| Objective: Hypomenorrhea is a common disease in gynecology, it has always merged with Longer menstrual interval. If not timely medical treatment, it will develop for amenorrhea,infertility. This disease has constantly perfected and arranged by past medical books and alex edition textbooks of《TCM Gynaecology》, but nowadays there hasn't established standard of diagnosis and differentiation. The report about the pattern of syndrome was different on magazine, and there was different zheng-hou in the same pattern of syndrome. Our study aimd at exploring the discipline of Diagnosis and syndrome in Hypomenorrhea by clinical epidemiology research methods, thus to provide thread and methods with evaluate standard of Hypomenorrhea for mirror.Method:1Literature researchBy Looking up successive dynasties Chinese Medical gynecology book in library, and using《ZHONG GUO YI JI DA CI DIAN》as keytool, we arrange and analyse 200 books from《Nei Jing》to the late Qing Dynasty in Hebei Medical University West Campus Library; we used computer retrieval by China journal full-text database,important conference proceedings full-text database, etc. Initial screening correlated sympoton of Hypomenorrhea, which provide literature supportment for formulating questionnaire about the diagnostic criteria of Hypomenorrhea.2Clinical researchAt the base of investigating literature, make up the questionnaire of Hypomenorrhea. We chose 231 patients who fit the inclusion standard of Hypomenorrhea as disease group; chose 200 nomal healthy women as control group (besides Cerebrovascular disease, Liver, Kidney, Adrenal, Thyroid, Hypophysis and other gynecological diseases, Diseases of the nervous system, Blood etc). There was 26 persons with Longer menstrual interval, 6 persons with Irregular menstruation cycle, 5 persons with Advanced menstrual interval; the oldest is 44, the youngest is 16, mean age is 31.17±8.63. With the help of investigators, respondents fill up the questionnaire, use the sanitary napkin unify distributed to collet menstrual blood, recording the menstrual quantity at chart and taking back unifily.Result:1Literature research1.1The result of literature research show that ancient medical literature description about Hypomenorrhea often mingle with Amenorrhea, there was no evident limit. Most medical scientist used"obviously reduced by volume""period one or two days"as diagnostic basis. In 1959, there has a Gynaecology》, which the chief editor is Chengdu institute of traditional Chinese medicine: Hypomenorrhea mean that menstrual blood run not smoothly, the quantity are less than usual, but have a normal cycle. Many teaching material have been continually modificated the definition of Hypomenorrhea, in 1973,《TCM Gynaecology》,which the chief editor is Shandong medical Chinese medical department TCM gynaecology group, point out that Hypomenorrhea means that the cycle of menstruation is normal, but the volume of menstrual blood is more less (less than 30ml), or the period only keep one or two days. This is the firstest description about Hypomenorrhea's menstrual quantity than before.1.2By the use of Frequency Analysis to analyze every Hypomenorrhea syndrome in literature, we draw the conclusion that the main type of syndrome are Blood stasis syndrome, Blood deficiency syndrome, Nephrasthenia syndrome, Phlegmatic hygrosis syndrome.Within them, Blood stasis syndrome 65.52%, Blood deficiency syndrome 62.07%, Nephrasthenia syndrome 37.93%, Phlegmatic hygrosis syndrome 27.59%. The main dialectical point of Blood stasis syndrome is that menstrual discrease, color violet black with patches, the lower abdomen distension painful but cannot pressed, the pain has been relieved after discharging coagulated blood, purple blue-black tongue, with the petechia, pulses deep and unsmooth; The main dialectical point of Blood deficiency syndrome is that menstrual discrease, color reddish and no patches, substance clear, dizzy and giddiness, tinnitus and palpitation, sallow complexion or lusterless complexion, the lower abdomen empty pain, the skin are not greasy, cold hands and feet, less sleep, tongue reddish, no moss