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According to *Liang Fang* (Good Prescriptions): Women's irregular menstruation is caused by labor injuring Qi and Blood, leading to a weak constitution where Wind-Cold pathogens invade the Uterus (Zang Gong), damaging the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel). If the Cun (Inch) pulse is Wiry (Xian) and the Guan (Bar) pulse is Deep (Chen) (Wiry and Deep pulses indicate Qi disorders, while Slippery indicates Excess), this is a Liver disorder, primarily accompanied by abdominal pain and sores in orifices. If the Chi (Cubit) pulse is Slippery and the Guan pulse is Full/Excess, this is Qi stagnation. These conditions mainly manifest as lower abdominal pain radiating to the waist, with Qi attacking the chest and diaphragm.

Commentary: Xue Lizhai states that the aforementioned symptoms belong to the Liver and Gallbladder meridians, as they are interior-exterior partners, often injured by anger. If it is Wind-Heat in the meridian itself, use Bu Gan San (Liver-Nourishing Powder); for Blood deficiency, use Si Wu Tang (Four Substance Decoction) with Suan Zao Ren (Ziziphus Seed); for insufficiency of Kidney Water, use Liu Wei Wan (Six-Ingredient Pill).

According to *Chan Bao Fang* (Prescriptions for Childbirth): Women prioritize Blood. At age forty-nine (seven sevens), the hexagram numbers are complete; upon completion, menstruation ceases, the Chong and Ren vessels become deficient and weak, Tian Gui (Heavenly Water) is exhausted, the Earthly Way is blocked, and conception becomes impossible. Or, due to excessive labor, irregular emotions of joy and anger, after the meridians have weakened, if attacked by pathogenic factors, bleeding may occur when it should stop, resulting in metrorrhagia and metrostaxis. Treatment must distinguish the specific pathogen.

Xue Lizhai states: If the aforementioned condition involves Deficient-Heat of the Liver and Kidneys, use Xu Xueshi Dang Gui San (Bai Sabin's Angelica Powder); for Liver Blood Deficient-Heat, use Si Wu Tang (Four Substance Decoction) added with Chai Hu (Bupleurum Root), Shan Zhi (Gardenia Fruit), and Dan Pi (Moutan Cortex); for internal stirring of Liver Fire, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Shan Zhi and Dan Pi; for Liver Fire causing Blood Dryness, use Jia Wei Xiao Yao San (Modified Free Wanderer Powder); for Stagnant Fire of the Spleen Meridian, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction); for Liver-Spleen Stagnant Fire, take Gui Pi Tang and Xiao Yao San together; for Liver-Kidney depletion, take Gui Pi Tang and Liu Wei Wan together, still used in conjunction with treatments for irregular menstruation.

Jie Gu states: For women whose menses do not arrive, first drain Heart Fire, and the Blood will flow naturally. The *Nei Jing* (Inner Canon) says: Diseases of Er Yang (Two Yangs) originate in the Heart and Spleen. With hidden grievances and unspoken distress, women cease menstruating. Its transmission leads to Feng Xiao (Wind Emaciation), and its further transmission leads to Xi Ben (Breathful Accumulation), which is incurable and fatal. Er Yang refers to Yang Ming. Yang Ming stomach disease affects the Heart and Spleen. The Heart governs Blood; Heart disease causes Blood stagnation. The Spleen governs taste/flavor; Spleen disease causes failure to transform flavors. Failure to transform flavors leads to insufficiency of Essence, hence the inability to harbor hidden feelings. When Spleen Earth is depleted, Wind pathogens prevail, and Qi diminishes further. The Classics also state: Menses not arriving is due to closure of Bao Mai (Uterine Vessels). Bao Mai belongs to the Heart and connects to Bao Zhong (Center of the Uterus). Now, Qi presses upward against the Lung, preventing Heart Qi from descending smoothly, thus causing irregular menstruation.

