Ms. Lin was 29 when she first walked into the clinic in September 2023. She was a graphic designer who worked long hours and often skipped meals. Her main complaint was menstrual irregularity — her cycles had become unpredictable over the past year, sometimes arriving at 20 days, sometimes not until day 45.
Her flow was light for the first two days, then became heavy with dark clots. She felt exhausted before each period and experienced dull aching in her lower abdomen that improved slightly with warmth and pressure.
“I have been on birth control pills before,” she said. “They regulated everything, but I felt emotionally flat. I want to try a different approach.”
Her menstrual history alone suggested a stagnation pattern — the dark clots, the pain. Many practitioners would have reached for blood-invigorating herbs immediately. But the full clinical picture told a more nuanced story.
Additional symptoms included:
The diagnosis was qi deficiency with blood stasis — a pattern where insufficient qi fails to move the blood properly, leading to stagnation. The clots and pain were real, but they were secondary. The primary problem was deficiency.
In TCM gynecology, this is a common and easily misunderstood pattern. The classic fu ke (gynecology) text by Fu Qingzhu (Ming dynasty) emphasizes that “women’s diseases are mostly rooted in qi and blood.” But there is a critical distinction between treating the blood and treating the qi that governs it.
Qi is the commander of blood. It drives circulation. When qi is strong and flowing, blood moves smoothly. When qi is weak, blood stagnates — not because there is too much of it, but because there is not enough force to keep it moving.
This is why simply prescribing blood-invigorating herbs — like Dan shen, Chuan xiong, or Tao ren — would have been counterproductive in Ms. Lin’s case. Invigorating blood without supporting qi is like trying to push water through a pipe while the pump is failing. You might move some fluid, but you will also strain the system.
The correct approach: supplement qi first, then gently invigorate blood.
I prescribed a modified Gui Ling Si Wu Tang (Four-Substance Decoction with Atractylodes and Poria), which combines qi-tonifying herbs with gentle blood-nourishing and blood-moving ingredients:
The high dose of Huang qi (30g) was deliberate. This herb is one of the most potent qi tonics in the pharmacopeia. Modern research has shown that Huang qi can improve uterine microcirculation and enhance immune function — effects that align with its traditional role of lifting qi and consolidating the exterior.
E jiao was included because her bleeding tended to be heavy once it started. This gelatin, derived from donkey hide, is a hemostatic that also nourishes blood — a dual action that makes it uniquely suited for heavy menstrual bleeding with an underlying deficiency pattern.
I instructed Ms. Lin to take the formula in two phases:
Phase 1 (days 5–14 of the cycle): Full formula as above, focusing on building qi and nourishing blood.
Phase 2 (days 15–28 or until menstruation): Reduce E jiao and Shu di huang, add Xiang fu (Cyperus) 10g and Yan hu suo (Corydalis) 10g to promote blood movement and prevent premenstrual pain.
This two-phase approach is common in TCM gynecology. The follicular phase is a time of building; the luteal phase is a time of moving.
After two months of treatment, Ms. Lin reported that her cycle had shortened to 30 days and her flow was more even — still with some dark color but significantly fewer clots. The premenstrual fatigue had improved noticeably.
By the fourth month, her cycles were regular at 28–29 days. The clots had nearly disappeared. Her energy levels were better overall — she no longer felt the need for an afternoon nap.
Her tongue had changed as well. The teeth marks were less pronounced, and the color had shifted from pale to a healthier pink.
What makes this case instructive is the diagnostic decision to prioritize qi deficiency over blood stasis. In clinic, it is tempting to focus on the most dramatic symptom — the dark clots and pain — and treat the stasis directly. But experienced practitioners know that stagnation in the context of deficiency requires a different strategy.
As the Neijing states: “When qi is sufficient, blood circulates naturally. When qi is deficient, blood stagnates of its own accord.”
This principle extends beyond gynecology. In chronic pain, in skin disorders, in digestive complaints — whenever stasis coexists with deficiency, supplementing qi (or yin, or yang, depending on the pattern) must come first or at least simultaneously. Otherwise, you are trying to clear a traffic jam by honking louder instead of fixing the engine.
Ms. Lin’s case is a reminder that in TCM, the most visible symptom is not always the most important one. Sometimes the quiet deficiency is the true driver, and the dramatic stagnation is merely its consequence.
Professor Zhao Hanqing is a senior TCM practitioner at Beijing Heniantang, specializing in traditional Chinese medicine theory, classical formula research, and TCM informatics. With years of clinical experience and academic dedication, Professor Zhao bridges the wisdom of ancient Chinese medical classics with modern computational approaches to advance the field of TCM knowledge systems.
Disclaimer: This article is presented for educational and informational purposes. Individual results may vary. Always consult qualified healthcare providers before beginning any treatment.
发表回复