A Case Study: Adenomyosis with Excessive Bleeding Leading to Anemia
The patient, a 46-year-old woman surnamed Liu from Shandong Province, underwent ultrasound on August 7, 2024 at Shandong Provincial Hospital. The results showed that the myometrium of the posterior uterine wall was slightly thickened (about 3.1 cm), with rough, heterogeneous echogenicity, and adenomyosis was diagnosed. The patient had previously sought my help for thyroid cancer; after being diagnosed with adenomyosis, the hospital recommended direct hysterectomy. Fearing surgery, she came to me. I suggested she take the Chinese patent medicines Guipi Wan (Spleen-Returning Pill) and Erzhi Wan (Two-Seed Pill). Although the interval between her periods lengthened slightly (by two days) and menstrual flow decreased somewhat after taking them, the overall effect was not satisfactory.
On April 22, 2025, feeling that her symptoms had worsened, she came back to me. Long-term bleeding from adenomyosis had already caused moderate anemia. She experienced palpitations and chest tightness after walking a little, was fatigued, could not lift heavy objects, and had abdominal distension. Considering the limited effect of the patent medicines she had taken, I decided to try a decoction. Her condition at that point was one of dual deficiency of qi and blood, so treatment focused on supporting the righteous qi (fuzheng).
The formula was as follows: Agrimonia (xianhecao) 100 g; raw Astragalus (sheng huangqi) 30 g; Angelica sinensis (danggui) 6 g; Codonopsis (dangshen) 15 g; Polygonatum (huangjing) 15 g; Ophiopogon (maidong) 10 g; Schisandra (wuweizi) 10 g; Sanguisorba carbon (diyu tan) 15 g; Ligustrum (nüzhenzi) 10 g; Eclipta (mohanlian) 10 g; Astragalus complanatus (shayuanzi) 10 g; Cuscuta (tusizi) 10 g; prepared Rehmannia (shudihuang) 15 g; Paeonia Alba (baishao) 10 g; human hair carbon (xueyu tan) 6 g; petiole carbon (zonglü tan) 10 g; Atractylodes macrocephala (baizhu) 10 g; Poria (fuling) 10 g; honey-fried Licorice (zhi gancao) 10 g; Morinda (bajitian) 10 g; Epimedium (xianlingpi) 10 g. One decoction daily, taken once after breakfast and once after dinner.
After taking 10 doses, the bleeding stopped, menstruation did not return for 50 days, her physical strength improved markedly, and palpitations occurred only occasionally. I then advised her to stop the decoction and switch to Jiawei Xiaoyao Wan (Modified Free-and-Easy Wanderer Pill) for follow-up.
My formula was Huangqi Shengmai Yin (Astragalus Generate-the-Pulse Drink) combined with Erzhi Wan and the "four kidney herbs," with additions. I used a heavy dose of Agrimonia (up to 100 g) because Agrimonia has a potent hemostatic effect—but to exert that effect, the daily dose must reach 100 g. A large dose of Agrimonia not only stops bleeding but also rapidly restores the patient's strength. Besides Agrimonia, Sanguisorba carbon, Eclipta, human hair carbon, and petiole carbon all have some hemostatic action. Raw Astragalus, Angelica, prepared Rehmannia, and Paeonia Alba nourish blood; Codonopsis, Ophiopogon, Schisandra, Polygonatum, Atractylodes, and Poria supplement qi and strengthen the spleen; Morinda and Epimedium warm kidney yang and strengthen tendons and bones. Hence the patient quickly stopped bleeding and regained strength.
Adenomyosis is a common gynecological disease. In TCM it falls under "metrorrhagia and metrostaxis" (benglou), whose main symptom is irregular intermenstrual uterine bleeding; severe patients become anemic from chronic bleeding. Modern medicine has no particularly good treatment for such conditions, and hospitals usually recommend hysterectomy for women with severe bleeding. But hysterectomy also causes many later problems, so this traumatic treatment is not popular with patients.
TCM also has few effective protocols for this disease; my heavy use of Agrimonia was a recourse born of necessity. Fortunately, Agrimonia is essentially free of toxic side effects, and the other herbs in the formula are relatively safe, so this approach is a reasonable one. The formula combines blood-nourishing and hemostatic herbs, and is also suitable for bleeding that is hard to stop and leads to anemia from other causes.