Tcm Menstrual Disorders

CHIM 2: WK 1-3 - MENSTRUAL DISORDERS EARLY MENSES, DELAYED MENSES Smooth Liver qi is common practice in treating ob/gyn but those methods, formulas may cause Yin/blood Deficiency And in womens disorders important to not damage yin. Acrid, Moving medicinals have dispersing condition and may cause Yin/Blood Xu. This is why Xiao Yao San is safer than Chai Hu Shu Gan San. Xiao yao san has much less chance of causing blood deficiency.

EARLY MENSES

1. At least 7 days Earlier 2. Happened at least 3 Months in a Row Regarded as Bleeding Disorder. Causes of Bleeding: Heat, Stasis, SP Qi Xu, Cold. Herbs for Stop bleeding should be divided into those subgroups. No herbs that specifically Stop bleeding by Tonify Qi, must use tonify qi herbs. The 2 MAJOR patterns are due to: 1. Blood Heat, 2. SP Qi Xu

SP Qi Deficiency (with Yang Sinking)

Bu Zhong Yi Qi Tang or Ju Yuan Jian Lifting the Original Decoction (smaller Bu Zhong Yi Qi Tang)

This is a Bleeding disorder so want to Lift.

Must Know INGREDIENTS in these formulas.

s/s: Pale, Light Color, Profuse, Thinner. Fatigue, Digestion issues, (poor memory=blood xu), Mild bloating, spontaneous sweating, dull pain associated with Sinking empty sensation in Abdomen ‘xiou tong.’ T: Pale, Teeth Marks (vs Kd Yang xu, would be same but more wet with bluish color); P: Weak

Blood Heat:

Zhi Bai Di Huang Wan

Deficiency Heat (KD Yin

or

Deficiency)

**Da Bu Yin Wan (better because stronger in this case. ex: 45/50 yr old Sweating through Clothing and sheets at night)

Here want to Tonify KD Yin rather than Clear Deficiency Heat Long process to Tonify Yin, not over night. If patient suffering from heat can clear Xu heat to affect symptoms more immediately

s/s: (early) Scanty, Darker, Thicker (because heat congeals blood), Palm/Soles Chest heat, Worse in Afternoon/evening

or Liang Di Tang fu qing zhu formula

HERBS IN FORMULA: • Huang Qi 12-24g (C) • Ren Shen/Dang Shen, Bai Zhu, Zhi Gan Cao (D) (Fu Ling is not here because it has downbearing action and instead want to lift) • Dang Gui 6-12g(A) (Tonifies the qi in the Blood; augments qi by invigorating blood; prevents damage to yin)

• Chen Pi 6-9g (A) (help digest Tonics) • Sheng Ma 3-6g (E), Chai Hu 3-9g (E) Ju Yuan Jian (More Commonly used) • Huang Qi • Ren Shen/Dang Shen • Bai Zhu • Sheng Ma • Zhi Gan Cao Tonify Qi, Lift Yang; Difference from BZYQT is Ju Yuan Jian is used MUCH more commonly in OB/GYN because the 3 ingredients taken away are Warm and Pungent which could more likely damage yin and Blood. Doesn’t mean can’t use BZYQT for ob/gyn cases. Side note: When pure LV Qi Stagnation, Chai Hu is perfect. If LV Qi stag has already caused Yang to rise Chai Hu must not be used

SIDE NOTES: • Stop Bleeding by Cooling Blood: • Bai Mao Gen • Di Yu • Ce Bai Ye • Da Ji • Bai Ji • Stop Bleeding by Invigorating Blood: • Pu Huang • San Qi • Stop Bleeding by Warming Channel: • Ai Ye MODIFICATIONS: • Long Standing Diarrhea (would expect Watery Thin Stool, undigested food, without Strong odor): • Chi Shi Zhi • Rou Dou Kou • Lian Zi, Shan Yao maybe: Ge Gen, He Zi • Sleeping Problems, Insomnia due to Qi/Blood xu; Blood Deficiency related Shen problems (these herbs calm shen by tonifying deficiency): • Long Yan Rou • Suan Zao Ren • Bai Zi Ren • He Huan Pi, Ye Jiao Teng

Side Note: Post partum Mild Abdominal Pain formula- (includes goat meat), ‘xiou tong’: Dang Gui Sheng Jiang Yang Rou Tang- dang gui, sheng jiang, yang rou

