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Zhu Danxi stated: Menstrual blood is Yin blood. Yin must follow Yang; therefore, its color is red, inheriting the hue of Fire. Blood is the companion of Qi. If Qi is hot, blood becomes hot; if Qi is cold, blood becomes cold. If Qi ascends, blood ascends; if Qi descends, blood descends. If Qi stagnates, blood coagulates; if Qi is obstructed, blood is blocked. If Qi is clear, blood is clear; if Qi is turbid, blood is turbid. Corresponding to the moon in heaven, its flow follows a regular pattern, hence it is named "Jing" (Menses). As the companion of Qi, it moves with Qi. The formation of clots is due to Qi stagnation. Pain occurring just before menstruation is due to Qi obstruction. Pain occurring after menstruation is due to deficiency of both Qi and Blood. A pale color indicates deficiency, often mixed with dampness/water. Irregular or profuse bleeding is due to Qi disorder. A purple color indicates Qi heat, while a black color indicates extreme heat. Nowadays, people only see purple or black blood, pain, or clots, and generally attribute them to Wind-Cold invasion, administering warm and hot remedies. This leads to disaster almost immediately. This error stems from *Zhubing Yuanhou Lun* (The Source and Characteristics of All Diseases), which attributes all menstrual disorders to Wind-Cold invasion. No wonder this has become a common practice. Some ask: Black is the color of Water in the North; purple is lighter than black. Is it not cold? I say: The medical classics state, "When things reach an extreme, they cause harm; only through control can balance be maintained." Extreme heat necessarily incorporates the transformation of Water. Thus, heat results in purple, and extreme heat results in black. Moreover, women are often stubborn and their insights limited, with doubled desires. The Fire of Jue-Yang (Defiant Yang) in their Zang-Fu organs rises daily. How can this not be Heat? If it were Wind-Cold, it must be externally acquired. Even if such cases exist, they are rare, perhaps one in a thousand.

Wenken Tang's *Yixue Zhunsheng Liuyao* states: In Cold syndromes, when external pathogens are initially contracted and enter the meridians, pain is inevitable. If there is no pain, stagnation will eventually transform into Heat. Since Cold causes coagulation, if the blood is purple or black during flow, it is not Cold. (The explanations of these two masters are very clear.)

Ye Shi said: Black blood belongs to Heat; Zhu Danxi's discussion is excellent. However, cases of external Wind-Cold invasion are seen in one or two out of ten. How can they be distinguished? Generally, Cold governs contraction and astringency. There must be frequent cold pain in the lower abdomen. During menstruation, the hands and feet may be cold, the lips cyanotic, and the face pale. The Chi pulse (at the wrist) may be slow, faint, or deficient, or even if large, it must be forceless. In Heat syndromes, the Chi pulse may be surging, rapid, or full, or even if small, it must be forceful. By examining these aspects, the true nature of the condition can be ascertained. (Correlating pulse and symptoms is particularly accurate.)

Li Shi said: The Heart governs Blood, so red is the correct color. Even if the cycle is irregular, if the color is normal, it is easy to treat. Purple color indicates Wind; black indicates extreme Heat; pale white indicates Deficiency, possibly mixed with Phlegm or retained water. Blood resembling smoke/dust water, roof leak water, or bean juice, or yellow and turbid/muddy, indicates Damp-Phlegm. Clots forming sheets where the blood itself remains unchanged indicate Qi stagnation or Wind-Cold invasion. Color changing to purple-black indicates Blood Heat. Generally, for purple color, use Siwu Tang (Four Substances Decoction) added with Fangfeng (Saposhnikovia Root), Baizhi (Angelica Dahurica Root), and Jingjie (Schizonepeta Spike). For black color, use Siwu Tang added with Huangqin (Scutellaria Root), Lianzi (Coptis Rhizome), and Xiangfu (Cyperus Rhizome). For pale white color, use Xionggui Tang (Ligusticum and Angelica Decoction) added with Renshen (Ginseng Root), [text missing, likely Huangqi or Baizhu], Baishao (White Peony Root), and Xiangfu. For Phlegm, use Erchen Tang (Two-Aged Decoction) added with Chuanxiong (Ligusticum Chuanxiong Rhizome) and Danggui (Angelica Sinensis Root). For smoke-like appearance, use Erchen Tang added with Qinjiao (Gentiana Macrophylla Root), Fangfeng, and Cangzhu (Atractylodes Rhizome). For bean juice-like appearance, use Siwu Tang added with Huangqin and Huanglian. For clots, use Siwu Tang added with Xiangfu, Yuanshusu (Corydalis Rhizome), Zhike (Bitter Orange Fruit), and Chenpi (Tangerine Peel), selected according to symptoms.