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Menopathy

Menopathy includes irregular menstruation, menorrhagia, amenorrhea, dysmenorrhea and the symptoms appearing in the menstrual cycle as well as menopausal syndrome.

Etiology and Pathogenesis

In menopathy there are chiefly two pathogeneses: internal damage and exogenous pathogenic factors. The former denotes emotional upsets, and the latter includes chiefly cold, heat and dampness evils. However, the constitutional variations serve as the root causes of menopathy, including the dysfunction of zang-fu organs, incoordination between qi and blood, and damage of the Chong and Ren, Du or Dai meridians.

Diagnosis and Differential Diagnosis

Diagnosis of menopathy should be made according to the menstrual period, the quantity, color, quality and odor of the menses and the associated symptoms, as well as the patient's physique, complexion, qi and pulse. Syndrome differentiation will be discussed individually in the corresponding sections.

Therapeutic principles

A. Menstruation must be noted. If a disease happens after irregular menstruation, the therapy of regulating menstruation should be employed first, and the disease may disappear spontaneously. If a disease results in irregular menstruation, the disease should be treated first, and the irregular menstruation may recover spontaneously.

B. The principle of "apply symptomatic treatment first in an acute case and causative treatment in a chronic case" should be used flexibly. The time of the menstrual cycle and the age of the patient should be considered as well.

PRECEDED MENSTRUAL CYCLE

Menstruation occurring a week or more earlier than the normal cycle or occurring twice a month is considered preceded menstrual cycle. Cases in which menstruation precedes the normal cycle by three to five days but without any other symptoms or only precedes the normal cycle occasionally should not be considered this disorder.

Etiology and Pathogenesis

Blood-heat causing blood extravasation and qi deficiency resulting in the dysfunction of the Chong and Ren meridians are the main causes of this disorder.

Diagnosis and Differential Diagnosis

Preceded menstrual cycle should be distinguished from metrorrhagia. The former is a disorder in which menstruation precedes the normal menstrual cycle by over seven days and involves a normal or large amount of menses, while the latter is characterized by uterine bleeding occurring between two menstrual periods (the ovulation period) and a small amount of discharge.

Syndrome Differentiation and Treatment

A. Asthenia-heat: Profuse discharge of purple and thick viscous menses.

B. Yin-deficiency with heat: Scanty discharge of reddish viscous menses.

C. Stagnation of liver-qi with formation of fire: Various amount of discharge of reddish or purplish menses accompanied by symptoms of chest oppression, hypochondriac pain and lower abdominal distension.

D. Qi-deficiency: Profuse discharge of pale and thin menses.

Therapeutic principles: The therapy of clearing away heat and invigorating qi is recommended. However, drugs of bitter taste and cold nature should not be used in order to prevent the stagnation of blood by cold. Drugs that regulate qi should be added to avoid the stagnation of qi by tonics. In addition, for cases with difficulty in menstruation or discharge of clotted menses but without any other discomforts (which differ from those with stagnation of blood and qi), the therapy of activating blood circulation should be employed instead of that for removing blood stasis.

A. Blood-heat syndrome

(a) Asthenia-heat type

Manifestations: Preceded menstrual cycle with large amount of purplish-red and viscous menses or blood clot occasionally, local hot sensation, chest oppression, red tongue with thin, yellow coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, cool the blood, and regulate menstruation.

Prescription: The Powder of Clearing Away Heat

Radix Paeoniae Alba 15 g
Cortex Moutan Radicis 10 g
Cortex Lycii Radicis 10 g
Radix Rehmanniae Praeparata 15 g
Poria 15 g
Herba Artemisiae Annuae 10 g
Cortex Phellodendri 10 g

Remarks: For cases with predomination of heat, add Radix Scutellariae (10 g). For cases with profuse menstruation, omit Poria to avoid the damage of yin. For cases with profuse bleeding, add Radix Sanguisorbae (fried, 15g), Flos Sophorae (fried, 15 g), Herba seu Radix Cirsii Japonici (10 g) and Herba Cephalanoploris (10 g) to cool the blood and stop bleeding.

