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(From *Suwen: Fuzhong Lun*)

The Yellow Emperor asked: There is a patient suffering from distension and fullness in the chest and hypochondrium, which interferes with eating. Upon the onset of the illness, they first perceive a fishy and gamey odor, discharge clear fluid, expectorate blood in saliva, experience cold limbs, dizziness, and frequent bleeding from both the anterior and posterior orifices. What is this disease called?

How did it arise? (Note: "Distension and fullness" refers to a sensation of fullness as if obstructed by a prop. The Lung governs Qi, and its odor is fishy; the Liver governs Blood, and its odor is gamey. If Lung Qi fails to regulate Liver Wood, both Liver and Lung Qi rebel upward, turbid Qi fails to descend, and clear Qi fails to ascend, hence the perception of fishy/gamey odors and vomiting of clear fluid. Expectorating blood indicates that Blood fails to return to its vessels. Cold limbs indicate that Yang Qi cannot circulate throughout the body. Dizziness of the head and eyes results from excessive blood loss, with Qi departing along with the Blood. Since Qi and Blood are disordered, bleeding occurs intermittently at the anterior and posterior orifices, while menstruation becomes irregular. "Gamey" is pronounced like "Sao".)

Qibo replied: This disease is named Xueku (Blood Depletion). It arises from a history of massive blood loss during youth, or from sexual activity while intoxicated, leading to exhaustion of Middle Qi and injury to the Liver, resulting in scanty or absent menstruation. (Note: "Xueku" refers to the cessation of menstrual flow. There are two main causes for this condition: First, massive blood loss in youth, such as from multiple pregnancies, postpartum hemorrhage, metrorrhagia, hematemesis, or epistaxis. Second, sexual intercourse after intoxication; when Blood is abundant and hot, indulgence leads to the complete depletion of Yin Essence. When Essence is lost, Qi is also lost, causing exhaustion of Middle Qi. The Kidney governs storage, and the Liver governs dispersion. This injures not only the Kidney but also the Liver. Over time, the Three Yin meridians become deficient, leading to the symptoms described above, ultimately resulting in Xueku and the cessation or scarcity of menstruation. Although this example focuses on women, if men suffer from these conditions, they may develop Jingku (Essence Depletion), which falls under the category of consumptive diseases.)

The Yellow Emperor asked: How should it be treated? What method should be used?

Qibo replied: Use four parts of Hai Piao Xiao (Cuttlebone) and one part of Qian Cao (Madder Root). Combine these two substances and form pills using sparrow eggs, sized like small beans. Take five pills after meals, washed down with Abalone Fish juice. This will benefit the intestines and nourish the injured Liver. (Note: "Fu" means to restore the source of Qi and Blood. "Hou fan" means taking medicine before eating food. Hai Piao Xiao is the bone of the cuttlefish. Its flavor is salty and warm, with a descending action, so it treats leukorrhea and blood stasis/depletion in women. Due to its astringent nature, it can also promote fertility. Qian Cao, also known as Ru Cao, has a sweet and cold flavor and is non-toxic. It stops bleeding, treats metrorrhagia, tonifies Essence and Qi, and invigorates Blood to unblock meridians. According to *Jiayi Jing*, *Tai Su*, and *Xin Zheng Xiao*, the character "Ru" is incorrect. Ru Cao is toxic and unsuitable for Xueku patients; this error stems from a lack of detailed examination. Sparrow eggs have a sweet and warm flavor, tonifying Essence and Blood. They treat male impotence, promote fertility in men, and address leukorrhea and difficult urination in women. Baoyu refers to dried salted fish, preferably made from Stonehead fish or Crucian carp. It has a pungent and warm flavor and is non-toxic. As aquatic creatures, their properties enter the Water Zang organs, unblock Blood vessels, and nourish Yin Qi. Boiled juice taken with other herbs can treat blood stasis in women. All four ingredients unblock Blood vessels. Since the Liver governs Blood, these are applicable to any disease injuring the Liver. My commentary: Xueku resembles Xuege (Blood Obstruction), both presenting as amenorrhea. However, "Ku" (Depletion) and "Ge" (Obstruction) are opposites, like ice and charcoal. "Ku" means dryness/exhaustion, representing extreme Blood deficiency. "Ge" means blockage, where Blood is not deficient but obstructed by Qi stagnation, Cold, or accumulation. Ge is acute, presenting with pain or excess signs, and resolves with unblocking therapies (purging). Ku develops gradually, with internal exhaustion of the Chong and Ren meridians, presenting without distinct forms, and absolutely contraindicates unblocking therapies. I often see practitioners today who claim to diagnose Xueku amenorrhea but prescribe Si Wu Tang plus Tao Ren (Peach Kernel) and Hong Hua (Safflower), even using harsh purgatives like Xiao Shi (Mirabilite), Pu Xiao (Niter), San Leng (Burreed Rhizome), and E Zhu (Curcuma Rhizome). If Blood is already depleted, one must tonify Yin Qi to replenish Blood, allowing menstruation to return naturally; why insist on unblocking? Forcing it will worsen the depletion, leading to danger. Such practitioners not only misunderstand the pathology but fail to comprehend the meaning of "Ku," equating them with the illiterate. It is impossible for them to avoid harm, let alone heal patients. "Ze" is pronounced like "Zhi". "Ru" and "Qian" are pronounced like "Lu".)