Acupuncture and Woman's Health: Gynecology
Some years ago I started to study a style of yoga called Iyengar yoga. I was shocked to discover that in each class the teacher asked if any woman had her period. If there were students who were menstruating, these women were asked to refrain from doing certain poses (asanas), particularly inversions such as headstand, shoulderstand, handstand, etc. Instead, beneficial poses were recommended that would support the woman while she was bleeding, and that she could do both in class and at home.
All images courtesy of the artist Marsha Posner by special permission.
My initial reaction to this prohibition to inversion was to scoff and think how backward it was. After all, I was brought up in a time when advertisements for Tampax showed smiling women wearing white outfits and sailing on yachts or being dazzling on tennis courts. I myself never missed a ballet class, or later in my life, a ballroom dancing competition (yes, in a white ball gown), no matter where I was in my cycle. For that matter, I showed up for every assignment in my medical school training and post-graduate work, no matter how arduous the task and no matter how hard I might be bleeding.
But the more I thought about it, the more I realized the wisdom and beauty of the Iyengar yoga instruction. And I was shocked that my first reaction had been to dismiss, rather than to celebrate it. So strongly had I embraced the contemporary, Western, linear model of dealing with a woman's gynecological health, that I had failed to fully appreciate the dictates of a cyclic model for women's health. This attitude persisted, despite years of practicing Chinese Medicine and incorporating the Taoist philosophy of balance into most aspects of my personal life. Ask any woman: Every day is not the same. Intuitively women know this.
For me, a product of the Feminist movement of the 1960's, I think it has been a tricky point to acknowledge. It would have been extremely difficult for me to go to medical school 30 years ago, if I had then had an Eastern mind-set about women's cycles. My generation was concerned with anything that might label women as less capable than men. Thus any acknowledgement on our part that activities might have to be adjusted, (as in no yoga inversions), or curtailed to respect biological differences, was rejected. But now, having been enlightened by the wisdom of the East, I can see that the issue is not whether women are inferior or less capable than men, but simply that women are different from men. For women's optimal health, that difference needs to be honored in spirit and in practice on a daily basis. To borrow the title of a popular book on women's cardiovascular health, women are not small men.*
So we come to the issue of why women have so many health issues related to pelvic and breast health. Why do so many women and girls suffer from PMS, menstrual problems (including irregular or heavy bleeding, scant bleeding or none at all), menstrual cramping, masses including ovarian cysts, uterine fibroids and breast cysts, endometriosis, infertility and menopausal distress?
My personal belief is that a culture that fails to acknowledge and cultivate women's rhythms sets the stage for disharmonies in women's bodies that result in the health issues just described. The picture is further aggravated by the stresses of our fast-paced society.
Let us examine how:
(Note: Menopause is discussed in detail on The Menopause Page.)
Radiant health in Chinese Medicine presumes that the underlying life-force energy in our bodies, known to the Chinese as qi, has three characteristics: it is abundant, it is freely flowing in the body and it is in (yin/yang) balance.
Over the course of our lives, we develop symptoms that reflect a disruption of any of the three qi characteristics. Thus, a person can have inadequate qi, in which case he or she is usually quite ill (think cancer or TB). Symptoms can also develop because of a blockage of energy, or because the energy is out of balance. Most of the pelvic and breast symptoms we see at Turning Point Acupuncture are related to these latter two.
To make matters more complicated, the qi is associated with different internal organ systems. There are three that we need to be concerned with here: the kidney and spleen organ systems, and particularly, the liver organ system. (Note: In Traditional Chinese Medicine the name of an organ, e.g., kidney, refers to the organ as well as the functions ascribed to it.) As you may know, each of the internal organ systems in Traditional Chinese Medicine (TCM) is also associated with an emotion. The liver is associated with anger, the lung with sadness, the heart with joy, the spleen with worry and the kidney with fear. These associations are important when thinking about women's health.