(b) Liver-qi stagnation with blood-heat

Manifestations: Preceded menstrual cycle with various amount of purplish-red, viscous and clotted menses, difficulty in menstruation, irritability, bitter taste in the mouth, dryness of throat, headache, eye distention, distress over the chest and hypochondria, distending pain over the breasts and lower abdomen, mental depression, epigastric distension, red tongue with thin, yellow coating and wiry and rapid pulse.

Therapeutic principles: Disperse the stagnated liver-qi, clear away heat, and regulate menstruation.

Prescription: Xiaoyao Powder of Moutan Radicis and Gardeniae

Cortex Moutan Radicis 10 g
Fructus Gardeniae 10 g
Radix Bupleuri 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 15 g
Radix Glycyrrhizae Praeparata 6 g
Herba Menthae 6 g

Remarks: For cases with difficulty in menstruation and discharge of clotted blood, add Radix Salviae Miltiorrhizae (15 g), Herba Lycopi (10 g) and Herba Leonuri (15 g). For cases with hypochondriac and lower abdominal pain and distending pain of the breasts, add Fructus Toosendan (15 g), Rhizoma Corydalis (10 g), Folium Citri Reticulatae (10 g) and Semen Citri Reticulatae to disperse the stagnated liver-qi, clear away heat, activate blood circulation, remove blood stasis and stop pain. For cases with menorrhagia, Radix Angelicae is not advisable since it is acrid-warm in nature and activates blood circulation.

(c) Yin-deficiency with blood-heat

Manifestations: Preceded menstrual cycle with scanty, red and viscous menses, flushed cheeks, feverish sensation over the palms, soles and chest, red tongue with little coating and thready and rapid pulse.

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

Prescription: The Modification of Liangdi Decoction

Radix Rehmanniae 15 g
Cortex Lycii Radicis 10 g
Radix Scrophulariae 15 g
Radix Ophiopogonis 10 g
Colla Corii Asini 6 g
Radix Paeoniae Alba 15 g

Remarks: For cases with upward attack of asthenic yang manifested by dizziness, tinnitus and feverish sensation, add Ramulus Uncariae cum Uncis (10 g, decocted later), Spica Prunellae (10 g) and Concha Margargartifera (30 g, decocted first) to calm the liver and suppress yang.

B. Qi-deficiency syndrome

Manifestations: Preceded menstrual cycle with large amount of thin, reddish menses, spiritlessness, weakness of limbs, pale complexion, shortness of breath, hollow and bearing-down sensation in the lower abdomen, reddish tongue with thin, moist coating and feeble and weak pulse.

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

Prescription: The Decoction for Strengthening Middle-Jiao and Benefiting Qi

Radix Codonopsis Pilosulae 15 g
Radix Astragali 15 g
Radix Glycyrrhizae Praeparata 6 g
Radix Angelicae Sinensis 10 g
Pericarpium Citri Reticulatae 10 g
Radix Bupleuri 10 g
Rhizoma Cimicifugae 6 g
Rhizoma Atractylodis Macrocephalae 15 g

Remarks: For cases with menorrhagia, omit Angelicae Sinensis, and add Concha Ostreae (30 g) and Os Draconis (30 g, both decocted first) to stop bleeding. For cases with deficiency of spleen-qi, manifested as poor appetite, loose stool, gastric upset, abdominal distention and slow and feeble pulse, use the Decoction for Invigorating the Spleen and Nourishing the Heart to tonify the spleen, benefit qi, strengthen the Chong meridian and stop bleeding. For cases with yang deficiency after long-term suffering from qi deficiency and manifested as pale, dull and thin menses, cold sensation over the lower abdomen and deep and slow pulse, add Rhizoma Zingiberis Carbonisatus (6 g) and Fructus Psoraleae (15 g) to warm meridians and stop bleeding. For cases with qi deficiency complicated by blood stagnation, add Nodus Nelumbinis Rhizomatis Carbonisatus (15 g), Herba Leonuri (15 g) and Radix Notoginseng (6 g) to eliminate blood stasis and stop bleeding.

