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METRORRHAGIA (UTERINE BLEEDING) (METROSTAXIS)

GENERAL

Clinical Manifestations
Treatment Principle
Herb Formulas	For Yin Exhaustion: Sheng Mai San For Yang Collapse: Shen Fu Tang
Points	REN-4, SP-6 SP-4, SP-10, LIV-2, LIV-3, ST-36, DU-4, PC-6 LIV-3, ST-30, ST-36, SP-6 , UB-43, four fingers below McBurney’s point SP-1, SP-2, LIV-3, HT-1, HT-5, REN-6, UB-40. UB-55, ST-18 ST-36, SP-6 , REN-3, REN-4, KI-3, LU-6 UB-23, UB-31, UB-32, UB-33, UB-34, ST-36, SP-6 , SP-9, SP-10, REN-4 REN-3, REN-4, SP-6 , SP-10, Zigong REN-3, REN-4, REN-6, LIV-1, LIV-3, KI-2, KI-10, SP-2, SP-6, SP-10, ST-12, HT-1, PC-3, UB-40 REN-3, REN-6, LIV-1, LIV-3, KI-2, KI-10, SP-6 REN-3, Zigong LIV-3, SP-6 SP-1, SP-6 , SP-10, REN-6 SP-1, ST-36 REN-4, SP-1, SP-10, ST-36 HT-3, LIV-2, PC-6 Ear: a. Ovary, Kidney, Internal Secretion, Uterus b. Uterus, Subcortex, Endocrine, Ovaries – 1-2 hours with periodic stimulation Cutaneous: SP-1, SP-3, SP-4, SP-6 , SP-10, UB-15, UB-17, UB-18, UB-20, UB-22, UB-23, UB-31, UB-32, UB-33, UB-34, DU-20, REN-4, REN-6, PC-6, LIV-1, Huatuojiaji from T-1-S-4 Head: Reproduction, Bladder Moxa: 3 cones – Zigong, SP-1, SP-6 If there is spotting 1 ½ days after bleeding stops: 5 cones – REN-4, REN-6, SP-6 For Excess bleeding (heavy and sudden): REN-3, REN-4, REN-6, SP-1, SP-6 , LIV-1 For dripping (spotting): REN-4, UB-23, moxa: UB-20, SP-6, LIV-3, SP-1, SP-10 For precocious bleeding: SP-10, LIV-2 For delayed menstruation: ST-36, SP-4 For continuous bleeding: Moxa: UB-17, UB-18, UB-23, DU-4, REN-3, REN-6, PC-5, SP-10, KI-10, LIV-2 Functional Uterine Bleeding: a. UB-24, Shiqizhuixia, SP-6 b. UB-31, UB-32, UB-33, UB-34, ST-36, SP-2, SP-6 , SP-10, Zigong, REN-4, REN-6

SPLEEN QI DEFICIENCY - SPLEEN NOT GOVERNING BLOOD

Clinical Manifestations	Sudden, severe uterine bleeding The Blood is pale and watery Lightheadedness Fatigue Cold extremities Shortness of breath A stifling sensation in the chest Loose stools Persistent uterine bleeding with continuous spotting A shiny, pale complexion Slight facial edema T: Pale and swollen with teethmarks C: Thin and white P: Thin and frail or Hollow
Treatment Principle	Tonify the Blood AugmentQi Stops bleeding
Herb Formulas	Gu Ben Zhi Beng Tang Gui Pi Tang Ba Zhen Tang Shen Ling Bai Zhu San Ju Yuan Jian With inconsolidation of the Chong and Ren chnnels: Gu Chong Tang
Points	REN-6, ST-36, SP-1, SP-8, UB-20, KI-3, LIV-3 For very cold/pale patient: Moxa REN-4

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 Ju Yuan Jian Shi Quan Da Bu Tang Li Zhong Tang
Points	Moxa UB-20, UB-23, ST-36, SP-6, SP-9, REN-4, REN-12

LIVER QI AND BLOOD STAGNATION

Clinical Manifestations	Bleeding between periods Scanty or normal Blood flow If no Heat the color is normal If there is Heat the color is deep red and thick The flow starts and stops during menses There are small clots Distended pain in the lower abdomen 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 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: Red edges C:Thin white or yellow P: Wiry and Deficient or Wiry, tight and Deficient
Treatment Principle	Regulate Liver Qi and Blood Remove Stagnation Regulate menstruation
Herb Formulas	Xiao Yao San
Points

