洁古曰∶女子月事不来者，先泻心火，血自下也。《内经》曰∶二阳之病发心脾，有不
得隐曲，故女子不月，其传为风消。王启玄注曰∶大肠胃热也。心脾受之，心主血，心病则
血不流；脾主味，脾病则味不化，味不化，则精不足，故其病则不能隐曲。脾土已亏，则风
邪胜，而气愈消也。又经曰∶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，后服《局方》中五补丸，后以卫生汤治脾
养血也。（泻心火、养脾血，是从本文之义。愚谓当原隐曲推解，盖人有隐情曲意，难以舒其衷者，则
气郁而不畅，不畅则心气不开，脾气不化，水谷日少，不能变见气血，以入二阳之血海矣，血海无余，所以不月也，
传为风消者，阳明主肌肉，血不足则肌肉不荣，其不消瘦乎？风之名，火之化也，故当根不得隐曲上看，乃有本）
东垣曰∶经闭不行有三，妇人脾胃久虚，形体羸弱，气血俱衰，而致经水断绝不行；或
病中消胃热，善食渐瘦，津液不生。夫经者，血脉津液所化，津液既绝，为热所烁，肌肉渐
瘦，时见渴燥，血海枯竭，病名曰血枯经绝，宜泻胃之燥热，补益气血，经自行矣（立方固有法，然不必太泥，因人易
辙可也）。此病或
经适行而有子，子亦不成，而为胎病者有矣（此中焦胃热结也）。或心包络脉洪数，躁作时见
大便秘涩，小便虽清不利，而经水闭绝不行，此乃血海干枯，宜调血脉，除包络中火邪，而
经自行矣（此下焦胞脉热结也）。或因劳心，心火上行，月事不来者，胞脉闭也。胞脉者，属
于心，而络于胞中。今气上迫肺，心气不得下通，故月事不来，宜安心补血泻火，经自行矣
（此上焦心肺热结也）。
楼氏曰∶上东垣、洁古治血枯之法，皆主于补血泻火也。补血者，四物之类，泻火者，东
垣分上中下。故火在中，则善食消渴，治以调胃承气之类。火在下，则大小便秘涩，治以玉
烛之类。玉烛者，四物与调胃承气等分也。火在上，则得于劳心，治以芩连及三和之类。三
和者，四物凉膈等分也。洁古先服降心火之剂者，盖亦芩连三和玉烛之类，后服五补卫生者
，亦补气之剂也。（据此论当有四证，如胃热、包络热、劳心热三证，皆有余，宜泻火养胃是矣。而所言脾胃久虚，
致经水断绝，一症，又当以补脾胃为主，岂得舍而勿论耶。盖水入于经，其血乃生，谷入于胃，脉道乃行，水去荣散，
谷消卫亡。况脾统诸经之血，而以久虚之脾胃，以致气血俱衰者，可不为之补益乎。即此以分虚实，明是四证无疑，
而楼全善乃遗补虚一证，何欤）
洁古说：女子月经不来的，先清泻心火，血液自然下行。《内经》说：阳明（胃与大肠）的病变发于心脾，有难以言说的隐情曲意，所以女子月经不来，这种病传变下去称为“风消”。王启玄注释说：这是肠胃热盛。心脾受病，心主血，心病则血液运行不畅；脾主运化水谷精微，脾病则饮食不能化为精微，精微不化，则精气不足，所以患病者会有难以言说的隐情。脾土已经亏损，则风邪偏胜，而人气更加消瘦。又经书说：月经不来的，是胞脉闭塞。胞脉属于心，联络于胞宫，如今气机上逆逼迫肺脏，心气不能向下通达，所以月经不来。先服用降泄心火的药剂，后服用《局方》中的五补丸，最后用卫生汤治疗以健脾养血。（“泻心火、养脾血”是根据本文的意思提出的。我认为应当从“不得隐曲”推究解释，大概是人心中有隐情曲意，难以舒展衷肠，则气机郁结而不通畅，不通畅则心气不开，脾气不运化，水谷摄入日少，不能变化生成气血，从而注入阳明的血海，血海空虚，所以月经不来。传变为“风消”的，是因为阳明主管肌肉，血不足则肌肉失于荣养，能不消瘦吗？“风”的名称，是“火”的转化所致，所以应当从“不得隐曲”这一根本原因上去探究，这才是有本源的。）
东垣说：月经闭止不行有三种情况。一是妇人脾胃长久虚弱，形体瘦弱，气血俱衰，而导致经水断绝不行；二是患中消症（胃热），食欲旺盛但逐渐消瘦，津液不生。所谓经血，是由血脉和津液化生而成的，津液既然枯竭，被热邪灼烧，肌肉逐渐消瘦，时常感到口渴干燥，血海枯竭，病名叫做“血枯经绝”，适宜清泻胃中的燥热，补益气血，月经自然就会来潮（创制方剂固然有定法，但不必过于拘泥，可以根据人的具体情况灵活变通）。这种病有的在月经刚来时怀孕，胎儿也不能成形，而产生胎病的也有（这是中焦胃热结聚所致）。有的心包络脉象洪大数急，烦躁发作时常见大便秘结涩滞，小便虽然颜色清亮但不利，而经水闭绝不行，这是血海干枯，适宜调理血脉，清除心包络中的火邪，月经自然就会来潮（这是下焦胞脉热结所致）。有的是因为劳心过度，心火上炎，导致月经不来的，这是胞脉闭塞。胞脉，归属于心，而联络于胞宫。如今气机上逆逼迫肺脏，心气不能向下通达，所以月经不来，适宜安心神、补血、泻心火，月经自然就会来潮（这是上焦心肺热结所致）。
楼氏说：以上东垣、洁古治疗血枯的方法，都主张补血泻火。补血，是用四物汤之类的方剂；泻火，是东垣分为上、中、下三焦论治。所以火在中焦，则表现为善食消渴，治疗用调胃承气汤之类的方剂。火在下焦，则表现为大小便秘涩，治疗用玉烛散之类的方剂。玉烛散，就是四物汤与调胃承气汤等量配合而成。火在上焦，则是由于劳心过度引起，治疗用黄芩、黄连及三和汤之类的方剂。三和汤，就是四物汤与凉膈散等量配合而成。洁古说先服用降心火的药剂，大概也是黄芩、黄连、三和汤、玉烛散之类的方剂，后服用五补丸、卫生汤，也是补气类的药剂。（根据这个论述应当有四类证候，如胃热、心包络热、劳心热这三类证候，都属于有余之证，适宜泻火养胃是正确的。然而所说的因脾胃长久虚弱，导致经水断绝的一类症状，又应当以补益脾胃为主，怎么能舍弃它而不讨论呢？况且水进入经脉，血液才能生成，谷物进入胃中，脉道才能通行，水液去则营气散，谷物消则卫气亡。何况脾统摄各经之血，对于因长久虚弱的脾胃，导致气血俱衰的情况，难道不需要为之补益吗？由此区分虚实，明确是四类证候无疑，而楼全善却遗漏了补虚这一证候，为什么呢？）
