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EARLY MENSTRUATION

GENERAL

Etiology:	Inconsolidation of the Chong and Ren channels
Clinical Manifestations	Menstruating 7 days early for 3 months consecutively
Treatment Principle
Herb Formulas	Ding Jing Fang one week before the patients cycle begins
Points

SPLEEN QI DEFICIENCY

Clinical Manifestations	Early period 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	Tonify The Spleen Nourish Middle Jiao Qi
Herb Formulas	Gui Pi Tang Bu Zhong Yi Qi Tang Ju Yuan Jian
Points	LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

CENTRAL QI SINKING

Clinical Manifestations	Prolapse of one or more organs Sallow complexion Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath T: Pale and flabby - may have teethmarks C: White P: Even or Soft and thready
Treatment Principle	Strengthen the Spleen Benefit Qi Reinforce the Center Invigorate Yang
Herb Formulas	Bu Zhong Yi Qi Tang
Points	DU-20, other points are selected according to the type of prolapse

SPLEEN NOT GOVERNING THE BLOOD

Clinical Manifestations	Sallow or pale complexion Anorexia Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia T: Pale and flabby - may have teethmarks C: White P: Thready and weak
Treatment Principle	Benefit Qi Conserve Blood
Herb Formulas	Gui Pi Tang Bu Zhong Yi Qi Tang modified Gui Pi Tang + Jiao Ai Tang Si Wu Tang modified
Points	SP-1, SP-3, ST-36, UB-20 For Deficiency type uterine bleeding: DU-20, LI-11, REN-4, SP-4, SP-10, SP-14, UB-17

LIVER QI STAGNATION WITH HEAT IN THE BLOOD

Clinical Manifestations	The Blood is deep red in color, thick and clotted The Blood does not flow smoothly, (it starts and stops) Breast distention Lower abdominal pain Irritability Short temper Restlessness Fever or tidal fever Red eyes Dry mouth and throat Palpitations Lower abdominal pain Difficult urination Painful urination Increased menstrual flow Uterine bleeding Early menstruation Aching in limbs Dizziness Mental instability Red face Thirst Turbid urine Alternating chills and fever Red cheeks Wheezing Nervousness Headache Red eyes Dry mouth Anorexia	Infertility Abdominal pain Spontaneous sweating or night sweats with fever Anxiety Dry eyes Hypochondriac pain Anorexia Somnolence Insomnia Aching shoulders Five sole Heat Earache Premenstrual tension Hot flashes Fatigue Lassitude Depression Restlessness Constipation with flushing up Pale complexion Bitter taste in mouth Vertigo Abdominal distention near the umbilicus Epistaxis Irregular menstruation Heaviness in the lower abdomen T:Red or Red edges C: Thin and yellow P: Thready, rapid and wiry or Wiry and tight and rapid
Treatment Principle	Soothe the Liver Clear Heat Cool the Blood Consolidate the Chong Mai
Herb Formulas	Jia Wei Xiao Yao San
Points

LIVER FIRE ATTACKS THE STOMACH

Clinical Manifestations	Restlessness Easily angered Regurgitation of gastric acid Stomach pain Hungers easily Dry mouth Bitter taste in mouth T: Red C: Yellow P: Wiry and Rapid
Treatment Principle	Reduce Liver Fire
Herb Formulas	Hua Gan Jian
Points	ST-36, REN-12, SP-4, PC-6, LIV-2, LIV-14, LI-4, LI-11 PC-6, ST-36, REN-12, LIV-2, LIV-3

LIVER YIN DEFICIENCY

Clinical Manifestations	Dizziness Blurred vision Impaired vision Dry eyes Night blindness Tinnitus Headache Nervousness Insomnia with much dreaming Dry throat Thirst Five Sole Heat Night sweats Light menses or Late menses or Amenorrhea T: Red C: Little P: Thready, wiry and rapid
Treatment Principle	Nourish Yin Nourish the Liver
Herb Formulas	Yi Guan Jian
Points	KI-3, LIV-3, UB-18, UB-23

LIVER YIN DEFICIENCY WITH LIVER QI STAGNATION

Clinical Manifestations	Dizziness Blurred vision Impaired vision Dry eyes Night blindness Tinnitus Headache Nervousness Insomnia with much dreaming Dry throat Thirst Five Sole Heat Night sweats Light menses or Late menses or Amenorrhea Hypochondriac and chest pain Dry, parched mouth and throat Bitter taste in mouth Acid regurgitation Dizziness Epigastric and abdominal distention Maybe constipation T: Red and dry C: Little or None P: Thready and weak or Wiry and deficient
Treatment Principle	Nourish Yin Nourish the Liver Spread Liver Qi
Herb Formulas	Yi Guan Jian
Points	KI-3, LIV-3, UB-18, UB-23

