BENG LOU 崩 漏

THE TREATMENT OF MENORRHAGIA WITH THE

WOMEN’S TREASURE REMEDIES

COPYRIGHT GIOVANNI MACIOCIA

 BENG LOU 崩 漏

NORMAL

“HEAVY PERIODS”

BENG 崩 = FLOODING BENG LOU

LOU 漏 = TRICKLE
AETIOLOGY PATHOLOGY
• EMOTIONAL STRAIN 1. BLOOD HEAT (OR BLOOD
•OVERWORK EMPTY HEAT OR
•EARLY SEXUAL DAMP-HEAT)
ACTIVITY 2. QI DEFICIENCY (OR QI AND
•EXCESSIVE PHYSICAL YIN DEFICIENCY)
WORK 3. BLOOD STASIS
•CHILDBIRTH
 The condition of Flooding and Trickling is called Beng Lou in
Chinese:

and lou means “trickle,

beng means
drip, dribble” or
“flood” or
trickling, dripping,
“flooding,
dribbling, leaking”.
bursting
through”

Flooding and Trickling encompasses two distinct symptoms, the former

indicating a period that starts suddenly with a flood, often before the proper
time, and the latter a period that continues with a trickle after the proper
time.
 BENG LOU - PATHOLOGY

1. BLOOD HEAT is characterized by profuse bleeding with bright-red or

dark-red blood. It may cause both Flooding and Trickling.

Blood-Heat most commonly derives from

Liver-Fire (itself deriving from emotional
problems as explained above): as the Liver
stores Blood and influences the Chong and Ren.

The Heart also plays its part

as Heart-Fire may heat Blood
because the Heart is linked to
the Uterus through the Uterus
Vessel (bao mai).
2. BLOOD EMPTY HEAT is characterized by lesser
bleeding or by prolonged spotting after the end of the
proper period. The colour of the blood is red or scarlet
red.

3. QI DEFICIENCY may cause flooding at the beginning

of the period or prolonged spotting after the period. The
menstrual blood is pale-red. Qi deficiency involves mainly
the Spleen and the Kidneys and there is an element of
sinking of Qi.
4. KIDNEY DEFICIENCY is very important in the
pathogenesis of Flooding and Trickling. When Kidney-
Qi or Kidney-Yang is deficient, the Chong and Ren do
not thrive. When the Chong and Ren are affected by a
Kidney deficiency they become “unstable”: they fail to
contain Blood, and Flooding and Trickling result. It
may also be a deficiency of Kidney-Yin.

5. 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 and the
period usually painful.
 BLOOD STASIS IN BENG LOU

When stagnant Blood obstruct the blood vessels, new Blood cannot
occupy its rightful place and leaks out giving rise to haemorrhages: thus,
in an apparent paradox, Blood stasis may cause bleeding. This happens
frequently in menorrhagia.

NEW
BLOOD Cannot enter the blood
vessels in the Uterus as
they are obstructed by
X
stagnant Blood and it
BLOOD leaks out
BLOOD
VESSELS IN
STASIS
Obstructs blood UTERUS
vessels

Haemorrhage
BLOOD HEAT QI OR YIN XU BLOOD STASIS

BLOOD HEAT QI XU
Liver (Heart) Spleen and BLOOD STASIS
SHI Kidneys (Yang) Liver (Heart)

BLOOD YIN XU
EMPTY HEAT Liver and
Liver and Kidneys (Yin)
Kidneys (Heart)
XU-SHI
BLOOD HEAT QI XU
Liver (Heart) Spleen and
SHI Kidneys (Yang)
Make blood spill out of Fail to hold blood in
vessels
BLOOD vessels

BLOOD YIN XU
EMPTY HEAT Liver and
Liver and Kidneys (Yin)
Kidneys (Heart)
XU-SHI

BLOOD STASIS
Liver (Heart)
POLL
In my experience, the pathology of excessive menstrual
bleeding is usually caused by:
a) Blood Heat
b) Blood Heat and Qi deficiency in roughly equal
proportions
c) Qi deficiency
d) Blood stasis
e) Emotional problems
 SINKING OF QI

