Chapter 32: Scanty and Dark Menstrual Flow

Zhang Jing shook his head helplessly.

Li Ziqi had misunderstood; she thought her mother or Bai Bing had already disclosed her background. In her agitation, she could no longer maintain her ladylike facade. She stood up abruptly and protested loudly, "I have never had a boyfriend! Although I’ve been on dates with a few guys, we were just the most casual friends. I promise you, I haven’t even held hands with any of them!"

"Miss, I think there’s been a misunderstanding. I never meant to question you. Besides, whether or not you have a boyfriend has nothing to do with me," Zhang Jing replied with a wry smile. He found her sudden shift in demeanor quite baffling, though he reasoned that it might actually be for the best, as it would allow him to be blunt during the consultation.

"How could it have nothing to do with you? Didn’t my mom just talk to you about it? I want to be your girlfriend, and she has already picked you out," Li Ziqi said brazenly, showing no signs of shyness.

"Your mother did say something to that effect, but I did not agree to it," Zhang Jing stated sternly.

"Why? Do I look that annoying to you?" Li Ziqi asked, pouting.

"No. To be honest, I think you’re quite cute," Zhang Jing replied truthfully.

"Cute? More like 'pitiful and unloved,'" Li Ziqi said dejectedly.

"I..." Zhang Jing was never good with words, especially when dealing with women. Since this matter couldn't be settled quickly, he decided to change the subject. "Miss, let’s continue with the consultation."

Li Ziqi was stunned for a moment, but after a brief thought, she nodded in agreement. She didn't want to sour their relationship just yet. "Alright then. Do I need to keep my mouth open?"

"Yes," Zhang Jing nodded.

"But I really can't open it very wide. I’ve been suffering from internal heat lately, and the corners of my mouth are a bit sore," Li Ziqi said, frowning slightly.

"That's fine. Just open it as much as you can; I’ll use a tongue depressor to help," Zhang Jing said calmly.

After some effort, the tongue examination was completed. Zhang Jing recorded in the digital medical record: *Pale tongue, white and greasy coating in the middle and back.*

Next was the inquiry phase. While studying under Master Li Yu, Zhang Jing had learned that many cases of menstrual irregularity in women were related to high work stress or working night shifts. He decided to start by asking about her occupation.

"Miss Li, what do you do for a living?"

Work? Li Ziqi perked up immediately. But she was a food livestreamer, which wasn't exactly a "proper" job. Would Dr. Zhang look down on her for that? If she lied now, he would surely look down on her even more later. After weighing the options, she decided to be vague. "Oh, I work in the IT and internet industry."

"Is the work pressure high? Do you often work night shifts?" Zhang Jing asked.

Li Ziqi felt a warmth in her heart. *This handsome guy might seem dull on the outside, but he knows how to show concern,* she thought.

"For young people today, as long as you aren't living off your parents, there’s always some pressure. As for night shifts, they are unavoidable. But I can adjust my schedule in the future and try to get my work done during the day."

"Well, if your work allows it, I suggest you try not to stay up late. Especially for women, lack of sleep has a significant impact on menstruation," Zhang Jing said seriously.

"I’ll remember that. Thank you, Dr. Zhang," Li Ziqi replied sweetly.

"How is your menstrual cycle? Does it come early or late?" Zhang Jing continued.

"It’s always two or three days early, so it's around 28 days."

"That isn't considered 'early'; 28 days is a normal menstrual cycle."

"Isn't 30 days the standard?" Li Ziqi looked at him curiously.

"Actually, the time for menstruation, pregnancy, and lactation is most accurately measured in weeks. For example, the 'ten months of pregnancy' people talk about is actually only 280 days, which is exactly forty weeks. In this context, four weeks or 28 days is considered one month."

"Oh," Li Ziqi nodded, half-understanding. She had no experience with pregnancy and had only vaguely seen similar trivia online.

"What about the volume? Is it heavy or light? How many days until it stops completely?" Zhang Jing asked after correcting her perception.

"The volume is very light. It’s only a bit heavier on the first day, and it’s completely gone in three days."

"What about the color? Dark or light? Are there many blood clots? Do you have period pain?"

"The color is on the darker side, there are some clots, and I have occasional cramps, though they aren't too severe. Also, my lower back aches a bit during my period."

