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Metrorrhagia

Metrorrhagia refers to uterine bleeding appearing at completely irregular intervals, the amount of flow being profuse during a short period or scanty over a prolonged period.

Etiology and Pathogenesis

The dysfunction of the Chong and Ren meridians failing to control menstrual flow is considered the mechanism of metrorrhagia. This may result from blood-heat, spleen deficiency, kidney deficiency, stagnation of liver-qi, blood stasis or dampness-heat.

Diagnosis and Differential Diagnosis

A. Diagnostic evidence:

(a) uterine bleeding not occurring at regular cycles;

(b) abrupt and profuse bleeding or prolonged and dripping bleeding.

B. Differential diagnosis:

Metrorrhagia may be distinguished from (a) metrorrhagia, (b) prolonged menstrual period, and (c) uterine bleeding not occurring in the menstrual period.

Syndrome Differentiation and Treatment

Whether the disorder is attributed to cold or heat, asthenia or sthenia syndrome, should be based on the quality, color and quantity of uterine bleeding. Sudden occurrence of profuse uterine bleeding at irregular intervals followed by dripping of light-colored and thin blood suggests an asthenia-syndrome. A large amount of bright red or purplish red and viscous discharge indicates a heat-syndrome. A dark purplish and odorous discharge containing blood clots reveals a heat-dampness syndrome. Bleeding with acute onset usually suggests a qi-deficiency syndrome, while a dripping flow over a long period of time indicates a blood-stasis syndrome. A dull-colored and thin flow indicates an asthenia-cold syndrome. A chronic case usually signifies deficiency and stagnation of qi and blood.

In addition, the imbalance between kidney-yin and yang and the dysfunction of liver and spleen should be noticed such as insufficiency of kidney-qi and deficiency of the Chong and Ren meridians during puberty, impairment of the Chong and Ren meridians in a woman of childbearing age and consumption of the liver and kidneys and weakness of spleen-qi during menopause.

Generally speaking, secondary symptoms appear during the bleeding, and the manifestation of the primary disease may appear after the bleeding is reduced or stopped. Accordingly, the following therapies may be adopted flexibly according to the therapeutic principle of "relieving the secondary symptoms in an acute case, and dealing with the primary cause in a chronic case."

A. Hemostatic therapy: It should be employed first during a profuse bleeding, otherwise collapse-syndrome will develop. However, the drugs applied should vary with different syndromes (cold or heat, asthenia or sthenia).

B. Causative treatment: The therapy should aim at the cause, and indiscriminate use of cold-natured drugs of warm-natured tonics is harmful.

C. Restoration therapy: This therapy restores the bodily functions and the health of the patient. The therapy of tonifying the kidneys and invigorating the spleen is applied successively according to which organ is chiefly affected. The treatment of individual cases should be based on the following classifications:
 

A. Blood-heat syndrome  

(a) Sthenia-heat syndrome

Manifestations: Profuse or dripping bleeding with dark red or dull purplish and viscous discharge containing clots, flushed face, dryness of mouth, restlessness, thirst with desire for cold drink, red tongue with yellow coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, cool the blood, and stop bleeding.

Prescription: The Modified Decoction for Clearing Away Heat and Checking Uterine Bleeding

Cortex Lycii Radicis 10 g
Radix Rehmanniae 15 g
Plastrum Testudinis 15 g
Pulvis Concha Ostreae (decocted) 30 g
Colla Corii Asini 10 g
Fructus Gardeniae 10 g
Radix Sanguisorbae 15 g
Radix Scutellariae 10 g
Nodus Nelumbinis Rhizomatis 15 g
Vagina Trachycarpi Carbonisatus 15 g
Radix Glycyrrhizae 6 g
Radix Ophiopogonis 10 g

Remarks: For cases accompanied by stagnation of heat in the liver meridian manifested as distending pain over the lower abdomen and hypochondria, irritability and wiry pulse, add Radix Bupleuri (10 g) to disperse the stagnated liver-qi, Spica Prunellae (10 g) to clear away liver-heat and Herba Leonuri (15 g) to eliminate blood stasis. For cases with fatigue and listlessness due to exhaustion of qi and yin by sthenic heat, add Radix Adenophorae Strictae (15 g) to benefit qi and nourish yin.

(b) Asthenia-heat syndrome

Manifestations: Continuous dripping or sudden profuse discharge of bright red and viscous blood, dizziness, tinnitus, restlessness, hectic fever, insomnia, dreaminess, yellow urine or constipation, red tongue with yellow coating and thready and rapid pulse.

Therapeutic principles: Nourish yin, clear away heat, arrest bleeding, and regulate menstruation.

