Flooding and Trickling

CHAPTER 17 Flooding and Trickling

The condition of Flooding and Trickling is called Beng Lou in Chinese: beng means ‘flood’ or ‘flooding, bursting through’ and lou means ‘trickle, drip, dribble’ or ‘trickling, dripping, dribbling, leaking’. It corresponds to metrorrhagia in Western medicine but I prefer the more descriptive Chinese name.

Flooding and Trickling encompasses two distinct symptoms, the former (Beng) indicating a period that starts suddenly with a flood, often before the proper time, and the latter (Lou) a period that continues with a trickle after the proper time. Flooding and Trickling should be distinguished from Heavy Periods (Ch. 11): the latter indicates heavy blood loss during the proper period time (about 5 days), with the periods coming at regular intervals, rather than the sudden, profuse and often early bleeding of Flooding. In terms of quantity, Flooding involves a heavier bleeding than Heavy Periods. In general, the pathology of Heavy Periods and of Flooding and Trickling is the same although the latter is a more serious condition and therefore more difficult to treat. See Figure S4.1 (p. 198).

The earliest reference to Flooding (Beng) is in Chapter 7 of the Simple Questions: “When Yin is deficient and Yang throbs, Flooding occurs”.¹ In the context of this chapter, this statement refers to pulse diagnosis, i.e. when the Yin pulses are deficient and the Yang pulses forceful, a woman may suffer from Flooding. However, the statement may also be interpreted in a general sense, i.e. when Yin is deficient and Yang in excess, there may be Flooding because excess Yang heats the Blood and makes it spill from the blood vessels.

The Synopsis of Prescriptions from the Golden Cabinet mentions Trickling (Lou): “Continuous menstrual bleeding with an incessant trickling of dark blood [can be treated with] E Jiao Sheng Jiang Tang”.² E Jiao Colla Corii asini is still widely used to stop uterine bleeding.

Aetiology

Emotional strain

Any emotion may lead to stagnation of Qi and this, in turn, to Fire. Fire usually affects the Liver and, as this stores Blood, it may cause Blood-Heat. Heat makes the Blood reckless and causes it to burst out of the blood vessels. This is a major cause of bleeding of the excess type in gynecological problems. On the other hand, Fire may injure Yin and therefore lead to Blood Empty-Heat which may also cause menorrhagia.

Emotional problems may also cause bleeding in a different way, by leading to stagnation of Qi which will, in time, cause stasis of Blood. Stasis of Blood in the Uterus prevents new blood from taking its place and it therefore leaks out (Fig. 17.1).

Figure 17.1 Emotional stress as aetiological factor in metrorrhagia.

Overwork

Overwork weakens Liver- and Kidney-Yin. Deficiency of Yin over a long period of time gives rise to Empty-Heat which may heat the Blood. Empty-Heat may also make the Blood reckless just as Blood-Heat does, causing it to burst out of the blood vessels.

Deficiency of Kidney-Yin may also cause excessive menstrual bleeding by itself, without Empty-Heat, when Kidney-Yin fails to hold Blood.

Physical overwork, chronic illness

Physical overwork and chronic illness weaken the Spleen which fails to control Blood so that this leaks out. This is another major cause of excessive menstrual bleeding of the deficient type.

Childbirth

Excessive loss of blood at childbirth can weaken the Kidneys and Liver which fail to hold Blood and therefore cause bleeding. On the other hand, stasis of Blood often occurs after childbirth in women who have a tendency to stagnation. Stasis of Blood in the Uterus may cause bleeding in the way described above.

Irregular diet

Irregular diet consisting in the excessive consumption of hot-energy foods may lead to Blood-Heat which may cause blood to spill out of the vessels. Please note that under ‘hot-energy foods’ we should include alcohol.

Early sexual activity

By ‘early’ sexual activity I mean sexual activity that takes place before puberty and also within 2 years of puberty. Around the time of puberty, the Uterus is in a vulnerable condition and it is easily invaded by external pathogenic factors or damaged by sexual activity. Early sexual activity also ‘destabilizes’ the Directing and Penetrating Vessels (Ren and Chong Mai) possibly leading to metrorrhagia.

Pathology

As for pathology, the major patterns in uterine bleeding are:

• Blood Empty-Heat

• Qi deficiency

• Kidney deficiency

• Blood stasis.

In addition to these five main pathological conditions, we also need to discuss:

• unstable Directing and Penetrating Vessels

• sinking of Qi

• complex pathological conditions.

