Wk 4 - Prolonged Menstrual Periods and Menorrhagia
Prolonged Menstrual Periods (Menostaxis) & Increased Menstrual Flow (Menorrhagia)
Prolonged Periods (Menostaxis)
Definition and General Characteristics
MENOSTAXIS Definition: Refers to menstrual flow lasting more than 7 days, extending up to 2 weeks.
Location of Disease: Primarily located in the Chong and Ren Mai and the uterus.
Pathology: Usually categorized as either an excess or deficiency pattern.
Most Common Presentation: Prolonged menstrual period often accompanied by menorrhagia (heavy bleeding).
Potential Underlying Causes (Western Medicine Perspective)
Incomplete breakdown of the corpus luteum.
Pelvic inflammatory disease (PID).
Endometritis.
Problems caused by intrauterine devices (IUDs) - irritation.
Clinical History
May include a history of:
Dietary irregularity.
An unhealthy lifestyle.
Emotional disorders.
Pelvic infection or inflammation.
Use of an IUD.
Clinical Manifestations
Cycle: Generally normal in length.
Flow Duration: Exceeds 7 days, lasting up to 2 weeks.
Accompanying Symptoms:
Often a heavy menstrual flow.
Lower abdominal pain.
A bearing down sensation in the lumbosacral region.
Specific to Chronic PID or Endometritis:
Increased vaginal discharge, which may be yellow or red-tinged.
Gynecological (GYN) exam for Pelvic Inflammatory Disease (PID) may reveal thickening and tenderness of the uterine adnexa (the structures located near the uterus, specifically the ovaries and fallopian tubes).
Positive signs of uterine tenderness.
Auxiliary Examinations
Blood tests: To track hormone levels.
Hysteroscopy.
Endometrial biopsy: To confirm diagnosis.
Differential Diagnosis
Abnormal Uterine Bleeding (Metrostaxis):
METROSTAXIS: By menstrual bleeding at times other than during the expected menstrual period.
Spotting or heavy bleeding may persist for months.
Distinction: Menostaxis (lengthy periods) occurs at the correct time, though it may or may not recur monthly.
Reddish Leukorrhea:
Is a discharge, not true bleeding, and occurs between periods.
Though blood-like, it is distinct from menstrual bleeding.
Therapeutic Principle (Traditional Chinese Medicine - TCM)
Core Principle: Stop bleeding and regulate menstruation by securing the Chong and Ren Mai.
Role of the Kidneys:
The Kidneys are critically implicated in gynecological bleeding disorders.
Both the Chong Mai and Ren Mai originate in the uterus.
The uterine vessels are directly linked to the Kidneys.
The Kidneys are considered the root of the Chong and Ren Mai and the fundamental source of menstrual blood.
Nei Jing Quote: "At seven times two years (14 years old), the woman's Tian Gui arrives. Her Ren Mai opens through. The great Chong Mai is abundant. The monthly event descends in a timely way."
Interpretation: This passage illustrates that robust Kidney Qi is essential for the engendering of Tian Gui (Heavenly Dew).
The health and balance (abundance or decline) of Kidney Qi directly determine the normalcy of menstruation.
When a woman ages, her kidneys are taxed and the capacity to support the Tian Gui wanes, leading to erratic patterns and disharmony of the Chong and Ren Mai.
Patterns and Treatments of Menostaxis
Qi Deficiency Type
Clinical Manifestations:
Prolonged menstruation with a heavy flow (qi not holding) of pale red (qi deficiency) blood.
Accompanied by mental fatigue (interconnection of mind-blood—heart), lack of strength, shortness of breath (without a desire to speak) ( metal/lungs are deficient), and a bearing down sensation in the lower abdomen.
Tongue and Pulse:
Pale tongue with a thin coating.
Moderate weak pulse.
Pathology Explanation:
General Qi deficiency leads to instability of the Chong and Ren Mai, resulting in a loss of control over menstrual bleeding.
