bubble_chart Concept

The menstrual blood being dark purple refers to the color of menstrual blood being dull and not fresh. Jingyue Quanshu．The "Women's Rules" section contains similar records such as "purple mixed with black," "deep black and spoiled," and "purple close to black." The color "purple" is often seen together with "red" or "black." Whether it is "purple-red" or "purple-black," it must appear dull and lackluster to be termed "dark purple menstrual blood."

bubble_chart Pattern Analysis

1. Internal Accumulation of Stagnant Heat︰The menstrual blood is dark purple and thick with clots, accompanied by abdominal pain that resists pressure, dysphoria, thirst, or low-grade fever before menstruation, and even abdominal heat. Leukorrhea is yellow and thick. The tongue texture is dark red with purpura, and the pulse is wiry, rapid, and choppy. This condition often arises when external pathogens invade during menstruation or postpartum when the blood chamber is open, transforming into heat and accumulating in the uterus and appendages. Alternatively, it may result from pre-existing stagnant blood in the uterus and appendages, which festers and transforms into heat. If emotional distress leads to anger damaging the liver, causing liver depression and stagnation, blood may follow qi stagnation, resulting in sticky menstrual discharge, feverish dysphoria, red lips, thirst, a rapid pulse, and other signs of blood heat. This indicates a combination of blood stasis and heat accumulation.
2. Qi Stagnation and Blood Stasis︰The menstrual blood is dark purple with clots, accompanied by lower abdominal distension and fullness and pain, or even hard pain that refuses pressure, mental depression, chest phlegmonous mastitis distension, dull and lusterless complexion, purple and dark tongue texture, and wiry and rough pulse. In addition to the common symptoms of blood stasis obstructing the uterus with appendages, there are also manifestations of mental unhappiness and distending pain in the breasts and ribs due to liver depression qi stagnation, which is caused by the binding of qi and blood. For cases of internal binding of stasis-heat, the main treatment is to purge heat and expel stasis using Peach Kernel Purgative Decoction; for cases of qi stagnation and blood stasis, the method is to regulate qi and blood using the Blood Stasis-Dispelling Decoction.
3. Cold Evil Congealing and Stagnating︰The menstrual blood is dark purple or black in color, not fresh, thin in texture, and may contain blood clots. There is cold pain in the lower abdomen, waist, and legs, which is relieved by warmth. The tongue texture is normal, with a white and moist coating, and the pulse is deep and tight. This condition is often caused by consuming cold foods during menstruation or postpartum, exposure to rain or cold, or mistakenly taking cold-natured medications, leading to blood congealing due to cold. The key issue is the obstruction of cold evil in the Jingmai, resulting in poor blood circulation. The abdominal pain usually occurs during or before menstruation, presenting as colicky pain or pulling pain, and is relieved by warmth but aggravated by pressure. Particularly during menstruation, reversal cold of the limbs, a pale complexion, and bluish lips are characteristic symptoms.
4. Blood Deficiency with Cold︰The menstrual blood is dark purple like bean paste, thin in texture, with dull pain and cold sensation in the lower abdomen, preferring warmth and pressure. The patient has a pale complexion, dizziness, blurred vision, severe palpitations, a pale or slightly dark tongue, and a deep, thin pulse. This condition is often caused by prolonged illness or loss of blood, which first damages yin-blood, followed by exposure to cold during menstruation or childbirth, allowing cold to invade the blood chamber. Although both conditions share common manifestations such as late-stage menstruation [third stage], scanty and thin menstrual flow with clots, and cold pain in the lower abdomen, their mechanisms of disease differ, and the accompanying symptoms vary. "Cold causes contraction," so the focus here is on the emptiness of the Blood Sea combined with cold pathogens. The abdominal pain often occurs after menstruation and is mostly dull pain, preferring warmth and pressure. Accompanying symptoms may include palpitations, dizziness, a pale complexion, and lackluster nails, which are signs of blood deficiency, aiding in differentiation. For cold stagnation, treatment should focus on warming the meridians and dissipating cold, with Meridian-Warming Decoction as the main prescription. For blood deficiency combined with cold, it is appropriate to nourish blood and warm the meridians, using Angelica, Fresh Ginger and Mutton Decoction or Ass-Hide Glue and Argyi Leaf Four Ingredients Decoction with modifications.

The symptom of dark purple menstruation can be clinically categorized into cold, heat, deficiency, and excess types. The key to differentiation lies in observing the characteristics of the menstruation. Thick and sticky menstrual discharge often indicates heat or excess, while thin and clear discharge suggests cold or deficiency. However, in clinical practice, one should not hastily conclude based on a single symptom. It is essential to consider accompanying symptoms and conduct a comprehensive analysis.

bubble_chart Documentation

1. Jiyin Gangmu．On the abnormal color of menstrual discharge, quoting Ye's theory: "Black blood is attributed to heat, and Zhu Danxi's discussion is excellent. Those affected by external wind-cold are commonly seen in one or two out of ten cases, how to distinguish them? Cold mainly causes astringency, there must be frequent cold pain in the lower abdomen, during menstruation, there may be reversal cold of hands and feet, blue lips and pale face, the chi pulse may be slow, faint, or weak, or although large, it must be without strength. In cases of heat, the chi pulse may be surging, rapid, or solid, or although small, it must be forceful. By examining these, one can understand the situation."