Yang XX, female, 27 years of age, single.  First office-call April of 1973.
For two years, every time the menstrual cycle was at day ten, there was a little bleeding that was brown, and lasted about 4 to 5 days.  The cycle came early, was red in color, copious, and with small clots.  There was premenstrual lower abdominal distending pain, pre and postmenstrual thick and copious discharge, aching and weak low back, and sleep and appetite were of poor quality.  The tongue was red, with a thick yellow and greasy coating, and the pulse was slippery, wiry and forceless.  The pattern belongs to liver heat with blood vacuity, and damp heat pouring down.
On further examination of the postmenstrual time, there was dizziness, achy low back, and copious discharge.  Treat by clearing heat and disinhibiting damp while nourishing the blood and calming the liver.

Formula:  Qin Dang Gui, Hang Bai Shao, Nu Zhen Zi each 9g, Sang Ji Sheng 15g, Bai Ji Li, Hang Ju Hua, (added at the end), each 9g, Che Qian Zi 12g, Chun Gen Bai Pi, Qu Mai each 15g, Huang Qin 9g, Fen Gan Cao 6g          3 packets, water decoct.
Separately: put She Chuang Zi 9g, Chuan Huang Bo 6g, and Dan Wu Yu 3g, in a cloth bag, steep use as a sitz bath 2x/day.


2nd Visit, May 6th
After 8 packets, there was no more discharge, or mid-cycle bleeding, and the patient’s achy low back symptom had decreased.  The menses arrived this morning and was relatively copious, with a heavy sensation in the low abdomen and back.  The pulse was slightly rapid and wiry.  Another treatment was given to nourish yin, clear heat, cool the blood and consolidate the menses.

    Formula:  Qin Dang Qui 15g, Hang Bai Shao 9g, Da Sheng Di 15g, Chuan Xiong 4.5g, Mu Dan Pi 9g, Chao Di Yu 15g, Chuan Qian Cao 6g, Liu Ji Nu 9g, Zhi Xiang Fu 6g, Sheng Ce Bai Ye 9g, Wu Zei Gu 15g, Huang Qin 6g, E Jiao 9g
3 packets, water decoct.



3rd Visit, May 20th
After 5 packets the menses stopped.  This time, in comparison to the last, the menses was relatively light, as two pads were sufficient.  The tongue was red with a thin white coating and the pulse was slow, wiry and moderate.
    The patient was advised to take 1 pill of Jia Wei Xiao Yao Wan in the morning, and 20 pills of Er Zhi Wan in the afternoon for 7 days.  Then take 5 packets of the first formula given.  When the menses arrive, take 3-5 packets of the second formula given.  After following this regulating method for 4 months, the menstrual cycle is nearly normal, and the mid-cycle bleeding did not appear again.


Note:  In this case, the early menses was copious, with dizziness and achy low back.  The pattern belongs to liver channel depressed heat with liver and kidney insufficiency.  The pre and post-menstrual thick and copious discharge, and the yellow, greasy tongue coating is from damp heat pouring down.
    During the menses, the damp heat, which has accumulated, floods the blood collaterals, moves and damages the blood and causes it to spill out of the vessels, and this is why there is mid-cycle bleeding.  After the menses has past, the blood and essence are vacuous, and liver wood loses its nourishment so you see symptoms like dizziness and achy low back.  Damp heat pours down and causes thick and turbid discharge.  Use Dang Gui, Bai Shao, Nu Zhen Zi, Han Lian Cao and Sang Ji Sheng to nourish and boost the liver and kidney.  Use Huang Qin, Ju Hua, and Bai Ji Li to clear heat and calm the liver.  When the liver and kidney are nourished, and depressed heat is cleared, then the Chong and Ren are harmonious, and the blood will flow naturally in the channels.  Use Che Qian Zi, Qu Mai, and Chun Gen Pi to clear and disinhibit damp heat, which allows for dredging and disinhibiting of the vessels.  When the qi and blood are unobstructed, then there is no need to worry about the menses damaging the blood.
   
 
Ha Li Tian: Clinical Case Studies from 100 Famous Chinese Doctors. .  “A Case of Mid-Cycle Bleeding”: Compiled by: Ha Xiao Xian, Gu Jin Hong, Ha Xiao Buo.  Page 71.  Chinese Medicine Publishers, Beijing, 2003.  
Translated by Dana Balassi.