Anovulatory dysfunctional uterine bleeding

　　1. Etiology

　　1. Adolescence

　　The blood E2 level of functional uterine bleeding patients during adolescence is within the normal range of reproductive-aged women, but there is no normal mid-cycle LH, FSH peak, indicating that the main cause is the abnormal positive feedback response of the hypothalamus-pituitary axis to estrogen. The establishment of the normal function of the central nervous system-hypothalamus-pituitary-ovary axis in adolescence requires a period of time. Within the first year of menarche, 80% of the menstrual cycles are anovulatory. Within 2-4 years after menarche, anovulatory menstrual cycles account for 30%-55%. At 5 years after menarche, there may still be less than 20% of menstrual cycles without ovulation, and one-third of the cycles have insufficient luteal bodies. This is due to the more complex and delicate regulation required for the establishment of the ovarian axis positive feedback regulatory mechanism. If excessive fatigue, stress, or other stimuli, or genetic factors such as obesity and insulin resistance, are present at this time, it may cause functional uterine bleeding or other menstrual disorders, such as polycystic ovary syndrome.

　　2. Perimenopausal Period

　　At this time, the ovarian reserve of women is low, and their sensitivity to gonadotropins is also reduced, or the hypothalamus-pituitary axis shows a reduced responsiveness to the positive feedback regulation of sex hormones. Therefore, it may first appear with insufficient luteal function, intermittent or irregular ovulation, and eventually, ovulation stops. At this time, the follicles still have a certain degree of development, but it is slow and insufficient, or irregularly degenerate, which is not enough to cause positive feedback, leading to insufficient or absent levels of progesterone, and causing this disease.

　　3. Reproductive Age

　　Temporary anovulation can be caused by certain stimuli from the internal and external environment, such as fatigue, stress, abortion, surgery, or illness, etc. It can also be caused by long-term factors such as obesity, polycystic ovary syndrome, and hyperprolactinemia, leading to persistent anovulation.

　　Two, Pathogenesis

　　The pathophysiological changes in dysfunctional uterine bleeding are abnormalities in the neuroendocrine regulation of the hypothalamus-pituitary-ovary axis of the central nervous system or local regulatory functions of the ovary, endometrium, or myometrium.

　　A small number of anovulatory women may have regular menstrual cycles, which is clinically known as 'anovulatory menstruation', while the majority of anovulatory women experience menstrual irregularities. Follicles in the ovary develop asynchronously and to varying degrees, without the formation of dominant follicles and corpus luteum. Developing follicles continuously secrete varying amounts of estrogen, but it is not enough to induce a blood LH peak; low progesterone levels cause the endometrium to continuously proliferate or even hyperplasia. Due to the irregular development and regression of follicles, blood estrogen levels also fluctuate irregularly; the endometrium, due to insufficient estrogen or fluctuations, sheds irregularly, that is, the site, depth, range, and timing of regression and shedding are irregular, leading to estrogen withdrawal or breakthrough bleeding.

　　1. Estrogen withdrawal bleeding occurs when estrogen is stopped after administration of appropriate doses and treatment durations to women who have had their ovaries removed, or when the estrogen dose is reduced by more than half, resulting in uterine bleeding, known as 'estrogen withdrawal bleeding'. However, if the estrogen dose is too low, the treatment duration is too short, or the reduction in estrogen dose is too small, there may be no uterine bleeding. Postmenopausal women also experience fluctuations in blood estrogen concentration at a low level, but there is no menstrual onset. This is because bleeding occurs when the endometrium reaches a certain thickness and loses hormonal support, which some scholars have hypothesized as the 'estrogen endometrial bleeding threshold'; after exceeding this threshold, if the estrogen stimulation is weakened to below this threshold, uterine bleeding will occur; conversely, if the estrogen stimulation intensity is below this threshold and fluctuates below this level, bleeding will not occur.

　　2. Estrogen breakthrough bleeding is caused by a long-term effect of a certain concentration of estrogen without the opposing influence of progestin, which can lead to excessive proliferation of the endometrium to varying degrees. Without the opposing stimulation of estrogen, which acts directly on the blood vessels to reduce vascular tension; stimulates the expression of VEGF in the stroma, reduces the production of PGF2a and AngⅡ, promotes the generation of nitric oxide (NO), PGE2, and prostacyclin (PGI2), causing vasodilation, increased blood flow, or due to the asynchronous development of the endometrial stroma, blood vessels, and glands, lysosomes develop excessively and become unstable, releasing hydrolytic enzymes, leading to increased or continuous, unpredictable bleeding, known as 'estrogen breakthrough bleeding'.

