bubble_chart Concept

Thin menstrual quality refers to the thin texture of menstrual blood. In the Yizong Jinjian．Gynecology Essentials, it is referred to as "clear" and "thin in form" menstrual discharge.

bubble_chart Pattern Analysis

1. Blood Deficiency︰The menstrual flow is pale red and scanty, delayed in cycle, with little amount or just spotting, followed by lingering dull pain in the lower abdomen that prefers massage. The complexion is pale, accompanied by dizziness, blurred vision, palpitations, insomnia, pale lips and tongue, and a deep, thin, weak pulse. This condition mainly arises from chronic hemorrhagic diseases (such as hypermenorrhea, menorrhagia, metrostaxis, hematemesis, bloody stool, etc.), or early abortion, late abortion, postpartum hemorrhage, which deplete nutrient-blood. Alternatively, it may result from long-term insufficient dietary intake, leading to inadequate essence from food and water, causing a deficiency in blood source. Consequently, the Chong and Ren meridians suffer from blood deficiency, resulting in pale red and scanty menstrual flow.
2. Qi Deficiency︰The menstrual discharge is thin, pale in color, with early periods and heavy flow, or metrorrhagia, or fistula disease. There is a sensation of emptiness and sagging in the lower abdomen, listlessness, shortness of breath, reluctance to move, spontaneous sweating, and aversion to cold. The tongue texture is pale and swollen, and the pulse is deep and weak or feeble and foreeless. The causes, aside from inherent weakness of the spleen and stomach leading to insufficient generation and transformation, may also result from excessive labor or prolonged illness depleting healthy qi. Due to qi deficiency, the essence cannot transform into red, hence the menstruation is pale and thin; failure of qi to control blood leads to early periods with heavy flow, prolonged menstruation, or incessant dripping. This is the main characteristic distinguishing qi deficiency from blood deficiency. The accompanying symptoms also differ in emphasis: palpitation, insomnia, dizziness, and blurred vision are signs of blood deficiency; fatigue, shortness of breath, spontaneous sweating, and aversion to cold are manifestations of qi deficiency. In clinical practice, it is essential to differentiate the primary and secondary aspects. For blood deficiency, the focus should be on nourishing blood and regulating menstruation, supplemented by tonifying qi. The prescription used is Four Ingredients Decoction, with additions such as Astragalus Root and Cyperus as appropriate. For qi deficiency, the emphasis should be on tonifying qi and regulating menstruation, supplemented by nourishing blood. The prescription used is Four Gentlemen Decoction with additions of Chinese Angelica and Peony Root, or alternatively, Middle-Tonifying Qi-Replenishing Decoction may be selected.
3. Cold-dampness Stagnation︰The menstrual discharge is thin and scanty, with mostly delayed periods, appearing purplish-black and dull, or like black soybean juice, occasionally mixed with blood clots. During menstruation, there is cold and painful lower abdominal pain, which alleviates with warmth. Leucorrhea is excessive, accompanied by soreness in the lower back and heaviness in the body. There may also be chest stuffiness, epigastric distension, loose stools, a white and greasy tongue coating, and a deep and tight pulse. This is caused by prolonged residence in damp and cold environments or exposure to cold-dampness during menstruation, such as wading through rain or water. The cold-dampness binds with the thoroughfare and conception vessels, invading the uterus with appendages, and congealing menstrual blood, leading to the pattern of pathogenic cold coagulation. The characteristics include thin menstrual discharge with a dull color, resembling black soybean juice, occasionally mixed with blood clots, and cold, painful lower abdominal pain that resists pressure. Treatment should focus on warming the meridians and invigorating blood, as well as warming and resolving cold-dampness. The recommended formula is Meridian-Warming Decoction with added Poria and Dried Ginger.
4. Liver-kidney Yin Deficiency︰The menstrual flow is thin and bright red in color, with delayed periods and scanty volume, or early periods with excessive volume, or prolonged dripping without cessation. There is flushing of the cheeks, feverish feeling in palms and soles, palpitation, insomnia, vertigo, tinnitus, soreness and weakness in the lower back and knees. The tongue texture is tender and red, and the pulse is thin, rapid, and weak. This is caused by congenital yin deficiency, chronic illness, excessive sexual activity, or other factors that deplete essence and blood. When essence and blood are insufficient, the Blood Sea becomes empty, resulting in thin and scanty menstrual flow, characterized by bright red color. If yin deficiency with effulgent fire forces blood to flow recklessly, it may also lead to early periods, excessive menstrual volume, or menorrhagia and metrostaxis, accompanied by signs of deficiency fire flaming upward, such as flushed cheeks, dry mouth, vexing heat in the chest, palms and soles, tinnitus, dizziness, palpitation, insomnia, and a thin, rapid pulse.
5. Spleen-kidney Yang Deficiency︰Delayed menstruation, with pale and dull or pale watery menstrual flow, scanty or heavy in amount, bluish lips and pale complexion during menstruation, reversal cold of hands and feet, cold pain in the lower abdomen relieved by warmth, usually pale complexion, cold limbs, cold pain in the lower back and knees, profuse leucorrhea, loose stools, frequent urination, pale and swollen tender tongue texture, and deep slow weak pulse. Due to constitutional yang deficiency, excessive consumption of raw or cold foods, misuse of cold and purgative medications damaging spleen-stomach yang, or chronic diarrhea or dysentery injuring spleen-kidney yang. Loss of yang's warming function and emptiness of the Sea of Blood result in the characteristic dull or pale watery menstrual flow. Pale complexion, aversion to cold with cold limbs, bluish lips during menstruation, cold pain in the lower abdomen relieved by warmth and pressure, and deep slow pulse clearly differentiate this from liver-kidney yin deficiency with clear and thin menstrual quality. In treatment, for liver-kidney yin deficiency, use Left-Restoring Decoction to nourish water and moisten wood as the main approach; for spleen-kidney yang deficiency, use Right-Restoring Decoction to warm and tonify kidney yang, supplementing fire to generate earth.

The symptom of thin and clear menstrual discharge is often associated with deficiency and cold. Generally, if the discharge is thin and red, it indicates deficiency heat; if it is thin and pale, it indicates deficiency cold. However, clinical diagnosis should not be rigidly adhered to these rules. It is essential to consider the pulse and other symptoms comprehensively for a thorough analysis.

bubble_chart Documentation

1. Yizong Jinjian Gynecology Essentials．The Tiaomen Jing states: "Hypermenorrhea, clear and thin with a light red color, is due to qi deficiency failing to control blood... If the discharge is clear with a foul smell, it is caused by dampness, stasis, cold, and deficiency." "A light and clear color indicates insufficient heat."