Somewhere between Heaven and Earth

(A PERSONAL EPILOGUE)
Jolene Albrecht DTCM R.Ac

Dedicated to Rachel Dykerman, a woman who taught me about being one, and the late Dr. Ben Le for my first inspirations.


What hurts most about chronic pain is the impact it has on our over all life style. Pain causes emotional imbalances, social change, physical change, as well as mental change. What most people do not know about me is that I suffer from varying degrees of pain everyday of my life. I have endometriosis, a disease found somewhere in the depths of my genetics, and one that has drastically changed the last two years of my life. What I hope to accomplish through this personal epilogue is a deeper understanding and compassion for pain sufferers, more specifically women with endometriosis.

I remember being fifteen years old and suffering from unbearable dysmenorrhea. I was quickly prescribed birth control pills to regulate my cycle and relieve my pain. It worked magic, but little did I know how it was affecting my Tian Gui and uterine qi. Upon studying the art of Traditional Chinese Medicine, the beauty of menstruation, and researching the affects of “the pill” I took myself off of it. It was then that the damage done to my cycle, and the symptoms of endometriosis became apparent. I suffered from anovulation for over two years, and when my menstruation finally returned it hovered anywhere from forty-six to sixty-four days. On June 18th, 2003 I was rushed to the emergency room with unbearable left ovarian pain. Ultrasound located a seven centimeter hemorrhagic cyst that later burst in my abdomen. Pain became a constant part of my life, affecting how I sat, walked, interrupting with my bowels and my bladder, as well as hindering my sexual activity. Daily levels of high pain began eating away at my Shen. Before ovulation and menstruation I became irritable and frustrated; post-ovulation and menstruation left me depressed, sad, and very solemn. For eighteen months I woke every morning either hurting the same level as the day before, or worse. Time to recollect my thoughts and heal was a must and I was forced to defer a license exam, postpone a semester of school, and take a seven month leave of absence from work. It was during this time I desired to learn as much as possible about my disease.

Endometriosis is a disorder of the blood with the primary pattern of moderate to severe blood stasis. However the disease can be complicated with blood, qi, yang, and/or yin deficiency, as well as damp or qi stagnation. Uterine cells migrate outside the uterus, attach to areas of the pelvic cavity, and resume responding to fluctuations of a menstrual cycle. This means these cells grow an endometrial layer and bleed into the pelvis at the time of menses. The blood that would have normally been shed becomes stagnant and causes pain. As the stasis becomes chronic, inflammation and stagnation ensue forming lesions and adhesions. One of the least understood characteristics of endometriosis is the behavior of the uterus itself. The uterus of a woman with endometriosis produces prostaglandins that act like cramp hormones. The effect is a blanching of the uterine lining during menses, much like that of ringing out a towel. The only treatment western medicine offers is to create a pseudo pregnancy, or pseudo menopause; by shutting off ovulation the ramifications of endometriosis magically become ignorable. That is why birth control is so readily prescribed, and hence the reason I agreed to take it at a young age. However, what most women do not know is that it is not a treatment for endometriosis, but merely a pain management tool. The pill regulates hormone levels so the cramp hormones mentioned above are not produced. Pain ceases while endometrial lesions are aloud to grow unnoticed.

I desired to understand more about my cycle and began paying great detail to how my body was changing each month after coming off “the pill”. I now have compiled four and a half years worth of charts and analyze my estrogen levels via saliva tests, cervical mucous, cervical position, as well as monitor my basal body temperature (BBT). The pattern of blood stasis in endometriosis is supported by the “stair stepping” (alternation of high and low temperatures) of my BBT, and higher post menstruation temperatures are indicative of deficient heat arising from yin and blood deficiency. What I found the most interesting was how I was able to find a pattern of yin and yang waxing and waning in my charts. As estrogen, a yin hormone, rose preparing for ovulation my cervix would soften, open to allow passage of sperm into the uterus, and cervical mucous would form; yin rising to nurture my body for the next ovulation, or possible implantation. After ovulation as progesterone, a yang hormone, rose my temperatures would stay high as my body prepared the endometrium for implantation; yang rising for creation. The yin and yang rollercoaster of menstruation follows exactly the same rollercoaster of the yin and yang of the full moon (ovulation) and new moon (menstruation). These phenomena lead me to wonder. If we desire to follow natural order to live in harmony with nature, could you thereby balance emotional changes of a menstruation cycle by following the rise and fall of yin and yang of heaven and earth?

The I Ching is the earliest most detailed book describing the unity of Heaven and Humanity. The first two Gua of the I Ching relate specifically to the waxing and waning of a menstrual cycle, and help support the rational of regulating it to that of a lunar cycle. Qian, the first Gua, is Heaven and can be translated as Initiating. It is an image of the sun rising and spreading qi for the nourishment of Kun (Earth). Heaven is the symbol for the most firm, most healthy, and purest yang energy in the universe. It is the provider of the purest yang and most powerful strength for the regulation of all under heaven. Kun, the second Gua, is Earth and can be translated as Responding. It is an image of yin energy extending over Earth and is the function of Earth responding to Heaven. Earth is the purest yin, most responsive, flexible, and devoted. Earth can not create or develop on its own, and must receive pure yang from Heaven. The sequence of the first Gua says “After heaven and earth have come into existence, myriad beings are produced. Qian and Kun are the origin and source of creation”. (The Complete I Ching, Taoist Master Alfred Huang, pg. 22, 1998). From the I Ching we can develop a deeper understanding of the macrocosm of Heaven and Earth and the interdependence of the wax and wane of yin and yang. “Creation and reception, initiation and submission, yang and yin, should unite into one and complement each other”. (The Complete I Ching, Taoist Master Alfred Huang, pg.38, 1998).

