A past patient of mine emailed me on my day off. She was frightened because she was bleeding VERY heavily. Here is what she wrote:
Everything looked usual in the beginning, started right on time, heavy in the first 24 hours, then tapering off, nothing unusual. Then, at day 6, when I would expect that the cycle is almost over, I have a flood of blood. There is so much it soaks my tampon and pads very quickly, I change them several times. It has been about 10 hours since the flood began, and I am still bleeding heavily. I would say that I’ve probably saturated a tampon or pad every hour. In addition, there are a lot of chunks of stuff coming out– some big, meaty chunks. I am a bit worried about the amount of blood loss, the chunks of stuff, and the unusual pattern.
I invited her to come right in for a diagnosis and some herbs. I asked about the conditions during the previous month. I wanted to know if there had been any unusual conditions. She told me that she and her family had gone to Florida and that she developed a cold on the way home (to the frigid North). It was a bad cold that manifested with a strong aversion to cold, fever and intense body pain. The body pain was especially strong in her lower back and she felt cold into her pelvic area. She said it felt like she had broken her back. Then the cold went deeper and she got very hot, with a hight fever, cough, stuffiness and she felt very agitated. Slowly she recovered from this. Then her next menstruation arrived in the manner described above.
This patient is on the thin side in general and tends to be colder. Sweating, urination, bowels, appetite and sleep were all normal. She was beginning to feel fatigued from the heavy bleeding but was not feeling faint or shaky. Her pulses were wiry, choppy and slightly slow. Her tongue was pale red but not extremely pale. Abdominal palpation revealed tight rectus muscles with pressure pain in the lower belly. If anything, she preferred warmth on her belly.
This patient had initially suffered from cold damage. This transformed into Yang Ming heat. I carefully ruled out the possibility that this heat had entered her blood chamber to cause bleeding by determining that currently there were no signs of heat. There were clear signs of blood stasis given the very congealed clots. I had to differentiate between the type of clots that form as a result of heavy bleeding from the type of clots that can cause heavy bleeding. Soft, large “livery” clots can form as blood pools in the uterus or vaginal tract and are due to the bleeding. However, the more congealed, tissue like and dense clots were due to blood stasis. Considering the causes of blood stasis, I ruled out heat but cold was a clear factor given the intensity of the cold back pain she felt when she had cold damage. So, my diagnosis was bleeding due to cold stasis in the womb with resulting deficiency of Qi. The treatment principle was to supplement Qi, warm the womb and vitalize blood in order to stop bleeding. I gave her my teacher, Qiu Xiao-Mei’s Shen Qi Jiao Ai Tang modified in raw herb decoction:
Dang Gui Tan 36 gm
Chuan Xiong 18 gm
Pao Jiang 9 gm
Rou Gui 36 gm
Bai Shao 36 gm
Pu Huang Tan 18 gm
Ai Ye 9 gm
Xi Yang Shen 18 gm
Zhi Huang Qi 60 gm
E Jiao 36 gm (stirred in)
Xu Duan Tan 36 gm
My patient cooked up the herbs that evening, sipping the decoction regularly. She emailed me the next morning:
During the day, the bleeding remained the same, heavy and consistent. At home around 8-9pm, after I cooked up the herbs, and drank a cup, the bleeding seemed lessened, maybe 25% less, judging by how much blood there was after a half hour period. Overnight, it has been hard to gauge the amount of blood because I am not up every half hour. In the early morning, around 4 am, after another cup of herbs, the blood seems about 50% less per half hour period compared to the heavy bleeding of yesterday.
It seems like things are going in the right direction. Although, I wonder if I should have a limit of when a certain time has passed, the bleeding needs to be substantially stopped. Since I was bleeding so heavily before, 50% less still feels like a lot. Right now it’s about 37 hours after the heavy bleeding began on day 6 of my cycle. I don’t know how fast blood replenishes itself, and I don’t want to catch myself at the too late phase. Do you think I am in danger of this?
I wrote her back the following, “I don’t know exactly where the line is in terms of going to the doctor. Since it is slowing down, maybe you can take today to rest, nourish and continue the herbs. Also really really stay warm and off your feet. On the other hand, I would have someone on call to drive you in case you start to feel weak. Follow your sense of things. I think you could take a quarter to half cup every hour to hour and a half.
The next morning she wrote, “Bleeding stopped yesterday, but at the end of the day I had some spotting of blood which might be because i was doing a little too much. I really am trying to rest, but there are some things I’ve been taking care of too. I am still spotting a little. I’ve thawed a chicken and plan to cook it up with some blood nourishing herbs today. We should talk about what I need to do next. What would you suggest? Shall I make an appointment in your clinic?”
I wrote back, “I was so happy to hear that the bleeding stopped! Let me know how you are this morning and let’s talk about what to do next. We should really nourish up your blood and consolidate so this doesn’t come back. Please stay nourished and warm, in bed as much a possible. This is a really good time to catch up on a novel or some knitting!”
She stayed in bed for the next few days and there was no more bleeding. She was able to go to school then and come for a follow up appointment. She was already feeling much stronger and consolidated though her pelvic area still felt too vulnerable to have sex. Following my teacher’s advice to consolidate the treatment to avoid relapse, I gave her the following formula based on Wen Jing Tang:
Gui Zhi 45 gm
Bai Shao 45 gm
Dang Gui 45 gm
E Jiao 45 gm
Shu Di Huang 36 gm
Fu Zi 18 gm
Shan Yao 36 gm
Da Zao 27 gm
Dang Shen 45 gm
Zhi Gan Cao 27 gm
1 package for 5 days to 1 week.
So far, so good!
This was an intense case in which the patient really did not want to go to the hospital. I had to both support this wish while making sure she was remaining safe. It is important to allow for the possibility that my skills may not be enough! I find it important to make agreements with patients in cases like this such as – after an agreed upon period of time or if symptoms get worse, they will go to the ER. Without this, I am not comfortable working with these kinds of crises. On the other hand, with this kind of clear communication, it is great to see what the herbs can do.
Bleeding can cause bleeding and bleeding can cause blood stasis.
In this case, the primary cause of the bleeding was stasis of blood due to cold damage. However, bleeding itself causes damage to the spleen and kidney Qi, making them unable to wrap and consolidate the blood. So, after the stasis was cleared, I had to supplement and help consolidate. My teacher, Dr. Qiu Xiao-Mei, taught how to stage the treatment of bleeding, both in terms of what to do first, second, third etc. and how to adjust the strength of the formula according to the seriousness of the bleeding. With the second formula, though the root of the bleeding was Qi deficiency, simply supplementing Qi would not be enough to stop such a heavy flow. For Qi deficiency heavy bleeding she will alway add Xu Duan Tan, Gou Ji Tan, Duan Long Gu and Duan Mu Li to Shen Qi Jiao Ai Tang. The base formula is made up of Zhi Huang Qi, Dang Shen, Ai Ye and E Jiao. This is Dr. Qiu’s experiential formula. San Qi powder is added because bleeding itself is a cause of blood stasis. Dr. Qiu teaches that, if the stasis from the bleeding is not transformed, there is a good chance of recurrence.
If anyone is interested in learning how to work effectively with women’s bleeding issues, I have a course on this that can be taken through ProD Seminars, or alternatively the material is also covered in the upcoming Graduate Mentorship Program which can be taken live or through live streaming or through online video after class.