LIVER FIRE

Clinical Manifestations	Severe, splitting headaches with dizziness Sudden tinnitus or deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Bitter taste in mouth Thirst Vomiting sour or bitter liquid Insomnia Restlessness Constipation or dry stools Maybe rib pain T: Red tip and edges C: Thick, yellow, dry and rough P: Wiry, Shi and rapid In severe cases (due to Liver Fire damaging the Luo Mai): Mania. Bleeding of Shi Heat type: Hemoptysis Hematemesis Epistaxis
Treatment Principle	Clear Heat Descend Liver Fire
Herb Formulas	Long Dan Xie Gan Tang For Liver Qi Stagnation turning to Heat: Ping Gan Kai Yu Zhi Xue Tang Jia Wei Xiao Yan San
Points	LIV-2, GB-20, Bleed UB-20, Taiyang and KI-1

KIDNEY YIN DEFICIENCY

Clinical Manifestations	Light-headedness Vertigo Tinnitus Soreness and weakness in low back and legs Spontaneous and nocturnal emissions Night sweats Dry mouth and throat Thirst with a desire to drink Dizziness Forgetfulness Deafness Rhinitis Dizziness	Dribbling of urine Malar flush Five sole heat Insomnia Hair loss Loss of teeth Infertility Amenorrhea Uterine bleeding Spontaneous perspiration Spermatorrhea Poor vision T: Red and shiny C: Little or None P: Thready and rapid
Treatment Principle	NourishYin Tonify the Kidneys SupplementJing Benefit Marrow
Herb Formulas	Zuo Gui Wan modified Liu Wei Di Huang Wan Liang Di Tang modified
Points	REN-4, REN-6, KI-2, KI-6, KI-10, LIV-8, LU-7, UB-18, UB-23 HT-6, KI-6, SP-1, Duanhong (between the knuckles of the second and third fingers - Master Tung Point)

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Edema of whole body particularly at and below the waist Pitting edema Lumbago: low back feels cold, weak and aching Abdominal distention with full sensations Feeling chilled Aversion to cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Vaginal discharge Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Low libido Infertility (“uterus cold and infertile”) Dribbling after urination Incontinence of urine Face gray and congested or pale Feeling nervous and cold with mental weariness Hearing deficit Maybe anorexia Maybe loose stools Maybe chronic diarrhea or “cock crow” diarrhea T: Pale and swollen C: Thin and white or Thick, white and sticky P: Deep and thready - maybe slow
Treatment Principle	Warm Kidey Yang Stop the bleeding
Herb Formulas	You Gui Wan modified Da Bu Yuan Jian modified Shi Quan Da Bu Tang
Points	SP-6, REN-4, REN-12, KI-8, KI-7, DU-4, UB-23 Moxa REN-4, REN-6, ST-36, KI-3, KI-10, SP-1, SP-8, UB-23, UB-52, DU-4

KIDNEY QI DEFICIENCY

Clinical Manifestations	Early period May be much Blood due to Inconsolidation of the Chong and Ren channels May be little Blood due to Jing Deficiency The Blood is pale-brown red in color, clea,r thin and watery Frequent urination Copious amounts of clear urine Incontinenceof urine Enuresis Abortion or miscarriage Either a tendency towards being too hot of too cold Shortness of breath Asthma Cold limbs Weak back and knees T: Pale C: White P: Deep, weak possibly tight
Treatment Principle	Tonify Kidney Qi Consolidate the Chong and Ren channels
Herb Formulas	Shen Qi Wan To stimulate ovulation: Yu Lin Zhu
Points

KIDNEY AND LIVER YIN DEFICIENCY

Clinical Manifestations	Vertigo Headache Anger Insomnia Malar flush Five sole heat Painful flanks Sore back Maybe hemiplegia T: Red C: Little P: Thin, wiry and rapid
Treatment Principle	Nourish Kidney and Liver Yin
Herb Formulas	Qi Ju Di Huang Wan Yi Guan Jian Zuo Gui Wan modified With Liver Qi Stagnation Transforming in to Fire: Zi Shui Qing Gan Yin
Points	UB-18, UB-23, LIV-3, KI-3, SP-6

