I remember being very envious of one of my high school girlfriends: she always had very light periods. She said she only needed one lightdays pad for each day of her 3 day cycle. Without going into too much detail, let’s just say that I was on the other end of the spectrum. Ugggh.
One of the best things about studying TCM (traditional Chinese Medicine) is learning the reasons behind all these symptoms and how to remedy them using natural solutions. This blog will outline the main TCM syndromes (patterns of disharmony) that result in Scanty or Profuse periods, as well as reviewing the recommended TCM herbal formulas for each pattern. (Thanks to our fabulous Gynecology professor, Dr. Jing Zhang for her knowledge and teachings)
1. Scanty periods. Like my light days friend, most women consider themselves lucky to have scanty periods, and may not think of it as a problem. However, it may lead to amenorrhea (lack of period) which can result in fertility problems, and in general, it is a good idea to make sure that you are as healthy as possible, so here goes. Firstly, please note that during the first 3 months of pregnancy, a woman may still have periods, but with a reduced quantity, so if scanty periods are new to you, check to see if you may be pregnant!
Scanty periods means that you have light bleeding, maybe just a small drip, and the cycle may be normal, or shortened. The main reasons behind this are: Blood Deficiency, Kidney deficiency, Blood stasis, Phlegm-dampness.
1.a Deficiency conditions leading to Scanty periods. First let’ s look at the deficiency situations: the menstrual blood will be a light color, and there will be no pain associated with the period. If it is due to Blood deficiency, the woman will have a pale face and tongue, and may have a thin or choppy pulse or experience heart palpitations. There are lots of great blood tonic formulas in the TCM arsenal, but the one that Dr. Zhang recommends for this condition is Zi Xue Tang (the purple snow special pill).
If the woman has the aforementioned light blood with no pain, by the color is more of a pale, or dull grey color, with a thin consistency and she also has general Kidney Yang Deficiency signs like cold limbs and frequent urination, and low back pain, then we can give her a modification of Jin Kui Shen Qi Wan called Gui Shen Wan.
Of course, moxa on Ren 4 Guan Yuan and points like LV 8 Qu Quan and St 36 Zu San Li are beneficial to nourish the blood and essence.
If the blood is thin and red, and she shows other Kidney yin Deficiency signs like a thin red tongue with no coating, a rapid and thin pulse, and peri-menopausal symptoms like night sweats, 5 centre heat, and a dry throat, then we wouldn’t use moxa, but rather use more Acupoints to clear deficiency heat like KD 6 Zhao Hai, and LU 7 Lie Que. We could still give her the Gui Shen Wan formula, but modify it using herbs like Mu Dan Pi and Zhi Mu to clear heat.
1.b Excess conditions leading to Scanty periods. For the excess conditions, if there is Blood Stasis, the menstrual blood will be dull or dark in color with clots . There will also likely be abdominal pain that becomes worse with pressure. If it’s due to phlegm-dampness, the blood will be red, or light red, and sticky in consistency.
If the blood is purple/dark with clots and she experiences obstructive pain in the lower abdomen, chances are she has blood stasis. Her pulse may be thin and choppy, and her tongue would have purple dots and enlarged veins underneath. For this type of woman, we need to move qi and resolve blood stasis using a formula like Tao Hong Si Wu Tang, and the famous 4 gates (although Dr. Mui suggests we use the 6 gates, including SP 6 San Yin Jiao).
If she has pale blood that is sticky/greasy in consistency, and other phlegm–damp signs like leukhorrea, obesity, oppression of the chest, and a slippery pulse with a tongue that is pale with white/greasy fur, then we should give her a formula to resolve phlegm/dry dampness like Cang Fu Dao Tan Wan. Acupuncturists can use points like ST 28 Shui Dao or Ren 9 Shui Fen to drain dampness, and Ren 6 Qi Hai to move Qi.
2. Profuse menstruation. If a woman loses more than 80 mL of blood per cycle ( I know, who measures?!) but the cycle is still regular, it is considered profuse menstruation. (If the cycle is irregular, and profuse, this is a whole other special condition called Beng Luo, which I will get to writing about another day.) Of course, in addition to being a giant pain in the you know where, too much blood loss can lead to Qi/Blood and Yin all deficient which can cause a lot of problems down the road, so if you suffer from profuse menses, read up, and then go see a TCM professional to get the right formula to reduce your blood loss. Oh, and don’t eat food that is too cold, or too spicy during your menstruation.
The main etiologies of profuse menstruation are: Qi deficiency, Blood Heat, and Blood stasis.
2.a Profuse menstruation due to deficiency. If a woman has profuse, but pale and thin blood, with general Qi deficiency signs and symptoms like pale face, fatigue, palpitations. shortness of breath, etc.. We can give her a formula like Ju Yuan Jian (lift the source decoction) which is very similar to Bu Zhong Yi Qi Tang. During the cycle, we can add in some stop bleeding herbs like charred (Tan) E Jiao, Ai Ye, or Wu Zei Gu.
2.b Profuse menstruation due to Excess: Blood Heat or Blood Cold.
If a woman has excess blood heat, it may manifest as profuse bright/deep red blood, that may be thick and sticky, and her tongue is red with a yellow coating, and the pulse is slippery and rapid. She may also have mental restlessness, thirst, dark yellow urine and/or constipation. We need to clear heat and cool the blood, using a formula like Bao Yin Jian, or An Chong Tang with Dang Shen if she also has underlying Qi Deficiency. Extra herbs like Qian Cao, Di Yu and Huai Hua can be added into stop bleeding and cool the blood.
If it is really bad, and the Blood heat is turning to fire, there may be inflammation, resulting in dark purple blood with a foul odor. There may be a tight/hard lower abdomen with pain that becomes worse with pressure, and she might develop fever and an aversion to cold if an infection is developing. For this type of severe blood heat, we should give her a stronger formula like Jie Du Si Wu Tang, and add herbs like Bai Jiang Cao and Hong Teng to clear toxin.
If there is an excess condition of blood stasis due to cold accumulation the blood will be profuse with thick/sticky dark clots and she will have lower abdominal pain that is worse with pressure. The Tongue will be purple, and the pulse will be thin and choppy. We need to use a strong formula to move blood stasis, like the famous Shao Fu Zhu Yu Tang (decoction to resolve stasis in the lower mansion). Remember to give her the handy little formula Shi Xiao San (suddenly smile powder) to activate blood circulation and relieve pain. Also, Yi Mu Cao helps to resolve stasis that results in painful menses.
For Acupuncturists: Sp 8 Di Ji is the Xi Cleft point of the Spleen channel, and useful to stop bleeding.
In treating women who are prone to profuse menstrual bleeding, the approach is two-fold: during the menstruation, we focus on stopping bleeding, and after the period, we focus on consolidating the Chong (extra-ordinary meridian).
Thanks again to Dr. Jing Zhang for her knowledge and teachings. She is one of the fabulous professors at Oshio College, and also has a private practice at # 250 1641 Hillside Ave. Phone her at 778 433 4858. to make an appointment with one of Victoria’s best TCM doctors.