Case Study: Uterine Prolapse by Jin Zhao DTCM Ph.D compiled and recorded by Inbar Cohen Dipl. C.M

Patient: 61-year-old woman with uterine prolapse for about 3 years

Additional Symptoms:

- Severe abdominal pain. Exacerbated after movement or exercise

- Fatigue

Medical History:

- Menopause at age 50

- Two pregnancies, two deliveries

Tongue: Pale, slightly swollen, white and wet coating, yellow in the center. Deep crack in the upper jiao

Pulse: Deep, thin, slippery, lacking force under pressure

Prescription:

Huang Qi 20g

Zhu Ye Chai Hu 10g

Fu Ling 20g

Bai Zhu 20g

Fu Zi 5g

Sha Ren 3g

Ren Shen 5g

Gan Jiang 5g

Shan Yao 15g

Xu Duan 15g

Rou Gui 3g

Bai Bian Dou 15g

Chao Bai Shao 10g

Bai Dou Kou 5g

Chao Cang Zhu 15g

Huo Xiang 15g

Jian Qu 10g

Sheng Jiang 5g

The patient received 24 packets for 24 days.

Explanation and Analysis:

Organ prolapse, particularly in the lower burner, is typically associated with a weak Spleen unable to hold organs in place. In this patient, the signs point to Qi and Yang deficiency in the Spleen. However, the formula suggests that the deficiency also involves the Kidneys, not just the Spleen. The main indicator for this is the pulse - weak even under pressure. If only the Spleen were involved, we would feel the Kidney Qi present while pressing the pulse deeper.

The weak Spleen fails to separate the turbid from the pure, resulting in dampness as seen on the tongue, with an inability to raise the pure upwards - leading to Spleen Qi sinking and uterine prolapse. The main formula chosen to address this is Bu Zhong Yi Qi Tang.

The deficiency in Yang and Qi causes insufficient Qi movement and proper warming of the middle, creating cold stagnation in the middle - manifested as severe abdominal pain (cold contraction), originating from deficiency (worsened by movement). The main formula chosen to address this is a combination of Fu Zi Li Zhong Wan + Huang Qi Jian Zhong Tang.

As everything sinks downward, dampness and fluid retention are formed and stagnant, and the tongue coating becomes yellowish. Yet, the tongue coating is moist, not dry, indicating that the problem lies with fluids and damp, and there's no need to clear heat to treat stagnant heat. Once we address the Yang deficiency and dampness, the heat will dissipate on its own.

Another interesting point to note is the cracks on the tongue - indicating essence (Jing) deficiency. Typically, to treat this, we would need to use essence and Yin tonifying herbs. However, since the patient's main complaint doesn't primarily relate to this at present, and because essence-tonifying and Yin-tonifying herbs would be too difficult to digest for a patient with Qi and Yang deficiency and cold in the middle, Dr. Jin chooses a gentle strategy of strengthening Spleen Yin to support this issue in the background.

According to Dr. Jin, Spleen Yin deficiency is a type of Yin deficiency at a relatively low level. Its manifestation will be in the failure of the Spleen's absorption and retention functions - leakage, sweating, blood escaping its vessels, etc., and the main formula for treating this would be Shen Ling Bai Zhu San, which strengthens Spleen Qi and Yin. The two main herbs in it addressing Spleen Yin would be Shan Yao + Bai Bian Dou.

The main formulas chosen for the patient:

Bu Zhong Yi Qi Tang

Fu Zi Li Zhong Wan + Huang Qi Jian Zhong Wan

Shen Ling Bai Zhu San

Bu Zhong Yi Qi Tang:

• Huang Qi

• Ren Shen

• Bai Zhu

• Zhu Ye Chai Hu - slightly cooler than the original herb

Omitted from the prescription: Dang Gui, Chen Pi, Sheng Ma

Fu Zi Li Zhong Wan + Huang Qi Jian Zhong Wan:

• Fu Zi

• Ren Shen

• Gan Jiang

• Bai Zhu

• Rou Gui (instead of Gui Zhi)

• Chao Bai Shao - stir-fried. Changes its temperature from cool to warm.

• Sheng Jiang

Modifications to strengthen Kidney Qi and Yang:

• Xu Duan

This is a combination of the two aforementioned formulas, both aimed at warming the middle and supporting the Spleen and Kidneys.

Dr. Jin adds Xu Duan, which has a gathering quality - known to absorb Kidney Qi and thus helps with prolapses and bleeding.

Bai Shao is present here both as part of the formula and as an herb in its own right - known to stop pain due to deficiency. If the pain were due to excess, we would see herbs like Yan Hu Suo or herbs from the Qi-Regulating group.

Omitted from the prescription: Yi Tang, Gan Cao, Da Zao - all sweet and thus unsuitable when there's significant dampness.

Shen Ling Bai Zhu San:

• Ren Shen

• Bai Zhu

• Fu Ling

• Shan Yao

• Sha Ren

• Bai Bian Dou

Omitted from the original formula: Yi Yi Ren, Lian Zi, Jie Geng

Modifications:

Aromatic, acrid, and Spleen-awakening herbs:

Dr. Jin adds a group of aromatic, acrid, and warm herbs to the formula, whose function is to awaken the Spleen, move cold from the middle, and help it return to its function. 

These herbs are considered Wind Herbs - their direction is upward and outward, and they help raise Yang Qi and open the Xuan Fu pores throughout the body.

• Huo Xiang

• Bai Dou Kou

• Sha Ren

Jian Qu - very similar to Shen Qu, focuses more on dampness and not just food stagnation. Treats external cold better.

As part of its function as an herb that helps with food stagnation, it knows how to move stagnation and turbidity in the Middle Jiao and support the Spleen and Stomach.

Chao Cang Zhu - stir-fried with wheat bran, which makes the herb warmer, reduces its aroma, and thus refines its activity.

Together with Fu Ling, it is intended to help dry dampness from the middle and the entire body (greasy tongue coating) and help open the Xuan Fu.