Early menopause usually refers to onset before age 45. Premature menopause or premature ovarian insufficiency occurs before age 40.

Site Factors Hormones affected

hypothalamus Psychosomatic factors, obesity, brain tumors

Gonadotropin releasing hormone

pituitary Nutritional, chronic disease, pituitary tumors or hypofunction

Follicle stimulating hormone, luteinizing hormone, prolactin

ovary Thyroid disorder, primary ovarian dysfunction, PCO,

Estrogen, progesterone, androgens

uterus Congenital absence or hypoplasia,surgery, radiation, endometritis

none

• Amenorrhea due to long term use of oral contraceptives

• Amenorrhea due to excessive physical exercise and sports

:از منظر طب چینی آمنوره به دو دسته عمده تقسیم می شود•

deficiencyکمبود

excessازدیاد

Macrocosm

Microcosm

Congenital deficiency

Improper intake of food and overstrain

Severe or chronic disease

Excessive loss of blood

Deficiency of Qi and Blood

Emptiness of the sea of blood

Stagnation of liver Qi

Attack of pathogenic cold

Retention of dampness

Retardation of Qi and Blood

Obstruction in the passage of menses

Amenorrhea

•Qi•Blood•Essence

Qi

• The concept of Qi or energy indicates that it is something that is at the same time material and immaterial. It lies between the atomic particle and the waveform.

• In man, it represents the source of all things, being the interaction of the Qi of the heavens and the Qi of the Earth that came together to create man.

Qi

• Where does Qi come from?

• We all inherit a certain amount of Qi from our parents, which is termed prenatal Qi .

• However, the main way we obtain Qi is by eating and breathing.

• This involves digestion, so we are talking about the Spleen, which processes the food to form pure Qi , which is moved upward to the Lung, and impure Qi , which is discarded through the Large Intestine.

Qi

• It is the Stomach’s job to separate out the pure from the impure Qi and to move the impure Qi downward into the Intestines.

• When the Stomach becomes rebellious, the impure Qi will move upward instead of downward, and that is when we experience belching and vomiting.

Qi

• In the Lung, the air Qi is mixed with the pure Qi from the Spleen to create essential Qi (Zheng Qi).

• The essential Qi, if not immediately used, is moved downward in the body and stored in the Kidney, the root of all energy, where the prenatal Qi and Jing are stored.

Qi

• Last, we have the regulation of Qi which is the work of the Liver.

• The Liver is responsible for the smooth regulation of both Qi and Blood and, indeed, is the “Great Regulator” of the body.

• The Liver is very sensitive to emotions, especially anger, and constrained emotions will cause a decrease in regulation and a decrease of Qi in the body.

Qi

• In summary, Qi is:

• Created and raised upward in the Spleen,

• Energized (transformed) and moved downward by the Lungs,

• Stored in the Kidneys,

• Regulated by the Liver

Qi

• Practically, this cycle of energy production is important to appreciate, because it focuses your attention on the areas of energy production in those patients who are weak, fatigued, or chronically ill.

• These patients must have a breakdown in the Qi cycle at one or multiple points.

Qi

• Two other forms of Qi that fall under the Zheng or essential Qi are the Wei Qi and Ying Qi. They are both of paramount clinical importance.

• Wei Qi is the surface circulation of Qi in the skin and the muscles and is the body’s outer defense against invading pathogens.

• This Qi can be tonified using certain herbal combinations. These combinations are used as a prophylaxis against viruses and other infections and they are the “immune stimulants” of Chinese medicine.

Qi

• The Ying Qi is the Qi that is partly the meridian Qi circulating in the Chinese acupuncture meridians and is also part of the nutritive Qi in the Blood.

• It is the energy that is moved when administering acupuncture.

• It is the Qi that is augmented with the use of moxibustionand electrical stimulation of acupuncture points.

Qi

• Qi is subject to conditions of congestion and depletion called Qi pathology.

• Congestion of Qi results from the pathogenic influences of Heat, Cold, Wind, Dampness, and Phlegm as well as from trauma, shock, emotional inhibition, and overeating.

• Depletion of Qi occurs with overwork, excessive sex, undernutrition, overexposure to environmental, mental or emotional stress, and prolonged or difficult illness.