Blood-Heat

Blood-Heat is characterized by profuse bleeding with bright red or dark red blood. It may cause both Flooding and Trickling. Blood-Heat most commonly derives from Liver-Fire (itself deriving from emotional problems as explained above): as the Liver stores Blood and influences the Directing and Penetrating Vessels, Fire in this organ may heat the Blood and make it spill from the blood vessels. This is a very common cause of Flooding and Trickling from Blood-Heat.

Blood-Heat may also derive from invasion of an external pathogenic factor which reaches the Blood level (within the Four Levels) or from the excessive consumption of hot, spicy foods and alcohol. Blood-Heat agitates the Directing and Penetrating Vessels and the Uterus and causes Flooding and Trickling. The Liver is not the only organ involved in Blood-Heat as the Heart also plays its part. Emotional problems affecting the Heart may lead to Heart-Fire and, as this organ governs Blood and is linked to the Uterus through the Uterus vessel (bao mai), this may lead to excessive uterine bleeding.

Blood Empty-Heat

Blood Empty-Heat is characterized by lesser bleeding or by prolonged spotting after the end of the proper period. The colour of the blood is red or scarlet red. Blood Empty-Heat can be generated in two ways: either a prolonged deficiency of Yin leads to Empty-Heat, or a chronic condition of Blood Full-Heat may lead to injury of Yin by Heat and consequently Empty-Heat. In the latter case, the pathology may be quite complex: Blood-Heat causes Yin deficiency, which generates Empty-Heat, which, in turn, causes Blood Empty-Heat. In such complex cases, a woman may display symptoms of excessive bleeding from both Full-Heat and Empty-Heat agitating the Blood.

Qi deficiency

Qi deficiency may cause flooding at the beginning of the period or prolonged spotting after the period. The menstrual blood is pale red. Qi deficiency involves mainly the Spleen, although this is often associated with Lung-Qi deficiency too. The deficient Spleen-Qi fails to raise Qi and to hold Blood in the vessels, which therefore leaks out. Deficient Spleen-Qi not holding Blood in the vessels is also associated with sinking of Qi.

In my experience, many practitioners have a ‘bias’ towards Spleen-Qi deficiency as a cause of Flooding and Trickling. I would say that, in my experience, Blood-Heat and Qi deficiency account for roughly 50% of cases of Blood-Heat and Qi deficiency each.

Kidney deficiency

Kidney deficiency is very important in the pathogenesis of Flooding and Trickling. When Kidney-Qi or Kidney-Yang is deficient, the Directing and Penetrating Vessels do not thrive: this may happen because of a hereditary Kidney deficiency in young women or because of the natural decline of Kidney-Qi in the menopause. When the Directing and Penetrating Vessels are affected by a Kidney deficiency, they become ‘unstable’: they fail to contain Blood, and Flooding and Trickling result.

If Kidney-Yin is deficient, excessive bleeding occurs for two reasons: first of all, Kidney-Yin fails to hold Blood in the vessels (in much the same way as Kidney-Qi does), and second, Yin deficiency may lead to Empty-Heat which heats the Blood and makes it spill out of the vessels.

Blood stasis

Blood stasis causes excessive blood loss during the period and also some blood loss before the proper period time. The blood is dark with dark clots and the period usually painful. Excessive bleeding from stagnant Blood is caused by the fact that stagnant Blood obstructs the Uterus and the blood vessels, newly-formed blood cannot take its normal place in the Uterus and blood vessels, and therefore leaks out (Fig. 17.2).

Figure 17.2 How Blood stasis leads to bleeding.

Thus, there are three major areas of pathology causing Flooding and Trickling. The first is Blood-Heat which may be Full or Empty; the second is deficiency, which may be of Qi/Yang (Spleen and Kidneys) or of Yin (Liver and Kidneys); the third is Blood stasis which usually is an aggravating rather than a causative factor (Table 17.1).

