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By Karta Purkh Singh Khalsa

Dong quai, cinnamon, white peony and bupleurum are four Chinese herbs that help women maintain balanced health.

Susan, age 40, and Valerie, 20, visited the same traditional Chinese medicine practitioner for similar problems—both were experiencing premenstrual syndrome (PMS) and dysmenorrhea (painful periods). After careful examination, the practitioner prescribed an herbal formula containing bupleurum and peony for Susan and one containing dong quai and cinnamon for Valerie. Why would the practitioner prescribe two different formulas for similar symptoms? The answer lies in the principles of traditional Chinese medicine (TCM).

    Unlike Western medicine, which identifies a disease then treats it accordingly, TCM treats the patient. That is, a TCM practitioner analyzes the person's physical, emotional and psychological states to identify specific disease-causing patterns of imbalance in the body. He or she then uses acupuncture, diet and herbs to reestablish the body's equilibrium. This individualization of treatment optimizes TCM's effectiveness in treating gynecological and all other health problems, says Martha Benedict, O.M.D., of Santa Cruz, Calif., adding that TCM has few side effects. If you're having gynecological problems, discuss the benefits of TCM with your health provider.

Life's Vital Forces

The concept of qi (pronounced "chee") is integral to TCM. Qi is the vital force that flows through our bodies. When qi isn't circulating properly, disease can occur.

    Blood is another bodily force that affects health, and many gynecological problems are blood-related, says Michael Sasnow, Dipl.Ac., C.H., D.C., who practices traditional Chinese medicine and chiropractic in Boulder, Colo. Blood and qi are interdependent—qi moves the blood, and blood nourishes the organs that produce qi. Dysfunction of one can result in dysfunction of the other. Dysfunctions in the qi-blood complex can result in many women's ailments including premenstrual and menstrual complaints, breast and ovarian cysts, vaginal discharges and infections, and infertility. Because blood and qi are so closely related, both aspects must be treated to remedy gynecological problems, say the authors of A Handbook of Traditional Chinese Gynecology, compiled by the Zhejiang College of Traditional Chinese Medicine (Blue Poppy Press).

Organ Networks

When determining underlying causes of qi/blood dysfunction, TCM practitioners identify which organ system(s) aren't working properly. Organ systems are described in terms of networks rather than individual organs because they include not only the organs but also the meridians (energy channels), and they affect related body tissues, sensory organs and emotions. The Spleen Network includes the spleen and stomach; the Lung Network includes the lung and large intestines; the Kidney Network includes the kidney and urinary bladder; and the Liver Network includes the liver and gallbladder.

    Though gynecological problems can be traced to any network, they're most often related to the Kidney and Liver networks, and especially to the Liver Network. This is because qi flows through the liver system before it reaches the genitalia, and the uterus shares the liver's task of storing blood, says Sasnow. (Note: Because TCM differs from Western medicine, terms used by both philosophies such as liver must be interpreted according to which modality you're referencing.)

    Integral to identifying qi-blood imbalance is the concept of yin-yang—the dual, opposing manifestations of qi. Yin is feminine, cold and damp; yang is masculine, hot and dry. "Health is defined as the poised balance between yin and yang, and sickness is the result of deficiency or excess, a yin-yang disharmony, say Harriet Beinfield, L.Ac., and Efrem Korngold, L.Ac., O.M.D., in their book Between Heaven and Earth (Ballantine).

    Qi is yang and blood is yin; it's the interplay of these elements that helps determine health. Yin-yang disharmony can be caused by imbalance in their components including cold-heat (body temperatures) and dry-damp (tissue moisture.) Cold can be the result of an external condition such as eating cold foods, or it can be caused by an internal condition such as yang deficiency. Heat, too, can be caused by an external condition such as eating spicy foods or by an internal condition such as qi blockage in the body. Dampness is an abnormal buildup of fluids or excess secretions, and dryness is a deficiency of body fluids.

