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These are the aforementioned conditions. When the menstrual period arrives but does not come, it is caused by deficiency in the Middle Jiao (Middle Burner) where essence and qi fail to generate, and deficiency in the Lower Jiao (Lower Burner) where blood and qi naturally become short. Therefore, this condition is also treated with Tuguagen Powder (Melon Root Powder). Women's menstruation is called "Jing Xue" (Menstrual Blood) because it originates from the fullness of Qi in the Twelve Meridians and flows downward following the waxing and waning of the moon. However, its source and mechanism have two main pathways: First, the root of essence generated from the Stomach passes through the Spleen, Lung, Liver, and Kidney, finally reaching the Heart. The Zang-Fu organs along this path each privately extract essence to nourish their own meridians; this is one pathway. Second, the Liver stores blood; the surplus blood within the Zang travels through the Liver Collaterals inward to enter the Blood Chamber (Xue Shi) and outward to reach the meridians, merging with the blood of the meridians nourished by various Zang-Fu organs into a single entity; this is the other pathway. This resembles the rising tide. The "Shao Huo" (Ministerial Fire/Physiological Fire) generates Qi, growing subtly and secretly. By the thirtieth day, the exterior of the meridians becomes full and does not accept the infusion of the two types of blood (abnormal bleeding or stasis), causing the external Qi to be peaceful while internal Qi ceases to grow excessively. Moreover, the excess externally tends to reverse flow inward, so the Qi submerges like the receding tide. The blood of the Twelve Meridians closes and returns to the Blood Chamber, flowing downward as menstruation. This occurs when blood stasis is located in the Liver collaterals of the lower abdomen. The blood within the Liver desires to reach outward through the Blood Chamber to nourish the meridians, but due to collateral obstruction, it cannot pass through the Blood Chamber, resulting in irregular vaginal discharge (referred to here as non-cyclic bleeding). Thus, I state that this is distinct from leakage during pregnancy. It is said that this method causes blood to return to the normal meridians.

For leukorrhea, irregular menstruation, distending pain in the lower abdomen, and menstruation occurring twice in one month, Tuguagen Powder (Melon Root Powder) is the primary treatment.
Tuguagen Powder Formula: Tuguagen (Melon Root), Guizhi (Cinnamon Twig), Shaoyao (Peony Root), E Chong (Ground Beetle) (each 3 fen).
The above four ingredients are pounded into a powder. Each dose is one Fang Cun Bi (a square-inch measure). Taken three times daily. It also treats vulvar swelling.
This corresponds to the initial symptoms described in the previous clause. "Leukorrhea" here also refers to red leukorrhea, as detailed previously. Irregular menstruation occurs because the blood in the meridians relies solely on the supply from the Spleen and Stomach, while blood from the Liver leaks out continuously, leading to a deficiency and shallowness of Qi and blood in the meridians, causing menstruation to be unsmooth when due. Distending pain in the lower abdomen is the manifestation of blood stasis and Qi stagnation. Menstruation occurring twice in one month follows the discussion on leukorrhea. It implies that the condition of leukorrhea leads to deficiency of Jing Qi in the upper parts of the meridians, failing to secure and protect, thus causing menstruation to occur twice in a month. If these two conditions persist for a long time, they will develop into severe symptoms like those in the previous clause. Therefore, one should immediately use this formula to cure them, preventing them from gradually evolving into a pattern requiring Wenjing Tang (Warming the Menses Decoction). Shaoyao (Peony Root) guides downward into the Blood aspect; E Chong (Ground Beetle) has a Yin nature and moves blood clots; Guizhi (Cinnamon Twig) is acrid to disperse and warm to promote circulation. Combining these three herbs completes the function of removing stasis. Tuguagen (Melon Root) is the root of vine-like guidance; its nature ascends. Vines guide through meridians, and ascending action holds the blood of the Liver, allowing it to fill the Twelve Meridians upward. Since this is the initial stage of the previous pattern, Yin blood is not yet damaged, hence Wenjing Tang uses less Dang Gui (Angelica Sinensis), Chuan Xiong (Sichuan Lovage Rhizome), Ejiao (Donkey-hide Gelatin), and Maidong (Ophiopogon Tuber). Yang Qi is not yet cold, hence Wenjing Tang uses less Renshen (Ginseng), Gan Jiang (Dried Ginger), and Wuzhuyu (Evodia Fruit); this is the reason. Once stasis is removed and Liver blood can return to the meridians from the Blood Chamber, leukorrhea stops, and lower abdominal distending pain ceases. With abundant meridian Qi, there is momentum for blood to settle in the Blood Chamber, so menstruation flows smoothly. Furthermore, nourishment from blood above enriches Qi, enhancing securing power and lifting ability, so the occurrence of menstruation twice in a month also resolves. Blood stasis below causes vulvar itching; Qi stagnation below causes vulvar swelling. This formula promotes blood circulation and lifts Qi, so it also treats these conditions.

