Herbs and Acupuncture for Amenorrhea

Chief Complaint: sporadic menstrual cycles
Western Diagnosis: amenorrhea
Medical History: 27 year old female triathlete. Runs, bikes, skis. Menstrual cycles sporadic since age 16. Diet fairly balanced, except red meat and iron rich foods lower than needed. Until recently patient worked three jobs.
Questioning exam: 1-2 menstrual cycles a year presenting with low back cramping, onset with brown blood, duration 3-4 days, ending with brown blood. Flow remains light throughout cycle. Fatigue during cycle. especially. Low grade anxiety, cold hands and feet, slight constipation, occasional floaters, and sometimes hard to fall asleep, especially prior to onset of cycle. Patient also complains of “coming down with every cold that comes along”.
Pulse exam: Pulses on left overall choppy and thin. Pulses on right soft. Especially notable are the Heart, Liver, and Spleen pulses, as they are the weakest.
Tongue exam: Pale, thin, with redder tip, some scallops, and slight central crack.
OM Diagnosis: Blood Deficiency, general Qi Deficiency.
The three pulses that were the weakest are of the Organs involved with Storing, Holding, and Controlling the Blood. The menstrual blood is brown and is not sufficiently produced showing a Deficiency. Not falling asleep easily leading into the cycle, general anxiety, constipation, and achy low-grade cramping also signify Blood Xu, but also the type of pain and the fact that the Wei Qi is easily overcome shows the Qi Xu also. Qi and Blood need each other. Also the tongue is pale and thin, which signifies that Qi and Blood are affected. The scallops are in the Central Jiao area, showing the Central Qi is affected. The slight central crack is showing that the chronic Blood Xu is beginning to affect the Yin.
Treatment Principle: Nourish Blood, Tonify Qi, Benefit menses
Point Prescription: Spleen-6, Spleen-4 & Pericardium-6, CV-4, Liver-8, Lung-7 & Kidney-6, Stomach-36, Tonify.
Herbal Formula: Si Wu Tang modified; Shu Di Huang (12 grams), Bai Shao(10 grams), Dang Gui (10 grams), Chuan Xiong (6 grams), E Jaio(6grams), Huang Qi(10 grams), Bai Zhu (8 grams), Da Haung (3 grams) Granular Formula- 2 gram-spoonfuls, 3x daily after food in warm water.
Lifestyle Prescription: Patient advised to eat small amounts of organic red meat daily and to incorporate more iron-rich foods in diet. Also advised to not overwork, including exercising. Patient is seen for acupuncture every one to two weeks.
Results: When patient is in compliance with formula, she has a menstrual cycle. Last cycle was heavy, which is unusual for her and so she stopped her formula instead of coming in for treatment, assuming the formula made her bleed too heavy.