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, being pungent and warm, 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 Chong and Ren channels to consolidate the root, eliminate blood stasis, generate new blood, thereby regulating menstruation and naturally curing the 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 metrorrhagia caused by qi failing to control blood. For cases accompanied by abdominal pain, Gui Zhi Fuling Wan is added; for severe qi deficiency, Dangshen, Huangqi, and Licorice are added; for severe bleeding, Shanzhuyu 20g, Yuanshou 20g, raw Longmu each 15g, and Cuttlebone 15g are added; for low blood pressure, Dangshen 10g, Mai Dong 10g, and Wuweizi 6g are added; for shock, 30g of Ginseng is used along with 50g of brown sugar, decocted in water for 10 minutes, and taken immediately. This treatment approach generally falls under the category of qi failing to control blood mentioned earlier. From a modern medical perspective, such vaginal bleeding is mainly functional uterine bleeding rather than organic lesions. If there are many blood clots, Taoren and Honghua are added; if the amount of bleeding is excessive, additional ingredients such as raw Longmu, Cuttlebone, Ejiao, and Mugwort are added; if B-ultrasound shows benign masses, Sanleng, Ezhushi, Seaweed, Kelp, Han Sanqi, and Water Leech 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, Diyi Tang is used as the main formula with modifications, incorporating Moutan Bark, Digu Pi, Shengdi, Xuan Shen, Mai Dong, and Bai Shao. If there is excessive white discharge that is yellow in color, Er Miao San is added; if constipation is present, Dahuang and Shi are added; for vulvar itching, Jinyinhua, Lianqiao, Pugongying, Baijiang Cao, Kushen, and Huangbo may be added as appropriate. If there is excessive menstrual flow, pale color, thin consistency, accompanied by obvious fatigue, dizziness, and anemic appearance, it indicates a syndrome of spleen failing to control blood, and Guipi Tang is used as the main formula 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 Danggui to nourish blood. Given the complex clinical manifestations of patients with metrorrhagia—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 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 stagnate, and door hinges do not rot." When treating metrorrhagia, one must avoid solely relying on hemostatic plugs, as this will only cause blood that has already left the cycle to accumulate within the uterus, even if temporary hemostasis is achieved, there will inevitably be subsequent problems. Because blood stasis remains in the body, new blood cannot be generated, leading to new illnesses and further complications. Therefore, Professor Pei Zhengxue’s prescriptions for metrorrhagia mostly follow the principle of “treating the underlying cause through its manifestation.” Han Sanqi and Water Leech 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 it; instead, they remove pathogenic factors, unblock stagnation, and allow qi, blood, and body fluids to flow freely, thereby achieving the fundamental goal of treatment. Eight: Case Examples Case 1: A 27-year-old married woman presented with "irregular menstruation for three years, worsening over the past six months." Past medical history and menstrual history: Menarche at age 14. Gave birth to one child at age 24, after which her periods became irregular, with heavy flow and bright red color, occasionally with blood clots. The duration of menstruation extended from as short as 7 days to as long as 15 days. In the past six months, her condition worsened, and she had previously tried Western medicine for hemostasis with poor results. Present illness: Ten days ago, her period started but continued to bleed profusely, with bright red color and occasional blood clots, though the amount was not large. She felt fatigued, her complexion was dull, she was weak and listless, spoke little due to lack of energy, had poor appetite, and experienced constipation. Her tongue was pale red, with a thin white coating, and her pulse was deep. [Western Diagnosis] Irregular