王节斋曰∶妇人女子，经脉不行，多有脾胃损伤而致，不可便作经闭死血，轻用通经破血药。凡遇此证，须
审其脾胃何如。若因饮食劳倦，损伤脾胃，少食泄泻疼痛。或因误服汗下攻克药，伤其中气，以致血少不行，
只用健脾胃药。脾旺则生血，而经自行。又有饮食积滞，致损脾胃，亦宜消积补脾。若果脾胃无病，有血块凝
滞，方用行血通经之剂。
慎斋按∶以上七条，序妇人经闭属于内伤不足之病也。经闭有心气不通，有血虚气结，有肝伤肾竭脾伤，
皆足致经闭。此为内伤虚证，而与前条风冷寒凝，火邪热结，积痰污血为病者，有余不足，各自不同也。
李氏曰∶妇人以血为主，天真气降，壬癸水合，肾气全盛，血脉流行，尝以三旬一见，以象月盈则亏，故
曰月经。经行与产后一般，若其时有余血一点未净，或被风寒湿热暑邪，或内伤生冷，七情郁结，为痰为瘀，
凝积于中，曰血滞。或经止后，用力太过，入房太甚，及服食燥热，以致火动，则邪气盛而津液衰，曰血枯。
陈良甫曰∶经后被惊，则血气错乱妄行，逆于上则从口鼻出，逆于身则血水相抟，变为水肿。恚怒则气血
逆于腰腿心腹，背胁手足之间重痛，经行则发，过期则止。怒极伤肝，则有眩晕、呕血、瘰 、血风、疮疡等
病，加之经血渗漏，遂成窍血生疮，淋漓不断。湿热相抟，为崩带，血结于内，变 瘕。凡此变证百出，不过
血滞与血枯而已。重则经闭不通，轻则经水不调，不止虚与热二者也。
王节斋说：妇女出现月经停止不行的情况，大多是因为脾胃受损所致，不能立刻当作经闭死血（瘀血阻滞）来处理，轻易使用通经破血的药物。凡是遇到这种情况，必须仔细审查其脾胃的功能状态。如果是由于饮食不节或过度劳累，损伤了脾胃，导致食欲减退、腹泻、腹痛等症状；或者是误服了发汗、泻下、攻逐的药物，损伤了中焦之气，致使血液亏少而运行不畅，这时只需用健脾益胃的药物。脾胃功能旺盛则能化生血液，月经自然就会来潮。又有因为饮食积滞，进而损害脾胃的情况，也应当先消除积滞，再补益脾气。如果确实脾胃没有病变，而是有血块凝结阻滞，这才使用行血通经的方剂。
慎斋按语：以上七条论述，是说明妇女经闭属于内伤不足类的疾病。经闭有心气不通畅的情况，有血虚气机郁结的情况，有肝、肾、脾受损的情况，这些都足以导致经闭。这属于内伤虚证，与前一条所述的风冷寒凝、火邪热结、积痰污血致病的情况相比，一为有余（实证），一为不足（虚证），各自不同。
李氏说：妇女以血为本，天真之气下降，壬癸水（指肾精/天癸）相合，肾气全盛，血脉流行，通常每三十天来一次月经，以象征月亮满盈后亏损的规律，所以称为月经。月经来潮与产后情况类似，如果当时有少许余血未排净，或者受到风、寒、湿、热、暑等外邪侵袭，或者内伤生冷食物，以及七情（喜、怒、忧、思、悲、恐、惊）郁结，形成痰浊或瘀血，凝结积聚在体内，这叫作“血滞”。或者在月经结束后，用力过猛，房事过度，以及食用燥热食物，导致火热内生，使得邪气亢盛而津液衰少，这叫作“血枯”。
陈良甫说：月经刚结束时受到惊吓，会导致气血错乱妄行，逆冲向上则从口鼻出血，逆冲于身体则血与水相互搏结，变为水肿。愤怒会导致气血逆乱于腰腿、心腹、背胁、手足之间，引起剧烈疼痛，这种疼痛在经期发作，过期则停止。大怒至极会损伤肝脏，从而出现眩晕、呕血、瘰疬（颈部淋巴结结核）、血风、疮疡等疾病，加上经血渗漏，最终形成窍道出血生疮，淋漓不断。湿热相互搏结，会导致崩漏和带下病，血结于体内，变为瘕聚（腹部肿块）。所有这些变化多端的证候，不过是血滞与血枯两种情况罢了。严重的导致经闭不通，轻微的导致月经不调，不仅仅是虚证和热证这两种情况。
Wang Jiezhai stated: In women, the cessation of menstruation is often caused by damage to the Spleen and Stomach. One should not immediately diagnose it as amenorrhea due to fixed blood stasis (blood stasis obstruction) and lightly employ drugs that promote menstruation and break up blood stasis. Whenever encountering such cases, one must carefully examine the condition of the Spleen and Stomach. If the cause is improper diet or overwork damaging the Spleen and Stomach, resulting in poor appetite, diarrhea, and abdominal pain; or if it is due to the mistaken use of diaphoretic, purgative, or attacking medicines that injure the Qi of the Middle Jiao, leading to insufficient blood and impaired circulation, then only tonifying the Spleen and Stomach with appropriate herbs is needed. When the Spleen is robust, it generates blood, and menstruation will resume naturally. There are also cases where food stagnation damages the Spleen and Stomach; in such instances, one should first eliminate the stagnation and then tonify the Spleen Qi. Only if the Spleen and Stomach are indeed free from disease, but there are blood clumps causing stagnation, should one employ formulas that invigorate blood and unblock menstruation.
