Irregular menstruation （月经失调） Shuguang hospital affiliated to shanghai TCM university Doctor: zhang qin hua

Irregular menstruationIrregular menstruation（月经失调）（月经失调）

Shuguang hospital affiliated to shanghai TCM university

Doctor: zhang qin hua

DefinitionClassification PathogenesisKey points of syndrome differentiationExamples :Treatments on the types of syndr

ome differentiation

contentscontents

menstruationmenstruation

Cycle: 21-35dLast: 3-7 dQuanitity: 50-80mlTexture: no clot

Definition Definition

Cycle irregulation:

Quantity irregulation

•early menstruation•delayed menstruation•Irregularity menstrual cycle

•profuse menstruation•scanty menstruation

abnormal changes of the cycle or quantity of menstruation

TCM Cause TCM Cause

emotional factorsExogenous ：

cold \Heat\Dampness Improper Life style

Multiparity Excessive sexual life Improper diet

Congenital weakness

Kidney qi and essence

Spleen qi

spleen and kidney

Qi and blood’s flow

Liver and spleen

Cause of west medicineCause of west medicine

hormonal imbalances Stress a bleeding disorder fibroids polyps endometriosis medication

pcos thyroid disease liver or kidney disease infection IUD MalignancyTB

Another factorsAnother factors

Normal adolescence Perimenopause /Menopause Weight gain /Weight loss Vegetarian diet intensive exercise

When the cause disappear, the menstruation will be normal

Disorder of viscera

Disorder of qi and blood

Irregular menstruation

Pathogenesis Pathogenesis

kidney tiangui vessels uterus

Treatment Treatment

regulating Qi and blood nourishing the kidney strengthening the spleen dispersing the stagnation of liver Qi

Different treatment Different treatment on different timeon different time

Before menstruation: focuses on the root aspect :asthenia or sthenia

During menstruation: concentrates on the branch aspect : stop pain, active blood,regulation menses ,etc

After menstruation: emphasizes on the regulation of the spleen and stomach as well as that of Qi and Blood.

irregular menstruation disease

Treament according to the age of the patient.

diseaseirregular menstruation

Key points according to Key points according to cycle or quantitycycle or quantity

Menses increase type Increase in the quantity or time or frequency

Menses decrease type Decrease in the quantity or time of frequency

Irregular menses

Menses increase type

Early menstruation

profuse menorrhea

intermenstrual bleeding

Metrorrhagia and

metrostaxis

Qi asthenia

Blood heat

• yang abudance

• yin asthenia

Blood stasis

Menses decrease type

Delayed menstruation

scanty menstruation

Amenorrhea

Blood asthenia

Blood cold

Blood stasis

Liver depression Kidney asthenia

Irregular Menses

Liver depression Kidney asthenia

Color ： Bright red\dark red heat Pink /light red asthenia Dark black cold Light dark asthenia cold

Texture Sticky heat(yang excess) Thin asthenia\cold Clot stasis

Complications (heat\cold\sthenia\asthenia)

Key points according to Key points according to color or texturecolor or texture

prognosisprognosis

Depeng on The long or short of history The strong or weakness of constitution In time or delayed in therapy

Examples:Examples:

2004.4.14 Mrs Ren, 28 year-old, married, worker Main symptoms:

early menstruation for more than one year menses occurs every 20 days, lasting for 4 days, normal

volume, the menses is reddish and purplish, sticky with blood clot

distending and pain in the breast, chest, hypochondrium and two sides of lower abdomen.

Often feel bitter mouth ,thirst ,constipation.

