TCM Treatment for Gynaecological Diseases - Irregular Menstruation Academic research paper on "Biological sciences"

Lecture

TCM Treatment for Gynaecological Diseases - Irregular Menstruation

Engin CAN

EVERWELL Chinese Medical Centre, London, U.K

Menstruation is the periodic shedding (usually monthly) of the lining of the womb. Generally speaking, menstruation starts during puberty around 10-16 years old and continues until the menopause about 45-55 years old. An average menstrual cycle is about 28 days, but it may vary between 24-35 days. According to a study most women have more than 500 periods in a lifetime. Any abnormality of the above menstrual conditions can be regarded as irregular.

In traditional Chinese medicine theory, irregular menstruation is termed 'Yuejing Shitiao (irregular menstruation)', referring to disorders in the menstrual cycle and abnormalities in the amount, color and nature of the menstrual blood.

Clinically, an irregular menstruation includes many different menstrual conditions in TCM, such as early menstrual cycle, delayed menstrual cycle, irregular menstrual cycle, menorrhagia, scanty menstruation, etc. In fact, most, if not all, women have experienced symptoms of irregular menstruation to some extent in their lives.

TCM has had thousands of years of experience in the treatment of most patterns of irregular menstruation with acupuncture, herbal medicine and other therapies.

AETIOLOGY AND PATHOLOGY

Irregular menstruation can be caused by many physical or emotional factors or even due to something as simple as changing the contraceptive pill. A disturbance in the balance of estrin and progesterone, which regulates the menstrual cycle, is often a common cause of irregular menstruation. Hormone imbalance can occur as a result of weight

loss or gain, heavy exercise, stress or other illness. Another possible cause is disorder of the thyroid as normally the thyroid gland produces hormones that maintain the body's metabolism including menstruation.

In TCM theory, menstrual blood is discharged from the uterus, but it is related to the internal viscera, meridians, qi and blood, especially to the kidney-qi. According to the records in the Huangdi Neijing, the earliest TCM classical text in China (BC 475 - 221), the kidney is the key internal organ for the physiological development of women throughout their lifetime including menstruation. It states that, 'at the age of 7, a female is increasingly rich in kidney-qi as she begins to get her adult teeth and grow long hair. At the age of 14, 'Tian Guf (a reproductive substance like a hormone in the Western medicine) is well developed, the circulation of the Ren Meridian is smooth; and the Chong Meridian predominates. As a result, men- struation occurs regularly. However, on reaching the age of 49, the Ren Meridian becomes deficient, the Chong Meridian declines, Tian Gui has been exhausted and menstruation stops'. Additionally, the liver, spleen and other organs are also connected with the formation and development of menstruation in TCM theory.

TCM believes that the irregular menstruation can be caused by many factors

1) Emotional disorders, such as worry, stress, upset, depression and restlessness, may cause stagnation of the liver-qi and then develop into blood stasis in the Ren Meridian and the Chong Meridian; 2) Invasion of the Ren Meridian and the Chong Meridian by pathogenic cold, heat or dampness can affect the circulation of the qi and blood as well as the

functions of the kidney, liver and spleen; 3) Lack of proper care after prolonged illness or excessive sexual activities can consume the kidney-qi and blood. All the above factors can lead to some pathogenic conditions such as heat in blood, deficiency of qz, blood stasis, cold in blood and stagnation of qz', etc.

Basically, heat in blood may drive blood out of the blood vessels and cause an early menstrual cycle or profuse menstruation; deficiency of spleen-qz' can make blood circulation out of control, leading to an early menstrual cycle or profuse bleeding; blood stasis and cold in blood generally results in a delayed menstrual cycle or scanty menstruation; and stagnation of qi is often one of the causes leading to irregular menstrual cycle.

DIFFERENTIAL DIAGNOSIS Common types of irregular menstruation

1) Early Menstrual Cycle: The menstruation occurs 7-10 days earlier than usual. If menstruation occurs only 3-5 days earlier than usual or just occurs occasionally, both are still regarded as normal, but the continuous occurrence of early menstruation for 3 months can be diagnosed as Early Menstrual Cycle.

