TCM Gynaecological Diseases

TCM Gynaecological Diseases
Dr. Weixiang Wang
Definition
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Jing – Menstruation
Dai – Leukorrhea
Tai – Pregnancy
Chan – Delivery
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Bao Gong – Uterus, house of the fetus.
Zi Men – Cervix
Yin Dao – Vagina
Ru Fang – Milk House
Women’s physiology
¡ 
¡ 
Women’s physiology is dominated by Blood as the Lower
Burner houses the Uterus which stores Blood. In women,
Blood is not only the source of the periods but also of fertility,
conception, pregnancy and childbirth. In order to understand
women’s physiology, it is useful to compare it and contrast it
with men’s physiology.
Women pertain to Yin but some aspects of their physiology
are Yang; men pertain to Yang but some aspects of their
physiology are Yin. Women’s physiology is rooted in Blood
men’s in Qi; men store Essence, women store the Uterus,
Blood and fetus.
Women’s physiology
“Men store Essence, women the Uterus and the fetus. Men
take Qi as their foundation, they are Yang constitutionally but
Yin functionally; the sperm is white but can be red if there is
Fire. Women take Blood as their foundation; they are Yin
constitutionally but Yang functionally; menstrual blood is red but
it can be white if there is Phlegm”.
“Men pertains to Yang but there is Yin within Yang. The Yin
number is 8 so man’s Yang essence rises at the age of 8 and
is abundant at the age of 16. Women pertains to Yin but there
is Yang within Yin. The Yang number is 7 so woman’s
essence rises at the age of 7 and is abundant at the age of 14.
Menstruation
¡  Menarche
Industrialized countries
10-15 y.o
China
13-15 y.o
Menarche: 2x7
Years with menses: 5x7
Menopause: 7x7
Cycle of a period: between 3x7 to 5x7
Duration of bleeding: ½ x7 to 7
Menstruation
Amount: 50 – 80 ml
Day 1
Light
Day 2-3
Heavier
Day 4 after
Light
Color:
Day 1
Light red
Day 2-3
Dark red
Day 4 after
Light red
Quality:
mild thickness
no clots
no odor
Menstruation – rare phenomenon
¡  Bing
yue: every 2 months one menstruation
¡  Ju jing: every 3 months one menstruation
¡  Bing nian: once a year
¡  An jing: no menstruation but can be pregnant
¡  Shi nu: no menstruation, cannot be pregnant
¡  Ji jing: early stage of pregnancy with light
menstruation without interference of fetus.
Uterus – Menstruation
Heart
uterus vessel (bao mai)
Uterus
uterus collaterals (bao luo)
Kidneys
Yellow Emperor on female Tiangui –
黃帝內經曰：「女子七歲，腎氣盛，齒更髮
長；二七天癸至，任脈通，太衝脈盛，月
事以時下，故有子；三七腎氣平均，故真
牙生而長極；四七筋骨堅，髮長極，身體
盛壯；五七陽明脈衰，面始焦，髮始墬；
六七三陽脈衰於上，面皆焦，髮始白；七
七任脈衰，太衝脈衰少，天癸竭，地道不
通，故形壞而無子也。」
Yellow Emperor on male Tiangui –
「丈夫八歲，腎氣實，髮長齒更；二八腎氣
盛，天癸至，精氣溢瀉，陰陽和，故能有
子；三八腎氣平均，筋骨勁強，故真牙生
而長極；四八筋骨隆盛，肌肉滿壯；五八
腎氣衰，髮墬齒槁；六八陽氣衰竭於上，
面焦，髮鬚頒白；七八肝氣衰，筋不能動，
天癸竭，精少，腎氣衰，形體階極；八八
則齒髮去。」
Shui gu zhi Qi
Water-grain Qi
Parents
Kidney Essence
Tian Gui
Menstruation
Pregnancy
Zangfu and menstruation
¡  Heart
– dominate blood.
¡  Liver – store blood.
¡  Spleen – control blood.
¡  Lung – dominate Qi which is
the commander of blood.
¡  Kidney – store essence
which transfer into blood.
menstruation
Spirit activities and consciousness
Heart – shen
Liver – plan-decision
making
Spleen – thoughts
Kidney – will power
menstruation
Extra Meridians and menstruation
Ren
Chong
Du
Dai
Uterus
Eight Hui Points with extraordinary meridians
LU7 – Ren mai – KD 6 – Yin qiao mai
Exterior syn.
GB41 – Dai mai – sj5 – Yang wei mai
Shaoyang syn.
SI3 – Du mai – BL62 – Yang qiao mai
Sp4 – Chong mai – pc 6 – Yin wei mai
Interior syn.
Zangfu syn.
Gyn.
Xi – cleft points
LU6 kongzui
PC 4 ximen
HT6 yinxi
SP8 diji
pain
LV6 zhongdu
KD5 shuiquan
KD8 jiaoxin – Yin qiao mai
KD 9 zhubin – Yin wei mai
pain
Blood
pain
Related aetiology and pathology
¡  7
emotions
¡  6 climatic evils
¡  Pre-heaven kid. Qi
deficiency
¡  Too many births
¡  Excessive sexual
activities
¡  Exhaustion
¡  Dysfunctional
Lv Sp Kd
¡  Disorders of Qi and Blood
¡  Injury
of Chong & Ren Mai
¡  Diseases
of menstruation
Diagnostic essentials
of menstrual diseases
¡  The
changes of duration and amount.
¡  Differentiate Late Period, amenorrhea from
physiological stop of menstruation (for example
pregnancy)
¡  Differentiate Long Period, Heavy Period, Flooding
and Trickling.
Pattern differentiation essentials
¡  Focus
on menses duration, amount, color, quality
and odor, besides other accompanied symptoms.
