Gynecology- women’s health

Pre-menstrual syndrome (PMS)

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NEW! Visit our Weblog Discussion Board. Click here. Share Your Thoughts! PMS Any disorder that comes regularly around menses. Click on the links below for more info… Fever Breast Tenderness Headaches Body Aching Diarrhea Epistaxis & Hematemesis (nosebleed & vomit blood) Cankers Hives Dizziness Edema Emotional Disorders Fever Diagnosis Acute, each occurrence any 1-2 days before-during-after period LR KI Yin ↓ → end of cycle manifestations Once period is finished – fever should be gone Is there an external pathogenic invasion history? Regularly for at least 3 months consecutively Differentiate – ovulation, temperature goes up but no feverish feeling comes with this. Etiology 1. LR KI Yin ↓ - around period Yin/Blood get used for Uterus → heat. 2. Heat in Blood (LR heat) – during menses – need more Qi to make period happen & this generates heat. 3. Qi (blood) ↓ - Ying & Wei are not harmonized, before fever there probably be chills – then fever & chills alternate. 4. Blood stag. – usually mixed w/ ext. patho. invasion, & already have Blood Stasis in Uterus – disharmony of Ying & Wei, - stag. leads to heat. Pathogenesis Differentiation & Treatment 1. LR KI Yin ↓ - tidal fever during last few days of bleeding, scanty blood Plus – Yin ↓ sym. T-red-scanty coat P-thin-rapid P/T – nourish Yin – clear ↓ heat Rx – Liang Di Tang 2. Heat in Blood – pre-menstrual high fever, red complexion, heavy periods, can have early periods. Plus – hot sym. T-red P-rapid P/T – clear heat – cool blood to reduce fever Rx – Qing Jing Tang 3. Qi (blood) ↓ - low fever during last few days of bleeding, could be spontaneous sweat, Heavy flow, pale-thin Plus – Sp Qi & blood ↓ sym. P/T – nourish SP Qi to harmonize Ying – nourish blood, to reduce fever. Rx – Bu Zhong Yi Qi Tang 4. Blood stag. – fever comes before or during bleeding, dark-purple blood w/ clots & Pain P/T – promote circ. – remove Blood Stasis to reduce fever Rx – Tao Hong Si Wu Tang or Xue Fu Zhu Yu Tang Breast Tenderness Diagnosis Around period breasts (KI) feel tender, sore, distended, or have itchy pain in the nipples (LR) Etiology 1. LR Qi stag. – LR effects nipple – if the LR attacks the ST the breasts are effected. Qi is not able to flow smoothly. 2. LR KI Yin ↓ - breasts are effected during menses, blood is ↓ - collaterals then lack nourishment & this leads to stag. Differentiation Tumor – generally has inverted nipple, breast skin looks like an orange peel, Areola border is not clear. Cyst – can be big or small – change w/ cycle hormone levels, can have many, they are fluid filled sacs. Pathogenesis Differentiation & Treatment 1. LR Qi stag. – pre-menstrual tenderness, itchy, distended Plus – LR Qi stag. sym. P/T – sooth LR to relieve stag. Rx – Chai Hu Shu Gan San or Xiao Yao San 2. LR KI Yin ↓ - tenderness in last few days of bleeding Plus – LR KI Yin ↓ Heat sym. P/T – nourish LR KI Yin Rx – Yi Guan Jian Headaches Diagnosis When period is finished the headache will go away. Etiology All Zang-fu Qi/essence go up to nourish head All Yang meridians & LR go to head When clear Qi/essence can’t raise to head → headache 1. Blood ↓ - can’t nourish head, when blood is needed to start menses headache comes 2. LR Fire – pre-menstrual headache, Chong is full of blood & LR has heat, this drives Qi upward. 3. Blood Stasis – pain during bleeding, cold or trauma causes Stasis. Turbid Qi can’t go down – instead it goes up & interferes w/ ascending clear Qi. Differentiation – ext. patho. invasion – the headaches do not happen at a regular time around menses. Pathogenesis Differentiation & Treatment Blood ↓ dull headache during last days of bleeding, dizziness, scanty menses, LR blood → top of head. Plus – Blood ↓ sym. T-pale-thin P-thin-uneven P/T – nourish Qi & blood to relieve pain Rx – Ba Zhen Tang w/ gou qi zi & he shou wu LR Fire pre-menstrual or starting period headaches, more severe, temporal/behind eyes/vertex, dizziness. Plus – LR Fire sym. T-red P-rapid-wiry P/T – clear LR fire & nourish LR Yin to sooth LR, expel Wind Rx – Qi Ju Di Huang Wan Blood Stasis trauma or chronic illness causes fixed stabbing pain in head. P/T – promote circ. – remove Stasis to relieve pain Rx – Tong Qiao Huo Xue Tang (common headache formula) Body Aching Diagnosis Body aching around menses. Etiology 1. Blood ↓ - aching last few days of bleeding, body simply lacks nourishment. 