Treatment principle: Regulate qi and activate blood circulation, remove stasis and unblock the meridians.

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Findings: Amenorrhea for several months, distending pain in the lower abdomen with tenderness to palpation, depression, irritability, fullness and distension in the chest and hypochondria, sighing due to internal heat, purple-dark tongue body or ecchymoses, and a deep, wiry or涩 (stagnant) pulse that is strong. Treatment principle: Regulate qi and activate blood circulation, remove stasis and unblock the meridians. Prescription: Modified Taohong Siwu Decoction combined with Danzhi Xiaoyao Powder. Peach kernel 10g, safflower 6g, angelica root 10g, rehmannia root 12g, chuanxiong rhizome 6g, white peony root 15g, licorice 6g, atractylodes rhizome 10g, bupleurum root 10g, poria 12g, moutan bark 6g, gardenia fruit 10g, leech 6g. If the lower abdominal distending pain is severe, add puhuang, wulingzhi, and yanhusuo as appropriate; if breast distending pain is obvious, add bupleurum, melia fruit, curcuma, and vicia seeds as appropriate; if qi stagnation is prominent, add citrus peel, agarwood, costus root, and motherwort as appropriate; if cold congealing causes cold pain in the lower abdomen and the pulse is deep and slow, add fennel seed, cinnamon, and evodia fruit as appropriate; if there is frequent lower abdominal pain, a purple-dark tongue, yellow and dry coating, and a rapid pulse, add zelan and danshen as appropriate. 2. Cold-congealing and blood-stasis type Findings: Amenorrhea for several months, cold pain in the lower abdomen with tenderness to palpation, pain relieved by warmth; cold limbs and pale complexion; purple-dark tongue, white coating, and a deep, tight pulse. Treatment principle: Warm the meridians to dispel cold, activate blood circulation and unblock the meridians. Prescription: Modified Wenjing Decoction. Codonopsis root 10g, evodia fruit 6g, ophiopogon root 10g, donkey-hide gelatin (processed) 10g, dried ginger 6g, cinnamon twig 10g, angelica root 10g, white peony root 15g. If the cold pain in the lower abdomen is severe, add mugwort leaf, fennel seed, and costus root to warm the meridians, nourish the uterus, and relieve pain; if the limbs are cold and the patient feels chilly, add processed aconite, evodia fruit, and cinnamon to warm the meridians, tonify yang, and unblock the meridians. 3. Phlegm-damp obstruction type Findings: Delayed menstruation, scanty menstrual flow, pale color and sticky consistency, gradually leading to amenorrhea; accompanied by obesity, chest tightness and nausea, fatigue, poor appetite, excessive phlegm or increased vaginal discharge, white color; greasy tongue coating, slippery pulse. Treatment principle: Dry dampness and transform phlegm, activate blood circulation and remove stasis. Prescription: Modified Daotan Decoction. Pinellia ternata 6g, arisaema erubescens 10g, tangerine peel 6g, realgar 10g, poria 12g, codonopsis root 10g, acorus calamus 10g, bamboo shavings 10g, licorice 6g. If chest fullness and oppression are severe, add trichosanthes fruit, citrus peel, and curcuma as appropriate; if the tongue coating is yellow and greasy, add coptis and scutellaria as appropriate. 4. Qi and blood deficiency type Findings: Late menstruation, scanty and pale menstrual flow, gradually leading to amenorrhea, dizziness and fatigue, sallow complexion, forgetfulness and insomnia, shortness of breath and reluctance to speak, lack of luster in hair and skin, pale tongue, and a weak, feeble pulse.