　　Fraser et al. (1996) found that hysteroscopy in patients with endometrial hyperplasia commonly reveals superficial blood vessels with tortuous endometrium, thinning vascular walls, and easy rupture. Abnormal endometrial vascular structure includes poor development of spiral arteries, increased venous vessels, and the formation of venous sinuses, which may also increase the tendency for bleeding. Other studies have also shown an increase in endometrial bleeding to varying degrees. Local changes such as reduced PGF2a production or increased PGE2 synthesis, as well as elevated NO and fibrinolytic activity, may play a certain role in the bleeding of this condition.

　　The main manifestation of dysfunctional uterine bleeding without ovulation is completely irregular menstruation, generally without dysmenorrhea. The type of bleeding depends on the level of serum estrogen and its decline speed, the duration of estrogen's continuous action on the endometrium, and the thickness of the endometrium. Anovulatory dysfunctional uterine bleeding can lead to secondary infection, infertility, and psychological burden. Sometimes, this condition can coexist with certain organic diseases, such as uterine fibroids, estrogen-secreting ovarian tumors, and so on.

　　The main manifestation of dysfunctional uterine bleeding without ovulation is completely irregular menstruation, generally without dysmenorrhea. The type of bleeding depends on the level of serum estrogen and its decline speed, the duration of estrogen's continuous action on the endometrium, and the thickness of the endometrium. The amount can be as little as a few drops, or as much as large blood clots causing severe anemia; the duration can range from 1 to 2 days to several months; the interval can range from several days to several months, so it can be mistaken for amenorrhea. Due to the prolonged course, there may also be anemia, hirsutism, obesity, lactation, infertility, and other symptoms.

　　1. Whether adolescent dysfunctional uterine bleeding patients can establish a normal menstrual cycle ultimately is related to the length of the course. Patients who establish a normal cycle within 4 years of onset account for 63.2%, and it is difficult for those with a course longer than 4 years to recover naturally, and they may have polycystic ovary syndrome.

　　1. The possibility of pregnancy and childbirth is very high after ovulation-inducing drugs are used in patients of childbearing age, but only a small number of patients can have regular ovulation or oligoovulation after childbirth, and most still have anovulation. Menstruation may be irregular or continuous irregular.

　　2. Atypical hyperplasia of the endometrium. Literature reports a canceration rate of 10% to 23%. The average time to canceration is 4 years (1 to 11 years). Even patients who recover normal menstruation are prone to recurrence under certain stimuli. The course of dysfunctional uterine bleeding during the perimenopausal period can be long or short, ending with menopause. After excluding malignant changes, observation and waiting can be adopted. Patients with anovulatory dysfunctional uterine bleeding should be effective to endocrine treatment. The specific plan should be comprehensively considered based on factors such as the patient's age, course of disease, hemoglobin level, past therapeutic effects, whether there is a need for childbirth or contraception, cultural level, local medical conditions, and follow-up conditions. The general principle is: in the stage of bleeding, it should stop bleeding and correct anemia quickly and effectively. After stopping bleeding, it is necessary to clarify the cause as soon as possible and perform targeted treatment, choose an appropriate plan to control the menstrual cycle or induce ovulation, prevent recurrence and long-term complications.

　　1. The estrogen level in the vaginal smear shows mild to moderate influence.

　　2. Serum E2 concentration is equivalent to the middle and late follicular phase level, losing normal cyclic changes.

　　3. Progesterone concentration

　　4. Normal levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) or an excessively high LH/FSH ratio, with the cyclic peak disappearing.

　　5. Routine blood test, coagulation function test, human chorionic gonadotropin (HCG), prolactin (PRL), and thyroid function test.

　　6. Tissue pathology examination endometrial biopsy pathological examination may show proliferation, simple hyperplasia, compound hyperplasia (adrenal gland structure irregular, but without glandular epithelial atypical changes), endometrial polyps or atypical hyperplasia (glandular epithelium has atypical changes), without secretory phase, atypical hyperplasia belongs to precancerous lesions, occasionally may be complicated with endometrial adenocarcinoma.

　　7. Hysterosalpingography.

　　8. Transvaginal ultrasound examination.

　　9. Hysteroscopy.

　　10. Basal body temperature (BBT) curve shows a unimodal type.

　　1. Dietetic recipe for amenorrheic dysfunctional uterine bleeding

　　1. Egg water zelas soup

　　Ingredients: 1 egg, water zelas (bone-breaking orchid) leaf 25 to 50 grams.

　　Method: Cut the water zelas leaf into pieces, and cook it with the egg together. 10 grams per time, 2 times a day.

　　Function: Activate blood circulation, resolve stasis, and stop bleeding.