Qi

QI

Defensive QI

Nutritive QI

Essence

Original QI

Body Fluids

Blood

OrgansNormal Qi

Direction

Pathological Qi

DirectionSymptoms

Lung Downward Upward Facial swelling, cough, asthma

Heart Downward Upward Mental restlessness, insomnia

Spleen Upward Downward Prolapse, diarrhea

Stomach Downward UpwardBelching, hiccup, nausea,

vomiting

Liver Upward

Excessive

Upward

Downward

Horizontally

To the stomach

To the spleen

To the intestines

Headache, dizziness, irritability,

burning sensation, pain,

belching, nausea, distention,

diarrhea, constipation

Blood

• Blood circulates through the body, nourishing and moistening the organs, sinews, muscles, mucous membranes, and skin, and is under the domain of Yin.

• The concept of Blood in Chinese medicine is somewhat different from that of Western medicine.

• In TCM, Blood is a form of very condensed and materialized Qi. Blood and Qi are inseparable.

Blood

• Blood gives Qi form and movement and Qi creates Blood.

• We could look at this concept as the relationship between oxygen (Qi) and the blood (Blood) in which it is flowing within the hemoglobin of the red cells.

• Blood is made in the Spleen from the Body Fluids that are distilled from food in the Stomach and combined with ZhengQi from the Lung and Kidney Jing (marrow).

Blood

• In Western medicine anemia is connected to deficiencies of iron, B12 , or folic acid absorption.

• In TCM, anemia (Blood Deficiency) is associated with a weak Spleen and Lung and poor digestive function.

• The Blood is circulated by the Heart Qi.

Blood

• The Blood is stored in the Liver.

• This is especially true when we go to sleep.

• The Blood moving into the Liver sedates consciousness.

• The Liver also regulates the Blood, for example, the Liver regulates menstruation.

Blood

• In summary, Blood is:

• • created by the Spleen, Lung, and Kidney Jing (marrow),

• • moved and circulated by the heart,

• • stored in the Liver,

• • regulated by the Liver.

Blood

• Blood is subject to conditions of depletion and congestion, called Blood pathology.

• Congestion of Blood occurs as a result of trauma, emotional distress, and the development of other pathogenic conditions such as Heat, Cold, and Phlegm which disrupt, retard, or obstruct its circulation.

• Depletion of Blood arises from overwork, undernutrition, excessive bleeding, exhaustion from difficult or prolonged illness, difficult pregnancy or childbirth, excessive thinking, and chronic sleep deprivation.

Blood

Essence

• Jing is the source of life — the unfolding etheric template through time that governs our growth, reproduction, and decline. It is a mostly Yin substance but has characteristics between that of Yin and Yang, is stored in the Kidneys, and is fluid in nature. Jing has two sources:

• Prenatal (Pre-Heaven)

• Postnatal (Post-Heaven)

Essence

• Prenatal (Pre-Heaven) Jing is inherited from our parents at conception and defines the strength of our constitutions.

• A lot of Essence equals a strong constitution.

• This is a fixed amount and, when it is used up and no more is produced, death results.

Essence

• Postnatal (Post-Heaven) Jing is maintained and replenished in life from the food that we eat in conjunction with the activity of the Spleen and Stomach.

Essence

• Jing circulates through the body and most particularly through the “Eight Extraordinary Vessels,” especially the Governing and the Conception Vessels.

• It vivifies the body and, with Original Qi, determines how long we will live.

Essence

• Functions of Jing

• 1. Growth, reproduction, and development;

• 2. As the basis of Kidney Qi;

• 3. Producing marrow, the common matrix of the bone marrow, spinal cord, and brain;

• 4. As the basis of constitutional strength.

Essence

• In summary, Jing is:

• • Partly inherited from birth,

• • Partly sustained and nourished by the same process that makes Qi,

• • Stored in the Kidneys.

Essence

• Essence can be eroded (Jing pathology) as a consequence of injury, overwork, abuse of drugs and medicines, inadequate nutrition, difficult or prolonged illness, abortions or miscarriages, multiple births, and excessive or frequent loss of Blood and Body Fluids.

• Essence deteriorates as a natural consequence of aging and this decline is responsible for many of the observable changes in our bodies with aging.

Essence

Amenorrhea due to blood exhaustion

:علائم بالینی•

سال18عدم شروع قاعدگی تا سن •

شروع به موقع قاعدگی ولی کم شدن مقدار و دفعات با افزایش سن•

سرگیجه، وزوز گوش•

ضعف در زانوها و کمر•

خشکی دهان و گلو•

تعریق شبانه•

احساس سوزش در کف پاها•

:پاتوفیزیولوژی•

.باعث کاهش خونرسانی مغز و سرگیجه می شود(Blood Deficiency)کم خونی•

.کم خونی و کمبود اسانس کلیه باعث احساس ضعف در زانو ها و کمر میشوند•

دهان است و کمبود آن باعث کمبود مایعات بدن میشود و این علت خشکییین خون ذاتا•.و گلو و همچنینی احساس سوزش در کف پاها است

