CMAC311. Session 2. Menstruation disorders. Chinese Medicine Department. Early menstruation Late menstruation Irregular menstruation Scanty periods

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1 CMAC311 Session 2 Menstruation disorders Early menstruation Late menstruation Irregular menstruation Scanty periods Chinese Medicine Department

2 Session Content Endeavour College of Natural Health 2

3 Session Contents Brief introduction of menstrual irregularities: TCM Explanation/definition common aetiology factors, diagnosis & treatment Early periods, Late periods, Irregular periods & Scanty periods : Describe aetiology, pathology, diagnosis (any special biomedical tests for the diagnosis? If yes, what are the western medical diagnosis standards? ) Outline pattern differentiation & the treatments principle & methods, precautions & prevention Endeavour College of Natural Health 3

4 Learning Outcomes After this session study, students should be able to: Describe and explain the aetiology & pathology of early periods, late periods, irregular periods and scanty periods. Outline and decide the TCM pattern differentiation and treatments principles & methods accordingly. Endeavour College of Natural Health 4

5 Physiology SPLEEN MAKES & HOLDS BLOOD; KEEPS UTERUS IN PLACE HEART BLOOD & YANG GOES DOWN TO UTERUS CHONG CHANNEL PROVIDES & MOVES BLOOD STOMACH VIA CHONG MAI LIVER PROVIDES & MOVES XUE AND QI UTERUS KIDNEYS PROVIDE ESSENCE ROOT OF PRE NATAL QI, YUAN QI REN CHANNEL PROVIDES ESSENCE & YIN DAI CHANNEL BINDS CHANNELS DU CHANNEL PROVIDES YANG, MINGMEN FIRE Endeavour College of Natural Health 5

6 Early periods Definition? Periods that occur consistently up to 9 days early, The cycle the less than 28 days, Can apply if two or more successive cycles are early. Bio-medical special tests and diagnosis standards? Endeavour College of Natural Health 6

7 AETIOLOGY & PATHOGENESIS OF EARLY PERIODS

8 excessive physical work or nutritionally poor diet weakens spleen fails to hold blood in vessels blood leaks out Overwork; menopausal decline of Kid Qi Kid Xu Kid can t consolidate Chong & Ren Excess hot spicy foods & alcohol External heat penetrates the interior Blood Heat Enters blood portion Blood in Chong/Ren agitated blood overflows early menses Emotional stress (anger, frustration etc) leads to Liver Qi Stag Prolonged, leads to Liver Fire Fire invades blood portion Hot Blood pushes out of vessels Chronic illness; overwork; too many children too close together Liv & Kid Yin Xu Xu Heat enters blood portion Blood Heat Endeavour College of Natural Health 8

9 Notes The two key pathogenesis factors of early periods: Qi deficiency SP & Kid Blood heat o Full heat --liver heat & heart fire o Empty heat liv & kid Yin-deficiency with empty fire Endeavour College of Natural Health 9

10 Differential Diagnosis Early periods Spleen Qi Deficiency Liver Blood Heat Stagnant Liver Qi turning into Fire with Blood Heat Liver and Kidney Yin Xu with Xu heat Kidney-Qi not firm Heart-fire Early menses; pale & dilute flow Accompanying S/S: Early menses; heavy, bright red or dark red flow; anxiety; mental restlessness Accompanying S/S: Early menses; heavy, dark clotted flow; abdominal pain Accompanying S/S: Early menses; scant or heavy flow Accompanying S/S: Early periods, pale, dilute blood Early period, heavy period, bright red Accompanying S/S: Endeavour College of Natural Health 10

11 Treatment of Early Periods o TCM treatment principles based on your TCM pattern identification o What TCM treatment methods you will choose or combine based on your treatment principles? Acupuncture? Moxibustion? Cupping? Gua sha? Tui Na? Electro acupuncture? Laser acupuncture? Endeavour College of Natural Health 11

