No+Menstrual+Period,+Amenorrhea

//Western Diagnosis// absence of menstruation

1. absence of menarche by age 16 1. absence of menstruation for > 3 months in women with previous menses
 * Primary**
 * Secondary**

Normal menstruation
1. 25-31 days for 65% of women 2. can be 18-40 days 3. once pattern established, variation usually not greater than 5 days 4. menses 3-7 days, usually 5 5. 130 ml blood loss, range from 13-300 ml

Signs & Symptoms
1. try to find hormonal changes 2. hirsutism: inc in sexually stimulated hair 3. virilization ---masculinization ---hirsutism ---temporal balding ---voice deepening ---inc muscle mass ---clitoromegaly ---inc libido 4. defeminization ---dec breast size ---vaginal atrophy 5. galactorrhea - nonpuerperal lactation 6. polycystic ovary syndrome (Stein-Leventhal Syndrome) ---chronic anovulation ---unopposed estrogen ---[increased androgens - testosterone; glucose and insulin mayv play a role, too much insulin as stimulated by the androgen. Increasing insulin resistance changes the pattern] ---amenorrhea, hirsutism, obesity ---may present with irregular profuse uterine bleeding and no other sxs or sns

Diagnosis
1. x-rays of sella turcica for pituitary tumors 2. CT scan, MRI 3. many hormonal tests 4. ultrasound: see greater than 12 cysts, 2-9mm. in diameter

Treatment
-Metformin is the standard treatment currently to address insulin levels -Oral contraceptives used to be used -Removal of the ovaries -Medications to initiate menstruation -Aldactone/Spironolactone [a diuretic that blocks testosterone] -Chromium -study of 3 women 1000mg./day changed insulin resistance

Serum hormone binding globulin (SHBG) found in flax seed meal may theoretically bind testosterone. -Soy: seems to increase SHBG which would bind estrogen. No studies, theoretical.

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====================================================================================== //TCM Pathology// Defined as 3 months without menses It is considered primary amenorrhea menses has not occurred at all after the age of 18 years old, females tending to be thin and tall are more likely to begin menarche at a later age. If menses has occurred in the past and no longer occurs it is considered a secondary amenorrhea

TCM Etiology and Pathogenesis
-Deficiency of Kidney & Liver -Deficiency of Qi & Blood -Yin deficiency & blood dryness -Qi stagnation & blood stasis -Obstruction of phlegm-dampness

Essentials of Diagnosis
-Disease history -Physical examination

Differential Diagnosis
-Early Pregnancy

Deficiency of both Liver & Kidney
Absence of menstruation after 18 y/o, amenorrhea following delayed menstruation w/ little menstrual flow, general weakness, poor development, dark complexion, dizziness, tinnitus, soreness/weakness of loins & knees, insomnia, amnesia [Shu Di Huang (10g.), Shan Zhu Yu (10g.), Shan Yao (10g.), Tu Si Zi (10g.), Du Zhong (10g.), Fu Ling (10g.) ,Dang Gui (8g.), Gou Qi Zi (10g.)]
 * Tongue:** pale red tongue; little coat
 * Pulse:** Deep, weak, thin, choppy
 * Treatment Principles:** Supplement kidney, nourish liver, regulate periods
 * Acupuncture:** //BL-18, BL-23, CV-4, LR-3, SP-6, KI-3;// CV-6, BL-17, LR-8, ST-36, KI-13, LU-7, KI-6
 * Herbal Treatment:** Gui Shen Wan

Qi & Blood Deficiency
Progressive delayed menstruation w/ scanty, light & thin menstrual blood, followed by amenorrhea, dizziness, blurred vision, palpitations, shrtness of breath, listlessness, lethargy, lusterless face & hair, pale lips [Ren Shen, Huang Qi, Bai Zhu, Fu Ling, Chen Pi, Zhi Gan Cao, Dang Gui, Bai Shao, Shu Di Huang, Wu Wei Zi, Yuan Zhi, Rou Gui]
 * Tongue:** pale tongue, thin white coat
 * Pulse:** deep, fine, weak, slow
 * Treatment Principles:** Supplement Qi, Nourish blood, regulate periods
 * Acupuncture:** //SP-6, ST-36, CV-6, LR-8, BL-17, BL-18, BL-20//; BL-23, CV-4
 * Herbal Treatment:** Ren Shen Yang Rong Tang

