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I'm not too sure if the doctor diagnosed me correctly but my

symptoms are: tongue pale with thin white coating with teethmarks on

the sides, spotting mid-cycle and also spotting for 8-9 days before

period is due, menstrual blood dark purple with clots, constant

fatigue, irritability, always have cold hands and feet, low libido,

infertility. Does this sound only like liver qi stagnation? Could

this also be kidney yang deficiency?

Shan

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>I'm not too sure if the doctor diagnosed me correctly but my

>symptoms are: tongue pale with thin white coating with teethmarks on

>the sides, spotting mid-cycle and also spotting for 8-9 days before

>period is due, menstrual blood dark purple with clots, constant

>fatigue, irritability, always have cold hands and feet, low libido,

>infertility. Does this sound only like liver qi stagnation? Could

>this also be kidney yang deficiency?

 

No one can diagnose via email, BUT these can be symptoms of Kidney Yang

Deficiency. Kidney Yang Deficiency needs to be ruled in or out. Do a search

in the message group for Kidney Yang Deficiency for more details.

 

IF Kidney Yang Deficiency is present, this needs to be addressed.

 

>I live in a small city where there is only one Chinese Medical

doctor. I went to see him after trying to get pregnant for about

four years without success. I explained my situation where I'm

always cold, have constant fatigue, have spotting for a few days

mid-

cycle and I also have a week of premenstrual bleeding. Also I

was

diagnosed with endometriosis (mild) which was lasered off during

a

laparoscopy.

 

>He put me on the Bupleurum & Dong Quai formula to be taken all

cycle

since he diagnosed me with liver qi stagnation.

 

This is not a formula for all cycle. It's not necessarily a formula for PMS.

It can be for SOME cases of PMS, but not all.

 

In order to understand why this formula is not suitable for all cases of

menstrual problems and when it is, only for certain phases of the cycle,

it's important to look at the menstrual cycle from a TCM standpoint. There

are four phases to the menstrual cycle: Blood, Yin, Yang, and Qi. The

Root(s)of the problems - and thus the treatment and timing of the treatment

- will vary according to what phase of the cycle the woman is having

problems in.

 

Phase 1 begins the day the menstrual bleeding stops. This is the Yin part of

the cycle. " Because blood is created, at least in part out of kidney essence

and because, compared to yang qi, essence is a ty0e of yin substance, during

phase one, the body busies itself with making more yin and blood to

replenish that which was discharged. Therefore, in Chinese gynecology, we

say that phase one corresponds to yin and the emphasis in the body is on

replenishing yin blood. " (Bob Flaws, Curing PMS Naturally with Chinese

Medicine, p.35.)

 

Phase 2 is the days around ovulation. This is the Yang stage. " However, for

ovulation to occur, yin must trnasform into yang. This transformation of

yin into yang ocrresponds to the rise in basal body temperature which occurs

after ovulation. If there is insuffiecient yin, it cannot transform into

yang. Conversely, if there is insufficient yang, it cannot transform yin.

In addition, if either the qi and blood are not flowing freely, this

transformation may also be impeded. " (Flaws, p. 36.) My note: Two functions

of Yang are to warm and activate. Hypoglandular states - including

hypothyroidism - are not uncommon in people who are Yang Deficient. There

simply is not enough Yang to warm and activate the body sufficiently.

Hypothyroidism can be a factor in infertility as well as various menstrual

problems.

 

The third phase is the pre-menstrual phase, the Qi phase. " For things to go

as they should in the woman's body, yang qi must stay strong enough long

enough and the qi must flow freely and in the right directions. Many of the

signs and symptoms of PMS have to do with the yang qi not being strong

enough or the qi (and therefore the blood) not flowing freely. " (Flaws, p.

36.) That part about the Yang Qi needing to stay strong enough long enough

is important. Qi Stagnation is NOT the only possible cause of premenstrual

problems. Insufficient Yang and Qi Stagnation can occur separately without

the other, or, together.

 

The menses is the 4th. phase, the Blood part of the cycle. There has to be

sufficient blood for menses to occur. One of the possible causes of lack of

a period is Blood Deficiency. (It's not the only one.)