HERBS IN FORMULA: Da Bu Yin Wan • Shu Di • Gui Ban • Huang Bai • Zhi Mu • Zhu Ji Shui- pig spinal cord; essential ingredient in here, reliable [Not listed on Box but it IS in there] Liang Di Tang • Sheng Di, Di Gu Pi, Xuan Shen, Mai Dong, E jiao, Bai Shao + Er Zhi Wan- Nu Zhen Zi, Han lian Cao) • E Jiao- Tonify Blood, STOPS BLEEDING Herbs that clear Xu Heat: Zhi Mu, Huang Bai, Yin Chai Hu, Hu Huang Lian, Di Gu Pi, Bai Wei Sidenote: Bai Wei called ‘#1 Single herb in Ob/gyn’ because can treat xu heat and urination problems which is very common in female disorders.

MODIFICATIONS:

Sidenote: Han Lian Cao also STOPS BLEEDING, and Tonifys Yin (like E Jiao) Sidenote: Formulas like Qing hao bie jia tang are more for clearing deficiency heat AFTER febrile disease, smoldering heat. (inaccurate translation to say Morning coldness, evening heat. It is Morning normal, evening heat)

Blood Heat: Excess Heat 1. External Heat Invasion (not common; possibly right after child birth or during menses when ‘Blood house is Wide open’)

Shi Hui San ‘10 Charred’- all over bleeding due to heat

or Si Sheng Wan Clearing heat (Difficult to access these herbs so may not have option to use this formula)

s/s: Bright Red or Darker, Thicker, whole body fever, Red face, Thirst, Dry stool/constipation, Yellow urine, Anxiety, or Shen problems P: surging, flooding, rapid

or Qing Jing San Fu Qing Zhu formula protect, support yin/blood

Excess Heat 2. Internal Heat Generation specifically- LV Qi Stagnation related Heat

Dan Zhi Xiao Yao San/Jia Wei Xiao Yao San Fxn: Smooth Liver Qi and Clear Liver heat s/s: emotional problems, irritability, Eye issuesredness, swelling, oversensitive to Light, Headaches, dizziness, tinnitus, bitter taste in mouth, Red face; almost always (due to LV Qi Yu) Mid jiao problems too- ST pain, Nausea, hiccups, acid reflux

HERBS IN FORMULA: Shi Hui San • Da Ji, Xiao Ji, He Ye, Ce Bai Ye, Bai Mao Gen, Qian Cao Gen, Zhi Zi, Da Huang, Mu Dan Pi, Zong Lu Pi

MODIFICATIONS: • Thirst (want herbs that clear heat and generate body fluids) • Lu Gen • Tian Hua Fen

Si Sheng Wan (all Raw/fresh herbs) • Sheng Di Huang • Sheng Ce Bai Ye • Sheng Ai Ye (when this is raw or fresh it treats bleeding due to HEAT) • Sheng He Ye Qing Jing San • Mu Dan Pi, Di Gu Pi, Huang Bai, Qing Hao, Fu Ling, Shu Di, Bai Shao **Original formula nothing included specifically to stop bleeding so should add: Di Yu, Xiao Ji (lower body bleeding)/Da Ji (upper body bleeding), Qian Cao Gen (commonly used in ob/gyn bleeding)

Regarding the 4 levels: Blood Level Heat- besides bleeding, talking about Shen problems- Severe Shen problems, coma, delirium. But when just have bleeding due to blood heat don’t necessarily have these Severe shen problems, should not use Xi Jiao Di Huang Tang.

Modern research actually shows that Charring does not increase ability to stop bleeding. Sometimes actually the opposite.

Sidenote: Herbs that stop bleeding only by Charring- Jing Jie Tan, Zhi Zi Tan

HERBS IN FORMULA: • Chai Hu • Dang Gui, Bai Shao • Bai Zhu, Fu Ling, Zhi Gan Cao • Zhi Zi • Mu Dan Pi Sheng Jiang, Bo He optional (Tantan would prefer not to use them. Sheng Jiang too warm and Bo He too pungent) **Almost always ADD to this: • Chuan Lian Zi