Tongue: red tongue with yellowish fur Pulse: taut and rapid

Lab: B ultrasound suggested: no special abnormal signs

answeranswer

Diagnosis:early menstruation Syndrome differentiation:

liver depression transferring to heat Treatment:

Clearing away the heat of liver and soothing the stagnation of liver Qi cooling the blood to regulate menstruation

Drug: Modified Danzi Xiaoyao SanDanpi10 Shanzizi9 Danggui10 Baishao9 Caihu6 Baishu9 Fuling9 Zhigancao6 Hanliancao10

Early menstruationEarly menstruation

definition: 7-10days earlier than usual; continues occurren

ce for 3 circle is regarded morbidDiagnosis

Accompanied with heavy amount—metrorrhagia and metrostaxis

>10d earlier –intermenstrual bleeding Pelvic examination: normal

Syndrome --Qi asthenia Syndrome --Qi asthenia

syndrome Main symptoms:

Early menses with prolonged duration and profuse light-colored and thin menses Spleen qi asthenia’s symptom

Threaputic methods: Nourishing qi and supplementing the spleen,controlling blood

circulation and regulating menses)

Durg: Modified Buzhongyiqi tang

(Anorexia,loose stool,empty prolaspsing sensation in the lower abdomen,light-colored tongue with thin and whiteish fur,thin and slow pulse)

(huangqi 10g dangshen10g baishu10g chaihu6g

chenpi 6g danggui10g shengma6g gancao3g )

modificationmodification

For yang asthenia accompanied by cold Main symptom:

Blackish ,thin and scanty menses Pain preference for warmth Moist and whitish tongue fur

Drug:buzhongyiqi tang addXiangfu 10g aiye 6g

For spleen asthenia and dampness obstruction Whitish and greasy tongue Drug:buzhongyiqi tang add

Zisugeng10g sharen5g

Fo insufficiency of kidney qi Body chills ,profuse uration at nighes Drug:buzhongyiqi tang add

Xuduan10g duzhong10g


Syndrome–liver stagnation and bSyndrome–liver stagnation and blood heat lood heat


Early menses with profuse Purplish and reddish and sticky menses liver depression transform to fire’s symptom

Threaputic methods: Soothing the liver ,clearing away heat and regulatin

g menses Durg: Modified danzhi xiaoyao san

(hypochondria and breasts distension, mental depression, irritability,bitter taste ,thirsty,yellow urine,dry stool,red tongue with yellow fur,wiry and fast pulse)(mudanpi10g zhizi 6g chaihu6g danggui 10g baishao10g fuling10g baishu10g bohe6g guya12g gancao3g )

For profuse

Xianhecao15g diyu12g For profuse with blood stasi

s

Yimucao15g shensanqi3g For severe distention

and pain:

Yanhusuo 10

chuanlianzi6g


For severe heat Xiakucao6g huangqin10g

For affect spleenHoupu6g chenpi6g

For greasy tongur furcangshu6g zhibanxia6g

Syndrome–yin astheniaSyndrome–yin asthenia and blood heat and blood heat


Early menses with scanty Purplish and sticky menses kidney yin asthenia’s symptom

Threaputic methods: Nouring yin ,clearing away heat and regulating men

ses Durg: Modified liangdi tang

(back pain with knee weakness, fever sensation in palms and soles ,tidal fever and night sweating,restlesseness and insomnia,reddish tongue with scanty fluid, thin tongue without fur,thin and rapid pulse)

(shengdihuang10g xuanshen10g maidong10g digupi10g ajiao10g baishaoyao10g)

For hyperactivity of liver yang Dizziness or tinnitus (hypertension)

Zhiguiban15g wuzeigu15g shenglugu2

xiakucao15g insomnia due to asthenia heat

Zhizi6g suanzaoren10g


Examples:Examples:

1999.2.28 Miss Li ,28 year-old, worker Main symptoms:

delayed menstruation for 3 years From the menarche ,menses occurred once 30-45 day

s. Blackish menses with blood clot. In recent 3 years, menses occurs once 2 months , which is scanty , blackish ,light-color and thin

accompanied with pain in loins and sacrum,, frequent urine in the night,, leucorrhea

