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 depletion of 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 has both deficiency and excess aspects, with deficiency 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, or by stagnation of qi and blood; 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 menstruation 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 water comes from the kidneys,” “If menstrual water stops early, it seems that the kidney water has dried up.” The “Golden Cabinet Summary · Miscellaneous Diseases and Pulse Diagnosis in Women” believes that “due to deficiency, accumulation of cold, and stagnation of qi, all menstrual waters are cut off.” The “Plain Questions · Chapter 40 · Discussion on the Abdomen” says: “Blood depletion... involves massive blood loss, such as when one gets drunk and engages in sexual activity, causing qi exhaustion and liver damage, thus leading to fewer menstrual periods.” It proposes “massive blood loss” and “drunken sexual activity” as factors that damage the liver, spleen, and kidneys, leading to deficiency of qi and blood, which in turn leads to blood stasis, with liver damage being one of the key links. The “Golden Cabinet Summary · Miscellaneous Diseases and Pulse Diagnosis in Women” not only points out that excessive pathogenic factors can lead to amenorrhea, but also that physical deficiency can cause 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 disruption of qi flow lead to obstruction of blood 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 blocking the Chong and Ren meridians. Zhang Yuzhen pointed out that the essence of the pathogenesis of amenorrhea is kidney-spleen deficiency, with liver stagnation 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, inability of the blood sea to fill up, or dysfunction of organs like the liver and spleen affecting the kidneys, or external invasion of the six evils and internal injury from emotional trauma damaging the kidneys, resulting in imbalance of kidney yin and yang, deficiency of qi and blood, malnutrition of the uterus, difficulty in menstruating on time, and eventually amenorrhea. Section 3: Dysmenorrhea Dysmenorrhea refers to periodic lower abdominal pain experienced by women during menstruation or around the time of menstruation, 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 “periodic 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 their first menstruation, 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 and pathology: 1. 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 their 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 uterine muscle layer, 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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Menstrual or perimenstrual lower abdominal pain is characterized by paroxysmal, cramping, or distending pain, often accompanied by a sensation of heaviness and descent. The pain may radiate to the lumbosacral region and the medial thighs, and in severe cases can be associated with pallor, cold sweats, cold extremities, nausea, vomiting, syncope, and other symptoms.

2. Physical Signs Gynecological examination reveals no abnormalities.

3. Diagnosis Diagnostic Key Points: (1) Medical History: Attention should be paid to whether there has been improper living habits, emotional stress, exposure to cold during menstruation, or excessive consumption of raw and cold foods. (2) Clinical Presentation: Lower abdominal pain occurs in association with the menstrual cycle, with no positive findings on gynecological examination. (3) Laboratory Tests: Prostaglandin levels in menstrual blood are generally found to be abnormally elevated, particularly PGF2α. (4) Auxiliary Examinations: Ultrasound and laparoscopy may be performed when necessary to rule out organic lesions.

4. Western Medical Treatment

5. General Treatment Provide psychological comfort and alleviate concerns; when pain is unbearable, appropriate analgesics, sedatives, and antispasmodics should be administered.

6. Prostaglandin Synthase Inhibitors These drugs can block prostaglandin synthesis. ① Phenylpropionic acid derivatives: such as ibuprofen 200–400 mg, 3–4 times daily, or ketoprofen 50 mg, 3 times daily. ② Nonsteroidal anti-inflammatory drugs: flufenamic acid 200 mg, 3 times daily, starting from the onset of menstruation and continuing for 2–3 days. ③ Indomethacin suppositories: 1/3 to 1/2 suppository each time, inserted rectally.

7. Short-Acting Contraceptives These suppress ovulation, reduce PG synthesis and uterine contractions, thereby alleviating pain, and are suitable for those who wish to use contraception.

8. Professor Pei Zhengxue’s Clinical Experience Professor Pei Zhengxue believes that deficiency of kidney qi, lack of essence and blood, insufficient nourishment of Chong and Ren channels, or congenital spleen qi deficiency and impaired transportation function can lead to insufficient sources of blood and biochemical substances. Alternatively, major or prolonged illnesses can result in severe depletion of qi and blood. Whenever menstrual blood flows, the "sea of blood" overflows, causing the Chong and Ren channels and the uterus to lose their nourishment, thus triggering dysmenorrhea—this is "pain due to lack of nourishment." Yang deficiency leads to internal accumulation of yin-cold, which causes contraction and stagnation, affecting the circulation of qi and blood. Or, if one has a phlegm-damp constitution, the sticky nature of dampness easily obstructs the flow of qi and stagnates blood circulation. Similarly, a liver-stagnation constitution, characterized by frequent anger, results in qi stagnation and poor blood flow. A blood-stasis constitution, where blood stasis leads to qi stagnation, also hinders the smooth flow of qi and blood, obstructing the Chong and Ren channels, all of which can trigger dysmenorrhea—this is "pain due to obstruction." Dysmenorrhea can arise from deficiency, excess, heat, or cold. It is evident that individual patterns of cold, heat, deficiency, and excess are all potential factors contributing to the onset of dysmenorrhea. If one habitually consumes raw and cold foods, drinks ice-cold beverages, swims during menstruation, or sits and lies in damp places, it is easy for pathogenic cold to invade, impairing the propelling and warming functions of yang qi, leading to qi and blood stasis and resulting in dysmenorrhea. Alternatively, if one frequently eats rich, sweet, and heavy foods, over time phlegm-dampness accumulates within the body, obstructing the flow of qi. When qi cannot move freely, blood stasis occurs—this is "pain due to obstruction."

Professor Pei Zhengxue believes that the etiology of dysmenorrhea ultimately falls into two categories: deficiency or excess, or a combination of both. The primary pathogenesis is either "pain due to obstruction" or "pain due to lack of nourishment." In cases of excess, qi stagnation and blood stasis, cold-induced blood stasis, or damp-heat obstruction can lead to poor circulation of qi and blood in the uterus, resulting in "pain due to obstruction." In cases of deficiency, the main cause is weakness of qi and blood, along with kidney qi deficiency, leading to inadequate nourishment of the uterus, hence "pain due to lack of nourishment."

Professor Pei Zhengxue further notes that the onset of dysmenorrhea is closely related to the unique physiological state during and around menstruation, so it often occurs in conjunction with the menstrual cycle. During non-menstrual periods, since the qi and blood of the Chong and Ren channels are balanced, there are usually not enough pathogenic factors to cause stagnation or insufficiency of qi and blood in the Chong and Ren channels and the uterus, thus no pain occurs. However, during and around menstruation, the "sea of blood" overflows from fullness to discharge, and qi and blood shift from abundance to sudden deficiency, causing rapid changes in the qi and blood of the uterus and Chong and Ren channels. This makes it easier for pathogenic factors to interfere, compounded by individual constitutional factors, leading to poor circulation or inadequate nourishment of qi and blood in the uterus and Chong and Ren channels, resulting in pain due to obstruction or lack of nourishment. After menstruation ends, as the qi and blood of the uterus and Chong and Ren channels gradually recover, the pain naturally subsides. However, if the underlying causes are not eliminated and the individual's constitution is not improved, the pain will recur with the next menstrual period.