Dysfunctional uterine bleeding

　　1. Etiology

　　The causes of anovulatory dysfunctional uterine bleeding differ between adolescence and menopause. Anovulatory dysfunctional uterine bleeding in adolescence is often due to incomplete or delayed development of the hypothalamic-pituitary-ovarian axis, the establishment of a perfect positive feedback regulatory mechanism between the hypothalamus and ovary has not yet been achieved, under the action of pituitary follicle-stimulating hormone (FSH) and luteinizing hormone (LH), follicles develop and secrete estrogen, but estrogen has not yet formed a normal menstrual cycle FSH and LH peak positive feedback to the hypothalamus, so although there is follicular development in the ovary, ovulation cannot occur. Dysfunctional uterine bleeding in menopause is mainly due to the natural decline in ovarian function, the decrease in the number of follicles and the inability to mature, as well as a decrease in the response to pituitary gonadotropin hormones, leading to the cessation of ovulation when ovarian function declines and resulting in anovulatory dysfunctional uterine bleeding during menopause.

　　There are four causes of ovulatory dysfunctional uterine bleeding:

　　1. Deficient luteal function:There is follicular development and ovulation during the menstrual cycle, but insufficient secretion of progesterone or early luteal regression during the luteal phase leads to poor endometrial secretion.

　　2. Incomplete shedding of the endometrium:That is, due to incomplete involution of the corpus luteum, estrogen and progesterone cannot decline rapidly, and the endometrium cannot shed regularly due to the imbalance of hormone levels, causing the bleeding period to be prolonged, blood volume to increase, and also known as incomplete involution of the corpus luteum.

　　3. Prolonged endometrial repair:Due to the delayed or poor development of new follicles in the next cycle after the endometrial shedding during the menstrual period, the estrogen secreted is insufficient, causing the endometrium to be unable to regenerate and repair on schedule, leading to prolonged menstruation.

　　4. Ovulatory period bleeding:Due to the temporary drop in hormones during the ovulatory period, the endometrium loses the support of hormones and some endometrial shedding occurs, causing withdrawal bleeding. When sufficient estrogen is secreted, the endometrium is repaired and bleeding stops.

　　Second, Pathogenesis

　　Normal menstruation is controlled by the hypothalamus-pituitary-ovary axis. When the follicle develops and synthesizes estrogen, the endometrium proliferates; after ovulation, the corpus luteum forms in the ovary, synthesizes estrogen and progesterone; progesterone causes the proliferative endometrium to undergo secretory phase changes. If the ovulated egg is not fertilized, the corpus luteum regresses about 14 days after ovulation and stops secreting estrogen and progesterone; at this time, the endometrium loses the support of estrogen and progesterone and shrinks, the spiral arteries contract strongly, venous return slows, and endometrial ischemia and necrosis occur, causing the functional layer of the endometrium to shed and menstruate. At the same time, thrombi form at the ends of the spiral arteries in the endometrium, reducing blood flow, and a new follicular cycle begins and secretes estrogen, causing the endometrium to repair and stop bleeding. Therefore, the bleeding volume of normal menstruation is relatively constant and naturally stops bleeding.

　　If ovulation does not occur, the ovaries do not synthesize progesterone, and the endometrium proliferates under the action of a single estrogen. When the estrogen level can no longer maintain the thickened endometrium, part of the endometrium detaches and bleeds (breakthrough bleeding), one place is repaired and another detaches, causing continuous bleeding. Due to the lack of progesterone, the ends of the spiral arteries in the endometrium do not contract, causing excessive bleeding. If there are multiple open bleeding vessels in the area of endometrial shedding, the bleeding volume increases sharply.

　　The first menstruation of girls is often anovulatory, so functional uterine bleeding can occur during the first menstruation, or within 2 to 3 years after the first menstruation, or after regular menstruation.

　　Hyperthyroidism or hypothyroidism during adolescence can be accompanied by functional uterine bleeding. Experiments have found that when thyroid function is low, the metabolic rate of ovarian cells decreases, follicle development is poor, and estrogen secretion is insufficient. In human observation, when thyroid function is low, blood TSH levels rise, affecting the production of gonadotropins, leading to anovulation or insufficient luteal function. During hyperthyroidism, the secretion of ovarian hormones increases, the menstrual cycle shortens, or ovulation stops, the endometrium hyperplasia is prolonged, and functional uterine bleeding occurs.

　　Polycystic ovary syndrome may occur during adolescence, characterized by anovulation, manifested as amenorrhea or functional uterine bleeding. Some cases are accompanied by hirsutism, obesity, and (or) enlargement of both ovaries.

　　Adrenocortical hyperplasia during adolescence, due to increased androgens in the body, can also lead to functional uterine bleeding due to ovulatory disorders.

　　Most adolescent dysfunctional uterine bleeding is due to the incomplete development of the hypothalamus-pituitary-ovary axis. Mental stress or illness can easily cause functional uterine bleeding by disrupting the function of the hypothalamus-pituitary-ovary axis that has just matured.

　　Excessive blood loss and prolonged bleeding often lead to anemia. Some are accompanied by thyroid dysfunction, adrenal cortical hyperplasia, and polycystic ovary syndrome, etc.

　　1. Patients with menstrual disorders or excessive menstrual bleeding due to ovarian dysfunction may also have concomitant organic lesions.

