Integrative Woman’s Health Course DAOSHING NI

Excessive Menstrual Flow HYPERMENORRHEA, MENORRHAGIA DAOSHING NI

Clinical Case #4 Dr Wang, Zi Yu 王子瑜  31yo,married,excessivemenstrualflowforfivemonths.

 Duetofamilymembersickness,shehasbeendepressedandemo?onal,excessivemenstrualflow,took9daystoclear,premenstrualrestlessness,irritability,biAermouth,excessivedreams,flowexcessivewithclots,facepale,coa?ngthinyellow,pulsethreadywiryrapid.

Menorrhagia or Hypermenorrhea  Menorrhagiaisthemedicaltermformenstrualperiodswithabnormallyheavyorprolongedbleeding.

 Althoughheavymenstrualbleedingisacommonconcernamongpremenopausalwomen,mostwomendon'texperiencebloodlosssevereenoughtobedefinedasmenorrhagia.

Symptoms  Thesignsandsymptomsofmenorrhagiamayinclude:◦ Soakingthroughoneormoresanitarypadsortamponseveryhourforseveralconsecu?vehours

◦ Needingtousedoublesanitaryprotec?ontocontrolyourmenstrualflow◦ Needingtowakeuptochangesanitaryprotec?onduringthenight◦ Bleedingforlongerthanaweek◦ Passingbloodclotswithmenstrualflowformorethanoneday◦ Restric?ngdailyac?vi?esduetoheavymenstrualflow

◦ Symptomsofanemia,suchas?redness,fa?gueorshortnessofbreath

Classical Texts  <JinKuiYaoLue金匱要略>descrip?onofmenorrhagiaunderWenJingTang溫經湯sec?on

 <SuWenBingJiQiYiBaoMingJi素問病機氣宜保命集>definedwhatmenorrhagiameans

 <DanXiXinFa丹溪心法>describede?ologyofHeatintheBlood,excessivephlegm,andblooddeficiency.

 <ZhengZhunZuangSheng証治準繩>focusedonDeficientHeatandQiDeficiencyastwoofthemaincauses.

Common Disorders Menorrhagia  Abnormaluterinebleeding

 Uterinefibroids(leiomyomas)

 Uterineenlargement

 Endometriosis/adenomyosis

 IUD

Etiology  QiDeficiency氣虛

 HeatintheBlood血熱

 BloodStagna?on血瘀

Qi Deficiency 氣虛

InjurytoSpleenQi

PoorDiet

OverstrainingorOverworrying

ChronicIllnessorSickness

MiddleJiaoQiInsufficiency

ChongRenDysfunc?onlosingholdingfunc?on

Heat in the Blood 血熱

HeatDisturbingChongRen

LiverStasistransforming

toFire

ExogenousHeat

PathogenOverIntakeofSpicyFoods

ForcingBloodtoFlowUncontrollably

Blood Stagnation 血瘀

StagnantBloodRetainsInternally

Cons?tu?onalStasis

QiStasisBloodStagna?on

InvasionofExogenous

PathogenduringLaboror

Menstrua?on

StagnancyblocksChongRenChannels,BlooddoesnotreturntoChongRenChannels

Pathology  Theloca?onofthedisorderisintheChongRenChannels.ChongRenlosesitscontrolfunc?onofthemenstrualbloodisthekeymechanismofthiscondi?on.

 Thiscondi?onhasbothdeficiencyandexcesstypesandfrequentlyacombina?onofboth.

Pathology Qi

Deficiency

ChongRenlosingControl

BloodLostControl

HeatintheBlood

HeatDisturbsChongRen

ForcingBloodtoFlow

Uncontrollably

ExcessiveMenstrual

Flow

BloodStagna?on

Stagna?onBlockingChongRen

BloodDoesNotReturntoChannel

Etiopathology Summary Exogenous

HeatPathogen

SpecialMenstrualPhysiology

Cons?tu?onalFactor

EndogenousEmo?onalFactors

DietaryFactorXueYu

XueRe

QiXu BloodLosesControl

Stagna?onBlocksChongRen

HeatDisturbsChongRen

Diagnosis  MainSymptom:MenstrualFlowincreasedobviously,buttendstostopon?me.MenstrualCycleiss?llregular.

