“Metrorrhagia”- dysfunctional uterine bleeding (1)
(崩漏 – 功能性子宮出血)
“Dysfunctional uterine bleeding” is defined as uterine bleeding caused by endocrinologic dysfunction with no apparent lesions of the genital organs. According to whether the ovary ovulates or not, it is divided into ovulatory uterine bleeding and anovulatory uterine bleeding. In clinical practice, anovulatory uterine bleeding is more commonly seen and it usually occurs in adolescent or climacteric women. In cases of the typical anovulatory uterine bleeding, the menstrual episode is delayed for a variable period, but when it does occur, it might be excessive, prolonged but painless. (may persist for 5-6 weeks). Ovulatory uterine bleeding manifests itself by prolonged and excessive menstrual bleeding and short menstrual cycles and it is in fact, the result of luteal phase defect. Traditional Chinese medicine defines dysfunctional uterine bleeding as “metrorrhagia” which implies two meanings: the bleeding may be excessive but it may also be persistent and dribbling.
Metrorrhagia is excessive vaginal bleeding due to the derailment of blood flow from the channels. Abnormal vaginal bleeding is not uncommon clinically and is often the chief cause that renders patients to seek for medical treatment. But the relation of abnormal vaginal bleeding with liver disease is only known by few people and is easily neglected by physicians as well as patients. Therefore, this kind of “chronic hepatitis” patients often lose the opportunity of “treating the fundamental” and, as time passes, they may have undergone a prolonged use of hemostatic drugs to lessen the bleeding or to shorten the menstrual phase or may be forced to use sexual hormones to decrease the menstrual amount. But it is certain that if systemic TCM therapy for chronic hepatitis is not used to obtain clinical cure, the subsequent liver stagnation and lung dryness, black age of channels and blood stases and abnormal liver function all may induce coagulopathy. The final result is formation of marked “deficiency of gi and blood”. Female liver disease patients, suffering from lower-jiao wetness-heat, might have the following manifestations:
Blood heat: deficiency of yiu with overabundance of yang, hyperactivity of liver or vaporization of lung and stomache, dysfunction of fu-organs leading to generation of heat in the blood. It might show heat of muscles and skin or even hematemesis, nasal hemorrhage, hematochezia, hematouria, shortening of menstrual cycle and large amount of menstrual blood. Blood stragnation: hyperactivity of liver and out of temper easily, injury of the interior and existence of blood extravasation. The blood, leaving the channels, cannot exercise its normal flow resulting in congestion and pricking pain. The patient often feels pricking pain in the chest and tiredness of the limbs. She can eat but the stools are red, the urine dribbling, the menses irregular with large amounts and numerous clots. Her pulse is deep and unsmooth. Metrorrhagia: abundance of liver fire, heat retention in the lower-jiao causing quick flowing of blood and dysfunction of Rush and Conceptional meridians. All these may cause metrorrhagia. The symptoms include vaginal bleeding, profuse in amount, in clots, or in the form of bloody water. Most of the manifestations belong to the deficiency syndrome category and others might be caused by weakness of the body and heat of the blood. Those belong to the sthenic heat category are not commonly seen.
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Introduction of cases
| Case 12
Ching (code number 2037) female, age 79 years. Date of first visit: January 2000. Her chief complaint was repeated loin pain with locomotive dysfunction for ten more years. Since menopause and especially in the recent years, she had repeated vaginal bleeding which were becoming more frequent and with increasing amounts. Frequent and painful urination together with constipation were present for half a year. Modern medical examination showed the existence of cervical polp which was excised later and she also received diagnostic curettage but still the cause of bleeding had not been demonstrated. She was hospitalized many times because of frequent and profuse vaginal bleeding and doctors advised her to have hysterectomy but it was not accepted by her family members on account of her old age. Then she had a prolonged intake of hemostatics and high fibre emollient cathartics but of no avail. Physical examination: senile appearance, lean, tongue purplish red, enlarged and dry, apparent asymmetrical anomaly of hypochondria, percussion tenderness over hepatic region, hepatomegaly of 3 cm. The diagnosis was chronic hepatitis, blockage of channels and stasis of blood and wetness-heat of lower-jiao (stranguria, metrorrhagia) TCM treatment was therefore administered. At the beginning of TCM therapy, there was wetness-heat abdominal pain, diarrhea, flatulence, frequent and painful urination. But after 2 parcels of TCM drugs, the liver was normal. After another 5 parcels, she felt good mentally. She passed stools 3 times a day and although she still had vaginal bleeding, the amount was decreasing day by day. After 12 parcels, the vaginal bleeding turned to pinkish color and stopped after 2 weeks. Systemic TCM treatment continued for 7 weeks and was stopped after the attainment of clinical cure. One the return visit one and a half month after discontinuation of TCM drugs, she said that vaginal bleeding did not occur and there was no discomfort other than constipation, The liver was normal and there was no more hemorrhage.
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By WONG Kwok Hung
published on 11th September 2001
(translated by Professor ZHENG Hua En in 2003)