Amenorrhea due to blood exhaustion

درمان

:اصول درمان

Reinforcing Qi and nourishing Blood

ین تقویت و همچنچی کلیه تقویت طحال و معده ، هدف اصلی انتخاب این نقاط تنظیم فعالیت . است Renو Chongمریدین های

one branch

ascends inside

the spinal

column

a branch emerges

at Qichong ST-30

and ascends via

Yinjiao REN-7

through points

Henggu KID-11 to

Youmen KID-21

then disperses inthe ches originates in the lower

abdomen

(in the uterus in women)

and descends to

emerge at

Huiyin REN-1

Coalescent points:

• Huiyin REN-1

• Yinjiao REN-7

• Qichong, ST-30

• Henggu KID-11

• Dahe KID-12

• Qixue KID-13

• Siman, KID-14

• Zhongzhu KID-15

• Huangshu KID-16

• Shangqu KID-17

• Shiguan KID-18,

• Yindu KID-19

• Futonggu KID-20

• Youmen KID-21

:انتخاب نقاط طب سوزنی

Gan shu (BL 18) :چون خون در کبد ذخیره میشود، تقویت جریان خون

PI shu (BL 20) :تقویت رشد و تکامل، طحال در تولید و کنترل خون نقش مهمی دارد ،تقویت جریان خون

Ge Shu (BL 17) :تقویت جریان خون

Shen shu (BL 23) :تقویت اسانس کلیه

Guan yuan (RN 4) :تقویت اسانس کلیه

Zusanli (ST 36) :تقویت رشد و تکامل

Sanyinjiao (SP6) : تکاملتقویت رشد و

Chong meridianCoalescent points :تقویت خونرسانی به رحم

THE BACK-SHU POINTS

• The Back-Shu acupoints are the sites in the back of the body to which the visceral organs’ Qi flows. Each of the zang–fu organs has a Back-Shu acupoint, so there are 12 in all. They are given names according to these organs. The Back-Shu acupoints all belong to Yang. They are located along the two sides of the spinal column along the Bladder Meridian of Foot-Taiyang. In general, their vertical order follows that of the visceral organs and they are mostly located near their respective organs. The Back-Shu acupoints are important sites where Yin-type illnesses are treated by a Yang-type approach.

45

BL18 Back-Shu point of the Liver

Location1.5 cun lateral to the posterior midline, on the level of the

lower border of the spinous process of the 9th thoracic

vertebra (T9).

NeedlingOblique insertion towards the spine, 0.5 to 1 cun, or

transverse-oblique insertion 1 to 1.5 cun.

Caution: perpendicular needling or oblique needling away

from the spine carries a substantial risk of causing a

pneumothorax.

Locate at the visible highest point of the paraspinal

muscles

BL 20 Back-Shu point of the Spleen

LOCATION1.5 cun lateral to the lower border of the

spinous process of the eleventh thoracic

vertebra (T11).

LOCATION NOTE

Locate at the visible highest point of the paraspinal

muscles.

NEEDLINGOblique insertion towards the spine, 0.5 to 1 cun, or

transverse-oblique insertion 1 to 1.5 cun.

Caution: perpendicular needling or oblique needling away

from the spine carries a substantial risk of causing a

pneumothorax.

BL17 Diaphragm Shu/Hui-Meeting point of Blood

LOCATION

1.5 cun lateral to the lower border of the spinous process

of the seventh thoracic vertebra

LOCATION NOTE

Locate at the visible highest point of the paraspinal

muscles.

NEEDLINGOblique insertion towards the spine, 0.5 to 1 cun, or

transverse-oblique insertion 1 to 1.5 cun.

Caution: perpendicular needling or oblique needling away

from the spine carries a substantial risk of causing a

pneumothorax.

BL23 Back-Shu point of the Kidneys

LOCATION1.5 cun lateral to the lower border of the spinous process

of the second lumbar vertebra (L2).

NEEDLING

Oblique or perpendicular-oblique insertion

towards the spine, 1 to 1.5 cun.

Caution: deep perpendicular needling carries

a risk of injuring the kidney.

RN4 Gate of Origin

LOCATIONOn the midline of the lower abdomen, 3 cun inferior to the

umbilicus and 2 cun superior to the pubic symphysis.

NEEDLINGPerpendicular insertion 0.5 to 1 cun, or oblique insertion

directed inferiorly, 1 to 1.5 cun.

Caution: deep insertion may penetrate a full bladder

which should therefore be emptied before treatment.

