We have discussed the etiology and treatment of premature ovarian failure (POF), and proposed the concept of “depression is the cause of the disease, stasis is the main link, and deficiency is the final result”, and advocated the treatment of premature ovarian failure from stasis. Premature ovarian failure (POF) is a syndrome of ovarian failure due to multiple etiologies. POF is a multi-cause ovarian failure syndrome in which women with normal development develop persistent amenorrhea and sexual organ atrophy before the age of 40, accompanied by elevated follicle stimulating hormone (FSH) and luteinizing hormone (LH) and decreased estrogen (E2). The prevalence is 1 to 3% in the general population, and about 2% to 10% in amenorrheic patients [1]. In our clinical work, we found that the incidence of premature ovarian failure is increasing year by year, and the trend is younger, especially in teachers, accountants or senior managers. The symptoms of premature ovarian failure are characterized by “stasis”, and treatment with the method of eliminating stasis and opening the ligaments is more effective. In this regard, this article discusses the treatment of premature ovarian failure from stasis as follows. The cause of premature ovarian failure is not described as “premature ovarian failure” in Chinese medical literature, but according to its manifestations, it belongs to the categories of blood depletion, blood isolation, amenorrhea and infertility. Because of facial fever, night sweats and vaginal dryness, most people believe that kidney deficiency is the main cause of this disease and that kidney tonification is the main treatment. In the beginning of the Nei Jing, it is said that “when the heavenly sap arrives at the second seventh day, the ren vein is open, the tai-chong vein is strong, and the menstrual events take place at the right time, so there is a child …… and the ren vein is weak, the tai-chong vein is weak, the heavenly sap is exhausted, and the earthly channel is not accessible, so the form is bad and there is no child.” Many books of later generations have quoted this as the basis for kidney deficiency is female aging. But let’s read carefully, this scripture not only emphasizes the kidney energy, but also the “Ren pulse” is an important factor. The patient with premature ovarian failure has a common feature, first ovarian ovulation disorder, manifested as menstrual disorders, menopause, when a long period of time without ovulation, the ovaries gradually atrophy and lead to premature failure. When the ovaries do not ovulate for a long time, they gradually atrophy and cause premature failure. Therefore, the whole process of premature ovarian failure should be summarized as “depression is the cause of the disease, stasis is the main link, and deficiency is the final result”. 1, depression is the cause of the disease Due to the speed of social processes, the acceleration of the pace of work, the increasingly fierce competition, the changing human environment and other factors, “sub-health status”, “chronic fatigue syndrome” and other modern diseases are increasing, premature ovarian failure is no exception. The clinical findings show that the onset of premature ovarian failure has no direct impact on the living conditions, but is closely related to the nature of work. The incidence of work stress and mental burden is as high as 90%. The reason for this is the word “depression”. Jing Yue Quan Shu” on the cause of menstrual disease, “if you do not know how to be careful, then the seven emotions of the injury is even, and labor and fatigue second”; “clinical guide to medical cases” that “women with liver as the first, Yin condensation, easy to whisk depression, depression is stagnant blood is also stagnant”. The heavy mental burden, once the discharge is not smooth, what is sought is not achieved, and in the long run, the emotions are depressed, the liver is not in order, the Qi is depressed and the Qi is not smooth, resulting in poor ovulation of the ovaries, affecting the menstruation and menstrual disorders. This is the initial stage of ovarian decline. At this stage, in addition to menstrual changes, there are many symptoms of liver qi disorders, such as dizziness and heaviness, chest tightness, palpitations, sweating, weakness, sleepiness, poor mental health, sleep disorders, and dietary changes. 