Integrative Woman’s Health Program DAOSHING NI
Delayed Menstruation ⽉月经后期 MENSTRUAL IRREGULARITIES ⽉月经不调
Case #2 Delayed Menstruation Dr. Wang Zi Yu 王子瑜 29YO,FirstVisit11-25-2005 DelayedMenstrua:onfor14years,Married/TGP2Years
153-5/32-60,Clomipheneuseforthreecycleswithoutpregnancy,LMP11/11-11/16,moderateamount,brightredflow,clots,nopain,nobreasttenderness,tonguedarkred,coa:ngyellowgreasyinthemiddle,pulsethinwiry,pelvicexamnormal,exceptuterusissmall
Overview and Definition Delayedmenstrua:onreferstowhenmenstrua:onis7ormoredayslaterthanusualperiodcycleandoccurredfortwoormoreconsecu:vecycles.Some:mesmenstrua:oncanbedelayeduptosixmonths.
ClassicalTexts◦ JinKuiYaoLue金匱要略–firstdefinedthecondi:onofDelayedMenstrua:on◦ JingYueQuanShu景岳全書(Chapter38)–Descrip:onofe:ologyandtreatmentofHBcausingdelayedmenstrua:on◦ NuKeQieYao女科切要–e:ologiesofdelayedmenstrua:onasBlooddeficiency,ColdnessintheBlood,andStasis.
What are the known causes of Delayed Menstruation Pregnancy Stress
MajorWeightLossorExcessiveExercise
ThyroidIrregularity
PCOS
BCPusage
ChronicIllnesses◦ CeliacDisease
PrematureMenopause
Etiologies KidneyDeficiency BloodDeficiency
DeficientColdness ExcessColdness
QiStasis
Etiology Deficiencies
KidneyQi,Blood,EssenceDeficient
Overstraining/PregnancyDamagingtheKidneyKidneyQiDeficiency
ZFnotwarmed,transforma:onweakens,Qi/Xuebecomes
deficient
ChronicIllnessdamagingtheYangCons:tu:onalYangDeficiency
YinBloodDeficiencyDiseaseorPregnancyCausingLossofBlood
SpleenDeficiencyLackofTransforma:on
Etiology Excess
BloodFlownotSmoothandDelayed
ColdPathogenStagnatesBlood
ExogenousColdInvasion,ExcessiveIntakeofColdFoods
BloodFlownotSmoothandDelayed
StagnantQiCausesStagnancyinBlood
ChronicDepressionandExcessiveWorrying
Pathology Kidney
Deficiency
QiStasis
ColdnessintheBlood
BloodDeficiency
Insufficiencyof
EssenceandBlood
DeficientCold
ExcessCold
CannotNourish
Chong-Ren
ChongRenBlockages
DelayedBloodFlow
DelayedMenstrua:o
n
SeaofBloodisnotfullon
:me
Etiology and Pathology Summary
ColdPathogen(exogenou
s)
Emo:onalFactors
(endogenous)
Nutri:onalFactor
Cons:tu:onal
Tendencies(endogenou
s)
KidneyDeficiency
BloodDeficiency
DeficientCold
ExcessCold
QiStasis
InsufficientEssenceand
BloodInsufficientChong-RenSeaofBlood
DoesnotFillon:me
BloodFlowStagnatesChong-RenBlocked
Diagnosis and Differentiation MainSymptom:menstrua:onis7ormoredaysdelayedthanusualperiodcycleandoccurredfortwoormoreconsecu:vecycles.
MinorSymptom:Theremaybechangesinmenstrualflowamount.
Diagnosis and DS PelvicExam:Normaloruterusmightappearedtobesmaller
BBT:◦ ScenarioOne:ovula:on14daysbeforemenstrua:on◦ ScenarioTwo:ovula:ononCD14andlutealphaseelongated◦ ScenarioThree:monophasicthroughout
Differential Diagnosis DelayedMenstrua.on
EarlyPregnancy PregnancyBleeding
CommonSymptom
DelayedMenstrua:on
DelayedMenstrua:on
DelayedMenstrua:on
Differen:a:on Delayedmenstrua:on7daysofmore,2ormorecycles
EarlypregnancysignsandsymptomssuchasurinehCG(+),enlargeduterus,pigmenta:onchangeofcervix,presenceofsacinuterusviaultrasound
Regularmenstrualcyclehistory,urinehCG(+),abdominalpains,bleedingorspojng
Differentiation in Syndromes
Condi.ons Symptoms
KidneyDeficiency Delayedscantymenstrua:on,colordarkandpale,thinviscosity,soreback,andweakknee
BloodDeficiency Delayedscantymenstrua:on,colorpaleandthin,ver:goandpalpita:on
DeficientCold Delayedscantymenstrua:on,colorpaleandthin,abdominalintermikentpain,desireswarmthandaversiontocold
ExcessCold Delayedscantymenstrua:on,colordarkorwithclots,abdominalcoldpainaversiontopressure
QiStasis Delayedscantymenstrua:onornormalmenstrualflow,darkredcolororwithclots,abdominaldisten:onwithpain
Treatment Principle Tonifywhatisdeficient,Sedatewhatisexcess.(虛者補之,實者瀉之)
DeficiencySyndromes–tonifykidneynourishbloodorwarmupchannelsandnourishblood.
