Last month, as part of the free formula series I am doing, I did a talk on Healthy Seminars on the formula Da Huang Mu Dan Tang. This is a Jin Gui Yao Lue formula that is not really known about or used in the TCM world. Yet, it is extremely useful in the right situations and those to “carry up one’s sleeve.” The formulas I have chosen for this series are ones I want to really get to the bottom of in terms of understanding. I find it so interesting that, when I take the time to really go in-depth into a formula, cases appear that need it! In line with that, just after the June lecture on Da Huang Mu Dan Tang, Sara Rivkin, an herbalist in Brooklyn, NY, posted the query below on our forum. She combined this formula with Yi Yi Fu Zi Bai Jiang San. This is a common combination. One of the lectures I gave in the series was on this formula so I am also including an Ebook here on that formula. Before sharing her wonderful case, I want to share some resources that are mentioned in the post:
White Pine Forum (open to all practitioners of Chinese medicine)
Da Huang Mu Dan Tang Ebook (An Ebook comes with each of the free lectures in the formula series)
Graduate Mentorship Program (New program beginning September 2018)
Formula Series (These are free now but will become a “course” soon)
Gua Lou Qu Mai Wan (The next formula, lecture is Today!)
Hello, all, I would love some advice here:
Patient of mine has been diagnosed with a suspected ectopic pregnancy. I say suspected because it is a diagnosis of exclusion: Despite repeated ultrasounds, they can’t see anything. But she’s already had one D&C and injections of metholtrexate and levels of HCG still aren’t dropping as they should.
Signs and symptoms: chiefly fatigue and abdominal cramping. She had the d&c three days before. I did a lot of moxa on her (used a moxa box on her abdomen) and some gentle acupuncture Monday night after which the pain greatly diminished and the bleeding lessened. She is having mild bleeding with clots, an abdomen that is tender to the touch. Tongue is pale and enlarged, with a slightly dry coat. No visible sublingual veins. Pulse is slightly thin, but not very remarkable. She reported she had woken up sweaty, but she’d been sleeping with a hot water bottle on her abdomen, so not sure if it was internally or externally triggered.
Background: She’s 36, someone I’ve been seeing for a few months for fertility. Previously she’d had short cycles with spotting between ovulation and menstruation. I couldn’t find a lot clearly wrong with her, other than that, but with some breast tenderness and a wiry pulse and a tendency to run hot, I tried moving liver qi and clearing heat, while supporting qi and blood, which seemed to work. Her cycles were getting longer and the spotting had mostly gone away. She then opted to take progesterone too (not my call), but then had textbook cycles and got pregnant the second month on herbs+progesterone.
Ten days ago when the doctor said this pregnancy wasn’t viable, I treated her with acupuncture to boost her qi (my diagnosis as to why she hadn’t miscarried on her own was mostly qi and blood deficiency) and move gently. The following day she started to bleed a little and I gave her the following formula:
Tao Hong Si Wu Tang (modifiedo
Shu di huang 12
Bai shao 18
Chuan xiong 6
Dang gui 12
Tao ten 6
Hong hua 4.5
Yi mu cao 10
Gan cao 6
Huang qi 15
Dang Shen 10
She had paused that formula when she had the d&c last week, but I advised her to go back on it, which she has for the past two days.
She is feeling much better than she was and the bleeding/clotting is greatly reduced. Do I want to employ more opening-through strategies here/now? Add tian hua fen? Have her stay the course till they test her again? I should add they are planning to do a second D&C on Friday if her levels have dropped. Trying to help her avoid this!
Thanks for any advice,
I would suggest Da Huang Mu Dan Tang. You can also add Mo Yao and Ru Xiang to break anything down. I am attaching the ebook I made on the formula. You’ll see that it can treat ectopic pregnancy. It can break down the contents of the pregnancy and help the HcG stop rising.
Here is an update:
On Sharon’s advice, I took a look at Da Huang Mu Dan Tang. I gave her the following in granules, instructing her to take 3g per dose, initially 2x per day, then 3x per day on the second day.
(I wasn’t 100% sure on the formula, since she wasn’t constipated, even if the rest of the picture seemed to fit–hence the conservative dosing.)
Da Huang 12.0
Mang Xiao 6.0
Mu Dan Pi 10.0
Tao Ren 10.0
Dong Gua Ren 20.0
After taking the formula for two days, she had her HSG re-tested and it had dropped significantly. Enough that her doctors said they weren’t going to do any further intervention for the moment, only have her come back to re-test in a few days. I had warned her she might have some diarrhea on the formula: Initially she said that although she was having some it was manageable, but when we discussed it further she said it felt depleting, so I decided to make some modifications to the formula. (She was still having cramping, light bleeding with some clots, and a thick tongue coat in the rear.)
Sharon had also sent me a book of case studies on using this formula, and the following passage from Dr. Zhao Dong-Qi caught my eye. He writes, “Whether or not pus has been formed, this formula can be used with Yi Yi Fu Zi Bai Jiang San. When this pattern arises, the swelling and pain may be hard and distended or it may be soft. There may be fever and chills or no fever. The pulse may be hesitant and tight or rapid.” The patient’s tongue coat showed the presence of cold-damp and while her abdomen was tender to the touch, it was generally soft. Pulse was wiry and slightly rapid. Based on this I opted to combine the two formulas, as seen in some of the cases, arriving at the following. This time I did it in raw for two reasons–so that I could give her wine-fried da huang (to make it less of a laxative, I wasn’t sure what this would do to the overall efficacy of the formula, but decided to try it) and so that we could easily adjust the dose of mang xiao:
Mang Xiao 6.0
Mu Dan Pi 10.0
Tao Ren 10.0
Dong Gua Ren 12.0
Da Huang (Jiu Chao) (Wine) 12.0
Bai Shao 18.0
Yan Hu Suo 10.0
Yi Yi Ren 15.0
Fu Zi (Zhi) 6..00
Bai Jiang Cao 10.00
She took a bag per day for two days of this formula, and her digestion seemed ok, even with the mang xiao. After the two days, they retested her HSG and it had continued to drop. The plan is to retest it weekly until it gets to zero.
When I saw her earlier this week she was still having slight spotting and a little abdominal discomfort but was feeling much better, just tired. Tongue coat looked better, pulse was still wiry. However she had developed a lot of red, pustular acne, something she is sometimes prone to, and I put her on the following, will see her again on Monday and can report back, if it’s of interest. I think she’s getting her HSG checked again tomorrow.
Mu Dan Pi 6.0
Tao Ren 6.0
Dong Gua Ren 10.0
Da Huang (Jiu Chao) (Wine) 6.0
Bai Shao 18.0
Yi Yi Ren 15.0
Bai Jiang Cao 10.0
Chai Hu 10.0
Fu Ling 10.0
Bai Zhu 10.0
Dang Gui 12.0
Zhi Zi 6.0
Gan Cao (Zhi) 6.0