12 Treatment of Early Periods Pattern Identification Treatment principle Treatment methods SP Qi Deficiency Kidney Qi Not Firm Liver Blood Heat Stagnant Liv-Qi Turning into fire Heart Fire Liv-kid Yin deficiency With empty-heat Strengthen Sp Tonify & Raise Qi Consolidate Penetrating Vessel Contain blood Strengthen Kid Tonify Qi Warm Yang Consolidate Directing &Penetrating Vessels Clear heat Cool blood Regulate the periods Clear & pacify liver Move Qi Clear heat Cool blood Regulate the periods Drain fire Clear heart Calm the mind Nourish Yin Clear empty fire Regulate the periods Acupuncture: POINTS? Other TCM treatment methods: i.e. : Herbal patents? Gui Pi Tang; Bu Zhong Yi Qi Tang Acupuncture: POINTS Other TCM treatment methods: i.e.: Herbal patents? Gui Rong Bu Chong Tang; Shou Tai Wan Acupuncture: POINTS? Other TCM treatment methods: i.e.: Herbal patents? Qing Jing San Acupuncture: POINTS? Other TCM treatment methods: i.e.: Herbal patents? Dan Zhi Xiao Yao San Acupuncture: POINTS? Other TCM treatment methods: i.e.: Herbal patents? Qing Xin Ping Gan Tang Acupuncture: POINTS? i.e: Herbal patents? Liang Di Tang; Qing Jing San Endeavour College of Natural Health 12

13 Late Periods Definition? Cycle consistently longer than days, or At least for 3 consecutive months Bio-medical special tests and diagnosis standards? Endeavour College of Natural Health 13

14 AETIOLOGY AND PATHOGENESIS OF LATE PERIODS

15 Excessive physical work; chronic illness Prolonged chronic bleeding; excess breast feeding Weakens Spleen Blood Xu Qi & Blood Xu Chong/Ren malnourished Prolonged excess cold raw foods Excess exposure to Cold and Damp weather Internal Cold (maybe Yang Xu Internal Cold & Damp Cold invades blood portion & blood congeals New blood can t be generated; Chong/Ren become empty & can t be filled late menses Constitutional Kid weakness; overwork; too many children too close together Kid Xu Chong & Ren malnourished; Jing not transformed into Blood; sea of blood can t fill uterus Long standing emotional stress Liv Qi Stag Blood Stasis Chong & Ren obstructed Endeavour College of Natural Health 15

16 Differential diagnosis late periods Blood Xu Late menses; pale scanty flow Accompanying S/S: Cold in Uterus Late menses; scanty dark flow with clots; dysmenorrhea; abdominal pain relieved by warmth, worse for pressure; feeling cold Accompanying S/S: Kidney Yang deficiency Late menses; scanty flow with small dark stringy clots; dysmenorrhea; abdominal pain relieved by warmth and pressure Liver Qi Stagnation Accompanying S/S: Late menses; scanty flow with clots; PMS Accompanying S/S: Endeavour College of Natural Health 16

17 Treatment of Late Periods o TCM treatment principles based on your TCM pattern identification o What TCM treatment methods you will choose or combine based on your treatment principles? Acupuncture? Moxibustion? Cupping? Gua sha? Tui Na? Electro acupuncture? Laser acupuncture? Endeavour College of Natural Health 17

18 Pattern Identification Blood Xu Treatment of Late Periods Cold in Uterus Kidney Yang deficiency Liver Qi Stagnation Principles Nourish Blood Regulate the periods warm the uterus expel the cold Regulate the periods Tonify yang Warm the uterus Pacify the liver Move Qi & invigorate blood Regulate the periods Methods Acupuncture points? Herbal patents? Ren Shen Yang Rong Tang Acupuncture points? Herbal patents? Wen Jing Tang ; Ai Fu Nuan Gong Wan Acupuncture points? Herbal patents? Jin Gui Shen Qi Wan Acupuncture points? Herbal patents? XiaoYan San; Chai Hu Shu Gan Tang Endeavour College of Natural Health 18

19 Notes Blood-xu, Qi-stagnation & Cold are the three key pathological factors to focus in both indentifying patterns and deciding treatment methods. Cold includes: cold in the uterus the Full / Empty type Internal empty cold due to Kid-yang xu Treatment: Nourishing blood-yin, regulating Qi and easing the different type of Cold Endeavour College of Natural Health 19

