4 Cardiac Dysfunction

Spleen Deficiency and Blood Deficiency: The spleen loses its ability to transform and transport, leading to insufficient production of blood. This results in deficiency of blood in the Chong and Ren channels, causing the "Sea of Blood" to fail to fill and overflow on time, which may lead to delayed menstruation, scanty menstruation, or amenorrhea; if the fetus lacks nourishment from the blood, it may result in fetal restlessness, fetal leakage, miscarriage, abortion, or intrauterine growth restriction. Spleen Yang Deficiency: When Spleen Yang is deficient, the spleen's function of transformation and transportation is impaired, leading to internal retention of dampness and water, which then spreads to the skin, potentially causing pregnancy edema. If damp turbidity descends and permeates the Ren and Dai channels, it can weaken the Ren channel and loosen the Dai channel, resulting in leukorrhea. Additionally, if damp turbidity remains internally and combines with phlegm to rise upward, it may cause vomiting during pregnancy. (4) Cardiac Dysfunction The heart stores the spirit and governs the blood vessels; the uterine network belongs to the heart but connects to the uterus. If worries and thoughts are not resolved and remain in the heart, they will secretly deplete yin blood, preventing the heart blood from descending to the uterus, which may lead to scanty menstruation or amenorrhea. If there is insufficient heart yin and excessive heart fire rises upward, it may cause oral ulcers during menstruation. (5) Pulmonary Dysfunction The lungs govern qi and regulate downward movement. If lung yin is inherently deficient, during menstruation the yin blood descends into the Chong and Ren channels, further depleting lung yin. The resulting deficiency of lung yin and excess of virtual fire can damage the lung network, leading to hunger during menstruation. (6) Qi-Blood Disharmony Qi-blood disharmony is an important pathogenic mechanism in gynecological and obstetric diseases. Women’s menstruation, pregnancy, childbirth, and lactation all depend on blood as their foundation, and they often consume a lot of blood, thus keeping the body in a physiological state where blood is usually insufficient while qi is relatively abundant. Qi leads blood, and blood nurtures qi; qi moves blood, and blood carries qi. Qi and blood can depend on each other and mutually nourish one another. Diseases of qi can affect blood, and diseases of blood can also affect qi. Therefore, when diagnosing and treating, it is necessary to distinguish whether the disease lies in the blood or in the qi, while also paying attention to the close relationship between qi and blood. ① Pathogenesis of Qi Disorders Qi Deficiency: Whether due to inherent weakness, overwork, or prolonged illness, all can lead to qi deficiency. When qi is deficient, the Chong and Ren channels become unstable, which may cause early menstruation, excessive menstrual flow, metrorrhagia, or persistent lochia after childbirth; qi deficiency also weakens the stomach's ability to contain food, leading to spontaneous milk discharge; furthermore, qi deficiency compromises the body's defensive functions, making it prone to catching colds during menstruation or experiencing spontaneous sweating after childbirth. Qi Collapse: When qi is weak and unable to lift and support, it collapses downward, losing the ability to carry the fetus and connect to the uterus, which may result in fetal leakage, fetal restlessness, or uterine prolapse. Qi Stagnation: When liver qi becomes depressed and qi circulation is blocked, the Chong and Ren channels, the uterus, and the uterine network become obstructed, leading to delayed menstruation, dysmenorrhea, amenorrhea, and breast tenderness during menstruation. When qi does not flow smoothly, fluids stagnate, and dampness cannot be dispersed, resulting in edema during menstruation or pregnancy swelling. Qi stagnation can also cause blood stasis, blocking the Chong and Ren channels and the uterine network, which may lead to scarring or infertility. Qi Reversal: When anger causes qi to rise upward, and during menstruation the Chong channel qi becomes overly vigorous, combined with reversed liver qi that damages the yang network, it may cause hunger during menstruation. After pregnancy, if the Chong channel qi is excessively strong and combines with stomach and lung qi that reverse upward, the stomach loses its ability to descend and regulate, leading to nausea and vomiting, while the lungs lose their ability to descend and