Eight: Case Examples

, Gui Zhi's warming and drying properties; Ginseng and Licorice, with their sweet taste, enter the Spleen meridian, benefiting Qi and tonifying the middle jiao to assist in generating the source of transformation and production, thus enabling Yang to arise and Yin to grow, and Qi to flourish while Blood becomes abundant; Banxia, with its pungent and warm nature, can unblock and descend Stomach Qi while dispersing accumulations. When combined with Ginseng and Licorice, it strengthens the Spleen and harmonizes the Stomach, helping to remove stasis and regulate menstruation; Fresh Ginger warms the interior and dispels cold, and when used together with Banxia, it warms the center and harmonizes the Stomach to aid in transformation and production. All of the above serve as assistant herbs; Licorice also harmonizes all the other herbs and functions as a guiding herb. Together, these herbs warm the meridians and disperse cold to invigorate blood circulation, nourish the Chong and Ren channels to consolidate the root, eliminate blood stasis, generate new blood, thereby regulating menstruation and eliminating disease. "The Siwu Decoction is not exclusively for activating or nourishing blood; rather, it is a supreme formula for regulating the Liver," this is a famous saying by the renowned Qing Dynasty physician Ke Yunbo. Professor Pei Zhengxue consistently uses this formula as the primary prescription for treating collapse bleeding due to Qi failing to control the Blood. For cases accompanied by abdominal pain, Guizhi Fuling Wan is added; for severe Qi deficiency, Dangshen, Huangqi, and Licorice are added; for heavy collapse bleeding, Shan Zhu Yu 20g, Yuan Rou 20g, Sheng Longmu each 15g, and Wuzi Gu 15g are added; for low blood pressure, Dangshen 10g, Mai Dong 10g, and Wu Wei Zi 6g are added; for shock, 30g of Ginseng and 50g of brown sugar are used, decocted in water for 10 minutes, and taken immediately. This treatment approach generally falls under the category of Qi failing to control the Blood mentioned earlier. From a modern medical perspective, such vaginal bleeding is primarily functional uterine bleeding rather than organic pathology. If there are many blood clots, Tao Ren and Hong Hua are added; if the amount of bleeding is excessive, Sheng Longmu, Wuzi Gu, A Jiao, and Ai Ye are added; if B-ultrasound shows benign masses, San Leng, E Zhu, Hai Zao, Kun Bu, Han San Qi, and Shui Zhi are added. If menstruation occurs several days early, with heavy flow and bright red color, or if it is prolonged and incomplete, accompanied by heat in the palms and soles, a red tongue with yellow coating, and a floating, rapid pulse, Di Li Tang is used as the main prescription with modifications, incorporating Mu Dan Pi, Di Gu Pi, Sheng Di, Xuan Shen, Mai Dong, and Bai Shao. If there is excessive white discharge with yellow color, Er Miao San is added; if constipation is present, Da Huang and Shi are added; for vulvar itching, Jin Yin Hua, Lian Qiao, Pu Gong Ying, Bai Jiang Cao, Ku Shen, and Huang Bo may be added as appropriate. If there is excessive menstrual flow, pale color, thin consistency, obvious fatigue, dizziness, and anemic appearance, it indicates a syndrome of Spleen failing to control the Blood, and Gui Pi Tang is used as the main prescription to strengthen the Spleen, benefit Qi, and stop bleeding. For those with palpitations and excessive sweating, more Ginseng and Huangqi are added, along with Bai Shao and Dang Gui to nourish the Blood. Given the complex clinical manifestations of patients with collapse bleeding—often alternating or simultaneously presenting with Qi deficiency, Blood Heat, and blood stasis—it is crucial to avoid confusing primary and secondary symptoms and to distinguish between root and branch. At the same time, various auxiliary examinations should be conducted, among which irregular menstruation, pelvic inflammatory disease, and benign gynecological tumors can all benefit from the advantages of TCM diagnosis and treatment. However, in cases of cervical cancer, ovarian cancer, or incomplete abortion, Western medical methods must be combined to avoid delaying treatment, misdiagnosis, or mistreatment. Professor Pei Zhengxue often says, "Running water does not spoil, and a door hinge does not rot." When treating collapse bleeding, one must avoid solely relying on hemostatic methods. If such methods are used, the blood that has already left the meridians will accumulate in the uterus, and even if temporary hemostasis is achieved, there will inevitably be subsequent problems, because stagnant blood remains in the body, and without removing the stasis, new blood cannot be generated, leading to new illnesses and further complications. Professor Pei Zhengxue’s prescriptions for collapse bleeding mostly follow the principle of “treating the cause by addressing the symptom.” Han San Qi and Shui Zhi have powerful effects in breaking up blood stasis and expelling blood, and Professor Pei Zhengxue uses them skillfully. Although these drugs break up blood, they do not deplete the Blood; instead, they remove pathogenic factors, unblock stagnation, and allow Qi, Blood, and body fluids to flow freely, thereby achieving the fundamental goal of curing the disease. Eight: Case Examples Case 1: 27 years old, married. Chief complaint: “Irregular menstruation for 3 years, worsening for half a year.” History of present illness: Menarche at age 14. Gave birth to one child at age 24, after which menstruation became irregular, with heavy flow and bright red color, occasionally with blood clots. Menstrual period lengthened, ranging from 7 to 15 days. In the past six months, condition worsened, and Western medicine hemostasis was tried without success. Current history: Ten days ago, menstruation started but continued to bleed, with bright red color and occasional blood clots, though the amount was small. Patient felt fatigued, had a dull complexion, weakness, shortness of breath, lack of appetite, and constipation. Tongue was pale red, coating thin and white, pulse deep. [Western Diagnosis] Irregular menstruation, prolonged menstrual period. [TCM Differentiation] Kidney Yang deficiency, Qi and Blood deficiency. [Treatment Principle] Tonify Kidney and strengthen Yang, nourish Blood and benefit Qi. [Prescription] Dabuyuan Jian combined with Gui Pi Tang with modifications. Dangshen 10g, Huangqi 30g, Danggui 10g, Sangjisheng 20g, Sizi 20g, Baizhu 10g, Shudi 10g, Gouqi 10g, Shanyao 10g, Shan Zhu Yu 10g, Du Zhong 10g, Xu Duan 10g, Jiu Bai Shao 10g, Yin Yang Huo 10g. Modified according to symptoms, after continuous medication for 4 months, menstrual cycle returned to normal, with regular periods lasting 6 days. Case 2: 27 years old, married. Due to family disputes with her husband, she became upset and developed chest and flank distension, loss of appetite, feeling cold, delayed menstruation by one week, with light flow and blood clots, lower abdominal distension and pain, purple-dark tongue, thin white coating, and string-like pulse. [TCM Differentiation] Qi stagnation injuring the Liver. [Treatment Principle] Soothe the Liver and resolve depression, regulate Qi and menstruation. [Prescription] Chaihu Shugan San with modifications. Chaihu 10g, Chenpi 6g, Xiangfu 6g, Quanshi 10g, Chuanxiong 10g, Bai Shao 15g, Licorice 6g, Danggui 10g, Baizhu 10g, Fuling 10g, Danshen 30g, Yimu Cao 30g. Decocted in water, one dose per day. Also advised to maintain emotional balance; after taking 10 doses, all symptoms disappeared. Case 3: 28 years old, came for consultation due to menstrual irregularity for four months. Menstruation was late, with light flow and dark purple