Female

disease

PANKAJ GUPTA a tcm thinker

Female Reproductive
Organ
Anatomy and
Physiology
 The External
Female Reproductive Organs
 Mons pubis Symphsis pubis

prepuce Clitoris
Body
Urethral orifice Glans

Labia majora
Hymen
Vaginal orifice
Perineal membrane Labia minora

Anus

External anal sphincter

The External Female Reproductive Organs

 External Female Reproductive Organs
• The external female reproductive organs
collectively are called the vulva (which
means covering). The vulva serves to
protect the urethral and vaginal openings
and is highly sensitive to touch to
increase the female’s pleasure during
sexual arousal.
• The structures that make up vulva include
the mons pubis, the labia majora and
minora, the clitoris, the structures within
the vestibule, and the perineum.
 Mons Pubis
• The mons pubis is the elevated, rounded
fleshy prominence over the symphysis
pubis (pubic bone). This fatty tissue and
skin is covered with pubic hair after
puberty. It protects the symphysis pubis
during sexual intercourse.
 Labia
The Labia Majora (large lips), which are
relatively large and Fleshy. The labia majora
contain sweat and sebaceous (oil-secreting)
glands; after puberty, they are covered with
hair. Their function is to protect the vaginal
opening.
clitoris

Labia Majora

Labia Minora
The Labia Minora (small lips) are the delicate
hairless inner folds of skin; They lie just
inside the labia majora and surround the
openings to the vagina and urethra. The labia
minora grow down from the anterior inner
part of the labia majora on each side. They
are highly vascular and abundant in nerve
supply. They lubricate the vulva, swell in
response to stimulation, and are highly
sensitive.
 Clitoris and Prepuce
The clitoris is a small, cylindrical mass of
erectile tissue and nerves. It is located at the
anterior junction of the labia minora. There
are folds above and below the clitoris. The
joining of the folds above the clitoris forms
the prepuce, a hood-like covering over the
clitoris; the junction below the clitoris forms
the frenulum.
• A rich supply of blood vessels gives the
clitoris a pink colour.
• The clitoris is very sensitive to touch,
stimulation, and temperature and can
become erect.
• For its small size, it has a generous blood
and nerve supply.
• There are more free nerve endings of
sensory reception located on the clitoris
than on any other part of the body, and it
is, unsurprisingly, the most erotically
sensitive part of the genitalia for most
females. Its function is sexual stimulation
 Vestibule
The Vestibule is an oval area enclosed by the
labia minora laterally. It is inside the labia
minora and outside of the hymen and is
perforated by six openings.
• Opening into the vestibule are the urethra
from the urinary bladder, the vagina, and
two sets of glands.
• The opening to the vagina is called the
introitus, and the half-moon–shaped area
behind the opening is called the
fourchette.
• Through tiny ducts beside the introitus,
Bartholin’s glands, when stimulated,
secrete mucus that supplies lubrication
for intercourse.
• Skene’s glands are located on either side
of the opening to the urethra. They secrete
a small amount of mucus to keep the
opening moist and lubricated for the
passage of urine.
 Hymen
The vaginal opening is surrounded by the
Hymen. The hymen is a tough, elastic,
perforated, mucosa-covered tissue across
the vaginal introitus. In a virgin, the hymen
may completely cover the opening, but it
usually encircles the opening like a tight
ring. Because the degree of tightness varies
among women,
the hymen may tear at the first attempt at
intercourse, or it may be so soft and pliable
that no tearing occurs. In a woman who is
not a virgin, the hymen usually appears as
small tags of tissue surrounding the vaginal
opening, but the presence or absence of the
hymen can neither confirm nor rule out
sexual experience.
 Perineum
The perineum is the most posterior part of
the external female reproductive organs.
This external region is located between the
vulva and the anus. It is made up of skin,
muscle, and fascia.
The perineum can become lacerated or
incised during childbirth and may need to be
repaired with sutures. Incising the perineum
area to provide more space for the presenting
part is called an episiotomy.
Although still a common obstetric
procedure, the use of episiotomy has
decreased over the past 25 years.
The procedure should be applied selectively
rather than routinely. An episiotomy can add
to postpartum discomfort and perineal
trauma and can lead to fecal incontinence
 Internal Female Reproductive Organs
The internal female reproductive organs
consist of the Vagina, Uterus, Fallopian
Tubes, and Ovaries. These structures
develop and function according to the
specific hormone influences that affect
fertility and child bearing.
 Ureter

Ovary
Fallopian tube Rectum

Uterus

Urinary bladder Posterior fornix

of vagina
Symphysis pubis
Cervix
Urethra
Vagina
Clitoris

Urethral orifice Anus

Vaginal orifice

Internal Female Reproductive Organs Lateral view

 Suspensory ligament
Fundus of uterus
of ovary
Fallopian tube Ovanam ligament

Uterus
Perimetrium Ovary
Secondary
Corpus of the uterus
oocyte myometrium
Abdominal opening of Internal os of cervix
fallopian tube Endometrium
Corpus luteum of Cervix
menstruation Cervical canal
Vagina
External os
Labia minora

Internal Female Reproductive Organs Anterior view

 Vagina
• The vagina is a highly distensible
musculomembranous canal situated in
front of the rectum and behind the
bladder.
• It is a tubular, fibro
muscular organ lined
with mucous
membrane that lies in
a series of transverse Vagina

folds called rugae.

• The rugae allow for extreme dilatation of the
canal during labor and birth.
• The vagina is a canal that connects the
external genitals to the uterus. It receives
the penis and the sperm ejaculated during
sexual intercourse, and it serves as an exit
passageway for menstrual blood and for
the fetus during childbirth.
• In the adult, the vaginal cavity is 3 to 4
inches long.
• During a woman’s reproductive years, the
mucosal lining of the vagina has a
corrugated appearance and is resistant to
bacterial colonization.
• Before puberty and after menopause (if
the woman is not taking estrogens), the
mucosa is smooth due to lower levels of
estrogens.
• The vagina has an acidic environment,
which protects it against ascending
infections.
• Antibiotic therapy, douching, perineal
hygiene sprays, and deodorants upset the
acid balance within the vaginal
environment and can predispose women
to infections.
 Uterus
• The uterus is a pear-shaped muscular
organ at the top of the vagina. It lies
behind the bladder and in front of the
rectum and is anchored in position by
eight ligaments, although it is not firmly
attached or adherent to any part of the
skeleton. A full bladder tilts the uterus
backward; a distended rectum tilts it
forward.

Uterus
• The uterus alters its position by gravity or
with change of posture, and is the size
and shape of an inverted pear.
• It is the site of menstruation, implantation
of a fertilized ovum, development of the
fetus during pregnancy, and labor.
• Before the first pregnancy, it measures
approximately 3 inches long, 2 inches
wide, and 1 inch thick.
• After a pregnancy, the uterus remains
larger than before the pregnancy.
• After menopause, it becomes smaller and
atrophies.
• The uterine wall is relatively thick and
composed of three layers:
1. The Endometrium (innermost layer),
2. The Myometrium (muscular middle layer),
and
3. The Perimetrium (outer serosal layer that
covers the body of the uterus).
• The endometrium is the mucosal layer that
lines the uterine cavity in nonpregnant
women. It varies in thickness from 0.5 mm
to 5 mm and has an abundant supply of
glands
and blood vessels.
• The myometrium makes up the major
portion of the uterus and is composed of
smooth muscle linked by connective tissue
with numerous elastic fibers. During
pregnancy, the upper myometrium
undergoes marked hypertrophy, but there
is limited change in the cervical muscle
content.
Anatomic subdivisions of the uterus include
• the convex portion above the uterine tubes
(the fundus);
• the central portion (the corpus or body)
between the fundus and the cervix;
• and the cervix, or neck, which opens into
the vagina.
 Cervix
• The cervix, the lower part of the uterus,
opens into the vagina and has a channel
that allows sperm to enter the uterus and
menstrual discharge to exit. It is
composed of fibrous connective tissue.
• During a pelvic
examination, the
part of the cervix
that protrudes into
the upper end of the
vagina can be
visualized.
• Like the vagina, this part of the cervix is
covered by mucosa, which is smooth,
firm, and doughnut-shaped, with a visible
central opening called the external os .
• Before childbirth the external cervical os
is a small, regular, oval opening. After
childbirth, the opening is converted into a
transverse slit that resemble lips.
• Except during menstruation or ovulation,
the cervix has an alkaline environment,
which protects the sperm from the acidic
environment in the vagina
• The canal or channel of the cervix is lined
with mucus secreting glands. This mucus
is thick and impenetrable (impossible to
pass through) to sperm until just before
the ovaries release an egg (ovulation).
• At ovulation, the consistency of the
mucus changes so that sperm can swim
through it, allowing fertilization. At the
same time, the mucus-secreting glands of
the cervix actually become able to store
live sperm for 2 or 3 days.
• These sperm can later move up through the
corpus and into the fallopian tubes to
fertilize the egg; thus, intercourse 1 or 2
days before ovulation can lead to
pregnancy.
• Because some women do not ovulate
consistently, pregnancy can occur at
varying times after the last menstrual
period.
• The channel in the cervix is too narrow for
the fetus to pass through during
pregnancy, but during labor it stretches to
let the new born through.
Corpus
 Corpus
• The corpus, or the main body of the uterus,
is a highly muscular organ that enlarges to
hold the fetus during pregnancy. The inner
lining of the corpus (endometrium)
undergoes cyclic changes as a result of the
changing levels of hormones secreted by
the ovaries: it is thickest during the part of
the menstrual cycle in which a fertilized
egg would be expected to enter the uterus
and is thinnest just after menstruation.
• If fertilization does not take place during
this cycle, most of the endometrium is
shed and bleeding occurs, resulting in the
monthly period.
• If fertilization does take place, the embryo
attaches to the wall of the uterus, where it
becomes embedded in the endometrium
(about 1 week after fertilization); this
process is called implantation.
• Menstruation then ceases during the 40
weeks (280 days) of pregnancy.
• During labor, the muscular walls of the
corpus contract to push the baby through
the cervix and into the vagina.
 Fallopian Tubes