DELAYED MENSTRUAL CYCLE

Delayed menstrual cycle refers to the prolongation of the menstrual cycle by more than seven days or the regular occurrence of a 50-day cycle. However, a prolongation of only three to five days occurring only occasionally or appearing in the menarche and the climacterium should not be considered as this disorder.

Etiology and Pathogenesis

A. Asthenic type is caused by blood insufficiency or deficiency of yang-qi.

B. Sthenic type is due to the obstruction of the Chong and Ren meridians by qi and blood stagnation or cold accumulation. When the condition is associated with hypomenorrhea, no matter which type, amenorrhea may ensue.

Diagnosis and Differential Diagnosis

Delayed menstrual cycle should be distinguished from amenorrhea and the early stage of pregnancy.

Syndrome Differentiation and Treatment

Asthenic and sthenic types of this disorder can be differentiated according to the color, quality and quantity of the menses as well as the general symptoms. The case with a small amount of dull red and thin menses containing clots and lower abdominal pain which can be relieved by heat is attributed to sthenia-cold; that with a small amount of light red and thin menses and abdominal dull aching which can be relieved by pressure and heat is considered as asthenia-cold; that with a small amount of light red menses and empty sensation and pain over the lower abdomen as blood deficiency; and that with a small amount of normal-colored menses and lower abdominal pain and distention as qi stagnation. Therapeutic principles: Warming meridians and nourishing blood are the chief therapeutic principles for asthenia-cold syndrome, and activating blood and removing blood stasis are those for qi and blood stagnation. As for the complicated case with both asthenia and sthenia syndromes, the therapy should be based on the identification of the predominant syndrome and the involved organ (liver, spleen or kidneys).

 A. Blood-cold (sthenia-cold) syndrome

Manifestations: Delayed menstrual cycle with small amount of dark menses containing clots, cold pain over the abdomen which can be relieved by heat, aversion to cold, cold limbs, white coating and deep and tense pulse.

Therapeutic principles: Warm meridians, expel cold, activate blood circulation, remove the stagnation, and regulate menstruation.

Prescription: The Decoction for Removing Blood Stasis in the Lower Abdomen

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

Remarks: For cases with deficiency of spleen-yang and kidney-yang, manifested with cold pain over the back and lumbus and loose stool, add Rhizoma Atractylodis Macrocephalae (fried, 15 g), Fructus Psoraleae (15 g), Radix Morindae Officinalis (10 g) and Cornu Cervi Degelatinatum (12 g).

B. Asthenia-cold syndrome

Manifestations: Delayed menstrual cycle with small amount of light red and thin menses, dull pain over the lower abdomen which can be relieved by heat and pressure, soreness and weakness of lumbus, dizziness, pallor, diarrhea, pale tongue with thin, white coating and deep and slow pulse.

Therapeutic principles: Warm meridians, expel cold, benefit qi, and nourish blood.

Prescription: The Decoction for Warming Meridians

Fructus Evodiae 6 g
Ramulus Cinnamomi 10 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Alba 10 g
Colla Corii Asini 10 g
Cortex Moutan Radicis 10 g
Radix Codonopsis Pilosulae 15 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Pinelliae 10 g
Radix Ophiopogonis 10 g
Rhizoma Zingiberis Recens 6 g

Remarks: For serious cases with deficiency of spleen-yang and kidney-yang, Radix Ginseng (10 g) is used instead of Codonopsis Pilosulae. For cases with severe cold, add Radix Aconiti Lateralis Praeparata (6 g).

C. Blood-deficiency syndrome

Manifestations: Delayed menstrual cycle with small amount of light red menses, empty sensation and pain over the lower abdomen, dizziness, palpitations, insomnia, sallow complexion, reddish tongue with little coating and thready and weak pulse.

Therapeutic principles: Nourish blood and regulate menstruation.

