Gynecology- women’s health

2. Kidney Qi deficiency – pre-heaven def., pre-menopausal, cycles shorten between 40-50, pregnancy close together or amount of miscarries etc all use KI essence/Qi. KI Qi controls lower orifices, this makes Ren & Chong lose control.

3. Hyper Yang with heat in blood – general Yang life/constitution, lots of spicy food, fire invasion, hot working environment.

4. Liver Qi stagnation with heat in the blood – attack Ren & Chong, can’t consolidate.

5. Yin deficiency with heat in blood – TB, long term bleeding will injure Yin, over active reproductive parts (sex – babies), Ren & Chong can’t consolidate.

6. Blood Stasis – after delivery or during menses get attacked by ext. pathos, emotional upset can cause Qi stag. – Stasis, period stops early – next month comes early (blood stasis clogs uterus).

Pathogenesis differentiation & treatment

Spleen Qi deficiency

early period, more blood (not hold in vessels), less blood (SP Qi sink, pale-red colour, watery, low abdominal empty feeling, T – pale, white coat P - weak

Plus – Spleen deficiency symptoms (see Appendix 1)

P/T – nourish SP & middle Jiao Qi

Rx – Gui Pi Tang (stops heavy bleeding)

or Bu Zhong Yi Qi Tang (raises Qi , light bleeding)

Kidney Qi deficiency

early period, more blood (Chong & Ren can’t consolidate), less blood

(Essence deficiency), pale-brown red in colour, clear thin watery, T – pale

P - weak

Plus – Kidney Qi deficiency symptoms (see Appendix 1)

P/T – nourish KI Qi – consolidate Ren & Chong

Rx – Gui Shen Wan (KI tonic)

or Wen Chong Tang (more cold signs)

excess Yang with Heat in the blood

blood amount is more, fresh red or darker & sticky, blood may feel hot, T – red, yellow coat P – slippery, rapid

Plus – Heat symptoms (see Appendix 1)

P/T – clear Heat – cool blood to regulate menses.

Rx – Qing Jing Tang

Liver Qi stagnation with Heat

can be more or less quantity of blood, deep red in colour, thick clotted blood that does not flow smoothly (start & stop), breast distention and low abdominal pain, T – red sides P – wiry

Plus – Liver Qi stagnation symptoms (see Appendix 1)

P/T – soothe LR clear heat & cool blood to consolidate Chong Mai

Rx – Dan Zhi Xiao Yao San

Yin deficiency with heat in the blood

this pattern happens more around menarche & menopause deficiency Heat in Chong & Ren push blood out of Jing = early scanty, dark colour & sticky, T – red, scanty coat P – fine rapid

Plus – Yin deficiency symptoms (see Appendix 1)

P/T – nourish Yin, clear ↓ heat, consolidate Chong

Rx – Liang Di tang

Blood Stasis

cold blocks blood, Chong, & Ren - new blood can’t stay in uterus, woman starts spotting dark with clots, painful although better once clots pass, cold in uterus, whole body may not show cold signs, T – purple spots P – uneven

Plus – Blood Stasis symptoms (see Appendix 1)

P/T – promote blood circulation, remove Blood Stasis to regulate menses.

Rx – Tao Hong Si Wu tang

Late Periods

Diagnosis

Menstruate for 35 days or more, 3 months consecutively, more common during menarche and menopause. Is pregnancy a consideration?

Etiology

1. Blood deficiency - chronic illness, bleeding disorders

2. Yang deficiency (Kidney) – can’t warm organs – impairs production of blood – deficient Chong

3. Yin deficiency (Kidney) – deficiency Fire impair fluids and blood – deficient Chong blood

4. Cold stagnation – restrict blood circ – blood stasis

5. Qi stagnation turns to Blood Stasis – block Ren and Chong, Chong will not fill on time

6. Phlegm stagnation – overweight – phlegm damp retention can block Ren and Chong, Chong can’t fill – too damp (diabetes etc.)

