Understanding Understanding Gynecology in TCM Gynecology in TCM ZhangqinhuaZhangqinhua

Gynecology of Shuguang hospitalGynecology of Shuguang hospital

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MenopauseMenopause InfertilityInfertility Extra eight meridiansExtra eight meridians

physiological structuresphysiological structures

women have special physiological structures likwomen have special physiological structures like the uterus that affect menstruation, pregnance the uterus that affect menstruation, pregnancy, childbirth and lactation. y, childbirth and lactation.

These organs especially need blood and qi to fThese organs especially need blood and qi to function with the meridians acting as communicunction with the meridians acting as communicating channels. ating channels.

the physiological functions are dependent upon the physiological functions are dependent upon the promotional effects of the organs,meridians,the promotional effects of the organs,meridians, blood and qi working together. blood and qi working together.

Zang and fu Zang and fu physiological functions of the uterus are associphysiological functions of the uterus are associ

ated with the ated with the heartheart, , liverliver, , spleenspleen and and kidneyskidneys a as well as the Conception and Thoroughfare Ves well as the Conception and Thoroughfare Vessels. ssels.

The heart rules the blood. The heart rules the blood. The liver stores the blood. The liver stores the blood. The spleen governs the blood. The spleen governs the blood. The kidneys store essence. The kidneys store essence. The Conception and Thoroughfare Vessels conThe Conception and Thoroughfare Vessels con

trol qi and blood in the uterus. trol qi and blood in the uterus.

eight meridianseight meridians

Normal physiological functioning also depNormal physiological functioning also depends on the proper regulation of the eight ends on the proper regulation of the eight meridians. meridians.

Because the majority of uterine qi and bloBecause the majority of uterine qi and blood travels within these meridians, the relaod travels within these meridians, the relationship of the uterus and the extra meriditionship of the uterus and the extra meridian network is extremely close.an network is extremely close.

eight meridianseight meridians

Their main function is to strengthen the liTheir main function is to strengthen the links between the twelve regular meridians nks between the twelve regular meridians and to regulate qi and blood circulation.and to regulate qi and blood circulation.

They have special relationships with the They have special relationships with the liverliver, , kidneykidney, , spleen, spleen, uterus, brain and muterus, brain and marrow and thus influence these structures arrow and thus influence these structures physiologically and pathologically. physiologically and pathologically.

Blood and qi Blood and qi

Menstruation, pregnancy, childbirth and lactatioMenstruation, pregnancy, childbirth and lactation are unique to women. n are unique to women.

Blood is the elementary basis of these physioloBlood is the elementary basis of these physiological functions hence there is the saying thatgical functions hence there is the saying that "women take blood as primary." \ "women take blood as primary." \

TCM believes that a woman is always in a statTCM believes that a woman is always in a state of blood insufficiency and is relatively excess e of blood insufficiency and is relatively excess qi inside the body. qi inside the body.

However, the blood and qi mutually generate aHowever, the blood and qi mutually generate and depend on each other nd depend on each other

Seven emotions Seven emotions

The seven emotions exert their effects on The seven emotions exert their effects on various organs significantly. various organs significantly.

Anxiety and anger damage the Anxiety and anger damage the liverliver, whic, which then fails to regulate blood and qi flow. h then fails to regulate blood and qi flow.

Pensiveness damages the spleen, which Pensiveness damages the spleen, which then loses its role in consolidating the blothen loses its role in consolidating the blood. od.

Pattern of chongren’s dieasPattern of chongren’s dieaseses

Cold sydrome in chongrenCold sydrome in chongren Shaofuzhuyu tangShaofuzhuyu tang

Heat sydrome in chongrenHeat sydrome in chongren Qinliansiwu tang add zhixiangfu- true heatQinliansiwu tang add zhixiangfu- true heat Danzhixiaoyaosan –emotion lead to fireDanzhixiaoyaosan –emotion lead to fire Liangditang—empty yinLiangditang—empty yin

Indeficiency sydrome in chongrenIndeficiency sydrome in chongren Dangguidihuang tangDangguidihuang tang

Uncontrol syndrome in chongrenUncontrol syndrome in chongren Shoutai pillShoutai pill

stasis syndrome in chong ren stasis syndrome in chong ren Guizhifulin pill Guizhifulin pill Zhuyu tang< yilingaicuo>Zhuyu tang< yilingaicuo>

Dampness and blood stasis in chong renDampness and blood stasis in chong ren Baijiangcao chaohu zhishi shaoyao gancao dansheBaijiangcao chaohu zhishi shaoyao gancao danshe

n gegen yimucao n gegen yimucao Ezhu shenmiren Ezhu shenmiren

Penetrating vessel (Chong mai)

The Penetrating vessel influences the supply and proper circulation of blood in the uterus

controlling the cycle-length, quantity, quality, duration and coloration of menstruation.

acts as a reservoir for the blood “sea of blood.”

