Seattle Institute of Oriental Medicine

Translations: Modern Masters

A Summary of Li JinYong’s Clinical Experiences

A Summary of Li Jin Yong's Clinical Experiences

(15) Stools not regulated during the menstrual cycle

Each time that the menstrual cycle approaches the stools are not regulated. There is watery and sloppy diarrhea or difficult stools. After the period end the stools improve. This condition is called "menstrual cycle stools not regulated".

1. Menstrual cycle diarrhea
Each time as the menstrual cycle approaches, or during the menses, the stools become watery and sloppy (like diarrhea). This is accompanied by stomach distention, fullness, and discomfort that is worse in the afternoon; as well as fatigued spirit, lack of strength, and copious amounts of pale menstrual blood.
This is usually spleen vacuity. During the menstrual cycle qi and blood are lost and the spleen's ability to renew and add qi is vacuous and weak. Therefore the stool is watery and sloppy, the abdomen is distended and full, and the symptoms are particularly severe in the afternoon. Qi and blood assimilation is not being managed, therefore the menses are heavy with pale blood. The spleen is vacuous and the yang qi is not roused, therefore the spirit is fatigued and there is a lack of strength. The treatment should be to boost the qi, fortify the spleen, and regulate the menses using Si Wu Tang and Li Zhong Tang modified:
Shu di 10g, dang gui 10g, fu pian 8g, chuan xiong 10g, dang shen 10g, chao bai zhu 10g, gan jiang 10g, zhi gan cao 8g.
Take the above eight ingredients, add a suitable amount of water, decoct, remove the dregs and then take the juice. One bag per day, decoct and take two times.
If there is concurrent weakness and soreness of the lumbar and knees, along with aversion to cold and cold limbs, then this disease falls into the category of spleen and kidney both vacuous. If this is the case, the following herbs should be added to the above formula : du zhong 10g, bu gu zhi 10g.
The above formula uses dang shen, bai zhu, and zhi gan cao to boost the qi and fortify the spleen; gan jiang and fu pian to warm the interior and assist yang; shu di, dang gui, and chuan xinog to harmonize the blood and regulate the menses. All of the herbs used together can boost the qi, warm the yang, fortify the spleen so that it is flourishing, and normalize movement and transportation so that diarrhea can be healed. Du zhong and bug u zhi can warm and supplement the kidney yang, and therefore can be added if there is concurrent kidney vacuity.

2. Menstrual cycle constipation
a) blood heat constipation
During the menstrual cycle, or either pre- or post-menstrually, the stools are dry and bound, there is thirst with a desire for cool drinks, and there is vexation and agitation. The periods are early and heavy. The tongue fur is yellow and the pulse is wiry and rapid.
The cause is heat in the blood aspect. When the menses arrive the heat moves into the large intestine and makes the stool dry. Heat evil is depressed internally, scorching and damaging the fluids, therefore there is thirst with a desire for cool drinks. Heat harasses the heart spirit, therefore there is vexation and agitation. Heat hurries the movement of the blood, therefore the periods are early and heavy. The treatment should be to clear heat, cool blood, and free descending [of the stool] by using Yu Zhu San:
Sheng di 10g, dang gui 10g, bai shao 10g, chuan xiong 10g, da huang 8 grams (add at the end of cooking), mang xiao (melted) 8g, zhi gan cao 8g.
Add a suitable amount of water to the above seven ingredients, decoct, remove the dregs and add the mang xiao to the juice. Take the decoction once it has cooled to a warm temperature. Take one bag a day, two times per day.
The above formula uses sheng di, dang gui, bai shao, and chuan xiong to harmonize the blood and regulate the menses; da huang and mang xiao to open and drain the stool in order to dispel evil heat; zhi gan cao to support and assist the right qi, guard against too much downward movement, and simultaneously harmonize and regulate the other herbs. The formula as a whole clears heat, opens the bowels and treats blood heat causing menstrual cycle constipation.

b. blood stagnation constipation
During or before the period the stool is constipated, bound, and hard to resolve [incomplete]. The abdomen is painful and uncomfortable; after a bowel movement the pain is alleviated but it soon recurs. There are blood clots in the menstrual blood and the tongue has stagnation macules. The cause is blood stasis in the interior, when the menses arrive there is obstruction in the large intestine channel and collateral, therefore the stool is constipated, bound, and hard to resolve, accompanied by abdominal pain and discomfort. After a bowel movement the channels and collaterals are temporarily open, therefore the abdominal pain is lessened. Still, blood stasis is not eliminated and soon there is obstruction again causing bound stool and abdominal pain to recur. Static blood obstructs the channels and collaterals, therefore there are clots in the blood and macules on the tongue. Treatment should be to invigorate blood, transform stasis, and free down-bearing by using Tao Hong Si Wu Tang modified:
Sheng di 12g, dang gui 10g, chuan xiong 10g, chi shao 10g, tao ren 10g, hong hua 10g, zhi shi 10g, da huang 10g.
Add a suitable amount of water to the above eight ingredients and decoct. Then remove the dregs and take the juice. Use one bag per day, divide into two portions and take warm.
The above formula uses sheng di and dang gui to nourish the blood; chi shao to invigorate the blood; chuan xiong to rectify the blood and central qi; tao ren and hong hua to dispel stasis; da huang to dispel stasis and free down-bearing; zhi shi to move the qi in order to reinforce the strength of the stasis dispelling herbs. Taken all together, the herbs nourish and invigorate the blood, dispel stasis and free down-bearing. They are suitable to use when blood stasis causes constipation during menses.
c) blood vacuity constipation
After or during the menses the stool is constipated, bound, and difficult. The mouth and tongue are dry, the flesh and skin are not moist, and the menses are pale and scanty.
There is constitutional blood vacuity and during the menses qi and blood are lost in the flow. Yin and blood become even more vacuous and there is not luxuriant moisture in the large intestine, therefore the stool is constipated and difficult. Since the yin fluids are lost and vacuous the mouth and tongue are dry and the flesh is not moist. The treatment ought to be to supplement blood, moisten dryness, and free down-bearing. Use Si Wu Tang modified:
Sheng di 15g, dang gui 10g, bai shao 10g, chuan xiong 10g, huo ma ren 15g, yu li ren 12g, rou cong rong 10g
Add a suitable amount of water to the above seven ingredients and decoct. Remove the dregs and take the juice. Use one bag per day, divide into to doses and take warm.
The above formula uses sheng di, dang gui, bai shao, and chuan xiong to nourish and supplement the blood; huo ma ren, yu li ren, and rou cong rong to moisten the intestines and free the stool. Combined all together they nourish the blood, moisten dryness and free the stool.

By Andrea Kurtz

Series of National Famous Old Chinese Doctor's Clinical Experiences)