Cilia (beating, hair-

like extensions on
cells)
 Fallopian Tubes
• The fallopian tubes are hollow, cylindrical
structures that extend 2 to 3 inches from
the upper edges of the uterus toward the
ovaries.
• Each tube is about 7 to 10 cm long and
approximately 0.7 cm in diameter.
• The end of each tube flares into a funnel
shape, providing a large opening for the
egg to fall into when it is released from
the ovary.
• Cilia (beating, hair-like extensions on
cells) line the fallopian tube and the
muscles in the tube’s wall.
1. The fallopian tubes convey the ovum from
the ovary to the uterus and sperm from
the uterus toward the ovary.
2. This movement is accomplished via ciliary
action and peristalsis.
3. If sperm is present in the fallopian tube as
a result of sexual intercourse or artificial
insemination, fertilization of the ovum can
occur in the distal portion of the tube.
4. If the egg is fertilized, it will divide over a
period of 4 days while it moves slowly
down the fallopian tube and into the
uterus.
 Ovaries
• The ovaries are a set of paired glands
resembling unshelled almonds set in the
pelvic cavity below and to either side of
the umbilicus.
• They are homologous to the testes. Each
ovary weighs from 2 to 5 grams and is
about 4 cm long, 2 cm wide, and 1 cm
thick.
• The ovaries are not attached to the
fallopian tubes but are suspended nearby
from several ligaments, which help hold
them in position.
• The development and the release of the
ovum and the secretion of the hormones
estrogen and progesterone are the two
primary functions of the ovary.
• The ovaries link the reproductive system
to the body’s system of endocrine glands,
as they produce the ova (eggs) and
secrete, in cyclic fashion, the female sex
hormones estrogen and progesterone.
After an ovum matures, it passes into the
fallopian tubes.
Anatomy Of The Breasts

Lymph nodes

Alveoli
Ducts
Areola
Nipple
 Breasts
• The two mammary glands, or breasts, are
accessory organs of the female
reproductive system that are specialized
to secrete milk following pregnancy.
• They overlie the pectoralis major muscles
and extend from the second to the sixth
ribs and from the sternum to the axilla.
• Each breast has a nipple located near the
tip, which is surrounded by a circular area
of pigmented skin called the areola.
• Each breast is composed of approximately
9 lobes (the number can range between 4
and 18)
• Which contain glands (alveolar) and a duct
(lactiferous) that leads to the nipple and
opens to the outside.
• The lobes are separated by dense
connective and adipose tissues, which
also help support the weight of the
breasts.
• During pregnancy, placental estrogens
and progesterone stimulate the
development of the mammary glands.
Because of this hormonal activity, the
breasts may double in size during
pregnancy.
• At the same time, glandular tissue replaces
the adipose tissue of the breasts.
• Following childbirth and the expulsion of
the placenta, levels of placental hormones
(progesterone and lactogen) fall rapidly,
and the action of prolactin (milk-producing
hormone) is no longer inhibited.
• Prolactin stimulates the production of milk
within a few days after childbirth, but in the
interim, a dark yellow fluid called
colostrums is secreted.
• Colostrums contains more minerals and
protein, but less sugar and fat, than mature
breast milk.
• Colostrums secretion may continue for
approximately a week after childbirth, with
gradual conversion to mature milk.
• Colostrums is rich in maternal antibodies,
especially immunoglobulin A (IgA), which
offers protection for the new-born against
enteric pathogens.
 Female Sexual Response
• With sexual stimulation, tissues in the
clitoris and breasts and around the vaginal
orifice fill with blood and the erectile
tissues swell. At the same time, the vagina
begins to expand and elongate to
accommodate the penis.
• As part of the whole vasocongestive
reaction, the labia majora and minora swell
and darken.
• As sexual stimulation intensifies, the
vestibular glands secrete mucus to
moisten and lubricate the tissues to
facilitate insertion of the penis.
• Hormones play an integral role in the
female sexual response as well.
• Adequate estrogens and testosterone must
be available for the brain to sense
incoming arousal stimuli.
• Research indicates that estrogens
preserves the vascular function of female
sex organs and affects genital sensation. It
also is believed to promote blood flow to
these areas during stimulation.
• Testosterone is thought to be the hormone
of sexual desire in women.
• The zenith (high time) of intense
stimulation is orgasm, the spasmodic and
involuntary contractions of the muscles
in the region of the vulva, the uterus, and
the vagina that produce a pleasurable
sensation to the woman.
• Typically the woman feels warm and
relaxed after an orgasm.
• Within a short time after orgasm, the two
physiologic mechanisms that created the
sexual response, vasocongestion and
muscle contraction, rapidly dissipate
 The female reproductive cycle
• The female reproductive cycle is a general
term encompassing the ovarian cycle, the
endometrial cycle,
• The hormonal changes that regulate them,
and the cyclical changes in the breasts.
• The endometrium, ovaries, pituitary gland,
and hypothalamus are all involved in the
cyclic changes that help to prepare the
body for fertilization.
• Absence of fertilization results in
menstruation, the monthly shedding of
the uterine lining.
• Menstruation marks the beginning and
end of each menstrual cycle.
• Menopause is the naturally occurring
cessation of regular menstrual cycles.
 Menstruation
• Menstruation is the normal, predictable
physiologic process whereby the inner
lining of the uterus(endometrium) is
expelled by the body. Typically, this occurs
monthly.
• The average age at menarche (the start of
menstruation in females) is 12.8 years,
with a range between 8 and 18.
• In healthy pubertal girls, the menstrual
period varies in flow heaviness and may
remain irregular in occurrence for up to 2
years following menarche. After that time,
the regular menstrual cycle established.
• Most women will experience 300 to 400
menstrual cycles within their lifetime.
Normal, regular menstrual cycles vary in
frequency from 21 to 36 days (with the
average cycle lasting 28 days), bleeding
lasts 3 to 7 days, and blood loss averages
20 to 80 mL.
• Irregular menses can be associated with
irregular ovulation, stress, disease, and
hormonal imbalances.
 Reproductive Cycle
• The female reproductive cycle involves
two cycles that occur simultaneously:
i. the ovarian cycle, during which
ovulation occurs,
ii. The endometrial cycle, during which
menstruation occurs.
• Ovulation divides these two cycles at
midcycle.
• Ovulation occurs when the ovum is
released from its follicle; after leaving the
ovary, the ovum enters the fallopian tube
and journeys toward the uterus. If sperm
fertilizes the ovum, pregnancy occurs.
Ovarian Cycle
• The ovarian cycle is the series of events
associated with a developing ovum or
egg, within the ovaries.
• While men manufacture sperm daily, often
into advanced age, women are born with a
single lifetime supply of ova that are
released from the ovaries gradually
throughout the childbearing years.
• The ovarian cycle begins when the
follicular cells (ovum and surrounding
cells) swell and the maturation process
starts.
• The maturing follicle at this stage is called
a graafian follicle.
• The ovary raises many follicles monthly,
but usually only one follicle matures to
reach ovulation.
• The ovarian cycle consists of three
phases:
1. The follicular phase,
2. Ovulation, and
3. The luteal phase.
 Follicular Phase
• This phase is so named because it is when
the follicles in the ovary grow and form a
mature egg.
• This phase starts on day 1 of the menstrual
cycle and continues until ovulation,
approximately 10 to 14 days later.
• The follicular phase is not consistent in
duration because of the time variations in
follicular development.
• These variations account for the
differences in menstrual cycle lengths.
• The hypothalamus is the initiator of this
phase.
• Increasing levels of estrogen secreted from
the maturing follicular cells and the
continued growth of the dominant follicle
cell induce proliferation of the
endometrium and myometrium.
• This thickening of the uterine lining
supports an implanted ovum if pregnancy
occurs.
• Prompted by the hypothalamus, the
pituitary gland releases follicle-stimulating
hormone (FSH), which stimulates the ovary
to produce 5 to 20 immature follicles.
• Each follicle houses an immature egg.
• The follicle that is targeted to mature fully
will soon rupture and expel a mature egg
in the process of ovulation.
• A surge in luteinizing hormone (LH) from
the anterior pituitary gland is actually
responsible for affecting the final
development and subsequent rupture of
the mature follicle.
 Controlled by hypothalamus

