Amenorrhea

No period for three months consecutively.

 Menstrual flow begins at about fourteen in healthy girls. Menstruation thatdoes not come until 18 or suppression of menstruation for over three months iscalled amenorrhea. Stop of menses during gestation period and lactation periodis of normal physiological phenomena. The causative factors of amenorrhea fallinto deficiency and excess types. The deficiency type is mostly seen due to deficiencyof blood, and the excess type is caused by excessive pathogenic factorsobstructing the passage of menses.

The clinical differentiation and treatment are usually conducted in the lightof blood stagnation and blood depletion.

Etiology and Pathogenesis

a) Blood stagnation: It is due to the seven emotional disturbances, stagnation of liver qi, resulting in retardation of both qi and blood in the uterus and obstruction in the passage of menses.

b) Blood depletion: Improper intake of food or overstrain undermines the reproducing source of qi and blood, severe or chronic diseases that consume blood, or by grand multipara or indulgence in sexual life that exhaust essence and blood, all of which may drain the sea of blood, deprive the Chong and Ren Meridians of nourishment and result in amenorrhea.

Differentiation

a) Blood stagnation: Main manifestations: Absence of menses for months, lower abdominal distending pain aggravated by pressure, hard mass in lower abdomen, distension and fullness in the chest and hypochondriac region, dark purple tongue coating with purplish spots on its borders, deep string - taut pulse.

Analysis: Worry and anger cause qi stagnation and failure of it to control blood, bringing on blockage of the Chong and Ren Meridians and amenorrhea. The abnormal function of qi gives rise to lower abdominal distending pain and fullness in the chest and epigastrium. Blood stasis retaining in the sea of blood binders menstrual flow, manifested by the abdominal pain aggravated by pressure and hard mass in the lower abdomen. Purple tongue coating with purplish spots on its borders and deep string - taut pulse are signs of stagnation of qi and blood.

a) Blood stagnation: Method: Points of the Ren, Foot - Taiyang and Foot - Jueyin Meridians are selected as the principal points. Acupuncture with the reducing method is used to remove the stagnation and regulate the circulation ofqi and blood in the meridians.

Prescription: [RN3 - ST29 - SP10 - LR3 - LI4 - SP6].

Supplementary points: Pain in the lower abdomen with hard mass aggravated by pressure: KI14.

Explanation: RN4, an intersecting point of the three foot - yin meridians, may regulate the Chong and Ren Meridians and dredge the blockage from the lower jiao. ST29 is chosen as a local point to remove blood stasis from the uterus. SP10 and LR3 applied together can regulate the liver qi, and relieve stagnation and stasis. LI4 and SP6 can get qi and blood down to restore the normal menstruation. KI14 may be added when there is pain and hard mass in the lower abdomen aggravated on pressure.

Qi and Blood stagnation

                emotional relation

                Acupuncture – Ren 6 & SP 6, LR 2 & SP 10, LR 14 & GB 34 (hypochondriac distension)

b) Blood depletion: Main manifestations: Delayed menstrual cycle, gradual decrease of menses and amenorrhea, sallow complexion in prolonged cases, lassitude, vertigo and dizziness, poor appetite, loose stools, dry skin, pale tongue with white coating, slow weak pulse, all of which are signs of deficiency of qi and blood: dizziness and tinnitus, sore and weak low back and knees, dry mouth and throat, hot sensation in the palms, soles and epigastrium, afternoon fever and night sweating, pale tongue with little coating, string - taut and thready pulse, all of which are signs of deficiency of essence and blood.

Analysis: Blood is transferred from food through the function of transportation and transformation of the spleen, and dysfunction of the spleen leads to blood deficiency. Blood deficiency causes malnutrition of the Chong and Ren Meridians and the void ness in the sea of blood. Hemorrhage causes exhaustion of blood, and finally delayed menstrual cycle and the gradual decrease of menses till amenorrhea. Blood deficiency Fails to nourish the muscles, skin and head, bringing on sallow complexion, dry skin, vertigo and dizziness and lassitude. Dysfunction of transportation and transformation of the spleen gives rise to poor appetite and loose stools. Pale tongue with white coating and slow, weak pulse are signs of blood depletion. Since the kidney dominates bone and marrow, while the brain is the sea of marrow, deficiency in the kidney may lead to dizziness, tinnitus, sore and weak low back and knees. Yin deficiency produces internal heat manifested by the dry mouth and throat, hot sensation in palms, soles and epigastrium, afternoon fever and the night sweating. Pale tongue and string - taut thready pulse are signs of deficiency of essence and blood.

b) Blood depletion: Method: Select points of the Ren, Liver, Spleen and Kidney Meridians. Acupuncture is used with the reinforcing method. Moxibustion is applied sometimes to tonify blood and restore menses.

Prescription: [RN4 - BL18 - BL20 - BL23 - ST36 - SP6].

Explanation: The spleen, the foundation of the acquired essence, abstracts nutrient particles from food and transforms them into qi and blood. When blood supply is abundant the menstrual cycle is normal. So BL20, ST36 and SP6 are selected to strengthen the function of the spleen and stomach. The kidney is the foundation of congenital essence, and ample kidney qi guarantees sufficient qi and blood. For this reason BL23 and RN4 are chosen to replenish kidney qi. BL18 is selected to promote the blood in the liver, where blood is stored. When the spleen, liver and kidney carry out well their functions of controlling blood, storing blood and essence respectively, the Chong and Ren Meridians are well nourished and amenorrhea is cured.

Kidney Qi deficiency

                young women do not get menarche until late years, slow development

                Acupuncture – Tonify, moxa, Shu, RN, BL23 & RN4, ST30 & SP6

Qi and Blood deficiency

                Acupuncture – tonify, moxa, BL20, ST36, SP6, BL17 & RN6

                                - dizzy, blurred vision, BL18, DU20

Phlegm-Damp stagnation

                post delivery overweight patients

                Acupuncture – RN17, ST40, RN6, RN12

                                - clear vaginal discharge- BL32

Yin deficiency

                chronic disorders

                Acupuncture – BL15, BL23, KI3, SP6, LR3

                                - insomnia- HT7, MH6

Cold stagnating Blood

                Acupuncture – Moxa RN8 with ginger, RN3, RN4, DU4, LR3 & LI4, SP6

Alternative Treatment Methods

                auricular- endocrine, reproductive organs, subcortex, KI LR, SP, HT

                7 star- Hua Tou Jia Ji T5 to coccyx and Dai Mai (L2 to navel)

 Remarks

Included in this disease is amenorrhea resulted from endocrinal and neuropsychiatric factors.