| Menstrual disorder,as the most common gynecological disease,has been on the rise in recent years,posing a great physical and mental threat to women.If the treatment is delayed,or therapeutic error happens,it may cause amenorrhea,leakage,anemia,infertility and other diseases,and it could seriously affect the work and life of women.Therefore,the diagnosis and treatment of irregular menstruation of a certain type of syndrome differentiation and treatment and opinions witch come from physicians and scholars' s own experience are rich,but there is still a lack of systematic combing.In recent years,experts and scholars have found that TCM has its own unique advantages in the treatment of menstrual disorders,and the curative effect is remarkable.Therefore,in this paper,the development and evolution of the theory of diagnosis and treatment of irregular menstruation are studied in depth,and the theoretical framework of diagnosis and treatment of irregular menstruation in traditional Chinese medicine is constructed to guide the theoretical research and clinical diagnosis and treatment of irregular menstruation for supplying some beneficial helps.The thesis is divided into five parts:The first part is the introduction.From the perspective of research methods,the principles and methods of selection for literature materials were clarified.Literatures related to menstruation theory were collected and sorted out from medical books of the Pre-qin Dynasty,Han Dynasty to Qing DDynasties,including four classics of traditional Chinese medicine,official medical books,books on obstetrics and gynecology of the past dynasties,the comprehensive medical books,there are totally 59 ancient books were selected.Guided by theoretical principles,this study was carry out with philology,terminology,and the methods of frame theory comprehensively.Secondly,the core concept,the selectiing principles of each monograph,and the method of constructing the system of core concepts were defined.The second part is the historical origin and development of the theory of menstrual disorder.With the time dimension as the main axis,the theory of menstrual disorder in medical books of past dynasties is combed vertically.With the disease as the main axis,the pandect of menstrual disorder,and the development situations of disease names,etiology,pathology,syndromes and treatment of advanced menstruation,retarded menstruation,irregular menstrual cycle,menorrhagia,and hypomenorrhea were studied horizontally.The third part is the research on the core concepts of the theory of menstrual disorder.Based on the research methods identified by the 973 program,disease name,pathogenesis,syndrome and treatment of irregular menstruation are systematically combed and defined,totally 179 core concepts.construct the system of the core concepts of menstrual disorder diagnostic theory,define the connotation and extension of core concepts,deep the understanding and expression of the internal structure of the theoretical system of irregular menstruation.And according to the hierarchical relationship between the concepts,the core conceptual system of the theory of diagnosis and treatment of irregular menstruation is sorted out.The fourth part is the research on core monographs of menstrual disorder clinical theory.Select the representative and original monograph of ancient doctors on menstrual disorder,and make a deep understanding of their connotations;express and explain academic origin and value of them.The fifth part studies and collates the framework of the theory of diagnosis and treatment of irregular menstruation and various diseases in past dynasties,complete the construction of theoretical framework for the diagnosis and treatment of irregular menstruation,focusing on pathogenesis,and the etiology,pathogenesis,syndrome and treatment is complete.The followings are specific results of the research with synthesized the research above: 1.The evolution of the disease name of menstrual disorderThe name of the disease “menstrual disorder” was first recorded in the book “Prescriptions Worth Thousand Gold for Emergencies”,and it has been recognized that menstrual disorders include abnormal in menstrual cycles and menstrual volumes at that time.there appeared some diseases In the Song,Jin and Yuan Dynasties,such as " Yue Shui disoorder","Yue Hou disorder" and "Jing Hou disorder",but they were not standardized.In the Ming and Qing Dynasties,the names of diseases have been keep used basically as former dynasties,and fewer new names were created.The main reason is that during the Song,Jjin and Yuan Dynasties,the doctors