color, cold lower abdominal pain, preference for warmth and aversion to pressure, slightly increased white discharge, accompanied by discomfort and fullness in the stomach area, thin white coating on the tongue, and slow, deep pulse. [Western Diagnosis] Delayed menstruation. [TCM Differentiation] Cold accumulation syndrome. [Treatment Principle] Warm the meridians, dispel cold, and activate blood circulation. [Prescription] Wen Jing Tang combined with Taohong Siwu Tang with modifications. Tao Ren 10g, Hong Hua 10g, Danggui 10g, Sheng Di 12g, Chi Shao 15g, Chuanxiong 6g, Gui Zhi 10g, Fuling 10g, Bai Shao 15g, Dan Pi 6g, Wu Zhu Yu 10g, Dangshen 10g, Gan Jiang 6g, Ban Xia 6g, Mai Dong 10g, A Jiao 6g (sample), Danshen 10g, Muxiang 6g, Caodou Kou 6g, Sheng Longmu each 15g, Wuzi Gu 15g, Licorice 6g. Decocted in water, one dose per day. After two months of treatment, cured. Case 4: 26 years old. Menstrual irregularity, early onset and heavy flow, irritability, dry mouth and throat, increased white discharge, red tongue, thin white coating. [Western Diagnosis] Menstrual irregularity. [TCM Differentiation] Liver depression with Blood Heat. [Treatment Principle] Soothe the Liver and resolve depression, regulate menstruation. [Prescription] Danzhi Xiaoyao San and Taohong Siwu Tang with modifications. Dan Pi 6g, Zhi Zi 10g, Danggui 10g, Bai Shao 10g, Chaihu 10g, Baizhu 10g, Fuling 10g, Licorice 6g, Tao Ren 10g, Hong Hua 6g, Chuanxiong 6g, Sheng Longmu each 15g, Wuzi Gu 15g, Xiangfu 10g, Yimu Cao 20g, Pu Gong Ying 15g, Bai Jiang Cao 15g. Seven doses, one dose per day. After taking two doses, menstrual flow began, and abdominal pain eased. Continued taking the above prescription for two months, and the patient’s menstruation returned to normal, with no abnormalities found during a six-month follow-up. Case 5: 34 years old. In recent years, menstrual flow has been light, color pale, texture thin, with blood clots, dull complexion, pale tongue, and weak pulse. [Western Diagnosis] Menstrual irregularity. [TCM Differentiation] Qi deficiency and blood stasis. [Treatment Principle] Benefit Qi and activate blood circulation. [Prescription] Buzhong Yiqi Tang and Taohong Siwu Tang with modifications. Huangqi 30g, Baizhu 30g, Dangshen 30g, Danggui 9g, Muxiang 9g, Bai Shao 15g, Chaihu 9g, Hong Hua 6g, Tao Ren 9g, San Leng 15g, E Zhu 15g, Xiangfu 30g, A Jiao 30g. Decocted in water, one dose per day. After taking over 30 doses of the above prescription with modifications, the patient’s menstruation returned to normal, and all symptoms disappeared. Follow-up for one year showed no abnormalities in menstruation. Case 6: 36 years old. First visit due to early menstruation. Previously, menstrual cycle was normal, but in the past three months, cycle length was 17–20 days, with normal duration and moderate flow, bright red color, thick consistency with a warm sensation, accompanied by dry mouth and throat, heat in the palms and soles, red rashes on the face, yellow urine, dry stools, red tongue, thin yellow coating, and slippery pulse. Usually enjoys spicy food. [Western Diagnosis] Early menstruation. [TCM Differentiation] Heat disturbing the Chong and Ren channels, instability in the Blood Sea. [Treatment Principle] Clear heat and cool blood, nourish Kidney and Yin, regulate and consolidate the Chong and Ren channels. [Prescription] Qing Jing San with modifications. Sheng Di 10g, Mu Dan Pi 10g, Huang Bo 10g, Di Gu Pi 10g, Bai Shao 15g, Nüzhen Zi 15g, Han Lian Cao 15g, Gouqi 10g, Qian Cao 15g, Wuzi Gu 10g, Chao Di Yu 10g. Fifteen doses, one dose per day, twice daily, taken after menstruation ends, with a 15-day course. After two months of continuous use, the patient reported that after one course of treatment, menstrual cycle became 22 days long, with bright red color, and improvements in dry mouth and