MODIFICATIONS: • Mid Jiao problems; ST pain, hiccups, Acid Reflux • Zuo Jin Wan- Huang lian 5: Wu Zhu Yu 1 • Diarrhea d/t LV overacting on SP/ST: painful, better after diarrhea, explosive • Tong Xie Yao Fang- Bai Zhu, Bai Shao, Chen Pi, Fang feng (why fang feng? for explosive aspect which is caused by Intestinal Wind) If Liver Qi Stagnation is cause of Mid Jiao pain, it is most likely due to heat rather than cold Wu Zhu Yu- hot, but great for vomiting, nausea; combined with big Dose of Huang lian to offset hot property Side note: another formula like Zuo Jin Wan where one herbs temperature/taste offsets the other [Ma Xing Shi Gan Tan] Ma Huang 1: Shi Gao 4

DELAYED MENSES

1. Delayed 7 days at Least 3. Happens at least 3 months in a row Can be caused by Deficiency (yin or blood)- patient just does not have enough blood to flow out or Excess (blockage)- Chong and ren channel has been blocked by coldness, blood stagnation or phlegm

Yin/ Blood Deficiency

in other books called: Chong and Ren Channel emptiness

Si Wu Tang Common place to use : *Ba Zhen Tang because in order to Tonify Blood, also want to Tonify Qi (in clinic we have: Fu Ke Ba Zhen Tang; Fu ke means ob/gyn; exactly same formula)

s/s: Scanty amount; if Blood xu more than yin xu, Color is lighter; if Yin more than Blood xu, color is darker because heat congeals. Also Sleeping problems, insomnia, dream disturbed sleep, heart palpitations, pale complexion, poor memory/focus, P: Thin, Weak

Shi Quan Da Bu Tang + Huang qi, Rou Gui- Rou Gui used to Warm ming men to warm vessels to promote Qi blood regeneration; person may or may not show cold signs. Rou Gui is not necessarily used here for warming coldness

Can we use Dang Gui Bu Xue Tang for general Blood deficiency?- No it is never for chronic long standing blood xu; Originally it was for post partum conditions. DGBXT is for Acute Blood loss with heat signs- not Xu Heat, so qi has no place to attach and qi flows out to cause heat signs; Huang Qi in large dose to strongly tonify qi to hold it back

MODIFICATIONS: • For more Yin Deficiency, Dryness, vision problems, hearing problems, dry hair; for these cases it’s a little more severe because yin xu is causing a delayed menses: • Liu Wei Di Huang Wan • Zui Gui Wan • also want to use Animal parts, in tcm called ‘herbs with passion’ because they are stronger: Gui Ban, Bie Jia, Lu Rong, Lu Jiao Jiao (safer than Lu Rong) • Shen problems: poor focus, insomnia, anxiety etc. These are herbs that calm shen by TONIFYING Deficiency •Bai Zi Ren, Suan Zao Ren, Ye Jiao Teng, He Huan Pi/hua

Kidney Deficiency (KD Yang Deficiency)

Jin Gui Shen Qi Wan KD Yang Xu delayed menses S/S: Pale, Scanty, Thinner very light colordescribed as Watery blood. Why is it watery? Yang provides needed heat/warmth. “For blood regeneration, relays SP/St nutrition from food and KD Yang to provide needed heat/warmth to turn it into Red blood” Other S/S: Diarrhea, Cold temperature, Low back weakness, frequent urination, Edema

HERBS IN FORMULA: • Liu Wei Di Huang Wan + Rou Gui, Fu Zi also called Gui Fu Di huang wan • Shan Zhu Yu does tonify Kd Yang

• Jin gui shen qi wan came before Liu wei di huang wan • In order to tonify KD yang, also must tonify KD yin

HERBS IN FORMULA:

Kidney Deficiency (KD Yin Deficiency)

Liu Wei Di Huang Wan or Gui Shen Wan S/S: Scanty, Dark red blood with clots, general dryness of hair/scalp, 5 palm heat, thin build, thirst *

Qi/Blood Stagnation Can happen after emotional problems/upset

Xue Fu Zhu Yu Tang - this formula is not only good for chest/heart conditions. It can be use for ANY qi/blood stagnation anywhere in the body. (shao fu zhu yu tang is warming so may not be appropriate here because qi/blood stag usually creates heat)

S/S: Pain, distention, sharp, doesn’t like pressure, irritability, darker color, painful menses, clotting, darker and thicker blood, Choppy pulse

