Early Periods

CHAPTER 8 Early Periods



AETIOLOGY 201

PATHOLOGY 202

IDENTIFICATION OF PATTERNS AND TREATMENT 202
QI DEFICIENCY 202

Spleen-Qi deficiency 202

Kidney-Qi not firm 204

BLOOD-HEAT 205

Full-Heat: Liver Blood-Heat 205

Full-Heat: stagnant Liver-Qi turning into Fire with Blood-Heat 206

Full-Heat: Heart-Fire 207

Liver- and Kidney-Yin deficiency with Empty-Heat 208

PROGNOSIS AND PREVENTION 209

Early Periods are defined as periods that come consistently up to 9 days early so that the cycle is less than 28 days long; the definition applies if this happens more than twice in succession. The amount of bleeding may be normal, scanty or excessive.



Aetiology




Excessive physical work, irregular diet


Excessive physical work or a diet lacking in nourishment weaken the Spleen; when Spleen-Qi is deficient, it may fail to hold blood in the vessels and this may leak out giving rise to a period before the right time. This is an Empty type of bleeding.



Overwork, menopausal decline of Kidney-Qi


Overwork often causes Kidney-Yin deficiency; because the deficient Kidney cannot sustain and consolidate the Directing and Penetrating Vessels (Ren and Chong Mai), blood leaks out and the period occurs before time. This is also an Empty type of bleeding and is due to Kidney-Qi not holding blood.



Irregular diet, invasion of external Heat


Excessive consumption of hot, spicy foods and alcohol may lead to Blood-Heat which affects the Directing and Penetrating Vessels. The blood in these vessels is agitated, it overflows from the vessels and the period comes before the right time. This may also occur when external Heat penetrates the Interior and enters the Blood portion. This is a Full type of bleeding.



Emotional stress


Emotional stress deriving from anger, repressed anger, resentment, frustration or guilt results in stagnation of Liver-Qi and, over time, this may lead to Liver-Fire. Fire may invade the Blood portion (especially since the Liver stores Blood) and cause Blood-Heat. Hot Blood pushes out of the vessels and the period occurs before the right time. This is also a Full type of bleeding.


The periods may come early also when emotional stress affects the Heart and the Mind. As we have seen, the descending of Heart-Qi to the Uterus induces the start of menstrual bleeding. If the Mind is affected by emotional stress, it may induce Heart-Qi to descend prematurely. This may happen in case of shock, fear, worry and guilt.



Chronic illness, overwork, too many children, chronic bleeding


A long, chronic illness, overwork or having too many children too close together may cause Liver- and Kidney-Yin deficiency which eventually creates Empty-Heat. This enters the Blood portion and causes Blood-Heat so that the blood pushes out of the vessels and the period comes before time. This is a mixed Full and Empty type of bleeding: Full because of the Empty-Heat, Empty because it derives from Yin deficiency. This situation may also arise from chronic bleeding itself. For example, a woman may suffer from excessive bleeding from Qi deficiency; after many years, the excessive loss of Blood may lead to Yin deficiency and this to Empty-Heat. Empty-Heat makes the Blood reckless and causes the period to come early.



Pathology


Thus, the pathology of this condition falls into two broad groups, the first from Qi deficiency, the second from Blood-Heat. Within the first group is Spleen-Qi or Kidney-Qi deficiency; within the second group, Full-Heat or Empty-Heat (see Fig. 8.1). Deficient Qi (whether Spleen- or Kidney-Qi) fails to hold blood in the vessels. Blood-Heat (whether deriving from Full- or Empty-Heat) pushes the blood out of the vessels.


image

Figure 8.1 Pathology of early periods.


The aetiological factors under the first two situations given above lead to deficient Spleen-Qi and Kidney-Qi, respectively, not holding blood. The aetiological factors under the next two situations lead to Full-Heat and those under the last situation lead to Empty-Heat.


The pattern of Empty-Heat is more likely to occur in older women. The treatment can be given according to the four phases of the menstrual cycle. For example, in cases of Qi deficiency, treatment could be given only during and after the period (first and second phases); in cases of Full-Heat, it could be administered before and during the period (fourth and first phases); and in cases of Empty-Heat, it could be given during and at mid-cycle (first and third phases).


The patterns discussed are:


• Qi deficiency:
• Spleen-Qi deficiency

• Kidney-Qi not firm.

• Blood-Heat:
• Full-Heat: Liver Blood-Heat; Stagnant Liver-Qi turning into Fire with Blood-Heat; Heart-Fire.

• Empty-Heat: Liver- and Kidney-Yin deficiency with Empty-Heat.


Identification of patterns and treatment


All the herbal prescriptions in the following chapters are detailed in Appendix 1 on p. 937.



Qi deficiency



Spleen-Qi deficiency



Clinical manifestations


Early period, pale and dilute menstrual blood, loose stools, epigastric distension, tiredness. Tongue: Pale. Pulse: Weak.



Treatment principle


Strengthen the Spleen, tonify and raise Qi, consolidate the Penetrating Vessel, contain blood.



Acupuncture


ST-36 Zusanli, SP-6 Sanyinjao, Ren-12 Zhongwan, BL-20 Pishu, Du-20 Baihui, Ren-4 Guanyuan, Ren-6 Qihai. All with reinforcing method, moxa is applicable.




Explanation


– ST-36, SP-6, Ren-12 and BL-20 strengthen the Spleen and tonify Qi.