constipation. After two courses of treatment, cycle length reached 27 days, all symptoms disappeared, tongue normal, thin white coating, and slippery pulse. Follow-up for three months showed normal menstrual cycles. Case 7: 24 years old, menstruation hasn’t come for over 50 days, with light flow and dark color, lower back pain and fatigue, clear and long urine, loose stools, pale tongue with white coating, and slow, deep pulse. [Western Diagnosis] Late menstruation. [TCM Differentiation] Kidney essence deficiency, Yang qi deficiency. [Treatment Principle] Tonify Kidney and strengthen Yang, warm the meridians to remove stagnation. [Prescription] Yu Lin Zhu and Jin Gui Shen Qi Wan with modifications. Fuzi 10g, Rou Gui 3g, Shudi 10g, Danggui 10g, Chuanxiong 10g, Wu Zhu Yu 10g, Du Zhong 10g, Tu Si Zi 10g, Lu Jiao Jiao 10g, Sangjisheng 10g, Xiangfu 6g, Hong Hua 10g, Baizhu 10g, Bai Shao 10g, Licorice 6g. Decocted in water, one dose per day. After taking 12 doses, menstruation finally arrived. Case 8: 36 years old, came for consultation due to early menstruation by 10 days. Self-reported heavy flow and bright red color, heat in the palms and soles, no abdominal pain or other discomfort. Examination revealed red tongue with little coating, and rapid, fine pulse. [TCM Differentiation] Yin deficiency with internal heat, heat disturbing the Blood Sea, forcing blood downward. [Treatment Principle] Nourish Yin and enrich Blood. [Prescription] Danggui 10g, Sheng Di 12g, Di Gu Pi 12g, Dan Pi 10g, Chuanxiong 6g, Bai Shao 10g, Xuan Shen 10g, Mai Dong 10g, A Jiao 10g (sample), Fuling 12g, Gui Zhi 10g, decotted in water, one dose per day. After taking three doses, menstrual flow stopped, but the patient reported lower back and knee soreness, so Sheng Di 12g, Shan Yu Rou 10g, Shanyao 10g, Fuling 12g, Ze Xie 10g, Dan Pi 6g, Du Zhong 15g, Chuan Ni Xi 10g, Yin Yang Huo 5g, Xu Duan 15g, Sangjisheng 15g, Gui Zhi 10g, Fuzi 6g, Tao Ren 10g, Hong Hua 6g were added, decocted in water, one dose per day. After two months of adjustments based on the above prescription, all symptoms disappeared, and menstruation returned to normal. Case 9: 25 years old. The patient reported having had menstruation for more than half a month, with light flow and pale color, fatigue, dizziness, forgetfulness, insomnia, no abdominal pain or other discomfort. Examination revealed pale red tongue, thin white coating, and a deep, weak pulse. B-ultrasound showed no abnormalities in the uterine adnexa. [Western Diagnosis] Functional uterine bleeding. [TCM Differentiation] Qi failing to control the Blood. [Treatment Principle] Benefit Qi and strengthen the Spleen, regulate menstruation and stop bleeding. [Prescription] Gui Pi Tang with modifications. Dangshen 10g, Huangqi 20g, Baizhu 10g, Danggui 10g, Sheng Di 12g, Yuan Zhi 10g, Long Yan Rou 6g, Muxiang 6g, Chuanxiong 6g, Bai Shao 10g, Sheng Longmu each 15g, Wuzi Gu 15g, Fuling 12g, Licorice 10g, Four Dates 4 pieces, decocted in water, one dose per day, seven doses. One week later, the patient revisited, reporting that after taking three doses of the above prescription, the prolonged menstrual flow had subsided, and after seven doses, symptoms like dizziness and fatigue had basically disappeared. Examination showed a red tip of the tongue with thin coating, and a string-like, weak pulse. The prescription was adjusted to: Dangshen 10g, Mai Dong 10g, Wu Wei Zi 3g, Danggui 10g, Sheng Di 12g, Chuanxiong 6g, Sheng Longmu each 15g, Wuzi Gu 15g, Bai Shao 15g, A Jiao 10g (sample), Jin Yin Hua 15g, Lian Qiao 15g, Chao Zao Ren 15g, Bai Zi Ren 15g. Decocted in water, one dose per day, seven doses. To ensure better outcomes. Case 10: 40 years old, first visit due to menstrual disorder for half a year, with vaginal bleeding for over 20 days. The patient began experiencing menstrual disorders six months ago, with