Understanding Gynecology in TCM

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Understanding Gynecology in TCM

• Zhangqinhua
• Gynecology of Shuguang hospital

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link

• Menopause
• Infertility
• Extra eight meridians

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physiological structures

• women have special physiological structures like
  the uterus that affect menstruation, pregnancy,
  childbirth and lactation.
• These organs especially need blood and qi to
  function with the meridians acting as
  communicating channels.
• the physiological functions are dependent upon
  the promotional effects of the organs,meridians,
  blood and qi working together.

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Zang and fu

• physiological functions of the uterus are
  associated with the heart, liver, spleen and
  kidneys as well as the Conception and
  Thoroughfare Vessels.
• The heart rules the blood.
• The liver stores the blood.
• The spleen governs the blood.
• The kidneys store essence.
• The Conception and Thoroughfare Vessels control
  qi and blood in the uterus.

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eight meridians

• Normal physiological functioning also depends on
  the proper regulation of the eight meridians.
• Because the majority of uterine qi and blood
  travels within these meridians, the relationship
  of the uterus and the extra meridian network is
  extremely close.

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eight meridians

• Their main function is to strengthen the links
  between the twelve regular meridians and to
  regulate qi and blood circulation.
• They have special relationships with the liver,
  kidney, spleen, uterus, brain and marrow and thus
  influence these structures physiologically and
  pathologically.

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Blood and qi

• Menstruation, pregnancy, childbirth and lactation
  are unique to women.
• Blood is the elementary basis of these
  physiological functions hence there is the saying
  that "women take blood as primary." \
• TCM believes that a woman is always in a state of
  blood insufficiency and is relatively excess qi
  inside the body.
• However, the blood and qi mutually generate and
  depend on each other

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Seven emotions

• The seven emotions exert their effects on various
  organs significantly.
• Anxiety and anger damage the liver, which then
  fails to regulate blood and qi flow.
• Pensiveness damages the spleen, which then loses
  its role in consolidating the blood.

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Pattern of chongrens dieases

• Cold sydrome in chongren
• Shaofuzhuyu tang
• Heat sydrome in chongren
• Qinliansiwu tang add zhixiangfu- true heat
• Danzhixiaoyaosan emotion lead to fire
• Liangditangempty yin
• Indeficiency sydrome in chongren
• Dangguidihuang tang

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• Uncontrol syndrome in chongren
• Shoutai pill
• stasis syndrome in chong ren
• Guizhifulin pill
• Zhuyu tanglt yilingaicuogt
• Dampness and blood stasis in chong ren
• Baijiangcao chaohu zhishi shaoyao gancao danshen
  gegen yimucao
• Ezhu shenmiren

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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.

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• One branchthe 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 vessels 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.

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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.

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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 mothers 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.

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easing morningsickness in pregnant women.

• subduing rebellious Penetrating vessel qi
• stop morning sickness
• Mu Xiang
• Sha Ren
• Chen Pi
• Su Ye

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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, scanty and without clots.
• She had had a digestive problem for three years
  with reduced appetite, 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 blood deficiency and emptiness of
  the Penetrating vessel
• Ba Zhen Tang plus E Jiao and Gou Qi Zi

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• 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.

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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 foetus,
• most important during pregnancy

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

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• The Conception vessel can be used to nourish the
  bodys
• 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.

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• 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.

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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 Penetrating
  vessel.

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Case History

• A 45 year old female patient
• Hot flushes, night sweating and irritability for
  six months, accompanied by soreness of the lower
  back,
• heavy and irregular periods with red blood which
  was thick 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.

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• 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
  symptoms.
• Zhi Bai Di Huang Wan and Zuo Gui Wan are
  traditional 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.

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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.

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Some herbs

• Fu Zi
• Rou Gui
• Gan Jiang
• Chuan Jiao
• Gui Zhi
• possess heating qualities that are in keeping
  with the Governing vessels yang nature.

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Case History

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

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• 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.

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• at her due date she bore a healthy baby.
• This case is restless foetus caused by Kidney qi
  deficiency.
• Shou Tai Wan is a formula for consolidating
  Kidney qi.
• Dang Shen and Bai Zhu added to tonify the Spleen
  and 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.

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

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• The Kidneys functions of storing essence and
  lowering and holding qi
• the Spleens function of raising qi
• The Livers function of smoothing the flow of qi
  all rely on the Girdle vessels encircling of the
  body.
• Impairment of the Girdle vessels function can
  lead to a decline in the Spleens ability to
  transform and transport food and drink.
• contributing to dampness which may infuse
  downwards
• and cause excessive vaginal discharge.