　　Indications: Amenorrheic dysfunctional uterine bleeding with blood stasis; symptoms include irregular vaginal bleeding, sometimes stopping and starting, or coming after a long time, or dripping and difficult to stop, with a large amount, dark red or purple blood color, thick and sticky with many lumps, lower abdominal pain, lumbar pain, and dark complexion and lips.

　　2. Selaginella celery eggs

　　Ingredients: Fresh selaginella tenuifolia and fresh celery, each 30 grams, eggs 2 pieces.

　　Method: Boil the eggs until they are cooked, peel them off, then cook them with selaginella tenuifolia and celery for 10 minutes, remove the dregs, and drink the soup while eating the eggs. One dose per day, take for 2 to 3 days consecutively.

　　Function: Promote blood circulation and resolve stasis, nourish yin, and nourish blood.

　　Indications: Amenorrheic dysfunctional uterine bleeding with blood heat and stasis; symptoms include irregular vaginal bleeding, sometimes stopping and starting, or coming after a long time, or dripping and difficult to stop, with a large amount, deep red or purple blood color, quality

　　Symptoms: Thick and sticky with many lumps, lower abdominal pain, lumbar pain, dry mouth and thirst, irritability and anger, dry stools, and short yellow urine.

　　3. Hundred-herb frost eggs

　　Ingredients: Hundred-herb frost 10 grams, eggs 3 pieces.

　　Method: Beat the eggs and mix them evenly with hundred-herb frost, dry-fry until cooked, and take it all at once (finish in one dose).

　　Function: Stop bleeding, moisturize dryness, and harmonize the营.

　　Indications: For the bleeding phase of amenorrheic dysfunctional uterine bleeding due to yin deficiency and blood deficiency; symptoms include vaginal bleeding that is not stopped, with a small amount, bright red blood color, dry mouth and throat, feverish sensation in the palms and soles, night sweats, irritability, and insomnia.

　　4. Lotus leaf drink

　　Ingredients: Fresh lotus leaves 2 pieces, brown sugar 30 grams.

　　Method: Wash the fresh lotus leaf clean, cut into fine strips, put it into the pot, add an appropriate amount of brown sugar, bring it to a boil on a strong fire, then simmer over a low fire for 30 minutes, filter out the lotus leaf dregs, and drink the juice as tea. Take it frequently, and it can be taken continuously.

　　Function: Nourish yin, clear heat, and stop bleeding.

　　Indications: For the bleeding phase of amenorrheic dysfunctional uterine bleeding due to yin deficiency and blood heat; symptoms include vaginal bleeding that is not stopped, with a small amount, bright red blood color, dry mouth and throat, feverish sensation in the palms and soles, night sweats, irritability, and insomnia.

　　5. Two lotus root juices

　　Ingredients: Fresh lotus root and fresh mao root, each 120 grams.

　　Method: Wash the fresh lotus root clean, cut into slices 0.2 cm thick; wash the mao root clean, and chop it. Put both of them into an aluminum pot, add an appropriate amount of water, bring the pot to a boil on a strong fire, then simmer over a low fire for 20 to 30 minutes, filter out the dregs, and drink it as tea whenever needed. It is recommended to take it regularly.

　　Function: Nourish Yin, clear heat, stop bleeding, and regulate the menstrual cycle.

　　Indications: For uterine bleeding due to functional disorders of anovulatory infertility, which belongs to the blood heat type; symptoms include little vaginal bleeding, red and sticky blood, dizziness and tinnitus, dry mouth and throat, fever in the palms and soles, night sweats, irritability and loss of sleep.

　　sleeping.

　　6. Fresh Stinging Nettle Juice

　　Ingredients: 250 grams of fresh stinging nettle and an appropriate amount of honey.

　　Method: Clean the fresh stinging nettle, wrap it in gauze, squeeze the juice, add honey, 10-20 milliliters per dose, twice a day, drink until the bleeding stops.

　　Function: Clear heat and cool blood to stop bleeding.

　　Indications: For the bleeding period of uterine bleeding due to functional disorders of anovulatory infertility caused by blood heat; symptoms include irregular vaginal bleeding, intermittent onset and cessation, thick and red blood with clots, dry mouth and constipation, irritability and restlessness.

　　7. Celery Juice

　　Ingredients: Fresh celery and an appropriate amount of sugar.

　　Method: Wash celery clean, squeeze the juice, add sugar to taste, and drink it whenever needed.

　　Function: Clear heat and cool blood, stop bleeding and regulate the menstrual cycle.

　　with a large amount of vaginal bleeding that cannot stop, deep red blood color, thick and sticky texture with clots, dry mouth and constipation, irritability and restlessness.

　　8. Black Fungus Rice Porridge

　　Ingredients: 5 grams of black fungus (or silver ear), 5 dates, 100 grams of glutinous rice, and an appropriate amount of rock sugar.

