Wk 3 - Oligomenorrhea,
Late Menstrual Periods (Oligomenorrhea)
Definition: Cycles longer than 35 days for at least 3 consecutive cycles; a definitive pattern must be observed.
In extreme cases, menstrual periods may be overdue by 3-5 months.
Long cycles shorter than 35 days are not considered late, nor are occasional delays.
Late and irregular cycles are considered normal during:
The first year after menarche
The perimenopausal period.
Causes
Causes may include deficiency or stasis or a complex of both.
The Chong mai cannot be filled on time either due to deficiency or obstruction.
The ensuing menstrual flow may be scanty but will flow for the normal duration or time.
Western Medicine Perspective: Delayed menses indicate delayed ovulation or a concurrent condition in dysfunctional uterine bleeding (DUB).
Kidney Qi / Yang Deficiency (Late Period pattern in Oligomenorrhea)
Symptoms
Characteristics of Menstruation:
Late period
Scanty, darkish, clean (no clots) and thin menses
Clear discharge (during menses).
Insufficient Fire in the Lower Burner:
Results in darkish, thin, and clear (without clots) menses.
Kidney Deficiency Signs:
Aching low back and knees
Dizziness and tinnitus
Dull or dark complexion with dark macules on the face.
Tongue: Pale tongue body, dip at rear, thin white coat.
Pulse: Deep and thready pulse.
Pathophysiology
Kidney Qi/Yang deficiency leads to insufficient warming and transformation in the lower jiao and lack of security of Ren and Dai mai; turbid dampness may appear as a clear, thin vaginal discharge.
Note: Extraordinary vessels are insubordinate to the Kidneys; when EVs need supplementing, treat the Kidney. This applies to ALL diseases exhibiting EV insecurity/disconnection, not only gynecological/monthly issues.
Treatment Principles
Supplement Kidney Qi/Yang, nourish blood, and tiao (attune) Yue Jing.
Herbal Formula: Dang Gui Di Huang Yin (代理⽅)
Ingredients and Functions:
Shan Yao 10g: Supports Kidney Qi.
Shu Di Huang 10g: Nourishes blood & replenishes essence.
Du Zhong 10g: Supports Kidney Qi; fortifies the lower back & bones.
Dang Gui 10g: Nourishes blood & replenishes essence.
Shan Zhu Yu 10g: Nourishes blood & replenishes essence; supplements Kidney qi.
Huai Niu Xi 10g: Supports the lower back & bones.
Zhi Gan Cao 5g: Harmonizes.
Modifications for Vaginal Discharge
Excessive Vaginal Discharge: Add Qian Shi, Jin Ying Zi, +/- Wu Wei Zi (to astringe).
Deficient Ministerial Fire: Add Rou Gui, +/- Fu Zi.
Dull Pain in Lower Abdomen: Add Bai Shao (to nourish blood + relax spasms), E Jiao, Xiang Fu (regulates Qi + moves blood in the lower jiao, attunes the cycle).
Other Formulas to Consider: Shen Qi Wan, You Gui Wan.
Acupuncture Points (to secure Kidney Qi)
Ki-13: At the level of Ren-4; nourishes & supports the Kidney; regulates Ren & Chong.
R-4, R-6: Sea of Qi Points.
R-5: Mu of San Jiao; stimulates movement of the Ministerial Fire.
K-7: Metal point on Water channel; Mother point (nourishing for Kidney).
DU-4: Secures Kidney Qi.
SP-6 & ST-36: Support Blood & Qi together.
Addresses Chong, Ren, Dai, Bao Luo.
Chong Mai Points: SP-4, KI-11, ST-30, UB-11.
Lower He Sea Points: ST-37, ST-39 - relate to the Chong Mai as extended Yang aspects of the Heart.
Other Points: SP-10, LV-3, REN-1; Dai Mai: GB-41, GB-26, GB-27, LV-13.
Bao Mai (Uterus - HT): REN-4, REN-14; open the Chong Mai (SP-4, ST-30).
“Nameless Point” / “Equilateral Triangle @ REN-4”/ “Ho Kung”: 3 points that form an equilateral triangle with sides measuring the distance from REN-4 to REN-8.
