The Menstrual Cycle According to Traditional Chinese Medicine

 

This is the second post in a series of three. If you haven’t read the first one yet, here it is.

Those Couple of Days Before You Start Your Period…

…can potentially suck pretty bad.

PMS can pretty much feel like this.
PMS can pretty much feel like this.

We see it all of the time in the community acupuncture clinic, that assortment of discomforts that can include bloating, irritability, breast pain, cramps, loose stools, and an aching lower back. Then there are the little ‘subtle’ things, like the appetite from hell and road rage. The bad skin and the bad hair. The Chicken Little anxiety that you wake up with one day and carry with you all day long.

I had one patient say to me once: “I feel like the sky is falling. If it does, I’ll punch it.”

Wraps up that feeling nicely, huh?

Most of the time, these seemingly unrelated issues can be attributed to underlying liver qi stagnation. Since the liver is in charge of  the ‘push’ that will start menstruation, any underlying constraint will deter this outward movement and cause the qi and blood to further stagnate. To add insult to injury, stagnation that “sits around for too long” will create heat and make everything worse. This can manifest as migraines, headaches, flares of rage, an especially “hot” type of insomnia (wake up suddenly and feel hot and irritable, then eventually fall back asleep, repeat). Thankfully, these complaints often disappear as soon as menstruation begins; in fact, the onset of menstruation often feels like falling backwards into a cool pool of relief after being tied to a spit for a couple of days (see the biomedical theory of why this happens here).

I jokingly refer to the days before bleeding as The Hulks.  If you tend to get Incredibly Hulky before your period starts, check out my post on how to help with that underlying liver qi stagnation. Also, know that acupuncture is SUPER EFFECTIVE for this kind of thing. Those magic needles can soothe the Hulk and transform him (her) back into the socially withdrawn and emotionally reserved Brucie Banner IN NO TIME AT ALL!!!

Menstruation

Just before starting your period, your body temperature will drop, signalling the beginning part of the yin phase of your cycle. Once your period starts, it’s best to stay rested and comfortable. Does that mean you should withdraw from society and eat soup for 3 days? Yes!

Actually, no. Though soup is a great choice during this time, as are all Spleen-nourishing foods and activitiesWhat I am saying is this: If you can, and if you so desire, take it easy, Gina!

Similar to the days before your period, any problems that arise during the beginning of menstruation (cramps, headaches, emotional instability) usually indicate underlying qi and blood stagnation. However, problems that arise at the end of the period (fatigue, shortness of breath, muscle weakness, anxiety, lack of appetite) usually indicate qi and blood deficiency. Acupuncture and herbs can help with both.

The Days After Your Period Begins Up Until Ovulation (Follicular Phase)

This is a yin and blood building time, according to Traditional Chinese Medicine, which is well-illustrated by the growth of new endometrial tissue. The word “yin” is associated with growth, form, and substance.

If you were already blood deficient to begin with, the first couple days after your period ends can leave you feeling depleted and exhausted. Lack of blood disrupts the smooth flow that is associated with elasticity of tissue and emotional flexibility. This is the best time for long walks and Yin/ Restorative yoga. Also a good time for friends who are nice and funny and like to feed you.

Some patients find that they enjoy this phase the most, and report that they are more likely to feel balanced and energetic. In clinic, I find that the patients who feel this way about the follicular phase are those who struggle with milder cases of blood deficiency, which means that their period doesn’t leave them feeling vampiric – in other words, it makes perfect sense that they would feel best while their slight deficiency rectifies itself as their blood and yin gain strength.

Yin Yoga.
Feeling follicular? How ’bout some yin yoga?

Make sure to get plenty of nutrients during this part of your cycle; foods that nourish blood and yin are especially helpful. If you find that your symptoms are aggravated during this phase, there is a good chance that an underlying blood and/or yin deficiency needs to be addressed.

Ovulation: Yin into Yang

During ovulation, your body temperature spikes and the body moves from the yin phase into the yang phase. In Traditional Chinese Medicine, “yang” is associated with the words warmth, activity, and energy. Some patients report that they feel the strongest, mentally and physically, around ovulation. I’ve also heard more than a few reports that sexual desire tends to increase during this part of the cycle.

From a biomedical perspective, the rise in progesterone slightly warms the uterus and dries up the cervical fluid to help provide an opportune environment for an embryo to implant. This biomedical explanation of what is happening overlaps nicely with the Traditional Chinese Medicine theory of the menstrual cycle. This warming and drying phase of menstruation is considered the yang part of the cycle. Doctors of Traditional Chinese Medicine recognized the importance of a “warm” womb long ago; in fact, a “cold womb” or “cold in the uterus” is a diagnosis that is treated in order to increase fertility.

If there is any underlying qi stagnation, ovulation can cause acute cramps (called “mittelschmerz”, which is German for middle pain), or present with a flare of liver heat (which often manifests as irritability, stomach pain, reflux, headaches).

The time around ovulation is the time to move qi and blood (and warm the yang, if deficient). The following foods can help move qi and blood: turmeric, ginger, basil, nutmeg, rosemary, mint,  cardamon, cumin, fennel, eggplant, beet, onions, garlic, mustard greens, and sprouted grains.  In small amounts, the following are potent qi movers: horseradish, wasabi, coffee, red wine, citrus, and vinegar (mmmm… pickles).

The Days After Ovulation Until You Start Your Period (Luteal Phase)

Generally speaking, this is the qi and yang building period, and a good time to do what you can to help your qi move smoothly (exercise that brings your heart rate up is an efficient and easy way to do this). Problems/complaints that arise during this time often indicate a qi and/or yang deficiency, though the one that we see most in clinic involves an underling liver qi stagnation. WTF, LIVER??!!!

If you haven’t noticed, the liver seems to be implicated in most problems involving menstruation and the menstrual cycle. Why is that? Well, first of all, the liver channel runs through the pelvis and through the uterus. Also, any type of stress will cause liver “depression” (the liver loses it’s ability to maintain the free flow of qi and blood and stagnation results). It is a common saying in TCM that “If there is free flow, there is no pain; if there is pain, there is no free flow.” Stagnant qi manifests as pain and distention that can be dull, crampy, or colicky. Static blood is characterized by localized, fixed, sharp, stabbing, or lancinating pain. (Blood clots are common when one’s blood is stagnant).

Ironically, the foods we often crave during this time are not the foods that are best for us. Do your best to limit excess amounts of cow dairy, eggs, hot spices, poor quality fats, refined sugar, poor quality animal protein, and excess alcohol. All of those things have potential to further stagnate the liver and create dampness. And heat. The qi and blood moving foods listed above (in the section on ovulation) are also appropriate during this time.

Eventually, your period will start, and the cycle of transformation renews itself. Yang is released and transformed into yin through a healthy menstrual flow. And on and on and on. And don’t forget – no matter where you are in your cycle, acupuncture and herbs are invaluable in regards to maintaining balance.

See The Menstrual Cycle According to Biomedicine for the last post in this series.