Shenzhai commented: The above seven items outline that female amenorrhea belongs to diseases of internal injury and deficiency. Amenorrhea can result from the Heart Qi failing to flow freely, from Blood deficiency with Qi binding, or from damage to the Liver, Kidney, and Spleen; all of these are sufficient to cause amenorrhea. This constitutes an internal injury deficiency syndrome. Compared to the previous section which described conditions caused by wind-cold coagulation, fire-heat accumulation, phlegm-turbidity, and foul blood, these differ significantly between excess (fullness) and deficiency (emptiness).
Li stated: Women are primarily governed by Blood. When the Tianzhen Qi descends and the Ren and Gui waters (referring to Kidney essence/Tian Gui) combine, and Kidney Qi reaches its peak, the blood vessels flow smoothly. Menstruation typically occurs every thirty days, mirroring the waxing and waning of the moon, hence it is called "menstrual period." The state during menstruation is similar to that after childbirth. If a small amount of residual blood remains uncleaned at that time, or if exposed to external pathogens such as Wind, Cold, Dampness, Heat, or Summerheat, or if internally injured by raw/cold foods, or due to emotional stagnation (Seven Emotions), forming Phlegm or Blood Stasis that accumulates within, this is termed "Blood Stagnation" (Xue Zhi). Or, after menstruation ceases, excessive physical exertion, excessive sexual intercourse, or consumption of dry-hot foods may stir up Fire, causing pathogenic factors to flourish and Body Fluids to decline; this is termed "Blood Withering" (Xue Ku).
Chen Liangfu stated: Being startled after menstruation causes Qi and Blood to become disordered and flow recklessly. Reversing upward, they exit through the mouth and nose; reversing into the body, Blood and Water contend with each other, transforming into edema. Anger causes Qi and Blood to reverse into the waist, legs, heart, abdomen, back, flanks, hands, and feet, causing severe pain that manifests during menstruation and stops when the period ends. Extreme anger injures the Liver, leading to dizziness, hematemesis, scrofula (Luo Li), Blood Wind, sores, and other diseases. Combined with leaking menstrual blood, this eventually forms bleeding from orifices and sores, dripping continuously. Damp-Heat contending together leads to metrorrhagia (Beng) and leukorrhea (Dai); Blood binding inside transforms into mass formations (Jia). All these myriad variable syndromes are merely manifestations of either Blood Stagnation or Blood Withering. Severe cases result in complete amenorrhea, while mild cases result in irregular menstruation; it is not limited to just deficiency and heat syndromes.