Amenorrhea

Amenorrhea

Women experience four types of amenorrhea: cold, heat, excess, and deficiency.

Cold amenorrhea occurs when cold accumulates and qi stagnates, causing the menstrual cycle to stop. Over the years, the uterine opening is damaged by cold, the meridians become rigid, and there is pain in the yin area, with cold in the lower abdomen pulling up the lower back and causing a hernia around the navel; or blood stasis prevents the flow of blood, leading to stone masses—both are manifestations of frost and ice. Treatment involves Wen Jing Tang, or using warming medicines, such as Fu Zi Li Zhong Tang combined with Dang Gui, Peach Kernel, Rhubarb, Xixin, Niu Xi, and Cinnamon, with Sheng Hua Tang being particularly effective. After the menstrual cycle resumes, taking Shen Qi Wan can consolidate the effect. The patient with heat syndrome has the uterus as the "blood chamber," which is governed by the liver. When liver fire becomes rebellious, it forces its way upward through the uterine vessels to the heart and lungs. If the qi of the heart and lungs cannot descend, symptoms such as chills and fever, dizziness, tinnitus, irritability and anger, coughing with upward rushing qi will appear. The treatment should focus on calming the liver fire, allowing the lung qi to descend and the heart blood to flow downward, thus unblocking the meridians. Use Danggui Luhui Wan with peach kernels for attacking the condition, or Danzhi Xiaoyao San with peach kernels for harmonizing it. It is also said that the Chong and Ren meridians originate in the uterus and ascend to the Yangming channel. If there is rebellious fire in the uterus, it will surge upward along these two channels, causing dizziness, redness of the cheeks, throat discomfort, fever, thirst, coughing, and wheezing. This is a case of upward rebellion of uterine qi, merging with the qi of the Yangming channel, resulting in a dry and agitated syndrome. The treatment should be to regulate the Yangming channel to counteract the rebellious qi, allowing the fire to descend and unblocking the meridians. Use Yuzhu San for this purpose. If the spleen and stomach are inherently weak and unable to withstand aggressive treatment, use Yunv Jian with peach kernels and Danpi for treatment. The Jin Gui formula Mai Men Dong Tang is particularly effective in reversing the rebellious qi of the Yangming channel. All these formulas work by descending the qi of the Yangming channel, allowing the qi to reach the uterus and thereby unblocking the meridians. There is also a method of drawing the qi downward from the kidneys to unblock the meridians, using Liu Wei Di Huang Tang with Zhi Zi, Bai He, Niu Xi, and peach kernels. This is another approach to draw the rebellious qi downward and treat the condition.

For women with actual syndrome of amenorrhea, their lower abdomen feels like a round vessel (1), and urination is slightly difficult but not accompanied by thirst. This indicates that water and blood have become congealed in the blood chamber, and Da Huang Gan Sui Tang is the main prescription. Furthermore, Zhang Zhongjing stated: "When a woman suffers from cold damage or wind-heat, her menstrual flow stops abruptly, and she experiences fullness and distension in the chest and flanks, resembling the condition of 'Jie Xiong,' with delirium, this indicates that heat has entered the blood chamber. Xiao Chai Hu Tang is the main prescription (2)." For women with amenorrhea and persistent hard masses in the abdomen (3), there is dried blood inside, which has been corrupted by damp-heat, producing white discharge. Apply Fanzhi Mo into the vagina. I suggest using Tu Gua Gen Tang with Huang Bai and Fang Ji for treatment. Alternatively, if there is lower abdominal pain, black stools, difficulty in urination, and the blood seems ready to flow out but refuses to do so, then Di Dang Tang is appropriate, and at times, Ge Xia Zhu Yu Tang can also be used.

For women with deficiency syndrome of amenorrhea, it may be due to excessive blood loss, resulting in pale yellowish-white complexion and nails; since the blood has already been drained from the upper body, how can it possibly return to the uterus to form menstrual flow? The treatment should focus on stopping the bleeding and allowing the blood to descend, then replenishing the deficiency, so that the blood can regenerate and the qi can flow smoothly, ultimately enabling the blood to flow down to the uterus and unblocking the meridians. Use Si Wu Tang with Niu Xi, Zhi Ke, Jiang Xiang, Yu Jin, Xue Yu, Tong Bian, Fu Ling, Gan Cao, and A Jiao. Alternatively, if the depletion of sexual essence leads to insufficient kidney water, preventing the stimulation of the Chong pulse's blood, resulting in a situation where yang does not support yin and water does not transform into blood, then nourishing the water to benefit the Tian Gui is necessary. Zu Gui Yin and San Cai Tang are both suitable for this purpose. Or, if excessive childbirth has led to blood depletion and exhaustion, Sheng Yu Tang is the main prescription. For young girls (4) whose blood is depleted, known as "childhood tuberculosis," when they are at the peak of their blood production but still suffer from blood deficiency, leading to bone-steaming and muscle heat, pale complexion, red cheeks, lack of appetite, dry and thin skin, coughing, and wheezing, it is necessary to greatly nourish the source of blood production, so that the blood can rapidly increase, and all related illnesses will recede. Zhi Gan Cao Tang is the main prescription for this. Additionally, if women and girls are unable to express their inner feelings, their emotions are suppressed, leading to stomach problems, loss of appetite, fatigue, mental confusion, palpitations, forgetfulness, inability to digest food properly, and inability to transform qi into blood, resulting in blood deficiency and absence of menstrual flow. Blood deficiency causes internal heat and muscle wasting, like something being consumed by the wind, hence the name "wind consumption." This condition is difficult to treat, and Gui Pi Tang is the main prescription. When blood deficiency leads to rampant fire without restraint, the heart overpowers the lung metal, the metal qi cannot circulate, water remains trapped in the chest, and the fluid turns into phlegm, causing incessant coughing. Over time, this can develop into tuberculosis, which is referred to as "transmission of breathlessness" and cannot be treated, resulting in wheezing. Du Qi Wan with ginseng, Mai Dong, Zao Ren, Wu Wei Zi, and Zhong Lu Shi can be used for treatment, as can Tian Wang Bu Xin Dan, Bao He Wan, and Qing Zao Jiu Fei Tang, all of which can help treat breathlessness. Ye Shi Yang Wei Tang with Shu Di, Wu Wei, and Yun Ling is also a good option.

