Obstetrics and
Gynecology
in Chinese
Medicine
Commissioning Editor: Claire Wilson
Development Editor: Veronika Watkins
Project Manager: Nancy Arnott
Designer/Design Direction: Charles Gray
Illustration Manager: Merlyn Harvey
Illustrator: Michael Courtney/Richard Morris/Jonathan Haste/E.P.S
Obstetrics and
Gynecology
in
Chinese Medicine
SECOND EDITION
Giovanni Maciocia CAc (Nanjing)
Acupuncturist and Medical Herbalist
Visiting Professor, Nanjing University of Traditional Chinese Medicine
Nanjing, People’s Republic of China
Foreword by
Dr Ted J Kapthcuk OMD
Associate Professor of Medicine, Harvard Medical School, Boston, USA
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2011
© 2011 Giovanni Maciocia. Published by Elsevier Ltd. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
First edition 1998
Second edition 2011
ISBN 978-0-443-10422-0
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and
to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors or editors assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the
material herein.
Printed in China
CONTENTS
Foreword to the First Edition ix
Preface to the Second Edition xi
Acknowledgements xiii
Note on the Translation of Chinese Medical Terms xv
Plates
SECTION 4
MENSTRUAL IRREGULARITIES 197
CHAPTER 8
EARLY PERIODS 201
SECTION 1
PHYSIOLOGY AND PATHOLOGY 1
CHAPTER 9
LATE PERIODS 211
CHAPTER 1
CHAPTER 10
HISTORY OF GYNECOLOGY IN CHINESE MEDICINE 3
IRREGULAR PERIODS 225
CHAPTER 2
CHAPTER 11
WOMEN’S PHYSIOLOGY 7
HEAVY PERIODS 231
CHAPTER 3
CHAPTER 12
WOMEN’S PATHOLOGY 49
SCANTY PERIODS 239
CHAPTER 13
SECTION 2
LONG PERIODS 249
AETIOLOGY AND DIAGNOSIS 75
CHAPTER 14
PAINFUL PERIODS 255
CHAPTER 4
AETIOLOGY 77
CHAPTER 15
BLEEDING BETWEEN PERIODS 285
CHAPTER 5
DIAGNOSIS 97
CHAPTER 16
NO PERIODS 295
SECTION 3
CHAPTER 17
METHODS OF TREATMENT 119
FLOODING AND TRICKLING 319
CHAPTER 18
CHAPTER 6
PRINCIPLES AND METHODS OF TREATMENT 121
CHAPTER 7
TREATMENT OF THE EXTRAORDINARY VESSELS 157
PRE-MENSTRUAL SYNDROME 357
vi Contents
SECTION 5
PROBLEMS AT PERIOD TIME 379
CHAPTER 33
OEDEMA DURING PREGNANCY 495
CHAPTER 34
CHAPTER 19
ANXIETY DURING PREGNANCY 501
PRE-MENSTRUAL BREAST DISTENSION 381
CHAPTER 35
CHAPTER 20
DIZZINESS DURING PREGNANCY 509
HEADACHES DURING PERIODS 395
CHAPTER 36
CHAPTER 21
CONVULSIONS DURING PREGNANCY 513
OEDEMA DURING PERIODS 405
CHAPTER 37
CHAPTER 22
FEELING OF SUFFOCATION DURING PREGNANCY 519
DIARRHOEA AT PERIOD TIME 411
CHAPTER 38
CHAPTER 23
APHONIA DURING PREGNANCY 523
BODY ACHES AT PERIOD TIME 415
CHAPTER 39
CHAPTER 24
COUGH DURING PREGNANCY 525
FEVER AT PERIOD TIME 421
CHAPTER 40
CHAPTER 25
URINARY SYNDROME DURING PREGNANCY 529
EPISTAXIS OR HAEMOPTYSIS AT PERIOD TIME 429
CHAPTER 41
CHAPTER 26
RETENTION OF URINE DURING PREGNANCY 533
MOUTH ULCERS AT PERIOD TIME 433
CHAPTER 42
CHAPTER 27
CONSTIPATION DURING PREGNANCY 539
SKIN ERUPTIONS AT PERIOD TIME 439
CHAPTER 43
CHAPTER 28
HABITUAL MISCARRIAGE 545
DIZZINESS AT PERIOD TIME 445
CHAPTER 44
ACUPUNCTURE AND HERBAL TREATMENT IN
MIDWIFERY 555
SECTION 6
DISEASES OF PREGNANCY 449
SECTION 7
CHAPTER 29
DISEASES AFTER CHILDBIRTH 587
MORNING SICKNESS 457
CHAPTER 45
CHAPTER 30
POST-NATAL DEPRESSION 593
ABDOMINAL PAIN DURING PREGNANCY 469
CHAPTER 46
CHAPTER 31
ABDOMINAL PAIN AFTER CHILDBIRTH 601
THREATENED MISCARRIAGE 477
CHAPTER 47
CHAPTER 32
FETUS NOT GROWING 491
PERSISTENT LOCHIAL DISCHARGE (AND RETENTION
OF LOCHIA) 607
Contents vii
CHAPTER 48
CHAPTER 60
URINARY DIFFICULTY AFTER CHILDBIRTH 615
ABDOMINAL MASSES 793
CHAPTER 49
CHAPTER 61
SWEATING AFTER CHILDBIRTH 625
EXCESSIVE VAGINAL DISCHARGE 813
CHAPTER 50
CHAPTER 62
CONSTIPATION AND HAEMORRHOIDS AFTER
CHILDBIRTH 629
VAGINAL ITCHING (AND TRICHOMONAS AND CANDIDA
INFECTIONS AND GENITAL ECZEMA) 827
CHAPTER 51
CHAPTER 63
FEVER AFTER CHILDBIRTH 639
PROLAPSE OF THE UTERUS 835
CHAPTER 52
CHAPTER 64
JOINT PAIN AFTER CHILDBIRTH 651
VULVAR SORES 841
CHAPTER 53
CHAPTER 65
BREAST MILK NOT FLOWING (AND ACUTE
MASTITIS) 657
ENDOMETRIOSIS 849
CHAPTER 66
CHAPTER 54
POLYCYSTIC OVARY SYNDROME 889
SPONTANEOUS FLOW OF MILK 669
CHAPTER 67
CHAPTER 55
MYOMA 923
COLLAPSE AFTER CHILDBIRTH 673
CHAPTER 56
CONVULSIONS AFTER CHILDBIRTH 679
SECTION 8
MISCELLANEOUS DISEASES 683
CHAPTER 57
INFERTILITY 685
CHAPTER 58
MENOPAUSAL SYNDROME 735
CHAPTER 59
BREAST LUMPS 769
APPENDIX 1: HERBAL PRESCRIPTIONS 935
APPENDIX 2: SUGGESTED SUBSTITUTIONS OF
CHINESE HERBS 1009
PINYIN–ENGLISH GLOSSARY OF CHINESE TERMS 1011
ENGLISH–PINYIN GLOSSARY OF CHINESE TERMS 1021
CROSS-REFERENCE OF CHINESE DISEASE-SYMPTOMS
WITH WESTERN DISEASES 1031
CROSS-REFERENCE OF WESTERN DISEASES WITH
CHINESE DISEASE-SYMPTOMS 1033
CHRONOLOGY OF CHINESE DYNASTIES 1035
BIBLIOGRAPHY 1037
INDEX 1039
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FOREWORD TO THE FIRST
EDITION
East Asian medicine must always negotiate a peculiar
tension between revered point of departure and
thousands of years of experience. If the ancients are
overvalued, the clinical application could be interpreted
as a decline. If the accumulated experience is praised
too highly, the original sources can seem to have been
a bit too flawed. Each practitioner must also embody
this tension; to what extent does one follow strictly the
established authority and to what extent do unique
cultural and personal exigencies supersede ‘standard’
perspectives? Successfully navigating this polarity has
been a key component of the vitality of the entire East
Asian medical tradition and a hallmark of a sensitive
and masterly practitioner.
Excellence in the tradition of East Asian medicine
has always been defined by the ability to be simultaneously immersed in the past while also responding meaningfully and practically to the present. To
be a great teacher for any generation of the tradition
requires the rare ability to summarize contemporary
experience and then integrate these insights into the
perennial dialogue of the archaic. Time and timelessness. New insights and revered knowledge. Change
and reverence. Movement and stillness. These two
poles must balance upon a single fulcrum, becoming
a unified body of knowledge in an unbroken transmission. An almost impossible goal, this enterprise is also
an absolutely necessary task for every generation. The
history of East Asian medicine is a remarkable chain
of transmission and modulation from one generation,
dynasty, and even country, to the next.
Our generation seems especially significant in this
transmission and transformation of East Asian medicine. We are participants in a huge leap: health
expectations, disease burdens, linguistic barriers
and complex cultural obstacles must be bridged. The
ancient traditions must not only co-habit and interact
with modern biomedicine and a host of other complementary therapies, but also graft themselves upon a
very different civilization. Clarity, sensitivity, knowledge and wisdom must all be brought to bear lest the
authenticity of age-old theory and techniques weaken
into shallow semblance. Under what circumstances
should modern clinical experience suggest modification in ancient approaches? How would such alteration fit comfortably into the tradition? How can such
an adjustment become the very link to preserving the
continuity with the past? These are serious questions
needing thoughtful responses.
Giovanni Maciocia is a respected guide in this transitional period of East Asian medicine to the Western
arena. His accomplishments as a teacher and writer
have made him a major force in this successful movement from one world to another. The Foundations of
Chinese Medicine, The Practice of Chinese Medicine and
Tongue Diagnosis in Chinese Medicine are all outstanding contributions of scholarship and clinical acumen,
and this present volume, Obstetrics and Gynecology
in Chinese Medicine, adds significantly to his accomplishments. Indeed, one begins to see the outlines of a
Maciocia transmission or tradition existing within our
very own generation.
This volume is simultaneously an encounter with
the classics of Chinese medicine, this morning’s patient
and the insights of a seasoned practitioner. It is a wonderful example of balancing old and new in order to
fulfil the mandate of ‘accurate’ transmission. The contemporary clinical insights in Obstetrics and Gynecology
in Chinese Medicine are deep, while its references to classical sources are precise and relevant. Classical citations are balanced with contemporary case histories
to provoke understanding and clinical guidance while
x Foreword
eschewing mere pedantry. Giovanni Maciocia is wonderful in exhuming details of the archaic knowledge
that has been neglected in Asia itself. This is apparent
throughout the text and two important examples are
his discussions of the Extraordinary Vessels and of
post-natal melancholy. Giovanni Maciocia is comfortable acknowledging the divergence of his clinical experience with that of his mentors in China.
This textbook is unafraid to present the details of patterns of disharmony that are relatively infrequent in
China, and therefore not mentioned in typical books
or lectures, but which actually appear frequently in
Western societies. The text extensively addresses a
simultaneous deficiency of Kidney-Yin and KidneyYang in women which is rarely mentioned in Chinese
sources. Giovanni Maciocia is also unafraid to quote
contradictory authoritative sources. The ancients were
physicians, not a ‘health cult’ with all the answers, and
their multiple voices in this text help to give them depth
and allow our modern voice to embrace diversity.
Obstetrics and Gynecology in Chinese Medicine is a
paradigmatic work. It is tempered with reverence and
innovation, meticulous archival attention and detailed
modern clinical insight. When future generations
look back at this work and other books by Giovanni
Maciocia, they will find not only knowledge and wisdom but also reasons for inspiration and awe. As a
community of practitioners, we are fortunate to benefit from the efforts of giants such as Giovanni Maciocia.
Because of his efforts and also our entire community’s
dedication, our ‘generation’ will probably succeed in
its critical destiny and responsibility for bringing East
Asian medicine to the centre of a new cosmopolitan
healthcare agenda.
Ted J Kaptchuk
1997
PREFACE TO THE SECOND
EDITION
I finished writing the first edition of Obstetrics and
Gynecology in Chinese Medicine in 1997. Now, 13 years
later, I have had the chance to treat many more women
and to appreciate even more how effective Chinese
medicine is in treating gynecological problems.
The main features of the second edition of this text
compared to the first are as follows:
1. The text has been thoroughly revised throughout.
2. I have added more patterns and new prescriptions
to many diseases.
3. I have added three chapters on important
biomedically defined diseases, i.e. endometriosis,
polycystic ovary syndrome and myomas.
4. The chapter on obstetrics (Ch. 44) has been
completely revised and expanded by Sarah Budd,
a midwife/acupuncturist at the forefront of the
integration of acupuncture in a biomedical setting
for labour and pre- and post-natal care.
As for the first edition, I have chosen to name the gynecological conditions in the traditional Chinese way, for
example ‘Painful Periods’ rather than ‘Dysmenorrhoea’,
‘Flooding and Trickling’ rather than ‘Metrorrhagia’,
‘Heavy Periods’ rather than ‘Menorrhagia’, ‘No Periods’
rather than ‘Amenorrhoea’, etc. Please note that these
are disease entities (which I call ‘disease-symptoms’) in
Chinese medicine although not in Western medicine.
For example, in Western medicine, ‘painful periods’ is
not a disease but a symptom; endometriosis is a ‘disease’
which could cause the symptom of painful periods.
A Chinese gynecologist would always diagnose the
disease before diagnosing the pattern. Diagnosing the
disease (e.g. Flooding and Trickling) is called bian bing
while diagnosing the pattern is called bian zheng. It
may be argued by some that diagnosis of the (Chinese)
disease is not that important because we treat according to patterns. This is not so for two main reasons.
The first is that one should be clear about the disease
being treated. For example, a woman might complain
of ‘heavy periods’ and we might diagnose ‘Flooding
and Trickling’ when, on close observation, she suffers
from ‘Mid-Cycle Bleeding’. Second, simply treating
according to pattern is not enough. For example, the
Blood stasis occurring in ‘Flooding and Trickling’
is treated differently (and therefore with different
formulae) than the Blood stasis in ‘Painful Periods’.
Even more so, the Blood stasis in ‘Abdominal Masses’
is treated very differently than the Blood stasis in
‘Painful Periods’.
As in all my other texts, the acupuncture points given
under each pattern are not combinations of points
(with a few exceptions) but a range of points from
which the practitioner can choose. Whenever points do
form a combination, it is called ‘Ancient Prescription’.
The principles of combination of points is discussed at
length in The Channels of Acupuncture.
The reader should be alerted to the fact that some
of the formulae contained in this book may contain
substances that are illegal in certain countries, either
because they are protected species of plants or animals
or because the substance is deemed to be toxic (in some
cases wrongly so). The reader is therefore urged to
familiarize himself or herself with the laws governing
the use of herbs (and minerals and animal products)
of their particular country. The prescriptions containing potentially illegal substances have been retained in
this book for two reasons. First, since the book is sold
all over the world, laws governing the use of such substances vary from country to country; for example, the
use of Fu Zi Radix Aconiti lateralis preparata is illegal in
Europe but not in the USA. Second, the formulae have
been given as they appear in old and modern Chinese
books to highlight the thinking and treatment strategy behind a particular formula. Once we understand the rationale of a formula’s composition, we are
in a position to modify it by making substitutions for
some of its ingredients. If we did not know the original
ingredients, we could not make a rational substitution.
xii Preface to the Second Edition
For example, if a formula contains Fu Zi Radix Aconiti
lateralis preparata we know that it is meant to heat the
body strongly and expel Cold and so, should we decide
to eliminate Fu Zi from the formula, we need to substitute another herb (or possibly more than one) in a dose
that is high enough to mimic the action of Fu Zi. In this
example, Rou Gui Cortex Cinnamomi would be a possible substitution. Another example is that of Quan Xie
Buthus Martensi (scorpion): a formula that contains
this animal product is meant to have a strong Windextinguishing action and, if we want to replace it, we
know that we need to use a herb (or possibly more than
one) that has a similar strong action.
On the subject of toxicity and the law regulations, I would like particularly to draw attention to
Mu Tong and Aristolochia. There are several species
that are called ‘Mu Tong’ in Chinese (and some of
them are not Aristolochia, e.g. Akebia) and the use of
Aristolochia is not allowed in Europe due to its alleged
renal toxicity. As there has been an exceptional level
of attention dedicated to this herb following cases of
renal toxicity, I strongly advise practitioners against
using this herb (in any country). Indeed, authorities
are so strict on this that they do not allow the use of
any herb called ‘Mu Tong’ even if it not Aristolochia
(e.g. Caulis Akebiae) due to the possibility of mistaken
identification. Again, the reason this herb has been
retained in the old formulae is to allow the practitioner to make a rational substitution. In particular, a frequent substitution for Mu Tong is Tong Cao
Medulla Tetrapanacis.
The material in this book is gathered from many
old and modern Chinese texts, from the teaching of
various Chinese teachers and from my own experience. Whenever I write something that reflects my
experience, I make that clear by saying ‘according to
my experience’. The two main texts used as sources
are Gynaecology in Chinese Medicine by Cong Chun Yu
(Zhong Yi Fu Ke Xue) 1989 Ancient Chinese Medicine
Texts Publishing House, Beijing, and Luo Yuan Kai’s
Gynaecology in Chinese Medicine (Zhong Yi Fu Ke
Xue) 1986 Shanghai Science and Technology Press,
Shanghai.
Please note that the dosages indicated in the herbal
prescriptions are those from the original texts. In my
practice, I generally use low dosages and certainly
lower than those used in modern China. For example,
my dosages for a decoction range generally from 3 to
9 grams per herb daily whereas doctors in China tend
to use 10 grams or usually more. Thus, whenever a
source does not specify the dosages within a prescription, I have indicated the dosages that I would use.
Compared to the first edition, I have removed all
Chinese patent remedies due to the unverifiable quality
controls of Chinese patent remedies.
Finally, each chapter includes the differentiation of the
disease-symptom discussed in Western medicine: e.g. the
possible causes of painful periods in Western medicine.
Of course, this is not intended to replace a good book on
Western gynecology (some are mentioned in the bibliography): it is simply meant to provide the practitioner
in a clinical setting with a quick check list of the possible Western causes of that particular symptom. This
is important because we should know when to refer a
patient to a Western gynecologist for a further diagnosis.
For example, a patient may come to us presenting
with post-menopausal uterine bleeding and we should
know when to suspect uterine carcinoma. Another reason for familiarizing ourselves with the Western differentiation of symptoms is prognosis. Although Chinese
medicine is excellent at providing not only a diagnosis
but also a reasonable prognosis by carefully examining symptoms, signs, tongue and pulse, in many cases
the prognosis depends also on the Western diagnosis; it
makes a considerable difference to prognosis, for example, if excessive uterine bleeding is merely functional or
is caused by a large myoma.
The last 13 years of practice (since the publication
of the first edition) have confirmed to me even more
the importance of a Western diagnosis in many
gynecological conditions, e.g. breast lumps (possible
breast cancer), uterine bleeding (possible myoma),
painful periods (possible endometriosis), amenorrhoea
(possible polycystic ovary), etc.
Giovanni Maciocia
2011
ACKNOWLEDGEMENTS
I acknowledge with sincere thanks the many people
who, in one way or another, have helped me to write
this book.
The most important period in my professional training was spent at the Nanjing University of Traditional
Chinese Medicine and I am deeply indebted to its directors, teachers and other members of staff for the care
and patience in sharing their profound knowledge
with me. I am also grateful to the teaching staff of
the Jiangsu Province Hospital for Traditional Chinese
Medicine where my clinical training took place.
The late Dr J H F Shen was an inspiration for me. I
owe him a debt of gratitude for communicating his
diagnostic skills to me.
Dr Ted Kaptchuk provided my first introduction to
Chinese herbs and for that I am very grateful.
I am indebted to Fi Lyburn for editing and proofreading my manuscript with great care and for providing
useful suggestions.
I was fortunate to obtain the collaboration of Sarah
Budd, a midwife/acupuncturist who has been practising
midwifery at Derriford Hospital, Plymouth, England
since 1988 using acupuncture for ante-natal, intra- and
post-partum care within the National Health Service:
her knowledge and long experience in the use of Chinese
medicine in obstetrics is a great bonus to my book.
I am also indebted to Debra Betts for her contribution and suggestions regarding the chapter on labour
(Ch. 44).
I am indebted to Dr Xia Gui Cheng, director of the
Gynaecology Department of the Nanjing Province
Hospital of Chinese Medicine (affiliated to the Nanjing
University of Traditional Chinese Medicine) for
communicating his experiences to me during my study
period in Nanjing.
Dr Serena Selva read the sections on the Western
differentiation in each chapter and gave me her invaluable comments and criticism: for this I am very grateful.
I would like to thank the staff of Elsevier for their
expertise, efficiency and courtesy: in particular, I am
grateful to Veronika Watkins and Claire Wilson for
their help and support with this project.
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NOTE ON THE TRANSLATION
OF CHINESE MEDICAL TERMS
The terminology used in this book generally follows
that used in The Foundations of Chinese Medicine (2nd
edn) and The Practice of Chinese Medicine (2nd edn). In
my books, I have opted for translating all Chinese medical terms with the exception of ‘Yin’, ‘Yang’, ‘Qi’ and
‘cun’ (unit of measurement).
I have also continued to use initial capitals for the
terms which are specific to Chinese medicine. For
example, ‘Blood’ indicates one of the vital substances
of Chinese medicine, whereas ‘blood’ denotes the liquid
flowing in the blood vessels; e.g. ‘In Blood deficiency
the menstrual blood may be pale’. I use initial capitals
also for all pulse qualities and for pathological colours
and shapes of the tongue body.
This system has served readers of my books well. As
most teachers (including myself) use Chinese terms
when lecturing (e.g. Yuan Qi rather than ‘Original Qi’),
I have given each term in Pinyin whenever it is introduced for the first time. One change I have introduced
recently (as in the second edition of The Foundations of
Chinese Medicine) is to use the Pinyin terms more often
throughout the text and at least once in each chapter
when the Chinese term is first introduced. I have done
this to reduce the frequency with which the reader may
need to consult the glossary.
I made the choice of translating all Chinese terms
(with the exceptions indicated above) mostly for reasons of style: I believe that a well-written English text
reads better than one peppered with Chinese terms in
Pinyin. Leaving Chinese terms in Pinyin is probably the
easiest option but this is not ideal also because a single
Pinyin word can often have more than one meaning; for example, jing can mean ‘channels’, ‘periods’,
‘Essence’ or ‘shock’, while shen can mean ‘Kidneys’,
‘Mind’ or ‘Spirit’.
I am conscious of the fact that there is no such thing
as a ‘right’ translation of a Chinese medicine term and
my terminology is not proposed in this spirit; in fact,
Chinese medicine terms are essentially impossible to
translate. The greatest difficulty in translating Chinese
terms is probably that a term has many facets and
different meanings in different contexts: thus, it would
be impossible for one translation to be ‘right’ in every
situation and every context. For example, the term
jue ( ) has many different meanings; a translation
can illustrate only one aspect of a multi-faceted term.
In fact, jue can mean a state of collapse with unconsciousness; coldness of hands and feet; or a critical situation of retention of urine. In other contexts it has
other meanings: e.g. jue qi (
), a condition of chaotic Qi; jue xin tong (
), a condition of violent
chest pain with cold hands; and jue yin zheng (
),
the Terminal-Yin pattern within the Six-Stage
Identification of Patterns characterized by Heat above
and Cold below.
Many sinologists concur that Chinese philosophical terms are essentially impossible to translate and
that, the moment we translate them, we distort them
with a world view that is not Chinese. Ames is particularly clear about the intrinsic distortion of Chinese
concepts when they are translated. He gives examples
of Chinese terms that are distorted when translated,
such as Tian (‘Heaven’), You-Wu
(‘Being’ and
‘Non-Being’), Dao (‘Way’), Xing (‘human nature’),
Ren (‘benevolence’), Li (‘Principle’), Qi (‘primal
substance’), etc.1
Ames is particularly forceful in rejecting a single,
one-to-one translation of a Chinese term into a
Western one in the introduction of his book Focusing
the Familiar (a translation of the Confucian text Zhong
Yong).2 Ames says:
Our Western languages are substance-oriented and are
therefore most relevant to the descriptions of a world
defined by discreteness, objectivity and permanence. Such
languages are ill disposed to describe and interpret a world,
such as that of the Chinese, that is primarily characterized
by continuity, process and becoming.3
xvi Note on the Translation of Chinese Medical Terms
Ames then gives some examples of what he considers
to be serious mis-translations of Chinese philosophical terms. The important thing is that these are not
‘mis-translations’ because the terms are ‘wrong’ but
because of the intrinsic difference between Chinese and
Western thinking and therefore the inherent inability
of Western terms to convey Chinese philosophical
ideas. Ames says:
hand, the language of deference [Chinese] does not employ
proper names simply as indicators of particular individuals
or things, but invokes hints, suggestions, or allusions to
indicate foci in a field of meanings.6
As an example of this intrinsic impossibility of translating a Chinese philosophical term into a Western
language, Ames then cites Steve Owen’s reluctance in
translating shi as ‘poem’. Owen says:
For example, ‘You’ and ‘Wu’ have often been uncritically rendered as ‘Being’ and ‘Non-Being’. Influential
translators, until quite recently, have rendered ‘wu xing’
as ‘Five Elements’. ‘Xing’ is still most often translated as ‘nature’. All these translations promote the fixed
and univocal characterizations of objects or essences emergent from a language rooted in a substantialist perspective
[our Western languages].4
If we translate ‘shi’ as ‘poem’, it is merely for the sake of
convenience. ‘Shi’ is not a ‘poem’: ‘shi’ is not a thing made
in the same way one makes a bed, a painting or a shoe.
A ‘shi’ can be worked on, polished and crafted; but that has
nothing to do with what a ‘shi’ fundamentally ‘is’ … ‘Shi’
is not the ‘object’ of its writer: it is the writer, the outside
of an inside.7
Ames stresses that the use of a ‘substances language’
(i.e. a Western language) to translate Chinese insights
into a world of process and change has led to seriously
inappropriate interpretations of the Chinese sensibility.
Ames asserts that it is the very difference between
Chinese and Western philosophy that makes translation
of Chinese terms virtually impossible. He says:
Ames gives various translations of Li (a Confucian
concept) as an example of how a multiplicity of terms
may apply to a single Chinese term and how none of
them is ‘wrong’. He says that Li has been variously
translated as ‘ritual’, ‘rites’, ‘customs’, ‘etiquette’,
‘propriety’, ‘morals’, ‘rules of proper behaviour’ and
‘worship’. Ames says:
In the classical traditions of the West, being takes precedence over becoming and thus becoming is ultimately
unreal. Whatever becomes is realized by achieving its end –
that is, coming into being. In the Chinese world, becoming
takes precedence over being. ‘Being’ is interpreted as a
transitory state marked by further transition.5
Properly contextualized, each of these English terms can
render li on occasion. In classical Chinese, however, the
character carries all of these meanings on every occasion
of its use.8
Ames then says:
The Chinese world is a phenomenal world of continuity,
becoming and change. In such a world there is no final
discreteness. Things cannot be understood as objects.
Without this notion of objectivity, there can only be the
flux of passing circumstances in which things dissolve
into the flux and flow. A processive language precludes
the assumption that objects serve as references of
linguistic expressions. The precise referential language
of denotation and description is to be replaced by a language of ‘deference’ in which meanings both allude to
and defer to one another in a shifting field of significance.
A referential language [Western language] characterizes an event, object, or state of affairs through an act of
naming meant to indicate a particular thing. On the other
This confirms clearly how, by the very translation, we
limit a Chinese term that is rich with multiple meanings to a single meaning in Chinese.
Ames says that in classical Chinese philosophical
texts, allusive and connotatively rich language is more
highly prized than clarity, precision and argumentative
rigor. This rather dramatic contrast between Chinese
and Western languages with respect to the issue of
clarity presents the translator of Chinese philosophical
texts with a peculiar burden.
For the Chinese, the opposite of clarity is not
confusion, but something like vagueness. Vague ideas
are really determinable in the sense that a variety of
meanings are associated with them. Each Chinese term
constitutes a field of meanings which may be focused
by any of a number of its meanings. Ames says that
in the translation of Chinese texts we must avoid what
Whitehead called ‘the Fallacy of the Perfect Dictionary’.
Note on the Translation of Chinese Medical Terms xvii
By this, he means the assumption that there exists a
complete semantic repository of terms of which we
may adequately characterize the variety and depth of
our experience and that, ideally, one may seek a one-toone correspondence between word and meaning.
With this ‘fallacy’ in mind, Ames and Hall say:
We challenge the wisdom and accuracy of proposing
‘one-to-one’ equivalencies in translating terms from one
language to another. We introduce the notion of ‘linguistic
clustering’ as an alternative strategy to ‘literal translation’
that allows us to put the semantic value of a term first by
parsing [describe grammatically] its range of meaning
according to context, with the assumption that a range
of meaning with a different configuration of emphasis is
present on each appearance of the term.9
These ideas could not be more apt to illustrate the
problems in translating Chinese medicine terms. Of
course we must strive for precision and consistency but
to think that there is a one-to-one, ‘right’ correspondence between a Chinese medicine idea and a Western
term is a misunderstanding of the very essence of
Chinese medicine.
For example, to say that the only ‘right’ translation
of Chong Mai is ‘Thoroughfare Vessel’ makes us fall into
the trap of what Whitehead calls the ‘Fallacy of the
Perfect Dictionary’. Of course, Chong Mai can be translated as ‘Thoroughfare Vessel’ but that is only one of
its meanings and it is absolutely impossible for a single
Western term to convey the richness of ideas behind
the word Chong Mai (which I translate as ‘Penetrating
Vessel’): to think that we can reduce a rich Chinese
medicine idea to a single, one-to-one term in a Western
language reveals, in my opinion, a misunderstanding
of the very essence of Chinese medicine.
Ames makes this point very forcefully. He says:
The Fallacy of the Perfect Dictionary is largely a
consequence of our analytical bias towards univocity.
We would suggest that this bias does not serve us well
when approaching Chinese texts. Not only is there the
continued possibility of novel experiences requiring
appeal to novel terminologies, but also there is seldom, if
ever, a simple, one-to-one translation of Chinese terms
into Western languages. The allusiveness of the classical
Chinese language is hardly conducive to univocal translations. We would contend that, in translating Chinese texts
into Western languages, it is most unproductive to seek
a single equivalent for a Chinese character. In fact, rather
than trying to avoid ambiguity by a dogged use of formally
stipulated terms, the translator might have to concede that
characters often require a cluster of words to do justice to
their range of meanings – all of which are suggested in
any given rendering of the character. In fact, any attempt
to employ univocal translations of Chinese terms justified by appeal to the criteria of clarity or univocity often
reduces philosophical insight to nonsense and poetry to
doggerel. Such an approach to translation serves only to
numb Western readers to the provocative significance harboured within the richly vague and allusive language of the
Chinese texts.10
As an example of the multiplicity of meanings of a
Chinese term and therefore of the fact that it is perfectly
legitimate to translate a single Chinese idea into more
than one term according to different contexts, Ames
says that he translates the term zhong (‘centre’ or
‘central’) in the title of the Confucian text sometimes
as ‘focus’, sometimes as ‘focusing’ and other times as
‘equilibrium’. Other times, he even translates it as ‘centre’ or ‘impartiality’. He says strongly:
The Chinese language is not logocentric. Words do not
name essences. Rather, they indicate always-transitory
processes and events. It is important therefore to stress the
gerundative character of the language. The language of
process is vague, allusive and suggestive.11
According to Ames, in the field of philosophy, two
terms particularly stand out as being influenced by
a Western thinking when translated, namely Tian
(‘Heaven’) and Ren (‘benevolence’). Ames says:
When we translate Tian as ‘Heaven’, like it or not, we
invoke in the Western reader a notion of transcendent
creator Deity, along with the language of soul, sin and
afterlife … When we translate Ren as ‘benevolence’, we
psychologize and make altruistic a term which originally
had a radically different range of sociological connotations.
Being altruistic, for example, implies being selfless in the
service of others. But this ‘self-sacrifice’ implicitly entails
a notion of ‘self” which exists independently of others
and that can be surrendered – a notion of self which we
believe is alien to the world of the Analects [of Confucius]:
indeed, such a reading [of the term ‘ren’] transforms what
is fundamentally a strategy for self-realization into one of
self-abnegation.12
xviii Note on the Translation of Chinese Medical Terms
With regard to Chinese medicine, the term Xue
(‘Blood’) is a good example of the above-mentioned
problem reported by Ames. When we translate the
word Xue as ‘Blood’ we immediately alter its essential
character and give it a Western medical connotation; in
fact, in Chinese medicine, Xue is itself actually a form of
Qi and one that is closely bound with Nutritive Qi (Ying
Qi). Indeed, the term mai
appearing in the Yellow
Emperor’s Classic of Internal Medicine is often ambiguous as it sometimes clearly refers to the acupuncture
channels and other times to the blood vessels.
After highlighting the problems in translating
Chinese terms, Ames confirms that a single Chinese
term may have different meaning in different contexts.
For example, the term shen
in some cases means
‘human spirituality’, in others it means ‘divinity’.13
As he considers only the philosophical meanings of
the word shen, we could actually add many others in
the context of Chinese medicine, for example ‘mind’,
‘spirit’, ‘lustre’ (in the context of diagnosis).
Graham says:
Every Western sinologist knows that there is no exact
equivalent in his own language for such a word as ren
or de , and that as long as he thinks of it as synonymous
with ‘benevolence’ or ‘virtue’ he will impose Western preconceptions on the thought he is studying.14
Ames then surveys the options that are presented
to a translator and seems to favour simply transliterating the Chinese terms and leave them untranslated.
He says:
To some, this approach may appear to be simply the laziest
way out of a difficult problem. But ‘ritual’ has a narrowly
circumscribed set of meanings in English, and Li an
importantly different and less circumscribed set. Just as
no Indological scholar would look for English equivalent
for ‘karma’, ‘dharma’ and so on, perhaps it is time to do
the same for classical Chinese, the homonymity of the
language notwithstanding.15
Hall confirms that a single Chinese term may have a
plurality of meanings. He says:
The Chinese have traditionally affirmed as the ground of
their intellectual and institutional harmony the recognition of the co-presence of a plurality of significances with
which any given term might easily resonate.16
Finally, another sinologist, Yung Sik Kim, discusses
the difficulty presented by the plurality of meanings of
a single Chinese term. He says:
I have adopted the policy of sticking to one English
translation for a particular Chinese word whenever possible
… Of course, exceptions cannot be avoided altogether. I have
had to resort to different translations for such characters as
‘xin’ which means both ‘heart’ and ‘mind’; ‘tian’ , both
‘heaven’ and ‘sky’.17
In another passage, Yung Sik Kim affirms that transliteration of a Chinese term with a plurality of meanings is the only alternative:
The term ‘li’ is difficult to define. It is difficult even to
translate because there is no single word in Western languages that covers all facets of what ‘li’ meant to the traditional Chinese mind. The existence of many translations
for the term, which often leaves transliteration as the only
viable option, bespeaks the difficulty.18
Although a diversity of translation of Chinese
terms may present its problems, these are easily overcome if an author explains the translation in a glossary and, most importantly, explains the meaning of a
given Chinese term in its context (in our case, Chinese
medicine).
In my books, I have chosen to translate all Chinese
medicine terms rather than using Pinyin purely for
reasons of style as a sentence written half in English
and half in Pinyin is often awkward. Moreover, if we
use Pinyin terms in writing, it could be argued that
we should be consistent and use Pinyin terms for all
Chinese medicine terms and this would not make for
very clear reading. Consider the following sentence:
“To treat Pi-Yang Xu we adopt the zhi fa of bu pi and wen
Yang” (“To treat Spleen-Yang deficiency we adopt the
treatment principle of tonifying the Spleen and warming Yang”).
Moreover, the problem arises only in the written
form as, in my experience, most lecturers in colleges
throughout the Western world normally prefer using
Pinyin terms rather than their counterparts in English
(or any other Western languages). Thus, a lecturer
will refer to Kidney-Jing rather than ‘Kidney-Essence’.
Indeed, when I myself lecture, I generally use the Pinyin
terms rather than their English translation. Again,
most lecturers use a pragmatic approach translating
Note on the Translation of Chinese Medical Terms xix
some terms into English (such as ‘treatment principle’
instead of ‘zhi fa’) and leaving others in Pinyin such as
‘Yuan Qi’ or ‘Chong Mai’.
When I lecture I always try to give the participants
an idea of the meaning of a particular Chinese character and its significance and application in Chinese medicine. Indeed, the use of Pinyin when lecturing renders
Chinese medicine truly international as I can lecture in
the Czech Republic and mention Jing, Yang Qiao Mai, Wei
Qi, etc., knowing that I will be understood by everyone.
A diversity of translation of Chinese terms may even
have a positive aspect as each author may highlight
a particular facet of a Chinese term so that diversity
actually enriches our understanding of Chinese medicine. If someone translates Zong Qi (
) as ‘Initial Qi’,
for example, we learn something about that author’s
view and understanding of Zong Qi; the translation
cannot be branded as ‘wrong’ (I translate this term as
‘Gathering Qi’). Another example: if someone translates yang qiao mai as ‘Yang Motility Vessel’, the translation captures one aspect of this vessel’s nature; again,
this could not be defined as wrong (I translate the name
of this vessel as ‘Yang Stepping Vessel’).
Trying to impose a standard, ‘right’ translation of
Chinese medicine terms may lead to suppression of
healthy debate; I therefore hope that readers will continue to benefit from the diversity of translation of
Chinese medicine terms and draw inspiration from the
rich heritage of Chinese medicine that it represents.
I firmly believe that the future lies not in trying to
establish a rigid, embalmed, fossilized, ‘right’ terminology based on single, one-to-one translations of Chinese
ideas. Indeed, I believe this is a potentially dangerous
trend as it would, in my opinion, lead students and practitioners away from the richness of Chinese language
and richness of meanings of Chinese medicine ideas.
The adoption of a standardized, ‘approved’ terminology of Chinese medicine terms may indeed, in time,
divorce students and practitioners from the essence of
Chinese medicine. If an ‘official’, standardized translation of Chinese terms took hold, then students would
be less inclined to study the Chinese terms to explore
their meaning.
Ames and Hall make the same point:
Such translations have been ‘legitimized’ by their gradual
insinuation into the standard Chinese–English dictionaries
and glosses. By encouraging the uncritical assumption
in those who consult these reference works that this
formula of translations provides the student with a
‘literal’ rendering of the terms, these lexicons have become
complicit in an entrenched cultural equivocation that we
strive to avoid.19
They then further make the point that using a oneto-one translation of Chinese terms ignores the cultural
background where they came from:
Our argument is that it is in fact these formulaic
usages that are radical interpretations. To our mind, to
consciously or unconsciously transplant a text from its
own historical and intellectual soil and replant it in one
that has decidedly different philosophical landscape is to
take liberties with the text and is radical in the sense it
tampers with its very roots.20
As I said above, an ‘official’, standardized translation
of Chinese terms may make students and practitioners
less inclined to study the Chinese terms to explore their
meaning with their own interpretation. Ames and Hall
say:
Our goal is not to replace one inadequate formula with
another. Our translations are intended as no more than
suggestive ‘placeholders’ that refer readers back to this
glossary to negotiate their own meaning, and, we hope, to
appropriate the Chinese terms for themselves.21
Moreover, imposing an ‘approved’ terminology in
English betrays an Anglo-centric world view: to be consistent, we should then have an ‘approved’ terminology
in every major language of the world. It seems to me
much better to try and understand the spirit and the
essence of Chinese medicine by studying its characters
and their clinical significance and using Pinyin transliteration whenever appropriate.
Trying to fossilize Chinese medicine terms into an
imposed terminology goes against the very essence of the
Chinese language which, as Ames says, is not logocentric
and in which words do not name essences: rather, they
indicate always-transitory processes and events. The
language of process is vague, allusive and suggestive.
Because Chinese language is a language of process,
the question arises also whether practising Chinese
medicine actually helps the understanding of Chinese
medicine terminology: in my opinion, in many cases it
does. For example, I feel that clinical experience helps us
to understand the nature of the Chong Mai (Penetrating
xx Note on the Translation of Chinese Medical Terms
Vessel) and therefore helps us to understand the term
Chong in a ‘knowing practice’ way (as Farquhar defines
it)22 rather than a theoretical way.
Of course, a translator of Chinese books should strive
for precision and consistency, but we must accept that
there is a rich multiplicity of meanings for any give idea
of Chinese medicine. The Chong Mai is a good example
of this multiplicity as the term chong could be translated as ‘thoroughfare’, ‘strategic cross-roads’, ‘to penetrate’, ‘to rush’, ‘to rush upwards’, ‘to charge’, ‘activity’,
‘movement’ and ‘free passage’. Which of these translations is ‘correct’? They are all correct as they all convey
an idea of the nature and function of the Chong Mai.
I therefore think that the future of teaching Chinese
medicine lies not in trying to impose the straight-jacket
of a rigid terminology of the rich ideas of Chinese
medicine, but in teaching students more and more
Chinese characters explaining the richness of meanings associated with them in the context of Chinese
medicine. I myself would not like my own terminology
to be ‘adopted’ as the ‘correct’ or ‘official’ one: I would
rather see colleges teaching more and more Chinese
to their students by illustrating the rich meanings of
Chinese medicine terms. As mentioned above, my main
motive for translating all terms is purely for reasons of
style in an English-language textbook; when I lecture
I generally use Pinyin terms but, most of all, I show the
students the Chinese characters and try to convey their
meaning in the context of Chinese medicine.
Finally, I would like to explain my continued translation of Wu Xing as ‘Five Elements’. The term ‘Five
Elements’ has been used by most Western practitioners of Chinese Medicine for a long time (also
in French and other European languages). Some
authors consider this to be a misunderstanding of the
meaning of the Chinese term ‘Wu Xing’, perpetuated
over the years. ‘Wu’ means ‘five’ and ‘Xing’ means
‘movement’, ‘process’, ‘to go’, ‘conduct’ or ‘behaviour’. Most authors therefore think that the word
‘Xing’ cannot indicate ‘element’ as a basic constituent of Nature, as was supposedly intended in ancient
Greek philosophy.
This is, in my opinion, only partly true as the elements, as they were conceived by various Greek philosophers over the centuries, were not always considered
‘basic constituents’ of Nature or ‘passive motionless
fundamental substances’.23 Some Greek philosophers
conceived the elements as dynamic qualities of Nature,
in a way similar to Chinese philosophy.
For example, Aristotle gave a definite dynamic interpretation to the four elements and called them ‘primary
form’ (prota somata). He said:
Earth and Fire are opposites also due to the opposition of
the respective qualities with which they are revealed to our
senses: Fire is hot, Earth is cold. Besides the fundamental
opposition of hot and cold, there is another one, i.e. that
of dry and wet: hence the four possible combinations of
hot–dry [Fire], hot–wet [Air], cold–dry [Earth] and cold–
wet [Water] … the elements can mix with each other and
can even transform into one another … thus Earth, which
is cold and dry, can generate Water if wetness replaces
dryness.24
To Aristotle, therefore, the four elements became
the four basic qualities of natural phenomena, classified as combinations of four qualities: hot, cold, dry
and wet. As is apparent from the above statement, the
Aristotelian elements could even transform into one
another and generate each other.
This interpretation is very similar to the Chinese
one, in which the elements are qualities of Nature.
Furthermore, it is interesting to note the similarity with the Chinese theory of Yin–Yang: the four
Aristotelian elements derive from the interaction
of the basic Yin–Yang qualities of cold–hot and
dry–wet.
Thus, it is not entirely true to say that the Greek elements were conceived only as the basic constituents of
matter, the ‘building blocks’ of Nature which would
make the use of the word ‘element’ wrong to indicate
xing. Furthermore, the word ‘element’ does not necessarily imply that: it does so only in its modern chemical
interpretation.
In conclusion, for the above reasons I have kept the
word ‘element’ as a translation of the Chinese word
‘xing’. According to Wang, the term ‘Five Elements’
could be translated in a number of ways, e.g. ‘agents’,
‘entities’, ‘goings’, ‘conduct’, ‘doings’, ‘forces’, ‘activities’
and ‘stages of change’.25
Recently, the term ‘Five Phases’ is gaining acceptance but some sinologists disagree with this translation and propose returning to ‘Five Elements’. Friedrich
and Lackner, for example, suggest restoring the term
‘elements’.26 Graham uses the term ‘Five Processes’.27
I would probably agree that ‘processes’ is the best translation of Wu Xing. In fact, the book Shang Shu written
during the Western Zhou dynasty (1000–771 BC) said:
Note on the Translation of Chinese Medical Terms xxi
The Five Elements are Water, Fire, Wood, Metal and Earth.