Sacral Liao Points: UB-31 - UB-34; deep into the Bao Luo.
Needling Consideration: Points must “tong” for fertility;
UB Channel represents the cold water of the North; use for heat conditions with moxa for cold conditions.
Blood Deficiency (Late menses with scanty, clear, thin, light red flow)
Symptoms
Characteristics:
Late menses with scanty, clear, thin, light red flow.
General Blood Deficiency Signs:
Sallow (pale yellow) complexion; dizziness; blurred vision; palpitations; insomnia; dull lower abdominal pain responding to pressure.
Tongue: Pale lips and tongue with thin white coating.
Pulse: Thready weak pulse or hollow (scallion-stalk) pulse.
Etiology
Repeated damage to the blood;
Multiple pregnancies in rapid succession;
Breastfeeding many infants at once;
Difficult pregnancies/postpartum blood loss;
Constitutional easiness after prolonged illness;
Inadequate nourishment for various reasons (physical overwork & undernourishment).
Pathomechanism
Ying-blood depletion results in inability to supplement the Chong and Ren Mai;
Sea of blood / Chong fails to fill on time, leading to late period with scanty flow;
Light red and thin menses due to essence and blood deficiency;
Dull lower abdominal pain reflects blood’s inability to nourish the Bao Luo (uterine vessels).
Blood deficiency can cause head/eye symptoms (blurred vision, dizziness) and heart-nourishment issues (vexation, palpitation, insomnia).
Treatment Principles
Replenish Qi, supplement blood, and tiao Yue Jing.
Herbal Formula: Da Bu Yuan Jian (Major Origin–Supplementing Brew)
Ingredients:
Ren Shen 10g
Shan Yao 15g
Shu Di Huang 10g
Du Zhong 15g
Dang Gui 10g
Shan Zhu Yu 15g
Gou Qi Zi 15g
Zhi Gan Cao 5g
Modifications/Variants
For Spleen Deficiency: Add Bai Zhu, Bai Bian Dou, Sha Ren.
For Heart Blood Deficiency: Add Yuan Zhi, Wu Wei Zi, Suan Zao Ren.
For Concurrent Deficiency Heat Signs (e.g., tidal fever, night sweats, vexation): Add Nu Zhen Zi, Han Lian Cao, He Shou Wu, Di Gu Pi.
Sheng di Huang: Nourishes blood deeply/cool effect.
Other Formulas to Consider: Shen Ling Bai Zhu San.
Acupuncture Points (to nourish blood & support Chong/Ren)
Points: SP-4, SP-6, ST-36, Ren Mai (R4 + R6), SP-10, others including HT-7, PC-6.
Additional: moxa on UB-20, UB-18; attend to Bao Luo and Bao Mai.
Stasis Types: Cold in the Blood (Excess type)
Symptoms
Late menstrual period with scanty, dark flow with clots.
Cold blood signs: Lower abdominal pain aggravated by pressure and improved with warmth.
Pale bluish complexion, aversion to cold, cold limbs.
Tongue: Dark / dusky tongue with white coating.
Pulse: Deep, wiry or tight pulse.
Etiology
External cold or overconsumption of cold-natured foods can lead to blood coagulation; emotional trauma can lead to cold invasion.
Pathomechanism
Obstructed blood circulation in Chong and Ren; Sea of blood fails to fill/empty on time, leading to dark, scanty, clotted flow.
Internal cold lodges in uterus, disrupting Qi and blood flow; Yang cannot circulate externally, resulting in cold limbs.
Treatment Principle
Warm the channels, dissipate cold, tiao (“attune”) Yue Jing.
Herbal Formula: Wen Jing Tang (Flow-Warming Decoction)
Ingredients:
Ren Shen 10g
Dang Gui 6g
Chuan Xiong 6g
Rou Gui 6-10g
E Zhu 6g
Mu Dan Pi 6g
Chuan Niu Xi 10g
Gan Cao 10g
Variations During Menses
Remove E Zhu and Niu Xi during menses.
Add Pao Jiang (charred ginger; warms & dissipates cold, does not linger) and herbs to stop bleeding.
