Free Chinese Gynecology Research Reports

Translated by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Copyright © Blue Poppy Enterprises, Inc., 2000. All rights reserved.

The following research reports from the People’s Republic of China all deal with various gyneco­logical conditions. They are offered for free as examples of the other research reports Blue Poppy sells.

Various Menstrual Diseases

"The Treatment of Menstrual Disease with Hua Gan Jian (Transform the Liver Decoction) by Wang Cui-ping, Tian Jin Zhong Yi (Tianjin Chinese Medicine), #2, 1993, p. 8

The author of this article reports on the treatment of various menstrual diseases using Hua Gan Jian. This formula is found in Zhang Jie-bin's Jing Yue Quan Shu (The Complete Writings of [Zhang] Jing-yue). It is comprised of: Pericarpium Citri Reticulatae Viride (Qing Pi), Pericarpium Citri Reticulatae (Chen Pi), Fructus Gardeniae Jasminoidis (Zhi Zi), Cortex Radicis Moutan (Dan Pi), Rhizoma Alismatis (Ze Xie), Radix Albus Paeoniae Lactiflorae (Bai Shao), and Tuber Bolbostemmae Paniculati (Tu Bei Mu). This formula is used to treat angry qi damaging the liver with qi counterflow stirring fire resulting in vexatious heat, rib-side pain, distention, and fullness, stirring blood, etc. This formula resolves liver qi depression, levels qi counterflow, and scatters depressive fire. With various additions and subtractions, it may be used to treat various menstrual diseases.

Early menstruation

Case history: Female 36 years old, married, peasant. For the previous four months, this woman's menses had been coming approximately 10 days early. When severe, she would have two menstruations in a single month. The color of the menstruate was purplish red and its amount was excessive. Before menstruation, she experienced chest oppression, vexation and agitation, and bilateral breast distention and pain. After the menses, she suffered from heart palpitations, vertigo, dry mouth, profuse dreams, shortness of breath, fatigue, and low back and knee soreness and weakness. Her tongue was pale with thin, yellow fur. Her pulse was bowstring and fine. This pattern was categorized as liver depression and blood heat with loss of nourishment of the chong and ren. The treatment principles were, therefore, to course the liver and clear heat, level and supplement the qi and blood in order to nourish the chong and ren.

She was given Hua Gan Jian Jia Jian (Transform the Liver Decoction with Additions & Subtractions): Pericarpium Citri Reticulatae Viride (Qing Pi), 10g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Fructus Gardeniae Jasminoidis (Zhi Zi), 9g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 18g, Radix Bupleuri (Chai Hu), 9g, Radix Angelicae Sinensis (Dang Gui), 12g, Radix Pseudostellariae (Tai Zi Shen), 15g, uncooked Radix Rehmanniae (Sheng Di), 12g, Fructus Ligustri Lucidi (Nu Zhen Zi), 15g, and Herba Ecliptae Prostratae (Han Lian Cao), 30g. Three ji were decocted in water and administered. After taking the above medicinals, her condition immediately improved and her menstruation returned to normal after two months of treatment.

Erratic menstruation

Case history: Female, 43 years old, worker. For a half year, this woman's menses had been coming sometimes early and sometimes late. Along with menstruation, she experienced lower abdominal distention and pain, her menstruate was dark red, it contained clots, but its amount was moderate. She commonly had excessive vaginal discharge which was yellow in color and pasty in consistency. This was sometimes accompanied by vaginal itching. Her stools were dry and her urination was yellow. The tip of her tongue was red and it had thin, yellow fur. Her pulse was bowstring and a little rapid. This pattern was categorized as liver qi depression and binding with menstrual irregularity. Its treatment methods were to course the liver and resolve depression, clear heat and eliminate dampness.

She was given Hua Gan Jian Jia Jian: Pericarpium Citri Reticulatae Viride (Qing Pi), 10g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Radix Bupleuri (Chai Hu), 9g, Cortex Radicis Moutan (Dan Pi), 10g, Fructus Gardeniae Jasminoidis (Zhi Zi), 9g, Radix Angelicae Sinensis (Dang Gui), 10g, Tuber Curcumae (Yu Jin), 10g, Herba Leonuri Heterophylli (Kun Cao), 30g, Semen Coicis Lachryma-jobi (Yi Mi), 20g, Rhizoma Atractylodis and Atractylodis Macrocephalae (Cang Bai Zhu), 10g each, stir-fried Herba Seu Flos Schizonepetae Tenuifoliae (Jing Jie), 10g, Semen Plantaginis (Che Qian Zi), 10g, Rhizoma Alismatis (Ze Xie), 10g, and Radix Glycyrrhizae (Gan Cao), 6g. Three ji were decocted in water and administered. After taking these medicinals, there was no result; therefore, another 3 ji were given and after that the period came with obvious improvement in premenstrual signs and symptoms. This formula was given again for 10 days before each menstruation for three whole months and the menses came on time both then and subsequently.

