Gynecology- women’s health

Pre-menstrual syndrome (PMS)

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 PMS

Any disorder that comes regularly around menses.

 

 

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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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