MENORRHAGIA (HEAVY MENSTRUATION, LONG MENSTRUATION)

GENERAL

Clinical Manifestations	The amount of menstrual bleeding is significantly increased during menstruation, to 100 ml/day more or less. (normal 30-80ml). There here may be a regular, early, or late cycle. the color of the Blood is pale, dark, or purple red. The consistency of the Blood is thick and sticky or, thin, or clotted. Sometimes there may be pain.
Treatment Principle
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Points	SP-1, SP-6 PC-6, SP-4

SPLEEN QI DEFICIENCY

Clinical Manifestations	Pale-red to normal Blood color Thin and watery Blood with clots Irregular menstruation Sallow complexion Fatigue Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath May be much Blood due to Spleen Not Governing Blood May be little Blood due to Spleen Qi Sinking The Blood is pale-red in color and watery An empty feeling in the lower abdomen Spleen Not Governing Blood: Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia Spleen Qi Sinking: Prolapse of one or more organs T: Pale and flabby - may have teethmarks C: White P: Even, forceless and deficient
Treatment Principle	Nourish the Middle Jiao Qi Keep the Blood in the Chong and Ren channels
Herb Formulas	Gui Pi Tang Ju Yuan Jian modified Bu Zhong Yi Qi Tang Si Jun Zi Tang Menorrhagia #2 With inconsolidation of the Chong and Ren channels: Gu Chong Tang Chinese Patent Medicine: Gui Pi Wan
Points	DU-20, KI-3, REN-6, SP-1, SP-6, SP-8, ST-36, Tituo, UB-20

SPLEEN NOT GOVERNING THE BLOOD

Clinical Manifestations	Abdominal pain Uterine bleeding (metrorrhagia) Excessive menstruation Menstruation with constant spotting Postpartum bleeding Bleeding during pregnancy The Blood is pale and thin without clots Weakness Sore lower back Post abortion bleeding Dull complexion Weakness and pain of the legs Whole body heavy and lethargic Wants to lie down Poor appetite Palpitations Dry mouth Sallow complexion Loss of taste Light red, unelevated and indistinct eruptions T: Pale C: Thin and white or Whitish and moist P: Thready and weak
Treatment Principle	Nourish and warm the Blood Stop bleeding Regulate menstruation Calm the fetus Prevent miscarriage
Herb Formulas	Jiao Ai Tang Bu Wei Fang Gui Pi Tang Gui Pi Tang + Jiao Ai Ba Zhen Tang Bu Zhong Yi Qi Tang modified Gui Pi Tang + Jiao Ai Tang Shou Pi Jian
Points	SP-1, SP-3, SP-10, UB-17, UB-20, ST-36, other points are selected according to signs and symptoms

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Body cold Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food Cock-crow diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Tonify Spleen and Kidney Yang
Herb Formulas	Dang Gui Shao Yao San
Points	Moxa UB-20, UB-23, ST-36, SP-6, SP-9, REN-4, REN-12

HEART BLOOD AND SPLEEN QI DEFICIENCY

Clinical Manifestations	Palpitations Insomnia Much dreaming Easily startled Poor memory Four limbs tired and lethargic Loss of appetite Distention and fullness of the epigastrium and abdomen Loose stools Sallow complexion Copious, pale menses Uterine bleeding or Light menstrual flow or Amenorrhea T: Pale P: Thready and weak
Treatment Principle	Reinforce and Benefit the Heart and Spleen
Herb Formulas	Gui Pi Tang Zhi Gan Cao Tang
Points	HT-7, REN-4, SP-1, SP-6, ST-36, UB-15, UB-20

LIVER QI STAGNATION WITH KIDNEY DEFICIENCY

Clinical Manifestations	Irregular periods Scanty bleeding Clots in the menstrual Blood Abdominal distention Breast distention Premenstrual tension Depression Sighing Irritability T: Normal or Slightly red on the sides C: Normal P: Wiry
Treatment Principle	Nourish the Blood Invigorate the Blood Regulate menstruation Tonify the Kidneys Benefit the Spleen
Herb Formulas	Ding Jing Fang
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LIVER QI STAGNATION WITH BLOOD DEFICIENCY