cycles lasting 40–50 days, each lasting over ten days, with heavy flow and blood clots. She had visited multiple hospitals before, and gynecological examination and B-ultrasound showed no organic lesions in the pelvis. Pathology report after curettage indicated endometrial hyperplasia, diagnosed as anovulatory dysfunctional uterine bleeding. Hormone therapy was administered for three months, but symptoms recurred after stopping medication. This time, vaginal bleeding lasted over 20 days, with heavy flow, dark red color, large blood clots, dizziness, fatigue, heat in the palms and soles, lower back pain, and occasional lower abdominal pain. [Western Diagnosis] Anovulatory dysfunctional uterine bleeding. [TCM Diagnosis] Collapse bleeding (Kidney Yin deficiency combined with blood stasis). [Treatment Principle] Tonify Kidney and nourish Yin, dissolve stasis and stop bleeding. [Prescription] Zuo Gui Wan combined with Taohong Siwu Tang with modifications. Tao Ren 10g, Hong Hua 10g, Danggui 10g, Chuanxiong 10g, Chi Shao 15g, Shudi 15g, Nüzhen Zi 15g, Han Lian Cao 15g, Xu Duan 10g, Gouqi 10g, Shan Zhu Yu 10g, Chao Di Yu 15g, Shanyao 10g, Qian Cao 15g, San Qi 3g (to be taken orally). Decocted in water, one dose per day, seven doses. Second visit: Vaginal bleeding significantly reduced, but still some small blood clots, no abdominal pain, still feeling dizzy and fatigued, but lower back pain and heat in the palms and soles have lessened, tongue pale with thin coating, pulse deep and weak. Based on the original prescription, additional ingredients were added: Tai Zi Shen 15g, Huangqi 30g, Baizhu 20g. Decocted in water, one dose per day, seven doses. Third visit: Vaginal bleeding stopped for three days, still feeling fatigued, occasional lower back pain, tongue pale with thin coating, pulse weak. After more than a month of adjustments based on the above prescription, menstruation returned to normal. Case 11: 41 years old, first visit due to heavy menstrual flow. Normally, menstruation is regular, but for the past three years, periods have been irregular, sometimes lasting only a few months, sometimes several months, with symptoms alleviated by Western medicine treatment. Last October, due to family troubles, old ailments relapsed, and despite seeking treatment from multiple doctors, results were minimal. In the past half month, vaginal bleeding has worsened, with fluctuating amounts, dark purple color and clots, sticky consistency, accompanied by lower back pain, dizziness, tinnitus, shortness of breath, sweating, dry mouth, slightly dark red tongue, and thin, string-like pulse. [Western Diagnosis] Collapse bleeding. [TCM Differentiation] Qi stagnation and blood stasis combined with Blood Heat. [Treatment Principle] Activate blood circulation and dissolve stasis, clear heat and stop bleeding. [Prescription] Tao Ren 10g, Hong Hua 10g, Danggui 10g, Sheng Di 12g, Chi Shao 15g, Chuanxiong 6g, Dan Pi 6g, A Jiao 6g (sample), Ai Ye 6g, Xiangfu 9g, Yan Hu Suo 10g, Danshen 15g, Xian He Cao 15g, Yimu Cao 15g, Licorice 6g. Decocted in water, one dose per day. After taking seven doses, the above symptoms greatly reduced, and continuing with the original prescription for another ten-odd doses resulted in cessation of bleeding. Thereafter, active blood-circulating and stasis-dissolving herbs were frequently used in combination with Gui Pi Tang and Liu Wei Di Huang Tang with modifications, adjusting the treatment for over two months until recovery. Nine: Discussions on Collapse Bleeding by Ancient and Modern Physicians Records regarding "Collapse Bleeding" first appear in "Su Wen," where it is stated: "When Yin is deficient and Yang is vigorous, it is called Collapse." In "Su Wen Tai Su · Volume Three · Miscellaneous Discussions on Yin and Yang," it is noted: "Collapse means bleeding downward." Leakage,