Transcript Understanding Gynecology in TCM

Understanding
Gynecology in TCM
Zhangqinhua
Gynecology of Shuguang hospital
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 Menopause
 Infertility
 Extra eight meridians
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.
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.
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.
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.
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
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.
Pattern of chongren’s
dieases
 Cold sydrome in chongren
 Shaofuzhuyu tang
 Heat sydrome in chongren
 Qinliansiwu tang add zhixiangfu- true heat
 Danzhixiaoyaosan –emotion lead to fire
 Liangditang—empty yin
 Indeficiency sydrome in chongren
 Dangguidihuang tang
 Uncontrol syndrome in chongren
 Shoutai pill
 stasis syndrome in chong ren
 Guizhifulin pill
 Zhuyu tang< yilingaicuo>
 Dampness and blood stasis in chong ren
 Baijiangcao chaohu zhishi shaoyao gancao
danshen gegen yimucao
 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 morning
sickness in pregnant women.
 subduing rebellious Penetrating vessel qi
 stop morning sickness
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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,
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
 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
foetus,
 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
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 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
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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.
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.
 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.
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
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Fu Zi
Rou Gui
Gan Jiang
Chuan Jiao
Gui Zhi
possess heating qualities that are in
keeping 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
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
 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
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.
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.
 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.
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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.
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
 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.
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.
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.
 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.
Etiology
1. KI Yin ↓ - pregnancy, menses,
breastfeeding & abortions consume
Essence & Tian Gui, Chong & Ren can’t
be nourished. This creates hyper Yang
rising.
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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
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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
 KI Yang ↓
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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
 Usually KI Yin & Yang deficiencies are
complicated…
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P/T – nourish KI Yin & Yang
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Er Xian Tang (this may be taken long term)
 EMERGENCY HEMORRHAGE
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Shen Fu Tang
 + stop bleeding herbs (Xian He Cao, Ai Ye Cao,
Bai Ji, Han Lian Cao)
Benefits of TCM for
Fertility
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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
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.
 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.