Lyle Pannell

Li, Jin-Yong. Summary of Li Jin Yong’s Clinical Experience. Beijing: China’s Medical    Science and Technology Publishing House, 1998.

Li, Jin-Yong. Li Jin Yong Lin Chuang Jing Yan Ji Yao. Beijing: Zhong Guo Yi Yao Ke Ji Chu Ban Shi, 1998.

Chapter 3.  pgs 353-359

I. Early Onset Menstruation
     Early onset menses is defined as menstrual flow that starts 7 –10 days early.  If menstrual flow only comes 3- 5 days early or if it accidentally happens once and there are no obvious symptoms that fit the disease pattern, then it is within the normal limits.
     The cause and pathomechanism, which is responsible for this disease, is mainly due to heat in the blood level or qi deficiency unable to contain blood.  Blood encountering cold congeals.  Blood encountering heat moves.  If the blood level has heat and disturbs the “sea of blood”, then it compels the Blood to move downwards.  This could cause early onset menses.  “Qi is the commander of Blood and its function is to contain Blood.”  If Qi is deficient, then the Qi is not controlling the Blood.  The chong and ren vessels are not harmonized and the “sea of Blood” is not consolidated.  Consequently, menstruation begins early.  You should treat according to the situation using differential pattern diagnosis.

1.  Early Onset Menstruation Due to Blood Heat

(1)    Excess Heat Pattern 
In this disease pattern of early onset menstruation you can see the following:  heavy menstrual flow, purple colored blood of a sticky quality with blood clots in the flow.  These signs are often accompanied by dry mouth and desire for cold beverages, a restless sensation in heart and chest, dry and hard bowel movements, scanty, yellow urine.  There may also be heart vexation and tendency to be easily angered, bitter taste in the mouth and dry throat, a trapped and full sensation in the chest and hypochondriac region, breast and lower abdomen distension, yellow tongue coating and a rapid, wiry pulse.
Many of the above mentioned symptoms are due to an excess yang constitution or are caused by over-eating spicy, dry foods, which aid the yang.  This will cause pathogenic heat to be generated internally and lurk in the chong and ren vessels.  This pathogenic heat forces the blood to move downwards and, therefore, causes early onset menstruation.  Blood heat causes blood to overflow vessel boundaries, which results in heavy menstrual flow.  The heat burns the ying and blood, therefore, the color is purple and the quality is sticky.  The pathogenic heat may also damage the Luo vessels and cause blood and pathogenic heat to bind and depress, which is why there are blood clots.  Pathogenic heat damages the jin (body fluids), which results in thirst with desire to drink, hard and dry bowel movements and red, scanty urine.
The Liver stores Blood and it’s emotion is anger.  The heat lurks in the chong and ren vessels, which affects the Liver and Heart and gives rise to the symptoms of heart vexation, feeling easily angered, having a bitter taste in the mouth and dry throat.  The Liver channel enters the chest and hypochondriac region and, therefore, there is a sensation of fullness and trapped energy in the chest and hypochondriac region and also breast distention.
The proper treatment is to drain heat and cool the Blood.  If the patient has Liver depression symptoms, then dredge the Liver and use either Si Wu Tang or Dan Zhi Xiao Yao San.

Modification of Si Wu Tang:
15g Sheng Di
10g Dang Gui
10g Bai Shao
10g Zhi Zi
10g Huang Qin
6g Da Huang

Take the above six herbs and put them in appropriate amount of water and boil to make a decoction. Strain and throw out dregs.  Each day take one ji (one bag of the formula).  Divide into two parts and drink warm.
 Dang Gui harmonizes the blood.  Sheng Di and Bai Shao clear heat and nourish yin. Zhi Zi and Huang Qin clear heat. Da Huang drains heat and enters the blood level.  The formula as a whole can clear and drain heat from the blood level in order to treat early onset menstruation due to blood heat.