　　2. Long-term irregular bleeding without ovulation, or long-term estrogen therapy, both require attention to changes in the endometrium, whether it develops into adenomatous hyperplastic endometrium or endometrial adenocarcinoma.

　　3. Complications include uterine fibroids combined with anovulatory dysfunctional uterine bleeding, which is particularly common during the menopausal period. If diagnosed early, treatment for menopausal dysfunctional uterine bleeding can prevent patients with uterine hypertrophy or small fibroids from undergoing surgery, and can also provide better conditions for surgery that is necessary (such as fibroids).

　　Anovulatory dysfunctional uterine bleeding patients can have various different clinical manifestations. The most common symptom in clinical practice is irregular uterine bleeding, characterized by menstrual cycle disorder. The duration of menstrual periods varies, blood loss is sometimes more and sometimes less, and even massive bleeding. Sometimes there is amenorrhea for several weeks or months, followed by irregular vaginal bleeding, which is often more severe and lasts for 2-4 weeks or longer, difficult to stop; sometimes it starts with irregular vaginal bleeding, or it can also manifest as cyclic bleeding similar to normal menstruation. There is no lower abdominal pain or other discomfort during the bleeding period, and anemia is often accompanied by excessive bleeding or prolonged bleeding. Gynecological examination shows that the size of the uterus is within the normal range, and the uterus is softer during bleeding.

　　First, classification of abnormal uterine bleeding

　　Dysfunctional uterine bleeding is classified according to abnormal uterine bleeding as:

　　1. Menorrhagia:Regular menstrual periods, prolonged menstrual periods longer than 7 days, or excessive menstrual blood loss greater than 80ml.

　　2. Excessive uterine bleeding:Irregular cycles, prolonged menstrual periods, and excessive menstrual blood loss.

　　3. Irregular uterine bleeding:Irregular cycles, prolonged menstrual periods, and normal menstrual blood loss.

　　4. Menorrhagia:Frequent menstrual periods, shortened cycles, less than 21 days.

　　Second, clinical classification

　　1. Anovulatory dysfunctional uterine bleeding is divided into two groups according to age.

　　(1) Pubertal dysfunctional uterine bleeding: seen in adolescent girls after menarche, due to the immaturity of the HPOU axis, which cannot establish regular ovulation. Clinical manifestations include irregular menstrual periods after menarche, irregular menorrhagia after short-term amenorrhea, prolonged menstrual periods, and persistent spotting, leading to severe anemia.

　　(2) Menopausal (perimenopausal) dysfunctional uterine bleeding: refers to dysfunctional uterine bleeding in women aged 40 or older around the time of menopause, with an increasing incidence of anovulatory dysfunctional uterine bleeding each year. Clinical manifestations include frequent menstrual periods, irregular cycles, excessive menstrual blood loss, and prolonged menstrual periods. 10-15% of patients present with severe irregular menorrhagia, metrorrhagia, and severe anemia. Endometrial biopsy often shows varying degrees of endometrial hyperplasia, so curettage is necessary, and special attention should be paid to excluding non-dysfunctional uterine bleeding caused by gynecological tumors (uterine fibroids, endometrial cancer, ovarian cancer, cervical cancer).

　　2. Ovulatory DUB is most common in women of childbearing age, partially seen in adolescent girls and women in menopause.Clinical classification includes the following types:

　　(1) Ovulatory menstrual disorders

　　① Ovulatory menstrual oligomenorrhea: Seen in adolescent girls. After menarche, the follicular phase is prolonged, the luteal phase is normal, the cycle ≥40 days, menstrual oligomenorrhea and oligomenorrhea, often a sign of polycystic ovary syndrome, rarely seen in women near menopause, often progressing to natural menopause.

　　② Ovulatory menstrual frequent occurrence: In adolescent girls, the ovary's sensitivity to gonadotropin is enhanced, causing accelerated follicle development, shortened follicular phase, frequent menstrual periods, but the ovulatory and luteal phases are still normal. If the patient is a menopausal woman, then both the follicular phase and the luteal phase are shortened and early menopause occurs.

　　(2) Luteal dysfunction

　　① Luteal insufficiency: That is, the corpus luteum regresses prematurely, with the luteal phase shortened to ≤10 days. Clinical manifestations include frequent menstrual periods, short cycles, menstrual bleeding before menstruation, menorrhagia, and infertility and early abortion. Endometrial pathology shows irregular maturation or incomplete secretion.

　　② Incomplete luteolysis: Also known as prolonged luteal function, meaning the corpus luteum cannot completely regress within 3-5 days, or the regression time is prolonged, or it continues to secrete a certain amount of progesterone during the menstrual period, resulting in irregular shedding of the endometrium. Menstrual periods are prolonged and continuous, and when combined with early regression of the corpus luteum, it presents with frequent menstrual periods and menorrhagia. It is more common in women after induced abortion or cesarean section, combined with uterine fibroids, endometrial polyps, and adenomyosis.

　　3. Menstrual mid-cycle bleeding:Also known as ovulatory bleeding. It often occurs with ovulatory pain, caused by ovulatory stimulation and estrogen fluctuations, resulting in small amounts of bleeding (1-3 days) and abdominal pain. Some cases have more bleeding and last until the menstrual period, forming pseudo-menstrual frequent bleeding.

