Urban bleeding refers to irregular vaginal bleeding in women. "Treatise on the Causes and Symptoms of Various Diseases." "Women's Miscellaneous Diseases" says: "Blood coming down from time to time and continuous dripping is called leakage," and "burst suddenly is called metrorrhagia." Although the clinical manifestations of metrorrhagia and hemorrhage are different, the causes are the same, and In the process of pathogenesis development, they can often transform into each other. If the collapse slows down slightly, it can become a leak; if the leakage continues for a long time, it can also become a collapse. For example, "Jisheng Fang" says: "The disease of metrorrhagia basically has one syndrome. The milder ones are called leakage, and the more serious ones are called intrauterine bleeding." Moreover, because the amount of bleeding in this disease is sometimes more and sometimes less, and is often not fixed, so the collapse It is not easy to distinguish it from uterine bleeding, so it is often referred to as uterine bleeding in clinical practice.
Urban bleeding is the most common symptom of a variety of gynecological diseases, such as: Chongren disordered uterine bleeding, menorrhagia, five-color band, fetal leakage, postpartum halo, persistent lochia, Vaginal bleeding that occurs in areas such as vaginal bleeding falls into the category of metrorrhagia. Modern discussions on metrorrhagia tend to dismiss disordered vaginal bleeding.
[Identification]
Common syndromes
Kidney yin deficiency and uterine bleeding: excessive vaginal bleeding, or continuous dripping, bright red or purple blood, thick texture , occasional blood clots, soreness in the waist and limbs, dizziness and tinnitus, restlessness and heat, dry mouth and no desire to drink. The tongue is red or light (when blood is deficient), and the pulse is thready and rapid.
Urban bleeding due to kidney yang deficiency: excessive vaginal bleeding or continuous dripping, light red color, thin texture, no lumps, or chloasma on the face, cold appearance, cold limbs, fat body, and low back pain. The tongue is fat and pale, or has tooth marks, and the pulse is weak or weak (when blood is deficient).
Spleen deficiency and metrorrhagia: excessive vaginal bleeding or continuous dripping, pale blood, thin texture, pale complexion, tiredness and poor appetite, lower abdominal distension, or loose stools. Pale tongue, thin and weak pulse or weak pulse (when blood deficiency occurs).
Blood stasis and metrorrhagia: heavy vaginal bleeding or continuous dripping, dark purple menstruation with blood clots, pain in the lower abdomen that refuses to be pressed, and the pain is relieved after the blood clots are discharged.
The tongue is purplish or there are petechiae on the tip of the tongue, and the pulse is heavy or slippery (when blood deficiency or blood stasis transforms into heat). (However, for some patients with long-term bleeding and persistent leakage who are ineffective in treatment with syndrome differentiation prescriptions, they should be considered to be caused by blood stasis even if they do not have the above-mentioned blood stasis syndrome).
Identification analysis
Urban bleeding due to kidney yin deficiency and uterine bleeding due to kidney yang deficiency: both are deficiency syndromes, but the causes and pathogenesis are different. Metrorrhagia due to kidney yin deficiency is caused by multiple factors: body yin deficiency, or damage to kidney yin due to early marriage, labor, or multiple childbirths, resulting in the internal activation of the deficiency fire, loss of Chong and Ren, and metrorrhagia. As for kidney yang deficiency, metrorrhagia is mostly caused by yang deficiency in the body, insufficient kidney qi in adolescence, or excessive consumption of sweet and cold medicine due to yin deficiency syndrome, which damages the kidney yang. Yang deficiency means that Chong and Ren qi are not solidified. Causing metrorrhagia. Its dialectical characteristics are: Kidney yin deficiency, metrorrhagia, will have bright red blood, thick texture, and thready pulse; while kidney yang deficiency, metrorrhagia, will have light red blood, thin texture, fat body, and slow and weak pulse. If the bleeding is prolonged, several pulses may be seen. However, the pulse of Yang deficiency is frequent but weak, or the pulse is weak and weak; the pulse of Yin deficiency is frequent but strong, thin and slippery. Among metrorrhagia syndromes, counting pulses is more common in deficiency syndromes. Therefore, Zhang Jingyue said: "The pulse number disease is the most damaging. The more deficient the pulse is, the more frequent it is. The more frequent the pulse is, the more dangerous it is. Isn't it true that counting pulses is all a fever disease? If the pulse is counted with deficiency, If you count the heat, you will be invincible. "It can be seen that if there are multiple pulses in metrorrhagia, the diagnosis cannot be based on the pulse rate alone, but must be distinguished by pulse strength and pulse shape. As for the treatment of metrorrhagia due to kidney yin deficiency, the treatment should be to nourish kidney yin, combined with cooling blood to stop bleeding. The prescription for nourishing yin and stopping bleeding is commonly used. After the bleeding has stopped, the prescription for nourishing the kidney and regulating circumference can be used; for the treatment of metrorrhagia due to kidney yang deficiency, it should be treated with warming and tonifying kidney yang, and combined with To replenish qi and stop bleeding, choose a prescription that warms yang and stops bleeding. After the bleeding stops, use a prescription that warms the kidney and regulates circulation.
