The Menstrual Cycle in Chinese Medicine: The Four Phases
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
The menstrual cycle is one of the most important diagnostic frameworks in Chinese medicine. While Western medicine divides the cycle into the follicular and luteal phases based on hormonal activity, traditional Chinese medicine maps the cycle into four distinct phases, each governed by specific movements of Qi, Blood and the Yin-Yang balance. Understanding your cycle through this lens explains why symptoms occur when they do — and guides the timing of acupuncture and herbal treatment for maximum effectiveness.
The four phases of the menstrual cycle in TCM
Phase 1: Menstruation (days 1–5) — Blood moves
Menstruation represents the release of the Blood that has been building in the Uterus (Bao Gong) throughout the previous cycle. In TCM terms, this is a time of active Blood movement, governed by the Chong channel (the Sea of Blood). The Liver — which stores Blood and governs its smooth flow — plays a central role in facilitating this release. When the flow is smooth, painless and adequately abundant, the Blood is free and unobstructed. When it is painful, clotted, scanty or absent, there is obstruction (Blood stasis, Cold or Qi stagnation) that needs to be addressed. This phase corresponds to the withdrawal of progesterone and the shedding of the endometrium in Western physiology. Treatment during this phase focuses on facilitating smooth Blood flow and addressing pain, using points and herbs that move stasis and regulate the Liver.
Phase 2: Post-menstrual (days 6–13) — Yin and Blood build
After the Blood has been discharged, the body naturally enters a phase of Yin and Blood replenishment. The Kidney (which governs reproduction in TCM) begins to generate new Yin essence to rebuild the endometrial lining and develop the follicle. This phase corresponds to the follicular phase and the rise in FSH that drives follicle development. In TCM terms, the Kidney Yin, Liver Blood and Jing (Essence) must all be adequate at this stage to produce a healthy follicle and a rich endometrium. This is the phase when nourishing Kidney Yin, building Blood and supporting Jing is most important — relevant to anyone trying to conceive or managing low AMH, irregular cycles or thin endometrium. Key herbs include Liu Wei Di Huang Wan and Si Wu Tang.
Phase 3: Ovulation (days 14–16) — Yin transforms to Yang
Ovulation is the pivotal moment in the cycle — the transformation of Yin into Yang, the release of the egg from the follicle that has been nourished over the preceding two weeks. In TCM, this requires the movement of Kidney Yin towards Yang, a surge of Liver Qi to facilitate the release of the egg, and adequate Qi and Blood to support the process. The LH surge of Western physiology corresponds to the Yang Qi rising and the Liver Qi moving to release the egg. Problems at this phase — absent ovulation (anovulation), late ovulation or poor LH surge — reflect either insufficient Yin-Jing to generate the Yang transformation, or Liver Qi stagnation blocking the smooth release. Treatment at this phase uses Qi-moving and mildly Yang-warming herbs alongside those that facilitate the Yin-Yang transformation, including Chai Hu Shu Gan San and warming Kidney Yang herbs.
Phase 4: Luteal phase (days 17–28) — Yang rises
After ovulation, the corpus luteum begins producing progesterone in Western physiology — this corresponds in TCM to the rise of Kidney Yang, which warms the uterus to prepare for implantation. Adequate Kidney Yang is essential to maintain the warmth, Blood flow and Qi movement in the uterus that support a fertilised egg implanting and developing. A failure of Kidney Yang in this phase produces the TCM pattern of “luteal phase defect” — a shortened or insufficient luteal phase, low progesterone, and a tendency to miscarriage in early pregnancy. Premenstrual symptoms (PMS) that appear in this phase reflect the failure of Kidney Yang and Liver Qi to rise smoothly and maintain the warmth and movement of the Uterus — stagnant Liver Qi is the most common cause of the irritability, breast tenderness and bloating of PMS. Treatment in this phase focuses on warming Kidney Yang with herbs such as You Gui Wan modifications and regulating Liver Qi with Xiao Yao San.
Why timing acupuncture to the cycle matters
This four-phase model is the reason TCM practitioners ask detailed questions about your cycle — every aspect (flow colour, duration, clotting, pain timing, mid-cycle symptoms, PMS symptoms) provides diagnostic information about which phase is dysfunctional and which TCM patterns are present. Acupuncture and herbal prescriptions are adjusted throughout the cycle to support each phase in turn. For fertility, this precision is particularly important: building Yin and Blood before ovulation, facilitating the ovulatory transition, and warming Yang in the luteal phase addresses the specific dysfunction at each stage rather than applying a single protocol throughout.
See: Irregular menstrual cycle treatment | Dysmenorrhoea treatment | Acupuncture for PMS | Fertility treatment
To discuss your menstrual cycle and treatment options, contact me or book a consultation in Wokingham.