Prescription: The Decoction for Invigorating Primordial Qi

Radix Ginseng 10 g
Rhizoma Dioscoreae 15 g
Radix Rehmanniae Praeparata 15 g
Cortex Eucommiae 15 g
Radix Angelicae Sinensis 10 g
Fructus Corni 10 g
Fructus Lycii 15 g
Radix Glycyrrhizae Praeparata 6 g

Remarks: For cases with spleen deficiency manifested with anorexia and loose stool, omit Angelicae Sinensis, and add Rhizoma Atractylodis Macrocephalae (fried, 15 g) and Fructus Amomi (6 g) to tonify the spleen and stomach. For cases with palpitations and insomnia, add Radix Polygalae (6 g) and Fructus Schisandrae (10 g) to coordinate the heart and kidneys and calm the mind. For cases with blood and yin deficiency manifested by afternoon fever, night sweating and vexation, add Fructus Ligustri Lucidi (10 g), Herba Ecliptae (15 g), Radix Polygoni Multiflori (20 g) and Cortex Lycii Radicis (10 g).

D. Stagnation syndrome

Manifestations: Delayed menstrual cycle with small amount of dark red menses sometimes containing clots, distending pain over the chest, lower abdomen, breasts and hypochondria, normal tongue coating or thin, yellow coating and wiry and unsmooth pulse.

Therapeutic principles: Regulate qi circulation and menstruation.

Prescription: The Decoction of Linderae Radix Linderae 10 g
Rhizoma Cyperi Praeparata 10 g
Radix Aucklandiae 6 g
Radix Angelicae Sinensis 10 g
Radix Glycyrrhizae Praeparata 6 g

Remarks: For cases with scanty menses containing clots, add Rhizoma Chuanxiong (10 g) to activate blood circulation and regulate menstruation. For cases with marked distending feeling over the chest and hypochondrium, add Radix Bupleuri (10 g) and Radix Curcumae (10 g) to disperse the stagnated liver-qi. For cases with distending pain over the breasts, add Semen Citri Reticulatae (15 g) and Folium Citri Reticulatae. For cases with severe pain over the lower abdomen, add Rhizoma Corydalis (10 g) to activate qi and blood circulation and relieve pain. For cases with qi stagnation with formation of fire manifested by large amounts of red menses, restlessness, red tongue with thin, yellow coating and wiry and rapid pulse, use Xiaoyao Powder of Moutan Radicis and Gardeniae.

E. Phlegm-retention syndrome

Manifestations: Menstrual cycle markedly delayed, sometimes occurring only once in several months, with light-colored and viscous menses, profuse leucorrhea, obesity, chest oppression and epigastric distention, poor appetite, profuse sputum, spiritlessness, palpitations, shortness of breath, flat taste in the mouth, white and greasy tongue coating and smooth pulse.

Therapeutic principles: Tonify the spleen, eliminate sputum, activate blood circulation, and regulate menstruation.

Prescription: Erchen Decoction Modified with Angelicae Sinensis and Chuanxiong

Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Rhizoma Pinelliae 10 g
Pericarpium Citri Reticulatae 10 g
Poria 15 g
Radix Glycyrrhizae 6 g

Remarks: For cases with abdominal pain and anorexia, add Radix Aucklandiae (6 g) and Fructus Amomi (6 g).

IRREGULAR MENSTRUATION

This disorder is characterized by menstruation which does not occur at normal intervals and whose menstrual cycles are entirely irregular.

Etiology and Pathogenesis

Irregular menstruation is chiefly caused by the dysfunction of the Chong and Ren meridians and the blood sea resulting from the disorder of zang-fu organs. The stagnation of liver-qi and the deficiency of kidneys are the common types clinically.

Diagnosis and Differential Diagnosis

A. Irregular menstrual cycle, preceded or delayed for more than seven days.

B. The key point to distinguish irregular menstruation from menopause is the age of the patient and the accompanying symptoms. Menopause occurs usually at the age of about 50 and is manifested as irregular cycle accompanied by dizziness, tinnitus, irritability, sweating, feverish sensation over palms, soles and the chest or even emotional disorder.

Syndrome Differentiation and Treatment

The quantity, quality and color of menses should be considered together with the pulse condition and its symptoms for the differentiation of syndrome. Generally, cases with various amount of dull red menses containing clots, and distension of lower abdomen, chest and hypochondrium denote the stagnation of liver-qi; those with moderate or small amount of light red and thin menses and lumbago signify the deficiency of kidneys.