Tongue: light-colored tongue with white fur Pulse: deep, weak and thready

answeranswer

Diagnosis:delayed menses Syndrome differentiation: asthenia of kidney Treatment: Nourishing kidney and supplementing

blood to regulate menstruation Drug: Modified Danggui Dihuang Tang

Shoudihuang20 Shanzhuyu20 Shanyao10 Danggui10

Duzhong20 Huainiuxi10 Tusizi15 Bajitian15

Xianlingpi15 Gancao6

Delayed menstruationDelayed menstruation

Definition: 7 days later than usual or occurs once 40-50 da

ys.Diagnosis:

continues >3 circle Exclude pregnancy

Syndrome-blood astheniaSyndrome-blood asthenia

Main symptoms: Delayed and scanty, light-color and thin menses or acco

mpanied by lower abdominal pain blood asthenia’s symptoms

Therapeutic methods Supplementing blood ,nourishing Qi and regulating me

nstruaiton Prescription: modified dabuyuan jian

Dangshen15 shanyao15 shoudi10 danggui12 baishao12 duzhong10 shanzhuyu10 danshen10 xiangfu10 shenggancao3

(pale complexion, lusterless skin, dizziness, lassitude, palpitation, insomnia ,light-colored tongue and thin pulse)

For asthenia –heat due to consumption of yin by prolonged diease flushed cheeks, tidal fever feverish sensation ov

er the palms and soles Digupi10 zhimu10

For insomnia and palpitation Yejiaoteng15 syabzairen10


Syndrome—asthenia-coldSyndrome—asthenia-cold

Main symptom: delayed blackish or light-color, scanty Yang deficiency of kidney’s symptom

Therapeutic methods Supporting yang, eliminating cold and regulatin

g menstruation Prescription:Modified Aifu Nuangong Wan

(aching pain in loins and sacrum,frequent urine in the night,loose stool etc)

(Aiye6 Xiangfu10 Danggui12 Wuzhuyu5 Danshen10 Shengdi10 Rougui6 Mudanpi10 Huangqi10 Xuduan10)

For clear uring and severe loose stool Buguzhi10 baizhu10

For insufficiency if yang-qi with phlegm and dampness Cangzu10 yiyiren15


Syndrome-blood coldSyndrome-blood cold

Main symptoms: Delayed ,blackish,scanty menses or with blood clot, or

abdominal pain that can be alleviated with warmth,aversion to cold

blood cold’s symptoms

Therapeutic methods Warming meridians to dispel cold and regulating menst

ruation

Prescription:Modified Wenjing Tang

(Cold limbs,blackish tongue with whitish fur and deep-tense pulse)

(Renshen12 Danggui10 Chuanxiong5 Baishaoyao10 Guizhi5 Wuzhuyu5 Mudanpi10 Niuxi10 Eshu10 Gancao3)

For severe abdominal pain Wuyao10 yanhusuo10

For unpressable abdominal pain with blood clot Shengpuhuang10 wulingzhi10


Syndrome-qi stagnationSyndrome-qi stagnation

Main symptoms: deep red and scanty menses or with blood clot symptoms of Qi stagnation

Therapeutic methods Regulating Qi and eliminating stagnation combi

ned with activiation blood Prescription:Modified Caihu Shugan San

(dysphoria, irritability ,preference for sighing, hypochondria and breasts distension, epigastric oppession and anorexia,thin and yellow tongue fur,wiry pulse)

(chaihu6 zhike10 baishao10 gancao3 xiangfu10 chuanixiong5 niuxi10 yanhusuo10 dnshen10)

Example:Example:

2004.9.20 Miss Liu,30 year-old ,teacher Main symptoms:

Irregularity of menstrual cycle for 4 months sometimes scanty, sometimes profuse menorrhea, pur

plish menses with blood clot, dysmenorrhea accompanied with distending pain in the breasts ,preference for sighing, epigastric oppression and anorexia, normal urine and stool.

