Ice and Menstruation
Ice and Menstruation
Published on July 23rd, 2009 @ 01:49:45 pm , using 1202 words, 1526 views
by Eric Brand
An anthropologist could spend years studying the cultural perceptions around ice. Ice poses an interesting question for TCM, because the widespread consumption of ice is a relatively new phenomenon. The modern icemaker and freezer are inventions that were never mentioned in classical Chinese medical literature, so the conclusions about ice on a massive scale are pretty much being formed by only the current generation of practitioners.
In China, Hong Kong, and especially Taiwan, there is a widespread popular conception that drinking iced drinks exacerbates menstrual pain. This belief is common among TCM doctors as well as the general population. By contrast, Westerners never think about the effect of ice and iced drinks on menstruation, and we consume ice in voracious quantities.
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A few years back, I remember covering a class at Chang Gung University in Taiwan. The class was full of science nerds from the Western medical track, and at the end of class, a girl shyly raised her hand and asked me: "We've heard that Western girls can drink iced drinks during their period. Is that true?" When I responded that Western girls never think about the effect of iced drinks on menstruation, the entire class of 50 students exhibited nothing but stunned amazement. They wanted to know why, how, what was different about our constitutions, etc. The belief is that pervasive.
I even recall my teacher Feng Ye asking me about it, speculating about how it could be possible that something that was "so obvious" could be missed by an entire culture of women. The theory is that drinking iced drinks during menstruation is similar to the "brain freeze" headache one gets when drinking a frozen beverage too quickly, when all the blood in your head rushes to your mouth. In this case, the blood is moving from the chong/ren channels to the stomach to warm the cold drink. Cold by nature causes contraction and congealing, and this situation worsens menstrual pain.
So we have an interesting situation: Millions of people in Chinese society think ice worsens menstrual pain. Millions of people in Western society never even worry about it. If someone in Taiwan drinks ice and has pain, they blame it on the ice. If they don't drink ice and still have pain, they think "good thing I didn't drink ice, imagine how bad it would have been." If they don't drink ice and don't have pain, the lack of pain was aided by the fact that they didn't drink ice. And if they do drink ice but don't have pain, they just think their constitution is getting better. Any way one looks at it, one can't rule out the fact that it could all be one self-fulfilling prophecy or placebo effect. From youth, the girls think they will have pain from ice, so they drink ice and expect pain. They get the pain and it confirms their suspicions.
We can only draw a few logical conclusions. For example:
1) Ice doesn't really affect menstrual pain unless you have the cultural expectation that it will
2) Ice does affect menstrual pain but Westerners don't think to connect the two
3) Westerners are more hot in terms of their constitution, so they don't have any problem with ice
So what's the deal? Old wives' tale or key clinical issue? It should be easy to do a clinical trial, as we have millions of people that menstruate and have heavy ice or no ice habits. Or maybe we'd find that ice habits were more common in patients with heat patterns, or that only patients with cold patterns exhibited exacerbation of symptoms with ice. Regardless, it is an extremely pervasive cultural belief that there is either no connection (as in the West) or a close connection between ice and menstrual pain (as in the East). Maybe the truth is somewhere in the middle.
TCM is encountering all manners of new questions in the modern world. An invention like the ice machine is a prime case in point. There is no doubt that ice is cooling. There is no doubt that overly cold things can adversely affect patients with cold patterns of menstrual pain. But how cooling is ice? It is just water, a fundamentally neutral substance, but it takes some degree of yang qi to heat it up so that it can be used. Ice is different than a cold substance like shi gao (gypsum), but to what degree?
Historically, China only had ice in glaciers or cold northern regions. The Emperor had a special room in the Forbidden City that held ice, which was hauled down from a glacier by horses from hundreds of miles away. It was stored in a chamber and was fanned to make some of the world's first air conditioning. But common people didn't have ice around until just a few decades ago, a blip in TCM time.
Similarly, Chinese medicine has incorporated new herbs for centuries, but some have only been around for decades. Many plants from India exist in the materia medica, such as sandalwood, and items like Rou Gui are sourced from areas such as Vietnam. Ru Xiang, Mo Yao, and Niu Huang came from the Middle East, and modern TCM materia medicas have New World medicinals like chili, coca, and valerian. Many more herbs will come with the Chinese exploration of Africa and South America, and new discoveries and questions will always be coming up. (Interestingly, Maca from South America is one of the most popular new herbs in the East.)
