Mehanisms of Menstruation: the Chines Medicine Perspective. What never ceases to amaze me about Chinese Medicine is its holistic nature. The playful balance between all of the organs and substances within the body, and the dynamic the body has with its environment. With each new exploration into the mechanisms of disease, it is this balance which helps us determine the root of the disease, the prognosis of the disease and its potential progression.
Gynecology in Chinese Medicine is the basis of all functions for women and influences every aspect of women’s health and consequently it developed as school of thought on its own, much like internal medicine, external medicine, oncology, etc. and thus has some terminology unique unto itself.
To introduce the mechanical concepts of menstrual physiology, lets start with some of these definitions.
Tian Gui is a Yin-essence. It is a necessary substance for the regulation of growth, reproduction, menstruation and pregnancy. It originates from the Kidney and is nourished by the food-essence of the Spleen and Stomach. Women around 14 years old have strong Kidney Qi and this is when Tiangui arrives (menarche). When women are around 49 years old, their Kidney Qi is weak and Tiangui dries up (menopause).
The Uterus, in Chinese Medicine is one of the six ‘extra Yang organs’. It is related to the Kidney via a Channel called the Uterus Channel (Bao Luo). The Uterus is also related to the Heart via a Channel called the Uterus Vessel (Bao Mai). Normal menstruation and fertility occur in the Uterus, but depend on the Kidney and Heart.
It is said that menstruation depends on Tiangui’s creation, the coordination between- and the normal functional activity of the zang-fu organs, Qi-Blood, and Meridians.
Relationships between Menstruation and the Organs: the Kidney, Liver and Spleen play the most important roles in the mechanism of menstruation, though recent studies have included the Heart.
Kidney: when talking about the Kidney, we especially mean Kidney Qi and Kidney Essence. First, the Kidney’s strength decides the arrival of Tiangui, an important substance for normal menstruation. Second, is the relationship between Kidney Essence and menstrual Blood: Kidney Essence is the source of menstrual Blood and these substances can transform into each other. Both the Kidney Essence and Blood are the material basis for menstrual Blood; therefore the Kidney is a very important organ for menstruation.
The Kidneys also includes Kidney Yin and Kidney Yang. Together they maintain a dynamic balance. Kidney deficiency may be caused by an innate deficiency, early pregnancy, too many pregnancies, or too much sex. Kidney deficiency impairs Chong and Ren function. Deficiency can be divided into Kidney Qi deficiency, Kidney Yang deficiency or Kidney Yin deficiency. Mechanisms of deficiency include:
- Kidney Qi Deficiency: Kidney Qi means the functional activity of the Kidney. The Kidney Qi’s strength or weakness decides the arrival or dispersal of Tiangui. Moreover, the Chong and Ren meridians are rooted in the Kidney. The uterus is connected with the Kidney through its vessel and collateral. Therefore, a Kidney Qi deficiency can cause a dysfunction of Chong and Ren resulting in menstrual problems, vaginal discharge, pregnancy problems, post partum problems and other various problems.
- Kidney Yin Deficiency: a Kidney Yin deficiency along with insufficient Essence-Blood may result in malnourishment of the Chong and Ren manifesting as delayed menstruation, scanty periods, amenorrhea, dry vagina, irregular uterine bleeding, menopausal syndrome, infertility, intrauterine growth retardation (IUGR), etc. Kidney Yin deficiency with deficient heat will injure blood vessels and can cause early periods, abnormal uterine bleeding, nose bleeding during menstruation or fever during menstruation.
- Kidney Yang Deficiency: Kidney Yang deficiency with the declining of “fire from the life-gate” may not be able to warm uterus causing cold sensations in vulva, low sexual desire, and infertility, intrauterine growth retardation, or miscarriage. Kidney Yang deficiency also affects the consolidation function of Kidney, causing uterine bleeding, excessive vaginal discharge, diarrhea during period or edema in pregnancy.
- Kidney Yin & Yang Deficiency: As stated before, Kidney Yin and Kidney Yang depend on each other. A Kidney Yin deficiency can deplete Kidney Yang and a Kidney Yang deficiency can also damage Kidney Yin. So, a long term deficiency of Kidney Yin or Kidney Yang may develop into a deficiency of both of Kidney Yin and Kidney Yang. When diagnosing and differentiating, an analysis should be done as to the predominant deficiency to focus on which to treat first.