The origin of menstrual blood has been explained in detail in the four volumes, but here we will briefly discuss amenorrhea, outlining its symptoms and treatments, with adjustments made according to individual circumstances.

The final section discusses methods for generating blood, which are roughly the same for men and women, and those treating blood-related conditions must study them carefully.

[Notes] (1) Dun-shaped: A dun is an ancient bronze utensil with a hemispherical lid and body, forming a complete sphere when combined. "Dun-shaped" refers to a shape resembling a sphere. (2) The original text in "Shang Han Lun" reads: "If a woman suffers from wind-heat for seven or eight days and subsequently develops intermittent chills and fever, with her menstrual flow suddenly stopping, this indicates that heat has entered the blood chamber. The blood will inevitably coagulate, causing malaria-like symptoms that occur intermittently. Xiao Chai Hu Tang is the main prescription." (3) Jian Pi: A hard mass hidden between the ribs. (4) Young girl: An unmarried woman.

[Commentary] This chapter classifies amenorrhea into four types: cold, heat, deficiency, and excess. Cold syndrome involves accumulated cold and stagnant qi, leading to cessation of menstrual flow, with symptoms such as lower abdominal coldness or blood stasis, resulting in stone-like masses. For the former, use Wen Jing Tang; for the latter, use Fu Zi Li Zhong Tang and Sheng Hua Tang combined with blood-activating and stasis-resolving herbs. Heat syndrome includes cases where liver fire rebels and forces the qi of the heart and lungs to fail to descend, as well as cases where rebellious qi rises and stimulates the Yangming channel's intense fire. The former presents with dizziness, chills and fever, irritability, and tinnitus, and Dan Zhi Xiao Yao San and Dang Gui Luhui Wan are recommended. The latter presents with dizziness, red cheeks, throat discomfort, fever, and thirst, and Yuzhu San is recommended. For those with inherently weak spleen and stomach, use Yunv Jian and Mai Men Dong Tang combined with Dan Pi and peach kernels. Alternatively, one can draw rebellious qi downward from the kidneys, using Zhi Bai Di Huang Tang with Niu Xi and peach kernels. Actual syndrome includes two types: water-stagnant blood chamber and heat-entering blood chamber. The former presents with a lower abdomen resembling a dun, slight difficulty in urination, and no thirst, and Da Huang Gan Sui Tang is recommended; the latter presents with chest and flank fullness resembling "Jie Xiong," accompanied by delirium, and Xiao Chai Hu Tang, Tu Gua Gen Tang, Ge Xia Zhu Yu Tang, and Di Dang Tang are recommended. Deficiency syndrome includes several situations: excessive blood loss leading to insufficient blood to form menstruation, treated with Si Wu Tang plus Niu Xi, Zhi Ke, Jiang Xiang, etc.; depletion of sexual essence leading to imbalance between yang and yin, treated with Zu Gui Yin and San Cai Tang; excessive childbirth leading to blood depletion and exhaustion, treated with Sheng Yu Tang; and young girls whose blood is depleted, known as "childhood tuberculosis," presenting with bone-steaming and muscle heat, pale complexion, treated with Zhi Gan Cao Tang; women who are anxious and unable to express their thoughts, resulting in muscle wasting like something being consumed by the wind, hence the name "wind consumption," treated with Gui Pi Tang; and blood deficiency accompanied by rampant fire that long-term damages the lung metal, leading to phlegm and cough, eventually developing into "breathlessness," treated with Du Qi Wan, Tian Wang Bu Xin Dan, Bao He Wan, Qing Zao Jiu Fei Tang, etc.

The author uses cold, heat, deficiency, and excess as the framework to categorize and explain the treatment of amenorrhea. Among them, cold syndrome amenorrhea may include congenital underdevelopment of the uterus and some patients with uterine fibroids, while heat syndrome amenorrhea refers to certain inflammatory conditions of the pelvis and adnexa. Actual syndrome amenorrhea refers to chronic pelvic inflammatory diseases and tumors, whereas deficiency syndrome amenorrhea covers a broader range, potentially including endocrine and autonomic nervous system disorders caused by various systemic wasting diseases.