Jiegu said: In cases where a woman's menstruation does not arrive, one should first clear and drain Heart Fire (Xin Huo), and the blood will naturally flow downward. The *Neijing* states: "Diseases of the Yangming (Stomach and Large Intestine) originate in the Heart and Spleen; due to unspoken grievances or repressed emotions, women may experience amenorrhea. If this condition transmits, it is called 'Wind Consumption' (Feng Xiao)." Wang Qixuan commented: "This refers to heat accumulation in the intestines and stomach." When the Heart and Spleen are affected, since the Heart governs Blood, Heart pathology leads to stagnant blood circulation; since the Spleen governs the transformation of flavors (nutrients), Spleen pathology leads to the failure of nutrients to be transformed. If nutrients are not transformed, essence becomes insufficient, hence the patient experiences unspoken grievances. Once the Spleen Earth is depleted, Wind Pathogens prevail, leading to further emaciation. Another classic text states: "Amenorrhea is caused by the closure of the Bao Mai (Uterine Vessels). The Bao Mai belongs to the Heart and connects to the Bao Zhong (Uterus). Now, if Qi forces upward against the Lung, the Heart Qi cannot descend smoothly, resulting in amenorrhea." One should first administer formulas that descend and drain Heart Fire, then take the Wubu Wan from the *Ju Fang*, and finally treat with Weisheng Tang to strengthen the Spleen and nourish Blood. ("Clearing Heart Fire and Nourishing Spleen Blood" aligns with the meaning of this text. I believe one should deduce the explanation from "unspoken grievances." Generally, when a person harbors hidden feelings or repressed intentions that cannot be expressed, Qi becomes depressed and unsmooth. Unsmooth Qi prevents the opening of Heart Qi and the transformation of Spleen Qi. Daily intake of water and grain decreases, preventing the generation of Qi and Blood to enter the Sea of Blood of the Yangming. With an empty Sea of Blood, menstruation ceases. Regarding "Wind Consumption," since Yangming governs muscles, lack of Blood means muscles lose nourishment, so they inevitably become emaciated. "Wind" is the manifestation/transformation of "Fire"; thus, one must investigate from the root cause of "unspoken grievances" to find the origin.)