Table 17.1 Pathology of Flooding and Trickling

Blood-Heat	Deficiency	Blood stasis
Blood Full-Heat (Liver and Heart) = Full condition	Qi deficiency (Spleen and Kidneys)	Blood stasis (Liver and Heart)
Blood Empty-Heat (Liver and Kidneys) = Full/Empty condition	Yin deficiency (Liver and Kidneys)

The Jade Rule of Gynaecology says: “There are six major causes of Flooding and Trickling: Fire, Deficient Cold, Exhaustion (xulao), sinking Qi, Blood stasis and Deficiency”.³ Deficient Cold, mentioned in this text, is not a frequent cause of excessive menstrual bleeding. The Golden Mirror of Medicine (1742) relates Flooding and Trickling to the three basic conditions of Heat, Qi deficiency and Blood stasis:

Continuous dripping is called Lou, while a sudden flood is called Beng. Dark blood with clots and pain is due to Blood-Heat, after a long time it injures the Directing and Penetrating vessels. A deficient Spleen fails to hold Blood, Qi sinks, anger injures the Liver which makes Blood reckless: one must differentiate clearly, in Deficiency one must tonify, in stasis dissolve, and in Heat clear.⁴

Directing and Penetrating Vessels (Ren and Chong Mai) unstable

Whatever the cause and pathology of Flooding and Trickling, the Directing and Penetrating Vessels are always involved in this condition as they are responsible for the Uterus, Blood storage and menstruation. The General Treatise on the Aetiology and Symptoms of Diseases (AD 610) says:

Flooding is due to injury of the Directing and Penetrating vessels. These vessels originate from the Uterus and are the Sea of channels; when they are injured their Qi becomes deficient and fails to hold Blood in the blood vessels and channels.⁵

Of the two vessels, the Directing Vessel is particularly involved in the pathology of Flooding and Trickling because this vessel influences the Uterus and the Kidneys. Chinese books describe this pathology of these two vessels as ‘Ren and Chong unstable’ (Ren Chong Bu Gu): this condition of the Directing and Penetrating Vessels is a factor in Flooding and Trickling, whatever the pattern (i.e. Blood-Heat or deficiency). For this reason, to treat this condition, I nearly always needle LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left) to regulate the Directing Vessel plus Ren-4 Guanyuan and KI-13 Qixue. Due to the importance of the Directing Vessel in the pathology of Flooding and Trickling, the Kidneys also play a very important and central role in the pathology and treatment of this condition. Whatever the type of Flooding and Trickling, eventually the Kidneys have to be treated. It is a very important principle that Flooding and Trickling is eventually treated not by stopping bleeding but by tonifying the Kidneys and consolidating the Directing and Penetrating Vessels.

The main herbs that ‘stabilize’ the Directing and Penetrating Vessels are Xu Duan Radix Dipsaci, Du Zhong Radix Eucommiae and Gui Ban Plastrum Testudinis. Although the first two herbs are Yang tonics, one of them may be added to a formula for Blood-Heat or Yin deficiency to consolidate the Directing and Penetrating Vessels; vice versa for Gui Ban which is a Yin tonic.

Whatever the pattern (e.g. Blood-Heat, Qi deficiency), in Flooding and Trickling the Directing and Penetrating Vessels are unstable.

To stabilize Directing and Penetrating Vessels with acupuncture, needle LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left) plus Ren-4 Guanyuan and KI-13 Qixue. The main herbs that ‘stabilize’ the Directing and Penetrating Vessels are Xu Duan Radix Dipsaci, Du Zhong Radix Eucommiae and Gui Ban Plastrum Testudinis.

Sinking of Qi

There is another important feature in the pathology of Flooding and Trickling and that is sinking of Spleen- and Kidney-Qi. Whatever the pattern causing Flooding and Trickling, the constant downwards flow of Blood over several years means that sinking of Qi is always a factor in the pathology of this disease. This applies not only to deficient patterns but also to excess ones. It follows that, in treatment, besides treating the pattern (e.g. Blood-Heat), one must also lift Qi of the Spleen and Kidneys. This is the reason why even some formulae for Flooding and Trickling from Yin deficiency include the herb Xu Duan Radix Dipsaci to consolidate the Directing and Penetrating Vessels and lift Kidney-Qi.

Please note that, in Flooding and Trickling, it is not only Spleen-Qi that is sinking but also Kidney-Qi. With acupuncture, to lift Spleen- and Kidney-Qi in Flooding and Trickling, I would use the following point combination: LU-7 Lieque (on the right) with KI-6 Zhaohai (on the left), together with Du-20 Baihui and Ren-4 Guanyuan.

With herbal medicine, one raises Qi by combining Huang Qi Radix Astragali with Chai Hu Radix Bupleuri and Sheng Ma Rhizoma Cimicifugae. This combination of herbs can be added to any formula addressing the pattern that is causing Flooding and Trickling.

It is a very important principle that Flooding and Trickling is eventually treated not by stopping bleeding but by tonifying the Kidneys and consolidating the Directing and Penetrating Vessels.