Yin Deficiency & Blood Dryness
Hypomenorrhea followed by amenorrhea, red cheeks, tidal fever, night sweating, 5-palm heat or tidal fever, steaming bone heat, cough w/ hemoptysis, dry mouth & throat [Sheng Di Huang, Shu Di Huang, Mai Men Dong, Zhi Mu, Bai Shai, Di Gu Pi, Gan Cao]
 * Tongue:** red tongue; little coat
 * Pulse:** fine & rapid
 * Treatment Principles:** Nourish Yin, clear heat, regulate periods
 * Acupuncture:** //BL-17, BL-23, CV-4, SP-6, KI-3, KI-6;// KI-13, CV-6, BL-20, KI-2, LR-8, ST-36
 * Herbal Treatment:** //Jia Jian Yi Yin Jian//

Qi Stagnation & Blood Stasis
No period for several months, emotional depression or irritability, distention & fullness in the chest & costal region, distending pain w/ tenderness in the lower abdomen, or abdominal fullness [Tao Ren, Hong Hua, Dang Gui, Sheng Di Huang, Chi Shao, Chuan Xiong, Chai Hu, Zhi Ke, Chuan Niu Xi, Jie Geng, Gan Cao]
 * Tongue:** dark or purplish tongue; ecchymosis
 * Pulse:** deep choppy or deep wiry
 * Treatment Principles:** Move Qi, invirate blod, eliminate blood stasis, unblock periods
 * Acupuncture:** //CV-3, LR-3, LI-4, SP-10, CV-6;// SP-6, SP-8, ST-29
 * Herbal Treatment:** //Xue Fu Zhu Yu Tang//

Accumulation of Phlegm
Delayed menstruation or one menstrual cycle several months followed by amenorrhea, overweight, chest& epigastric fullness, nausea, profuse sputum, lassitude, or edema of face & limbs, excessive white vaginal discharge [Ban Xia, Fu Ling, Chen Pi, Zhi Gan Cao, Cang Zhu, Xiang Fu, Zhi Ke, Dan Nan Xing, Sheng Jiang, Shen Qu]
 * Tongue:** pale puffy tongue; white greasy coat
 * Pulse:** slippery
 * Treatment Principles:** Dissolve phlegm, expel dampness, regulate qi, invigorate blood, unblock periods
 * Acupuncture:** //Sp-9, SP-6, ST-28, ST-40, CV-6;// LI-4, CV-9, BL-22, KI-14
 * Herbal Treatment:** //Cang Fu Dao Tan Wan & Fo Shou San//

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 * IBIS:**

Definition:
Absence of menstruation.

Etiology:
• physiologic delay: The late onset of menses in a physiologically normal female. No work-up is necessary in the female who has secondary sexual characteristics but no menstrual cycles until she is 18; however, if no secondary characteristics appear by age 14 and no menses has occurred, then a work-up should be started earlier. The age of menarche of the mother will often provide clues as to when the female child should expect to begin.

• primary ovarian failure: These patients are divided into two groups: those with normal but infantile genitalia (e.g. Turner's syndrome), and those with ambiguous genitalia (e.g. hermaphrodites). Karyotyping is necessary. Causes include: » hypothalamic or pituitary failure: Insufficiency or organic disease (tumors, lesions) of either of those organs. » congenital abnormalities: Vaginal agenesis; vaginal septa; cervical atresia; uterine agenesis; uterine septi; or bicornuate uterus. » imperforate hymen: This could impede the outflow of the menstruum. The girl will report monthly cyclical abdominal cramping due to the build-up of the menstrual flow. Treatment includes opening the hymen after a needle aspiration of the area behind the hymen demonstrates that a vagina exists.

causes of secondary amenorrhea: (those examples marked "*" mean that they can be secondary or primary, but are usually secondary).

• endometrial sclerosis: This usually occurs as a result of a D&C after which the tissues heal by fibrosis.

• cervical stenosis: This can occur after a cervical conization, where the cervix scars or the os cannot be found. Intrauterine growths must be ruled out.