Treatment principle: Tonify qi and nourish blood, strengthen the spleen and calm the spirit. Prescription: Modified Guipi Decoction. Astragalus root 15g, atractylodes rhizome 10g, codonopsis root 10g, angelica root 10g, poria 10g, polygala root 6g, agarwood 6g, honey-fried licorice 6g, four red dates, sour jujube seeds 10g, six slices of fresh ginger, dodder seed 10g, curcuma 6g, safflower 6g, bupleurum root 10g, costus root 6g. If appetite is poor, add fried three treasures, chicken gizzard, and raw rhubarb as appropriate; if the lower back and knees feel sore and weak, add eucommia bark, achyranthes root, and eucommia bark as appropriate. 7. Analysis of prescriptions used by Professor Pei Zhengxue Professor Pei Zhengxue commonly uses the following three prescriptions in clinical treatment of premature ovarian failure: 1. Modified GuiZhi FuLing Wan GuiZhi 10g, poria 12g, white peony root 15g, moutan bark 10g, peach kernel 10g, angelica root 10g, rehmannia root 12g, chuanxiong rhizome 6g, safflower 3g, panax notoginseng 3g (added separately), leech powder 10g (added separately). Decoct in water and take one dose daily. This formula is suitable for young and middle-aged women in good health. The formula combines GuiZhi FuLing Wan with Taohong Siwu Decoction, adding powerful blood-stasis-breaking and blood-moving ingredients such as panax notoginseng and leech. GuiZhi FuLing Wan originates from “Jin Kui Yao Lue · Women’s Pregnancy Diseases, Pulse Diagnosis, and Treatment.” It consists of equal parts of gui zhi, poria, moutan bark, peach kernel, and white peony. Gui zhi is pungent and warm, promoting blood circulation and removing blood stasis, serving as the chief herb. Peach kernel is the key herb for resolving blood stasis, while poria removes phlegm and promotes diuresis, helping to eliminate phlegm and promote water metabolism. Together, these two herbs activate blood circulation and remove stasis, while also promoting diuresis and eliminating dampness, thus assisting the chief herb in its blood-stasis-clearing effect, serving as the assistant herb. White peony relieves spasms and stops abdominal pain. Moutan bark cools the blood, breaks up blood stasis, and removes blood stasis; when combined with the chief and assistant herbs, its blood-activating effect further enhances the clearing power, addressing both newly formed blood stasis and long-term accumulated heat, serving as the supporting herb. Honey is used to make pills, moderating the harshness of the other herbs, serving as the guiding herb. Together, these herbs work to activate blood circulation and transform phlegm, alleviating blockages. 2. Modified Wenjing Decoction Codonopsis root 10g, cinnamon twig 10g, donkey-hide gelatin 10g (processed), ophiopogon root 10g, evodia fruit 10g, angelica root 10g, chuanxiong rhizome 6g, rehmannia root 128, red peony root 10g, peach kernel 10g, safflower 3g, hemp seed 10g, dried ginger 6g, four red dates, honey-fried licorice 6g, costus root 6g, motherwort 15g, decocted in water and taken one dose daily. This formula is suitable for women of childbearing age who have not yet given birth, with scanty menstrual flow, delayed periods, or even amenorrhea in young and middle-aged women. The formula combines the Great Wenjing Decoction with Taohong Siwu Decoction. Although it has the effect of activating blood circulation and removing stasis, warming the meridians to dispel cold is its most important function. In the Wenjing Decoction, evodia fruit is pungent and very hot, entering the liver, stomach, and kidney meridians. Its pungency can disperse, its bitterness can descend, and its intense heat can also warm and disperse cold pathogens, thus dispersing cold and relieving pain. Cinnamon twig is pungent and sweet, warming the meridians to dispel cold and promoting blood circulation. Together, these two herbs serve as the chief herbs. Angelica root, chuanxiong rhizome, and red peony root enter the liver meridian, activating blood circulation and removing stasis, nourishing blood and regulating menstruation. Moutan bark is bitter and