ExcessSyndromes–circulateQiandrelievestagna:on
Combinedsyndromes–differen:ateforprimary/secondaryandtreatbothatthesame:me.
CarefulnottousestrongpungentdryingherbsorbloodbreakingherbsespeciallyforDeficientColdsyndromes
Five Syndromes KidneyDeficiency BloodDeficiency
ColdnessinBlood–DeficientCold ColdnessinBlood–ExcessCold
QiStasis
Kidney Deficiency Delayedmenstrua:on,scantyflow,darkorpaleflow,thinflow,vaginaldischargeclearthin,soreback,weakknees,dizziness,:nnitus,darkfacialcomplexion,orwithdarkspots,tonguepale,coa:ngthinwhite,pulsedeepthready.
TonifyKidneyNourishBloodRegulateMenstrua:on
DangGuiDiHuangYin當歸地黃飲
Kidney Deficiency Dang Gui Di Huang Yin 當歸地黃飲 DangGui6-9g,ShuDi9-15g,ShanYao6g,DuZhong6g,NiuXi4.5g,ShanZhuYu3g,ZhiGanCao2.4.
KidneyDeficiencyLowerBackPains CompleteWorksofJingYue(JingYueQuanShu景岳全書)
LowerJiaoDeficientCold,addRouGui3-6g,Strongdeficientcold,addFuZi;turbidleukorrhea,addJinYingZi6gorPoGuZhi3g.IfQideficient,addRenShen3-6g,GouQiZi6-9.
Blood Deficiency Delayedmenstrua:on,scantyflow,palered,flowthin,pelvicintermikentache,orver:go,palpita:on,lackofsleep,paleface,sallowface,tonguepale,pulsethinweak.
TonifyBloodandQi,RegulateMenstrua:on.
DaBuYuanJian大補元煎
Blood Deficiency Da Bu Yuan Jian 大補元煎 RenShen,ShanYao,ShuDi,DuZhong,DangGui,ShanZhuYu,GouQiZi,ZhiGanCao. Iflackofappe:te,loosestools,indiges:on,addBaiZhu,BianDou,ShaRen.
Cold Blood – Deficient Cold Delayedmenstrua:on,scantyflow,paleredorwatery,thinflow,abdominalache,likeswarmthandpressureonabdomen,soreback,fa:gue,longclearurina:on,loosstools,tonguepale,coa:ngthinwhite,pulsedelayeddeeporthinweak.
AssistYangDisperseColdRegulateMenstrua:on
《JinKui》WenJingTang金匱溫經湯
Cold Blood – Deficient Cold Jin Kui Wen Jing Tang 金匱溫經湯 WuZhuYu,DangGui,BaiShao,ChuanXiong,GuiZhi,ShengJiang,DanPi,BanXia,MaiDong,RenShen,AJiao,GanCao.
吳茱萸,當歸,白芍,川芎,川芎,桂枝,生薑,丹皮,半夏,麥冬,人參,阿膠,甘草。
Strongercoldpainandaversiontocold,addBuGuZhi,BaJiTian,XianLingPi.
Cold Blood – Excess Cold Delayedmenstrua:on,scantyflow,darkflow,clots,pelviccoldpainaversiontopressurebutbekerwithwarmth,aversiontocold,coldextremi:es,bluishwhitefacialcomplexion,tonguedarkpale,coa:ngwhite,pulsedeep:ght.
Warmupchannel,dispersecold,regulatemenstrua:on.
<LiangFang>WenJingTang良方溫經湯
Cold Blood – Excess Cold <Liang Fang> Wen Jing Tang 良方溫經湯 DangGui,ChuanXiong,BaiShao,GuiZhi,DanPi,ErZhu,RenShen,GanCao,NiuXi. Ifexcessivemenstrualflow,ridofErZhu,NiuXi,addPaoJiang,AiYe.
