Excerpted from The Secret Treasury of the Orchid Chamber (Lan Shi Mi Zang)

(Three Types of Menstrual Block and Failure of Movement)

The Extra Treatise on Yin and Yang (Yin Yang Bie Lun) notes: “Diseases of the second yang develop within the heart and spleen in such a manner that one cannot comprehend their hidden message, and a woman does not menstruate. It is said that [when this condition manifests in the context of] wind wasting thirst and inverted cup syndrome it is fatal and cannot be treated.” When women experience a long standing vacuity of the spleen and stomach, or their bodies are emaciated such that the qi and blood are both debilitated, this results in an expiry of menstrual water which fails to move.

[Another possibility is that] the disease may be one of wasting stomach heat where the patient likes food but nonetheless becomes emaciated and the fluids and humors are not engendered. The menses are the product of the transformation of fluids and humors within the blood vessels, and when the fluids and humors expire, then heat scorches the muscle and flesh causing them to waste away and become emaciated. When we see [this condition with] thirsting and agitation, the sea of blood has become desiccated, and this is called blood desiccation menstrual expiry ( xue ku jing jue). It is appropriate to clear the dry heat from stomach while supplementing and boosting the qi and blood. In this way the menses move on their own. This pattern may be present in those cases where conception occurs during the course of menstruation or where restless fetus causes an illness in pregnancy

[Another possible cause is that] the pericardium vessel may be surging and rapid and agitation may be apparent, accompanied by rough stool constipation, urination which is clear and inhibited, menstrual block expiry and failure to move. All this is a condition of desiccation of the sea of blood. It is appropriate to regulate the blood vessels and eliminate the heat pathogen from within the bao luo and the menses will move on their own.”

The Inner Classic notes:

When the small intestine transmits heat into the large intestine this produces a deep-lying conglomeration causing [the menses] to disappear. Since the vessels are astringed and inhibited, the menses are deeply stagnant and inhibited. Thus it is said that worry-some conglomerations produce a deeply [stagnant menstrual flow].

[Another possibility is that] the menses fail to arrive as a result of heart taxation and an ascending movement of heart fire. When one calms the heart and drains fire the menses flow of their own accord.

The Inner Classic states:

When the menses do not arrive [this means that] the enveloping vessel [bao mai] is blocked. The enveloping vessel pertains to the heart and diffusely connects to the uterus. When the qi ascends to distress the lungs, the heart qi does not descend freely and so the menses do not arrive.”

Two Types of Incessant Menstrual Leaking

“The Extra Treatise on Yin and Yang (Yin Yang Bie Lun)” says that when there is a vacuity of yin and yang strikes, this is called flooding. When women suffer from a vacuity detriment of the spleen and stomach, the life gate pulse becomes deep, fine, and rapid. On the other hand, it may be deep, wiry, flooding, large and with strength. The inch and bar pulses may also have these [qualities]. All of these [pulse qualities] are due to a depletion of the spleen and stomach [which allows the qi to] sink down into the kidneys and combine with ministerial fire producing a descending distress of damp heat which results in incessant menstrual leaking. Its color will be purple black, which is like meat rotting during the summer months. If this is mixed with a white discharge the pulse will be wiry and fine, [which is indicative of] cold in the middle. If it is mixed with a red discharge heat is evident, provided there is a flooding and rapid pulse, [which is indicative of] brilliant heat. There will also be lumbar pain, or sub-umbilical pain. When the menses are about to move one will first see alternating cold and heat, and a sense of urgent contraction in the costal region. If there is a concurrent spleen stomach pattern, the four limbs will feel hot, there will be cardiac vexation which prohibits lying down to sleep, and a sense of sub cardiac urgency. [In this case] it is appropriate to greatly supplement the spleen and stomach and to raise the blood and qi. With the administration of only one dose the patient will be cured.

[Another possible cause is that] a person of nobility may lose her status, being reduced to staying at home and not meeting friends, or she may have once been wealthy and then become impoverished. This disease is referred to as desertion of productivity (tuo ying). [It is the result of] an insufficiency of heart qi and fire blazing strongly to produce an effulgence within the blood vessels. Also, as a result of an irregularity of drink and food within the spleen and stomach, fire may overwhelm the middle. If the disposition of the form and flesh appear as if there is no disease, then the condition is a heart disease. Since one cannot diagnose through the form, if the drink and food within the spleen stomach is unregulated, then the pattern will be evident.

