JOURNAL OF CHINESE MEDICINE NUMBER 67 OCTOBER 2001
DISCUSSION OF THE
MENSTRUAL CYCLE AND
THE CYCLE-REGULATING
TREATMENT
by Prof. Xia Guicheng
Translated by Fu Zhiwen
Introduction by Giovanni Maciocia. Annotated by Peter Deadman
Introduction responsible for the discharge of the eggs at ovulation and the
Prof. Xia Guicheng is one the most eminent gynaecology blood at menstruation and therefore for the crucial times of
specialists in China today. In my own practice, I find that transformation from yin to yang and yang to yin. He often
adapting the treatment principle to the menstrual phase is attributes endometriosis pain to a Heart pathology.
an excellent treatment strategy that definitely produces 6. Prof. Xia attaches great important to the normal clear,
better results in gynaecological problems. This strategy is egg-white-like vaginal secretion that should occur around
particularly important for the treatment of infertility. ovulation. If this is absent or is too short-lived, it indicates
The following is a summary of the main lessons I derived Kidney deficiency, even in the absence of any other symp-
from Prof. Xia’s teaching. toms of Kidney deficiency.
1. Prof. Xia explains in a very simple and effective way the
physiology and pathology of the four phases of the men- Early in the mid-1960’s, we developed our initial under-
strual cycle as the ebb and flow of yin and yang. During the standing of the “Menstrual Cycle and the Cycle-Regulating
first half of the cycle yin increases and yang decreases, while Treatment”. With the benefit of continued clinical practice
in the second half yang increases and yin decreases. Ovula- and observation for over 30 years, we have been able to
tion marks a rapid change from yin to yang (i.e. yang continually develop this method. It has proved to be effec-
increases and yin decreases), while menstruation marks a tive in the treatment of disorders such as infertility, dys-
rapid change from yang to yin (i.e. yang decreases and yin menorrhoea and functional uterine bleeding, and in recent
starts to increase). In other words, yin is at its maximum just years it has also been applied for some organic diseases
before ovulation, while yang is at its maximum just before such as hysteromyoma, endometriosis and chronic pelvic
menstruation. inflammation, also with good results. This article offers a
2. As a result of this basic interpretation of the menstrual brief discussion of the Menstrual Cycle and the Cycle-
cycle in terms of yin and yang, some pre-menstrual prob- Regulating Treatment.
lems are attributed to excess of yang and, in particular, The first day of menstrual bleeding each month to the first
Liver and Heart fire (rather than the usual interpretation of day of the next menstruation is taken as one menstrual cycle.
Liver qi stagnation that is nearly always attributed to pre- The whole menstrual cycle is divided into four phases, known
menstrual problems). respectively as i. the menstruation phase, ii. the post-men-
3. Prof. Xia often talks about “retention of menses” as a strual phase, iii. the inter-menstrual phase, and iv. the pre-
pathological condition, i.e. the insufficient discharge of menstrual phase. Each phase has its particular characteristics
menstrual blood which may lead to blood stasis. in terms of physiology, pathology and treatment.
4. Prof. Xia uses basal body temperature (BBT) charts in a
very creative and innovative way and he is able to make a 1 Physiological characteristics of the four
Chinese diagnosis on the basis of a BBT chart. For example, phases of the menstrual cycle
he attributes a saw-tooth pattern in the pre-menstrual phase The physiological changes of the different phases of the
to Heart and Liver fire1. menstrual cycle are manifested both by the cyclical decline
5. Prof. Xia attributes an important role to the Heart in the and growth of yin and yang and the mutual transformation
physiology and pathology of menstruation. The Heart is between yin and yang. Of the four phases of the entire
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JOURNAL OF CHINESE MEDICINE NUMBER 67 OCTOBER 2001
menstrual cycle, two are characterised by transformation sea of blood”, in traditional Chinese medicine. The other is
between yin and yang, and two by the growth and decline the decline of yang; yin grows and yang declines.