regulate, causing coughing during pregnancy. ② Pathogenesis of Blood Disorders Blood Deficiency: After major illnesses or prolonged sickness, excessive blood loss during menstruation or childbirth, or excessive mental strain that harms the spleen, or inherent weakness of the spleen and stomach leading to insufficient blood production, all can result in blood deficiency. People with blood deficiency have an empty "Sea of Blood" and deficiencies in the Chong and Ren channels, which may lead to delayed menstruation, scanty menstruation, dysmenorrhea, amenorrhea, abdominal pain during pregnancy, fetal growth restriction, postpartum body pain, insufficient lactation, and infertility. Blood Stasis: Qi stagnation, cold congealing, heat burning, qi deficiency, or external injuries can all cause blood stasis. Stagnant blood blocks the uterine network, the uterine connections, and the Chong and Ren channels, obstructing the menstrual pathways and leading to delayed menstruation, scanty menstruation, amenorrhea, and infertility. When blood stasis blocks the network, qi and blood cannot circulate, and "no circulation means pain," resulting in dysmenorrhea, headaches during menstruation, postpartum abdominal pain, and postpartum body pain. Moreover, stagnant blood prevents old blood from being expelled and new blood from settling properly, causing blood to deviate from its normal course, which may lead to excessive menstrual flow, metrorrhagia, or persistent lochia. In addition, stagnant blood can combine with phlegm and dampness to form lumps and masses in the lower abdomen. Blood Heat: External exposure to heat pathogens or excessive consumption of spicy and warming foods can lead to excessive yang and blood heat, or inherent yin deficiency and internal heat. When heat pathogens interact with blood, they disturb the Chong and Ren channels, making the "Sea of Blood" restless and forcing blood to flow abnormally, which may result in early menstruation, excessive menstrual flow, metrorrhagia, fetal leakage, fetal restlessness, or persistent lochia after childbirth. Blood Cold: External exposure to cold pathogens or excessive consumption of cold medicines and foods can damage the body's yang qi; or inherent yang deficiency and yin excess can cause cold pathogens to interact with blood, leading to blood becoming cold and congealing, blocking the Chong and Ren channels and the uterine network, which may result in delayed menstruation, scanty menstruation, dysmenorrhea, amenorrhea, abdominal pain during pregnancy, postpartum abdominal pain, postpartum body pain, and infertility. Damage to the Chong, Ren, Du, and Dai channels, along with various causes and dysfunction of internal organs, as well as qi-blood disharmony, can all lead to pathological changes in the body. However, only when damage occurs to the Chong, Ren, Du, and Dai channels, subsequently affecting the uterus, uterine network, and uterine connections, will gynecological and obstetric diseases arise. Damage to the Chong, Ren, Du, and Dai channels, as well as damage to the uterus, uterine network, and uterine connections, constitute the fundamental pathogenic mechanisms and ultimate sites of gynecological and obstetric diseases, and are also the key distinguishing features that set these diseases apart from those of other specialties. Both the Chong and Ren channels originate in the uterus. The Chong channel is known as the "Sea of Blood" and the "Sea of the Twelve Meridians," capable of regulating the qi and blood of all twelve meridians; the Ren channel is the "Sea of Fetal Life" and the "Sea of Yin Meridians," intersecting with the Three Yin Meridians of the foot, thereby regulating the body's yin meridians. Only when the Ren channel is unblocked and the Chong channel is robust can Tian Gui fully exert its effects on human growth, development, and reproduction, maintaining normal reproductive function. Therefore, damage to the Chong and Ren channels will inevitably lead to various gynecological and obstetric diseases. The main pathogenic mechanisms of Chong and Ren damage include Chong and Ren deficiency, Chong and Ren instability, Chong and Ren disharmony, Chong and Ren blockage, cold congealing of the Chong and Ren channels, and heat accumulation in the Chong and Ren channels. Du Channel Deficiency: The Du channel also originates in the uterus, running through the spine and connecting to the kidneys, serving as the "Sea of Yang Meridians" that oversees all yang meridians. Both the Ren and Du channels originate in the uterus and converge at the Jiao