The syndrome differentiation of this disease should be based on the quantity, color, quality and clinical testimony of menstruation. Those with heavy menstrual flow, light color, and thin texture are mostly due to qi deficiency; those with soreness and weakness in the waist and knees, and dizziness are mostly due to kidney deficiency; those with heavy menstrual flow, purple-red color, and thick texture are mostly due to blood heat; more or less amount, color or Red or purple, distending pain in the chest, hypochondrium and lower abdomen, frequent belching, red face and red eyes are due to liver stagnation transforming into fire; small amounts and red color, bone steaming and hot flashes are due to yin deficiency and exuberance of fire; there are more blood clots in menstruation and abdominal pain. There is blood stasis.
The basic treatment for early menstruation is to clear away heat and replenish deficiency. However, it is not advisable to use severe bitterness or severe cold to clear away heat to prevent cold and blood stagnation; to replenish deficiency, you must use products that regulate qi to avoid sudden replenishment of stagnant qi. For those with blood stasis, only blood-activating products should be considered, and blood-breaking products should not be used indiscriminately.
(1) Qi deficiency. Early menstruation, heavy menstruation, light color and thin texture, mental and physical fatigue, palpitations, shortness of breath, empty lower abdomen, little food and loose stools. The tongue is pale and white, and the pulse is weak. The treatment is suitable for replenishing qi, absorbing blood and regulating menstruation. The preferred prescription is Guipi Decoction ("The Good Prescription for Women"). Ginseng (or Codonopsis pilosula) 10 to 15g, Astragalus 15g, longan meat and jujube kernels 12g each, Atractylodes macrocephala, Poria root, and Polygala root 10g each, Acosta sinensis, Angelica sinensis, and licorice 6g each, 3 slices of ginger, and 10 jujubes. For patients with heavy bleeding, add 30g of agrimony, 15g of cuttlefish bones, and 10g of donkey-hide gelatin to nourish the yin and stop bleeding; for those with excessive urination and loose stools, add 10g each of aphrodisiac and psoralen to stop diarrhea and cure diarrhea; for those with palpitations, Add 10g of Bai Ziren and 6g of Schisandra chinensis to nourish the heart and calm the mind.
The reference prescriptions are as follows.
① Juyuan Jian ("The Complete Book of Jingyue"). 10g each of ginseng and atractylodes, 15g astragalus, 6g licorice, and 3g cohosh (applicable to those with Qi deficiency or signs of collapse).
②Buzhong Yiqi Decoction ("Spleen and Stomach Theory"). 15g of astragalus, 10g each of ginseng and atractylodes, 6g each of angelica, tangerine peel, cohosh, and licorice, and 3g bupleurum (suitable for those with insufficient Qi).
(2) Yin deficiency and blood heat. Menstruation is heavy in the early stages, dark red or purple in color, and thick in texture. Irritability, red face and dry lips, thirst for cold drinks, short red urine, and dry stools. The tongue is red or falling, the coating is yellow and dry, and the pulse is slippery and rapid. Treatment should be to clear away heat, cool blood and regulate menstruation. The preferred prescription is Qingjing Powder ("Fu Qingzhu Nvke").
15g each of white peony root and Digupi, 10g each of Poria, Paeoniae, Artemisia annua and Rehmannia glutinosa, and 6g Phellodendron cypress. For heavy menstruation, add 30g each of Imperata cognac and lotus root joints, and 10g Rubia root to cool blood and stop bleeding; for those with dry mouth and throat, add 12g Polygonatum ginseng and 10g Ophiopogon japonicus to clear away heat and promote fluid production; for those with dry stools, add rhubarb (lower back) 6g, for purging heat and laxative.
The reference prescriptions are as follows.
① Qingre Zhixue Decoction (edited by "Obstetrics and Gynecology", Shanghai College of Traditional Chinese Medicine). 20g of fresh rehmannia glutinosa, 15g each of angelica charcoal, raw white peony root, sophora japonica, and eclipta grass, 30g agrimony, 12g paeonol, 10g fried cattail, and 8g cooked army charcoal (suitable for those with excessive heat and lower abdominal pain).
②Xianqi Decoction ("Principles of Syndrome and Treatment"). 15g each of Rehmannia glutinosa and white peony root, 10g each of Angelicae Sinensis, Cortex Phellodendri, Anemarrhenae, Scutellaria baicalensis and Cyperus rotundus, 10g donkey-hide gelatin (yanghua), 6g each of Coptis chinensis, Chuanxiong rhizome, mugwort leaf and Zhigancao (applicable to those with excessive menstrual flow).
(3) Liver meridian stagnation and heat. Menstruation is early, more or less heavy, purple or red in color, or has blood clots.
Distension and pain in the chest, flanks, breasts, and lower abdomen, upset and irritable, bitter mouth and dry throat. The face is red, the eyes are red, the tongue is red, the fur is thin and yellow, and the pulse is stringy and rapid. Treatment should be to clear the liver, relieve stagnation and regulate menstruation. The preferred prescription is Danzhi Xiaoyao Powder (Digest of Internal Medicine). 10g each of paeonol bark, gardenia, bupleurum, atractylodes, and poria, 12g each of white peony root and angelica root, 3g mint, and 3 slices of ginger. For those who suffer from rising liver fire, bitter mouth and dry throat, flushed face and red eyes, add 10g of Gentian grass to purge liver fire; for those with light menstrual flow and blood clots, add 20g of motherwort and 12g of Adenophora to nourish and activate blood; those with unstable mood For patients, add 15g of Albizia Julibrissin peel to relieve depression; for those with severe swelling and pain in the chest, flanks, and breasts, add 15g of orange and lychee cores each to harmonize Qi.
