»Menstrual blood is not Blood but Heavenly Water, originating within the Kidneys … It is red like blood, but it is not blood. That is why is called Heavenly Water.« - Fu Qing Zhu, the 17th century Chinese gynecologist.
In Chinese the most common word for menstruation is yue jing, meaning »moon flow«, which occurs monthly, regularly without change. Since it comes regularly like the moon's waxing and waning, it is also called monthly sign, monthly thing, monthly water, and monthly flood. According to the Nei Jing, a woman's life comprises a series of seven-year cycles. By age fourteen, a girl's Qi should be strong and robust so that she can transform into a woman with the onset of menstruation. Ancient practitioners called menstruation TIAN GUI, or HEAVENLY WATER, because they believed that menstrual blood was different than the blood that circulates through and nourishes our body.
However, the major component of menstruation is Blood. Menstrual blood first begins to flow when a number of factors come together at the age of fourteen, as believed by ancient practitioners. The Kidney energy must be strong and enough Blood must be accumulated to come out of the uterus. In addition, Qi and Blood must be balanced and moving smoothly through the Zang-Fu organs. As well, the two channels responsible for governing the seven-year women's cycle must be properly functioning. The Conception Vessel (Ren Mai – the Sea of all Yin) must be flowing strongly, and the Penetrating Vessel (Chong Mai – the Sea of Blood) must be abundantly supplied with Blood. When these variables come together, a woman can begin to menstruate. Briefly speaking, the menstrual cycle is the joint effort of the Kidney qi, the reproduction-stimulating essence, the Chong mai and the Ren mai, which make the Qi and Blood of the uterus become full and overflow. In this process, Kidney qi is predominant factor, the reproduction-stimulating essence is the driving force, the Chong mai and the Ren mai are the passageways, the uterus is the location, and the Qi and Blood are the material basis.
Qi and Blood in Relation to the Menstruation
There is a reciprocal relationship between Blood and Qi that have a strong impact on the process of menstruation. The Qi is the commander of Blood. If Qi is weak, it will not engender and transform the Blood. If, for example, Qi is deficient the Blood also becomes deficient and this may give rise to delayed, scanty, absent, or painful menstruation. Further, the Qi moves the Blood. In A compendium of Chinese Medical Diseases is written: »If the Qi moves, the Blood moves. If the Qi stops, the Blood stops.« Hence, if the Qi becomes stagnant, the Blood may become static and stuck, which may also result in delayed, scanty, absent, or painful menstruation. Reversely, the Blood is the mother of Qi. If the Blood is insufficient, the Qi will lose its root and flush upward and to the exterior which causes internal wind. If the Blood becomes static and stuck, the Qi may become sluggish and stagnant as well, giving rise to abdominal and breast distention, premenstrual depression, and painful menstruation, for instance.
Qi, Blood, Yin and Yang in Relation to the Menstrual Cycle
»Woman's menstruation has a constant time. This schedule is due to the rise and fall of the whole body's yin and yang.« (A Compendium of Chinese Medical Menstrual Diseases). The rise and fall of yin and yang responsible for the menstrual cycle is made up of four approximately seven days segments. According to TCM theory, during each of these four segments, different physiological processes take place. In order to apply right therapy at the right time, it is crucial to understand these four segments. They are related to the Blood, yin, yang and Qi, respectively. These four segments of the menstrual cycle are shown in the diagram below:
The cycle begins on the day one of the period. It is called the menstrual phase. During the menstruation, the Blood flows down and out. The uterus that was full to overflowing becomes gradually emptied, as well as Chong mai becomes empty, and the yang transforms into yin. In this phase, the free flow of Liver Qi and sufficient Liver Blood are essential. If the Blood is unable to flow freely, even though there may be sufficient Blood, there may be delayed, scanty, painful, or blocked menstruation, thus regulation of movement of Qi and Blood is needed. If the Blood is freely flowing, by the end of menstruation, the uterus or the “sea of blood” is empty. In terms of Western medicine, this is the phase when the levels of estrogen and progesterone are low.
During the second week or approximately seven days after the onset of the menstruation the post-menstrual or pre-ovulation phase takes place. The discharge has stopped and the Blood begins to grow. Blood deficiency is being replenished and nourished by enriching the yin and the Chong mai is being filled with the Blood. In Western medicine terms, FSH and estrogen level rise, 10-30 follicles begin to grow, and cervical secretions increase.
The Blood becomes normally full on or around day 14. In other words, yin has reached its extreme and it starts transforming into yang, which, according to TCM theory, is related to ovulation and the rise of basal body temperature that follows ovulation. For ovulation to occur, yin must transform into yang. Thus, in the third segment of the menstrual cycle or mid-cycle phase, invigorating and warming yang is very important, but also regulating the movement of Qi and Blood. According to Western medicine perspective, LH increases and the egg is being released.
From day 21 on to the onset of menstruation on the fourth segment or pre-menstrual phase, yang qi rises, Heart Qi must move the Blood down to the uterus, and the Liver Qi starts to move allowing Blood to fill the Chong mai in preparation for the menstruation. It is the Liver Qi which controls the flow and discharge of Qi, including the Heart Qi. If the Liver Qi is stagnant, the Qi may counterflow during this segment of the cycle, which may have a great impact on menstruation, in terms of several menstrual disorders. Therefore, during the premenstrual phase, the emphsasis is on enabeling the free flow of Qi, nourishing the Blood, and promoting yang. In Western medicine, this is the luteal phase, and progesterone is being secreted.
The Liver in Relation to the Menstruation
The Liver has a significant influence on the menstruation and menstrual cycle in terms of two functions: storing of blood and commanding circulation and the free flow of Qi. The Liver is reservoir for blood. It supplies Chong mai or Penetrating Vessel with Blood, which then accumulates in the uterus and, when being superabundant, is discharged as menstrual bleeding. Because the uterus is identified with “the sea of blood and the blood chamber” which are also said to store the blood, there is a special relationship between the Liver and the uterus. The link between the Liver and uterus takes place in the foot jue yin Liver channel, which runs internally through the pelvic cavity and connect with the Ren mai or Conception vessel and thence with the uterus. The flow of the blood from the uterus is dependent upon the transporting function of the Qi and the Liver controls the circulation of the Qi. In this regard, the Liver is accorded an especially important role in the regulation of menstruation. In addition, the Liver network vessels irrigates the external genitalia. Therefore, if the Liver Qi becomes stagnant, this can have an especially pronounced effect on the free flow of menstruation. Stagnant Liver Qi can also manifest on a physical level as a backache, tender breasts, headaches, feeling bloated, constipation, or breast masses. The pattern related to the first function is Liver Qi stagnation, and the one related to the second function is Liver Blood Deficiency. As Qi is “the commander of Blood” and “when Qi stagnates Blood congeals”, stagnation of Qi over a long period of time can easily induce stasis of Liver-Blood. Especially in women, these two patterns, are interlaced.
In the next blog, I will write about SELF-CARE during Heavenly Water in order to avoid Liver Qi Stagnation or Liver Blood Deficiency.
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Based on my thesis "Liver Qi Stagnation as the cause of Irregular Menstruation" (2018)