Library

Gynecology already has specialized books. However, the blood of men and women shares the same origin; therefore, they are discussed together. The *Yellow Emperor's Inner Classic* states: "When a girl reaches fourteen (two sevens), Tian Gui (a subtle substance promoting reproductive maturity) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes abundant, causing menstruation to occur on schedule, thus enabling conception." What is called Tian Gui refers to the dynamic Qi within the congenital Kidney, which transforms into Gui Water. "Arrives" means reaching the Bao Zhong (uterus). Water is transformed by Yang Qi; when Yang initiates, Yin must follow. Blood belongs to Yin and is governed by the Chong and Ren vessels; thus, it responds to Gui Water and subsequently transfuses blood into the Bao Zhong. The descent of blood following water is termed "Yin following Yang." Both the Chong and Ren vessels originate from the Bao Zhong and ascend to connect with the Stomach Meridian of Foot-Yangming. The Yangming meridian is the sea of postnatal food and fluid essence, situated in the middle Jiao, referred to as Wu Earth. It transforms Qi, extracts juices, changes redness into blood, and follows the Chong and Ren vessels downward to merge with Gui Water; this is termed the combination of Wu and Gui. This applies to both men and women. Men primarily govern Qi, so blood transforms into essence along with water; women primarily govern Blood, so blood transforms into menstruation along with water. Essence in men contains blood, and menstruation in women contains water. Therefore, before and after menstruation, watery discharge can be observed as verification. This water is generated by the Chong-Yang Qi in the Kidney. If Qi is hyperactive, water dries up, leading to insufficient nourishment of blood, and heat syndromes arise therefrom. If Qi is cold, water becomes cold, leading to impaired blood circulation, and cold syndromes arise therefrom. Therefore, whenever regulating blood, one must first regulate water; regulating water is essentially regulating Qi. Qi originates in the Kidney but is controlled by the Lung. Blood is generated in the Stomach but stored in the Liver. Since the Sea of Blood falls under the jurisdiction of the Liver, and the Metal of the Lung governs the regulation of Qi and serves as the upper source of water, when regulating blood and water, one must know where to begin. One may either regulate the water within Qi to nourish Blood, or regulate the Qi within Blood to promote diuresis; this is the method for women to regulate menstruation. This principle also applies to the treatment of all blood disorders, and students should study it carefully.

Blood Heat arises from an insufficiency of Water. Symptoms include menstruation occurring early, fever, and thirst. Use Si Wu Tang (Four Substance Decoction) added with Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Huang Qin (Scutellariae Radix), Hua Fen (Trichosanthis Radix), Chai Hu (Bupleuri Radix), E Jiao (Colla Corii Asini), and Niu Xi (Achyranthis Bidentatae Radix) to nourish Water thereby moistening Blood. Alternatively, use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) to nourish the Lung and Kidney, which can also open the source of Water. This is using the method of nourishing Water to tonify Blood.

Blood Cold arises from Water not being warm. Symptoms include menstruation occurring late, with a dark, pale, clear, and cold appearance, accompanied by stagnation and pain. Use Si Wu Tang added with Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), Hei Jiang (Charred Ginger), and Fu Zi (Aconiti Lateralis Radix Praeparata) to warm Water thereby moving Qi; when Qi moves, Blood moves.

Blood Deficiency manifests as scanty or excessive menstruation, along with dryness, thinness, and various deficiency syndromes appearing mixed and difficult to describe. If confirmed as an insufficiency of Tian Gui Water in the Kidney, symptoms must include bone-steaming heat, rebellious Qi, flaccidity of the legs, rapid pulse, dryness of the uterus, and absence of watery discharge before and after menstruation. Use Zuo Gui Yin (Left Restoring Decoction) added with Tu Si Zi (Cuscutae Semen), Gui Ban (Carapax Testudinis), E Jiao (Colla Corii Asini), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), and Rong蓉 (Cynomorii Herba) to nourish the Tian Gui Water. If confirmed as Stomach deficiency leading to insufficiency of Blood in the Yangming, Chong, and Ren vessels, menstruation will necessarily be pale, consisting only of watery discharge without fresh red blood. Use Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) or Yang Rong Tang (Nourish Ying Decoction), used judiciously, to tonify the source of blood generation, thereby curing Blood Deficiency.

Blood Stasis refers to obstruction by static blood. Symptoms include body pain, abdominal distension, mixed cold and heat with leukorrhea and metrorrhagia, irregular menstruation, and amenorrhea. All these are caused by static blood obstructing Qi flow. Without static blood, menstruation would flow naturally and smoothly; how could it become disordered? For all such cases, removing stasis is paramount. Use Si Wu Tang added with Yuan Hu (Corydalis Rhizoma), Tao Ren (Persicae Semen), Xiang Fu (Cyperi Rhizoma), Ru Xiang (Olibanum), and Mo Yao (Myrrha) as the main treatment. If there is heat, add Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma); if there is cold, add Gan Jiang (Zingiberis Rhizoma) and Fu Pian (Prepared Aconite Slice). Wang Qingren's Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) and Ge Xia Zhu Yu Tang (Drive Out Stasis Below the Diaphragm Decoction) are also suitable. For severe static blood, only Zhang Zhongjing's Tu Gua Gen Zhe Chong Wan (Trichosanthes Root and Ground Beetle Pill) or similar decoctions can treat it; see the Static Blood chapter for details.

In summary, Blood and Qi are inseparable. There is Qi within Blood, and Qi is essentially Water. I have discussed this in detail in this section and in the Treatise on Water, Fire, Qi, and Blood. Understanding this, we know that in cases of Blood Stasis obstructing Qi, it is the fault of the Blood blocking the Qi; thus, breaking down and dispersing the Blood allows Qi to flow freely. Tao Ren (Persicae Semen), Dan Pi (Moutan Cortex), and Wu Ling Zhi (Trogopterori Faeces) are essential. Blood Heat in the Blood aspect arises because the Water in the Qi aspect is insufficient to moisten the Blood, causing Heat; using Zhi Zi (Gardeniae Fructus) and Huang Qin (Scutellariae Radix) to drain Fire is equivalent to nourishing Water. Blood Cold in the Blood aspect arises because the Water in the Qi aspect is condensed, damp, stagnant, and unable to transform, leading to stagnation and lack of flow. Using Wu Zhu Yu (Evodiae Fructus), Xi Xin (Asari Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), and Ai Ye (Artemisiae Argyi Folium) warms the Water; when Water is warm, Qi harmonizes; when Qi harmonizes, Blood harmonizes. From this, we can see that for men, the treatment methods for Heat Binding and Cold Coagulation due to Blood Stasis are no different. Observing the method of generating Tian Gui to produce Blood reveals the method for men to nourish the Kidney and tonify Blood. Observing the method of tonifying Yangming to replenish the source of Blood reveals the root of tonifying Blood for men. Observing the method of nourishing the Lung to generate Blood reveals the method for men to generate fluids to nourish Blood. Even when Blood Heat causes Water to condense into Phlegm, or Blood Deficiency causes Water to overflow as Sweat, although they are of the same category, their manifestations differ; all are fully revealed here.