bubble_chart Concept

Vicarious menstruation, also known as "vicarious menstruation," refers to the symptom of periodic bleeding from the mouth or nose that occurs one or two days before menstruation, during menstruation, or after menstruation. Most patients are accompanied by a decrease in menstrual flow, or even amenorrhea.

The term "vicarious menstruation" originated from the Qing Dynasty Yizong Jinjian . Gynecology Essentials . Fu Qing-zhu referred to it as "reverse menstruation," while Ye Tian-shi called it "vicarious menorrhea" or "vicarious menstruation." Although the names differ, they all indicate that this condition is related to the menstrual cycle.

Women who previously had normal menstruation and occasionally experience hematemesis or nosebleeds before or after menstruation should not be considered as having "vicarious menstruation."

bubble_chart Pattern Analysis

1. Liver Channel Stagnation Heat︰Nosebleed or vomiting before or during menstruation, bitter taste in mouth, dry throat, flushed face, red eyes, dizziness and distension, dysphoria, irritability, restless sleep, distending pain in the chest, ribs, and breasts, irregular menstrual cycles, scanty and unsmooth menstrual flow with red and scant discharge, lower abdominal distension and fullness with pain, dark urine, red tongue texture, yellow tongue coating, wiry and rapid pulse. Mostly caused by anger damaging the liver, qi depression transforming into fire, liver fire stirring, and failure to store yin blood; accompanied by symptoms such as dizziness, blurred vision, flushed face, red eyes, dysphoria, irritability, bitter taste in mouth, dry throat, and distending pain in the chest and ribs. Due to the dysfunction of liver qi in free coursing and the irregular storage and discharge of the Sea of Blood, the main characteristics include irregular menstrual cycles, unsmooth and hesitant menstrual flow, and distending pain in the lower abdomen and breasts during menstruation. Treatment should focus on clearing the liver and resolving depression, directing qi downward, and stopping bleeding. The recommended formula is Peony and Gardenia Peripatetic Powder with modifications.
2. Stomach Fire and Blood Heat︰Nosebleeds or vomiting before or during menstruation, thirst and fetid mouth odor, preference for cold and aversion to heat, swollen or ulcerated gums with bleeding, early menstruation with red or purple color, heavy and sticky flow, dry stools, dark urine, red tongue with yellow coating, and a surging, rapid pulse. This is often caused by excessive consumption of spicy, fried, or rich foods, leading to accumulated heat in the stomach and upward flaring of stomach fire. Therefore, the key diagnostic points include toothache and gum swelling, fetid mouth odor, thirst, constipation, and heavy menstruation. Since these symptoms all belong to the "excess pattern" and "heat pattern," the treatment principle is generally to cool the blood and clear heat, while stopping bleeding by guiding the menstrual flow downward. The appropriate treatment involves clearing stomach fire, cooling the blood, and stopping bleeding. The recommended formulas are Rhinoceros Horn and Rehmannia Decoction with modifications, or Ophiopogon Decoction with adjustments. For severe cases, Four Fresh Ingredients Pill can be used with the addition of Skullcap Root, Coptis Rhizome, etc.
3. Lung Dryness Due to Yin Deficiency︰Hemoptysis and epistaxis mostly occur during or after menstruation, with scanty and bright red blood. Usually accompanied by dizziness, tinnitus, dry throat and nose, dry cough, hoarseness, afternoon tidal fever, flushed cheeks, night sweats, scanty menstruation with bright red blood and no clots, tender red and dry tongue texture, patchy or absent tongue coating, and thin, rapid, weak pulse. It is often caused by constitutional yin deficiency, excessive childbirth and breastfeeding, overexertion due to sexual activity, and other factors leading to essence depletion and blood consumption, yin deficiency with effulgent fire, scorching the lungs and damaging fluids, injuring the yang collaterals, resulting in a syndrome of deficient heat. The main symptom is scanty bleeding with bright red blood. It is also accompanied by symptoms of yin deficiency and lung dryness such as dry cough, hoarseness, dry nose and throat, tidal fever, night sweats, and a red tongue with scant moisture. The treatment should focus on nourishing yin and moistening the lungs, clearing heat and cooling blood, using modified Adenophora and Ophiopogon Decoction.
4. Spleen Failing to Control Blood︰Bleeding from the mouth or nose during or after menstruation, with pale red color and thin texture, {|###|}complexion㿠白{|###|}, fatigue and drowsiness, shortness of breath and reluctance to speak, poor appetite, {|###|}abdominal distension and fullness{|###|}, {|###|}loose stool{|###|}, {|###|}leukorrhea{|###|} that is continuous, thin and white in color, heavy menstrual flow, or metrorrhagia or {|###|}fistula disease{|###|}, pale menstrual color, thin and clear texture, a swollen and pale tongue with tooth marks on the edges, and a thin and weak or empty and large pulse with no strength. This is caused by dietary {|###|}overstrain injury{|###|} to the spleen and stomach, deficiency of {|###|}middle qi{|###|}, and the spleen losing its ability to control blood. The characteristic features are pale red bleeding with a thin and clear texture, accompanied by fatigue, reluctance to speak, poor appetite, {|###|}abdominal distension and fullness{|###|}, {|###|}loose stool{|###|}, pale and thin menstrual flow, a pale tongue, and other symptoms. The treatment should focus on {|###|}tonifying the spleen and replenishing qi{|###|}, and guiding blood to the {|###|}meridian tropism{|###|}. The recommended formula is Returning to Spleen Decoction with modifications.

The condition of vicarious menstruation is often caused by blood heat and qi counterflow, and is less commonly caused by the spleen failing to control blood. In clinical practice, it should be differentiated and analyzed based on the amount, color, and quality of the bleeding, combined with accompanying symptoms. As for whether the vomiting or nosebleed occurs before, during, or after menstruation, it is not necessary to be overly rigid. However, according to clinical observations, this condition mostly occurs before menstruation. Treatment should follow the principle of Neijing "clearing heat when there is heat" and "calming counterflow when there is counterflow," focusing mainly on clearing heat and cooling blood to reduce counterflow.