Obstetrics amp Gynecology in Chinese Medicine Maciocia Dysmenorrhea Characterized by cramping pains in the lower abdomen preceding during or following menstruation Pain may extend through the lower back to the sacral region ID: 999580
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1. GynecologyClass 2Practical Therapeutics of TCM, WuObstetrics & Gynecology in Chinese Medicine, Maciocia
2. DysmenorrheaCharacterized by cramping pains in the lower abdomen, preceding, during or following menstruationPain may extend through the lower back to the sacral region In severe cases, pain can cause fainting
3. Etiology & PathogenesisCoagulation of Cold & DampnessStagnation of Liver QiDescent of Damp HeatVacuity of Yang with Internal ColdVacuity of Liver and KidneyVacuity of Qi and Blood
4. Coagulation of Cold & DampnessClinical Manifestations:Cold and pain of the lower abdomen, preceding or during menstruation; pain worse with pressure; some relief with application of external heat; scanty menstrual discharge, dark in color, clots, aversion to cold and occasionally body aches and pains.Tongue: white slimy coating; Pulse: deep, tightTxWarm the vessels, dissipate cold, dispel dampness, dispel blood stasis, relieve pain
5. Coagulation of Cold & Dampness (2)Acupuncture RxRen-3; St-28; Sp-8Severe pain: Ub-32; St-29Abodminal Pain extending through low back: Du-4; Ub-23Herbal RxShao Fu Zhu Yi Tang (Lesser Abdomen Stasis Expelling Decoction)Dang Gui, Chi Shao, Pu Huang, Mo Yao, Chuan Xiong, Wu Ling Zhi; Yan Hu Suo; Gan Jiang, Rou Gui, Xiao Hui XiangFortify Spleen & Dispel Damp: Cang Zhi; Fu LingSevere pain, fainting, cold extremities, cold sweat: Zhi Fu Zi
6. Liver Qi StagnationClinical ManifestationsDistending pain in the lower abdomen preceding or during menstruation , worse with pressure, difficult menstruation, scanty menstrual discharge that is dark purple, clots, decreased pain on expulsion of clots, disappearance of pain with termination of period. May have distending sensation in the chest, hypochondria, and breastsTongue: dark, thin white coating, Pulse: deep, wiry or slippery, wiryTx:Sooth Liver, Rectify Qi, Dispel Blood Stasis, Relieve Pain
7. Liver Qi Stagnation (2)Acupuncture RxRen-6; Liv-3; Sp-6Abdominal distention & fullness: GB-34; GB-37Chest Oppression: PC-6Herbal RxGe Xia Zhu Yu TangWu Ling Zhi, Dang Gui, Tao Ren, Hong Hua, Chuan Xiong, Mu Dan Pi, Wu Yao, Xiang Fu Zi; Chi Shao, Zhi Ke, Yan Hu Suo, Gan Cao
8. Liver Qi Stagnation (3)Liver Qi Stagnation giving rise to heat, bitter taste in mouth, tongue – thick yellow coating, lengthened menstrual period with blackish- purple thick sticky discharge: Shan Zhi Zi, Xia Ku Cao, Yi Mu CaoHeaviness & distention in urethral and anal region: chuan lian zi; Chai HuLiver Depression attacks Spleen with oppression in the chest and loss of appetite: Bai Zhu; Fu Ling; Chen PiSevere Pain w/ nausea & vomiting: Wu Zhu Yu, Huang Lian, Sheng Jiang
9. Descent of Damp-HeatClinical Manifestations Lower abdominal pain preceding menstruation, pain worse with pressure, burning sensation or distending pain in the lower back and sacrum. Can have recurrent pain in the lower abdomen that becomes more severe with the onset of menstruation.Thick blackish-red menstrual discharge, clots thick yellowish leukorrhea, scanty concentrated urine, mild feverTongue: Red, with yellow slimy coat Pulse: rapid, wiry or rapid, slippery
10. Descent of Damp-Heat (2)TxClear Heat, Dispel Dampness, Dispel Blood Stasis, Relieve PainAcupuncture RxRen-3; Sp-8; St-29; Liv-3; UB-32; LI-4Herbal RxQing Re Tiao Xue TangMu Dan Pi, Sheng Di Huang, Bai Shao, Huang Lian, Dang Gui, Chuan Xiong, Hong Hua, Tao Ren, E Zhu, Xiang Fu Zi, Yan Hu SuoReinforce Heat Clearing & Damp Dispersal: Hong Teng, Bai Jiang Cao, Yi Yi Ren
11. Vacuity of Yang With Internal ColdClinical ManifestationsCold and pain of the lower back during or following menstruation, some pain relief with pressure or application of external heat, small volume of dark colored menstrual discharge, weak aching low back and legs, copious clear urineTongue: white, moist coating Pulse: deepTxWarm the Channels, Warm the Uterus, Relieve Pain