menstruation, prolonged menstruation. [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 Guipi Tang with modifications. Dangshen 10g, Huangqi 30g, Danggui 10g, Sangjisheng 20g, Sizhi 20g, Baizhu 10g, Shudi 10g, Gouqi 10g, Shanyao 10g, Shanzhuyu 10g, Duzhong 10g, Xuduan 10g, Jiubai Shao 10g, Yinyanghuo 10g. The prescription was adjusted according to symptoms, and after four months of continuous medication, her menstrual cycle returned to normal, with regular periods lasting six days. Case 2: A 27-year-old married woman developed chest and flank distension, loss of appetite, aversion to warmth, delayed menstruation by one week, reduced flow with blood clots, lower abdominal distension and pain, purple-dark tongue, thin white coating, and a taut pulse after a quarrel with her husband over family matters and subsequent sulkiness. [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, Chuanchong 10g, Bai Shao 15g, Licorice 6g, Danggui 10g, Baizhu 10g, Fuling 10g, Danshen 30g, Yimu Cao 30g. Decocted in water, one dose per day. She was also advised to maintain a positive emotional state, and after ten doses, all symptoms disappeared. Case 3: A 28-year-old woman came for consultation due to menstrual irregularities lasting four months. Her periods were late, with scanty 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 a slow, deep pulse. [Western Diagnosis] Delayed menstruation. [TCM Differentiation] Cold accumulation syndrome. [Treatment Principle] Warm the meridians, disperse cold, and activate blood circulation. [Prescription] Wenjing Tang combined with Taohong Siwu Tang with modifications. Taoren 10g, Honghua 10g, Danggui 10g, Shengdi 12g, Chishao 15g, Chuanchong 6g, Gui Zhi 10g, Fuling 10g, Bai Shao 15g, Danpi 6g, Wu Zhu Yu 10g, Dangshen 10g, Gan Jiang 6g, Banxia 6g, Mai Dong 10g, Ejiao 6g (as a substitute), Danshen 10g, Muxiang 6g, Caodoukou 6g, Raw Longmu each 15g, Cuttlebone 15g, Licorice 6g. Decocted in water, one dose per day. After two months of treatment, she recovered. Case 4: A 26-year-old woman with menstrual irregularities, early onset and heavy flow, irritability, dry mouth and thirst, increased white discharge, red tongue, and a thin white coating. [Western Diagnosis] Menstrual irregularities. [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. Danpi 6g, Zhizi 10g, Danggui 10g, Bai Shao 10g, Chaihu 10g, Baizhu 10g, Fuling 10g, Licorice 6g, Taoren 10g, Honghua 6g, Chuanchong 6g, Raw Longmu each 15g, Cuttlebone 15g, Xiangfu 10g, Yimu Cao 20g, Pugongying 15g, Baijiang Cao 15g. Seven doses, one dose per day. After taking two doses, menstrual flow began, and abdominal pain eased. After continuing the above regimen for two months, her menstruation became regular, and during a six-month follow-up, no abnormalities were observed. Case 5: A 34-year-old woman who has had scanty periods in recent years, with pale color, clear texture, occasional blood clots, a dull complexion, pale tongue, and a weak, fine pulse. [Western Diagnosis] Menstrual irregularities. [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, Honghua 6g, Taoren 9g, Sanleng 15g, Ezhushi 15g, Xiangfu 30g, Ejiao 30g. Decocted in water, one dose per day. After taking more than thirty doses of the above prescription, her menstruation became regular, and all symptoms disappeared. During a one-year follow-up, her menstruation remained normal. Case 6: A 36-year-old woman who came for consultation due to early menstruation. Previously, her menstrual cycle was normal, but in the past three months, her cycle length was 17–20 days, with normal duration, moderate flow, bright red color, thick consistency with a feeling of heat, accompanied by dry mouth and throat, heat in the palms and soles, red rashes on the face, yellow urine, dry stools, a reddish tongue, a thin yellow coating, and a slippery pulse. She has always liked spicy food. [Western Diagnosis] Early menstruation. [TCM Differentiation] Heat disturbing Chong and Ren channels, blood sea unrest. [Treatment Principle] Clear heat and cool blood, nourish kidney and yin, regulate and consolidate Chong and Ren channels. [Prescription] Qingjing