A 35-year-old woman with a 10-year history of premenstrual stomach pain and chronic diarrhea was managed using a Liver-soothing and menstruation-regulating herbal strategy.

Case ID: CHC-0011

Case Summary

This case describes a 35-year-old woman who presented with a 10-year history of epigastric pain that predictably flared up just before her menstrual periods, along with chronic diarrhea. The original report documented a conventional diagnosis of chronic superficial gastritis with erosion and a TCM assessment of Liver Qi stagnation. The practitioner managed the condition by treating the gynecological root cause, using a Liver-soothing herbal approach that successfully resolved both the digestive and menstrual symptoms.

Patient Presentation

• Patient: 35-year-old female.
• Main Complaint: Epigastric pain for 10 years and chronic diarrhea for over 5 years.
• History: The patient experienced epigastric pain that consistently began two days prior to menstruation, accompanied by breast distension, irritability, and dry stools. Additionally, she reported a five-year history of diarrhea, passing yellow, loose stools 3 to 5 times a day with occasional mucus and abdominal pain. Her menstrual cycle was regular, but the blood flow during the first five days was scanty and difficult to pass. Her general sleep and urination were normal, and she had no history of allergies or toxic exposure.

Examination and Diagnosis

• Conventional Diagnosis: Chronic superficial gastritis with erosion. Physical examination of the abdomen was unremarkable (flat, soft, no tenderness or rebound pain, negative Murphy’s and McBurney’s signs).
• TCM Tongue and Pulse: The tongue had red edges and a red tip with a thin, yellow coating. The pulse was stringy (弦).

TCM Assessment

The original practitioner interpreted the presentation as Epigastric Pain driven by Liver Qi stagnation (肝气郁结).

According to the holistic framework of yin and yang Chinese Medicine, the Liver is responsible for maintaining the smooth, unobstructed flow of Qi and emotions, as well as storing blood for menstruation. In this patient, the underlying erosive gastritis made her stomach physically vulnerable. However, the exact timing of her pain points to the Liver. As her menstrual period approached, natural physiological shifts caused her Liver Qi to become severely stagnant. This stagnant energy “overacted” on or invaded the Stomach, acting as the precise trigger for her severe premenstrual epigastric pain. The stringy pulse, irritability, red tongue edges, and breast distension are classic clinical markers of this Liver Qi blockage.

Treatment Approach

The primary treatment principle was to soothe the Liver and regulate menstruation (疏肝调经). The strategy aimed to treat the digestive complaint by addressing the energetic and gynecological root cause—a classical TCM concept known as “treating different diseases with the same method” (异病同治).

Herbal Formulas and Modifications

• Formula Prescribed (May 5, 2020): A customized formula based on the principles of clearing Liver stagnation and nourishing blood, strongly resembling the classical Danzhi Xiaoyao San.
• Action and Composition:
  • Soothing the Liver and Clearing Heat: Chai Hu (Bupleurum), Xiang Fu (Cyperus), and Mei Gui Hua (Rose) strongly soothe Liver Qi to relieve emotional and physical tension. Zhi Zi (Gardenia) and Dan Pi (Moutan) clear the localized heat generated by the prolonged stagnation (indicated by the red tongue edges and irritability).
  • Nourishing Blood and Regulating Menses: Dang Gui (Angelica), Bai Shao (White Peony), Yi Mu Cao (Motherwort), and Niu Xi (Achyranthes) nourish the Liver blood, invigorate circulation, and ensure a smooth menstrual flow, directly addressing her scanty periods.
  • Strengthening the Spleen and Stomach: Bai Zhu (Atractylodes), Fu Ling (Poria), and Zhi Gan Cao (Licorice) fortify the digestive system to stop the chronic diarrhea and protect the Stomach from further Liver Qi invasion.

Follow-Up

• May 25, 2020 (Second Visit): The source reported that her menstrual period arrived on schedule with a normal, smooth flow. Notably, the premenstrual epigastric pain did not occur at all. The practitioner instructed her to take 7 doses of this formula prior to each menstrual cycle for six months to consolidate the results.
• Summer 2020: During a subsequent visit accompanying a family member, the patient actively reported to the practitioner that her epigastric pain had completely resolved and had not returned since the treatment.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the clear demonstration of treating a structural digestive disorder through a gynecological pathway. The patient suffered from epigastric pain for 10 years and carried a Western diagnosis of erosive gastritis. However, the original practitioner prioritized the strict timing of the pain (two days before menstruation) and the accompanying systemic signs.

Rather than utilizing standard antacids or relying heavily on Stomach-focused herbs, the practitioner aimed directly at the Liver. By smoothing the Liver Qi and regulating the menstrual flow, the pathological mechanism of “Liver invading the Stomach” was dismantled. As the original editorial notes point out, this highlights the flexibility of TCM pattern differentiation: identical diseases (gastritis) require entirely different treatments if the underlying mechanisms (in this case, menstrual Liver Qi stagnation) differ.

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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

• Original source: Dongguan Hospital of Traditional Chinese Medicine (东莞市中医院) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】董明国：疏肝调经法治疗胃脘痛案
• Practitioner: Professor Dong Mingguo (董明国)
• Publication date: October 31, 2024
• Original language: Chinese
• Source link: View original page
• ChineseHerb.org version: English translation and editorial adaptation