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TCM Perspective on the Menstrual Cycle

TCM Perspective on the Menstrual Cycle

Remember the four substances in Chinese medicine that I’ve previously talked about here?

(They’re Qi, blood, yin and yang energy.) Those substances each correspond to a certain phase of your menstrual cycle. I’m going to do a deep dive here of the key organs at work during your cycle, how the four substances come into play with them and how to nourish those specific organs and substances. Armed with that information, you’ll  get a better idea of what you need to do during each phase of the menstrual cycle to boost your fertility.


The major organs involved in your cycle are heart, liver, spleen, kidneys, the ovaries and the uterus. They’re what we call extraordinary organs in Chinese medicine, and they’re truly extraordinary alright, because without them, pregnancy is not possible.  

You might notice that the list of key organs is lengthier than the three generally emphasized in Western medicine, often referred to as the HPO (hypothalamus, pituitary and ovaries) axis. The hypothalamus is the area of the brain that sends the signal to the pituitary gland to produce the follicle-stimulating hormone. Then the follicle-stimulating hormone stimulates the ovaries to produce follicles. As the follicles are growing and the estrogen levels are rising, the ovaries send the signal back to the pituitary to produce the luteinizing hormone, and that’s what you test for on the OPKs— the LH hormone surge. After the LH surges, you ovulate. Think of the HPO like an elevator going from the top floor of the brain to the first floor of the ovaries. If the elevator malfunctions on any of the levels, you’re going to have problems.  

And that brings me back to the Chinese medicine version of events, where we focus on six organs instead of three.


Let’s start with the heart organ. Side note: You’re going to hear me use words like “deficient” and “not functioning properly,” but keep in mind that this does not mean you’re going to have a heart attack, liver failure, or your spleen is going to explode. We’re only talking energy flow.  So please don’t freak out and think something is seriously wrong with you.  

So, the heart functions very much like the hypothalamus. I call it the Commander-

in-Chief. The heart, in Western medicine, controls circulation of the blood. Similarly in Chinese medicine, the heart also controls circulation, and it is the organ that sends blood to the uterus every month.  What the heck does that mean? Think of it as a distribution center. It provides blood flow to the uterus to help thicken the lining. If heart energy is not 100 percent, blood flow to the uterus would decrease or slow down, and that can decrease lining quality. What’s interesting is that each organ is associated with an emotion, and for heart, it’s the emotion of joy.

If the heart energy is chronically depleted, it will probably cause the Chinese medicine pattern of blood deficiency.  

If your heart energy is weak, you’re going to have a decreased blood flow. That means your period could stop altogether in cases of hypothalamic amenorrhea, or HA; you could have very light period flow; you could have a thin uterine lining; and you could have a ton of anxiety. Women who are trying to conceive typically are highly anxious, but those with heart blood deficiency will notice that it’s even more intense for them.


The spleen organ is one the most important organs in Chinese medicine because the health of the spleen organ is directly impacted by diet, and because it transports energy to the muscles and tissues.

When the spleen energy is deficient, the supply of energy decreases, and that starts a chain reaction causing the rest of the body to become imbalanced. One of the organs that is most frequently affected by this is the heart organ. And when the energy supply to the heart decreases, the blood supply to the uterus also decreases. That causes a bunch of problems, such as spotting during the luteal phase, and miscarriage.

The emotion associated with spleen is worry, and it also affects clarity and focus if it’s not functioning at 100 percent. Worrying can affect your cycle so strongly, especially because it can deplete your spleen energy and maybe even affect your overall energy level, digestion and uterine lining. Spleen issues can lead to digestive issues, causing malnourishment to the organs in the body, mid-cycle spotting, miscarriages, fibroids, cysts and endometriosis.  


Liver is the signal-caller, and it triggers ovulation. Liver is in charge of ensuring the energy made by the spleen flows smoothly. It is also the organ most affected by stress, which slows energy flow way down and causes a blockage. The blockage stops the signals to the ovaries, thereby preventing ovulation.

Liver’s emotion is anger and causes irritability, moodiness, and depression if it’s really stuck.

So stuck liver energy can can prevent ovulation, and if it’s really stuck, you’ll likely experience PMS symptoms and painful periods.  Liver Qi stagnation can also be the cause of cysts, and fibroids.


The kidneys are probably the most important organs. Anytime you have trouble conceiving, the kidneys are always involved.

There are two kidneys, and one represents yin (left) and the other yang (right) energetics.

This is obviously a little different than Western medicine philosophy. In Chinese medicine, both kidneys store reproductive energy. The left kidney is responsible for sending energy to the ovaries, to help produce a quality egg, like the FSH and estrogen. The right kidney sends energy to the uterus, and helps with sustaining pregnancy, like supplying progesterone.  