One branch—the foot yangming channel which is rich in qi and blood

One branch connects the Kidney channel which stores jing which is also an important source of blood.

The Penetrating vessel’s pathway flows upwards, connecting these two blood-rich channels.

This characteristic makes it possible for the Penetrating vessel to serve as a reservoir for blood, counterbalancing excessive or deficient blood supply to the uterus, and thus regulating menstruation.

Chinese herbs affect the Penetrating vessel

strengthening the Penetrating vessel Gui Ban Bie Jia E Jiao ,Zi He Che Zhi Mu Xuan Shen Huang Bai Sheng Di Huang Gou Qi Zi

Regulating its qi. Yan Hu Suo, Chuan Lian Zi, Xiang Fu Yu Jin , Qing Pi and Xiao Hui Xiang.

Morning sickness

results from rebellious qi in the Penetrating vessel.

During pregnancy, especially the first three months, profound changes to the Penetrating vessel take place.

The mother’s blood, essence and Kidney energy are diverted to nourish the foetus, so qi and blood become relatively deficient in the Penetrating vessel and its qi rebels upwards towards the Stomach and chest.

easing morningsickness in pregnant women.

subduing rebellious Penetrating vessel qi stop morning sickness

Mu Xiang Sha Ren Chen Pi Su Ye

Case History

A 42 year old patient had late periods for three consecutive months. Her menstrual bleeding was pale red in colour, thin in quality, sca

nty and without clots. She had had a digestive problem for three years with reduced app

etite, fullness and copious abdominal gas, alternating constipation and diarrhoea

a pale tongue with a thin white, slightly greasy tongue coating. diagnosis was delayed menstruation. The differentiation was Spleen deficiency.which caused qi and blo

od deficiency and emptiness of the Penetrating vessel

Ba Zhen Tang plus E Jiao and Gou Qi Zi

After three weeks of treatment, her period came on time (and was subsequently regular), and there was a great improvement in digestive function.

Ba Zhen Tang is a formula which tonifies qi and blood; E Jiao and Gou Qi Zi tonify blood and are the herbs that strengthen the Penetrating vessel.

Conception vessel (Ren mai)

The Conception vessel is very closely related to the uterus and to the female reproductive function.

It regulates qi and blood in all the yin channels. helps to regulate menstruation directs the development and growth of the foet

us, most important during pregnancy

The function of the Conception vessel is related to its course. It originates from the uterus in women and emerges at Huiyin in th

e perineum. It runs anteriorly to the pubic region and all the way up to the throat along the midline of the body. From the throat it ascends to curve around the lips and up to the eyes to meet the Stomach channel Along this path, it connects with

the yin channels of the hand and foot, and the Yin Linking (Yin Wei) vessel many times. It connects all the yin channels of the human body, combining yin, essence and fluids, and so is called “the sea of yin channels.” This means that the Conception vessel provides the yin substances for all female physiological processes, including puberty, conception, pregnancy, childbirth and menopause.

The Conception vessel can be used to nourish the body’s yin energy, particularly in women after menopause, and to reduce the effects of empty-heat symptoms deriving from yin deficiency which is a common problem in the menopausal stage. It can also be used for problems relating to menarche, conception, fertility and pregnancy, especially for pregnancy, because the Conception vessel controls the foetus.

Conception vessel has meeting points with the Spleen, Liver and Kidney channels

Spleen is the root of qi and blood Liver is responsible for the free flow of qi

and stores blood Kidney stores essence and is responsible

for reproduction.

herbs for nourishing the Conception vessel

Gui Ban , Bie Jia, E Jiao, Zi He Che Zhi Mu, Xuan Shen, Huang Bai Sheng Di Huang Gou Qi Zi The same to those for nourishing the Pen

etrating vessel.

Case History

A 45 year old female patient Hot flushes, night sweating and irritability for six month

s, accompanied by soreness of the lower back, heavy and irregular periods with red blood which was t

hick in quality with few clots. tongue was red with little coating Pulse was fine and rapid. diagnose as suffering from menopausal syndrome differentiated as Kidney yin deficiency with empty heat. Zuo Gui Wan plus Gui Ban and Zhi Mu.

