Patient's question:
Heavy menstrual bleeding, it's been more than three and a half months since my last period. Last month of the last year.Doctor's answer:
Analysis of the Condition: Based on the anatomical location of the primary cause, amenorrhea can be classified into four categories: uterine, ovarian, pituitary, and hypothalamic.1. Uterine Amenorrhea and Its Causes: Uterine amenorrhea refers to the absence of menstruation caused by uterine disease, leading to the absence of the endometrium. Due to the absence of the endometrium, both progesterone and artificial cycle tests are negative. The causes of uterine amenorrhea include:
(1) Congenital absence or underdevelopment of the uterus. The uterus may appear nodular, and the vagina may be absent, leading to primary amenorrhea. These patients have normal body types and development but often have skeletal underdevelopment, spinal curvature, and renal malformations. Ovarian function is normal, with ovulation, biphasic basal body temperature, and normal gonadotropins.
(2) Postnatal endometrial damage. Severe postpartum infection, severe tuberculous endometritis, or radiation therapy can cause amenorrhea. Excessive scraping during induced abortion, leading to scars or adhesions in the uterine cavity, can also cause amenorrhea.
(3) Poor endometrial response. Prolonged breastfeeding or long-term use of contraceptives can lead to prolonged lack of sex hormones, causing excessive endometrial atrophy and amenorrhea.
Guidance:
1. Pattern Differentiation: Liver qi stagnation, stomach dysfunction, and blocked meridians.
Treatment Principle: Soothe the liver, harmonize the stomach, activate blood, and promote menstruation.
Formula Name: Liver-Soothing and Blood-Activating Menstruation-Promoting Decoction.
Composition:
- Baked Angelica Sinensis 10g
- Evodia Fructus 6g
- Fennel 6g
- Salvia Miltiorrhiza Root 15g
- Fructus Meliae 10g
- Baked Corydalis 6g
- Persicae Semen 6g
- Auricularia 6g
- Angelica Sinensis Root 12g
- Moutan Cortex 10g
- Pinelliae Rhizoma 10g
- Radix Paeoniae Rubra and Alba 6g each
- Baked Atractylodes Rhizoma 6g each
Usage: Decoction, once daily, taken three times a day.
Source: Qu Wenlou’s Prescription.
2. Pattern Differentiation: Deficiency of both qi and blood.
Treatment Principle: Tonify qi and blood, and invigorate the spleen and kidneys.
Formula Name: Modified Eight Treasure Decoction.
Composition:
- Codonopsis 12g
- Poria 9g
- Atractylodes Macrocephala Rhizoma 9g
- Angelica Sinensis Root 9g
- Cinnamon Bark 9g
- Ligusticum Wallichii Rhizoma 9g
- Rehmannia Glabra Root 15g
- Uncariae Cumii Radix 15g
- Prepared Aconite 6g
- Dried Ginger 6g
- Baked Licorice 6g
Usage: Decoction, once daily, taken three times a day.
Source: Zhu Nansun’s Prescription.
3. Pattern Differentiation: Liver qi stagnation.
Treatment Principle: Soothe the liver, relieve depression, and regulate menstruation.
Formula Name: Four-Ingredient Free and Easy Decoction.
Composition:
- Bupleurum 9g
- Angelica Sinensis Root 9g
- Ligusticum Wallichii Rhizoma 9g
- Baked Angelica Sinensis 9g
- Corydalis 9g
- Persicae Semen 9g
- Carthamus Tinctorius Flower 9g
- Radix Paeoniae Rubra 12g
- Rehmannia Glabra Root 12g
- Green Peel 6g
Usage: Decoction, once daily, taken twice a day.
Source: Zhu Nansun’s Prescription.
4. Pattern Differentiation: Qi stagnation and blood stasis.
Treatment Principle: Activate blood and regulate qi.
Formula Name: Blood-Activating Decoction.
Composition:
- Persicae Semen 9g
- Carthamus Tinctorius Flower 9g
- Radix Angelicae Sinensis 9g
- Lindera aggregata 9g
- Radix Paeoniae Rubra 9g
- Baked Angelica Sinensis 9g
- Tangerine Peel 9g
- Achyranthes Bidentata Root 9g
- Leonurus Cardiaca Herba 12g
- Salvia Miltiorrhiza Root 30g
- Bupleurum 6g
- Licorice 3g
Usage: Decoction, once daily, taken twice a day.
Source: Sun Yimin’s Prescription.
5. Pattern Differentiation: Blood stasis obstruction.
Treatment Principle: Activate blood and unblock collaterals.
Formula Name: Sharp Flower Decoction.
Composition:
- Polygonum Aviculare 10g
- Clerodendrum Folium 6g
- Rubia Cordifolia Root 6g
- Leonurus Cardiaca Fruit 6g
- Corydalis 6g
- Baked Angelica Sinensis 6g
- Baked Ligusticum Wallichii Rhizoma 15g
- Baked Salvia Miltiorrhiza Root 15g
- Artemisia Vaginata Leaf 5g
- Baked Licorice 3g
Usage: Decoction, once daily, taken twice a day.
Source: Shi Jinmo’s Prescription.
6. Pattern Differentiation: Blood deficiency and kidney deficiency.
Treatment Principle: Nourish blood, enrich yin, and tonify the kidneys.
Formula Name: Four-Two-Five Combined Formula.
Composition:
- Angelica Sinensis Root 9g
- Ligusticum Wallichii Rhizoma 3g
- Radix Paeoniae Rubra 9g
- Rehmannia Glabra Root 12g
- Rubus Fructus 9g
- Cuscuta Chinensis Seed 9g
- Schisandra Fruit 9g
- Plantago Seed 9g
- Achyranthes Bidentata Root 12g
- Goji Berry 15g
- Asparagus 9g
- Akebia 12g
Usage: Decoction, once daily, taken twice a day.
Source: Liu Fengwu’s Gynecological Experience.
7. Pattern Differentiation: Depletion of liver and kidney essence and severe deficiency of qi and blood.
Treatment Principle: Tonify qi and blood, and nourish the liver and kidneys.
Formula Name: Qi-Strengthening and Conception-Promoting Decoction.
Composition:
- Codonopsis 15g
- Atractylodes Macrocephala Rhizoma 12g
- Poria 12g
- Angelica Sinensis Root 9g
- Rehmannia Glabra Root 12g
- Astragalus 9g
- Goji Berry 9g
- Cuscuta Chinensis Seed 9g
- Baked Licorice 9g
Usage: Decoction, once daily, taken twice a day.
Source: Chinese Gynecological Treatment.
8. Pattern Differentiation: Qi and blood deficiency with heart and spleen depression.
Treatment Principle: Tonify the spleen and heart, invigorate qi and blood, and clear liver heat.
Formula Name: Modified Gui Pi Decoction.
Composition:
- Angelica Sinensis Root 3g
- Poria 3g
- Atractylodes Macrocephala Rhizoma 3g
- Baked Astragalus 3g
- Longan Fruit 3g
- Polygala Tenuifolia Root 3g
- Baked Sour Jujube Seed 3g
- Moxa 1.5g
- Baked Licorice 0.9g
- Ginseng 3g
- Bupleurum 2g
- Gardenia Fruit 2g
Usage: Decoction, once daily, taken twice a day.
Source: Lesser Essentials of the Golden Cabinet, Volume 2.