Dongyuan stated: There are three types of amenorrhea. First, when a woman's Spleen and Stomach have been deficient for a long time, her physique is emaciated, and both Qi and Blood are exhausted, leading to the cessation of menstruation. Second, suffering from Zhongxiao (Middle Jiao Xiao/Thirst, characterized by Stomach Heat), where appetite is strong but the body gradually wastes away, and fluids are not generated. Menstrual blood is transformed from blood vessels and fluids. Once fluids are exhausted and scorched by Heat, muscles gradually waste, thirst and dryness frequently appear, the Sea of Blood dries up, and the disease is named "Blood Depletion and Menstrual Cessation." It is appropriate to clear the dryness-heat of the Stomach and tonify Qi and Blood, after which menstruation will resume naturally. (Although there are fixed methods for prescribing formulas, one should not be overly rigid; adjustments can be made according to individual circumstances.) This condition may also occur when conception happens during menstruation, yet the fetus fails to develop, resulting in fetal pathology (this is due to heat accumulation in the Middle Jiao Stomach). Or, when the Pericardium Collateral pulse is surging and rapid, accompanied by irritability, frequent constipation, and difficult urination despite clear urine, while menstruation is completely absent, this indicates a dried-up Sea of Blood. It is appropriate to regulate the blood vessels and eliminate the Fire pathogen in the Pericardium Collateral, after which menstruation will resume naturally (this is due to heat accumulation in the Lower Jiao Uterine Vessels). Or, due to mental overexertion, Heart Fire ascends, causing amenorrhea because the Bao Mai is closed. The Bao Mai belongs to the Heart and connects to the Uterus. Now, Qi forces upward against the Lung, and Heart Qi cannot descend, causing amenorrhea. It is appropriate to calm the Mind, nourish Blood, and drain Fire, after which menstruation will resume naturally (this is due to heat accumulation in the Upper Jiao Heart and Lungs).
Lou stated: Both Dongyuan and Jiegu's treatments for Blood Depletion emphasize nourishing Blood and draining Fire. Nourishing Blood involves formulas like Siwu Tang. Draining Fire, as categorized by Dongyuan, is divided into Upper, Middle, and Lower Jiao. If Fire is in the Middle Jiao, manifesting as polyphagia and thirst, treatment uses formulas like Tiaowei Chengqi Tang. If Fire is in the Lower Jiao, manifesting as constipation and difficult urination, treatment uses Yuzhu San. Yuzhu San consists of equal parts Siwu Tang and Tiaowei Chengqi Tang. If Fire is in the Upper Jiao, caused by mental overexertion, treatment uses Huangqin, Huanglian, and Sanhe Tang. Sanhe Tang consists of equal parts Siwu Tang and Liangge San. Jiegu's recommendation to first take formulas descending Heart Fire likely refers to combinations involving Huangqin, Huanglian, Sanhe Tang, or Yuzhu San. His subsequent recommendation of Wubu Wan and Weisheng Tang refers to Qi-tonifying formulas. (Based on this discussion, there should be four types of syndromes. The three syndromes of Stomach Heat, Pericardium Heat, and Mental Overexertion Heat all belong to excess patterns, suitable for draining Fire and nourishing the Stomach, which is correct. However, the syndrome described as menstrual cessation due to long-term Spleen-Stomach deficiency should primarily be treated by tonifying the Spleen and Stomach. How can this be omitted? Water entering the channels generates Blood; grain entering the Stomach allows the Mai Dao (Vessel pathways) to circulate. If water departs, Ying (Nutrient) Qi scatters; if grain is consumed without replenishment, Wei (Defensive) Qi perishes. Moreover, the Spleen commands the Blood of all meridians. For cases where long-term Spleen-Stomach deficiency leads to exhaustion of both Qi and Blood, is it not necessary to provide tonification? By distinguishing between deficiency and excess based on this, it is clearly four syndromes. Why did Lou Quanshan omit the deficiency syndrome?)