Menorrhagia refers to excessive uterine bleeding occurring at the regular intervals of menstruation.

Etiology and Pathogenesis

A. Retention of heat in the blood leads to the impairment of the Chong meridian and extravasation of blood.

B. Deficiency of qi fails to control the blood circulation.

Diagnosis and Differential Diagnosis

A. Large amount of light-colored and thin menses indicates the qi-deficiency syndrome.

B. Large amount of bright red or purplish and viscous menses denotes the blood-heat syndrome.

C. Discharge of dark purplish menses containing clots, accompanied by lower abdominal pain indicates the blood-stasis syndrome. The differentiation between an asthenic and a sthenic syndrome should be based on other symptoms as well.

Syndrome Differentiation and Treatment

During the menstrual period, the main therapy should aim at stopping bleeding in order to prevent excessive blood loss and yin impairment, while in the days without menstruation, the therapy for calming and strengthening the Chong meridian should be employed as a causative treatment. As for the case with blood stasis, the therapy of eliminating blood stasis may be used to stop bleeding, but the drugs of warm and dry nature must be applied carefully so as to avoid exhaustion of the blood.

A. Qi-deficiency syndrome

Manifestations: Excessive menstrual flow with pink and thin menses, pale complexion, shortness of breath, weakness of limbs, empty and bearing-down sensation over the lower abdomen or palpitations, pale tongue and thready and weak pulse.

Therapeutic principles: Tonify qi, strengthen the Chong meridian, and stop bleeding.

Prescription: Jiuyan Decoction

Radix Ginseng 10 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Atractylodis Macrocephalae 15 g
Rhizoma Cimicifugae 6 g
Radix Astragali 15 g

Remarks: During the menstrual period with excessive uterine bleeding, add Colla Corii Asini (10 g), Folium Artemisiae Argyi Carbonisatus (6 g), Os Sepiellae seu Sepiae (15 g) and Rhizoma Zingiberis Carbonisatus to stop bleeding. For cases with marked prolongation of the menstrual period, add Pollen Typhae (wrapped in cloth, 10 g) and Herba Leonuri (15 g) to activate blood circulation and stop bleeding. For cases with cold pain over the abdomen and lumbus, add Radix Dipsaci (10 g), Fructus Psoraleae (15 g) and Folium Artemisiae Argyi Carbonisatus (6 g) to tonify the liver and kidneys, strengthen and warm the Chong and Ren meridians and stop bleeding.

B. Blood-heat syndrome

Manifestations: Excessive menstrual flow with bright red or dark red and viscous menses containing clots, restlessness, thirst, yellow urine, constipation, red tongue with yellow coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, cool the blood, and stop bleeding.

Prescription: The Modification of Protecting Yin Decoction

Radix Rehmanniae 15 g
Radix Rehmanniae Praeparata 15 g
Radix Scutellariae 10 g
Cortex Phellodendri 10 g
Radix Paeoniae Alba 15 g
Rhizoma Dioscoreae 15 g
Radix Dipsaci 10 g
Radix Glycyrrhizae 6 g

Remarks: For cases with consumption of qi and yin after blood loss manifested as blood-heat syndrome accompanied by fatigue, shortness of breath or palpitations and insomnia, use the Modification of Anchong Decoction as follows:

Radix Codonopsis Pilosulae 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Astragali 15 g
Os Draconis (decocted) 30 g
Concha Ostreae (decocted) 30 g
Radix Rehmanniae 15 g
Radix Paeoniae Alba 15 g
Os Sepiellae seu Sepiae 15 g
Radix Rubiae 12 g
Radix Dipsaci 10 g

For those with yin-deficiency, manifested as hectic fever, feverish sensation over the palms, soles and the chest, flushed face and profuse bleeding, use the Gujing Decoction composing of Radix Paeoniae Alba (15 g), Plastrum Testudinis Praeparata (15 g), Radix Scutellariae (10 g), Cortex Phellodendri (10 g), Cortex Ailanthi (15 g), Rhizoma Cyperi Praeparata (10 g), Herba Leonuri (15 g) and Herba Portulacae (15 g) to tonify yin and clear away heat.

C. Blood-stasis syndrome

Manifestations: Excessive or prolonged menstrual flow with dark purplish menses containing clots, lower abdominal pain and tenderness, dark purplish tongue with petechiae and thready and unsmooth pulse.

Therapeutic principles: Activate blood circulation, eliminate blood stasis, and stop bleeding.

Prescription: The Modified Powder for Dissipating Blood Stasis

Crinis Carbonisatus 10 g
Radix Rubiae Carbonisatus 12 g
Radix Notoginseng 3 g
Herba Leonuri 15 g
Pollen Typhae (wrapped in cloth) 15 g
Faeces Trogopterori 10 g

Remarks: For cases accompanied by symptoms of yin deficiency such as red tongue with little coating, dryness of mouth and throat, feverish sensation over palms, soles and the chest, night sweating, etc., add Radix Ophiopogonis (10 g), Radix Adenophorae Strictae (15 g), Herba Ecliptae (15 g), Fructus Schisandrae (10 g) or Fructus Ligustri Lucidi (10 g).

Copyright 1995 Hopkins Technology