Although not generally recognized in biomedicine, the concept of Cold in the Uterus (hán gōng 寒宮) is a therapeutically useful traditional Chinese medicine (TCM) pattern that has been discussed and utilized since ancient times. Understanding the signs and symptoms of a ‘cold womb’ offers a practitioner insight in how to remedy numerous gynecological and reproductive difficulties in women.
The name for the uterus in Chinese is zǐ gōng 子宮, which translates as ‘a palace for the child’. This nest where a mother will nourish and grow a baby needs to be warm, cozy, and healthy. A warm Lower Jiao, including the uterus and ovaries, is considered vital to support a woman’s health and ability to conceive. Cold in the Uterus is the most common cause of infertility in younger women. Although there may be other causes to consider, such as Liver Qi Stagnation, Dampness, or Blood Stagnation, Cold may be implicated in many symptoms affecting women’s health including a sensation of cold in the lower abdomen (especially during menses), dysmenorrhea, delayed or absent periods, irregular cycles, pelvic pain, abdominal masses, and red or dark blood with clots during menses. Frequently, these issues are only diagnosed when a woman seeks therapy for fertility issues. However, the etiology of this condition often begins when a woman is younger. What can be done to alleviate this condition? Let us explore.
Biomedicine Considerations
Hormonal Imbalance
The hormones involved in the female reproductive function primarily include estrogen, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH). Testosterone, thyroxine, oxytocin, and prolactin also contribute. Together they regulate the menstrual cycle, ovulation, uterine lining thickness, implantation, and conception. The pituitary, the thyroid, ovaries, adrenals, and the corpus luteum all have roles to play. Disruption in hormonal balance can cause cycle irregularities, amenorrhea, insufficient endometrial development, or infertility along with issues related to sexual receptivity, emotional and mental wellbeing, immune response, stress reduction, and metabolism. Estrogen, in addition to initiating the development and release of ova, promotes uterine blood vessel growth and lining thickness, while progesterone prepares the uterus for pregnancy. When these hormones are not in balance, the uterus may become “inactive” or less receptive, and the menstrual cycle may become disrupted.
When a woman’s lower abdomen is cold, this may be caused by inadequate progesterone, which may be caused by anovulatory cycles. When during a woman’s cycle, an egg is not released, then no corpus luteum forms around the developing follicle in the uterus. Since most of a woman’s progesterone is produced by the corpus luteum, progesterone becomes inadequate. Progesterone is literally thermogenic. After ovulation, rising progesterone levels increase a woman’s basal body temperature by 0.2–0.5°C. This increase in basal body temperature is one means by which to track a woman’s fertility. When progesterone is insufficient, the post-ovulatory temperature rise is blunted or absent, the uterine lining develops poorly, menstruation may arrive early or irregularly, and the lower abdomen may remain at a lower temperature.
Poor circulation
Poor blood circulation to the pelvic area may lead to symptoms like a cold lower abdomen, menstrual pain, and even infertility. Reduced uterine perfusion (blood flow) has been associated with impaired endometrial receptivity and decreased fertility. Women with lower sub-endometrial blood flow, especially during the implantation window, were shown to have lower conception rates. (Somaclinic)
Reproductive disorders
Luteal phase defect, pelvic inflammation caused by infections, fallopian tube obstruction, diminished ovarian reserve, endometriosis, submucosal uterine fibroids and polycystic ovary syndrome are common reproductive disorders that have significant effects on the uterus and ovaries. Endometriosis occurs when tissue similar to the endometrium grows outside the uterus, causing inflammation, pain, and scarring. Women with PCOS often have insulin resistance and increased levels of androgens, which interfere with ovulation and uterine receptivity. Submucosal uterine fibroids, which form under the endometrium, can interfere with egg implantation because they often distort the shape of the uterus. These conditions can all lead to chronic pelvic pain, inflammation, irregular and painful menstruation, and hormonal imbalance.