Dan Zhi Xiao Yao San:
10g Chai Hu
10g Dang Gui
10g Bai Shao
10g Bai Zhu
10g Fu Ling
10g Dan Pi
10g Zhi Zi
3g Bo He (add at end)
8g Gan Cao
3g Sheng Jiang

Take the above ten herbs, place in an appropriate amount of water and boil to make a decoction.   Wait until the herbs have almost finished cooking, then add Bo He and boil together. After the fragrance begins to rise, drain and throw out dregs.  Each day take one ji.  Divide into two parts and drink when warm.
 Dang Gui and Bai Shao nourish blood and soften Liver.   Chai Hu courses the Liver and releases depression.  Bai Zhu, Fu Ling and Gan Cao strengthen the Spleen and harmonize the middle.  Dan Pi and Zhi Zi clear heat and cool blood.  Add a little Fresh ginger (Sheng Jiang) as an envoy.  Bo He is acrid and dispersing and is used to tonify the Liver.  The formula as a whole can dredge the Liver and release depression, clear heat and cool the blood.  It treats Liver stasis and blood heat, which leads to early onset menses. 

(2) Deficient Heat Pattern:
This pattern presents with early onset menstruation with scanty flow or relatively heavy flow, which is red and thick.  These symptoms are often accompanied by dry mouth and throat, vexing heat in the five hearts (palms, soles and chest), a red tongue with little coating and a fine, rapid pulse. 
This pattern is caused by a yin deficient constitution or a chronic disease which has injured the yin.  Yin deficiency generates internal heat, which disturbs the “sea of blood.”  This causes early onset menses.  Water depletion, blood deficiency and exuberant fire cause scanty, red, thick menstrual flow.  If deficient heat damages the Luo and the blood is compelled by heat, then the flow may be heavier.  If deficient heat rises up and jinye (body fluids) are insufficient, then the mouth and throat will be dry and vexing heat in the five hearts will result.  The proper treatment is to enrich the yin, clear heat and cool the blood, but do not overuse bitter, cold herbs.  Use my own formula:

15g Sheng Di
10g Chi Shao
10g Dan Pi
10g Yu Zhu
10g Mai Dong
10g Xi Cao
10g Huai Hua
10g Ling Xiao Hua

Take the above eight herbs, place in an appropriate amount of water and boil to make a decoction. Strain and throw out dregs.  Divide into two parts and drink warm.

 Sheng Di, Mai Dong, Yu Zhu enrich the yin.  Chi Shao, Dan Pi, Xi Cao, Huai Hua and Ling Xiao Hua clear heat and cool blood.  The formula as a whole enriches the yin, clears heat and cools the blood, which can cure early onset menstruation due to deficient heat.

2. Early Onset Menstruation Due to Qi Deficiency

(1)    Heart and Spleen Qi Deficiency Pattern:
     This pattern presents with early onset menstruation with heavy flow with pale red color and thin quality.  These signs are accompanied by lassitude of spirit and fatigue, palpitations and shortness of breath, decreased appetite, lazy speech, an empty and sunken sensation in the lower abdomen, thin tongue fur, general weakness and no strength.
These symptoms are due to Heart qi deficiency and lack of governance of the blood. The Spleen qi is deficient and the blood loses its “controller”.  Therefore, you will see early onset menstruation with a heavy, pale-colored flow of a thin consistency.  Heart qi deficiency causes lassitude of spirit, heart palpitations and shortness of breath.  When Spleen qi is deficient, then there is fatigue, reduced appetite, lazy speech and an empty and sunken sensation in the lower abdomen. Clinically, it is possible to see patients who lean towards Heart qi deficiency or Spleen qi deficiency.  The proper treatment is to tonify and nourish the Heart and Spleen, augment qi and consolidate the menses.  Use Gui Pi Tang or Bu Zhong Yi Qi Tang.

Gui Pi Tang:

10g Dang Shen
12g Zhi Huang Qi
12g Chao Bai Zhu
10g Fu Shen
10g Dang Gui
6g Guang Mu Xiang
10g Suan Zao Ren
10g Long Yan Rou
10g Yuan Zhi
8g Gan Cao

Take the above ten medicinals, place in an appropriate amount of water and boil to make a decoction.  Strain and throw out dregs.  Each day take one ji.  Divide the decoction into two parts and drink warm.

 Dang Shen, Zhi Huang Qi, Bai Zhu and Gan Cao  tonify and augment Spleen qi.  Fu Shen, Zao Ren, Long Yan Rou and Yuan Zhi tonify Heart and calm spirit.  Dang Gui tonifies and nourishes blood.  Mu Xiang regulates qi and harmonizes the Stomach.  The formula as a whole can strengthen the Spleen and augment qi, nourish the Heart and tonify the Blood.  When the Heart qi is sufficient, the Heart is able to control Blood in the blood vessels.  The menstrual blood will flow and naturally arrive on time.

