Amenorrhea refers to the stop of periods for over 3 months. It appears after normal periods and is usually 16 years old. Before determining the diagnosis, rule out pregnancy, breastfeeding, menopause and pre-puberty.
Etiology / Pathology
Weak constitution or chronic diseases leads to kidney and liver deficiency and further cause qi and blood deficiency which causes Chong and Ren Channel to empty, eventually resulting in no blood flowing down. Stress (abnormal emotion) plus cold leads to qi and blood stagnation, finally causing Chong and Ren Channel blockage.
Diagnosis
The TCM diagnosis could be established with the special clinical manifestations discussed above.
Syndrome Patterns
1) Liver and kidney Deficiency
No periods over 3 cycles + delayed the first period or delayed periods, scanty periods + dizziness, tinnitus, sore back/knee; red tongue, thin and scanty coating; thin/weak/deep pulse
2) Qi and Blood Deficiency
No periods over 3 cycles + delayed periods or scanty and light pulse or amenorrhea; + pale complexion, dizziness, palpitation, shortness of breath, poor appetite; pale tongue, thin/white coating; weak/thin pulse
3) Qi and Blood Stagnation
No periods over 3 cycles + lower abdominal pain (worsened by pressure), irritability, anger, oppressed chest/hypochondriac region; purple spots/purple tongue, wiry/deep pulse
4) Cold and Damp
No periods over 3 cycles + lower abdomen pain (worsened by pressure, reduced by warmth), cold limb + slow and deep pulse, purple tongue with white coating
Treatment
1) Deficiency PatternsBasic Acupuncture points
BL20, ST36, SP6: nourish blood
BL23, RN4: tonify kidney
BL18, BL17: nourish liver blood
Modifications
Add DU4, KI 10 and yao yian, if sore knees and backache due to KI deficiency
Add BL 43 and KI 2, if tidal fever, night sweating due to KI yin deficiency
Add ST25, SP10 and RN12, if there is poor appetite and diarrhea due to spleen qi deficiency
Add PC 6, if palpitation2) Excess Patterns
Basic acupuncture points
RN3: remove blood stasis, regulate menstruation
SP8: cleft point, “a point for qi among points for blood”
LI4 + SP6: move qi and blood
LV3: soothe liver, move qiST40: resolve phlegm
Modification
Add RN6 and KI14, if abdominal distension
Add LV14 and SJ6, if chest/hypochondriac distension
Add RN4 and RN3, if chest/hypochondriac distension (acupuncture + moxa)
Add BL32, if leucorrhea
Other Treatment
1) Plum Acupuncture
jia ji hua tuo or back shu, lower abdomen;
2) Ear Acupuncture
kidney, liver, spleen, heart, endocrine, genital, subcortex; 3-5 points, 15～30 m; or seeds
Note: Acupuncture treatment for amenorrhea is a practical way in the clinic. For a successful treatment, a practitioner must identify its syndrome pattern, if possible, combine Chinese herbs for the treatment.