Lifestyle factors
Chronic stress, inadequate sleep, a sedentary lifestyle, and a diet high in processed or nutritionally poor foods has been linked to inflammation, metabolic disorders, and impaired fertility and can contribute to hormonal and circulatory problems. Chronic stress can also result in high cortisol levels, which can suppress reproductive hormones, leading to irregular menstruation and ovulatory dysfunction.
Treatment
Treatment modalities in biomedicine include stress reduction, adequate sleep, exercise, an improved and adequate diet, and hormone replacement therapies (especially progesterone), including birth control pills or medications designed to induce ovulation such as clomiphene.
Traditional Chinese Medicine Discussion
In TCM, the uterus is considered the ‘Extraordinary’ organ responsible for menstruation, fertility, and reproduction. The Uterus is controlled by the Kidney, especially the Kidney Jing, and is related to the Liver through the Liver Blood, which fills the Uterus at the time of menses. The Uterus needs a rich supply of Qi, Blood, and Jing for its correct function. Both the Chong Mai (Penetrating or Sea of Blood) and Ren Mai (Conception) channels originate in the Uterus and the Uterus along with the Ren Mai are considered the pregnancy channels, which must be free of obstruction for pregnancy to occur. Moreover, a balanced and warm Uterus is believed to support a woman’s overall health and ability to conceive.
When there is an excess of Cold lodged in the Uterus or deficiency Cold (from Yang deficiency), there will be insufficient warmth in the Uterus that will impair the flow of Qi and Blood to the uterus, leading to Cold in the Uterus syndrome (hán gōng 寒宫). It is important to understand that Cold Uterus is a pattern caused by an inability to dispel Cold, or a deficiency in the warming, activating energy of the Yang Qi that allows the uterus to build a receptive lining, sustain regular menstruation, and support fertilized egg implantation.
The keynote objective finding is a cold lower abdomen and perhaps also the lower back, especially during menstruation. A subjective symptom report, or a lack of a report, from one’s patient will not suffice and cannot be depended on. The simplest way to discover this sign is by placing one’s hands directly on the patient’s skin. Palpation is unnecessary, although the elicitation of pain upon palpation is additional evidence to consider. The other major characteristics to look for are pain or stiffness in the lower back, irregular or delayed periods, and difficulty conceiving, or recurrent pregnancy loss. The patient may also report periods that run late, menstrual blood that is dark and clotted, cramping that eases with a hot water bottle or heating pad, hands and feet perpetually cold, or a basal body temperature that does not rise clearly after ovulation.
Etiology
Blood Cold occurs when Cold invades the Uterus and settles there. Cold in the Uterus may either come from the exterior or be a consequence of Kidney Yang deficiency leading to Deficiency Cold (sometimes called Empty Cold). Exterior pathogenic Cold (sometimes referred to as Full Cold) may mean either Wind Cold invading the space between the skin and muscles or Cold invading the Uterus directly. During menstruation and especially after labor, the Blood Connecting Channels are open, and the space between skin and muscles is especially vulnerable to invasions of Wind Cold. Whether it is full or empty, Blood Cold affects the Uterus by obstructing it with Cold. It should be noted that Cold congeals the Blood, which leads to Blood Stasis. Blood Stasis is its own source of potentially serious dysfunction in the human body. Read more about Blood Stasis in our previous article.
Invasion of Cold is probably the most common cause of primary infertility in young women. If a female undergoing puberty is exposed to Cold and Dampness (especially during her period) when exercising, or playing sports, Cold may invade the Uterus, where it becomes a pattern of lingering internal Cold. This in turn can obstruct the Uterus, the Ren Mai and the Chong Mai, and can prevent fertilization and potentially cause other gynecological dysfunction.
Other sources of Cold in the Uterus include chronic environmental cold such as living in cold conditions without adequate warmth, working in cold environments for extended hours, and consuming cold foods habitually. These factors can increase the likelihood of a Cold invasion, and they can, over time, lead to a constitutional Yang deficiency and foster the general depletion of health. It is commonplace to see people inadequately dressed for the weather, eschewing coats, hats, gloves, and scarves, even on the coldest days. Any uncovered skin causes the body to lose core temperature. Consider wearing a hat on cold days since 10% of a person’s body heat is lost through an uncovered head. Our energetic and active brains are housed in the head where there is little or no insulation.