　　1. Classification

　　Abnormal uterine bleeding caused by dysregulation of the neuroendocrine mechanism regulating the reproductive system is called dysfunctional uterine bleeding (abbreviated as DUB), which is a common gynecological disease, more common in adolescence and menopause. Western medicine divides it into ovulatory DUB (luteal dysfunction) and anovulatory functional DUB (follicular phase dysfunction) based on the degree of ovarian dysfunction.

　　1. Functional bleeding

　　Abnormal uterine bleeding can be excessive, insufficient, frequent, irregular, or post-menopausal bleeding. Among women with abnormal bleeding, about 25% are caused by organic diseases, while the remaining 75% are due to endocrine disorders that affect the regulation of the reproductive system. These hormones are produced by the hypothalamus and pituitary gland and are common in women of reproductive age. This type of bleeding is called functional uterine bleeding. Vaginal bleeding before puberty and after menopause are abnormal bleeding.

　　In medicine, abnormal uterine bleeding that occurs without organic lesions of the whole body or reproductive organs is called dysfunctional uterine bleeding, which is often abbreviated as DUB. DUB is divided into ovulatory DUB and anovulatory DUB, with anovulatory DUB being the most common, accounting for about 85%. Women can develop DUB from the onset of menarche to the end of menopause. Reports show that DUB in adolescence accounts for 20%, in the reproductive period 30%, and in the perimenopausal period 50%.

　　2. Vaginal bleeding caused by organic diseases

　　Vaginal bleeding can be caused by external genitalia and vaginal injury, sexual abuse, vaginitis (including infection caused by foreign bodies), uterine infection, or blood diseases with abnormal coagulation, such as leukemia, thrombocytopenia, etc. In addition, cancer and benign tumors, such as uterine fibroids, uterine adenomyoma, and ovarian tumors with hormone-secreting function, can also cause vaginal bleeding. Sometimes, the prolapse of the urethral opening can also cause bleeding.

　　3. Vaginal bleeding in different age groups

　　Age is an important factor in diagnosing uterine bleeding. Newborn girls may have a little vaginal bleeding within a few days after birth, which is due to the mother's estrogenic influence before birth and there is no need to worry. Vaginal bleeding during childhood may be due to the onset of puberty early (sexual precocity) (see Section 258). Pubic hair and breast development are signals of adolescent development. Sexual precocity may be caused by certain drugs, brain lesions, low thyroid hormone levels, or tumors of the adrenal glands and ovaries that secrete hormones. However, the etiology of many cases is still unclear.

　　Vaginal bleeding during childhood may be caused by excessive hyperplasia of the vaginal glandular tissue (vaginal adenosis), which may be related to the mother's use of diethylstilbestrol (DES) before birth. Girls with vaginal adenosis have an increased risk of developing vaginal cancer and cervical cancer later.

　　Vaginal bleeding in women of childbearing age may be caused by contraceptive measures such as oral contraceptives, progesterone, intrauterine devices, or pregnancy complications such as placenta previa. In addition, ectopic pregnancy, hydatidiform mole, endometriosis, cancer, etc., can also cause vaginal bleeding.

　　The most dangerous cause of postmenopausal vaginal bleeding is cancer, such as endometrial cancer, cervical cancer, or vaginal cancer. The most common non-cancerous causes of vaginal bleeding include thinning of the vaginal wall (atrophic vaginitis), thinning or hyperplasia of the endometrium, and endometrial polyps, etc.

　　II. Precautions

　　1. For those with a history of abortion, if there is amenorrhea or BBT rising for more than 14 days, urine or blood pregnancy test should be performed immediately for early diagnosis and treatment.

　　2. Maintain a cheerful spirit, a comfortable mood, and a balance between work and rest.

　　3. The traditional Chinese medicine cycle therapy is divided into four stages, and the formula and medicine should be selected according to the days of the menstrual cycle. The four basic formulas introduced in the book can be modified according to the differentiation and typing. If there are special situations such as common cold with fever or diarrhea during the medication period, adjust the medication or suspend the cycle treatment, and treat the superficial symptoms such as common cold and diarrhea first.

　　I. Physical examination

　　This includes general examination, gynecological examination, etc., to exclude systemic diseases and organic lesions of the reproductive tract.

　　II. Auxiliary diagnosis

　　1. Diagnostic curettage:In order to exclude endometrial lesions and achieve hemostasis, it is necessary to perform a complete curettage, scraping the entire uterine cavity. During curettage, attention should be paid to the size and shape of the uterine cavity, the smoothness of the uterine wall, the nature and quantity of the scraping material. To determine ovulation or luteal function, curettage should be performed within 6 hours of the onset of menstruation or before the menstrual period; for irregular vaginal bleeding, curettage can be performed at any time. Endometrial pathological examination may show proliferative changes or hyperplasia, without secretory phase appearance.

　　2, Hysteroscopy:Under hysteroscopy, the endometrium can be seen to be thickened, or it may not be thickened, with a smooth surface without tissue protuberances, but with congestion. Under the direct vision of hysteroscopy, the lesion area is selected for biopsy, which is more valuable than blind endometrial biopsy, especially for improving the diagnostic rate of early uterine cavity lesions such as endometrial polyps, submucosal fibroids, and endometrial cancer.