Liver: The Liver has two functions that affect menstruation. First, the Liver stores the Blood. Second, the Liver regulates the distribution of Blood amount in the body. The Liver also smoothes and regulates Qi, making Qi flow freely in the whole body and activates Blood circulation. When Liver Blood goes down to the “SeaofBlood” (Chong Meridian) and changes into menstrual Blood, women have menstruation. Normal menstruation depends on the proper functioning of the Liver in storing and distributing Blood. Long term or violent depression or anger can damage the Liver’s function, so it performs in excess or deficiency. The Liver stores Blood, and with insufficient Liver Yin (Blood) or with Yin deficiency, a hyperactivity of Yang can occur, causing many gynecological problems. For example,
- Liver Qi Stagnation: Liver Qi stagnation affects the movement of Blood, causing breast distention during periods, painful periods, no periods, lack of lactation etc. Liver Qi stagnation also can affect the Liver’s functions of regulating Qi and distributing Blood, resulting in theSea ofBlood not able to store and drain Blood regularly, causing irregular periods.
- Liver Fire: Liver stagnation can create Liver fire which can go up and injure the blood vessels resulting in headaches during periods, early period, heavy period, long period, uterine flooding bleeding (metrorrhagia), nosing bleeding during period, spontaneous flow of milk etc.,
- Liver Yin Deficiency (+/- hyperactivity of Liver Yang): since the Liver stores the Blood, sufficient Liver Blood ensures balance of Liver Yin and Liver Yang. Liver Yin deficiency may cause hyperactivity of Liver Yang resulting in dizziness during period or pregnancy, menopause syndrome, pre-eclampsia etc. As the situation gets worse it can cause Liver-Wind stirring inside the body showing convulsions in pregnancy or after childbirth. Liver Qi stagnation with Spleen deficiency can produce damp-heat, which goes downward to cause excess vaginal discharge or vulvae itching.
Spleen/Stomach: the Spleen and Stomach, since they are an earth element, have the function of transforming the food essence into Blood and Qi, so the Spleen and Stomach are the source of Qi and Blood. Menstrual Blood originates from the Blood, therefore a Spleen deficiency causes menstrual problems by failing to make enough Blood. Spleen Qi has the function of consolidating Blood and if Spleen Qi is deficient, Blood may leak out and cause bleeding problems. Also, the Spleen controls the Blood in the vessels. Finally, the Spleen also has the function of transforming water and is known as the pivot for water metabolism. For these three reasons, if some pathogenic factor such as eating improperly or too much thinking injures Spleen function, a deficiency can occur and the Spleen can no longer transform food and water or control the Blood in the vessels and gynecological problems will happen.
- Spleen Fails to Transport & Transform: Spleen cannot transport and convert the food essence into Qi-Blood, causing a Qi-Blood deficiency. Insufficiency of theSea ofBlood can affect normal menstruation, causing late period, scanty period, or no period. When the Spleen is deficient it cannot convert water resulting in conditions such as water retention or flooding, diarrhea during periods, excessive vaginal discharge, or edema during periods or pregnancy. If water-damp retention combines with heat, sputum-dampness accumulates in the uterus or Chong and Ren meridians and blocks the uterine vessel resulting in no period, infertility, and uterine masses. This relates to syndrome differentiations of Blood & Spleen Qi deficiency or Spleen Qi deficiency with dampness.
- Spleen Fails to Control Blood: a deficient Spleen cannot control Blood in the Blood vessels, affect the function of the Chong and Ren meridians, resulting in early periods, heavy periods, uterine flooding-bleeding, or prolapsed uterus.
Heart: The Heart influences menstruation in various ways: it governs Blood, it is connected to the Uterus via the Uterus Vessel (Bao Mai), and the coordination of Heart Qi descending (to the uterus) and the Kidney Qi ascending to the Heart maintains the transformation of period Blood (Qihua).
Relationships between Qi & Blood and Menstruation: Menstruation needs Blood. Blood is produced by the functional activity of the Zang-fu organs. Qi and Blood depend on each other: Qi is the commander of the Blood, while Blood is the mother of Qi. Because of the interdependence of Qi and Blood, a woman’s good health depends on the well-coordinated harmony of Qi and blood. The disharmony between Blood and Qi is the main pathological mechanism in gynecology. Because Blood is the basis for menstruation, women easily exhaust Blood during pregnancy, delivery, and feeding the baby, which easily results in a hyperfunction of Qi with Blood deficiency. With the interdependent relationship between Qi and Blood, Blood problems can affect Qi, and Qi problems can affect Blood.
- Blood Deficiency: many factors can cause a Blood deficiency such as long term chronic diseases and hemorrhage. A Blood deficiency results in not enough Blood to flow into the Sea of Blood, and gynecological problems such as late periods, scanty periods, no periods, painful periods, abdomen pain in pregnancy, puerperal abdomen pain, lack of lactation, and puerperal faintness.
- Blood Stasis: emotional or external factors such as cold or heat may cause Blood stasis. Blood stasis can cause gynecological problems such as painful periods, no periods, uterine flooding, heterotropic pregnancy, puerperal abdominal pain, leucorrhea, infertility, or mass etc.
