A 37-year-old woman with prolonged menstruation and a cesarean scar defect was treated with staged herbal therapy and moxibustion.

Case ID: CHC-0001

Case Summary

This case describes a 37-year-old woman who presented with prolonged menstrual bleeding following her second cesarean section. The original report documented a western medical diagnosis of a cesarean scar defect and a TCM assessment of Spleen and Kidney Qi deficiency, managed through a phased herbal approach and targeted moxibustion.

Patient Presentation

• Patient: 37-year-old female.
• Main Complaint: Menstrual periods lasting more than 10 days, followed by intermittent spotting.
• History: The patient’s symptoms began after her menstrual cycle returned following her second cesarean delivery in February 2025 and the conclusion of breastfeeding in June. She also reported abdominal discomfort, lower-back soreness, marked premenstrual irritability, bloating, and severe fatigue.

Examination and Diagnosis

• Conventional Diagnosis: An ultrasound revealed a Cesarean Scar Defect (CSD)—a 6x4mm pouch in her surgical scar where fluid was pooling, which contributed to the prolonged menstruation.
• TCM Tongue and Pulse: (Note: Detailed tongue and pulse records were omitted in the provided excerpt, but would typically be documented here).

TCM Assessment

The original practitioner interpreted the presentation as Spleen and Kidney Qi deficiency. In TCM theory, childbirth and multiple surgical procedures can significantly deplete the body’s vital energy (Qi). When Spleen Qi is insufficient, it is thought to lose its ability to “hold blood within the vessels,” leading to continuous spotting. Concurrently, Kidney Qi deficiency is traditionally associated with the presentation of lower-back soreness.

Treatment Approach

Within the TCM framework reported in the case, treatment focused on addressing the underlying pattern rather than the bleeding symptom alone. The practitioner utilized a staged treatment strategy, changing the therapeutic emphasis according to the menstrual phase.

Herbal Formulas and Modifications

• Post-Menstruation (Bu Zhong Yi Qi Tang): In TCM terminology, this formula is used to tonify and raise Central Qi. A simple way to understand this traditional concept is as supporting Qi that is considered “sinking.” It aims to strengthen the Spleen so it can properly hold the blood in place, addressing the prolonged dripping.
• Pre-Menstruation and During Menstruation (Dang Gui Shao Yao San): This formula was used in the week leading up to and during her period. It is designed to soothe the Liver, nourish blood, and manage excess dampness, directly addressing the patient’s severe premenstrual irritability and abdominal pain.
• Other Treatments (Targeted Moxibustion): Warm moxibustion (burning mugwort) was applied to specific acupoints on the lower abdomen to address internal cold and relieve pain.

Follow-Up

• February 2026 (Second Visit): At the second follow-up, her menstrual duration had decreased to seven days. Intermenstrual spotting was significantly reduced, and premenstrual mood symptoms had improved.
• May 2026 (Later Follow-Up): At the May 2026 follow-up, the source reported that her menstrual cycle had returned to its usual duration and that intermenstrual bleeding and premenstrual symptoms had resolved.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the staged treatment strategy. Rather than using the same formula throughout the entire month, the original practitioner changed the therapeutic emphasis according to timing and symptoms. By lifting energy (Qi) after the period and regulating flow before and during the period, the treatment respected the natural physiological shifts of Yin and Yang in Chinese medicine—adapting the intervention to match the body’s monthly cycle rather than employing a static approach to a dynamic condition.

What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

ChineseHerb.org version: English translation and editorial adaptation

Original source: Guangdong Provincial Hospital of Chinese Medicine (广东省中医院) / Guangdong Provincial Administration of Traditional Chinese Medicine (广东省中医药局)

Original title: 以案说医丨子宫憩室经期总拖尾？补中益气汤升阳举陷，还你干净利落的月经

Practitioner: Professor Li Xiaobin (黎小斌教授)

Publication date: June 17, 2026

Original language: Chinese

Source link: 广东省中医药局发布页面