Li Dongyuan states: There are three types of amenorrhea. First, long-standing Spleen-Stomach deficiency, emaciated physique, and deficiency of both Qi and Blood lead to cessation of menses. Second, during illness, Xiao Ke (Wasting-Thirst) occurs; Stomach Heat causes good appetite but thinness, and fluids are not generated. Menses are transformed from blood vessels and body fluids. Once fluids are exhausted and scorched by Heat, muscles gradually waste away, dryness and thirst appear intermittently, the Sea of Blood dries up, named Xue Ku (Blood Depletion). Amenorrhea should be treated by purging; if Stomach Earth is dry and hot, tonifying Qi and Blood will allow menses to resume naturally (this is a Middle Jiao Spleen-Stomach disorder). Third, the Pericardium Collateral vessels are Surging and Rapid, with intermittent dry heat, constipation, clear but difficult urination, and cessation of menstrual blood. This is dryness of the Sea of Blood; one should regulate blood vessels, remove Fire pathogens from the Pericardium collaterals, and menses will resume naturally (this is Lower Jiao Pericardium collateral Heat binding). Fourth, mental labor stirs Fire, depleting red fluids; or worry and thought knot Qi, closing Bao Mai. Qi presses upward against the Lung, preventing Heart Qi from descending, so menses do not come. One should first administer agents to descend Heart Fire, then use medicines to nourish Spleen Blood, and menses will return naturally (this is Upper Jiao Heart-Lung Heat binding).

Draining Heart Fire and nourishing Spleen Blood aligns with the meaning of this text. I believe we should deduce from "hidden grievances." When people have hidden feelings and twisted intentions, Qi becomes stagnant and unsmooth. Unsmoothness prevents Heart Qi from opening and Spleen Qi from transforming. Daily intake of water and grain decreases, unable to transform into Qi and Blood to enter the Sea of Blood of Er Yang. With no surplus in the Sea of Blood, menstruation stops. Transmission to Feng Xiao: Yang Ming governs muscles; insufficient Blood means muscles lack nourishment. How can there be no emaciation! The name "Wind" is the transformation of Fire; thus, one must trace back to the root of "inability to express hidden grievances" to find the origin.

Based on this discussion, there should be four syndromes. If Gastric Heat, Pericardium Collateral Heat, and Mental Labor Heat all exist, purging Fire and nourishing Blood is appropriate. However, regarding the syndrome of long-standing Spleen-Stomach deficiency causing amenorrhea, treatment should focus on tonifying the Spleen. How can this be ignored? Water entering the meridians generates Blood; grain entering the Stomach allows vessel pathways to flow. If Water departs and Ying (Nutrient) scatters, Grain clears and Wei (Defensive) perishes. Moreover, the Spleen commands the Blood of all meridians. Should we not tonify those whose Qi and Blood decline due to long-standing Spleen-Stomach deficiency? Distinguishing Excess and Deficiency based on this clearly indicates four syndromes without doubt. Why did Lou Quanshan omit the deficiency-tonifying syndrome in his supplementation?

Commentary: Xue Lizhai states: Menstrual blood is Yin Blood, belonging to the Chong and Ren vessels. Upward it becomes milk; downward it becomes menses.

Pathologies arise from: Spleen deficiency failing to generate Blood—regulate and tonify; Spleen stagnation failing to move Blood—resolve and tonify; Stomach Fire consuming Blood—clear Blood and tonify; Spleen-Stomach damage with little Blood—warm and tonify; Mental labor injuring Heart Blood failing to move—rest and tonify; Anger injuring Liver Qi failing to move—harmonize and tonify; Lung Qi deficiency failing to move—tonify Spleen and Stomach; Kidney Qi deficiency failing to move—tonify Spleen and Lungs. The Classics say: Damage the Lung, benefit its Qi; damage the Heart, regulate Ying and Wei; damage the Spleen, regulate diet and adjust cold/warmth; damage the Liver, soothe its center; damage the Kidney, benefit its Essence. Refer to these when treating, to avoid error.