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Ye Yiqian stated: Blood stasis (Xue Zhi) and blood deficiency (Xue Ku) do not exceed the four syndromes of deficiency-heat (Xu Re), phlegm (Tan), and qi (Qi). Blood stasis may also involve deficiency-heat, and blood deficiency may also involve deficiency-heat. Therefore, for cases of stasis, it is inappropriate to use overly promoting and unblocking methods; after unblocking, one must nourish blood and benefit yin (Yang Xue Yi Yin) to ensure the free flow of body fluids (Jin Ye) and blood. For cases of deficiency, one should not use drastic tonifying agents, lest the root constitution be too weak to bear them. Moreover, acrid-hot (Xin Re) preparations would instead dry up essence and blood (Jing Xue).

Zhang Jingyue stated: Liver disease causing blood injury presents similarly to blood obstruction (Xue Ge), both manifesting as amenorrhea (Jing Bi). However, "deficiency" (Ku) and "obstruction" (Ge) are as different as ice and charcoal. "Deficiency" means exhaustion, indicating extreme blood deficiency. "Obstruction" means blockage; the blood itself is not deficient, but due to qi stagnation or cold pathogen, or accumulation, there is some reversal and blockage. Obstruction arises suddenly, with symptoms of pain or excess; unblocking leads to recovery. In contrast, deficiency develops gradually, with internal exhaustion of the Chong and Ren vessels (Chong Ren Er Mai), presenting without fixed morphological signs. Since the blood is already depleted, one should tonify and nourish yin qi so that blood naturally replenishes. If one were to use peach kernel (Tao Ren), safflower (Hong Hua), mirabilite (Xiao Shuang), rhubarb (Da Huang), polygonum ziziphoides (Leng Sui Gen), and curcuma zedoaria (E Zhu), this would further attack the healthy qi, causing the deficient state to worsen, with death imminent.

Chen Liangfu stated: Amenorrhea due to blood stasis suitable for blood-breaking treatment arises from dietary toxicity and heat, or violent anger causing blood stasis condensation and phlegm accumulation. One must directly use substances like rhubarb (Da Huang) and dried lacquer (Gan Qi) to eliminate the old and generate the new, allowing old blood to dissipate and new blood to arise. If qi is robust but blood is deficient, originating from overwork and worry/thought, gentle and tonifying methods are appropriate. If accompanied by phlegm-fire or damp-heat, clearing and cooling methods are especially suitable. Cinnamon twig (Rou Gui) is often used as an assistant herb because heat promotes blood circulation. However, one must not rely solely on drastic drugs, as this would impair the way of yin-blood. Harmonizing diet will naturally allow qi and blood to circulate freely. If one neglects to nourish qi and blood, relying only on toxic drugs to attack, it is like seeking a thousand gold coins from a beggar; death is the inevitable outcome.

Shenzhai commented: The above five passages outline the differentiation between blood stasis and blood deficiency in female amenorrhea. Blood stasis belongs to the category of excess (You Yu); excess conditions require purgation (Xie). This refers to the wind-cold, fire-heat, accumulated phlegm, and foul blood discussed previously under *Jin Gui Yao Lue*, caused by external and internal factors. Blood deficiency belongs to the category of insufficiency (Bu Zu); insufficiency conditions require tonification (Bu). This refers to heart qi insufficiency, blood deficiency with liver injury, spleen decline, and kidney depletion discussed previously under *Nei Zhao*, which develop gradually. The causes of stasis and deficiency do not extend beyond these few aspects, and those regulating menstruation can understand them by analogy.