Bu Zhong Yi Qi Tang:

12g Zhi Huang Qi
10g Dang Shen
10g Bai Zhu
10g Chen Pi
3g Sheng Ma
3g Chai Hu
10g Dang Gui
8g Zhi Gan Cao

Take above eight herbs, boil an appropriate amount of water and make a decoction.  Strain the decoction and throw out dregs.  Each day take one ji.  Divide into two parts and drink warm. 

 Zhi Huang Qi, Dang Shen, Bai Zhu and Zhi Gan Cao tonify Spleen and augment qi. Dang Gui harmonizes and tonifies blood.  Chen Pi regulates qi and strengthens Spleen. As assistants add Chai Hu and Sheng Ma to uplift the middle qi.  The formula as a whole can raise the yang, augment the qi, tonify the middle and stabilize the original.  Then the Spleen will be able to govern the Blood.  This original middle qi deficiency leads to the problem of early onset menstruation.

(2) Kidney Qi Deficiency Pattern
 
 This pattern presents with early onset menstruation with heavy, dim red-colored flow.  This pattern is accompanied by dizziness, tinnitus, weak, aching lumbus and knees, general lack of strength and a thin, weak pulse lacking strength. 
The pattern of Kidney qi deficiency causes disharmony of the chong and ren vessels and lack of consolidation of the “sea of blood”.  This results in early onset menstruation with heavy flow and dim color.  Because the Kidneys are deficient, the Kidneys are unable to produce Jing (essence) and adequately nourish the “sea of Marrow” and bones.  Therefore, you can see symptoms of dizziness, tinnitus, weak, aching lumbus and knees and lack of strength. The proper treatment is to tonify and nourish Kidney qi, harmonize the chong and ren vessels using a modification of You Gui Yin:

10g Shu Di
10g Shan Yu Rou (Shan Zhu Yu)
10g Shan Yao
3g Rou Gui
3g Fu Pian (Fu Zi)
10g Du Zhong
10g Gou Qi Zi
10g Tu Si Zi
10g Nu Zhen Zi
10g Wu Wei Zi
6g Gan Cao

Take the above eleven herbs, place in an appropriate amount of water and boil to make a decoction.  Strain and throw out the dregs.  Each day take one ji.  Divide into two parts and drink warm. 
 Shu Di, Shan Yu Rou, Shan Yao, Tu Si Zi, Gou Qi Zi, Nu Zhen Zi  tonify Kidney yin.  Rou Gui and Fu Pian warm Kidney yang.  Du Zhong invigorates Kidney and strengthens the lumbus and knees.  Wu Wei Zi enriches the Kidney and consolidates the Jing (essence).  Gan Cao regulates and harmonizes all of the herbs.  The formula as a whole makes the Kidney Jing (essence) plentiful, the Kidney yang exuberant, the Kidney qi sufficient and the chong and ren vessels harmonized.  Then the menstrual cycle will return to normal.

II. Delayed Onset Menstruation

When the menstrual cycle is delayed seven or more days, or even forty to fifty days, it is called delayed onset menstruation or chaotic menstruation.  If the menses comes 3 to 5 days late, or is occasionally late one time and does not have obvious problematic signs of the pattern, then the menstrual cycle is still within the normal limits.  If during adolescence the menses is delayed several months or if during menopause menses is delayed, then, in general, this is not a disease. 
The three disease causes of this pattern are cold congealing the blood, qi and blood insufficiency and Kidney deficiency.  If blood encounters cold, it will congeal, such as with an external cold pathogen or overeating cold foods.  The cold pathogen enters the blood level.  Then the blood congeals and the blood flow is not smooth.  The chong and ren vessels will lack openness, which causes the menses not to flow on time as expected and be delayed.  The next cause is patients with constitutional deficiency and weakness and insufficient qi and blood.  Insufficiency of the “sea of blood” and deficiency of the chong and ren vessels can also cause delayed onset menstruation.  In a normal menstrual cycle the menstrual flow, Kidney qi, Tian Gui and chong and ren vessels are all intimately related.  If the Kidney qi is weak, then the Tian Gui is insufficient, the chong and ren are in a state of disharmony and the menstrual cycle will be delayed. 