– Du-20 raises Qi.

– Ren-4 tonifies the Uterus and consolidates the Directing and Penetrating Vessels.

– Ren-6 tonifies and raises Qi.


Herbal treatment



a Prescription



– GUI PI TANG

– Tonifying the Spleen Decoction


Explanation

This famous prescription is widely used to stop bleeding from Qi deficiency. This is because it tonifies Qi and it enters the Blood portion.


– Huang Qi, Ren Shen and Bai Zhu tonify and raise Qi.

– Dang Gui nourishes Blood and enters the Blood portion.

– Fu Shen, Suan Zao Ren, Long Yan Rou and Yuan Zhi calm the Mind.

– Mu Xiang moves Qi and is added to counteract and balance the cloying nature of Qi and Blood tonics.

– Zhi Gan Cao, Sheng Jiang and Hong Zao harmonize. Hong Zao also nourishes Blood.


b Prescription



– JU YUAN JIAN Variation

– Raising the Original [Qi] Decoction Variation


Explanation

The original formula, composed of the first five herbs, tonifies and raises Qi to stop bleeding.


– Ren Shen, Huang Qi and Bai Zhu tonify and raise Qi.

– Zhi Gan Cao harmonizes and also tonifies Qi.

– Sheng Ma, in combination with Huang Qi, raises Qi.

– E Jiao is added to the original formula to enter the Blood portion so as to affect the periods.

– Hai Piao Xiao (also called Wu Zei Gu) is astringent and absorbing, thus helping to prevent bleeding before the period.


c Prescription



– BU ZHONG YI QI TANG

– Tonifying the Centre and Benefiting Qi Decoction


Explanation

This well-known formula tonifies and raises Qi. It is suitable to treat Early Periods because it contains Dang Gui which enters the Blood portion.


– Huang Qi, Ren Shen and Bai Zhu tonify and raise Qi.

– Dang Gui nourishes Blood and enters the Blood portion.

– Chen Pi resolves Dampness: it is added to counteract and balance the cloying nature of Qi and Blood tonics.

– Sheng Ma and Chai Hu, in combination with Huang Qi, raise Qi.


Comparison of Gui Pi Tang, Ju Yuan Jian and Bu Zhong Yi Qi Tang

To compare and contrast these three formulae, Gui Pi Tang is particularly suitable if the patient also suffers from anxiety and palpitation deriving from emotional problems. The second formula, Ju Yuan Jian, is very similar to the third, Bu Zhong Yi Qi Tang, but it is more astringent than the latter and it is therefore suitable if the period, besides being early, is also heavy. Bu Zhong Yi Qi Tang, on the other hand, is better if the patient suffers from depression.



Modifications

These modifications apply to all three prescriptions.


• If the bleeding is heavy add Long Gu Fossilia Ossis mastodi and Mu Li Concha Ostreae.

• If there is Yang deficiency, add herbs that warm the Uterus, scatter Cold and stop bleeding such as Ai Ye Folium Artemisiae argyi, Pao Jiang Rhizoma Zingiberis preparatum (fried) or Bu Gu Zhi Fructus Psoraleae.

• If there is stasis of Blood, add Qian Cao Gen Radix Rubiae, Yi Mu Cao Herba Leonori and San Qi Radix Notoginseng.

• If the period is scanty and there is a Kidney deficiency with loose stools, add Lu Jiao Shuang Cornu Cervi degelatinatum and Du Zhong Cortex Eucommiae.


Three Treasures remedies



– TONIFY QI AND EASE THE MUSCLES

This remedy is a variation of Bu Zhong Yi Qi Tang: it tonifies and raises Qi, enters the Blood portion and resolves Dampness. It is suitable if the patient suffers from depression. The tongue presentation appropriate to this remedy is a Pale body with a sticky, white coating.


– CALM THE SHEN

This remedy is a variation of the formula Gui Pi Tang which tonifies Qi and Blood of the Spleen and Heart: it can be used to stop bleeding from Qi deficiency. The tongue presentation appropriate to this remedy is a Pale body.



Summary



Spleen-Qi deficiency


Clinical manifestations

Early period, pale and dilute menstrual blood, loose stools, epigastric distension, tiredness. Tongue: Pale. Pulse: Weak.



Treatment principle

Strengthen the Spleen, tonify and raise Qi, consolidate the Penetrating Vessel, contain blood.



Acupuncture

ST-36 Zusanli, SP-6 Sanyinjao, Ren-12 Zhongwan, BL-20 Pishu, Du-20 Baihui, Ren-4 Guanyuan, Ren-6 Qihai. All with reinforcing method, moxa is applicable.



Herbal treatment


Prescriptions



• GUI PI TANGTonifying the Spleen Decoction

• JU YUAN JIAN Variation Raising the Original [Qi] Decoction Variation

• BU ZHONG YI QI TANGTonifying the Centre and Benefiting Qi Decoction


Three Treasures remedies



• TONIFY QI AND EASE THE MUSCLES

• CALM THE SHEN


Kidney-Qi not firm



Clinical manifestations


Early period, pale, dilute menstrual blood, lower backache, dizziness, nocturia, feeling cold. Tongue: Pale, Swollen. Pulse: Deep and Weak.

Related posts:

  1. Collapse after Childbirth
  2. Prolapse of the Uterus
  3. Acupuncture and Herbal Treatment in Midwifery
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Early Periods

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