Library

The *Mai Jing* (Pulse Classic) states: "When a woman suffers from diarrhea and her menstruation unexpectedly ceases, what is the reason?" The Master said: "One should only stop the diarrhea, and the menstruation will resume naturally; do not be surprised." The reason why continuous diarrhea leads to amenorrhea is that diarrhea depletes the body's Jin-Ye (body fluids), causing the cessation of menses. Once the diarrhea stops and Jin-Ye recovers, menstruation will naturally return. If a woman has vaginal bleeding, dry throat but no thirst, her menstruation must cease; this is due to insufficient Ying-Blood (nutritive blood). She inherently has slight cold in her body, hence she does not desire to drink. If she feels thirsty and desires to drink, it indicates that Jin-Ye are flowing freely, and Ying-Wei (nutritive and defensive qi) are harmonized; consequently, her menstruation will surely resume.

Li stated: Women are primarily governed by blood. When Tian-Zhen Qi (innate vital energy) descends and Ren-Gui water (Kidney water) combines, with Kidney Qi at its peak, blood vessels flow smoothly. Menstruation should occur every thirty days, mirroring the waxing and waning of the moon, hence it is called "Jing-Yue" (regular menstruation). The condition during menstruation is similar to the postpartum period. If residual blood remains uncleaned at this time, or if external pathogens such as Wind-Cold, Damp-Cold, Summer-Heat, or Heat invade, or if internal injury occurs from consuming raw and cold foods, combined with emotional stagnation (Seven Emotions) leading to Phlegm or Blood Stasis condensing within, this is termed "Blood Stagnation". Alternatively, after menstruation ends, excessive physical exertion, excessive sexual intercourse, or consumption of drying and heating foods may cause Fire to flare up, leading to excess pathogenic factors and depletion of Jin-Ye; this is termed "Blood Withering".

The *Liang Fang* states: Being startled after menstruation causes Qi and Blood to become chaotic and flow recklessly ("Startling causes Qi chaos, thus meridians run erratically"). If Qi rebels upward, blood may exit through the mouth and nose ("Anger causes Qi to rebel upward, severely leading to hematemesis"); if it rebels within the body, Blood and Water contend, transforming into edema. Anger causes Qi and Blood to rebel in the waist, legs, heart, abdomen, back, flanks, and between hands and feet, causing heavy pain that manifests during menstruation and subsides afterward. Extreme anger injures the Liver, leading to dizziness, hematemesis, scrofula, Blood Wind, sores, and other diseases. With menstrual blood leaking into these areas, it forms ulcers in orifices, dripping continuously. Damp-Heat contending together leads to metrorrhagia and leukorrhea. Blood coagulating internally transforms into masses (Zheng-Jia). All these varied complications stem merely from Blood Stagnation and Blood Withering (summary). However, Blood Stagnation can involve Deficient Heat, and Blood Withering can also involve Deficient Heat; severe cases result in complete amenorrhea. Speaking separately of Stagnation and Withering, mild cases involve only irregular menstruation, pertaining solely to Deficiency and Heat. For amenorrhea caused by Blood Stagnation suitable for breaking methods, the cause is often toxic heat from diet or violent anger, leading to condensed stasis and accumulated phlegm. One must use herbs like Da Huang (Rhubarb Rhizome) and Gan Qi (Drywood Lacquer) to push out the old and generate the new, eliminating old blood so new blood can arise. If Qi is robust but Blood is withered, originating from labor and worry, one should employ gentle warming and tonifying methods. If accompanied by Phlegm-Fire or Damp-Heat, clearing and cooling are especially appropriate; Cinnamon Twig (Rou Gui) is often used as an assistant herb because heat promotes blood circulation. However, one must not use purely harsh drugs, lest they damage the Yin pathway. Regarding the theory of exhausting Qi to benefit Blood, although it is a key method in Gynecology, Blood is the companion of Qi; if Qi is hot, it is hot; if cold, it is cold; if ascending, it ascends; if descending, it descends; if moving, it moves; if stagnant, it stagnates. Only if there is constrained Fire and Qi exceeds Blood can one solely use Xiang Fu Wan Powder or Yi Qi San, adding Mu Xiang (Costus Root), Bing Lang (Areca Seed), and Zhi Ke (Aurantium Fruit) to open constraints and move Qi. If Qi is chaotic, regulate it; if cold, warm it; if deficient, tonify it. This applies to both men and women; when Yang grows, Yin naturally lengthens; when Qi declines, Blood also dries up. How can one exclusively exhaust Qi? Commentators often cling to Shu He's statement that "Blood is abundant while Qi is deficient," unaware that Shu He was discussing the Liver and Lung pulses (since the Liver stores Blood and the Lung governs Qi), implying the Liver should be more robust than the Lung. Actually, harmonious Qi and Blood are required for conception, hence he subsequently stated that the two organs must be harmonious. However, women often have narrow perspectives and humble status, with unfulfilled ambitions, leading to constant depression and anger; thus, Cyperus Rhizome (Xiang Fu) is considered a celestial medicine for women. The Classics state: "Excess pathogenic factors lead to Excess patterns; loss of healthy Qi leads to Deficiency patterns." Should one not realize this? Generally, there are only four syndromes: Deficiency, Heat, Phlegm, and Qi. Irregular menstruation is largely similar; treat according to the syndrome, harmonize diet, and naturally Qi and Blood will flow. If there is still stagnation, then one may use formulas such as Hong Hua Dang Gui San, Zi Wei San, Tong Jing Wan, or Dao Jing Wan. For Deficiency, only Dang Gui San should be used to promote flow. After promoting flow, one must nourish Blood and benefit Yin to ensure Jin-Ye circulate. If one neglects to strive for the fullness and harmony of Qi and Blood, relying instead on toxic drugs to attack, it is like seeking a thousand gold from a beggar; death is the inevitable outcome.