Acupuncture and the Follicular Phase

This article is the second in an ongoing series about the basal body temperature chart and what this can tell us diagnostically according to Chinese Medicine. In this article, we will be looking at pathological patterns in the follicular phase (i.e. before ovulation) and what they might represent in terms of energy imbalances in the body.

If the average temperature in the follicular phase is consistently low (i.e. below 36 degrees), then this indicates that person's yang energy is deficient. Figure 1 shows an example of this kind of chart. It may be that this person's thyroid is underactive, and they might have additional hypothyroid symptoms such as lethargy, weight gain and a sensitivity to cold. If someone has this kind of pattern, it would be very important to warm the yang energy throughout the whole cycle. Techniques like applying warmth to the whole lower abdomen either with moxa or a heat lamp in the treatment room, and then using a hot water bottle every day when at home can help to support this deficiency in yang energy.

Another possibility is that the follicular phase is too long. In figure 2 for example, the follicular phase is 24 days. If a cycle fluctuates on the long side, it is usually the follicular phase that is the culprit, although as we will see in the next article the luteal phase can also be long. In this case, there could be stagnant energy blocking the usual flow of energy that leads to ovulation. Alternatively, the nutritive energies necessary for the development and release of an egg may be insufficient, leading to a slow development and delayed release. In the most extreme cases, ovulation might be missed altogether. In this case we would want to strengthen and nourish the yin energies (blood, kidney yin and kidney jing) responsible for follicle and egg development.

Figure 3 gives an example of a cycle with a short follicular phase (9 days). In this case, heat may be present which is causing an egg to be released before it has developed fully. Heat can also be present in a person with a very high metabolic rate, which could be observed in a cycle with a high average follicular temperature. A hyperactive thyroid is also a possibility here, which might also present with symptoms such as agitation, a fast resting heart rate, insomnia or weight loss. A patient with this kind of heat might also have acidic or scant cervical mucus, or mucus that is hostile to sperm, or an endometrium which is not thick or nourished enough to support a pregnancy. In this case, acupuncture and herbal treatment would definitely be aimed at clearing heat and supporting yin.

If the high temperature at the start of the cycle is a natural continuation of the temperature at the end of the last cycle (i.e. it hasn't dropped down by the time the period has arrived), this could be due to yang not properly transforming to yin, as would be expected in a healthy cycle. This can sometimes be indicative of endometriosis. An example of this can be seen in figure 4.

Our last follicular phase pattern is shown in figure 5. In this case the variability between the temperature values during the follicular phase is higher than normal (i.e. varying by more than about 0.2 - 0.3 degrees). Fever, a lack of sleep or alcohol consumption the previous night can all cause this pattern, but if there is no obvious cause, then it can be viewed as liver or heart fire harassing the usually calm heart yin and shen. As well as acupuncture and herbs, in this case it can be helpful for the patient to investigate stress reduction and general relaxation techniques, or meditation.

In our next article in this series, we will look more closely at patterns connected to the luteal phase.