My proposition for this essay, as I stated earlier, is that it is very hard to be a woman growing up in our society and this, in and of itself, is a stressor. In TCM it is the liver organ system that deals with stress. The job of the liver organ system in Chinese medicine is to smooth and harmonize, particularly muscular motion and emotions. It is also responsible for the storage and smooth circulation of blood. When we are stressed, the liver becomes constrained, causing an array of symptoms both physical and emotional. Conversely, in a chicken and egg fashion, emotions - especially, anger, frustration, depression, and repression - can also cause the liver to be constrained. Constrained liver qi is like a violin string that has been turned too tightly. Symptoms of this disharmony include headache and irritability. The free flow of qi in the channels is impeded. Menstrual irregularities are common.
According to TCM theory, blockage of energy can, over time, coalesce into a mass. Since the liver meridian runs through the pelvis and has a link to the breast, in women we see the development of ovarian cysts, uterine fibroids, endometrial cysts, etc. In my clinical experience, this is most dramatically seen in women who were molested and sexually abused as they developed into adulthood. A causal relationship might well be drawn here.
Acupuncture is an excellent tool for addressing constrained liver qi. Herbs are also helpful. A classic formula for this condition is Free and Easy Wanderer (Xiao Yao Wan). As the name implies, it helps to uncoil the taut energy.
At Turning Point we offer another way to address pelvic problems caused by constrained liver qi using the Mayan Abdominal Massage. To read about this unique technique, please visit this webpage.
Long standing constraint of liver qi can also lead to a condition called "liver invading the spleen." It is at this stage of disharmony when most liver-related menstrual manifestations appear.
The spleen organ system is primarily involved with processing - including processing thoughts (recall the associated emotion for the spleen is worry), digesting food, preparing the uterus monthly for a potential implantation and nourishing a pregnancy should one ensue. The spleen makes the blood and also has an important role in the regulation of water in the body. Clearly, anything that disrupts the spleen organ function will strongly impact women's reproductive systems. Most commonly seen symptoms include menstrual problems such as heavy bleeding, PMS, and water retention.
Spleen disharmonies respond to acupuncture and Chinese herbs. Since the spleen is involved with digestion, poor dietary habits - especially fried foods, sugar and /or alcohol - can cause or aggravate disharmonies. For women with spleen deficiency, warn, cooked, non-cloying food is essential for healing.
The last of the most commonly involved organ systems in women's health is the kidney. I have written about this previously when discussing infertility on this page: The Fertility Page.
The role of the kidney organ system in fertility is critical: The kidney acts as our pilot light and is the source of generative energy. The kidney qi regulates the rhythmic flow of blood for the menstrual cycle. It is also the seat of ancestral energy, known as Jing - that part of the life force energy that defines the strength of our gene pool. Contemporary women with kidney depletion appear weak and pale and feel cold, especially in the extremities. The uterus is also cold by TCM definition and will not sustain a pregnancy. Frequent miscarriages ensue. Chinese herbs are essential here to warm and nourish the kidney.
In TCM, the kidney organ system is associated with fear. This organ system includes the kidney/adrenal axis of Western medicine. Thus we understand that fear can deplete the kidney qi in exactly the same way that it causes the adrenals to become drained by the continual excretion of adrenaline in a "fight or flight" mode to deal with ongoing emergency situations. This is particularly true in NYC, and indeed, most urban areas, since 9/11. Here again we can see that women, who are generally the primary nurturers and care givers in the family and work-place, are challenged to protect their loved ones and the things they care about. The stress of this new concern has increased the likelihood of critical energetic disharmonies in women.
The other important element in looking at women's health from a TCM perspective is blood. Blood is essential for nourishing the organs and muscles of the body. Blood and bodily fluids (sweat, tears, secretions) come from the same source and are generated by the foods we eat.
In TCM, the uterus is thought of as the "blood chamber." In ancient times it was imagined as a vessel that fills with blood every month and overflows when the cup is full. Scant or absent menses reflected problems with the creation of blood in the body.
