th-3I’m so glad to have the website launched so I can get back to the business of talking about Chinese medicine in this blog!  

About six years ago, I wrote a blog post about E Zhu and San Leng.  Over time, I’ve only come to appreciate these herbs more and more.  Recently I treated a woman who had a history of severe dysmenorrhea since menarche.  This was the kind of painful menstruation that leaves a woman unable to function.  In cases of severe dysmenorrhea, I always ask if there are any meat-like or tissue-like clots in the menstruate.  I also ask if there is relief of pain upon discharging one of these clots.  In her case the answer was yes to both of these questions.  This was a clear case of membranous dysmenorrhea.  She did not have any craving for warmth or aversion to cold related to her menstruation. Typically she would start to have pain and water retention starting a week and a half before her menstruation.   2 weeks before the start of her menstruation I gave her a formula to vitalize the blood, disolve masses and stop pain.  The formula included E Zhu and San Leng as well as Xu Duan to direct the formula to her uterus.  There were no herbs to disinhibit water.  When I saw her again, a week before her menstruation, she had felt none of her typical premenstrual symptoms of pain and water retention.  I was hopeful that the endometrium was breaking down much more effectively.  A week later she arrived at clinic having just gotten her menstruation at 28 days instead of the usual 32 days.  She had had very slight water swelling and minimal pain.  Her blood had flowed out easily with no clots.  What wonderful herbs!  This is the E Zhu and San Leng at work!  
I am convinced that membranous dysmenorrhea cannot be treated without these herbs.  I consider them gentle.  Recently I translated the following passage from a text written by one of the gynecologists I sat clinic with when I lived in China, Sheng Yu-Feng.  

San Leng and E Zhu: Their character is quite harmonious and balanced.  They are really wonderful herbs for opening through the menses and scattering the masses.

San Leng and E Zhu function well to crack stasis and move the Qi.  They are essential herbs to treat abdominal lumps.  However, doctors often fear to use them even lightly, believing them to be violent herbs.  In regard to the Zhang Jingyue had an insight.  He considered the character of these herbs to be harmonious and balanced, while still being wonderful herbs to open through the menses and scatter lumps.  He glowingly praised the herbs for their ability to treat “lumps with distention in men, abdominal lumps in women, amenorrhea due to the menses not opening through.  The character is not violent and they work very quickly.”  He learned this through clinical experience.  In order to rectify this bias, he pointed out that “Doctors always use Xiang Fu to regulate Qi and never use E Zhu and San Leng.  Because they are able to crack masses, it is assumed they are violent.  They don’t know that, though they have the ability to crack masses, they are not as fierce as Xiang Fu. I humbly and painstakingly tested this for many years.  In terms of scattering the Qi, Xiang Fu will do this more than San Leng and E Zhu.  In terms of scattering hard masses, E Zhu and San Leng are much better than Xiang Fu.”

sanlengI think of E Zhu and San Leng as primarily penetrating.  They penetrate into hardenings in order to dissolve them.  If there is heavy bleeding due to the presence of masses, E Zhu and San Leng will help to diminish the bleeding.

However, when you are treating heavy bleeding with fibroids, consider the situation very carefully!  Most women will come in having been told that the heavy bleeding is due to the presence of the fibroids.  This is not correct!  What IS correct is that the presence of the fibroids and the bleeding come from the same root cause.  The root cause could be Kidney Qi or Yang deficiency, spleen Qi deficiency, Qi stasis…..there are many factors and each situation is different.  In my practice I have found that, if I focus on disolving masses, the situation doesn’t get better and often becomes worse.  Of course, I was trained to always vitalize blood and crack stasis in the case of fibroids so this left me confused.  Over years of consideration and experience I found that if I focus on stopping bleeding based on the root cause of the bleeding, the bleeding stops.  Furthermore, the fibroid either shrinks or it becomes a non-issue.  In other words, I rarely use E Zhu and San Leng for fibroids unless the fibroid is in the endometrium AND there is membranous dysmenorrhea.  These two herbs will do nothing for a myoma that is on the outside of the uterus or pedunculated.  I believe that the literature the tells us to treat fibroids by cracking stasis way was just too simplistic.

If you are interested in the ins and outs of working with bleeding patterns in gynecology, join the White Pine Graduate Mentorship Program or check out my bleeding course on ProD.