 Combina?onDisorder◦ CanCombinewithMenstrualCycleIrregularity

◦ CanCombinewithincreaseofMenstrualDays◦ CanCombinewithDysmenorrhea,Infer?lity,andZhengJiacondi?ons

Examinations  PelvicExamstocheckforfibroids/sizeofuterus

 Ultrasoundtocheckforpolyps/adenomyosis/fibroids

 OvarianFunc?onTests◦ Ovula?onindica?on/FSH/E2

 EndometrialBiopsy

Differentiation between Menorrhagia and AUB

Menorrhagia AbnormalUterineBleeding

Similarity VaginalHeavyBleeding

Differences MenstrualCycleisregular

MenstrualCycleisnotregular.LongerBleedingandcannotstopbyitself

Differentiation of Syndromes E4ology Symptoms

Quan?ty Color Quality Cycle

QiXu Excessive Palered Thin Normal

XueRe Excessive DeepBrightRed

ThickandS?cky

Normal

XueYu Excessive DarkPurpleRed

Clots Normal

Treatment Principles  RegulateUterus,ChongRen,QiandBlood DuringMenstrua?on–StopBleedingandStrengthenChong

 OutsideofMenstrua?on–TonifyQi,ClearHeat,NourishYin,DissolveStagna?on.

 Carefulnottousetoomuchwarming,pungent,anddryingherbstopreventincreaseofbloodflow

Herbal Therapy Qi Deficiency  Excessivemenstrualflow,palecolor,thinflow,fa?gue,dyspnea,feeblespeech,emptypelvisfeeling,paleface,tonguepale,coa?ngthin,pulsethreadyandweak.

 MiddleJiaoQideficiency,ChongRennotcontrolling,Bloodlosingcontrolinflow

 TonifyQiControlBloodStrengthenChong

 JuYuanJian舉元煎

 RenShen,HuangQi,BaiZhu,ShengMa,ZhiGanCao.人參，黃芪，白朮，升麻，炙甘草。

Herbal Therapy Qi Deficiency  JuYuanJian舉元煎

 RenShen,HuangQi,BaiZhu,ShengMa,ZhiGanCao.人參，黃芪，白朮，升麻，炙甘草。

 AddAiYe,WuZeiGu,XueYuTan,AJiaoduringmenstrua?on

 Ifthereisclotsorwithdysmenorrhea,addSanQi,PuHuang,YiMuCao.

 Ifthereislumbagoandcoldtypeofabdominalpains,addXuDuan,AiYe,BuGuZhi.

Ju Yuan Jian 舉元煎  <JingYueQuanShu景岳全書>

 RenShen15,ZhiHuangQi15,ZhiGanCao6,ShengMa2,ChaoBaiZhu6

 TonifyQiStrengthenHeart,RaiseandControlBlood QiDeficiencywithprolapse,abnormalbleeding,prolapseofYang,etc.

Herbal Therapy Heat in the Blood  Excessivemenstrualflow,brightordeepredcolor,thickands?ckyfloworwithsmallclots,restlessness,thirst,urina?onyellowandscanty,cons?pa?on,tongueisred,coa?ngyellow,pulseslipperyrapid.

 HeatdisturbingtheChongRen,Causinguncontrolledbloodflow

 Clearheat,coolsblood,strengthenChongandstopbleeding

 ModifiedBaoYinJian保陰煎

 BaoYinJian+DiYu,QianCao,MaChiMi.

 ShengDi,ShuDi,HuangQin,HuangBo,BaiShao,ShanYao,XuDuan,GanCao,DiYu,QianCao

Herbal Therapy Heat in the Blood  ModifiedBaoYinJian保陰煎

 BaoYinJian+DiYu,QianCao,MaChiMi.

 ShengDi,ShuDi,HuangQin,HuangBo,BaiShao,ShanYao,XuDuan,GanCao,DiYu,QianCao CanaddWuZeiGu,XianHeCao,XiaoJitofor?fystopbleedingac?on

 Ifheatisstrongandexcessivesuchashavingfever,addPuGongYin,BaiJianCao,HongTeng,PuHuang

Herbal Therapy Xue Yu  Excessivemenstrualflow,darkflowwithclots,abdominalpainwithaversiontopressure,tonguepurpledarkorwithstagnantspots,pulsethinandhesitant.