• anovulation: This may be sporadic or constant. These can be causes for anovulation: » hypothalamic causes*: The organ disorder may be due to organic lesions (tumors, scars) or insufficiency (polycystic ovarian disease, hyperprolactinemia amenorrhea). » pituitary causes*: Including insufficiency (Sheehan's syndrome) or organic disease (tumors, adenomas). » ovarian causes*: From scarring, tumors, cysts. » low body fat from excess exercise*: (less than 10% body fat). Although this form of anovulation is similar to that which is induced with anorexia nervosa, in this type, when the patient regains weight or stops exercising excessively the period will return. » adrenal dysfunction: Hyperplasia, adenomas, tumors. » systemic causes of anovulation: Cushing's disease; post oral contraceptive agent syndrome; hyperprolactinemia; both over and underactive thyroid problems; and other diseases (ulcerative colitis, diabetes mellitus, steroid use for auto-immune diseases, celiac disease). Usually when these diseases are corrected the menses will return to normal.

• psychiatric disorders*: These include: » physical or emotional trauma. » chronic stress. » anorexia nervosa: Severe malnutrition. Can also be labeled a hypothalamic-pituitary disease.

• pregnancy: must be ruled out, as progesterone withdrawal testing, which is done with further analysis of amenorrhea, is teratogenic.

Nutrition:
eating principles: • correct dietary deficiencies • eat adequate calories to maintain healthy body weight and body fat percentage

therapeutic foods: • increase foods rich in Omega-3 fats such as cold-water fish, seeds and nuts • increase foods rich in organic sources of Sodium • increase foods rich in Iron and Vitamin C • increase foods that nourish Xue (Blood) and tonify the Spleen and Stomach; bland foods • increase polyunsaturates (Zeff)

foods to avoid: • minimize consumption of refined foods, especially those that deplete Magnesium and other key nutrients essential for proper hormone production • minimize consumption of cabbage, kale, broccoli, cauliflower, brussel sprouts and other members of the Brassicae family; constituents can inhibit thyroid function • eliminate coffee, chocolate and other sources of methylxanthines which stress liver function and can compromise healthy hormaone balance

Botanicals
• Aletris farinosa: amenorrhea from uterine engorgement (Ellingwood, p. 480; Priest and Priest, p. 104) • Anemone pulsatilla (toxic): amenorrhea from getting feet wet; cold extremities and feeble pulse (Ellingwood, p. 150) • Caulophyllum thalictroides (toxic): stimulates oxytocin, use in small frequent doses as large dose can elevate blood pressure, cause headaches and nausea (Felter and Lloyd, p. 471; Lust, p. 129; Felter, p. 94) • Commiphora myrrha: alters heat of the body and promotes menses (Felter and Lloyd, p. 1300; Grieves, p. 572) • Glycyrrhiza glabra: induces ovulation in hyperandrogenic and oligomenorrheic women (Heron) • Gossypium spp. (toxic): reportedly safest and most efficient oxytocic. Infusion of root bark taken in small sips throughout the day until bleeding begins (Weed, p. 11; Felter, pp. 94, 105) • Hedeoma pulegioides (toxic): a powerful emmenagogue. Hot infusion or 20 drops tincture in hot water taken 1 cup four times per day for no longer than 5 days (Nissim, p. 61; Weed, p. 8; Felter, p. 94) • Leonurus cardiaca: a relaxing emmenagogue useful when amenorrhea is related to stress and tension ; also indicated from amenorrhea from cold (Heron; Felter, p. 94; Ellingwood, p. 483) • Lithospermum ruderale: a phytoprogesterone to be used in second half of menstrual cycle to help establish normal hormonal function. 30- 50 drops a day in early cycle and three times daily in second half of cycle (Nissim, pp. 60-61) • Viburnum prunifolium: indicated for atonic amenorrhea (Priest and Priest, p. 106; Felter, p. 94)

