Essentials of the Golden Cabinet
【Original Usage and Formula Dosage】Question: A woman aged fifty has been suffering from diarrhea for several days without relief, experiences fever in the evening, has urgency in the lower abdomen, abdominal fullness, hot palms, and dry lips and mouth. What is the cause? The teacher said: This condition is related to “leukorrhea”. Why? Because she has had a previous childbirth, and there is retained blood in the lower abdomen. How do we know this? The symptom of dry lips and mouth indicates this.
The treatment should be with Warming the Channels Decoction (温经汤) (Golden Cabinet: Miscellaneous Diseases of Women: 9).
Warming the Channels Decoction consists of: Wu Zhu Yu (Evodia) 3 liang, Dang Gui (Angelica Sinensis) 2 liang, Chuan Xiong (Ligusticum) 2 liang, Bai Shao (White Peony) 2 liang, Ren Shen (Ginseng) 2 liang, Gui Zhi (Cinnamon Twig) 2 liang, E Jiao (Donkey-hide Gelatin) 2 liang, Sheng Jiang (Fresh Ginger) 2 liang, Mu Dan Pi (Moutan Root) 2 liang (remove the heart), Gan Cao (Licorice) 2 liang, Ban Xia (Pinellia) 0.5 sheng, Mai Men Dong (Ophiopogon) 1 sheng (remove the heart). Combine these twelve ingredients with one dou of water, boil down to three sheng, and divide into three warm doses.
This formula is also indicated for women with cold in the lower abdomen who have not conceived for a long time; it can also be used for excessive bleeding during menstruation or when menstruation is delayed.
【Formula Explanation】The formula uses Wu Zhu Yu and Gui Zhi as the monarch herbs to warm the channels, dispel cold, and promote blood circulation; Dang Gui and Chuan Xiong invigorate blood and dispel stasis to generate new blood, while Mu Dan Pi dispels stasis, promotes menstruation, and reduces fever, serving as ministerial herbs; E Jiao, Mai Men Dong, and Bai Shao nourish yin and blood, and can also stop bleeding. Ren Shen and Gan Cao tonify qi and strengthen the spleen, also regulating blood. Ban Xia connects the Chong and Ren meridians, which are both connected to the Stomach meridian of the Foot Yangming, and it helps to descend Stomach qi and disperse clumping, aiding in dispelling stasis and promoting menstruation. Sheng Jiang warms the Stomach, descends rebellious qi, and disperses cold, also assisting in transformation. Gan Cao harmonizes the other herbs and serves as a messenger herb.
【Discussion of the Formula】Li Erchen said: When a woman reaches fifty, she has passed the period of seven sevens, the Ren meridian is deficient, and the Chong meridian is weak, the heavenly essence is exhausted, and the earthly path is obstructed. The condition of diarrhea, according to this text, is observed as a bleeding condition. Blood belongs to yin, and yin deficiency causes fever, and evening also belongs to yin. The Ren meridian governs the uterus, and the Chong meridian is the sea of blood; both meridians originate in the uterus and exit at the perineum, which is precisely the area of the lower abdomen. When the Chong and Ren meridians are deficient, there is urgency in the lower abdomen, and the presence of stagnant blood also causes abdominal fullness. The Inner Canon states: The Ren meridian is the cause of disease; for women, leukorrhea and masses are the result. The back of the hand is yang, while the palm is yin, and it is the place where the three yin meridians pass. Yin deficiency causes heat in the palms. The Yangming meridian encircles the mouth and lips, and meets the Wei meridian at the Qi Street, both belonging to the Dai meridian. The Difficult Classic states: Blood governs moistening; if the Wei meridian’s blood is obstructed, then the Yangming fluids are deficient and cannot moisten. Therefore, dry lips and mouth indicate that the condition belongs to leukorrhea, and due to the previous childbirth, the stagnant blood in the lower abdomen prevents the fluids from distributing, and new blood cannot be generated, which is the cause of dry lips and mouth. (Huang Zhu Zhai, “Essentials of the Golden Cabinet: Commentary”)
【Clinical Applications and Case Studies】
(1) Gynecological Diseases
