A 45-year-old woman with a two-year history of severe fatigue, poor sleep, and dysmenorrhea with blood clots was managed using a phased herbal strategy adjusting to her menstrual cycle.

Case ID: CHC-0022

Case Summary

This case describes a 45-year-old woman who presented with a two-year history of unexplained exhaustion, sleep disturbances, and painful menstruation. The original report documented a Western medical diagnosis of chronic fatigue syndrome (CFS) and a TCM assessment of Consumptive Disease (Xu Lao) driven by Spleen and Kidney Qi deficiency complicated by Blood stasis. The patient was managed through a dynamic herbal approach that prioritized blood-moving herbs before her period and transitioned to deep tonification after her period.

Patient Presentation

• Patient: 45-year-old female.
• Main Complaint: Severe fatigue, physical exhaustion, and poor sleep for two years.
• History: The patient reported a two-year history of fatigue and heavy limbs without any obvious trigger. Her sleep was poor, characterized by difficulty staying asleep and frequent awakenings. Associated symptoms included dry eyes and dry stools, though her appetite and urination were normal. Her menstrual cycle was relatively regular, but the menstrual blood was dark and contained clots, accompanied by lower back soreness and abdominal pain during her period. Her last menstrual period prior to the first consultation began in late August 2022.

Examination and Diagnosis

• Conventional Diagnosis: Chronic Fatigue Syndrome.
• TCM Tongue and Pulse: The tongue was pale red with a thin coating, and the sublingual veins were visibly thickened and engorged. The pulse was fine (脉细).

TCM Assessment

The original practitioner interpreted the presentation as Consumptive Disease driven by Spleen and Kidney Deficiency with Blood Stasis (虚劳 – 气虚血瘀证).

Within the foundational framework of yin and yang Chinese Medicine, the Kidney is considered the root of congenital essence, while the Spleen is the postnatal source of Qi and blood production. The original report noted that a deficiency in Kidney essence led directly to her lower back soreness and profound fatigue. Meanwhile, a weakened Spleen failed to nourish her muscles (causing heavy limbs) and failed to produce enough blood to anchor her mind at night (resulting in poor sleep).

Crucially, because Qi acts as the motive force that pushes blood through the vessels, her chronic Qi deficiency led to sluggish circulation. Over two years, this sluggishness developed into physical Blood Stasis—objectively confirmed by her dark menstrual blood with clots and her engorged sublingual veins.

Treatment Approach

The primary treatment principle was to tonify the Spleen, benefit the Kidneys, warm the meridians, and invigorate blood (补脾益肾，温经活血). Because the patient presented with a complex mix of deficiency (lack of Qi/Essence) and excess (Blood Stasis), and because her first visit coincided with her pre-menstrual phase, the practitioner utilized a carefully staged approach based on her menstrual cycle.

Herbal Formulas and Modifications

• Stage 1: Pre-Menstrual Phase (Initial Visit – September 19, 2022): The focus was heavily on unblocking stasis to prepare for menstruation.
  • The practitioner prescribed a modified combination of Taohong Siwu Tang (Peach Red Four-Substance Decoction) and Si Junzi Tang (Four Gentlemen Decoction).
  • Dang Shen, Fu Ling, and Gan Cao fortified Spleen Qi.
  • Tao Ren, Hong Hua, Dang Gui, and Bai Shao strongly nourished and invigorated blood to clear the uterine stasis.
  • Gui Zhi and Xiao Hui Xiang were added to warm the meridians and stop the abdominal pain, while Du Zhong tonified the Kidneys to address the back soreness.
• Stage 2: Post-Menstrual Phase (Second Visit – October 11, 2022): Following her period, the therapeutic focus shifted toward deep restorative tonification.
  • The practitioner prescribed a modified combination of Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) and Si Junzi Tang.
  • Shu Di Huang, Shan Yu Rou, Nv Zhen Zi, and Du Zhong were heavily utilized to nourish Kidney Yin and Liver blood to replenish what was lost during menstruation.
  • Huang Qi and Dang Shen were used to strongly boost Spleen Qi to resolve the fatigue.
  • Small amounts of Tao Ren and Hong Hua were retained to maintain healthy micro-circulation.

Follow-Up

• October 11, 2022 (Second Visit): The source reported that after the first course of medicine, the patient’s fatigue had lessened, and her bowel movements became smoother. She had a menstrual period on September 27, during which her abdominal pain was notably reduced.
• Long-Term Outcome: After continuously taking the dynamically adjusted formulas for two months, the patient’s severe fatigue and exhaustion basically disappeared. Her sleep quality improved significantly, and both her bowel movements and urination were fully regulated.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the sophisticated integration of chronic disease management with gynecological timing. Chronic Fatigue Syndrome is highly refractory, and it is common to simply prescribe heavy tonics like Ginseng or Astragalus.

However, the original practitioner recognized that the patient’s Qi deficiency had created a secondary physical blockage (Blood Stasis). Simply pumping the body with tonics while the meridians are blocked often leads to internal heat and aggravation. By strictly timing the treatment to her menstrual cycle—aggressively moving blood and warming the uterus right before her period, and then heavily tonifying the Spleen and Kidneys right after—the practitioner effectively cleared the structural blockage first, allowing the restorative Qi tonics to properly rebuild her energy levels.

---

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: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：气虚血瘀劳病缠，补脾益肾血自安]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 20, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation