Amenorrhea

Menstrual flow begins at about fourteen in healthy girls . Menstruation that does not come until 18 or suppression of menstruation for over three months is called amenorrhea . Stop of menses during gestation period and lactation period is of normal physiological phenomena . The causative factors of amenorrhea fall into deficiency and excess types . The deficiency type is mostly seen due to deficiency of blood , and the excess type is caused by excessive pathogenic factors obstructing the passage of menses .

The clinical differentiation and treatment are usually conducted in the light of blood stagnation and blood depletion .

Etiology and Pathogenesis

a ) Blood stagnation : It is due to the seven emotional disturbances , stagnation of liver qi , resulting in retardation of both qi and blood in the uterus and obstruction in the passage of menses .

b ) Blood depletion : Improper intake of food or overstrain undermines the reproducing source of qi and blood , severe or chronic diseases that consume blood , or by grand multipara or indulgence in sexual life that exhaust essence and blood , all of which may drain the sea of blood , deprive the Chong and Ren Meridians of nourishment and result in amenorrhea .

Differentiation

a ) Blood stagnation : Main manifestations : Absence of menses for months , lower abdominal distending pain aggravated by pressure , hard mass in lower abdomen , distension and fullness in the chest and hypochondriac region , dark purple tongue coating with purplish spots on its borders , deep string - taut pulse .

Analysis : Worry and anger cause qi stagnation and failure of it to control blood , bringing on blockage of the Chong and Ren Meridians and amenorrhea . The abnormal function of qi gives rise to lower abdominal distending pain and fullness in the chest and epigastrium . Blood stasis retaining in the sea of blood binders menstrual flow , manifested by the abdominal pain aggravated by pressure and hard mass in the lower abdomen . Purple tongue coating with purplish spots on its borders and deep string - taut pulse are signs of stagnation of qi and blood .

b ) Blood depletion : Main manifestations : Delayed menstrual cycle , gradual decrease of menses and amenorrhea , sallow complexion in prolonged cases , lassitude , vertigo and dizziness , poor appetite , loose stools , dry skin , pale tongue with white coating , slow weak pulse , all of which are signs of deficiency of qi and blood : dizziness and tinnitus , sore and weak low back and knees , dry mouth and throat , hot sensation in the palms , soles and epigastrium , afternoon fever and night sweating , pale tongue with little coating , string - taut and thready pulse , all of which are signs of deficiency of essence and blood .

Analysis : Blood is transferred from food through the function of transportation and transformation of the spleen , and dysfunction of the spleen leads to blood deficiency . Blood deficiency causes malnutrition of the Chong and Ren Meridians and the void ness in the sea of blood . Hemorrhage causes exhaustion of blood , and finally delayed menstrual cycle and the gradual decrease of menses till amenorrhea . Blood deficiency Fails to nourish the muscles , skin and head , bringing on sallow complexion , dry skin , vertigo and dizziness and lassitude . Dysfunction of transportation and transformation of the spleen gives rise to poor appetite and loose stools . Pale tongue with white coating and slow , weak pulse are signs of blood depletion . Since the kidney dominates bone and marrow , while the brain is the sea of marrow , deficiency in the kidney may lead to dizziness , tinnitus , sore and weak low back and knees . Yin deficiency produces internal heat manifested by the dry mouth and throat , hot sensation in palms , soles and epigastrium , afternoon fever and the night sweating . Pale tongue and string - taut thready pulse are signs of deficiency of essence and blood .

Treatment

a ) Blood stagnation : Method : Points of the Ren , Foot - Taiyang and Foot - Jueyin Meridians are selected as the principal points . Acupuncture with the reducing method is used to remove the stagnation and regulate the circulation ofqi and blood in the meridians .

Prescription : Zhongji ( Ren 3 ) , Guilai ( S 29 ) , Xuehai ( Sp 10 ) , Taichong ( Liv 3 ) , Hegu ( Li 4 ) , Sanyinjiao ( Sp 6 ) . Supplementary points : Pain in the lower abdomen with hard mass aggravated by pressure : Siman ( K 14 ) .

Explanation : Zhongji ( Ren 4 ) , an intersecting point of the three foot - yin meridians , may regulate the Chong and Ren Meridians and dredge the blockage from the lower jiao . Guilai ( S 29 ) is chosen as a local point to remove blood stasis from the uterus . Xuehai ( Sp 10 ) and Taichong ( Liv 3 ) applied together can regulate the liver qi , and relieve stagnation and stasis . Hegu ( Li 4 ) and Sanyinjiao ( Sp 6 ) can get qi and blood down to restore the normal menstruation . Siman ( K 14 ) may be added when there is pain and hard mass in the lower abdomen aggravated on pressure .

b ) Blood depletion : Method : Select points of the Ren , Liver , Spleen and Kidney Meridians . Acupuncture is used with the reinforcing method . Moxibustion is applied sometimes to tonify blood and restore menses .

Prescription : Guanyuan ( Ren 4 ) , Ganshu ( B 18 ) , Pishu ( B 20 ) , Shenshu ( B 23 ) , Zusanii ( S 36 ) , Sanyinjiao ( Sp 6 ) .

Explanation : The spleen , the foundation of the acquired essence , abstracts nutrient particles from food and transforms them into qi and blood . When blood supply is abundant the menstrual cycle is normal . So Pishu ( B 20 ) , Zusanii ( S 36 ) and Sanyinjiao ( Sp 6 ) are selected to strengthen the function of the spleen and stomach . The kidney is the foundation of congenital essence , and ample kidney qi guarantees sufficient qi and blood . For this reason Shenshu ( B 23 ) and Guanyuan ( Ren 4 ) are chosen to replenish kidney qi . Ganshu ( B 18 ) is selected to promote the blood in the liver , where blood is stored . When the spleen , liver and kidney carry out well their functions of controlling blood , storing blood and essence respectively , the Chong and Ren Meridians are well nourished and amenorrhea is cured .

Remarks

Included in this disease is amenorrhea resulted from endocrinal and neuropsychiatrical factors .