Part 4

Or excessive blood loss leads to deficiency of middle qi and loss of its governing function, causing blood to deviate from its normal channels and flow abnormally, resulting in sudden heavy bleeding or persistent dripping, which manifests as metrorrhagia, menorrhagia, and other conditions. Meanwhile, Professor Pei Zhengxue frequently emphasizes that with the accelerating pace of modern life, people often neglect their lifestyle and dietary habits. Many tend to eat at fast-food restaurants, or consume excessive amounts of fatty, sweet, rich, spicy, and irritating foods, leading to dietary imbalances and unreasonable, unscientific nutritional combinations that harm the spleen and stomach. Furthermore, some women blindly pursue a slim figure and engage in extreme dieting for weight loss, thereby damaging the spleen and stomach. In addition, due to intense competition in modern society and increasing pressures from life, work, and study, coupled with long working hours and lack of exercise, excessive thinking harms the spleen, while overwork damages the spleen and stomach, leading to spleen deficiency and weakened governing function, which impairs the normal transportation and transformation functions of the spleen and stomach, easily causing qi and blood deficiency and inability to nourish the Chong and Ren meridians, thus resulting in menstrual irregularities. Professor Pei Zhengxue believes that blood stasis is a pathological product formed by the invasion of external pathogenic factors into the uterus and organs, or by dysfunction of organ functions, or by qi stagnation and qi deficiency. Anger and frustration injure the liver, leading to qi stagnation and blood stasis; or when external pathogenic factors invade the uterus, these factors clash with the blood to form stasis—for example, when exposed to cold pathogens, cold invades the uterus and causes the blood to congeal; or when one is inherently melancholic, qi stagnates and blood stasis occurs—both situations obstruct the Chong and Ren meridians, impeding the smooth flow of blood. When blood stasis blocks the Chong and Ren meridians and the uterus, it can lead to amenorrhea or scanty menstruation; if the blockage occurs in the uterus, preventing new blood from settling properly, the menstrual blood flows erratically, resulting in prolonged menstruation or excessive menstrual flow. Professor Pei Zhengxue believes that Western medicine mainly uses estrogen and progesterone to regulate the menstrual cycle and ovulation, but many of the ovulation-inducing drugs have poor safety and relatively limited treatment options. Traditional Chinese medicine has a long history of treating menstrual irregularities and generally achieves good therapeutic effects. The differentiation and diagnosis of menstrual irregularities focus on changes in the timing, amount, color, and quality of menstruation, as well as accompanying systemic symptoms during the menstrual cycle, while also considering overall syndrome patterns. Treatment is primarily based on the liver, spleen, kidneys, qi and blood, and the balance of cold and heat, with comprehensive analysis conducted using the Four Diagnostic Methods and Eight Principles. The key to treating menstrual irregularities lies in addressing the root cause to regulate menstruation, and regulating menstruation itself is treating the root cause. Common approaches include soothing the liver, tonifying the spleen, nourishing the kidneys, and regulating qi and blood in the Chong and Ren meridians. During treatment, it is first necessary to distinguish between diseases caused by other conditions and those specific to the menstrual system. If menstrual irregularities are caused by other diseases, the underlying disease should be treated first; once the underlying disease is cured, the menstrual irregularities will naturally resolve. If menstrual irregularities give rise to other diseases, then the menstrual irregularities should be addressed first; once the menstrual irregularities are regulated, the other diseases will naturally heal. Next, it is important to differentiate between urgent and non-urgent issues: treat the urgent ones first, and the non-urgent ones