By Keren Zelicha
崩 Beng – Metrorrhagia (irregular massive uterine bleeding)
漏 Lou – Metrostaxis (slight but continuous uterine bleeding) more then 2 weeks
The uterine bleeding must occur more then two weeks
Beng Lou is one of the frequent gynecology disease which is also considered as a difficult one.
The term Beng was already mentioned in the neijing as a yin deficiency and yang dominant .later the term beng lou was mentioned in the 《 病 源 侯 论》bing yuan hou lun as a disorder of the chong- ren which cant control the blood therefore causing bleeding not in the right time .
Today we conceder the root of this disease as an involvement of kidney deficiency.
Mechanism & pathology:
imbalance and damage of the chong-ren , inability to control blood & menstruation causing uterine bleeding out of time and menstruation disorder .
Frequently seen is blood heat, kd xu, sp xu, blood stagnant…..
1. 血 热 – heat in the blood :
heat in chong ren can cause blood moving out of the vessels . heat of blood is divided into 2 parts:
《实 热》- excessive heat : over surging of yang , liver yang easily effected or a long disease which causes stagnation that changes into fire. Another possibility is an invasion of external heat pathogen or eating hot spicy food that is changing into fire. Fire enter chong-ren influencing the sea of blood and causing bleeding not in time of menstruation- beng lou.
《虚热》- deficient heat : due to yin deficiency or long disease which damaged to yin and blood. Yin and water are less in quantity , the heart and liver are not nourished therefore heat is accumulating inside of the body. Heat influencing the sea of blood and causing bleeding not in time of menstruation – beng lou.
2. 肾 虚 – kidney deficiency :
Pre heaven qi deficiency , weakness of kd qi ,tian kui ( 7 years cycle) is not matured, all causing un fullness of chong-ren or – As the years go by the kd qi is weakening , causing sever deficiency.
Another reason can be due to surgery that damaged the uterus and kd qi. When kd qi is week the ability of storing is declining, chong ren are not firmed, cant control menstruation blood causing beng lou.
3. 脾虚 – sp deficiency :
over thinking, over eating harming the sp qi , qi direction diverse downwards, weakness, chong-ren not firm, cant control blood causing beng lou.
4. 血 淤 – blood stagnation:
7 emotion disorder causing chong ren stagnation. Too much bleeding after delivery or when in menstruation, pathogen cold or heat invading the body leading to stagnation. Stagnation influencing the free flow of chong ren causing beng lou.
Beng lou can damage blood and qi, prolong time can lead to both blood & qi deficiency , qi & yin deficiency or yin yang deficiency. The disease can involve 4 zang but dominancy will be of kd ,sp.
If 5 organs are involved the kd symptoms will be dominant.
Diagnosis:
Sudden big quantity of bleeding not in the proper time, or dripping of blood for long time more than 14 days after the regular time of menstruation.
This disease although the quantity of blood can be similar to other menstruation diseases there are few differences : in early menstruation the period comes early in a regular fixed time , while beng lou is bleeding without any fixed date or connection to the menstruation cycle. Excessive menstruation bleeding can be similar to beng (amount is big) , prolonged menstruation can be similar to lou (drips of blood continuously) but these two diseases happen during the cycle in a fixed time and after 7-14 days stops by them selves.
Irregular menstruation : the time of menstruation is not normal – it can come early or late during 7-14 days but the period of bleeding is normal (ex.4-6 days).
Beng lou today should be differentiated from delivery problems, red leucorrhea, myoma and other uterus bleeding.
Differentiation:
The main symptom is bleeding, therefore we need to consider the blood’s color & amount.
Most of beng lou are of deficient type, heat is more than cold, but the heat refers to deficient heat.
Sometimes beng is more dominant sometimes lou is more seen, the two can change to each other .chronic beng causes weakness, chronic lou causes stagnation.
Treating beng we don’t use acrid warm moving blood herbs but astringent the blood. Treating lou we cant astringent blood but need to nourish it and move qi. In young women the strategy will focus on boosting chong ren, tonifying kd qi , in more adult years the focus is to open liv qi and nourish it. In elderly women nourishing kd harmonizing liver supporting sp and securing chong ren.
血热 heat in blood：
虚 热 证 empty heat ：
Symptoms: sudden bleeding without a connection to the cycle, amount is big – or small drops of blood, blood is fresh red and thick, little yellow urine, dry stools, tongue thin yellow coating, pulse thin, fast.
This is yin xu + heat in the blood ,chong ren aren’t stable. Heat is breaking the blood out of the vessels and not in the proper time. If yin xu is dominant so the amount of blood will be little, if the heat is dominant the blood amount will be large.
Action: nourish yin, clear heat, stop bleeding, harmonize menstruation.
Formula: bao yin jian 保阴煎
Shu di, bai shao, huang qin, huang bai, chuan duan, shan yao, gan cao,
add ren shen mai dong wu wei zi
实 热 证 excessive heat:
symptoms: sudden bleeding or drops of blood for long time, deep red color sticky, thirst feeling of heat, irritability, yellow little urine, constipation, tongue yellow or yellow sticky coating, pulse- overflowing ,fast.
Excess heat stagnated inside, harming chong ren, the sea of blood is imbalanced blood is flowing outside, heat is damaging heart so there is irritability and damage to the St causes thirst.
Action: clear heat cool blood, stop bleeding harmonize menstruation.
Formula: qing re gu jing tang 清热固经汤
Huang qin, zhi zi, sheng di, di gu pi, di yu, E jiao, ou jie, long gu, mu li, gui ban, sheng gan cao.
