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Module 5   Lesson 2   Jing Yun

Women: cycle, pregnancy and menopause

How do tongue and pulse change through the cycle, pregnancy and the menopause, and how do you read them in menstrual complaints?

After this lesson you put the cycle day in the record for every woman and compare in the same phase, you recognise the slippery pulse of pregnancy with its confusions and its worrying forms, you know the tongue and pulse of the patterns behind painful, heavy and irregular periods and around the menopause, and you know which findings go first to a GP (or primary care doctor) or the midwife.

before and during: more slippery compare in the same phase 1 Menstruation day 1 to 5 2 After menstruation day 6 to 13 3 Around ovulation day 14 to 20 4 Before menstruation day 21 to 28 Pregnant pulse slippery, rolling, slightly faster chi stays palpable under pressure tongue: no picture of its own a test decides, not the pulse Painful periods pain before or during: more often Excess pain during or after: more often Deficiency tongue and pulse choose the pattern new or growing pain: medical first Menopause Kidney-Yin: Red, peeled, thin-rapid Kidney-Yang: Pale, wet, deep-weak often both: pulse deep and thin the tongue follows what dominates
Schematic. The ring is a common division of the cycle in TCM gynaecology (textbook), here for a cycle of 28 days; with a longer or shorter cycle the phases shift accordingly. Red: Blood that moves and is discharged; blue: Blood and Yin being replenished; green: the turn around ovulation; light red: Yang and Qi preparing the Blood.

Know by heart

  • The pulse through the cycle. Just before and during menstruation, the pulse of a healthy woman is often more slippery. Note the cycle day and compare a woman with herself in the same phase; mnemonic: calendar first, then the pulse.
  • The pregnancy pulse. Slippery, rolling, slightly faster and harmonious; the chi positions stay palpable when you press; classically: the pulse of the Heart moves strongly (Su Wen 18); mnemonic: pearls that do not break at the root. A test decides, not the pulse.
  • A worrying pregnancy pulse. Deep, thin and choppy, or both chi very weak: Kidney-Qi and the Chong and Ren fall short. With bleeding or abdominal pain: the midwife first.
  • Painful periods. Qi stagnation and Blood stasis: Purple or purple spots; wiry or choppy. Cold: dark or Pale with a white coating; deep and tight. Qi and Blood deficiency: Pale, Thin; thin and weak. Damp-Heat: Red, yellow sticky; slippery and rapid; mnemonic: pain before is more often full, pain after more often empty.
  • Heavy or irregular periods. Heat in the Blood: Red, yellow coating; rapid and slippery. Qi not holding the Blood: Pale, often teeth marks; thin and weak, right guan. Liver-Qi stagnation: tongue nearly normal; wiry.
  • The menopause. Kidney-Yin deficiency: Red, little coating; thin-rapid. Kidney-Yang deficiency: Pale, Swollen, wet; deep and weak. Often both: pulse deep and thin, the tongue follows what dominates. Heart involved: redder tip. Liver involved: wiry.
  • Red flags. Pregnant or possibly pregnant with bleeding, one-sided abdominal pain, shoulder pain or fainting; late in pregnancy headache, flashing lights, pain high in the abdomen or suddenly swollen hands and face; bleeding after the menopause; pain with fever and abnormal discharge.

The rest of this lesson is reference.

Three practice questions from this lesson

Case. A woman of 27, regular 28-day cycle, no complaints. At a check-up on day 27 her pulse feels clearly more slippery than at the previous reading on day 9. How do you read that?
  1. Normal: a more slippery pulse fits the days before menstruation
  2. Dampness: a more slippery pulse means Dampness has been added
  3. Pregnancy: the pulse shows that she is pregnant

Answer: Normal: a more slippery pulse fits the days before menstruation. Around menstruation the pulse of a healthy woman is often more slippery. If you compare day 27 with day 9, you are measuring the cycle; compare in the same phase. Dampness also gives a sticky coating and heaviness, and whether she is pregnant is decided by a test, not the pulse.

Case. A woman of 31, seven weeks late, nauseous in the morning, tired. Tongue normal. Pulse slippery, rolling, slightly faster; the chi positions stay palpable when you press.
  1. A test decides; the pulse fits a pregnancy
  2. Damp-Phlegm in the Stomach: slippery, rolling and nauseous
  3. Liver invading the Stomach: nauseous and tired

Answer: A test decides; the pulse fits a pregnancy. A slippery, harmonious pulse with chi positions that do not disappear under pressure is the classical pregnancy pulse. Even so, the pregnancy test decides, not the pulse. Damp-Phlegm gives a sticky coating, Liver invading the Stomach a string.

Case. A woman of 33, eight weeks pregnant (scan seen). Since this morning some bleeding and cramps. Pulse deep, thin and somewhat choppy; both chi weak.
  1. Call the midwife straight away
  2. Kidney-Qi not firm: wait calmly at home
  3. Blood stasis: the midwife tomorrow if the bleeding continues

Answer: Call the midwife straight away. Bleeding with cramps in early pregnancy goes straight to the midwife. The pulse (deep, thin, choppy, weak chi) fits what textbooks call a pregnancy that is struggling, and does not make it any less urgent.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 18 case-based practice questions, 18 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 5: Going deeper.

Try two lessons freeSee Tongue and Pulse