bubble_chart Concept

Menorrhagia and metrostaxis refer to irregular vaginal bleeding in women. Zhubing Yuanhou Lun states: "When blood flows out at irregular times and continuously, it is called fistula disease," and "sudden heavy bleeding is called menorrhagia." Although the clinical manifestations of menorrhagia and fistula disease are different, their disease causes are the same, and they can often transform into each other during the development of the disease mechanism. For example, if the intensity of menorrhagia slightly eases, it can turn into fistula disease; if fistula disease persists for a long time, it can also develop into menorrhagia. As Jisheng Fang says: "The conditions of menorrhagia and metrostaxis are fundamentally the same. The mild form is called fistula disease, while the severe form is called menorrhagia." Moreover, because the amount of bleeding in this condition varies and is often inconsistent, it is difficult to clearly distinguish between menorrhagia and fistula disease. Therefore, in clinical practice, they are often referred to together as menorrhagia and metrostaxis.

Menorrhagia and metrostaxis are common symptoms manifested in various gynecological diseases, such as dysfunctional uterine bleeding, hypermenorrhea, multi-colored leukorrhea, vaginal bleeding during pregnancy, postpartum dizziness due to hemorrhage, lochiorrhea, abdominal mass, etc. All these conditions involving vaginal bleeding fall under the category of menorrhagia and metrostaxis. In modern discussions, menorrhagia and metrostaxis are often associated with dysfunctional vaginal bleeding.

bubble_chart Pattern Analysis

1. Kidney Yin Deficiency︰Excessive vaginal bleeding or continuous spotting, bright red or purplish-red in color, thick in texture, occasionally with blood clots, soreness in the lower back and weakness in the limbs, dizziness, tinnitus, vexing heat in the chest, palms, and soles, dry mouth but no desire to drink. The tongue appears red or pale (in cases of blood deficiency), and the pulse is thin and rapid. This condition is often caused by constitutional yin deficiency, early marriage, excessive sexual activity, or multiple childbirths damaging kidney yin, leading to internal stirring of deficient fire and failure of the Chong and Ren meridians to retain blood, resulting in menorrhagia and metrostaxis. The key diagnostic features include bright red blood, thick texture, and a thin, rapid pulse. Treatment should focus on nourishing kidney yin, supplemented by cooling the blood and stopping bleeding. The commonly used formula is "Enriching Yin and Stopping Bleeding Decoction." After bleeding stops, the "Nourishing the Kidney and Regulating the Cycle Decoction" can be used.
2. Kidney Yang Deficiency︰Excessive or continuous vaginal bleeding, light red in color, thin in texture, without clots, or with yellowish-brown facial spots, cold limbs and body, overweight, lumbago. The tongue is pale and swollen, or with tooth marks, and the pulse is deep and weak or deficient and rapid (in cases of blood deficiency). This is often due to constitutional yang deficiency, insufficient kidney qi during adolescence, or excessive consumption of sweet and cold remedies for yin deficiency patterns, which damages kidney yang. Yang deficiency leads to insecurity of the Chong and Ren meridians, resulting in menorrhagia and metrostaxis. The diagnostic features include light red bleeding, thin texture, overweight body, deep and weak pulse, etc. The treatment should focus on warming and tonifying kidney yang, supplemented by tonifying qi to stop bleeding. The recommended formula is the Warming Yang to Stop Bleeding formula. After the bleeding stops, use the Kidney-Warming Cycle-Regulating formula.
3. Spleen Deficiency︰Excessive or continuous vaginal bleeding with pale, thin blood; sallow complexion; fatigue and poor appetite; lower abdominal distension and fullness with a sinking sensation; or loose stools. The tongue appears pale, and the pulse is thin and weak or deficient and rapid (in cases of blood deficiency). The main manifestations include spleen deficiency and sinking of middle qi, such as sallow complexion, fatigue, poor appetite, lower abdominal distension and fullness with a sinking sensation, etc. These symptoms are commonly seen in middle-aged women or those who have overexerted and damaged their qi. The treatment should focus on tonifying the spleen and replenishing qi, while also stopping bleeding. Use a qi-tonifying and hemostatic formula, and after the bleeding stops, switch to a spleen-nourishing and cycle-regulating formula.
4. Blood Stasis︰Excessive or continuous vaginal bleeding, with dark purple menstrual blood containing blood clots, lower abdominal pain that is tender to touch, and pain relief after the expulsion of clots. The tongue appears dark purple or has petechiae at the tip or edges, and the pulse is deep and choppy or wiry and slippery (in cases of blood deficiency or blood stasis transforming into heat). (However, for some patients with prolonged bleeding or persistent fistula disease who do not respond to pattern identification-based treatments, even if the above stasis patterns are absent, static blood stagnation should still be considered as the cause.) This condition arises from internal stagnation of static blood. If static blood is not removed, new blood cannot follow the meridian tropism, leading to persistent menstrual strangury. The symptoms are characterized by three features:
   Menstrual blood containing large, medium, or small static blood clots;
   1. Lower abdominal pain that is tender to touch, with pain relief after the expulsion of clots;
   2. Prolonged minor bleeding unresponsive to pattern identification-based treatments.
   The presence of any one of these features is sufficient to diagnose a stasis pattern. Moreover, this condition often occurs during the course of other symptoms and signs, distinguishing it clearly from kidney yin deficiency, kidney yang deficiency, or spleen deficiency-related menorrhagia and metrostaxis. Treatment for blood stasis patterns should focus on invigorating blood and resolving stasis, supplemented by tonifying qi and resolving stasis to stop bleeding. Once bleeding stops, further treatment should follow the three aforementioned symptom and sign patterns to regulate the cycle, as this condition is not the entirety of menorrhagia and metrostaxis but rather a specific stage within the process.

