Menstrual disease is a common clinical condition in gynecology, and is characterized by abnormalities in the menstrual cycle, menstrual period and menstrual volume, as well as obvious discomfort accompanying the menstrual cycle.
The common menstrual diseases include premenstruation, late menstruation, irregular menstruation, excessive menstruation, scanty menstruation, prolonged menstruation, intermenstrual bleeding, menorrhagia, amenorrhea, dysmenorrhea, menstrual fever, menstrual headache, menstrual epistaxis, menstrual diarrhea, menstrual breast pain, abnormal menstrual flow, before and after menstruation, menstrual break, etc.
The main mechanism of menstrual disease is the dysfunction of the internal organs and the disharmony of qi and blood, resulting in the damage of the two channels of menstruation. The causes of menstrual disease are exogenous, internal injuries, labor, diet, but also pay attention to the impact of physical quality on the occurrence of menstrual disease.
The identification of menstrual disease focuses on the period, quantity, color, quality of menstruation and the symptoms that accompany the menstrual cycle, as well as the systemic symptoms, using the four diagnoses and eight syllabuses for comprehensive analysis.
The principle of treatment for menstrual diseases is to treat the root cause and regulate menstruation. In the process of treatment, the first step is to identify the difference between other diseases and menstrual diseases. If the menstrual disorder is caused by other diseases, we should treat other diseases, and the disease will go to the menstrual disorder; if the menstrual disorder is caused by other diseases, we should regulate the menstrual disorder, and the menstrual disorder will heal itself. The second identification of the symptoms of the different, urgent is to treat the symptoms, slow is to treat the root. If menstrual cramps are severe, pain relief should be the main focus. Then identify the different phases of the menstrual cycle. During the menstrual period, the blood chamber is open, the cold and hot agents should be used with caution; before the menstrual period, the sea of blood is full, do not indiscriminately tonic, should be dredged; after the sea of blood is empty, do not attack, should be adjusted to tonic, but always to the evidence of deficiency discretion to use attack and tonic. This is the general rule of treatment of menstrual disease.
The main method of treatment for menstrual disease is to tonify the kidneys, support the spleen, dredge the liver and regulate the qi and blood. “Menstrual water comes out of the kidneys”, so the essence of regulating menstruation is in the kidneys. The kidney is to benefit the innate true yin, to fill the essence and nourish the blood, with the help of Yang and Qi products, so that Yang and Yin grow, the essence and blood are flourishing, then the menstruation will be regulated. Even in the case of disease caused by lewdness, it is appropriate to tonify the kidneys after eliminating the evil. The spleen is to benefit the source of qi and blood, to strengthen the spleen and ascend the yang, the spleen and stomach is healthy, the qi and blood is full, the source is strong and the flow is smooth. However, it is not advisable to use too much sweet and moist or pungent and warm products to avoid stagnating the spleen yang or depleting the stomach yin. The liver in the regulation of qi, to open the depression and move the qi, accompanied by liver nourishing products, so that the liver qi can be unblocked, qi and blood regulation can be smooth, the menstrual disease can be healed. Regulate the qi and blood when the identification of qi disease, blood disease, disease in the qi, treatment of qi is the main, treatment of blood for supporting; disease in the blood, treatment of blood is the main, treatment of qi for supporting. Qi and blood originate from the internal organs, and the method of tonifying the kidneys, supporting the spleen, and draining the liver also implies the regulation of Qi and blood. The above-mentioned methods, and often to nourish the kidney to support the spleen as the important. For example, “Jing Yue Quan Shu” said: “Therefore, the regulation of menstruation, expensive in the spleen and stomach to fund the source of blood, nourishing the kidneys to the blood room, know that the two, then all good.” In addition, women of different ages have different physiological characteristics, and the focus of treatment is also different and should be considered.