After two weeks of treatment, she felt much better, except for continuing mild night sweats.

Zhi Bai Di Huang Wan was then prescribed About three months later, she had no further s

ymptoms. Zhi Bai Di Huang Wan and Zuo Gui Wan are tr

aditional formulas for nourishing Kidney yin, and the former can also clear empty heat.

Gui Ban and Zhi Mu are the herbs which nourish the Conception vessel and clear empty heat.

The Governing vessel

originates in the uterus and descends to Huiyin REN-1. This is common to all three of the Governing, Conception and Penetrating vessels, which is why Li Shi-zhen calls them “three branches of one vessel”.

The Governing vessel primary pathway runs posteriorly along the midline of the sacrum, its first branch curls around the vagina and the interior of the spinal column and enters the Kidneys, and its abdominal (second) branch ascends the midline of the abdomen and has an influence on the genital system in women.

Some herbs

Fu Zi Rou Gui Gan Jiang Chuan Jiao Gui Zhi possess heating qualities that are in keep

ing with the Governing vessel’s yang nature.

Case History

A 34 year old woman in her 31st week of pregnancy,suddenly for no apparent reason fel

t contraction of her uterus, lower abdominal pain, dull pain and soreness in the lower back that was also occasionally sharp in nature, and excessive thin white odourless vaginal discharge. There was no vaginal bleeding.

The tongue was pale red with little coating the pulse was slippery and fine; the chi (root) positions of the pulse were weak. Diagnose was preterm labour. The Chinese medicine diagnosis was “restless foetus” differentiated asKidney qi deficiency.

Shou Tai Wan add Dang Shen and Bai Zhu

Three days later, she reported no further pain in the abdomen, with only slight remaining soreness in her lower back.

However there was redness at the tip of her tongue which indicated the presence of heat, so this time I added Huang Qin to the formula.

at her due date she bore a healthy baby. This case is restless foetus caused by Kidney qi deficie

ncy. Shou Tai Wan is a formula for consolidating Kidney qi. Dang Shen and Bai Zhu added to tonify the Spleen an

d dry dampness in order to treat the excessive vaginal discharge.

Because of her red tongue tip showing heat, Huang Qin was added to the formula, especially because Huang Qin and Bai Zhu in combination are very good at calming the foetus.

Girdle vessel (Dai mai)

The Girdle vessel is the only horizontal vessel of the body.

It encircles the waist like a belt. The Girdle vessel encircles and influence

s all the channels in a longitudinal direction,and directly affects female physiology and pathology.

The Kidney’s functions of storing essence and lowering and holding qi

the Spleen’s function of raising qi The Liver’s function of smoothing the flow of qi all rely

on the Girdle vessel’s encircling of the body. Impairment of the Girdle vessel’s function can lead to a

decline in the Spleen’s ability to transform and transport food and drink.

contributing to dampness which may infuse downwards and cause excessive vaginal discharge.

Deficiency of the Girdle vessel results in the sinking of Spleen qi, which can induce a prolapse of the uterus.

The foetus depends not only on the Kidneys and the Conception vessel, but also on the Girdle vessel

If the Girdle vessel is slack, it fails to restrain essence, causing an unstable foetus, and the mother may have vaginal bleeding during pregnancy, a restless foetus or even miscarriage.

The Girdle vessel can be used in gynaecology to treat irregular periods, painful periods (dysmenorrhoea) and excessive vaginal discharge. Sheng Ma affects the Girdle vessel. has an ascending movement, and can be used to treat

pathological conditions of the Girdle vessel. Certain astringent herbs will enter the Girdle vessel, inc

luding Wu Wei Zi, Shan Yao, Qian Shi,Fu Pen Zi , Sang Piao

Xiao Dang Gui, Bai Shao , Xu Duan Long Gu, Ai Ye and Gan Cao.

Case History

A 34 year old woman suffered from excessive vaginal discharge for four months. The discharge was white, occasionally slightly yellow in colour, thi

ck in quality and odourless. She had a bearing-down sensation in the vagina, a sallow comple

xion, cold limbs, oedema of the medial aspect of the ankles, lassitude and loose stools.