May also involve exhaustion of Ming Men Fire, which influences normal blood transformation, causing the blood to be thin and light red.
Ming Men Fire: originates in the Kidneys, circulates through the San Jiao.
Insufficient Middle (SP) Qi impairs the circulation of Yang, leading to fatigue, weakness, shortness of breath (without desire to speak), and a bearing down sensation.
General failure of holding functions.
Treatment Principle: Supplement Qi to control blood, secure the Chong Mai, and attune menses (tiao Yue Jing).
Primary Formula: Jia Yuan Jian (Origin-Lifting Brew) + E Jiao and Chao Ai Ye.
Herb Dosages:
Ren Shen: 10g - strong GENERAL qi & blood tonic
Huang Qi: 15g - strong qi tonic; has raising/lifting and diffusing quality; goes to the LUNGS
Bai Zhu: 15g - strong SPLEEN qi tonic; bolsters the SP to improve holding function. Strong influence on the KIDNEY as well (EARTH - WATER: controlling relationship; support earth to unburden water).
Sheng Ma: 10g
Zhi Gan Cao: 6g
E Jiao: 10g
Chao Ai Ye: 30g
Modifications:
Herbs for heavy menstrual bleeding: Add Pao Jiang (charred ginger; stops GYN Bleeding; warms), Xue Yu Tan (charred human hair), and Chi Shi Zhi.
Herbs for HT Blood deficiency: signs of dizziness, palpitations, insomnia, and excessive dreaming: Add He Shou Wu, Shu Di Huang, Suan Zao Ren.
When the Heart and Spleen are depleted, causing blood to fail to return to the vessels: Use Gui Pi Tang.
When the Middle Qi falls downward and the Qi cannot absorb the blood: Use Bu Zhong Yi Qi Tang.
Acupuncture: Specific points not detailed in the transcript but indicated as treatment modality.
REN-6 (Qi Hai) - qi support / qi moving; especially in lower jiao
REN-5 - Qi support for San Jiao
REN-12 - Qi support for Middle Jiao (especially ST); Inderjeet uses to descend Yang Ming
ST-36 + SP-6 -
SP-3 - Drying; strong to restore the Tai Yin capacity of holding
SP-15 - intestinal relationship; holding/containing nature vs. descending nature of ST-25
SP-16 - strong to restore the Tai Yin capacity of holding; think of as similar to SP-3
LI-10 -
LU-9 - Hui-mtg point of the Blood Vessels
LU-8 - horary pt of the LU Channel; use METAL to generate WATER; support the Qi by strengthening LUNG Metal
REN-17 - qi support / qi moving; especially in upper jiao
REN-10 - ascend Tai Yin upwards
LV-13 - front Mu of Spleen
Deficiency Heat (Yin Deficiency with Internal Heat)
Clinical Manifestations:
Scanty menstrual flow, bright red in color, thin in nature, and without clots.
Accompanied by other Yin deficiency signs such as: a dry throat and mouth, tidal fever, malar flush, a sensation of 5-centered heat (heat in palms, soles, and chest), and dry, bound stools.
Tongue and Pulse:
Tongue: Red tongue with scanty coating.
Pulse: Rapid, may also be thready pulse.
Pathology Explanation:
Yin deficiency combined with internal heat harasses the Chong and Ren Mai, leading to uncontrolled menstrual bleeding and a prolonged flow.
Yin deficiency and fluid depletion result in a scanty, thin menstrual flow without clots.
The bright red color of the blood is a direct result of the exuberance of fire.
Xu (Empty) Fire scorches the body fluids, preventing them from moisturizing the upper part of the body, which manifests as a dry mouth and throat.
Too much fire in the Ren Mai will manifest as heat in the throat - sore throat.
Treatment Principle: Nourish Yin, clear heat, and stop bleeding.
Primary Formula: Liang Di Tang + Er Zhi Wan.
