– cycle- days, on time, etc.

– bleed- 4-7 days normal

– amount- 50-80 ml, # of tampons/day – absorbency, history

– colour- bright-red to brown-red

– characteristic- thin/thick, sticky, clots, consistence

– odour- is there any odour – inflammation

*Symptoms surrounding menses

– pain, headache, edema, irritability

*Tongue & Pulse

P/T regulate the root

– differentiate

– harmonize Yin/Yang

– regulate Qi/Blood

– strengthen KI

– Nourish SP

– Sooth LR

– consolidate Ren & Chong

Early Periods

Diagnosis

Menstruating 7 days early for 3 months consecutive.  May also bleed between periods (mid-cycle) – not a true period.

Etiology

Ren & Chong not consolidated

1. Spleen Qi deficiency – diet, fatigue, overwork, worry, over-think, makes Qi sink – can’t keep blood in vessels.
2. Kidney Qi deficiency – pre-heaven def., pre-menopausal, cycles shorten between 40-50, pregnancy close together or amount of miscarries etc all use KI essence/Qi. KI Qi controls lower orifices, this makes Ren & Chong lose control.
3. Hyper Yang with heat in blood – general Yang life/constitution, lots of spicy food, fire invasion, hot working environment.
4. Liver Qi stagnation with heat in the blood – attack Ren & Chong, can’t consolidate.
5. Yin deficiency with heat in blood – TB, long term bleeding will injure Yin, over active reproductive parts (sex – babies), Ren & Chong can’t consolidate.
6. Blood Stasis – after delivery or during menses get attacked by ext. pathos, emotional upset can cause Qi stag. – Stasis, period stops early next month comes early (blood stasis clogs uterus).

Pathogenesis differentiation & treatment

Spleen Qi deficiency early period, more blood (not hold in vessels), less blood (SP Qi sink, pale-red colour, watery, low abdominal empty feeling, T – pale, white coat  P – weak Plus – Spleen deficiency symptoms (see Appendix 1) P/T nourish SP & middle Jiao Qi Rx – Gui Pi Tang  (stops heavy bleeding) or Bu Zhong Yi Qi Tang  (raises Qi , light bleeding)

Kidney Qi deficiency early period, more blood (Chong & Ren can’t consolidate), less blood (Essence deficiency), pale-brown red in colour, clear thin watery, T pale P – weak Plus Kidney Qi deficiency symptoms (see Appendix 1) P/T nourish KI Qi – consolidate Ren & Chong Rx Gui Shen Wan  (KI tonic) or Wen Chong Tang  (more cold signs)

 Excess Yang with Heat in the blood amount is more, fresh red or darker & sticky, blood may feel hot, T red, yellow coat  P  slippery, rapid Plus Heat symptoms (see Appendix 1) P/T clear Heat cool blood to regulate menses. Rx Qing Jing Tang

Liver Qi stagnation with Heat can be more or less quantity of blood, deep red in colour, thick clotted blood that does not flow smoothly (start & stop), breast distention and low abdominal pain, T red sides  P wiry Plus Liver Qi stagnation symptoms (see Appendix 1) P/T – soothe LR clear heat & cool blood to consolidate Chong Mai Rx Dan Zhi Xiao Yao San

Yin deficiency with heat in the blood this pattern happens more around menarche & menopause deficiency Heat in Chong & Ren push blood out of Jing = early scanty, dark color & sticky, T red, scanty coat  P fine rapid Plus Yin deficiency symptoms (see Appendix 1) P/T nourish Yin, clear ↓ heat, consolidate Chong Rx Liang Di tang

Blood Stasis cold blocks blood, Chong, & Ren – new blood can’t stay in uterus, woman starts spotting dark with clots, painful although better once clots pass, cold in uterus, whole body may not show cold signs, T purple spots  P uneven Plus Blood Stasis symptoms (see Appendix 1) P/T promote blood circulation, remove Blood Stasis to regulate menses. Rx Tao Hong Si Wu tang

Late Periods

Diagnosis

Menstruate for 35 days or more, 3 months consecutively, more common during menarche and menopause.  Is pregnancy a consideration?

