I used to think it was always cold, but today I偶然 saw that it could also be heat. Clinical practice should pay attention to this in the future.
Fu Qingzhu’s Gynecology Song Summary - Volume 1 - Regulating Menstruation - Abdominal Pain Before Menstruation (Twenty-One)——
Women who have abdominal pain several days before menstruation and then experience menstrual flow usually have purple-black clots. People think it is due to extreme cold, but who knows it might be due to extreme heat and fire that is not dissipated! The liver belongs to wood, and there is fire within it. When it is smooth, it is unobstructed; when it is depressed, it does not rise. When menstruation is to occur but the liver does not respond, it restrains the qi and causes pain. However, when the menstruation is full, it cannot be stored inside, and the depressed fire in the liver burns, forcing the menstruation out, which causes the fire to erupt angrily. The purple-black color indicates the battle between water and fire; the formation of clots is the shape formed by fire burning. Menstruation loses its nature as menstruation because of depressed fire internally seizing its power. The treatment seems to require the great draining of fire in the liver, but draining the liver fire without resolving liver depression will remove the surface symptoms of heat but not eliminate the root, so how can it be beneficial! The prescription used is Xuan Yu Tong Jing Tang.
Bai Shao (5 qian, stir-fried with wine) Dang Gui (5 qian, washed with wine) Dan Pi (5 qian) Shan Zhi Zi (3 qian, stir-fried) Bai Jie Zi (2 qian, stir-fried and ground) Chai Hu (1 qian) Xiang Fu (1 qian, stir-fried with wine) Chuan Yu Jin (1 qian, stir-fried with vinegar) Huang Qin (1 qian, stir-fried with wine) Sheng Gan Cao (1 qian) decocted in water. Take continuously for four doses, and next month the pain before menstruation will stop and menstruation will proceed normally. This prescription nourishes liver blood, resolves liver depression, facilitates liver qi, and lowers liver fire, which is why it acts so quickly.
Summary: Abdominal pain before menstruation occurs because the heat is extreme and not dissipated, causing depressed fire to attack. Purple-black clots result from the battle between water and fire, and angry discharge. Xuan Yu with Bai Shao, Dang Gui, Dan Pi, and Shan Zhi Zi, along with Bai Jie Zi, Chai Hu, and Xiang Fu are powerful. Yu Jin, Huang Qin, and Sheng Gan Cao taken continuously for four doses will regulate menstruation on its own.
But how exactly should it be diagnosed? Does anyone have clinical cases to share?