Amanda J. Silver, a Turning Point practitioner who specializes in women's health issues, shares these thoughts on blood in Chinese gynecology.
"One way we can visualize the blood's role in the body is to think of the life-giving sustenance streams and rivers provide to the earth. One of the most common menstrual imbalances I see in the office is a deficiency of blood leading to stagnation. If we over exercise (excessive sweat) or eat poorly, the riverbeds begin to dry up, and the water stagnates into puddles. The physical manifestation of this imbalance created by stagnation can be experienced as a painful blockage of energy (endometriosis, cramps, headache), or manifest as a physical mass (fibroids or cysts). Temperature can also affect the blood. Excess cold (raw foods or being improperly dressed in cold weather during the menstrual cycle) can lead to a congealing of the blood and a cold womb. Excess heat (spicy foods or infection or irritability) will dry up the blood and can lead to amenorrhea (no menses), menorragia (heavy bleeding) and vaginal dryness.
To properly nourish and maintain the body's precious blood supply, one should include a diet high in blood-tonifying food (green leafy vegetables), exercise in moderation, and make sure to get enough sleep. Taking these simple steps can improve the quality (and quantity) of the blood and the reproductive system as a whole, leading to a healthy and balanced menstrual cycle."
The blood is related to the functional integrity of the internal organs. Looking at the main systems affecting women, we again see the liver, spleen and kidneys are involved:
The liver stores the blood and is responsible for its smooth circulation.
The spleen makes the blood.
The kidney provides the qi for the rhythmic flow of the menstrual blood.
Let's put it all together and examine a common symptom: Using irregular bleeding as an example, we see that if the kidney organ system is weak, the menstrual blood flow will be, too. Liver constrained qi would block the blood, and this stagnation would interfere with the proper menstrual flow. In fact, under extreme conditions of hardship, as in starvation (including anorexia), or in war-time, during which the liver and kidney are very affected, women will often stop menstruating altogether. The body will direct its energetic resources to more vital functions than the preparation of the body for pregnancy. One last thought. Life style has been mentioned many times in this article with regard to expectations for optimal health. Pertinent to this is diet and exercise. Although relevant, it is outside the purview of this article to discuss body image and the root causes of eating disorders in women in Western society. Suffice it to say that when women exercise excessively to lose weight or to shape their body to some externally imposed model, they hurt the underlying qi and set themselves up for gynecological problems, as described above by Amanda Silver.
I started this article by talking about Iyengar yoga. The exercise regimes prescribed by eastern medicine are yoga in the Ayurvedic tradition (from India), and tai chi or qi gong in TCM. I only wish that I had practiced one of these gentler, more healing styles of movement when I was younger. I have come to believe that weight training is helpful for bone strength, and aerobic exercise is good for cardiovascular health, but in both cases only when done in moderation. For the skeptics, I will say that yoga and tai qi/qi gong can be quite challenging, physical disciplines. But more importantly, both have the capacity to bring internal harmony and thus another level of healing to the endeavor. This internal harmony can have spiritual and emotional benefits that go a long way to help nurture the women's health we have been discussing.
In closing, I want to say that this essay is not meant to be a comprehensive discussion of women's health from a TCM perspective. There are many very large textbooks on the subject. Rather I hope that it will start the reader thinking about our attitudes about women's cyclic natures and what practices can be employed to foster luminous health.
If you want to know more about Iyengar yoga I recommend these books (available at Amazon):
Greeta Iyengar: Yoga: A Gem for Women
Linda Sparrowe, Patricia Walden, Judith Hanson Lasater :The Woman's Book of Yoga and Health : A Lifelong Guide to Wellness
And here is a link to the Iyengar Institute in NYC link: The Iyengar Yoga Association of Greater New York
* The quote, "Women Are Not Small Men", is from this important book on women's heart health:
Nieca Goldberg, MD, Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women (New York: Ballantine Books, 2002)