洁古曰∶经言月事不来者，胞脉闭也。胞脉属于心，络于胞中，今气上迫肺，心气不得下通，故月事
不来。先服降心火之剂，如芩连四物汤、三和汤去硝黄。后服局方五补丸。后以卫生汤治脾养血也。李氏论经
闭有二∶曰血滞血枯。如经行时余血一点未净，或外感风寒，内伤生冷，七情郁结，为痰为瘀，凝窒经络，
为血滞。或经尽后，劳伤冲任，咳嗽骨蒸，火逼水涸，为血枯。
血滞经闭，如当归散、元归散以破瘀，加味导痰汤以涤痰，滞去则经通。若血枯经闭，多主伤肝。《素问》云∶
有病胸胁支满，妨于食，病至则先闻腥臊臭，出清液，先唾血，四肢清，目眩，时时前后血，病名血枯。此
得之年少时有所大脱血，若醉入房中，气竭肝伤，故月事衰少不来也。治以四乌 骨、一芦茹，二物并合之，
丸以雀卵，大如小豆，日干。以五丸为后饭，饮以鲍鱼汁。利肠中及伤肝也。盖胸胁支满，肝病也。妨食、肝
病传脾也，故闻腥臊臭，出清液，肝病肺乘也。故唾血，四肢清，目眩、肝血伤矣。芦茹即茜根，能散血。
后饭，先药也。鲍鱼汁利肠垢，和肝伤，取臭秽以佐乌 骨辟宿瘀也。有因饮食劳倦，损伤脾胃者。节斋云∶只
宜补养脾胃。白术为君，茯苓、芍药为臣，佐以黄 、甘草、陈皮、麦芽、川芍、当归、柴胡。脾能生血，
经自行矣。有因思郁致损心血者，寇宗 云∶童男室女，积想在心，思虑过度，男则神色消散，女则月水先闭。
盖忧愁思虑，多伤心脾，故神衰食减。火炎烁金，肺金燥，肾水绝，木气失荣，四肢干痿，五脏传遍，死矣。能
改易心志，用药扶持，宜柏子仁丸、泽兰汤。益阴制火，忌青蒿、虻虫等凉血行血。凡经闭因血滞者，多凝瘀
积痰，牛膝散、导痰汤。若胃热消渴，津液燥竭，玉烛散。若思郁成损，归脾汤。潮热骨蒸，加味逍遥散加熟
地、龟板。室女经行复闭，羸热成劳，肝脉弦出寸口上鱼际者，急与婚配。宜加味小柴胡汤。若干嗽，地黄汤
去丹、泽。加甜杏仁、五味、白芍、贝母。妇人经少渐闭，五心烦热，肌削脉数，乃阴虚阳乘，当养血益阴。
人参固本丸。下利而经断者，利止经自来，若脉微涩，虽经止二三月不行，亦非胎，养血经自行也。
〔经早〕先期至者主血热。加味四物汤添鲜藕、红枣。立斋分肝经血燥者，加味逍遥散。脾经郁滞者，
归脾汤。肝经怒火者，加味小柴胡汤。血分有热者，加味四物汤。劳役动火者，补中益气汤。景岳分血赤脓紫，
脉洪多火而经早者，清化饮。微火阴虚，内热动血者，保阴煎。脉证无火，心脾不摄，经亦早者，小营煎、七
福饮，加杜仲、五味子。若一月二三至者，乃气血败乱。当调其寒热虚实，不得以经早血热概之。大约血热者，
腹多不痛，其
来必多。固经丸加生地黄、芍药。
〔经迟〕后期至者主血虚。加味五珍汤。立斋分脾经血虚者，人参养营汤。肝经血少者，地黄汤。气血
俱弱者，八珍汤。景岳分血淡不鲜，脉微迟无火而后期者，大营煎。亦有阴火内烁，血本热而仍后期者，
乃水亏血少，加味四物汤、地黄丸。过期作痛者，气血两虚，八珍汤加木香。肥人过期色淡为痰。二陈汤加
芎、归、贝母。大约血虚者，腹多空痛，脉大无力或濡细。八物汤加香附。
〔经乱〕迟早无定，乍前乍后，多因心肺虚损，滋血汤。或因受惊，气乱经亦乱者，茯神、枣仁、柏子
仁、麦冬、下归附丸。或气盛于血，不受孕者，抑气散。景岳分三阴亏，兼阳虚者，大营煎去牛膝。忧思损
心脾者，归脾汤、七福饮。食少脾不健运，宜温燥者，理中汤、六君子汤。脾虚不摄，为淋漏者，保元汤加杜
仲、芡实、牡蛎。肝虚不藏，多惊惕者，补肝散去独活、木瓜，加茯神。情志不遂，肝脾气结，经期乱者，
逍遥饮。
〔经痛〕有经前身痛拘急者，散其风，越痛散加秦艽。有经前腹痛畏冷者，温其寒。调经饮加姜、桂、