Reference prescription: Qinggan Dayu Decoction ("Re-edited Treatise on Febrile Diseases"). 12g each of white peony root and angelica root, 10g each of gardenia, chrysanthemum, and paeonol bark, 6g each of tangerine peel, bupleurum, licorice, and orange leaves, and 3g of mint (applicable to those with liver stagnation, fullness in the chest, and severe hypochondriac pain).
(4) Yin deficiency and internal heat. In the early stage of menstruation, the amount of menstruation is light or normal (there are also cases of heavy menstruation), with red color and thick matter. Flushing of both cheeks, fever in the afternoon, bone steaming and night sweats, and dryness and heat in the five cores. The tongue is red and dry, with little coating, and the pulse is thready and weak. Treatment should nourish yin, clear away heat and regulate menstruation. The preferred prescription is Liangdi Decoction ("Fu Qingzhu Nvke"). 30g each of Rehmannia glutinosa and Polygonatum ginseng, 15g each of Ophiopogon japonicus and white peony root, 10g each of Digupi and donkey-hide gelatin (yellow). 30g each of keel bone and oyster can be added to the recipe to consolidate Yang and consolidate Yin. For those with severe upset fever, add 10g each of turtle shell, artemisia annua, and whiteweed to reduce deficiency heat.
The reference prescriptions are as follows.
①Rehmannia glutinosa powder ("Suwen: Pathogenesis, Qi and Life-Proofing Collection"). 12g each of raw rehmannia, cooked rehmannia, and rehmannia glutinosa, 10g each of wolfberry, asparagus, astragalus, white peony root, and skullcap, and 6g of licorice (suitable for those with heavy menstrual flow and qi deficiency).
② Digupi Drink ("Yizong Jinjian"). 10g each of Rehmannia glutinosa, Radix Paeoniae, and Angelicae Sinensis, 12g each of Rehmannia Rehmanniae and White Peony Root, and 6g Chuanxiong (suitable for those with blood deficiency and heat).
(5) Kidney deficiency is not solid. Menstruation is early, more or less abundant, light in color and thin in texture.
Soreness in the waist and knees, dizziness, ringing in the ears, lack of energy, frequent urination, and dripping vaginal discharge. The tongue is light red, the coating is thin and white, and the pulse is thin and weak. The treatment is suitable for replenishing the kidneys and regulating menstruation. The preferred prescription is Bushen Guchong Pills ("Obstetrics and Gynecology", Hubei University of Traditional Chinese Medicine). 240g of Cuscuta, 90g of Dipsacus Dipsacus, Deer Jiao Shuang, Morinda officinalis, Eucommia ulmoides, Lycium barbarum, and Atractylodes, 60g of Angelica sinensis, 120g of donkey-hide gelatin and Codonopsis pilosula, 15g of Amomum villosum, 50 jujubes (pitted), and 150g of Rehmannia glutinosa. The medicine is made into fine powder, and the honey is made into pills. Take 6g each time, 3 times a day, stop taking during menstruation. For those with heavy menstruation, remove Angelica sinensis and add 60g of psoralen to strengthen the menstrual flow; for those with heavy menstrual bleeding and loose stools, add 20g of nutmeg and 20g of Evodia to warm and invigorate the spleen yang.
Note: This prescription was originally used to treat miscarriage caused by insufficient kidney qi and insufficient Chong and Ren. Clinical use has shown that it is also effective in treating early menstruation caused by insufficient kidney qi. For diseases caused by kidney deficiency, it is difficult to achieve full success overnight, so it is more appropriate to use pills to relieve the symptoms.
Reference prescription: Guyinjian ("Jingyue Complete Book"). Codonopsis pilosula 12g, Rehmannia glutinosa 15g, dodder 18g, yam and schisandra chinensis 6g each, cornus 10g, polygala and licorice 3g each (applicable to those with insufficient kidney yin and menstrual water that is advanced or not solid due to deficiency).
(6) Blood stasis and blockage. Early menstruation, dark purple color with blood clots, full pain in the lower abdomen that refuses to be pressed, abdominal pain relieved after the blood clots are discharged. The tongue is dark or has ecchymosis, and the pulse is thready or astringent. Treatment should be to activate blood circulation, promote stagnation and regulate menstruation. The preferred prescription is Taohong Siwu Decoction ("Yizong Jinjian"). 10g each of peach kernel and angelica root, 6g each of safflower and chuanxiong, 15g of rehmannia glutinosa, and 12g of white peony root. 10g of Panax notoginseng can be added to the prescription to promote blood circulation and stop bleeding. For those with qi stagnation, add 10g each of Cyperus rotunda and Wuyao to regulate qi; for those with heavy menstruation and obvious abdominal pain, add 9g each of cattail charcoal and pistil stone to remove blood stasis, stop bleeding and relieve pain.
Reference prescription: Shaofu Zhuyu Decoction ("Yi Lin Gai Cuo"). 10g each of Angelica sinensis, red peony root, Wulingzhi, and Yuanhu, 6g each of Chuanxiong, Puhuang, dried ginger, myrrh, cumin, and cinnamon (applicable to those who also experience cold symptoms).