Water moistens downwards; Fire flares upwards; Wood
can be bent and straightened; Metal can be moulded and
can harden; Earth allows sowing, growing and reaping.28
10.
11.
12.
13.
14.
Some sinologists (e.g. Needham and Fung Yu Lan)
still use the term ‘element’. Fung Yu Lan suggests that a
possible translation of wu xing could be ‘Five Activities’
or ‘Five Agents’.29 Although the term ‘five phases’ has
gained some acceptance as a translation of ‘wu xing’, I
find this term restrictive as it clearly refers to only one
aspect of the Five Elements, i.e. phases of a (seasonal)
cycle.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
END NOTES
1. Ames R T, Rosemont H 1998 The Analects of Confucius – A Philosophical
Translation, Ballantine Publishing Group, New York, p. 311.
2. Ames R T, Hall D L 2001 Focusing the Familiar – A Translation and
Philosophical Interpretation of the Zhong Yong, University of Hawaii
Press, Honolulu, pp 6–16.
3. Ibid., p. 6.
4. Ibid., p. 6.
5. Ibid., p. 10.
6. Ibid., p. 10.
7. Ibid., p. 13.
8. Ibid., p. 69.
9. Ames R T, Hall D L 2003 Daodejing – Making This Life Significant,
A Philosophical Translation, Ballantine Books, New York, p. 56.
25.
26.
27.
28.
29.
Ibid., p. 16.
Ibid., p. 16.
The Analects of Confucius, p. 312.
Ibid., p. 313.
Hall D L, Ames R T 1998 Thinking from the Han – Self, Truth and
Transcendence in Chinese and Western Culture, State University of
New York Press, New York, p. 238.
The Analects of Confucius, p. 314.
Thinking from the Han, p. 4.
Yung Sik Kim 2000 The Natural Philosophy of Chu Hsi, American
Philosophical Society, Philadelphia, p. 11.
Ibid., p. 19.
Daodejing, p. 55.
Ibid., pp 55–56.
Ibid., p. 56.
Farquhar J 1994 Knowing Practice – The Clinical Encounter of
Chinese Medicine, Westview Press, Boulder, USA.
Needham J 1977 Science and Civilization in China, Vol. 2, Cambridge
University Press, Cambridge, p. 244.
Lamanna E P 1967 Storia della Filosofia (History of Philosophy), Vol.
1, Le Monnier, Florence, pp 220–221.
Wang Ai He 1999 Cosmology and Political Culture in Early China,
Cambridge University Press, Cambridge, p. 3.
Friedrich M, Lackner M 1986 Once Again: the Concept of Wu Xing,
Early China 9–10: 218–219.
Graham A C 1986 Yin–Yang and the Nature of Correlative
Thinking, Institute of East Asian Philosophies, Singapore, pp 42–66
and 70–92.
Shang Shu (c. 659 BC) cited in Practical Chinese Medicine (Shi Yong
Zhong Yi Xue
) 1975 Beijing Publishing House,
Beijing, p. 32. The book Shang Shu is placed by some in the early
Zhou dynasty (hence c. 1000 BC), but the prevalent opinion is that it
was written sometime between 659 BC and 627 BC.
Fung Yu Lan 1966 A Short History of Chinese Philosophy, Free
Press, New York, p. 131.
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SECTION 1
PHYSIOLOGY AND
PATHOLOGY
1. HISTORY OF GYNECOLOGY IN CHINESE MEDICINE 3
2. WOMEN’S PHYSIOLOGY 7
3. WOMEN’S PATHOLOGY 49
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CHAPTER 1
HISTORY OF GYNECOLOGY
IN CHINESE MEDICINE
Like all branches of Chinese medicine, traditional
gynecology has a long history. The earliest records of
gynecological medical writings date from the Shang
dynasty (1500–1000 BC): bones and tortoise shells
have been found with inscriptions dealing with childbirth problems. The text Book of Mountains and Seas
from the Warring States period (476–221 BC) describes
medicinal plants to treat infertility.
The Yellow Emperor’s Classic of Internal Medicine –
Simple Questions (Huang Di Nei Jing Su Wen) has many
references to women’s physiology, anatomy, diagnosis
and treatment of gynecological problems. It describes
the function of the Uterus and states its connection to
the Heart and Kidneys via the Bao Mai (Uterus Vessel)
and Bao Luo (Uterus Channel) respectively. For example, the Simple Questions in Chapter 33 says:
In amenorrhoea, the Uterus Vessel is shut. The Uterus
Vessel pertains to the Heart and communicates with the
Uterus; when Qi rebels upwards to press towards the
Lungs, Heart-Qi cannot flow downwards and
amenorrhoea results.1
In Chapter 47 it says: “The Uterus Channel connects
with the Kidneys; the Kidney channel reaches the root of
the tongue.”2
The very first chapter of the Simple Questions describes
the hormonal changes occurring in women at 7-year
intervals and attributes these to the waning and waxing of the Directing and Penetrating Vessels. The Simple
Questions also describes the aetiology and treatment of
amenorrhoea and menorrhagia.
The first chapter of the Simple Questions mentions for
the first time the important substance Tian Gui. Tian Gui
is a transformation of Kidney-Essence that occurs at
puberty. In men, it is sperm; in women, it is menstrual
blood and ova. Chapter 1 of the Simple Questions says:
“When a girl is 14, the Tian Gui arrives, the Directing
Vessel is open and the Penetrating Vessel flourishing, the
period arrives and she can conceive.”3
That gynecology already existed as a speciality during
the Warring States period is recorded in the Historical
Annals (Shi Ji) which refers to the famous doctor Bian
Que as one who ‘treats diseases under the skirt belt’
(Dai Xia Yi), i.e. a gynecologist. During the Han dynasty
(206 BC–AD 220), a gynecologist was called a ‘breast
doctor’ (Ru Yi) or ‘women’s doctor’ (Nu Yi). The earliest
recorded gynecologists under that name were two doctors called Yi Xu and Chun Yu Yan who treated one of
the empresses during the Western Han dynasty (206
BC–AD 24).
The famous doctor Zhang Zhong Jing refers in his
work Discussion on Cold-induced Diseases (Shang Han
Lun) to a previous book entitled Series of Herbs for
Obstetrics (Tai Lu Yao Lu) which proves that even before
the Han dynasty there were books dealing exclusively
with gynecology, but all of these have been lost. The
Discussion of Prescriptions of the Golden Cabinet (Jin Gui
Yao Lue Fang Lun) by the same author has three chapters on gynecology, i.e. ‘On pregnancy’, ‘Post-partum
diseases’ and ‘Women’s miscellaneous diseases’.
These chapters discuss disorders of menstruation, leucorrhoea, pregnancy, miscellaneous diseases and postpartum problems. Over thirty gynecological formulae
are discussed, e.g. Wen Jing Tang Warming the Menses
Decoction, Jiao Ai Tang Donkey’s Hide Glue-Artemisia
Decoction, Dang Gui San Angelica Powder, Gan Jiang
Ren Shen Ban Xia Wan Zingiber-Ginseng-Pinellia Pill,
Gui Zhi Fu Ling Wan Ramulus Cinnamomi-Poria Pill,
etc. All these formulae are still widely used nowadays.
These three chapters on gynecology represent one of
the earliest gynecological treatises and they formed the
model upon which subsequent books were based.
The Pulse Classic (Mai Jing, AD 280) by Wang Shu
He, a famous doctor of the Jin dynasty (265–420),
describes pulse pictures and differentiation of women’s
4 Section 1: Physiology and Pathology
diseases in Volume 9. This book constitutes an assimilation and systematization of the gynecological material
from earlier texts, notably the Yellow Emperor’s Classic
of Internal Medicine, the Classic of Difficulties and the
Synopsis of Prescriptions from the Golden Cabinet. Wang
Shu He also added a wealth of comment from his personal experience in the gynecological field. For example, he says that “The Kidneys govern the Uterus, and its
condition is reflected at the Rear position of the pulse. If the
pulse at this region does not fade on pressure, it indicates
pregnancy.”4 In another passage he says that “A superficial pulse accompanied by abdominal pain referred to the
midline of the lower back, indicates impending labour.”5
The book also describes the qualities of the pulse before
an imminent miscarriage, normal and abnormal pulses
during the post-partum stage and pulses in women
with abdominal masses in relation to prognosis.
During the Sui dynasty (581–618), Chao Yuan
Fang wrote the General Treatise on the Symptomatology
and Aetiology of Diseases (Zhu Bing Yuan Hou Zong Lun,
AD 610) which deals with gynecology and obstetrics in
Volumes 37 to 44. The book describes 283 syndromes
covering diseases of menstruation, leucorrhoea, pregnancy and post-partum diseases.
The Thousand Golden Ducat Prescriptions (Qian Jin Yao
Fang, AD 652) written by Sun Si Miao during the Tang
dynasty (618–907) has three volumes dealing with
gynecology, including the differentiation and treatment of infertility, diseases of pregnancy, menstruation, leucorrhoea, etc., with hundreds of formulae for
these diseases. Sun Si Miao made the interesting observation that a metal knife should never be used to cut
the umbilical cord: from a modern perspective, this
was an important recommendation as, if dirty, a metal
instrument could easily provoke a tetanus infection.
The Treasure of Obstetrics (Jing Xiao Chan Bao), written during the Tang dynasty, is the earliest obstetrics
book. The book contains 12 chapters on diseases of
pregnancy, 4 chapters on difficult labour and 25 chapters on post-partum diseases. Diseases of pregnancy
discussed include morning sickness, bleeding, threatened miscarriage, miscarriage, urinary problems and
oedema. The discussion on labour problems includes
formulae for promoting labour, and on dealing with a
dead fetus, prolonged labour or retention of placenta.
The discussion on post-partum diseases includes tetanus, puerperal infections, abdominal pain, persistent
bleeding, retention of urine, insufficient lactation and
mastitis.
During the Song dynasty (960–1279), the imperial medical college was staffed by 300 people; there
were nine departments, one of which was obstetrics
and gynecology. This was probably the earliest medical school department dedicated entirely to gynecology and obstetrics. The specialization fostered by the
division of the imperial medical college into different
departments stimulated the development of the various specialties, among which was gynecology. This led
to the publication of many books specializing in obstetrics and gynecology, an important one being the Great
Treatise of Useful Prescriptions for Women (Fu Ren Liang
Fang Da Quan, 1237) written by Chen Zi Ming during
the Southern Song dynasty. The book comprises 24
volumes including 20 chapters on menstrual diseases,
91 on miscellaneous diseases, 10 on infertility, 8 on
‘fetal education’, 9 on pregnancy problems, 70 on postpartum diseases and 10 on boils and ulcers. More than
260 diseases are discussed in all with various formulae for each. This book exerted a profound influence on
the development of obstetrics and gynecology in subsequent dynasties.
During the Jin and Yuan dynasties (1115–1368)
many different medical schools of thought flourished,
among which the main ones were those headed by Liu
Wan Su, Li Dong Yuan, Zhu Dan Xi and Zhang Zi He.
Liu Wan Su (1120–1200) maintained that Fire is the
primary cause of disease and he therefore advocated
the use of cold herbs in gynecological problems. For
example, he attributed amenorrhoea to Heart-Fire.
He also advocated treating the Kidney channel in girls
before puberty, the Liver channel in young women and
the Spleen channel in post-menopausal women. He
also paid attention to modifying gynecological formulae according to the seasons. Recognizing the influence
of the seasons on medical conditions, he advocated
doubling the dosage of Chuan Xiong Radix Chuanxiong
within the formula Si Wu Tang Four Substances Decoction
during springtime, doubling Bai Shao Radix Paeoniae
alba in summertime, doubling Shu Di Huang Radix
Rehmanniae preparata during the autumn and doubling
Dang Gui Radix Angelicae sinensis in wintertime. He
also suggested adding Fang Feng Radix Saposhnikoviae
in springtime, Huang Qin Radix Scutellariae in summertime, Mai Men Dong Radix Ophiopogonis in the autumn
and Gui Zhi Ramulus Cinnamomi in winter.
Li Dong Yuan (1180–1251) was the founder of the
‘School of Stomach and Spleen’ which emphasized a
disharmony of these two organs as the main aetiology
History of Gynecology in Chinese Medicine 5
and pathology of diseases. He therefore advocated tonifying the Stomach and Spleen as the main method of
treatment in gynecology too. In his book Secret Record
of the Orchid Chamber (Lan Shi Mi Cang), he says that
prolonged deficiency of the Stomach and Spleen leads
to amenorrhoea, and that to treat this, one needs to
clear Stomach-Heat, generate Stomach fluids and tonify Qi and Blood. He says that uterine bleeding is due
to deficiency of the Stomach and Spleen, arousing
Minister Fire of the Kidneys and causing Damp-Heat to
infuse downwards: to treat this he advocates tonifying
the Stomach and Spleen and raising Qi.
Zhu Dan Xi (1281–1358) maintained that “Yang is
often in excess and Yin is often deficient” and therefore
advocated nourishing Yin as one of the most important
treatment principles. For example, for problems before
childbirth he advised clearing Heat and nourishing
Blood. He also indicated Huang Qin Radix Scutellariae
and Bai Zhu Rhizoma Atractylodis macrocephalae as two
important herbs to prevent miscarriage.
Zhang Zi He (1156–1228) treated diseases by the
three methods of sweating, vomiting and moving
downwards. He used tonics only after first using herbs
that eliminate pathogenic factors, since one cannot
tonify when these are present. He applied this method
to gynecological diseases as well, often advocating that
the patient be made to vomit and using downwardmoving methods of treatment to eliminate Phlegm and
Water in menstrual problems.
The doctors of the Ming dynasty (1368–1644) consolidated and integrated the theories of these four great
schools of medical thought. Many important gynecological books were written during the Ming dynasty,
e.g. Standards of Diagnosis and Treatment of Women’s
Diseases (Zheng Zhi Zhun Sheng – Nu Ke, 1602) by Wang
Ken Tang, Summary of Gynecology and Obstetrics (Nu Ke
She Yao, 1548) by Xue Ji, Summary of Fertility (Guang Si
Ji Yao) and Women’s Secrets (Fu Ren Mi Ke) by Wan Quan.
He said that, in order to conceive, the man should clear
his Heart and control his sexual desire to nourish the
Essence, while a woman should calm her Mind and settle Qi to nourish Blood. The above-mentioned Standards
of Diagnosis and Treatment by Wang Ken Tang summarized the experience of doctors of previous generations
in the treatment of gynecological diseases. His book
dealt with menstrual problems, miscellaneous diseases, pregnancy problems and post-partum diseases.
Wu Zhi Wang adopted this book as a chief source to
write his Compendium of Therapy of Women’s Diseases
(Ji Yin Gang Mu, 1620) which became an authoritative
text for subsequent generations of gynecologists.
The Complete Works of Jing Yue (Jing Yue Quan Shu,
1624), by Zhang Jing Yue, has an extensive section on
gynecology and obstetrics discussing the treatment of
problems of pregnancy and labour, leucorrhoea, breast
diseases, fertility, abdominal masses and menstruation.
Zhang Jing Yue recommended paying particular attention to regulating menstruation in gynecological diseases. He said that the key to regulate menstruation is
to nourish Blood by tonifying the Stomach and Spleen
and calming the chamber of Blood by tonifying the
Kidneys. On the question of whether the Spleen or the
Kidneys was the more important organ, he decided in
favour of the latter.
During the Qing dynasty (1644–1911) many gynecological treatises were written. The three most important ones were Fu Qing Zhu’s Gynecology (Fu Qing Zhu
Nu Ke) by Fu Qing Zhu (1607–1684), the Golden Mirror
of Medicine (Yi Zong Jin Jian, Vol. 3, 1742) by Wu Qian
and the Treatise on Obstetrics (Da Sheng Bian, 1715) by
Ji Zhai Ju Shi (a pseudonym meaning ‘the Buddhist of
Ji House’).
Fu Qing Zhu’s Gynecology is unlike any other gynecology book insofar as the author proposes his own personal, and often unorthodox, ideas on the pathogenesis
and treatment of gynecological diseases and his formulae are unlike any of those from previous gynecological books. One of the central theses of Fu Qing Zhu’s
book is that the Kidneys are the most important organ
for the menstrual function as they are the origin of
menstrual blood. According to him, menstrual blood
is unlike normal ‘Blood’: it is a precious fluid derived
from the Kidney-Essence. His book discusses the differentiation and treatment of menstrual problems, pregnancy, post-partum diseases, infertility, leucorrhoea
and labour, with the different patterns and formulae
for each.
The gynecology volume of the Golden Mirror of
Medicine by Wu Qian discusses the pathology and treatment of menstrual problems, leucorrhoea, pregnancy,
labour, post-partum diseases, abdominal masses and
miscellaneous diseases. One particular feature of this
book is that it is written in a style that is easy to read.
The Treatise on Obstetrics focuses on diseases of pregnancy, management of normal and difficult labour,
and post-partum diseases.
During the late Qing dynasty, Western medicine
was introduced to China and integrated with Chinese
6 Section 1: Physiology and Pathology
medicine. The two principal doctors who advocated
the integration of Chinese and Western medicine were
Tang Zong Hai (1862–1918) and Zhang Xi Chun
(1860–1933). These doctors did not write specialized
books on gynecology but they did discuss gynecological
and obstetric problems in their works. For example, in
his book Discussion on Blood Syndromes (Xue Zheng Lun,
1885), Tang Zong Hai discusses the treatment of menstrual problems, uterine bleeding, stasis of Blood, accumulation of Blood, amenorrhoea, etc. Zhang Xi Chun
paid special attention to regulating Spleen and Kidneys
and invigorating Blood in treating gynecological diseases. He formulated several important prescriptions
such as Li Chong Tang Regulating the Penetrating Vessel
Decoction, An Chong Tang Calming the Penetrating Vessel
Decoction, Gu Chong Tang Consolidating the Penetrating
Vessel Decoction and Shou Tai Wan Fetus Longevity Pill
in his book Records of Combined Chinese and Western
Medicine (Yi Xue Zhong Zhong Can Xi Lu, 1918).
Since 1949, the combination of Western and
Chinese medicine has been emphasized and many
innovative treatments have been devised. For example, ectopic pregnancy is often treated with acupuncture and Chinese herbs without recourse to
surgery; acupuncture is used in breech presentation of the fetus; Chinese herbs are used in the treatment of myomas and cervical carcinoma, etc. Since
the major colleges of traditional Chinese medicine
were established in 1956, many modern gynecology
textbooks have been published and the ancient ones
reprinted.
END NOTES
1. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Ti Nei Jing Su Wen
), People’s Health
Publishing House, Beijing, p. 197. First published c. 100 BC.
2. Ibid., p. 259.
3. Ibid., p. 4.
4. Wang Shu He 1988 A Revised Explanation of the Pulse Classic (Mai
Jing Jiao Shi
), with commentary by the Fuzhou City People’s
Hospital, People’s Health Publishing House, Beijing, p. 585. First published in AD 280.
5. Ibid., p. 588.
CHAPTER 2
WOMEN’S PHYSIOLOGY
THE UTERUS 8
PHYSIOLOGY OF MENSTRUATION AND THE
FOUR PHASES 10
The origin, nature and function of Tian Gui 10
The four phases of the menstrual cycle 12
Menstruation in Western medicine 14
Hypothalamus–pituitary–ovarian axis 17
Chinese medicine view of the four phases in detail 19
The four phases and treatment principles 23
MENSTRUATION AND THE INTERNAL ORGANS 24
Kidneys 24
Liver 28
Spleen 30
Heart 31
Lungs 32
Stomach 32
MENSTRUATION AND THE EXTRAORDINARY
VESSELS 33
Penetrating Vessel (Chong Mai) 33
Directing Vessel (Ren Mai) 36
Governing Vessel (Du Mai) 38
Girdle Vessel (Dai Mai) 40
Yin Stepping Vessel (Yin Qiao Mai) 42
CONCEPTION 43
PREGNANCY 44
MENOPAUSE 45
Women’s physiology and gynecological systems are
influenced particularly by one organ, one vital substance and one structure:
•
•
•
The Kidneys.
Blood.
The Uterus.
The Kidneys play a huge role in gynecology as they
are the origin of Tian Gui, i.e. menstrual blood, and the
ova from the ovaries. Without Tian Gui, there would be
no menstrual cycle and no fertility. The origin, nature
and function of Tian Gui are discussed at length
below.
In women, Blood plays a role in menstruation, fertility, conception, pregnancy and childbirth. Although
Tian Gui is not equivalent to Blood, the Blood stored by
the Liver and the Uterus does play a role in women’s
physiology. Moreover, although menstrual blood is Tian
Gui (and therefore ‘Water’), the Post-Natal Qi and Blood
produced by Stomach and Spleen do play a (secondary)
role in producing menstrual blood.
CLINICAL NOTE
Although menstrual blood is Tian Gui (and therefore
‘Water’), the Post-Natal Blood of Stomach and
Spleen does play a secondary role in producing
menstrual blood. For this reason, in order to tonify
Blood in women, we can reinforce BL-20 Pishu and
BL-23 Shenshu to nourish the Post-Natal Blood
and the Tian Gui respectively.
Women’s physiology is, of course, also dominated
by the fact that their lower Dan Tian houses the Uterus
which, in turn, stores Blood. This is of huge clinical significance: because women’s lower abdomen contains
the Uterus which stores Blood, women are much more
prone to Blood stasis than men are.
CLINICAL NOTE
Women are very prone to Blood stasis. In
complicated, chronic gynecological problems,
always suspect Blood stasis.
8 Section 1: Physiology and Pathology
In order to understand women’s physiology, it may
be helpful to compare 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.
The book Elementary Medicine (1575) says:
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.1
The Secret Records of Master Feng’s Brocade Bag says:
Man 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. Woman 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 14.2
This passage of course makes reference to the life
cycles of men (8 years) and women (7 years) first introduced by Chapter 1 of the Simple Questions.
The discussion of women’s physiology will consist of
the following parts:
•
•
•
•
•
•
•
The Uterus
Physiology of menstruation and the Four Phases
Menstruation and the internal organs
Menstruation and Extraordinary Vessels
Conception
Pregnancy
Menopause
THE UTERUS
The Uterus received many different names during the
development of Chinese medicine: Zi Bao, Bao Gong, Zi
Zang, Zi Chu, Xue Zang (Baby’s Bao, Bao Palace, Baby’s
Zang, Baby’s Abode, Blood Zang). The Chinese word Bao
conveys the idea of a ‘container’ and for this reason the
Uterus is called Zi Bao, i.e. the contained or the baby (in
pregnancy). However, please note that Bao by itself is a
structure that is common to both women and men; it is
only the Zi Bao (‘baby’s container’) that is exclusive to
women. As indicated below, in men, Bao is the Jing Shi
which can be translated either as ‘Room of Sperm’ or
‘Room of Essence’.
In women, the Uterus corresponds to the Lower Field of
Elixir (Dan Tian) which in men houses the ‘Room of Sperm’.
The Golden Mirror of Medicine (Yi Zong Jin Jian, 1742) says:
The Governing Vessel [Du Mai] arises within the lower
abdomen, externally in the abdomen, internally in the Bao …
also called Dan Tian in both men and women: in women it
is the Uterus, in men it is the Room of Sperm.3
This passage clearly shows that Bao is a structure
common to both men and women, being the Uterus in
women and the ‘Room of Sperm’ in men. As we shall see,
the Extraordinary Vessels arise from this area (Fig. 2.1).
The Uterus is one of the six ‘extra Yang organs’.
These organs have the shape of a Yang organ (i.e. hollow) and the function of a Yin organ (i.e. storage). The
Uterus’s shape is hollow and menstruation and labour
are an expression of its function of discharging (as a
Yang organ). On the other hand, the Uterus stores
Blood and nourishes the fetus during pregnancy (an
expression of its function as a Yin organ; see Fig. 2.2).
The Uterus is related to the Kidneys via a channel
called the Uterus Channel (Bao Luo). Chapter 47 of the
Simple Questions says: “The Uterus Channel extends to the
Kidneys.”4 The Uterus is also physiologically related to
the Heart via a channel called the Uterus Vessel (Bao
Mai). Chapter 33 of the Simple Questions says: “The
Uterus Vessel pertains to the Heart and extends to the
Uterus” and “When the period does not come it means that
the Uterus Vessel is obstructed”5 (Fig. 2.3).
LOWER DAN TIAN
BAO
In men
ROOM OF JING
UTERUS –
ZI BAO
SPERM
MENSTRUAL
BLOOD
TIAN GUI
Figure 2.1 The Bao in men and women.
In women
Women’s Physiology 9
Stores fetus
Shape of a Zang
Stores Blood
Discharges Blood
including the fallopian tubes and the ovaries. Thus, the
‘Uterus’ and, in particular, the Kidneys are responsible
for all the functions that in Western medicine are related
to uterus, tubes and ovaries, and indeed including the
hypothalamus–pituitary–ovarian axis. For this reason,
too, Tian Gui has a broader meaning than simply menstrual blood as it must include the ova from the ovaries.
Function of Fu
Discharges baby
Figure 2.2 The Uterus as one of the six Extraordinary Yang organs.
!
The ‘Uterus’ of Chinese medicine includes the ovaries
and Tian Gui includes the ova.
HEART
Uterus Vessel
(Bao Mai )
UTERUS
Uterus Channel
(Bao Luo)
KIDNEYS
Figure 2.3 The Uterus connection with Kidneys and Heart.
CLINICAL NOTE
The Uterus is functionally related to the Kidneys
via the Uterus Channel (Bao Luo) and to the Heart
via the Uterus Vessel (Bao Mai). The latter connection
with the Heart explains the strong influence of
emotional stress on menstruation. In order to
influence the Uterus through the Heart channel I
use mostly HE-5 Tongli.
Hence normal menstruation and fertility depend on
the state of the Kidney-Essence and of Heart-Qi and
Heart-Blood. The Kidney-Essence and Tian Gui are the
primary factors in menstruation and fertility: if the
Kidney-Essence is deficient, there may be amenorrhoea
and/or infertility. However, the Heart also plays a role.
If Heart-Qi does not descend to the Uterus, this may
also cause amenorrhoea. Figure 2.4 shows the connection between the Uterus and the internal organs.
‘Uterus’ has a broad definition in Chinese medicine, encompassing structures beyond the uterus itself,
Interestingly, in Western medicine too there is a connection between the uterus and ovaries. There is evidence that hysterectomy with conservation of the
ovaries is associated with earlier ovarian failure and this
may be due to a reduction in the blood supply to the ovaries following surgical clamping of the uterine arteries.
Animal studies have shown that uterine tissue is necessary to ensure the development of ovarian follicles.6
SUMMARY
Uterus
• The Uterus was variously called Baby’s Bao, Bao
Palace, Baby’s Zang, Baby’s Abode, Blood Zang
• Bao by itself is a structure that is common to both
women and men: in men, Bao is the Jing Shi
which can be translated either as ‘Room of Sperm’
or ‘Room of Essence’
• The Uterus is one of the six ‘extra Yang organs’
with the shape of a Yang organ (i.e. hollow) and
the function of a Yin organ (i.e. storage)
• Menstruation and labour are an expression of its
function of discharging (as a Yang organ). On the
other hand, the Uterus stores Blood and nourishes
the fetus during pregnancy (an expression of its
function as a Yin organ)
• The Uterus is related to the Kidneys via a channel
called the Uterus Channel (Bao Luo) and to the Heart
via a channel called the Uterus Vessel (Bao Mai)
• Normal menstruation and fertility depend on the
state of the Kidney-Essence and of Heart-Qi and
Heart-Blood
• ‘Uterus’ has a broad definition in Chinese medicine,
encompassing structures beyond the uterus itself,
including the fallopian tubes and the ovaries
10 Section 1: Physiology and Pathology
Pr
nd
sa d
ide Bloo
s
ve
mo
SPLEEN
ov
d
an d
es Bloo
k
Ma lds
ho
Keeps Uterus
in place
Provides Essence,
UTERUS
Yin
via
vid
e
nis s Ya
n
ter
Fir g,
e
Mi
el
ss
Ve
DIRECTING
VESSEL
Pro
ng
ati
tr
ne
Pe
PENETRATING
VESSEL
Pr
o
mo vide
s
ve
s B and
loo
d
LIVER
HE-Yang goes down
to Uterus Vessel
HE-Blood goes
down to Uterus
HEART
Provides
Essence
GOVERNING
VESSEL
STOMACH
Uterus
Channel
KIDNEYS
Figure 2.4 The Uterus and internal organs.
PHYSIOLOGY OF MENSTRUATION
AND THE FOUR PHASES
Menarche (the onset of the first menstrual period) statistically starts at 12.8 years of age in industrialized
countries, with a range of 10 to 16 years. In the United
Kingdom, menarche occurs between the ages of 11 and
15 in 95% of girls and the median age is 13.7 In the USA,
90% of girls experience menarche between the ages of
11 and 13.75 and the median age is 12.43.8 In China,
menarche occurs within the 13 to 15 age range in the
overwhelming majority of girls.9 Menarche occurring
before the age of 10 is considered premature, and menarche is delayed if it has not occurred by the age of 16.
The mean age of menopause is 50: if it occurs before the
age of 35 it is termed premature, and if it has not occurred
by the age of 55, delayed. From a Western medical perspective, the menstrual cycle occurs every 21 to 36 days
and lasts 3 to 7 days, with the woman losing an average amount of 30–80 ml. The colour is usually dark red,
lighter at the beginning, deep in the middle and pinkish at
the end of the period. The normal flow does not coagulate
and there are no clots; the blood is neither dilute nor thick.
A study of 321 women showed that the commonest bleeding lengths were 5 and 6 days, found in 49% of women.10
The range of the above ‘normal’ values from a
Western medical perspective is somewhat broader
than what Chinese medicine would consider ‘normal’. For example, Chinese medicine would consider
a range of 26 to 32 days more normal for the length
of the menstrual cycle than a range of 21 to 36 days.
It should be stressed here that regularity of the cycle
is all-important: if the cycle length varies from month
to month, this would be considered abnormal even
if it fell within the 26 to 32 days range. On the other
hand, were the period to occur regularly every 33 days,
this would be considered normal. Similarly, Chinese
medicine would consider a duration of 4 to 6 days for
menstruation as more ‘normal’ than that of 3 to 7 days.
The origin, nature and function of
Tian Gui
Tian Gui is mentioned in the first chapter of the Simple
Questions in connection with the life cycles of men and
women. Chapter 1 of the Simple Questions says: “At 14
Women’s Physiology 11
the Tian Gui arrives, the Directing Vessel [Ren Mai] is open
and the Penetrating Vessel [Chong Mai] flourishing, the
period arrives and the girl can conceive.”11 Tian Gui is the
ancient Chinese equivalent of hormonal development
in modern medicine.
In men, Tian Gui is sperm, while in women, it is menstrual blood and the ova. The root of Tian Gui is in the
Kidney-Essence and the Minister Fire which are present from conception. They need 14 years in girls and 16
years in boys to mature into ova and sperm respectively.
The Post-Natal Qi and Blood of the Stomach and Spleen
play a role (albeit a secondary one) in the formation of
menstrual blood and the maturation of eggs at puberty.
The term Tian Gui is impossible to translate because Tian
means ‘heaven’ or ‘heavenly’ but Gui refers to the 10th
Heavenly stem of the Chinese calendar: thus the word
‘Gui’ must remain untranslated. The fact that the term
for Tian Gui refers to ‘Heaven’ is significant: it refers to the
fact that women’s menstrual cycle is influenced by cosmic
cycles. Indeed, the term Tian Gui refers to ‘Heaven’ twice:
once in the term ‘heavenly’ itself and once because Gui is
a Heavenly stem, i.e. representing the heavenly influence
of a particular year. Each year is denoted by one of the 10
Heavenly stems and one of the 12 Earthly Branches.
Moreover, it is significant that the Heavenly stem Gui
pertains to Water: in fact there are 10 stems divided
into 5 couples, each couple pertaining to one of the Five
Elements. The fact that the stem Gui pertains to Water
indicates that Tian Gui is a form of Water, a transformation of Kidney-Water.
What exactly is Tian Gui? All Chinese books say that
Tian Gui is menstrual blood and that, for this reason,
menstrual blood is not the same as Liver-Blood, i.e. the
‘Blood’ that nourishes the sinews, eyes, hair and skin.
Menstrual Blood is a precious fluid that originates from
Kidney-Water and Kidney-Essence.
Thus menstrual Blood is called ‘Heavenly Gui’
because it represents the descending of Heavenly Gui
materializing into Water (the 10th stem Gui pertains
to Water). The Great Treatise of Beneficial Formulae for
Women (1237) explains:
When the girl is 14 the Heavenly Gui arrives, the
Directing Vessel is open, the Penetrating Vessel is
flourishing and the period arrives. “Heavenly” indicates
the descending of the True Qi of Heaven; “Gui” indicates
Water [as this stem pertains to Water]: [menstrual
blood is therefore] like heavenly clouds generating
water.12
The famous Qing dynasty gynecologist Fu Qing
Zhu (1607–1684) stressed forcefully that menstrual
blood is not ‘Blood’ but ‘Water’. Fu Qing Zhu holds
that menstrual blood is not Blood but Tian Gui which
originates from the Kidneys. He says it is formed
from Kidney-Yin but with the participation of HeartYang (another way in which the Heart influences
menstruation) and that despite being blood-red in
colour it is not Blood; hence its name of Tian Gui.13
He also says that the generation of Tian Gui has nothing to do with Heart, Liver or Spleen; these organs
only help its transformation into Blood. His original
passage says:
Menstrual blood is not Blood but Heavenly Water,
originating within the Kidneys, it is the essence of extreme
Yin and Qi of extreme Yang. It is red like blood but it is
not blood. That is why it is called Heavenly Gui. People
nowadays regard menstrual blood as Blood, a mistake
perpetuated for 1000 years … in fact it is not called bloodwater [Xue Shui] but menstrual water [Jing Shui] … the
generation of Kidney Water [and therefore menstrual
blood] has nothing to do with Heart, Liver and Spleen, but
the transformation of Kidney Water is helped by Heart,
Liver or Spleen.14
It should be emphasized that while menstrual blood
is a form of Tian Gui, this is not only menstrual blood as
it is also the origin of sperm in men (Fig. 2.5).
However, in women, in my opinion Tian Gui is not
simply menstrual blood but it must include the ova.
The first chapter of the Simple Questions obviously
refers to the ova when it says that “Tian Gui arrives and
the girl can conceive”. It is the maturation of the ova
occurring at puberty, not menstrual blood, that allows
conception.
TIAN GUI
KIDNEY-WATER
HEART
LIVER
SPLEEN
Help transformation of Water into Tian Gui
Figure 2.5 Generation and transformation of Tian Gui
according to Fu Qing Zhu.
12 Section 1: Physiology and Pathology
SUMMARY
The origin, nature and function of Tian Gui
• Tian Gui is mentioned in the first chapter of the
Simple Questions in connection with the life cycles
of men and women
• When a girl is 14, the Tian Gui arrives, the
Directing Vessel (Ren Mai) is open and the
Penetrating Vessel (Chong Mai) flourishing, the
period arrives and the girl can conceive
• In men, Tian Gui is sperm, while in women it is
menstrual blood and the ova
• The root of Tian Gui is in the Kidney-Essence and
the Minister Fire which are present from conception
• The Post-Natal Qi and Blood of the Stomach and
Spleen play a role (albeit a secondary one) in the
formation of menstrual blood and the maturation
of eggs at puberty
• Tian Gui is menstrual blood and, for this reason,
menstrual blood is not the same as Liver-Blood, i.e.
the ‘Blood’ that nourishes the sinews, eyes, hair
and skin. Menstrual blood is a precious fluid that
originates from Kidney-Water and Kidney-Essence
• The famous Qing dynasty gynecologist Fu
Qing Zhu (1607–1684) stressed forcefully that
menstrual blood is not ‘Blood’ but ‘Water’
• Fu Qing Zhu holds that menstrual blood is not
Blood but Tian Gui which originates from the
Kidneys. He says it is formed from Kidney-Yin with
the participation of Heart-Yang
• He also says that the generation of Tian Gui is
from the Kidneys while the Heart, Liver and Spleen
help its transformation into menstrual blood
• In women, in my opinion, Tian Gui is not simply
menstrual blood but it must include the ova
The four phases of the menstrual cycle
The theory of the four phases of the menstrual cycle is not
an ancient, traditional theory but a modern one. However,
it is a modern theory that is based on the integration of
the ancient concepts of Yin-Yang and Kidney-Yin and
Kidney-Yang with modern hormonal knowledge.
This theory was developed largely by Professor Xia Gui
Cheng of the Nanjing University of Traditional Chinese
Medicine. According to this theory, the menstrual cycle
is determined by the ebb and flow of two tides: one of
Kidney-Yin, the other of Kidney-Yang. The amount of Yin
and Yang (and specifically Kidney-Yin and Kidney-Yang)
fluctuates like a tide during the month in a determined
pattern. The pattern is that Yang decreases when the
period starts and reaches a minimum at mid-cycle; Yin
increases when the period starts and reaches a maximum
at mid-cycle. Thus, Yang reaches its maximum level just
before the period starts and then begins to decrease rapidly as soon as the period starts (this rapid decline of Yang
explains the disappearance of pre-menstrual symptoms
when the period starts). Yang reaches its minimum level
at mid-cycle after which it starts to rise again. It rises rapidly in the few days before the period. As for Yin, it is at its
minimum level at the beginning of the period after which
it starts to rise, reaching its maximum at mid-cycle. After
that, it starts to decline until the next period starts. Thus,
at mid-cycle, there is a maximum of Yin and minimum
of Yang; when the period starts, there is a maximum of
Yang and minimum of Yin.
Note that there are two crucial times of transformation from Yin to Yang and Yang to Yin. In fact, when the
period starts, Yang decreases from its maximum level
and Yin increases from its minimum level: thus, there is
a switch, a transformation from Yang to Yin. The opposite happens at mid-cycle (around ovulation time). At
this time, Yin has reached its maximum and starts to
decline while Yang has reached its minimum level and
starts to increase: thus, there is a switch, a transformation from Yin to Yang, the opposite of what happened
at the beginning of the period.
This transformation of Yang to Yin and vice versa is
under the control of the Heart: it relies on the descending
of Heart-Qi and Heart-Blood. If for any reason Heart-Qi
does not descend to the Uterus (via the Bao Mai, Uterus
Vessel), then the period or ovulation might be delayed:
conversely, should Heart-Qi descend too soon, the period
or ovulation might come early. The times of transformation of Yang to Yin and vice versa are marked by discharge
and downward movement. In fact, when the period starts
(transformation from Yang to Yin), there is a discharge
and downward movement of blood. During mid-cycle
(transformation from Yin to Yang), there is a discharge
and downward movement of the ovum (or ova).
Figure 2.6 illustrates the ebb and tide of Yin and
Yang in the four phases of the menstrual cycle. Please
note that the diagram of the four phases is rather
theoretical, i.e. it shows the ebb and flow of Yin and
Yang as perfectly symmetrical during the month. In
practice, it is not so. In practice, the diagram representing the ebb and flow of Yin and Yang would be
rather different. One difference is, for example, that
the Yin is at its minimum level not at the beginning
Women’s Physiology 13
Gonadotropins
LH
FSH
Maturing follicle
Ovulation
Corpus luteum
Endometrium
Day 4
Day 14
Day 28
98
97.5
Temperature
97
PROGESTERONE
OESTROGEN
YIN
YANG
PERIOD
AFTER PERIOD
MID-CYCLE
BEFORE PERIOD
Menses
Post-menstrual phase
(oestrogen – follicular
proliferative)
Ovulation
Pre-menstrual phase
(luteal or progesterone)
Blood moving
Blood-Yin empty
Blood-Yin fill up in
Directing and
Penetrating Vessels
Yang-Qi rises
Liver-Qi rises
Move Blood if too little:
stop bleeding if too much
Nourish Blood and Yin
(Liver and Kidneys)
Nourish Essence
Tonify Yang if it is
deficient; move Liver-Qi if
Qi is stagnant
Figure 2.6 The four phases of the menstrual cycle. FSH, follicle-stimulating hormone; LH, luteinizing hormone.
of the period but towards the end of it. In fact, at the
end of the period, Blood and Yin are in a state of ebb.
Another difference is that the rise of Yang in the second
half of the cycle is steeper at first and then levels off
after ovulation (reflecting the rise in temperature that
occurs after ovulation). Taking these two differences
into account, the diagram might look like the diagram
in Figure 2.7.
14 Section 1: Physiology and Pathology
Figure 2.7 Actual representation of flow of Yin and Yang in
the four phases.
SUMMARY
The four phases of the menstrual cycle
• The menstrual cycle is determined by the ebb and flow of
two tides: one of Kidney-Yin, the other of Kidney-Yang
• The amount of Yin and Yang (and specifically
Kidney-Yin and Kidney-Yang) fluctuates like a tide
during the month in a determined pattern
• The pattern is that Yang decreases when the
period starts and reaches a minimum at mid-cycle;
Yin increases when the period starts and reaches a
maximum at mid-cycle
• Thus, at mid-cycle, there is a maximum of Yin and
minimum of Yang; when the period starts, there is
a maximum of Yang and minimum of Yin
• There are two crucial times of transformation from
Yin to Yang and Yang to Yin. When the period
starts, Yang decreases from its maximum level and
Yin increases from its minimum level: thus, there is
a switch, a transformation from Yang to Yin. The
opposite happens at mid-cycle
• This transformation of Yang to Yin and vice versa
is under the control of the Heart: it relies on the
descending of Heart-Qi and Heart-Blood
• The times of transformation of Yang to Yin and vice versa
are marked by discharge and downward movement of
menstrual blood in the former and of ova in the latter
thickens. Follicles in the ovary begin developing under the
influence of a complex interplay of hormones and, after
several days, one or occasionally two become dominant
(non-dominant follicles atrophy and die). The dominant
follicle releases an ovum, inducing ovulation.
After ovulation, in the luteal phase, the remains of the
dominant follicle in the ovary become a corpus luteum
which produces large amounts of progesterone. Under
the influence of progesterone, the endometrium changes
to prepare for potential implantation of an embryo to
establish a pregnancy. If implantation does not occur
within approximately 2 weeks, the corpus luteum will
involute, causing sharp drops in levels of both progesterone and oestrogen. These hormone drops cause the
uterus to shed its lining inducing menstruation.
The following is a description of the individual menstrual phases from the Western medical viewpoint.
Menstruation (bleeding time)
The flow of menses normally serves as a sign that a
woman has not become pregnant. Eumenorrhoea
denotes normal, regular menstruation that lasts for a
few days, usually 3 to 5 days, but anywhere from 2 to
7 days is considered normal (not in Chinese medicine).
The menstrual fluid is largely a mixture of blood and
tissue from the endometrium. The average blood loss
during menstruation is 35 ml with 10–80 ml considered normal. The enzyme plasmin inhibits clotting in
the menstrual fluid. Slight cramping in the abdomen,
back or upper thighs is common during the first few
days of menstruation. When menstruation begins,
symptoms of pre-menstrual syndrome (PMS) such as
breast tenderness and irritability generally decrease.
From the Chinese perspective, the menstruation
(bleeding phase) is under the control of Liver-Blood
and the Penetrating Vessel (Chong Mai).
SUMMARY
Menstruation in Western medicine
The menstrual cycle in Western medicine is largely composed of two main phases: the follicular phase (dominated by oestrogen) in the first half and the luteal phase
(dominated by progesterone) in the second half. The
release of oestrogen by the ovaries is triggered by folliclestimulating hormone (FSH) from the pituitary gland, and
the release of progesterone by luteinizing hormone (LH).
