TCM Notes: Prolonged Menstrual Periods (Menostaxis)

Prolonged Periods (Menostaxis)

Definition and General Characteristics

  • Definition: Refers to menstrual flow lasting more than 77 days, extending up to 22 weeks.

  • Location of Disease: Primarily located in the Chong and Ren Mai and the uterus.

  • Pathology: Usually categorized as either an excess or deficiency pattern.

  • Most Common Presentation: A prolonged menstrual period often accompanied by menorrhagia (heavy bleeding).

Potential Underlying Causes (Western Medicine Perspective)

  • Incomplete breakdown of the corpus luteum.

  • Pelvic inflammatory disease (PID).

  • Endometritis.

  • Problems caused by intrauterine devices (IUDs).

Clinical History

  • May include a history of:

    • Dietary irregularity.

    • An unhealthy lifestyle.

    • Emotional disorders.

    • Pelvic infection or inflammation.

    • Use of an IUD.

Clinical Manifestations

  • Cycle: Generally normal in length.

  • Flow Duration: Exceeds 77 days, lasting up to 22 weeks.

  • Accompanying Symptoms:

    • Often a heavy menstrual flow.

    • Lower abdominal pain.

    • A bearing down sensation in the lumbosacral region.

  • Specific to Chronic PID or Endometritis:

    • Increased vaginal discharge, which may be yellow or red-tinged.

    • Gynecological (GYN) exam for PID may reveal thickening and tenderness of the adnexa.

    • Positive signs of uterine tenderness.

Auxiliary Examinations

  • Blood tests: To track hormone levels.

  • Hysteroscopy.

  • Endometrial biopsy: To confirm diagnosis.

Differential Diagnosis

  • Abnormal Uterine Bleeding (Metrostaxis):

    • Characterized by menstrual bleeding at times other than during the expected menstrual period.

    • Spotting or heavy bleeding may persist for months.

    • Distinction: Menostaxis (lengthy periods) occurs at the correct time, though it may or may not recur monthly.

  • Reddish Leukorrhea:

    • Is a discharge, not true bleeding, and occurs between periods.

    • Though blood-like, it is distinct from menstrual bleeding.

Therapeutic Principle (Traditional Chinese Medicine - TCM)

  • Core Principle (from S. Weizenbaum, as given by Dr. Qiu Xiao Mei): Stop bleeding and regulate menstruation by securing the Chong and Ren Mai.

  • Role of the Kidneys:

    • The Kidneys are critically implicated in gynecological bleeding disorders.

    • Both the Chong Mai and Ren Mai originate in the uterus.

    • The uterine vessels are directly linked to the Kidneys.

    • The Kidneys are considered the root of the Chong and Ren Mai and the fundamental source of menstrual blood.

  • Nei Jing Quote: "At seven times two years (1414 years old), the woman's Tian Gui arrives. Her Ren Mai opens through. The great Chong Mai is abundant. The monthly event descends in a timely way."

    • Interpretation: This passage illustrates that robust Kidney Qi is essential for the engendering of Tian Gui (Heavenly Dew).

    • Tian Gui's Role: Tian Gui acts upon the Chong and Ren Mai, leading to an abundant "sea of blood."

    • Menstrual Flow: Menses then descends predictably, "like the tide."

    • Conclusion: The health and balance (abundance or decline) of Kidney Qi directly determine the normalcy of menstruation.

Patterns and Treatments

Qi Deficiency Type

  • Clinical Manifestations:

    • Prolonged menstruation with a heavy flow of pale red blood.

    • Accompanied by mental fatigue, lack of strength, shortness of breath (without a desire to speak), and a bearing down sensation in the lower abdomen.

  • Tongue and Pulse:

    • Pale tongue with a thin coating.

    • Moderate weak pulse.

  • Pathology Explanation:

    • Qi deficiency leads to instability of the Chong and Ren Mai, resulting in a loss of control over menstrual bleeding.

    • May also involve exhaustion of Ming Men fire, which influences normal blood transformation, causing the blood to be thin and light red.

    • Insufficient Middle Qi impairs the circulation of Yang, leading to fatigue, weakness, shortness of breath (without desire to speak), and the bearing down sensation.

