Treatment:

Dang Gui (9g), Zhi Xiang Fu (9g), Huai Niu Xi (12g), Zi Dan Shen (9g), Fen Gan Cao (4.5g), Chuan Xiong (9g), Wu Zhu Yu (4.5 g), Chi and Bai Shao (9g each), Du Hong Hua (6g)

Second visit :

She used the herbs and had a period, but still experienced dizziness. With heart disease, one must avoid a vigorous "attacking method"; but if one doesn't attack, it is difficult to stimulate menstruation.

Dang Gui (9g), Huai Niu Xi (15g), Wu Zhu Yu (9 g), Rou Gui (9g), Zhi Shou Wu (12g), Dang Shen (12g), Du Zhong (9g), Ze Lan (9g), Tao Ren (15g), Du Hong Hua (9g), Zhi Gan Cao (3g).

Third visit:

Though she had a period, the blood was pink, sticky and was trickling out without ample flow. Her abdomen was distended, but since her pulses were not very strong, one still can't vigorously "attack".

Dang gui (15g), Hei Chou (6g), Shan Zhu Yu (9g), Shu Di Huang (15g), Pao Fu Zi (6g), Zhi Gan Cao (4.5g), Xiang Fu (9g), San Leng (9g), Ba Ji Tian (9g), Chuan Xiong (9g), Pao Jiang Tan (4.5g).

Analysis: (From an anthology of Zhang Ci Gong's Experience in the Art of Healing)

This is one of Zhang Ci Gong's amenorrhea cases. It is a pattern of qi vacuity blood stagnation with the root being vacuity and the branch being repletion. For this patient, dual vacuity of heart and kidney and insecurity of the fetus resulted in multiple miscarriages which damaged the chong and ren vessels contributing to even more extreme kidney vacuity. The blood's movement had no strength, so the qi and blood became congealed and stagnant and since the channels are not flowing smoothly, amenorrhea is the result.

The treatment is relatively tricky. Without invigorating the blood, the menstruation can't be stimulated, but if the blood is invigorated, there is risk of damaging the right qi. Zhang's treatment is split into two steps:

• The first treatment used a mild formula to rectify qi, invigorate blood and open channels so as to nourish the blood and regulate the cycle without wearing out and damaging the right qi. Dang gui, chuan xiong, bai shou, zi dan shen, du hong hua and xiang fu frees and moves the qi and blood; huai niu xi tends to move downward and it invigorates the blood and regulates the cycle; wu zhu yu warms and disperses the cold, congealed qi stagnation in the liver channel, it also has the action of inhibiting fibrin accumulation which leads to thrombosis and the build-up of blood; thus, it also can assist the qi moving, blood invigorating herbs to regulate the cycle.
• At the time of the second treatment, the patient was menstruating but the flow was not normal. The reason was that the vacuous qi did not have the strength to move the blood and drive out the stagnation. Once more, herbs were used that boost the qi and nourish the blood, enrich and supplement the liver, spleen and kidney; dang shen, dang gui, du zhong, wu zhu yu, zhi shou wu. These herbs were used in combination with herbs such as tao ren and hong hua and ze lan that free stagnation and move the menses, so as to simultaneously support the right and expel evil. After taking the herbs, the menses was dribbling rather than flowing easily, indicating that stagnation was still obstructing the flow.
• Thus, at the third visit, herbs were used that supplemented and augmented yin and yang in combination with san lang, hei chou, pao jiang and other herbs that expel stagnation and invigorate blood.

Zhang's treatment, from beginning to end, stayed true to the idea of protecting the root, first using a mild formula to stimulate the cycle, freeing and nourishing as appropriate, and continuing with simultaneously attacking and nourishing to get the effect.