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Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Table of Contents 1 Considerations Regarding Bleeding 4 A Inquiry 4 A detailed inquiry into the disease history is necessary for an exact diagnosis 4 B Differentiating the pattern and determining the cause According to the cause decide the treatment 6 C Disease Patho mechanisms 7 Beng and Luo constitute one illness and transform into each other 9 T D Treatment 11 Grasp the stage on the basis of the pattern decide the treatment 11 Sharon s commentary 12 E Other Considerations 13 AF Integrating Western and Chinese medicine and improving the effectiveness of treatment 13 Pay attention to dispersing stasis and guard against congealed blood 14 Work with both the Qi and Blood regulate Qi and stop bleeding 15 Supplement and nourish the Liver and Kidney regulate the Chong and Ren 15 Regulate the Spleen and Stomach consolidate the effect of the treatment 16 Differentiation and Methods 17 D R A Supplementing the Qi and absorbing blood 17 Patho mechanisms 17 Special points for differentiating the pattern 18 Spleen Qi Deficiency 19 Kidney Qi 19 Collapsed Qi 22 Commonly used formulas and herbs 22 Commonly used herbs 23 To bank up and increase density in the absorptive function of the Spleen use 23 To humidify the Spleen when dryness is preventing absorption 23 To supplement Kidney Qi 23 To treat collapse 23 Stopping Bleeding 24 Non charred herbs used frequently to stop bleeding when there is Lax type Spleen Qi deficiency 24 Non charred herbs used frequently for dry type Spleen Qi deficiency 24 Charred herbs used frequently for Spleen Qi deficiency 24 Charred herbs used frequently for Kidney Qi deficiency 24 Calcined herbs used for Kidney Qi deficiency 24 Commonly used formulas 25 Dang Gui Bu Xue Tang 25 Gui Pi Tang 25 Gu Ben Zhi Flooding Tang Fu Qing Zhu 25 Shen Qi Jiao Ai Tang Dr Qiu Xiao mei 26 Dr Qiu on Shen Qi Jiao Ai Tang 26

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 2 Yi Qi Gu Chong Tang 27 Restrain the Flow Giovanni s Patent 28 Wu Ji Bai Feng Pian Wan 28 Dr Qiu Xiao mei s case examples of bleeding due to Qi Deficiency 29 Example One 29 Sharon s Commentary 31 Case Example Two 32 Sharon s Commentary 34 Case Example Three 34 Sharon s Commentary 37 Case Example Four 38 D R AF T B Clearing Heat and cooling the blood 39 Pathology 39 Special points for differentiating the pattern 40 Further differentiation of excessive types 42 Liver Qi stasis with Depressive Heat Shao Yang 42 Liver Fire 43 Liver Rebellion 43 Heat in the Blood chamber 43 Damp Heat in the Liver Channel 43 Deficiency Heat 43 Commonly used herbs 44 Treating the Base Excess Heat 44 Heat in the Heart 44 Heat in the Liver 44 Heat Rebellion 44 Heat in the Shao Yang Pivot 44 Stop Bleeding Excess Heat 45 Stop Bleeding Charred Herbs 45 Damp in the Lower Warmer Herbs 45 Treating the Basics Empty Heat 45 Enrich Yin 45 Enrich Yin Cool the Blood and Stop Bleeding 45 Calcined Herbs 46 Carbonized Herbs 46 Commonly used Formulas 46 Excess Heat 46 Heat in the Heart 46 Liver Qi Depressive Heat 48 Liver Fire 49 Liver Rebellion 51 Heat in the Blood Chamber 51 Damp Heat in the Liver Channel 52 This is an experiential formula of Dr Liu Feng Wu He uses this primarily for mid cycle bleeding but it s use can be expanded for spotting before or after menstruation In addition the idea of disinhibiting dampness from the lower warmer can be applied to other pathomechanisms 52 Empty Heat 54 Sheng Di Long Mu Tang Rehmannia Dragon Bone and Oyster Shell Decoction by Dr Qiu Xiao Mei 54 Liang Di Tang Two Earth Decoction 55 Er Zhi Tang Two Solstice Decoction 55

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 3 Zuo Gui Wan 56 Clear Empty Heat and Cool the Menses Giovanni Patent 56 Nourish Yin and Restrain the Flow 57 Mixed Excess and Deficiency Heat Bleeding formulas 58 Bao Yin Jian 58 Qing Re Zhi Flooding Tang Clear Heat Arrest Flooding Decoction 58 T Case 1 Liver Fire and Rebellious Liver 59 Case Two Liver Fire 61 Case 3 Excess Heat with damaged fluids 63 Case 4 Mixed Deficiency Excess Heat 65 Case 5 Blood Heat 66 Case 6 Heat in the Blood Chamber 68 Case 7 Empty Heat with Yin Deficiency 70 Case 8 Yin Deficiency with Empty Heat and Blood Stasis 72 Case 9 Yin Deficiency with Empty Heat 74 Case Example 10 Liver Depressive Heat with Rebellion 79 Case 11 Kidney Yin and Yang deficiency with inner heat 80 Case 12 by Liu Feng Wu Damp Heat ovulatory bleeding 83 Case 13 Kidney Yin Deficiency 84 AF Second Visit 85 Third Visit 86 Discussion 86 D R C Vitalizing Blood 87 Patho mechanisms 87 Special Points for Differentiating the Pattern 88 Commonly Used Herbs and Formulas 89 Commonly used herbs 90 Harmonizing the Blood Herbs 90 Herbs that harmonize the blood in small doses 90 Vitalize the blood to stop bleeding herbs 90 Charred herbs to vitalize the blood 90 Commonly used formulas 91 Si Wu Tang 91 Shi Xiao San 91 Zhen Ling Dan Arouse the Spirit Elixir 91 Xue Fu Zhu Yu Tang 91 Chan Hou Sheng Hua Tang Liu Feng Wu 92 Invigorate Blood and Stem the Flow Giovanni Patent 92 Wu Jin Wan 93 Yu Nan Bai Yao 93 Case Examples 94 Case 1 Congealed Blood causing Bleeding 94 Case 2 Bleeding due to Blood Stasis and Qi Deficiency 95 Case 3 Bleeding Due to Blood Stasis and Kidney Deficiency 100 Case 4 Bleeding Due to Qi and Blood Constraint 103 Case 5 Scanty continuous bleeding with pain 105 Case 6 Post Abortion Bleeding 106 Case 7 Lochia failing to stop 108 Case 8 Early menstration failing to flow 109 D Warming the Menses and Stopping Bleeding 110

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 4 Special points for differentiating the pattern 111 Commonly used formulas and herbs 111 Herbs that can be added to Wen Jing Tang or Li Zhong Tang to stop bleeding 111 Commonly used Formulas 112 Case Example 112 Summary 114 AF T E Jue Yin Bleeding 114 Commonly used Formulas 116 Special points for differentiating the pattern 116 Case Example One 117 Case Example Two 119 Considerations Regarding Bleeding A Inquiry R A detailed inquiry into the disease history is necessary for an exact diagnosis In terms of differential diagnosis of Beng Luo the practitioner must pay careful attention to the presence or absence of abdominal distention D abdominal pain as well as abdominal distention and pain together Moreover one must observe whether the Blood color is dark or pale whether the Blood quality is thick or thin and whether the Blood is mixed with clots All of this information must be compared with the pulse tongue and the symptoms of the whole body In this way the practitioner can differentiate cold from heat and vacuity from repletion In one example in the case study section the manifestation of the illness consisted of pale colored menstrual Blood dull lower abdominal pain pale tongue body and a thin pulse Therefore the differential diagnosis

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum consisted of Qi vacuity unable to consolidate the Blood In another case 5 example the endometrium had pathological lumps and the tongue was infused with purple so I determined that the diagnosis was congealed Blood accumulated in the interior Clinically the practitioner must do a careful examination and a minutely detailed inquiry into the disease history Only then will the differential diagnosis be exact The main purpose of the differentiations I have mentioned here is to T make treatment easy Never the less the practitioner cannot be limited by these categories because in the clinic they are very hard to differentiate They occur simultaneously and emerge intermingled Moreover each of AF these categories can transform into the others Above all don t be mechanical in your observation of the categories Generally for the treatment of this disease when there is vacuity supplement it when there is heat clear it when there is depression course it and when there is congealed Blood move it When the practitioner sees bleeding she should not arbitrarily stop bleeding Neither should she R blindly adhere to the saying In Blood diseases cool or without exception go by the treatment principles of clearing heat cooling Blood promoting circulation consolidating and astringing This is especially true in the cases D of congealed Blood and inner accumulation In theses cases one should use even more caution with stop bleeding herbs and act on the principle in differential diagnosis seek out and scrutinize the cause to determine the treatment One should have a good command of the distinction between the root cause and the symptoms the chronic and the acute and adapt oneself to the changing conditions The appropriate measures to take are determined by the pattern One should not rigidly take charge of the situation without flexibility

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum In addition when treating this disease one should pay careful 6 attention to the proper care of the Spleen and Kidney This is true not only when there are obvious signs of Spleen vacuity and Kidney decline but also in the treatment of the aftermath of Beng Luo in order to consolidate the effects and prevent a relapse Clinical practice has shown that regulating the Spleen and Kidney is definitely an effective method for treating this disease and is worth paying attention to T B Differentiating the pattern and determining the cause According to the cause decide the treatment AF A special characteristic of Chinese medicine is its ability to differentiate patterns seek the cause and according to the cause determine treatment With the treatment of bleeding patterns one cannot simply focus on stopping bleeding One should study the causes of bleeding in detail and according to the pattern determine the treatment If there is a case in which there is no heat yet you give cold and cool herbs you can congeal the blood and R cause the illness to return or transform into something worse You must pay attention to this In terms of differential diagnosis of this disease the practitioner must pay attention to the presence or absence of abdominal distention or D abdominal distention and pain She must notice the characteristics of the pain whether the blood is profuse or scanty whether the blood color is dark or light and whether the substance of the blood is thick or watery In addition these signs and symptoms must be related to the tongue and pulse and the symptoms of the whole body so as to distinguish between cold and heat and vacuity and repletion In this way the basis of the treatment can be determined When treating Beng Luo the practitioner should inspect the degree of seriousness of the disease characteristics On the basis of the principle

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum When there is urgency treat the symptoms and when the situation is 7 relaxed treat the root of the disease cause one should determine the treatments The practitioner should also know well the following three treatment steps and methods 1 Staunch the flow 2 Clear the source and 3 Restore the former When large amounts of blood come out of the vagina the disease has the characteristics of a crisis One must use the principle of stopping bleeding in order to staunch the flow and guard against collapse Next in T order to clear the source one must differentiate the disease seek the cause Knowing the cause one can consider the treatment Finally in order to restore the source and consolidate the root use the principles of fortifying AF the Spleen harmonizing the stomach boosting the Qi and nourishing the Blood Having done this there will not be a reoccurrence In terms of specific application of herbal prescriptions again the practitioner should make decisions on the basis of the different types In R accordance with these distinctions the treatment should be carried out C Disease Patho mechanisms Dr Qiu Xiao mei writes D The primary mechanism that causes Beng Luo is damage to the Chong and Ren Mai The Chong Mai is the sea of Blood while the Ren Mai governs the uterus These two Mai have a close relationship to the menses If they are damaged this is bound to lead to menstrual abnormalities even to the point of Beng Luo The Comprehensive Treatise of the Origins and Symptoms of Diseases states When there is Beng it is because the Zang Fu is damaged the Mai of the Chong and Ren and the Qi and Blood are vacuous If Luo drips below it is because the Chong and Ren Mai are exhausted

Commonly used methods for the treatment of bleeding presentations in gynecology 8 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum The pathological transformation of the Zang Fu in this disease is due to imbalance in the function of the three Zang Liver Spleen and Kidney The Kidneys are especially implicated This is because the Chong and Ren Mai both arise in the uterus and the uterine vessels are linked to the Kidneys In this way the Kidneys are the root of the Chong and Ren and are the source of the menstrual blood The Nei Jing says At seven times two years the woman s Tian Gui arrives Her Ren Mai opens through The great Chong Mai is abundant The monthly event descends in a timely way Clearly T when the Kidney Qi is abundant then and only then will the Tian Gui be engendered The Tian Gui acts upon the Chong and Ren Mai making the sea of Blood plentiful Then menses then comes like the tide The AF abundance and decline of the Kidney Qi determines whether the menstruation will be normal or abnormal The Kidney Zang includes both the Kidney Yin and the Kidney Yang The two are in a relationship of mutual generation When the Yin is calm and constant and the Yang is secret closed tight and contained there will be harmony The converse creates disease When the Kidney Yang is R insufficient the uterus is vacuous and cold the Chong and Ren are not consolidated This may give rise to Beng Luo When the Kidney Yin is debilitated vacuity fire tends to be excessive This fire harasses the Blood of D the Chong and Ren and compels it to reckless movement hence Beng Luo Furthermore because there is an interrelated and interdependent relationship between the Zang Fu Kidney illness can influence the other Zang Kidney illness can lead to Heart Liver Spleen and other Zang to loose their synchronicity Indirectly or directly this influences the Chong and Ren Mai and can result in Beng Luo If the Kidney Yang is insufficient Fire won t generate Earth Consequently the Spleen Yang won t be braced up The Spleen will no longer be able to fortify the body through digestion or move the flood

Commonly used methods for the treatment of bleeding presentations in gynecology 9 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum matter through the digestive tract It will loose its capacity to tong gather the Blood into the interconnected system of vessels This can result in Beng Luo Sometimes Kidney Water descends and becomes depleted It is unable to ascend as it should to ji communicate with and benefit the Heart Heart Fire left alone in this way becomes excessive This Fire heats the Blood and the Blood moves recklessly and may manifest as Beng Luo Insufficient Kidney Yin also can cause Liver Wood to loose its T nourishment and incline the Liver Yang to be excessive The official duty of the Liver to store the Blood cannot be carried out and the Fire that appears harasses and stirs the Chong and Ren Mai causing Beng Luo AF Next there is a close relationship between Beng Luo and lack of proper care for the Spleen Zang function Fatigue from a lot of overwork and over thinking and brooding can damage the Spleen and cause it to become vacuous and weak and to fall downward Because the Spleen governs the gathering of the Blood into the network of vessels when the Spleen is damaged its Qi can t restrain the Blood as it should This can result in Beng R Luo In addition when one s emotions are not expressed the Liver Qi becomes depressed and knotted This chronic depression of Liver Qi D transforms into fire and this leads to the Liver failing in its duty to store the Blood It may cause Qi stagnation and Blood coagulation These pathologies influence the Chong and Ren Mai and can also give rise to Beng Luo Beng and Luo constitute one illness and transform into each other Dr Qiu Xiao mei writes Beng Luo refers to Blood Beng Flooding and this is joined with Luo which is dripping Blood Beng is menstrual Blood abruptly and violently going down with a great force Luo is menstrual Blood dribbling without stopping and it breaks out with a comparatively moderate force The Formulary for

Commonly used methods for the treatment of bleeding presentations in gynecology 10 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum the Aiding of Life says The root disease of Beng Luo is really one illness When this illness is light it is called Luo Xia or dribbling down When it is extreme it is called Beng which is like being in the midst of an avalanche Therefore the dissimilarities of Beng and Luo are only in terms of the disease characteristics of light and heavy and urgent and moderate In terms of its inherent nature there are not two types Both are Blood going out of the uterus Moreover Blood Beng and menstrual dripping often transform into one another T It is said dribbling is the gradual leading into Beng and Beng is the extreme of dribbling This means that chronic dribbling without stopping will break out with a force that daily advances until it becomes Beng When AF Beng is chronic and doesn t stop Qi and Blood become consumed This can also change into dribbling Because of factors in history our predecessors were bound within limits and were not able to do certain special examination They were not able to distinguish other types of qualitative pathological change in the reproductive organs such as cervical cancers cancers of the uterine body R cervical polyps cervical erosion and uterine fibroids Functional uterine bleeding may also be the result of endocrine disorders The clinical manifestations of all of these disorders may resemble Beng Luo D The TCM name for uterine bleeding is Beng Luo Beng Luo includes but relates to a broader scope of possibilities than the above diseases It also includes postpartum bleeding bleeding after an artificial abortion bleeding from a uterine fibroid uterine inflammation and bleeding induced by diseased blood Therefore functional uterine bleeding and Beng Luo cannot be talked about as the same illness

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 11 D Treatment Grasp the stage on the basis of the pattern decide the treatment Dr Qiu Xiao mei writes In the treatment of bleeding patterns it is extremely important to master the understanding of the various stages and to distinguish the various treatments formulas and methods there with Tang Rong chuan put forward stopping bleeding dispersing stasis calming the blood and supplementing the blood as T the four steps to take at the various stages I have learned from experience the following 1 During the time when a patient is bleeding it often comes with force and AF is acute If one does not stop bleeding this will certainly lead to hemorrhage The result could be collapse Based on the principle When acute treat the branch one should stress stopping bleeding This stopping bleeding represents the first stage 2 After the bleeding has stopped it is likely that there is residual stasis When there is static blood it is difficult for the new blood to safely abide R So it is important to continue the treatment principle of dispelling static blood so that the static blood will be gone and the new blood can return and abide to it s normal place This dispelling stasis represents the D second stage 3 Now the bleeding has been stopped and the stasis dispelled but after a few days the bleeding resumes Why The reason is because the cause has not been eliminated The network vessels are not quieted and the blood not settled in the channels One must investigate the causes to determine the treatment for example heat will require cooling cold will require warming excess will require draining Following the correct diagnosis will result in settling the blood and incurring healing This quieting the blood represents the third stage

Commonly used methods for the treatment of bleeding presentations in gynecology 12 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 4 After loosing blood the ying and blood will be vacuous Although the disease cause has been eliminated if the basic origin is not restored there is the worry that the cure is not really consolidated Because of this one must regulate and supplement in the aftermath Supplementing blood represents the forth stage When I am treating beng luo I base the treatment on the stages elucidated pathology 1 Staunching the flow AF 2 Settling the source T by Yu Tang dai He wrote to pay attention to the following stages of the 3 Returning health back to its original strength Sharon s commentary R Summarizing these 4 stages Stage 1 Stop Bleeding Stage 2 Dispel Stasis D Stage 3 Quiet the Blood Address the root Stage 4 Nourish and Supplement These stages are essential in the treatment of bleeding disorders Here they are written about in a way that implies working with the stages in the order they are listed It seems that after the bleeding stops we should dispel stasis and when we are sure there is no residual stasis address the root etc This is not a correct way to read these stages

Commonly used methods for the treatment of bleeding presentations in gynecology 13 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum When working with stage 1 stopping bleeding the bleeding should be stopped in a way that addresses the root patho mechanism that is causing the bleeding The focus of the formula will be stopping bleeding but it will take the root issues into account In addition as stage 1 is worked with blood stasis is usually considered in the formula The amount the stasis is dealt with will depend on the amount of stasis present in the patient T While working with stage 4 nourishing and supplementing one does not simply nourish back the blood Again how this is done will take into account the patho AF mechanism responsible for the bleeding mixing stage 3 with stage 4 We can see this list as chronological in terms of what the priority of treatment should be but at the same time we need to think of all the issues implied with each stage in every formula we give R E Other Considerations Integrating Western and Chinese medicine and improving the effectiveness of treatment Dr Qiu Xiao mei writes D Practitioners must adhere to the integration of Chinese and western medicine especially in diagnosis A method of integrating differentiation of the disease with differentiation of the pattern should be adopted As related above the root causes that give rise to Beng Luo are relatively complex Many different diseases can lead to bleeding from the uterus Clinically one must make the necessary examinations in order to make a clear diagnosis On this basis go on to differentiate the pattern and separate the category In this way the quality of the therapeutic focus will be relatively strong and the effect of the treatment will improve

Commonly used methods for the treatment of bleeding presentations in gynecology 14 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Take for example a case in which the western diagnosis is uterine fibroid and the TCM differential diagnostic category is Qi and Blood vacuity weakness In terms to treatment in addition to supplementing Qi and nourishing Blood in order to consolidate the root one should also consider the particular contradictions implied by the fibroid and adopt the corresponding treatment measures In case example three her check up revealed a uterine myoma On the basis of TCM differentiation of syndromes the treatment method should invigorate the Blood and transform T the coagulations in order to disperse the pathological accumulations This will enable menstruation to become normal In summary by integrating western and Chinese medicine can learn AF from each other and compensate for each other s weaknesses This is an important way to improve the effectiveness of treatment Pay attention to dispersing stasis and guard against congealed blood Dr Qiu Xiao mei writes Dispersing stasis occupies an important position in the treatment of bleeding R patterns in gynecology In the first place bleeding patterns can be directly due to blood stasis Secondly extravasated blood easily pools and congeals If it is not removed in a timely way blood stasis can develop Bleeding will D often be intermittent stopping and then starting again The illness over time becomes complex and difficult to treat Because of this clinically one should disperse stasis or simultaneously disperse stasis and stop bleeding as the principle method when blood stasis is giving rise to bleeding Using these two methods together is complementary It is said When to vessels are open through the Qi and blood will follow You will achieve the goal of moving the blood and stopping bleeding After the bleeding is stopped often ingredients are mixed into a prescription to disperse stasis in order to prevent a relapse Previous doctors said It is good to stop bleeding

Commonly used methods for the treatment of bleeding presentations in gynecology 15 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum without causing the malady of congealed stasis When I treat Beng Lou I carefully pay attention to and examine to see if there is lower abdominal distention or pain In addition I check to see if the color of the blood is purple and if there are clots This information is coordinated with tongue and pulse Work with both the Qi and Blood regulate Qi and stop bleeding T Dr Qiu Xiao mei writes Qi is the commander of Blood and blood follows the movement of the Qi When Qi is regulated the bleeding is normal and when the Qi is disordered AF then there is reckless excessive movement Because of this in the treatment of bleeding in gynecology regulating the Qi is an aspect that should not be ignored If Qi rebels and the effect is that there is vomiting blood during menstruation one should down bear the Qi as the main principle When the Qi is going down the blood also will go down and cease to overflow in a harmful way If the Qi is sinking with the effect of profuse menstruation beng lou or blood in the stool the supplementing the Qi will be the main R principle When the Qi is abundant it has the power to absorb the blood The blood will spontaneously cease to go down If the Qi is stagnant so that the blood congeals one should course and open through the Qi D mechanism When the Qi flows easily the blood can circulate and blood stasis is dispersed Supplement and nourish the Liver and Kidney regulate the Chong and Ren Dr Qiu Xiao mei writes Supplementing the Liver and Kidney is an important method in gynecology for the treatment of bleeding Because the Chong and Ren are subordinate to the Liver and Kidney when there is pathology profuse menstruation or Beng Lou many times this is due to depletion of the Liver and Kidney that

Commonly used methods for the treatment of bleeding presentations in gynecology 16 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum results in lack of regulation of the Chong and Ren vessels We could say that supplementing and nourishing the Liver and Kidney is the same as regulating the Chong and Ren and the when the Chong and Ren are consolidated the reckless movement of blood will spontaneously cease Regulate the Spleen and Stomach consolidate the effect of the treatment Dr Qiu Xiao mei writes T Regulating the Spleen and Stomach is an important link in the treatment of bleeding in gynecology This is because the Spleen and stomach are in the middle and are the central pivot of all the rising and falling in the body The AF Spleen Qi primarily rises and the Stomach Qi descends If the Spleen and Stomach Qi loose their fortification the ascending and descending can also become abnormal and the blood fluid can also overflow upward or downward This could manifest as such problems as vomiting blood during menstruation or profuse menstruation or Beng Lou Because of this it is important to regulate the Spleen and Stomach when treating bleeding R patterns When the ascending and descending is normal the blood flow will also be calm and without abnormal pathological changes In addition the Spleen and Stomach are the source of the generation of Qi and Blood After bleeding is stopped or during convalescence it is even more important to D regulate the Spleen and Stomach as a means of supporting the source of transformation When the Ying and blood are brought back it helps consolidate the treatment effect and prevent a relapse

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 17 Differentiation and Methods Patho mechanisms Dr Qiu Xiao mei writes T A Supplementing the Qi and absorbing blood AF Next there is a close relationship between Flooding and Trickling and lack of proper care for the Spleen Zang function Fatigue from overwork and over thinking and brooding can damage the Spleen and cause it to become vacuous and weak and to fall downward Because the Spleen governs the gathering of the Blood into the network of vessels when the Spleen is damaged its Qi can t restrain the Blood as it should This can result in R Flooding and Trickling It is the Spleen s job among the Zang to gather the blood into an D interconnected system Tang Rong Chuan says The Qi transports upward to the Heart and Lungs and irrigates all around overflowing into the muscles It resides in the center and flows into the four directions Blood follows this movement incessantly This is why it is said that the Spleen gathers the blood into an interconnected system If the Spleen and Stomach are debilitated the Qi cannot absorb the Blood and the Blood will flow outside the vessels This can lead to various types of bleeding

Commonly used methods for the treatment of bleeding presentations in gynecology 18 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum I like to translate the term used here she as to absorb It is translated as to contain by both Eastland Press and Wiseman 1 This brings up the image of the Spleen as sponge like in its absorptive capacity Our methods should focus on helping the Spleen s absorptive function These methods will either 1 Bank up and increase the density of the sponge like quality of the Spleen when it is too lax and loose or 2 Enrich and humidify the Spleen making it more peat like When the Spleen Qi is dry this can be likened to dry soil in which the absorptive surface has T become dry causing run off as opposed to absorption2 AF Special points for differentiating the pattern Dr Qiu Xiao mei writes There may be heavy bleeding or chronic bleeding without stopping The color will be pale red with a watery substance The facial complexion will appear yellowish and the patient will have weak breath and speech The appetite may be poor and the spirit weary There may be dizziness and sticky stool The tongue body will be pale red with a thin white moss and R the pulse will be thin and weak or big and without strength D This passage is an example of the standard way of differentiating patterns in which the possible and likely signs and symptoms are listed This way of listing symptoms can be misleading in diagnosis Lists such as these serve the purpose of helping us understand the general patho mechanism of bleeding due to Spleen Qi deficiency They give us a sort of picture of the scenario See Eastland Press Draft Glossary 2006 and A Practical Dictionary of Chinese Medicine Second Edition by Nigel Wiseman and Feng Ye 1 2 The most important property of peat is retaining moisture in soil when it s dry and yet preventing the excess of water from killing roots when it s wet Peat can also store nutrients although it is not fertile itself LINK

Commonly used methods for the treatment of bleeding presentations in gynecology 19 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Yet so many of these above signs and symptoms could be from other pathologies Heavy or chronic incessant bleeding is a good example of a symptom that is not particular to Spleen Qi deficiency yet actually all the signs and symptoms listed here could be attributed to other patho mechanisms Spleen Qi Deficiency So what signs and symptoms would tell the practitioner that bleeding is actually T due to Spleen Qi deficiency We would see definitive deficiency signs and symptoms along with one or more of the following Pale tongue with digestive symptoms AF Scalloped tongue edges Weakness of the four limbs Lax spongy abdominal muscles or deficient tense dry abdominal muscles Soft empty pulse or thin weak pulse We want to see some of the above signs and symptoms that will help explain the R bleeding and other signs and symptoms Kidney Qi In her chapter on Bleeding Patterns Dr Qiu does not go into her methods for D diagnosing and treating Kidney deficiency type bleeding However in her chapters on Early Menstruation and Flooding And dripping she goes into much more detail about these methods In addition many of her case studies involve bleeding due to Kidney Qi Yin or Yang deficiency as a patho mechanism Indeed in our own clinics we will see this as perhaps the most common factor in gynecological bleeding disorders She has very particular and effective methods for treating this pathology that I have now used in the clinic for many years Dr Qiu writes

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 20 The Kidneys are especially implicated in gynecological bleeding disorders This is because the Chong and Ren Mai both arise in the uterus and the uterine vessels are linked to the Kidneys In this way the Kidneys are the root of the Chong and Ren and are the source of the menstrual blood In the Nei Jing it states At seven times two years the woman s Tian Gui3 arrives Her Ren Mai opens through The great Chong Mai is abundant The monthly event descends in a timely way This illustrates that when the Kidney Qi is T abundant then and only then will the Tian Gui be engendered The Tian Gui acts upon the Chong and Ren Mai making the sea of Blood plentiful AF Then menses then comes like the tide The abundance and decline of the Kidney Qi determines whether the menstruation will be normal or abnormal The Kidney Zang includes both the Kidney Yin and the Kidney Yang The two are in a relationship of mutual generation When the Yin is calm and constant and the Yang is secret closed tight and contained there will be harmony The converse creates disease When the Kidney Yang is insufficient the uterus is vacuous and cold the Chong and Ren are not R consolidated This may give rise to Flooding and Trickling When the Kidney Yin is debilitated vacuity fire tends to be excessive This fire harasses the Blood of the Chong and Ren and compels it to reckless movement hence D Flooding and Trickling Furthermore because there is an interrelated and interdependent relationship between the Zang Fu Kidney illness can influence the other Zang Kidney illness can lead to Heart Liver Spleen and other Zang to loose their synchronicity Indirectly or directly this influences the Chong and Ren Mai and can result in Flooding and Trickling 3 Tian Gui or Heavenly water is likened both to menstrual fluid and to the hormonal activity of the pituitary gland

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum If the Kidney Yang is insufficient Fire won t generate Earth 21 Consequently the Spleen Yang won t be braced up The Spleen will no longer be able to fortify the body through digestion or move the flood matter through the digestive tract It will loose its capacity to tong gather the Blood into the interconnected system of vessels This can result in Flooding and Trickling Sometimes Kidney Water descends and becomes depleted It is unable to ascend as it should to ji communicate with and benefit the Heart Heart T Fire left alone in this way becomes excessive This Fire heats the Blood and the Blood moves recklessly and may manifest as Flooding and Trickling Insufficient Kidney Yin also can cause Liver Wood to loose its AF nourishment and incline the Liver Yang to be excessive The official duty of the Liver to store the Blood cannot be carried out and the Fire that appears harasses and stirs the Chong and Ren Mai causing Flooding and Trickling The diagnostic and treatment methods for Kidney Qi deficiency are worth mentioning here Though Dr Qiu does not go over this directly from reading her R case studies it is possible to see what signs and symptoms lead her to a diagnosis of Kidney Qi deficiency and what methods she uses to treat this D Dr Qiu will include Kidney Qi supplements when a patient shows general deficiency signs and symptoms and complains of weakness and soreness of the lower back In my own clinical work I will diagnose and treat Kidney deficiency if in addition to what Dr Qiu mentions the lower abdomen is lax and without resilience and or if there is a feeling of a chopstick along the Ren vessel channel on the lower belly There may be a dip in the back of the tongue The proximal pulse may be weak I will also ask patients if they have a subjective sense of bottom falling out I have found that most patients can feel the difference between simple heavy bleeding and a collapsing feeling in the lower body