20 Irregular Periods Definition? Irregular periods refers to periods that come sometimes early and sometimes late irregular cycle (unpredictable) Bio-medical special tests and diagnosis standards? Endeavour College of Natural Health 20

21 Aetiology & pathology of Irregular periods Emotional stress Liver Qi Stagnation Obstructs the Chong & Ren Working long hours without adequate rest; too many children too close together Blood Stasis Chong & Ren malnourished Uterus unfilled Chong s storing & spilling function disturbed irregular menses Endeavour College of Natural Health 21

22 Notes Irregular periods is always related to the Liver and Kidneys, esp. the kidneys : Liver Qi stagnation & Kidney deficiency (Yin or Yang) Regardless of the causes, there is a disharmony between: Qi and Blood & Chong and Ren Mai(disturbing the Chong's storing and spilling function) Endeavour College of Natural Health 22

23 Differential diagnosis irregular periods Liver Qi Stasis Kidney Yang Xu Kidney Yin Xu Irregular menses; scant, thick flow with clots; can be dark and flow unevenly other Liver Stag s&s.. Irregular menses; scanty with pale flow; no clots, backaches, tinnitus, dizziness, feels cold other yang xu s&s.. Irregular menses; scanty with pale flow, dizziness, blurred vision, night sweats, other yin xu s&s.. Endeavour College of Natural Health 23

24 Treatment of Irregular Periods o TCM treatment principles based on your TCM pattern identification o What TCM treatment methods you will choose or combine based on your treatment principles? Acupuncture? Moxibustion? Cupping? Gua sha? Tui Na? Electro acupuncture? Laser acupuncture? Endeavour College of Natural Health 24

25 Treatment of irregular periods Pattern Identification Principles Methods Liver Qi Stasis Pacify Liver, Move Qi Acupuncture points? Stagnation, Regulate Herbal patents? Periods Xiao Yan San Kidney Yang Xu Tonify and warm Kidneys, regulate periods, consolidate the Penetrating and Directing vessels Acupuncture points? Herbal patents? You Gui Wan Kidney Yin Xu nourish Yin, Tonify Kid, consolidate the Penetrating and Directing vessel Acupuncture points? Herbal patents? Liu Wei Di Huang Wan Zuo Gui Wan Endeavour College of Natural Health 25

26 Scanty Periods Definition? Period bleeding is very light, or lasts only 2-3 days, or is extremely scanty, like a small drip. Bio-medical special tests and diagnosis standards? Endeavour College of Natural Health 26

27 AETIOLOGY & PATHOGENESIS OF SCANTY PERIODS

28 Protracted chronic illness; bleeding; poor nutrition; OCP Blood Xu Sea of Blood Xu Chong/Ren depleted Overwork; constitutional weakness; too many children too close together Kid Yin Xu Water depleted Kid Jing can t transform into Tian Gui Traumas; abdominal surgery Long standing emotional stress Liv Qi Stag Blood Stasis Blood stagnates in uterus Scanty menses Excess dairy & greasy foods Excess exercise, work or sports Dampness & Sp weakness Phlegm Uterus, Chong & Ren obstructed by Phlegm Endeavour College of Natural Health 28

29 Differential diagnosis scanty periods Blood Xu Kidney Xu (Yin or Yang Xu) Blood Stasis Phlegm Obstructing Uterus Scanty menses maybe only a drip; pale dilute flow; vague abdominal pain Accompanying S/S: Scanty menses Kid Yang Xu: Kid Yin Xu: Scanty menses; dark clotted flow; dysmenorrhea; abdominal pain worse for pressure relieved with passing of clots Accompanying S/S: Scanty menses with a brownish discharge; period stops and starts; excessive vaginal discharge Accompanying S/S: Endeavour College of Natural Health 29

30 Treatment of Scanty Periods o TCM treatment principles based on your TCM pattern identification o What TCM treatment methods you will choose or combine based on your treatment principles? Acupuncture? Moxibustion? Cupping? Gua sha? Tui Na? Electro acupuncture? Laser acupuncture? Endeavour College of Natural Health 30

