Part 2 of 4 in the menopause series. Part 1 is what is happening in the body; part 3 is when to see a doctor first; part 4 is daily life and what a consultation asks.

"TCM says this is about the 'kidney' — is something wrong with my kidneys?" It is a question readers often ask.

No. The "kidney" of the theory is a functional system, not the organ a blood or urine test measures. This part sets out the words the theory uses, one at a time.

The short version

• TCM theory places menopause mainly with the "kidney" — the WHO's TCM terminology standard says perimenopausal disorders often result from kidney qi failure and imbalance between yin and yang. The "kidney" here is a set of functions, not the organ of Western medicine.
• Four of the words are really one line: kidney essence → kidney qi → Tian Gui → kidney yin.
• Mood sits with "the liver governs free flow"; bone sits with "the kidney governs the bones". Liver and kidney share one source, so in the theory the two are linked.
• The theory's account and the oestrogen account each stand on their own; neither needs translating into the other.
• Which explanation applies to you is the practitioner's judgement after the consultation, the tongue and the pulse — not the reader's to assign.

First, the things that cannot wait

Any bleeding after menopause needs a doctor — even if it has only happened once, there is only a small amount, or it is only pink or brown discharge. The NHS states it can be a sign of cancer, which is why it is always checked.

Chest pain or palpitations with breathlessness or a cold sweat — call 999 now, or go to the nearest hospital emergency department.

The full list is in part 3. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. The theory places this change with the "kidney"

The WHO's TCM terminology standard defines perimenopausal disorders as a group of disorders involving irregular menstruation and gradual menopause, and states that they often result from kidney qi failure and imbalance between yin and yang.

The standard defines its words one at a time. Four to know:

• Kidney essence (肾精) — the essence stored in the kidney, inherited from one's parents and nourished by food and water; the foundation of the kidney's physiological activities.
• Kidney qi (肾气) — transformed by kidney essence, and the driving force of the kidney's physiological activities.
• Tian Gui (天癸) — a material substance transformed and generated by abundant kidney essence, which boosts the maturity of reproductive organs and maintains the reproductive function. The classical texts attribute this stage to Tian Gui gradually running out — the theory's account of why periods stop, a paraphrase rather than a quotation, and not the standard's own sentence.
• Kidney yin (肾阴) — the yin essence of the kidney which, as opposed to kidney yang, is the quiescent and moistening aspect of the kidney's functions. The theory reads episodic heat, night sweating and a dry mouth in the direction of this aspect weakening.

Put simply, it is one line: kidney essence → kidney qi → Tian Gui → kidney yin. The theory attributes this stage to Tian Gui running out, and reads the heat and sweating through another entry, "yin deficiency leading to heat" (阴虚则热) — the standard defines it as a pathological state in which yin fluid fails to control yang, causing a relative hyperactivity of yang and deficiency heat. So "kidney qi failure" and the "kidney yin gradually waning" you often hear point, in the theory, to one root.

One thing to be clear about: stringing these entries into a line is a reading from within TCM theory, not a sentence from the WHO standard — the standard defines them one by one; the joining up is the tradition's.

II. Mood and bone sit in the same system

The theory links two more things outward.

• The liver governs free flow (肝主疏泄) — the WHO standard's entry is one sentence: the liver maintains free flow of qi over the entire body. The theory places mood swings and irritability here, and adds the sense of ease in the chest and flanks — that extension is clinical tradition, not the entry's own sentence. The standard also has the liver storing blood, and liver and kidney sharing one source: the kidney stores essence, and blood and essence can transform into each other — which is why, in the theory, mood sits alongside the kidney.
• The kidney governs the bones (肾主骨) — the standard's account is that kidney essence generates marrow to nourish bones. That defines a function; filing the state of the bones under the "kidney" system is what the theory does with it.

These are the theory's directions, not a judgement about you. The same hot flush can have more than one explanation in the theory; which one applies is the practitioner's judgement after the consultation, the tongue and the pulse — not the reader's to assign. Words like Tian Gui and kidney yin are not targets to be "tonified" or "regulated" in a consultation. Whether the change needs handling, and how, belongs first to the doctor of parts 1 and 3.

For the "kidney" system in general, see What Does "Kidney Deficiency" Actually Mean?.

III. Two accounts, each reading one hot flush

They are not two names for one thing. The medical account is in part 1; the theory's is in the two sections above. Each stands on its own, in its own language and its own ways of checking — oestrogen is not a translation of "kidney yin", and Tian Gui is not a hormone. This article does not merge them, or use one to prove the other.

Picture one flush: early evening, face, neck and chest suddenly hot, sweating, gone after a few minutes.

