TCM

1. Menorrhagia
Menorrhagia is defined as menstruation at regular cycle intervals but with
excessive flow and duration and is one of the most common gynecologic
complaints in contemporary gynecology.
Is the medicalterm for menstrualperiodswith abnormally heavy or
prolonged bleeding.Although heavy menstrualbleeding is a common
concern among premenopausal women,mostwomen don't experience
blood loss severe enough to be defined as menorrhagia.
Heavy or prolonged menstrual periods,or menorrhagia, are the most
commontype of abnormal bleeding from the uterus. Periods are
considered heavy if there is enough blood to soak a pad or tampon every
hour for several consecutive hours. ... Passing large blood clots during
menstruation.
Causes
 Hormone imbalance. In a normal menstrual cycle, a balance between
the hormones estrogenand progesterone regulates the buildup of the
lining of the uterus (endometrium), which is shed during menstruation. If
a hormone imbalance occurs,the endometrium developsin excess and
eventually sheds by way of heavy menstrual bleeding.
 Dysfunction of the ovaries. If your ovaries don't release an egg
(ovulate) during a menstrual cycle (anovulation), your body doesn't
produce the hormone progesterone,as it would during a normal
menstrual cycle. This leads to hormone imbalance and may result in
menorrhagia.

2.  Uterine fibroids. These noncancerous (benign) tumors of the uterus
appear during your childbearing years. Uterine fibroids may cause
heavier than normal or prolonged menstrual bleeding.
 Polyps. Small, benign growths on the lining of the uterus (uterine
polyps)may cause heavy or prolonged menstrual bleeding.Polyps of
the uterus most commonlyoccur in women of reproductive age as the
result of high hormone levels.
 Adenomyosis.This condition occurs when glands from the
endometrium become embeddedin the uterine muscle, often causing
heavy bleeding and painful menses.Adenomyosisis most likely to
develop if you're a middle-aged woman who has had children.
 Intrauterine device(IUD). Menorrhagia is a well-known side effectof
using a nonhormonal intrauterine device for birth control. When an IUD
is the cause of excessive menstrual bleeding,you may need to remove
it.
 Pregnancy complications. A single, heavy, late period may be due to a
miscarriage. If bleeding occurs at the usual time of menstruation,
however, miscarriage is unlikely to be the cause. An ectopic pregnancy
— implantation of a fertilized egg within the fallopian tube instead of the
uterus — also may cause menorrhagia.

3.  Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can
cause excessive menstrual bleeding.
 Inherited bleeding disorders. Some blood coagulation disorders —
such as von Willebrand's disease,a condition in which an important
blood-clotting factoris deficientor impaired — can cause abnormal
menstrual bleeding.
 Medications. Certain drugs, including anti-inflammatory medications
and anticoagulants, can contribute to heavy or prolonged menstrual
bleeding.
 Other medicalconditions.A number of other medical conditions,
including pelvic inflammatory disease (PID),thyroid problems,
endometriosis,and liver or kidney disease,may be associated with
menorrhagia.
TCM
Generally speaking, a period may be called ‘heavy’ if it starts with a gush of
blood,catching the woman unaware and necessitating an urgent resort to a
tampon or sanitary towel (pad), or if the woman has to make very frequent
changes of these protective devices.

4. Aetiology
Excessive physicalwork,including exercise or sports,may injure the
Spleen, so that deficientSpleen-Qifails to hold Blood, the Directing and
Penetrating Vesselsare weakened and the period becomesheavy.
Emotionalstress,irregular diet,externalheatEmotionalstress leads
to Qi stagnation and, if this continues for a long time, stagnant Qi may turn
into Fire. Excessive consumptionof hot, spicy foods and alcohol may also
lead to Heat or Fire, which may derive from external Heat as well.
Whatever the cause, if Heat enters the Blood portion and agitates the
Blood so that it spills out of the blood vessels,this gives rise to heavy
periods.
Emotionalstress,surgery,post-partum conditionsQi stagnation from
emotional stress as describedabove may turn into Blood stasis rather than
Fire. Abdominalsurgery and post-partum conditions also frequently lead to
Blood stasis. Whatever the cause, when Blood stagnates, the Directing and
Penetrating Vesselsbecome obstructed,new Blood cannot enter the
channels (because they are blocked by stagnant Blood),bleeding occurs
and heavy periods may develop.
PathologyThe pathologyof Heavy Periods consists of:
• Qi deficiency
• Blood-Heat
• Blood stasis.
In the first pattern, Blood leaks out because deficientSpleen-Qifails to
hold it in the vessels.In the second,it spills over because Heat agitates it
and forces it out of the vessels.

