Advances In Clinical Research Progress Of Traditional Chinese Medicine And Western Medicine In The Treatment Of Mild Mellitus (Anovulatory Dysfunctional Hemorrhage) And Diagnosis And Treatment Of Adolescent Miscarriage

Dysfunctional uterine bleeding (DUB) is a common intractable gynecological disease, mainly caused by dysfunction of hypothalamic-pituitary-ovarian axis (HPOA), which is currently distinguished from abnormal uterine bleeding due to organic disease. DUB can be classified as ovulatory or anovulatory:anovulatory DUB is more common occurred (80% to 90%) at the extremes of reproductive age, such as early puberty and perimenopause; ovulatory DUB (10% to 20%) usually occurs at childbearing age. In the traditional Chinese medicine, DUB is classified under metrorrhagia and metrostaxis (Beng and Lou) disease, where metrorrhagia is uterine bleeding at excessive flow rate and metrostaxis means slight but persistent uterine bleeding. Due to the complex cause, serious symptom and prolonged duration as DUB has, plus the potential possibility of causing anemia, pelvic infection and infertility, it severely affect the mental and physical life quality of patients.Epidemiological investigation (last 5 years):DUB has a high morbidity at the early puberty age, with complex and various risk factors, including high study and work pressure, overwrought menstrual period, improper diet, BMI<18.5 or≥24.0, genetic and mental problem, etc. Symptom investigation from 1016 metrorrhagia and metrostaxis patients shows that most patients have weak conditions on viscera, causing deficiency symptom, especially in spleen and kidney. Clinically, multi-symptom condition is more common, where bi-symptom is the most common situation for this disease.Mechanism:in the Western medicine, anovulatory DUB is usually caused by disorder of HPOA. In addition, other factors such as uterine micro-environment, mental and genetic problem are counted as causes of anovulatory DUB. In the traditional Chinese disease, mechanism of metrorrhagia and metrostaxis can be concluded as mental disorder and improper diet, rendering viscera dysfunction, disharmony of Ying & Yang blood, etc. where viscera dysfunction is closely related with kidney, spleen and liver; disharmony of Ying & Yang blood is usually performed as blood-heat, deficiency of vital energy and blood stasis.Treatment:in the Western medicine, anovulatory DUB usually has two treatments: pharmaceutical and surgical, where hormone drug is largely used under pharmaceutical treatment, including individual hormone drug, combined hormone drug, estrogen-progestogen sequential treatment, estrogen-progestogen period treatment, progestogen semi-period treatment, etc. Advantages of hormone drug include fast hemostasis, while disadvantages include serious side effects, as well as high recurrence rate, causing relatively low compliance from patients; surgical treatment includes diagnostic dilation and curettage (D&C), levonorgestrel intrauterine system (LNG-IUS), hysterectomy and endometrial ablation. In clinical, D&C is the most common method with fast hemostasis, however this is usually not acceptable by puberty DUB patients. Therefore, in the Western medicine, treatment for puberty DUB patients is limited and unsatisfied, while in the traditional Chinese medicine, principle of treating metrorrhagia and metrostaxis disease is "symptom relief for acute case, cause treatment for chronic case", flexibly applying "plug flow", "purification" and "reintegration", depending on either syndrome, or artificial cycle, or age groups. The clinical performance of this treatment is significant, particularly for puberty DUB, which can not only avoid side effects, but also recover the kidney-menstruation-Chongren-uterus axis gradually with low recurrence, that is easily accepted by patients.Professor Xin Xu, my advisor, treats puberty metrorrhagia and metrostaxis (puberty anovulatory DUB) patients with accurate diagnosis, focusing on spleen and kidney, applying antifebrile drug based on different viscera heat effect as well as combining ultrasound. The treatment performance is significant for both hemostasis and recovering menstrual cycle.This article firstly demonstrates on the mechanism, treatment and future improvement of metrorrhagia and metrostaxis disease (anovulatory DUB) from both traditional Chinese and Western medicine literature review respectively, then shows some clinical trials on this disease from Professor Xu.