Wk 4 - Prolonged Menstrual Periods and Menorrhagia

These flashcards cover the key terms and concepts related to prolonged menstrual periods (Menostaxis) and increased menstrual flow (Menorrhagia), including definitions, related conditions, and treatment principles.

Menostaxis

Refers to prolonged menstrual bleeding, lasting more than 7 days and up to 2 weeks.

Menorrhagia

Increased menstrual flow without abnormal changes in the regularity of the menstrual cycle. It may involve soaking through one or more sanitary pads or tampons every hour for several consecutive hours.

Pelvic Inflammatory Disease (PID)

An infection of the female reproductive organs that can cause prolonged menstrual periods.

Hysteroscopy

A procedure used to examine the inside of the uterus, often part of the diagnostic process for menstrual irregularities. It involves the insertion of a hysteroscope through the vagina and cervix into the uterus.

Endometriosis

A condition in which tissue similar to the lining of the uterus grows outside the uterus, causing pain and heavy periods.

Thyroid Dysfunction

A condition that can influence menstrual irregularities and should be considered in differential diagnosis.

Disease Patterns Contributing to Menostaxis

Menostaxis, or prolonged menstrual flow, can be attributed to several Traditional Chinese Medicine (TCM) disease patterns, including:

1. Qi Deficiency: Leading to an inability to hold and restrain blood.

2. Yin Deficiency + Heat: Causing agitation of Blood and reckless flow.

3. Blood Stasis: Obstructing the smooth flow of Qi and Blood, resulting in prolonged discharge.

Menostaxis d/t Qi Deficiency - Pathomechanism

Insufficient Spleen Qi (responsible for 'holding' blood) leads to failure in restraining menstrual blood, resulting in prolonged or heavy flow. This often involves the Chong and Ren Mai.

Menostaxis d/t Qi Deficiency - Clinical Presentation

Symptoms include pale or light-red menstrual blood, prolonged but possibly scanty flow, fatigue, shortness of breath, a weak and possibly thready pulse, and a pale tongue with thin white coating.

Menostaxis d/t Qi Deficiency - Herbal Treatment

Focuses on strengthening Qi and consolidating the Chong and Ren Mai. Formulas like Jia Yuan Jian (strengthens Qi, regulates menstruation), Buzhong Yiqi Tang, or Gui Pi Tang are common.

Menostaxis d/t Qi Deficiency - Acupuncture Points

Points to tonify Spleen Qi and consolidate the Chong and Ren Mai typically include:\n1. SP6 (Sanyinjiao): harmonizes Spleen, Liver, Kidney\n2. ST36 (Zusanli): strengthens Spleen/Stomach\n3. RN6 (Qihai): tonifies Qi\n4. GB26 (Daizong): regulates Dai Mai\n5. BL20 (Pishu): Spleen Shu point\n6. BL21 (Weishu): Stomach Shu point

Menostaxis d/t Yin Deficiency + Heat - Pathomechanism

Lack of Yin fails to anchor Yang, leading to Xu Heat (Empty Heat) within the blood. This heat agitates the blood, causing it to flow recklessly and resulting in prolonged, often heavier, menstrual bleeding.

Menostaxis d/t Yin Deficiency + Heat - Clinical Presentation

Symptoms include bright red menstrual blood, prolonged flow, a sensation of heat or flushing (especially in the evening), sweating, thirst, a rapid and thready pulse, and a red tongue with little or no coating.

Menostaxis d/t Yin Deficiency + Heat - Herbal Treatment

Aims to nourish Yin, clear heat, and stop bleeding. Formulas like Liang Di Tang (nourishes Yin, clears heat) or Da Bu Yin Wan are often used, possibly with E Jiao (stops bleeding, nourishes blood).

Menostaxis d/t Yin Deficiency + Heat - Acupuncture Points

Points to nourish Yin, clear empty heat, and cool blood:\n1. KI3 (Taixi): nourishes Kidney Yin\n2. SP6 (Sanyinjiao): nourishes Yin, cools blood\n3. RN4 (Guanyuan): tonifies Kidney essence\n4. HT6 (Yinxi): clears heat\n5. LIV3 (Taichong): moves Liver Qi, cools blood heat (when stagnation contributes to heat)

Menostaxis d/t Blood Stasis - Pathomechanism

Obstruction in the flow of Qi and Blood within the uterus leads to accumulated 'stasis.' This stagnation creates pressure, causing blood to flow out erratically and prolongedly, or it prevents the proper shedding of the uterine lining.

Menostaxis d/t Blood Stasis - Clinical Presentation

Symptoms include dark purple or clotted menstrual blood, severe lower abdominal pain (relieved by passage of clots), possibly distention, a choppy or wiry pulse, and a dark/purple tongue or with purple spots.

Menostaxis d/t Blood Stasis - Herbal Treatment

Focuses on invigorating blood, dispelling stasis, and moving Qi. Formulas like Xue Fu Zhu Yu Tang, Tao Hong Si Wu Tang, or Ge Xia Zhu Yu Tang are common, potentially with herbs like Chuan Xiong or Tao Ren.