Prescription: The Modified Decoction for Promoting Yin

Radix Ophiopogonis 10 g
Fructus Schisandrae 10 g
Colla Corii Asini 10 g
Radix Rehmanniae 15 g
Radix Rehmanniae Praeparata 15 g
Radix Paeoniae Alba 15 g
Rhizoma Dioscoreae 15 g
Radix Dipsaci 10 g
Radix Scutellariae 10 g
Cortex Phellodendri 10 g
Radix Glycyrrhizae 6 g

B. Spleen-deficiency syndrome

Manifestations: Profuse or dripping bleeding with reddish and thin discharge, pale complexion, puffy face, shortness of breath, fatigue, cold limbs, poor appetite, abdominal distention, loose stool, reddish and corpulent tongue with thin and moist or greasy coating and weak pulse.

Therapeutic principles: Tonify qi, stop bleeding, nourish blood, and regulate menstruation.

Prescription: The Decoction of Strengthening the Root for Relieving Menorrhagia

Radix Codonopsis Pilosulae 15 g
Radix Astragali Praeparata 15 g
Rhizoma Atractylodis Macrocephalae 15 g
Radix Rehmanniae Praeparata 15 g
Radix Angelicae Sinensis 10 g
Rhizoma Zingiberis Praeparata 6 g

Remarks: For cases with profuse bleeding, add Herba Agrimoniae (15 g) and Galla Chinensis (10 g), and omit Angelicae Sinensis. For cases with prolonged dripping bleeding, add Pollen Typhae (fried, 10 g) and Os Sepiellae seu Sepiae (15 g). For cases with insomnia and palpitations, add Semen Ziziphi Spinosae (fried, 15 g), Fructus Schisandrae (15 g) and Caulis Polygoni Multiflori (15 g).

C. Kidney-deficiency syndrome

(a) Kidney-yin deficiency syndrome

Manifestations: Dripping bleeding with small amount of bright red discharge, dizziness, tinnitus, feverish sensation over the chest, palms and soles, insomnia, night sweating, soreness and weakness of loins and legs or lumbago and heel pain, red tongue with little coating and thready, rapid and weak pulse.

Therapeutic principles: Invigorate kidneys, tonify yin, supplement essence, and arrest bleeding.

Prescription: The Modified Bolus of Six Drugs Containing Rehmanniae Praeparata

Radix Rehmanniae Praeparata 15 g
Rhizoma Dioscoreae 15 g
Poria 10 g
Cortex Moutan Radicis 10 g
Rhizoma Alismatis 10 g
Fructus Ligustri Lucidi 12 g
Herba Ecliptae 20 g
Fructus Lycii 10 g
Colla Corii Asini 10 g
Plastrum Testudinis 15 g
Herba Agrimoniae 15 g

(b) Kidney-yang deficiency syndrome

Manifestations: Irregular menstrual cycles, sudden profuse or dripping bleeding with reddish or dull and thin discharge, dimmish complexion, lower abdominal bearing-down sensation, soreness and weakness of lumbus and legs, pale tongue with thin, white coating and deep and thready pulse.

Therapeutic principles: Warm the kidneys, strengthen the Chong meridian, regulate menstruation, and stop bleeding.

Prescription: The Modified Yougui Bolus

Radix Rehmanniae Praeparata 15 g
Rhizoma Dioscoreae 15 g
Fructus Corni 10 g
Fructus Lycii 15 g
Semen Cuscutae 15 g
Colla Cornus Cervi 15 g
Cortex Eucommiae 15 g
Radix Aconiti Lateralis Praeparata 6 g
Radix Astragali 15 g
Halloysitum Rubrum 15 g
Fructus Psoraleae 15 g
Fructus Rubi 15 g

Remarks: For young women with insufficiency of kidney-qi, add Placenta Hominis (10 g) and Herba Epimedii (10 g) to enhance the effects of invigorating the kidneys and benefiting the Chong meridian. For cases accompanied by deficiency of spleen-yang manifested as edema, poor appetite and cold extremities, add Rhizoma Atractylodis Macrocephalae (fried, 15 g), Fructus Amomi (6 g) and Rhizoma Zingiberis Praeparata (6 g) to benefit the spleen and warm the middle-jiao.

(c) Liver-qi stagnation and blood-heat syndrome

Manifestations: Irregular menstrual cycles, dripping or profuse discharge of red and viscous blood containing clots, distending pain over the lower abdomen, hypochondrium and breasts, irritability, red tongue with yellow coating and wiry and rapid pulse.

Therapeutic principles: Calm the liver, disperse the stagnated liver-qi, regulate the Chong meridian, and stop bleeding.