The opinions and observations of one or two generations of practitioners means little in the grand scheme of Chinese medicine. In Chinese medicine, ideas are refined and applied and developed for hundreds of years before a consensus emerges. There have always been important pioneering works by people like Li Dong-Yuan and Li Shi-Zhen, and there are certain to be many more pioneering works in the future. But trying to establish consensus on even the most basic thing, like ice, takes time.
Ice appears as a medicinal in historical Chinese materia medicas, but now is the first time that it has been consumed in massive quantities. I wonder what consensus will emerge in the TCM community after 100 years of daily ice consumption. Clearly the central properties will always be the same, but I wonder which attitudes will prevail about ice and menstruation.
According to the Zhong Yao Da Ci Dian (Great Encyclopedia of Chinese Medicinals), the properties of ice are as follows: Sweet, very cold, nontoxic. Abates heat and disperses summerheat, resolves thirst and eliminates vexation. It treats cold damage (shang han) yang toxin, severe heat with stupor, and summerheat strike with vexation and thirst. It should not be consumed in excessive quantities.
The Ben Cao Shi Yi states that it governs the elimination of heat vexation.
The Ben Cao Gang Mu states that it is good to put a piece of ice on CV-17 (Dan Zhong) to treat cold damage (shang han) yang toxin and severe heat with stupor. It also says that ice resolves liquor toxin.
The Yi Lin Zuan Yao states that excessive consumption damages stomach yang and leads to debility of the ming men fire, causing spleen-stomach transformation failure.
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I'm inclined to think this may be closely related to constitution and genetics after just returning from a vacation in hot and tropical South East Asia. I myself am Asian (in case the name doesn't give it away) and my travel partner was Caucasian, of Western European descent. We couldn't help but notice the difference in how each of our physiologies responded to the humidity. I was hot, and did perspire...but my poor friend was sweating vigorously the entire time. Perhpas the Asian genes are simply programmed for hot climates, and therefore less equipped to deal with an icey gut? For example, we don't have a high percentage of body or facial hair, we tend to have petite body frames, and hardly ever sweat vigorously. I can tell you first hand that this particular physiology leaves me feeling vulnerable to cold in general, and I hardly ever travel without a sweater. Perhaps this is just one factor in the mythic tale of ice and menstruation... Who knows, as new generations of practitioners begin to emerge it's possible that many of the classical concepts will be challenged by the advances of modern medicine, genetics, and hopefully integrative research.
Jocelyn
It is indeed an interesting question as to whether or not there are differences between the prevalence of TCM patterns between different ethnic groups. Genetics in general may offer fascinating opportunities for integrative research. For example, in biomedicine it is increasingly recognized that different genetic markers may help predict the response to individual drugs. In a field like psychiatry, trial and error has been the traditional method of understanding a patient's brain chemistry and response to various drugs. However, the slow onset of action and the long period of time required for clearance of an unsuccessful drug for something like depression limits their utility. Thus, they are trying to crack the metabolic and genetic predictors so that they can more efficiently get to the correct medicine for any given patient. In many ways, the method of grouping patients into different cohorts (or patterns) for drug medications is quite similar to traditional Chinese medicine, albeit with more sophisticated technology. A field like genetics may give us a good place to research the biomedical equivalent of something like heat in TCM (i.e., what markers do people have if their bleeding improves from cold herbs like huang qin vs. if their bleeding improves from qi-supplementing agents like ginseng).Whether or not different clinical patterns are more prevalent in a given culture certainly merits research. In biomedicine, the prevalence of different diseases definitely varies depending on geography and genetics. To answer this question, we'd need to pay attention to diagnostic standards that preserve TCM pattern differentiation for the purposes of research (mentioned in previous blogs here at Blue Poppy). We'd want to have a few thousand digital records that we could use to match the similar records already in use in the East. It may well be that there are statistically significant differences.
As you mentioned, basic things like sweating can vary tremendously based on constitution, but the degree to which constitution and race can be correlated may be a relatively new subject for Chinese medicine. Certainly the racial variation in patients is greater now than ever before in TCM history. Personally, I sweat much more than the locals when I am in Asia; complete strangers often offer me napkins because they think I must be dying of heatstroke to sweat so much. But it is just business as usual for my body in a hot, humid environment. Whether it pathological or just healthy variation, I have no idea.
With regard to the ice and menstruation, I honestly don't know the answer. On the one hand, I feel like the attitude towards ice in a place like Taiwan is almost too exaggerated, but at the same time I think that most Westerners pay too little attention to something like the temperature of food. Interesting stuff.
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