Menstrual health has long been a topic of interest. It is also the cornerstone for fertility and pregnancy. In recent times, Traditional Chinese Medicine (TCM) has emerged as a compelling alternative approach in addressing these menstrual concerns. In this article, we explore how TCM views menstruation and how to reconcile that view to modern science.
The name "月经" is coined for menstruation as it is likened to the waxing and waning of the moon to its fullness, showing a regularity in its occurrence. Other names used in ancient literature to describe menstruation are "月事" and "月水".
Menstruation typically starts between 11 to 16 years of age, with an average of 12 years old [1]. A normal cycle length is between 21 to 35 days (28 days on average) and period length between 3 to 7 days. A healthy volume is around 50ml to 80ml, typically having more volume on day 2 of the period.
What causes menstruation?
In TCM, there is an axis called “肾气--天癸--冲任--胞宫轴” (in English: Kidney Qi-Tian Gui-Chong Ren Meridians-Uterus Axis), which highlights the key players involved in the period bleed. The key players are “肾气” Kidney Qi, “天癸” Tian Gui, “冲任” Chong and Ren Meridians, and “胞宫” uterus.
Below further describes the events that need to take place at each link of the axis for successful menstruation to occur:
1.肾气盛：The onset of menstruation begins when “肾气盛”, where the accumulation of Kidney Qi reaches a sufficient level as the female matures and undergoes puberty. The sufficiency of Kidney Qi is also nourished by the nutrients from her diet which is termed “后天”, translated to as “acquired aspect” in English. When there is sufficient Kidney Qi, a refined substance called “天癸” is formed. “天癸” is also known by ancient Chinese as “无形之水” (invisible water).
2. 天癸至：This refined substance travels from the Kidneys to the “冲任二脉” (Chong and Ren Meridians) to promote the function of these two meridians. It is related to growth and development of the human body, as well as its reproductive function.
3. 任通冲盛：Comprising of two aspects, “任脉通” and “太冲脉盛”, this is not only an important factor, it is central to causing menstruation. “任脉通” refers to “天癸” reaching the “任脉”, translated as Ren Meridian. While the word “通” (means through or open) is used, it actually connotes “达” (reach, attainment) in ancient literature. Under the action of “天癸”, the Ren Meridian produces abundant “精、血、津、液” (essence, blood, fluid, liquid respectively). As “天癸” travels to “冲脉” (Chong Meridian), and under its influence, it causes the Chong Meridian to receive and gather blood from the organs. The action of Chong and Ren Meridians causes “血海盛满”, which means the sea of blood becomes full.
4. 血溢胞宫、月经来潮：As the sea of blood becomes full, it overflows and menstruation occurs.
The absence or dysfunction of any of the segments will cause menstruation problems. On top of that, the axis relies on a healthy and balanced organ system. For example, healthy Spleen, Heart and Lung functions are required to convert nutrients from one’s diet into blood, which is an important component in menstruation. Meanwhile, the Liver organ is responsible for storing blood and regulating Qi circulation. Any dysfunction or imbalance in the organ systems can lead to disruption to the axis.
The analogy of a cup of water
Renowned TCM Physician and Professor 柴松岩, who specialises in gynaecology, uses the analogy of ‘a cup of water’ to illustrate this process: An empty cup is constantly filled and the water level in the cup rises. Once the cup is full, it overflows. After that, the cup becomes empty, and the process repeats again.[2]
She explains that the water represents blood, which is an important substance in menstruation; while the cup represents the Chong Meridian, also known as “血海” (Sea of Blood). The blood that fills the Chong Meridian is excess blood from the body’s organs. The water level in the cup signifies the amount of blood that fills the Chong Meridian. In order to ‘have water to fill the cup’ in the first place, the proper function of the body’s organs, as well as the harmonious relationship between the organs need to be established. Not only that, the active force that causes the ‘infilling of the cup with water’ comes from the Kidney’s Qi. In that regard, there must be sufficient Kidney Qi as well. Only when ‘the cup is full’, menstruation occurs. Following which, ‘the cup becomes empty’, and is required to be filled again for the next cycle. In essence, she summarises two conditions required for the occurrence of menstruation: one, “血海充盈” which is the infilling into Chong Meridian which causes the eventual overflow of blood as menstruation; two, “血海有继” which refers to the subsequent infilling of blood after menstruation that sets the stage for the next cycle.
How is this relevant to modern science?
In science, the onset of menstruation relies heavily on the cyclic production of hormones. There is an axis equivalent to TCM’s one, known as the hypothalamic-pituitary-ovarian (HPO) axis.
The hypothalamus releases gonadotropin hormone-releasing hormone (GnRH) which stimulates the anterior pituitary gland to secrete follicle stimulating hormone (FSH) and luteinising hormone (LH). FSH and LH subsequently act on the ovaries, causing the production of oestrogen and progesterone.
Taking on a holistic view
Both axes are conceptual frameworks that are important in understanding menstruation. The TCM framework is based on principles of TCM theories and uses terminologies like Qi (energy) and meridians (energy pathways). On the other hand, while modern science’s explanation is rooted in endocrine pathways, we must not employ the lens of science to view TCM’s framework, nor can we use TCM’s theories to interpret the framework of science. If we do so, we may find ourselves disappointed.
Be it ancient wisdom or scientific insights, we can see that the interplay and interconnectedness between the various organs and systems are crucial in the regulation of menstruation. Any disruption or imbalance along the axes can lead to dysregulation of menstruation, or the development of menstrual disorders. These frameworks also form the foundation for understanding pathology behind menstrual disorders and their management strategies.
By integrating the two perspectives, we gain a more comprehensive understanding of regulation of menstruation, leading to a holistic management of its dysregulation.
References:
Lacroix AE, Gondal H, Shumway KR, et al. Physiology, Menarche. [Updated 2023 Mar 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470216/
Chai, S., & Teng, X. (2016). 柴松岩治闭经. Bei Jing Ke Xue Ji Shu Chu Ban She.
Author: Physician Aw Ching Yi Eunice
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