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Oligomenorrhea

Oligomenorrhea is a disorder characterized by markedly diminished menstrual flow or shortened menstrual period (one to two days) but with regular menstrual cycles. Clinically, it is usually accompanied by a delayed menstrual cycle and appears as a prodrome of amenorrhea.

Etiology and Pathogenesis

Deficient blood production or exhausted essence and blood resulting in the insufficiency of blood sea is the cause of oligomenorrhea of the asthenic type, and the retention of blood stasis or the stagnation of phlegm-dampness leading to obstruction of channels is the cause of sthenic type.

Diagnosis and Differential Diagnosis

Oligomenorrhea may be differentiated from regular menstruation during pregnancy. The former is characterized by an insidious onset, a gradual diminution of menstrual flow and an absence of other signs of early pregnancy. The latter is characterized by a sudden occurrence of oligomenorrhea accompanied by symptoms of early pregnancy such as dizziness, nausea, etc., and a positive pregnancy test.

Syndrome Differentiation and Treatment

A. Asthenic type: Gradual diminution of menstrual flow with lightcolored and thin menses, and no distention or pain over the abdomen.

B. Blood-stasis type: Diminution of menstrual flow with dark purplish menses containing clots and accompanied by abdominal pain and tenderness.

C. Phlegm-dampness type: Sudden diminution of menstrual flow with pink, viscous menses. Since the asthenic type of oligomenorrhea is more frequently seen than the sthenic type, the therapy of nourishing essence and blood should be emphasized. Even in the cases of blood-stasis syndrome (a subgroup of sthenic type), they may be accompanied by astheniasyndrome, so the drugs for eliminating blood stasis should be used with precaution in order to avoid the impairment of qi and blood. The treatments are as follows:

A. Blood-deficiency syndrome

Manifestations: Markedly diminished menstrual flow with pale and unclotted menses, dizziness, palpitations, sallow complexion, empty and bearing-down sensation over the lower abdomen, reddish tongue and thready and weak pulse.

Therapeutic principles: Nourish blood and regulate menstruation.

Prescription: Nourishing Blood Decoction

Radix Ginseng 10 g
Radix Astragali 15 g
Rhizoma Dioscoreae 15 g
Poria 15 g
Rhizoma Chuanxiong 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 15 g
Radix Rehmanniae Praeparata 15 g

Remarks: For cases with consumption of essence and blood and a tendency towards amenorrhea, add Fructus Lycii (15 g), Fructus Corni (10 g) and Radix Polygoni Multiflori Praeparata (20 g) to tonify the liver and kidneys and nourish the essence and blood. For cases with spleen deficiency and poor appetite, add Pericarpium Citri Reticulatae (10 g) and Fructus Amomi to activate qi circulation and invigorate the spleen.

B. Kidney-deficiency syndrome

Manifestations: Diminished menstrual flow with pink or dull red and thin menses, weakness of knees, lumbago, heel pain, dizziness, tinnitus or cold feeling over the lower abdomen, nocturia, pale tongue and deep, thready and weak pulse.

Therapeutic principles: Tonify the kidneys, nourish blood, and regulate menstruation.

Prescription: Guishen Pill

Semen Cuscutae 15 g
Cortex Eucommiae 15 g
Fructus Lycii 15 g
Fructus Corni 10 g
Radix Angelicae Sinensis 10 g
Radix Rehmanniae Praeparata 15 g
Rhizoma Dioscoreae 15 g
Poria 10 g

Remarks: For cases with symptoms of kidney-yang deficiency, such as dull red menses, cold pain over the lower abdomen, nocturia, etc., add Herba Epimedii (10 g), Radix Morindae Officinalis (10 g), Rhizoma Curculiginis (6 g), Fructus Psoraleae (15 g) and Fructus Alpiniae Oxyphyllae (10 g) to warm kidney-yang. For cases with symptoms of insufficiency of kidney-yin and deficiency of yin-blood, such as red menses, feverish sensation over the palms, soles and the chest, dryness of mouth and throat, red tongue with a little coating and thready and rapid pulse, add Radix Rehmanniae (15 g), Radix Scrophulariae (15 g) and Fructus Ligustri Lucidi (10 g) to nourish kidney-yin. For cases with yin deficiency and fire hyperactivity, omit Semen Cuscutae and Eucommiae, and add Cortex Moutan Radicis (10 g) and Rhizoma Anemarrhenae (10 g) to cool the blood and nourish yin.

C. Blood-stasis syndrome

Manifestations: Diminished menstruation with dark purplish menses containing clots, lower abdominal distending pain and tenderness which can be relieved after the discharge of blood clots, dark purplish tongue with petechiae and deep and unsmooth pulse.

Therapeutic principles: Activate blood circulation, eliminate blood stasis, and regulate menstruation.

Prescription: The Decoction of Four Drugs with Persicae and Carthami

Semen Persicae 10 g
Flos Carthami 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 10 g
Radix Rehmanniae Praeparata 15 g
Rhizoma Chuanxiong 10 g

Remarks: For cases with severe lower abdominal pain or distending sensation over the chest and hypochondrium, add Rhizoma Cyperi Praeparata (10 g) and Radix Linderae (10 g) to regulate qi circulation and eliminate blood stagnation. For cases with stagnation of cold and blood manifested as lower abdominal pain which can be relieved by warmth, add Cortex Cinnamomi (10 g) and Fructus Evodiae (6 g) to warm and dredge the meridians.

D. Phlegm-dampness syndrome

Manifestations: Diminished menstruation with pale and viscous or mucous menses, obesity, chest upset, nausea, profuse and thick leucorrhea, pale tongue with white and greasy coating and smooth pulse.

Therapeutic principles: Eliminate phlegm and dampness, activate blood circulation, and dredge the meridians.

Prescription: The Modification of Erchen Decoction with Chuanxiong and Angelicae Sinensis

Rhizoma Chuanxiong 10 g
Radix Angelicae Sinensis 10 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Pinelliae 10 g
Poria 15 g
Radix Glycyrrhizae 6 g
Radix Gyathulae 10 g
Caulis Spatholobi 15 g
Radix Platycodi 10 g
Fructus Aurantii 12 g
Fructus Crataegi 15 g

Copyright 1995 Hopkins Technology

 


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