茴香。气滞者，行其滞，加味乌药汤。血瘀者逐其瘀，通瘀煎。气血 结者，理其络，失笑散。 瘕痞胀者，
调其气血，交加地黄丸。虚寒急痛者，温其里，五物煎。痛在经后者，补其虚，八珍汤加香、砂。一切心
腹攻筑，胁肋刺痛，月水失调者，和其肝，元胡索散加枳壳。经滞脐腹，痛不可忍者，导其壅，琥珀散，从
《本事方》改订，并治产后恶露不快，血上抢心，迷闷不醒，气绝欲死。《金匮》云∶妇人腹中痛，当归芍
药汤主之。此补中泻木。又云∶妇人腹痛，小建中汤主之。此亦补脾伐肝之意。
〔经色〕凡经以色红为正，其紫者风也，四物汤加荆、防、白芷。黑者热甚也，四物汤加芩、连。紫黑
兼腹痛者，气血并也，四乌汤加蓬术、川连。不痛者，但加川连。淡白者，虚而兼带也，芎归汤加参、 、术、
芍。赤白兼脐腹冷痛者，虚寒也，伏龙肝汤。如米泔水，如屋漏水，或带黄，混浊模糊者，湿痰也，六君子汤
加苍术、香附。如豆汁者，热也，四物汤加丹参、丹皮。成
块成片者，血随气凝，或风冷乘之也，通瘀煎去泽泻。风入胞门，忽崩鲜血，一味防风丸、旋夏花汤下。
〔倒经〕经期气逆，直犯清道而为吐衄，折其逆势而调之。用山栀、丹皮、生地、丹参、白芍、苏子、
郁金、童便。或用四物汤和韭汁，童便服。因怒火伤肝致逆者，龙胆、丹皮、青皮、黄芩、白芍、山栀。
因心气不足，衄血面黄者，茯苓补心汤。
〔居经〕三月一行为居经，俗名按季。或由脉微，气血俱虚。或由寸口脉微而涩，少阴脉微而迟。或由
阳脉浮大，阴脉反弱。又一岁一行者为避年，此因禀受不齐，勿与经闭同治。
〔淋沥不止〕症多气不摄血，止经汤加参、 。子宫虚寒淋沥，胶艾四物汤。血分有热不断，蒲黄散。
〔乍多乍少〕经水过多，当归饮。过多淋沥，胶艾四物汤，或保元汤。经水涩少，四物加葵花汤。
Jieguo stated: The medical classics record that when menstruation does not occur, it is due to the closure of the Baomai (uterine vessels). The Baomai belongs to the Heart and connects with the Baogong (uterus). Now, if Qi rebels upward and presses upon the Lung, the Qi of the Heart cannot descend and communicate downward, thus menstruation does not come. First, administer formulas that descend and clear Heart Fire, such as Qinlian Siwu Tang (Scutellaria and Coptis Four Substances Decoction) or Sanhe Tang (Three Harmonies Decoction) without Mangxiao (Mirabilite) and Dahuang (Rhubarb). Later, administer Ju Fang Wubu Wan (Bureau Formula Five Tonics Pill). Finally, use Weisheng Tang (Health Preservation Decoction) to regulate the Spleen and nourish Blood.
Li discussed amenorrhea in two categories: Xue Zhi (Blood Stasis) and Xue Ku (Blood Depletion). For instance, if a trace of residual blood remains after menstruation, or if one contracts external Wind-Cold, injures oneself internally with cold/raw foods, or suffers from emotional stagnation transforming into Phlegm or Blood Stasis that obstructs the meridians, this is called Xue Zhi (Blood Stasis). Or, after menstruation ends, if labor damages the Chong and Ren vessels, leading to coughing and bone-steaming fever, where Fire scorching fluids leads to depletion, this is called Xue Ku (Blood Depletion).
For amenorrhea caused by Xue Zhi (Blood Stasis), use Danggui San (Angelica Powder) or Yuangui San to break up stasis, and Jiawei Daotan Tang (Modified Phlegm-Draining Decoction) to drain phlegm; once the stasis is removed, menstruation will flow freely. If amenorrhea is caused by Xue Ku (Blood Depletion), it mostly pertains to Liver injury. The *Suwen* states: "There is a disease characterized by fullness and distension in the chest and hypochondrium, interfering with eating; before the illness strikes, the patient smells fishy and foul odors, secretes clear fluid, expectorates blood first, experiences cold limbs, dizziness, and frequent bleeding from both bowels and urine. This disease is named Xue Ku (Blood Depletion)." This results from significant blood loss in youth, or sexual intercourse while intoxicated, causing Qi exhaustion and Liver injury, thus menstruation becomes scanty or ceases. Treatment uses Si Wuie Gu Yi Lu Ru Fang (Four Parts Cuttlebone One Part Rubia Decoction), combining these two herbs, formed into pills with quail eggs, sized like small beans, taken dry daily. Take five pills after meals, washed down with Abalone Juice. This benefits the intestines and repairs Liver damage. Fullness in the chest and hypochondrium indicates Liver disease; interference with eating indicates Liver disease transmitting to the Spleen, hence smelling fishy odors and secreting clear fluid indicates Liver disease overacting on the Lung; expectorating blood, cold limbs, and dizziness indicate Liver Blood injury. Lu Ru is Qian Cao Gen (Rubia Root), which disperses blood stasis. "Hou fan" means taking medicine after eating. Abalone juice clears intestinal turbidity and harmonizes Liver injury; its foul odor assists the Cuttlebone in expelling old stasis.
There are also cases due to dietary irregularity and fatigue damaging the Spleen and Stomach. Jiezai said: Only tonify and nourish the Spleen and Stomach are suitable. Use Baizhu (Atractylodes Macrocephala Rhizome) as the Sovereign herb, Fuling (Poria) and Shaoyao (Peony Root) as Ministers, assisted by Huangqi (Astragalus Root), Gancao (Licorice Root), Chenpi (Tangerine Peel), Maiya (Malt), Chuanxiong (Sichuan Lovage Rhizome), Danggui (Angelica Sinensis Root), and Chaihu (Bupleurum Root). When the Spleen can generate Blood, menstruation will naturally resume.
There are also cases due to worry and depression damaging Heart Blood. Kou Zongsu said: Unmarried men and women, harboring excessive thoughts, suffer from overthinking; men lose their spirit and luster, while women experience early cessation of menstruation. Since sorrow and worry mostly injure the Heart and Spleen, Spirit declines and appetite decreases. If Fire flares up and scorches Metal, the Lung Metal becomes dry, Kidney Water is exhausted, Wood Qi loses nourishment, limbs become dry and atrophic, and transmission among the Five Viscera leads to death. If one can change their mindset and support with medication, use Baizi Ren Wan (Biota Seed Pill) or Zelan Tang (Lycopus Decoction). The aim is to nourish Yin and control Fire; avoid Qinghao (Artemisia Annua Herb) and Mengchong (Leech) etc., which cool blood and move blood.
