menstruation（月经失调）（ppt69）课件

Irregular menstruation （月经失调）,Shuguang hospital affiliated to shanghai TCM university Doctor: zhang qin hua,Definition Classification Pathogenesis Key points of syndrome differentiation Examples :Treatments on the types of syndrome differentiation,contents,menstruation,Cycle: 21-35d Last: 3-7 d Quanitity: 50-80ml Texture: no clot,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,emotional factors Exogenous： cold HeatDampness Improper Life style Multiparity Excessive sexual life Improper diet Congenital weakness,Kidney qi and essence,Spleen qi,spleen and kidney,Qi and bloods flow,Liver and spleen,Cause of west medicine,hormonal imbalances Stress a bleeding disorder fibroids polyps endometriosis medication,pcos thyroid disease liver or kidney disease infection IUD Malignancy TB,Another 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,Pathogenesis,Treatment,regulating Qi and blood nourishing the kidney strengthening the spleen dispersing the stagnation of liver Qi,Different treatment on 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.,Treament according to the age of the patient.,Key points according to cycle 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,Liver depression,Kidney asthenia,Color： Bright reddark red heat Pink /light red asthenia Dark black cold Light dark asthenia cold Texture Sticky heat(yang excess) Thin astheniacold Clot stasis Complications (heatcoldstheniaasthenia),Key points according to color or texture,prognosis,Depeng on The long or short of history The strong or weakness of constitution In time or delayed in therapy,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,answer,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 San Danpi10 Shanzizi9 Danggui10 Baishao9 Caihu6 Baishu9 Fuling9 Zhigancao6 Hanliancao10,Early menstruation,definition: 7-10days earlier than usual; continues occurrence for 3 circle is regarded morbid Diagnosis Accompanied with heavy amountmetrorrhagia and metrostaxis 10d earlier intermenstrual bleeding Pelvic examination: normal,Syndrome -Qi asthenia,syndrome Main symptoms: Early menses with prolonged duration and profuse light-colored and thin menses Spleen qi asthenias 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 ),modification,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 add Xiangfu 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,modification,Syndromeliver stagnation and blood heat,syndrome Main symptoms: Early menses with profuse Purplish and reddish and sticky menses liver depression transform to fires symptom Threaputic methods: Soothing the liver ,clearing away heat and regulating 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 stasis Yimucao15g shensanqi3g For severe distention and pain: Yanhusuo 10 chuanlianzi6g,modification,For severe heat Xiakucao6g huangqin10g For affect spleen Houpu6g chenpi6g For greasy tongur fur cangshu6g zhibanxia6g,Syndromeyin asthenia and blood heat,syndrome Main symptoms: Early menses with scanty Purplish and sticky menses kidney yin asthenias symptom Threaputic methods: Nouring yin ,clearing away heat and regulating menses 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,modification,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 days. 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,answer,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 menstruation,Definition: 7 days later than usual or occurs once 40-50 days. Diagnosis: continues 3 circle Exclude pregnancy,Syndrome-blood asthenia,Main symptoms: Delayed and scanty, light-color and thin menses or accompanied by lower abdominal pain blood asthenias symptoms Therapeutic methods Supplementing blood ,nourishing Qi and regulating menstruaiton 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 over the palms and soles Digupi10 zhimu10 For insomnia and palpitation Yejiaoteng15 syabzairen10,modification,Syndromeasthenia-cold,Main symptom: delayed blackish or light-color, scanty Yang deficiency of kidneys symptom Therapeutic methods Supporting yang, eliminating cold and regulating 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,modification,Syndrome-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 colds symptoms Therapeutic methods Warming meridians to dispel cold and regulating menstruation 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,modification,Syndrome-qi stagnation,Main symptoms: deep red and scanty menses or with blood clot symptoms of Qi stagnation Therapeutic methods Regulating Qi and eliminating stagnation combined 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:,2004.9.20 Miss Liu,30 year-old ,teacher Main symptoms: Irregularity of menstrual cycle for 4 months sometimes scanty, sometimes profuse menorrhea, purplish 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,answer,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 cycle,Definition: 7 days earlier or later than usual Scanty or profuse menses Diagnosis Continuous3 cycles Differentiate with metrorrhagia and metrostaxis,Syndrome-Liver stagnation,Main symptom: Scanty or profuse menses Purplish menses and unsmooth menses Liver depressions 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,modification,Syndromekidney asthenia,Main symptom: Irregular cycle with light colored,Scanty and thin menses Kidney asthenias 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 TANG Chaihu 6 danggui10 baishao 10 shoudi10 shanyao15 tusizi10 jingjiesui6,modification,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 menorrhea, 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 heavier,answer,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,Example：,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 profuse and reddish. LMP:3.6, profuse and reddish menses for 10 days, then the volume 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,answer,Diagnosis: profuse menorrhea Syndrome differentiation: blood heat Treatment: clearing away heat and cooling the blood ; strengthening the thoroughfare vessels and stopping bleeding Drug: Modified Qingre Gujing Tang Danpi9 Shanzhi6 Shengdihuang12 Diyutan15 Oujietan15 Chenzongtan10 Guiban10 Huaruishi15 Yimucao15 Chansha10 Caihu10 Baishao12,Profuse menorrhea,Definition: quantity of menses obviously increase or menstruation 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 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, controlling 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,modification,Syndromeblood 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 and 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,modification,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 menorrhea 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,answer,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:,2003.4.9 Mrs Lu, 34 year-old, doctor Main symptoms: Menopause for 7 months Because of work pressure ,the patient suffered from disorders 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,answer,Syndrome differentiation: stagnation of liver Qi and blood stasis Drug: Modified Gexia Zhuyu Tang Danggui12 Chuanxiong12 Chishao12 Taoren12 Zhike9 Yanhu15 Wulingzhi12 Danpi12 Wuyao12 Xiangfu12 Gancao6 Caihu9 niuxi12 Shengdi12,Scanty menstruation,Definition: menorrhea is obviously reduced and the menstrual cycle is less than 2 Days Diagnosis: Regularly cycle with scanty amout Exclude the situation of contraception pills Exclude the early pregnancy with bleeding,Syndrome-blood asthenia,Main symptoms: scanty, light-color and thin menses blood asthenias symptoms Therapeutic methods Nourishing blood ,invigorating Qi and regulating 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,modification,Syndrome-kidney asthenia,Main symptoms: scanty, light-color and thin menses kidney asthenias symptoms Therapeutic methods Reinforcing the kidney,Nourishing blood and regulating