Clinical Manifestations	Hypochondriac pain Headache Vertigo Bitter taste in the mouth Dizziness Frequent sighing Epigastric pain and distention Flatulence Dry mouth and throat Fatigue Anorexia Alternating chills and fever Irregular menstruation Breast distention Lassitude Insomnia Shoulder and back pain Rib pain Various types of menstrual discharges Premenstrual cramps Excessive menstrual bleeding Tightness or fullness in the chest Cold extremities Pain in the arms and legs Heaviness of the head Night sweats Bloating and pain at the umbilicus and abdomen Diarrhea alternating with constipation Five Sole heat Palpitations Malar flush Depression Irritability Increased desire to sleep Flatulence T: Pink C: Thin white or yellow P: Wiry and deficient or Wiry, and rapid
Treatment Principle	Pacify the Liver Spread Liver Qi Strengthen the Spleen Nourish the Blood Harmonize the Liver and Spleen
Herb Formulas	Hei Xiao Yao San
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LIVER WIND STIRRING INTERNALLY: LIVER BLOOD DEFICIENCY GENERATES WIND

Clinical Manifestations	Pale complexion Pale lips Blurred or failing vision Spots before eyes Dizziness Dry eyes Pale nail beds Irritability Frightens easily Insomnia with much dreaming Tinnitus Numbness of limbs Tremor, spasms or involuntary movements (chorea) Involuntary shaking of head Light menses or amenorrhea Late menses Tic or tremor of hands and feet Maybe trismus T: Pale C: Little P: Thready and wiry
Treatment Principle	Nourish the Blood Subdue Wind
Herb Formulas	Si Wu Tang
Points	DU-16, DU-20, GB-20, LIV-3, REN-4, SP-6, ST-36, UB-17, UB-18, UB-20

LIVER BLOOD DEFICIENCY

Clinical Manifestations	Pale complexion Pale lips Blurred or failing vision Spots before the eyes Dizziness Dry eyes Pale nail beds Irritability Frightens easily Insomnia with much dreaming Tinnitus Numbness of the limbs Light menses or Amenorrhea Late menses T: Pale C: Little P: Thready
Treatment Principle	Nourish the Liver Reinforce the Blood
Herb Formulas	Si Wu Tang For menstrual disorders: Hei Xiao Yao San
Points	Moxa or needle LIV-3, REN-4, SP-6, ST-36, UB-17, UB-18, UB-20

KIDNEY, SPLEEN AND HEART DEFICIENCY

Clinical Manifestations	Irregular periods Scanty bleeding Clots in the menstrual Blood Abdominal distention Breast distention Premenstrual tension Depression Sighing Irritability T: Normal or Slightly red on the sides C: Normal P: Wiry
Treatment Principle	Nourish the Blood Invigorate the Blood Regulate menstruation Tonify the Kidneys Benefit the Spleen
Herb Formulas	Ding Jing Tang
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KIDNEY AND LIVER YIN DEFICIENCY

Clinical Manifestations	Weak and sore lower back and knees Weakness and atrophy of the legs Dry, parched mouth and throat Dizziness Blurred vision Insomnia Dream disturbed sleep Spermatorrhea Prematurely gray hair Premature hair loss A bitter taste in the mouth Nocturnal emissions Hypermenorrhea T: Red and dry
Treatment Principle	Nourishes Kidney and Liver Yin and Blood
Herb Formulas	Er Zhi Wan With Blood Heat: Liang Di Tang + Er Zhi Wan
Points	With Blood Heat: KI-3, KI- 6, REN-3, SP-8, SP-10 With hot flashes: + HT-6, KI-7 With Dampness: + SP-9, ST-40

QI, BLOOD AND YANG DEFICIENCY

Clinical Manifestations	Fatigue Anorexia Dizziness Pale face Weak voice Reluctance to speak Sweating with little or no exertion Dizziness Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods Chills Cold limbs Inability to get warm Loose stools Profuse clear urine Spontaneous sweating Lassitude T: Pale C: White or Thin, white and dry P: Slow, deep and weak or Empty or Thready and rapid or Weak
Treatment Principle	Tonify Qi and Blood Strengthen the Spleen Tonify Yang
Herb Formulas	Ren Shen Dang Shao San
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BLOOD DEFICIENCY

