调周法在不孕症中的运用 Treating Infertility by Regulating the Menstrual Cycle Prof. Shulan Tang www.shulanclinic.co.uk
? How does the Yin and Yang wax and wane during the menstrual period? - Menstruation The Four Stages of Menstruation Pre- Period Post- Period 1 - - Menstrual Period Phase Extreme Yang transforms into Yin 2) - - Post Period Phase Yin waxes whilst Yang wanes At the end of this phase, the yin reaches its extreme point and yang reaches its lowest. 3 - - Ovulation Phase Extreme Yin transforms into Yang Ovulation Yang waxes to its extreme point and yin wanes to its lowest 4 - - Pre-period Phase Yang waxes whilst Yin wanes The entire process reiterates resulting in the menstrual cycle. Regulating menstruation should be based on closely monitoring these details. The reason of introducing the four phases is to gain the best possible affect from the prescriptions:
What s the difference between phases, and what are their treatment principles? Two waxing and waning phases are longer Where as the two of transforming phases are shorter Treatment during the phase of Yin-Yang transformation in the menstrual cycle. 1) - The transformation during the Menstruation Phase - Extreme Yang transforms into Yin.,,,, Treatment principle is to regulating blood and qi, Invigorate blood and regulate menstruation, Nourish Yin, and dispersing stasis Prescriptions: Ba Zhen Yi Mu Wan and/or Gui Shao Di Huang Wan Acupuncture Points: Ren4. Ren6. ST25. ST36. KI3. KI13(Qi Xue). KI14(Si Man) In the case of stagnation of qi and blood the transformation could be hindered resulting in scanty menstrual blood. The treatment should be rooted in the heart and the liver if the transformation is hindered due to stagnation of qi. + Ze Lan, Chong Wei Zi, Dan Shen, Xiang Fu, Chen Pi, Wang Bu Liu Xing + Liv3, HT7 Should the transformation be hindered by blood stagnation, the treatment should be based on resolving stasis and clearing the channels + Tao Ren, Hong Hua, Chuan Niu Xi + SP10, SP8 (Di Ji), SP6 Should both blood and qi stagnation exist, the Chong and Ren channels as the sea of blood, are unable to perform their function of consolidation and storage, it is then appropriate to reinforce the chong and to regulate menstruation. + Ji Xue Teng, Hong Zao, Xiang Fu, Xu Duan + Liv2, Liv14 ( Qi Men) Ren6 & Ren17 ( Tan Zhong ), ST36 & SP3 (Tai Bai)
2) 经间期的治疗 - Treatment during the Ovulation phase 补阴助阳 理气和血 补血通络 阴阳并补 The actual ovulation lasts only one day although the mid-cycle phase lasts about 3 to 5 days. Nu Ke Zhun Sheng quotes what Dr. Ken Tang Wang (王肯堂) a well known gynaecologist of Ming dynasty, said: There must be a day when ovulation occurs. It is usually observable that the vagina discharge is stilly when ovulation occurs.. Also, one might feel backache and fullness of the lower abdomen and these symptoms could last for 3 to 5 days. By using a conventional cervical smear test and urine test; ovulation can be verified. The basic body temperature should also reach the highest peak during this phase. Treatment principles: Nourishing Yin supplemented by assisting Yang and regulating Qi & blood. Invigorating blood and clearing channels supplemented by tonifying kidney, Nourishing Yin and Yang but more to Yang Prescriptions: 补肾调血汤 - Bu Shen Tiao Xue Tang: Dang Gui 10g Chi Shao 10g Bai Shao 10g Shan Yao 10g Sheng Di Huang 10g Mu Dan Pi 10g Fu Ling 10g Xu Duan 10g Tu Si Zi 10g 排卵汤 - Pai Luan Tang: Dang Gui 10g Chi Shao 10g Ze Lan 10g Xu Duan 10g Chong Wei Zi 10g Dan Shen 10g Hong hua 6g 促黄体汤 Cu Huang Ti Tang: Gui Ban 10g Dan Shen 10g Nu Zhen Zi10g Shao Yao 10g Tu Si Zi 10g Rou Cong Rong 10g Gou Qi Zi 10g Xu Duan 10g Xian Ling Pi 10g KI3, SP9, SP8, Lun9, ST25, ST36, Ren4, Ren6 Du4, BL23, B24, Du3 Should the transformation from Yin into Yang be hindered, resulting in overabundance of Yin, or Yin and Yang at the same level, the treatment should be emphasised on promoting blood circulation and clearing channels. + Chuang Xiong, Yi Mu Cao, Wang Bu Liu Xing, Xiang Fu. + SP10, Liv3
