian Men Dong; Si Wu Tang plus Tian Men Dong, doubling Di Huang. In Winter, add Gui Zhi; Si Wu Tang plus Gui Zhi, doubling Dang Gui. (This method of doubling embodies the subtle principles of the four seasons. Doubling Dang Gui welcomes Spring Qi, doubling Chuan Xiong welcomes Summer Qi, doubling Bai Shao welcomes Autumn Qi, doubling Di Huang welcomes Winter Qi. Using Dang Gui generates Yang Qi, using Bai Shao generates Yin Qi; both are wonders of ascending and descending. Remember this, remember this.) If blood deficiency causes abdominal pain, slight sweating, and aversion to wind, add Bai Zhu and Gui Zhi to Si Wu Tang, called Abdominal Pain Liu He Tang. If wind causes dizziness, add Qin Jiao and Qiang Huo, called Wind Liu He Tang. If Qi is deficient, causing weakness upon rising and even falling, add Hou Po and Chen Pi, called Qi Liu He Tang (Should one add Qi-draining herbs when Qi is deficient? One should substitute with Ren Shen). If fever and irritability prevent sleep, add Huang Lian and Zhi Zi, called Heat Liu He Tang. If deficiency-cold presents with faint pulse, spontaneous sweating, and difficulty breathing, but normal urination and defecation, add Gan Jiang and Fu Zi, called Cold Liu He Tang. If dampness invades, causing heavy body, weakness, cool skin, and slight sweating, add Bai Zhu and Fu Ling, called Dampness Liu He Tang. If women suffer from bone, tendon, limb, and joint pain, headache with string-taut pulse, and aversion to cold resembling malaria, treat with Wind-Resolving Liu He Tang: Si Wu Tang plus Qiang Huo and Fang Feng. If blood and Qi rush upward, causing fullness and oppression in the heart, abdomen, and hypochondrium, treat with Qi-Regulating Liu He Tang: Si Wu Tang plus Mu Xiang and Bing Lang. If deficiency-cold below the navel causes abdominal pain, and dull pain between the waist and spine, treat with Yan Hu Suo Liu He Tang: Si Wu Tang plus Yan Hu Suo and Ku Lian. If Qi rushes through meridians, causing frequent and heavy menstruation with much lower abdominal pain, double Bai Shao and add Huang Qin. If menstruation is about to start, with severe cramping pain during the period, indicating stagnant blood, add Yan Hu Suo, Ku Lian (crushed, stir-fried until charred), Mu Xiang, and Bing Lang. If women with blood deficiency suffer unbearable cramping pain in the heart and abdomen, remove Di Huang and add Gan Jiang, named Si Shen Tang. To tonify the Lower Origin, add Gan Jiang and Gan Cao. For Qi-knitting pain in the lower abdomen, add Yan Hu Suo. If stabbing pain in the abdomen prevents discharge of lochia, double Dang Gui and Bai Shao. If abdominal pain makes sounds and meridians are unsmooth, add one part Shu Di Huang and half-part Gui Xin. For menstrual pain with lower back pain, add Yun Tai, Niu Xi, Hong Hua, Wu Zhu Yu, and Gan Cao; decoct in water using a silver vessel with Deng Xin, and take hot. If menstrual flow is scanty and sluggish, add Kui Hua decoction, plus Hong Hua and Xue Jian Chou. If menstrual flow is scanty but color is normal, double Shu Di Huang and Dang Gui. If menstrual flow is sudden and profuse, add Huang Qin; if painful, add Huang Lian; in summer, do not remove Huang Qin. If menstrual fluid looks like black bean juice, add Huang Qin and Huang Lian. If menstrual flow is excessive without other symptoms, use Huang Qin Liu He Tang: Si Wu Tang, Huang Qin, and Bai Zhu in equal parts. For continuous dripping of menstrual blood, add dried Ruan Lian Fang (lotus seed pod) stir-fried into the medicine. If menstruation occurs during sexual intercourse, add