Etiology

1. 1. Blood deficiency – chronic illness, bleeding disorders
2. Yang deficiency (Kidney) – can’t warm organs – impairs production of blood – deficient Chong
3. Yin deficiency (Kidney) – deficiency Fire impair fluids and blood – deficient Chong blood
4. Cold stagnation – restrict blood circ – blood stasis
5. Qi stagnation turns to Blood Stasis – block Ren and Chong, Chong will not fill on time
6. Phlegm stagnation – overweight – phlegm damp retention can block Ren and Chong, Chong can’t fill – too damp (diabetes etc.)

Must Read: Ling Jiao Gou Teng Tang – cools Liver, extinguishes Wind, increases fluids, soothes sinews

Pathogenesis Differentiation & Treatment

Blood deficiency scanty bleeding that is pale in colour and thin in consistency, T pale, thin P thin, weak Plus blood deficiency symptoms (see Appendix 1) P/T nourish blood to nourish Chong Rx Xiao Ying Jian

Kidney Yang deficiency cold symptoms, scanty purple pale thin menstrual blood, dull cold low abdominal pain, T pale swollen, tender baby  P  deep thin Plus Yang deficiency symptoms (see Appendix 1) P/T warm up KI Yang to nourish Chong Rx You gui wan

Kidney Yin deficiency scanty dark coloured menstrual blood with small clots, T red, scant coat P fine, rapid Plus Yin deficiency symptoms (see Appendix 1) P/T nourish KI Yin to regulate period Rx Liu Wei Di Huang Wan

Full Cold stagnation scanty purple red blood with large clots, cold pain in low abdomen, complexion is white/blue, T  purple  P tense maybe uneven (stasis), deep (internal) Plus whole body feels cold P/T warm meridians, expel cold, promote circulation to remove stagnation Rx Wen Jing Tang

Liver Qi stagnation scanty or normal, if no heat colour normal, if heat – deep red, thick, start/stop bleeding during menses, small clots, distended pain in low abdomen, T red on sides  P wiry Plus Liver Qi stagnation symptoms (see Appendix 1) P/T regulate LR Qi, remove stagnation to regulate menses Rx Xiao Yao San

Phlegm stagnation more (Damp) or less (stagnation) blood quantity, mixed with sticky pale coloured leukorrhea, generally overweight, T greasy thick coat  P slippery, wiry Plus Phlegm symptoms (see Appendix 1) P/T ransform Phlegm, dry Damp, promote blood circulation to regulate menses. Rx Er Chen Tang

Irregular Periods

Diagnosis

Menstruation is 7 days or more early, or 7 days or more late for 3 months consecutively.

Etiology

1. Kidney Qi deficiency – stores essence, works w/ all other Zang to regulate menses.  Kidney can’t store essence properly & other organs malfunction especially Liver.
2. Liver Qi stagnation can’t control amount of blood in Chong Mai, stagnation = late, excess = early

3. Spleen Qi deficiency – can’t produce Blood or keep blood in vessels.  Chong empty = late, blood escaping from vessels = early.

Pathogenesis Differentiation & Treatment

Kidney Qi deficiency scanty, pale, thin, large amounts of clear thin vaginal discharge, T pale P weak Plus Kidney Qi deficiency symptoms (see Appendix 1) P/T nourish KI Qi to regulate menses Rx Shen Qi Wan or You Gui Wan

Liver Qi stagnation large or scanty amounts, colour normal, if heat it is darker, flow start/ stop, clots, PMS distended abdominal pain until menses,  pre-menstrual breast distention, T red on sides  P wiry Plus Liver Qi stagnation symptoms (see Appendix 1) P/T soothe Liver, harmonize Qi & blood to regulate menses. Rx Dan Zhu Xiao Yao San (heat) Xiao Yao San (no heat)

Spleen Qi deficiency more blood if vessels not controlled,  less blood if production is poor, pale red, thin, T pale, white coat  P weak Plus Spleen Qi deficiency symptoms P/T nourish Spleen Qi & blood Rx Ba Zhen Tang  (Si Jun Zi Tang + Si Wu Tang)

Heavy Periods

Diagnosis

Amount of menstrual bleeding is significantly increased during period to around or over 100 ml/day (normal 30-80ml).  Although, there may be a regular, early, or late cycle.

Colour pale, dark, or purple red.

Consistency thick sticky, or, thin, or clotted.

Sometimes there may be pain.