The tongue was pale with a thin white greasy tongue coating soggy and weak pulse. examined by a gynaecologist, and no positive signs were found. The diagnosis was deficiency and sinking of Spleen qi. Wan Dai Tang add Sheng Ma and Long Gu

After one week of treatment, the patient felt much better. Three weeks later, she recovered

totally. Wan Dai Tang is a formula which treats the Spl

een qi deficiency pattern of leucorrhoea; Sheng Ma directs the flow of Spleen qi upward,

and Long Gu consolidates the Girdle vessel and astringes the leucorrhoea.

menopausemenopause

TCM doesn't recognize menopause as one parTCM doesn't recognize menopause as one particular syndrome. Instead, it aims in treating the ticular syndrome. Instead, it aims in treating the particular symptoms that are unique to each inparticular symptoms that are unique to each individual. For example, if ten women are treated dividual. For example, if ten women are treated with TCM for hot flashes and night sweats, eacwith TCM for hot flashes and night sweats, each of these ten women will likely receive a uniquh of these ten women will likely receive a unique, customized treatment with different acupuncte, customized treatment with different acupuncture points, different herbs, and different lifestylure points, different herbs, and different lifestyle & diet recommendations. This gives a very efe & diet recommendations. This gives a very effective result. fective result.

Diagnosis of menopauseDiagnosis of menopause

+/- 49 years young, menses stop. Around this t+/- 49 years young, menses stop. Around this time symptoms & signs start to appear. Cycle bime symptoms & signs start to appear. Cycle becomes irregular, dizziness, blurred vision, tinnecomes irregular, dizziness, blurred vision, tinnitus, hot flashes, red complexion coming & goinitus, hot flashes, red complexion coming & going in waves, very emotional (anger, irritated, sag in waves, very emotional (anger, irritated, sadness, anxiety, etc.), edema, low back & knee dness, anxiety, etc.), edema, low back & knee weakness / pain, digestive problems, cold limbweakness / pain, digestive problems, cold limbs, & urinary disorders. s, & urinary disorders.

These do not come all at once, some women oThese do not come all at once, some women only get a few & some women encounter many. nly get a few & some women encounter many. This may last for weeks to years in some cases.This may last for weeks to years in some cases.

TCM diagnosis can be divided into 3;TCM diagnosis can be divided into 3; 1. menstrual cycle gets very irregular, bleed a lot, may 1. menstrual cycle gets very irregular, bleed a lot, may

be serious hemorrhage. Then may experience very ocbe serious hemorrhage. Then may experience very occasional menses until they cease completely. May loscasional menses until they cease completely. May lose hair from blood ↓.e hair from blood ↓.

2. ↓ Yang symptoms → Yang rises due to Yin ↓ (relativ2. ↓ Yang symptoms → Yang rises due to Yin ↓ (relative Yang ↑). WM says this is due to blood vessels contrae Yang ↑). WM says this is due to blood vessels contraction. Sudden heat → break sweat (hot flashes), dizzinction. Sudden heat → break sweat (hot flashes), dizziness, palpitations & rapid pulse.ess, palpitations & rapid pulse.

3. emotional imbalances → easy to anger, sadness et3. emotional imbalances → easy to anger, sadness etc.. Manic behavior, depressed, abnormal, violence, & ic.. Manic behavior, depressed, abnormal, violence, & insomnia are all common. A blood test may show high nsomnia are all common. A blood test may show high FSH meaning ovary function has ceased. FSH meaning ovary function has ceased.

EtiologyEtiology

1. 1. KI Yin KI Yin ↓ - pregnancy, menses, br↓ - pregnancy, menses, breastfeeding & abortions consume Essenceastfeeding & abortions consume Essence & Tian Gui, Chong & Ren can’t be nourie & Tian Gui, Chong & Ren can’t be nourished. This creates hyper Yang rising.shed. This creates hyper Yang rising.

2. 2. KI YangKI Yang ↓ - use of a lot of KI Qi fo ↓ - use of a lot of KI Qi for pregnancy, menses, breastfeeding & abr pregnancy, menses, breastfeeding & abortion consume the Ming Men Fire → KI ortion consume the Ming Men Fire → KI Yang is ↓ --cold signs. Yang is ↓ --cold signs.

Pathogenesis Differentiation & TrePathogenesis Differentiation & Treatmentatment

1. 1. KI YinKI Yin ↓ ↓ - occasional menses → scanty → cease compl- occasional menses → scanty → cease completely. Vaginal dryness & itchinessetely. Vaginal dryness & itchiness

PlusPlus – Yin ↓ sym. dizzy, tinnitus, insomnia, night – Yin ↓ sym. dizzy, tinnitus, insomnia, night sweats, afternoon heat feelings, back/knee pain/weakness, hot flasweats, afternoon heat feelings, back/knee pain/weakness, hot flashes w/ sweating, whole body itchiness.shes w/ sweating, whole body itchiness.