Spleen deficiency menorrhagia and metrostaxis and kidney yang deficiency menorrhagia and metrostaxis: one is yang decline, the other is qi deficiency, but in some individuals, both can coexist, or qi sinking can develop into yang decline. Given that clinically, kidney yang deficiency and spleen qi deficiency symptoms are complex and often mixed, a comprehensive analysis of pulse and complexion is necessary during clinical diagnosis. In treatment, qi-tonifying herbs and yang-warming herbs should be used in combination. The commonality between the two syndromes is that both are deficiency pattern, with non-heat menorrhagia and metrostaxis, one being yang deficiency and the other qi deficiency. Both yang and qi are essential for functional activities, hence both manifest as insufficient consolidation and guarding functions of the Chong and Ren meridians.

Kidney yin deficiency menorrhagia and metrostaxis and kidney yang deficiency menorrhagia and metrostaxis: both are deficiency pattern, but the disease cause and mechanism differ. If bleeding is severe, a rapid pulse may be observed. However, in yang deficiency, the rapid pulse is weak or deep and faint; in yin deficiency, the rapid pulse is strong and accompanied by thin and slippery qualities. In menorrhagia and metrostaxis syndromes, a rapid pulse is particularly common in deficiency pattern, hence Zhang Jing-yue stated: "Among diseases with a rapid pulse, deficiency is the most common. The more deficient, the more rapid; the more rapid, the more critical. How can all rapid pulses be attributed to Rebing? If a deficient rapid pulse is mistaken for a heat rapid pulse, failure is inevitable." This shows that in menorrhagia and metrostaxis with a rapid pulse, the syndrome cannot be identified solely based on pulse rate; pulse strength and form must also be considered.

The cause of "menorrhagia and metrostaxis" is generally believed to be damage to the thoroughfare and conception vessels, leading to dysfunction in regulating menstrual blood. As stated in Zhubing Yuanhou Lun, in the section on women's miscellaneous diseases: "The condition of menorrhagia is due to damage to the Chong and Ren meridians. The Chong and Ren meridians both originate within the uterus, being the sea of Jingmai. Overexertion leads to qi deficiency in the Chong and Ren meridians, resulting in an inability to regulate menstrual blood." The causes of damage to the thoroughfare and conception vessels are commonly seen in kidney yin deficiency, kidney yang deficiency, spleen deficiency, and blood stasis. Treatment generally involves two stages: stopping bleeding during the bleeding stage and regulating the cycle after bleeding stops. The former requires attention to pattern identification to determine the disease cause, treating based on the cause, and not solely focusing on astringency; the latter emphasizes kidney tonification, as the root of this condition lies in the kidney, but the cause must also be considered, and not just blindly tonifying the kidney.

bubble_chart Documentation

1. Yizong Jinjian-Gynecology Essentials: "After menstruation, if a woman continues to have dripping discharge, it is called menstrual fistula disease. If there is a sudden and excessive flow of menstrual blood, it is called menorrhagia. If the blood is purple and forms clots, accompanied by distending pain in the abdomen and flanks, it is due to heat and blood stasis. If the bleeding persists for a long time and is excessive without clots or pain, it is often caused by injury to the Ren and Chong meridians. Additionally, excessive worry can damage the spleen, leading to spleen deficiency and inability to control blood; sinking of middle qi can result in the inability to secure blood; sudden anger can damage the liver, causing the liver to fail in storing blood and leading to reckless bleeding. When diagnosing, it is essential to carefully examine the cause and differentiate it meticulously. Treat deficiency with tonification, resolve stasis, and clear heat. With proper treatment, recovery is certain."
2. Nyuke Jinglun-Menorrhagia and Leukorrhea quotes Fang Yue's words: "Blood belongs to yin; when calm, it flows through the meridians to nourish the interior; when agitated, it disrupts the meridians and flows recklessly. Therefore, when the seven emotions are excessive, the five emotions become hyperactive, leading to a sudden and prolonged flow of menstrual blood, which is called menorrhagia. The initial treatment should focus on stopping the bleeding to block its flow; the middle stage should focus on clearing heat and cooling the blood to clarify its source; the final stage should focus on tonifying the blood to restore its original state. If only the flow is blocked without clarifying the source, the overwhelming force cannot be stopped; if only the source is clarified without restoring the original state, the floating yang cannot be stabilized. This must be carefully considered."