Internal Med 2 Final Painful Periods and Amenorrhea Deficiency Patterns

Question 1

What is Bao Gong?

Answer 1

Directly translated as “uterus,” it has a broad definition in TCM, encompasses all interior female reproductive organs, including ovaries and fallopian tubes. One of the “extraordinary organs” - shape of a yang organ, function of yin organ. Menstruation and labor are functions of discharge like a yang organ. Storage of blood and nourishing fetus are like a yin organ.

Question 2

What is Tian Gui?

Answer 2

Translation is “Tenth Layer of Heaven.” For women, refers to material substances to induce body growth, sexual maturity, menstrual blood, and fertility. It originates from prenatal essence, is stored in the kidneys, and nourished by postnatal food essences.(May be partly equivalent to hormones.) It is transformed into menstrual blood.

Question 3

Why is Chong Mai so important for Bao Gong?

Answer 3

Chong Mai is the most important EV for women’s physiology, which is rooted in blood, and Chong Mai is “Sea of Blood” and “Sea of the 12 Channels;” has deep influence on menstruation. It influences the SUPPLY and PROPER MOVEMENT of blood in the Bao Gong, controlling all aspects of menstruation. Chong is supported by ST qi and KID true yin and yang, and also connects with all yang channels in the head so that yang qi can warm blood in the Chong Mai.

Question 4

Why is Ren Mai so important to Bao Gong?

Answer 4

Ren Mai is “Sea of Yin Channels,” closely connected to yin, essence, blood, and fluids. It supports Bao Gong and impacts female physiological processes, including puberty, conception, pregnancy, childbirth and menopause. Ren Mai connects with ST, LIV, SP, and KID channels and therefore the Bao Gong receives yin, essence, fluids, qi and blood through the Ren Mai.

Question 5

Explain KID relationship with Bao Gong.

Answer 5

Bao Gong is connected to KID via Bao Luo (uterus channel) and through Chong, Ren, and Du Mai. Bao Gong relies on KID for QI (kidneys are root of original qi), ESSENCE (kidneys are root of prenatal essence, storing essence which is the origin of Tian Gui and important for puberty, fertility, conception, pregnancy and menopause), YANG (kidney fire is the fire of the Gate of Life, warming uterus, balancing yin, making conception possible, and influencing sexual desire), and YIN (kidney yin nourishes Bao Gong and is the source of menstrual blood, also balances yang influences).

Question 6

Explain LIV relationship with Bao Gong.

Answer 6

Bao Gong connects to liver via liver channel connections with Chong Mai at SP6, Ren Mai at CV2, and Du Mai at GV20. BLOOD: LIV stores, regulates vol., regulates and supplies blood to Bao Gong (important in menstruation, conception, and breast feeding). QI: LIV qi moves blood, and liver is responsible for smooth flow of qi in the body, therefore also the smooth flow of blood.

Question 7

Painful Periods due to Qi Stagnation and Blood Stasis- Indications?

Answer 7

Presence of chronic/intense emotional strain (anger, frustration, resentment, etc.) Qi stagnation s/s: distending pain before/during start of period, feeling distention in abdomen and breasts, hesitant start to period. Blood stasis s/s: intense, stabbing pain before/during start of period, dark menstrual blood with large clots, pain relieved after passing clots.

Question 8

Painful Periods due to Qi Stagnation and Blood Stasis - Tx Principles?

Answer 8

Regulate Qi, invigorate Blood, eliminate stasis, stop pain

Question 9

Painful Periods due to Qi Stagnation and Blood Stasis - Basic Formula?

Answer 9

Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction)

Question 10

Painful Periods due to Stagnation of Cold in the Uterus- Indications?

Answer 10

Precipitated by exposure to cold, Cold invasion, or underlying yang deficiency. Lower abdominal pain before/after period, scanty blood with dark clots, feeling cold in cetner of low abdomen, pain relieved by application of heat.

Question 11

Painful Periods due to Stagnation of Cold in the Uterus - Tx Principles?

Answer 11

Warm the Bao Gong, expel Cold, invigorate blood, stop pain

Question 12

Painful Periods due to Stagnation of Cold in the Uterus - Basic Formula?

Answer 12

Wen Jing Tang (Warm the Menses Decoction)

Question 13

Painful Periods due to Obstruction by Heat-Dampness- Indications?

Answer 13

Pain before the period and sometimes mid-cycle, burning sensation extending to sacrum, menstrual blood red with small clots, yellow smelly vaginal discharge.

Question 14

Painful Periods due to Obstruction by Heat-Dampness - Tx Principles?

Answer 14

Clear Heat, eliminate Dampness, dispel stasis, stop pain

Question 15

Painful Periods due to Obstruction by Heat-Dampness - Basic Formula?

Answer 15

Qing Re Tiao Xue Tang (Clear Heat and Regulate the Blood Decoction)

Question 16

Painful Periods due to Qi and Blood Deficiency- Indications?

Answer 16

Precipitated by physical overwork or chronic illness. Chong and Ren malnourished, blood has no force to move, causing stagnation and pain. Dull pain toward end or after period, dragging sensation in lower abdomen, pain relieved by pressure and massage, scanty, pale and thin bleeding. Tired but maybe unable to sleep, poor concentration. Other blood deficient and qi deficient s/s.

