Ye Tian Shi's Differentiation and Treatment of Painful Menstruation
Abstract of a Translated Article on Ye Tian Shi's
Differentiation and Treatment of Painful Menstruation
Translated by David McGraw
This article attempts an "approximately complete" overview of the treatment methods and formulas used by Ye Tian Shi to treat painful menstruation. According to the article, Ye Tian Shi's primary strategy is to open / free (tong). The medicinals he employs most often in basic patterns are Chuan Lian Zi, Shan Zha, Dang Gui, Yan Hu Suo, and Ze Lan. When there is cold in the pattern he is most likely to include Xiao Hui Xiang and Rou Gui, and when there is heat, Dan Pi and Bai Shao. The article then details painful menstruation patterns and treatment primarily distinguished by location of pain and at what point during a woman's period the pain occurs.
The first pattern listed is abdominal pain that occurs before the menses which results from astringed blood failing to move, and is treated with Tong Jing Tang (Free the Menses Decoction) which contains Shu Di, Dang Gui, Chuan Xiong, Bai Shao, Chuan Lian Zi, Xiao Hui Xiang, Bing Lang, Yan Hu Suo, and Mu Xiang. If when the menses arrives there is low back and abdominal pain, this is due to qi obstruction and blood repletion. In this case the treatment is with Tao Ren Tang, which contains Dang Gui Wei, Chi Shao, Sheng Di, Xiang Fu, Dan Pi, Hong Hua, Yan Hu Suo and Tao Ren. If when the menses arrives there is pain in the low abdomen, the treatment is to powder Yan Hu Suo and charred hair, then to take with wine. Finally, abdominal pain that occurs after the menses is finished is ascribed to stagnation within deficiency, and the treatment is to take Jia Wei Ba Wu Tang, containing Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Shu Di, Dang Gui, Bai Shao, Chuan Xiong, Mu Xiang, Xiang Fu, Qing Pi, Sheng Jiang and Da Zao.
The author of the article then states that in clinic a pattern of painful menstruation due to qi obstruction, blood stasis and cold congealed in the uterus is often seen (it is unclear from the article if Ye Tian Shi writes about this pattern, or if this is a note from the author's own observations). The article discusses the effectiveness of formulas created by Wang Qing Ren, a physician who practiced medicine years after the death of Ye Tian Shi, for these patterns. The formulas are Ge Xia Zhu Yu Tang and Shao Fu Zhu Yu Tang, either of which, the author states, can be used well for qi and blood stagnation with cold in the uterus.
Referring again to Ye Tian Shi, the author next describes that in addition to freeing method, Dr Ye emphasizes treating disease of the extraordinary vessels, in particular the Ren and Chong Mai, and Yin and Yang imbalance. In this case, Ye advocates the method of freeing Yang and preserving Yin. He uses herbs such as Sheng Di, Tian Dong, Dang Gui, Bu Gu Zhi, and Bai Zi Ren to preserve Yin; Rou Cong Rong, Xiao Hui Xiang, Chuan Jiao, Lu Jiao Shuang, Zi Shi Yin to open Yang; Shan Zha, Niu Xi, Fu Ling to free the menses.
The next couple of sections detail the "Differential Treatment of Normal Patterns", divided into categories of repletion and deficiency. Only the raw basic presentations for each pattern are included, despite that up to four different formulas may be presented for treatment, each with its own different emphasis. In all there are four repletion patterns and two deficiency patterns. The repletion patterns mostly center upon stagnation of blood and qi and the various effects this may have depending upon where this occurs. The deficiency patterns are more complex. The first involves disease of the Chong and Ren Mai, Yin and Yang, and the specific presentations of this pattern are stated in greater depth as many of the symptoms may appear to be from repletion. The author includes warnings not to treat these as such.