Dysmenorrhea

Case history: Female, 20 years old, student. For two years, the patient would have two days of lower abdominal pain with her menses accompanied by low back and lower limb soreness. When the pain was severe, she would also have chills and sweating. The amount of menstruate was normal but contained blood clots. As soon as these clots were discharged, the pain diminished. The patient was typically vexed and easily angered and her sleep was disturbed. Her tongue was red and her pulse was bowstring and fine. This pattern was categorized as liver depression and qi stagnation with blood stasis obstructing the menses. The treatment principles were to course the liver and rectify the qi, quicken the blood and transform stasis.

The patient was given Hua Gan Jian Jia Jian: Pericarpium Citri Reticulatae Viride (Qing Pi), 10g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 18g, Radix Bupleuri (Chai Hu), 9g, Tuber Bolbostemmae Paniculati (Tu Bei Mu), 12g, Herba Leonuri Heterophylli (Kun Cao), 30g, Semen Pruni Persicae (Tao Ren), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 15g, Tuber Curcumae (Yu Jin), 12g, and Radix Glycyrrhizae (Gan Cao), 6g. Three ji were decocted in water and administered. After taking these medicinals, the menses came and the lower abdominal pain was diminished and the clots discharged were smaller. Therefore, Persica was removed from the formula and Radix Pseudostel­lariae (Tai Zi Shen), 30g, was added and another three ji were given. After menstruation, the patient felt short of breath and with little strength. Therefore, she was given Ba Zhen Tang Jia Jian (Eight Pearls Decoction with Additions & Subtractions). For the next two cycles, one week before menstruation, she was treated again as above and was completely cured.

Amenorrhea

Case history: Female, 40 years old, worker. This woman had had high blood pressure for three years. Beginning one year previous, her menses had started coming late and she had had amenorrhea for the last eight months. Her body was weak and deficient and she was fatigued and without strength. Her spirit was emotionally depressed and her chest and rib-side regions were not comfortable. She did not sleep well and her appetite was diminished. Her blood pressure was 170/110mmHg and her head was distended and painful. Her tongue was purple and dark and her pulse was bowstring and rapid. This pattern was categorized as liver depression and qi binding with liver yang hyperactive above. The treatment principles were to course the liver and resolve depression, level the liver and subdue yang.

The patient was given Hua Gan Tang Jia Jian: Pericarpium Citri Reticulatae Viride (Qing Pi), 10g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Fructus Gardeniae Jasminoidis (Zhi Zi), 10g, Tuber Bolbostemmae Paniculati (Tu Bei Mu), 12g, Cortex Radicis Moutan (Dan Pi), 10g, Rhizoma Gastrodiae Elatae (Tian Ma), 20g, uncooked Concha Haliotidis (Sheng Shi Jue), 30g, Ramulus Uncariae Cum Uncis (Shuang Gou), 20g, Radix Achyranthis Bidentatae (Niu Xi), 12g, Dens Draconis (Long Chi), 30g, Radix Bupleuri (Chai Hu), 9g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 18g, Fructus Corni Officinalis (Zhu Rou), 15g, Fructus Ligustri Lucidi (Nu Zhen Zi), 12g, Semen Zizyphi Spinosae (Zao Ren), 30g, Radix Glycyrrhizae (Gan Cao), 10g, Herba Lycopi Lucidi (Ze Lan), 15g, Cortex Phellodendri (Juan Bai), 15g, and Herba Leonuri Heterophylli (Kun Cao), 30g. Three ji were decocted in water and administered.

After taking these medicinals, the patient's blood pressure was 150/90mmHg. Semen Pruni Persicae (Tao Ren), 10g, was added and another seven ji administered. After another five ji, she experienced some insidious lower abdominal pain and had a small amount of dark, blackish colored menstrual blood. Two days later, her menses came on in full and her blood pressure was 140/80mmHg. Radix Salviae Miltiorrhizae (Dan Shen), 20g, Caulis Millettiae Seu Spatholobi (Ji Xue Teng), 30g, and Ramulus Loranthi Seu Visci (Ji Sheng), 30g, were added to the previous formula for treatment the next month after which the blood pressure returned to normal and the amenorrhea was cured.

The author comments that the liver is the viscus of wind wood. It stores yin blood and is the abode of ministerial fire. In form it is yin but in function it is yang. If the liver becomes depressed and does not course, the qi mechanism becomes shut and does not flow freely. In that case, ministerial fire may not be able to be disseminated and spread about. Thus stirring fire may damage the blood. As Zhang Jing-yue has said, "Qi counterflow stirs fire." In this case, this may also result in blood stasis, water accumulation, damp obstruction, and phlegm gathering diseases. Further, if there is liver depression and qi stagnation, this will affect the functioning of the chong and ren resulting in the generation of menstrual diseases.

