On July 16, 2017, a young woman was brought to the clinic by her colleague due to prolonged menstrual bleeding that would not stop.
She felt generally healthy and hadn’t taken the matter too seriously. She reported having gone diving abroad in April. Her period at the end of April was normal, but after her menstrual period began in May, the bleeding had continued without ceasing. She experienced a small amount of bleeding every day, which had persisted for over a month. She occasionally had dry stools but reported no other discomfort. On examination, her pulse was deep (chen), her tongue coating was white and greasy, her bowel and bladder functions were normal, and her appetite was good. She also mentioned, quite remarkably, that she could consciously delay her menstruation through sheer willpower — something she claimed had worked every time she tried.
I considered that the bleeding was likely caused by a disruption in the spleen and stomach qi mechanism, leading to blood stasis and obstruction. After all, she had no other symptoms — the presentation was more like an incomplete discharge of menstrual blood, complicated by the retention of dampness in the body. I therefore prescribed a modified Tao Hong Si Wu Tang (Peach Kernel and Safflower Four-Substance Decoction), with Xian He Cao (Agrimony) included as an experiential addition. In hindsight, it is difficult to say whether the improvement was due to the Agrimony or the decoction itself — but at the time, my choice of Agrimony was primarily guided by her pulse presentation.
The bleeding stopped on the third day after taking the above formula. At her follow-up visit the following week, the tongue coating remained thick and greasy and the pulse was still deep. I advised her that she would need a course of conditioning treatment and should wait until her next normal menstrual cycle before reassessing, and I prescribed the following formula.
After taking this second formula, her tongue coating showed slight changes, indicating that the pivotal mechanism was beginning to shift. I instructed her to continue with the same formula and observe the results.
中文原文 / Chinese Original
2017年7月16日，这个小姑娘因月经淋漓不尽被同事介绍一同前来就诊。
她自我感觉身体状况良好，没把这个当回事。自诉4月曾在国外进行潜水活动，4月底来月经正常，5月来月事后一直出血，每日均有少量出血，持续至今已有月余，偶尔大便干，其他无任何不适。刻诊脉沉，苔白厚腻，二便可，胃纳佳。另外，她还提到自己能依靠意志力让月经延后，屡试不爽，令人称奇。
这种出血我考虑应该是脾胃气机不顺，瘀血阻滞所致，毕竟她没有任何不适感，更像是出血没出尽，因为湿瘀阻于体内，故选用桃红四物汤加减，仙鹤草为经验用药，现在看起来就很难说清楚到底是仙鹤草的作用还是桃红四物汤的作用，但是在当时用仙鹤草更多考虑到脉象的因素。
上方服后第三天出血止，下周复诊时发现仍然舌苔厚腻，脉沉，告知应调理一段时间，等到下次月经正常后方可，遂书下方。
此方服后舌苔略有变化，说明枢机将动，守方继进，以观后效。
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