　　3, Basal Body Temperature Measurement:It is a simple and feasible method to determine ovulation. Basal body temperature shows a uniphasic pattern, indicating the absence of ovulation.

　　4, Cervical Mucus Crystalline Examination:The appearance of fern-like plant leaf crystals before menstruation suggests the absence of ovulation.

　　5, Vaginal Sloughing Cell Smear Examination:Smears generally show moderate to high estrogenic influence.

　　6, Hormone Testing:To determine whether there is ovulation, serum progesterone or urinary estradiol-2 can be measured. The medical history often reports a shortened menstrual cycle, infertility, or miscarriage during early pregnancy. Gynecological examination of the reproductive organs is within the normal range. Basal body temperature shows a biphasic pattern, but the temperature rises slowly after ovulation, with a low rise range, and the rise time only lasts for 9 to 10 days before it drops. The endometrium shows poor secretory response.

　　First, Diet and Food Therapy Recipes

　　1, Dendrobium and Jujube Chicken Soup:10 grams of Dendrobium officinale (sliced), 30 grams of jujube (with seeds removed), 1童子鸡 (with feathers and internal organs removed) cleaned, all placed in a steaming pot, boil until the chicken is tender and then take it for consumption.

　　2, Astringent Persimmon Peel Decoction:50 grams of astringent persimmon peel, 30 grams of codonopsis, 30 grams of Astragalus membranaceus. Boil in water, remove the residue, add a moderate amount of honey, and drink. Take twice a day.

　　3, Ginseng Stewed Turtle:One turtle (with intestines and impurities removed) cleaned and cut into pieces, 3 grams of ginseng, all placed in a steaming pot, boil until the turtle is tender and then take it for consumption.

　　4, Longan, Jujube, and Chinese Wolfberry Decoction:30 grams of longan, 20 grams of jujube, 20 grams of Chinese wolfberry, decocted for drinking.

　　5, Hairtail Turtle Shell Lean Pork Soup:50 grams of hairtail, 20 grams of turtle shell, 50 grams of lean pork. Put the turtle shell in a pot, add water and boil for 20 minutes, then add the hairtail and lean pork, cook until done and season for eating.

　　6, Hairtail and Job's Tears Soup:30 grams of hairtail, 30 grams of Job's tears, 50 grams of lean pork, boil and cook, season and eat as a side dish.

　　7, Horsehoof Powder:50 grams of horsehoof (or ox hoof) burned to charcoal and ground into fine powder, take 9 grams each time, 3 times a day, taken with plain salt water. Take for 1 to 3 days.

　　8, Brown Sugar and Black Fungus:120 grams of black fungus (soaked), 60 grams of brown sugar. Boil the black fungus first, then mix in the brown sugar. Take it all at once. Take for 7 days as one course of treatment. Suitable for functional uterine bleeding.

　　9, Corn Silk Pork Soup:15 to 30 grams of corn silk, 250 grams of pork. Boil the two ingredients together, eat the meat and drink the soup after the meat is cooked. Take one dose per day. Suitable for functional uterine bleeding.

　　10, Black Plum Paste:1500 grams of black plum. Add 3000 milliliters of water to the black plum, boil with charcoal fire, wait until the water evaporates to half, then add water back to the original amount, boil to a thick consistency, filter the residue with clean gauze, and bottle for later use. Add sugar to taste when taking, adults take 5 to 10 milliliters each time, diluted with boiling water, and take 3 times a day. It is suitable for functional uterine bleeding.

　　11, Pork Skin Jelly:1000 grams of pork skin, 250 grams of yellow wine, 250 grams of brown sugar. Cut the pork skin into small pieces, put it in a large pot, add an appropriate amount of water, stew over low heat until the meat skin is tender and the juice is thick and sticky. Add yellow wine and brown sugar, mix well, and stop heating when done. Pour into a porcelain bowl, cool, and use as needed. It has the effects of nourishing yin and blood, stopping bleeding. It is suitable for symptoms such as excessive menstruation, dysfunctional uterine bleeding, and all bleeding symptoms.

　　12, Black Plum Brown Sugar Soup:15 grams of black plum, 30 to 50 grams of brown sugar. Put black plum and brown sugar in a pot, add half a bowl of water, boil until half a bowl remains, remove the residue, and take it warm. It has the effects of nourishing blood and stopping bleeding, and beautifying the skin. It is suitable for symptoms such as excessive menstruation or dysfunctional uterine bleeding. (6) Chinese date stewed pork skin. 15 to 20 Chinese dates (with the seeds removed), 100 grams of pork skin. Clean the pork skin, cut it into small pieces, clean the dates, and put them in a steaming pot. Add a small amount of water, and steam until the pork skin is tender. It has the effects of strengthening the spleen and nourishing blood, increasing the luster and elasticity of the skin. It is suitable for treating spleen deficiency type metrorrhagia and physical weakness and other symptoms.

　　13, Ginger Juice and Rice Wine Clam Meat Soup:3 to 5 milliliters of ginger juice, 20 to 30 milliliters of rice wine, 150 to 200 grams of clam meat, an appropriate amount of cooking oil and salt. Clean the clam meat, fry it with peanut oil, add rice wine, ginger juice, and a little water, and boil until the meat is done. Add salt for seasoning. It has the effects of nourishing yin and blood, clearing heat and detoxifying, and moistening and softening the skin. It is suitable for symptoms such as excessive menstruation and physical weakness.

