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Integrative Woman’s Health Program DAOSHING NI

Early Menstruation ⽉月经先期 MENSTRUAL IRREGULARITIES ⽉月经不调

Overview Menstrual Disorders  Fiveareasofchanges◦ Cyclevaria2ons◦  Inter-menstrualsymptoms◦  Premenstrual,Postmenstrual,Midcycle

◦ Flowamount

◦ Flowcolor◦ Flowquality

Overview Menstrual Irregularities  QiDeficiency BloodDeficiency YinDeficiency KidneyDeficiency SpleenQiDeficiency QiStasis BloodStagna2on HeatintheBlood ColdintheBlood PhlegmDamp–SpleenYangDeficiency

Etiology and Pathology

6 7 F S SP

WeakeningorinjuringtheQiofZang

IrregularFunc2onsoftheZang

Fu

Produc2onandFlowof

QiandBlood

BecomesIrregular

ChongRenChannelInjuries

MenstrualIrregularies

Differentiation of Syndromes  FourDiagnosis◦ Visual–Face,Tongue,VaginalDischarge,Clots,Skin,Veins◦ Ausculta2onandOlfac2on–voice,abdominalsounds,vaginalsmell,bodysmell,throatsmell◦ Palpa2on–Pulse,abdomen◦  Inquiry–medicalhistory,currentandpast

 EightPrinciples◦ Yin/Yang◦ Biao/Li◦ Han/Re◦ Xu/Shi

Treatment Principles

TonifyKidney

StrengthenSpleen

PacifyLiver

RegulateQiXue

Tonify Kidney  ReplenishEssenceandBlood SupportwithAssis2ngYang

Tonify Kidney

Menstrua2onRegulates

YangGlowYinPlenty

SupportwithAssis2ngYang

ReplenishEssenceand

Blood

Strengthen Spleen

Menstrua2onRegulates

AvoidsOverlyPungentGreasy

StrengthenSpleenRaise

Yang

SourceofBlood

Pacify Liver

Menstrua2onRegulates

AvoidConsump2onofLiverBlood

AvoidConsump2onofBFandYin

AvoidOverlyPungentand

Drying

CirculateLiverQi

Regulate Qi Xue REGULATEQI

 MainFocusonQi◦ TonifyQi◦ CirculateQi

 SupportFocusonXue

REGULATEBLOOD

 MainFocusonXue◦ NourishXue◦ CirculateXue

 SupportFocusonQi

Background Focus Besidesthemaintreatmentprinciple,TonifyKidneyandStrengthentheSpleenshouldalwaysbeinthebackground

Caution  Menstrua2oncondi2onsarefrequentlyaffectedbytheovula2onprocess.Itisimportanttoalwaysinferpossiblemenstrualproblemstoovula2on.

 Menstrualirregulari2escanbecausedbyothercondi2ons.Frequentlytreatmentofothercondi2onscansolvemenstrualirregulari2esproblems.

 Itisimportanttosolveacuteproblemsfirstsuchasabnormalheavyuterinebleedingsbeforeembarkingonregula2ngcycles.

Early Menstruation

Case #1 Early Menstruation Dr. Zhu, Nan Sun 朱南孫  32YO,single;visitdate3/11 CC:earlymenstrua2onwithdysmenorrhea8years

 Menarcheat13,mostofthe2me,periodsareregular5/26-30,moderateamountbutwithcramps.Age19joinedtrackclubrunningmarathons,periodsbecame20-daycycles,amountandpainnochange,LastAugust,shehadtwoperiodsinonemonth,frequentfa2gue,premenstrualbreastdistendingpain,acne,restlessness,LMP3/19,PMP2/11,BBTbiphasic,poorsleep,drystools,pulsewiryrapid,tongue2pred,coa2ngyellowgreasy.

Overview and Definition  Earlymenstrua2onreferstowhenmenstrua2onis7ormoredaysearlythanusualperiodcycleandoccurredfortwoormoreconsecu2vecycles

 ClassicalTexts◦ JinKuiYaoLue金匱要略–descrip2onoftreatmentofearlymenstrua2onduetostagnantblood

◦ JingYueQuanShu景岳全書–QideficiencylosingcontrolcanbeoneofthecauseofEarlyMenstrua2on

