Integrative Woman’s Health Course DAOSHING NI

Beng Lou – Abnormal Uterine Bleeding (AUB) 崩漏

Definitions Beng Lou – Abnormal Uterine Bleeding (AUB)  FrequentlytermedasDysfunc2onaluterinebleeding(DUB)andisdefinedasabnormaluterinebleedingintheabsenceoforganicdisease.Dysfunc2onaluterinebleedingisthemostcommoncauseofabnormalvaginalbleedingduringawoman'sreproduc2veyears.

Case Study Dr. Ding, Qi Hou 丁启后  45yo,married,firstvisit11-12-2004.

 AUB3months.Irregularmenstrualcyclesinceoneyearago,fluctua2ngmenstrualcycleupto10days,menstrualflowismoderateandnotheavy,7daystoclean.Beganthreemonthsago,sincemenstrua2on,bleedinghasnotstoppedsince,fa2gue,restlessness,insomnia,appe2teok,noabdominalpain,nofever,bleedingmoderate,paleandthin,tongueflabby,coa2ngthinyellow,pulsedeepslowforceless,pelvicexam(-).

AUB has wider terminology in WM  Bleedingbetweenperiods BleedingaPersex SpoRngany2meinthemenstrualcycle

 Bleedheavierorformoredaysthannormal

 BleedingaPermenopause

Causes  Pregnancy Ectopicpregnancy Adenomyosis

 IUDorOCP Uterineorcervixinfec2on Fibroids

 ProblemswithbloodcloRng

 Polyps Endometrialhyperplasia

 Cancerofcervix,uterusorvagina Polycys2covarysyndrome

Exams  History Sonohysterography Ultrasound MRI

 Hysteroscopy Endometrialbiopsy

Beng Lou 崩漏  Bengusuallydenotestouncontrolledheavybleeding LouusuallydenotestoincessantspoRngorlighterbleeding

 Bothtermwhencomestogethertodefineabnormaluterinebleeding

Classical Texts  <ZhuBingYuanHouLun–LouXiaHou>諸病源候論，漏下候:definedbothBengandLou

 JinKuiYaoLue–WenJingTangandJiaoAiTang

TCM Etiology

SpleenDeficiency

KidneyDeficiency

HeatintheBlood

BloodStagna2on

TCM Etiology Spleen Deficiency

ChronicSpleenWeakness

ExcessiveStrainingandWorrying

IrregularFoodIntake

SpleenDeficiency

ChongRenDysfunc2on

BloodLostControl

TCM Etiology Kidney Deficiency

KidneyQiDeficiency

TianGuiDeficiency

TrueYinDamage

DeficientFireForma2on

DeficientFiremovingBlood

BloodExtravasa2on

ExcessiveLaborandSex

ChronicorMajorIllness

ChronicYangDeficiency

MingmenFireWeakening

ChronicYinDeficiency

TianQuiDeple2on

TCM Etiology Heat in the Blood

Cons2tu2onalYang

AbundanceandYinDeficientcrea2ngHeat

Emo2onalInjury

LiverStasistransformingto

Heat

HeatDamagesChongRen

Accumula2onofDampHeat

ForceBloodExtravasa2on

TCM Etiology Blood Stagnation

Cold,Heat,DeficientStasis

Emo2onalInjury

QiStasisBloodStagna2on

Stagna2onBlockingtheChongRen

BlooddoesnotreturntoChannel

MenstrualandGesta2onal

Accumula2ons

TCM Pathology  DisorderLoca2on:ChongRenChannels Pathology:dysfunc2onofChongRencausingmenstrualbloodtobeirregularanduteruslostitsstoringfunc2on.

TCM Pathology SpleenDeficiency

LostofControlFunc2on

KidneyDeficiencyLostofStoringFunc2on

HeatintheBlood

HeatDamagesChongRen

BloodStagna2on

StagnantBloodBlocking

MenstrualBloodLostTiming

UterusStoringDysfunc2on

BengLuo

TCM Pathology

UterineStoring

Dysfunc2on

Deficiency

HeatStagna2on

Diagnosis  MainSymptoms:Irregularmenstrualcycle,menstrua2oncanlastsmorethan14days,orseveralmonths.Itcanbeaccompaniedwithsuddenstoppageorsuddenhemorrhagingflow.