5. In the third, it leaks out because the vessels are obstructed by stagnant
Blood and newly generated Blood has no place to go to.
The pattern of Qi deficiencyis thereforeprimarily related to the
Spleen,but the Kidneys also play their part because Kidney-Qi also
holds Blood in the vessels (especially the blood vessels of the Uterus). The
patterns of Blood-Heat and Blood stasis are mostly related to the Liver.
Qi deficiencyClinical manifestations
Heavy period,pale and dilute blood,pale complexion,tiredness.Spleen-Qi
deficiency:loose stools,slight abdominal distension.
Kidney-Qi deficiency:frequent urination, backache, dizziness. Tongue:
Pale. Pulse: Weak.
Treatmentprinciple
Tonify and raise Qi of Spleenand/or Kidneys, contain Blood, consolidate
the Directing and Penetrating Vessels.
Acupuncture
Du-20 raises Qi. This point can be stimulated with a moxa stick.
– Ren-12,ST-36,SP-6 and BL-20 tonify Spleen-Qi.
– Ren-6 tonifies and raises Qi. It is very effective with direct moxa cones.
– Ren-4 tonifies the Kidneys and consolidates Directing and Penetrating
Vessels.
– BL-23 is used if there is also a Kidney deficiency.
Blood-HeatClinicalmanifestations
Heavy period,bright red or dark red, dense blood,mental restlessness,
anxiety, a feeling of heat, thirst, dark urine, headaches. Tongue: Red,

6. reddersides.Pulse: Rapid, Overflowing. This pattern affects mostly the
Liver and Heart.
Treatmentprinciple
Clear Heat, coolBlood,stop bleeding.
Acupuncture
– SP-4 and P-6 regulate the Penetrating Vessel.This vesselis the Sea of
Blood and is therefore closelyinvolved in menstrual bleeding from Blood-
Heat.
– L.I.-11,SP-10,SP-6 and BL-17 cool Blood.
– KI-2 and LIV-3 in combination coolBlood.
– SP-8,Accumulation point, stops uterine bleeding.
Blood stasis Clinical manifestations
Heavy period with dark, clotted blood,painful period,abdominal pain which
is worse with pressure and better after passing menstrual clots.Tongue:
Purple. Pulse: Wiry.
Treatmentprinciple
Invigorate Blood, eliminate stasis, stop bleeding,regulate the periods.
Acupuncture
– SP-4 and P-6 regulate the Penetrating Vesseland invigorate Blood as
this vesselis the Sea of Blood.
– BL-17 and SP-10 invigorate Blood.
– SP-8 stops bleeding.
– SP-6 invigorates Blood.
– Ren-6 moves Qi in the Lower Burner.
– KI-14,a point of the Penetrating Vessel,eliminates stagnation in the
Lower Burner and Uterus.
– ST-29 invigorates Blood in the Uterus.

