30d, moderate flow, good quality.

728 30d, moderate flow, good quality. 9. Discussions on amenorrhea by ancient and modern physicians Amenorrhea has been recorded in traditional Chinese medicine since ancient times, referred to as “jing bi,” “xue ku,” “bu yue,” “yue shi bu lai,” “jing shui bu tong,” and so on. The “Women’s Gynecology Treatise” states: “All diseases in women originate from the heart... The symptom of amenorrhea is primarily caused by insufficient mental state and depleted heart qi.” It believes that amenorrhea is related to the heart, spleen, and mental-emotional factors. The “Complete Works of Jing Yue · Women’s Regulations” says: “Xue ku is different from xue ge. Ge means obstruction, and obstruction is caused by the stagnation of pathogenic factors, resulting in reversed blood flow; ku means depletion, caused by the deficiency of the Chong and Ren channels...” It believes that amenorrhea can be divided into deficiency and excess types. Deficiency is mainly caused by obstacles in the production of menstrual blood, leading to emptiness in the uterus and meridians, with no blood to flow down; excess is often caused by blockage in the uterus and meridians, hindering the flow of menstrual blood, obstructing the meridians, or causing qi and blood stagnation; the two often occur together, forming mixed deficiency-excess conditions, laying the theoretical foundation for later understanding of the etiology and pathogenesis of amenorrhea. The “Danxi Heart Method” believes that “if the period does not come, it is not because there is no blood, but because phlegm obstructs the transformation.” The “Fu Qingzhu Women’s Gynecology” points out: “Menstrual blood comes from the kidneys.” “If the menstrual flow stops early, it seems that the kidney water has dried up.” The “Jin Kui Yao Lue · Women’s Miscellaneous Diseases, Pulse Diagnosis, and Treatment” believes that “due to deficiency, cold accumulation, and qi stagnation, all menstrual flows are cut off.” The “Suwen · Chapter 40 · Discussion on the Abdomen” says: “Blood depletion... involves massive blood loss. If one indulges in sexual activity while drunk, the qi will be exhausted and the liver injured, thus causing the menstrual flow to become sparse and stop.” It proposes “massive blood loss” and “drunken sexual activity” as damaging the liver, spleen, and kidneys, leading to deficiency of qi and blood, which in turn leads to blood stasis, with liver injury being one of the key links. The “Jin Kui Yao Lue · Women’s Miscellaneous Diseases, Pulse Diagnosis, and Treatment” not only points out that excessive pathogenic factors can cause amenorrhea, but also that physical deficiency can lead to amenorrhea. In the Yuan Dynasty, Zhu Danxi’s medical cases mentioned that qi and blood deficiency combined with qi stagnation, qi stagnation and blood stasis in the uterus, and phlegm-dampness can all lead to amenorrhea. Zhang Congzheng pointed out that obese people have deficient yang qi, unable to transform water into fluids, leading to phlegm-dampness accumulating in the uterus, blocking the meridians and forming phlegm-dampness-type amenorrhea. Liu Zhaoling summarized the pathogenesis of amenorrhea as deficiency of liver, kidney, and essence-blood. Wang Xianggui believed that spleen-kidney yang deficiency is the root cause, with blood stasis and phlegm-dampness as the manifestation. Zhang Changcai believed that emotional trauma, emotional stagnation, and disrupted qi flow lead to blocked blood circulation and inability to flow. Liu Lili believed that the pathogenesis of phlegm-dampness-type amenorrhea is spleen-kidney yang deficiency, with water retention inside the body forming phlegm, and phlegm-dampness obstructing the Chong and Ren meridians. Zhang Yuzhen pointed out that the essence of the pathogenesis of amenorrhea is kidney-spleen deficiency, with liver depression and blood fatigue, leading to the failure of the kidney-Tian Gui-Chong and Ren uterine axis function. Chai Songyan believed that kidney deficiency is the fundamental pathogenesis, with congenital insufficiency, deficiency of kidney yin and yang, leading to malnutrition of the uterus and meridians, the sea of blood cannot be filled, or dysfunction of organs like the liver and spleen affecting the kidneys, or external invasion of the six evils and internal emotional injuries affecting the kidneys, leading to imbalance of kidney yin and yang, deficiency of qi and blood, malnutrition of the uterus, difficulty in having periods on time, and eventually amenorrhea. Section 3: Dysmenorrhea Dysmenorrhea refers to periodic lower abdominal pain experienced by women during or around their menstrual period, sometimes accompanied by lower back and leg soreness, affecting normal work and life. This condition falls under the category of “dysmenorrhea,” “abdominal pain during menstruation,” “menstrual abdominal pain,” and “period-related abdominal pain” in traditional Chinese medicine, and is divided into primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea refers to dysmenorrhea without any organic lesions in the pelvic cavity, often occurring in adolescent girls 1–2 years after menarche, also known as functional dysmenorrhea; secondary dysmenorrhea refers to dysmenorrhea caused by organic diseases such as pelvic inflammatory disease, endometriosis, and adenomyosis, also known as organic dysmenorrhea, more common in women of childbearing age.