　　14, Two Fresh Juices:500 grams of fresh lotus node and 500 grams of fresh white radish. Clean the ingredients, crush them together, wrap them in clean gauze to extract the juice, and add an appropriate amount of rock sugar. It has the effects of clearing heat and cooling blood, stopping bleeding, and whitening the skin. It is suitable for symptoms such as excessive menstruation. Home remedy

　　15, Ginseng and Prepared Slices Chicken

　　Ingredients: 20 grams of prepared slices, 6 grams of ginseng, 100 grams of chicken.

　　Preparation: Cut the chicken into pieces, slice the ginseng, and steam with the prepared slices for 1 hour over water. Add a little salt.

　　Effect: Warm the kidney and consolidate the pulse, replenish qi and control bleeding.

　　Usage: Eat with meals.

　　16, Angelica and Earth Stewed Lamb

　　Ingredients: 500 grams of lamb, 15 grams of angelica sinensis, 15 grams of raw earth, 10 grams of dried ginger.

　　Preparation: Cut the lamb into pieces, put it in a pot, and add angelica sinensis, raw earth, dried ginger, soy sauce, sugar, cooking wine, etc., and simmer over low heat until the lamb is tender.

　　Effect: Warm the kidney and consolidate the pulse, regulate the menstrual cycle and stop bleeding.

　　Usage: Eat in small portions with meals.

　　17, Boiled Oyster Meat

　　Ingredients: 250 grams of fresh oyster meat, 500 milliliters of meat soup.

　　Preparation: Boil the meat soup, add oyster meat, and boil until it is done. Season with salt and monosodium glutamate.

　　Effect: Nourish yin and blood, clear heat and stop metrorrhagia.

　　Usage: Eat the meat and drink the soup.

　　18, Turtle and Worm Grass Soup

　　Ingredients: One turtle (about 500 grams), 20 grams of winter worm summer grass, 50 grams of lotus node.

　　Preparation: Remove the head and internal organs of the turtle, cut into pieces, and put them in a pot with winter worm summer grass and lotus node. Add an appropriate amount of water, simmer over low heat for 1 hour, and add seasonings.

　　Effect: Nourish yin and clear heat, consolidate the pulse and stop bleeding.

　　Usage: Drink the soup and eat the meat.

　　19, Rubia cordifolia turtle soup

　　Ingredients: 1 turtle, 30 grams of haliotis, 20 grams of rubia cordifolia.

　　Preparation: Scald the turtle with boiling water, remove the shell and internal organs, clean, cut into small pieces, and add haliotis, rubia cordifolia to the pot, add an appropriate amount of water, boil over high heat, then simmer over low heat for 3 hours, and season to taste.

　　Effect: Nourish Yin and cool blood, regulate menstruation and stop bleeding.

　　Usage: Eat and drink as desired.

　　20, Cuttlefish stewed black-bone chicken

　　Ingredients: 250 grams of cuttlefish, 1 turtle, 1 black-bone chicken.

　　Preparation: Remove the bones from the cuttlefish, remove the joints, claws, and internal organs from the turtle, scald with boiling water and remove the black skin, clean the feathers and internal organs of the black-bone chicken, and put them all into the pot. Add an appropriate amount of water, boil on high heat, then simmer over low heat for 1 hour until tender, and season with salt.

　　Effect: Nourish Yin and blood, remove blood stasis and regulate menstruation.

　　Usage: Eat with meals as desired.

　　21, Longan and lotus seed porridge

　　Ingredients: 20 grams of longan meat, 15 grams of lotus seed meat, 6 red dates, 30 grams of glutinous rice.

　　Preparation: Remove the kernel from red dates, add glutinous rice, longan meat, and lotus seed meat to the pot, add an appropriate amount of water, boil on high heat, then simmer over low heat until soft, and add sugar to taste.

　　Effect: Strengthen the spleen and Qi, nourish blood and stop bleeding.

　　Usage: Take 1 dose per day, can be eaten regularly.

　　22, Cuttlefish bone stewed chicken

　　Ingredients: 30 grams of cuttlefish bone, 100 grams of chicken.

　　Preparation: Cut chicken into pieces, crush the cuttlefish bone into beans, put the chicken and cuttlefish bone into a pot, add water and seasonings, and simmer over low heat for 2 hours.

　　Effect: Strengthen the spleen and Qi, nourish blood and control blood.

　　Usage: Eat with meals, remove the beak when eating. Take 1 dose per day, 5 days as a course.

　　23, American ginseng and astragalus pigeon soup

　　Ingredients: 5 grams of American ginseng, 15 grams of astragalus, 1 pigeon.

　　Preparation: Remove feathers and internal organs from the pigeon, stuff with slices of ginseng and astragalus, add an appropriate amount of water, steam over low heat for 1 hour, and season with a little salt.

　　Effect: Strengthen the spleen and Qi, elevate Yang and control blood.

　　Usage: Eat with meals.

　　24, Ginseng and cimicifuga porridge

　　Ingredients: 6 grams of ginseng, 3 grams of cimicifuga, 30 grams of glutinous rice.

　　Preparation: Boil the juice of the first two ingredients with glutinous rice to make porridge.