2. Blood Stasis – pre-menstrual body pains when stagnation blocks meridians. Pathogenesis Differentiation & Treatment Blood ↓ last few days of bleeding → numbness/pain/weakness in limbs (mostly lower), scanty bleeding Plus – Blood ↓ sym. T-pale-thin P-thin-uneven P/T – nourish & harmonize blood to lube tendons/muscles Rx – Dang Gui Bu Xue Tang Blood Stasis pre-menstrual aches/pain in low back/knees, cycle may be delayed (generally) P/T – move & nourish Blood, warm up meridians to relieve pain. Rx – Chen Tong Tang Diarrhea Diagnosis Significant soft/loose or watery stool around the menses that stops when period ceases. Not necessarily related to diet. SP ↓ is the most common pattern. WM – women w/ Uterus retroflexion have more pressure on the bowels when endometrial lining grows. Differentiate – Chronic diarrhea can occur at any time but may get worse around menses. Poor diet may cause diarrhea anytime. External Pathogenic invasion can also cause acute diarrhea. Etiology 1. SP Qi ↓ - controls blood, T&T of fluids, SP has to work hard to make blood for menses, when weak it has trouble w/ T&T → diarrhea. 2. KI Qi ↓ - controls gates, menses need KI Qi to transform Essence into blood, the gates are weak, & it is also difficult to steam water to the BL → more water → diarrhea. Pathogenesis Differentiation & Treatment SP Qi ↓ pre/during/last days = soft stools, heavy-pale-thin bleeding. Plus – SP Qi ↓ sym. T-pale white coat P-soft P/T – strengthen SP Qi – transform Damp Rx – Shen Ling Bai Du San Tong Xie Yao Tang (Wood overact on Earth) KI Qi ↓ during/last days = diarrhea (can be 5 am), thin-pale bleeding. Plus – KI Qi ↓ sym. P/T – nourish KI Qi Rx – Si Shen Wan Epistaxis & Hematemesis (nosebleed & vomit blood) Diagnosis Nosebleeds &/or Hematemesis regularly pre/during menses. Stops when period ceases. Etiology 1. LR Fire – Stagnated LR causes fire, LR supplies Blood to Chong Mai, Fire causes Chong to rise causing bleeding. 2. ST Heat – diet – spicy food, alcohol etc. causes Heat to rise w/ Chong Mai. 3. KI LU Yin ↓ - ↓ Fire → Chong travels upward w/ KI meridian, pushes blood out of vessels. Pathogenesis Differentiation & Treatment LR Fire Epi/Hema pre/during menses, bright-red early lg. amt. of menstrual blood. Plus – LR Qi stag. – LR Fire sym. P/T – sooth LR – clear LR Heat – cool blood Rx – Qing Gan Ying Jing Tang ST Heat similar to LR Fire sym. + bleeding upper gums. Plus – ST heat sym → bad breath, thirst P-forceful P/T – purge ST Fire Rx – San Huang Si Wu Tang KI LU Yin ↓ Epi/hema during/last days of menses, bright-red scanty early menses. Plus – KI LU Yin ↓ sym P/T – nourish KI LU Yin Rx – Shun Jing Tan + Niu Xi Cankers Diagnosis Cankers around menses, Mouth → ST, Tongue → HT. Heat related – frequently around period. Differentiate – Behcet’s Syn. – autoimmune ulcers in eyes/mouth/genitals, not related to menses. Etiology 1. ST Heat – heat goes up w/ Chong meridian (ST/Chong Mai have a relation) 2. Yin ↓ → hyper HT Fire – worry a lot, a lot of ↑ emotions – injures HT Yin, around period have even more Yin ↓ sym. because of bleeding → more HT Yin ↓ Fire goes up. Pathogenesis Differentiation & Treatment ST Heat during cycle painful ulcers appear, bad breath, heavy-deep-red menstrual bleeding. Plus – ST Heat sym. P/T – clear ST Fire – purge Fire Rx – Qing Wei San or Liang Ge San (cool diaphragm) HT Yin ↓ → hyper HT Fire around menses – tip of tongue ulcerated & painful, scanty early menstruation. Plus – HT Yin ↓ sym. (mental restlessness, malar flush) P/T – nourish Yin – descend Fire Rx – Zhi Bai Di Huang Wan Hives Diagnosis Itchy skin, raised eruptions around periods. Main Pathogen = Wind → exterior or interior (blood ↓) Etiology 1. Blood ↓ - produces internal Wind – during menses blood is more ↓ , itchyness & eruptions occur. 