Integrative Woman s Health Course DAOSHING NI

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1 Integrative Woman s Health Course DAOSHING NI

2 Prolonged Menstrual Flow 經期延長

3 Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 49 yo, married, prolonged menstrua4on for 2 years. Most regular periods 5-6/30, medium amount, clots. Since beginning of the year, pa4ent has experienced many cycles of prolonged period flow. OBGYN advised D&C followed by estrogen and progesterone cyclical usage, but did not work well. She exhibits insomnia, anxiety, head pressure, recently her menstrua4on again lasted 10 days and through ultrasound, her uterine lining was very thick (12 mm). Her tongue is slightly red, coa4ng thin yellow greasy, pulse wiry thready. TCM Diagnosis: Prolonged Menstrua4on; WM Diagnosis: AUB

4 Definition With menstrual cycle normal, the days of menstrual flow increased to beyond 7 days to 14 days Hypermenorrhea or menorrhagia is s4ll the western medicine defini4on even though here indicates a prolonged menstrua4on 4me regardless the quan4ty of the flow

5 Possible conditions Corpus luteum dysfunc4on PID D&C Ovulatory dysfunc4on

6 Etiology Qi Deficiency (Qi Xu) 氣虛 Deficient Heat (Xu Re) 虛熱 Blood Stagna4on (Xue Yu) 血瘀

7 Etiology Qi Deficiency Insufficient Food Intake Cons4tu4onal Weakness Overstraining Injury to Spleen Qi, Middle Jiao Qi Deficient Chong Ren Dysfunc4on cannot control blood flow

8 Etiology Deficient Heat Chronic Illness injuring the Yin Excessive pregnancies Yin Blood deficient, heat rises Overstraining or excessive sexual ac4vi4es Heat disturbs Chong Ren, Sea of Blood becomes restless

9 Etiology Blood Stagnation Chronic depression or stasis, injuring Liver, Qi Stasis Blood Stagna4on Exogenous pathogens stuck in uterus, causing blood to stagnate Chong Ren Uterus becomes stagnant Menstrual Flow out of control

10 Pathology Disease Loca4on: Chong Ren. The main pathology is Chong Ren Sea of Blood. Chong Ren losing controlling func4on, menstrual blood losing control Deficiency Qi Deficiency, Deficient Heat Chong Ren Losing Control, Heat disturbs Chong Ren Menstrual Blood Lost Control Excess Blood Stagna4on, Chong Ren Blockage Menstrual Blood Lost Control

11 Etiopathology Summary Exogenous Pathogens Endogenous Emo4onal Factors Dietary Factor Cons4tu4onal Factor Special Menstrual Physiology Qi Xu Xu Re Xue Yu Chong Ren losing control, menstrual blood losing control Heat disturbs Chong Ren, menstrual blood losing control Chong Ren Blockage, menstrual blood losing control

12 Diagnosis Main Symptom: menstrual flow lasted more than 7 days, but cycle normal Combina4ons: can see increased menstrual flow, menstrual.cycle irregular, or dysmenorrhea, lumbago, or leukorrhea

13 Exams Pelvic examina4on to check for the size of uterus or remained POC or POM Pelvic tenderness Sex hormone levels

14 Differentiation of Syndromes E"ology Symptoms Quan4ty Color Quality Cycle Qi Xu more pale Thin Not clean Not clear Xue Re less Bright red thick Normal Xue Yu More or less Purple dark Clots Normal

15 Treatment Principles Focus on Chong s controlling func4on Strengthen Chong Stop Bleeding Regulate Menstrua4on To shrink menstrua4on 4me Qi Deficiency Tonify Qi and Control Blood Deficient Heat Nourish Yin Clear Heat Stop Bleeding Blood Stagna4on Ac4vate Blood Dissolve Stagna4on Stop Bleeding

16 Herbal Therapy Qi Deficiency Prolonged menstrua4on, excessive flow, pale and thin flow, fa4gue, dyspnea, feeble speech, pale face, tongue pale, coar4ng thin, pulse slow and weak. Chong Ren weakened control, cannot control menstrual blood flow Tonify Qi Control Blood, Strengthen Chong Regulate Menstrua4on Modified Ju Yuan Jian 舉元煎 (Ju Yuan Jian + A Jiao, Ai Ye, Wu Zei Gu) Ren Shen, Huang Qi, Bai Zhu, Sheng Ma, Zhi Gan Cao, A Jiao, Ai Ye, Wu Zei Gu

17 Herbal Therapy Qi Deficiency Modified Ju Yuan Jian 舉元煎 (Ju Yuan Jian + A Jiao, Ai Ye, Wu Zei Gu) Ren Shen, Huang Qi, Bai Zhu, Sheng Ma, Zhi Gan Cao, A Jiao, Ai Ye, Wu Zei Gu If excessive flow, add Mu Li If with dysmenorrhea, add San Qi, Pu Huang, Xue Yu Tan