1. Breast Hyperplasia (Mammary Fibrosis) Ms. Bai, female, 33 years old, an official, consulted on March 8, 2001. She reported bilateral breast pain accompanied by lumps for over three years, worsening before menstruation. A diagnosis from another hospital indicated cystic breast hyperplasia, and she had improved symptoms after taking breast lump dispersing pills and other medications. One month ago, due to anger, the breast pain worsened, especially on the left side, accompanied by late menstruation, reduced flow, dark color, and clots. Physical examination revealed a soft, tender lump approximately 2.0cm x 2.5cm on the outer side of the left breast, and a lump approximately 1.0cm x 1.5cm on the outer side of the right breast, with tenderness (+) and mobility. No enlarged lymph nodes were palpated in both axillae. The tongue was dark with a thin coating, and the pulse was deep and wiry. A computer infrared breast diagnostic device indicated bilateral breast hyperplasia. The TCM diagnosis was breast fibrosis (Chong and Ren disharmony, phlegm-damp obstruction). The treatment should warm and nourish qi and blood, dispel lumps and resolve stasis. The modified Warming the Channels Decoction was prescribed: Dang Gui 20g, Chuan Xiong 15g, Chi Shao (Red Peony) 15g, Gui Zhi 6g, Chuan Niu Xi (Cyathula) 20g, Wu Zhu Yu 10g, Dang Shen (Codonopsis) 15g, Ban Xia 10g, Mu Dan Pi 10g, Chuan Shan Jia (Pangolin) 10g, Shan Ci Gu (Rhizoma Paridis) 15g, Lu Jiao Shuang (Deer Antler) 15g, Cu Yuan Hu 10g, Chen Pi (Aged Tangerine Peel) 15g, Sheng Jiang 2 slices, and Da Zao (Jujube) 3 pieces as a guide. Decoction was taken once daily. After 7 doses, the breast pain decreased; after continuing for another 7 doses, the lumps reduced by more than half, and menstruation came with a larger volume than before. Subsequently, one week before menstruation, the Warming the Channels Decoction was the main formula with slight modifications, and after taking for 5-7 doses, menstruation came, and the medication was stopped. After two menstrual cycles of treatment, the breast lumps gradually disappeared, and other symptoms resolved. A follow-up with the computer infrared breast diagnostic device showed no abnormalities in both breasts. To date, menstruation has been regulated. [Cui Yonghua. Examples of Warming the Channels Decoction in Treating Gynecological Diseases. Henan Traditional Chinese Medicine, 2006, 26(5): 15]
2. Amenorrhea Ms. Wang, female, 28 years old, married. Initial consultation on April 10, 1998. Main complaint: “Amenorrhea for 1 year.” The patient had her first menstruation at 16, with irregular periods, volume, color, and quality. After marriage, it remained the same. The menstrual cycle was delayed by about 40 days, with scanty dark flow, abdominal pain during menstruation, and one year ago, during menstruation, due to urgent and exhausting circumstances, she immediately experienced amenorrhea. She had taken various Chinese medicines and intramuscular injections of progesterone without effect. Western gynecological examinations showed no organic changes. Current examination: she felt chronic lower back pain and cold abdomen, symptoms worsening during menstruation, with increased white discharge that was thin and fishy. The tongue coating was white and greasy, with cracks in the tongue, and the pulse was deep, thin, wiry, and weak. The diagnosis was deficiency of qi and blood, yang deficiency with cold congealing, obstructing the meridians. The modified Warming the Channels Decoction was prescribed: Gui Zhi 10g, Wu Zhu Yu 6g, Chuan Xiong 10g, Dang Gui 20g, Bai Shao 10g, Dan Pi 10g, Pao Jiang (Dried Ginger) 10g, Ban Xia 10g, Mai Dong 10g, Dang Shen 10g, E Jiao 6g, Zhi Gan Cao 6g, Ji Xue Teng (Sanguisorba) 20g, Xian Ling Pi (Epimedium) 10g, Du Zhong (Eucommia) 10g. After taking 2 doses, menstruation came, dark in color, thick in quality, scanty, lasting 3 days. After continuing with 20 doses, menstruation returned to normal. [Wang Caiqing. Clinical Experience of Warming the Channels Decoction in Gynecological Diseases. Sichuan Traditional Chinese Medicine, 2008, 26(6): 83]