Therapeutic principles: Dispersing liver-qi, tonifying the kidneys, regulating blood and qi circulation as well as the Chong and Ren meridians are the general principles for the treatment of irregular menstruation.

A. Liver-qi stagnation syndrome

Manifestations: Irregular and difficult menstruation with purplish red menses containing clots, chest distress or distending pain over the hypochondrium, breasts and lower abdomen, white or thin, yellow tongue coating and wiry pulse.

Therapeutic principles: Disperse the stagnation of liver-qi, nourish blood and regulate menstruation.

Prescription: Xiaoyao Powder
Radix Angelicae Sinensis 10 g
Radix Bupleuri 10 g
Radix Paeoniae Alba 15 g
Poria 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae 6 g
Herba Menthae (decocted later) 6 g
Rhizoma Zing iberis Praeparata 6 g

Remarks: For cases with insufficient liver-blood and predomination of liver-yang, omit Zingiberis Praeparata and Menthae, and add Fructus Mori (15 g). For cases with blood stasis, manifested as lower abdominal pain and distention and difficult menstruation with clots discharged, add Radix Salviae Miltiorrhizae (15 g), Herba Lycopi (10 g) and Herba Leonuri (15 g) to activate blood circulation and eliminate blood stasis. For cases with fire formation, manifested as profuse red and viscous menses, restlessness, bitter taste in the mouth, dry throat and wiry and rapid pulse, omit Angelicae Sinensis and Zingiberis Praeparata and add Cortex Moutan Radicis (10 g) and Fructus Gardeniae (10 g) to cool the blood and stop bleeding.

B. Kidney-deficiency syndrome

Manifestations: Irregular menstruation with small amount of pale, dull and thin menses, lumbago, dizziness, pale tongue with a little coating and deep and weak pulse.

Therapeutic principles: Tonify the kidneys and regulate menstruation.

Prescription: Guyin Decoction Radix Ginseng 10 g
Radix Rehmanniae Praeparata 15 g
Rhizoma Dioscoreae 15 g
Fructus Corni 10 g
Semen Cuscutae 15 g
Radix Polygalae 6 g
Fructus Schisandrae 10 g
Radix Glycyrrhizae Praeparata 6 g

Remarks: For cases with delayed menstrual cycle and scanty menses, use the Shoutai Pill which is composed of Ramulus Taxalli (15 g), Radix Dipsaci (10 g), Semen Cuscutae (15 g) and Colla Corii Asini (10 g, dissolved in the decoction), and add Caulis Spatholobi (15 g), Fructus Leonuri (15 g), Radix Angelicae Sinensis (10 g), Rhizoma Chuanxiong (10 g), Herba Lycopi (10 g) and Radix Achyranthis Bidentatae (10 g). For cases with preceded menstrual cycle with profuse discharge, use the Shoutai Pill and add Radix Paeoniae Alba (15 g), Radix Rehmanniae (15 g), Radix Rubiae (10 g) and Herba Ecliptae (15 g).

PROLONGED MENSTRUAL PERIOD

This disorder is a prolongation of the menstrual period to more than seven days, even up to half a month, but with a normal menstrual cycle. When the bleeding is slight and persistent, it is known as metrostaxis.

Etiology and Pathogenesis

A. Sthenic type is due to the obstruction of the Chong and Ren meridians by blood stasis, resulting in the failure of distribution of fresh blood to the meridians.

B. Asthenic type is caused by the disarrangement of the blood sea, resulting from yin-deficiency and internal heat.

Diagnosis and Differential Diagnosis

Metrostaxis is persistent uterine bleeding beyond the menstrual period, while prolonged menstrual period refers to excessive uterine bleeding occurring at the regular intervals of menstruation. Vaginal bleeding during pregnancy is a scanty and irregular bleeding from the vagina after a period of menolipsis for more than 40 days.