In conclusion, menstrual disease is a common disease, with a variety of lesions and mixed evidence of deficiency, cold and heat. It is necessary to fully understand the kidney’s mastery of menstruation, pay attention to the spleen, liver and the influence of qi and blood on menstruation, fully grasp its treatment and apply it flexibly.
Section 2: Pre-menstruation
Pre-menstrual cycle that is 1-2 weeks early is called “pre-menstruation”, also called “over-advancement of menstruation” or “early menstruation”.
This disease is equivalent to the luteal failure and uterine bleeding caused by pelvic inflammatory disease in Western medicine ovulatory dysfunctional uterine bleeding disease. Pre-menstruation with excessive menstruation may further develop into a leaky menses and should be treated promptly.
[Etiology and mechanism]
The main mechanism is that the menstrual blood is not restrained due to the failure to consolidate the flush and the menstrual bleeding. The common types of symptoms are Qi deficiency and blood heat.
Qi deficiency
It can be divided into spleen qi deficiency and kidney qi deficiency.
(a) Spleen qi deficiency;
Weakness of the body, or excessive exertion, worrying, eating disorderly, damage to the spleen, spleen injury, weakness of the middle qi, not solid, can not regulate the menstrual blood, so the menstruation comes early.
(II) Kidney Qi deficiency
The kidney is weak, the kidney is deficient, the stroke is not solid and cannot control the menstrual blood, so the menstruation comes early.
Blood heat
It can be divided into Yin deficiency blood heat, Yang Sheng blood heat and liver depression heat.
(A) Yin deficiency blood heat
Yin deficiency, or loss of blood and injury to yin, or birth of many milk, depletion of essence and blood, or excessive thinking, Ying Yin dark depletion, Yin blood deficiency, deficiency heat, heat disturbing the flush, the flush is not solid, can not restrain the menstrual blood, resulting in early menstruation.
(2) Yang and blood heat
The body is full of yang, or over-eating warm, dry, spicy products, or feeling heat, heat injury to the ramifications, forcing the blood to move, resulting in early menstruation.
(C) Liver depression and heat
Depression in nature, or emotional injury, depression and unhappiness, liver qi stagnation, depression for a long time into heat, heat injury to the flushing, forcing the blood to move, resulting in premature menstruation.
[Identification and treatment]
The main treatment is to calm the flushing, or to tonify the spleen, consolidate the kidney and benefit the qi, or to clear heat and fire, or to nourish yin and clear heat.
I. Qi deficiency type
(A) Spleen Qi deficiency
The main symptoms: early menstruation, or a large amount, light color and thin texture, fatigue, lazy speech, small abdomen, loose stools, light red tongue, thin white fur, slow and weak pulse.
Analysis of the symptoms: Spleen-Qi deficiency, lack of power to regulate Blood, and lack of consolidation of the ramus, so the menstruation comes early and in large quantity; Qi deficiency and blood loss of warmth, so the menstruation is light in color and thin in quality; Spleen deficiency of middle energy, so fatigue, shortness of breath and lazy speech, small abdominal emptying; transport and transformation failure, so the bowels are loose. Pale red tongue, thin white fur, slow and weak pulse are also signs of spleen deficiency.
Treatment: Tonifying the spleen and benefiting Qi, consolidating flushing and regulating menstruation.
Example of formula: Tonifying Zhong Yi Qi Tang (Treatise on the Spleen and Stomach).
Ginseng, Radix Astragali, Radix Glycyrrhiza Uralensis, Radix Angelicae Sinensis, Pericarpium Citri Reticulatae, Radix Achyranthes Bidentatae, Rhizoma Atractylodes Macrocephalae
In case of excessive menstruation, remove Angelica sinensis and reapply Radix Astragali and Radix Codonopsis to benefit qi and regulate blood; during menstruation, remove Angelica sinensis and add mugwort, aconite and squid bone to stop bleeding and consolidate blood; in case of loose stools, add yam, sand and coix seed to support the spleen and stop diarrhea.