Complex pathological conditions

Excessive menstrual bleeding often leads to complex pathological conditions as, over many years, the blood loss itself becomes a pathogenic factor. For example, bleeding for many years from Blood-Heat may lead to Blood deficiency; as Blood is the mother of Qi, this leads to Qi deficiency and deficient Qi fails to hold Blood, further contributing to bleeding. In such a case, it is easy to misdiagnose the cause of bleeding as the woman would present with many Qi deficiency manifestations and we may conclude (wrongly) that the bleeding is from Spleen- and Kidney-Qi not holding Blood. The following case history is a good example of this situation.

A 33-year-old woman had been suffering from Flooding and Trickling for over 10 years. She suffered from both Flooding and Trickling after the period. During some months, she bled almost constantly, so much so that it was sometimes difficult to know when she had a period.

Most of her clinical manifestations pointed to Qi and Blood deficiency. She was pale, her voice was low, she looked depressed, her eyes lacked shen, she felt cold. Her tongue was Pale and her pulse was Deep. The diagnosis seemed to be very obvious: deficiency of Qi and Yang with Qi not holding Blood. On the basis of other manifestations (slight abdominal distension, poor appetite, backache and frequent urination), it seemed to be obvious that there was a deficiency of both Spleen and Kidneys.

The treatment principle I adopted was therefore to tonify Spleen- and Kidney-Qi, consolidate Directing and Penetrating Vessels and stop bleeding. I used a variation of the formula Yi Qi Gu Chong Tang Benefiting Qi and Consolidating the Penetrating Vessel Decoction (see below under Spleen not holding Blood).

• Huang Qi Radix Astragali 15 g

• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g

• Dang Shen Radix Codonopsis 9 g

• Ai Ye Folium Artemisiae argyi 4.5 g

• Xian He Cao Herba Agrimoniae 6 g

• Jing Jie Herba Schizonepetae 6 g (charred)

• Dang Gui Radix Angelicae sinensis 6 g

• Xu Duan Radix Dipsaci 6 g

• Sheng Ma Rhizoma Cimicifugae 3 g

• Gan Cao Radix Glycyrrhizae 3 g

After using variations of this formula for 3 months, there was no improvement at all. When this happens, I usually check the diagnosis again. On careful analysis of the manifestations, I noticed certain ones that I had overlooked. These were: a certain redness of the cheekbones, slightly red sides of the tongue, the occasional feeling of heat, occasional thirst, dry lips. I therefore concluded that the bleeding was originally caused by Blood-Heat and that Qi deficiency was the result rather than the cause of the bleeding.

This misdiagnosis had happened because the Qi and Blood deficiency deriving from the blood loss masked the Blood-Heat so that the manifestations of this pathology became mild and somewhat hidden. I therefore changed my treatment principle to cool Blood and this produced an immediate improvement.

Another example of a complex pathology deriving from the bleeding itself is that of excessive bleeding from Blood-Heat which may eventually lead to Blood and Yin deficiency. This, in turn, leads to Empty-Heat, which itself becomes a further cause of bleeding. Excessive bleeding from Qi deficiency will eventually also cause Blood deficiency. As Blood is the mother of Qi, blood loss will further weaken Qi thus perpetuating the condition.

Furthermore, Flooding and Trickling may interact with or cause one another. In fact, chronic flooding may lead to trickling and vice versa. A Chinese medicine saying states: “Flooding is an extreme form of Trickling; Trickling is the saturation of Flooding”. Figure 17.3 illustrates three possible complex pathological conditions resulting from bleeding.

Figure 17.3 Three complex pathological conditions deriving from bleeding.

The pathology associated with Flooding and Trickling is somewhat related to the age of the patient: in young girls, Flooding and Trickling is usually due to ahereditary Kidney weakness; in young women, it is more often caused by Blood-Heat from Liver Fire; and, in pre-menopausal women, it often results from Liver- and Kidney-Yin deficiency. Of course, these are only generalizations from which clinical practice may deviate.

Treatment principles

The treatment strategy for Flooding and Trickling is largely based on the general principles to stop bleeding.⁶ These were first advanced in the book Discussion of Blood Syndromes by Dr Tang Zong Hai (1884). There are four aims in the strategy to stop bleeding:

1. Harmonize Blood.

2. Treat the root cause of bleeding.

The first of these treatment aims, in turn, is composed of four steps advanced by Tang Zong Hai in his Discussion of Blood Syndromes:

1. Stop bleeding.

2. Eliminate stasis.

4. Nourish Blood.

Let us now analyse these four treatment aims to stop bleeding with particular reference to gynecology (see Fig. 17.4).

