Library

Zhu Danxi said: There was a woman suffering from malaria, with reduced appetite and amenorrhea. Upon examining her pulse, no pulse could be felt in either hand. At that time, during the cold season, I treated it as a deficiency-cold syndrome, prescribing Siwu Tang (Four Substances Decoction) added with Fuzi (Prepared Aconite Root), Wuzhuyu (Evodia Fruit), and Shenqu (Medicated Leaven) made into pills for her to take. I reflected that this prescription was highly inappropriate. The next morning, upon seeking another consultation, I saw that her daily activities were normal and she showed no signs of fatigue. I exclaimed, "The previous medication was mistaken." Amenorrhea is not due to a lack of blood, but rather obstruction by phlegm preventing its flow. The absence of a pulse is not due to blood deficiency causing pulse extinction, but rather accumulated phlegm generating heat, which knots and hides within, making the pulse invisible. It should be treated as an excess-heat syndrome using Sanhua Shenyu Wan (Three-Flower Divine Protection Pill), after which all six pulses became palpable.

Zhu Danxi said: In cases where accumulated phlegm flows downward to the Baomen (uterine opening), causing blockage and cessation of menstruation, use Nongpu Erchen Tang (Magnolia Bark and Two-Ingredient Decoction). In other cases where excessive phlegm occupies the Xuehai (Sea of Blood, referring to the Chong Mai), leading to amenorrhea, if there is excessive phlegm combined with blood deficiency, one may use pills made from Nanxing (Arisaema Rhizome), Erzhu (Cangzhu and Baizhu, i.e., Atractylodes Rhizomes), Huanglian (Coptis Rhizome), and Chuanxiong (Ligusticum Rhizome). For obese individuals with abundant internal fat/phlegm, use Daotan Tang (Phlegm-Guiding Decoction) added with Chuanxiong and Huanglian, omitting Dihuang (Rehmannia Root), because Dihuang is cloying and would obstruct the chest and diaphragm.

Lou Quanshan said: Female amenorrhea can be caused by foul blood stagnating at the Baomen, accompanied by lower abdominal pain, presenting with either heat or cold symptoms. If the amenorrhea is due to heat, one may use Luo Qianfu's Xuexi Gao (Blood Extremity Ointment), which consists solely of Dahuang (Rhubarb Rhizome) ground into powder and boiled with vinegar into an ointment. This treats female Ganxue Qi (Dry Blood Syndrome), promoting one or two bowel movements, after which menstrual blood naturally flows; it can be considered a miraculous medicine for women. Zhang Zhongjing's Didang Tang (Resolutely Overcome Decoction) also treats irregular menstruation in women. Tao Ren Jian (Peach Kernel Decoction) from *Qianjin Fang* (*Essential Prescriptions Worth a Thousand Gold*) treats amenorrhea caused by blood accumulation. If cold congeals foul blood preventing menstruation, Yunqi's Honghua Danggui San (Safflower and Angelica Powder) can be used to treat amenorrhea in married or unmarried women, or lower abdominal pain caused by accumulated stasis.

Shenzhen commented: The above three cases describe female amenorrhea resulting from accumulated phlegm and foul blood, leading to the cessation of menstruation. This is a disease caused by excess pathogenic factors (excess evil). The primary treatment should focus on guiding out phlegm and expelling stasis.

*Neizhao Jing* (*Internal Illumination Classic*) states: Amenorrhea in women is a disorder of blood stagnation. Tracing it to its root, it arises from the failure of Heart Qi to circulate freely. Therefore, instead of directly treating the blood, one should treat the Heart.

Zhu Danxi said: The medical classics state, "When Qi forces upward against the Lung, Heart Qi cannot descend smoothly," thus causing amenorrhea. The classics also state, "Amenorrhea occurs because the Baomai (Uterine Vessels) are closed."