2) Delayed Menstrual Cycle: The menstruation occurs a week or even later than usual. However, an occasional delayed menstruation is still regarded as normal; if delayed menstruation occurs for consecutive 3 months, it can be diagnosed as Delayed Menstrual Cycle.

3) Irregular Menstrual Cycle: The menstruation which occurs irregularly and alternatively over 7 days, sometimes earlier and sometimes later than usual is termed Irregular Menstrual Cycle.

Common syndromes of irregular menstrual cycles

1) Heat in Blood: Early menstrual cycle, or profuse menstruation, marked by bright, or dark red menstrual fluid, or fluid that is thick and sticky, accompanied by a flushed face, restlessness, a dry mouth and excessive thirst, yellow urine, constipation,

a red tongue with yellow fur, and a rapid pulse.

2) Deficiency of Qi: Early menstrual cycle, or profuse menstruation, marked by light-coloured and thin menses, poor appetite, loose stools, fatigue, pale tongue with thin and whitish fur, and a thready and weak pulse.

3) Blood Stasis: Delayed menstrual cycle, scanty menstruation, marked by dark-coloured menses with clots, pain in the lower abdomen which is alleviated after the discharge of clots, a dark-coloured tongue and a taut or hesitant pulse.

4) Cold in the Blood: Delayed menstrual cycle, or scanty menses with blood clots, marked by abdominal pain that can be alleviated with warmth, cold limbs, an aversion to cold, a blackish tongue with white fur, and a deep and taut pulse.

5) Stagnation of Qi: Irregular menstrual cycle, or scanty or profuse menstruation, marked by purplish and hesitant flow, dysphoria, a susceptibility to rage, a preference for sighing, hypochondriac distension or pain, breast distension, a thin tongue with white fur , and a taut pulse.

DIAGNOSIS IN WESTERN MEDICINE

1) A history of personal menstruation and details of menstrual cycle as well as any abnormal condition in the amount, color and nature of menses with other accompanying symptoms are all required for the diagnosis.

2) Gynecological examinations and other necessary check-ups are needed to confirm that there is no organic change in the pelvis.

3) Some tests such as Ultrasonic B Wave examination, colposcopy, and pelvic scans, can be applied to make sure that there is no other serious organic disease.

TCM TREATMENTS Body acupuncture

Basic acupoints: Guanyuan (CV 4), Zhongji (CV 3), Sanyinjiao (SP 6). Supplementary acupoints: For heat in blood, add Quchi (LI 11), Hegu (LI 4) and Xuehai

(SP 10); For deficiency of qi, add Qihai (CV 6), Zusanli (ST 36) and Pishu (BL 20); For blood stasis, add Xuehai (SP 10), Waiguan (TE 5) and Ganshu (BL 18); For cold in blood, add Baihui (GV 20), Mingmen (GV 4) and Dazhui (GV 14); For stagnation of qi, add Qimen (LR 14), Taichong (LR 3) and Waiguan (TE 5).

Method: Use filiform needles to puncture the acupoints selected. For the syndromes of heat in blood, blood stasis and stagnation of qi, use the reducing method; For the syndromes of deficiency of qi, and cold in blood, use the reinforcing method and also apply moxibustion to Guanyuan (CV 4), Zusanli (ST 36) and Sanyinjiao (SP 6) or other acupoints selected.

Ear acupuncture

Ear points: Pelvic Cavity, Pt. Kidney, Pt. Liver, Pt. Endocrine, Pt. Spleen.

Method: 3-6 points are selected for each treatment. The auricular-seed-pressing therapy can be used. The seeds should be re-placed once every 3-5 days.

Herbal Therapy

1) Heat in Blood

Therapeutic principle: Clearing away heat, cooling blood and regulating menstruation.

Formula: Modified Qingjing San/Powder or Decoction for Clearing Menstruation-heat).