3. Functional Uterine Bleeding (Menorrhagia) Case of Ms. Yue Mei: Ms. Zhou, female, 51 years old, from Shenh County, Hebei Province, first consultation on May 7, 1960. The patient had stopped menstruating for 3 years and had experienced occasional bleeding for half a year without treatment. One month later, the condition worsened, with continuous light bleeding, accompanied by abdominal pain. A diagnosis from a hospital in Tangshan indicated “functional uterine bleeding”. After injection of hemostatic drugs and taking hemostatic medicine, bleeding stopped for several days, but abdominal fullness and pain persisted, and after stopping the medication, the bleeding resumed. After taking several doses of Chinese medicine, there was no effect, and the patient became increasingly emaciated, leading her to seek treatment in Beijing. Upon examination, her complexion was pale, with five hearts feeling hot, afternoon tidal fever, dry throat, and constipation. Seven years prior, she had a miscarriage. The tongue was pale red, with a thin white coating, and the pulse was thin and rough. The diagnosis was deficiency of the Chong and Ren meridians, with stagnant blood internally. The treatment was to warm and tonify the Chong and Ren meridians, nourish blood, and dispel stasis, using Warming the Channels Decoction: Wu Zhu Yu 9g, Dang Gui 9g, Chuan Xiong 6g, Bai Shao 12g, Dang Shen 9g, Gui Zhi 6g, E Jiao 9g (melted), Dan Pi 6g, Ban Xia 6g, Sheng Jiang 6g, Zhi Gan Cao 6g, Mai Dong 9g. After taking 7 doses, the bleeding and afternoon tidal fever decreased. Continuing with the same formula, with slight modifications based on symptoms, after taking 20 doses, the bleeding suddenly increased, with black-purple blood clots, varying in color, and abdominal fullness that was sometimes light and sometimes heavy. The patient was very worried. The pulse had changed to deep and slow, and symptoms of five hearts feeling hot, dry throat, and fatigue had greatly improved. The doctor reassured the patient that the pulse and symptoms had improved, and the sudden increase in bleeding was a good sign, indicating that the righteous qi was driving out the evil. This stasis must be resolved for new blood to be generated, and the condition would be difficult to cure otherwise. The patient was advised to continue taking the original formula for 6 doses, one dose every other day. After taking the medicine, she passed blood clots for 5 days, and then the bleeding gradually decreased, with no more blood clots. Abdominal pain and fullness basically disappeared. After taking the original formula for another 5 doses, every other day, the bleeding stopped, but there was still constipation, which improved after 2 weeks of treatment with Ma Ren Run Chang Wan (Sesame Seed Laxative Pill). Follow-up after 10 years showed no recurrence.
4. Late Menstruation Patient Ms. Zhang, female, 20 years old, unmarried, first consultation on September 13, 1998. The patient reported that for the past six months, without obvious cause, her menstrual cycle had become irregular, occurring every 40-60 days. Previously, her menstruation was regular, starting at 14 years old, with a cycle of 30-35 days, lasting 3-4 days, with moderate flow, dark red color. The last menstruation was on February 5, 1998, with scanty flow, dark color, and clots, accompanied by cold pain in the lower abdomen, preferring warmth and light pressure, with cold limbs, and lower back pain, and a feeling of heaviness in the lower abdomen, frequent urination at night. The tongue was pale with a thin white coating, and the pulse was deep and thin. Examination showed normal external genitalia. Rectal examination revealed a retroverted uterus, small in size, with no tenderness on movement, and both adnexa were negative. B ultrasound indicated a small uterus. The Western diagnosis was sparse menstruation. The TCM differentiation was cold congealing in the uterus, with deficiency of the Chong and Ren meridians. The treatment principle was to warm the uterus, disperse cold, and replenish the Chong and Ren meridians. The modified Warming the Channels Decoction was used: Salt-fried Wu Zhu Yu 9g, Dang Gui 12g, Bai Shao 15g, Chuan Xiong 10g, Mu Dan Pi 12g, E Jiao 15g, Dang Shen 15g, Sheng Jiang 6g, Gan Cao 3g, Ba Ji Tian 9g, Rou Gui 6g, and Shu Di Huang 15g. Decoction was taken once daily. After taking 10 doses, menstruation came, and lower back and abdominal pain decreased. The patient was advised to take Wu Ji Bai Feng Wan (Black-Bone Chicken and White Phoenix Pill) for two boxes after menstruation, and to take the initial prescription for 6-9 doses on the 22nd day after menstruation. After continuous treatment for 3 months, menstruation returned to regular cycles, and symptoms of frequent urination and lower back pain also resolved. [Xu Qiuhui, Wang Xiurong. Three Cases of Warming the Channels Decoction in Treating Menstrual Disorders. Chinese Folk Therapy, 2005, 13(3): 53-54]
