A 37-year-old woman with a history of prolonged, heavy menstrual bleeding who declined a surgical D&C was managed using a Qi-tonifying and blood-invigorating herbal strategy.

Case ID: CHC-0031

Case Summary

This case describes a 37-year-old woman who presented with a multi-month history of irregular menstruation, characterized by prolonged periods, heavy bleeding, and continuous dribbling. The original report documented a conventional diagnosis of functional uterine bleeding (for which a D&C was recommended but refused) and a TCM assessment of Benglou (Flooding and Spotting) driven by Qi deficiency and Blood stasis. The patient was managed through a dynamic herbal approach that first prioritized lifting Spleen Qi to stop the bleeding, followed by deep Kidney and blood tonification.

Patient Presentation

• Patient: 37-year-old female (Surname: Zhu).
• Main Complaint: Prolonged menstrual bleeding with heavy volume and mild abdominal pain lasting for several months.
• History: The patient sought consultation on April 11, 2023. Over the previous months, she experienced severe menstrual irregularities where her bleeding was continuous, pale in color, thin in texture, and mixed with blood clots. Conventional medical evaluations diagnosed her with functional uterine bleeding and recommended a diagnostic dilation and curettage (D&C). Fearing the potential side effects and trauma of the procedure, she opted for TCM. Associated systemic symptoms included severe physical fatigue, shortness of breath, and a reluctance to speak (classic signs of severe Qi depletion).

Examination and Diagnosis

• Conventional Diagnosis: Functional uterine bleeding.
• TCM Tongue and Pulse: The tongue was pale with a thin, white coating. The pulse was fine and weak (脉细弱).

TCM Assessment

The original practitioner interpreted the presentation as Benglou (Flooding and Spotting) driven by Qi Deficiency and Blood Stasis (崩漏 – 气虚血瘀证).

According to the holistic principles of yin and yang Chinese Medicine Qi is considered the “commander of blood.” One of the primary functions of healthy Spleen Qi is to secure and hold blood within the vessels. The original report noted that the patient’s profound Qi deficiency (evidenced by her severe fatigue, shortness of breath, pale tongue, and weak pulse) meant her body literally lacked the energy to stop the bleeding.

Concurrently, the presence of blood clots and abdominal pain indicated that this chronic loss of fresh blood had led to Blood Stasis. In TCM gynecology, if old, stagnant blood is not cleared away, new blood cannot find its proper place in the vessels, leading to continuous, endless dribbling.

Treatment Approach

The primary treatment principle was to benefit Qi, secure the blood, and invigorate blood to resolve stasis (益气固摄，活血化瘀). The practitioner strictly avoided simply prescribing heavy, astringent “clotting” herbs, opting instead to rebuild the Spleen’s holding power while actively clearing the stagnant clots.

Herbal Formulas and Modifications

• Initial Formula (April 11, 2023): The practitioner prescribed a modified version of the classic Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
  • Tonifying Spleen Qi to Secure Blood: Huang Qi (Astragalus, 15g), Bai Zhu (Atractylodes, 15g), and Fu Ling (Poria, 20g) formed the core to strongly rebuild the Spleen’s energy, directly treating the root cause of the uncontrolled bleeding.
  • Moving Blood and Generating the New: Gan Yi Mu Cao (Dried Motherwort, 30g) and Qian Cao (Madder Root, 15g) were heavily utilized. These herbs perfectly fit the strategy of “invigorating blood to stop bleeding”—they clear out the stagnant clots (stasis) so that the blood can return to its normal pathways.
  • Regulating Qi Dynamic: Zhi Shi (Immature Bitter Orange, 10g) and Bei Chai Hu (Bupleurum, 10g) were paired. Combined with Huang Qi, they create a dynamic of “one tonifying, one draining,” ensuring the heavy Qi tonics do not create stagnation. Gan Cao Pian (10g) harmonized the decoction.
• Modification (Second Visit – April 28, 2023): With the bleeding controlled, the practitioner shifted the focus toward deeper restorative tonification to address her lingering fatigue.
  • Yin Yang Huo (Epimedium, 30g) and Jiu Nv Zhen Zi (Wine-treated Ligustrum, 30g) were added to tonify Kidney essence.
  • Ji Xue Teng (Spatholobus, 15g) and Gui Zhi (Cinnamon Twig, 10g) were added to warm the meridians and promote circulation.
  • Dang Shen Pian (Codonopsis, 20g) was introduced to boost the Qi-tonifying power, while Chi Shao (10g) and Bai Shao (10g) were paired to nourish the blood and soften the Liver.

Follow-Up

• April 28, 2023 (Second Visit): After consuming six daily doses of the initial decoction, the source reported a highly successful outcome. The patient’s menstrual bleeding was significantly reduced, and her abdominal pain was completely relieved. Because she still experienced systemic fatigue (indicating that her deep Qi depletion was not yet fully corrected), the practitioner adjusted the formula to heavily tonify her Spleen, Kidneys, and Blood, prescribing an additional seven doses.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is its demonstration of the TCM approach to treating acute, heavy menstrual bleeding without surgical intervention. Dysfunctional uterine bleeding can be frightening, and the conventional recommendation of a D&C physically scrapes the uterine lining to stop the cycle.

The original practitioner recognized that the bleeding was a symptom of severe “engine failure” (Spleen Qi deficiency). A fascinating aspect of the prescription is the heavy use of Yi Mu Cao (Motherwort) and Qian Cao during an active bleeding phase. Counterintuitively, these are blood-moving herbs. The practitioner applied the ancient wisdom that if you try to stop bleeding solely with heavy astringents while stasis (clots) is still present, the bleeding will never fully resolve. By pairing Qi-lifting herbs (Huang Qi) with blood-moving herbs, the treatment successfully healed the patient from the inside out, allowing her to avoid surgery.

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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: Guangdong Provincial Administration of Traditional Chinese Medicine / Beijing University of Chinese Medicine Shenzhen Hospital (Longgang)
• Original title: 【以案说医】王进东：崩漏不止气血伤，固本培元血渐昌
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 11, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation