integrative woman’s health program€¦ · menstrual irregularities 经不调 . overview...
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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.