ST36

LOCATIONBelow the knee, 3 cun inferior to Dubi ST-35, one

fingerbreadth lateral to the anterior crest of the tibia.

NEEDLING

Perpendicular insertion 1 to 1.5 cun.

SP6 Three Yin Intersection

LOCATION

On the medial side of the lower leg, 3 cun

superior to the prominence of the medial

malleolus, in a depression close to the medial

crest of the tibia.

NEEDLINGPerpendicular or oblique proximal insertion, 1

to 1.5 cun.

Caution: contraindicated in pregnancy.

متد سوزن زدن

.سون1.5تا 1بصورت مایل به عمق : بک شو پوینت ها•

reinforcingسون با متد 1.5تا 1عمودی، : سایر نقاط•

دقیقه20مدت زمان درمان هر جلسه •

.انجام دهیدmoxibustionبعد از خارج کردن سوزنها میتوانید •

Amenorrhea due to blood stasis/ stagnation

:علائم بالینی•

سه عدم وجود قاعدگی به مدت طولانی، افسردگی، تحریک پذیری ،احساس پری در قف•سینه و شکم

:پاتوفیزیولوژی•

.استQIعامل اصلی توقف جریان خون و چی •

فسردگی انسداد در مسیر چی باعث تبدیل چی به آتش پاتولوژیک می شود که این موجب ا•.و تحریک پذیری است

.انسداد در مسیر چی همچنین باعث احساس پری در قفسه سینه و شکم می شود•

درمان

:اصول درمان•

Liver QIبرقراری جریان منظم در •

تنظیم کلی جریان چی در بدن•

resolving phlegmتقویت طحال و دفع اخلاط •

pathogenic coldگرم کردن مریدین ها و بیرون راندن سرمای مهاجم •

•Zhongji (RN 3) : باز کننده جریان خون قاعدگی از طریق تنظیم مریدین هایChong Renو

•Diji (SP 8) :برای تنظیم جریان خون و رفع استاز

•Hegu (LI 4) :تقویت چی کل بدن

•Sanyinjiao (SP 6) :ترکیب آن با . محل تلاقی سه مریدین یین در پاLI 4 نه تنها باعثدفع اخلاطبرای حذف رطوبت و تقویت طحال تقویت جریان چی میشود بلکه در

resolving phlegmبسیار موثر است.

•Taichong (LR 3) :تنظیم چی کبد

•Fenglong (ST 40) : تقویت طحال و دفع اخلاطresolving phlegm

•Chong meridianCoalescent points : رحم و رفع استازتقویت خونرسانی به

:انتخاب نقاط طب سوزنی

Zhongji (RN 3)

LOCATIONOn the midline of the lower abdomen, 4 cun inferior to the

umbilicus and 1 cun superior to the pubic symphysis.

NEEDLINGPerpendicular insertion 0.5 to 1 cun.

Caution: deep insertion will penetrate a full bladder

which should therefore be emptied before treatment.

Diji (SP 8)

LOCATIONOn the medial side of the lower leg, 3 cun inferior to

Yinlingquan SP-9, in a depression just posterior to the

medial crest of the tibia.

LOCATION NOTE

i. This point is most readily located one handbreadth

inferior to Yinlingquan SP-9; ii. Alternatively, it may be

located at the junction of the upper third and the lower

two thirds of a line drawn between the popliteal crease

and the prominence of the medial malleolus.NEEDLING

Perpendicular or oblique insertion, 1 to 1.5 cun.

Hegu (LI 4)

LOCATION NOTE

Ask the patient to squeeze the thumb against the base of

the index finger, and locate Hegu L.I.-4 at the highest

point of the bulge of the muscle and approximately level

with the end of the crease.NEEDLING

i. Perpendicular insertion 0.5 to 1 cun; ii. Oblique insertion

directed proximally 1 to 1.5 cun.

Caution: contraindicated in pregnancy.

Taichong (LR 3)LOCATION

On the dorsum of the foot, in the hollow distal to the

junction of the first and second metatarsal bones.

NEEDLING

In the direction of Yongquan KID-1, 0.5 to 1.5 cun.

Fenglong (ST 40)

LOCATION

On the lower leg, midway between the tibiofemoral joint

line (level with the popliteal crease) and the lateral

malleolus, two finger-breadths lateral to the anterior crest

of the tibia (i.e. one finger-breadth lateral to Tiaokou ST-

38).

NEEDLING

Perpendicular or oblique insertion 1 to 1.5 cun.

متد سوزن زدن

دقیقه در محل بمانند30الی 20سوزن ها reducingروش •