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Women with amenorrhea (cessation of menstruation) may have it caused by damage to the Spleen and Stomach; one should not immediately diagnose it as blood stasis or consumption, nor lightly employ drugs that promote menstruation and break up blood stasis. When encountering such symptoms, one must examine the condition of the Spleen and Stomach. If the Spleen and Stomach are damaged due to improper diet or overexertion, leading to poor appetite, aversion to food, diarrhea, and pain; or if they are damaged by the mistaken use of diaphoretic or purgative drugs, injuring the Middle Qi, resulting in insufficient blood that fails to flow, then only nourishing and tonifying the Spleen and Stomach is appropriate. Use *Baizhu* (Atractylodis Rhizoma) as the sovereign drug, *Fuling* (Poria) and *Shaoyao* (Paeoniae Radix) as minister drugs, assisted by *Huangqi* (Astragali Radix), *Gancao* (Glycyrrhizae Radix et Rhizoma), *Chenpi* (Citri Reticulatae Pericarpium), *Maiya* (Hordei Fructus Germinatus), *Chuanxiong* (Ligustici Chuanxiong Rhizoma), *Danggui* (Angelicae Sinensis Radix), and *Chaihu* (Bupleuri Radix). When the Spleen is robust, it can generate blood, and menstruation will flow naturally. There are also cases where food stagnation damages the Spleen and Stomach; in these cases, eliminating stagnation and tonifying the Spleen is also suitable. Only if the Spleen and Stomach are healthy but there is indeed a凝结 of blood masses (blood stasis) should one employ methods to move blood and unblock menstruation.

I note: The Classic states, "When food enters the Stomach, its essence floats and overflows, being transported upward to the Spleen. The Spleen scatters the essence, which returns upward to the Lung. The Lung regulates the water passages, transporting them downward to the Bladder. Water and essence are distributed throughout the body, and the five meridians proceed together." It also states, "Disease of the Yangming (Two Yangs) originates from the Heart and Spleen; when there is 'inability to express hidden desires' (emotional constraint), women experience amenorrhea. 'Two Yangs' refers to the Yangming Stomach and Large Intestine." Therefore, when the Heart and Spleen are harmonious, the bones and five Zang organs are moistened, and menstruation is regular. If the Heart and Spleen are injured, blood lacks nourishment and control, leading to irregular menstruation. Thus, regulating menstruation should primarily focus on regulating the Heart and Spleen. Mr. Danxi also said, "Menstruation arriving early is due to blood heat; menstruation arriving late is due to blood deficiency." I believe that early menstruation can be caused by dryness of blood in the Spleen meridian, depression-fire in the Spleen meridian, anger-fire in the Liver meridian, heat in the blood level, or fire movement due to overexertion. Late menstruation can be caused by blood deficiency in the Spleen meridian, blood deficiency in the Liver meridian, or Qi deficiency and weak blood. The treatment methods are: for Spleen meridian blood dryness, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); for Spleen meridian depression-fire, use Guipi Tang (Restore the Spleen Decoction); for Liver meridian anger-fire, use Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction); for heat in the blood level, use Jiawei Siwu Tang (Modified Four Substances Decoction); for fire movement due to overexertion, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for Spleen meridian blood deficiency, use Renshen Yangrong Tang (Ginseng Nourishing the Vigor Decoction); for Liver meridian blood deficiency, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill); for Qi deficiency and weak blood, use Bazhen Tang (Eight Treasures Decoction). Since blood is born from Spleen Earth, it is said that the Spleen controls blood. For all blood diseases, bitter and sweet agents should be used to assist Yang Qi and generate Yin blood. Generally, for Liver-Spleen blood dryness, Siwu Tang is primary; for Liver-Spleen blood weakness, Buzhong Yiqi Tang is primary; for Liver-Spleen depression-fire, Guipi Tang is primary; for Liver meridian anger-fire, Jiawei Xiaoyao San is primary. Etiologies are numerous and cannot be exhaustively listed; treatment should be adapted to the specific clinical presentation.

A woman suffered from afternoon fever, emaciation and fatigue of the limbs, poor appetite with no taste, amenorrhea, occasional epistaxis (nosebleed), or metrorrhagia (uterine bleeding), lasting for half a year. Treatments using Qi-regulating, heat-clearing, and hemostatic agents were ineffective, worsening her chills and fever, and causing frequent nausea. I diagnosed this as damage to the Spleen and Stomach due to depression and anger, with deficient fire causing erratic blood flow. Therefore, she took Buzhong Yiqi Tang in the morning and Liuwei Dihuang Wan in the evening. After several doses of each, she recovered after half a year.

Another woman, who was naturally quiet, suffered from afternoon fever and internal heat, with irregular menstruation. Later, every one or two months, she would bleed about a bowl's worth from between her teeth, under her tongue, or in her throat. This persisted for over a year. Her condition worsened after taking heat-clearing, blood-cooling, and regulating medicines. She sought my treatment. I diagnosed it as Liver and Spleen Qi depression with rising blood heat. I first prescribed Jiawei Guipi Tang, followed by Jiawei Xiaoyao San. This drew the blood back to its source, regulating menstruation and instantly resolving previous symptoms.

An unmarried girl, aged seventeen, suddenly developed a red spot on the outer side of her leg, which was itchy. Scratching it caused profuse bleeding like a gush, and many flying insects appeared. Upon inquiry, she experienced chills and fever beforehand, with nodules appearing below both ears. The outer leg and area below the ears belong to the Gallbladder Meridian. The Gallbladder is the Fu organ of the Liver; the Liver governs Wind. Heat generates worms, and blood flows erratically when exposed to wind. Excessive Liver Fire caused the bleeding, indicating deficiency of both Yin and Yang in the Liver and Gallbladder. For deficiency diseases, tonify the mother organ. Kidney is the mother of Liver. Use Liuwei Wan to nourish Kidney Water to generate Liver Wood, combined with Siwu Tang, Chaihu, Zhizi (Gardeniae Fructus), and Gouteng (Uncariae Ramulus cum Uncis) to generate Liver Blood, suppress Wind-Heat, and achieve recovery.