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The *Ping Re Bing Lun* (Treatise on Evaluating Heat Diseases) states: "When menstruation does not occur, it is due to the closure of the Bao Mai (uterine vessels). The Bao Mai belongs to the Heart and connects with the Bao Zhong (uterus). Now, if Qi rises upward and presses upon the Lung, the Qi of the Heart cannot descend and communicate smoothly, thus menstruation does not occur."

The *Yin Yang Bie Lun* (Treatise on Distinguishing Yin and Yang) states: "Diseases of the Two Yang (Stomach and Large Intestine) originate from the Heart and Spleen. If there are difficulties in intimate matters or hidden grievances, women will experience amenorrhea. If this transmits into 'Feng Xiao' (wind wasting, describing emaciation), or transmits into 'Xi Ben' (accumulated Qi causing dyspnea), death ensues; it is incurable."

The *Xie Qi Zang Fu Bing Xing Pian* (Chapter on Pathogenic Factors and Manifestations of Zang-Fu Diseases) states: "A faint and choppy Kidney pulse indicates amenorrhea."

Blood deficiency (Xue Ku) and blood stagnation/blockage (Xue Ge) are inherently different. "Ge" refers to obstruction; "Ku" refers to exhaustion. Obstruction arises from pathogenic factors blocking flow, causing blood to逆流 (regurgitate/rebel); exhaustion arises from the depletion and failure of the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel), where the source of the stream is cut off. In cases of chronic illness in women lasting months or half a year, amenorrhea invariably follows. Precisely because Yin fluids are exhausted, blood becomes dry. The meaning of "dry" implies a state devoid of blood. Therefore, patients may present with emaciation, fatigue, cough, night fevers, reduced appetite, history of hemorrhage or blood loss, and generally without abdominal distension or pain, nor any sense of blockage or obstruction, yet menstruation has been absent for a long time. These are all signs of amenorrhea due to blood exhaustion. To prevent further drying, nothing is better than nourishing Ying Blood (Nutritive Blood); to restore flow, nothing is better than replenishing the source. Just as melting snow brings spring water naturally, when blood is abundant, the meridians flow freely. With a surging source, who could possibly obstruct it? Regrettably, current practitioners, regardless of whether there is stagnation or not, often incorporate herbs that promote opening and guiding. In severe cases, they rely exclusively on herbs like Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos), focusing on purgative and unblocking actions. They fail to realize that while stagnant blood can be unblocked, exhausted blood cannot be forcibly moved. Once blood is exhausted, forcing it to move only exhausts it further; what difference is there from squeezing out the last drop of juice? This error stems from a misunderstanding of the term "exhaustion," causing significant harm. One must avoid this pitfall. The treatment method here should be considered in conjunction with the preceding sections on Blood Deficiency and Kidney Deficiency.

Kou Zongshi stated: "Human life is rooted in Qi and Blood. Disease invariably begins by damaging Qi and Blood. For unmarried youths, persistent thoughts accumulate in the heart. Excessive worrying and thinking often lead to consumptive disorders. In men, spirit and luster dissipate; in women, menstruation ceases first. Worry and sorrow injure the Heart, causing blood to rebel and Qi to exhaust, leading to the dissipation of spirit and cessation of menstruation. Furthermore, Heart disease fails to nourish the Spleen, resulting in poor appetite; Spleen deficiency leads to Lung Metal deficiency, causing cough; when Kidney Water is exhausted, Liver Wood fails to receive nourishment, leading to dry and flaccid limbs, irritability, scorched hair, and weak sinews and bones. If the disease transmits through all five Zang organs, death is inevitable. This type is among the most difficult to treat within consumptive diseases. Since the pathology originates within the five Zang organs, there is no definite timeline for recovery, and medicinal force may be insufficient. However, if the patient can change their mindset, followed by medicinal support and connection, one might achieve a one-in-nine chance of survival. Taking this as an example, other formulas can be applied according to pulse and syndrome differentiation."

Zhang's commentary states: "For young women with prolonged amenorrhea, Qing Hao (Artemisiae Annuae Herba) and other cooling herbs must strictly be avoided. Many physicians assume young women have blood heat and use cooling herbs to resolve it. They do not understand that blood flows when warm and coagulates when cold. This view is elaborated in detail in *Yang Sheng Bi Yong Fang* (Essential Formulas for Health Preservation) and is highly reasonable; it must not be ignored. If menstruation is scanty and gradually stops, accompanied by vexing pain in the hands, feet, bones, and muscles, progressive emaciation, and emerging tidal fever, with a faint and rapid pulse, this is caused by Yin deficiency and blood weakness, allowing Yang to invade. Little water cannot extinguish strong fire; fire forces water to dry up, consuming body fluids. Treatment should focus on nourishing blood and benefiting Yin. Do not use toxic drugs to forcibly induce menstruation. It is appropriate to use Baizi Ren Wan (Bai Zi Ren Pill) or Ze Lan Tang (Ze Lan Decoction)."

Li Ji (Xue Ji) stated: "Menstrual blood is Yin blood, governed by the Chong Mai and Ren Mai. It transforms upwards into milk and downwards into menstrual blood. Its disorders arise from various causes: those caused by Spleen-Stomach deficiency failing to generate blood require regulation and tonification; those caused by Spleen depression injuring blood requiring resolution and tonification; those caused by Stomach Fire scorching blood requiring clearing and tonification; those caused by labor injuring the Heart with blood deficiency requiring quietude and tonification; those caused by anger injuring the Liver with blood deficiency requiring harmonization and tonification; those caused by Kidney Water deficiency failing to generate Liver blood requiring tonification of the Spleen and Lung; and those caused by Lung Qi deficiency failing to move blood requiring tonification of the Spleen and Stomach. The Classics state: 'Damage to the Lung benefits its Qi; damage to the Heart regulates Ying and Wei; damage to the Spleen regulates diet and adjusts to cold and warmth; damage to the Liver soothes its interior; damage to the Kidney benefits its Essence.' Examining these carefully before treating ensures no errors. Grain enters the Stomach, transforms into blood, nourishes the four extremities, and internally sustains the five Zang and six Fu organs. If bitter-cold agents are taken, further damaging Stomach Qi, it will inevitably lead to untreatable conditions."