Tongue: reddish and purplish tongue with white fur

Pulse: taut

answeranswer

Diagnosis: irregular menstruation Syndrome differentiation: liver stagnation Treatment: Soothing the liver and regulating Qi to

regulate menstruation Drug: Modified Xiaoyao San

Chaihu6 Baishaoyao10 Fuling10 Danggui10 Gancao6 Danshen10 Yimucao15 Puhuang10

Irregularity of menstrual cycleIrregularity of menstrual cycle

Definition: 7 days earlier or later than usual Scanty or profuse menses

Diagnosis Continuous>3 cycles Differentiate with metrorrhagia and metrostaxis

Syndrome--Liver stagnationSyndrome--Liver stagnation

Main symptom: Scanty or profuse menses Purplish menses and unsmooth menses Liver depression’s symptom Threaputic methods:

Soothing the liver , regulating qi ,nourishing blood and regulationg menses

Durg: Modified xiaoyao san

(dysphoria, irritability ,preference for sighing, hypochondria and breasts distension, epigastric oppession and anorexia,thin and yellow tongue fur, wiry pulse)

(chaihu6g danggui 10g baishao10g fuling10g baishu10g bohe6g jingjie6g gancao3g )

For qi stagnation transforming into fire Bitter taste in the mouth Yellowish tongue fur

Mudanpi10 zhizi6 huangqin10

For unpressable abdominal pain with blood clot Yimucao 15 shensanqi5


Syndrome—kidney astheniaSyndrome—kidney asthenia

Main symptom: Irregular cycle with light colored,Scanty and thi

n menses Kidney asthenia’s symptom Threaputic methods:

Nourishing the kidney and harmonizing the spleen,nourishing blood and regulationg menses

Durg: Modified guishen wan(tusizi10 duzhong10 gouqizi10 shanzhuyu10 danggui10 shoudi10 shanyao15 fuling10 )

(dizziness and tinnitus, weak waist and knees, pain in the heel and lower abdomen, frequency urine in the night, light-colored tongue ,deep and slow pulse)

For simultaneous diease of the liver and kidney ,bothe the liver and kidney should be treated with DINGJING TANGChaihu 6 danggui10 baishao 10 shoudi10

shanyao15 tusizi10 jingjiesui6


Example:Example:

2004.4.21 Mrs Chen 30 year-old ,married Main symptoms:

profuse menorrhea for 10 years LMP:4.20, because of busy work, extreme profuse men

orrhea, bright-red colored menses accompanied with back pain, dizziness, palpitation ,thirst, lack of Qi, lassitude, insomnia ,dry stool, yellowish urine. Pale complexion, weight lose.

Tongue: light-colored tongue with yellowish fur Pulse: thready and rapid, weak when pressing hea

vier

answeranswer

Diagnosis ； profuse menorrhea Syndrome differentiation:

interior heat due to yin asthenia, causing extravasation of blood Treatment:

Nourishing Yin and clearing away heat; supplementing Qi and stopping bleeding

Drug: Modified Liangdi Tang Shengdihuang30 Ejiao15 Digupi12 Taizishen15 Maidong15 Wuweizi4.5 Huangqin10 Xianhecao15 Hanliancao24 Guanzhong

ExampleExample ：： 1990.4.8 Miss Li, 24 year-old, worker Main symptoms:

dripping menses for 20 days, sudden profuse discharge for 6 days From the menarche ,the menstruation often come earlier , slight pr

ofuse and reddish. LMP:3.6, profuse and reddish menses for 10 days, then the volum

e reduced but dripping. A week ago, the patient quarreled with other man ,then menses appeared sudden profuse discharge, which was reddish with blood clot, accompanied with susceptibility to rage due to dysphoria, dry mouth, liking drinking ,constipation .