5. Dysmenorrhea Ms. Li, female, 45 years old, first consultation on May 5, 1993. Ten years ago, she developed dysmenorrhea after an abortion. Each menstrual period was accompanied by severe lower abdominal pain and coldness, and pain relief medications were ineffective. Menstruation was delayed, with scanty dark flow and clots. This time, menstruation started yesterday, accompanied by dry mouth, dizziness, lower back pain, and weakness in the legs. The tongue was dark, and the pulse was deep. The diagnosis was deficiency of the Chong and Ren meridians with cold and stagnant blood. The treatment should warm the channels, disperse cold, dispel stasis, and nourish blood. The modified Warming the Channels Decoction was prescribed: Wu Zhu Yu 8g, Gui Zhi 10g, Sheng Jiang 10g, Dang Gui 12g, Bai Shao 12g, Chuan Xiong 12g, Dang Shen 10g, Zhi Gan Cao 10g, Dan Pi 10g, E Jiao 10g, Ban Xia 15g, Mai Dong 30g. After taking 5 doses, the cold pain in the lower abdomen significantly reduced. Continuing with the original formula for another 5 doses, by the next menstruation, there was no lower abdominal pain, and menstruation became regular without discomfort.
In this case, after the abortion, the Chong and Ren meridians were empty, and cold evil took advantage of the situation, obstructing qi and blood, causing the meridians to be unblocked. Therefore, during menstruation, the meridians could not open, leading to lower abdominal pain. The “Complete Book of Women’s Good Remedies” states: “For women, abdominal pain during menstruation is due to labor injuring qi and blood, leading to body deficiency, and wind-cold qi invading the meridians, damaging the Chong and Ren meridians.” This is all due to deficiency of the Chong and Ren meridians with cold and stagnant blood, hence the effectiveness of the Warming the Channels Decoction. [Chen Ming, Liu Yanhua, Li Fang. Selected Cases of Liu Duozhou. Beijing: Xueyuan Press, 2007: 158-159]
6. Uterine Fibroids (Zheng Jia) Ms. Zhou, female, 49 years old, urban resident, first consultation on March 10, 2002. The patient experienced irregular menstruation with dark color and clots for one month due to emotional distress and overwork. She had previously improved with Western medication but relapsed after stopping. Symptoms included dizziness, fatigue, lower back pain, and dull pain in the lower abdomen. The tongue was dark, with a thin white coating, and the pulse was wiry and thin. B ultrasound indicated a slightly enlarged uterus with uterine fibroids (approximately 1.5cm x 2.0cm). Diagnosis: Menorrhagia (stagnant blood obstruction, kidney deficiency). The treatment should regulate the Chong meridian and stabilize the kidney, dispel stasis, and stop bleeding. The modified Warming the Channels Decoction was prescribed: Dang Gui 20g, Chuan Xiong 6g, Bai Shao 20g, Wu Zhu Yu 15g, E Jiao 15g (melted), Hei Dan Pi 10g, Shan Yao (Chinese Yam) 15g, Xian He Cao (Agrimonia) 15g, Jiao Shan Zha (Hawthorn) 15g, Gui Zhi 3g, Di Yu Tan (Burnt Ground) 10g, Sheng Jiang 2 slices, Da Zao 3 pieces as a guide. After taking 6 doses, the blood clots increased, and other symptoms gradually improved. Fatigue and weakness were due to prolonged bleeding damaging yin blood and kidney deficiency. The Stomach meridian of the Foot Yangming connects with the Chong meridian, nourishing yin, dispelling stasis, and warming the kidney to stabilize the Chong meridian. The formula was modified by removing Gui Zhi and Chuan Xiong, adding Ban Xia 10g, Mai Dong 15g, San Qi 10g, Rou Gui 3g, Du Zhong 10g, and Tu Si Zi 10g. After taking 6 doses, the bleeding stopped, and all symptoms disappeared. Follow-up B ultrasound showed no abnormalities in the uterus and adnexa. Clinically cured. [Cui Yonghua. Examples of Warming the Channels Decoction in Treating Gynecological Diseases. Henan Traditional Chinese Medicine, 2006, 26(5): 15]