Cold foods include raw fruit and vegetables, ‘cold cut’ sandwiches, dairy products, and iced drinks. Unfortunately, many popular diet ideas include salads, smoothies, and fruit, which, if continually consumed, can be detrimental to health. From a Chinese medicine perspective, the Spleen likes dry and warm foods and dislikes cold and wet ones. Excessive consumption of raw foods, although in theory providing abundant vitamins and minerals, may be detrimental because such foods will be difficult for the Spleen, Stomach and Intestines to digest and absorb. The physiology of the human body including absorption of nutrients, digestion, enzymes, biochemical pathways, and nutrient transport are optimized at 98.6°F, and putting Cold into the digestive system robs heat from the rest of the body in an attempt to rectify this. Over time, the Channels, the Blood, and the Middle and Lower Jiaos adapt to the lower temperature, and the resultant condition can become Yang deficiency, which can lead to many health problems, including Cold in the Uterus.
Chinese Medicine Treatment Modalities
Acupuncture Treatment
(Selected points suggested for Cold in the Uterus)
- Ren 2 Qugu: Regulates the Lower Jiao, Warms and invigorates the Kidneys.
- Ren 4 Guanyuan: Tonifies and nourishes the Kidneys, Tonifies Yuan Qi, Benefits Jing, Regulates the Lower Jiao, Regulates menstruation, Tonifies Qi, Nourishes Blood and Yin, Warms Yang and dispels Cold, Regulates the uterus, Assists conception, Stimulates sex hormones.
- Ren 7 Yinjiao: Regulates menstruation, Nourishes Yin, Regulates the uterus, Tonifies the Kidneys, Regulates the Lower Jiao.
- Du 4 Mingmen: Tonifies the Kidneys, Warms and tonifies Kidney Yang, Tonifies Yuan Qi, Dispels Cold from the Lower Jiao.
- UB 23 Shenshu: Tonifies and regulates the Kidneys (Qi, Yin and Yang) and Yuan Qi, Fortifies Yang, Benefits Jing, Regulates the Lower Jiao, Benefits and warms the uterus, Nourishes Blood.
- KI 7 Fuliu: Tonifies and regulates the Kidneys (Qi, Yin and Yang), Regulates menstruation, Empirical Endocrine point for thyroid, adrenals, and ovaries.
- ST 30 Qichong: Stabilizes and promotes the Jing, Regulates Qi and Blood, Regulates menstruation, Regulates the Chong channel, Regulates Qi in the Lower Jiao.
- Reinforcing techniques including moxibustion is indicated at all points.
Chinese Herbal Medicine Treatment
The representative formula for Full Cold leading to Blood Stasis is Shao Fu Zhu Yu Tang/Wan/San. Sometimes this formula is named Warm the Mansion decoction (‘Mansion’ and ‘Palace’ refer to the Uterus).
Shao Fu Zhu Yu Wan (Stasis in the Lower Palace Teapills) Ingredients
| Dang gui | Angelica sinensis root | Tonifies Blood, regulates the menses, invigorates and harmonizes the Blood and disperses Cold. |
| Pu huang | Typha angustifolia pollen | Stops bleeding by astringing, invigorates Blood and dispels Blood Stasis. |
| Chi shao | Paeonia lactiflora root | Invigorates the Blood, dispels Blood Stasis, clears Heat, cools the Blood and relieves pain. |
| Ru xiang | Boswellia carterii resin | Invigorates the Blood and promotes the movement of Qi, alleviates pain. |
| Mo yao | Commiphora myrrha resin | Invigorates the Blood, dispels Blood Stasis, alleviates pain and reduces swelling. |
| Yan hu suo | Corydalis yanhusuo rhizome | Invigorates the Blood, circulates Qi, stops pain and disperses extravasation. |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood, promotes the movement of Qi, expels Wind and alleviates pain. |
| Rou gui | Cinnamomum cassia bark | Warms the Kidneys, Spleen and Heart, strengthens the Yang and Mingmen Fire, disperses deep Cold, warms the channels, unblocks the channels and vessels, alleviates pain and assists the generation of Qi and Blood. |
| Chao Xiao hui xiang | Foeniculum vulgare fruit-fried | Warms the Liver and Kidneys, expels Cold, Regulates Qi, harmonizes the Stomach and alleviates pain. |
| Chao Gan jiang | Zingiber officinale rhizome-dried-fried | Warms the Middle, expels Cold and dispels Wind-Dampness seeping into the Lower Jiao. |
This formula is available from Mayway Herbs as Plum Flower® Stasis in the Lower Palace Teapills or Shao Fu Zhu Yu San (extract powder).