Clinical Manifestations	Scanty periods with pale dilute Blood and a later period Dizziness Blurred vision Tingling of the limbs Insomnia Palpitations Poor memory Dull pale complexion T: Pale and thin C: Normal P: Choppy or Thready or Weak
Treatment Principle	Strengthen the Spleen Nourish Blood Regulate menstruation
Herb Formulas	Ren Shen Zi Xue Tang With Heat: Wen Qing Yin With Blood Stagnation: Si Wu Tang Jian Wei
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BLOOD STASIS

Clinical Manifestations	Abnormal, frequent bursts of menstrual bleeding Dark purple blood with clots Lower abdominal Excess pain that subsides when the clots pass Palpable masses that may or may not be painful Lower abdominal pain without palpable masses Lower abdominal distention Lower back pain Lower abdominal distention during menstruation Frequent menstruation (3-5 timer per month) Spotting Dark purple menstrual Blood (usually with clots) Abnormal uterine bleeding with abdominal soreness and pain Aversion to Cold Depression Cold extremities White vaginal discharge T: Pale or With purple spots C: White P: Choppy
Treatment Principle	Invigorate the Blood Dispel Stasis Stop bleeding
Herb Formulas	Shao Fu Zhu Yu Tang Tao Hong Si Wu Tang modified With Heat: Si Wu Tang + Shi Hui San With Kidney Deficiency: Ding Jing Tang Chinese Patent Medicines: Fu Ke Zhong Zi Wan
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BLOOD STAGNATION WITH BLOOD DEFICIENCY

Clinical Manifestations	Copious bleeding of dark purple blood The blood is sticky during menstruation May or may not have clots Menstrual cycle is shortened (early menstruation) Palpitations Dizziness Blurred vision Pale, lusterless complexion Pale nails Abdominal pain Irregular menstruation with little flow Fixed lower abdominal pain Vertigo Tinnitus Pale lips May be amenorrhea Insomnia Menstruation may also be accompanied by distention and pain T: Pale C: Normal P: Thin and weak or Thin and choppy
Treatment Principle	Tonify and Invigorate the Blood Regulate Blood Circulation Break up Stagnation Eliminate Blood Stagnation Regulate menstruation Alleviate pain
Herb Formulas	Tao Hong Si Wu Tang Zong Pu San With abdominal pain: + Shi Xiao San
Points	LIV-3, LIV-13, LIV-14, SP-6, UB-17 REN-3, SP-6, SP-10, ST-29, Zigong

EXCESS HEAT IN THE BLOOD

Clinical Manifestations	Abnormal bursts of profuse, prolonged menstrual bleeding Very heavy, bright-red, sticky-thick or purple Blood The Blood feels warm There may be clots Early menstruation Lower abdominal distension relieved when the Blood comes Red face Thirst with a desire for cold drinks Agitation Insomnia General feeling of Heat Heartburn Dark yellow urine Constipation T: Red C: Yellow P: Rapid and slippery
Treatment Principle	Clear Heat Cool the Blood Stop bleeding
Herb Formulas	Shu Yu Qing Gan Yin Shi Hui San Qing Jing San Bao Yin Jian Dang Gui Yin Due to Yin Deficiency with Fire Rising: Menorrhagia #1 With dark red, thick menstrual Blood, a dry mouth, dysphoria and a smothering sensation: Qing Re Zhi Xue Tang
Points	KI-2, LIV-3, REN-4, SP-1

BLOOD HEAT DUE TO EXCESS HEAT IN THE CHONG AND REN

Clinical Manifestations	Continuous menstruation or Uterine bleeding that alternates between spotting and gushing The Blood is very red, thick and sticky and may contain dark-purple clots A sensation of Heat and irritability in the chest Menstruation may be delayed Dry mouth Leukorrhea Dysuria Abdominal pain Dark urine Red urine Red face Difficulty defecating T: Red C: Normal or Yellow P: Wiry or Wiry and rapid or Tight and rapid or Slippery and rapid
Treatment Principle	Enrich Yin Clear Heat Clear Deficiency Heat Stop bleeding Stabilize the Menses
Herb Formulas	Gu Jing Wan
Points

