Integrative Woman’s Health Course DAOSHING NI

Prolonged Menstrual Flow 經期延長

Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫  49yo,married,prolongedmenstrua4onfor2years.

 Mostregularperiods5-6/30,mediumamount,clots.Sincebeginningoftheyear,pa4enthasexperiencedmanycyclesofprolongedperiodflow.OBGYNadvisedD&Cfollowedbyestrogenandprogesteronecyclicalusage,butdidnotworkwell.

 Sheexhibitsinsomnia,anxiety,headpressure,recentlyhermenstrua4onagainlasted10daysandthroughultrasound,heruterineliningwasverythick(12mm).Hertongueisslightlyred,coa4ngthinyellowgreasy,pulsewirythready.

 TCMDiagnosis:ProlongedMenstrua4on;WMDiagnosis:AUB

Definition  Withmenstrualcyclenormal,thedaysofmenstrualflowincreasedtobeyond7daysto14days

 Hypermenorrheaormenorrhagiaiss4llthewesternmedicinedefini4oneventhoughhereindicatesaprolongedmenstrua4on4meregardlessthequan4tyoftheflow

Possible conditions  Corpusluteumdysfunc4on

 PID

 D&C Ovulatorydysfunc4on

Etiology  QiDeficiency(QiXu)氣虛

 DeficientHeat(XuRe)虛熱

 BloodStagna4on(XueYu)血瘀

Etiology – Qi Deficiency

InjurytoSpleenQi,MiddleJiaoQiDeficient

Cons4tu4onalWeakness

InsufficientFoodIntake

Overstraining

ChongRenDysfunc4oncannotcontrolblood

flow

Etiology – Deficient Heat

YinBlooddeficient,heatrises

ChronicIllness

injuringtheYin

Excessivepregnancies

Overstrainingorexcessive

sexualac4vi4es

HeatdisturbsChongRen,SeaofBloodbecomesrestless

Etiology – Blood Stagnation

ChongRenUterusbecomesstagnant

Chronicdepressionorstasis,injuringLiver,QiStasis

BloodStagna4on

Exogenouspathogensstuck

inuterus,causingbloodto

stagnate

MenstrualFlowoutofcontrol

Pathology  DiseaseLoca4on:ChongRen.ThemainpathologyisChongRenSeaofBlood.ChongRenlosingcontrollingfunc4on,menstrualbloodlosingcontrol

Deficiency QiDeficiency,DeficientHeat

ChongRenLosingControl,HeatdisturbsChongRen

MenstrualBloodLostControl

Excess BloodStagna4on,

ChongRenBlockage

MenstrualBloodLostControl

Etiopathology Summary ExogenousPathogens

SpecialMenstrualPhysiology

Cons4tu4onalFactor

EndogenousEmo4onalFactors

DietaryFactorXueYu

QiXuChongRenlosingcontrol,menstrualbloodlosingcontrol

ChongRenBlockage,menstrualbloodlosingcontrol

XuReHeatdisturbsChongRen,menstrualblood

losingcontrol

Diagnosis  MainSymptom:menstrualflowlastedmorethan7days,butcyclenormal

 Combina4ons:canseeincreasedmenstrualflow,menstrual.cycleirregular,ordysmenorrhea,lumbago,orleukorrhea

Exams  Pelvicexamina4ontocheckforthesizeofuterusorremainedPOCorPOM

 Pelvictenderness

 Sexhormonelevels

Differentiation of Syndromes E"ology Symptoms

Quan4ty Color Quality Cycle

QiXu more pale Thin NotcleanNotclear

XueRe less Brightred thick Normal

XueYu Moreorless Purpledark Clots Normal

Treatment Principles  FocusonChong’scontrollingfunc4on StrengthenChongStopBleedingRegulateMenstrua4on

 Toshrinkmenstrua4on4me

 QiDeficiency–TonifyQiandControlBlood

 DeficientHeat–NourishYinClearHeatStopBleeding

 BloodStagna4on–Ac4vateBloodDissolveStagna4onStopBleeding

Herbal Therapy Qi Deficiency  Prolongedmenstrua4on,excessiveflow,paleandthinflow,fa4gue,dyspnea,feeblespeech,paleface,tonguepale,coar4ngthin,pulseslowandweak.

 ChongRenweakenedcontrol,cannotcontrolmenstrualbloodflow

 TonifyQiControlBlood,StrengthenChongRegulateMenstrua4on

 ModifiedJuYuanJian舉元煎(JuYuanJian+AJiao,AiYe,WuZeiGu)

 RenShen,HuangQi,BaiZhu,ShengMa,ZhiGanCao,AJiao,AiYe,WuZeiGu

Herbal Therapy Qi Deficiency  ModifiedJuYuanJian舉元煎(JuYuanJian+AJiao,AiYe,WuZeiGu)

 RenShen,HuangQi,BaiZhu,ShengMa,ZhiGanCao,AJiao,AiYe,WuZeiGu

 Ifexcessiveflow,addMuLi

 Ifwithdysmenorrhea,addSanQi,PuHuang,XueYuTan

Herbal Therapy Deficient Heat  Prolongedmenstrualflow,lessflow,brighterred,thickors4ckyflow,drythroatandmouth,orwithflushedface,4dalheat,orwithfivesoleheat,tonguered,coa4ngscanty,pulsethreadyrapid.

 Yindeficiencywithinternalheat,heatdisturbingChongRen,SeaofBloodrestlessandnotcalm

 NourishYinClearHeatStopBleeding

 LiangDiTang+ErZhiWan+WuZeiGu+QianCao兩地湯＋二至丸＋烏賊骨＋茜草

 ShengDi,XuanShen,MaiDong,DiGuPi,AJiao,BaiShao,NvZhenZi,HanLianCao，WuZeiGu,QianCao.

 生地，玄參，麥冬，地骨皮，阿膠，白芍，女貞子，旱蓮草,烏賊骨，茜草。

Herbal Therapy Deficient Heat  LiangDiTang+ErZhiWan+WuZeiGu+QianCao兩地湯＋二至丸＋烏賊骨＋茜草

 ShengDi,XuanShen,MaiDong,DiGuPi,AJiao,BaiShao,NvZhenZi,HanLianCao，WuZeiGu,QianCao.

 生地，玄參，麥冬，地骨皮，阿膠，白芍，女貞子，旱蓮草,烏賊骨，茜草。

 Ifscantyflow,addShuDi,DanShen,Ifstrong4dalfeverorheatsymptoms,addBaiWei白薇

Herbal Therapy Blood Stagnation  Prolongedmenstrualflow,lessflowamount,darkredcolorwithclots,pelvicpainaversiontopressure,tonguepurpledarkorwithstagnantspots,pulsewirysluggish.

 Stagna4onblockingtheproperfunc4onofChongRenandUterus,menstrualflowbecomesuncontrolled.

 Ac4vateBlood,DissolveStagna4onStopBleeding

 TaoHongSiWuTang+ShiXiaoSan+YiMuCao+QianCao桃紅四物湯+失笑散+益母草＋茜草。

 TaoRen,HongHua,DangGui,ShuDi,ChuanXiong,BaiShao,PuHuang,WuLingZhi,YiMuCao,QianCao.

Herbal Therapy Blood Stagnation  TaoHongSiWuTang+ShiXiaoSan+YiMuCao+QianCao桃紅四物湯+失笑散+益母草＋茜草。

 TaoRen,HongHua,DangGui,ShuDi,ChuanXiong,BaiShao,PuHuang,WuLingZhi,YiMuCao,QianCao.

 Ifwithpelvicdistendingpain,addEZhuandYanHuSuo莪朮，延胡索

Herbal Instructions  Mostof4me,itwouldbemoreeffec4vetotaketheherbsduringthemenstrua4on.

 Stayawayfromastringentherbstoavoidfurtherblockageandconges4on.

Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫  49yo,married,prolongedmenstrua4onfor2years.

 Mostregularperiods5-6/30,mediumamount,clots.Sincebeginningoftheyear,pa4enthasexperiencedmanycyclesofprolongedperiodflow.OBGYNadvisedD&Cfollowedbyestrogenandprogesteronecyclicalusage,butdidnotworkwell.

 Sheexhibitsinsomnia,anxiety,headpressure,recentlyhermenstrua4onagainlasted10daysandthroughultrasound,heruterineliningwasverythick(12mm).Hertongueisslightlyred,coa4ngthinyellowgreasy,pulsewirythready.

 TCMDiagnosis:ProlongedMenstrua4on;WMDiagnosis:AUB

Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫  Thepa4entisat7x7age,herliverandkidneyessenceandyinhavedepleted,atthesame4me,sheexhibitedministerialfirerising,yindeficiencywithfirecausingheaddisten4on,emo4onalinstability,heatdisturbingChongRencausingmenstrualbloodlosingcontrol,thereforeprolongedperiod.

 LiverKidneyYinDeficiency,HeartBrainLackedNourishment

 NourishLiverandKidney,CalmsHeartandCalmsSpirit

 DangGui,ShuDi,SuanZaoRen,YeJiaoTeng,HeHuanPi,YuanZhi,FuShen,HuaiXiaoMai,ZhiGanCao.14bags.

Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫  SecondVisit:sleepimproved,dizzinessimproved,appe4tenormal,bmregular,lastperiodlasted7daysinsteadof10days.Pulsethinsop,tonguered,coa4ngthin.

 DangGui15,ShuDi12,ShaRen3,SuanZaoRen9,YeJiaoTeng20,FuShen12,FuLing12,HeHuanPi12,YuanZhi6,HuaiXiaoMai30,ZhiGanCao6,BaiZhu9,BaiShao9.14bags