The kidneys are the only organs whose energy cannot be replenished. It’s like a savings bank that you can only withdraw from but never can deposit back into. Spleen, for example, gets its energy from foods that we eat, and the rest of the organs get energy supply from the spleen.  Even if spleen energy is deficient, it’s a situation that can be remedied by adjusting diet and lifestyle. But the amount of reproductive energy stored in the kidneys is preset, much like the number of eggs we are born with is predetermined by our genetics when we are fetuses, so you need to be super-nice to your kidneys and preserve that energy!

The emotion of the kidneys is fear, and being fearful depletes the kidney energy exponentially.  

If the kidneys are really, you will have fertility challenges. I should mention that if you have a kidney-related issue, don’t panic. You’re not doomed and you’re not broken. It just means that your savings bank has been depleted faster than expected due to whatever reason, and we just have to figure out other ways of replenishing.  

I want to re-iterate this again: That’s why lifestyle, diet, and stress management are so important, because kidney energies need to be preserved since they are so closely-linked to reproduction.  

To summarize: The heart sends blood to the uterus and ovaries and is nourished by the spleen. The spleen also nourishes the ovaries and uterus. The right and left kidneys also supply energy to the ovaries and uterus, as well as the liver, which triggers ovulation.

Now that the important organs have been covered, let’s talk about how they work together, in conjunction with the four substances and within the phases of the menstrual cycle.

In Chinese medicine, there are four phases of the menstrual cycle, and each is predominantly governed by one of the four substances.

Phase 1 is controlled by blood for cycle days 1-5. This is the bleeding phase, or your period. If you experience pain, that means something is “stuck.” If bleeding is very light, that could indicate blood deficiency.

Phase 2 is controlled by the yin energy for cycle days 6-12. During Phase 2, or the pre-ovulation phase, yin energy is very active. Yin functions very much like the estrogen in producing an egg and cervical mucus.  When the yin energy is strong, cervical fluid is clear, stretchy, and you’ll have plenty of it. Having a yin phase that is too long or too short indicates yin deficiency, or the equivalent of estrogen imbalance. The left kidney is the organ in charge here.

Phase 3 is controlled by Qi cycle days 13-16. This is the Qi phase, also the ovulation phase.  Liver and spleen control Qi and are very active during this phase. If Qi is stuck, ovulation won’t occur, or it will happen really late.  If Qi is deficient, you’ll see some spotting around this time, and if your Qi is really really stuck, you’ll also have PMS symptoms.

Most of us are taught that PMS is a normal part of the menstrual cycle. It actually isn’t. Having PMS most likely means energy flow is not smooth. If energy flow is not smooth, it will interfere with implantation. Think of it as trying to dock a boat in choppy water. In this scenario, the embryo is the boat and it’s going to have a tough time docking.

Phase 4 is controlled by yang energy cycle days 17-28. This is the “two-week wait.” Most of the energy in this phase comes from the right kidney. Yang energy is warming by nature, and during this time, you may experience night sweats, or just feel hot in general.  

Yang energy deficiency can lead to a short luteal phase, spotting that’s not related to implantation, and miscarriage. This would be similar to a Luteal Phase Defect. A great way to tell if you are yang deficient is perception of body warmth. If you’re the one in the room who’s always cold, needing to wear socks to bed, or wear long sleeve shirts in the summer, you may have some imbalance with the yang energy. If the yang energy is really deficient, a miscarriage can happen due to what we call “cold uterus.” Cold uterus is a Chinese medicine term used to describe the less-than-ideal condition of the uterus.

So what does all of this mean?

Knowing the four phases of the menstrual cycle comes in handy because it gives a timeline and organ/substance guide for boosting your fertility.  For example, knowing that the first phase is the blood phase, you know to incorporate foods that will nourish the blood to replenish what’s lost. During the second phase, because the yin energy is dominant and you want that lubricating and cooling energy, you’d avoid eating spicy foods. Phase 3 is controlled by Qi, so you would want to make sure you’re really bumping up self-care and doing everything you can to relax more, so the Qi doesn’t get stuck.  

Let’s not forget the organs either. In Phase 1, the blood phase, heart energy is going to be very active. Phase 2, the yin phase, the left kidney energy is active. Phase 3: Qi, you can have liver or spleen depending on your pattern, because Qi can become stuck or become deficient, or both. And the right kidney is working hard in Phase 4, or the yang phase.  

Whew! This was a ton of new information, and a lot to digest. For a better visual, you can check out LINK HERE as a freebie with some sample recipes I recommend for each phase of the menstrual cycle.

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