Ingredients:

Mudanpi (tt^^ Cortex Moutan Radicis)/Moutan bark 9 g

Digupi Cortex Lycii)/Wolfberry bark 9 g

Baishao (S^ Radix Paeoniae Alba)/White peony root 9 g

Shengdihuang (Radix Rehmanniae)/Dried rehmanniae root 9 g

Huangbai (^tt Cortex Phellodendri)/Phellodendron bark 9 g

Qinghao (WM Herba Artemisiae)/Sweet wormwood 6 g

Yimucao Herba Leonuri)/Motherwort 15 g

Shengdiyu ( ^ № ^ Radix Sanguisorbae)/Raw sanguisorba root 15 g

Administration: All the above herbs should be soaked in a saucepan of water for 2 h or more, then brought to the boil and simmered for 25-30 min. After this time the remaining liquid can be drained away from the herbs to make a tea or decoction, for the patient to drink. Half the liquid should be taken in the morning, the other half in the evening.

2) Deficiency of Qi

Therapeutic principle: To strengthen the spleen to maintain the blood flow in the vessels and regulate menstruation.

Formula: Gui Pi Tang ( J/3 ^ )/Decoction for Strengthening the Spleen with additional ingredients.

Ingredients:

Baizhu (S^ Rhizoma Atractylodis Macrocephalae) /Bighead atractylodes rhizome 9 g Fushen (Poria cum Radix Pini)/Poria with hostwood 9 g

Huangqi Radix Astragali)/Astragalus root 12 g Longyanrou (Arillus Longan)/Longan aril 12g

Suanzaoren Semen Ziziphi Spinosae)/Wild

jujube seed 12 g

Renshen (A# Radix Ginseng)/Ginseng 6 g Muxiang Radix Aucklandiae)/Aucklandia root 6 g

Zhigancao Radix Glycyrrhizae Praeparatae)/

Prepared licorice root 3 g

Danggui Radix Angelicae Sinensis)/Chinese

angelica root 9 g

Yuanzhi Radix Polygalae)/Polygala root 6 g Aiyetan ( X Bf ^ Folium Artemisiae Argyi)/ Carbonized Argyi leaf 9 g

Paojiang (^^ Rhizoma Zingiberis Praeparatae)/ Baked ginger 9 g

Administration: All the above herbs should be soaked in a saucepan of water for 2 hours or more, then brought to the boil and simmered for 25-30 min. After this time the remaining liquid can be drained away from the herbs to make a tea or decoction, for

the patient to drink. Half the liquid should be taken in the morning, the other half in the evening.

3) Blood Stasis

Therapeutic principle: Promoting blood circulation and removing blood stasis to regulate menstruation.

Formula: Tao Hong Siwu Tang ( ^ HB ^ ^)/Four-ingredient Decoction plus Peach Kernel and Safflower.

Ingredients:

Shudihuang (Radix Rehmanniae)/Prepared rehmannia root 9 g

Danggui Radix Angelicae Sinensis)/Chinese

angelica root 9 g

Chishao Radix Paeoniae Rubra)/Red peony

root 9 g

Chuanxion (j 1Rhizoma Chuanxiong)/ Chuanxiong rhizome 6 g

Taoren Semen Persicae)/Peach kernel 9 g Honghua (^X^ Flos Carthami)/Safflower 9 g

Administration: All the above herbs should be soaked in a saucepan of water for 2 h or more, then brought to the boil and simmered for 25-30 min. After this time the remaining liquid can be drained away from the herbs to make a tea, or decoction, for the patient to drink. Half the liquid should be taken in the morning, the other half in the evening.

4) Cold in Blood

Therapeutic principle: Warming meridians and dispelling cold to regulate menstruation.

Formula: Modified Wen Jing Tang ( fi ^ )/ Decoction for Warming Meridians.

Ingredients:

Wuzhuyu (M^^ Fructus Evodiae)/Evodia fruit 9 g

Danggui Radix Angelicae Sinensis)/Chinese angelica root 6 g

Baishao Radix Paeoniae Alba)/White peony root 6 g

Chuanxion Rhizoma Chuanxiong)/Chuanxiong

rhizome 6 g

Renshen (A# Radix Ginseng)/Ginseng 6 g Guizhi Ramulus Cinnamomi)/Cinnamon twig

Mudanpi (tt^^ Cortex Moutan Radicis)/Moutan bark 6 g

Shengjiang Rhizoma Zingiberis Recens)/Fresh ginger 6 g

Gancao Radix Glycyrrhizae) /Licorice root 6 g

Administration: All the above herbs should be soaked in a saucepan of water for 2 h or more, then brought to the boil and simmered for 25-30 min. After this time the remaining liquid can be drained away from the herbs to make a tea or decoction, for the patient to drink. Half the liquid should be taken in the morning, the other half in the evening.

