Integrative Woman’s Health Course DAOSHING NI

Amenorrhea 闭经

Case Study Dr. Fang, He Qian 方和謙  41yo,9-12-2005FirstVisit Amenorrheahalfyear,starteda;ermuchstresswithwork.

 NowfeelsBred,drythroat,insomnia,LMP3-8,tonguepale,pulsethinslow.Hadaphysicalexam,normal.

Definition  LackofmenstruaBon,overtheageof16,nomenarche(primary),orhadperiodsbutstoppedforatleast6monthsormore(secondary).

 <HuangDiNeiJing–SuWen>describedhowsixemoBonalinjuriescancauseamenorrhea.

 ToexcludelackofmenstruaBonduringpregnancy,lactaBon,postpartum,andmenopause.

 Lackofcertainorganssuchasovaries,uteruscanallcausethiscondiBon

Etiology & Pathogenesis  Womenwith46,XYKaryotype

 AnatomicalAbnormaliBes

 HypothalamicDefects

 OvarianFailure OvarianDysfuncBon Obesity

Women with 46, XY Karyotype  ThesexuallyundifferenBatedmalefetaltesBssecretsmullerianinhibiBngfactor(MIF)andtestosterone.MIFpromotesregressionofallMullerianstructures:theuterinetube,theuterus,andtheuppertwo-thirdsofthevagina.Testosterone

WM Etiology Anovulatory Amenorrhea  Amenorrheaisusuallyclassifiedasanovulatoryorovulatory.

 AnovulatoryAmenorrhea◦ HypothalamicdysfuncBon(parBcularlyfuncBonalhypothalamicanovulaBon)◦ PituitarydysfuncBon◦ Prematureovarianfailure◦ Endocrinedisordersthatcauseandrogenexcess(parBcularlypolycysBcovarysyndrome)

WM Etiology Ovulatory Amenorrhea  CongenitalgenitalabnormaliBes◦ Cervicalstenosis(rare)◦ Imperforatehymen◦ PseudohermaphrodiBsm◦ Transversevaginalseptum◦ Vaginaloruterineaplasia(eg,Müllerianagenesis)

 AcquireduterineabnormaliBes◦ Ashermansyndrome◦ EndometrialTB◦ ObstrucBvefibroidsandpolyps

Etiology

QiandBlood

Deficiency

KidneyQiDeficiency

YinDeficiencyBloodDryness

QiStasisandBloodStagnaBon

PhlegmDamp

Qi Xue Xu Qi and Blood Deficiency

ConsBtuBonalWeakness

ExcessiveWorrying

IrregularFoodIntake

SpleenDeficiencyunabletotransform

ConsumeQi-Xue

ChronicorMajorIllness

SeaofBloodEmpty

YingXueDeficientQiXueXu

Kidney Qi Deficiency

ConsBtuBonalKidney

Deficiency

EssenceandQiDeficiency

KidneyQiDeficiency

TianGuiLacking

ExcessiveSexandLabor

DamagestoKidneyQi

ChongRenDamage

Yin Deficiency Blood Dryness

ConsBtuBonalYinBloodDeficiency

BloodLossRisingof

DeficientHeatFiredryingWater

DamageYinandBlood

ChronicorMajorIllness

DamagetoYingYin

ConsumingBloodCausingBloodDryness

Qi Stasis and Blood Stagnation

LiverStasisQiStasisCausing

BloodStagnaBon QiStasisand

BloodStagnaBon

StagnantBloodBlockingChannels

ColdInvasionduring

menstruaBon

Contractureofblooddueto

cold

StagnaBonblockingofChongRen

Phlegm Damp

SpleenDeficiencyunabletotransform

DampAccumulaBonProducingPhlegm

PhlegmDampConsBtuBon

PhlegmDampBlockingChongRenorformaBonofPhlegmnodule

causingblockageofbloodflow

Pathology  LocaBon:ChongRen TwoScenarios◦ Nobloodtobleed◦ Bloodblockedsocannotbleed◦ (orcombinaBon)

 DifferenBatebetweenXu,Shi,Han,Re;butmostlyaredeficiencycondiBonordeficiencymorethanexcess.

Exams  BBT Vaginalculture Ultrasound MRI

 Hysteroscopy DiagnosBcD&C SerumFSH,E2,PRL,TSH.T

 Karyotype

Qi Xue Xu Qi and Blood Deficieny  Amenorrhea,haddelayedmenstruaBonwithscantypalethinflow,faBgue,decreasedlibido,vaginaldrynessoratrophy,tonguepale,pulsesloworweak.

 ChongRenDeficiency,SeaofBloodEmpty

 TonifyQi,BloodRegulatecycle RenShenYangRongTang人參養榮湯

 RenShen,HuangQi,BaiZhu,FuLing,ChePi,GanCao,ShuDi,DangGui,BaiShao,WuWeiZi,YuanZhi,RouGui

 CanaddZiHeChe,LuJiaoShuang,LuRongforJingdeficiency

Kidney Qi Deficiency  Primaryamenorrheaordelayedmenarche,gradualonsetofamenorrhea,faBgue,poordevelopmentofphysique,poorsecondarysexcharacterisBcsdevelopment,tonguepaledark,coaBngthinwhite,pulsedeepthin

 TonifyKidneyBenefitQi,RegulateChongRen ModifiedCongRongTuSiZiTang蓯蓉菟絲子湯(DrZhuo,YuNong’sExperienBalFormulaBon)卓雨農

 RouCongRong,TuSiZi,FuPenZi,GouQiZi,SangJiSheng,ShuDi,DangGui,AiYe;addZiHeChe,XianLingPi

 肉苁蓉、菟丝子、覆盆子、枸杞子、桑寄生、熟地、当归、焦艾叶，紫河車，仙靈脾。

Yin Deficiency Blood Dryness  Amenorrhea,delayedmenstruaBonpriorhistorywithscantyredthickflow,gradualonsetofamenorrhea,tonguered,coaBnglacking,pulsethinrapid.

