Sharing My Simple Understanding of TCM Treatment for Menstrual Disorders
Author: Gu Yuxi Editor: Gu Yuxi Translator: Gu Yuxi
Today it’s my turn to share the weekly topic with everyone in the group. The following is the original content shared in the group:
Dear fellow practitioners, good morning. Week one was shared by senior practitioner Wu, and now it’s week two, my turn to share. The topic I’m sharing is my simple understanding of menstrual disorders. As my verbal expression isn’t very strong, I’ll use written words instead. I hope for your kind understanding. Most of the following content was taught to me by my teacher and friend, Dr. Xue, supplemented by some literature I researched myself. Here, I’m expressing it in my own words according to my own understanding.
Let’s first talk about the “physiological mechanism of menstruation.”
From a Western Medicine perspective
The menstrual cycle is precisely regulated by the hormonal control axis composed of the hypothalamus-pituitary-ovarian (HPO) axis. Among these, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) promote follicular development and ovulation; while estrogen and progesterone regulate endometrial proliferation and shedding. During this process, if the egg is not fertilized, the corpus luteum will atrophy, and estrogen and progesterone levels will drop sharply, leading to ischemia, necrosis, shedding, and bleeding of the endometrium, thus forming menstruation.
From a Traditional Chinese Medicine perspective
The generation of menstruation is the result of the coordinated action of the “Kidney Qi – Tian Gui – Chong Mai & Ren Mai – Uterus” axis. When Kidney Qi is abundant, Tian Gui matures, promoting the filling of Chong Mai and Ren Mai with Qi and blood, and the uterus periodically stores and discharges, forming the menstrual cycle. The Chong Mai is the “Sea of Blood,” and the Ren Mai governs pregnancy; their coordination results in regular menstruation. The uterus is the site where menstruation forms and is expelled, relying on the nourishment of Qi and blood and the coordination of the internal organs.
More specifically:
Kidney Qi is the fundamental driving force for human growth and development, and its abundance or decline directly regulates reproductive function. Kidney Qi includes Kidney Yin (material basis) and Kidney Yang (functional driving force), and the two work together to promote the maturation of Tian Gui.
Tian Gui originates from the congenital Kidney essence and is nourished by acquired essence from food. It is a refined substance that promotes growth, development, and reproduction. The Neijing calls it “yin jing,” and modern understanding often likens it to sex hormone-like substances. After Tian Gui matures, it acts on the uterus through the Chong Mai and Ren Mai, causing menstruation to occur on time. The arrival and depletion of Tian Gui mark the beginning and end of a woman’s reproductive capacity.
The Chong Mai is the “Sea of Blood,” mainly storing and overflowing blood; the Ren Mai governs pregnancy and controls the Qi and blood of the yin meridians. Both need to be filled with Qi and blood under the promotion of Kidney Qi to maintain the menstrual cycle.
Under the regulation of Kidney Qi, Tian Gui, and the Chong Mai and Ren Mai, the uterus periodically completes “storage” (thickening of the endometrium) and “discharge” (expulsion of menstrual blood). The Neijing refers to the uterus as an “extraordinary fu organ,” possessing the dual functions of both zang and fu organs.
Normal menstruation is characterized by periodicity and self-limitation.
The first day of bleeding following premenstrual symptoms marks the beginning of the menstrual cycle. The interval between the first days of two consecutive menstrual periods is called one menstrual cycle, which is generally 21 to 35 days, with an average of 28 days. The duration of each menstrual period is called the menstrual period, which is generally 2 to 8 days, with an average of 4 to 6 days. Menstrual flow refers to the total blood loss during one period. Normal menstrual flow is 20 to 60 ml, and more than 80 ml is considered excessive menstruation.
Regarding emotional fluctuations, from a Western medicine perspective, the luteal phase (7 days before menstruation):
The decline in progesterone triggers a decrease in serotonin, leading to irritability and anxiety (premenstrual syndrome). Premenstrual physical symptoms include breast tenderness, lower back pain, and lower abdominal pain. This reaction progresses from top to bottom, with pressure transmitted layer by layer. In normal individuals, these symptoms will lessen after normal bleeding occurs.
Generally, the menstrual period (3-7 days).
No special symptoms, but during menstruation, due to the downward flow of qi and blood to the uterus (from a Western medicine perspective, pelvic congestion and the effects of prostaglandins), some women experience lower abdominal and lumbosacral discomfort or uterine contraction pain, and may have gastrointestinal disturbances such as diarrhea. A few patients may have headaches and mild symptoms of nervous system instability.
Dysmenorrhea, or painful menstruation, means the bleeding is not normal, and the entire body’s pressure is focused on the lower abdomen, unable to be released.