7. Cold Uterus Infertility Ms. Jin, female, 28 years old, first consultation on March 15, 2005. She reported: Married at 22, has not conceived to date, and her partner’s reproductive system examination showed no abnormalities. Her gynecological examination was normal, and the fallopian tubes were patent. B ultrasound monitoring indicated follicle development. At the initial consultation, her menstruation was irregular, with cold pain in the lower abdomen, relieved by warmth, with scanty flow, pale color, and a watery appearance. She had severe breast tenderness before menstruation, was overweight, and usually felt cold with warm limbs, emotional distress, and occasional nausea with sour regurgitation. The tongue was fat with a white greasy coating. The diagnosis was deficiency of the Chong and Ren meridians with cold and stagnant blood. The modified Warming the Channels Decoction was prescribed: Dang Gui 15g, Chuan Xiong 12g, Chi Shao 15g, Shu Di Huang 18g, Dang Shen 12g, Wu Zhu Yu 6g, Gui Zhi 6g, Dan Pi 10g, Ban Xia 12g, E Jiao 15g, Mai Dong 9g, Yi Mu Cao (Motherwort) 12g, Tao Ren (Peach Kernel) 9g, Tu Si Zi 12g, Gan Cao 6g, Sheng Jiang 3 slices, Da Zao 6 pieces. The patient was instructed to take 5 doses after each menstruation for 6 cycles. Upon follow-up, she reported that menstruation had returned to normal, and accompanying symptoms had improved. She was advised to continue taking for 10 more cycles, and subsequently gave birth to a healthy baby boy. [Sun Guomin. Examples of Warming the Channels Decoction in Treating Gynecological Diseases. Journal of Shanxi University of Traditional Chinese Medicine, 2007, 8(2): 38-39]
8. Habitual Abortion Patient Ms. Cui, age 26, consulted on February 12, 2006. She reported having had 7 abortions in 5 years of marriage, which had become habitual, causing her great distress. The abortions occurred around 70 days of gestation, and she was currently 50 days pregnant, seeking to maintain the pregnancy and deliver at term. Upon examination, her body was plump, but her face was pale and puffy, with symptoms of lower abdominal heaviness, lower back pain, weakness in the legs, frequent nausea and vomiting, and poor appetite. The tongue was pale and tender, with a thin white coating, and the pulse was deep, slow, and weak, with intermittent irregularities. The diagnosis was deficiency of the Chong and Ren meridians with cold and declining kidney fire. The treatment should warm the kidney, support yang, tonify qi, and stabilize the Chong meridian, using a modified Warming the Channels Decoction. The prescription included: Dang Shen 12g, Dang Gui 10g, Bai Shao 12g, E Jiao 9g, Ban Xia 9g, Wu Zhu Yu 5g, Gui Zhi 6g, Du Zhong 12g, Lu Jiao Jiao (Deer Antler) 9g, Bu Gu Zhi (Psoralea) 6g, Chuan Xiu Duan (Chinese Angelica) 12g, Zhi Gan Cao 5g. After taking 3 doses, nausea and vomiting stopped, and lower back pain and abdominal heaviness decreased. The original formula was continued, removing Ban Xia and Gui Zhi, and adding Tu Si Zi 15g, with instructions to take one dose every three days until the end of the pregnancy. After taking a total of 23 doses, the pregnancy was stable, and in October of that year, she gave birth to a healthy boy, with both mother and child in good health. [Sun Guomin. Clinical Application of Warming the Channels Decoction. Journal of Chifeng University (Natural Science Edition), 2007, 23(5): 111]
9. Immature Uterus Ms. Li, a farmer, age 26. After three years of marriage, she had not conceived, and the maternal and child health hospital diagnosed her with an immature uterus. The patient had her first menstruation at 19, with irregular cycles, sometimes as long as six months between periods, with scanty flow and light red color. She was short in stature but in good spirits, with a weak, thin pulse and a pale tongue with a thin white coating. The Inner Canon states: “At the age of fourteen, the heavenly essence arrives, the Ren meridian is open, and the Chong meridian is strong, thus menstruation occurs regularly.” This woman had her first menstruation at nineteen, with scanty and light red flow, indicating insufficient kidney qi, unable to transform and generate essence and blood. With insufficient blood, the uterus fails to receive nourishment, resulting in a small uterus. The deficiency of essence and blood leads to delayed