Patient's question:
Test results:Doctor's answer:
Functional uterine bleeding, abbreviated as FUB, is a common gynecological disorder characterized by abnormal uterine bleeding that does not reveal any systemic or genital organic lesions upon examination, but is instead caused by dysfunction of the neuroendocrine system. It is manifested as irregular menstrual cycles, excessive menstrual flow, prolonged menstrual periods, or irregular bleeding. It is primarily caused by dysfunction of the nervous and endocrine systems, and normal menstrual cycles depend on the regulation and mutual restraint of the central nervous system, the hypothalamic-pituitary-ovarian axis, and other systems. Any internal or external factors that disrupt the normal regulation of the gonadal axis can lead to FUB.Treatment Recommendations:
Traditional Chinese Medicine Treatment
(1) Pattern Differentiation: Yin deficiency with blood heat.
Treatment Principle: Nourishing yin, consolidating, clearing blood heat.
Formula Name: Nourishing Yin and Stopping Bleeding Decoction.
Composition:
- Raw Rehmannia 24g
- Raw White Peony Root 12g
- Scutellaria 12g
- Radix Salviae Miltiorrhizae Precoated 12g
- Dendrobium 12g
- Cortex Phellodendri 12g
- Calcined Oyster Shell 30g
- Calcined Agate 30g
- Carbonized Stipa 30g
- Side Branch Leaf 15g
- Carbonized Lotus Plumule 12g
Administration: Decoction, oral administration.
Source: Gynecology and Obstetrics.
(2) Pattern Differentiation: Qi stagnation with spleen deficiency.
Treatment Principle: Strengthening the spleen and suppressing the liver, with hemostatic support.
Formula Name: Tonifying Spleen and Relieving Liver Decoction.
Composition:
- Codonopsis 15g
- White Atractylodes 9g
- Poria 9g
- Bupleurum 6g
- Fried White Peony Root 9g
- Fried Persicae Flower 9g
- Carbonized Human Hair 6g
- Carbonized Artemisia 9g
Administration: Decoction, once daily, twice a day.
Source: Treatment of Gynecology with Traditional Chinese Medicine.
(3) Pattern Differentiation: Liver qi dysfunction.
Treatment Principle: Nourishing blood and soothing the liver, regulating menstruation and stopping bleeding.
Formula Name: Nourishing Blood and Pacifying Liver Powder.
Composition:
- Angelica Sinensis (soaked in wine) 6g
- Fried White Peony Root 6g
- Cyperus (carbonized) 6g
- Bitter Orange (carbonized with vinegar) 2.4g
- Bupleurum 2.4g
- Ligusticum 2.4g
- Raw Rehmannia 2.4g
- Licorice 1.5g
Administration: Decoction, taken before meals.
Source: Essentials of Gynecology and Obstetrics.
(4) Pattern Differentiation: Kidney qi deficiency.
Treatment Principle: Consolidating essence, tonifying the kidneys, nourishing blood, and stopping bleeding.
Formula Name: Tonifying Kidneys and Regulating Menstruation Decoction.
Composition:
- Astragalus 15-20g
- Tribulus (or Epimedium) 10g
- Dipsacus (or Psoralea) 12g
- Angelica Sinensis 10g
- White Peony Root 10g
- Prepared Rehmannia 15g
- Carbonized Side Branch Leaf 15g
- Fried Artemisia 6g
Administration: Decoction, once daily, twice a day.
Source: Journal of Zhejiang College of Traditional Chinese Medicine.
(5) Pattern Differentiation: Kidney yin deficiency with blood heat.
Treatment Principle: Nourishing yin, cooling blood, clearing heat, and consolidating.
Formula Name: Nourishing Kidneys and Consolidating Decoction.
Composition:
- Raw Rehmannia 15g
- Goji Berry 9g
- Cornus 9g
- Phellodendron 9g
- Carbonized Human Hair 9g
- Calcined Dragon Bone 30g
- Calcined Oyster Shell 30g
- Carbonized Side Branch Leaf 30g
- Tortoise Shell 12g
- Eclipta 12g
- Carbonized Lotus Plumule 12g
Administration: Decoction, once daily, twice a day.
Source: Gynecology and Obstetrics.
(6) Pattern Differentiation: Uterine damp-heat.
Treatment Principle: Cooling blood, resolving stasis, and consolidating to stop bleeding.
Formula Name: Cuttlefish Bone and Rubia Decoction.
Composition:
- Calcined Cuttlefish Bone 15g
- Carbonized Rubia 15g
- Carbonized Sanguisorba 15g
- Sambucus 15g
- Carbonized Persicae Flower (wrapped) 10g
- Carbonized Sophora Flower 50g
- Chrysanthemum 50g
- Portulaca 50g
- Licorice 5g
Administration: Decoction, once daily, twice a day.
Source: Journal of Traditional Chinese Medicine.
(7) Pattern Differentiation: Kidney deficiency with blood stasis.
Treatment Principle: Tonifying kidneys, consolidating, nourishing yin, and resolving stasis to stop bleeding.
Formula Name: Astragalus and Dipsacus Decoction for Stopping Bleeding.
Composition:
- Astragalus 40g
- Dipsacus 20g
- Cornus 10g
- Prepared Rehmannia 15g
- Goji Berry 15g
- Fried White Atractylodes 10g
- Fried White Peony Root 10g
- Rubia 12g
- Prepared Panax Notoginseng Powder 6g
- Fried Licorice 10g
Administration: Decoction, once daily, three times a day.
Source: Yi Xiuzhen’s Formula.
