Women's bodies are beautiful, amazing and complex. But the monthly menstrual cycle is draining – literally. Pregnancy, childbirth and breastfeeding are even more demanding on the body. In our rush to succeed in school, careers, and the ever-expanding social horizons of our modern world, it is also possible to not fully appreciate the unique physiology of women related to menstruation. Indeed, some women may find their period a hassle, a needless interruption to their schedule, a problem to be managed pharmacologically with birth control pills.

Traditional Chinese Medicine & Menstruation

In the world of Traditional Chinese Medicine theory, doctors have long given special attention to the physiological demands of menstruation and its associated states of pregnancy and childbirth. They have sought above all to modulate menstruation, to help a woman achieve regularity in one’s menstrual cycle, to moderate blood flow, and to minimize the unpleasant symptoms that can be associated with that “time of month.”

Although Doctors of Chinese Medicine do not have anything in their arsenal as “powerful” as birth control pills, a mainstay of Western medicine gynecology, the strength of their therapeutic strategies lies in the ability to fine-tune the menstrual cycle through the use of gentle but effective herbs.

It is this ability to gently modulate a woman’s cycle (as well as the special states of pregnancy and post-partum recovery) that has made gynecology one of the most popular subfields of Traditional Chinese Medicine in China. 

Linking Her Cycle to Her Qi

The key to regulating a women’s cycle in Traditional Chinese Medicine is the concept of “blood.” In western medicine, blood is the substance that courses through our arteries and veins, comprised of red and white blood cells, platelets and innumerable other immune system components.

In Traditional Chinese Medicine theory, the notion of blood is less fine-grained in terms of its constituent parts, but more expansive in terms of how it relates to the various organs and entities of the body.

According to Traditional Chinese Medicine theory, blood is one of the fundamental substances of the body, along with Essence, Qi, and Fluids. It nourishes and moistens all parts of the body.

To paraphrase the great Ming dynasty physician, Zhang Jingyue: with proper nourishment from the Blood, our skin, nails and hair will be radiant; our bones and tendons will be supple; our senses will be keen; our muscles will be strong; our spirit will be calm.

For women, menstruation, pregnancy, childbirth and breastfeeding can only proceed smoothly when the Blood nourishes and flows appropriately. Doctors of Traditional Chinese Medicine are therefore particularly concerned when Blood fails to circulate and nourish. These failures are either caused by a relative “deficiency” of Blood or a “stagnation” of that flow.

These two pathological states are key concerns in Traditional Chinese Medicine gynecology and they can be mutually reinforcing.

A Powerful Formula for Regularity Support: Four Substance Decoction

Four Substance Decoction is a centuries old formula (in Chinese, Si Wu Tang), which addresses both the problem of Blood deficiency and stagnation but with a greater emphasis on the former (both Traditional Chinese Medicine terms).

It has been one of the most popular formulas in gynecological therapy in China, not only for treating menstrual irregularities but also for managing problems of pregnancy, post-partum recovery, and breastfeeding. Many doctors of Traditional Chinese Medicine use it as base for treating a very wide array of gynecological problems, modifying it with the addition of a few herbs in accordance with the individual’s presentation.

Its unique combinations of herbs allow it to address many aspects of irregular menstruation. Let’s take a look some specific symptoms, using the history, heritage, popularity and methodology of Chinese medicine theory as our guide.

According to Traditional Chinese Medicine Theory, the Formula is Good For:

1. Irregular Blood Flow: Blood deficiency is one important cause of scanty, inadequate menstrual bleeding, and Si Wu Tang (Four Substance) can be an important formula for helping to correct this problem. But it can also be used in some cases of excessive blood flow, because, according to Chinese medicine, blood stagnation can cause blood to ”leave the meridians,” resulting in greater bleeding than normal. In the latter case, the patient may also have noticeable clotting during menstruation or other signs of blood stagnation.

2. Menstrual Cramping: Both blood deficiency and stagnation are important causes of pain in general and therefore are important factors in painful menstruation more specifically. The quality of the pain may be more enduring and diffuse with blood deficiency and more sharp and localized with Blood stagnation.  

The Herbs Behind Four Substance

The composition of this formula is a beautiful example of how the principle of balance is used in designing Chinese Medicine formulas. The formula consists of four herbs, two are considered to have “quiet”, supplementing properties, two have “active,” blood moving properties.

In the first group, there is prepared rehmannia root and white peony root. But substances strongly nourish blood, particularly in the liver and kidney. According to Chinese Medicine theory, white peony root is also considered to be sour and astringent, making it ideal for mitigating muscle spasms associated with menstrual cramping and controlling excess bleeding. These two herbs are rich and therefore potentially cloying, which can lead to “blood stagnation”.

As a result, they are blended with the two active herbs of Chinese angelica root (in Chinese, tang kuei) and ligusticum root. Chinese Angelica root both nourishes blood and gently moves it. Ligusticum root, however, only invigorates the blood. It is said to move blood “up to the top of the head and down to the sea of blood (an expression referring to the organs and meridians most involved in menstruation).”

In addition to preventing stagnation caused by the supplementing effects of the previous three herbs, ligusticum root can direct Blood to the head to alleviate headaches, dizziness, blurred vision while releasing constraint below to soothe abdominal pain. 

Taken Daily After Your Cycle is Over

It would be misleading to suggest that one formula, even with many modifications, can solve all gynecological problems. Nonetheless, countless women in China have used Si Wu Tang as a general remedy for managing their menstrual discomforts. We believe that many of our consumers could benefit from just this kind of home care.

We suggest that women with mild to moderate menstrual irregularities consider taking Four Substance twice a day at the start of the one’s cycle, about 1 – 2 days after bleeding has stopped, over a period of 5 – 7 days. (Women with more severe menstrual irregularities should consider working with a Traditional Chinese Medicine specialist in gynecology in order to get the full benefits of Chinese herbal therapies and acupuncture).

The theory behind this timing is that the formula aids in the recovery from the physical demands and blood loss of menstruation itself while also helping to get the next cycle off to an optimal start. This pattern can be repeated over several menstrual cycles to achieve the best results. 

Four Substance is a must after menses to modulate one’s monthly cycle. In later blogs, we will discuss its uses to aid post-partum recovery and breastfeeding.  

Care Consideration: Just a reminder that the above information is not a substitute for medical care and is not a substitute for medical advice or recommendations  from a healthcare provider.  This information is not intended to treat, mitigate or cure any disease.  That said, we encourage you to connect with an Acupuncturist in your community to learn more about this and other Traditional Chinese Medicine options.  If you’ve got questions about Chinese herbal medicine or getting started with an Acupuncturist, feel free to connect with us on hello@mydaolabs.com. 

Dr. Eric Karchmer is a practicing Chinese medical doctor, medical anthropologist, and co-founder and Chief Doctor of Chinese Medicine for DAO Labs. From 1995-2000, Eric studied at the Beijing University of Chinese Medicine and today is both a licensed acupuncturist and professor at Appalachian State University. Eric can be reached at drkarchmer@mydaolabs.com.