In these cases the menstrual water descends [too] often; it suddenly arrives and suddenly terminates, or it may violently descend and does not cease. In treatment one should first utter words of death and woe to urge her on to make her fear death and to urge her not to stir her heart [with things that are long past and cannot be changed]. One may then administer medicinals for major supplementation of the qi and blood to raise and nourish the spleen and stomach, and in addition, administer small amounts of medicinals to settle and downbear heart fire. Treat the heart by supplementing the yin and draining yang, and the menses will be arrested on their own.

Formulas

Raising the Yang and Eliminating Dampness Decoction ( Sheng Yang Chu Shi Tang) This formula is also called Regulating the Menses, Raising the Yang and Eliminating Dampness Decoction (Tiao Jing Sheng Yang Chu Shi Tang).

[This prescription] treats leaking of malignant blood in women, irregular menstruation, sudden incessant flooding [of menstrual blood], and copious discharge of viscous fluid. All of these conditions are due to unregulated intake of drink and food or taxation damaging the body or simple heart qi insufficiency. This is because [unregulated intake of] drink and food, or taxation and fatigue may cause heart fire to overwhelm the spleen. Thus the patient must suffer from lassitude and a desire to lie down, loss of use of the limbs, and a lack of [physical] strength. When the qi does not stir, there is shortness of breath and ascension of qi, urgent counterflow and ascending surgance. The pulse is moderate and, when pressed, is flooding and large; yet is still present upon deeper palpation. [In this case] spleen earth has contracted an evil. The spleen governs nourishment of the entire body. The heart governs the blood and the blood governs the vessels. Thus, when these two [the spleen and heart] contract a pathogen, the disease will always occur within the vessels as well. The vessels are the storehouse of the blood. The vessels are also a person’s spirit. If the heart is unable to govern, then the enveloping network (bao luo) substitutes for it.

Therefore, it is said that the government of the heart vessels pertains to the heart ligation. The heart ligation is the vessel of the enveloping network and life gate and governs menstrual affairs. If there is a vacuity of the spleen and stomach and the pericardium overwhelms it, this results in an unregulated downward leaking of menstrual water. The condition of the spleen and stomach is the root and base of the qi and blood, and of yin and yang. One should therefore eliminate dampness, rid heat, and boost the wind qi so that it extends upward and overcomes dampness. [ The Inner Classic] also states that the [same condition] may develop when fire becomes depressed.

[This prescription contains] Radix Angelicae Sinensis (Dang Gui) which has been soaked in wine, and Radix Angelicae Pubescentis (Du Huo), 5 fen each, Fructus Viticis (Man Jing Zi) 7 fen, Radix Ledebouriellae Divaricatae (Fang Feng), Rhizoma Cimicifugae (Sheng Ma), and mix-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao), Rhizoma et Radix Ligustici (Gao Ben), one qian each, Radix Bupleuri (Chai Hu), Rhizoma et Radix Notopterygii (Jiang Huo), Rhizoma Atractylodis Lancea ( Cang Zhu), and Radix Astragali Membranacei (Huang Qi), 1 qian and 5 fen each.

Slice these into the size of sesame [seeds and mung] beans but do not powder the prescription. Administer this in a single dose using five large cups of pure, newly drawn water which are then cooked down to one large cup. Remove the dregs administer hot on an empty stomach and then wait one half an hour before eating. One dose will produce a cure.

One may also moxa both Sea of Blood (Xue Hai, Sp 10) acupoints on the foot tai yin spleen channel 7 times. [The above] medicinals use wind to overcome dampness, to induce the stomach qi to sink, and to induce the distressed qi to descend. This salvages the violent flooding of blood.

Once one disposes of the malign blood condition, one may then use [medicinals such as] Radix Astragali Membranacei (Huang Qi ), Radix Panacis Ginseng (Ren Shen), mix-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao), and Radix Angelicae Sinensis (Dang Gui) to supplement [the qi and blood] with Supplement the Qi and Upbear the Yang Decoction (Bu Qi Sheng Yang Tang). To this one may also add blood [supplementing] medicinals. If the menstrual blood continues to contain malign substances and does not cease, it is still appropriate to investigate the root source. To treat the root of the menstrual [disorder] one need only boost the spleen and stomach and abate the hyperactivity of heart fire as a means of treating the root. If, during the summer months, a white leukorrhea and incessant leaking desertion develops ,then it is appropriate to use this decoction [Supplement the Qi and Upbear the Yang Decoction (Bu Qi Sheng Yang Tang) or an analog]. [The leukorrhea and the leaking] will be arrested with only one administration.