5) Stagnation of Qi

Therapeutic principle: Smoothing the liver-gi and nourishing blood to regulating menstruation.

Formula: Xiaoyao San (H )/Bupleurum and Tang-Kuei Formula (Ease Powder or Decoction).

Ingredients:

Zhigancao Radix Glycyrrhizae Praeparatae)/

Prepared licorice root 9 g

Danggui Radix Angelicae Sinensis)/Chinese

angelica root 10 g

Fuling Poria)/Tuckahoe 9 g

Baishao (S^ Radix Paeoniae Alba)/White peony

root 9 g

Baizhu (S^ Rhizoma Atractylodis Macrocephalae)/ Bighead atractylodes rhizome 9 g Chaihu (^SJI Radix Bupleuri)/Bupleurum root 9 g Bohe Herba Menthae)/Peppermint 6 g

Administration: All the above herbs except Bohe (^ ^ Herba Menthae) should be soaked in a saucepan of water for 2 h or more, and then brought to the boil. The Bohe Herba Menthae) can be added at this point and simmered with the other herbs for the required 5-10 min. After this time the remaining

liquid can be drained away from the herbs to make a tea or decoction, for the patient to drink. Half the liquid should be taken in the morning, the other half in the evening.

LIFESTYLE AND DIETARY ADVICE

1) During menstruation, the pudenda should be kept clean and hygienic; stress, fatigue, and heavy physical labour or working with scorching sun directly overhead should be avoided; women should strictly abstain from swimming and vaginal examinations.

2) The abdomen should be kept warm during menstruation. Cold bathing, wading across a river, being drenched with rain, sitting or lying on the wet ground or working in damp fields are not recommended.

3) Diet is very important in order to keep the body healthy and this also applies to health during menstruation. Light and nutritious food is advised. Too much sour, pungent, aromatic food as well as uncooked and cold food is not good during menstruation; it is also inadvisable to drink too much caffeinated drinks such as coffee, tea, cola, etc.

4) Weight can influence the hormonal balance and menstruation. If a patient is underweight, their hormones might not be functioning properly and their periods may stop. Recent research has also shown that obesity can also throw the hormones out of balance, which may cause irregular menstruation. Therefore being underweight or overweight is not recommended.

5) Sexual activities have been seen to affect the menstrual cycle, probably due to hormones released during lovemaking. Couples should always practice healthy, regular and proper sexual activities and avoid excessive coitus. During menstruation, couples should strictly abstain from sexual intercourse.

Notes/About author: Prof. ZHANG Enqin (Engin

CAN), a senior specialist in TCM. He graduated from Shandong University of Traditional Chinese Medicine (TCM) in 1982 with a Post-graduate Dip., Master of Medicine and later also obtained his M.D. and Professorship in Alternative and Chinese Medicines from 4 international and Chinese universities and institutes. He was director of the Advanced Studies Department of Shandong TCM University in 1985-1991 as well as the author and chief editor of many TCM books, such as the series 'A Practical English-Chinese Library of TCM', composed of 14 books, the first English edition of TCM textbooks in the world, published by Shanghai TCM University Press in 1990, has been distributed to more than 66 countries. In 1991, The Academic Degree Committee of Chinese State Council & Education Ministry awarded 695 Chinese doctor & Master Degree holders for their outstanding achievements; one of them was ZHANG Enqin. Since 1992 he has lectured and practiced in many countries including Middlesex University, the U. K. Now he mainly practices at the Everwell Chinese Medical Center, London Clinic 7. Address: 36 Gerrard Street, Chinatown, London, W1D 5QA, the U. K. (Tel: 02072870805.E-mail: prof.engincan@ hotmail.co.uk)

Lecture for TCM Week at Royal Society of Medicine U.K. (1 Wimpole Street, London, W1G 0AE, on 30/07/2008 at 2.30-3.00 pm. Tel: 07846193488)