What are the known causes?  Youngage Emergencymorningaherpillusage

 BCPuse IUD

 STD

 Suddenlossorgainofweight

 Stress PCOS

 Miscarriages

 Implanta2onBleeding

 TimeZoneChangeTravels

 Aging OtherovarianandUterineIssues

Etiologies  QiDeficiency HeatintheBlood

Etiology Qi Deficiencies

InjuringSpleenQiOverstrainingorExcessiveWorries

Cons2tu2onalWeaknessorPoorDiet

DamagingKidneyExcessiveLaborandSexKidneyQiDeficient

Etiology Heat in the Blood

Hyperac2vityofYangHeatintheBlood

ExcessiveIntakeofPungentFood

Hyperac2vityofYangwithExogenousAiack

ChronicStasisTurnstoFire–HeatintheBloodLiverQiStasisChronicEmo2onal

Depression

DeficiencyHeatHeatintheBlood

DamageYinConsump2onofBloodYinDeficiency

Pathology MiddleQiDeficiency

KidneyQiDeficiency

Hyperac2vityofYang-HB

DeficientHeat-HB

LiverStasis-HB

LosingHoldingControl

LosingStorageControl

HeatDamagesChongRen

HeatHiddenInChongRen

ChongRenLosingHoldingControl

UnseilingofSeaofBlood

EarlyMenstrua2on

Etiologies Summary

HeatPathogen

(Exogenous)

Cons2tu2onalTendencies

Emo2onalFactor

(Endogenous)

Nutri2onalFactor(Other)

QiDeficiencyLossofControl

Chong/RenDysfunc2on

HeatintheBloodHeathidesinChong/

RenInjuringZigong

Diagnosis and Differentiation  MainSymptom:menstrua2onis7ormoredaysearlythanusualperiodcycleandoccurredfortwoormoreconsecu2vecycles.

 MinorSymptom:Theremaybechangesinmenstrualflowamount.

Diagnosis and DS  PelvicExam:Normal

 MayhavehistoryofPID

 EarlyLutealPhase:follicular2menochangewhilelutealphasehasshortened.(lutealphasedefect–BBT,EndoBiopsy)

 EarlyOvulatoryPhase:follicular2meshortenedwhilelutealphasenochange.(BBT,TVS,CD2-3E2)

 EarlyOvula2on/LutealPhase:bothfollicular/lutealphaseshaveshortened.(BBT,TVS,CD2-3E2,EndoBiopsy)

Normal BBT

Abnormal BBT

Endometrial Biopsy

Hormonal Cycle

DifDiag: Early Menstruation vs. Inter-menstrual Bleeding

EarlyMenstrua-on Inter-menstrualBleeding(OvulatoryBleeding)

Sharedsymptoms Bleeding7ormoredaysearlier

BleedingaroundCD12-CD16

Differen2atedsymptoms Shortercyclebutquality,amount,anddaysofflowarebasicallythesameasusual

Bleedingamountmuchless,andshorterindays(2-3days)

Differentiation of Syndromes (DS) – Table 1

SyndromesMenstrualCharacteris-cs

Quan2ty Color Quality Cycle

QiDeficiency

SPQiDef More lighter thin early

KIQiDef Moreorless lighter thin early

HeatintheBlood

HyperYang More brighter S2ckythick early

YinDef Less>More normal thick early

LiverStasisMoreorLess brighter

thickclots early

DS – Table 2 Syndromes BodySymptoms

TongueandPulse

Tongue Pulse

QiDeficiency

SPQiDefFa2gue,dyspnea,weakvoice,pelvicprolapsefeeling,poor

appe2te,loosestoolsthin

Threadyweak

KIQiDefVer2go,2nnitus,lumbago,dark

facewithdarkspots thinDeep

thready

HeatintheBlood

HyperYangRestless,thirst,redface,cons2pa2on,yellowurine

S2ckythick

Rapidorslipperyrapid

YinDefFlushedface,palms-solesheat,

drythroatandmouth thickThreadyrapid

LiverStasis

Chestorhypochondriacorbreast,orpelvicdisten2on,restlessness,irritability,biiermouth,dry

throat

thickclots Wiryrapid

Treatment Principles (TP) Syndromes TP

SpleenQiDeficiency TonifySpleenQi

KidneyQiDeficiency TonifyKidneyQi

Heart-SpleenDeficiency NourishHeartandSpleen

Spleen-KidneyDeficiency TonifySpleenandKidney

Hyperac2vityofYangHB ClearHeatandCoolsBlood

YinDeficiencyHB NourishYinandClearHeat

LiverStasisHB PacifyLiverandClearHeat

HB–HeatintheBlood

Herbal Therapies Syndromes Formula-on Herbs

SpleenQiDef BuZhongYiQiTang補中益氣湯

RenShen,HuangQi,GanCao,DangGui,ChenPiShengMa,ChaiHu,BaiZhu

KidneyQiDef GuYinJian固陰煎

TuSiZi,ShuDi,ShanZhuYu,RenShen,ShanYao,ZhiGanCao,WuWeiZi,YuanZhi

Hyperac2vityofYangHB

QingJingSan清經散

DanPi,DiGuPi,BaiShao,ShuDi,QingHao,HuangBo,FuLing

YinDeficiencyHB LiangDiTang兩地湯

ShengDi,DiGuPi,XuanShen,MaiDong,AJiao,BaiShao

LiverStasisHB DanZhiXiaoYaoSan丹梔逍遙散

DanPi,ShanZhiZi,ChaiHu,DangGui,BaiShao,BaiZhu,FuLing,ShengJiang,GanCao,BoHe

Spleen Qi Deficiency Bu Zhong Yi Qi Tang  補中益氣湯

 RenShen,HuangQi,GanCao,DangGui,ChenPiShengMa,ChaiHu,BaiZhu

 Duringmenstrua2onwithheavybleeding,getridofDangGuiandaddappropriateamountofLongGu,MuLitocontrolbleeding.

