Uterine Bleeding

Vaginal hemorrhage beyond menstrual period, either copious or continuously dripping, is generally defined as metrorrhagia. The copious bleeding with a sudden onset is referred to as profuse metrorrhagia, and the scanty bleeding with a gradual onset as continuous scanty uterine bleeding. Although they are different in manifestations, the two are intertransmutable during the process of the disease course. Chronic profuse bleeding consumes qi and blood, leading to continuous scanty bleeding, whereas prolonged scanty bleeding becomes worse, it inevitably turns to profuse bleeding. In terms of severity, the profuse bleeding is severe and the scanty bleeding is comparatively mild. It says in Recipes for Saving Lives, Vaginal bleedings are of the same scope of a disease, while the mild one is called continuous scanty bleeding and the severe one is named profuse metrorrhagia.

 

Etiology and Pathogenesis

a) Excessive heat: The causative factors may be constant excess of yang, exposure to external pathogenic heat, indulgence in spicy food and disturbance of the seven emotions, etc., which transform into internal fire. The Chong and Ren Meridians are injured by heat and there appears bleeding. It may also be due to exasperation that hurts the liver. Abundant liver fire expels the blood out of its shedding house, causing metrorrhagia.

b) Qi deficiency: Worries, irregular intake of food and overstrain may damage the spleen qi. A weakened spleen is unable to restrict blood, destabilizes the activities of the Chong and Ren Meridians and finally metrorrhagia presents.

 

Differentiation

a) Excessive heat: Main manifestations: Sudden onset of profuse or prolonged continuous vaginal bleeding in deep red color. Fidgets, insomnia, dizziness, red tongue with yellow coating, rapid pulse.

Analysis: The blood escape is due to excessive internal heat. When the heat disturbs the mind there present fidgets and insomnia. Dizziness is caused by the upward going of heat. Red tongue with yellow coating and rapid pulse are signs of heat in the blood.

b) Qi deficiency: Main manifestations: Sudden profuse bleeding or continuous scanty bleeding marked by light red and thin blood, lassitude, shortness of breath, apathy, anorexia, pale tongue, thready weak pulse.

Analysis: It is caused by the failure of the qi in control of blood and the disordered Chong and Ren Meridians. Lassitude, shortness of breath and apathy are manifestations of qi deficiency in the middle jiao. Anorexia derives from the dysfunction of the spleen in transportation and transformation. The light - colored and thin blood is due to failure of blood to be warmed up. The pale tongue and thready weak pulse are signs of deficiency of qi and blood.

Treatment

a) Excessive heat:

Method: Mainly select points of the Ren and Foot - Taiyin Meridians. Acupuncture with the reducing method is used to clear off heat and stop bleeding.

Prescription: [RN3 - SP10 - SP1 - LR8].

Supplementary points:

Affection of external heat: LI11.

Excessive heart Fire: HT8.

Excessive liver fire: LR3.

Explanation: RN3, the meeting point of the three foot yin meridians and the Ren and Chong Meridians, is used to adjust the qi of the Chong and Ren Meridians so as to check the escape of blood. SP1, the Jing-Well Point of the Spleen Meridian, is often helpful to metrorrhagia. LR8 functions to sooth and regulate the liver qi. SP10 used with the reducing method may remove heat from blood to stop bleeding. All the points functioning together can clear heat, reduce fire, regulate meridians and cease bleeding. In case of varied symptoms, LI11 is added to dissipate the pathogenic heat, and HT8 is used to clear away the heart fire, and LR3 to reduce the liver fire.

b) Qi deficiency:

Method: Select the points of the Ren and Foot - Taiyin Meridians as the principal points. Acupuncture with the reinforcing method and moxibustion are employed to promote the restricting function of qi.

Prescription: [DU20 - RN4 - ST36 - SP6 - SP1 - SJ4].

Supplementary points:

Spleen qi deficiency manifested by anorexia and loose stools: BL20, BL21.

Explanation: Ren 4 can adjust the Chong and Ren Meridians, promote the restricting function of qi and stop uterine bleeding. SP6, SP1 and ST36 are together used to tonify the spleen and foster the restriction of qi on blood. Moxibustion applied to DU22 helps the ascending of yang qi, an application of the principle of using upper points for lower disorders. SJ 4 is the Yuan-Primary Point of the Sanjiao Meridian, which maintains the qi in general. Needling SJ4 with the reinforcing method may build up the functions of the Chong and Ren Meridians and foster the restriction of qi on blood.

Remarks

This disease includes functional uterine bleeding due to ovarian dysfunction, but organic disorders of the reproductive system must be excluded.

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