7. – LIV-3 moves Liver-Qi and invigorates Liver-Blood.
1. Scanty period,Hypomenorrhea
Scanty menstrual periods are periods in which the duration of blood flow is
less than two days or the amount of blood flow is less than 80ml. Most
women though, use the term to mainly mean a decreased blood flow,even
if the duration of the periods are more than 2 days.
Disorderscausingscantymenstruation
One cause of hypomenorrhea is Asherman'ssyndrome (intrauterine
adhesions), of which hypomenorrhea (or amenorrhea) may be the only
apparent sign. The degree of menstrual deficiencyis closelycorrelated to
the extent of the adhesions.
Uterine: Scanty loss sometimes means that the bleeding surface is smaller
than normal, and is occasionally seen when the endometrialcavity has
been reduced in size during myomectomyor other plastic operation on the
uterus. However, it rarely indicates uterine hypoplasia because the
presence of this condition in a uterus which is responsive to hormones
indicates ovarian under-activity, and this manifest itself by infrequent
(oligomenorrhea)rather than scanty menstruation.
Nervous and emotional: Psychogenic factors such as stress due to
exams, or excessive excitementabout an upcoming event may cause
hypomenorrhea. Such factors suppress the activity of the centers in the
brain that stimulate the ovaries during the ovarian cycle (to secrete
hormone like estrogenand progesterone),and may result in low production
of these hormones.
Low body fat: Excessive exercise and crash dieting can cause scanty
menstrual periods when the proportionof bodyfat drops beneath a certain
level. It may cause a total absence of periods (also called amenorrhea).

8. TCM
The periods are defined as ‘Scanty Periods’when the bleeding is very light
(to necessitate few changes of sanitary towels/pads or tampons), or when
the bleeding lasts only 2–3 days or is extremely scanty, like a small drip. It
is importantto ask women aboutthe amountof bleeding in detail as
most of them do not see scanty bleedingas a ‘problem’.
Aetiology
Chronic illness,haemorrhage,irregulardietA protracted,chronic
illness easily leads to Blood deficiency.So does a serious haemorrhage,
such as that might occur during labour and a slow, continuous bleeding in
menorrhagia. A diet lacking in nourishment and Blood-forming foods also
leads to Blood deficiency: this can happenwhen younggirls embrace
vegetarianism withoutpaying attention to food combinations that
properly replace the protein value of meat. Whatever the cause, Blood
deficiencyis an obvious cause of scanty periods as the Sea of Blood
becomesEmpty, the Directing and PenetratingVessels depleted and
the period scanty. Please note that, since menstrual blood is Tian Gui
which derives from the Kidneys, a ‘deficiencyof Blood’in gynecologyis
treated by tonifying both the Liver and the Kidneys.
Overwork,hereditary weakness,too many children too close together
Overwork in the sense of working long hours under stress without adequate
rest may lead to Kidney-Yin deficiency.Having too many children is also
often a cause of Overwork in the sense of working long hours under stress
without adequate rest may lead to Kidney-Yin deficiency.Having too many
children is also oftena cause of Kidney deficiency.WhenKidney-Yin is
deficient,Water is depleted,Kidney-Essence cannot be transformed into
Heavenly Gui and the periods are or become scanty.
Traumas,abdominalsurgery,emotionalstress, cold Traumas and
abdominal surgery can easily lead to stasis of Blood in the Uterus,
especiallyafter repeated operations that result in the formation of
adhesions.Emotional stress that affects the Liver Causes Liver-Qi
stagnation and, after some time, this can resultin Liver-Bloodstasis.

9. Internal Cold obstructs the circulation of Blood and may lead to Blood
stasis in the Uterus. This is a commoncause of scanty periods in young
women or in schoolgirls who have beenplaying sports in shorts and T-
shirts on cold and damp days. Whatever the cause, when Blood stagnates
in the Uterus, the period may become scanty.
Irregulardiet, physicaloverwork Excessiveconsumption ofdairy
foods and greasy,fried foods leads to the formation of Dampness and
weakens the Spleen. This organ is also weakened by excessive exercise,
physical work or sports. Phlegm obstructs the Uterus and the Directing and
Penetrating Vesselsand this results in scanty periods.Womensuffering
from this pattern are often overweight.
Contraceptive pill A very commoneffectof the contraceptive pill is
scanty periods.If a woman stops the contraceptive pill after taking it for
some years, very often the periods are very scanty or completelyabsent. In
my opinion, this is usually due to Blood deficiency.
Pathology
The main pathological factors causing Scanty Periods are:
• Blood deficiency(of the Liver)
• Kidney deficiency(Yin or Yang deficiency)
• stasis of Blood
• Phlegm.
Blood deficiency is more commonin young women or girls and it is often
a result of prolonged use of the contraceptive pill.
A Kidney deficiency (especially of Kidney-Yin)can occur either in older
women because of overwork or in young women as a consequence ofa
hereditary weakness.
Phlegm as a cause of Scanty Periods is often seen in women suffering
from polycystic ovary syndrome:these women tend to obesity.
Some of the old Chinese gynecologybooks made a clear and interesting
distinction between thin and overweight women, saying that scanty periods