of yin and yang. Yin and yang should be in balance, and the The inter-menstrual phase
transformation between yin and yang is the inevitable The inter-menstrual phase corresponds to the ovulation
consequence of the growth and decline of yin and yang. In phase in modern medicine4. It determines the arrival of the
the two phases of the growth and decline of yin and yang, premenstrual phase and also plays an important role in the
yin and yang are moving in opposite directions and the functions of the pre-menstrual phase. One of the two main
balance between them is disrupted. When the imbalance of characteristics of this phase is that yin grows to its maxi-
yin and yang reaches a physiological limit, it is corrected mum level, completing its transformation through the proc-
through the transformation between yin and yang. Gener- ess of ovulation and giving place to yang. The other charac-
ally speaking, the movement of yin and yang in their teristic is that in the ovulatory process, the qi and blood
growth and decline phases is slow; while in the transforma- activity is carried out in the lateral aspects of the lower
tion phases it is intense. abdomen, the ovaries and the fallopian tubes, reflecting an
upward-going tendency. The growth of the yin to its maxi-
Yang Yin mum level and its normal transformation into yang are the
important elements for the qi and blood activity in this
phase and for normal ovulation.
The pre-menstrual phase
The pre-menstrual phase corresponds to the luteal phase in
modern medicine. It is a stage when yang is in predomi-
nance. One characteristic of this phase is that the yang
grows, which is reflected by the elevated body temperature
in the basal body temperature chart. The growing yang
warms the uterus, which is helpful both for fertilisation and
menstruation. The endometrium also softens and dissolves
Menstruation Post-menstrual Inter-menstrual Pre-menstrual under the warming effect of the yang. The other character-
phase phase phase phase istic is the decline of yin.
transformation of yang to yin
2 Pathological characteristics of the four
transformation of yin to yang
phases of the menstrual cycle
The menstruation phase
The menstruation phase There are two possibilities for pathological changes in the
The menstruation phase marks the ending of one menstrual menstruation phase. One is the failure of yang to reach its
cycle and at same time, the beginning of the next menstrual expected level. As a result, normal qi and blood activity will
cycle. It is important that the excretion of the menses during also be affected, leading to qi and blood stagnation. Exam-
this phase is complete and thorough because retaining men- ples include dysmenorrhoea and irregular menstruation
ses will cause blood stagnation, which consequently affects with prolonged menstrual cycle and a small volume of
the regeneration of blood2. There are two main characteristics menses. The other possibility is that the growth of yang
of this phase. One is that yang is at its maximum level, exceeds its expected level. This results in hyperactivity of qi
accomplishing its transformation through the menstruation and blood or hyperactivity of qi and fire. A typical example
phase and giving place to yin in the post-menstrual phase. is the condition of irregular menstruation with increased
The other is that the qi and blood activity mainly takes place volume of menses, shortened menstrual cycle and pro-
in the lower abdomen and uterus which reflects a downward- longed period.
going tendency. All physiological changes, including the The post-menstrual phase
particular qi and blood activity of this phase and the normal The possible pathological changes in the post-menstrual
excretion of the menses, depend on the maximum level of the phase are that either the growth of yin is too slow so that the
yang and its transformation into yin. duration of the phase is prolonged, or that the growth of yin
The post-menstrual phase is too rapid so that the duration of the phase is shortened.
The post-menstrual phase corresponds to the follicular The inter-menstrual phase
phase in modern medicine. It is the key time for consolidat- In the inter-menstrual phase, if yin fails to grow to its
ing the material foundation of the whole menstrual cycle3. expected level, it will affect the normal activity of the qi and
There are also two characteristics of this phase. One is the blood, leading to problems in ovulation or failure of ovula-
growth of yin. The growing yin has the function of nourish- tion. If the growth of yin surpasses its normal level, the qi
ing the ova to assist their development and maturation, and and blood will be hyperactive which may result in abdomi-
helping the growth of the endometrium, understood as the nal pain or bleeding in the ovulation phase, or bleeding in
consolidation of the material foundation of the uterus, “the the pre-menstrual phase.
