A menstrual cycle that is delayed by seven days or more, up to one or two months (excluding early pregnancy), is referred to as "late menstruation [third stage]." If the delay is only six to seven days without any other discomfort, or if it occurs occasionally with a longer interval, it is not considered late menstruation [third stage].

bubble_chart Pattern Analysis

1. Chong and Ren Blood Deficiency︰Delayed menstruation, scanty flow, pale red color, no abdominal pain, accompanied by dizziness, and flusteredness. The tongue texture is pale, and the pulse is thin and weak. The condition mostly affects the liver and spleen. Scanty flow, pale color, pale tongue texture, and thin, weak pulse indicate treatment should focus on tonifying blood and qi, using Tangshen Tonifying Blood Decoction. However, if accompanied by thin and clear blood quality, dark black menstrual color, lingering abdominal pain, fear of cold, cold limbs, dull complexion, deep, slow, and weak pulse, and other signs of yang deficiency and internal cold, it can be differentiated from late-stage menstruation due to deficiency of the Chong and Ren channels with blood deficiency. Treatment should focus on nourishing blood and warming the channels, tonifying yang, and dispersing cold, using Xiangui Drink.
2. Chong and Ren Meridians Deficiency-Cold︰Delayed menstruation, scanty flow, thin quality, dark menstrual color, or mixed with small blood clots, dull abdominal pain that prefers pressure and is relieved by heat. Fear of cold, cold limbs, dull complexion. Pale and moist tongue texture, thin white coating, deep and slow weak pulse. The pathological changes are in the liver and kidneys. The characteristic symptoms are: although the menstrual flow is scanty, the tongue texture is pale and moist, similar to
3. Cold Stagnation in the Thoroughfare and Conception︰Delayed menstruation, scanty and dark purple menstrual blood with clots, lower abdominal pain that refuses pressure, prefers heat application. Complexion is dark and bluish, body is robust. Tongue texture is moist or dark purple, coating is white, pulse is deep, slow, and forceful or deep and tight. Due to consuming raw or cold foods during menstruation, or exposure to rain, wading in water, swimming, or sitting or lying on damp ground, cold invades the Chong and Ren meridians, causing poor circulation of qi and blood, hence the delayed menstruation. The clinical manifestations include: lower abdominal pain that refuses pressure, menstrual blood mixed with large or small clots, pain alleviates or disappears after the clots are discharged, which is excess cold. This pattern shares similarities with the pattern of deficiency cold in symptoms, but also has differences. For example, although the pattern of deficiency cold also involves lower abdominal pain, the pain lessens with pressure; although the menstrual blood may contain clots, the texture is thin. Treatment should focus on warming the meridians and relieving stagnation, using the prescription Meridian-Warming Decoction.
4. Liver Qi Depression︰Prolonged menstrual intervals, dark purplish menstrual blood with clots, lower abdominal distension and fullness with pain, and distension in the chest, flanks, and breasts. The tongue coating is normal, and the pulse is wiry or choppy. This condition is caused by emotional depression, qi stagnation, and blood stasis, leading to delayed menstruation. The menstrual blood is dark purplish with clots, accompanied by lower abdominal distension and fullness with pain, as well as distension in the chest, flanks, or breasts. However, the absence of a rigid lower abdomen upon palpation distinguishes it from the cold-stagnation pattern of the Chong and Ren vessels. Treatment should focus on relieving depression, moving qi, and invigorating blood to regulate menstruation, using the Liqi Tongjing Decoction.
5. Damp Phlegm︰Delayed menstruation with pale and sticky discharge, obesity, chest tightness, poor appetite, excessive phlegm, lethargy, palpitation, shortness of breath, and usually excessive leucorrhea. The tongue is pale with greasy coating, and the pulse is soggy and thin. Spleen-kidney yang deficiency and phlegm-dampness stagnation lead to obstruction of the thoroughfare and conception vessels, resulting in delayed menstruation. The discharge is pale and sticky, the body is obese, there is chest tightness and poor appetite, excessive leucorrhea, and a soggy, thin pulse. The treatment should focus on warming the kidneys and strengthening the spleen, resolving phlegm and dispelling dampness. The recommended formula is Degelatined Deer-Horn Drink.

bubble_chart Documentation

1. Jingyue Quanshu．婦人規：「凡 blood cold 者，經必 late stage [third stage] 而至。然血何以寒?亦惟 yang qi 不足，則寒從中生而 generation and transformation 失期，是即所謂寒也※""凡 yang qi 不足，blood cold delayed menstruation 者，色多不鮮，或色見沉黑，或澀滯而少；其脈或微或細，或沉遲弦澀；其臟氣形氣必 aversion to cold 喜暖。凡此者皆無火之證。」
2. Shengji Zonglu．婦人血 sweat pore》云："凡 menstruation 不利，有因風冷傷於經絡，血氣得冷則澀而不利者；有因 heart qi 抑滯，血 qi depression 結，不能宣流者。二者當審訂而療之。」
3. Danxi Xinfa．經病：「經水過期紫黑有塊，亦血熱也，必作痛，四物加 Cyperus、Coptis Rhizome。」