uterine bleeding

January 24, 2004

Female, 42, heavy periods, just off OCP's 3 months ago. All s/s point

to spleen qi not holding blood and liver blood vacuity. No reported or

elicited s/s point to liver depression. However, the patient does have

cramps and clots. This is attributed to blood stasis due to qi

vacuity. The patient is known to me for several months when she

reports this problem. She is very earth constitution, no hint of wood

in her demeanor as far as I could tell. Anyway, she responds to bu

zhong yi qi tang plus stop bleeding herbs one week before her period

with early and profuse bleeding. This happens in month 1 and month 3.

during month 2, she is on vacation and takes jia wei xiao yao san all

month and has a normal period. Upon questioning, she has been quite

irritable, hot-tempered and sighing frequently (but I suspect this is

situational and was not necessarily the case all along). All this is

confirmed by her regular carpool companion who is present in the exam

room.

Though her tongue and pulse seem to point very much towards qi and

blood xu, the patient has good energy. The tongue is dry from the

blood loss and in hindsight, the weak pulse and pale tongue could be

due to excessive blood loss from liver depression heat. but then

wouldn't the tongue redden or purple again after ovulation if their

really was heat building up. The tongue does have the sublingual

distended veins at this time, though. Thus, it seems that perhaps the

patient got more stagnant and hot from taking bu zhong yi qi tang. Its

hard for me to see how that is the case as BZYQT contains chen pi, dang

gui, chai hu and sheng ma are all dispersing. and perhaps huang qi

also has this property as well. Or perhaps the patient is just

readjusting to life after 12 years on the pill and we should be

patient. At this point, my sense is to use blood building after her

period, then shift to jia wei xiao yao after ovulation if the liver

depression persists (perhaps the OCPs were masking or relieving the

liver depression). the blood loss may of course may a major factor in

the mounting depression and heat, as well. finally, the patients 7

female relatives on her mother's side all had hysterectomies from heavy

blood loss before age 35. thoughts?

As a side note, how do people address female complaints in general.

Several of my professors always nourish blood after the period,

supplement yang around ovulation and moves qi premenstrually,

regardless of the patient's pattern. In other words, treatment is for

the pattern plus blood tonics post menstrually and so on. They use

this strategy for infertility and PMS. Do others agree? does it apply

to uterine bleeding as well, even in the early stages of treatment.

How do yang tonics figure into this equation in people's experience?

Chinese Herbs

FAX:

January 26, 2004

When are the cramps and clots coming? I think that's key. I read in

someone's book that all cases of bleeding involve Blood stasis - must

have been that Wang Qing Ren guy again... If she's getting cramps and

clots on Day 1, you should strongly consider Blood stasis, and tonics

from Day 14 to Day 1 will worsen the problem. I do the 'side note' you

mention all the time, except I don't always tonify yang. Instead, I

often move the Blood durning the period (when they have cramps and pain

on Day 1) My patients find it works very well.

Geoff

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Message: 12

Sat, 24 Jan 2004 10:37:03 -0800