Case 2 from the practice of Dr. Qiu Xiao-mei The relationship between the breasts and women’s disharmonies such as amenorrhea, dysmenorrhea and infertility.
Ji Mai San Case Example 2
Ms. Wu was twenty-eight years old when she came for her first visit on December 8, 1976. She had been married for four years without becoming pregnant. At a hospital she underwent an iodized oil radiograph which showed that her uterus was crooked and collapsed. Her two fallopian tubes were unobstructed. By her own report she suffered from premenstrual abdominal pain and breast distention. Her pulse was sinking and thin and her tongue was red and moist. For treatment it was appropriate to course the Liver and rectify the Qi while simultaneously boosting the Kidney. I gave her the following prescription:
Ju He and Ju Luo Semen et Vascularis Citri Each 4.5 gm.
Chai Hu Radix Bupleurum 9 gm.
Bo He Gen Herba Menthe 4.5 gm.
Bai Ji Li Fructus Tribuli 9 gm.
Da Mai Ya Fructus Hordei Germinatis 15 gm.
Fu Pen Zi Fructus Rubi 9 gm.
Tu Si Zi Semen Cuscutae 9 gm.
Che Qian Zi Semen Plantaginis 9 gm.
Gou Qi Zi Fructus Lyci 9 gm.
Wu Wei Zi Fructus Schizandra 4.5 gm.
Shu Di Prepared Radix Rehmannia 30 gm.
Zhi Shou Wu Prepared Radix Polygoni Multiflorum 15 gm.
I gave Ms. Zhou more than twenty packages of this prescription with additions and subtractions according to her changing signs and symptoms. By February of the next year she had become pregnant.
This example of infertility appeared with premenstrual abdominal pain and breast distention. The pulse was sinking and fine and the tongue was red and moist. These manifestations relate to Liver depression and Kidney vacuity. Therefore I used modified versions of Ji Mai San [Tribulus and Germinated Barley Powder] and Wu Zi Yan Zong Wan[Five Seed Develop Ancestor Pill]. When the Liver and Kidneys were synchronized the result was obtained quickly.
This case shows Dr. Qiu’s ability to treat a mixed presentation by stringing formulas. The patient was suffering from both Liver Qi stasis and Kidney Qi deficiency. The symptoms of premenstrual abdominal pain and breast distention show us that there is Liver Qi stasis. Her thin deep pulse showed deficiency. The deficiency and stasis both help explain the misplaced and prolapsed uterus.
Often, when I was sitting in clinic with Dr. Qiu, she would mention that she was using a formula and yet just use two or three ingredients from that formula. At times she would add just the two seeds Tu Si Zi and Gou Qi Zi to a formula and call this Wu Zi Yan Zong Wan. Many times she would add Chai Hu and Bo He to a formula and say she was using Xiao Yao San. Over time she taught me to see and use the ideas a formula represents rather than simply being strict about using the entire formula. This is one of the ways to incorporate the flexible use of formulas.
This case also illustrates Dr. Qiu’s use of Ji Mai San in cases in which there is premenstrual breast distention, especially when this is related to infertility.
Comment from Steven Clavey
I don’t remember who said it first, but a very old saying in Chinese gynecology is “If her breasts are sore, and she is trying to get pregnant, fix the sore breasts first.”
Over the years I have found that pretty good advice. Generally, aside even from the qi blockage that sore breasts evidence, there is usually fluid retention. And if the breasts are holding fluid, chances are the fallopian tubes are holding fluid (to some extent) too, and thus no longer moving with the agility a good tube should have. So if I see any signs of fluid retention in cases like this, I will usually add Fu Ling or Che Qian Zi to a qi-moving formula (like Ji Mai San, or Xiao Yao, or Chai Hu Shu Gan) to help things along.