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Zhu Danxi stated: Menstrual blood is Yin blood. Yin must follow Yang; therefore, its color is red, which is endowed with the color of Fire (Huo). Blood is the companion of Qi. When Qi is hot, heat prevails; when Qi is cold, cold prevails. When Qi ascends, blood ascends; when Qi descends, blood descends. When Qi stagnates, blood stagnates; when Qi is obstructed, blood is obstructed. When Qi is clear, blood is clear; when Qi is turbid, blood is turbid. It corresponds to the Heart (Xin) above, and its movement follows a regular pattern, hence it is called "Jing" (Menstruation). Because it is the companion of Qi, it moves with Qi. The formation of clots is due to the stagnation of Qi. Pain before menstruation is due to the obstruction of Qi. Pain after menstruation is due to the deficiency of both Qi and Blood. A pale color indicates deficiency, mixed with dampness (Shi). Irregular or excessive bleeding is due to the disorder of Qi. A purple color indicates heat in Qi. A black color indicates extreme heat. Nowadays, people only see purple or black colors, pain, or clots, and generally attribute them to invasion by Wind-Cold (Feng Leng), using warm and hot remedies, which leads to immediate disaster. This is largely because the *Suwen* (Pathogenesis Treatise) attributes menstrual diseases to Wind-Cold invasion, making this a common custom. Some ask: Black is the color of Water (Shui) in the North, and purple is a gradual change from black; is it not cold? I say: The *Neijing* states, "When things reach an extreme, they cause harm; control comes from what opposes them." Extreme heat must manifest with transformations resembling Water. Thus, heat causes purple, and extreme heat causes black. Moreover, women often have stubborn natures and excessive desires, causing the Fire of Jue-Yang (Defiant Yang) in their Zang-Fu organs to rise daily. Is this not heat? If one insists it must be Wind-Cold, it must come from external exposure. Perhaps such cases exist, but I fear they are one in a thousand.

Commentary: This discussion on menstrual diseases is very detailed. Generally, one should not simply attribute these conditions to Wind-Cold invasion. This caution is issued because the statements in *Liangfang* were often followed by the secular world, misleading people. However, if it is a Cold syndrome, external pathogens initially invading the meridians will certainly cause pain. If there is no pain, over time, the pathogen will stagnate and transform into Heat. Furthermore, Cold causes coagulation; since the blood has flowed and is purple or black, it is not Cold.

The *Yin Yang Bie Lun* chapter of the *Neijing* states: "Yin deficiency with Yang pounding is called Beng (Metrorrhagia)." Li Dongyuan said: In women, Spleen-Stomach deficiency leads to a Mingmen (Gate of Life) pulse that is deep, fine, rapid, or deep, wiry, and forceful/huge, with similar characteristics at the Cun and Guan positions. All these arise from Spleen-Stomach deficiency where Qi sinks into the Kidney, combining with Ministerial Fire (Xiang Huo). Damp-Heat forces downward, causing persistent metrorrhagia with purple-black blood smelling like rotting meat in summer. If white discharge is present, the pulse is likely wiry and fine, indicating Cold in the Middle Jiao. If red discharge is present, the pulse is huge, rapid, and quick, clearly indicating Heat. There will definitely be lower back pain or umbilical pain. Before menstruation begins, there may be alternating chills and fever, tightness and contraction of the hypochondrium, accompanied by Spleen-Stomach symptoms, or four limbs fatigue, mental restlessness, insomnia, and epigastric urgency. Treatment should involve greatly tonifying the Spleen-Stomach and raising/lifting Qi and Blood, which can result in recovery after one dose. For those who lose status due to misfortune, have few social interactions, or decline from wealth to poverty, Heart Qi becomes deficient. This allows Heart Fire to blaze excessively within the blood vessels, further causing Spleen-Stomach dietary irregularities and Fire attacking the Middle Jiao. Although physical appearance seems healthy, this is because patients with Heart disease fail to recognize the diagnosis, so Spleen-Stomach dietary dysfunction symptoms become apparent, leading to irregular menstruation, sudden cessation, or profuse bleeding. Treatment should first explain the danger of death to persuade the patient to remain calm and unmoved. Use herbs to greatly tonify Qi and Blood to support the Spleen-Stomach, with slight additions of sedating herbs to subdue Heart Fire, treating the Heart by tonifying Yin and draining Yang, so menstruation stops naturally. The *Wei Lun* (Treatise on Flaccidity) states: "Excessive grief severs the Bao-Luo (Pericardium Collaterals), causing internal movement of Yang Qi, resulting in Heart Beng (collapse/bleeding) and frequent bloody urine." Thus, the *Ben Bing* chapter says: "When the Great Meridians are empty, muscle Bi (obstruction) occurs, transmitting to Mai Wei (Vascular Flaccidity)." This refers to the aforementioned condition.

*Liangfang* discusses: Metrorrhagia in women is caused by damage to Zang-Fu organs and deficiency of Qi and Blood in the Chong and Ren meridians. The Chong and Ren are the Seas of the Twelve Meridians. Qi and Blood circulate externally along the meridians and internally nourish the Zang-Fu. Without damage, Yin and Yang are harmonious, and Qi and Blood are balanced. Excessive labor damages all Zang-Fu, weakening the Qi of Chong and Ren, which cannot constrain the menstrual blood, causing sudden profuse bleeding. Alternatively, Yin and Yang struggle, attacked by Heat, damaging Chong and Ren. Blood,受热 (heated), scatters, potentially leading to fainting. The pulse is rapid and quick; a small pulse is favorable, while a large pulse is unfavorable.

Commentary: This thoroughly explains the causes of meridian diseases, rooted in Zang-Fu damage. Combined with Li Dongyuan's previous discussions, it exhaustively describes pathogenesis due to Heat, Deficiency, or emotional factors like grief, leaving little unstated.