As a follow-up to my last blog entry, I thought I would share another “cool” case in which there is heavy bleeding due to heat.
If you’d like to know more about how to very successfully treat bleeding disorders – here’s another reminder that I will be teaching a two-day course on this topic January 7th and 8th of this year. This course is streamed live so you can take it from anywhere. For more information on this course click here.
As I wrote in the last entry, excess heat is almost always the body’s own physiological warmth building up due to blockage. This blockage can take place in all sorts of places which means we have to have a wide variety of methods so that we can accurately address the correct location of the block. In the last entry, the blockage was at the Shao Yang and the pressurized heat moved into the Jue Yin.
In the following case, the body’s warmth is pressurized into heat due to a blockage in the Tai Yang and Yang Ming channel. This heat caused the blood to run reckless. This case is one of hundreds in a wonderful book that is full of the clinical experiences of well known Shang Han physicians. The book is organized by Shang Han Lun formulas with 10 or so cases by a variety of physicians for each formula. The cases offer a great perspective on how to treat the correct presentation with one formula for a wide variety of illnesses. These cases were gathered by none other than Liu Du-Zhou and many of them are from his own clinical experience. Dr. Liu offers commentary after each case.
This case is particularly interesting to me as Da Qing Long Tang is not a formula I immediately think of for Beng Lou. I think Dr. Liu’s commentary here is particularly interesting!
Dr. Zhang Yuan-Mao
Female patient aged 41
She was not certain where she was in her menstrual cycle. It came 1-3 times a month and was sometimes heavy and sometimes scanty. During the heavy times the strength of it was like a dyke breaking and she would fill a basin – like Beng. During the scanty times it would just drip slightly – like Lou. Her facial complexion was dull white and without luster, she had no appetite, she had heart palpitations and fatigue. Sometimes she was agitated. She experienced fear of cold with fever and no sweating. Her pulse was floating and tight. The right guan position was rapid. Her tongue was pale with a red tip. The tongue moss was thin and white. Based on the pulse and presentation, I gave her one package of Da Qing Long Tang and advised her to carefully watch for changes.
She came back the following day. She had taken the herbs warm after boiling. After ½ an hour her whole body broke into a sweat and then suddenly brightened. Today however, she took the herbs twice and did not sweat. The cold and heat had already cleared. The bleeding also stopped. She still felt exhausted and agitated. It was now appropriate to give her Gui Pi Tang to consolidate the treatment. She came in for a check up half a year later and she felt strong and there was no more Beng Lou.
Discussion by Liu Du-Zhou:
Generally it is said “when the blood is forced out, there will be no sweat and when sweat is forced out, there will be no blood”. (Ling Shu: Ying Wei Sheng Hui Pian) “When there is hemorrhaging, do not induce sweating” (clause 87) “When there is nosebleed, do not induce sweating” clause 86). However, in the clinic, it is also important to pay attention to common changes. In this case, although the Beng Lou had lasted over a period of time, the Zheng Qi was still upright. The true presentation was one of exterior cold and inner heat. Because there was no sweating with inner agitation, This was a Da Qing Long Tang presentation and this formula needed to be used. Be resolute and don’t doubt it. The formula had the desired effect. Moreover, Zhang Zhongjing had cases in which he induced sweating in bleeding presentations. For example, in the Shang Han Lun, clause 55, “When, in cold damage, with a pulse that is floating and tight, sweating is not promoted, and this gives rise to bleeding, Ma Huang Tang governs”. In the Ling Shu: Heat Illnesses it says “when sweating does not issue out, there may be vomiting and bleeding and there will be death” “When there is cough with bleeding and sweat does not issue out, or does not issue out enough, there will be death. This is a very clear lesson. All diseases causes are not the same. Treatments also vary. There is no such thing as an absolute taboo. The important thing is differentiating the presentation and seeking the cause. There is Interrogation – Cause – Theory – Treatment. To use this formula, one should grasp the meaning of external cold with interior heat. Also, in this case, the Zheng Qi was up upright. If it is not, do not rashly use this method.
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