In the clinical evidence of TCM gynecology, the author found that multiple changes in follicles not only directly affect the menstrual cycle, but also determine the thickness of the endometrium, the amount of menstrual flow and the severity of the condition. Therefore, the diagnosis and treatment of amenorrhea requires ultrasound examination as a routine test to observe follicular changes, and then combined with systemic signs for diagnosis and treatment, which can reduce detours, thus guiding the use of medication and improving the efficacy of treatment. According to the clinical evidence, follicles have the following changes in different cycles and in different individuals. 1. The follicles can be large, but have difficulty in continuing to develop. This type of amenorrhea is common in clinical practice, and most patients come to the clinic after two months of inactivity. At this time, ultrasound shows that the follicles on one side of the ovary are more than 1 or 2 cm in diameter, which may be due to stress, improper medication and nutritional reasons (also seen around perimenopause), making it difficult for the follicles to continue to develop and mature. In this case, if progesterone is used, the follicles will shrink and the menstrual cycle will become more disordered, although menstruation can occur. In Chinese medicine, the main treatment is to promote follicular development by tonifying the kidneys, activating the blood and promoting the flow of qi. After about three to four days, the follicles develop to about 1.8 cm in diameter and the method of tonifying the kidneys, invigorating blood and promoting qi can be used to promote follicular discharge. After 2-3 times of normal ovulation, the menstrual cycle will return to normal. 2. The follicles can mature but cannot be discharged and become cysts. This condition is mostly seen in cases of long-term anovulation, such as polycystic ovary syndrome, or post-abortion damage to the flush, and also in those with irregular menstrual cycles. Due to repeated or prolonged anovulation of the ovaries, the ovarian envelope thickens and occasionally the follicles mature but have difficulty discharging and become cysts. Ovarian cysts vary in size, but are more common than 5 cm in diameter. In this case, modern medicine advocates surgical removal of the cyst and ovary, which does not affect the function of the internal secretion on one side, but the pain of surgery is difficult to accept. In this case, the general method of treating amenorrhea, that is, activating blood circulation, may cause the cyst to continue to grow or even rupture, with unimaginable consequences. In contrast, treatment with the method of removing phlegm, eliminating blood stasis and moving Qi can often make the cysts disappear quickly. Some ovarian cysts are not large, but the space occupied by the cysts affects the development of other follicles and causes late menstruation and amenorrhea (such cases are also seen in patients with ovarian chocolate cysts, the author treated a patient with a 3 or 7 cm diameter chocolate cyst in her left ovary, who was infertile for three years after marriage.) After the follicles became cysts, the cysts should be treated with the method of removing phlegm and eliminating blood stasis to make the cysts disappear and then promote follicular development and ovulation, the cysts no longer appear after ovulation. If it is an ovarian chocolate cyst, the treatment should be based on the mutual conclusion of phlegm and stasis. The follicles are more than ten and the diameter is less than 1 cm. unilateral or bilateral ovarian enlargement (or normal), small but many follicles, some even more than twenty, ultrasound shows dense or wheel-like arrangement, and no dominant follicles, indicating that the polycystic ovary syndrome is more severe. The former is often treated by clearing the liver and nourishing the kidneys to invigorate blood flow, and the herbs used are Scutellaria baicalensis, Dandelion, Paeonia lactiflora, Licorice, Cornu Cervi Pantotrichum, Radix et Rhizoma tridentata and Curcuma longa. After symptomatic treatment with herbal medicine, one follicle often develops or matures normally, but it is often difficult to ovulate. If the follicle is as large as 1 or 6 cm in diameter, it is necessary to thin the ovarian envelope and expel the follicle by invigorating blood and breaking down blood stasis and moving Qi. After three to four ovulations, the ultrasound will show normal ovarian size and the signs of polycystic disappears, which means that the disease is fundamentally cured. I have treated many patients with polycystic ovaries whose follicles developed to 1 or 8 cm after half a month of medication and then successfully became pregnant after ovulation. 4.There are more than two slightly large follicles, but the endometrium is hyperplastic due to the absence of ovulation. Most of the menstrual periods are related to excessive endometrial hyperplasia, which is caused by more than two follicles with a diameter of more than 1 or 2 cm, and due to the increase of multiple follicles, the estrogen level is too high, which makes the endometrium hyperplastic, and some endometrium is thicker than 2 cm, but due to the maturity of the follicles and the inability to secrete progesterone, the endometrium is in a hyperplastic state, and it is difficult to turn into a secretory phase, which leads to amenorrhea. In this case, the key to treatment is to tonify the kidneys, activate blood circulation and promote ovulation, and the medicines such as Chuanjian, Cuscuta, Wang Bu Liu Xing, Tao Ren and Soapberry are commonly used. As the mature follicles cannot be discharged, most of them become cysts. In this case, the treatment should be based on removing phlegm and promoting Qi to eliminate the cysts, which will also thin the overgrown lining and reduce menstrual flow. After the next menstrual cycle, on the one hand, the Yin blood should be replenished to restore the lost Yin blood, and on the other hand, the kidneys should be replenished to enable the development of new follicles, with follicles around 1,5cm in diameter in the middle of the menstrual cycle, that is, to promote ovulation, otherwise it is often difficult to expel oversized follicles, making the disease linger on. 5. Ovaries shrink due to few or no follicles (premature failure). When the ultrasound shows that the ovaries have few or no follicles and are shrinking in size, it is important to ask the length of amenorrhea. In cases within six months, the normal size and ovulation function of the ovaries can often be restored after treatment. The treatment mostly involves tonifying the kidneys, activating the blood and promoting the flow of Qi. The medicine can be chosen from Cornu Cervi Pantotrichum, Eucommia Ulmoides, Sambucus, Curcuma Longa, Peach kernel, Wang Bu Liu Xing, and Chicken Blood Vine. If the follicles do not develop, it means that the medication is not right and the treatment and prescription should be adjusted. As mentioned above, the treatment of amenorrhea cannot be summarized by one treatment method and often varies greatly from individual to individual or from one body to another at different times. The majority of amenorrhea tends to be closely related to ovarian follicle development and ovulation. Before the invention of ultrasound, the treatment of this disease was mainly based on the subjective judgment of the physician, and although it could treat most gynecological disorders, it was inevitably blind, and in some cases even misdiagnosed and mistreated. The author also had a detour, since the ultrasound examination of amenorrhea patients, the use of drugs will be targeted, the effectiveness of treatment has been improved. Especially when there is no evidence to identify, with the help of B examination can help to diagnose, so that the corresponding treatment method. Moreover, if some diseases can be detected and treated early, the pain of surgery can be avoided. Ultrasonography is more economical, more accurate and more intuitive than serum immunoassay, and can help diagnose and provide a basis for medication, as well as test the efficacy of the medication. In addition, when the patient sees the enlarged follicles or ovulation after the treatment, thus gaining confidence in the treatment, the liver qi is also conducive to qi and blood flushing, thus promoting follicle development and ovulation and treating amenorrhea at its root.