If the heart and spleen are both deficient, the symptoms are early menstruation, palpitations and palpitations, insomnia and dreaminess, tiredness of the limbs, light tongue with thin coating and weak pulse.
Atractylodes Macrocephala, Fu Shen, Astragalus, Longan Flesh, Sour Jujube, Ginseng, Mu Xiang, Angelica, Yuan Zhi, Licorice, Ginger, Jujube
Ginseng, Atractylodes Macrocephala, Astragalus, Glycyrrhiza glabra to strengthen the spleen and fix the punch; angelica, longan flesh, jujube to strengthen the spleen and nourish the blood; sour jujube, Fu Shen, Yuan Zhi to nourish the heart and nourish the mind; ginger, mullein to move the qi and wake up the spleen. The whole formula works together to nourish the spleen and nourish the heart, solidifying the flushing and regulating the menstrual effect.
(II) Kidney Qi Deficiency
Main symptoms: Premature menstruation, low volume, pale and dull color, thin texture, lumbago and leg weakness, dizziness and tinnitus, frequent urination, dull face or dull spots, pale and dull tongue, thin white fur, sunken and thin pulse.
Kidney deficiency is the essence of the kidney, so menstruation is early. The color of kidney water floods upward, so the face is dull or has dull spots. Pale and dull tongue and sunken pulse are also signs of kidney deficiency.
Treatment: tonifying the kidney and benefiting the qi, consolidating the flushing and regulating the menstruation.
Example of formula: Gu Yin Decoction (Jing Yue Quan Shu).
Ginseng, Radix Rehmanniae, Rhizoma Dioscoreae, Cornu Cervi Pantotrichum, Rhizoma Polygonati, Radix Glycyrrhiza Uralensis, Semen Cuscutae
In this formula, Cuscuta tonicizes the kidney and benefits essence; Shu Di and Cornu nourishes the kidney and benefits essence; Ginseng, Yam and Roasted Glycyrrhiza strengthen the spleen and benefit the qi, nourishing the heavenly bodies to strengthen the vital gate; Wu Wei Zi and Yuan Zhi transport the heart and kidney, enabling the heart qi to flow downward to strengthen the power of kidney qi fixation. The whole formula works together to tonify the kidneys and benefit the qi, solidifying the flushing and regulating the menstruation.
If the lumbago is very severe, add Xiejian and Du Zhong to nourish the kidneys and stop lumbago; if the nocturnal urination is frequent, add Jiji Ren and Jinzhu Zi to consolidate the kidneys and reduce stool.
Second, blood heat type
(A) Yin deficiency blood heat evidence
Main symptoms: early menstruation, low volume, red and thick, red cheek and lips, hot hands and feet, dry throat and dry mouth, red tongue, little coating, thin pulse.
Analysis of the symptoms: Yin deficiency, internal heat, heat disturbs the ramus, the ramus is not fixed, so the menstruation is early; Yin deficiency, blood deficiency, the ramus is insufficient, the sea of blood is full and overflowing, so the menstrual blood is low; blood is hot, so the menstruation is red and thick; deficiency heat floats, so the cheek is red and the lips are red; Yin deficiency, so the hands and feet are hot; Yin deficiency, less fluid, so the throat is dry. The red tongue with little coating and thin pulse is also a sign of Yin deficiency and blood heat.
Treatment: Nourishing Yin and clearing heat, cooling the Blood and regulating menstruation.
Example of formula: Two Earths Soup (Fu Qingzheng masters of female medicine).
Radix Rehmanniae Praeparata, Radix et Rhizoma Ginseng, Radix et Rhizoma Dioscoreae, Radix Macrocephalae, Radix Aconiti, Radix Paeoniae Alba
The whole formula works together to nourish Yin and clear heat, cool the blood and regulate menstruation.