Generally, amenorrhea due to Blood Stasis involves accumulated stasis and phlegm; Niuxi San (Achyranthes Powder) or Daotan Tang (Phlegm-Draining Decoction) are used. If due to Stomach Heat and Xiao Ke (Wasting-Thirst) with dry exhaustion of body fluids, Yuzhu San (Jade Candle Powder) is used. If due to worry-depression causing damage, Guipi Tang (Restore the Spleen Decoction) is used. If there is tidal fever and bone-steaming, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Shudihuang (Prepared Rehmannia Root) and Guiban (Tortoise Shell) is used. For maidens whose menstruation stops again after starting, becoming emaciated with fever forming consumptive disease, if the Liver pulse is wiry and extends above the cun position to the yuji area, urgent marriage is recommended to relieve stagnation. Use Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction). If accompanied by dry cough, use Dihuang Tang (Rehmannia Decoction) removing Mudanpi (Moutan Bark) and Zexie (Alisma Rhizome), adding Tian Xingren (Sweet Apricot Seed), Wuweizi (Schisandra Fruit), Baishao (White Peony Root), and Beimu (Fritillaria Bulb). For women with gradually decreasing menstruation leading to amenorrhea, with five-center heat, emaciation, and rapid pulse, this is Yin deficiency with Yang hyperactivity; nourish Blood and benefit Yin using Renshen Guben Wan (Ginseng Root-Firming Pill). If diarrhea occurs with cessation of menstruation, menstruation returns when diarrhea stops; if the pulse is faint and choppy, even if menstruation has ceased for two to three months, it is not pregnancy; nourishing Blood will allow menstruation to resume naturally.
[Early Menstruation] Menstruation arriving early is primarily due to Blood Heat. Use Jiawei Siwu Tang (Modified Four Substances Decoction) with fresh lotus root and red dates. Lizhai categorized Liver Meridian Blood Dryness using Jiawei Xiaoyao San; Spleen Meridian Stagnation using Guipi Tang; Liver Meridian Fire Anger using Jiawei Xiaochaihu Tang; Blood Level Heat using Jiawei Siwu Tang; and fatigue-induced Fire using Buzhong Yiqi Tang. Jingyue categorized bright red/purple blood with surging pulse indicating excess Fire and early menstruation using Qinghua Yin (Clear Transformation Drink); slight Fire with Yin deficiency and internal heat moving Blood using Bao Yin Jian (Preserve Yin Decoction); no Fire signs in pulse/symptoms but Heart-Spleen failing to contain Blood with early menstruation using Xiaoying Jian (Small Camp Decoction) and Qifu Yin (Seven Blessings Drink) plus Duzhong (Eucommia Bark) and Wuweizi (Schisandra Fruit). If menstruation occurs two or three times a month, this is chaotic Qi and Blood. Regulate Cold/Heat and Deficiency/Excess; do not generalize all early menstruation as Blood Heat. Generally, Blood Heat cases have little abdominal pain and heavy flow. Use Gujing Wan (Stabilize Menses Pill) with Shengdihuang (Raw Rehmannia Root) and Shaoyao (Peony Root).
