The Three Treasures Newsletters
WINTER 2002
THE FOUR PHASES OF THE MENSTRUAL CYCLE
EBB AND FLOW OF YIN AND YANG IN THE MENSTRUAL
CYCLE
Menstrual blood is not like "ordinary" Blood in Chinese
medicine. In other words, the "Blood" that nourish the
eyes and the sinews is not the same as menstrual blood. Menstrual
blood is a direct manifestation of the Kidney-Essence equivalent
to sperm in men. Menstrual Blood is called Tian Gui which could
be translated as "Heavenly Dew" although the character
Gui actually refers to the 10th Stem that pertains to Water. The
association with Water is not casual as menstrual Blood is part
of Water and derives from the Yin part of the Kidneys. The great
gynaecologist of the Qing dynasty Fu Qing Zhu often stressed this,
saying that not by chance menstrual blood is called Jing Shui ("Period
Water").
The menstrual cycle is like a tide of Yin and Yang: the "water"
of this tide is the substance of the Kidneys in its Yin and Yang
aspect. Therefore, it is the ebb and flow of Kidney-Yin and Kidney-Yang
that determines the menstrual cycle. The menstrual cycle goes through
two moments of transformation of Yin to Yang and vice versa: the
onset of the period marks the maximum of Yang and the transformation
from Yang to Yin while the onset of ovulation marks the maximum
of Yin and the transformation of Yin to Yang. This transformation,
together with the discharge of menstrual blood and the eggs, is
under the control of the Heart whose Qi needs to go down to communicate
with the Kidneys. See Figure 1.
THE FOUR PHASES
The menstrual cycle may be divided into four phases as follows:
| 1. |
the period itself lasting approximately
5 days |
| 2. |
the post-menstrual phase of about
1 week |
| 3. |
the inter-menstrual phase of about
1 week |
| 4. |
the pre-menstrual phase also lasting
approximately 1 week. |
The following is a description of the physiology of each phase with
the relevant treatment principle. See
Figure 2 and 3.
Phase 1 - the period
During the period, Blood moves and both Qi and Blood move downwards.
During the period, expelling the "old" (i.e. old Blood)
is important: if not enough "old" expelled, this could
lead to "retention of menses". Most people pay attention
to excessive bleeding but scanty bleeding may lead to "retention
of menses" and Blood stasis. Just before the beginning of the
period, Yang is at its maximum and it rapidly decreases with the
onset of the period. It is a moment of transformation from Yang
to Yin. Pre-menstrual symptoms are often due to Heat and the reason
they rapidly disappear with the onset of the period is precisely
because Yang decreases rapidly as soon as the period starts.
Treatment principle: invigorate Blood. If bleeding is heavy,
invigorate Blood and stop bleeding.
Phase 2 - the post-menstrual phase
This lasts for approximately 1 week starting from the end of the
period. At this time, Blood and Yin are relatively empty but Yin
is beginning to rise. The rapid decrease of Yang that takes place
with the onset of the period ensures the growth of Yin (mutual consuming
of Yin and Yang). This phase is therefore an important crossroads
of Yin and Yang and it influences the whole menstrual cycle. Growth
of Yin also implies growth of fluids which are manifested by the
clear, egg-white-like vaginal secretion that occurs before ovulation.
The post-menstrual phase is crucial to establish a regular cycle.
It is therefore important to treat during this phase to establish
the foundations for a good menstrual cycle.
Treatment principle: nourish Blood, tonify the Kidneys.
Phase 3 - the inter-menstrual phase (ovulation)
During the third phase, the Chong Mai and Ren Mai are in full activity
and they promote ovulation. In this phase, Yin reaches its maximum
and Yang starts to grow rapidly. It is a moment of transformation
from Yin to Yang. Qi and Blood are active in this phase: this is
similar to the activity of Qi and Blood during the period except
that during the former phase there is an upward movement of Qi and
Blood and during the latter a downward movement. This upward movement
affects the Heart and Liver channels often with Heat.
During the third phase, physiological activity is concentrated on
the lateral abdomen (Shao Fu) while during the period it is concentrated
on the central abdomen (Xiao Fu).
During the third phase there is an increase in fluids and there
should be a transparent, egg-white-like vaginal secretion immediately
before ovulation. This should last at least 3 days. An absence of
such secretion indicates a Kidney deficiency even in the absence
of any Kidney symptom.
Treatment principle: tonify the Kidneys, strengthen the Spleen,
resolve Dampness.
Phase 4 - the pre-menstrual phase
During the fourth phase, Yang reaches its maximum and Qi moves.
Yin decreases to allow growth of Yang (mutual consumption of Yin
and Yang). The decrease of Yin and growth of Yang during this phase
is comparable to the increase of Yang and decrease of Yin during
the second phase but it is more significant. Growth of Yang implies
that there is warmth in the Uterus at this time. Cold in the Uterus
prevents fertilization of the egg. As this is a time of maximum
Yang, Yin pathogenic factors affect the Uterus especially at this
time as they rely on Yang to be dispersed. Examples of Yin pathogenic
factors are Blood stasis, Phlegm, Cold and Dampness. Endometriosis
and polycystic ovary are characterized by Yin pathogenic factors
(Blood stasis and Damp-Phlegm) and therefore treatment by warming
Yang in this phase is important.
Treatment principle: move Qi, stimulate the free flow of
Liver-Qi, invigorate Blood, warm the Uterus.
