bubble_chart Concept

Postmenopausal hemorrhage refers to the sudden resumption of menstruation in elderly women who have already ceased menstruating for more than a year. It is commonly known as "reverse blooming." Yizong Jinjian refers to it as "postmenopausal hemorrhage," Fuqingzhu Gynecology also calls it "the return of menstrual flow in old age."

bubble_chart Pattern Analysis

1. Liver-kidney Yin Deficiency︰After several years of amenorrhea, sudden reappearance of menstrual bleeding with bright red color and scanty flow, accompanied by occasional flushing or hot flashes on the cheeks, vertigo, tinnitus, or feverish feeling in the palms and soles, restlessness, insomnia, red lips, dry mouth, tender red tongue texture, and thin rapid pulse. This condition is often caused by constitutional yin deficiency, excessive sexual activity leading to failure of yin to control yang and impaired liver storage; or by advanced age and physical decline with inherent deficiency of liver and kidney yin essence, further aggravated by indulgence damaging essence and stirring ministerial fire internally, resulting in fire forcing blood to move. This syndrome commonly occurs after intercourse, characterized by sudden onset of menstrual bleeding, varying in amount, red and sticky in quality. It is also accompanied by tinnitus, dizziness, malar flushing, night sweats, vexing heat in the chest, palms and soles, insomnia, and excessive dreaming. The pulse is invariably rapid and weak. Treatment focuses on nourishing water to moisten wood and cooling blood to secure the menses, using formulas such as Yiyin Decoction or Anemarrhena, Phellodendron, and Rehmannia Decoction supplemented with Tortoise Carapace, glossy privet fruit, and Yerbadetajo Herb. For cases with liver depression transforming into fire, treatment emphasizes soothing the liver and relieving depression, clearing heat and cooling blood, modified with Peony and Gardenia Peripatetic Powder.
2. Liver Depression Transforming into Fire︰The menstrual blood suddenly comes in large amounts, appearing purplish-red or purplish-black in color, thick in texture, or mixed with blood clots. Symptoms include irritability, breast distending pain, restless sleep with many dreams, a red tongue with thin white or slightly yellow coating, and a wiry, rapid pulse. This condition is caused by depression and anger damaging the liver, leading to qi stagnation transforming into fire and forcing the blood to recklessly flow. It is commonly seen in women with an irritable temperament. The characteristics include heavy menstrual flow, purplish-red and thick blood with purple clots, accompanied by chest and breast distending pain, dysphoria, irritability, bitter taste in the mouth, a red tongue with yellow coating, and a pulse that is rapid and forceful. Although both conditions involve fire forcing the blood to overflow, one is deficient and the other is excessive, making them distinctly different.
3. Spleen Qi Deficiency︰The menstrual blood is pale in color and scanty in amount, the complexion is pale, the limbs are fatigued, there is a bland taste in the mouth with no appetite, and edema may be observed. The tongue texture is swollen and pale, and the pulse is deep and weak. This condition arises due to inherent weakness of spleen qi, improper diet, excessive worry, or other factors that injure spleen qi, leading to spleen deficiency and qi sinking, which impairs its ability to govern nutrient-blood. The clinical characteristics include: pale and thin bleeding, accompanied by limb fatigue, mental exhaustion, poor appetite, abdominal distension and fullness, edema of the lower legs, and a pale tongue texture. The treatment should focus on tonifying the spleen and replenishing qi to control blood, and Returning to Spleen Decoction with Cooking Stove Earth can be used.
4. Dampness Toxin Pouring Downward︰The menstrual blood suddenly appears, dark red and thick, even with mixed colors, emitting a foul odor, accompanied by a bitter and sticky taste in the mouth, dark urine, constipation, a yellow and greasy tongue coating, and a wiry, thin, and slippery pulse. This is often caused by engaging in sexual activity during menstruation or postpartum without restraint, or unclean bathing, allowing damp-toxin filth and turbidity to invade the uterus and appendages when the body is weak. This leads to internal accumulation of damp-toxin, multiple abscesses in the lower energizer, scorching of the Chong and Ren meridians, and reckless blood flow. The characteristic features are dark red and turbid menstrual blood, often mixed with various colors and emitting an unbearable stench. Treatment should focus on clearing heat, draining dampness, and removing toxins, using the Shengshi Pill.

Postmenopausal hemorrhage is a condition that is often clinically attributed to deficiency or fire, and even when it is due to fire, it is mostly deficiency fire. However, there are also cases due to excess or cold. The key to differentiation lies in the color and quality of the bleeding, combined with a comprehensive analysis of accompanying symptoms, to avoid misdiagnosis.

According to clinical observations, this condition is commonly seen in some patients with cervical cancer. Therefore, it is important to conduct gynecological examinations to rule out the possibility of malignancy.

bubble_chart Documentation

1. Fuqingzhu Gynecology．Regulating Menstruation: "When women over the age of fifty or even sixty or seventy suddenly menstruate, either passing purple blood clots or red blood, some may say it is a sign of rejuvenation, but who would have thought it is the onset of menorrhagia! By the time women reach their late forties, their reproduction-stimulating essence is already depleted, and without taking tonifying yang medicines, how can their essence be full enough to transform into menstrual blood, just like that of a young woman? However, when menstruation occurs inappropriately, it is due to the liver not storing and the spleen not governing, leading to either excessive leakage of essence stirring the fire of the life gate or severe qi depression igniting the fire of the dragon and thunder. When these two fires flare up together, blood rushes out, resembling menstruation but not actually being menstruation. For such symptoms, unless the qi and blood of the liver and spleen are greatly replenished, how can the blood suddenly stop?"