bubble_chart Concept

When the amount of menstruation exceeds the normal range, or the duration of menstruation is prolonged with increased bleeding, but still maintains its normal periodicity, it is called "hypermenorrhea." In classical medical texts, the descriptions of this condition are essentially consistent. For example, Danxi Xinfa, Zhengzhi Zhunsheng, Fuqingzhu Gynecology, Yizong Jinjian and other books all refer to it as "hypermenorrhea"; Jiyin Gangmu records "persistent hypermenorrhea" and "continuous menstruation"; Fuke Yuchi describes it as "excessive flow without cessation" and "menstruation lasting more than ten days without stopping." All of these emphasize the characteristic of "excessive menstrual flow" in this condition. "Hypermenorrhea" is different from the clinical concept of "flooding" (崩). The latter refers to heavy vaginal bleeding outside the menstrual period, while the former has a normal menstrual cycle, and although the flow is heavy, it is not as sudden and severe as "flooding." However, if "hypermenorrhea" persists and does not heal, it can gradually develop into "flooding."

bubble_chart Pattern Analysis

1. Liver-kidney Yin Deficiency︰Menstruation occurs earlier with heavy flow, or prolonged dripping without cessation, the menstrual blood is bright red in color and thin in quality, the body is emaciated, there is occasional flushing heat in the cheeks, vexing heat in the chest, palms and soles, vertigo and tinnitus, tidal fever and night sweat, insomnia with dreamfulness, soreness and weakness in the lumbar region and knees, dryness in both eyes, dry stools, the tongue texture is tender and red with scant coating, and the pulse is thin and rapid. This is a deficiency pattern, caused by constitutional yin deficiency with exuberant yang, or excessive childbirth and breastfeeding, or excessive indulgence in sexual activity, or prolonged illness leading to malnourishment, resulting in liver and kidney deficiency damage, essence depletion and blood consumption, water failing to nourish fire, and reckless blood flow due to forced movement. This belongs to deficiency-heat, with emphasis on yin depletion. The clinical manifestations are a series of signs of exuberant deficiency-fire (flushed cheeks, tidal fever, night sweat and insomnia, vexing heat in the chest, palms and soles, a tender red tongue, a thin and rapid pulse, etc.), advanced menstruation with heavy flow, red and clear quality, and abdominal pain that is not very obvious. In terms of treatment, the focus is on nourishing water to moisten wood and cooling blood to secure the menses. Use Six-Ingredient Rehmannia Decoction with additions such as Barbary Wolfberry Fruit, Yerbadetajo Herb, and Tortoise Carapace, or modify with Rehmannia and Lycium Root-Bark Decoction.
2. Up-flaming of Liver Fire︰Menstruation arrives early, with excessive or prolonged menstrual flow, bright red or purplish-black in color, thick and sticky in texture, containing blood clots, accompanied by flushed face, irritability, impatience, chest tightness, breast distension, dizziness, headache, restless sleep, bitter taste in the mouth, dry mouth, poor appetite, dry stools, scanty dark urine, red tongue with yellow coating, and wiry rapid pulse. This is an excess pattern, caused by emotional distress leading to liver depression transforming into fire, or sudden anger damaging the liver, resulting in excessive liver fire forcing blood to move recklessly. This belongs to excess heat, with the key issue being liver fire. Therefore, the clinical characteristics are: menstrual blood that is purplish-black or bright red, sticky in texture, interspersed with clots, breast distension during menstruation, lower abdominal distension and fullness with pain, along with manifestations of liver depression qi stagnation and exuberant liver fire (impatience, irritability, dizziness, headache, chest tightness, breast distension, irritability, bitter taste in the mouth, wiry rapid pulse). The treatment focuses on clearing heat and cooling blood, soothing the liver and relieving depression, using Peony and Gardenia Peripatetic Powder with modifications.
3. Spleen Qi Deficiency︰Advanced menstruation with heavy flow or prolonged duration, pale red and thin in color, lower abdomen feeling empty and sagging, or post-menstrual lower abdominal pain relieved by pressing, pale complexion, physical fatigue, mental fatigue, shortness of breath and reluctance to speak, spontaneous sweating and aversion to wind, reduced appetite, loose stools, or even diarrhea, facial puffiness and limb swelling, usually with increased leucorrhea resembling nasal mucus or saliva, possibly accompanied by prolapse of the uterus, pale and swollen tongue with tooth marks on the edges, and a deep weak pulse. The primary issue is spleen deficiency and qi deficiency. Spleen deficiency hypermenorrhea arises from congenital middle qi insufficiency, dietary irregularities, excessive worry damaging the spleen, or overexertion depleting qi, leading to spleen deficiency failing to retain and control, resulting in weakened Chong and Ren meridians and improper blood circulation. Its clinical features include: menstruation arriving early with heavy flow, pale color, lower abdominal distension and sagging, fine weak pulse, or fine rapid and weak pulse. Typically, leucorrhea is thin, resembling nasal mucus or saliva. Treatment should focus on tonifying the middle and replenishing qi, lifting and consolidating, using Middle-Tonifying Qi-Replenishing Decoction, Returning to Spleen Decoction, or Original-Qi Lifting Decoction with modifications.
