TCM Patterns of Imbalance for Menstrual Symptoms

“In TCM, there are several causes of dysmenorrhea [menstrual pain], including: Qi, blood stagnation and/or blood deficiency. Multiple categories of health, including diet, exercise and sleep habits,  are essential to understand when treating dysmenorrhea because they are all part of an actionable whole-body profile that helps us to more effectively customize a treatment strategy.” - Dr. Xia Hongsheng, Elix Medical Advisor

The Root Causes of Menstrual Symptoms (According to Traditional Chinese Medicine)

According to TCM, the root causes of menstrual symptoms often come from imbalances in parts of the body outside the reproductive system. The liver, spleen, and kidneys are part of the Zang-Fu collection of organs that are responsible for certain bodily functions, but they also carry important roles in menstruation. Their meridians actually run through the pelvis and uterus, so the flow of Qi through these pathways greatly affects our cycles.

The liver is important for menstruation because it focuses on the smooth and free flow of Qi and blood. Disharmony in liver Qi and blood can cause irregular or painful menstruation. 

The Effect of New Blood and Blood Stagnation on Your Menstrual Cycle

The production of blood matters, too. The spleen gives rise to Qi and blood, and it also helps manage blood flow. Qi rules over blood, so when Qi moves, blood also moves. When Qi stops moving, so does blood. The two substances travel through the uterus via the meridian pathways, connecting the spleen to the uterus. A lack of movement (stasis or stagnation), buildup, or deficiency of Qi and blood can result in menstrual symptoms.

Qi and blood are very closely related; if one experiences imbalance, the other does as well. Multiple factors including diet, exercise, and external influences like Cold, Heat, and Dampness (moisture) also affect the quality of menstruation. Cramps, fatigue, heavy bleeding, bloating, and nausea — to name a few — reveal an underlying imbalance or multiple kinds of imbalance in the body.

Common Patterns of Imbalance for Menstrual Symptoms 

Rather than just treating the surface level of symptoms, Pattern Diagnosis helps us dig deeper and thoroughly examine the underlying imbalances and inflammation that are causing those symptoms. Here we will focus on common patterns of imbalances in the areas that support menstruation. 

Read more about Pattern Diagnosis here. 

Liver Qi and Blood Stagnation

Blockage of liver Qi prevents easy blood flow to the uterus, causing both Qi and blood stagnation. Reasons for this imbalance include stress (a huge factor) and internal trauma resulting from hormonal contraception (IUDs and oral pills) or surgery. Outside factors like cold weather, cold foods like raw vegetables, and Dampness can also cause blood stagnation. 

Symptoms of Qi stagnation on your menstrual cycle:

• Psycho-emotional issues (anxiety, depression)
• Constipation
• Breast tenderness
• PMS
• Cysts and Fibroids
• Painful cramps (dysmenorrhea)
• Acne
• Abnormal vaginal discharge

Symptoms of blood stagnation on your menstrual cycle:

• Irregular menstruation
• Painful menstruation (includes cramps)
• Sharp pains
• Blood clots
• Dark red blood

The treatment goals for Qi and blood stagnation:

• Soothe the liver
• Nourish blood and increase its circulation
• Clear the internal Heat caused by Qi and blood stagnation 

“Dark red blood with clots can reflect blood stagnation. In TCM, we address this by stimulating the movement of blood in the body, eating foods that are acrid in flavor (ginger, turmeric, etc.), and consuming herbs that can help to move blood (i.e., angelica, motherwort, corydalis, etc.)”  - Dr. Liem Quang Le

Phlegm Damp Accumulation

An accumulation of Dampness leads to phlegm, which ultimately leads to spleen dysfunction. Some causes for it include internal and external Dampness, poor diet, overwork, and emotional stress. Since the spleen turns food into nutrients for creating Qi and blood, any sign of imbalance within it leads to an insufficient production of blood for healthy menstruation. A weak spleen causes fluids to stop moving, allowing phlegm and Dampness to build up in the body. Phlegm impedes the flow of Qi and blood into and out of the uterus.

Symptoms of Phlegm Damp accumulation:

• Absence of periods
• Longer cycles
• Pale blood color

The treatment goals:

• Dry the Dampness
• Eliminate phlegm
• Nourish the spleen
• Regulate the flow of Qi and blood

Kidney Yang Deficiency

The Kidneys are highly tied to menstruation because they store the substance of essence (marrow), and essence is vital for creating life — ovulation and conception. The kidneys send Qi and essence to the uterus through the meridian pathways. Each organ has Yin and Yang components to stay balanced, so when the kidneys experience a deficiency of Yang, an imbalance arises and manifests as menstrual symptoms. Reasons for such imbalances range from older age and chronic illness to emotional distress and shock. 

Symptoms of Kidney Yang Deficiency: 

• Feeling cold in the limbs and feet (excess of Yin)
• Long or irregular cycles
• Reduced or heavy flow
• Cramps
• Lower back pain

The Treatment Goals:

• Give the kidneys more energy (tonify)
• Increase Yang 

At Elix, we tailor herbal healing to your body’s unique pattern of imbalance. Take the Elix Health Assessment to discover your pattern and recommended blend of herbs.

Note that people with Endometriosis or Fibroids often have some combination of Qi and blood stagnation. For those with PCOS — blood stagnation, Qi deficiency in the spleen and kidneys, and a buildup of phlegm are common. But no matter if it’s chronic menstrual illness or PMS symptoms, targeting the root imbalances is key.

Read our case studies for more patterns of imbalance here.

Holistic Healing For Menstrual Symptoms

If we take the TCM concept of Yin and Yang and apply it to our cycles, we know that the body has an ideal state of balance for menstruation. TCM theory views menstrual pain and symptoms as signs of imbalance in the body — but those experiences should not be normalized. Our bodies need treatments that nourish and heal without uncomfortable, unwelcome side effects. 

There is no one-size-fits-all approach to treatment, but TCM offers a solution that can work for our individualized needs. Healing requires a holistic perspective that takes patterns of imbalance, diet, emotional well-being, genetics, environment, and unique body dispositions into account. TCM also believes that synthetic hormonal contraception can interfere with the body’s internal balance — for example, birth control pills used for menstrual pain can actually affect the liver’s healthy function. However, TCM practices like acupuncture and herbs can help alleviate menstrual symptoms, as shown by eye-opening research.

So why not invest in a holistic approach that focuses on the root causes of your symptoms? Elix is on a mission to democratize access to the healing potential of holistic herbal medicine.

Take the Health Assessment to learn what healing herbs can help you on your menstrual wellness journey.

This article was reviewed by Dr. Liem Le.
Dr. Liem Le is a Doctor of Chinese Medicine, Functional Medicine Practitioner, and Nutritionist Integrative Medicine Department at H. Lee Moffitt Cancer Center. He is a part of the teaching staff for the Masters program for the Functional Medicine and Human Nutrition program at University of Western States. Dr. Le is currently working on his fellowship in Integrative Medicine with the Academy of Integrative Health and Medicine via a scholarship from the White House to complete the initiative.