Chinese Formulae
• Three-stage approach, each formula applied for two weeks: Tang Kuei and Ginseng Eight F. (Ba Zhen Tang) or Ginseng and Longan C. (Gui Pi Tang) (Xue Xu (Blood Deficiency) and Qi Xu (Deficiency)); Bupleurum and Cyperus F. (Chai Hu Shu Gan San) (Liver Qi Stagnation); Cinnamon and Hoelen F. (Gui Zhi Fu Ling Wan) plus eucommia (du zhong), achyranthes (huai niu xi) and cuscuta (tu si zi) (Xue Yu (Blood Stasis) and Kidney Xu (Deficiency)) (Three-stage approach: Dharmananda, p. 324; Tang Kuei and Ginseng Eight: Hsu, 1980, p. 248; Yeung, p. 33; Dharmananda, 1986, p. 107; Bensky and Barolet, p. 259; Ginseng and Longan: Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255; Bupleurum and Cyperus: Yeung, p. 54; Dharmananda, 1986, p. 226; Bensky and Barolet, p. 146; Cinnamon and Hoelen: Hsu, 1980, p. 423; Yeung, p. 113; Bensky and Barolet, p. 322) • Four Major Herbs C. (Si Wu Tang): Xue Xu (Blood Deficiency) (Hsu, 1980, p. 264; Yeung, p. 214; Dharmananda, 1986, p. 103; Bensky and Barolet, p. 248) • Xue Fu Zhu Yu Tang; Tang Kuei Tablets (patent); Dang Gui Yang Xue Gao - Tang Kwe Gin (patent): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency) (Xue Fu Zhu Yu Tang: Yeung, p. 269; Bensky and Barolet, p. 314; Tang Kuei Tablets: Dharmananda, 1990, p. 26; Dang Gui Yang Xue Gao: Zhu, p. 283; Fratkin, p. 183) • Bu Xue Tiao Jing Pian (Butiao Tablets) (patent); Wu Chi Pai Feng Wan (patent): Xue Xu (Blood Deficiency) with Qi Stagnation (Bu Xue: Zhu, p. 254; Fratkin, p. 177; Wu Chi: Fratkin, p. 184) • Tang Kuei and Ginseng Eight C. (Ba Zhen Tang); Tang Kuei 18 (patent); Chien Chin Chih Tai Wan (patent): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency): pale complexion, palpitations with anxiety, reduced appetite, easily-fatigued extremities, lightheadedness, pale tongue (Tang Kuei and Ginseng Eight C.: Hsu, 1980, p. 248; Yeung, p. 33; Dharmananda, 1986, p. 107; Tang Kuei 18: Dharmananda, 1990, p. 25; Chien Chin Chih Tai Wan: Zhu, p. 246; Fratkin, p. 95) • Cinnamon and Persica C.; To Jing Wan (patent): Xue Yu (Blood Stasis) (Cinnamon and Persica: Hsu, 1980, p. 573; Dharmananda, 1986, p. 573; To Jing Wan: Fratkin, p. 132) • Persica and Rhubarb C. (Tao He Cheng Qi Tang): Xue Yu (Blood Stasis) with Internal Heat: constipation (Hsu, 1980, p. 435; Yeung, p. 228; Bensky and Barolet, p. 312)

Acupuncture
after assessing the person and palpating, consider these patterns: Xue Xu (Blood Deficiency) and Dryness; Xue Yu (Blood Stasis); Cold Uterus; dysfunction of the Chong Mai (Penetrating Vessel); Xu (Deficiency) of the Yang Qiao Mai (Yang Motility Vessel) and/or Shi (Excess) of the Yin Qiao Mai (Yin Motility Vessel)