18 Herbal Therapy Deficient Heat Prolonged menstrual flow, less flow, brighter red, thick or s4cky flow, dry throat and mouth, or with flushed face, 4dal heat, or with five sole heat, tongue red, coa4ng scanty, pulse thready rapid. Yin deficiency with internal heat, heat disturbing Chong Ren, Sea of Blood restless and not calm Nourish Yin Clear Heat Stop Bleeding Liang Di Tang + Er Zhi Wan + Wu Zei Gu + Qian Cao 兩地湯 + 二至丸 + 烏賊骨 + 茜草 Sheng Di, Xuan Shen, Mai Dong, Di Gu Pi, A Jiao, Bai Shao, Nv Zhen Zi, Han Lian Cao, Wu Zei Gu, Qian Cao. 生地, 玄參, 麥冬, 地骨皮, 阿膠, 白芍, 女貞子, 旱蓮草, 烏賊骨, 茜草

19 Herbal Therapy Deficient Heat Liang Di Tang + Er Zhi Wan + Wu Zei Gu + Qian Cao 兩地湯 + 二至丸 + 烏賊骨 + 茜草 Sheng Di, Xuan Shen, Mai Dong, Di Gu Pi, A Jiao, Bai Shao, Nv Zhen Zi, Han Lian Cao, Wu Zei Gu, Qian Cao. 生地, 玄參, 麥冬, 地骨皮, 阿膠, 白芍, 女貞子, 旱蓮草, 烏賊骨, 茜草 If scanty flow, add Shu Di, Dan Shen, If strong 4dal fever or heat symptoms, add Bai Wei 白薇

20 Herbal Therapy Blood Stagnation Prolonged menstrual flow, less flow amount, dark red color with clots, pelvic pain aversion to pressure, tongue purple dark or with stagnant spots, pulse wiry sluggish. Stagna4on blocking the proper func4on of Chong Ren and Uterus, menstrual flow becomes uncontrolled. Ac4vate Blood, Dissolve Stagna4on Stop Bleeding Tao Hong Si Wu Tang + Shi Xiao San + Yi Mu Cao + Qian Cao 桃紅四物湯 + 失笑散 + 益母草 + 茜草 Tao Ren, Hong Hua, Dang Gui, Shu Di, Chuan Xiong, Bai Shao, Pu Huang, Wu Ling Zhi, Yi Mu Cao, Qian Cao.

21 Herbal Therapy Blood Stagnation Tao Hong Si Wu Tang + Shi Xiao San + Yi Mu Cao + Qian Cao 桃紅四物湯 + 失笑散 + 益母草 + 茜草 Tao Ren, Hong Hua, Dang Gui, Shu Di, Chuan Xiong, Bai Shao, Pu Huang, Wu Ling Zhi, Yi Mu Cao, Qian Cao. If with pelvic distending pain, add E Zhu and Yan Hu Suo 莪朮, 延胡索

22 Herbal Instructions Most of 4me, it would be more effec4ve to take the herbs during the menstrua4on. Stay away from astringent herbs to avoid further blockage and conges4on.

23 Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 49 yo, married, prolonged menstrua4on for 2 years. Most regular periods 5-6/30, medium amount, clots. Since beginning of the year, pa4ent has experienced many cycles of prolonged period flow. OBGYN advised D&C followed by estrogen and progesterone cyclical usage, but did not work well. She exhibits insomnia, anxiety, head pressure, recently her menstrua4on again lasted 10 days and through ultrasound, her uterine lining was very thick (12 mm). Her tongue is slightly red, coa4ng thin yellow greasy, pulse wiry thready. TCM Diagnosis: Prolonged Menstrua4on; WM Diagnosis: AUB

24 Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 The pa4ent is at 7x7 age, her liver and kidney essence and yin have depleted, at the same 4me, she exhibited ministerial fire rising, yin deficiency with fire causing head disten4on, emo4onal instability, heat disturbing Chong Ren causing menstrual blood losing control, therefore prolonged period. Liver Kidney Yin Deficiency, Heart Brain Lacked Nourishment Nourish Liver and Kidney, Calms Heart and Calms Spirit Dang Gui, Shu Di, Suan Zao Ren, Ye Jiao Teng, He Huan Pi, Yuan Zhi, Fu Shen, Huai Xiao Mai, Zhi Gan Cao. 14 bags.

25 Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 Second Visit: sleep improved, dizziness improved, appe4te normal, bm regular, last period lasted 7 days instead of 10 days. Pulse thin sop, tongue red, coa4ng thin. Dang Gui15, Shu Di12, Sha Ren 3, Suan Zao Ren 9, Ye Jiao Teng 20, Fu Shen 12, Fu Ling 12, He Huan Pi 12, Yuan Zhi 6, Huai Xiao Mai 30, Zhi Gan Cao 6, Bai Zhu 9, Bai Shao bags

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