Overview】 Menstrual disorders, also known as menstrual disorders, refer to abnormal changes in the menstrual cycle, period or volume of menstruation. Most women have menstruation once in 28-30 days, but it is still normal to have menstruation within 7 days early or late, and the duration of menstruation is usually 3-7 days, and the bleeding volume of one menstruation is about 30-50 ml. Menstrual disorders include early menstruation, late menstruation, irregular menstruation, and excessive menstruation. Clinical manifestations】 Menstrual disorders are mainly manifested by irregular changes in menstrual cycle, color, quantity and quality of menstruation, and may be accompanied by dizziness, lumbago, vague pain or distension in the abdomen, irritability, fear of cold and warmth, etc. 1. Pre-menstruation: Menstrual cycle more than 7 days in advance, or even more than half a month in a row, more than 3 consecutive menstrual cycles. (1) Internal disturbance of blood heat: heavy menstrual flow, red and sticky, with small blood clots, irritable heat and thirst, yellow urine and hard stool, red tongue, yellow fur, slippery pulse. (2) Qi does not take in blood: menstruation is thin and light in color, fatigue, shortage of breath and lazy speech, empty abdomen, loose stools, light tongue and weak pulse. 2. Late menstruation: Menstrual cycle over 35 days, more than 3 consecutive menstrual cycles. (1) Blood cold stagnation: low menstrual flow, dark with blood clots, cold pain in the abdomen, relieved by heat, cold in the extremities, white fur, sunken and tight pulse. (2) Deficiency of liver blood: low menstrual flow, pale color without clots, vague pain in the abdomen, dizziness, palpitations and sleeplessness, pale or yellow face, pale red tongue and weak pulse. (3) Liver qi stagnation: low menstrual flow, dark red or small blood clots, distension and pain in the abdomen or pain in the chest, abdomen, both sides and breasts, thin white tongue coating and string pulse. 3. Irregular menstruation: Menstrual cycle either first or second, both more than 7 days, and more than 3 consecutive menstrual cycles. (1) Liver qi stagnation: menstrual flow may be high or low, purple-red with lumps, irregular menstrual flow, pain in the chest, breasts and abdomen, stuffiness, sighing, thin white or thin yellow fur, string pulse. (2) Kidney Qi deficiency: low menstrual flow, light color, thin texture, fatigue, lumbosacral pain, dizziness and tinnitus, light tongue with little coating and weak pulse. 4）Excessive menstruation: The menstrual flow is significantly higher than normal, while the cycle is basically normal. (1) Qi does not take in blood: excessive menstruation, light red color, thin texture, or pale face, shortage of breath, lazy speech, weak limbs, or empty abdomen, light tongue, thin pulse. (2) Blood-heat internal disturbance: heavy menstrual flow, bright red or deep red, thick and sticky, or small blood clots, often accompanied by distress and thirst, yellow urine and constipation, red tongue, yellow coating, smooth pulse. (3) Stagnation of the uterus: menstrual flow is heavy, or not clean, purple and black, with blood clots or with pain in the abdomen and refusal to press, purple and dark tongue or petechiae, fine and astringent pulse. 5.Low menstruation: Although the period is accurate, the menstrual volume is significantly reduced compared with normal, or the period is less than 2 days, and the menstrual volume is low. (1) Deficiency of liver blood: low menstrual flow or spotting, pale color without lumps, or accompanied by dizziness, palpitations, palpitation, yellowish face, empty abdomen, light red tongue, thin pulse. (2) Deficiency of kidney yang: low menstrual flow, pale red or dark red, thin texture, soreness of the waist and spine, dizziness and tinnitus, or cold abdomen, excessive nocturnal urination, pale tongue, weak or sluggish pulse. (3) Stasis in the uterus: low menstrual flow, purple-black color, blood clots, distension and pain in the abdomen, refusal to press, distension and pain relieved after the blood clots are discharged, purple-dark tongue or stasis points, thin and string-like pulse. (4) Phlegm-damp obstruction: low menstrual flow, light red color, sticky texture, obesity, chest tightness and vomiting, or thick leucorrhea, white greasy coating, slippery pulse. Diagnosis】 1. Pre-menstruation (1) Menstrual cycle more than 7 days in advance, or even more than half a month in a row, for more than 3 consecutive menstrual cycles. (2) The menstrual cycle is half a month early, which should be distinguished from intermenstrual bleeding, puberty and menopausal premenstruation. 2.Late menstruation (1) Menstrual cycle more than 35 days, more than 3 consecutive menstrual cycles. (2) Delayed cycle in women of childbearing age should be distinguished from late menstruation in pregnancy, puberty and menopause. (3) Gynecological examination, ultrasound or pneumoperitoneography to exclude organic diseases of the uterus and ovaries. (3) Irregular menstruation (1) Menstrual cycle either before or after, both more than 7 days, and more than 3 consecutive menstrual cycles. (2) Menstrual cycle disorder should be distinguished from menstrual disorder during puberty and menopause. (3) Gynecological examination and ultrasound to exclude organic lesions, basal body temperature measurement, vaginal smear, cervical mucus crystallization examination to understand ovarian function. (4) Excessive menstruation (1) The menstrual cycle is basically normal, but the volume of menstruation is significantly increased, above 50 ml, or longer than 7 days. (2) Gynecological examination and ultrasound examination to exclude organic diseases such as uterine fibroids. (3) Exclude excessive menstruation due to thrombocytopenia and coagulation mechanism disorder. 