 SecondarySymptoms:differentlevelsofanemiaduetochronicbleeding

Exams  Ultrasound Hysteroscopy Diagnos2cD&C CTorMRI

Diagnosis Syndromes Characteris1cs

HeatSyndrome Suddenbleeding,excessiveandacute,incessantwithnostoppage,brightredordeepred,viscousflow

DeficiencySyndrome Suddenbleeding,orincessantflowwithnostoppage,palethinflow

BloodStagna2on Sluggishflowonandoff,fluctua2ngbetweenheavyandnone,startandstop,colorpurpledarkwithabdominalpain

ColdSyndrome Suddenbleedingwithnostoppage,paledarkflow,thinflowwithaversiontocold

Treatment Principle  Whenacute,treatsthemanifesta2on,whennon-acute,treatsthecause.急則治其標，緩則治其本。◦ StopTheFlow(SaiLiu塞流)–stopbleeding,especiallyduringacutephasewherethebleedingheavyanduncontrolledtoavoidanycollapsesitua2on.◦ Dis2lla2ontoFindtheSource(DengYuan澄源)–seekclarifica2onwherethesourceoftheproblemis.Itisatreatmentprincipleusedduringlessacutestagewherethebleedingisnotasheavy◦ Return(FuGui复歸)–aPersuccessfultreatments,thisiswherewepreventfurtheroccurrenceofAUB.Thetreatmentprinciplesduringthisperiodshouldbetotonifykidney,assistspleenorpacificliver.

Syndromes  SpleenDeficiency KidneyDeficiency◦ KidneyQiDeficiency◦ KidneyYangDeficiency◦ KidneyYinDeficiency

 HeatintheBlood◦ ExcessHeat◦ DeficientHeat

 BloodStagna2on

Spleen Deficiency  Suddenbleedingorincessantbleeding TonifyQi,ControlBlood,StrengthenChong,StopBeng GuBenZhiBengTang固本止崩湯

 ShuDi,BaiZhu,DangShen,DangGui,HuangQi,BlackGinger(PaoJiang) <FuQingZhuNvKe> Fa2gueaddTianQi,YiMuCaoorShiXiaoSan

Kidney Qi Deficiency  Irregularmenstrualcycle,profuseincessantflow

 TonifyKidneyQi,StrengthenChong,StopBleeding ModifiedCongRongTuSiZiWan(addDangShen,HuangQi,AJiao)

 CongRongTuSiZiWan蓯蓉菟絲子丸 －ShuDi,RouCongRong,FuPenZi,DangGui,GouQiZi,SangJiSheng,TuSiZi,AiYe,TianQi

 Palpita2onaddGuiPiWan

Kidney Yang Deficiency  Irregularmenstrua2on,heavybleedingorincessantspoRngorlightflow,orstopfewmonths,suddenheavyflowagain

 WarmUpKidneyBenefitQi,StrengthenChong,StopBleeding

 YouGuiWan右歸丸+DangShen,HuangQi,TianQi

 YouGuiWan:ZhiFuZi,RouGui,ShuDi,ShanYao,ShanZhuYu,GouQiZi,TuSiZi,AiYe.

 Lumbagoanddiarrhea,addBaiZhu,PaoJiang,BuGuZhi,XianLingPi

Kidney Yin Deficiency  Irregularmenstrua2on,bleedingincessantbutnotoverlyheavy,canstopforafewmonthsandcomebackonsuddenly.

 NourishKidneyBenefitYin,StrengthenChong,StopBleeding. ZuoGuiWan+ErZhiWanorZiYinGuQiTang滋陰固氣湯

 ZuoGuiWan左歸丸:ShuDi,ShanYao,ShanZhuYu,GouQiZi,TuSiZi,LuJiaoJiao,GuiBan,NiuXi.

