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*Zhunsheng* states: Women suffering from continuous menstruation, dripping without cessation, may have this due to fatigue damaging Qi and Blood, thereby injuring the Chong and Ren vessels. Alternatively, engaging in sexual intercourse during menstruation can also lead to Qi deficiency failing to control the blood. If the bleeding stops and starts intermittently, accompanied by abdominal pain and a deep, fine pulse, this is caused by cold-heat pathogenic factors invading the uterus, not due to weakness. Xue Ji stated: For the aforementioned symptoms, if caused by emotional stagnation injuring the Spleen, use Guipi Tang (Restore the Spleen Decoction); if caused by anger injuring the Liver, use Xiaoyao San (Free and Easy Wanderer Powder); if caused by hyperactive Liver Fire, use Jiawei Siwu Tang (Modified Four Substances Decoction); if caused by Spleen Qi deficiency, use Liujunzi Tang (Six Gentlemen Decoction); if caused by sinking of Yuan Qi (Original Qi), use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if heat injures Yuan Qi, add Wuweizi (Schisandra Fruit), Maidong (Ophiopogon Tuber), and Chaohei Huangbai (Charred Phellodendron Bark) to the previous decoctions.

*Chanbao* states: Men are born in Yin years (or hours), where Yin belongs to Wood, containing Yin within Yang; thus, men follow the number eight (e.g., cycles of eight). Women are born in Shen years (or hours), where Shen belongs to Metal, containing Yang within Yin; thus, women follow the number seven (e.g., cycles of seven). Men prioritize Qi; upon reaching the age of 8x8 (64 years), their cycle numbers are exhausted. Women prioritize Blood; upon reaching the age of 7x7 (49 years), their cycle numbers end. Once ended, menstruation ceases, the Chong and Ren vessels become deficient and weak, Tian Gui (Heavenly Water/Reproductive Essence) is exhausted, the reproductive pathway is blocked, and conception becomes impossible. Or, due to excessive labor injury and irregular emotions, when the meridians are already declining, further attack by pathogenic factors causes menstruation that should stop to continue as metrorrhagia. Xu Shuwei stated: For women with overdue menstruation that does not stop, accompanied by lower back and abdominal pain, or those who have reached the age of 49 but still menstruate, Danggui San (Angelica Powder) is appropriate.

*Chanbao* states: Menstruation circulates Qi and Blood, communicates Yin and Yang, and nourishes the body. When Qi and Blood are abundant and Yin and Yang are harmonious, the physical form is unobstructed. If external Wei Qi (Defensive Qi) lacks nourishment and internal Ying Blood (Nutritive Blood) lacks irrigation, resulting in insufficient Qi and Blood, the body may experience pain before the onset of menstruation. (This discusses body pain.)

*Liangfang* states: Abdominal pain during menstruation in women is caused by Wind-Cold-Dampness pathogens lodging in the Bao Luo (Uterine Collaterals) and Chong and Ren vessels, or injuring the Taiyang and Shaoyin meridians. Wenyang Tang (Warm the Meridians Decoction) or Guizhi Taoren Tang (Cinnamon Twig and Peach Kernel Decoction) can be used. If worry and thought cause Qi stagnation leading to Blood stasis, Guizhi Taoren Tang or Dihuang Tongjing Wan (Rehmannia Menstruation-Unblocking Pill) is used. If Blood coagulation forms masses, Wanbing Wan (Ten Thousand Diseases Pill) is used.

Zhu Danxi stated: Pain occurring before menstruation indicates Blood Excess, or sometimes Qi Stagnation; Siwu Tang (Four Substances Decoction) added with Taoren (Peach Kernel), Xiangfu (Cyperus Rhizome), and Huanglian (Coptis Rhizome) can be used. Lower back and abdominal pain during the flow of menstruation indicates stagnation with Blood Stasis; Siwu Tang added with Honghua (Safflower), Taoren, Ezhu (Curcuma Rhizome), Yanhusuo (Corydalis Rhizome), and Muxiang (Aucklandiae Radix) can be used. If there is Heat, add Huangqin (Scutellaria Root) and Chaihu (Bupleurum Root) [some add Xiangfu, Qingpi (Green Tangerine Peel), Taoren, Wuyao (Lindera Root), Danpi (Moutan Cortex), Xiaohui (Fennel Seed), and Wulingzhi (Trogopterus Dung)]. Pain occurring after menstruation indicates deficiency of both Qi and Blood; Bazhen Tang (Eight Treasures Decoction) modified can be taken. Dai Yuanli stated: Abdominal pain during menstruation, or abdominal pain when menstruation does not occur, are both due to irregular Blood. To regulate Blood, one must first regulate Qi. Siwu Tang added with Wuzhuyu (Evodia Fruit) half qian and Xiangfuzi (Cyperus Fruit) one qian can be used; Heqi Yin (Harmonizing Qi Decoction) added with Wuzhuyu half qian is also acceptable. For severe pain, Xuanhusuo Tang (Corydalis Decoction) is used. However, one must also consider pain caused by external pathogens or dietary injury, which is not due to Blood issues; such cases require careful examination, whereas Heqi Yin can treat multiple causes. For pain caused by Cold accumulation, Da Wenyang Tang (Great Warm the Meridians Decoction) is suitable. For severe Cold, Maidong should be omitted.

