bubble_chart Concept

Menstrual blood with clots refers to the presence of coagulated blood clots during menstruation.

Throughout medical literature, there is no dedicated discussion on the condition of "menstrual blood with clots"; rather, it is sporadically mentioned within the context of "menstrual irregularities" and is generally categorized under the syndrome of "static blood."

This condition is easily confused with early pregnancy abortion. The latter is often mistaken for a delayed menstruation, but it can be distinguished by a history of missed periods, early pregnancy symptoms, and accompanying vaginal bleeding, lower back soreness, and lower abdominal pain. If there are occasional small clots in menstrual blood without any other discomfort, it is not considered pathological.

bubble_chart Pattern Analysis

1. Qi Stagnation and Blood Stasis︰The menstrual flow is scanty and unsmooth, mixed with blood clots that are purplish-black or resemble rotten flesh. Pain is alleviated after the clots are expelled. The menstrual cycle is irregular, with abdominal distension and fullness, pain that is worse upon pressure, a dull or even bluish-purple complexion, and scaly skin. The individual often experiences mental depression, distension in the chest, hypochondrium, and breasts, and a poor appetite. If accompanied by cold, symptoms may include fear of cold, cold limbs, cold pain in the lower abdomen, thin and clear menstrual flow, dark and black clots, and a pale and dull tongue texture. If the stasis has transformed into heat over time, symptoms may include irritability, dry mouth and throat, sticky and thick menstrual flow, and bright-colored clots. The condition is primarily caused by stagnation of qi and blood, manifesting as liver depression and qi stagnation, static blood retention, and symptoms such as mental depression, distension in the chest and breasts, poor appetite, a dull complexion, bluish lips and tongue, or ecchymosis, and a choppy pulse. The menstrual characteristics include a large number of clots, some as big as rotten flesh, delayed menstruation with purplish-black blood, severe abdominal pain that worsens upon pressure, and slight relief after the clots are expelled. Clinically, the condition may be complicated by cold or heat, requiring careful differentiation.
2. Cold Coagulation and Blood Stasis︰Scanty menstrual flow with dark red or dark black color, thin and clear menstrual quality, accompanied by blood clots that are purplish-dark in color, cramping and cold pain in the lower abdomen before or during menstruation, which can be relieved by warmth, and often delayed menstrual cycles. If the complexion is pale, limbs are cold, fear of cold, leucorrhea is thin and clear, and the pulse is deep and tight, it indicates a pattern of pathogenic cold coagulation; if menstruation is scanty and pale in color, abdominal pain is relieved by warmth and pressure, and the pulse is deep, slow, and weak, it indicates a pattern of deficiency cold. Although the two have different disease causes and mechanisms of disease, they share certain intrinsic connections. If anger damages the liver, qi depression prevents its free flow, and blood cannot follow qi, leading to stagnation and stasis. If the body is constitutionally yang-deficient, or if external contraction of cold occurs during menstruation or postpartum when lochia is not fully expelled, or if internal damage is caused by cold drinks, cold pathogens can invade the thoroughfare and conception vessels, causing blood to coagulate with cold and form dark clots. This is blood coagulated by cold. Therefore, the clinical features, in addition to delayed menstruation and scanty, unsmooth flow, also include dark red and thin menstrual blood, dull and lusterless clots, etc. Patients may experience colicky pain or cold pain in the abdomen, preferring warmth and fearing cold, with cool hands and feet, which is also due to internal excess of pudendal coldness and yang qi failing to warm. If yang deficiency prevents the transformation of qi to generate blood, circulate blood, and warm the uterus with appendages, symptoms such as pale menstrual blood, abdominal pain relieved by warmth and pressure, and a deep, slow, weak pulse may manifest as a pattern of deficiency cold. For qi stagnation and blood stasis, the focus should be on regulating qi and relieving depression, invigorating blood and resolving stasis, using Peach Kernel, Carthamus and Four-Ingredient Decoction plus Cyperus, Curcuma Root, Linderae Radix, and Aucklandia Root; for cold coagulation and blood stagnation, the focus should be on warming the meridians and dissipating cold, invigorating blood to regulate menstruation, with Lesser Abdomen Stasis-Expelling Decoction as the main treatment; for deficiency cold, Meridian-Warming Decoction can be modified.