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• 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.

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• 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, including
• 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.

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Case History

• A 34 year old woman
• suffered from excessive vaginal discharge for
  four months.
• The discharge was white, occasionally slightly
  yellow in colour, thick in quality and odourless.
  
• She had a bearing-down sensation in the vagina, a
  sallow complexion, 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

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• 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 Spleen
  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.

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menopause

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

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Diagnosis of menopause

• /- 49 years young, menses stop. Around this
  time symptoms signs start to appear. Cycle
  becomes irregular, dizziness, blurred vision,
  tinnitus, hot flashes, red complexion coming
  going in waves, very emotional (anger, irritated,
  sadness, anxiety, etc.), edema, low back knee
  weakness / pain, digestive problems, cold limbs,
  urinary disorders.
• These do not come all at once, some women only
  get a few some women encounter many. This may
  last for weeks to years in some cases.

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• TCM diagnosis can be divided into 3
• 1. menstrual cycle gets very irregular, bleed a
  lot, may be serious hemorrhage. Then may
  experience very occasional menses until they
  cease completely. May lose hair from blood ?.
• 2. ? Yang symptoms ? Yang rises due to Yin ?
  (relative Yang ?). WM says this is due to blood
  vessels contraction. Sudden heat ? break sweat
  (hot flashes), dizziness, palpitations rapid
  pulse.
• 3. emotional imbalances ? easy to anger, sadness
  etc.. Manic behavior, depressed, abnormal,
  violence, insomnia are all common. A blood
  test may show high FSH meaning ovary function has
  ceased.

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Etiology

• 1. KI Yin ? - pregnancy, menses, breastfeeding
  abortions consume Essence Tian Gui, Chong Ren
  cant be nourished. This creates hyper Yang
  rising.
• 2. KI Yang ? - use of a lot of KI Qi for
  pregnancy, menses, breastfeeding abortion
  consume the Ming Men Fire ? KI Yang is ? --cold
  signs.

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Pathogenesis Differentiation Treatment

• 1. KI Yin ? - occasional menses ? scanty ? cease
  completely. Vaginal dryness itchiness
• Plus Yin ? sym. dizzy, tinnitus, insomnia,
  night sweats, afternoon heat feelings, back/knee
  pain/weakness, hot flashes w/ sweating, whole
  body itchiness.
• T- red w/ scanty coat P- thin rapid
• P/T nourish KI Yin
• Zou Gui Wan (essence) or
• Liu Wei Di Huang Wan Huang Bai, Zhi
  M
• Zhi Bai Di Huang Wan
• E Jiao, Gui Ban, Bie Jia, He Shou Wu, Nu Zhen Zi

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• KI Yang ?
• HEAVY periods, irregular uterine bleeding, then
  gradually finish menses completely
• T- pale P- deep thin
• Plus Yang ? sym. cold, soft stools, ?
  frequency of urine, incontinence,
• low back/knee weakness/pain, Edema of lower limbs
  /or face.
• P/T warm KI Yang strengthen SP
• You Gui Wan Li Zhong Wan

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• Usually KI Yin Yang deficiencies are
  complicated
• P/T nourish KI Yin Yang
• Er Xian Tang (this may be taken long term)
• EMERGENCY HEMORRHAGE
• Shen Fu Tang
• stop bleeding herbs (Xian He Cao, Ai Ye Cao,
  Bai Ji, Han Lian Cao)

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Benefits of TCM for Fertility

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

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Causes of infertility

• Kidney Deficiency
• This kind of infertility involves irregular
  menstruation with scanty light flow. It is
  accompanied with general fatigue, dizziness,
  tinnitus, and lower back knees soreness.
• Blood Deficiency
• This kind of infertility involves scanty flow of
  light red blood and delayed cycles. It is
  accompanied by loss of weight, dull complexion,
  dizziness, and general fatigue.

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• Cold in the Uterus
• Sometimes the menstruation is delayed with dark
  red flow with clots. The flow is often dilute. It
  is accompanied by cold extremities, cold pain in
  lower abdomen alleviated by warmth, and frequent
  profuse urination.
• Phlegm-Dampness
• This is often in overweight people with prolonged
  menstruation or even no periods and profuse
  discharge of sticky leucorrhea.

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