The Cunkou pulse is wiry and large. Wiry indicates decline; large indicates hollow (Kou pulse). Decline indicates Cold; hollow indicates Deficiency. Cold and Deficiency intertwine, named Ge Pulse (Reed Mat Pulse). In women, this results in miscarriage with continuous leakage. Xuanfuhua Tang (Stellaria Decoction) is the primary treatment.
Xuanfuhua Tang Formula: Xuanfuhua (Inula Flower) (3 liang), Cong Bai (Scallion White) (14 stems), Xinjiang (New Crimson Dye) (a small amount).
The above three ingredients are boiled in 3 sheng of water until 1 sheng remains. Taken all at once.
The textual meaning and pulse analysis are noted under the Blood Section. Continuous leakage after miscarriage is caused by Upper Jiao deficiency failing to lift and External deficiency failing to wrap. Scallion is acrid and warm, descending first then ascending, promoting Kidney Yang outward. Thus, it is used in Baitong Tang, deriving from this principle. Using 3 liang of Xuanfuhua and naming the decoction after it has two intentions: First, Upper deficiency allows Yin Qi to invade; Xuanfuhua descends rebellious Yin, creating space for Yang to rise. Second, it works synergistically with Scallion to descend and warm Kidney Yang. Light red is Jiang (crimson); Xinjiang is newly dyed crimson. Silk from cocoons ascends; red-dyed silk enters the Heart and Diaphragm. This is essentially a small Shengji Wan (Kidney Qi Pill). Scallion (acrid-hot and Qi-rich) replaces Guizhi and Fuzi; Xuanfuhua (descending) replaces Dihuang and Shanzhuyu; Xinjiang (ascending to Heart/Diaphragm) replaces Mudanpi. This first aids descent, then slowly guides ascent, tonifying Zong Qi (Gathering Qi). With sufficient lifting and wrapping force, leakage after miscarriage stops. However, this formula is merely an emergency expedient. For stability, Jianzhong Tang (Middle-Jian Decoction) and Shengji Wan/Pills are more appropriate and without drawbacks. A century later, wise physicians will agree with me, not just Zhongjing's spirit nodding in approval.

Women with Xian Jing (Sunken Meridian) syndrome present with leakage of black blood that does not resolve. Jiao Jiang Tang (Gelatin and Ginger Decoction) is the primary treatment. (Formula missing. Lin Yi notes: We checked various editions and found no Jiao Jiang Tang formula. We suspect it is Jiao Ai Tang (Gelatin and Mugwort Decoction) used in pregnancy. Careful analysis shows Jiao Ai Tang matches this syndrome closely. Perhaps 'Jiang' (Ginger) is a typo for 'Ai' (Mugwort). We follow this correction.)
Xian Jing (Sunken Meridian) syndrome shares the same meaning as Bao Zu (Uterine Obstruction) in pregnancy. Generally, if dead blood accumulates in the lower abdomen, preventing Liver blood from nourishing meridians via the Blood Chamber, resulting in leakage, it is called Dai Xia (Leukorrhea/Bleeding). If there is no blood stasis blocking the lower abdomen, but Liver Qi is deficient and fails to steam upward, and Liver Blood is deficient and fails to moisten upward, the blood reaches the Blood Chamber but sinks and falls midway, it is called Xian Jing (Sunken Meridian). This is similar to Bao Zu where no stasis blocks, and Qi/Blood leak due to deficiency. Hence, it shares the same meaning as pregnancy Bao Zu. Blood deficiency leads to Qi Cold; blood turns dark/black due to Cold. Prolonged Cold makes it black like bean dregs. The syndrome is identical to pregnancy Bao Zu, so the treatment Jiao Ai Tang is the same. The intent is detailed under Bao Zu. The difference is: for Bao Zu, it tonifies blood and warms Qi to nourish the fetus; here, it tonifies blood and warms Qi to nourish the meridians. Regarding Jiao Jiang Tang, in my humble opinion, it fits the Xian Jing pattern. I suspect it may contain Dang Gui, Shaoyao, Guizhi, and Mudanpi. Ejiao (Donkey-hide Gelatin) wraps and lifts; Dang Gui (Angelica Sinensis) warms and tonifies blood deficiency; Sheng Jiang (Fresh Ginger) ascends and spreads; Guizhi (Cinnamon Twig) warms and tonifies Qi Cold. Shaoyao guides into the Liver; Mudanpi clears the vessels. Thus, Xian Jing leakage of black blood resolves within warming, tonifying, ascending, and moving actions. Wise observers may not consider this mere speculation.

