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Wang Shuhe said: There was a woman who brought her daughter for consultation. The girl was fifteen years old. She stated that her menstruation had started naturally at fourteen, but now it had stopped. Why is this? The physician said: If this woman were to marry and bear children in the future, it would be because she had her first menstruation at fourteen; thus, this interruption is called "Bi Nian" (Avoidance Year), and menstruation will resume spontaneously afterward. This occurs because the primordial Qi is still weak and the constitutional endowment has always been frail. It is advisable to consolidate the congenital primordial Qi, causing Kidney Water to ascend and Heart Fire to descend, so that the Five Zang Organs will harmonize naturally, and the meridians and collaterals will flow freely.

*Shengji Zonglu* states: At the age of fourteen (two sevens), Tian Gui arrives in women, the Ren Mai becomes unobstructed, and menstruation occurs on time. If the constitutional endowment is insufficient, or if the Ren Mai is constrained by wind-cold pathogens, leading to the coagulation of wind qi, menstruation cannot occur on schedule. If left untreated for a long time, it may develop into a consumptive disease. One should not administer harsh blood-breaking medicines; instead, one should promote the circulation of Heart Qi, regulate Ying and Wei, and lubricate the meridians.

Dai Fu'an said: In some young girls, menstruation has occurred only once or twice, then stops for one or two years; or it occurs only once every four seasons, or returns after three to five months. This is originally due to weak and underdeveloped blood vessels, resulting in intermittent menstruation. It is appropriate to soothe Qi and nourish Blood; when Qi and Blood become robust, flow will restore itself. Do not use attacking methods.

Kou Zongshi said: Human life is based on Qi and Blood; no illness arises without first damaging Qi and Blood. If virgins or young men indulge in excessive fantasies and thoughts, it often leads to consumptive damage. In men, spirit and complexion dissipate; in women, menstruation closes first. Sorrow and worry damage the Heart, leading to blood exhaustion. Furthermore, Heart pathology fails to nourish the Spleen, resulting in poor appetite. Spleen deficiency leads to Lung metal deficiency (Earth failing to generate Metal), causing cough. When Kidney Water is exhausted, Liver Wood qi loses its nourishment, leading to dry and flaccid limbs and irritability. One should not use cooling and blood-moving herbs such as Qing Hao (Artemisiae Annuae Herba) or Meng Chong (Tabanidae); instead, Baizi Ren Wan (Bai Zi Ren Pill) and Zelan Tang (Ze Lan Decoction) should be used to benefit Yin and Blood to control deficient fire.

*Chanbao* states: Prolonged obstruction of the menstrual channels is no trivial matter but a serious illness. If it affects a virgin, it may initially stem from greedily consuming sour and salty foods, leading to dried-up blood vessels and evolving into a consumptive disease.

Wei Yilin said: Women experience the arrival of Tian Gui at fourteen and its depletion at forty-nine. Early onset of menstruation indicates a cunning nature; late onset indicates a dull nature. Only when menstruation flows smoothly can Yin and Yang harmonize, enabling conception. If menstruation does not begin between the ages of fourteen and twenty, life is like a candle in the wind, precarious from morning to night; if illness strikes, death ensues. Rarely do they survive—less than one in a hundred—and even then, they suffer from frequent illnesses throughout their lives. However, some menstruate once every four seasons, once a year, or never follow a regular cycle. If they develop masses or fixed pain in old age, it is difficult to treat.

Shenzhai commented: The above six passages describe the syndrome of amenorrhea in virgins. Amenorrhea in virgins differs from that in married women. Amenorrhea in virgins, if not caused by weak congenital Yuan Qi and underdeveloped Qi and Blood, is due to an inability to obtain a husband, unfulfilled desires, worry damaging the Heart, and depression injuring the Liver, resulting in the closure of menstruation and disease formation. Therefore, widows, nuns, and temple servants suffering from amenorrhea should be treated with the same methods. It is regrettable that predecessors did not discuss this.