Pathogenesis Differentiation & Treatment

Blood deficiency

scanty bleeding that is pale in colour and thin in consistency, T – pale, thin

P – thin, weak

Plus – blood deficiency symptoms (see Appendix 1)

P/T – nourish blood to nourish Chong

Rx – Xiao Ying Jian

Kidney Yang deficiency

cold symptoms, scanty purple pale thin menstrual blood, dull cold low abdominal pain, T – pale swollen, tender baby P – deep thin

Plus – Yang deficiency symptoms (see Appendix 1)

P/T – warm up KI Yang to nourish Chong

Rx – You gui wan

Kidney Yin deficiency

scanty dark coloured menstrual blood with small clots, T – red, scant coat

P – fine, rapid

Plus – Yin deficiency symptoms (see Appendix 1)

P/T – nourish KI Yin to regulate period

Rx – Liu Wei Di Huang Wan

Full Cold stagnation

scanty purple red blood with large clots, cold pain in low abdomen, complexion is white/blue, T – purple P – tense maybe uneven (stasis), deep (internal)

Plus – whole body feels cold

P/T – warm meridians, expel cold, promote circulation to remove stagnation

Rx – Wen Jing Tang

Liver Qi stagnation

scanty or normal, if no heat colour normal, if heat – deep red, thick, start/stop bleeding during menses, small clots, distended pain in low abdomen, T – red on sides P – wiry

Plus – Liver Qi stagnation symptoms (see Appendix 1)

P/T – regulate LR Qi, remove stagnation to regulate menses

Rx – Xiao Yao San

Phlegm stagnation

more (Damp) or less (stagnation) blood quantity, mixed with sticky pale coloured leukorrhea, generally overweight, T – greasy thick coat P – slippery, wiry

Plus – Phlegm symptoms (see Appendix 1)

P/T – transform Phlegm, dry Damp, promote blood circulation to regulate menses.

Rx – Er Chen Tang

Irregular Periods

Diagnosis

Menstruation is 7 days or more early, or 7 days or more late for 3 months consecutively.

Etiology

1. Kidney Qi deficiency - stores essence, works w/ all other Zang to regulate menses. Kidney can’t store essence properly & other organs malfunction especially Liver.

2. Liver Qi stagnation – can’t control amount of blood in Chong Mai,

stagnation = late, excess = early

3. Spleen Qi deficiency - can’t produce Blood or keep blood in vessels. Chong empty = late, blood escaping from vessels = early.

Pathogenesis Differentiation & Treatment

Kidney Qi deficiency

scanty, pale, thin, large amounts of clear thin vaginal discharge, T – pale

P – weak

Plus – Kidney Qi deficiency symptoms (see Appendix 1)

P/T – nourish KI Qi to regulate menses

Rx – Shen Qi Wan or You Gui Wan

Liver Qi stagnation

large or scanty amounts, colour normal, if heat it is darker, flow start/ stop, clots, PMS distended abdominal pain until menses, pre-menstrual breast distention,

T – red on sides P – wiry

Plus – Liver Qi stagnation symptoms (see Appendix 1)

P/T – soothe Liver, harmonize Qi & blood to regulate menses.

Rx – Dan Zhu Xiao Yao San (heat)

Xiao Yao San (no heat)

Spleen Qi deficiency

more blood if vessels not controlled, less blood if production is poor, pale red, thin, T – pale, white coat P – weak

Plus – Spleen Qi deficiency symptoms

P/T – nourish Spleen Qi & blood

Rx – Ba Zhen Tang (Si Jun Zi Tang + Si Wu Tang)

Heavy Periods

Diagnosis

Amount of menstrual bleeding is significantly increased during period to around or over 100 ml/day (normal 30-80ml). Although, there may be a regular, early, or late cycle.

Colour – pale, dark, or purple red.

Consistency – thick sticky, or, thin, or clotted.

Sometimes there may be pain.

Etiology

1. Qi deficiency - Spleen Qi deficiency = can’t keep blood in vessels = heavy bleeding. Long term Heart & Spleen deficiency (both Qi & blood), or Spleen and Kidney Qi deficiency (can cause Yang deficiency cold)

2. excess Heat – whole body dry Heat (spicy foods, Liver Qi stagnation turns to heat, or exterior Wind/Heat invasion), Heat enters blood = heavy bleeding

3. deficiency Heat – Yin deficiency, or febrile late stage turns to deficiency Heat, work in high temperatures can also lead to deficiency Heat, long term emotional stress consumes Yin fluids, excess sex injures Yin-Essence. Deficiency Heat attacks Ren & Chong = heavy bleeding.

