Significant fatigue in the context of iron deficiency anemia with heavy periods and severe dysmenorrhea
Woman, 31 years old, overweight.
August 2019: Consulted for significant fatigue in the context of iron deficiency anemia.
The menstrual cycle is irregular, ranging from 21 to 35 days. Periods last 10 days and are heavy, with large clots. There is significant lower abdominal pain during the first 3-4 days of menstruation. There is also a right ovarian cyst and white vaginal discharge throughout the cycle.
In addition, she experiences constipation with hard, dry stools once every 4-5 days, abdominal fullness and distension, significant thirst (approximately 3.5 liters per day), a dry mouth, awakenings (1-2 times) during sleep, and a feeling of heaviness in her body. The patient also presents with a highly emotional state, with frequent crying.
The pulse is thin (xi) and slippery (hua) at the left cubit, and stagnant (zhi) at other positions. The tip of the tongue is red. The abdomen shows periumbilical induration and fullness with significant tenderness on palpation, and painful spots below the umbilicus (oketsu).
Treatment :
Tao He Cheng Qi Tang is prescribed until a loose or diarrheal stool is obtained. This is immediately followed by the Gui Zhi Fu Ling Wan formula augmented with zhishi and jiu dahuang , in standard decoction, and then again with this latter formula for a period of 10 days between menstrual periods for 3 months.
Results :
After two days of taking Tao He Cheng Qi Tang , followed by 10 days of increased Gui Zhi Fu Ling Wan, bowel movements are slightly loose once a day, and the first period is painless, lasting five days, though still with clots. The emotional state with easy crying has subsided. The sensations of heaviness, night awakenings, and fatigue have decreased. The pulse is still somewhat thin (xi) and slippery (hua) at the left cubit and stagnant (zhi) at other positions. The abdomen is soft and significantly less tender to the touch, but there is still oketsu.
At the end of the three-month treatment, fatigue has disappeared; the cycle is regular (29 days); periods last 5 days without pain or clots; there is no more vaginal discharge; sleep is good; bowel movements are normal (1-2 times/day); the pulse is no longer thin (xi) and slippery (hua), but remains somewhat stagnant (zhi). Six months later, there has been no recurrence.