《评热病论》曰∶月事不来者，胞脉闭也。胞脉者，属心而络于胞中，今气上迫肺，心
气不得下通，故月事不来也。
《阴阳别论》曰∶二阳之病发心脾，有不得隐曲，女子不月。其传为风消，其传为息贲
者，死不治。
《邪气脏腑病形篇》曰∶肾脉微涩，为不月。
血枯之与血隔，本自不同。盖隔者，阻隔也；枯者，枯竭也。阻隔者，因邪气之隔滞，
血有所逆也；枯竭者，因冲任之亏败，源断其流也。凡妇女病损，至旬月半载之后，则未有
不闭经者。正因阴竭，所以血枯，枯之为义，无血而然。故或以羸弱，或以困倦，或以咳嗽
，或以夜热，或以食饮减少，或以亡血失血，及一切无胀无痛，无阻无隔，而经有久不至者
，即无非血枯经闭之候。欲其不枯，无如养营；欲以通之，无如充之。但使雪消则春水自来
，血盈则经脉自至，源泉混混，又孰有能阻之者？奈何今之为治者，不论有滞无滞，多兼开
导之药，其有甚者，则专以桃仁、红花之类，通利为事，岂知血滞者可通，血枯者不可通也
。血既枯矣，而复通之，则枯者愈枯，其与榨干汁者何异？为不知枯字之义耳，为害不小，
无或蹈此弊也。此之治法，当与前血虚肾虚二条，参而用之。
寇宗 曰∶夫人之生，以血气为本。人之病，未有不先伤其血气者。若室女童男，积想
在心，思虑过度，多致劳损，男子则神色消散，女子则月水先闭。盖忧愁思虑则伤心，而血
逆气竭，神色先散，月水先闭。且心病则不能养脾，故不嗜食；脾虚则金亏，故发嗽；肾水
绝则木气不荣，而四肢干痿，故多怒，鬓发焦，筋骨痿。若五脏传遍，则必至于死。此一种
，于劳中最难治。盖病起于五脏之中，无有已期，药力不可及也。若或自能改易心志，然后
用药扶接，如此则可得九死一生。举此为例，其余诸方，可按脉与证而治之。
张氏云∶室女月水久不行，切不可用青蒿等凉药。医家多以为室女血热，故以凉药解之
，殊不知血得热则行，冷则凝，《养生必用方》言之甚详，此说大有理，不可不知。若经候
微少，渐渐不通，手足骨肉烦疼，日渐羸瘦，渐生潮热，其脉微数，此由阴虚血弱，阳往乘
之，少水不能减盛火，火逼水涸，耗亡津液治当养血益阴，慎毋以毒药通之，宜用柏子仁
丸、泽兰汤。
立斋曰∶夫经水，阴血也，属冲任二脉，主上为乳汁，下为月水。其为患，有因脾胃虚
，不能生血而不行者，调而补之；有因脾郁伤血，耗损而不行者，解而补之；有因胃火，血
消烁而不行者，清而补之；有因劳伤心，血少而不行者，静而补之；有因怒伤肝，血少而不
行者，和而补之；有因肾水亏，不能生肝血而闭者，补脾肺；有因肺气虚，不能行血而闭者
，补脾胃。经曰∶损其肺者益其气，损其心者调其荣卫，损其脾者调其饮食，适其寒温，损
其肝者缓其中，损其肾者益其精。审而治之，庶无误矣。五谷入胃，化以为血，以荣四末，
内养五脏六腑。若服苦寒之剂，复伤胃气，必致不起。
《评热病论》说：月经不来的原因，是胞脉闭塞。胞脉，归属于心并联络于子宫（胞宫），如今气机上逆逼迫肺脏，导致心气不能下行通达，所以月经不来。
《阴阳别论》说：阳明经（胃与大肠）的病变发源于心和脾，如果有难以启齿的情志郁结或性生活障碍，女子就会出现月经停闭。如果病情传变发展为“风消”（形容形体消瘦如被风吹干），或者传变为“息贲”（呼吸急促、胸中积气），就会死亡，属于无法治疗的病症。
血枯证与血隔证，本来就不相同。所谓“隔”，是指阻隔；所谓“枯”，是指枯竭。所谓的“隔”，是因为邪气阻滞，导致血液运行逆乱；所谓的“枯”，是因为冲脉和任脉亏损败坏，源头断绝了水流。凡是妇女身体受损，经过数月甚至半年的病程之后，没有不发生闭经的。正是因为阴液枯竭，所以血液干枯。所谓“枯”的含义，就是无血可下的结果。因此，患者往往表现为身体瘦弱，或者困倦乏力，或者咳嗽，或者夜间发热，或者饮食减少，或者曾经有过失血、大出血的情况，以及一切没有腹胀、没有疼痛、没有阻滞、没有阻隔，但月经长期不来的情况，都属于血枯经闭的症状。想要让血液不再干枯，没有比滋养营血更好的方法；想要让月经通畅，没有比充盈血源更好的方法。只要使冰雪消融则春水自然到来，血液充盈则经脉自然通畅，水源滚滚而来，又有谁能阻挡呢？无奈现在的治疗者，不论是否有瘀滞，大多兼用开导通利的药物，其中严重的，则专门使用桃仁、红花之类的药物，以通利为能事，哪里知道血滞者可以疏通，血枯者不可疏通呢？血液既然已经干枯，如果再强行疏通，那么干枯的会更加干枯，这与把榨干的汁液有什么区别呢？这是因为不知道“枯”字的含义罢了，造成的危害不小，不要重蹈这种弊病。这里的治疗方法，应当与前文提到的血虚、肾虚两条内容，参考结合使用。
