Transcript Main symptoms

Irregular menstruation
（月经失调）
Shuguang hospital affiliated to shanghai
TCM university
Doctor: zhang qin hua
contents
 Definition
 Classification
 Pathogenesis
 Key
points of syndrome differentiation
 Examples :Treatments on the types of
syndrome differentiation
menstruation
 Cycle:
21-35d
 Last: 3-7 d
 Quanitity: 50-80ml
 Texture: no clot
Definition
abnormal changes of the cycle or quantity
of menstruation
 Cycle
irregulation:
 Quantity
•early menstruation
•delayed menstruation
•Irregularity menstrual cycle
irregulation
•profuse menstruation
•scanty menstruation
TCM Cause
 emotional
factors
 Exogenous：

cold \Heat\Dampness
 Improper



Liver and spleen
Qi and blood’s
flow
Life style
Multiparity
Excessive sexual life
Improper diet
 Congenital
weakness
Kidney qi and
essence
Spleen qi
spleen and kidney
Cause of west medicine
 hormonal
imbalances
 Stress
a
bleeding disorder
 fibroids
 polyps
 endometriosis
 medication
 pcos
 thyroid
disease
 liver or kidney disease
 infection
 IUD
 Malignancy
 TB
Another factors





Normal adolescence
Perimenopause /Menopause
Weight gain /Weight loss
Vegetarian diet
intensive exercise
When the cause disappear, the
menstruation will be normal
Pathogenesis
Disorder of
viscera
kidney
Disorder of
qi and blood
tiangui
vessels
Irregular menstruation
uterus
Treatment
 regulating



Qi and blood
nourishing the kidney
strengthening the spleen
dispersing the stagnation of liver Qi
Different treatment
on different time



Before menstruation: focuses on the root
aspect :asthenia or sthenia
During menstruation: concentrates on the
branch aspect : stop pain, active
blood,regulation menses ,etc
After menstruation: emphasizes on the
regulation of the spleen and stomach as
well as that of Qi and Blood.
irregular menstruation
disease
irregular menstruation
disease
Treament according to the age of the patient.
Key points according to
cycle or quantity
 Menses

Increase in the quantity or time or frequency
 Menses

increase type
decrease type
Decrease in the quantity or time of frequency
 Irregular
menses
Menses increase type
Early menstruation
Qi asthenia
profuse menorrhea
Blood heat
intermenstrual bleeding
• yang abudance
Metrorrhagia and
• yin asthenia
metrostaxis
Blood stasis
Menses decrease type
Delayed menstruation
Blood asthenia
scanty menstruation
Blood cold
Amenorrhea
Blood stasis
Irregular Menses
Liver depression
Kidney asthenia
Liver depression
Kidney asthenia
Key points according to
color or texture

Color：





heat
asthenia
cold
asthenia cold
Texture




Bright red\dark red
Pink /light red
Dark black
Light dark
Sticky
Thin
Clot
heat(yang excess)
asthenia\cold
stasis
Complications (heat\cold\sthenia\asthenia)
prognosis
 Depeng



on
The long or short of history
The strong or weakness of constitution
In time or delayed in therapy
Examples:
2004.4.14 Mrs Ren, 28 year-old, married, worker
 Main symptoms:





early menstruation for more than one year
menses occurs every 20 days, lasting for 4 days, normal
volume, the menses is reddish and purplish, sticky with
blood clot
distending and pain in the breast, chest, hypochondrium
and two sides of lower abdomen.
Often feel bitter mouth ,thirst ,constipation.
 Tongue:


red tongue with yellowish fur
Pulse: taut and rapid
 Lab:
B ultrasound suggested: no special
abnormal signs
answer
Diagnosis:early menstruation
 Syndrome differentiation:



Treatment:


liver depression transferring to heat
Clearing away the heat of liver and soothing the
stagnation of liver Qi cooling the blood to regulate
menstruation
Drug: Modified Danzi Xiaoyao San
Danpi10
Baishu9
Shanzizi9 Danggui10 Baishao9 Caihu6
Fuling9
Zhigancao6 Hanliancao10
Early menstruation
 definition:

7-10days earlier than usual; continues
occurrence for 3 circle is regarded morbid
 Diagnosis



Accompanied with heavy amount—
metrorrhagia and metrostaxis
>10d earlier –intermenstrual bleeding
Pelvic examination: normal
Syndrome --Qi asthenia

syndrome

Main symptoms:
Early menses with prolonged duration and profuse
 light-colored and thin menses
 Spleen qi asthenia’s symptom



(Anorexia,loose
stool,empty prolaspsing sensation in
Threaputic
methods:
the
lower abdomen,light-colored
tongue with thin

Nourishing
qi and supplementing the spleen,controlling
blood
circulation
and fur,thin
regulatingand
menses)
and
whiteish
slow pulse)
Durg: Modified Buzhongyiqi tang
(huangqi 10g dangshen10g baishu10g chaihu6g
chenpi 6g
danggui10g
shengma6g gancao3g
)
modification
 For

yang asthenia accompanied by cold
Main symptom:
 Blackish
,thin and scanty menses
 Pain preference for warmth
 Moist and whitish tongue fur

Drug:buzhongyiqi tang add
Xiangfu 10g aiye 6g
modification

For spleen asthenia and dampness obstruction



Whitish and greasy tongue
Drug:buzhongyiqi tang add
Zisugeng10g sharen5g
Fo insufficiency of kidney qi


Body chills ,profuse uration at nighes
Drug:buzhongyiqi tang add
Xuduan10g duzhong10g
Syndrome–liver stagnation and
blood heat
 syndrome

Main symptoms:
 Early
menses with profuse
 Purplish and reddish and sticky menses
 liver depression transform to fire’s symptom
(hypochondria and breasts distension, mental
 Threaputic methods:
depression, irritability,bitter taste ,thirsty,yellow
 Soothing the liver ,clearing away heat and regulating
urine,dry stool,red tongue with yellow fur,wiry and
menses
fast pulse)
 Durg:
Modifiedzhizi
danzhi
(mudanpi10g
6g xiaoyao
chaihu6gsan danggui 10g
baishao10g
fuling10g baishu10g bohe6g
guya12g
gancao3g )
modification



For profuse
Xianhecao15g diyu12g
For profuse with blood
stasis
Yimucao15g shensanqi3g
For severe distention
and pain:
Yanhusuo 10
chuanlianzi6g
For
severe heat
Xiakucao6g huangqin10g
For
affect spleen
Houpu6g chenpi6g
For
greasy tongur fur
cangshu6g zhibanxia6g
Syndrome–yin asthenia
and blood heat
 syndrome

Main symptoms:
 Early
menses with scanty
 Purplish and sticky menses
 kidney yin asthenia’s symptom
 pain
Threaputic
methods:
(back
with knee
weakness, fever sensation in palms and
soles ,tidal
fever and
sweating,restlesseness
and
 Nouring
yin night
,clearing
away heat and regulating
menses tongue with scanty fluid, thin tongue
insomnia,reddish
without
fur,thin
and rapid
pulse) tang
 Durg:
Modified
liangdi
(shengdihuang10g xuanshen10g maidong10g
digupi10g
ajiao10g
baishaoyao10g)
modification
 For


hyperactivity of liver yang
Dizziness or tinnitus (hypertension)
Zhiguiban15g wuzeigu15g shenglugu2
xiakucao15g
insomnia due to asthenia heat
Zhizi6g suanzaoren10g
Examples:
1999.2.28 Miss Li ,28 year-old, worker
Main symptoms:







delayed menstruation for 3 years
From the menarche ,menses occurred once 30-45
days. Blackish menses with blood clot. In recent 3
years, menses occurs once 2 months , which is scanty
, blackish ,light-color and thin
accompanied with pain in loins and sacrum,, frequent
urine in the night,, leucorrhea
Tongue: light-colored tongue with white fur
Pulse: deep, weak and thready
answer
Diagnosis:delayed menses
 Syndrome differentiation: asthenia of kidney
 Treatment: Nourishing kidney and supplementing
blood to regulate menstruation
 Drug: Modified Danggui Dihuang Tang