 

A formula which addresses Qi Stagnation is only going to help problems which

come from Qi Stagnation. It's not going to do anything to help Yang

Deficiency or Yin Deficiency. Furthermore, there are different Roots of Qi

Stagnation. Because there are different causes of Qi Stagnation, different

formulas are called for in different cases. The Bupleurum & Dong Quai

formala, aka Xiao Yao San, aka " Rambling Powder " is for a very specific set

of symptoms and signs, for a very specific clinical picture. From another

discussion group:

 

" Giovanni explained that " Xiao Yao San is for liver qi stagnation

but is for

only one particular type of liver qi stagnation. Xiao Yao San is

for liver

qi stagnation occurring against a back ground of liver blood

deficiency and

some spleen qi deficiency. That's what Dang Gui and Bai Shao are

doing in

there. They are nourishing liver blood. By nourishing liver

blood you

harmonise the liver. So it's for that type of liver qi

stagnation against a

back ground of liver blood deficiency. That is why it is so good

for women. "

 

" Giovanni mentioned he would rather use Yue Ju Wan when his

patient has Liver

qi stagnation with some heat and without liver blood deficiency.

He

mentioned it comes from the ancient perscription Zhu Dan Xi.

 

" There are many cases in which people are using Xiao Yao San

where our

amazing author and practitioner Giovanni, would use Yue Ju Wan

or Ban Xia Ho

Po Tang, " because the stagnation is more in the lungs and heart

rather than

the liver. " "

 

http://208.233.90.104/_studdisc3/00000010.htm

 

Emphasis: " Xiao Yao San is

for liver

qi stagnation occurring against a back ground of liver blood

deficiency and

some spleen qi deficiency. "

 

There are a number of things which can cause Qi to Stagnate. One of these is

Liver Blood Deficiency and Blood Stasis. Blood Stasis can trigger Qi

Stagnation if left untreated - just as Qi Stagnation can result in Blood

Stasis is untreated.

 

" Indications: Hypochondriac pain, headache, vertigo, a bitter taste in the

mouth, dry mouth and throat, fatifue, reduced appetite, pale-red tongue, and

a wiry, dificient pulse. There may also be alternating fever and chills,

and irregular menstruation or distended breasts.

 

" This is Liver constraint with blood deficiency. The relationship between

the Liver and Spleen is very close. When the Liver qi is constrained its

control over the Spleen becomes excessive, resulting in Spleen deficiency.

This is known as transverse rebellion of Liver qi violating the Spleen

Deficiency of the Spleen, whose function is to transform nutrients into

blood and qi, often results in blood deficiency. Consversely, blood

deficiency (regardless of origin) can lead to Liver constraint. The Liver,

a yin organ which stores blood, depends upon the yang to carry out its

spreading function. But if the supply of liver blood is insufficient, a

surplus of qi may ensue, which is known as constrained Liver qi. " (Dan

Bensky & Randall Barolet, Chinese Herbal Medicine Formulas & Strategies, p.

147.)

 

What they're talking about here is the " Victor-Vanquished " 5 Elements

relationship between Wood (Liver) and Earth (Spleen). Or, as Maciocia puts

it, " Liver Overacting on Spleen " . Bupleurum & Dong Quai formula, aka Xiao

Yao San, aka " Rambling Powder " is for cases where Liver Blood Deficiency has

resulted in Liver Qi Stagnation and " Liver Invading Spleen " , thus

triggering some mild Qi Deficiency because the Spleen isn't up to extracting

Qi from food and forming Qi in the body. Xiao Yao San works great for this.

But it leaves a lot to be desired and can even hurt in some situations. For

example, if the primary problems are Qi Deficiency and Spleen Deficiency.

 

One of the functions of Qi - in particular Spleen Qi - is to hold blood in

vessels. Spleen Not Controlling Blood is a Spleen Qi Deficiency pattern.

The symptoms are " Any of the Spleen-Qi deficiency manifeswtations, pulse:

purpura, blood spots under the skin, blood in the urine or stools,

menorrhagia or metrorrhagia, sallow complexxtion and shortness of breath. "

The tongue will be pale and the pulse fine. " All these symptoms are due to

the impairment of the Spleen funciton of controlling Blood. When Spleen-Qi

is deficient, it cannot hold the blood in the vessels and bleeding appears

from various sources, such as under the skin, in the stools or urine or from

the uterus. This is bleeding of Deficient nature, as opposed to the

bleeding from Heat in the Blood which is of an Excess nature. " (Maciocia,

Foundations, p. 244.)