In the follicular phase, stimulated by gradually
increasing amounts of oestrogen, the lining of the uterus
Menstruation in Western medicine
• Eumenorrhoea denotes normal, regular menstruation
that lasts for a few days, usually 3 to 5 days
• The menstrual fluid is largely a mixture of blood
and tissue from the endometrium
• The average blood loss during menstruation is
35 ml with 10–80 ml considered normal
• From the Chinese perspective, the menstruation
(bleeding phase) is under the control of Liver-Blood
and the Penetrating Vessel (Chong Mai)
Women’s Physiology 15
Follicular phase
The follicular phase is also called the proliferative phase
because oestrogen causes the lining of the uterus to
grow during this time. Through the influence of a rise
in FSH during the first days of the cycle, a few ovarian follicles are stimulated. These follicles, which were
present at birth and have been developing in a process
known as folliculogenesis, compete with each other for
dominance. Under the influence of several hormones,
all but one of these follicles will stop growing, while
one dominant follicle in the ovary will continue to
maturity. The follicle that reaches maturity is called a
tertiary, or Graafian, follicle, and it forms the ovum.
As they mature, the follicles secrete increasing amounts
of oestradiol. The oestrogens initiate the formation of a new
layer of endometrium in the uterus, histologically identified
as the proliferative endometrium. The oestrogen also stimulates crypts in the cervix to produce fertile cervical mucus.
From a Chinese perspective, the follicular phase is
under the influence of Liver-Blood, the Kidneys and the
Directing Vessel (Ren Mai).
SUMMARY
Follicular phase
• The follicular or proliferative phase is characterized
by the growth of follicles under the influence of FSH
• Under the influence of several hormones, all but one
of these follicles will stop growing, while one dominant
follicle in the ovary will continue to maturity when it is
called the Graafian follicle: this forms the ovum
• As they mature, the follicles secrete increasing
amounts of oestradiol
• The oestrogens initiate the formation of a new
layer of endometrium in the uterus
• The oestrogen also stimulates crypts in the cervix
to produce fertile cervical mucus
• From a Chinese perspective, the follicular phase
is under the influence of Liver-Blood, the Kidneys
and the Directing Vessel (Ren Mai)
Ovulation
When the egg has nearly matured, the level of oestradiol in the body has increased enough to trigger a sudden release of LH from the anterior pituitary gland. In
the average cycle, this LH surge starts around cycle day
12 and may last 48 hours. The release of LH matures
the egg and weakens the wall of the follicle in the
ovary, causing the fully developed follicle to release
its secondary oocyte. The secondary oocyte promptly
matures into an otid and then becomes a mature ovum.
The mature ovum has a diameter of about 0.2 mm.
After being released from the ovary, the egg is swept into
the fallopian tube by the fimbria, a fringe of tissue at the
end of each fallopian tube. After about a day, an unfertilized egg will disintegrate or dissolve in the fallopian tube.
Fertilization by a spermatozoon, when it occurs, usually takes place in the ampulla, the widest section of
the fallopian tubes. A fertilized egg immediately begins
the process of embryogenesis.
From the Chinese perspective, the ovulation phase
is under the influence of the Kidneys (Yin and Yang)
and of the Directing and Penetrating Vessels (Ren and
Chong Mai).
SUMMARY
Ovulation
• When the egg has nearly matured, the level of
oestradiol in the body has increased enough to
trigger a sudden release of luteinizing hormone
(LH) from the anterior pituitary gland
• In the average cycle, this LH surge starts around
cycle day 12 and may last 48 hours
• The release of LH matures the egg and starts a process
that leads eventually to the release of an ovum
• If the ovum is not fertilized, it dissolves in the
fallopian tube
• From the Chinese perspective, the ovulation phase
is under the influence of the Kidneys (Yin and
Yang) and of the Directing and Penetrating Vessels
(Ren and Chong Mai)
Luteal phase
The luteal phase is the part of the cycle that starts at
ovulation and ends the day before the next period.
It usually lasts about 14 days. The corpus luteum
produces progesterone in preparing the body for
pregnancy. The luteal phase must be at least 10 days
long to support pregnancy.
Once the follicle expels the egg, the follicle is called a
‘corpus luteum’ (‘yellow body’ from its colour). The corpus luteum is responsible for producing progesterone: this
induces a thickening of the uterine lining and the development of blood vessels, which gives the embryo a place to
attach to. During the luteal phase, the corpus luteum will
produce progesterone for approximately 12 to 15 days.
From a Chinese perspective, the luteal phase should
be subdivided into two parts. The first half is under the
16 Section 1: Physiology and Pathology
influence of the Minister Fire which is reflected in the
increase in temperature occurring after ovulation. This
half is also under the control of Kidney-Yang and of the
Governing Vessel (Du Mai). The second half of the luteal
phase is under the control of Liver-Qi and Liver-Blood
(whose movement is essential to move Blood in preparation
for the period) and of the Penetrating Vessel (Chong Mai).
Figure 2.8 illustrates the changes occurring in the
hormones and uterus lining during the menstrual cycle.
Table 2.1 shows a comparison between the phases of
Table 2.1 Comparison of menstrual phases in
Western medicine with the Chinese view of the four
phases of the menstrual cycle
PHASE
START DAY
(28-DAY
CYCLE)
END
DAY
CHINESE
PHASE
Menstrual phase
1
4
1
Follicular phase
5
13
2
Ovulation
14
14
3
SUMMARY
Luteal phase
15
26
3–4
Luteal phase
Ischaemic phase
27
28
4
• The luteal phase is the part of the cycle that starts
at ovulation and ends the day before the next
period. It usually lasts about 14 days
• The corpus luteum produces progesterone in
preparing the body for pregnancy
• From a Chinese perspective, the first half of the luteal
phase is under the influence of the Minister Fire,
Kidney-Yang and of the Governing Vessel (Du Mai)
• The second half of the luteal phase is under the
control of Liver-Qi and Liver-Blood and of the
Penetrating Vessel (Chong Mai)
FSH
Ovulation
6 8 10 12 14 16 18 20 22 24 26 28
Pituitary
Hormones
2 4
LH
Growing Follicle
Corpus Luteum
Oestrogen
Progesterone
Ovulation
Ovarian
Hormones
Egg
Development
Uterus
Lining
Menses
2 4
6 8 10 12 14 16 18 20 22 24 26 28
Figure 2.8 Hormonal and endometrial changes during the
menstrual cycle.
the menstrual cycle in Western medicine and those in
Chinese medicine. The beginning of the luteal phase corresponds to the Chinese phase 3 while the latter part
corresponds to Chinese phase 4. Thus, there is a fairly
close correspondence between phases 1 and 2 between
Chinese and Western medicine (phase 1 being the
bleeding time and phase 2 the follicular phase, which
last about 8 days, but is variable). By contrast, the
luteal phase, which may last 12 to 15 days and is fairly
constant (except in pathology), is split between Chinese
phases 3 and 4.
Note that, although increased levels of FSH result in
the formation of a mature egg-containing follicle, it is
the surge of LH that prompts the follicle to burst and
release the egg into the fallopian tube. LH also causes
the fluid inside the follicles to change into the corpus
luteum which is responsible for producing progesterone in the second half of the cycle. Therefore, the luteal
phase spans two Chinese phases, i.e. 3 and 4. Phase 3
is characterized by ovulation itself under the influence
of LH, the rise in temperature occurring after ovulation
and by the initial development of the corpus luteum.
In phase 4, the temperature dips slightly and levels off,
LH drops and the sharp increase in Yang seen during
and after ovulation levels off. In addition, the uterus
lining thickens and new blood vessels develop: from the
Chinese perspective, this reflects the influence of LiverBlood and the Penetrating Vessel (Chong Mai).
Progesterone is responsible for the rise in basal body
temperature during the luteal phase. A level of progesterone less than 14 ng/ml indicates that progesterone
production in the luteal phase is inadequate. Should
progesterone levels prove to be low, the temptation in
Western medicine is often to ‘treat the symptom’ by
Women’s Physiology 17
giving the patient progesterone supplementation during the luteal phase. In the case of inadequate corpus
luteum performance, progesterone support may indeed
be the appropriate solution. However, inadequate follicle development (in the follicular phase) may also be
causing the low progesterone levels. Thus, it is important to measure mid-cycle follicle size (via ultrasound)
and oestradiol levels (via a blood test). If follicle development is normal, then progesterone supplementation
during the luteal phase is normally the correct treatment (from the Western point of view). If follicle development is inadequate, an ovulatory stimulant such
as Clomid is often used; these drugs help the follicle
to mature more appropriately, which has the double
benefit of producing a higher quality egg and a better
functioning corpus luteum. However, from the Chinese
perspective this is achieved at a cost: Dr Xia Gui Cheng
thinks that follicle-stimulating drugs such as Clomid
damage the ovaries.
Women whose linings fail to respond to normal progesterone levels often have normal follicle development and adequate progesterone levels at 7 days post
ovulation. An ultrasound image of the lining at 7
days after ovulation, however, will show a lining that
has failed to convert from the triple layer lining typical of the time of ovulation. In this case, women are
often given additional progesterone supplementation
in the luteal phase in the hope that a higher level will
be the push that the lining needs to convert appropriately. Some doctors use injections of human chorionic
gonadotropin to further stimulate the corpus luteum.
However, these injections can cause false positive pregnancy results. Thus, although oestradiol increases in
the follicular phase stimulating development of the follicle, it is the surge in LH that induces ovulation. This
confirms the Chinese view of the menstrual cycle in
which Kidney-Yin (oestradiol and FSH) and KidneyYang (progesterone and LH) are inextricably linked.
One depends on the other and ovulation cannot occur
without both of them. The fact that the luteal phase
depends partly on a good follicular phase also confirms
what Dr Xia Gui Cheng says about phase 2, i.e. that it
is a very important phase to set the menstrual cycle on
the right footing (see below).
hormone (GnRH) which, in turn, stimulates the secretion
of FSH and LH by the pituitary.
FSH stimulates follicle development in the ovaries
during the follicular phase while LH stimulates the corpus luteum during the luteal phase. With the rise in
oestrogen during the follicular phase, LH receptors are
also expressed on the maturing follicle that produces
an increasing amount of oestradiol. Eventually, at the
time of the maturation of the follicle, the oestrogen
rise leads via the hypothalamic interface to the ‘positive feedback’ effect, a release of LH over a 24 to 48
hour period. This LH surge triggers ovulation and the
conversion of the residual follicle into a corpus luteum
that, in turn, produces progesterone to prepare the
endometrium for a possible implantation.
GnRH is a neurohormone produced in the pre-optic
area of the hypothalamus. In the pituitary, GnRH stimulates the synthesis and secretion of the gonadotropins,
FSH and LH. These processes are controlled by the size
and frequency of GnRH pulses, as well as by feedback
from androgens and oestrogens. Low-frequency GnRH
pulses lead to FSH release, whereas high-frequency GnRH
pulses stimulate LH release (Fig. 2.9). In females, the frequency of the pulses varies during the menstrual cycle
and there is a large surge of GnRH just before ovulation.
GnRH secreted by the hypothalamus also stimulates the
production of prolactin by the pituitary gland (Fig. 2.10).
The hypothalamus–pituitary–ovarian axis has its
correspondent in the Du/Ren axis in Chinese medicine.
Both the Governing and Directing Vessels originate
HYPOTHALAMUS
Gonadotropin releasing hormone (GnRH)
PITUITARY
FSH
LH
FOLLICLE
CORPUS LUTEUM
Oestrogen
Progesterone
Hypothalamus–pituitary–ovarian axis
UTERUS
The menstrual cycle is the result of a complex and delicate
interplay among the hypothalamus, pituitary and ovaries. The hypothalamus secretes gonadotropin releasing
Figure 2.9 Hypothalamus–pituitary–ovarian axis.
18 Section 1: Physiology and Pathology
Hypothalamus
Pituitary
Prolactin
Hypothalamus
Pituitary
FSH
LH
REN MAI
Ovary
Oestrogens
Progesterone
Ovaries
Uterus
DU MAI
Uterus
REN
Figure 2.11 Correspondence between hypothalamus–
pituitary–ovarian axis and Governing/Directing Vessels.
Figure 2.10 Stimulation of prolactin secretion by GnRH.
in the ‘Kidneys’ (which includes the ovaries). The
Governing Vessel, controlling the Yang aspect of the
menstrual cycle, flows through the brain (where the
hypothalamus is); both the Directing and Governing
Vessels, controlling the Yin and Yang aspect of the
menstrual cycle, flow through the ovaries (Fig. 2.11).
Although one has to exercise caution when making
direct comparisons between Western and Chinese medicine, we can postulate that oestrogen is Yin (produced
by Kidney-Yin) and progesterone Yang (produced by
Kidney-Yang). Indeed, oestrogen is related to mucus
production in the cervical glands and the fallopian tubes
and a lower temperature: hence, mucus = fluids = Yin.
Progesterone is linked to the drying up of the cervical
mucus and the rise in temperature occurring after ovulation: hence, dryness = rise in temperature = Yang.
It is interesting that exactly the same hypothalamus–
pituitary–gonads axis exists in men. In men, the LH
which is secreted by the pituitary gland in response to a
GnRH signal acts on the Leydig cells in the testes. Once
stimulated with LH, the Leydig cells in the testes produce testosterone. FSH is also secreted by the pituitary
gland in men. Together with testosterone, FSH stimulates Sertoli cells (located in the seminiferous tubules of
the testes) to support the developing sperm (Fig. 2.12).
SUMMARY
Hypothalamus–pituitary–ovarian axis
• The menstrual cycle is the result of a complex
and delicate interplay among the hypothalamus,
pituitary and ovaries
• The hypothalamus secretes gonadotropin releasing
hormone (GnRH) which in turn stimulates the
secretion of follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) by the pituitary
• FSH stimulates follicle development in the ovaries
during the follicular phase while LH stimulates the
corpus luteum during the luteal phase
• The hypothalamus–pituitary–ovarian axis has
its correspondent in the Du/Ren axis in Chinese
medicine
• Both the Governing and Directing Vessels originate
in the ‘Kidneys’ (which includes the ovaries). The
Governing Vessel, controlling the Yang aspect of the
menstrual cycle, flows through the brain (where the
hypothalamus is); both the Directing and Governing
Vessels, controlling the Yin and Yang aspect of the
menstrual cycle, flow through the ovaries
• Oestrogen is Yin (produced by Kidney-Yin) and
progesterone Yang (produced by Kidney-Yang)
Women’s Physiology 19
Hypothalamus
GnRH
Pituitary
Prostate
GnRH
agonists
T (-) T (-)
Luteinizing hormone
T (+)
Testicular
Leydig cells
Figure 2.12 Hypothalamus–pituitary–testis axis in men.
T, testosterone.
Chinese medicine view of the four
phases in detail
In Chinese medicine, the four phases of the menstrual
cycle are the result of the ebb and flow of Kidney-Yin
and Kidney-Yang and also of the feedback mechanism
between the Kidneys and the Heart. The Heart plays
a role in the feedback mechanism. As we have seen,
Heart-Qi descends to the Kidneys to promote ovulation and menstruation, and the switch from Yang to
Yin occurs when the period starts and that from Yin
to Yang when ovulation occurs. Thus, at the peak of
Yin and Yang, there is a feedback to the Heart to induce
that downward movement; at the ebb of Yin and Yang
there is a feedback to the Kidneys (Fig. 2.13).
Feedback to Heart
Feedback to KI
The communication between Heart and Kidneys in
the physiology of menstruation is one aspect of the
‘vertical’ connection between Heart and Kidneys, Fire
and Water. Fire and Water (and Heart and Kidneys)
communicate with, respond to and nourish each other:
this relationship is a direct one that is independent of
the Five Element scheme in which the Kidneys nourish
the Liver and this the Heart.
Shen Zhai Wei Shu states:
The harmony of Heart and Kidneys depends on the
ascending of the Kidney-Qi and descending of the
Heart-Qi. The Kidneys pertain to Water, how can it ascend?
Because there is genuine Yang in Water (i.e. Heart-Qi).
The Heart pertains to Fire, how can it descend? Because
there is genuine Yin in Fire (i.e. Kidney-Qi).
The Governing and Directing Vessels control the
ebb and flow of Yin-Yang in the menstrual cycle. The
two Stepping Vessels (Yin and Yang Qiao Mai) help
the balance of Yin-Yang while the two Linking Vessels
(Yin and Yang Wei Mai) control the connection of YinYang. They have a secondary role in the regulation of
the menstrual cycle as they do not flow through the
uterus.
Phase 1: Menstrual
During phase 1, bleeding occurs. This phase is characterized by a downward movement of Qi and Blood
which helps a good discharge of blood during the
period. The activity during this phase is centred around
the Xiao Fu area of the abdomen, i.e. the central area
of the lower abdomen below the umbilicus (Fig. 2.14).
This phase is under the influence of the Penetrating
Vessel (Chong Mai) primarily.
Feedback to Heart
Feedback to Heart
Feedback to KI
Feedback to KI
Figure 2.13 Feedback between Heart and Kidneys in the menstrual cycle.
Feedback to Heart
Feedback to KI
Feedback to Heart
Feedback to KI
20 Section 1: Physiology and Pathology
discharge of old blood. If the blood discharge is insufficient, he says this may lead to ‘retention of menses’
and possibly endometriosis.
SUMMARY
Phase 1: Menstrual
SHAO FU
XIAO FU
Figure 2.14 Xiao Fu and Shao Fu areas in the lower abdomen.
From the point of view of Yin-Yang, the beginning of
phase 1 is characterized by a sharp drop of Yang which
usually induces the disappearance of pre-menstrual
symptoms. The beginning of the period marks a point
of transformation (or switch) from Yang to Yin, i.e.
Yang decreases rapidly and Yin begins to grow.
The downward movement of Qi and Blood and the
transformation from Yang to Yin occur under the influence of the descending of Heart-Qi. Phase 1 is under
the influence of Liver-Blood and the Penetrating Vessel
(although the main activity is in the centre of the abdomen in the Ren Mai area). So both Penetrating and
Directing Vessels influence this phase.
In phase 1, Yang decreases rapidly: if Yang does not
decrease, the period may not start or may start late. If
Yang decreases too much or too rapidly (due to a preexisting Yang deficiency) then menstruation may be
early and heavy.
Herbs that conduct Blood downwards during the
menses are: Chuan Niu Xi Radix Cyathulae, Ze Lan
Herba Lycopi and Dan Shen Radix Salviae miltiorrhizae.
CLINICAL NOTE
Herbs that conduct Blood downwards during
the menses are: Chuan Niu Xi, Ze Lan and Dan
Shen. It follows that the use of these herbs is not
recommended if the period is heavy.
Dr Xia Gui Cheng attaches great importance to a
woman having a good discharge of menstrual blood
during the period: he calls this a ‘discharge of the old’, i.e.
• Phase 1 is characterized by a downward
movement of Qi and Blood which helps a good
discharge of blood during the period
• The activity during this phase is centred around
the Xiao Fu area of the abdomen
• The beginning of phase 1 is characterized by a
sharp drop of Yang and the beginning of the
period marks a point of transformation (or switch)
from Yang to Yin, i.e. Yang decreases rapidly and
Yin begins to grow
• The downward movement of Qi and Blood and
the transformation from Yang to Yin occur under
the influence of the descending of Heart-Qi
• Phase 1 is under the influence of Liver-Blood and
of the Penetrating Vessel
• Dr Xia Gui Cheng attaches great importance to
a woman having a good discharge of menstrual
blood during the period: he calls this a ‘discharge
of the old’, i.e. discharge of old blood
Phase 2: Post-menstrual
During phase 2, Yang is decreasing and Yin is increasing fairly rapidly, reflecting the development of the
follicle under the influence of FSH. If Yin does not
grow sufficiently, ovulation may be delayed. If Yang
does not decrease sufficiently, ovulation may occur
early.
In phase 2, Blood and Yin are relatively Empty (as
they have been consumed by the loss of blood during
the period). Please note that the stress is on the word
‘relatively’. Therefore, this does not mean that every
woman at the end of the period and in phase 2 suffers
from Blood and/or Yin deficiency. What it does mean
is that, in phase 2, Blood and Yin are relatively lower
compared to other phases.
According to Dr Xia Gui Cheng, phase 2 is a very
important phase to establish a good basis for a normal
menstrual cycle. This is confirmed by Western medicine as a good follicular phase also influences the luteal
phase.
Women’s Physiology 21
There are three main characteristics in phase 2:
1. Yin starts to grow from its minimum level. This
is an increase of Kidney-Yin, corresponding to
oestrogen and the follicular phase. This phase is
very important to lay the foundation for the whole
menstrual cycle. During this phase, the Essence
(Jing) matures, thus nourishing the Uterus and
the follicles and promoting the growth of the
endometrium.
2. The decrease of Yang in this phase ensures the
growth of Yin (mutual consuming of Yin and
Yang). If Yin or Yang fails to grow/decrease at
the right time, it means that Yin and Yang at that
time are too ‘equal’ and the cycle cannot progress
normally.
3. The growth of Yin also implies growth of fluids in
the vagina and the beginning of the formation of
the cervical secretion in mid-cycle.
SUMMARY
Phase 2: Post-menstrual
• During phase 2, Yang is decreasing and Yin is
increasing fairly rapidly
• In phase 2, Blood and Yin are relatively Empty (as
they have been consumed by the loss of blood
during the period)
• According to Dr Xia Gui Cheng, phase 2 is a very
important phase to establish a good basis for a
normal menstrual cycle
• During this phase, the Essence (Jing) matures,
thus nourishing the Uterus and the follicles and
promoting the growth of the endometrium
• The decrease of Yang in this phase ensures the
growth of Yin (mutual consuming of Yin and Yang)
• The growth of Yin also implies growth of fluids in
the vagina and the beginning of the formation of
the cervical secretion in mid-cycle
under the influence of LH and progesterone: this is
reflected in the rise in temperature occurring soon after
ovulation. In phase 3, Yin has reached its maximum.
During phase 3, the activity is centred around the
Shao Fu area, i.e. the lateral sides of the lower abdomen
which are under the influence of the Penetrating Vessel
(Fig. 2.14). The cervix produces a viscous, transparent
secretion that indicates the imminent ovulation. This
secretion reflects the maximum of Yin at the beginning
of this phase.
Soon after the period, there is a sticky or ‘tacky’ cervical secretion. Immediately prior to ovulation, there is
an increased cervical secretion that is wet and slippery
(similar to the consistency of raw egg white). When
placed between two fingers and the fingers are prized
apart, the secretion stretches between the two fingers
(Fig. 2.15). Generally, the body produces the greatest
amount of this type of cervical secretion on the day
of ovulation. Immediately following the day of ovulation, the cervical secretion gradually becomes thicker
in consistency, and less is secreted.
The os of the cervix will remain closed until the
oestrogen levels in the body begin to rise and trigger its
gradual opening and the production of fertile mucus.
As ovulation approaches, the os begins to open and
the quality and consistency of mucus changes: fertile
mucus can be seen clinging to the surface of the cervix
in strands (Fig. 2.16). During the peak of fertility, the os
of the cervix is open, with clear, stretchy mucus present. The mucus looks wet: it is clear in colour rather
Stretchy mucus
Phase 3: Mid-cycle (ovulation)
Ovulation occurs at the beginning of phase 3. During
this phase, the Governing, Directing and Penetrating
Vessels are in full activity to produce ovulation.
Ovulation depends on Kidney-Yin (the ova and oestrogen) but it needs the Heat of the Minister Fire (progesterone). At the beginning of phase 3, Yang rises steeply
Figure 2.15 Stretchy cervical secretion.
22 Section 1: Physiology and Pathology
Os
Mucus
Figure 2.16 Cervical secretion on os of cervix.
than the cloudy or whitish colour when peak fertility
was still approaching.
The fertile secretion appearing in phase 3 is a direct
and reliable manifestation of the Kidney-Yin and
Essence. When treating a woman for infertility, we
should always ask about this secretion (see below). If
this secretion is absent or very short lasting (e.g. only
1 day), it indicates a Kidney deficiency even in the
absence of any Kidney symptom.
Phase 3 can be compared and contrasted to phase 1.
In both phases there is a transformation: in phase 1 from
Yang to Yin and in phase 3 from Yin to Yang. Also, in both
phases there is a movement of Qi: in phase 1 a downward flow in the Xiao Fu area and in phase 3 an upward
flow in the Shao Fu area. Phase 1 is under the influence
of the Penetrating Vessel (Chong Mai), phase 3 under the
influence of the Governing, Directing and Penetrating
Vessels (Du, Ren and Chong Mai). The descending of
Heart-Qi induces the transformation of Yin to Yang and
the discharge of the ovum from the ovaries.
There are two characteristics of phase 3:
1. The flourishing of Directing and Penetrating Vessels
ensures ovulation. There is a lot of activity of Qi and
Blood which may cause distension in the Shao Fu
abdomen, mood changes and breast distension.
2. During phase 3, Yin reaches its maximum and a
transformation from Yin to Yang occurs. Oestrogen
reaches its highest level. At this time, there is a
physiological cervical secretion that is transparent;
stringy, like egg white.
Strictly speaking, one can distinguish two sub-phases
in phase 3: before/during ovulation and after ovulation. In the first phase, the influence of Directing and
Governing Vessels (Ren and Du) is obvious and Yang
rises rapidly (hence the rise in temperature). The time
after ovulation is under the influence of the Penetrating
Vessel (Chong Mai) and the increase in Yang flattens
out. However, for the purpose of treatment, it is not
essential to distinguish these two sub-phases.
The cervical secretion occurring before ovulation
occurs in phase 3: it is under the influence of the
Directing Vessel (Ren Mai) and is a direct expression of
Kidney-Essence. If it is absent or too short, it automatically indicates a deficiency of the Kidneys.
During phase 3, Yin is decreasing and Yang increasing: if Yin does not decrease and/or Yang does not
increase, Dampness and Phlegm are easily formed in the
Uterus. Thus, excess of Yin in phase 3 means Dampness
or Phlegm obstructing the Uterus: this may delay ovulation. The same would happen in deficiency of Yang.
Vice versa, if there was excess of Yang, ovulation may
come early: the same in case of deficiency of Yin.
SUMMARY
Phase 3: Mid-cycle (ovulation)
• Ovulation occurs at the beginning of phase 3. During
this phase, the Governing, Directing and Penetrating
Vessels are in full activity to produce ovulation
• Ovulation depends on Kidney-Yin (the ova and
oestrogen) but it needs the Heat of the Minister
Fire (progesterone)
• At the beginning of phase 3, Yang rises steeply
under the influence of LH and progesterone: this is
reflected in the rise in temperature occurring soon
after ovulation
• In phase 3, Yin has reached its maximum
• During phase 3, the activity is centred around the
Shao Fu area
• During phase 3, the cervix produces a viscous,
transparent secretion that indicates the imminent
ovulation
• The fertile secretion appearing in phase 3 is a
direct and reliable manifestation of the Kidney-Yin
and Essence
• The descending of Heart-Qi induces the
transformation of Yin to Yang and the discharge
of the ovum from the ovaries
• During phase 3, Yin is decreasing and Yang
increasing: if Yin does not decrease and/or Yang
does not increase, Dampness and Phlegm are
easily formed in the Uterus
Women’s Physiology 23
Phase 4: Pre-menstrual phase
During phase 4, Qi and Blood are moving in preparation
for the period. It is primarily Liver-Qi and Liver-Blood
that influence this movement. From the point of view
of Extraordinary Vessels, the Penetrating Vessel exerts
the strongest influence at this time. From the point of
view of Yin and Yang, Yang is rising rapidly during this
phase and Yin is decreasing. The increase in Yang is
important to expel potential Yin pathogenic factors in
the Uterus such as Blood stasis, Damp-Phlegm or Cold.
Pre-menstrual symptoms may appear in this phase.
Please note that not all pre-menstrual symptoms are
due to Liver-Qi stagnation. Since Yang is increasing in
this phase, an excess of Yang (e.g. Liver-Fire or HeartFire) may cause pre-menstrual symptoms. A deficiency
of Yang too (e.g. Spleen- and Kidney-Yang deficiency)
may cause pre-menstrual symptoms.
CLINICAL NOTE
Not all pre-menstrual symptoms are due to Liver-Qi
stagnation. An excess of Yang (e.g. Liver-Fire or
Heart-Fire) may cause pre-menstrual symptoms. A
deficiency of Yang too (e.g. Spleen- and Kidney-Yang
deficiency) may cause pre-menstrual symptoms.
There are two characteristics to phase 4:
1. During this phase, Yang grows rapidly and Yin
decreases. The growth of Yang provides warmth to
the Uterus which makes the endometrium receptive
to implantation. The growth of Yang in this phase
ensures the expulsion of Yin pathogenic factors
from the Uterus such as Cold, Phlegm, Dampness
and Blood stasis. For example, in endometriosis
and polycystic ovary syndrome there is Blood
stasis and Damp-Phlegm respectively, which are
Yin pathogenic factors: growth of Yang in phase 4
is therefore important to prevent Blood stasis and
Dampness/Phlegm/Cold.
2. The decrease of Yin in this phase ensures the growth
of Yang: this is comparable to the decrease of Yang in
phase 2 but it is clinically more significant.
SUMMARY
Phase 4: Pre-menstrual phase
• During phase 4, Qi and Blood are moving in
preparation for the period. It is primarily Liver-Qi
and Liver-Blood that influence this movement
• The Penetrating Vessel exerts the strongest
influence at this time
• Yang is rising rapidly during this phase and Yin
is decreasing. The increase in Yang is important
to expel potential Yin pathogenic factors in the
Uterus such as Blood stasis, Damp-Phlegm or
Cold
• Pre-menstrual symptoms may appear in this phase.
Please note that not all pre-menstrual symptoms
are due to Liver-Qi stagnation.
The four phases and treatment
principles
An important clinical significance of the four phases
lies in adapting the treatment principles according to
them. I cannot emphasize how important and how useful this application of the four phases is in practice. We
really cannot treat menstrual irregularities, infertility,
endometriosis and polycystic ovary without adapting
the treatment principle to the four phases. This means
that often we may use two, three or even four different
herbal formulae during the menstrual cycle. Indeed,
this method applies also to acupuncture: with acupuncture too, we can concentrate on treating a woman
according to the four phases.
From the point of view of Extraordinary Vessels, in
a nutshell:
•
•
•
•
Phase 1 = Penetrating Vessel (Chong Mai)
Phase 2 = Directing Vessel (Ren Mai) and Kidney-Yin
Phase 3 = Directing and Governing Vessels (Ren and
Du Mai) and Kidney-Yin and Kidney-Yang
Phase 4 = Penetrating Vessel (Chong Mai)
The treatment principles applied in each phase are
as follows.
Phase 1
Invigorate (‘move’) Blood. Phase 1 is the best time to
invigorate Blood as Qi and Blood are already descending at this time. However, we cannot invigorate Blood if
the period is heavy: in such a case, we should use herbs
that simultaneously invigorate Blood and stop bleeding (e.g. San Qi Radix Notoginseng, Pu Huang Pollen
Typhae, Qian Cao Gen Radix Rubiae). The Women’s
Treasure remedy, Invigorate Blood and Stem the Flow,
does exactly that, i.e. it invigorates Blood and stops
bleeding.
24 Section 1: Physiology and Pathology
Phase 2
Nourish Blood and tonify the Kidneys. During phase
2, it is a good time to nourish Blood as Blood is relatively Empty at this time. As menstrual blood is part
of Tian Gui, we must also tonify the Kidneys. Phase
2 is a very important phase to establish a good basis
of a menstrual cycle. If I need to nourish Blood in a
woman, I often do so in phases 2 and 3 even in nongynecological problems. It certainly would not make
sense to nourish Blood in phase 1 when a woman is
bleeding.
Phase 3
Tonify the Kidneys, strengthen Governing, Directing and
Penetrating Vessels, if necessary resolve Dampness and
tonify the Spleen. During phase 3, it is a good time to
continue tonifying the Kidneys as we do in phase 2. If
there is Dampness, phase 3 is also a good time to eliminate it.
Phase 4
Move Qi, invigorate Blood, warm the Uterus, if necessary
expel Cold, resolve Damp-Phlegm. Phase 4 is the best time
to move Qi and Blood before the period. It is also a good
time to warm the Uterus to expel Cold or to resolve
Damp-Phlegm.
SUMMARY
The four phases and treatment principles
• Phase 1: Invigorate (‘move’) Blood. If the period is
heavy: invigorate Blood and stop bleeding
• Phase 2: Nourish Blood and tonify the Kidneys
• Phase 3: Tonify the Kidneys, strengthen
Governing, Directing and Penetrating Vessels, if
necessary resolve Dampness and tonify the Spleen
• Phase 4: Move Qi, invigorate Blood, warm the
Uterus, if necessary expel Cold, resolve Damp-Phlegm
• From the point of view of Extraordinary Vessels, in
a nutshell:
• Phase 1 = Penetrating Vessel (Chong Mai)
• Phase 2 = Directing Vessel (Ren Mai) and Kidney-Yin
• Phase 3 = Directing and Governing Vessels (Ren
and Du Mai) and Kidney-Yin and Kidney-Yang
• Phase 4 = Penetrating Vessel (Chong Mai)
MENSTRUATION AND THE
INTERNAL ORGANS
Kidneys
The Kidneys are the root of Pre-Natal Essence and the
root of the Original Qi. They store the Essence which
is the material basis for the formation of menstrual
blood. In particular the Kidney-Essence is the origin for
the formation of the Tian Gui, the material substance of
menstrual blood. At puberty, the Heavenly Gui is crystallized and gives rise to the periods.
Chapter 1 of the Simple Questions says: “At 14 the
Tian Gui arrives, the Directing Vessel [Ren Mai] is open and
the Penetrating Vessel [Chong Mai] flourishing, the period
arrives and the girl can conceive.”15 Menstrual blood is
called ‘Heavenly Gui’ because it represents the descending of Heavenly Gui materializing into Water: in fact,
the 10th heavenly stem Gui pertains to Water.
The Great Treatise of Beneficial Formulae for Women
(1237) explains:
When a girl is 14 the Heavenly Gui arrives, the Directing
Vessel is open, the Penetrating Vessel is flourishing and
the period arrives. ‘Heavenly’ indicates the descending of
the True Qi of Heaven; ‘Gui’ indicates Water [as this stem
pertains to Water]: [menstrual Blood is therefore] like
heavenly clouds generating water.16
Fu Qing Zhu (1607–1684) holds that menstrual
blood is not Blood but Heavenly Gui which originates
from the Kidneys. He says it is formed from Kidney-Yin
but with the participation of Heart-Yang (another way
in which the Heart influences menstruation) and that
despite being blood red in colour it is not Blood; hence
its name of Heavenly Gui.17 He also says that the generation of the Heavenly Gui has nothing to do with Heart,
Liver or Spleen: these organs only help its transformation into Blood. To repeat his original passage:
Menstrual blood is not Blood but Heavenly Water, originating
within the Kidneys, it is the essence of extreme Yin and Qi
of extreme Yang. It is red like blood but it is not blood. That
is why it is called Heavenly Gui. People nowadays regard
menstrual blood as Blood, a mistake perpetuated for 1000
years … in fact it is not called blood-water [Xue Shui] but
menstrual water [Jing Shui] … the generation of Kidney
Water [and therefore menstrual blood] has nothing to do with
Heart, Liver and Spleen, but the transformation of Kidney
Water is helped by Heart, Liver or Spleen.18
Women’s Physiology 25
It should be emphasized that while in women menstrual
blood is a form of Tian Gui; in men, sperm is also Tian Gui.
Thus, the Kidney Essence, being the basis of Tian
Gui, greatly influences the physiology of women
and especially puberty, fertility, conception, pregnancy and menopause. The Water of the Kidneys, or
Kidney-Yin, is the material basis for menstrual blood.
Fu Qing Zhu makes this point by saying that it is not
by chance that menstrual blood is called Jing Shui,
i.e. ‘period’s water’, rather than Jing Xue (‘period’s
blood’).19
Tang Zong Hai, in his Discussion of Blood Syndromes
(1885), has a slightly different view of the formation of
menstrual blood and he says:
Fluids transformed by Qi turn red and form Blood which,
following the Directing and Penetrating Vessels, joins
the Heavenly Gui Water below in both men and women.
Men pertain to Qi and, in them, Blood is transformed
from Water to make Sperm; women pertain to Blood
and, in them, Blood is transformed from Water to make
menstrual blood. Thus, in men there is Blood within
Water and, in women there is Water within Blood,
forming menstrual blood.20
Thus, the Heavenly Gui is found in both men and
women; in men it forms sperm, and in women menstrual blood (Fig. 2.17).
Another way in which the Kidneys influence menstruation is simply through the connection of mutual
nourishment between Blood and Essence and that
between Liver and Kidneys. On the one hand, Blood,
as a form of Post-Natal Qi, integrates and replenishes
the Essence; on the other hand, the Essence contributes to making Blood by facilitating the transformation of Gathering Qi (Zong Qi) into True Qi (Zhen Qi)
and by being the origin of Bone Marrow which also
makes Blood. It is for this reason that, when nourishing Blood in gynecological conditions, we usually
tonify not only the Kidneys but also the Liver. Indeed,
many of the gynecological herbs that tonify the
Kidneys also tonify the Liver (e.g. Shu Di Huang Radix
Rehmanniae preparata, Shan Zhu Yu Fructus Corni,
Sheng Di Huang Radix Rehmanniae, Gou Qi Zi Fructus
Lycii, etc.). The Kidneys influence women’s reproductive systems also through the Governing, Directing
and Penetrating Extraordinary Vessels which will be
discussed below.
Finally, the role of the Gate of Life (Ming Men) in
women’s physiology should be discussed. While the
Water of the Kidneys is the origin of menstrual blood,
the Kidneys are also the source of physiological Fire,
which also plays its part in menstruation. The Fire of the
Gate of Life represents the physiological Fire within the
Kidneys. It arises from the area between the two kidneys
and is closely related to the Original Qi (Yuan Qi) and
the Motive Force (Dong Qi) from which the Governing,
Directing and Penetrating Vessels originate (Fig. 2.18).
Under physiological conditions, the Fire of the Gate
of Life warms the Uterus and balances the Yin influences: it makes conception possible because it promotes
the maturation of the follicles and the production of
the ova (Fig. 2.19). It is also related to sexual desire.
In fact, some doctors say that “it is through Kidney-Yang
[and therefore the Fire of the Gate of Life] that the Tian
Gui turns red [i.e. it turns into Blood].”21
QI
SPERM
Blood within Water
FLUIDS
BLOOD
TIAN GUI
MENSTRUAL BLOOD
Water within Blood
CHONG
REN
Figure 2.17 The formation of menstrual blood according to Tang Zong Hai.
26 Section 1: Physiology and Pathology
Directing
Vessel
Penetrating
Vessel
REN-4
Governing
Vessel
MOTIVE
FORCE
(DONG QI)
DU-4 =
Minister
Fire
CONCEPTION
REN-1
Figure 2.18 The Minister Fire and the Extraordinary Vessels.
KI-WATER
provides ESSENCE
UTERUS
JING (IMMATURE)
KI-FIRE (Minister Fire)
provides FIRE
BLOOD
Figure 2.19 The Uterus and Kidney-Water and Kidney-Fire.
Takes 14–16 years
The Fire of the Gate of Life is the origin of the ‘formless’ Minister Fire which also generates Water, hence
the Kidneys are the source of both Water and Fire. The
Minister Fire is called ‘formless’ because it is a nonsubstantial Fire which actually generates Water rather
than overcoming it. It is a pre-natal type of Fire formed
at conception on the Governing/Directing Vessel axis.
In fact, the Golden Mirror of Medicine (1742) says:
The Pre-Natal Tian Gui originates from the mother and
father, the Post-Natal Essence and Blood are derived
from food and water, a girl’s Tian Gui matures at 14,
the Directing Vessel is open, the Penetrating Vessel is
flourishing and the periods arrive22 (Fig. 2.20).
MINISTER FIRE
MATURE JING
Figure 2.20 Pre-natal origin of Minister Fire.
This last passage is interesting as it confirms that the
Motive Force and the Minister Fire are pre-natal and
present before the onset of the periods (Figs 2.21 and
2.22). It also highlights the close integration of the
Minister Fire and the Heavenly Gui (the Yang and Yin
aspects of the Kidneys). Zhang Jing Yue says:
The Gate of Life is the Root of the Original Qi [Yuan Qi]
and the residence of [both] Water and Fire. The Yin of the
5 Yin Organs cannot nourish without it and their Yang
cannot develop without it.24
The commentary then explains:
At 7 the Motive Force [Dong Qi] is flourishing. At 14
the Tian Gui matures: this is the Motive Force [i.e. the
Minister Fire] within the Pre-Natal Water of Tian Gui,
crystallizing in a girl’s uterus.23
This passage clearly shows how the Fire of the Gate of
Life can be the source of both Fire and Water. Thus, the
Minister Fire is the Fire within Water, interdependent
with Water and inseparable from it. The Emperor Fire
is called ‘with form’, i.e. it is a substantial Fire which
Women’s Physiology 27
JING OF FATHER
JING OF MOTHER
EMPEROR FIRE
(Heart)
Person – Post-natal
With ‘form’
Overcomes Water
MINISTER FIRE
(Kidneys)
Heaven – Pre-natal
Without ‘form’
Nourishes Water
CONCEPTION
– PRE-NATAL JING
OF FETUS
Active
Matures at
from
puberty
conception
Figure 2.23 Emperor Fire and Minister Fire.
MINISTER FIRE
– YANG ASPECT
OF JING
SPERM-OVA
– YIN ASPECT
OF JING
‘Pre-Natal of Pre-Natal’
‘Post-Natal of Pre-Natal’
Figure 2.21 Yin and Yang aspects of Essence (Jing).
Jing of
mother
Jing of
father
Uterus which stores Blood. Since Blood is part of Water
but the Uterus is also warmed by the Minister Fire of
the Kidneys, in women a deficiency of the Kidneys very
often involves a deficiency of both Water (Yin) and Fire
(Yang) (Fig. 2.24).
Under pathological circumstances, the Fire of the
Gate of Life can become either deficient or excessive.
When it is deficient, it fails to warm the Uterus, which
becomes obstructed by Cold: this may lead to infertility, dysmenorrhoea and lack of sexual desire. When it
is excessive, it heats the Blood causing excessive menstrual bleeding, infertility or miscarriage (Fig. 2.25).
Finally, the Minister Fire plays an important role in
the transformation of Kidney-Water into Tian Gui. We
have stressed above that Kidney-Water is the origin
of Tian Gui: however, the Minister Fire of the Kidneys
plays a role in its formation. One of the ancient texts
says that “Tian Gui is the crystallization of Kidney-Water
under the influence of the Minister Fire.” The use of the
word crystallization is interesting and it lends itself to
MINISTER FIRE
MINISTER
FIRE
Fire within Water
14 years in girls and
16 years in boys
TIAN GUI
(sperm and ova)
Figure 2.22 The Minister Fire in conception.
YIN
overcomes Water, is formed after birth and is therefore
post-natal. The Minister Fire pertains to Heaven and
the Emperor Fire to human beings (Fig. 2.23).
Thus, the Kidneys are the origin of both Water and
Fire: the Kidney-Water is the source of menstrual blood
and both Kidney-Water and Kidney-Fire influence the
YANG
Kidney-Yin deficiency
(primary)
YIN
YANG
Kidney-Yang deficiency
(primary)
Figure 2.24 Simultaneous deficiency of Kidney-Yin and
Kidney-Yang.
28 Section 1: Physiology and Pathology
Deficient
Normal
Painful periods,
endometriosis,
infertility,
lack of libido
Excessive
Heavy periods,
infertility,
miscarriage
Figure 2.25 Pathology of Minister Fire.
an interesting illustration of this principle. If we prepare a saturated solution of water with salt and apply a
source of heat to it, after some time the water will evaporate and salt crystals will be formed (Fig. 2.26). In this
analogy, the solution of water and salt is Kidney-Water,
the source of heat is Kidney-Fire (Minister Fire) and the
salt crystals are Tian Gui.