Bai Shao: Can ease cramping when added with Gan Cao.
Acupuncture Points (to move blood & warm channels)
Acupoints include: PC-6, SP-4, SP-6, SP-2, SP-8, LV-5, Gb-38, HT-5.
Additional assessment of Chong Mai at ST-30, Ren Mai, K6 and others.
KI Yang Deficiency Cold Type (Late menstrual period with scanty flow)
Symptoms
Scanty flow, light red in color, thin, no clots.
Dull lower abdominal pain with preference for warmth and pressure; lumbar aching and weakness.
Copious clear urine and loose stools.
Tongue: Pale with white coat.
Pulse: Deep and slow or thready and weak.
Diagnosis
Deficient Kidney Yang Qi causes internal cold development; internal organ function impairment.
Lack of Yang results in inability to complete Qi and Blood creation/transformation.
Deficiency leads to scanty, thin, light-red flow, dull lower abdominal pain, lumbar pain, copious urine, and loose stools.
Treatment Principle
Warm the channels, reinforce Yang, nourish blood, tiao Yue Jing.
Herbal Formula: Wen Jing Tang (Channel-Warming Decoction)
Ingredients:
Wu Zhu Yu 6g
Dang Gui 10g
Chuan Xiong 10g
Bai Shao 15g
Gui Zhi 6g
Ren Shen 10g
Mu Dan Pi 10g
Ban Xia 10g
Mai Dong 10g
E Jiao 10g
Gan Cao 10g
Modifications
If unresolved abdominal pain during menses: Add Ba Ji Tian, Xiao Hui Xiang, Xiang Fu.
If sloppy diarrhea: Add Chao Bai Zhu, Shen Qu, Pao Jiang.
For Kidney Yang support: Add Tu Si Zi, Bu Gu Zhi, Yi Zhi Ren.
Acupuncture Points
Concentration on nourishing and warming the kidney.
Qi Stagnation Type (Late menstrual period with clots, dark red, mentally depressed)
Symptoms
Late period with slightly reduced or normal volume; flow is sluggish, dark red with clotting.
Secondary Complications: If complicated by heat or cold, the amount may vary (less or more).
Liver Qi Stasis Signs: Mental depression; lower abdominal distention and pain; breast swelling.
Tongue: Normal or red, possibly thin yellow coat.
Pulse: Wiry or choppy.
Etiology
Liver injury due to depression impairs Qi flow and disturbs Blood circulation, preventing Chong Mai from filling timely.
Pathomechanism
Liver constraint causes distention in breasts, hypochondrium/ribs, and lower abdomen.
Treatment Principles
Regulate Qi, move stagnation, activate blood, tiao Yue Jing.
Herbal Formula: Wu Yao Tang (Secrets from the Orchid Chamber)
Ingredients:
Wu Yao 10g
Xiang Fu 10g
Mu Xiang 10g
Dang Gui 10g
Gan Cao 10g
Modifications
For period pain: add E Zhu and Yan Hu Suo.
If constraint turns into fire: add Mu Dan Pi, Zhi Zi.
Severe distension/pain: add Chai Hu, Yu Jin, Chuan Lian Zi, Wang Bu Liu Jin.
Scanty menses: add Ji Xue Teng (and Dan Shen).
Cold in lower abdomen: add Ai Ye, Rou Gui.
Acupuncture Points:
Liver Qi and Blood movement points include: LV14, P6 (to regulate liver and move jueyin outward).
Pair with REN-17 (upward needling) to open Qi flow.
Support with K13, Sp6, St30, Sp4.
Irregular Menstrual Cycle - Menorrhagia
Definition
A cycle length differing from a standard monthly cycle by more than 7 days for at least 3 consecutive periods.
Characteristics
Patterns of early followed by late cycles or vice versa; may present as early menstruation that can lead to heavy/prolonged bleeding or spotting; may result in amenorrhea if characterized by long cycles with scant bleeding.
Causes and WM View
Generally caused by liver constraint or kidney deficiency, leading to unregulated storage/discharge from the sea of blood.