San with modifications. Shengdi 10g, Moutan Bark 10g, Huangbo 10g, Digu Pi 10g, Bai Shao 15g, Nüzhenzi 15g, Hanlian Cao 15g, Gouqi 10g, Qiancao 15g, Cuttlebone 10g, Chao Diyu 10g. Fifteen doses, one dose per day, twice daily, taken after menstruation ends, with a 15-day course. After two months of continuous use, she reported that after completing one course, her menstrual cycle became 22 days long, with bright red flow, and improvements in dry mouth and constipation. After two courses, her cycle length reached 27 days, all symptoms disappeared, her tongue returned to normal, with a thin white coating and a slippery pulse. During a three-month follow-up, her menstrual cycle remained normal. Case 7: A 24-year-old woman whose period has been absent for over fifty days, with scanty flow and dark color, lower back pain and fatigue, clear and long urine, loose stools, pale tongue with white coating, and a slow, deep pulse. [Western Diagnosis] Late menstruation. [TCM Differentiation] Kidney essence deficiency, yang qi insufficiency. [Treatment Principle] Tonify kidney and strengthen yang, warm the meridians to remove stagnation. [Prescription] Yulinzhu and Jin Gui Shenqi Wan with modifications. Fuzi 10g, Rougui 3g, Shudi 10g, Danggui 10g, Chuanchong 10g, Wu Zhu Yu 10g, Duzhong 10g, Tu Si Zi 10g, Lu Jiao Jiao 10g, Sangjisheng 10g, Xiangfu 6g, Honghua 10g, Baizhu 10g, Licorice 6g. Decocted in water, one dose per day. After twelve consecutive doses, her period finally arrived. Case 8: A 36-year-old woman who came for consultation because her period was ten days early. She reported heavy flow and bright red color, heat in the palms and soles, but no abdominal pain or other discomfort. Examination revealed a red tongue with little coating and a fine, rapid pulse. [TCM Differentiation] Yin deficiency with internal heat, heat disturbing the blood sea, forcing blood downward. [Treatment Principle] Nourish yin and blood. [Prescription] Danggui 10g, Shengdi 12g, Digu Pi 12g, Danpi 10g, Chuanchong 6g, Bai Shao 10g, Xuan Shen 10g, Mai Dong 10g, Ejiao 10g (as a substitute), Fuling 12g, Gui Zhi 10g, decotted in water, one dose per day. After taking three doses, her menstrual flow stopped, but she reported lingering soreness in the lower back and knees, so she was given Shengdi 12g, Shanyu Rou 10g, Shanyao 10g, Fuling 12g, Ze Xie 10g, Danpi 6g, Du Zhong 15g, Chuanniu Xi 10g, Yinyanghuo 5g, Xuduan 15g, Sangjisheng 15g, Gui Zhi 10g, Fuzi 6g, Taoren 10g, Honghua 6g, decotted in water, one dose per day. After two months of adjustments based on the above prescription, all symptoms disappeared, and her menstruation became normal. Case 9: A 25-year-old woman who reported having had her period for more than half a month, with scanty flow and pale color, fatigue, dizziness, forgetfulness, insomnia, but no abdominal pain or other discomfort. Examination showed a pale red tongue with a thin white coating, and her pulse was deep, thin, and weak. B-ultrasound indicated no abnormalities in the uterine adnexa. [Western Diagnosis] Functional uterine bleeding. [TCM Differentiation] Qi failing to control blood. [Treatment Principle] Benefit qi and strengthen the spleen, regulate menstruation and stop bleeding. [Prescription] Guipi Tang with modifications. Dangshen 10g, Huangqi 20g, Baizhu 10g, Danggui 10g, Shengdi 12g, Yuanzhi 10g, Longyan Rou 6g, Muxiang 6g, Chuanchong 6g, Bai Shao 10g, Raw Longmu each 15g, Cuttlebone 15g, Fuling 12g, Licorice 10g, Four Dates 4 pieces, decotted in water, one dose per day, seven doses in total. One week later, the patient returned for a follow-up visit, stating that after taking three doses of the above prescription, her prolonged menstrual bleeding had subsided, and after seven doses, symptoms such as dizziness and fatigue had largely disappeared. Examination showed a red tip of the tongue with a thin coating, and a taut, thin pulse. The prescription was then adjusted to: Dangshen 10g, Mai Dong 10g, Wuweizi 3g, Danggui 10g, Shengdi 12g, Chuanchong 6g, Raw Longmu each 15g, Cuttlebone 15g, Bai Shao 15g, Ejiao 10g (as a substitute), Jinyinhua 