Qingre Tiaoxue Decoction for Treating Dysmenorrhea and Excessive Menstrual Bleeding

Qingre Tiaoxue Decoction is recorded in the Gu Jin Yi Jian (Medical Mirror Ancient and Modern). It consists of Mudanpi (Cortex Moutan), Shengdihuang (Radix Rehmanniae), Xiangfu (Rhizoma Cyperi), Danggui (Radix Angelicae Sinensis), Taoren (Semen Persicae), Yanhusuo (Rhizoma Corydalis) and Baishao (Radix Paeoniae Alba), each 3 qian (9 g); Huanglian (Rhizoma Coptidis), Chuanxiong (Rhizoma Ligustici Chuanxiong) and Honghua (Flos Carthami), each 2 qian (6 g); and Ezhu (Rhizoma Curcumae) 1 qian (3 g).

Qingre Tiaoxue Decoction has the actions of clearing heat and cooling blood, dispelling stasis and stopping pain. It is indicated for "women, when menstruation is about to arrive, with episodic abdominal pain that comes and goes, when both qi and blood are excess," presenting as burning distending pain in the lower abdomen before and during menstruation, tenderness refusal, dark-red menstrual blood that is thick in quality with clots. It may be accompanied by lumbosacral distending pain, or by intermittent lower abdominal pain that worsens upon menstruation. Most patients show persistent low-grade fever, scanty dark urine, chronic yellow malodorous vaginal discharge, a red tongue with yellow greasy coating, and a wiry rapid or soft rapid pulse. In modern practice, Qingre Tiaoxue Decoction is commonly used for dysmenorrhea due to damp-heat stasis obstruction caused by dysmenorrhea, endometriosis, uterine adenomyosis and pelvic inflammatory disease.

Qingre Tiaoxue Decoction is essentially Tao Hong Siwu Decoction (Shengdihuang, Chuanxiong, Danggui, Baishao, Taoren, Honghua) with added Mudanpi, Xiangfu, Yanhusuo, Huanglian and Ezhu. Tao Hong Siwu Decoction mainly dispels stasis and stops pain, and activates blood to reduce swelling. The addition of Mudanpi and Huanglian adds the effect of clearing heat and cooling blood; Xiangfu and Yanhusuo enhance the action of moving qi and stopping pain; Ezhu adds the action of breaking blood and dispelling accumulation. Therefore this formula is indicated for the intermingling of stasis and heat with concrete masses (zhengjia), where stasis obstruction coexists with damp-heat.

If heat is pronounced and causes excessive menstrual bleeding or prolonged periods, Baishao in this formula should be replaced with Chishao (Radix Paeoniae Rubra), and Diyu (Radix Sanguisorbae), Huaihua (Flos Sophorae), Machixian (Herba Portulacae), Xiaoji (Herba Cephalanoploris), Yimucao (Herba Leonuri) and Hanliancao (Herba Ecliptae) should be added to remove stasis, clear heat, cool blood and stop bleeding. When yin deficiency with internal heat is marked, this formula may be combined with Erzhi Pill, adding Mohanlian (Herba Ecliptae) and Nuzhenzi (Fructus Ligustri Lucidi); in severe cases, Shengzhizi (Fructus Gardeniae), Xuanshen (Radix Scrophulariae), Dahuang (Radix et Rhizoma Rhei) and Xiaoji may be further added to clear heat and cool blood. When damp-heat is heavy with yellow foul-smelling vaginal discharge, Huangbai (Cortex Phellodendri), Tufuling (Rhizoma Smilacis Glabrae), Cheqiancao (Herba Plantaginis) and Chungenpi (Cortex Ailanthi) are added to clear heat, drain dampness and stop discharge. For lumbago and back pain, Xuduan (Radix Dipsaci), Duzhong (Cortex Eucommiae), Gouji (Rhizoma Cibotii), Qinjiao (Radix Gentianae Macrophyllae), Tusizi (Semen Cuscutae) and Shayuanzi (Semen Astragali Complanati) are added to tonify the kidney. When uterine adenomyosis presents the above symptoms, Mianhuagen (Radiss Gossypii) may be added to this formula.