Jiao acupoint, where their qi flows back and forth, regulating the body's yin-yang balance and maintaining the physiological functions of the uterus. Du channel deficiency can lead to yin-yang imbalance, resulting in amenorrhea, metrorrhagia, symptoms before and after menopause, and infertility. Dai Channel Loosening: The Dai channel wraps around the waist and indirectly connects with the Chong, Ren, and Du channels, playing a role in restraining the meridians and supporting the uterus. Dai channel loosening can lead to excessive leukorrhea, fetal restlessness, miscarriage, and uterine prolapse. Uterus, Uterine Network, and Uterine Connections Damage: The uterus is connected to internal organs through the uterine network and works in coordination with the uterine network to fulfill its primary functions of menstruation and pregnancy. Apart from dysfunction of internal organs, qi-blood disharmony, and damage to the Chong, Ren, Du, and Dai channels indirectly affecting the uterus's functions, the uterus can also be directly damaged by falls, sprains, trauma (including surgical trauma within the uterine cavity), or irregular sexual activity during menstruation, leading to fetal leakage, fetal restlessness, miscarriage, abortion, menstrual disorders, dysmenorrhea, amenorrhea, and leukorrhea. Alternatively, abnormalities in the uterine structure (such as infantile uterus, uterine malformation, uterine fibroids, or partial adhesions after uterine surgery) can affect its physiological functions, triggering gynecological and obstetric diseases. Any abnormality in the menstrual cycle, period length, or menstrual flow, or any disease accompanied by obvious discomfort during the menstrual cycle, or a series of symptoms appearing before or after the end of menstruation, is collectively referred to as menstrual disease in traditional Chinese medicine. Menstrual disease is a common and frequently occurring condition in gynecological clinical practice. Common menstrual diseases in gynecology include abnormal uterine bleeding, amenorrhea, polycystic ovary syndrome, dysmenorrhea, endometriosis and adenomyosis, premenstrual syndrome, and menopausal syndrome. The main factors leading to menstrual disease are disruptions or abnormalities in the neuroendocrine regulation of the hypothalamus-pituitary-ovarian axis, as well as abnormalities in target organs such as the uterus or lower reproductive tract, or other endocrine gland dysfunctions. Section 1: Abnormal Uterine Bleeding Abnormal uterine bleeding refers to abnormal bleeding originating from the uterine cavity in women of childbearing age who are not pregnant, and which does not conform to the normal menstrual cycle in terms of frequency, regularity, duration of menstruation, or amount of menstrual bleeding. Clinically, it can manifest as chronic abnormal uterine bleeding and acute abnormal uterine bleeding. The former refers to abnormal uterine bleeding that occurs at least three times within six months, requiring standard diagnosis and treatment rather than emergency intervention. Acute abnormal uterine bleeding refers to severe bleeding that requires immediate treatment, and can occur in patients with or without a history of chronic abnormal uterine bleeding. Causes and Pathology: When the body is affected by various internal and external factors—such as mental stress, malnutrition, metabolic disorders, chronic diseases, sudden changes in environment and climate, dietary imbalances, excessive exercise, alcohol abuse, and other drugs—the brain cortex and central nervous system can disrupt the function of the hypothalamus-pituitary-ovarian axis or cause abnormal effects on target cells, ultimately leading to abnormal uterine bleeding. 2. Clinical Manifestations

1. Symptoms: (1) Anovulatory abnormal uterine bleeding. Primarily characterized by irregular uterine bleeding, often presenting as menstrual cycle disturbances, varying period lengths and amounts of bleeding, ranging from light spotting to heavy bleeding. Excessive bleeding or prolonged bleeding can lead to secondary anemia, accompanied by fatigue, dizziness, palpitations, and even hemorrhagic shock. (2) Luteal phase insufficiency. The menstrual cycle shortens, sometimes remaining within the normal range, but the follicular phase extends while the luteal phase shortens, often accompanied by infertility or early pregnancy loss. (3) Irregular shedding of the endometrium. The menstrual cycle remains normal, but the period lengthens, sometimes lasting up to 9–10 days, with variable amounts of bleeding.