Tongue: red tongue with yellow and dry fur Pulse: slippery and rapid

answeranswer

Diagnosis: profuse menorrhea Syndrome differentiation: blood heat Treatment: clearing away heat and cooling the blood ; str

engthening the thoroughfare vessels and stopping bleeding Drug: Modified Qingre Gujing Tang

Danpi9 Shanzhi6 Shengdihuang12 Diyutan15Oujietan15 Chenzongtan10 Guiban10 Huaruishi15Yimucao15 Chansha10 Caihu10 Baishao12

Profuse menorrheaProfuse menorrhea

Definition: quantity of menses obviously increase or menst

ruation lasts for over seven days Diagnosis:

Can stop at a certain period of time Usually appears together with early of delayed

menses If cycle is irregular indicate metrorrhagia and

metrostaxis

Syndrome-qi astheniaSyndrome-qi asthenia

Main symptom: light color and thin texture menses prolonged menorrhea Symptoms of qi asthenia

(Short breath, eager to sleep all day, empty prolapsing sensation in the lower abdomen,dull cold pain in the loins and abdomen,bright whitish complexion,light and tender tongue with thin fur,asthenia and floating or weak pulse)

Therapeutic method: invigorating Qi and lifting the sinking, controll

ing blood and strengthening the thoroughfare vessel

Prescription:Modified Juyuan Jian Dangshen12 Huangqi10 Baishu10

Shengma6 Gancao3 xianhecao30

Duanlonggu30 duanmuli30

For during menstrual course Aiyetan6 weuzeigu15 xueyutan15

For prolonged or dripping menses Shengpuhuang 10 yimucao15

For cold pain in the loins and abdomen Xuduan10 aiye6


Syndrome—blood heatSyndrome—blood heat

Main symptom: Profuseor or prolonged menses purplish red ,sticky or blood clot lower abdominal pain symptoms of blood heat

Therapeutic methods Clearing away heat and cooling blood ,nourishing yin a

nd stopping bleeding Prescription: Modified Gujing Wan

(Huangbai6 Huangqin10 Baihao10 Guiban10 Xiangfu10 Chungenpi15 Ejiao10 Digupi10)

( fever, dysphoria, thirst, scanty and yellowish urine, constipation, reddish tongue with yellowish fur and slippery and rapid pulse)

For heat transformation into fire and changes into toxin Fever ,aversion to cold Unpressable pain and hardness in abdominal

Baijiangcao12 hngteng12

pugongying12 shengpuhuang10

For long time illness lead to qi and yin asthenia Shengmai san


Example:Example:

2004.4.30 Miss Liu, 17 year-old, student Main symptoms:

scanty menorrhea for 1 year Because of study pressure, in resent one year, the meno

rrhea is obvious reduced, lasting 2 days, light color and thin menses accompanied with dizziness, fatigue, palpitation, sallow complexion

Tongue: light-colored tongue with thin fur Pulse: deep and thin

Lab: Blood regular test: HGB:92g/L

answeranswer

Syndrome differentiation: Blood asthenia Treatment: Nourishing blood and supplementing

Qi to regulating menstruation Drug: Modified Zixue Tang

Dangshen12 Shanyao12 Huangqi12 Fuling10

Chuanxiong6 Danggui10 Baishaoyao10

Shoudi10 Sharen6 Chenpi10 Baishu10

Example:Example:

2003.4.9 Mrs Lu, 34 year-old, doctor Main symptoms:

Menopause for 7 months Because of work pressure ,the patient suffered from dis

orders of menstrual circle, delayed menorrhea, scanty menorrhea accompanied with distending sensation in the breast and abdomen.. Now menopause for 7 months ,often feel distending sensation in the breast and abdomen, susceptibility to rage due to dysphoria, insomnia, poor appetite, constipation.

