Irregular Menses

Irregular menstruation refers to any abnormal change in menstrual cycle, in quantity and color of flow, and other accompanying symptoms. Commonly seen cases are antedated and postdated menstruation, irregular menstrual cycle. Menstruation earlier than due time by seven to eight days, or even twice a month, is regarded as antedated menstruation, while menses later than due time by eight to nine days or even once every forty to fifty days is considered as postdated menstruation.

Menopathy is caused by many factors, such as the exogenous pathogenic cold, heat and damp, emotional disturbances - worries, depressed rage, indulgence in sexual life, grand multiparity, etc., leading to the disharmony between qi and blood and the injury of the Chong and Ren Meridians.

1. Etiology and Pathogenesis

1.1. Early menstruation

Heat in the blood: It is due to abundance of the internal heat, yin deficiency and yang excess, or overtake of pungent food, over dosage of the warm property drugs acting on uterus, or to fire transformed from stagnated liver qi, etc. All of these lead to the injury of the Chong and Ren Meridians by excessive heat,  bringing about antedated menstruation.

Qi deficiency: This is caused by overexertion, improper diet leading to weakness of the spleen qi and insufficient qi in the middle jiao, which fails to control the menstrual flow, resulting in antedated menses. Dr. Zhang Jingyue pointed out, "If the pulse does not reflect excessive heat internally it means antedated menstruation is caused by qi deficiency of the heart and spleen that fail to control the blood. "

1.2. Late menstruation

Blood deficiency: The blood may be marred due to chronic hemorrhage, debility resulted from chronic diseases and multiparity. Irregular diet and overexertion may injure the spleen and stomach, causing insufficiency of blood in the Chong and Ren Meridians. Finally, postdated menstruation occurs.

Cold in the blood: It is due mostly to constant yang deficiency and internal growth of cold, or due to overtake of raw and cold food, exposure to rain and cold during the menstrual periods. Then the pathogenic cold invades the Chong and Ren Meridians, impeding the free flow of blood, hence the menstrual cycle delays.

Qi stagnation: It is due to emotional depression, disturbing the qi activity and resulting in qi stagnation. The stagnated qi impairs the smooth now of blood which leads to abnormal function of the Chong and Ren Meridians. The sea of blood cannot be filled up at due time, and postdated menstruation occurs.

1.3. Irregular menstrual cycles

Qi stagnation in the liver: It is due usually to depressed rage that hurts the liver and disturbs the storage of blood, which leads to dysfunction of the blood in the Chong, Ren Meridians and uterus, hence irregular menstrual cycles.

Kidney deficiency: It is due to marriage at an immature age, indulgence of sexual life, grand multiparity, etc., which consume the essence and blood. The kidney qi fails to conduct its function in storing essence and adjusting the Chong and Ren Meridians, resulting in irregular menstrual cycles.

2. Differentiation and Treatment

2.1. Early menstruation

Heat in blood

Main manifestations: Shortened cycle, dark red and thick blood flow in large quantities, restlessness, ftrilness in the chest, brown urine, reddened tongue with yellow coating, rapid and forceful pulse.

Analysis: Dark red, thick and profuse menses indicate internal excessive heat, which impairs the heart and liver, leading to restlessness and fullness in the chest  When the heat shifts from the heart down to the small intestine there appears scanty and dark yellow urine. The yellow tongue coating and the rapid pulse are signs of internal heat.

Heat in the blood

Method: Points of the Spleen and Kidney Meridians are selected as the principal points. Acupuncture with the reducing method is applied to regulate the Chong and Ren Meridians and, clear ofT heat from blood.

Prescription: [LI11 - RN3 - SP10 - KI5].

Supplementary points:

Liver qi transforming into fire: LR2.
Yin deficiency with internal heat: KI2.

Explanation: LI 11 is the He - Sea Point of the Hand - Yangming Meridian while SP10 is the Jing - River Point of the Foot - Taiyin Meridian. When they are used together, heat is removed from blood. RN3, the intersecting point of the three yin meridians of foot, works to regulate the Chong and Ren Meridians and remove internal heat from the lower jiao. KI5, Xi - Cleft Point of the Kidney Meridian, strengthens yin, reduces heat and regulates menses. All the points used together serve the purpose of clearing off heat and regulating menstruation.  LR2 is added to clear away the heat from the liver in case of stagnated liver qi transforming into fire. KI2 is used to nourish yin, reduce heat and to regulate menses.

Qi deficiency

Main manifestations: Profuse, thin and light red menses in shortened cycle, lassitude, palpitation, shortness of breath, subjective empty and heavy sensation in the lower abdomen, pale tongue with thin coating, weak pulse.

Analysis: The spleen qi dominates the middle jiao and controls blood. Qi insufficiency fails to check the blood, there occurs disturbance of the Chong and Ren Meridians, leading to profuse, thin and light red menses in shortened cycle. Lassitude, shortness of breath and empty heavy sensation are manifestations of qi deficiency. Palpitation and pale tongue account for blood deficiency, and the weak pulse is a sign of qi deficiency.