Figure 17.4 The four aims and four steps of treatment to stop bleeding.

Harmonize Blood

In a nutshell, the reasons for adopting the above four steps to harmonize Blood in bleeding are as follows:

• Stop bleeding: to arrest blood loss.

• Eliminate stasis: to prevent Blood from congealing.

• Calm Blood: to prevent recurrence of bleeding.

• Nourish Blood: to restore Blood after the blood loss.

These four treatment aims to harmonize Blood are all the more important in gynecology as Blood is obviously central to all women’s gynecological complaints.

Nourish Blood

Nourishing Blood is necessary to restore it to replace the Blood lost in bleeding.

The main herbs which nourish Blood are of course Dang Gui Radix Angelicae sinensis and Shu Di Huang Radix Rehmanniae preparata. E Jiao Colla Corii asini is also very important as it nourishes Blood and stops bleeding.

Treat the root cause of bleeding

The root cause of bleeding in Flooding and Trickling may be:

• Blood Empty-Heat

• Qi deficiency

• Kidney deficiency

• stasis of Blood

• Cold (this is quite rare).

Blood-Heat

Herbs are chosen from the category of clearing Heat and draining Fire and, especially, the category of clearing Heat and cooling Blood:

• Clear Heat and drain Fire: the most important of all in this category is Shan Zhi Zi Fructus Gardeniae especially if charred. Other herbs that help to stop bleeding by clearing Heat are Shi Gao Gypsum fibrosum, Huang Qin Radix Scutellariae and Huang Lian Rhizoma Coptidis.

• Clear Heat and cool Blood: herbs from this category are the most important ones to stop bleeding from Blood-Heat in gynecology. The three most important ones are Sheng Di Huang Radix Rehmanniae, Chi Shao Radix Paeoniae rubra and Mu Dan Pi Cortex Moutan.

Blood Empty-Heat

The two main herbs that stop bleeding by clearing Empty-Heat are Qing Hao Herba Artemisiae annuae and Han Lian Cao Herba Ecliptae. Han Lian Cao is the more important one in gynecology and is often used in conjunction with Nu Zhen Zi Fructus Ligustri lucidi.

Qi deficiency

Any Qi tonic will stop bleeding from Qi deficiency but the most effective one is Huang Qi Radix Astragali. The main formula to stop bleeding from Qi deficiency in gynecology is Dang Gui Bu Xue Tang Angelica Tonifying Blood Decoction which is composed only of Huang Qi Radix Astragali and Dang Gui Radix Angelicae sinensis in the proportions of 5:1.

Kidney deficiency

The two most important Kidney tonics that stop excessive uterine bleeding are Xu Duan Radix Dipsaci and Du Zhong Cortex Eucommiae. If there is a Kidney-Yin deficiency, the two most important herbs are Nu Zhen Zi Fructus Ligustri and Han Lian Cao Herba Ecliptae.

Stasis of Blood

Any Blood-invigorating herb can stop bleeding from Blood stasis, but the best are those which invigorate Blood and stop bleeding such as Pu Huang Pollen Typhae, San Qi Radix Notoginseng and Qian Cao Gen Radix Rubiae. Other herbs particularly used in gynecology to invigorate Blood are Yi Mu Cao Herba Leonuri and a combination of Hong Hua Flos Carthami and Tao Ren Semen Persicae.

Yang deficiency and Cold

Yang deficiency is quite a rare cause of bleeding in gynecology as internal Cold deriving from it has the tendency to coagulate Blood. The main herb to stop bleeding from the Uterus by warming it is Ai Ye Folium Artemisiae argyi.

Astringe

The main astringent herbs used in this context in gynecology are Shan Zhu Yu Fructus Corni and Bai Shao Radix Paeoniae alba.

One of the stopping-bleeding herbs used in gynecology is also astringent: this is Di Yu Radix Sanguisorbae.

Treat Qi

Treating Qi includes tonifying and firming Qi, used especially for bleeding from Qi deficiency. However, please note that one herb to firm Qi is usually included also in formulae for bleeding from other causes such as Blood-Heat.

The main herbs used in gynecology for this purpose are Huang Qi Radix Astragali, Ren Shen Radix Ginseng, Fu Zi Radix Aconiti lateralis preparata (if there is deficiency of Yang), Mu Li Concha Ostreae and Zhi Gan Cao Radix Glycyrrhizae preparata. Mu Li is included in this category because it is astringent and absorbent, thus helping to stabilize Qi.