¡  The changes of Duration and Amount often
overlapped, for example, Early period often with
heavy menstruation; Late Period often with scanty
menstruation.
¡  Deficiency, excess, cold and heat all can cause
menstrual diseases.
Treatment principles
¡  Regulate
Qi and blood – which is dominating?
¡  Tonify kidney
¡  Strengthen spleen
¡  Dredge liver – stop therapy/herbs in time to
prevent liver yin consuming.
¡  Menstruation disorder cause other diseases
¡  Other diseases cause menstruation diseases
Menstruation related diseases
¡  Premenstrual
Syndrome – PMS
¡  Dysmenorrhoea
¡  Dysfunctional Uterine Bleeding
(Beng Lou)
¡  Menopausal Syndrome
¡  Irregular Menstruation
¡  Amenorrhoea
¡  Bleeding between periods
Irregular menstruation - 月经不调
Early periods – 月经先期
Late periods – 月经后期
Irregular periods – 月经先后无定期
Heavy periods – 月经过多
scanty periods – 月经过少
Long periods – 经期延长
The menstruation comes early, or late, or
irregular thrice in succession.
Early periods – 7 days↑early (once in two weeks)
Late periods – 7 days↑late (once in six weeks)
Irregular periods – earlier than 7 days or later than 7
days irregularly.
Time
Heavy 月经过多 – Scanty 月经过少
¡  Heavy
periods – heavier than before, can be
rather subjective due to difficult to gauge.
¡  scanty periods – light bleeding, last less than 2
days.
amount
Long period - 经期延长
¡  Long
periods – prolonged bleeding, longer than 7
days (can be up to 14 days), but regular cycle,
normal blood amount.
duration
Dysmenorrhea-痛经
¡  Painful
periods –
Before, during or after the menstruation.
Periodically attack
lower abdomen, sacral region, possible to legs.
¡  Severe case – nausea, vomiting or fainting.
Pain
Patterns – nature of Pain
¡ 
¡ 
¡ 
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¡ 
¡ 
Excessive: (severe) pain before or during menstruation,
dislikes pressure
Deficient: (dull) pain after or during menstruation, likes
pressure
Cold: more cramping pain, like warmth
Heat/damp-heat: more burning pain, dislikes heat
Blood stasis: stabbing pain, fixed location, refuses
pressure, pain relieved after blood clots, warmth?
Qi stagnation: distending pain, no fixed location, distending
in chest and hypochondriac region.
liver involving: sides of lower abdominal pain
kidney involving: lower back – sacrum pain
Kidney and Chong Mai involving: centre of lower abdominal pain.
Tian Gui
Reservoir
Patterns – Treatment
1. Qi stagnation and blood stasis – Ge Xia Zhu Yu Tang
2. Cold residue in uterus – Shao Fu Zhu Yu Tang
// Wen Jing Tang
3. Heat damp flowing downward – Qing Re Tiao Xue Tang
4. Qi and blood deficiency – Sheng Yu Tang
5. Kidney and liver deficiency – Tiao Gan Tang
Acupuncture
Main Points
Zhongji RN3, Ciliao BL32, Diji SP8, Sanyinjiao SP6
¡  Stagnation of Qi and Blood: Hegu (LI 4), Taichong (LV 3),
Shuidao (ST 28)
¡  Cold in the uterus: Guilai ST29, Guanyuan RN3, Zigong
(extra)
¡  Heat dampness: Yinlingquan SP9, Lieque LU7, Zhaohai KI6,
Taichong LV3, Sanjiaoshu BL22
¡  Deficiency of Qi and Blood: Zusanli (ST 36), Shenshu (BL
23), Guanyuan (REN 4)
¡ 
Prognosis
1. 
2. 
3. 
4. 
Empty patterns are easier to treat that the full patterns.
In case of complex patterns of excessive and empty, better
to eliminate the pathogenic factors first.
Take a treatment break during the menstruation.
Endometriosis caused dysmenorrhea takes longer than
functional painful period.
Disorders at period time – 经行病
These happen around the period (may be before, during or immediately after).