pungent, slightly cool, entering the heart, liver, and kidney meridians, activating blood circulation and removing stasis, while also dissipating hidden heat in the blood, serving as the assistant herb. Donkey-hide gelatin is sweet and neutral, nourishing the liver blood and enriching kidney yin, with the effects of nourishing blood, stopping bleeding, and moistening dryness. Ophiopogon root is sweet and slightly bitter, nourishing yin and clearing heat, and can also temper the warming and drying effects of evodia fruit and cinnamon twig. Codonopsis root and licorice are sweet and enter the spleen meridian, benefiting qi and replenishing the source of life, allowing yang to flourish and yin to grow, strengthening qi and enriching blood. Pinellia ternata is pungent and warm, able to descend stomach qi and disperse knots, working with codonopsis root and licorice to strengthen the spleen and harmonize the stomach, aiding in removing stasis and regulating menstruation. Fresh ginger warms the interior and dispels cold, working with pinellia ternata to warm the center and harmonize the stomach, aiding in the process of generating life. All of these herbs together serve as the supporting herbs; licorice also helps harmonize the other herbs, serving as the guiding herb. Together, these herbs warm the meridians to dispel cold and activate blood circulation, nourish the Chong and Ren channels to consolidate the foundation, remove blood stasis, generate new blood, and thus regulate menstruation, naturally curing the disease. Research shows that the Wenjing Decoction can regulate the physiological functions of the hypothalamus-pituitary-ovarian axis, regulate the menstrual cycle, and promote the secretion of luteinizing hormone. Pharmacological studies show that evodia fruit contains evodiamine, which can contract the uterus, while angelica root has a bidirectional regulatory effect on the uterus. Pinellia ternata and fresh ginger form the Xiao Banxia Tang, treating phlegm and fluid accumulation, stomach cold and vomiting, and can also reverse and stabilize the flow. 3. Modified Danzhi Xiaoyao Powder Angelica root 10g, atractylodes rhizome 10g, white peony root 10g, poria 12g, bupleurum root 10g, fresh ginger 6g, peppermint 3g, rehmannia root 12g, cornelian cherry 10g, Chinese yam 10g, alisma 10g, cinnamon twig 10g, peach kernel 10g, deer antler 3g (added separately). Decocted in water and taken one dose daily. This formula is suitable for middle-aged women with decreased libido and early menstruation. The formula uses Danzhi Xiaoyao Powder, GuiFu BaWei Wan, and modified GuiZhi FuLing Wan, aiming to enhance endocrine function and increase estrogen secretion. The deer antler in this formula is the finishing touch—this medicine contains both male and female hormones, the former used for male impotence, now used for female premature ovarian failure. This can be described as “those who excel at tonifying yang should tonify yang within yin, and those who excel at tonifying yin should tonify yin within yang.” In Danzhi Xiaoyao Powder, moutan bark has the effect of clearing heat and cooling blood, atractylodes rhizome strengthens the spleen and benefits qi, poria strengthens the spleen and promotes diuresis, gardenia fruit clears heat, promotes diuresis, and cools blood to detoxify, white peony balances liver yang and nourishes blood, angelica root nourishes blood, bupleurum soothes the liver and harmonizes the stomach, raising yang and lifting the fallen, peppermint disperses wind and dissipates heat. Moutan bark and gardenia fruit work together to release blood and extinguish the fire of the three jiao; poria and atractylodes rhizome work together to strengthen the spleen and promote diuresis, helping the blood to be produced abundantly; angelica root, white peony, and bupleurum work together to ensure smooth flow of liver qi. The entire formula has the effects of soothing the liver and clearing heat, strengthening the spleen and harmonizing the center, and nourishing blood and regulating menstruation. 