later. Finally, it is necessary to consider the different stages of the menstrual cycle. During the menstrual period, when the blood chamber is open, caution should be exercised when using strongly cold or strongly hot formulas; before menstruation, when the blood reservoir is full, avoid excessive tonification and instead focus on guiding and dispersing; after menstruation, when the blood reservoir is empty, avoid aggressive tonification and instead focus on regulating and tonifying, but always adjust the dosage according to the actual condition of deficiency or excess. Professor Pei Zhengxue believes that the fundamental methods for treating menstrual irregularities include tonifying the kidneys, supporting the spleen, soothing the liver, and regulating qi and blood. “Menstrual water originates from the kidneys,” so the root of regulating menstruation lies in the kidneys. Tonifying the kidneys means nourishing the innate true yin to replenish essence and nourish blood, supplemented by warming yang and boosting qi, so that yang rises and yin grows, essence and blood both flourish, and menstruation will naturally regulate itself. Supporting the spleen means nourishing the source of qi and blood, focusing on strengthening the spleen and raising yang, so that the spleen and stomach function well and qi and blood are abundant, providing a strong source for smooth flow. Soothing the liver means regulating qi, unblocking the flow of qi, primarily to dispel depression and promote the smooth flow of qi, supplemented by herbs that nourish the liver, so that the liver qi is relieved, qi and blood flow smoothly, and menstrual disorders can be cured. Regulating qi and blood requires distinguishing between qi-related illnesses and blood-related illnesses: if the illness is related to qi, treat the qi first and the blood second; if the illness is related to blood, treat the blood first and the qi second. Traditional Chinese medicine has excellent efficacy in treating menstrual irregularities, but early pregnancy and ectopic pregnancy should never be mistaken for menstrual irregularities and treated as such. Menstrual irregularities caused by organic lesions of the reproductive system should be promptly and appropriately addressed to avoid delaying treatment. 6. Professor Pei Zhengxue’s differential diagnosis and treatment (1) Liver Qi Stagnation Symptoms: Irregular menstrual cycles, varying amounts of menstrual flow, breast tenderness before menstruation, or dry mouth, fever, thirst, yellow vaginal discharge, dark or pale tongue, thin yellow or white coating. There may also be blood clots, breast tenderness before menstruation, distension and pain in the flanks and lower abdomen, irritability and anger, red tongue, thin white coating, and string-like or fine string-like pulse. Treatment principle: Soothe the liver and relieve stagnation, regulate the Chong and Ren meridians and promote the flow of qi. Prescription: Modified Chaihu Shugan San combined with Xiaoyao San. Ingredients: Chaihu 20g, Chenpi 6g, Xiangfu 6g, Quanshi 10g, Chuanchiong 10g, Baishao 15g, Zhigancao 6g, Danggui 10g, Baizhu 10g, Fuling 10g. If there is abdominal pain during menstruation and blood clots mixed in the menstrual flow, add Taohong Siwu Tang, fried Puhuang, and Sanqi to dissolve stasis and stop bleeding; if breast tenderness is severe during menstruation, add Gua Wei, Wang Buliu Xing, and Yujin to relieve depression, disperse stagnation, and relieve pain; if there is liver stagnation and kidney deficiency, with irregular menstrual cycles, add Dingjing Tang (Danggui, Baishao, Shudi Huang, Chaihu, Shanyao, Fuling, Tusi Zi, fried Jingjing) to soothe the stagnant qi of the liver and kidneys, replenish the essence and blood of the liver and kidneys, relax the liver qi and strengthen the kidney essence, allowing qi and blood to flow freely, ensuring normal accumulation and release of blood, so that menstruation will no longer be irregular; if the cheeks are flushed and the lips are red, the palms and soles are hot, and the throat is dry, add Xuanshen and Maidong to nourish yin and clear heat; if thirst is obvious, add Tianhuafen and Lugen to nourish yin and generate fluids; if