寇宗奭说：人的生存，以血气为根本。人的疾病，没有不先损伤其血气的。如果是未婚少女或少年，思虑积聚在心中，思虑过度，多导致劳损，男子则神色消散，女子则月经先闭。忧愁思虑会伤心，导致血逆气竭，神色先散，月经先闭。而且心病则不能养脾，所以食欲不振；脾虚则肺气亏虚（土不生金），所以发生咳嗽；肾水枯竭则肝木之气不得荣养，四肢干枯痿软，所以容易发怒，鬓发焦黄，筋骨痿弱。如果五脏依次传遍，则必然导致死亡。这一种类型，在劳损病中最难治疗。因为病起于五脏内部，没有痊愈的期限，药力也难以达到。如果能自己改变心志，然后用药扶持接续，这样才可能获得九死一生的生机。举这个例子为例，其余各种方剂，可以根据脉象和症状来治疗。
张氏说：少女月经长期不行，切不可使用青蒿等寒凉药物。医家多认为少女血热，所以用凉药来解之，殊不知血得热则运行，得冷则凝滞，《养生必用方》对此论述非常详细，此说很有道理，不可不知。如果月经量微少，逐渐不通，手足骨骼肌肉烦痛，日渐消瘦，渐渐产生潮热，脉象微数，这是由阴虚血弱，阳气乘虚侵袭所致，少量的水不能抑制旺盛的火，火逼迫水液枯竭，耗亡津液。治疗应当养血益阴，千万不要用毒药强行通经，适宜使用柏子仁丸、泽兰汤。
薛立斋说：月经，属于阴血，隶属于冲脉和任脉，主管上行为乳汁，下行为月经。它产生的病患，有因脾胃虚弱，不能生血而导致不行的，应当调理并补益；有因脾郁伤血，耗损而导致不行的，应当疏解并补益；有因胃火炽盛，血被消烁而导致不行的，应当清泻并补益；有因劳伤心神，血少而导致不行的，应当静养并补益；有因愤怒伤肝，血少而导致不行的，应当调和并补益；有因肾水亏虚，不能生肝血而导致闭经的，应当补脾肺；有因肺气虚弱，不能行血而导致闭经的，应当补脾胃。经书说：损伤肺的，要补益其气；损伤心的，要调和其营卫；损伤脾的，要调节饮食，适应寒温；损伤肝的，要舒缓其情志；损伤肾的，要补益其精。仔细审察后进行治疗，才不会有误。五谷进入胃中，化生为血液，以营养四肢末端，向内滋养五脏六腑。如果服用苦寒的药物，再次损伤胃气，必定导致无法救治。
The *Ping Re Bing Lun* (Treatise on Evaluating Heat Diseases) states: "When menstruation does not occur, it is due to the closure of the Bao Mai (uterine vessels). The Bao Mai belongs to the Heart and connects with the Bao Zhong (uterus). Now, if Qi rises upward and presses upon the Lung, the Qi of the Heart cannot descend and communicate smoothly, thus menstruation does not occur."
The *Yin Yang Bie Lun* (Treatise on Distinguishing Yin and Yang) states: "Diseases of the Two Yang (Stomach and Large Intestine) originate from the Heart and Spleen. If there are difficulties in intimate matters or hidden grievances, women will experience amenorrhea. If this transmits into 'Feng Xiao' (wind wasting, describing emaciation), or transmits into 'Xi Ben' (accumulated Qi causing dyspnea), death ensues; it is incurable."
The *Xie Qi Zang Fu Bing Xing Pian* (Chapter on Pathogenic Factors and Manifestations of Zang-Fu Diseases) states: "A faint and choppy Kidney pulse indicates amenorrhea."
