Section 9 Uterine Bleeding refers to sudden and massive vaginal bleeding or continuous bleeding in women during menstruation. The former is called collapse and the latter is called collapse and leakage. If the menstrual period is extended for more than 2 weeks, the category of metrorrhagia in this year is called metrorrhagia or metrorrhagia. General sudden bleeding, sudden onset, and excessive blood volume are called collapse; Slow bleeding, less blood is called leakage. Although the bleeding situation of metrorrhagia and metrorrhagia is different, their pathogenesis is the same, and they often transform into each other in the process of disease development. If metrorrhagia lasts for a long time and qi and blood are exhausted, it can become metrorrhagia and metrorrhagia, so it is often called metrorrhagia and metrorrhagia in clinic. As Fang Jisheng said, "The disease of metrorrhagia depends on one syndrome, and the lighter one is called metrorrhagia, or even metrorrhagia." This disease is a common disease, often due to alternating metrorrhagia and leakage, causal coherence, leading to lingering lesions, becoming a difficult and serious gynecological disease. This disease is equivalent to anovulatory dysfunctional uterine bleeding in western medicine. Irregular vaginal bleeding caused by genital inflammation and some genital tumors can also be treated with reference to this disease. 【 Etiology and Pathogenesis 】 The main pathogenesis is injury of chong and ren, and menstrual blood cannot be restricted. The common causes of unstable chong and ren are kidney deficiency, spleen deficiency, blood heat and blood stasis. First, kidney deficiency is a congenital deficiency of kidney qi, which is weak in young girls, gradually declining in menopause, or early marriage and prolificacy, indecent sexual intercourse, and impaired in kidney qi. If blood is consumed, kidney yin deficiency is damaged, yin deficiency causes internal heat, heat rushes up, and blood is forced to rush, resulting in irregular menstruation; Or the life gate is weakened by fire, the kidney-yang deficiency is damaged, the seal is dereliction of duty, and the chong and ren are not solid, which can not restrict menstrual blood, and it also causes menstrual blood to flow out from time to time, leading to metrorrhagia. Second, spleen deficiency, excessive anxiety, eating fatigue, impaired temper, qi stagnation, unstable chong and ren, out of control of qi and blood, untimely birth, resulting in metrorrhagia and leakage. Third, blood heat is full of yang, or emotional dissatisfaction, liver depression turns into fire, or heat evil, or spicy products that help yang overeat, heat is abundant, heat injury flushes and drains, forcing blood to flush and drain, and sometimes metrorrhagia. Four, the seven emotions of blood stasis are internal injuries, qi stagnation and blood stasis, or the evil of cold and heat, blood stasis caused by cold coagulation or heat burning, blood stasis blocking Chong Ren, blood does not follow menstruation, and sometimes it is metrorrhagia. 【 Syndrome Differentiation and Treatment 】 Uterine metrorrhagia is characterized by aperiodic vaginal bleeding. Combined with the changes of bleeding volume, color and quality and systemic syndromes, it can be distinguished between cold and heat deficiency and excess. According to the urgency of the disease and the long-term bleeding, the treatment should adopt the principle of "treating the symptoms if it is urgent, and curing the disease if it is slow", and flexibly use the three methods of cutting off the flow, clearing the source and restoring the old. Stop bleeding is stop bleeding. Hemorrhage is the main cause of uterine bleeding, and hemostasis is an urgent task to treat this disease. When using hemostasis, we should also pay attention to the difference between collapse and leakage. To treat collapse, it is advisable to strengthen the body resistance, not to warm the heart and promote blood circulation, so as to avoid excessive blood loss and lead to yin and yang failure; Treatment of leakage should nourish blood and promote qi, and should not be biased towards blood stasis to avoid blood stasis. The drugs for blocking flow can be Dendrobium powder, Yunnan Baiyao, Zidiningxue powder, etc. Chengyuan is to seek the cause and cure the problem. Uterine bleeding is caused by many reasons. According to the specific causes of metrorrhagia, the methods of tonifying kidney and strengthening spleen, clearing heat and regulating qi, and removing blood stasis are adopted to fundamentally treat metrorrhagia. The two methods of blocking flow and clearing the source are often carried out at the same time. Reliving the past is to clean up the mess. After metrorrhagia stops, the spleen and kidney should be recuperated to make it better. All previous dynasties believed that after metrorrhagia and metrorrhagia, spleen and stomach should be regulated, and qi and blood should be regenerated to restore it. Modern research points out that metrorrhagia and metrorrhagia can be completely treated only by tonifying kidney and benefiting qi and rebuilding menstrual cycle. "Kidney flows out through water", which is full of kidney qi. For patients with deficiency syndrome in adolescence and childbearing age, it is more important to tonify kidney and regulate menstruation. Of course, the restoration also needs to consider Chengyuan. In a word, there are differences and internal relations between blocking the flow, inheriting the future and rejuvenating the children, and they must be used flexibly according to the specific situation. 