1.  Cold Congealing the Blood Causing Delayed Onset Menstruation

      This pathocondition presents with delayed onset menstruation with black colored flow containing clots.  This pattern is often accompanied by cold limbs, fear of cold and cold pain in the lower abdomen, which is relieved by heat.  There is also reduced appetite, sticky stools, a thin tongue coat, a thin, sinking pulse.
The pattern is caused by cold at the blood level.  Blood congeals and the menses does not flow smoothly.  Therefore, one sees delayed onset menstruation with black colored, scanty flow.  The cold pathogen resides in the uterus, which causes clots in the menstrual flow.  There will be cold pain in the lower abdomen, which is relieved by heat.  Cold is a yin pathogen, which damages the yang qi.  Then the yang qi is unable to warm the body, which causes cold limbs, fear of cold, reduced appetite and sticky stools.  The proper treatment is to warm the menses, disperse the cold and open the yang.  Use Wen Jing Tang (Warm the Menses Decoction). 

10g Dang Shen
10g Dang Gui
10g Bai Shao
10g Chuan Xiong
10g E Jiao (dissolved)
10g Wu Zhu Yu
10g Gui Zhi
10g Dan Pi
15g Mai Dong
8g Fa Ban Xia
10g Sheng Jiang
8g Gan Cao

Take the above twelve herbs, place in an appropriate amount of water and boil to make a decoction. Strain.  Add the dissolved E Jiao to decoction.  Throw out dregs.  Each day take one ji.  Divide into two parts and drink warm.

 Dang Gui, Bai Shao, Chuan Xiong and E Jiao nourish the Blood and harmonize the menses.  Wu Zhu, Gui Zhi and Sheng Jiang free the yang and warm the menses.  Dang Shen augments qi.  Dan Pi invigorates the Blood.  Mai Dong and Ban Xia harmonize the Chong and Ren vessels.  Gan Cao harmonizes all the herbs.  The formula as whole can warm and disperse cold in the Blood causing the blood vessels to move freely.  Then the delayed menstrual cycle as well as other symptoms will disappear by themselves.

2. Qi and Blood Insufficiency Causing Delayed Onset Menstruation

This pathocondition presents with delayed onset menstruation with scanty, thin, pale-colored flow.  This condition is often accompanied by an empty and sunken lower abdomen, dull pain that is relieved by pressure, a wilting yellow complexion, dizziness, and heart palpitations.
This pattern is caused by insufficiency of blood and qi, emptiness and deficiency of the “sea of blood” and depletion of the source of menstrual blood.   Therefore, the menses is delayed with scanty, pale flow. The blood is deficient and the qi is weak and lacks strength of movement.  The uterus lacks nourishment.  Therefore, the lower abdomen is empty with dull pain that is relieved by pressure.   When blood is deficient, it is unable to flourish upwards and reach the head.  This causes a wilting yellow complexion and dizziness.  The blood deficiency is unable to nourish the Heart, which leads to heart palpitations.  The proper treatment is to augment qi, tonify blood and harmonize the menses.  Use Ba Zhen Yi Mu Tang.

10g Dang Shen
10g Bai Zhu
10g Fu Ling
10g Zhi Gan Cao
15g Shu Di
10g Dang Gui
10g Bai Shao
10g Chuan Xiong
12g Yi Mu Cao

Place the above nine herbs in an appropriate amount of water.  Boil and make a decoction.  Strain and throw out dregs.  Each day take one ji.  Divide into two parts and drink warm.

 Dang Shen, Bai Zhu, Fu Ling and Gan Cao strengthen the Spleen and augment qi.  Shu Di, Dang Gui, Bai Shao and Chuan Xiong tonify and harmonize Blood.  Yi Mu Cao invigorates the blood and harmonizes the menses.  The formula as a whole produces sufficient qi and blood and makes the source of menstrual blood exuberant.  Then the menses will descend in a timely fashion.



3. Kidney Deficiency Causing Delayed Onset Menstruation
 This pathocondition presents with delayed onset menstruation with dim-colored, scanty menstrual blood.  This condition is accompanied by dizziness and tinnitus, weak, aching lumbus and knees, cold limbs, frequent and clear urine.
This pattern is caused by Kidney qi deficiency and weakness, insufficiency of Tian Gui, depletion and deficiency of the chong and ren vessels and failure of uterus to fill.  Therefore, the menses arrives late with scanty, dim colored flow.  The lumbus is the palace of the Kidneys.  When Kidney qi is deficient, it is unable to fully nourish and replenish the sinews and bones.  Therefore, the lumbar and knees will be weak and aching.  The Kidney opens at the ears.  When the Kidney essence is unable to fully nourish the “sea of marrow”, there is dizziness and tinnitus.  When the Kidney is deficient, the yang qi is unable to reach the four limbs.  Therefore, the limbs will be cold.  When the Kidney yang is unable to move water and transform qi, there is frequent urination with clear urine.  The treatment is to tonify the Kidneys and regulate the menses.  Use a modification of Gui Shao Di Huang Tang:

15g Shu Di
10g Shan Yu Rou (Shan Zhu Yu)
10g Shan Yao
10g Fu Ling
8g Ze Xie
8g Dan Pi
10g Dang Gui
10g Bai Shao
15g Tu Si Zi
10g Bu Gu Zhi
10g Du Zhong

Take the above eleven herbs, place in an appropriate amount of water and boil to make a decoction.  Strain and throw out dregs.  Each day take one ji.  Divide into two parts and drink warm.

This formula contains Liu Wei Di Huang Tang to tonify and boost Kidney yin.  Bu Gu Zhi, Tu Si Zi and Du Zhong warm and tonify Kidney yang, boost the Kidneys and bolster the Jing.  Dang Gui and Bai Shao nourish the Blood and regulate the menses.  The formula as a whole helps tonify yin and yang, regulates fire and water, helps produce sufficient  Kidney qi and makes yin and Blood exuberant.  Then the menstrual cycle will arrive in a timely fashion.

Menstruation at Irregular Intervals

Menstruation that does not come on time, or comes early, or comes late, or has no fixed pattern, is called menstruation at irregular intervals.  It is also called menstruation past the appointed time or chaotic menstruation.  The regular arrival of the menses is dependent on the overflowing of the chong vessel.  The chong vessel arises from the uterus.  It percolates upward to the three yang.  It percolates downward to the three yin.  Therefore it is the sea of the twelve channels.  The Su Wen- Shang Gu Tian Zhen Lun Pian says, “When the tai chong vessel is exuberant, menstruation occurs on time.”  The normal function of the chong vessel in terms of overflow and discharge is intimately related to the Liver, Spleen/ Stomach and Kidney.  Therefore, there are the sayings of “the chong vessel belongs to the Liver”, “the chong vessel originates at the Kidney” and “the chong vessel links with the yang ming.”  Therefore, the menstrual period and these three zang (organs) are intimately interrelated. 

1.    Menstruation at irregular intervals due to Liver depression and qi stagnation

This pathocondition presents with menstruation at irregular intervals with menstrual flow that is not smooth.  This condition is accompanied by pre- or post- menstruation breast distention and tenderness, lesser abdomen distention and fullness, chest obstruction and sighing.  The tongue coat is thin and white.  The pulse is wiry.

The Liver stores the blood, governs dredging and draining and manages the sea of blood.  When the Liver qi reaches out in an orderly fashion, dredges and drains normally, the sea of blood fills and overflows on time, then the menstrual period will be normal.  If the Liver qi is depressed and stagnant, then it loses it’s regulation of dredging and draining.  If dredging and draining are excessive, then menstruation will come early.  If this action is insufficient, then menstruation will be late to flow.  This results in menstruation at irregular intervals.  When the Liver is depressed and the qi is stagnant, then the channels and vessels are inhibited.  Therefore, the menstrual flow will not be smooth, the breasts, chest, ribsides and lower abdomen, the areas where the Liver channel passes through, will be distended and painful.  The Liver qi desires to be soothed and, therefore, the patient sighs.  Treat by dredging the Liver, regulating the qi and regulating the menses.  Use Xiao Yao San modified:
10g Chai Hu
10g Dang Gui
10g Bai Shao
10g Bai Zhu
10g Fu Ling
3g Bo He
6g Gan Cao
3g Sheng Jiang
10g Qing Pi

Take the above nine herbs, place in an appropriate amount of water and boil to make a decoction.  Strain and throw out the dregs.  Each day take one ji.  Divide into two parts and drink warm.

The formula contains Chai Hu to dredge the Liver and resolve depression, Bo He and Sheng Jiang to aid the Liver’s orderly reaching, Dang Gui and Bai Shao to nourish blood and regulate the menses, Bai Zhu, Fu Ling and Gan Cao to strength Spleen and harmonize Stomach.  Qing Pi is added to regulate Liver channel qi.  This formula as a whole can make Liver qi dredge and reach out, can fortify Spleen qi to move and transform the source to make it abundant.  The menstrual blood will naturally come on time and descend.