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bubble_chart Concept

Menstrual flow exceeding the normal amount, or prolonged menstrual periods with increased bleeding, while still maintaining a normal cycle, is called "hypermenorrhea." In classical medical texts, descriptions of this condition are essentially consistent. For example, Danxi Xinfa, Zhengzhi Zhunsheng, Fuqingzhu Gynecology, and Yizong Jinjian all refer to it as "hypermenorrhea"; Jiyin Gangmu records "persistent hypermenorrhea" and "continuous menstruation"; Fuke Yuchi describes it as "excessive flow without stopping" and "menstruation lasting more than ten days without ceasing." All emphasize the characteristic of "excessive menstrual flow" in this condition. "Hypermenorrhea" differs from the clinical concept of "collapse" (崩). The latter refers to massive vaginal bleeding outside the menstrual period, while the former has a normal menstrual cycle with increased flow, though not as severe as "collapse." However, if "hypermenorrhea" persists, it can gradually develop into "collapse."

bubble_chart Common Symptoms and Signs

1. Liver and kidney yin deficiency hypermenorrhea: Menstruation starts early with heavy flow, or prolonged dripping, bright red in color, thin in texture, accompanied by emaciation, occasional facial flushing, five-center heat, vertigo, tinnitus, hot flashes, night sweating, insomnia with frequent dreams, soreness and weakness in the lower back and knees, dry eyes, dry stools, a tender red tongue with little coating, and a thin, rapid pulse.
2. Liver fire hyperactivity hypermenorrhea: Menstruation arrives early with excessive flow or prolonged menstruation, bright red or purplish-black in color, thick and sticky with clots, flushed face, irritability, chest tightness, breast distension, dizziness, headache, restless sleep with frequent dreams, bitter and dry mouth, poor appetite, dry stools, scanty dark urine, a red tongue with yellow coating, and a wiry, rapid pulse.
3. Spleen deficiency with weak qi hypermenorrhea: Early menstruation with heavy flow or prolonged periods, pale red and thin in color, a sensation of emptiness in the lower abdomen, or post-menstrual lower abdominal pain relieved by pressure, pale complexion, fatigue, shortness of breath, reluctance to speak, spontaneous sweating, aversion to wind, reduced appetite, loose stools, or even diarrhea, facial and limb swelling, usually with increased leukorrhea, like nasal mucus or saliva, or accompanied by uterine prolapse, a pale and swollen tongue with tooth marks, and a deep, weak pulse.
4. Chong and Ren deficiency with cold hypermenorrhea: Late menstruation with heavy flow or prolonged periods, dull in color, thin in texture, or like black soybean juice, sometimes with clots, often accompanied by cold pain in the lower abdomen during menstruation, relieved by warmth and pressure. Usually accompanied by listlessness, pale or dull complexion, cold limbs, soreness and coldness in the lower back and knees, thin leukorrhea, loose stools, frequent nighttime urination, or infertility, a pale and dull tongue, and a deep, slow, and weak pulse.
5. Dampness-heat pouring down hypermenorrhea: Early menstruation with heavy flow, deep red or purplish-black in color, foul-smelling, thick and sticky with turbid discharge, vulvar itching, increased leukorrhea before and after menstruation, yellow or red, or yellowish-green, thick and foul-smelling, accompanied by a greasy complexion, heavy body, chest and gastric stuffiness, reduced appetite, abdominal distension, sticky stools, scanty dark urine, a red tongue with yellow, greasy coating, and a slippery, rapid pulse.