Anterior pituitary

Maturing follicle
FSH LH LH peak triggers ovulation

ovulation

Degenerating corpus luteum

 Day
27
and
Day 1-5 Day 6-14 Day 15-26 28

Estrogen Progesterone

Ovarian hormones

Thickness of endometrial
lining during the menstrual
cycle

Uterine Menstrual Proliferative Secretory ischemic Menstrual

ovarian Follicular Luteal

0 5 14 26 28
 Ovulation
• At ovulation, a mature follicle ruptures in
response to a surge of LH, releasing a
mature ovum. This usually occurs on day
14 in a 28-day cycle.
• When ovulation occurs, there is a drop in
estrogens. Typically ovulation takes place
approximately 10 to 12 hours after the LH
peak and 24 to 36 hours after estrogen
levels peak.
• The distal ends of the fallopian tubes
become active near the time of ovulation
and create currents that help carry the
ovum into the uterus.
• The lifespan of the ovum is only about 24
hours; unless it meets a sperm on its
journey within that time, it will die.
• During ovulation, the cervix produces thin,
clear, stretchy, slippery mucus that is
designed to help the sperm travel up
through the cervix to meet the ovum for
fertilization. The one constant, whether a
women’s cycle is 28 days or 120 days, is
that ovulation takes place 14 days before
menstruation.
 Luteal Phase
• The luteal phase begins at ovulation and
lasts until the menstrual phase of the next
cycle. It typically occurs day 15 through day
28 of a 28-day cycle.
• After the follicle ruptures as it releases the
egg, it closes and forms a corpus luteum.
The corpus luteum secretes increasing
amounts of the hormone progesterone,
which interacts with the endometrium to
prepare it for implantation.
• At the beginning of the luteal phase,
progesterone induces the endometrial
glands to secrete glycogen, mucus, and
 other substances.
• These glands turns and have large lumens
due to increased secretory activity.
• The progesterone secreted by the corpus
luteum causes the temperature of the body
to rise slightly until the start of the next
period. A significant increase in
temperature, usually 0.5 to 1 degrees F., is
generally seen within a day or two after
ovulation has occurred; the temperature
remains elevated for 12 to 16 days, until
menstruation begins.
• This rise in temperature can be plotted on
a graph and gives an indication of when
ovulation has occurred.
• In the absence of fertilization, the corpus
luteum begins to degenerate and
consequently ovarian hormone levels
decrease.
• As estrogen and progesterone levels
decrease, the endometrium undergoes
involution.
• In a 28-day cycle, menstruation then
begins approximately 14 days after
ovulation in the absence of pregnancy.
• FSH and LH are generally at their lowest
levels during the luteal phase and highest
during the follicular phase.
 Endometrial Cycle
The endometrial cycle occurs in response to
cyclic hormonal changes. The four phases of
the endometrial cycle are
1. The proliferative phase,
2. Secretory phase,
3. Ischemic phase, and
4. Menstrual phase.
 Proliferative Phase
• The proliferative phase starts with
enlargement of the endometrial glands in
response to increasing amounts of
estrogen. The blood vessels become
dilated and the endometrium increases in
thickness dramatically from 0.5 to 5 mm in
height and increases eight-fold in
thickness in preparation for implantation of
the fertilized ovum.
• Cervical mucus becomes thin, clear,
stretchy, and more alkaline, making it more
favourable to sperm to enhance the
opportunity for fertilization.
• The proliferative phase starts on about
day 5 of the menstrual cycle and lasts to
the time of ovulation.
• This phase depends on estrogens
stimulation resulting from ovarian
follicles, and this phase coincides with the
follicular phase of the ovarian cycle.
 Secretory Phase
• The secretory phase begins at ovulation to
about 3 days before the next menstrual
period. Under the influence of progesterone
released by the corpus luteum after
ovulation, the endometrium becomes
thickened and more vascular and glandular
(secreting more glycogen and lipids).
• These dramatic changes are all in preparation
for implantation, if it were to occur. This
phase typically lasts from day 15 (after
ovulation) to day 28 and coincides with the
luteal phase of the ovarian cycle. The
secretory phase doesn’t take place if
ovulation has not occurred.
 Ischemic Phase
• If fertilization does not occur, the ischemic
phase begins.
• Estrogens and progesterone levels drop
sharply during this phase as the corpus
luteum starts to degenerate.
• Changes in the endometrium occur with
spasm of the arterioles, resulting in
ischemia of the basal layer.
• The ischemia leads to shedding of the
endometrium down to the basal layer, and
menstrual flow begins.
 Menstrual Phase
• The menstrual phase begins as the spiral
arteries rupture secondary to ischemia,
releasing blood into the uterus, and the
sloughing of the endometrial lining
begins.
• If fertilization does not take place, the
corpus luteum degenerates. As a result,
both estrogen and progesterone levels fall
and the thickened endometrial lining
sloughs away from the uterine wall and
passes out via the vagina.
• The beginning of the menstrual flow
marks the end of one menstrual cycle and
the start of a new one. Most women report
bleeding for an average of 3 to 7 days.
 Menstrual Cycle Hormones
The menstrual cycle involves a complex
interaction of hormones. The predominant
hormones include.
• Gonadotropin-releasing hormone,
• FSH,
• LH,
• Estrogens,
• Progesterone, and
• Prostaglandins.
 Gonadotropin-Releasing Hormone
• Gonadotropin-releasing hormone (GnRH)
is secreted from the hypothalamus in a
pulsatile (throbbing) manner throughout
the reproductive cycle.
• It pulsates slowly during the follicular
phase and increases during the luteal
phase.
• It act on the gonads (testes and ovary) to
increase the production of sex hormones.
• GnRH induces the release of FSH and LH
to assist with ovulation.
 Follicle-Stimulating Hormone
• Follicle-stimulating hormone (FSH) is
secreted by the anterior pituitary gland
and is primarily responsible for the
maturation of the ovarian follicle.
• FSH secretion is highest and most
important during the first week of the
follicular phase of the reproductive cycle.
 Luteinizing Hormone
• Luteinizing hormone (LH) is secreted by
the anterior pituitary gland and is required
for both the final maturation of
preovulatory follicles and luteinisation of
the ruptured follicle.
• As a result, estrogens production declines
and progesterone secretion continues.
• Thus, estrogens levels fall a day before
ovulation, and progesterone levels begin
to rise.
 Estrogens
• Estrogen is secreted by the ovaries and is
crucial for the development and maturation of
the follicle.
• Estrogens is predominant at the end of the
proliferative phase, directly preceding
ovulation.
• After ovulation, estrogen levels drop sharply
as progesterone dominates.
• In the endometrial cycle, estrogen induces
proliferation of the endometrial glands.
• Estrogens also causes the uterus to increase
in size and weight because of increased
glycogen, amino acids, electrolytes, and
water. Blood supply is expanded as well.
 Progesterone
• Progesterone is secreted by the corpus
luteum.
• Progesterone levels increase just before
ovulation and peak 5 to 7 days after
ovulation.
• During the luteal phase, progesterone
induces swelling and increased secretion
of the endometrium.
• This hormone is often called the hormone
of pregnancy because it reduces uterine
contractions and allowing pregnancy to be
maintained.
 Prostaglandins
• Prostaglandins are a closely related group
of oxygenated fatty acids that are
produced by the endometrium, with a
variety of effects throughout the body.
• Although they have regulatory effects and
are sometimes called hormones,
prostaglandins are not technically
hormones because they are produced by
all tissues rather than by special glands.
• Prostaglandins increase during follicular
maturation and play a key role in ovulation
by freeing the ovum inside the graafian
follicle.
• Large amounts of prostaglandins are
found in menstrual blood.
 Menopause
• Premenopause and menopause are
biologic markers of the transition from
young adulthood to middle age.
• Neither of these is a symptom or disease,
but rather a natural maturing of the
reproductive system.
• During the premenopausal years (2 to 8
years prior to menopause) women may
experience physical changes associated
with decreasing estrogen levels, which
may include vasomotor symptoms of hot
flashes, irregular menstrual cycles, sleep
disruptions, forgetfulness, irritability,
 mood disturbances, decreased vaginal
lubrication, fatigue, vaginal atrophy, and
depression.
• Menopause refers to the cessation of
regular menstrual cycles. This naturally
occurring phase of every woman’s life
marks the end of menstruation and
childbearing capacity.
• The average age of natural menopause—
defined as 1 year without a menstrual
period—is 51.
• Most women can expect to spend more
than one third of their lives beyond
menopause.
• It is usually marked by atrophy of the
breasts, uterus, fallopian tubes, and
ovaries.
Disease
 The emotion is the main cause of the disease
Yang Anger GB Yang joy
Teat by yin anger Anger LUO point H5
Yang sadness Water point – Si2
Yang agony Metal point – Si5
Yang joy Earth point – Si8
Yin Anger Liv Yin joy
Treat by Yang anger Joy LUO point – Si7
Yin sadness Water point – H3
Yin agony Fear Metal point – H4
Yin joy Earth point - H7
Yang anger
Yang joy Si
LUO point - Liv5
Treat by Yin joy
Metal point – GB44
Yang fear
Earth point GB34
Yang sadness
Fire point – GB38
Yang agony
Yin anger
Yin joy H
LUO point - GB37
Sadness Agony Treat by Yang joy
Metal point - Liv4
Yin fear
Earth point - Liv3
Yin sadness
Fire point – Liv2
Yin agony
• Physical disease may cause metaphysical
problems.
• Mental problem may cause physical
problems.
• Brain is the controller of our mind and
metaphysical function
The six fundamental symptoms of
metaphysical factors
1. Thoughts : too many thoughts and ideas
indicate bubbling, a character of wind
energy. By balancing wind and humidity in
brain, one can balance thought in brain
Sp1 – Liv3
2. Emotion : too much sensitivity indicates
getting into action very fast, either excited
or depressive. Balance heat and dryness
in brain to balance emotions.
H4 – Lu10
3. Reasons : too much individuality in the
form of desires, overconciousness etc.
indicate hotness in brain balance hotness
and coldness in brain to be reasonable.
P3 – K2
4. Analysis: thinking over, gathering the
thought and analysis is done by humidity
in brain. One may be very alert while the
other may be absent minded. Balance
humidity and wind in brain.
Liv3 – Sp1
5. Planning : planning is binding the brain’s
functions into certain limits within a
certain format. Balance dryness and heat
in brain to do balanced planning
Lu10 – H4
6. Decisions : contraction of brain power to
an extent of final decision indicates
coldness. Balance coldness and hotness
in brain to develop decision making
power.
K2 – P3
Metaphysical levels in the human body
There are four levels of metaphysical
manifestation in the human body
1. Emotional level – this is the first level of
disease, it is easily curable.
It is Yin in Yang level.
2. Mental level – this is the second level of
disease. The disease level is Yang in Yin.
Here, the physical disease is of second
level yin nature and mental disease is of
first level yang level. Mental depression,
phobias, are mental level disease
3. Character level : this is the third level of
disease. This disease level is Yin in Yin.
Hence the physical disease is of third
level yin nature and metaphysical disease
of second level yin level.
4. Spiritual level : this is the ultimate and
last level of metaphysical achievements.
The disease level is most Yin in Yin. Here
the physical ease or disease is of fourth
level
• As per Traditional Chinese Medicine
uterus is one of the extraordinary Fu
organ.
• Its nourishment depends upon liver blood,
• Liver stores blood, If sufficient blood is
stored in liver, then the menstrual flow is
normal, If the liver has insufficient blood
stored, amenorrhea or oligomenorrhea
may result.
• When excess blood reaches the liver or
there is increase of heat in the blood,
menorrhagia or metrorrhagia may occur.
• When the flow of energy in the body is
normal, a person’s emotions are normal,
and they lead a satisfied life.
• When the flow of energy is stagnated, the
person is frustrated, depressed, and
experiences repressed anger.
• Along with these emotional problems,
there is pain and heaviness in the chest,
pms depression.
• So the path of the disease for uterus starts
from,
A desire to perform task but and inability to
complete then causes Liver Qi stagnation,