Cooling the Blood Rehmanniae Decoction (Liang Xue Di Huang Tang)

[This prescription] treats gynecological flooding of blood due to a kidney water yin vacuity which is unable to settle and protect the ministerial fire in the enveloping network which, in turn, results in blood traveling and flooding. [It contains] Radix Scutellariae Baicalensis (Huang Qin ) and Herba Schizonepetae Tenufoliae (Jing Jie), 1 fen each, Cortex Phellodendri (Huang Nieh), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Herba cum Radice Asari (Xi Xin), and Radix Ligustici Wallichi (Chuan Xiong), 2 fen each, Rhizoma Coptidis (Huang Lian), Rhizoma et Radix Notopterygii (Qiang Huo), Radix Bupleuri (Chai Hu), Rhizoma Cimicifugae (Sheng Ma ), and Radix Ledebouriellae Divaricatae (Fang Feng) 3 fen each, Radix Rehmanniae Glutinosae (Sheng Di), and Radix Angelicae Sinensis (Dang Gui) 5 fen each, Radix Glycyrrhizae Uralensis (Gan Cao ) 1 qian, and a small amount of Flos Carthami Tinctorii (HongHua).

Grind up the formula and take it in a single dose, in three cups [of water] cooked down to one cup. Remove the dregs and take it slightly warm on an empty stomach.

The two Sea of Blood (Xue Hai, Sp 10) points on the foot tai yin spleen channel lie above the inner angle of the knee-cap, two cun within the border of the white flesh. [Sea of Blood] treats downward leaking of malign blood in women, irregularity of the menstrual affairs, counterflow of qi causing abdominal distension, all with a relaxed pulse. Moxa [this point] three times.

The two Yin Valley (Yin Gu, Ki 10) points on the foot shao yin kidney channel are located on the inside of the knee behind the supporting bones, below the large sinew and above the small sinew. [To locate it] press with the corresponding hand and stretch the knee. [Yin Valley] treats piercing [pain] in the knee, inability to stretch and flex [the knee], tongue loose and drooling, vexation counterflow and difficult urination, lower abdominal urgency, drawing yin [genital] pain, and thigh and inner calf pain. [It also treats] incessant leaking of blood in women, abdominal distension and fullness, inability to breathe, yellow urination, and ku . In women who are pregnant it may be moxed three times.

Wine Cooked Angelicae Pills (Jiu Zhu Dang Gui Wan).

[This prescription] treats tui shan, a downward pouring of white leukorrhea, leg qi, and a sensation in the lumbar region as if it were in an icy rain. In an effort to dry it out, [the patient] wears very thick clothing and cover one’s head; yet the cold chill is still unbearable because [this is a condition of ] utmost yin cold. The face is white like desiccated fish. The muscles and flesh feel as if they have been flayed with a knife and become quickly emaciated. There is uncontrolled urination, copious flow of white leukorrhea that cannot be secured, unconsciousness, white facial complexion, eyes are green-blue like the color of vegetables, and the vision is blurry and one cannot see. The body is heavy like a mountain, movement and walking is deviated, yet one cannot remain quiet. The legs and knees become withered and fine, and defecation is difficult. The mouth is unable to speak, and one is extremely listless. Food will not descend, there is subcardiac pi, cardiac vexation, and a burning sensation in the region of the heart which is unbearable. The facial complexion is dirty. The upper back is cold, and there is urinary incontinence of which the patient is unaware. These [symptoms lie in the] upper middle and lower three yang. The genuine qi is entirely vacuous and on the verge of exhaustion. There is vomiting and retching because the stomach is extremely vacuous. The pulse is deep and inverted, tense and rough, yet it is empty and vacuous upon [deeper] palpation. If the pulse is surging, large, and rough, it will lack strength upon [deeper] palpation. If this is a pattern of cold within, how is it that [the pulse] will be empty and vacuous upon palpation? If the pulse does respond upon palpation, this is yin cold and a condition due to an extreme vacuity of qi and blood.

[This formula contains] Fructus Foeniculi Vulgaris (Hui Xiang), 5 qian, Radix Lateralis Aconiti Charmichaeli Preparatae (He Fu Zi), Rhizoma Alpiniae Officinari (Liang Jiang), and Radix Angelicae Sinensis (Dang Gui), 1 liang each of the above.

Take these four ingredients and slice them to the size of sesame [seeds and mung beans] and then cook them together in one and a half cups of good wine, Next draw off the wine and let them dry. Next take mix-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao), Cortex Meliae Radicis (Ku Lian Zi), Flos Caryophyllae (Ding Xiang) and Rhizoma Cimicifugae (Sheng Ma), one qian each, Radix Bupleuri (Chai Hu), two qian , fried Yellow Salt (Huang Yan) Buthus Martensi (Chuan Xie), 3 qian each, Rhizoma Corydalis (Yan Hu Suo) 4 qian. Mix these ingredients with the previous four ingredients and powder them finely. Cook this [powder] with wine down to a paste and form into pills the size of large parasol tree seeds. Take 50-70 pills each time on an empty stomach. Do not consume any oily, greasy, chilled foods, wine or wet flour during treatment.

