叶以潜曰∶血滞血枯，不越虚热痰气四证而已。血滞亦有虚热，血枯亦有虚热。故滞者不宜过于宣通，
通后又须养血益阴，使津血流通。血枯亦不可峻行补益，恐本主无力。而辛热之剂反燥精血矣。
张景岳曰∶肝病血伤证与血隔相似，皆经闭不通之候。然枯之与隔，有如冰炭。枯者竭也，血虚极矣。隔者，
隔阻也。血本不虚，而或气或寒，或积，有所逆也。隔者，病发于暂，其证或痛或实，通之则行而愈。若枯者，
其来也渐，冲任内竭，其证无形。夫血既枯矣。宜补养阴气，使血自充。如用桃、红、硝、黄、棱、蓬，反加
克伐，则枯者愈枯，毙可立俟也。
陈良甫曰∶血滞经闭宜破者，原因饮食毒热，或暴怒凝瘀积痰，直须大黄、干漆之类推陈致新，俾旧血消而
新血生也。若气旺血枯，起于劳役忧思，自宜温和滋补。或兼有痰火湿热，尤宜清之凉之。每以肉桂为佐者，
热则血行也。但不可纯用峻药，以亏阴道。调和饮食，自然血气流通。苟不务充养气血，唯以毒药攻之，是求千
金于乞丐，必死而后已也。
慎斋按∶以上五条，序妇人经闭有血滞血枯二证之辨也。血滞为有余，有余者宜泻，即前条《金匮》以下，
所论风冷火热，积痰污血，所感而成也。血枯者，为不足，不足者宜补，即前条《内照》以下，所论心气不足，
血虚肝伤，脾衰肾涸，以渐而致也。滞与枯之因，不外此数端，而调经者，可以类通之矣。
叶以潜说：血滞和血枯，不出虚热、痰气这四种证候的范畴。血滞也可能伴有虚热，血枯也可能伴有虚热。所以，对于血滞者，不适宜过度使用宣通之法，在通利之后又需要养血益阴，使津液和血液流通顺畅。对于血枯者，也不可以使用猛烈峻补的药物，恐怕身体根本虚弱无力承受。而辛热性质的药物反而会使精血更加燥竭。
张景岳说：肝病导致的血伤证与血隔证相似，都是经闭不通的表现。然而，“枯”与“隔”，就像冰和炭一样截然不同。“枯”就是枯竭，指血虚到了极点；“隔”就是阻隔，指血液本身并不虚弱，而是因为气机或寒邪，或有积滞，导致气血逆乱阻滞。血隔证，发病突然，症状表现为疼痛或实证，通过疏通治疗即可痊愈。至于血枯证，其病程逐渐发展，冲任二脉内部枯竭，症状没有固定的形质表现。既然血液已经枯竭，应当滋补养阴之气，使血液自然充盈。如果此时使用桃仁、红花、芒硝、大黄、三棱、莪术等药物，反而会加重对正气的克伐，那么枯竭的身体会更加枯竭，死亡就在眼前了。
陈良甫说：因血滞导致的经闭，适合用破血法治疗的，原因是饮食毒热，或者暴怒导致瘀血凝结、痰浊积聚，必须使用大黄、干漆之类的药物来推陈出新，使旧血消散而新血产生。如果是气旺但血枯的情况，起因于劳累役作和忧思过度，自然应该采用温和滋补的方法。如果兼有痰火湿热，尤其适宜清热凉血。每方中常以肉桂作为佐药，是因为热能促使血液运行。但是不可单纯使用峻猛的药物，以免亏损阴血之道。调和饮食，血液和气自然就会流通。如果不致力于充养气血，只用毒药去攻伐，这就像向乞丐乞求千金财富一样，必定导致死亡才会停止。
慎斋按语：以上五条内容，阐述了妇人经闭分为血滞和血枯两种证候的辨别。血滞属于有余之证，有余则宜泻，即前条《金匮》以下所论述的风冷、火热、积痰、污血等外感内伤所致。血枯属于不足之证，不足则宜补，即前条《内照》以下所论述的心气不足、血虚肝伤、脾衰肾涸等逐渐形成的原因。滞与枯的成因，不外乎这几方面，调理月经的人，可以由此类推贯通了。
Ye Yiqian stated: Blood stasis (Xue Zhi) and blood deficiency (Xue Ku) do not exceed the four syndromes of deficiency-heat (Xu Re), phlegm (Tan), and qi (Qi). Blood stasis may also involve deficiency-heat, and blood deficiency may also involve deficiency-heat. Therefore, for cases of stasis, it is inappropriate to use overly promoting and unblocking methods; after unblocking, one must nourish blood and benefit yin (Yang Xue Yi Yin) to ensure the free flow of body fluids (Jin Ye) and blood. For cases of deficiency, one should not use drastic tonifying agents, lest the root constitution be too weak to bear them. Moreover, acrid-hot (Xin Re) preparations would instead dry up essence and blood (Jing Xue).