Herb Dosages:
Sheng Di Huang: 15g - moistening
Xuan Shen: 10g - moistening
Di Gu Pi: 10g - moistening KI + LV
Mai Men Dong: 15g - moistening
E Jiao: 10g - treats bleeding
Bai Shao: 10g
Nu Zhen Zi: 15g - tonify qi of the LV + KI to stop bleeding
Han Lian Cao: 15g - tonify qi of the LV + KI to stop bleeding
Formula Effects: This combination effectively nourishes Yin, clears heat, stops bleeding, and regulates menstruation without causing stagnation from tonification or stasis from arresting bleeding.
Modification:
Herb for strong thirst: Add Tian Hua Fen - opens the capacity of the Spleen (EARTH) to receive water (metaphor of dessert earth, water rolls off and doesn’t sink in).
Acupuncture:
KI-10 - HORARY pt on WATER channel
LV-8 - Mother point; WATER on WOOD; deeply nourishing; restores
KI-9 - Xi-cleft of the Yin Wei; opens the luo so that water can penetrate (think about desiccated desert metaphor) - linked to all other Yin channels
PC-3 / HT-3 - WATER point on the FIRE channel; controlling
SI-2 / SJ-2 - WATER point on the YANG FIRE channel; descends excess fire
GB-41 - clears that from the head / eyes
ST-44 -
LI-11 -
LV-2 - clears deficient Fire;
REN-3 - mu of UB; full of Cooling Water. Pair with KI-12 to enhance this effect.
Blood Stasis
Clinical Manifestations:
Prolonged menstrual period with a variable flow.
Both: flow over time (day-to-day) is not smooth (may also have qi stasis) AND there are variations in texture (clots and thin and other fluids) all at once.
The blood is darkish purple in color and contains clots.
Lower abdominal pain with an aversion to pressure during menstruation.
Tongue and Pulse:
Tongue: Darkish purple tongue, may also have small petechiae.
Pulse: Choppy, may also be forceful.
Pathology Explanation:
Blood flow is obstructed due to blood stasis, leading to an inconstant and irregular flow.
The obstructed flow is the cause of the lower abdominal pain experienced during menstruation.
The presence of darkish purple blood and clots is characteristic of blood stasis.
Treatment Principle: Activate blood, dispel stasis, and stop bleeding.
Primary Formula: Tao Hong Si Wu Tang + Shi Xiao San, Yi Mu Cao, and Qian Cao.
Herb Dosages:
Dang Gui: 15g - important GYN herb; will attune Menstruation
Sheng Di Huang: 15g
Chi Shao: 15g - treats blood stasis; strong for moving the blood. Inderjeet sometimes does 50/50 chi shao + bai shao
Chuan Xiong: 10g
Tao Ren: 10g - invigorate blood;
Hong Hua: 10g - invigorate blood; cool blood
Pu Huang: 10g - invigorate & move; treats pain
Wu Ling Zhi: 10g - invigorate & move; treats pain
Yi Mu Cao: 10g - important GYN herb; will attune Menstruation; cooling nature; hones to the uterus
Qian Cao: 10g
Other formulas to consider: Xue Fu Zhu Yu Tang; Wen Jing Tang, Tao He Cheng Qi Tang (w/ constipation); Dang Gui Xiao Yao San.
Dang Gui Xiao Yao San: Harmonizing the fluids within the blood; blood stasis due to general lack of ying/nourishment in the blood. There is yin deficiency, blood deficiency, qi deficiency, together causing blood stasis.
Dang Gui - conditions the blood
Bai Shao - conditions the blood
Chuan Xiong - conditions the blood
Bau Zhu - moves the fluids
Fu Ling - moves the fluids
Ze Xie - moves the fluids
Lifestyle/Mindset modifications: how do we advise patients to maintain/pursue a calm disposition to avoid the extremes of seven emotions?
Sleep Hygiene
Diet/Dietary hygiene - do not multitask at mealtimes; build the daily routine around meals as the central point of structure around which everything else flows.