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Pale, watery Blood Palpitations Shortness of breath Laconic speech A sinking sensation in the lower abdomen Fatigue A shiny, pale complexion Abdominal fullness Lower back pain T: Pale C: Moist and thin P: Deficient and frail or Weak and smooth
Treatment Principle	Tonify Qi Nourish Blood
Herb Formulas	Ju Yuan Jian Si Wu Tang Gu Ben Zhi Beng Tang With Cold: Shi Quan Da Bu Tang
Points	UB-20, ST-36, SP-6, SP-9, SP-10, REN-4, REN-12

BLOOD STAGNATION

Clinical Manifestations	Uterine bleeding is unexpected, in large or small amount but persistent The menses are dark purple and contain clots Pain in the lower abdomen, with guarding T: Cyanotic or speckled with purpuric spots C: Normal P: Choppy
Treatment Principle	Invigorate the Bood Eliminate Stasis Strengthen the Chong channel Stop bleeding
Herb Formulas	Zhu Yu Zhi Ben Tang
Points	REN-3, REN-4, Zigong, SP-6, SP-8, SP-10 , LIV-3, PC-6

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 Fixed lower abdominal pain Irregular menstruation with little flow 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 Invigorates the Blood Regulate Blood Circulation Break up Stagnation Eliminate Blood Stagnation Regulate menstruation Alleviate pain
Herb Formulas	Shi Xiao Si Wu Tang Tao Hong Si Wu Tang, modified
Points	SP-8, SP-10, SP-12, REN-3, REN-4, REN-6 Ear Points: Zigong, Internal circulation

BLOOD HEAT

Clinical Manifestations	Spotting or bleeding between periods Flooding Blood, before period should begin or Trickling blood for a long time after the end of the period Bright red or dark red menstrual blood, Red face Thirst Agitation General feeling of Heat Dark yellow urine Constipation T: Red C: Dry-Yellow P: Rapid (thin if Deficiency Heat) or Forceful, rapid and overflowing
Treatment Principle	Clear Full-Heat and Fire Cool the Blood Stop bleeding Nourish the Yin fluids
Herb Formulas	Bao Yin Jian Qing Re Gu Jing Tang modified Shi Hui San
Points	REN-6, SP-8, SP-10, LI-11 With Liver Qi Stagnation: + LIV-2, LIV-3, SJ-5, GB-34 With Damp-Heat: REN-6, SP-1, SP-6, SP-9, LIV-5

BLOOD HEAT DUE TO SPLEEN QI DEFICIENCY

Etiology	Overeating Over thinking
Clinical Manifestations	Continuous small amount of bleeding (spotting) Sometimes a lot Blood is thin and light red in color May be Yang Xu (Cold) symptoms Lassitude Weariness Poor appetite Loose stools Sallow face Spontaneous perspiration Desires to lie down Maybe palpitations Arms ache Greenish-yellow complexion No saliva White lips T: Pale and shiny with teethmarks P: Thready and forceless or Fine and weak
Treatment Principle	Tonify the Spleen Replenish Qi
Herb Formulas	Gu Ben Zhi Beng Tang modified
Points	REN-7, SP-6, UB-20, ST-36, Moxa DU-4 and REN-4, Ear: Subcortex, Endocrine, Ovary, Uterus LIV-1, SP-1, SP-6, REN-4, REN-6, Moxa DU-4 and REN-3 REN-4, UB-20, SP-5, SP-6, KI-2 SP-6, SP-10, Moxa REN-4, ST-36 UB-20, REN-6, LIV-13, SP-6 REN-7, Moxa SP-1, SP-6, UB-20, UB-18, DU-4, REN-4 SP-6, REN-4, REN-6, ST-36, UB-20, UB-21

BLOOD HEAT DUE TO KIDNEY YIN DEFICIENCY WITH EMPTY FIRE RISING

Etiology	Early sex Multiple deliveries Sexual strain
Clinical Manifestations	Continuous small amount of bleeding (spotting) Bright red blood Tinnitus Restlessness Tidal fever Dizziness Chest and ribs swollen Limbs and loins ache Dry throat Face bluish yellow Eyes red at first then white T: Red or Shiny C: Thin or None P: Thready and rapid
Treatment Principle	Clear Heat Cool the Blood Nourish Kidney Yin
Herb Formulas	Metrorrhagia #1 Liang Di Tang Zuo Gui Wan modified Qing Re Zhi Beng Tang + Liu Wei Di Huang Wan Qing Re Gu Jing Tang Bao Yin Jian Zhi Bai Di Huang Tang
Points	REN-7, SP-6, SP-10, Ear: Uterus SP-6, REN-4, KI-2, KI-8, KI-10, UB-23 REN-4, REN-6, SP-1, SP-8, KI-2, KI-10, UB-23, DU-4 With night sweating: + HT-6 Sedate, KI-7 Tonify or Even With insomnia: + KI-6, UB-62 Sedate Ear: Subcortex, Endocrine, Ovary, Uterus

