by Susan Johnson, L.Ac.
Article originally published April, 2025
From the start of the period until ovulation is the estrogen phase of a women’s menstrual cycle. During this time, the blood that was lost during the period is replenished, and a lush new bed (the uterine lining/endometrium) is created for potential fertilization during ovulation. Between ovulation and the start of menstrual bleeding is the progesterone phase of the menstrual cycle, when progesterone prevents bleeding in the event that conception has occurred. It is during this phase that women with excess Liver qi congestion experience breast pain, uterine cramping, temple headaches, visual eye disturbances, and emotionality or mood swings. Most women have one very good week following ovulation, when their energy is good, and PMS is mild or non-existent. Typically, if a woman cannot remember when her period is due, I have noted that it is usually during week three of her cycle. When the body recognizes that there is no fertile egg, progesterone production is cut off, and when the progesterone level drops low enough, menses begins.
The following are some of my favorite treatments using Tung's Acupuncture Points. For best results, please do not combine them. See herbal formulas and commentary below:
- 11.17 Wood (Anger), needled on the left with 11.24 Gynecological Points; 11.06 Return to the Nest, needled unilaterally on opposite sides; 88.04-88.06 Three Sisters needled bilaterally or Three Plum Blossom.
- 11.17 Wood (Anger), needled on the left with 11.24 Gynecological Points, 11.06 Return to the Nest, needled unilaterally on opposite sides, with bilateral 77.18-77.21 Three Emperors* and LI4/LV3 Four Gates.
- 11.06 Return to the Nest, 11.24 Gynecological Points, needled unilaterally on opposite sides with SP6 San Yin Jiao, needled bilaterally with electrical stimulation.
- 11.06 Return to the Nest, 11.24 Gynecological Points, needled unilaterally on opposite sides with right-side 66.02 Wood Wife (treats Liver excess).
- 11.06 Return to the Nest, 11.24 Gynecological Points needled unilaterally on opposite sides, 66.02 Wood Wife needled unilaterally or bilaterally, with unilateral 66.05 Golden Gate (Tung’s ST43) and/or ST44 Nei Ting.
- 66.02 Wood Wife, needled unilaterally or bilaterally, 66.03 Fire Hardness (Tung’s LV2) needled bilaterally, 77.21 Man Emperor (Tung’s SP6) needled bilaterally with or without electric stimulation, or pricking bleeding tiny veins (found between the medial malleolus and 77.21).
- REN24 Cheng Jiang, needled quickly without contacting the maxilla (see comments, below), 66.02 Wood Wife, needled unilaterally or bilaterally with bilateral 66.03 Fire Hardness (Tung’s LV2).
- 11.24 Gynecological Points and 11.06 Return to the Nest, needled unilaterally on opposite sides with unilateral 66.05 Golden Gate (Tung’s ST43) and bilateral 77.18-77.21 Two Emperors.
- 11.24 Gynecological Points, REN24 Cheng Jiang, needled with bilateral 66.15 Water Fairy (Tung’s KD5).
- 77.04 Catching Ball (Tung’s UB57), 66.03 Fire Hardness (Tung’s LV2), bilaterally needled with unilateral 66.05 Golden Gate (ST43), REN24 Cheng Jiang (Jing-Well point of the Ren Channel) and right-side 66.02 Wood Wife (Dr. Young, 2008). Note: Needling UB57 in the combination above cannot be accomplished with the patient face up on the table. For that reason, I do not use this combination. However, I could suggest using a deep needle on 77.08 Four Flower Middle to thread through to 77.04 (Tung’s UB57). Alternatively, with the patient lying on their back with bent knees, needle UB57 using an in-and-out technique and strong stimulation, then proceed to the rest of the needle treatment.
Cramping before menstruation (Liver qi congestion):
-
11.17 Wood (Anger), needled on the left hand with 11.24 Gynecological Points and 11.06 Return to the Nest, needled unilaterally on opposite sides, with bilateral 77.21 Man Emperor (SP6).
- If the patient has breast pain, irritability, and temple headache, add LV3/LI4 Four Gates, needled bilaterally.
Menstrual cramping on days one and two (blood stagnation):
- SP6 San Yin Jiao with electric stimulation on day one of the period will stop cramps immediately. (For SP6 only, it is okay to cross the body with north and south electrical leads on either side. Otherwise, do not cross sides of the body with your north and south electrical leads.)
