TCM GYNECOLOGY Mary Anne Matta

EASTERN LENGTH WESTERN ZANG FU TREATMENT PHASE IN DAYS PHASE INVOLVED PRINCIPLE MENSTRUAL 5 Menstrual Phase: sharp fall in & progesterone. LV Qi and LV Blood Move blood if scanty. Necrosis of endometrial lining are moving Stop bleeding if heavy POST MENSTRUAL 7 Follicular Phase: follicle grows & estrogen levels rise under FSH Ren & Chong depleted Nourish blood and Yin ie: Blood & Yin depleted (LV &KD) MID CYCLE 7 Ovulatory Phase: ovum is released from the follicle and the Ren and Chong: Promote ovulation by nourishing corpus luteum develops under LH Blood and Yin filling up essence (KD, GV, CV) PRE MENSTRUAL 7 Luteal Phase : corpus luteum grows and secretes progesterone LV Qi moves Tonify Yang if deficient. Yang Qi rises Move LV Qi if stagnant

AMENORRHEA Excess Patterns Qi & Blood Stagnation Lack of for 3+ mo, abd.masses, pain in Pulse – deep tight CV 3, LV3, SP 6, LI 4, ST 29, ST 30, Chong (SP 4, chest or hypochondraic, worse w/ pressure Tongue – purple w/ spots in LV/G PC 6), KD 14 (abd masses), KD 6 (if yang is injured) Phlegm Damp Obstruction Overweight, heavy body, stuffy chest, nausea, possible Pulse – slippery SP 6, SP 9, ST 40, ST 28, Yang Wei (TH 5, GB 41) leucorrhea Tongue – swollen, greasy yellow coat BL 22, CV 6, 9, 12 Deficient Patterns Qi & Blood Deficiency Gradual loss of blood – cycle delayed over time; fatigue, Pulse – weak thin, possibly slow CV 4, BL 17, 18, 20, 23, SP 6, ST 36, KD 3, loose stools, poor appetite, dry skin, dizziness, blurred Tongue - pale KD 6, LV 8, Zigong Xue vision, sore back/knees, possible yin def heat sx HT/SP Blood Deficiency Palpitations, dream disturbed sleep, poor memory & Pulse – thin weak ST 36, SP 6, CV 12, BL 20, BL 15, CV 14, appetite, loose stools Tongue – pale, red tip HT 7, CV 4, LV 8 LV Blood & KD Deficiency LV - Stiff sinews, eye px, brittle nails Pulse – weak ST 36, SP 6, BL 18, 23, 52, LV 8, CV 4, KD 13, KD – sore back/knees, no willpower, dizzy, depressed Tongue – pale Ren (LU 7, KD 6), CV 6, CV 17 SP/KD Yang Deficiency Sore back/knees, fatigue, digestive issues, possible Pulse – deep weak Moxa. ST 36, SP 6, CV 4, CV 6, 12, 17, KD 3 prolapse Tongue – swollen wet BL 20, 21, 23, 52 HT/KD Yin Deficiency Emotional issues, palpitations, insomnia, dream Pulse – floating empty HT 7, PC 7, KD 3, SP 6 disturbed sleep (etc … yin deficient signs) Tongue – red, no coat CV 4,14, 15, BL 44 (outer HT Shu)

IRREGULAR MENSTRUATION Early Heat in the Blood Red face, hot body, red/dry lips & mouth, Bright red blood Pulse – fast wiry SP 6, LV 2, KD 2, LI 11, KD 5, CV 3 irritable, angry, dizzy, constipated, H/A Tongue – red, yellow coat Qi Deficiency Pale, shiny face, tired, palpitations, SOB Pale red blood Pulse – empty. Tongue – pale, thin ST 36, SP 6, SP 8, CV 4, CV 6, CV 12 Congealed Blood Heavy or irregular, lack of smooth flow, Purple or dark Pulse – choppy wiry CV 3, SP 10, SP 6, SP 7, SP 8, SP 10, ST 29 abd distention & masses, bloating blood w/ clots Tongue – dark or purple

Late Blood Deficiency Thin weak body, sallow complexion, dry Pale red and Pulse – thin weak CV 4 & 6, SP 6, ST 36, BL20, BL 23, SP 10, BL skin, palpitations, insomnia scanty blood Tongue - pale 17, ST 29, LV 8, Ren Mai (LU 7, KD 6)

