Gynecological and Pediatric Diseases
DYSMENORRHEA
Shao Jing-ming’s Medical Record
Li, female, 22
[Chief Complaint]
Dysmenorrhea for eight years
[Present Medical History]
This patient’s first menarche was at the age of 14; it was painful. She did not have treatment because the pain was not serious at that time. Four years ago, after being caught in the rain during her period the pain became worse. She took western medicine which stopped the pain, but when menstruating she would still have severe abdominal pain. Her lower abdomen felt cold; she had scanty menstrual flow that was dark in colour with clots. Recently, her menstrual pain was unendurable. Her limbs were cold and there was a cold pain in her lower abdomen. So, she came in for treatment.
[Examination]
Slim build, with a pained expression on her face, sweating from the head; the tongue was slightly dark, with a thin coating, the pulse was wiry
[Diagnosis]
Dysmenorrhea (due to cold stagnated in the uterus)
[Treatment Principles]
Warm the channels to dispel cold, move the qi to activate blood
[Treatment]
RN 4 (guān yuán) | SP 6 (sān yīn jiāo) | BL 32 (cì liáo) |
The lifting, thrusting and rotating method of tonification and draining was used. Moxibustion was applied as well.
RN 4 (guān yuán) was inserted to a depth of 1.5 inches, causing the arrival of the needle sensation in the perineum. SP 6 (sān yīn jiāo) was inserted perpendicularly 1~1.5 inches, causing the needling sensation to travel to the sole of the foot. BL 32 (cì liáo) was inserted 1.5~2 inches into the posterior sacral foramen, resulting in the needling sensation to travel to the lower abdomen and perineum.
Her pain was immediately relieved after the arrival of qi and disappeared 10 minutes later. The needle was retained for 30 minutes and manipulated twice in that time. Later, she was treated regularly from 3 to 5 days before her menses till it started, in succession for three periods, after which she was cured. A two year follow-up failed to find any recurrence of the pain.
[Note]
TCM holds that dysmenorrhea is caused by the obstruction of qi and blood. The pathogenic factors leading to obstruction of qi and blood are cold damp retention, liver qi stagnation, qi and blood deficiency and so on. This patient’s dysmenorrhea is due to cold obstructed in the uterus. RN 4 (guān yuán) is used to tonify the kidney yang to dispel cold, circulate qi and regulate her menstruation. SP 6 (sān yīn jiāo) is used to strengthen the spleen to circulate qi and activate blood. BL 32 (cì liáo) is to regulate the lower jiao and adjust the chong and ren vessels.
Liang Ci-ming’s Medical Record
Yao, female, 23
[Chief Complaint]
Lower abdominal pain during menstruation
[Present Medical History]
[Examination]
Pulse was deep and slow
[Diagnosis]
Dysmenorrhea (due to cold retention, qi stagnation)
[Treatment Principles]
Reinforce qi, invigorate the blood, dispel cold, stop pain
[Note]
Pathogenic cold and qi stagnation block the uterus, causing the menstrual flow not to be smooth, thus there is dysmenorrhea. LI 4 (hé gŭ) is the yuán-source point of the hand yangming; it is full of qi and blood. SP 6 (sān yīn jiāo) is the point of the foot taiyin that is closely related with blood. As the left side is that of blood while the right side is of qi; right LI 4 (hé gŭ) and left SP 6 (sān yīn jiāo) are used to tonify qi and invigorate blood. When the cold is dispelled, the pain will naturally stop on its own.