How the medical side reads it. The WHO describes that scene as a sudden feeling of heat in the face, neck and chest, often with flushing, sweating and palpitations, lasting several minutes; the NHS adds it can happen by day or at night, and at night it is a night sweat. The NHS's potential triggers: spicy food, caffeine, hot drinks, smoking and alcohol. So the medical side asks: what did you eat and drink before it?

How the theory reads it. Through the WHO standard's "yin deficiency leading to heat" entry. It asks about the time of day (the theory assigns dusk and night to yin), whether the mouth is dry, how the night went, and the person's state overall.

Different questions, almost the same things to write down: what time, what was eaten, how much sweat, how the night went. Track it for two weeks — the record serves doctor and practitioner alike.

This is how two accounts read one flush, not a judgement about yours — how yours is read belongs to your doctor and your practitioner.

The words in this part

All five definitions are the WHO standard's own.

• Kidney essence (肾精) — the essence stored in the kidney; the foundation of its activity.
• Tian Gui (天癸) — a substance generated by abundant kidney essence; it maintains the reproductive function.
• Kidney yin (肾阴) — the quiescent, moistening aspect of the kidney's functions.
• Yin deficiency leading to heat (阴虚则热) — a pathological state: yin fluid fails to control yang, so yang is relatively hyperactive and deficiency heat arises.
• The liver governs free flow (肝主疏泄) — the liver maintains free flow of qi over the entire body.

Frequently asked questions

Does "kidney qi failure" mean something is wrong with my kidneys? No — the "kidney" of the theory is a functional system, not the organ a blood or urine test measures; this part speaks the theory's language, not an index on a test report.

The other three parts

• Part 1: What is actually happening in menopause — what falls in the body
• Part 3: When to see a doctor first, and what is generally done
• Part 4: Daily life in Malaysia, hormone therapy, and what a consultation asks

👉 If you are not sure "where to start setting out the changes of this stage for a practitioner", you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in "First, the things that cannot wait" above or in part 3 applies, see a doctor or a gynaecologist first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 — https://www.who.int/publications/i/item/9789240042322
• World Health Organization, Menopause fact sheet, 16 October 2024 — https://www.who.int/news-room/fact-sheets/detail/menopause
• NHS, Symptoms of menopause and perimenopause, page last reviewed 19 May 2026 — https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
• NHS, Things you can do to help menopause and perimenopause symptoms, page last reviewed 19 May 2026 — https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/
• NHS, Postmenopausal bleeding, page last reviewed 24 September 2026 — https://www.nhs.uk/symptoms/post-menopausal-bleeding/

本文是「更年期」系列的第 2 篇，共 4 篇。第 1 篇讲身体里在发生什么，第 3 篇讲什么时候要先看医生，第 4 篇讲日常怎么安排、看诊会问什么。

「中医说这是「肾」的事——是肾脏出了毛病吗？」不少读者常问这句话。

答案是不是。理论里的「肾」是一个功能系统，和验血验尿的那个肾脏不是同一件事。这一篇把理论用来理解这段变化的几个词，一个一个说清楚。

一分钟看完

• 中医理论把更年期主要放在「肾」来看：世卫的中医术语标准说，「绝经前后诸证」常由肾气衰退、阴阳失衡所致。理论里的「肾」是一组功能，不是西医的肾脏。
• 四个词其实是一条线：肾精 → 肾气 → 天癸 → 肾阴。
• 情绪归在「肝主疏泄」，骨头归在「肾主骨」；肝肾同源，所以在理论里两边连在一起。
• 理论的说法与雌激素那一套各自成立，不需要互相翻译。
• 哪一种解释适用于您，是医师问诊、看舌、把脉之后的判断，不是读者对号入座的事。

先说不能等的几件事

停经之后出现任何出血，请务必就医——即使只有一次、量很少、只是粉色或褐色分泌物。NHS 写明它可能是癌症的征兆，所以一律要检查。

胸痛、心悸伴随气促或冒冷汗——请立刻拨打 999，或前往最近的医院急诊部。

完整的清单，见第 3 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、理论把这段变化放在「肾」

世卫的中医术语标准把「绝经前后诸证」定义为一组涉及月经不规律与逐渐绝经的病证，并说明这些病证常由肾气衰退、阴阳失衡所致。

标准是一个词一个词定义的。先认识四个：

• 肾精——藏于肾的精，禀受于父母、由水谷所养，是肾生理活动的基础。
• 肾气——由肾精所化，是肾生理活动的动力。
• 天癸——由充盛的肾精所化生的一种物质，促进生殖器官成熟并维持生殖功能。经典把这个阶段归于天癸渐竭——这是理论对「为什么会停经」的解释，是转述而不是逐字引文，也不是标准的原句。
• 肾阴——肾的阴精，相对于肾阳，指肾功能中宁静与濡润的一面。理论把阵发的热潮、夜间出汗、口干，放在这一面减弱的方向来理解。