Tongue: darkish tongue with petechiae ,white and thin fur Pulse: taut and thready

answeranswer

Syndrome differentiation: stagnation of liver Qi and blood stasis

Drug: Modified Gexia Zhuyu TangDanggui12 Chuanxiong12 Chishao12 Taoren12

Zhike9 Yanhu15 Wulingzhi12 Danpi12

Wuyao12 Xiangfu12 Gancao6 Caihu9

niuxi12 Shengdi12

Scanty menstruationScanty menstruation

Definition: menorrhea is obviously reduced and the menstr

ual cycle is less than 2 DaysDiagnosis:

Regularly cycle with scanty amout Exclude the situation of contraception pills Exclude the early pregnancy with bleeding

Syndrome-blood astheniaSyndrome-blood asthenia

Main symptoms: scanty, light-color and thin menses blood asthenia’s symptoms

Therapeutic methods Nourishing blood ,invigorating Qi and regulatin

g menstruation Prescription:Modified Zixue Tang

(pale complexion, lusterless skin, dizziness, lassitude, palpitation, in somnia ,light-colored tongue and thin pulse)

(Gangshen12 Shanyao15 Fuling12 Shoudihuang10 Danggui10 Baishaoyao10 Chuanxiong5 Huangqi10)

For asthenia heat Dihupi10 xuanshen10

For insomnia and palpitation due to blood asthenia Yejiaoteng15 wuweizi5

For hypechondria distension or breast distending pain Chaihu5 xiangfu10 chuanlianzi6


Syndrome-kidney astheniaSyndrome-kidney asthenia

Main symptoms: scanty, light-color and thin menses kidney asthenia’s symptoms

Therapeutic methods Reinforcing the kidney,Nourishing blood and r

egulating menstruation Prescription:Modified gui shen wan

(dizziness and tinnitus, weak waist and knees, pain in the heel, cold sensation in the lower abdomen, profuse urine in the night, light-colored tongue ,deep and slow pulse)

(duzhong10 tusizi10 shoudi10 danggui10 shanyao15 fuling10 shanzhuyu10 gouqizi10)

For kidney –yang asthenia Yingyanghuo10 bajitian10 xianmao10

For kidney-yin asthenia Shengdi 10 nvzenzi12 xuanshen10

For severe internal heatmudanpi10 shanzhi6 zhimu10


Syndrome-blood stasisSyndrome-blood stasis

Main symptoms: scanty, blackish with blood clot blood stasis’s symptoms

Therapeutic methods Activating blood to resolve stasis and nourishin

g blood to regulating menstruation Prescription:Modified Taohong siwu tang

(Unpalpable distending or sting pain in the lower abdomen which is alleviated after blood clot being discharged, thirst without desire for drinking, grayish tongue with thin and taut pulse )

(taoren10 honghua12 danggui10 chuanxiong5 baishao10 shoudi10 zelan12 wulingzhi10 danshen12 gancao3 )

For qi stagnation and blood stasis Xiangfu 10 wuyao10

For cold coagulation and blood stasis Guizhi6 wuzhuyu6


Syndrome-phlegm dampnessSyndrome-phlegm dampness

Main symptoms: scanty, light-color and sticky menses phlegmdampness’s symptoms

Therapeutic methods Resolving phelgm,drying dampness and regu

lating menstruation Prescription:Modified cangfu daotan wan

(heavy body,chest oppression and nausea , discharge, weakness of the four limbs, light-colored tongue and slippery pulse)

(cangzhu10 xiangfu10 fuling12 banxia10 chenpi 10 gancao3 dannanxing10 zhike10 liuqu12 shengjiang3)

For delayed scanty menses and gradual onset of amenorrhea Danggui12 zelan12 chuanniuxi12

For profuse phlegm and fat Shichangpu10 zhiyuanzhi10


non-prescription treatmentnon-prescription treatment

stress reduction and/or relaxation techniques

elimination of overly physical exercise eliminate any eating disorders such as purgi

ng, bulimia, or anorexia

Documents

Irregular menstruation （月经失调） Shuguang hospital affiliated to shanghai TCM university Doctor: zhang qin hua