Securing the Genuine Pills (Gu Zhen Wan)

[This prescription] treats long-standing and incessant white leukorrhea and chilling pain in the umbilicus and abdomen, as well as in the yin [genitals]. There is a current of fire in the eye due to an ascending obstruction, One sees things when there is nothing to be seen. If there is a malignant heat in the gums causing pain while eating, one must administer finely powdered Rhizoma Coptidis (Huang Lian) topically to arrest the pain. One will desire to eat only dry foods and have a great aversion to soupy foods.

These illnesses are all due to cold damp overwhelming the interior of the uterus, such that the patient prefers dry foods and has an aversion to damp. Yin fire within the liver channel ascends and spills over into the topmost branches where it stagnates above and produces a stream of fire in the eyes . Kidney water invades the liver and spills upward, therefore the eyes are blurry and cannot see. The malignant heat in the gums when eating is due to hidden heat in the shao yin and yang ming . Treatment methods should consist of major drainage of cold dampness using medicinals in pill form to treat this condition. Therefore, it is said that in the case of cold in the lower warmer it is appropriate to move slowly. Decoctions and powders are strongly cautioned against.

[This formula] uses wine prepared Halloysitum Album (Bai Shi Zhi) and Os Draconis (Bai Long Gu) to desiccate the dampness and blast-fried Rhizoma Zingiberis (Gan Jiang) which is spicy and hot to drain cold water. The very cold Radix Dioscoreae Bulbiferae (Huang Yao) is used for [its cold nature] to treat [a cold condition] and as a guiding [medicinal]. Therefore, as for treatment methods, it is said that even when the ancients convicted a man of a felony, his offspring were not executed. [In the same way] they also recognized that that which governs [treatment] is hidden. [One must] first find the cause [of the disease and then one may] also drain malign heat rheum from the gums. Use Radix Bupleuri (Chai Hu) as an envoy to the root channel, and five fen of Radix Paeoniae Lactiflorae (Bai Shao) as a guide, lest the acrid hot medicinals become detrimental to the liver channel. [In this manner] one should use some slightly draining [medicinals]. Use the pungent warm Corpus Radicis Angelicae Sinensis ( Dang Gui Shen) for major supplementation of the blood vessels. This is a complete method for the use of medicinals. Use Radix Astragali Membranacei (Huang Qi)-wine soaked, Radix Paeoniae Lactiflorae (Bai Shao ), five fen each, Radix Bupleuri (Chai Hu), and Halloysitum Albae (Bai Shi Zhi), one qian each. Fire [the Halloysitum Albae] until it is red, and spray it with water while it is finely ground, and dry it inthe sun. Os Draconis (Bai Long Gu) is wine cooked and sun dried, and sprayed with and powdered,Radix Angelicae Sinensis (Dang Gui), wine soaked. Two qian of each of the above are used. Rhizoma Zingeberis Dessicatus (Gan Jiang), four qian is blast fried. Having water sprayed the Halliositum Albae (Bai Shi Zhi) and Os Draconis (Bai Long Gu) grind [all of the ingredients] finely and mix them with water boiled flour to form pills the size of Gorgon fruit seeds (Ji Tou Ren). Take thirty pills with each dose, on an empty stomach with a substantial amount of boiling water. So that it won’t stagnate in the stomach, wait a half an hour before eating a meal, lest the hot medicinals attack the stomach. Raw and chilling [foods] are prohibited, as are tough substances, alcohol and damp flour.

Lindera Decoction (Wu Yao Tang)

[This formula] treats pain and soreness in the sea of blood in women. It contains Radix Angelicae Sinensis (Dang Gui), Radix Glycyrrhizae Uralensis (Gan Cao), Radix Auklandiae Lappae (Mu Xiang), five qian each, Radix Linderae (Wu Yao) two qian, Rhizoma Cyperi Rotundi ( Xiang Fu Zi), two liang, fried. Grind the above ingredients, and take five qian per dose with two cups of water, and remove the dregs. Administer warm before meals.

Assisting the Yang Decoction ( Ju Yang Tang),- also called Upbearing the Yang Drying Dampness

Decoction (Sheng Yang Zao Shi Tang).