1. Pathogenesis: Increased prostaglandin release The occurrence of primary dysmenorrhea is related to the release of prostaglandins (PG) from the endometrium during menstruation. It has been confirmed that patients with dysmenorrhea have higher levels of PGF2a and PGE2 in the endometrium and menstrual blood compared to normal women, and elevated PGF2a can cause excessive contraction of the uterine smooth muscle, vascular spasm, and ischemia and hypoxia in the myometrium, leading to dysmenorrhea.
2. Psychological and neurological factors Emotional stimulation, anxiety, fear, and other factors can stimulate the pelvic nerve fibers through the central nervous system, causing pain.
3. Clinical manifestations
4. Symptoms

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Findings: Menstruation has been absent for several months, with distension and pain in the lower abdomen that is aggravated by palpation, depression, irritability, fullness and distension of the chest and hypochondria, sighing due to internal heat, a dark purple tongue body or presence of ecchymoses, and a deep, wiry or涩 (stagnant) pulse that is strong. Treatment principle: Regulate qi and activate blood circulation, remove stasis and unblock the meridians. Prescription: Modified Taohong Siwu Decoction combined with Danzhi Xiaoyao Powder. Peach kernel 10g, safflower 6g, angelica root 10g, rehmannia root 12g, chuanxiong rhizome 6g, white peony root 15g, licorice 6g, atractylodes rhizome 10g, bupleurum root 10g, poria 12g, moutan bark 6g, gardenia fruit 10g, leech 6g. If the lower abdominal distension and pain are severe, add puhuang, wulingzhi, and yanhusuo as appropriate; if breast distension and pain are obvious, add bupleurum, melia fruit, curcuma, and vicia seeds as appropriate; if qi stagnation is prominent, add citrus peel, agarwood, costus root, and motherwort as appropriate; if cold congealing causes cold pain in the lower abdomen and the pulse is沉迟 (slow and deep), add fennel seeds, cinnamon, and evodia as appropriate; if there is frequent lower abdominal pain, a dark purple tongue, yellow and dry coating, and a rapid pulse, add zelan and danshen as appropriate. 2. Cold-congealing and blood-stasis type Findings: Menstruation has been absent for several months, with cold pain in the lower abdomen that is aggravated by palpation and relieved by warmth; cold limbs and pale complexion; dark purple tongue with white coating, and a deep, tight pulse. Treatment principle: Warm the meridians to dispel cold, activate blood circulation and unblock the meridians. Prescription: Modified Wenjing Decoction. Codonopsis root 10g, evodia fruit 6g, ophiopogon root 10g, donkey-hide gelatin (processed) 10g, dried ginger 6g, cinnamon twig 10g, angelica root 10g, white peony root 15g. If the lower abdominal cold pain is severe, add mugwort, fennel seeds, and costus root to warm the meridians, nourish the uterus, and relieve pain; if the limbs are cold and the patient feels chilly, add processed aconite, evodia fruit, and cinnamon to warm the meridians, tonify yang, and unblock the meridians. 3. Phlegm-damp obstruction type Findings: Delayed menstruation, scanty flow, pale color and sticky consistency, gradually leading to amenorrhea; accompanied by obesity, chest tightness and nausea, fatigue, poor appetite, excessive phlegm or increased vaginal discharge, which is white; greasy tongue coating, slippery pulse. Treatment principle: Dry dampness and transform phlegm, activate blood circulation and remove stasis. Prescription: Modified Daotan Decoction. Pinellia ternata 6g, arisaema erubescens 10g, tangerine peel 6g, realgar 10g, poria 12g, codonopsis root 10g, acorus calamus 10g, bamboo shavings 10g, licorice 6g. If chest fullness and oppression are severe, add trichosanthes fruit, citrus peel, and curcuma as appropriate; if the tongue coating is yellow and greasy, add coptis and scutellaria as appropriate. 4. Qi and blood deficiency type Findings: Late menstruation, scanty flow and pale color, gradually leading to amenorrhea, dizziness and fatigue, sallow complexion, forgetfulness and insomnia, shortness of breath and reluctance to speak, lack of luster in hair and skin, pale tongue, and a weak, feeble pulse.