In Western Medicine, associated with dysfunctional uterine bleeding (DUB).
Liver Constraint Pattern (Common Cause)
Symptoms
Irregular cycles; variable flow; menses are dark red/purplish with clots.
Signs of liver constraint: breast/rib pain, lower abdomen pain; frequent sighing, belching, reduced appetite.
Tongue: normal or red; coat may be thin white or thin yellow. Pulse: wiry.
Etiology
Chronic depression/anger damages liver, causing disharmony of Chong and Ren Mai, leading to variable volume/pace of blood discharge.
Pattern and Formula
Xiu Yao San (Free Wanderer Powder) variant:
Chai Hu 10g
Dang Gui 15g
Bai Shao 10g
Bai Zhu 15g
Fu Ling 15g
Pao Jiang 6g
Bo He 5g
Gan Cao 10g.
Additional Modifications
With vexation and bitter mouth: Add Mu Dan Pi, Zhi Zi.
With menstrual pain: Add Xiang Fu, Yan Hu Suo.
With blood clots during menses: Add Ze Lan, Yi Mu Cao.
With epigastric fullness and poor appetite: Add Zhi Qiao, Hou Po, Chen Pi.
With kidney deficiency: Add Tu Si Zi, Shu Di Huang, Xu Duan.
With dizziness/blurred vision: Add Shi Jue Ming, Ju Hua, Gou Teng.
If both kidney and liver deficiencies exist: Treat together with Ding Jing Tang (Menstruation-Stabilizing Decoction).
Acupuncture:
In-class exercise (no specific points listed).
Kidney Deficiency Irregular Menstrual Cycle
Pattern
Irregular cycle can be short or long with scanty flow of light red blood.
Symptoms
Aching weak low back and knees; dizziness and tinnitus; dull complexion or macula.
Tongue: Pale with moist white coating and posterior dip.
Pulse: Thin or thready weak pulse.
Pathophysiology
Kidney is the root of Chong and Ren Mai; when Qi is insufficient, the storing function is impaired, leading to irregular release of blood from the sea of blood.
Scanty flow due to deficiency of essence and blood; responsibility for light red thin, clear flow due to kidney Qi insufficiency and Yang deficiency failing to warm blood.
Treatment Principle
Supplement Kidney and regulate menstruation.
Herbal Formula: Gu Yin Jian (Yin-Securing Brew)
Ingredients:
Tu Si Zi 10g
Shu Di Huang 15g
Shan Zhu Yu 15g
Ren Shen 10g
Shan Yao 15g
Wu Wei Zi 6g
Yuan Zhi 6g
Zhi Gan Cao 6g.
Acupuncture:
In-class exercise.
Notes on Key Concepts and Connections
Chong Mai, Ren Mai, and Dai Mai are central channels involved in regulating menstrual blood and its timing; deficiencies or blockages in these vessels lead to irregularities in filling/emptying the Sea of Blood (Bao Luo).
Patterns illustrate a holistic framework where organ systems (kidney, liver, spleen, heart) interact with Qi, Blood, and Body Fluids to manage menstruation.
Treatments blend herbs to tonify deficiency (e.g., Kidney qi/blood), move stagnation (Qi/Blood), warm cold, and secure vessel function, typically incorporating targeted acupuncture for same networks (Chong/Ren/Dai, Liver Qi, Kidney Yang, etc.).
If both kidney and liver are involved, combined formulas like Ding Jing Tang are recommended, illustrating pattern overlap and integrated treatment need.
Ethical/Practical Note: This documentation summarizes Traditional Chinese Medicine patterns and suggested formulas; a professional medical evaluation is essential for any menstrual irregularities, particularly in cases of heavy bleeding, severe pain, or systemic symptoms.
Periods may be overdue by 3-5 months; cycles longer than 35 days are not considered late, and late/irregular cycles can be normal during the first year post-menarche and perimenopause phase.
Causes encompass deficiency or stasis, or a combination thereof. The Chong Mai may fail to fill timely due to deficiency or blockage. Ensuing menstrual flow might be scanty but expected duration persists.
Delayed menses suggest delayed ovulation or concurrent conditions associated with DUB.