I recently gave a talk on Medigogy as a way to introduce the course I am giving in Vancouver in January on bleeding disorders in women. During the class a student/practitioner asked what I meant by “heat in the blood chamber” as a cause of bleeding. So, I thought I would write a bit about this and share a couple of cases. If you are interested in watching the 1 hour medigogy talk it is available here.
We all know that heat can induce the blood to run reckless. However, because there are many reasons for heat to develop, there are many methods for clearing heat in order to stop bleeding.
It is very important to differentiate the cause of the pathological heat so that the method hits the mark.
In Dr. Qíu Xiào-méi’s case below, we can see that the patient was treated improperly with several clearing heat methods before the patient came to Dr. Qiu. She recognized the cause of bleeding as heat in the blood chamber. Once she did, a long term condition resolved quickly.
I started with a case from my own practice to help illustrate this important concept.
Before going to the cases let’s look at the patho-mechanisms of heat in the blood chamber as well as the key signs and symptoms for the diagnosis of it.
Heat in the blood chamber is mentioned in clause 144 of the Shang Han Lun.
A woman has Zhong Feng, for 7-8 days it continues with chills and fever, occurring periodically, coinciding with the cessation of the menstrual flow, this is heat entering the blood chamber, the blood will become knotted, thus causing malaria-like symptoms, occurring periodically, Xiao Chai Hu Tang governs.
The primary formula for treating heat in the blood chamber is Xiao Chai Hu Tang. This is the representative formula for the Shao Yang presentation. A Shao Yang presentation can manifest with more or less heat and the Shao Yang formula Xiao Chai Hu Tang can be modified according to the amount of heat and the manifestations of heat. There is an internal/external relationship between the Shao Yang and the Jue Yin. When the heat in the Shao Yang is excessive and the blood of the Jue Yin is deficient, this heat can enter the Jue Yin blood aspect and cause bleeding. The blood chamber is synonymous with the uterus and refers to the blood of the uterus. So, in the case of bleeding due to heat in the blood chamber, we are seeing a Shao Yang excess heat presentation. Because the heat is particularly due to a block in the Shao Yang, any other method other than using a Shao Yang formula would be off the mark and ineffective.
The key signs and symptoms for diagnosing heat in the blood chamber are the same as the key signs and symptoms for a Shao Yang presentation: red eyes, bitter taste in the mouth, sore throat, wiry pulse, rib-side pain, dizziness, alternating cold and heat and gloomy affect. Another key that should alert a practitioner to check for this presentation is that the bleeding occurs after an infection or flu of some type. In the heat in the blood chamber presentation, the Shao Yang signs and symptoms are combined with symptoms of heat in the blood. This is true of both of the cases below.
My own case involves a 43 year-old woman who had had a needle stick 6 years prior to seeing me.
She took anti-retrovirals and became ill from the medications with blindness in the left eye, one-sided face pain and shingles that were so severe that she was hospitalized. These symptoms had slowly resolved but she developed heavy periods. By the time I saw her, 6 years after the anti-retrovirals. Her heavy periods lasted 8-10 days and the blood contained large clots. Premenstrually she experienced periodic feverishness, dizziness, and uterine cramping pain. Other signs and symptoms were very poor sleep, exhaustion, very sallow complexion, blurry vision with floaters, weak fingernails, poor night vision, pain on external palpation of uterus, spider veins on legs, pulse thin and wiry, tongue pale with orange sides, a dip in the rear and a yellow coating. Her symptoms were all worse with stress and her spirit was gloomy.
This patient’s diagnosis included blood deficiency, blood stasis and Kidney Qi deficiency. Both blood stasis and Kidney Qi deficiency can be causative factors for heavy bleeding. However, the yellow tongue moss and palpable pain in the uterus led me to first want to clear heat. I saw that she had a chronic low grade uterine infection. (though uterine infections are not always due to heat) I determined that the heat in this case was due to heat in the blood chamber because the following signs and symptoms pointed to the Shao Yang: Shingles (this occurs on the rib-side and is often related to a Shao Yang disorder), dizziness, gloomy affect, periodic heat, blurry vision and wiry pulse. The heat in the Shao Yang had taken advantage of the deficiency of blood and entered the blood chamber – almost like the weakest spot in a levy. I gave her four weeks worth of the following formula: (amounts are in grams of bulk herbs per week)
Chai Hu 60
Huang Qin 45
Ban Xia 36Ren Shen 27
Da Zao 27
Gan Cao 18
Sheng Jiang 18
Yi Mu Cao 36
Dang Gui 36
Ze Lan 36
Di Gu Pi 36
Mu Dan Pi 36
Lian Qiao 36
I saw this patient a month later and her last premenstrual period had been pain and fever free while her menstruation had become normal in length and amount with no clots. Upon palpating her uterus, there was no pain. The coating on her tongue had become thin and white. She was sleeping well with no dizziness and her mood had picked up.