Etiology

1. Qi deficiency – Spleen Qi deficiency = can’t keep blood in vessels = heavy  bleeding.  Long term Heart & Spleen deficiency (both Qi & blood), or Spleen and Kidney Qi deficiency (can cause Yang deficiency cold)
2. Excess Heat whole body dry Heat (spicy foods, Liver Qi stagnation turns to heat, or exterior Wind/Heat invasion), Heat enters blood = heavy bleeding
3. Deficiency Heat – Yin deficiency, or febrile late stage turns to deficiency Heat, work in high temperatures can also lead to deficiency Heat, long term emotional stress  consumes Yin fluids, excess sex injures Yin-Essence.  Deficiency Heat attacks Ren & Chong = heavy bleeding.
4. Blood Stasis – emotional depression leads to Qi stagnation which leads to Blood stasis.  During menses or after delivery it is easy to be attacked by Cold which may cause Blood Stasis.  Abortions, or after surgery that was not quite done careful enough may create toxic local Heat = Blood stasis in Ren & Chong, this keeps old blood in the uterus which then mixes with new blood = heavy bleeding (with pain)

Pathogenesis Differentiation & Treatment

 Qi deficiency pale-red to normal blood colour, thin watery, clotted, T-pale P-thin-weak Plus Spleen Qi deficiency symptoms (see Appendix 1) P/T nourish mid-Jiao Qi, keep blood in Chong Mai Rx Gui Pi Tang

Excess Heat in Blood VERY heavy, bright-red, sticky-thick, blood feels warm, maybe clots, low abdominal distension relieved when blood comes, T-red with yellow coat P-rapid-slippery Plus excess Heat symptoms (see Appendix 1) P/T Clear Heat cool blood to stop bleeding Rx  Shu Yu Qing Gan Yin (new Rx)

Deficiency Heat Yin deficiency leads to hyper Yang with deficiency Fire, deep-red sticky blood, prolonged cycle (i.e.: 7-10 days), early period is common, T-red w/ scanty coat P-thin-rapid Plus Yin deficiency symptoms (see Appendix 1) P/T nourish Yin, clear deficiency Heat to stop bleeding Rx Bao Yin Jian

Blood Stasis dark purple blood with clots, low abdomen excess pain that subsides when clots pass, T-purple dots P-uneven Plus Blood Stasis symptoms (see Appendix 1) P/T promote circulation, remove Stasis to stop bleeding. Rx Shao Fu Zhu Yu Tang (low Jiao)

Scanty Periods

Diagnosis amount of blood quite small or spotting, only 1-3 days of bleeding.  Generally starts @ menarche.  Certain birth control methods can cause this.  WATCH for possible early pregnancy.

Etiology

1. Blood ↓ – SP ↓ can’t produce blood, any severe bleeding, other illness – trauma
2. KI ↓ – late menarche, over sex, overwork stress → essence ↓ → can’t make enough blood for Chong/Ren
3. Cold in Blood external cold invades meridian → blocks blood movement, internal ↓ cold (SP KI) can’t T & T enough blood
4. Qi stag. emotions → stag. → Blood Stasis
5. Phlegm stag. any reason (create phlegm) → block Qi/Blood circ.

Pathogenesis Differentiation & Treatment

1. Blood ↓ – pale thin, commonly delayed Plus Blood ↓ sym.  T-pale-thin P-thin P/T nourish blood & SP Qi Rx Ba Zhen Tang  (Si Wu Tang + Si Jun Zi Tang)

2. KI ↓ – scanty & late menarche, or gradually becomes scanty → delayed, pale, thin. Plus  KI ↓ sym.  T-pale P-deep-thin P/T  nourish KI Qi & essence Rx Zou Gui Wan  or  Shen Qi Wan

3. Cold in Blood cold pain & difficult to start full flow, dark colour, clots, delayed (late) Plus Cold pain in low abd., history of Cold inv. T-normal → pale P-tense P/T warm meridians, disperse Cold Rx Wen Jing Tang

4. Qi stag. difficult to start full flow, distention in breasts & abd., normal → (if stasis = dark w/ clots) Plus – PMS  T-purple spots on sides  P-wiry-uneven P/T regulate Qi, promote blood circ. Rx Xiao Yao San

5. Phlegm-stag. sticky, mixed w/ sticky fluids, delayed (late), leukorrhea, Plus Phlegm sym., generally overweight, chest oppression T-swollen greasy  P-slippery P/T eliminate phlegm promote circ. Rx  Er Chen Tang + blood invigorating herbs

Dysmenorrhea (painful period)

Diagnosis recurring pain in lower abdomen 1-2 days before, during, or after period.  Pain can radiate to whole abdomen, lower back, & anal/genital area (Endometriosis can have a feeling of downward pulling on the anus).  The pain generally diminishes after period ends.  The pain can be stabbing, burning, squeezing, dull, down-bearing, & in severe cases can cause nausea, vomiting, cold sweating, & fainting.  This seems to happen mostly in younger women.