    In Chinese gynecology, most problems are caused by excesses or deficiencies in temperature (cold-hot) or moisture (damp-dry), say the authors of A Handbook of Traditional Chinese Gynecology. For example, if cold is in excess, painful menstruation, scanty menstruation or blood clots can result. Excess cold also leads to a condition called "cold in the uterus" which can cause infertility, says Sasnow. Cold deficiency can result in a relative heat excess, causing a condition called "empty fire." Empty fire can dry out body fluids and turn them to phlegm, which manifests as a sticky vaginal discharge, says Sasnow. True excess heat can force the blood to surge through the body, leading to excessive menstruation, uterine bleeding or ovarian cysts. Dampness is characterized by swelling and a sense of heaviness. A condition found in many women is damp heat, says Sasnow, which can result in vaginal and uterine infections and inflammation, candida, and leukorrhea (vaginal discharge).

    The TCM practitioner determines which of these polar categories of cold-heat and damp-dry are out of balance through careful patient interview including pulse analysis and tongue examination. 

Keep Your Qi Moving

Stagnation (the inability of a substance to circulate properly) is another term used by TCM practitioners, and gynecological disorders are often caused by qi or blood stagnation, says Sasnow. Qi stagnation can result in dysmenorrhea, breast pain during menses, premenstrual syndrome or breast lumps, he says. Blood stagnation results in the accumulation of blood and fluid, particularly in the pelvis, that inhibits proper circulation of blood to the liver, ovaries or uterus. Examples of blood stagnation diseases include amenorrhea (cessation of menstruation), breast cysts, menstrual cramps, blood clots, painful intercourse, infertility, painful labor or uterine fibroids.

    Stagnation of qi or blood is often emotionally based. "When powerful emotions are squeezed down and held back, qi slows and becomes congested. When this occurs over a long period of time, blood begins to congeal forming lumps and masses," write Beinfield and Korngold.

    Emotional disturbances can also result in hyperactivity of liver yang, which may give rise to eclampsia (convulsions during pregnancy), say the authors of A Handbook of Traditional Chinese Gynecology. In addition, fright and fear may damage the kidney system and lead to miscarriage.

    Many women experience premenstrual emotional imbalance. An explanation of the function of the liver network will help explain why. Liver function affects everything that flows through the body including qi, blood and emotions, says Sasnow. So if liver qi is stagnant, blood and emotions get stuck. This explains why before blood flows, women's emotions can get blocked and often burst forth in an explosive way. Because anger, frustration and resentment are the emotions connected with the liver, these are the feelings that sometimes get out of control.

    Benedict adds that blood lost during menstruation must be replenished to ensure emotional as well as physical rehabilitation. She suggests that in addition to herbal remedies, women eat black, blue, red and green foods such as blueberries, beets, strawberries, red meat, spinach and broccoli. 

Cultural Imbalance

Benedict believes women have become more unbalanced than ever for cultural as well as for physical and emotional reasons. "In Taoist tradition, women are yin, and yin is equated with keeping the hearth," she says. "Yin is nutrition and nurturing, and women get power from keeping the home fires burning and keeping peoples' stomachs happy. This concept is missing in our culture. In fact, we have a negative attitude about the role of women as nurturers. I think we're out of balance because of it," she adds.

    Feminine imbalance (yin deficiency) has more far-reaching effects than those related to the individual, says Benedict. It extends to the intimate relationship between lovers. "Quality of life depends to some degree on the quality of the marriage bed," says Benedict, adding that "marriage bed" refers to lovemaking between any couple. "The condition of the uterus has to be right. A cold, damp uterus often indicates lack of sex drive. A hot uterus often implies a demanding sexual appetite. Bringing the uterus into balance can result in a happy love life, and therefore a better quality of life in general," she says.