Qi Stasis Delayedmenstrua:on,scantyornormalamountofflow,deepredflow,withsomemoderateclots,pelvicdistendingpain,depressiveeffect,premenstrualbreasttenderandpain,tonguepinkorred,coa:ngthinwhiteorthinyellow,pulsewiryorwiryrapid.
CirculateQi,relievestasis,regulatemenstrua:on.
WuYaoTang烏藥湯
Wu Yao Tang 烏藥湯 WuYao,XiangFu,MuXiang,DangGui,GanCao.
Scantyflowwithclots,addChuanXiong,DanShen.
Condi.on HerbalFormula.on Herbs
KidneyDeficiency
DangGuiDiHuangYin當歸地黃飲
DangGui6-9g,ShuDi9-15g,ShanYao6g,DuZhong6g,NiuXi4.5g,ShanZhuYu3g,ZhiGanCao2.4.當歸,熟地,山藥,杜仲,牛膝,山茱萸,炙甘草
BloodDeficiency
DaBuYuanJian大補元煎
RenShen,ShanYao,ShuDi,DuZhong,DangGui,ShanZhuYu,GouQiZi,ZhiGanCao.人參,山藥,熟地,杜仲,當歸,山茱萸,枸杞子,炙甘草。
DeficientCold
JinKuiWenJingTang金匱溫經湯
WuZhuYu,DangGui,BaiShao,ChuanXiong,GuiZhi,ShengJiang,DanPi,BanXia,MaiDong,RenShen,AJiao,GanCao.吳茱萸,當歸,白芍,川芎,川芎,桂枝,生薑,丹皮,半夏,麥冬,人參,阿膠,甘草。
ExcessCold <LiangFang>WenJingTang良方溫經湯
DangGui,ChuanXiong,BaiShao,GuiZhi,DanPi,EZhu,RenShen,GanCao,NiuXi.當歸,川芎,白芍,桂枝,丹皮,莪朮,人參,甘草,牛膝。
QiStasis WuYaoTang烏藥湯
WuYao,XiangFu,MuXiang,DangGui,GanCao.烏藥,香附,木香,當歸,甘草。
Acupuncture Treatments Delayed Menstruation
Syndromes Formula.on Procedure
KidneyDeficiency BL23,GV4,KI3,CV4,ST36,SP6
Tonifica:onMethodorwithMoxa
BloodDeficiency CV6,CV4,ST29,CV3,SP6,ST36
Tonifica:onMethodorwithMoxa
ColdBlood–DeficientCold
CV4,CV6,ST29,SP8,SP6,ST36,BL32,ST25.
Tonifica:onMethodorwithMoxa
ColdBlood–ExcessCold
Seda:onMethodorwithMoxa
QiStasis SP4,PC6,LR3,SP6,SP8,SP10
Seda:onMethodandNOMoxa
Auricular Ovary,Uterus,Kidney,Endocrine
EmbeddingorNeedle
Case #2 Delayed Menstruation Dr. Wang Zi Yu 王子瑜 29YO,FirstVisit11-25-2005 DelayedMenstrua:onfor14years,Married/TGP2Years
153-5/32-60,Clomipheneuseforthreecycleswithoutpregnancy,LMP11/11-11/16,moderateamount,brightredflow,clots,nopain,nobreasttenderness,tonguedarkred,coa:ngyellowgreasyinthemiddle,pulsethinwiry,pelvicexamnormal,exceptuterusissmall
Case #2 Delayed Menstruation Dr. Wang Zi Yu 王子瑜 KidneyDeficiencyDelayedMenstrua:onPrimaryInfer:lity
TonifyKidneyNourishBlood,ReplenishEssence,FacilitatePregnancy,usemodifiedSiWuTang
DangGui10,ShengDi15,ShuDi15,ChiShao10,BaiShao10,ChuanXiong10,XuDuan15,TuSiZi30,BaJiTian10,ZiHeChe10,ZiShiYing15,AiYe3,ShanYao15,ShouWu15,RouGui10
7bags,onebagdaily;7visitswithminormodifica:onweekly,pregnancyachieved.
Dr. Wang Zi Yu 王子瑜 1921- ChiefTCMPhysician,OBGYNdepartment,DongZhiMenHospital,BeijingUniversityofTCMaffiliatedhospital.