 Stagna?onblockingtheChongRen,Blooddoesnotreturntothechannels. Ac?vateblooddissolvestagna?onandstopbleeding

 ModifiedShiXiaoSan失笑散

 ShiXiaoSan+YiMuCao,SanQi,QianCao

Herbal Therapy Xue Yu  ModifiedShiXiaoSan失笑散

 ShiXiaoSan+YiMuCao,SanQi,QianCao

 PuHuang,WuLingZhi,YiMuCao,SanQi,QianCao

 Ifsevereabdominalpain,addYuanHuSuo,ChuanLianZi,XiangFu.

Acupuncture Therapy  LI11,LR3,SP6,LR2,HT5,seda?on,forXueRe SP6,ST36,CV6,BL15,BL20,tonifica?onforQiXu

 BL17,LI4,SP10,LR3,LR2,SP6,HT5,seda?onforXueYu Auricular:Kidney,uterus,pelvis,endocrine,adrenal,subcortex

Other Cautions  Stayawayfromspicyfoods,reduceemo?onals?mula?on,focusonea?ngproperly.

Clinical Case #4 Dr Wang, Zi Yu 王子瑜  31yo,married,excessivemenstrualflowforfivemonths.

 Duetofamilymembersickness,shehasbeendepressedandemo?onal,excessivemenstrualflow,took9daystoclear,premenstrualrestlessness,irritability,biAermouth,excessivedreams,flowexcessivewithclots,facepale,coa?ngthinyellow,pulsethreadywiryrapid.

Clinical Case #4 Dr Wang, Zi Yu 王子瑜  LiverStasistransformingtoHeat,Heatcausingblooduncontrolledbleeding

 PacifyLiver,ClearHeat,CoolsBlood,StopBleedingandregulatemenstrua?on

 ModifiedDanZhiXiaoYaoSan

 ShengDi,ChaiHu,BaiShao,DanPi,JiaoShanZhi,ShanYao,WuZeiGu,PuHuang,DiYuTan,YiMUCao,SanQiFen,7bags,1bagperday

Clinical Case #4 Dr Wang, Zi Yu 王子瑜  Secondvisit:menstrualflowdecreased,took7daystoclear,tonguedarkandpale,coa?ngthinyellow,pulsedeficientandwiry.

 Sameformula?onridofDiYu,WuZeiGu,PuHuang,YiMuCaoandaddDangGui,AJiao,DangShen,HuangJing.7bags,1bageachday

Clinical Case #4 Dr Wang, Zi Yu 王子瑜  Thirdvisit:menstrua?onisnormalbutwithpremenstrualbreasttenderness.

 Sameformula?onassecondvisitplusJuYe,JuKe.

Integrative Woman’s Health Course DAOSHING NI

Decreased Menstrual Flow 月經過少

Clinical Case #5 Dr Xu, Run San 許潤三  29yo,hadanabor-onD&Ctwomonthsago,hermenstrualflowhasdecreaseddrama-callylasttwocycles.

 Opera-onwasnon-even@ulwithnocomplica-ons,decreasedvaginaldischarge,noclots,tonguepale,coa-ngthinwhite,pulsethinweak.

Definition  Withmenstrualcyclenormal,theamountofmenstrua-ondecreasedsignificantlyorthemenstrual-meistwodaysofless.

 Hypomenorrhea,alsoknownasshortorscantyperiods,isextremelylightmenstrualbloodflow.