If a woman's lower abdomen is full and shaped like a Dun (a vessel narrow at top, wide at bottom), with slight difficulty urinating but no thirst, occurring postpartum, this is Water and Blood binding in the Blood Chamber. Dahuang Gansui Tang (Rhubarb and Kansui Decoction) is the primary treatment.
Dahuang Gansui Tang Formula: Dahuang (Rhubarb Root) (4 liang), Gansui (Kansui Root) (2 liang), Ejiao (Donkey-hide Gelatin) (2 liang).
The above three ingredients are boiled in 3 sheng of water until 1 sheng remains. Taken all at once. Blood stasis should be discharged.
"Dun" describes a shape narrow at the top and wide at the bottom. Postpartum lower abdominal fullness resembling a Dun reflects underlying symptoms: fetal Qi, water accumulation, and blood stasis can all cause this. Difficulty urinating indicates water accumulation. Slight difficulty suggests urine still passes and water accumulation is not severe. If thirsty with slight difficulty, it would be pure water retention. Since there is no thirst, the fullness is not purely water. Combined with postpartum status, ruling out pure water and pregnancy, the fullness must be due to postpartum blood stasis. Thus, Dahuang (Rhubarb) breaks stasis, and Gansui (Kansui) expels water. These can be used confidently. However, postpartum blood deficiency warns against harsh purgation damaging Yin. Ejiao (Donkey-hide Gelatin) nourishes blood. Blood deficiency retains water; tonifying blood helps eliminate water. Generating new blood expels dead blood; tonifying blood helps drive out stasis. These five sentences contain only twenty-nine characters, yet the literary style is versatile, and diagnostic logic is profound. Post-Han medical texts cannot compare.

For women with difficult or obstructed menstruation, Didang Tang (Hit-and-Kill Decoction) is the primary treatment. It also treats men with bladder fullness/urgency due to blood stasis. (Note: There are no such parenthetical notes in the original text; this may be a later addition.)
Didang Tang Formula: Meng Chong (Blue Bottle Fly) (30 pieces, roasted, wings/legs removed), Shui Zhi (Leech) (20 pieces, roasted), Taoren (Peach Seed) (20 pieces, skin/point removed), Dahuang (Rhubarb Root) (3 liang, wine-soaked).
The above four ingredients are powdered. Boiled in 5 sheng of water until 3 sheng remain. Strain. Take 1 sheng warm.
This is also due to blood stasis in internal collaterals, weakening the Qi of blood circulation, causing difficult menstruation. Compared to the previous clause, this involves more stasis in the Upper and Middle Jiao, such as in the Danzhong area or Spleen/Stomach collateral branches, caused by prior hemoptysis, overeating, or cold exposure/drinks. Stasis causes Qi stagnation and menstrual difficulty. Meng Chong (Fly) naturally targets the upper; Shui Zhi (Leech) naturally targets the lower. They introduce treatment into dead blood collaterals. Taoren (Peach Seed) breaks and agitates; Dahuang (Rhubarb) drives down. Wine-soaking Dahuang enhances its floating and gentle nature, allowing it to sweep from above and below. Thus, I say this involves more Upper/Middle Jiao stasis than the previous case. This is for robust patients in the early stage. Robust patients tolerate harsh drugs; early stage means blood is not yet deficient, so no blood tonics are added.