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 22 Collapsed Qi If there has been a large amount of bleeding the Qi will follow the blood out In this case the complexion will be very pale white with a spontaneous clammy perspiration and cold limbs It may be that there is a cold faint The pulse will be floating and large without root or thin and weak like a thread T In this paragraph Dr Qiu also mentions that if there is a large amount of bleeding the Qi will follow the blood out Here she is talking about the possibility of shock When these signs and symptoms are seen a different protocol is needed AF than what one would typically apply for Spleen Qi deficient bleeding Commonly used formulas and herbs Dr Qiu Xiao mei writes When the Heart and Spleen are both depleted and there is no power in wrapping the blood so the blood does not return to the channels one should use Gui Pi Tang When the middle Qi falls downward and the Qi R cannot absorb the blood one should use Bu Zhong Yi Qi Tang When there is Qi deficiency Flooding And dripping I use my experiential formula Shen Qi Jiao Ai Tang see page 187 to a great effect If the Qi follows the blood D and collapses this is a crisis of Qi collapse In this case use Du Shen Tang or Shen Fu Tang You can also select stop bleeding herbs such as Ai Ye Tan Pu Huang Tan Ce Bai Tan Chen Zong Tan Zi Zhu Cao and Xian He Cao This is very general and points us in the direction we need to move in relation to treating bleeding due to Qi deficiency Below I will break this down into more specific categories that I have found indispensible in the clinic

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Commonly used herbs 1 Treating the Base in general any herbs that treat Qi deficiency in general will be used as the base to treat Qi deficiency bleeding To bank up and increase density in the absorptive function of the Spleen use Huang Qi Bai Zhu Lian Zi T Fu Ling To humidify the Spleen when dryness is preventing absorption Gui Zhi and Bai Shao AF Ren Shen Gan Cao Xi Yang Shen Tai Zi Shen To supplement Kidney Qi Xu Duan Gou Ji R Duan Mu Li Duan Long Gu Du Zhong D Bu Gu Zhi Chi Shi Zhi Sang Ji Sheng To treat collapse Ren Shen Fu Zi 23

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Stopping Bleeding 24 The above herbs treat the base or root of the cause of bleeding The practitioner will need to assess the constitution of the patient the length of time the patient has been bleeding the amount of bleeding and the stage of the bleeding in coordination with the phase of the menstrual cycle to assess how much to include herbs to specifically stop bleeding ii Xian He Cao AF iii Chen Zong Pi T Non charred herbs used frequently to stop bleeding when there is Lax type Spleen Qi deficiency i Ai Ye iv Shi Liu Pi v Da Ji vi Zhu Ma Gen Non charred herbs used frequently for dry type Spleen Qi deficiency vii E Jiao viii Bai Shao R ix Shan Zhu Yu Charred herbs used frequently for Spleen Qi deficiency x Ai Ye Tan D xi Jing Jie Tan xii Chen Zong Tan xiii Di Yu Tan xiv Pao Jiang Charred herbs used frequently for Kidney Qi deficiency xv Xu Duan Tan xvi Gou Ji Tan Calcined herbs used for Kidney Qi deficiency xvii Duan Mu Li xviii Duan Long Gu

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum xix Duan Gui Ban Commonly used formulas Dang Gui Bu Xue Tang 6 Huang Qi 30 T Dang Gui Ren Shen Huang Qi Dang Gui Bai Zhu Suan Zao Ren Long Yan Rou R Zhi Yuan Zhi 6 AF Gui Pi Tang 12 12 12 12 9 9 6 Sheng Jiang 9 Da Zao 12 Zhi Gan Cao 3 D Mu Xiang Gu Ben Zhi Flooding Tang Fu Qing Zhu Ren Shen 9 Huang Qi 9 Dang Gui 15 Bai Zhu 30 25

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Shu Di Huang 30 Pao Jiang 26 3 Shen Qi Jiao Ai Tang Dr Qiu Xiao mei 15 Qing Zhi Huang Qi 24 E Jiao 12 Ai Ye 2 4 T Chao Dang Shen AF Dr Qiu on Shen Qi Jiao Ai Tang Shen Qi Jiao Ai Tang Ginseng Astragalus Ass Hide Glue and Artemesia Soup Herbal Constituents Radix Codonpositis Qing Zhi Huang Qi Water Prepared Radix Astragalus 24 gm E Jiao Corii Asini Gelatinum 12 gm AiYe Follium Arlemesia Argyi 1 2 gm 15 gm D R Chao Dang Shen Method for Use Decoct in Water Function Supplement Qi absorb Blood induce Blood to return to the channels Indications Threatened Miscarriage due to Qi and Blood dual vacuity or excessive menstruation like Flooding Formula Explanation In the prescription I use Dang Shen Radix Codonpositis and Huang Qi Radix Astragalus to greatly boost the source Qi When the Qi is exuberant the Blood is dependable and the fetus is then safely covered E Jiao Corni Asini Gelatinum nourishes the

Commonly used methods for the treatment of bleeding presentations in gynecology 27 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Blood so the Qi and Blood can be coordinated A small amount of Ai Ye Follium Artemesia Argii assists by inducing Blood to return to the channels This prescription supplements the middle and restrains encourages the Blood follow the normal pathway and secures against dripping and pouring of Blood Though Qi and Blood are different substances they have the same source They are mutually dependent and mutually benefiting This is why our worthy predecessors said Qi is the master of Blood and To synchronize the menstruation or the channels synchronize the Qi This prescription principally supplements Qi This is so that the formless of Yin and Yang T Qi can rapidly consolidate and thereby prevent the downward dropping and the separation If a woman had heavy bleeding or dripping of Blood that doesn t stop AF add stop bleeding herbs such as Di Yu Tan Radix Sanguisorbae Officinalis Carbonized Zong Lu Tan Fibra Stipulae Trachyazrpi Carbonized Xian He Cao Herba Agrimoniae Pilosae or Zhu Ma Gen Tan Radix Boehmeriae Carbonized If there is Kidney vacuity with back and waist pain and soreness add Xu Duan Tan Radix Dipsaci Asperi Carbonized Gou Ji Tan Rhizoma Cibotii Carbonized or Sang Ji Sheng If you want to increase and strengthen the consolidating and R securing strength add Mu Li Concha Ostrea Gui Ban Plastrum Testudinis or Long Gu Os Draconis D Yi Qi Gu Chong Tang Huang Qi 15 Bai Zhu 6 Dang Shen 9 Ai Ye 4 5 Xian He Cao 6 Jing Jie Tan 6 Dang Gui 6

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Xu Duan 6 Sheng Ma 3 Gan Cao 3 28 Restrain the Flow Giovanni s Patent Jing Jie Tan Ren Shen Xu Duan T Huang Qi Bai Zhu Tu Si Zi Dang Gui Ce Bai Ye San Qi Sheng Ma Gan Cao AF Shu Di Huang Shan Zhu Yu Pattern Qi deficiency Spleen and Kidney Qi not holding Blood Action Tonify Qi to hold Blood R Indications Heavy periods that start with a flood and or continue for a long time with a trickle bright red and rather dilute blood tiredness depression weariness loose stools poor appetite backache frequent pale urination sweating pale D complexion Classical antecedent Gu Ben Zhi Beng Tang Consolidating the Root and Stopping Flooding Decoction and Yi Qi Gu Chong Tang Benefiting Qi and Consolidating the Penetrating Vessel Decoction Wu Ji Bai Feng Pian Wan

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Wu Ji Bai Feng Wan Wu Ji Bai Feng Pian invigorates Qi and 29 nourishes the blood regulates menstruation and checks leucorrhea The herbal formula is used for treating deficiency of Qi and blood emaciation weakness and soreness of the loins and knees irregular menstruation metrorrhagia metrostaxis and leucorrhea Xiang Fu Mu Li Tian Men Dong Lu Jiao Shuang Gan Cao T Dang Shen Bie Jia Di Huang Sang Piao Xiao Chuan Xiong Dang Gui Bai Shao Shan Zhu Yu Wu Ji Dan Shen AF Huang Qi Shan Yao Du Zhong Xu Duan E Jiao R Dr Qiu Xiao mei s case examples of bleeding due to Qi Deficiency Example One Ms Lu was forty three years old and on March 11 1973 she came in for her D first visit From the beginning of January last year her menstruation became irregular dripping without stopping Her last menstruation flowed on December 12 1972 and has dripped without stopping until now The color of the menstruate is pale The accompanying symptoms were dizziness feeling of weakness poor appetite pasty thin bowel movements and occasional dull pain in her lower legs sensitivity to cold and a facial complexion that lacked luster Her pulse was thin The tongue body was pale red and the tongue coating was thin and white

Commonly used methods for the treatment of bleeding presentations in gynecology 30 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum In her case my diagnosis was simultaneously dual Spleen and Kidney depletion and Qi not restraining the Blood The treatment should fortify the Spleen and boost the Kidney supplement the Qi and restrain the Blood Simultaneously I will gather up the Blood and stop bleeding I gave her 3 packs of the following prescription 15 gm Zhu Ma Gen Tan Boehmaria Nivea Carbonistatum 30 gm Zhi Huang Qi Radix Astragalus Prepatatum 12 gm Gou Ji Tan Radix Cibot Carbonistatum 12 gm Duan Mu Li Concha Ostrae Calcined 30 gm Chi Shi Zhi Halloysitum Rubrum 9 gm AF T Dang Shen Radix Codonopsis Duan Long Gu Os Draconis Calcined 15 gm Jing Jie Tan Herba Schizonopetae Carbonistatum 4 5 gm Ji Mu Tan Radix Loropetali Carbonistatum 30 gm Second Visit R After taking the herbs her menstrual dripping stopped Her facial complexion had a little luster but her back still felt sore and her legs still felt weak Her tongue and pulse were the same as on the first visit I switched D over to using seven packs of modified version of Gui Pi Tang Restore the Spleen Decoction Hai Er Shen Radix Pseudostellariae 15 gm Bai Zhu Rhizoma Atractylodis Macrocephalae 4 5 gm Zhi Huang Qi Radix Astragalus Preparate 12 gm Fu Ling Poria 9 gm Yuan Zhi Radix Polygalae 4 5 gm Chao Zao Ren Stir fried Semen Ziziphi Spinosae 9 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Guang Mu Xiang Radix Auklandiea 4 5 gm Zhi Xu Duan Processed Radix Dipsaci 9 gm Zhi Gou Ji Processed Radix Cibot 9 gm 31 After continuing to observe her for three months her menstruation had returned to normal Editorial Comments T In this example of menstrual dripping without ceasing the menstrual color was pale Some of the accompanying symptoms were dizziness weakness low back soreness thin pulse and pale red tongue On the basis AF of the symptoms and the examination of the pulse my diagnosis was dual depletion of the Spleen and Kidney and Qi failing to restrain the Blood The method of the first prescription should therefore fortify the Spleen boost the Kidney supplement the Qi and restrain the blood while simultaneously stopping bleeding I obtained a food effect by treating both the root cause and the symptoms simultaneously In order to complete the cure I used Gui R Pi Tang Restore the Spleen Decoction continuously Sharon s Commentary This case is a good example of Dr Qiu taking into account the staging of treatment D At this patient s first visit Dr Qiu observed that though the bleeding was not heavy the length of time it had been going on was long 3 months The effects of bleeding for so long were beginning to show on this patient This meant that she felt she needed to use heavier stop bleeding methods so she used the base of Dang Shen and Huang Qi with added carbonized and calcined herbs This is also a good example of Dr Qiu combining the treatment of Spleen Qi with Kidney Qi in the treatment of bleeding disorders This is something she does frequently This makes sense since the Kidney Qi is responsible for consolidating the lower body and is the absorptive foundation of the Spleen s absorptive abilities

Commonly used methods for the treatment of bleeding presentations in gynecology 32 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Among the carbonized herbs she used are Xu Duan and Gou Ji This is because of the weakness the patient felt in the lower body indicating Kidney weakness The Duan Long Gu Duan Mu Li and Ci Shi Zhi also all help consolidate the Kidney Qi Case Example Two First Visit April 14 1965 Ms Guo was a 17 year old student Her first menstrual period was in February of 1964 Previously the amount of her T menstruation was normal but her last menstruation began on April 6 1965 and didn t stop At the time of her last flow she went on a long and difficult trek and her menstrual quantity suddenly flooded and didn t stop She AF experienced abdominal pain that was relieved by pressure At the time of the exam her facial color was shining white She experienced visual dizziness and palpitations and felt as if she was about to faint Her hematocrit was only 3 5 gm Her pulse was vacuous and large and simultaneously floating The body of her tongue was pale red with a thin coating My diagnosis was a depletion of both Qi and Blood I used the formula Shen Qi Jiao Ai Tang R Ginseng Astragalus Asshide Glue and Mugwort Decoction which supplements the Qi and astringes the Blood in order to prevent the loss of large amounts of Blood Her Qi and Blood were slack and the disease was D already in the danger zone Her flow urgently needed to be staunched I gave her three packages of the following formula Qing Zhi Qi Water prepared Radix Astragalus 30 gm Dang Shen Radix Codonopsis 15 gm Chen Zong Tan Trachycarpus Stipulae Carbonistatum 15 gm E Jiao Zhu Colla Corii Asini 12 gm Chen Ai Ye Herba Artemesia Argyi 1 2 gm Xian He Cao Herba Argrimoniae 30 gm Di Yu Tan Radix Sanguisorbi Carbonistatum 15 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Duan Mu Li Calcined Concha Ostrae 30 gm Duan Long Gu Calcined Os Draconis 33 30 gm Shen San Qi Radix Notoginseng Powdered swallowed separately 3 gm Second Visit Her menstrual quantity was distinctly reduced and her abdominal pain was already gone She still experienced visual dizziness and palpitations Her pulse was relatively slow and lacked strength Her facial complexion showed some color I repeated the previous prescription adding packages T Xiang fu Tan Rhizoma Cyperi Carbonistatum 7 5 gm I gave her five AF Third Visit Ms Guo s menstruation had completely stopped and was clear of secretions Her sleep was peaceful though her food intake was low Her pulse was thin and weak and the coating on her tongue was thin and white Her hematocrit had risen to 7 From the previous prescription I removed E Jiao Zhu Colla Corii Asini Huang Qi Radix Astragalus and Ai Ye Herba Artemesia Argyi and added 12 gm of both Gu Ya Fructus Oryzae Germinatus R and Bian Dou Semen Dolichoris D Editorial Comments This case was related to taxing overwork Ms Guo s Chong and Ren Mai were damaged Her menstruation arrived like an avalanche and resulted in Qi and Blood damage The force of this was about to result in the separation of Yin and Yang She nearly collapsed from weakness For the acute situation I gave her Shen Qi Jiao Ai Tang Ginseng Astragalus Asshide Glue and Mugwort Decoction with double the amount of Huang Qi Radix Astragalus The aim of this was to nurture the Qi and Blood in order to prevent further downward falling After the herbs the force of the illness had markedly changed for the better I continued the original formula

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum with additions and subtractions Upon taking the herbs the illness was 34 dispelled The effect was striking Sharon s Commentary In contrast to the last case in this case the bleeding had not been going on for a long time but it was very heavy The patient was young and not generally weak though the blood loss was reaching a critical point In terms of staging Dr Qiu also wanted to use strong styptic measures to stop bleeding while also rescuing the T Qi She did this by using larger doses of Huang Qi than in the first case and also combining her formula Shen Qi Jiao Ai Tang with carbonized and calcined herbs It is good to notice that she did not use carbonized Xu Duan and Gou Ji because AF this patient did not exhibit Kidney deficiency She did add San Qi which will help prevent and clear up blood stasis This is because bleeding can easily cause blood stasis and this patient had some abdominal pain At the second visit the patient was much better but still bleeding slightly This is a key time in treating bleeding disorders The movement in a good direction should R not divert the doctor from continuing with strong treatment A little bleeding after a flood can easily revert back to flooding Dr Qiu knowing this continued with the same strength of treatment in spite of the improvement Only at the 3rd visit when D the patient had stopped bleeding entirely did she change the staging At this point she began to address the patient s appetite which is essential to promote for the production of new blood Yet still she uses the styptic stop bleeding herbs to prevent a relapse Case Example Three Ms And dripping was 16 when she came for her first visit on June 14 1973 She had begun to menstruate in January of this year It began normally but on May 13 she flowed and did not stop The bleeding became heavy and

Commonly used methods for the treatment of bleeding presentations in gynecology 35 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum then there was sudden Flooding that did not cease During her outpatient visit her complexion was very pale white She also was dizzy with palpitations lower abdominal pain This was followed by fainting spells Her blood test showed 4 hemoglobin so she entered the hospital and was given 200 ml of blood Her pulse was soft and large and hollow Her tongue moss was thin and the body was pale This was a case of Qi not absorbing the blood with the danger of Yin and Yang separating I used staunch the flow T Shen Qi Jiao Ai Tang to supplement the Qi to absorb blood and urgently 15 Zhi Huang Qi 30 E Jiao Zhu 12 Chen Ai Ye 1 2 Xian He Cao 30 Chen Zong Tan 12 Di Yu Tan 12 Duan Long Mu 30 Huang Qin Tan 4 5 Shan Zha Tan 12 San Qi Mo 1 5 add as powder in decoction Xiang Fu Tan 6 D R AF Chao Dang Shen 3 packages Second Visit After taking the herbs the vaginal bleeding had clearly decreased The color of the menstruate had become pale The abdominal pain had cleared She still had dizziness and palpitations Her pulse had become moderate but with pressure still lacked strength She had lost a lot of blood and her Qi and Yin were damaged I continued with the original

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum method taking out the Shan Zha and Xiang Fu and adding the following 36 herbs Hong Zao 4 dates Fu Shen 12 Shi Liu Pi 12 6 packages Third visit The vaginal bleeding had stopped She still had a small amount T of pale yellow secretion palpitations and her sleep was not good Her facial complexion had become slightly rosy Her pulse was thin and soft and the tongue moss was thin and white I again decided to supplement the Qi AF nourish the blood and consolidate and astringe 12 Zhi Huang Qi 15 Shan Yu Rou 12 Duan Long Mu 30 each E Jiao Zhu 12 Shi Liu Pi 12 Chao Zao Ren 9 Jing Jie Tan 4 5 D R Chao Dang Shen Hong Zao 15 Bai Ji Mo 1 5 as a draft Zhi Yuan Zhi 4 5 5 packages Forth Visit She had no vaginal bleeding She still felt weakness in her limbs and her appetite was poor Her pulse was thin and weak Her tongue moss

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum was thin and white and slightly greasy I gave her the previous formula 37 taking out the E Jiao and Jing Jie Tan I added the following herbs Shen Qu 9 Gu Ya 12 Fifth visit After taking the herbs to supplement her Qi and fortify her Spleen the patient s condition improved She wanted to leave the hospital T Her hemoglobin was now 7 5 I continued to supplement both her Spleen and Stomach I gave her herbs in a pill form to consolidate the health AF treatment and advised her to take this outside the hospital to nurture her Discussion This illness was related to over work causing the source Qi to become damaged This caused the amount of menstruation to be like Flooding and for the Qi and Yin to become damaged The Yin could not wrap the Yang and the Yang could not be absorbed by the Yin Yin and R Yang threatened to separate In an acute stage we should use Shen Qi Jiao Ai Tang so as to supplement the Qi and Blood and absorb and stop Flooding and avoid collapse After the herbs the disease strength clearly decreased I D continued with the same formula with modifications and there was a clear improvement Afterwards I gave her a pill to continue the improvement Sharon s Commentary In this case we see the way in which Dr Qiu modifies her base formula of Shen Qi Jiao Ai Tang to address an acute stage of bleeding In the case of Qi deficiency bleeding she regularly adds Xian He Cao Chen Zong Lu Tan Di Yu Tan Duan Long Gu and Duan Mu Li These are the herbs I have learned to keep around and use in these kinds of cases It is also interesting to note Dr Qiu s use of food stagnation herbs to improve the appetite Even in the first treatment she uses Shan Zha Tan though this herb also vitalizes blood so she may have used it because the

Commonly used methods for the treatment of bleeding presentations in gynecology 38 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum patient complained of abdominal pain When there is some pain with the bleeding in Qi deficient cases Dr Qiu regularly adds San Qi and often adds carbonized Xiang Fu In my own clinic I like to palpate the lower belly above the pubic symphysis to ascertain if there is discomfort for the patient If there is I then differentiate if the pain is due to blood and Qi stasis or if there is an infection I T don t only rely on the patient s report about the presence or absence of pain Case Example Four Ms Wang was a 38 year old office worker Every month her menstruation is too AF heavy It is a pale color and goes on 8 9 days before stopping Her facial color lacked luster and she also had dizziness heart palpitations and poor sleep One year previously she had and abortion Her pulse was soft and thin and her tongue was pale red A blood test showed her hemoglobin was 8 and her platelets were 6000 cubic milliliter Coordinating the pulse and pattern it was clear this case was related to Ying deficiency and scanty blood with a lack of consolidation of the R Chong and Ren vessels For treatment it was suitable to supplement and nourish the Qi and Blood while regulating and absorbing the Chong and Ren I used the formula Ren Shen Yang Rong Tang modified 12 Dang Gui 10 D Dang Shen Chao Bai Shao Chao Bai Zhu 9 9 Shu Di Huang 12 Zhi Yuan Zhi 9 E Jiao 10 Fu Shen 9 Long Yan Rou 12 Zhi Gan Cao 5

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Hong Zao 4 39 After 10 packages of this formula her next menstruation had a decreased amount and her other symptoms changed for the better Discussion In this case the patient s Chong and Ren vessels had been damaged during an abortion This caused her menstruation to be profuse and long In this kind of case it is difficult to avoid damaging the Ying and blood Symptoms such as dizziness heart palpitations poor sleep numbness thin pulse and pale tongue may T arise The formula to use is Ren Shen Yang Rong Tang to supplement and nourish the Qi and Blood regulate the Chong and Ren and thereby have a good effect Pathology AF B Clearing Heat and cooling the blood Dr Qiu Xiao mei writes Yan Yong he said whenever there is reckless movement of blood there must be heat When blood receives heat it overflows Zhang Jing Yue said The R foundation of blood is Yin and Jing and it should not be aroused If they are aroused then this is pathological The cause of arousal is most often fire Fire will compel the blood to move recklessly As for the mechanism that causes blood heat it may be from hyperactivity of heart fire in which D blood looses it s governance Liver channel fire causing the liver to be unable to store the blood or the stored Yin may be insufficient with vacuity fire moving internally damaging the Chong and Ren vessels a causing the blood to run recklessly One should differentiate excess and deficiency types in the clinic and give treatment accordingly Here she is dividing bleeding due to heat into two basic categories Excess and Deficiency types

Commonly used methods for the treatment of bleeding presentations in gynecology 40 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Within the Excess category she further divides this into two types Hyperactivity of Heart fire and Liver channel fire Within the Deficiency category she describes only Yin insufficiency with deficiency fire moving internally damaging the Chong and Ren vessels a causing the blood to run recklessly we can further differentiate as follows Liver Qi Stasis AF Hyperactivity of Heart fire T Clinically Dr Qiu makes more subtle differentiations than these In terms of Excess Excess of Liver fire Liver Rebellion Heat in the Blood chamber R Damp Heat in the Liver Channel Here we can take these one by one discussing how to differentiate and treat each type Clinically we will see from Dr Qiu s case studies below that these patho D mechanisms occur together with each other as well as with other patterns Often Excess and Deficiency heat mix together Heat can frequently mix with blood stasis as well The case studies should help the reader see how an experienced doctor flexibly integrates treatment principles using staging of treatment as well as working with the phases of the menstrual cycle Special points for differentiating the pattern Dr Qiu writes When heat is excess the amount of bleeding will be profuse and the strength of it will be acute The color is crimson red or purple red with clots The

Commonly used methods for the treatment of bleeding presentations in gynecology 41 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum facial complexion will be ruddy there will be thirst palpitations dislike of heat and desire for cold yellow or red urine constipation red tongue with yellow moss and a big forceful or slippery and rapid pulse As we saw in the section on Qi deficiency bleeding Dr Qiu uses the common method of discriminating patterns Rather than determining the key symptoms for differentiating heat she paints a scenario of symptoms that could show up if there is heat Taking the symptoms one by one we see that most of them such as T profuse bleeding purple blood with clots thirst palpitations red urine and constipation can all manifest with patho mechanisms other than heat Some symptoms such as a ruddy complexion or a dislike of heat can arise when there is AF heat is one area yet cold in another So these points leave us without the key signs that would tell us that the bleeding is from heat Since clinically it is actually rare to see all or most of these symptoms at the same time I think it is important to have clear ways of determining the exact patho mechanisms What we will look for first are general signs of excess and deficiency in the basic R constitution of our patient This will be the main guide as to their tendency to excess or deficient heat bleeding It is important to remember that all excess heat is depressive heat In other words all excess heat is our normal physiological heat D that has become blocked and pent up there by becoming pathological All empty heat is heat that has lost its root due to some deficiency We can see from this that the basic constitution of a patient will strongly determine the nature of their pathological heat Determining the basic constitution The general look of a patient is important Patients with strong constitutions have strong thick muscles they are upright Patients with weaker constitutions will have lax soft or thin muscles and generally have a weaker appearance

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 42 The abdomen is key Patients with strong constitutions have resilient musculature on their bellies and areas of fullness that resist pressure while weaker patients have soft lax or stiff weak musculature with areas of flaccidity or even chopstick lines on the channel of the Ren vessel The tongue is also a key Look at the size of the tongue as well as at the moss on the tongue As small or thin tongue indicates deficiency while a larger tongue T indicates excess If the moss is peeled or absent then this is a fluid deficiency while if the moss is yellow or dry this is more excessive When the bleeding is due to excess heat generally there will be a red tongue When the bleeding is due to AF deficiency heat the tongue may be pale with a red tip If there has been significant blood loss the tongue may even be very pale Pulse diagnosis can be misleading though generally it is very helpful Depressive conditions can manifest with a deep pulse that seems minute Deficiency conditions can develop stasis signs and symptoms that are due to the weakness R The pulse can reflect this by being full in some or all positions Additionally a heat condition does not always manifest with a rapid pulse The important task is to explain the pulse picture with what you know for sure In mixed presentations the D pulse is often the determining factor in your decision to tonify or disperse Once you know excess or deficient you can now explain the more non definitive signs and symptoms such as constipation thirst etc with the base you have determined Further differentiation of excessive types Liver Qi stasis with Depressive Heat Shao Yang

Commonly used methods for the treatment of bleeding presentations in gynecology 43 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum will manifest with some of the following Irritability gloominess stasis symptoms related to the menstrual cycle indented tongue or red stasis spots on the tongue breast distention or pain Liver Fire will manifest with the above plus a red tongue or very red edges to the tongue and more acute heat signs such as red eyes rage busting out bleeding vaginal redness Liver Rebellion with manifest with the Liver Qi stasis signs but the bleeding will be vicarious T Heat in the Blood chamber will manifest with the Liver Qi stasis signs with other pivot signs such as stasis palpated under the rib side and clear cyclic hot and cold signs AF Damp Heat in the Liver Channel Will manifest with a greasy tongue moss and damp heat in the lower warmer signs such as yellowish vaginal discharge Deficiency Heat Dr Qiu Xiao mei writes R When heat is due to deficiency the amount of bleeding will be relatively scanty or profuse It may also drip without stopping The color will be crimson red or pale red She will have red cheeks afternoon fever dizziness heart palpitations 5 heart feverishness dry mouth restlessness D night sweats low back soreness and pain bowels tending to be dry red tongue with cracks and little moss and a this rapid pulse without strength or a wiry thin rapid pulse Again we see a whole picture painted without the key signs and symptoms we need to differentiate and again we cans see that most of these signs and symptoms can manifest in other and sometimes opposite patho scenarios The key signs and symptoms have been differentiated above

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Commonly used herbs Treating the Base Excess Heat Heat in the Heart Huang Lian Huang Qin Huang Bai Ren Dong Teng Zhi Chun Pi Guan Zhong AF Da Huang Sheng Di Huang Heat in the Liver Zhi Zi Mu Dan Pi Chi Shao Huang Qin R Long Dan Cao Chai Hu Yin Chen Hao D Heat Rebellion Wa Leng Zi Chuan Niu Xi Zhi Juan Bai Chong Wei Zi Heat in the Shao Yang Pivot Chai Hu Huang Qin Qing Hao Zhu Ru T Da Xue Teng Hong Teng 44

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Stop Bleeding Excess Heat Bai Mao Gen Ma Chi Xian Ji Mu Gen Bai Ji Mo Di Yu Stop Bleeding Charred Herbs Huang Bai Tan Jiao Zhi Zi Guan Zhong Tan AF Pu Huang Tan T Huang Qin Tan Jin Yin Hua Tan Qian Cao Gen Tan Sheng Di Tan Damp in the Lower Warmer Herbs Qu Mai R Bian Xu Che Qian Zi Mu Tong D Treating the Basics Empty Heat Enrich Yin Sheng Di Huang Shu Di Huang Shan Zhu Yu Bai Shao E Jiao Mai Men Dong Nu Zhen Zi Enrich Yin Cool the Blood and Stop Bleeding 45

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Sang Ye 46 Han Lian Cao Di Gu Pi Calcined Herbs Duan Long Gu Duan Mu Li Duan Gui Ban Carbonized Herbs Xu Duan Tan Gou Ji Tan AF Hei Han Lian T Duan Niu Jiao Sheng Di Tan Commonly used Formulas Excess Heat R Heat in the Heart Xie Xin Tang 6 gm Huang Lian 3 gm Huang Qin 3 gm D Da Huang San Huang Ren Dong Teng Tan Three Yellows Lonicera Twig Decoction Dr Qiu s Experiential Formula Huang Bai 9 gm Huang Lian 4 5 gm Huang Qin 9 gm Ren Dong Teng 15 gm Guan Zhong 12

