For many women, each menstrual period brings only scant traces on sanitary pads, and the cycle is frustratingly short. This not only raises concerns about physical health but can also impact fertility. How does Traditional Chinese Medicine (TCM) approach regulating this?
What Causes Menstrual Scantiness?
Dr. Que Poh Yuen Albert, a TCM Gynecology Expert at Singapore Gong Fang Tang TCM, explains that TCM terms scant menstruation as "Jing Shui Se Shao" (经水涩少). The core pathological mechanisms are "insufficient blood sea" (血海不充) or "blockage in the uterine vessels" (胞脉阻滞), requiring pattern differentiation for treatment.
Blood Deficiency (血虚): Long-term malnutrition, excessive dieting, or chronic illness impairing nourishment can lead to inadequate production of Qi and Blood. When Qi and Blood are insufficient, the "Blood Sea" is depleted, naturally resulting in reduced menstrual flow – like a dried-up river struggling to fill. Additionally, significant blood loss during childbirth or miscarriage, without timely recuperation, can easily cause Blood Deficiency affecting menstruation.
Qi Stagnation and Blood Stasis (气滞血瘀): A fast-paced life and high stress levels, prolonged emotional suppression, anxiety, or depression can cause Liver Qi Stagnation, blocking Qi movement and impairing Blood circulation. When Blood flow is obstructed internally and cannot discharge smoothly, it leads to scant menstruation, often with dark-colored blood and clots.
Cold Congealing in the Uterus (寒凝胞宫): Indulging in cold drinks/foods, exposure to cold during menstruation, or prolonged residence in cold, damp environments allows Cold pathogens to invade the body and congeal in the uterus. Cold causes contraction, making blood vessels constrict and flow sluggish – akin to frozen pipes in winter hindering water flow – ultimately causing scant periods and dysmenorrhea.
Phlegm-Damp Obstruction (痰湿阻滞): Dietary irregularities, excessive consumption of greasy, sweet foods, or lack of exercise damage Spleen function, impairing its transportation and transformation role. This leads to internal Dampness production, which congeals into Phlegm. Phlegm-Damp obstructing the uterus disrupts Qi and Blood circulation, causing scant menstruation, often accompanied by obesity and excessive leukorrhea.
How Does TCM Effectively Regulate Menstrual Scantiness with Dark Discharge?
For menstrual scantiness, Physician Dr. Que Poh Yuen Albert recommends the classic formula Tao Hong Si Wu Tang (Peach Kernel & Carthamus Four Substances Decoction). This formula, originating from the "Golden Mirror of Medicine" (医宗金鉴), has the effect of invigorating Blood and unblocking menstruation.
Tao Hong Si Wu Tang consists of six herbs: Shu Dihuang (熟地黄, Rehmannia Root, prepared), Danggui (当归, Chinese Angelica Root), Baishao (白芍, White Peony Root), Chuanxiong (川芎, Szechuan Lovage Root), Taoren (桃仁, Peach Kernel), and Honghua (红花, Carthamus Flower). It is an excellent formula for nourishing Blood and invigorating Blood.
Shu Dihuang nourishes Yin and Blood, replenishes essence, and benefits marrow, being a key herb for Blood tonification.
Danggui tonifies Blood, invigorates Blood, regulates menstruation, and alleviates pain – it both supplements and moves Blood.
Baishao nourishes Blood, astringes Yin, soothes the Liver, and relieves pain.
Chuanxiong invigorates Blood and moves Qi, known as the "Qi-moving herb within the Blood," enhancing the Blood-invigorating effect.
Taoren and Honghua are a classic pairing (黄金搭档) for dispelling Blood Stasis, unblocking channels and collaterals, and promoting Blood circulation.
The formula is skillfully composed: it tonifies Blood without causing stagnation and invigorates Blood without damaging it. By regulating Qi and Blood, it fills the "Blood Sea," thereby improving symptoms of menstrual scantiness.
Physician Qiu also tailors the Tao Hong Si Wu Tang formula flexibly based on the patient's specific constitution and symptoms. For example, Huangqi (黄芪, Astragalus Root) or Dangshen (党参, Codonopsis Root) may be added to tonify Qi and nourish Blood, or Xiangfu (香附, Cyperus Rhizome) and Wulingzhi (乌药, Lindera Root) may be included to regulate Qi and menstruation, making the formula better suited to the patient's needs.
Medical Case
Patient: Ms. Lin, 31 years old.
Chief Complaint: Menstrual flow drastically reduced for 3 years (since abortion), requiring only panty liners. Discharge dark with clots, accompanied by stabbing lower abdominal pain requiring painkillers. Ultrasound showed thin endometrium (4mm).
Initial Consultation: Tongue dark red with thin white coating; pulse wiry, thin, and choppy.
Pattern Differentiation: Blood Stasis in the Uterus, blockage in the vessels.
Prescription: Modified Tao Hong Si Wu Tang.
Herbs: Taoren (9g), Honghua (6g), Danggui (15g), Chuanxiong (12g), Chishao (12g), Shu Dihuang (18g), plus Yimucao (30g), Jixueteng (20g). Taken for 5 days before menstruation until day 3 of the period.
Result: Cycle 1: Menstrual blood color changed from black to dark red, clots reduced by 50%, abdominal pain decreased. Cycle 2: Menstrual flow doubled (soaking regular sanitary pads), endometrium thickened to 6mm. Cycle 3: Period duration returned to 5 days, flow and color normalized, ultrasound showed endometrium reaching 8mm.