　　Method: Soak black fungus (or silver ear) in warm water until it swells, remove the root and impurities, tear into pieces and set aside. Put clean glutinous rice, dates, and black fungus in a pot, add an appropriate amount of water, and cook into porridge. Boil first with high heat, then simmer with low heat until soft, and add rock sugar to dissolve, then it is ready.

　　Function: Nourish Yin, moisten the lungs, and tonify the spleen and stomach.

　　Indications: For uterine bleeding due to functional disorders of anovulatory infertility caused by spleen deficiency; symptoms include irregular vaginal bleeding, intermittent onset and cessation, or after a long time, or continuous and difficult to stop, pale red or bright red blood color, few clots or no clots.

　　with fatigue and weakness, pale or yellowish complexion, poor appetite, and lack of speech and movement. Note: Pregnant women and those with fever and cold should not take this.

　　9. Raw Rehmannia Rice Porridge

　　Ingredients: 50 grams of raw rehmannia root, 100 grams of rice, 1000 milliliters of water, and 100 grams of rock sugar.

　　Method: Wash the raw rehmannia root clean and squeeze the juice (or boil 100 grams of raw rehmannia root in 1000 milliliters of water for about 20 minutes, remove the residue and take the juice), cook porridge with clean rice and an appropriate amount of water, the porridge is thick and sticky, pour the rehmannia juice into the porridge, mix with rock sugar and stir well, boil for a while, and it is ready to eat. Take warm porridge in the morning and evening meals every day.

　　Function: Clear heat and cool blood, nourish Yin and generate fluid.

　　Indications: For uterine bleeding due to functional disorders of anovulatory infertility caused by both qi and Yin deficiency; symptoms include irregular vaginal bleeding, intermittent onset and cessation, or after a long time, or continuous and difficult to stop, deep red or dark red blood color, few clots or no clots, lumbago, fatigue, dry mouth and thirst, irritability, insomnia and dreams, low fever due to Yin deficiency, shortness of breath, and lack of speech.

　　10. Cuttlefish Ink Sac Powder

　　Ingredients: An appropriate amount of ink sac from a fresh cuttlefish.

　　Method: Dry and grind the ink sac of a fresh cuttlefish into fine powder. Take 1 gram per dose, twice a day.

　　Function: Tonify deficiency and stop the bleeding.

　　Indications: Qi deficiency type anovulatory dysfunctional uterine bleeding; with irregular vaginal bleeding, intermittent, or for a long time, or dripping, with light red or bright red blood, few or no blood clots, fatigue and weakness, yellow or pale complexion, poor appetite, shortness of breath, and lack of speech.

　　11. Wheat Bran Baicao Shuang Cake

　　Ingredients: Wheat bran 100 grams, brown sugar 250 grams, baicao shuang 50 grams.

　　Preparation: Mix the three ingredients with boiling water, divide them into 100 grams per serving, make cakes, and steam them. Take one with white开水 in the morning and evening on an empty stomach.

　　Function: Harmonize the middle, stop the bleeding.

　　Indications: Spleen deficiency type anovulatory dysfunctional uterine bleeding; with irregular vaginal bleeding, intermittent, or for a long time, or dripping, with light red or bright red blood, few or no blood clots, fatigue and weakness, yellow or pale complexion, poor appetite, lack of speech, and less movement.

　　12. Chicken Skin Lotus Node Decoction

　　Ingredients: Chicken claw skin 10 grams, lotus node 15 grams, a little sweet wine.

　　Preparation: Roast and grind the two into powder and mix them together, take them with sweet wine, 1 time per day.

　　Function: Cool the blood, replenish the blood, and stop the bleeding.

　　Indications: All types of anovulatory dysfunctional uterine bleeding; with continuous bleeding, bright red blood.

　　13. Lujiāo Dangshen Stewed Chicken

　　Ingredients: Chicken meat 250 grams, lujiāo 15 grams, dangshen 30 grams, ginger 10 grams, red dates 4 pieces.

　　Preparation: Peel the chicken skin, remove the kernel of the red dates, and wash the ginger. Put all the ingredients in a炖盅, add an appropriate amount of boiling water, cover the lid, and stew over boiling water for 1 hour. Serve hot and divide it into 1-2 servings.

　　Function: Tonify the kidney and enrich the essence, firm up the lochia and stop the bleeding.

　　Indications: Anovulatory dysfunctional uterine bleeding caused by long-term illness, kidney yang deficiency, and insufficient essence and blood; with irregular vaginal bleeding, heavy bleeding, dripping, lower abdominal cold pain, soreness and weakness in the lower back and knees, dizziness and fatigue. It can also be used for anovulatory uterine functional hemorrhage, anemia, menopausal syndrome, with symptoms of yang deficiency and insufficient essence and blood.