4. Chong and Ren Meridians Deficiency-Cold︰During the late stage [third stage] of menstruation, the flow is heavy or prolonged, with dark and dull menstrual blood that is thin in texture, resembling black soybean juice, or containing blood clots. There is often cold pain in the lower abdomen during menstruation, relieved by warmth and pressure. Typically, the patient exhibits mental fatigue, a pale or dull complexion, cold limbs, soreness and coldness in the lower back and knees, clear and thin leukorrhea, loose stools, frequent nocturia, or infertility. The tongue appears pale and dull, and the pulse is deep, slow, and weak. The condition is primarily due to kidney deficiency and yang deficiency. Causes may include early marriage and childbirth, excessive delivery and feeding of infants, overexertion from sexual activity, consumption of raw or cold foods during menstruation, exposure to rain or cold water, or cold pathogens attacking the Chong and Ren meridians. It may also result from congenital yang deficiency, leading to cold and deficiency in the uterus with appendages, resulting in instability of the Chong and Ren meridians and excessive menstrual flow. The characteristics of menstruation include pale, thin, and dull menstrual blood with clots, cold pain in the lower abdomen relieved by pressure, and manifestations of yang deficiency (pale complexion, cold body and limbs, fear of cold and preference for warmth, clear and thin leukorrhea, loose stools, frequent nocturia, pale and dull tongue texture, deep and slow pulse, etc.). Treatment should focus on warming the meridians and dissipating cold, nourishing blood, and stabilizing the Chong meridian, using Meridian-Warming Decoction with modifications.
5. Dampness-heat︰Menstrual periods come early with heavy flow, dark red or purplish-black in color, foul-smelling, thick and sticky with turbid discharge, vulvar itching, increased leukorrhea before or after menstruation, which may be yellow, red, or yellowish-green, thick, turbid, and foul-smelling. Accompanied by greasy facial complexion, heavy body sensation, chest and gastric stuffiness, poor appetite, abdominal distension and fullness, greasy stools, scanty dark urine, red tongue with yellow greasy coating, and slippery rapid pulse. The formation of dampness-heat is attributed to two pathways: one is direct exposure to external dampness-toxin, and the other is dysfunction of the zang-fu organs leading to internal dampness. Generally, it arises from dietary overstrain damaging the spleen, impairing its transportation function, causing internal accumulation of dampness-turbidity, which transforms into heat; or from excessive consumption of rich, greasy foods, leading to internal dampness-heat; or from emotional distress such as worry and anger, injuring the liver and spleen, resulting in stagnant fire flaring internally and impaired transportation, binding dampness and heat together; or from engaging in sexual activity during menstruation or postpartum, allowing filthy turbid dampness-toxin to invade internally. As a result, dampness-heat steams and scorches the Chong and Ren vessels, forcing blood to recklessly flow, manifesting as early and heavy menstrual flow. Clinically, it can be categorized as dampness-dominant or heat-dominant. The distinguishing features are: - **Dampness-dominant**: Menstrual blood is red with mucus, leukorrhea is white or slightly yellow, chest and gastric stuffiness, heavy body sensation with facial puffiness, white or slightly yellow greasy tongue coating, and soggy slippery pulse. - **Heat-dominant**: Menstrual blood is purplish-black, thick, and foul-smelling, leukorrhea is yellow and thick or yellowish-green, bitter and dry mouth, scanty dark urine, greasy stools, yellow greasy tongue coating, and slippery rapid pulse. The symptoms of heavy flow, sticky texture, and purplish-red or purplish-black color resemble those of excessive liver fire. However, the mixing of menstrual and vaginal discharge, foul odor, unbearable vulvar itching, and increased leukorrhea before or after menstruation are unique symptoms and signs of dampness-heat flooding the lower energizer. Therefore, if these characteristic symptoms and signs are identified, differentiation is not difficult. For treating dampness-heat pouring down hypermenorrhea, the principle should focus on clearing and draining damp-heat. The modified Gentian Liver-Draining Decoction can be used.

Hypermenorrhea is often caused by liver-kidney yin deficiency, spleen deficiency with weak qi, and deficiency-cold of the Chong and Ren meridians. Cases due to excessive liver fire or dampness-heat pouring downward are relatively rare, especially those involving excessive menstrual flow due to dampness-heat pouring downward, which have seldom been discussed by medical scholars throughout history. When differentiating syndromes, it is essential to comprehensively integrate the characteristics of menstruation, pulse and tongue signs, and accompanying symptoms to ensure accurate pattern identification. Additionally, in treating this condition, astringent and hemostatic agents should not be used prematurely to avoid trapping pathogens and exacerbating the condition.

bubble_chart Documentation

1. Danxi Xinfa．Woman: "When phlegm occupies the position of the Blood Sea, leading to excessive discharge, the eyes will gradually become dim. For obese individuals with such conditions, use Arisaema, Atractylodes Rhizome, Sichuan Lovage Rhizome, and Cyperus to make pills for consumption."