Author: Ilana Sowter, 17 December 2019
Amenorrhoea is a medical term when a woman ceases menstruation (Klein & Poth, 2013). Medically it is classified into two types: primary and secondary. Primary Amenorrhoea refers to a woman who has not started the menstruation by the age of 16. Secondary amenorrhoea refers to the abnormal stopping of the menstrual cycle for more than 3-6 months, when previously the cycle was regular (Maciocia, 2011).
Amenorrhoea Radio Talk
Listen to Ilana Sowter & Heiko Lade discuss Amenorrhoea and Chinese Herbs here.
Aetiology & Pathology
Scientifically, primary amenorrhoea may be caused by genetic or anatomical reasons. Secondary Amenorrhea may be caused by too much exercises; over-stress; ovarian or hormonal disorders, thyroid to nutritional disorders (Klein & Poth, 2013). In clinic, I see many patients who have take the Oral Contraceptive Pill long-term. When they have stopped taking it, in their case, menstruation stops and the cycle has no regularity.
Bi Jing & Patterns
In Traditional Chinese Medicine (TCM), amenorrhea is referred to as Bi Jing.
It is essentially considered in the following patterns:
- Kidney Jing and Liver Blood Deficiency
- Yin Deficiency with Blood Dryness
- Qi and Blood Deficiency
- Qi and. Blood Stagnation
- Phlegm and Dampness Obstruction (Maciocia, 2018; Tan et al., 2007).
Some experts also consider congealing Cold pattern and Spleen deficiency pattern as a cause (Lei & Cohen, 2014; Si-Tu & Wang, 2007). Amenorrhoea is a blood disease which is related to the heart, spleen, liver and kidney.
In the Jin Gui Yao Lue, Zhang Zhongjing affirms “women’s diseases which are due to emptiness, accumulated coldness, or bound Qi may result in menstrual water being stop”(cited in Flaws, 2005). Amenorrhoea can be due to lack of blood or blockage of blood flow. Heart which governs the blood may fail its function because of emotional disturbance. The Heart is an important organ to consider seeing that the Bao Mai, that connects the Heart to the Uterus can be blocked.
Over working, stress, lack of or too much exercise, improper and orthorexic diets may cause the Spleen to fail its function of producing and transporting blood. Dampness or Phlegm may appear when the Spleen is too weak which may block the uterus hence no period. Kidney Jing originates from menstrual blood. Excessive sex and other exhaustive factors like over working may weaken the Kidney and consume Liver Blood; which lead to deficiency of Chong Mai and Ren Mai. The Liver has the function of storing blood which also supply the blood to the uterus coordinating with the Ren Mai.
Excess patterns are also damaging. As blood and fluids have the same resource, excessive fluid loss may lead to blood consumption. Too much dampness, phlegm or coldness accumulated in the body which is due to different factors may result in Qi stagnation and blood stasis. The blockage leads to amenorrhea (Si-Tu & Wang, 2007).
Treatment of Amenorrhoea
Before treating amenorrhoea, pregnancy should be firstly ruled out. Medical treatment is usually hormone therapy. Hormonal drugs do not always regenerate nor regulate the menstrual cycle and they come with some side effects as well (Klein & Poth, 2013). Maciocia (2011) implies that long-term use of OCP cause blood deficiency.
In TCM, Amenorrheoa is treated according to syndrome differentiation which can be divided into excess or deficiency patterns (Tan et al., 2007.; Maciocia & Kapthcuk, 2011).
Excess Patterns
The amenorrhea is usually caused by the blockage of the channels due to excessive Damp Heat, Qi and Blood Stagnation and Congealed Cold. The treatment principle can be promoting the Qi and Blood circulation and clearing the excess for the target of regulating menstruation (Lei & Cohen, 2014).
Basic Chinese Herbal Formulae for Excess Patterns
- Xue Fu Zhu Yu Tang (severe blood stagnation)
- Tao Hong Si Wu Tang (to remove blood stasis);
- Wen Jing Tang (to warm the channels);
- Cang Fu Dao Tan Wan (to resolve damp and phlegm).
Commonly used acupoints are: ST30 Qi Chong; SP10 Xue Hai; RN3 Zhong Ji; ST40 Feng Long; SP9 Yin Ling Quan (all points with reducing or even method with moxa applicable when treating congealed cold) (Ellis, Wiseman, & Boss, 1991)
Deficiency Patterns
For deficiency patterns, the patients might have experienced late menarche and/or postponed period with small amount of blood for each period. The blood is deficient for this pattern which might because of the deficiency of kidney, liver, spleen, yin which lead to the absence of menstruation. The treatment principle for this type is to tonify blood and the deficient organs with the target of regulating menstruation (Maciocia, 2011).
