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Dai said: When blood flows out in large quantities, it is called "Beng Zhong" (Metrorrhagia), with the blood being either clear or turbid, or purely consisting of stagnant blood that has become putrid. The condition is unstoppable, presenting various symptoms and caused by different factors. In severe cases, dizziness and vertigo of the head and eyes, as well as cold limbs, occur. All such cases are suitable for treatment with Jiao Ai Tang (Cordyceps and Moutan Decoction) and swallowing Zhen Ling Dan (Zhen Spirit Pill, which can both stop bleeding and promote circulation; only Yuanli could explain and use it). It should be assisted with San Hui San (Three Ash Powder), or Li Zhong Tang (Regulate the Middle Decoction) decocted with urine from an uncircumcised boy, or Chen Xiang Jiang Qi Tang (Aucklandia Descending Qi Decoction) added with Bai Cao Shuang (Soot from Hundred Herbs), taken down with rice drink. When metrorrhagia is severe and accompanied by abdominal pain, people often suspect that evil blood has not been fully expelled (a unique insight). Seeing the dark, stagnant color of the blood further confirms this belief, making them afraid to use astringent methods. Generally speaking, when blood is affected, if it stays in the abdomen before flowing out, it turns into a stagnant color. It is difficult to assume all of it is evil blood (a brilliant argument). How can one know that stagnant blood is not due to deficiency and cold? If one must wait until stagnant blood is seen before using astringent methods, it is feared that even normal blood will be exhausted. There is another explanation for this abdominal pain: Abdominal pain caused by blood stasis stops when blood circulation resumes; abdominal pain caused by metrorrhagia stops when bleeding ceases. In such cases, Xiong Gui Tang (Angelica and Chuanxiong Decoction) added with Gan Jiang (Dried Ginger) and Shu Fu Zi (Prepared Aconite Root, 1 qian) is suitable (not to be used if qi collapse has occurred due to long-term metrorrhagia). Once the bleeding stops, the pain naturally subsides (The following are all astringent methods, yet crab shell and Huang Ma have the ability to break blood stasis). One should still use pieces blackened by rubbing with Ci Hua Xiu (Thorn Flower Embroidery?), burn them to ash, grind into powder, and take with rice drink. Another method is to burn Mao Xie Ke (Crab Shell) until it retains its nature, and take it with rice drink.

Xue said: My cousin's wife, aged fifty, suffered from metrorrhagia in the Xin Chou year, to which various medicines were ineffective. In the eighth month of the Ren Yin year, she experienced fever, body pain, dizziness, runny nose, expectoration, and poor appetite. The public treated her as having fire-heat, which exacerbated the fever, leading to several days of fasting. Upon diagnosis, I said: The spleen and stomach have been deficient for a long time; overuse of cold medicines has failed to cure the disease, and a cold pathogen has arisen again. Therefore, I used Ba Wei Wan (Eight-Ingredient Pill) ingredients. After one dose, she asked for a few spoons of porridge the next morning. After taking it again, her appetite doubled, fever decreased, and pain stopped. She then took Ba Wei Wan and recovered. In the autumn of the Gui Mao year, due to labor, worry, and anger, the illness recurred in the summer of the Jia Chen year. She had chest fullness, fever, back pain, lumbar pain, and depressed spirit. Some treated it as heatstroke, resulting in metrorrhagia, hematochezia, irritability, thirst with excessive drinking, inability to eat rice, and intermittent coma. The pulse was flooding but weak upon deep pressure. This is rootless fire, internal deficiency-cold with external false-heat. I prescribed Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) added with Fu Zi (Aconite Root) for one dose. She immediately ate three or four spoons of porridge, and the bleeding gradually decreased. Taking Ba Wei Wan daily eventually led to complete recovery. (Various insights and major principles like this have their own understanders.)

The wife of Wang Tiancheng, a Dayin (Magistrate), suffered from long-term metrorrhagia. She self-medicated with Si Wu Tang (Four Substances Decoction) and other cooling-blood agents, with intermittent improvement. Due to anger and fever, the bleeding did not stop. Previous medicines were ineffective, so the focus shifted to clearing fire, which aggravated severe pain in the abdomen and hypochondrium, with cold hands and feet. I said: This is caused by spleen-stomach deficiency-cold. First, use Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction). Once body heat and pain subsided, Ji Sheng Gui Pi Tang (Ji Sheng Spleen-Tonifying Decoction) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) were used, and the metrorrhagia instantly healed. If one sticks to the notion that "pain cannot be treated with tonification," it would be a mistake. (Fever due to anger is not primarily attributed to the liver, but specifically warming and tonifying the spleen and stomach captures the root cause. However, the prescription differs significantly from the previous cold-injury case; who is correct?)

The wife of Yang Yongxing, a Jin Yi (Imperial Guard), suffered from the aforementioned condition. Overuse of cold-cooling agents worsened her symptoms, adding epigastric fullness, inability to eat, fever, irritability, and a flooding yet empty pulse. I said: This is irritability caused by deficiency of qi and blood in the spleen meridian. Urgent treatment with Ba Zhen Tang (Eight-Treasure Decoction) added with Pao Jiang (Roasted Ginger) for warming and tonification is necessary; delay means no salvation. Disbelieving this, she took hemostatic and fire-clearing agents, causing deficiency syndromes to arise in droves. Only then did she believe my words, but it was too late to treat. (Although both cases involved overuse of cold agents, the prescriptions differed, yet neither abandoned Jiang (Ginger) and Fu Zi (Aconite); there must be a principle. Two recovered after two doses, while one died from non-compliance. Can one not discern the intent of these annotations?)