[This formula] treats white vaginal discharge, pain in the yin door [vagina], urgent pain, a jaundiced body and slack skin. The body is heavy like a mountain, and the yin [genitals] are like ice. Slice the ingredients to the size of sesame [seeds] and mung [beans] and administer once daily in three cups of water cooked down to one cup. Take this before meals and slightly warm.

[This formula contains] unprocessed Radix Scutellariae Baicalensis (Sheng Huang Qin), PericarpiumCitri Erythrocarpae (Ju Pi), five fen of each of the above, Radix Ledebouriellae Diverticulae (Fang Feng), Semen Alpiniae Oxyphyllae (Gao Liang Jiang), Rhizoma Zingiberis Desiccatus (Gan Jiang), Semen Pruni (Yu Li Ren ), and Radix Glycyrrhizae Uralensis (Gan Cao), one qian of each of the above, Radix Bupleuri (Chai Hu), one qian three fen, Sunflower (Bai Kua Hua), seven flowers.

Slice [the above ingredients] to the size of sesame [seeds and mung] beans, and divide them into two doses. Take each dose in two cups of water cooked down to one cup and remove the dregs. Administer it warm and before eating.

Water Storage Elixir (Shui Fu Dan)

[This formula] treats long-standing vacuity with accumulated chill in women. The menses do not move.

There are concretions and conglomerations in the abdomen accompanied by with clots and sudden pain. The face looks dirty, dark, emaciated and bony.

Cinnabaris (Nao Sha), separate with paper and cook in the froth of boiling water, Fructus Alpiniae Galangae (Hong Tou ), five qian each, Cortex Cinnamomi (Gui Xin), separated from the wood, Radix Auklandiae Lappae (Mu Xiang), Rhizoma Zingiberis Dessicatus (Gan Jiang), one liang each, Fructus Amomi ( Sha Ren), blast-fried Ophicalcitum (jing duan Hua Rui Shi) one liang five fen, Mylabris (Ban Mao) with the head and wings removed, the juice of unprocessed Radix Rehmanniae Glutinosae (Sheng Di Huang Zhi), Urinae Hominis (Tong Zi Xiao Bian), one sheng each, Gall et Canis (Gou Dan) collected in deep winter (lao yue) seven gallbladders, and Cantharis (Wan Qing) three items with the head and feet removed, fried in one sheng of roasted glutinous rice until the rice is yellow. This is then removed and not used.

Grind the nine ingredients to a fine powder and then together with the three juices, cook them down to a paste. Form pills the size of Gorgon fruit seeds (Ji Tou Ren). and coat them with Cinnabaris (Zhu Sha). Take one pill daily, chewing it thoroughly with warm wine. Administer prior to meals or with rice gruel.

This formula may not be taken in pregnancy.

Caryophyllii and Gelatin Decoction (Ding Xiang E Jiao Tang)

[This formula] treats incessant flooding and leaking, and heart qi insufficiency, due to taxation and unregulated intake of drink and food, as well as shortened duration between menstrual flows. The two cubit (chi) [pulses] are both wiry, tense and surging, yet upon pressure they lack strength. This pattern expresses itself as an ice-like sensation below the umbilicus and a preference for thick clothing to ward off the cold. There is white discharge and white slimy substances. However, intermixed with this is a downward leaking of [menstrual] water which is sometimes a fresh red color. The right cubit (chi) pulse may sometimes be slightly surging.

Radix Rehmanniae Glutinosae Conquitae (Shu Di), Radix Paeoniae Lactiflorae (Bai Shao), three fen each, Radix Ligustici Wallichii (Chuan Xiong), Flos Caryophyllii (Ding Xiang), four fen each, Gelatinum Corii Asini (E Jiao), six fen, unprocessed Herba Artemisiae Argyii (Sheng Ai Ye) one qian, and Radix Angelicae Sinensis (Dang Gui), one qian two fen. Grind the Radix Ligustici Wallichi finely and soak the Radix Angelicae Sinensis in wine and slice it. The Radix Rehmanniae Glutinosae Conquitae and the Flos Caryophyllii are powdered finely, and the Artemesiae is sliced as well. These are all taken in a single dose with five cups of water.

First cook the five ingredients in one cup of water two fen, and remove the dregs. Then add the Gelatin and return the preparation to the fire. Cook this down to one large cup and administer it hot on an empty stomach.