Exercise (mild)
Breathing exercises
Mindfulness/meditation practices, time in nature, creative outlets
Digital disconnect/boundaries with technology
Social support & engagement
Acupuncture:
SP-8 - invigorates the blood to clear blood stasis; vaporizes phlegm
Pair with LV-5 - move & regulate the LV to move blood & clear blood stasis
SP-10 - move blood stasis; cooling
SP-4 - open the Chong Mai to reach the Uterus
ST-30 - open the Chong Mai to support blood flow throughout the whole body
KI-16 -
UB-11
ST-37 - pt of the Sea of Blood; Lower He-Sea of the LI
ST-39 - pt of the Sea of Blood; Lower He-Sea of the SI; disseminates the virtue of the HT SHEN (re-roots/re-integrates the Shen in the body, calms the Shen); descending action on the Heart Fire
Menorrhagia: An Overview
Menorrhagia: Increased menstrual flow without abnormal changes in the regularity of the menstrual cycle.
Frequency: It is common, occurring with a frequency of 20% of menstruating individuals.
Western Medical (WM) Terminology: Functional Uterine Bleeding (FUB).
Flow Volume: Excess of 80ml.
Presentation: Most commonly observed in prolonged cycles, but may also present in early or late cycles.
Related Conditions (Potential Causes)
Fibroids
Hypertrophy of the uterine lining
Endometritis
Endometriosis
Intrauterine Devices (IUDs)
Primary Pathogenesis (TCM)
The primary pathogenesis involves:
Instability of Chong and Ren Mai.
Dysfunction of the uterus's storage and discharge function.
Mainly attributed to:
Qi failing to control the blood.
Overflow due to blood heat.
Internal Obstruction: Stasis may lead to extravasation of blood from the vessels, causing heavy bleeding.
Long-Term Menorrhagia Consequences
Often gives rise to Qi collapse following Yin injury or heat leaking along with blood loss.
Consequently, excess transforms into deficiency or a combination of deficiency and excess, such as:
Qi deficiency with blood heat.
Deficiency of both Qi and Yin with mixed blood stasis.
Primary Causes (Summary)
Deficiency:
Constitutional weakness.
Improper diet.
Severe or protracted disease.
Blood Heat:
Constitutional Yang exuberance.
Overeating pungent, dry foods.
Contracting a heat pathogen.
Emotional extremes causing frenetic movement of blood, complexing of Imperial and Ministerial fires.
Blood Stasis:
Depression or excessive/repressed anger causing Qi stagnation, which engenders Blood Stasis.
Contracting a pathogen during menstruation or post-partum.
Sexual strain.
Diagnosis - Clinical History
Important to ascertain:
Severe or chronic illness.
Psychological disorder.
Improper diet.
Sexual intercourse during menstruation or after labor - mechanical irritation, possible introduction of a pathogenic influence when the uterus is in a vulnerable state.
Use of an IUD.
Clinical Manifestations
Obvious increase in menstrual flow, more than 80ml, which stops after a period of time.
Bleeding may be prolonged.
May have a history of dysmenorrhea or infertility.
This condition can develop into:
Flooding (Beng) and Spotting (Lou) - a more severe form of disordered uterine bleeding.
BioMedical Differential Diagnosis
Flooding and Spotting (Metrorrhagia):
Both can display as profuse vaginal bleeding.
Key Difference: Metrorrhagia is disordered and does not stop spontaneously, whereas menorrhagia occurs during the regular period and stops spontaneously despite being heavy.
Abdominal Masses:
Fibroids, endometrial polyps, endometrial carcinoma, etc., may display heavy bleeding.
Diagnosis made through ultrasound, Dilatation and Curettage (D&C), etc.
Blood Diseases:
Thrombocytopenia, aplastic anemia, etc., can lead to menorrhagia.