ReputableforMenopause,dysmenorrhea,endometriosis
Integrative Woman’s Health Program DAOSHING NI
Irregular Menstrual Cycle ⽉月经先后不定期 MENSTRUAL IRREGULARITIES ⽉月经不调
Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之 32YO,8-1-1990FirstVisit IrregularMenstrualCyclesforseveralyears
Irregularmenstrualcycles,dizziness,restlessness,poorsleep,pelviccoldtothetouch,leukorrhea,soreback,chestGghtness,hypochondriacGghtness,hasusedChineseherbsfocusedonPacifyingLiverAcGvateBloodwithnoreliefbutfurtheraggravaGonofsymptoms,pulsewiry,leMCunsmall,rightChideep,pulsepale,coaGngwhite.
Definition MenstruaGonoccurseitherearlierorlaterthan7daysforthreeconsecuGvecycles.
<CompleteBookofJingYue(JingYueQuanShu景岳全書)>“DerangedMenstruaGon”
<DrFuQingZhu’sGynecology(FuQingZhuNvKe傅青主女科)>IrregularMenstruaGonisduetoliverkidneystagnaGonandshoulduseDingJingTang定經湯tosootheLiverandKidneyQi,totonifyLiverandKidneyEssence.
What are the known causes of Irregular Menstrual Cycles? Adolescence Uncontrolleddiabetes EaGngdisorders Hyperthyroidismorhypothyroidism
HyperprolacGnemia(anabnormallyhighconcentraGoninthebloodofprolacGn,aproteinhormone)
MedicaGons,suchasanGepilepGcsoranGpsychoGcs
Perimenopauseorprematureovarianfailure
PolycysGcovarysyndrome(PCOS)
Pregnancy StressandTravel
Etiology Irregular Menstrual Cycle
EmoGonalstagnaGon,angerinjuringtheLiver DerangedLiverQi
PatencyflowdysfuncGon
causingSeaofBlooddysfuncGon
KidneyQiinsufficiency,chronicillnessinjuringtheKidney WeakenedKidneyQi
DysfuncGonofregulaGonofChong-RencausingSeaofBlooddysfuncGon
Pathology Irregular Menstrual Cycle
LiverStasis
KidneyDeficiency
DysfuncGoninPatency
Flow
DysfuncGoninStorage
andDischarge
Chong-RenIrregular
SeaofBloodStorageandDischargeDysfuncGon
IrregularMenstrualCycle
EmoGonalFactors ConsGtuGonalFactors
Diagnosis Irregularmenstrualcycledelayorearlygreaterthan7daysandconsecuGve3cyclesormore.Menstrualflowcanbenormalamount,uteruscanbenormalsizedorslightlysmaller.
Differentiation of Syndrome Syndromes Symptoms
LiverStasis QuanGtymoreorless,darkflow,orwithclots,abdominaldistenGon,chestdistenGon,pulsewiry
KidneyDeficiency QuanGtyless,paleflow,minimalclots,lowerbacksoreness,tonguepale,pulsethinandweak
LiverStasisKidneyDeficiency QuanGtymoreorless,darkorpaleflow,orwithclots,abdominaldistenGon,chestdistenGon,lowerbackpain,pulsewiryandthin
Treatment Principle LiverStasis–CirculateQiPacifyLiverRegulateMenstruaGon
KidneyDeficiency–TonifyKidneyRegulateMenstruaGon
LiverStasisKidneyDeficiency–PacifyLiver,TonifyKidney,RegulateMenstruaGon
Herbal Treatments Liver Stasis Irregularmenstrualcycle,quanGtymoreorless,colordarkredorpurplered,orwithclots,orsluggishmenstrualflow,chest,breasts,pelvicdistensions,sighing,belching,poorappeGte,tonguecoaGngthinwhiteorthinyellow,pulsewiry.
Angerinjuringliver,patencyflowdysfuncGon,seaofblooddysfuncGon
PacifyLiverRegulateQiRegulateMenstruaGon
XiaoYaoSan逍遙散
Xiao Yao San 逍遙散 ChaiHu,DangGui,BaiShao,BaiZhu,FuLing,BoHe,ShengJiang 柴胡,當歸,白芍,白朮,茯苓,薄荷,生薑。
Menstrualdistendingpainwithclots,addDanShen,YiMuCao,XiangFu,YuanHu.
Herbal Treatment Kidney Deficiency Irregularmenstrualcycle,scantyflow,colorpaleordark,viscositythin,lowerbackache,weakknees,dizziness,Gnnitus,tonguepale,coaGngwhite,pulsethinandweak.
KidneyQiDeficiency,dysfuncGoninstorage,ChongRenirregularity,seaofblooddysfuncGoninstoringanddischarging.