T- red w/ scanty coat P- thin rapidT- red w/ scanty coat P- thin rapid P/TP/T – nourish KI Yin – nourish KI Yin Zou Gui Wan (essence) or…Zou Gui Wan (essence) or… Liu Wei Di Huang Wan + Huang Bai, Zhi MLiu Wei Di Huang Wan + Huang Bai, Zhi M = Zhi Bai Di Huang Wan= Zhi Bai Di Huang Wan + E Jiao, Gui Ban, Bie Jia, He Shou Wu, Nu Zhen Zi+ E Jiao, Gui Ban, Bie Jia, He Shou Wu, Nu Zhen Zi

KI YangKI Yang ↓ ↓ HEAVY periods, irregular uterine bleedinHEAVY periods, irregular uterine bleedin

g, then gradually finish menses completelyg, then gradually finish menses completely T- pale P- deep thinT- pale P- deep thin PlusPlus – Yang ↓ sym. cold, soft stools, ↑ frequen – Yang ↓ sym. cold, soft stools, ↑ frequen

cy of urine, incontinence,cy of urine, incontinence, low back/knee weakness/pain, Edema of lower low back/knee weakness/pain, Edema of lower

limbs &/or face.limbs &/or face. P/TP/T – warm KI Yang – strengthen SP – warm KI Yang – strengthen SP You Gui Wan + Li Zhong Wan You Gui Wan + Li Zhong Wan

Usually KI Yin & Yang deficiencies are complUsually KI Yin & Yang deficiencies are complicatedicated……

P/TP/T – nourish KI Yin & Yang – nourish KI Yin & Yang Er Xian Tang (this may be taken long terEr Xian Tang (this may be taken long ter

m)m) EMERGENCY HEMORRHAGEEMERGENCY HEMORRHAGE Shen Fu TangShen Fu Tang + stop bleeding herbs (Xian He Cao, Ai Ye Cao, + stop bleeding herbs (Xian He Cao, Ai Ye Cao,

Bai Ji, Han Lian Cao)Bai Ji, Han Lian Cao)

Benefits of TCM for FertilityBenefits of TCM for Fertility Increases blood flow to the uterus Increases blood flow to the uterus Can regulate hormones and entire endocrine system Can regulate hormones and entire endocrine system Promotes ovulation Promotes ovulation Helps thicken the lining of the uterus if it is too thin Helps thicken the lining of the uterus if it is too thin Relaxes the uterus Relaxes the uterus Improves function of the ovaries Improves function of the ovaries Reduces stress Reduces stress Strengthens the immune system Strengthens the immune system Supports a healthy pregnancy and prevents miscarriages Supports a healthy pregnancy and prevents miscarriages Treats the side effects of western pharmaceutical medications Treats the side effects of western pharmaceutical medications For men, it improves the quality and quantity of spermFor men, it improves the quality and quantity of sperm

Causes of infertilityCauses of infertility

Kidney DeficiencyKidney Deficiency This kind of infertility involves irregular This kind of infertility involves irregular

menstruation with scanty light flow. It is menstruation with scanty light flow. It is accompanied with general fatigue, dizziness, accompanied with general fatigue, dizziness, tinnitus, and lower back & knees soreness.tinnitus, and lower back & knees soreness.

Blood DeficiencyBlood Deficiency This kind of infertility involves scanty flow of This kind of infertility involves scanty flow of

light red blood and delayed cycles. It is light red blood and delayed cycles. It is accompanied by loss of weight, dull accompanied by loss of weight, dull complexion, dizziness, and general fatigue.complexion, dizziness, and general fatigue.

Cold in the UterusCold in the Uterus Sometimes the menstruation is delayed with daSometimes the menstruation is delayed with da

rk red flow with clots. The flow is often dilute. It rk red flow with clots. The flow is often dilute. It is accompanied by cold extremities, cold pain iis accompanied by cold extremities, cold pain in lower abdomen alleviated by warmth, and fren lower abdomen alleviated by warmth, and frequent profuse urination.quent profuse urination.

Phlegm-DampnessPhlegm-Dampness This is often in overweight people with prolongThis is often in overweight people with prolong

ed menstruation or even no periods and profused menstruation or even no periods and profuse discharge of sticky leucorrhea. e discharge of sticky leucorrhea.