31 Treatment of Scanty periods Pattern Identification Principles Methods Blood Xu Kidney Xu (Yin or Yang Xu) Blood Stasis Phlegm Obstructing Uterus Nourish blood Strengthen liver Tonify kidneys Regulate the periods Tonify kidney Yin/yang Regulate the periods Invigorate blood Eliminate stasis Regulate the periods Resolve pheghem Dry dampness Tonify sp Regulate the periods Acupuncture points? Herbal patents? Ba Zhen Tang Acupuncture points? Herbal patents? Zuo Gui Wan; You Gui Wan Acupuncture points? Herbal patents? Tao Hong Si Wu Tang Acupuncture points? Herbal patents? Cang Fu Dao Tan Wan Endeavour College of Natural Health 31

32 Notes The main pathological factors of scanty periods are: Blood deficiency (of the liver) Kidney deficiency (Yin or Yang) Stasis of Blood Phlegm Endeavour College of Natural Health 32

33 Extra slides attached slide34-38 Endeavour College of Natural Health 33

34 Treatment based on the Phase of Menstrual Cycle There are 4 phases in a menstrual cycle in TCM view, each averaging about 7 days; Phase1- Menstrual phase Phase2- Post-menstrual phase Phase3- Mid-cycle phase Phase4- Pre-menstrual phase Regulating the period is the aim of treatment for menstrual disorders, and the treatment principle and methods are different from the other. Endeavour College of Natural Health 34

35 Treatment based on the Phase of Menstrual Cycle Phase 1-- Menstrual phase Day 1-5 Menses Aim: Regulate menses Treatment principle: Invigorate + add points to invigorate the qi & blood circulation Endeavour College of Natural Health 35

36 Treatment based on the Phase of Menstrual Cycle Phase 2-- Post-menstrual phase Day 4-9 Proliferative Stage/hypothermal phase Aim: Promote follicular development treatment principle: nourish yin & blood + add points to nourish blood& kidney yin Endeavour College of Natural Health 36

37 Treatment based on the Phase of Menstrual Cycle Phase 3-- Mid-cycle phase Day10-16 Ovulatory stage/transitional phase Aim: Promote ovulation Treatment principle: Tonify, strengthen + add points to warm the Yang and to Invigorate the qi & blood Endeavour College of Natural Health 37

38 Treatment based on the Phase of Menstrual Cycle Phase 4 -- Pre-menstrual phase Day Aim: Fortify the function of corpus luteum Treatment principle: Move Qi, invigorate blood, warm the uterus + add points to nourish & warm the kidneys and Regulate the Blood and Qi Endeavour College of Natural Health 38

39 Break Endeavour College of Natural Health 39

40 Practical section Endeavour College of Natural Health 40

41 Session 2 Practical Activity o Session review questions: assessment, diagnosis and management plan for each menstruation disorder in this session o Case study based practical skills building up Endeavour College of Natural Health 41

42 Case Study Read the following case history and answer the questions below 29 year old female, accountant and mother of three. After birth of last child two years ago menstrual cycle between days. Flow is heavy, pale and dilute. Accompanying S/S: dizziness, tired, insomnia, palpitations, poor memory. Working for a couple of hours brings on palpitations and dizziness. Appetite, bowels and urination normal. On examination: pale dull complexion, listless, weak. Tongue: pale with thin white coat. Pulse: deep, thin, weak. Endeavour College of Natural Health 42

43 Case Questions What is the TCM diagnosis (Disease and Pattern)? What is the TCM treatment principle based on your diagnosis? What TCM treatment methods will you choose to combine in the management for the patient s condition? Choose at least five acu-points for your acupuncture prescription to treat this condition based on your diagnosis. Give the rationale for the above acupuncture points & demonstrate your appropriate needling techniques. Recommend suitable lifestyle/dietary advice for this condition based on Chinese Medicine theory. Endeavour College of Natural Health 43

44 References o Lyttleton J, 2004 The Treatment of Infertility with Chinese Medicine Churchill Livingstone o West Z, 2008 Acupuncture in Pregnancy and Childbirth, 2 nd edition Churchill Livingstone o Maciocia, G 2011 Obstetrics and Gynecology in Chinese Medicine 2 nd Ed, Elsevier, London o Betts, D 2006 The essential guide to Acupuncture in Pregnancy and Childbirth, Eastland Press, USA Endeavour College of Natural Health 44

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