Scanty Periods, Dark Color, Lasting Only Two Days – Seemingly Convenient, But May Be a Health Alert from the Body. How Does TCM Regulate When It Doesn't Flow Properly?
What Causes Scanty Menstrual Flow?
Dr. Que Poh Yuen Albert, a TCM Gynecology Specialist at Singapore Gong Fang Tang TCM, states that scanty menstrual flow in TCM can fall under categories like "Scanty Menstruation" or "Sparse Menstrual Flow," and its causes are complex.
Blood Deficiency (血虚) is one common cause. Long-term malnutrition, excessive dieting, or chronic illness leading to physical weakness can all result in insufficient production of Qi and Blood, leaving the Chong and Ren vessels and the Sea of Blood empty, naturally reducing menstrual flow.
Blood Stasis (血瘀) is equally significant. Factors like cold congealing, Qi stagnation, or trauma cause poor blood circulation, leading to stasis obstructing the uterus and hindering menstrual discharge.
Phlegm-Dampness Obstruction (痰湿阻滞) is often related to dietary irregularities and lack of exercise. Spleen dysfunction leads to internal phlegm-dampness, which blocks the uterine vessels and affects the downward flow of menstrual blood.
What are the Harms of Scanty Menstrual Flow?
Precipitous Decline in Ovarian Reserve Function
Menstrual Blood = "Mirror" of Ovarian Function
Data: Persistent flow <5ml correlates with a 3-fold increase in the rate of decline of AMH levels (Ovarian Reserve).
Endometrium Thin as Paper
Scanty Flow → Inadequate Endometrial Shedding → ↑Risk of Intrauterine Adhesions
Consequences: Implantation failure, recurrent miscarriage.
Early Menopause Symptoms Arrive Ahead of Schedule
Hot flashes, night sweats, irritability, insomnia, skin laxity – looking 45 at age 35!
Severe Infertility Crisis
Clinical Statistics: 40% of secondary infertility cases develop from scanty menstrual flow.
How Does TCM Regulate Scanty Menstrual Flow?
When regulating scanty menstrual flow, Dr. Que Poh Yuen Albert often uses the classic formula Danggui Shaoyao San (当归芍药散, Tangkuei and Peony Powder). This formula originates from the "Jin Gui Yao Lue" (Essential Prescriptions from the Golden Cabinet) and consists of Danggui (Angelica Sinensis), Shaoyao (Paeonia Lactiflora), Chuanxiong (Ligusticum Chuanxiong), Fuling (Poria Cocos), Baizhu (Atractylodes Macrocephala), and Zexie (Alisma Orientale). It has the effects of nourishing blood, activating blood, strengthening the spleen, and dispelling dampness.
Shaoyao (Peony Root) is used in a heavy dose to nourish blood and soften the liver, relieving cramping and pain.
Danggui (Chinese Angelica) nourishes blood and activates blood circulation. Paired with Shaoyao, it enhances the power to nourish blood and regulate menstruation.
Chuanxiong (Szechuan Lovage Root), known as the "Qi-moving herb in the blood," both activates blood and moves Qi, while also assisting Danggui and Shaoyao in nourishing blood and regulating the liver.
Fuling (Poria), Baizhu (White Atractylodes), and Zexie (Water Plantain) strengthen the spleen and promote diuresis to eliminate dampness. They help the source of transformation (digestion) and guide dampness out through the urine.
Combined, these herbs work synergistically to nourish blood, soothe the liver, strengthen the spleen, and eliminate dampness. This is precisely suitable for cases like the patient described (Xiao Yan), involving liver depression, spleen deficiency, Qi-blood deficiency, and dampness obstruction.
Modifications and Clever Applications:
Increase Blood-Activating Before Period: + Jixueteng (Spatholobus Stem) 30g, Yimucao (Motherwort) 15g (Add 5 days before period to promote downward flow of menses).
Kidney Deficiency with Sore Back: + Tusizi (Cuscuta Seed) 12g, Duzhong (Eucommia Bark) 10g (Tonify kidney and essence).
Phlegm-Dampness with Obesity: + Cangzhu (Atractylodes) 10g, Chenpi (Tangerine Peel) 9g (Resolve phlegm and aid weight loss).
Case Study
Patient: Ms. Zhang, 28 years old.
Chief Complaint: Presented for scanty menstrual flow and shortened period duration. Over the past year, her menstrual cycle had become irregular, with significantly reduced flow. Each period required only minimal sanitary pads and lasted only 2 days. The blood color was dark red, accompanied by small clots.
Initial Consultation: Sallow complexion. Tongue pale and dusky with ecchymotic spots (瘀斑) at the edges, thin white coating. Pulse thready and choppy (细涩).
TCM Diagnosis: Scanty Menstruation (月经过少).
Pattern Differentiation: Blood Deficiency with Blood Stasis (血虚血瘀证).
Prescription: Modified Danggui Shaoyao San.
Herbs: Danggui (Chinese Angelica) 12g, Baishao (White Peony Root) 15g, Chuanxiong (Szechuan Lovage Root) 10g, Fuling (Poria) 15g, Baizhu (White Atractylodes) 12g, Zexie (Water Plantain) 10g, Shudi (Prepared Rehmannia) 15g, Yimucao (Motherwort) 15g, Taoren (Peach Seed) 10g, Zhigancao (Honey-fried Licorice) 6g.
Administration: 1 dose daily, decocted in water and taken warm twice daily (morning and evening). Continuous use for 14 days constitutes 1 course of treatment. Instructed to observe her next menstrual period.
Second Consultation: After completing 1 course, Ms. Zhang reported reduced symptoms of dizziness and fatigue. During her next period, the flow increased compared to before, the duration extended to 4 days, clots decreased, and lower abdominal dull pain was significantly relieved. As the formula was effective, the original prescription was continued for 2 more courses to consolidate the regulation.
Result: Menstrual flow and duration returned to normal. Complexion became rosy.
