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1. Shijia (a hard mass in the uterus) arises from cold pathogenic factors invading the Bao Palace (uterus). Its manifestation is an abdominal distension resembling pregnancy accompanied by amenorrhea; if the Bao Mai (uterine vessels) are obstructed and heat pathogenic factors force upward to the Lung, it leads to coughing and impairs the normal circulation of Heart Qi and Blood.
[Annotation] The *Huangdi Neijing* states: "Shijia originates in the Bao Palace. Cold pathogens lodge at the Zi Men (cervical os), causing closure and coldness at the Zi Men. Qi cannot flow freely. The evil blood that should be discharged remains stagnant, accumulating day by day until it enlarges, resembling pregnancy, with menstruation failing to occur on time. This condition occurs exclusively in women and can be treated by guiding or purging methods." This passage discusses amenorrhea caused by cold pathogens lodging in the lower jiao, resulting in Shijia rather than Fei Lao (pulmonary consumption). The *Huangdi Neijing* also states: "When menstruation does not arrive, it is due to the obstruction of the Bao Mai. The Bao Mai belongs to the Heart and connects to the Bao Palace. Now, if Qi forces upward upon the Lung, Heart Qi cannot descend and communicate, thus menstruation fails to arrive." This passage discusses the obstruction of the Bao Mai caused by heat pathogenic factors attacking the upper jiao, thereby forcing the Lung and inducing cough, resulting in Fei Lao rather than Shijia.

2. Diseases of the Er Yang (Yangming Stomach) originate in the Heart and Spleen. Amenorrhea may occur alongside unspoken emotional distress. If this progresses to Xue Ku (Blood Depletion) and subsequently transmits into Feng Xiao (muscular emaciation as if blown away by wind) or Xi Ben (labored breathing/wheezing), it becomes a fatal condition incurable by medical treatment.
[Annotation] "Er Yang" refers to the Yangming Stomach channel. When women experience unspoken emotional constraints, it causes stagnation and discomfort in Heart and Spleen Qi, leading to Yangming Stomach disease. Dietary intake decreases daily, leaving no source for Blood generation, hence amenorrhea ensues. Blood deficiency generates internal heat; the greater the heat, the more deficient the body becomes. Muscles become dry and emaciated, resembling objects dried by wind, hence named Feng Xiao. When Fire is excessive and uncontrolled, Heart Fire overacts upon Lung Metal. Lung Qi fails to circulate and distribute; water essence stagnates in the chest, and all body fluids transform into phlegm. Persistent coughing over a long period leads to consumption, transmitting into Xi Ben, which becomes incurable. Xi Ben refers to wheezing or labored breathing.

3. Excessive blood loss, hypersexuality, and multiple pregnancies or lactations lead to gradual depletion of Blood (Xue Ku), resulting in scanty then absent menstruation. Symptoms include bone-steaming tidal fever, pale complexion, malar flush, anorexia, emaciation, and frequent coughing.
[Annotation] Excessive blood loss results in a pale yellowish-white color of the face and fingernails, indicating the syndrome of Tuo Xue (Blood Evacuation/Depletion). This may be caused by excessive sexual activity leading to Essence exhaustion, or by numerous births and prolonged lactation damaging Blood and causing Blood Depletion. Menstruation gradually becomes scanty, and after two or three months, amenorrhea sets in. Consequently, symptoms such as bone-steaming skin heat, withered pale complexion, red malar eminences, aversion to food, dry skin, emaciation, and incessant frequent coughing appear, typically forming a Xu Sun (Deficiency Injury) syndrome.