» illustrative combinations: • CV-4, Sp-6 and LI-4 for amenorrhea; also consider St-36, Sp-10 and UB-23 with Xu (Deficiency) symptoms; Lv-3 and CV-3 with Shi (Excess) symptoms (Liu, p. 384) • CV-7, UB-23 and Sp-6 (also consider: St-30, UB-17, Sp-10, Sp-8 and/or Lv-8) for amenorrhea (Shanghai, p. 670) • CV-3, CV-6, UB-23, LI-4, long men and Sp-6 for amenorrhea (Shanghai, p. 670) • LI-4 and Sp-6; UB-38/43, St-36 and St-25; Lv-8; CV-3, CV-2 and St-29; UB-60, CV-2 and GV-1 for amenorrhea (Mann, p. 147) • GV-4, UB-26, UB-32, CV-4, GB-26, Sp-8, GV-3, UB-23, UB-33, CV-3, Kd-15 and Sp-6 for amenorrhea (Lee and Cheung, p. 331) • UB-17, UB-18, UB-20, CV-12, CV-6, CV-4, St-36, Sp-10 and Sp-6 (+) for amenorrhea due to Xue Xu (Blood Deficiency) • UB-20, UB-17, UB-18, CV-4, CV-6 and Sp-10 for amenorrhea due to Xue Xu (Blood Deficiency) (McWilliams, et al, Lesson 31, p. 23) • UB-23, CV-7, Sp-6, UB-17 and Sp-10 for amenorrhea with Drying of Blood (Lee and Cheung, p. 329) • UB-20, UB-21, CV-12, CV-6, St-36, UB-43/48, UB-18, CV-4 and Sp-6 for amenorrhea due to Dryness of Xue (Blood) and Liver and Kidney Yang Xu (Deficiency) (McWilliams, et al, Lesson 31, p. 22) • UB-25, CV-4, LI-11, LI-4, Sp-6, Sp-10 and LI-2 for amenorrhea due to Stagnation of Qi and Xue (Blood) (McWilliams, et al, Lesson 31, p. 22) • UB-23, UB-25, UB-32, LI-11, LI-4, Lv-13, CV-3, St-29, St-30, Sp-8, Sp-6, Lv-8 and Lv-2 for amenorrhea due to Stagnation of Qi and Xue (Blood) • Sp-6, LI-8, LI-2, Sp-8, St-30 and LI-4 for amenorrhea due to Xue Yu (Blood Stasis) (McWilliams, et al, Lesson 31, p. 23) • UB-23, CV-7, Sp-6, St-30, Sp-8 and Lv-8 for amenorrhea with Stagnation of Blood (Lee and Cheung, p. 329) • Sp-6, LI-11, TW-6 and St-36 for delayed menstruation (Lee and Cheung, p. 330) • GV-2 and Kd-6 (D) for cessation of periods (Shanghai, p. 670) • GV-4, UB-26, UB-32, CV-4, GB-26, Sp-8, GV-3, UB-23, UB-33, CV-3, Kd-15 and Sp-6 for cessation of menstruation (Shanghai, p. 670) • GV-4, UB-23, UB-25, GV-1, LI-4, Sp-6, Sp-8, Sp-10, Kd-14, Kd-12, CV-4, CV-3, CV-2, St-29 and UB-60 for cessation of menstruation (Shanghai, p. 670) • GB-26 and GB-43 for pain and stiffness in lower abdomen; lack of menstruation (Shanghai, p. 187) • CV-15, CV-16, CV-19, Kd-13, Sp-6, Kd-11, UB-47/52, GB-37, GB-5, UB-60 and CV-10: influence pituitary (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • Kd-13, UB-67, Kd-7, GB-37, Sp-6, Kd-2, GV-4 and Lv-3: influence ovaries (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • CV-3 and Sp-6: regulate the Qi function of the Lower Warmer and the function of the genital organs - Sp-6 sends Qi up; CV-3 sends it deep (Finkelstein, p. 84) • PC-6 and Sp-4: activate Yin Wei Mai (Yin Linking Vessel) which connects all the Yin channels and tonifies Xue (Blood) • Sp-4 and PC-6: open the Chong Mai (Penetrating Vessel) for which reproductive disorders are a general symptom of dysfunction • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which gynecological problems are a Xu (Deficiency) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which gynecological problems are a Shi (Excess) symptom • CV-6 and CV-4 (+): adjust Yuan (Original) Qi of whole body; "Sea of Qi" and Small Intestine Mu Alarm point • LI-4 (+) and Sp-6 (-): move Xue (Blood), Qi and Uterus to bring menses • UB-17, 18 and 20 (+): build Xue (Blood)

