This is post #2 in the WPC blog. Click here to visit the blog homepage.
There is much one can say about the enigmatic Wu Mei Wan. Below I share a case of mine as well as a similar case from forty years ago from a well-known classic formula doctor, Yáo Méi-Líng 姚梅龄. The White Pine Circle also has an instructive video on Wu Mei Wan by Laura McGraw.
Acute illnesses should change quickly with treatment. When someone comes into the clinic with an acute issue, I often ask them to contact me the next day to let me know how they are doing. The good thing about treating someone who is acutely ill is that the results will be dramatic and very positive (if you get it right).
Yesterday, a patient came in for her second treatment. In her previous visit, she had just stopped 19 days of moderate to light bleeding and cramping two weeks before and was very wiped out. She is 52 and had gone through menopause when she began to bleed again. I had recommended she go to her gynecologist to rule out endometrial cancer, which she did.
She presented with an ashen complexion and a voice so soft and trailing that it was challenging to hear. She complained of being cold despite the hot weather. She felt uterine cramping that craved heat and was depressed in a way that felt physical, cold, and dark to her. During the bleeding, she also had a headache and diminished appetite. Her pulses were thin and wiry with very weak Chi positions. I diagnosed her with extreme depletion and cold of blood, blood stasis in the womb, and Kidney Yang deficiency. This was a deficiency taxation disease with a weakness of the Shaoyin and Jueyin. She did not want herbs as she felt she might react to them. I supplemented her Heart channel on the right side with + Ht 1 and Liv 1 and – Ht 3 and Ki 3.
After this, she felt very renewed for four days, with the cramping stopping and the depression lifting. She reported this to me during the week.
When I saw her yesterday, she began to bleed lightly again two days previously. At the time of the visit, she had stopped bleeding but reported that her energy and spirit dropped precisely when she began to bleed. She had a bad headache, neck tension, and uterine cramping. She was cold, very depressed feeling, and had vomited recently.
I brought her a cup of hot water with Wu Mei Wan granules stirred in and had her drink before the acupuncture. She was nervous about drinking the herbs but agreed. I then supplemented the Heart on the right and Small Intestine on the left. (+SI 3, GB 41, -SI 2, Bl 66). By the end of the treatment (leaving the needles in for 20 minutes), her headache was gone, and her depression lifted.
When I asked her about her experience with the herbs, she reported that as she felt them go down, she felt her middle area warm and open and the fullness in her head flow downward. I was amazed to hear her describe what I expected Wu Mei Wan to do.
I sent her home with the following formula, with instructions to start slow. It is a raw powder to be steeped overnight in a thermos:
Wu Zhu Yu 3
Lan Gui 12
Dang Gui 9
Bai Shao 9
Gan Cao 6
Gan Jiang 3
Ren Shen 6
Fu Zi 9
Huang Lian 3
Huang Qin 9
You can see that this is a modified version of Wu Mei Wan and a bit reminiscent of Wen Jing Tang. This morning, I got an email from her with "Phew!" as the subject line:
"I feel so much better today in body, mind, and spirit. I made my first batch of herbs last night by splitting the overall dose in half for today to see how I do. Just had my first tea, and it was easy to drink. Thank you for the gift of this medicine. I'm scheduled to dance in Mexico as part of a larger retreat in late July, and I'm Ms looking forward to it."
Below is a case from Dr. Yáo Méi-Líng 姚梅龄 that is similar to my case1:
Ms. Tian was 29 years old, and her first visit was on April 27, 1975. The patient had been married for seven years with no pregnancy. The man and the woman were examined, and no abnormalities were found. She complained of cold pain in the lower abdomen 5-6 days before menstruation, which was slightly relieved by warmth, accompanied by cold limbs, a burning sensation under the Heart, irritability, dry mouth, thirst, preference for warm drinks, noisy stomach, hunger, hiccups after eating, gas rushing up to the chest followed by vomiting, yellow urine, and normal bowel movements. Menstruation was late by 3-5 days, with a small amount of dark, pig liver-colored blood clots, and it was evident in 4 days, with slight leucorrhea. The pulse was thin and rough, slightly wiry and rapid. Her tongue was light red, and the moss was white and slightly thick.
Diagnosis: Infertility, mixed cold and heat in Jueyin meridians, and blood stasis.
Treatment: Seven packages to take before menstruation.
The patient started taking the medicine on May 15, and her period came six days later. The abdominal pain before menstruation was significantly reduced, vomiting and limb syncope were eliminated, the menstrual volume increased slightly, and the color turned slightly red. However, she now experienced a bitter mouth and increased vexation, thirst for cold drinks, pimples on her face, red tongue with yellow moss, and a thin, rapid, and rough pulse.
I switched her formula to Lian Mei Tang with Jiang Can, Yin Hua, Mu Dan Pi, Hong Hua, and Ze Wan. The symptoms were reduced after taking five doses; on July 9, she continued taking five more doses, and all symptoms disappeared. The patient came to our hospital's obstetrics and gynecology department for examination in September 1975 and was diagnosed with early pregnancy. She later gave birth to a boy.
Notes: Menstrual and childbirth diseases are often related to liver qi and blood disorders. The symptoms in this case are a mixture of cold and heat in the Jueyin meridians. At the same time, the thin and rough pulse, abdominal pain before menstruation, and dark red blood clots during the menstrual period are caused by the evil stagnating the liver blood. Therefore, this disease is a mixed cold and heat syndrome in the Jueyin meridians and blood stasis. It can be treated with Wu Mei Wan plus Tao Ren. After the patient took the medicine, the abdominal pain was significantly reduced, and the cold symptoms, such as limb coldness and vomiting, were eliminated. It is a sign that Yang prevails over Yin, and the disease is improving. However, the bitter taste in the mouth and the irritability were aggravated, the pulse was more rapid, and the face became covered with pimples. This is the disadvantage of excessive Yang recovery caused by excessive hot medicine. This point should be paid attention to when using Wu Mei Wan.
Wu Mei Wan is a very fast acting and effective formula. Above Dr. Yáo mentions it for a “mixed hot and cold pattern.” What I see clinically is that this is primarily a warming formula for fundamentally warm patterns. The heat occurs because the middle or lower Jiaos get shut down and closed due to the cold. This shut down stops the downward movement of Yang through the middle, which leads to a buildup of heat above along with a failure to descend. This is what causes the Yang heat aspect. In other words, it is secondary to the cold stasis. In Dr. Yao’s case, we are shown that the balance of hot and cold herbs might have been weighted a bit to the hot ones. This led to increase vexation and facial pimples. However, the primary pattern was so much better and the formula was easily adjusted.
If you don’t want to or can’t use Xi Xin, you can substitute Xin Yi Hua. If you can’t use Fu Zi, you can use Rou Gui or, better yet, An Gui.
1 From the Jiang Xi Chinese Herbs journal, February, 1980
2 Lian Mei Tang includes Huang Lian 6 gm, Wu Mei (pit removed) 9 gm, Mai Men Dong (heart removed) 9 gm, Sheng Di 9 gm, and E Jiao 6 gm.
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