Prescription: The Decoction for Calming the Liver, Alleviating Mental Depression and Stopping Bleeding

Radix Paeoniae Alba 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Angelicae Sinensis 10 g
Cortex Moutan Radicis 10 g
Radix Rehmanniae 15 g
Radix Bupleuri 10 g
Herba Schizonepetae Carbonisatus 10 g
Radix Notoginseng 6 g
Radix Glycyrrhizae 6 g

Remarks: For cases with profuse bleeding, add Radix Sanguisorbae (15 g) and Rhizoma Dryopteris Crassirhizomae (15 g) to clear away heat and stop bleeding. For cases with hypofunction of spleen manifested as menorrhagia, shortness of breath and poor appetite, add Radix Astragali (15 g), Rhizoma Atractylodis Macrocephalae (10 g) and Rhizoma Dioscoreae to benefit qi and strengthen the spleen.

(d) Blood-stasis syndrome

Manifestations: Dripping or sudden profuse bleeding with purple and clotted discharge, lower abdominal pain and tenderness which can be relieved by discharge of clots, petechiae on the tongue margin and deep and unsmooth pulse.

Therapeutic principles: Activate blood circulation, eliminate blood stasis, regulate the Chong meridian, and stop bleeding.

Prescription: The Decoction of Persicae and Carthami in Four Drugs

Semen Persicae 10 g
Radix Angelicae Sinensis 12 g
Radix Rehmanniae Praeparata 15 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Alba 15 g
Flos Carthami 10 g

Remarks: For cases with cold pain over the lower abdomen due to stagnation of cold and blood, add Folium Artemisiae Argyi Carbonisatus (6 g) and Rhizoma Zingiberis Carbonisatus (6 g) to warm meridians and arrest bleeding. For cases with profuse bleeding, omit Angelicae Sinensis and Persicae and add Radix Notoginseng (6 g) and Herba Leonuri (15 g) to eliminate blood stasis and arrest bleeding. For cases with amenorrhea after bleeding, add Radix Achyranthis Bidentatae (10 g) and Rhizoma Zedoariae (10 g) to promote menstruation. For cases with distending pain over the lower abdomen due to stagnation of qi and blood, add Faeces Trogopterori (10 g), Pollen Typhae (wrapped in cloth, 10 g) and Rhizoma Cyperi (10 g) to regulate qi and blood circulation, eliminate blood stasis and stop pain.

(e) Dampness-heat syndrome

Manifestations: Continuous dripping bleeding with dark-purplish odorous discharge containing clots, distending pain and tenderness over the lower abdomen, fever, fatigue, heavy feeling in the extremities, thirst but without desire for drink, red tongue with yellow, greasy coating and soft-floating and rapid pulse.

Therapeutic principles: Clear away heat, eliminate dampness, and arrest bleeding.

Prescription: The Modification of Three Wonder Drugs Decoction with Sargentodoxae

Rhizoma Atractylodis 10 g
Caulis Sargentodoxae 15 g
Cortex Phellodendri 10 g
Herba seu Radix Cirsii Japonici 10 g
Herba Cephalanoploris 10 g
Herba Agrimoniae 15 g
Herba Patriniae 15 g
Semen Coicis 15 g
Herba Leonuri 15 g
Herba Verbenae 15 g
Rhizoma Cyperi Praeparata 10 g
Rhizoma Paridis 15 g

Remarks: For cases with heat as the predominant syndrome, use the Decoction of Lonicerae, Forsythiae and Sargentodoxae for Removing Toxic Materials

Flos Lonicerae 15 g
Fructus Forsythiae 15 g
Caulis Sargentodoxae 15 g
Herba Patriniae 15 g
Semen Coicis 15 g
Cortex Moutan Radicis 10 g
Fructus Gardeniae 10 g
Radix Paeoniae Rubra 10 g
Semen Persicae 10 g
Rhizoma Corydalis 10 g
Fructus Toosendan 12 g
Olibanum 10 g
Myrrha 10 g

For cases with sudden profuse bleeding, fever, thirst, yellow, greasy tongue coating and bounding, large pulse, add the following drugs to the above decoction: Rhizoma Paridis (15 g), Rhizoma Dryopteris Crassirhizomae (10 g), Flos Chrysanthemi Indici (10 g), Herba Hedyotis Diffusae (15 g), Herba Artemisiae Annuae (10 g), Herba Agrimoniae (15 g) and Radix Rubiae (12 g), and omit Coicis and Corydalis to clear away heat, cool the blood and stop bleeding.

Copyright 1995 Hopkins Technology

 


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