Shanlarson: June 25, 2020, 6:09am
Hi everyone,
I have a irregular bleeding case that is proving challenging. The patient came to see me 1 month ago. For the last
year she has been having beng luo where she will spot and lightly bleed for a while and then heavy bleed. She took
western medication once to stop it but she had such pain after and then passed a horrible clot she said it felt like she
was having a miscarriage. Since then she has only used Chinese herbs to stop the bleeding that she gets from a very
experienced Herbalist. She has had to use the herbs on 3 different occasions to stop the bleeding.She started seeing
me because her herbalist is hard to get into to see and doesn’t speak english so she always needs her sister to come
with her to translate. I am giving her herbs as well but that is story for another forum.
I’ll break these symptoms down into SAAM categories after this synopsis so you can get a quick snap shot. She is
33 years old.She has a higher BMI but not obese. She has dense firm body. She originally had chronic diarrhea
with stronger odour but that has cleared up since seeing me. She had stuffiness after eating with lower appetite.
That has improved as well. She is not particularly thirsty but if she did drink she wanted Ice cold. That has just
recently changed. Now she just wants room temp.Her skin is more dry but a little oily on her face. She runs hot and
easily feels overheated. She sweats easily. She use to have menstrual cramps but hasn’t in a few years. Now she
experiences no cramping. Her periods sometime don’t come for 40 some days. The bleeding can be endless days of
spotting or sometimes will switch to heavy bleeding. Anytime when she runs she will spot a bit. The irregular
bleeding started over a year ago during the time she was planning her wedding. It was very stressful. She says she
can get easily irritable at work but lessened since working at home during Covid and after 1st week of herbs
doesn’t feel irritable . Her nails are a little weak. Her tongue is a little small. It was red/purple, stiff with
teethmarks, just recently it’s more pale. She had rib side tension on the right side but that has resolved. She has
knee pain that is worse after running. It feels stiff. She had okestu pain but that has resolved.
heavier set 6+
She has dense firm body. 6+
bright eyes 4+
Polite 6+
pale complexion 6+
facial symmetry 4+
menstrual pain 0
Oketsu pain 7+ (now resolved)
irregular bleeding 9+++
dry skin 6+
oily face 5+
diarrhea 7+ (now resolved)
full easily 6+
Knee pain 6+
right rib side tension 8++ (now resolved)
resources 6+ (she has been temporarily let go from work a month but that doesn’t seem like a big stress to her. Has
a big wedding rock)
Hot 8+15/01/2024, 12:32Uterine bleeding difficult case – Qiological Community
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warm/soft epigastrium 6+
wants cold drinks 8+ (now resolved)
Irritable 7+ (now resolved)
When I first started seeing her she was roughly on day 22 of cycle. She wasn’t yet bleeding other than having
spotting when she runs which was bothering her. She was feeling very hot. Her pulse had an almost rapid feel.
I decided to do BL+ because of:
Hot 8+
warm/soft epigastrium 6+
rapid pulse.
The next week the bleeding during running had stopped. She was on day 30 of her cycle but hadn’t started to bleed.
She was worried it was going to extend to 40+ days. At the time she had the strong rib side tension and diarrhea.
LU XS seemed the most present. I decided to do ST+ because of
right rib side tension 8++
heavier set 6+
dry skin 6+
diarrhea 7+
full easily 6+
.
I also thought that the downward action of the ST+ it might help the menses come on time.
The next week when she came in she had started bleeding but it was light and more constant spotting with quarter
size clots. She had been bleeding like this for a week. I was on the fence about what to do. She no longer had the
rib side tension and she no longer had diarrhea just looser stool. What was standing out the most was the Oketsu
pain. This is where I may have gone a little off but she seemed quite in the middle between SI/ KI XS maybe a
little more towards SI XS. But Okestu pain seemed very prominent.
I did SI+.
The next week the bleeding was slightly more but still, very light. She was just using a light pad and having clots.
She now had been bleeding for over 14 days. She was now worried about this going on for weeks as it has in the
past for her.
