Integrative Woman’s Health Program DAOSHING NI

Delayed Menstruation ⽉月经后期 MENSTRUAL IRREGULARITIES ⽉月经不调

Case #2 Delayed Menstruation Dr. Wang Zi Yu 王子瑜  29YO,FirstVisit11-25-2005 DelayedMenstrua:onfor14years,Married/TGP2Years

 153-5/32-60,Clomipheneuseforthreecycleswithoutpregnancy,LMP11/11-11/16,moderateamount,brightredflow,clots,nopain,nobreasttenderness,tonguedarkred,coa:ngyellowgreasyinthemiddle,pulsethinwiry,pelvicexamnormal,exceptuterusissmall

Overview and Definition  Delayedmenstrua:onreferstowhenmenstrua:onis7ormoredayslaterthanusualperiodcycleandoccurredfortwoormoreconsecu:vecycles.Some:mesmenstrua:oncanbedelayeduptosixmonths.

 ClassicalTexts◦ JinKuiYaoLue金匱要略–firstdefinedthecondi:onofDelayedMenstrua:on◦ JingYueQuanShu景岳全書(Chapter38)–Descrip:onofe:ologyandtreatmentofHBcausingdelayedmenstrua:on◦ NuKeQieYao女科切要–e:ologiesofdelayedmenstrua:onasBlooddeficiency,ColdnessintheBlood,andStasis.

What are the known causes of Delayed Menstruation  Pregnancy Stress

 MajorWeightLossorExcessiveExercise

 ThyroidIrregularity

 PCOS

 BCPusage

 ChronicIllnesses◦ CeliacDisease

 PrematureMenopause

Etiologies  KidneyDeficiency BloodDeficiency

 DeficientColdness ExcessColdness

 QiStasis

Etiology Deficiencies

KidneyQi,Blood,EssenceDeficient

Overstraining/PregnancyDamagingtheKidneyKidneyQiDeficiency

ZFnotwarmed,transforma:onweakens,Qi/Xuebecomes

deficient

ChronicIllnessdamagingtheYangCons:tu:onalYangDeficiency

YinBloodDeficiencyDiseaseorPregnancyCausingLossofBlood

SpleenDeficiencyLackofTransforma:on

Etiology Excess

BloodFlownotSmoothandDelayed

ColdPathogenStagnatesBlood

ExogenousColdInvasion,ExcessiveIntakeofColdFoods

BloodFlownotSmoothandDelayed

StagnantQiCausesStagnancyinBlood

ChronicDepressionandExcessiveWorrying

Pathology Kidney

Deficiency

QiStasis

ColdnessintheBlood

BloodDeficiency

Insufficiencyof

EssenceandBlood

DeficientCold

ExcessCold

CannotNourish

Chong-Ren

ChongRenBlockages

DelayedBloodFlow

DelayedMenstrua:o

n

SeaofBloodisnotfullon

:me

Etiology and Pathology Summary

ColdPathogen(exogenou

s)

Emo:onalFactors

(endogenous)

Nutri:onalFactor

Cons:tu:onal

Tendencies(endogenou

s)

KidneyDeficiency

BloodDeficiency

DeficientCold

ExcessCold

QiStasis

InsufficientEssenceand

BloodInsufficientChong-RenSeaofBlood

DoesnotFillon:me

BloodFlowStagnatesChong-RenBlocked

Diagnosis and Differentiation  MainSymptom:menstrua:onis7ormoredaysdelayedthanusualperiodcycleandoccurredfortwoormoreconsecu:vecycles.

 MinorSymptom:Theremaybechangesinmenstrualflowamount.

Diagnosis and DS  PelvicExam:Normaloruterusmightappearedtobesmaller

 BBT:◦ ScenarioOne:ovula:on14daysbeforemenstrua:on◦ ScenarioTwo:ovula:ononCD14andlutealphaseelongated◦ ScenarioThree:monophasicthroughout

Differential Diagnosis DelayedMenstrua.on

EarlyPregnancy PregnancyBleeding

CommonSymptom

DelayedMenstrua:on

DelayedMenstrua:on

DelayedMenstrua:on

Differen:a:on Delayedmenstrua:on7daysofmore,2ormorecycles

EarlypregnancysignsandsymptomssuchasurinehCG(+),enlargeduterus,pigmenta:onchangeofcervix,presenceofsacinuterusviaultrasound

Regularmenstrualcyclehistory,urinehCG(+),abdominalpains,bleedingorspojng

Differentiation in Syndromes

Condi.ons Symptoms

KidneyDeficiency Delayedscantymenstrua:on,colordarkandpale,thinviscosity,soreback,andweakknee