or moss thin and white, pluses weak and trifling or trifling and thin. The main dialectical point of Nephrasthenia syndrome is that menstrual discrease, color reddish, substance subtilty, the lower abdomen crymodynia, lumbar debility, heel pain, tinnitus, dizzy, nocturia increase, tongue reddish, moss thin, pluses deep and weak or deep and trifling or deep and late; The main dialectical point of Phlegmatic hygrosis syndrome is that menstrual discrease, color reddish, substance sticking and greasy, leukorrhagia, tired, chest distress, body fat, tongue pale, moss white and greasy, pulses chord and slip.2Clinical research2.1The result of menstrual quantity in HypomenorrheaBy clinical researching, we can see that the average menstrual quantity of normal heathy women is 45.58±7.89ml, the patient of Hypomenorrhea's is 27.16±4.54ml, compared the two groups, the menstrual quantity of Hypomenorrhea's is obviously less than the normal women's. According to the result, we can initially decide that the people whose menstrual quantity are less than 30ml was belong to Hypomenorrhea, which coincide with literature report.2.2The research of Hypomenorrhea syndrome types According to the result of clinical questionnaire, we statist Hypomenorrhea syndrome types with frequency estimation method. Results show: Nephrasthenia syndrome 32.65%, Phlegmatic hygrosis syndrome 11.26%, Kidney asthenia with phlegmatic hygrosis syndrome 11.68%, QI stagnation syndrome 9.09%, Blood deficiency syndrome 11.68%, Kidney asthenia with blood stasis syndrome 7.79%, Blood stasis syndrome 9.09%, Qi deficiency to blood stasis syndrome 6.49%. Nephrasthenia syndrome is the most appeared in Hypomenorrhea.By logistic gradual regressive analysis, we draw the conclusion about each Hypomenorrhea syndrome type which has statistical significance(main syndrome is the important dialectical index of all syndrome types, from big to small by the value of OR)as follow:①Nephrasthenia syndrome: menstrual discrease, color reddish, lumbar debility, dysphoria in chestpalms-soles, pluses deep and thready.②Phlegmatic hygrosis syndrome: menstrual discrease, substance sticking and greasy, body fat, chest distress, indigestion and loss of appetite, excrement sticking and greasy with not well, tongue have the indentation.③Kidney asthenia with phlegmatic hygrosis syndrome: menstrual discrease, substance sticking and greasy, body fat, lumbar debility, tongue have the indentation.④QI stagnation syndrome: menstrual discrease, color darkred, breast distending pain before the period, chest distress, the abdomen distension painful but cannot pressed, pulses chord.⑤Blood deficiency syndrome: menstrual discrease, color reddish, substance subtilty, the abdomen dull pain and happy to press, dizzy, giddiness, lusterless complexion, pulses thin and unsmooth.⑥Kidney asthenia with blood stasis syndrome: menstrual discrease, color violet black with patches, substance ropiness, the lower abdomen sharppain, lumbar debility, face unlucky and dark, tongue have petechia, pulses deep thready and chord.⑦Blood stasis syndrome: menstrual discrease, color violet black with patches, substance ropiness, the lower abdomen sharppain, face unlucky and dark, dryness of throat, excrement dry and hard, tongue have petechia.⑧Qi deficiency to blood stasis syndrome: menstrual discrease, color deep red, tired, shortness of breath, lack of qi and no desire to speak, sallow complexion, cold limbs, tongue have petechia.2.3To contrast menstrual volume of all syndrome types of HypomenorrheaCompared with Nephrasthenia syndrome,menstrual blood volume of QI stagnation syndrome, Blood deficiency syndrome, Kidney asthenia with blood stasis syndrome, Blood stasis syndrome, and Qi deficiency to blood stasis syndrome were cut down(P<0.01), there were no statistical significance between Nephrasthenia syndrome and Phlegmatic hygrosis syndrome, Kidney asthenia with phlegmatic hygrosis syndrome(P>0.05); Compared with Phlegmatic hygrosis syndrome, menstrual blood volume of QI stagnation syndrome, Blood deficiency syndrome, Kidney asthenia with blood stasis syndrome, Blood stasis syndrome, and Qi