Patient's question:
Before menstruation, there is lower abdominal pain. The menstrual period lasts for about 10 days, and the flow is heavy, lasting 2 to 3 days. The blood test results show platelets at 35 units, with no coagulation. The ultrasound results: the uterus is in a horizontal position, the size of the uterine body is about 5.85.6 cm, the uterine wall has non-uniform echoes, and no space-occupying mass was detected; the endometrium is about 1.4 cm thick, with echoes in the central position; the cervix is not thick, and no space-occupying mass was observed. The bilateral ovaries are displayed: the left ovary is 4.13.0 cm, with a cystic dark area of about 2.81.6 cm inside. The right ovary is 2.61.8 cm, and a network of tortuous dilated veins is visible around the uterus. Please advise.Doctor's answer:
The occurrence of this disease is primarily caused by the instability of Chong and Ren meridians, closely related to the liver, spleen, and kidneys. Clinically, the following patterns are commonly observed.1. Qi deficiency: A deficiency in the body's middle Qi, or exhaustion from overwork damaging the spleen, leading to further spleen deficiency and loss of control over blood circulation, resulting in unstable Chong and Ren meridians and prolonged menstrual bleeding. As the Comprehensive Collection of Good Methods for Women states: "Women may experience continuous menstruation with abdominal pain, or this may be due to exhaustion damaging Qi and blood, injuring the Chong and Ren meridians."
2. Blood heat: A deficiency in the body's Yin, or irregular sexual activity, or excessive childbirth, leading to internal consumption of essence and blood, internal Yin deficiency and internal heat, which disturbs the Chong and Ren meridians, causing menstrual blood to lose its proper flow. Some cases may also involve anger injuring the liver, leading to impaired regulation and continuous menstruation. As Wang Mengying noted: "There are cases where heat disrupts the body's normal balance."
Treatment Principles
Although this disease may be classified as Qi deficiency or blood heat, the primary approach should focus on replenishing deficiencies. For Qi deficiency, the treatment is to replenish Qi and control bleeding; for blood heat, the treatment is to nourish Yin and clear heat, but excessive use of bitter-cold herbs should be avoided to prevent further Yin depletion. Strengthening the body () is the fundamental method, and once balance is restored, the menstrual cycle will normalize.
Pattern Differentiation and Treatment
1. Qi deficiency
Main symptoms: Prolonged menstrual bleeding with pale, thin quality; fatigue, poor spirit, palpitations, insomnia, poor appetite, loose stools; pale tongue with thin white coating; weak and slow pulse.
Analysis: Spleen deficiency with insufficient middle Qi leads to loss of blood control, resulting in prolonged menstruation. Qi deficiency impairs Yang energy, preventing blood from turning red, hence the pale, thin quality. Prolonged bleeding depletes blood, failing to nourish the heart, causing palpitations and insomnia. Spleen deficiency impairs transportation, leading to poor appetite and loose stools. A pale tongue with thin white coating and weak, slow pulse indicate spleen deficiency and Qi weakness.
Treatment: Replenish Qi and strengthen the spleen, warm the meridians to stop bleeding.
Medication: Spleen-Poisoning Decoction (from Jisheng Fang) plus carbonized black ginger, cuttlefish bone, and carbonized rattan fruit. The formula includes ginseng, astragalus, and licorice to replenish the spleen and Qi. Fu Shen (Poria) and Yuan Zhi (Polygala)