Dysmenorrhea Case

[Guest guest]

Group:

 

I would like some thoughts on diagnosis, Tx strategy and pronosis for

the following:

 

24 y.o. female presents with c/o dysmenorrhea. There is a 9 yr hx, on

birth control for last 6 years. She typically bled for 14 days prior

to the initiation of estrogen & progestin therapy. Since then her

bleeding has gradually decreased, currently she does not bleed. (Most

recent menses was light and pale.) Early this year she was diagnosed

with endometriosis and underwent lapascopic resection resulting in

elimination of pain for 5 months. The pain has now returned to pre-

surgical levels and she is obviously frustrated.

 

Other history includes seasonal allergies (taking Claritin prn),

moderate obesity, stools 2-3x/day (soft-formed) with regular bouts of

diarrhea (3x/month), no GERD Sx, Hx of hypoglycemia (managed

dietarily), IBS Dx'd in adolesence (no recurrence per her assessment,

but maybe some residual effects per mine).

 

Examination: Pulse: thin, deep, tight on left and slippery on right.

Tongue: pale, swollen, toothmarks; slimy, thin white coat.

 

Saw her once, did not palpate her abdomen for masses/response to

pressure, will next appointment.

 

Assessment: I believe she has an underlying spleen qi (perhaps yang)

deficieny and that the dysmenorrhea is due to blood stasis. I suspect

the etilogy of the dysmenorrhea is cold and dampness in the uterus. I

also believe the use of oral contraceptives for treatment has added

blood deficiency to the mix.

 

Tx Stategy: My thoughts are to tonify the spleen, warm the uterus,

disipate cold, dispel dampness, dispel the stasis, and tonify blood.

However I am not sure what to expect as she will most likely continue

to be on the oral contraceptives.

 

What are your thoughts?

[Guest guest]

Hi,

>Tx Stategy: My thoughts are to tonify the spleen,

warm the uterus,

disipate cold, dispel dampness, dispel the stasis, and

tonify blood.

However I am not sure what to expect as she will most

likely continue

to be on the oral contraceptives.

What are your thoughts?<

 

Basically, I think Your diagnosis and Tx didn¡¦t make

mistakes although You didn¡¦t provide prescription

here.

 

My thought is ¡§did she ever stop /intermittent her

oral contraceptives during pass six years?¡¨ Sometimes

People¡¦s organs are very lazy and mal-function if

there is some one take the place of.

 

Those oral contraceptives substitute the function of

ovary,and, uterus¡¦s function also count on ovary¡¦s

hormone, too.

 

If she did intermittent or stop use them for a long

while before,there is no wonder her ovary and uterus

are almost out of function and extremely

cold out there.

 

She might have to consider change her contraception.

 

Jean

 

 

 

 

 

 

 

 

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[Guest guest]

my experience with endometriosis is that there is always a degree of blood

stasis and dampness...therefore treatment is often long and

tenuous...acupuncture is quite useful for the pain, both emotional and

physical...herbs that move blood, coursing channels and colaterals(bugs,

vines) along with herbs that warm the uterus (wen jing tang w/ modifications)

are often VERY beneficial. The underlying cause whether it be deficiency or

excess must be determined. It must be made very clear to your patient that

she need s to be patient with the process because Chinese medicine is an

extremely successful modality with this presentation. In her mind she must be

willing to embrace the process for at least 3 months and most likely for long

term resolution a year. Diet is a BIG factor that will expedite her healing

process. Dairy, refined sugars and cold foods should be slowly decreased if

not eliminated from her diet until she can handle the absorption of it maybe

in the future. Especially dairy. Massage that helps stimulate sp/lv/kd like

AMMA therapy is a great modality to incorporate with the process. Moxa to CV

3 and gv 4 great for dysmennoreah. You should be very confident about

Chinese medicine in this presentation. Chronic menstrual problems, pain

etc...is very stressful, frustrating and depressing for the patient because

it's almost anticipated and guaranteed every 28 days...so there's also a big

emotional component with the anticipation of a few days of misery...it's as

though they plan for it.

good luck

susan schiff

[Guest guest]

Michael,

yes you can expect results while she's on bc pill...it will be just one more

hurdle that might make the process that much more difficult...she most likely

will NOT get the results she is looking for though FROM the bc pill. it is

usually prescribed to regulate hormonal fx, and influence the flow...minimize

pain and as a result...it's most likely a shot in the dark as most gyns don't

understand or care to specialize in this problem...most gyns want to deliver

healthy babies or do hysterecomies! (not to make broad sweeping generalities

or anything!)

susan

[Guest guest]

, Jeansu <jeansu009> wrote:

 

> > She might have to consider change her contraception.