Also included in this strategy of treatment is raising Qi to stop bleeding downwards caused by sinking of Spleen-Qi and/or Kidney-Qi. The two herbs that do this are Chai Hu Radix Bupleuri and Sheng Ma Rhizoma Cimicifugae. In gynecology, excessive bleeding may occur not only from Spleen-Qi sinking but often also from Kidney-Qi sinking. In this case, the main herb to use is Xu Duan Radix Dipsaci.

Three steps in treatment

With specific reference to gynecology, the steps in the strategy of treatment are traditionally three, following the general principle of “urgently treating the Manifestation (biao) in acute cases and slowly treating the Root (ben) in chronic cases”.

1. Shore up the flow

‘Shore up the flow’ means stopping the bleeding. This is the method adopted in acute cases or during the period itself, especially for flooding (as opposed to trickling). To stop bleeding, one should harmonize Blood (the first aim of treatment outlined above, consisting of four steps) and stop bleeding with haemostatic herbs.

2. Settle the Source

‘Settle the Source’ means treating the Root (Ben) of the condition by addressing the cause, the ‘Source’ being the source of bleeding, i.e. the underlying pattern that is causing bleeding (Blood-Heat, Qi deficiency, etc.). This method must be adopted to treat the underlying cause of bleeding, once the bleeding itself has been dealt with in the preceding step. This therefore consists in clearing Heat and cooling Blood for Blood-Heat, clearing Empty-Heat, cooling Blood and nourishing Yin for Empty-Heat, tonifying and raising Qi for Qi deficiency, invigorating Blood for Blood stasis, and tonifying the Kidneys for Kidney deficiency. Following the four aims of treatment mentioned above, ‘settling the Source’ involves harmonizing Blood, firming Qi and treating the root cause.

As indicated above, apart from treating the pattern at the root of Flooding and Trickling (e.g. Blood-Heat, Qi deficiency), it is necessary to ‘consolidate’ the Directing and Penetrating Vessels and to tonify the Kidneys: these two treatment methods are closely connected, i.e. tonifying the Kidneys will consolidate the Directing and Penetrating Vessels and vice versa.

Whatever the type of Flooding and Trickling, eventually the Kidneys have to be treated. It is a very important principle that Flooding and Trickling is eventually treated not by stopping bleeding but by tonifying the Kidneys and consolidating the Directing and Penetrating Vessels. The best time to treat the Kidneys and to consolidate the Directing and Penetrating Vessels is in phase 2.

The treatment to ‘consolidate’ the Directing and Penetrating Vessels is very simple: I use LU-7 Lieque (on the right) with KI-6 Zhaohai (on the left), together with Ren-4 Guanyuan and KI-13 Qixue. Please note that the Penetrating Vessel goes through Ren-4 and this point therefore tonifies and ‘consolidates’ both the Directing and the Penetrating Vessel.

3. Restore the old

‘Restore the old’ means to treat the organs involved in the disharmony which caused bleeding. This method is adopted after a woman has been successfully treated for Flooding and Trickling and consists in tonifying the Kidneys, regulating the Liver, strengthening the Spleen and tonifying the Heart, according to circumstances.

These three approaches to the strategy of treating Flooding and Trickling can be applied separately. For example, one would concentrate on treating the Manifestation (‘shoring up the flow’) during the period, on the Root (‘settle the Source’) outside the period, and on the organs involved (‘restore the old’) after the patient has been treated successfully. However, these three approaches need not necessarily be separated in time and may be used in combination: for example, in a chronic, longstanding case of Flooding and Trickling, one can treat the Manifestation (‘shore up the flow’) and the Root (‘settle the Source’) simultaneously, as well as treating the relevant internal organs.

Herbal treatment

There are specific guidelines one should follow when treating Flooding and Trickling; in particular, different treatment methods apply to the two separate conditions, one being flooding, the other trickling.

As far as herbal treatment is concerned, in flooding (as opposed to trickling), in general one should use herbs that lift Qi, consolidate and astringe, and not use warm, pungent herbs that move Blood (except, of course, if there is stasis of Blood).

In trickling (as opposed to flooding), in general one must nourish Blood and regulate Qi and not make much use of consolidating, astringent herbs. In young girls, one must tonify the Kidneys and strengthen the Directing and Penetrating Vessels; in young women, one must pacify and nourish the Liver; and in pre-menopausal women, one must nourish Liver- and Kidney-Yin, strengthen the Spleen and consolidate the Directing and Penetrating Vessels.