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Dr Qiu Xiao mei writes 47 Method for Use Decoct in Water Function Clear Heat Cool Blood and Stop Bleeding Indications Blood heat early menstruation profuse menstruation and Flooding And dripping Formula Explanation Blood heat leads to movement When cold is received this leads to stoppage Yang heat hyperactivity leads compels the Blood to impetuous movement and can provoke the menstruation to arrive early even T so far as to be Flooding And dripping In this case one should clear heat in order to stop bleeding Hence this prescription uses the three yellows to clear and drain the fire of the three Jiaos The assistants are Ren Dong Teng AF Caulis Lonicerae and Guan Zhong Radix Dryopteris which strengthen the clear heat and cool the Blood function All together these herbs function to clear heat cool Blood and stop bleeding Personal Experience of Usage The composition of the prescription uses bitter cold and heat clearing herbs to counter Blood heat impetuous R movement It treats repletion patterns of early menstruation profuse menstruation and Flooding And dripping The results are quite good D Qing Re Gu Jing Tang Clear Heat and Consolidate the Menses Decoction Zhi Zi 9 Chao Huang Qin 15 Huang Bai 9 Sheng Di Huang 24 Mu Dan Pi 9 Di Yu 24 Ce Bai Ye Tan 30

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chun Gen Pi 30 Duan Gui Ban 15 Bai Shao 15 48 Gu Jing Tang Consolidate the Menses Decoction Zhu Dan xi s formula 30 Chao Bai Shao 30 Chao Huang Qin Xiang Fu 30 22 5 7 5 AF Chun Gen Pi T Zhi Gui Ban Liver Qi Depressive Heat Dan Zhi Xiao Yao San Chai Hu Bo He R Chi Shao 9 9 9 9 Bai Zhu 9 Fu Ling 9 D Chao Dang Gui Mu Dan Pi 9 Zhi Zi 9 Zhi Gan Cao 4 5 Ping Gan Kai Yu Zhi Xue Tang Calm the Liver Open Stasis Stop Bleeding Decoction by Fu Qing Zhu Chai Hu 3

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Bai Zhu 30 30 Bai Shao 30 Bai Zhu 30 Mu Dan Pi 9 San Qi Fen 9 Sheng D Huang 9 Gan Cao 6 Jing Jie Tan 2 Huang Qin Zhi Zi Mu Tong Che Qian Zi R Ze Xie AF Liver Fire Long Dan Xie Gan Tang Long Dan Cao T Dang Gui 49 9 12 12 6 15 12 9 Sheng Di Huang 15 Dang Gui 12 Gan Cao 6 D Chai Hu Dr Qiu Xiao mei writes Long Dan Xie Gan Tang from Yi Zong Jin Jian contains the 10 flavors Long Dan Cao Huang Qin Zhi Zi Mu Tong Ze xie Sheng Di Chai Hu Che Qian zi Dang Gui and Gan Cao As for the meaning of this formula the Shan Bu Ming Yi Fang Lun says Long Dan Cao drains the Liver and Gallbladder of fire Chai Hu is the Liver envoy Gan Cao moderates Liver agitation The assistants Fu Ling Zhi Zi Mu Tong Ze Xie and Che Qian Zi greatly disinhibit the front Yin

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum and make damp heat come out Although all of these ingredients clear the 50 Liver when the illness is extreme there is a chance the Liver will be damaged This is why the formula also contains Dang Gui and Sheng Di to supplement blood and nourish the Liver Because the Liver stores the blood supplementing blood is the same as supplementing the Liver The idea that this formula defeats and sooths comes from the fact that it drain and supplements the Liver It is clear that the principle function of this formula is to drain the Liver and Gallbladder of excess fire It clears and discharges the Liver of damp heat for T treating symptoms such as headache red eyes tinnitus ear swelling rib side pain with jaundice and strangury Following the principle of treating the same disease with different methods and treating different diseases with the same AF method I use this formula in the gynecology clinic to treat many types of pathology with a very good effect Below are some case examples to illustrate this Cool the Menses Giovanni s Patent Formula based on Qing Re Zhi Flooding Tang Clear Heat Arrest Flooding Decoction and Long Dan Xie Gan Tang R Long Dan Cao Huang Qin Zhi Zi D Huang Bai Mu Dan Pi Di Yu Xian He Cao Sheng Di Huang Dang Gui Ce Bai Ye Chun Gen Pi Huang Jing

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Bai Shao 51 Qian Cao Gen Pu Huang Xu Duan Liver Rebellion Gui Jing Tang Return the Menses Decoction by Dr Qiu Xiao mei 15 T Yi Mu Cao Wa Leng Zi 30 Zhi Juan Bai 15 9 AF Chuan Niu Xi Dr Qiu Xiao mei writes Decoct in Water Function to induce blood to move downward Principle use vicarious menses R Formula breakdown The Nei Jing says all rebellion flowing up belongs to fire In many cases vicarious menstruation is caused by the Qi and Fire being compelled upward Blood follows this upward movement Therefore this D formula uses Wa Leng Zi because its flavor is salty and its substance is heavy It can calm the chong and down bear rebellion Yi Mu Cao dispels what is congealed and generates the new Combining Niu Xi with Wa Leng Zi induces the blood to go down Juan Bai is added to clear heat and cool the blood This formula adheres to the principle that when the heat is cleared the rebellion will descend and the menstruation will return to being normal and not move rebelliously Heat in the Blood Chamber

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Xiao Chai Hu Tang 24 Huang Qin 9 Ban Xia 24 Sheng Jiang 9 Ren Shen 9 Zhi Gan Cao 9 Da Zao 12 pieces Damp Heat in the Liver Channel Qu Mai Bian Xu Mu Tong Che Qian Zi Huang Qin R Haui Niu Xi AF Qing Gan Li Shi Tang T Chai Hu 52 12 12 3 9 9 9 9 Chuan Lian Zi 9 Chai Hu 4 5 Jing Jie 4 5 D Mu Dan Pi This is an experiential formula of Dr Liu Feng Wu He uses this primarily for midcycle bleeding but it s use can be expanded for spotting before or after menstruation In addition the idea of disinhibiting dampness from the lower warmer can be applied to other patho mechanisms Dr Liu Feng Wu writes

Commonly used methods for the treatment of bleeding presentations in gynecology 53 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Ovulatory bleeding mostly occurs between two menstruations on days 1216 after the first day of the menstruation Patients who have mid cycle bleeding typically also have lower abdominal pain The bleeding can last for several days and the amount is scanty Chinese medical texts to do not have much discussion of this presentation In addition to the mid cycle bleeding the patient also complains of lower abdominal pain or dysmenorrhea Because of this often herbs to warm the womb and scatter cold are given but the effect is not very good It can be observed that this type of patient T also has a profuse vaginal discharge and the tongue moss is white and sticky or yellow and thin The pulse is often wiry and slippery The doctor should differentiate the relative preponderance of cold and heat and whether each AF is true of false All cases are not cold When the pain is due to cold the facial complexion is sallow The pulse would be wiry and thin and the tongue moss would be thin and white In this type of patient the facial complexion is normal or slightly red the pulse is wiry and slippery and the tongue moss is slimy and white or yellow and thin R In this kind of case the lower abdominal pain is due to damp heat obstructing the channels and collaterals The Qi and Blood of the Chong and Ren vessels are not open through and pain results Mid cycle bleeding D is then due to the dampness and heat that are deep lying within the Chong and Ren vessels As the Chong and Ren fill after ovulation the Yang function of them becomes full The Yang function leads to heat and this stirs the deep lying dampness and heat This can pour downward as a profuse vaginal discharge When this heat enters the blood collaterals bleeding occurs Dr Lui uses Qing Gan Li Shi Tang and this has been effective for this presentation This formula frees flow and therefore treats diarrhea vaginal

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum discharge and bleeding Damp heat is cleared while Qi and Blood flow 54 smoothly blood vessels are opened and the Chong and Ren are harmonized Bleeding is thus stopped Empty Heat Sheng Di Long Mu Tang Rehmannia Dragon Bone and Oyster Shell Decoction by Dr Qiu Xiao Mei 30 Sang Ye 30 T Sheng Di Huang Duan Mu Li 30 Hei Han Lian Pu Huang Tan 15 12 AF Duan Long Gu 12 Dr Qiu Xiao Mei writes Method for Use Decoct in Water Function Nourish Yin Clear Heat Consolidate and Astringe and Stop R Bleeding Indications Flooding And dripping and Flooding And dripping over the course of time damaging the Yin D Formula Expression Central to this formula is Sheng Di Radix Rehmannia which enriches the Yin and nourished the Blood Duan Mu Li Calcined Concha Ostrea and Duan Long Gu Calcined Os Draconis settle and subdue consolidate and astringe Dong Sang Ye Follium Mori and Hei Han Lian Herba Ecliptia Carbonistatum clear heat and cool the Blood supplement the Kidneys and stop Bleeding Pu Huang Tan Pollen Typhea Carbonistatum has the function of dispelling the congealed Blood and stopping Bleeding Personal Experience of Usage The root of women is blood and Blood is the Yin Fluid When a woman has Flooding And dripping with each passing day

Commonly used methods for the treatment of bleeding presentations in gynecology 55 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum it consumes the Yin Level Hence to make the force of this disease tend in a direction of changing for the better use Sheng Di Long Mu Tang Rehmannia Dragon Bone and Oyster Shell Decoction This will enrich the Yin clear heat consolidate and astringe It will prevent a relapse Sheng Di Long Mu Tang Rehmannia Dragon Bone and Oyster Shell Decoction contains Sang Ye It imitates the meaning behind Fu Qing Zhu s Gynecology s Qing Hai Wan Clear the Sea Pill It supplements Yin without us needing to be concerned with excessive rising movement It contracts the T Blood without the hardships of cold herbs It causes the uterus to cool and in these ways the Blood by itself returns to the appropriate channels If the appetite is poor add Gu Ya Fructus Oryzae Germinatus and Ji AF Nei Jin Endothelium Corneum Gigeriae Galli If there is Yin vacuity add Di Gu Pi Cortex Lycii Radicis and Fu Xiao Mai Fructus Tritci Levis If there is back and knee pain and weakness add Sang Ji Sheng Ramulus Loranthus and Du Zhong Cortex Eucommiae R Liang Di Tang Two Earth Decoction 18 Di Gu Pi 9 Xuan Shen 12 Mai Men Dong 12 Bai Shao 12 E Jiao 9 D Sheng Di Huang Er Zhi Tang Two Solstice Decoction Han Lian Cao 15 Nu Zhen Zi 15

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Zuo Gui Wan 240 Shan Yao 120 Gou Qi Zi 120 Shan Zhu Yu 120 Chuan Niu Xi 90 Tu Si Zi 120 Lu Jiao Jiao 120 T Shu Di Huang Gui Jiao 120 AF Clear Empty Heat and Cool the Menses Giovanni Patent Sheng di Huang Bai Shao Shan Yao Huang Qin Huang Bai R Xu Duan Han Lian Cao Qing Hao D Di Yu Qian Cao Gen Zhi Mu Ou Jie Gou Qi Zi Huang Jing Xian He Cao Ce Bai Ye Gan Cao1 56

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Mu Dan Pi 57 Shan Zhu Yu Giovanni Writes Action Cool Blood clear Empty Heat nourish Yin stop bleeding Indications Heavy periods that may start with a flood or go on trickling for a long time after the proper period time or both bright red or scarlet red blood mental restlessness anxiety insomnia agitation a feeling of heat in the afternoon or evening night sweating malar flush dry throat T Tongue Red without coating it may be cracked Pulse Floating empty or fine rapid AF Classical antecedent Bao Yin Jian Protecting Yin Decoction Nourish Yin and Restrain the Flow Sheng Di Huang Shan Yao Shan Zhu Yu R Gou Qi Zi Tu Si Zi Huang Jing Bai Shao D Xian He Cao Ce Bai Ye Wu Wei Zi Fu Ling Gu Ya Giovanni writes Pattern Yin deficiency Empty Heat Action Nourish Kidney Yin clear Empty Heat stop bleeding

Commonly used methods for the treatment of bleeding presentations in gynecology 58 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Indications Heavy menstrual bleeding during the period itself and not so much outside the normal period time bright red or scarlet red blood night sweating a dry throat at night dizziness tinnitus backache depression a feeling of heat in the evening malar flush dry skin and hair Tongue Red without coating or with rootless coating It may also be without coating but normal color Pulse Floating empty Classical antecedent Zuo Gui Wan Restoring the Left Kidney Pill Er Zhi T Wan Two Solstices Pill and Liang Di Tang Two Di Decoction Bao Yin Jian AF Mixed Excess and Deficiency Heat Bleeding formulas Sheng Di Huang 24 Shu Di Huang 15 Bai Shao Shan Yao Huang Qin R Huang Bai 12 12 9 9 6 Gan Cao 3 Han Lian Cao 9 Qing Hao 6 Di Yu 9 Qian Cao Gen 9 D Xu Duan Qing Re Zhi Flooding Tang Clear Heat Arrest Flooding Decoction Zhi Zi 9 Chao Huang Qin 15

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Huang Bai 9 24 Mu Dan Pi 9 Di Yu 24 Ce Bai Ye Tan 30 Chun Gen Pi 30 Duan Gui Ban 15 Bai Shao 15 Case 1 Liver Fire and Rebellious Liver T Sheng Di Huang 59 AF Ms Xu was 44 years old when she came for her first visit on July 24 1979 Three months previously she had had a quarrel with someone There after on the first day of her menstruation she bled a normal amount but also had a profuse nose bleed with profuse dark blood On the second day her menstruation increased and the nose bleed did as well At this point she also had chest oppression dizziness heart palpitations easy anger poor R sleep with many dreams a wiry rapid pulse a red tongue with a thin yellow moss Her last menstruation came on July 4 1979 Differential diagnosis was related to angry Qi damaging the Liver Liver constraint transforms into D fire the Qi and fire rebelled upward causing vicarious bleeding Treatment should clear and discharge the Liver channel of excess fire to induce the blood to go down I used modified Long Dan Xie Gan Tang Long Dan Cao 10 Jiao Zhi Zi 9 Chao Dang Gui 9 Mu Dan Pi 9 Chao Chi Shao 9 Chao Chuan Xiong 2 4

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chai Hu 4 5 Zhi Juan Bai 9 Chong Wei Zi 12 Duan Wa Leng Zi 15 Chuan Niu Xi 15 Bai Mao Gen 15 60 Seven packages T Second visit 7 31 1979 Her menstruation was about to arrive She had heart palpitations easy to anger and poor sleep Her pulse was wiry and her tongue body was infused with purple with a thin yellow moss I AF continued with the same idea in order to avoid the vicarious bleeding 10 Jiao Zhi Zi 9 Chao Chi Shao 9 Chao Dang Gui 9 Duan Wa Leng Zi 9 Ou Jie 9 Che Qian Zi 12 Zhi Juan Bai 9 D R Long Dan Cao Chuan Niu Xi 15 Bai Mao Gen 15 Zhen Zhu Mu 30 Third visit 8 4 1979 Her menstruation had come yesterday and the amount was heavy but there was no nose bleed Her tongue and pulse were as before I gave her the original formula with modifications Long Dan Cao 10

Chuan Niu Xi 15 Zhi Juan Bai 9 Mu Dan Pi 4 5 Da Sheng Di 15 Che Qian Zi 9 Ou Jie 9 Chao Dang Gui 4 5 Chao Bai Shao 9 Bai Mao Gen 30 61 T Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Jiao Zhi Zi 9 AF Forth visit 8 27 1979 After taking the above formula the menstruation was heavy lasting for 5 days with no nose bleed She also said that her body also felt very comfortable Her menstruation had arrived the day before which was 5 days early The amount was relatively less the color was purple and she had no abdominal pain or nose bleed She still had a difficult time sleeping Her pulse was wiry and thin and her tongue body R tended to red I gave her modified Gui Pi Tang to consolidate the effect Discussion This case of vicarious bleeding was due to a great anger D damaging the Liver with Liver fire rebelling upward I gave her modified Long Dan Xie Gan Tang before and after her menstruation in order to clear and drain the Liver of excess fire and regulate the menstruation I added Wa Leng Zi Chuan Niu Xi Zhi Juan Bai and Chong Wei Zi to induce the blood to go down and to descend the rebellion This is from my own experience Case Two Liver Fire Ms Shang was 50 years old Recently her menstruation had been coming early The color was dark it had a fishy smell and the amount was profuse

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum like Flooding This lasted for 10 days Simultaneously she had a dark 62 colored discharge strong low back pain a bitter taste in her mouth poor appetite wiry pulse crimson tongue with a thin yellow moss This was related to Liver channel damp heat compelling the blood to move recklessly 9 Huang Qin 4 5 Jiao Zhi Zi 9 Huang Bai 4 5 Chai Hu 4 5 Yin Chen Hao 15 Zi Cao 9 Ze Xie Bei Xie AF Long Dan Cao T I gave her a modified version of Long Dan Xie Gan Tang 9 9 7 packages Second visit Before taking the Long Dan Xie Gan Tang Ms Shang s R menstruation cleared as did the bitter taste in her mouth She still had the leucorrhea Her tongue moss had gradually transformed Her pulse was wiry and thin I again wanted to drain the Liver Gallbladder of damp heat D Hu Huang Lian 4 5 Huang Bai 4 5 Huang qin 9 Mian Yin Chen 15 Ze Xie 9 Chai Hu 9 Bei Xie 9 Sheng Chao Yi Yi Ren 12 each Zhi Cang Zhu 4 5

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 5 packages 63 I continued with this method for 10 more packages When she got her menstruation the amount was normal and it lasted for 5 days Subsequently she went through menopause Discussion This was a case in which the patient s menstruation was early and profuse and accompanied by leucorrhea bitter taste in the mouth T crimson tongue with yellow tongue moss and a wiry pulse This was an obvious case of Liver channel damp heat compelling the blood to run recklessly so I used Long Dan Xie Gan Tang modified to clear and drain the AF Liver channel damp heat At the start there was no bleeding so I could not stop bleeding I went with the saying To treat the illness seek the root Afterwards I used Gui Pi Tang to supplement the Qi and blood in order to consolidate the extraordinary vessels This is an example of slowly and carefully reaching the goal so as not to have a relapse R Case 3 Excess Heat with damaged fluids Ms Hu was an 18 year old student She had bled for more than 4 months in a relatively profuse quantity The color was crimson red She also had a D dry mouth and a wiry rapid pulse The tip of her tongue was red with prickles This was heart fire harassing and causing the blood to move recklessly I gave her a modified version of San Huang Ren Dong Teng Tang Ren Dong Teng 30 Huang Bai Tan 9 Huang Qin Tan 9 Jiao Zhi Zi 9 Chao Huang Lian 2 4 Ji Mu Gen 30

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Guan Zhong Tan 15 Pu Huang Tan 9 Zhi Chun Pi 9 Ma Chi Xian 15 Bai Ji Mo 3 in draft 64 5 packages After the herbs her menstruation cleared after 10 days Her pulse was wiry T and thin and her tongue tended to red I decided to clear heat and nourish the Yin and assist with consolidating and astricting 9 Dong Sang Ye 30 Zhi Gui Ban 30 Sheng Di Huang 30 Juan Bai 4 5 AF Huang Qin Han Lian Cao 12 Duan Long Gu 15 R 7 packages Discussion This was a case of chronic bleeding that was profuse and of D crimson color which are both signs for blood heat In addition her tongue was red with prickles her pulse was wiry and fast and her mouth was dry This was all evidence of exuberant Yang heat Because of this I used San Huang Ren Dong Teng Tang in order to clear heat and cool the blood After the herbs the bleeding stopped so the effect was good On the return visit I considered the damage to the Yin from blood loss and the continued presence of heat I continued to clear heat and in addition nourished Yin to treat both the root and the branch This way I could prevent a relapse

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Case 4 Mixed Deficiency Excess Heat 65 Ms Shi was 41 when she came for her first visit on April 12 1978 She began to menstruate when she was 17 and her cycle had always been regular In February of 1978 her menses began to arrive early every half month with a heavy flow that continued 7 10 days Before her menses she experienced breast distention accompanied by heart palpitations and back soreness Her last menses stopped on April 7 Her pulse was thin and her T tongue was red with white moss This pathology corresponded to blood vacuity heat and Chong and Ren irregularity For treatment I used Gu Jing AF Tang with modifications 10 packages 30 Huang Bai Tan 4 5 Xu Duan Tan 9 Xiang Fu Tan 4 5 Gou Ji Tan 9 Zhi Chun Pi 9 Chao Sheng Di 30 Huang Qin Tan 9 Duan Mu Li 30 D R Zhi Gui Ban Second Visit May 5 1978 Ms Shi s menses arrived on May 3 The amount was still profuse She experienced lower abdominal dull pain low back pain dizziness and palpitations Her pulse and tongue were as before I again gave her 10 packages of a prescription that expressed the ideas of Gu JIng Tang Zhi Gui Ban Huang Bai Tan 30 4 5

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chao Sheng Di 30 Duan Mu Li 30 Xiang Fu Tan 9 Gou Ji Tan 9 Xu Duan Tan 9 Zi Zhu Cao 15 Zhi Chun Pi 9 66 T At a check up more than a year later Ms Shi s menses were regular and the amount had decreased She bled now for 7 days AF Discussion This case involves a woman who has early profuse menstruation that comes twice each month accompanied by back soreness thin pulse and red tongue body The diagnosis was Yin vacuity with blood heat and lack of regulation of the Chong and Ren vessels so I used Gu Jing Tang with modifications In the formula Gui Ban and Sheng Di enrich Yin and clear heat Huang Qin Huang Bai and Chun Pi clear heat stop R bleeding and consolidate the menses Gou Ji and Xu Duan supplement the Kidneys and consolidate the Chong and Ren I added Mu Li in order to increase the strength of the consolidating and astringing function Xiang Fu D rectifies and regulates Qi These herbs combine harmoniously and all together have the effect of enriching Yin clearing heat supplementing the Kidney and consolidating the menses When I treat cases of early menses profuse menses or Flooding And dripping due to Yin vacuity and blood heat I often use modified Gu Jing Tang with good effect Case 5 Blood Heat

Commonly used methods for the treatment of bleeding presentations in gynecology 67 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Ms Gao who was 24 years old suffered from irregular menstruation Each month she flowed two times and afterwards dripped without stopping The amount was sometimes profuse and sometimes scanty This had gone on for half a year without stopping The Blood color was sometimes dark and sometimes crimson She was also constipated and her urine was red Her abdomen often felt slightly distended and uncomfortable She also experience dry throat dizziness and head distention She went to an out patient hospital for treatment but it was ineffective She didn t want to take western T medicines to artificially synchronize her cycle She preferred to try traditional Chinese medicine Her pulse was wiry thin and rapid The coating on her tongue was slightly yellow and the tongue body was tending to be crimson AF She had a red flush on her face This pattern fell into the category of Blood heat inciting impetuous movement of the Blood I gave her five packages of San Huang Ren Dong Teng Tang Three Yellows Lonicera Twig Decoction with the following additions 9 gm Mu Dan Pi Tan Cortex Moutan Carbonistatum 9 gm Duan Mu Li Calcined Concha Ostrea 30 gm Pu Huang Tan Pollen Typhae Carbonisatum 9 gm D R Xiang Fu Tan Rhizoma Cyperi Carbonistatum Upon taking the five packages her menstrual flow decreased progressively The Blood color had changed to a paler red Her abdomen felt more comfortable her face no longer flushed red and her urination ran clear On the second visit her tongue and pulse were that same as before I continued with five packages of the previous prescription with some modifications

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chuan Lian Zi Semen Mellitiai 3 gm Huang Qin Tan Radix Scutellariae Carbonistatum 9 gm Huang Bo Tan Radix Phellodendron Carbonistatum 6 gm Ren Dong Teng Caulis Lonicerae 15 gm Guan Zhong Tan Radix Dryopteris Carbonistatum 68 12 gm 30 gm Jing Jie Tan Herba Schizonopeta Carbonistatum 4 5 gm Chun Gen Pi Cortex Ailanthus 9 gm Shi Liu Pi Pericarpium Granati 9 gm T Duan Mu Li Calcined Concha Ostrea After these five packages the flooding stopped She experienced a AF poor appetite and felt sleepy Her pulse was thin I took proper care of her Spleen and Stomach in order to consolidate the result Case 6 Heat in the Blood Chamber Patient Ms Guo woman age 33 R Initial Visit 12 12 83 Main Complaint Each menstruation is accompanied by a high fever of around 39 centigrade or 102 Fahrenheit Her menstrual blood is profuse the color dark with blood clots mixed in She simultaneously experiences lower D abdominal pain facial edema swelling of her limbs breast distention and lower back soreness She feels irritable and easily angered Three years previously she suffered from eclampsia during delivery and also had a high fever She was ill for a half year A previous doctor gave her Qin Jiao Bie Jia Tang after which the fever during menstruation ceased to arise though after continued use this prescription lost its effectiveness Switching over to using clear heat and cool the blood type herbs also had no visible effect

Commonly used methods for the treatment of bleeding presentations in gynecology 69 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Check Up Upon surveying the tongue I saw that the body tended to be bright red and the moss was thin and greasy Pressing the pulse showed it to be wiry and thin Differential Diagnosis and Treatment Method I categorized the syndrome as heat entering the Blood Chamber and used Xiao Chai Hu Tang Minor Bupleurum Decoction with added flavors I gave her five doses of the following prescription Radix Bupluri 15 gm Xian Ban Xia Rhizoma Pinellia 9 gm Dan Zi Qi Preparatae Radix Scultellariae Nova 9 gm AF T Ruan Chai Hu Radix Codonopsis 9 gm Gan Cao Radix Glycyrrltizae Uralensis 3 gm Sheng Jiang Rhizoma Zingiberis Officil1alis Recens 3 slices Hong Zao Fructus Zizyphi 12 gm Huo Xiang Herba Agastache sell Pogostemi 9 gm Pei Lan Herba Eupatorii Fortrmei 9 gm Chao Bian Dou Stir fried Semen Dolichoris lablab 10 gm Mu Dan Pi Cortex Moutan 9 gm R Dang Shen D Second Visit After the herbs the menses changed There was no appearance of high fever with edematous swelling Menstruation flowed smoothly and the irritability was eased This prescription was effective and I advised her to continue to take five doses for the seven days preceding menstruation and afterward according to her need She continued in this way for three months in succession Her menstruation flowed on schedule and without a high fever Comments In this example each time the menstruation flows the Sea of Blood is vacuous and the heat evil overwhelms the vacuity and enters This

Commonly used methods for the treatment of bleeding presentations in gynecology 70 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum heat evil struggles with the menstrual Blood This is the evil and the correct mutually contending The Blood knotted by the uterine heat enters the Blood Chamber I imitated Zhang Zhong ling s method from the Shang Han Lun using Xiao Chai Hu Tang to harmonize resolve and clear heat In this case the medicine and the syndrome were mutually in accord Altogether the Case 7 Empty Heat with Yin Deficiency T effect was very rapid Ms Wang was 42 years old when she came in for her first visit on May 10 1976 Since the beginning of last year her menstruation began to arrive AF early It came one time every half month and flowed profusely like Flooding The color of the Blood was crimson and was mixed with clots Accompanying symptoms were low back soreness profuse discharge and dizziness Her pulse was wiry and thin The body of her tongue was red and suffused with purple After undergoing a diagnostic D C the western physicians R discovered that she suffered from uterine membrane hyperplasia Their diagnosis was functional uterine bleeding According to Chinese medical differential diagnosis her difficulties fell D into the category of Kidney Yin depletion damage and Chong and Ren Mai not consolidated The treatment principle was to supplement Kidney consolidate and restrain I used seven packages of the following Chao Sheng Di Stir fried Rehmannia 24 gm Shan Yu Rou Fructus Cornus 12 gm Xu Duan Tan Radix Dipsacis Carbonistatum 9 gm Duan Mu Li Calcined Concha Ostrae 30 gm Duan Long Gu Calcined Os Draconis 12 gm Zhi Huang Jing Prepared Radix Polygonum 12 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Hei Han Lian Herba Ecliptia Carbonistatum 12 gm Zhi Gui Ban Prepared Plastrum Testudinis 30 gm Gou Ji Tan Rhizoma Cibotii Carbonistatum 9 gm 71 Second Visit During the previous visit I gave medicinals that followed the treatment principle of nourishing Yin and supplementing Kidneys The menstrual cycle arrived four days later than usual and the amount was less She bled for five days and then stopped She was still experiencing dizziness T low back soreness and hot flashes Her tongue and pulse were the same as before I diagnosed her with Yin vacuity and internal heat The formula to use was a modified version of Qin Jiao Bie Jia Tang Gentiana Qin Jiao and herbs AF Soft shelled Turtle Shell Decoction I gave her 7 packs of the following 12 gm Chao Zhi Mu Stir fried Radix Anemarrhenae 9 gm Qing Hao Herba Artemesia Chinghao 9 gm Chai Hu Radix Bupleuri 9 gm Tian Hua Fen Radix Trichosanthis 9 gm Qin Jiao Radix Gentianae Qinjiao 9 gm R Di Gu Pi Cortex Lycii Radicis D Shi Xian Tao Herba Pseudobulbus Pholidotae rattlesnake orchid Fu Shen Poria cum Pini Radice 12 gm Dang Gui Angelica Sinensis 9 gm 9 gm After this her menstruation became normal and the hot flashes gradually retreated Editorial Comments In this example the diagnosis was Yin vacuity and inner heat along with Chong and Ren Mai not consolidated The focal point of the