- Blood Heat: exterior heat or Liver fire attacking the Blood causes Blood heat which can in turn injure the Chong and Ren vessels, resulting in early periods, heavy periods, uterine flooding bleeding, nose bleeding during periods, or headache during periods. Yin deficiency can produce interior heat, causing deficient heat to affect menses resulting in early periods.
- Blood Cold: Yang deficiency can produce interior cold, exterior cold can invade body, and cold can retain in the uterus and affect the function of the Chong and Ren meridians. Blood cold can cause late periods, scanty periods, painful periods, no period, infertility, fetal growth retardation or puerperal abdominal pain.
- Qi Deficiency: Chronic disease or overwork can cause a Qi deficiency resulting in the vessels not being able to control the Blood and causing a dysfunction of Chong and Ren with symptoms such as early periods, or heavy periods. Qi deficiency with prolapse can cause uterine prolapse. Qi deficiency with Wei-Qi deficiency can cause cold at period time, puerperal spontaneous sweating, etc.
- Qi Stagnation: this is related to the function of the Liver and Spleen, and affects the Chong and Ren meridian leading to a dysfunction and resulting in irregular periods, painful periods, breast distention at period time, no periods, or infertility.
- Qi Rebellion: the adverse rising of Liver Qi affects both the Lung and Stomach, resulting in nose bleeding or hematemesis during periods, morning sickness, full sensation in the chest during pregnancy.
Because of the relationship between Qi and Blood, Qi problems can affect Blood and Blood problems can affect Qi, causing Qi-Blood problems such as Qi-Blood deficiency, prolapse of Qi with exhaustion of Blood, and Qi stagnation with Blood stasis.
Relationship between the Meridians and Menstruation: Meridians are the bridges that connect the different parts of the body to help the human body work as a single unit. Meridians also house Qi and Blood and distribute the Qi and Blood to every part of the body to nourish the whole body. A Woman’s physiology requires the normal functioning of the meridians. The Chong meridian, Ren meridian, Du meridian and Dai meridian are most closely related to women’s physiology and pathology.
- Chong Meridian: the Chong meridian originates from the uterus. It has three branches that connect with the Kidney and Stomach. The Chong meridian has the function of regulating the Blood of twelve meridians and is therefore known as the ‘Sea ofBlood.’ Blood goes down to the Chong meridian for menstrual blood, so Yellow Emperor Internal Classic said “If Chong meridian is flourishing, the period will come regularly.”
- Ren Meridian: the Ren meridian also originates from uterus and travels along the midline of the front of the body. Ren meridian is the “Sea ofYin” meridians. The Yellow emperor Classic also said “After Ren meridian has opened, periods come and women can become pregnant.”
- Du Meridian: the Du meridian originates from uterus and travels along the midline of the back of the body. The Du meridian is the “Sea ofYang” meridians. Together, the Ren and Du meridians maintain the balance of Yin and Yang of the whole body, so periods can stay normal.
- Dai Meridian: the Dai meridian originates from the lowest rib. It is a belt-like channel, and the pathway travels around the waist in a circle. The function of the Dai meridian is to bind together or restrain the other meridians. This is important for the women’s physiology because if the Dai meridian cannot restrain other meridians, Damp-Heat may infuse downward and result in vaginal discharge (leucorrhea).
The three meridians of Chong, Ren and Du all originate from the uterus, connect with the Zang-fu organs and meridians, and play a very important role in women’s physiology. The impairment of the Chong & Ren meridians is the most important pathological mechanism, and menstrual problems are always related with the impairment of the Chong and Ren meridians. No matter what pathogenic factors exist, such as cold, heat, dampness, emotional stress, diet, sex, trauma, or body constitution, when these factors affect the function of the Zang-fu organs or Qi-Blood function, many kinds of problems can occur. All factors that directly or indirectly affect the Chong or Ren meridian will cause gynecological problems. Impairment of the Chong and Ren meridians is the end cause of all gynecological problems. This is special characteristic of pathogenic mechanism in gynecology.
Again, it is they dynamic balance in which our bodies flow that allows for health and flourishing in life. The Kidney, Liver and Spleen are the main organs involved in menstrual physiology, though more recently, there has been added interest in the Heart as an organ that influences the menstruation through the Uterine Vessel. Yet the proper functioning of the organs is entirely related the state of the Qi and Blood and their flow through the organs and meridians. In an article of this small size, it is difficult to adequately describe the beauty of the interrelationships between these different concepts. We take each aspect on its own and explore its mechanism and pathology, but it’s when we put it all together that the magic takes place.
Caroline Prodoehl, R. TCMP
Wang, Yuxiang. (2011). Gynecology Treatment Course Notes. TorontoSchoolof Traditional Chinese Medicine.