Homeopathy
• Aconitum napellus: exposure to chill, cold wind, fright or checked perspiration; fever; thirsty; nervousness; if no relief, follow with puls. • Belladonna: appears suddenly due to cold; bearing down, throbbing pains; painful urination; flushed face, throbbing headache; < noise, jar; excitable • Bryonia: frequent nosebleeds; irritability; < motion; vertigo on rising or moving about; epistaxis instead of menses • Calcarea carbonica: first menses are delayed; congestion to head/chest causes lung troubles; flabby, fair women, perspiring easily on the head; with stomach acidity; abdomen bloated, cannot bear the weight of clothing • Castoreum canadense: painful tympany; uterine tenesmus; nervous colic with pallor; cold sweat and sudden loss of strength caused by emotion, chilling feet; cutting about the navel; distention of abdomen with flatus • Chamomilla: irritable and impatient about everything; < checked perspiration or fits of anger; one cheek red/other pale; < night • Dulcamara: suppression due to cold or living in damp basement; or sudden change in weather to cold and damp; breasts engorged and hard; warts often present • Ferrum metallicum: delayed first menses with debility, palpitations; sickly complexion; puffiness about ankles; weak, chlorotic women with flushed face or pale with blue margins about the eyes • Graphites: with obstinate constipation and indurated ovaries; can be used after puls.; sallow complexion, frequent paroxysms of headaches; feeling of abdominal emptiness • Kali carbonicum: when nat-m. fails, though indicated; one of the best remedies for primary or secondary amenorrhea with dyspepsia, heart palpitations, abdominal cramps; swelling of cheek and gums; leukorrhea • Lac Humanum: history of difficult mother-daughter relationship; issues of nourishment • Lycopodium: suppression from fear; delayed first menses to 18 years old; breasts do not develop and ovaries do not function; discharge of flatus from the vagina; headache, sour vomiting; swelling of feet, fainting fits and leukorrhea; bloating and fullness of the stomach • Pulsatilla: the remedy which comes first to mind; suppression due to getting the feet wet; delayed first menses in chlorotic girls; poor appetite; longing for acids; apt to faint easily; suffers from a tremulous anxiety; epistaxis instead of menses • Senecio aureus: diseases such as hysteria cough, chorea, chlorosis, hoarseness, dyspnea from suppression of menses; sensation of a ball rising in the throat • Sepia: with severe hysterical headaches, leukorrhea, toothache; delicate constitution with yellowish spots on the face; delay of first menses where a leukorrhea occurs instead; from cold in feeble women; bloated abdomen with bearing-down pains; sensation as if vulva enlarged • Sulphur: when other remedies have failed; especially when there is an all-gone sensation at the pit of the stomach with headache; in those subject to eruptions, especially when suppressed

Subtle Support
• notes: A, A#, C, C#, D, D#, E, F, G

• chords: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

Mind/Body
• Some forms are due to physical or emotional stress. (Rossi, p. 295) • Not wanting to be a woman; dislike of the self. (Hay, 1988, p. 12) • Rejection of femininity; guilt; fear; belief that genitals are sinful or dirty (i.e., 'the curse'). (Hay, 1984, p. 174) • Monthly periods are an expression of Yin: femininity, fertility, and receptivity. Compliance with this natural law touches on one of the central aspects of femininity, self-surrender. If the urge to dominate is great, the menses can be unconsciously suppressed. (Dethlefsen, p. 184-6) • Many beliefs, attitudes, and conflicts can affect the individual woman's menses. Some may be due to anxiety and role conflict related to feminine sexual identity. The culprits for one woman may bear no resemblance to the problematic issues for another woman. We cannot generalize findings about one woman to fit all women. (Mehl, p. 173)

• Heart ~ Xin houses the Shen (Spirit); governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.
 * Chinese psychophysiology:**

• Spleen ~ Pi transforms food into Qi and Xue (Blood); governs the Xue (Blood) and holds it in the vessels; and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; muscular weakness; and, indirectly, obesity. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Liver ~ Gan is the residence of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry skin and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging, particularly the internal aspects of the reproductive organs; houses the Zhi (Will); expresses ambition and focus; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies
Amennorrhea is a condition in which the regular menstrual period is absent. Is not necessarily a sign of illness. It can be quite normal for a young woman to not begin her first menstrual period until the age of about 16. Also, some women occasionally skip a period in times of illness or stress. However, if a woman does not begin menstruating by the time she is 17 years old or misses 3 menstrual periods, there is probably an underlying disease process at work, unless she is pregnant.

Amenorrhea happens naturally during pregnancy, throughout all or part of the breastfeeding period, after the end of menopause, and after giving up the use of birth control pills. When amenorrhea occurs, these causes should be among the first investigated. This is particularly important since some herbs and other medications for amenorrhea may have a harmful effect on pregnant and nursing women and their babies.

Amenorrhea is often brought on by stress, anorexia, severe malnutrition, and mental illness. It may also be attributed to crash dieting, intensive athletics, severe obesity, overuse of amphetamines and antidepressants, and certain other illnesses.

A physician should definitely be consulted in cases when amenorrhea is accompanied by an extreme weight fluctuation or when an adolescent over the age of 16 has not started to develop pubic hair and grow breasts. Also contact your physician if amenorrhea is associated with cramping or pain, the use of drugs, or deep depression.