deficiency to blood stasis syndrome were cut down(P<0.01), there were no statistical significance between Phlegmatic hygrosis syndrome and Nephrasthenia syndrome, Kidney asthenia with phlegmatic hygrosis syndrome(P>0.05); Compared with Kidney asthenia with phlegmatic hygrosis syndrome, menstrual blood volume of Blood deficiency syndrome, Blood stasis syndrome, and Qi deficiency to blood stasis syndrome were cut down(P<0.01), there were no statistical significance between Kidney asthenia with phlegmatic hygrosis syndrome and Nephrasthenia syndrome, Phlegmatic hygrosis syndrome, QI stagnation syndrome, Kidney asthenia with blood stasis syndrome(P>0.05); Compared with QI stagnation syndrome, menstrual blood volume of Nephrasthenia syndrome, Phlegmatic hygrosis syndrome, Blood deficiency syndrome, Blood stasis syndrome, Qi deficiency to blood stasis syndrome were cut down(P<0.01), there were no statistical significance between QI stagnation syndrome and Kidney asthenia with phlegmatic hygrosis syndrome, Kidney asthenia with blood stasis syndrome (P>0.05); Compared with Blood deficiency syndrome, menstrual blood volume of Nephrasthenia syndrome, Phlegmatic hygrosis syndrome, Kidney asthenia with phlegmatic hygrosis syndrome, QI stagnation syndrome, Blood stasis syndrome, and Qi deficiency to blood stasis syndrome were cut down(P<0.01), there were no statistical significance between Blood deficiency syndrome and Kidney asthenia with blood stasis syndrome(P>0.05); Compared with Kidney asthenia with blood stasis syndrome, menstrual blood volume of Nephrasthenia syndrome, Phlegmatic hygrosis syndrome, Qi deficiency to blood stasis syndrome were cut down(P<0.05), there were no statistical significance between Kidney asthenia with blood stasis syndrome and Kidney asthenia with phlegmatic hygrosis syndrome, Blood deficiency syndrome, QI stagnation syndrome, Blood stasis syndrome(P>0.05); Compared with Blood stasis syndrome, menstrual blood volume of Nephrasthenia syndrome, Phlegmatic hygrosis syndrome, Kidney asthenia with phlegmatic hygrosis syndrome, QI stagnation syndrome, Blood deficiency syndrome were cut down(P<0.01), there were no statistical significance between Blood stasis syndrome and Kidney asthenia with blood stasis syndrome, Qi deficiency to blood stasis syndrome(P>0.05); Compared with Qi deficiency to blood stasis syndrome, menstrual blood volume of Nephrasthenia syndrome, Phlegmatic hygrosis syndrome, Kidney asthenia with phlegmatic hygrosis syndrome, QI stagnation syndrome, Blood deficiency syndrome, Kidney asthenia with blood stasis syndrome were cut down(P<0.05), there were no statistical significance between Qi deficiency to blood stasis syndrome and Blood stasis syndrome(P>0.05).Conclusion:This study use the method of literature research and clinical epidemiology investigation, make a initial systemic research about the diagnose,differentiation of symptoms and signs in Hypomenorrhea, conclusion as followed:1Use the method of literature inveatigation, probe the diagnostic code about Hypomenorrhea by past dynasties doctors and teaching material, sum up the main dialectical point of all types of syndrome, grasp the differentiation thought, establish the base of the theory and disease evaluation criteria for further research.2The blood volume of Hypomenorrhea were less than normal female, the average menstrual blood volume were 27.16±4.54ml, we can preliminary assess that the people whose menstrual blood volume less than 30ml belong to Hypomenorrhea. But there is different menstrual blood volume between the type of Hypomenorrhea syndromes, Blood stasis syndrome is the lowest, and Nephrasthenia syndrome is the highest.3There were eight types in Hypomenorrhea, respectively, Nephrasthenia syndrome, QI stagnation syndrome, Phlegmatic hygrosis syndrome, Blood deficiency syndrome, Blood stasis syndrome, Kidney asthenia with phlegmatic hygrosis syndrome, Kidney asthenia with blood stasis syndrome, and Qi deficiency to blood stasis syndrome. They have the same clinical manifestation, but have peculiar clinical manifestation.
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