This is where I definitely went wrong. I did KI+. Unfortunately even though she looked calm and I checked in with
her 5 min into the treatment, she told me at the end of the treatment that she was more fidgety than she had been all
the other treatments. (Polite maybe more +)
The next day she started bleeding heavy! She said she instinctively felt it was after the acupuncture treatment. Uh
oh. Now I was in a bind. I didn’t want to do SI+ to undo the adverse treatment because I was worried about more
bleeding and it hadn’t really been effective the first time I used. Patient came in 2 days later and was still super hot
with a forceful pulse especially in right guan. I decided to do BL+ again. The bleeding came down a bit. She came
in again 2 days later. I did BL+ again. The bleeding again came down. Now instead of bleeding through a pad
every 2 hours she was using super tampons and needing to change every 2-3 hours and she was have some hours
when there was no bleeding then it would start up again.
I just saw her again 2 days after that. She was no longer wanting ice cold drinks. She was still warm but felt it was
more hot flashes. I wasn’t sure where to go but because she said she felt her complexion is pale and with all the15/01/2024, 12:32Uterine bleeding difficult case – Qiological Community
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blood loss I did LIV+. And once I took the needles out I moxa’d SP1. I also have been giving her herbs. Haven’t
heard from her in a couple of days. Hopefully that’s a good sign. Any insight would be helpful. Thanks for reading
my long winded case! Clinic is hard! …But I also love it.
KristinWisgirda: June 25, 2020, 2:09pm
Thanks for the interesting case @Shanlarson.
Shanlarson:
I didn’t want to do SI+ to undo the adverse treatment because I was worried about more bleeding and it hadn’t
really been effective the first time I used.
In your shoes, the same thought process would be spinning in my head. However, there is no greater “for sure” sign
than an adverse reaction. K+ sending her clearly in the wrong direction gives SI+ the strongest weight for the next
right move.
Shanlarson:
I am giving her herbs as well but that is story for another forum.
Since enough of us prescribe herbs here to know what you are talking about and because they had to have some
significant influence on her system, please feel free to include at the least the gist of what you have been doing
herbally. The heat stands out as a significant factor and seems more excess rather than deficient. Yangming is
obvious affected. What is your diagnosis of the source?
From my easy chair, Liv+ probably would have been the best strategy after the SI+ treatment.
Sorry that this isn’t that helpful. Please let us know how it goes.
Shanlarson: June 25, 2020, 9:19pm
Thanks Kristin for the response. Over the weeks my diagnosis has evolved. I started with:
Wood stasis
Heat in the stomach
liver blood def
SP Qi def.
Shao yang disharmony:
I gave her Xiao Chai hu tang. At the time she was more irritable, easily overheated. Her tongue was a little red and
stiff and smallish , teeth marks and she had very strong rib side tension on her right side and smelly diarrhea. This15/01/2024, 12:32Uterine bleeding difficult case – Qiological Community
https://forum.qiological.com/t/uterine-bleeding-difficult-case/1106/print4/6
is when I did BL+
The next treatment she was feeling more mellow and after going through her intake again it became apparent she
had a glomus. She gets stuffy in the epigastrium and eats smaller meals. Her right guan was super slippery. I
modified my formula to Ban Xia Xie Xin Tang with Chai hu.
This is when I did ST+
The third time she came in she had started spotting but was light. The stuffiness was less but still present. The
bowels were no longer diarrhea but still loose and she was still hot and wanting ice cold drinks. I modified my last
formula by adding Bai Shao, Dang Gui, Chuan Xiong and mu dan pi. This is when I did SI +
The following week still very light bleeding but it had been like that for 2 weeks. That’s when I did KID+. And on
top of this I am embarrassed to say but I followed more closely the formula her other practitioner gave her. She
kept telling me how it had worked for her in the past and I think I let it intimidate me. It’s a long formula but
basically cover your bases kind of formula.
Right after the acupuncture treatment she started to bleed heavy.
She came in 2 days later. I just gave her acupuncture. That’s when I did BL+.
