Metro-menorrhagia

　　Caused by emotional depression, overwork, improper diet and rest after childbirth or post-abortion, irregular sexual life, and other factors leading to dysfunction of the two meridians of Chong and Ren.

　　1. Sudden metrorrhagia leading to collapse: prolonged metrorrhagia without stopping leads to deficiency of Qi and blood in the internal organs.

　　2. Deficiency of both Qi and blood: repeated attacks of metrorrhagia and menorrhagia lead to the loss of Qi with blood, resulting in deficiency of both Qi and blood.

　　3. Deficiency of both spleen and kidney: due to inherent spleen deficiency or excessive childbirth and room labor injury to the kidney, and improper diet, damage to the spleen and stomach, deficiency of both spleen and kidney, and inability to control blood leading to metrorrhagia and menorrhagia.

　　4. Yin deficiency of liver and kidney: due to endogenous Yin deficiency or excessive blood loss from serious illness, both essence and blood are deficient, leading to malnutrition of the Chong and Ren meridians.

　　5Blood heat: due to endogenous Yang excess or emotional disorders, the Qi stagnates and transforms into fire, injuring the Chong and Ren meridians.

　　6. Qi stagnation and blood stasis: Liver Qi stagnation, long-term blood stasis, blocking the uterus, new blood cannot return to the meridian, and blood that leaves the meridian wanders, leading to metrorrhagia and menorrhagia.

　　⑴Anemia: excessive blood loss in metrorrhagia can lead to pale complexion, pale lips, dizziness, drowsiness, shortness of breath, weakness, palpitations, insomnia with frequent dreams, and a thin and weak pulse, a series of anemia symptoms.

　　⑵Hypotension: if the onset of metrorrhagia is sudden and the bleeding is severe, the continuous bleeding can often lead to hypotension, with symptoms such as fainting, pale face, cold limbs, dripping sweat, shortness of breath, and rapid breathing, floating and large pulse without root or sinking and not visible, which is a critical condition. If not treated in time, it may be life-threatening.

　　⑶Pathogenic infection: manifested as lower abdominal pain that is difficult to press, back pain, thick and sticky leukorrhea, yellowish and foul-smelling or mixed colors, accompanied by irritability, thirst, yellow urine, dry stool, yellow greasy tongue coating, and thin and slippery pulse.

　　This disease is more common in adolescent and perimenopausal women. It is often caused by blood heat, deficiency of Qi, Yin deficiency of liver and kidney, blood stasis, and Qi stagnation, which damage the Chong and Ren meridians, leading to Qi deficiency in the Chong and Ren meridians. Treatment of metrorrhagia should prioritize hemostasis to prevent fainting and collapse. After the blood becomes less or stops, treatment can be based on the cause, that is, treating the symptoms urgently and the root slowly.

　　Metrorrhagia and menorrhagia are general terms for vaginal bleeding during non-menstrual periods. Clinically, vaginal bleeding is the main manifestation. Sudden onset with heavy bleeding is called metrorrhagia; while light bleeding or continuous bleeding is called menorrhagia. Vaginal bleeding caused by functional uterine bleeding, female reproductive organ inflammation, tumors, and other conditions in Western medicine all belong to the category of metrorrhagia and menorrhagia. Metrorrhagia and menorrhagia are a relatively serious and complex symptom in women's menstrual diseases.

　　This disease is more common in adolescent and perimenopausal women. It is often caused by blood heat, deficiency of Qi, Yin deficiency of liver and kidney, blood stasis, and Qi stagnation, which damage the Chong and Ren meridians, leading to Qi deficiency in the Chong and Ren meridians. Treatment of metrorrhagia should prioritize hemostasis to prevent fainting and collapse. After the blood becomes less or stops, treatment can be based on the cause, that is, treating the symptoms urgently and the root slowly.

　　⑴注意身体保健。要增加营养，多吃富含蛋白质的食物以及蔬菜和水果。在生活上合理安排工作和休息，不参加重体力劳动和剧烈运动，保证充足的睡眠，保持精神愉快，避免在思想上产生不必要的压力。这对功血崩漏的预防和治疗非常有效。

　　⑵止血药物的应用。止血方法有两种：一种是使子宫内膜脱落干净，可注射黄体酮；另一种是使子宫内膜生长，可注射苯甲酸雌二醇。再使用一些止血药物，如云南白药、安络血、维生素K、止血酸和止血敏等，一般都可以达到治疗功血崩漏的目的。

　　⑶ Restore ovarian function and regulate the menstrual cycle. Generally, drugs such as dienestrol are taken continuously, 0.5-1 gram per day, for 20 days, with an increase in intramuscular injections of progesterone to 20 milligrams in the last 5 days of medication. Generally, for adolescent functional uterine bleeding, with the growth of age and reasonable treatment, it can be cured quickly. For ovulatory functional uterine bleeding, injection of chorionic gonadotropin before ovulation can be expected to regulate the menstrual cycle.

Uterine bleeding and leukorrhea specifically refers to menstrual cycle disorders with vaginal bleeding resembling a flood or leakage, including metrorrhagia and menorrhagia. It is more common in adolescent and perimenopausal women, and no tumors or other lesions are found during examination.

2. Other diseases besides uterine bleeding and leukorrhea that cause abnormal vaginal bleeding often include:

⑴ Excessive vaginal bleeding with a palpable mass in the lower abdomen is often hydatid disease.