2. Signs: There is varying degrees of anemic appearance, but gynecological examination shows no obvious abnormalities.
3. Diagnosis:
4. Diagnostic Points: (1) Medical History: Thoroughly inquire about the type of abnormal uterine bleeding, onset time, disease course, whether there was amenorrhea before bleeding, and previous treatment history. Pay attention to the patient's age, menstrual history, marital and reproductive history, contraceptive measures, and use of hormonal medications; also note whether the patient has previously suffered from liver disease, blood disorders, diabetes, hyperthyroidism, or hypothyroidism. (2) Clinical Manifestations: Irregular uterine bleeding. Often manifested as abnormalities in the menstrual cycle, period length, or menstrual flow, or bleeding during the ovulation period. (3) Gynecological Examination: Gynecological examination shows no obvious abnormalities. (4) Laboratory and Other Examinations: ① Diagnostic Curettage, abbreviated as D&C. Its purpose is to stop bleeding and clarify the pathological diagnosis of the endometrium. For patients over 35 years old with abnormal uterine bleeding who have not responded to drug treatment or are at high risk of endometrial cancer, D&C should be used to confirm endometrial lesions. During the procedure, the entire uterine cavity must be scraped, paying attention to the size and shape of the cavity, whether the uterine wall is smooth, and the nature and quantity of the scraped material. Unmarried patients whose hormonal treatment has failed or who are suspected of having organic lesions should undergo D&C only after obtaining informed consent from the patient or their family. To determine ovulation and luteal function, D&C should be performed 6 hours before the expected period or during menstruation; if irregular shedding of the endometrium is suspected, D&C should be performed on the 5th day of menstruation; for irregular vaginal bleeding or heavy bleeding, D&C can be performed at any time. ② B-mode Ultrasound Examination: Vaginal B-mode ultrasound can assess the size and shape of the uterus, whether there are any growths in the uterine cavity, and the thickness of the endometrium. ③ Hysteroscopy: Allows direct visualization of the uterine cavity, enabling biopsy of lesion areas to diagnose intrauterine lesions. ④ Basal Body Temperature Measurement: Helps determine whether ovulation has occurred and assess luteal function. A single-phase basal temperature curve suggests no ovulation; even if the luteal phase is present, a two-phase curve indicates that the high-temperature phase lasts less than 7 days; irregular shedding of the endometrium also presents a two-phase curve, but the decline is slow. Hormone Testing: During the mid-luteal phase, measuring progesterone levels reveals follicular-phase levels, indicating no ovulation; testosterone, prolactin, and thyroid function can also be tested to rule out other endocrine disorders. Pregnancy Test: Individuals with a history of sexual intercourse should undergo a pregnancy test to rule out pregnancy and related conditions. Cervical Cytology Examination: Can rule out cervical cancer and precancerous lesions. Complete Blood Count and Coagulation Function Tests: Check hemoglobin, platelet count, bleeding and clotting times, prothrombin time, activated partial thromboplastin time, etc., to assess the degree of anemia and rule out blood system disorders.
5. Western Medical Treatment:
6. Anovulatory Abnormal Uterine Bleeding: For adolescents and women of childbearing age, the treatment principle is to stop bleeding and regulate the cycle; those with fertility requirements need ovulation-inducing treatment. For perimenopausal women, the treatment principle is to stop bleeding, regulate the cycle, reduce menstrual flow, and prevent endometrial lesions. Commonly used hormonal medications are employed to stop bleeding and regulate the menstrual cycle. (1) Hemostasis: Hormonal medications are often used for hemostasis. Hemostatic drugs can be used as adjuncts during bleeding episodes. For patients with massive bleeding, hormonal treatment should take effect within 8 hours, and bleeding should basically stop within 24–48 hours. If bleeding persists beyond 96 hours, the possibility of organic lesions should be considered. (2) Regulating the Menstrual Cycle: After hemostasis, the menstrual cycle must be regulated. For adolescent and childbearing-age patients with anovulatory abnormal uterine bleeding, the first step is to restore normal endocrine function to establish a normal menstrual cycle; for perimenopausal patients, the focus is on controlling bleeding and preventing endometrial hyperplasia to avoid recurrence of abnormal uterine bleeding. (3) Curettage: Can quickly stop bleeding and has diagnostic value, allowing assessment of endometrial pathology and exclusion of malignant lesions. For perimenopausal patients and those with long disease courses, especially those of advanced age who are not suitable for follow-up, curettage should be considered first. (4) Surgical Treatment: For patients whose response to drug treatment is poor or who are unsuitable for medication, especially older patients who are not suitable for follow-up, surgical treatment should be considered.
7. Luteal Phase Insufficiency: Treatment methods include promoting follicle development, encouraging the LH peak during the mid-menstrual cycle, luteal function stimulation therapy, and luteal function supplementation therapy.
8. Irregular Shedding of the Endometrium: Treatment methods include using progestins to ensure timely atrophy of the corpus luteum, chorionic gonadotropin to promote luteal function, and combined short-acting oral contraceptives to control the cycle.
