Introduction
Amenorrhea refers to no occurrence of menarche over 18 years old or stoppage of menstruation for 3 months. The former is primary amenorrhea and the latter is secondary amenorrhea. This syndrome pertains to the conception of amenorrhea in TCM, also known as unsmooth menorrhea and stoppage of menstruation. Amenorrhea is usually caused by insufficient transformation of blood from the spleen and stomach as well as severe consumption of yin blood and exhaustion of blood source; or by retention of blood coagulation in the meridians and vessels due to retention of pathogenic factors in the uterus resulting from cold attack or cold drinks or due to mental depression.
Syndrome Differentiation
1. Asthenia Syndrome
The main symptoms are gradual reduction of menstrual flow, or even amenorrhea. Amenorrhea due to asthenia of qi and blood is usually accompanied by sallow complexion, emaciation, dispiritedness, vertigo, palpitation, light-colored tongue and thin pulse. Amenorrhea due to insufficiency of the liver and kidney is accompanied by vertigo, tinnitus, aching weakness of the loins and knees, feverish sensation in the five centers (palms, soles and chest), tidal fever, night sweating, darkish-colored tongue and taut and thin pulse.
2. Sthenia Syndrome
The main symptoms are amenorrhea and stoppage of menstruation for several months. Amenorrhea due to qi stagnation and blood stasis is accompanied by unpressable pain in lower abdomen, restlessness, susceptibility to anger, distending fullness in the chest and hypochondria, blackish-colored tongue or with ecchymoses and deep-taut pulse. Amenorrhea due to cold coagulation and blood stagnation is accompanied by cold body and limbs, cold pain in the lower abdomen, blackish-colored tongue with ecchymoses and deep-tense pulse. Amenorrhea due to phlegmatic dampness obstruction is accompanied by obesity, fullness and oppression in the chest and hypochondria, dispiritedness and lassitude, anorexia and profuse sputum, leukorrhagia, greasy tongue fur and slippery pulse.
Treatment
2.1 Body Acupuncture
(1) Asthenia Syndrome:
Prescription: Qihai (CV 6), Zusanli (ST 36) and Sanyinjiao (SP 6).
Modification: For asthenia of blood, Pishu (BL 20) and Geshu (BL 17) are added; for insufficiency of the liver and kidney, Ganshu (BL 18), Shenshu (BL 23) and Guanyuan (CV 4) are added; for aching and weakness of the loins and knees, Mingmen (GV 4) and Zhishi (BL 52) are added; for tidal fever and night sweating, Fuliu (KI 7) and Taixi (KI 3) are added; for palpitation, Neiguan (PC 6) and Shenmen (HT 7) are added.
Performance: The reinforcing needling technique is used. Qihai (CV 6) is needled obliquely downward with rotating reinforcing technique; Sanyinjiao (SP 6) is needled obliquely upward to enable the needling sensation to transmit to the upper part; for asthenia of qi and blood, moxibustion can be added.
(2) Sthenia Syndrome:
Prescription: Zhongji (CV 3), Xuehai (SP 10) and Sanyinjiao (SP 6).
Modification: For qi stagnation and blood stasis, Hegu (LI 4), Taichong (LR 3) and Diji (SP 8) are added; for cold coagulation and blood stagnation, Guanyuan (CV 4) is added; for retention of phlegmatic dampness in the middle energizer, Zhongwan (CV 12) and Fenglong (ST 40) are added.
Performance: The filiform needles are used with reducing techniques. In needling Zhongji (CV 3), urination is done first and the needle is inserted obliquely downward with rotating reducing technique; Guanyuan (CV 4) is needled with the addition of moxaroll moxibustion or moxacone moxibustion. The rest acupoints are needled with reducing techniques.
2.2 Electro-acupuncture
Prescription: Guilai (ST 29) is combined with Sanyinjiao (SP 6), Zhongji (CV 3) is combined with Diji (SP 8), and Qugu (CV 2) is combined with Xuehai (SP 10).
Performance: Each time one couple of the acupoints are selected or the couples of acupoints are selected alternatively. After the needling sensation is felt, the impulse current is attached to the needles for 10 - 15 minutes. Electropuncture is performed once a day or once every other day.