2. External Wind – Qi & Blood are used in great quantity for menstruation, if person had preexisting Heat patterns → mix w/ Wind/Heat. Pathogenesis Differentiation & Treatment Blood ↓ whole body can be itchy, when scratched hives will appear, worse @ night, delayed scanty menstruation. Plus – Blood ↓ sym. (dry skin, blurry vision) T-pale, thin P/T – nourish Blood – expel Wind Rx – Dang Gui Yin Zi Wind/Heat big patches of red elevated hives, when scratched you can see clear red lines on the persons skin, severe itchiness, heat makes it worse, early-heavy menstruation. Plus – Heat sym. (maybe exterior sym.) P/T – nourish blood – clear Heat – cool blood – expel Wind Rx – Xiao Feng San Dizziness Diagnosis Regular dizziness &/or blurred vision around period, severe cases can have spinning & tinnitus. Differentiate – Meniere’s syndrome – inner ear fluid causing tinnitus & dizziness (balance) when eyes are open, also may have cold limbs. Also general dizziness will occur at anytime within the cycle. Etiology 1. Blood ↓ - long term bleeding or SP ↓ - can’t produce enough blood, during menses blood goes down to lower Jiao → not enough can go up to head. 2. Yin ↓ → hyper LR Yang – Yin ↓ in lower Jiao causes relative Yang ↑ , Yang rises causing Wind (dizziness). 3. SP ↓ - produces Phlegm-Damp – this blocks the meridians & impairs clear Yang to rise to head for nourishment (Qi helps clear Yang to rise, i.e. SP Qi ↓, Qi is used to move menses in Lower Jiao). Pathogenesis Differentiation & Treatment Blood ↓ during/post menses dizziness, maybe delayed period. Plus – LR HT Blood ↓ sym. T-pale, thin P-weak P/T – nourish HT SP for Qi/Blood Rx – Gui Pi Tang + gou qi zi, he shou wu Yin ↓ → hyper LR Yang during menses dizziness, tinnitus, scanty-bright-red blood, T-red-scant yellow coat P-thin wiry rapid Plus – LR Heat sym. (irritable, anger, thirst) P/T – nourish Yin – subdue Yang Rx – Tian Ma Gou Teng Tang (dizzy wind soup) SP ↓ produces Phlegm-Damp – pre/during menses dizziness & heavy head, vaginal leukorrhea, T-white greasy coat P-soft (damp) slippery (phlegm) Plus – SP ↓/phlegm-damp sym. (fullness in chest, nausea, soft stools edema. P/T – strengthen SP – trans. damp – eliminate Phlegm Rx – Ban Xia Bai Zhu Tian Ma Tang Edema Diagnosis Around period face &/or limbs get puffy/swollen. ↑ - LR Qi stag., pre-menses, quick-return pitting. ↓ - SP KI, mostly in morning, during/after menses, pitting. Differentiate – check kidney/renal function (WM). Etiology 1. SP KI ↓ - can’t control T&T or the gates. 2. Qi/Blood stag. – Qi can’t move water transformation in Lower Jiao (abd. bloating) Pathogenesis Differentiation & Treatment 1. SP KI Yang ↓ - pitting during/post menses, more in morning (face), delayed scanty purple-pale blood, cold signs. Plus – SP KI Yang ↓ sym. (except urine will be scanty) P/T – nourish SP – warm KI – induce diuresis Rx – Ling Gui Zhu Gan Tang 2. Qi/Blood stag. – pre menses edema, abd. bloating, fatigue, delayed-dark-clotted blood, Dysmenorrhea. Plus – LR Qi stag. sym. P/T – regulate LR Qi – promote blood circ. Rx – Ba Wu Tong + fu ling, zi lan Emotional Disorders Diagnosis Around period feel very irritable, angry, sad, depressed, violent mania, anxiety &/or insomnia. Recede after menses stop. Differentiate – Heat invading the Blood – effects the LR HT, causes delirium at night w/ fever. Etiology 1. HT Blood ↓ - during menses HT gets weak (Shen) 2. LR Qi stag. → Fire – pre-menses – Chong goes upward because of the Heat. Fire rising also effects HT Shen. 3. Phlegm-Fire – LR Heat / SP Phlegm accumulates pre-menses, Heat goes upward along Chong & effects Shen. Pathogenesis Differentiation & Treatment 1. HT Blood ↓ - during menses – anxiety, lack of concentration, slow mental function, sadness, talk to themselves, delayed-scanty-pale blood. Plus – fatigue, insomnia, palpitation, Blood ↓ sym. T-pale thin coat P/T – nourish Blood – calm Shen Rx – Yang Xin Tang + long gu, mu li Gan Mai Da Zao Tang (mild strength for sadness) 2. LR Qi stag. → Fire – pre-menses – irritable, anxiety, anger, violent, heavy-red-early periods. Plus – LR Qi stag. sym. P/T – clear LR Heat – sooth LR – calm Shen Rx – Dan Zhi Xiao Yao San 3. Phlegm-Fire – during menses – violent, irritable, lg. amt. yellow smelly-sticky leukorrhea. Plus – Phlegm-Heat sym. (fullness in chest, nausea, + heat) T- red P- slippery rapid wiry P/T – clear Phlegm-Heat to calm Shen Rx – Wen Dan Tang (er chen tang cousin w/ heat herbs)

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