Late+Menstruation+(Late+Period)

Defined as periods that come consistently up to 9 days late so the cycle is more than 28 days long. Definition implies if this happens more than twice in succession. The amount of bleeding may be normal, excessive or scanty

TCM Etiology and Pathogenesis
-Accumulation of pathogenic cold -Stagnation of Qi -Obstruction of phlegm in the channels -Kidney Yin deficiency -BLood deficiency -Kidney Yang deficiency

Differential Diagnosis
-Pregnancy -Ectopic Pregnancy -Amenorrhea

Excess Cold in the Blood (Uterus)
scanty/normal flow, dark red blood, cold pain, relieved by heat, bluish white complexion, aversion to cold, cold limbs, purple lips [Rou Gui (10g.), Dang Gui (10g.), Bai Shao (12g.), Chuan Xiong (10g.), Ren Shen (10g.), Mu Dan Pi (10g.), E Zhu (10g.), Chuan Niu Xi (6g.), Gan Cao]
 * Tongue:** dark red tongue w/ ecchyomosis; thin white coat
 * Pulse:** Deep tight OR deep choppy
 * Treatment Principles:** Warm uterus, disperse cold & regulate periods
 * Acupuncture:** //CV-4, CV-6, SP-6, KI-13,// St-25, ST-29, SP-10
 * Herbal Treatment:** Wen Jing Tang

Kidney Yang Xu Cold in the Blood
scanty/normal flow, pale & thin blood w/out clots, dull pain in lower abdomen relieved by heat or pressure, sallow complexion, cold extremities, aversio to cold, cold pain in lower back, low spirit, fatigue, curled up when sleeping, profuse urine, loose stools [Dang Gui (10g.), Sheng Di Huang (10g.), Bai Shao (10g.), Chuan Xiong (10g.), Huang Qi (10g.), Rou Gui (3g.), Ai Ye (10g.), Wu Zhu Yu (6g.), Xiang Fu (12g.), Xu Duan (6g.)]
 * Tongue:** Puffy tongue w/ toothmarks; white coat
 * Pulse:** Deep slow OR fine weak
 * Treatment Principles:** Warm Yang, Expel Cold, Regulate periods
 * Acupuncture:** //CV-4, SP-6, GV-4, BL-23, KI-13//, KI-3, CV-6, BL-23.
 * Herbal Treatment:** Ai Fu Nuan Gong Wan
 * Modifications:** Severe cold: + Wu Tou

Blood Deficiency
Scanty, thin, pale red flow w/out clots, dull lower abdominal pain, pale or sallow complexion, dizziness, blurred vision, palpitations, insomnia, tiredness, lusterless skin, pale lips & fingernails, numbness of hands & feet [Ren Shen (9g.), Shan Yao (6g.), Zhi Gan Cao (6g.), Shu Di Huang (12g.), Dang Gui (9g.), Gou Qi Zi (9g.), Shan Zhu Yu (6g.), Du Zhong (6g.)]
 * Tongue:** Pale tongue; thin white coat
 * Pulse:** Fine & weak
 * Treatment Principles:** Nourish Blood, Regulate Menses
 * Acupuncture:** //SP-6, BL-20, BL-17, LR-8//, CV-6, KI-13, ST-36
 * Herbal Treatment:** //Da Bu Yuan Jian//

Kidney Yin Deficiency
Scanty, normal or dark color, thick in quality or w/ small clots, malar flush, tidal heat, night sweats, steaming bone, dry mouth/thraot, 5-palm heat, palpitations, insomnia, dizziness, tinnitus [Shan Yao (10g.), Shan Zhu Yu (6g.), Shu Di Huang (12g.), Fu Ling (6g.), Gou Qi Zi (6g.), Zi Gan Cao (3g.)]
 * Tongue:** Red tongue; no/little/peeled coat
 * Pulse:** Fine & Rapid
 * Treatment Principles:** Nourish Kidney Yin, Supplement Chong & Ren, Regulate periods
 * Acupuncture:** //SP-6, BL-23, KI-3, KI-6, CV-4//, KI-13, KI-2
 * Herbal Treatment:** //Zuo Gui Yin//

Qi Stagnation
Scanty or normal flow, normal or dark red color, or w/ smaller clots, unsmooth discharge (spottng), lower abdominal distending pain not relieved by pressure, distending chest, costal or breast region before menstruation, emotional depression or irritability, vexation, sighing [Wu Yao (10g.), Xiang Fu (8g.), Mu Xiang (8g.), Dang Gui (8g.), Gan Cao (5g.)]
 * Tongue:** Normal or slightly red tongue, thin white or slight yellow coat
 * Pulse:** Wiry OR wiry & rapid
 * Treatment Principles:** Move Qi, Regulate Periods
 * Acupuncture:** //LR-3, SP-6, CV-6, LI-4//, LR-14, KI-13.
 * Herbal Treatment:** //Wu Yao Tang//

Obstruction of Phlegm
Scanty or heavy, pale red blood, sticky w/ mucus, cough w/ profuse sputum, overweight, profuse leukorrhea, chest & epigatric fullness, dizziness, palpitations, nausea, loose stools [Ban Xia (12g.), Chen Pi (12g.), Fu Ling (10g.), Gan Cao (5g.), Chuan Xiong (10g.), Dang Gui (10g.)]
 * Tongue:** Puffy tongue w/ teethmarks; thick white greasy coat
 * Pulse:** Wiry & Slippery
 * Treatment Principles:** Dry Dampness, dissolve phlegm, invigorate blood, regulate periods
 * Acupuncture:** //SP-6, ST-40, SP-9, KI-14, CV-3//, ST-30, ST-36, BL-20, CV-12
 * Herbal Treatment:** //Xiong Gui Er Chen Tang//