The bleeding came down a bit. 2 days later she came in again.I did BL + again and decided to switch the formula. I
didn’t feel great about giving her that formula. (I could hear Sharon my head asking does this formula really match
my diagnosis) I needed to remind myself “I drive the bus!” plus it wasn’t like the formula was helping
spectacularly. Patient still was feeling hot wanting cold drinks and bleeding heavy. This is where I went back to
BL+ . And gave her Ban Xia Xia xin tang with Huang Bai, Ren dong Tang, Pu huang tan, Jing jie tan, Chun pi and
Bai Shao.
I saw her 3 days later and the bleeding was less. She no longer was craving cold drinks, no longer stuffy in the
epigastrium, her BM’s were formed and she felt less hot. Her tongue looked more pale with a red tip and peeled
patch in the upper 1/3. That’s when I did LIV+ and switched her formula one more time. My new diagnosis was Sp
Qi def, blood def and fluid damage and blood stasis…
Huang Qi, Dang Shen, E jaio, Bai Zhu, Sha ren, Huang bai Sheng di. Mu dan pi, Xian he cao, Di yu tan, Duan long
gu, Duan Mu li.
And I am pleased to say she just texted me the bleeding has significantly decreased. She only needs to change a
pad 1X a day and not more gushing. PHEW!!!
I hope that wasn’t too long winded. I had planned on discussing herbs in another forum. So Kristin you think
acupuncture wise I should have gone back to SI+. Even though I had done it once with no real results. I can
understand. Move blood to stop bleeding. And the bleeding being a real adverse result. It just felt risky. Now that
things are calming down. My plan is to do LIV+ next time I see her. Unless something is really sticking out. Or do
you think it would be time to do SI+? I now feel like I should do SI+ sometime based on such a strong adverse
result to KID+.
Thanks for your input!
KristinWisgirda #4June 25, 2020, 9:54pm15/01/2024, 12:32Uterine bleeding difficult case – Qiological Community
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Shanlarson:
I now feel like I should do SI+ sometime based on such a strong adverse result to KID+.
The subject of what to do after an adverse reaction has come up a number of times. Again and again, Toby says you
gotta do the counterbalancer. Her body told you directly that it needs SI+.
The herbal details help flesh out her picture. Since she was taking the formerly helpful stop bleeding formula, it
reinforces that the K+ really was the problem.
It sounds like the primary reason for the bleeding is excess heat in the Yangming/Shaoyang affecting the the
Kidney causing bleeding. Even though SI+ didn’t do much, the consolidating action of the K+ stopped up a system
that is having a hard time staying open through in at least the Yangming at the time (as indicated by the thirst for
cold).
Thanks for taking a considerable amount of time to write up the case from both the acupuncture and herbal sides.
You are not alone having to remind yourself that “I drive the bus!”. We all are having to deal with outside
influences and assert ourselves so we can practice in a way that we feel good about.
Shanlarson: June 25, 2020, 10:05pm
Thanks Kristin. It was a good SA’AM lesson.
Shanlarson: June 26, 2020, 1:20am
Just thinking about this further I can really see what you are saying about:
KristinWisgirda:
It sounds like the primary reason for the bleeding is excess heat in the Yangming/Shaoyang affecting the the
Kidney causing bleeding. Even though SI+ didn’t do much, the consolidating action of the K+ stopped up a
system that is having a hard time staying open through in at least the Yangming at the time (as indicated by the
thirst for cold).
Her yang ming was moving too slow for time and the shao yin fire wasn’t able to descend through yang ming.
Then I go and consolidate the SHAO YIN FIRE of the kidney. I added more fuel to the fire.
I can totally SEE that. Now strengthening SI makes so much sense. It’s a little less about the blood stasis and more
about the consolidation of the fire.15/01/2024, 12:32Uterine bleeding difficult case – Qiological Community
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KristinWisgirda: June 26, 2020, 1:13pm
Shanlarson:
It’s a little less about the blood stasis and more about the consolidation of the fire.
You can’t articulate this stuff too many times because it is the cure for the bad habit of resorting to over
simplifications like kidney stops bleeding because SI moves blood. What a super helpful case to teach all of us that
lesson!