2. Stasis is the main link As the disease progresses, depression for a long time affects the flow of blood and develops from menstrual disorders to amenorrhea. This is due to stasis in the veins and the lack of flow. This is an important aspect of premature ovarian failure. Clinically, if these patients can adjust their mentality and receive active treatment, they can restore ovarian function and maintain normal menstruation. According to the “Treatise on Blood”, “the blood in a woman’s cell is changed once a month to remove the old and create new blood, the old blood is stagnant blood. Long-term stagnation of the blood vessels and veins, failure of menstruation, obstruction of qi flow, and unfavorable flow of qi and blood will lead to systemic symptoms. If the skin is not nourished, sallow complexion, facial pigmentation and rough skin will appear; if the blood does not nourish the liver for a long time, liver yang will be present, resulting in irritability, irritability of the five hearts, flushing of the cheekbones and baking heat. “Stasis” is particularly typical in tongue changes. Tongue diagnosis is one of the main diagnostic methods in Chinese medicine to understand the physiological functions and pathological changes of the human body, and is also one of the bases for clinical diagnosis, legislation and medication. According to our clinical observation of ovarian premature failure patient’s tongue, tongue light, tongue fat, coating white smooth, etc. belong to kidney Yang deficiency; or tongue red, less coating, less fluid, etc. belong to Yin deficiency are rare, but to tongue dark red or light purple, tongue veins under the blue purple, purple red, vivid purple, purple-black for the most common. If this stage is not treated in time, the deficiency will lead to loss of glory and the decay of ovarian function. The essence in the kidney is the essence of the body, which comes from the congenital, but needs constant nourishment from the acquired essence. The “Nei Jing? The “meridians and veins” cloud: “drink into the stomach, overflowing essence upward transmission in the spleen, spleen qi dispersion of essence, up to the lungs, through the water channel, down to the bladder, water essence four cloth, five meridians parallel. Combined in the four seasons, the five organs of yin and yang, consider the degree as normal.” Stasis for a long time is not eliminated, the ligament is not blocked, it is bound to affect the entire metabolic process of the human body, including the transformation of the kidney essence. The kidney essence gradually decreases, so that it is difficult to produce “heavenly sebum” to maintain human reproductive function, ovarian atrophy. The symptoms of kidney deficiency gradually appear, such as tinnitus and deafness, forgetfulness and trance, lumbago and weakness of the knees, clear and long urine, lack of color and indifference to sexual matters. It can also lead to deficiency and dysfunction of the heart and spleen, commonly including insomnia and dreaminess due to heart-kidney disorder, and loose stools and floating face due to spleen-kidney Yang deficiency. Due to the deficiency of the organs, the harmful pathological products stay, not only the “stasis” image is aggravated, but also the phlegm and dampness stay, and even the phlegm and stasis are intertwined, resulting in pain in the bones, obesity, numbness in the limbs, and other evidence of deficiency and reality. The main drugs used to dispel blood stasis and pass through the ligaments are leeches, shanjia tablets, lutong, tongcao and hosin. These drugs have a common characteristic of being good at running away, specializing in the nature of travel, breaking blood and eliminating stasis, and passing blood vessels. They are very suitable for premature ovarian failure, which is caused by stagnation of blood vessels and channels. The specific application, combined with the severity of the disease, the characteristics of the menstrual cycle with the liver, blood, kidney, blood and other drugs used in combination. 1.Liver de-stasis and blood circulation method The drugs to remove blood stasis and blood circulation are combined with drugs to de-stasis the liver, such as Chai Hu, Yu Jin, Jiang Huang, Green Plum Blossom and Xiang Shen, etc., which are mostly used in the beginning stage of premature ovarian failure. At this stage, the patient starts to have menstrual disorders, some manifesting as low menstrual flow, or delayed menstruation, while others have menopause for 2-3 months, with E2 and progesterone (P) dropping, but FSH and LH still in the normal range. Depression is the cause of the onset of the disease, and the application of de-liverizing and draining the liver at this stage is particularly important. If treated in time, it can stop the decline of ovarian function and restore normal menstruation. Yu often encounters patients who, in addition to menstrual disorders, show numerous signs of deficiency, such as dizziness and heaviness, chest tightness, palpitations, sweating, weakness, drowsiness of the limbs, poor mental health, sleep disorders, and changes in diet, etc., which are actually closely related to the dysfunction of liver qi drainage, as stated in the “Red Water Xuanzhu”: “There are people with vegetative deficiency, once things are not as they should be, their head and eyes The first thing to do is to open up and smooth out the Qi, and the disease will heal itself”. Therefore, I mostly use the medicine to dispel blood stasis and open up the ligaments with Prosperity San, or Four Inversions San, and achieve better results. If you see deficiency, you will get twice the result with half the effort. 