bubble_chart Concept

Early menstruation refers to a menstrual cycle shortened to within 21 to 23 days, or even twice a month. If the cycle is only advanced by three to seven days without other obvious symptoms, it is still within the normal range; or if it occurs only occasionally, it is not considered early menstruation.

bubble_chart Pattern Analysis

1. Blood Heat︰Before menstruation, the flow is heavy, dark red or purplish-black in color with clots, thick and sticky in texture, or with a foul odor. There is irritability, dry mouth, preference for cold and aversion to heat, constipation, and dark urine. The tongue is red with thin yellow coating, and the pulse is slippery and rapid. Heavy bleeding, dark red color, thick texture, red tongue, and slippery-rapid pulse indicate an interior heat excess pattern. Treatment should focus on clearing heat and cooling blood, using Scutellaria and Coptis Four Ingredients Decoction with added processed Cyperus.
2. Yin Deficiency︰Menstrual period comes early, with scanty flow, red color without clots, dizziness, palpitation, insomnia, soreness in the lower back, feverish feeling in palms and soles, or low-grade fever, or flushed cheeks. The tongue is red with little coating, and the pulse manifestation is thin and rapid. Scanty flow, red color, dizziness, insomnia, soreness in the lower back, dry red tongue without coating, and thin rapid pulse indicate an interior heat deficiency pattern, which can be distinguished from the pattern of blood heat characterized by heavy menstrual flow and slippery rapid pulse. The treatment should focus on enriching yin and clearing heat, using Rehmannia and Lycium Root-Bark Decoction with the addition of Liquorice Root.
3. Liver Depression Transforming into Fire︰Menstruation occurs earlier than usual, with varying amounts of flow, red or purple in color, sometimes with blood clots or streaks, and the menstrual discharge is not smooth. It is accompanied by distension and pain in the breasts, chest, flanks, and lower abdomen during menstruation. There may also be symptoms such as mental depression, irritability, susceptibility to anger, bitter taste in the mouth, dry throat, or a dull greenish complexion. The tongue is red with thin yellow coating, and the pulse is wiry and rapid. Menstruation with varying amounts of flow, red or purple in color, may resemble a blood-heat pattern. However, early menstruation due to liver depression transforming into heat is primarily characterized by distension and pain in the breasts, chest, flanks, and lower abdomen, bitter taste in the mouth, dry throat, and a wiry, rapid pulse. In contrast, early menstruation due to heat is distinguished by a slippery and rapid pulse, making clinical differentiation straightforward. The treatment principle is to soothe the liver and relieve depression, clear heat and cool the blood. The recommended formula is the modified Peony and Gardenia Peripatetic Powder. For younger individuals with insufficient kidney qi, human placenta may be added.
4. Blood Stasis︰Menstrual periods come early, usually with heavy flow at first and then scanty, or continuous dripping, dark purple in color with clots, lower abdominal distension and tenderness. The tongue texture is normal or slightly purple or with ecchymosis, and the pulse is deep and hesitant or deep and thin. It is mostly caused by prolonged qi stagnation or poor hygiene during menstruation, leading to qi stagnation and blood stasis in the uterus, hence the dark purple menstrual blood with clots, lower abdominal distension and pain that refuses pressure. However, there are no symptoms of liver qi depression such as breast distending pain or pain in the chest and hypochondrium, which can be distinguished from the pattern of liver qi depression. Treatment should focus on invigorating blood and removing stagnation, using Cinnamon Twig and Ground Beetle Decoction.
5. Qi Deficiency︰In the early stage of menstruation, the flow is heavy, pale in color, and thin in quality, with a sensation of emptiness and sagging in the lower abdomen, or distension in the lumbar region. Mental fatigue, limb weakness, palpitation, shortness of breath, or poor appetite and loose stools, facial puffiness, and a pale complexion. The tongue is pale with a thin coating, or with tooth marks on the edges, and the pulse is weak and feeble. This is mostly caused by spleen qi deficiency, which fails to secure the Chong and Ren meridians. Although the menstrual flow is heavy in this pattern, it is pale in color, thin in quality, and the pulse is weak and feeble, which can be distinguished from early menstruation due to blood heat or blood stasis. Additionally, the blood heat pattern is commonly seen in adolescence, whereas this pattern is often observed in women of childbearing age. The treatment should focus on tonifying qi to secure the menses, using the prescription Original-Qi Lifting Decoction with the addition of Donkey-hide Gelatin and Solomonseal Rhizome.

Blood heat, yin deficiency, and liver depression transforming into heat, the disease mechanism is mainly due to pathogenic heat disturbing the Chong and Ren meridians, forcing the blood to move recklessly. However, the factors causing pathogenic heat are different, hence there are distinctions between deficiency and excess. Some are due to internal heat in the body, or indulgence in spicy foods, excessive consumption of hot and yang-supporting substances, leading to heat disturbing the Blood Sea; some are due to constitutional yin deficiency and yang exuberance, or prolonged illness causing loss of blood and damage to yin, leading to heat forcing the blood to move; some are due to emotional anger, liver depression transforming into fire, forcing the blood to move recklessly.

bubble_chart Documentation

1. 《Fu Qing Gynaecology．Menstrual Regulation: "Why is it that even though the menstrual period comes early, there is a difference between deficiency and excess?..., Early arrival is due to the rush of fire energy, while the amount is a test of water energy. Therefore, if the period comes early and is abundant, it is due to excessive fire and sufficient water; if it comes early but is scanty, it is due to excessive fire and insufficient water. If one sees an early arrival and assumes it is due to excessive heat, only purging the fire without supplementing water, or purging both fire and water, will it not exacerbate the illness?"
2. Jingyue Quanshu．Women's Rules: "Those with blood heat often have their periods arrive early, but one must examine the deficiency and excess of yin qi. If the complexion is mostly red, or purple and thick, or if the flow is heavy, the pulse is slippery, and the organ energy prefers cold and fears heat, these are all signs of fire." "Although early arrival is said to be due to fire, if there is deficiency accompanied by fire, the focus should be on deficiency, and the main treatment should be to nourish and calm the blood. Moreover, there are also cases of early arrival without fire, where one should either supplement middle qi or secure the life gate, and it is not appropriate to overuse cold and cooling methods."
3. Yixue Xinwu．Menstrual Irregularities: "Medical texts consider early arrival as heat and delayed arrival as cold, which is somewhat reasonable, but it should not be rigidly adhered to. For example, if the zang-fu organs are empty, and the menstrual flow is continuous and frequent, how can it simply be diagnosed as heat? Similarly, if there is internal heat and blood depletion, and the Jingmai is sluggish and does not come, how can it simply be diagnosed as cold? One must examine the accompanying symptoms. If the pulse is rapid, there is internal heat, dry lips and mouth, fear of heat and preference for cold, then it is heat; if the pulse is slow, the abdomen is cold, the lips are pale, the mouth is normal, and there is a preference for heat and fear of cold, then it is cold. The distinction between yang and yin organs is thus made."