TonifyKidneyandregulatemenstruaGon
GuYinJian固陰煎
Gu Yin Jian 固陰煎 TuSiZi,ShuDiShanZhuYu,RenShen,ShanYao,ZhiGanCao,WuWeiZi,YuanZhi.
菟絲子,熟地, 山茱萸,人參,山藥,炙甘草,五味子,遠志。
AddDuZhongandXuDuanforlowerbackpains.
Herbal Treatment Liver Stasis Kidney Deficiency Irregularmenstrualcycle,quanGtymoreorless,colordarkredorpalered,orwithclots,menstrualbreastdistedningpain,lowerbackpain,soreknee,faGgue,tonguepale,coaGngwhite,pulsewirythin.
AngerorstagnancyinjuringtheLiver,dysfuncGoninpatencyflow,KidneyQiweakened,storagedysfuncGon,ChongRenirregular.
TonifyKidneyPacifyLiverRegulateMenstruaGon
DingJingTang定經湯
Ding Jing Tang 定經湯 ChaiDu,JingJie,DangGui,BaiShao,ShanYao,FuLing,TuSiZi,ShuDi
柴胡,荊芥,當歸,白芍,山藥,茯苓,菟絲子,熟地。
Excessiveleukorrhea,addLuJiaoShuang,JinYingZi.
Other Guidance FocusonemoGonalmanagement
Focusonstressmanagement
Focusonsleephygiene FocusonGmezonechangetravel
Herbal Review
Syndromes HerbalFormula3on Herbs
LiverStasis XiaoYaoSan逍遙散 ChaiHu,DangGui,BaiShao,BaiZhu,FuLing,BoHe,ShengJiang柴胡,當歸,白芍,白朮,茯苓,薄荷,生薑。
KidneyDeficiency GuYinJian固陰煎 TuSiZi,ShuDiShanZhuYu,RenShen,ShanYao,ZhiGanCao,WuWeiZi,YuanZhi.菟絲子,熟地, 山茱萸,人參,山藥,炙甘草,五味子,遠志。
LiverStasisKidneyDeficiency
DingJingTang定經湯 ChaiDu,JingJie,DangGui,BaiShao,ShanYao,FuLing,TuSiZi,ShuDi柴胡,荊芥,當歸,白芍,山藥,茯苓,菟絲子,熟地。
Acupuncture Treatments Irregular Menstrual Cycle
Syndromes Formula3on Procedure
LiverStasis BL18,LR14,CV3,LR3,SP6
SedaGonMethod
KidneyDeficiency
CV6,SP6,BL23,BL20,ST36,KI8
TonificaGonMethodorwithMoxa
LiverStasisandKidneyDeficiency
CV6,LR3,CV3,SP6,ST36,PC6
EvenMethod
Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之 32YO,8-1-1990FirstVisit IrregularMenstrualCyclesforseveralyears
Irregularmenstrualcycles,dizziness,restlessness,poorsleep,pelviccoldtothetouch,leukorrhea,soreback,chestGghtness,hypochondriacGghtness,hasusedChineseherbsfocusedonPacifyingLiverAcGvateBloodwithnoreliefbutfurtheraggravaGonofsymptoms,pulsewiry,leMCunsmall,rightChideep,pulsepale,coaGngwhite.
Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之 BloodDeficiencyLiverStasis BloodDeficiencyistheCauseandLiverStasisistheManifestaGon
NourishBloodRegulateLiver–MainTP
StrengthenSpleenWarmKidney–SecondaryTP
Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之 ShengDi18,DangGui18,ChiBaiShao12each,ChaiHu3,ChuanLianZi9,BaiZhu12,FuLing18,SuanZaoRen12,ZhiYuanZhi6,ChenPi10,XianLingPi9,HongHua9,DuZhong12,DanPi6
7bags,1bagdaily
Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之 SecondVisit Dizzinessdecreased,sleepingbeoer,lesschestandhypochondriacdistenGon,emoGonsarebeoer,lessleukorrhea,pulsesoMerandlesswiry,tonguecoaGngrootpeeled. LiverStasisisdecreasingbutyinbloodsGlldeficient,themotherofliveriskidney,YiGuiTongYuan(YinWoodandYinWatersharethesamesource) RidofHongHua,YuanZhi,ChenPi,DuZhong AddShuDi10,GouQiZi12,HuaiNiuXi10,DangShen18,ZhiXiangFu12,ShengJiang3pieces 10bags,onebagdaily.
Dr. Wang, Mian Zhi 王綿之 1923-2009 19thgeneraGonalpracGGoner Educatoraswell,focusedongeneralmedicine,formularies.
ReputablewithDSandFormulaGonbooks