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.
Diagnosis
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.
Treatment
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.
MENORRHAGIA
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.
Diagnosis
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.
Treatment
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.
CANDIDIASIS
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.
Diagnosis
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.
Treatment
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.
PAINFUL PERIODS
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.
Diagnosis
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.
Treatment
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.
MENOPAUSAL SYNDROME
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.
Diagnosis
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.
Treatment
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.
PAINFUL PERIODS
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.
Diagnosis
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.
Treatment
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.
MENOPAUSAL SYNDROME
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.
Diagnosis
This is a clear case of Heart- and Kidney-Yin deficiency. The symptoms
indicating a Heart pattern are nervous tension, insomnia, anxiety
and palpitations.
Treatment
I prescribed Heavenly Empress which nourishes
Heart- and Kidney-Yin and clears Heart Empty Heat.
MENOPAUSAL SYNDROME
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.
Diagnosis
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.
Treatment
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.
MENOPAUSAL SYNDROME
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.
Diagnosis
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.
Treatment
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. |
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