This is a translation of a case study from a great book titled ‘A Taste of Chinese Medical Chicken Soup’ written by Dr. Xiang Hong in Beijing. This is a case study book which presents several of her own cases as well as numerous by prominent modern Beijing physicians (老医). The case I will be translating is one by professor Fan Zheng-Lun (樊正伦), a great physician who I had the pleasure of observing while in Beijing.

Pre-Menstrual headaches and heart vexation (treated by) calming the liver and clearing heat with the happy free and easy wanderer.

On July 15, 2000 it was professor Fan Zheng-Lun’s clinical day at the ‘Ping Xin Tang clinic’. A 47 year old female patient was presenting her case. Recently her menstrual cycles were arriving early and much heavier than ever with numerous large blood clots. She experienced headaches and distension in her head prior to her cycles along with heart vexation and a sore and achy low back. In addition she was seen in the Gynecology department where she was diagnosed with a uterine myoma and since menopause was approaching, surgery was unnecessary. She felt warm quite easily and found herself quite irritable prior to the cycle.
Professor Fan simultaneously felt her pulse and inspected her tongue. Only the tongues margins were red and there was a thin white coating. The tongue body was swollen with slight teeth marks on the margins. The left bar (guan) position of the pulse was wiry and the cubit (chi) weak. The right pulse had an overall slippery wiry manifestation.

Professor Fan believed this to be a case of Liver depression, Spleen vacuity with a Chong and Ren disharmony causing headaches. Therefore the treatment method would involve clearing the Liver, strengthening the Spleen and regulating the Ren and Chong vessels.
The formula administered was as follows:

(Mu) Dan Pi 9g
Chao Zhi Zi 6g
Chao Bai Zhu 9g
Dang Gui 9g
Fu Ling 9g
Cu Chai Hu 9g
Zhi Xiang Fu 9g
Gui Zhi 6g
Bai Zhi 6g
Zhi Gan Cao 6g
Man Jing Zi 9g
Chuan Xiong 6g
Tao Ren 9g
Bai Shao 12g
Chao Du Zhong 12g

7 Packages were given to be decocted in water.

The patient was explained that the basis of treatment was to regulate the cycle and therefore the formula should be taken one week prior to the start of her cycle.
A month later the patient said that after taking the weeks’ worth of herbs, her headaches and backache had clearly decreased, the menses was not as heavy and the clots were smaller. The patient was instructed to take these herbs again one week prior to her cycle in order to consolidate treatment. According to this method, taking these herbs for several months should have a positive effect on the uterine myoma as well.

This formula is a modified version of “Dan Zhi Xiao Yao San” (Moutan and Gardenia Free and Easy Wanderer powder) with “Gui Zhi Fu Ling Wan” (Cinnamon and Poria pills).
Dan Zhi Xiao Yao San is Xiao Yao San (Dang Gui, Bai Shao, Chai Hu, Huang Qin (1), Chao Bai Zhu, Zhi Gan Cao, Sheng Jiang, Bo He) with Dan Pi and Zhi Zi.
Xiao Yao San is from the ‘Imperial Grace Formulary of the Tai Ping Era’ (He Ji Ju Fang) and is a great Liver coursing, depression resolving, Spleen strengthening, blood nourishing formula. Adding Dan Pi and Zhi Zi increases its ability to clear Liver heat.
This patient had pre-menstrual vexation and headaches which are a manifestation of Liver channel depressive heat, therefore this formula was chosen.
Herbs are selected according to the pattern and re-analyzed if there is no reduction (of symptoms).

When seeing patients with uterine myomas the use of Gui Zhi Fu Ling Wan can be quite efficacious. Gui Zhi Fu Ling Wan is originally found in the 20th chapter of the \’Jin Gui Yao Lue\’ (Prescriptions from the Golden Cabinet) section on Diseases, Pulses, Patterns and Treatments of Pregnancy related (Obstetric) diseases. Gui Zhi Fu Ling Wan is a very famous and effective Gynecological formula.
Chinese medicine believes that concretions or abdominal masses are accumulations and gatherings in the abdomen becoming clots or accumulated blood creating a very typical heavy menstrual cycle with clots.
Within the formula, Gui Zhi warms and frees the vessels; Dan Pi and Tao Ren attack concretions and accumulations and break static blood. Using Fu Ling disinhibits dampness and Bai shao harmonizes the Ying (nutritive). Altogether these herbs achieve the function of breaking stasis and generating new (blood).

Generally headaches occurring prior to the menses are caused by Liver heat, while headaches occurring after the cycle are governed by blood vacuity. Clinical practice should be based on the system of treatment according to pattern identification.

(1) Huang Qin is not mentioned in the original formula. My initial assumption is that it is merely a typo, but was included in the translation in order to stay true to Dr. Xiang’s book.