Menstrual Cycle Phases In TCM

By Rob Benhuri - May 6, 2015 2:11:00 PM

woman_acu_chartMany people are turning to acupuncture to help alleviate menstrual cramps, aid in fertility, normalize the cycle, or to cope with the symptoms of menopause.

If you are interested in using acupuncture for women's health, it will be helpful to understand the menstrual cycle phases from a TCM perspective. 

TCM (Traditional Chinese Medicine, the foundation of acupuncture theory) sees the menstrual cycle in 4 distinct phases. Here is a brief review of each one:

Phase 1: The Blood Phase

This phase starts on day 1 of the cycle. Just to make sure we are all on the same page, day 1 is the first day of "real" bleeding. If you spot for a couple of days before your period, the spotting days are considered the end of the last cycle. The new cycle always starts on the first day of full bleeding.

With this in mind it is no wonder why the Chinese named this the "Blood Phase." The key to this phase is movement. All of the old blood and tissue from the previous cycle is pushed out of the body during phase 1, setting the stage for a successful ovulation in phase 2. If you have painful periods, intense menstrual cramps and/or clots in the menstrual blood, it is likely that you are not getting the old blood fully pushed out in Phase 1. The best treatment from an acupuncture point of view is to help the body move blood in Phase 1 and you will feel relief in Phase 4.


graphic_menstrualcyclePhase 2: The Yin Phase

Yin is a concept in acupuncture theory without a good corollary in English. Yin represents "substance," meaning it has shape and form. Things that are dense and/or gooey are rich in yin. In the case of the female reproductive cycle, the endometrium is yin, and it is in this phase that the lining is built.

Phase 2 continues all the way until ovulation, which can be considered the fullness of yin. The chart to the right has ovulation on day 14 but this is academic. Your Phase 2 continues until you ovulate, whatever day that may be. If you ovulate well past day 14, there may be an issue with the building of yin, and an acupuncture session would focus on helping your body bring the yin to fruition.

Phase 3: The Yang Phase

Just as we say, "the night is always darkest before dawn," so the yin phase of the menstrual cycle must eventually give way to the dawn of the yang. This is the continuous cycle we see both on earth and in the body. Yang is another concept in acupuncture theory without a good English equivalent. Yang represents "movement," meaning it has no specific shape, but it gives power to things that do have shape, allowing them to move. The wind is yang. It does not have a shape in and of itself, but when it touches the yin leaves of a tree, you can see the yang in the rustling of the branches.

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In modern medical terms, this relationship can best be understood by looking at how the dominant egg "pops out" during ovulation. Up until the point the dominant egg emerges the body is building more and more estrogenic (yin) hormones. The "popping out" is a classic case of full yin turning to yang. When the dominant egg is released and a woman ovulates, her yang energy is what pushes the egg dpwn the fallopian tube for possible implantation.

When ovulation does not occur regularly, an acupuncturist will likely suspect either that the yin is not able to reach the point where it tunrs to yang, or that the yang in this phase is not strong enough to bring the egg down the tube. It is a difficult relationship to fully understand, but it is central to all issues of women's health in acupuncture theory.

Another change in Phase 3 is that the estrogenic hormones of Phase 1 and 2 are phased out and progesterone production is increased. Progesterone is considerd by modern acupuncturists to be a yang hormone, and it has a warming and drying effect. The successful hand over from yin to yang in Phase 3 accounts for the raise in basal body temperature that anyone who is TTC can tell you all about. If there is not enough yang present throughout phase 3, the acupuncturist will focus on "cold in the uterus," and the appropriate treatment will follow.

Phase 4: The Qi Phase

This one was always most confusing to me in acupuncture school. But now I am able to see phase 4 as the yang reaching full potential, morphin into yin. Again this is a mirror of the daily cycle, where the sun reaches it's zenith around 12 pm and starts the long descent down after that.

The Qi phase will be different depending on whether or not you conceived a baby during ovulation. Obviously if you are pregnant you will not reach the fullness of phase 4 and start a new cycle so it is not as useful to keep talking about it as a phase.

If you are not pregnant, this is the phase in which your body produces more and more yang, gearing up to push out all the blood and tissue that had been made in phase 2. For many women who experience long periods (or irregular periods) the problem is here in phase 4. Your body must be able to produce enough Qi before it can push the blood and tissue out, so the menses (bleeding) will not start until that happens.

When I said before that spotting does not count as day 1, this is why - that spotting is often your body trying to start menses, but you lack sufficient Qi to make it happen. It is therefore a problem of phase 4 and it will not do you well to treat it as a problem of phase 1.

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