　　14. Ginseng Ejiao Stewed Wuguyu

　　Ingredients: Wuguyu 250 grams, high-quality ginseng (high-quality ginseng food) 10 grams, ejiao 12 grams.

　　Preparation: Slaughter the wuguyu, take the chicken meat, wash and chop it into pieces; peel off the ginseng and slice it; crush the ejiao. Put the ingredients in a炖盅, add an appropriate amount of boiling water, cover the炖盅, simmer over low heat for about 3 hours, season and serve.

　　Function: Tonify qi and control bleeding, firm up the lochia and stop the leakage.

　　Indications: Anovulatory dysfunctional uterine bleeding, with symptoms of spleen and qi deficiency; with pale complexion, fatigue, heavy menstrual bleeding, continuous leakage, light and thin blood, or several times a month, shortness of breath, and lack of speech, decreased appetite.

　　Two: What to eat for anovulatory dysfunctional uterine bleeding that is good for the body

　　1. Eat nutritious and easily digestible foods, and eat more iron-rich foods: such as animal internal organs like liver, wuguyu, black fungus, longan meat, spinach, and fresh vegetables and fruits.

　　2. Those with genuine heat should eat more fresh vegetables, fruits, and low-fat foods, including milk, soy milk, eggs, lean meat, liver soup, shechuangxin, wuguyu, shiwei, lotus root powder, porophyllum, watermelon juice, pear, water chestnut, hawthorn, crucian carp, black fungus, chive, etc.

　　3. For those with deficiency of the spleen and kidney, it is advisable to eat more astringent and tonifying foods: mung bean, jujube, pork stomach, Chinese yam, lychee, white fungus, black fungus, black, yellow croaker, leek, euryale, pork kidney.

　　4. Foods that tonify the heart and spleen, such as rice, millet, wheat, mung bean, Chinese yam, sesame, lotus seed, jujube, longan, are good; foods that tonify the liver and kidney, such as millet, wheat, Chinese yam, sesame, chestnut, walnut, are good. For heat syndrome, choose millet, wheat, red bean, mung bean; for cold syndrome, choose rice, sorghum, mung bean, dried fruit. Birds and animals have strong tonifying power, and they are suitable for both deficiency and excess syndromes. Especially pork, beef, chicken meat, milk, eggs are neutral in nature and can be eaten regardless of cold or heat. Water buffalo meat is especially suitable for blood-building and stopping hemorrhage.

　　5. Fruits are slippery and do not cause blood leakage, and they also have the function of tonifying the body, such as sugarcane, apple, cherry, fig, banana, grape, persimmon, and loquat can tonify the spleen, mulberry can tonify the liver and kidney. When bleeding is continuous and unceasing for a long time, add plum and hawthorn to contract and stop bleeding.

　　Third, the best foods to avoid for functional uterine bleeding without ovulation

　　1. For those with deficiency and coldness, attention should be paid to choosing warm-toned tonifying foods, as they are suitable, but not excessively hot, such as pepper, mustard, ginger, and cinnamon. For实证, heat syndrome, it is more taboo to use warm and hot substances.

　　2. Lamb, dog meat, and sparrow meat are warm in nature, so they should be used with caution in cases of heat syndrome.

　　3. Avoid foods such as ginger, pepper, and garlic when there is excessive bleeding.

　　First, the traditional Chinese medicine treatment for functional uterine bleeding without ovulation

　　1. Blood heat

　　(1) Treatment for虚 heat: nourish yin and clear heat, stop bleeding and regulate the menstrual cycle.

　　Prescription: Modified Bao Yin Decoction. 20g of raw Rehmannia, 15g of prepared Rehmannia, 20g of white peony root, 15g of Chinese yam, 15g of续断, 15g of Scutellaria baicalensis, 15g of Phellodendron amurense, 10g of甘草. Add 15g of carbonized Phellodendron amurense, 15g of carbonized Dandelion if bleeding is continuous and unceasing; add 15g of Ophiopogon japonicus, 15g of sand ginger, 15g of Artemisia annua if there is redness on the cheeks and feverish sensation in the palms and soles.

　　(2) Treatment for excess heat: clear heat, cool the blood, and consolidate the pulse to stop bleeding.

　　Prescription: Modified Qingre Gujing Decoction. 20g of raw Rehmannia, 15g of prepared Rehmannia, 15g of Cortex phellodendri, 15g of Scutellaria baicalensis, 15g of carbonized oyster shell, 15g of deer antler gelatin (melted), 20g of oyster powder, 20g of Sanguisorba officinalis, 15g of lotus node, 25g of carbonized palm, 10g of甘草. Add 20g of carbonized Nephelium mongolicum if there is excessive bleeding; add 15g of carbonized Sinapis nigra if there are clots in the blood; add 15g of carbonized pollen if there is restlessness and thirst, irritability, and insufficient sleep.

