Tilo Medical and Acupuncture

Menstrual Bleeding

Midcycle Bleeding

abstracted & translated by

Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, gynecology, midcycle bleeding, ovulatory bleeding, Er Zhi Wan (Two Ultimates Pills)

Midcycle bleeding is a common complaint in clinical practice and one which Chinese medicine typically deals quite well with as exemplified by the following summary of research published in China. The title of the original Chinese article is, "An Analysis of the Treatment of 32 Cases of Inermenstrual Bleeding by the Methods of Enriching Yin & Clearing Heat Compared to 30 Cases Treated with Western Medicine." This article was written by Huang Jie of the Hangzhou Municipal Infertility & Sterility Hospital in Zhejiang province. It appeared in issue #7, 2003 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) on page 288.

Cohort description

All 62 women enrolled in this study were seen as out-patients at the Chinese author's hospital in Hangzhou and all suffered from midcycle bleeding which typically lasted for 2-5 days. Their basal body temperature charts were biphasic, and bleeding coincided with a rise in body temperature at ovulation. Ultrasonography revealed no abnormalities in the uterus or adnexa of these women. The ages of these women ranged from 21-38 years, with a median age of 31 ± 1.24 years. The shortest duration of bleeding was two days and the longest was seven days, with a mean duration of 3 ± 0.14 days. These women were randomly divided into two groups, a treatment group of 32 and a comparison group of 30. There were no significant statistical differences between these two groups in terms of age or duration of bleeding.

Treatment method

The treatment group received Er Zhi Wan Jia Wei (Two Ultimates Pills with Added Flavors): Fructus Ligustri Lucidi ( Nu Zhen Zi ), Herba Ecliptae Prostratae ( Han Lian Cao ), Gelatinum Corii Asini ( E Jiao ), and uncooked Radix Rehmanniae Glutinosae ( Sheng Di ), 15g each, Fructus Lycii Chinensis ( Gou Qi Zi ), 12g, Radix Albus Paeoniae Lactiflorae ( Bai Shao ), Cortex Phellodendri ( Huang Bai ), and Cortex Radicis Moutan ( Dan Pi ), 10g each, and Rhizoma Cyperi Rotundi ( Xian gFu ), 9g. If there was accompanying low back and knee soreness and limpness, fear of cold, and loose stools, Semen Cuscutae Chinensis ( Tu Si Zi ), Rhizoma Cimicifugae ( Sheng Ma ), and Radix Dioscoreae Oppositae ( Shan Yao ) were added. If bleeding was profuse, Radix Sanguisorbae ( Di Yu ), uncooked Plastrum Testudinis ( Gui Ban ), uncooked Pollen Typhae ( Pu Huang ), and Radix Rubiae Cordifoliae ( Qian Cao Gen ) were added. These medicinals were started 2-3 days after the cessation of menstruation. It is assumed that the patients in this group eceived one packet of these medicinals per day decocted in water and administered internally. The comparison group received 0.2g of Holoperidol Gelatin Capsules TID as well as 0.5g of Hemostatic Aromatic Acid ( Zhi Xue Fang Suan ) TID. Seven days equaled one course of treatment for both groups.

Treatment outcomes

Cure was defined as cessation of midcycle bleeding with no recurrence for three menstrual cycles of more. Improvement was defined as cessation of midcycle bleeding but recurrence of a small amount of bleeding within three months accompanied by reduced symptoms. No cure meant that the bleeding increased or there was no obvious change in accompanying symptoms. Based on these criteria, after three courses of treatment, seven out of 32 cases on the treatment group were judged cured, 18 were improved, and seven got no effect, for a total effectiveness rate of 78.13%. In the comparison group, three cases were cured, 12 improved, and 15 got no effect, for a total effectiveness rate of only 50%.

Discussion

According to Chinese medical theory, by the end of menstruation, the sea of blood is empty and vacuous. Then from the end of menstruation to just prior to ovulation, yin is growing and blood is being replenished. When yin reaches its apogee at midcycle, it transforms into yang. This basically coincides with ovulation. Since yin controls yang, if yin is sufficient at this time to transform into yang but insufficient to control yang, yang may become hyperactive. Thus vacuity heat may damage the chong and ren and cause the blood to move frenetically outside its vessels. In this case, Dr. Huang believes it is appropriate to mainly supplement the kidneys and nourish yin, clear heat and stop bleeding. Therefore, within the above formula, Han Lian Cao stops bleeding and Nu Zhen Zi clears vacuity heat. Sheng Di enriches yin and cools the blood. Dan Pi and Huang Bai likewise clear heat and cool the blood. E Jiao, Bai Shao , and Gou Qi Zi nourish the blood and stop bleeding, while Xiang Fu regulates the qi and stops bleeding. When all these medicinals are used together, Dr. Huang says their effect is to make the yin essence full and sufficient. Thus yin is level and yang is secreted, vacuity fire is automatically extinguished, and bleeding automatically stops.

While this protocol is an effective one for some patients, I remind readers that midcycle bleeding may also be due to transformation of depressive heat. In that case, the treatment principles are to course the liver and resolve depression, clear heat and stop bleeding using a formula more like Dan Zhi Xiao Yao San (Moutan & Gardenia Rambling Powder) or Wen Qing Yin (Warming & Clearing Drink).

For more information on the Chinese medical treatment of midcycle bleeding, see Bob Flaws's A Handbook of Menstrual Diseases in Chinese Medicine available from Blue Poppy Press.