If the menstrual flow is low, add Yam, Fructus Lycii, Radix et Rhizoma Polygoni to nourish the kidneys to produce essence and blood; if the heart of the hands and feet is hot, add Bai Wei and Turtle Board to clear deficiency heat.
(B) Yang and blood heat evidence
Main symptoms: early menstruation, high volume, purple-red color, thick texture, heart and chest boredom, thirst for cold drinks, dry stools, short and red urine, red face, red tongue, yellow fur, smooth pulse.
Analysis of the symptoms: Heat injures the flushing, forcing the blood to move delicately, so the menstruation is early and abundant; blood is burned by heat, so the menstruation is purple-red and thick; heat disturbs the heart and liver meridians, so the heart and chest are troubled; heat hurts the fluids, so thirst for cold drinks; the large intestine has little fluids, so the ambassador is dry; heat burns the bladder, so the urine is short and red. Red face, red tongue, yellow coating, and slippery pulse are signs of heat.
Treatment: Clearing heat and lowering fire, cooling blood and regulating menstruation.
Examples of prescriptions: Clearing the menstrual flow (Fu Qingzhu Women).
Danpi, Dioscorea, Bai Shao, Shu Di, Artemisia, Huang Bai, Fu Ling
In this formula, Huang Bai, Artemisia annua and Dang Pi clear heat and cool the blood; Shu Di and Di Bone Pi clear blood heat and generate water; Bai Shao nourishes blood and astringes yin; Fu Ling moves water and drains heat. The whole formula to clear heat and fire, cool the blood and nourish yin, so that the heat is not injured yin, blood and regulate since.
If excessive menstruation, Poria, discretionary addition of ground elm, celandine root to cool the blood to stop bleeding; if the menstrual abdominal pain, menstrual blood clots, discretionary addition of fried Pu Huang, San Qi to stop bleeding.
(C) Liver stagnation and heat
Main symptoms: early menstruation, high or low volume, purple-red menstruation, thick and lumpy, premenstrual pain in the breast, chest and abdomen, irritability, dry mouth, red tongue, yellow fur, and string veins.
Analysis of symptoms: Liver stagnation turns into heat, heat disturbs the flushing, forcing the blood to move, so the menstruation is early; liver depression and blood disorders, so the menstruation is heavy or light; blood is burned by heat, so the menstruation is purple-red, thick and lumpy; qi stagnation in the liver meridian, so the premenstrual breast, chest and abdomen are distended and painful; qi is not smooth, then irritability and anger; heat in the liver meridian, so the mouth is bitter and dry. The tongue is red, the coating is yellow, and the pulse is stringy, which is a sign of liver stagnation and heat.
Treatment: Clearing the liver and relieving depression, cooling the blood and regulating menstruation.
Example of prescription: Dan Gardenia Easy-going San (“Summary of Female Medicine”).
Dampi, fried gardenia, angelica, white peony, Chai Hu, poria, roasted licorice
In this formula, Chai Hu, Gardenia, Dampi detoxify the liver and cool the blood; Angelica, White Peony nourish the blood and soften the liver; Atractylodes, Poria and Roasted Licorice cultivate the spleen and the middle. The whole formula works together to clear the liver and relieve depression, cool the blood and regulate menstruation.
If excessive menstruation, menstruation to remove angelica, discretion to add oyster, cyperus, fried elm to fix the flushing and stop bleeding; menstruation is not smooth, with blood clots, discretion to add zelenium, motherwort to activate blood stasis; menstruation breast swelling pain is very much, discretion to add guadua, Wang Bu Liu Xing, yujin to relieve depression, stagnation and pain.
Section 3: Late menstruation
If the menstrual cycle is wrong for more than 7 days, or even for 3-5 months, and the period is normal, it is called “late menstruation”, also called “wrong period”, “late menstruation”.
This disease is equivalent to the Western medicine of menstrual scarcity. If the late menstruation is accompanied by low menstrual flow, it can often develop into amenorrhea.