SUMMARY
Kidneys
• The Kidney-Essence is the origin for the formation of
the Tian Gui, the material substance of menstrual blood
• Menstrual blood is called ‘Heavenly Gui’ because
it represents the descending of Heavenly Gui
materializing into Water
• Fu Qing Zhu (1607–1684) holds that menstrual
blood is not Blood but Heavenly Gui which
originates from the Kidneys
• The Heavenly Gui is found in both men and
women; in men it forms sperm, and in women
menstrual blood
• The Kidneys influence women’s reproductive
systems also through the Governing, Directing and
Penetrating Extraordinary Vessels
• The Fire of the Gate of Life represents the
physiological Fire within the Kidneys: it arises from
the area between the two kidneys and is closely
related to the Original Qi (Yuan Qi) and the Motive
Force (Dong Qi) from which the Governing,
Directing and Penetrating Vessels originate
• The Fire of the Gate of Life warms the Uterus and
balances the Yin influences: it makes conception
possible because it promotes the maturation of
the follicles and the production of the ova
• The Minister Fire is a pre-natal type of Fire formed at
conception on the Governing/Directing Vessel axis
• The Motive Force and the Minister Fire are prenatal and present before the onset of the periods
• The Kidneys are the origin of both Water and Fire,
the Kidney-Water is the source of menstrual blood
and both Kidney-Water and Kidney-Fire influence
the Uterus which stores Blood
• When the Minister Fire is deficient, it fails to
warm the Uterus which may lead to infertility,
dysmenorrhoea and lack of sexual desire
• When it is excessive, it heats the Blood causing
excessive menstrual bleeding, infertility or miscarriage
• The Minister Fire plays an important role in the
transformation of Kidney-Water into Tian Gui
Liver
The Liver has a paramount importance in women’s
physiology and menstruation, mostly through its
relationship with the Uterus and Blood. The Uterus
stores Blood and this is received mostly from the Liver,
hence with regard to menstruation the Uterus and the
Liver’s function of Blood storage are one and the same
(although Liver-Blood has many other non-gynecological functions). For this reason, Liver-Blood has a paramount importance in menstruation. The Blood stored
in the Liver is both menstrual blood and therefore Tian
Gui deriving from the Kidneys, but also the Post-Natal
Blood made by the Post-Natal Qi of Stomach and Spleen.
For this reason, when nourishing Liver-Blood, we often
need to tonify the Liver itself, the Kidneys (especially in
gynecological conditions) and the Spleen to promote
the formation of Post-Natal Qi and Blood (Fig. 2.27).
CLINICAL NOTE
To nourish Liver-Blood in gynecological conditions,
I generally reinforce Ren-4 Guanyuan, LIV-8 Ququan,
ST-36 Zusanli and SP-6 Sanyinjiao. This combination
tonifies Kidneys, Liver and Spleen. To nourish LiverBlood in non-gynecological conditions, one can either
reinforce the couple BL-18 Ganshu and BL-17 Geshu
or the couple BL-20 Pishu and BL-23 Shenshu to tonify
Spleen and Kidneys.
Women’s Physiology 29
WATER (KIDNEY-JING)
Changes
into
WATER NaCl
SALT CRYSTALS
(TIAN GUI)
MINISTER FIRE
Figure 2.26 Analogy between Tian Gui and salt crystals.
LIVER
CHONG MAI
Stores Blood
Is Sea of Blood
Free and Easy Wanderer Powder illustrates this principle
in its composition. In fact, in the formula, Chai Hu Radix
Bupleuri and Bo He Herba Menthae haplocalycis move
Liver-Qi while Dang Gui Radix Angelicae sinensis and Bai
Shao Radix Paeoniae alba nourish Liver-Blood.
Figure 2.27 Liver-Blood and the Uterus.
CLINICAL NOTE
Therefore, when nourishing Blood in gynecological conditions, we always need to nourish Liver-Blood,
even though, as mentioned above, menstrual blood is
Tian Gui that derives from the Kidneys. Indeed, this is
reflected in Chinese herbal medicine as some herbs have
a dual function of tonifying the Kidneys (and therefore
Tian Gui) and nourishing Liver-Blood. For example: Shu
Di Huang Radix Rehmanniae preparata, Sheng Di Huang
Radix Rehmanniae and Gou Qi Zi Fructus Lycii.
The Liver has an important influence on menstruation
also through Qi. Liver-Qi has the very important function
of moving Blood via Qi. Especially in the pre-menstrual
phase, Liver-Qi needs to move Blood in preparation for
the period. If Liver-Qi stagnates it may cause irregular
periods, dysmenorrhoea and pre-menstrual syndrome.
Liver-Qi and Liver-Blood are the Yang and Yin part of the
Liver and, as such, they are interrelated. Yin needs to root
and embrace Yang, and if Liver-Blood is deficient it can
cause a secondary stagnation of Liver-Qi: the fact that
it is secondary is evident from the symptoms of Liver-Qi
stagnation together with a Pale tongue and Choppy pulse
(Fig. 2.28). A deficiency of Liver-Blood is often at the root
of Liver-Qi stagnation and the formula Xiao Yao San
Although Liver-Qi stagnation is an important and
frequent pathological condition in gynecology, in
my opinion it is somewhat overemphasized both in
China and in the West.
The Liver also represents the connection between the
menstrual blood (which is part of Tian Gui) and the ‘normal’ Blood (the one which nourishes hair, nails, sinews,
eyes, etc.). If Liver-Blood is deficient there may be amenorrhoea, scanty periods or late periods together with
other Blood deficiency symptoms related to hair, nails,
Breast distension,
irritability
LIV-QI
STAGNATION
Pale tongue,
choppy pulse
Figure 2.28 Interrelationship between Liver-Blood and
Liver-Qi.
30 Section 1: Physiology and Pathology
SUMMARY
Liver
• The Uterus stores Blood and this is received mostly
from the Liver
• The Blood stored in the Liver is both menstrual
blood and therefore Tian Gui deriving from the
Kidneys, but also the Post-Natal Blood made by
the Post-Natal Qi of Stomach and Spleen
• When nourishing Blood in gynecological
conditions, we always need to nourish Liver-Blood
• Liver-Qi has the very important function of moving
Blood via Qi
• Liver-Qi and Liver-Blood are the Yang and Yin part
of the Liver and, as such, they are interrelated. Yin
needs to root and embrace Yang, and if Liver-Blood
is deficient it can cause a secondary stagnation of
Liver-Qi: the fact that it is secondary is evident from
the symptoms of Liver-Qi stagnation together with
a Pale tongue and Choppy pulse
• The Liver also represents the connection between
the menstrual blood (which is part of Tian Gui)
and the ‘normal’ Blood (the one which nourishes
hair, nails, sinews, eyes, etc.)
Eyes
Skin
TIAN GUI
LIVER
BLOOD
Hair
Sinews
Hun
UTERUS
Scanty
periods
Blurred vision,
dry skin, dry hair,
dry nails, cramps,
insomnia, etc.
Figure 2.29 Overlap between menstrual blood (as Tian Gui)
and ‘normal’ Liver-Blood.
sleep, sinews and eyes, such as dry hair, brittle nails,
excessive dreaming, cramps and blurred vision. If LiverBlood is hot, there may be menorrhagia (Fig. 2.29).
Spleen
The Spleen makes Blood which is then stored in the
Liver. Therefore the ‘Blood’ of the Liver is both the gynecological blood expression of Tian Gui of the Kidneys
and the Post-Natal Blood deriving from the Post-Natal
UTERUS
KIDNEYS
LIVER
Tian Gui
Menstrual blood
SPLEEN
Post-Natal blood
Figure 2.30 Liver-Blood and Spleen-Blood.
Qi of Stomach and Spleen. A deficiency of Liver-Blood
in women therefore may refer to the Tian Gui (in which
case both Liver and Kidneys need to be strengthened) or
to Post-Natal Blood which may also be called ‘SpleenBlood’ (in which case Liver and Spleen need to be tonified; see Fig. 2.30).
The Secret Records of Master Feng’s Brocade Bag says:
The Spleen is the source of Qi and Blood and the Heart
governs the Blood of all channels. When the Heart and
Spleen function well the periods are normal … Blood is
produced by the Spleen and is transformed into sperm
in men and menstrual blood and breast milk in women.
Although the Heart governs Blood and the Liver stores
Blood, Blood is controlled by the Spleen. To nourish Blood,
one must tonify the Spleen and pacify the Stomach …
the Heart and Spleen should be treated before the arrival
of the Heavenly Gui and the Liver and Kidneys after its
arrival. Menstrual blood and breast milk are both produced
by the Spleen and Stomach. After being digested by the
Stomach, the pure part of water and food goes to the Heart
channel where it changes its colour becoming red, thus
forming Blood. The excess of Blood goes to the Directing
and Penetrating Vessels producing the menses … Soon
after delivery the pure part of food goes to the Lungs and
then flows into the breasts to become milk, which is white
in colour, white being the colour of the Lungs. When
breastfeeding is stopped, the pure part of food turns into
Blood again.25
This passage is interesting as it says that, to tonify Blood in women, before puberty one should tonify Spleen and Heart and, after puberty, Liver and
Kidneys.
The Spleen influences women’s physiology and
pathology also through Qi. Spleen-Qi has an ascending
movement and it keeps the uterus in place. Thus, sinking of Spleen-Qi may cause prolapse of the uterus or
Women’s Physiology 31
SPLEEN-QI
SINKING
•
Prolapse uteri
Menorrhagia
•
Interstitial cystitis
Figure 2.31 Sinking of Spleen-Qi.
bladder. With regard to sinking of Spleen-Qi, it should
be noted that prolapse is not its only manifestation.
Sinking of Spleen-Qi is also a factor in menorrhagia
and chronic urinary symptoms such as interstitial cystitis (Fig. 2.31). Moreover, in such gynecological and
urinary conditions, it is not only Spleen-Qi that sinks
but also Kidney-Qi.
CLINICAL NOTE
Sinking of Spleen- and Kidney-Qi is a factor in
menorrhagia and chronic urinary symptoms such
as interstitial cystitis. To tonify and lift Spleen- and
Kidney-Qi in such conditions, I use LU-7 Lieque on
the right together with KI-6 Zhaohai on the left (to
open the Directing Vessel) plus Du-20 Baihui and
either Ren-4 Guanyuan for menorrhagia or Ren-3
Zhongji for urinary conditions.
Spleen-Qi also ‘gathers’ Blood and, if it is deficient,
Blood may leak out causing menorrhagia: this is a
major cause of deficient-type menorrhagia. Please
note that in gynecology, Kidney-Qi also ‘gathers’
Blood and therefore it should be tonified and lifted in
menorrhagia.
SUMMARY
Spleen
• The Spleen makes Blood which is then stored in
the Liver
• The ‘Blood’ of the Liver is both the gynecological
Blood expression of Tian Gui of the Kidneys and
the Post-Natal Blood deriving from the Post-Natal
Qi of Stomach and Spleen
• A deficiency of Liver-Blood in women therefore
may refer to the Tian Gui (in which case both Liver
•
•
and Kidneys need to strengthened) or to PostNatal Blood (in which case Liver and Spleen need
to be tonified)
Spleen-Qi has an ascending movement and it keeps
the uterus in place. Thus, sinking of Spleen-Qi may
cause prolapse of the uterus or bladder
Sinking of Spleen-Qi may cause not only
prolapse, as sinking of Spleen-Qi is also a factor in
menorrhagia and chronic urinary symptoms such
as interstitial cystitis
In such gynecological and urinary conditions, it is
not only Spleen-Qi that sinks but also Kidney-Qi
Spleen-Qi also ‘gathers’ Blood and, if it is deficient,
Blood may leak out causing menorrhagia: this is a
major cause of deficient-type menorrhagia
Heart
As mentioned above, the Heart influences menstruation in various ways:
•
•
•
•
•
The Heart governs Blood and therefore has a
general influence on Blood.
The Heart is connected to the Uterus via the Uterus
Vessel (Bao Mai): due to this connection, HeartBlood plays a role in gynecological conditions.
According to Fu Qing Zhu, the Kidney-Essence forms
the Heavenly Gui with the help of Heart-Yang.
The Heart controls the transformation of Yang to
Yin occurring when the period starts and that of
Yin to Yang at ovulation.
The descending of Heart-Qi to the Uterus promotes
the descending of menstrual blood with the period
and that of the ovum (or ova) at ovulation.
Fu Qing Zhu was not the only gynecologist that
attributed an important function to the Heart with
regard to menstruation. In fact, the Secret Records of
Master Feng’s Brocade Bag (1702) says:
Menstrual Water in women is rooted in four channels: the
Directing and Penetrating vessels, the Small Intestine and
the Heart. The Penetrating Vessel is the Sea of Blood and
the Directing Vessel controls the Uterus and fetus; if these
two vessels are flourishing the woman is fertile. The Small
Intestine channel pertains to a Yang organ which controls
the Exterior and the Yang [energies], the Heart channel
pertains to a Yin organ and controls the Interior and the
Yin [energies]. Above, these two channels produce breast
milk; below, they produce menstrual Blood.26
32 Section 1: Physiology and Pathology
This passage is interesting because it connects the
Small Intestine channel with breast milk: this could
explain the use of S.I.-1 Shaoze for agalactia (lack of
milk after childbirth).
The General Treatise on the Aetiology and Symptomatology of Diseases (AD 610) says something similar:
The Directing and Penetrating Vessels originate from the Uterus
and they are the Sea of the Channels. The Small Intestine
and Heart channels are exteriorly–interiorly related and they
govern the downward [infusion] of menstrual Blood.27
Lungs
The Lungs have only a minor influence on the menstrual function. Because they govern Qi, they can
therefore influence some pathological conditions,
such as prolapse of the uterus or menorrhagia, due to
Qi deficiency, usually in conjunction with Spleen-Qi
deficiency. Their influence on menstruation can be
seen in cases when sadness and grief induce a depletion of Qi and stoppage of the menses.
Stomach
The connection between the Heart, the Uterus and
menstruation explains the strong influence of emotional stress on this function. For example, deficiency
of Blood in the Uterus after childbirth can affect the
Heart and cause depression, while stasis of Blood in the
Uterus after childbirth may cause post-natal psychosis.
The influence of the Heart on the menstrual function
can also be seen when an emotional shock affecting the
Heart may lead to amenorrhoea.
Indeed, Heart-Blood affects menstruation in a similar
way to Liver-Blood: Heart-Blood deficiency may cause
scanty periods or amenorrhoea; Heart-Blood stasis
may cause painful periods; and Heart-Blood Heat may
cause menorrhagia.
SUMMARY
Heart
• The Heart governs Blood and therefore has a
general influence on Blood
• The Heart is connected to the Uterus via the Uterus
Vessel (Bao Mai): due to this connection, HeartBlood plays a role in gynecological conditions
• According to Fu Qing Zhu, the Kidney-Essence
forms the Heavenly Gui with the help of Heart-Yang
• The Heart controls the transformation of Yang to
Yin occurring when the period starts and that of
Yin to Yang at ovulation
• The descending of Heart-Qi to the Uterus promotes
the descending of menstrual blood with the period
and that of the ovum (or ova) at ovulation
• Heart-Blood affects menstruation in a similar way
to Liver-Blood: Heart-Blood deficiency may cause
scanty periods or amenorrhoea; Heart-Blood stasis
may cause painful periods; and Heart-Blood Heat
may cause menorrhagia
The Stomach is connected to the Uterus via the
Penetrating Vessel (Chong Mai). In fact, this Extraordinary Vessel arises from the Uterus and goes through
the Stomach, passing through the important Stomach
point ST-30 Qichong. The connection between the
Penetrating Vessel and the Stomach explains the development of morning sickness during the early stages of
pregnancy.
The Stomach also influences breastfeeding in nursing mothers in two ways. First, the Stomach channel flows through the breast. Second, although breast
milk is a transformation of menstrual Blood occurring
within the Penetrating Vessel, it is supplemented by the
Post-Natal Qi extracted from food which, itself, depends
on the Stomach (Fig. 2.32).
The Stomach is very important in gynecology as it is,
together with the Spleen, the source of Qi and Blood.
The Correct Purpose of Gynecology says:
The Simple Questions says [in Chapter 7] “The two
Yang channels affect the Heart and Spleen and their
malfunction causes impotence in men and amenorrhoea
in women”. The two Yang channels are the Stomach
and Large Intestine channels: these channels transform
food and drink and the Heart and Spleen rely on them.
The lower part of the Stomach communicates with the
upper part of the Small Intestine; when the Stomach is
healthy the Small Intestine can transform and transport
[food essences] and therefore Heart-Qi flows properly
and no pathogenic factor can attack it. When the Large
Intestine is healthy it can transform and transport,
food is transformed and digested and the Spleen cannot
be injured. When the two Yang channels [Stomach
and Large Intestine] are diseased, therefore, food is
not digested and transformed and the disease affects
the Heart and Spleen so that Qi and Blood cannot be
produced.28
Women’s Physiology 33
• The Stomach also influences breastfeeding in
nursing mothers in two ways:
• First, the Stomach channel flows through the breast
• Second, breast milk is supplemented by the
Post-Natal Qi extracted from food
• The Stomach is very important in gynecology as it is,
together with the Spleen, the source of Qi and Blood
Figure 2.33 illustrates the connection between the
internal organs and menstruation.
MENSTRUATION AND THE
EXTRAORDINARY VESSELS
Figure 2.32 The Penetrating Vessel and the transformation of
menstrual blood into breast milk.
This passage illustrates the importance of the
Stomach and the digestive system in general (including
Small Intestine and Large Intestine) for the production
of Qi and Blood: a deficiency of Qi and Blood affects the
Heart (which governs Blood) and the Spleen and may
therefore cause menstrual problems, especially scanty
periods or amenorrhoea.
SUMMARY
Stomach
• The Stomach is connected to the Uterus via the
Penetrating Vessel (Chong Mai) which arises from
the Uterus and goes through the Stomach, passing
through the important Stomach point ST-30 Qichong
• The connection between the Penetrating Vessel and
the Stomach explains the development of morning
sickness during the early stages of pregnancy
The menstrual function depends on the three
Extraordinary Vessels: the Governing, Directing and
Penetrating Vessesls (Du, Ren and Chong Mai). The
Governing Vessel governs the Yang within the menstrual
cycle, the Directing Vessel the Yin and the Penetrating
Vessel the Blood. All three vessels arise from the space
between the Kidneys where the Motive Force throbs
and they then flow through the uterus in women (and
the ‘Room of Sperm’ in men). These three vessels can
be considered as three branches of the same vessel. The
Mirror of Medicine abstracted by Master Luo says:
The Penetrating, Directing and Governing Vessels are
three branches from the same source. The Penetrating
Vessel is the Sea of Blood, the Directing Vessel governs all
Yin channels and the Governing Vessel governs all Yang
channels. The Blood of the Internal Organs flows to the
Penetrating Vessel which is the foundation of the menses.
However, the flourishing of the Penetrating Vessel depends
on the Stomach which is its foundation. For this reason,
all Blood disorders should be treated with sweet and warm
herbs as bitter and cold herbs may damage Stomach-Qi.29
Figure 2.34 illustrates the connection between the
Extraordinary Vessels, the Motive Force, the Uterus, the
Kidneys and Heart.
Penetrating Vessel (Chong Mai)
The Penetrating Vessel is probably the most important of the Extraordinary Vessels and could be considered the origin of them all. It has a deep influence
on menstruation both because it originates from the
Kidneys and because it is the Sea of Blood. This vessel
34 Section 1: Physiology and Pathology
KIDNEY ESSENCE
Essence is biological basis for
menstrual blood (Heavenly Gui)
MINISTER FIRE
Minister Fire is origin of both Fire and Water.
Fire warms and activates
LIVER
BLOOD
Provides Blood to Uterus
Penetrating Vessel
QI
MENSTRUATION
LIV-Qi moves Blood for menstruation to occur
HEART
Governs Blood. HE-Blood goes down
to Uterus (Uterus Vessel)
HE-YANG
Directing Vessel
Goes down to Uterus and Kidneys and
contributes to forming Heavenly Gui
SPLEEN
Makes Blood
Governing Vessel
QI
SP-Qi holds blood in vessels
and Uterus in place
LUNGS
LU-Qi contributes to making Blood
STOMACH
Connected to Uterus via the Penetrating Vessel
Figure 2.33 Internal organs and menstruation.
influences the supply and proper movement of Blood in
the Uterus and controls menstruation in all its aspects.
The trajectory of the Penetrating Vessel is quite complex (Fig. 2.35). It starts in the area between the kidneys where the Motive Force (Dong Qi) throbs. Passing
through the uterus, it flows down to Ren-1 Huiyin; this
part of its trajectory is common to all three vessels –
Penetrating, Governing and Directing – which is why
Li Shi Zhen calls them “three branches of one vessel”.
From Ren-1, the Penetrating Vessel emerges at ST-30
Qichong and then flows with the Kidney channel up to
KI-21 Youmen (some authors say up to KI-27 Shufu).
It continues its flow up to the throat, circles around the
mouth and goes up to the forehead where it “oozes into
the Yang and irrigates the Yin”.30 From Ren-1, a branch
flows inside the spine (some authors say up to the level
of BL-23 Shenshu). Another branch flows down from
ST-30 in the inner side of the leg to the medial side of
the foot, where it splits into two branches following the
Kidney and Spleen channels (the latter reaching the big
toe). Thus the Penetrating Vessel influences the whole
body except the arms.
The spinal branch of the Penetrating Vessel explains
how a woman can experience menstrual pain in the
sacrum and lower lumbar vertebrae. The descending
branch of the Penetrating Vessel explains how menstrual
pain can sometimes irradiate down to the inner thighs.
The changes that take place in the Governing,
Directing and Penetrating vessels determine the
hormonal changes that occur in women at intervals of
Women’s Physiology 35
HE-YANG
Directing
Vessel
Governing
Vessel
Penetrating
Vessel
MOTIVE
FORCE
(Source of
extraordinary
vessels)
REN-4
Pre-natal
Essence
accumulates
here at
conception
Descends
to Kidneys
KI-ESSENCE
DU-4
Minister
Fire
HEAVENLY GUI
Transformed
into Blood (with
help of Liver
and Spleen)
UTERUS
Directing
Vessel
BLOOD
Governing
Vessel
BL-11 Dashu, ST-37 Dajuxu and ST-39 Xiajuxu, are
Penetrating Vessel points (Fig. 2.36). Being the Sea of
Blood, it has a paramount importance in the menstrual
function. It provides and moves Blood, oozes into the
Yang and irrigates the Essence.
The Penetrating Vessel is related to Blood and body
hair. When its Blood is abundant it moistens the skin
and promotes the growth of body hair. Chapter 35 of
the Spiritual Axis says:
The Penetrating and Directing Vessels go to the throat, lips
and mouth. If both Qi and Blood are abundant the skin is
filled and the muscles warmed, if only Blood is abundant it
will penetrate into the skin and beard grows. Women have
more Qi than Blood because they lose some of it with the
periods, hence the Penetrating and Directing Vessels carry
less Blood to chin and lips and therefore no beard grows.32
The Penetrating Vessel, together with the Directing
Vessel, regulates the uterus and menstruation and it
nourishes and moves Blood. It can be used in such conditions as dysmenorrhoea, irregular periods, pre-menstrual tension and menorrhagia. If the Penetrating
Vessel is Empty, there may be amenorrhoea, scanty
periods or late periods. Stagnant Qi and/or Blood in the
Penetrating Vessel may cause dysmenorrhoea.
The Classic of Categories has an interesting summary
of the energetic sphere of action of the Penetrating
Vessel and explains more in depth the meaning of this
vessel’s being the ‘Sea of the 12 Channels’:
At 14 the Heavenly Gui comes into play, the Directing Vessel
circulates strongly, the Penetrating Vessel is flourishing, the
menses come at regular intervals and the girl can conceive
… at 49 the Directing Vessel becomes deficient and the
Penetrating Vessel depleted, the Heavenly Gui dries up,
menstruation stops and she can no longer conceive.31
The Penetrating Vessel is the Sea of the 12 Channels,
it goes upwards to connect with BL-11 Dashu and
downwards to connect with ST-37 Shangjuxu and ST-39
Xiajuxu. The Penetrating Vessel goes down to ST-30
Qichong and up to connect with the Kidney channel. It
goes up to the eyes and head and down to the feet; it goes
to the back [in the lumbar spine] and to the front in the
abdomen. It goes into the Interior in the rivers and valleys
[the big and small muscles of the abdomen] and into
Exterior in the skin and muscles. It therefore connects with
both Yin and Yang and both Interior and Exterior … 100
diseases originate from the Penetrating Vessel because it
is the most ‘penetrating’ [of the channels]. It controls the
Qi and Blood of the 12 Channels which nourish the whole
body and for this reason it is called the Sea of the 5 Yin and
6 Yang Organs.33
Some authors say that the Penetrating Vessel is the
Sea of Blood and, for this reason, the Sea of Blood points,
This energetic sphere of action is illustrated in
Figure 2.37.
REN-1
Figure 2.34 The Extraordinary Vessels and the Uterus.
7 years or thereabouts, as described in the first chapter
of the Simple Questions which says:
36 Section 1: Physiology and Pathology
Kl channel
ST-30
Figure 2.35 The Penetrating Vessel.
SUMMARY
Penetrating Vessel (Chong Mai)
• The Penetrating Vessel has a deep influence on
menstruation both because it originates from the
Kidneys and because it is the Sea of Blood
• This vessel influences the supply and proper
movement of Blood in the Uterus and controls
menstruation in all its aspects
• The changes that take place in the Governing,
Directing and Penetrating Vessels determine
the hormonal changes that occur in women at
intervals of 7 years or thereabouts, as described in
the first chapter of the Simple Questions
• The Penetrating Vessel is the Sea of Blood and, for
this reason, the Sea of Blood points, BL-11 Dashu,
ST-37 Dajuxu and ST-39 Xiajuxu, are Penetrating
Vessel points
• Being the Sea of Blood, it has a paramount
importance in the menstrual function
• The Penetrating Vessel is related to Blood and
body hair. When its Blood is abundant it moistens
the skin and promotes the growth of body hair
• The Penetrating Vessel, together with the
Directing Vessel, regulates the uterus and
menstruation and it nourishes and moves Blood
Directing Vessel (Ren Mai)
The Directing Vessel is very closely related to the Uterus and
to the whole female reproductive system including internal
and external genitalia in women. All problems of cervix,
vagina and vulva are related to the Directing Vessel.
Women’s Physiology 37
BL-11
Eyes
KI channel
Exterior
(skin, muscles)
BL-11
CHONG MAI
Penetrating Vessel
(Chong mai)
Abdomen
Spine
Sea of
Blood
Interior
(abdomen)
ST-30
ST-37
ST-39
Feet
Figure 2.37 Energetic sphere of the Penetrating Vessel.
ST-37
ST-39
Figure 2.36 The Penetrating Vessel and the points of the Sea
of Blood.
The Directing Vessel starts from the space between
the kidneys where the Motive Force throbs. Passing
through the uterus, it emerges at Ren-1 Huiyin. It then
flows upwards through all the Directing Vessel’s points
up to Ren-24 Chengjiang. It then circles the mouth and
enters the eyes from ST-1 Chengqi (Fig. 2.38).
In terms of energies, the Directing Vessel is connected to Yin, Essence and fluids (as opposed to the
Penetrating Vessel, which is related mostly to Blood
and Qi); in fact, it is called the ‘Sea of the Yin channels’.
This means that the Directing Vessel provides the Yin
substances (including Essence, Blood and fluids) for all
women’s physiological processes and hormonal gateways, including puberty, conception, pregnancy, childbirth and menopause. The Penetrating Vessel, on the
other hand, is related more to Blood and menstruation
Figure 2.38 The Directing Vessel.
38 Section 1: Physiology and Pathology
and its pathology is dominated by Blood stasis and Qi
stagnation.
The Directing Vessel can be used to nourish the Yin
energy of the body, particularly in women after menopause, and to reduce the effects of Empty-Heat symptoms deriving from Yin deficiency.
The main difference between the Penetrating Vessel
and the Directing Vessel in relation to menstruation is
that the former controls Qi and can be used to tonify
and nourish, whereas the latter controls Blood and is
mostly used to move Qi and Blood and remove obstructions. Thus the Directing Vessel has more responsibility for conception, fertility, menarche, pregnancy and
menopause, the Penetrating Vessel for menstruation
and most of its irregularities.
SUMMARY
Directing Vessel (Ren Mai)
• The Directing Vessel is very closely related to the
Uterus and to the whole female reproductive
system including internal and external genitalia
• All problems of cervix, vagina and vulva are related
to the Directing Vessel
• The Directing Vessel is connected to Yin, Essence
and fluids
• The Directing Vessel provides the Yin substances
(including Essence, Blood and fluids) for all
women’s physiological processes and hormonal
gateways, including puberty, conception,
pregnancy, childbirth and menopause
… its separating branch travels upwards to the forehead,
then to the vertex, then downward in the midline of the
occiput, travelling along the spine to enter the sacrum:
this [separating branch] is the Governing Vessel. It then
flows to the genitals, passing upward through the pubis
to enter the umbilicus, moving upwards in the abdomen
to enter the clavicle area and downward to enter the
lungs.34
Thus this pathway of the Governing Vessel flows not
only down the spine but also up the abdomen.
Chapter 60 of the Simple Questions has the following pathway for the Governing Vessel: it starts near
the uterus and goes down to the pubic bone and, in
women, to the vagina. Its connecting channel goes
around the vagina, passes to the perineum, then the
buttocks, down to meet the Kidney and Bladder channels inside the upper thighs; it then rises up the spine
to wrap around the kidneys (Fig. 2.39). In men it goes
around the penis and then the perineum. The ‘main
vessel’ starts in the abdomen and goes up to the umbilicus, past the heart, throat and chin, and around the
lips to reach the eyes (Fig. 2.40).35 Some see this ‘main
vessel’ as being the Directing Vessel, others as a branch
of the Governing Vessel; in fact, Li Shi Zhen considered
it a branch of the Governing Vessel flowing with the
Directing Vessel:
Governing Vessel (Du Mai)
The Governing Vessel also arises from the space
between the kidneys. Passing through the uterus, it
emerges in the perineum at Ren-1 Huiyin. From here
it goes to Du-1 Changqiang and flows up the spine to
the base of the skull where it enters the brain. From
the vertex, it flows in the midline down to the upper
lip ending at Du-28 Yinjiao. However, its internal
pathway is more complex than this outline may suggest. There is a contradiction between the Classic of
Difficulties, which has the Governing Vessel running
upwards, and the Spiritual Axis (Ch. 16), which has it
running downwards as a branch of the Liver channel
and which, after describing the pathway of the Liver
channel, says:
Figure 2.39 Genital branch of the Governing Vessel.
Women’s Physiology 39
Through brain
Through heart
To vagina
To BL and Kl
channels in thigh
Figure 2.41 The secondary channels of the Governing Vessel.
Figure 2.40 Abdominal branch of the Governing Vessel.
Another branch [of the Governing Vessel] starts in the
lower abdomen, comes up the abdomen, to the umbilicus,
the heart, enters the throat, goes to the chin and to the
centre of the eyes, following the pathway of the Directing
Vessel.36
Figure 2.41 illustrates the secondary channels of the
Governing Vessel from the Simple Questions (Ch. 60)
and from the Study of the Eight Extraordinary Vessels by
Li Shi Zhen.
The implication of the above pathway is that the
Governing and Directing vessels are almost like two
branches of the same vessel, one Yang and one Yin,
intersecting inside. Li Shi Zhen says:
The Directing and Governing Vessels are like midnight and
midday, they are the polar axis of the body … there is one
source and two branches, one goes to the front and the
other to the back of the body … we can make connections
between them. When we try to divide these, we see that
Yin and Yang are inseparable. When we try to see them as
two, we see that it is an indivisible whole.37
Literally translated, the last sentence says: “They are
one but two, they are two but one.” Thus the ‘main vessel’
that the Simple Questions describes may be seen either
as the Directing Vessel or as a branch of the Governing
Vessel and, given the close connection between these
two vessels, in practice it does not make much difference which one it is.
However, the important implication of the above
pathways in gynecology is that the Governing Vessel
extends a branch to the front of the body curling
around the vagina; when a woman has problems of the
genitalia the Directing Vessel is the obvious choice but
the Governing Vessel can be used too, and if there is a
marked deficiency of Kidney-Yang, it should be chosen
in preference to the Directing Vessel.
In relation to menstruation, the Governing Vessel
influences the tide of Yang (Kidney-Yang) that
decreases with the onset of the period and increases
40 Section 1: Physiology and Pathology
from ovulation. In other words, arising from the
uterus like the Directing and Penetrating vessels, it
represents the Yang aspect of women’s reproductive functions. As we have seen above, the Governing
Vessel represents the influence of the Fire of the Gate
of Life (Ming Men) and the Minister Fire in women’s
physiology.
The Governing and Directing vessels can be seen
as two branches, one Yang and one Yin, of the same
continuous energetic circuit arising from the space
between the kidneys, flowing through the uterus,
emerging at the perineum and flowing upwards, one
at the back, the other at the front, to reach the head
and the brain, connecting with the heart on the way
(Fig. 2.42). Thus, from a Chinese perspective, these two
vessels connect the Uterus with the Kidneys, the Heart
and the Brain, which goes some way to explaining the
influence of mental–emotional problems on the menstrual and ovarian functions and vice versa. In terms
of vital substances, the Governing and Directing
vessels’ circuit connects the Essence (Kidneys), Blood
(Uterus and Heart), Marrow (spine and Kidneys) and
Sea of Marrow (Brain). Seen from a Western perspective, the Governing and Directing Vessels clearly represent the hypothalamus–pituitary–ovarian axis which
is responsible for ovulation (Fig. 2.43).
SUMMARY
Governing Vessel (Du Mai)
• The Governing Vessel also arises from the space
between the kidneys
• The Governing Vessel has a branch going to the
front of the body in the genital area: it goes to the
vagina in women and penis in men
• The Governing Vessel also has an abdominal
branch that follows the same pathway as that of
the Directing Vessel
• The Governing and Directing Vessels are almost
like two branches of the same vessel, one Yang
and one Yin, intersecting inside
• In relation to menstruation, the Governing Vessel
influences the tide of Yang (Kidney-Yang) that
decreases with the onset of the period and
increases from ovulation
• Arising from the uterus like the Directing and
Penetrating Vessels, the Governing Vessel
represents the Yang aspect of women’s
reproductive functions
• The Governing Vessel represents the influence of
the Fire of the Gate of Life (Ming Men) and the
Minister Fire in women’s physiology
Girdle Vessel (Dai Mai)
REN-1
Figure 2.42 Circuit of Governing and Directing Vessels.
The Girdle Vessel is the only horizontal channel of
the body. Its pathway is simply a belt-like channel
encircling the waist and passing through G.B.-26
Daimai, G.B.-27 Wushu and G.B.-28 Weidao. Some
authors say it also connects with LIV-13 Zhangmen.
In the back, it intersects the Kidney divergent channel (Fig. 2.44).
The Girdle Vessel has an important influence in
women’s physiology and pathology. Encircling the leg
channels, it interrelates with and restrains the Liver’s
smooth flow of Qi (through LIV-13 Zhangmen), and
Women’s Physiology 41
Hypothalamus
Pituitary
Figure 2.43 Governing and Directing Vessels as
hypothalamus–pituitary–ovarian axis.
Joins KI divergent channel
(level of BL-23)
Figure 2.44 Girdle Vessel.
harmonizes the ascending and descending of both
Spleen and Kidneys. Hence the Kidney’s nourishment
of the Essence and descending of Qi, the Spleen’s raising of Qi and the Liver’s smooth flow of Qi all rely on
the Girdle Vessel being ‘relaxed and stretched’: these
are all very important aspects of women’s physiology and pathology. Because of this, the Girdle Vessel
guides and supports the Qi of the Uterus and the
Essence. If the Girdle Vessel does not exercise enough
restraint, Damp-Heat, usually deriving from a chronic
Spleen deficiency, may infuse downwards causing
leucorrhoea.
Because the Girdle Vessel connects with LIV-13
Zhangmen (Front-Collecting point of the Spleen)
and BL-23 Shenshu (Back-Transporting point of the
Kidneys), it connects the Post-Natal with Pre-Natal Qi
(in a similar way to that of the Penetrating Vessel).
Because of the gynecological sphere of influence
of the Girdle Vessel, some doctors say that in terms
of energy it is part of the Directing Vessel and the
Penetrating Vessel: its deficiency pathology is related
to the Directing Vessel while its excess pathology
is related to the Penetrating Vessel. Deficiency of
the Girdle Vessel makes it too ‘slack’. This slackness
leads to Kidney and Liver deficiency. The Girdle Vessel
fails to restrain the Essence, Spleen-Qi sinks and the
Post-Natal Qi is unsupported, so that the Directing,
Governing and Penetrating Vessels all become
deficient.
When the Girdle Vessel is slack, Qi cannot rise, the
organs sag and there may be prolapse of the uterus or
miscarriage, due to long-term Qi deficiency, Post- and
Pre-Natal Qi deficiency and clear Qi descending. The
fetus depends not only on the Kidneys and the Directing
Vessel, but also on the Girdle Vessel. If the Girdle Vessel
is slack, Qi cannot rise, the fetus is not stabilized and
the mother may miscarry.
The Governing and Directing vessels cut across
the Girdle Vessel linking it with the Heart above, the
genital system below, the umbilicus in front and the
Penetrating Vessel in the middle. This emphasizes why
these four vessels (Governing, Directing, Penetrating
and Girdle) are interlinked for the production, circulation, discharge and regeneration of the Essence. When
these vessels are blocked, the Essence cannot be produced properly and all kinds of gynecological problems
ensue. Figure 2.45 illustrates the relationship among
the Governing, Directing, Penetrating and Girdle vessels in gynecology.
42 Section 1: Physiology and Pathology
• Deficiency of the Girdle Vessel makes it too
‘slack’. This slackness leads to Kidney and Liver
deficiency. The Girdle Vessel fails to restrain the
Essence, Spleen-Qi sinks and the Post-Natal Qi is
unsupported, so that the Directing, Governing and
Penetrating Vessels all become deficient
Penetrating Vessel
BRAIN/HEART
Directing
Vessel
sel
Girdle Ves
Governing
Vessel
UTERUS
Yin Stepping Vessel (Yin Qiao Mai)
The Yin Stepping Vessel starts from KI-6 Zhaohai. It
ascends along the medial surface of the leg and thigh
and then goes over the abdomen, passing through the
external genitalia, and ascending to the chest, the clavicle, the throat and face to end at the inner canthus of
the eye (Fig. 2.46).
The Yin Stepping Vessel influences the reproductive system and the lower abdomen in women. It is
REN-1
Figure 2.45 Relationship among Governing, Directing,
Penetrating and Girdle vessels.
SUMMARY
Girdle Vessel (Dai Mai)
• The Girdle Vessel is the only horizontal channel of
the body
• Its pathway is simply a belt-like channel encircling
the waist and passing through G.B.-26 Daimai,
G.B.-27 Wushu and G.B.-28 Weidao
• Encircling the leg channels, the Girdle Vessel
interrelates with and restrains the Liver’s smooth
flow of Qi (through LIV-13 Zhangmen), and
harmonizes the ascending and descending of both
Spleen and Kidneys
• The Kidney’s nourishment of the Essence and
descending of Qi, the Spleen’s raising of Qi and
the Liver’s smooth flow of Qi all rely on the Girdle
Vessel being ‘relaxed and stretched’
• If the Girdle Vessel does not exercise enough
restraint, Damp-Heat, usually deriving from a
chronic Spleen deficiency, may infuse downwards
causing leucorrhoea
• Its deficiency pathology is related to the Directing
Vessel while its excess pathology is related to the
Penetrating Vessel
Figure 2.46 The Yin Stepping Vessel.
Women’s Physiology 43
particularly used for excess patterns of the Lower
Burner such as abdominal masses, fibroids, difficult
delivery and retention of placenta. Since it passes
through the external genitalia, it may also be used for
problems that occur in this area, provided there is a
background of excess.
Figure 2.47 summarizes the interrelationship among
the internal organs, the Vital Substances, the Uterus
and the Extraordinary Vessels.
Heavenly
‘GUI’
(Pre-natal)
Mother’s
ESSENCE
MINISTER
FIRE
Father’s
ESSENCE
BLOOD
(Post-natal)
CONCEPTION
Figure 2.48 Factors in conception.
CONCEPTION
As described above, conception relies on an abundant supply of Blood and Essence, the flourishing
of Kidneys and Liver, and healthy Penetrating and
Directing Vessels, factors which depend on the mother;
other factors depend on the father. Thus both the PreNatal Qi, in the form of Essence, and the Post-Natal
Qi, in the form of Blood, are essential for conception
to occur. However, Blood and Essence are only the Yin
essences of the body and conception depends also
on the Yang energies of the Fire of the Gate of Life.
This is the formless Minister Fire which is intrinsically
and indissolubly related to Water. The Minister Fire
(related to the Governing Vessel) provides the spark
necessary for the Essence and Blood to form a new
being (Fig. 2.48).
However, the Essence of the mother is only one aspect
of the necessary energies for conception to occur. The
mother’s Corporeal Soul (Po) also plays an important
role in conception. A physical type of soul that pertains
to Earth, it is Yin in nature, is stored in the Lungs and
comes from the mother; it dies with the body at the end
of a life. The Corporeal Soul interacts closely with the
Essence: it could be said that it brings the Essence into
LUNGS
Governs
QI
SPLEEN
Menarche
Makes
Ma
Commands
ke
s
flow
e-
Fre
Mother
LIVER
Menstruation
Penetrating
Stores and
moves
Pregnancy
Directing
BLOOD
Governing
Vessels
HEART
UTERUS
Delivery
Governs
Replenishes
Lactation
Makes
KIDNEYS
ESSENCE
Stores
Uterus Vessel
Uterus Channel
Menopause
Blood is ‘lower source’ of milk
Figure 2.47 Interrelationship among the internal organs, the Vital Substances, the Uterus and the Extraordinary Vessels.
44 Section 1: Physiology and Pathology
play in all physiological processes. In fact, Chapter 8 of
the Spiritual Axis says: “The Corporeal Soul is the entering and exiting of the Essence.”38 In particular, the fetus’s
Corporeal Soul is formed at conception from the mother’s: thus the father plays no role in this particular aspect
of conception. Thus, from this point of view, the influence of the mother’s energies on conception is stronger
than that of the father. This also implies that the hereditary constitution of a baby depends not only on the parents’ Kidneys, but also on the mother’s Lungs.
PREGNANCY
Pregnancy is a time of change. As a result of the stopping of the menses, the Penetrating and Directing
Vessels undergo many changes, which are typical of
pregnancy and do not occur at other times. During
pregnancy there is an abundance of Yin, because
there is no longer a monthly loss of blood and because
there is a gradual increase in fluids (amniotic fluid);
there is also a plethora of Yang, because the absence
of periods leads also to an accumulation of Minister
Fire (as the Water and the Fire within the Kidneys are
inseparable).
After conception, Blood is gradually transformed into
milk and also transfers its location from the Lower to
the Upper Burner. During the first 3 months, because
of the profound changes taking place in the Penetrating
Vessel and because of the transformation of Blood into
milk with its upward movement to the breasts, rebellious Qi often goes up in the Penetrating Vessel. This
causes not only morning sickness in the first 3 months
but also a general feeling of heat above and distension
of the breasts.
From an energetic point of view, pregnancy has a
dual effect on the Kidneys. On the one hand, it poses
a strain on the Kidneys as their Qi and Essence go to
feed the fetus. However, the stoppage of the menses
also means that menstrual blood (which is not actually ‘Blood’ as seen above, but Tian Gui) can now go
to feed the body itself (as well as the fetus). It could be
said that during pregnancy, Blood is transformed into
Essence which nourishes the body (and the fetus). In
fact, under normal circumstances and a healthy pregnancy, a pregnant woman looks very florid and healthy
and not at all Blood deficient (especially between the
fourth and seventh months).
The transformation of Blood into Essence during
pregnancy is mirrored, from a Western point of view,
by the secretion of large amounts of oestrogen, progesterone and chorionic gonadotropin by the placenta,
which explains why some women are healthier in pregnancy and others deteriorate; the difference depends
both on the pre-existing state of Kidney-Qi and on how
well the woman looks after herself during the pregnancy. Two examples of health problems that often
improve during pregnancy are asthma and migraine.
The increased pigmentation along the midline of the
body and round the nipples is due to changes occurring
in the Directing Vessel.
