| Objective: Based on the literature study and specialist questionnaires survey, guided by Evidence-based Medicine and theories of Traditional Chinese Medicine, the present topic was to investigate on hemorrhagic menopathy (advanced menstruation, hypermenorrhea and prolonged menstruation) through multicenter and large sample of clinical epidemiologic investigation, and did frequency and composition descriptive statistical analysis on investigation results, to study the rule of the distribution of percent hemorrhagic irregular menstruation syndromes and symptoms, It could provide clinical evidences for Standardized research on patterns of hemorrhagic menopathy. We hope to offer information and guidance for present gynecology in clinic, teaching and scientific research. At the same time, it also could provide an idea and a method for the standardization of diagnostic criteria of hemorrhagic menopathy and we hope to promote the present standardization study.Methods: The methods of cross-sectional study in clinical epidemiologic investigation were mainly used in the present study.1 Investigation MethodsThe questionnaires were formulated. To avoid differences in areas, the methods of the large sample, and multicentre clinical epidemiologic investigation were used. During January ,2009 to September, 2010, we carried out the on-the-spot investigation on 1522 cases with hemorrhagic menopathy from five provinces and cities'hospital and out-patient clinic in Jiangsu (eastern), Guangdong (southern), Liaoning (northern), Sichuan (western) and Hebei (middle) directions to investigate on the distribution of patterns and symptoms. 2 Methods of data record, analysis and statistics:2.1 The total data of questionnaires were entered into the Excel sheet to establish the corresponding database, and make descriptive statistics of the frequency and constituent ratio of the distribution of each pattern and symptom.2.2 Surveying and Statistical Method of Menstrual Blood VolumeWeighting method was adopted, the blood-stained sanitary napkins was weighted, recorded the weight, and then calculated the blood weight. The SPSS 13.0 software was used to do statistical analysis. If it matched normality, the referrence range was maked according to nomal distribution law. If it did not match normality, the referrence range was maked according to Percentile method.At the same time, compared the nomal group with the excessive menstrual flow group.Results:Part 1:Patterns Distribution of advanced menstruation: kidney-qi deficiency, spleen-qi deficiency, syndrome of liver congestion and blood heat, blood stagnation, liver-qi stagnation, blood heat due to yin deficiency. On these results, we suggested to further investigate and consider adding the blood stasis into the common syndromes of advanced menstruation.Patterns distribution of hypermenorrhea: spleen-qi deficiency, stagnation of blood, syndrome of liver-qi congestion and blood heat, kidney-qi deficiency, liver-qi stagnation, blood heat due to yin deficiency. On these results, we suggested to further investigate and consider adding the deficiency of kidney-qi into the common syndromes of hypermenorrhea.Patterns distribution of prolonged menstruation: spleen-qi deficiency, kidney-qi deficiency, stagnation of blood, syndrome of liver-qi congestion and blood heat, stagnation of liver-qi, blood heat due to yin deficiency. On these results, we suggested to further investigate and consider adding the deficiency of kidney-qi and stagnation of liver-qi and blood heat into the common syndromes of prolonged menstruation. Part 2:According to frequency statistical results, the TCM theory and specialist experience, patterns and symptoms distribution of hemorrhagic menopathy were as follows:1 The main constitutive manifestations attributed to various syndromes of menorrhea were as follows (by orders of menstruation, leucorrhea, general symptoms, tongue and pulses):Deficiency of kidney-qi: advanced menstruation, more or less menstrual volume, dark red of menstrual color, thin or normal in texture with or without small clots, more or normal leucorrhea, with thin or normal texture, tasteless, light yellow or white color. Tiredness and lassitude, soreness and weakness of waist and knees, bad memory and distraction, dizziness, short breath, tinnitus, dim complexion, vague pain in lower abdomen relieved by pressure, frequent urination and nocturia, light red tongue with thin white coating, thready and deep pulse.Deficiency of spleen-qi: advanced menstruation, menstrual volume is more with light red or dark red color and thin nature, having no or small clots, scanty or profuse leucorrhea, white color or colorless, tasteless and thin nature. Lassitude in