Astragalus, Angelicae and Ginseng Decoction (Huang Qi Dang Gui Ren Shen Tang)

During the winter the Kuo Da Fang came to say she had developed a sudden and incessant flooding of her menstrual water. First she had experienced a bodily detriment [i.e. miscarriage] with loss of blood and thereafter [her menstrual cycle] arrived ten days early. This time it would not stop. She had become overly worried, she was irritable and very frightened. My diagnosis was heart qi insufficiency, and unregulated intake of drink and food. Da Fang stated her disagreement, however, further diagnosis revealed that there was cold in the palms. The pulse was deep fine and relaxed, and intermittently deep and rapid. The nine orifices were inhibited, and the four extremities lacked strength. There was asthmatic ascension, shortness of breath and rough [respiration] and the qi of the nose and mouth was unregulated, all resulting in a pattern of insufficiency of heart qi and vacuity of the spleen and stomach.

Her stomach and precordial region was painful, the left subcostal region was contracted and there was an accumulation there. She was mindful of her umbilical region [and the sensation of] movement of qi there, there were sounds in her abdomen, she experienced a descension of qi and difficult bowel movements.

This was a quintessential vacuity pattern and the attendant symptoms] cannot be listed in their entirely. One must first decide to treat the root, the remains of the pattern will then be eliminated. One should calm the heart and settle the ambition (zhi), secure [the spirit] from collapse and bolster it, regulate and harmonize the spleen and stomach, greatly boost the original qi, supplement the blood vessels, and nourish the spirit with formulas for major warming to eliminate winter cold congelation from within the skin.

The addition of a small amount of Radix Rehmanniae Glutinosae (Sheng Di), eliminates ministerial fire from the life gate and forestalls depletion atony in the four extremities. Rhizoma Coptidis Chinensis (Huang Lian ) one fen, Radix Rehmanniae Glutinosae (Sheng Di) three fen, fried Massa Fermentatae (Shen Qu), Pericartium Citri Reticulatae Rubrae (Ju Pi), Ramulus Cinnamomi (Gui Zhi), five fen each, Semen Alpiniae Katsumadae (Cao Dou Kou Ren) six fen, Radix Astragali Membranacei(Huang Qi), Radix Panacis Ginseng (Ren Shen), Herba Ephedra (Ma Huang) with the nodes removed, one qian each,Corpus Radicis Angelicae Sinensis (Dang Gui Shen) one qian five fen, Semen Pruni Armeniacae (Xing Ren) five pieces, grind separately into a paste.

Grind the above ingredients and administer in two doses [per day] in two and a half large cups of water. Cook the Herba Ephedrae at a boil and remove the froth, cooking it down to two cups. Next add the other ingredients and cook them together down to one large cup. Take it in the morning with a little food.

One dose will arrest [the bleeding] on the spot.

If there is gastric duct pain and there is a visitation of cold in the stomach then take fifteen of the very hot medicinal Semen Alpiniae Katsumadae Pills (Cao Dou Kou Ren Wan) with boiling water and the pain will be arrested on the spot. This is also a medicinal for liver accumulation and will eliminate the root source of the accumulation and produce a cure.

Angelica and Peony Decoction (Dang Gui Bai Shao Tang)

Treats incessant downward leaking of the menses in women where the blood is a fresh red color. This tends to occur in the ninth month [September] and is a concern during the summer-heat. The initial cause is taxation [producing] spleen stomach vacuity depletion, shortness of breath and qi counterflow, incessant spontaneous perspiration, generalized heat producing a sense of oppression and chaos (men luan), aversion to the sight of drink and food. Not only can one not eat, but one cannot even think of food. The four extremities lack strength and there is occasional diarrhea. Later, as a result of an insufficiency of heart qi there is incessant menstrual movement. Although one may experience a downward desertion of qi, this condition is actually an ascending counterflow of original qi which has become completely absent. The patient may experience a sense of qi moving downward from the upper abdomen, and may report a shortness of breath. The patient may be unable to speak but this is due to a lack of strength to speak as opposed to some laziness in describing [her symptoms]. The following medicinals govern [this condition].

Radix Bupleurum (Chai Hu), two fen, mix-fried Radix Glycyrrhizae Uralensis (zhi Gan Cao), Radix Rehmanniae Glutinosae (Sheng Di Huang), three fen, Pericarpium Citri Reticulatae (Ju Pi) with the whites removed [i.e. the vasciculum], Radix Rehmanniae Glutinosae Conquitae ( Shu Di Huang), five fen each, Radix Astragali Membranacei (Huang Qi) one qian five fen, Rhizoma Atractylodes (Cang Zhu) soaked in rice water and skinned. Corpus Radicis Angelicae Sinensis ( Dang Gui Shen ), Radix Paeoniae Lactiflorae (Bai Shao Yao), Rhizoma Atractylodes Macrocephelae (Bai Zhu), two qian. Take the above ten ingredients and slice them to the size of sesame [seeds and mung] beans. Administer this in two doses in two and a half cups of water cooked down to one cup. Discard the dregs and administer slightly warm on an empty stomach.

