Amenorrhea

WESTERN MEDICINE: There are two kinds of amenorrhea: primary amenorrhea is the delay of menarche beyond 18; secondary amenorrhea is the cessation of uterine bleeding in women who have previously menstruated.

SYMPTOMS AND SIGNS: Amenorrhea of excessive type show symptoms of sudden onset of cessation of uterine bleeding, accompanied with distension and pain in the lower abdomen, pain aggravated by pressure. There may be a mass on palpation, deep wiry pulse. Amenorrhea of deficient type shows delayed menstruation at first, gradually decreasing in amount to amenorrhea, sallow complexion, dry skin, restlessness, anorexia, soreness or pain at lumbar regions or knees, loose stools, white tongue coating, forceless pulse.

ETIOLOGY AND PATHOLOGY: Etiological factors of amenorrhea are either due to deficient type, or excessive type. Deficient type includes the deficiency of liver and kidney, or Qi and blood deficiency, excessive type includes the Qi stagnation and blood stasis, or obstruction of damp-phlegm. The pathological changes are either due to the insufficient Qi, blood (include essence) for Ren and Chong channels, or due to the obstruction of Ren and Chong channels caused by Qi, blood, and damp-phlegm.

DIFFERENTIATIONS: 

1. Amenorrhea due to the Deficiency of Liver and Kidney:

Indications: Delay of menstruation beyond age 18, or menstruation showing in later age with scanty bleeding and pinkish color, gradually developing into amenorrhea, accompanied with dizziness, tinnitus, sore and weak sensation of knees and lumbar regions, dry mouth and throat, hot sensation of five palms (palms of both hands and feet, plus the center of chest}, tidal fever(fever feeling at afternoon or night), night sweating. Red tongue, scanty coating, wiry and thready pulse or thready and uneven pulse. 

Treatment & Formulas: Tonify the liver and kidney so as to nourish the blood and regulate the channels. 

Products

  • Jia Wei Chang Chun (Ginseng & Codonopsis Combination, or Youth Formula, Item No. D3041): This is a very good formula as a kidney tonic. 
  • Huan Sao Dan (Lycium Formula, Item No. 2264): This is also a very popularly used formula for kidney Yin and Yang tonic. 
  • Ji Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia Six Formula, Item No. 2290): This is a kidney Yin tonic, it also clears the deficient fire. 
  • Ba Wei Di Huang Wan (Rehmannia Eight Formula, Item No. 2011 ): This is a formula for both kidney Yin and Yang. 
  • Liu Wei Di Huang Wan (Rehmannia Six Formula, Item No. 2051 ): This is a kidney Yin tonic. 

2. Amenorrhea due to the Deficiency of Qi and Blood:

Indications: Delay of menstruation, gradually to cessation, pale and dull complexion, dizziness, blurry vision, palpitation, shortness of breath, dislikes talking, fatigue, weak limbs, poor appetite, loose stool, pale tongue and lips, thready and weak pulse, or thready and slow pulse. 

Treatment & Formulas: Tonify the Qi and blood by promoting the function of the spleen and stomach. 

Products:

  • Ba Zhen Tang (Tang - kuei and Ginseng Eight Combination, Item No. 2010): This is a typical Qi and blood tonic.
  • Shi Quan Da Bu Tang (Ginseng and Tang - kuei Ten Combination, Item No. 2015): It is also a good tonic formula for Qi and blood. 
  • Gui Pi Tang (Ginseng and Longan Combination, Item No. 2261 ): It tonifies the Qi and blood by promoting the functions of heart and spleen. 

3. Amenorrhea due to Qi Stagnation and Blood Stasis:

Indications: Delay or cessation of menstrual period, depression, easily irritated, restlessness, oppression and fullness of chest and hypochondriac regions, lower abdominal fullness and pain, refuse pressing in pain area, dark purplish tongue, or with petechiae, deep wiry pulse or deep and uneven pulse. 

Treatment & Formulas: Regulate the stagnated Qi and dispel the blood stasis by promoting the circulation of Qi and blood 

Products:

  • Si Wu Tang (Tang - kue Four Combination, Item No. 2060) plus Tao ren (Persica Seman, Item No. 1163) and Hong Hua (Carthamus Flos, Item No. 1148), or combined with Xiao Yao San (Tang - kuei and Bupleurum Formula, Item No. 2195). 

4. Amenorrhea due to the Damp-Phlegm:

Indications: Cessation of menstrual period, over­weight body type, fullness and suffocation of chest and hypochondriac regions, nausea, vomiting, fa­tigue, lassitude, profuse white vaginal discharges, greasy tongue coating, slippery pulse.

Treatment & Formulas: Dissipate the damp-phlegm by dryness, regulate the channels by promoting the circulation of blood. 

Products:

  • Er Chen Tang (Citrus & Pinellia Combination, Item No. 2003)
  • The following herbs can be added for better result:
  • Gang Zhu (Atractylodes Lancea Rizoma, Item No. 1218)
  • Xiang Fu (Cyperus Rhizoma, Item No. 1117) 
  • Tian Nan Xin (Arisaema Rhizoma, Item No. 1042)
  • Zhi Ke (Aurantium Fructus, Item No. 1122)
  • Sheng Jiang (Fresh Ginger, Item No. 1071)
  • Dang Gui (Angelica Sinensis Radix, Item No. 1214)
  • Chuan Xiong (Cnidii Rhizoma, Item No. 1007)
  • The dosage for the above herbs depends on the patient's situation. 
  • Ban Xia Bai Zhu Tian Ma Tang (Pinelia and Gastrodia Combination, Item No. 2066)
  • They may also be combined with Si Wu Tang (Item No. 2060)

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