Treatment during the two phases of Yin -Yang waxing and waning in the menstrual cycle. The phase of Yin waxing arrives when the menstrual period end, it is called the post- period phase. Yang waxing is dominant when the basic body temperature has reaches its extreme, this phase is called the pre-period phase. The waxing and waning phases usually last relatively longer than the transformation phase. It is important to note that the waxing will result in Yin or Yang to reach their extremes during these two phase, the treatment plan should reflect this. 1) - Treatment during the post-period stage (Yin-waxing) The Yin waxes and the Yang wanes during the post-period phase. It is the phase that provides material basis for the menstrual cycle. The post-period phase normally lasts 7 to 10 days although 12 to 14 days is also possible. The Yin waxes during this phase from low to medium, then to high (end) in three stages. The low and medium stages are relatively longer than the high one. It is not uncommon to see more deficiency of Yin during the low and medium stages. Treatment Principle: Nourishing Yin and regulating blood, Tonifying Yin and regulating blood supplemented by tonifying Yang. Nourishing both Yin and Yang. Prescriptions: Gui Shao Di Huang Wan modification Dang Gui 10g Bai Shao 10g Shao Yao 10g Sheng Di Huang 10g Mu Dan Pi 10g Fu Ling 10g Ze Xie 10g Huai Niu Xi 10g Han Lian Cao 9g Xu Duan 9g Tu Si Zi 9g Ba Ji Tian 6g
- Modified recipe of Er Zhi di Huang Tang Plus Wu Zi Bu Shen Wan Nu Zhen Zi 10g Han Lian Cao 10g Xu Duan 10g Shao Yao 10g Tu Si Zi 9g Sheng Di Huang 10g Fu Pen Zi 10g KI3, Lun9, SP10, ST25, ST36, Ren 4, Ren 6, KI13, KI14, KI18, KI19 Should the patient have a overabundance of yin essence causing dampness and stagnation, modified recipe of Er Chen Wan (+ST40) to invigorate the spleen and disperse the depressed liver energy and to eliminate dampness and resolve the stagnation is used. For those with severe deficiency of spleen Yang: + Yin Yang Huo 9g, Xian Mao 9g + Du4, Du3, Bl 23, Bl24 For those who have over-abundance of Yang, showing liver-fire and damp-heat: + Jia wei xiao yao wan, Shi Re Ning Wan In some people there may be little waxing of Yin and waning of Yang resulting in Yin-Yang balance at very low level, Unable to progress as they should from the initial stage of the post-period phase, they usually have delayed menstruation or sometimes even amenorrhoea, The treatment in this case should start by tonifying Yin for 5 to 7 days and then warming Yang and assisting blood circulation so as to promote Yin- Yang waxing and waning. Prescription: Gui Shao Di Huang Wan Nuan Gong Yun Zi Wan Jin Kui Shen Qi Wan Acupuncture points: KI3, KI13, KI14, KI18, Ren4, Ren6, Sp10, ST36, Du4, Bl23, Bl24
2) ) - Treatment during the pre-period stage ( Yang Waxing) The Yang waxes and the Yin wanes during the pre-period stage. It usually lasts for 7 to 10 days, Again, it goes medium and high (end) resulting in Yang waxing to its extreme. The initial and medium stages are usually longer than the high(end) stage. Clinical evidence indicates that the Yang waxing may sometimes not reach it s Extreme. It is therefore essential to tonify mainly Yang so as to reflect the need of physiological process and to promote the normal progress of menstrual cycle. Treatment Principles Invigorating blood and tonifying Yang Tonifying Yin and regulating Liver Tonifying Yang and regulation liver together with regulating Qi and menstruation - Yu Lin Zhu modification Dang Gui 10g Tu Si Zi 10g Dan Shen 10g Bai Shao 10g Roug Cong Yong 10g Shan Yao 10g Ba Ji Tian 9g Mu Dan Pi 10g Xiang Fu 9g Fu Ling 10g Yu Jin 6g Xu Duan 10g Chen Pi 6g Should the yang be over abundant, causing heart and liver heat: + Jia Wei Xiao Yao Wan, Jin Ju Di Dan Wan + Lun 7, LI11, Lun9, KI3, Liv 3
What is the characteristics of the pathology and physiology during the ovulation part of the cycle, and what is the treatment principle? 1 Physiology Ovulation 2) Pathology Dysfunction of Ovulation a Anovulation b) Irregular Ovulation : 3) Key Points of Treatment During Ovulation a 10g, 15g, 9g, 5g. b 10g, 9 6
Note: 1 2 3 4 5
谢谢 Thank You Shulan Tang