>

> Jean

 

Jean:

 

Thanks for the response.

 

I didn't say this clearly before, but the oral contraceptives are

prescribed by her western doctor to treat the endometriosis, not to

prevent pregnancy.

 

In contemplating this issue further, the fundemental question in this

case for me is can I expect to get results with TCM if she continues

to take the contraceptives?

 

Thanks,

 

Michael Buyze

[Guest guest]

acuschiff wrote:

my experience with endometriosis is that there

is always a degree of blood

stasis and dampness...therefore treatment is often long and

tenuous...acupuncture is quite useful for the pain, both emotional

and

physical...herbs that move blood, coursing channels and colaterals(bugs,

vines) along with herbs that warm the uterus (wen jing tang w/

modifications)

are often VERY beneficial. The underlying cause whether it be deficiency

or

excess must be determined. It must be made very clear to your patient

that

she need s to be patient with the process because Chinese medicine

is an

extremely successful modality with this presentation. In her mind

she must be

willing to embrace the process for at least 3 months and most likely

for long

term resolution a year. Diet is a BIG factor that will expedite

her healing

process. Dairy, refined sugars and cold foods should be slowly

decreased if

not eliminated from her diet until she can handle the absorption

of it maybe

in the future. Especially dairy. Massage that helps stimulate sp/lv/kd

like

AMMA therapy is a great modality to incorporate with the process.

Moxa to CV

3 and gv 4 great for dysmennoreah. You should be very confident

about

Chinese medicine in this presentation. Chronic menstrual problems,

pain

etc...is very stressful, frustrating and depressing for the patient

because

it's almost anticipated and guaranteed every 28 days...so there's

also a big

emotional component with the anticipation of a few days of misery...it's

as

though they plan for it.

good luck

susan schiff

 

Very well put, Susan. This corresponds with my experience in working

with patients with endometriosis. With the oral contraceptive treatment

of the problem, we are masking the real situation, allowing it to slowly

worsen while suppressing the troublesome symptoms. It is a tough

case, but our patients need to choose if they want to invest the time and

go through the process with treatment of the root through acupuncture and

herbs or go the pharmaceutical way. We do not know how long-term

oral contraceptive use for this purpose (or for birth control) affects

kidney & spleen qi and the blood.

Frances

 

 

Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate academics

specializing in Chinese Herbal Medicine, provides a variety of professional

services, including board approved online continuing education.

 

 

[Guest guest]

Hi,Michael,

 

>Thanks for the response.

You are welcome.

 

 

>In contemplating this issue further, the fundemental

question in this case for me is can I expect to get

results with TCM if she continues to take the

contraceptives?

 

Of course,but the dosage must be bigger then usual

for gain the balance and this is not necessary.

If patient seeking TCM treatment,maybe she need

to stop the contraceptives threapy for a while

because it seems useless for the treatment.

 

The other doctors also provide their opinion for you.

And,they are all work ,too.

Warm up uterus and treat the blood stasis ,tonik

liver,Kidney yin/yang ,Chun-Mai and Zen-Mai ,ect,

the patient's Endo...will dispear,according to TCM

theory.Wen-Ching-San4-Hang2,Hou3-Xue-Hua4-Yu,All the

problem will gone.But it need time and patient because

the patient got 9 years hx.

 

Jean

 

 

 

 

 

 

 

 

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< ºô ¸ô ¥Í ¬¡¡EºÉ ¦b ©_¼¯ > http://www.kimo.com.tw

[Guest guest]

Hi,Michael,

 

This is another Herbal formula specially treat for

" endometriosis " .

 

Kei4-Jy-Fu2-Lin2-Wan2(form Jing-Kei4-Yo4-Lue4)

 

kei-jy+Fu-Lin+Dan-Pi+Tao-zen+Shuo-Yo+ white honey

become " Wan " .

Try Win-Jen-Tan + Kei4-Jy-Fu2-Lin2-Wan2

 

Maybe this formula can fit your expect:

" I expect to get results with TCM if she continues

to take the contraceptives? "

 

Do more reading and thinking before you use it.

 

Jean

 

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< ºô ¸ô ¥Í ¬¡¡EºÉ ¦b ©_¼¯ > http://www.kimo.com.tw