Possible conditions  Smalluterusorpoordevelopmentoftheuterus

 Sexhormonefunc-ondecreases

 Mul-plepelvicopera-ons

Etiology  KidneyDeficiency(ShenXu)腎虛

 BloodDeficiency(XueXu)血虛

 BloodStagna-on(XueYu)血瘀

 PhlegmDamp(TanShi)痰濕

Etiology – Kidney Deficiency

ChongRenEmpty,notenoughtobleed

KidneyQiWeakness

KidneyQiWeakness,BloodandEssenceWeakness

Excessivepregnancies,

excessivesexualac-vi-es

Etiology – Blood Deficiency

SeaofBloodEmpty

ChronicIllnessinjurytheblood,

YingXuedeficiency

ChongRenDeficiency

Poordiet,overstraining,overworryinginjuringtheSpleen

Etiology – Blood Stagnation

BlockageofChongRen,menstrual

flowblockage

ExogenousColdcausingblockagesinChongRen

ChronicstasiscausingQiandBloodStagna-on

Etiology – Phlegm Damp

Blockageof

MenstrualBlood

Cons-tu-onalPhlegmDamp

PhlegmBlockingChannelsand

Collaterals,bloodflowissluggish

Spleenlosttransforming

func-on,collec-onofdampturningintophlegm

Pathology  DiseaseLoca-on:ChongRen.ThemainpathologyisChongRenSeaofBlooddeficientoremptying,causingsluggishanddecreasedflow.

Deficiency

KidneyDeficiency,Blood

Deficiency

DeficiencyofChongRenSeaofBlood

LackofMenstrualBlood

Excess

BloodStagna-on,PhlegmDamp

ChongRenBlockage

BloodFlowSluggish

Etiopathology Summary

ExogenousCold,Damp

SpecialMenstrualPhysiology

Cons-tu-onalFactor

EndogenousEmo-onalFactors

DietaryFactor

XueYuTanShi

ShenXuXueXu

ChongRenSeaofBloodDeficient,MenstrualBlood

Deficient

ChongRenBlockage,MenstrualFlow

Sluggish

Diagnosis  MainSymptom:decreasemenstrualbloodflow,butcyclenormal

 Combina-ons:canseemenstrualcycleirregular,tendstocombinewithdelayedmenstrualcycle.

Exams  Pelvicexamina-ontocheckforthesizeofuterus

 Ultrasoundtoseeanyuterineblockages

 Sexhormonelevels

 Anemia

Differentiation of Syndromes E"ology Symptoms

Quan-ty Color Quality Cycle

ShenXu decreased Paledark Thin Normal

XueXu decreased Palered Thin Normal

XueYu Sluggishanddecreased

Purpledark Clots Normal

TanShi decreased Palered S-cky Normal

Treatment Principles  RegulateUterus,ChongRen,andQiXue◦ KidneyDeficiency–TonifyandNourishKidney◦ BloodDeficiency–NourishEssenceandBlood◦ BloodStagna-on–WarmUpchannelsandcirculateQi◦ PhlegmDamp–dissolvephlegm

Herbal Therapy Kidney Deficiency  Decreasedmenstrualflow,paleordarkredcolor,thinflow,dizziness,-nnitus,lumbago,weakknees,heelpains,pelviccoldness,nocturia,tonguepale,pulsedeepweakordeepslow

 KidneyQideficiency,ChongRenSeaofBlooddeficiency TonifyKidneyBenefitEssence,NourishBlood,RegulateMenstrua-on

 GuiShenWan歸腎丸

 TuSiZi,DuZhong,GouQiZi,ShanZhuYu,DangGui,ShuDi,ShanYao,FuLing.菟絲子，杜仲，枸杞子，山茱萸，當歸，熟地，山藥，茯苓。

Herbal Therapy Kidney Deficiency  GuiShenWan歸腎丸

 TuSiZi,DuZhong,GouQiZi,ShanZhuYu,DangGui,ShuDi,ShanYao,FuLing.菟絲子，杜仲，枸杞子，山茱萸，當歸，熟地，山藥，茯苓。

 AddXianLingPi,BaJiTian,XianMaoforYangDef

 AddShengDi,NvZhenZi,XuanShenforYinDef

 AddDanPi,ZhiZi,ZhiMuforinternalheat

Herbal Therapy Blood Deficiency  Decreasedmenstrualflow,palecolor,dizziness,blurryvision,palpita-on,sallowfacialcomplexion,pelvicemptyprolapsefeeling,tonguepaleandpulsethready

 ChongRenSeaofBlooddeficient NourishBloodBenefitQiRegulateMenstrua-on

 ZiXueTang滋血湯

 RenShen,DangGui,HuangQi,ShanYao,FuLing,ChuanXiong,BaiShao,ShuDi

Herbal Therapy Blood Deficiency  ZiXueTang滋血湯

 RenShen,DangGui,HuangQi,ShanYao,FuLing,ChuanXiong,BaiShao,ShuDi

 Ifinsomniawithpalpita-on,addYeJiaoTeng,WuWei,SuanZaoRen

 Ifpoorappe-te,addShaRen,ChenPi,BaiZhu

Herbal Therapy Blood Stagnation  Decreasedbloodflow,purpledarkflow,clots,pelvicdistendingpainaversiontopressure,releaseofclotsreducesdisten-onandpain,tonguepurpledarkandpulseisthreadywiry.