YIN DEFICIENCY HEAT

Clinical Manifestations	Threatened miscarriage early in pregnancy Mild menorrhagia that suddenly transforms into copious menorrhagia Clear, light red, and thick blood or The blood is bright red A general feeling of Heat Thirst Evening fever Deep-red sticky Blood Prolonged cycle (i.e.: 7-10 days) Early period is common Hot palms and soles Restlessness Insomnia Dark yellow urine T: Red C: Yellow or Little or none
Treatment Principle	Nourish Yin Clear Deficiency Heat Stop Bleeding
Herb Formulas	Bao Yin Jian Liang Di Tang With Qi Deficiency: An Chong Tang
Points	HT-6, KI-6, SP-1, Duanhong (Master Tung Point)

DAMP-HEAT

Etiology	Lingering of Dampness and Heat Unregulated intake of drink and food Taxation damaging the body Heart Qi insufficiency.
Clinical Manifestations	If Dampness is predominant: Blood mixed with mucus Sallow or yellowish complexion Slightly puffy face Heavy head Dizziness Listlessness Stuffy chest and epigastrium Sticky sensation in the mouth T: Normal C: Thin whitish and sticky P: Slippery and Choppy If Heat is predominant: Profuse purplish vaginal Hemorrhage Repulsive odor Flushing or Heat sensations Spontaneous sweating Bitter taste in mouth Thirst Dark, scanty urine Constipation or diarrhea T: Red C: Sticky and yellow P: Slippery and rapid
Treatment Principle	Clear Heat Resolve Dampness
Herb Formulas	Jia Wei Xiao Yao Sanmodified Sheng Yang Chu Shi Tangmodified Yin Chen Hao Tang San Miao Hong Teng Tang For restoring Qi and Yang once the pathogen has been eliminated: Bu Zhong Yi Qi Tang With Heat in the Blood: Si Miao Wan modified
Points	SP-1, SP-6, SP-9, REN-3, REN-6 Moxa SP-10 KI-3, KI- 6, REN-3, SP-8, SP-9, SP-10, ST-40 With hot flashes: + HT-6, KI-7

TAN YIN (PHLEGM-DAMP)

Clinical Manifestations	Anorexia Edema Abdominal distention Chest and hypochondriac distention Dizziness Nausea Vomiting Thirst with no desire to drink Maybe no thirst Palpitations Shortness of Breath T: Normal C: Thick and slippery P: Slippery, full and maybe wiry
Treatment Principle	Warm and Dissolve Tan Yin
Herb Formulas	Li Zhong Tang modified
Points	PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

DEFICIENCY OF THE CHONG AND REN

Clinical Manifestations	Menorrhagia or Prolonged menstruation Lower abdominal Cold, distention and pain Sporadic abdominal pain which is better with warmth pressure Irregular menstruation (usually long and heavy or scant with clots) Delayed menstruation with a small amount of pale Blood Mild, persistent uterine bleeding Lumbar and sacral pain which are worse following menstruation or when tired Profuse, clear, watery leukorrhea Maybe infertility Maybe dark rings around the eyes Palpitations Shortness of breath Faint, weak respiration Drenched with perspiration Dizziness Vertigo Above symptoms worse on exertion or when tired Four limbs cold and sore Intolerance of Cold Cold abdominal pain An extremely pale face Cyanosis of mouth and lips Reduced appetite Loss of taste Fatigue Upset stomach Loose stools T: Pale and thick with teeth marks C: White and greasy P: Minute (on the point of collapse) or Deep and slow
Treatment Principle	Return Yang Scatter Cold Consolidate Exhaustion
Herb Formulas	Wen Jing Tang Bu Zhong Yi Qi Tang Jiao Ai Tang Qing Jing San Gu Chong Tang Bu Zhong Xiong Gui Tang
Points	Moxa REN-8, Moxa-needle REN-4, REN-6, ST-36, DU-25 For shock: PC-6 In combination with DU-25, DU-26, PC-9, KI-1 Moxa REN-4, REN-8, Moxa-needle UB-23, UB-26, DU-4 For menstruation with clots: SP-10, SP-6 For infertility: Bao Men Zi Hu (3 cun below the umbilicus and 2 cun lateral to the umbilicus) For clear, thin vaginal discharge: UB-52, GB-26 For lower abdominal pain: SP-8 For dysmenorrhea: SP-10, ST-29

MENORRHAGIA (HEAVY MENSTRUATION, LONG MENSTRUATION)

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