bubble_chart Differential Analysis

1. Liver kidney yin deficiency hypermenorrhea and liver fire hyperactivity hypermenorrhea: both are caused by fire forcing blood to move and the liver failing to store blood, but the deficiency and excess are distinctly different. The former is deficient, while the latter is excessive. Liver kidney yin deficiency hypermenorrhea is caused by constitutional yin deficiency and yang excess, or excessive childbirth and breastfeeding, or excessive indulgence in desires, or prolonged illness leading to poor nourishment, resulting in liver kidney deficiency damage, essence deficiency and blood consumption, water failing to control fire, and blood being forced to move recklessly. This belongs to deficient heat, with a focus on yin deficiency. Liver fire hyperactivity hypermenorrhea is caused by emotional distress leading to liver depression transforming into fire, or sudden anger damaging the liver, and liver fire hyperactivity forcing blood to move. This belongs to excessive heat, with a focus on liver fire. Therefore, the clinical manifestations of liver kidney yin deficiency hypermenorrhea are a series of signs of deficient fire hyperactivity (flushed cheeks, tidal fever, night sweating, insomnia, heat in the five centers, tender red tongue, thin and rapid pulse, etc.), advanced menstruation with heavy flow, red and clear color, and not very obvious abdominal pain. The clinical characteristics of liver fire hyperactivity hypermenorrhea are: menstrual color purple-black or bright red, menstrual texture sticky, with clots, breast distension during menstruation, slight abdominal distension and fullness pain, accompanied by liver depression qi stagnation and liver fire hyperactivity manifestations (irritability, dizziness, headache, chest phlegmonous mastitis distension, heart vexation, bitter mouth, wiry and rapid pulse). In treatment, for liver kidney yin deficiency, the focus is on nourishing water to moisten wood and cooling blood to stabilize menstruation, using Six-Ingredient Rehmannia Decoction with Barbary Wolfberry Fruit, Yerbadetajo Herb, Tortoise Carapace, etc., or using Rehmannia and Lycium Root-Bark Decoction with modifications; for liver fire hyperactivity, the focus is on clearing heat and cooling blood, soothing the liver and relieving depression, using Peony and Gardenia Peripatetic Powder with modifications.
2. Spleen deficiency with qi weakness and hypermenorrhea, as well as Chong and Ren deficiency-cold hypermenorrhea: both belong to deficiency pattern. The former emphasizes spleen deficiency and qi deficiency; the latter emphasizes kidney deficiency and yang deficiency. Spleen deficiency hypermenorrhea is caused by insufficient middle qi in the constitution, or dietary irregularities, excessive worry damaging the spleen, overexertion injuring qi, leading to spleen deficiency failing to control, Chong and Ren becoming unstable, and blood not following its meridian tropism. Its clinical features include: menstruation arriving early with heavy flow, pale color, lower abdominal distension, thin and weak pulse, or thin and rapid pulse with weakness. Usually, leukorrhea is thin, resembling nasal mucus. Chong and Ren deficiency-cold hypermenorrhea is often caused by early marriage and childbirth, or excessive childbirth and breastfeeding, or sexual overexertion, or consuming raw and cold foods during menstruation, exposure to rain and wading in water, leading to cold pathogens attacking Chong and Ren; or constitutional yang deficiency, cold in the uterus and appendages, Chong and Ren losing stability, resulting in excessive menstrual flow. Its menstrual characteristics include: pale and dark menstrual color with clots, cold pain in the lower abdomen that prefers pressure. It also shows signs of yang deficiency (pale complexion, cold limbs, aversion to cold and preference for warmth, thin leukorrhea, loose stools, frequent nocturia, pale and dark tongue, deep and slow pulse, etc.). For spleen deficiency with qi weakness, treatment should focus on tonifying the middle and replenishing qi, lifting and securing, using Middle-Tonifying Qi-Replenishing Decoction, Returning to Spleen Decoction, or Original-Qi Lifting Decoction with modifications. For Chong and Ren deficiency-cold, treatment should focus on warming the meridians and dissipating cold, nourishing blood and stabilizing Chong, using Meridian-Warming Decoction with modifications.
3. Dampness-heat pouring down hypermenorrhea: the production of dampness-heat comes from two sources, one is direct exposure to external dampness toxins; the other is dysfunction of zang-fu organs leading to internal dampness. Generally, it is caused by dietary overstrain damaging the spleen, middle transportation becoming weak, dampness turbidity accumulating internally, transforming into heat; or indulging in rich and greasy foods, leading to internal dampness-heat; or excessive worry and anger damaging the liver and spleen, causing stagnant fire internally, leading to dampness-heat intermingling; or engaging in sexual activity during menstruation or postpartum, allowing filthy turbidity dampness toxins to invade. This leads to dampness-heat steaming, Chong and Ren being scorched, forcing blood to flow recklessly, resulting in early and heavy menstruation. Clinically, there is a distinction between dampness predominance and heat predominance. The distinguishing points are: for dampness predominance, menstrual color is red with mucus, leukorrhea is white or slightly yellow, chest and stomach stuffiness, heavy body and facial puffiness, white or thin yellow greasy tongue coating, soggy and slippery pulse; for heat predominance, menstrual color is purple-black, thick and foul-smelling, leukorrhea is yellow and thick, or yellow-green, bitter and dry mouth, short and red urine, sticky stools, yellow greasy tongue coating, slippery and rapid pulse. The symptoms of heavy menstrual flow, thick and sticky, purple-red or purple-black color, etc., resemble excessive liver fire, but the mixture of menstrual flow and leukorrhea, foul smell, unbearable genital itching, increased leukorrhea before and after menstruation, are unique symptoms and signs of dampness-heat pouring down to the lower energizer. Therefore, if the symptom and sign characteristics are grasped, it is not difficult to differentiate. For treating dampness-heat pouring down hypermenorrhea, the focus should be on clearing and draining damp-heat, using Gentian Liver-Draining Decoction with modifications.

Hypermenorrhea is mostly caused by liver-kidney yin deficiency, spleen deficiency with qi weakness, and Chong and Ren deficiency-cold, while excessive liver fire and dampness-heat pouring down are less common, especially dampness-heat pouring down with excessive menstrual flow, which is rarely discussed by past scholars. During differentiation, the characteristics of menstruation, pulse, tongue, and accompanying symptoms must be organically combined to ensure accurate differentiation. Additionally, the treatment of this condition should not prematurely use astringent and hemostatic agents to avoid retaining pathogens and nurturing disease.

bubble_chart Literary Supplement

1. Danxi Xinfa. Women: "When phlegm occupies the Blood Sea position, leading to heavy flow, the eyes will gradually become dim. For obese people, use Arisaema, Atractylodes Rhizome, Sichuan Lovage Rhizome, Cyperus, made into pills for consumption."