Changes in the cycle length, period length, period volume, or the presence of any menstruation-related symptoms like pain, headache, spotting in between cycles et cetera, all fall under the big umbrella of 月经病, otherwise known as "menstruation disorders".
In the previous article, the “肾气--天癸--冲任--胞宫轴” forms the core mechanism and foundation for the onset as well as the regulation of menstruation. Any disharmony in the organ functions or imbalance in the Qi and Blood can potentially affect the Chong and Ren Meridians and disrupt the axis, subsequently affecting the function of the uterus, giving rise to menstrual disorders.
The importance of Chong and Ren Meridians
《临证指南医案》有“血海者，即冲脉也，男子藏精，女子系胞。不孕、经不调，冲脉病也。” In Lin Zheng Zhi Nan Yi An, it states that the Chong Meridian is also known as the Sea of Blood (血海), which is involved in the function of the male and female reproductive systems. Any conditions that are related to menstruation, or infertility, is considered to be disease involving the Chong Meridian. In the same literature, “冲任二脉损伤，经漏经年不痊” implies that Chong and Ren Meridians play a crucial role in menstruation.
The obstruction of Chong and Ren Meridians (冲任壅阻) result in the development of “癥瘕积聚” (masses/tumours) in the female reproductive system, which can cause period irregularities, heavy period flow, blood clots during period, or dysmenorrhea (痛经). “癥瘕”、“积聚” is the TCM equivalent of conditions involving masses like inflammatory masses, uterine fibroids and ovarian cysts.
The insecurity of Chong and Ren Meridians (冲任不固) leads to development of conditions that are ‘leaky’ or ‘descending’ patterns, such as metrorrhagia and metrostaxis (崩漏). Other gynaecological conditions include habitual miscarriage (滑胎), threatened abortion (胎动不安), uterine prolapse (阴挺).
The deficiency in Chong and Ren Meridians (冲任亏损) can give rise to menstrual problems characterised by ‘deficiency pattern’, such as irregular and/or infrequent periods, dysmenorrhea (痛经) and subsequently even infertility.
In certain conditions, the Chong and Ren Meridians experience a reverse flow of Qi (气逆). In other words, the Qi ascends, causing problems such as nausea, vomiting or dizziness during menstruation.
The Three Main Organs
It is believed that the Kidneys, the Liver and the Spleen are organs that play a vital role in the regulation of menstruation, due to their involvement in the Chong and Ren Meridians.
In essence, the Kidney is the source of the Chong and Ren Meridians; the Liver regulates the Qi and blood in the body which, as a result, fills the Sea of Blood; while the Spleen is responsible for translating nutrients ingested into Qi and Blood.
Thus, TCM management of menstrual problems involve managing the Qi and blood levels, as well as supporting the organs’ functions to regulate Chong and Ren Meridians.
TCM Cycle Therapy Method: 月经周期疗法
With the advancement of science, certain hormones have been identified to be major key players at different phases of the menstrual cycle. In general, the menstrual cycle is known to have four phases: bleeding phase, follicular phase, ovulation phase and luteal phase. The rate of secretion of FSH, LH, oestrogen and progesterone vary as the cycle progresses through the phases. This phenomenon has also led to a generally lower Basal Body Temperature (BBT) during follicular phase (before ovulation), and a higher BBT during luteal phase (after ovulation).
Apart from regulating Chong and Ren Meridians, there is a TCM modern-day approach of harmonising findings from the West into our clinical practice. Coined in 2010, a popular method used in the management of menstrual disorders is “中医药周期疗法” (TCM menstrual cycle therapy). By targeting the known phases in the cycle, the TCM treatment principle and formula varies according to the characteristics of each phase.
