血瘀成 瘕，旋即经闭，因而枯涸，此乃血将枯而先瘀，非以瘀而枯也。但问经水未断之前，所下无若秫米、绿豆
大瘀块者，即以纯虚论，何也。瘀块皆小于绿豆，下之时极痛，此乃脉隧之瘀，结于血管，以妨新血之生，最为大害，
虽其人极虚，亦宜亟破之。今无是证，虽曾有瘀块，现有 瘕，皆置勿论，但补其枯，血液既生，瘀者自化，即不然，
缓以治之，弗为害也。若先攻之，于人无益，虚者反加损矣。故治之但以归脾汤，如鹿茸、阿胶、麦冬，如“调经门”
中经水两月一至第六条法。倘肝郁而逆者，参服逍遥散，去白术、柴胡，加贝母、竹茹、石决明之属。
（〔批〕上条名为血瘀，实是血枯。此条名为血枯，实系经闭。总见参伍错综，精辨施治不可疏忽。下条亦同。盖经
闭一候实不易辨，往往误治致死，故一再言之，而列于血枯一门之首。）
妇人方壮强，经水断，无寒热，历年不愈，人疑为血枯，非也。肾水不足，而心脾之气不舒也。滋水源，辞气郁，
佐以调血，备大法。
大熟地 白归身 盐杜仲 贝母 山药 牛膝 女贞子 山萸肉 细抚芎 白芍 木香 芥穗
其人尺脉旺，精气足者，但交其心肾，相火太旺者，加黄柏炭。
远志筒 茯神 首乌藤 酒白芍 炒枣仁 贝母 细抚芎
Blood stasis forms a mass (zhajia, abdominal mass), followed immediately by amenorrhea, leading to exhaustion. This is blood becoming exhausted and stagnating first, not exhaustion caused by stasis. One should inquire whether, before the menstrual flow ceased, any expelled clots were as large as millet or mung beans. If not, it should be treated as a pure deficiency syndrome. Why? If the clots are smaller than mung beans and extremely painful upon expulsion, this indicates stasis in the pulse channels, knotted within the blood vessels, hindering the generation of new blood, which is most harmful. Even if the person is extremely deficient, urgent resolution of stasis is indicated. However, since these symptoms are absent now, even if there were previous clots or current masses, they may be disregarded for the moment. Focus solely on tonifying the exhaustion; once blood is generated, stasis will resolve naturally. Even if not, treating slowly will cause no harm. Attacking stasis first benefits no one and further damages the deficient. Therefore, treatment should only employ Guipi Tang (Restore the Spleen Decoction), adding such herbs as Lurong (Cervus Nippon Antler Gelatin), Ejiao (Donkey-Hide Gelatin), and Maidong (Ophiopogon Tuber). Refer to the sixth method in the "Menstrual Regulation Section" regarding menstruation occurring once every two months. If liver qi stagnation with counterflow exists, combine with Xiaoyao San (Free and Easy Wanderer Powder), removing Baizhu (Atractylodes Macrocephala Rhizome) and Chaihu (Bupleurum Root), and adding Beimu (Fritillaria Bulb), Zhuru (Bamboo Shavings), and Shijueming (Concha Arcae), etc.
([Comment] The preceding article is named Blood Stasis but is actually Blood Exhaustion. This article is named Blood Exhaustion but is actually Amenorrhea. It demonstrates that conditions are complex and interwoven; precise differentiation and treatment must not be negligent. The following article is similar. Amenorrhea is indeed difficult to differentiate, often leading to fatal misdiagnosis and treatment, hence repeated emphasis and its placement at the head of the Blood Exhaustion section.)
A woman in her prime strength experiences amenorrhea without chills or fever, persisting for years. People suspect Blood Exhaustion, but this is incorrect. It is due to insufficient Kidney Water and constrained Heart and Spleen Qi. Tonify the Water source, relieve emotional constraint, assist with blood regulation, preparing the major methods.
Shudi (Prepared Rehmannia Root), Danggui Shen (Angelica Sinensis Root Body), Yanshen Duzhong (Salt-processed Eucommia Bark), Beimu (Fritillaria Bulb), Shanyao (Dioscorea Rhizome), Niuxi (Achyranthes Root), Nvzhenzi (Ligustrum Fruit), Shanzhuyu (Cornus Fruit), Xifu Xiong (Fine Ligusticum Chuanxiong Rhizome), Baishao (White Peony Root), Muxiang (Aucklandia Root), Jiesui (Saposhnikovia Root).
If the person’s Chi pulse is vigorous and essence and qi are sufficient, simply communicate between the Heart and Kidney. If Ministerial Fire is too vigorous, add Huangbo Tan (Charred Phellodendron Bark).
Yuanzhi Tong (Polygala Root Tube), Fushen (Poria with Hostwood), Shouwuteng (Polygonum Vine), Jiubaishao (Wine-processed White Peony Root), Chao Zaoren (Stir-fried Zizyphus Seed), Beimu (Fritillaria Bulb), Xifu Xiong (Fine Ligusticum Chuanxiong Rhizome).