gradually described various diseases with menstrual disorders as independent diseases by creating new separate names,and this has made great contribution to the nomenclature of various diseases.The disease name “advanced menstruation” was first recorded in the book “Annotation of Fu Ren Liang Fang”.In addition,there are some disease names like "Jing Xing advanced ","Jing Shui advanced","Jing Zao".And the disease name of “retarded menstruation” was first recorded in the book “Mi Yao of Gynecology”.And it was expressed as “period late” or “period retarded” by doctors.It was recorded as “the late of Yue Shui” or “Yue Shui retarded” in the book “General Records of Holy Universal Relief”.And there were some different disease names of “irregular menstrual cycle” like “before or after the period”,“disorder of menstruation”,“delay” or “irregular of menstruation”.Sun Simiao is the first doctor who used “the menstruation comes before or after the period” to describe the irregular menstrual cycle,and it was keep using by the most doctors in following dynasties.The earliest record of“disorder of menstruation” is found in “Jingyue Quanshu”,and “irregular of menstruation” was first recorded in “Fu Qingzhu Nuke”.The name of “delay” was first recorded in “Chan Yu Bao Qing Ji”,and also was recorded in “Hundred questions of Gynecology”,“Complete Effective Prescriptions for Women”,“The Standards of Diagnosis and Treatment of Gynecology” and “Golden Mirror of Medicine”,but it does not specifically refers to the irregular menstrual cycle.The name of "Delay" was mainly refers to the retarded menstruation before Song dynasty,and it became the collectively of advanced menstruation and retarded menstruation in “Synopsis of Treating Women's Diseases”.And the name of “before or after the period” is “delay” was certainly pointed out in “Golden Mirror of Medicine”,and it was keeping used by the following doctors,so the disease name of “delay” should be distinguished precisely.The disease name of “menorrhagia” was first recorded in “General Records of Holy Universal Relief”,but just considered as one kind of syndromes.Until Liu Wansu first presented the disease name of “menorrhagia” the menorrhagia became a special disease.The disease name of hypomenorrhea was first mentioned as “Jing Shui is scanty” in “The Pulse Classic” book,and the following doctors also used the word like “scanty”,“astringent and scanty” or “scanty much” to describe hypomenorrhea.2.The reason of menstrual disorderThe proposition during the Pre-Qin and Han Dynasty required that the meridians in the human body need corresponding with the nature,and the exogenous pathogenic factors of warmness and coldness could cause menstrual disorder.In the Jin and Tang Dynasty,doctors began to pay attention to the combination of exogenous and internal injuries.The earliest definite cause of irregular menstruation was the pathogenic factors of exhaustion,injury,Qi and blood,and exogenous wind and cold was found in “General Treatise on Causes and Manifestations of All Diseases”,and most doctors in the Song,Jin and Yuan Dynasties followed this theory.And the factors of emotional illness,pointing out that irregular menstruation can be caused by depression of mood,emotional disorder and depression of blood and qi was added by “General Records of Holy Universal Relief”.Since the Ming Dynasty,great breakthroughs have been made in understanding the causes of irregular menstruation.The damaged by excess of seven emotions,six exogenous pathogenic factors,eating disorders and living disorders that could cause irregular menstruation were first mentioned in “Nu Ke Cuo Yao”.The causes of irregular menstruation are attributed to seven aspects: emotion,fatigue,debility of Chong and Ren Channels,exogenous pathogenic factor,mistreatment,congenital weakness,sexual strain and so on were argued in “Jingyue Quanshu”,and the emotional pathogenicity is in the first place.In the “Golden Mirror of Medicine”,based on the theory of three-cause pathogenesis,it is considered that the external causes of menstrual diseases are mainly caused by cold,heat and wind pathogens,internal causes of menstrual diseases are mainly caused by seven emotions,and the pathogenic factors neither endogenous nor exogenous of menstrual diseases include spleen and stomach injury,sexual strain injury and excessive childbirth,etc.The advanced menstruation,retarded menstruation,irregular menstruation cycle,excessive menstruation and less menstruation become special diseases later because of the understanding of its etiology is mainly in Ming and Qing Dynasties and it is