　　2. Kidney deficiency

　　(1) Treatment for kidney yang deficiency: tonify the kidney and nourish yin, stop bleeding and regulate the menstrual cycle.

　　Prescription: Modified Zuo Gui Wan. 20g of prepared Rehmannia, 20g of Chinese yam, 15g of Chinese wolfberry, 15g of Cornus officinalis, 15g of Cuscuta chinensis, 15g of deer antler gelatin, 20g of Eucommia ulmoides, 15g of tortoise shell glue, 15g of Schisandra chinensis, 20g of Prunella vulgaris. Add 15g of Salvia miltiorrhiza, 15g of carbonized Phellodendron amurense, 15g of carbonized lotus leaf, 25g of carbonized Sanguisorba officinalis if bleeding is continuous and profuse; add 15g of Ophiopogon japonicus, 15g of silver柴胡 if there is restlessness and discomfort at night with feverish sensation in the five heart regions.

　　(2) Treatment for kidney Yang deficiency: Warm the kidneys and reinforce the Qì of the kidneys, stop bleeding and regulate the menstrual cycle.

　　Prescription: Yougui Pill with modification. Prepared Aconitum 10g, Raw Rehmannia 20g,山药 20g, Shanyao 15g, Juejin 15g, Semen Cuscutae 15g, Cornu Cervi 15g, Duzhong 20g, Astragalus 30g, Fupenzi 15g, Chishili 10g. Add 15g of Sichuan Lovage, Sea Urchin 15g, Brow Coal 25g for unclean, continuous bleeding; add 20g of Xuanduan, 15g of Zhishi for soreness in the lower back and knees, clear urine.

　　3. Spleen deficiency

　　Treatment method: Tonify Qi, control blood, and reinforce the Qì of the kidneys to stop bleeding.

　　Prescription: Guichong Decoction with modification. Baizhu 20g, Astragalus 30g, Longgu 20g, Oyster Shell 20g, Bai Shao 25g, Sichuan Lovage 15g, Sea Urchin 15g, Brow Coal 25g, Spatholobus Carbonisatus 25g. Add 25g of Dangshen for fatigue, lassitude, shortness of breath on movement, dizziness and palpitations, add 15g of Shanyao for poor appetite and loose stools.

　　4. Blood stasis

　　Treatment method: Promote blood circulation and remove blood stasis, stop bleeding and regulate the menstrual cycle.

　　Prescription: Four Substances Decoction with modification. Raw Rehmannia 20g, Angelica Sinensis 15g, Chuanxiong 15g, Bai Shao 25g, Stir-fried Pohuang 15g, Peach Kernel 15g, Moutan Bark 15g. Add 40g of Red Rooster Comb for dark blood with clots, add 15g of Yuanhu for abdominal pain, add 30g of motherwort.

　　Second, special prescription

　　1. Spatholobus and Bitter Wine Decoction:Raw Spatholobus 250g, bitter wine (i.e., rice vinegar) 1000ml, soaked for 7 days, discard the dregs and leave the liquid for use. 30ml each time, 3 to 4 times a day orally. Suitable for patients with chronic leakage.

　　2. Hemostatic Elixir;Eucommia Ulmoides 3g, Hematite 2g, ground into fine powder, taken once, three times a day orally. Suitable for patients with chronic leakage due to kidney Yang deficiency.

　　3. Compound Four Coal Decoction:Brow Coal 25g, Niuhen Coal 25g, Moxa Coal 15g, Pohuang Coal 15g, Angelica Sinensis 15g, Bai Shao 15g, Raw Earth 25g, Donkey-hide Gelatin 15g (dissolved). Add 2000ml of water, boil to 600ml, take 200ml each time, three times a day orally. Suitable for patients with various types of metrorrhagia.

　　Three, other therapy physical therapy

　　Use a flat current to stimulate the breasts and back therapy, or infrared radiation to照射 the breast area, through neural reflex to the central nervous system, adjust endocrine function, and improve the menstrual cycle. Treatment once a day, each time 15 to 20 minutes, and then perform 2 to 3 more times after stopping bleeding. Traditional Chinese Medicine:

　　1. Guanxin Ning Capsules:1 to 2 pills each time, taken 3 times a day orally; for severe hemorrhage, 3 to 4 pills each time, taken 4 times a day orally, preferably after meals.

