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Wang Jiezhai stated: In women, the cessation of menstruation is often caused by damage to the Spleen and Stomach. One should not immediately diagnose it as amenorrhea due to fixed blood stasis (blood stasis obstruction) and lightly employ drugs that promote menstruation and break up blood stasis. Whenever encountering such cases, one must carefully examine the condition of the Spleen and Stomach. If the cause is improper diet or overwork damaging the Spleen and Stomach, resulting in poor appetite, diarrhea, and abdominal pain; or if it is due to the mistaken use of diaphoretic, purgative, or attacking medicines that injure the Qi of the Middle Jiao, leading to insufficient blood and impaired circulation, then only tonifying the Spleen and Stomach with appropriate herbs is needed. When the Spleen is robust, it generates blood, and menstruation will resume naturally. There are also cases where food stagnation damages the Spleen and Stomach; in such instances, one should first eliminate the stagnation and then tonify the Spleen Qi. Only if the Spleen and Stomach are indeed free from disease, but there are blood clumps causing stagnation, should one employ formulas that invigorate blood and unblock menstruation.

Shenzhai commented: The above seven items outline that female amenorrhea belongs to diseases of internal injury and deficiency. Amenorrhea can result from the Heart Qi failing to flow freely, from Blood deficiency with Qi binding, or from damage to the Liver, Kidney, and Spleen; all of these are sufficient to cause amenorrhea. This constitutes an internal injury deficiency syndrome. Compared to the previous section which described conditions caused by wind-cold coagulation, fire-heat accumulation, phlegm-turbidity, and foul blood, these differ significantly between excess (fullness) and deficiency (emptiness).

Li stated: Women are primarily governed by Blood. When the Tianzhen Qi descends and the Ren and Gui waters (referring to Kidney essence/Tian Gui) combine, and Kidney Qi reaches its peak, the blood vessels flow smoothly. Menstruation typically occurs every thirty days, mirroring the waxing and waning of the moon, hence it is called "menstrual period." The state during menstruation is similar to that after childbirth. If a small amount of residual blood remains uncleaned at that time, or if exposed to external pathogens such as Wind, Cold, Dampness, Heat, or Summerheat, or if internally injured by raw/cold foods, or due to emotional stagnation (Seven Emotions), forming Phlegm or Blood Stasis that accumulates within, this is termed "Blood Stagnation" (Xue Zhi). Or, after menstruation ceases, excessive physical exertion, excessive sexual intercourse, or consumption of dry-hot foods may stir up Fire, causing pathogenic factors to flourish and Body Fluids to decline; this is termed "Blood Withering" (Xue Ku).

Chen Liangfu stated: Being startled after menstruation causes Qi and Blood to become disordered and flow recklessly. Reversing upward, they exit through the mouth and nose; reversing into the body, Blood and Water contend with each other, transforming into edema. Anger causes Qi and Blood to reverse into the waist, legs, heart, abdomen, back, flanks, hands, and feet, causing severe pain that manifests during menstruation and stops when the period ends. Extreme anger injures the Liver, leading to dizziness, hematemesis, scrofula (Luo Li), Blood Wind, sores, and other diseases. Combined with leaking menstrual blood, this eventually forms bleeding from orifices and sores, dripping continuously. Damp-Heat contending together leads to metrorrhagia (Beng) and leukorrhea (Dai); Blood binding inside transforms into mass formations (Jia). All these myriad variable syndromes are merely manifestations of either Blood Stagnation or Blood Withering. Severe cases result in complete amenorrhea, while mild cases result in irregular menstruation; it is not limited to just deficiency and heat syndromes.