简单说，就是一条线：肾精 → 肾气 → 天癸 → 肾阴。 理论把这个阶段归于天癸渐竭，把阵发的热与汗放在标准另一条「阴虚则热」上——标准把它定义为阴液不能制约阳气、阳相对亢盛而生虚热的病理状态。所以「肾气衰退」和常听到的「肾阴渐衰」，在理论里指向同一个根源。

要说清楚一件事：把这几条串成一条线，是中医理论内部的读法，不是世卫标准里的原句。 标准做的是逐条定义，串线是传统的做法。

二、情绪和骨头也在同一个系统里

理论再往外连两条。

• 肝主疏泄——世卫标准这一条只有一句：肝维持全身气机的通畅。理论把情绪的起伏与烦躁放在这里，也把胸胁的舒畅感连在一起——这一层是传统临床的说法，不在标准那一句里。标准另有肝藏血一条，而肝与肾同源——肾藏精，血与精可以互相转化，所以情绪的变化在理论里与肾的变化连在一起。
• 肾主骨——标准的说明是，肾精生髓以濡养骨。这是一条功能的定义；把骨的状态归在「肾」这个系统，是理论依这条功能做的归类。

这些是理论的方向，不是对您个人的判断。 同一个热潮，理论上可以有不止一种解释；哪一种适用，是医师问诊、看舌、把脉之后的判断，不是读者对号入座的事。天癸、肾阴这些词不是问诊要「补」或「调」的目标。这段变化本身要不要处理、怎么处理，先属于第 1 篇与第 3 篇所说的医生。

「肾」这个系统的一般说明，见〈「肾虚」到底是什么〉。

三、两套说法，各自读一次热潮

它们不是同一件事的两个名字。 医学那一边的账在第 1 篇，理论那一边就是上面两节。两套说法各自成立，用的是不同的语言与检验方法——雌激素不是「肾阴」的翻译，「天癸」也不是荷尔蒙。这篇不把它们合并，也不用一边去证明另一边。

设想一次热潮：傍晚，脸、颈、胸突然发热，出汗，几分钟后退去。

医学那边怎么读。 世卫把这一幕描述为面、颈、胸突然发热，常伴脸红、出汗、心悸，持续几分钟；NHS 补充它可以在白天或夜间发生，夜间的就是盗汗。NHS 列出的潜在诱因是辛辣食物、咖啡因、热饮、吸烟与酒精。所以医学那边会问：这次热潮之前，吃了、喝了什么？

理论那边怎么读。 用的是世卫标准里「阴虚则热」那一条。它问的是时段（理论把傍晚与夜间归于阴）、有没有口干、睡得如何，以及这个人整体的状态。

问的问题不同，要记的东西却几乎一样：几点、吃过什么、出了多少汗、当晚睡得如何。先记两周——这份记录给医生和医师都用得上。

这是两套说法读一次热潮的方式，不是对您那次热潮的判断——您那次热潮怎么读，分别是医生与医师的事。

这篇出现的几个词

下面五个词的定义都出自世卫的中医术语标准。

• 肾精——藏于肾的精，是肾生理活动的基础。
• 天癸——由充盛的肾精所化生的物质，维持生殖功能。
• 肾阴——肾功能中宁静与濡润的一面。
• 阴虚则热——阴液不能制约阳气、阳相对亢盛而生虚热的病理状态。
• 肝主疏泄——肝维持全身气机的通畅。

常见问题

「肾气衰退」是说肾脏有毛病吗？ 不是。理论里的「肾」是一个功能系统，不等于验血验尿的那个器官；这一篇说的是理论的语言，不是检验报告上的指标。

这个系列的另外三篇

• 第 1 篇：更年期到底在发生什么——身体里什么在下降
• 第 3 篇：什么时候要先看医生，一般做法有哪些
• 第 4 篇：日常怎么安排，荷尔蒙治疗与看诊会问什么

👉 如果您不确定「这段时间的变化，该从哪里整理起来说给医师听」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若有本文「先说不能等的几件事」或第 3 篇列出的情况，请先看医生或妇产科。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022 — https://www.who.int/publications/i/item/9789240042322
• 世界卫生组织，Menopause fact sheet，2024 年 10 月 16 日 — https://www.who.int/news-room/fact-sheets/detail/menopause
• NHS，Symptoms of menopause and perimenopause，页面最后审阅 2026 年 5 月 19 日 — https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
• NHS，Things you can do to help menopause and perimenopause symptoms，页面最后审阅 2026 年 5 月 19 日 — https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/
• NHS，Postmenopausal bleeding，页面最后审阅 2026 年 9 月 24 日 — https://www.nhs.uk/symptoms/post-menopausal-bleeding/