Another change taking place during pregnancy is a
certain increase in Heat. The Qing dynasty gynecologist, Chen Jia Yuan, explains:
During pregnancy the Emperor and Minister Fire
gradually nourish the fetus and there is normally a
feeling of heat and a certain restlessness [in the mother].
The Heart governs Blood [during pregnancy], Blood
protects the fetus and cannot irrigate the Sea of Blood.39
This passage is interesting because it confirms that
Blood deficiency can cause hot flushes and a feeling of
heat in a similar way to Yin deficiency. The passage is
interesting also because it states that during pregnancy,
although the Blood is abundant (as the menses stop),
it is directed to nourish and protect the fetus rather
than flowing into the Sea of Blood. This may explain
the fact that, from a Western point of view, although
during pregnancy there is a substantial increase in the
volume of fluids, including those in the plasma (to a
total of about 3300 ml), a 30% increase in the volume
of blood and an increase in the total absolute number
of red blood cells (by about 20%), there is a decrease
in the haemoglobin content because the haemoglobin
concentration and the red blood cell count fall in relation to the large increase in blood volume.
Seen from a Chinese perspective, these physiological
changes of pregnancy are mirrored in the idea that the
Blood increases (because the menses stop) but it is deviated away from the Sea of Blood to nourish and protect
the fetus. Hence, while from a Western point of view
the mother may be said to suffer from anaemia (due to
the fall in red cell count and haemoglobin in relation to
the increased volume of blood), she cannot be said to
suffer from Blood deficiency in a Chinese sense.
Interestingly, a study conducted on 153 602 pregnant women by three English medical colleges showed
that women with low haemoglobin levels were more
Women’s Physiology 45
likely to carry the pregnancy to full term and give birth
to healthy babies. In fact, risks of a pre-term baby or
one born with a low birth weight increased seven times
in women whose haemoglobin levels failed to fall during pregnancy. In other words, the widely seen drop in
iron blood levels in pregnant women is perfectly normal, signifying good expansion in blood volume, not
anaemia.40 This confirms what was said above, i.e. that
the haemoglobin level of pregnant women is lower only
in relation to the increased blood and fluid volume.
Birth weight is the single biggest determinant of
mortality in the first year of life and is therefore a
good indicator of the efficiency with which a woman
has supported her fetus. The authors of the abovementioned study conclude that the mechanism by
which expansion of the plasma volume enhances
fetal growth is not known, but it may be that reduced
blood viscosity favours blood flow in the low-velocity flow system of the maternal intervillous space.
This last observation ties in well with Chinese views
as, although the mother’s Blood goes to nourish
the fetus, there is more of it due to the cessation of
menses.
In Chinese medicine, pregnancy is considered to last
10 lunar months (roughly equivalent to 9 calendar
months) and each month corresponds to an internal
organ as follows:
1. Liver
2. Gall Bladder
3. Pericardium
4. Triple Burner
5. Spleen
6. Stomach
7. Lungs
8. Large Intestine
9. Kidneys
10. Bladder.
The use of points on a particular channel in theory
was prohibited in the relevant month, but this rule is
not followed nowadays. The correspondence between
the tenth month and the Bladder is interesting: this
would provide an explanation for the use of the point
BL-67 Zhiyin in the last month of pregnancy to turn
the fetus. The fact that it has the effect of moving the
fetus would confirm the idea that, under normal circumstances, points from that channel should not be
used in the tenth month and, by inference, neither
should the other channels be needled in the relevant
months. However, the Qing dynasty gynecologist Chen
Jia Yuan has a different correspondence between the
months of pregnancy and internal organs:
1. Gall Bladder
2. Liver
3. Pericardium
4. Heart
5. Stomach
6. Spleen
7. Large Intestine
8. Lungs
9. Bladder
10. Kidneys.
The Thousand Golden Ducat Prescriptions of the Tang
dynasty describes the changes occurring at each
month of pregnancy. It says that in the first month the
conceived being is called embryo (some ancient doctors
compared it to ‘dew’), in the second month ‘fat’ (Gao),
in the third month ‘fetus’ (Bao); in the fourth month it
acquires a body shape, in the fifth it can move, in the
sixth the sinews and bones are formed, in the seventh
the skin and hair are formed, in the eighth the organs
are fully formed, in the ninth the Food Qi (Gu Qi) enters
the Stomach, in the tenth month the Shen is fully established and childbirth occurs.41
MENOPAUSE
Chapter 1 of the Simple Questions says:
At 49 [in a woman] the Directing Vessel becomes deficient,
the Penetrating Vessel depleted, the Tian Gui dries up, the
fluids in the channels are exhausted, her body becomes old
and she can no longer become pregnant.42
Thus, the most important change occurring around
this age is a decline of the Kidney energy and the
Directing and Penetrating Vessels, together with a general drying up of fluids and Blood. This is consistent
with the symptoms of menopausal problems.
‘Menopause’ indicates the complete or permanent
cessation of menstruation: an interval of 6 to 12
months is usually necessary to establish the diagnosis.
‘Climacteric’ indicates the phase in a woman’s life during which she makes the transition from a reproductive
to a non-reproductive stage: this transition is a period
of declining ovarian function which usually spans 2 to
5 years around the menopause. Thus, when we refer to
the discomfort and symptoms appearing during these
46 Section 1: Physiology and Pathology
years, it would be more appropriate to call them climacteric syndrome rather than menopausal syndrome: however, since the latter term is more generally used and
understood, I shall use it throughout this book.
Menopause usually occurs between the ages of 48
and 55 and the median age in industrialized countries
is about 51. It will be remembered that the very first
chapter of the Simple Questions describes the 7-year
cycles of women, according to which menopause
occurs at 49 (7 × 7): this is not far from the abovementioned median age of 51. Furthermore, data analyses indicate that the menopausal age has remained
unchanged for centuries.43 Indeed, the mean age at
menopause is just over 50 and this is remarkably constant not only throughout the Western world but also
other countries. A survey of Malaysian women showed
a mean age at menopause of 50.7 years, and another
of seven Asian countries found that most women
reached menopause at around 50.44
The primary basis for the progressive decline of
reproductive power in women is in the ovary itself,
as ovarian follicles are greatly depleted by the time of
the menopause. There are about 300 000 follicles at
menarche and about 10 000 at the time of the menopause. As the follicle activity decreases and then ceases,
there is a lack of oestrogen and therefore a cessation of
the menses.
Menopause is not a disease, it is the normal physiological transition in a woman’s life from a reproductive to a
non-reproductive age: indeed, many women experience
Empty–Heat
YIN
Empty–Heat
YANG
Other patterns:
• Phlegm
• Qi stagnation
• Blood stasis
• Empty heat
• Liver-Yang rising
Kidney-Yin deficiency
(primary)
Night sweating, feeling of heat,
hot flushes, tongue without coating
(red in severe cases), cold feet,
frequent urination
Figure 2.49 Pathology of menopause.
YIN
YANG
Kidney-Yang deficiency
(primary)
Backache, feeling cold,
cold feet, frequent urination,
hot flushes, pale tongue
no ‘symptoms’ during this time. From a Chinese perspective, menopausal symptoms (if there are any) are generally due to a decline of Kidney-Essence in its Yin or Yang
aspect; however, within this basic pathology there can
be many variations of pattern. Moreover, the deficiency
of the Kidneys may often be combined with excess patterns, especially Phlegm, stagnation of Qi, stasis of
Blood, Empty-Heat, or Liver-Yang rising (Fig. 2.49).
For a discussion of menopausal problems, see
Chapter 58.
END NOTES
1. Elementary Medicine (Yi Xue Ru Men) 1575 cited in Zhang Qi
Wen 1995 Menstrual Diseases (Yue Jing Bing Zheng
),
People’s Hygiene Publishing House, Beijing, p. 10.
2. Feng Tao Zhang 1702 Secret Records of Master Feng’s Brocade Bag
(Feng Shi Jin Nang Mi Lü) cited in Menstrual Diseases, p. 13.
3. Cited in Chinese Medicine Research Institute and Guangzhou College
of Chinese Medicine 1980 Concise Dictionary of Chinese Medicine
(Jian Ming Zhong Yi Ci Dian
), People’s Health
Publishing House, Beijing, p. 186.
4. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Di Nei Jing Su Wen
), People’s
Health Publishing House, Beijing, p. 259. First published c. 100 BC.
5. Ibid., p. 197.
6. Ann McPherson 1993 Women’s Problems in General Practice,
Oxford University Press, Oxford, p. 201.
7. Whincup P H, Gilg J A, Odoki K et al 2001 Age of Menarche in
Contemporary British Teenagers: Survey of Girls Born between
1982–1986, British Medical Journal 322: 1095–1096.
8. Chumlea W C, Schubert C M, Roche A F et al 2003 Age at Menarche
and Racial Comparisons in US Girls, Pediatrics 111: 110–113.
9. Wu Da Zhen 1994 Hundred Methods for the Treatment, Prevention
and Dietary Therapy of Menstrual Irregularities (Yue Jing Bing Fang
Zhi He Shi Liao 100 Fa
100 ), China
Medicinal Herbs Scientific Publishing House, Beijing, p. 12.
10. Ibid., p. 194.
11. Simple Questions, p. 5.
12. Chen Zi Ming 1237 Great Treatise of Beneficial Formulae for Women
(Fu Ren Liang Fang Da Quan) cited in Menstrual Diseases, p. 10.
13. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai,
p. 27. First published in 1827. Fu Qing Zhu was born in 1607 and
died in 1684.
14. Ibid., p. 27.
15. Simple Questions, p. 5.
16. Chen Zi Ming 1237 Great Treatise of Beneficial Formulae for Women
(Fu Ren Liang Fang Da Quan) cited in Menstrual Diseases, p. 10.
17. Fu Qing Zhu’s Gynaecology, p. 27.
18. Ibid., p. 27.
19. Ibid., p. 55.
20. Pei Zheng Xue 1980 A Commentary on the Discussion of Blood
Syndromes (Xue Zheng Lun Ping Shi
), People’s
Health Publishing House, Beijing, p. 159. The Discussion of Blood
Syndromes (Xue Zheng Lun
), by Tang Zong Hai was originally published in 1885.
21. Cong Chun Yu 1989 Chinese Medicine Gynaecology (Zhong Yi Fu Ke
Xue
), Ancient Chinese Medicine Texts Publishing
House, Beijing, p. 11.
22. Wu Qian 1977 Golden Mirror of Medicine (Yi Zong Jin Jian
), People’s Health Publishing House, Beijing, Vol. 3,
p. 7. First published in 1742.
23. Ibid., p. 7.
Women’s Physiology 47
24. Zhang Jing Yue 1986 The Complete Works of Jing Yue (Jing Yue
Quan Shu
), Shanghai Science and Technology Press,
Shanghai, p. 19. First published in 1624.
25. Cited in Menstrual Diseases, p. 13.
26. Ibid., p. 13.
27. Chao Yuan Fang AD 610 General Treatise on the Aetiology and
Symptomatology of Diseases (Zhu Bing Yuan Hou Zong Lun) cited in
Menstrual Diseases, p. 179.
28. Ibid., p. 27.
29. Luo Guo Gang 1789 Mirror of Medicine abstracted by Master Luo
(Meng Shi Hui Yue Yi Jing) cited in Menstrual Diseases, p. 15.
30. 1981 Spiritual Axis (Ling Shu Jing
), People’s Health
Publishing House, Beijing, p. 79. First published c. 100 BC.
31. Simple Questions, p. 5.
32. Spiritual Axis, p. 120.
33. Zhang Jing Yue 1982 Classic of Categories (Lei Jing
), People’s
Health Publishing Company, Beijing, p. 281. The Classic of
Categories was first published in 1624.
34. Spiritual Axis, p. 49.
35. Simple Questions, p. 320.
36. Wang Luo Zhen 1985 A Compilation of the Study of the
Eight Extraordinary Vessels (Qi Jing Ba Mai Kao Jiao Zhu
37.
38.
39.
40.
41.
42.
43.
44.
), Shanghai Science Publishing House,
Shanghai, p. 81. The Study of the Eight Extraordinary Vessels (Qi
Jing Ba Mai Kao
) by Li Shi Zhen was published in
1578.
Ibid., p. 81.
Spiritual Axis, p. 23.
Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi
Shu Ba Zhong
), Ancient Chinese Medicine Texts
Publishing House, Beijing, p. 13. Chen’s book, written during the
Qing dynasty (1644–1911), was entitled Secret Gynaecological
Prescriptions (Fu Ke Mi Fang
).
Steer P, Alam M A, Wadsworth J et al 1995 Relation between
Maternal Haemoglobin Concentration and Birth Weight in Different
Ethnic Groups, British Medical Journal 310: 489–491.
Sun Si Miao 652 Thousand Golden Ducat Prescriptions (Qian Jin Yao
Fang) cited in Luo Yuan Kai 1986 Gynaecology in Chinese Medicine
(Zhong Yi Fu Ke Xue
), Shanghai Science and
Technology Press, Shanghai, p. 14.
Simple Questions, p. 5.
Clarke-Pearson D L, Dawood M Y 1990 Green’s Gynaecology: Essentials
of Clinical Practice, Little, Brown and Company, Boston, p. 457.
Women’s Problems in General Practice, p. 198.
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CHAPTER 3
WOMEN’S PATHOLOGY
PATHOLOGY OF THE INTERNAL ORGANS 49
Kidneys 49
Liver 52
Spleen 60
Heart 61
Lungs 64
Stomach 64
QI AND BLOOD PATHOLOGY 64
Qi rebellious 65
Blood-Cold 65
triple relationship of Blood–Uterus–Kidneys: a deficiency of Blood, which often occurs in women, affects
the Uterus, and since this is functionally related to the
Kidneys, the Kidneys also become deficient. Hence,
in women, a Blood and a Kidney deficiency are often
overlapping.
CLINICAL NOTE
In women, Blood and Kidney deficiencies are often
overlapping.
PATHOLOGY OF THE EXTRAORDINARY VESSELS 67
Penetrating Vessel (Chong Mai) 67
Directing Vessel (Ren Mai) 71
Governing Vessel (Du Mai) 71
Girdle Vessel (Dai Mai) 72
Yin Stepping Vessel (Yin Qiao Mai) 73
Yin Linking Vessel (Yin Wei Mai) 74
Women’s pathology will be discussed under three
main headings:
1. Pathology of the internal organs.
2. Qi and Blood pathology.
3. Pathology of the Extraordinary Vessels.
PATHOLOGY OF THE INTERNAL
ORGANS
Kidneys
Kidney deficiency
Kidney deficiency, one of the major pathologies in
gynecology, is at the root of many women’s problems.
It is probably more common in women because of the
In women more than men, a Kidney deficiency often
involves both Yin and Yang, albeit one will always be
predominant. The tongue illustrates clearly which is
predominant: if it is Pale, Kidney-Yang deficiency predominates; if it lacks a coating, Kidney-Yin deficiency
predominates.
The reason why Kidney-Yin deficiency and KidneyYang deficiency often occur simultaneously in women
is three-fold:
1. Because of the connection between Penetrating
Vessel–Blood–Uterus–Kidneys (the Penetrating
Vessel is the Sea of Blood, it arises from the
Uterus and pertains to the Kidney channel),
a deficiency of Kidney-Yang will affect the
Penetrating Vessel, which affects the Blood, itself
part of Yin, hence a Yin deficiency arises. Or,
a deficiency of Kidney-Yin affects the Uterus,
which stores Blood; this affects the Penetrating
Vessel which is the Sea of Blood and which
originates from the space between the kidneys
where the Motive Force (Dong Qi) throbs. This
Motive Force itself originates from the Fire of the
Gate of Life (Ming Men) and therefore a KidneyYang deficiency results.
50 Section 1: Physiology and Pathology
2. The Minister Fire is the source of both Fire and
Water. Water forms menstrual blood, hence when
the Kidneys are deficient, both Water and Fire are
deficient.
3. In men as well as women, a deficiency of KidneyYin or Kidney-Yang may simply arise and develop
simultaneously into the other because Yin is
the material substance of Yang and Yang is the
function of Yin and the two are indissolubly
connected. Kidney-Yin and Kidney-Yang are like
an old-fashioned Chinese oil lamp: Kidney-Yin is
the oil, Kidney-Yang the flame at the end of the
wick. If the oil is decreased, eventually the flame
dies down; vice versa, if the flame dwindles, less oil
is burned, and eventually it will coagulate and dry
up (Fig. 3.1).
In women, a simultaneous deficiency of Kidney-Yin
and Kidney-Yang is far more common after age 40.
As Kidney-Yin and Kidney-Yang can both be deficient,
in women this causes the very common situation when
there are both Hot and Cold symptoms. This is because
the Yin-deficient part of the Kidneys can give rise to
Empty-Heat even if there is a predominance of Yang
deficiency. For example, a woman may have backache,
frequent, pale urination, swollen ankles, cold feet, Pale
tongue (symptoms of Kidney-Yang deficiency) and hot
flushes. Vice versa, a woman may suffer from backache,
dizziness, night sweating, a Red-Peeled tongue, hot
flushes (symptoms of Kidney-Yin deficiency), but
cold feet and frequent urination. Figures 3.2 and 3.3
illustrate the above clinical situations when there is a
deficiency of both Kidney-Yin and Kidney-Yang with
a predominance of Kidney-Yang and Kidney-Yin
respectively.
Empty-Heat
KI-YANG
KI-YIN
TONGUE PALE
Many cold
symptoms
Some
Empty-Heat
symptoms
Figure 3.2 Simultaneous deficiency of Kidney-Yin and KidneyYang with a predominance of the latter.
Empty-Heat
KI-YANG
KI-YIN
TONGUE RED
Some cold
symptoms
Many
Empty-Heat
symptoms
Figure 3.3 Simultaneous deficiency of Kidney-Yin and KidneyYang with a predominance of the former.
Flame = Kidney-Yang
Oil = Kidney-Yin
Figure 3.1 Kidney-Yin and Kidney-Yang as an oil lamp.
This clinical situation is so common in women aged
over 40 that I think it is the rule rather than the exception. Over the years I have made a note of all the cases
presenting with contradicting Hot and Cold symptoms stemming from a simultaneous deficiency of both
Kidney-Yin and Kidney-Yang (there are other causes
of contradicting Hot and Cold symptoms not related to
the Kidneys, which will be explained later). The following is a partial list of the most glaring examples, with
the patient’s age indicated at the start of each entry.
Women’s Pathology 51
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
42: cold feet, pale urine, Pale tongue, hot feet in bed
at night.
44: night sweating, frequent urination, Pale tongue,
cold hands, hot feet, dry throat.
46: always feeling very cold, needs to wear socks in
bed, pale urine, Red tongue without coating, poor
memory, hot flushes.
48: hot flushes, Pale tongue.
53: hot flushes, Pale tongue, feeling cold, cold feet.
42: Red, Peeled tongue, dry mouth, feeling very
cold.
44: Pale tongue, feeling cold, very hot feet at night.
38: feeling very cold, backache, Pale tongue, hot feet
at night.
52: backache, dizziness, tinnitus, night sweating,
Red tongue, feeling cold.
53: night sweating, Red tongue, dryness of vagina,
feeling cold, oedema.
49: Pale tongue, feeling cold, dry throat, scanty urine,
hot in bed (husband says she is ‘boiling in bed’).
51: hot flushes, feeling of heat, Pale tongue.
43: hot and red face, sweating, dry mouth, Pale
tongue.
44: backache, oedema, feeling cold, extremely Pale
tongue, hot at night.
65: Pale tongue, oedema of ankles, no thirst, feeling
of heat, scanty urination, constipation.
43: night sweating, hot flushes, Pale tongue (helped
by moxa on Ren-4).
42: hot flushes, Pale tongue, likes a hot-water bottle
on her back, backache.
46: Pale tongue, hot flushes (helped by moxa on
KI-3 Taixi).
42: Pale tongue, hot flushes, feeling of heat at night,
hot feet in bed at night, but very cold feet in daytime.
42: Red tongue, feeling of heat, tinnitus, likes a hotwater bottle on her back.
47: feeling cold during her periods, Pale tongue, hot
chest and face at night.
44: hot flushes, night sweating, Pale tongue.
45: Pale tongue, feeling of heat, hot in bed.
45: Red tongue which feels sore and dry, night
sweating, hot soles, cold back.
42: feeling very cold, red tip of tongue, bitter taste,
night sweating, frequent urination.
52: night sweating, dry mouth, constipation, Pale
tongue.
83: Red, Peeled tongue, knee-ache, tinnitus, night
sweating, oedema of ankles.
•
•
46: very Pale tongue, Deep pulse, legs feeling cold
up to the knees, very hot at night, insomnia.
54: very Pale tongue, pale urine, backache, hot
flushes.
A few interesting observations can be made analysing
the above list. First, all the women listed (bar one) are
over 40, and the overwhelming majority are in their
40s. This is because, before 40, as the pathology is less
long-standing, there is usually a clear-cut deficiency
of either Kidney-Yang or Kidney-Yin. As the energy
of the Kidney starts declining after 40 and it is often
intertwined with a Blood pathology, a deficiency of
Yang begins to induce a deficiency of Yin or vice versa,
hence the overlapping of Kidney-Yin and Kidney-Yang
deficiency (Fig. 3.4). After this time, in a woman over
60, whichever deficiency is primary will start to settle
in and predominate over the other. Another observation that can be made is that the overlapping symptoms
of Heat and Cold usually manifest in the feet with cold
feet or hot feet at night, or in the face with a feeling of
heat (the face does not usually have a feeling of cold).
The above are only few of the presenting symptoms
to illustrate the presence of Hot and Cold symptoms
from a simultaneous deficiency of Kidney-Yin and
Kidney-Yang. There are other causes of the simultaneous occurrence of Hot and Cold symptoms and they
are discussed below, under the ‘Qi and Blood Pathology’
heading.
Tongue without coating
Empty-Heat
YIN
Pale tongue
Empty-Heat
YANG
Kidney-Yin deficiency
(primary)
Night sweating, feeling of heat,
hot flushes, cold feet, frequent
urination, tongue without coating
(red if there is Empty-Heat)
YIN
YANG
Kidney-Yang deficiency
(primary)
Backache, feeling cold,
cold feet, frequent urination,
hot flushes, pale tongue
Figure 3.4 Symptoms of simultaneous deficiency of KidneyYin and Kidney-Yang.
52 Section 1: Physiology and Pathology
As explained in the chapter on physiology (Ch. 2), the
waxing and waning of Kidney-Yin and Kidney-Yang are
responsible for the menstrual cycle. However, KidneyYin and Kidney-Yang are also interdependent and,
because a deficiency of one often implies a deficiency of
the other, often both are tonified, especially in the treatment of infertility. For example, Dr Lian Fang advocates
adding Yin Yang Huo Herba Epimedii to Kidney-Yin tonics and Nu Zhen Zi Fructus Ligustri lucidi and Han Lian
Cao Herba Ecliptae to Kidney-Yang tonics when treating
infertility.1 Indeed, the two important formulae You Gui
Wan Restoring the Right [Kidney] Pill and Zuo Gui Wan
Restoring the Left [Kidney] Pill, which tonify KidneyYang and Kidney-Yin respectively, contain herbs that
tonify Kidney-Yin and Kidney-Yang respectively. In
fact, You Gui Wan (which tonifies Kidney-Yang) contains Gou Qi Zi Fructus Lycii which nourishes KidneyYin, and Zuo Gui Wan (which nourishes Kidney-Yin)
contains Tu Si Zi Semen Cuscutae and Lu Jiao Jiao Colla
Cornu Cervi which tonify Kidney-Yang.
Table 3.1 summarizes the Kidney patterns in
gynecology.
SUMMARY
Kidney deficiency
• Kidney deficiency, one of the major pathologies
in gynecology, is at the root of many women’s
problems
• In women more than men, a Kidney deficiency
often involves both Yin and Yang, albeit one will
always be predominant
• In women, a simultaneous deficiency of KidneyYin and Kidney-Yang is far more common after
the age of 40
• As Kidney-Yin and Kidney-Yang can both be
deficient, in women this causes the very common
situation when there are both Hot and Cold
symptoms
• The overlapping symptoms of Heat and Cold
usually manifest in the feet with cold feet or hot
feet at night, or in the face with a feeling of heat
(the face does not usually have a feeling of cold)
• The waxing and waning of Kidney-Yin and KidneyYang are responsible for the menstrual cycle
Liver
After the Kidneys, the Liver has the most important
influence in gynecology. A deficiency of Liver-Blood
is extremely common in women and so is Liver-Qi
stagnation. The Liver more than any other organ has
a particular characteristic in that patterns often occur
together. For example, it would not be at all unusual
for a woman to suffer from deficiency of Liver-Blood
combined with Liver-Qi stagnation, with Liver-Yang
rising (as a consequence of Liver-Blood deficiency) and
some Liver-Fire.
Table 3.1 Kidney patterns in gynecology
PATTERN
GYNECOLOGICAL SYMPTOMS
OTHER SYMPTOMS
TONGUE
PULSE
Kidney-Yang
deficiency
Menorrhagia, late periods,
leucorrhoea, diarrhoea with the
periods, oedema in pregnancy,
infertility
Chilliness, backache,
depression, frequent, pale
urination
Pale, wet
Deep, Slow
Kidney-Yin
deficiency
Menorrhagia, early periods, scanty
periods, amenorrhoea, eclampsia,
infertility
Dizziness, tinnitus,
backache, feeling of heat,
night sweating
Red, Peeled
Floating-Empty
or Fine and
Rapid
Kidney-Yin
and KidneyYang deficiency
(predominance
Yang)
Menorrhagia, late periods,
leucorrhoea, diarrhoea with the
periods, oedema in pregnancy,
infertility, miscarriage
Backache, cold hands
and feet, frequent, pale
urination, hot flushes,
possibly night sweating
Pale
Deep, Slow
Kidney-Yin
and KidneyYang deficiency
(predominance Yin)
Menorrhagia, early periods, scanty
periods, amenorrhoea, eclampsia,
infertility
Dizziness, tinnitus,
backache, feeling of heat,
night sweating, cold feet,
maybe frequent urination
Peeled
Floating-Empty
or Fine and
Rapid
Women’s Pathology 53
Liver-Yang
rising
Liver-Heat
Liver-Blood
deficiency
Liver-Qi
stagnation
Mid-cycle bleeding
Scanty periods
Pre-menstrual
tension
Liver-Blood
stasis
Pre-menstrual
headaches
Painful periods
Figure 3.5 Example of five Liver patterns overlapping.
It is even possible to have five patterns. For example,
Liver-Blood deficiency may lead to Liver-Qi stagnation
and this may lead to Liver-Blood stasis. On the other
hand, Qi stagnation may give rise to Heat and therefore Liver-Heat. On the other hand, Liver-Heat may also
generate Liver-Yang rising (Fig. 3.5).
SUMMARY
Liver
• After the Kidneys, the Liver has the most
important influence in gynecology
• Liver-Blood deficiency and Liver-Qi stagnation are
very common in women
• More than other organs, Liver patterns often occur
together
Liver-Qi stagnation
Liver-Qi stagnation is extremely common in gynecology. Because it provides the Yang action of moving Qi
and Blood in phase 4, Liver-Qi plays an important role
in menstruation; it is particularly active in the premenstrual phase when it prepares to move Blood with
the onset of the menses.
The most common cause of Liver-Qi stagnation is
emotional stress related to anger, suppressed anger,
resentment, worry, shame and guilt.
In pathology, if Liver-Qi stagnates, its effect is particularly noticeable in the pre-menstrual phase, causing
pre-menstrual tension, distension of breasts, irritability, depression, abdominal distension, etc. However,
please note that not all cases of pre-menstrual problems
are due to Liver-Qi stagnation.
Liver-Qi stagnation may also cause an irregular
cycle and painful periods. With Liver-Qi stagnation
the tongue may not change; in severe cases, it may be
slightly Red on the sides, and the pulse Wiry (which
may be only on the left). The most defining symptom
of Liver-Qi stagnation is a feeling of distension (zhang
in Chinese). This is a bloating feeling of the lower
abdomen, epigastrium or breasts.
CLINICAL NOTE
The most defining symptom of Liver-Qi stagnation is
a feeling of distension (zhang in Chinese). This is a
bloating feeling of the lower abdomen, epigastrium
or breasts.
Closely related to Liver-Qi stagnation in gynecology
is Liver-Yang rising, which is often associated with it.
Liver-Yang rising typically causes headaches before or
during the menses. Prolonged stagnation of Liver-Qi
may also give rise to Liver-Heat and this to Liver-Fire
as stagnant Qi may turn into Heat after a long period
of time. Liver-Heat or Liver-Fire will cause a complex
pathology; on the one hand, it may heat the Blood and
cause Blood-Heat; on the other, Fire may injure Yin,
eventually leading to Empty-Heat. Liver-Qi stagnation may also give rise to Liver-Blood stasis manifesting
with painful periods with large, dark clots and dark
menstrual blood (Fig. 3.6).
Liver-Qi
stagnation
Liver-Heat
Liver-Fire
Liver-Blood
stasis
Figure 3.6 Consequences of Liver-Qi stagnation.
54 Section 1: Physiology and Pathology
It is important to note that Liver-Qi and Liver-Blood
represent the Yang and Yin aspect of the Liver sphere:
they need to be harmonized, i.e. Yin should root and
‘embrace’ Yang. Very often, if Yin is deficient (i.e.
Liver-Blood deficiency), it fails to restrain and root
Yang (Liver-Qi) so that Liver-Qi stagnates. I therefore
distinguish two types of Liver-Qi stagnation: one I call
‘primary’ and this derives from emotional stress and
manifests with a pulse that is Wiry all over; the other I
call ‘secondary’ and that is Liver-Qi stagnation deriving
from Liver-Blood deficiency and due to a combination
of emotional stress, diet and overwork (Table 3.2).
That this stagnation is secondary to Liver-Blood deficiency is clear from the tongue being Pale and the pulse
either not Wiry or only very slightly Wiry on the left side.
In women, this situation is very common. This explains
the very common clinical situation of a woman who has
many typical symptoms of Liver-Qi stagnation such as
pre-menstrual tension, distension of breasts and abdomen, or irritability, but whose pulse and tongue do not
reflect this, i.e. the pulse is not Wiry and the tongue is
not Red or Purple on the sides. If the tongue is Pale and
the pulse Choppy or Fine and only slightly Wiry on the
left, this clearly means that the Liver-Qi stagnation is
secondary to Liver-Blood deficiency.
Please note that most modern Chinese books say that
in Liver-Qi stagnation the tongue is Purple on the sides:
I do not agree with this view. In my opinion, a Purple
colour of the tongue body always indicates Blood stasis
rather than Qi stagnation.
Table 3.2 Comparison of primary and secondary
Liver-Qi stagnation
PRIMARY LIVER-QI
STAGNATION
SECONDARY LIVER-QI
STAGNATION
Emotional origin
Arises ‘by itself’
Arises as a consequence of or
associated with Liver-Blood
deficiency
Pronounced irritability,
moodiness, depression
Aetiology emotional but also
dietary and overwork
Pulse all Wiry
Not so much irritability, more
depression and crying
Tongue normal or
slightly Red sides
Pulse all Choppy, or Fine on the
right and Wiry on the left or all
Fine and very slightly Wiry
Yue Ju Wan GardeniaChuanxiong Pill
Tongue normal or Pale
Xiao Yao San Free and Easy
Wanderer Powder
!
A Purple colour of the tongue body always indicates
Blood stasis rather than Qi stagnation.
In my opinion, Liver-Qi stagnation is somewhat overdiagnosed both in Chinese and in Western books. Yes,
Liver-Qi stagnation is very common but not as common as it is made out to be. Also, it is forgotten that
Liver-Qi stagnation is often secondary to other patterns
and notably a Liver-Blood deficiency or a Kidney deficiency. Moreover, it is important to note that Qi stagnation affects other organs besides the Liver, e.g. Heart,
Lungs, Stomach, Intestines. In gynecology, for example,
Lung-Qi stagnation affects the breasts and may cause a
feeling of distension of the breasts or even breast lumps.
As for the emotional origin of Qi stagnation, this
may derive from emotions other than anger, e.g.
resentment, frustration, worry, sadness, grief, guilt,
etc. In my opinion, anger tends to be overemphasized
in China due to the Confucian influence (which sees
anger as the most dangerous and disruptive of the
emotions because it induces people to ‘rebel’). I also
find that Qi stagnation is automatically considered to
be the consequence of ‘stress’, i.e. a person is under
stress, therefore we can assume that he or she suffers
from Liver-Qi stagnation.
As a consequence of the above, in my opinion the
formula Xiao Yao San Free and Easy Wanderer Powder is
somewhat overused.
CLINICAL NOTE
• In my opinion, Liver-Qi stagnation is somewhat overdiagnosed both in Chinese and in Western books
• Liver-Qi stagnation is secondary to other patterns
and notably a Liver-Blood deficiency or a Kidney
deficiency
• Qi stagnation affects other organs besides the
Liver, e.g. Heart, Lungs, Stomach, Intestines
• In gynecology, Lung-Qi stagnation affects the
breasts and may cause a feeling of distension of
the breasts or even breast lumps
• Qi stagnation may derive from emotions other
than anger, e.g. resentment, frustration, worry,
sadness, grief, guilt, etc.
• Anger is overemphasized in China due to the
Confucian influence (which sees anger as the
Women’s Pathology 55
most dangerous and disruptive of the emotions
because it induces people to ‘rebel’)
• Qi stagnation is often automatically (and wrongly)
considered to be the consequence of ‘stress’
• As a consequence of the above, in my opinion the
formula Xiao Yao San Free and Easy Wanderer
Powder is somewhat overused
SUMMARY
Liver-Qi stagnation
• Liver-Qi plays an important role in menstruation;
it is particularly active in the pre-menstrual phase
when it prepares to move Blood with the onset of
the menses
• The most common cause of Liver-Qi stagnation
is emotional stress related to anger, suppressed
anger, resentment, worry, shame and guilt
• In pathology, if Liver-Qi stagnates, its effect
is particularly noticeable in the pre-menstrual
phase, causing pre-menstrual tension, distension
of breasts, irritability, depression, abdominal
distension, etc. It may also cause an irregular cycle
and painful periods
• Prolonged stagnation of Liver-Qi may also give rise
to Liver-Heat and this to Liver-Fire
• Liver-Qi stagnation may also give rise to LiverBlood stasis manifesting with painful periods
with large, dark clots and dark menstrual blood
period in days. This is discussed more at length in
Chapter 5 on Diagnosis.
As explained in Chapter 2, although menstrual blood
is Tian Gui and therefore not ‘Blood’ but ‘Water’, there
is an overlap between Tian Gui and ‘normal Blood’ (see
Fig. 2.29 in Ch. 2). This overlap takes place thanks to
the Liver which partakes both of Tian Gui and of ‘ordinary Blood’. For this reason, when there are gynecological symptoms of Blood deficiency such as scanty
periods or amenorrhoea, there often are also symptoms
of deficiency of ‘ordinary Blood’, i.e. the Liver-Blood
that nourishes the hair, eyes, skin, nails and sinews:
these would be dry hair, blurred vision, dry skin, brittle
nails and cramps.
In Liver-Blood deficiency, the pulse would be
Choppy or Fine and the tongue Pale and possibly Thin
(although the tongue is seldom Thin, due to the common presence of Dampness or Phlegm which make it
Swollen).
One important characteristic of Liver-Blood deficiency is that it is often the origin of many other
pathologies as evidenced by Figure 3.7. The following
is a brief explanation of these pathologies with one or
more representative prescriptions for each.
1. Liver-Blood deficiency leading to Liver-Yang rising.
This is extremely common in women. The
symptoms and signs are throbbing headaches
either on the vertex or sides of the head occurring
around the period time (but also occasional
dull vertical or frontal headaches from Blood
Liver-Qi stagnation
Liver-Blood deficiency
Liver-Blood deficiency is fundamental in gynecology.
The Liver stores Blood and provides Blood to the Uterus
in close co-ordination with the Penetrating Vessel.
Women are very prone to Blood deficiency, partly from
the monthly loss of blood occurring with the periods
themselves, and partly from diet, overwork and emotional stress.
Liver-Blood deficiency can cause infertility, scanty
periods, delayed cycle or amenorrhoea. Please note
that ‘scanty period’ is not a symptom that would
be reported by most women as they would be more
alarmed by heavy rather than scanty periods. It is
therefore important to ask about the duration of the
Liver-Yang rising
Liver-Blood stasis
Qi deficiency
Wind-Heat in skin
Empty-Heat
Cold in Uterus
Heart-Blood
deficiency
Cold limbs
Kidney-Yang
deficiency
Kidney-Yin
deficiency
Figure 3.7 Pathologies deriving from Liver-Blood deficiency.
56 Section 1: Physiology and Pathology
deficiency), nausea, vomiting, dizziness, vision
disturbances, Pale and Thin tongue, Choppy
pulse. Representative prescriptions: Tian Ma Gou
Teng Yin Gastrodia-Uncaria Decoction or Bu Gan
Tang Tonifying the Liver Decoction. Among the
Three Treasures remedies, Bend Bamboo nourishes
Liver-Blood and subdues Liver-Yang.
2. Wind-Heat in skin. Liver-Blood nourishes and
moistens the skin. When Liver-Blood is deficient
the skin may become dry and itchy: this often
happens during the menopause when women
complain of itchy skin without any apparent
rash. Representative prescriptions: Yang Xue Ding
Feng Tang Nourishing Blood and Subduing Wind
Decoction or Yang Xue Run Fu Yin Nourishing
Blood and Moistening the Skin Decoction. Among
the Three Treasures remedies, Glorious Sea
nourishes Liver-Blood and expels Wind-Heat from
the skin.
3. Empty-Heat. Although strictly speaking EmptyHeat arises from Yin deficiency, in women it can
actually develop from Blood deficiency too. This
explains many cases of hot flushes without Yin
deficiency and with a Pale tongue. Representative
prescription: Qin Lian Si Wu Tang ScutellariaCoptis Four Substances Decoction.
4. Heart-Blood deficiency. Liver-Blood deficiency
often causes Heart-Blood deficiency due to the
relationship of Mother–Child within the FiveElement scheme. Besides this, the Liver stores Blood
and the Heart governs Blood, hence a deficiency in
the storage of Blood by the Liver naturally affects
Heart-Blood. Representative prescription: Gui Pi
Tang Restoring the Spleen Decoction. Among the
Three Treasures, it is Calm the Shen.
5. Kidney-Yin deficiency. Liver-Blood and Kidney-Yin
are closely connected and influence each other
due to the relationship of mutual nourishment
between Blood and Essence and that between
Liver and Kidneys. Representative prescriptions:
Dang Gui Di Huang Yin Angelica-Rehmannia
Decoction and Ba Wei Di Huang Wan Eight
Ingredients Rehmannia Pill, both variations of Liu
Wei Di Huang Wan Six Ingredients Rehmannia Pill.
Within the Women’s Treasure line, it is the remedy
Growing Jade.
6. Kidney-Yang deficiency. A deficiency of KidneyYang is often associated with Liver-Blood
deficiency due to the interrelationship Kidney-
Yang–Penetrating Vessel–Uterus–Blood–Liver.
Representative prescriptions: You Gui Wan
Restoring the Right [Kidney] Pill or Zan Yu Dan
Aiding Fertility Pill. Within the Women’s Treasure
line, it is the remedy Unicorn Pearl.
7. Cold limbs. Cold limbs can be caused by various
conditions. One of these, by far more common in
women, is Liver-Blood deficiency (others are Yang
deficiency and Qi stagnation). The representative
prescription for cold hands and feet from Blood
deficiency in women is Dang Gui Si Ni Tang
Angelica Four Rebellious Decoction.
8. Cold in Uterus. When Liver-Blood is deficient, the
Uterus is Empty and in a vulnerable condition so
that it can be easily invaded by Cold. Vice versa,
when Cold obstructs the Uterus, Liver-Blood
cannot be stored properly and this may lead to a
Blood deficiency. Thus, Liver-Blood deficiency and
Cold often coexist. The representative prescription
(especially for the latter condition) is Wen Jing
Tang Warming the Menses Decoction. Within the
Women’s Treasure range, Warm the Menses, Warm
the Palace and Warm the Mansion nourish Blood
and warm the Uterus.
9. Qi deficiency. As Blood is the mother of Qi, LiverBlood deficiency almost inevitably leads to Qi
deficiency. In fact, the representative prescription
for this condition is the well-known Ba Zhen
Tang Eight Precious Decoction. Among the Three
Treasures remedies, Brighten the Eyes tonifies Qi
and nourishes Liver-Blood. Within the Women’s
Treasure range, Precious Sea tonifies Qi and
nourishes Blood.
10. Liver-Blood stasis. When Liver-Blood is deficient,
Blood naturally fails to move properly and
this may lead to Blood stasis. Representative
prescription: Tao Hong Si Wu Tang PersicaCarthamus Four Substances Decoction. Among the
Women’s Treasure remedies, Stir Field of Elixir
invigorates Liver-Blood and eliminates stasis.
11. Liver-Qi stagnation. Liver-Blood and Liver-Qi
represent the Yin and Yang aspect of the Liver
respectively. Yin should ‘embrace’ and hold
Yang; the two need to be harmonized. When
Liver-Blood is deficient, Yin fails to hold Yang,
the harmony between the two is lost and LiverQi may stagnate. As mentioned above, this is
very common in women; when it occurs, a
woman shows many symptoms of Qi stagnation
Women’s Pathology 57
although the pulse is not Wiry but Choppy
or Fine and the tongue sides are not Red but
Pale or normal-coloured. That this situation is
very common is evident from the fact that its
representative prescription is one of the most
commonly used gynecological formulae, i.e. Xiao
Yao San Free and Easy Wanderer Powder. Among
the Women’s Treasure remedies, Freeing the Moon
nourishes Liver-Blood and moves Liver-Qi.
SUMMARY
New
Blood
X
Blood
vessels
Liver-Blood
stasis
Obstructs
blood vessels
UTERUS
Heavy periods
Figure 3.8 Liver-Blood stasis causing heavy menstrual
bleeding.
Liver-Blood deficiency
• Liver-Blood deficiency is fundamental in
gynecology
• Women are very prone to Blood deficiency
• Liver-Blood deficiency can cause infertility, scanty
periods, delayed cycle or amenorrhoea
• Although menstrual blood is Tian Gui and
therefore not ‘Blood’ but ‘Water’, there is an
overlap between Tian Gui and ‘normal Blood’.
This overlap takes place thanks to the Liver
which partakes both of Tian Gui and of
‘ordinary Blood’
• In Liver-Blood deficiency, the pulse would be Choppy
or Fine and the tongue Pale and possibly Thin
Liver-Blood stasis
Liver-Blood stasis develops from Liver-Qi stagnation
and causes painful periods with dark blood and dark
clots. Liver-Blood stasis may also cause pain in the premenstrual phase and this may be relieved by the onset
of the menses. It may also cause abdominal masses
such as cysts, endometriosis or myomas.
Liver-Blood stasis is extremely common in women:
this was explained in Chapter 2 on physiology. As their
Lower Burner houses the Uterus which stores Blood,
Blood easily stagnates in the lower abdomen. Indeed,
I would go so far as saying that in chronic and complicated gynecological conditions, one should always
suspect Blood stasis.
!
In chronic and complicated gynecological conditions,
always suspect Blood stasis.
Although Liver-Qi stagnation plays a prominent
role in modern Chinese books and also many Western
ones, Liver-Blood stasis is far more important because
it potentially gives rise to serious diseases such as
endometriosis, cervical cancer, uterine cancer, polycystic ovary syndrome and myomas. Liver-Qi stagnation by itself cannot cause any of the above diseases.
Moreover, although it may seem paradoxical, LiverBlood stasis may even cause heavy menstrual bleeding.
This happens because, when Liver-Blood stagnates,
the blood vessels in the Uterus are obstructed by stagnant Blood. On the other hand, new Blood is being
made all the time; this cannot take its place in the
Uterus because it is obstructed by stagnant Blood,
and it therefore spills out of the Uterus causing heavy
menstrual bleeding (with dark blood and dark clots;
see Fig. 3.8).