For women with amenorrhea, irregular menstruation, hard masses in the Zang that persist, dry blood inside, and discharge of white matter, Fanshi Wan (Alum Pill) is the primary treatment.
Fanshi Wan Formula: Fanshi (Alum) (3 fen, calcined), Xingren (Apricot Seed) (1 fen).
The above two ingredients are powdered. Honey pills made the size of a jujube pit. Insert into the vagina. For severe cases, insert another.
"Zang" refers to the vaginal introitus, as indicated by inserting the pill there. "Hard" refers to tissue in the vagina becoming hard due to Qi stagnation and blood stasis. "Jian Pi" means hardness persisting into a chronic disease. "White matter" is not typical leukorrhea or seminal emission, but rather white, powdery residue caused by damp-heat. Typical leukorrhea originates from the Dai Mai and Kidneys, distant and fluid-like. Here, it originates near the vaginal hard mass, is drier, whiter, and like accumulated grime. Amenorrhea is the heading; the hard mass and white discharge are the body. While amenorrhea/stagnation has specific formulas for blood stasis or deficiency-cold, sometimes amenorrhea causes external symptoms requiring external treatment. Amenorrhea causes Qi/Blood stagnation sinking into vaginal tissue, forming hard masses. Long-term stagnation dries into blood, generating heat and dampness, leading to white discharge. Fanshi (Alum) is cold, sour, and drying. Cold clears heat/fire; sour dissolves hardness and disperses blood; drying removes dampness. It is the Sovereign herb. Xingren (Apricot Seed) moves Qi to disperse stagnation. Since medication is hard to deliver to the vagina internally, pill form inserted externally is convenient. Various annotations are confused and miss the point.

For women suffering from sixty-two types of Wind pathogens and stabbing pain in the abdomen due to Blood and Qi, Honglanhua Jiu (Safflower Wine) is the primary treatment.
Honglanhua Jiu Formula: Honglanhua (Safflower) (1 liang).
One ingredient. Boil in 1 da sheng of wine until half remains. Take half at once. Repeat if necessary.
When old blood circulates freely, new blood generates fully, and Qi warms accordingly, circulating without disease. If old blood lags, new generation slows, leading to Qi and Blood deficiency. Blood deficiency causes dryness-heat and internal Wind; Qi/Blood deficiency weakens defensive exterior, inviting external Wind. These sixty-two Winds arise from this. Abdominal Blood deficiency causes dry painful collaterals; Qi deficiency causes spasmodic stabbing pain. Honglanhua (Safflower) moves Blood and Qi. Wine warms and floats, enhancing Qi movement and Blood flow, resolving internal/external Wind and abdominal stabbing pain.

For various abdominal pains in women, Danggui Shaoyao San (Angelica and Peony Powder) is the primary treatment. (Formula seen in Pregnancy section).
Various abdominal pains in women stem from True Yin deficiency and lingering external Water. True Yin deficiency causes acute internal collateral pain; external water accumulation causes obstructive internal collateral pain. Danggui Shaoyao San tonifies Blood and moves Fluids, hence it is used. See Pregnancy section for formula details.

For abdominal pain in women, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment. (Formula seen separately).
The previous clause addressed pain from Yin Blood deficiency in Lower/Middle Jiao. This clause addresses pain from Yang Qi deficiency in Upper/Middle Jiao. Cold Heaven (Yang deficiency) fails to shine, causing Yin-seeping pain. Empty Heaven (Qi deficiency) fails to transport, causing accumulation pain. Xiao Jianzhong Tang warms the Diaphragm and fills Qi. Warm Diaphragm Qi allows Yang Heat to descend, relieving Yin-seeping pain. Abundant Diaphragm Qi pushes downward, relieving accumulation pain. Hence it is used. See separate text for decoction meaning.

