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Case Histories - Heavy and Painful Periods
A 38-year-old woman had been suffering from heavy and painful periods. The periods came regularly, lasted about 7 days, the menstrual blood was dark with clots, and she suffered from severe menstrual pain which was relieved by the passage of clots.
She also suffered from knee-ache, backache, dizziness and cold feet. Her tongue was Pale and Swollen and her pulse was Weak on the whole.
This patient suffers from Kidney-Yang deficiency (knee-ache, backache, dizziness, cold feet), and Blood stasis (painful period with dark clots with pain alleviated after passing clots). The period is heavy because Kidney-Qi fails to hold Blood and painful because of the Blood stasis. However, the Blood stasis is not too severe as the tongue is not Purple.
I adopted the treatment methods of tonifying Qi to hold Blood and reduce bleeding, tonify Kidney-Yang and invigorate Blood. When several treatment principles are used in gynaecological problems, it is often better to adapt each treatment strategy to a phase of the menstrual cycle. In this case, I adopted the following strategies:
-During the period: tonify Qi to stop bleeding with Restrain the Flow and invigorate Blood with Invigorate Blood and Stem the Flow.
-For about 10 days after the period: tonify Kidney-Yang with Unicorn Pearl.
-For about 5 days before the period: invigorate Blood with Invigorate Blood and Stem the Flow.
The formula Invigorate Blood and Stem the Flow was chosen to invigorate Blood because the period was heavy. Had the period not been heavy, one could have used Stir Field of Elixir.
A 37-year-old woman had been suffering from heavy periods: these were regular, lasted 6 days and the blood was bright red without clots. She also suffered from backache, tiredness, poor appetite, loose stools and dizziness. Her tongue was Pale and Swollen but also very slightly Red on the sides and her pulse was Weak in general, especially on both Kidney positions.
There is a clear deficiency of the Spleen (tiredness, poor appetite, loose stools, Pale tongue) and of Kidney-Yang (backache, dizziness, Pale tongue). Her condition therefore seemed to be a straightforward case of Spleen- and Kidney-Qi not holding Blood and causing heavy periods.
I prescribed Restrain the Flow to tonify Qi and hold Blood to be taken before and during the period, followed by Unicorn Pearl to be taken after the period for about 1 week. However, this approach produced no results after four months. I therefore re-assessed the case and paid more attention to the redness of the sides of the tongue. This led me to enquire about any Blood Heat symptoms and, on interrogation, it turned out that she did feel slightly thirsty and she did feel hot occasionally. I therefore changed my approach and gave her Cool the Menses to cool the Blood and reduce bleeding, to be taken before and during the period, while I still asked her to continue taking Unicorn Pearl after the period. This strategy produced immediate results with a marked and gradual reduction of menstrual bleeding over 3 months.
This case illustrates an important point of diagnosis and treatment strategy of heavy menstrual bleeding. Although a woman suffering from heavy menstrual bleeding may present with many Qi-deficiency symptoms, it does not necessarily follow that that is the cause of excessive bleeding: it is perfectly possible for a woman to suffer from Qi deficiency but also some Blood Heat which may be the cause of heavy menstrual bleeding. Very often, the manifestations of Blood Heat are very slight but significant nevertheless. To put it differently, if a woman suffers from heavy menstrual bleeding and displays many symptoms of Qi deficiency and a Qi-tonifying approach does not yield results, it is always advisable to re-assess the case and check whether there is some Blood Heat.
A 40-year-old woman had been suffering from vaginal thrush for "a long time". She complained of redness, soreness and itching around the vagina which were worse both before and after the period. Her periods were regular, lasted 1 week and were not painful. She suffered from pre-menstrual tension manifesting primarily with depression and tiredness. She also complained of backache, a cold feeling, frequent urination, dizziness, tinnitus and night-sweating. On interrogation, it transpired that she often felt a sticky taste in her mouth. Her tongue was slightly Red on the sides, Swollen and with a sticky coating. Her pulse was Weak on the right and Choppy on the left.