urination is short and reddish, add Cheqianzi and Qumai to clear heat and promote urination; if menstrual flow is excessive, remove Fuling and add Diyu Tan and Qiancao Gen to cool the blood and stop bleeding; if the discharge is abundant and yellow, add Er Miao San; if there is vulvar itching, add Jinyinhua, Lianqiao, Pugongying, Baijiang Cao, Kusen, and Huangbo. (2) Blood Cold Congealing Symptoms: Late menstruation, scanty menstrual flow, difficulty in the flow of menstrual blood, dark red color, thick consistency, or presence of blood clots, pale complexion, fear of cold and cold limbs, cold or cramping pain in the lower abdomen that eases with warmth, pale and dull tongue, thin white coating, and deep, string-like or tight pulse. Treatment principle: Warm the meridians to dispel cold and activate blood circulation to regulate menstruation. Prescription: Modified Da Wenjing Tang. Ingredients: Guizhi 10g, Fuling 10g, Baishao 10g, Danpi 6g, Wu Zhu Yu 10g, Dangshen 10g, Ganjiang 6g, Banxia 6g, Maidong 10g, A Jiao 6g (as a substitute), Zhigancao 6g. If menstrual flow is scanty, add Zihéche, Rou Congrong, and Danshen to nourish essence and blood to facilitate menstruation; if vaginal discharge is abundant, add Lu Jiaojiao, Jin Yingzi, and Ying Shi to solidify and stop the discharge; if menstruation is significantly delayed, add Taoren, Honghua, Guizhi, and Niuxi to warm the meridians and activate blood circulation, guiding the blood downward; if there is subtle pain in the lower abdomen during menstruation, use more Baishao and add A Jiao, Xiangfu, and Yi Mu Cao; if abdominal pain is resistant to pressure and accompanied by blood clots, add Shixiao San and Yanhusuo to dissolve stasis and relieve pain; if constipation occurs, add Baizhu and Fuling to strengthen the spleen and promote diuresis. (3) Qi Stagnation and Blood Stasis Symptoms: Late menstruation, scanty and difficult menstrual flow, or menstrual blood flowing out at inappropriate times, with either excessive or insufficient flow, continuous dripping without complete cessation, dark purple color with clots, distension and pain in the lower abdomen that eases upon pressure, pain in the flanks and breasts, irritability and anger, dark purple tongue, possibly with petechiae or ecchymoses, thin coating, and string-like or fine string-like pulse. Treatment principle: Promote the flow of qi and blood, regulate menstruation and relieve pain. Prescription: Modified Taohong Siwu Tang combined with Shaofu Zhuyu Tang. Ingredients: Taoren 10g, Honghua 10g, Danggui 10g, Shengdi Huang 12g, Cheshao Yao 15g, Chuanchiong 6g, Xiao Hui Xiang 6g, Ganjiang 6g, Rou Gui 3g, Puhuang 10g, Wuling Zhi 10g, Yanhusuo 10g, Myrrh 10g, Zhigancao 6g. If breast tenderness is obvious, add Chaihu, Chuannianzi, Yujin, and Wang Buliu Xing; if qi stagnation is prominent, add Ke, Muxiang, Xiangfu, and Yi Mu Cao; if cold congealing causes cold pain in the lower abdomen and the pulse is slow, add Xiao Hui Xiang, Rou Gui, and Wu Zhu Yu; if there is frequent lower abdominal pain or low-grade fever that does not subside, with a dark purple tongue, yellow and dry coating, and rapid pulse, add Danpi, Zhizi, Ze Lan, and Danshen; if bleeding is excessive and does not stop, add Shenglong Mu, Wuzi Gu, A Jiao, Ai Ye, and Zonglu Tan. (4) Qi and Blood Deficiency Symptoms: Early menstruation, or delayed menstruation, or prolonged menstruation, scanty flow, pale color, thin consistency, fatigue, weakness in the limbs, dizziness, palpitations, insomnia and frequent dreams, dry skin, sallow complexion, poor appetite and bowel movements, feeling of emptiness and heaviness in the lower abdomen, pale tongue with thin coating, and weak, fine pulse. Treatment principle: Tonify qi and blood to regulate menstruation. Prescription: Modified Shiquan Dabu Tang combined with Gui Pi Tang. Ingredients: Dangshen 10g, Baizhu 10g, Fuling 10g, Huangqi 30g, Danggui 10g, Shudi Huang 10g, Baishao 10g, Chuanchiong 10g, Rou Gui 3g, Longyan Rou 10g, Fushen 10g, Suanzao Ren 10g, Yuanzhi 10g, Muxiang 6g, Zhigancao 6g. If appetite is poor, add Danshen, Muxiang, and Caodou; if both heart and spleen are deficient, add Gui Pi Tang; if menstrual flow is abundant, add Ai