• Liver stores blood , so stagnate Liver qi

may causes Liver blood statis. Liver qi
stagnation is the repressed anger causes
Liver heat rising upward. And so on …
Polycystic Ovaries
 What is Polycystic Ovary Syndrome?
• PCOS is a condition that can affect your
periods, fertility, hormones and aspects of
your appearance.
• It can also affect your long-term health.
• Estimates of how many women it affects
vary widely from 2 to 26 in every 100
women.
• This information is about the effects on
your long-term health and does not cover
specific treatment options for PCOS.
 What are Polycystic Ovaries?
• Polycystic ovaries are slightly larger than
normal ovaries and have twice the
number of follicles (fluid-filled spaces
within the ovary that release the eggs
when you ovulate).
• Having polycystic ovaries does not
necessarily mean that you have PCOS.
• Women with PCOS have symptoms as
well as polycystic ovaries.
 What are the symptoms of PCOS?
The symptoms of PCOS include:
• Irregular periods or no periods at all
• An increase in facial or body hair
(hirsutism)
• Loss of hair on your head
• Being overweight, experiencing a rapid
increase in weight or having difficulty
losing weight
• Oily skin, acne
• Difficulty becoming pregnant (reduced
fertility).
• Depression and psychological problems
can also result from having PCOS.
• The symptoms vary from woman to
woman. Some women have very few mild
symptoms, while others are affected more
severely by a wider range of symptoms.
• PCOS is a cause of fertility problems in
women.
• You may still become pregnant even if you
do not have periods. If you do not want to
become pregnant, you should seek advice
from your GP about contraception.
 What causes PCOS?
The cause of PCOS is not yet known but it
often runs in families. If any of your relatives
(mother, aunts, sisters) are affected with
PCOS, your risk of developing PCOS may be
increased. (This statement as per allopath
thinking)
 The symptoms are related to abnormal
hormone levels
• Testosterone is a hormone that is
produced in small amounts by the ovaries
in all women. Women with PCOS have
slightly higher than normal levels of
testosterone and this is associated with
many of the symptoms of the condition.
(if estrogen level decrease it may causes
testosterone level increase)
• Insulin is a hormone that controls the level
of glucose in the blood. If you have PCOS,
your body may not respond to insulin (this
is known as insulin resistance), so the level
of glucose is higher. To try to prevent the
glucose levels becoming higher, your body
produces even more insulin. High levels of
insulin can lead to weight gain, irregular
periods, fertility problems and higher levels
of testosterone.
 How is PCOS diagnosed?
• Having polycystic ovaries does not mean
you have PCOS. Women with PCOS often
have symptoms that come and go,
particularly if their weight goes up and
down. This can make it a difficult condition
to diagnose, which means it may take a
while to get a diagnosis.
 A diagnosis is made when you have any two
of the following
• Irregular, infrequent periods or no periods
at all
• An increase in facial or body hair and/or
blood tests that show higher testosterone
levels than normal
• An ultrasound scan that shows polycystic
ovary
 What could PCOS mean for my long-term
health?
• If you have PCOS, you are at greater risk
of developing the long-term health
problems discussed in next slide.
1. Insulin resistance and diabetes
• If your blood glucose does not stay
normal, this can lead to diabetes.
• One or two in every ten women with
PCOS go on to develop diabetes at some
point.
• If the diabetes is untreated, this can
cause damage to organs in the body.
• If you have PCOS, your risk of developing
diabetes is increased further if you:
o are over 40 years of age
o have relatives with diabetes
 o developed diabetes during a pregnancy
(known as gestational diabetes)
o are obese (a body mass index (BMI) of
over 30.
• If you are diagnosed with diabetes, you
will be given advice about your diet and
may be prescribed tablets or insulin
injections.
2. High blood pressure
• Women with PCOS tend to have high
blood pressure, which is likely to be
related to insulin resistance and to being
overweight rather than to the PCOS itself.
High blood pressure can lead to heart
problems and should be treated.
3. Cancer
• If you have fewer than three periods a
year, the lining of the womb (endometrium)
can thicken and this may lead to
endometrial cancer in a small number of
women.
• There are various ways to protect the
lining of the womb using the hormone
progestogen.
o Your doctor will discuss the options
with you. This may include a five-day
course of progestogen tablets used
every three or four months,
o taking a contraceptive pill or
o using the intrauterine contraceptive
system.
The options will depend on whether you
are trying for a baby. PCOS does not
increase your chance of breast or
ovarian cancer.
4. Depression and mood swings
• The symptoms of PCOS may affect how
you see yourself and how you think others
see you. It can lower your self-esteem.
5. Snoring and daytime drowsiness
• PCOS can lead to fatigue or sleepiness
during the day. It is also associated with
snoring.
 What can I do to reduce long-term health
risks?
Have a healthy lifestyle
The main ways to reduce your overall risk of
long-term health problems are to:
• Eat a healthy balanced diet. This should
include fruit and vegetables, lean meat,
fish and chicken. You should cut down the
amount of sugar, salt and caffeine that
you eat and drink.
• Eat meals regularly, especially breakfast
• Take exercise regularly.
• You should aim to keep your weight to a
level that is normal. BMI is the
measurement of weight in relation to
height and you should aim to keep your
BMI between 19 and 25.
• If you are overweight, it would be helpful
to lose weight and maintain your weight at
this new level.
The benefits of losing weight include:
• A lower risk of insulin resistance and
developing diabetes
• A lower risk of heart problems
• A lower risk of cancer of the womb
• More regular periods
• An increased chance of becoming
pregnant
• A reduction in acne and a decrease in
excess hair growth over time
• Improved mood and self-esteem.
You only have to lose a small amount of
weight to make a difference to your
symptoms and your health.
 Treatment as per TCM thinking
PCOS at young age
Understand the path of the disease:
• The immature follicles converted into cyst,
if the menstruation cycle is 28 days, on
one side ovary maturation of follicle time
is 56 days, if the follicle could not able to
mature at that time the immune system
treat the follicle as a pathogen (foreign
bodies),
• Treatment of immaturity is kidney essence
points, kidney essence, nourishes all organ
by ensuring the flow of food Qi and body
fluid to the immature cells,
• The nourishment of ovary taken by liver
blood, if liver blood is deficient the
nourishment impaired,
• The pcod is caused by the stagnation of
energy, that is liver energy.
• Ovary is a main organ to produce
hormones, so it is a hormonal imbalance
also.
 Flow chart
Kidney essence + Liver blood causes
weak ovarian energy weak energy flow
stagnate due to emotional attack into liver
that causes hormone imbalance.
• Kidney essence points
K3,K6,CV4,GV4,GV14,GV20,UB11,UB15,UB23
,GB39
• Liver blood deficiency points
P6,Sp6,St36,CV4,Liv8,UB17,UB18,UB20,UB23
• Liver Qi stagnation points
P6,TW6,Liv3,Liv13,Liv14,GB34
• Hormone Imbalance can be treating by
balance all yin chakra
At the time of middle age :
There are two cause
• Liver blood deficiency that causes lack of
nourishment of the ovary that may not
produce enough estrogen
• If blood circulation is impaired due to pre
or post menopausal symptoms the
treatment is heart yin deficiency points.
P6,H6,H7,Sp6,K6,K7,CV4,CV14,CV15,Lu7,H8
Uterine Fibroids
 What Are Uterine Fibroids?
• Uterine fibroids are swellings in the uterus.
They are formed by excess normal uterine
muscle tissue and hence are not cancers.
• Although they are not cancers, they can be
symptomatic, depending on the location of
the fibroid.
• They are classified according to location.
• The symptoms and treatment depend on
the location of the fibroid.
The following diagram describes its location
and name. Schematic drawing of various
types of uterine fibroids:
a= subserosal fibroids,
b= intramural fibroids,
c= submucosal fibroid,
d= pedunculated
submucosal fibroid,
e= fibroid in statu
nascendi,
f= intraligamental fibroid
 What Causes Uterine Fibroids?
No one definitely knows the cause of the
fibroid formation. However, people have
observed the following (1,2):
1. It occurs in families. If a mother or sister
has fibroids, then the chances of having it
are high.
2. It is more common in some cases,
especially those who start having periods
before the age of ten.
3. High alcohol intake, high blood pressure
and pelvic infections increase the
incidence.
4. On the other hand, pregnancy and taking
oral contraceptive pills can decrease the
incidence
• Female hormones tend to make the
fibroids grow in size, especially during the
first trimester, while they decrease in size
after menopause.
• Although half of all women can be found
to have fibroids if an ultrasound
examination is done, most of them do not
cause any symptoms.
What Are the Symptoms of Uterine Fibroids?
• Most women who have uterine fibroids do
not have any symptoms. For those who do,
the most common symptom is abnormal
uterine bleeding.
• Fibroids that occur near the uterine lining
can cause heavy or painful periods, longer
periods, or spotting at other times.
• Iron deficiency anemia can also occur
when there is excessive bleeding.
• Large fibroids may cause pelvic pain,
pressure, pressure on the bladder (causing
frequent urination or blocking urination),
or pressure on the rectum along with pain.
• Deteriorating (progressive) fibroids can
also cause severe pain in a small area.
• Although fibroids do not interfere with
ovulation, they may impair fertility and lead
to poorer pregnancy outcomes. This is true
especially of submucosal fibroids that
deform the inner uterine cavity. They often
cause miscarriage too.
 How Are Uterine Fibroids Diagnosed?
• Uterine fibroids could be diagnosed by
pelvic examination.
• However, they are commonly diagnosed
by ultrasound. Often, the ultrasound is
very helpful in differentiating the fibroid
from other conditions, such as ovarian
tumours.
• Diagnosis may also include MRI or CT
scans, but they are more expensive and
complex than ultrasound.
 What Are the Risks of Untreated Fibroids?
• In most cases, uterine fibroids do not
cause any problems, even if they are not
treated.
• Some fibroids that are not causing
symptoms may still be removed or
observed, especially if they are growing
rapidly, since there is a rare, cancerous
type of fibroid
 How Are Uterine Fibroids Treated?
Medical treatment :
• Medicines used for fibroids are typically
used to affect hormones, including
causing a decrease of estrogen
production. They are usually prescribed
for 3 to 6 months, and can shrink fibroids
by as much as half of the original size.
• Sometimes the drugs may be used to
decrease the size before surgery.
• Side effects may include hot flashes,
vaginal dryness, sleep disturbance, and
mood change, generally similar to the
effects of menopause.
• If they are used for over a year, they can
also lead to osteoporosis, or loss of bone.
• Other drugs can be used as well.
Mifepristone, sometimes known as the
"morning-after pill," can shrink the fibroid
and reduce the bleeding.
• Danazole is another medicine, however it
has many side-effects, including weight
gain, muscle cramps, decreased breast
size, acne, hirsutism (inappropriate hair
growth), oily skin, mood changes,
depression, decreased HDL.
• Oral contraceptives can be used in low
doses to decrease the abnormal bleeding
caused by fibroids, but they do not treat
the fibroids themselves. It has been found
that these drugs decrease the risk of new
fibroids, as well.
Surgical treatments
• Surgery is usually the preferred method of
treatment, when treatment is deemed
necessary.
• One type of surgery is hysterectomy,
which removes the whole uterus and the
fibroids altogether.
• Another type is myomectomy, which
involves only removing the fibroids,
through either open surgery or by using a
laparoscope.
• The recent development is the use of
single incision surgeries with a gasless lift
Laparoscope,
• If the doctor suspects there may be
malignancy or cancer, then surgery is
necessary.
• Some of the fibroids could be removed
endoscopically or through the uterine
opening, either by cutting them into small
pieces and removing them, which is called
resection, or by vaporizing them in place.
 Uterine artery embolization
• Uterine fibroid embolization is a minimally
invasive procedure used to treat fibroid
tumors of the uterus which can cause
heavy menstrual bleeding, pain and
pressure on the bladder or bowl. It uses a
form of real-time x-ray called fluoroscopy
to guide the delivery of embolic agents to
the uterus and fibroids.
• These agents block the arteries that
provide blood to the fibroids and cause
then to shrink
Uterine artery embolization
 Path of the disease as per TCM thinking
• Understand, as per TCM, the defensive Qi
is, the food Qi raised (transport) with the
help of spleen Qi to the Lung, and Lung Qi
mix with food qi and send (uniformly
spray) into the beneath of the skin. it’s
works is to defense (protect) from the
pathogen, if this defense Qi is weak the
nourishment of the skin will also be weak,
then the skin will be weak. The fibroid is
form at the uterus wall (skin of the uterus)
due to weak wall (weak skin)
• As per the TCM theory the uterus is
nourish by the Liver blood, (the blood
supply to the uterus by Liver)
• Pain in the pelvic region is due to blood
statis of the liver blood
Weak wall of uterus (Spleen Qi + Lung Qi)
causes uterine fibroid then supply of
the blood impaired
Understand a tumor is the stagnation of the
flow of body fluid. Into a tissue, enter the
body fluid by the spleen energy and exit the
body fluid by the Lung energy. The flow
maintain by both energy,
• The inhalation done by kidney energy and
exhalation done by Lungs energy. Every
tissue or cell breath by kidney and lungs
energy Uterus wall