ADAPTING THE TREATMENT PRINCIPLE TO THE FOUR
PHASES
Adapting the treatment principles to the four phases is crucial
in treating gynaecological problems. By adapting the treatment principle
to the four phases, the medication will work better because it follows
the natural rhythm of women's physiology and the ebb and flow of
Yin and Yang in the menstrual cycle. Adapting the treatment principle
to the four phases is particularly useful in complex gynaecological
conditions when 2, 3 or even 4 different remedies are used.
I will illustrate this principle with examples of increasing complexity.
Stagnation of Liver-Qi
Let us assume that a woman suffers purely from Liver-Qi stagnation
and no other pattern. If she suffers from pre-menstrual tension
we might want to prescribe Freeing Constraint and the best time
to administer this is in the pre-menstrual phase, i.e. roughly a
week before the period. There would be not much point in giving
this remedy in the post-menstrual phase because at that time Blood
is relatively empty: as Blood is the mother of Qi, moving Qi at
this time would have little effect.
Blood stasis
If a woman suffers from Blood stasis and painful periods, we prescribe
Stir Field of Elixir. The best time to give this remedy would be
in Phase 1, i.e. during the period because at this time the Blood
is already moving. However, the remedy could be started a few days
before the period. Again, there would be not much point in giving
this remedy after the period when Blood is relatively empty: at
such a time, the remedy would have little effect.
If the period is heavy, we can still invigorate Blood in phase 1
but we should replace Stir Field of Elixir with Invigorate Blood
and Stem the Flow.
Liver-Qi stagnation with Liver-Blood deficiency
Let us assume a woman suffers from pre-menstrual tension caused
by Liver-Qi stagnation occurring against a background of Liver-Blood
deficiency. In this case we can prescribe Freeing the Moon for the
pre-menstrual phase and Precious Sea during the post-menstrual phase
(possibly extending to Phase 3). This is an excellent combination
and timing that I use frequently.
Liver-Blood stasis and Kidney deficiency
Liver-Blood stasis and Kidney deficiency occur simultaneously very
frequently: these patterns may cause painful and/or irregular periods.
We can prescribe Unicorn Pearl or Growing Jade (according to whether
there is Kidney-Yang or Kidney-Yin deficiency respectively) to be
taken during phases 2 and 3, and Stir Field of Elixir during phases
4 and 1.
If the period is heavy, we can still invigorate Blood in phase 1
but we should replace Stir Field of Elixir with Invigorate Blood
and Stem the Flow.
Liver-Qi stagnation, Liver-Blood stasis, Kidney
deficiency
For these three patterns we can prescribe Freeing the Moon (or Freeing
Constraint) during phase 4, Stir Field of Elixir during phase 1
(or Invigorate Blood and Stem the Flow if the period is heavy),
and Unicorn Pearl or Growing Jade (according to whether there is
Kidney-Yang or Kidney-Yin deficiency respectively) during phases
2 and 3.
Liver-Blood stasis, Liver-Blood deficiency
Stir Field of Elixir during phases 4 and 1 (or Invigorate Blood
and Stem the Flow if the period is heavy) and Precious Sea during
phase 2.
Liver-Blood stasis, Kidney-Yang deficiency,
Dampness
Stir Field of Elixir during phases 4 and 1 (or Invigorate Blood
and Stem the Flow if the period is heavy), Unicorn Pearl during
phases 2 and 3 and Clear the Palace during phases 3 and 4.
Liver-Blood stasis, Kidney-Yang deficiency,
Dampness, Spleen-Qi deficiency
Stir Field of Elixir during phases 4 and 1 (or Invigorate Blood
and Stem the Flow if the period is heavy), Unicorn Pearl during
phases 2 and 3 and Clear the Palace during phases 3 and 4 (tonify
the Spleen with acupuncture).
Liver-Blood deficiency, Dampness, Kidney deficiency
Precious Sea during phase 2, Clear the Palace during phases 3 and
4, Unicorn Pearl or Growing Jade (according to whether there is
Kidney-Yang or Kidney-Yin deficiency respectively) during phases
2 and 3.
SUMMARY OF REMEDIES ACCORDING TO FOUR PHASES
| Phase 1 |
| • |
Clear Empty Heat and Cool the Menses |
| • |
Cool the Menses |
| • |
Drain Redness |
| • |
Free Flow |
| • |
Harmonizing the Moon |
| • |
Invigorate Blood and Stem the Flow |
| • |
Restrain the Flow |
| • |
Stir Field of Elixir |
| |
|
| Phase 2 |
| • |
Growing Jade |
| • |
Nourish Yin and Restrain the Flow |
| • |
Planting Seeds |
| • |
Precious Sea |
| • |
Unicorn Pearl |
|
| Phase 3 |
| • |
Clear the Palace |
| • |
Growing Jade |
| • |
Planting Seeds |
| • |
Unicorn Pearl |
| • |
Warm the Mansion |
| • |
Warm the Menses |
| • |
Warm the Palace |
| |
|
| Phase 4 |
| • |
Clear the Moon |
| • |
Free Flow |
| • |
Free-Flowing Sea |
| • |
Freeing Constraint |
| • |
Freeing the Moon |
| • |
Harmonizing the Moon |
| • |
Penetrating Vessel |
| • |
Stir Field of Elixir |
| • |
Warm the Mansion |
| • |
Warm the Menses |
| • |
Warm the Palace |
|
Fig 1. The Uterus
Fig 2. The 4 Phases of the Menstrual Cycle
Fig 3. The 4 Phases of the Menstrual Cycle
Written by Giovanni Maciocia
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