In my last article, I examined menstruation from the TCM perspective. Here, we are going to break down the cycle further and look at how TCM views each part of the cycle. The goal of this is to better understand what is happening physiologically from a TCM perspective, so we can time our treatments to match and encourage what is going on naturally in a woman's body. We start the story with day one - the first day of a woman's period.
This is the yin half/portion of the cycle, when the follicle and the lining grow in preparation for ovulation, fertilization and implantation. TCM further breaks down the cycle into four phases: the period, post-period, ovulation and post-ovulation. Specific physiological changes happen in each of these four phases that direct the nature of treatment.
On day one, the chong begins to empty, and the woman starts to shed her lining. As you can imagine, this phase is dominated by the movement of blood and qi. This is the best time of the cycle to regulate blood and qi in a woman who has blood stasis and qi stagnation, because your treatment coincides with the natural blood and qi movement that is occurring. Further, according to Jane Lyttleton, gynecologists in China believe that any treatment given at this time must include regulating blood and qi. The next phase is the proliferation phase, where a woman's uterine lining grows back.
The chong vessel (after emptying during the period) needs to be completely refilled to start building the uterine lining again and growing the follicles. This is accomplished through an overabundance of yin and blood to fill up the ren and chong so that the yin and blood can perform their function of producing the lining and the follicles. As you can imagine, we focus on building yin and blood during this phase. This happens from the end of the period at about day five right through to ovulation.
At ovulation, the fullness of yin turns into yang through the act of ovulation popping the dominant egg out of its follicle. This is why it is important to nourish yin and blood during the proliferation phase. Only when yin and blood are full and overflowing can the yin be transformed into yang. This process is mirrored physiologically by the threshold levels of the estrogenic-phase hormones needing to be reached before ovulation can occur. From a TCM perspective, the egg popping out and the movement of the fallopian tubes to gather and move the embryo into the uterus for implantation is the movement of qi and blood. Hence, treatment at this time should regulate the qi and blood to encourage this natural movement taking place within a woman. The next part of the cycle is the progestogenic yang phase of menstruation.
Here, the progesterone secreted by the corpus luteum slightly warms the uterus and dries up the cervical fluid to help provide the best nest for the embryo to develop. This is the part of the cycle during which a woman notices a slight change in her temperature if she is using a basal body-temperature chart to record her cycle changes. Not coincidentally, this warming and drying phase of menstruation is the yang part of the cycle. TCM doctors realized the importance of a warm womb long ago. In fact, there is a diagnosis labelled "cold womb" or "cold in the uterus," which is a cause of infertility. It is important to warm yang to ensure a healthy menstrual cycle.
Once again, the cycle of transformation of yin and yang renews itself by a fullness of yang being released and transformed into yin through a healthy menstrual flow. As you can see, not only can you help a woman have a healthier cycle following the natural physiological changes in a woman's reproductive system, but because this cycle is so important to a woman's overall physiology, we can greatly affect her overall health, too.
I want to make one other point. When you are treating a woman for menstrual problems, the phases of her cycle are only a basis for treatment. You still have to diagnose her overall condition and treat her overall patterns, as well as following the guidelines for regulating her cycle. This phasic information does not replace our regular diagnosis; it only supplements and hopefully makes our treatments more effective.
I would like to credit Jane Lyttleton and her excellent textbook The Treatment of Infertility with Chinese Medicine for much of the information in this article. If you would like a much more in-depth analysis of the phases, please refer to this text.
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