Chi Shi Zhi, Huang Qin, Rou Gui, Bai Cao Shuang, Ou Jie, Bai Zang Zong Hui, Rou Dou Kou, Dang Gui, Mu Xiang, Long Gu, Bai Fu Ling, Bai Zhu, and Di Yu. If menstruation starts and stops abruptly, or with alternating chills and fever, first administer Xiao Chai Hu Tang to resolve chills and fever, then harmonize with Si Wu Tang. If chills and fever do not subside, do not take Si Wu Tang; this is a transformed syndrome where exterior pathogens remain, rendering it ineffective (One must recognize exterior syndromes and follow proper sequence); treat transformed syndromes according to the previous discussion. For metrorrhagia, add Sheng Di Huang and Pu Huang. If blood is dark and clotted, add Ren Shen and Bai Zhu. If the Blood Viscera are deficient and cold, with excessive bleeding from metrorrhagia, add E Jiao and Ai Ye (Since metrorrhagia is due to deficiency-cold, Ai Ye is added; nowadays people use Jiao and Ai indiscriminately regardless of cold or heat, which is laughable). For irregular menstruation, metrorrhagia, varying amounts, timing, vomiting, and epigastric distension, add Chen Ai and Huang Qin (Epigastric distension requires careful examination). For red and white leukorrhea, use Xiang Gui Liu He Tang: Si Wu Tang plus Gui Zhi and Xiang Fu, each halved. Make Si Wu Tang into fine powder, honey pills, size of wutong seeds, take 30-40 pills with rice water on an empty stomach; effective for leukorrhea in elderly women. For white turbid discharge, add Long Gu, Di Huang, and Dang Gui. For leakage of five colors, grind She Xiang and take with good wine; for bright red, take with warm salted wine water; for leukorrhea, add Rou Gui, Pu Huang, Bai Cao Shuang, Gan Cao, Hei Dou, Bai Zhu, Yan Hu Suo, Bai Jiang, and Long Gu, take with salted wine on an empty stomach; for white leukorrhea, add Bai Long Gu, take with wine. (These are ancient methods; one must thoroughly understand them before following.) For blood accumulation in women, add E Zhu, Jing San Leng, and Gui Gan Qi (stir-fried until smoke ceases) in equal parts. For stagnant menstrual blood and abdominal pain due to blood and Qi, add E Zhu and Guan Gui in equal parts.
Wang Shifu said: Shu Di Huang stagnates blood and cannot relieve pain; better to replace it with Wu Ling Zhi. For blood stasis and blockage, add Tao Ren and Hong Hua. For amenorrhea, add Zhi Ke, Da Huang, Jing Jie, Huang Qin, Qing Pi, Hua Shi, Mu Tong, Qu Mai, Hai Jin Sha, Shan Zhi Zi, and Che Qian Zi (Why use diuretics for amenorrhea? Is it not to guide Qi stagnation in the Lower Jiao?) For blood cold, add Gan Cao, Wu Mei, Chai Hu, and Tao Liu Zhi. For long-term amenorrhea, add Rou Gui, Gan Cao, Huang Qin, Jiang Huang, Zao Zi, Mu Tong, and Hong Hua. For blocked menstruation, add Ye Zhu Gen, Niu Xi, Hong Hua, and Su Mu, decoct with old wine and water. For disharmony of blood and Qi, add Wu Zhu Yu in equal parts, and half amount of Gan Cao. For various deficiencies, add Xiang Fu Zi. Add half liang of Gan Cao to Si Wu Tang, make into fine powder and honey pills, eight pills per liang, decoct half cup of wine and vinegar, dissolve pills in the decoction, named Dang Gui Jian, removes bad blood and generates good blood; take another dose after walking five li, anytime. (Sweetness harmonizes Qi, generates fluids, and nourishes blood; suitable only for Qi deficiency. To regulate Qi, doubling Xiang Fu is best.) For deficiency-heat disease, combine Si Wu Tang with Shen Su Yin, named Bu Xin Tang; add Chai Hu to name Wu Shen Tang, greatly tonifying deficiency and resolving deficiency-heat. For