Shoudihuang20 Shanzhuyu20 Shanyao10 Danggui10
Duzhong20
Huainiuxi10 Tusizi15
Bajitian15
Xianlingpi15
Gancao6
Delayed menstruation
 Definition:

7 days later than usual or occurs once 40-50
days.
 Diagnosis:


continues >3 circle
Exclude pregnancy
Syndrome-blood asthenia

Main symptoms:


Delayed and scanty, light-color and thin menses or
accompanied by lower abdominal pain
blood asthenia’s symptoms
 Therapeutic
(pale
complexion, methods
lusterless skin, dizziness, lassitude,
 Supplementing
blood ,nourishing
Qi and
palpitation,
insomnia ,light-colored
tongue
andregulating
thin pulse)
menstruaiton

Prescription: modified dabuyuan jian
Dangshen15 shanyao15 shoudi10
danggui12
baishao12 duzhong10 shanzhuyu10 danshen10
xiangfu10 shenggancao3
modification
asthenia –heat due to consumption of
yin by prolonged diease
 For


flushed cheeks, tidal fever feverish sensation
over the palms and soles
Digupi10 zhimu10
 For

insomnia and palpitation
Yejiaoteng15 syabzairen10
Syndrome—asthenia-cold
 Main


symptom:
delayed blackish or light-color, scanty
Yang deficiency of kidney’s symptom
(aching
pain in loins
and sacrum,frequent urine in the
 Therapeutic
methods
night,loose stool etc)

Supporting yang, eliminating cold and
regulating menstruation
 Prescription:Modified Aifu Nuangong Wan
(Aiye6
Xiangfu10
Danggui12 Wuzhuyu5
Danshen10 Shengdi10
Rougui6
Mudanpi10
Huangqi10 Xuduan10)
modification
 For

clear uring and severe loose stool
Buguzhi10 baizhu10
 For
insufficiency if yang-qi with phlegm
and dampness

Cangzu10 yiyiren15
Syndrome-blood cold

Main symptoms:


Delayed ,blackish,scanty menses or with blood clot, or
abdominal pain that can be alleviated with
warmth,aversion to cold
blood cold’s symptoms
limbs,blackish
tongue with whitish fur and deep(Cold
Therapeutic
methods
tense
pulse) meridians to dispel cold and regulating
 Warming
menstruation
Danggui10 Chuanxiong5
(Renshen12
Prescription:Modified
Wenjing TangBaishaoyao10
Guizhi5
Eshu10
Wuzhuyu5 Mudanpi10
Gancao3)
Niuxi10
modification
 For

severe abdominal pain
Wuyao10 yanhusuo10
 For
unpressable abdominal pain with blood
clot

Shengpuhuang10 wulingzhi10
Syndrome-qi stagnation
 Main


symptoms:
deep red and scanty menses or with blood clot
symptoms of Qi stagnation
(dysphoria, irritability ,preference for sighing,
 Therapeutic methods
hypochondria and breasts distension, epigastric
 Regulating
Qi and eliminating
stagnation
oppession
and anorexia,thin
and yellow
tongue fur,wiry
pulse)
combined with activiation blood
 Prescription:Modified Caihu Shugan San
(chaihu6
zhike10
baishao10
gancao3
xiangfu10
chuanixiong5 niuxi10
yanhusuo10
dnshen10)
Example:
2004.9.20 Miss Liu,30 year-old ,teacher
Main symptoms:






Irregularity of menstrual cycle for 4 months
sometimes scanty, sometimes profuse menorrhea,
purplish menses with blood clot, dysmenorrhea
accompanied with distending pain in the breasts
,preference for sighing, epigastric oppression and
anorexia, normal urine and stool.
Tongue: reddish and purplish tongue with white
fur
Pulse: taut
answer
Diagnosis: irregular menstruation
 Syndrome differentiation: liver stagnation
 Treatment: Soothing the liver and regulating Qi to
regulate menstruation
 Drug: Modified Xiaoyao San



Chaihu6 Baishaoyao10 Fuling10
Gancao6 Danshen10
Yimucao15
Danggui10
Puhuang10
Irregularity of menstrual cycle
 Definition:


7 days earlier or later than usual
Scanty or profuse menses
 Diagnosis


Continuous>3 cycles
Differentiate with metrorrhagia and metrostaxis
Syndrome--Liver stagnation
 Main
symptom:
Scanty or profuse menses
 Purplish menses and unsmooth menses
 Liver depression’s symptom
(dysphoria,
irritability
,preference for sighing,
 Threaputic
methods:

hypochondria
and breasts distension, epigastric
 Soothing the liver , regulating qi ,nourishing blood
oppession
anorexia,thin
and yellow tongue fur,
andand
regulationg
menses
wiry pulse)

Durg: Modified xiaoyao san
(chaihu6g
baishu10g
danggui 10g baishao10g
bohe6g
jingjie6g
fuling10g
gancao3g )
modification
 For


qi stagnation transforming into fire
Bitter taste in the mouth
Yellowish tongue fur
 Mudanpi10
 For
zhizi6 huangqin10
unpressable abdominal pain with blood
clot

Yimucao 15 shensanqi5
Syndrome—kidney asthenia
 Main
symptom:
Irregular cycle with light colored,Scanty and
thin menses
 Kidney asthenia’s symptom
 Threaputic
methods:
(dizziness
and tinnitus,
weak waist and knees, pain in the

heel andlower
abdomen,
frequency
urine in thethe
night,
Nourishing
the kidney
and harmonizing
light-colored
tongue ,deep and
spleen,nourishing
bloodslow
andpulse)
regulationg menses

Durg: Modified guishen wan
(tusizi10
duzhong10
danggui10 shoudi10
gouqizi10 shanzhuyu10
shanyao15 fuling10 )
modification
 For
simultaneous diease of the liver and
kidney ,bothe the liver and kidney should be
treated with DINGJING TANG
Chaihu 6 danggui10 baishao 10 shoudi10
shanyao15 tusizi10 jingjiesui6
Example:
2004.4.21 Mrs Chen 30 year-old ,married
 Main symptoms:



profuse menorrhea for 10 years
LMP:4.20, because of busy work, extreme profuse
menorrhea, bright-red colored menses accompanied
with back pain, dizziness, palpitation ,thirst, lack of Qi,
lassitude, insomnia ,dry stool, yellowish urine. Pale
complexion, weight lose.
Tongue: light-colored tongue with yellowish fur
 Pulse: thready and rapid, weak when pressing
heavier

answer


Diagnosis； profuse menorrhea
Syndrome differentiation:


Treatment:


interior heat due to yin asthenia, causing extravasation of blood
Nourishing Yin and clearing away heat; supplementing Qi and
stopping bleeding
Drug: Modified Liangdi Tang
Shengdihuang30 Ejiao15
Digupi12 Taizishen15
Maidong15
Wuweizi4.5
Huangqin10
Xianhecao15
Hanliancao24
Guanzhong
Example：


1990.4.8 Miss Li, 24 year-old, worker
Main symptoms:





dripping menses for 20 days, sudden profuse discharge for 6 days
From the menarche ,the menstruation often come earlier , slight
profuse and reddish.
LMP:3.6, profuse and reddish menses for 10 days, then the volume
reduced but dripping. A week ago, the patient quarreled with other
man ,then menses appeared sudden profuse discharge, which was
reddish with blood clot, accompanied with susceptibility to rage
due to dysphoria, dry mouth, liking drinking ,constipation .
Tongue: red tongue with yellow and dry fur
Pulse: slippery and rapid
answer