15g, Lianqiao 15g, Chao Zaoren 15g, Baizi Ren 15g. Decocted in water, one dose per day, seven doses in total. To ensure better outcomes. Case 10: A 40-year-old woman who came for consultation due to menstrual irregularities lasting half a year, with vaginal bleeding for over twenty days. Six months ago, she first experienced menstrual irregularities, with cycles lasting 40–50 days, each period lasting more than ten days before stopping, with heavy flow and blood clots. She had visited multiple hospitals, and gynecological examinations and B-ultrasound scans of the pelvic cavity showed no organic lesions. A biopsy revealed endometrial hyperplasia, diagnosed as anovulatory dysfunctional uterine bleeding. She received hormone therapy for three months, but the condition recurred after discontinuation. This time, she experienced vaginal bleeding for over twenty 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] Metrorrhagia (kidney yin deficiency combined with blood stasis). [Treatment Principle] Tonify kidney and nourish yin, dissolve blood stasis and stop bleeding. [Prescription] Zuogui Wan combined with Taohong Siwu Tang with modifications. Taoren 10g, Honghua 10g, Danggui 10g, Chuanchong 10g, Chishao 15g, Shudi 15g, Nüzhenzi 15g, Hanlian Cao 15g, Xuduan 10g, Gouqi 10g, Shanzhuyu 10g, Chao Diyu 15g, Shanyao 10g, Qiancao 15g, Sanqi 3g (to be taken orally). Decocted in water, one dose per day, seven doses in total. Second visit: Vaginal bleeding significantly decreased, but small blood clots still remained, no abdominal pain, still feeling dizzy and fatigued, but lower back pain and heat in the palms and soles were alleviated, tongue pale with thin white coating, pulse deep, thin, and weak. Based on the original prescription, Taizishen 15g, Huangqi 30g, and Baizhu 20g were added. Decocted in water, one dose per day, seven doses in total. Third visit: Vaginal bleeding stopped three days ago, still feeling fatigued, occasional lower back pain, tongue pale with thin white coating, pulse thin and weak. After more than a month of adjustments based on the above prescription, her menstruation became normal. Case 11: A 41-year-old woman who came for consultation due to heavy menstrual flow. Normally, her periods were regular, but for the past three years, her cycles have been irregular, sometimes lasting several months, sometimes just a few days. She had previously taken Western medicine, which provided some relief. Last October, due to family troubles, her old condition relapsed, and she sought treatment from multiple doctors, but with very limited effect. In the past half month, her vaginal bleeding has worsened, with fluctuating amounts, dark purple color and clots, thick consistency, accompanied by lower back pain, dizziness, tinnitus, shortness of breath, sweating, dry mouth, a slightly dark red tongue, and a thin, taut pulse. [Western Diagnosis] Metrorrhagia. [TCM Differentiation] Qi stagnation and blood stasis combined with blood heat. [Treatment Principle] Activate blood circulation and dissolve blood stasis, clear heat and stop bleeding. [Prescription] Taoren 10g, Honghua 10g, Danggui 10g, Shengdi 12g, Chishao 15g, Chuanchong 6g, Danpi 6g, Ejiao 6g (as a substitute), Ai Ye 6g, Xiangfu 9g, Yanhusuo 10g, Danshen 15g, Xianhe Cao 15g, Yimu Cao 15g, Licorice 6g. Decocted in water, one dose per day. After taking seven doses, the above symptoms greatly subsided, and after continuing the original prescription for more than ten doses, the bleeding stopped. Thereafter, she frequently used blood-activating and stasis-dissolving herbs in combination with Guipi Tang and Liuwei Dihuang Tang, making adjustments and modifications, and after more than two months of treatment, she fully recovered. Nine: Discussions on Metrorrhagia by Ancient and Modern Physicians Records related to "metrorrhagia" first appear in the "Suwen," where it is stated, "When yin is deficient and yang is overly active, it is called metrorrhagia." In the "Suwen Taizu · Volume Three · Miscellaneous Discussions on Yin and Yang," it is noted, "Metrorrhagia refers to bleeding from below." Leakage,