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Case Histories - Menorrhagia (2)
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.