 

Many of the herbs and formulas that move Qi also dissipate Qi. If the

primary problem is Liver Qi Stagnation due to Liver Blood Deficiency and the

Spleen Qi is not Deficient or very mildly so, Xiao Yao San is a good

formula. BUT, if Spleen Qi Deficiency is marked, Xiao Yao San can make

Spleen Qi Deficiency (and bleeding) worse.

 

There are other things that can cause Qi to Stagnate. Like Cold. The Cold

can be Exterior Excess Cold (cold temperature in the environment) that has

invaded to the Interior, or, it can be Deficiency Cold (aka Yang

Deficiency). One of the functions of Yang is to warm the body. Note: In

cases of Exterior Excess Cold, the uterus is vulnerable to direct invasion

by Exterior Cold. ( " The Stomach is one of three organs (with Intestines and

Uterus) that can be attacked by exterior Cold directly, by-passing the

exterior layers of the body. " Maciocia, p. 270.) Note: Long-time Kidney

Yang Deficiency will increase a person's vulnerability to Exterior Cold.

 

No amount of Qi Moving herbs is going to get Qi moving properly in cases

where the Stagnation is due to Cold. The Cold has to be expelled and the

Interior warmed. This formula is not warm enough for someone with Interior

Cold. It could worsen Interior Cold.

 

Spinal misalignment can affect Qi flow adversely. Like in the case of an

injury to the back (though not restricted to back injuries).

 

>The formula took

away my menstrual cramps but did absolutely nothing for the

spotting

and infertility. Actually it made my spotting worse.

 

Besides the possibility of Spleen Unable to Control Blood increasing the

bleeding due to dissipation of Qi, a property of Dong Quai needs to be

considered:

 

" Dong quai may interact with the blood-thinning drug Coumadin

(warfarin),

increasing the risk of bleeding, according to one case report.14

Dong quai

might also conceivably interact with other blood-thinning drugs,

such as

heparin, aspirin, and Trental (pentoxifylline). Additionally,

dong quai

could conceivably interact with natural products with

blood-thinning

properties, such as garlic, ginkgo, or high-dose vitamin E. "

 

http://www.healingpeople.com/hp_html/primapub/pg000448.htm

 

>After four months of being on this formula I couldn't handle

the

bleeding anymore but he refused to change the formula so I

stopped

going to see him.

 

Proper TCM treatment involves monitoring the client regularly for changes

and CHANGING TREATMENT as needed.

 

>I truly believe in Chinese Herbal Healing but

this

doctor told me " Maybe this type of bleeding is normal for you " .

 

This type of bleeding is NOT normal. It is a sign that something is wrong.

 

>Even

though I'm not a herbalist I do disagree with his statement.

Since there are no other doctors in my area I don't know what

to

do. I really don't feel comfortable seeing him again but I would

still love to pursue chinese herbal medicine.

 

TCM healers - like allopathic doctors - have varying general levels of

skill, knowledge, training, and wisdom. Also, like allopathic doctors, TCM

healers are better at and more knowledgeable about some things than others.

For example some TCM healers specialize in TCM gynecology. Some may know

more about Hot conditions than Cold conditions or vice versa.

 

>I know there are a

few

companies that sell herbal formulas and you could have an

over-the-

phone consult with their herbalist. What are your

recommendations on

this? Since this seems to be my only option and since western

medicine has failed to help me, it seems that this may be my

only

option.

I've read both of Bob Flaw's books Endometriosis, Infertility

and

Traditional and also Fulfilling the Essence.

Reading both of these books I believe that the Chinese doctor I

was

seeing could have done alot more to help me.

 

Have you cautiously tried using some of the information contained in the

Flaws' books. I know the Curing PMS Naturally book has suggestions on

various formulas and other things. Or, you may consider a trip to a distant

city for a consultation with another healer. You could make a mini-holiday

out of the trip. See the doctor, take in some sights, spend the night, and

relax.

***************

 

For students reading this post: The main things to remember are that Qi

Stagnation can have different causes, and the herbs and formula (or other

treatment) for resolving Qi Stagnation will need to be chosen accordingly.

There are no " one size fits all cases of Qi Stagnation " formulas or

selection of acupoints.

 

Also, in TCM gynocology, the menstrual cycle is viewed as having 4 phases:

Yin, Yang, Qi, and Blood.

 

Also, TCM healers should re-evaluate frequently and change treatment as

needed. The correct and best treatment today seldom is the best or even the

proper treatment a month from today.

 

Victoria

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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