"If menstrual blood does not flow, it is due to the blockage of the Bao Mai." The blockage of the Bao Mai is often caused by kidney qi deficiency and the fact that "the menstrual blood all comes from the kidneys." It can also be caused by damage to the Chong and Ren meridians, leading to a blockage in the Ren meridian and a lack of abundance in the Chong meridian, making it difficult for the menstrual blood to flow on time. Therefore, there are three reasons for amenorrhea: kidney qi deficiency, imbalance in the Chong and Ren meridians, and abnormality in the Bao Palace. In addition, it can also be seen that liver imbalance, excessive dispersion, spleen deficiency leading to failure in transforming water and essence, insufficient qi and blood, and blood overflowing and causing amenorrhea.
Kidney Qi Deficiency - Nourishing the Kidneys is the Priority
When the kidney qi is deficient, there is insufficient transformation of Tian Gui, leading to blockage in the Ren meridian and lack of abundance in the Chong meridian, resulting in closure of the Bao Mai. When the kidney qi fails to transform, Tian Gui does not arrive, which is often the main cause of primary amenorrhea. If the kidney qi deficiency occurs after the menstrual cycle has started, causing the arrival of Tian Gui to cease, secondary amenorrhea occurs.
If kidney qi declines prematurely before menopause, Tian Gui will deplete early, resulting in cessation of menstrual flow before old age. Hence, ancient people said, "With inherent kidney deficiency, how can it be replenished and transformed into menstrual blood?"
The treatment of amenorrhea should focus on nourishing the kidneys. For patients with kidney deficiency and amenorrhea, common clinical symptoms include congenital malformation, history of serious illness, multiple childbirths and lactation, and history of excessive bleeding during menstruation. The treatment should mainly focus on nourishing the kidneys, and Yi Jing Tang can be used for conditioning.
Prescription: 30g cooked Rehmannia, 30g roasted Atractylodes, 15g Angelica sinensis, 15g roasted Chinese yam, 9g roasted white peony, 9g roasted sour jujube seed, 3g Bupleurum, 9g Eucommia, 9g Red ginseng, 6g Moutan bark.
Add Radix Astragali and Licorice for Qi deficiency. Add Radix Morindae Officinalis, Ligustrum lucidum, and Schisandra chinensis for Yin deficiency. Add Cinnamomum cassia, Epimedium, and Morinda officinalis for Yang deficiency. Also, timely add Chuanxiong, Salvia miltiorrhiza, Achyranthes bidentata, Persica, and safflower to promote blood circulation and regulate menstruation.
Imbalance in the Chong and Ren Meridians - Treatment Focuses on Promoting Flow
The Ren meridian is the sea of Yin meridians, and the Chong meridian is the sea of blood. If the blood sea is empty and there is no downward flow, menstruation will stop. Obstruction of the Chong and Ren meridians is often seen in cases of weak qi and blood, qi stagnation, blood stasis, cold congealing, and phlegm-dampness affecting the smooth flow of the Chong and Ren meridians, resulting in menstrual disorders and amenorrhea.
When there is damage to the Chong and Ren meridians causing amenorrhea, it is often associated with congenital malformation or damage to the Chong and Ren meridians due to multiple pregnancies or miscarriages. The physician Zhang Jingyue pointed out, "The deficiency in the Chong and Ren meridians cuts off their flow. To prevent them from withering, they must be nourished. To promote flow, they must be filled." The treatment should focus on nourishing the blood and flesh, replenishing essence and blood, and irrigating the Chong and Ren meridians. Gui Lu Er Xian Gao is commonly used for this purpose. As the Chong and Ren meridians are related to the kidneys, kidney-tonifying herbs can be added accordingly.
Prescription: 15g raw Rehmannia, 15g Angelica sinensis, 10g turtle shell glue, 10g deer antler glue, 10g Cistanche deserticola, 10g Ophiopogon japonicus, 10g Rehmannia glutinosa, 10g gelatin, 12g roasted white peony. It can also be taken with mutton and sheep kidney to enhance the therapeutic effect.
The treatment of amenorrhea caused by obstruction in the Chong and Ren meridians focuses on promoting flow. For qi stagnation and amenorrhea, Liver-soothing Qi Regulating Decoction is often used. For blood stasis and amenorrhea, promoting blood circulation and removing blood stasis is the key, and Ge Xia Zhu Yu Tang can be used. For cold congealing and amenorrhea, warm and unblock the meridians with Li Fang Wen Jing Tang. For phlegm obstruction and amenorrhea, treatment should focus on eliminating phlegm and dampness, regulating qi and blood, and promoting menstruation. Cang Fu Dao Tan Wan can be selected, and Angelica sinensis and Ligusticum chuanxiong can be added if necessary. For qi stagnation, blood stasis, cold congealing, and phlegm obstruction causing amenorrhea, it is important to pay attention to holistic treatment, combining dredging with tonification to ensure a regular and abundant menstrual flow.
Abnormality in the Bao Palace - Nourishing Qi Cultivates the Source
If there is an abnormality in the Bao Palace, its function cannot be fulfilled. The development of the Bao Palace is closely related to the essence of the kidneys. Insufficient kidney essence will result in stunted growth of the Bao Mai and a small and underdeveloped Bao Palace, leading to amenorrhea. If external pathogenic factors invade the Bao Palace, the flow of menstrual blood will be obstructed, resulting in stagnation and accumulation, and amenorrhea will occur. It is said, "Kidney stones are caused by cold air invading the Bao Palace. When the Bao Palace is closed, cold air cannot pass through, and the evil blood cannot be discharged. The stagnant blood remains, and it grows day by day, resembling a fetus. The menstruation does not come on time." For the treatment of Bao Palace abnormalities, it is related to kidney qi deficiency, so nourishing kidney qi to promote the development of the Bao Palace is the key. Kidney Qi Decoction is commonly used for treatment, with modifications based on the specific symptoms. It can be used to tonify qi and blood, relieve menstrual pain and promote blood circulation, or warm the meridians and promote circulation.
In addition, strengthening the spleen and cultivating the source is also a major principle for treating amenorrhea. Strengthening the spleen and nourishing qi and blood are the basis for the production of essence and transformation. Si Jun Zi Tang with modifications can be used for treatment. The prescription includes 15g Codonopsis pilosula, 15g roasted Atractylodes, and 12g Poria. Add Radix Astragali for tonifying qi and blood. For those with both qi and blood deficiency, use Si Wu Tang to tonify the Chong and Ren meridians. When the Chong and Ren meridians are regulated and the qi and blood are abundant, the transformation into menstrual blood can occur. If liver qi discomfort is observed clinically, the focus should be on regulating qi, promoting blood circulation, and unblocking the meridians. When qi and blood are smooth, menstruation can be expected to come on time.