The traditional formula includes Chao Wu Ling Zhi / Dry-fried Faeces Trogopterori, which is no longer allowed for importation by FDA.
Syndrome Diagnosis
Blood Stasis Accumulating in the Lower Jiao by Cold
Primarily indicated for an Excess condition.
Clinical Indications for use
Blood and Phlegm stagnation in the Lower Jiao presenting with immobile lower abdominal masses accompanied by pain that increases with pressure, abdominal distension, tenderness, or spasms, difficult menstruation, slow starting, scanty or infrequent menstruation with abdominal distention and pain, menstrual pain and cramping, frequent or excessive menstrual bleeding, continuous spotting of purple or dark blood (usually with clots), and retention of the lochia. There may be an aversion to Cold and cold extremities.
The tongue may be pale, slightly purple or purple, with distended and dark sublingual veins and a white coat. The pulse is often choppy (Se Mai).
Treatment Principles
- Invigorates the Blood and dispels Blood Stasis
- Promotes the movement of Qi
- Warms and regulates menstruation
- Unblocks the Channels and Collaterals
- Alleviates pain
Cautions and contraindications
Contraindicated during pregnancy. Use with caution in hemorrhagic disorders or with patients on anti-coagulant therapy.
The second formula to consider is Wen Jing Tang/San, which is reputed to be the top prescription for regulating menstruation in TCM gynecology, and is one of the commonly used prescriptions in treating infertility in women. This is the representative formula for treating Cold Uterus due to Yang deficiency along with Blood Stasis. A recent research study concluded that Wen Jing Tang significantly improved clinical effective rate, pregnancy rate, ovulation rate, increased endometrial thickness and dominant follicle diameter, and elevated serum E2 while reducing FSH and LH. Moreover, the pregnancy rate of patients taking Wen Jing Tang combined with clomiphene was also better than clomiphene alone. (Chen.)
Wen Jing Tang (Warm the Menses Decoction) Ingredients
| Wu zhu yu | Evodia rutaecarpa fruit | Warms the Middle Jiao, disperses Cold, expels Damp-Cold, promotes the movement of Qi, spreads the Liver, descends rebellious Qi, stops diarrhea and vomiting, and alleviates pain. |
| Ban xia | Pinellia ternata rhizome | Dries Dampness, transforms Phlegm, harmonizes the Stomach, descends Rebellious Qi, stops vomiting and reduces distention. |
| Mai men dong | Ophiopogon japonicus tuber | Nourishes Stomach Yin. |
| Dang gui | Angelica sinensis root | Tonifies the Blood, regulates menstruation, invigorates and harmonizes the Blood, disperses Cold and alleviates pain. |
| Bai shao | Paeonia lactiflora root | Alleviates pain, nourishes the Blood, softens the Liver and regulates menstruation. |
| Ren shen | Panax ginseng root | Tonifies Yuan Qi and Spleen and Stomach Qi. |
| Shu di huang | Rehmannia glutinosa root-prep | Nourishes the Jing, Yin, and Blood. |
| Gan cao | Glycyrrhiza uralensis root | Tonifies the Spleen, tonifies Qi, moderates spasms, alleviates pain and harmonizes the harsh properties of other herbs. |
| Mu dan pi | Paeonia suffruticosa root-bark | Clears Heat, cools and harmonizes the Blood, clears deficiency Fire, activates the Blood and dispels Blood Stasis. |
| Sheng jiang | Zingiber officinale rhizome-fresh | Disperses Cold, warms the Middle Jiao, stops vomiting and reduces toxicity of other herbs. |
| Chuan xiong | Ligusticum chuanxiong rhizome | Invigorates the Blood and regulates Qi. |
| Gui zhi | Cinnamomum cassia twig | Warms the channels and collaterals, disperses Cold, unblocks Yang, transforms the Qi, warms the Middle, directs Turbid Yin downward, assists the Heart Yang, warms and facilitates the flow of Blood through the Vessels. |
This formula is available from Mayway Herbs as Plum Flower® Warm Cycle Teapills.