Like Liver-Qi stagnation, Liver-Blood stasis also affects
the Mind; it causes the Mind to be Unsettled leading to
insomnia, excessive dreaming, mental restlessness and
agitation. In severe cases, Blood stasis may also lead
to Mind Obstructed with more serious symptoms and
a certain loss of insight such as, for example, in postnatal psychosis.
The pulse in Liver-Blood stasis is Wiry, Firm or
Choppy (the last if it is associated with a deficiency of
Blood), and the tongue is Purple, sometimes only on
the sides.
CLINICAL NOTE
A Purple colour of the sides of the tongue in women
usually reflects Blood stasis in the Uterus rather than
in the Liver itself.
58 Section 1: Physiology and Pathology
CLINICAL NOTE
The main points I use for Liver-Blood stasis in
gynecological conditions are SP-4 Gongsun on the
right with P-6 Neiguan on the left (Penetrating
Vessel), plus KI-14 Siman, SP-10 Xuehai and LIV-3
Taichong.
SUMMARY
Liver-Blood stasis
• Liver-Blood stasis develops from Liver-Qi stagnation
and causes painful periods with dark blood and
dark clots
• Liver-Blood stasis is extremely common in women
• Liver-Blood stasis potentially gives rise to serious
diseases such as endometriosis, cervical cancer,
uterine cancer, polycystic ovary syndrome and
myomas
• Liver-Blood stasis may even cause menstrual
bleeding
• Like Liver-Qi stagnation, Liver-Blood stasis also
affects the Mind causing insomnia, excessive
dreaming, mental restlessness, agitation.
Although the Liver pertains to Wood, within Wood there
is a dragon-thunder Fire which is the Minister Fire. The
Minister Fire should be quiet and not agitated: if it is quiet,
there is tranquillity, if it is agitated, it burns. Because
Wood has such Fire within it, it is easily agitated and seldom quiet. In people’s lives not a day goes by that this Fire
is not stirred. Violent anger stirs this Fire even more.3
The pathological Minister Fire affects the Liver
also through the Pericardium. When pathological
Minister Fire is stirred by emotional stress, it has the
tendency to flare upwards affecting the Pericardium
and Heart (Fig. 3.9). Since the Liver is connected to the
Pericardium within the Terminal Yin (Jue Yin), it is also
affected by the pathological Minister Fire. In ancient
texts, the flaring of pathological Minister to the Liver
and Pericardium was compared to a “Fire Dragon flying
to the top of high mountains” while the flaring of pathological Minister Fire in the Kidneys was compared to a
“Fire Dragon immersing in the deep sea” (Fig. 3.10).
Liver-Blood Heat is a major cause of the excess type
of menorrhagia, from reckless Blood pushing out of
the blood vessels.
The pulse will be Rapid and possibly Overflowing in
the left Middle position. It may also feel slightly Wiry or
Hard in the Middle level in all positions.
PERICARDIUM
Liver-Blood Heat
Liver-Blood Heat may develop from prolonged stagnation of Liver-Qi or directly from aetiological factors which cause Blood-Heat (such as emotional
stress and diet). Liver-Blood is also heated by the flaring of pathological Minister Fire. As mentioned in
Chapter 2 on physiology, the formless Minister Fire
within the Kidneys is essential to all physiological
processes. A special type of Fire, it generates Water
rather than drying it. However, it may become pathological, especially when emotional problems (notably anger, frustration, resentment, hatred or guilt)
stir it up. Pathological Minister Fire easily affects the
Liver since this organ is naturally ‘restless’ and readily agitated. Because the physiological Minister Fire
is essential to all bodily processes while the pathological one consumes the vital substances, it is said
that “small Fire generates Qi, excessive Fire eats Qi.”2
Fu Qing Zhu says:
HEART
Flares up
MINISTER FIRE
Stir
EMOTIONS
Figure 3.9 Flaring of Minister Fire.
Women’s Pathology 59
Liver, Gall Bladder,
Pericardium
Minister Fire
Fire Dragon flying to the
top of high mountain
Fire Dragon immersing in
the deep sea
Kidneys
Figure 3.10 Pathological Minister Fire as ‘Fire Dragon’.
SUMMARY
Liver-Blood Heat
• Liver-Blood Heat may develop from prolonged
stagnation of Liver-Qi or directly from aetiological
factors which cause Blood-Heat (such as emotional
stress and diet)
• Liver-Blood is also heated by the flaring of
pathological Minister Fire
• The pathological Minister Fire affects the Liver also
through the Pericardium
• Liver-Blood Heat is a major cause of the excess
type of menorrhagia, from reckless Blood pushing
out of the blood vessels
Damp-Heat in the Liver channel
Damp-Heat in the Liver channel is a relatively common pattern in gynecological conditions. In fact, the
occurrence of genital symptoms in the presence of
Damp-Heat allows us to diagnose Damp-Heat in the
Liver channel (as opposed to Damp-Heat in the Gall
Bladder).
Damp-Heat in the Liver channel in women causes
urinary and/or genital symptoms such as difficult
and/or painful urination, excessive vaginal discharge,
vaginal itching and/or soreness. Please note that
modern Chinese books place excessive emphasis (in
my opinion) on Damp-Heat as opposed to Dampness
without Heat. In my experience, it is very common to
see Dampness in the Lower Burner without Heat in
Western patients.
CLINICAL NOTE
The main points to resolve Dampness from the Liver
channel in urinary and genital problems in women
are LIV-5 Ligou, SP-9 Yinlingquan, Ren-3 Zhongji,
ST-28 Shuidao and BL-22 Sanjiaoshu.
Liver-Yang rising
In gynecology, Liver-Yang rising causes menstrual
headaches. These headaches may occur before or
during the period and they are located on the sides
of the head or over the eyes; they are usually unilateral and with a throbbing character. They may
be accompanied by nausea and vomiting and visual
disturbances.
The most common origin of Liver-Yang rising in
menstrual headaches is Liver-Blood deficiency; however, they may also derive from Liver-Yin and/or
Kidney-Yin deficiency.
Liver-Wind
In gynecology, the most important manifestation of
Liver-Wind is that which may be seen during pregnancy. In eclampsia or pre-eclampsia, there is usually
Liver-Wind. Indeed, the development of Liver-Wind
in pregnancy is always a serious sign that should be
treated immediately.
Table 3.3 summarizes the Liver patterns in
gynecology.
60 Section 1: Physiology and Pathology
Table 3.3 Liver patterns in gynecology
PATTERN
GYNECOLOGICAL
SYMPTOMS
OTHER SYMPTOMS
TONGUE
PULSE
Liver-Blood
deficiency
Amenorrhoea, scanty periods,
late periods, infertility
Dizziness, tingling in limbs, insomnia,
blurred vision, dry skin/hair/nails
Pale, Thin
Choppy or Fine
Liver-Qi
stagnation
Pre-menstrual tension, painful
periods, irregular periods,
breast distension, amenorrhoea,
infertility, premature menopause
Irritability, moodiness, depression,
abdominal distension, nausea,
constipation with bitty stools
No major
change, or
slightly Red
sides
Wiry
Liver-Blood
stasis
Very painful periods with dark
clots, irregular periods, infertility,
premature menopause
Dark complexion, insomnia,
abdominal pain
Purple (or
Purple sides)
Wiry, Choppy
or Firm
Liver
stagnation
turning to
Heat
Early periods, heavy periods,
menorrhagia, pre-menstrual
tension, vomiting with periods,
discharge from nipples
Irritability, mental restlessness, feeling
of heat, depression, hypochondrial
pain, thirst
Red sides
Wiry, slightly
Rapid
Damp-Heat
in Liver
channel
Leucorrhoea, urinary problems
with the period, dysmenorrhoea,
vaginal itching
Irritability, feeling of heaviness,
nausea, sticky taste
Red, stickyyellow
coating
Slippery, Wiry,
Rapid
Liver-Yang
rising
Pre-menstrual tension, headaches
with the period, irregular periods,
dizziness in pregnancy
Headaches, dizziness, tinnitus,
irritability, prone to anger, red face,
insomnia, dream-disturbed sleep,
stiff neck
Red sides
Wiry
Liver Wind
Eclampsia, post-partum
convulsions
Dizziness, headaches, tics, tremors,
stiff neck
Red sides
Wiry
Spleen
Spleen-Qi deficiency
Spleen-Qi deficiency is not a direct cause of gynecological
problems but it is involved in them because Spleen-Qi is
the origin of Post-Natal Qi and Blood and thus Blood deficiency may occur. For this reason, when nourishing Blood
in gynecology, we treat both Liver and Kidneys (to treat
Tian Gui) and the Spleen to nourish the Post-Natal Blood.
Spleen-Qi deficiency is also important in gynecology
because it leads to Dampness, a major pathogenic factor in women’s problems. Moreover, deficient Spleen-Qi
which fails to hold Blood is a major cause of menorrhagia
of the deficient type although it should be remembered
that in such cases deficient Kidney-Qi also plays a role.
Spleen-Qi also raises Qi and holds the internal organs
in place. Sinking of Spleen-Qi may therefore cause
prolapse of the uterus or bladder. Besides actual prolapse, sinking of Spleen-Qi is also frequently a factor
in chronic urinary or genital problems. Again, in such
cases, Kidney-Qi also plays a role.
The pulse is Empty or Weak, and the tongue is Pale.
If there is Phlegm, the tongue is definitely Swollen; if there
is Dampness, the tongue has a thick, sticky coating.
SUMMARY
Spleen-Qi deficiency
• Spleen-Qi deficiency may lead to deficiency of Blood
and this affects the Uterus as Post-Natal Blood plays
a (secondary) role in menstrual blood formation
• Spleen-Qi deficiency is also important in
gynecology because it leads to Dampness, a major
pathogenic factor in women’s problems
• Deficient Spleen-Qi which fails to hold Blood is a
major cause of menorrhagia of the deficient type
• Spleen-Qi also raises Qi and holds the internal
organs in place. Sinking of Spleen-Qi may
therefore cause prolapse of the uterus or bladder
• Besides actual prolapse, sinking of Spleen-Qi also
frequently is a factor in chronic urinary or genital
problems
Women’s Pathology 61
Spleen-Blood deficiency
Although there is no pattern of this name, Spleen-Blood
deficiency does occur in women. It occurs when the
Spleen is deficient and does not make Blood: this affects
the Liver and causes Liver-Blood deficiency. For this
reason, when Liver-Blood is deficient, the Spleen as well
as the Liver should always be tonified.
The pulse is Weak, Fine or Choppy and the tongue
is Pale and Thin (unless there is Dampness, which is
nearly always the case).
deficiency of Blood in the Uterus after childbirth can
affect the Heart and cause depression, while stasis of
Blood in the Uterus after childbirth may cause postnatal psychosis. The influence of the Heart on the menstrual function can also be seen when an emotional
shock affecting the Heart may lead to amenorrhoea.
In fact, Chapter 33 of the Simple Questions says:
When the period does not come, it is due to the Uterus
Vessel being shut; this vessel connects the Uterus to the
Heart. When Qi rises to harass the Lungs, Heart-Qi cannot
get through downwards, hence the period does not come.4
Spleen-Qi sinking
Spleen-Qi sinking is a type of Spleen-Qi deficiency and
is characterized by Spleen-Qi strongly descending.
This causes prolapse of the uterus or bladder. It also
plays a role in chronic urinary and genital problems.
The pulse is Weak and the tongue is Pale.
Table 3.4 summarizes the Spleen patterns in
gynecology.
Heart
The Heart has an influence on gynecological problems,
as it plays a role in the formation of menstrual blood
and it is connected to the Uterus via the Uterus Vessel.
Due to this connection and since the Heart houses the
Mind and governs Blood, mental–emotional problems
have a direct and profound influence on the menstrual
function, pregnancy, childbirth and menopause.
The connection between the Heart, the Uterus
and menstruation explains the strong influence
of emotional stress on this function. For example,
The sentence about Qi rising to harass the Lungs is
a clear reference to emotional problems such as sadness, worry and grief which affect both Heart and
Lungs and therefore the menstrual function through
the Uterus Vessel.
As mentioned in Chapter 2 on physiology, the Heart
governs Blood and therefore has a general influence
on Blood. Many gynecologists emphasize the need
to nourish Heart-Blood in women’s problems caused
by Blood deficiency. This is necessary also because,
as Fu Qing Zhu maintains, the Kidney-Essence forms
the Tian Gui with the help of Heart-Yang. As will
be remembered, other doctors also stressed the
importance of the Heart in women’s physiology and
pathology: the Secret Records of Master Feng’s Brocade
Bag (1702) connects the Small Intestine and Heart
channel with breast milk and menstruation. It says:
“The Small Intestine and Heart channels are exteriorly–
interiorly related: they control menstrual water below and
breast milk above.”5
Table 3.4 Spleen patterns in gynecology
PATTERN
GYNECOLOGICAL SYMPTOMS
OTHER SYMPTOMS
TONGUE
PULSE
Spleen-Qi and Blood
deficiency
Amenorrhoea, scanty periods, late
periods
Tiredness, poor appetite,
loose stools
Pale
Weak
Spleen-Qi deficiency
with Dampness
Leucorrhoea, infertility, oedema during
pregnancy, amenorrhoea, ovarian cysts
Tiredness, feeling of
heaviness, nausea, loose
stools
Pale, sticky
coating
Weak and
Slippery
Spleen not
gathering Blood
Heavy periods, early periods, prolonged
periods, menorrhagia
Tiredness, poor appetite,
tendency to bruising
Pale
Weak
Spleen-Qi sinking
Menorrhagia, heavy periods, early periods,
prolapsed uterus, miscarriage, chronic
leucorrhoea, chronic urinary problems
Tiredness, poor appetite,
depression, loose stools
Pale
Weak
62 Section 1: Physiology and Pathology
Heart-Blood has a similar influence on the gynecological system as that of Liver-Blood. For instance,
Heart-Blood deficiency may lead to scanty periods;
Heart-Blood Heat may lead to menorrhagia; and HeartBlood stasis may lead to painful periods.
The Heart influences the menstrual function also
because the descending of its Qi and Blood promotes
the discharge of blood at the period time and the
discharge of the eggs at ovulation. Thus, if Heart-Qi
does not descend, the onset of the period or ovulation
may be delayed; conversely, it Heart-Qi descends too
soon, the period or ovulation may come early.
SUMMARY
Heart
• The Heart plays a role in the formation of
menstrual blood and it is connected to the Uterus
via the Uterus Vessel
• Due to this connection and since the Heart houses
the Mind and governs Blood, mental–emotional
problems have a direct and profound influence on
the menstrual function, pregnancy, childbirth and
menopause
• The Heart governs Blood and therefore has a
general influence on menstrual blood too
• Heart-Blood has a similar influence on the
gynecological system as that of Liver-Blood. For
instance, Heart-Blood deficiency may lead to scanty
periods; Heart-Blood Heat may lead to menorrhagia;
and Heart-Blood stasis may lead to painful periods
• The Heart influences the menstrual function
also because the descending of its Qi and Blood
promotes the discharge of blood at the period
time and the discharge of the eggs at ovulation.
Thus, if Heart-Qi does not descend, the onset
of the period or ovulation may be delayed;
conversely, it Heart-Qi descends too soon, the
period or ovulation may come early
Heart-Fire
Long-term stagnation of Qi of the Heart often turns
into Heart-Fire; Fire harasses downwards and disturbs
the Directing and Penetrating Vessels, the Sea of Blood
becomes reckless and this may result in heavy periods
or Flooding and Trickling (Beng Lou). The Ji Yin Gang
Mu says: “Fire burns the Heart, Blood becomes reckless
and causes bleeding downwards.”7 The Great Dictionary
of Chinese Acupuncture mentions HE-5 Tongli for heavy
periods or Flooding and Trickling, especially in combination with LIV-2 Xingjian and SP-6 Sanyinjiao (Great
Compendium of Acupuncture, 1601).8
When there is Fire in the Heart channel, it rises to
harass the Heart and below it may cause excessive vaginal discharge or vaginal soreness. Chen Zi Ming says:
“Vaginal sores in women are due to mental restlessness and
chaotic Heart and weak Stomach-Qi resulting in stagnation
of Qi and Blood.” The Simple Questions, in the chapter
Zhi Zhen Yao Da Lun, says: “Pain, itching and sores are due
to the Heart.”9
The book An Explanation of Acupuncture Points recommends tonifying HE-8 Shaofu for prolapse of the
vagina or vaginal pain and itching.10
SUMMARY
Heart-Fire
• Long-term stagnation of Qi of the Heart often
turns into Heart-Fire
• Fire harasses downwards and disturbs the
Directing and Penetrating Vessels, the Sea of
Blood becomes reckless and this may result in
heavy periods or Flooding and Trickling (Beng Lou)
• Fire in the Heart channel rises to harass the Heart
and may also cause excessive vaginal discharge or
vaginal soreness
Heart-Yin deficiency with Empty-Heat
CLINICAL NOTE
To stimulate the descending of Heart-Qi to the
Uterus, I use the point HE-5 Tongli.
Dr Yao Shi An mentions several patterns of the
Heart which affect the gynecological functions.6
Sadness over a long period of time may cause Heart-Yin
deficiency. The Mind has no residence and this causes
Heart-Yang to float and may cause menorrhagia.
The Simple Questions says in Chapter 44: “Sadness leads
to severance of the Uterus Channel: when this is severed
Yang Qi is agitated in the Interior and the Heart causes
menorrhagia.”11
Women’s Pathology 63
Overwork weakens Heart-Yin which leads to EmptyHeat: this may also cause amenorrhoea. The Secret
Record of the Orchid Room (Lan Shi Mi Cang) says:
“Mental strain and stress weakens the Heart, Heart-Fire
rises and the periods do not come.”12
SUMMARY
Heart-Yin deficiency with Empty-Heat
• Long-term sadness may cause Heart-Yin deficiency.
The Mind has no residence which causes HeartYang to float and may cause menorrhagia
• Overwork weakens Heart-Yin which leads to
Empty-Heat. This may also cause amenorrhoea
Heart-Blood Heat in pregnancy
After conception, Blood is deviated to the nourishment of the fetus, Fire easily rises, this disturbs the
Heart and causes mental restlessness. The Discussion
of Gynecology (Nu Ke Jing Lun) says: “When the Heart
is affected by Blood-Heat, Heart-Qi is not clear and this
causes mental restlessness.”15
Worry agitates the Heart and causes a difficult birth.
The Gynecology of the Bamboo Grove (Zhu Lin Nu Ke)
says: “When the Heart is affected by worry and pensiveness, Qi and Blood stagnate or flow in the wrong direction,
in many cases this causes a difficult birth.”16
SUMMARY
Heart-Blood heat in pregnancy
Heart-Qi rebelling upwards
When Heart-Qi rebels upwards, it impairs the descending of Lung-Qi and of Heart-Qi; Qi cannot descend and
communicate with the Uterus Vessel and amenorrhoea
results. The Simple Questions says in Chapter 33: “If the
periods do not come it means the Uterus Vessel is shut … Qi
rises to harass the Lungs, Heart-Qi does not descend and the
periods do not come.”13
Pensiveness and worry agitate the Heart, the Emperor
Fire moves and fails to communicate with the Kidneys,
Water and Fire do not communicate and infertility may
result. Wang Yu Tai says:
Pensiveness and worry may make it difficult for a woman
to conceive, the Heart houses the Mind, pensiveness makes
the Heart turn towards the outside, the Emperor Fire cannot descend, Above and Below do not communicate, Water
and Fire do not communicate and infertility may result.14
SUMMARY
• After conception, Blood is deviated to the
nourishment of the fetus, Fire easily rises, this
disturbs the Heart and causes mental restlessness
• Worry agitates the Heart and causes a difficult birth
Heart-Qi and Heart-Blood deficiency
Heart-Qi and Heart-Blood need to flow down to the
Kidneys and Uterus: their doing so means that the
Heart assists in the formation of menstrual blood
and also in the discharge of blood at period time and
ovum at ovulation. Thus, deficiency of Heart-Qi and/
or Heart-Blood may indirectly lead to a deficiency of
Blood, when they fail to communicate with the Kidneys,
and to stasis, when they fail to move Blood. In this latter sense, Heart-Qi and Heart-Blood assist Liver-Qi and
Liver-Blood. Thus, a deficiency of Heart Qi or Blood
may lead to amenorrhoea, scanty periods, or a delayed
cycle. A deficiency of Heart-Qi and Heart-Blood may
also lead to scanty period or delayed ovulation as they
fail to descend to the Uterus to promote the discharge
of menstrual blood and of ova.
Heart-Qi rebelling upwards
• When Heart-Qi rebels upwards, it impairs the
descending of Lung-Qi and of Heart-Qi; Qi cannot
descend and communicate with the Uterus Vessel
and amenorrhoea results
• Pensiveness and worry agitate the Heart, the
Emperor Fire moves and fails to communicate with
the Kidneys, Water and Fire do not communicate
and infertility may result
SUMMARY
Heart-Qi and Heart-Blood deficiency
• Heart-Qi and Heart-Blood need to flow down to
the Kidneys and Uterus. Their doing so means that
the Heart assists in the formation and discharge of
menstrual blood and of ovum at ovulation
64 Section 1: Physiology and Pathology
• Deficiency of Heart-Qi and/or Heart-Blood may
indirectly lead to a deficiency of Blood when they
fail to communicate with the Kidneys, and to
stasis when they fail to move Blood
• A deficiency of Heart-Qi or Blood may lead to
amenorrhoea, scanty periods, a delayed cycle or
delayed ovulation
KIDNEY
LIVER
LIV-Qi stagnation
LIV-Blood deficiency
LIV-Blood stasis
LIV-Blood-Heat
SPLEEN
SP-Qi deficiency
SP-Blood deficiency
SP-Qi sinking
HEART
HE-Qi HE-Blood deficiency
HE-Blood stasis
LUNGS
LU-Qi deficiency
LU-Qi stagnation
STOMACH
ST-Qi rebellious
Heart-Blood stasis
Since Heart-Blood flows down to the Uterus, stasis
of Heart-Blood may influence menstruation causing
an irregular cycle or dysmenorrhoea. The important
effect of the acupuncture point P-6 Neiguan in gynecology in moving Blood is an example of the influence
of the Heart on menstrual irregularities.
Lungs
The Lungs do not play an important role in the pathology of gynecological problems. Lung-Qi deficiency is
often associated with Spleen-Qi deficiency and it may
therefore play an indirect role in menorrhagia from Qi
deficiency, in prolapse of the uterus or in chronic urinary and genital problems.
Stagnation of Lung-Qi from emotional stress plays
an indirect role in pre-menstrual tension because in
the chest area it affects the breasts in women and may
therefore cause breast distension, slight breathlessness,
sighing, etc. This is an often overlooked factor; Qi stagnation is invariably related to the Liver only, while, in
fact, it does affect the Lungs too.
Worry, grief and sadness may all lead to stagnation
of Lung-Qi in the chest and contribute to the abovementioned pre-menstrual symptoms. The importance
of the point LU-7 Lieque in moving Qi in the chest in
pre-menstrual tension is an example of the influence
of the Lungs in Qi stagnation in gynecology.
Stomach
The Stomach is connected to the Uterus via the
Penetrating Vessel. In fact, the Penetrating Vessel
emerges from ST-30 Qichong and it also enters the
stomach in the epigastrium. When Qi rebels in the
Penetrating Vessel it often affects the Stomach and
causes Stomach-Qi to rebel upwards: this pathological process explains morning sickness during pregnancy and also generally nausea in the context of
KI deficiency
Figure 3.11 Pathology of the internal organs in gynecology.
gynecological problems such as pre-menstrual tension or painful periods. The herb Ban Xia Rhizoma
Pinelliae preparatum harmonizes Stomach-Qi and is
often used in gynecological prescriptions for this purpose (see, for example, Wen Jing Tang Warming the
Menses Decoction).
The Stomach is also involved in lactation problems as
milk is partly produced by the Post-Natal Qi and Blood
and Stomach and Spleen.
Figure 3.11 summarizes the pathology of the internal organs.
QI AND BLOOD PATHOLOGY
The conditions of Qi and Blood pathology in gynecology are:
•
•
•
•
•
•
•
•
Qi deficiency
Qi stagnation
Qi sinking
Qi rebellious
Blood deficiency
Blood-Heat
Blood stasis
Blood-Cold.
These have all been discussed under the relevant organs
(i.e. the Spleen for Qi deficiency and Qi sinking, and the
Liver for Qi stagnation, Blood deficiency, Blood-Heat and
Blood stasis) except for Qi rebellious and Blood-Cold.
Women’s Pathology 65
Qi rebellious
Rebellious Qi in the context of gynecology indicates Qi
rising in counterflow in the Penetrating Vessel. Taking
the main channels into account, it involves also the Liver
channel. It may occur in pre-menstrual syndrome causing
nausea, vomiting and a feeling of oppression in the chest,
with a feeling of energy rising from the lower abdomen.
Mild morning sickness in the first 3 months of pregnancy is due to Qi of the Penetrating Vessel flowing up
to the Stomach and making Stomach-Qi ascend. This
is generally due to the profound changes occurring in
the Penetrating Vessel in the Lower Burner. Such mild
morning sickness is almost physiological and could
not be described as ‘rebellious Qi of the Penetrating
Vessel’. However, if there is a pre-existing condition
of rebellious Qi of the Penetrating Vessel, this would
aggravate the morning sickness so that this becomes
very severe and may last beyond the initial 3 months:
this is definitely a pathology and would aptly be
described as ‘rebellious Qi of the Penetrating Vessel’.
The pulse typical of Qi rebellious in the Penetrating
Vessel is Firm on all three positions especially on the
left side, or only on the Middle position of both sides.
Rebellious Qi will be discussed in greater detail below,
under the Penetrating Vessel’s pathology.
SUMMARY
Qi rebellious
• Rebellious Qi in the context of gynecology indicates
Qi rising in counterflow in the Penetrating Vessel
which involves the Liver channel
• It may occur in pre-menstrual syndrome causing
nausea, vomiting and a feeling of oppression in
the chest, with a feeling of energy rising from the
lower abdomen
• Mild morning sickness in the first 3 months of
pregnancy is due to Qi of the Penetrating Vessel
making Stomach-Qi ascend
terized by red blood with small dark clots. Cold in the
Uterus is a very frequent cause of dysmenorrhoea
especially in young girls and young women.
The pulse is Choppy and Slow or Tight and Slow and
the tongue is Bluish-Purple.
Finally, it should be noted that, in women, Hot and
Cold syndromes acquire a different meaning from
those they have in men and the symptoms may often be
contradictory. This is because, in many cases, Hot and
Cold symptoms are not due to Hot and Cold syndromes.
A very common cause of simultaneous and contradictory Hot and Cold symptoms is a simultaneous deficiency of Kidney-Yin and Kidney-Yang as explained
above. Of course, there can be reasons unrelated to the
Kidneys for the simultaneous occurrence of Hot and
Cold symptoms: for example, it is perfectly possible for
someone to suffer from Spleen-Yang deficiency (giving rise to Cold) and Damp-Heat in the Bladder or from
Kidney-Yang deficiency and Heart-Heat (Fig. 3.12).
Another cause of mixed Hot and Cold symptoms is
Yin-Fire, which arises from a deficiency of the Original
Qi (Yuan Qi): this deficiency may give rise to Cold symptoms while the Yin-Fire causes Hot symptoms (Fig.
3.13).17 Yet another reason for the overlapping of Hot
and Cold symptoms is severe stagnation of Qi: when Qi
stagnates for a long time it may give rise to some Heat
(e.g. Red sides on the tongue, a feeling of heat in the
face, etc.) but, because stagnant Qi obstructs the circulation of Qi in the channels, the patient may also have
cold hands and feet (Fig. 3.14).
Yet another cause of coexistence of Hot and Cold
symptoms in women is rebellious Qi of the Penetrating
Vessel (Chong Mai). When the Qi of the Penetrating
Vessel rebels upwards, it rushes over the abdomen,
chest, throat and face causing a feeling of heat in the
face; on the other hand, as it rushes upwards, not
enough of its Qi flows down to the descending branch
and the feet feel cold. The feeling of heat of the face
Heart-Heat
Palpitations, insomnia, anxiety,
thirst, red tongue
Blood-Cold
Blood-Cold occurs when Cold invades the Uterus and
settles there. Cold in the Uterus may either come from
the Exterior or be a consequence of Kidney-Yang deficiency. It frequently leads to stasis of Blood causing
infertility, a delayed cycle or painful periods charac-
Kidney-Yang
deficiency
Lower backache, dizziness, tinnitus,
cold back and knees, frequent urination,
pale tongue
Figure 3.12 Hot and Cold symptoms from Heart-Heat and
Kidney-Yang deficiency.
66 Section 1: Physiology and Pathology
Fails to
ascend
MIDDLE BURNER
Yuan Qi weak
Yin
Fire
Feeling of heat, low-grade
fever, dry mouth,
restless limbs
Minister
Fire
Spontaneous sweating,
tiredness, shortness of
breath, pale tongue,
Empty pulse
SP-QI
Dampness
infuses down
LOWER BURNER
Dampness
Displaces Minister
Fire from place of
concealment
Figure 3.13. Yin Fire.
Feeling of heat
in face
Hot
Qi Rebellious
Cold
Cold hands
and feet
Uterus
Ren-1
Qi Deficient
in leg branch
QI STAGNATION
Face
BL-23 (Kidney
divergent)
Legs
Figure 3.15 Hot and Cold symptoms from Rebellious
Qi of the Penetrating Vessel.
deficiency. In women, Blood deficiency often gives rise
to Cold symptoms such as cold hands and/or feet: on
the other hand, if the Blood deficiency is severe, there is
some Empty-Heat developing from it causing a feeling
of heat of the face and possibly red cheekbones on a
pale face.
To summarize, there are six conditions giving rise
to contradictory Hot and Cold symptoms in women:
Figure 3.14 Hot and Cold symptoms in Qi stagnation.
in this case is neither Full- nor Empty-Heat: it is just a
disharmony of the Penetrating Vessel (Fig. 3.15).
Finally, another cause of contradictory Hot and Cold
symptoms in women is Empty-Heat deriving from Blood
1. A simultaneous deficiency of Kidney-Yin and
Kidney-Yang.
2. Severe Qi stagnation.
3. Yin Fire.
4. Rebellious Qi of the Penetrating Vessel.
5. Empty-Heat from Blood deficiency.
Women’s Pathology 67
6. Simply a coexistence of Yang deficiency and Heat
(e.g. Kidney-Yang deficiency causing cold feet and
Heart-Heat causing hot and red face).
Qi deficiency
Qi stagnation
QI
Qi sinking
Qi rebellious
SUMMARY
Blood deficiency
Blood-Cold
• Blood-Cold occurs when Cold invades the Uterus
and settles there. Cold in the Uterus may either
come from the Exterior or be a consequence of
Kidney-Yang deficiency
• It frequently leads to stasis of Blood causing
infertility, a delayed cycle or painful periods
characterized by red blood with small dark clots
• Cold in the Uterus is a very frequent cause of
dysmenorrhoea, especially in young girls and
young women
Figure 3.16 summarizes the pathology of Qi and
Blood in gynecology, Table 3.5 summarizes the Qi
pathology in gynecology and Table 3.6 summarizes the
Blood patterns in gynecology.
PATHOLOGY OF THE
EXTRAORDINARY VESSELS
Penetrating Vessel (Chong Mai)
The main symptomatology of the Penetrating Vessel is
rebellious Qi rising from the abdomen towards the chest
and face. This Penetrating Vessel symptom is called li ji
which is difficult to translate and is interpreted differ-
Blood-Heat
BLOOD
Blood stasis
Blood-Cold
Figure 3.16 Pathology of Qi and Blood in gynecology.
ently by different authors. Chapter 29 of the Classic of
Difficulties says: “The Penetrating Vessel’s symptomatology
is rebellious Qi and internal urgency (li ji).”18 The more or
less general consensus seems to be that, translated as
‘internal urgency’, li ji here indicates a feeling of anxiety deriving from rebellious Qi and manifesting in the
chest with a sense of tightness or oppression and in the
abdomen with distension and pain. The Penetrating
Vessel is also the ‘Sea of the Channels’ and controls all
the ‘avenues of Qi of the abdomen’ and thus stagnation
and upwards rebellion of Qi within the vessel often manifest with abdominal distension and pain. Chapter 26
of the Spiritual Axis says:
When Qi rebels upwards needle the depressions on the
sides of the chest and the [places where] the arteries [can
be palpated] in the lower chest. Abdominal pain should be
treated by needling [the places where] the arteries [can be
palpated] on the sides of the umbilicus . . . if pain is not
relieved, needle ST-30 Qichong.19
Table 3.5 Qi patterns in gynecology
PATTERN
GYNECOLOGICAL
SYMPTOMS
OTHER SYMPTOMS
TONGUE
PULSE
Qi deficiency
Menorrhagia, heavy periods,
prolonged periods, early
periods
Tiredness, weak voice, poor
appetite, loose stools
Pale or normal
Weak or
Empty
Qi stagnation
Pre-menstrual tension, breast
distension, irregular periods,
painful periods
Abdominal or epigastric
distension, irritability, depression
Normal or Red
sides
Wiry
Qi rebellious
Pre-menstrual tension with
vomiting, severe vomiting in
pregnancy
Feeling of tightness of the chest,
feeling of energy rising from the
abdomen, agitation, restlessness
Normal or Red
sides
Wiry
Qi sinking
Leucorrhoea, prolapsed uterus,
miscarriage, menorrhagia
Tiredness, loose stools, depression
Pale
Weak
68 Section 1: Physiology and Pathology
Table 3.6 Blood patterns in gynecology
PATTERN
GYNECOLOGICAL
SYMPTOMS
OTHER SYMPTOMS
TONGUE
PULSE
Blood deficiency
Amenorrhoea, scanty periods,
infertility, late periods
Blurred vision, tingling
of limbs, dry skin/hair,
dizziness, insomnia
Pale, Thin
Choppy or
Fine
Blood stasis
Painful periods with dark clots,
premature menopause
Dark complexion, abdominal
pain, abdominal masses,
insomnia
Purple
Wiry, Choppy
or Firm
Blood-Heat Full
Menorrhagia, early periods,
heavy periods, blood bright-red,
miscarriage
Feeling of heat, red face,
thirst, insomnia
Red with
yellow coating
Rapid,
Overflowing
Early periods, prolonged periods,
menorrhagia, blood scarlet-red
Feeling of heat in the
evening, malar flush, fivepalm heat, night sweating
Red without
coating
Fine and
Rapid
Late periods, scanty periods,
blood red but with small dark
clots, painful periods, infertility
Chilliness, abdominal pain,
pale complexion
White coating
Slow, Full
Late periods, scanty periods, blood
dilute, infertility, leucorrhoea
Chilliness, dull, pale
complexion
Pale
Slow, Empty
Empty
The points on the chest are presumably Penetrating
Vessel points on the Kidney channel and the points
on the sides of the umbilicus are presumably KI-16
Huangshu, also a Penetrating Vessel point. Li Shi Zhen
says: “When Qi [of the Penetrating Vessel] rebels upwards,
there is a feeling of constriction of the throat, breathlessness with wheezing and the patient cannot lie down.”20
The stagnation and upward rebellion of Qi in
the Penetrating Vessel can arise by itself from emotional stress or it can be the result of a deficiency of
the Kidneys within the vessel: in the latter case, the
Kidneys and Blood are deficient in the Lower Burner
so that the Qi of the Penetrating Vessel rebels upwards
towards the chest and face. This can cause a feeling
of heat in the face and cold feet: the former is due to
the rushing of Qi upwards and the latter to the Kidney
deficiency below. Neither heat above nor cold below is
a true Heat or Cold symptom, and the feeling of heat
in the face is not due to Empty-Heat: they are simply
caused by the imbalance of Qi within the Penetrating
Vessel with Emptiness of the Kidneys below and Qi
rebelling upwards. The Emptiness of the Kidneys leads
to cold feet because of the descending branch of the
Penetrating Vessel which flows down the medial side
of the leg and terminates at the big toe (see Figs 3.15
and 3.17). This situation is extremely common and
HOT
FACE
QI rebellious
Blood-Cold Full
KI channel
UTERUS
BLOOD
KIDNEYS
QI deficient
Empty
REN-1
COLD
LEGS
FEET
Figure 3.17 The rebellious Qi of the Penetrating Vessel.
Women’s Pathology 69
explains many contradictory signs of apparent Heat
and Cold in women. The hot face and cold feet therefore
are purely due to a Penetrating Vessel imbalance with a
deficiency of Qi below and the rebelling of Qi upwards.
In other words, rebellious Qi in the Penetrating Vessel,
possibly with an underlying deficiency of Blood and/
or Kidneys, often epitomizes complicated situations of
mixed Heat/Cold and Deficiency/Excess in women.
Thus, the main symptoms of rebellious Qi of the
Penetrating Vessel are (from the top down and in addition to a feeling of anxiety):
•
•
•
•
•
•
•
•
•
•
•
•
•
•
headache
a feeling of heat of the face
a feeling of lump in the throat
breast distension/pain
flutter in the chest or above the stomach, nausea
palpitations
slight breathlessness
tightness/oppression of chest
hypochondrial fullness/distension/pain
epigastric fullness/distension/pain
umbilical fullness/distension/pain
lower abdominal fullness/distension/pain
irregular/painful periods
hypogastric fullness/distension/pain.
Of course, one should not expect to see all these
symptoms in order to diagnose rebellious Qi of the
Penetrating Vessel. The syndrome can be diagnosed in
the presence of three or four of these symptoms occurring at different levels.
Rebellious Qi in the Penetrating Vessel also accounts
for many conditions in women characterized by abdominal pain, dysmenorrhoea, breast distension, a feeling
of tightness of the chest with anxiety and a sensation
of obstruction in the throat. The most characteristic
symptom which would definitely indicate the use of
the Penetrating Vessel opening points is a feeling of distension and fullness in the lower abdomen propagating upwards towards the chest and throat. Of course,
a proper diagnosis of this symptom involves a certain
skill in asking the patient the ‘right’ questions; no
patient would ever spontaneously describe this symptom as a sensation propagating from the lower abdomen and reaching up to the chest and throat.
The pattern of rebellious Qi of the Penetrating
Vessel is akin to the ‘Running Piglet Syndrome’. The
Running Piglet Syndrome is described in the Synopsis
of Prescriptions of the Golden Cabinet (Jin Gui Yao Lue) by
Zhang Zhong Jing as follows:
The Running Piglet Syndrome arises from the lower abdomen and rushes upwards towards the throat so that the
patient feels he is close to death; the disease comes and goes
and is caused by fear and shock.21
Interestingly, the aetiology of this syndrome is attributed to fear and shock, both of which injure the Kidneys.
In practice, this syndrome, and its corresponding rebelling of Qi in the Penetrating Vessel, may be either of the
Full type stemming from stagnation of Liver-Qi or of
the Empty type stemming from a Kidney deficiency. This
latter type is particularly common in women: the deficient Kidney within the Penetrating Vessel in the Lower
Burner fails to root and anchor Qi so that this rebels
upwards affecting both Kidney and Liver channels and
causing a sensation of upsurge towards the chest and
throat. Thus, the syndrome is a complex one, characterized by a deficiency of the Kidney and stagnation of
the Liver with rebellious Qi in the Penetrating Vessel; in
terms of areas, deficiency below (the lower abdomen)
and excess above (the chest, throat and face). In gynecology, this syndrome is very common in women over
40, in menopausal problems or in dysmenorrhoea.
The opening and associated points of the Penetrating
Vessel (SP-4 Gongsun on the right and P-6 Neiguan on
the left) are excellent to treat this condition. However,
these points are usually associated with points along the
Penetrating Vessel, such as ST-30 Qichong, KI-13 Qixue,
KI-14 Siman, KI-16 Huangshu and KI-21 Youmen.
The Penetrating Vessel flows to the chest and the heart
and can therefore be used for palpitations and anxiety
during the menopause, symptoms which are themselves
often caused by the decline of the Blood and Kidneys in
the Penetrating Vessel with consequent rebellious Qi
escaping upwards along the vessel. Indeed, a pre-existing condition of rebellious Qi of the Penetrating Vessel
often aggravates menopausal problems; conversely, the
decline of Kidney-Essence occurring at the menopause,
combined with emotional stress, can trigger a condition
of rebellious Qi of the Penetrating Vessel.
The relationship of the Penetrating Vessel with the
Uterus and the Stomach explains morning sickness in
pregnancy, caused by Qi in the Penetrating Vessel rebelling upwards because of the profound changes taking
place in the uterus in the first 3 months of pregnancy.
As explained above, a mild feeling of nausea in the first 3
months of pregnancy is almost physiological and would
not classify as ‘rebellious Qi of the Penetrating Vessel’.
Women who suffer very severe morning sickness and
70 Section 1: Physiology and Pathology
vomiting, sometimes extended beyond the first 3 months,
usually have a pre-existing condition of rebellious Qi in
the Penetrating Vessel. As the Penetrating Vessel arises
from the Uterus, is the Sea of Blood and flows to the head
and face via all the Kidney channel points, it provides
a link between the Uterus, Blood and the Kidneys. As
Blood pertains to Yin, this explains why in women even
a deficiency of Kidney-Yang will manifest with some Yin
deficiency symptoms due to the connection between the
Penetrating Vessel, Uterus, Blood and Kidneys. During
nursing, Blood no longer flows downwards but is transformed into milk which flows upwards to the breasts via
the Penetrating Vessel. The cessation of the downward
flow of Blood and the commencing of the upward flow
of milk are an added reason for the rising Qi sensation so
common in pregnancy.
The Penetrating Vessel’s control of all the BloodConnecting (Blood-Luo) channels explains the connection
between disharmony of Blood in the Uterus and the development of muscular pains, something which often occurs
after childbirth. It also explains why women often suffer
external invasions during menstruation: the depletion of
Blood in the Penetrating Vessel induces an Emptiness of
the Blood-Connecting channels and therefore the space
between skin and muscles (cou li) becomes Empty and
prone to invasion of external pathogenic factors.
The Penetrating Vessel is the Sea of Blood and it
exerts an enormous influence on the menstrual physiology and pathology. Its chief pathology is of course
stasis of Blood in the abdomen causing dysmenorrhoea. The Penetrating Vessel is also called ‘avenues
of Qi of the abdomen’ as it connects with the Kidney
channel either side of the umbilicus. The Penetrating
and Directing Vessels are related to the state of the zong
muscles (zong jin) of the abdomen: if the Penetrating
and Directing Vessels are not flourishing, the zong muscles are slack. A slackness of the zong muscles may
cause prolapses in women. The Penetrating Vessel is
primarily responsible for menstruation, the Directing
Vessel for conception and pregnancy.
SUMMARY
Penetrating Vessel (Chong Mai )
• The main symptomatology of the Penetrating Vessel
is rebellious Qi rising from the abdomen towards
the chest and face
• The stagnation and upward rebellion of Qi in the
Penetrating Vessel can arise by itself from emotional
stress or it can be the result of a deficiency of the
Kidneys within the vessel
• The Emptiness of the Kidneys leads to cold
feet because of the descending branch of the
Penetrating Vessel which flows down the medial
side of the leg and terminates at the big toe
• The main symptoms of rebellious Qi of the
Penetrating Vessel are (from the top down and in
addition to a feeling of anxiety):
• headache
• a feeling of heat of the face
• a feeling of lump in the throat
• breast distension/pain
• flutter in the chest or above the stomach, nausea
• palpitations
• slight breathlessness
• tightness/oppression of chest
• hypochondrial fullness/distension/pain
• epigastric fullness/distension/pain
• umbilical fullness/distension/pain
•
•
•
•
•
•
• lower abdominal fullness/distension/pain
• irregular/painful periods
• hypogastric fullness/distension/pain
The Penetrating Vessel flows to the chest and the
heart and can therefore be used for palpitations
and anxiety during the menopause
The relationship of the Penetrating Vessel with the Uterus
and the Stomach explains morning sickness in pregnancy,
caused by Qi in the Penetrating Vessel rebelling upwards
because of the profound changes taking place in the
uterus in the first 3 months of pregnancy
During nursing, Blood no longer flows downwards
but is transformed into milk which flows upwards
to the breasts via the Penetrating Vessel
The Penetrating Vessel’s control of all the BloodConnecting (Blood-Luo) channels explains the
connection between disharmony of Blood in the
Uterus and the development of muscular pains,
something which often occurs after childbirth
The Penetrating Vessel is the Sea of Blood and it exerts
an enormous influence on the menstrual physiology
and pathology. Its chief pathology is of course stasis of
Blood in the abdomen causing dysmenorrhoea
The Penetrating Vessel is primarily responsible for
menstruation, the Directing Vessel for conception
and pregnancy
Women’s Pathology 71
Directing Vessel (Ren Mai)
The Directing Vessel has a very broad application in
gynecology as it controls the Uterus, menarche, fertility, conception, pregnancy, delivery and menopause. Because of this very broad range of action, the
Directing Vessel is one of the most widely used of the
Extraordinary Vessels.