Ye, A Jiao, and Wuzi Gu to stop bleeding and consolidate; if there is subtle pain in the lower abdomen during menstruation, use more Baishao and add A Jiao and Xiangfu; if chest feels stuffy, add Gua Wei and Ke; if feeling nauseous and vomiting, add Sharen and Zhike; if vaginal discharge is abundant, add Cangshu, Huangbo, and Cheqianzi. (5) Liver and Kidney Deficiency Symptoms: Late menstruation, scanty flow, even amenorrhea, dizziness, tinnitus, soreness in the lower back and knees, heat in the palms and soles, sometimes hot flashes and night sweats, constipation, or general fatigue and weakness, fear of cold and cold limbs, soreness in the lower back and knees, diminished libido, long and clear urine, thin stools, dull complexion, dark red tongue, and deep, fine or rough pulse. Treatment principle: Nourish the liver and kidneys, nourish blood and regulate menstruation. Prescription: Modified Dabuyuan Jian combined with Zuogui Wan or Yougui Wan. Ingredients: Renshen 10g, Shanyao 10g, Danggui 10g, Sangjisheng 20g, Sizi 20g, Baizhu 10g, Shudi Huang 10g, Gouqi 10g, Shanyao 10g, Shanjuyu 10g, Du Zhong 10g, Xuduan 10g, Jiubai Yao 10g, Zhigancao 6g. For those with kidney yin deficiency, add Nüzhenzi and Hanlian Cao; for those with kidney yang deficiency, add Bajitian, Yin Yang Huo, and Rou Gui; for those with kidney qi deficiency, add Dangshen, Huangqi, and Baizhu; if lower back pain is severe, add Xuduan, Du Zhong, Niuxi, and Sangjisheng to nourish the kidneys and relieve lower back pain; if leakage persists for a long time, add Ou Jie Tan, Qiancao Tan, fried Puhuang, A Jiao, and Ai Ye; if frequent nocturnal urination occurs, add Yizhiren and Jin Yingzi to strengthen the kidneys and reduce urination; if phlegm and dampness accumulate internally and obstruct the Chong and Ren meridians, add Er Chen Tang to dry dampness and transform phlegm, activating blood circulation to regulate menstruation; if feeling stuffy and nauseous, add Sharen, Quanke, and Banxia to relieve nausea; if vaginal discharge is abundant, add Cangshu, Huangbo, and Cheqianzi to dry dampness and stop the discharge. Bleeding and leakage refer to menstrual blood that either gushes out uncontrollably or drips continuously, or fails to stop completely. The former has the force of a collapse of heaven and earth, hence called “collapse”; the latter resembles water leaking from a broken roof, hence called “leak.” According to the “Jisheng Fang,” “The disease of bleeding and leakage originates from a single syndrome: mild cases are called ‘leak,’ while severe cases are called ‘collapse.’” In modern medicine, any vaginal bleeding that occurs in cases of menstrual irregularities, pelvic inflammatory disease, gynecological tumors, and other conditions falls under the category of “bleeding and leakage.” Professor Pei Zhengxue believes that traditional Chinese medicine broadly classifies the syndrome of bleeding and leakage into three types: first, qi failing to govern blood; second, blood heat running amok; third, obstruction of the meridians. Although these three types have distinct pathogenic mechanisms, their root cause ultimately lies in the Chong and Ren meridians—the Chong being the blood reservoir and the Ren being the blood chamber—and both the Chong and Ren are governed by the liver. Therefore, regulating the liver is the fundamental approach in traditional Chinese medicine for treating bleeding and leakage. Obstruction of the meridians in cases of bleeding and leakage is commonly seen in what Western medicine calls ovarian cysts, uterine fibroids, endometrial hyperplasia, cervical cancer, and other conditions; blood heat running amok is similar to what Western medicine refers to as adnexal inflammation, including vaginitis, cervical erosion, and pelvic inflammatory disease, and anyone exhibiting characteristics of blood heat running amok can refer to these conditions for differential diagnosis and treatment; the clinical manifestations of qi failing to govern blood are similar to functional uterine bleeding in Western medicine. Professor Pei Zhengxue closely integrates the principles of traditional Chinese medicine differential diagnosis with Western medical diagnostic criteria to conduct differential diagnosis and treatment based on specific syndromes. He emphasizes that diagnosing and treating this condition must be based on medical history, syndrome presentation, and relevant auxiliary examinations. 