Some modern doctors place the emphasis on invigorating Blood and eliminating stasis for any type of Flooding and Trickling. For example, Dr Kuang Yi Huang advocates always invigorating Blood in this condition and combining this treatment method with cooling Blood, tonifying the Kidney or tonifying the Spleen according to clinical manifestations.⁷ The main rationale behind this approach is that stagnant blood obstructs the Uterus so that newly formed blood cannot take its proper place and leaks out. The following case history illustrates the importance of invigorating Blood in Flooding and Trickling.

A 42-year-old woman had been suffering from Flooding and Trickling for about 10 years. The condition was serious insofar as she was bleeding practically all the time, at times flooding and at others trickling. Her periods (during which she flooded) were very heavy, painful and with dark clots.

The cause of her bleeding was clearly a deficiency of Spleen and Kidneys. She was overweight and suffered from tiredness, poor digestion, backache, frequent urination, dizziness and cold knees. Her tongue was Pale and her pulse was Deep and Weak.

As the bleeding was due clearly to a deficiency (and sinking) of Spleen and Kidneys, I adopted the method of tonifying and raising Spleen- and Kidney-Qi with variations of Gu Ben Zhi Beng Tang Consolidating the Root and Stopping Flooding Decoction (see below). This formula produced no improvement whatsoever in 3 months.

I re-checked the diagnosis and, although the main diagnosis was correct (deficient Spleen and Kidney-Qi not holding Blood), I had overlooked the complicating factor of Blood stasis. Somehow, I had overlooked the fact that her periods were painful and with dark clots, clear signs of Blood stasis.

Interestingly, the only remedy that started to produce an improvement and reduced bleeding was one that invigorates Blood (and simultaneously stops bleeding) called Invigorate Blood and Stem the Flow (from the Women’s Treasure range).

Acupuncture

As for acupuncture, although it is effective in stopping bleeding, its points are less specific in their action than the above herbs. Although in order to stop bleeding with acupuncture one can follow the four-step protocol outlined above, unlike herbs there are no ‘astringent’ points, nor are there points which ‘calm Blood’ as such. However, the general principle of treating the root cause of bleeding, harmonizing Blood and stopping bleeding is still valid.

Astringe

No points have this specific action.

Treat Qi

To tonify and raise Qi, use Ren-6 Qihai, Ren-12 Zhongwan, Du-20 Baihui.

Stop bleeding

As for points which specifically stop bleeding, Accumulation points, and especially those of the Yin channels, can stop bleeding. For example:

– LU-6 Kongzui: coughing of blood.

– L.I.-7 Wenliu: nosebleed, bleeding gums.

– ST-34 Liangqiu: nosebleed, bleeding gums, vomiting of blood.

– SP-8 Diji: uterine bleeding.

– HE-6 Yinxi: vomiting of blood and epistaxis.

– S.I.-6 Yanglao: blood-shot eyes.

– BL-63 Jinmen: urinary bleeding.

– KI-5 Shuiquan: urinary and uterine bleeding.

– P-4 Ximen: vomiting of blood, coughing of blood, bleeding under the skin.

– T.B.-7 Huizong: bleeding from ear-drum.

– G.B.-36 Waiqiu: not for bleeding.

– LIV-6 Zhongdu: urinary and uterine bleeding.

– KI-8 Jiaoxin (Accumulation point of the Yin Stepping Vessel): bloody leucorrhoea and uterine bleeding.

Thus, the two main points to stop uterine bleeding are SP-8 Diji and KI-8 Jiaoxin.

Other points specifically affect the Sea of Blood and can therefore be used to direct the effect of the treatment to the Blood portion in order to stop bleeding. These points are BL-17 Geshu and SP-10 Xuehai.

The Connecting points, especially those of the Yin channels, can also stop bleeding. This is because they control the Blood-Connecting channels, a network of Connecting channels that occupy a deeper energetic space than that occupied by the main channels.

Chapter 81 of the Spiritual Axis says:

If fluids are harmonized … in the Middle Burner, they are transformed into Blood, when Blood is harmonized it first fills and irrigates the Blood Connecting channels, then percolates to the Connecting channels and finally in the main channels.⁸

The Blood-Connecting channels are particularly involved in chronic conditions with stasis of Blood. The Connecting points, especially those of the Yin channels, can therefore be used to stop bleeding in chronic cases, particularly if there is some stasis of Blood. For example:

– LU-7 Lieque: coughing of blood, nosebleed.