Menstrual cramping after day two (blood deficiency):
- 11.06 Return to the Nest, 11.24 Gynecological Points, needled unilaterally on opposite sides; Dr. Miriam Lee’s Ten Great Needle Treatment (bilaterally needle ST36, SP6, LI11, LI4, LU7).
- 11.06 Return to the Nest, 11.24 Gynecological Points, needled unilaterally on opposite sides to keep cramps from returning.
- 66.02 Wood Wife, needled right side or unilaterally with unilateral 66.05 Golden Gate (ST43) and ST44 Nei Ting.
Herbal Formulas:
Cramping before menstruation (excess):
- Xiao Yao Wan (Free and Easy Wanderer).
- Tong Jing Wan (Calm in the Sea of Life).
Blood deficiency:
- Ovulation through day two: Use Xiao Yao Wan.
- Day two to ovulation: Use Gui Pi Tang to calm the spirit and tonify qi and blood.
Stagnation:
Qi and blood:
- Ge Xia Zhu Yu Tang (Vitalize Blood Below the Diaphragm Formula).
- Tong Jing Wan (Calm in the Sea of Life).
Cold and dampness:
- Shao Fu Zhu Yu Tang (Vitalize Blood in the Lower Abdomen Formula).
Liver and Kidney deficiency:
- Tiao Gan Tang (Regulating the Liver Decoction).
Eliminate heat and toxins, relieve pain by circulating qi and blood:
- Shao Yao Tang (Peony Formula).
Comments:
Cramping due to Liver qi congestion:
Cramps, breast pain, and migraines that occur before the period begins are indicative of significant Liver qi congestion, an excess condition. For these patients, symptoms usually ease immediately or shortly after the period begins. If the patient feels exhausted before their period, but they feel terrific as soon as they start to bleed, it is a Liver excess condition. Cramping or migraines that occur just before the period, or in the first two days of the cycle indicates Liver qi congestion and the need to vitalize qi and blood (Xiang fu / Rhizoma Cyperi and Chai hu / Radix Bupleri could be useful herbal additions here). If patients are notably cold with Liver qi congestion, we can use Moxa Heat Packs on UB13, UB43, LU1-LU2 in order to tonify metal to control wood.
Cramping due to blood deficiency:
Patients who feel completely wiped out at the end of their period are blood deficient. If they have cramps after day three (or after the major letdown of blood, which could be on day two), or after the period has completely ended, blood deficiency is the issue. If the headaches come after the primary bleeding (2-4 days into the period), this also indicates depletion. I am careful about recommending iron supplements because excess iron can be problematic, but if I were ever to prescribe it, this would be the time, and I would direct the patient to take 325mg of ferrous sulfate, three times a day. Confirm the patient’s need for iron by checking the color of their inner eyelids, which might be pale or white, their tongue, and their pulse. If the tongue is pale and the patient is not vegetarian, I tell her to eat a small amount of red meat daily in the week before her period begins, to tonify the blood. Note: Patients who like to chew on ice are often anemic due to iron deficiency; this is a tell-tale symptom and not uncommon in pregnancy. For additional information, please see Master Tung's Magic Points Volume Three - The Clinician’s Best Friend, Heart Disorders: Heart numbness (patient is agitated, cannot lie down, or sit still) for the treatment of blood deficiency during menses leading to heart numbness.
SP6 with electrical stimulation:
Return to the Nest relieves dysmenorrhea better or at least as well as SP6 San Yin Jiao, because Return to the Nest prevents acute or chronic cramping from reoccurring. However, SP6 with electrical stimulation is more effective for intense cramping on the first or second day of menses. When needled with electricity once full bleeding has commenced, cramps will not return in the same menstrual cycle. Unfortunately, this powerful effect of electricity on SP6 is only temporary and will not be effective prior to the commencement of bleeding. This is, however, a great “trick” when women are suffering from severe cramping.
Three Sisters/Three Plum Blossom:
Three Sisters points can be used at any time of the cycle for dysmenorrhea, and they are usually my points of choice along with Wood (Anger), Return to the Nest and Gynecological Points. If a woman is cramping and bleeding heavily due to uterine fibroids or cysts, I needle Three Plum Blossom during weeks two and three, but not during the menses or the week before, because the swelling and pressure in the lower abdomen would be uncomfortable for the patient. Fibroids typically swell before the onset of menses (please see Master Tung's Magic Points, Volume Three - The Clinician’s Best Friend: Fibroids or tumors, tipped uterus.)