Some variants of the formula also include E Jiao/ Colla. Corii Asini (Donkey Hide Gelatin, a controversial animal product), which Tonifies Blood and stops bleeding. In a decoction, Dang shen/ Codonopsis root may be substituted for Ren shen.
Mu dan pi clears any empty Heat that might arise from Blood deficiency, because although this formula is for Cold in the Uterus, one of its symptoms is a feeling of heat in the face. Ban xia regulates the Penetrating Vessel (Chong Mai). It does so because of the close relationship between the Stomach channel, which Ban xia directly affects, and the Chong Channel via the point Stomach 30/ Qi Chong, which is a point of the Chong Mai.
Syndrome Diagnosis
Blood Stasis due to Cold with Deficiency Cold of the Chong and Ren channels.
Primarily intended for a deficiency pattern.
Treatment Principles
- Warms and regulates the Uterus and menstruation
- Dispels Cold
- Tonifies the Yuan and Middle Jiao Qi
- Warms the Ren and Chong channels
- Nourishes the Qi and Blood
- Invigorates Blood and Dispels Blood Stasis
Clinical Indications for Use
Lower abdomen Cold, deficiency and cold of the Chong and Ren channels causing Blood stasis presenting with mild persistent uterine bleeding, extended or continuous menstrual flow, bleeding between periods (metrorrhagia), irregular menstruation (could be early, late, or skipped), dark and clotted menstrual blood, coldness of the lower abdomen, distention and pain in the lower abdomen, pain that is relieved with warmth, low back pain that is worse after menstruation or when fatigued, thin watery vaginal discharge, five palms heat, dry lips and mouth, dry skin or hair, low-grade fever at dusk, fatigue, weak or cold limbs, loose stools, pale face, diminished desire to drink, irritability, and urinary incontinence.
The tongue may be pale or purple, possibly with purple or dark spots, or with distended and dark sublingual veins. The pulse may be slow (Chi Mai), thin (Xi Mai), deep (Chen Mai), thin and choppy (Se Mai), or wiry (Xuan Mai) depending on the preponderance of the syndrome and which other factors may be present.
Cautions and Contraindications
Contraindicated during pregnancy. Contraindicated for bleeding or abdominal masses due to Blood stasis from excess. Contraindicated for dysmenorrhea due to Heat.
Cold in the Uterus is a common cause of many conditions which challenge a woman’s health, especially fertility. In my experience as a clinical supervisor, I noticed that it is underdiagnosed. Yet, the remedies available to TCM practitioners are extremely effective. I recommend making it a habit to touch your patient’s belly. Is it cold to the touch? There is your first clue.
References
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- Chen, Y., et al., “Traditional Chinese Medicine in the Treatment of Infertility: A Comprehensive Review”, Basic & Clinical Pharmacology & Toxicology, February 2026, https://onlinelibrary.wiley.com/doi/full/10.1111/bcpt.70214#bcpt70214-bib-0046
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- Sacred Lotus, www.sacredlotus.com
- Somaclinic, “Cold Womb Syndrome: A Comprehensive Look at Symptoms, Causes, and Therapies”, April 2025, https://somaclinic.sg/cold-womb/
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