Uterine Bleeding

WESTERN MEDICINE: Uterine bleeding means abnormal uterine bleeding, which includes:

(1). Menstruation of excessive duration (hypermenorrhea), and/or excessive amount (menorrhagia),

(2). too frequent menstruation (polymenorrhea),

(3). intermenstrual bleeding (metrorrhagia), and

(4). postmenopausal bleeding. Slight bleeding at ovulation is physiologic in some women.

SYMPTOMS AND SIGNS: Uterine bleeding may be of abrupt onset, profuse or lingering and scanty, the two conditions may possibly occur alternately. Other symptoms include dizziness, fatigue, lower back pain and general weakness. Red tongue and rapid pulse in blood-heat type, pale tongue and weak pulse in deficient type. 

ETIOLOGY AND PATHOLOGY: The major pathological changes of uterine bleeding are due to the damage of Chong and Ren channels causing them to lose control of blood circulation. The etiological factors are mostly due to heat in the blood, blood stasis and spleen and kidney deficiency. 

(1).Heat in the blood: This is mostly due to the Yang body type, or too much spicy and hot food, or prolonged strong emotions. Those factors are going to produce interior heat which goes into the blood causing bleeding. 

(2). Blood stasis: This mostly happens after menstruation or child birth. Blood stasis will obstruct the circulation of blood causing bleeding. 

(3). Spleen deficiency: One of the major function of spleen is to hold blood circulated inside of blood vessels. If there is the deficiency of spleen, the Q1 loss its function of holding the blood so to cause bleeding. 

(4). Kidney deficiency: Usually due to excessive sexual activities, or too many child births. Kidney deficiency can cause the Chong and Ren channels to be out of control. 

DIFFERENTIATIONS: 

1. Uterine Bleeding due to Heat of Blood:

Indications: Sudden onset of uterine bleeding with profuse amounts of deep red blood, or a lingering chronic uterine bleeding with deep red color, thirsty, dizziness, flushed complexion, restlessness, insomnia. Tongue is red with yellow coating, slippery and rapid pulse. 

Treatment & Formulas: Clear interior heat and cool blood, strengthen the meridian (of Chong and Ren) so as to stop bleeding. 

Products:

    • Long Dan Xie Gan Tang (Gentian Combination, Item No. 2267): This is a strong formula to clear the damp-heat of liver (which connects with Chong and Ren channels). It is better to combine it with Si Sheng Wan (Rehmannia and Lotus Leaf Formula, Item No. 2058) which is a very good formula to cool the heat of blood. 
    • Dang Gui Liu Huang Tang (Tang-kuei and Six Yellow Combination, Item No. 2231): This is very good formula for the Yin and blood deficiencies body type plus strong interior heat. It also can be combined with Si Sheng Wan to cool blood at the same time. 
    • Jia Wei Xiao Yao San (Bupleurum and Paeonia Formula, Item No. 2068): It treats uterine bleeding due to liver fire plus interior heat. 

2. Uterine Bleeding due to the Blood Stasis:

Indications: Lingering uterine bleeding, or sudden profuse bleeding with clots, lower abdominal pain, refusal to press the painful areas, pain will be alleviated once the clots come out of the body. Deep dark tongue, or with petechia at tip or two sides of the tongue, deep uneven pulse or wiry and tight pulse. 

Treatment & Formulas: Regulate blood and eliminate the blood stasis. 

Products:

    • Si Wu Tang (Tang-kuei Four Combination, Item No. 2060): This is a blood tonic formula with a regulating function too. Other herbs may be added to strengthen the circulation of blood, such as San Qi (Notoginseng Radix, ltem No.1374), Hong Hua (Carthamus Flos, Item No. 1148). 
    • Xiong Gui Jiao Ai Tang (Tang-kuei and Gelatin Combination, Item No. 2100): This is a very popular formula used for uterine bleeding due to blood or Yin deficiency plus interior heat. It tonifies the blood and cools blood at the same time. It is also used to prevent uterine bleeding, or abortion. 

3. Uterine Bleeding due to Spleen Deficiency:

Indications: Sudden profuse uterine bleeding, or lingering drop-like bleeding, blood color is pale and loose in quality, pale or edematous face, fatigue, cold limbs, shortness of breath, dislike talking, fullness of chest, poor appetite, loose stool, thin and slippery, or greasy tongue, tender and enlarged tongue or with teeth margin at side of tongue, thready and weak pulse, or empty pulse. 

Treatment & Formulas: Tonify the Qi and blood by promoting the function of spleen and stomach. 

Products:

    • Shi Quan Da Bu Tang (Ginseng and Tang -kuei Ten Combination, Item No. 2015): This is a very good QI and blood tonic formula by promoting the function of spleen. 
    • Ren Shen Yang Rong Tang (Ginseng Nutritive Combinations, Item No. 2007)
    • Gui Pi Tang (Ginseng and Longan Combination, Item No. 2261)
    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225)
    • They are all popularly used formulas for the Qi and blood  tonification. 

4. Uterine Bleeding due to Kidney Deficiency:

(1). Uterine Bleeding due to Kidney Yin Deficiency:

Indications: Scanty lingering uterine bleeding with deep red color, dizziness, tinnitus, restlessness, hot sensation of five palms (both hands, feet and middle of chest), insomnia, night sweating, soreness or pain of lumbar region and knees. Tongue is red with scanty or no coatings, pulse is thready and rapid or weak. 

Treatment & Formulas: Tonify the kidney Yin and clear the deficient interior fire so as to stop the bleeding. 

Products:

    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No. 2123): This is kidney Yin tonic, and at the same time, it can clear the deficient interior fire.
    • Qi Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia Six Formula, Item No. 2290): It is a tonic for both kidney and liver Yin. 

(2). Uterine Bleeding due to Kidney Yang Deficiency: 

Indication: Profuse uterine bleeding, or lingering drop-like bleeding with pinkish color, lower spirit, empty minded, dizziness, aversion to cold, cold limbs, dull complexion, frequent and profuse urine, loose stool, pale tongue, white and thin coating, deep and thready, or weak and soft pulse. 

Treatment & Formulas: Warm and tonify the kidney Yang so as to stop bleeding. 

Products:

    • Jia Wei Chang Chun (Youth Formula, Item No. D3041): This is a very good tonic for kidney, especially kidney Yang.
    • Huan Sao Dan (Lycium Formula, Item No. 2264): This also is a very good kidney tonic formula, owns the name as rejuvenescent formula. 
    • Ba Wei Di Huang Wan (Rehmannia Eight Formula, Item No. 2011): This is a kidney tonic for both Yin and Yang. 

COMMENTS: Generally speaking, uterine bleeding ls a process of losing blood. According to its onset and amount of bleeding, TCM has three major principles for different stages: 

(1). Stop bleeding: This is the first principle when there happens to be a sudden and large amount of uterine bleeding. Strong herbs or formulas need to be given quickly to stop bleeding according to its diff entiations of cold, or heat, excessive or deficiency factors. 

(2). Look for the pathogenic factors which cause the bleeding. 

(3). Tonification for recovery period: after bleeding stops, it is still necessary to use tonic herbs to strengthen the function of the spleen and kidney soto prevent its recurrence. 

(4). lf bleeding causes fainting or coma, the single herbs, such as Ren Shen (Ginseng Radix, Item No. 1321), or combined with Fu Zi (Baked Aconitum Radix, Item No. 1294) may be used. 


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