Summary
Dysmenorrhea refers to pain in the lower abdomen and low back before, after or during menstruation. Acupuncture – moxibustion is effective for its treatment, not only to immediately stop the pain, but also to improve the long-term condition of the patient. Pain before or during the menstruation is mostly due to the excess syndromes of cold retention and/or qi stagnation; while the pain after menstrual flow is usually from deficiency. Cold excess should be treated by warming the channels to dispel cold; qi stagnation should be treated by regulating qi to remove stasis. Deficiency syndromes should be treated through regulating and tonifying
the liver and kidney and by nourishing qi and blood. Acupuncture – moxibustion should be applied once a day, 3 to 5 days before the onset of menstruation, until the flow comes. For those with severe or prolonged cases, acupuncture – moxibustion should be given for at least 3 to 4 cycles.
the liver and kidney and by nourishing qi and blood. Acupuncture – moxibustion should be applied once a day, 3 to 5 days before the onset of menstruation, until the flow comes. For those with severe or prolonged cases, acupuncture – moxibustion should be given for at least 3 to 4 cycles.
Main points: RN 4 (guān yuán), SP 6 (sān yīn jiāo), LV 3 (tài chōng).
RN 3 (zhōng jí), BL 32 (cì liáo) and SP 8 (dì jī) are added for those cases of abdominal pain made worse by pressure. PC 6 (nèi guān), GB 34 (yáng líng quán) and RN 6 (qì hăi) are added for cases of pain which involve the hypochondrium and breasts. BL 23 (shèn shù) and ST 36 (zú sān lĭ) are added for cases of abdominal pain with soreness in the lower back.
AMENORRHEA
Record in Acupuncture – Moxibustion for Difficult Diseases (Qí Nán Zá Bìng Zhēn Jiŭ Zhì Liáo)
Yan, female, 43, first visit was on October 12, 1980
[Chief Complaint]
Amenorrhea for half a year
[Present Medical History]
This patient usually has normal menstrual cycles; colour, quantity and quality of the blood are normal. Half a year ago, while she had her cycle she went swimming, and the period suddenly stopped. She had accompanying soreness of the low back, feeling of limb weakness, aversion to wind, headache, and a cold sensation in the lower abdomen. Vaginal discharge was without smell.
[Examination]
Pale tongue with a thin white coating, deep and slow pulse
[Diagnosis]
Amenorrhea (due to cold retention, blood stasis)
[Treatment Principles]
Warm the channels to dispel cold
[Note]
Synopsis of Prescriptions of the Golden Chamber – Women’s Miscellaneous Diseases (Jīn Guì Yào Luè: Fù Rén Zá Bìng, 
) says: “Women’s diseases are due to deficiency, accumulation of cold, and stagnation of qi; menstruation stops.” RN 4 (guān yuán) is the intersecting point of the ren vessel and the three foot yin channels, additionally it is the place from where the qi of the san jiao originates; it is one of those points that can tonify the whole body. The herbs hú jiāo (Fructus Piperis), dīng xiāng (Flos Caryophylli) and ròu guì (Cortex Cinnamomi) are pungent and warm medicinals, they warm the channels and dispel cold to stop pain. They strengthen kidney yang, dispel cold, unobstruct the channels and regulate the ren to smooth the menstrual flow.
) says: “Women’s diseases are due to deficiency, accumulation of cold, and stagnation of qi; menstruation stops.” RN 4 (guān yuán) is the intersecting point of the ren vessel and the three foot yin channels, additionally it is the place from where the qi of the san jiao originates; it is one of those points that can tonify the whole body. The herbs hú jiāo (Fructus Piperis), dīng xiāng (Flos Caryophylli) and ròu guì (Cortex Cinnamomi) are pungent and warm medicinals, they warm the channels and dispel cold to stop pain. They strengthen kidney yang, dispel cold, unobstruct the channels and regulate the ren to smooth the menstrual flow.Cheng Xin-nong’s Medical Record
Hu, female, 40, first visit was on January 3, 1992
[Chief Complaint]
Amenorrhea for two years
[Present Medical History]
Two years ago, the patient had a quarrel with someone during her menses; prior to this she had been depressed and her periods were becoming increasingly irregular. There were accompanying symptoms of lower abdominal distention, cold pain in the loins that radiated to the back, fullness in chest, sighing, irritability, limbs numbness and loose stools 2 to 3 times a day.