tidal fever, add Huang Qin, Di Gu Pi, and Chai Hu; one formula adds Chai Hu, Gan Ge, Huang Qin, and Ren Shen. For deficiency-heat with dry mouth, add Mai Men Dong and Huang Qin. For deficiency-thirst, add Ren Shen, Gan Ge, Wu Mei, and Gua Lou Gen. For deficiency with excessive sweating, add Mu Li and Ma Huang Gen. For deficiency-chills and fever, add Chai Hu, Di Gu Pi, Bai Zhu, Fu Ling, Gan Cao, Qin Jiao, Zhi Mu, Huang Qin, Mai Ya, Bei Mu, Ren Shen, Wu Mei, and Zao Zi. For swollen and painful limbs unable to move, use Cang Zhu Ge Ban Tang (The pairing with Cang Zhu shows superior insight, but suitable only for dampness). For dry constipation, combine Si Wu Tang with Tiao Wei Cheng Qi Tang equally, named Yu Zhu San. For moistening dryness, use Si Wu Li Zhong Ge Ban Tang. For combined blood and Qi deficiency, combine Si Wu Tang with Si Jun Zi Tang equally, named Ba Zhen Tang; add Su Sha Ren to protect fetal Qi and aid conception; add Huang Qin if heat exists. If wind arises from heat, add Chuan Xiong, Chai Hu, and Fang Feng (If wind arises from heat, one should clear heat; here, clearing depression-heat instead of direct heat-clearing requires mental discernment). For blood-Qi labor, add Jing Jie and Chai Hu (Not treating labor, but moving Liver/Gallbladder blood-Qi stagnation generating heat, similar to using Qing Hao) (The next three sections treat blood-wind, but transformed syndromes differ, and medications vary; one must comprehend mentally). For blood-wind causing knotty pain in both hypochondria or intestinal masses, add Da Huang, Bi Bo, and Ru Xiang. For blood-weakness generating wind, causing limb bi-pain and difficulty walking, add Ren Shen, Ru Xiang, Mo Yao, She Xiang, Gan Cao, Wu Ling Zhi, Qiang Du Huo, Fang Feng, Jing Jie, Di Long, Nan Xing, Fu Zi, and Ze Lan, make into powder and honey pills, take with Mu Gua salted water soup (A wonderful medicine for bi-pain). For blood-wind distension, add Gan Cao, Mu Xiang, Zhi Ke, Ma Dou Ling, Ting Li, Zi Su, Huo Xiang, and Di Huang, take on empty stomach. For organ constipation, add Da Huang and Tao Ren. For loose stools, add Guan Gui and Fu Zi (Using Si Wu Tang for diarrhea is unbelievable to people, but students should know); for vomiting, add Bai Zhu and Ren Shen (One formula includes Sheng Jiang). For persistent vomiting, add Huo Xiang, halve Bai Zhu, and halve Ren Shen again. For retching with inability to eat, add Bai Zhu, Ding Xiang, Gan Cao, Ren Shen, Suo Sha, Yi Zhi Ren, and Hu Jiao (The added herbs for vomiting/retching are appropriate, but are they compatible with Si Wu Tang?). For cough, add Sang Bai Pi, Ban Xia, Ren Shen, Sheng Jiang, Bei Wu Wei Zi, and Gan Cao (Ancients often used Ren Shen and Wu Wei Zi for cough, but verify deficiency/excess before trusting). For chills and fever, add Gan Sheng Jiang, Mu Dan Pi, and Chai Hu. For alternating chills and fever, add Pao Gan Jiang and Mu Dan Pi, each 2.5 fen. For mild chronic deficiency-dizziness, emaciation, fatigue, and amenorrhea, use only Sheng Jiang and Bo He; these are commonly taken by women, being mild in flavor and nature, slow in effect but profound in merit (Xiao Yao San uses Bo He as a guide, implying this). For extreme thirst, add Zhi Mu and Shi Gao. For water retention under the heart with slight vomiting, add Zhu Ling, Fu Ling, and Fang Ji. For heart and abdominal fullness, add Zhi Ke and Qing Pi. For deficiency sweating, add Ma Huang Gen. For excessive sweating, add Fu Mai. For intestinal wind bleeding, add Huai Jiao, Huai Hua, Zhi Ke, Jing Jie, Huang Qin, Da Fu