Blood deficiency (Xue Ku) and blood stagnation/blockage (Xue Ge) are inherently different. "Ge" refers to obstruction; "Ku" refers to exhaustion. Obstruction arises from pathogenic factors blocking flow, causing blood to逆流 (regurgitate/rebel); exhaustion arises from the depletion and failure of the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel), where the source of the stream is cut off. In cases of chronic illness in women lasting months or half a year, amenorrhea invariably follows. Precisely because Yin fluids are exhausted, blood becomes dry. The meaning of "dry" implies a state devoid of blood. Therefore, patients may present with emaciation, fatigue, cough, night fevers, reduced appetite, history of hemorrhage or blood loss, and generally without abdominal distension or pain, nor any sense of blockage or obstruction, yet menstruation has been absent for a long time. These are all signs of amenorrhea due to blood exhaustion. To prevent further drying, nothing is better than nourishing Ying Blood (Nutritive Blood); to restore flow, nothing is better than replenishing the source. Just as melting snow brings spring water naturally, when blood is abundant, the meridians flow freely. With a surging source, who could possibly obstruct it? Regrettably, current practitioners, regardless of whether there is stagnation or not, often incorporate herbs that promote opening and guiding. In severe cases, they rely exclusively on herbs like Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos), focusing on purgative and unblocking actions. They fail to realize that while stagnant blood can be unblocked, exhausted blood cannot be forcibly moved. Once blood is exhausted, forcing it to move only exhausts it further; what difference is there from squeezing out the last drop of juice? This error stems from a misunderstanding of the term "exhaustion," causing significant harm. One must avoid this pitfall. The treatment method here should be considered in conjunction with the preceding sections on Blood Deficiency and Kidney Deficiency.
Kou Zongshi stated: "Human life is rooted in Qi and Blood. Disease invariably begins by damaging Qi and Blood. For unmarried youths, persistent thoughts accumulate in the heart. Excessive worrying and thinking often lead to consumptive disorders. In men, spirit and luster dissipate; in women, menstruation ceases first. Worry and sorrow injure the Heart, causing blood to rebel and Qi to exhaust, leading to the dissipation of spirit and cessation of menstruation. Furthermore, Heart disease fails to nourish the Spleen, resulting in poor appetite; Spleen deficiency leads to Lung Metal deficiency, causing cough; when Kidney Water is exhausted, Liver Wood fails to receive nourishment, leading to dry and flaccid limbs, irritability, scorched hair, and weak sinews and bones. If the disease transmits through all five Zang organs, death is inevitable. This type is among the most difficult to treat within consumptive diseases. Since the pathology originates within the five Zang organs, there is no definite timeline for recovery, and medicinal force may be insufficient. However, if the patient can change their mindset, followed by medicinal support and connection, one might achieve a one-in-nine chance of survival. Taking this as an example, other formulas can be applied according to pulse and syndrome differentiation."
Zhang's commentary states: "For young women with prolonged amenorrhea, Qing Hao (Artemisiae Annuae Herba) and other cooling herbs must strictly be avoided. Many physicians assume young women have blood heat and use cooling herbs to resolve it. They do not understand that blood flows when warm and coagulates when cold. This view is elaborated in detail in *Yang Sheng Bi Yong Fang* (Essential Formulas for Health Preservation) and is highly reasonable; it must not be ignored. If menstruation is scanty and gradually stops, accompanied by vexing pain in the hands, feet, bones, and muscles, progressive emaciation, and emerging tidal fever, with a faint and rapid pulse, this is caused by Yin deficiency and blood weakness, allowing Yang to invade. Little water cannot extinguish strong fire; fire forces water to dry up, consuming body fluids. Treatment should focus on nourishing blood and benefiting Yin. Do not use toxic drugs to forcibly induce menstruation. It is appropriate to use Baizi Ren Wan (Bai Zi Ren Pill) or Ze Lan Tang (Ze Lan Decoction)."
Li Ji (Xue Ji) stated: "Menstrual blood is Yin blood, governed by the Chong Mai and Ren Mai. It transforms upwards into milk and downwards into menstrual blood. Its disorders arise from various causes: those caused by Spleen-Stomach deficiency failing to generate blood require regulation and tonification; those caused by Spleen depression injuring blood requiring resolution and tonification; those caused by Stomach Fire scorching blood requiring clearing and tonification; those caused by labor injuring the Heart with blood deficiency requiring quietude and tonification; those caused by anger injuring the Liver with blood deficiency requiring harmonization and tonification; those caused by Kidney Water deficiency failing to generate Liver blood requiring tonification of the Spleen and Lung; and those caused by Lung Qi deficiency failing to move blood requiring tonification of the Spleen and Stomach. The Classics state: 'Damage to the Lung benefits its Qi; damage to the Heart regulates Ying and Wei; damage to the Spleen regulates diet and adjusts to cold and warmth; damage to the Liver soothes its interior; damage to the Kidney benefits its Essence.' Examining these carefully before treating ensures no errors. Grain enters the Stomach, transforms into blood, nourishes the four extremities, and internally sustains the five Zang and six Fu organs. If bitter-cold agents are taken, further damaging Stomach Qi, it will inevitably lead to untreatable conditions."