5.Menorrhagia (1) The menstrual cycle is basically normal, and the menstrual volume is very small, less than 30 ml, or even spotting. (2) This disease should be differentiated from early pregnancy. (3) Exclude menorrhagia caused by tuberculosis. Differential diagnosis】 1. Intermenstrual bleeding: bleeding between periods, lasting 2-3 days, less than normal menstrual volume, and periodic, may be accompanied by lumbar acidity, swelling and pain in the lower abdomen, swelling and itching in the breasts, and an increase in the band, with a sticky texture like egg white. If the basal body temperature shows bleeding at alternating low and high temperatures, it can be used as the basis for the diagnosis of this disease. 2.Breakage: It is characterized by serious disorder of the period and volume of menstruation, and menstruation does not follow the cycle, bleeding or as much as a note; or dripping constantly, or even repeatedly not finished. The clinical manifestations are different from those of premenstruation, prolonged menstruation, and irregular menstruation, although they belong to the same category of menstrual period and volume abnormalities. 3, before and after menopause: the onset of menopause is usually 45-55 years old before and after menopause, with menstrual disorders, abnormal emotions, red flushing, hot sweating, abnormal skin sensation and other symptoms. (1) Basic techniques 1. The patient is placed in a supine position, the doctor stands next to him/her and kneads the tianshu (double) with both thumbs, so that a feeling of heat and swelling is appropriate. 2.The doctor presses the patient’s lower abdomen with his palm, focusing on Guan Yuan for 2 minutes. Subsequently, press the five pivots and caudal region continuously with both thumbs, pressing from light to heavy, repeatedly applying the operation for 2 minutes. Point and press the middle pole for about 1 minute. 3. The doctor does palm rubbing along the patient’s inner thigh from Yinlian to the Sea of Blood, repeatedly for 2 minutes. Then tap and press the Sea of Blood for 1 minute. With both thumbs, press Yinlingquan to Sanyinjiao continuously and alternately for 2 minutes. 4. With the patient in a prone position, the doctor performs palm kneading along both sides of the patient’s back (from Liver Yu to Lumbosacral area), repeatedly for 2 minutes. Press the Liver Yu, Spleen Yu and Kidney Yu for about 1 minute each. 5.The doctor makes a fist and rubs the patient’s lumbosacral region with the back of the fingers to get a local heat sensation. Then use both thumbs to point and press the subs for 1 minute. (II) Symptomatic treatment 1. abdominal pain during menstruation: press the painful menstrual reaction point under the laboratorium and the 5th lumbar vertebra. 2.Pre-menstruation: focus on pressing Diaphragm Yu, Blood Sea and Tai Chong. 3.Late menstruation: pressure on Quchi and Yanglingquan. 4.Irregular menstruation: lift the small abdomen with tremor to make a warm feeling in the small abdomen. Press the point of regulating menstruation 1 inch outside Yongquan on the bottom of the foot. 5.Menstrual flow: the same as late menstruation. 6.Low menstrual flow: the same as the first menstrual period, plus foot San Li. 7.Increased leucorrhea: press Ji Men and Yin Ling Quan. Acupuncture and moxibustion 1. Basic formula for the first menstruation period: Guan Yuan, Blood Sea, Sanyinjiao. 2.Basic formula for late menstruation: Qi point, Sanyinjiao, Zhongji. 3. Basic formula for menstruation without regularity: Zhongji, Sanyinjiao. For kidney deficiency, add Guan Yuan and Kidney Yu; for liver depression, add Taichong, Zhimen and Liver Yu. Use the diarrhea method for solid evidence and the tonic method for deficiency evidence. Ear acupuncture Take the liver, kidney, uterus and ovaries, and apply pressure with Wang Bu Liu Xing seeds. (a) Premenstruation 1. Qi deficiency type: It is advisable to tonify Qi and regulate menstruation with the formula of tonifying Zhong Yi Qi Tang plus flavor. 2. Blood-heat type: It is advisable to clear heat and cool the blood to regulate menstruation, using the formula Qing Jing San plus reduction. (2) Late menstruation 1. Blood cold type: it is recommended to warm the menstruation and disperse cold, invigorate the blood and remove stagnation. 2. Blood deficiency: It is advisable to tonify blood and benefit qi to regulate menstruation, with Ginseng Yang Ying Tang plus or minus. 3. Liver-depression type: It is advisable to regulate menstruation by regulating Qi, using Wu-Yao Tang or Chai-Hu De-Liver-San with addition. (3) Irregular menstruation. 1. Kidney deficiency: It is recommended to tonify the kidney and regulate menstruation, using Solid Yin Decoction with addition and subtraction. 2. Liver-depression type: It is recommended to relieve liver depression and nourish blood to regulate menstruation. High menstrual flow or low menstrual flow should be treated symptomatically. Prevention and care] 1. Pay attention to life conditioning and menstrual hygiene. 2.Keep a happy mood and avoid over exertion or restfulness. Indications for admission 1.Menstrual cycle disorder, high or low volume, affecting normal life and workers. 2.Menstrual disorders accompanied by obvious systemic symptoms and weakness. Treatment standard I. Premenstruation, late menstruation, irregular menstruation 1.Cure: The menstrual cycle can be maintained for more than 3 months. 2.Improved: The menstrual cycle returns to normal, but cannot be maintained for more than 3 months. 3.Uncured: No change in menstrual cycle. Excessive menstruation and scanty menstruation 1.Cured: The menstrual flow is back to normal and can be maintained for more than 3 months. 2.Improved: The menstrual flow is obviously reduced or the menstrual period is normal (excessive menstruation); the menstrual flow is obviously increased or the menstrual flow is back to normal (excessive menstruation), but it cannot be maintained for more than 3 months. 3.Unhealed: No change in menstrual cycle and menstrual volume. Discharge criteria Menstrual cycle, menstrual volume and color return to normal, and systemic accompanying symptoms disappear. Clinical evaluation index Cure rate>70%; improvement rate>20%; failure rate<10%; morbidity and mortality rate0.