Exhalation
Tumor
Stasis of body Body fluids
fluids
Inhalation
The treatment is
• Treat liver qi stagnation + liver blood statis
points
P6,TW6,Liv3,13,14,GB34 +UB17,18,CV6,Sp10
Treat spleen qi + Lung qi
Sp3,6,CV12,St36,UB20,21 +
Lu7,9,CV6,UB13,GV12
• When spleen is deficient it may cause
humidity excess, then treat humid heat in
Large intestine for any uterine
inflammation
Li3,11,St37,Sp6,9,CV3,12,UB17,20,22,25
• For inhalation and exhalation treat Lung qi
deficiency and Kidney qi deficiency.
• Lu7,9,CV6,St36,UB13,GV12
• K3,CV4,GV4,UB23,47,gingong
Abnormal menstruation
 Normal Menstruation
• Duration of menstrual blood loss: 2-7 days,
mean of 5 days.
• Excessive menstruation >7 days.
• Blood loss: difficult to evaluate.
• The average blood loss during a period is
about 80cc. The 90% of the blood loss will
be 1-3 days.
• 50–75% of menstrual flow is blood, the rest
is made up of fragments of endometrial
tissue and mucus.
• Menstrual blood does not clot –
Aggregation of endometrial tissue, red
blood cells, degenerated platelets and
fibrin.
• Endometrium contains large amounts of
fibrin degradation products.
• When blood loss is excessive, lytic
substances (lysis are the breaking down of
membrane of a cell) that are rapidly
consumed lead to the presence of clots in
menstrual flow – Excessive menstrual
blood flow.
 ABNORMAL MENSTRUATION
• Menorrhagia (hyper menorrhea): uterine
bleeding excessive in both amount and
duration of flow, but occurring at regular
intervals.
• Oligomenorrhea: menstrual periods at
intervals of more than 35 days.
• Menometrorrhagia: uterine bleeding
usually excessive and prolonged occurring
at frequent and irregular intervals.
• Polymenorrhea: frequent but regular
episodes of uterine bleeding occurring at
intervals of 21 days or less.
• Metrorrhagia: uterine bleeding occurring
at irregular intervals. We can say bleeding
outside the normal menstrual period
• Hypo menorrhea: uterine bleeding that is
regular but decreased in amount.
• Intermenstrual bleeding: uterine bleeding,
usually not excessive, occurring at any
time during the menstrual cycle other than
during normal menstruation.
 Menorrhagia
• In a normal menstrual cycle, there is a
balance between estrogen and
progesterone. These are hormones in the
body that help regulate the build-up of the
endometrium, which is shed each month
during menstruation.
• For menorrhagia, there may be an
imbalance in estrogen and progesterone
levels. As a result of imbalance, the
endometrium develops in excess. When it
is eventually shed, there is heavy
menstrual bleeding.
• As hormone imbalances are often seen in
adolescents and women approaching
menopause, this type of menorrhagia is
fairly common in these group.
• Another frequent cause of menorrhagia is
Uterine fibroids, endometrial cancer,
inflammation or infection of vagina, cervix,
or pelvic organs, thyroid condition, using
blood thinning drugs.
 Metrorrhagia
• Metrorrhagia is abnormal bleeding that
occurs between periods or that is not
associated with menstruation.
• There are many cause of metrorrhagia,
including hormone imbalance, abnormal
growths, pregnancy complications, and
infection.
Doctor will perform a physical examination.
• During your pelvic examination, cultures
may be taken to test for infection or
sexually transmitted disease.
• Blood tests may be used to test your
thyroid and hormone levels.
• You may be tested for pregnancy.
• PAP smear may be taken to check for
cervical cancer.
• An ultrasound may be used to create
pictures of your reproductive organ to
allow your doctor to check for abnormal
growths.
 Etiology and pathology :
• Emotional strain
Liver qi stagnate causes liver fire
liver stores blood so liver fire causes blood
heat heat makes the blood reckless and
causes it to come out of blood vessels
This is the important cause of bleeding in
gynecological problems. Treatment points is
Liver qi stagnation - P6,TW6,Liv3,13,14,GB34
Liver heat rising upward - Liv2,3,GB13,20,
UB18,19, Liv8
If pain is excess then we can add liver blood
stasis points also – UB17, CV6, Sp10
• Excessive sexual activity and overwork
Excessive sexual activity and overwork
causes deficiency of kidney and liver yin
it causes empty heat it causes blood to
come out from the blood vessels.
Kidney yin deficiency raising empty heat
points
Lu10, H5, K2 K3,6,9,10, Sp6, CV4
Lu5 methi
Liver yin def. point add Liv8 UB17,18 20,23.
GV20 by taking inference
• Chronic illness and excessive physical
work
Chronic illness and excessive physical work
weakens the spleen weak spleen fails to
control blood,
Spleen not controlling blood
Sp1,3,6,10,CV12,St36,UB17,20,21
• Excessive loss of blood at childbirth
Excess loss of blood at childbirth can causes
heart qi deficient and heart blood deficiency.
Heart qi deficiency P6,H5,CV6,CV17,UB15
Heart blood deficiency
P6,CV4,14,15,H7,UB17,20
• Prevention
Woman who has a tendency to
menorrhagia should avoid overwork.
Avoid spicy foods and alcohol.
Avoid emotional stress.
 Following conditions come under abnormal
menstruation
• Early menstruation : Menstruation is early
if it comes seven or more days before the
regular expected date, for at least two
consecutive cycles.
• Delayed menstruation : Menstruation is
delayed or late, if it comes seven or more
days after its regularly expected date, for
at least two consecutive cycles.
• Irregular cycles of menstruation : The
menses comes sometime late some time
early, for at least three consecutive cycles.
• Excessive menses : Excessive menses
means, the quantity of menstrual flow is
significantly more then normal, either in
duration or heaviness or both.
• Decreased menses : Decreased menses
means the quantity of menstrual flow is
significantly less than normal, either in
duration or heaviness or both.
• Prolonged menstruation : Prolonged
menstruation means the menstrual flow
continues for more than 7 days and usually
less than 14 days.
Etiology and pathology :
Abnormal menstruation may be classified in
two categories.
1. Excess type
2. Deficiency type
 1. Excess type
• Heat in blood
a. Full heat in blood causes early or
excessive menstruation
Liver heat rising upward
Liv2,3,GB13,20,UB17,18,19, Sp10,6,St30
Liv8
b. Empty heat in blood due to Yin deficiency
causes early or prolonged menstruation
Kidney Yin deficiency raising empty heat
K2,H5,Lu10 K3,6,9,10,Sp6,CV4, UB17,23
• Cold in blood
a. Full cold in blood (exposure to cold evil
during menses) causes delayed and
decreased menses
Spleen Yang deficiency and Kidney Yang
deficiency, expel cold first then warm the
blood
Sp6,9,CV9,St28,UB22
Sp3,CV12,St36,UB20,21 +
K3,7,CV4,6,GV4,UB23,47
b. Empty cold in blood level also causes
delayed and decreased menses
Deficiency of Yang causes empty cold, due
to deficiency of yang, internal cold may arise
Kidney yang deficiency is the root of all yang
K3,7,CV4,6,GV4,UB23,47, +
Sp3,6,CV12,St36,UB20,21
• Stagnation of Qi causes abnormal
menstruation
Liver qi stagnation may cause irregular
menstruation or delayed and decreased
menses
P6,TW6,Liv3.13,14.GB34
• Stasis of blood causes prolonged
menstruation
LIV3,GB34,CV6,Sp10,UB17,18
• Excess of humidity causes delayed
menstruation
2. Deficiency type :
• Spleen qi deficiency causes abnormal
menstruation
a. Spleen qi deficiency causes blood
deficiency, blood deficiency leading to liver
blood deficiency, it causes late or scanty
menstruation
P6,Sp6,St36,CV4,Liv8,UB17,18,20,23
b. Spleen qi deficiency causes loosing of
ability to control blood, it leads to early
menstruation, polymenorrhea or prolonged
menstruation
Sp1,3,6,10,CV12,St36,UB17,20,21
c. Spleen qi sinking may cause irregular
menstruation
Sp3,6,CV12,St36,UB20,21,CV6,St21,GV1,20
• Kidney deficiency causes abnormal
menstruation
a. Kidney qi deficiency may cause early or
prolonged menses, if kidney qi is weak
abnormally it may cause irregular menses
K3,CV4,GV4,UB23,47, Gingong
a. Kidney yin deficiency may cause delayed or
scanty menses
K3,6,9,10,Sp6,CV1,4
Amenorrhea
Amenorrhea : amenorrhea means that no
periods, although you have not puberty, are
not pregnant, and have not gone through
menopause. There are two types
Primary amenorrhea : This is when a young
woman has not had her first period by the
age of 16.
Secondary amenorrhea : This is when a
woman who has had normal menstruation
cycles stops getting her monthly period for 3
or more months.
Causes
Possible cause of primary amenorrhea –
• Failure of ovaries
• Problem in central nervous system or the
pituitary gland
• Problem with reproductive organs
Common causes of secondary amenorrhea –
• Pregnancy
• Breastfeeding
• Menopause
• Some birth control methods, such as Depo-
Provera or certain types of intrauterine
devices.
Other causes of secondary amenorrhea
include :
• Stress
• Poor nutrition
• Depression
• Certain drugs
• Extreme weight loss
• Over-exercising
• Ongoing illness
• Obesity
• Hormonal imbalance due to PCOS
• Thyroid gland disorders
• Tumors on the ovaries or brain
As per TCM, there are two causes of
amenorrhea :
1. Amenorrhea due to deficiency
2. Amenorrhea due to excess
1. Amenorrhea due to deficiency - If the
patient has gone beyond the normal age of
menarche or the menstrual flow has
progressively diminished, then it stop, and
there are other symptoms of deficiency,
then the amenorrhea is due to deficiency
• Deficiency of liver and kidney causes
kidney essence + liver blood deficiency
K3,6,CV4,GV4,14,20,UB11,15,23,GB39 +
P6,Sp6,St36,Liv8,UB17,18,20,
• Deficiency of Qi and blood
The menses cycle become progressively
longer and menses decrease in amount,
the color of the menses is light and thin-
causes of disease – chronic weakness of
stomach and spleen, improper diet,
excessive thinking, grief or anxiety.
Treat lungs qi + spleen qi + heart qi
deficiency
Lu7,9,CV6,ST36,UB13,GV12 + Sp3,6,CV12,
UB20,21, + P6,H5,CV17,UB15
• Deficiency of blood due to yin deficiency
The menses progressively become less
until menstruation ceases. The cause of
the disease may be excess blood loss or
stomach heat due to drying or spicy food
its lead to emptying of the sea of blood
causes amenorrhea or severe illness
causes yin deficiency and may lead to
amenorrhea.
Kidney yin deficiency raising empty heat
K3,6,9,10,Sp6,CV4, Lu10,H5,K2 Liv8
Lu7 methi
2. Amenorrhea due to excess :
• Accumulation of phlegm-humidity causes
secondary amenorrhea with increased
vaginal discharge. The woman is obese or
has generalized edema.
• In obese persons phlegm and humidity are
in excess due to impaired spleen function
causes fats, and obstructs the Chong Mo
and Ren Mo vessels
expel phlegm and humidity – circulate blood
Sp3,6,CV12,St36,UB20,21
Sp9,St28,CV9,UB22,CV3, UB15
• Stasis of blood due to cold in blood
causes secondary amenorrhea
Causes of disease- blood becomes
insufficient after childbirth or blood also
becomes insufficient during and after the
menstrual flow. Insufficient blood and
excess consumption of cold and raw
foods, produces internal cold which
lodges in Chong Mo and Ren Mo vessels.
That lodged cold then congeals blood and
causes stasis so that sea of blood can not
fill
St30,Sp8,Liv8, UB17,23,CV7,Sp6,10
 Dysmenorrhea