Pi, Qian Cao, Di Yu, Shi Nan Ye, and Bai Ji Guan Hua, make into powder, decoct half, turn remainder into powder, take with salted water and old wine on empty stomach (Old wine is used because new wine is toxic). For epistaxis and hematemesis, add Zhu Qing, Pu Huang, Ou Jie, Ban Xia, Ding Xiang, He Zi, Gui Hua, Hong Zao, Fei Luo Mian, Bai Mao Gen, and Bang Fen (Gui Hua refers to Gui Xin; Gui combined with Ding and Ban treats vomiting/epistaxis; modern people find this difficult, but ancients used it often; keep for reference). For dizziness and stiff neck, add Ren Shen and Huang Qin. For deficiency-cold resembling Shang Han, add Ren Shen, Chai Hu, and Fang Feng. For deficiency-irritability and insomnia, add Zhu Ye and Ren Shen. For pains with dampness, combine Si Wu Tang with Bai Zhu equally (Previously Cang Zhu was used for swollen limbs; here Bai Zhu is used for damp pains; consider this), add Tian Ma, Fu Ling, and Chuan Shan Jia, decoct with wine. For wind-constipation in elderly, add Qing Pi in equal parts (Adding Qing Pi for elderly wind-constipation is unknown to many; also used postpartum). For sores, add Jing Jie, decoct in wine for regular use. For breast abscess, add Lian Qiao, Ci Gu Zi, Qian Cao, Bai Zhi, Jiao Bai, Jing Jie, Niu Xi, Shan Wu Gong, Ru Xiang, Mo Yao, Lou Lu, and Sheng Di Huang. For red eyes and head-wind disease, add Bo He and clear tea. For red eyes with wind, add Fang Feng and Huang Qin. For wind-sores with redness and swelling, add Jing Jie, Niu Bang Zi, He Shou Wu, Gan Cao, Fang Feng, Qiang Huo, Di Huang, and salted wine. For foot swelling, add Da Fu Pi, Chi Xiao Dou, Fu Ling Pi, and Sheng Jiang Pi. If women suffer from Shang Han after sweating/purging, with reduced diet and blood deficiency, add Huang Qi, Bai Zhu, Fu Ling, and Gan Cao; use Ba Wu Tang. If pregnant women suffer from Shang Han/Wind Strike, with exterior deficiency, spontaneous sweating, headache, stiff neck, fever, aversion to cold, and floating-weak pulse (Taiyang channel disease), use Biao Xu Liu He Tang: Si Wu Tang 4 liang, Gui Zhi and Di Gu Pi 7 qian each. If pregnant women suffer from Shang Han, with headache, fever, no sweat, and floating-tight pulse (Taiyang channel disease), use Biao Shi Liu He Tang: Si Wu Tang 4 liang, Ma Huang and Xi Xin 0.5 liang each. If pregnant women suffer from Shang Han with Wind-Damp invasion, causing vexing pain in joints, floating-hot pulse, and headache (Taiyang marked disease), use Feng Shi Liu He Tang: Si Wu Tang 4 liang, Fang Feng and Cang Zhu 7 qian each. If pregnant women suffer from Shang Han after purging, passing the stage without cure, with warm-toxin macules like brocade patterns, use Sheng Ma Liu He Tang: Si Wu Tang 4 liang, Chai Hu and Huang Qin 7 qian each. If pregnant women suffer from Shang Han, with chest/hypochondriac fullness/pain, string-taut pulse, Shaoyang dizziness/stiff neck, use Chai Hu Liu He Tang: Si Wu Tang 4 liang, Chai Hu and Huang Qin 7 qian each. If pregnant women suffer from Shang Han, with hard stool, red urine, fullness, and deep-rapid pulse (Yangming/Taiyang root disease), purge urgently; use Da Huang Liu He Tang: Si Wu Tang 4 liang, Da Huang 0.5 liang, Tao Ren 10 (skin/kernel removed, bran-fried). If pregnant women suffer from Shang Han after sweating/purging, with persistent cough, use Ren Shen Liu He Tang: Si Wu Tang 4 liang, Ren Shen and Wu Wei Zi 0.5 liang each. If pregnant women suffer from Shang Han after sweating/purging, with deficiency-fullness/bloating (Yangming root deficiency), use Hou Po Liu He Tang, also treating