Please note that in Beng Lou, there is always

sinking of Qi especially in Xu types, i.e. Qi Xu
or Yin Xu. However, even in the Full types
from Blood Heat, in chronic cases (years
duration) there is an element of Qi sinking and
“lack of consolidation” of Ren and Chong Mai
(Chong Ren Bu Gu 冲 任 不 固)
Sinking of Qi seen in Beng Lou involves not only the Spleen
but also the Kidneys as they influence the Uterus. Thus, one
must lift Qi of the Spleen and Kidneys. In acupuncture, this
is done with LU-7 on the right, KI-6 on the left, Du-20 and
Ren-4.

In herbal medicine, this is done by adding Huang Qi and

Chai Hu to the formula.

Acupuncture: Du-20, Ren-4, LU-7 and KI-6 (Ren Mai)

 BENG LOU PATHOLOGY - CHANNELS

Irrespective of the cause of bleeding (e.g. Blood Heat, Qi Xu, etc.) in Beng
Lou there is always what is called “Chong and Ren not stable” (Chong Ren
Bu Gu 冲 任 不 固 ). This means that in Beng Lou bleeding, there is
always a pathology of the Chong and Ren (and Du) irrespective of the
cause.

One must therefore “consolidate the Chong and Ren” to treat chronic
menorrhagia. This involves using some warm herbs even though the
bleeding may be from Blood Heat. Do not forget Du Mai if there is KI-
Yang Xu.
 The “General Treatise on the Aetiology and Symptoms of
Diseases” (AD 610) says:

“Flooding is due to injury of the Ren and

Chong Mai. These vessels originate from
the Uterus and are the Sea of channels;
when they are injured their Qi becomes
deficient and fails to hold Blood in the blood
vessels and channels”.

Chao Yuan Fang AD 610 General Treatise on the Aetiology and Symptoms of Diseases (Zhu
Bing Yuan Hou Zong Lun 诸 病 源 候 总 论 ) cited in Nanjing College of Traditional
Chinese Medicine 1979 Gynaecology in Chinese Medicine (Zhong Yi Fu Ke Xue 中 医 妇 科
学 ), Nanjing College of Traditional Chinese Medicine, Nanjing, p. 47.
Of the two vessels, the Ren Mai
is particularly involved in the
pathology of Beng Lou because
this vessel influences the Uterus
and the Kidneys.

For this reason, to treat this condition, I

nearly always needle LU-7 Lieque (on the
right) and KI-6 Zhaohai (on the left) to
regulate the Ren Mai.

Due to the importance of the Ren Mai in the pathology of Beng Lou, the
Kidneys also play a very important and central role in the pathology and
treatment of this condition.
Whatever the type of Beng Lou, eventually the Kidneys have to be
treated. Indeed, “consolidating Chong and Ren and Du” involves
tonifying the Kidneys.

Together with LU-7 and KI-6, I

use Ren-4 Guanyuan, most
important point to consolidate
Chong and Ren, often together
with KI-13 Qixue.

The main herbs that “consolidate Chong and Ren” are:

Xu Gui Ban Du Zhong

Duan Plastrum Cortex
Radix Testudinis Eucommiae
Dipsaci
POLL
Thinking of my experience in treating menorrhagia, I use the following
modality:
a) Only acupuncture
b) Only herbal medicine (custom-made prescriptions)
c) Ready-made formulae only
d) Combination of acupuncture and ready-made formulae
e) Combination of acupuncture and custom-made prescriptions
 TREATMENT PRINCIPLES
In Beng (as opposed to Lou), one should use herbs that lift Qi,
consolidate and astringe, and not use warm-pungent herbs that move
Blood (except, of course, if there is Blood stasis).

In Lou (as opposed to Beng), in general one must nourish Blood and
regulate Qi and not make much use of consolidating, astringent
herbs.