Three Emperors and Four Gates:
When dysmenorrhea occurs alongside Kidney deficiency and Liver qi congestion, these point patterns can be added to our standard finger points. I find myself using this protocol frequently when the above issues are related to infertility or perimenopausal conditions. My only caution with this protocol is that when a woman is exiting fertility and periods are less frequent and lighter, the needling of 11.06 and 11.24 can bring her back to regular cycling. For some women, that is advantageous. For others, especially those whose periods are difficult, sometimes it is best to leave well enough alone and let nature take its course without interfering. For women who have premenstrual syndrome (PMS) or who are menopausal with emotional turbulence, this combination can work wonders. Consider adding Prefrontal Scalp Points.
Dr. Miriam Lee’s Ten Great Needle Treatment:
When women are exhausted after menses, I always go to Miriam’s Ten Needles. This needle treatment is very versatile, but in this case, it is used for exhaustion, depression, and anxiety, to tonify the Kidneys and clear any remaining turbid qi. We can begin using this treatment as soon as the major letdown of blood has transitioned into a lighter flow (usually by day 2 or day 3), and throughout the menstrual cycle to help patients recover from excessive blood loss or extreme depletion. Moxa over the kidneys and/or ST36 and SP6 will benefit any depleted patient, though I avoid using moxa over the uterus until bleeding is complete so as not to congeal the blood. I sometimes send women home with Moxa Heat Packs to use between treatments and after their menses.
66.02 Wood Wife:
This point is exceptionally useful when Liver qi congestion causes a premenstrual flare-up of interstitial cystitis. It can be needled unilaterally or bilaterally. The point tends to be painful, but not as painful as bladder spasms. Women who have experienced the benefits of Wood Wife come into the clinic asking for it (please see Volume Three: Bladder spasm/interstitial cystitis for further information).
REN24 Cheng Jiang can be very painful when needled:
Pinch up the skin and needle quickly so that you do not plow into the bone. If you pinch up the skin and there is a “tent” of skin around the needle, that is fine because this tent of skin gently presses the tip of the needle to the maxilla, further stimulating the point without grinding the needle into the bone. Because REN24 is extremely sensitive, I do not use it frequently; however, this point is specific for dysmenorrhea because it opens the orifices and regulates the REN Mai, qi, and blood. Needling this point will not make you any friends, so use it sparingly. It causes the patient’s eyes to water involuntarily. Counsel your patient first, and then insert the needle consciously and very quickly to a depth of 0.2-0.4 cun.
Premenstrual Syndrome (PMS):
Emotional and physiological symptoms related to PMS may include: moodiness and anger; breast pain; dysmenorrhea; irregular, prolonged or heavy menstruation; difficulty sleeping; infertility; and tumors or fibroids in the uterus. I judge a female patient’s level of Liver qi stagnation based on the degree of her premenstrual breast pain. If she has no breast pain, I consider her Liver qi congestion to be mild. If she has breast pain for a day or two, she clearly needs a little help. If she has two weeks of breast pain before her period, this indicates a serious case of Liver qi and blood stagnation. Often, such a patient may also have migraine headaches, nausea and vomiting, and severe menstrual cramping.
“For premenstrual or menopausal women, the practitioner should primarily treat the Liver. Women with hormonal imbalances may have a tendency toward anger, worry and frustration. These emotions can generate Liver fire, inflaming the Heart. 77.18-77.21 Three Emperors with 66.02 Wood Wife is a good combination to soften the Liver and nourish water to control fire” (Dr. Miriam Lee, 1992). I usually needle Wood (Anger) rather than Wood Wife because the points are less painful. Please note that the Wood (Anger) points can be especially sensitive. To avoid needling a blood vessel or a nerve, careful placement of the needles is essential.
Tung's Acupuncture for PMS (again, choose, do not combine):
- 11.17 Wood (Anger), needled on the left with 11.24 Gynecological Points, 11.06 Return to the Nest, needled unilaterally on opposite sides, LI4/LV3 Four Gates, 77.18-77.21 Three Emperors, needled bilaterally.
- 66.02 Wood Wife, needled unilaterally with 77.18-77.21 Three Emperors, needled bilaterally,
- 11.17 Wood (Anger), needled on the left with 11.24 Gynecological Points, 11.06 Return to the Nest, needled unilaterally on opposite sides; bilaterally needle 88.04-88.06 Three Sisters and Prefrontal Scalp Points.