BloodDeficiency Delayedscantymenstrua:on,colorpaleandthin,ver:goandpalpita:on

DeficientCold Delayedscantymenstrua:on,colorpaleandthin,abdominalintermikentpain,desireswarmthandaversiontocold

ExcessCold Delayedscantymenstrua:on,colordarkorwithclots,abdominalcoldpainaversiontopressure

QiStasis Delayedscantymenstrua:onornormalmenstrualflow,darkredcolororwithclots,abdominaldisten:onwithpain

Treatment Principle  Tonifywhatisdeficient,Sedatewhatisexcess.(虛者補之，實者瀉之)

 DeficiencySyndromes–tonifykidneynourishbloodorwarmupchannelsandnourishblood.

 ExcessSyndromes–circulateQiandrelievestagna:on

 Combinedsyndromes–differen:ateforprimary/secondaryandtreatbothatthesame:me.

 CarefulnottousestrongpungentdryingherbsorbloodbreakingherbsespeciallyforDeficientColdsyndromes

Five Syndromes  KidneyDeficiency BloodDeficiency

 ColdnessinBlood–DeficientCold ColdnessinBlood–ExcessCold

 QiStasis

Kidney Deficiency  Delayedmenstrua:on,scantyflow,darkorpaleflow,thinflow,vaginaldischargeclearthin,soreback,weakknees,dizziness,:nnitus,darkfacialcomplexion,orwithdarkspots,tonguepale,coa:ngthinwhite,pulsedeepthready.

 TonifyKidneyNourishBloodRegulateMenstrua:on

 DangGuiDiHuangYin當歸地黃飲

Kidney Deficiency Dang Gui Di Huang Yin 當歸地黃飲  DangGui6-9g,ShuDi9-15g,ShanYao6g,DuZhong6g,NiuXi4.5g,ShanZhuYu3g,ZhiGanCao2.4.

 KidneyDeficiencyLowerBackPains CompleteWorksofJingYue(JingYueQuanShu景岳全書)

 LowerJiaoDeficientCold,addRouGui3-6g,Strongdeficientcold,addFuZi;turbidleukorrhea,addJinYingZi6gorPoGuZhi3g.IfQideficient,addRenShen3-6g,GouQiZi6-9.

Blood Deficiency  Delayedmenstrua:on,scantyflow,palered,flowthin,pelvicintermikentache,orver:go,palpita:on,lackofsleep,paleface,sallowface,tonguepale,pulsethinweak.

 TonifyBloodandQi,RegulateMenstrua:on.

 DaBuYuanJian大補元煎

Blood Deficiency Da Bu Yuan Jian 大補元煎  RenShen,ShanYao,ShuDi,DuZhong,DangGui,ShanZhuYu,GouQiZi,ZhiGanCao. Iflackofappe:te,loosestools,indiges:on,addBaiZhu,BianDou,ShaRen.

Cold Blood – Deficient Cold  Delayedmenstrua:on,scantyflow,paleredorwatery,thinflow,abdominalache,likeswarmthandpressureonabdomen,soreback,fa:gue,longclearurina:on,loosstools,tonguepale,coa:ngthinwhite,pulsedelayeddeeporthinweak.

 AssistYangDisperseColdRegulateMenstrua:on

 《JinKui》WenJingTang金匱溫經湯

Cold Blood – Deficient Cold Jin Kui Wen Jing Tang 金匱溫經湯  WuZhuYu,DangGui,BaiShao,ChuanXiong,GuiZhi,ShengJiang,DanPi,BanXia,MaiDong,RenShen,AJiao,GanCao.

 吳茱萸，當歸，白芍，川芎，川芎，桂枝，生薑，丹皮，半夏，麥冬，人參，阿膠，甘草。

 Strongercoldpainandaversiontocold,addBuGuZhi,BaJiTian,XianLingPi.

Cold Blood – Excess Cold  Delayedmenstrua:on,scantyflow,darkflow,clots,pelviccoldpainaversiontopressurebutbekerwithwarmth,aversiontocold,coldextremi:es,bluishwhitefacialcomplexion,tonguedarkpale,coa:ngwhite,pulsedeep:ght.

 Warmupchannel,dispersecold,regulatemenstrua:on.

 <LiangFang>WenJingTang良方溫經湯

Cold Blood – Excess Cold <Liang Fang> Wen Jing Tang 良方溫經湯  DangGui,ChuanXiong,BaiShao,GuiZhi,DanPi,ErZhu,RenShen,GanCao,NiuXi. Ifexcessivemenstrualflow,ridofErZhu,NiuXi,addPaoJiang,AiYe.