 ChongRenisbloacked,bloodflowissluggishandhesitant,menstrualbloodisblocked.

 Ac-vatebloodanddissolvestagna-on

 TaoHongSiWuTang桃紅四物湯

 TaoRen,HongHua,DangGui,ShuDi,ChuanXiong,BaiShao

Herbal Therapy Blood Stagnation  TaoHongSiWuTang桃紅四物湯

 TaoRen,HongHua,DangGui,ShuDi,ChuanXiong,BaiShao

 IfQistasiswithbloodstagna-on,addXiangFu,WuYao

 Ifcoldcontracturebloodstagna-on,addGuiZhi,WuZhuYu

Herbal Therapy Phlegm Damp  Decreasedbloodflow,palecolor,s-ckythickerflow.Obeseoroverweight,chestdisten-on,nausea,vaginalleukorrhea,fa-gue,tonguepale,coa-ngthinwhitegreasy,pulseslippery

 PhlegmblocksChongRencausingsluggishmenstrualbloodflow

 Dissolvephlegm,dryupdampness,regulatemenstrua-on

 CangFuDaoTanTang蒼附導痰湯

 CangZhu,XiangFu,BanXia,FuLing,ChenPi,GanCao,DanNanXing,ZhiKe,ShengJiang,ShenQu.

 蒼朮，香附，半夏，茯苓，陳皮，甘草，膽南星，枳殼，生薑，神曲。

Herbal Therapy Phlegm Damp  CangFuDaoTanTang蒼附導痰湯

 CangZhu,XiangFu,BanXia,FuLing,ChenPi,GanCao,DanNanXing,ZhiKe,ShengJiang,ShenQu.

 蒼朮，香附，半夏，茯苓，陳皮，甘草，膽南星，枳殼，生薑，神曲。

 Ifmenstrua-onstopsoramenorrhea,addDangGui,ChuanXiong,ZeLan,ChuanNiuXi.

Acupuncture Therapy  BL17,BL15,ST36,SP6,SP10,tonifica-onforXueXu CV3,GV4,BL23,CV6,SP6,SP10,tonifica-onforShenXu

 BL17,LI4,LR3,SP10,LR2,SP6,seda-onforXueYu CV3,ST36,ST40,SP9,seda-onforTanShi

 Auricular:ovary,uterus,liver,sanjiao,pelvis

Other Cautions  Duringmenstrua-on,addingsomeac-va-ngbloodherbscanbehelpful

 Outsideofmenstrua-on,focusshouldbeonnourishingessenceandblood.

 Stayawayfromastringentherbsifpossible

Clinical Case #5 Dr Xu, Run San 許潤三  29yo,hadanabor-onD&Ctwomonthsago,hermenstrualflowhasdecreaseddrama-callylasttwocycles.

 Opera-onwasnon-even@ulwithnocomplica-ons,decreasedvaginaldischarge,noclots,tonguepale,coa-ngthinwhite,pulsethinweak.

 LiverKidneyInsufficiency,ChongRenInsufficiency

 NourishKidneyandBlood DangShen30,DangGui30,ChuanXiong10,EZhu10,ShuDi10,ShouWu20,XiangFu10,ChuanNiuXi15,,BaiShao15,YiMuCao20,7bags,daily1bag

Clinical Case #5 Dr Xu, Run San 許潤三  Secondvisit,bloodflowimprovedbut-redanddizziness,pulsethreadyweak

 XianLingPi10,XianMao10,BaJiTian10,NvZhenZi20,ShaYuanZi20,GouQiZi20,TuSiZi30,ZiHeChe10,ShouWu20,ChuanDuan30,XianFu10,YiMuCao10.

Dr Xu, Run San 許潤三  1926– ChinaJapanFriendshipHospitalLife-meProfessor,Beijing,China

 Focusedoninfer-lity,endometriosisandtubalblockages

Prolonged Menstrual Flow 經期延長