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Women's menstruation may present with irregular cycles, varying amounts of flow, intermittent onset and cessation, intermittent pain, and even alternating chills and fever, resembling consumptive disease (a chronic wasting condition). All these are caused by the stagnation and discomfort of Liver Qi.

There is no fixed method for treatment; generally, warming and unblocking methods are more commonly used, though cooling methods are also applicable. However, the initial approach must always be to soothe the Liver. The Liver is the child of Water and the mother of Fire, and it holds the authority of dispersion and descent. Therefore, when Liver Qi is not free-flowing, the transformation of Heart-Kidney intersection becomes abnormal, and the command of dispersion and descent loses its rhythm. The therapeutic principle follows that of Xiaoyao San (Free and Easy Wanderer Powder).

Chao Danggui (Fried Angelicae Sinensis Radix), Baifuling (Poria), Chuanxiong (Ligusticum Wallichii Rhizome), Xiang Beimu (Fritillariae Thunbergii Bulbus), Chao Zhizi (Fried Gardeniae Fructus), Da Shengdi (Rehmanniae Radix Preparata), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Zhi Baizhu (Processed Atractylodis Macrocephalae Rhizoma), Xi Qingpi (Citri Reticulatae Pericarpium Viride), Gan Qizi (Lycii Fructus), Shijueming (Argonautae Oca), Shanyao (Dioscoreae Rhizoma), Chao Zhuru (Fried Bambusae Caulis in Materia Medica), Hei Jiesui (Schizonepetae Spica Carbonisata).

After taking several doses of this prescription, if the Liver Qi has harmonized, further treatment should be administered according to the specific syndrome.

Menstrual irregularities characterized by variable timing, volume, and presence or absence, as described in the previous section, are collectively termed "Irregular Menstruation" (Jingshui Budiao). Menstrual blood is essentially generated from the essence of food and water transformed by the Spleen and Stomach. The Classic states: "When Earth Qi is excessive, it becomes Dunfu." "Dunfu" means thick and high. Chen Xiuyuan stated: "Since it is both high and thick, it should be reduced." It is appropriate to use Pingwei San (Peaceful Stomach Powder) with added Dahuang (Rhei Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Zhishi (Aurantii Fructus Immaturus), and Taoren (Persicae Semen).

Chen Xiuyuan's Modified Pingwei San:
Zhi Cangzhu (Processed Atractylodis Rhizoma), Guang Chenpi (Citri Reticulatae Pericarpium), Quan Danggui (Angelicae Sinensis Radix), Sheng Baishao (Raw Paeoniae Radix Alba), Taoren Ni (Persicae Semen Paste), Zhi Houpo (Processed Magnoliae Officinalis Cortex), Chao Zhishi (Fried Aurantii Fructus Immaturus), Chuanxiong (Ligusticum Wallichii Rhizome), Huainiuxi (Achyranthis Bidentatae Radix, fried).

Pingwei San already contains Zhishi, so there is no need to increase the dose, lest it excessively deplete Qi. If the stool is not dry and there is no stasis bleeding, Dahuang need not be added. Adding Dahuang would combine it with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi). Although Mangxiao (Natrii Sulfas), Guizhi (Cinnamomi Ramulus), and Gancao (Glycyrrhizae Radix et Rhizoma) are absent, the intent is complete. This must only be applied to patients with robust constitution and excess syndromes.
(Parenthetical note: For individuals of refined diet and weak constitution, this formula should be used lightly; it is better to take two or three additional doses rather than acting too abruptly. There are no contraindications for robust individuals.)

Irregular menstruation is less often caused by excessive Earth Qi (Spleen/Stomach Qi) and more often by deficient Earth Qi. The Classic states: "When Earth Qi is deficient, it becomes Beijian." "Beijian" means low and sinking. Chen Xiuyuan stated: "Since it is both low and sinking, it should be fortified." It is appropriate to use Liujunzi Tang (Six Gentlemen Decoction) with added Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligusticum Wallichii Rhizome), Chaihu (Bupleuri Radix), and Baishao (Paeoniae Radix Alba).

Chen Xiuyuan's Modified Liujunzi Tang:
Dangshen (Codonopsis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), Chaihu (Bupleuri Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma), Chuanxiong (Ligusticum Wallichii Rhizome), Baishao (Paeoniae Radix Alba).

The main purport of this formula remains unchanged; one must further examine the cold or heat in the Blood Chamber (Uterus/Chong and Ren vessels) and add warming or cooling herbs accordingly. Mr. Chen also had a general governing formula for regulating menstruation, based on Siwu Tang (Four Substances Decoction) with added Xiangfu (Cyperi Rhizoma), Fushen (Poria with Hostwood), and Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma). In cases of Yin excess and cold, add Ganjiang (Zingiberis Rhizoma), Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata), Wuyu (Evodiae Fructus), Taoren (Persicae Semen), Honghua (Carthami Flos), etc. In cases of Yang excess and heat, add Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), Lianzu (Coptidis Rhizoma), Xuduan (Dipsaci Radix), Maidong (Ophiopogonis Radix), etc. Although these are very simple and plain formulas, they can be used routinely. One need not seek novelty to dazzle the common people for ordinary diseases. Mr. Chen also claimed that Zhang Zhongjing's Wenjing Tang (Warming the Meridian Decoction) could govern amenorrhea, menorrhagia, metrorrhagia and metrostaxis, infertility due to long-term failure to conceive, and various menstrual disorders in gynecology. This is an over-praise of the Sage, tantamount to slandering him. How suitable are Wuyu and Shengjiang for those with Heat in the Sea of Blood? How suitable are Banxia and Guizhi for those with Blood deficiency? Thus, I directly consider this slander of the Sage. The Sage first emphasized correct naming, and Zhang Zhongjing established formulas in the same manner. The formula is named "Warming the Meridian," yet it uses Wuyu first, revealing its intent to warm and unblock the Lower Yuan (Kidney and Mingmen). Even someone as erudite as Chen Xiuyuan falls into this error; how awe-inspiring is the difficulty of the medical Dao!