BLOOD HEAT DUE TO EXCESS HEAT

Etiology	Long standing predominance of Yang Excess pungent, spicy food Stagnant emotions generating Liver Fire
Clinical Manifestations	Continuous small amount of bleeding Sudden heavy bleeding Blood Is deep red Blood maybe purple Blood is foul smelling Small clots Thirst Flushed face Insomnia Headaches Dizziness Dry mouth Irritability Easily angered Breast distention Constipation Swollen, painful lower abdomen T: Deep red C: Yellow dry P: Slippery or Wiry and rapid, or Thready
Treatment Principle	Clear Heat Cool and replenish Blood
Herb Formulas	Metrorrhagia #2 Qing Re Zhi Beng Tang modified Qing Re Gu Jing Tang
Points	REN-7, SP-6, SP-10, LIV-1, LIV-2 LIV-1, SP-1, SP-6, SP-10, REN-4, REN-6, UB-17, UB-18, UB-23 Moxa: REN-4, SP-1, SP-6, UB-20, UB-23, DU-20 SP-10, LIV-1 KI-14, REN-3, SP-6, SP-10 REN-7, SP-1, SP-6, SP-10, LIV-1, UB-18, UB-20 With heavy bleeding: DU-20 SP-1, SP-6, SP-10, REN-6, KI-5 REN-6, SP-8, SP-10, LI-11 With Damp-Heat:REN-6, SP-1, SP-6, SP-9, LIV-5 With Liver Qi Stagnation: + LIV-2, LIV-3, SJ-5, GB-34 Ear: Uterus, Subcortex, Endocrine, Ovary

BLOOD HEAT DUE TO BLOOD STAGNATION

Etiology	Sex during menstruation External invasion during menstruation
Clinical Manifestations	Continuous bleeding Blood is purple-black Lower abdominal pain Pain is better after heavy bleeding T: Purple or black spots C: Thin white P: Deep and wiry or Tight and Choppy
Treatment Principle	Eliminate Stagnation to stop bleeding
Herb Formulas	Metrorrhagia #3 Si Wu Tang + Shi Xiao Tang modified Shao Fu Zhu Yu Tang Zhu Yu Zhi Xue Tang
Points	REN-7, SP-6, SP-10 LIV-1, LIV-3, SP-1, SP-6, REN-4, REN-6, ST-30 SP-1, SP-6, SP-8, SP-12, REN-6, ST-30 LIV-3, ST-30 REN-3, REN-4, Zigong, SP-6, SP-8, SP-10 , LIV-3, PC-6 Ear: Uterus, Subcortex, Endocrine, Ovary

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 San modified Sheng Yang Chu Shi Tang modified Yin Chen Hao Tang San Miao Hong Teng Tang With damage to Yin and Blood: Qing Gan Zhi Ling Tang To induce diuresis to stop bleeding: Ba Zheng San For restoring Qi and Yang once the pathogen has been eliminated: Bu Zhong Yi Qi Tang
Points	SP-1, SP-6, SP-9, REN-3, REN-6 Moxa SP-10 SP-1, SP-9, SP-8, LIV-5, ST-36, REN-7, REN-9, UB-22, UB-32

COLD WITH DEFICIENCY OF THE CHONG AND REN CHANNELS

Clinical Manifestations	Constant flow Light color Afternoon fever Five sole heat Dry mouth Thirst Cold abdominal pain Infertility Dysmenorrhea Uterine bleeding Chronic pelvic inflammation Menopause Habitual abortion
Treatment Principle	Warm the Cold Consolidate the Chong and REN channels
Herb Formulas	Wen Jing Tang modified With Blood Stasis in the uterus: Zhen Ling Dan
Points	Moxa SP-6, REN-4, REN-12, KI-8, KI-7, DU-4, UB-23 Moxa UB-20, UB-23, ST-36, SP-6, SP-9, REN-4, REN-12