• Dysmenorrhea, also known as painful

periods or menstrual cramps. Its usual
onset occurs around the time that
menstruation begins. Symptoms typically
last less than three days. The pain is
usually in the pelvis or lower abdomen.
Other symptoms may include back pain,
diarrhea or nausea.
• In young women, painful periods often
occur without an underlying problem.
• In older women it is more often due to an
underlying issues such as uterine fibroids,
adenomyosis or endometriosis. It is more
common among those with heavy periods,
irregular periods, whose periods started
before twelve years of age or who have low
body weight,
• A pelvic examination and ultrasound may
useful to help in diagnosis.
Medication that may help include NSAIDs
such as ibuprofen, hormonal birth control and
IUD (intrauterine device) with progestogen
Diagnosis of dysmenorrhea :
• Diagnosis of dysmenorrhea is done by
differentiating between
o cold induced dysmenorrhea
o and heat induced dysmenorrhea.
• Diagnosis of dysmenorrhea is done by
differentiating between
o excess type of dysmenorrhea
o and deficiency type of dysmenorrhea
1. Diagnosis by time and pain : pain before
and during period is usually of excess type
2. Diagnosis by pressure : if the pain is worse
by pressure, it indicate excess condition. If
the pain is relieved by pressure, it indicates
deficient condition.
3. Diagnose by hot and cold : if the pain
relieved by hot water bottle it indicates
either a cold condition or stasis of blood
due to cold. If the pain is aggravated by
heat, it indicates blood heat
4. Location of pain : pain in both side of lower
abdomen treat liver, if pain on sacrum treat
kidney
5. Diagnose by monthly cycle : If the cycle is
prolonged and menstrual blood is dark
and clotted, it indicate stasis of blood, and
if menstrual blood is red with small dark
clots, it indicates cold in uterus. If the
cycle is short, the period is heavy and the
blood is bright-red, it indicates blood heat.
6. Diagnose by type of pain :
• Pain better after passing clots – stasis of
blood
• Pain but more distension – liver qi
stagnation
• Burning pain – blood heat
• Cramping pain – cold in uterus
• Stabbing pain – stasis of blood
• Pulling pain – stasis of blood
• Bearing down pain before period – stasis of
blood
• Bearing down pain after period – kidney
deficiency
Excess type :
• Stagnation of qi and blood causes
dysmenorrhea during or one to two days
before the period, distention of breasts
and abdomen, hesitant start of period,
menstrual blood dark purple with clots,
pain relived after passing clots, irritation
and purple tongue.
Liv3,GB34,UB17,18,CV6,Sp10 +
Lu7,K6,Sp4,P6 by inference + Sp8,St29
• Stasis of blood due to cold in blood
causes
o lower abdomen pain before or after
period,
o pain more central,
o pain relived by hot water bottle,
o scanty menstruation with bright red
with dark clots, sore back.
o The causes is expose to cold during
period or at the time child birth expose
to cold
Treat pain on first priority then treat the
cause
CV4,6,St29,Sp8,6
Then treat spleen yang deficiency points
Sp3,6,CV12,St36,UB20,21
Sp9,CV9,St28,UB22
• Accumulation of humid heat in uterus
causes hypo gastric pain before the
period, some time in mid cycle, burning
sensation goes up to sacral, the menses
may be excessive, the duration of menses
may be prolonged, feeling of heat, flow
could be red or purple with small clots,
between periods there is vaginal discharge
which is yellow, viscid and malodorous.
Refrigerate heat, resolve humidity,
eliminate stasis
Sp6,9,St28,UB22, CV9 + CV3, St32 + Lu7, K6
then treat spleen qi deficiency points
Deficiency type :
• Qi and blood deficiency causes dull hypo
gastric pain at the end or after the
periods, pain relieved by pressure or
massage, the periods, light, thin and
scanty,
Causes : weak constitution, severe illness,
Deficiency of stomach and spleen causes
insufficient extraction of nutrients from
food, it causes deficiency of qi and blood
CV4,6,St36,Sp6,8,UB20
Then tone spleen qi deficiency
• Kidney and liver yin deficiency causes dull
hypo gastric pain at the end or after the
period, scanty period, the menses are thin
and light, sore back, pain relieved by
pressure and massage
Causes : over indulgence in sex, multiple
pregnancies or chronic illness
Kidney and liver yin deficiency
K3,6,Liv8,CV4,UB10,17,18,20,23,GV20
PMS (Premenstrual Syndrome)
 PMS (Premenstrual Syndrome)
• Premenstrual syndrome is a condition that
affects a woman’s emotions, physical health,
and behavior during certain days of the
menstrual cycle, generally just before her
menses.
• PMS symptoms start five to eleven days
before menstruation and typically go away
once menstruation begins.
• Ovulation, the period when an egg is released
from the ovary, occurs on day 14 of the cycle.
Menses, occur on day 28 of the cycle. PMS
symptoms can begin around day 14 and last
until seven days after the start of menses)
• Level of estrogen and progesterone
increase during certain times of the
month, it affects the serotonin levels also.
Serotonin is a chemical in the brain and
gut that affects moods, emotions, and
thoughts.
• The ovarian steroids androgens,
androstenedione and testosterone also
modulate activity in part of the brain
associated with PMS.
Risk factors for PMS include :
• A history of depression or mood
disorders, such as postpartum depression
or bipolar disorder
• A family history of PMS
• Domestic violence
• Physical or emotional trauma
Associated condition include :
• Dysmenorrhea
• Major depressive disorder
• Seasonal affective disorder
• Generalized anxiety disorder
• Schizophrenia
 The symptoms of PMS :
• Abdominal bloating
• Abdominal pain
• Sore breasts
• Acne
• Food craving, sweets craving
• Constipation or diarrhea
• Sensitivity of light
• Change in sleep patterns
• Anxiety, depression
• Emotional outbursts
• Sadness
Easing the symptoms of PMS :
• Drinking plenty of fluids to ease abdominal
bloating
• Eating a balance diet to improve overall
health
• Taking supplements, such as folic acid,
vitamin B-6, calcium, and magnesium to
reduce cramps and mood swings
• Taking vitamin D to reduce symptoms
• Sleeping at least eight hours to reduce
fatigue
• Exercising to decrease bloating and
improve mental health. Reduce stress by
through exercising and reading
Excess type of PMS :
• Stagnation of Liver qi causes abdominal
and breast distention before periods with
irritation, mood swings, anger, depression,
headache before period and hypochondriac
distension.
P6,TW6,Liv3,13,14,GB34 + Sp6,GB41
GB41 treats the breast distention and pain
Sp6 is the meeting point of three yin
meridian of leg, it soothes liver qi
• Phlegm fire attacking upwards causes
premenstrual agitation, depression,
slightly manic behavior, aggressiveness,
blood shot eyes, a feeling of oppression in
chest. A women suffering from this type of
PMS may develop mastitis also. Greasy
foods and dairy products should be avoid
it causes phlegm.
Treat pericardium qi excess point
P3,7,8,UB14 + Sp4,P6 + St8,40,GV24
(calm the mind)
+ CV12,UB20 (to reduce production of
phlegm)
Deficiency type of PMS :
• Liver blood deficiency causes depression,
weepiness before periods, breast
distention, scanty periods, poor memory,
poor sleep, slight dizziness, and pale
complexion.
P6,Sp6,St36,CV4,Liv8,UB17,18,20,23 +
Lu7,K6
• Liver and Kidney Yin deficiency causes
slight breast pain and distension before
period, irritation before period, backache,
knee pain, blurred vision, dry eyes, poor
memory, insomnias, mental restlessness,
vertex headache, and scanty period.
K3,6,Liv8,CV4,UB10,17,18,20,23,GV20 +
Liv3
• Spleen and Kidney Yang deficiency
causes slight premenstrual tension with
depression and weeping, backache,
tiredness, feeling cold at the time of
menses, frequent copious urination, low
sexual desire,
K3,7,St25,36,37,GV4,UB20,21,23,25,CV6 +
Lu7,K6
Leucorrhoea
 Leucorrhoea
• Leucorrhoea flow of a whitish, yellowish,
or greenish discharge from the vagina of
the female, that may be normal or that may
be a sign of infection.
• Such discharges may originate from the
vagina, ovaries, fallopian tubes, or most
commonly the cervix.
• It may occur during pregnancy and is
considered normal when the discharge is
thin, white, and relatively odorless.
• Physiologic leucorrhoea is a normal
condition occurring within several months
to a year of the onset of menses in
• adolescent girls and is sometimes present
in newborn girls, usually lasting one to two
months.
• However, in many case, leucorrhoea is a
sign of infection, especially when the
discharge is yellow or green, have an
offensive odor, and is accompanied by
irritation, itching, pain, or tissue
inflammation.
• Many sexually transmitted diseases, which
involve the transmission of viruses or
bacteria and include diseases such as
gonorrhea and Chlamydia, are major
causes of leucorrhoea.
• These disease lead to infection of the
cervix.
• Leucorrhoea is also a sign of vaginitis
which is often causes by infection with the
fungus Candida albicans or by infection
with the protozoan parasite trichomonas
vaginalis.
 Colour of discharge
• A white discharge indicates a cold pattern.
The cold pattern may be due either
i. Spleen yang deficiency
ii. Kidney yang deficiency
iii. External humid cold
iv. Stagnation of qi
• A yellow discharge indicates humid heat in
the lower warmer.
• A greenish discharge indicates humid heat
in liver.
• A red and white discharge also indicate
humid heat.
• A yellow discharge with pus and blood
after menopause indicates toxic humid
heat in the uterus
Consistency of discharge :
i. A watery consistency indicates cold damp
pattern
ii. A thick consistency indicates a humid
heat pattern
Smell of discharge :
i. A fishy smell indicates a humid cold
ii. A leathery smell indicates humid heat
• Spleen Yang deficiency causes copious
and persistent vaginal discharge, white or
pale yellow discharge, with no foul odor
along with no appetite, loose stools,
Sp3,6,CV12,St36,UB20,21
Sp9,CV9,St28,UB22
Add- CV6, UB30, GB26
• Kidney Yang deficiency causes white, thin
but copious and dribbles all day vaginal
discharge along with waist pain, cold
feeling in lower abdomen, excess of
urination, loose stools
Deficient kidney yang fails to store the
fluids. This lead to downward escape of
yin fluids. This causes abnormal vaginal
discharge of white, clear, thin, copious
fluids
K3,7,CV4,6,GV4,UB23,47,Gingong
Add- UB30,Sp6,GB26,St36
• Kidney Yin deficiency causes vaginal
discharge red and white, slightly viscid,
without foul smell along with burning
sensation in the vulva. Other symptoms
occurs dizziness, blurred vision, flushed
face, constipation and dark urine.
Deficient Kidney Yin leads to downward
escape of Yin fluids. Empty fire rises due
to deficiency of Kidney Yin, this causes
red and white vaginal discharge.
K2,H5,Lu10 K3,6,9,10,CV4,Sp6,Lu7
• Humid heat in lower warmer causes
vaginal discharge of copious, yellow or
mixed yellow and white, viscid with foul
smell, in some patient the discharge is
like beam curd. Other symptoms scanty
dark urine, a sticky mouth, poor appetite,
pain in lower abdomen
Humid heat in liver and gallbladder
Liv2,Liv14,GB24,34,GV9,UB18,19,Sp9,Li11
Add – CV6,UB30,GB26 Sp3,6,CV12
 Infertility
Suspensory
Fundus of
Fallopian tube ligament of ovary
uterus Ovanam
ligament