Often accompanied by general hemorrhage like cutaneous (skin) or gingival (gum) bleeding.
Identified by blood analysis.
Pattern Differentiation and Treatment - General Principles
Differentiation Basis: Amount, color, and quality of the blood, general symptoms, along with tongue and pulse diagnosis to distinguish Qi Deficiency, Blood Heat, or Blood Stasis.
Importance: Comprehensive differentiation of patterns is very important in clinical practice. The severity and urgency of the symptoms must also be attended to.
Transformation of Patterns (Long-Term Menorrhagia)
Menorrhagia over a longer term may display patterns that transform into each other:
Qi Deficiency => Yin Deficiency => Internal Heat => Deficiency of both Qi and Yin.
Long-term heavy bleeding in Qi deficiency eventually causes Yin deficiency, which leads to the generation of internal heat.
Qi Deficiency => Blood Stasis.
Qi deficiency can also contribute to stagnant blood circulation and a gradual formation of blood stasis, resulting in a combined pattern of Qi Deficiency with Blood Stasis.
Yin Deficiency with Blood Heat => Qi Exhaustion to Blood Heat with Qi Deficiency or Blood Stasis.
Yin deficiency with blood heat gives rise to Qi exhaustion following bleeding, leading to the pattern of blood heat with Qi deficiency or blood stasis.
Stage-Based Treatment
Treatment differs depending on the menstrual phase:
During the Menstrual Phase (Bleeding): Emphasize reduction of bleeding to prevent excessive blood loss and damage to Yin.
During Non-Bleeding Phases: Address the root/causes and secure Chong and Ren Mai.
Pattern-Based Treatment Principles
Qi Deficiency: Replenish Qi to control the blood.
Blood Heat: Clear heat and cool blood strategies.
Blood Stasis: Activate the blood with regulating menstruation.
Fundamental Principle: "When Yin is at peace and Yang is compact, the storage and discharge of the uterus can be normal."
In Excessive Bleeding: Always stem the bleeding first.
Classification of Patterns and Treatment Strategies
Qi Deficiency
Clinical Manifestations:
Flow: Heavy, light red, thin and clear (without clots and maybe watery).
General Qi Def signs:
Complexion: Lusterless.
Energy: Mental fatigue, lack of strength, shortness of breath (SOB) with no desire to speak.
Pain: Dull, persistent pain in the lower abdomen.
Tongue and Pulse:
Tongue: Light red body, thin white coat.
Pulse: Thready, weak.
Pathogenesis Explanation:
When Qi is deficient, Yang declines, and transformation into blood fails, resulting in menstrual blood that is thin, clear, and light red.
Qi fails to distribute Yang, causing a pale complexion.
The Middle Qi is weak, leading to shortness of breath with no desire to speak.
Dull persistent lower abdominal pain is due to lack of nourishment of the uterine vessels (Bao Luo) because blood fails to circulate adequately within these vessels, thereby setting the stage for blood stasis.
Treatment Principles:
Supplement Qi.
Secure Chong Mai.
Control blood.
Regulate menstruation.
Herbal Formulas:
Ju Yuan Jian (Origin-Lifting Brew): leaning towards Si Jun Zi Tang.
Ren Shen (Ginseng) 10g
Huang Qi (Astragalus) 20g
Zhi Gan Cao (Licorice, prepared) 6g
Sheng Ma (Cimicifuga) 10g
Chao Bai Zhu (Atractylodes, prepared) 15g
Related Formulas: Gui Pi Tang (Restore the Spleen Decoction).
When due to Kidney Qi Deficiency:
Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) + Jiao Ai Tang (Ass-Hide Gelatin and Mugwort Decoction).
Zuo Gui Wan / Zuo Gui Yin (Restore the Left (Kidney) Pill / Decoction) + Jiao Ai Tang.