Question 17

Painful Periods due to Qi and Blood Deficiency - Tx Principles?

Answer 17

Tonify Qi, Nourish Blood, stop pain

Question 18

Painful Periods due to Qi and Blood Deficiency - Basic Formula?

Answer 18

Huang Qi Jiang Zhong Tang (Astragalus Decoction to Construct the Middle) add: Dang Gui, Dang Shen

Question 19

Painful Periods due to LIV & KID Deficiency- Indications?

Answer 19

Constitutional deficiency, or too many childbirths/pregnancies, or excessive sexual activity cause blood and essence depletion, Chong and Ren cannot move qi and blood. Dull pain toward end/after period, scanty, dull, pale bleeding, sore/weak lower back, pain relieved by pressure and massage, blurred vision.

Question 20

Painful Periods due to LIV & KID Deficiency - Tx Principles?

Answer 20

Tonify LIV and KID, nourish blood and essence, stop pain

Question 21

Painful Periods due to LIV & KID Deficiency - Basic Formula?

Answer 21

Tiao Gan Tang (Regulate the Liver Decoction): Dang Gui, Bai Shao, Shan Zhu Yu, E Jiao, Ba Ji Tian, Shan Yao, Gan Cao

Question 22

Amenorrhea - what is the PATHOLOGY?

Answer 22

1. LIV and KID deficiency: not enough essence in KID (origin of menstrual blood) and not enough blood stored in LIV -> malnourished Chong andRen -> cannot supply blood and essence to Bao Gong -> periods stop. 2. Qi and blood deficiency: not enough qi and blood to fill and nourish Chong and Ren -> cannot supply qi and blood to Bao Gong -> periods stop. 3. Yin deficiency -> Empty Heat -> dries blood -> failure to nourish Chong and Ren -> fail to nourish Bao Gong -> periods stop. 4. Qi stagnation and blood stasis-> obstructed qi and blood flow in Chong and Ren -> (etc) 5. Cold in blood -> enters Chong and Ren -> obstructs qi and blood flow in Chong, Ren, Bao Gong 6. Damp-Phlegm obstructs -> impairs qi and blood flow in Chong, Ren, Bao Gong

Question 23

Amenorrhea - what are deficiency patterns?

Answer 23

Liver and Kidney Deficiency, Qi and Blood Deficiency, Depletion of Yin and Dryness of Blood

Question 24

Amenorrhea - what are excess patterns?

Answer 24

Stagnation of Qi and Blood, Cold in the Blood with Blood Stasis, Obstruction by Phlegm-Dampness

Question 25

Amenorrhea due to LIV and KID Deficiency - Indications?

Answer 25

Primary amenorrhea and looks under-developed, or if secondary amenorrhea, period scanty, often delayed, probably long-term gyn disorder, possibly Flooding & Trickling disorder in past; blood was pale, thin, light, no clots/pain. LBP during period. Eyes very tired, vision problems. Maybe KID yang deficient (if Cold s/s), yin def (if Empty Heat s/s) or KID Qi deficiency (not much H/C s/s). Has general LIV/KID def s/s.

Question 26

Amenorrhea due to LIV and KID Deficiency - Tx Principles?

Answer 26

Regulate menses, tonify KID, nourish LIV, tonify blood (and tonify essence)

Question 27

Amenorrhea due to LIV and KID Deficiency - Basic Formula?

Answer 27

Gui Shen Wan (Restore the Kidney Pill) add: Ji Xue Teng, He Shou Wu

Question 28

Amenorrhea due to Qi and Blood Deficiency - Indications?

Answer 28

Period was extremely scanty, v light flow, short time, no clots/pain or mild pain with empty sensation. PMS mild to none, but maybe dizzy/lightheaded, blurred vision, palps, forgetful, light sleep, many dreams, pale dry skin, dry thin hair, maybe hair loss/lack of growth, poor concentration/mental energy.

Question 29

Amenorrhea due to Qi and Blood Deficiency - Tx Principles?

Answer 29

Tonify Qi, Nourish Blood, regulate menses

Question 30

Amenorrhea due to Qi and Blood Deficiency - Basic Formula?

Answer 30

Ren Shen Yang Ying Tang (Ginseng Decoction to Nourish the Nutritive Qi)

Question 31

Amenorrhea due to Yin Deficiency with Dryness of Blood - Indications?

Answer 31

Period was very late, color maybe red but very scanty with thicker consistency, very short time of bleeding. PMS s/s usually indicate empty Heat, such as feeling warm/hot at night, nightsweats, hot palms/soles, red dry lips/tongue, dry/sore throat, thirsty. Compexion pale, hands/feet cold to touch, weight loss/emaciation.

Question 32

Amenorrhea due to Yin Deficiency with Dryness of Blood - Tx Principles?

Answer 32

Nourish yin, generate water, nourish blood, regulate menses

Question 33

Amenorrhea due to Yin Deficiency with Dryness of Blood - Basic Formula?

Answer 33

Jia Jian Yi Yin Jian (Modified Yin-Boosting Decoction) with Huang Jing, Dan Shen, Zhi Ke