Cold from External Invasion

Gui Zhi Fu Ling Wan originally for blood stagnation related masses

Wen Jing Tang (shao fu zhu yu tang ok, but wen jing tang better at warming)

MODIFICATIONS:

Gui Shen Wan • Shu di, Shan Yao, Shan Zhu Yu, Fu Ling • Dang Gui, Gou Qi Zi, Du Zhong, Tu Si Zi Why Dang Gui and Gou Qi Zi? besides tonifying yin, should tonify blood because this is a menstrual problem Tu si zi- warms kidneys but induces astringency, take this away for problems with delayed menses

HERBS IN FORMULA: **Specialty: Xue Fu Zhu Yu Tang is appropriate formula because it also moves Qi as well as blood** • Tao Ren • Hong Hua • Chuan Xiong- (tx’s windcold headaches) • Dang Gui • Chi Shao • Chuan Niu Xi • Sheng Di • Chai Hu • Jie Geng • Zhi Ke • Gan Cao

MODIFICATIONS:

HERBS IN FORMULA: •

MODIFICATIONS: • Stop bleeding by warming • Ai Ye • Huang Tu (zao xin tu) • Pao Jiang

Wen Jing Tang helps with 1. Warming channel 2. Moving blood

or Can happen after emotional problems/upset

MODIFICATIONS: • Water Retention/Edema • Gui Zhi • Hu Lu Ba • Lower Abdominal Coldness or general body coldness • Ai Fu Nuan Gong Wan- ai ye, xiang fu major ingredients; This formula contains original Si Wu Tang + ai ye, xiang fu + huang qi, rou gui + Xu Duan ‘Warming the Uterus formula’- originally used for Infertility due to KD Yang Deficiency; now used for any ob/gyn with this pattern. What kind of cold expected? Dull pain, Warm compress/massage will temporarily relieve pain

S/S: Sharp pain, palpation or massage makes it worse, Darker, clot

Side Note: What other formulas treat blood stagnation?: Tao Hong Si Wu Tang Gui Zhi Fu ling wan Shi Xiao San Shen Tong Zhu Yu Tang Tong Qiao Huo Xue Tang The point here is that for all these formulas should each ones specialty

Irregular Menstruation

Irregular Menstrual cycle most common causes 1. Emotional- LV Qi Stagnation 2. teenager that first gets there menses many times it is irregular when it trying to establish pattern- KD Deficiency

LV Qi Stagnation

HERBS IN FORMULA: • Chai Hu • Bai Shao • Bai Zhu, Fu Ling, Zhi Gan Cao • Dang Gui

Xiao Yao San S/S:

Sidenote: 3 major herbs to treat Heat pattern Vomiting/Nausea- Huang Lian, Zhu Ru, Lu Gen

must know ingredients

HERBS IN FORMULA:

MODIFICATIONS: • Breast Fibroids • Xia Ku Cao • Qing Pi (not great choice) • Ju He • Pu Gong Ying • Commonly causes Midjiao problems (probably see heat): borborygmous, acid reflux, burping • add Zuo Jin Wan MODIFICATIONS:

KD Deficiency younger patients: kidney not strong enough to establish menstrual cycle

S/S:

Profuse Bleeding ‘yue jing guo duo’ from Fu Qing zhu

Same patterns as Early Menses. Also though includes Blood Stagnation HERBS IN FORMULA:

SP Qi Deficiency

HERBS IN FORMULA:

MODIFICATIONS:

HERBS IN FORMULA:

MODIFICATIONS: • Herbs that tx 1. heat toxicity, 2. invigorate blood, 3. discharging pus (Must know these 3 Major Functions) • Bai Jiang Cao • Hong Teng

Blood Heat: Deficiency Heat (KD Yin Deficiency)

Blood Heat:

Jie Du Si Wu Tang

Excess Heat - Western Med: may point towards tumor or cancer

May develop into Heat Toxicity s/s: very dark color, sticky, thick purplish with strong foul odor, Lower abd. pain, high fever, chills; pus is causing foul odor