Wang Shishan treated a woman, small in stature, over twenty years old, with purple menstrual blood, irregular timing (early or late), abdominal pain before flow, aversion to cold preferring warmth, occasional cold invasion causing abdominal pain. Her pulse was fine, soggy, and near slippery; the two Chi positions were slightly surging and slippery upon heavy pressure, indicating Blood Heat. Someone asked: "How can this be Heat given the severe aversion to cold?" Wang replied: "Extreme Heat resembles Cold." He prescribed Jiu Zhu Huanglian (Wine-Boiled Coptis) four liang, Xiangfu and Danggui Shenwei (Danggui root tip and tail) two liang each, and Wulingzhi one liang, ground into powder, made into pills with rice congee, and swallowed on an empty stomach, resulting in cure. (This case relied entirely on pulse diagnosis; otherwise, this prescription would not have cured it.) Another woman, twenty-one years old, experienced menstruation in the sixth month with unbearable scraping-like abdominal pain. Her pulse was fine, soft, and rapid; the Chi position was deep, weak, and near rapid. Wang said: "Fine and soft indicates Dampness; rapid indicates Heat; deep Chi indicates stagnation." He prescribed Jiu Zhu Huanglian half jin, Chao Xiangfu six liang, Wulingzhi (half fried, half raw) three liang, and Danggui Shenwei two liang, ground into powder, made into pills with rice congee, taken with warm water on an empty stomach, three to four qian per dose. After five or six courses, she conceived nine years later. It remained effective for many years, but after fifteen years, the previous medicine lost efficacy. (Stop medication once the disease is addressed; do not finish all doses unnecessarily. The Classic says: Do not exceed the limit, lest you damage healthy Qi.) Wang re-examined her; the pulse was surging, slippery, and powerless, though she retained spirit. Wang said: "This is no longer the same as before. Previously it was Depressed Heat; now it is Deficiency Cold. Li Dongyuan said: Initially Heat Zhong, finally Cold Zhong." The Classic says: "When the pulse follows but does not throb under pressure, it is Yin Excess repelling Yang, and should be treated as Cold. Moreover, initially the body was thin; now it is fat." Books state: Thin people have Blood Heat; fat people have Blood Deficiency. How can they be treated identically? What is concerning is profuse sweating without the pulse weakening, or massive hemorrhage without the pulse diminishing due to blood loss. (These two statements are flawed; only in Shanghan with pathogens does the pulse not weaken with sweat indicate untreatability; here, Yang has no attachment due to Blood loss, hence the powerless pulse. It is incorrect to say the pulse does not diminish due to blood loss.) Her pain was heavier by day and lighter by night, indicating Yang Deficiency failing to move normally, leading to stagnation and pain. Correlating symptoms with the pulse, Yang-tonifying therapy is appropriate. If the pulse softens and pain lightens, it is a good sign. He administered a large dose of Renshen (Ginseng), [missing character], Danggui, and Baizhu (Atractylodes Macrocephala Rhizome), plus Rougui (Cinnamon Bark) and Fuzi (Aconite Lateral Root) for one dose. Re-examining the next morning, the pulse had calmed slightly. After twenty to thirty doses, the illness healed. (This was also because previous cold-cooling treatments were excessive, essentially treating medicine-induced pathology with medicine; thus, these warming and tonifying agents were applicable, healing in thirty doses.) Diseases have beginnings and endings, differences in Cold and Heat, and variations in drug usage over time. Physical constitutions vary in fatness, thinness, strength, and youth. How can one formula treat all?