Dysfunctional uterine bleeding

　　Dysfunctional uterine bleeding is mainly caused by menstrual irregularities due to dysfunction of the nervous and endocrine systems. Normal menstrual cycles depend on the control of the central nervous system, the mutual regulation and restriction of the hypothalamus-pituitary-ovary reproductive腺 axis system. Any internal or external factors that interfere with the normal regulation of the reproductive腺 axis can lead to dysfunctional uterine bleeding.

　　14. Factors of systemic nature include adverse mental trauma, stress, malnutrition, endocrine and metabolic disorders, such as iron deficiency, anemia, aplastic anemia, blood diseases and hemorrhagic diseases, diabetes, thyroid and adrenal diseases.

　　13. Dysfunction of the HPO axis includes disorders of the rhythm of reproductive hormone release, dysregulation of feedback function, and dysfunction of ovulation and luteal function.

　　12. Factors related to the uterus and endometrium include abnormal structure and function of spiral arteries, microcirculatory vascular bed, endometrial steroid receptors, lysosomal dysfunction, abnormal local coagulation mechanism, and abnormal secretion of prostaglandins TXA2 and PGI2.

　　11. Iatrogenic factors include steroidal contraceptives, intrauterine devices that interfere with the normal HPOU axis function, and drugs for certain systemic diseases (especially those affecting the central nervous and nervous systems) that can affect normal menstrual function through neuroendocrine mechanisms.

　　Dysfunctional uterine bleeding is prone to complications such as anemia, infection, infertility, and endometrial adenocarcinoma.

　　7. Anemia: Due to long-term bleeding, anemia of varying degrees may occur, and some patients may develop severe anemia.

　　6. Secondary infection: Long-term uterine bleeding provides an opportunity for bacteria and viruses to invade, so DUB patients are prone to secondary pelvic infection, causing symptoms such as abdominal pain and abnormal discharge.

　　5. Infertility: DUB patients may become infertile due to anovulation or insufficient luteal function; in addition, anemia and pelvic infection are also causes of infertility.

　　4. Endometrial adenoma or endometrial adenocarcinoma of hyperplastic type: Patients with long-term anovulatory irregular uterine bleeding or those treated with estrogen for a long time should pay attention to whether the changes in the endometrium develop into adenomatous hyperplastic endometrium or endometrial adenocarcinoma.

　　The clinical manifestations of dysfunctional uterine bleeding (DUB) include irregular uterine bleeding, menstrual cycle disorders, prolonged bleeding time, increased menstrual blood volume, and even massive bleeding or continuous bleeding. According to the presence or absence of ovulation, DUB is usually divided into anovulatory and ovulatory types, with the former being the most common, accounting for 80-90%, mainly occurring during adolescence and menopause, and the latter more common in women of childbearing age.

　　1. Irregular uterine bleeding, the amount of blood varies from time to time, or suddenly increases. Long-term amenorrhea, with more bleeding that may last for several months. Cycles shorter than 21 days, intermittent bleeding.

　　2. Physical examination of the reproductive organs is normal, or both ovaries are symmetrically slightly enlarged.

　　3. Basal body temperature is unimodal.

　　4. Anemia symptoms excessive bleeding can cause anemia, severe cases may appear dizziness, palpitations, shortness of breath, fatigue, edema, loss of appetite and other phenomena.

　　5. Symptoms of excessive hormone excretion include breast tenderness, lower abdominal distension, emotional excitement, etc.

　　The preventive measures for dysfunctional uterine bleeding are as follows: two points:

　　1. Pay attention to menstrual hygiene:For girls in the青春期, the reproductive system is entering a period of development, and they are not mature enough. Therefore, at the time of menarche, they often neglect and may cause menstrual irregularities due to carelessness. Based on this, when choosing a menstrual pad, it is important to choose soft and easy-to-wash fabric. The used menstrual pad should be washed with soap water, boiled, dried in the sun, and then wrapped in clean cloth for storage. During the menstrual period, clean the external genitalia with clean warm water every day, wash from front to back, not from back to front, to avoid bringing bacteria from the anus to the external genitalia. During the menstrual period, avoid bathing in a basin or sitting in a bath, and can take a shower or wipe bath. The towel used to wipe the external genitalia should not be shared with others, nor should it be used for bathing or wiping feet, to avoid bringing bacteria into the vagina.