4. Blood Stasis – emotional depression leads to Qi stagnation which leads to Blood stasis. During menses or after delivery it is easy to be attacked by Cold which may cause Blood Stasis. Abortions, or after surgery that was not quite done careful enough may create toxic local Heat = Blood stasis in Ren & Chong, this keeps old blood in the uterus which then mixes with new blood = heavy bleeding (with pain)

Pathogenesis Differentiation & Treatment

Qi deficiency

pale-red to normal blood colour, thin watery, clotted, T-pale P-thin-weak

Plus – Spleen Qi deficiency symptoms (see Appendix 1)

P/T – nourish mid-Jiao Qi, keep blood in Chong Mai

Rx – Gui Pi Tang

excess Heat in Blood

VERY heavy, bright-red, sticky-thick, blood feels warm, maybe clots, low abdominal distension relieved when blood comes, T-red with yellow coat P-rapid-slippery

Plus – excess Heat symptoms (see Appendix 1)

P/T – Clear Heat – cool blood to stop bleeding

Rx – Shu Yu Qing Gan Yin (new Rx)

deficiency Heat

Yin deficiency leads to hyper Yang with deficiency Fire, deep-red sticky blood, prolonged cycle (i.e.: 7-10 days), early period is common, T-red w/ scanty coat P-thin-rapid

Plus – Yin deficiency symptoms (see Appendix 1)

P/T – nourish Yin, clear deficiency Heat to stop bleeding

Rx – Bao Yin Jian

Blood Stasis

dark purple blood with clots, low abdomen excess pain that subsides when clots pass, T-purple dots P-uneven

Plus – Blood Stasis symptoms (see Appendix 1)

P/T – promote circulation, remove Stasis to stop bleeding.

Rx – Shao Fu Zhu Yu Tang (low Jiao)

Scanty Periods

Diagnosis – amount of blood quite small or spotting, only 1-3 days of bleeding. Generally starts @ menarche. Certain birth control methods can cause this. WATCH for possible early pregnancy.

Etiology

1. Blood ↓ - SP ↓ can’t produce blood, any severe bleeding, other illness – trauma

2. KI ↓ - late menarche, over sex, overwork stress → essence ↓ → can’t make enough blood for Chong/Ren

3. Cold in Blood – external cold invades meridian → blocks blood movement, internal ↓ cold (SP KI) can’t T & T enough blood

4. Qi stag. – emotions → stag. → Blood Stasis

5. Phlegm stag. – any reason (create phlegm) → block Qi/Blood circ.

Pathogenesis Differentiation & Treatment

1. Blood ↓ - pale thin, commonly delayed

Plus – Blood ↓ sym. T-pale-thin P-thin

P/T – nourish blood & SP Qi

Rx – Ba Zhen Tang (Si Wu Tang + Si Jun Zi Tang)

2. KI ↓ - scanty & late menarche, or gradually becomes scanty → delayed, pale, thin.

Plus – KI ↓ sym. T-pale P-deep-thin

P/T – nourish KI Qi & essence

Rx – Zou Gui Wan or Shen Qi Wan

3. Cold in Blood – cold pain & difficult to start full flow, dark colour, clots, delayed (late)

Plus – Cold pain in low abd., history of Cold inv.

T-normal → pale P-tense

P/T – warm meridians, disperse Cold

Rx – Wen Jing Tang

4. Qi stag. – difficult to start full flow, distention in breasts & abd., normal → (if stasis = dark w/ clots)

Plus – PMS T-purple spots on sides P-wiry-uneven

P/T – regulate Qi, promote blood circ.

Rx – Xiao Yao San

5. Phlegm-stag. – sticky, mixed w/ sticky fluids, delayed (late), leukorrhea,

Plus – Phlegm sym., generally overweight, chest oppression

T-swollen greasy P-slippery

P/T – eliminate phlegm – promote circ.

Rx – Er Chen Tang + blood invigorating herbs

Dysmenorrhea (painful period)

Diagnosis – recurring pain in lower abdomen 1-2 days before, during, or after period. Pain can radiate to whole abdomen, lower back, & anal/genital area (Endometriosis can have a feeling of downward pulling on the anus). The pain generally diminishes after period ends. The pain can be stabbing, burning, squeezing, dull, down-bearing, & in severe cases can cause nausea, vomiting, cold sweating, & fainting. This seems to happen mostly in younger women.

Differential Diagnosis – Appendicitis (pain only in right side, severe when pressed & let go), Ulcers (usually in epigastrium), Ovarian cysts & Uterine fibroids (milder pain), Inflammatory bowel diseases & reproductive & intestinal Cancers (constant dull pain), all of these can happen at any time within the cycle.

Etiology

1. Qi & Blood stag. - LR, emotional upset/stress stagnates Qi → blood stasis. Sea of Blood stagnates & causes pain.

2. Cold in Uterus – common in young women (swimming, Yang ↓, living enviro., cold foods), cold invades lower abdomen, Yang ↓ can also cause cold in Ren/Chong. Mostly Cold/Damp ↑ or Yang ↓.