Commonly used methods for the treatment of bleeding presentations in gynecology 72 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum differential diagnosis is the early profuse crimson menstruation hot flashes and red tongue body Based on this the main treatment principle on the first visit was to enrich and nourish the Kidney Yin It is said The principle of strengthening water is to restrain the Yang light rays After taking the herbs the patient s Yin fluid became fortified and the vacuity Yang was gradually pulled in Still the hot flashes hadn t receded so I continued treatment with a modified version of Qin Jiao Bei Jia Tang desired result T Gentiana Qinjiao and Soft shelled Turtle Shell Decoction and obtained the AF Case 8 Yin Deficiency with Empty Heat and Blood Stasis Ms Yang came for her first visit on September 20 1976 She was 44 years old and in March of this year her menstruation began to be abnormal in that it arrived earlier and earlier The amount was profuse and it dripped without stopping According to her own account she underwent many gynecology check ups She was diagnosed as having a uterine fibroid Her last R menstruation came on August 28 and ended September 16 Her pulse was deep and fine The body of her tongue was slightly crimson I first used the method of clearing and nourishing and gave her seven packs of the D following herbs Zhi Gui Ban Prepared Plasturn Testudinis 30 gm Sheng Mu Li Concha Ostrae 30 gm Chao Bai Shao Stir fried Radix Paeoniae Alba 9 gm Sang Ye Follium Mori 30 gm Hei Han Lian Herba Ecliptia Carbonistatum 12 gm Shan Yu Rou Fructus Corni 12 gm Zhi Chun Pi Prepared Cortex Ailanthi 9 gm Di Gu Pi Cortex Lycii Radicis 9 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Sang Ji Sheng Ramulus Loranthus 9 gm 73 Second Visit When I saw this patient again her pulse was thin Her tongue body was slightly purple and the coating was thin I switched my approach to using dispel the congealed and generate the new method I gave her 3 packs of the following herbs Chao Dang Gui Stir fried Angelica Sinensis 9 gm T Su Mu Lignum Sappan 9 gm Tian Xian Teng Caulis Aristolochiae 9 gm Chao Wu Ling Zhi Stir fried Feces Trogopterorum 4 5 gm 4 5 gm Chong Wei Zi Fructus Leonori 9 gm Zhi Xiang Fu Prepared Rhizoma Cyperi 9 gm Chao Pu Huang Stir fried Pollen Typhae 6 gm Chao Chi Shao Stir fried Radix Paeoniae Rubra 9 gm Yue Ji Hua Rosae Chinensis Flos et Fructus 9 gm Ze Lan Herba Lycopi 9 gm R AF Chao Chuan Xiong Stir fried Rhizoma Ligustici Third Visit When the next menstruation came the amount was still profuse D and crimson and was accompanied by low back pain and dull lower abdominal pain The day she came for the third visit was the third day of her menstruation Her pulse was deep and fine The body of her tongue was pale red with purple I gave her the following formula Duan Mu Li Calcined Concha Ostrea 30 gm Chao Bai Shao Stir fried Paeoniae Alba 9 gm Huai Shan Yao Rhizoma Dioscoreae 12 gm Ji Mu Gen Lorapetelti 30 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum She She Cao Herba Hedoytis Duffusae 9 gm Xu Duan Tan Radix Dipsacis Carbonistatum 9 gm Gou Ji Tan Rhizoma Cibotii Carbonistatum 9 gm Huang Qin Tan Radix Scutellariea Carbonistatum 9 gm Chao Dang Shen Stir fried Radix Codonopsis 9 gm 74 After this at the onset of each menstrual period I gave her a formula to synchronize her menstruation and stop bleeding for a short period of T time After her menstruation ended I nourished Then right before her menses I changed her prescription to quicken the Blood and transform stasis I continued this treatment and observed her for more than five AF months Her menstruation had become a normal size Editorial Comments In this example of profuse and early menstruation and dripping the western gynecology exam showed the presence of a uterine fibroid On the basis of the method of combining together identification of the disease with identification of the pattern the treatment principle for the R up coming menstruation was to synchronize the menstruation and stop bleeding After the menstruation passed I switched over to the treatment principle of nourishing and just before the menses invigorating the Blood D and transforming coagulation in order to disperse the pathological clumping It is important to abide by the dictum When the situation is urgent treat the branch and when the situation is moderate treat the root In this way a result will be obtained quickly Case 9 Yin Deficiency with Empty Heat First Visit April 28th 1979 Ms Chen was 24 years old She began her menstrual flow at age 18 and for the past six years it has not been synchronic

Commonly used methods for the treatment of bleeding presentations in gynecology 75 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Each time the menstruation comes it is difficult to stop The flow is neither heavy nor scanty This situation has caused her to be excessively weary Her last menstruation began on April 23 1979 and has not yet stopped Simultaneously she was also experiencing acute lower abdominal pain Her pulse was thin and the body of her tongue was crimson Going by a correlation of the pattern with the pulse I determined the diagnosis to be Yin vacuity Blood heat and the Chong and Ren not being consolidated The treatment needed to enrich Yin clear heat and consolidate and astringe the T Chong and Ren Mai I gave her three packages of the following formula 30 gm Zhi Gui Ban Prepared Plasturn Testudinus 30 gm Dong Sang Ye Follium Mori 30 gm Huang Qin Tan Radix Scutellaria Carbonistatum 9 gm Shi Liu Pi Pericarpium Cranati 12 gm Zhi Chun Pi Prepared Cortex Ailanthi 9 gm Guan Zhong Tan Rhizoma Dropteris Carbonistatum 15 gm Duan Mu Li Calcined Concha Ostea 30 gm Duan Long Gu Calcined Os Draconis 15 gm Chi Shi Zhi Halloysitum Rubrum 6 gm Sheng Ma Tan Rhizoma Cimicifuga Carbonistatum 9 gm D R AF Sheng Di Tan Radix Rehmannia Carbonistatum Second Visit May 5 1979 After the herbs Ms Chen s menstruation stopped It has remained clear for three days Her pulse and tongue were similar to before To treat her I gave her five packages of a modified version of Gu Jing Tang Consolidate the Menses Decoction Chao Sheng Di Stir fried Radix Rehmannia Zhi Gui Ban Prepared Plasturn Testidinus 30 gm 30 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Dong Sang Ye Follium Mori 30 gm 9 gm Chao Bai Shao Stir fried Radix Paeoniae Alba 15 gm Zhi Chun Pi Prepared Cortex Ailanthi 9 gm Hei Han Lian Herba Ecliptia Carbonistatum 15 gm Duan Mu Li Calcined Concha Ostea 30 gm Duan Long Gu Calcined Os Draconis 15gm Zhi Xiang Fu Prepared Rhizoma Cyperus 4 5 gm Sheng Ma Tan Rhizoma Cimicifuga Carbonistatum 6 gm T Chao Huang Bo Stir fried Radix Phellodendron 76 Third Visit May 7 1979 Ms Chen s menstruation had dripped for six years AF and after the herbs it cleared in one week with no recurrence Her Chong and Ren Main were consolidated Both of her pulses were thin and slow and the body of her tongue was slightly crimson I continued by using seven packages of Sheng Di Mu Li Tang Rehmannia Oyster Shell and Dragon Bone Decoction R Chao Sheng Di Stir fried Radix Rehmannia 30 gm Dong Sang Ye Follium Mori 30 gm Chao Huang Bo Stir fried Radix Phellodendron 9 gm D Zhi Gui Ban Prepared Plasturn Testudinus 30 gm Zhi Chun Pi Prepared Cortex Ailanthi 9 gm Hei Han Lian Herba Ecliptia Carbonistatum 15 gm Duan Mu Li Calcined Concha Ostea 30 gm Duan Long Gu Calcined Os Draconis 15 gm Xiang Fu Tan Rhizoma Cyperus Carbonistatum 4 5 gm Xu Duan Tan Radix Dipsacis Carbonistatum 6 gm

Commonly used methods for the treatment of bleeding presentations in gynecology 77 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Fourth Visit She again took nourish Yin clear heat consolidate and astringe the Chong and Ren Mai formula Her menstrual dripping had already stopped and her sleeping and eating were normal She had some relatively profuse leukorrhea Her pulse was thing and slow and the body of her tongue was red and moist I followed the same method as before in order to consolidate 30 gm Shu Di Prepared Radix Rehmannia 30 gm Dong Sang Ye Follium Mori 30 gm T Sheng Di Radix Rehmannia 9 gm Zhi Chun Pi Prepared Cortex Ailanthi 9 gm Hei Han Lian Herba Ecliptia Carbonistatum 12 gm Duan Mu Li Calcined Concha Ostea 30 gm Duan Long Gu Calcined Os Draconis 12 gm Huai Shan Yao Rhizoma Dioscoreae 12 gm Fu Ling Poria 9 gm R AF Chao Huang Bo Stir fried Radix Phellodendron Fifth Visit May 26 1979 When I saw Ms Chen she happened to be on the second day of her menstrual flow The Blood color was fresh and the amount D was normal She was experiencing low back soreness and lower abdominal distention and pain Her pulse and tongue were similar to before For treatment I gave her five packages of a modified version of Si Wu Tang Sheng Di Huang Radix Rehmannia 15 gm Shu Di Prepared Radix Rehmannia 15 gm Gou Ji Radix Cibotii 15 gm Chao Chuang Xiong Stir fried Rhizoma Ligusticum 2 4 gm Sheng Bai Shao Radix Paeoniae Alba 9 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Niu Xi Radix Achyranthis Bidentate 15 gm Zhi Xiang Fu Prepared Rhizoma Cyperi 9 gm Duan Mu Li Calcined Concha Ostrea 30 gm Chao Dang Gui Stir fried Radix Angelica Sinenesis 6 gm 78 Sixth Visit Her menstruation stopped by May 30th 1979 without any more discomfort Her pulse was fine and slow and the body of her tongue was red and moist Again I used a modified version of Sheng Di Mu Li Tang T Rehmannia Oyster Shell and Dragon Bone Decoction along with Gui Pi Tang Restore the Spleen Decoction in order to prevent her from falling into the same rut again I gave her seven packages of the following herbs In addition AF I have her 250 gm of Ji Sheng Gui Pi Wan Life Saving Restore the Spleen Pill and instructed her to take 9 gm of the pill each morning and evening 15 gm Shu Di Prepared Radix Rehmannia 15 gm Chao Chuan Xiong Stir fried Rhizoma Ligusticum 1 2 gm Hei Han Lian Herba Ecliptia Carbonistatum 9 gm Sheng Bai Shao Radix Paeoniae Alba 9 gm Duan Long Gu Calcined Os Draconis 30 gm Dong Sang Ye Follium Mori 15 gm D R Sheng Di Radix Rehmannia Zhi Xiang Fu Prepared Rhizoma Cyperi 9 gm Duan Mu Li Calcined Concha Ostrea 30 gm Chao Dang Gui Stir fried Radix Angelica Sinenesis 6 gm Editorial Comments In this case Ms Chen had been dribbling menstruation for six years This taxed and damaged her Chong and Ren Mai and led to Yin vacuity and Blood heat Continuous administrations of enrich Yin clear heat consolidating and astringing prescriptions was necessary so that this chronic

Commonly used methods for the treatment of bleeding presentations in gynecology 79 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum illness could fully recover In this case the herbal formulas were Gu Jing Tang Consolidate the Menses Decoction and Sheng Di Mu Li Tang Rehmannia Oyster Shell and Dragon Bone Decoction modified in accordance with the pattern In my experience this vain of prescriptions are used for Yin vacuity Blood heat Chong and Rend Main not consolidated type profuse menstruation or Flooding And dripping The results were striking Furthermore Sheng Di Mu Li Tang Rehmannia Oyster Shell and Dragon Bone Decoction was used during the convalescent period Its effectiveness T extends even to the point of consolidating the results and preventing AF recurrence Case Example 10 Liver Depressive Heat with Rebellion Ms Tang was 27 and was despondent with right side rib distention and pain a tendency to sigh and heavy menses that were purple in color This was accompanied by nose bleed a wiry rapid pulse and a reddish tongue This reverted menstruation was because of overbearing Liver Qi whose R surplus turned to fire This fire was driven upward with the effect of compelling the blood to over flow At this point in her cycle she is about to bleed so I wanted to first course her Liver and resolve depression while clearing heat and cooling the blood I used Dan Zhi Xiao Yao San with D modifications Su Chao Chai Hu 4 5 Dang Gui 9 Shen Bai Shao 9 Mu Dan Pi 9 Jiao Zhi Zi 9 Long Dan cao 6 Xiang Fu Tan 9 Jiang Xiang 6

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chuan Niu Xi 9 Duan Wa Leng Zi 12 Zhi Juan Bo 9 Bai Mao Gen 15 80 5 packages Second visit Ms Tang got her menstruation in two day and the amount was relatively profuse but without any nose bleed Her pulse was wiry and T her tongue body was red I gave her three more packages of the original formula I also advised her to take the formula for 5 days before each menstruation In half a year her menstruation was without vicarious AF bleeding Discussion The Nei Jing say When the Chong rebels upward it is always due to fire When there is a nose bleed with menstruation there is one type of pathology to create the patient s condition which is blood heat with Qi rebellion In this example the patient s emotions were despondent and R depressed and her Liver Qi counter flowed The Qi transformed into fire and the blood followed the Qi rebellion and fire upward to overflow This caused a nose bleed with menstruation I used Dan Zhi Xiao Yao San to D course the Liver and resolve depression in order to clear Liver fire I also added Xiang Fu and Jiang Xiang to lower the rebellious Qi and Niu Xi and Wa Len Zi to help the blood move downward The depression resolved and the fire cleared The Qi went down and guided the blood with it and so the vicarious bleeding was calmed Case 11 Kidney Yin and Yang deficiency with inner heat

Commonly used methods for the treatment of bleeding presentations in gynecology 81 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Another Ms Qian who was 38 when she came to see me on November 1 1978 Her menstruation came early even to the point of coming several times in one month The amount could be profuse or scanty Her back and spine were very sore and painful Her last menstruation ended October 29 Her pulse was wired and thin and her tongue body tended to be crimson Her diagnosis was Yin vacuity with inner heat along with Kidney being weak and unable to consolidate For treatment I nourished Yin cleared heat supplemented Kidney and consolidated the menses I gave her five T packages of the following prescription 30 Huang Bai Tan 4 5 Zhi Gui Ban 30 Xu Duan Tan 9 Duan Long Gu 15 Sheng Mu Li 30 Bu Gu Zhi 9 Chi Shi Zhi 15 wrap separately Huang Qin 9 Gou Ji Tan 15 D R AF Dong Sang Ye Second Visit 11 5 78 After the herbs the back soreness had clearly decreased and she had not gotten her menses Her pulse was thin and her tongue body was moist The previous formula was already effective I modeled the next formula on the same idea and gave her 7 packages of the following formula Xu Duan Tan 15 Shu Di Huang 30

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chao Shan Zha 12 Gou Ji Tan 15 Zhi Gui Ban 30 Du Zhong Ye 30 Chi Shi Zhi 15 wrap separately Sheng Mu Li 30 Bu Gu Zhi 9 82 T Third Visit 11 28 78 Her menses arrived on this day and the amount was not profuse The color was red and she had back soreness Her pulse and tongue were as before For treatment I nourished Yin boosted the Kidneys AF and consolidated the menses I gave her 5 packages of the following formula 15 Shu Di Huang 15 Xu Duan Tan 12 Du Zhong Ye 15 Dang Gui 10 Sheng Bai Shao 9 Zhi Gui Ban 2 4 D R Sheng Di Huang Gou Ji Tan 15 Dong Sang Ye 15 Xiang Fu Tan 9 A check up after half a year reveal regulated menstruation Discussion The manifestation and pathological mechanism of this case is similar to case one Because of this I used Gu Jing Tang with modifications

Commonly used methods for the treatment of bleeding presentations in gynecology 83 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum which was effective in enriching Yin clearing heat supplementing Kidneys and consolidating the menses The herb Dong Sang Ye clears heat from the sea of blood With the other herbs to nourish Yin and clear heat it is very effective for treating uterine heat with blood overflowing causing early menses heavy menses flooding and dripping and fetal dripping Case 12 by Liu Feng Wu Damp Heat ovulatory bleeding T Ms Zhang was 27 years old and came to the outpatient ward on July 13 1974 She complained of mid cycle bleeding that had lasted over half a year The AF bleeding lasts for 2 3 days The amount was scanty and the color was blackish purple Ms Zhang typically felt chilled in her lower abdomen and had pain Her pain was worse before and during menstruation She also experienced a profuse vaginal discharge Ms Zhang had a history of pelvic inflammation She had been married for a year but had not become pregnant She had been given herbs to warm her womb and scatter cold R but the mid cycle bleeding had not improved Exam tongue moss was white and slim with a red tongue body Pulse wiry D and slippery Diagnosis Damp heat pouring downward and heat damaging the network vessels Treatment principle Clear heat disinhibit dampness move the qi and quicken the blood Qu Mai 12 Bian Xu 9 Mu Tong 3 Che Qian Zi 9

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chuan Lian Zi 12 Yan Hu Suo 9 Pu Gong Ying 15 Bai Jiang Cao 12 Chi Shao 9 Bai Shao 9 84 Ms Zhang was given 30 packages of this formula over a period of a month Throughout this time herbs such as Chai Hu Jing Jie Xiang Fu Che Qian Zi T Chun Gen Pi and Cang Zhu were used The cold feeling diminished though she still experienced dull lower abdominal pain At ovulation there was a slight amount of bleeding I removed Bai Jiang Cao and Pu Gong Ying and Bi Xie AF added the following herbs Yi Mu Cao 12 12 Huai Niu Xi 9 Wu Ling Zhi 9 R After another month there was no mid cycle bleeding On October 13th she had a positive pregnancy test Later she gave birth at full term and her post D partum condition was good She showed no more mid cycle bleeding Case 13 Kidney Yin Deficiency Ms Wang was 21 years old Her menstrual flow had not stopped for 4 months She experienced dizziness and sometimes a slight fever She felt heat in her hands feet and heart area and had pain in her heels ear ringing and a dry mouth and throat Her pulse was wiry and thin and her tongue was crimson I gave her 5 packages of modified Shen Mai Di Huang Tang Ginseng Ophiphogonon and Rehmannia Decoction

9 Mu Dan Pi 9 Huai Shan Yao 9 Zhi Nu Zhen 12 Shi Liu Pi 12 Fu Ling 9 Zhi Mai Dong 9 Hai Er Shen 15 Zhi Chun Pi 12 Jing Jie Tan 4 5 Chen Shan Zhu Yu 12 AF Ze Xie 85 T Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Da Shu Di 30 Second Visit After the herbs the dripping sometimes paused and the amount decreased The color became pale like coffee The dizziness and tinnitus decreased and the pulse and tongue were as before I continued with the same method R giving her 7 packages of the following formula 30 Ze Xie 9 Mu Dan Pi 9 Duan Mu Li 30 Huai Shan Yao 9 Chao Shan Zha 9 Jiao Shen Qu 9 Fu Shen 12 Bai Shao Yao 9 D Da Shu Di

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Mu Dan Pi Tan 4 5 Dang Shen Tan 9 Jing Jie Tan 4 5 Chen Shan Zhu Yu 12 Guang Chen Pi 4 5 Hong Zao 15 Zhi Mai Dong 9 86 T Third Visit The menstrual dripping cleared Her appetite increased and the dizziness and ear ringing had stopped Her sleep at night was peaceful and her pulse AF was thin and moderate Her tongue was moist I used a pill formula to consolidate the treatment and gave her 120 grams of Shen Mai Di Huang Tang Ginseng Ophiphogonon and Rehmannia Decoction advising her to take 6 grams every morning I also gave her 120 grams of Gui Pi Wan Return the Spleen Pill and advised her to take 6 grams every afternoon R Discussion This example was Liver and Kidney Yin depletion with the Chong and Ren loosing consolidation resulting in menstrual dripping Before and after I used Modified Shen Mai Di Huang Tang Ginseng Ophiphogonon and D Rehmannia Decoction for both of these diagnoses In this way the Yi and Kui are both treated Nourishing the Liver and Kidney is the same as boosting the source of the Chong and the Ren vessels When the source is full the Chong and Ren are able to consolidate and the dripping spontaneously stops

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 87 C Vitalizing Blood Patho mechanisms Dr Qiu Xiao mei writes The Nei Jing says When there is blood excess one should resolve Tang Rong Chuan says When blood is static it does not move and new blood cannot be generated Blood stasis obstructs the channels and vessels T Especially after bleeding there is often a lot of blood that stays and stagnates When blood stasis is not expelled new blood cannot stay housed and the blood has no choice but to go out again Because of this dispelling stasis is AF a most important method for stopping bleeding The concept of blood stasis as a cause of bleeding is one that can be difficult to wrap one s mind around This is because bleeding is in a basic and obvious way inappropriate and unceasing flow of blood Why would we want to move blood when it is already moving in a way it should not This can be counter intuitive unless we consider it more deeply And we really need to consider this more R deeply because stasis of blood is not only a common cause of bleeding by itself or in combination with other disease factors bleeding is itself a cause of blood stasis D When thinking about blood stasis as a cause of bleeding it is important to visualize the vessels and capillaries as tubules Blood stasis involves thickening and slowing of the blood flow to the point that it blocks these tubules This causes the tubules to break due to the pressure of new blood trying to flow through This is bleeding and it occurs on a micro capillary level When the blood breaks out of the vessels it is no longer in the normal pathways that control its flow Because the normal pathways are blocked up the blood can continue to be diverted out of these pathways and bleeding continues Only when the sluggish thick blood lightens up and begins to flow can the blood return to the pathways In fact it is natural for the

Commonly used methods for the treatment of bleeding presentations in gynecology 88 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum blood to flow in the vessels when they are open and flowing The blood returns of its own accord Blood stasis then is not simply one block It can be a diagnosis of the general thickened and sluggish quality of the blood Vitalizing the blood as a treatment method is not then simply pushing blood more forcefully through the vessels If we think of it in just this limited way then of T course we would want to have caution in cases of bleeding Yet it is only when we are using the strong vitalizing methods purging or cracking stasis that we need to maintain this kind of caution Blood vitalizing methods can also improve the AF blood quality helping it flow more smoothly and thereby easing the congestion in the vessels and thereby stopping the tendency to bleed We may worry that by improving the blood quality we are thinning the blood in the way that blood thinners work Yet this is not so Improving the blood quality improves the flow of the blood but also improves the ability for blood to coagulate when it has left the R vessels When there is a pattern of blood stasis not only is it safe to vitalize the blood you cannot stop bleeding unless you vitalize the blood It may be unsafe not to vitalize D blood Using one s discretion this method can be used after an artificially induced abortion when tissue remains in the uterus or after birth when some of the placenta remains and gives rise to bleeding Special Points for Differentiating the Pattern Dr Qiu Xiao mei writes

Commonly used methods for the treatment of bleeding presentations in gynecology 89 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum When there is blood stasis the bleeding may be heavy or last a long time or be scanty The color is dark with clots There may be lower abdominal pain that resists pressure or lower abdominal pain with masses The tongue body may be purple or dark or have dark spots The pulse may be deep and knotted or thin and rough Flooding and dripping that is caused by congealed Blood may occur with lower abdominal pain and distention that pulls the two sides of the lower back and resists pressure The patient s legs may feel weak and she T may feel dizzy and her chest will feel stuffy Qi counter flow Her Qi may gather in her belly and fail to reach her limbs causing her hands and feet to be cold and tense The amount of the menstruation may be sometimes AF profuse like flooding and sometimes scanty like dripping The color of the menstruate will be purple mixed with blood clots Her pulse may be fine and choppy Her tongue moss may be thin and the tongue body will be suffused with purple and may show purple dots Dr Qiu is showing us the basic scenario of the blood stasis presentation Clinically R the key signs are as follows Pain related to the menstrual cycle Clots in the blood D Purplish tongue and or distended sublingual veins Abdominal diagnosis hardness palpated around the umbilicus below the St 25 line and or pressure pain around St 27 area especially on the left Visual diagnosis I also look at the patient s lower legs to see if there is darkened skin or broken blood vessels Also the patient s complexion may be sallow and dark Commonly Used Herbs and Formulas

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Commonly used herbs Harmonizing the Blood Herbs Dang Gui Chuan Xiong Dan Shen Ji Xue Teng Xiang Fu Mu Dan Pi Mo Yao AF Ru Xiang T Chi Shao Herbs that harmonize the blood in small doses Hong Hua Yi Mu Cao Ze Lan R Liu Ji Nu Vitalize the blood to stop bleeding herbs Pu Huang D Ou Jie Qian Cao Gen Hua Rui Shi San Qi Charred herbs to vitalize the blood Pu Huang Tan Shan Zha Tan Dang Gui Tan 90

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Jing Jie Tan Huai Mi Tan Commonly used formulas Si Wu Tang Dang Gui Chuan Xiong T Shao Yao Shi Xiao San Wu Ling Zhi Pu Huang AF Di Huang Zhen Ling Dan Arouse the Spirit Elixir Limonitum 120 gm Zi Shi Ying Floritum 120 gm Chi Shi Zhi Halloysitum 120 gm Dai Zhe Shi Haematitum 120 gm D R Yu Liang Shi Ru Xiang Gummi Olibanum 60 gm Mo Yao Myrrha 60 gm Wu Ling Zhi Excrementum Trogopteri seu Pteromi 60 gm Zhu Sha Cinnabaris 30 gm Glutinous Rice 120 gm Xue Fu Zhu Yu Tang Tao Ren 12 91

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Hong Hua 9 9 Chuan Xiong 4 5 Chi Shao 6 Huai Niu Xi 9 Chai Hu 3 Jie Geng 4 5 Zhi Ke 6 T Dang Gui Sheng Di 9 3 AF Gan Cao Chan Hou Sheng Hua Tang Liu Feng Wu Chuan Xiong Dang Gui Yi Mu Cao Hong Hua R Ze Lan 3 9 3 3 3 1 5 Pao Jiang 1 5 Shan Zha 6 D Gan Cao Invigorate Blood and Stem the Flow Giovanni Patent Dang Gui Chuan Xiong Sheng Di Huang Bai Shao Tao Ren Hong Hua 92

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Pu Huang Qian Cao Gen San Qi Xian He Cao Dan Shen Xiang Fu Chi Shao Yao T Mu Dan Pi Shan Zhu Yu Yi Mu Cao San Leng E Zhu Xiang Fu Yan Hu Suo R Wu Zhu Yu AF Wu Jin Wan Xiao Hui Xiang Mu Xiang Bai Shao D Chuan Xiong Dang Gui Shu Di Huang Bu Gu Zhi Pu Huang Yu Nan Bai Yao 93

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 94 Case Examples Case 1 Congealed Blood causing Bleeding Ms Ding was 17 and a student She had been bleeding for more than three months with no break The amount ranges from profuse to scanty the color is dark She also experiences abdominal distention and pain that resists T pressure low back soreness dizziness and weak limbs Her pulse was thin and rough and her tongue body was purple crimson I diagnosed Qi stasis and congealed blood The menstrual fluid could not return to the vessels I AF used Pu Huang Tang modified 9 Chuan Xiong 4 5 Mu Dan Pi 9 Zhi Xiang Fu 9 Shen Shan Zha 15 Dang Gui Tan 9 Yan Hu Suo 9 Jing Jie Tan 4 5 Ze Lan 9 Di Yu 9 Qing Pi 4 5 D R Hei Pu Huang 5 packages Second Visit After one package of Pu Huang Tang the next day the amount of bleeding increased The blood was dark and mixed with clots The distention and pain was gone and the menstruation stopped after 6 days I gave her Ba Zhen Tang after that

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 95 Discussion This case of menstrual dripping was induced by Qi stasis and congealed blood It is as the sage says when congealed blood occupies the blood chamber the blood cannot return to the vessels Here the blood was dark and contained clots she felt lower abdominal distention and pain that resisted pressure Her pulse was thin and rough and the tongue body was purple On the basis of this the diagnosis was blood stasis Pu Huang San modified moves the Qi and expels stasis When stasis is gone the new AF menstrual dripping ceases T blood is generated and the blood is able to return to the vessels and the Case 2 Bleeding due to Blood Stasis and Qi Deficiency First Visit March 21 1977 Ms Wang was 39 years old After her marriage she gave birth to one full term baby Previously in both 1966 and 1967 she had had artificial abortions Since after the second artificial abortion when she was given a contraceptive injection her menstruation had become R irregular gradually reaching the point of dribbling without stopping This condition had been lingering until now without recovery Ms Wang underwent a gynecological exam that revealed that her D cervix was lustrous and that the uterine body was more or less normal The exam also showed that her uterus was retroverted and when it was moved she experienced pressure pain When she moved she felt a pressing down pain Additional investigative reports were negative After these exams she was diagnosed as having irregular menstruation and endometritis 4 She took many medicinals for treatment without any clear result Ms Wang had dripped blood for nine years and her cycle was irregular Her last menstruation was February 24 1977 It was accompanied 4 This question mark is in the original It expresses that Dr Qiu found this diagnosis questionable

Commonly used methods for the treatment of bleeding presentations in gynecology 96 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum by low back soreness dizziness and pasty small bowel movements Her pulse was wiry and fine The body of her tongue was infused with purple All of this related to Liver depression Spleen vacuity Qi stagnation and congealed Blood The treatment principle was to course the Liver fortify the Spleen dispel coagulation and generate the new I gave her 5 packages of the following formula Jiao Dong Zhu Scorched Rhizoma Atractylodes Macrocephalae9 gm 9 gm Yi Mu Cao Herba Leonor us 9 gm T Chao Pu Huang Stir fried Pollen Typhae 9 gm Chai Hu Radix Butlery 4 5 gm AF Chao Dang Gui Radix Angelica Sinensis 9 gm Shan Zha Tan Fructus Crataegi Carbonistatum 12 gm Da Mai Ya Fructus Hordei Germinatus 12 gm Huai Mi Tan Flos Sophora Carbonistatum 30 gm Chuan Xiong Rhizoma Ligustici 2 4 gm Bo He Geng Herba Menthae twigs 4 5 gm R Bai Ji Li Fructose Tribuli Second Visit March 28 1977 After taking the herbs Ms Wang s menses D flowed on March 24th The flow was profuse Her bowels were normal and the back pain had been better Her pulse was thin The tongue body was red and moist At this point the treatment should involve the use of a formula to consolidate and astrict in order to guard against menstrual dripping I gave her 5 packages of the following formula Duan Mu Li Calcined Concha Ostrea 30gm Hai Er Shen Radix Pseudostellaria 30 gm Duan Niu Jiao Calcined Cervi Bovis 30 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Xu Duan Tan Radix Dipsacis Carbonistatum 9 gm 97 Gou Ji Tan Rhizoma Cibot Carbonistatum 9 gm Chi Shi Zhi Halloysitum Rubrum 9 gm Bu Gu Zhi Fructus Psoraleae 9 gm Chen Shan Zhu Rou Fructus Cornus 12 gm Bai Ji Mo Rhizoma Bletilla tips 4 5 gm Duan Long Gu Calcined Os Draconis 15 gm T Third Visit April 4 1977 After taking this prescription her menses cleared on April 1 without any dripping Yet she still feels weak has a poor appetite profuse discharge and a wan yellowish complexion Her pulse was thin and AF her tongue coating was thin Again I fortified her Spleen consolidated and astringed 9 gm Bu Gu Zhi Fructus Psoraleae 9 gm Wei He Zi Roasted Fructus Chebulae 9 gm Xu Duan Tan Radix Dipsacis Carbonistatum 9 gm Gou Ji Tan Rhizoma Cibot Carbonistatum 9 gm Chi Shi Zhi Halloysitum Rubrum 9 gm Chao Gu Ya Stirfried Aristae Germinatis 12 gm D R Jiao Dong Zhu Scorched Rhizoma Atractylodes Macrocephalae Huai Mi Tan Flos Sophora Carbonistatum 30 gm Duan Long Gu Calcined Os Draconis 30 gm Duan Mu Li Calcined Concha Ostrea 30 gm Bai Ji Mo Rhizoma Bletilla tips 4 5gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 98 After this before her menses I treated her by coursing her Liver fortifying her Spleen dispelling coagulation and generating the new During or after menses I used the method of fortifying her Spleen consolidating and astringing I continued this protocol for more than three months and her menstruation was restored to normal Editorial Comments This example of menstruation dripping without ceasing T in TCM is Beng Luo syndrome The main cause of the problem was the two artificial abortions during which the Chong and Ren Mai were damaged and Qi and Blood were lost in the process The clinical manifestations were AF menstrual dripping accompanied by low back soreness dizziness pasty stool chest and abdominal distention and pain a wiry fine pulse and purple infused tongue The Spleen takes charge of movement and transformation and it rules the gathering of Blood into the interconnected system of vessels Because of this when there is menstrual dripping without stopping this is the result of R Spleen vacuity and the Spleen loosing its power to gather the Blood In addition to the symptom of menstrual dripping other signs of this are dizziness and pasty stool D The Liver rules coursing and releasing This patient s symptoms of chest and abdominal distention and pain and the wiry thin pulse are all symptoms of Liver Qi Depression and knotting and the Qi mechanism not flowing smoothly Lower back soreness is a result of Kidney vacuity The tongue being infused with purple is a sign of the congealed Blood The crux of the treatment plan and method lies in full control over the use of the two dissimilar treatment principles stopping bleeding and dispelling stasis If the practitioner doesn t stop bleeding when she should or