行经期 (Bleeding Phase) – 重阳必阴，阴阳转化
Based on TCM Basic Theory, Yin and Yang are of mutual opposites, mutual restriction, and mutual interdependence. As such, the accumulation of Yang from the previous phase causes Yang to transform to Yin. This is corresponded to the disintegration of corpus luteum and the eventual fall of progesterone and oestrogen. Consequently, the uterine lining sheds and menstruation results. In TCM, the abundant blood inside the Chong Meridian (or Sea of Blood) overflows and causes bleeding. As blood leaves the body, the body experiences loss of Yin and Yang. During this phase, some women may experience discomforts like abdominal cramps and headaches. The TCM treatment principle at this phase is to promote blood circulation and unblock meridians, ensuring no obstruction to Chong Meridian. This promotes a smooth and comfortable period, and allows for all the necessary blood to leave the uterus. Common herbs used during this phase are: 当归、川芎、地黄、益母草、桃仁、红花、丹参、柴胡、香附、赤芍、白芍等。
经后期 (Follicular/Proliferative Phase) – 阴长阳消
After the bleeding phase, the Sea of Blood is now empty. Also known as the follicular phase, follicle-stimulating hormone (FSH) causes follicles in the ovary to grow and mature. As the follicles grow in size, they secrete more oestrogen. Oestrogen is considered to belong to Yin in TCM, and rises in the body. Under the action of oestrogen, the endometrium thickens and prepares for a possible conception in the next phase. To support this restoration process and Yin growth in the body, the TCM treatment principle is to nourish Yin, aid the body to store essence (精) and blood, so that the Kidney Qi can be abundant, which leads to abundant Chong and Ren Meridians downstream. Common TCM herbs used are: 熟地黄、女贞子、旱莲草、牛膝、枸杞子、菟丝子、覆盆子、阿胶、当归、白芍、淮山等。
经间期 (Ovulation Phase) – 重阴必阳，阴阳转化
When the accumulation of Yin has reached a certain level, it transforms into Yang under the influence of Kidney Qi. In science, the high level of oestrogen causes luteinizing hormone (LH) to surge. This effect causes ovulation to occur, which is the release of an ovum from a dominant follicle. The TCM principle at this phase is to tonify the Kidneys and improve blood circulation to aid ovulation. Other than nourishing Yin, we need to assist Yang so that the Yin-Yang transformation process is smooth and successful. Common TCM herbs used during this phase are: 熟地黄、菟丝子、枸杞子、女贞子、淫羊藿、续断、覆盆子、丝瓜络、路路通、茺蔚子等。
During this phase, some women may experience ‘ovulation bleeding’ which is spotting or small amount of vaginal bleeding, also known as 经间期出血 in TCM. However, TCM believes that the occurrence of 经间期出血 is due to deficiency in Kidney Yin, or deficiency in Spleen Qi, or obstruction by dampness-heat or blood stasis, affecting the Yin-Yang transformation at this stage.
经前期 (Luteal/Secretory Phase) – 阳长阴消
Following ovulation, the ruptured follicle transforms into corpus luteum, which secretes progesterone. This begins the luteal phase. Progesterone prepares the uterine lining for a potential implantation of a fertilised egg and inhibits the release of FSH and LH. The high levels of progesterone in the body also causes BBT to rise. From the TCM perspective, the Yang in the body rises, making it relatively higher than Yin. To support this phase, the TCM principle is to warm the Kidney Yang, boost Qi and nourish blood, which will help sustain the corpus luteum and prepare the endometrium lining in preparation for a possible pregnancy. Common TCM herbs used are: 熟地黄、枸杞、女贞子、覆盆子、淫羊藿、巴戟天、肉苁蓉、党参、当归、鹿角胶、白术等。
If fertilisation does not occur, the corpus luteum breaks down, causing a decline in progesterone levels, subsequently leading to the shedding of the endometrium. For some women, the corpus luteum may not produce enough progesterone which may lead to fertility issues, miscarriage, or an early period.
Prioritise Your Menstrual Health
Just like the waxing and waning of the moon, Yin and Yang rises and decreases to maintain a balance within the body, and to ensure a continuity in the menstrual cycle. TCM cycle therapy uses herbs (and/or acupuncture) to regulate the body and assist the menstruation process. A TCM physician will assess one’s medical history, as well as her organ’s functions, Qi and blood levels, combining pulse and tongue diagnosis to determine the management strategy and direction.
Prioritising menstrual health is paramount for overall well-being. TCM offers a natural, safe and holistic way to manage menstrual disorders. Even for ladies trying to conceive, having a regular period cycle will help you tremendously.
Disclaimer: Do not self-medicate, always consult with a qualified TCM practitioner before starting any herbal treatments, as they can ensure the appropriate herbs and dosages for your condition.
References:
罗元恺. (1983). 肾气·天癸·冲任的探讨及其与妇科的关系. 上海中医药杂志(1).
中醫週期療法及在婦科學上的運用. (n.d.). https://dlweb01.tzuchi.com.tw/dl/acdactive/content/library/01/training/intern/intern9408/9408_2.pdf
Author: Physician Aw Ching Yi Eunice
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