7. Analysis of prescriptions used by Professor Pei Zhengxue Professor Pei Zhengxue believes that activating blood circulation and removing blood stasis is the fundamental principle for treating all gynecological diseases, whether it's menstruation or vaginal discharge—activating blood circulation and removing blood stasis is always the primary method, with additional measures such as soothing the liver and relieving stagnation, strengthening the spleen and nourishing the kidneys, and tonifying qi and nourishing blood built on top of this foundation. Early menstruation is associated with heat, so cooling and clearing heat are effective; late menstruation is associated with cold, so warming the meridians to dispel cold and regulating the Chong and Ren meridians are effective. Early menstruation is often due to inflammation, while delayed menstruation is often due to insufficient female hormones. For early menstruation, use Danzhi Yaosan, Taohong Siwu Tang, and Guizhi Ling Wan; for delayed menstruation, use Da Wenjing Tang. Abdominal pain during menstruation is due to blood stasis, so activating blood circulation and removing blood stasis is necessary, often using Jinlingzi San and Shixiao San. Taohong Siwu Tang focuses on removing blood stasis, supplemented by nourishing blood and promoting the flow of qi. This formula first appeared in the “Yizong Jinjian,” and after several generations of refinement by physicians, it has become a renowned formula for regulating menstruation and activating blood circulation. Its basic ingredients include Danggui, Chuanchiong, Shudi Huang, Baishao, Honghua, and Taoren, among others. Among them, Danggui and Shudi Huang can nourish yin and tonify the liver, regulating menstruation and nourishing blood; Honghua and Taoren can activate blood circulation, promote the flow of qi, and relieve pain and remove blood stasis; Chuanchiong can activate blood circulation and promote the flow of qi, assisting the effect of activating blood circulation; Baishao can soothe the liver and relieve pain, nourishing blood; and Zhigancao harmonizes all the herbs, together achieving the effects of promoting the flow of qi and removing blood stasis, tonifying the liver and nourishing blood, and activating blood circulation to promote the flow of qi and blood. The formula relies heavily on powerful blood-dispersing ingredients like Taoren and Baishao to remove blood stasis; Shudi Huang and Shedi Huang provide yin-nourishing and blood-tonifying effects, helping to regulate menstruation; Chuanchiong activates blood circulation and promotes the flow of qi, assisting the effect of activating blood circulation. The entire formula is well-balanced, effectively removing blood stasis, generating new blood, and facilitating the flow of qi, making the removal of blood stasis and generation of new blood the most distinctive feature of this formula. The combination of all the herbs achieves a balance between yin and yang, capable of both nourishing the liver and replenishing yin to regulate blood, making it an excellent prescription for treating menstrual irregularities. Modern research shows that Taohong Siwu Tang has the effects of vasodilation, anti-inflammation, anti-fatigue, anti-shock, immune regulation, lipid-lowering, trace element supplementation, and allergy prevention, fundamentally regulating and promoting the recovery of menstruation. Xiaoyao San was first recorded in the “Taiping Huimin Heji Ju Fang,” evolving from the “Shanghan Lun”’s four reverse formulas and the Danggui Shao Yao San. Xiaoyao San consists of Chaihu, Danggui, Baishao, Baizhu, Fuling, Zhigancao, and peppermint. Chaihu is the chief herb for soothing the liver and relieving stagnation, containing saponins that have anti-inflammatory, uterine-stimulating, sedative, calming, and analgesic effects. Danggui nourishes blood and qi, with a pungent and dispersing flavor, acting as a qi medicine in the blood, containing volatile oils that can counteract