From the I Ching we learn the functions of the four seasons are originating, developing, maturing, and declining. This sequence is also represented by the new moon and full moon as it relates to the yin and yang of menstruation. The following diagram illustrates the wax and wane of yin and yang as the macrocosm depicts the microcosm.


The originating sequence of the follicular phase is the point at which yang becomes yin and yin begins to rise. This is the new moon and is represented by Day One, or the first day of bleeding. This sequence is governed by yin so not only is a woman loosing both yin and blood, her LV/KD yin must be sufficient enough to reinitiate the maturation of a new follicle for the next cycle. It becomes easy to understand why the patterns of endometriosis are so difficult to treat, why birth control added fuel to the fire, and why my shen was disturbed. The principle of treatment is to supplement LV/KD yin, tonify LV blood, and nourish the HT to calm the spirit. If this phase is too short there is heat usually due to deficiency of yin. Too long of a phase is indicative of KD yin deficiency, or less frequently the KD yang and/or SP qi are too deficient to perform the transformation. The quality of yin affects the quality of the egg itself, as well as the growth of the follicle protecting it. Regeneration of the endometrial layer begins 2-3 days after the onset of menses so this formula should begin on Day 4.

Shu Di
E. Jiao
Tu Si Zi
Yu Zhu
Suan Zao Ren
Ze Xie
Gou Qi Zi
Wu Ling Zhi
Gui Ban
Hei Zhi Ma
Sha Shen
Lian Zi
Shan Zhu Yu
Mu Dan Pi
Ye Jiao Teng
Da Zao


The developing sequence of the follicular phase is governed by the movement of LV qi and Blood. LR qi triggers the transformation of yin into yang to support ovulation. The free flow of liver qi is a must so ovulation can happen. Ovulatory pain is indicative of blood stasis, and that of bloating is LV qi stagnation. The yin and blood must continue to be nourished, so the above is modified with additions and subtractions, and should begin on Day 8.

Bai Shao
Yi Mu Cao
Xu Duan
Xiang Fu
Dong Chong Xia Cao
Chaun Xiong
Dang Gui
Chen Pi
Zhi Ke
Shan Zha
Gou Qi Zi
Sha Shen
Hei Zhi Ma
Dan Shen
Da Zao


The maturing sequence of the luteal phase is the point where yin becomes yang. The exact moment of the transformation is ovulation and the time of the full moon as yang begins to rise. This sequence is governed by KD yang and SP qi. The luteal phase must be fourteen days for the sole purpose of successful implantation to occur. Less than fourteen days is indicative of KD yang and SP qi deficiency, spotting that of heat, qi and/or blood stasis, and breast tenderness that of qi stagnation. The following is administered after the full moon/ovulation.

Ji Xue Teng
Dang Gui
Long Yan Rou
Bai Zhu
Fu Shen
Sha Ren
Lu Rong
Ren Shen
Fu Zi
Yin Yang Huo
Gui Zhi
Du Zhong
Chi Shao
Shan Yao
Gan Jiang
Bu Gu Zhi
Huang Qi


Lastly, the declining sequence of the luteal phase is the premenstrual phase. This is where yang begins to turn back into yin to prepare for menses, and the most important time to move blood strongly so the body can rid itself of chronic stasis. The following formula should be taken on Day 22.

Tao Ren
Hong Hua
Chuan Xiong
Xiang Fu
Dang Gui
Yan Hu Suo
Yu Jin
Sheng Di
E. Zhu
Bie Jia
Dan Shen
Huai Niu Xi
Ji Xue Teng
Sheng Jiang
Bai Shao


Yin and yang of Heaven and Earth encompass us everyday of our lives; The I Ching supports this, the lunar cycle is one of many balances created by this, and the menstrual cycle depends on this. So it only makes sense to utilize the greater being and strive for regulation of the menses through the virtues of Heaven and Earth. I can not tell you if I will ever be completely pain free, but I stand to tell you that I have not felt this balanced or grounded since I was a young woman. The sequence of the fortieth Gua says “Things cannot remain in hardship with out end. Thus after Hardship, Relief follows”. (The Complete I Ching,Taoist Master Alfred Huang, pg. 327,1998). I know in my heart it is my turn for Relief.


BIBLIOGRAPHY

Huang, Alfred, Taoist Master. The Complete I Ching. Vermont: Inner Traditions International, 1998.

Lewis, Randine, Ph.D. The Infertility Cure. NewYork: Little, Brown and Company, 2004.

Lyttleton, Jane. Treatment of Infertility with Chinese Medicine. Edinburgh: Churchill Livingstone, 2004.

Nofziger, Margaret. A Cooperative Method of Natural Birth Control. Tennessee: The Book Publishing Comapany, 1992.

Weschler, Toni, MPH. Taking Charge of Your Fertility. New York: HarperCollins Publishers Inc, 2002.