　　Effect: Tonify Qi, control blood, elevate Yang and lift the fallen.

　　Usage: Take 1 dose per day, for 1 week continuously.

　　25, Black fungus steamed chicken

　　Ingredients: 30 grams of black fungus, 200 grams of chicken.

　　Preparation: Soak black fungus in water, clean and set aside; cut chicken into small pieces, marinate with salt, soy sauce, cornstarch, sugar, and monosodium glutamate for 20 minutes, then mix with black fungus and steam over low heat.

　　Effect: Remove blood stasis and stop bleeding.

　　Usage: Eat with meals as desired.

　　26, Hawthorn and brown sugar water

　　Ingredients: 30 grams of hawthorn, 20 grams of brown sugar, 20 grams of motherwort.

　　Preparation: Put hawthorn and motherwort into a pot, add an appropriate amount of clear water, boil to extract the juice, add brown sugar, and continue to boil until the brown sugar is completely dissolved.

　　Effect: Activate blood circulation and remove blood stasis.

　　Usage: Take 1 dose per day, divided into 2 servings.

　　27, Panax notoginseng and lotus root egg porridge

　　Ingredients: Fresh lotus root in appropriate amount, 5 grams of powder of Panax notoginseng, 1 egg.

　　Preparation: Wash the lotus root clean and chop it, squeeze the juice with a cloth into 1 small cup, add a little water to boil, mix the powder of Panax notoginseng with eggs, pour into the lotus root juice to make a porridge, season with salt and lard.

　　Effect: Remedy blood stasis and stop bleeding.

　　Usage: The above is a single dose, take twice a day.

　　28. Motherwort cooked eggs

　　Formula: Motherwort 60 grams, eggs 2 pieces

　　Preparation: Boil motherwort and eggs together until cooked, remove the shell of the egg, and boil for a few more minutes.

　　Effect: Activate blood and regulate menstruation.

　　Usage: Take 1 dose a day, divided into two servings to eat eggs and drink soup.

　　29. Fresh lotus root and side柏leaf juice

　　Formula: Fresh lotus root 500 grams, raw side柏leaf 100 grams, honey 15 grams

　　Preparation: Clean the lotus root with the joints, squeeze the juice; stir and squeeze the juice of the side柏leaf. Mix the two juices, mix with honey, put them in a炖盅, steam for 5 minutes with low heat.

　　Effect: Clear heat, cool blood, and dissipate blood stasis to stop bleeding.

　　Usage: Drink as desired.

　　30. Water chestnut grass root juice

　　Formula: Water chestnuts 500 grams, fresh grass root 500 grams

　　Preparation: Peel and juice water chestnuts, wash the fresh grass root, cut into small sections, and squeeze the juice. Mix the two juices, put them in a炖盅, steam for 5 minutes with low heat.

　　Effect: Clear heat, cool blood, and stop bleeding.

　　Usage: Drink as desired.

　　31. Celery and lotus root slices soup

　　Formula: Fresh celery 150 grams, fresh lotus root 150 grams, cooking oil 250 grams

　　Preparation: Cut celery into sections, cut lotus root into slices. Heat oil in a pot, stir-fry celery and lotus root slices for a moment, then add 500 milliliters of water, and cook until done.

　　Effect: Clear heat, cool blood, dissolve blood stasis, and stop bleeding.

　　Usage: Take 1 dose a day, divided into two servings. 7 days is a course.

　　32. Dandelion instant drink

　　Formula: Fresh dandelion 2500 grams, sugar 500 grams

　　Preparation: Cut the fresh dandelion into pieces, boil it for 1 hour with medium heat, remove the residue and take the juice, then concentrate it with low heat into a paste. When warm, add sugar, absorb the medicine, cool it down, dry it, and grind it into powder, then put it into bottles.

　　Effect: Clear heat, cool blood, and stop bleeding.

　　Usage: Take 10 grams each time, pour boiling water, take it warm, three times a day.

　　33. Shepherd's purse and water spinach soup

　　Formula: Shepherd's purse 100 grams, water spinach 100 grams.

　　Preparation: Boil shepherd's purse and water spinach with an appropriate amount of water, add salt, vinegar, and sesame oil for seasoning.

　　Effect: Clear heat, cool blood, and stop bleeding.

　　Usage: Drink soup and eat vegetables.

　　Second, for dysfunctional uterine bleeding, what is good for the body?

　　1. It is advisable to eat nutritious and easily digestible foods, and eat more iron-rich foods:Such as animal internal organs like liver, black chicken, black fungus, longan meat, spinach, etc. fresh vegetables and fruits.

　　2. For those with属实热，it is advisable to eat more fresh vegetables, fruits, and low-fat foods:Including milk, soy milk, eggs, lean meat, liver soup, shepherd's purse, black chicken, persimmon cake, lotus root powder, parsley, water spinach, watermelon juice, pear, water chestnut, hawthorn, crucian carp, black fungus, chives, etc.

　　3. For those with spleen and kidney deficiency, it is advisable to eat more astringent and nourishing foods:Lentils, jujube, pork stomach, yam, litchi, white fungus, black fungus, black, yellow croaker, chives, chestnuts, pork kidneys.

