One of the great things about reading and studying case study literature is that we are able to learn from experienced practitioners, new and unique ways of using classical formulas we may never had thought of. When first seeing this case written up under the Wu Ling San heading, I was surprised, as treating uterine bleeding with this formula would never have existed within my thought process. Initially I thought I stumbled upon a true goldmine, but after reading the case it was clear that the practitioner was merely putting more stock into the presentation, rather than the actual disease. This is essentially the bread and butter of Chinese medicine, yet so easily disregarded these days. So nothing too dramatic nor enlightening here but still an interesting case.
***A 35 year old female presented at the clinic on May 12, 1978. The patient has always been overweight and suffered with excessive menstrual bleeding. The timing of her period has always been indeterminate, with flows usually lasting longer than seven days. This afternoon she suddenly experienced acute lower abdominal pain, and violent, heavy menstrual flooding. A local hospital treated her in the emergency department and administered medicinals to stop bleeding, along with intravenous fluid injections, all to no avail. At this point she was referred to me for treatment.
Current signs and symptoms: Sallow white facial complexion, icy cold extremities, beads of sweat emanating from the head, spitting up of turbid frothy phlegm, acute lower abdominal pain, which favours palpation, a pale, tender, enlarged tongue body, with stasis macules on the edges, a white slightly greasy tongue coat, and a choppy pulse. Laboratory results were as follows: Hemoglobin 6.5g, white blood cells 5200 m3, neutrophils 65%, lymphocytes 30%, monocytes 2%.
Diagnosis: Fulminant flooding (functional uterine bleeding)
Pattern: Damp-phlegm obstructing the uterus
Treatment Principle: Boost qi, stop bleeding, free the yang, and disinhibit dampness.
Formula: The formula used was Wu Ling San (Five ingredient powder with poria), with the addition of Shai Shen 10g (Sun-dried ginseng), E Jiao 10g (melted and added to decoction), San Qi 10g (powdered and infused). 2 packages were administered.
Follow up consultation on May 14: She reported that her spirit felt awakened, her limbs now felt warm, and the bleeding had ceased. The original formula was continued for another five packages which were enough to completely resolve the bleeding and bring about a resolution to her condition.
Commentary: Along with her main symptoms, this patient was also presenting with spitting up of turbid, frothy phlegm, an enlarged tongue body, with a greasy coat, and had always been overweight, which signify the presence of damp-phlegm retention. This damp-phlegm was obstructing the uterus, and causing insecurity of the ren and chong channels, causing menstrual flooding. Wu Ling San was chosen to free the yang, and disinhibit dampness. Shai Shen, E Jiao, and San Qi were added to boost qi, nourish the blood, and stop bleeding. Therefore by simultaneously treating the root and branch of the syndrome, we are able to achieve excellent results.
(This case was translated from ‘Selected Cold Damage cases from the Clinical Experience of Famous Physicians’. Originally found in the ‘Chao Nan Journal of Traditional Chinese Medicine, 1989; (6): 19)’
Mr. Wang, male, 46 years old.
Eran Even, Ph.D., Dr. TCM. 