3. Damp/Heat – inflammations, cold turns to heat, surgery, abortions etc cause Damp/Heat in lower Jiao, Ren/Chong & Uterus stagnate → blocked flow → pain.

4. Qi & Blood ↓ - after surgery, illness, constitution, all can cause stagnation → pain.

5. LR KI ↓ - ↑ births, ↑ sex, ↑ abortions → essence/blood ↓ → not enough blood in Ren/Chong → pain after menses (lack of lubrication idea).

Pathogenesis Differentiation & Treatment

1. ↑ or ↓ - PMS is more ↑, pain after period starts is ↓.

2. How severe is the pain?

3. General condition – angry, Qi ↓, Blood ↓, leukorrhea (damp), etc.

4. In Qi or Blood level / in LR or KI

-if pain in lower abdomen → radiates to sides = LR

-if pain radiates to lower back = KI

-if pain is fixed = blood stasis

-if pain moves (not fixed) = Qi stagnation.

5. Eight-principle diagnosis

P/T – regulate REN/Chong – Qi & Blood

- combine root/branch (pain first)

- choose herbs according to type of pain symptoms

Qi & Blood stagnation – 1 or 2 days before or during 1^st day of menses – lower abdominal distension pain, pressure makes worse, generally scanty blood flow, start/stop flow, dark-purple colour w/ clots, when clots pass the pain is relieved (or when menses stop).

Plus – LR Qi stag. sym. (PMS) T-dark-red P-wiry

P/T – regulate Qi, move stasis to relieve pain

Rx – Ge Xia Zhu Yu Tang (below diaphragm).

Cold in Uterus – a) ↓ Cold (Yang ↓) → painful during or after, pressure & warmth helps, scanty dull-dark red blood.

Plus – KI Yang ↓ sym. T-pale, moist white coat P-deep

P/T – warm Chong/Ren/Uterus to regulate blood & relieve pain

Rx – Wen Jing Tang

- b) Cold/Damp ↑ block lower Jiao causing lower abdomen cold pain – few days before or during, pain gets worse w/ pressure – better w/ warmth, scanty very-dark blood w/ clots.

Plus - cold sym. w/ aching all over T-white coat P-tense

P/T – expel cold, eliminate Damp, warm meridians to relieve pain

Rx – Shao Fu Zhu Yu Tang + eliminate damp (cang zhu, fu ling)

Damp/Heat – in lower Jiao causes distension pain before or during menses, pressure makes worse, hot sensations, yellow smelly vaginal leukorrhea, dark-red thick blood w/ clots, maybe more blood.

Plus – Damp/Heat sym. T-red, yellow greasy coat P-wiry-rapid

P/T – clear heat – eliminate damp to relieve pain

Rx – Qing Re Tiao Xue Tang

Qi & Blood ↓ - dull pain during or after period, pressure helps, scanty pale thin blood.

Plus – Qi/Blood ↓ sym. T-pale P-thin

P/T – nourish Qi & Blood

Rx – Ba Zhen Tang

LR KI ↓ - dull softer pain during or after period, dull-dark scanty thin blood

Plus – LR KI ↓ sym. T-pale P-weak

P/T – nourish LR KI to relieve pain

Rx – Tiao Gan Tang (regulate LR w/ KI herbs)

Bleeding between periods

Diagnosis – around ovulation (3-5 days) there is spotting or bleeding for 2-3 days which is scanty but significant. This can last for 2-3 days and generally is recurring. Can have low back soreness, pain in lower abdomen over the ovaries, sticky egg-white discharge or leukorrhea.

Differential Diagnosis – similar to early periods → check amount of blood to see if it is actual menstruation (early) or not (bleeding btwn periods). If you follow basal temperature charting, if bleeding comes while temperature is consistently high (after ovulation) then it is early, if it is before this rise → bleeding between periods.

Etiology

1. KI Qi & or Yin ↓ - (essence & blood), generally more in young women → Yin-essence transforms Qi (Qi is needed to make ovulation happen) → Qi is not transformed & KI Qi can’t consolidate Ren/Chong = bleeding

2. Damp/Heat – interior or exterior → injures Ren/Chong. Damp/Heat is Yang – too much Yang around ovulation (which has a Yang Qi action) pushes too hard = bleeding