　　2. Enhance physical health, pay attention to diet:Functional uterine bleeding is mainly caused by endocrine system disorders, so in daily life, attention should be paid to increasing nutrition, eating more protein-rich foods, vegetables, and fruits. The body's resistance is weaker during the menstrual period, so avoid eating cold, spicy, and刺激性 foods. Eat foods rich in protein and vitamins. In life, combine work and rest, do not participate in heavy physical labor and intense activities, ensure adequate sleep, be cheerful, and do not allow unnecessary stress to affect the endocrine system over a long period of time.

　　For patients with long-standing dysfunctional uterine bleeding or anemia, a comprehensive physical examination is required to exclude systemic organic diseases. Gynecological examination usually shows no special findings, and sometimes the uterus may be slightly enlarged, or the enlarged ovaries may be palpable.

　　1. Diagnostic curettage is used for married women to understand the size and shape of the uterine cavity, whether the uterine wall is smooth and consistent in hardness, the nature and quantity of the material scraped out. The tissue scraped can be sent for pathological examination to make an accurate diagnosis.

　　2. Basal body temperature measurement shows a unimodal curve in anovulatory cases; a bimodal curve in ovulatory cases.

　　3. The cervical mucus crystalline examination shows fern-like crystals before the menstrual period, indicating anovulation.

　　4. The vaginal smear shows estrogenic effect in anovulatory dysfunctional uterine bleeding. In cases of insufficient luteal function, the lack of typical cell aggregation and creases reflects insufficient progesterone action.

　　5. Hormone testing, if it is necessary to determine ovulatory function and whether the corpus luteum is intact, estriol can be measured.

　　6. Hysterosalpingography can understand uterine cavity changes and exclude organic lesions.

　　7. Checking blood routine, coagulation time, and platelet count can understand the degree of anemia and exclude blood diseases.

　　For abnormal uterine bleeding, it is recommended to avoid eating cold and raw fruits and vegetables as well as spicy and刺激性 foods. With the need for body development, a large amount of energy is consumed, and it is necessary to increase nutrition to meet the needs of body development, and to supplement proteins, trace elements such as iron, copper, and zinc, as well as vitamins A, B vitamins, vitamin C, and vitamin E.

　　It is recommended to eat more green leafy vegetables and foods with hemostatic effects, such as qicai, huanghuangcai (fresh huanghuangcai should be steamed or boiled before eating to prevent colchicine poisoning), lianou, qincai, muer, as well as carrots, tomatoes, lily, fruits and vegetables rich in vitamins and cooling and calming properties. For those with deficiency, it is advisable to eat more foods with the effect of nourishing Yin and blood, such as shanyangrou, wuchicai, guiyuan, taizi, gouqi, and these nutrients are not only necessary for body development but also for the development of ovaries and gonads. Providing adequate nutrients plays an important role in promoting ovarian development and preventing the occurrence of functional uterine bleeding during adolescence.

　　Abnormal uterine bleeding belongs to the category of 'uterine hemorrhage' in traditional Chinese medicine. The main pathogenesis of this disease is due to the injury of the Chong and Ren meridians, which cannot retain the essence. The causes of the injury to the Chong and Ren meridians are mostly blood heat, qi deficiency, qi stagnation, and blood stasis, among which blood heat and qi deficiency are more common. In the 'Supplement to Danxi's Method', a medical text from the Ming Dynasty, the physician Fang Yezhi said: 'At the initial stage, stop the bleeding to stop the flow; in the middle stage, clear heat and cool the blood to clarify the source; in the late stage, replenish the blood to restore its original state. If only the flow is stopped without clarifying the source, the situation cannot be controlled; if only the source is clarified without restoring the original state, the yang will have no foundation to stand on. Therefore, it is necessary to treat the root and the branch without omission and maintain order throughout the process. 'Later physicians adopted the three major treatment principles advocated by him, namely 'stop the flow', 'clarify the source', and 'restore the original state', as the three major principles for treating abnormal uterine bleeding. Medicines such as Taiizi参, Shudi, Aiyi, Danggui, Qicao, Hanliancao, Ejiao, Xianhecao, Yimucao can be used in decoction. The dosage and quantity should be adjusted according to age, physique, and deficiency or excess.

