Gynecology In TCM
Gynecology – cycle- days, on time, etc. – bleed- 4-7 days normal – amount- 50-80 ml, # of tampons/day – absorbency, history – colour- bright-red to brown-red – characteristic- thin/thick, sticky, clots, consistence – odour- is there any odour – inflammation *Symptoms surrounding menses – pain, headache, edema, irritability *Tongue & Pulse P/T – regulate the root – differentiate – harmonize Yin/Yang – regulate Qi/Blood – strengthen KI – Nourish SP – Sooth LR – consolidate Ren & Chong Early Periods Diagnosis Menstruating 7 days early for 3 months consecutive. May also bleed between periods (mid-cycle) – not a true period. Etiology Ren & Chong not consolidated 1.Spleen Qi deficiency – diet, fatigue, overwork, worry, over-think, makes Qi sink – can’t keep blood in vessels. 2. Kidney Qi deficiency – pre-heaven def., pre-menopausal, cycles shorten between 40-50, pregnancy close together or amount of miscarries etc all use KI essence/Qi. KI Qi controls lower orifices, this makes Ren & Chong lose control. 3. Hyper Yang with heat in blood – general Yang life/constitution, lots of spicy food, fire invasion, hot working environment. 4. Liver Qi stagnation with heat in the blood – attack Ren & Chong, can’t consolidate. 5. Yin deficiency with heat in blood – TB, long term bleeding will injure Yin, over active reproductive parts (sex – babies), Ren & Chong can’t consolidate. 6. Blood Stasis – after delivery or during menses get attacked by ext. pathos, emotional upset can cause Qi stag. – Stasis, period stops early – next month comes early (blood stasis clogs uterus). Pathogenesis differentiation & treatment Spleen Qi deficiency early period, more blood (not hold in vessels), less blood (SP Qi sink, pale-red colour, watery, low abdominal empty feeling, T – pale, white coat P – weak Plus – Spleen deficiency symptoms (see Appendix 1) P/T – nourish SP & middle Jiao Qi Rx – Gui Pi Tang (stops heavy bleeding) or Bu Zhong Yi Qi Tang (raises Qi , light bleeding) Kidney Qi deficiency early period, more blood (Chong & Ren can’t consolidate), less blood (Essence deficiency), pale-brown red in colour, clear thin watery, T – pale P – weak Plus – Kidney Qi deficiency symptoms (see Appendix 1) P/T – nourish KI Qi – consolidate Ren & Chong Rx – Gui Shen Wan (KI tonic) or Wen Chong Tang (more cold signs) excess Yang with Heat in the blood blood amount is more, fresh red or darker & sticky, blood may feel hot, T – red, yellow coat P – slippery, rapid Plus – Heat symptoms (see Appendix 1) P/T – clear Heat – cool blood to regulate menses. Rx – Qing Jing Tang Liver Qi stagnation with Heat can be more or less quantity of blood, deep red in colour, thick clotted blood that does not flow smoothly (start & stop), breast distention and low abdominal pain, T – red sides P – wiry Plus – Liver Qi stagnation symptoms (see Appendix 1) P/T – soothe LR clear heat & cool blood to consolidate Chong Mai Rx – Dan Zhi Xiao Yao San Yin deficiency with heat in the blood this pattern happens more around menarche & menopause deficiency Heat in Chong & Ren push blood out of Jing = early scanty, dark colour & sticky, T – red, scanty coat P – fine rapid Plus – Yin deficiency symptoms (see Appendix 1) P/T – nourish Yin, clear ↓ heat, consolidate Chong Rx – Liang Di tang Blood Stasis cold blocks blood, Chong, & Ren – new blood can’t stay in uterus, woman starts spotting dark with clots, painful although better once clots pass, cold in uterus, whole body may not show cold signs, T – purple spots P – uneven Plus – Blood Stasis symptoms (see Appendix 1) P/T – promote blood circulation, remove Blood Stasis to regulate menses. Rx – Tao Hong Si Wu tang Late Periods iagnosis Menstruate for 35 days or more, 3 months consecutively, more common during menarche and menopause. Is pregnancy a consideration? Etiology 1. Blood deficiency – chronic illness, bleeding disorders 2. Yang deficiency (Kidney) – can’t warm organs – impairs production of blood – deficient Chong 3. Yin deficiency (Kidney) – deficiency Fire impair fluids and blood – deficient Chong blood 4. Cold stagnation – restrict blood circ – blood stasis 5. Qi stagnation turns to Blood Stasis – block Ren and Chong, Chong will not fill on time 6. Phlegm stagnation – overweight – phlegm damp retention can block Ren and Chong, Chong can’t fill – too damp (diabetes etc.) Pathogenesis Differentiation & Treatment Blood deficiency scanty bleeding that is pale in colour and thin in consistency, T – pale, thin P – thin, weak Plus – blood deficiency symptoms (see Appendix 1) P/T – nourish blood to nourish Chong Rx – Xiao Ying Jian Kidney Yang deficiency cold symptoms, scanty purple pale thin menstrual blood, dull cold low abdominal pain, T – pale swollen, tender baby P – deep thin Plus – Yang deficiency symptoms (see Appendix 1) P/T – warm up KI Yang to nourish Chong Rx – You gui wan Kidney Yin deficiency scanty dark coloured menstrual blood with small clots, T – red, scant coat P – fine, rapid Plus – Yin deficiency symptoms (see Appendix 1) P/T – nourish KI Yin to regulate period Rx – Liu Wei Di Huang Wan Full Cold stagnation scanty purple red blood with large clots, cold pain in low abdomen, complexion is white/blue, T – purple P – tense maybe uneven (stasis), deep (internal) Plus – whole body feels cold P/T – warm meridians, expel cold, promote circulation to remove stagnation Rx – Wen Jing Tang Liver Qi stagnation scanty or normal, if no heat colour normal, if heat – deep red, thick, start/stop bleeding during menses, small clots, distended pain in low abdomen, T – red on sides P – wiry Plus – Liver Qi stagnation symptoms (see Appendix 1) P/T – regulate LR Qi, remove stagnation to regulate