[Late Menstruation] Menstruation arriving late is primarily due to Blood Deficiency. Use Jiawei Wuzhen Tang (Modified Five Precious Decoction). Lizhai categorized Spleen Meridian Blood Deficiency using Renshen Yangying Tang (Ginseng Nourishing Ying Decoction); Liver Meridian Blood Scarcity using Dihuang Tang (Rehmannia Decoction); Qi and Blood both weak using Bazhen Tang (Eight Treasures Decoction). Jingyue categorized pale blood, faint/slow pulse without Fire and late menstruation using Daying Jian (Great Camp Decoction). There are also cases of internal gnawing by Yin Fire, where Blood is originally hot but still late, due to Water deficiency and Blood scarcity; use Jiawei Siwu Tang and Dihuang Wan (Rehmannia Pill). If pain occurs after delay, it is Qi and Blood dual deficiency; use Bazhen Tang with Muxiang (Aucklandia Root). In obese individuals, delayed and pale menstruation is due to Phlegm; use Erchen Tang (Two Aged Herbs Decoction) with Xiong (Chuanxiong), Gui (Danggui), and Beimu (Fritillaria). Generally, Blood Deficiency presents with empty abdominal pain, large/weak or soggy/thin pulses; use Bawu Tang (Eight Substances Decoction) with Xiangfu (Cyperus Rhizome).
[Irregular Menstruation] Irregular timing, sometimes early, sometimes late, is mostly due to Heart-Lung deficiency; use Zixue Tang (Nourish Blood Decoction). Or due to fright, where Qi chaos causes menstrual chaos; use Fushen (Poria with Hostwood), Zaoren (Ziziphus Seed), Baiziren (Biota Seed), Maidong (Ophiopogon Tuber), and Xiagui Fu Wan. Or if Qi exceeds Blood, preventing conception; use Yiqi San (Suppress Qi Powder). Jingyue categorized Three Yin deficiency with Yang deficiency using Daying Jian removing Niuxi (Achyranthes Root); worry-sorrow damaging Heart-Spleen using Guipi Tang and Qifu Yin; poor appetite and Spleen failure to transport using warm/drying formulas like Lizhong Tang (Regulate Middle Decoction) or Liujunzi Tang (Six Gentlemen Decoction); Spleen deficiency failing to contain Blood causing dripping leakage using Baoyuan Tang (Protect Origin Decoction) with Duzhong, Qianshi (Euryale Seed), and Muli (Oyster Shell); Liver deficiency failing to store Blood causing palpitations using Bugan San (Tonify Liver Powder) removing Duhuo (Angelica Pubescens Root) and Mugua (Chaenomeles Fruit), adding Fushen; emotional frustration causing Liver-Spleen Qi knotting and menstrual irregularity using Xiaoyao Yin (Free and Easy Wanderer Drink).
[Dysmenorrhea] For body pain and stiffness before menstruation, disperse Wind; use Yue Tong San (Overcome Pain Powder) with Qinjiao (Gentiana Macrophylla Root). For abdominal pain and aversion to cold before menstruation, warm Cold; use Tiaojing Yin (Regulate Menses Drink) with Jiang (Ginger), Gui (Cinnamon Twig), and Huixiang (Fennel Fruit). For Qi stagnation, move stagnation; use Jiawei Wuyao Tang (Modified Lindera Decoction). For Blood stasis, purge stasis; use Tongyu Jian (Unblock Stasis Decoction). For Qi-Blood knotting, regulate collaterals; use Shixiao San (Instantly Effective Powder). For masses and bloating, regulate Qi and Blood; use Jiaohuang Dihuang Wan (Intersecting Rehmannia Pill). For deficiency-cold acute pain, warm the interior; use Wuwu Jian (Five Materials Decoction). For pain after menstruation, tonify deficiency; use Bazhen Tang with Xiangfu and Sharen (Amomum Fruit). For all epigastric/abdominal attacking pain, hypochondriac stabbing pain, and irregular menstruation, harmonize the Liver; use Yuanhusuo San (Corydalis Powder) with Zhike (Aurantii Fructus). For menstrual stagnation in umbilical/abdominal region with unbearable pain, guide out obstruction; use Hupo San (Amber Powder), revised from *Ben Shi Fang*, also treating postpartum lochia retention, Blood rushing to the Heart causing coma and near-death state. The *Jinkui* states: "For abdominal pain in women, Danggui Shaoyao San (Angelica and Peony Powder) governs." This is tonifying center and draining Wood. It also states: "For abdominal pain in women, Xiaojianzhong Tang (Minor Construct the Middle Decoction) governs." This is also tonifying Spleen and subduing Liver.