Kidney Qi Deficiency Gu Yin Jian  固陰煎

 TuSiZi,ShuDi,ShanZhuYu,RenShen,ShanYao,ZhiGanCao,WuWeiZi,YuanZhi

 HeavybleedingaddShanZhuYuandPaoJiang.

Hyperactivity of Yang HB Qing Jing San  清經散

 DanPi,DiGuPi,BaiShao,ShuDi,QingHao,HuangBo,FuLing

 Heavybleeding–ridofFuLing,addDiYuandQianCao

Yin Deficiency Liang Di Tang  兩地湯

 ShengDi,DiGuPi,XuanShen,MaiDong,AJiao,BaiShao

 Heavybleeding–addNuZhenZi,HanLianCao,DiYu

Liver Stasis HB Dan Zhi Xiao Yao San  丹梔逍遙散

 Heavybleeding–ridofDangGui,addQianCao,DiYu,MuLi

Acupuncture Treatments Early Menstruation

Syndromes Formula-on Procedure

SpleenQiDef ST36,SP6,CV6,CV4,BL20

Tonifica2onMethodorwithMoxa

KidneyQiDef BL23,CV4,CV3,KI10,KI3

Tonifica2onMethodorwithMoxa

Hyperac2vityofYangHB

LI11,CV3,SP10,KI5,

Seda2onMethodandNOMoxa

YinDeficiencyHB KI2,KI6,LR8,SP6

Tonifica2onMethodandNoMoxa

LiverStasisHB SP8,SP10,SP6,LR2,BL18

Seda2onMethodandNOMoxa

AuricularAcupuncture

Ovary,Endocrine,Uterus

EmbeddingorNeedle

Case #1 Early Menstruation Dr. Zhu, Nan Sun 朱南孫  32YO,single;visitdate3/11 CC:earlymenstrua2onwithdysmenorrhea8years

 Menarcheat13,mostofthe2me,periodsareregular5/26-30,moderateamountbutwithcramps.Age19joinedtrackclubrunningmarathons,periodsbecame20-daycycles,amountandpainnochange,LastAugust,shehadtwoperiodsinonemonth,frequentfa2gue,premenstrualbreastdistendingpain,acne,restlessness,LMP3/11,PMP2/19,BBTbiphasic,poorsleep,drystools,pulsewiryrapid,tongue2pred,coa2ngyellowgreasy.

Case #1 Early Menstruation Dr. Zhu, Nan Sun 朱南孫  EarlyMenstrua2on,Dysmenorrhea

 LiverHeat,KidneyDeficiency,ChongRenRegula2onfunc2onweak,YinBloodconsump2on,LiverHeatincreases,thereforepremenstrualbreastdistendingpain,restlessness,drystools,pulsewiryrapid,etc.

 ClearLiver,BenefitKidney,RegularChongRen

 ShengDi15,HuangQin6,ZhiMu12,DiGuPi12,HuangQi15,ChuanDuan12,DuZhong12,SangJiSheng12,ZhuMaGen20,SangBiaoXiao12,YiYiRen15,BaiZhu9

 12bags,onebagdaily

Case #1 Early Menstruation Dr. Zhu, Nan Sun 朱南孫  SecondVisit3/25,CD15 Occasionalirritability,acne,drystools,frequenturina2on,pulsethinwiry,tongueslightlyred,coa2ngyellowgrreasy,

 ShengDi15,BaiShao12,HuangQin6,ZhiMu12,QingHao9,DiGuPi12,SangJiSheng12,ZhuMaGen20,SangBiaoXiao12,JinYingZi12,ChaiHu6,YanHuShuo6.10bags,onebagdaily

Case #1 Early Menstruation Dr. Zhu, Nan Sun 朱南孫  ThirdVisit4/15,LMP4/4(24)

 Prolapsefeelingofexternalgenitalia,nodysmenorrhea,regularirritability,swea2ng,recentbreasttendernessfortwodays,drymouth,appe2tegood,pulsethinwiry,tongueslightlyred,coa2ngyellowgreasy

 ShengDi15,BaiShao12,NvZhenZi12,HanLianCao12,XiaKuCao15,XuDuan12,SangJiSheng12,ZhuMaGen20,SangBiaoXiao12,YinHua9,GanCao6.12bags,onebagdaily

Dr. Zhu, Nan Sun 朱南孫  1921- ProfessoratShanghaiUniversityofTCM,thirdgenera2onprac22oner.

 Grandfather–Zhu,NanShan

 Father–Zhu,XiaoNan

 Focus–YiGuiarethesamesource,乙癸同源.