Differential Diagnosis Appendicitis (pain only in right side, severe when pressed & let go), Ulcers (usually in epigastrium), Ovarian cysts & Uterine fibroids (milder pain), Inflammatory bowel diseases & reproductive & intestinal Cancers (constant dull pain), all of these can happen at any time within the cycle.

Etiology

1. Qi & Blood stag. – LR, emotional upset/stress stagnates Qi → blood stasis.  Sea of Blood stagnates & causes pain.
2. Cold in Uterus – common in young women (swimming, Yang ↓, living enviro., cold foods), cold invades lower abdomen, Yang ↓ can also cause cold in Ren/Chong.  Mostly Cold/Damp ↑ or Yang ↓.
3. Damp/Heat – inflammations, cold turns to heat, surgery, abortions etc cause Damp/Heat in lower Jiao, Ren/Chong & Uterus stagnate → blocked flow → pain.
4. Qi & Blood ↓ – after surgery, illness, constitution, all can cause stagnation → pain.
5. LR KI ↓ – ↑ births, ↑ sex, ↑ abortions → essence/blood ↓ → not enough blood in Ren/Chong → pain after menses (lack of lubrication idea).

Pathogenesis Differentiation & Treatment

1. ↑or ↓ – PMS is more ↑, pain after period starts is ↓.
2. How severe is the pain?
3. General condition – angry, Qi↓, Blood↓, leukorrhea (damp), etc.
4. In Qi or Blood level / in LR or KI -if the pain in lower abdomen → radiates to sides = LR -if pain radiates to lower back = KI -if pain is fixed = blood stasis -if pain moves (not fixed) = Qi stagnation.

5. Eight-principle diagnosis P/T regulate REN/Chong – Qi & Blood – combine root/branch (pain first) – choose herbs according to type of pain symptoms

Qi & Blood stagnation 1 or 2 days before or during 1^st day of menses lower abdominal distension pain, pressure makes worse, generally scanty blood flow, start/stop flow, dark-purple colour w/ clots, when clots pass the pain is relieved (or when menses stop). Plus LR Qi stag. sym. (PMS)  T-dark-red  P-wiry P/T regulate Qi, move stasis to relieve pain Rx Ge Xia Zhu Yu Tang (below diaphragm).

Cold in Uterus a) ↓ Cold (Yang ↓) → painful during or after, pressure & warmth helps, scanty dull-dark red blood. Plus KI Yang ↓ sym.  T-pale, moist white coat  P-deep P/T warm Chong/Ren/Uterus to regulate blood & relieve pain Rx Wen Jing Tang – b) Cold/Damp ↑ block lower Jiao causing lower abdomen cold pain few days before or during, pain gets worse w/ pressure – better w/ warmth, scanty very-dark blood w/ clots. Plus – cold sym. w/ aching all over  T-white coat  P-tense P/T expel cold, eliminate Damp, warm meridians to relieve pain

             Rx Shao Fu Zhu Yu Tang + eliminate damp (cang zhu, fu ling)

Damp/Heat in lower Jiao causes distension pain before or during menses, pressure makes worse, hot sensations, yellow smelly vaginal leukorrhea, dark-red thick blood w/ clots, maybe more blood. Plus Damp/Heat sym.  T-red, yellow greasy coat  P-wiry-rapid P/T clear heat – eliminate damp to relieve pain Rx – Qing Re Tiao Xue Tang

Qi & Blood ↓ – dull pain during or after period, pressure helps, scanty pale thin blood. Plus – Qi/Blood ↓ sym.  T-pale  P-thin P/T – nourish Qi & Blood Rx – Ba Zhen Tang

LR KI ↓ – dull softer pain during or after period, dull-dark scanty thin blood Plus – LR KI ↓ sym.  T-pale  P-weak P/T – nourish LR KI to relieve pain Rx – Tiao Gan Tang (regulate LR w/ KI herbs)

Bleeding between periods

Diagnosis around ovulation (3-5 days) there is spotting or bleeding for 2-3 days which is scanty but significant.  This can last for 2-3 days and generally is recurring.  Can have low back soreness, pain in lower abdomen over the ovaries, sticky egg-white discharge or leukorrhea.