Qi Stasis  Delayedmenstrua:on,scantyornormalamountofflow,deepredflow,withsomemoderateclots,pelvicdistendingpain,depressiveeffect,premenstrualbreasttenderandpain,tonguepinkorred,coa:ngthinwhiteorthinyellow,pulsewiryorwiryrapid.

 CirculateQi,relievestasis,regulatemenstrua:on.

 WuYaoTang烏藥湯

Wu Yao Tang 烏藥湯  WuYao,XiangFu,MuXiang,DangGui,GanCao.

 Scantyflowwithclots,addChuanXiong,DanShen.

Condi.on HerbalFormula.on Herbs

KidneyDeficiency

DangGuiDiHuangYin當歸地黃飲

DangGui6-9g,ShuDi9-15g,ShanYao6g,DuZhong6g,NiuXi4.5g,ShanZhuYu3g,ZhiGanCao2.4.當歸，熟地，山藥，杜仲，牛膝，山茱萸，炙甘草

BloodDeficiency

DaBuYuanJian大補元煎

RenShen,ShanYao,ShuDi,DuZhong,DangGui,ShanZhuYu,GouQiZi,ZhiGanCao.人參，山藥，熟地，杜仲，當歸，山茱萸，枸杞子，炙甘草。

DeficientCold

JinKuiWenJingTang金匱溫經湯

WuZhuYu,DangGui,BaiShao,ChuanXiong,GuiZhi,ShengJiang,DanPi,BanXia,MaiDong,RenShen,AJiao,GanCao.吳茱萸，當歸，白芍，川芎，川芎，桂枝，生薑，丹皮，半夏，麥冬，人參，阿膠，甘草。

ExcessCold <LiangFang>WenJingTang良方溫經湯

DangGui,ChuanXiong,BaiShao,GuiZhi,DanPi,EZhu,RenShen,GanCao,NiuXi.當歸，川芎，白芍，桂枝，丹皮，莪朮，人參，甘草，牛膝。

QiStasis WuYaoTang烏藥湯

WuYao,XiangFu,MuXiang,DangGui,GanCao.烏藥，香附，木香，當歸，甘草。

Acupuncture Treatments Delayed Menstruation

Syndromes Formula.on Procedure

KidneyDeficiency BL23,GV4,KI3,CV4,ST36,SP6

Tonifica:onMethodorwithMoxa

BloodDeficiency CV6,CV4,ST29,CV3,SP6,ST36

Tonifica:onMethodorwithMoxa

ColdBlood–DeficientCold

CV4,CV6,ST29,SP8,SP6,ST36,BL32,ST25.

Tonifica:onMethodorwithMoxa

ColdBlood–ExcessCold

Seda:onMethodorwithMoxa

QiStasis SP4,PC6,LR3,SP6,SP8,SP10

Seda:onMethodandNOMoxa

Auricular Ovary,Uterus,Kidney,Endocrine

EmbeddingorNeedle

Case #2 Delayed Menstruation Dr. Wang Zi Yu 王子瑜  29YO,FirstVisit11-25-2005 DelayedMenstrua:onfor14years,Married/TGP2Years

 153-5/32-60,Clomipheneuseforthreecycleswithoutpregnancy,LMP11/11-11/16,moderateamount,brightredflow,clots,nopain,nobreasttenderness,tonguedarkred,coa:ngyellowgreasyinthemiddle,pulsethinwiry,pelvicexamnormal,exceptuterusissmall

Case #2 Delayed Menstruation Dr. Wang Zi Yu 王子瑜  KidneyDeficiencyDelayedMenstrua:onPrimaryInfer:lity

 TonifyKidneyNourishBlood,ReplenishEssence,FacilitatePregnancy,usemodifiedSiWuTang

 DangGui10,ShengDi15,ShuDi15,ChiShao10,BaiShao10,ChuanXiong10,XuDuan15,TuSiZi30,BaJiTian10,ZiHeChe10,ZiShiYing15,AiYe3,ShanYao15,ShouWu15,RouGui10

 7bags,onebagdaily;7visitswithminormodifica:onweekly,pregnancyachieved.

Dr. Wang Zi Yu 王子瑜  1921- ChiefTCMPhysician,OBGYNdepartment,DongZhiMenHospital,BeijingUniversityofTCMaffiliatedhospital.