Jiao Ai Tang (Ass-Hide Gelatin and Mugwort Decoction):
E Jiao (Ass-hide gelatin) 6g
Ai Ye (Mugwort leaf) 9g
Sheng Di Huang (Rehmannia, raw) 12g
Dang Gui (Angelica Sinensis) 9g
Chuan Xiong (Sichuan lovage root) 6g
Shao Yao (Peony root) 12g
Gan Cao (Licorice) 6g
Acupuncture:
Points:
Sp1 - needle or most to strengthen SP holding function.
Sp6 - support the Yin level & Blood.
Lv3 - support the Yin level & Blood.
REN-6 - raising the qi.
Pair with SP-10 to also attend to the blood.
Moxibustion:
Sp1 (needle and/or moxa),
REN-8 - support the SP + KI Yang & Qi.
Pair with KI-16 to support the KI Yang.
REN-4
SP-6 / ST-36
R10
Blood Heat - Menorrhagia - Pathomechanism
Is the pivot involved?
Irritability, stiff joints, difficulty with twisting motions, tight jaw, ocular soreness/redness of the eyes, soreness around SP-21, restrictions in the Dai Mai.
Clinical Manifestations:
Flow: Heavy, bright red or dark red menstrual flow, which may be thick and sticky (“with a sheen or shine, like a reduction sauce”) or contain small clots.
Blood may be dark due to fluid loss, happens over time with heat conditions.
General Heat Signs: Vexation, thirst, general fever or flushed face, dry bound stool, yellow urine which may be accompanied by a scorching sensation.
Tongue and Pulse:
Tongue: Red body, yellow coat.
Pulse: Rapid, slippery.
Treatment Principles:
Clear heat.
Cool blood.
Secure Chong Mai.
Stop bleeding.
Herbal Formulas:
Bao Yin Jian (Yin-Safeguarding Brew) + Di Yu and Huai Hua:
Sheng Di Huang (Rehmannia, raw) 15g - nourish Yin & Blood, clear heat.
Shu Di Huang (Rehmannia, prepared) 15g - nourish Yin & Blood, clear heat.
Huang Qin (Scutellaria) 10g - clear heat from the pivot.
Huang Bai (Phellodendron) 10g - clear heat through all 3 jiaos; (affinity w/ middle, but will clear through all 3 together).
Think about Huang Bai when there is Heat in the Menstruation!!
Bai Shao (White peony root) 10g - nourish the blood, restrains.
Shan Yao (Dioscorea) 15g - earth-herb; quells fire. Works on both SP & KI to anchor.
Xu Duan (Dipsacus) 15g - support the KI Yang (not a hot herb).
Gan Cao (Licorice) 5g - earth; harmonizing.
Di Yu (Sanguisorba) 10g - to stop bleeding.
Huai Hua (Sophora flower) 10g - to stop bleeding.
Other formulas: Qin Lian Si Wu Tang (Scutellaria and Coptis Four-Substance Decoction) with stop bleeding herbs.
Qing Ru Gu Jing Tang (Clear Heat and Stabilize the Menses Decoction):
Huang Qin (Scutellaria) 10-15g
(Shan) Zhi Zi (Gardenia) 6-10g
Sheng Di Huang (Rehmannia, raw) 6-10g - clear heat from blood.
Di Gu Pi (Lycium bark) 10-12g - clear heat from blood.
Di Yu (Sanguisorba) 10-15g - stop bleeding.
E Jiao (Ass-hide gelatin) 9g - stop bleeding.
Ou Jie (Lotus rhizome node) 15-20g - stop bleeding.
Gui Ban (Tortoise shell) 10-15g
Mu Li (Oyster shell) 20-30g - cool, descend, astringe.
Zong Lu Tan (Palm fiber charred) 10g
Gan Cao (Licorice) 3g.
Acupuncture:
Points:
Sp1 - jing well pt; clears excess heat.
ST-44 - clears Heat from the ST channel.
Sp10 - clear heat from the blood; harmonize menstruation.
Li11,
Du14 - meeting pt of all the Yang; Clears Heat.