Differential Diagnosis – similar to early periods → check amount of blood to see if it is actual menstruation (early) or not (bleeding btwn periods).  If you follow basal temperature charting, if bleeding comes while temperature is consistently high (after ovulation) then it is early, if it is before this rise → bleeding between periods.

Etiology

1. KI Qi & or Yin ↓ – (essence & blood), generally more in young women → Yin-essence transforms Qi (Qi is needed to make ovulation happen) → Qi is not transformed & KI Qi can’t consolidate Ren/Chong = bleeding
2. Damp/Heat – interior or exterior → injures Ren/Chong.  Damp/Heat is Yang – too much Yang around ovulation (which has a Yang Qi action) pushes too hard = bleeding
3. Blood Stasis – in uterus.  If also Yin ↓ → more Heat injures collaterals = bleeding.

Pathogenesis Differentiation & Treatment

1. KI Yin↓ – scanty bright-red blood (earlier in cycle) Plus – KI Yin ↓ sym.  T-red-scanty coat  P-thin-rapid P/T – nourish KI Yin, clear ↓ Heat to stop bleeding Rx Liu Wei Di Huang Wan

2. KI Qi ↓ – scanty pale-red blood (later in cycle). Plus – Qi ↓ sym.  T-pale  P-weak P/T nourish KI Qi to consolidate Ren/Chong Rx – Shen Qi Wan -or → Yu Ling Zhu stimulate ovulation

3. Damp/Heat sticky thick blood, thick yellow smelly vaginal leukorrhea. Plus Low Jiao Damp/Heat sym  T-red-yellow slippery   P-slippery-rapid P/T – clear Heat – induce diuresis to stop bleeding Rx – Ba Zheng San

4. Blood Stasis – dark-purple blood w/ clots, stabbing pain in lower abdomen. Plus – T-purple dots  P-thin-wiry P/T – remove Blood Stasis to stop bleeding Rx – Zhu Yu Zhi Xue Tang

Bi Jing Amenorrhea

 

Diagnosis

1. Primary Bi Jing – Menstruation has never come
2. Secondary Bi Jing – women’s period stops completely for more than 3 months.

 –   Normal times for Bi Jing Pregnancy, During puberty when period isn’t regulated yet, Pre-menopausal, During breast-feeding, Environmental change, Stress

Differentiate:

Pregnancy:  period usually stops suddenly with pregnancy signs

i.e.- morning sickness, cravings.

Etiology

1. LR KI↓ – young age, essence can’t transform blood and liver has no blood to store so Chong and Ren meridians never receive any blood

– poor diet, over sexual activity

2. KI Yang↓ – Ming men fire is deficient creating deficient cold blocking the meridians.
3. 3.Qi & Blood↓ – Spleen and stomach deficiency do not produce blood so there are no stores of blood.  There is no Qi to push and move blood out of uterus.
4. 4.Yin/Blood↓ – no source of blood, sea of blood is dry (blood dryness)

5. 5.Qi & Blood stag.- cold invasion and stress leads to Qi and blood stagnation
6. Phlegm-Damp acc.- Spleen Qi/Yang deficiency blocks Chong and Ren meridians.  Patient will usually be over weight.

Primary Bi-Jing female needs physical check up to see if there are any physical problems.

