Uterine Bleeding

A nineteen year-old female was referred by her mother for help with uterine bleeding during her cycle beyond normal menstruation. During episodes of intermenstrual bleeding she had a small volume of vaginal bleeding, for two to three days over a period of fourteen months. Her first menstruation occurred at twelve years old, has come regularly once a month, generally with a small volume of purple blood and clots, with five to six days of bleeding per cycle, in twenty-five day cycles. She had no dysmenorrhea or other associated symptoms. Her latest menstruation ended one week before her first visit. She experienced lassitude, fatigue and occasional poor sleep. Her appetite and urination were normal, but she had dry stool with one bowel movement a day. She did not have back aches or headaches. Examination showed that her face was pale with slight acne that worsened three to four days prior to menstruation, and improved after menstruation. Her tongue body was medium size, pale red with a thin, white coating. Her pulse was thready and weak in the proximal position. The Ears Pressure Test revealed significant pain from slight touch on the locations corresponding to the brain, endocrine, neck, waist, leg, and shenmen, that she reported as a pain level of 5-6/10. She had no tenderness or pain from slight touch to the head, neck, lower back or lower limbs.

Based on Traditional Chinese Medicine, her condition was due to yin deficiency and Blood heat, disorders of Blood and Qi. The treatment used was to tonify yin, clear heat, cool Blood, regulate the Qi and invigorate Blood to stop bleeding. Acupuncture points included ST36, PC6, LI4, 11, SP6, 10, RN6, DU20, Yintang and LV2. Acupuncture was administered for 15 minutes each week. The Ear points included brain, endocrine, shenmen, uterus, among others. The Chinese herbal formula included Sheng Di Huang, Chi Shao Yao, Xuan Shen, Mu Dan Pi, Huang Qin, Ce Bai Ye, Zi Cao, Han Lian Cao, Xuan He Cao and Zi Cao. This was prescribed as a 50g herbal powder Rx for one week, to be taken orally three times a day, 2g per dose, mixed with 2 to 3 oz. warm water.

After a few weeks of treatment, she reported the acne improved, but she still had intermenstrual bleeding. The acupuncture points were the same treatment plan. The Chinese herbal formula was modified to strengthen the regulation of Qi and invigorate Blood to stop bleeding. The herbs included Huang Qi, Dang Shen, Dang Gui, Chuan Xiong, Tao Ren, Pu Huang, San qi, San Leng, E Zhu, Qian Cao, Yan Hu Suo, Xian He Cao and Yi Mu Cao. This was prescribed as a 50g herbal powder Rx for one week, to be taken orally three times a day, 2g per dose, mixed with 2-3 oz. warm water. After a few weeks on the regimen, she reported that there was no sign of the intermenstrual bleeding, and after two months treatment, it did not recur. She asked that she be provided with a prepared Chinese herbal formula for two months. Following up two years later, the intermenstrual bleeding had not recurred.

In July 2014, a thirty-nine year-old female visited my clinic for acupuncture and Chinese herbs to treat her uterine fibroids, heavy bleeding, and abdominal pain. She suffered from heavy bleeding and abdominal pain during menstruation for two months. She was diagnosed with uterine fibroids, one measuring about 7cm and another one about 3.5cm. She was engaged in hormone replacement therapy to lessen the heavy bleeding and abdominal pain, but the symptoms did not noticeably improve. She was waiting to schedule for surgery. She had recently been suffering from lower abdominal pain, especially pain on the right side of abdomen, that worsened during menstruation. She had heavy uterine bleeding with bright red blood at the beginning of menstruation, and dark color with clots at the end of menstruation. Her first menstruation appeared at age eleven, had come monthly, with five days of menstruation per cycle, with twenty-four days for each cycle. Her last menstruation ended in 6/14/2014. She also experienced fatigue, body weakness, stress, with occasional poor sleep and headaches. Her appetite was normal, with one bowel movement per day, and her urination and libido were normal. She felt coldness in her limbs and sometimes had a backache.

Examination showed she had a thin body, sallow skin with dark spots on her face. Her tongue was pale red with teeth marks on the edges with a thin, white tongue coating. Her pulse was weak and wiry. There was pain on even slight touch to her lower abdomen – she reported the pain level on right side as 6-7/10, and the pain level on the left side as 2-3/10. Slight touch to her upper back was also painful, reported as 3-4/10. Slight touch to her lower back was painful as well, with the pain level reported as 4-5/10. The Ear Pressure Test brought significant pain with pressure on the corresponding parts of the brain, neck, waist and sacral, and shenmen – she reported the pain level here at 6-7/10 in the right ear, and 4-5/10 in left.