Syndrome Differentiation and Treatment

Hemostatic therapy is recommended for cases of prolonged menstrual period. The therapy of activating blood circulation and eliminating blood stasis should be adopted for cases with obstruction by blood stasis, which manifest themselves as difficult menstruation with a moderate amount of dark purplish menses containing clots, lower abdominal distending pain and tenderness; the therapy of nourishing yin and clearing away heat and calming the Chong meridian and blood should be employed for those with yin deficiency and internal heat characterized by a small amount of bright red and viscous menses, red tongue and thready and rapid pulse.

A. Blood-stasis syndrome

Manifestations: Prolonged menstrual period with a small amount of dark menses containing clots, lower abdominal pain and tenderness, dark purplish tongue with or without petechiae and wiry and unsmooth pulse.

Therapeutic principles: Activate blood circulation, eliminate blood stasis, and stop bleeding.

Prescription: Decoction of Four Drugs with Persicae and Carthami

Semen Persicae 10 g
Flos Carthami 10 g
Radix Angelicae Sinensis 12 g
Rhizoma Chuanxiong 10 g
Radix Rehmanniae Praeparata 15 g
Radix Paeoniae Alba 10 g
Pollen Typhae (wrapped in cloth) 10 g
Faeces Trogopterori 10 g
Radix Rubiae 12 g
Herba Leonuri 15 g

B. Yin-deficiency and blood-heat syndrome

Manifestations: Prolonged menstrual period with a small amount of red and viscous menses, flushed cheeks, feverish sensation over the palms, soles and the chest, dryness of mouth and throat, red and dry tongue with a little coating and thready and rapid pulse.

Therapeutic principles: Tonify yin, clear away heat, and stop bleeding.

Prescription: Liangdi Decoction with Erzhi Pill

Radix Rehmanniae 15 g
Radix Scrophulariae 15 g
Radix Paeoniae Alba 15 g
Radix Ophiopogonis 10 g
Colla Corii Asini 10 g
Cortex Lycii Radicis 10 g
Herba Ecliptae 15 g
Fructus Ligustri Lucidi 12 g
Radix Rubiae Carbonisatus 12 g
Os Sepiellae seu Sepiae 15 g

C. Spleen and qi deficiency syndrome

Manifestations: Prolonged menstrual period with small amount of pale and thin menses, spiritlessness, fatigue, weakness of extremities or dizziness, palpitations, insomnia, loose stool, poor appetite, pale tongue with thin and white coating and slow and weak pulse.

Therapeutic principles: Tonify the spleen, benefit qi, warm the meridians, and stop bleeding.

Prescription: The Modification of Decoction for Invigorating the Spleen and Nourishing the Heart

Rhizoma Zingiberis Carbonisatus 6 g
Os Sepiellae seu Sepiae 15 g
Folium Artemisiae Argyi Carbonisatus 6 g
Rhizoma Atractylodis Macrocephalae 15 g
Lignum Pini Poriaferum 10 g
Radix Astragali 15 g
Arillus Longan 10 g
Semen Ziziphi Spinosae 15 g
Radix Ginseng 10 g
Radix Angelicae Sinensis 10 g
Radix Polygalae 6 g
Radix Glycyrrhizae Praeparata 6 g
Radix Aucklandiae 6 g
Fructus Jujubae 10 g
Rhizoma Zingiberis Recens 6 g

D. Heat-dampness retention syndrome

Manifestations: Prolonged menstrual period with small amount of dark, mucous and foul menses, lumbago, abdominal pain and distention, profuse yellow and foul leucorrhea, red tongue with yellow, greasy coating and soft-floating and rapid pulse.

Therapeutic principles: Clear away heat-dampness and stop bleeding.

Prescription: The Modification of Simiao Powder

Flos Lonicerae 15 g
Fructus Forsythiae 15 g
Rhizoma Dryopteris Crassirhizomae 10 g
Radix Sanguisorbae 15 g
Radix Rubiae 12 g
Herba Leonuri 15 g
Rhizoma Atractylodis 15 g
Cortex Phellodendri 10 g
Semen Coicis 15 g
Radix Achyranthis Bidentatae 10 g

Remarks: For cases with severe abdominal pain, add Fructus Toosendan (10 g) and Rhizoma Corydalis (10 g) to activate qi and stop pain.

Copyright 1995 Hopkins Technology

 


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