Pathogenesis Differentiation & Treatment

1. LR KI ↓ -primary Bi Jing -secondary Bi Jing – cycle slowly gets slower and slower till it gradually stops, weak body symptoms Plus – LR KI ↓ sym.    T– pale  P- deep, weak P/T – Nourish liver and kidney to regulate menstruation Rx – Gui Shen Wan
2. Qi & Blood↓ – gradually menstruation becomes smaller and disappears before – Amount -little Amenorrhea – Colour – pale,  Consistency -thin Plus – whole body Qi/Blood ↓ sym.  T-pale-thin  P-empty P/T – nourish Qi and Blood to regulate period Rx – Ren Shen Yang Ying Tang (Ba Zhen Tang = base formula for def. Qi and blood)
3. 3. Yin ↓ w/ dry Blood  – patient had scanty menstruation which slowly becomes smaller and disappears. Plus – Yin ↓ sym.  T- red, scanty coat  P- thin, rapid P/T – nourish yin and blood, clearing deficient heat to regulate period. Rx – Jia Jian Yi Yin Jian
4. Qi & Blood stag.- absence of menstruation, easily angered and/or depressed with hypochondriac / chest fullness, pain in lower abdomen. Plus – T- purple  P- wiry-uneven-deep P/T – regulate Qi, promote blood circulation and remove blood stasis to regulate period. Rx – Zue Fu Zhu Yu Tang
5. Phlegm Dampness  –  patient generally over weight – puffy face, ankle edema, large amount of leucorrhoea, fullness in chest, heavy feeling with fatigue. Plus –  T- greasy coat   P- slippery P/T – eliminate phlegm and dampness, regulate Qi and Blood to promote period. Rx – Cang Fu Dao Tan Wan

Metrorrhagia & Metrostaxis Beng Lou

Diagnosis

   Irregular uterine bleeding between patients cycle.  Large amount of blood, or spotting for long periods of time.

   Blood will come suddenly in large quantities or in small quantities but for a long duration.

   Blood will be fresh red, dark red, or bright red and can be either thin or thick with possible clots and a possible odour.

Etiology

1. KI Qi↓  -kidney does not close the “gate” properly causing irregular uterine bleeding.
2. SP Qi↓  -spleen cannot keep blood in vessels causing irregular uterine bleeding
3. Heat in Blood(↓ or ↑). -pushes blood out of Chong meridian
4. Blood stag. -in Chong and Ren meridians, new blood unable to enter meridians causing irregular uterine bleeding.

3 Principles of Treatment

1. Stop bleeding
2. Go to root
3. Regulate Chong/Ren

Pathogenesis Differentiation & Treatment

1. ↓Heat in Blood – scanty for long period of time (if heat becomes fire – lg. amount of blood), bright red, thick irregular bleeding. Plus – Yin ↓ sym.  T-red-scanty coat  P-thin-rapid P/T – nourish Yin, clear Heat to stop bleeding Rx – Bao Yin Jian

2. ↑ Heat in Blood – acute sudden onset of large amounts of blood, deep or bright red-thick Plus – Heat sym.  T-red  P-rapid P/T – clear/purge Heat – cold blood to stop bleeding Rx – Qing Re Gu Jing Tang

3. KI Yang ↓ – sudden irregular – more or less blood, pale-thin Plus – KI Yang ↓ sym.  T-pale  P-weak

           P/T – nourish KI Yang – consolidate Chong/Ren to stop bleeding Rx – Yu (right) Gui Wan

4. KI Yin ↓ – Metrostaxis (dripping) bright red-thick, possibly large amounts (usually scanty) Plus – KI Yin ↓ sym.  T-red-scanty  P-rapid-thin P/T – nourish KI Yin to stop bleeding Rx – Zou (left) Gui Wan

5. SP Qi ↓ – alternate amounts of blood w/ spotting starting after, pale-thin Plus – SP Qi ↓ sym.  T-pale  P-empty P/T – nourish SP Qi to keep blood in vessels Rx – Gu Ben Zhu Beng Tang  or  Gui Pi Tang

6. Blood Stasis – blood may stop then flow again, or amenorrhea then bleeding occurs in dark colour w/ clots Plus – Pain in abdomen P/T – promote circ. – remove stasis to stop bleeding Rx – Si Wu Tang + Shan Qi, Hong Hua, Qian Cao

Prolonged Periods

Diagnosis

Bleed for more than 7 days

Differentiate – bleeding between periods & irregular bleeding

Etiology

1. Qi ↓
2. Heat in Blood (↑ or ↓)
3. Blood Stasis

Pathogenesis Differentiation & Treatment

1. Qi ↓ –  P/T – nourish Qi to stop bleeding Rx – Gui Pi Tang

2. Heat in Blood(↓) P/T  nourish Yin, clear ↓ heat, stop bleeding Rx Liang Di Tang + Er Zhi Tang

3. Heat in Blood(↑) Damp / Heat P/T  clear ↑ heat to stop bleeding Rx Si Miao San + Nui Xi

4. Blood Stasis P/T remove Blood Stasis & promote circulation Rx Tao Hong Si Wu Tang