3. Qi Deficiency︰Excessive menstrual flow, or metrorrhagia or fistula disease, with continuous dripping, pale red and thin in color, occasionally mixed with small, light-colored blood clots, a sensation of emptiness and sagging in the lower abdomen, lingering dull pain or bloating without pain after menstruation, and irregular menstrual cycles. Typically, the complexion is pale, accompanied by shortness of breath and reluctance to speak, occasional spontaneous sweating, reduced appetite, a pale and tender tongue, and a deep, faint or thin, weak pulse. Due to overexertion, or severe or prolonged illness depleting healthy qi, qi deficiency leads to an inability to circulate blood, resulting in sluggish blood flow that stagnates and forms clots. The clinical features include: pale red and heavy menstrual flow, or continuous dripping from fistula disease, prolonged periods beyond the due date, mixed with small blood clots, a sensation of emptiness and sagging in the lower abdomen, or lingering dull discomfort after menstruation.
4. Blood Heat︰The menstrual flow is heavy, with a purplish-red color, sticky texture, and clots that are purplish-black in color. The face is red, the lips are dry, there is heart vexation and thirst, irritability, and easy anger. The tongue coating is thin and yellow, and the pulse is fine, rapid, and forceful. This is a pattern of replete heat. If the menstrual flow is scanty and red in color, thin in texture with clots, accompanied by red cheeks, burning heat in the palms, or tidal fever and night sweats, and the tongue texture is tender red with scant fluids or glossy red without coating, this is a pattern of deficiency heat. This condition arises from external contraction of pathogenic heat, habitual consumption of spicy foods, excessive use of warm uterine medicines, extreme seven emotions, or the five minds transforming into fire, leading to heat lodging in the thoroughfare and conception vessels. The blood is scorched by heat, resulting in impeded flow and stasis. In cases of exuberant heat in the blood aspect, the menstrual color is purplish-red with heavy flow, the texture is sticky with clots, the clots are bright, the lips are red, the mouth is dry, the face is flushed, there is heart vexation, irritability, and frequent anger. In cases of yin deficiency with internal heat, the menstrual flow is scanty and thin with clots, accompanied by red cheeks, night sweats, and vexing heat in the chest, palms, and soles. For qi deficiency, it is appropriate to tonify qi and invigorate blood to regulate menstruation, Sage Cure Decoction plus Cyperus. For blood heat, it is suitable to clear heat, nourish blood, and regulate menstruation, Four Ingredients Decoction plus Skullcap Root, Coptis Rhizome, and Cyperus. For yin deficiency with heat, it is advisable to nourish yin and clear heat, using Initial Yin Decoction with modifications.

The symptom of menstrual blood with clots falls under the category of "static blood." Clinically, it is more commonly seen in cases of qi stagnation and blood stasis, cold congealing and blood stagnation, and blood heat with stasis, while cases caused by qi deficiency forming clots are relatively rare. The key to pattern identification is first to distinguish whether the color of the clots is bright or dull. Secondly, a comprehensive analysis must be conducted based on the color, volume, and texture of the menstruation, as well as accompanying symptoms. Only in this way can the attributes of cold, heat, deficiency, and excess be accurately identified.

bubble_chart Documentation

1. Nyuke Jinglun．The "Menstruation" chapter quotes Zhu Dan-xi as saying: "Menstrual blood is yin blood. Yin must follow yang, hence its red color, inheriting the color of fire. Blood is paired with qi; if the qi is hot, the blood is hot; if the qi is cold, the blood is cold. Qi stagnation leads to stagnation, as it is paired with qi and moves with it. Seeing clots is a sign of qi coagulation... Nowadays, people see purple-black clots causing pain and hastily attribute it to wind-cold invasion, using warm and hot remedies, leading to immediate disaster."