The difference between uterine bleeding due to spleen yang deficiency and uterine bleeding due to kidney yang deficiency is that uterine bleeding caused by kidney yang deficiency has clinical manifestations of yang deficiency, such as: chloasma on the face, cold limbs, and a fatter constitution. Symptoms such as cold and pain in the waist are more common in young people; spleen deficiency and metrorrhagia are mainly manifested by spleen deficiency and depression of middle qi, such as: pale complexion, tiredness and lack of appetite, and lower abdominal distension and other symptoms, which are common in middle-aged people Women and people suffering from overwork. One is yang deficiency and the other is qi deficiency, but in some individuals, it can be both, or it can develop from qi deficiency to yang deficiency. In view of the clinical symptoms of kidney-yang deficiency and spleen-spleen deficiency, which are complicated and often appear together, ginseng must be combined during clinical treatment. During treatment, Qi-enhancing drugs and Yang-warming drugs should be used in combination. The most common point between the two syndromes is that they are both deficiency syndromes with no heat and metrorrhagia. One is Yang deficiency and the other is Qi deficiency. Both Yang and Qi have main functional activities, so both of them show insufficient Chong, Ren and Clinging functions. If the spleen is weak and collapses, the treatment should be to nourish the spleen and replenish qi, and also to stop bleeding. Use the prescription of replenishing qi to stop bleeding. After the bleeding stops, use the prescription of tonifying the spleen and regulating circumference.
Blood stasis and metrorrhagia: caused by internal stagnation of blood stasis. If the blood stasis does not go away, the new blood will not return to the menstruation, so the menstrual bleeding will not stop. There are three characteristics of its symptoms: (1) menstrual blood carries large, medium and small blood clots; (2) pain in the lower abdomen and resistance to pressing, and the pain is relieved after the blood clots are discharged; (3) small amount of bleeding that persists for a long time, dialectical Those whose medication efficacy is not significant. Anyone with the above characteristics (1), (2) or (3) can be diagnosed as blood stasis syndrome. Furthermore, this syndrome often occurs in the process of other syndromes, and it is obviously different from kidney-yin deficiency, kidney-yang deficiency, and spleen deficiency with metrorrhagia. The treatment of blood stasis syndrome should focus on activating blood circulation and removing blood stasis, as well as replenishing qi, removing blood stasis and stopping bleeding. After the bleeding has stopped, treatment should be based on the above three syndromes and the cycle should be adjusted. Because this disease is not the whole process of metrorrhagia, It is a certain stage in the process of metrorrhagia.
The cause of "uterine bleeding" is generally believed to be caused by Chongren damage and abnormal function of restricting menstrual blood. Such as "Treatise on the Causes and Symptoms of Various Diseases." "Women's Miscellaneous Diseases" says: "The condition of collapse is damage to the Chongren pulse.
The meridians of Chong and Ren all originate from the intracellular space and form a sea of ??meridians. If overworked and Chong and Ren Qi are deficient, menstrual blood cannot be controlled. "The four most common causes of Chong and Ren injuries are kidney yin deficiency, kidney yang deficiency, spleen deficiency, and blood stasis. Its treatment is generally divided into two stages, namely, hemostatic treatment during the bleeding stage, and periodic treatment after the bleeding has stopped. The former We should pay attention to syndrome differentiation and seeking causes, examine the causes and treat them, and we should not focus on fixing astringency; the latter needs to focus on nourishing the kidneys, because the root of the disease lies in the kidneys, but it must be combined with seeking the causes and not just nourishing the kidneys.
< p>[Documentation Notes]"Yi Zong Jin Jian. Key Points of Gynecological Heart Techniques": "After a woman has menstruation, she will have constant discharge, which is called daily menstrual leakage." The sudden heavy menstrual blood flow is called menstrual cramps. If the color is purple, clouds form into lumps, and there is swelling and pain in the abdomen and hypochondriac, it is a sign of heat stasis. If it persists for a long time, or the bleeding is excessive without any pain, it is mostly caused by damage to the Ren and Chong meridians. Worry may damage the spleen, and the spleen cannot absorb blood due to spleen deficiency; there may be depression of qi in the middle, which cannot consolidate blood; there may be anger that damages the liver, and the liver does not store blood and the blood flows freely. When experiencing symptoms, we must carefully examine the causes and identify them in detail. Tonify the deficiency, eliminate the blood stasis, clear the heat, and if the treatment is correct, everything will be cured."
"Nvke Jinglun. Collapse Daimen" quotes Fang Yue's words: "Blood belongs to yin. If it is still, it will follow the meridian, and if it is moving, it will move along the wrong meridian. Therefore, if the seven emotions are too extreme, the five wills will be extremely high, and the menstrual blood will fall violently and last for a long time, which is called collapse. The treatment method is to stop bleeding at the beginning to stop the flow; to clear away heat and cool blood to clear the source; to replenish the blood at the end to restore the original state. If the flow is stopped and its source is not clarified, the monstrous force will be unstoppable; if the source is stopped and its source is not restored, the rise of Guyang will be unstoppable and must be examined.
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