Diagnosis: profuse menorrhea
Syndrome differentiation: blood heat
Treatment: clearing away heat and cooling the blood ;
strengthening the thoroughfare vessels and stopping
bleeding
Drug: Modified Qingre Gujing Tang
Danpi9
Shanzhi6
Shengdihuang12 Diyutan15
Oujietan15 Chenzongtan10 Guiban10
Huaruishi15
Yimucao15 Chansha10
Caihu10
Baishao12
Profuse menorrhea
 Definition:

quantity of menses obviously increase or
menstruation lasts for over seven days
 Diagnosis:



Can stop at a certain period of time
Usually appears together with early of delayed
menses
If cycle is irregular indicate metrorrhagia and
metrostaxis
Syndrome-qi asthenia
 Main



symptom:
light color and thin texture menses
prolonged menorrhea
Symptoms of qi asthenia
(Short breath, eager to sleep all day, empty
prolapsing sensation in the lower abdomen,dull cold
pain in the loins and abdomen,bright whitish
complexion,light and tender tongue with thin
fur,asthenia and floating or weak pulse)
 Therapeutic

method:
invigorating Qi and lifting the sinking,
controlling blood and strengthening the
thoroughfare vessel
 Prescription:Modified
Juyuan Jian
Dangshen12 Huangqi10 Baishu10
Shengma6
Gancao3
xianhecao30
Duanlonggu30 duanmuli30
modification
 For

Aiyetan6 weuzeigu15 xueyutan15
 For

prolonged or dripping menses
Shengpuhuang 10 yimucao15
 For

during menstrual course
cold pain in the loins and abdomen
Xuduan10 aiye6
Syndrome—blood heat

Main symptom:
Profuseor or prolonged menses
 purplish red ,sticky or blood clot
 lower abdominal pain
 symptoms of blood heat
 Therapeutic
methods
( fever, dysphoria,
thirst, scanty and yellowish
 urine,
Clearing
away heat and
cooling
bloodwith
,nourishing
yin
constipation,
reddish
tongue
yellowish
andand
stopping
bleeding
fur
slippery
and rapid pulse)


Prescription: Modified Gujing Wan
(Huangbai6 Huangqin10
Xiangfu10 Chungenpi15
Baihao10
Ejiao10
Guiban10
Digupi10)
modification

For heat transformation into fire and changes into
toxin



Fever ,aversion to cold
Unpressable pain and hardness in abdominal
Baijiangcao12
hngteng12
pugongying12 shengpuhuang10
For long time illness lead to qi and yin asthenia

Shengmai san
Example:
2004.4.30 Miss Liu, 17 year-old, student
 Main symptoms:



scanty menorrhea for 1 year
Because of study pressure, in resent one year, the
menorrhea is obvious reduced, lasting 2 days, light
color and thin menses accompanied with dizziness,
fatigue, palpitation, sallow complexion
Tongue: light-colored tongue with thin fur
Pulse: deep and thin
 Lab: Blood regular test: HGB:92g/L

answer
Syndrome differentiation: Blood asthenia
 Treatment: Nourishing blood and supplementing
Qi to regulating menstruation
 Drug: Modified Zixue Tang

Dangshen12 Shanyao12
Chuanxiong6 Danggui10
Shoudi10
Sharen6
Huangqi12
Fuling10
Baishaoyao10
Chenpi10
Baishu10
Example:
2003.4.9 Mrs Lu, 34 year-old, doctor
 Main symptoms:




Menopause for 7 months
Because of work pressure ,the patient suffered from
disorders of menstrual circle, delayed menorrhea,
scanty menorrhea accompanied with distending
sensation in the breast and abdomen.. Now menopause
for 7 months ,often feel distending sensation in the
breast and abdomen, susceptibility to rage due to
dysphoria, insomnia, poor appetite, constipation.
Tongue: darkish tongue with petechiae ,white and
thin fur Pulse: taut and thready
answer
 Syndrome
differentiation: stagnation of
liver Qi and blood stasis
 Drug: Modified Gexia Zhuyu Tang
Danggui12
Zhike9
Wuyao12
niuxi12
Chuanxiong12 Chishao12
Yanhu15
Wulingzhi12
Xiangfu12
Gancao6
Shengdi12
Taoren12
Danpi12
Caihu9
Scanty menstruation
 Definition:

menorrhea is obviously reduced and the
menstrual cycle is less than 2 Days
 Diagnosis:



Regularly cycle with scanty amout
Exclude the situation of contraception pills
Exclude the early pregnancy with bleeding
Syndrome-blood asthenia
 Main

symptoms:
scanty, light-color and thin menses
 blood asthenia’s symptoms
(pale complexion, lusterless skin, dizziness, lassitude,
 Therapeutic
methods
palpitation,
in somnia
,light-colored tongue and thin pulse)

Nourishing blood ,invigorating Qi and
regulating menstruation
 Prescription:Modified Zixue Tang
(Gangshen12 Shanyao15
Fuling12
Shoudihuang10
Danggui10 Baishaoyao10 Chuanxiong5 Huangqi10)
modification
 For

asthenia heat
Dihupi10 xuanshen10
 For
insomnia and palpitation due to blood
asthenia

Yejiaoteng15 wuweizi5
 For
hypechondria distension or breast
distending pain

Chaihu5 xiangfu10 chuanlianzi6
Syndrome-kidney asthenia
 Main

symptoms:
scanty, light-color and thin menses
kidney asthenia’s symptoms
(dizziness
and tinnitus,
weak waist and knees, pain in the
 Therapeutic
methods

heel, cold sensation in the lower abdomen, profuse urine in
 Reinforcing
thetongue
kidney,Nourishing
the night,
light-colored
,deep and slowblood
pulse)and
regulating menstruation
 Prescription:Modified gui shen wan
(duzhong10 tusizi10 shoudi10
danggui10
shanyao15 fuling10 shanzhuyu10 gouqizi10)
modification
 For

Yingyanghuo10 bajitian10 xianmao10
 For

kidney –yang asthenia
kidney-yin asthenia
Shengdi 10 nvzenzi12 xuanshen10
 For
severe internal heat
mudanpi10 shanzhi6 zhimu10
Syndrome-blood stasis
 Main

symptoms:
scanty, blackish with blood clot
blood stasis’s symptoms
(Unpalpable
distending
or sting pain in the lower abdomen

Therapeutic
methods

which is alleviated after blood clot being discharged, thirst
 Activating blood to resolve stasis and
without desire for drinking, grayish tongue with thin and
nourishing
blood to regulating menstruation
taut pulse
)
 Prescription:Modified Taohong
siwu tang
(taoren10 honghua12 danggui10 chuanxiong5 baishao10
shoudi10 zelan12 wulingzhi10 danshen12 gancao3 )
modification
 For

Xiangfu 10 wuyao10
 For

qi stagnation and blood stasis
cold coagulation and blood stasis
Guizhi6 wuzhuyu6
Syndrome-phlegm dampness
 Main

symptoms:
scanty, light-color and sticky menses
phlegmdampness’s symptoms
(heavy
body,chest oppression

Therapeutic
methods and nausea , discharge,

weakness of the four limbs, light-colored tongue and
 Resolving
slippery
pulse) phelgm,drying dampness and
regulating menstruation
 Prescription:Modified cangfu daotan wan
(cangzhu10 xiangfu10 fuling12 banxia10 chenpi 10
gancao3 dannanxing10 zhike10 liuqu12 shengjiang3)
modification
 For
delayed scanty menses and gradual
onset of amenorrhea

Danggui12 zelan12 chuanniuxi12
 For

profuse phlegm and fat
Shichangpu10 zhiyuanzhi10
non-prescription treatment
 stress
reduction and/or relaxation
techniques
 elimination of overly physical exercise
 eliminate any eating disorders such as
purging, bulimia, or anorexia