similar to the general etiology of irregular menstruation,with slight emphasis on each disease.3.The pathogenesis of irregular menstruationThe discussion on the pathogenesis of irregular menstruation was first seen in “Synopsis of the Golden Chamber”,for the first time,the author put forward the viewpoint that cold in blood,accumulates into uterus and cold injury meridians and collaterals due to deficiency,cold and Qi stagnation.The earliest theory of women's "blood-based,Qi-based" was proposed in “General Records of Holy Universal Relief”,and it is believed that the general pathogenesis of irregular menstruation depends on the disorder of Qi and blood,and the impairment of Chong and Ren channels;“Puji Benshi Fang” believes that the overwhelming and declining of Yin and Yang is an important cause of irregular menstruation,and both opinions were widely followed by later generations.Zhu Zhenheng emphasized the pathogenesis of phlegm is phlegmatic hygrosis and dampness from the aspect of constitution.Xue Ji first proposed the that the heart and spleen are peaceful and the menstruation will be normal,and this opinion has been accepted by later generations of physicians and widely used.Wanquan summarized the pathogenesis of irregular menstruation from three aspects: spleen deficiency,injury of Chong and Ren channels and fat-phlegm stasis.Generally speaking,the understanding of the pathogenesis of irregular menstruation is more accurate and abundant in the Qing Dynasty.The understanding of the pathogenesis of advanced menstruation began form Zhudanxi.He proposed that blood-heat,Qi and blood are both heat lead to advanced menstruation.Doctors of later generations mostly follow the theory of “advance menstruation due to blood heat”.“Wanshi Nu Ke” proposed that blood heat is divided into excess and deficiency of blood.And “Cang Sheng Si Ming”supplements the pathogenesis of qi deficiency.By the time till “Jingyue Quanshu”,a comprehensive overview of the pathogenesis of premenstrual menstruation depend on blood-heat and Qi deficiency,and blood-heat is divided into deficiency heat and excess-heat;Qi Deficiency is divided into deficiency of heart and spleen qi deficiency,spleen and kidney qi deficiency.During the Ming and Qing Dynasties,because of the influence of Vital Gate Theory,some doctors began to treat from kidney.It is believed in “Gujin Yitong Daquan” that the premenstrual menstruation is deficiency of kidney-yin and can not be maintained.And “Fu Qingzhu Nuke” pointed out that the pathogenesis was caused by excessive fire and water in the kidney,or by excessive fire and water deficit in the kidney.The understanding of the pathogenesis of delayed menstrual cycle also began in Zhu Danxi.He thinks that blood deficiency,blood-heat,phlegm-dampness and qi-blood deficiency can cause such disease.The “Take Charge of Human Body”suggested that the pathogenesis was clod of qi,blood deficiency and Qi adversity.“Jingyue Quanshu” points out that blood cold can be divided into exogenous cold evil and yang deficiency.“Fu Qingzhu Nuke” distinguishes excess-cold and insufficiency-cold according to the amount of menstruation.It is point out that delayed menstrual cycle with less menstrual blood volume is due to blood cold and insufficient.And delayed menstrual cycle with more menstrual blood volume is due to blood cold and excessive.Generally speaking,the understanding of the pathogenesis of delayed menstrual cycle can be summarized as blood deficiency,qi-blood deficiency,Yang deficiency,blood-cold,blood-heat,qi stagnation and phlegm-dampness.The understanding of irregular menstrual cycle is later.It can be summarized as deficiency of blood,deficiency of the kidney,deficiency of the spleen and liver depression."Wanshi Female" suggests that irregular menstrual cycle is caused by deficiency."Jingyue Quanshu" holds that the pathogenesis can be divided into deficiency of blood and deficiency of the kidney.Deficiency of the kidney can be divided into deficiencyof kidney-yang and deficiency of kidney-yin.“Fu Qingzhu Nuke” puts forward that the pathogenesis is stagnation of liver and kidney.“Yeshi Nuke ” and “Zhulinsi Nuke” believed that the pathogenesis lies in weakness of spleen and stomach.“Doctor's Mirror of Gusongyuan” believes that the pathogenesis lies in disorder of qi.The understanding of the pathogenesis of hypermenorrhea can be summarized as blood-heat,deficiency-heat,qi-deficiency,blood-deficiency and phlegm.“Danxi Xinfa”points out that phlegm is obstructed and blood does not follow the meridian and causes hypermenorrhea.“Wanshi Nuke”point out the pathogenesis of blood-heat.