bubble_chart Concept

Thick menstrual texture refers to the dense consistency of menstrual blood. Jingyue Quanshu．Guidelines for Women describes menstrual flow as "purple and thick," and the "thick" in "thick and forming clots or strips" refers to thick menstrual texture; Yizong Jinjian．Gynecology Essentials records menstrual blood as "deep red and turbid," "thick and foul-smelling," where "turbid" also refers to this condition. "Thick menstrual texture" is different from "menstrual blood with clots." "Menstrual blood with clots" refers to menstruation mixed with coagulated blood clots, which can appear in either thick or thin menstrual blood.

bubble_chart Pattern Analysis

1. Blazing of Heart-liver Fire︰Excessive menstrual flow, or even menorrhagia, with thick and sticky consistency like paste, bright red, purplish-red, or purplish-black in color, accompanied by facial flushing, red eyes, irritability, insomnia with dreamfulness, chest and hypochondriac distending pain, bitter taste in the mouth and thirst, or possible menstrual fever, hematemesis, epistaxis, a red tongue with yellow coating, and a wiry rapid pulse. This condition often occurs in individuals with a constitutionally excessive yang, or due to habitual consumption of spicy foods, leading to heat lodging in the thoroughfare and conception vessels; or due to excessive mental strain, which depletes heart yin and causes heart yang to become hyperactive; or due to unfulfilled emotional desires, transforming qi depression into fire; or due to excessive indulgence depleting kidney essence, resulting in water failing to nourish fire, etc. These factors lead to the flaring up of both the sovereign and ministerial fires, causing blood to be scorched by heat. Symptoms include early menstruation, purplish-red and excessive flow, or even metrostaxis with dripping or sudden heavy bleeding, or menstrual blood flowing from the mouth and nose, with particularly prominent manifestations of internal fire excess (such as irritability, easy anger, flushed face and eyes, vertigo, insomnia, a red tongue, and a wiry rapid pulse, etc.). Treatment primarily focuses on clearing heat and cooling blood, using Three-Yellow Four Ingredients Decoction or Peony and Gardenia Peripatetic Powder with modifications.
2. Dampness-heat︰The menstrual flow is excessive, thick, turbid, and foul-smelling, with a dark red color, or mixed with vaginal discharge. Accompanied by a sallow and greasy complexion, head distension and heaviness, epigastric and abdominal stuffiness and distension, sticky stools, increased leukorrhea that is yellow and foul-smelling, vulvar itching, a yellow and greasy tongue coating, and a wiry, slippery, and rapid pulse. This is often caused by dietary overstrain damaging the spleen, impairing its transport function, leading to dampness accumulating and transforming into heat; or habitual consumption of rich and greasy foods, resulting in internal exuberance of dampness-heat; or excessive contemplation and emotional stagnation, leading to liver depression and spleen weakness, with prolonged stagnation transforming into fire; or engaging in sexual activity during menstruation or postpartum, all of which can cause dampness-heat pathogens to accumulate in the uterus with appendages, clashing with qi and blood to trigger the condition. The symptoms include early menstruation with a thick and sticky flow. Treatment should focus on clearing and draining damp-heat, using Gentian Liver-Draining Decoction.
3. Damp Phlegm︰Delayed menstruation with scanty flow, thick and pale in color. Usually accompanied by excessive phlegm, bland taste in mouth, dizziness, nausea, chest stuffiness, abdominal distension and fullness, thick leucorrhea. If accompanied by heat, symptoms may include irritability, insomnia, and early menstruation with heavy flow. The tongue coating is white and greasy, and the pulse is wiry and slippery. This condition is often caused by dietary overstrain, living in damp environments, or exposure to rain. The key mechanism of disease lies in spleen deficiency leading to damp accumulation and phlegm-damp obstruction, resulting in delayed and scanty menstruation. Treatment should focus on resolving dampness and dispelling phlegm, modified from Danxi's Chuanxiong and Danggui Two Old Ingredients Decoction.
4. Internal Accumulation of Static Heat︰Menstruation comes early with heavy flow, dark purplish-red in color, sticky and clotted, accompanied by lower abdominal pain that refuses pressure, or fever during menstruation, dysphoria, dry mouth, dark red tongue texture, and wiry, rapid, and choppy pulse. The main cause is emotional distress, liver depression and discomfort, blood following qi stagnation, prolonged stasis transforming into heat; or exposure to external pathogens during menstruation, which invade the interior and transform into heat, clashing with the Chong and Ren channels. If stasis-heat congests the uterus with appendages, blood flow is severely obstructed, and menstruation may also become scanty. Treatment focuses on draining heat and expelling stasis, with modifications of Peach Kernel Purgative Decoction.

The accumulation of dampness-heat and the downward infusion of phlegm-dampness, although related in terms of disease cause, differ in their mechanisms of disease and clinical manifestations. Both conditions may present with increased leucorrhea, abdominal distension and fullness, gastric stuffiness, nausea, and loose stools around the menstrual period. However, in the former, the menstrual blood is dark red, and the leukorrheal discharge is yellow and foul-smelling; in the latter, the menstrual blood is pale, and the leukorrheal discharge is white with a fishy odor.

The symptom of sticky menstrual discharge is often associated with heat pattern or excess pattern in clinical practice. The key to differentiation lies in observing the color of menstruation. Generally, if the discharge is thick and red, purple, or black, it is attributed to heat or excess; if it is thick and pale, it is attributed to cold or deficiency. However, cases of deficiency/excess in complexity are also common. A comprehensive analysis of pulse and symptoms is necessary in clinical practice to make an accurate diagnosis.

bubble_chart Documentation

1. Yizong Jinjian．Gynecology Essentials Menstrual Regulation Section: "When blood is transformed by heat, it becomes thick, sticky, and foul-smelling; when transformed by cold, it becomes clear, thin, and fishy-smelling. If there is internal decay, the purgation will show a mixture of five colors, resembling pus and blood. If there is also a foul odor from decaying organs, and it continues to discharge profusely without stopping, it is a critical condition, and the patient's life is in grave danger!"