Major way in China to tx Cervical cancer Clear Heat Tox, Invigorate blood, Discharge pus: 1. Huang lian jie du tang 2. Si Wu Tang- change Dang gui for Dang Gui Wei and Bai Shao for Chi Shao COMBINED TOGETHER= Jie Du Si Wu Tang + Bai Jiang Cao + Hong Teng If there are Masses (Tumor) add: **Know • Yu Jin • San Leng • E Zhu • Dan Shen • Yi Mu Cao also Chuan Shan Jia but hard to get

other disorder where there may be heat toxicity and pus= Appendicitis

SCANTY MENSES

Compared to that patients normal amount Caused by deficiency or Excess. Should be taken seriously because may lead to stoppage of menses: Amenorrhea Deficiency- means yin or Blood Xu Excess- talking about blockage/obstruction 1. Qi Stagnation, Blood Stagnation AND Phlegm Accumulation phlegm, or damp phlegm is a major condition in ob/gyn HERBS IN FORMULA:

Phlegm Accumulation

Er Chen Tang most basic

Cang Fu Dao Tan Wan major point here is moving qi to help move damp phlegm s/s: overweight, heaviness, dizziness, unclear thinking, brownish color with sticky mucus, digestion problems, gas, bloating, full sensation in chest/abdomen, burping, belching T: thick, sticky greasy coat P: Slippery

Cang Fu Dao Tan Wan • Cang Zhu • Xiang Fu- ‘in order to move dampness must move qi’ • Chen Pi • Ban Xia • Fu Ling • Gan Cao • Tian Nan Xing • Zhi Ke • Sheng Jiang

MODIFICATIONS: • Vaginal Discharge • Lian Zi, Bai Guo, Qian Shi • Lian Xu, Shan Yao • Burping, gas • Ping Wei San • Liu Jun Zi Tang • Long Standing Diarrhea • Shen Ling Bai Zhu San

Shen Ling Bai Zhu San- originally created for Pediatricsmalnutrition, ground into powder and swallowed with meat soup. Help to tonify SP/ST, move midjiao qi stagnation, transform dampness. - Not only for midjiao qi Diarrhea

PAINFUL MENSES ‘tong jing’

Mostly affect Young women. Pain can be very very bad. It can be so bad they have a cold sweat, become pale. ‘Bu tong ze tong’- Blockage leads to Pain or Pain caused by blockage. But is all pain caused by blockage? no. ‘Bu Rong ze Tong’- Deficiency can also lead to Pain Caused by: Deficiency or Excess side note: To treat internal wind, treat blood first; after blood is taken care of, wind should be gone- This applies to Wind due to Yin or blood xu- ex: da ding feng zhu; Usually in clinic, when see wind usually due to Deficiency Spasms, TMJ is Wind also!

HERBS IN FORMULA:

(KD) Yin, Blood Deficiency

Kd yin xu is much more common than lv yin/blood xu

Ba Zhen Tang

use as Base but ADD:

Ji Xue Teng, Mu Gua. Increase Bai Shao to 15g s/s: milder pain, worse after menses. Still can have pain during menses but worse after menses. T: P:

single herb that helps to tonify deficiency while stopping pain/spasms= Bai Shao, Mu Gua Sour herbs that have nothing to do with inducing astringency: Bai Shao, Mu gua; they both have strong reliable action to go to liver to Soften LV meridian. Also Ji Xue Teng important to relax meridians along with Bai Shao, Mu Gua in treating pain due to deficiency Sidenote: Western Medicine: Calf Contractions: Trace Mineral deficiency in TCM- LV blood xu

HERBS IN FORMULA:

Excess: Qi/Blood Stagnation

Yan Hu Suo Zhi Tong Pian (patent) This is purified Yan Hu Suo. ONLY for painful menses from Qi/Blood Stagnation

Ge Xia Zhu Yu Tang -originally for treating cirrhosis; Now also good formula for stopping pain by moving blood for menses because includes yan hu suo, wu ling zhi; also softens hardness, masses

MODIFICATIONS: • Blood Xu related Dryness • Sang Shen • He Shou Wu

Single Herb that theoretically would be best: Yan Hu Suo; same plant as opium but NOT addictive and milder If taken singley, grind a little and can swallow it with warm water. within 5-10 min can relieve pain

Shao fu zhu yu tang, Wen Jing Tang not the best because warm. s/s: SEVERE stabbing pain; pain is worse prior or at start of menses; Sometimes a little better after onset becaseu blood can flow out; breast tenderness; sometimes pain so bad have vomiting, nausea. Why N/V? Liver overacts on Sp/St T: P:

MODIFICATIONS: • LV overacting on SP/ST= Nausea, Vomiting • add Zuo Jin Wan- Huang Lian, Wu Zhu Yu • • Painful Diarrhea, better after moving bowels, explosive. This is Wood overacting on Earth • Tong Xie Yao Fang (why fang feng? for explosive aspect which is caused by Intestinal Wind) • • • • • • •

KD Yang Xu=

Coldness 1. KD Yang deficiency

HERBS IN FORMULA:

MODIFICATIONS: • A lot of Leukorrhea, itchy, burning, foul odor, maybe pink • Ku Shen, Huang Bai, Bai Xian Pi, Hua Jiao (to kill parasites), Long Dan Cao, Bai Fan

use as Base but ADD: This is coldness from Internal generation

s/s: - pain is mild, responds well to warmth, massage, blood is thinner, lighter, weakness, soreness in Low back and Knees TP: Warm KD Yang some single Herbs: Fu Zi, Rou Gui, Gan Jiang, Hu Lu Ba

Coldness contracts and leads to blood stagnation: Wen Jing Tang or Shao Fu Zhu Yu Tang

External Cold=

Cold can come from internal generation of external

s/s: darker, lots of clots, more painful, sometimes can feel bumps in lower abdomen

Sheng Hua Tang -classic indication was lingering lochia

Long Dan Xie Gan Tang can use as base or

encounter this a lot, TCM better at treating this than western

MODIFICATIONS: • • • • • •

Jin Gui Shen Qi Wan

2. External Cold

Lower Jiao Damp-Heat Accumulation

HERBS IN FORMULA:

Qing Re Tiao Xue Tang Fu Qing Zhu formula s/s: pain is burning warm sensation, low grade fever, diarrhea, discharge- thick sticky foul odor, local skin itching burning sensation; this may indicate tumor or cancer T: P:

Qing Re Tiao Xue Tang • Sheng Di • Dang Gui • Chuan Xiong • Tao Ren • Hong Hua • Huang Lian • Xiang Fu • E Zhu (anti-cancer, esp Cervical CA) • Yan Hu Suo + Hong Teng, Bai Jiang Cao, Yi Yi Ren

AMENORRHEA ‘Bi Jing’ closure of Menses

2 Situations: 1. Primary- has not had period yet Race related, genetics can create a variety of ages that have there first period 2. Secondary- has had period before and then it has stopped Excess and Deficiency HERBS IN FORMULA:

Qi/Blood Deficiency

Translated into western’s nutrition related amenorrhea, low energy, general dryness, thin body build, poor concentration, nails are brittle, skin sensation issues

Ba Zhen Tang Shi Quan Da Bu Tang Ren shen yang yin (rong) tang (take chuan xiong away, ADD chen Pi, wu wei zi, Yuan zhi by tonifying qi to calm shen wu wei zi is great at holding heart qi together since the HT Qi is scattered, shen problems, poor concentration, poor memory

Skin sensation problems- decrease skin sensation, muscle twitch-diabetes is very common disease with this issue! Feeling of ants everywhere, hurt themselves since they cannot feel the burning water (This is due to Ying and Wei disharmony): Use Gui Zhi and ADD Huang Qi

Huang Qi Gui Zhi Wu Wu Tang

MODIFICATIONS: • • •

HERBS IN FORMULA:

LV/KD Yin Deficiency & Blood Xu primary- never had period before and doesn’t come (USE ZI HE CHE) secondary- had period before and it stops

Liu Wei Di Huang Wan

Gui Shen Wan • Shu di, Shan Yao, Shan Zhu Yu, Fu Ling • Dang Gui, Gou Qi Zi, Du Zhong, Tu Si Zi

Gui Shen Wan

= Tonify’s Kd Yin

-Can occur with either Primary or Secondary Secondary s/s: scanty, delayed menses prior to stopping, vision/hearing problems insomnia, dream disturbed sleep, 5 center heat

possible Test Question: Difference between Gui shen Wan and other yin tonic formulas is that Gui shen Wan also takes care of blood as well (via Dang Gui and Gou Qi Zi)

HERBS IN FORMULA:

Qi/Blood Stagnation

More commonly Secondary Amenorrhea

Xue Fu Zhu Yu Tang what makes this formula different than other blood moving formulas: also moves qi s/s: - usually had irregular menses for a while, emotional problems, irritable, digestive problems- burping, gas, bloating, hiccups, vomiting, nausea, breast distention or breast fibroids