“Outline of Medicine” puts forward that the pathogenesis lies in deficiency-heat and Qi-deficiency.“Fu Qingzhu Nuke”point out that the metromenorrhagia due to deficiency of blood and bolood not returning to meridian.Early recognition of the pathogenesis of Hypomenorrhea.“Huang Di Nei Jing” earliest proposal the name of hypomenorrhea.It is pointed out that the pathogenesis is exhaustion of Qi and liver injury.“The Pulse Classic” points out that hypomenorrhea is caused by the loss of body fluid.Thereafter,doctors believed that the pathogenesis was deficiency of blood,phlegm congestion and cold accumulation.Generally speaking,it can be divided into two aspects: deficiency and excess.Deficiency includes insufficiency of kidney water,deficiency of blood,deficiency of middle qi,deficiency of Qi and blood,deficiency of yin and deficiency of yang.The excess includes phlegm coagulation,qi stagnation and liver injury,qi stagnation and blood stasis,fire sparkling body fluid and blood-cold stagnation.4.Treatment according to syndrome differentiation of menstrual disorderThe treatment according to syndrome differentiation of menstrual disorder can be divided into two aspects: treatment according to qi-blood and treatment according to Zang and Fu.Doctors of the past dynasties paid more attention to "nourishing blood and regulating qi",and developed a variety of therapeutic principles and methods.“effective prescriptions for universal relief” pointed out that it should adjust its Qi and blood,and peace is best.“Prescriptions for Succouring the Sick” points out that Qi and blood are treated together,but regulating qi is more important than regulating blood.“Synopsis of Treating Women's Diseases” points out that regulating menstruation should restrain qi.“A Profound Theory of Birth”points out that regulating menstruation is based on smoothing Qi and nourishing the blood.“Nuke Jinglun” summarize the predecessor's medical theory,put forward that "regulating menstruation and nourishing blood based on smoothing Qi","regulating menstruation should not precede nourishing blood,nourishing blood should not precede regulating qi".The treatment according to Zang and Fu can be divided into heart and spleen,kidney and liver.“Wanshi Nuke” points out that "regulating menstruation,regulating qi and tonifying the heart and spleen are the main methods".“Yizong Cuiyan” emphasizes that regulating menstruation should not consume its Qi,but should nourish the heart and the spleen.“Nuke Jinglun” points out that the regulation of menstruation is based on the principle of nourishing the spleen and stomach.Zhang Jiebin said that the key to regulating menstruation lies in invigorating the spleen and stomach for the source of blood and nourishing the kidney for the room of blood.Zhao Xianke put forward that "regulating menstruation must mainly nourish water" and "nourishing water should nourish fire".And the theory of tonifying kidney has been developed.Differentiating and treating irregular menses from liver is first seen in “Fuqingzhu Nuke”.5.Theoretical framework for diagnosis and treatment of irregular menstruationTo sort out the theoretical framework of diagnosis and treatment of irregular menstruation in terms of etiology,pathogenesis,syndromes and treatment.The core pathogenesis is “the pathogenic heat disturbs Chong Channel and Ren channel”,“Chong Channel and Ren channel is unstable”,“emptiness of Ren channel”,“block of Chong Channel and Ren channel”,“loss the function of contraction and expansion”,“dysfunction of Ren channel” and “disorder of Chong channel and Ren channel ”.The core disease syndrome is “blood heat syndrome”,“blood cold syndrome”,“Qi stagnation and blood stasis syndrome”,“phlegm obstructing syndrome”,“Yin deficiency syndrome”,“Yang deficiency syndrome”,“spleen deficiency syndrome”,“kidney deficiency syndrome” and “syndrome of stagnation of liver Qi”.The core therapy is “clearing away pathogenic heat and cooling blood”,“warming channel to nourish blood”,“improve blood circulation and disperse stasis”,“invigorating spleen and clearing damp”,“nourishing yin clearing heat”,“tonifying spleen and kidney” and “soothing liver-qi stagnation”.To form a theoretical framework for the diagnosis and treatment of menstrual irregularities.This study systematically combs the irregular menstruation and clarifies the origin,core concepts,core monographs and common diagnosis and treatment theory of TCM for irregular menstruation,and the clinical guiding value for the diagnosis and treatment of modern irregular menstruation is contained in this thesis. |
PDF Full Text Request