Integrative Woman’s Health Course DAOSHING NI
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