　　2. Ginseng and Spleen Pill:1 pill (9g) each time, taken 3 times a day orally.

　　3. Yunnan Baiyao:0.5 to 1g each time, taken 2 to 3 times a day orally.

　　Acupuncture and Moxibustion:

　　1. The patient assumes a semi-fist position with both hands and acupoints are located between the second and third metacarpophalangeal joints, in the depression. Acupuncture method: Straightly insert the needle 1 to 1.5 cun deep, twist until there is a sensation of soreness, distension, numbness, or electric shock, once a day.

　　2、取关元、三阴交、隐白为主穴。虚热者加内关、太溪穴；实热者加血海、水泉穴；脾虚者加膨俞、足三里穴。每日针1次。

　　四、无排卵型功能失调性子宫出血西医治疗方法

　　1、止血

　　(1)诊断性刮宫：用机械的方法将增厚的内膜基本刮净而止血。显效迅速，还可进行内膜病理检查除外恶性情况。诊刮时了解宫腔大小、有无不平感也有助于鉴别诊断。对于病程较长的已婚育龄期或绝经过渡期患者，应常规使用。但对未婚患者，及近期刮宫已除外恶变的患者，则不必反复刮宫。罕见的情况是刮宫后出血仍不止，应注意适当抗炎，或试加小量雌激素帮助内膜修复。

　　(2)孕激素内膜脱落法：即药物刮宫法。针对无排卵患者子宫内膜缺乏孕激素影响的病理生理改变，给患者以足量孕激素使增殖或增生的内膜转变为分泌期；停药后2～3天后内膜规则脱落，出现为期7～10天的撤退出血，在内源性雌激素的影响下，内膜修复而止血。常用肌注黄体酮20mg/d，连续3～5天；或口服微粒化孕酮-黄体酮(安琪坦，urogestane)200～300mg/d，连续3～5天；或甲羟孕酮(安宫黄体酮，MPA)6～10mg/d，连续10天。可根据不同患者出血的病程、子宫内膜的厚度决定孕激素的剂量及疗程。本法优点是效果确实可靠；缺点是近期内必有进一步失血，若累积于宫腔的内膜较厚，则撤退出血量会很多，可导致血红蛋白进一步下降。故只能用于血红蛋白>70g/L的患者。为了减少撤退出血量，可配伍丙酸睾酮，25mg/d，(青春期患者)或50mg(绝经过渡期患者)，与黄体酮同时肌注，但总量应低于200mg。在撤退出血量多时，应卧床休息，给一般止血剂，必要时输血，此时不用性激素。若撤退出血持续10天以上不止，应怀疑器质性疾病的存在。

　　(3)雌激素内膜生长法：只适用于青春期未婚患者及血红蛋白

　　近来上市的结合雌激素(倍美力)针剂为25mg/支，以无菌注射用水5ml溶解后缓慢经静脉推注，多数患者在6h内止血；6～12h后视出血情况可重复1次，但应注意肝肾功能。次日应给予口服结合雌激素(倍美力)3.75～7.5mg/d，并逐渐减量，持续20天，第11天起加用甲羟孕酮(MPA)10天。大剂量雌激素用于止血为权宜之计，不宜频繁使用。对此类患者应重在预防再一次发生严重的出血。

　　(4)高效合成孕激素内膜萎缩法：适用于：

　　①育龄期或绝经过渡期患者：血红蛋白

　　② Hematological patients: those who need to stop menstrual bleeding due to the condition. The method is: levonorgestrel 2 to 3mg/d, norethindrone 5 to 10mg/d, medroxyprogesterone acetate (medroxyprogesterone acetate,妇宁) 8mg/d, medroxyprogesterone acetate (medroxyprogesterone acetate, 安宫黄体酮) 10mg/d, etc., for a continuous period of 22 days. The purpose is to make the proliferative or hyperplastic endometrium become decidualized, and then the secretion will exhaust and atrophy. The dose can also be gradually reduced after the bleeding stops to maintain it. At the same time, actively correct anemia. The endometrium will also shed and bleed after stopping the medication. Synthetic progestins, especially those derived from 19-nor-methyltestosterone, have different strengths of androgen activity; therefore, the dose should not be too high, especially when treating functional uterine bleeding caused by polycystic ovary syndrome. For hematological patients, whether to discontinue medication or continue medication should be decided according to the condition of the hematological disease.

　　(5) General hemostatic treatment: It has an auxiliary role in the treatment of this disease. Commonly used ones include:

　　① Menadione (Vitamin K4) 4mg each time, 3 times/d, taken orally; or sodium metabisulfite menadione (Vitamin K3) 4mg intramuscularly, 1 to 2 times/d, which has the effect of promoting blood coagulation.

　　② Erythromycin sulfate (hemostatic, hemostatic) can enhance the function of platelets and the resistance of capillaries, with a dose of 0.25 to 0.5g intramuscularly, 1 to 2 times/d; or mixed with 5% glucose solution to form a 1% solution for intravenous infusion, 5 to 10g/d.