In young girls one must tonify the

Kidneys and strengthen the Chong and
Ren;
in young women one must pacify and
nourish the Liver;
and in pre-menopausal women one must
nourish Liver- and Kidney-Yin,
strengthen the Spleen and consolidate
the Chong and Ren.
 TREATMENT PRINCIPLES

BENG: raise Qi, LOU: nourish Blood, regulate Qi, not much
consolidate, astringe consolidation or astringing

IMPORTANT ADVICE
! !
Both practitioner and patient must be patient: it takes time to treat
Beng Lou, I would say a minimum of 6-9 months.

Also, do not pay excessive attention to stopping bleeding. In the long

run, Beng Lou can be treated only by treating its cause and consolidating
Chong and Ren. Eventually must always treat the KI to consolidate
Chong and Ren. Treat according to the 4 phases if at all possible.
 ADVICE FOR BENG LOU TREATMENT

1. DO NOT OVERCONCENTRATE ON STOPPING BLEEDING, TREAT

THE ROOT CAUSE AND TRUST

2. TREAT DURING PHASE 2 TO TONIFY KIDNEYS AND

CONSOLIDATE CHONG AND REN

3. DO NOT TRY TO STOP BLEEDING IN THE LOU PHASE, LET IT

BE, AND CONSOLIDATE CHONG AND REN

4. SUSPECT BLOOD STASIS IN CHRONIC CONDITIONS

5. TREAT ACCORDING TO 4 PHASES

 Three Steps in Treatment
1. “Shore up the flow”: this means stopping the bleeding. This is the
method adopted in acute cases or during the period itself, especially for
Flooding (as opposed to Trickling).
2. “Settle the Source” means treating the Root (ben) of the condition by
addressing the cause, the “source” being the source of bleeding, i.e. the
underlying pattern that is causing bleeding (Blood-Heat, Qi deficiency,
etc.). This method must be adopted to treat the underlying cause of
bleeding, once the bleeding itself has been dealt with in the preceding
step.

3. “Restore the Old” means to treat the organs involved in the disharmony
which caused bleeding. This method is adopted after a woman has been
successfully treated for Flooding and Trickling and consists in tonifying
the Kidneys, regulating the Liver, strengthening the Spleen and tonifying
the Heart, and consolidating the Chong and Ren according to
circumstances.
 THE FOUR PHASES OF THE MENSTRUAL CYCLE

YANG

YIN

Phase 1: Period Phase 2: Post- Phase 3: Mid-cycle Phase 4: Pre-

menstrual menstrual
Transformation Transformation
from Yang to Yin from Yin to Yang
 ADAPTING THE TREATMENT METHODS OF BENG LOU TO 4
PHASES
Ultimately, Beng Lou can be treated only by regulating the 4 phases, NOT
by stopping bleeding. If the phases can be identified, the treatment
principles are as follows:

Phase 1: stop bleeding, invigorate Blood if there is Blood stasis

Phase 2: nourish Blood, tonify the Kidneys, consolidate Chong, Ren and Du.
Important to treat during this phase.
Phase 3: tonify the Kidney, consolidate Chong and Ren, treat Ben
Phase 4: move Qi, invigorate Blood if necessary, treat Ben, resolve Dampness
if necessary.
If it is difficult to identify the phases, treat Ben and stop bleeding. Wait for
period (an increase in bleeding), stop bleeding during the period and then
treat for a week after the end of period taking it to be Phase 2. If there is the
fertile vaginal mucus, adopt treatment principle relevant to phase 3.
 WHAT TO DO WHEN THE PERIOD IS IRREGULAR

1. WAIT FOR PERIOD : THAT IS PHASE 1 AND AFTER THE

BLEEDING, PHASE 2

2. CHECK FOR CERVICAL SECRETION: WHEN THAT APPEARS,

THE WOMAN IS IN BEGINNING OF PHASE 3

3. CHECK BBT : WHEN IT RISES, THE WOMAN IS AT THE

BEGINNING OF PHASE 3 AND, AFTER THAT, PHASE 4

4. CHECK FOR PRE-MENSTRUAL SYMPTOMS : PHASE 4

POLL

Thinking of your experience with treating excessive menstrual

bleeding, which statement applies to you?
a) I never treat menorrhagia according to the 4 phases.
b) I sometimes treat menorrhagia according to the 4 phases.
c) I always treat menorrhagia according to the 4 phases.
d) There is no evidence that treating according to the 4 phases
makes any difference
 PATHOLOGY OF CHRONIC BENG LOU