 熟地黃24克 山藥12克 山茱萸12克 枸杞子12克 菟絲子12克 鹿角膠12克 龜板12克 牛膝9克

Zi Yin Gu Qi Tang 滋陰固氣湯  《实用中医妇科学》Prac2calTCMGynecology

 DangShen,HuangQi,BaiZhu,AJiao,XuDuan,TuSiZi,HeShouWu,ShanZhuYu,LuJiaoShuang,BaiShao,ZhiGanCao

 党参、黄芪、白术、阿胶、续断、菟丝子、何首乌、山茱萸、鹿角霜、白芍、炙甘草。

 Aspecificformula2onespeciallyusedforBengLou

HB due to Deficient Heat  Abnormaluterinebleeding,incessantbleedingorspoRngorsuddenheavybleeding

 NourishYin,ClearHeat,StrengthenChong,StopBleeding ShangXiaXiangZiTang上下相資湯

Shang Xia Xiang Zi Tang 上下相資湯  <ShiShiMiLu>1687AD,Chapter6《石室秘錄》卷六

 ShuDi,ShanZhuYu,WeiRui(YuZhu),RenShen,YuanShen(XuanShen),ShaShen,DangGui,MaiDong,WuWeiZi,NiuXi,CheQianZi.

 UsedoriginallyfordrycrackingofmouthandtongueaPerAUB.

 熟地1兩，山茱萸5錢，葳蕤5錢，人參3錢，元參3錢，沙參5錢，當歸5錢，麥冬1兩，北五味2錢，牛膝5錢，車前子1錢。

 血崩之后，口舌燥裂，不能飲食。

HB due to Excess Heat  Abnormaluterinebleeding,suddenonsetorincessantspoRngformanydays.

 ClearHeatCoolsBlood,StrengthenChong,StopBleeding QingReGuJingTang清熱固經湯

Qing Re Gu Jing Tang 清熱固經湯  ZhiGuiBan,MuLi,AJiao,ShengDi,DiGuPi,ShanZhi,HuangQin,DiYu,ZongLuTanzhong(CarbonizedPe2oleofWindmill-palm),OuJie,GanCao.

 炙龜板8錢（研粗末，先煎），牡蠣粉5錢（包煎），清阿膠5錢（陳酒燉沖），大生地5錢，地骨皮5錢，焦山梔3錢，生黃芩3錢，地榆片5錢，棕榈炭3錢，生藕節5錢，生甘草8分.

Blood Stagnation  Abnormaluterinebleeding,sluggishfluctua2ngflow,alterna2ngbetweenheavy,light,none,orincessantspoRng.

 Ac2vateBloodDissolveStagna2on,StrengthenChong,StopBleeding ZhuYuZhiXueTang逐瘀止血湯fromDrFu,QingZhu’sGynecology

 ShengDi,DaHuang,ChiShao,DanPi,DangGuiWei,ZhiKe,GuiBan,TaoRen.

 生地酒炒30克 大黃9克 赤芍9克 丹皮3克 當歸尾15克 枳殼15克 龜板醋炙9克 桃仁10粒

Emergency Measure Stop the Flow – Sai Liu  Ginseng FuZi+Ginseng YunnanWhitePowder(TianQi)

 CV20BaiHuai百會,LR1Dadun大敦,SP1Yinbai隱白,Moxa

 Bloodtransfusion,D&C,IVfluid

Case Study Dr. Ding, Qi Hou 丁启后  45yo,married,firstvisit11-12-2004.

 AUB3months.Irregularmenstrualcyclesinceoneyearago,fluctua2ngmenstrualcycleupto10days,menstrualflowismoderateandnotheavy,7daystoclean.Beganthreemonthsago,sincemenstrua2on,bleedinghasnotstoppedsince,fa2gue,restlessness,insomnia,appe2teok,noabdominalpain,nofever,bleedingmoderate,paleandthin,tongueflabby,coa2ngthinyellow,pulsedeepslowforceless,pelvicexam(-).

Case Study Dr. Ding, Qi Hou 丁启后  KidneyQideficiency,QiBloodDeficiency,ChongRenWeakness

 DangShen15,ShanYao15,ShanZhuYu12,ShuDi15,YuZhu15,DiYuTan10,QianCao6,XianHeCao20,NvZhenZi15,HanLianCao15,WuZeiGu15,AJiao15,ChuanDuan15,MaiDong12,BaiShao15,LongGu30,MuLi30,JingJie10

Case Study Dr. Ding, Qi Hou 丁启后  Secondvisit Herbleedinghasstoppedoneweek,duetofinancialdifficul2es,sheistotakeGuiPiWanoutsideofhermenstrua2onandduringhermenstrua2onshewouldtakethefirstformula2on.

 Everythingnormalized.