Question: A woman suffers from normal diet, irritability, heat, inability to lie flat, and reliance on sitting to breathe. What is this? Master says: This is called Zhuan Bao (Displaced Bladder/Uterus), inability to urinate. Caused by the Bao Xi (Bladder/Uterus ligaments) being twisted and distorted. Promoting urination cures it. Shenqi Wan (Kidney Qi Pill) is the primary treatment. (Formula seen in Deficiency/Labor section).
This clause states inability to urinate is the root, causing Zhuan Bao, which causes irritability/heat and orthopnea. This is clear. Why Shenqi Wan specifically? Kidney congenital Qi ascends from the spine to warm the Diaphragm, mixing with Wei Qi from food/lungs to form Zong Qi (Gathering Qi) in the chest. Full Zong Qi promotes respiration and water passage. Now, Kidney Qi fails to ascend, Diaphragm Qi is shallow, water flow slows, Qi stagnates, and urination fails. Bladder fullness pushes up the Uterus, loosening ligaments and twisting them ("Zhuan"). Both Bladder and Uterus Qi turn upward, narrowing the chest cavity, causing irritability and breathing difficulty. How do we know? Normal diet indicates Upper/Middle Jiao and anterior pathways are healthy; the issue is deficient congenital Kidney Qi failing to transport in the chest. "Liao Li" describes twisted ligaments like hooks shaking. Shenqi Wan uses Fuling/Zexie to drain water, Shan Yao to strengthen Earth/drain water, softening the bladder and allowing the uterus to drop. Dihuang/Shanzhuyu, guided by Guizhi/Fuzi into Liver/Kidney, with Mudanpi drawing Qi up from the spine, forces Chest Qi downward, resetting the uterus and straightening ligaments, curing irritability and breathing issues. This is Zhongjing's brilliance in using Shenqi Wan instead of simple diuretics. Who can share this insight?

For women with cold in the Yin region, use warming sitz bath medicine. Shechuangzi San (Cnidium Powder) is the primary treatment.
Shechuangzi San Formula: Shechuangzi Ren (Cnidium Fruit).
One ingredient. Powdered. Mix with a little Baifen (white powder/starch). Form pills like jujube pits. Wrap in silk and insert. Naturally warms.
"Yin Han" refers to cold in the vaginal introitus, not necessarily the uterus itself. Sitz baths treat external symptoms; internal meds affect deep Zang-Fu. External symptoms require external treatment to avoid conflicting with Zang preferences. Cnidium grows where snakes rest, indicating its warmth. Acrid-sweet disperses, spreading warmth horizontally. Used as a sitz bath, it warms the Yin. A skeptic argues: Cold in Yin must start from uterine cold. You only warm the introitus, not the uterus. Is your view biased? I reply: The Golden Cabinet classifies diseases. Listing formulas symptom-by-symptom seems fragmented. One must see the whole spirit. Like a lacquered screen, joints fit perfectly. You see only fragments. If uterine cold is congenital, isn't Shenqi Wan available? If acquired, isn't Lizhong Wan available? Why not warm the root internally first, then treat the branch externally? If sitz baths warmed the uterus, would mouthwash cure Middle Jiao disease? The skeptic laughed and was speechless.

If Shaoyin pulse is slippery and rapid, ulcers appear in the Yin. If erosive ulcers exist, Ye Langya Tang (Wolf Tooth Herb Decoction) wash is used.
Ye Langya Tang Formula: Ye Langya (Wolf Tooth Herb) (3 liang).
One ingredient. Boil in 4 sheng of water until 0.5 sheng remains. Wrap in silk like a cocoon, dip in decoction, and drip/wash the Yin four times daily.
Slippery indicates Dampness; Rapid indicates Heat. Shaoyin pulse relates to the lower Yin introitus. Damp-Heat in the pulse indicates genital ulcers. The ulcer description is not repetition but progression: first two lines diagnose initial symptoms; next two lines describe chronic erosion with insect generation due to Damp-Heat. Ye Langya is bitter and cold. Cold conquers Heat; Bitter dries Dampness; especially kills parasites. Hence used for washing.

Stomach Qi leaks downward, causing flatulence through the vagina (Yin Chui) while bowel movements remain normal. This is due to excess Grain Qi. Gao Fa Jian (Fat and Hair Decoction) guides it out. (Formula seen in Jaundice section).