Uterus
Perimetrium Ovary
Secondary
Corpus of the uterus
oocyte myometrium
Abdominal opening Internal os of
of fallopian tube Endometrium cervix
Corpus luteum Cervix
of menstruationCervical canal
Vagina
External os
Labia minora

Internal Female Reproductive Organs Anterior view

 Day 27
and 28
Day 1-5 Day 6-14 Day 15-26

Estrogen Progesterone

Ovarian hormones

Thickness of endometrial
lining during the menstrual
cycle

Uterine Menstrual Proliferative Secretory ischemic Menstrual

ovarian Follicular Luteal

0 5 14 26 28
Definition :
• A diagnose of infertility means the woman
have not been able to get pregnant after a
year of trying.
• If a woman over 35, it means you have not
been able to get pregnant after 6 month of
trying.
• Woman who are able to conceive but not
carry a pregnancy to term may also be
diagnosed with infertility.
• A women who’s never been able to get
pregnant will be diagnosed with primary
infertility
• A woman who’s had at least one
successful pregnancy in the past will be
diagnosed with secondary infertility.
• Infertility is not just a woman’s problem.
Men can be infertile too. In fact men and
women are equally likely to have fertility
problems.
Cause of male infertility :
• Effective production of sperm, sperm
count, or the number of sperm, shape of
sperm, movement of sperm, which includes
both wiggling motion of the sperm
themselves and the transport of the sperm
through the tube of the male reproductive
system. Few medical conditions and
medications that can also affect fertility.
Risk factors :
• Older age, smoking, heavy use of alcohol,
being overweight, exposure to toxins, such
as pesticides, herbicides, and heavy metals
Some medical conditions that can causes
male infertility
• Retrograde ejaculation, varicocele, or the
swelling of the veins around the testicles,
testicle that have not descended into the
scrotum, having antibodies that attack the
sperm and destroy them, a hormonal
imbalance, such as low testosterone
production.
• Various medications and drug also affect
male infertility - chemotherapy or radiation
therapy, which are used for cancer,
sulpasalazine which is used for rheumatoid
arthritis or ulcerative colitis
Calcium channel blockers, which are used
for high blood pressure, anabolic steroid.
Cause of female infertility
Female infertility can be caused by a
variety of factors that affect or interfere
with the following biological process :
• Ovulation, when the mature egg is
released from the ovary
• Fertilization, which occurs when sperm
meets the egg in the fallopian tube after
traveling through the cervix and
• Uterus implantation, which occurs when a
fertilized egg attaches to the lining of the
uterus where it can grow and develop into
a baby
Risk factors for female infertility include :
• Increasing age
• Smoking
• Heavy use of alcohol
• Being overweight, obese
• Or underweight
• Having sexually transmitted infection that
can damage the reproductive organ.
Medical conditions affect the female
reproductive system and cause infertility
• Ovulation disorders, which can be caused
by polycystic ovary syndrome. Pelvic
inflammatory disease, endometriosis,
uterine fibroids, premature ovarian failure
Certain medications and drugs that can affect
female infertility include :
Chemotherapy, or radiation therapy, long
term use of high dose of NSAIDS such as
aspirin and ibuprofen, anti psychotic
medications
Infertility testing
Men –
Men should plan to see a doctor after one
year of trying to conceive or if any of the
following applying
• Erectile dysfunction (ED), Problems with
ejaculation, such as delayed ejaculation or
retrograde ejaculation, low sex drive, pain
and swelling in the genital area having
undergone a previous surgery in genital
area
• After taking patient history a doctor advise
a semen analysis.
 Depending on the results of initial exam
and semen analysis, doctor may want to
perform additional tests
• Hormonal testing, genital ultrasound
genetic testing
Cause of female infertility :
• Women under 35 should visit a doctor
after one year of trying to get pregnant
while 35 and over should visit after 6
month of trying.
• Doctor will take medical history they will
ask for current state of patient’s health,
sexual history, and any conditions or
illness that could contribute to fertility.
• Doctor will see patient’s ovulation every
month. This can be determined with an at
home ovulation testing kit or through
bloods testing.
• An ultrasound may also be used to
examine the ovaries and uterus.
Other common test for women
• Hysterosalpingography, which is a type of
X-ray used to evaluate the fallopian tube
and uterus.
• Laparoscopy, which uses a camera to
examine the internal organs
• Ovarian reserve testing, which uses a
combination of hormone tests to
determine a woman’s potential for
conceiving as FSH.
Infertility treatment :
The type of treatment that’s recommended
can depend on a variety of factors –
• The cause of infertility, if known how long
you have been trying to conceive.
• Overall health of both male and female
Male –
Treatment option of male infertility include
surgery, medication, and assisted
reproductive technology (ART)
Surgery :
• Surgery can fix obstructions that are
preventing sperm from being present in
the ejaculate. It can also correct
conditions such as varicocele. In some
cases, sperm can be retrieved directly
from the testicles after which it can be
used in ART treatment.
Medications :
• Medication can be used to treat issues
such as hormonal imbalances, they can
also be used to treat other conditions that
can affect male fertility, such as ED, or
infections that affect sperm count
ART :
• ART refers to treatments in which egg and
sperm are handled outside of the body. It
can include treatments such as in vitro
fertilization (IVF) intracytoplasmic sperm
injection, sperm for ART treatments can
be received from ejaculate, extraction
from the testicles, or a donor.
Women :
Treatment option of female infertility can
also surgery, medication, and assisted
reproductive technology (ART). Some time
several type of treatment are needed to
help address female infertility.
Surgery – surgery can improve fertility by
• Correcting an abnormally shaped uterus,
unblocking fallopian tubes, removing
fibroids
ART – Reproductive assistance can involve
methods such as intrauterine insemination
(IUI). During IUI, millions of sperm are
injected into a woman’s uterus near the
time of ovulation.
• IVF is one type of ART and involves the
removal of eggs that are then fertilized with
a man’s sperm in a laboratory. After
fertilization, the embryo is placed back into
the uterus.
Medication : The medication used to treat
female infertility work like hormones that
are naturally present in the body to either
encourage or regulate ovulation.
Treatment as per TCM for infertility –
Male fertility
1. Deficiency type
• For male infertility deficient Kidney Yang
(weak warmth energy) and kidney essence
may cause infertility.
• Treatment points
• K3,7,CV4,6,GV4,UB23,47,gingong tone
• K3,6,CV4,GV4,14,20,UB11,15,23,GB39 tone
2. Excess type
• Small Intestine heat + heart fire blazing may
causes heat in testes and burn the sperm
lead to low sperm count.
For female :
1. Kidney yang deficiency causes infertility
with loss of libido, delayed and decreased
menstruation with pale menses, infrequent
menses, even amenorrhea may be there,
weak legs and waist.
Cause of disease –
• Kidney Yang become deficient due to
o Inadequate prenatal endowment
o Excessive sexual activity
• Deficient Kidney Yang fails to warm and
nourish the uterine meridian. Hence Ren
Mo and Chong Mo become deficient.
• The essence could not gel and form into a
fetus.
• When the Kidney Yang is deficient, the fire
of vital gate declines and is unable to
proper qi and move water.
• Cold and humidity gels in Chong Mo and
Ren Mo and blockage there.
• Humidity fills the uterine meridians, so
that essence can not el and form into a
fetus.
Treatment principles :
• Warm the Kidney, generate blood, nourish
Chong Mo and Ren Mo vessels.
Treatment protocol
• Kidney Yang deficiency
K3,7,CV4,6,GV4,UB23,47,Gingong tone
• Kidney essence points
K3,6,CV4,GV4,14,20,UB11,15,23,GB39 tone
• Some time pericardium Qi also deficient
due to insufficient Kidney Yang
P6,GV25,26,Sp6,K3,7,Liv13,UB15,H7,Sp4
tone
• Add points Sp4,P6 and Lu7,K6 by taking
inference.
2. Kidney Yin deficiency causes infertility
with early and decreased menses with
emaciation, dizziness, blurred vision,
palpitation, insomnia, low grade fever in
the afternoon and five palm heat.
Causes of disease :
• Deficient Kidney Yin allow Yang to be
overactive. This overactive Yang Qi raises
internal heat. This internal heat goes to
Ren and Chong Mo and disturb the sea of
blood, so that essence can not gel and
form a fetus.
• Excessive sexual activity can consume
essence and blood causing deficiency of
 Kidney Yin.
• Inadequate prenatal endowment may also
causes Kidney Yin deficiency and
consequent infertility.
Treatment
• K2,H5,Lu10 sedate
K3,6,9,10,Sp6,CV4,UB23, Lu7 tone
• Treat kidney essence points
• Add Lu7,K6 and Sp4,P6 by taking
inference.
3. Stagnation of Liver Qi may cause infertility
with premenstrual breast distention,
decreased and dark colored menses
containing clots or irregular menses.
Other symptoms restlessness or anger.
Cause of disease –
• Pent up emotion may cause stagnation of
liver qi.
• Liver qi stagnation impairs liver function.
This causes disharmony of qi and blood.
Chong Mo and Ren Mo can not support
each other. Essence can not gel and form
into fetus.
Treatment :
Liver qi stagnation points –
P6,TW6,GB34,Liv3,13,14 sedate
Add CV3,4,6,Sp6, sedate
 4. Accumulation of internal humid phlegm
due to deficiency of Spleen causes
infertility with delayed menses or
amenorrhea, leucorrhea and weight gain.
Cause of disease –
• Excess consumption of fatty and spicy
foods and in obesity humidity and phlegm
accumulate in the interior and obstructs qi
movement.
• Reduced qi movement causes loss of
control of Ren Mo and Chong Mo.
• There is overflow of fat in the uterine
channels, it impaired uterine function, now
essence can not gel and form into a fetus.
Treatment
• Dry humidity
• Resolve phlegm
• Mobilize qi
• Regularize menses
• Resolve infertility
treatment points
Sp6,Sp9,St40,CV4,6,St28,UB22 sedate
Then treat Spleen Qi deficiency points
Sp3,6,CV12,St36,UB20,21 tone