 ReputableforMenopause,dysmenorrhea,endometriosis

Integrative Woman’s Health Program DAOSHING NI

Irregular Menstrual Cycle ⽉月经先后不定期 MENSTRUAL IRREGULARITIES ⽉月经不调

Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之  32YO,8-1-1990FirstVisit IrregularMenstrualCyclesforseveralyears

 Irregularmenstrualcycles,dizziness,restlessness,poorsleep,pelviccoldtothetouch,leukorrhea,soreback,chestGghtness,hypochondriacGghtness,hasusedChineseherbsfocusedonPacifyingLiverAcGvateBloodwithnoreliefbutfurtheraggravaGonofsymptoms,pulsewiry,leMCunsmall,rightChideep,pulsepale,coaGngwhite.

Definition  MenstruaGonoccurseitherearlierorlaterthan7daysforthreeconsecuGvecycles.

 <CompleteBookofJingYue(JingYueQuanShu景岳全書)>“DerangedMenstruaGon”

 <DrFuQingZhu’sGynecology(FuQingZhuNvKe傅青主女科)>IrregularMenstruaGonisduetoliverkidneystagnaGonandshoulduseDingJingTang定經湯tosootheLiverandKidneyQi,totonifyLiverandKidneyEssence.

What are the known causes of Irregular Menstrual Cycles?  Adolescence Uncontrolleddiabetes EaGngdisorders Hyperthyroidismorhypothyroidism

 HyperprolacGnemia(anabnormallyhighconcentraGoninthebloodofprolacGn,aproteinhormone)

 MedicaGons,suchasanGepilepGcsoranGpsychoGcs

 Perimenopauseorprematureovarianfailure

 PolycysGcovarysyndrome(PCOS)

 Pregnancy StressandTravel

Etiology Irregular Menstrual Cycle

EmoGonalstagnaGon,angerinjuringtheLiver DerangedLiverQi

PatencyflowdysfuncGon

causingSeaofBlooddysfuncGon

KidneyQiinsufficiency,chronicillnessinjuringtheKidney WeakenedKidneyQi

DysfuncGonofregulaGonofChong-RencausingSeaofBlooddysfuncGon

Pathology Irregular Menstrual Cycle

LiverStasis

KidneyDeficiency

DysfuncGoninPatency

Flow

DysfuncGoninStorage

andDischarge

Chong-RenIrregular

SeaofBloodStorageandDischargeDysfuncGon

IrregularMenstrualCycle

EmoGonalFactors ConsGtuGonalFactors

Diagnosis  Irregularmenstrualcycledelayorearlygreaterthan7daysandconsecuGve3cyclesormore.Menstrualflowcanbenormalamount,uteruscanbenormalsizedorslightlysmaller.

Differentiation of Syndrome Syndromes Symptoms

LiverStasis QuanGtymoreorless,darkflow,orwithclots,abdominaldistenGon,chestdistenGon,pulsewiry

KidneyDeficiency QuanGtyless,paleflow,minimalclots,lowerbacksoreness,tonguepale,pulsethinandweak

LiverStasisKidneyDeficiency QuanGtymoreorless,darkorpaleflow,orwithclots,abdominaldistenGon,chestdistenGon,lowerbackpain,pulsewiryandthin

Treatment Principle  LiverStasis–CirculateQiPacifyLiverRegulateMenstruaGon

 KidneyDeficiency–TonifyKidneyRegulateMenstruaGon

 LiverStasisKidneyDeficiency–PacifyLiver,TonifyKidney,RegulateMenstruaGon

Herbal Treatments Liver Stasis  Irregularmenstrualcycle,quanGtymoreorless,colordarkredorpurplered,orwithclots,orsluggishmenstrualflow,chest,breasts,pelvicdistensions,sighing,belching,poorappeGte,tonguecoaGngthinwhiteorthinyellow,pulsewiry.

 Angerinjuringliver,patencyflowdysfuncGon,seaofblooddysfuncGon

 PacifyLiverRegulateQiRegulateMenstruaGon

 XiaoYaoSan逍遙散

Xiao Yao San 逍遙散  ChaiHu,DangGui,BaiShao,BaiZhu,FuLing,BoHe,ShengJiang 柴胡，當歸，白芍，白朮，茯苓，薄荷，生薑。

 Menstrualdistendingpainwithclots,addDanShen,YiMuCao,XiangFu,YuanHu.

Herbal Treatment Kidney Deficiency  Irregularmenstrualcycle,scantyflow,colorpaleordark,viscositythin,lowerbackache,weakknees,dizziness,Gnnitus,tonguepale,coaGngwhite,pulsethinandweak.

 KidneyQiDeficiency,dysfuncGoninstorage,ChongRenirregularity,seaofblooddysfuncGoninstoringanddischarging.

 TonifyKidneyandregulatemenstruaGon

 GuYinJian固陰煎

Gu Yin Jian 固陰煎  TuSiZi,ShuDiShanZhuYu,RenShen,ShanYao,ZhiGanCao,WuWeiZi,YuanZhi.