　　③ Antifibrinolytic drugs: aminomethylbenzoic acid (antifibrinogen, p-carboxybenzylamine) and tranexamic acid (tranexamic acid, Tocainide). The dose of the former is 0.2 to 0.4g, diluted with 10ml of 5% glucose solution and administered intravenously, 2 to 3 times/d; the latter is 1.0g, diluted in the same way and administered intravenously, with a total daily dose of 1 to 2g, or 1 to 2g/d orally.

　　④ Vitamin C and carboxymethyl cellulose (Anluoxue) can enhance the resistance of capillaries. The former can be taken orally or administered intravenously, 300mg to 3g/d; the latter is 5 to 10mg orally, 3 times/d, or 10 to 20mg intramuscularly, 2 to 3 times/d.

　　⑤ Thrombin (Lepidium) is a purified thrombin, 1U per vial, which can be administered intramuscularly or intravenously, 2U per dose, twice on the first day, once on the second day, and 1U per dose from the 3rd to 4th day. After 20 minutes of injection, the bleeding time will shorten by 1/3 to 1/2, and the efficacy can last for 3 to 4 days.

　　2. Ovulation induction or control of menstrual cycle

　　After the bleeding stops, follow-up should continue. Measure the basal body temperature. Choose the right time to examine the vaginal smear or serum reproductive hormone concentration. According to the different requirements of patients, formulate a medication plan for ovulation induction or cycle control to prevent irregular uterine bleeding from recurring.

　　(1) Patients requiring fertility should choose ovulation-inducing drugs based on the etiology of anovulation. The most commonly used is clomiphene citrate. The initial dose is 50mg/d, starting from the 5th day of the cycle, taken for 5 consecutive days, while also measuring BBT to observe the efficacy. The dose can be increased as needed to 100-150mg/d. The results of 119 cases with 924 cycles of clomiphene citrate treatment at Peking Union Medical College Hospital showed that 65.8% of patients ovulated, 15% had regular menstrual cycles but no ovulation, and the remaining 19.2% were ineffective.

　　(2) If anovulation is caused by hyperprolactinemia, bromocriptine should be selected. The dose is 5-7.5mg/day. Regular re-examination of serum PRL concentration is needed to adjust the dose.

　　(3) For patients who want to avoid pregnancy, various short-acting contraceptives can be taken to control bleeding. For unmarried adolescents or patients who are not responsive to clomiphene, cyclic use of progestins can be used to make the endometrium shed regularly, thus controlling the cycle.

　　(4) For patients with low estrogen levels in the body, estrogen and progesterone cyclic sequential replacement therapy should be used to control the cycle.

　　(5) Adolescent unmarried patients may occasionally take clomiphene, but it is not suitable for long-term use.

　　(6) For patients in the perimenopausal period, progesterone can be combined with testosterone propionate or medroxyprogesterone acetate (MPA) every 1-2 months to cause endometrial shedding once. If there is no withdrawal bleeding within 2 weeks after medication, it is estimated that the level of estrogen in the body has decreased, and menopause is not far away, only follow-up observation is needed.

　　(7) When there is atypical hyperplasia of the endometrium, the treatment plan should be determined according to the degree of lesion (mild, moderate, severe), the patient's age, and whether there is a desire for childbirth. For those with mild lesions and young patients who desire childbirth, hydroxyprogesterone caproate (caproate of progesterone) 500mg weekly, levonorgestrel 2-4mg daily, chlormadinone acetate 2-4mg daily, and medroxyprogesterone acetate (medroxyprogesterone acetate) 4-8mg daily can be used. Generally, the endometrium needs to be re-examined after 3 months, and the treatment plan should be determined based on the patient's response to the medication, whether to discontinue medication, continue medication, or change to surgical treatment. If the lesion disappears, then ovulation-inducing drugs should be used to achieve pregnancy. According to reports, the pregnancy rate is 25% to 30%, but recurrence may occur after childbirth. For patients with severe lesions, aged over 40, and without a desire for childbirth, hysterectomy can be considered. For uterine bleeding caused by blood diseases, a detailed examination should be conducted to determine the type, and long-term endometrial atrophy treatment or surgical resection of the uterus or endometrium should be selected based on different prognoses.

　　In summary, try to achieve the therapeutic goal with the minimum effective dose to reduce side effects. The plan strives for simplicity. It is best to guide patients to understand the regularity of condition changes and medication strategies, and to ask patients to come to the hospital for follow-up examination at the appropriate time. After 3 to 6 months of medication, a short-term medication break can be considered to observe the possibility of natural adjustment. If symptoms recur, medication should be taken early again, and it is also possible to control them effectively.