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Amenorrhea

Primary amenorrhea is a failure of menstruation to occur at puberty, and secondary amenorrhea refers to the cessation of menstruation after it has been established at puberty. Amenorrhea occurring during lactation, pregnancy and menopause or within several months after menarche are considered physiological amenorrhea. Individual physiological variations in which the menstrual cycle occurs regularly once every two or three months, or even once a year, and temporary amenorrhea due to change in environment or mental stress, which recovers spontaneously, should not be grouped under the category of amenorrhea.

Amenorrhea resulting from functional disorders are discussed in this section, and those caused by organic diseases such as congenital ametria, anovaria, colpatresia, etc., are not included.

Etiology and Pathogenesis

Deficiency of the liver and kidneys, insufficiency of essence, blood and qi or blood-dryness due to yin-deficiency may result in asthenic type amenorrhea. Stagnation of qi and blood, retention of phlegmdampness or obstruction of meridians may induce sthenic type amenorrhea.

Diagnosis and Differential Diagnosis

A. Diagnostic evidence

(a) A female over 18 years old without menophania.

(b) Absence of menstruation for more than three months in a woman who had had normal menstrual cycles.

(c) Physiological amenorrhea excluded.

B. Differential diagnosis

Clinically, amenorrhea should be distinguished from the early stage of pregnancy.
 

Syndrome differentiation and Treatment

Primary amenorrhea or amenorrhea developing gradually and accompanied by other manifestations of asthenia-syndrome usually appears as the asthenic type. Amenorrhea occurring abruptly and accompanied by manifestations of sthenia-syndrome is usually attributed to the sthenic type.

In general, tonifying therapy is the therapeutic principle for asthenic type amenorrhea, including tonifying liver and kidneys, nourishing qi and blood, etc. For sthenic type, in addition to promoting menstruation, a purging therapy, such as activating blood circulation, eliminating blood stasis, regulating qi circulation, expelling evils, etc., should be employed. However, indiscriminate use of blood stasis removing or tonifying agents should be avoided unless the asthenia or sthenia syndrome is identified. For cases of amenorrhea secondary to other diseases, the primary diseases should be treated first.

A. Insufficiency in liver and kidneys

Manifestations: Primary or secondary amenorrhea or delayed menophania accompanied by dimmish complexion, dizziness, tinnitus, soreness and weakness of loins and knees, dryness of throat and mouth, hectic fever, sweating, flushed cheeks, red tongue or pale tongue with little coating and thready and wiry pulse.

Therapeutic principles: Tonify liver and kidneys, nourish blood, and regulate menstruation

Prescription: The Modification Decoction for Invigorating the Kidneys

Radix Rehmanniae Praeparata 15 g
Rhizoma Dioscoreae 15 g
Fructus Corni 10 g
Poria 15 g
Radix Angelicae Sinensis 10 g
Fructus Lycii 15 g
Cortex Eucommiae 15 g
Semen Cuscutae 20 g
Caulis Spatholobi 15 g
Radix Polygoni Multiflori Praeparata 20 g
Fructus Leonuri 15 g

Remarks: For cases with deficiency of liver-yin and kidney-yin with heat formation manifested as hectic fever, night sweating, feverish sensation over the chest, palms and soles and consumptive fever, omit Eucommiae, and add Fructus Ligustri Lucidi (15 g), Cortex Lycii Radicis (10 g) and Radix Achyranthis Bidentatae (10 g) to tonify yin and eliminate heat.

B. Deficiency of qi and blood

Manifestations: Delayed menstrual cycle, oligomenorrhea with lightcolored and thin menses, gradually resulting in amenorrhea, with sallow complexion, dizziness or palpitations, shortness of breath, fatigue, poor appetite, loose stool, lusterlessness and dropping out of hair, pale lips and tongue and thready, slow and weak pulse.

Therapeutic principles: Benefit qi, nourish blood, andregulate menstruation.