9. Professor Pei Zhengxue's Clinical Experience: Abnormal uterine bleeding falls under the categories of "metrorrhagia" and "menstrual disorder" in traditional Chinese medicine. Professor Pei Zhengxue believes that the main causes and pathogenesis of menstrual disorders are internal injuries caused by the seven emotions or external invasion by the six pathogenic factors, or congenital kidney qi deficiency, frequent childbirth and labor, medication or induced abortion, overwork, and improper diet, all of which damage the zangqi and lead to dysfunction of the liver, spleen, and kidneys, as well as qi-blood disharmony, ultimately damaging the Chong and Ren channels and developing into menstrual disorders. Traditional Chinese medicine treats this through herbal formulas that strengthen the spleen and benefit qi, regulate menstruation and nourish blood, tonify the kidneys and regulate qi, and activate blood circulation and remove blood stasis, thereby adjusting the normal arrival of menstruation. Professor Pei Zhengxue believes that the occurrence of menstruation is a physiological phenomenon resulting from the coordinated action of the zangfu organs, Tian Gui, qi, and meridians on the uterus after a woman reaches maturity. The physiological changes in women's menstruation originate from the "Yellow Emperor's Classic of Internal Medicine," which states: "At the age of twenty-one, a woman's Tian Gui arrives, the Ren channel opens, the Tai Chong channel becomes vigorous, and menstruation occurs on time." The generation of menstruation is closely related to the liver, spleen, and kidneys, with the kidneys playing the leading role, the spleen being the postnatal foundation, and the liver being innate. The reasons for menstrual disorders are multifaceted, including both primary and secondary factors. Among the primary factors are differences in innate endowment, postnatal spleen-stomach disharmony, excessive expression of the seven emotions, liver qi stagnation, exposure to cold and dampness, and phlegm-blood stasis, all of which can cause chaos in the body's qi and blood, imbalance of yin and yang, instability of the Chong and Ren channels, and menstrual disorders. In addition, iatrogenic injuries, such as drug-induced abortions, artificial abortions, or improper medical procedures that damage the uterine network, or medication errors, can also affect the function of the Chong and Ren channels and lead to menstrual disorders. Due to women's physiological characteristics of taking blood as the foundation and relying on blood, most of their illnesses are primarily deficiency syndromes, with mixed deficiency and excess being quite common. Professor Pei Zhengxue believes that menstrual disorders involve more yang before menstruation and more yin after menstruation, so the period before menstruation is considered hot and the period after menstruation is considered cold. Therefore, one should not supplement before menstruation and should not purge after menstruation. From the perspective of organ function, since the liver stores blood and is responsible for dispersing it, it is the innate aspect of women; the kidneys store essence and are the organs of water and fire, with essence and blood generating each other, and the Chong and Ren channels are connected to them. The spleen controls blood and is the source of qi and blood production, so the liver, kidneys, and spleen all play important roles in the pathogenesis of menstrual disorders. In addition, there is a close relationship with damp heat, blood stasis, phlegm-dampness, artificial and drug-induced abortions, and other factors. Women take blood as the foundation, and all parts of the body produce blood based on it, which is stored in the liver. Liver blood flows into the Chong channel, regularly filling and overflowing the "Sea of Blood," participating in the regulation of menstruation. Women consume blood during menstruation, pregnancy blood nourishes the fetus, and childbirth involves bleeding, resulting in women having more qi than blood. The liver channel intersects with the Chong and Ren channels, communicating with the uterus through them, regularly filling and overflowing the "Sea of Blood," thereby participating in the regulation of the menstrual cycle, period length, and menstrual flow. Internal emotional injuries are the easiest to cause liver dysfunction and qi-blood disharmony. Emotional factors are stimulated by joy, anger, sorrow, worry, grief, fear, and panic, and emotions are one of the important causes of menstrual disorders. With the acceleration of modern life and increasing social competition, women's work, study, and daily life are becoming increasingly stressful, and excessive emotions exceed the liver's regulatory capacity, leading to qi stagnation, liver dispersion failure, and disruption of the zangfu qi and blood, ultimately causing menstrual disorders. "Prolonged staring harms the liver, prolonged sitting harms the bones." More and more modern women use computers, and sitting in front of a computer for long periods can also cause liver qi to be uncomfortable and qi and blood to be disordered, leading to menstrual disorders. The kidneys' yin and yang are the root of qi and blood, and essence and blood share the same origin. If kidney essence is insufficient and the Chong and Ren channels lack blood, the "Sea of Blood" cannot be filled and overflow on time, resulting in delayed periods, scanty menstruation, and even amenorrhea. If the spleen's function of transforming and transporting water and grain is weakened, and the spleen cannot produce enough blood, qi and blood production will be insufficient, the "Sea of Blood" will be empty, and menstruation will not be generated, resulting in scanty menstruation or even amenorrhea, pale menstrual color, etc.; if the spleen's function of transforming and transporting dampness is abnormal, and the spleen is too damp, dampness will block the meridians, or if it accumulates and turns into heat, it will scorch the blood, making blood flow difficult, resulting in scanty menstruation or even amenorrhea, dark menstrual color; if the spleen's function of lifting and sorting blood is abnormal, blood will overflow outside the meridians, or flow out at inappropriate times, or persist beyond the expected time,