[Menstrual Color] Red is the correct color. Purple indicates Wind; use Siwu Tang with Jingjie (Schizonepeta), Fangfeng (Saposhnikovia Root), and Baizhi (Angelica Dahurica Root). Black indicates severe Heat; use Siwu Tang with Huangqin (Scutellaria Root) and Lian (Coptis Rhizome). Purple-black with abdominal pain indicates Qi and Blood conflict; use Siwu Tang (Note: Text says Siwu Tang but context implies a formula for stasis/heat, likely referring to a variation or typo in source for a specific stasis-clearing mix, but strictly translating text 'Si Wu Tang' here as per source structure, though clinically often distinct) with Pengzhu (Curcuma Zedoaria) and Chuanlian (Coptis). If no pain, add only Chuanlian. Pale white indicates Deficiency with leukorrhea; use Xionggui Tang (Ligusticum and Angelica Decoction) with Renshen (Ginseng), Huangqi (Astragalus), Baizhu (Atractylodes), and Shaoyao (Peony). Red-white mixed with cold abdominal pain indicates Deficiency-Cold; use Fulonggan Tang (Dragon's House Earth Decoction). Like rice wash water, like leaking roof water, or yellow, turbid and blurry indicates Damp-Phlegm; use Liujunzi Tang with Cangzhu (Atractylodes Lancea Rhizome) and Xiangfu (Cyperus Rhizome). Like bean juice indicates Heat; use Siwu Tang with Danshen (Salvia Miltiorrhiza Root) and Danpi (Moutan Bark). Clots or pieces indicate Blood condensing with Qi, or invasion of Wind-Cold; use Tongyu Jian removing Zexie (Alisma Rhizome). If Wind enters the Baomen (uterine gate) causing sudden profuse bright red bleeding, use Yiwu Fangfeng Wan (Single Windproof Pill) or Xuanxia Hua Tang (Inula Flower Decoction).
[Retrograde Menstruation] During menstruation, Qi rebels directly invading the clear orifices causing hematemesis or epistaxis; reverse the rebellious trend and regulate. Use Zhizi (Gardenia Fruit), Danpi (Moutan Bark), Shengdi (Raw Rehmannia Root), Danshen (Salvia), Baishao (White Peony), Suzi (Perilla Seed), Yujin (Turmeric Tuber), and Tongbian (Child's Urine). Or use Siwu Tang mixed with Leizhi (Garlic Juice) and Tongbian. If due to Fire Anger injuring Liver causing rebellion, use Longdan (Gentiana Root), Danpi, Qingpi (Green Tangerine Peel), Huangqin, Baishao, Zhizi. If due to Heart Qi deficiency with epistaxis and sallow complexion, use Fuling Buxin Tang (Poria Tonify Heart Decoction).
[Jujing] Menstruation occurring once every three months is called Jujing, commonly known as seasonal menstruation. It may be due to faint pulse indicating Qi and Blood deficiency. Or faint/choppy pulse at Cun Kou and faint/slow pulse at Shaoyin. Or floating/large Yang pulse with weak Yin pulse. Once-a-year menstruation is called Bi Nian (Avoidance Year), due to constitutional differences; do not treat as amenorrhea.
[Persistent Dribbling] Symptoms are mostly due to Qi failing to control Blood; use Zhijing Tang (Stop Menstruation Decoction) with Renshen and Huangqi. Uterine deficiency-cold causing persistent dribbling; use Jiao Ai Siwu Tang (Collagen and Mugwort Four Substances Decoction). Blood level Heat causing continuous dribbling; use Puhuang San (Lygodium Spore Powder).
[Fluctuating Volume] Excessive menstruation; use Danggui Yin (Angelica Drink). Excessive with persistent dribbling; use Jiao Ai Siwu Tang or Baoyuan Tang. Scanty menstruation; use Siwu Tang with Kuihua (Hibiscus Flower).