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JOURNAL OF CHINESE MEDICINE NUMBER 67 OCTOBER 2001
The pre-menstrual phase Shan Yao (Radix Dioscoreae Oppositae) 9-12g
The main pathological change in the pre-menstrual phase is Shan Zhu Yu (Fructus Corni Officinalis) 6-9g
that yang fails to grow to its expected level. This can be Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 9-12g
determined by recording the basal body temperature. In- Mu Dan Pi (Cortex Moutan Radicis) 10g
stead of the normal rise, the body temperature either does Fu Ling (Sclerotium Poriae Cocos) 10g
not rise enough, or the rise is unstable. This may affect the Huai Niu Xi (Radix Achyranthis Bidentatae) 10g
normal qi and blood activity, leading to conditions such as Example: Infertility.
dysmenorrhoea or bleeding in the pre-menstrual phase. Modifications
The pathological changes of the four phases in the men- • add Zhi Bie Jia (Liquid-fried Carapax Amydae Sinensis),
strual cycle are various and complicated. The ones men- Gui Ban (Plastrum Testudinis) and Nu Zhen Zi (Fructus
tioned above are only the most common ones. In practice, it Ligustri Lucidi) in cases of empty heat due to yin deficiency.
is important to have a good command of the normal physi- • add Hong Hua (Flos Carthami Tinctorii) and Wu Ling Zhi
ology of each phase so as to have a better understanding (Excrementum Trogopterori seu Pteromi) in cases of blood
when there is any pathological change in the menstrual stagnation.
cycle. • add Tai Zi Shen (Radix Pseudostellariae Heterophyllae),
Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Shan
3 Cycle-regulating treatment Zha (Fructus Crataegi) etc. in cases of Spleen deficiency.
The menstrual cycle carries on like an endless ring. The four The inter-menstrual phase
phases of the menstrual cycle are closely related to each other. Principle of Treatment: reinforce the Kidneys, regulate qi and
In the treatment of menstrual disorders it is important to blood.
regulate the whole menstrual cycle, with a different focus in Recommended formula: Bu Shen Cu Pai Luan Tang (Decoction
each phase based on the characteristics of that particular for Reinforcing Kidney to Promote Ovulation).
phase. In the menstruation phase, the main task is to regulate Main ingredients
menstruation; in the post-menstrual phase, to nourish yin Dan Shen (Radix Salviae Miltiorrhizae) 10-15g
and blood; in the inter-menstrual phase, to reinforce the Chi Shao (Radix Paeoniae Rubrae) 10g
Kidneys and regulate qi and blood; and in the pre-menstrual Bai Shao (Radix Paeoniae Lactiflorae) 10g
phase, to reinforce the Kidneys so as to assist yang. Shan Yao (Radix Dioscoreae Oppositae) 10g
The menstruation phase Shan Zhu Yu (Fructus Corni Officinalis) 9g
Principle of treatment: activate blood, regulate menstruation. Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10g
Recommended formula: Wu Wei Tiao Jing San (Powder of Five Mu Dan Pi (Cortex Moutan Radicis) 9g
Ingredients for Regulating Menstruation) Fu Ling (Sclerotium Poriae Cocos) 9g
Main ingredients Xu Duan (Radix Dipsaci) 12g
Dan Shen (Radix Salviae Miltiorrhizae) 10-15g Tu Si Zi (Semen Cuscutae) 12g
Chi Shao (Radix Paeoniae Rubrae) 10-15g Hong Hua (Flos Carthami Tinctorii) 5g
Wu Ling Zhi (Excrementum Trogopterori seu Pteromi) 10-15g Example: intermenstrual bleeding.
Yi Mu Cao (Herba Leonuri Heterophylli) 15-30g Modifications
Ai Ye (Folium Artemisiae) 6-10g • add Nu Zhen Zi (Fructus Ligustri Lucidi) and Han Lian
Shan Zha (Fructus Crataegi) 10g Cao (Herba Ecliptae Prostratae) in cases of Kidney yin
Example: irregular menstruation. deficiency.
Modification: More ingredients can be added according to the • add Dang Shen (Radix Codonopsis Pilosulae), Bai Zhu
presenting symptoms in individual patients. For example: (Rhizoma Atractylodis Macrocephalae) and Huang Qi (Ra-
• add Hong Hua (Flos Carthami Tinctorii) and Tao Ren dix Astragali) in cases of yang qi deficiency.
(Semen Persicae) to increase the action of activating blood • remove Shu Di Huang and Shan Zhu Yu, and add Da Ji
in cases of blood stagnation. (Herba Cirsii Japonici), Xiao Ji (Herba Cephalanoplos Segeti)
• add Fu Ling (Sclerotium Poriae Cocos) and Yi Yi Ren and Yi Yi Ren (Semen Coicis Lachryma-jobi) in cases of
(Semen Coicis Lachryma-jobi) or even Che Qian Zi (Semen complication by damp-heat.