3. Blood Stasis – in uterus. If also Yin ↓ → more Heat injures collaterals = bleeding.

Pathogenesis Differentiation & Treatment

1. KI Yin ↓ - scanty bright-red blood (earlier in cycle)

Plus – KI Yin ↓ sym. T-red-scanty coat P-thin-rapid

P/T – nourish KI Yin, clear ↓ Heat to stop bleeding

Rx – Liu Wei Di Huang Wan

2. KI Qi ↓ - scanty pale-red blood (later in cycle).

Plus – Qi ↓ sym. T-pale P-weak

P/T – nourish KI Qi to consolidate Ren/Chong

Rx – Shen Qi Wan

-or → Yu Ling Zhu – stimulate ovulation

3. Damp/Heat – sticky thick blood, thick yellow smelly vaginal leukorrhea.

Plus – Low Jiao Damp/Heat sym T-red-yellow slippery P-slippery-rapid

P/T – clear Heat – induce diuresis to stop bleeding

Rx – Ba Zheng San

4. Blood Stasis – dark-purple blood w/ clots, stabbing pain in lower abdomen.

Plus – T-purple dots P-thin-wiry

P/T – remove Blood Stasis to stop bleeding

Rx – Zhu Yu Zhi Xue Tang

Bi Jing – Amenorrhea

Diagnosis –

Primary Bi Jing – Menstruation has never come
Secondary Bi Jing – women’s period stops completely for more than 3 months.

- Normal times for Bi Jing – Pregnancy, During puberty when period isn’t regulated yet, Pre-menopausal, During breast-feeding, Environmental change, Stress

Differentiate:

Pregnancy: period usually stops suddenly with pregnancy signs

i.e.- morning sickness, cravings.

Etiology

1. LR KI ↓ - young age, essence can’t transform blood and liver has no blood to store so Chong and Ren meridians never receive any blood

- poor diet, over sexual activity …

2. KI Yang ↓ - Ming men fire is deficient creating deficient cold blocking the meridians.

3. Qi & Blood ↓ - Spleen and stomach deficiency do not produce blood so there are no stores of blood. There is no Qi to push and move blood out of uterus.

4. Yin/Blood ↓ - no source of blood, sea of blood is dry

(blood dryness)

5. Qi & Blood stag. - cold invasion and stress leads to Qi and blood stagnation

6. Phlegm-Damp acc. - Spleen Qi/Yang deficiency blocks Chong and Ren meridians. Patient will usually be over weight.

Primary Bi-Jing – female needs physical check up to see if there are any physical problems.

Pathogenesis Differentiation & Treatment

1. LR KI ↓ -primary Bi Jing

-secondary Bi Jing – cycle slowly gets slower and slower till it gradually stops, weak body symptoms

Plus – LR KI ↓ sym. T– pale P- deep, weak

P/T - Nourish liver and kidney to regulate menstruation

Rx - Gui Shen Wan

2. Qi & Blood ↓ - gradually menstruation becomes smaller and disappears

before - Amount -little

Amenorrhea – Colour – pale, Consistency -thin

Plus – whole body Qi/Blood ↓ sym. T-pale-thin P-empty

P/T - nourish Qi and Blood to regulate period

Rx - Ren Shen Yang Ying Tang

(Ba Zhen Tang = base formula for def. Qi and blood)

3. Yin ↓ w/ dry Blood - patient had scanty menstruation which slowly becomes smaller and disappears.

Plus – Yin ↓ sym. T- red, scanty coat P- thin, rapid

P/T - nourish yin and blood, clearing deficient heat to regulate period.

Rx - Jia Jian Yi Yin Jian

4. Qi & Blood stag.- absence of menstruation, easily angered and/or depressed with hypochondriac / chest fullness, pain in lower abdomen.

Plus - T- purple P- wiry-uneven-deep

P/T - regulate Qi, promote blood circulation and remove blood stasis to regulate period.

Rx - Zue Fu Zhu Yu Tang

Gynecology- women’s health

Menstrual disorders

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Menstrual Disorders

P/T – regulate the root

Early Periods

Etiology

Ren & Chong not consolidated

Pathogenesis differentiation & treatment

Late Periods

Etiology

Pathogenesis Differentiation & Treatment

Irregular Periods

Etiology

Pathogenesis Differentiation & Treatment

Heavy Periods

Scanty Periods

Dysmenorrhea (painful period)

Bleeding between periods

Bi Jing – Amenorrhea

Etiology

1. LR KI ↓ -primary Bi Jing

3. Yin ↓ w/ dry Blood - patient had scanty menstruation which slowly becomes smaller and disappears.

4. Qi & Blood stag.- absence of menstruation, easily angered and/or depressed with hypochondriac / chest fullness, pain in lower abdomen.

5. Phlegm Dampness -