menstruation. The treatment should replenish the pre-natal essence, warm the Chong and Ren meridians, and nourish the uterus. The modified Warming the Channels Decoction was used: Dang Gui 30g, Chuan Xiong 6g, Bai Shao 5g, E Jiao 15g, Rou Gui 6g, Ba Ji Tian 12g, Dang Shen 30g, Dan Pi 5g, Gan Jiang 6g, Gan Cao 12g, Zi He Che (Placenta) 2g (taken in water). The addition of Ba Ji Tian warms the kidney and supports yang, promoting pre-natal strength, while Zi He Che nourishes qi and blood, originally meant to nourish the uterus, now returning to nourish the uterus, embodying the principle of mutual support (pharmacological studies confirm that Zi He Che contains various hormones, making it very compatible). After six months of treatment, she gave birth to a baby girl. [Zhang Qingyun. Clinical Application of Warming the Channels Decoction. Henan Traditional Chinese Medicine, 1985(6): 21]
10. Menopausal Syndrome A study of 60 patients was randomly divided into two groups. The treatment group had 30 cases, and the control group had 30 cases. Both groups underwent B ultrasound examinations to exclude gynecological organic diseases, cardiovascular, neurological, and endocrine gland organic diseases. Treatment methods: The treatment group used Warming the Channels Decoction. The composition included: Wu Zhu Yu 6g, Dang Gui 10g, Bai Shao 30g, Chuan Xiong 10g, Ren Shen 10g, Gui Zhi 10g, E Jiao 10g, Mu Dan Pi 10g, Sheng Jiang 10g, Gan Cao 10g, Ban Xia 12g, Mai Dong 20g. For those with severe qi deficiency, add Huang Qi (Astragalus), Bai Zhu (Atractylodes), and increase Ren Shen; for those with severe blood deficiency, increase Dang Gui and Bai Shao; for those with severe yang deficiency and cold intolerance, increase Sheng Jiang and Wu Zhu Yu; for those with severe yin deficiency, add Shu Di Huang and increase Mai Dong. Each menstrual cycle, take the medicine for two weeks after menstruation, one dose per day, decocted in water. The control group took 1mg of Norethisterone and 2mg of Progesterone tablets, taking one dose each during the second and third weeks after menstruation. Both groups were observed for three menstrual cycles. The comparison of the rates between the two groups used the chi-square test, and the mean comparison used the t-test. P≤0.05 was considered statistically significant. Results: After observing three menstrual cycles, the treatment group had 6 cases cured (symptoms disappeared, estradiol (E2) levels rose, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels significantly decreased), 18 cases improved (symptoms improved or partially disappeared, serum E2 levels rose, and FSH and LH levels decreased), and 6 cases ineffective (no change or worsening of symptoms, E2 levels remained low, and FSH and LH levels increased), with a total effective rate of 80%. The control group had 3 cases cured, 15 cases improved, and 12 cases ineffective, with a total effective rate of 60%. The comparison of total effective rates between the two groups showed a statistically significant difference (P<0.05). [Ma Xiaomei, Mu Qijin. Clinical Observation of Warming the Channels Decoction in Treating Menopausal Syndrome in 30 Cases. Shandong Medical Journal, 2008, 48(31): 102]
11. Sheehan’s Syndrome Ms. Ye, female, 28 years old, first consultation on November 29, 1992. She reported that during childbirth on March 14, 1991, she experienced massive hemorrhage due to retained placenta, leading to shock. After rescue, she survived, but 15 days postpartum, she began to experience hair loss, which later extended to pubic and axillary hair, along with insufficient lactation. To date, over 20 months later, menstruation has not resumed, libido has decreased, and her breasts have shrunk. The patient appeared pale and sallow, with sparse and dry hair, fatigue, shortness of breath, low energy, soft voice, spontaneous sweating, poor appetite, abdominal distension, and cold pain in the lower abdomen, with cold limbs, especially in the lower extremities, and afternoon low-grade fever (around 37.6°C), which subsided at night. The tongue was pale and swollen with a thin white coating, and the pulse was deep, thin, and weak. Gynecological examination revealed hair loss, dry and atrophic vaginal mucosa, and a soft, movable uterus