mind, tastelessness, anorexia and bad appetite, deficient breath and speech, dizziness, insomnia and dreaminess, loss of memory and distraction, sallow complexion,pale lip and onyx, loose stool, lower abdomen has fall and break feel, excessive sweating, pale tongue, plump tongue with teeth-printed, with thin white coating, moderate and weak pulse.Syndrome of blood stasis: advanced menstruation, dark red or crimson with dim color, ropiness in nature with small or large clots, normal in quantity and quality leucorrhea, tasteless and colorless or light yellow color; dim complexion, constipation, distending oppression or stabbing pain in chest and hypochondria, stabbing opthalmalgia like the mass, or unpressable distending pain in lower abdomen, ecchymosis or petechia on tongue with light dark color, thin white coating, deep, thready and hesitant pulse.Syndrome of liver-qi stagnation and blood heat: advanced menstruation, menstrual volume more or less, crimson or dark red color, ropiness in nature with small clots, ropiness or normal leucorrhea, tasteless, white or light yellow color;. restlessness and tantrum, distending pain of breast in menstruation or ante- menstruation, Dry or bitter taste of mouth and dry pharynx, distending oppression in chest and hypochondria, constipation, short and yellow urination, anxious or gloomy, colliquative sweating, unpressable distending pain in lower abdomen, red tongue with light yellow coating, stringy and rapid pulse.Syndrome of yin deficiency and blood heat: advanced menstruation, bright or dark red color, ropiness or normal in nature with no or small clots, normal or below normal leucorrhea, ropiness or normal in nature, tasteless, colorless or light yellow, dysphoria with feverish sensation in chest, palms and soles, insomnia and dreaminess, dry mouth and pharynx, constipation, flush complexion, short and yellow urination, night sweating, thin and red tongue with light white coating, thready and rapid pulse.Syndrome of yang excess and blood heat: advanced menstruation, more capacity, crimson color, having blood clots; normal or below normal leucorrhea, ropiness or normal in nature, ropiness or normal in nature with tasteless and light yellow color, constipation, dry mouth and pharynx, excessive sweating, cool drink, short and yellow urination, excessive appetite, red fringe and acute of tongue with light yellow coating, rapid and slippery pulse.2.2 clinical investigation of hypermenorrhea2.2.1 Investigation Results of menstrual volume (MBV)It was discovered from clinical investigation, MBV of healthy female was 114.91±32.02g(109.44±30.50ml),MBV of hypermenorrhea female was 345.22±59.72g(310.40±67.45ml). Compared with each other, There was more MBV of menorrheal female than that of healthy ones (p<0.05).2.2.2 The main constitutive manifestations attributed to various syndromes of hypermenorrhea are as follows (by orders of menstruation, leucorrhea, general symptom, tongue and pulses):Deficiency of spleen-qi: excessive menstrual volume, excessive menstrual volume with light red or dark red color and thin nature, with or without small clots, normal or profuse leucorrhea, with white or no color, tastelessness and thin nature. Lassitude in mind, tastelessness, anorexia and bad appetite, short breath and lazy to talk, dizziness, insomnia and dreaminess, bad memory and distraction, sallow complexion,Labiali claw armour pale white, fall and empty sensation in lower abdomen,loose stool, light red tongue with teeth-printed, with thin white coating, moderate and thready pulse.Syndrome of blood stasis: excessive menstrual blood volume, dark red or crimson color, ropiness in nature with small or large clots, normal or multitude leucorrhea, with light yellow color or colorless, tasteless and normal or thick in nature, dim complexion, constipation, distending oppression or stabbing pain in chest and hypochondria, stabbing opthalmalgia like the mass, or unpressable distending pain in lower abdomen, ecchymosis or petechia on tongue with light dark color, thin white coating, thready and hesitant pulse.Syndrome of liver stagnation and blood heat: excessive menstrual blood volume with crimson and dark red color, ropiness in nature with small clots, normal or ropiness leucorrhea, light yellow or white color, tasteless and thick or normal in nature. restlessness and tantrum, distending pain of breast in menstruation or ante- menstruation, Dry or bitter taste of mouth and dry pharynx, distending oppression in chest and hypochondria, constipation, short and yellow urination, anxious or gloomy, dizziness and cephalalgia, unpressable distending pain in lower abdomen, red tongue with light yellow coating, strong stringy and rapid pulse.Deficiency of kidney-qi: excessive menstrual blood volume, dark red of menstruation color, thin or normal in texture with no or small clots; more or less leucorrhea, with thin or normal texture, tasteless, light yellow or white color. Tired and lassitude, soreness and weakness of waist and knees, loss of memory and distraction, dizziness, vague pain and relief with pressure in lower abdomen, short breath, tinnitus, dim complexion, frequent micturition and urination at night, pink tongue with thin white coating, thready and deep pulse. 