I saw that the heat in the blood chamber had resolved. I followed up by supplementing her blood with a modified Wen Jing Tang and Dang Gui Bu Xue Tang below
Gui Zhi 36
Bai Shao 45
Dang Gui 45
Shu Di Huang 45
Gan Jiang 18
Da Zao 60
Mai Men Dong 36
E Jiao 36
Zhi Huang Qi 60
Lu Jiao Jiao 36
Ye Jiao Teng 90
I continued in this way for several months and the patient felt she became much stronger.
Heat in the Blood Chamber: A Case from Dr. Qíu Xiào-méi’s Experiences in Gynecology (裘笑梅妇科临床经验选 Qíu Xiào-méi Fú Kē Lín Chuán Jīng Yàn).
Patient: Ms Guo, woman, age 33
Initial Visit: 12/ 12/83
Main Complaint: Each menstruation is accompanied by a high fever of around 39 centigrade or 102 Fahrenheit. Her menstrual blood is profuse, the color dark with blood clots mixed in. She simultaneously experiences lower abdominal pain, facial edema, swelling of her limbs, breast distention and lower back soreness. She feels irritable and easily angered.
Three years previously she suffered from eclampsia during delivery and also had a high fever. She was ill for a half year. A previous doctor gave her Qin Jiao Bie Jia Tang after which the fever during menstruation ceased to arise though, after continued use this
prescription lost its effectiveness. Switching over to using clear heat and cool the blood type herbs also had no visible effect .
Check Up: Upon surveying the tongue, I saw that the body tended to be bright red and the moss was thin and greasy. Pressing the pulse showed it to be wiry and thin.
Differential Diagnosis and Treatment Method: I categorized the syndrome as heat entering the Blood Chamber and used Xiao Chai Hu Tang Minor Bupluerum Decoction with added flavors. I gave her five doses of the following prescription:
|Ruan Chai Hu||Radix Bupluri||15 gm|
|Xian Ban Xia||Rhizoma Pinellia||9 gm|
|Dan Zi Qi||Preparatae Radix Scultellariae Nova||9 gm|
|Dang Shen||Radix Codonopsis||9 gm|
|Gan Cao||Radix Glycyrrltizae Uralensis||3 gm|
|Sheng Jiang||Rhizoma Zingiberis Officil1alis Recens||3 slices|
|Hong Zao||Fructus Zizyphi||12 gm|
|Huo Xiang||Herba Agastache sell Pogostemi||9 gm|
|Pei Lan||Herba Eupatorii Fortrmei||9 gm|
|Chao Bian Dou||Stir- fried Semen Dolichoris lablab||10 gm|
|Mu Dan Pi||Cortex Moutan||9 gm|
Second Visit: After the herbs the menses changed. There was no appearance of high fever with edematous swelling. Menstruation flowed smoothly and the irritability was eased. This prescription was effective and I advised her to continue to take five doses for the seven days preceding menstruation and afterward according to her need. She continued in this way for three months in succession. Her menstruation flowed on schedule and without a high fever.
Comments: In this example, each time the menstruation flows, the Sea of Blood is vacuous and the heat evil overwhelms the vacuity and enters. This heat evil struggles with the menstrual Blood. This is the evil and the correct mutually contending. The Blood knotted by the uterine heat enters the Blood Chamber. I imitated (Zhang) Zhong ling’s method from the Shang Han Lun, using Xiao Chai Hu Tang to harmonize, resolve and clear heat. In this case, the medicine and the syndrome were mutually in accord. Altogether, the effect was very rapid.