heavymenstruation

Traditional Chinese
Medicine Cases

The cases below are for educational purposes and not for self
diagnosis and treatment. Please see a professional for a
proper assessment and treatment.

45 year old, Caucasian female
CC: Heavy menstruation, discharge between menses with a tinge of blood, PMS

Other: Low back pain, occasional migraines, occasional light/restless sleep
Medication: Imitrex when necessary for migraines
Surgeries: C-Section 1999, Surgical Implants 2004

History:
The patient started getting severe migraine headaches about 7 years ago. The migraines were
associated with the menstrual cycles, around the second or third day, but she hasn’t had this
problem for the past 2 or 3 months. She also has a very heavy menstrual flow, with some clots,
but no significant pain. Her cycles, last 5 to 7 days, and are regular. She also experiences PMS
approximately one week before menstruation. She has mood changes, feels extremely irritable,
and frustrated. She describes it as if she is not herself, and has no patience or tolerance, or
control over her self. The patient received acupuncture treatments, about 3 years ago for these
conditions, and the treatment seemed to help, and stopped the treatments. Her migraines
reappeared last year, and she got one treatment. Currently she is not complaining of migraines,
the last episode was about 2 to 3 months ago, but her main concern is profuse menstrual
bleeding, prolonged cycles, PMS, and a recent vaginal discharge with a tinge of blood.

She also has a slight low back pain, which started in August of 2005, after a cold draft, and
another time later that year in October she sat on the ground. She has been doing a lot of
exercises, such a medicine balls. The pain is slight at this time, but she feels it with certain
motions and movements, such a getting in and out of the car.

The patient’s sleeping patterns fluctuates, sometimes she has a deep and comfortable sleep, and

other time her sleep is light, restless, and wakes up easily. She has no trouble falling asleep, but
when she wakes up during the night, she has trouble going back to sleep. She has been trying to
meditate.

Her energy level is low, and her diet includes a lot of salads, and generally doesn’t eat well or
regular. Her bowel movements seem to be normal. She has hemorrhoids, no bleeding. The
patient appears pale, and dull complexion, fatigued, and lacks energy and vitality.

Tongue: Pale, slight teethmarks, greasy white coating

Pulse: Right side: Weak Left side: Weak, Slightly wiry, slippery

TCM Diagnosis: Spleen qi deficiency, liver blood deficiency, damp accumulation

Spleen qi is responsible for holding the blood and holding the organs in place. Spleen qi
deficiency also leads to damp accumulation. When spleen qi fails to hold the blood,
menorrhagia of the deficiency type occurs. This patient also has hemorrhoids, which spleen qi
in this case is failing to raise the qi, and resulting in prolapse. Spleen produces blood, and if it
is deficient, it causes qi and blood deficiency. Deficient blood fails to nourish the brain and
this results in deficiency type headaches/migraines, which usually occur during or after the
period. Spleen qi deficiency causing blood deficiency, which cannot nourish the liver blood.
Blood is the mother of qi, and this results in liver qi stagnation/liver fire, leading to emotional
instability, irritability, and frustration. Blood deficiency also results in blood not nourishing the
heart, and therefore resulting in a light sleep, and difficulty staying asleep.

Treatment Principle: Tonify spleen qi, nourish blood, resolve damp

Western Approach: Essential/Primary Menorrhagia

Essential/Primary Menorrhagia is defined as menstrual loss of greater the 80ml, and may result
in anemia, but it is possible not to be anemic. Menorrhagia is categorized by the presence or
absence of a clinically identifiable cause. Where such a process can be identified, the bleeding
is classed as secondary menorrhagia, when no cause is evident, primary/essential menorrhagia is
presumed. Secondary menorrhagia can originate from a number of potential pathologies within,
or outside the uterus. Endometriosis, leiomyoma, adenomyosis, climacteric changes, fibroids,
and neoplasia are examples.

Current evidence supports an overproduction or an imbalance in the relative ratios of uterine
prostaglandins as the cause of primary menorrhagia. The dominant prostaglandin in
menorrhagia appears to be PGE2. This prostaglandin, along with prostacyclin PGI2, act as
vasodilators and smooth muscle relaxants, and they may act to disperse platelets, counteracting
the action of thromboxane A2. Some evidence suggests that patients with primary menorrhagia
may also have increased fibinolysis, further enhancing a tendency to bleed.

Western Treatment: Oral contraceptives, Estrogen therapy

Acupuncture Points:

Liv 3, Sp 3, Kid 3, Du 20, Sp 6, St 36, Liv 8, Kid 7, Du 24

Explanation of points:

Liv 3 Shu Stream point, Yuan Source Point, Earth point, spreads liver qi, nourishes liver blood
and yin, regulates menstruation, regulates lower jiao
Sp 3 Shu Stream point, Yuan Source Point, tonifies the spleen, resolves damp harmonizes spleen
and stomach
Kid 3 Shu Stream point, Yuan Source Point, Tonifies the kidney
Du 20 Raises yang, calms shen
Sp 6 Meeting point Spleen, Liver and Kidney, tonifies spleen and stomach, resolves damp,
regulates menstruation, harmonizes lower jiao, calms shen, harmonizes liver, tonfies the kidney
St 36 He Sea, and Earth point, fortifies spleen, resolves damp, supports the Zhen qi, and fosters
Yuan Qi, tonifies qi, nourishes blood and yin,
Liv 8 He Sea and water point, Clears damp from lower jiao, nourishes blood and yin
Kid 7 Jing River, Metal point, benefits kidney, regulates water passages, drains damp
Du 24 Calms shen

Herbal Formula: Gui Pi Tang Modified

Huang qi 12, Dang Shen 9, Bai Zhu 12, Dang Gui 9, Gan Cao 6, Fu Ling 12, Yuan Zhi 9, Suan
Zao Ren 9, Mu Xiang 9, Long Yan Rou 9, Sheng Jiang 6, Da Zao 6, Gou Qi Zi 9, He Shou Wu
12, Ce Bai Ye 9

Explanation of Formula:

Huang Qi, Dang Shen , Bai Zhu Tonify Qi
Mu Xiang Regulate the Qi
Yuan Zhi, Suan Zao Ren, Long Yan Rou Calm Shen, insomnia
Fu Ling, Strengthen spleen, resolve damp, calm shen
Gou Qi Zi, Long Yan Rou, Dang Gui, He Shou Wu Nourish the blood
Sheng Jiang, Da Zao, Gan Cao Harmonize the middle jiao to resolve damp, produce qi and
blood

Sources:

Beers M.H. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research
Laboratories, Whitehouse Station, N.J. 1999
Smith, R. Gynecology in Primary Care. Williams & Wilkins, Baltimore, MD, 1997
Deadman P. A Manual of Acupuncture. Journal of Chinese Medicine Publications, England,
2001
Yeung H.C. Handbook of Chinese Herbs. Institute of Chinese Medicine, Rosemead, CA, 1996
Yeung H.C. Handbook of Chinese Herbal Formulas. Institute of Chinese Medicine,
Rosemead, CA, 2004
Maciocia, G. Obstetrics and Gynecology in Chinese Medicine. Churchill Livingstone, London,
1998