Premenstrual bleeding
Introduction
Introduction 3-5 days or even 7 days before menstruation, the uterus has a small amount of blood dripping down. The color is fresh or sputum, or it is reddish. This condition occurs continuously for more than two months, which is called premenstrual dripping or premenstrual bleeding. Because the disease is quite similar to menstrual leakage, early menstruation and other diseases, most of the relevant statements of Chinese medicine are scattered in these diseases.
Cause
Cause
Premenstrual dripping is more common in clinical practice and belongs to one of the manifestations of so-called "functional uterine bleeding" in Western medicine. The incidence is closely related to the lack of corpus luteum function, so it is called "luteal bleeding". Generally speaking, when the follicles in the ovary grow large enough, the wall of the follicles ruptures, and the mature eggs break out of the wall and flow into the abdominal cavity. This is "ovulation." After the egg is discharged, the follicle shell left in the ovary forms a yellow mass, about 1 cm in diameter, called the "luteal body". The corpus luteum can produce estrogen and progesterone. The endometrium is affected by these two sex hormones and grows and thickens. The endometrium in this period is called the secretory membrane. If the egg is not fertilized, the corpus luteum begins to shrink around 9 days after ovulation, the secretion of progesterone is reduced, and the endometrium stops growing. About 14 days after ovulation, the endometrium falls off, causing bleeding, which is discharged by YD. Menstruation. However, if the corpus luteum is not fully developed, it will degenerate prematurely in less than 8 days, resulting in insufficient progesterone secretion. The endometrium will show a poor secretion during the early secretory phase, which is manifested in the clinical period of shortening the menstrual cycle or premenstrual dripping.
Traditional Chinese medicine believes that the pathogenesis of premenopausal dripping is mainly related to qi deficiency or blood heat. Qi deficiency has spleen qi deficiency and kidney qi deficiency, spleen qi deficiency can not be fixed, kidney qi deficiency can not be closed, will lead to premenstrual dripping bleeding. Blood heat also has a difference between the real and the real. The actual person may be caused by liver stagnation or liver heat and dampness, while the virtual one is related to yin deficiency and fire. The fiery enthusiasm of the fiery blood makes the blood move, and the blood sea (rushing veins) is restless, leading to premenstrual bleeding. The pathological changes of spleen deficiency are mostly caused by the loss of temper in the usual diet or overwork. It can also be caused by insufficient factors or after a long illness. Stomach qi deficiency is associated with insufficient congenital endowment or adolescent kidney qi, or a worsening of kidney qi in menopause. It can also be caused by abortion or improper surgery that directly damages kidney gas. Liver stagnation is often caused by unsatisfactory emotions, liver qi stagnation, heat for a long time, betting on the meridians (the meridians associated with **), or the external evils of dampness and heat directly invade. If the yin deficiency is too hot, it may be due to the yin deficiency or long-term illness, or the sexual intercourse is frequent, so that the yin essence is dark and the heat is endogenous.
Examine
an examination
Related inspection
Gynecological ultrasound examination of sex hormones six tests
Normal menstruation index
cycle:
Every woman's cycle is not the same, from 21 days to 35 days are normal, the key is whether it is punctual. Regular sex life (eg, once a week) can help you comb the hormones, which is very helpful for the regularity of menstruation.
Blood volume:
The amount of blood lost by women during menstruation should be within 85 grams for 3 to 7 days. The maximum amount of bleeding is concentrated in the first 3 days (90% of the total blood loss).
Blood clot:
If the menstrual blood is blocked in the same area and not discharged in time, a blood clot will form after 5 to 10 minutes of hoarding. Blood clots usually just get up in the morning or sit for a long time.
Meridian color:
Normal menstrual blood is dark red, sticky and free of clots. If the menstrual blood is as thin as water, it is pink, black or purple, or the menstrual blood is completely clot, it is not normal, you should seek medical treatment as soon as possible.
Menstrual period:
The menstrual period of women is about 3-7 days. When the amount of bleeding is the most, it is concentrated in the first 3 days, and then gradually decreases until the menstrual blood is clean. Some people have come a little after a day or two after the blood has been cleaned. It is commonly called "menstrual blood returning to the head", which is also a normal phenomenon. However, some people have a menstrual period of 10-20 days, and menstruation is inexhaustible; some menstrual periods are extremely short, just "swinging". Both of these phenomena are not normal.