Breast distension
Fever
Headache
Body aches
Diarrhea
Epistaxia or haemoptysis
Mouth ulcers
Skin eruptions
Dizziness
Edema
Emotional disorders
Breast distension
Liver Qi stagnation – Cai Hu Shu Gan San
Yin deficiency of liver and kidney – Yi Guan Jian
Liver Qi stagnation – LV, GB and ST meridians
Yin deficiency of liver and kidney – LV. KD. BL. Meridian
Stomach
Liver
Fever
Blood heat – Qing Jing San
Yin deficiency of liver and kidney – Liang Di Tang
Deficiency of Qi and Blood – Bu Zhong Yi Qi Tang
Heat, Blood stasis – Xue Fu Zhu Yu Tang
Body constitute
Shi re
Blood heat – LI, LV Meridians
Yin deficiency of liver and kidney – KI, LV, SP, BL Meridians
Deficiency of Qi and Blood – BL, ST, SP, RN Meridians
Heat, Blood stasis – LI, SP, PC Meridians
Xu re
Headache
Blood deficiency – Ba Zhen Tang
Liver fire – Qi Ju Di Huang Wan
Blood stasis – Tong Qiao Huo Xue Tang
XU, Yu, Huo
Blood deficiency – RN, ST-SP, BL, LV Meridians
Liver fire – LV, GB, SJ, LI Meridians
Blood stasis – LV, SP, RN Meridians
Body aches
Blood deficiency – Dan Gui Bu Xue Tang
Blood stasis – Chen Tong San
k
c
a
l
s
n
Tendo
en
m
h
s
i
r
of nu
t
Blood deficiency – BL, ST, LV, RN Meridians
Blood stasis – SP, LV,BL Meridians
Diarrhea
Deficiency
Spleen deficiency – Shen Ling Bai Zhu San
Kidney deficiency – Si shen Wan
Spleen deficiency – RN, DU, SP, ST Meridians
Kidney deficiency – BL, RN, SP, KI Meridians
Epistaxia or haemoptysis
Stagnation of Qi turn into fire – Qing Gan Yin Jing Tang
Yin deficiency of Lung and kidney – Shun Jing Tang
Dao Jing
Stagnation of Qi turn into fire – LV, SP, LU Meridians
Yin deficiency of Lung and kidney – LU, KD, BL, RN Meridians
Mouth ulcers
KD Yin deficiency with empty fire – Zhi Bai Di Huang Wan
Stomach heat damp – Liang Ge San
KD Yin deficiency with empty fire – LU, KD, HT Meridians
Stomach heat damp – ST, LI,SP Meridians
Skin eruptions
Blood deficiency – Dang Gui Yin Zi
Wind heat invades blood – Qing Feng San
Spicy food
Blood deficiency – LV,SP, ST, BL Meridians
Wind heat invades blood – LU, LI, BL, KD Meridians
Dizziness
Blood deficiency – Gui Pi Tang
Hyperactive liver yang – Tian Ma Gou Teng Yin
Phlegm with spleen Qi deficiency – Ban Xia Ba Zhu Tian Ma Tang
Blood deficiency – SP, HT, RN, BL Meridians
Hyperactive liver yang – LV, KD, GB Meridians
Phlegm with spleen Qi deficiency – ST, SP, SJ Meridians
Edema
Yang deficiency of spleen and kidney – Ling Gui Zhu Gan Tang
Qi stagnation and blood stasis – Ba Wu Tang
Puffy sensation
Yang deficiency of spleen and kidney –BL, SP, KI,RN Meridians
Qi stagnation and blood stasis – LV, GB, SJ, RN, PC Meridians
Emotional disorders
Liver Qi stagnation – Xiao Yao San
Phlegm fire flaring up – Sheng Tie Luo Yin
Before period
Liver Qi stagnation – LV, SP, HT Meridians
Phlegm fire flaring up – ST, LI, PC, SJ Meridians
Bleeding between periods – 经间期出血
¡  Bleeding
between periods –
bleeding between 2 periods
on the day (1-2) of ovulation
it happens periodically
Ovulation
bleeding
Diagnosis
1. 
2. 
Between 2 periods, blood amount is less than
normal period, last 1-2 days.
Accompanied with lower back soreness, one or
both side-abdomen pain, breasts distension and
itching, more discharge of sticky as egg white
leucorrhea.
Differentiation diagnosis
¡  Early
period is not between periods, normal or a
bit heavy menses.
¡  Bleeding between periods: light bleeding.
¡  Scanty period: light period with regular intervals.
Aetiology and pathology
¡ 
¡ 
¡ 
¡ 
Overwork, too many children birth or too close together.
Irregular diet
Traumas, abdominal operations, post partum blood stasis.
Excessive physical exercise.
Patterns
¡  1,
kidney yin deficiency
¡  2, heat-dampness
¡  3, blood stasis
1. kidney yin deficiency
¡ 
¡ 
¡ 
Small amount bleeding between periods, red color, no clots,
no abdominal pain, dizziness, lower backache, light sleep,
difficult to discharge defecation with dark urine. Red tongue
body, thready and slight wiry with a bit rapid.
Liang Di Tang plus Er Zhi Wan
LU7, KD6, RN 6, SP6, KD3, RN7, KD13, SP10, SP8
2. heat-dampness
¡ 
¡ 
¡ 
Bleeding maybe heavy or scanty, sticky viscous blood, no
clots, tiredness, joints pain, oppression chest, poor appetite,
scanty dark urine, vaginal discharge. Sticky yellow fur and
slippery pulse.
Qing Gan Zhi Lin Tang
SP6, 8, 9, RN3,9, GB41 SJ5, BL20, ST29.
3, blood stasis
¡ 
¡ 
¡ 
Bleeding between periods that may be scanty or profuse,
dark clots, lateral abdominal distension or stabbing pain,
oppression chest and restlessness, purple tongue or with
purple spots, wiry pulse.
Zhu Yu Zhi Xue Tang
SP4, PC6, ST29, RN1, 6, 8, KD14, ST29.
Prognosis
1, acupuncture and herbal medicine has good
effectives on bleeding between periods though
patients and doctors needs patience.
2, in case of excessive dampness mixes with kidney
deficiency, better to eliminate dampness before
tonify kidney yin.
Amenorrhea - 闭经
¡ 
¡ 
No periods –
old than 18 years old.
have more than 3 months stop of menstruation.
Physical no periods –
pregnancy
breast feeding
happens right after the menarche
Patterns
¡ 
1. 
2. 
Excessive patterns
Qi stagnation and
blood stasis
Phlegm-damp blocks
the uterus
¡ 
1. 
2. 
3. 
Deficiency patterns
Liver kidney
deficiency
Qi and blood
deficiency
Yin deficiency and
blood dried up
1. Qi stagnation and blood stasis
¡ 
¡ 
¡ 
¡ 
No period for more than 3 months, irritability,
moodiness, abdominal distension and pain,
depression, dark complexion. Purple tongue wiry
pulse.
Shao Fu Zhu Yu Tang
Tao Hong Si Wu Tang
SP4, PC6,RN6,Zigong, LV3,SP6,KD14,KD6.
2. Phlegm-damp blocks the uterus
¡ 
¡ 
¡ 
¡ 
Prolonged cycle develop into no period, obesity,
vaginal discharge, lassitude, heaviness sensation,
oppressive chest, nausea. Swollen tongue with stick or
sticky-yellow coating which is thicker on the root,
slippery pulse.
Can Fu Dao Tan Wan plus Fo Shou San
Yu Dai Wan
SP9, SP6, BL22, ST27, GB41, SJ5, RN12, RN9, ST40.
3. Liver kidney deficiency
¡ 
¡ 
¡ 
¡ 
Menses not started by 18, or stopped after becoming
scanty, tiredness, lower back, knee joints pain,
dizziness, depression, mentally tired, lack of will-power,
feeling cold, pale tongue, deep weak pulse.
Gui shen Wan
Dang Gui Di Huang Yin
BL18, 23, 52,RN4, 6,17, LU7, SP6, KD3, KD16 Moxa
4. Qi and Blood deficiency
¡ 
¡ 
¡ 
¡ 
Menstruation stops after a few months decreasing periods,
dizziness, blurred vision, numbness and tingling, poor
memory, insomnia, palpitation, dull-pale complexion, dry
skin, falling hair, dry eyes, tiredness, pale and thin tongue
body, often swollen tongue, choppy or fine pulse.
Ren Shen Yang Rong Tang
Ba Zhen Tang
ST36,SP6, KD3, RN4,6,17,BACK-SHU POINTS OF
DIAPHRAM, LIVER, SPLEEN, STOMACH, KIDNEY, LUNG,
QIHAI GUANYUAN AND HEART.
5. Yin deficiency and blood dried up
¡ 
¡ 
¡ 
Menstruation decreasing gradually till no periods, five palms
fever, red zygoma, night sweating, or bone steaming fever,
or cough blood, red tongue scanty fur, thready and rapid
pulse.
Yi Guan Jian
LU7, KD6, LV2, LV8, SP10, SP6, BL62, LU5.
Prognosis
¡ 
¡ 
¡ 
¡ 
Amenorrhea respond well to herbal and acupuncture therapy
though it takes a bit long duration of therapy.
It is better to combine acupuncture with herbal medicine.
Only 3 succession months ensures the period recovered
truly.
Phlegm-dampness blocks the uterus is the most difficult
pattern from excessive while Kidney and liver yin deficiency
from deficient patterns.
Flooding and Trickling – 崩漏
Common but difficult to treat
¡  Beng
Lou –
Ben: it starts suddenly with a flood before the
proper time
Lou: a period continues with a trickle after the
proper time.
Differentiation:
flooding & trickling Vs. Heavy period
¡  Quantity:
Beng-flooding is heavier that Heavy period.
¡  Intervals: Heavy period indicates heavy blood loss
during the proper period at regular intervals. Floodingtrickling is a sudden, profuse without regular intervals.
Flooding
trickling
Abnormal
Duration
Heavy
Period
Abnormal
Amount
Pattern 1: Blood Heat Type
¡ 
¡ 
¡ 
Main Symptoms:
Sudden onset of profuse or prolonged vaginal bleeding in bright
red colour, thirst, irritability, red tongue with yellow coating,
rapid pulse; in case of Yin Deficiency following signs are usually
seen: dizziness, feverish sensation in the palms and soles, red
tongue, lack of coating, thready pulse.
Deficient heat: tidal fever/lower fever, empty and thready pulse
Form: Bao Yin Jian [Yin-Safeguarding Brew] Clears Heat,
Nourishes Yin, Regulates menstruation, Stops bleeding; P: Heat
and Blood Deficiency
Excessive heat: higher and persistant fever, dry stool/
constipation, full pulse.
Form: Qing Re Gu Jing Tang [Heat-Clearing Channel-Securing
(Menses-Securing) decoction] Clears excess Heat and Fire,
Cools Blood, Stops bleeding; P: Heat excess injuring Yin and
Blood
Pattern 2: Blood Stasis Type
¡ 
¡ 
¡ 
¡ 
Main Symptoms:
Irregular vaginal bleeding with clots, distending abdominal pain,
dark purple or stasis spotted tongue, white and thin coating,
unsmooth pulse.
Herbs and Formulae:
Si Wu Tang (Angel Four Form) + Shi Xiao San [Four Agents
Decoction + Sudden Smile Powder]; Enrich the Blood and regulate
the menstruation + Invigorates Blood, dispels Blood stasis,
disperses accumulation and alleviates pain; P: Blood deficiency
with or without Blood stasis + Retention of Blood stasis which
obstructs the network vessels in the lower abdomen. (Originally for
very severe post partum epigastric and abdominal pain))
Sheng Hua Tang (Post-Natal Form)
Gui Zhi Fu Ling Wan (Uter Form)
Pattern 3: Deficiency Type
¡ 
Main Symptoms:
Profuse bleeding or continuous scanty bleeding marked by light red and thin blood,
lassitude, shortness of breath, cold feeling and pain in the lower abdomen, pallor,
poor appetite, pale tongue with white and slippery coating, thin and weak pulse.
¡ 
Herbs and Formulae:
Kidney yin deficiency: Zuo Gui Wan + Er Zhi Wan [Left Restoring Pill + Double
Supreme Pill] ; Nourish Yin, tonify Kidney, supplement Essence and benefit marrow
+ Supplement kidney yin and nourish the liver.; P: Deficiency of Kidney (especially
marrow and Essence) + Deficiency of Liver and Kidney Yin
Kidney yang deficiency: You Gui Wan: [Right Restoring Pill (=Life Gate)] Warm and
tonify Kidney Yang, replenish Essence and tonify Blood; P: Kidney Yang deficiency
with waning of Ming Men Fire (beter without Rou Gui = too hot)
Spleen deficiency: Gu Ben Zhi Beng Tang [Root-Securing Flood-Stanching
Decoction] Tonifies Blood, augments Qi and stops bleeding; P: Inability of Spleen to
control the Blood leading to uterine bleeding.
Wu Ji Bai Feng Wan (White Phoenix Form)
Bu Zhong Yi Qi Tang (Middle Form)
Shi Quan Da Bu Wan (Ten Complete)
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
Acupuncture prescription
¡ 
Guanyuan (REN 4), Sanyinjiao (SP 6), Yinbai (SP 1)
¡ 
Excessive Heat - Xuehai (SP 10), Shuiquan (KI 5)
Yin Deficiency - Neiguan (PC 6), Zhaohai (KI 6)
Qi Deficiency - Pishu (BL 20), Zusanli (ST 36)
¡ 
¡ 
Premenstrual syndrome - 月经前后诸症
“premenstrual tension”, they may even last through
the first day of menstruation. Once the period has
begun, however, the symptoms usually disappear. The
underlying causes of PMS are hormonal changes in
the woman’s body, but why and how they produce
particular symptoms is unclear. They also vary from
one woman to another. In some cases, the physical
and especially the psychological symptoms are so
severe that women become practically incapacitated.
Doctors then speak of “premenstrual dysphoric
disorder” (PMDD).
Possible Symptoms of PMS
¡ 
生理问题(Physical):
头痛(headache)
头昏眼花(dizziness)
痤疮(acne)
上臂肿胀和腿关节或肌肉疼痛
(swelling in arms and legs
joint or muscle pain)
乳房疼痛(sore breasts)
背痛(back pain)
便秘或腹泻(constipation or diarrhea)
腹胀(bloated abdomen)
腹痛或痛经(abdominal pain or cramps)
呕吐(nausea)
¡ 
精神问题
(Psychological):
喜怒无常(moodiness)
易怒(irritability)
健忘(forgetfulness)
定向障碍(confusion)
焦虑(anxiety)
愤怒(anger)
紧张(tension)
哭泣(tearfulness)
食欲改变(appetite
changes)
疲乏(fatigue)
失眠(insomnia)
消沉(depression)
TCM
Premenstrual Syndrome is a specific symptom
complex manifested as distending pain in the
breasts or costal and hypochondriac region,
headache, dizziness, irritability, insomnia, or loose
stool and lassitude, etc. which appears several
days before menstruation. In TCM it is closely
related to the Liver, Kidney, Heart and Spleen.
Pattern 1: Liver Qi Stagnation
¡ 
Distending pain in the breasts or costal and hypochondriac region
several days before the menstruation; colic and distending pain in the
lower abdomen after menstruation started, scanty bleeding in fresh
colour, or dark clots visible, or accompanied by headache and
irritability. White or red-tipped tongue with yellow coating, wiry pulse.
Herbs and Formulae:
¡  (Chai Hu) Shu Gan Wan (Auranti Form): excessive with more emotion
mostly excessive cause: Sooth the Liver the relieve stagnation;
Regulate the flow of Qi to alleviate pain; P: Stagnation of Liver Qi.
¡ 
Xiao Yao Wan (Ease Form): liver blood deficiency, less intense
depression, less or no wiry pulse: [3.3] Sooth stagnated Liver-Qi and
remove stagnation; Strengthen Spleen and harmonise Ying; P:
Disharmony of Liver and Spleen (stagnation of Liver Qi with deficiency
of Blood and Spleen Qi)
Pattern 2: Yin Deficiency of Liver and Kidney
Dull pain in the costal and hypochondriac region or distending colic
pain in the lower abdomen before menstruation, excessive bleeding
in fresh red or pale colour; dizziness, vertigo, dryness of the mouth,
tinnitus; red tongue with scanty coating and thready wiry pulse.
Herbs and Formulae:
¡  Yi Guan Jian (Brew Form): more liver yin deficiency than kidney yin
deficiency: Nourish Yin and ease stagnated Liver; (more Liver then
Kidney); P: Yin deficiency of Kidney and Liver with depressed Liver
Qi
¡  Zhi Bai Di Huang Wan (Eigth Form): Nourish Yin of Liver and Kidney
and clear Fire for empty Heat; P: Flaring up of Fire due to Yin
deficiency
¡  Liu Wei Di Huang Wan (6 form): for milder cases with less empty heat
signs
Pattern 3: Deficiency of the Heart and Spleen
¡  Palpitation,
insomnia, lassitude, cold limbs, loose
stool before menstruation, thin and profuse
leucorrhoea, pale tongue, white coating, deep and
thready pulse.
Herbs and Formulae:
¡  Gui Pi Tang (Lilly Form [Return Spleen
Decoction]): Invigorate Qi and nourish Blood,
strengthen Spleen and Heart; for Blood deficiency;
P: Deficiency of Heart Blood and Spleen Qi
Pattern 4: Kidney and spleen yang deficiency
Main Symptoms:
Morning diarhhoea, cold limbs, lower back pain, knee pain,
clear and long urine, loose stool (can be with undigested
food), edema/puffy face, lassitude, low sex drive, tongue pale
and swollen, pulse weak and deep.
Herbs and Formulae:
¡  You Gui Wan: Warm and tonify Kidney Yang, replenish
Essence and tonify Blood; P: Kidney Yang deficiency with
waning of Ming Men Fire
¡ 
Pattern 5: phlegm obstructing the heart
Main Symptoms:
Maniac, for nuts, aggressive, yellow sticky tongue coating,
bloodshed eyes.