Therefore, the author thinks that correct treatment method for liver depression should be based on the saying, "Depressed wood should be out-thrust."  Hua Gan Jian uses no other medicinals than those which course and open. Green Orange Peel courses the liver, loosens the chest, and resolves depressive anger. Gardenia clears heat and diffuses depression. Since heat damages yin blood, it is combined with Peony which enters the blood division. Together these two medicinals supplement blood vacuity while draining liver repletion. Moutan is added to clear blood heat and move blood stagnation. When stagnation is removed and heat eliminated, depression is automatically resolved. Alisma drains and percolates dampness and disinhibits water. Thus protecting against dampness stops accumulation of phlegm. Orange Peel rectifies the qi and transforms phlegm, while Bolbostemma Paniculatum down-bears phlegm and opens binding.

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Premenstrual Lip Swelling & Pain

"One Case of Premenstrual Swelling & Pain of the Mouth Lips Treated by Xie Huang San (Draining Yellow Powder)" by Zhang Shu-min, Bei Jing Zhong Yi (Beijing Chinese Medicine), #6, 1993, p. 46

Xie Huang San originally comes from the Xiao Er Yao Zheng Zhi Jue (Proven, Straightforward Rhymes [Concerning] Medicinals for Children). It was meant to treat pediatric spleen heat affecting the tongue. The fifth edition of Fang Ji Xue (The Study of Formulas & Prescriptions) says it is also able to treat spleen/­stomach hidden heat, oral ulcers, bad breath, vexatious thirst, easy hunger, a dry mouth and lips, etc. Composed of Herba Agastachis Seu Pogostemi (Huo Xiang Ye), Fructus Gardeniae Jasminoidis (Shan Zhi Zi), Gypsum Fibrosum (Shi Gao), Radix Glycyrrhizae (Gan Cao), and Radix Ledebouriellae Divaricatae (Fang Feng), this formula is capable of draining spleen-stomach hidden fire.

Case history: Female, 42 years old, cadre. This woman came for her first diagnosis in November 1988. For one year previously, each time before her menses came, her lips would become swollen and painful. She had already been treated with Western medical antibiotics and vitamins but with no obvious improvement. Therefore, she had come for Chinese medical diagnosis and treatment. Her condition manifested as swollen and enlarged lips of the mouth. Her lips were red and when she ate, her lips would crack causing extreme aching and pain. The mucosa inside her oral cavity was normal, and, after menstruation, her condition relaxed and resolved. The amount of her menstrual blood was categorized as profuse. Its color was dark and it contained clots. Her menses lasted 7-8 days. Her last menstruation had come on Oct. 22. This month her menses had not yet come. Abnormal vaginal discharge was colored yellow but was not excessive in amount. For the last half day, her stools had been dry and knotted. She was vexed, tense, and easily angered. Her tongue was pale red with yellow fur, and her pulse was bowstring and rapid.

Her pattern discrimination was spleen-stomach stagnant heat which flamed upward with menstruation. The treatment principles were to drain heat and scatter fire, cool the blood and regulate the menses. The formula consisted of: Herba Agastachis Seu Pogostemi (Huo Xiang), 20g, Fructus Gardeniae Jasminoidis (Shan Zhi Zi), 10g, Gypsum Fibrosum (Shi Gao), 20g, Radix Ledebouriellae Divaricatae (Fang Feng), 15g, Rhizoma Coptidis Chinensis (Huang Lian), 10g, Herba Menthae Haplocalycis (Bo He), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 10g, Flos Pruni Mume (Lu O Mei), and Radix Glycyrrhizae (Gan Cao), 10g. She was given three ji, decocted in water and administered.

At her second examination (i.e., second visit), she reported that, after taking the above medicinals, the swelling and pain of the lips of her mouth had very markedly diminished. However, the amount of her menses had been excessive. Therefore, 10 grams each of Herba Artemesiae Apiaceae (Qing Hao) and Herba Leonuri Heterophylli (Kun Cao) were added to her formula and she was given three more ji. This led to her disease being cured. She used the above treatment during the week of her menses for the next three months. The amount of her menstruation diminished and was without clots and her menstrual flow lasted five days and then stopped.

According to the author's discussion, premenstrual lip swelling and pain is not commonly seen in clinical practice. This disease is not (solely) located in the viscera and bowels, and, therefore, using (only) bitter, cold medicinals to clear heat, it is difficult to get a completely satisfactory result. This is because this disease is located within the spleen channel. The spleen opens into the orifice of the mouth, and its efflorescence is in the lips. In this case, there is stagnant heat in the spleen and stomach. This is due to depressive fire internally harassing. Heat tends to flame upward and this causes premenstrual swelling and pain of the lips of the mouth. After menstruation , this heat follows the exiting of the blood and the condition disappears. If there is heat within the body, this may also affect the two vessels, the chong and ren. This then manifests as heavy and prolonged menses. The appropriate treatment for this condition is to drain and scatter fire.

Within the formula Xie Huang San, uncooked Gypsum's acridity and coldness scatters fire, while its bitterness and coldness clear heat. In addition, it enters the spleen and stomach. Gardenia, which is bitter and cold, clears and disinhibits the three burners. Thus heat is exited via the urination. Because, in this case, heat is flaring upward in the spleen channel, Ledebouriella is used to course and scatter stagnant heat. Therefore, the upper and lower are divided and dispersed, resulting in heat being disinhibited and conducted. This is based on the principle in the Nei Jing (Inner Classic), "Out-thrust depressive heat." Agastaches fragrantly and aromatically out-thrusts and scatters. It is assisted by Ledebouriella which scatters fire. These two also arouse the spleen and harmonize the stomach. Uncooked Licorice drains fire and resolves toxins. It also regulates the other medicinals and harmonizes the center. Coptis is added to assist Gypsum downbear heat in the spleen/stomach. Mint and Flos Pruni Mume, which are acrid and cool, are added to scatter depressive fire. Red Peony cools the blood and regulates the menses. Artemesia Apiacea fragrantly and aromatically penetrates and scatters heat from the blood division. And Leonurus quickens the blood and transforms stasis, thus regulating the chong and ren. Therefore, taken as a whole, this formula courses and scatters above and below. This agrees with the Ming dynasty master of medicine Wu Kun's saying:

Use windy medicinals to scatter hidden fire. Use clearing medicinals to drain accumulations and stagnation. Combine these with sweet, relaxing (medicinals) to harmonize the center. Thus the righteous qi will not be damaged. This method is quite good.

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Gynecologic Impediment Condition

"The Treatment of 100 Cases of Gynecologic Bi Zheng with Great Supplementation of the Qi & Blood Method" by Jin Ming-mo, Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), #5, 1993, p. 27

This clinical audit describes the treatment of 100 cases of gynecological impediment condition using the method of greatly supplementing the qi and blood. The author treated these women between 1982-1992. This condition is called gynecological impediment because a D&C, miscarriage, induced labor, or postpartum (condition) results in impediment pain. Of the 100 women, 17 had had D&Cs, nine had had miscarriages, five had had induced labors, five had had Caesarean births, and 64 had had normal births. Thirteen came for examination one week after delivery, 46 in the second week after delivery, 30 one whole month after delivery, and 11 after more than a month after delivery. Forty-five cases had generalized aching and pain in their joints. Twenty-two had low back pain. Nineteen had knee pain, and 14 had shoulder and upper arm joint pain. Ten cases had fear of wind and fear of chill. Twenty-three cases had headache and vertigo. Eight cases had shoulder, upper back, and hip pain due to wind cold external invasion. Nine cases had facial edema and three cases had generalized edema. Six cases had toothache, three cases had ringing in the ears, two cases had feet and leg pain, three cases had eye pain, two cases had tearing, and three cases had spoon-shaped fingernails.

In order to greatly supplement the qi and blood, the following medicinals were used: Radix Rubrus Panacis Ginseng (Hong Shen), 10g, Radix Astragali Membranacei (Huang Qi), 100g, Semen Pruni Persicae (Tao Ren), 10g, Radix Ligustici Wallichii (Chuan Xiong), 10g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 10g, Cortex Cinnamomi Cassiae (Rou Gui), 5g, Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 10g, Radix Angelicae Pubescentis (Du Huo), 10g, Radix Et Rhizoma Notopterygii (Qiang Huo), 10g, Scolopendra Subspinipes (Wu Gong), 2 pieces, and Buthus Martensis (Quan Xie), 5g. These were decocted in water and administered two times per day.

If there was shoulder and upper back pain, Rhizoma Curcumae (Jiang Huang) was added. If there was low back pain, Radix Dipsaci (Chuan Duan) and Radix Achyranthis Bidentatae (Niu Xi) were added. If there was knee pain, Cortex Eucommiae Ulmoidis (Du Zhong) and Ramulus Loranthi Seu Visci (Sang Ji Sheng) were added. If there was edema, shortness of breath, and dizziness, the amount of Astragalus was increased. If there was poor appetite, scorched Three Immortals (Jiao San Xian) were added.^[1] If there were spoon-shaped fingernails, Dang Gui was added. If there were flourishing of wind evils, Zaocys Dhumnades (Wu She) was added, but if damp evils were victorious, Rhizoma Dioscoreae Hypoglaucae (Bi Xie) and Semen Coicis Lachryma-jobi (Yi Yi Ren) were added. And if cold evils were flourishing, Radix Aconiti Carmichaeli (Chuan Wu) was added.

Of these 100 cases, 86 were completely cured, meaning that, after treatment, their aching and pain disappeared, their movement became normal, and one half year later there was no recurrence. Ten cases received some results. This meant that their aching and pain did not completely disappear but they were able to work normally. And four cases experienced no results, their condition not changing from before to after treatment. Thus the total amelioration rate with this protocol was 96%.

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Menstrual Pneumothorax

"A Clinical Report on the Treatment of 6 Cases of Menstrual Pneumothorax Using Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction)" by Shen Guo-nan & Cheng Qun-cai, Zhong Yi Za Zhi (Journal of Chinese Medicine), #11, 1993, p. 668

Menstrual pneumothorax refers to either one-sided or bilateral pneumothorax occurring in women either premenstrually or during menstruation. This typically recurs each cycle. It is a rarely seen condition in clinical practice. However, since 1983, the authors have seen six cases of this disease which they have treated with Xue Fu Zhu Yu Tang with good results.