Diagnosis
Differential diagnosis
Because of the different pathogenesis, syndrome manifestations, treatments, and prescriptions are also different. According to the theory of traditional Chinese medicine, premenstrual bleeding can be divided into the following three types, which should be identified:
1, spleen is not photographed: the performance of pre-menstrual bleeding is less dilute, no blood clots, blood reddish and accompanied by food and less sputum, burnout, lying, Shenpi fatigue, or lower abdomen, face complexion, pale tongue Thin, pulse slow and other symptoms. The rule of law should be spleen and qi, solid rushing to take blood, and you can use Guipi Decoction (Dangshen, Astragalus, Atractylodes, Poria, Licorice, Angelica, Hangbai, Rehmannia, Epimedium, Antler Cream). If you have qi deficiency and sputum and see small abdominal pain, you can add valerian, motherwort, Yuanhu, etc.; qi deficiency will lead to yang deficiency for a long time, and see the bloody sputum black and thin, cold belly pain, pulse depression and other cold elephants, warming Hemostasis products, such as gun ginger charcoal, Jiaoaiye, psoralen and so on.
2, kidney deficiency is not solid: visible blood color dull, less than a small amount or a small amount of thin, accompanied by lumbar sore or soft feet weak, or frequent nocturia, pale tongue, white and moist, veins and weak embolism. Treatment with Bushen Yiqi, Guchong Hemostasis, can be used to add or subtract from Guilu Bu Chong Decoction (Traditional Radix, Radix Astragali, Radix Glycyrrhizae, Antler Gum, Tortoiseshell, Ai Ye, White Pelican, Cannon, and Squid). Such as low back pain, can add Eucommia, Chuanhuan, mulberry parasitic and so on. Liver stagnation: Before the bleeding, the color is dark red or purple, the amount is less or slightly more, thick or thick. At the same time accompanied by dizziness, swelling, upset, less bitter, dry mouth, dry throat, RF pain, or chest flank is not comfortable, soft stool, small yellow color, normal or reddish tongue, thin yellow tongue and less Jin, pulse String slip and other symptoms. Governing with the method of soothing the liver and clearing the heat, select Danxiaoyao San for addition and subtraction (fried Bupleurum, fried Angelica, Hangbaiyu, Heishan, fried Danpi, Poria, Coptis). Head dizziness, dizziness, can add chrysanthemum, hook vine, white sputum; insomnia is heavier, add Gansong, fried jujube, night vine; soft stool, go to scorpion, add fried atractylodes, yam, Amomum . Liver menstrual heat: manifested as less bleeding red color, sticky or sticky mucus, and see chest tightness irritability, bitter bitter food, lower abdomen pain, lumbosacral pain, red tongue, pale or yellow, thick and greasy roots, The pulse of the string is slippery. Treatment of liver and dampness, kidney and blood, optional Qinggan Zhiling Decoction (when women, white peony, habitat, paeonol, medlar, glutinous rice, Chinese yam, Chuanbai, mulberry, red peony). If you have less abdominal pain, add Wulingzhi, Yuanhusuo, and Sauce.
3, virtual Yin Huowang: more performance for the blood less thick, bright red, and see five upset hot, dry throat, or upset, sleepless, backache, soft legs, red tongue, less moss, pulse Shen count embolism. Expelling nourishing yin and clearing heat, can be used to add and subtract two soups (raw land, earth bone, Scrophulariaceae, Ophiopogon japonicus, Mulberry, Ligustrum lucidum, Eclipta prostrata). If you see dizziness, tinnitus, and irritability, you can add white peony, chrysanthemum, pine, and fried dates. Although there are several different types of syndromes in premenopause, there is a primary understanding of the pathogenesis of qi deficiency and blood heat in specific treatments, and it is advisable to examine the two sides when they cross each other, such as spleen deficiency. Damp heat, kidney deficiency has liver fire, yin deficiency and damp heat, etc., in order to select the prescription for the main card, and then according to the combination of drugs for drug addition and subtraction. In addition, it is also necessary to master the time of taking the medicine. Generally, the medicine should be started at the beginning of the ovulation period, and the menstrual cramps should be stopped, so as not to affect the normal menstrual flow.