　　4. Classification of nourishment:It is good to nourish the heart and spleen with rice, millet, wheat, lentils, yam, sesame seeds, lotus seeds, jujube, longan, etc.; to nourish the liver and kidneys with millet, wheat, yam, sesame seeds, chestnuts, walnuts, etc. For heat syndrome, it is advisable to choose millet, wheat, red beans, mung beans; for cold syndrome, it is advisable to choose rice, sorghum, lentils, dried fruits. Poultry and livestock have strong nourishing power, so they are suitable for both虚证者和实证者. Especially pork, beef, chicken meat, milk, eggs are of neutral nature, which can be eaten regardless of cold or heat. Water buffalo meat is especially suitable for nourishing the blood and stopping uterine bleeding.

　　5. Fruits are smoothing and not likely to cause blood leakage, and they also have a lot of tonifying effects:Such as sugarcane, apple, cherry, fig, banana, grape, persimmon, and angle can replenish the spleen, while mulberry can benefit the liver and kidney. When there is persistent and continuous bleeding for a long time, add Sour plum and hawthorn to achieve hemostasis.

　　III. Foods to avoid for dysfunctional uterine bleeding

　　1. For those with deficiency and coldness, pay attention to selecting warm-tonified foods among the tonifying foods, and avoid excessively warm and hot foods such as pepper, mustard, ginger, and cinnamon. For those with实证 and heat syndrome, it is strictly prohibited to use warm and hot foods.

　　2. Mutton, dog meat, and sparrow meat are warm in nature. Be cautious when using them for those with heat syndrome.

　　3. Avoid ginger, pepper, garlic, etc. when there is excessive bleeding.

　　I. Treatment methods for dysfunctional uterine bleeding disease in traditional Chinese medicine

　　1. Treatment method for spleen and kidney yang deficiency:Strengthen the spleen and warm the kidney to regulate the menstrual cycle.

　　Prescription: Modified Yougui Wan.

　　Shude 12g, Huaishan 10g, Shanyaoju 9g, Gouqizi 9g, Duzhong 10g, Susongzi 12g, Shufuzi 9g (pre-cooked), Danggui 9g, Lujiaojiao 12g (dissolved in boiling water), Additions and subtractions: for those with loose stools, add Paojiang 9g; for those with shortened luteal phase, add Huangqi 15g and Xianlingpi 10g; for infertility, add Shechuangzi 15g and Yejiaoweng 12g during the middle phase of the menstrual cycle, and remove Lujiaojiao; for those with insufficient menstrual amount and unsmooth menses, remove Lujiaojiao and add Guizhi 9g.

　　2. Treatment method for kidney and liver yin deficiency:Nourish yin and benefit the kidney to regulate the menstrual cycle.

　　Prescription: Modified Zuogui Wan.

　　Shengdi 12g, Huaishan 12g, Shanyaoju 9g, Susongzi 12g, Gouqizi 12g, Nuzhenzi 10g, Guibingjiao 12g (dissolved in boiling water), Shengbaishao 10g, Danggui 9g, Additions and subtractions: for those with unsmooth menses, remove Guibingjiao and add Chuanniuxi 10g; for those with early menstruation and excessive amount, add Huanliancao 15g; for those with incomplete luteal shedding and unclean menstrual blood, add Shuangqiong 9g and Sheng蒲黄 12g (packaged).

　　3. Treatment method for kidney deficiency and liver depression:Benefit the kidney and regulate the liver to regulate the menstrual cycle.

　　Prescription: Modified Duhuang Decoction.

　　Huaishan 15g, Ejiao 9g (dissolved in boiling water), Danggui 9g, Dabai Shao 12g, Shanyaoju 10g, Baijie Tian 10g, Chaihu 9g, Yujin 9g, Gouqizi 10g, Foshou pian 9g, Additions and subtractions: for those with liver depression and qi stasis and abdominal distension, add Chuanzi 9g and Zhike 10g; for those with lumbago and infertility, add Xianlingpi 9g and Susongzi 12g.

　　II. Western treatment methods for dysfunctional uterine bleeding disease

　　The principle is to achieve hemostasis, correct anemia, and restore ovulatory function. At the same time, treat the associated diseases.

　　1. Hemostasis

　　(1) Estrogen: promotes the growth of the shed endometrium to achieve the purpose of hemostasis. It is suitable for those with heavy bleeding and anemia.

　　① Estradiol benzoate: 2mg intramuscular injection, once every 6 to 8 hours, gradually reduce the dose as the bleeding decreases significantly, and change to oral estrogen when the dose reaches 1mg per day. After the hemoglobin level rises, add gestagen for 7 to 10 days, and then discontinue the medication to cause withdrawal uterine bleeding (also known as drug abortion).

　　② Diethylstilbestrol injection: 2mg intramuscular injection, the method is the same as above.

　　③ Combined estrogen injection: 25mg intravenous injection, once every 4 hours, for a total of 3 times.

　　④ Combined estrogen tablets: 1.25mg, once every 4～6 hours, until the blood volume is significantly reduced, then gradually reduce the dose to 0.625mg/day, and continue to add progestin for 7～10 days as above.

　　⑤ Diethylstilbestrol tablets: 2mg, once every 6～8 hours, reduction and addition of progestin methods are the same as above.

　　⑥ Ethinylestradiol tablets: 0.005mg/day, maintenance dose (after the estrogen dose is reduced for injection).