⑵ Vaginal bleeding in confirmed pregnancy can be seen in fetal leakage or ectopic pregnancy.

⑶ Postpartum vaginal bleeding, with a large amount of bleeding, is divided into new postpartum hemorrhage, hemorrhexis, and late postpartum hemorrhage; with a small amount of intermittent bleeding, it is postpartum lochia that does not stop.

⑷ Uterine bleeding and leukorrhea with systemic subcutaneous hemorrhage and fever should consider diseases such as purpura, purpura, and blood stasis disease.

⑸ Slight vaginal bleeding between two menstrual periods (i.e., the nebula period) with an increase in leukorrhea is intermenstrual bleeding.

⑹ Vaginal bleeding caused by injury, with identifiable injury causes, is called female genital injury.

⑺ With multiple bleeding sites throughout the body and difficulty stopping bleeding without fever, it may be blood effusion disease.

⑻ Middle-aged and elderly women with intermittent vaginal bleeding, malodorous leukorrhea, or blood streaks, should be suspected of uterine cancer and other possible conditions.

3. Routine gynecological and obstetric examination should be considered as an essential diagnostic measure.

4. Routine blood tests, blood biochemistry tests, and if necessary, spinal fluid and cell culture tests can be performed.

5. Abdominal X-ray, ultrasound, CT scan, etc., can help determine the location of the disease and make an accurate diagnosis.

　　(1) Uterine bleeding and leukorrhea caused by Qi deficiency is mainly due to weakness of the body or overwork, which often leads to unceasing vaginal bleeding. Such patients should eat more nutritious foods such as beef, eggs, pork liver, spinach, and soy milk.
　　
　　(2) Uterine bleeding and leukorrhea caused by blood heat is often due to internal heat, excessive consumption of spicy and hot foods, or exposure to pathogenic heat, leading to excessive vaginal bleeding. In this case, it is advisable to eat more fresh vegetables, fruits, eggs, and legumes in the diet.
　　
　　(3) Uterine bleeding and leukorrhea caused by Qi stagnation and blood stasis is often due to liver Qi stagnation and mental stimulation, and it is advisable to eat more foods such as tangerines, luffa, fresh lotus root, honey, and water chestnuts in the diet.
　　
　　(4) Uterine bleeding and leukorrhea caused by kidney deficiency should be treated with kidney-nourishing foods such as black fungus, chives, goji berries, chestnuts, pork kidneys, shrimp, and jellyfish.
　　
　　(5) For those with persistent and unceasing uterine bleeding and leukorrhea, slightly consuming sour foods such as plum juice, strawberry, hawthorn, and lemon juice can help stop bleeding.
　　
　　(6) Regardless of the cause of uterine bleeding and leukorrhea, to prevent anemia, it is advisable to frequently consume high-iron foods such as the livers of various livestock and poultry, black-bone chickens, black fungus, longan meat, amaranth, spinach, and amaranth, etc.

　　⑴Hemostasis

　　①Progestin drugs: Medroxyprogesterone acetate,妇宁片, or妇康片, taken orally. For those with prolonged amenorrhea and thickened endometrium, concurrent use of testosterone propionate, 25mg/day for young people, 50mg/day for the elderly, injected intramuscularly for 3-5 days. Suitable for patients with hemoglobin greater than 6g and menopausal dysfunctional uterine bleeding.

　　②Estrogen preparations: Diethylstilbestrol 2mg, once every 6-8 hours, reduce the dose by 1/3 after 3 days of bleeding, maintain a dose of 0.5mg/day, until 20 days after the bleeding stops. Or use estradiol benzoate 2mg, injected intramuscularly every 6-8 hours, using the same decreasing method as above, and switch to oral diethylstilbestrol after the bleeding stops. Suitable for adolescent dysfunctional uterine bleeding patients with significant anemia and acute massive hemorrhage.

　　③Other hemostatic drugs: Such as Angiostasin, hemostatic sens, hemostatic acid, vitamin K, etc., but the effect is not ideal, so it is only used as an auxiliary measure for hemostasis.

　　⑵Adjust the menstrual cycle (used after the bleeding stops).

　　①Artificial menstrual cycle therapy (see Oligomenorrhea).

　　②Combined estrogen-progestin therapy: Generally use oral contraceptives, take as for contraception, suitable for those of childbearing age without childbearing requirements.

　　③Progestin Therapy: Inject 20mg of progesterone daily 1-2 days before the next bleeding or after the bleeding starts, for a total of 3 days, or take oral medroxyprogesterone acetate,妇摩片, etc. For menopausal dysfunctional uterine bleeding, take for 3 cycles in a row.

　　⑶Restore ovulatory function, which is the fundamental measure for treating anovulatory dysfunctional uterine bleeding in adolescents and childbearing age.

　　①Clomiphene (see Menstrual Frequency).

　　②Tamoxifen (see Menstrual Frequency).

　　③Chorionic Gonadotropin; Injected intramuscularly every other day at 5000-10000IU on days 16-18 of the menstrual cycle, for a total of 2 times.

　　④Gonadotropin-Releasing Hormone: Administered continuously in pulse form during the middle of the menstrual cycle, 5mg per day, for a total of 3 days.

　　⑷Induced Menopause: For menopausal and elderly women, use methyltestosterone 5-10mg/day, or cottonphthalide drugs to suppress the endometrium, so that menstruation gradually decreases until menopause.

　　⑸Hysterectomy: Used for severe patients who are ineffective with conservative treatment and do not require fertility.