10. in thin women are due to Blood deficiencyand in overweight women are
due to Phlegm and Dampness.
Blood deficiency
Clinical manifestations
Scanty period with pale, dilute blood,may be only a drip, dizziness, blurred
vision, tingling of limbs, insomnia, palpitations, poor memory, dull, pale
complexion.Tongue: Pale and Thin. If, in addition to Blood deficiency,
there is Qi deficiencyand Dampness (a very commonoccurrence),the
tongue might be Swollen.
Pulse: Choppy or Fine.
Treatment principle
Nourish Blood,strengthen the Liver, tonify the Kidneys, fill the Directing
and Penetrating Vessels (Renand Chong Mai), regulate the periods.
Acupuncture
– LU-7 and KI-6 regulate the Directing Vessel.
– Ren-4 nourishes Blood and strengthens the Uterus; it is particularly
effective with direct moxa cones.
– LIV-8,ST-36 and SP-6 nourish Blood and strengthen the Liver. They are
particularly
– LIV-8 nourishes Liver-Blood.
– KI-3,SP-6 and ST-36 tonify the Kidneys. Warm needle can be used on
KI-3.
– Du-4, with direct moxa cones,would be used only if the deficiencyof
Yang is very pronounced and there are symptoms of internal Cold.

11. Kidney-Yin deficiency
Clinical manifestations
Scanty periods,dizziness, tinnitus, a dry throat, night sweating. Tongue:
without coating (also Red if there is Empty-Heat). Pulse: Floating-Empty or
Fine-Rapid.
Treatmentprinciple
Nourish Kidney-Yin, nourish Blood and Essence,regulate the periods.
Acupuncture
– LU-7 and KI-6 regulate the Directing Vessel,strengthen the Uterus and
nourish Yin.
– KI-3,SP-6 and ST-36 nourish Yin and strengthen the Kidneys.
– Ren-4 nourishes the Kidneys and strengthens the Uterus.
Stasis of Blood
Clinical manifestations
Scanty period with dark blood and clots, painful periods,abdominal pain
which is better after passing clots.Tongue: Purple. Pulse: Wiry.
Treatmentprinciple
Invigorate Blood, eliminate stasis, regulate the periods.
Acupuncture
– SP-4 and P-6 regulate the Penetrating Vesseland invigorate Blood as
this vesselis the Sea of Blood.
– SP-10,BL-17 and SP-6 invigorate Blood.
– KI-14,a point of the Penetrating Vessel, invigorates Blood and moves Qi
in the lower abdomen.
– Ren-6 moves Qi in the lower abdomen.

12. – Ren-4 invigorates Blood and strengthens the Uterus.
– ST-29 invigorates Blood in the lower abdomen.
Phlegm obstructing the Uterus
Clinical manifestations
Scanty period with a brownish discharge, obesity,a feeling of oppressionof
the chest, excessive vaginal discharge,period stops and starts, tiredness,
a feeling of heaviness. Tongue: Swollen. Pulse: Slippery.
Treatmentprinciple
Resolve Phlegm, dry Dampness,tonify the Spleen, regulate the periods.
– LU-7 and KI-6 regulate the Directing Vesseland strengthen the Uterus.
– Ren-6 moves Qi in the lower abdomen: moving Qi helps to resolve
Dampness and Phlegm.
– ST-28,Ren-9 and BL-22 promote the transformation and excretion of
fluids by the Triple Burner.
– BL-32 also promotes the transformation of fluids and affects the Uterus.
– SP-9 and SP-6 resolve Dampness.
– Ren-12 and BL-20 tonify the Spleen.
– Ren-4 strengthens the Uterus.