Chinese Therapy for Women

Herbal therapy is a major part of TCM treatment. Herbs are chosen based on their ability to restore and maintain balance in the body. When choosing an herb for a woman's gynecological problem, the TCM practitioner considers the herb's taste, which correlates with yin-yang properties. Pungent-tasting herbs are heating and drying; salty herbs are cooling; sour herbs are cooling and drying; bitter herbs are cooling and drying; sweet herbs are cooling and moisturizing.

    Most herbal remedies are given in formulas. The dominant herb is called the emperor and addresses the main problem: dampness, heat, deficiency or stagnation, says Sasnow. Secondary herbs are added to enhance or solidify what the first herb does or to achieve another function that helps the emperor move along. Other herbs work with other aspects of the problem, he adds. 

    For instance, when choosing an herb for Susan, the practitioner determined she has a yang profile: She has an athletic, muscular body; she's usually hot; and she has a short menstrual cycle and sharp menstrual cramps. Susan also has anxiety just before her period. Her practitioner discovered that she has liver heat and blood stagnation– conditions calling for the cooling herbs bupleurum and peony.

    In Valerie's case, the practitioner discovered a yin profile: She's somewhat frail, is tired most of the time, has problems with digestion, and is normally cold. Valerie has a long menstrual cycle and dull, achy cramps. Because her practitioner determined that Valerie has blood deficiency and liver stagnation, she prescribed a formula based on warming dong quai and cinnamon.

Dong Quai: Energetically, dong quai is sweet, pungent and mildly warming. It contains coumarins, blood-thinning chemicals that help blood circulate to female organs. It also contains high levels of vitamin B_l2, a blood-building nutrient.

    Scientific and clinical studies have verified dong quai's use in the treatment of menopausal symptoms. A study conducted by Tori Hudson, N.D., of the National College of Naturopathic Medicine in Portland, Ore., and Leanna Standish, Ph.D., N.D., of Bastyr University in Seattle, Wash., used dong quai with a combination of other herbs. The result showed a reduction in the severity of hot flashes, insomnia, mood changes and vaginal dryness (Alternative Medicine, May 1994).

    In Chinese herbology, a woman who is cold, fatigued, pale, anemic and in poor overall health might be given a formula based on dong quai. Dong quai shouldn't be taken during pregnancy, by overly hot people or by those with diarrhea or endometriosis.

Bupleurum root (Chai Hu): This cooling herb is often used in formulas designed to regulate the menstrual cycle or to treat PMS. Its liver-supportive qualities help reduce sugar cravings, a common PMS symptom, and because it's a relaxing herb, it can help reduce anxiety and irritability associated with PMS. The main action of this herb is to relieve liver, qi and blood stagnation. A menstruating woman experiencing heat, irritability, nausea and dizziness might be treated with a formula built around bupleurum.

White Peony

White Peony root (Bai shao): Peony is a sour, bitter, cool yin and blood-tonic that dissolves liver congestion and disperses heat. Peony is a blood nourisher and is used to treat menopausal symptoms including excessive and irregular bleeding, night sweats, insomnia, and mood swings. Since peony root is a sedative and antispasmodic, it helps reduce muscle pain and allows a comfortable night's sleep.

    The peony type woman is hot, with muscle cramps in the abdomen, hands, and feet. She has headaches and sweats at night.

Cinnamon bark (Rou Gui): Cinnamon is a pungent, sweet, and hot yang tonic, which makes it good for promoting menstruation and treating menstrual cramps. The classic cinnamon woman is cold, dry and frail and often suffers from osteoarthritis, asthma and digestive problems. Cinnamon has few side effects but should be used with caution during pregnancy. You'll find medicinal quality cinnamon in your health food store or Chinese herb pharmacy.

To locate a TCM practitioner in your area, contact the American Association of Acupuncture and Oriental Medicine (AAAOM) at 433 Front St., Catasaqua, PA 18032; 610-433- 2448, or http://www.aaaom.org. Karta Purkh Singh Khalsa, C.N., A.H.G., is a professional member of the American Herbalists Guild.