1. IRREGULAR MENSTRUATION Lee Chong Leng 1

4. CONTENTS 1)Introduction5 - 10 2)Clinical Manifestations11 - 27 3)Essentials for Diagnosis28 - 29 4)Treatment with Tuina Therapy30 - 62 5)Cautions63 4

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8. IRREGULAR MENSTRUATION  Menstrual disorder, a common gynecological disease.  Abnormal changes of menstrual period, quantity, color and quality, including advanced, delayed or irregular menstruation 8

9. IRREGULAR MENSTRUATION  Advanced menstruation -- menstruation occurs one week earlier than usual  Delayed menstruation -- menstruation occurs one week later than usual, even forty or fifty days later than usual  Irregular menstruation -- menstruation occurs without a fixed period, it may be advanced or delayed 9

10. IRREGULAR MENSTRUATION In modern medicine, irregular menstruation is thought to be caused by  Disorder of estrogen excretion  Dysfunction of autonomic nerve  Emotional stimulation,  Cold and fatigue  Other diseases 10

11. CLINICAL MANIFESTATIONS Abnormal changes of  Menstrual period  Quantity  Color  Quality 11

12. CLINICAL MANIFESTATIONS  Abnormal changes of menstrual period  advanced 经 早  Delayed 经迟  Irregular 乱 经 12

13. CLINICAL MANIFESTATIONS  Abnormal quantity -- excessive or scanty menstruation  Abnormal changes of menstrual color -- thick or thin menstruation with blood clots or bad smell 13

14. CLINICAL MANIFESTATIONS  Irregular menstruation also can be accompanied by  Discomfort in the lower abdomen  Distension or pain in the breast or hypochondriac distension and pain  Headache  Vomiting  Unsmooth urination and defecation 14

15. CLINICAL MANIFESTATIONS 1.Advanced menstruation: Menstruation occurs earlier than usual, even twice in one month due to  Excess heat 实热  Yin deficiency and blood heat 阴虚血 热  Liver stagnation transforming into heat 肝 郁化 热  Qi deficiency 气虚 15

16. CLINICAL MANIFESTATIONS Advanced menstruation due to excess heat : （ 血 热）  excessive thick and purple menstruation  Chest oppression  Light and yellowish tongue coating, floating and rapid pulse 16

17. CLINICAL MANIFESTATIONS Advanced menstruation due to Yin deficiency and blood heat : （ 阴虚血 热）  Scanty menstruation  Flushed face and hot palm  Reddish tongue with yellowish coating, thin and rapid pulse 17

18. CLINICAL MANIFESTATIONS Advanced menstruation due to liver stagnation transforming into heat : （ 肝郁化 热）  Menstruation with clots  Distension and pain in the chest, breasts and lower abdomen  Irritability  Wiry pulse 18

19. CLINICAL MANIFESTATIONS Advanced menstruation due to Qi deficiency : （ 气虚 ）  Scanty and thin menstruation  Lassitude and palpitation  Dropping and distending sense in the lower abdomen  Light-colored tongue and weak pulse 19

20. CLINICAL MANIFESTATIONS 2.Delayed menstruation: Menstruation occurs later than usual due to  Excessive cold 实 寒  Cold 虚寒  Qi stagnation 气郁  Blood deficiency 血虚 20

21. CLINICAL MANIFESTATIONS Delayed menstruation due to excessive cold : （实 寒 ）  Scanty and blackish menstruation  Colic in the lower abdomen to be alleviated with warmth  Bluish complexion and cold limbs  Light-colored tongue with whitish coating, deep and tense pulse 21

22. CLINICAL MANIFESTATIONS Delayed menstruation due to cold : （ 虚寒 ）  Scanty and light-colored menstruation  Abdominal pain to be alleviated by pressure and warmth  Pale complexion  Light-colored tongue with white coating, deep and slow pulse 22

23. CLINICAL MANIFESTATIONS Delayed menstruation due to Qi stagnation : （ 气郁 ）  Scanty menstruation  Lower abdominal distension and pain  Depressed mind  Discomfort and fullness in the chest to be alleviated after sighing  Yellowish tongue coating, taut and unsmooth pulse 23

24. CLINICAL MANIFESTATIONS Delayed menstruation due to blood deficiency : （ 血虚 ）  Lower abdominal pain  Shallow complexion  Dry skin  Palpitation  Giddiness  Light-colored tongue with thin coating, weak and thin pulse 24

25. CLINICAL MANIFESTATIONS 3.Disordered menstruation: Early or delayed menstruation due to  Liver stagnation 肝郁  Kidney deficiency 肾 虚 25

26. CLINICAL MANIFESTATIONS Disordered menstruation due to liver stagnation: （ 肝郁 ）  Unsmooth menstruation  Distension and pain in the chest, breasts and lower abdomen  Depression  Chest oppression  Taut pulse 26

27. CLINICAL MANIFESTATIONS Disordered menstruation due to kidney deficiency : （肾 虚 ）  Scanty, thin & light-colored menstruation  Blackish complexion  Vertigo and tinnitus  Soreness & weakness in lower back & knees  Frequent urination at night  Light-colored tongue and coating, deep and weak pulse 27

28. ESSENTIALS FOR DIAGNOSIS 1. Advanced menstruation: Menstruation occurs 7 days or even half a month earlier than usual over twice in a month 2. Delayed menstruation: Menstruation is delayed more than 35 days for over two periods B ultrasonic examination should be taken to rule out organic diseases of uterus and ovary 28