 菟絲子，熟地， 山茱萸，人參，山藥，炙甘草，五味子，遠志。

 AddDuZhongandXuDuanforlowerbackpains.

Herbal Treatment Liver Stasis Kidney Deficiency  Irregularmenstrualcycle,quanGtymoreorless,colordarkredorpalered,orwithclots,menstrualbreastdistedningpain,lowerbackpain,soreknee,faGgue,tonguepale,coaGngwhite,pulsewirythin.

 AngerorstagnancyinjuringtheLiver,dysfuncGoninpatencyflow,KidneyQiweakened,storagedysfuncGon,ChongRenirregular.

 TonifyKidneyPacifyLiverRegulateMenstruaGon

 DingJingTang定經湯

Ding Jing Tang 定經湯  ChaiDu,JingJie,DangGui,BaiShao,ShanYao,FuLing,TuSiZi,ShuDi

 柴胡，荊芥，當歸，白芍，山藥，茯苓，菟絲子，熟地。

 Excessiveleukorrhea,addLuJiaoShuang,JinYingZi.

Other Guidance  FocusonemoGonalmanagement

 Focusonstressmanagement

 Focusonsleephygiene FocusonGmezonechangetravel

Herbal Review

Syndromes HerbalFormula3on Herbs

LiverStasis XiaoYaoSan逍遙散 ChaiHu,DangGui,BaiShao,BaiZhu,FuLing,BoHe,ShengJiang柴胡，當歸，白芍，白朮，茯苓，薄荷，生薑。

KidneyDeficiency GuYinJian固陰煎 TuSiZi,ShuDiShanZhuYu,RenShen,ShanYao,ZhiGanCao,WuWeiZi,YuanZhi.菟絲子，熟地， 山茱萸，人參，山藥，炙甘草，五味子，遠志。

LiverStasisKidneyDeficiency

DingJingTang定經湯 ChaiDu,JingJie,DangGui,BaiShao,ShanYao,FuLing,TuSiZi,ShuDi柴胡，荊芥，當歸，白芍，山藥，茯苓，菟絲子，熟地。

Acupuncture Treatments Irregular Menstrual Cycle

Syndromes Formula3on Procedure

LiverStasis BL18,LR14,CV3,LR3,SP6

SedaGonMethod

KidneyDeficiency

CV6,SP6,BL23,BL20,ST36,KI8

TonificaGonMethodorwithMoxa

LiverStasisandKidneyDeficiency

CV6,LR3,CV3,SP6,ST36,PC6

EvenMethod

Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之  32YO,8-1-1990FirstVisit IrregularMenstrualCyclesforseveralyears

 Irregularmenstrualcycles,dizziness,restlessness,poorsleep,pelviccoldtothetouch,leukorrhea,soreback,chestGghtness,hypochondriacGghtness,hasusedChineseherbsfocusedonPacifyingLiverAcGvateBloodwithnoreliefbutfurtheraggravaGonofsymptoms,pulsewiry,leMCunsmall,rightChideep,pulsepale,coaGngwhite.

Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之  BloodDeficiencyLiverStasis BloodDeficiencyistheCauseandLiverStasisistheManifestaGon

 NourishBloodRegulateLiver–MainTP

 StrengthenSpleenWarmKidney–SecondaryTP

Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之  ShengDi18,DangGui18,ChiBaiShao12each,ChaiHu3,ChuanLianZi9,BaiZhu12,FuLing18,SuanZaoRen12,ZhiYuanZhi6,ChenPi10,XianLingPi9,HongHua9,DuZhong12,DanPi6

 7bags,1bagdaily

Case #3 Irregular Menstrual Cycles Dr. Wang, Mian Zhi 王綿之  SecondVisit Dizzinessdecreased,sleepingbeoer,lesschestandhypochondriacdistenGon,emoGonsarebeoer,lessleukorrhea,pulsesoMerandlesswiry,tonguecoaGngrootpeeled. LiverStasisisdecreasingbutyinbloodsGlldeficient,themotherofliveriskidney,YiGuiTongYuan(YinWoodandYinWatersharethesamesource) RidofHongHua,YuanZhi,ChenPi,DuZhong AddShuDi10,GouQiZi12,HuaiNiuXi10,DangShen18,ZhiXiangFu12,ShengJiang3pieces 10bags,onebagdaily.

Dr. Wang, Mian Zhi 王綿之  1923-2009 19thgeneraGonalpracGGoner Educatoraswell,focusedongeneralmedicine,formularies.

 ReputablewithDSandFormulaGonbooks