How Chinese Medicine understands the Menstrual Period

The female menstrual period represents a very physical external expression of female reproductive health. The characteristics and quality of the menstrual flow gives Chinese Medicine practitioners vital diagnostic information.

In health the menstruation should have a regular 28 day cycle which follows the waxing and waning of the moon, arriving and departing uneventfully like the peaking and ebbing of the ocean tides.

The Chinese Medicine understanding is that when there is an imbalance in female reproductive functioning menstrual irregularities arise.

Symptoms can include delayed, scant, absent or painful periods, breast distension, premenstrual tension, irritability, menstrual migraines, clotting, lower back or flank pain, skin breakouts, bloating, fluid retention, diarrhoea and/or constipation.

It is also very common for menstrual irregularities to follow the female lineage. Girls often follow a similar developmental path to their mothers and grandmothers, experiencing similar symptoms.

As such stories and experiences of menstrual irregularities are passed from generation to generation with girls and young women suffering needlessly thinking that their symptoms are ‘normal’ and unaware that there are complementary and alternative treatments available.

The first period

The arrival of the first period or menarche is a major transitional event in a female’s reproductive life. It is one of the many physical signs that indicate the transition from childhood into puberty.

Chinese medicine considers the menstrual cycle to be very precious. It should be carefully guarded and nurtured with the utmost care and attention for it plays a vital role in cultivating healthy sexual reproductive function and is the base from where a young girl will someday bear her children and ensure continuity of her family blood line.

There are many differences in the history, philosophy and development of Eastern and Western medicine. The understanding of sexual maturation, growth and development is no exception. For example Chinese medicine doesn’t have a concept of ‘hormones’ so automatically there is no point of reference between the two modalities. As such we will endeavour to explain how the physiology of menstruation is seen according to Traditional Chinese Medicine theory.

The menstrual cycle according to Western Medicine

According to Western Medical understanding under normal circumstances baby girls are born with ovaries, fallopian tubes, and a uterus. The ovaries contain thousands of eggs, or ova.

As a girl enters puberty, the pituitary gland releases hormones that stimulate the ovaries to produce oestrogen and progesterone. These hormones have the role of supporting sexual maturation, growth and development.

As part of healthy reproductive function each month the ovaries release a mature egg which travels down the fallopian tube toward the uterus. This is known as ovulation.

In the days prior to ovulation, production of oestrogen increases which stimulates the uterus to build up its lining or endometrium with extra blood and tissue, making the walls of the uterus thick and cushioned, in preparation for receiving a fertilised egg.

If the egg is not fertilised it will not attach to the wall of the uterus, the lining of the uterus or endometrium will break down and excess blood, tissue, and unfertilised egg will be shed from the uterus, via the vagina as the menstrual period.

The menstrual cycle according to Chinese Medicine

There is a Chinese medicine saying that goes, ‘a woman’s reproductive organs hangs off her digestion like a bell’. This statement an indication of the degree of importance placed on maintaining optimal digestive function when treating any gynaecological condition at any age.

According to TCM a girl’s digestion before the age of 7 is not fully matured. After this time her digestion starts to manufacture and store a daily excess of energy and blood.

By the age of 14 a she is manufacturing sufficient energy and blood to sustain all her physical needs a well as an excess that ‘accumulates’ and is stored in her uterus.

After puberty every 28 days this surplus is discharged as a menstrual period. The first period is known as the arrival of Tian Gui or ‘heavenly water’. The use of such beautiful imagery gives an indication of how sacred the Chinese hold this event and how precious this fluid is considered to be.

The menstrual cycle can also be explained according to the concepts of Yin and Yang, the two opposing forces of nature, and the cycle of change. Under normal circumstances women will have an established, regular 28 day menstrual cycle.

This cycle reflects the pattern of build-up and breakdown of the endometrium, or nutritious lining of the uterus. The monthly purge of ‘old’ blood and nourishment makes way for new nourishment and is a perfect system of biological cleansing designed to maintain optimal reproductive health.

Change occurs in cycles

Examples of these cycles might include the cycle of the day, the week, the month, the year, the decade and of course the menstrual cycle.

There are 4 distinct phases of the monthly cycle.

  1. The start of the menstrual cycle is calculated from day 1 with the commencement of the period. This occurs when the blood is abundant and overflowing. By the end of the period all surplus blood is expelled and bleeding ceases.
  2. By day 7 the body has started busying itself to produce more energy and blood to replenish that which has been lost.
  3. Around day 14 of the cycle the volume of blood is relatively full again and the body temperature increases. The additional body heat causes egg follicles to mushroom and ripen, resulting in ovulation.
  4. From day 21 excess energy and blood continues to accumulate in the uterus creating a rich, nutritious endometrial lining in preparation for either receiving a fertilised egg or being expelled as a period.

From day 28 the cycle begins again.

Menstrual characteristics of interest to Chinese Medicine

Chinese Medicine practitioners will never perform internal, vaginal examination under any circumstance. The primary method of collecting diagnostic information is through asking clinical questions, palpating the radial pulse at the wrist and inspecting the tongue.

No Chinese medicine question is ever without purpose.  Questioning will help to establish the length of the menstrual cycle, how many days you bleed, the quality, quantity and colour of the flow. These questions can be very intimate so if women happen to be culturally sensitive or uncomfortable with a male practitioner they may need to factor this into their choice of practitioner.

Other symptoms of clinical interest include how heavy or light the menstrual flow is, if there is clotting, fluid retention, and period pain during the period or if the period is preceded by premenstrual breast distension, stress or headaches.

Women might also become aware of symptoms that prior to TCM treatment they believed to be a ‘normal’ part of their female cycle and were either unconcerned or unaware that effective treatment was available. Many women are pleasantly surprised by how quickly menstrual symptoms can improve with the correct attention.