3 The main constitutive manifestations attributed to various syndromes of prolonged menstruation were as follows (by orders of menstruation, leucorrhea, general symptom, tongue and pulses):Deficiency of spleen-qi: prolonged menstruation, light red or dark red color and thin or normal nature with no or small clots. The leucorrhea is normal or profuse, with white or light yellow color, tasteless and thin nature. Lassitude and laziness, tastelessness, anorexia and bad appetite, deficient breath and speech, dizziness, insomnia and dreaminess, sallow complexion,loss of memory and distraction, Labiali claw armour pale white, loose stool, pale, plump tongue with teeth-printed, thin white coating, moderate and thready pulse.Deficiency of kidney-qi: prolonged menstruation, dark red of menstruation color, thin or normal in texture with no or small clots. The leucorrhea is profuse or scanty, with thin or normal texture, tasteless, light yellow or no color. Tired and lassitude, soreness and weakness of waist and knees, dizziness, loss of memory and distraction, short breath, tinnitus, vague pain and relief with pressure in lower abdomen, dim complexion, frequent urinary and urination at night, pink tongue with thin white coating, thready and deep pulse.Syndrome of blood stasis: prolonged menstruation, scanty or profuse menstrual blood volume, dark red or crimson color, thick or normal in nature with small or large clots. The leucorrhea is normal or multitude, with light yellow color or colorless, tasteless and normal or thick in nature, dim complexion, constipation, stabbing opthalmalgia like the mass, distending oppression or stabbing pain in chest and hypochondria, unpressable distending pain in lower abdomen, ecchymosis or petechia on tongue with light dark color with thin white coating, hesitant pulse.Syndrome of liver stagnation and blood heat: menostaxis, prolonged menstruation, crimson and dark red color, thick in nature with small clots. The leucorrhea is normal or profuse, with light yellow color, tasteless and thick or normal in nature. restlessness and tantrum, distending pain of breast in menstruation or ante-menstruation, Dry or bitter taste of mouth and dry pharynx, distending oppression in chest and hypochondria, constipation, short and yellow urination, anxious or gloomy, dizziness and headache, unpressable distending pain in lower abdomen, red tongue with light yellow coating, stringy and rapid pulse.Syndrome of yin deficiency and blood heat: prolonged menstruation, scanty menstrual volume, bright or dark red color, thick or normal in nature with no or small clots, normal or profuse leucorrhea, with light yellow or no color, tasteless and thick or normal in nature, dysphoria with feverish sensation in chest, palms and soles, insomnia and dreaminess, dry mouth and pharynx, constipation, flush complexion, night sweating, short and yellow urination, thin and red tongue with light white or yellow coating, thready and rapid pulse.Conclusions:1 Through the results of the multicenter and large sample of clinical epidemiologic investigation, it initially indicated the distribution of the pattern and symptoms of hemorrhagic menopathy (advanced menstruation, hypermenorrhea and prolonged menstruation) compared with ancient and modern literature and materials: the blood stasis was added into the common patterns of advanced menstruation, the deficiency of kidney-qi was added into the common patterns of hypermenorrhea. the deficiency of kidney-qi and stagnation of liver-qi and blood heat were added into the common patterns of prolonged menstruation..2 The results of clinical epidemiology indicate that Hemorrhagic irregular menstruation (advanced menstruation, hypermenorrhea and prolonged menstruation) syndromes was not have significant changes.3 According to the clinical epidemiologic study, MBV of healthy female and hypermenorrhea female was significantly changed. MBV of healthy female was 114.91±32.02g(109.44±30.50ml),MBV of hypermenorrhea female was 345.22±59.72g(310.40±67.45ml(formerly 50-80ml).Compared with each other, There was more MBV of menorrheal female than that of healthy ones (p<0.05).(formerly≥80-100ml). |
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