“Metrorrhagia”- dysfunctional uterine bleeding (2)
(崩漏 – 功能性子宮出血)
In fact, the determination of treatment based on syndrome differentiation in “metrorrhagia” is extremely detailed and complete in traditional Chinese medicine. The result is inability of absorbing blood or stasis of blood frustrating the return of new blood or inducing overabundance of fire which causes heat to occupy the lower-jiao and promote quick flowing of blood. Heat or coldness, deficiency or excess, dysfunction of Rush and Conceptional meridians, all might cause “metrorrhagia”. When metrorrhagia occurs, there is profuse vaginal bleeding, the time prolonged, the blood in clots or in the form of bloody water. It may be evoked by abortion or occur after delivery. Metrorrhagia usually belongs to the deficiency syndrome and not few patients develop this disease because of weakness of body and heat of blood, but dangerous cases are those caused by sudden profuse hemorrhage from masses (like benign or malignant tumors). When hemorrhage is profuse, hemostasis is the first choice in treatment, and when the bleeding regresses, treatment according to syndrome differentiation should be instituted to prevent relapse. Therefore, in treating metrorrhagia, the combined use of TCM and modern medicine therapy is imperative. According to TCM syndrome differentiation, “metrorrhagia” can be divided into:
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Blood heat: color deep red, or in dark purplish clots, thirst but having a preference for cold drinks, urine scanty and stoals dry, tongue proper red, coating yellow, pulse rapid and string-like. Treatment should aim at removal of pathogenic heat from blood. Blood stasis: downflowing blood excessive and rapid, or blood scanty and dribbling endlessly, color purplish with clots, abdomen painful and resistant to palpation, tongue showing purplish spots or patches, pulse deep and string-like or deep and uneven. Treatment should aim at promotion of blood circulation and removal of blood stasis. Defieiency of qi and blood: metrorrhagia or endless dribbling of menstrual blood, blood light red and dilute, whitish color of face, palpitation, shortness of breath, sweating, tongue color pale, pulse weak or feeble and hallow. Treatment should aim at supplement of gi and nourishment of blood.
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The above mentioned forms are only different stages of development of chronic hepatitis, but the formation of “metrorrhagia” is usually due to wetness-heat of lower-jiao produced by invasion of virus evil upon the humane body. Therefore, the above syndrome differentiation and determination of treatment must base on the principle of “soothe the liver, relieve stagnation, clear wetness-heat, activate gi, promote blood circulation, warm the uterus.” It is only when the patients general condition has been strengthened that the endometrium, after shedding off, might regenerate and heal and then metrorrhagia can be stopped. The fundamental measure is to treat chronic hepatitis and improve the blood coagulative mechanism and only in this way abrupt hemostasis of metrorrhagia can be attained.
Introduction of cases (continued)
| Case 13
Chan (code number 527), female, age 18 years. Her first visit was on June 1994, with the chief complaint of marked emaciation for half a year, her body weight dropped from 96 lbs to 89 lbs. She often had insomnia, yellowish urine and irregular menstruation. In the recent ten more days, she had continuous vaginal bleeding, the color bright red or brownish, the amount profuse, and in association, she experienced vertigo, nausea, sweating palpitation and the pulse was 100/min. Physical examination: the patient lean, palish looking, tired expression, hepatomegaly of 4.5 cm with marked percussion tenderness. The diagnosis was chronic hepatitis, deficiency of gi and blood, blockage of channels and wetness-heat of lower-jiao (metrorrhagia). After 6 parcels of TCM drugs, the amount of menstrual blood decreased gradually and the color of blood was red. The liver had retracted 3 cm. After another 3 parcels of TCM drugs, the menstrual bleeding ceased; the liver returned to normal and her sleeping and mental condition was good. TCM therapy was continued and after 9 parcels, her menstrual appeared and the liver enlarged again to 3 cm. After another 3 parcels of TCM drugs, the liver was normal and the menses lasted for 6 days. Systemic TCM treatment continued to the tome of attainment of clinical cure and then she was followed up. After the cessation of TCM therapy, before each menstrual period, she took TCM drugs for 3 days, and her general condition was good. The menses following were regular and there was no hepatomegaly. Her last return visit was on June 1996, at which time no hepatomegaly was found, anemia was corrected and her menstruation was entirely normal.
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| Case 14
Kwok (code number 444), female, age 14 years. Date of first visit: May, 1998. Her chief complaint was continuous vaginal bleeding for 2 months, the daily amount large, especially marked after activity, the color bright red and with occasional blood clots. Her menarche was at 12 years, regular at the beginning, but later became once every two months with bright red color and large amounts. There were also blood clots and dysmenorrhea. She felt tired and also experienced vertigo, loss of appetite, palpitation and shortness of breath. Physical examination: thin and undeveloped, body weight 80 lbs. skin palish yellow, generalized tinea versicolor over skin of trunk, heart rate 100/min, blood pressure 70/50 mmHg, marked percussion tenderness over hepatic region, hepatomegaly of 4.5 cm, no edema of lower extremities. The diagnosis was chronic hepatitis, deficiency of gi and blood, blockage of channels and stasis of blood and wetness-heat of lower-jiao (metrorrhagia). After taking 7 parcels of TCM drugs, the liver margin regressed 1.5 cm, the menstrual blood decreased but had not totally stopped. Sleeping and appetite was good. The blood pressure rose to 90/60 mmHg and the pulse was normal. Anther 3 parcels of TCM drugs was instituted and the menstruation stopped, the liver returned to normal. Systemic TCM treatment was administered for 4 weeks totally, at the end of which all symptoms disappeared. Treatment was discontinued at the attainment of clinical cure. |
By WONG Kwok Hung
published on 18th September 2001
(translated by Professor ZHENG Hua En in 2003)