– HE-5 Yinxi: coughing or vomiting of blood.

– SP-4 Gongsun: bleeding under the skin.

– KI-4 Dazhong: uterine or urinary bleeding.

– P-6 Neiguan: coughing of blood and bleeding under the skin.

– LIV-5 Ligou: urinary or uterine bleeding and bleeding under the skin.

Thus, the two most important Connecting points to stop excessive uterine bleeding are KI-4 Dazhong and LIV-5 Ligou.

Treating Flooding and Trickling according to the four phases

Treating Flooding and Trickling according to the four phases gives very good results and it is something that should be attempted. I say ‘attempted’ because sometimes when Flooding and Trickling is particularly severe, the woman may be bleeding the whole month and it may even be difficult to identify when she has a period (i.e. is in phase 1).

I will therefore describe the treatment principle in each phase for each of the patterns.

Blood stasis

• Phase 1: invigorate Blood and stop bleeding.

• Phases 2 and 3: tonify the Kidneys, nourish Blood.

• Phase 3: invigorate Blood and stop bleeding, move Qi.

Treatment principles

• Harmonize Blood

• Stop bleeding

• Eliminate stasis

• Nourish Blood

• Treat the root cause of bleeding

• Blood Empty-Heat

• Qi deficiency

• Kidney deficiency

• Stasis of Blood

• Yang deficiency and Cold

Three steps in treatment

1. Shore up the flow

2. Settle the Source

3. Restore the old

Herbal treatment

• Harmonize Blood

• Treat the root cause

• Stop bleeding

Treating Flooding and Trickling according to the four phases

• Blood-Heat:

• Phase 1: clear Heat, cool Blood, stop bleeding with astringent herbs.

• Phase 2: tonify the Kidneys, nourish Blood. If the woman is spotting (trickling), I would not concentrate on stopping it.

• Phases 3 and 4: clear Heat, cool Blood.

• Blood Empty-Heat

• Phase 1: clear Empty-Heat, cool Blood, stop bleeding with astringent herbs.

• Phase 2: tonify the Kidneys, nourish Blood, nourish Yin. If the woman is spotting (trickling), I would not concentrate on stopping it.

• Phases 3 and 4: clear Empty-Heat, cool Blood.

• Spleen- and Kidney-Qi deficiency

• Phase 1: tonify and raise Qi to stop bleeding. Use astringent herbs.

• Phase 2: tonify the Kidney, tonify and raise Qi, nourish Blood.

• Phase 3: tonify the Spleen.

• Phase 4: tonify and raise Qi to stop bleeding.

• Liver- and Kidney-Yin deficiency

• Phase 1: tonify and raise Qi to stop bleeding. Use astringent, sweet, cold herbs.

• Phases 2 and 3: tonify the Liver and Kidneys, nourish Blood, nourish Yin.

• Phase 4: nourish Liver- and Kidney-Yin, move Liver-Qi.

• Blood stasis

• Phase 1: invigorate Blood and stop bleeding.

• Phases 2 and 3: tonify the Kidneys, nourish Blood.

• Phase 3: invigorate Blood and stop bleeding, move Qi.

Full conditions

Blood-Heat

Clinical manifestations

Flooding suddenly, often before the proper time, or trickling of blood for a long time after the end of the proper period, blood bright red or dark red, thirst, red face, agitation, feeling of heat, dark urine, constipation. Tongue: Red with a yellow coating. Pulse: Rapid-Overflowing.

Treatment principle

Clear Heat, cool Blood, stop bleeding.

Acupuncture

SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), L.I.-11 Quchi, SP-10 Xuehai, SP-8 Diji, SP-1 Yinbai, KI-5 Shuiquan, SP-6 Sanyinjiao, KI-2 Rangu and LIV-3 Taichong, LIV-5 Ligou, KI-4 Dazhong, LIV-1 Dadun. Reducing method, no moxa.

Prescriptions from the Great Compendium of Acupuncture⁹

– Ren-6 Qihai, LIV-1 Dadun, KI-10 Yingu, LIV-3 Taichong, KI-2 Rangu, SP-6 Sanyinjiao, Ren-3 Zhongji.

– HE-5 Tongli, LIV-2 Xingjian, SP-6 Sanyinjiao.

Herbal treatment

b. Prescription

– QING JING SAN

– Clearing the Menses Powder

d. Prescription

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Tags: Obstetrics and Gynecology in Chinese Medicine

Jun 6, 2016 | Posted by admin in GYNECOLOGY | Comments Off

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