cough/wheezing/fullness: Si Wu Tang 4 liang, Hou Po and Zhi Shi (bran-fried) 0.5 liang each. If pregnant women suffer from Shang Han after sweating/purging, with insomnia, use Zhi Zi Liu He Tang: Si Wu Tang 4 liang, Zhi Zi and Huang Qin 0.5 liang each. If pregnant women suffer from Shang Han, with high fever, extreme thirst, vexing heat, and long-large pulse, use Shi Gao Liu He Tang: Si Wu Tang 4 liang, Shi Gao and Zhi Mu 0.5 liang each. If pregnant women suffer from Shang Han, with difficult urination (Taiyang root disease), use Fu Ling Liu He Tang: Si Wu Tang 4 liang, Fu Ling and Ze Xie 0.5 liang each. If pregnant women suffer from Shang Han, with difficult urination (Taiyang root disease), and red urine like blood, use Hu Po Liu He Tang: Si Wu Tang 4 liang, Hu Po and Fu Ling 0.5 liang each. If pregnant women suffer from Shang Han after sweating/purging, with continuous blood leakage and damaged fetal Qi, use Jiao Ai Liu He Tang: Si Wu Tang 4 liang, E Jiao and Ai Ye 0.5 liang each (One formula adds Gan Cao as above; another adds Gan Jiang, Gan Cao, and Huang Qi). If pregnant women suffer from Shang Han, with limb spasms, cool skin with slight sweat, abdominal pain, and deep-slow pulse (Shaoyin disease), use Fu Zi Liu He Tang: Si Wu Tang 4 liang, Fu Zi (roasted, skin/navel removed) and Gui 0.5 liang each. If pregnant women suffer from Shang Han with blood accumulation syndrome, do not use abortifacients; use Si Wu Da Huang Tang: Si Wu Tang 4 liang, Sheng Di Huang and Da Huang (wine-soaked) 0.5 liang each. Si Wu Tang can be combined equally with Ma Huang, Gui Zhi, Bai Hu, Chai Hu, Li Zhong, Si Ni, Zhu Yu, Cheng Qi, Liang Ge, etc., to form half-decoctions; cannot elaborate fully; this is the general principle of Yi Lao's medication. For fetal calming and stopping leakage bleeding, add E Jiao, Da Ai, Gan Cao, and Pu Huang (fried). For restless fetus with continuous bleeding, add 5-7 leaves of Ai Ye per dose, plus Cong Bai, E Jiao powder, and Huang Qi; halve the four main ingredients, use only small amount of Dang Gui. If condition is severe, cut 0.5 liang of each of the four ingredients finely, add 4 cups water, 6 pieces of cooked Ai Ye (egg-sized), 5-7 slices of E Jiao, decoct to 2.5 cups, strain, divide into four doses, finish in one day; one formula adds Fen Cao, Gan Jiang, and Huang Qi, take 2-3 times daily, up to two "La" periods (one La = 7 days); add E Jiao and Ai Ye decocted in water, named Liu Wu Tang, take 1-2 times daily before/during pregnancy; also treats persistent bloody dysentery and unbearable abdominal pain; one formula adds Huang Qi, Bai Ye, E Jiao, Gan Cao, and Xu Duan, treats persistent irregular menstrual flow, varying amounts/colors/timing, effective with prolonged use. For conception-related Small Intestine Qi pain, add Mu Xiang and Hui Xiang. For pre-pregnancy cough, add Zhi Ke, Gan Cao, Kuan Dong, Ma Dou Ling, Ban Xia, Mu Tong, Ting Li Zi, Ren Shen, Jie Geng, and Mai Men Dong. For fetal Qi rushing Liver, causing waist/leg bi-pain and difficulty walking, add Zhi Ke, Mu Tong, Lian Qiao, Jing Jie, Di Huang, Qiang Du Huo, Shan Zhi, Gan Cao, and Deng Xin, take on empty stomach. For pregnancy-related vexation, add a piece of Zhu Ru; if bad blood exists, use Dang Gui from the upper section, replace Bai Shao with Chi Shao, and Shu Di Huang with Sheng Di Huang. For pregnancy nausea/cold, blue face, loss of appetite, and emaciation, add Chen Pi, Zhi Ke, Bai Zhu, Fu Ling, and Gan Cao. For threatened abortion with continuous bleeding, headache, chills/fever, tinnitus, and blood-Qi labor...