Plantaginis) to eliminate dampness in cases of pathogenic • remove Shu Di Huang and Shan Zhu Yu, and add Wu
dampness. Ling Zhi (Excrementum Trogopterori seu Pteromi), Sheng
The post-menstruation phase Pu Huang (Raw Pollen Typhae) (Wrapped) and Shan Zha
Principle of treatment: nourish yin and blood (Fructus Crataegi) in cases of blood stagnation.
Recommended formula: Gui Shao Di Huang Tang (Decoction The pre-menstrual phase
Prepared mainly with Dang Gui, Shao Yao and Di Huang) Principle of treatment: reinforce the Kidneys, assist yang.
Main ingredients Recommended formula: Yu Lin Zhu (Unicorn Growing Pill).
Chao Dang Gui (Radix Angelicae Sinensis) 9-12g Main ingredients
Chi Shao (Radix Paeoniae Rubrae) 9-12g Chao Dang Gui (Radix Angelicae Sinensis) 10g
Bai Shao (Radix Paeoniae Lactiflorae) 9-12g Chi Shao (Radix Paeoniae Rubrae) 10g
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JOURNAL OF CHINESE MEDICINE NUMBER 67 OCTOBER 2001
Bai Shao (Radix Paeoniae Lactiflorae) 10g 2 This is known as "the clearing of the old to allow growth of the
Shan Yao (Radix Dioscoreae Oppositae) 10g new". The most important factor is the complete and thorough
excretion of the menstrual blood. Prof. Xia says that he used to
Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10g
think that heavy menstrual bleeding was the main concern
Mu Dan Pi (Cortex Moutan Radicis) 12g during menstruation, but now thinks that scanty bleeding is
Fu Ling (Sclerotium Poriae Cocos) 12g more of a problem since it can reflect retention of menses
Xu Duan (Radix Dipsaci) 12g which may lead to diseases such as ovarian cysts,
Tu Si Zi (Semen Cuscutae) 12g endometriosis, fibromyoma etc.
Xiang Fu (Rhizoma Cyperi Rotundi) 9g 3 Again, when he began as a gynaecologist, Prof. Xia thought
Dang Shen (Radix Codonopsis Pilosulae) 12g that this was the least important phase of the menstrual cycle
Example: premenstrual syndrome, irregular menstruation in terms of treatment since it is essentially asymptomatic. He
now emphasises the importance of this phase in building the
with prolonged menstrual cycle and dysmenorrhoea.
material basis of the menstrual cycle, nourishing follicular
Modifications growth and the sea of blood to fill the endometrium and
• add ingredients such as Qing Pi (Pericarpium Citri increasing fluid and mucus in the vagina, uterus and fallopian
Reticulatae Viride), Chen Pi (Pericarpium Citri Reticulatae) tubes. He emphasises the nourishment of Kidney yin rather
and Yu Jin (Tuber Curcumae) to soothe the Liver and than blood in this phase. It is especially important to treat
regulate qi in cases of premenstrual syndrome. during this phase in cases of amenorrhoea, infertility,
functional uterine bleeding and polycystic ovarian syndrome.
• add Ze Lan Ye (Folium Lycopi Lucidi), Dan Shen (Radix
4 a. The outward sign that yin has reached its fruition in this
Salviae Miltiorrhizae), Wu Ling Zhi (Excrementum
phase is the appearance of stretchy, clear, egg-white mucus. b.
Trogopterori seu Pteromi) and Shan Zha (Fructus Crataegi) in
The qi and blood whose activity is increased during this phase
cases of irregular menstruation with prolonged menstrual may move upwards leading to excessive excitation,
cycle and dysmenorrhoea caused by blood stagnation. manifesting with restlessness, mood changes, tightness in the
chest, i.e. symptoms similar to the pre-menstrual phase but
Notes less severe.
1 For a thorough discussion of Prof. Xia's approach to the use of
the BBT, please refer to Infertility and the Use of Basal Body Prof. Xia Gui Cheng works at the TCM Gynaecology Department,
Temperature in Diagnosis & Treatment by Virginia Wood in JCM Jiangsu Provincial Hospital of TCM, Nanjing, China.
No. 61, October 1999.
33
