Menstrual Blood

Menstrual Blood

Although there are specialized books on gynecology, since men and women share the same fundamental blood origin, they should be discussed together. The classics state: "When a woman reaches the age of twenty-one, Tian Gui arrives, the Ren channel opens, the Tai Chong channel flourishes, and menstruation occurs regularly, enabling her to bear children." (1) Tian Gui refers to the innate vital energy stored in the kidneys, which transforms into Gui water; "arrives" means it reaches the uterus. Water is generated by yang energy, and when yang prevails, yin must follow. Blood is yin, governed by the Chong and Ren channels, so it should correspond to Gui water and transport blood to the uterus. The fact that blood follows water is akin to a wife following her husband. Both the Chong and Ren channels originate in the uterus, ascend to the Yang Ming channel, which is the sea of postnatal food and water, and is referred to as "Wu Earth" in the central palace.

When qi is transformed into juice, turning red into blood, and combining with Gui water along the Chong and Ren channels, it is called the union of Wu and Gui, applicable to both men and women. Men are primarily qi-driven, so their blood is transformed from water into semen; women are primarily blood-driven, so their blood is transformed from water into menstrual blood. Blood is the essence of men, and water contains blood; menstrual blood is the essence of women, and blood contains water, so there is always water present before and after menstruation, which can be verified. This water is generated by the yang qi of the kidney, and when qi is overly active, water is depleted while blood remains moist, leading to heat-related illnesses. When qi is cold, water becomes cold and blood cannot circulate, leading to cold-related illnesses. Therefore, when regulating blood, one must first regulate water, and regulating water is equivalent to regulating qi. Qi is generated in the kidneys and controlled by the lungs. Blood is generated in the stomach and stored in the liver, with the blood reservoir being part of the liver. The lung metal element controls the regulation of qi and serves as the primary source of water, so anyone dealing with blood and water should understand this relationship. Thus, one can either regulate the water within qi to nourish blood, or regulate the qi within blood to benefit water—this is the method women use to regulate their periods, and scholars should observe this approach when dealing with any blood-related condition.

For those with blood heat, it is due to insufficient water, as evidenced by early onset of menstruation, fever, thirst, and other symptoms. Si Wu Tang with tian dong, mai dong, huang qin, flower pollen, bupleurum, e jiao, niu xi, and other herbs can be used to nourish water and moisten blood, or Liu Wei Di Huang Tang can be used to nourish the lungs and kidneys, thereby activating the source of water—this is a method of nourishing blood by nourishing water. For those with blood cold, it is due to lack of warmth in the water, as evidenced by the late stage of menstruation, a pale and cold appearance, and accompanying stiffness and pain. Si Wu Tang with fu ling, gan cao, gui zhi, black ginger, fu zi, and other herbs can be used to warm the water and stimulate qi, so that qi flows and blood flows. For those with blood deficiency, menstruation is too infrequent, and the blood is dry and thin, with various deficiency symptoms appearing difficult to describe. If it is due to insufficient Tian Gui water in the kidneys, one will experience bone heat, qi rebellion, weak legs, rapid pulse, and a dry uterus, with no fluid before or after menstruation; in such cases, Zuo Gui Yin with tu si, turtle shell, e jiao, mai dong, five flavors, and cang rong should be used to nourish Tian Gui water. If it is due to stomach deficiency and insufficient blood in the Yang Ming Chong Ren channels, menstruation will be very light, with only water and little blood; in such cases, Zhi Gan Cao Tang and Yang Rong Tang should be used appropriately to replenish the source of blood, thereby treating blood deficiency.

For those with blood stasis, blood is blocked due to stagnation, as evidenced by body pain, abdominal distension, alternating hot and cold leaks, and closed menstruation—stagnation always blocks qi. If there were no stagnation, menstruation would flow freely and proceed smoothly, so why would it become chaotic? Therefore, the general principle is to remove stagnation, using Si Wu Tang with yuan hu, peach kernels, xiang fu, milk incense, and myrrh. For heat, add huang qin and huang lian; for cold, add gan jiang and fu pian. Wang Qing Ren's Xue Fu Zhu Yu Tang and Ge Xia Zhu Yu Tang are both suitable. For severe cases of blood stasis, only Zhong Jing's Tu Gua Gen and other anti-stagnation decoctions can effectively treat them; see the section on blood stasis for more details.

In summary, qi and blood are inseparable; blood contains qi, and qi is essentially water. I have already explained this in detail in this article and in the discussion on water, fire, qi, and blood. Understanding this means recognizing that blood stasis is caused by blood blocking qi, which is the fault of the blood itself; therefore, breaking up the blood allows qi to flow freely, and peach kernels, dan pi, and wu ling zhi are essential for this purpose. For cases of blood heat, the qi in the water is sufficient to moisten the blood, so the blood becomes hot; using gardenia and huang qin to clear fire is equivalent to nourishing water. For cases of blood cold, the qi in the water condenses and becomes stagnant, preventing circulation; using wu zhu yu, xi xin, gui zhi, and mugwort to warm the water warms the blood, and when the water is warm, qi is harmonious, and when qi is harmonious, blood is harmonious. From this, we can see that men's blood stasis, whether caused by heat or cold, requires the same treatment. Observing the process of generating Tian Gui to produce blood reveals that men should nourish their kidneys and blood; observing the process of supplementing Yang Ming to replenish the source of blood reveals that men should replenish their blood; observing the process of nourishing the lungs to nourish blood reveals that men should generate fluids to nourish blood. Even when blood becomes hot and water condenses into phlegm, or when blood deficiency causes water to overflow as sweat, the similarities and differences are all evident.

[Note] (1) Quoted from "Su Wen · On the Primordial Truth of Ancient Times." (2) Zhan: to rush ahead.

[Commentary] Regarding the mechanism of menstrual blood production, the author has already detailed it in the first volume of this book, "On the Differences Between Men and Women," with the basic idea being that men's kidney essence and women's menstruation are both derived from blood. Men are primarily qi-driven, so their blood is transformed from water into semen; women are primarily blood-driven, so their blood is transformed from water into menstrual blood. Although men's semen is water-based, water contains blood, and although women's menstruation is blood-based, blood contains water. Therefore, when treating irregular menstruation, one should regulate both blood and water, and according to the view that "water is qi, and qi is water," regulating water is equivalent to regulating qi. Thus, the principle of treating menstruation should be to treat qi and blood together. The author says: "Qi is generated in the kidneys and controlled by the lungs, while blood is generated in the spleen and stored in the liver." Therefore, when treating menstruation, one should consider the kidneys, lungs, livers, and spleens. The clinical manifestations of irregular menstruation can be broadly categorized into four types: blood heat, blood cold, blood deficiency, and blood stasis. For blood heat, there is insufficient water; for blood cold, the water is not warm enough; for blood deficiency, there is insufficient blood; for blood stasis, there is blood blockage. Based on this, for those with blood heat, symptoms include fever and thirst, and menstruation occurs earlier than expected; treatment should include Si Wu Tang with winter melon and flower pollen. For those with blood cold, symptoms include a pale and cold appearance and delayed menstruation; treatment should include Si Wu Tang with fu ling, gui zhi, ginger, and fu zi. For those with blood deficiency, menstruation is light, dry, and short, and those with spleen problems should use Ren Shen Yang Rong Tang, while those with kidney problems should use Zuo Gui Yin with turtle shell, mai dong, and five flavors. For those with blood stasis, symptoms include body pain, abdominal distension, and alternating hot and cold leaks; treatment should include Si Wu Tang with yuan hu, peach kernels, xiang fu, and milk incense.