Bupleurum Regulate the Menses Decoction ( Chai Hu Tiao Jing Tang)

[This formula] treats incessant flow of menstrual water which is bright red in color, distress of the neck sinews, brain pain and rigidity, and pain in the bones of the spine. [It contains] mix-fried baked Radix Glycyrrhizae Uralensis (zhi Gan Cao), Corpus Radicis Angelicae Sinensis (Dang Gui Shen), Radix Peurariae Lobatae (Ge Gen), three fen each, Radix Angelicae Pubescentis (Du Huo ), Rhizoma et Radix Ligustici Gaoben (Gao Ben), Rhizoma Cimicifugae (Sheng Ma), five fen each, Radix Bupleuri Chinensis (Chai Hu) seven fen, Rhizoma Atractylodes Lancea (Cang Zhu), one qian each, and a little bit of Flos Carthamii Tinctori (Hong Hua).

Slice the above ingredients to the size of sesame [seeds and mung] beans, and administer in a single dose in four large cups of water cooked down to one cup. Discard the dregs and administer slightly warm on an empty stomach. Once a slight perspiration is induced [the bleeding] will be arrested on the spot.

A woman’s menstrual indicators may reveal black blood which is congealed, bound, and containing clots, and on the left side there are blood conglomerations. [In addition], there may be incessant watery diarrhea, and grains may sometimes fail to be transformed. Subsequently, the blood clots and then suddenly descends, accompanied by a pouring down of watery [diarrhea]. What is readily apparent in the region of both the anterior and posterior yin is the downward desertion of exhausted blood. . If [this condition becomes] long-standing, not only are the menstrual indicators unregulated, but one may observe a watery diarrhea two or three times per day. The consumption of food causes heart vexation, there is diminished intake of drink and food, and ultimately emaciation and weakness.

Old man Dong-yuan says: the sage who treats disease must root [himself] in the principles of the four seasons, ascension and descension , the floating and the sinking. He must weigh his priorities. He must first harvest the qi and not diminish the celestial harmony, producing no overcoming and no vacuity, leaving nowhere for death and disease [to afflict] a person. Thus, [the physician] does not produce an evil, and does not lose the correct [qi], even a patient on the verge of expiring will live. Therefore, Zhong-jing said: When yang is exuberant and yin is vacuous, purgation [xia] will produce a cure, and diaphoresis will result in death. When yin is exuberant and yang is vacuous diaphoresis will produce a cure and purgation will result in death. The great sages established methods to nourish each [condition] naturally.

Moreover, formulas for raising the yang or effusing and dispersing assist the yang qi of spring and summer. In promoting ascension and up bearing, one drains the perishing cold qi stored during the autumn and winter and the disease is arrested. Thus one should use this, the ultimate principle of raising and descending floating and sinking as [the primary] treatment method. The qi of heaven and earth produces ascension and decision floating and sinking, and acts in accordance with the four seasons, and in treating disease one cannot act in a manner contrary to this. The classic states, when [one acts] in accordance with heaven the result is prosperity, and when [one acts] contrary to heaven the result is loss. How can one fail to be in awe of this!

A person’s body also has four seasons and the qi of heaven and earth and one cannot profess to be separate from it. A person’s body is also the same as heaven and earth. When the menses leak incessantly, this is a downward desertion of the qi and blood of the anterior yin. When there is also watery diarrhea for a number of years this reflects a downward sinking of the qi and blood of the posterior yin producing desertion. The posterior yin governs substance with form. The anterior yin is the abode of the essence qi, and when it becomes downwardly exhausted it afflicts the qi and blood of the patient’s entire body. This commonly occurs during the autumn and winter months, and since the yin governs ominous [developments] the disease is stored. Yang engenderment and yin growth occur during the spring and summer. In the human body this up bearing and floating of qi is the upward movement of grain qi. When there is not engenderment and growth of qi and blood within the entire body of a patient, the grain qi cannot be victorious. The resulting wasting of the muscle and flesh reflects the complete expiry of these two polar qi. When the two yin of in the lower source become completely deserted, the qi and blood become exhausted. Even though this is a heat pattern, the chronic desertion in the lower warmer transforms it to cold.

