A woman who has reached the age of 18 without the onset of menstruation, or who has ceased menstruation for more than three months after establishing a menstrual cycle (excluding early pregnancy), is considered to have amenorrhea. The former is primary amenorrhea, while the latter is secondary amenorrhea. Physiological cessation of menstruation, commonly seen before puberty, during pregnancy, lactation, and the late stage of menopause (third stage), as well as rare cases of trimonthly menstruation, annual menstruation, and latent menstruation, are not categorized as amenorrhea. This discussion primarily focuses on amenorrhea caused by functional disorders, which can be effectively treated with medication. Amenorrhea resulting from congenital absence of the uterus, absence of the vagina, or imperforate hymen, as well as sexually transmitted diseases, is not discussed here.

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1. Kidney Qi Deficiency︰Menstruation does not occur beyond the normal age, or the first period is delayed, with scanty flow that is red or brownish, gradually progressing to amenorrhea. There is usually no leukorrhea, and no abdominal distending pain. There is aching pain in the lower back and limbs that feel cold, accompanied by dizziness, tinnitus, a dull complexion, or brown spots. The tongue texture is normal or slightly pale, and the pulse is deep, thin, and weak. This condition is often caused by congenital deficiency of kidney qi, leading to emptiness in the Chong and Ren meridians; or excessive postpartum metrorrhagia, resulting in depletion of essence and blood, causing amenorrhea (a more severe condition). The manifestations include menstruation not occurring beyond the normal age, delayed menarche, or a history of postpartum hemorrhage, often accompanied by aching pain in the lower back, dizziness, tinnitus, a dull complexion, and a deep, thin pulse—signs of kidney yang deficiency and insufficient essence and blood. The clinical distinction is not difficult based on the medical history. For amenorrhea due to kidney qi deficiency, treatment should focus on warming and tonifying kidney yang and regulating the Chong and Ren meridians, using the Wen Shen Tong Jing Decoction. If menstruation resumes, the Bu Shen Yang Xue Decoction can be used for further treatment to consolidate the effects.
2. Deficiency of Both Qi and Blood︰Menstruation often arrives late in the third stage, with scanty flow gradually leading to cessation, and no distending pain in the lower abdomen. The complexion may appear pale yellow or pale white, accompanied by dizziness and palpitations; or there may be poor appetite and loose stools, facial puffiness, limb swelling, mental fatigue, and lack of strength. The tongue texture may be normal or pale, and the pulse manifestation may be thin and weak, or thin and rapid with no strength. However, a few patients may present with amenorrhea as the main symptom without other accompanying signs. This condition is mostly caused by spleen deficiency, blood loss, parasitic diseases, internal depletion of nutrient-blood, or severe malnutrition. The condition is relatively mild. The key points for differentiation are: it often evolves gradually from delayed menstruation or scanty menstrual flow. Treatment should focus on tonifying qi, nourishing blood, and promoting menstruation, using the Nourishing Blood and Promoting Menstruation Decoction. After menstruation resumes, continue with the Blood-Nourishing Decoction for regulation and supplementation.
3. Qi Stagnation and Blood Stasis︰Menstruation does not occur for several months, with lower abdominal distension and fullness, pain, or tenderness upon pressure. Mental depression, chest tightness, hypochondriac pain, irritability, and a tendency to anger. The tongue edges appear purplish-dark or with ecchymotic spots, and the pulse manifestation is deep and wiry. This condition is often caused by emotional stress or changes in living environment, leading to liver qi depression and obstruction of the thoroughfare and conception vessels' qi and blood flow. Symptoms include amenorrhea, lower abdominal distension and fullness, pain, or tenderness upon pressure, which can differentiate it from amenorrhea due to kidney qi deficiency or qi-blood deficiency, where there is no abdominal distending pain. Treatment should focus on soothing the liver and regulating qi, invigorating the blood to unblock the meridians, using Cold-Limbs Powder with additions such as Salvia, Motherwort Fruit, and Chinese rose flower. After menstruation resumes, follow up with Ginseng Nourishing Glory Pill or Eight Precious Ingredients Motherwort Pill to tonify and replenish qi and blood for recovery.
4. Damp Phlegm︰The menstrual flow gradually decreases until amenorrhea occurs. The body gradually becomes obese, with soreness in the waist, edema, increased leukorrhea, chest tightness, nausea, palpitations, shortness of breath, poor appetite, lack of strength, fatigue, and a pale complexion. The tongue texture is pale and swollen, or the tongue coating is white and greasy, with a deep and soggy or thin and slippery pulse. If amenorrhea persists for too long, milk regurgitation may occur. This is often due to spleen-kidney yang deficiency, with phlegm-dampness stagnating in the Chong and Ren meridians, obstructing blood circulation and leading to the cessation of menstruation. The clinical characteristics are: after amenorrhea, the body gradually becomes obese, which differs from patients with kidney qi deficiency, qi-blood deficiency, or qi stagnation and blood stasis amenorrhea. Additionally, symptoms such as edema, lack of strength, chest tightness, anorexia, leukorrhea, and a white, greasy tongue coating indicate internal excess of phlegm-dampness. The treatment should focus on warming the kidneys and tonifying the spleen, dispelling phlegm and draining dampness, moving qi to restore menstruation. The recommended formula is the heavy version of degelatined deer-horn decoction.

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1. Lanshi Micang-Women's Section: "When a woman's spleen and stomach are chronically deficient, or her physical form is emaciated with both qi and blood depleted, this may lead to the cessation of menstruation. Alternatively, in cases of stomach heat from consumptive disorders, excessive eating accompanied by gradual wasting, and failure to generate bodily fluids—since menstruation is transformed from blood vessels and bodily fluids—once the fluids are exhausted and scorched by heat, the muscles become emaciated, with frequent thirst and dryness. The Xuehai (Sea of Blood) dries up, resulting in a condition called 'blood exhaustion and menstrual cessation.' In such cases, it is appropriate to purge stomach dryness-heat and supplement qi and blood, after which menstruation will resume on its own... Another cause may be overexertion of the heart, leading to upward flare of heart fire and the absence of menstruation. By calming the heart, harmonizing blood, and purging fire, menstruation will resume. Thus, the Neijing states: 'The absence of menstruation is due to the blockage of the uterine vessels. The uterine vessels belong to the heart and connect to the uterus. When qi ascends to oppress the lungs, heart qi cannot descend and circulate, hence menstruation does not come.'"