¡  Herbs and Formulae:
Wen Dang Tang - Regulate Qi and resolve Plegm; Clear
Heat in Gallbladder and regulate Stomach for Phlegm turned
into Heat; P: Phlegm-Heat in interior, disharmony of
Gallbladder and Stomach plus
Meng Shi Gun Tan Wan - Drain Fire and drive out Phlegm;
P: Excess Heat with chronic Phlegm or Phlegm-Fire
¡ 
Acupuncture prescription
Main Points:
Hegu (LI 4), Sanyinjiao (SP 6), Guanyuan (REN 4)
¡  Supplementary Points:
¡  Stagnation of Liver Qi - add: Neiguan (PC 6), Taichong (LV
3)
¡  Yin Deficiency - add Zhaohai (KI 6), Fengchi (GB 20)
¡  Deficiency of Heart and Spleen - add Zusanli (ST 36),
Shenmen (HT 7)
¡  Spleen and Kidney yang deficiency: RM 4, DM4, Sp6, BL20,
BL23, ST 36, SP3, KI3, KI6+LI7
¡  Phlegm obstructing heart: PC7 Daling, ST40, ST8, DU24
¡ 
Menopause syndrome - 绝经前后诸症
¡  Menopause
vs Menopause syndrome
¡  Premature menopause
¡  Surgical menopause syndrome
¡  Age: <42, >56
Western medicine
¡  The
symptoms of menopause are caused
by changes in estrogen and
progesterone levels. As the ovaries
become less functional, they produce
less of these hormones and the body
responds accordingly. The specific
symptoms vary from woman to woman
from mild, moderate, to severe.
The potential symptoms
Hot flashes and skin flushing
¡  Night sweats
¡  Insomnia
¡  Mood swings including irritability, depression,
and anxiety
¡  Irregular menstrual periods
¡  Spotting of blood in between periods
¡  Vaginal dryness and painful sexual intercourse
¡  Decreased sex drive
¡  Vaginal infections
¡  Urinary tract infections
The long-term effects of menopause include:
¡  Bone loss and eventual osteoporosis
¡  Changes in cholesterol levels and greater risk of
¡ 
HORMONE REPLACEMENT THERAPY
¡ 
¡ 
¡ 
For years, hormone replacement therapy (HRT) was
the main treatment for menopause symptoms. Many
physicians believed that HRT was not only good for
reducing menopausal symptoms, but also reduced the
risk of heart disease and bone fractures from
osteoporosis. However, the results of a major
study -- called the Women's Health Initiative -has led physicians to revise their recommendations.
In fact, this important study was stopped early
because the health risks outweighed the health
benefits. Women taking the hormones did see some
benefits. But they greatly increased their risk
for breast cancer, heart attacks, strokes, and
blood clots.
If your symptoms are severe, you may still want to
consider HRT for short-term use (2-4 years) to
reduce vaginal dryness, hot flashes, and other
Prevention
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
Menopause is a natural and expected part of a
woman's development and does not need to be
prevented. However, there are ways to reduce or
eliminate some of the symptoms that accompany
menopause. You can also reduce your risk of longterm problems like osteoporosis and heart disease.
DO NOT smoke -- cigarette use can cause early
menopause
Exercise regularly to strengthen your bones,
including activity that works with the resistance
of gravity
Take calcium and vitamin D
Eat a low-fat diet
If you show early signs of bone loss, consult with
doctor about medications that can help stop
further weakening
Control your blood pressure, cholesterol, and
other risk factors for heart disease
TCM Aetiology
From a TCM point of view, it is primarily attributed
to a dysfunction of the Kidney, which gives rise to
disorders of the Spleen, Heart and Liver.
¡  Emotional
stress
¡  Overwork
¡  Too
many children too close together
Patterns and treatment
¡  Kidney
yin
deficiency
¡  Kidney
yang
deficiency
1.  General Kd yin deficiency
2.  Lv and Kd yin deficiency
3.  Disharmony between Ht and Kd
1.  General Kd yang deficiency
2.  Kd yang and Kd yin deficiency
Menopause syndrome
- Kidney Yin deficiency
¡ 
General Kd yin
deficiency
¡ 
Lv and Kd yin
deficiency
¡ 
Disharmony between
Ht and Kd
ZUO GUI YIN
ZUO GUI YIN
ER ZHI WAN
TIAN WANG BU XIN DAN
Menopause syndrome
- Kidney Yang deficiency
¡ 
General Kd yang
deficiency
¡ 
Kd yang and Kd
yin deficiency
YUO GUI YIN
LI ZHONG WAN
ER XIAN TANG
ER ZHI WAN
Acupuncture prescription
Main points
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
Baihui (DU 20)
Dazhui (DU 14)
Guanyuan (REN 4)
Shenshu (BL 23)
Shenmen (HT 7)
Sanyinjiao (SP 6)
Zusanli (ST 36)
Taichong (LV 3)
Taixi (KI 3)
Other points
¡ 
¡ 
¡ 
¡ 
¡ 
¡ 
Neiguan (PC 6)
Jianshi (PC 5)
Ligou (LV 5)
Yinxi (HT 6)
Fuliu (KI 7)
Shenmai (BL62)
Diet and Life style modification
calm
relax
Diet
Warning!!!
¡ 
Never think that you understand the
world.
¡ 
Until you understand women very well
¡  Some
more basic information also
good to know…
Leukorrhea
¡ 
¡ 
¡ 
¡ 
- Normal vaginal discharge should be thin,
clear, & have no odor. Around ovulation it
may be a little thicker, like a raw egg white.
- Before period or during pregnancy the
amount may be more.
- Normal healthy discharge comes from the
Kidneys for proper lubrication.
- When old this normal lubricant can dry up
due to Kidney Yin Def.
Pregnancy
¡ 
¡ 
¡ 
¡ 
¡ 
- After Menarche – until Menopause women
are able to conceive.
- The duration of this period of time is
closely related to Kidneys, especially the
Yin-essence.
- Combined with the Yang-essence from
men, you have conception.
- Shen enables development to start.
- From 1st day of last period, gestation is
280 days, or +/- 10 months.
Pregnant Steps
Menses stop, picky for food (sour, tasteless), morning
sickness 9-12 weeks, dizziness, fast slippery forceful
pulse, nipples change colour & may get itchy.
12+/- weeks feel Uterus. 16+/- can feel movement.
After 20 weeks start to show. 20+/- weeks breasts
may get leaky, baby reaches umbilicus. 24 weeks if
problems are to come around now is the time – back
pain, pee problems, blood def., edema (poor circ.).
30-36 weeks, very careful with diet because of
increase in appetite, eat healthy, not too much, less
carbohydrates & fats. Normal to gain 20-25 lbs, 40 is
too much. 36+/- weeks baby head drops down, treat
between 32-36 weeks to turn fetus.
Delivery
- Three things a woman MUST do; relax, get enough sleep, and
take it slow & easy.
“When the fruit is ready, it will fall.”
Pre-delivery – will start with regular contractions, may start spotting
blood when cervix opens. Water breaks for lubrication, if it breaks
early before dilation the cord can flow down with the water and wrap
around the neck.
Post-partum
- Mom and baby should rest for I month and take
good care of themselves as to restore Qi and
Blood.
- Wear flat soft shoes.
Within first week – may experience light fever,
spontaneous sweat, aversion to cold.
Milk starts 4-24 hours after delivery, first milk is
slightly yellowish & full of antibodies.
1 week – month, abdominal pain may arise from
blood stasis, this is quite normal. Bloody clotty
discharge, dark turning to pale from lots to a little
happens over 3 weeks. this gradual decline is
normal.
Breastfeeding
- 4-24 hours after birth milk should come.
- The first milk is absolutely essential for the
health of the child.
- Initially feed a lot to get the milk ducts flowing
freely.
- Eat well as to nourish blood for milk production.
- Milk will gradually reduce after 6-8 months.
MORNING SICKNESS
Morning sickness is a commonly seen disorder
appearing in the early stage of pregnancy,
marked by a group of syndromes including
nausea, vomiting, dizziness and anorexia.
Severe condition may emaciate the pregnant
women very quickly and induce other diseases.
From a TCM point of view, morning sickness is
often due to Deficiency of Stomach Qi, upward
flow of fetal Qi invading the Stomach, or
disharmony between the Stomach and the
Liver.
Differentiation and Treatment
¡ 
¡ 
1. Deficiency of the Spleen and Stomach
Main Symptoms:
Nausea and vomiting of liquid or undigested food
immediately after the meals, feeling of fullness and
distension in the chest, lassitude and sleepiness, pale
tongue with white coating, slippery and weak pulse during
the first trimester of pregnancy.
¡ 
¡ 
Treatment Principle: reinforce Spleen and Stomach,
descend the Stomach Qi to relieve vomiting
2. Disharmony between the Liver and Stomach
¡ 
¡ 
Main Symptoms:
Vomiting of bitter or sour liquid, epigastric fullness
and hypochondriac pain, frequent belching and
sighing, mental depression, dizziness and eye
distension, white or yellow tongue-coating, red
tongue, wiry and slippery pulse.
Treatment Principle:harmonize the Liver and
Stomach
Acupuncture Treatment
Main Points:
Zusanli (ST 36), Neiguan (PC 6), Zhongwan (REN 12)
¡  Supplementary Points:
¡  Deficiency of the Spleen:
add Gongsun (SP 4), Shangwan (REN 13)
¡  Disharmony between Stomach and Liver
add Taichong (LV 3), Tanzhong (REN 17)
¡  Method: Even movement is applied.
¡ 
THREATENED ABORTION
¡ 
¡ 
The condition in which there is a small amount of vaginal
bleeding during pregnancy without lumbar soreness and
abdominal pain is described as “Tai Lou” (colporrhagia
during pregnancy); while another condition can occur with
lumbar soreness, abdominal pain or distension in the lower
abdomen with a small amount of vaginal bleeding. Both of
the two conditions are the premonition of fetal abortion or
miscarriage.
Threatened abortion in TCM is attributed to weak
constitution, Deficiency of Kidney Qi, or Deficiency of Qi and
Blood which results in the fetus failing to be nourished, or
constitutional excessive Yang giving rise to abnormal bloodflow.
Differentiation and Treatment
¡ 
¡ 
¡ 
1. Kidney Deficiency
Main Symptoms:
Vaginal bleeding, dark in colour, soreness in the
back, gravitating pain in the lower abdomen, or
dizziness, tinnitus, or a history of several
abortions, pale tongue with white fur, deep and
weak pulse, especially at the Chi site.
Treatment Principle: Reinforce the Kidney and
tonify Qi
2. Deficiency of Qi and Blood
¡ 
¡ 
Main Symptoms:
A small amount of vaginal bleeding during
pregnancy with pale blood, gravitating and
distending sensation in the waist and abdomen,
accompanied with spiritlessness and lassitude
in the limbs, pale complexion, palpitations,
shortness of breath, pale tongue with thin white
fur, thready and slippery pulse.
Treatment Principle: Tonify Qi and Blood,
reinforce the Kidney to prevent abortion
3. Heat in the Blood
¡ 
¡ 
Main Symptoms:
Vaginal bleeding (bright in colour) during
pregnancy, or gravitating and distending pain in
the waist and abdomen, accompanied by
restlessness, feverish sensation in the palms
and soles, dry mouth and throat, red tongue
with yellow and dry fur, slippery and rapid pulse.
Treatment Principle: Nourish Yin and Blood,
clear heat to calm the fetus
CHRONIC PELVIC INFLAMMATION
¡ 
¡ 
This disease refers to a chronic inflammation
occurring in the internal genital organs, pelvic
connective tissue and pelvic peritoneum. The
main manifestations are distending and
gravitating pain in the lower abdomen, soreness
and pain in the lumbosacral region, or
accompanied by frequent urination, profuse
leucorrhoea and fever.