2. The method of removing blood stasis and clearing the ligaments is to combine drugs for removing blood stasis and clearing the ligaments with drugs for replenishing blood and qi, such as angelica, peony, rehmannia, astragalus, codonopsis, shouwu, etc., which are mostly used for those with premature ovarian failure due to liver qi transverse rebellion and qi and blood failure. The “liver body yin with yang” is particularly special in women. The liver qi can consume the liver’s yin and blood, and can also take advantage of the spleen to rush the heart, without source to transform the qi and blood. Especially in cases of Qi deficiency, the Qi does not flow through the Blood, aggravating the stasis. Patients not only have obvious changes in menstruation, such as menstrual failure for several months, or low menstrual blood volume, dark color, E2 and P decrease, FSH and LH slightly increase, but also have symptoms of Qi and Blood deficiency, such as lack of color, insomnia, weakness, and dark purple lips. I often come across patients who have not been able to have menstruation for several months, see a Western doctor, and use hormone replacement therapy. These patients may have small follicles on the ovaries but no dominant follicles as shown by ultrasound. Once the drug is stopped, menstruation also stops. I use Chinese herbal treatment to tonify qi and blood to remove blood stasis and promote the growth of follicles on the one hand, and to promote ovulation on the other, thus restoring normal menstruation. 3. The method of tonifying the kidneys to remove blood stasis and open the ligaments is to combine the drugs to remove blood stasis and open the ligaments with drugs to tonify the kidneys, such as Xian Mao, Xian Ling Spleen, Ba Shao Pao, Cistanches, Lock Yang and Cuscuta. The purpose of tonifying the kidneys is to restore the essence in the kidneys so as to produce “Tian Kuei” (maturation of follicles); the purpose of removing blood stasis is to unblock the flow of Qi and Ren (normal ovulation). The combination of the two is mostly used in cases of premature ovarian failure, where menstruation does not occur for several months. In addition to the decrease in E2 and P, FSH and LH rise and the ovaries shrink bilaterally. In this stage of treatment, I usually use a combination of Chinese and Western medicine, i.e. Western hormones to restore menstruation and Chinese herbal medicine to restore ovarian function by tonifying the kidneys and removing blood stasis. I treated a 37-year-old patient with premature ovarian failure who had been amenorrheic for more than a year, with E2 and P decreasing and FSH at 78 mIU/ml. When she came to our clinic, she had not had menstruation for 3 months. On examination, she had a dark tongue, obvious stagnation of the veins under the tongue, dark lips and astringent pulse. She took 20 doses of the formula to treat the kidney and remove blood stasis, and her menstruation started immediately. I compared the formula with the Chinese medicine she was taking before, the kidney tonics such as Xian Ling Spleen, Bacopa Monniera, Cistanches, Shu Di, etc. were basically the same, but the key to my effectiveness was the use of drugs that dispel blood stasis and open the channels, such as leeches, Shanjia tablets, Tongcao, etc. The only way to be effective is to use both attack and supplementation, and to use the kidney and eliminate blood stasis. The above three methods are only for different degrees of premature ovarian failure. When applied, they must be combined with the characteristics of the menstrual cycle and be flexible. For example, during the menstrual period (1st to 4th day of menstruation), add drugs that tonify Qi and invigorate Blood, such as Astragalus, Radix et Rhizoma, Zelenia, Motherwort, etc., so that the Qi and Blood will flow and promote smooth menstrual excretion; during the follicular period (4th to 11th day of menstruation), add drugs that tonify Blood, such as Angelica, Radix et Rhizoma, Radix Rehmanniae, etc. According to TCM, the sea of blood is empty at this time and needs a process of gradual accumulation and recovery, which is a long period of yin. Replenishing blood can promote the normal growth and development of the endometrium and follicles; during the ovulation period (12th to 16th day of menstruation), add drugs that invigorate blood and open the ligaments, such as Lulutong, Shanjia tablets and Hosin. Promote the development and maturation of follicles and stimulate ovulation; during the luteal phase (17th-30th days of menstruation), add some Yang tonifying drugs, such as Cuscuta, Cuscuta and Bacopa monniera. Chinese medicine believes that this is the Yang phase, when the kidney’s Yang energy is gradually flourishing and the essence is hidden but not leaked, so tonic Yang is good for maintaining the luteal function, allowing the endometrium to grow normally and preparing for menstruation. In conclusion, the occurrence of premature ovarian failure is closely related to depression, stasis and deficiency, the earlier the treatment, the better the outcome.