The vaginal thrush is obviously due to Damp-Heat which is apparent from the redness, soreness and itching of the vagina; Dampness is also confirmed by the swelling of the tongue and the sticky coating. There is an underlying deficiency of Spleen- and Kidney-Yang deficiency, especially the latter manifesting with backache, cold feeling, frequent urination, dizziness and tinnitus.
In cases such as these, it is important to decide whether to put the emphasis on tonifying the deficiency of expelling the pathogenic factor (in this case Damp-Heat). Given the intensity of her vaginal thrush, I decided to concentrate on treating the Manifestation and therefore expel the pathogenic factor, i.e. resolve Dampness and clear Heat in the Lower Burner. I therefore prescribed Drain the Jade Valley to resolve Dampness, clear Heat and stop itching in the vagina. I also gave her some herbs to use externally as a vaginal wash:
She Chuang Zi Fructus Cnidii monneri
Ku Shen Radix Sophorae flavescentis
Shi Gao Gypsum
Huang Bo Cortex Phellodendri
Bai Zhi Radix Angelicae dahuricae
I also used acupuncture treating mostly the following points:
-LU-7 Lieque and KI-6 Zhaohai to open the Directing Vessel.
-SP-9 Yinlingquan, SP-6 Sanyinjiao and BL-32 Ciliao to resolve Dampness from the Lower Burner.
-KI-7 Fuliu and BL-23 Shenshu to tonify Kidney-Yang.
-Ren-12 Zhongwan to resolve Dampness.
This patient reacted well to treatment and the combination of the internal treatment with Drain the Jade Valley and the external wash cured the thrush problem over a period of 10 months. It is envisaged that eventually the treatment will have to be followed up by tonification of the Spleen and Kidneys.
A 29-year-old woman had been suffering from painful periods for 10 years. Her periods came regularly but were very painful, the pain being of a severe, cramping nature; the menstrual blood was clotted and she felt noticeably cold during the period. The pain was alleviated by the application of heat. She also suffered from backache, dizziness, tinnitus and frequent urination. She had been suffering from allergic asthma from the age of 7 and her urine was very pale during an asthma attack. Her tongue was Pale and her pulse was Fine but also slightly Tight.
This is a clear case of Cold in the Uterus causing the periods to be painful: the signs of Cold in the Uterus are severe, cramping pain, clots, feeling cold during the period and alleviation of the pain by the application of heat. She also suffers from an underlying Kidney-Yang deficiency (backache, dizziness, tinnitus, frequent urination) which is also the cause of allergic asthma: the paleness of the urine during an asthma attack is a particularly telling symptom.
I used Warm the Menses to expel Cold from the Uterus and acupuncture to treat the underlying condition by tonifying Kidney-Yang. The combination and integration of a herbal remedy to treat the Manifestation (Biao) and acupuncture to treat the Root (Ben) is particularly useful.
A 60-year-old woman had been suffering from menopausal problems for 5 years after stopping HRT (hormone-replacement therapy); she had taken HRT for 15 years. Her main symptoms were hot flushes, sweating, palpitations, a faint feeling, vaginal dryness and aches in the joints. She also suffered from backache, dizziness, tinnitus, frequent-pale urination and cold feet. Her tongue-body colour was normal but the tongue was slightly peeled on the root. Her pulse was Weak on both Kidney positions.
There is a deficiency of both Heart- and Kidney-Yin. The symptoms of Kidney-Yin deficiency are backache, dizziness, tinnitus, hot flushes and the peeling on the root of the tongue. The symptoms of Heart deficiency are the palpitations, the sweating and the faint feeling. If there is Kidney-Yin deficiency why is the tongue-body colour normal (not Red) and why does she suffer from frequent-pale urination and cold feet (symptoms of Kidney-Yang deficiency)? The reason is that she is being seen at a time of life when there is a transition from Kidney-Yang to Kidney-Yin deficiency: as the tongue is turning from Pale to Red, at the time of observation, it was normal-coloured.