5. Stasis of blood in the uterus causes
infertility with delayed and decreased
menses or dysmennorrhea, menstrual
blood is dark purple with clots.
Cause of disease :
• Body’s defensive qi system is weakened by
o Excessive sexual activities, Exposure to
cold and water during menses, Post
partum bleeding
• Now external evils attack the body more
frequently. When the external evil
intermixes with blood, it causes stasis of
blood, it blocks the uterine channels,
essence can not gel and form a fetus
Treatment principles :
• Mobilize blood
• Remove stasis
• Regulate menses
• Promote conception
Liv3,Li4,St29,CV6,4,Sp6,UB20,32 sedate
Abortion
1. What is threatened abortion ?
During pregnancy if a woman has lower
abdominal and waist pain and slow
bleeding from the vagina, she is said to
have threatened abortion.
Main symptoms :
• Lower abdominal pain during first or
second trimester of pregnancy
• Aches in the waist
• Slow vaginal bleeding
• In china this condition called
“restlessness and disturb fetus”
2. What is gestational leakage ?
slow vaginal bleeding during the first or
second trimester of pregnancy without
abdominal pain or lumbago is called
gestational leakage.
Main symptoms –
1. Intermittent slow bleeding from the vagina
during first or second trimester of
pregnancy
2. Persistent dribbling from the vagina
during first or second trimester of
pregnancy
3. No abdomen pain, no other symptoms.
3. What is abortion and spontaneous
abortion?
Spontaneous abortion is the expulsion of
the fetus before the fetus is viable.
4. What is habitual abortion?
Three or more occurrences (miscarriage)
of spontaneous abortion is called habitual
abortion.
Patterns of abortion and their treatment :
• Deficiency of Kidney Qi causes poor
nourishment of the fetus and consequent
fetal restlessness that may result in
threatened or spontaneous abortion.
Main symptoms :
• Slow uterine bleeding of dusky pale and
thin blood during frequency
• Aches and weakness in waist and knees
• Fetal restlessness
• May result in threatened or spontaneous
abortion.
• Dizziness, polyuria, nocturia, incontinence
of urine
Causes of disease :
• Deficiency of Kidney qi may be due to
inadequate prenatal endowment, multiple
pregnancies, excessive sexual activities,
sexual activity during pregnancy. If the
Kidney is insufficient, Chong Mo and Ren
Mo also becomes weak and fail to nourish
the fetus. The fetus looses nourishment,
become restless it may result in
threatened or spontaneous abortion.
• Treatment points
• K1,3,CV4,GV4,UB23,47
Add H4 and UB37 tone all points
2. Deficiency of blood and Qi causes
threatened abortion during first trimester
with light uterine bleeding of light colored
and thin blood.
Main symptoms :
• Aches and weakness in knees and waist.
• Abdominal distention with pain.
• There may be history of habitual abortion.
• Tiredness, weak limbs, pale complexion,
palpitation, shortness of breath,
Cause of disease :
• Deficiency of blood and Qi is caused by
weak constitution, excessive fatigue,
improper diet, mental stress, during
recovery from the major illness
• Spleen Qi deficiency reduces production of
qi and blood, the fetus needs blood for
nourishment and qi for maintenance.
• Deficiency of qi and blood may lead to
threatened or spontaneous abortion.
Treatment points :
Sp3,6,St36,UB20,21 (Spleen qi deficiency)
Add Lu9,UB13,GV12 (Lung qi deficiency)
Add UB17,18,23, Liv8 (nourish the blood) tone
3. Heat in blood may lead to threatened
abortion with bleeding of bright red blood,
fetal unrest and lower abdominal pain.
Other symptoms :
• Agitation
• Five palm heat
• Dry throat and mouth
• Constipation
• Red tongue with yellow and dry coating
Cause of disease :
• Heat in blood is caused by constitution of
excess Yang, constitution of deficient Yin
producing empty heat, heat readily
transforms into fire,
• Over eating strong flavoured or spicy
foods cause heat in blood.
• Attack of external heat evil causes heat in
blood
• Injury by passion (emotion) causes heat in
blood.
• Heat disturbs Chong Mo and Ren Mo
vessel and force blood to move erratically,
• Insecurity of the sea of blood leads to
uterine bleeding, hence threatened
abortion or spontaneous abortion.
Treatment Principles :
Nourish Yin, refrigerate heat, generate
blood, calm the fetus.
Treatment points
Sp4, P6 sedate Chong Mo
Take inference of Liv3 and Sp1 for
balancing blood control
sedate Sp6 for bleeding from any where
treat Sp8 sedate this is Xi cleft point and its
treat acute and painful menstrual issue due
to blood stagnation.
• Treat Sp10 sedation to reduce heat in
blood
• Treat Li11 by taking inference , this is a
thermostat point it balance heat and cold
condition as per requirement
• Treat K2 and K5 also cools the blood.
4. Blood stasis with qi stagnation may lead
to threatened or spontaneous abortion
due to uterine mass or trauma in pelvic
area.
Other symptoms :
• Aches in waist, abdomen pain, vaginal
bleeding, black tongue.
Cause of disease :
• Blood stasis and qi stagnation are caused
by uterine or pelvic mass, trauma of pelvic
area, previous surgery of pelvic area,
defects in uterus, improper living habits
during pregnancy, trauma and over strain.
• Blood stasis and qi stagnation causes
disturbance of qi and blood in Chong Mo
and Ren Mo, this lead to threatened or
spontaneous abortion.
Treatment points
P6,TW6,Liv3,13,14,GB34 sedation
Add Liv1,St30, Sp6,8,10,12, sedation
Add Sp4 sedation
Menopause symptoms
What is menopause :
• A woman is born with all of her eggs,
which are stored in her ovaries.
• The ovaries also make the hormones
estrogen and progesterone, which control
her period and the release of eggs.
• Menopause happens when the ovaries no
longer release an egg every month and
menstruation stops.
Menopause process :
Natural menopause is not caused by any
type of medical treatment. It has three
stage.
• Per menopause : This phase usually begins
several years before menopause, when
ovaries slowly make less estrogen. In the
last 1-2 years of this stage, estrogen levels
fall faster.
• Menopause : This is when it’s been a year
since you had a period. The ovaries have
stopped releasing eggs.
• Post menopause : These are the year after
menopause, menopausal symptoms such
as hot flashes usually ease. But health risk
related to the loss of estrogen increase as
you get older.
Menopause symptoms :
• Most women nearing menopause will have
hot flashes, sudden feelings of warmth
that spread over the upper body, often
with blushing and sweating. These flashes
can range from mind in most women to
severe in other.
Other symptoms include.
• Irregular periods
• Insomnia
• Mood swings
• Fatigue
• Depression
• Tachycardia
• Headache
• Joint and muscle pain
• Changes in libido
• Vaginal dryness
• Trouble controlling
 Menopause Complication – the loss of
estrogen linked with menopause is tried to a
number of health problem –
• Bone loss (osteoporosis)
• Heart disease
• Bladder and bowels that do not work like
they should
• Higher risk of Alzheimer disease
• More wrinkles
• Poor muscle power and tone
• Weaker vision, such as from cataracts,
and macular degeneration
• Sexual changes like vaginal dryness, loss
of sex drive
 Your doctor might also test your blood for
levels of
• Follicle stimulating hormone (FSH) – This
usually goes up as you near menopause.
• Estradiol – This tells your doctor how much
estrogen your ovaries are making.
• Thyroid hormones – This shows problems
with your thyroid gland, which can affect
your period and cause symptoms that look
like menopause.
• Anti - Mullerian hormone (AMH) – Your body
makes AMH in its reproductive tissues. It
can help your doctor learn about the reserve
of eggs in your body
Medical treatment for Menopause :
• Hormone replacement therapy (HRT) – this
is also called menopause hormone therapy.
You take medication to replace the
hormones that your body is not making
anymore. Certain drugs or combinations
can help with hot flashes and vaginal
symptoms, as well as making your bones
stronger. But they can also put you at
higher risk of health problems like heart
disease or breast cancer, so you should
take the lowest dose that works for the
shortest time possible.
• Topical hormone therapy- an estrogen
cream, insert, or gel that you put in your
vagina to help with dryness.
• Non hormonal medications –
antidepressant drug paroxetine is FDA
approved to treat hot flashes. The nerve
drug gabapentin and blood pressure drug
clonidine might also ease them. Medicines
called selective estrogen receptor
modulators help your body use its
estrogen to treat hot flashes and vaginal
dryness.
• Medication for osteoporosis – you might
take medicines or vitamin D supplements
to keep your bone strong.
Treatment as per Traditional Chinese Medicine
• Liver blood deficiency points nourish the
ovary and help to normalizes the hormone
P6,Sp6,St36,CV4,Liv8,UB17,18,20,23 tone
• Heart Yin deficiency points helps
normalizes the menopausal symptoms like
hot flash and dryness of vagina.
P6,H6,7,Sp6,K6,7,CV4,14,15,Lu7,H8 tone
• Kidney and Heart Yin deficiency points
help to normalizes more chronic
menopausal symptoms.
K3,9,10,CV4,Sp6 tone,
P6,H5,6,7,UB15 sedate
CV15,GB13,GV24 methi
Breast nodes
Lymph nodes

Alveoli
Ducts
Areola
Nipple

Anatomy Of The Breasts

Benign Breast Lumps :
• Cyst – fluid filled sacs that tend to form
and dissipate spontaneously within the
breast tissue. They form when fluid from
the glandular breast tissue is pushed out
into a sac. By the appearance on
ultrasound, the radiologist can determine
whether or not the area is a cyst.
• Fibroadenoma – it is a solid lesion
composed of fibrous and glandular tissue.
It is affected by hormones and may
enlarge during pregnancy
• Lymph nodes – lymph node are small
bean shaped glands that vary in size, they
are an important part of immune system.
Lymph nodes can enlarge when there is
inflammation or infection. Doctor may
recommend a mammogram or an
ultrasound to rule out a more serious
condition.
Treatment principle :
• Treat liver qi stagnation points
P6,TW6,Liv3,13,14,GB34, sedate
• Treat Spleen qi deficiency points and
Lungs Qi deficiency points
Sp3,6,CV12,St36,UB20,21 tone
Lu7,9,CV6,St36,UB13,GV12 tone
• Add points for blood circulation
Heart qi deficiency points
P6,H5,CV6,17,UB15 tone
If age is near menopause treat Heart Yin
deficiency points
P6,H6,7,Sp6,K6,7,CV4,14,15,Lu7,H8 tone