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, clear thin and watery Frequent urination Copious amounts of clear urine Incontinence of 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	Gui Shen Wan Shou Tai Wan Gu Yin Jian He Che Da Zao Wan For more Cold signs: Wen Jing Tang
Points

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Lower abdominal pain which is vague and occurs during or following menstrual flow Preference for pressure The menses are decreased and are light and thin Lassitude Weakness Dizziness Palpitations of the Heart Insomnia with dream-disturbed sleep Pale complexion T: Pale C: Thin P: Thready and feeble
Treatment Principle	Augment Qi Generate Blood Harmonize the Middle Jiao Stop pain
Herb Formulas	Huang Qi Jian Zhong Tang modified Ba Zhen Tang Sheng Yu Tang modified
Points	DU-4, UB-23, REN-4, ST-36, KI-12

BLOOD DEFICIENCY WITH HEAT IN THE BLOOD

Clinical Manifestations	Short menstrual cycle Early menstruation Purple Blood Heavy flow Red, sticky vaginal discharge Tidal fever Greenish complexion Metrorrhagia with thick blood Dizziness Blurred vision Palpitations Insomnia Irritability T: Red C: Yellow P: Thready, forceful and rapid
Treatment Principle	Tonify the Blood Drain Heat
Herb Formulas	Qin Lian Si Wu Tang Xian Qi Tang Qing Jing San Liang Di Tang
Points

BLOOD STAGNATION

Etiology	Cold blocks the Blood and the Chong, and Ren channels. New blood can’t stay in uterus.
Clinical Manifestations	Spotting Dark Blood with clots Painful although better once clots pass Cold in the uterus The whole body may not show Cold signs T: Purple spots C: White P: Choppy
Treatment Principle	Invigorate the Blood Break up Blood Stasis
Herb Formulas	Tao Hong Si Wu Tang
Points

YIN DEFICIENCY WITH HEAT IN THE BLOOD

Etiology	This pattern happens more around menarche and menopause
Clinical Manifestations	Early menstrual period (short cycle) Tends to be prolonged Discharge of a small amount of thick, bright red Blood Heavy flow Mid cycle bleeding (spotting) Bloody vaginal discharge Discharge begins with scant light-colored Blood Dizziness Blurred vision Hectic fever Flaccidity of the lower limbs Flushed cheeks Sore throat Tinnitus Heartburn Thirst Five sole Heat Night sweats Lack of skin luster T: Red or Crimson C: Little or None P: Thready and rapid or Deep, small and weak Menstruation tends to come early
Treatment Principle	Nourish Yin Clear Heat Consolidate the Chong and Ren channels Regulate menstruation
Herb Formulas	Liang Di Tang Zi Shui Qing Gan Yin
Points

YANG EXCESS WITH HEAT IN THE BLOOD

Clinical Manifestations	Menstruation tends to come early Menses tend to be excessive Bright red or dark red sticky menstrual blood The Blood may feel hot Spotting or bleeding between periods Flooding Blood, before period should begin or Trickling blood for a long time after the end of the period Restlessness Chest fullness Red face Thirst Agitation General feeling of Heat Decreased and dark urine Constipation with dry feces T: Red C: Dry-Yellow P: Rapid (thin if Deficiency Heat) or Forceful, rapid and overflowing or Slippery, and rapid
Treatment Principle	Clear Heat Cool the Blood Regulate menstruation.
Herb Formulas	Qing Jing San
Points

DAMP-HEAT

Clinical Manifestations	Early menstruation Dysmenorrhea Irregular menstruation Abdominal pain before or during period Menses with dark red clots Dark menstrual blood Dry stools Dry sore eyes Heavy period Headache Insomnia Irritability Outbursts of yelling or anger Thirst General feeling of Heat May be acne related to the period T: Red body (redder on sides) C: Yellow P: Wiry and rapid
Treatment Principle	Soften the Liver Release constraint Dredge the channels Drain Fire
Herb Formulas	Xuan Yu Tong Jing Tang Jia Wei Xiao Yao San For mild Heat signs: Jin Ling Zi San
Points	LIV-8, SP-8, LU-7, KI-4 REN-6, REN-7, LIV-1

PHLEGM-HEAT

Clinical Manifestations	Early menstruation Cough with sticky, yellow, difficult to expectorate sputum Rapid breathing with a harsh voice Restless fever Sore throat Constipation Dry stools Mania Shortness of breath Dyspnea Nausea Vomiting Chest and/or epigastric fullness Pain in the ribs T: Scarlet C: Yellow or Yellow and greasy or Yellow and smooth P: Rapid and smooth or Slippery and rapid
Treatment Principle	Clear Heat Resolve Phlegm
Herb Formulas	Re Tan Wan
Points