I prescribed Heavenly Empress to nourish both Heart- and Kidney-Yin (2 tablets twice a day). This produced a very good improvement in all her symptoms.
A 40-year-old woman had been suffering from painful periods for 7 years. The periods were regular and the flow was normal, lasting 4 days. The blood was bright-red with small clots. The pain was in the central part of the lower abdomen and was better with the application of heat. She also suffered from occasional tinnitus and night-sweating and from frequent urination. She felt generally cold and tired. Her tongue was Pale, tending to Bluish-Purple and Swollen, and her pulse was Weak on both Kidneys positions.
The painful period is due to Empty Cold in the Uterus (bright-red menstrual blood with small clots, alleviation of the pain by heat) with an underlying deficiency of Kidney-Yang.
I prescribed Warm the Palace for Empty Cold in the Uterus to be taken during the period and Unicorn Pearl to tonify Kidney-Yang to be taken for about 10 days after the period.
A 52-year-old woman had been suffering from menopausal problems manifesting with hot flushes, night-sweating, dry mouth, insomnia (waking up during the night), a feeling of heat, nervous tension, anxiety, and palpitations. Her tongue was Red and slightly peeled and her pulse was Weak on both Kidney positions.
This is a clear case of Heart- and Kidney-Yin deficiency. The symptoms indicating a Heart pattern are nervous tension, insomnia, anxiety and palpitations.
I prescribed Heavenly Empress which nourishes Heart- and Kidney-Yin and clears Heart Empty Heat.
A 51-year-old woman had been suffering fro menopausal problems for 5 years. Her main symptoms were hot flushes, ache in the joints, poor memory, backache, dizziness, occasional tinnitus, and night-sweating. Although she suffered from hot flushes, she also suffered from frequent and pale urination and cold feet. Her tongue was Pale, tending to Bluish-Purple on the sides but slightly Red in the centre, and her pulse was Weak on both Kidney positions.
This is another example of a simultaneous deficiency of both Kidney-Yin and Kidney-Yang that is so common during the menopausal years. The tongue clearly shows the transition from Kidney-Yang deficiency to Kidney-Yin deficiency that is taking place at the time of consultation. The tongue was obviously Pale and had been so in the past but is now beginning to turn Red. Her symptoms also show clearly the combination of Kidney-Yin (night-sweating, hot flushes) and Kidney-Yang deficiency (cold feet, frequent-pale urination). Besides a Kidney deficiency, there is also Blood stasis deriving from Empty Cold, itself deriving from Kidney-Yang deficiency.
I prescribed Ease the Journey - Yang 3 tablets to be taken in the morning and Ease the Journey - Yin 1 tablet to be taken at night. I also used acupuncture using a choice from the following points:
-LU-7 Lieque on the right and KI-6 Zhaohai on the left to open the Directing Vessel.
-Ren-4 Guanyuan and KI-7 Fuliu to tonify the Kidneys.
-P-6 Neiguan to invigorate Blood.
-ST-36 Zusanli and SP-6 Sanyinjiao to tonify Qi and Blood.
Besides an improvement in the menopausal symptoms, this patient also lost ½ stone in weight after three months of treatment.
A 55-year-old woman had been suffering from menopausal symptoms for about two years. Her periods had stopped since about two years. Her main symptoms were hot flushes and headaches. Her tongue was slightly Red and slightly peeled on the sides, towards the root. Her pulse was Weak on the right and Wiry on the left.
Although this patient does not present with many symptoms, the few symptoms which she does have clearly point to deficiency of Liver-Yin and rising of Liver-Yang. It is interesting that, although she suffers from menopausal symptoms, there are absolutely so symptoms of Kidney deficiency: she suffered no backache, no dizziness, no tinnitus, no urinary problems.
Given the deficiency of Liver-Yin and rising of Liver-Yang, I chose Female Treasure which nourishes Liver- and Kidney-Yin and subdues Liver-Yang. The dosage used was 2 tablets twice a day with hot water after meals. This remedy produced a good improvement after one month.