Tuesday, February 21, 2012

Symptomatic Diagnosis: Female Reproductive

Female reproductive issues make up the bulk of many a Chinese medicine herbalist’s practice. This article describes some of the key symptoms along with their differentiations, treatment principles, and formulas. Complaints include:
Light menstrual flow – Dark purple flow or thick flow – Thick menstrual flow – Thin flow – Early menstruation – Late menstruation – Amenorrhea (lack of period) – Metrorrhagia (heavy flow) – Irregular menstrual cycle – Fever during menstruation


Light menstrual flow

  • qi and blood deficiency

    Clinical Manifestations
    • Light flow, delayed cycle,
    • abdominal aching, fatigue, dizziness
    • T: Pale
    • P: Thready
    • Anemia
    • Heavy flow possible in the case of qi deficiency with no blood deficiency.
    Formula
    • Ba Zhen Tang (Eight Treasure Decoction)
  • Accumulation of phlegm damp

    Clinical Manifestations
    • Light flow, obese patient, irregular cycles,
    • heavy sensation in body
    • T: Swollen tongue body with greasy coat
    • P: Soft and slippery
    Formula:
    • Jia Wei Er Chen Tang (Modified Two Aged Decoction)

 Dark Purple Flow or Thick Flow

  • Qi and blood stagnation

    Clinical Manifestations
    • Dark purple flow with clots, sever abdominal pain, sever PMS symptoms
    • T: Purple
    • P: Choppy
    Formula
    • Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi)
  • Heat and blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    Formula
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach)
  • Cold stagnation leading to blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    • Lower back cold, patient prefers warmth
    • T: White coat
    • P: Deep and tense
    Formula
    • Wen Jing Tang (Warm the Menses Decoction)

Thick Menstrual Flow

  • Qi and blood stagnation

    Clinical Manifestations
    • Dark purple flow with clots, sever abdominal pain, sever PMS symptoms
    • T: Purple
    • P: Choppy
    Formula
    • Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi)
  • Heat and blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    Formula
    • Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach)
  • Cold stagnation leading to blood stagnation

    Clinical Manifestations
    • Thick dark clotty flow
    • Severe abdominal pain, fever, mental symptoms
    • Lower back cold, patient prefers warmth
    • T: White coat
    • P: Deep and tense
    Formula
    • Wen Jing Tang (Warm the Menses Decoction)
  • Damp Heat accumulation

    Clinical Manifestations
    • Dark thick flow, strange oder, burning and itching in the vaginal region.
    • Phlegm accumulation
    • Clinical Manifestations
    • Thick, though not dark flow. Congestion, dizziness, leukorrhea
    • T: Greasy coat
    • P: Slippery

Thin flow (the quality of the blood, see “light”
flow).

Early menstruation (early in the month, not early in life)

  • Blood heat

    Clinical Manifestations
    • Bright red, copious flow. Could lead eventually to very dark red if the heat goes
      untreated.
  • yin deficiency heat in the blood

    Clinical Manifestations
    • scanty quality, red.
  • blood stagnation leading to heat in the blood.

    Clinical Manifestations
    • Clots, abdominal pain
    • Early or late period, heavy or light amount, spotting,
  • qi deficiency

    Clinical Manifestations
    • Light and thin flow.
    • Abdominal pulling or bearing down sensation, fatigue
    • P: Weak

Late menstruation (In the month, not in life)

  • Cold and blood stagnation

    Clinical Manifestations
    • Abdominal pain, patient desires warmth, flow with clots.
    • T: Purple
    • P: Deep, slow, possibly choppy.
  • phlegm/damp accumulation

    Clinical Manifestations
    • Delayed, or lack of menses
    • Pale red thick flow
    • Obesity, indigestion
    • T: Greasy coat
    • P: Soft
  • deficiency of qi and blood

Amenorrhea (Lack of period)

  • Kidney qi deficiency

    Clinical Manifestations
    • Congenital Kidney qi deficiency (Primary amenorrhea)
    • No period as of the 15th birthday
    • Emaciation, Lower back pain, fatigue,
    • slow development
    • P: Weak
    • T: Pale
    Treatment principle
    • Tonify Kidney
  • Qi and blood deficiency

    Clinical Manifestations
    • Usually found after an illness or post partum
    • No pain, no period
    • Palpitations
    • Fatigue, weakness
    • P: Weak
    Treatment principle
    • Tonify qi and blood
    Formula
    • Ba Zhen Tang (Eight Treasure Decoction)
  • Qi and blood stagnation

    Clinical Manifestations
    • Amenorrhea following traumatic injury or stress.
    • Lots of distention and pain
    • fatigue, depression, anger
    • T: Varies
    • P: Deep and wiry
  • Damp and phlegm accumulation

    Clinical Manifestations
    • Menopausal symptoms
    • Delayed cycle, quantity of flow is light.
    • Amenorrhea, weight gain, water retention
    • T: Pale with white greasy coat
    • P: Soft and slippery

Metrorrhagia (heavy flow)

  • Qi and blood deficiency

    Clinical Manifestations
    • Heavy quantity, thin quality and light color.
  • Heat in blood

    Clinical Manifestations
    • Dark Red flow
    • blood stagnation
    • Clinical Manifestations
    • Irregular flow, spotting, dark purple color clots, pain in abdomen, which gets better
      after the onset of the flow.
    • T: Purple
    • P: Deep and choppy, or wiry and slippery

Irregular Menstrual cycle

  • Liver qi stagnation (accounts for 95% of cases)

    Formula
    • Xiao Yao San (Rambling Powder)
  • Kidney qi deficiency

Fever during menstruation

  • Liver qi stagnation with Liver fire (most common)

    Clinical Manifestations
    • Fever alternating with chills, more often before period, sometimes during.
    • Early or irregular cycle, irritation, dizziness
    • Thirst, dry mouth
    • T: Red with yellow coat
    • P: Wiry and Rapid
      • Jia Wei Xiao Yao San (Modified Rambling Powder) (aka Dan Zhi Xiao Yao San)
    • Formula
  • Yin deficiency Fever

    Clinical Manifestations
    • Fever following illness of post partum.
    • This fever tends to happen before or during the period.
    • Emaciation, irritability, dry mouth, thirst.
    • T: Red and thin
    • P: Thready and rapid
      • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)
    • Formula
  • Wind cold

    Clinical Manifestations
    • Chong and Ren channels are weak just prior to menses
    • Tai yang syndrome
    Formula
    • Gui Pi Tang (Bolster the Spleen Decoction) even if there’s no sweating.
    • Xiao Chai Hu Tang if fever is also associated with chills.
  • blood stagnation before or during period

    Clinical Manifestations
    • Abdominal pain, dark complexion
    • Flow is purple with clots.
    Formula
    • Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction)
  • Qi deficiency or qi and blood deficiency fever

    Clinical Manifestations
    • Fever before or during the period
    • Light color and thin quality, scanty quantity
    • T: Pale
    • P: Weak
    Formula
    • Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)

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