The phenomenon of delayed menstruation is becoming increasingly common. Previously, it was often seen in postpartum menstrual irregularities, but now young girls are also experiencing it.
Delayed menstruation is generally divided into deficiency and excess. Excess syndrome often manifests as irritability, insomnia, abdominal bloating, but the period just won’t come. At this time, drinking some Angelica and Sichuan Lovage water might help it come.
If it’s more serious, and there are some organic lesions, taking some blood-activating and stasis-dispelling medicine can also help it come quickly.
Deficiency syndrome is different; it’s usually because the overall blood and qi are deficient, causing the period to not come on time, and the process will be delayed even longer. In modern terms, it means your metabolism is too slow. Therefore, recovery also requires fundamental conditioning; only by replenishing the blood, qi, and even kidney qi can the period continue to come normally.
The reason more and more women are experiencing delayed menstruation nowadays is due to physical deficiency, which is closely related to staying up late. Some stay up late using their phones, which adds injury to injury.
Regularly going to bed after midnight (strictly speaking, past 11 PM can deplete essence and blood), over time, combined with daily work pressure or excessive mental and visual strain, all of these indirectly deplete blood, leading to gradual menstrual irregularities and delayed menstruation. At this point, recovery can only be done slowly; it can’t be rushed.
Some people might go to the hospital and get a couple of shots to bring on their period, but this is often counterproductive. Although it can bring on the period, the flow is usually very light, and it might lead to a new problem: the body’s function hasn’t recovered, so the waste that should be expelled isn’t expelled, leading to continued stagnation the next month.
For women with very deficient bodies, even hormone shots won’t bring on their period. At this time, a change in approach is needed; don’t be impatient for quick results!
I. Core of Traditional Chinese Medicine Diagnosis for Delayed Menstruation
1. Key Points of Deficiency and Excess Differentiation
- Excess Syndrome Characteristics: Irritability, insomnia, abdominal bloating, refusal to be touched, premenstrual breast tenderness
- Typical Tongue Appearance: Red tongue with yellow greasy coating, wiry and slippery pulse
- Representative Formula: Peach Kernel and Safflower Four Substances Decoction + Bupleurum Liver-Soothing Powder
- Deficiency Syndrome Characteristics: Sallow complexion, dizziness, fatigue, pale and scanty menstrual blood
- Typical Tongue Appearance: Pale and swollen tongue with teeth marks, thin and weak pulse
- Representative Formula: Spleen-Restoring Decoction + Eight Treasures Decoction
2. Modern Medical Comparison
- Risk of Hormone Dependency: Long-term use of progesterone may lead to endometrial atrophy (Lancet study)
- Harm of Qi and Blood Imbalance: Insufficient qi and blood can reduce metabolic rate by 30%, triggering premature ovarian failure
II. In-Depth Analysis of Typical Cases
Patient, female, 18 years old, unmarried and nulliparous, previously had regular menstruation. Last menstrual period was on July 31, with light flow; August 26, normal flow.
Currently reports no menstruation since September.
[Initial Prescription on 10.13]
Astragalus 50g, Zhejiang Fritillary Bulb 20g, Forsythia 10g, Stir-Fried Atractylodes 20g, Pinellia 20g, Ginger Magnolia Bark 20g, Coix Seed 30g, Angelica 15g, Sichuan Lovage 10g, Fried Peach Kernel 15g, Prepared Evodia Fruit 5g, Black Smooth Pieces xxg, Cinnamon 5g; 6 doses
[Analysis]
Menstruation is closely related to qi and blood, organ function, and the Chong and Ren meridians. This patient had regular menstruation previously; this delay is related to recent school activities, where she was given many tasks and often stayed up until the early morning. Insufficient qi and blood led to the blood sea not being able to fill up on time, causing delayed menstruation. The focus is on nourishing qi and blood, and going to bed early on time.
10.20 Follow-up, there were signs of menstruation, but she participated in a school physical fitness test and over-exercised, causing menstruation to still not come. Continued with 6 more doses of the prescription.
11.1 Follow-up, there were signs of menstruation, but she ran 800 meters during a school sports event and over-exercised, causing menstruation to still not come. Continued with 5 more doses of the prescription.
11.6 Follow-up, no menstruation, the medicine spoiled and could not be taken, continued with 3 new doses of medicine for her.
[Fourth Prescription] Astragalus 50g, Codonopsis 30g, Fried Gardenia 10g, Trichosanthes Root 30g, Stir-Fried Atractylodes 15g, Dried Ginger 10g, Tangerine Peel 15g, Angelica 20g, Sichuan Lovage 10g, Fried Peach Kernel 15g, Vinegar-Processed Curcuma 15g, Bupleurum 8g, Black Smooth Pieces xxg, Cinnamon 5g, Motherwort 30g; 3 doses
[Feedback] On 11.8, menstruation came, and the flow, color, and quality were all normal. Followed up for the next two months, the cycle was basically normal, and menstruation was basically restored.