BLOOD BLOOD XU YIN XU

HEAT
BLOOD
EMPTY
HEAT

QI XU BLOOD XU BLOOD
EMPTY
HEAT

BLOOD BLOOD XU QI XU
HEAT
 CASE HISTORY

A 32-year-old woman had been suffering from Beng Lou

for 5 years. She was bleeding almost every day,
sometimes flooding and sometime trickling. She was
pale, tired, looking depressed, moving slowly, her pulse
was weak.

Diagnosed Beng Lou from Qi Xu. Treated her accordingly without

results.
Re-checked diagnosis and found out:
•Cheeks occasionally red
•Felt occasionally thirsty and occasionally hot
•Tongue slightly red on sides
Treated her for Beng Lou from Blood Heat and started to improve
 CASE HISTORY
A 42-year-old woman had been suffering from Beng Lou for a
long time. She bled most of the month. During the period the
blood was dark with clots and the period was painful. The
underlying pattern was clearly SP and KI-Yang Xu not
holding Blood.

Her tongue was Pale and her pulse was Deep and
Weak. She was overweight.

I started by giving her a remedy for Beng Lou from Qi Xu: this produced
no improvement. I then gave her a remedy that nourished Yin and stopped
bleeding (because her tongue lacked coating in patches), with no
improvement. I reviewed the case and paid more attention to the painful
periods
 BLOOD-HEAT

Clinical manifestations
Flooding suddenly, often before the proper time, or
trickling of blood for a long time after the end of
the proper period, blood bright-red or dark-red,
thirst, agitation, feeling of heat, dark urine,
constipation.

Tongue: Red with a yellow coating.

Pulse: Rapid-Overflowing.

Treatment principle
Clear Heat, cool Blood, stop bleeding.
 Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), L.I.-11 Quchi,
SP-10 Xuehai, SP-8 Diji, SP-1 Yinbai, KI-5 Shuiquan, SP-6 Sanyinjiao, KI-
2 Rangu and LIV-3 Taichong, LIV-5 Ligou, KI-4 Dazhong, LIV-1 Dadun.
Reducing method, no moxa.
-Ren-6 Qihai, LIV-1 Dadun, KI-10 Yingu, LIV-3 Taichong, KI-2 Rangu,
SP-6 Sanyinjiao, Ren-3 Zhongji.
-HE-5 Tongli, LIV-2 Xingjian, SP-6 Sanyinjiao.

Prescriptions from the “Great Compendium of Acupuncture” Heilongjiang Province National

Medical Research Group, 1984, An Explanation of the Great Compendium of Acupuncture (Zhen Jiu
Da Cheng Jiao Shi 针 灸 大 成 校 释 ), People's Health Publishing House, Beijing, p.
1107. The "Great Compendium of Acupuncture" itself was published in 1601.

COOL THE MENSES

 BLOOD EMPTY HEAT

Clinical manifestations
Sudden flooding outside the time of the proper
period or trickling for many days after the
period, blood fresh-red and rather watery,
mental restlessness, feeling of heat in the
evening, malar flush, scanty-dark urine, dry
stools.

Tongue: Red without coating.

Pulse: Floating-Empty or Fine-
Rapid.
 Treatment principle
Clear Empty Heat, cool Blood, nourish Yin, stop bleeding.

Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), KI-2 Rangu,
LIV-3 Taichong, KI-5 Shuiquan, SP-1 Yinbai, SP-6 Sanyinjiao, SP-8
Diji, Ren-4 Guanyuan, L.I.-11 Quchi, SP-10 Xuehai, LIV-1 Dadun.
Reducing method except on Ren-4 which should be reinforced.

CLEAR EMPTY HEAT AND COOL THE MENSES

 STASIS OF BLOOD

Clinical manifestations
The period is hesitant, starting and stopping; it may seem
to stop then start again with a flood or it may trickle for a
long time after the period; pain before the period; blood
dark with clots, abdominal distension, dark complexion.