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum stops bleeding when she shouldn t either way this will be a mistaken 99 treatment and certainly will make the patient s disease worse In view of the patient s Spleen vacuity and Liver Depression congealed Blood and inner stagnation premenstrually one should fortify Spleen and course the Liver along with Invigorating the Blood and dispelling stasis I used the formula Xiao Yao San Relaxed Wanderer Powder in order to synchronize and harmonize the Spleen and Liver as well as such herbs as Pu Huang Pollen Typhae Yi Mu Cao Herba Leonorus Chuan Xiong Rhizoma T Ligusticum and Shan Zha Fructus Crateagea These herbs dispel stasis and generate the new I also added Da Mai Ya Fructus Hordei Geminatus and Bai Ji Li Fructus Tribuli in order to strengthen the coursing of the Liver and AF the resolving of depression effect During or after menstruation it was necessary to bank up and supplement the source Qi while simultaneously consolidating and astringing in order to guard against menstrual dripping Hence it was very important to use Hai Er Shen Radix Pseudostellaria to boost Qi and supplement the Spleen At the same time I used herbs such as Xu Duan Tan Radix Dipsacis Carbonistatum Gou Ji Tan Rhizoma Cibot R Carbonistatum Chi Shi Zhi Halloysitum Rubrum and Bu Gu Zhi Fructus Psoraleae to supplement the Kidney and synchronize the Chong and Ren Mai Furthermore I used Da Ji to consolidate astringe and stop bleeding in D order to prevent the menstrual dripping This kind of treatment method is based upon considerations of the root and branch and the moderate and acute I then adopted the corresponding treatment method This case is a concrete illustration of the distinguishing characteristic of Chinese medicine the identification of patterns and determination of treatment In this example I arrived at the differential diagnosis without error which led me to the appropriate medicinals Nine years of severe illness recovered

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 100 Case 3 Bleeding Due to Blood Stasis and Kidney Deficiency First Visit February 24 1978 Another Ms Wang was age 18 Her menstruation began at age 14 Three years ago she happened to have an incident in which she ran forcefully during her menstruation damaging her Chong and Ren Mai Since then her menstrual fluid has been dripping and T was difficult to exhaust It would stop for two to three days and then flow again The amount was sometimes profuse and sometimes scanty Simultaneously she had lower abdominal pain and distention low back AF soreness poor appetite and poor sleep My examination showed that her pulse was fine and rough the body of her tongue was infused with purple By correlating the pulse and symptoms I determined that this case related to congealed stasis in the Chong and Ren Mai Blood failing to return to the proper channels Her Blood loss was already chronic and her nutritive Yin was damaged from overwork This was a case that was complicated R because of the mixed vacuity and repletion It was first important to move the coagulation and harmonize the Blood I gave her five packages of the following modified version of the two prescriptions Shi Xiao San Powder for D Loss of Smile and Si Wu Tang Soup of Four Things Wu Ling Zhi Feaces Trogopterorum 9 gm Chao Pu Huang Stirfried Pollen Typhae 9 gm Chao Dang Gui Stirfried Radix Angelica Sinensis 9 gm Chao Chi Shao Stirfried Radix Paeoniae Rubra 9 gm Zhi Xiang Fu Prepared Rhizoma Cyperi 9 gm Ze Lan Herba Lycopi 9 gm Chen Ai Ye Herba Artemesia Argyi 2 4 gm Chao Chuan Xiong Stirfried Rhizoma Ligusticum 2 4 gm

Commonly used methods for the treatment of bleeding presentations in gynecology 101 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Shu Di Prepared Radix Rehmanniae 15 gm Chong Wei Zi Semen Leonorus 15 gm Xue Jie Sanguis Draconis 1 2 gm Second Visit February 27 1978 After the herbs her menstruation stopped Her lower abdomen still felt distended and painful and she still experienced low back soreness poor appetite and poor sleep Her pulse and tongue were T the same as before I continued her on four packs of the same formula Third Visit March 6 1978 Ms Wang s menstruation hadn t flowed for ten days already She no longer felt the lower abdominal pain and distention The AF body of her tongue was slightly crimson and the coating was thin and white Her pulse was thin and slow The congealed Blood had already been transformed the Chong and Ren Mai were now synchronized and the low back soreness was less but her condition was still not sufficiently rectified The three Zang Heart Spleen and Kidney were all vacuous The treatment now had to fortify her Spleen in order to reinforce transformation boost the R Kidney in order to synchronize the Chong and Ren Mai and enrich the Heart in order to calm the Zang of the Shen I gave her five packages of the D following prescription Xu Duan Radix Dipsacis 9 gm Fu Shen Poria Pararadicis 9 gm Chao Bian Dou Stirfried Semen Dolichoris 9 gm Hai Shan Yao Rhizoma Diosoreae 9 gm Zhi Ji Nei Jin Prepared Endothelium Cormeum Gieriae Galla 9 gm Zhi Gou Ji Prepared Radix Ciboti 15 gm Sang Ji Sheng Ramulus Loranthus 15 gm Shou Wu Teng Caulus Polygonum Multiflorum Ye Jiao Teng 15 gm

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Zhi Yuan Zhi Prepared Radix Polygolae 4 5 gm 102 Editorial Comments In this example of Blood dripping syndrome the proper focus of the differential diagnosis of syndromes is on the congealed Blood and internal stagnation Because of this the method I used for both the first and second treatment was to invigorate the Blood and transform stagnation In this way I was able to drive out the congealed Blood The healthy Blood was then able to return to the proper channels on its own Three years of a T stubborn illness could then recover This case is a good example of the importance of not simply stopping bleeding when Blood is seen by indiscriminately prescribing of cool cold consolidating or astricting formulas AF In this kind of case it is all the more important to differentiate the pattern D R seek out the cause and determine the treatment on the basis of the cause

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 103 Case 4 Bleeding Due to Qi and Blood Constraint Ms Qian was 25 when she came for her first visit on November 27 1978 Her menses had been coming early every half month for half a year The amount was scanty and after her mense she felt lower abdominal distention and pain Her last mense was November 11 Usually her menstruation was accompanied by back soreness dizziness and stomach duct pain Her T pulse was thin and moderate and her tongue was red and moist I diagnosed her with Kidney vacuity Liver constraint For treatment I coursed the Liver and boosted the Kidney in order to regulate her menses I gave her AF 7 packages of the following formula 9 Zhi Yan Hu Suo 4 5 Wu Wei Zi 2 4 Zhi Shou Wu 9 Bo He 2 4 R Chai Hu 9 Tu Si Zi 9 Da Shu Di 30 D Gou Qi Zi Chao Chuan Lian Zi 2 4 Zhi Xiang Fu 9 Qing Pi 15

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 104 Second Visit February 28 1978 After the herbs Ms Qian s menses became regular She still had premenstrual chest distention and dizziness caused by Liver constraint and Qi stasis I again gave her herbs to course the Liver and regulate menses I 9 Ju He 4 5 Ju Luo 4 5 Chao Bai Shao 9 Zhen Zhu Mu 30 Da Mai Ya 9 Bai Ji Li 9 AF Chai Hu T gave her 7 packages of Ji Mai San with modifications 15 each Chao Chuan Xiong 2 4 R Sheng Shu Di Huang Third Visit July 7 1979 D After the second visit her menses continued to be regular She was 3 months pregnant She felt dizziness palpitations and decreased appetite Her pulse was thin and slippery and her tongue was pale red For treatment I regulated and harmonized the Liver and Stomach rectify the Qi and calm the fetus I gave her 5 packages of the following formula Tai Zi Shen 15 Chao Bai Shao 9 Dan Zhu Ye 9

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chao Gu Ya 12 Huo Xiang 4 5 Sha Ren 1 2 drink as draft Duan Shi Jue Ming 30 Su Geng 3 Zhen Zhu Mu 30 Shai Bai Zhu 9 105 T Discussion The Chong and Ren vessels are subordinate to the Liver and Kidneys so when the Liver and Kidney function lapses it can often give rise to irregular menstruation This example of early menstruation accompanied AF by dizziness and back soreness comes from Kidney vacuity and lack of consolidation of the Chong and Ren vessels In addition the post menstrual lower abdominal distention and pain and occasional stomach duct pain is indicative of Liver constraint and Qi stasis as well as lack of harmony between the Liver and Stomach Therefore the formula to supplement the Kidney and course the Liver had the desired effect At the second visit I R emphasized coursing the Liver and rectifying the Qi using my own experiential formula Ji Mai San modified After this the menses returned to D normal and she became pregnant Case 5 Scanty continuous bleeding with pain Ms Zhang was 46 and married After surgery for a thyroid gland tumor her menses became scanty and dripped without stopping already for 20 days The color was dark and she had lower abdominal acute pain and back soreness Her pulse was wiry and thin and her tongue was pale red and moist I gave her three packages of Zhen Ling Dan with additions and subractions Dang Gui Tan 4 5

Chao Chuan Xiong 2 4 Mu Dan Pi 9 Ru Xiang Mo 4 5 Dai Zhe Shi 12 Wu Ling Zhi 4 5 Zi Shi Ying 15 Qian Cao 9 Guan Mu Xiang 4 5 Yu Yu Liang 9 106 T Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Chao Pu Huang 12 AF Second Visit After the herbs the bleeding had decreased There was only trace bleeding when she urinated The abdominal pain had basically dispersed Her pulse was thin and her tongue was red I continued with the original method to consolidate the treatment Discussion When I treat Beng Lou due to Blood stasis I often use Shi Xiao R San or Zhen Ling Dan modified according to the pattern In this case I used Zhen Ling Dan modified to obtain the results Shi Xiao San is used when the stasis is scanty the menstrual dripping is relatively light and the course of D disease is relatively short Zhen Ling Dan is used is used when there is a lot of stasis and the dripping is more chronic and will not stop The two formulas can also be combined Case 6 Post Abortion Bleeding Ms Cha was 35 After an abortion she had had continuous bleeding for half a month that was sometimes profuse and sometimes light The color ranged from fresh to purple and in recent days the amount was more profuse like menstruation She also had lower abdominal distention and pain thin wiry pulse and a red tongue with scanty moisture This was Blood heat and

Commonly used methods for the treatment of bleeding presentations in gynecology 107 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Blood stasis I used the clear heat and dispel stasis method I gave her three 4 5 Zhi Chun Pi 15 Jing Jie Tan 4 5 Gou Ji Tan 15 Chao Hei Pu Huang 12 Shi Liu Pi 15 Ma Chi Xian 15 Ban Zhi Lian 9 Guan Zhong Tan 12 Xu Duan Tan 15 AF Chao Wu Ling Zhi T packages Second visit After the herbs the bleeding stopped She still felt back soreness poor appetite dizziness and abdominal distention Her pulse was thin and moderate and her tongue moss was thin yellow I changed the method to supplement the Kidneys and fortify the Spleen and assisted by R clearing heat in order to complete the effect Discussion Dispelling stasis method is often combined with other methods D and in this case it was combined with clearing heat method This patient had bleeding after an abortion that would not stop The amount was heavy and the color was dark The tongue body was red with scanty moisture This is post partum yin and Blood depletion The evil heat took advantage of the weakness and entered the Blood chamber In addition there is post partum stasis with lower abdominal pain and distention The stasis and heat mutually contend with each other so I used Shi Xiao San to dispel stasis and vitalize Blood along with Ban Zhi Lian Ma Chi Xian to clear heat and resolve toxin I also added Xu Duan Tan and Gou Ji Tan for ther ability to boost the

Commonly used methods for the treatment of bleeding presentations in gynecology 108 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Kidneys consolidate the Chong and stop bleeding Shi Liu Pi Zhi Chun Pi Guan Zhong and Jing Jie Tan are effective for stopping bleeding With vitalizing the blood was combined opening through while protecting so that for chronic beng and chronic lou pattern it was appropriate Case 7 Lochia failing to stop Ms Wang was 29 and a worker At the correct time she gave birth but the T baby died because of an umbilical cord wrapped around it s neck After more than forty days the lochia had not stopped The amount was not profuse and the color was dark This was accompanied by lower back AF soreness and abdominal distention poor appetite wiry thin pulse pale red tongue body that was infused with purple For treatment I first used dispel stasis and generate the new and clear heat method I gave her three packages of the following formula 6 Chao Pu Huang 12 R Wu Ling Zhi Xiang Fu Tan 9 9 Chao Shan Zha 9 D Ban Zhi Lian Shen Qu 9 Guan Zhong Tan 9 She She Cao 9 Yi Mu Cao 9 Zhi Ji Nei Jin 9 Second Visit After the herbs the bleeding stopped The right side of her lower abdomen still felt a dull pain Her appetite had improved and her two pulses were now thin and moderate Her tongue body was tending to dry I

Commonly used methods for the treatment of bleeding presentations in gynecology 109 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum changed the method to a recuperative one and gave her a modified version of Ba Zhen Tang Discussion In this case the patient s lochia failed to stop due to congealed blood stagnating internally New blood could not return to the channels I used Shi Xiao San with Yi Mu Cao in order to vitalize blood to dispel stasis I combined this with Xiang Fu Tan which courses through the Qi mechanism This goes along with the saying when the Qi moves the Blood moves T When Xiang Fu is carbonized it also restrains and stops bleeding Ban Zhi Lian She She Cao clear heat I often use these herbs for post partum lochia failing to stop This helps avoid post partum infection I used Shan Zha as AF well In addition to fortifying the stomach and dispersing food it also vitalizes blood In higher dosages it is also useful for pubic bone pain Case 8 Early menstration failing to flow Ms Lu was a 25 year old worker Her menstruation arrived early with abdominal pain The color was dark and congealed with stasis clots On R the first day she bled but it did not flow Her pulse was thin and rough and her tongue body was purple Taking these findings altogether I diagnosed her with Qi stasis and congealed Blood The Chong and Ren were irregular D and the pathway of her menstruation was not open through This was causing pain For treatment it was suitable to move Qi and vitalize Blood I gave her 5 packages of the following formula Dang Gui 9 Chao Chuan Xiong 4 5 Guan Mu Xiang 9 Ru xiang 4 5 Mo Yao 4 5 Chuan Lian Zi9

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Zhi Yan Hu Suo 9 Chi Shao 9 Chao Xiao Hui 2 4 Su Mu 9 110 Second visit After the herbs the dysmenorrhea had clearly lightened I advised her to take another 5 packages of the above formula pre T menstrually Discussion Qi stasis and congealed Blood are the primary cause of dysmenorrhea I often use the secret formula I aquired from a master Tiao AF Jing Ding Tong San see page 188 With modifications It is very effective and this case is an example of its use Within the formula Dang Gui Chuan Xiong and Chi Shao vitalizes the Blood and harmonizes the Ying Chuan Lian Zi and Yan Hu Suo regulate Qi and stop pain It is often used for dysmenorrhea and early menstruation Ru Xiang and Mo Yao increase the vitalize Blood and relieve pain effect Mu Xiang Xiao Hui and Su Mu move R Qi and opens through stasis and complies with the saying move the Qi and move the Blood These herbs fit together in a compatible way and are D coordinated with the patho mechanism D Warming the Menses and Stopping Bleeding Dr Qiu Xiao mei writes Though blood heat is a most important cause of bleeding patterns cold in the blood can also give rise to bleeding Qi belongs to Yang and blood belongs to Yin Yin and Yang are in a mutually dependent and close relationship If external Yang damages the Yang or Yang Qi is deficient the

Commonly used methods for the treatment of bleeding presentations in gynecology 111 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Yang cannot consolidate the Yin The blood is then unable to follow the channels and this becomes a bleeding pattern In this type of pattern it is suitable to warm the channels to stop bleeding Usually when we think of the causes of bleeding we think of three causes Heat Qi Deficiency and Blood Stasis Here Dr Qiu seems to add another cause Cold is typically thought of as a quality that slows and stops the blood How is it that cold T can cause bleeding The first thing we can think of is the relationship between the lower warmer Yang and the absorptive function of the Qi Qi can only absorb fluids that have enough AF Yang within them for them to steam up When the fluids are not transformed by Yang they will pour downward Secondly Yang deficiency can cause a condition of cold and blood stasis We R have already seen how blood stasis can cause bleeding Special points for differentiating the pattern The blood color may be watery and clear or dark and purple and it may D contain clots There may be pain in the lower belly that feels cold and responds favorably to warmth The mouth may feel a sense of being tasteless without thirst there may be fear of cold cold limbs pale tongue body with a thin white slippery moss and a slow pulse The key diagnostic sign for differentiating cold is lower abdominal pain that is better with warmth Commonly used formulas and herbs Herbs that can be added to Wen Jing Tang or Li Zhong Tang to stop bleeding

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Ai Ye 112 Ai Ye Tan Xian He Cao Pao Jiang Commonly used Formulas Wen Jing Tang Warm the Menses Decoction Wu Zhu Yu 3 1 2 as draft T Rou Gui Dang Gui 9 Bai Shao Ren Shen Mu Dan Pi Ban Xia 4 5 9 AF Gan Jiang 9 9 9 Mai Men Dong 9 E Jiao 9 R Zhi Gan Cao 3 9 Bai Zhu 9 Gan Jiang 9 Zhi Gan Cao 9 D Li Zhong Wan Ren Shen Case Example Ms Li was a 38 year old worker with profuse menstruation every cycle The color was pale red and contained clots Often she felt lower abdominal pain that liked pressure and warms She dislike cold felt lower back soreness

Commonly used methods for the treatment of bleeding presentations in gynecology 113 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum and had profuse clear watery leucorrhea Her menstruation was about to arrive Her pulse was deep thin and slow and her tongue was pale with a thin white moss Coordinating the pulse and tongue I diagnosed Yang deficiency with cold in the womb and Chong and Ren vessels loosing consolidation For treatment it was suitable to warm the channels and absorb the blood I used modified Wen Jing Tang 9 Rou Gui Wei 1 2 used as a draft Wu Zhu Yu 3 Gan Jiang Tan 4 5 Ai Ye Tan 9 Chao Xiao Hui Xiang 3 Chao Bai Shao 9 Chao Dang Shen 10 Mu Dan Pi 4 5 Chao Mai Dong 10 Zhi Gan Cao 4 5 AF T Dang Gui R 5 packages Second visit Her menstruation had been flowing for three days The D amount was less compared to the past and the lower abdominal pain also decreased Her tongue was as before I continued with the same method giving her 3 packages of the same formula Third visit Her menstruation had stopped so I gave her Jin Gui Shen Qi Wan modified Shu Di Huang 12 Fu Ling 9 Shan Zhu Rou 9

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Jiao Shan Yao 12 Mu Dan Pi 6 Ze Xie 6 Rou Gui Wei 1 2 give as a draft Dan Fu Zi 4 5 Yin Yang Huo 6 Tu Si Zi 12 114 T 5 packages Discussion Wen Jing Tang warms the channels and disperses cold It also has the function of supplementing Yang and harmonizing Yin and is an AF ancient formula for regulating the menstruation In the case the menstruation was profuse and the color was pale She had lower abdominal pain that liked pressure she feared cold her pulse was thin deep and slow and her tongue was pale This was Yang deficiency and cold womb so I used Wen Jing Tang modified in order to warm the channels scatter cold and thereby regulate the menstruation After the menstruation finished I R used the Shen Qi Wan method to warm the kidneys and boost the Chong and Ren and also to treat the root Summary The disease causes and pathological mechanisms of blood patterns in D gynecology or complex Because of this the above mentioned categories of types and treatments are interrelated and should be applied in a mixed fashion when needed One cannot see bleeding and simply stop bleeding One should first determine the cause of the bleeding and treat according to the pattern E Jue Yin Bleeding Contained within Jue Yin is the middle Qi of the Shao Yang ministerial fire Jue Yin is the unity of wind and ministerial fire It is the fanning force behind the

Commonly used methods for the treatment of bleeding presentations in gynecology 115 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum circulation of ministerial fire in the hollow yang realm as well as the warm rising of blood within the solid yin realm of the body Jue Yin contains and steers the blood which it spreads freely in all four directions up down in and out The driving force behind this distribution of blood is the moving warm qi contained within the blood or in other words the Shao Yang Jue Yin is born from water and gives birth to fire As such it is the bridge between water and fire and the eastern pathway through which rising water of the north communicates and connects with descending fire of the south The Yin segment of T the Jue Yin tract belongs to the Liver which stores and moves the blood The yang segment of the Jue Yin tract belongs to the pericardium Jue Yin is the resolution of Yin the death of Yin As such it is the precursor to the AF birth of yang just as on a material level blood is the mother of qi Yang is born from the water within the earth at the midnight time as represented by the hexagram fu recovery Jue Yin wood fans the birth of this initially lesser fire allowing it to increasingly warm and ascend the steaming boiling fluids of the northern water element This is the end of night until the break of dawn during which time yang rises from within R the water upwards through the earth to arise from the horizon and form the yang D conformations Of all the Yin conformations Jue Yin thus holds the most yang and least yin and its overall direction is upward and outward When the Jue Yin closes too much or too prematurely yang is not born due to absence of resolution of the Yin stage This results in blood remaining too cold and

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum too stagnant unable to rise and float and failing to warm and nourish the 116 extremities and the surface such as in Dang Gui Si Ni Tang 5 Commonly used Formulas Wu Mei Wan 480 24 30 Hua Jiao 120 1 5 3 Xi Xin 180 Huang Lian 480 Gan Jiang Zhi Fu Zi 9 12 180 6 9 300 6 9 180 3 6 180 3 6 R Gui Zhi 1 5 3 AF Huang Bai T Wu Mei Ren Shen 180 6 9 Dang Gui 120 3 9 D Steep the Wu Mei in vinegar overnight pit and mash and cook with rice until the rice is done Add the remaining ingredients grind into powder and add refined honey to form into small pills the size of a parasol tree seed Take 10 pills three time before meals Special points for differentiating the pattern Diarrhea or constipation Cold extremities 5 Arnaud Versluys from The Lantern

Commonly used methods for the treatment of bleeding presentations in gynecology 117 Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Upward surging of qi vomiting headache anxiety dry retch anorexia throat obstruction insomnia Abdominal pain Deep pulse Case Example One Ms Wen was a 24 year old Cadre She came in for her first visit on September 15 T 1989 She still had bleeding one month after an abortion There was dripping without stop Gynecology check up Her uterus had returned to a normal size with no obvious AF pathology She was given medicinals such as Yi Mu Wan progesterone Zhen Zhu Mu muscular injection p aminomethyl beozoic acid antifibrinolytic with no obvious effect The bleeding still came and went It increased markedly in the last 3 days and included blood clots She also had strong abdominal pain that resisted touch This was accompanied by paroxysmal heart palpitations agitation dry retching with an inability to take food dizziness cold limbs pale tongue with thin R yellow moss and a deep thin pulse Ms Wen was a 24 year old Cadre She came in for her first visit on September 15 1989 She still had bleeding one month after an abortion There was dripping D without stop Gynecology check up Her uterus had returned to a normal size with no obvious pathology She was given medicinals such as Yi Mu Wan progesterone Zhen Zhu Mu muscular injection p aminomethyl beozoic acid antifibrinolytic with no obvious effect The bleeding still came and went It increased markedly in the last 3 days and included blood clots She also had strong abdominal pain that resisted touch This was accompanied by paroxysmal heart palpitations agitation dry retching with an inability to take food dizziness cold limbs pale tongue with thin yellow moss and a deep thin pulse

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum 15 Dang Shen 15 Dang Gui 6 Pao Jiang 6 Chuan Huang Lian 9 T Wu Mei Tan Xi Xin 3 Chuan Jiao Fu Zi 3 AF Huang Bai Tan Gui Zhi 118 2 5 5 R After the herbs the menstrual bleeding decreased All of the other pathology also decreased Her spirit improved I continued to use the above formula removing the Chuan Jiao and changing the Chuan Huang Lian to 3 grams I added 15 grams of both vinegar fried Bai Shao and vinegar fried Lu Xian Cao and gave her 3 more D packages After this all the bleeding stopped and the other symptoms cleared Discussion Wu Mei Wan is used when there is combined cold and heat It returns the correct and dispels the evil It has the function of harmonizing Yin and Yang In this case there was spleen and kidney yang deficiency with cold and heat mixed With Wu Mei Wan the Yin and Yang join and Water and Fire mutually flow into each other The kindled fire returns to its source Wu Mei Wan warms without drying It cools without damaging the Yang This is how it regulates the Chong and Ren vessels It warms below and clears above returns the correct and dispels the evil It does not stop bleeding but the bleeding stops by itself

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Case Example Two 119 Ms Li was 41 and had been bleeding irregularly for the past 2 years Sometimes her bleeding was long and sometimes short sometimes heavy and sometimes light The gynecology exam revealed functional uterine bleeding Treatment has been ineffective This month the bleeding had not stopped for half a month The past two days had been heavy with clots She also had dizziness flowery vision poor appetite and a weary spirit She had a bitter taste in the mouth agitation back and T leg soreness and pain with aversion to cold Her tongue was pale with thin yellow moss Her pulse was wiry thin and rapid This presentation was the Qi mechanism running contrary with damage to the Chong and Ren vessels The Qi AF and blood lost their harmony and cold and heat were mixed I used pungent to open and bitter to descend in order to settle the source I used sour to gather in and astringe in order to staunch the flow I also supplemented the Qi and blood in order to return what had been I gave 5 packages of the following formula and the bleeding clearly decreased Wu Mei 5 R Hua Jiao 20 5 Hei Jiang 6 D Xi Xin Rou Gui 6 Dang Shen 12 Bai Shao 12 Zhi Fu Pian 10 Huang Bai 10

Commonly used methods for the treatment of bleeding presentations in gynecology Based on the writings of Dr Qiu Xiao mei Translation and commentary by Sharon Weizenbaum Huang Lian 9 120 I gave her another 4 packages and the bleeding stopped and all the other symptoms D R AF T cleared as well A follow up a half year later showed there had been no relapse

Lack of Bleeding 1 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Considerations 2 A To become pregnant one must first regulate the menses 2 B Illnesses 2 D R AF T Differentiation and Methods 2 Qi and Blood deficiency determent type 3 Patho mechanisms 3 Special Points for Differentiation 4 Commonly Used Herbs and Formulas 4 Qiu Xiao mei s cases 6 Case example 1 6 Case Example Two 7 Case Example Four 9 Chong and Ren insufficiency 11 Patho mechanisms 11 The Kidneys Store the Jing and Govern Growth Development and Reproduction 12 Special Points for Differentiation 13 Commonly Used Herbs and Formulas 13 Gui Xian Tang Cinnamon Immortal Decoction Dr Qiu s experiential formula 13 Dr Qiu Xiao mei s cases 15 Case 1 15 Case 2 16 Case 3 19 Yin Deficiency Inner Heat type 21 Patho mechanisms 21 Special Points for Differentiation 22 Commonly Used Herbs and Formulas 22 Dr Qiu Xiao mei s cases 23 Case 1 23 Qi Stasis and Blood Congealed type 25 Patho mechanisms 25 Special Points for Differentiation 25 Commonly Used Herbs and Formulas 26 Qi Stasis 26 Ji Mai San 26 Blood Stasis 29 Tong Jing Wan 30 Dr Xia Gui Cheng writes 31 1 Wu Wei Tiao Jing San Five Flavor Regulate the Menstruation Powder 32 2 Jia Jian Tong Yu Jian Modified Open Through Stasis Decoction 38 3 Xin Jia Cu Jing Tang Newly Modified Promote the Menses Decoction 42 4 Yi Shen Tong Jing Tang Boost the Qi and Open the Menses Decoction 43 5 Jin Tui Wen Jing Tang Advance and Retreat Warm the Menses Decoction 47 6 Xin Jia Xue Fu Zhu Yu Tang 49 7 Zeng Sun Shao Fu Zhu Yu Tang 51 8 Qing Re Xie Jing Tang Clear Heat Discharge the Menses Decoction 52 Dr Qiu Xiao mei s cases 55 Case 1 55 Case 2 Ji Mai San and Gui Xian Tang 56 Case 3 Ji Mai San 57