Menostaxis d/t Blood Stasis - Acupuncture Points

Points to invigorate blood, break stasis, and regulate Qi:\n1. SP10 (Xuehai): invigorates blood, resolves stasis\n2. SP6 (Sanyinjiao): moves blood, regulates uterus\n3. LIV3 (Taichong): moves Qi and blood\n4. BL17 (Geshu): influences blood\n5. RN3 (Zhongji): regulates uterus, moves Qi/blood in lower abdomen\n6. Zigong (Extra point): regulates uterus

Disease Patterns Contributing to Menorrhagia

Menorrhagia, or heavy menstrual bleeding, can be attributed to several Traditional Chinese Medicine (TCM) disease patterns, including:

1. Qi Deficiency: Leading to an inability to restrain blood.

2. Blood Heat: Causing agitation of Blood and reckless flow.

3. Blood Stasis: Obstructing the smooth flow of Qi and Blood, resulting in prolonged or heavy discharge.

Qi Deficiency (Menorrhagia) - Pathomechanism

Insufficient Spleen Qi (responsible for 'holding' blood) leads to failure in restraining menstrual blood, resulting in abnormally heavy menstrual flow. This often involves the Chong and Ren Mai.

Qi Deficiency (Menorrhagia) - Clinical Presentation

Symptoms include pale or light-red menstrual blood, profuse flow, fatigue, shortness of breath, a weak and possibly thready pulse, and a pale tongue with thin white coating. Bleeding may worsen with exertion.

Qi Deficiency (Menorrhagia) - Herbal Treatment

Focuses on strengthening Qi and consolidating the Chong and Ren Mai. Formulas like Buzhong Yiqi Tang (tonifies Middle Jiao Qi), Gui Pi Tang (tonifies Spleen Qi and nourishes Blood), or Jia Yuan Jian are common. Herbs like Huang Qi or Dang Shen.

Qi Deficiency (Menorrhagia) - Acupuncture Points

Points to tonify Spleen Qi and consolidate the Chong and Ren Mai typically include:

1. SP6 (Sanyinjiao): harmonizes Spleen, Liver, Kidney, benefits blood

2. ST36 (Zusanli): strengthens Spleen/Stomach Qi

3. RN6 (Qihai): tonifies Qi

4. BL20 (Pishu): Spleen Shu point

5. BL21 (Weishu): Stomach Shu point

6. SP1 (Yinbai): stops bleeding (especially with moxa)

Blood Heat (Menorrhagia) - Pathomechanism

Excessive heat in the blood agitates its flow, causing it to override the restraining function of Qi, leading to profuse and heavy menstrual bleeding. This heat can be from excess or deficiency (Yin Deficiency leading to Empty Heat).

Blood Heat (Menorrhagia) - Clinical Presentation

Symptoms include bright red or dark red menstrual blood, profuse and possibly rapid flow, a sensation of heat, fever, thirst, dark urine, a rapid pulse, and a red tongue (possibly with a yellow coating). Bleeding may be sudden and heavy.

Blood Heat (Menorrhagia) - Herbal Treatment

Aims to clear heat, cool blood, and stop bleeding. Formulas like Xian Fang Huo Ming Yin, Qing Re Gu Chong Tang, or Liang Di Tang (if Yin Deficiency is present) are often used. Herbs like Sheng Di Huang, Zhi Mu, or E Jiao.

Blood Heat (Menorrhagia) - Acupuncture Points

Points to clear heat, cool blood, and stop bleeding:

1. SP10 (Xuehai): invigorates and cools blood

2. SP6 (Sanyinjiao): harmonizes Spleen, Liver, Kidney; cools blood

3. KI2 (Rangu): clears Kidney Empty Heat (if applicable)

4. BL17 (Geshu): influences blood (often combined with SP10)

5. LIV2 (Xingjian): clears Liver Fire/Heat

6. RN3 (Zhongji): regulates uterus, clears heat from lower Jiao

Blood Stasis (Menorrhagia) - Pathomechanism

Obstruction of blood flow in the uterus leads to accumulation of stagnant blood. This stasis can cause blood to extravasate, leading to heavy menstrual bleeding, or it can prevent proper shedding, causing excessive flow as the body tries to expel it.

Blood Stasis (Menorrhagia) - Clinical Presentation

Symptoms include dark purple or clotted menstrual blood, severe lower abdominal pain (often relieved by passage of clots), distention, a choppy or wiry pulse, and a dark/purple tongue or with purple spots. Flow may be gushing or irregular.

Blood Stasis (Menorrhagia) - Herbal Treatment

Focuses on invigorating blood, dispelling stasis, and moving Qi. Formulas like Xue Fu Zhu Yu Tang, Tao Hong Si Wu Tang, or Ge Xia Zhu Yu Tang are common. Herbs like Chuan Xiong, Tao Ren, Hong Hua, or Yi Mu Cao.

Blood Stasis (Menorrhagia) - Acupuncture Points

Points to invigorate blood, break stasis, and regulate Qi:

1. SP10 (Xuehai): invigorates blood, resolves stasis

2. SP6 (Sanyinjiao): moves blood, regulates uterus

3. LIV3 (Taichong): moves Qi and blood

4. BL17 (Geshu): influences blood

5. RN3 (Zhongji): regulates uterus, moves Qi/blood in lower abdomen

6. Zigong (Extra point): regulates uterus, moves blood