1. Patient’s Course of Illness
| Time | Symptoms | Intervention Measures | Key Issues |
|---|---|---|---|
| September-October | 20-day delay in menstruation + over-exercise | Astragalus and Cinnamon Twig Five Substances Decoction + Moxibustion at Guanyuan Point | Unrecovered qi and blood + excessive qi consumption |
| November | Three follow-ups ineffective | Switched to Eight Treasures Decoction + Bupleurum Liver-Soothing Powder | Worsening liver qi stagnation |
| November 8 | Finally menstruation arrived | Motherwort + Vinegar-Processed Curcuma to promote blood circulation and regulate menstruation | Balancing deficiency and excess |
2. Challenges and Breakthroughs in Conditioning
- Core Contradiction: Conflict between dual deficiency of qi and blood and liver qi stagnation turning into fire
- Solutions:
- Supplementing Deficiency: Astragalus 50g + Codonopsis 30g to greatly replenish vitality
- Soothe the Liver: Vinegar-Processed Curcuma 15g + Bupleurum 8g to break up qi stagnation
- Promote Menstruation: Motherwort 30g + Angelica 20g to promote blood circulation and nourish blood
III. Three Golden Rules for Conditioning Deficient Individuals
(With Daily Operation Guide and Prohibited List)
1. Secrets to Nourishing Qi and Blood
- Dietary Therapy: Angelica, Ginger, and Mutton Soup (Angelica 15g + Ginger 10g + Mutton Ribs 300g)
- Acupressure: Blood Sea Point (2 inches above the inner knee) massage for 5 minutes/day
2. Exercise Management Standards
- Appropriate Intensity: Eight Pieces of Brocade “Adjusting the Spleen and Stomach Must Lift Single-Handedly” daily morning practice
- Prohibited Warning: Avoid intense exercise (like running 800 meters) that causes qi and blood to dissipate
3. Emotional Regulation Methods
- Liver Qi Stagnation Relief: Rose 3g + Tangerine Peel 5g steeped in tea as a substitute for drinking
- Sleep Management: Go to bed before 11 PM, combined with Shenmen Point pressure
Many women have experienced the distress of delayed menstruation, especially young girls, and this phenomenon is becoming more and more common. It’s important to understand that qi and blood deficiency doesn’t happen overnight, and recovery also takes time; it can’t be rushed. Many diseases that were not originally difficult to treat become major problems because patients cannot persist with the correct treatment.
Sudden cessation of menstruation can be quite distressing. After ruling out unexpected pregnancy, the situation of amenorrhea often causes anxiety. Many people may experience irritability, acne, breast pain, lower back pain, and lower abdominal distension, but the period just won’t come. At this time, some might think of using progesterone to induce menstruation. In clinical practice, occasional use of progesterone to induce menstruation is feasible, but long-term dependency is not recommended.
Progesterone is a type of progestin that can cause the endometrium to grow, become congested, and thicken. If not pregnant, after stopping progesterone, the corpus luteum atrophies, and the endometrium sheds, leading to menstruation. However, progesterone has many side effects, such as abdominal pain, headaches, dizziness, hot flashes, nausea, and breast pain, and it may alter the menstrual cycle, causing menstruation to stop or irregular bleeding. More importantly, it cannot make menstruation come naturally and regularly.
To use an analogy, the uterus is like a house, and the endometrium is like the wallpaper. Normally, the wallpaper falls off on time, and the original renovation team comes to maintain and refurbish it. But sometimes the wallpaper doesn’t fall off on time, and the original team doesn’t show up. Some people then hastily hire a temporary team, which only forces the wallpaper to fall off without understanding the original renovation situation, and doesn’t care about subsequent maintenance. This repeated disruption causes the wallpaper to fall off irregularly, and the condition worsens.
Delayed menstruation, especially in cases of deficiency, requires more attention to conditioning because it is often due to overall qi and blood deficiency, which delays menstruation and slows down metabolism. In such cases, fundamental conditioning is needed, replenishing qi, blood, and kidney qi, so that menstruation can return to normal.
As in this case, the girl had to participate in a school physical fitness test, but indeed, over-exercising caused further delay.
This is also why I always emphasize that deficient individuals should be mindful of the intensity of their exercise.
If overdone, it can lead to qi and blood deficiency, affecting the normal internal circulation of the body. Exercise must also be done with attention to rhythm, gradually increasing the amount of exercise, and stopping when not feeling tired after exercising.
IV. Comparison Table of Traditional Chinese and Western Medicine Conditioning
| Issue | Western Medicine Treatment | Advantages of Traditional Chinese Medicine |
|---|---|---|
| Delayed Menstruation | Progesterone to induce menstruation | Eight Treasures Decoction + Moxibustion to restore the fundamental qi and blood |
| Scanty Menstrual Flow | Estrogen replacement therapy | Spleen-Restoring Decoction + Dietary Therapy for gradual nourishment |
| Premature Ovarian Failure | Hormone replacement therapy | Left-Returning Pill + Herbal Paste for slow adjustment of yin and yang |
Conditioning menstrual disorders requires treatment according to the course, especially at the first consultation. If the patient is severely deficient, two points must be emphasized:
1、Find the cause of the previous deficiency, whether it was due to childbirth or miscarriage? Long-term use of Western medicine or bad lifestyle habits? Emotional depression or family stress. If you don’t help the patient find their leak and fix it in time, the medication may never be effective.
Eventually, both the patient and you will lose confidence.
2、Explain the course of treatment in advance, don’t make promises to the patient, because the patient must believe what you say, and if it’s not fulfilled, the patient will immediately lose confidence.
Many methods for conditioning scanty menstruation nowadays are quick fixes, either using hormones or blood-activating and stasis-dispelling medicines.
This often makes the patient’s already deficient qi and blood worse. Often, the period comes immediately after taking the medicine, but it’s abnormal the next month. Or one problem is solved, but another arises.
Treating deficient individuals is like what is said in the Tao Te Ching: “If you want to cook a small fish.”
It must be done with great care, nurturing the body’s foundation, gradually replenishing qi and blood, while reminding the patient to pay attention to daily dietary restrictions and health maintenance. This way of conditioning not only adjusts the menstruation but actually adjusts the whole person. In the end, slow is fast.
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