A 29-year-old woman with severe menstrual pain, blood clots, and emotional irritability was managed using a staged herbal strategy to invigorate blood, move Qi, and clear localized heat.

Case ID: CHC-0018

Case Summary

This case describes a 29-year-old woman who presented with severe dysmenorrhea characterized by large blood clots and sharp abdominal pain. The original report documented a conventional diagnosis of dysmenorrhea and a TCM assessment of Blood Stasis Obstruction. The patient was managed through a dynamic herbal approach that vigorously moved blood during her menstrual phase, followed by a tonifying strategy post-menstruation to rebuild her foundational energy.

Patient Presentation

• Patient: 29-year-old female.
• Main Complaint: Severe menstrual pain with numerous blood clots.
• History: The patient sought consultation on March 10, 2024, reporting significant pain during her menstrual periods that actively worsened when pressure was applied to her abdomen (a clinical sign of “excess” pathology). She also reported being chronically prone to feelings of anger and frustration. Her general diet and sleep were normal. Her last menstrual period began on February 21, 2024.

Examination and Diagnosis

• Conventional Diagnosis: Dysmenorrhea.
• TCM Tongue and Pulse: The tongue was dark red with a slightly yellow coating. The pulse was deep and choppy (沉涩).

TCM Assessment

The original practitioner interpreted the presentation as Abdominal Pain during Menstruation driven by Blood Stasis Obstruction (经行腹痛 – 瘀血阻滞证).

According to the principles of Yin and Yang Chinese Medicine, physical pain is often the direct result of obstructed energy and blood circulation—”where there is no free flow, there is pain.” In this patient, a habitual tendency toward anger caused Liver Qi to stagnate, which subsequently prevented the blood from moving smoothly through the uterus. This stagnant blood formed physical clots, causing sharp pain that rejected pressure. Furthermore, the dark red tongue and slightly yellow coating provided objective evidence that this long-standing stasis had begun to generate localized internal heat, complicating the pathological picture.

Treatment Approach

The primary treatment principle was to invigorate blood, resolve stasis, move Qi, and stop pain (活血化瘀，行气止痛). The practitioner utilized a strategy that combined both warming and cooling herbs to break the stasis without exacerbating the underlying heat.

Herbal Formulas and Modifications

• Initial Formula (During/Approaching Menses): A 13-herb decoction was prescribed to aggressively unblock the meridians.
  • Moving Blood and Warming Channels: Gui Zhi (Cinnamon Twig) and Yi Mu Cao (Motherwort) served as the chief herbs to warm the vessels and regulate menstruation. Heavy blood-moving herbs including Tao Ren (Peach Kernel), Hong Hua (Safflower), Ji Xue Teng (Spatholobus), and Dang Gui (Angelica) were added to physically break down the blood clots.
  • Regulating Qi and Stopping Pain: Chai Hu (Bupleurum), Yuan Hu (Corydalis), Xiao Hui Xiang (Fennel), and Jiu Chuan Xiong (Wine-prepared Ligusticum) were utilized to soothe the emotional Liver Qi stagnation and provide strong analgesic effects.
  • Clearing Stasis-Heat: Huang Qin (Scutellaria) and Chao Bai Shao (White Peony) were strategically included. Huang Qin is bitter and cold, used to clear the heat generated by the prolonged stasis, while Bai Shao relieves smooth muscle spasms and protects Yin fluids from the drying effects of the other warming herbs.
• Modification (Post-Menstruation – March 22, 2024): Once the menstrual period ended and the stasis was cleared, the practitioner dramatically shifted the formula. The heavy blood-breakers (Tao Ren, Hong Hua, Jiu Chuan Xiong, Huang Qin, Xiao Hui Xiang) were removed. The focus shifted entirely to tonifying Qi and Yang to rebuild the body, adding Yin Yang Huo (Epimedium, 30g), Huang Qi (Astragalus, 15g), Bai Zhu (Atractylodes, 15g), and Fu Ling (Poria, 20g).

Follow-Up

• March 22, 2024 (Second Visit): The source reported that during the subsequent menstrual period, the patient experienced a significant reduction in pain, and the presence of blood clots visibly decreased. The treatment successfully transitioned into the post-menstrual restorative phase.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the sophisticated management of conflicting temperatures (cold/warm) within a stasis presentation. Blood stasis in the uterus is traditionally treated with warming herbs (like Gui Zhi and Xiao Hui Xiang) to melt the stagnation, much like melting ice.

However, the original practitioner recognized from the patient’s dark red tongue and yellow coating that the chronic stasis had already generated internal heat. Using only warming herbs would have worsened this heat and potentially caused heavy bleeding. By pairing warming blood-invigorators with cooling herbs like Huang Qin and Bai Shao, the practitioner successfully broke the stasis and cleared the heat simultaneously, without damaging the patient’s foundational Yin and blood. Additionally, the rapid shift to tonifying herbs (Yin Yang Huo, Huang Qi) immediately after the period demonstrates the classical TCM strategy of adapting treatment strictly according to the physiological phases of the menstrual cycle.

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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: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】王进东：瘀滞痛经愁绪绕，活血理气忧愁消
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 24, 2024
• Original language: Chinese
• Source link: View original page
• ChineseHerb.org version: English translation and editorial adaptation