These six cases were all between 14-19 years of age. They had experienced pneumothorax during their menses from 3-16 times. There were five cases of one-sided pneumothorax and one case of bilateral pneumothorax. In four cases, lung compression was below 30%, in one case 50%, and in one case 70%. There was no previous history of chest or lung disease. In two cases, examination of the pleura revealed the presence of endometriosis.

Xue Fu Zhu Yu Tang consisted of: Semen Pruni Persicae (Tao Ren), 10g, Flos Carthami Tinctorii (Hong Hua), 10g, Radix Angelicae Sinensis (Dang Gui), 12g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 15g, uncooked Radix Rehmanniae (Sheng Di), 12g, Radix Ligustici Wallichii (Chuan Xiong), 15g, Radix Bupleuri (Chai Hu), 12g, Fructus Citri Aurantii (Zhi Ke), 12g, Radix Platycodi Grandiflori (Jie Geng), 12g, Radix Achyranthis Bidentatae (Niu Xi), 12g, and Radix Glycyrrhizae (Gan Cao), 10g. The above medicinals were decocted in 800ml of water, afterward reserving 600ml of liquid. One ji was used per day divided into three doses administered orally during the entire episode of pneumothorax. Afterwards, beginning 10 days before the next menstruation, one ji was administered per day through menstruation. If there was no recurrence of pneumothorax, these medicinals were stopped after two menstrual cycles.

The smallest number of ji administered was seven and the largest was 15, with the average being nine ji. There was no recurrence of pneumothorax after 3-5 menstrual cycles and, on follow-up after one year, this disease had been cured by this treatment. Thus all six cases were healed.

Case history: Female, student, 16 years old. This girl's menstruation had begun at 14 years of age. For the previous six months, 3-5 days before the onset of each menstruation, she experienced chest oppression, rapid breathing, cough, and right-sided chest pain. She was diagnosed as suffering from right-sided pneumothorax and her lung compression was only 30% She was hospitalized for treatment for 10 days, (during which time) the gas (in her pleural cavity) was reabsorbed. Some time later her condition recurred. She experienced vexation and agitation and rapid breathing. Her lips were dark purple. Her tongue was static (colored) and dark with  thin, white fur. And her pulse was choppy and rapid. She had a stuffy feeling in the area of her right ribs and her breathing was diminished and weak. Again she was diagnosed as suffering from right-sided pneumothorax and her lung compression was 50%. Because she also experienced abdominal pain each time her menses came, because her menstruation's amount was scanty and dark colored, and because her menstruation was, to varying degrees, late, the authors diagnosed her case as suffering from menstrual pneumothorax and administered the above medicinals for three days, after which her menses came. Their amount was scanty and color was dark. They also contained clots. Eleven ji later, her pneumothorax was completely reabsorbed. For the next two menstrual cycles, the patient was administered these medicinals during her menses. Although she experienced a recurrence of pneumothorax, its symptoms were reduced and her lung compression was only 10% below normal. She stopped taking these medicinals after another two menstrual cycles and, one year later on follow-up, there had been no recurrence.

The authors say that menstrual pneumothorax may be associated with endometriosis. Because it presents with chest oppression and chest pain, rapid breathing, cough, and a suffocating feeling along with scanty menstruation which is dark colored and is accompanied by abdominal pain when the menstruation comes, it may be classified as qi stagnation and blood stasis. Therefore, its treatment should mainly consist of regulating and rectifying the qi mechanism, quickening the blood, and transforming stasis. Xue Fu Zhu Yu Tang is a formula which quickens the blood and transforms stasis. It treats diseases having these very disease mechanisms.

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Post-menstrual Strangury

"The Treatment of Post-menstrual Strangury with Jia Wei Lao Lin Tang (Added Flavors Taxation Strangury Decoction)" by Ni Shi-tao, Si Chuan Zhong Yi (Sichuan Chinese Medicine), #6, 1993, p. 41

Since 1981, the author has treated 70 cases of post-menstrual strangury using Zhang Jing-yue's Lao Lin Tang with added flavors, and, in all cases, this was completely effective. Jia Wei Lao Lin Tang consisted of: Radix Dioscoreae Oppositae (Shan Yao) and Rhizoma Imperatae Cyclindricae (Bai Mao Gen), 30-60g each, Herba Plantaginis (Che Qian Cao), 20-30g, Semen Euryalis Ferocis (Qian Shi) and uncooked Radix Astragali Membranacei (Sheng Huang Qi), 15-25g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), 10-15g, Gelatinum Corii Asini (E Jiao), Sclerotium Polypori Umbellati (Zhu Ling), and Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 10g each, and Radix Glycyrrhizae (Gan Cao), 6g.

If there was damp heat, the amount of Euryales and Astragalus was reduced and Caulis Akebiae (Mu Tong), Talcum (Hua Shi), and Cortex Phellodendri (Huang Bai) were added. If vacuity cold was severe, Imperata and Anemarrhena were subtracted and Ramulus Cinnamomi Cassiae (Gui Zhi) and Rhizoma Curculiginis Orchioidis (Xian Mao) were added. If there was copious blood in the urine, Herba Cephalanopoloris Segeti (Xiao Ji), uncooked Radix Rehmanniae (Sheng Di), and carbonized Pollen Typhae (Pu Huang) were added. If there was lower abdominal distention and fullness, Radix Auklandiae Lappae (Mu Xiang) and Rhizoma Cyperi Rotundi (Xiang Fu) were added. If there was low back and knee soreness and weakness, Radix Achyranthis Bidentatae (Huai Niu Xi), cooked Radix Rehmanniae (Shu Di), and Cortex Eucommiae Ulmoidis (Du Zhong) were added. These were decocted in water and administered, one ji per day. Administration began five days before menstruation and continued to the onset of the menses. Approximately 10-14 ji equalled one course of treatment.

Case history: Female, 36 years old. Each month after her menses, this woman would experience urinary frequency and urgency accompanied by a burning hot, unsmooth feeling. For the previous three years, after each menstruation, she had used antibiotics and vitamins B₁ and B₆ which reduced the symptoms somewhat. Currently, before each menstruation, she felt lassitude of the spirit and bodily fatigue. In addition, she had a dry throat and heart vexation, a pale tongue with thin, yellow fur, and a fine, rapid pulse. This pattern was categorized as spleen-kidney dual vacuity with vacuity heat harassing internally and inhibited  qi transformation. The treatment principles were to fortify the spleen and boost the kidneys, enrich yin and clear heat, and free the flow of strangury.

The formula used was Jia Wei Lao Lin Tang: Radix Dioscoreae Oppositae (Shan Yao) and Rhizoma Imperatae Cylindricae (Bai Mao Gen), 30g each, uncooked Radix Astragali Membranacei (Sheng Huang Qi), 20g, Semen Euryalis Ferocis (Qian Shi) and Herba Plantaginis (Che Qian Cao), 25g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), Gelatinum Corii Asini (E Jiao), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), and Sclerotium Polypori Umbellati (Zhu Ling), 10g each, and Radix Glycyrrhizae (Gan Cao), 6g. The patient was given three ji and then the menses came and the medicinals were stopped. Three day after the menstruation stopped, three ji of the previous formula were given and the symptoms disappeared. However, there was still low back and knee soreness and weakness. Therefore, 15g of Cortex Eucommiae Ulmoidis (Du Zhong) and 25g each of Radix Achyranthis Bidentatae (Huai Niu Xi) and cooked Radix Rehmanniae (Shu Di) were added to the above formula. She was given eight ji, five of which she took then and three of which she took before her next menstruation. After one course of treatment, she was cured and there was no recurrence after two years.

According to Dr. Ni's discussion, this condition corresponds to a urinary tract infection in Western medicine. In Chinese medicine, after menstruation, the qi and blood are both vacuous. During this period, the liver and kidneys may lose their regulation and the bladder qi may lose its control with heat being retained within the bladder. The Zhu Bing Yuan Hou Lun (Treatise on the Cause & Symptoms of Diseases) states,

Strangury is caused by kidney vacuity and heat in the bladder...Kidney vacuity leads to the urination being numerous. Heat in the bladder leads to water's descent being astringent. This then leads to dribbling which is not diffused and this is what is called strangury.

Therefore, this formula with its added ingredients supplements the kidneys and fortifies the spleen, boosts the qi and enriches yin, and clears heat and opens strangury. It supports the righteous without retaining evils and it disperses evils without damaging the righteous.

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Perimenstrual Hemoptysis

"One Case of Menstrual Movement Coughing Up Blood" by Zhang Xin, Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), #4, 1993, p. 28

The patient was an 18 year old female student. For the past four months she had been coughing up blood with her menstruation. (This is usually a symptom of endometriosis.) Menarche had occurred at 15 years of age and her menses had been normal until the last half year when she had been studying too hard and overworking her brain. This had resulted in excessive thinking, worry, and anxiety accompanied by dizziness, heart vexation, loss of sleep, and profuse dreams. She administered herself Jian Nao Bu Xin Wan (Fortify the Brain & Supplement the Heart Pills), Shen Qi Da Bu Wan (Ginseng & Astragalus Great Supplement Pills), and other such medicines but without result.

Four months earlier, during her menstruation, she suddenly felt that her throat was not right and subsequently coughed up and spit out 5ml of blood from her mouth. Mixed in with this were a small amount of phlegm fluids. After coughing up this blood, the feeling of something not right in her throat disappeared and there was no cough, vomiting, fever, or other such symptoms. Her menses was red in color and its amount was normal. However, it was accompanied by a light degree of lower abdominal distention and pain. After this, each day she coughed up 3-5ml of blood, 2-4 times per day without other symptoms. After menstruation was over, the hemoptysis stopped.

