including Yang-Qi or Yin-Qi deficiency. Thus it is not only Spleen deficiency which causes
deficient bleeding, but also Spleen-Yang, Kidney-Yang or Kidney-Yin deficiency.

Blood stasis causes excessive blood loss during the period and also some blood loss before the
proper period time. The blood is dark with dark clots.

Excessive menstrual bleeding often leads to complex pathological conditions as the excessive
bleeding over many years itself becomes a pathogenic factor. For example, excessive bleeding
from Blood-Heat may eventually lead to Blood and Yin deficiency. This, in turn, leads to
Empty-Heat which, itself, becomes a further cause of bleeding. Excessive bleeding from Qi
deficiency will eventually also cause Blood deficiency. As Blood is the mother of Qi, blood loss
will further weaken Qi thus perpetuating the condition.

Differentiation and Treatment

Treatment Principles

The treatment strategy of menorrhagia and metrorrhagia is largely based on the general
principles outlined in the chapter on "Bleeding" (Chapter 30). These were first advanced in the
book "Discussion of Blood Syndromes" by Dr Tang Zong Hai (1884). As will be remembered,
Dr Tang adopts a four-fold strategy, i.e.:

1. Harmonize Blood


2. Treat the Root-cause of bleeding


3. Astringe


4. Treat Qi.

The first of these treatment aims, in turn, is composed of four steps:

(a) Stop bleeding

(b) Eliminate stasis

(c) Calm Blood

(d) Nourish Blood.

Let us now analyse these four treatment aims to stop bleeding with particular reference to
gynaecology.