Copyright 2011 Giovanni Maciocia.

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BENG LOU

GIOVANNI MACIOCIA

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 BENG LOU

NORMAL

HEAVY PERIODS

BENG = FLOODING BENG LOU

LOU = 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

BENG LOU

The condition of Flooding and Trickling is called Beng

Lou in Chinese:
and lou means
beng means
trickle, drip,
flood or
dribble or
flooding,
trickling, dripping,
bursting
dribbling, leaking.
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.

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 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.

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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
X
obstructed by
BLOOD stagnant Blood and it
BLOOD
VESSELS IN leaks out
STASIS
UTERUS
Obstructs
blood vessels
Haemorrhage

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BLOOD HEAT QI OR YIN XU BLOOD
STASIS

BLOOD HEAT QI XU
Liver (Heart) Spleen and BLOOD
Kidneys (Yang) STASIS
SHI
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 Fail to hold
out of vessels BLOOD blood in vessels

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

BLOOD STASIS
Liver (Heart)

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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 )

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 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 ). 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.

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 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 ) cited in Nanjing College of
Traditional Chinese Medicine 1979 Gynaecology in Chinese Medicine (Zhong Yi Fu Ke
Xue ), Nanjing College of Traditional Chinese Medicine, Nanjing, p. 47.

Of the two vessels, the Ren

Mai is particularly
involved in the pathology
of Flooding and Trickling
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 Flooding

and Trickling, the Kidneys also play a very important and central role
in the pathology and treatment of this condition.

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 Whatever the type of Flooding and Trickling, 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

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 TREATMENT PRINCIPLES

In Flooding (as opposed to Trickling), 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 Trickling (as opposed to Flooding), 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.

Tonify the Kidneys Nourish and pacify Nourish Liver- and

and strengthen the Liver Kidney-Yin, strengthen
Chong and Ren the Spleen and
consolidate the Chong
and Ren

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 TREATMENT PRINCIPLES

BENG: raise Qi, LOU: nourish Blood, regulate Qi,

consolidate, not much consolidation or
astringe 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

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 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 from Yin to
Yin Yang

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 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

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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

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 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

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 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 ), People's Health Publishing House,
Beijing, p. 1107. The "Great Compendium of Acupuncture" itself was published in 1601.

COOL THE MENSES

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 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

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 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

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 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

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 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

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 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

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 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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