Tongue: Bluish-Purple or Reddish-Purple.

Pulse: Choppy or Wiry.
Treatment principle
Invigorate Blood, eliminate stasis, stop bleeding.

Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), LIV-3
Taichong, T.B.-6 Zhigou, LIV-1 Dadun, SP-8 Diji, ST-30 Qichong, SP-12
Chongmen, SP-10 Xuehai, SP-6 Sanyinjiao. Reducing method.

INVIGORATE BLOOD AND STEM THE FLOW

 SPLEEN NOT HOLDING BLOOD

Clinical manifestations
Flooding at the beginning of the period which
then stops and goes on with a trickle for a long
time after the period proper, pale and watery
blood, pale face, tiredness, slight dizziness, no
appetite, loose stools.

Tongue: Pale, teeth-marks.

Pulse: Weak.
Treatment principle
Tonify Qi, strengthen the Spleen, nourish Blood, stop bleeding.

Acupuncture
Ren-6 Qihai, Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20
Pishu, BL-21 Weishu, Du-20 Baihui, SP-8 Diji. Reinforcing method,
moxa may be used.

RESTRAIN THE FLOW

 KIDNEY-YANG DEFICIENCY

Clinical manifestations
Prolonged bleeding with a trickle for a long time after the proper
period, periods coming late, blood pale, feeling cold, sore back,
cold limbs, pale complexion, weak knees, pale urine.

Tongue: Pale and Swollen. Pulse:

Deep and Weak.

Treatment principle
Tonify and warm the Kidneys, consolidate the Directing and Penetrating
Vessels, stop bleeding.
Acupuncture
Ren-6 Qihai, BL-23 Shenshu, Ren-4 Guanyuan, ST-30 Qichong, KI-7
Fuliu, ST-36 Zusanli, SP-6 Sanyinjiao, KI-13 Qixue. Reinforcing method,
moxa must be used.
A prescription which is specific to raise Qi and consolidate the
Penetrating Vessel to hold Blood is: SP-1 Yinbai with moxa cones, BL-20
Pishu, SP-6 Sanyinjiao, Du-20 Baihui, Ren-6 Qihai and Ren-4 Guanyuan,
all with reinforcing method.

RESTRAIN THE FLOW

May be combined with small dose of Strengthen the Root

 KIDNEY-YIN DEFICIENCY

Clinical manifestations
Trickling of blood after the period proper, late
cycle, fresh-red and watery blood, dizziness,
tinnitus, weak knees, feeling of heat in the
evening, night-sweating, hot flushes, malar flush,
mental restlessness.

Tongue: Red without coating.

Pulse: Floating-Empty.

Treatment principle
Nourish Yin, strengthen the Kidneys, stop bleeding.
 KIDNEY-YIN DEFICIENCY

Acupuncture
Ren-6 Qihai, BL-23 Shenshu, Ren-4 Guanyuan, KI-3 Taixi, ST-36 Zusanli,
SP-6 Sanyinjiao, KI-2 Rangu, KI-13 Qixue, KI-10 Yingu, LU-7 Lieque (on
the right) and KI-6 Zhaohai (on the left). Reinforcing method on all points
except KI-2 which should be needled with even method. No moxa.

NOURISH YIN AND RESTRAIN THE FLOW

 HEAVY PERIODS – BENG LOU

• COOL THE MENSES (BLOOD HEAT)

(Clear Heat, cool Blood, stop bleeding)

• CLEAR EMPTY HEAT AND COOL THE MENSES (BLOOD EMPTY

HEAT)
(Clear Blood Empty Heat, stop bleeding)

• INVIGORATE BLOOD AND STEM THE FLOW (BLOOD STASIS)

(Invigorate Blood and stop bleeding)

• RESTRAIN THE FLOW (QI XU)

(Tonify Qi, stop bleeding)

• NOURISH YIN AND RESTRAIN THE FLOW (QI AND YIN XU)
(Nourish Kidney-Yin and stop bleeding)
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