12. Vacuity of Yang With Internal Cold (2)Acupuncture RxUB-23; Ren-4; St-36; Sp-6; Ren-3; Sp-8Herbal RxWen Jing TangWu Zhu Yu; Dang Gui, Bai Shao, Chuan Xiong, Ren Shen, Sheng Jiang, Mai Men Dong, Mu Dan Pi, Zhi Ban Xia, Gui Zhi, E Jiao, Gan CaoIncrease ability to warm the kidney and uterus, dissipate cold and relieve pain: Zhi Fu Zi, Ai Ye, Xiao Hui XiangCold Extremities, Pale and greenish face, tender pale tongue: Mai Men Dong, E Jiao
13. Vacuity of Liver & KidneyClinical ManifestationsIndistinct lower abdominal pain preceding or following menstruation, pain better with pressure, thin light colored menstrual discharge, aching of the lower back and spine, general fatigue, dizzy spells, tinnitus, some cases tidal fever.Tongue: Pale Pulse: Deep, thready or weak, threadyTxSupplement Liver & Kidney, Regulate & Rectify the Chong & Ren, Relieve Pain
14. Vacuity of Liver & Kidney (2)Acupuncture RxUB-18; UB-23, Ren-4; St-36; Kid-6Dizziness & tinnitus: GB-39; Kid-3Lower abdominal pain: Kid-12; Kid-13Herbal RxTiao Gan TangDang Gui; Bai Shao, Shan Zhu Yu, Ba Ji Tian, Shan Yao, Zhi Gan Cao, E JiaoPain extending through low back & sacrum: Xu Duan, Du ZhongDistending Pain in Costal or Lateral Lower abdomen: Chuan Lian Zi, Yan Hu Suo, Xiao Hui Xiang, Yu Jin
15. Vacuity of Qi & BloodClinical ManifestationsIndistinct lower abdominal pain either during or following menstruation, some relief with pressure, empty and bearing down sensation in the lower abdominal and pubic regions, scanty menstrual discharge that is light and thin in texture, tiredness, fatigue, occasionally dull complexion, loss of appetite, or diarrhea.Tongue: Pale Pulse: weak, threadyTxSupplement Qi & Blood; Relieve Pain
16. Vacuity of Qi & Blood (2)Acupuncture RxNeedle with Supplementation; add moxaUB-23; Ren-4; St-36; Sp-6Herbal RxSheng Yu TangHuang Qi, Ren Shen, Dang Gui, Chuan Xiong, Shu Di, Sheng Di HuangIncrease pain relief: (delete: Sheng Di) Add: Bai Shao, Xiang Fu Zi, Yan Hu Suo
17. Vacuity of Qi & Blood (3)Blood vacuity & Liver Qi Stagnation; pain in the costal regions, distending sensation in the breasts and distending pain in the lower abdomen: Chai Hu; Chuan Lian Zi; Xiao Hui Xiang, Wu YaoSevere Blood Vacuity, dizziness, vertigo, palpitations, insomnia: Ji Xue Teng; Suan Zao Ren; Da ZaoKidney Vacuity weak aching lower back and legs: Tu Su Zi, Xu Duan, Sang Ji Sheng
18. AmenorrheaGynecological disorders where menstruation has not begun by 18 or where the menstrual cycle has been interrupted for 3 months or longer.Amenorrhea not applicable: pregnancy, breastfeeding, menopause, and in young woman a cessation for a while after menarche
19. Etiology & PathogenesisVacuity of Kidney & LiverDepletion of Yin & Dryness of BloodVacuity of Qi & BloodStagnation of Qi & Stasis of BloodObstruction by Phlegm-Dampness
20. Vacuity of Liver & KidneyClinical ManifestationsAbsence of initial menstruation by 18 or late menstruation where the menstrual discharge gradually decreases to the point where menstruation does not occur, weak physical constitution, lower backache, weakness of the legs, dizziness, vertigo, tinnitus.Tongue: Pale, with little red coatingPulse: deep, weak or rough, threadyTxSupplement the Kidney, Nourish the Liver, Regulate Menstruation
21. Vacuity of Liver & Kidney (2)Acupuncture RxUB-18; UB-23; UB-17; Ren-4; Sp-6Aching lower back & knees: Du-4; Kid-10; Yao YanHerbal RxGui Shen WanTu Su Zi, Du Zhong, Di Gu Pi, Shan Zhu Yu, Dang Gui, Shu Di Huang, Shan Yao, Fu LingEnhance Liver Blood Supplementation: Ji Xue Teng, He Shou Wu
22. Depletion of Yin& Dryness of BloodClinical ManifesationsGradual decrease in menstrual discharge until menstruation no longer occurs, vexing heat in the five hearts, flushed cheeks, dry mouth and throat, night sweating, steaming bone fever, can be cough with blood streaked phlegmTongue:: red with little coating Pulse: rapid, threadyTxNourish Yin, Clear Heat, Regulate Menstruation