  • Treatment Principle: Supplement Qi to control blood, secure the Chong Mai, and attune menses (tiao Yue Jing).

  • Primary Formula: Jia Yuan Jian (Origin-Lifting Brew) + E Jiao and Chao Ai Ye

    • Herb Dosages:

      • Ren Shen: 1010g

      • Huang Qi: 1515g

      • Bai Zhu: 1515g

      • Sheng Ma: 1010g

      • Zhi Gan Cao: 66g

      • E Jiao: 1010g

      • Chao Ai Ye: 3030g

  • Modifications:

    • For heavy menstrual bleeding: Add Pao Jiang, Xue Yu Tan (charred human hair), and Chi Shi Zhi.

    • For dizziness, palpitations, insomnia, and excessive dreaming: Add He Shou Wu, Shu Di Huang, Suan Zao Ren.

    • When the Heart and Spleen are depleted, causing blood to fail to return to the vessels: Use Gui Pi Tang.

    • When the Middle Qi falls downward and the Qi cannot absorb the blood: Use Bu Zhong Yi Qi Tang.

  • Acupuncture: (Specific points not detailed in transcript, but indicated as a treatment modality).

Deficiency Heat (Yin Deficiency with Internal Heat)

  • Clinical Manifestations:

    • Scanty menstrual flow, bright red in color, thin in nature, and without clots.

    • Accompanied by a dry throat and mouth, tidal fever, malar flush, a sensation of 55-centered heat (heat in palms, soles, and chest), and dry, bound stools.

  • Tongue and Pulse:

    • Red tongue with little coating.

    • Rapid, thready pulse.

  • Pathology Explanation:

    • Yin deficiency combined with internal heat harasses the Chong and Ren Mai, leading to uncontrolled menstrual bleeding and a prolonged flow.

    • Yin deficiency and fluid depletion result in a scanty, thin menstrual flow without clots.

    • The bright red color of the blood is a direct result of the exuberance of fire.

    • Xu (Empty) Fire scorches the body fluids, preventing them from moisturizing the upper part of the body, which manifests as a dry mouth and throat.

  • Treatment Principle: Nourish Yin, clear heat, and stop bleeding.

  • Primary Formula: Liang Di Tang + Er Zhi Wan

    • Herb Dosages:

      • Sheng Di Huang: 1515g

      • Xuan Shen: 1010g

      • Di Gu Pi: 1010g

      • Mai Dong: 1515g

      • E Jiao: 1010g

      • Bai Shao: 1010g

      • Nu Zhen Zi: 1515g

      • Han Lian Cao: 1515g

  • Formula Effects: This combination effectively nourishes Yin, clears heat, stops bleeding, and regulates menstruation without causing stagnation from tonification or stasis from arresting bleeding.

  • Modification: For strong thirst: Add Tian Hua Fen.

  • Acupuncture: (Specific points not detailed in transcript, but indicated as a treatment modality).

Blood Stasis

  • Clinical Manifestations:

    • Prolonged menstrual period with a variable flow.

    • The blood is darkish purple in color and contains clots.

    • Lower abdominal pain with an aversion to pressure during menstruation.

  • Tongue and Pulse:

    • Darkish purple tongue with small petechiae.

    • Choppy, forceful pulse.

  • Pathology Explanation:

    • Blood flow is obstructed due to blood stasis, leading to an inconstant and irregular flow.

    • The obstructed flow is the cause of the lower abdominal pain experienced during menstruation.

    • The presence of darkish purple blood and clots is characteristic of blood stasis.

  • Treatment Principle: Activate blood, dispel stasis, and stop bleeding.

  • Primary Formula: Tao Hong Si Wu Tang + Shi Xiao San, Yi Mu Cao, and Qian Cao

    • Herb Dosages:

      • Dang Gui: 1515g

      • Sheng Di Huang: 1515g

      • Chi Shao: 1515g

      • Chuan Xiong: 1010g

      • Tao Ren: 1010g

      • Hong Hua: 1010g

      • Pu Huang: 1010g

      • Wu Ling Zhi: 1010g

      • Yi Mu Cao: 1010g

      • Qian Cao: 1010g

  • Acupuncture: (Specific points not detailed in transcript, but indicated as a treatment modality).