Cold

Cold may mean either Wind-Cold invading the space between skin and muscles or Cold invading the Uterus directly. During menstruation and especially after labour, the Blood-Connecting (Blood-Luo) channels are open and the space between skin and muscles is especially vulnerable to invasions of Wind-Cold.

Invasion of Wind-Cold during menstruation or after labour may cause aches in the joints and painful periods.

External Cold can also invade the Uterus directly causing painful periods. Again, this happens especially during menstruation or after labour.

Dampness

Dampness is a major pathogenic factor in gynecology. It invades the channels of the legs and creeps upwards to settle in the reproductive system in women, causing leucorrhoea, pain on ovulation or dysmenorrhoea. The invasion of Dampness too is facilitated during the menses or after labour.

Once inside the body, Dampness becomes an internal pathogenic factor which easily combines with Heat to form Damp-Heat: this is a major pathogen in gynecology, usually causing abdominal masses, dysmenorrhoea, ovarian cysts, leucorrhoea, infertility or menorrhagia.

Heat

Heat may be either Wind-Heat or Summer-Heat. After the Exterior stage, both these pathogenic factors can penetrate the Interior and enter the Blood portion causing Blood-Heat. This is a major cause of excessive menstrual bleeding.

Sadness and grief

Sadness and grief deplete Heart and Lungs and can influence menstruation in two ways. By affecting the Heart, they may deplete Heart-Blood, which may affect the Uterus via the Uterus Vessel (Bao Mai). This may lead to amenorrhoea, scanty periods or delayed cycle. If they deplete Lung-Qi, Qi may fail to move Blood and this may also cause amenorrhoea. Deficient Lung-Qi and Spleen-Qi may also either fail to hold Blood and lead to menorrhagia, or fail to raise Qi, leading to prolapses.

In women, sadness may sometimes affect the Liver directly, causing Liver-Blood deficiency. Chapter 8 of the Spiritual Axis says: “When sadness affects the Liver it injures the Ethereal Soul; this causes mental confusion … the Yin is damaged, the tendons contract and there is hypochondrial discomfort.”⁷ When sadness affects the Liver (which is fairly common in women), it easily causes gynecological problems such as amenorrhoea, scanty periods or delayed cycle, all associated with depression and a feeling of aimlessness due to the Ethereal Soul not being rooted in Liver-Blood.

Worry

Worry knots the Qi of the Lungs, Heart and Spleen. It leads to stagnation of Qi which may cause delayed periods or painful periods. It is important to note that stagnation of Qi is not always synonymous with Liver-Qi stagnation, as the above-mentioned organs also may suffer from stagnation. In particular, Lung-Qi may stagnate as a result of worry. This will cause a slight breathlessness, a pale complexion, sighing, a feeling of tightness of the chest and, in terms of gynecology, pre-menstrual tensions and distension of the breasts. Since the Lung channel courses through the chest area, stagnation of Lung-Qi, deriving from worry or grief, is often involved in the aetiology of breast lumps.

The Qing dynasty gynecologist Chen Jia Yuan wrote with regard to worry:

This passage confirms that stagnation of Qi affects not only the Liver but also the Lungs and Spleen (see below) and also that amenorrhoea may occur from stagnation as well as from a deficiency.

Moreover, in my opinion, worry also affects the Liver and makes Liver-Yang rising: this may cause menstrual headaches. Indeed, Zhang Jing Yue says that worry affects the Liver:

Anger

Anger includes frustration, resentment, bearing grudges, irritation, hatred, etc. These emotions are a major cause of menstrual problems as they cause stagnation of Liver-Qi, which may lead to irregular periods, pre-menstrual tension and dysmenorrhoea, and which can cause further problems in two ways. First of all it can lead to Liver-Blood stasis which causes a more painful type of dysmenorrhoea or abdominal masses; second, stagnant Qi may develop into Fire which causes Blood-Heat and therefore menorrhagia.

The Great Treatise of Beneficial Formulae for Women (1237) says of anger:

Fear

By ‘fear’ is meant either a sudden fright or a chronic state of anxiety. A sudden fright makes Kidney-Qi descend, but a chronic state of anxiety, especially when the Heart is weak, makes Qi rise. For example, fear (in the sense of chronic anxiety) may cause the Qi of the Penetrating Vessel to rebel upwards. This is a very common factor that aggravates menopausal problems.

The Great Treatise of Beneficial Formulae for Women (1237) says about fear:

This passage states that a state of fear and anxiety during the period upsets the Blood system, causing Blood to rebel upwards; as it rebels upwards, this may induce a deficiency of Blood and, eventually, Yin. Obviously this will only happen when the emotional problem continues for years.

Shock

Shock depletes Heart, Spleen and Kidneys. It may cause amenorrhoea or a delayed cycle. Shock typically manifests with a Moving pulse even many years after the event. The Moving pulse is rapid, short and shaped like a bean and it gives the impression of vibrating instead of pulsating.

Guilt

Guilt is an extremely common and damaging emotion in Western patients. It may derive from breaking religious or social taboos or from doing something wrong which weighs on the conscience. Of course, guilt can also arise in those who always tend to blame themselves, even if they have done nothing wrong; for example, someone blaming himself or herself unnecessarily for the breakdown of their marriage. This attitude can sometimes be due to patterns established in childhood if a child is never praised and always reprimanded. Interestingly, there is no modern Chinese word for ‘guilt’ used in its emotional rather than its legal sense. There is, however, an ancient word for it called jiu: this character is based on the ‘disease’ radical and a radical that means ‘long time’, i.e. a feeling harboured for a long time leading to disease. Another old Chinese expression for guilt is xin li you gui, which means ‘an evil spirit harboured in the Heart’.

In some cases, guilt may also arise from repressed and unrecognized anger which turns inwards and causes an attitude of self-punishment and guilt.

Guilt affects the Heart, Liver, Lungs and Kidneys and it causes either stagnation or sinking of Qi, depending on the pre-existing condition of the woman. In gynecology, it is common to see conditions caused by sinking of Qi as a consequence of longstanding guilt. This brings about a sinking of Kidney-Qi with an ensuing bearing-down feeling or an actual prolapse of the uterus or bladder. Very often, urinary problems characterized by frequent urination, a bearing-down sensation and a slight urinary incontinence in women are due to longstanding guilt causing Kidney-Qi to sink. The tongue will have a red tip and the pulse will be vibrating as it pulsates. The eyes will look unstable and often flap shut while the woman is talking. When guilt results from repressed anger, the pulse will be Wiry.