measuring 2cm x 2cm x 1cm, with mild tenderness, and both adnexa were negative. The Western diagnosis was Sheehan’s syndrome. The TCM differentiation was qi deficiency and blood loss, with deficiency of the Chong and Ren meridians with cold. The treatment plan was to tonify qi and blood, and warm and supplement the Chong and Ren meridians. The modified Warming the Channels Decoction was prescribed: Wu Zhu Yu, Gui Zhi, Dang Gui, Bai Shao (fried), E Jiao, Dan Pi, Mai Dong each 10g, Zhi Huang Qi 30g, Dang Shen, Dan Cang, Zhi Shou Wu each 15g, Hu Lu Ba, Yin Yang Huo each 12g, Ban Xia 6g, Gan Jiang 6g. One dose daily. On January 10, 1993, after taking 34 doses, her appetite increased, energy improved, spontaneous sweating stopped, and tidal fever ceased, but residual symptoms remained. The tongue turned pale red, with a thin white coating, and the pulse was deep and thin. The original formula was continued, removing Mai Dong, Ban Xia, Dan Pi, and Dan Cang, and adding Bu Gu Zhi, Gou Qi Zi, and Zi Shi Ying each 15g, and replacing Gui Zhi with Rou Gui 10g. After taking 40 doses, on February 18, she reported that menstruation had resumed on February 6, with scanty light red flow lasting 2 days, hair began to regrow, and sexual desire was occasionally present. Lower abdominal cold pain had decreased compared to before. The original formula was continued for another 30 doses. On March 20, she returned for a follow-up, reporting that menstruation was regular, with moderate red flow, and no special discomfort. Her complexion was rosy, and hair and axillary hair had regrown. Gynecological examination revealed white, transparent secretions in the vagina, a smooth cervix, and a uterine size of 4cm x 6cm x 4cm. To consolidate the effect, she continued with the prescription from February 18, taking 30 doses concentrated and mixed with honey, taking 15ml on an empty stomach every morning and evening. Follow-up for one year showed no recurrence. [Xia Shanling. Examples of Clinical Application of Warming the Channels Decoction. Henan Traditional Chinese Medicine, 1996, 16(6): 378-379]
12. Oral Ulcers During Menstruation Ms. Tan, female, 25 years old, married, first consultation on November 15, 1992. For over a year, every time menstruation approached, she experienced a burning sensation in the throat, and oral ulcers. She had sought treatment from various doctors, who either prescribed heat-clearing and fire-dispelling herbs or yin-nourishing and fire-reducing herbs, but her condition had persisted for over six months without improvement. In the last three months, the symptoms had worsened, lasting over 20 days before improving, and then worsening again with the next menstruation. Examination revealed a pale complexion, low energy, dry lips, and a lack of fluids, with multiple large ulcerations in the mouth and under the tongue, with surrounding mucosa slightly red and swollen, and the pharyngeal mucosa pale red, with a subjective feeling of dryness and burning pain. The tongue was pale red with petechiae, a thin white coating, and the pulse was deep, thin, and rough. The menstrual cycle was normal, with scanty flow, dark purple color with clots, and severe lower abdominal pain before and during menstruation, preferring warmth and light pressure, with severe pain on heavy pressure. The usual white discharge was thin and clear, with no foul odor. The diagnosis was deficiency of the lower jiao with cold, obstruction of the Chong and Ren meridians, and upward disturbance of deficiency fire. The treatment should warm the channels, dispel stasis, nourish blood, and moisten dryness, using a modified Warming the Channels Decoction. The prescription included: Wu Zhu Yu, Gui Zhi, Chuan Xiong, Ban Xia each 9g, Dang Gui, Chi Shao, Dan Pi, E Jiao (melted) each 12g, Mai Dong 18g, Sheng Jiang, Gan Cao each 6g. After taking 5 doses, the burning sensation in the throat and oral ulcers decreased. Continuing with another 5 doses, menstruation came, with a large amount of dark purple blood clots expelled, and significant relief of lower abdominal pain, with oral ulcers nearly healed. If the symptoms did not improve, another 5 doses were taken, and all symptoms disappeared. Follow-up for one year showed smooth menstruation, with no recurrence.