Qi deficiency:

Method: Select the main points from the Ren, Foot - Taiyin and Foot - Yangming Meridians to replenish qi so as to restore its function in controlling blood. Acupuncture is applied with the reinforcing method.

Prescription: [RN6 - SP6 - RN12 - ST36].

Explanation: RN6 can regulate qi of the whole body. Qi is the commander of blood and when it is abundant blood is totally controlled by it. SP6, RN12 and ST36 are chosen to build up the spleen qi, and strengthen spleen qi, controls blood. All the points applied together attain the purpose of replenishing qi and controlling blood.

2.2. Late menstruation

Blood deficiency

Main manifestations: Scanty and light red menses in delayed cycle, empty and painful feeling in the lower abdomen, emaciation, sallow complexion, lusterless skin, dizziness and blurred vision, palpitation and insomnia, pink tongue with little coating, weak and thready pulse.

Analysis: Owing to a chronic disease, weak body constitution or chronic hemorrhage, blood cannot form the timely tide in the sea of blood, bringing about scanty and light red menses in delayed cycle. When the blood fails to nourish the uterus, there is an emptiness and pain in the lower abdomen. When the meridians, vessels, muscles and skin are undernourished, there may appear emaciation, sallow complexion and lusterless skin. When the liver and heart fail to be nourished by blood, dizziness, blurred vision, palpitation and insomnia occur. If the tongue is malnourished and the vessels are not filled up, there present pink tongue and weak thready pulse.

Cold in the blood

Main manifestations: Scanty and dark - colored menses in delayed cycle, colic pain in the lower abdomen, slightly alleviated by warmth, cold limbs, thin and white tongue, deep and slow pulse.

Analysis: The invasion of pathogenic cold during menstruation impedes blood flow, leading to scanty and dark - colored menses in delayed cycle. Cold in the uterus binders the smooth flow of qi and blood and then there appears colic pain. Cold, yin by nature, injures yang qi and brings about cold limbs. Thin and white tongue coating, deep and slow pulse are signs of cold syndromes.

Blood deficiency and cold in the blood:

Method: Points of the Ren and Foot - Taiyin Meridians are selected as the principal points. In case of blood deficiency, acupuncture is applied with the reinforcing method to replenish qi and nourish blood. Moxibustion is also advisable. In case of cold in the blood, acupuncture is given with the even movement. Strong stimulation of moxibustion is used to warm up the meridians and disperse cold.

Prescription: [RN4 - RN6 - SP6].

Supplementary points:

Dizziness and blurred vision: DU20,
Palpitation and insomnia: HT7.

Explanation: RN4, an intersecting point of the three yin meridians of foot connects the uterus. When the reinforcing method is applied to RN4 and SP6, qi and blood are promoted, the Chong and Ren Meridians are regulated and then cold is dispelled from them. RN6 assists to adjust qi and blood so that the Chong and Ren Meridians are well regulated and menses comes on time. DU20 helps ascend qi and blood, nourishing the head and eliminating dizziness and blurred vision. HT7 pacifies the mind in case of palpitation and insomnia.

Qi stagnation

Main manifestations: Scanty and dark red menses in delayed cycle, distending pain in the lower abdomen, mental depression, stuffy chest alleviated by belching, distension in the hypochondria and breast region, thin, white tongue coating and string - taut pulse.

Analysis: Stagnated qi of the liver brings about retarded blood flow and results in scanty and delayed menses with distending pain in the lower abdomen. When the qi fails to travel smoothly, mental depression and stuffy chest present. Since the Liver Meridian runs through the costal and hypochondriac regions, the stagnated liver qi gives rise to the distension in the hypochondrium and breast. String - taut pulse is a typical sign of liver disorder and qi stagnation.

Qi stagnation:

Method: Points of the Foot - Jueyin and Foot - Yangming Meridians are selected as the principal points. Acupuncture is applied with the reducing method to activate qi and blood flow.

Prescription: [ST25 - KI13 - ST8 - LR3].

Supplementary points:

Fullness of the chest: MH4.
Distension in the hypochondriac region and breast: LR14.

Analysis: ST25 and RN6 are located on the Foot - Yangming Meridian. KI13 can promote qi and blood flow and regulate the Chong and Ren Meridians. SP8, a qi point of the blood system can adjust blood arid qi circulation. LR3, the Yuan Point of the Liver Meridian can soothe the liver and regulate liver qi. The points are used together to achieve free flow of qi and blood. MH6 is chosen to remove fullness from the chest and adjust qi. LR14 is added to regulate qi so as to weed out the disterision in the hypochondriac region and breast.

