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Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 49yo,married,prolongedmenstrua4onfor2years.
Mostregularperiods5-6/30,mediumamount,clots.Sincebeginningoftheyear,pa4enthasexperiencedmanycyclesofprolongedperiodflow.OBGYNadvisedD&Cfollowedbyestrogenandprogesteronecyclicalusage,butdidnotworkwell.
Sheexhibitsinsomnia,anxiety,headpressure,recentlyhermenstrua4onagainlasted10daysandthroughultrasound,heruterineliningwasverythick(12mm).Hertongueisslightlyred,coa4ngthinyellowgreasy,pulsewirythready.
TCMDiagnosis:ProlongedMenstrua4on;WMDiagnosis:AUB
Definition Withmenstrualcyclenormal,thedaysofmenstrualflowincreasedtobeyond7daysto14days
Hypermenorrheaormenorrhagiaiss4llthewesternmedicinedefini4oneventhoughhereindicatesaprolongedmenstrua4on4meregardlessthequan4tyoftheflow
Etiology – Qi Deficiency
InjurytoSpleenQi,MiddleJiaoQiDeficient
Cons4tu4onalWeakness
InsufficientFoodIntake
Overstraining
ChongRenDysfunc4oncannotcontrolblood
flow
Etiology – Deficient Heat
YinBlooddeficient,heatrises
ChronicIllness
injuringtheYin
Excessivepregnancies
Overstrainingorexcessive
sexualac4vi4es
HeatdisturbsChongRen,SeaofBloodbecomesrestless
Etiology – Blood Stagnation
ChongRenUterusbecomesstagnant
Chronicdepressionorstasis,injuringLiver,QiStasis
BloodStagna4on
Exogenouspathogensstuck
inuterus,causingbloodto
stagnate
MenstrualFlowoutofcontrol
Pathology DiseaseLoca4on:ChongRen.ThemainpathologyisChongRenSeaofBlood.ChongRenlosingcontrollingfunc4on,menstrualbloodlosingcontrol
Deficiency QiDeficiency,DeficientHeat
ChongRenLosingControl,HeatdisturbsChongRen
MenstrualBloodLostControl
Excess BloodStagna4on,
ChongRenBlockage
MenstrualBloodLostControl
Etiopathology Summary ExogenousPathogens
SpecialMenstrualPhysiology
Cons4tu4onalFactor
EndogenousEmo4onalFactors
DietaryFactorXueYu
QiXuChongRenlosingcontrol,menstrualbloodlosingcontrol
ChongRenBlockage,menstrualbloodlosingcontrol
XuReHeatdisturbsChongRen,menstrualblood
losingcontrol
Diagnosis MainSymptom:menstrualflowlastedmorethan7days,butcyclenormal
Combina4ons:canseeincreasedmenstrualflow,menstrual.cycleirregular,ordysmenorrhea,lumbago,orleukorrhea
Differentiation of Syndromes E"ology Symptoms
Quan4ty Color Quality Cycle
QiXu more pale Thin NotcleanNotclear
XueRe less Brightred thick Normal
XueYu Moreorless Purpledark Clots Normal
Treatment Principles FocusonChong’scontrollingfunc4on StrengthenChongStopBleedingRegulateMenstrua4on
Toshrinkmenstrua4on4me
QiDeficiency–TonifyQiandControlBlood
DeficientHeat–NourishYinClearHeatStopBleeding
BloodStagna4on–Ac4vateBloodDissolveStagna4onStopBleeding
Herbal Therapy Qi Deficiency Prolongedmenstrua4on,excessiveflow,paleandthinflow,fa4gue,dyspnea,feeblespeech,paleface,tonguepale,coar4ngthin,pulseslowandweak.
ChongRenweakenedcontrol,cannotcontrolmenstrualbloodflow
TonifyQiControlBlood,StrengthenChongRegulateMenstrua4on
ModifiedJuYuanJian舉元煎(JuYuanJian+AJiao,AiYe,WuZeiGu)
RenShen,HuangQi,BaiZhu,ShengMa,ZhiGanCao,AJiao,AiYe,WuZeiGu
Herbal Therapy Qi Deficiency ModifiedJuYuanJian舉元煎(JuYuanJian+AJiao,AiYe,WuZeiGu)
RenShen,HuangQi,BaiZhu,ShengMa,ZhiGanCao,AJiao,AiYe,WuZeiGu
Ifexcessiveflow,addMuLi
Ifwithdysmenorrhea,addSanQi,PuHuang,XueYuTan
Herbal Therapy Deficient Heat Prolongedmenstrualflow,lessflow,brighterred,thickors4ckyflow,drythroatandmouth,orwithflushedface,4dalheat,orwithfivesoleheat,tonguered,coa4ngscanty,pulsethreadyrapid.