REN-3 - front Mu of the UB; brings cold water to the lower jiao to clear heat from the uterus & LV system (connects to the tendinomusculo meridian of the LV).
Sp6 - blood support.
UB40 - cool the blood.
Lu7/Li4 (Luo-Yuan points) - circulate Qi & Blood at the Wei level (exterior) to cool the blood.
Blood Stasis - Menorrhagia
Clinical Manifestations:
Flow: Heavy or prolonged menstruation, dark/purplish colored with clots.
General Signs: Chest tightness, restlessness.
Pain: Aching pain in the lumbar-sacral region or lower abdominal pain that is averse to pressure.
Skin: Lusterless.
Tongue and Pulse:
Tongue: Dark purple/dusky body or petechiae and ecchymosis (small purplish spots/patches).
Pulse: Choppy deep pulse or a wiry deep pulse.
Pathogenesis Explanation:
Blood stasis obstructs the Chong and Ren Mai and the uterus, so blood circulation is hindered, giving rise to uncontrolled extravasation of blood.
This results in a heavy menstrual flow which may be prolonged.
The static blood moves downward and manifests as dark, purple, clotty menstrual flow.
If it obstructs the chest, abdomen, lower back, or skin, there will be chest tightness, restlessness, headache, pain in the lower abdomen or sacro-lumbar region, and lusterless skin.
Treatment Principles:
Activate the blood.
Resolve stasis.
Stop bleeding.
Regulate (Tiao) menstruation.
Herbal Formulas:
Shi Xiao San (Sudden Smile Powder) plus Yi Mu Cao, San Qi, Qian Cao: relieves pain.
Pu Huang (Typha pollen) 10g - stops pain w/ WLZ; Shi Xiao San.
Wu Ling Zhi (Trogopterus feces) 15g - stops pain w/ PH; Shi Xiao San.
Yi Mu Cao (Leonurus) 30g - cool, invigorates blood.
San Qi (Notoginseng) 6g - cool, invigorates blood.
Qian Cao Gen (Rubia root) 15g - cool, invigorates blood.
(Xue Yu Tan 30g is a charred form, can be replaced with other appropriate stop bleeding herbs such as Zhu Ma Gen, Xian He Cao, Ai Ye Tan, etc.)
Shi Xiao San + Si Wu Tang (Four-Substance Decoction):
Pu Huang (Typha pollen) 10g
Wu Ling Zhi (Trogopterus feces) 10g
Dang Gui (Angelica Sinensis) 10g
Bai/Chi Shao (White/Red peony root) 10g
Shu Di Huang (Rehmannia, prepared) 10g
Chuan Xiong (Sichuan lovage root) 6g
Yi Mu Cao (Leonurus) 10g
Qian Cao Gen (Rubia root) 10-15g
Xiang Fu (Cyperus) 10g
Other Formulas:
Shi Xiao San + Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) - milder & warming option.
Tao Hong Si Wu Tang (Peach Kernel and Safflower Four-Substance Decoction), milder option.
Ge Xia Zhu Yu Tang (Drive Out Stasis Below the Diaphragm Decoction).
Other Blood Invigorating Herbs: Ze Lan (Lycopus), Chong Wei Zi (Leonurus fruit), San Leng (Sparganium), E Zhu (Curcuma zedoaria).
Acupuncture
Points: invigorate blood, treat GYN Blood stasis:
Li4,
Lv3,
Lv2,
HT-5 - important point for persistent excessive menstruation; emotional disturbance; fatigue at the blood level. Close connection to the Bao Mai.
Sp6,
SP-10 - clear heat from the blood; harmonize menstruation.
SP-8 - very important point for invigorating blood, treating GYN Blood stasis. Breaks up accumulations (“vaporizes phlegm/blood accumulations).
LV-5 - very important point for invigorating blood, treating GYN Blood stasis.
Note: HT5 is an important point for persistent excessive menstruation.