Prescription: Ginseng Decoction for Nourishing Ying-Blood

Radix Ginseng 10 g
Radix Astragali 15 g
Rhizoma Atractylodis Macrocephalae (fried) 15 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g
Radix Paeoniae Alba 15 g
Radix Rehmanniae Praeparata 15 g
Lignum Cinnamomi 6 g
Radix Glycyrrhizae Praeparata 6 g
Fructus Schisandrae 10 g
Radix Polygalae

Remarks: For cases of postpartum hemorrhage with deficiency of qi and blood accompanied by symptoms caused by exhaustion of kidney-qi and dysfunction of the Chong and Ren meridians such as listlessness, dryness of vagina, dropping of pubic and axillary hairs, hyposexuality, atrophy of genital organs, etc., add Colla Cornus Cervi (10 g) and Placenta Hominis (10 g). In case of amenorrhea resulting from parasitic infestation, anthelmintic treatment should be adopted first, followed by the measures of invigorating spleen and tonifying qi and blood.

C. Stagnation of qi and blood

Manifestations: Amenorrhea for several months, mental depression, irritability, fullness sensation over the chest and hypochondrium, lower abdominal pain and tenderness, dark purplish tongue with petechiae and deep and wiry pulse.

Therapeutic principles: Regulate qi, activate blood circulation, eliminate blood stasis, and promote menstruation.

Prescription: Decoction for Removing Blood Stasis in the Chest

Semen Persicae 10 g
Flos Carthami 10 g
Radix Angelicae Sinensis 12 g
Radix Rehmanniae (dried) 15 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Rubra 10 g
Radix Achyranthis Bidentatae 10 g
Radix Platycodi 10 g
Radix Bupleuri 10 g
Fructus Aurantii 10 g
Radix Glycyrrhizae Praeparata 6 g

Remarks: For cases with qi stagnation as the predominant syndrome manifested by severe distention over the chest, hypochondrium and lower abdomen, add Radix Aconiti Lateralis Praeparata (10 g) and Radix Curcumae (10 g). For cases with blood stagnation as the predominant syndrome manifested by lower abdominal pain and tenderness, add Rhizoma Zedoariae (10 g), Rhizoma Sparganii (10 g) and Eupolyphaga seu Steleophaga (10 g).

D. Retention of cold-dampness

Manifestations: Amenorrhea, cold pain over the lower abdomen, pallor, coldness of limbs, aversion to cold, profuse and thin leucorrhea, loose stool, white tongue coating and deep and slow pulse.

Therapeutic principles: Warm the meridians, expel cold, dry dampness, eliminate blood stasis, and restore menstruation.

Prescription: Decoction for Removing Blood Stasis in the Lower Abdomen

Fructus Foeniculi (fried) 10 g
Rhizoma Zingiberis Praeparata 10 g
Rhizoma Corydalis 10 g
Myrrha 10 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Cortex Cinnamomi 6 g
Radix Paeoniae Rubra 10 g
Pollen Typhae (wrapped in cloth) 10 g
Faeces Trogopterori 10 g

Remarks: For cases of serious cold-syndrome with cold pain over the lower abdomen, add Radix Aconiti Praeparata (6 g). For cases of qi stagnation with marked abdominal distention, add Radix Linderae (10 g). For cases with loose stool due to domination of dampness and spleen deficiency, add Rhizoma Atractylodis (fried, 15 g).

E. Stagnation of phlegm-dampness

Manifestations: Amenorrhea, obesity, feeling of fullness and oppression over the chest and hypochondrium, vomiting, nausea, profuse expectoration, leucorrhagia with white and thin discharge, fatigue, puffiness of face and feet, white and greasy tongue coating and smooth pulse.

Therapeutic principles: Dry dampness, eliminate sputum, activate blood circulation, and restore menstruation.

Prescription: The Modification of Decoction of Atractylodis and Cyperi for Eliminating Phlegm

Rhizoma Atractylodis 15 g
Rhizoma Cyperi Praeparata 10 g
Rhizoma Pinelliae 10 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g
Fructus Aurantii 15 g
Radix Angelicae Sinensis 15 g
Rhizoma Chuanxiong 10 g
Herba Epimedii 15 g
Caulis Spatholobi 15 g
Herba Heonuri 15 g
Fructus Crataegi 30 g

Copyright 1995 Hopkins Technology


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