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A woman who has not yet reached the age of forty-nine (the end of the seven-seven cycle) but whose menstruation has ceased earlier is often considered to have amenorrhea due to blood deficiency. However, who would know that this is actually caused by the qi stagnation of the Heart, Liver, and Spleen?

If a person truly suffers from blood deficiency, how could they survive for long? Physicians seeing the cessation of menstruation attribute it to blood deficiency, but in reality, it is not blood deficiency, but blood obstruction. Moreover, menstrual fluid is not blood; it is "Heavenly One Water" (primordial essence), originating from the Kidney Meridian. It is the essence of extreme Yin yet contains the qi of extreme Yang, hence its red color resembles blood but is not blood. The common belief that menstrual fluid is blood is a misunderstanding spanning millennia. If it were merely blood, why is it not called "blood water"? The ancient sages named it "menstrual water" because it originates from the Kidney Meridian. Therefore, early cessation of menstruation seems like the depletion of Kidney Water. I argue, however, that this is due to the stagnation of Qi in the Heart, Liver, and Spleen. Why? Although the generation of Kidney Water does not directly stem from these three organs, its transformation is indeed related to them. Without the interaction of Liver Qi, Kidney Qi cannot open; without the intersection of Heart Qi, Kidney Qi cannot ascend; without the nourishment of Spleen Qi, Kidney Qi cannot form. If there is stagnation in any of these three meridians, Qi cannot enter the Kidneys, causing Kidney Qi to become blocked and unable to circulate freely. How much more so if all three are stagnant? Even if Kidney Water is truly sufficient, there will be a sense of blockage preventing discharge. Furthermore, if Kidney Qi is originally deficient, how can it generate abundant essence to transform into menstrual fluid and discharge it? This is why menstruation ceases, resembling blood deficiency. The treatment method must disperse the stagnation of the three meridians and greatly tonify the Kidneys. While tonifying the Kidneys, one must still supplement the Qi of the three meridians. Then, when essence overflows, menstruation will naturally flow. Use Yi Jing Tang (Overflowing Menstruation Decoction): Shu Di Huang (Prepared Rehmannia Root, 1 liang), Bai Zhu (Atractylodes Macrocephala Rhizome, 1 liang), Shan Yao (Dioscorea Opposita Rhizome, 5 qian), Sheng Zao Ren (Raw Ziziphus Jujuba Seed, 3 qian), Bai Shao (White Peony Root, 3 qian), Dang Gui (Angelica Sinensis Root, 5 qian), Dan Pi (Moutan Cortex, 2 qian), Sha Shen (Glehnia Root or Adenophora Root, 3 qian), Chai Hu (Bupleurum Root, 1 qian), Du Zhong (Eucommia Bark, 1 qian), Ren Shen (Ginseng Root, 2 qian). Decoct in water and take orally. After eight doses, menstruation will resume. After one month of use, health will be restored, amenorrhea will cease, and conception will become easier.

This formula treats the Heart, Liver, Spleen, and Kidney meridians simultaneously, using tonification to promote circulation and dispersion to open blockages. If only tonified, stagnation remains unresolved and generates fire; if only dispersed, Qi becomes weaker and essence is consumed. If hard-draining or pungent-warming substances are used, it will not only be ineffective but harmful.

For this condition, Xu Bu Tang (Continuing Tonification Decoction) is also effective:
Ren Shen (Ginseng Root, 2 qian), Dang Gui (Angelica Sinensis Root, 5 qian), Bai Shao (White Peony Root, 3 qian), Chai Hu (Bupleurum Root, 5 fen), Mai Dong (Ophiopogon Tuber, 5 qian), Bei Wu Wei Zi (Schisandra Berry, 10 grains), Bai Zhu (Atractylodes Macrocephala Rhizome, 1 liang), Ba Ji Tian (Morinda Officinalis Root, 5 qian), Chao Zao Ren (Stir-fried Ziziphus Jujuba Seed, 5 qian), Hong Hua (Carthamus Flower, 5 fen), Niu Xi (Achyranthes Bidentata Root, 1 qian), Sha Shen (Glehnia/Adenophora Root, 3 qian). Decoct in water and take orally. It will certainly resolve within ten doses.