Zhang Jingyue stated: Liver disease causing blood injury presents similarly to blood obstruction (Xue Ge), both manifesting as amenorrhea (Jing Bi). However, "deficiency" (Ku) and "obstruction" (Ge) are as different as ice and charcoal. "Deficiency" means exhaustion, indicating extreme blood deficiency. "Obstruction" means blockage; the blood itself is not deficient, but due to qi stagnation or cold pathogen, or accumulation, there is some reversal and blockage. Obstruction arises suddenly, with symptoms of pain or excess; unblocking leads to recovery. In contrast, deficiency develops gradually, with internal exhaustion of the Chong and Ren vessels (Chong Ren Er Mai), presenting without fixed morphological signs. Since the blood is already depleted, one should tonify and nourish yin qi so that blood naturally replenishes. If one were to use peach kernel (Tao Ren), safflower (Hong Hua), mirabilite (Xiao Shuang), rhubarb (Da Huang), polygonum ziziphoides (Leng Sui Gen), and curcuma zedoaria (E Zhu), this would further attack the healthy qi, causing the deficient state to worsen, with death imminent.
Chen Liangfu stated: Amenorrhea due to blood stasis suitable for blood-breaking treatment arises from dietary toxicity and heat, or violent anger causing blood stasis condensation and phlegm accumulation. One must directly use substances like rhubarb (Da Huang) and dried lacquer (Gan Qi) to eliminate the old and generate the new, allowing old blood to dissipate and new blood to arise. If qi is robust but blood is deficient, originating from overwork and worry/thought, gentle and tonifying methods are appropriate. If accompanied by phlegm-fire or damp-heat, clearing and cooling methods are especially suitable. Cinnamon twig (Rou Gui) is often used as an assistant herb because heat promotes blood circulation. However, one must not rely solely on drastic drugs, as this would impair the way of yin-blood. Harmonizing diet will naturally allow qi and blood to circulate freely. If one neglects to nourish qi and blood, relying only on toxic drugs to attack, it is like seeking a thousand gold coins from a beggar; death is the inevitable outcome.
Shenzhai commented: The above five passages outline the differentiation between blood stasis and blood deficiency in female amenorrhea. Blood stasis belongs to the category of excess (You Yu); excess conditions require purgation (Xie). This refers to the wind-cold, fire-heat, accumulated phlegm, and foul blood discussed previously under *Jin Gui Yao Lue*, caused by external and internal factors. Blood deficiency belongs to the category of insufficiency (Bu Zu); insufficiency conditions require tonification (Bu). This refers to heart qi insufficiency, blood deficiency with liver injury, spleen decline, and kidney depletion discussed previously under *Nei Zhao*, which develop gradually. The causes of stasis and deficiency do not extend beyond these few aspects, and those regulating menstruation can understand them by analogy.