"What about before your period? Do you experience breast tenderness?"

"That... I don't think it's very noticeable," Li Ziqi recalled.

After finishing the menstrual-related questions, Zhang Jing continued with the standard inquiry according to the "Ten Questions" protocol. About ten minutes later, the consultation concluded. Zhang Jing recorded the relevant information into the computer and added the pulse diagnosis.

He glanced over the patient file: *Female, 23 years old. For over a year, low menstrual volume, regular cycle, last period on October 6th. Fond of cold in summer, consumes excessive cold drinks and watermelon. Obvious cold intolerance in winter, cold hands and feet. Appetite normal, bowel and bladder normal, shallow sleep with frequent dreaming, no bitter taste in the mouth upon waking. Examination: Pale tongue, white and greasy coating in the middle and back, Grade I sublingual stasis, weak pulse.*

*Diagnosis: Jueyin disease (Cold coagulation and blood stasis).*
*Prescription: Danggui Sini plus Wuzhuyu and Ginger Decoction combined with Guizhi Fuling Pill.*

"Alright, Miss Li, let’s discuss your condition."

"Yes, Dr. Zhang, please go ahead, I’m listening carefully," Li Ziqi said, tilting her head with a lovestruck expression.

Zhang Jing ignored her and spoke matter-of-factly, "Based on the four diagnostic methods, the cause of your menstrual irregularities is primarily long-term internal cold, accompanied by mild blood stasis."

"I know that—it's 'palace cold' with blood stasis, right? How do we treat it?" Li Ziqi looked a bit proud, as if to say, *Don't think I'm ignorant.*

"That's roughly the idea," Zhang Jing nodded and began citing the classical source: "Article 352 of the 'Treatise on Cold Damage' states: 'If a person has long-term internal cold, Danggui Sini plus Wuzhuyu and Ginger Decoction is appropriate.'"

"What ginger soup? Do I just drink some ginger soup?" Li Ziqi looked bewildered.

"It’s not just ginger soup; it’s the Danggui Sini plus Wuzhuyu and Ginger Decoction. The original formula contains, in addition to half a jin of ginger, three liang of Angelica, three liang of Peony, two liang of toasted Licorice, two liang of Tongcao, three liang of Cinnamon Twig, three liang of Asarum, two sheng of Evodia, and twenty-five Jujubes," Zhang Jing explained.

"Twenty-five jujubes? That's so many. Won't it be too sweet? Can we put in less? I'm worried about gaining weight," Li Ziqi asked cautiously, trying to negotiate.

"What I just listed are the original dosages from the 'Treatise on Cold Damage.' We need to make adjustments based on clinical reality. Furthermore, combining this with the Guizhi Fuling Pill is more appropriate for your specific condition."

"Fine, whatever decoctions or pills they are, just prescribe them. I promise to take them all obediently."

Zhang Jing smiled faintly and entered the electronic prescription into the computer: 15g Angelica, 15g White Peony, 10g Toasted Licorice, 15g Cinnamon Twig, 3g Small Tongcao, 3g Asarum, 3g Evodia, 5 slices of Ginger, 5 Jujubes, 15g Poria, 15g Moutan Bark, 15g Peach Kernel.

He then gave detailed instructions on how to decoct the medicine: "Get seven doses from our pharmacy. Add five slices of fresh ginger, roughly the size and thickness of a coin, and be sure to break the jujubes open before boiling."

"Put everything into a ceramic pot, soak in about 1000ml of cold water for half an hour, and do not discard the soaking water."

"Then heat it on the stove. Bring it to a boil over high heat, then reduce to the lowest flame and simmer for thirty to forty minutes. Finally, pour out the decoction, which should total about 300ml. Filter out the residue and take it in two warm doses after meals."

"Wait, wait, it's so complicated, how will I remember all that? Can't you guys decoct it for me?"

"That’s certainly possible. However, I suggest that if you have the time, you should try to boil it at home using the traditional method for better efficacy. If you have any questions, feel free to call me. Ms. Bai should have given you my number, right?"

"Yes, yes, I have it. It’s fine as long as I can ask you; my mom doesn't work, so she has plenty of time."

When Li Ziqi mentioned her mother, Zhang Jing suddenly remembered there was something quite important he still needed to tell her.