The first repletion pattern is Qi and Blood stagnation Bi, with symptoms of premenstrual abdominal pain, abdominal rumbling with occasional diarrhea, and a rough pulse. Treatment is to rectify qi and harmonize blood. The formula to use in this case is Chuan Xiong Xiang Fu Fang, containing Chuan Xiong, Dang Gui, Xiang Fu, Mu Xiang, Shan Zha and Fu Ling, and one is told to consider adding Xiao Hui Xiang, Wu Yao, Ze Lan, or Dan Shen. Another formula used to treat this pattern is Dang Gui Shan Zha Fang, containing Dang Gui, Shan Zha Tan, Wu Zei Gu (Hai Piao Xiao), Xiang Fu, Ai Ye Tan, Yan Hu Suo. A third formula given is Shan Zha Xiang Fu Fang (Shan Zha, Xiang Fu, Yan Hu Suo, Dang Gui, Qing Pi, San Leng, E Zhu, Niu Xi, Chuan Lian Zi, Ze Lan, Rou Gui, Xiao Hui Xiang, and Cong Bai Zhi Wan. If there is simultaneously cold and heat in the pattern then Sheng Di Dan Pi Fang is used, containing Sheng Di, Dan Pi, Zhi Mu, Tian Hua Fen, Bie Jia, Ze Lan).
The second repletion pattern is Liver heat reverse flow, with symptoms during the menses of sinews pulling abdominal pain, often with heart pain and dry retching. Treatment involves diffusing and opening the qi and blood and regulating menstruation, avoiding warming and drying. The formula used to treat this is Jia Wei Jin Ling Zi San, containing Chuan Lian Zi, Dan Pi, Shan Zha, Hu Lian, Yan Hu Suo, Ze Lan, Gui Ban, Bai Shao Yao. In a variation, if during the onset of the menses there is qi "attacking and striking, with right shoulder pain and flaccidity, and a rapid pulse, the treatment is to clear qi aspect heat and dryness. The formula to use is Huang Qin Bai Yao Fang, containing Huang Qin, Bai Shao Yao, Hei Zhan Zhi Zi, Gou Teng, Fu Ling, Dang Gui Wei, Xiang Fu, Chong Wei Zi, and Sang Zhi.
The third repletion pattern is blood bind with depressed heat. Symptoms are late period with abdominal pain, wind macules and disquieted bound blood. The treatment is to free and disinhibit. The formula is Liang Ge San minus Mang Xiao, adding Dan Pi and Chi Shao, (Da Huang, Huang Qin, Shan Zha, Lian Qiao, Bo He, Gan Cao, Dan Pi, Chi Shao).
The fourth repletion pattern is blood stasis congealed and not smooth, with symptoms of menses flowing for four days without end, spontaneous heart and chest pain, and distention reaching the lower abdomen. Treatment aims to acridly diffuse bound blood using Jiu Bai Tao Ren Fang, which contains Jiu Bai Zhi, Tao Ren, Yan Hu Suo, Xiao Hui Xiang, Dang Gui Wei, and Chuan Lian Zi.
The first deficiency pattern is Yin and Yang not balanced, involving disease of the Chong and Ren Mai with symptoms of dark purple menstrual flow, arriving with noise, contraction and tightening of the vessels and luo causing pain. After menstruation there is vaginal discharge without stop, the upper body experiences upbearing of fire, and the lower jiao has coldness that penetrates to the bones, the patient's body becomes thinner daily, her right pulse is large while the left pulse is weak. Treatment is to free yang and preserve yin, but it is inappropriate to use an astringent tonifying blood formula. Instead use Bao Yu Cong Rong Fang, containing Bao Yu, Sheng Di, Cong Rong, Tian Dong, Dang Gui, Bai Zi Ren, Shan Zha, Niu Xi, Fu Ling, Hong Zao, and Qi Ai Tang as a pill. If symptoms are pale copious menstrual blood with attacks of wrenching pain in the lower abdomen wherein the patient discharges a "conglomeration" (clot) in the morning, the appropriate treatment is to free yang and preserve yin. It is inappropriate to break blood and this will discharge the Zhen Qi. The formula to use is Lu Jiao Shuang Zi Shi Yin Fang, containing Lu Jiao Shuang, Bu Gu Zhi, Dang Gui, Xiao Hui Xiang, Fu Ling, Chuan Jiao, Zi Shi Ying, and Rou Cong Rong.
The second deficiency pattern is Liver blood insufficiency, with symptoms of sinew pulling abdominal pain when the menses arrive. The treatment is to support the Liver and harmonize blood, using Bai Zi Ren Wan, which contains Bai Zi Ren, Ren Shen, Bai Zhu, Ban Xia, Wu Wei Zi, Mu Li, Ma Huang Gen, and Mai Fu Zao Rou Fan Wan.
The emphasis in these deficiency differentiations appears to lie in determining clearly when to tonify qi and blood versus when to free yang and preserve yin, as well as to express that in a deficiency pattern it may be appropriate to use a freeing method.