It can be used to nourish the Yin energy of the body and
the Kidneys. It promotes fertility and nourishes the fetus.
Li Shi Zhen reports Wang Bing as saying “The Penetrating
Vessel is the Sea of Blood, the Directing Vessel controls the
fetus: [it is only when] the two support each other [that] conception can occur.”22 The Directing Vessel is therefore used
to tonify the Uterus and the ovaries in amenorrhoea,
scanty periods, delayed cycle and infertility.
It is particularly useful to nourish Yin in women after
menopause as the Directing Vessel controls the Uterus
and determines a woman’s 7-year life cycles. It can
therefore regulate the energy of the reproductive system and, after the menopause, nourish Blood and Yin
to reduce the effects of Empty-Heat symptoms deriving
from Yin deficiency. Thus, it can be used for such symptoms as night sweating, hot flushes, feelings of heat,
mental irritability, anxiety, dry mouth at night, dizziness,
tinnitus or insomnia, all symptoms of Kidney-Yin deficiency and Heart Empty-Heat. When used in this way,
the opening and coupled points (LU-7 Lieque and KI-6
Zhaohai) are best combined with Ren-4 Guanyuan.
The Directing Vessel moves Qi in the Lower Burner
and Uterus, so that it can be used for lumps, fibroids
and carcinoma of the uterus. In men, it is used for hernia. According to Chapter 29 of the Classic of Difficulties
the Directing Vessel can be used to treat the “7 kinds of
Lower Burner pain” in men and the “8 kinds of lumps in
the lower abdomen” in women.23
Thus, the Directing Vessel can be used on the one
hand to nourish the Kidneys and in particular (but
not exclusively) Kidney-Yin and, on the other hand, to
move Qi in the Lower Burner. In both cases the opening
points LU-7 Lieque and KI-6 Zhaohai should be needled,
in the former case together with Ren-4 Guanyuan, and
in the latter with Ren-6 Qihai.
The Directing Vessel goes through the throat and
circles around the mouth and its pathology therefore
includes a dry throat, bleeding gums, receding gums,
etc., especially when such problems occur in conjunction with gynecological conditions or during pregnancy. A dry throat or hoarse voice in the context of
gynecological problems would be a typical Directing
Vessel symptom for which its opening points (LU-7
Lieque and KI-6 Zhaohai) can be needled. In fact,
Chapter 47 of the Simple Questions says:
Some women suffer from aphasia in the ninth month of
pregnancy [the Yellow Emperor asks]. [Qi Bo replies] The
Uterus Channel is severed: in fact this channel is connected
to the Kidneys and the Kidney channel flows to the root of
the tongue, hence the woman cannot speak.24
Qi Bo goes on to say that this condition does not
need treatment as it will be resolved soon after childbirth when the connection between the Uterus and the
Uterus Channel is restored.
The Directing Vessel also influences the Qi of the
Upper Burner through its important point Ren-17
Shanzhong. This vessel can therefore be used for
asthma, wheezing and breathlessness, particularly
when due to a deficiency of both Lungs and Kidneys.
SUMMARY
Directing Vessel (Ren Mai )
• The Directing Vessel controls the Uterus,
menarche, fertility, conception, pregnancy, delivery
and menopause
• It can be used to nourish the Yin energy of the
body and the Kidneys. It promotes fertility and
nourishes the fetus
• It is particularly useful to nourish Yin in women
after menopause as the Directing Vessel controls
the Uterus and determines a woman’s 7-year life
cycles
• The Directing Vessel moves Qi in the Lower Burner
and Uterus, so that it can be used for lumps,
fibroids and carcinoma of the uterus
• The Directing Vessel goes through the throat
and circles around the mouth and its pathology
therefore includes a dry throat, bleeding gums,
receding gums, etc., especially when such
problems occur in conjunction with gynecological
conditions or during pregnancy
Governing Vessel (Du Mai)
As mentioned in Chapter 2, the menstrual cycle is the
result of two tides: one of Kidney-Yin, one of KidneyYang. Kidney-Yin and Kidney-Yang go through an
72 Section 1: Physiology and Pathology
ebb and flow which determines the menstrual cycle.
However, this sounds rather theoretical: how do KidneyYin and Kidney-Yang determine this ebb and flow?
They do so through the Directing Vessel (Ren Mai) and
Governing Vessel (Du Mai) respectively as these two vessels arise from the kidneys and flow through the uterus.
Thus, the Governing Vessel is responsible for the Yang
part of the menstrual cycle. I call this vessel the ‘forgotten vessel’ in gynecology because it is not often mentioned in connection with the menstrual cycle (always
related to Directing and Penetrating Vessels). Without
the Governing Vessel there would be no Yang influence
on the menstrual cycle and therefore no menstruation: it is as important as the Directing and Penetrating
Vessels.
The Governing Vessel is closely related to the
Directing Vessel: as mentioned in Chapter 2 on physiology, these two vessels could be seen as two branches,
one Yin and one Yang, of the same circuit. Thus, if
the Directing Vessel corresponds to the Kidneys and
in particular to Kidney-Yin, the Governing Vessel corresponds to Kidney-Yang and the Minister Fire. The
two vessels therefore nourish and balance each other.
Therefore, a deficiency of the Governing Vessel and of
Kidney-Yang may cause various gynecological problems such as heavy periods, scanty periods, delayed
cycle and infertility.
Bearing in mind that the Governing Vessel flows to the
external genitalia and also has an abdominal branch, it
is easy to see that this vessel’s pathology also has an
influence on gynecological problems. In the same situations where one would normally use the Directing
Vessel but when there is also a marked underlying deficiency of the Fire of the Gate of Life (Ming Men), the
Governing Vessel can be used in women. Thus it could
be used for amenorrhoea, delayed cycle or infertility which occur against a background of pronounced
Kidney-Yang deficiency (manifesting with chilliness, a
Pale and Wet tongue and a Deep and Slow pulse). In
women, very often the Directing and Governing Vessels
can be used together, needling LU-7 Lieque, KI-6
Zhaohai, S.I.-3 Houxi and BL-62 Shenmai unilaterally
(see Ch. 7).
Bearing in mind that the abdominal branch of
the Governing Vessel flows through the heart, the
Governing Vessel has a strong influence on the mental–
emotional state because it is the channel connection
between Kidneys, Heart and Brain. One could therefore
say that it influences the Mind in every way (accord-
ing to a Western and Chinese perspective): through
the Kidneys it influences the Will-Power (Zhi), through
the Heart it influences the Mind and through the Brain
(residence of the Mind according to several doctors
such as Sun Si Miao, Li Shi Zhen and Wang Qing Ren)
it also influences the Mind. Due to its relation with the
Kidneys, Heart and Brain, the Governing Vessel is clinically often used for depression in gynecology, again
often combined with Directing Vessel points (see Ch. 7).
An example of a frequently used combination is Du-20
Baihui with Ren-4 Guanyuan for a woman suffering
from Blood deficiency and depression (Fig. 3.18).
SUMMARY
Governing Vessel (Du Mai)
• The menstrual cycle is the result of the ebb and
flow of Kidney-Yin and Kidney-Yang
• This ebb and flow occurs through the Directing
Vessel (Ren Mai) and Governing Vessel (Du Mai)
respectively as these two vessels arise from the
kidneys and flow through the uterus
• The Governing Vessel is responsible for the Yang
part of the menstrual cycle
• The Governing Vessel is closely related to the
Directing Vessel: these two vessels could be seen
as two branches, one Yin and one Yang, of the
same circuit
• Therefore a deficiency of the Governing Vessel and
of Kidney-Yang may cause various gynecological
problems such as heavy periods, scanty periods,
delayed cycle and infertility
• Bearing in mind that the Governing Vessel flows to
the external genitalia and also has an abdominal
branch, it influences gynecological problems
• The Governing Vessel has a strong influence on
the mental–emotional state because it is the
channel connection between Kidneys, Heart and
Brain
Girdle Vessel (Dai Mai )
One of the major symptoms of a pathology of the
Girdle Vessel is its inability to raise Qi (or to ‘restrain’
the leg channels so that their Qi does not infuse downwards) so that Dampness may pour downwards causing leucorrhoea. In fact, the term for ‘leucorrhoea’ is
Women’s Pathology 73
SHEN
ZHI
Figure 3.18 Governing Vessel connection of Kidneys,
Heart and Brain.
dai xia and some doctors say that it is called so after the
Girdle Vessel, i.e. Dai Mai (the character dai in ‘leucorrhoea’ is the same as that in the name of this vessel).
Another symptomatology of the Girdle Vessel
according to the Pulse Classic (Mai Jing) is abdominal
pain: “Lower abdominal pain [dong ku tong] radiating to
the Gate of Life, amenorrhoea in women or periods which
stop and start, feeling of cold in the genital region, infertility, in men emissions.” Also “Umbilical pain like a line
with backache radiating to thighs.”25
Thus, to summarize, the Girdle Vessel can be used in
gynecology for irregular periods, dysmenorrhoea and
leucorrhoea.
Because of the gynecological sphere of influence
of the Girdle Vessel, some doctors say that the Girdle
Vessel is energetically part of the Directing Vessel or,
at least, that its pathology is included in that of the
Directing Vessel.
The symptomatology of the Girdle Vessel in gynecology can be differentiated according to its deficiency
or excess condition and some doctors say that, in its
deficiency condition, the Girdle Vessel is part of the
Directing Vessel’s sphere, while, in its excess condition,
it is part of the Penetrating Vessel’s sphere.
Deficiency
This is due to Qi deficiency and to the Girdle Vessel being
slack. It is related to Kidney and Liver deficiency and
the Girdle Vessel not restraining the Essence, Spleen-Qi
sinking, Girdle Vessel not propping up the Post-Natal
Qi, so that Directing, Governing and Penetrating Vessels
become deficient.
When the Girdle Vessel is slack, Qi cannot rise, the
organs sag, the fetus may be miscarried and prolapses
may occur. This is due to long-term Qi deficiency, Postand Pre-Natal Qi deficiency, clear Qi descending, and
the Girdle Vessel being slack.
The treatment principle is to tonify Pre- and Post-Natal
Qi, raise the clear Qi and consolidate the Girdle Vessel.
The fetus depends not only on the Kidneys and the
Directing Vessel but also on the Girdle Vessel. If the
Girdle Vessel is slack, Qi cannot rise, the fetus is not stabilized and the mother may miscarry.
Another consequence of a deficiency of the Girdle
Vessel is infusing of Dampness down to the genitals
causing excessive vaginal discharge or vaginal itching
and soreness.
The Deficiency pathology of the Girdle Vessel is
related to the Directing Vessel.
Excess
Excess consists in the ‘Girdle Vessel not harmonized’,
due to its being ‘tight’. The main symptomatology is as
follows:
•
•
•
Fullness of the abdomen, back feels as if sitting in
water. This is due to invasion of Damp-Cold in the
Spleen channel.
Backache radiating to lower abdomen.
Feeling of heaviness of the body, coldness of the
back, feeling as if sitting in water, feeling of heaviness of the abdomen as if carrying 5000 coins. This
is due to exposure to dampness and rain.
In gynecology, the Girdle Vessel is very useful for
abdominal pain from Fullness, Dampness in the genital
system and dysmenorrhoea.
Yin Stepping Vessel (Yin Qiao Mai)
The Yin Stepping Vessel influences the reproductive
system and the lower abdomen in women. It is particularly used for excess patterns of the Lower Burner such
as abdominal masses, lumps, cysts, fibroids, difficult
delivery and retention of placenta. In gynecology, this
vessel is especially useful to resolve adhesions following
gynecological operations such as those for endometriosis or hysterectomy.
74 Section 1: Physiology and Pathology
SUMMARY
Girdle Vessel (Dai Mai)
• One of the major symptoms of a pathology of
the Girdle Vessel is its inability to raise Qi (or to
‘restrain’ the leg channels so that their Qi does not
infuse downwards) so that Dampness may pour
downwards causing leucorrhoea
• Another symptom of the Girdle Vessel according
to the Pulse Classic (Mai Jing) is abdominal pain
• In deficiency conditions, the Girdle Vessel is slack
so that Qi cannot rise, the organs sag, the fetus
may be miscarried and prolapses may occur
• Another consequence of a deficiency of the
Girdle Vessel is infusing of Dampness down to the
genitals causing excessive vaginal discharge or
vaginal itching and soreness
• The deficiency pathology of the Girdle Vessel is
related to the Directing Vessel
• In excess conditions, the Girdle Vessel is ‘tight’
• The main symptoms are fullness of the abdomen,
back feels as if sitting in water, backache radiating
to lower abdomen, feeling of heaviness of the
body, coldness of the back, feeling as if sitting in
water, feeling of heaviness of the abdomen as if
carrying 5000 coins
• In gynecology, the Girdle Vessel is very useful for
abdominal pain from Fullness, Dampness in the
genital system and dysmenorrhoea
Yin Linking Vessel (Yin Wei Mai )
Unlike the other extraordinary vessels, the Yin Linking
Vessel is used mostly to nourish, not to eliminate excess
conditions as the others do.
The Yin Linking Vessel is excellent to nourish Blood
and calm the Mind in women. It affects the Heart and it
can therefore be used for amenorrhoea, delayed cycle or
scanty periods, especially when associated with depression, anxiety and a feeling of tightness of the chest.
END NOTES
1. Lian Fang 1992 TCM Treatment of Luteal Phase Defect – An
Analysis of 60 Cases, Journal of Chinese Medicine 38: 21.
2. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai, p.
39. First published in 1827. Fu Qing Zhu was born in 1607 and died
in 1684.
3. Ibid., p. 39.
4. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Di Nei Jing Su Wen
), People’s
Health Publishing House, Beijing, p. 197. First published
c. 100 BC.
5. Feng Tao Zhang 1702 Secret Records of Master Feng’s Brocade Bag
(Feng Shi Jin Nang Mi Lu), cited in Zhang Qi Wen 1995 Menstrual
Disease (Yue Jing Bing Zheng
), People’s Hygiene
Publishing House, Beijing, p. 32.
6. Yao Shi An 1996 On the Relationship between the Heart and
Women’s Diseases (Lun Xin Yu Nu Ke), Journal of Chinese Medicine
(Zhong Yi Za Zhi
) 37(6): 328–329.
7. Ibid.
8. Yang Jia San 1988 Great Dictionary of Chinese Acupuncture (Zhong
Guo Zhen Jiu Da Ci Dian
), Beijing Physical
Training College Publishing House, Beijing, p. 827.
9. Ibid.
10. Yue Han Zhen 1990 An Explanation of Acupuncture Points (Jing
Xue Jie
), People’s Hygiene Publishing Company, Beijing,
p. 143. The text was first published during the early Qing dynasty.
11. Simple Questions, p. 247.
12. On the Relationship between the Heart and Women’s Diseases,
p. 329.
13. Simple Questions, p. 197.
14. On the Relationship between the Heart and Women’s Diseases, p. 329.
15. Ibid., p. 329.
16. Ibid., p. 329.
17. The concept of Yin-Fire was introduced by Li Dong Yuan in his celebrated Discussion on Stomach and Spleen (Pi Wei Lun). According to
Li Dong Yuan, irregular diet, overwork and emotional stress weaken
the Stomach and Spleen and the Original Qi. When the Original Qi
declines, the Minister Fire becomes pathological and rises from the
space between the Kidneys to harass the Heart and Pericardium:
this Fire is what Li Dong Yuan called Yin-Fire (which is not to be
confused with Empty-Heat). The pathological Minister Fire, i.e. the
Yin-Fire, ‘displaces’ the Original Qi because they both occupy the
same space in between the Kidneys: for this reason Li Dong Yuan
says that the Yin-Fire is a ‘thief ’ of the Original Qi. Thus, in this kind
of pathology, there may be some Cold symptoms and signs arising
from a deficiency of the Original Qi (such as cold feet, a feeling of
cold and a Pale tongue) and some hot manifestations from the rising
of the Yin-Fire (e.g. thirst, a feeling of heat in the face, etc.). Arousal
of Yin-Fire is treated not by clearing Heat but by tonifying the
Original Qi with sweet and warm herbs: the representative formula
for this is Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting
Qi Decoction (Tonify Qi and Ease the Muscles in the Three Treasures
range).
18. Nanjing College of Traditional Chinese Medicine 1979 A Revised
Explanation of the Classic of Difficulties (Nan Jing Jiao Shi
), People’s Health Publishing House, Beijing, p. 75. First
published c. AD 100.
19. 1981 Spiritual Axis (Ling Shu Jing
), People’s Health
Publishing House, Beijing, p. 64. First published c. 100 BC.
20. Li Shi Zhen 1985 A Compilation of the ‘Study of the
Eight Extraordinary Vessels’ (Qi Jing Ba Mai Kao Jiao Zhu
), edited by Wang Luo Zhen, Shanghai
Science Publishing House, Shanghai, p. 60. First published in 1578.
21. He Ren 1981 A New Explanation of the Synopsis of Prescriptions
from the Golden Cabinet (Jin Gui Yao Lue Xin Jie
),
Zhejiang Science Publishing House, p. 57. The Synopsis of
Prescriptions from the Golden Cabinet was written by Zhang Zhong
Jing c. AD 200.
22. A Compilation of the ‘Study of the Eight Extraordinary Vessels’, p. 77.
23. Classic of Difficulties, p. 74.
24. Simple Questions, p. 259.
25. Wang Shu He 1988 A Revised Explanation of the ‘Pulse Classic’
(Mai Jing Jiao Shi
), with commentary by the Fuzhou City
People’s Hospital, People’s Health Publishing House, Beijing, p. 90.
First published in AD 280.
SECTION 2
AETIOLOGY AND DIAGNOSIS
4. AETIOLOGY 77
5. DIAGNOSIS 97
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CHAPTER 4
AETIOLOGY
EXTERIOR PATHOGENIC FACTORS 78
Cold 79
Dampness 79
Heat 79
EMOTIONAL STRESS 79
Sadness and grief 80
Worry 80
Anger 81
Fear 81
Shock 81
Guilt 81
IRREGULAR DIET 83
Cold foods 83
Hot foods 83
Diet lacking in nourishment 83
Greasy and sweet foods 83
EXCESSIVE PHYSICAL WORK/EXERCISE 84
OVERWORK 86
PREGNANCY AND CHILDBIRTH 86
Pregnancy 86
Childbirth 87
EXCESSIVE/INSUFFICIENT SEXUAL ACTIVITY 88
SURGERY AND HYSTERECTOMY 93
CONTRACEPTIVE PILL 94
PREVENTION AND HYGIENE 94
The main aetiological factors in women are obviously
of the same type as in men but there are certain differences which should be noted. For example, the aetiological factor of ‘excessive sexual activity’ has quite a
different meaning in men and women.
In this chapter I shall therefore discuss aetiological
factors with specific reference to women and to gynecological problems.
The main aetiological factors are:
•
•
•
•
•
•
•
•
•
•
Exterior pathogenic factors
emotional stress
irregular diet
excessive physical work/exercise
overwork
pregnancy and childbirth
excessive/insufficient sexual activity
surgery and hysterectomy
contraceptive pill
prevention and hygiene.
Chinese medicine has always emphasized the importance for women to take extra care during the period
and after childbirth. All the precautions that apply to
the post-partum period also apply, albeit to a lesser
degree, to each period time. During the period, the
Uterus is in a vulnerable state because it is open; moreover, the loss of blood induces a state of relative Blood
deficiency and therefore any aetiological factor at this
time easily influences Blood, causing a deficiency or
stagnation.
A Qing dynasty text, Most Valuable Treasure of Women
and Babies, talks at length about the necessity for
women to take care during and immediately after the
period:
When the period arrives, new blood has not been produced
and old blood is being discharged; at this time women
become irritable and they should avoid overstrain, stress
and emotional problems. It is also most important that
they avoid cold food and sitting or lying in cold and damp
places. During the period the pores are open, old blood
enters the Penetrating Vessel in order to be discharged.
Exposure to cold at this time stops old blood from moving
downwards; it will instead accumulate in the body giving
78 Section 2: Aetiology and Diagnosis
rise to stagnant Blood, palpable masses, dysmenorrhoea
or short periods. New blood is produced 1–2 days after the
end of the period; exposure to cold at this time prevents the
production of new blood leading to exhaustion of Blood
manifesting with a sallow complexion, lassitude, long cycle
and leucorrhoea. This is why women suffer from more diseases that are difficult to cure. Women from rich families
are arrogant and often hide their feelings. They cannot stop
eating cold fruits if these are delicious; this causes Cold
to invade the Stomach. These women cool themselves too
much in summertime as they do not know that it is harmful to health. After some time, diseases will occur and they
may suffer from infertility. It must be pointed out that
women should avoid exposure to wind and cold and eating cold foods during the period. To eliminate Blood stasis,
this is the best time to give treatment [during the period].
Tonics should be taken after the end of the period. By following these rules a weak woman can get stronger, she will
not suffer from diseases and will be able to give birth to
many children.1
An interesting aspect of this passage is a reference
to treatment according to menstrual phases when it
says “To eliminate Blood stasis, this is the best time to
give treatment [during the period]. Tonics should be
taken after the end of the period.” This confirms the
modern view according to which the period (bleeding
time) is the best time to invigorate Blood and the postmenstrual phase (phase 2) the best time to tonify (the
Kidneys).
The Qing dynasty gynecologist Chen Jia Yuan classified the aetiological factors of women’s diseases into
four groups:
1. Excessive physical work (including excessive
sexual activity).
2. Mental depression.
3. Worry and pensiveness.
4. Dietary irregularities.
He included excessive sexual activity with ‘overwork’ and considered physical overwork as an external cause and excessive sexual activity as an internal
cause of disease (within the category of ‘overwork’).
He said that ‘mental depression’ is different from the
‘Six Stagnations’ (stagnation of Qi, Blood, Heat, Food,
Dampness and Phlegm) and that ‘worry and pensiveness’ are a non-substantial cause of disease while
dietary irregularity is a substantial one. Dr Chen’s
reference to ‘mental depression’ is interesting and
very modern. He specifically says that is not equiva-
External
cause
Excessive physical work
Internal
cause
Excessive sexual activity
Nonsubstantial
cause
Mental depression
Substantial
cause
Worry and pensiveness
Irregular diet
Figure 4.1 Gynecological causes of disease according to
Dr Chen Jia Yuan.
lent to the depression caused by the Six Stagnations
(defined by Zhu Dan Xi and for which Yue Ju Wan
Gardenia-Chuanxiong Pill is used). By ‘mental depression’ he means a general state of unhappiness which
may be due to many different patterns rather than
purely stagnation; as we shall see below, by ‘depression’ he also means a state of mental frustration due
to unfulfilled sexual desire (Fig. 4.1). Dr Chen said
that overwork should be treated with the tonification
method; emotional depression be treated by moving
and opening Qi; pungent herbs be used for worry and
pensiveness; dietary irregularities should be treated by
digestive herbs that dissolve retained food. Passages
from his work will be discussed below.
EXTERIOR PATHOGENIC FACTORS
Exterior pathogenic factors have a deep influence on
gynecological problems. The Golden Mirror of Medicine
(1742) says:
When the climate is moderate and harmonized, the periods
are calm. Cold congeals, Heat boils, Wind makes [the periods] surge; external pathogenic factors enter the Uterus
and deplete the Directing and Penetrating Vessels causing
menstrual problems.2
Shen Yao Feng, author of the Summary of Gynecology
(1850), says: “Warm, harmonious weather makes the
periods quiet; cold congeals them; heat makes them overflow; wind makes them surge.”3
The three most common Exterior pathogenic factors
in gynecology are Cold, Dampness and Heat.
Aetiology 79
Cold
Cold may mean either Wind-Cold invading the space
between skin and muscles or Cold invading the Uterus
directly. During menstruation and especially after
labour, the Blood-Connecting (Blood-Luo) channels are
open and the space between skin and muscles is especially vulnerable to invasions of Wind-Cold.
Invasion of Wind-Cold during menstruation or
after labour may cause aches in the joints and painful
periods.
External Cold can also invade the Uterus directly
causing painful periods. Again, this happens especially
during menstruation or after labour.
• External Cold can also invade the Uterus directly
causing painful periods
Dampness
• Dampness invades the channels of the legs and
creeps upwards to settle in the reproductive
system in women, causing leucorrhoea, pain on
ovulation or dysmenorrhoea
• Once inside the body, Dampness becomes
an internal pathogenic factor which easily
combines with Heat to form Damp-Heat: this is
a major pathogen in gynecology, usually causing
abdominal masses, dysmenorrhoea, ovarian cysts,
leucorrhoea, infertility or menorrhagia
Dampness
Heat
Dampness is a major pathogenic factor in gynecology.
It invades the channels of the legs and creeps upwards
to settle in the reproductive system in women, causing leucorrhoea, pain on ovulation or dysmenorrhoea.
The invasion of Dampness too is facilitated during the
menses or after labour.
Once inside the body, Dampness becomes an internal pathogenic factor which easily combines with
Heat to form Damp-Heat: this is a major pathogen
in gynecology, usually causing abdominal masses,
dysmenorrhoea, ovarian cysts, leucorrhoea, infertility
or menorrhagia.
• Heat may be either Wind-Heat or Summer-Heat
• Both these pathogenic factors can penetrate
the Interior and enter the Blood portion causing
Blood-Heat. This is a major cause of excessive
menstrual bleeding
Heat
Heat may be either Wind-Heat or Summer-Heat.
After the Exterior stage, both these pathogenic factors
can penetrate the Interior and enter the Blood portion
causing Blood-Heat. This is a major cause of excessive
menstrual bleeding.
SUMMARY
Exterior pathogenic factors
Cold
• Cold may mean either Wind-Cold invading the
space between skin and muscles or Cold invading
the Uterus directly
• Invasion of Wind-Cold during menstruation or
after labour may cause aches in the joints and
painful periods
EMOTIONAL STRESS
Emotional stress has a profound influence on menstruation, pregnancy, labour and menopause. The Golden
Mirror of Medicine (1742), when discussing emotional
causes of disease in gynecology, says: “Worry, anger,
depression injure the emotional life, Blood flows up rebelling upwards bringing Qi with it.”4
The Uterus Vessel connects the Uterus to the Heart:
since the Heart is always affected by emotional problems, this connection explains the profound influence of emotional stress on the menstrual function.
For example, Chapter 33 of the Simple Questions says:
When menstruation does not come, this is due to the
Uterus Vessel being blocked. The Uterus Vessel pertains to
the Heart and connects with the Uterus; when Qi rebels
upwards towards the Lungs, Heart-Qi cannot flow downwards and the periods do not come.5
‘Qi rebelling upwards towards the Lungs’ describes in
particular the effect of worry, sadness or grief. Although
the Heart plays a pivotal role in emotional stress since it
houses the Mind (Shen) that feels the emotions, of course
all other organs may be affected by emotional stress that
has repercussions on the Uterus. For example, the Liver
80 Section 2: Aetiology and Diagnosis
especially is affected by emotional stress that affects
menstruation. Liver-Qi stagnation, Liver-Blood stasis,
Liver-Blood-Heat and Liver-Fire may all be caused by
emotional stress and they all have a profound influence
on menstruation, conception, pregnancy and labour.
Emotional problems are all the more detrimental in
women if they occur around the time of puberty. At this
time, a girl’s health is particularly vulnerable and emotional problems will affect her body and mind deeply and
with long-lasting effect. In particular, emotional stress at
this time will deeply affect the Directing and Penetrating
Vessels (Ren and Chong Mai) creating the imbalances
that will cause gynecological problems later in life.
Emotional stress influences menstruation by affecting first the movement of Blood by Qi. In fact, the first
effect of emotional stress is to impair or alter the circulation of Qi by depleting Qi, making Qi stagnant or
making Qi rebellious. Each of these pathologies will
affect Blood which follows Qi and becomes deficient,
stagnant or rebellious and/or Hot (Fig. 4.2).
The Golden Mirror of Medicine says:
EMOTIONS
QI
Deficient
Stagnant
Rebellious
Women cannot control themselves and are frequently
affected by worry, pensiveness, anger or depression: these
make the Blood move, stop, rebel or conform, which is all
due to Qi movement.6
Of course, the part of the statement that says that
‘women cannot control themselves’ reflects a patronising Confucian attitude towards women: the emotional problems the book is referring to of course affect
women and men equally.
Sadness and grief
Sadness and grief deplete Heart and Lungs and can
influence menstruation in two ways. By affecting the
Heart, they may deplete Heart-Blood, which may affect
the Uterus via the Uterus Vessel (Bao Mai). This may
lead to amenorrhoea, scanty periods or delayed cycle. If
they deplete Lung-Qi, Qi may fail to move Blood and this
may also cause amenorrhoea. Deficient Lung-Qi and
Spleen-Qi may also either fail to hold Blood and lead to
menorrhagia, or fail to raise Qi, leading to prolapses.
In women, sadness may sometimes affect the Liver
directly, causing Liver-Blood deficiency. Chapter 8 of
the Spiritual Axis says: “When sadness affects the Liver it
injures the Ethereal Soul; this causes mental confusion …
the Yin is damaged, the tendons contract and there is hypochondrial discomfort.”7 When sadness affects the Liver
(which is fairly common in women), it easily causes
gynecological problems such as amenorrhoea, scanty
periods or delayed cycle, all associated with depression
and a feeling of aimlessness due to the Ethereal Soul
not being rooted in Liver-Blood.
Worry
BLOOD
Deficient
Stagnant
Hot
Scanty periods
Painful periods
Heavy periods
Figure 4.2 Effect of Qi derangement from emotional stress
on the Uterus.
Worry knots the Qi of the Lungs, Heart and Spleen. It
leads to stagnation of Qi which may cause delayed periods or painful periods. It is important to note that stagnation of Qi is not always synonymous with Liver-Qi
stagnation, as the above-mentioned organs also may
suffer from stagnation. In particular, Lung-Qi may
stagnate as a result of worry. This will cause a slight
breathlessness, a pale complexion, sighing, a feeling of
tightness of the chest and, in terms of gynecology, premenstrual tensions and distension of the breasts. Since
the Lung channel courses through the chest area, stagnation of Lung-Qi, deriving from worry or grief, is often
involved in the aetiology of breast lumps.
The Qing dynasty gynecologist Chen Jia Yuan wrote
with regard to worry:
Aetiology 81
Worry injures the Lungs and pensiveness injures the
Spleen, when these two organs are injured Qi and Blood
stagnate, there is a feeling of indignation, palpitations, a
feeling of oppression of the chest and amenorrhoea.8
Penetrating Vessel to rebel upwards. This is a very common factor that aggravates menopausal problems.
The Great Treatise of Beneficial Formulae for Women
(1237) says about fear:
This passage confirms that stagnation of Qi affects
not only the Liver but also the Lungs and Spleen (see
below) and also that amenorrhoea may occur from
stagnation as well as from a deficiency.
Moreover, in my opinion, worry also affects the Liver
and makes Liver-Yang rising: this may cause menstrual
headaches. Indeed, Zhang Jing Yue says that worry
affects the Liver:
Fear during the period causes disturbances of Blood, the
blood vessels and channels become obstructed, Qi rebels upwards in the Blood portion, and this may lead to a
severe deficiency.11
Worry pertains to the Lungs but it also affects the Heart.
Worry makes Qi rise and can affect the Liver; the Liver
becomes overactive and it invades the Spleen. The Spleen is
then affected by worry and this injures the Intellect [Yi].
Hence worry affects the Lungs, Heart, Liver and Spleen.9
Anger
Anger includes frustration, resentment, bearing
grudges, irritation, hatred, etc. These emotions are a
major cause of menstrual problems as they cause stagnation of Liver-Qi, which may lead to irregular periods,
pre-menstrual tension and dysmenorrhoea, and which
can cause further problems in two ways. First of all it
can lead to Liver-Blood stasis which causes a more painful type of dysmenorrhoea or abdominal masses; second, stagnant Qi may develop into Fire which causes
Blood-Heat and therefore menorrhagia.
The Great Treatise of Beneficial Formulae for Women
(1237) says of anger:
Anger causes Qi to rebel upwards: Blood follows Qi and
also rebels upwards. If the lower back and legs are affected,
there will be pain and a sensation of heaviness there during
the period, which will disappear at the end of the period …
If anger damages the Liver, there will be dizziness, hypochondrial pain, spitting of blood, acute skin infections and
prolonged uterine bleeding.10
Fear
By ‘fear’ is meant either a sudden fright or a chronic
state of anxiety. A sudden fright makes Kidney-Qi
descend, but a chronic state of anxiety, especially when
the Heart is weak, makes Qi rise. For example, fear (in
the sense of chronic anxiety) may cause the Qi of the
This passage states that a state of fear and anxiety during the period upsets the Blood system, causing Blood
to rebel upwards; as it rebels upwards, this may induce
a deficiency of Blood and, eventually, Yin. Obviously
this will only happen when the emotional problem
continues for years.
Shock
Shock depletes Heart, Spleen and Kidneys. It may cause
amenorrhoea or a delayed cycle. Shock typically manifests with a Moving pulse even many years after the
event. The Moving pulse is rapid, short and shaped like
a bean and it gives the impression of vibrating instead of
pulsating.
Guilt
Guilt is an extremely common and damaging emotion in Western patients. It may derive from breaking
religious or social taboos or from doing something
wrong which weighs on the conscience. Of course,
guilt can also arise in those who always tend to
blame themselves, even if they have done nothing
wrong; for example, someone blaming himself or
herself unnecessarily for the breakdown of their
marriage. This attitude can sometimes be due to
patterns established in childhood if a child is never
praised and always reprimanded. Interestingly, there
is no modern Chinese word for ‘guilt’ used in its
emotional rather than its legal sense. There is, however, an ancient word for it called jiu: this character
is based on the ‘disease’ radical and a radical that
means ‘long time’, i.e. a feeling harboured for a long
time leading to disease. Another old Chinese expression for guilt is xin li you gui, which means ‘an evil
spirit harboured in the Heart’.
In some cases, guilt may also arise from repressed
and unrecognized anger which turns inwards and
causes an attitude of self-punishment and guilt.
82 Section 2: Aetiology and Diagnosis
Guilt affects the Heart, Liver, Lungs and Kidneys and
it causes either stagnation or sinking of Qi, depending
on the pre-existing condition of the woman. In gynecology, it is common to see conditions caused by sinking of Qi as a consequence of longstanding guilt. This
brings about a sinking of Kidney-Qi with an ensuing
bearing-down feeling or an actual prolapse of the
uterus or bladder. Very often, urinary problems characterized by frequent urination, a bearing-down sensation and a slight urinary incontinence in women
are due to longstanding guilt causing Kidney-Qi to
sink. The tongue will have a red tip and the pulse will
be vibrating as it pulsates. The eyes will look unstable and often flap shut while the woman is talking.
When guilt results from repressed anger, the pulse
will be Wiry.
Case history
A 42-year-old woman complained of a persistent
bearing down, uncomfortable and achy feeling in
the hypogastrium (just over the bladder). Her periods were very heavy with bright-red blood without clots. Her complexion was pale, she looked
very depressed and her pulse was very Weak
on both Kidney positions. I diagnosed sinking
of Kidney-Qi with sinking Qi unable to contain
Blood. I enquired about her emotional and marital life. After a few sessions, she admitted that she
felt very guilty about her second marriage and the
impact it had had on her child from the first marriage. This is a clear example of the effect of guilt
on the Kidneys and the menstrual function.
SUMMARY
Emotional stress
Anger
• Emotional stress has a profound influence on
menstruation, pregnancy, labour and menopause
• The Uterus Vessel connects the Uterus to the Heart:
since the Heart is always affected by emotional
problems, this connection explains the profound
influence of emotional stress on the menstrual function
• All other organs may be affected by emotional
stress that has repercussions on the Uterus
• Emotional problems are all the more detrimental in
women if they occur around the time of puberty
• Anger includes frustration, resentment, bearing
grudges, irritation, hatred
• These emotions cause stagnation of Liver-Qi, which
may lead to irregular periods, pre-menstrual tension
and dysmenorrhoea
Sadness and grief
• Sadness and grief deplete Heart and Lungs and
can deplete Heart-Blood leading to amenorrhoea,
scanty periods or delayed cycle or Lung-Qi which
fails to move Blood and leads to amenorrhoea
• Deficient Lung-Qi and Spleen-Qi may also either fail
to hold Blood and lead to menorrhagia, or fail to
raise Qi, leading to prolapses
• In women, sadness may sometimes affect the Liver
directly, causing Liver-Blood deficiency
Worry
• Worry knots the Qi of the Lungs, Heart and Spleen
• It leads to stagnation of Qi which may cause
delayed periods or painful periods
• Lung-Qi stagnation may cause pre-menstrual
tensions, distension of the breasts and breast lumps
• Worry also affects the Liver and makes Liver-Yang
rising: this may cause menstrual headaches
Fear
• A sudden fright makes Kidney-Qi descend, but a
chronic state of anxiety, especially when the Heart is
weak, makes Qi rise
• A state of fear and anxiety during the period upsets
the Blood system, causing Blood to rebel upwards
Shock
• Shock depletes Heart, Spleen and Kidneys
• It may cause amenorrhoea or a delayed cycle
Guilt
• Guilt is an extremely common and damaging
emotion in Western patients
• In some cases, guilt may also arise from repressed
and unrecognized anger which turns inwards and
causes an attitude of self-punishment and guilt
• Guilt affects the Heart, Liver, Lungs and Kidneys
and it causes either stagnation or sinking of Qi,
depending on the pre-existing condition of the
woman
• In gynecology, it is common to see conditions
caused by sinking of Qi as a consequence of longstanding guilt
Aetiology 83
IRREGULAR DIET
Diet is an important aetiological factor in gynecology.
The Golden Mirror of Medicine says: “Blood is the essence
refined from food and water, if the Stomach and Spleen are
injured, fluids are not regulated, Blood dries up, and the
periods become unregulated.”12 The Qing dynasty gynecologist Chen Jia Yuan said:
Food can nourish but can also harm people … if a woman
has not enough exercise, the digestion is slow, Cold is generated, the Stomach and Spleen are injured so that they cannot transport [food], stuffiness and fullness develop with
accumulations and there may be vomiting and diarrhoea.13
Cold foods
Excessive consumption of cold foods may create Cold in
the Uterus: all the more likely to happen during puberty,
during menstruation and after labour, this is a major
cause of dysmenorrhoea and infertility. Cold foods
include raw fruit and vegetables (with few exceptions)
and iced drinks. This is a common cause of gynecological
problems.
The idea that an excessive consumption of salads and
fruit can be detrimental to health runs counter to all
modern ideas about diet, according to which, by eating
raw vegetables and fruit, we can absorb all the minerals
and vitamins contained in them. This is true to a certain extent and a moderate consumption of these foods
can be beneficial. However, from a Chinese perspective,
the Spleen likes dry and warm foods and dislikes cold
and wet ones: an excessive consumption of raw foods,
although in theory providing abundant vitamins and
minerals, may be detrimental because such foods will
be difficult for the Spleen, Stomach and Intestines to
digest and absorb.
Hot foods
Excessive consumption of hot foods may cause BloodHeat and therefore menorrhagia: this is usually more
likely to occur in an older woman than in a young
woman or girl. Hot foods include most meats (but especially lamb and beef), spices, curry and alcohol (especially spirits).
Diet lacking in nourishment
A diet lacking in nourishment (through following either a strict slimming diet or a vegetarian diet
which does not pay adequate attention to procuring alternative sources of protein) may lead to Qi
and Blood deficiency and therefore amenorrhoea,
scanty periods or infertility. This is, in fact, a cause
of gynecological problems which is becoming more
and more common due to the increasing popularity of vegetarianism among young girls. Although it
is perfectly possible to follow a vegetarian diet that
is sustaining and that provides adequate nourishment, it does require a sophisticated knowledge of
nutrition which is often beyond the capabilities of
the very young. They therefore end up not having
enough nourishment or eating excessive amounts of
dairy foods which create Dampness. Furthermore,
according to Li Shi Zhen, animal products are particularly beneficial to the Extraordinary Vessels and in
particular the Governing, Directing and Penetrating
Vessels. In fact, he says that the main substance for
the Governing Vessel is Lu Rong Cornu Cervi pantotrichum and the main foods for it are the marrow
and brain of beef and goat.14 The main substance
for the Directing and Penetrating Vessels is Gui Ban
Plastrum Testudinis.
Greasy and sweet foods
Excessive consumption of greasy and sweet foods
causes internal Dampness which often settles in the
Lower Burner: this may cause an excessive vaginal
discharge, dysmenorrhoea or cysts. Greasy and sweet
foods that cause Dampness or Phlegm include milk,
cheese, butter, cream, ice-cream, bananas, peanuts,
fatty meats, fried foods, sweets and sugar.
During gestation the fetus is pure Essence and
Corporeal Soul (Po): this relies on the mother’s
Corporeal Soul and Essence. The mother’s Essence
is transformed into Blood which nourishes the fetus’s
Essence and Corporeal Soul. The Corporeal Soul pertains to Earth, comes into being at conception and
returns to Earth at death. Since the Corporeal Soul
pertains to Earth, and since the fetus is ‘all Essence
and Corporeal Soul’, it is understandable that food
ingested by the mother during pregnancy has a direct
influence on the baby’s Corporeal Soul and therefore
its Lungs and skin (causing hereditary skin diseases
such as atopic eczema).
Table 4.1 lists the organs pertaining to each month
of pregnancy (bearing in mind that in Chinese medicine pregnancy is considered to last 10 lunar months),
the foods to avoid and the beneficial foods in each
month.
84 Section 2: Aetiology and Diagnosis
Table 4.1 Beneficial and contraindicated foods in pregnancy
MONTH
ORGAN/CHANNEL
FOODS TO AVOID
BENEFICIAL FOODS
1
Liver
Spicy, smoked foods, garlic, onions,
shallots
Barley
2
Gall Bladder
Spicy, smoked foods
3
Pericardium
Spicy, sour
4
Triple Burner
Rice, fish soup, chicken soup
5
Spleen
Tasty and fresh foods
6
Stomach
Pigeon, partridge, pheasant,
hare, rabbit
7
Lungs
Rice, lentils, dry foods
8
Large Intestine
9
Kidneys
10
Bladder
Hot foods, salty foods
SUMMARY
Irregular diet
• Excessive consumption of cold foods may create
Cold in the Uterus
• Excessive consumption of hot foods may cause
Blood-Heat and therefore menorrhagia
• A diet lacking in nourishment (through following
either a strict slimming diet or a vegetarian
diet which does not pay adequate attention to
procuring alternative sources of protein) may
lead to Qi and Blood deficiency and therefore
amenorrhoea, scanty periods or infertility
• Excessive consumption of greasy foods causes
internal Dampness or Phlegm which often settles
in the Lower Burner: this may cause an excessive
vaginal discharge, dysmenorrhoea or cysts
EXCESSIVE PHYSICAL
WORK/EXERCISE
Excessive physical work, exercise or sports can weaken
the Spleen, Liver and Kidneys (and therefore muscles,
sinews and bones) and adversely affect the Penetrating
and Directing Vessels by causing stagnation of Qi and/
or Blood leading to dysmenorrhoea. Chapter 23 of the
Simple Questions says: “Excessive standing injures the bones
[and therefore the Kidneys], excessive exercise and [physical] work injures the sinews [and therefore the Liver].”15
Excessive physical work is particularly detrimental
if it occurs during the puberty years because at this
time a girl’s body is especially vulnerable. In fact, during these years, the Directing and Penetrating Vessels
are undergoing profound changes and are in a state
of flux: this makes them more vulnerable to external
influences. Excessive physical work may either weaken
these two vessels or lead to stagnation, depending on
the constitution of the girl.