The young woman underwent various Western medical examinations and was given vitamin K₄ and San Qi Fen (Pseudoginseng Powder). After several months, she came for a Chinese medical examination. This revealed that her essence spirit was repressed and her depression was not aroused. Her tongue was red with thin, yellow fur. Her pulse was bowstring, fine, and rapid. These symptoms were categorized as liver depression and internal heat, yin vacuity and yang hyperactivity. Therefore, treatment was aimed at coursing the liver and resolving depression, nourishing yin and clearing heat, as well as leading the blood to move downward.

Thus, Qing Jing Si Wu Tang (Clear the Menses Four Materials Decocton) combined with Dan Zhi Xiao Yao San (Moutan & Gardenia Rambling Powder) with additions and subtractions was used: uncooked Radix Rehmanniae (Sheng Di), Radix Albus Paeoniae Lactiflorae (Bai Shao), Herba Ecliptae Prostratae (Han Lian Cao), and Haematitum (Dai Zhe Shi), 20g each, Radix Angelicae Sinensis (Dang Gui), Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), and Radix Cyathulae (Chuan Niu Xi), 12g each, Cortex Radicis Moutan (Mu Dan Pi), Fructus Gardeniae Jasminoidis (Zhi Zi), Fructus Arctii Lappae (Niu Bang Zi), Rhizoma Cyperi Rotundi (Xiang Fu), and Radix Polygalae Tenuifoliae (Yuan Zhi), 10g each, Radix Bupleuri (Chai Hu), 8g, and Rhizoma Imperatae Cylindricae (Bai Mao Gen), 30g. These were decocted in water and taken. Each day one ji was taken in two divided doses.

After taking three ji of the above prescription, menstruation ceased and the coughing up blood also stopped automatically. Then the patient was given Tian Wang Bu Xin Wan (Heavenly King Supplement the Heart Pills) combined with Xiao Yao Wan (Rambling Pills). Three days before the onset of the next menstruation, she was again given the above formula for the following seven days. During the five days of her menstrual flow, she coughed up blood three times. Its amount was scanty and less than before. She also experienced dizziness, heart vexation, and loss of sleep. She was advised how to pay attention to essence spirit regulation and discipline. She was administered two courses of the above method of treatment. One half year later on follow-up, the patient reported that she had had no recurrence of hemoptysis.

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Amenorrhea

"65 Cases of Amenorrhea Treated with Gua Shi Liu Wei Tang (Trichosanthes & Dendro­bium Six Flavors Decoction" by Tang Kun-hua & Zhu Guang-hua, Jiang Su Zhong Yi (Jiangsu Chinese Medicine), #11, 1993, p. 9

This clinical audit reports on the treatment of 65 cases of amenorrhea using Gua Shi Liu Wei Tang over several years. The ages of the patients ranged from 16-47 years, with a median age of 30.5 years of age. Among these women, the shortest duration of amenorrhea was three months and the longest was 10 years. In terms of their pattern discrimination, 26 cases were categorized as yin vacuity with blood heat, 17 cases as qi stagnation and blood stasis, 10 cases as liver-spleen disharmony, seven cases as liver-kidney insufficiency, and five cases as phlegm dampness obstruction and stagnation. In this audit, all the women experienced a resumption of normal menstruation within three months of treatment and were thus considered cured.

Gua Shi Liu Wei Tang was composed of: Fructus Trichosanthis Kirlowii (Quan Gua Lou), Herba Dendrobii (Shi Hu), Herba Leonuri Heterophylli (Yi Mu Cao), Cortex Radicis Moutan (Dan Pi), Radix Salviae Miltiorrhizae (Dan Shen), and Radix Achyranthis Bidentatae (Niu Xi). Each day, one ji was decocted in water and administered in two divided doses.

If the patient's pattern was yin vacuity with blood heat, uncooked Radix Rehmanniae (Sheng Di), Radix Scrophulariae Ningpoensis (Xuan Shen), Tuber Ophiopogonis Japonicae (Mai Dong), and Rhizoma Coptidis Chinensis (Huang Lian) were added. If the patient's pattern was qi stagnation and blood stasis, Radix Bupleuri (Chai Hu), Fructus Citri Aurantii (Zhi Ke), Rhizoma Cyperi Rotundi (Xiang Fu), Semen Biotae Orientalis (Bai Zi Ren), Herba Lycopi Lucidi (Ze Lan), Semen Vaccariae Segetalis (Wang Bu Liu Xing), and Herba Selaginellae Tamariscinae (Juan Bo) were added. If the patient's pattern was liver-spleen disharmony, Radix Bupleuri (Chai Hu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Ledebouriellae Divaricatae (Fang Feng), Rhizoma Cyperi Rotundi (Xiang Fu), Sclerotium Poriae Cocos (Fu Ling), Pericarpium Citri Reticulatae Viride (Qing Pi), and Pericarpium Citri Reticulatae (Chen Pi) were added. If the patient's pattern was liver-kidney insufficiency, uncooked Radix Rehmanniae (Sheng Di), cooked Radix Rehmanniae (Shu Di), Radix Dioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Zhu Rou), Radix Dipsaci (Chuan Duan), and Radix Morindae Officinalis (Ba Ji) were added. And if the patient's pattern was phlegm dampness obstruction and stagnation, Rhizoma Pinelliae Ternatae (Fa Ban Xia), Sclerotium Poriae Cocos (Fu Ling), bile-processed Rhizoma Arisaematis (Dan Nan Xing), Rhizoma Atractylodis (Cang Zhu), and Caulis Bambusae In Taeniis (Zhu Ru) were added.