From a Western medicine perspective, dysmenorrhea is the cyclical lower abdominal pain that occurs in women during or before menstruation, which may be accompanied by backache, nausea, fatigue, and even syncope. Traditional Chinese Medicine calls it “jing xing fu tong” and believes that the essence of dysmenorrhea is “no flow, then pain” or “no nourishment, then pain,” meaning pain caused by obstructed flow of qi and blood or deficiency of yin, yang, qi, and blood.
Please take a look at the diagram of the female reproductive organs below:
You can clearly see that the uterus is positioned roughly parallel to the ground, with one end connected to the vagina and the other resting on top of the bladder. Mr. Ni Hai-xia mentioned that when a normal person feels the urge to urinate, the bladder in the image fills up and lifts the other end of the uterus, roughly to a perpendicular position relative to the ground. During menstruation, this physiological response actually helps to better expel menstrual blood, just like it’s easier to pour wine from an upright bottle than a horizontal one.
Looking at the image above again, to the left of the vagina is the rectum. If accumulated stool in the rectum is not expelled in time and builds up sufficiently, it can put pressure on the vagina, which can also lead to unsmooth expulsion of menstrual blood. This is also a factor that can cause dysmenorrhea.
From this Western anatomical perspective, it’s very intuitive to see that difficulties with urination and defecation are also factors affecting dysmenorrhea. In clinical experience, it’s often observed that women with dysmenorrhea also frequently have symptoms of constipation and weak urination. Therefore, when treating dysmenorrhea, we should treat it from a holistic perspective, not just treating the menstruation as an isolated gynecological issue.
In the context of the “Shanghan Zabing Lun“, this is similar to first treating the six stages of Shanghan Lun, focusing on exterior and interior patterns, and then treating miscellaneous diseases.
The causes of dysmenorrhea from the perspective of miscellaneous diseases, which are frequently found in TCM textbooks and can be understood through organ pattern differentiation, can be specifically divided into the following five categories:
1. Qi stagnation and blood stasis.
Pathomechanism: Emotional stagnation leading to liver qi stagnation, obstruction of qi flow, unsmooth blood circulation, and blood stasis obstructing the uterus.
Symptoms: Distending pain in the lower abdomen before or during menstruation, aggravated by pressure; dark purplish menstrual blood with clots; breast tenderness; purplish dark tongue body or with ecchymoses; wiry and hesitant pulse.
2. Stagnation of blood due to congealing cold
Pathology: Exposure to frigid environmental factors during menstruation or excessive consumption of raw and cold food leads to the invasion of cold evil into the lower abdomen. When blood encounters cold, it congeals, causing the channels to become constricted and tense.
Symptoms: Lower abdominal cold pain during menstruation that is alleviated by warmth, dark red menstrual blood with a small amount and clots, aversion to cold, cold limbs, white greasy tongue coating, and a deep, tight pulse.
3. Damp-heat obstructing blood flow.
Pathology: Internal accumulation of damp-heat or external invasion of damp-heat evil interacts with blood, obstructing the thoroughfare and conception vessels.
Symptoms: Burning pain in the lower abdomen during menstruation, dark red and viscous menstrual blood, yellow and malodorous leukorrhea, red tongue with a yellow greasy coating, and a slippery, rapid pulse.
4. Deficiency of vital energy and blood.
Pathology: Weakness of the spleen and stomach or prolonged illness consuming blood leads to insufficient generation of vital energy and blood, resulting in malnourishment of the uterus.
Symptoms: Dull pain in the lower abdomen during or after menstruation, pale and thin menstrual blood, pale complexion, fatigue and palpitations, pale tongue with a thin coating, and a thready, weak pulse.
5. Deficiency of the liver and kidney
Pathology: Congenital deficiency or excessive sexual activity and multiple births deplete essence and blood, leading to insufficient nourishment of the thoroughfare and conception vessels and the uterus.
Symptoms: Empty pain in the lower abdomen after menstruation, soreness and weakness of the lower back and knees, dizziness and tinnitus, scanty and pale menstrual flow, red tongue with little coating, and a deep, thready pulse.
These five major pathological factors can be simply analogized as follows: the uterus is like a river. Under normal circumstances, when the flow of vital energy and blood is smooth, the river flows freely and the water is calm. During painful menstruation, vital energy stagnation and blood stasis are like the river being blocked; cold congealing blood stasis is like the river freezing; damp-heat obstructing blood flow is like the river being polluted; deficiency of vital energy and blood and deficiency of the liver and kidney are like the water flow being sluggish or the riverbed narrowing, thus causing the water to impact the riverbanks (uterine spasms), leading to discomfort.
Disclaimer:
The experiences and insights shared above represent the author’s personal usage and understanding, and are provided for reference only as part of academic exchange. Please do not blindly replicate or apply them; any consequences arising from such actions are solely your responsibility. As individual constitutions vary, medication should be tailored accordingly. It is advisable to use such treatments under the guidance of a qualified physician. If you have additional experiences to share, comments and submissions are welcome.
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