8. Case examples Case 1: A 37-year-old woman presenting with amenorrhea for half a year. The patient is obese, with a pale and lusterless complexion. Her menstruation gradually stopped over six months, and gynecological examination ruled out pregnancy. She also had abdominal distension, lower back pain, ulcers in the mouth and nose, sores on the tip of the tongue, irritability, a pale tongue, and a thin, wiry pulse. [Western medical diagnosis] Amenorrhea. [Traditional Chinese Medicine differentiation] Qi stagnation and blood stasis. [Treatment principle] Regulate qi, remove stasis, and unblock the meridians. [Prescription] Modified Taohong Siwu Decoction, Danzhi Xiaoyao Powder, and modified GuiZhi FuLing Wan. Peach kernel 10g, safflower 6g, angelica root 10g, rehmannia root 12g, chuanxiong rhizome 6g, white peony root 15g, licorice 6g, atractylodes rhizome 10g, bupleurum root 10g, poria 12g, moutan bark 6g, gardenia fruit 10g, cinnamon twig 10g, peach kernel 10g, leech 6g (ground into powder and taken separately). Decocted in water and taken one dose daily. After taking more than 30 doses, her menstruation returned with abundant flow, abdominal distension, lower back pain, and oral/nasal/lingual ulcers all subsided, her mood improved, and her periods became regular month after month. Case 2: A 35-year-old married woman, first visit on August 7, 2017. Chief complaint: amenorrhea for more than five months. Past medical history: The patient reported irregular menstrual cycles after an induced abortion in July 2014, with infrequent periods lasting up to three months each, and scanty, reddish flow. Now the patient also experiences hot hands and feet, flushing and sweating, insomnia and vivid dreams, vaginal dryness and burning pain, dizziness and tinnitus, lower back and knee soreness, dry eyes and blurred vision, a red tongue, little coating, and a thin, wiry, rapid pulse. Reproductive history: Two pregnancies, one cesarean section, one induced abortion. Auxiliary examinations: Urine pregnancy test (-), so she went to a Grade III hospital for a sex hormone panel: FSH: 65.23 mIU/ml; LH: 58.14 mIU/ml; PRL: 7.22 ng/ml; E2: 34.16 pg/ml; PRGE: 0.3 ng/ml; T: 0.34 ng/dl; Ultrasound showed: Uterus; 44mm x 29mm x 34mm, endometrium: 5mm, left ovary: 13mm x 15mm, right ovary: 14mm x 15mm, uterine size is small. [Western medical diagnosis] Premature ovarian failure. [Traditional Chinese Medicine differentiation] Liver depression and blood stasis. [Treatment principle] Soothe the liver, activate blood circulation, and unblock the meridians. [Prescription] Modified Taohong Siwu Decoction, Danzhi Xiaoyao Powder, and modified GuiZhi FuLing Wan. Peach kernel 10g, safflower 6g, angelica root 10g, rehmannia root 12g, chuanxiong rhizome 6g, white peony root 15g, licorice 6g, atractylodes rhizome 10g, bupleurum root 10g, poria 12g, moutan bark 6g, gardenia fruit 10g, cinnamon twig 10g, peach kernel 10g, costus root 6g, motherwort 15g, leech 6g (ground into powder and taken separately). Decocted in water and taken one dose daily. Take half an hour after breakfast and dinner. Also advised the patient to keep a calm mood. Second visit: August 22, 2017. Menstruation has not yet returned, but perimenopausal symptoms have improved, with a dark tongue, thin coating, and a deep, tight pulse. On top of the previous prescription, added Wenjing Decoction, with the following formula: Codonopsis root 10g, evodia fruit 6g, ophiopogon root 10g, donkey-hide gelatin (processed) 10g, dried ginger 6g, peach kernel 10g, safflower 6g, angelica root 10g, rehmannia root 12g, chuanxiong rhizome 6g, white peony root 15g, licorice 6g, atractylodes rhizome 10g, bupleurum root 10g, poria 12g, moutan bark 6g, gardenia fruit 10g, cinnamon twig 10g, peach kernel 10g, leech 6g (ground into powder and taken separately). Third visit: October 8, 2017. Menstruation has returned, with acceptable flow, lasting four days. Advised the patient to continue taking the above prescription. Six months later, a follow-up sex hormone panel at another hospital showed: FSH: 7.25 mIU/ml; LH: 8.13 mIU/ml; E2: 109.19 pg/ml; Periods came regularly, 5