According to Tang and Zhu, this formula enriches yin and clears heat, loosens the chest and transforms phlegm, moistens dryness and harmonizes the stomach, and quickens the blood and frees the flow of the channels. In particular, Trichosanthes loosens the chest and scatters nodulation, transforms phlegm and moistens dryness. Dendrobium enriches yin and nourishes the stomach, engenders fluids and eliminates heat. Leonurus quickens the blood and dispels stasis, engenders fluids and regulates the menses. Moutan clears heat and cools the blood, quickens the blood and scatters stasis. Salvia quickens the blood and transforms stasis, cools the blood and regulates the menses. And Achyranthis quickens the blood and expels stasis, supplements the kidneys and frees the flow of the channels. As a whole, this formula is for the treatment of yin vacuity with stomach heat. In this case, scorching heat has injured stomach fluids and humors. Thus the chong and ren lose their balance and menses is emitted only rarely. After some time, the essence and blood become consumed and exhausted and, therefore, there is amenorrhea.

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Meno-metrorrhagia

"A Comparative Study of the Treatment of Spleen-kidney Yang Vacuity Pattern Func­tional Uterine Bleeding (Using) Warming the Kidneys & Fortifying the Spleen Methods" by Fu You-feng et al., Jiang Su Zhong Yi (Jiangsu Chinese Medicine), #11, 1993, p. 7-8

The authors begin this study saying that functional uterine bleeding corresponds to what is called flooding and leakage, early menstruation, or menstruation before, after or at no fixed interval in Chinese medicine. They then go on to compare the Chinese medical reatment of 53 cases of specifically spleen-kidney yang vacuity functional bleeding to a control group of 19 patients treated with modern Western medicine. Among the group treated with Chinese medicine, nine were adolescents, 26 were of child-bearing age, and 18 were menopausal. Among the control group, four were adolescents, nine were of child-bearing age, and six were menopausal.

The criteria for these patient's Chinese pattern discrimination included excessive bleeding from the vaginal tract or dribbling and dripping of blood without cease. The color of the blood was pale red, and its consistency was dilute and without clots. Patients’ faces were ashen white, and their bodies were cold and limbs chilled. In addition, they suffered from low back and knee soreness and weakness or low back pain as if about to break, not enough warmth in their four limbs or edematous swelling, long, clear urination, and loose stools. Their tongues were pale red and swollen with the indentations of their teeth along their edges. The tongue fur was thin and white, and their pulses were deep, fine, without force.

The Chinese medicinal treatment was based on the principles of warming the kidneys and fortifying the spleen, boosting the qi and stopping bleeding. The formula consisted of: Fructus Psoraleae Corylifoliae (Bu Gu Zhi), Os Sepiae Seu Sepiellae (Wu Zei Gu), Cortex Cinnamomi Cassiae (Rou Gui), Radix Angelicae Sinensis (Dang Gui), processed Rhizoma Cyperi Rotundi (Zhi Xiang Fu), Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragali Membranacei (Huang Qi), and uncooked Rhizoma Atractylodis Macrocephalae (Bai Zhu). Each day, one ji or formula was given unless the case was serious, in which case two ji were given. These medicinals were given during the time of the bleeding and then again for three days before the next menses arrived. The control group received Zi Xue An (Uterine Bleeding Quieter, active ingredients unspecified), four pills three times per day. Typically bleeding stopped after 4-7 days of medicinals, with the longest requiring 10 days. The course of treatment lasted three whole months.

The definition of results were as follows: Marked results consisted of return of the amount of menstrual blood to normal or diminishment by more than half and bleeding stopping within seven days. Good results consisted of the amount of menstrual blood being reduced to from 1/3-1/2 and bleeding stopping in from 8-10 days. No results meant that the amount of menstrual blood was not diminished. Based on these definitions, among those treated with Chinese medicinals and whose bleeding was reduced in volume, 36 cases experienced marked results, 15 experienced good results, and two cases experienced no results. This gave a total amelioration rate vis á vis reduction of the amount of bleeding of 96.2%. This compared with a total amelioration rate vis á vis reduction of blood volume in the comparison group of only 78.9%. In terms of shortening the length of the period, 47 women in the Chinese medicinal group experienced marked results, four experienced good results, and two experienced no results for the same amelioration rate of 96.2% as compared to a total amelioration rate in the comparison group of only 36.8%.

"The Treatment of 124 Cases of Adolescent `Stirring Blood' by the Methods of Boosting the Qi, Nourishing Yin & Securing the Menses" by Zou Qi, Shang Hai Zhong Yi Yao Za Zhi (The Shanghai Journal of Chinese Medicine & Medicinals), # 6, 1993, p. 16-17