Author: Dr. Maryam Mahanian, DTCM, RAc

Case study: 34 year old female presenting constipation, stress, and menstrual cramps

Sarah presented with a recent onset of constipation for the last three months, more pronounced in the second half of her menstrual cycle. She would go two to three days without a bowel movement and it was painful and pebble-like. She occasionally had a hemorrhoid. Sarah also had bloating and gas. Prior to this bout of constipation, she normally had a BM once per day.

Menstrual cycle: Sarah has a 31 day menstrual cycle and bleeds for 8 days. Her flow is very heavy and dark. She has severe menstrual cramps accompanied by an achy heavy feeling in her perineum for the first two days of flow. Sarah also suffers from pms – irritability, bloating, and fatigue – one week prior to her menstrual period.

She generally had a healthy diet but consisted of smoothies and cold cereal many days per week. I recommended that she eat cooked warming foods and to avoid cold raw foods/drinks as much as possible as these foods are easier to digest and nourishing to the spleen and stomach.

Sarah has low iron (level was 9) in her blood, and has noticed recent hair loss. She sleeps well and has a good energy level. Sarah has a five year old and two year old and is currently still breastfeeding her second child. Sarah has had significant stress in her life over the last three months. She has mild eczema on her right hand.

Tongue: red tip
Pulse: bowstring

Pattern: Liver and Spleen disharmony, Blood deficiency, Blood stagnation, with slight heat accumulation

Explanation: Sarah’s constipation began at the same time as her stress which shows obvious liver qi stagnation overacting on the spleen. She has significant blood deficiency coming from the spleen not producing enough blood. Her pregnancies, two labors, and the fact that she has been breastfeeding for a long period of time has depleted her blood. The cold raw foods in her diet have also damaged her spleen. Sarah’s slight heat accumulation and blood stagnation is coming from the liver Qi stagnation.

Treatment principle: Harmonize the liver and spleen, nourish and move blood, clear heat

Formula: Dan Zhi Xiao Yao San (free and easy wanderer plus by Golden Flower)

Acupuncture protocol: Du 20, Yintang, Liver 3, Spleen 6, Stomach 36, Stomach 25, Ren 6, Ren 10, Ren 12, Large Intestine 4 plus tdp heat lamp on abdomen

Sarah had never had acupuncture before and was a bit apprehensive of needles so she was pleasantly surprised how relaxed she became after I inserted the needles. I treated Sarah with acupuncture three times (once per week for three weeks) and she consistently took the herbal formula for one and a half months. Immediately after the first acupuncture session, Sarah noticed a great improvement in her constipation but still had difficulty after a few days. After the second week of treatment, her constipation was no longer an issue and she experienced less menstrual cramps (although she still bled for 8 days which is too lengthy). I gave her one more acupuncture treatment and made sure she stayed on the herbal formula. One month later, Sarah reported that the constipation was still no longer an issue for her at all (yay!) and she was currently on day 5 of her menstrual cycle and she had absolutely no cramps whatsoever! What is more is that her ferritin levels were up to 58! Success!

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