 NourishYinClearHeatRegulateChongRen YiYinJian一陰煎

 ShengDi,BaiShao,MaiDong,DanShen,ShuDi,NiuXi,GanCao.

 生地黃6克 芍藥6克 麥門冬6克 丹參6克 熟地9克 牛膝5克 甘草3克

Qi Stasis Blood Stagnation  Amenorrhea,tonguepurpledarkwithstagnancyspots,pusledeepwirysluggish

 RegulateQiAcBvateBlood,RidofStagnancyRegulateMenstruaBon

 XueFuZhuYuTang血府逐瘀湯

 DangGui,ShengDi,TaoRen,HongHua,ZhiKe,ChiShao,ChaiHu,GanCao,JieGeng,ChuanXiong,NiuXi.

 當歸9克 生地黃9克 桃仁12克 紅花6克 枳殼6克 赤芍6克 柴胡3克 甘草3克 桔梗5克 川芎5克 牛膝9克

Phlegm Damp Blockage  Amenorrhea,priorhistoryofdelayedmenstruaBon,scantyflow,palesBckyflow,gradualonsetofamenorrhea,gradualonsetofweightgain,greasycoaBng,pulseslippery

 PhlegmDampblockingofChongRen

 StrengthenSpleen,DryupDampness,DissolvePhlegm

 SiJunZiTang+CangFuDaoTanTang＋DangGui四君子湯＋蒼附導痰湯＋當歸

 DangShen,FuLing,BaiZhu,FuLing+CangZhu,XiangFu,BanXia,ChenPi,DanNanXin,ChenPi,ShengJiang,ShenQu,DangGui,ChuanXiong

Case Study Dr. Fang, He Qian 方和謙  41yo,9-12-2005FirstVisit Amenorrheahalfyear,starteda;ermuchstresswithwork.

 NowfeelsBred,drythroat,insomnia,LMP3-8,tonguepale,pulsethinslow.Hadaphysicalexam,normal.

Case Study Dr. Fang, He Qian 方和謙  LiverStasisSpleenDeficiency RegulateLiverandSpleen,TonifyQiandNourishBlood ModifiedHeGanTang和肝湯

He Gan Tang 和肝湯  ExperienBalformulaBonofDr.Fang,HeQian.

 ComposiBon:DangGui10,BaiShao10,DangShen10,ChaiHu10,FuLing12,XiangFu10,BaiZhu10,SuGeng6,DaZao4pcs,BoHe5,ZhiGanCao6,ShengJian3pcs.

 FormulaBonusedonthispaBent:

 DangGui9,BaiShao9,DangShen9,ChaiHu9,FuLing9,XiangFu9,BaiZhu9,SuGeng6,DaZao4pcs,BoHe5,ZhiGanCao6,ShengJian3pcs,ShengShuDi10each,ZeLan6,DanShen6.10bags.Drink2daysandstop1day

Case Study Dr. Fang, He Qian 方和謙  10-24-2005SecondVisit Energyhasimprovedbutnoperiodyet.Thereissomepelvicdiscomfortwithincreasedvaginaldischarge.Bowelmovementnormal,tonguesBllpaleandpulseevenandslow

 PreviousformulaBonaddShanZhuYu6,MaiDong10,10bagsanddrinkeveryotherday.

Case Study Dr. Fang, He Qian 方和謙  12-15-2005,thirdvisit PeriodreturnedonDecember11,scantyflowfortwodays,darkcolor,pulseevenandslow,tonguepale.

 ThisisQiandBloodDeficiencythereforethemenstrualbleedingislight.WeneedtotonifyQiandBlood.UsemodifiedZiBuTang滋補湯

Zi Bu Tang 滋補湯  ThisisanexperienBalformulaBonofDr.Fang,HeQian方和謙.

 DangShen9,BaiZhu9,FuLing9,ZhiGanCao5,ShuDi9,BaiShao9,DangGui9,GuiZhi5,ChenPi9,MuXiang5,DaZao4pcs

 FormulaBonusedforthispaBent:

 DangShen9,BaiZhu9,FuLing9,ZhiGanCao6,ShuDi9,BaiShao9,DangGui9,GuiZhi5,ChenPi9,MuXiang3,DaZao4pcs,ShuDi9,GouQIZi10,MaiDong10,ZhiJuangQi15.12bags,drinkeveryotherday.

Dr. Fang, He Qian 方和謙  1923– ChaoYangHospital,Beijing,chiefphysician

 Famousfordifficultcases,pulmonary,heartdiseases,hepaBcdisorders.

 StudentofoneofthelastimperialphysicianDr.Zhao,YunQing趙雲卿

Last words  ThecauseisfocusedonLiver,Spleen,andKidneyandKidneydeficiencyisthemainfactor.

 Currentlytherearethreetypesoftreatments◦ Syndrometreatments◦ Phasictreatments◦ IntegratedwesternmedicineandTCMtreatments