2.3. Irregular menstrual cycles

Liver Qi Stagnation

Main manifestations: Alteration of menstrual cycles and quantity of blood flow, thick, sticky, and purple colored menses difficult to flow, distension in the hypochondriac region and breast, distending pain in the lower abdomen, scanty bleeding with some clots, patient is stressed out, experiences PMS, breast tenderness, mood swings, depression, frequent sighing, ‘Plum-pit’ syndrome, psychological feelings of being easily frustrated, a sense of being held down, digestive complaints, T- may be normal or have slight purple or red colour on the sides, P- wiry

Analysis ; Depressed rage injuries the function of the liver, leading to unsmooth flow of qi and blood and disturbance in the sea of blood, and finally to the alteration of menstrual cycles and quantity of blood flow. The stagnation of liver qi causes impeded flow of blood, bringing about difficult menstruation, distension in the hypochondriac region and breast, and distending pain in the lower abdomen. Frequent sighing may help to relieve the stagnated qi. String - taut pulse is a typical sign of liver qi stagnation.

Treatment

Method: Points of the Ren and Jueyin Meridians are selected as the principal points to ease the liver and regulate the Chong and Ren Meridians. Acupuncture is given with the even movement.

Prescription:

[RN6 - KI14 - MH5 - LR5] or
[LR3, LR5, LR14, SP6, SP8, SP10, ST29, SP4_R - MH6_L, zi gong, RN4, RN6]

Supplementary points:

Distension in the hypochondriac region and breast: RN17, LR14.
hypochondriac pain- GB34, TH6
Mental depression: HT7, LR3.

Explanation: RN6 and KI14 can promote the flow of qi and blood, regulate Chong and Ren Meridians. Located on the Jueyin Meridians, MH5 and LR5 remove stagnation of the liver qi and treat disordered menses. The irregular menstrual cycles will be removed once the liver restores its normal function and the Chong and Ren Meridians ate harmonized. RN17 and LR14 are included in the prescription to soothe the liver and relieve the stagnated qi of the liver and distending pain in the hypochondriac region and breast. HT7 and LR3 ease the mind and relieve depression.

Kidney deficiency

Main manifestations: Scanty, light red blood flow in altering cycles, dizziness and tinnitus, weak and aching of the lower back and knees, frequent night urination, loose stools, pale tongue with thin coating, deep and weak pulse.

Analysis: When there is insufficiency of kidney qi, disharmonized Chong and Ren Meridians bring on the derangement of the flow and ebb of tide in the sea of blood, resulting in the alteration of menstrual cycles. Insufficient kidney qi decreases the essence and blood, leading to scanty, thin and light red menses. Since the kidney dominates bones, generates marrow, and has its opening in the ear, and the Kidney Meridian runs through the waist, deficiency condition of the kidney causes lack of marrow, impairs audibility and malnourishes the waist, bringing on dizziness, tinnitus, sore and weak in knees and the lower back. When the kidney fails to control urination and defecation there appear frequent urination and loose stools. Pale tongue with thin coating and deep weak pulse indicate kidney yang deficiency.

Treatment

Kidney deficiency

Method: Points on the Ren and Foot - Shaoyin Meridians are selected as the principal points. Acupuncture is given with the reinforcing method. Moxibustion is used to replenish the kidney qi and regulate the Chong and Ren Meridians.

Prescription:

[RN4 - BL23 - KI8].

Supplementary points:

Sore and weak low back and knees: yaoyan, KI10.
Dizziness and tinnitus: DU20, KI 3.

Explanation: BL23 the Back - Shu point of the kidney, can strengthen congenital essence when used together with RN4 and KI8. The irregular menstrual cycles get redressed naturally once the kidney can carry out well its function in storing essence. Yaoyan (Extra) aims at the sore and weak low back and knees, while KI10 strengthens the bones through kidney activation. KI3 and DU 20 are added to promote marrow and nourish the brain by means of tonifying kidney to treat dizziness and tinnitus.

Kidney Yang deficiency

pale scanty bleeding, no clots, sore back &/or knees, tinnitus, feel cold, urinary incontinence or dribbling, copious clear urination, low libido, edema of the legs, loose stool (at 5am), excess clear vaginal discharge, T- pale moist, P- deep weak

P/T – warm & tonify Kidney Yang, regulate Chong and Ren

Acupuncture:

[KI3 - KI13 - BL23 - RN4 - ST36 - SP6]

Rx:

Jin Gui Shen Qi Wan, You Gui Wan, Gu Yin Jian

Kidney Yin deficiency

scanty thicker bright red or dark blood, dizziness, blurred vision, night sweats, dry mouth and throat, anxiety, irritable, feeling of heat in the head, hands, and feet in the afternoon, flushed cheeks, sore back, constipation, dark urine, T- red with no coating, may have cracks, P- thin rapid

P/T – nourish Kidney Yin, consolidate Chong and Ren to regulate menses

Acupuncture:

[LU7_R - KI6_L - KI3 - SP6 - RN4 - BL23]

Rx:

Liu Wei Di Huang Wan, Zuo Gui Wan

 4. Remarks

Included in this disorder is the irregular menorrhea resulted from dysfunction of antehypophysis or from ovarian dysfunction.

Alternative Treatment Methods

Auricular- Nei Shen Zhi Qi (internal reproductive), endocrine, subcortex, LR, SP, KI, Yuan
Zhong
scalp- human reproductive system (electro)