Lack of Bleeding 2 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Dr Xia s cases 59 Case 4 59 Wind Cold congealing and knotting 60 Patho mechanisms 60 Special Points for Differentiation 60 Commonly Used Herbs and Formulas 60 Dr Qiu Xiao mei s cases 61 Case 1 61 T Jue Yin Bleeding 62 Commonly used Formulas 63 Special points for differentiating the pattern 64 Case Example 64 Considerations AF A To become pregnant one must first regulate the menses Dr Qiu Xiao mei writes There is a close relationship between amenorrhea and infertility In regard to the R treatment of amenorrhea giving rise to infertility regulating the menstruation should be the priority When the menses are regulated then the woman will be able to become pregnant D B Illnesses Lack of bleeding is not bleeding when one should This can be late menstruation scanty menstruation or amenorrhea Differentiation and Methods Dr Qiu Xiao mei writes Amenorrhea is commonly seen in the gynecology clinic Here I have shown how to recognize and work with the differential diagnosis and treatment of this illness

Lack of Bleeding 3 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Differential diagnosis to determine treatment On the basis of my own clinical practice I have divided the various types of amenorrhea into the following 5 types Qi and Blood deficiency detriment Qi stasis and Blood congealed insufficiency of the Chong and Ren Yin deficiency with inner Qi and Blood deficiency determent type Patho mechanisms AF Dr Qiu Xiao mei writes T heat and wind cold accumulating and knotting This is mostly due to Spleen deficiency with a loss of movement in the digestion which causes the source of transformation to be insufficient This deficiency can also be caused by chronic illness in which the Qi and Blood become depleted This can also come about because of miscarriage abortion or many pregnancies in which there is blood loss and the inner Yin becomes depleted R There is not just one contributing factor to amenorrhea and so the treatment methods also vary Clinically Qi and Blood depletion is the most common type The cause is usually that the Spleen and Stomach are vacuous and weak source of transformation is insufficient The Spleen and Stomach are the root of post heaven D and are the source of generation of transformation and generation of the Qi and Blood If the Spleen and Stomach are damaged internally the Zang Fu loose their nourishment and externally the skin and muscles loose their fullness This is how it is for women with Chong Ren loosing regulation and empty sea of blood amenorrhea Therefore in treating amenorrhea regulating the Spleen and Stomach if a very important method Not only is this method important for women who have Qi and Blood depletion it is also important to add herbs to regulate the Spleen and Stomach for other types of amenorrhea If the patient has Yin deficiency with inner

Lack of Bleeding 4 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum heat type I often add Chen Pi Shan Zha Shen Qu and Ji Nei Jin This allows supplementation without causing stasis and enrichment of Yin without upsetting the Stomach This is especially true in the aftermath of treatment I often use Liu Jun Zi Tang or Gui Pi Tang to regulate and thereby consolidate the treatment Special Points for Differentiation T Dr Qiu Xiao mei writes The facial complexion becomes sallow or yellowed and the spirit is tired and weak There may be dizziness and heart palpitations poor appetite and sticky stool chilled AF four limbs Previous menses were late or scanty and of pale color Amenorrhea came on gradually The pulse may be thin and soft and the tongue pale red Commonly Used Herbs and Formulas Dr Qiu Xiao mei writes Treatment should fortify the Spleen and boost the Stomach supplement and nourish R the Qi and Blood Formula Gui Pi Tang or Ba Zhen Tang with additions and subtractions D Sharon s commentary Here Dr Qiu recommends Gui Pi Tang or Ba Zhen Tang but in the clinic Dr Qiu and other doctors rarely use these formulas as they are except to consolidate the effect of what they have already accomplished Yet the basic ideas of these formulas are used Based on the actual clinical methods used by Dr Qiu and other doctors below are some points to consider when prescribing for Qi and Blood deficiency amenorrhea 1 Check the patient s appetite Because the stomach and spleen are the source of transformation of food and fluids

Lack of Bleeding 5 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum into blood if the appetite is poor then the production of blood will be poor Dr Qiu will often add herbs such as Mai Ya Shen Qu Ji Nei Jin and Shan Zha to formulas to awaken the stomach and improve the appetite 2 Treat the root of the Wood Blood which is the Water Kidney The idea behind Ba Zhen Tang is to treat the Spleen Qi in order to promote blood production It includes a combination of Si Wu Tang and Si Jun Zi Tang to do this In the case of amenorrhea though there is a relationship to the Chong and Ren T which are connected to the Kidneys Because of this often herbs to nourish the blood that also enrich the Yin of the Kidneys are also used These are herbs such as Gou Qi Zi Shan Zhu Yu Nu Zhen Zi and Tu Si Zi In addition Huang Qi is often AF used to promote blood production Dr Qui Xiao mei writes Scanty Menstruation amenorrhea or late menstruation is often due to insufficiency of pre heaven Kidney Qi excessive childhood illnesses insufficiency of Tian Gui excessive births and long labors Kidney Yin R depletion and damage or emptiness of the sea of blood Just as the Yi Xue Zheng Zhuan Primary Themes of Medicine says Menstruation completely relies on the transformation of Kidney water When the Kidney water is already lacking the menstrual blood daily becomes more desiccated D Delayed menstruation scanty menstruation and in the extreme amenorrhea with no movement may be accompanied by dizziness back soreness and lack of strength in the limbs When Kidney Yin is insufficient there may be dry mouth or throat vexatious heat of the five hearts and emaciation of the body form The tongue will be crimson with scanty moss The pulse may be thin rapid and without strength The principle treatment will be to supplement the Kidneys boost the Jing If the Kidney Yang is insufficient it is appropriate to use Gui Xian Tang Return

Lack of Bleeding 6 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum the Immortals Decoction see page 187 or You Gui Yin Return the Right Drink If the Kidney Yin is insufficient it is appropriate to use Gui Shao Di Huang Tang Angelica Peony Reuhmannia Decoction or Da Bu Yin Wan Great Supplement the Yin Pill 3 Improve the quality of the blood as you enrich it T Si Wu Tang not only nourishes the blood it also harmonizes the blood This is another way of saying that Si Wu Tang improves the quality of the blood Dr Qiu and other doctors often augment this effect by using other herbs to improve the AF quality of the blood such as Dan Shen and Ji Xue Teng Qiu Xiao mei s cases Case example 1 Dr Qiu Xiao mei writes Ms Xu was 35 years old The date of her first visit was 5 28 1964 She had R amenorrhea for three months Her facial color was sallow white her spirit was tired without strength her body was emaciated and her appetite was poor She also complained of dizziness palpitations and back soreness This D illness came in 1962 after a miscarriage Her pulse was thin and weak and her tongue was pale red with a thin white moss Her diagnosis was Qi and Blood deficiency depletion For treatment it was important to supplement Qi and nourish Blood I gave her more than 40 packages of the following prescription modified according to her presentation Zhi Huang Qi 12 Dan Shen 12 Ji Xue Teng 12

Lack of Bleeding 7 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Chao Dang Gui 9 Chao Dang Shen 9 Chao Bai Shao 9 Zhi Ji Nei Jin 9 Chao Chuan Xiong 2 4 T She got her menses on 8 23 which lasted 3 days The blood was still dark After this I gave her Dang Gui Bu Xue Wan and Xiang Sha Liu Jun Zi Wan in AF order to regulate and rectify Discussion This example of amenorrhea after a miscarriage when taken together with the clinical picture is clearly a manifestation of Qi and Blood depletion I used Dang Shen and Huang Qi to fortify the Spleen and Boost the Qi I used Dang Gui Bai Shao Dan Shen Chuan Xiong and Ji Xue Teng in order to nourish the Blood and regulate the menses I used Ji Nei Jin as an R assistant in order to wake up the Stomach and make the Spleen happy After these herbs I continued by using Dang Gui Bu Xue Wan and Xiang Sha Liu Jun Zi Wan in order to regulate the Qi and Blood This generates the source D of transformation and addresses the root Case Example Two Ms Yang was 18 years old when she came for her first visit on September 5 1979 She had had amenorrhea for three years back soreness and leg and knee weakness aversion and fear of cold dizziness and tinnitus Her body was corpulent and she had not abdominal pain Her pulse was thin and her tongue was pale and wet with thin moss This was Kidney Yang insufficiency with emptiness in the sea of blood with the result of amenorrhea For treatment it was appropriate to warm the Kidney fill the Jing so as to nourish

Lack of Bleeding 8 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum the Chong and Ren I gave her 7 packages of Gui Xian Tang Cinnamon 15 Rou Gui 3 pwd Hu Lu Ba 9 Chao Chuan Xiong 2 4 Tian Cong Rong 9 Xian Ling Pi 15 Lu Jiao Pian 9 She Chuang Zi 4 5 Ba Ji Tian 9 Xian Mao 9 Chao Dang Gui 9 AF Zi Shi Ying T Immortals Decoction with added flavors Second visit September 19 1979 Ms Yang s back pain had recovered Her legs and knees were as before though her fear of cold was not as R extreme There was no menstruation and her tongue and pulse were as before I continued with the same method and gave her 7 packages of the following formula D Zi Shi Ying 15 Rou Gui 1 2 pwd Chi Shao Yao 9 Yi Mu Cao 9 Zhi Xiang Fu 9 Xian Ling Pi 15 Lu Jiao Pian 9 She Chuang Zi 4 5 Ba Ji Tian 9

Lack of Bleeding 9 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Xian Mao 9 Chao Dang Gui 9 Third visit September 26 1979 After taking the herbs to warm the Kidneys and fill the Jing on the 22nd of September Ms Yang menstruated The amount and color was normal Her pulse was thin and the tongue had become red and moist I gave the 10 packages of original formula without 15 Dan Shen 15 Ai Ye 4 5 AF Shu Di Huang T the Yi Mu Cao Yan Hu Suo and Chi Shao Yao I added Discussion The Two vessels Chong and Ren and the Kidney are closely related This patient presentation consisted of lower back and spine soreness leg and knee weakness fear and aversion to cold and three years of amenorrhea Her pulse was thin and her tongue was pale and moist This R obviously related to Kidney Yang insufficiency in which the Jing did not engender the blood This caused the source of menstruation to be deficient and damaged which resulted in amenorrhea I gave her Gui Xian Tang Return the Immortals Decoction to warm her Kidneys and fill the Jing and D thereby make the Kidney Qi exuberant and the Chong and Ren vessels flowing through The Jing and Blood gradually filled and the menstruation arrived Case Example Four Ms Li was thirty two and her main complaint was infertility after thirteen years of marriage This was connected to the fact that her physique was

Lack of Bleeding 10 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum weak She often suffered from dizziness and palpitations Her urination was viscous Because of her weariness she craved sleep Check up Ms Li s body was emaciated and her menstruation was late most of the time and scanty with a pale color Her facial complexion was dull yellow Her pulse was soggy and thin and her tongue body was pale red Treatment Method For treatment I used the principle of fortifying the Spleen supplementing the Qi and nourishing the Blood and gave her Yang Jing T Zhong Yu Tang Nourish the Jing to Breed Jade Soup as the principle prescription Prepared Radix Rehmannia AF Da Shu Di 30 gm Shan Zhu Yu Fructus Cornus 15 gm Chao Dang Gui Stir fried Radix Angelica Sinensis 15 gm Chao Bai Shao Stir fried Radix Peony Alba 15 gm Huang Qi Radix Astragalus Bai Zhu Rhizoma Atractylodes Macro Plastron Testudinus R Gui Ban Radix Codonopsis E Jiao Gelatinum Asini Lu Jiao Jiao Corii Gelatinum Cornu Cervi D Dang Shen I modified the above prescription according to Ms Guo s signs and symptoms She took one package every other day for over a half year and her menstruation became regular the amount and color normal her appetite increased and in May of the next year she became pregnant Discussion Blood is the root of women and absorbing Jing and being pregnant depends on the nourishment and abundance of Blood In this example the patient had a weak body and Blood loss had damaged her Ying

Lack of Bleeding 11 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Simultaneously her Spleen and Stomach were vacuous and weak The source of transformation was not abundant and this caused the Chong and Ren Mai to be empty and vacuous Her uterine vessels did not receive nourishment and she was unable to absorb Jing and become pregnant The prescription Yang Jing Zhong Yu Tan Nourish the Jing to Breed Jade Soup is from Fu Qing Zhu s gynecology writings on seeds is not only for supplementing the Blood but is also for replenishing the Jing In addition the characteristic of E T Jiao Gui Ban Lu Jiao Jiao is like flesh and Blood and they have the function of boosting the Qi and nourishing the Blood These additions are made to produce the entire effect Patho mechanisms AF Chong and Ren insufficiency The causes of Chong and Ren becoming depleted may be congenital Kidney insufficiency many illnesses in childhood exhausting long labor or many pregnancies The sea of Blood becomes empty and vacuous and the menses do not R arrive on time The Kidney has an important place among the 5 Zang in that it is the root of the pre heaven qi The principle functions of the Kidneys are to store the Jing govern water govern the bones generate marrow and open through to the brain The D Kidneys also grasp the qi open into the orifice of the ears and has a close relationship with the two Yin reproduction growth development aging and the regulation of fluids The two vessels of the Chong and Ren are subordinate to the Liver and Kidneys In addition the Chong is the sea of blood and the Ren governs the fetus Because of these two things the Kidneys affects menstruation pregnancy birthing and development in women The Kidneys consequently have a particularly important meaning in women s physiology and pathology Treatment for gynecological issues is often related to the Kidney s The application of the theory of the Kidneys in gynecology is illustrated in the examples below

Lack of Bleeding 12 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum The Kidneys Store the Jing and Govern Growth Development and Reproduction The Kidneys store the Jing are the root of the Chong and Ren and govern growth development and reproduction There are two meanings to the Kidney s storing the Jing 1 The five Zang and six Fu store the Jing Qi This Jing Qi originates from the essential aspect of the food and drink The minute essence of the digestive products is distributed to the five Zang and six Fu and what is left over T descends and is stored in the Kidneys As the Nei Jing says The Kidneys receive and store the essence of the five Zang and six Fu This is the fundamental substance of the activity of human life AF 2 It is by way Kidneys and Tian Gui function that the Jing is generated This is fundamental substance of birth and reproduction in the human body Man and woman combine their Jing Qi and this is called the Jing of reproduction This part is the Jing of generation and development The Kidneys are responsible for storing and discharging the Jing The Nei Jing says At 7 years the woman s Kidney Qi is abundant the teeth develop At R 7 times 2 years the Tian Gui arrives the Great Chong vessel is abundant and the Ren vessel opens through The monthly event descends and therefore there is a seed At three time 7 years the Kidney Qi evens out the true teeth have developed to their full extent At 6 times 7 years the three Yin vessels D decline and descend the surface is burnt and the hair is all white At 7 times 7 years the Ren vessel is empty and the Great Chong has waned The Tian Gui has put forth its full effort and the way of earth has closed Therefore the form declines and there is no longer a seed This all points to the decisive role of the rise and decline of the Kidney Zang s Jing Qi in growth development and decline as well as in reproductive ability of the human body In addition our predecessors considered the Jing the governor of the blood and that the Jing and blood come from the same source Because of this we can see

Lack of Bleeding 13 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum that the Kidney Jing has an important influence in the production of blood The foundation of women is blood Menstruation pregnancy birth and development all depend on the blood Therefore there is a close relationship between the abundance of Kidney Jing and women s physiology and pathology Special Points for Differentiation T Principle presentation The facial complexion may be sallow white or dusky and dark She may feel cold and be timid of cold Her lower back and spine may be sore She may feel dizzy and have ear ringing Her tongue will be pale white and AF her pulse deep and thin or thin and weak Commonly Used Herbs and Formulas Treatment should warm and supplement the Kidney Yang and regulate and nourish the Chong and Ren The formula to use is You Gui Wan or Modified Gui Xian Tang R Gui Xian Tang Cinnamon Immortal Decoction Dr Qiu s experiential formula Yin Yang Huo 15 9 Rou Gui 1 5 stirred into hot liquid Cong Rong 9 Ba Ji Tian 9 Zi Shi Ying 15 D Xian Mao Decoct in Water Function Warm the Yang warm the womb fill the Jing and boost the Kidneys

Lack of Bleeding 14 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Principle indications Kidney Yang insufficiency amenorrhea due to vacuity cold in AF T the uterus infertility Formula explanation The Chong is the sea of blood and the Ren envelops the Fetus When the sea of blood in empty and the uterine envelope suffers from deficiency cold just like when the earth is frozen cold the grasses and trees cannot grow and the abyss of the deep Yin cannot give life to fishes and dragons in this way how can the uterus give birth to life This can cause infertility or amenorrhea R Yin Yang Huo Xian Mao Ba Ji Tian Rou Gui Cong Rong and Zi Shi Ying warm the Kidney and the Heart When the Heart and Kidney Qi are flourishing fire is spontaneously generated and the ministerial fire is filled the Chong and Ren vessels become abundant the uterus is then warmed and the Bao Tai cold is spontaneously D scattered This causes the alchemical transformation like the qi of the warm spring days and the menstruation becomes pregnancy When the Liver is depressed and qi is stagnant add Xiang Fu Xiao Hui Yan Hu Suo and Mu Xiang If the blood is deficient add Dang Gui and Dan Shen If there is Kidney deficiency add Gou Ji Xu Duan and Tu Si Zi Clinical application See the medical discussion on amenorrhea due to Chong and Ren insufficiency with the case study page 55

Lack of Bleeding 15 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum T Dr Qiu Xiao mei s cases Case 1 AF Ms Yu was 38 years old when she came for her first visit on June 13 1973 She had not had a period for half a year She also experienced dizziness low back soreness and lack of warmth in her four limbs Her pulses were thin and weak and the moss on her tongue as thin white and slippery She was diagnosed as Chong and Ren insufficiency amenorrhea Treatment should supplement the Kidney and R warm the uterus I gave her the following formula 9 Xian Mao 9 Dang Gui 9 D Xian Ling Pi Cong Rong 9 Ba Ji Tian 9 Chao Chi Shao 9 Zi Shi Ying 30 Rou Gui Wei 1 2 powder Chao Chuan Xiong 2 4 He Che Da Zao Wan 12

Lack of Bleeding 16 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum I gave her this formula modified according to the presentation for 15 days She menstruated on July 1 I gave her modified Gui Xian Tang to consolidate the effect Discussion Gui Xian Tang warm and supplements the Kidney Yang It builds up the function of the Chong and Ren It often obtains very good results for Chong and Ren deficiency cold amenorrhea Gui Xian Tang also gives good results for modern medical ovarian dysfunction giving rise to amenorrhea T Case 2 Ms Wang was 31 when she came to my clinic on June 20 1979 On December 3 AF 1977 she had given birth at full term At that time she did not bleed too much but on the 28th day after the birth she abruptly bled profusely She went to the emergency room of another hospital for a dilation and curettage during which they scraped out a piece of placenta After this the bleeding stopped At the time there was no shock abdominal pain or fever and she was not given a blood transfusion In November of 1978 she weaned her baby but up to the time of this visit she had R not menstruated The western physician suspected Sheehan s syndrome The gynecological exam showed that her vagina and genitals were normal and that her cervix had a slight degree of inflammation Her uterus was ante verted and D slightly small The adenexis were normal Ms Wang underwent one cycle of artificially controlling her menstruation with western drugs but she still did not menstruate Her spirit was weak she feared cold had back soreness and her lower limbs felt cold Her appetite was adequate Her pulse was thin and weak and her tongue was pale Coordinating the pulse with the signs and symptoms I determined that her Kidney Jing was damaged and that her Jing did not generate her blood The source of transformation of the menstrual water was insufficient The Chong and Ren Mai were feeble This was the cause of

Lack of Bleeding 17 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum the amenorrhea For treatment it was important to warm the Kidney to supplement the Jing in order to nourish the Ying and Blood I gave her the following formula Lu Jiao Pian 9 Zi Shi Ying 15 Rou Gui Wei 9 given as a draft Chao Chuan Xiong 2 4 15 Chao Dang Gui 15 Zhi Xiang Fu 9 E Jiao 15 dissolved and stirred in Ji Xue Teng Chen Ai Ye AF Xian Mao T Xian Ling Pi 9 30 4 5 Second visit Ms Wang reported that she continuously took more than 20 packages R of herbs On July 15 she menstruated a small amount and the color was crimson She finished in one day Accompanying her menstruation she felt lower abdominal distention and pain and low back soreness and discomfort I continued her on the D same prescription Third visit After taking more than 30 packages of the formula modified according to the pattern Ms Wang menstruated in August and in September The number of days increased to 5 and the amount was relatively profuse The color was dark purple The amount had clearly increased While taking the Chinese herbs she took no western medicines Her pulse was thin the tongue moss was thin white and the body of the tongue was red and moist In order to guard against relapse I gave her the following formula

Lack of Bleeding 18 9 Xian Ling Pi 15 Xian Mao 9 Zi Shi Ying 15 Dan Shen 30 Zhi Xiang Fu 9 Chen Ai Ye 4 5 Chao Dang Gui 15 Rou Gui Wei 9 as a draft Chen E Jiao 15 AF Lu Jiao Pian T Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum After this her menstruation returned to normal Discussion In this case the cause was hemorrhage after childbirth At the same time the mother was nursing and breast milk is transformed blood Because the Qi and blood were significantly weak the Kidney Qi was depleted and the Chong and R Ren vessels were feeble after half a year of continuous breast feeding the menstrual water could not flow as before The Chong and Ren vessels are subordinate to the Liver and Kidney and the Kidneys store the Jing Blood is transformed from the Jing Because of all this when the Chong and Ren vessels are insufficient the see of D blood is empty and weak The real effect is that the Kidney Jing is damaged For treatment one must treat the root I used my formula Jia Wei Gui Xian Tang modified return the immortal decoction as the main formula I added Lu Jiao Pian which takes the place of Lu Jiao Jiao and Chen E Jiao These herbs have the characteristic of blood and flesh enter the Liver and nourish the blood enter the Kidney and enrich the Jing These two herb are used together take care of Yin and Yang and make the Kidney Qi abundant so the Jing is able to transform the blood Then the Chong and Ren are nourished and the sea of blood is plentiful With all of this the menstruation comes on time by itself

Lack of Bleeding 19 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Case 3 Ms Huang was 28 when she came for her first visit in January of 1970 She had not menstruated for 5 years On September 15 1965 she had given birth at full term and afterward she hemorrhaged and went into shock After this she had no breast milk Her head pubic and underarm hair all gradually fell out Her sexual desire and vaginal secretions decreased Her face color was sallow her appetite decreased and her spirit was weary She also experienced low back soreness fear of T cold lower limb coldness and forgetfulness Her blood pressure was 100 55 Her pulse was deep thin and without strength Her tongue was pale red During the gynecology exam I checked her external genitals menstruation and birth canal The AF cervical opening was small but glossy and her uterus was ante verted and slightly small and hard but with normal movement The adenexa were normal and the vaginal cytology showed that the hormone levels were slightly low She was diagnosed with Sheehan s syndrome Her Chinese medical diagnosis was postpartum Qi and Blood depletion and Kidney Qi insufficiency For treatment I used my experiential formula Yang Xue Bu Shen Zhu Yang Yin Nourish the Blood R Supplement the Kidney and Benefit the Yang Drink to take before sleep 12 Dan Shen 15 Bai Shao 9 Shu Di 30 Tu Si Zi 9 Rou Cong Rong 9 Ba Ji Tian 9 D Dang Gui Yin Yang Huo 12 Xian Mao 9 Lu Jiao Jiao 6 Chen E Jiao 12

Lack of Bleeding 20 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum The two jiaos are to be dissolved in hot water and added to the drink Zi He Che 3 powdered and added as a draft Second visit Ms Huang took 1 packages of the above herbs She noticed that her appetite had increased and that she felt emotionally better Her pulse and tongue were as before I continued with the original formula adding Huang Qi and Dang T Shen each 9 grams Third visit After 30 packages of theses herbs all of Ms Huangs symptoms were better Her blood pressure was 120 65 Her facial complexion had become red AF and moist her lower limbs felt warm her memory was strong and she had vaginal secretions Her pulse was still thin but it had strength Her tongue was red and moist I continued by using the following formula Dang Shen 9 9 Dang Gui 9 R Qing Zhi Huang Qi 15 Huai Niu Xi 15 Zhi Xiang Fu 9 Ba Ji Tian 9 Tu Si Zi 9 Gou Qi Zi 9 D Zi Dan Shen Yin Yang Huo 15 Xian Mao 9 Rou Gui Wei 1 2 powdered and given as a draft Zi Shi Ying 15

Lack of Bleeding 21 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Fourth visit I gave her 20 packages of the above herbs with one package every other day Her appetite greatly improved and her spirit began to shine Her fear of cold and back soreness was improved as well Gradually her hair grew back and she could walk a long way Already she could work for half a day Her tongue and pulse were as before I gave her the original formula Yang Xue Bu Shen Zu Yang Yin Nourish the Blood Supplement the Kidney and Benefit the Yang Drink We ran out of stock of Lu Jiao Pian so I substituted Lu Jiao Jiao I substituted Rou Gui for Zi He T Che for the same reason She came to see me again in May of 1970 On April 29 of that year she had a menstruation of a normal amount The color was crimson and it lasted 3 4 days She did not have and lower abdominal pain but just a weighing AF down soreness in her low back Her appetite was normal I gave her the same formula to take every other day to consolidate the effect Discussion In this example I used Yang Xue Bu Shen Zu Yang Yin Nourish the Blood Supplement the Kidney and Benefit the Yang Drink and added Huang Qi and Dang Shen in order to supplement the Qi to generate Blood Niu Xi and Qi Zi R were added to supplement the Liver and Kidney and open through the Luo vessels Rou Gui supplements Ming Men fire making the true fire generate the movement of the Qi and Blood I added Xiang Fu to course and regulate the Qi and cause the Ren vessel to open through and the great Chong vessel to be abundant so the Yin D event could occur I continued with the original formula to consolidate the effect Yin Deficiency Inner Heat type Patho mechanisms This type of amenorrhea is commonly seen in women who have had many children or for the aftermath of a feverish illness The result is that the uterine Yin is consumed and the deficiency Yang is relatively excessive

Lack of Bleeding 22 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum It is said in modern medicine that endometrial nodulation gives rise to amenorrhea Many women with this diagnosis have Yin deficiency with inner heat The Qi and Blood are consumed At the beginning of treatment I use Qin Jiao Bie Jia Tang to nourish Yin clear heat and treat steaming bones Afterward I continue with Gui Pi Tang to promote the generation and transformation from the source This will in turn fill the sea of blood I then move on to supplement the kidney and excite the Yang so that the Kidney Qi expand and spread and the Chong and Ren can receive T the nourishment In this way Yin and Yang become level in right relationship and Qi and Blood recover and the menstruation spontaneously arrives Otherwise the Yin enriching ingredients could damage the Spleen and Stomach and cover and hold AF back the Yang The result would be that the source of transformation would be even more insufficient and the illness would be worse In short in treating this illness enriching the Yin and clearing heat should be used as an expedient measure Warming and supplementing the Spleen and Kidney will be the root method In this I must be very clear R Special Points for Differentiation The body form may be gaunt with afternoon fever dry mouth and throat dizziness sore back palpitations poor sleep red crimson tongue with peeled moss and a D pulse that is thin and rapid or thin and wiry Commonly Used Herbs and Formulas Treatment should enrich Yin and clear heat nourish blood and regulate menses Formulas for this are Zhi Bai Di Huang Tang Da Bu Yin Wan or Qin Jiao Bie Jia Tang with additions and subractions

Lack of Bleeding 23 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Dr Qiu Xiao mei s cases Case 1 Ms Lou was 38 when she came in for her first visit on February 21 1973 She had had amenorrhea for 5 months She also had dizziness afternoon fever an emaciated body and mental weakness Her lower limbs felt weak and sore The pulse was thin and rapid and her tongue was red with thin moss The pattern T belonged to Yin deficiency with inner heat Treatment should enrich Yin clear heat and assist by regulating menstruation I Qin Jiao Zhi Mu Yin Chai Hu Qing Hao Chi Shao 9 9 9 9 9 9 R Mu Dan Pi AF gave her 10 packages of the following formula 12 Di Gu Pi 12 Zhi Bie Zha 15 Zhi Gan Cao 3 D Dan Shen After the herbs the tidal heat began to recede and the rapid pulse became moderate There was still no menstruation and her body and spirit were the same as before She had the stature consistent with chronic illness Her Qi and blood were greatly consumed and the sea of blood was vacuous which caused the menstrual flow to loose its source

Lack of Bleeding 24 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum I continued by using Gui Pi Tang with additions and subtractions as a means of 12 Sheng Di 12 Dan Shen 12 Ji Xue Teng 12 Dang Gui 9 Jiu Chi and Bai Shao 9 Dang Shen 9 Bai Zhu 9 Fu Shen 9 AF Huang Qi Chuan Mu Xiang 3 Zhi Gan Cao 3 Chuan Xiong T transforming the source 2 5 Also 12 gm of Gui Lu Er Xian Gao melted in after decocting R I gave her this formula with modifications for 20 days On March 28 1973 she had a period that was scanty and dark colored I continued the above formula to regulate and consolidate D Discussion In this example the diagnosis and disease mechanism was endometrial membrane nodules The Chinese differential diagnosis was Yin deficiency with inner heat type amenorrhea I used Qin Jiao Bie Jia Tang with modifications in order to enrich the Yin and clear heat After taking the herbs the tidal heat receded and the menses came In terms of this kind of illness it is mostly due to Qi and Blood both being consumed so I wanted to supplement and nourish the Qi and Blood To do this one must go to the source so I used Gui Pi Tan with modifications The idea was to warm and supplement the Heart and Spleen Qi

Lack of Bleeding 25 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum and Blood are mutually dependent When the Qi is built up it can generate Blood After the herbs the menses came and good results were obtained Qi Stasis and Blood Congealed type Patho mechanisms Dr Qiu Xiao mei writes The cause of this type of amenorrhea is mostly due to emotional dissatisfaction and T excessive worry This causes Liver Qi constraint and results in Qi stasis and congealed blood The medical books of previous generations placed great importance on the influence AF of the emotions and spirit on the cause and mechanism of amenorrhea As the Nei Jing says the two Yang illnesses begin in the Heart and Spleen One must not conceal and make concessions or the woman will not have her menstruation This provided the basis for the important theories of later generations The Ji Yin Gang Mu also says When a person has secrets and is too submissive it is difficult for the true heart to relax The Qi gets constrained and does not flow The lack of flow R causes the Heart Qi to not open and the Spleen Qi to not transform Food and drink become scantily received and the Qi and Blood are not transformed in order to enter the two Yang s Se of blood When the sea of blood does not fill there is no menstruation This exposition very clearly shows that when emotions don t flow D easily the function of the Zang Fu can get disordered and this is an important source cause of amenorrhea Therefore readjusting the Liver function and causing it to reach in an orderly way is an important link in the treatment of amenorrhea Special Points for Differentiation Dr Qiu Xiao mei writes The patient may complain of irritability and anger dizziness rib side pain chest oppression poor appetite sour tasting burp and breast distention The pulse will be wiry and thin or wiry and rough The tongue moss may be thin yellow