This disease is chronically deep and chronically down bearing and there is a massive overwhelming of damp cold which must urgently be salvaged. To drain cold use heat, and to eliminate dampness use dryness with massive up bearing and elevation to assist in engenderment and growth, to support and nourish the qi and blood so as to avoid a tendency toward their exhaustion. The sages established a treatment method whereby when there is a great overwhelming of damp qi, one should use [wind] to overwhelm and level dampness. One should first regulate and harmonize the stomach qi, and then use medicinals such as Rhizoma Atractylodes Macrocephelae (Bai Zhu) to dry the dampness, and to enrich the original qi. If this does not arrest [the bleeding and diarrhea], then use wind medicinals to overcome dampness. This is achieved by major elevation and major up bearing, which assists in the ultimate treatment of the enduring descent of the twin dampness of Spring and Summer.

Boost the Stomach Upbear the Yang Decoction (Yi Wei Sheng Yang Tang)

In the case of blood desertion, boost the qi. This is the method of the ancient sages. First boost the stomach qi to assist with the generation and production of qi. It is said that yang engenders and yin grows. Sweet medicinals are a priority and everyone understands that they supplement the qi, however they really not know that sweet is able to engender blood. This is the principle of yang engenderment and yin growth. Therefore first rectify the stomach qi because within a person’s body the stomach qi is most precious.

Radix Bupleuri (Chai Hu), Rhizoma Cimicifugae (Sheng Ma), five grams each, mix-fried Radix Glycyrrhizae Uralensis (zhi Gan Cao), Corpus Radicis Angelicae Sinensis (Dang Gui Shen)-wine soaked, Pericarpium Citri Reticulatae (Chen Pi), one qian each, Radix Panacis Ginseng (Ren Shen), remove the calyx, and delete this ingredient if there s there is cough, fried Massa Fermentatae (chao Shen Qu), one qian five fen each, Radix Astragali Membranacei (Huang Qi) two qian, Radix Atractylodes Macrocephelae (Bai Zhu), three qian, unprocessed Radix Scutellariae Baicalensis (sheng Huang Qin) a small amount.

Grind the above ingredients and take two qian with each dose, cooking them in two large cups of water down to one cup, and then removing the dregs. Administer slightly warm.

If there is abdominal pain add three fen of Radix Paeoniae Lactiflorae and a small amount of Cortex Cinnamoni (Gui), to each dose. If there is thirst and oral dryness, add two fen of Radix Puerariae Lobatae and take at any time.

Upbear the Yang Elevate The Menses Decoction (Sheng Yang Sheng Jing Tang) treats incessant flow of menstrual water. If the left chi pulse is empty (Kong) and vacuous upon pressure, this [reflects] a pattern of a complete desertion of qi and blood and great cold. With a light [touch of the] hand the pulse is rapid and racing (ji), and when one raises one’s finger it is wiry and tense, or choppy (se), all of which indicates a yang desertion pattern, as well as a collapse [due to] yin fire (yin huo chi wang); One may see a heat pattern in the mouth, nose and eyes, or thirst. This [is all due to an] agitation of yin which makes the yang to want to be the first to leave. [In treatment,] one should warm it, elevate it, upbear it (sheng zhi), float it, and dry it. These methods greatly upbear and float the blood and qi, and precisely supplement the downward desertion of the life gate.

Cortex Cinnamomi (Rou Gui) with the skin removed. Do not use in the exuberance of summer (cheng xia) but it may be used in the autumn and winter. Radix Paeoniae Lactiflorae, Flos Carthami Tinctori, five fen each. Herba Asari cum Radice six fen, Radix Panacis Ginseng (Ren Shen) with the calyx removed, Radix Rehmanniae Glutinosae Conquitae (Shu Di), Radix Ligustici Wallichi (Chuan Xiong) one qian, Radix Angelicae Pubescentis (Du Huo Gen), Radix Lateralis Aconiti Charmichaeli Preparatae (Hei Fu Zi) blast fried with the skin removed. mix-fried Radix Glycyrrhizae (zhi Gan Cao) one qian five fen, Rhizoma Notopterygi (Qiang Huo), Rhizoma et Radix Ligustici (Gao Ben) remove the earth, Radix Ledebouriellae Sesloidis (two qian each of the above), Rhizoma Atractylodes Macrocephelae (Bai Zhu), Radix Angelicae Sinensis (Dang Gui), Radix Astragali Membranacei (Huang Qi), Radix Bupleuri (Chai Hu), two qian of the above, and Semen Pruni Armeniacae (Tao Ren), ten pieces, cooked and soaked to remove the skin and tips, then ground finely.

Grind [the above ingredients] and administer three qian [per dose]. If the disease progresses one may increase the dose up to five qian. Administer [each dose] in three cups of water cooked down to one qian. Take this warm on an empty stomach.

Translated by: Charles Chace