There are unmarried women whose menstruation has not started, whose abdomens are distended as if pregnant, whose complexions fluctuate between red and pale, and whose pulses vary between large and small. They are diagnosed with amenorrhea due to blood deficiency, but who knows this is actually possession by a spirit? Generally, if the mind is upright, evil cannot invade; if the mind harbors evil thoughts, evil spirits will come. Some may experience mental confusion, seeking intimacy in dreams; some may have blurred vision, engaging in lewd acts during the day; some may pretend to be relatives, secretly indulging in pleasure; some may claim immortals wish to find joy in quiet places. Initially, they may be startled, thinking it a miraculous encounter, and refuse to tell others; later, they may feel ashamed, considering it obscene, and dare not speak of it. Over time, the body's essence and blood are insufficient to sustain the evil in the abdomen. As the evil grows stronger, the healthy Qi weakens, inevitably leading to amenorrhea and blood deficiency until death. To guide the menstruation, the evil occupies the abdomen, making flow difficult; to generate blood, the evil drinks the essence, making growth difficult. Physicians mistake it for pregnancy rather than pregnancy, or for a mass rather than a mass. Often, through delay and waiting, it develops into consumption (Lao Zhai), and they remain unaware until death. Is this not extremely tragic? The treatment should seem to involve tonifying healthy Qi to expel evil. However, if the evil is not removed first, tonifying healthy Qi is useless. One must first remove the evil, then tonify healthy Qi. Use Dang Xie Dan (Evil-Expelling Pill): Lei Wan (Omphalia Lapponica, 3 qian), Tao Ren (Peach Kernel, 30 grains), Da Huang (Rhubarb Root, 3 qian), Dang Gui (Angelica Sinensis Root, 5 qian), Dan Pi (Moutan Cortex, 5 qian), Sheng Gan Cao (Raw Licorice Root, 2 qian). Decoct in water and take orally.

One dose will likely expel half a bucket of foul matter. Then, treat with Diao Zheng Tang (Regulating and Correcting Decoction):
Bai Zhu (Atractylodes Macrocephala Rhizome, 5 qian), Cang Zhu (Atractylodes Lancea Rhizome, 5 qian), Fu Ling (Poria, 3 qian), Chen Pi (Citrus Reticulata Peel, 1 qian), Gan Cao (Licorice Root, 1 qian), Yi Ren (Coix Seed, 5 qian), Bei Mu (Fritillaria Bulb, 1 qian). Decoct in water and take orally.

After four consecutive doses, the Spleen and Stomach Qi will recover, and menstrual blood will gradually flow.

The former formula expels evil, the latter tonifies healthy Qi; there is indeed a sequence. Some may suspect that carrying a "ghost fetus" damages blood, leading to blood deficiency and amenorrhea. Now that the fetus has been expelled, why not tonify blood but instead tonify Stomach Qi? Because when ghost Qi invades the body, the healthy Qi must be known to be deficient. Moreover, blood cannot be generated suddenly, but Qi tonification easily generates blood. Bai Zhu and Cang Zhu are good at tonifying Yang Qi. When Yang Qi is robust, Yin evil cannot invade. This is an excellent method for post-treatment care. If blood-tonifying medicines are taken, it attracts Yin with Yin. I fear that although the ghost fetus is expelled, the ghost Qi may not be eradicated. Therefore, it is better to tonify Yang Qi to prevent invasion by spirits and accelerate blood generation.

For this condition, Sha Gui Po Tai Tang (Ghost-Killing and Fetus-Breaking Decoction) is also effective:
Shui Zhi (Leech, stir-fried black, powdered, 3 qian), Dan Pi (Moutan Cortex, 5 qian), Dang Gui Wei (Angelica Sinensis Tail, 5 qian), Da Huang (Rhubarb Root, 3 qian), Hou Po (Magnolia Bark, 2 qian), Hong Hua (Carthamus Flower, 5 qian), Niu Xi (Achyranthes Bidentata Root, 3 qian), Sheng Di Huang (Rehmannia Root, 5 qian), Tao Ren (Peach Kernel, deseeded and crushed). Decoct with water and wine to obtain one bowl. Take on an empty stomach. One dose will expel the fetus. If it does not, take two more doses. All cases will resolve; no need for a third dose.