It is attributed to down-ward flow of Damp Heat,
or Blood deficiency with retention of Cold
Dampness.
Differentiation and Treatment
¡ 
¡ 
¡ 
1. Downward flow of Damp Heat
Main Symptoms:
Fever, headache, distending pain and
tenderness in the lower abdomen, profuse
leucorrhoea, yellow or red and white in mixed
colour, frequent and yellow urination, dry stool,
red tongue with yellowish sticky coating,
slippery and rapid pulse.
Treatment Principle: Clear heat and detoxicate,
eliminate Dampness
2. Blood Deficiency with retention of Cold Dampness
¡  Main
Symptoms:
Dull pain in the lower abdomen,
responding to warmth and pressure,
soreness and pain in lumbosacral region,
profuse leucorrhoea, clear and thin, pale
tongue with white sticky coating, thready
and slow pulse.
¡  Treatment Principle: Nourish Blood,
disperse Cold, eliminate Dampness
Acupuncture Treatment
¡  Main
Points:
Daimai (GB 26), Baihuanshu (BL 30),
Qihai (REN 6), Sanyinjiao (SP 6)
¡  Supplementary Points:
predominant Damp Heat: add Xingjian
(LV 2), Yinlingquan (SP 9)
predominant Damp Cold: add
Guanyuan (REN 4), Zusanli (ST 36)
with moxibustion
HYPERPLASIA OF THE MAMMARY GLANDS
¡  Hyperplasia
of the mammary glands is
mostly seen in females of 20-45 years
and manifests as distending pain in the
breasts and multiple mammary lumps.
TCM considers hyperplasia of the
mammary glands within the realm of “Ru
Pi”(nodules of the breast), it is attributed
to stagnant Liver Qi with retention of
phlegm, or dysfunction of the Chong and
Ren meridians.
Differentiation and Treatment
¡ 
¡ 
¡ 
1. Stagnation of Liver Qi with retention of
phlegm
Main Symptoms:
More often in young women. Irritability, or
depression, distending or colic pain in the
breasts, aggravated before menstruation and
relieved afterwards, mammary lumps, irregular
in shape, pale tongue, white thin coating, wiry
pulse.
Treatment Principle: sooth the stagnant Liver
Qi,
activate the flow of Qi and Blood
2. Dysfunction of Chong and Ren Meridians
¡ 
¡ 
Main Symptoms:
More common in middle aged women. A
chronic course, emaciation, listlessness, or
afternoon tidal fever, insomnia, headache,
dizziness, irregular menstrual flow or even
amenorrhea, mammary lumps, flow of small
amount of liquid from the nipples, pale tongue,
white coating, deep and thready pulse.
Treatment Principle: Harmonize the Chong and
Ren meridians to resolve masses
Acupuncture Treatment
¡ 
¡ 
¡ 
Stagnation of Liver Qi
with retention of phlegm: Wuyi (ST 15), Rugen (ST 18),
Tanzhong (REN 17), Zusanli (ST 36)
Dysfunction of Chong and Ren Meridians: Tianzong (SI 11),
Jianjing (GB 21), Geshu (BL 17)
Supplementary Points:
for stagnant Liver Qi: add Taichong (LV 3), Hegu (LI 4)
for excessive Liver Fire: add Xiaxi (GB 43), Zhigou (SJ 6)
for Lv./Kd. Yin Deficiency: add Taixi (KI 3), Sanyinjiao (SP
6)
for Qi-Stag. with Blood Def.: add Yanglingquan (GB 34),
Waiguan (SJ 5)
FEMALE STERILITY
¡ 
¡ 
There are complicated causes for female
sterility, those which are attributed to
dysfunction of the genital organs, including
disorders of the ovary, hypoplasia of the uterus,
inadequacy of corpus lutheum and tubal
obstruction will be discussed in this section.
From a TCM point of view, female sterility is
related to Kidney deficiency, or stagnation of
Liver Qi, or retention and obstruction of Phlegm
Dampness, which give rise to dysfunction of the
Chong and Ren meridians.
Differentiation and Treatment
1. Kidney Deficiency
¡  Main Symptoms:
Sterility, delayed menarche, post-dated period,
scanty and pale menstrual bleeding, darkish
lustreless complexion, soreness and weakness
of the waist and knees, hyposexuality, or dilute
urine, loose stool, pale tongue, white coating,
deep and thready pulse.
¡  Treatment Principle:Tonify the Kidney and
replenish Qi and Blood, regulate and reinforce
the Chong and Ren
2. Stagnation of Liver Qi
¡  Main
Symptoms:
Sterility, irregular cycle, or
dysmenorrhoea, scanty but unsmooth
bleeding in dark colour, distending pain
of breasts before the period, depression,
white coating and wiry pulse.
¡  Treatment Principle: Ease stagnated
Liver Qi, reinforce the Spleen and
nourish blood
3. Retention of phlegm Dampness
¡  Main
Symptoms:
Sterility, obesity, delayed menstrual
period or even amenorrhea, lassitude
and fatigue, dizziness, palpitation,
stuffiness in the chest, pale tongue with
white sticky coating and slippery pulse.
¡ 
¡  Treatment
Principle: Drain Dampness and
resolve Phlegm
Main Points
¡  Guanyuan
(REN 4), Sanyinjiao (SP 6),
Guilai (ST 29)
¡  Supplementary Points:
Kidney Deficiency: add Shenshu (BL 23),
Zusanli (ST 36)
Stagnation of Liver Qi: add Taichong (LV
3), Hegu (LI 4)
Retention of Dampness: add
Fenglong (ST 40), Pishu (BL 20)