Constrained LV Qi PMS, depression, chest subcostal tension, Purple blood Pulse – wiry PC 6, PC 7, LV2, LV 3, LV 14, SP 8, KD 14, ST breasts tender, premenstrual abd bloating Tongue – normal or purple 25, SP 6, CV 4, CV 6, Chong (SP 4, PC 6) Cold & Deficient Shiny pale face, aversion to cold, tired Thin watery blood Pulse – weak slow. CV 6, SP 6, SP 10, BL 17, ST 29, GV 4, CV 4 Tongue – pale swollen

Chaotic (sometimes early and sometimes late) SP Deficiency Fatigue, sallow complexion, no appetite Pale red blood Pulse - floating thin SP 3, SP 6, ST 36, BL 20, BL 21 Tongue – pale, thin coat LV & KD Exhausted Pale or dark face, dizzy, weak lower body Pale red blood Pulse – deep weak KD 3, LV 3, CV 3, LV 13, CV 4, BL 23, Varying amounts Tongue – thin peeled KD 8 (Yin Qiao Xi Cleft) Constrained Qi Dizzy, premenstrual abd pain & distention, Purple or dark blood Pulse – wiry PC 5, 6, LV 2, 3, 5, 14, CV 4 ,6, 12, TW 6, KD chest oppression, irritable with uneven flow Tongue - dark 14

DYSMENORRHEA Excess – pain is worse before a/o during menses Qi Stagnation More distention than pain, bloating, breast tenderness Pulse – wiry LV 2, CV 3, CV 6, SP 6, SP 8, stuffy chest, belching, irritability, short temper Tongue – purplish, thin white coat GB 34 Blood Stagnation More pain than distention, abd pain worse with Pulse – deep wiry choppy ST 29, CV 6, SP 6, SP 10, LV 3 pressure, blood clots Tongue – purple w/ purple spots on sides, thin white coat Accumulation of Cold Pain that’s better with heat or pressure, scanty flow, Pulse – deep tight Moxa on CV 4, 8 dark blood, tiny clots Tongue – white coat ST 28, ST 36 Deficient Dysmenorrhea – pain is dull Blood Deficiency Dull pain after menses. Palpitations, dream disturbed Pulse – thin weak ST 36, SP 6, CV 12, BL 20, BL 15, sleep, poor memory & appetite, loose stools, Tongue – pale, red tip CV 14, HT 7, CV 4, LV 8 LV/KD Deficiency Dull pain during a/o after menses Pulse – deep fine thin ST 36, BL 18, 23, LV 8, CV 4, KD 3, LV – scanty blood Tongue – light red, thin white coat, may be flabby Open Ren & Chong KD – sore back/knees, no willpower, dizzy, depressed, possible etiology of multiple

POINTS TO CONSIDER

Lower Burner

ST 28 treats anything in lower burner – the , menstruation, and stasis ST 30 regulates menstruation, the Chong, and the lower burner LV 9 adjusts menstruation and regulates the lower burner Regulates Uterus & Menstruation

CV 5 TH Mu, warms the uterus CV 2 warms the uterus CV 3 benefits the uterus and regulates menstruation, leucorrhea BL 31-34 treat the uterus and menstrual problems (do not needle in ) LV 11 benefits the uterus, , irregular menstruation Zigong treats the ovaries, 3 cUn lateral to CV 3 K 13 reinforces CV 4, treats the uterus in deficiency, important in treating infertility K 6 Treats KD Yin – menstruation, cold uterus, infertility, leucorrhea Blood

SP 10 treats all blood diseases – heat, stasis (dys- & , irregular bleeding, clots, herpes) BL 17 treats all blood diseases – heat, stasis, deficiency ST 29 empirical point for returning menstruation, moves blood in uterus or abdomen KD 3 tonify KD and blood SP 1 stops periods in cases of heavy bleeding, especially in deficiency SP 8 treats acute or excess blood conditions in the uterus (Xi Cleft of Spleen) LV 8 nourishes and invigorates the blood, benefits the uterus and genitals, clears damp heat in lower burner LV 2 cools hot LV blood K 5 Xi Cleft of KD to regulate uterine blood whether excess or deficient ST 36 builds blood along with SP 6 SP 6 treats the uterus, yin of three leg channels, builds blood BL 32 profuse leucorrhea CV 6 treats deficiency in the middle & lower jiao, treats uterus, amenorrhea, dysmenorrhea, leukorrhea, hernia KD 14 treats menstruation, blood stasis (especially post partum)

Normal Range Average Signs Cycle 26 - 32 days 28 Menses 4 – 6 days - Menarche 10 – 16 yo 12 Menopause 35 – 55 yo 50 No bleeding for 1 yr