Basic Chinese Herbal Formulae for Deficiency Patterns
The common herbal formula for these patterns include:
- Gui Shen Wan (to tonify kidney and liver);
- Ren Shen Yang Rong Tang;
- Ba Zhen Tang (to tonify blood and qi);
- Modified Yi Yin Jian(to nourish Yin) (Maciocia & Kapthcuk, 2011).
Commonly used acupoints are: ST36 Zu San Li; BL17 Ge Shu; BL23 Shen Shu; RN4 Guan Yuan; RN6 Qi Hai; KD6 Zhao Hai (all with reinforcing method with the combination of moxibustion) (Tan et al., 2007).
Chinese Herbal Medicine Amenorrhoea Study
In one clinic trial, a cyclic method of therapy which included four phases of treatment of amenorrhea treating 223 patients (Yan, 2001). Different herbs and treatment purposes were used for different phases with 3 months as one course of treatment. After one course of treatment, the efficacy rate was 89.47% (Yan, 2001).
Conclusion
From a Chinese medicine perspective, TCM treatment aims to adjust the body’s function and rebalance the yin and yang to help to regulate the menstruation which is to treat the root of the problem instead of the symptoms with almost no side effects (Blakeway, n.d.; Cai, 2013). I find when treating amenorrhoea, the correct Differential Diagnosis and Chinese Herbal Formula can have a profound effect on the patient. Acupuncture is also very supportive. The patient must also follow lifestyle advice of relaxing more, exercising in balance, eating nourishing blood foods, and even meditation and basic supplements can support her to menstruate again. Many women seek treatment as they have come off the pill ready to conceive a baby, or are concerned that their lack of menstruation is harming their health.
References
Blakeway, J. (n.d.). Chinese Medicine Treats Amenorrhea. Retrieved April 28, 2019, from https://www.yinovacenter.com/blog/how-chinese-medicine-treats-amenorrhea/
Cai, C. (2013). Acupuncture and Moxibustion Treatment of Amenorrhea. Medical Acupuncture, 25(3), 205–208. https://doi.org/10.1089/acu.2012.0914
Ellis, A., Wiseman, N., & Boss, K. (1991). Fundamentals of Chinese acupuncture. Paradigm Publications. Retrieved from https://books.google.co.nz/books?id=bKoMiuhSb3YC&pg=PA17&lpg=PA17&dq=needling+precautions+insomnia&source=bl&ots=A2Wk1_Hj6u&sig=Xo71hC-Axq_cXw9CJEcQtZ7VG8g&hl=zh-CN&sa=X&ved=2ahUKEwidnefm3a3eAhXbAYgKHYyLDgoQ6AEwA3oECAUQAQ#v=onepage&q=needling precautions
Health Navigator. (2019). Menstruation. Retrieved April 28, 2019, from https://www.healthnavigator.org.nz/health-a-z/m/menstruation/
Jedel, E., Labrie, F., Odén, A., Holm, G., Nilsson, L., Janson, P. O., … Stener-Victorin, E. (2011). Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. American Journal of Physiology-Endocrinology and Metabolism, 300(1), E37–E45. https://doi.org/10.1152/ajpendo.00495.2010
Klein, D. A., & Poth, M. A. (2013). Amenorrhea: An Approach to Diagnosis and Management(Vol. 87). Retrieved from www.aafp.org/afpAmericanFamilyPhysician
Lei, L., & Cohen, M. R. (2014). TCM case studies. Gynecology. People’s Medical Publishing House. Retrieved from http://203.118.138.176:2000/#!resources/searchresult
Lu, P. (2000). Treatment in 32 Cases of Amenorrhea with Acupuncture Using SP6. Journal of Clinical Acupuncture and Moxibustion, 16(6), 44.
Maciocia, G. (2018). Diagnosis in Chinese medicine : a comprehensive guide.
Maciocia, G., & Kapthcuk, T. J. (2011). Obstetrics and gynecology in Chinese medicine. Elsevier.
Si-Tu, Y., & Wang, X. (2007). Menstrual disorders I : dysfunctional uterine bleeding & amenorrhea. People’s Medical Publishing House. Retrieved from http://203.118.138.176:2000/#!resources/searchresult
Tan, Y., Qi, C., Zhang, Q., Xiao, P., Ma, H. (2007). Zhong yi fu ke xue. Ren min wei sheng chu ban she. Retrieved from http://203.118.138.176:2000/#!resources/searchresult
Yan, W. (2001). Treatment in 223 Cases of Amenorrhea According to Staged Pattern Differentiation. Zhejian Journal of Traditional Chinese Medicine, 8(344).
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