the stimulating effects of adrenaline, posterior pituitary hormone, or histamine on the uterus, effectively enhancing the body’s immune function. Baishao nourishes blood and calms the liver, with a gentle and soothing effect, containing paeoniflorin that has good antispasmodic properties. When Danggui, Baishao, and Chaihu are used together, they complement each other, reinforcing the liver’s essence while supporting the liver’s yin, balancing blood and liver, making the liver calm and the blood soft, serving as supporting herbs. When the liver is depressed, the spleen suffers, so Baizhu, Fuling, and Zhigancao are used to strengthen the spleen and boost qi; adding a little peppermint to the formula can disperse the stifled qi and penetrate the heat trapped in the liver meridian; ginger can reverse the situation and neutralize the qi, serving as a supporting herb. Chaihu acts as a guiding herb for the liver meridian and also serves as a medicinal herb. Modern pharmacological studies show that Xiaoyao San has sedative, analgesic, and anti-convulsive effects, as well as anti-anxiety and anti-depressive effects, and can regulate the endocrine system, balance hormone levels, and correct immune dysregulation. The combination of all the herbs allows for holistic regulation through multiple pathways—central nervous system, nerves, endocrine system, and immune system—improving the body’s immunity. Danzhi Xiaoyao San is a clinically renowned formula for harmonizing the liver and spleen, with Danpi clearing the hidden fire in the blood, Zhizi clearing the heat in the liver, and guiding the heat downward. Together, these two herbs treat long-term liver stagnation that leads to internal heat deficiency; Chaihu soothes the liver and relieves stagnation; Baishao and Danggui nourish blood and nurture the liver, calming the liver and nurturing yin; Baizhu and Fuling strengthen the spleen and support the middle jiao; Xiangfu and Shengma clear heat and regulate qi; Zhigancao harmonizes all the herbs. The entire formula soothes the liver and strengthens the spleen, cools the blood and regulates menstruation, achieving harmony between the liver and spleen, making the liver qi smooth and the Chong and Ren meridians flow smoothly, so that menstruation arrives on time. Da Wenjing Tang originates from the “Jin Gui Yao Lue · Women’s Miscellaneous Diseases and Pulse Diagnosis and Treatment, Chapter 22,” with the following composition: Wu Zhu Yu three liang, Danggui, Shao Yao, Chuanchiong, Renshen, Guizhi, A Jiao, Mudan Pi, Ginger, and Zhigancao each two liang, Banxia half sheng, and Maidong one sheng. Its functions include warming the meridians to dispel cold, removing blood stasis and nourishing blood, and supporting the righteous while eliminating evil. Chen Xiuyuan commented on Wenjing Tang in his “Women’s Medical Essentials” as follows: “Wenjing Tang is the first formula in the ‘Jin Gui Yao Lue’ for warming the meridians, and regardless of whether one is deficient or excessive in yin and yang, facing blockages or collapses, young or old, as long as it is used properly, it will surely produce results…” In the formula, Wu Zhu Yu is bitter and extremely hot, entering the liver, stomach, and kidney meridians; its bitterness can disperse, its heat can descend, and its extreme heat can also warm and disperse cold pathogens, thus dispelling cold and relieving pain; Guizhi is pungent and warm, able to warm the meridians to dispel cold and promote blood circulation, and the two herbs together serve as the chief herbs. Danggui, Chuanchiong, and Shao Yao enter the liver meridian, able to activate blood circulation and remove blood stasis, nourishing blood and regulating menstruation; Mudan Pi is bitter and pungent, slightly cold, entering the heart, liver, and kidney meridians, activating blood circulation and removing blood stasis, while also dissipating the hidden heat in the blood, serving as supporting herbs. A Jiao is sweet and neutral, able to nourish the liver and blood while also nourishing the kidneys, having blood-tonifying and moisture-retaining effects; Maidong is sweet and slightly cold, able to nourish yin and clear heat, and can also restrain Wu Zhu Yu.