1. Kidney deficiency syndrome (1) The main symptoms of kidney yin deficiency syndrome are irregular menstruation, less or more bleeding, endless dripping, bright red blood, thick body, dizziness and tinnitus, soreness of waist and knees, fever of hands and feet, red cheekbones and lips, red tongue, less fur and rapid pulse. Syndrome analysis: kidney yin deficiency, excessive fire, hot fu chong ren, forced blood chong ren, so irregular menstrual blood, less or more bleeding, dripping constantly; Yin deficiency leads to internal heat, so the blood color is bright red and thick; Deficiency of kidney yin, deficiency of essence and blood, and inability to promote glory and empty orifices, so dizziness and tinnitus; Insufficient blood and blood can't afford to raise a family, so the waist and legs are weak; Yin deficiency and internal heat cause hand, foot and heart heat; Deficiency heat rises, cheekbones are red, and lips are red. Red tongue, less fur and thready pulse are also symptoms of kidney yin deficiency. Treatment: Tonifying kidney and nourishing yin, forcing flushing to stop bleeding. Examples of prescriptions: Zuo Gui Wan (Jing Yue Quan Shu) removes Radix Cyathulae, and adds Zaolian and fried Sanguisorba officinalis. Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Fructus Lycii, Fructus Corni, Semen Cuscutae, Colla cornus Cervi, Colla Plastri Testudinis, Radix Rehmanniae Preparata, Radix Cyathulae, Fructus Lycii and Fructus Corni nourish kidney yin and replenish blood; Yam and dodder tonify kidney-yang and essence, that is, yang generates yin. Colla Plastri Testudinis, Eclipta prostrata, and Radix Sanguisorbae preparata nourish blood and stop bleeding. The whole prescription * * * plays the role of tonifying kidney and nourishing yin, consolidating chong and stopping bleeding. Radix Rehmanniae, Radix Ophiopogonis and Cortex Lycii can be added for patients with yin deficiency and fever. This type can also use the lingering sound soup (Bering Gynecology). Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Radix Dipsaci, Herba Taxilli, Corni Fructus, cuttlefish bone, Carapax et Plastrum Testudinis, Concha Ostreae, Radix Paeoniae Alba, Colla Corii Asini, Radix Sanguisorbae preparata, Corni Fructus, Radix Dipsaci, and Herba Taxilli for invigorating kidney and essence; Tortoise shell, oyster and cuttlebone nourish kidney yin, force chong ren, astringe essence and stop bleeding; Yam tonifies spleen yin, white peony astringes liver yin, donkey-hide gelatin nourishes blood and nourishes yin, and Sanguisorba officinalis cools blood and stops bleeding. The whole prescription not only nourishes the kidney and yin, but also urges to stop bleeding. (2) The main symptoms of kidney-yang deficiency syndrome: irregular menstruation, excessive bleeding, endless dripping, pale and thin color, low back pain, cold limbs, long urination, thin stool, dull complexion, dull tongue, thin white fur and weak pulse. Syndrome analysis: deficiency of kidney yang, unstable chong and ren, and loss of qi and blood, so menstrual disorder is uncertain, and menstrual blood volume is large and dripping constantly; Deficiency of kidney yang, loss of menstrual blood in temperature, so the color is light and thin; Deficiency of kidney yang leads to backache, chills and cold limbs. The bladder loses temperature, so the urine is long; Kidney yang deficiency can't warm the spleen and soil, so the stool will be thin. Dark complexion, pale tongue, thin white fur and weak pulse are also manifestations of kidney-yang deficiency. Treatment rule: Warming kidney to help yang and stopping bleeding. Example of prescription: Dabuyuan decoction. Adding Fructus Psoraleae, Colla cornus Cervi and charcoal of Folium Artemisiae Argyi. Second, the main symptoms of spleen deficiency type: menstrual blood occurs from time to time, the amount is like bursting out, or dripping continuously, the color is light and thin, the body is tired, the breath is short and lazy, the limbs are not warm, or the face is swollen, the face is yellowish, the tongue is light and fat, the fur is thin and white, and the pulse is slow and weak. Syndrome analysis: spleen deficiency, unstable chong and ren, uncontrolled blood volume, so menstrual blood flows from time to time, such as collapse, or continuous dripping; Spleen deficiency and insufficient qi and blood, so menstrual flow is light in color and thin in quality; Deficiency of temper leads to mental fatigue, shortness of breath and laziness; Spleen dominates the limbs, and spleen deficiency causes the limbs to lose warm nourishment, so the limbs are not warm; Deficiency of spleen and yang, dereliction of duty in transportation and transformation, not thinking about diet; Spleen loses transport, water is wet and stops, water is wet and overflows the skin, and floating limbs are swollen. Pale face, pale tongue, thin white fur and weak pulse are also signs of spleen deficiency. Treatment: invigorating spleen and qi, stopping bleeding. Examples of prescriptions: Guchong Decoction (a record of western medical