Based on Traditional Chinese Medicine, her diagnosis was Spleen Qi deficiency with Qi unable to control Blood in the middle abdomen, and Blood stasis with painful menstruation. The treatment principle was to strengthen the Spleen, tonify Spleen Qi, invigorate the Blood and dispel stasis to stop bleeding. The acupuncture points included ST25, 27, and 36, SP6, 9, RN6, 10, Zigongxue, UB54 and 57, GB30, DU3, 4, 20, Yintang, Huatuojiaji, S3, 4. Acupuncture was administered for 15 minutes once a week. The ear points included brain, endocrine, uterine and shenmen, among others. The Chinese herbal formula was a modification of Bu Zhong Yi Qi Tang and Tao Hong Si Wu Tang. The herbs included Huang Qi, Dang Shen, Bai Zhu, Shan Yao, Ce Bai Ye, Dang Gui, Chuan Xiong, Tao Ren, Chi Shao Yao, Pu Huang, Yi Mu Cao and San Qi. This was prescribed as a 50g herbal powder Rx for one week, to be taken orally three times a day, 2g per dose, mixed with 2-3 oz. of warm water.

After treatment, she reported that abdominal pain was improved. After a few weeks of treatment, her abdominal pain improved during menstruation, the volume of blood was significantly reduced. After a few months of treatment, she no longer experienced abdominal pain during menstruation with normal bleeding. She changed her treatment schedule to once every two weeks for maintenance with acupuncture treatment and Chinese Herbal formula for three months. As of November 2014 she had also decided to go ahead with surgery for the uterine fibroids.

A 28-year-old woman came to my clinic for help with abnormal uterine bleeding that had been ongoing for three months. She had been pregnant three times, and the first and second pregnancies led to normal births, but the third pregnancy resulted in miscarriage at about 14 weeks. Subsequently, three months after the miscarriage, she began to experience uterine bleeding, and was diagnosed with retained placenta in uterus. Curettage surgery was recommended, but she did not agree to it, because it could lead to difficulty conceiving again. She hoped to find a different way to deal with her condition so that she could remain fertile. Her uterine bleeding was irregular, lasting from one to three days, then skipping one to three days, at which point she would then bleed again for three months. The bleeding was black blood with clots, and a small volume of odorless blood, though she had no other vaginal discharge. Along with the uterine bleeding, she also experienced abdominal pain, and occasionally back pain. However, her abdominal pain decreased during the time period of her bleeding, which ruled out clots as the cause of the abdominal pain. Other symptoms that she experienced included anxiety, stress, depression, a sense of being prone to anger, poor interrupted sleep, and intermittent hot flashes with sweating. She also experienced lassitude, headache, nasal congestion and a runny nose. She had a stiff neck and upper back with intermittent shoulder pain. Her appetite was normal with one bowel movement a day, and normal urination. Examination revealed her tongue body was medium size, pale red with a thin, white tongue coating. Her pulse was floating and stringy. Slight touch to tender areas of the neck was painful, with a severity that she described as 4-5/10. Slight touch to the lower back was also painful, with a severity of 4-5/10. Slight touch on the forehead was painful, a severity of 5-6/10. Slight touch to the abdomen was painful, described as a severity of the pain level was 3-4/10. The Ears Pressure Test revealed significant pain in areas corresponding to the endocrine, head, neck, chest, waist, leg, shenmen and uterus, with an average severity of 6-7/10.

Based on Traditional Chinese Medicine, her conditions were major Blood stagnation, minor Spleen Qi deficiency and shen disorders. The treatment plan was to invigorate and transform Blood, tonify Spleen Qi to stop uterine bleeding, and calm shen to help her anxiety. Electric acupuncture points included DU20, Yintang, RN12, 14; manual acupuncture points included ST36, 27, 25, SP6, LV3, LI4, 11, RN4, and RN6, among others. Acupuncture was administered 15 minutes once a week. The ear points included points corresponding to the brain, waist, leg, stomach, intestines and uterus. The Chinese herbal formula contained E Zhu, San Leng, Dang Gui, Pu Huang, Yi Mu Cao, Chi Shao Yao, Tao Ren, Jiang Huang, Wan Bu Liu Xing, Huang Qi, Dang Shen, Sheng Jiang, and Gui Zhi. The formula was a 50g herbal powder prescription for one week, to be taken orally three times a day, 2g per dose, mixed with about 2-3 oz. of warm water.

She was advised that she would have pain in her lower abdomen after treatment which would indicate retained placenta in her uterus would discharge soon, and that when she felt this pain, she should go to the ER or gynecological clinic for help. After treatment, she reported that her uterine bleeding stopped. Two days after her second treatment her husband called at about 10:30 pm to report she had severe pain in her lower abdomen, pubic bone and vaginal area, which suggested she must immediately go to the ER for help. The second day at 11:00 am her husband called to announce the retained placenta in the uterus which was about 2×2 inches was removed and pain disappeared. After one week, she came back to my clinic for help restarting menstruation. The treatment was changed to tonify Qi and Blood, invigorate Blood with a Chinese herbal formula and acupuncture until she menstruated normally for two months. She was advised to wait a year to improve her condition before becoming pregnant again.