　　1. Rapid hemostasis to treat the symptom, followed by the use of traditional Chinese medicine to treat the root cause

　　For patients with excessive blood loss, married individuals should undergo curettage, while unmarried individuals can use a 2ml compound estriol and 2mm phenylacetic acid estradiol intramuscularly, which can stop bleeding within 6 to 24 hours. Subsequently, 2ml of the compound estriol should be administered once a week as a maintenance dose for 4 weeks before discontinuing the medication. After止血 or reduction in blood volume, treatment should be tailored according to clinical manifestations and dialectical medicine. For those with blood heat, it is advisable to clear heat and consolidate the pulse; for those with qi deficiency, tonifying the spleen and reinforcing the qi are recommended; for those with kidney deficiency, reinforcing the kidney and consolidating the pulse can be considered; for those with blood stasis, methods for removing blood stasis and regulating the menstrual cycle should be employed. This method combines the advantages of Western medicine's rapid hemostasis and the stable and long-lasting efficacy of traditional Chinese medicine, creating favorable opportunities and conditions for treating the root cause of the disease. This integrated treatment method makes full use of the strengths of both Western and traditional Chinese medicine, resulting in satisfactory short-term and long-term efficacy.

　　2. Combined application of Qi consolidating and hemostatic drugs and antifibrinolytic drugs for the treatment of menorrhagia during puberty

　　Patients with menorrhagia during puberty, most of whom have irregular vaginal bleeding, continuous bleeding, or accompanied by anemia in clinical practice, and other symptoms are not obvious. The efficacy of Western medicine or traditional Chinese medicine alone is not ideal. The bleeding characteristics of menorrhagia during puberty are mostly large amounts of continuous bleeding. Due to large or long-term bleeding, Qi is lost with blood, and treatment should focus on tonifying Qi and consolidating the pulse to stop bleeding. In addition, the serum and menstrual blood of patients with menorrhagia have an increased amount of fibrinolytic products, which inhibit the closure of the tip of the spiral artery of the endometrial artery and the coagulation process, causing excessive bleeding. The use of antifibrinolytic drugs often has a good effect. Therefore, the disease can be treated with a combination of tonifying Qi, consolidating the pulse to stop bleeding and antifibrinolytic drugs. The method of tonifying Qi and consolidating the pulse to stop bleeding is based on the modified Guchong Decoction. Formula: 20g Baizhu, 35g Huangqi, 20g Longgu, 20g Muhua, 25g Baishao, 15g Qiancao, 15g Haishu, 25g Zongtan, 25g Diyu Tan, 15g Cebai Tan, 15g Daji, 40g Hongjiguan, 20g Xuuduan. Decoction for oral administration. Use Yunnan Baiyao 1g, three times a day, to take the above medicine. Antifibrinolytic drugs: 0.4g of tranexamic acid added to 40-50ml of 10% glucose solution for intravenous injection. You can also use 10mg of Angiostatin, twice a day by intramuscular injection, or 10mg of Angiostatin tablet, three times a day by oral administration. Both therapies are applied simultaneously. This method of integrated traditional Chinese and Western medicine is effective in treating menorrhagia during puberty.

　　3. Combine tonic and supporting therapy to enhance the body's ability to resist diseases

　　Patients with chronic or massive bleeding accompanied by anemia are physically weak, with insufficient vital energy, unable to absorb blood, and the Chong and Ren meridians are not stable, hence the symptoms are continuous bleeding without healing. Therefore, it is necessary to support vital energy and enhance the body's resistance, which is the foundation and a very important means of treating the disease, as the saying goes, 'When vital energy is within, evil cannot penetrate.' To support vital energy: commonly used are Ten-Complete Tonifying Soup (pill), Baizhen Soup, Ginseng Nourishing荣 Soup (pill), Spleen Nourishing Soup, Ginseng and Spleen Pill; Supportive therapy: adopt small doses, intermittent administration of fresh whole blood, 100-200ml each time, once a week, for 3 weeks, both methods are carried out simultaneously. Through the above treatment, the body's condition can be improved, and the next step of treatment can be carried out on this basis, which is mostly effective.