experience). Atractylodis Rhizoma, Radix Astragali, Os Draconis preparata, Concha Ostreae preparata, Cornus officinalis, Radix Paeoniae Alba, cuttlefish bone, Radix Rubiae, charcoal, Radix Astragali in Galla Chinensis, and Atractylodis Rhizoma for invigorating spleen, invigorating qi and nourishing blood; Keels, oysters, and cuttlebone are fixed and hurried; Cornus officinalis and Radix Paeoniae Alba nourish kidney and enrich blood, and stop bleeding by acid; Galla chinensis and brown charcoal astringent blood to stop bleeding; Madder promotes blood circulation and stops bleeding, stopping bleeding without leaving blood stasis. The whole prescription * * * has the functions of invigorating spleen and benefiting qi, consolidating chong and stopping bleeding. If there is a lot of bleeding, ginseng and Cimicifuga should be added as appropriate; For those who leak for a long time, add lotus root festival and stir-fry cattail pollen. If there is a large amount of vaginal bleeding, cold sweat in limbs, unconsciousness in servants and unclear pulse, it is imperative to replenish qi and consolidate the source, so Shen Du Decoction (Jing Yue Quan Shu) can be used. 25 grams of ginseng, decocted in water to obtain concentrated juice, and then decocted in other medicines. Or use Shengmai Powder (theory of syndrome differentiation and classification of internal and external injuries) for treatment, benefiting qi and promoting fluid production, astringing yin and stopping sweating. Ginseng, Ophiopogon japonicus and Schisandra chinensis should take Shenfu Decoction (a good prescription for women) if their symptoms are syncope, sweating and impotence. Ginseng, aconite, ginger and jujube. The main symptoms of blood-heat type: irregular menstrual blood, large amount, or continuous dripping, dark red blood, thick body, upset and insomnia, cold drinks, dizziness, red tongue, yellow fur and slippery pulse. Syndrome analysis: heat injury rushes to ren, forcing blood to rush to ren, so menstrual blood flows from time to time, such as collapse or continuous dripping; Blood burns due to heat, so the color of blood is dark red and sticky; Pathogenic heat is blazing inside, body fluid is consumed, and thirst is like drinking; Heat disturbs the mind, so it is upset and less sleepy; Pathogenic heat disturbs people, so they are dizzy and red. The tongue is red with yellow fur and slippery pulse, which is the image of blood heat. Treatment: clearing away heat, cooling blood and stopping bleeding. Examples of prescriptions: Qingre Gu Jing Decoction. Radix Rehmanniae, Cortex Lycii, Carapax et Plastrum Testudinis, Concha Ostreae powder, Colla Corii Asini, Scutellariae Radix, Nodus Nelumbinis, Charcoal, Glycyrrhrizae Radix, Fructus Gardeniae preparata, Scutellariae Radix, Cortex Lycii, Radix Rehmanniae, Colla Corii Asini for clearing heat, cooling blood and benefiting yin; Tortoise shell oyster nourishes yin and lowers yang, firmly grasping Chong Ren; Gardenia and Sanguisorba officinalis have the functions of clearing away heat, cooling blood and stopping bleeding; Lotus root nodes and brown charcoal astringent blood to stop bleeding; Glycyrrhiza uralensis Fisch blends various drugs. The whole prescription * * * has the functions of clearing away heat, cooling blood, and stopping bleeding. If liver depression turns into fire, chest pain, irritability, sighing, rapid pulse and other symptoms appear, it is advisable to calm the liver, clear heat and stop bleeding, and then stir-fry Rhizoma Cyperi, Pollen Typhae charcoal and carbonized blood with vinegar to regulate qi, blood and stop bleeding. Fourth, the main symptoms of blood stasis: menstrual blood is frequent, the amount is more or less, the drip is not clean, the blood color is purple and dark, the pain in the lower abdomen refuses to press, the tongue is purple or petechiae, and the pulse is astringent or strong. Syndrome analysis: Stagnation of blood stasis leads to chong ren, and blood does not follow menstruation, so menstrual blood flows from time to time, and the amount is more or less, dripping constantly; Chong Ren is blocked, and menstrual blood is not running smoothly, so the blood color is purple and dark, "if you can't do it, it hurts", so your lower abdomen hurts and you won't press it. Dark purple tongue or petechiae, unsmooth pulse or strong chord are also signs of blood stasis. Treatment: promoting blood circulation, removing blood stasis and stopping bleeding. Examples of prescriptions: Zhuyu Zhibeng Decoction (Selected Prescriptions of Anhui Traditional Chinese Medicine). Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Notoginseng, Myrrha, Oletum Trogopterori, Cortex Moutan, Radix Salviae Miltiorrhizae preparata, Folium Artemisiae Argyi preparata, Colla Corii Asini (parched with Pollen Typhae), Os Draconis, Concha Ostreae, cuttlefish bone Formula Myrrha, and Oletum Trogopterori for promoting blood circulation, removing blood stasis and relieving pain; Notoginseng Radix, Cortex Moutan and Radix Salviae Miltiorrhizae preparata promote blood circulation, remove blood stasis and stop bleeding; Angelica sinensis and Ligusticum chuanxiong nourish blood and promote blood circulation; Colla Corii Asini and parched Folium Artemisiae Argyi nourish blood and stop bleeding; Cuttlefish bone, keel and oyster stop bleeding.