[Examination]
Patient’s cheeks and lips were dark purple; tongue was purplish with a thin yellow coating, and pulse wiry, proximal position was weak.
[Diagnosis]
Amenorrhea (due to qi stagnation with blood stasis)
[Treatment Principles]
Regulate the qi, remove stasis
[Treatment]
RN 17 (dàn zhōng) | RN 6 (qì hăi) | RN 3 (zhōng jí) |
LI 4 (hé gŭ) | SP 10 (xuè hăi) | SP 6 (sān yīn jiāo) |
LV 3 (tài chōng) | LV 2 (xíng jiān) |
RN 3 (zhōng jí) was treated with moxibustion, other points were needled with an even method.
She insisted on seven courses of treatment, although these were not on a regular timescale. Her menstruation started again with regular cycles; the other symptoms disappeared.
[Note]
Concerning emotional factors, anger damages the liver causing qi stagnation that leads to blood stasis; so the menstruation stops. The free
flow of qi and blood is blocked, so she has pain in her back, loins and numbness of the limbs. Prolonged stagnation produces heat, so she has irritability and a yellow tongue coating.
flow of qi and blood is blocked, so she has pain in her back, loins and numbness of the limbs. Prolonged stagnation produces heat, so she has irritability and a yellow tongue coating.
Summary
Amenorrhea, if due to exhaustion of the blood which can be caused by bleeding, over-indulgence in sexual activities, multiple childbirth or prolonged disease, is known as exhaustive amenorrhea; if due to emotional causes like anger or invasion of cold, is known as stasis amenorrhea.
Main points: RN 4 (guān yuán), SP 6 (sān yīn jiāo), SP 10 (xuè hăi).
BL 20 (pí shù), BL 23 (shèn shù), RN 6 (qì hăi) and ST 36 (zú sān lĭ) are added for exhaustive amenorrhea to tonify kidney qi, strengthen the spleen and stomach and replenish yin and blood.
RN 3 (zhōng jí), LI 4 (hé gŭ) and LV 2 (xíng jiān) are added for stasis amenorrhea to reduce heat and remove stasis to produce new blood. Moxibustion is used for the cases with cold.
Bēng Lòu (UTERINE BLEEDING)
Cheng Xin-nong’s Medical Record
Liu, female, 31, first visit was on May 13, 1992
[Chief Complaint]
Prolonged menstruation for 14 days
[Present Medical History]
Fourteen days ago, this patient’s menstrual flow began, it was light in colour and accompanied by soreness in the lumbar region. She took some Chinese medicine but it was not effective. She had her first period at the age of 14. The cycle, colour and quantity of her menstruation were all normal. She got married at the age of 27, and has had two abortions within her two
years of marriage. She was always tired, afraid of cold, mentally fatigued and does not like to talk.
years of marriage. She was always tired, afraid of cold, mentally fatigued and does not like to talk.
[Examination]
Pale complexion, pale tongue with a thin coating, and a deep thready pulse
[Diagnosis]
Uterine bleeding (Bēng Lòu) (due to deficiency of chong and ren vessels, kidney qi deficiency)
[Treatment Principles]
Regulate and tonify the chong and ren vessels, tonify qi to control blood
[Treatment]
DU 20 (băi huì) | RN 4 (guān yuán) | ST 36 (zú sān lĭ) |
SP 6 (sān yīn jiāo) | SJ 4 (yáng chí) | SP 1 (yĭn bái) |
SP 1 (yĭn bái) was treated with moxibustion; other points were needled using a tonifying method.
After five treatments, the uterine bleeding was reduced and she felt better emotionally and physical strength was better. After seven treatments, the bleeding stopped. Another seven treatments consolidated her condition and all her symptoms disappeared.