23. Depletion of Yin& Dryness of Blood (2)Acupuncture RxUB-18; UB-23; UB-17; Sp-6; Kid-6Tidal Fever, coughing, night sweating: UB-43; Kid-2Herbal RxJia Jian Yi Yin JianSheng Di, Shu Di, Bai Shao, Mai Men Dong, Zhi Mu, Di Gu Pi, Zi Gan CaoNourish Yin & Rectify Qi & Blood: Huang Jing, Dan Shen, Zhi KePronounced Restlessness & Tidal Fever: Bie Jia, Qing Hao
24. Depletion of Yin& Dryness of Blood (3)Coughing with blood streaked phlegm: Chuan Bei Mu, Wu Wei Zi, Bai He, E JiaoRestlessness, Insomnia, Palpitations: Bai Zi Ren, Ye Jiao TengRepletion heat has scorched yin resulting dryness of blood and amenorrhea: Xuan Shen, Huang Bai
25. Vacuity of Qi & BloodClinical ManifestationsGradual Lengthening of the menstrual cycle, light menstrual discharge pale in color and thin consistency with menses eventually ceasing. Symptoms: dizziness, vertigo, blurred vision, palpitations, shortness of breath, tiredness, fatigue, loss of appetite, loos stools, loss of luster of the hair (sometimes loss of hair), emaciation, sallow complexionTongue: pale with white coating Pulse: weak, threadyTxSupplement Qi, Nourish the Blood, Regulate menstruation
26. Vacuity of Qi & Blood (2)Acupuncture RxRen-4; Ub-20; St-36; Sp-6; Sp-10Loss appetite & loose stools: Ren-12; St-25Herbal RxRen Shen Yang Rong TangRen Shen, Bai Zhu, Fu Ling, Huang Qi, Shu Di, Dang Gui, Bai Shao, Chen Pi, Rou Gui, Wu Wei Zi, Yuan Zhi, Sheng Jiang, Da ZaoAmenorrhea b/c of post-partum loss of blood, qi and blood vacuity sx; apathy, lack of vaginal mucous, loss of pubic hair, decreased libido, atrophy of reproductive organs (exhaustion of essence and blood, insufficiency of kidney qi and degeneration of Chong & Ren): Lu Rong, Lu Jiao Jiao, Zi He Che
27. Qi Stagnation &Blood StasisClinical ManifestationsCessation of menstruation, psychological depression, irritability, distention & fullness in the chest & costal region, lower abdominal distention with pain that is worse with pressureTongue: Darl, purplish, sometimes stasis macules on the tongue body Pulse: deep, wiry or deep, roughTxRectify Qi, Quicken the Blood, Dispel Stasis, Free Menstruation
28. Qi Stagnation &Blood Stasis (2)Acupuncture RxNeedle with draining: Ren-3; Sp-8; LI-4; Sp-6; Liv-3; Sp-10Lower abdominal distention or pain worse with pressure accompanied by internal mass: Ren-6; Kid-14Distention & fullness of chest & costal regions: Liv-14; Sj-6Herbal Rx:Xue Fu Zhu Yu TangTao Ren, Hong Hua, Dang Gui, Sheng Di, Chuan Xiong, Chi Shao, Niu Xi, Jie Geng, Chai Hu, Zhi Ke, Gan Cao
29. Qi Stagnation &Blood Stasis (3)Predominant Qi Stagnation, severe distention of the chest, costal and lower abdominal regions: Qing Pi, E Zhu, Mu XiangPredominant Blood Stasis, severe lower abdominal pain worse with pressure: Jiang Huang, San LengWen Jing TangCoagulation of cold and blood stasis, lack of warmth of limbs, lower abdominal cold & pain, white coating, deep tight pulseWu Zhu Yu, Dang Gui,Bai Shao, Chuan Xiong, Ren Shen, Sheng Jiang, Mai Men Dong, Mu Dan Pi, Zhi Ban Xia, Gui Zhi, E JiaoAccumulation of repletion of heat leading to blood stasis, burning sensation & pain in the lower abdomen, yellow vaginal discharge, yellow tongue coating, rapid pulse: Huang Bai, Bai Jiang Cao, Mu Dan Pi
30. Obstruction by Phlegm-DampnessClinical ManifestationsCessation of menstruation, obesity, fullness and oppression in the chest and costal regions, nausea and vomiting, excessive phlegm, tiredness, fatigue, excessive white vaginal discharge edema of the face and feetTongue: white greasy coating Pulse: slipperyTxExpel phlegm, dispel dampness, rectify qi, quicken the blood, free menstruation
31. Obstruction by Phlegm-Dampness (2)Acupuncture RxRen-3; Sp-8; St-40; Sp-6; LI-4; St-36Excessive white vaginal discharge: UB-32Herbal Rx (two formulae combined)Cao Fu Dan Tan TangCang Zhu, Xiang Fu Zi, Fu Ling, Fa Ban Xia, Chen Pi, Dan Xing, Zhi Ke, Spirit2 qu (?), Sheng Jiang, Zhi Gan CaoFo Shou SanFo Shou Gan, Dang Gui, Chuan Xiong