Yindeficiencywithinternalheat,heatdisturbingChongRen,SeaofBloodrestlessandnotcalm
NourishYinClearHeatStopBleeding
LiangDiTang+ErZhiWan+WuZeiGu+QianCao兩地湯+二至丸+烏賊骨+茜草
ShengDi,XuanShen,MaiDong,DiGuPi,AJiao,BaiShao,NvZhenZi,HanLianCao,WuZeiGu,QianCao.
生地,玄參,麥冬,地骨皮,阿膠,白芍,女貞子,旱蓮草,烏賊骨,茜草。
Herbal Therapy Deficient Heat LiangDiTang+ErZhiWan+WuZeiGu+QianCao兩地湯+二至丸+烏賊骨+茜草
ShengDi,XuanShen,MaiDong,DiGuPi,AJiao,BaiShao,NvZhenZi,HanLianCao,WuZeiGu,QianCao.
生地,玄參,麥冬,地骨皮,阿膠,白芍,女貞子,旱蓮草,烏賊骨,茜草。
Ifscantyflow,addShuDi,DanShen,Ifstrong4dalfeverorheatsymptoms,addBaiWei白薇
Herbal Therapy Blood Stagnation Prolongedmenstrualflow,lessflowamount,darkredcolorwithclots,pelvicpainaversiontopressure,tonguepurpledarkorwithstagnantspots,pulsewirysluggish.
Stagna4onblockingtheproperfunc4onofChongRenandUterus,menstrualflowbecomesuncontrolled.
Ac4vateBlood,DissolveStagna4onStopBleeding
TaoHongSiWuTang+ShiXiaoSan+YiMuCao+QianCao桃紅四物湯+失笑散+益母草+茜草。
TaoRen,HongHua,DangGui,ShuDi,ChuanXiong,BaiShao,PuHuang,WuLingZhi,YiMuCao,QianCao.
Herbal Therapy Blood Stagnation TaoHongSiWuTang+ShiXiaoSan+YiMuCao+QianCao桃紅四物湯+失笑散+益母草+茜草。
TaoRen,HongHua,DangGui,ShuDi,ChuanXiong,BaiShao,PuHuang,WuLingZhi,YiMuCao,QianCao.
Ifwithpelvicdistendingpain,addEZhuandYanHuSuo莪朮,延胡索
Herbal Instructions Mostof4me,itwouldbemoreeffec4vetotaketheherbsduringthemenstrua4on.
Stayawayfromastringentherbstoavoidfurtherblockageandconges4on.
Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 49yo,married,prolongedmenstrua4onfor2years.
Mostregularperiods5-6/30,mediumamount,clots.Sincebeginningoftheyear,pa4enthasexperiencedmanycyclesofprolongedperiodflow.OBGYNadvisedD&Cfollowedbyestrogenandprogesteronecyclicalusage,butdidnotworkwell.
Sheexhibitsinsomnia,anxiety,headpressure,recentlyhermenstrua4onagainlasted10daysandthroughultrasound,heruterineliningwasverythick(12mm).Hertongueisslightlyred,coa4ngthinyellowgreasy,pulsewirythready.
TCMDiagnosis:ProlongedMenstrua4on;WMDiagnosis:AUB
Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 Thepa4entisat7x7age,herliverandkidneyessenceandyinhavedepleted,atthesame4me,sheexhibitedministerialfirerising,yindeficiencywithfirecausingheaddisten4on,emo4onalinstability,heatdisturbingChongRencausingmenstrualbloodlosingcontrol,thereforeprolongedperiod.
LiverKidneyYinDeficiency,HeartBrainLackedNourishment
NourishLiverandKidney,CalmsHeartandCalmsSpirit
DangGui,ShuDi,SuanZaoRen,YeJiaoTeng,HeHuanPi,YuanZhi,FuShen,HuaiXiaoMai,ZhiGanCao.14bags.
Clinical Case #6 Dr. Zhu, Nan Sun 朱南孫 SecondVisit:sleepimproved,dizzinessimproved,appe4tenormal,bmregular,lastperiodlasted7daysinsteadof10days.Pulsethinsop,tonguered,coa4ngthin.
DangGui15,ShuDi12,ShaRen3,SuanZaoRen9,YeJiaoTeng20,FuShen12,FuLing12,HeHuanPi12,YuanZhi6,HuaiXiaoMai30,ZhiGanCao6,BaiZhu9,BaiShao9.14bags