　　(2) Progestin: It turns the endometrium proliferated by estrogen into the secretory phase. After discontinuation of medication, the endometrium undergoes menstrual-like withdrawal bleeding, and the endometrium is repaired through the body's own estrogen to achieve hemostasis. It is suitable for patients with long bleeding time, less bleeding, and ineffective with estrogen alone.

　　① Progesterone injection: 20mg intramuscular injection, once/day, for 5～10 days continuously.

　　② Medroxyprogesterone acetate (Ankun Huangti) tablets: 10～16mg/day, for 7～10 days continuously.

　　③ Mestranol acetate (Funing tablets): 8～12mg/day, for 7～10 days continuously.

　　④ Norethindrone (Fukang tablets): 6～12 tablets/day (0.625mg/tablet), for 7～10 days continuously.

　　Norethindrone is a derivative of 19-nortestosterone, with progestational and weak androgenic effects, and a strong inhibitory effect on the hypothalamus and anterior pituitary. Long-term use may affect the recovery of the hypothalamus-pituitary-ovary axis function in adolescent girls, and should not be used excessively. The reason for not using contraceptives as the first choice is the same.

　　(3) Androgens: 25～50mg of testosterone propionate intramuscular injection can reduce uterine bleeding, but similar to norethindrone, adolescent girls should use it with caution or not at all.

　　(4) Hemostatic drugs: use in conjunction with the above medications.

　　① Phenolsulfonate (hemostatic agent): 1000mg intramuscular or intravenous injection, 2～3 times/day.

　　② Aminocaproic acid: 4～6g + 100ml of 5% glucose or normal saline, intravenous infusion 2～3 times/day.

　　③ Aminomethylbenzoic acid (antihemorrhagic acid): 0.1～0.25g intravenous injection or infusion, 3 times/day.

　　④ Yunnan Baiyao: 0.2～0.3g, once every 4 hours.

　　⑤ Use of Carbazochrome (Anlutard), vitamin C, and vitamin K may be considered as appropriate.

　　2. Correct anemia

　　(1) Blood transfusion: transfuse blood cells or whole blood when hemoglobin is below 8g.

　　(2) Supplement iron: oral or intramuscular dextrose iron.

　　(3) Supplement various nutrients.

　　3. Restore ovulatory function:This disease is a difficult and severe condition in gynecological clinical practice. Its treatment cannot be solely focused on stopping bleeding, as doing so may achieve temporary hemostasis but lead to recurrence later. Therefore, the focus of treatment should be on adjusting the menstrual cycle and promoting ovulation, so that the menstrual periods of adolescents and women of childbearing age become normal, and menopausal dysfunctional uterine bleeding can become normal menopause. For different patients, appropriate treatments should be adopted according to their conditions and requirements.

　　Restoring or establishing normal ovulatory menstruation is the fundamental treatment of anovulatory dysfunctional uterine bleeding. Treatment should be arranged immediately after hemostasis. However, it is difficult for young adolescent girls to establish ovulatory function, and the primary purpose is to prevent recurrence of bleeding.

　　The treatment of dysfunctional uterine bleeding also includes effective regulation, such as keeping warm during the bleeding period, maintaining the cleanliness and hygiene of the vulva, doing family planning well, taking effective birth control measures, and doing less or no induced abortion.

　　(1) Estrogen-progesterone therapy: Also known as artificial cycle, that is, simulating the regularity of hormone changes in the normal menstrual cycle. First use estrogen, then progesterone, and the endometrium will shed and bleed after stopping the drug. After the bleeding stops, the drug is repeated for 3-5 cycles. After stopping the treatment, the basal body temperature is measured. If it is bimodal, it indicates that ovulation has occurred and the treatment can be stopped. If it is unimodal, progesterone is used for 7-10 days per month.

　　This therapy is suitable for younger girls whose secondary sexual characteristics have not yet matured. Some children can establish ovulatory cycles after treatment.

　　(2) Progesterone therapy: When there is no spontaneous menstruation after the above treatment and the basal body temperature is unimodal, progesterone is used for 7-10 days per month, repeated for 3-5 months, and a few girls may have ovulatory menstruation. This method is suitable for older girls with well-developed secondary sexual characteristics.

　　(3) Ovulation-inducing drugs: In theory, ovulation-inducing drugs are the fundamental method to solve anovulatory dysfunctional uterine bleeding, but these drugs are all substitute treatments (such as gonadotropin-releasing hormone, menopausal gonadotropin, etc.). They are effective during treatment, but return to their original state after stopping the drug. For adolescent girls without fertility requirements, the application significance is not great. If the child cannot persist in artificial cycle treatment (such as severe medication reactions) or the condition is stubborn, clomiphene (clomiphene) can be selectively used to induce ovulation.

　　Clomiphene (Clomiphene) is a synthetic ovulation-inducing drug, taken 50mg at the early stage of the menstrual cycle, once a day for 5 days, ovulation occurs 5-10 days later, with an ovulation success rate of 80% in adult women. If it is ineffective, the dose can be increased to 200mg per day month by month.

　　4. Treat the associated diseases at the same time

　　The prognosis of dysfunctional uterine bleeding is generally good, but the focus of treatment should be on adjusting the cycle and promoting normal ovulation. Simple hemostasis will often recur.