Lack of Bleeding 26 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Commonly Used Herbs and Formulas Dr Qiu Xiao mei writes Treatment should course the liver and rectify the Qi vitalize the blood and dispel that which is congealed Qi Stasis Dr Qiu Xiao mei writes T The formula to use is is Xiao Yao San or Wu Yao San with additions and subtractions I often add herbs such as Chai Hu Ju Luo Ba Yue Zha Bai Ji Li Da Mai Ya Chuan Lian Zi Yan Hu Suo and Xiang Fu in other formulas to course the AF Liver and resolve constraint In this way I get good results Dr Qiu also has a formula that is particular for amenorrhea with breast fullness or galactorrhea Here is what she writes about this formula R Ji Mai San Herbal Constituents Fructus Tribuli D Bai Ji Li 9 Ba Yue Zha Fructus Akebiae 9 Da Mai Ya Fructus Hordei Germinatis 12 Qing Pi Pericarpium Citri 3 Ju He Semen Citri 3 Ju Luo Vascularis Citri 3 Pu Gong Ying Herba Taraxacum 9 Function Course the Liver Rectify the Qi Disperse Knots

Lack of Bleeding 27 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Principle Use Liver Constraint breast lump amenorrhea painful menses and infertility Formula breakdown Bai Ji Li Qing Pi Ba Yue Zha Ju He and Ju Luo all course the Liver and Rectify the Qi resolve constraint and disperse knotting Pu Gong Ying Experience in Application T softens and disperses knots Coursing the Liver resolving depression and synchronizing the Qi mechanism AF The Chong and Ren Mai penetrate through reaching their full extent unobstructed Pregnancy will be easy The liver belongs to Wood and it likes orderly reaching The liver values happiness and ease and fears constraint and knotting Women easily develop constraint which gives rise to Liver constraint and Qi stasis This causes many pathologies relating to R menstruation pregnancy birth and development This is why the ancients said For women the Liver is the Pre Heaven This refers to the close relationship between the Liver and women s physiology and pathology Ji Mai San is my experiential formula for Liver constraint leading to breast lumps painful menstruation D amenorrhea and infertility As long as the differentiation of patterns is precise the effect is outstanding The Liver governs coursing and releasing and its character likes orderly reaching and dislikes depressed knotting The coursing releasing function of the Liver has a relationship to the human body s unimpeded ascending and descending Qi mechanism This Qi mechanism is the totality of the inner Zang s normal functional activity When it penetrates through and reaches its full extent unimpeded ascending and descending occurs in an orderly manner This is the manifestation of

Lack of Bleeding 28 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum the normal functional activity of the inner Zang When the Qi mechanism is unsynchronized the ascending and descending will be abnormal and this will manifest as pathological movement of inner Zang In women if the Liver Qi opens through fully the Qi will be able to move the Blood menstruation will be synchronize and harmonious and becoming pregnant will be easy On the other hand if the Liver Qi is depressed and knotted Qi will be stagnant and Blood will congeal This will cause menstrual abnormalities infertility and other pathological T changes The Foot Jue Yin Liver channel circles the genitals and reaches the lower abdomen The uterus resides in the lower abdomen Its branch rises up to link with the eyes and intersects with the Ren Mai Therefore the relationship between the AF Liver and women s reproductive organs is very important For women if the emotions are unfulfilled it is very easy for the Liver Qi to become depressed and knotted and for the coursing and releasing to become abnormal The result is that the Qi and Blood are not harmonized and the Chong and Ren Mai lose synchronicity Abnormal menstruation appears and she is unable to receive essence and achieve pregnancy Clinical manifestations will be delayed R and scanty menstruation with and unsmooth flow premenstrual lower abdominal pain and breast distention depression and loss of temper The pulse will be bowstring or fine and choppy and the tongue will be red and infused with purple For treatment of this kind of pathology it is appropriate to course the Liver and D rectify the Qi The prescription to use is Xiao Yao San Relaxed Wanderer Powder combined with Ji Mai San Tribulus and Germinated Barley Powder Common herbs to course the Liver and rectify the Qi are Chai Hu Radix Bupleurum Bai Ji Li Fructus Tribuli Ba Yue Zha Fructus Akebiae Ju He Semen Citri Ju Luo Vascularis Citri Da Mai Ya Fructus Hordei Germinatis Qing Pi Pericarpium Citri Immaturus Xiang Fu Rhizoma Cyperi Chuan Lian Zi Fructus Melia and Yan Hu Suo Rhizoma Corydalis If the Qi is static and simultaneously the Blood is congealed one should add ingredients to quicken the Blood and transform coagulation in order to penetrate through the Chong and Ren Mai and thereby disinhibit the uterine vessels

Lack of Bleeding 29 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Blood Stasis Dr Qiu Xiao mei writes Vitalizing the blood and dispelling stasis is a commonly used method for treating amenorrhea and is used when there is Qi stasis and congealed blood In addition you can according to the developing of the patient s condition you can use discretion and apply this method When there is Qi and Blood depletion or Chong T and Ren insufficiency you can use herbs that vitalize the Blood and dispel stasis within the formula for supplementing and nourishing There is a saying Within supplementation attacking can reside The curative effect will increase On the AF other hand one could first supplement and nourish until the Right Qi had returned Once the general condition had improved then use herbs such as Tao Ren Hong Hua Ze Lan and even San Leng and E Zhu in order to vitalize the Blood and break stasis and thereby hasten the downward movement of the menstruation This would be following the method of first supplementing and afterward attack Often this will give a very good effect In short clinically one should grasp the moment and R treat flexibly When thinking about blood stasis as a factor in amenorrhea there are some points to keep D in mind 1 Is there sluggish movement or an actual block or both a If there is a combination of blood deficiency and blood stasis this is sluggish movement of the blood In this case you will want to fill the blood vessels while improving the quality of the blood This will be done by using a formula such as Si Wu Tang combined with herbs such as Dan Shen and Ji Xue Teng You can also use small amounts of several blood vitalizing herbs such as Tao Ren Hong Hua Yi Mu Cao or Liu Ji Nu

Lack of Bleeding 30 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum b If there is blocked blood then the treatment principle will be to open through the menstruation Herbs that are commonly used for opening through the menstruation are i Chuan Niu Xi ii Huai Niu Xi iii Chong Wei Zi v Su Mu vi E Zhu vii Tao Ren AF viii Hong Hua in larger doses T iv Ze Lan Formulas to use are Tong Jing Wan From Fluid Physiology and Pathology by Steven Clavey The following translation is of the section edema in the Yi Xue Xin Wu R Medical Revelations 1732 by Cheng Guo Peng Discussion of Xue Fen and Shui Fen When a woman s menses stops first and then edema appears this is D called xue fen and the main formula is Tong Jing Wan promote menses pill designed by Chen Guo Pen himself If the edema appears first followed by amenorrhea this is called shui fen and should be treated by using Wu Pi Yin Five peel decoction to wash down Tong Jing Wan Tong Jing Wan Dang Gui Wei 30 Chi Shao 30

Lack of Bleeding 31 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum 30 Chuan Xiong 30 Huai Niu Xi 30 Wu Ling Zhi 30 Hong Hua 15 Tao Ren 15 Xiang Fu 60 Hu Po 22 5 T Sheng Di Huang Use 60 gm of Su Mu shavings and cook with the above herbs in wine AF add granulated sugar then gradually decoct until it is thick and suitable to make small pills The dose is 9 gm taken with wine If the patient is weak use Li Zhong Wan to wash the pills down If the blood is cold add 15 gm of Rou Gui to the formula R Dr Xia Gui Cheng writes It is said that lack of menstruation type menstrual illness consists of late D menstruation scanty menstruation and amenorrhea All of these are examples of menstruation not flowing when it should Lack of menstruation could also be classified into polycystic ovarian syndrome premature ovarian failure late menstruation and scanty menstruation On the basis of what I have come in contact with in the clinic polycystic ovarian syndrome is the one I have seen most often In fact I see it more and more The causes of amenorrhea are very complex I want to introduce herbs and formulas to regulate the menstruation However this is not essentially used during menstruation Rather this method is used when menstruation is about to come or to hasten its arrival Based on many years of clinical experience I have chosen the herbs and formulas I use most often to introduce to you There

Lack of Bleeding 32 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum are 8 formulas here namely Wu Wei Tiao Jing San Five Flavor Regulate the Menstruation Powder Jia Jian Tong Yu Jian Modified Open the Stasis Drink Xin Jia Cu Jing Tang Newly Modified Promote the Menses Decoction Yi Shen Tong Jing Tang Boost the Kidney Promote Menstruation Decoction Yi Shen Jin Tui Wen Jing Tang Advance and Retreat Warm the Menses Decoction Xin Jia Xue Fu Zhu Yu Tang Newly Modified Blood Mansion Decoction Zeng Sun Xiao Fu Zhu Yu Tang Minor Dispel Stasis in the Lower Abdomen Deoction and Qing Re Xie Jing Tang T Clear Heat and Discharge the Menses Decoction I shall analyse them one by one below Formula Name AF 1 Wu Wei Tiao Jing San Five Flavor Regulate the Menstruation Powder Regulating the Jing is regulating the menstruation promoting menstruation and causing the amount of the menstruation to become normal Generally I use light dosages of herbs to vitalize the blood and I use 5 flavors So this formula is made R up of the 5 herbs I use most often in the clinic I gathered them together to form Wu Wei Tiao Jing San and this is exactly why I named it Wu Wei Tiao Jing San D Formula Constituents Dang Gui 10 Chi Shao 10 Wu Ling Zhi 10 Ai Ye 6 Yi Mu Cao 15 30 Method of Application

Lack of Bleeding 33 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum This formula is to be decocted in water one package each day It should be stopped when the menses come Function Vitalizes blood and transforms stasis regulates the menstruation Presentation for Use Irregular menstruation late menstruation scanty menstruation lack of free flow with menstruation and even amenorrhea or prolonged cycle Formula explanation This is a light formula for vitalizing the blood and transforming stasis and it uses the T most frequently used herbs to regulate the menstruation Dang Gui and Chi Shao are the two common herbs from Si Wu Tang One is Yang and one is Yin and yet both are herbs that vitalize blood and transform stasis These are the principle herbs AF of Wu Wei Tiao Jing Tang Wu Ling Zhi enters the Liver channel It transforms stasis and stop pain It is able to transform while stopping bleeding When it is under the guidance of Dang Gui and Chi Shao it is able to vitalize the blood and regulate the menstruaion without forcing the blood to flow excessively This is assisted with Ai Ye which has a warm character that heats the womb When the menstrual blood is warm it will move and therefore Ai Ye warms and helps to make the blood flow R smoothly Finally there is Yi Mu Cao which transforms stasis and generates the new It also contracts the uterus which helps the Dang Gui Chi Shao and Wu Ling Zhi to fully discharge the menstrual blood When the blood goes out the new will be generated and the deficiency of the sea of blood will become abundant This way D the uterine lining becomes newly generated This is the function of Wu Wei Tiao Jing Tang Clinical Application This formula is a light formula for vitalizing the blood and regulating the menstruation It is also relatively harmonious and therefore it is appropriate for late or light menses or menstruation that does not flow smoothly However it is also appropriate for profuse or prolonged menstruation when there is blood stasis

Lack of Bleeding 34 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum 1 Heavy menstruation When there is heavy purple red menstruation with relatively large blood clots There may also be paroxysmal lower abdominal pain and distention Chest and stomach focal distention thirst without a desire to drink dark colored stool back and waist soreness The pulse may be thin and wiry or thin and rough The tongue may be purplish or have stasis spots and may have a thin white moss that is thick and sticky at the Da Xiao Ji or Chao Xu Duan T root In this case you would add herbs like Chao Pu Huang Qian Cao Tan 2 Prolonged menstrual cycle The bleeding amount is not heavy but the bleeding goes on without stopping or the amount is relatively profuse with AF episodes of bleeding with relatively large clots a purple red color lower abdominal distention discomfort in the chest and thirst without a desire to drink The tongue will be pale red and the moss will be thin white The pulse will be thin but not smooth In this kind of case one should also add herbs such as Chao Pu Huang Jing Jie and Zhi Xiang Fu Modifications R This formula has a very broad application for any menstrual illness in which there is blood stasis However if the pathology is combined with fire heat Ai Ye should be removed and one should add herbs such as Mu Dan Pi Ling Xiao Hua or Gou Teng If there is waist and back soreness then add herbs such as Chao Xu Duan Sang Ji D Sheng and Du Zhong If the Spleen and Stomach are lacking with abdominal distention flatulence and sticky stool add herbs such as Zao Mu Xiang Zhi Cang Zhu and Jiao Shan Zha Clinical Experience Wu Wei Tiao Jing Tang is the formula I use most often in the clinic I often use Dan Shen in place of Dang Gui Why Dang Gui and Dan Shen are both herbs that regulate the menstruation However Dang Gui has the function of moistening the large intestine and it easily induces a sticky stool In my clinical practice it is common for women to develop a sticky or loose stool during menstruation so I

Lack of Bleeding 35 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum substitute Dang Gui with Dan Shen Our predecessors said The single herb Dan Shen is the same as Si Wu Tang So in terms of regulating menstruation formulas it seems to be good to make this substitution But it should be kept in mind that when the menstruation is heavy or prolonged this substitution is not suitable because it is easy to cause excessive bleeding or increase bleeding with Dan Shen This comes from my many years of experience Therefore when the stool is not sticky or the menstrual discharge is profuse keep Dang Gui in the formula If the T stool is sticky or soft it is appropriate to use Dan Shen Clinically one should pay attention to the particular characteristics of the differential diagnosis and the pathological changes When the menstruation is irregular I AF consider this to be related to Liver depression Spleen deficiency Kidney deficiency blood stasis or phlegm turbidity Therefore the methods I apply will open the flow of the Liver fortify the Spleen supplement the Kidney dispel stasis and transform phlegm I will use the formula to fit the method When there is Liver depression I will smooth the flow of the Liver and regulate menstruation using Zhi Xiang Fu Wan Tang or Qi Zhi Xiang Fu Wan R Tang with Wu Wei Tiao Jing Tang When there is Spleen Qi deficiency with irregular menstruation I will fortify the Spleen and regulate the menstruation If this appears with sticky stool I will use Xiang Sha Liu Jun Zi Tang with Wu Wei Tiao Jing Tang If there is focal distention D with rebellious burping or nausea and vomiting then I will use Xiang Sha Ping Wei San with Wu Wei Tiao Jing Tang When there is Kidney deficiency causing irregular menstruation I will supplement the Kidneys and regulate the menses When there is Yang deficiency irregular menstruation use Xiao Wen Jing Tang with Wu Wei Tiao Jing Tang When there is Yin deficiency irregular menstruation the menstruation will often be profuse You can use Er Zhi Di Huang Wan with Wu Wei Tiao Jing Tang

Lack of Bleeding 36 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum When there is phlegm damp causing irregular menstruation you can use Cang Fu Dao Tan Tang If this tends more to damp heat you can use Si Miao Wan with Wu Wei Tiao Jing Tang When there is blood stasis causing menstrual irregularity with a tendency to cold fatigue you can use the Effective Formula for Women Wen Jing Tang with Wu Wei Tiao Jing Tang If there is more of a tendency to heat blood stasis this can easily give rise to heavier bleeding and you can use Si Cao Tang with Wu Wei Tiao T Jing Tang This is all to say that when you use Wu Wei Tiao Jing Tang alone or in combination you must consider the characteristics of the illness Dang Gui AF Detailed analysis of the principle herbs in this formula Dang Gui and Chi Shao Dang Gui is sweet pungent and warm It enters the 3 channels Heart Liver and Spleen It can supplement blood and vitalize blood It moistens dryness of the Large intestine The primary application for Dang Gui is for irregular menstruation R painful menstruation bleeding blood deficiency constipation and traumatic injury The Separate Records of Famous Physicians considers Dang Gui to produce warmth in the middle and to stop pain it dispel lodged blood inner cold inhibited sweat Qi deficiency cold and damp obstructive evil It can supplement D the 5 Zang and generate the muscles and flesh I consider Dang Gui to supplement the blood and regulate the menstruation Everyone in the world knows that Dang Gui is the important herbs for presentations of irregular menstruation blood deficiency amenorrhea and pathology before and after birth For example the Official Formulas for Harmony tells us that Si Wu Tang is Dang Gui combined with Shu Di Chuan Xiong and Bia Shao and that this is an important formula in the gynecology clinic Dang Gui has the function of regulating Qi and vitalizing blood It is able to treat congealed static Qi and blood abdominal pain from lack of harmony in the luo vessels rib side pain traumatic injuries as well as numbness and

Lack of Bleeding 37 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum pain presentations In general Qi stasis will over time cause the luo vessels to become congealed and the blood will not flow through easily When Dang Gui is combined with herbs to regulate Qi the effect for this type of condition is really good When blood stasis causes pain Dang Gui can be combined with herbs to regulate blood When there is blood deficiency with interior cold and abdominal pain Dang Gui can be combined with herbs to benefit the Yang When there is lack of harmony in the Luo vessels due to wind damp Dang Gui can be used with wind T damp herbs Keep in mind that Dang Gui can make the intestines slippery It is used for blood deficiency constipation but you should use caution when there is Chi Shao AF Spleen deficiency with diarrhea Chi Shao is sour and bitter and slightly cold It enters the 2 channels Liver and Spleen It discharges the Liver and clears heat scatters stasis vitalizes the blood and stops pain It is able to treat static blood that is congealed and stuck causing abdominal pain rib side pain amenorrhea blood obstruction masses and painful R swelling presentations Miao Xi yong considers this herb to crack and scatter open through and disinhibit and to enter the Liver blood level for evil Qi abdominal pain When it is combined with Dang Gui it primarily treats abdominal and rib side pain very effectively and so it is good for painful menstruation and irregular menstruation D It has a good and lasting effect Practical Experience When I use Wu Wei Taio Jing Tang in the clinic to regulate the menstruation up until the menstruation arrives or 1 2 days before menstruation I often combine it with Yue Ju Wan Yue Ju Wan contains Shan Zhi Zi for which I substitute Dan Pi It also contains Liu Qu for which I substitute Shan Zha This becomes one of my frequently used formulas in the clinic and the effect is quite good Yue Ju Wan helps the smooth flow of the Liver and regulates Qi Wu Wei Tiao Jing San Tang

Lack of Bleeding 38 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum regulates the menstruation from within the blood One formula is for the blood and one is for the Qi Each formula makes the other shine more brightly Honestly these are good herbs and good formulas for regulating the menstruation 12 gm Shan Zha 10 gm Xiang Fu 9 gm Hong Hua 6 9 gm Wu Yao 6 gm Qing Pi AF Chao Dang Gui Wei T 2 Jia Jian Tong Yu Jian Modified Open Through Stasis Decoction 5 gm Chuan Mu Xiang Ze Lan Ye Chi Shao Chuan Niu Xi 10 gm 10 gm 10 gm 6 10 gm R Tao Ren 9 gm Formula Function Regulates Qi and vitalizes the blood opens through stasis and synchronizes the menstruation D Formula Application This formula treats blood stasis type late menstruation scanty menstruation prolonged menstruation and dysmenorrhea Formula explanation This formula treats blood stasis type irregular menstrual pathology This includes blood mansion type dysmenorrhea and amenorrhea presentations It places Dang Gui Wei in an important position for vitalizing blood and transforming stasis However these days pharmacies do not discriminate between Dang Gui Wei Dang Gui Tou and Dang Gui Shen Consequently we assist the function of Dang Gui to open stasis with Tao Ren and

Lack of Bleeding 39 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Hong Hua and this becomes a stronger formula In addition Zhang Jing yue s original formula contains Hong Hua but is without Tao Ren This must be added Generally because of the demands of opening through stasis I base my formula on Tong Yu Jian I also add Ze Lan Ye and Chuan Niu Xi to open the pathways of the menstruation according to the clinical presentation The goal is to guide and vitalize the blood and open through the menses and so in addition to using herbs to vitalize blood and transform stasis one should also assist with synchronize Qi herbs to regulate Qi and move stasis The point is to T first give herbs to move the channel Qi It is said that When blood in the channels does not move first move the Qi because when the Qi moves the blood will move When there is Qi stasis there is blood stasis and when there is blood stasis the blood obstructs AF the Qi movement Because of this add Xiang Fu Wu Yao and Mu Xiang These 3 herb flavors regulate the Qi and synchronize the Qi of the Liver Kidney and Spleen Zang When regulating Qi and moving stasis it helps to vitalize blood and open the menstruation and so you can add Qing Pi This her helps flow and discharging and strengthens the regulating and synchronizing of the Liver Qi Because the Liver stores the blood and governs free flow and discharge when you want to help the flow and discharge it of R benefit to discharge the menstrual blood and this will regulate Qi and synchronize the menstruation Therefore when regulating the Qi and synchronizing the menstruation one should lay stress on the Liver One can add Shan Zha Master Zhang uses this not only to vitalize blood and open the menstruation Therefore this herb not only vitalizes the blood D and opens the menses it also to synchronizes and regulates the Qi mechanism Because of all this Jia Jian Tong Yu Tang is frequently used in the clinic Clinical Application According to Jing Yue Quan Shu Fu Ren Gui The Complete Works of Jing Yue Women s patterns Tong Yu Jian treats Qi stasis congealed blood inhibited channels and vessels and extreme abdominal pain In addition to treating late menstruation lack of smooth flow of menses and painful menstruation it can also treat post partum congealed blood excess pain as well as blood reversal or blood rebellion

Lack of Bleeding 40 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum 1 Late Menstruation scanty menstruation and painful menstruation This is usually seen with astricted scanty menstruate the does not flow smoothly There is abdominal pain that resists pressure and the blood is purple and dark with clots There is pain and distention in the abdomen with chest oppression and vexation The pulse is thin and wiry and the tongue is purple and dark In this circumstance you can add herbs such as Rou Gui and Ze Lan Ye 2 Post partum blood stasis abdominal pain During the post partum time if the lochia T stops too soon or does not flow out smoothly the blood has a purple dark color with clots there is lower abdominal distention and pain low back soreness and weakness with chest oppression abdominal distention purple dark tongue and a AF thin rough one should add Ze Lan Ye Yi Mu Cao and Yan Hu Suo to this formula 3 Blood stasis blood fainting This presentation can be from trauma from an accident abdominal pain during a scanty menstruation This may be accompanied by dizziness fainting cold limbs nausea and vomiting abdominal distention a thin pulse and a purple dark tongue In this circumstance you can add herbs such as Shi Chang Pu Guang Yu Jin Zhi Mo Yao or Zhi Ru Xiang R Modifications This formula is from the Patterns of Women and it can be modified as below 1 If there is cold stasis add Rou Gui and Wu Zhu Yu 2 If there is full fire with inner heat with blood that does not move due to dry blood D add Chao Shan Zhi Dan Pi 3 With slight heat and blood deficiency add Bai Shao and Gui Shen 4 With blood stasis with very scanty blood add Su Mu and Chong Wei Zi 5 With dry knotted stool add Da Huang and E Zhu or add Mang Xiao and Tao Ren Clinical Experience Tong Yu Jian is really 3 formulas 1 Tong Yu Jian comes from the Jing Yue Quan Shu Women s Patterns My Jia Jian Tong Yu Tang was developed based on this formula and my own clinical experience

Lack of Bleeding 41 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum 2 The second formula is from the Xian Nian Ji Immortal Collections Vol 4 This formula uses Gui Wei Da Huang Hong Hua Su Mu These are strong herbs for dispelling stasis but in this formula the dosages are light It is for moving evil blood and is used primarily dispelling for post partum congealed blood and stasis leading to poor flow of the menstruation These would all be considered evil blood 3 The third formula is from Guang Lue Liu Shu chapter 25 It uses Pu Huang Wu Ling Zhi Chuan Yu Jin Xiao Zhi Shi Bai Zhu Tang Jian Ze Xie Xi Chi Shao Tao T Ren Ni Ming Hu Bo This formula is used to treat blood stasis in which the abdomen becomes filled with fluid The pulse is rough and not smooth The Selected Writings on Formula Theory writes When blood stasis is not dispersed AF the Spleen and Stomach loose their ability to be fortified and to transform and transport the minute essences The turbid Yin gets stopped up and this leads to abdominal distention and fullness This is called Blood Gu Pu Huang cracks congealed blood it opens the channels and collaterals Wu Ling Zhi cracks congealed blood and also descends the turbid Yin Tao Ren cracks the congealed and also moistens dryness Chi Shao cracks the congealed and also discharges fire R Zhi Shi disperses distention and fullness Bai Zhu Tang fortifies the Spleen Qi Yu Jin synchronizes the Qi and opens depressive knotting Ze Xie separates the clear Yang Hu Bo disperses congealed blood and allows open permeability This causes the congealed to be transformed and for the Qi to be synchronized The result is D that the Chong vessel is clear and harmonized the Spleen and Liver Qi transform and the blockage is immediately opened How could abdominal distention not recede What these formulas treat is not the same However the meaning of the formulas is identical They can be used together in the clinic and adjusted according to the presentation When I use Tong Yu Jian in the clinic I often add Shi Xiao San Tao Ren Ze Lan and Chuan Niu Xi This strengthens the force of transforming stasis and opening the menstruation This is because when the menstruation is blocked and not flowing smoothly

Lack of Bleeding 42 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum this is usually related to congealed blood and Qi stasis So we can say that if we want to open the menstruation we must transform stasis If we want to transform stasis we must assist this by moving the Qi Qi and blood movement complement each other Therefore in relation to illnesses of menstruation the meaning of opening through stasis is to open through the menses and transform stasis In my own clinical practice I see patients who have serious endometritis This may develop after dilation and curettage surgery and it can give rise to adhesions of the uterine T cavity The degree of adhesions can vary as can the extent to which it influences the menstruation It may give rise to scanty menstruation or even amenorrhea In general though this is due to stasis and obstruction in the uterus with lack of free movement of the AF blood Tong Yu Jian can treat this but the effect is only good in relatively light cases For more serious cases surgery must be used to sever the adhesions and this formula can be used after that 3 Xin Jia Cu Jing Tang Newly Modified Promote the Menses Decoction 10 gm Shu Di Huang 10 gm R Xiang Fu Chi Shao 10 gm Bai Shao 10 gm E Zhu 9 gm 6 9 gm D Su Mu Dang Gui 12 gm Chuan Xiong 6 gm Hong Hua 10 gm Tao Ren 10 gm Rou Gui 5 gm Gan Cao 3 gm Chuan Niu Xi 12 Formula explanation

Lack of Bleeding 43 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum When there are extreme cases in which congealed blood has knotted together one must use heavy open through the menses and vitalize blood formulas Because of this Tao Hong Si Wu Tang is the principle formula Tao Hong Si Wu Tang is the foundational formula for transforming the congealed It also is the foundation for formulas that open the menses and vitalize blood However to increase the strength of the effect of expelling the congealed and opening through the menses one should add Chuan Niu Xi E Zhu and Su Mu Chuan Niu Xi guides all the herbs downward and it is an important herb for treating amenorrhea T E Zhu opens through the menses and also disperses masses and scatters knotting Su Mu vitalizes blood and opens through the collateral vessels When it is added to Tao Hong Si Wu Tang it increases the effect and strength of vitalizing blood and opening through the AF menses Xiang Fu is added to vitalize the blood and open through the menses There needs to be herbs to regulte Qi and move stasis Xiang Fu does this and also has the function of opening the menses Rou Gui is added to warm the Yang and supplement the Kidneys Warming the Yang helps to vitalize blood Supplementing the Kidneys helps to synchronize the cycle Gan Cao harmonizes the middle Altogether this formula vitalizes R the blood and opens the menstruation It has the effect of promoting menstruation 4 Yi Shen Tong Jing Tang Boost the Qi and Open the Menses Decoction 10 gm Dan Shen 10 gm Shu Di 10 gm Chuan Xu Duan 10 gm Ze Lan Ye 10 gm Chuan Niu Xi 10 gm Chao Dang Gui 10 gm Chi Shao 10 gm Bai Shao 10 gm D Bai Zi Ren

Lack of Bleeding 44 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Chong Wei Zi 15 gm Sheng Qian Cao 15 gm Zhi Bie Jia 9 gm cook ahead Shan Zha 10 gm Formula Name Yi Shen refers to supplementing and boosting the Kidneys However amenorrhea is often due to Liver and Kidney Yin deficiency and therefore supplementing and boosting the T Liver and Kidney should also be supplementing and boosting Yin Tong Jing refers to opening through the menstruation like making a tube open from end to end The meaing behind the name Yi Shen Tong Jing Tang is basically combining the methods of boosting Method of Application AF the Kidneys and opening through the menstruation This formula should be boiled in water and one package each day given Effect This formula supplements the Kidneys calms the Heart vitalizes the blood and opens through the menstruation R Suitable usages Liver and Kidney insufficiency amenorrhea late or scanty menstruation accompanied by chest oppression agitation lack of sleep and difficult bowel movements Formula explanation D The primary aim of this formula is on the Heart Kidney and uterus and so herbs to supplement the Kidney calm the Heart and regulate the uterus are used Bai Zi Ren and Dan Shen settle the Heart and calm the spirit In addition to this they also down bear the Heart Qi It is said that When the Heart Qi descends and opens through the Uterine vessels are also open through all the way The formula also uses Shu Di Huang Chuan Duan Niu Xi and Zhi Bie Jia These herbs all greatly supplement the Liver and Kidney Yin so that the menstrual fluid is abundant and full When the Kidney Yin is sufficient and the menstrual fluid is abundant the material substance of the menstruation is thick and heavy This is treating the root I have also added Dan Shen Dang Gui Chi Shao Chong Wei Zi

