AMENORRHEA

Giovanni MaciociaCopyright Giovanni Maciocia

The absence of periods (amenorrhoea) is called Bi Jing inChinese:

Western medicine distinguishes between primary amenorrhoeawhich occurs when a woman has not had a period by the timeshe is 18, and secondary amenorrhoea, which occurs when awoman has had periods but they have stopped for at least threemonths.

jing = menstruation and bi = "shut" or "closed"

Obviously, the temporary interruptionof the menses that occurs afterchildbirth and during breast-feeding isnot considered amenorrhoea, nor,similarly, is the stopping of the mensesfor one or two months as aconsequence of sudden environmentalor living condition changes.

If a woman presents with secondary amenorrhoea it is of coursevery important to exclude pregnancy first of all because, werethe patient treated for amenorrhoea, one might prescribe herbswhich are contraindicated in pregnancy. I shall call thiscondition “No Periods” rather than “amenorrhoea”.

A basic differentiation must be made between:

No Periods from a Deficiency

includes:

and No Periods from an Excess

Blood deficiency, Spleen andKidney deficiency, and Liverand Kidney deficiency.

It should be further differentiated between thatfrom a Pre-natal and that from a Post-natalweakness. Obviously primary amenorrhoea ismore likely to be due to a deficiency of the Pre-natal Essence and secondary amenorrhoea to adeficiency of the Post-natal Qi.

usually due tostagnation of: Qiand/or Blood,Phlegm or Cold.

In the "Yellow Emperor's Classic"No Periods was called "womanhaving no moon" (i.e. no monthlyflow) or "moon affair not coming",indicating the early connection ofmenstruation with the moon phases.

AETIOLOGY AND PATHOLOGY

1) EMOTIONAL STRESS

Sadness and grief are very common factors inthe development of amenorrhoea. They depleteQi of the Lungs and Heart: the Lungs govern Qi,the Heart governs Blood, and when Qi cannotmake or move Blood and Heart-Blood cannotdescend to the Uterus, the menses stop.

Anger, intended in a broad sense to includefrustration, resentment, hatred and irritation,may cause stagnation of Qi which, with time,may lead to stasis of Blood: this causes anExcess type of No Periods.

The “Secret Prescriptions for Gynaecological Patternsand Treatment” by Ye Tian Shi says:

“The Heart governs Blood and the Spleen is theRoot of Qi and Blood. Worry and pensiveness injurethe Heart making Heart-Qi depleted; this cannotgenerate Blood, the Spleen is the child of the Heartand [therefore] loses its nourishment, the appetitedeclines which cuts off the Root of generation andtransformation [i.e. the Spleen].”

Ye Tian Shi 1817 Secret Prescriptions for Gynaecological Patterns andTreatment by Ye Tian Shi (Ye Tian Shi Nu Ke Zheng Zhi Mi Fang), cited inCong Chun Yu 1989 Chinese Medicine Gynaecology (Zhong Yi Fu Ke Xue),Ancient Chinese Medicine Texts Publishing House, Beijing, p. 74.

Worry and pensiveness affect Lungs and Spleen and may lead todeficiency and stagnation of Qi simultaneously. Deficient Qi failsto make Blood while stagnant Qi fails to move Blood leading tostasis of Blood. Amenorrhoea can therefore result from asimultaneous deficiency and stasis of Blood. Chen Jia Yuan saysin his "Secret Gynaecological Prescriptions" (Qing dynasty):

“Worry injures the Lungs, pensiveness depletes the Spleen,since Lungs and Spleen are injured Qi and Bloodstagnate, the woman becomes irritable and resentful anddevelops palpitations and a feeling of distension andoppression, and eventually amenorrhoea..”

2. Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi ShuBa Zhong), Ancient Chinese Medical Books Publishing House, Beijing, p.153. Chen's book, written during the Qing dynasty (1644-1911), was entitledSecret Gynaecological Prescriptions (Fu Ke Mi Fang) and published in 1729.

2) EXCESSIVE PHYSICAL WORK OR EXERCISEThis weakens the Spleen which fails to make Bloodand, when occurring at puberty time, it may alsocause stagnation of Qi and Blood in the LowerBurner, thus causing primary amenorrhoea. In thiscase the amenorrhoea is due to a Deficiency (ofBlood) complicated by an Excess condition(stagnation of Qi and Blood in the Lower Burner).

3) HEREDITARY WEAKNESSA hereditary Kidney weakness can of course causeprimary amenorrhoea. In this case there is adeficiency of Kidney-Essence and usually also ofLiver-Blood.

4) DIETA diet poor in nourishment leads to depletion of Qi and Bloodand therefore secondary amenorrhoea from Blood deficiency andSpleen deficiency. This becomes a cause of disease especially if itoccurs at a young age when girls are likely to adopt a slimmingdiet or a vegetarian diet that fails to substitute for the meatprotein a judicious combination of vegetable types of protein.

“Amenorrhoea in overweight women is due toDampness and Phlegm obstructing the Membranes.”

Cong Chun Yu 1989 Chinese Medicine Gynaecology (Zhong Yi Fu Ke Xue), Ancient Chinese Medicine Texts Publishing House, Beijing, p. 74.

Excessive consumption of dairy foods andgreasy foods leads to the formation ofDampness and Phlegm: these can obstruct theLower Burner and lead to amenorrhoea.These women are often overweight. The book“Chinese Medicine Gynaecology” says:

5) OVERWORKOverwork in the sense of working long hours without adequaterest for many years, leads to deficiency of Liver- and Kidney-Yin which, in turn, may cause secondary amenorrhoea.

PATHOLOGY

From a pathology point of view, the main distinction to be madeis that between Deficiency and Excess types of amenorrhoea.

LIVER AND KIDNEY DEFICIENCYLiver and Kidney involves a deficiency of Kidney-Essence andLiver-Blood, which in turn leads to emptiness of the Penetratingand Directing vessels. It can be caused by hereditary weakness ofthe Kidney-Essence, too many childbirths too close together, oroverwork.

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