Common Chinese Patent Medicines
1. Kidney Yang Deficiency: Persistent vaginal bleeding with pale or dark, thin discharge; cold lower abdomen; preference for warmth; lower back and back pain; frequent nighttime urination; pale tongue with thin white coating.
Treatment: Warming and tonifying kidney yang.
Jin Gui Shen Qi Wan, You Gui Wan, or Zhuang Yao Jian Shen Wan. One each morning and evening, taken with warm water.
2. Kidney Yin Deficiency: Excessive vaginal bleeding with red, thick discharge; dizziness, tinnitus; lower back and leg pain; heat in palms and soles; poor sleep with frequent dreams; thin, red tongue.
Treatment: Nourishing kidney yin.
Liu Wei Di Huang Wan or Zhi Bai Di Huang Wan. One each morning and evening, taken with light salt water.
Liu Wei Di Huang Kou Fu Ye. One each morning and evening.
Gui Lu Er Xian Jiao Wan. One each morning and evening.
3. Qi and Blood Deficiency: Excessive vaginal bleeding with thin, pale-red discharge; sallow complexion; palpitations; dizziness; shortness of breath and fatigue; pale tongue with thin white coating.
Treatment: Tonifying qi and nourishing blood.
Shi Quan Da Bu Wan. One each morning and evening, taken with warm water.
Nu Qing Chun. Five to six tablets each time, three times a day, before meals.
Yang Xue Dang Gui Jing. Five to ten milliliters each time, twice a day, taken with warm water.
4. Qi and Blood Stasis: Excessive vaginal bleeding with dark clots; bleeding decreases after clots are expelled; lower abdominal pain and distension; grayish tongue.
Treatment: Promoting blood circulation and resolving stasis.
Fu Kang Ning Pian. Eight tablets each time, two to three times a day.
Dan Qi Pian. Three to five tablets each time, three times a day.
5. Spleen Qi Deficiency: Excessive vaginal bleeding with red or pale-red, continuous bleeding; shortness of breath; facial edema; abdominal fullness and loose stools; poor appetite and fatigue; taste; pale tongue with greasy white coating.
Treatment: Tonifying the spleen, nourishing blood, and strengthening qi.
Gui Pi Wan. One each morning and evening, taken with warm water.
Ren Shen Gui Pi Wan or Bu Zhong Yi Qi Wan. One each morning and evening, taken with warm water.
6. Liver Qi Stagnation: Irregular vaginal bleeding with varying amounts, timing, or continuous spotting; chest and hypochondriac fullness; bitter taste and dry throat; breast tenderness; irritability; headaches; thin yellow coating.
Treatment: Soothing the liver and regulating qi.
Jia Wei Xiao Yao Wan. One each morning and evening, taken with warm water.
Qi Zhi Xiang Fu Wan. Six grams each time, twice a day.
7. Excess Heat: Excessive vaginal bleeding with dark-red, thick discharge; flushed face; dry mouth and restlessness; red tip of tongue.
Treatment: Clearing heat and cooling blood.
Shi Hua San. One each time, three times a day. Taken with lotus root juice or radish juice mixed with ink.
8. Deficiency Heat: Less vaginal bleeding with red, thin discharge; flushed cheeks; heat in palms and soles; red, thin tongue with yellow coating.
Treatment: Nourishing yin and clearing heat.
Gu Jing Wan. Six grams each time, twice a day, taken with warm water.
Treatment Methods for Functional Uterine Bleeding
1. Hemostatic Treatment:
Many people have heard of the "dilation and curettage" method for stopping bleeding. Dilation and curettage is a minor surgical procedure that can be performed in an outpatient setting, usually with local anesthesia. Under sterile conditions, a doctor uses a small curette to scrape the uterine cavity mechanically, causing the proliferative endometrium to shed rapidly and thus achieving hemostasis. Although this method may cause some discomfort, it is fast, safe, and generally reliable. More importantly, the scraped endometrium can be sent to the pathology department for examination, allowing for the diagnosis of polyps, tumors, or other conditions. Therefore, dilation and curettage should be considered for married patients with prolonged irregular bleeding, especially those over 40. However, if a curettage has already been performed recently with no evidence of organic disease, repeated procedures are unnecessary. Bleeding usually stops immediately after curettage and completely within one week. Rest for about seven days before returning to work.
2. Pharmacological Dilation and Curettage:
For unmarried patients, dilation and curettage should be avoided or replaced with pharmacological methods. Pharmacological dilation and curettage targets the pathophysiological changes in patients with anovulatory FUB due to a lack of progesterone influence. Progesterone (20 mg/day) is administered intramuscularly for three days, causing the endometrium to transform into a secretory phase. After stopping the medication, the artificial decline in progesterone levels leads to regular endometrial shedding, known as "withdrawal bleeding," which is similar to a normal menstrual period and lasts about seven days, sometimes with heavy flow. This is expected and unavoidable. Therefore, patients must be informed that hemostatic effects will only appear after withdrawal bleeding stops to prevent them from abandoning treatment or using other hormones improperly, leading to medication confusion. To reduce the amount of withdrawal bleeding, testosterone propionate (a male hormone preparation) (25–50 mg/day for three days) can be administered intramuscularly concurrently. If the flow remains heavy, bed rest, oral or intramuscular administration of vitamin K, hemostatic, vitamin C, and aminopyridine may be necessary, and in severe cases, glucose or blood transfusions may be required. Withdrawal bleeding should not be treated with estrogen or progesterone preparations.
Estrogen Hemostatic Method:
If young, unmarried patients with FUB experience excessive blood loss or severe anemia (hemoglobin