Lack of Bleeding 45 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum and Sheng Qian Cao which vitalize the blood and regulate the menstruation Vitalizing the blood and regulating menstruation basically means that we are regulating the flow to the uterus So there are these 3 aspects to this formula and they are put together to create Yi Shen Tong Jing Tang which treats Kidney deficiency amenorrhea Clinical Application Though this formula treats menstrual irregularity due to Kidney deficiency it primarily treats scanty menstruation amenorrhea and late menstruation At the same time it can be T used to promote ovulation at mid cycle and for adolescent menstrual irregularity 1 When there is scanty ovulation discharge at mid cycle ovulation with dizziness back soreness and weakness weak spirit red tongue with scanty moss you can use this formula AF with Wu Ling Zhi and Tai Zi Shen 2 When there is adolescent menstrual irregularity with the menstruation coming 3 4 years late when it comes it is late or early but usually late or there is amenorrhea Leucorrhea is common There may also be insomnia thin wiry pulse and the tongue will tend to be red In this case you can use this formula with Zi He Che 6 9 gm and Tu Si Zi 10 gm Modifications R Yi Shen Tong Jing Tang is used for a very particular clinical application though there are still modifications that can be made If the stool is tending to be sticky you can take out Bai Zi Ren and Dang Gui and add He Huan Pi 10 gm Wei Mu Xiang 9 gm and Liu Shen 10 gm If there is clear back soreness D add Du Zhong 10 gm and Sang Ji Sheng 10 gm If there is thick moss in the middle of the tongue and scanty urine take out Sheng Di and add Fu Ling 12 Zhi Cang Zhu 10 gm and Yi Yi Ren 15 30 gm If there is Heart vexation with loss of sleep and the tongue is tending to red add Lian Zi Xin 5 gm and Qing Long Chi pre cook 10 gm Clinical Experience Yi Shen Tong Jing Tang is my special formula for amenorrhea when symptoms of Yin deficiency and Liver efflugence are manifesting This is because it stresses enriching the Yin down bearing fire and opening through the menstruation methods Down bearing fire is not clearing fire This is because clearing fire will not be able to reach the goal of

Lack of Bleeding 46 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum opening through the menses Therefore I chose Bai Zi Ren Wan and Ze Lan Ye Tang with modifications Let s consider Bai Zi Ren Wan and Ze Lan Ye Tang Both of these formulas come from The Complete Collection of Effective Formulas for Women Bai Zi Ren Wan is the principle formula and was originally for young women with worry in the heart type amenorrhea It uses the 4 herbs Bai Zi Ren Sheng Juan Bai Ze Lan Ye and Chuan Niu Xi which stress obstruction of Heart Qi In regard to this obstruction our predecessors considered this to be Liver depression We cannot ignore this However T the ancients especially in the Nei Jing considered depression presentation to be in the Heart For example it says the two Yang illnesses arise in the Heart and Spleen This cannot be kept a secret Women will have amenorrhea It also says that When the Heart AF Qi rises up to the Lungs it cannot descend and the uterine vessels will become obstructed and the monthly event will not occur This points to the fact that the vessels of the uterus and the collaterals of the uterus have a close relationship with the heart When the Heart Qi is obstructed the Heart blood will not descend and there will be amenorrhea This is actually seen in the clinic a lot Naturally we cannot ignore the importance of Bai Zi Ren Wan when there is insufficiency of the Kidney Yin and menstrual water The Ming dynasty R master Zhang Jing yue demonstrates this clearly with his formula from The Complete Collection of Effective Formulas for Women Bai Zi Ren Wan when by adding Chuan Duan and Shu Di it still treats amenorrhea We consider this formula very appropriate for this type of illness D Ze Lan Ye Tang is a frequently used light formula It includes Ze Lan Ye and Dang Gui as the principle herbs and these are assisted by Gan Cao This formula stresses treating the Heart and Kidney It treats the Heart by descending and calming the Heart and it treats the Kidney by supplementing it and enriching the Yin It opens through and down bears while enriching Yin It can also remove Heart and Liver fire This formula has several open through the menses and vitalize blood herbs and although it does open through the uterus and promotes the menstrual flow it also calms and descends the Heart Qi and induces the Heart blood to flow openly downward This deeper layer of meaning is with in

Lack of Bleeding 47 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum this formula Because of this it is also able to promote ovulation when there is Yin deficiency The principle herbs in these formulas are Bai Zi Ren Chaun Niu Xi and Ze Lan Ye I will put forth and analysis of these below 10 gm Chi Shao 10 gm Chuan Xiong 6 gm Gui Xin 9 gm E Zhu AF Dang Gui T 5 Jin Tui Wen Jing Tang Advance and Retreat Warm the Menses Decoction 9 gm Chuan Niu Xi Dang Shen Chao Gan Cao Shan Zha 12 gm 3 gm 10 gm 15 gm R Yi Mu Cao 10 gm Chuan Duan 10 gm Function D Warms the menses and scatters cold vitalizes the blood and opens the menses Clinical usage Late menstruation scanty menstruation cold pain in the lower abdomen cold thighs aversion to cold menstruation color is purple and dark pulse is wiry and thin or deep and rough Formula explanation This formula is aimed at warming the menstruation and vitalizing the blood as well as open through the menstruation It contains Gui Xin which warms the menses and scatters cold It also opens through the blood vessels and stops pain In this formula Gui Xin is the principle herb I usually use Rou Gui Dang Gui supplements the blood and synchronizes

Lack of Bleeding 48 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum the menstruation It also functions to vitalize blood and stop pain Chuan Xiong vitalizes the blood and moves Qi It is known as the Qi within the Blood herb When combined with Dang Gui it also synchronizes the menstruation Ren Shen or Dang Shen supplements the Qi and supports the correct It helps the Gui Gui and Xiong promote the unimpeded flow of Yang thereby warming the menses and scattering cold Peng E Zhu vitalizes blood and transforms the congealed It disperses and scatters accumulated stasis Niu Xi also vitalizes blood and synchronizes the menstruation and in addition it induces T the other herbs downward Mu Dan Pi can discharge and descend floating fire as well as vitalize blood and synchronize the menstruation Shao Yao and Gan Cao moderate tension and stop pain I also add Shan Zha and Yi Mu Cao to vitalize blood and promote AF menstruation These will also promote the contraction of the uterus Chuan Duan supplements the Kidneys and vitalizes the blood It helps the Rou Gui to benefit the Yang and scatter cold warm the menses and vitalize blood All these herbs together boost the Qi and open through the Yang warm the menses scatter cold vitalize blood and dispel stasis It is appropriate to use when cold Qi abides in the blood chamber leading to congealed and coagulated Qi and Blood manifesting as late menstruation and painful R menstruation Clinical Application This formula is not only appropriate for cold and stasis knotted together leading to accumulation type late menstruation scanty menstruation and amenorrhea It can also be D used for illnesses such as cold stasis infertility post partum lochia failing to stop and deficiency cold type anemia 1 Cold and stasis knotting causing accumulation type infertility This type of infertility will manifest with late or scanty menstruation with dark purple blood clots lower abdominal pain with a cold feeling soreness of the 4 limbs and low back thin wiry pulse and white sticky tongue moss 2 Cold and stasis knotted together causing accumulation type post partum lochia failing to stop This presentation will manifest with dark blood with clots lower

Lack of Bleeding 49 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum abdominal cold feeling with pain soreness of the low back thin pulse and purple sides to the tongue with a sticky white moss 3 Cold and stasis knotted together causing accumulation type anemia This presentation will manifest with dizziness nervousness sallow complexion coldness of the 4 limbs abdominal distention and pain with a cold feeling thin rough pulse pale red tongue with purple sides For this you can add herbs such as Huang Qi 6 Xin Jia Xue Fu Zhu Yu Tang 10 gm Hong Hua 9 gm Chao Dang Gui Chi Shao Chuan Xiong Shu Di AF Tao Ren T and Shu Di 10 gm 9 gm 6 gm 10 gm Chuan Niu Xi 6 gm R Jie Geng 9 gm 5 gm Gan Cao 3 gm Wu Ling Zhi 10 gm Yi Mu Cao 15 gm D Chai Hu Formula Name This Xue Fu can have several meanings It can refer to the Liver Zang within the chest the sea of blood or the blood mansion I agree that it should be thought of in a broad sense as referring to the blood level This Zhu Yu refers to attacking and dispelling stasis of the blood I have made modifcations based on the demands of the clinical presentation and created Xin Jia Xue Fu Zhu Yu Tang Newly Modified Dispel Stasis in the Blood Mansion Decoction Formula Constituents

Lack of Bleeding 50 10 gm Hong Hua 9 gm Chao Dang Gui 10 gm Chi Shao 9 gm Chuan Xiong 6 gm Shu Di 10 gm Zhi Qiao 9 gm Chuan Niu Xi 9 gm Jie Geng 6 gm Chai Hu 5 gm Gan Cao 3 gm Wu Ling Zhi Yi Mu Cao Method of Application AF Tao Ren T Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum 10 gm 15 gm Premenstrually or during the menses take one package each day Decoct in water and R divide the decoction into two doses Function Vitalize blood dispel stasis synchronize Qi and stop pain D Presentation for Use When there is a blood stasis presentation in women the menstruation may be scanty or painful or there may be amenorrhea or infertility Other symptoms may be chest pain headache or other kinds of piercing pain The original texts lists the following symptoms headache chest pain day break sweat internal heart heat called lantern disease dim vision agitation insomnia with many dreams abnormal sexuality choking when drinking water insomnia night crying in children palpitations and racing heart lack of peacefulness at night vulgar words Liver Qi disease dry retching bursting temper in the evening

Lack of Bleeding 51 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Formula explanation This formula was originally designed to treat blood stasis that is accompanied by Liver depression and Qi stasis with blood stasis in the chest rib side and abdomen blockage of the Qi In gynecology the blood stasis is in the lower warmer and this formula also contains herbs that are appropriate for this It uses Tao Hong Si Wu Tang as the foundation which vitalizes the blood and dispels stasis and also has the function of nourishing the blood For this Chi Shao can be changed to Bai Shao and Chai Hu Jie T Geng Niu Xi Zhi Qiao Gan Cao This formula contains Dang Gui Chuan Xiong Chi Shao Tao ren and Hong Hua to vitalize the blood dispel stasis open through the blood vessels Niu Xi dispels stasis and induces the downward movement of the blood These AF are the principle components of this formula Chai Hu courses the Liver and resolves depression and guides the clear Yang upward Zhi Qiao opens the chest and moves the Qi When the Qi moves the blood will move Shu Di Huang nourishes blood When it is combined with Dang Gui it is able to moisten dryness This insures that dispelling stasis will not damage the Yin and Blood Gan Cao regulates and harmonizes the formula and is a secondary component of the formula This formula not only transforms and moves at the R blood level it also resolves constraint and knotting at the Qi level Because there are two rising and two descending the up bearing and down bearing are opened up and constraint is resolved The blood is vitalized without damaging the blood It dispels stasis and generates the new This is the use for which the herbs are combined It causes stasis to be D dispelled and blood to move and makes the entire presentation resolve It can treat all Qi and blood stasis illness presentations This is a famous formula and is often used in the clinic to vitalize blood and dispel stasis 7 Zeng Sun Shao Fu Zhu Yu Tang Xiao Hui Xiang Chao Gan Jiang 5 gm Yan Hu Suo 10 gm

Lack of Bleeding 52 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum 5 gm Chi Shao 10 gm Sheng Pu Huang 9 gm Chao Wu Ling Zhi 10 gm Chuan Xiong 5 gm Dang Gui 9 gm Chuan Duan 10 gm Yi Mu Cao 15 T Guan Gui Da Huang Mang Xiao Gan Cao Shan Zhi Zi Bo He AF 8 Qing Re Xie Jing Tang Clear Heat Discharge the Menses Decoction 6 gm 9 gm 6 gm 9 gm 6 gm add after R Huang Qin 9 gm 12 gm Dan Shen 10 gm Chuan Xiong 6 gm Sheng Di Huang 10 gm Chi Shao 10 gm Zhu Ye 3 gm Chuan Niu Xi 10 gm D Lian Qiao Formula explanation Discharges fire purges the bowel clears above and discharges below synchronizes the menstruation Clinical Application

Lack of Bleeding 53 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Depressed evil generating heat in the middle and lower warmer fire heat blocked in the interior menstruation blocked in the lower body vexatious heat manifesting in the chest and abdomen body heat and thirst with a desire to drink red face ulcers on the tongue and in the mouth constipation and red urine amenorrhea red tongue with yellow sticky moss and a pulse that is slippery and rapid Modifications Within this formula Lian Qiao has an important position It principally clears heat and T resolves toxin When it is combined with Chi Shao and Chuan Xiong it clears chest and abdominal heat Shan Zhi Zi opens through and discharges heat in the 3 warmers and moves flaring heat downward Bo He and Zhu Ye disperse the exterior and internally AF clear Mang Xiao and Da Huang cleanse evil heat from the chest and abdomen and guides the discharge movement downward When it is combined with Gan Cao the heavy drainage functions of the Da Huang and Mang Xiao are moderated while their pushing ability is strengthened The intention of this formula altogether is to both clear the upper and drain the lower However the draining purgation is only for the purpose of clearing and draining depressive R heat from the chest and abdomen It is said one drains in order to clear and this is the intention here This formula is also meant to treat heat dryness amenorrhea and for this Si Wu Tang is added This formula nourishes the blood and synchronizes the menstruation and induces D the herbs to enter the blood level The addition of Si Wu Tang allows this formula to reach from clearing and drainage all the way to synchronizing the menstruation Because opening through the menstruation is the principle function of this formula when the menstruation arrives the depressed heat in the chest and abdomen is also discharged Si Wu Tang has two flavors to enrich and nourish the Yin and blood The Shao is changed to Chi Shao and the Di Huang is changed to Sheng Di Huang and Chuan Niu Xi is added to induce the blood to move downward In this way the menstruation is opened and discharged Clinical application

Lack of Bleeding 54 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum This formula can be used for irregular menstruation This symptom is accompanied by depressed heat in the chest and abdomen and fever with menstruation 1 Heat dryness amenorrhea Amenorrhea vexatious heat and dry mouth with a desire to drink red face dried up tongue body constipation and red urine The pulse is slippery and fast and the tongue moss is sticky and yellow while the tongue body is red This pattern is exactly what this formula is for T 2 Heat entering the blood chamber The menstrual blood comes and ends appropriately but does not flow smoothly There is lower abdominal distention and pain constipation and scanty yellow urine agitation chest and abdominal AF distention and pain When this presentation is extreme there may be fainting or delirious speech In this kind of circumstance I add Yi Mu Cao and Ze Lan 3 Bowel pain with menstruation The menstruation comes as it should and it is accompanied by lower cutting abdominal pain high fever thirst agitation difficult bowel movements and urination that is tending to be scanty and yellow The tongue body is red with yellow thick sticky moss In this case you can add Hong R Teng and Bai Jiang Cao to this formula Modifications One should modify this formula according to the presentation Within a specific D application generally one can omit Mang Xiao If the lower abdominal pain is extreme you can add herbs like Mo Yao Ru Xiang and Yan Hu Suo If the tongue moss is thick and sticky you can omit Huang Qin and Shan Zhi Zi and add Cang Zhu Yi Yi Ren and Mu Xiang Clinical experience For heat dryness amenorrhea according to the writings of our predecessors there are two types of circumstances The first is chest and abdominal vexatious heat with thirst and amenorrhea In the book Rumen Shiqing by Zhang Zi gives San He Tang for this The

Lack of Bleeding 55 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum second is vexatious heat in the Stomach with thirst amenorrhea For this the Rumen ShiqingI recommends Yu Zhu San These two formulas both have special characteristics Dr Qiu Xiao mei s cases Case 1 T Ms Ai was 37 when she came for her first visit on 8 14 1964 Amenorrhea began 6 months previously Her lower abdomen felt distended as if there was a lump to be expelled Her breasts felt distended and painful and her appetite was poor She AF also experienced dizziness low back soreness profuse vaginal discharge Her pulse was wiry and rough and her tongue moss was thin yellow while the tongue body was red purple She was diagnosed with Qi stasis blood congealed amenorrhea The treatment was directed to course the Liver rectify the Qi vitalize the blood and dispel that which is congealed I gave her the following formula with additions and R subtractions 9 Jiu Chi Shao 9 Da Mai Ya 9 Zhi Xiang Fu 9 Ji Xue Teng 12 Dan Shen 12 Xia Ku Cao 12 Qing Pi 4 5 Chuan Xiong 4 5 Shan Zha 9 Chuan Lian Zi 9 D Jiu Dang Gui

Lack of Bleeding 56 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum After 40 packages of this formula her menses arrived on 10 26 The amount was moderate and the color was dark The abdominal pain was completely gone I again gave her herbs to course the Liver and rectify the Qi vitalize the blood and regulate the menses When I saw her in three months her menses were completely normal Discussion This example of falls into the category of Qi stasis and congealed blood T I used Xiang Fu Qing Pi Chuan Xiong and Chuan Lian Zi to course the Liver and rectify the Qi Dang Gui Chi shao Ji Xue Teng and Dan Shen vitalize the blood and dispel stasis I added Xia Ku Cao Shan Zha to soften hardness and dispel knotting AF After these herbs her menses changed for the better Case 2 Ji Mai San and Gui Xian Tang Ms Qu was thirty years old when she carne for her first visit on April 5 1977 She had been married for three years without becoming pregnant The iodized oil roentgenograpy revealed that both sides to have inflammatory changes The liquid went through but not smoothly Her menstruation had been changing for several months This happened after using female hormones R after which the amount remained scanty and she experienced dull pain on both sides of her lower abdomen Her pulse was deep and thin and her tongue moss was thin and white This appeared to be a case of chong and Ren Mai vacuity cold and Liver Qi depressive knotting To D treat I decided to warm her uterus and course her Liver so I used modified Gui Xian Tang Cinnamon Immortal Soup as the prescription Zhi Shi Ying Fluoritum 15gm Yin Yang Huo Herba Epimidium 9gm Xian Mao Rhizoma Curculingus 9gm Rou Cong Rong Caulis Cistanches 12gm Ba Ji Tian Radix Morinda 12gm Rou Gu Mo Cortex Cinnamon Powder 3 gm stir in powder

Lack of Bleeding 57 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Massa Fermentata Hordei 15gm Chao Dang Gui Stir fried Radix Angeilca Sinensis 9gm Chao Chi Shao Stir fried Radix Peoniae Rubra 15gm Chao Chuan Xiong Stir fried Rhizoma Ligusticum 4 5 grn JuHe Semen Citri 4 5 gm Ju Luo Fructus Vascularis Citri 4 5 gm Tu Hong Hua Flos Carthami 4 5gm Pu Gong Ying Herba Cum Radicis Taraxum 12gm Bai Mao Teng Herba Solanum Lirati 30 gm T Da Mai Ya AF There after I used the same prescription modified in accordance with the symptoms She intermittently took the herbs for a period of close to one year In April of the next year she became pregnant Case 3 Ji Mai San R Ms Chang was twenty five when she came for her first visit on December 13 1976 She had been married for three years without becoming pregnant Premenstrually she suffered from breast distention and pain each month and her menstruation was early or late without regularity The amount was profuse and continued for six to seven days During menstruation her bowels D were sticky and each day moved repeatedly Her pulse was sinking and thin and her tongue moss was sticky Her pulse and pattern corresponded My differential diagnosis of Ms Chang s condition was Liver depression and Qi stasis and Spleen vacuity causing the Spleen to lose its ability to transport The treatment needed to course the Liver and fortify the Spleen I gave her seven packages of the following prescription Chai Hu Radix Bupleurum 9gm Bai Ji Li Fructus Tribuli 9gm Ba Yue Zha Fructus Akebiae 9gm

Lack of Bleeding 58 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Herba Mentha 4gm Qing Pi Pericarpium Citri Immaturus 4 5 gm Wang Bu Liu Xing Semen Vacarri 9gm Ju He Semen Citri 4 5 gm Ju Luo Vascularis Citri 4 5 gm Chao Bian Dou Stir fried Semen Dolichoris Lablab 12gm Da Mai Ya Fructus Hordei Germinatis 15gm Shen Qu Massa Fermentata 9gm T Bo He Second Visit December 22 1976 Ms Chang s case presented as before I continued with AF the previous method with some additions and subtractions and gave her seven packages of the following prescription Radix Bupleurum 9 gm Da Mai Ya Fructus Hordei Germinatis 15 gm Jiao Dong Zhu Scorched Rhizoma Atractylodis 4 5 gm Chao Chuan Xiong Stir fried Rhizoma Ligusticum 4 5 gm Wang Bu Liu Xing Semen Vacarri 9gm Zhi Ji Nei Jin Honey fried Endothelium Galli Gigerii 9gm u He Semen Citri 4 5 gm u Luo Vascularis Citri 4 5gm Hong Hua Flos Carthamis 9gm Bai Ji Li Fructus Tribuli 9gm Ba Yue Zha Fructus Akebiae 9gm Chao Shan Zha Stir fried Fructus Cratagai 9gm Shen Qu Massa Fermentata 9gm Dang Gui Radix Angelica Sinensis 9gm D R Chai Hu I gave Ms Chang the above prescription with additions and subtractions according to her pattern for an interval of over two months Her menstruation became regular and this year she

Lack of Bleeding 59 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum became pregnant Discussion In terms of infertility and unsynchronized menstruation due to Liver depression and knotting I use my proven prescription Ii Mai San Tribulus Germinated Barley Powder It has great unsurpassed effectiveness for this category of pathology Dr Xia s cases Case 4 T When I use Wu Wei Taio Jing Tang in the clinic to regulate the menstruation up until the menstruation arrives or 1 2 days before menstruation I often AF combine it with Yue Ju Wan Yue Ju Wan contains Shan Zhi Zi for which I substitute Dan Pi It also contains Liu Qu for which I substitute Shan Zha This becomes one of my frequently used formulas in the clinic and the effect is quite good Yue Ju Wan helps the smooth flow of the Liver and regulates Qi Wu Wei Tiao Jing San Tang regulates the menstruation from within the blood One formula is for the blood and one is for the Qi Each formula R makes the other shine more brightly Honestly these are good herbs and good formulas for regulating the menstruation I had a patient named Wang who was 32 years old Her menstruation was D late and scanty and now had not come for 3 months She began menstruating at age 12 and bled for 3 5 days every 30 days The color was red and there were small clots in it She had menstrual pain After she was married she used mechanical birth control She often had vaginal discharge At ovulation time she had bright stringy discharge for 3 days Gynecology check up There was a mild degree of cervical inflammation but otherwise there were no abnormalities In the last half year she had gotten very keyed up in relation to her work situation She felt emotional discomfort and her menstruation became irregular Gradually her menstruation came later 50

Lack of Bleeding 60 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum days between and the amount was scanty The color was purple red and there were clots in the blood She felt acute lower abdominal pain and premenstrually she felt chest oppression agitation breast distention and insomnia Her pulse was thin and wiry and the tongue moss was thin and white and sticky I gave her Yue Ju Wan and Wu Wei Tiao Jing Tang From 2 days before her menstruation until it had stopped she took the herbs We worked this way for about 2 months Her menstruation regulated to come back around to health Patho mechanisms AF Wind Cold congealing and knotting T every 35 17 days and the amount became normal On the whole she came Cold is received during the menstrual period or too much cold food is eaten Cold Qi makes itself at home in the uterus and knots the Chong and Ren obstructing the R Jing and Luo vessels This causes the menses to stop moving Special Points for Differentiation The facial expression may be weary lower abdominal distention and pain lower back soreness continuous vaginal discharge fear of wind headache thin white D tongue moss with a deep and slow or tight Commonly Used Herbs and Formulas Treatment should warm menses and scatter cold The formula to use is Wen Jing Tang Warm the Menses Soup with modifications

Lack of Bleeding 61 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Dr Qiu Xiao mei s cases Case 1 Ms Cai was 24 when she came for her first visit on July 16 1973 During her menses she waded in water and caught cold The cold Qi knotted the uterine gate and the movement of uterine blood became difficult and rough She had amenorrhea already for 4 months Her lower abdomen was distended and painful T at times Her pulse was thin and rough The tongue moss was thin white AF Differential diagnosis Wind Cold congealing and knotting causing amenorrhea Treatment should warm the menses and scatter cold I gave her 7 packages of the following formula and her menses returned Gui Zhi Ai Ye Su Ye 4 5 4 5 9 R Chao Dang Gui 4 5 9 Zhi Xiang Fu 9 Chuan Xiong 2 4 Wu Zhu Yu 1 8 Chao Dan Shen 12 D Chao Chi Shao After this I gave her the common formula Ba Zhen Tang with modifications Discussion In this example of amenorrhea Ms Cai received a cold wind and this gave rise to the cold evil making itself at home in her uterine gate I used herbs to nourish blood and regulate menses along with Gui Zhi Ai Ye and Su Ye to dispel wind and scatter cold in hopes that the external evil would leave and the uterine

Lack of Bleeding 62 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum blood would open and flow smoothly and the menstrual water would spontaneously flow down Jue Yin Bleeding Contained within Jue Yin is the middle Qi of the Shao Yang ministerial fire Jue Yin is the unity of wind and ministerial fire It is the fanning force behind the circulation of ministerial fire in the hollow yang realm as well as the warm rising of blood within the T solid yin realm of the body Jue Yin contains and steers the blood which it spreads freely in all four directions up down in and out The driving force behind this distribution of blood is the moving warm qi contained within the blood or in other words the Shao AF Yang Jue Yin is born from water and gives birth to fire As such it is the bridge between water and fire and the eastern pathway through which rising water of the north communicates and connects with descending fire of the south The Yin segment of the Jue Yin tract belongs to the Liver which stores and moves the blood The yang segment of the Jue Yin tract belongs to the pericardium R Jue Yin is the resolution of Yin the death of Yin As such it is the precursor to the birth of yang just as on a material level blood is the mother of qi Yang is born from the water within the earth at the midnight time as represented by the hexagram fu recovery D Jue Yin wood fans the birth of this initially lesser fire allowing it to increasingly warm and ascend the steaming boiling fluids of the northern water element This is the end of night until the break of dawn during which time yang rises from within the water upwards through the earth to arise from the horizon and form the yang conformations

Lack of Bleeding 63 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Of all the Yin conformations Jue Yin thus holds the most yang and least yin and its overall direction is upward and outward When the Jue Yin closes too much or too prematurely yang is not born due to absence of resolution of the Yin stage This results in blood remaining too cold and too stagnant unable to rise and float and failing to warm and nourish the extremities and the surface T such as in Dang Gui Si Ni Tang 1 Wu Mei Wan AF Commonly used Formulas 480 24 30 120 1 5 3 180 1 5 3 480 9 12 Huang Bai 180 6 9 Gan Jiang 300 6 9 Wu Mei Hua Jiao Xi Xin D R Huang Lian Zhi Fu Zi 180 3 6 Gui Zhi 180 3 6 Ren Shen 180 6 9 Dang Gui 120 3 9 1 Arnaud Versluys from The Lantern

Lack of Bleeding 64 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Steep the Wu Mei in vinegar overnight pit and mash and cook with rice until the rice is done Add the remaining ingredients grind into powder and add refined honey to form into small pills the size of a parasol tree seed Take 10 pills three time before meals Special points for differentiating the pattern Diarrhea or constipation T Cold extremities Upward surging of qi vomiting headache anxiety dry retch anorexia throat obstruction Abdominal pain Deep pulse R Case Example AF insomnia The use of Wu Mei Wan modified in the treatment of Chronic diarrhea and amenorrhea One Case by Qin Bo wei translated by Sharon Weizenbaum D Qin Bo Wei Chronic Diarrhea and Amenorrhea Ms Zhao was a 23 year old woman Main complaint in 1951 Ms Zhao bowel movements became sticky and loose The symptoms would come and go She took many western and Chinese drugs with no effect At the start of winter in 1961 the frequency of the diarrhea increased and began to happen at night so she came in for a check up

Dang Shen 10 gm Rou Gui 5 Huang Lian 3 65 Mu Xiang Lack 5of Bleeding Translations and Commentary Chuan Jiao 3 Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Dang Gui 9 Bai Shao 9 Check5up At the time of the visit Ms Zhao was moving her bowels 2 3 times per day and Zhi Gan Cao Si Shen Wan 181 2 times during the night Before she moved her bowels she heard noises and felt another abdominal distention and pain She would often leak when she had flatulence Her condition was hard for her to bear After moving her bowels she immediately felt more comfortable Ms Zhao also experienced profuse sweat heat in the heart and palms dry mouth with a desire to drink poor appetite sore lower back heavy lower limbs Her lower back liked to be warm She also had amenorrhea Her pulse was deep and thin and T her tongue body was pale with a slippery sticky white moss Differential diagnosis was Chronic diarrhea related to Kidney vacuity cold damp AF stagnating with heat accumulating Treatment method I used the pungent bitter sweet and sour flavor of Wu Mei Wan in order to treat chronic diarrhea 2 Second Visit After taking four packages of these herbs Ms R Zhao s abdominal pain had slightly decreased but all her other symptoms remained unchanged I reconsidered the sticky white tongue moss and decided to first dispel lower jiao heaviness with D accumulated damp I took out the Bai Shao and Si Shen Wan and added Cang Zhu Wu Yao Rou Dou Kou Pao Jiang 2 Taken from Zhong Guo Xian Dai Ming Zhong Yi Yi An Jing Hua Essential Traditional Chinese Medical Case Studies from Famous Modern Doctors Volume 3 page 1639 Pub by Bei Jing Science and Technology Press 1990

Lack of Bleeding 66 Translations and Commentary Dr Qiu Xiao Mei Translated by Sharon Weizenbaum Third Visit After 4 packages of the herbs the abdominal pain had greatly decreased and there was no flatulence At night there was no diarrhea Her tongue moss had transformed to thin Her menses came though the amount was scanty and the color purple I gave her more of the previous formula adding Xiao Hui Xiang to open through the Kidney Qi The illness was moving toward resolution Checking in a year later there was no relapse T This illness had lasted ten years The diarrhea was at daybreak and at night and was accompanied by low back soreness and limb heaviness and lower back craving warmth This showed lower warmer vacuity cold which belongs to the category of Kidney diarrhea AF On the other hand this was combined with interior abdominal distention and pain relief after moving the bowels as well as palm heat dry mouth and amenorrhea These signs and symptoms illustrate that the stomach and intestine are not transforming and dispersing food Simultaneously there are manifestations of Liver vacuity with depressive heat Vacuity Excess Cold and Heat are mixed Cold damp has heat knotted within In terms of chronic diarrhea and chronic leakage pathology Dr Qin often selects Wu Mei Wan D R method for treatment This often obtains a good result