29. ESSENTIALS FOR DIAGNOSIS 3.Disordered menstruation: Menstruation is advanced or delayed more than 7 days for over two periods. B ultrasonic examination should be taken to rule out other organic diseases Basic body temperature test, vagina smear test and cervical mucous crystal examination should be taken to examine the function of ovary 29

30. TREATMENT WITH TUINA THERAPY Principle: Regulating the Qi and blood, soothing liver and adjusting Qi （调 和气血 ， 疏肝理气 ） 30

31. TREATMENT WITH TUINA THERAPY Acupoints and location: Guanyuan (CV 4), Qihai (CV 6), Zhongji (CV 3), Pishu (BL 20), Ganshu (BL 18), Shenshu (BL 23), Sanyinjiao (SP 6), Taichong (LR 3), Taixi (KI 3), abdomen, waist and back, lower part of body 31

32. TREATMENT WITH TUINA THERAPY Operation 1: (1)Patient-- supine position (2)Push with one finger or rub Qihai (CV 6), Guanyuan (CV 4) and Zhongji (CV 3), 1 minute for each Acupoint till Qi is obtained (3)knead the lower abdomen clockwise for about 10 minutes 32

33. 33 Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

34. 34 Guanyuan ( 关元 )

35. 35 Zhongji ( 中极 )

36. TREATMENT WITH TUINA THERAPY Operation 2: (1)Patient -- prone position (2)Push with one finger along the bilateral lines of the bladder meridian, especially Pishu (BL 20), Ganshu (BL 18) and Shenshu (BL 23), for about 3-5 minutes (3)Press and rub Pishu (BL 20), Ganshu (BL 18) and Shenshu (BL 23), 1 minute for each Acupoint till Qi is obtained 36

37. 37 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

38. TREATMENT WITH TUINA THERAPY Operation 3: (1)Patient -- supine position (2)Press with thumbs and knead Sanyinjiao (SP 6), Taichong (LR 3) and Taixi (KI 3), 1 minute for each Acupoint till soreness and distension are felt 38

39. 39 Sanyinjiao ( 三阴交 )

40. 40 Taichong ( 太冲 )

41. 41 Taixi ( 太溪 )

42. MANIPULATIONS ACCORDING TO SYNDROME DIFFERENTIATION 42

43. (1) HEAT BLOOD  Press and knead Dadun (LR 1), Xingjian (LR 2), Yinbai (SP 1), Sanyinjiao (SP 6), Jiexi (ST 4) and Xuehai (SP 10), 1 minute for each Acupoint till Qi is obtained  Press and knead with thumbs, index fingers or middle fingers around Ganshu (BL 18), Weishu (BL 21) and Dachangshu (BL 25) for about 3-5 minutes 43

44. 44 Dadun ( 大敦 ) ， Xingjian ( 行间 ) ， Taichong ( 太冲 )

45. 45 Yinbai ( 隐白 )

46. 46 Jiexi ( 解溪 )

47. 47 Xuehai ( 血海 )

48. 48 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

49. 49 Weishu ( 胃俞 )

50. 50 Shenshu ( 肾俞 ) ， Dachangshu ( 大肠俞 )

51. (2) COLD BLOOD  Press Shenque (CV 8) for 3-5 minutes till it is warm in the lower abdomen  Rub the governor vessel, Shenshu (BL 23) and Mingmen (GV 4) for about 1- 2 minutes until the warmth penetrates into the skin 51

52. 52 Shenque ( 神阙 )

53. 53 Mingmen ( 命门 )

54. (3) DEFICIENCY - QI & BLOOD  Press Zhongwan (CV 12) and Qihai (CV 6), 3 minutes for each Acupoint until it becomes warm  Press and rub Zusanli (ST 36) and Sanyinjiao (SP 6), 3 minutes for each Acupoint until Qi is obtained  Press and knead with fingers over Pishu (BL 20) and Weishu (BL 21), 1 minute for each Acupoint  Rub Pishu (BL 20) and Weishu (BL 21) until the warmth penetrates into the body 54

55. 55 Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

56. 56 Zusanli ( 足三里 )

57. (4) LIVER DEPRESSION  Press and knead Zhangmen (LR 13) and Qimen (LR 14) for about 2 minutes  Press and knead Geshu (BL 17) and Ganshu (BL 18) for about 3-5 minutes 57

58. 58 Qimen ( 期门 ) ， Zhangmen ( 章门 )

59. 59 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

60. (5) DEFICIENCY OF KIDNEY  Press Guanyuan (CV 4) for 3-5 minutes until the warmth penetrates deeply into the abdomen  Press and knead the bilateral sides of Yongquan (KI 1) for about 1 minute  Rub vertically the sole of foot repeatedly until the warmth penetrates into it  Rub the governor vessel and the bilateral courses of the bladder meridian repeatedly for about 5-7 times  Rub Shenshu (BL 23), Mingmen (GV 4) and Baihuanshu (BL 30) until warmth 60

61. 61 Yongquan ( 涌泉 )

62. 62 Baihuanshu ( 白环俞 )

63. CAUTIONS 1.Tuina manipulation is applicable before and after the menstruation Cares should be taken to adjust the diet, avoid crapulence, fatty, cold uncooked and spicy foods 2.Pay attention to changes of weather and avoid cold and excessive heat 3.Keep a delighted mind, avoid extreme changes of emotions 4.Rest more and avoid overstrain and excessive sexual intercourse 63

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65. 65 THANK YOU