[Note]
The two abortions damaged her chong and ren vessels. Not taking care of one’s health causes qi and blood deficiency, thus the weakness of the chong and ren vessels, the liver and spleen lose their controlling and storing functions, hence the uterine bleeding.
DU 20 (băi huì) is used to lift the qi of the middle jiao. RN 4 (guān yuán) is used to tonify the yuán-source qi to regulate the chong and ren vessels; ST 36 (zú sān lĭ), SP 6 (sān yīn jiāo), SP 1 (yĭn bái) are used to harmonize liver and spleen to restore their functions in controlling and storing blood and replenish qi and blood; SJ 4 (yáng chí) is the yuán-source point of sanjiao channel, functioning to regulate the penetrating and ren vessels and
reinforce qi to control blood.
reinforce qi to control blood.
Xiao Shao-qing’s Medical Record
Huang, female, 24, first visit was on May 19, 1998
[Chief Complaint]
Irregular menstruation accompanied by Bēng Lòu (uterine bleeding) for seven years
[Present Medical History]
This patient was 15 at menarche. The cycle, colour and quantity of her menstruation were all normal. Since 1992, the cycle became disordered, she would have it once every two or three months, even up to six months between periods. The flow was profuse, even after she had bled for seven days and contained big clots. Hundreds of doses of herbal medicine, hormone therapy, and three D&C’s failed to have any effect. Presently she had irregular cycles that lasted for more than seven days with scanty dark flow, distending pain in lower abdomen, large clots, accompanied by dizziness, headache, and palpitations.
[Examination]
Sallow complexion, yellow and slight greasy tongue coating, thready and rapid pulse
[Diagnosis]
Uterine bleeding (Bēng Lòu) (due to liver qi stagnation, failure of the spleen in transportation and transformation)
[Treatment Principles]
Calm the liver and regulate qi, strengthen the spleen and replenish
blood, regulate the chong and ren vessels
[Treatment]
Acupuncture, moxibustion and herbal medicine were used in combination.
Points:
① | DU 20 (băi huì) | PC 6 (nèi guān) | RN 12 (zhōng wăn) |
ST 25 (tiān shū) | RN 6 (qì hăi) | RN 4 (guān yuán) | |
ST 30 (qì chōng) | SP 10 (xuè hăi) | SP 8 (dì jī) | |
SP 6 (sān yīn jiāo) | LV 3 (tài chōng) | ||
② | DU 23 (shàng xīng) | LI 4 (hé gŭ) | RN 8 (shén què) |
RN 4 (guān yuán) | ST 36 (zú sān lĭ) | SP 4 (gōng sūn) | |
SP 1 (yĭn bái) | KI 3 (tài xī) | ST 28 (shuĭ dào) | |
ST 29 (guī lái) | LV 14 (qī mén) |
RN 6 (qì hăi) was needled through to RN 4 (guān yuán).
The two groups of points were alternately used in turn. They were needled using an even method and retained for 30 minutes. During this time the Phoenix Flying technique was used to stimulate the needles once every 10 minutes. At the same time, RN 12 (zhōng wăn), RN 8 (shén què), ST 25 (tiān shū), RN 6 (qì hăi) and RN 4 (guān yuán) were treated with cupping for 5 to 10 minutes. Treatment was given once a day, one month being one course of treatment.
Medicines:
① | Dān Zhī Xiāo Yáo Wán | Augmented Free and Easy Wanderer Pill |
② | Guī Pí Wán | Restore the Spleen Pill |
The two medicines were taken together, twice a day, 4g each time, to strengthen the spleen and control blood.
Seven courses of treatment, 210 treatments in all together, brought her cycle into some semblance of regularity with about 40 days between periods; the quantity, colour and quality of the flow were all improved.
It lasted five to eight days, medium quantity, fresh red colour, small dark clots, and without being prolonged.
It lasted five to eight days, medium quantity, fresh red colour, small dark clots, and without being prolonged.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