DampPhlegm Accumulation

- moves qi; also want to increase the formulas qi moving ability, combine with:

+ Fo Shou San

MODIFICATIONS: •Breast Fibroids (LV and ST pass through breasts); Fibroids in general are more painful before menses, in TCM to tx this- Smooth LV Qi • Xia Ku Cao, Ju He • • • •

sidenote: Pu Gong Ying for breast abscess/mastitis

HERBS IN FORMULA:

Xiang Fu Dao Tan Tang

MODIFICATIONS: • • • • • •

s/s: overweight, always eating fast food, (ex: didn’t have first menses until 17yo), This pattern can happen in both secondary or primary amenorrhea, constant Leukorrhea issues, Mucous in Blood, general digestion appetite, burping, gas, Sweet taste in mouth because Spleen encumbered by damp

MODIFICATIONS: • Shen problems due to Damp phlegm accumulation; unclear thinking, shen problems • Shi Chang Pu, Yuan Zhi, Yu Jin • Meng Shi (used as last resort, for strong patients) Meng Shi Gun Tan Wan

- Fo Shou, Dang Gui, Chuan Xiong

IRREGULAR UTERINE BLEEDING ‘Beng Lou’

Not menstrual bleeding; happens outside of menstrual cycle Either profuse or spotty as long as it happens outside of the menstrual cycle In general- Deficiency is much more than Excess; Heat pattern is much more than cold pattern Can happen during Menopause or Young ladies where menstrual cycle hasn’t fully established yet To treat Beng Lou 3 Steps must follow: 1. Stopping Bleeding no matter what (of course this is treating the branch but this is ok) 2. When bleeding under control (not necessarily stopped) treat the patterns, root cause 3. Whenever possible try whatever you can to restore Menstrual Cycle HERBS IN FORMULA:

1. Stopping Bleeding

Yunnan Bai Yao -comes in many different forms; also in tiny red pill- called ‘emergency pills’- only have to take this when bleeding is very bad

MODIFICATIONS: • • •

HERBS IN FORMULA: • •

HERBS IN FORMULA:

Qi/Blood Stagnation

More commonly Secondary Amenorrhea

Xue Fu Zhu Yu Tang what makes this formula different than other blood moving formulas: also moves qi s/s: - usually had irregular menses for a while, emotional problems, irritable, digestive problems- burping, gas, bloating, hiccups, vomiting, nausea, breast distention or breast fibroids

Xiang Fu Dao Tan Tang - moves qi; also want to increase the formulas qi moving ability, combine with:

+ Fo Shou San

MODIFICATIONS: •Breast Fibroids (LV and ST pass through breasts); Fibroids in general are more painful before menses, in TCM to tx this- Smooth LV Qi • Xia Ku Cao, Ju He • • • •

sidenote: Pu Gong Ying for breast abscess/mastitis

HERBS IN FORMULA:

DampPhlegm Accumulation

MODIFICATIONS: • • • • • •

s/s: overweight, always eating fast food, (ex: didn’t have first menses until 17yo), This pattern can happen in both secondary or primary amenorrhea, constant Leukorrhea issues, Mucous in Blood, general digestion appetite, burping, gas, Sweet taste in mouth because Spleen encumbered by damp

MODIFICATIONS: • Shen problems due to Damp phlegm accumulation; unclear thinking, shen problems • Shi Chang Pu, Yuan Zhi, Yu Jin • Meng Shi (used as last resort, for strong patients) Meng Shi Gun Tan Wan

- Fo Shou, Dang Gui, Chuan Xiong

Move blood to Stop Pain: Ru Xiang, Mo Yao, Wu Ling Zhi, San Qi Move Qi to stop pain: Mu Xiang, Chuan Lian Zi, Bing Lang Coldness by warming the interior to stop pain: Wu Zhu Yu, Wu Yao, Ai Ye, Xiao Hui Xiang Bi Syndrome: Chuan Wu (Tou), Cao Wu (Tou) Stopping Pain by cooling blood and clearing heat: Mu Dan Pi, Chi Shao Qi Li San- Powder- Good for Int/Ext pain due to Qi/blood Stagnation due to Injury or Trauma An gong niu huang wan