THE FOLLOWING SUPPLEMENTS ARE USED AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Vitamin E – 400 Units per day. 2. B-complex vitamin – 25 milligrams once per day. 3. Vitamin C – 1,000 milligrams twice a day. 4. Calcium – 1,200 milligrams per day.

THE PROPER DIET FOR AMENORRHEA WILL INCLUDE: 1. Be sure to get enough high-quality protein in your diet. The number of grams of protein you need to eat daily is equal 1/2 of your weight in pounds. For example, if you weigh 140 pounds, you'll need to eat 70 grams of protein per day. Replace red meat with fish and chicken as much as possible, and include beans, nuts, and seeds. 2. Add seaweeds to your diet. Health food stores and Asian food stores usually carry several different kinds such as hijiki, arame, dulse, and nori. Consult a cookbook about the preparation. Kelp is easy to use because it can be purchased as a powder and sprinkled on food as a salty condiment.

HERBS USED FOR AMENORRHEA: 1. Ginger tea – Drink 1 to 4 cups per day. To make a cup, pour boiling water over 1 teaspoon of the powdered root. You can also use freshly grated Ginger Root by putting a tablespoon of this in a pot of water and letting it steep covered for a minute. 2. Blue Cohosh, False Unicorn, Chaste Tree, Blazing Star, and Angelica – Use equal parts of these herbs. Mix 1 tablespoon of the combination in a cup of boiling water. Steep for 20 minutes and drink 3 cups per day. As a tincture, which is a liquid herbal extract, add 1 teaspoon of the combined herbal tinctures to 1/4 cup of warm water and drink 3 times a day. 3. Pennyroyal and Tansy tinctures are used for amenorrhea that is long-standing – Put 15 drops of each tincture in a cup of hot water. Drink up to 3 cups per day but no more than this. After 5 days, discontinue use.

PHYSICAL THERAPY MEASURES FOR AMENORRHEA ARE AS FOLLOWS: 1. Take a warm sitz bath once or twice per week. Fill a bathtub about 1/3 full so that the water comes up to your navel. Sit sideways with your feet resting on a chair or stool outside of the bathtub. Add an infusion made of 1 pound oatstraw herb boiled in 2 quarts of water for 1/2 hour. Adjust the temperature to about 104 degrees Fahrenheit. Your exposed upper body and your feet should be covered with a sheet or large towel and a blanket (preferably wool). Soak in the bath water for about 10 to 15 minutes. 2. Clay compresses can be helpful. The clay may be available at your pharmacy or health food store, or you can sterilize your own clay by heating it in a low oven for about 1 hour and then grinding up the clay. Dilute the clay enough to make a thick, spreadable paste. Apply the paste to the lower part of the stomach and cover it with a cloth. Leave the compress on until the paste dries out and begins to crumble. 3. Castor oil packs – Moisten a thin cotton cloth with castor oil and place on your lower abdomen. Cover with a plastic bag and then a dry cloth. Leave in place and rest for an hour.

HOMEOPATHY: From the following homeopathic medicines, choose the one that best matches your symptoms. Dissolve 3 pellets under your tongue, one to three times per day, as needed. • Pulsatilla 6C: For a woman who is sensitive to stress or emotional situations that cause missed periods. Use 3 times a day for 3 weeks or until menses starts. • Natrum mur. 12C: For amenorrhea following intense mental strain on a woman who finds it difficult to show emotions. Note: A wide range of homeopathic medicines can be helpful for individuals with amenorrhea. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

ADDITIONAL MEASURES: 1. Stress reduction – You may not be able to eliminate stressful situations in your life (such as a busy schedule or a stressful relationship), but you can learn to cope better with the stress by following these guidelines: • Regular Physical Exercises – at least 30 minutes 3 times per week. • Relaxation techniques – 20 minutes once a day. Tapes can be bought at one of your local bookstores. Yoga practiced on a regular basis can serve the same purpose. • Breathing – most of us tend to hold our breath or breathe shallow breaths during stressful situations. This can cut down the amount of oxygen available to the body with every breath. Try to take a few 1 minute intervals of breathing and relaxation during the day. At these times, pay special attention to relaxing your shoulder muscles and breathing deeply.

2. Acupuncture can be helpful for establishing a normal menstrual period. Look for a licensed practitioner in your area.