How could a young girl incur this particular cause
of disease? She might be helping on a farm, or practising ballet, or training hard at a particular sport. Very
often this cause of disease is combined with that due
to external Cold: the typical example would be that of
a girl playing a lot of sports in a T-shirt and shorts in a
cold and damp climate such as that which is prevalent
in Northern Europe, Canada or the North of the USA.
Excessive exercise affects the Directing and Penetrating
Vessels adversely and, because of this weakness, the
external Cold invades the Lower Burner more easily
(especially when a girl plays sports in shorts in winter)
causing amenorrhoea or dysmenorrhoea.
Excessive lifting of weights is also particularly harmful, again more so if it happens during puberty. It weakens the Kidneys but it also leads to stagnation in the
Aetiology 85
Lower Burner and therefore dysmenorrhoea later in
life. Excessive lifting may occur if a girl is helping her
parents on a farm or in their business or during excessive gym work-outs. The following brief case history
illustrates this point.
Case history
A 36-year-old woman complained of painful
periods since she was about 20. She had been
diagnosed as having endometriosis. The pain
was both central and bilateral in the iliac fossae. The menstrual blood was dark with dark
clots and the pain was relieved by the application of a hot-water bottle. Her tongue was
Purple and her pulse was Wiry.
My diagnosis was stasis of Blood and retention of
Cold in the Uterus occurring against a background
of Kidney-Yang deficiency. On my asking her about
the possible causes of disease, it emerged that she
had started work at 18 becoming the manageress of a newsagent shop, thus lifting heavy bundles of newspapers every day. Coupled with this,
there was also a sudden exposure to Cold since she
had moved from Uganda (which has a very dry and
warm climate) to England a year prior to that. Thus
the aetiology was fairly typical: exposure to Cold
around puberty time coupled with excessive lifting.
Cold in the Uterus led to stasis of Blood which was
aggravated by the stagnation caused by the lifting.
Besides this, the excessive lifting also weakened the
Kidneys and, much later in life when the Kidney
energy starts to decline, her condition had been
aggravated by the development of endometriosis.
Excessive exercise is detrimental especially when it
occurs during periods, when pregnant or after childbirth. During the period it weakens the Spleen and
Kidneys and may lead to menorrhagia of the deficient
type. During pregnancy, it weakens the Directing and
Penetrating vessels and may cause the fetus to become
unstable, with the danger of miscarriage. Chinese
medicine stresses very much the importance of having adequate rest after childbirth. Excessive exercise
after childbirth also weakens the Spleen and Kidneys
and the Directing Vessel and may cause prolapse of the
uterus.
The Qing dynasty gynecologist Chen Jia Yuan
includes both excessive physical work and excessive
sexual activity under the same aetiological category in
women, the former being an ‘outer’ and the latter an
‘inner’ factor. He says:
If the woman head of the household is too hard-working,
it may injure her sinews and bones, whilst excessive sexual
activity injures the spirit. Thus Blood, Qi and Body Fluids
become depleted in the channels and lead to exhaustion of
the internal organs … so that Yin and Yang become both
deficient, there is steaming from the bones and Exhaustion
[Xu Lao] develops.16
It is interesting that he says that while excessive exercise injures sinews and bones, excessive sexual activity injures the Spirit (see below). However, inadequate
exercise may also become a cause of disease in women
because it either causes or aggravates stagnation of Qi.
The very same sentence of the Simple Questions that discusses excessive exercise also warns against lack of exercise: “Excessive lying down injures Qi [and therefore the
Lungs], excessive sitting injures the muscles [and therefore
the Spleen].”17
The Ye Tian Shi’s Secret Prescriptions of
Gynecological Patterns and Treatment by Ye Tian Shi
(1667–1746) says: “ In the time before childbirth one
should normally exercise; this makes Qi and Blood
move freely, [so that] the fetus can move and turn and
labour will be easy.” 18
SUMMARY
Excessive physical work/exercise
• Excessive physical work, exercise or sports can
weaken the Spleen, Liver and Kidneys (and
therefore muscles, sinews and bones) and
adversely affect the Penetrating and Directing
Vessels by causing stagnation of Qi and/or Blood
leading to dysmenorrhoea
• Excessive physical work is particularly detrimental
if it occurs during the puberty years
• Excessive lifting of weights weakens the Kidneys
but it also leads to stagnation in the Lower Burner
and therefore dysmenorrhoea later in life
• Inadequate exercise may also become a cause
of disease in women because it either causes or
aggravates stagnation of Qi
86 Section 2: Aetiology and Diagnosis
OVERWORK
By overwork I mean not physical overwork (which
comes under ‘excessive physical exercise’), but working too long hours, without adequate rest and with an
irregular diet. This causes Kidney-Yin deficiency and
is a common factor that aggravates menopausal problems and a cause of menorrhagia.
Overwork, in the sense intended above, is a common
cause of disease in older women, while excessive physical work is more common in young women or girls.
PREGNANCY AND CHILDBIRTH
Pregnancy
All modern Chinese books include ‘pregnancy’ automatically as a cause of disease in gynecology. I do not
agree with this view. Pregnancy may indeed become
a cause of disease under certain circumstances,
but not always and not automatically. Moreover,
under certain circumstances, pregnancy may even
improve some gynecological conditions (and also
some non-gynecological ones): this may happen
especially with migraine, asthma and eczema. The
following case history serves to highlight the fact
that while pregnancy taxes the Kidneys, the stoppage of the menses has a nourishing effect on the
mother; thus the net effect of the pregnancy on a
woman’s health depends on the pre-existing state of
her Kidneys. A Western medicine gynecology textbook confirms this when it says, with specific reference to asthma, that 25% of asthma cases improve
during a pregnancy, 25% worsen, and the remainder are unaffected by it.19
Case history
A 34-year-old woman had experienced a gradual hair loss for some years. During her first
pregnancy, the hair loss actually stopped and
the hair became thicker, while after the childbirth the hair loss started again.
This is a striking example of how the Kidneys can
actually get stronger during pregnancy and, in her
case, nourish the hair.
It should also be noted that pregnancy, or rather the
lack of it, may even account for a weaker constitution
of modern women compared with previous generations. In fact, although too many childbirths are weakening, so are menses occurring for several decades
in a woman’s life. In other words, modern women,
because they have fewer children, have children later
and breastfeed for a shorter time, have many more
menstrual cycles in the course of their fertile life than
women of previous generations: it could be argued
that menses are also weakening, occurring as they do
over three decades.
Assuming, for the sake of argument, menarche to
occur at 14 and menopause at 49, a woman would have
35 fertile years. If we compare two women, one having
seven children and another having two, and assuming
the former breastfeeds for 1 year (as was the custom
in previous generations) and the latter for 6 months,
the former woman will breastfeed for 84 months and
the second for 12 months in total. Assuming they do
not menstruate during breastfeeding, the first woman
will have a total of 266 periods and the second one a
total of 388, i.e. the first woman (with seven children)
will have 122 fewer periods than the one with two children. It is arguable that the increased number of periods leads to Blood and/or Kidney deficiency which, of
course, would have to be balanced against the weakening deriving from having seven children.
It is interesting that from the Western point of view
also, there is a correlation between breast cancer incidence and number of menstrual cycles. In fact, an
early onset of menarche is associated with a two-fold
increase in breast cancer risk. A study has shown that
the combination of early menarche and early establishment of regular cycles is associated with more than
a three-fold increase in breast cancer risk.20 Also menopause before the age of 45 leads to a two-fold reduction
in risk of breast cancer.
Pregnancy also has a protective effect: women who
have their first child before 20 have approximately half
the risk of breast cancer of nulliparous women. There
is also an inverse correlation between the number of
periods in a woman’s life and the risk of developing
breast cancer. In particular, it seems that the number
of menstrual cycles before the first pregnancy may be
the ultimate determinant of breast cancer risk. In fact,
both early age of onset of menstruation and later age
at the menopause seem to increase the risk of breast
cancer.21
Aetiology 87
Some doctors have also advanced the hypothesis that
the increasing incidence of endometriosis may be correlated with the increased number of menstrual cycles
between the time of menarche and that of the first
pregnancy. In fact, until this century, women typically
experienced only 2 or 3 years of menstruation between
menarche and first pregnancy (assuming the menarche to occur at 16 and first pregnancy at 18–19). In
modern times, the menarche is occurring earlier and
earlier and women are having the first pregnancy later
and later: thus, while until this century a woman might
have experienced about 36 menstrual cycles between
menarche and first pregnancy, nowadays she is likely
to have at least 150 menstrual cycles in the same time
(that is assuming a menarche at 13 and first pregnancy
at 25). Indeed, if a woman experienced her menarche
at 13 and had her first pregnancy at, say, 35, she would
have 264 menstrual cycles. There might well be a correlation between a high number of menstrual cycles
and the migration of endometrial cells to other sites in
the pelvis.
There is also a theory that links the number of ovarian cycles with the development of ovarian cancer.
According to this theory, the surface of the ovaries is
damaged each time a woman ovulates and this damage may eventually lead to the development of ovarian
cancer. There is, in fact, an inverse correlation between
the number of ovulation cycles and the risk of ovarian cancer, i.e. women who have more pregnancies
and fewer ovulation cycles have a lower risk of ovarian cancer.
Another theory links the risk of ovarian cancer with
the exposure to high levels of gonadotropins. Thus,
in essence, anything that prevents ovulation, such as
pregnancy, lowers the risk of ovarian cancer. It is for
these reasons that the risk of ovarian cancer in women
who took fertility drugs is three times that of women
who did not.22
Case history
A 45-year-old woman complained of aches in all
joints and muscles. These were aggravated by
exercise and improved by rest. She looked much
older than 45 and she felt totally exhausted.
Her tongue was very Pale and Swollen and her
pulse was very Deep and Weak, especially so on
both Kidney positions.
I diagnosed a severe deficiency of Blood and of
Kidney-Yang. Although aches such as these would
be classified as Painful Obstruction Syndrome in
Chinese medicine, I tend to consider this as ‘not
real’ Painful Obstruction Syndrome: in other words,
the aches are due more to deficient Blood not circulating properly and therefore not nourishing the
sinews and channels than to invasion of Wind-ColdDampness. When I enquired about her gynecological function, periods, pregnancy and childbirth, it
transpired that she had had 10 children in about
15 years and her husband told me “She is not the
same woman I married!”
I relate both an aggravation and an amelioration
of symptoms with pregnancy to a Kidney deficiency:
in the first case (aggravation) the Kidney deficiency
gets worse with pregnancy and in the latter case
(amelioration) the Kidney deficiency gets better with
pregnancy.
Childbirth
Childbirth is not necessarily a cause of disease in every
case, but may become one in five circumstances:
1. When the mother does not have enough rest
after labour, this induces a weakness of the space
between skin and muscles which predisposes her
to invasions of Wind. Besides this, lack of rest after
labour causes Blood and Kidney deficiency.
2. If there is excessive loss of blood (over 200 ml)
during labour, this obviously causes a sudden Blood
depletion, which is often the cause of post-natal
depression.
3. If a woman has a predisposition to mental–
emotional problems and fails to bond with the
baby, this may lead to psychosis. A predisposition
to mental–emotional problems may manifest
with a pulse that is Rapid and Overflowing in
the Heart position, and a deep Heart crack on a
tongue which is possibly also hammer shaped.
A psychotic episode after childbirth may also be
due to stasis of Blood developing after childbirth,
affecting the Heart and causing the Mind to
become obstructed.
4. If a woman has a pre-existing Blood and/or
Kidney deficiency she may experience problems
after childbirth even if she rests enough. This may
88 Section 2: Aetiology and Diagnosis
include an exacerbation of previous problems such
as backache, asthma, migraine, etc.
5. If a woman has too many children too close
together without spacing out the pregnancies,
this may cause problems (bearing in mind
that abortions and miscarriages also count as
‘childbirth’).
Wu Qian, author of the Golden Mirror of Medicine
(1742), says that if the mother is strong and the fetus
weak, there will be problems during the pregnancy,
whereas if the mother is weak and the fetus strong, there
will be problems after childbirth.23 He also gives guidelines as to how the birth room should be prepared. He
says that there should not be too many people in the room
(no more than one or two) because this may frighten the
mother and cause Heart-Qi deficiency; the room should
not be too hot or too cold and it should be quiet.24
It should be noted that excessive childbirth includes
miscarriage and abortion. There is, in fact, a saying in
Chinese gynecology that “miscarriage is more serious
than childbirth”.
SUMMARY
Pregnancy and childbirth
Pregnancy
• Pregnancy may become a cause of disease under
certain circumstances, but not always and not
automatically
• Under certain circumstances, pregnancy may even
improve some gynecological conditions (and also
some non-gynecological ones)
• Pregnancy, or rather the lack of it, may even
account for a weaker constitution of modern
women compared with previous generations
• In fact, although too many childbirths are
weakening, so are menses occurring for several
decades in a woman’s life
• There is a correlation between breast cancer
incidence and number of menstrual cycles
• Increasing incidence of endometriosis may be
correlated with the increased number of menstrual
cycles between the time of menarche and that of
the first pregnancy
• I relate both an aggravation and an amelioration
of symptoms with pregnancy to a Kidney
deficiency: in the first case (aggravation) the
Kidney deficiency gets worse with pregnancy
and in the latter case (amelioration) the Kidney
deficiency gets better with pregnancy
Childbirth
Childbirth may become a cause of disease when:
1. The mother does not have enough rest after
labour
2. There is excessive loss of blood (over 200 ml)
during labour
3. A woman has a predisposition to mental–
emotional problems and fails to bond with the
baby
4. A woman has a pre-existing Blood and/or Kidney
deficiency
5. A woman has too many children too close
together
EXCESSIVE/INSUFFICIENT
SEXUAL ACTIVITY
Excessive sexual activity depletes the Kidneys and can
therefore be the cause of gynecological problems such
as amenorrhoea, scanty periods or a delayed cycle.
Chinese medicine has traditionally always placed great
emphasis on excessive sexual activity as a cause of
disease because this may exhaust the Minister Fire by
depleting the Essence: the former is the Pre-Natal and
Yang aspect of the Pre-Natal Essence, and the latter is
the Post-Natal and Yin aspect of the Pre-Natal Essence.
This is illustrated in Figure 4.3.
Since depletion of the Essence through excessive sexual activity can exhaust the Pre-Natal Minister Fire, this
cause of disease is considered particularly detrimental because it consumes both Fire and Water, i.e. the
Minister Fire and the Essence. Thus sexual moderation
preserves the Yin aspect of the Essence, while a tranquil
mind preserves the Yang aspect of the Essence, i.e. the
Minister Fire. However, excessive sexual activity does
not affect women as much as men for various reasons.
In men, ejaculation is a direct (albeit temporary) loss of
Essence as sperm is derived directly from the Essence.
As there is no comparable loss in women, there is no
equivalent depletion after sex. Quite simply, the KidneyEssence is the origin of sperm in men and of menstrual
blood and ova in women: while men lose sperm during
sex, women do not lose menstrual blood or ova.
Aetiology 89
YANG ESSENCE
(Father)
YIN ESSENCE
(Mother)
the Uterus rather than the Room of Sperm, in women
excessive loss of blood after childbirth (or from chronic
menorrhagia) would be equivalent to excessive sex for
men. In men, the lower abdomen is occupied by the
Room of Sperm and it is therefore ‘Empty’, also because
sperm is easily discharged while Blood is not (see Fig.
2.1 in Ch. 2).
The book Elementary Medicine (1575) says:
CONCEPTION
Active from
birth
Pre-Natal Essence of fetus
Active from
puberty
Post-Natal Qi
supplements it
YANG ASPECT
Minister Fire
YIN ASPECT
Essence (sperm, ova)
Pre-Natal of Pre-Natal
FIRE
Post-Natal of Pre-Natal
WATER
Figure 4.3 Minister Fire and Essence.
Although some practitioners consider the lubricating
fluids secreted by the Bartholin’s glands during sexual
arousal in a woman to be also a manifestation of Essence
comparable to sperm, I tend to disagree because such
fluids are secreted by glands in the vagina and not by
sex glands (such as the ovaries in women or testicles in
men): I would therefore consider these fluids precisely as
a form of Body Fluids (jin ye) rather than a direct manifestation of Essence. In fact, the Bartholin’s glands in the
vagina are homologous to the Cowper’s glands in men
and their function is purely lubricative. In other words,
sperm is a direct manifestation of the Essence, the equivalent of which would be the ova and menstrual blood in
women: the former is lost in men’s orgasm, the latter are
not lost in women’s orgasm (Fig. 4.4).
Furthermore, the Lower Field of Elixir (Dan Tian)
in men contains the Room of Sperm which is directly
related to the Essence, while in women it contains the
Uterus which is related to Blood. The Room of Sperm is
related to the Kidneys while the Uterus is related also to
the Liver and Blood: hence sexual activity will weaken
the Kidneys and the Essence in men but not in women.
Because the Lower Field of Elixir in women contains
The Room of Sperm in men suffers no accumulation or
fullness, while the Blood Chamber in women suffers from
accumulation and it overflows downwards in the period
… [The Lower Dan Tian] in men stores Essence [=sperm]
while in women it stores the Uterus and fetus. Men pertain
to Qi and when it mixes with the Abysmal [the trigram
corresponding to Water], Qi makes Water steam and produces sperm which is white … Women pertain to Blood,
when this mixes with the Clinging [the trigram corresponding to Fire], Blood is transformed into the period
which is red.25
In a nutshell, both men and women obviously have
Essence, but in women this is not lost through the sexual
act. Hence, compared to men’s, women’s sexual physiology is more complex. In men, sperm is a direct manifestation of Essence, it is responsible for fertility, it is ejaculated
during orgasm and it may lead to conception. In women,
the ova are a direct manifestation of Essence, they are
responsible for fertility and the orgasm has no relation
with them. Moreover, menstrual blood is also partly
responsible for fertility and is an indirect manifestation of
Essence (Tian Gui). Thus in men, Essence, sperm, orgasm
and conception all occur in a single act along the same
axis, while in women, fertility, conception and orgasm
occur along three separate axes as follows:
•
Men:
Essence = sperm = fertility = orgasm = conception.
Women:
• Blood = menses = fertility
• Essence = ova = fertility = conception
• Orgasm.
•
•
However, excessive sexual activity does affect women
too, albeit to a much lesser degree than men. One particular case of excessive sexual activity in women is that
occurring at a very early age around puberty. Excessive
sexual activity (or indeed, any sexual activity) at an
early age seriously weakens the Kidneys and injures
the Directing and Penetrating Vessels from the point
of view of Chinese medicine. When excessive and/or
90 Section 2: Aetiology and Diagnosis
BLOOD = Uterus
Ovary
ESSENCE = Ova
Uterus
Vagina
Testis
= Essence
= Sperm
= Orgasm
Fluids = Bartholin glands
= Orgasm
Figure 4.4 Sexual differences between men and women.
early sexual activity affects women, it has serious consequences because they lose blood monthly. The Secret
Records of Master Feng’s Brocade Bag says:
Excessive sexual activity greatly damages the Essence of
both men and women. Diseases deriving from excessive
sexual activity have more serious consequences in women
as they are also subject to leucorrhoea and labour which
damage Qi and Blood. Thus it is even more important
for a woman to have a calm mind and restrain sexual
activity.26
Interestingly, this coincides with the Western medical view according to which excessive sexual activity at
an early age predisposes girls to cervical cancer. In fact,
during the teenage years, with the onset of ovulation
and the change in vaginal pH, active squamous metaplasia is taking place in the cervix; during this time of
cellular immaturity and vulnerability, a carcinogen is
most likely to have an influence on the squamous epithelium and this predisposes the girl to cervical cancer later in life.27 This is in perfect agreement with the
Chinese view of puberty as a very vulnerable and delicate stage in a woman’s life.
Another example of sexual activity as a cause of disease in women is when a woman has sex during her
period. During menstruation there is a downward
movement of Blood whereas during sexual intercourse there is an upward flow of Qi along the vagina
towards the uterus, and, after ejaculation, a migration
of sperm upwards along the vagina and tubes. The
clash of these two forces gives rise to stagnation and,
if this practice occurs regularly, it may cause dysmenorrhoea. Having sexual intercourse soon after the end
of the period (within 1 or 2 days) may cause irregular menstrual bleeding because sexual arousal causes
the cervix to open and therefore may induce bleeding
to start again.
Aetiology 91
Fu Qing Zhu often mentions sexual intercourse during or soon after the end of the period as a cause of
heavy menstrual bleeding. He says:
Some women engage in sexual intercourse that leads to
unstoppable bleeding … If a woman has sexual intercourse during the period, sperm travels upwards along the
[woman’s] blood vessels … One should know that the blood
vessels are tender and should be protected from injury
by sperm … If sperm is ejaculated into the uterus when
the menstrual flow is surging and gushing out, the blood
will retreat and contract … and the sperm will gather and
transform Blood.28
This passage clearly implies that sexual intercourse
during the period causes stasis of Blood in the woman.
In another chapter, commenting on the fact that
some women develop profuse menstrual bleeding after
the period, Fu Qing Zhu says:
When a woman is aroused the uterus is wide open and
the Imperial and Minister Fire are stirred … the Essence
chamber is agitated and the Sea of Blood overflows and
cannot be contained. The Liver, which likes storage, cannot
store Blood; the Spleen, which likes containment, cannot
contain Blood. Thus, menstrual flow follows sexual intercourse like an echo follows a sound.29
Chinese medicine texts also advise women against
having sex in the first 3 and last 3 months of pregnancy, i.e. sexual activity is not detrimental in the
fourth, fifth and sixth months of pregnancy. However,
not all doctors agree with this. For example, Fu Qing
Zhu advises against having sexual intercourse during
pregnancy and says:
orgasm is a release of such accumulated Yang energy
and, under normal circumstances, it is a beneficial
discharge of Yang-Qi and it promotes the free flow of
Qi. When sexual desire builds up, the Minister Fire is
stirred: this affects the Mind and, in terms of organs,
specifically the Heart and Pericardium. The Heart is
connected to the Uterus via the Uterus Vessel and the
orgasmic contractions of the uterus discharge the
accumulated Yang energy of the Minister Fire.
When sexual desire is present but does not have an
outlet in sexual activity and orgasm, the Minister Fire
can accumulate and give rise both to Blood-Heat and
to stagnation of Qi in the Lower Burner. This accumulated Heat will stir the Minister Fire further and harass
the Mind, while the stagnation of Qi in the Lower
Burner can give rise to gynecological problems such as
dysmenorrhoea.
Of course, if sexual desire is absent, then lack of sexual activity will not be a cause of disease. Conversely, if
one abstains from sexual activity but the sexual desire
is strong, this will also stir up the Minister Fire. Thus,
the crucial factor is the mental attitude.
With regard to sexual frustration, Qing dynasty’s
Chen Jia Yuan wrote very perceptively about some
women’s emotional longing and loneliness. Among the
emotional causes of disease, he distinguishes ‘worry
and pensiveness’ from ‘depression’. He basically considers depression, with its ensuing stagnation, due
to emotional and sexual frustration and loneliness.
He says:
Women should refrain from sexual intercourse during
pregnancy; if one does not abstain, a miscarriage might
occur. If a miscarriage does not occur, the child might be
difficult to rear. Take care! Guard against it!30
In women … such as widows, Buddhist nuns, servant girls
and concubines, sexual desire agitates [the Mind] inside
but cannot satisfy the Heart. The body is restricted on the
outside and cannot expand with the mind [i.e. the mind
longs for sexual satisfaction but the body is denied it]. This
causes stagnation of Qi in the Triple Burner and the chest;
after a long time there are strange symptoms such as a
feeling of heat and cold as if it were malaria but it is not.
This is depression.31
Chinese medicine has always stressed the importance of excessive sexual activity as a cause of disease
but not insufficient sexual activity. Especially in Western
women, this is often a cause of disease somewhat akin
to emotional stress. Sexual desire depends on the
Minister Fire and a healthy sexual appetite indicates
that this Fire is abundant. When sexual desire builds
up, the Minister Fire blazes up and Yang increases: the
Although the above thoughts derive from Dr Chen’s
clinical experience with servant girls, Buddhist nuns
and concubines and should therefore be seen in the
social context of the Qing dynasty, they also have relevance to our times as he is essentially talking about
sexual frustration and loneliness and his reference
to widows confirms this (in old China, widows were
shunned and seldom remarried). He perceptively refers
92 Section 2: Aetiology and Diagnosis
to sexual craving agitating the body but not finding a
satisfaction in the Heart and Mind: besides sexual frustration, he is also referring to emotional frustration
and craving for love. As sexual frustration in women
is fairly common in our society (often deriving from
men’s sexual inadequacy or inexperience), Dr Chen’s
observations on the influence of sexual frustration
on stagnation of Qi and depression acquire particular
relevance.
Finally, although Chinese medicine traditionally
stresses the importance of excessive sexual activity as a cause of disease, the broader Daoist tradition also considers the beneficial effects of sexual
activity. Briefly, these emanate from the meeting of
Water (women) and Fire (men), i.e. the quintessential Yin and Yang. Water and Fire are opposites but
complementary and the exchange of energy occurring during the sexual act can be such that women
absorb Yang energy and men Yin energy. Specifically,
through kissing and genital contact during sex, there
is a beneficial exchange of energy and fluids between
the Governing and Directing Vessels of the two partners. This also leads to the spanning of the ‘bridge’ in
the Governing–Directing Vessel circuit in the mouth
of both partners with a beneficial mobilization of
energy in these two vessels (Fig. 4.5).
Mouth
Du
Du
Ren
WOMAN
Ren
MAN
Genitals
Figure 4.5 Intersection of Governing and Directing Vessels
during sexual intercourse.
SUMMARY
Excessive/insufficient sexual activity
• Excessive sexual activity depletes the Kidneys
and can therefore be the cause of gynecological
problems such as amenorrhoea, scanty periods or a
delayed cycle
• Sexual activity may exhaust the Minister Fire by
depleting the Essence
• Excessive sexual activity does not affect women as
much as men
• In men, ejaculation is a direct (albeit temporary)
loss of Essence as sperm is derived directly from
the Essence. As there is no comparable loss in
women, there is no equivalent depletion after
sex
• In a nutshell, both men and women obviously have
Essence, but in women this is not lost through the
sexual act
• Sexual activity at an early age (around puberty)
seriously weakens the Kidneys and injures the
Directing and Penetrating vessels
• Having sex during the period may cause stagnation
and dysmenorrhoea
• Having sexual intercourse soon after the end of
the period (within 1 or 2 days) may cause irregular
menstrual bleeding because sexual arousal causes
•
•
•
•
•
•
•
the cervix to open and therefore may induce
bleeding to start again
Chinese medicine texts advise women against
having sex in the first 3 and last 3 months of
pregnancy, i.e. sexual activity is not detrimental in
the fourth, fifth and sixth months of pregnancy
Insufficient sexual activity may also become a
cause of disease
In women, this is often a cause of disease
somewhat akin to emotional stress
Sexual desire depends on the Minister Fire and a
healthy sexual appetite indicates that this Fire is
abundant
When sexual desire is present but does not have an
outlet in sexual activity and orgasm, the Minister
Fire can accumulate and give rise both to BloodHeat and to stagnation of Qi in the Lower Burner.
This accumulated Heat will stir the Minister Fire
further and harass the Mind, while the stagnation
of Qi in the Lower Burner can give rise to
gynecological problems such as dysmenorrhoea
The Daoist tradition considers the beneficial effects
of sexual activity
These emanate from the meeting of Water (women)
and Fire (men), i.e. the quintessential Yin and Yang
Aetiology 93
SURGERY AND HYSTERECTOMY
Abdominal surgery such as that following operations
for the removal of ovarian cysts, hysterectomy or endometriosis, often leads to the formation of adhesions. From
a Chinese medical perspective, women are particularly
prone to stagnation of Qi and/or Blood after abdominal
surgery. The reasons for this are two-fold: first, women are
more prone to Blood disharmonies, and second, the Lower
Field of Elixir (Dan Tian) in women contains the Uterus
which stores Blood, while in men it is Empty. Thus stasis
of Blood in the lower abdomen is much more common in
women and it often occurs after abdominal surgery.
As for hysterectomy, in addition to the possibility of
adhesions discussed above, this surgical procedure has
specific effects on women’s physiology. First of all, as
the Uterus stores Blood, its removal induces a certain
Blood deficiency. As the Uterus is related to the Kidneys
in several ways (through the Kidney channel, through
the Extraordinary Vessels and through the relationship
between Essence and Blood), a hysterectomy also induces
a Kidney deficiency: for this reason, the Kidney pulse
becomes Weak and Deep after this surgical operation.
Because a hysterectomy weakens Blood and the Kidneys,
the woman may feel very tired for several months after it.
However, if the cause of the hysterectomy was the presence of a large myoma (‘fibroid’) obstructing the proper
movement of Blood in the Lower Burner, a woman often
feels noticeably better after such an operation.
Uterus
Uterus
Ureter
Bladder
Cervix
Urethra
Vagina
Figure 4.6 Anatomy of uterus and bladder.
If there was stagnation of Qi in the Uterus before the
hysterectomy, with the removal of the uterus the Qi
stagnation is simply ‘transferred’ to the nearest organ,
i.e. the urinary bladder. It should be remembered that
the uterus and bladder are anatomically contiguous
and that for this reason the pathology of one organ
is easily transferred to the other (Fig. 4.6). Also, the
ureter passes under the uterine artery on its way to
the bladder and is very close to the cervix (Fig. 4.7).
Ureter
Uterine artery
Cervicovaginal
artery
Bladder
Figure 4.7 Anatomy of ureter and uterine artery.
94 Section 2: Aetiology and Diagnosis
From a Chinese point of view, the uterus and bladder are
closely related, so much so that the word bao was used
in the classics to mean both ‘uterus’ and ‘bladder’.
It is for this reason that when there is stagnation of
Qi in the Uterus, this stagnation is transferred to the
Bladder after a hysterectomy and many women start
experiencing urinary problems such as slight retention
of urine, discomfort, frequency, slight incontinence, etc.
Of course, such problems may also be due to a purely
mechanical cause such as bladder nerve damage during
the hysterectomy. These symptoms are usually wrongly
diagnosed as ‘cystitis’ and the connection with the hysterectomy is invariably denied by the medical profession:
antibiotics are prescribed unnecessarily, the problem
usually persists and, in addition, the woman may
develop candidiasis from the use of antibiotics. Seen
from a Chinese medical perspective, such urinary problems would fall under the category of Qi-Painful Urinary
Syndrome (Qi Lin) specifically from Qi stagnation.
The third effect of hysterectomy is very often the
development of occipital headaches. Although the
pathology of this phenomenon is more difficult to
explain, I have encountered it in practice very many
times. It is probably due to the severing of the Kidney
Channel following a hysterectomy so that the Kidney
channel fails to nourish the Bladder channel causing
dull headaches and stiffness along the course of this
channel in the neck.
SUMMARY
CONTRACEPTIVE PILL
As one author puts it, the literature on the contraceptive pill is “copious, complex, confusing and contradictory”,32 and analysis of it is well beyond the scope
of this book. Contraceptive pill use has been linked
with an increased risk of breast cancer (although
many studies do not show this), cervical cancer and
cardiovascular disease, and a decreased risk of ovarian and endometrial cancer. Absolute contraindications to the use of the contraceptive pill are considered to be:
•
•
•
•
past or present circulatory disease
liver disease
undiagnosed genital tract bleeding
oestrogen-dependent neoplasms.
From a Chinese perspective, long-term use of the contraceptive pill seems to induce a state of either Blood
deficiency (more commonly) or Blood stasis. Women
who stop using the contraceptive pill after some years
of use very often develop amenorrhoea or a very irregular, late cycle. Although this is sometimes due to
Blood stasis, in my experience it is more often due to
Blood deficiency with women manifesting all the symptoms and signs of this condition: a Pale tongue, tiredness, blurred vision and a Choppy pulse. In such cases,
it often takes a long time (several months) to restore the
menstrual cycle to normality.
PREVENTION AND HYGIENE
Surgery and hysterectomy
• Women are particularly prone to stagnation of Qi
and/or Blood after abdominal surgery
• Hysterectomy induces a certain Blood deficiency
and a Kidney deficiency
• If there was stagnation of Qi in the Uterus before
the hysterectomy, with the removal of the uterus
the Qi stagnation is simply ‘transferred’ to the
nearest organ, i.e. the urinary bladder, causing
urinary problems such as slight retention of
urine, discomfort, frequency, slight incontinence
• The third effect of hysterectomy is very often
the development of occipital headaches due to
the severing of the Kidney Channel following
a hysterectomy so that the Kidney channel fails
to nourish the Bladder channel causing dull
headaches and stiffness along the course of this
channel in the neck
Following on from everything that was said about the
aetiology of gynecological problems, we can formulate certain hygiene rules for women aimed at preventing such problems. An important principle underlying
many of these rules is the idea that the Uterus is in a
vulnerable state during each menstrual period, during
pregnancy and after childbirth. Every precaution that
applies to the time of the period applies all the more so
to the time after childbirth.
•
•
•
A woman should not have sex during the menstrual
period as this practice can cause stagnation of Qi
and Blood in the Uterus and heavy periods.
Exposure to cold and dampness during the menstrual period may cause Cold in the Uterus.
A woman should take care not to be exposed to cold
after sex as this may also cause Cold to invade the
Uterus.
Aetiology 95
•
•
•
•
•
•
•
•
•
•
•
•
•
A woman should not retain her urine and engage
in sexual intercourse with a very full bladder as this
may lead to stagnation in both the Uterus and the
Bladder.
Lifting during or immediately after the end of the
period may lead to sinking of Qi.
A pregnant woman should abstain from sex in the
first 3 and last 3 months of pregnancy.
It is important that a woman has adequate rest after
childbirth as resuming a normal routine of work
too soon is very depleting to Qi and Blood and the
Kidneys and Liver. However, too much rest and lying
down may also be harmful (leading to stagnation)
and moderate exercise is beneficial.
A pregnant woman should avoid emotional stress,
drugs and traumas during pregnancy.
It is important for a woman not to be exposed to Cold
after childbirth as this may cause Cold to invade the
Uterus leading to abdominal pain, or also the BloodConnecting channels leading to body aches.
A woman should take care not to work too much or
for too long hours during the period and after childbirth. Overwork at these times leads to deficiency
and sinking of Kidney-Qi: this can cause either a
prolapse or a slight incontinence of urine.
A woman should avoid the excessive consumption
of cold liquids and foods during the periods as these
may cause painful period or Painful Obstruction
Syndrome.
A woman should not drink alcohol during the periods as these may cause reckless blood in the limbs
(i.e. circulatory troubles in the limbs).
A woman should not get angry during the periods
as this may cause the period to stop.
Women should consume Blood-nourishing foods
during the periods, such as egg yolk, liver, beef,
chicken, carrots, spinach, wood-ear mushrooms,
peanuts and Chinese red dates.
Women should avoid eating sour foods during the
periods as these, being astringent, may stop the
period short. Examples of sour foods are yoghurt,
vinegar, pickles, oranges and orange juice, grapefruit and their juice, gooseberries, blackcurrants
and redcurrants.
Recommended foods during the menopause years
are Shan Zha Fructus Crataegi, Suan Zao Ren Semen
Ziziphi spinosae, celery, Bai He Bulbus Lilii, chicken,
eggs, fish, milk, soya beans and their products and
lean meats.
END NOTES
1. Xu Shi Hong 1750 Most Valuable Treasure of Women and Babies
(Fu Ying Zhi Bao) cited in Zhang Qi Wen 1995 Menstrual Diseases
(Yue Jing Bing Zheng
), People’s Hygiene Publishing House,
Beijing, pp 29–30.
2. Wu Qian 1977 Golden Mirror of Medicine (Yi Zong Jin Jian
), People’s Health Publishing House, Beijing, p. 9. First
published in 1742.
3. Shen Yao Feng 1850 Summary of Gynaecology (Nu Ke Ji Yao
), 1988 reprint, People’s Health Publishing House,
Beijing, p. 15.
4. Golden Mirror of Medicine, p. 9.
5. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Di Nei Jing Su Wen
), People’s
Health Publishing House, Beijing, p. 197. First published c. 100 BC.
6. Golden Mirror of Medicine, p. 9.
7. 1981 Spiritual Axis (Ling Shu Jing
), People’s Health
Publishing House, Beijing, p. 24. First published c. 100 BC.
8. Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi
Shu Ba Zhong
). Ancient Chinese Medical Books
Publishing House, Beijing, p. 152. Chen’s book, written during the
Qing dynasty (1644–1911) was entitled Secret Gynaecological
Prescriptions (Fu Ke Mi Fang
), and published in 1729.
9. Zhang Jing Yue 1982 Classic of Categories (Lei Jing
), People’s
Health Publishing Company, Beijing, Chapter 216, p. 561. The
Classic of Categories was first published in 1624.
10. Chen Zi Ming 1237 Great Treatise of Beneficial Formulae for Women
(Fu Ren Liang Fang Da Quan) cited in Menstrual Diseases, pp 9–10.
11. Great Treatise of Beneficial Formulae for Women cited in Menstrual
Diseases, p. 9.
12. Golden Mirror of Medicine, p. 9.
13. Eight Secret Books on Gynaecology, p. 152.
14. Obviously, in countries where bovine spongiform encephalopathy (BSE)
is prevalent, marrow and brain of beef should not be eaten.
15. Simple Questions, p. 154.
16. Eight Secret Books on Gynaecology, p. 152.
17. Simple Questions, p. 154.
18. Ye Tian Shi 1817 Secret Prescriptions for Gynaecological Patterns
and Treatment by Ye Tian Shi (Ye Tian Shi Nu Ke Zheng Zhi Mi Fang),
cited in Luo Yuan Kai 1986 Gynaecology in Chinese Medicine (Zhong
Yi Fu Ke Xue
), Shanghai Science and Technology Press,
Shanghai, p. 48.
19. E M Symonds 1994 Essential Obstetrics and Gynaecology,
Churchill Livingstone, Edinburgh, p. 112.
20. McPherson A 1993 Women’s Problems in General Practice,
Oxford University Press, Oxford, p. 18.
21. Baum M, Saunders C, Meredith S 1994 Breast Cancer, Oxford
University Press, Oxford, p. 136.
22. Harris R, Whittemore A S, Itnyre J 1992 Characteristics Relating to
Ovarian Cancer Risk: Collaborative Analysis of 12 US Case-Control
Studies, American Journal of Epidemiology 136: 1184–1203.
23. Golden Mirror of Medicine, Vol. 3, p. 64.
24. Ibid., p. 72.
25. 1575 Elementary Medicine (Yi Xue Ru Men) cited in Menstrual
Diseases, p. 10.
26. Feng Tao Zhang 1702 Secret Records of Master Feng’s Brocade Bag
(Feng Shi Jin Nang Mi Lü) cited in Menstrual Diseases, p. 14.
27. Clarke-Pearson D L, Yusoff Dawood M 1977 Green’s Gynaecology:
Essentials of Clinical Practice, Fourth Edition, Little, Brown and Co.,
Boston, p. 509.
28. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai, p. 10.
First published in 1827. Fu Qing Zhu was born in 1607 and died in 1684.
29. Ibid., p. 13.
30. Ibid., p. 10.
31. Eight Secret Books on Gynaecology, p. 152.
32. Women’s Problems in General Practice, p. 59.
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CHAPTER 5
DIAGNOSIS
INTERROGATION 98
Menstruation 98
Pain 102
Vaginal discharge 103
Fertility and pregnancy 103
Childbirth 103
Miscarriage and abortion 103
PALPATION 104
Pulse 104
Skin 108
Abdomen 108
OBSERVATION 109
Complexion 109
Lips 111
Tongue 111
AUSCULTATION 117
Hearing 117
Smelling 117
Diagnosis in gynecology naturally follows the same
basic principles as in other diseases and is articulated
in the four methods of interrogation (‘asking’), palpation (‘touching’), observation (‘looking’) and auscultation (‘hearing and smelling’).
These diagnostic methods are aimed at identifying both the Chinese disease-symptom (bian bing) and
the pattern (bian zheng). Chinese disease-symptoms of
course differ from the Western concept of ‘disease’ and
there is no direct correspondence between the two. In
a Western sense, Chinese disease-symptoms are obviously not ‘diseases’. For example, ‘Painful Periods’
(Tong Jing) is a ‘disease’ category in Chinese gynecology
but in Western medicine is a symptom, not a disease.
The Western diseases which might cause this symptom
are, for example, endometriosis, pelvic inflammatory
disease or myoma.
However, to diagnose a condition correctly and to find
the appropriate strategy and method of treatment, it is
essential to identify the Chinese disease-symptom first:
this procedure is called bian bing, which literally means
‘differentiating the disease’. This should be done before
identifying the pattern (bian zheng) because, even if this
is diagnosed correctly, the treatment will not be focused
if the disease is not identified too. For example, a case of
abnormal uterine bleeding could fall into any of the following categories of Chinese disease-symptoms: ‘Early
Periods’ (Yue Jing Xian Qi), ‘Late Periods’ (Yue Jing Hou
Qi), ‘Irregular Periods’ (Yue Jing Xian Hou Wu Ding Qi),
‘Heavy Periods’ (Yue Jing Guo Duo), ‘Scanty Periods’ (Yue
Jing Guo Shao), ‘Prolonged Periods’ (Jing Qi Yan Chang),
‘Bleeding between Periods’ (Jing Jian Qi Chu Xue),
or ‘Menorrhagia/Metrorrhagia’ (Beng Lou).
Each of these Chinese disease categories has its own
peculiar aetiology, pathogenesis and therefore treatment method, and simply to identify the pattern in
order to treat them would not suffice. For example,
Blood-Heat is a pattern that might cause ‘Early Periods’,
‘Heavy Periods’, ‘Prolonged Periods’, ‘Bleeding between
Periods’ or ‘Menorrhagia’, but the formula used to treat
Blood-Heat would be different in each disease category.
Thus, if one were to ask how to treat ‘endometriosis’,
the answer would be that by identifying the Chinese
‘disease’ accurately (bian bing) and diagnosing the pattern correctly (bian zheng), one arrives at the appropriate treatment method.
Thus, for each Chinese ‘disease’ there are several patterns. For example, the disease of ‘Painful Periods’ may
manifest with several patterns such as Liver-Qi stagnation, Liver-Blood stasis, Cold in the Uterus, Damp-Heat
in the Uterus (Fig. 5.1). On the other hand, each pattern may be found in many different diseases and the
important point is that, although the pattern is the
same, its treatment will differ somewhat according
to the disease with which it is manifesting. For example, the pattern of Liver-Blood stasis may be found in
98 Section 2: Aetiology and Diagnosis
Disease
Patterns
Qi stagnation
Painful
periods
Blood stasis
Cold in the Uterus
provide a lasting cure for this condition (even though it
might help to a certain extent).
The discussion of diagnosis in gynecology will be
carried out according to the following topics:
•
•
•
•
Interrogation.
Palpation.
Observation.
Auscultation.
Dampness in the Uterus
Figure 5.1 Identification of disease and identification of
pattern: one disease, many patterns.
INTERROGATION
The main areas of questioning are:
Pattern
Diseases
Pre-menstrual syndrome
Qi
stagnation
•
•
•
•
•
menstruation
pain
vaginal discharge
fertility, pregnancy and childbirth
miscarriage, abortion.
Irregular periods
Menstruation
Painful periods
Asking about menstruation is of course an absolutely
essential part of diagnosis. One should ask a female
patient about the menarche, cycle, amount, colour,
consistency, pain, pre-menstrual symptoms, and other
symptoms occurring at period time. When describing
the areas of questioning with regard to menstruation,
I am assuming the woman is not on the contraceptive pill or other forms of hormones and has not been
fitted with an intra-uterine device (IUD). Obviously,
the answers to questions are unreliable if the woman
is on the contraceptive pill or has an IUD. The contraceptive pill changes the cycle, amount, colour, consistency and pain of the period: it usually makes the cycle
regular, the period scanty, the colour lighter, the consistency usually without clots and the period painless.
The IUD makes the periods heavier and more painful.
In such cases, it is important to ask the patient what
her menstrual cycle was like before she began using the
contraceptive pill or IUD.
Abdominal pain after childbirth
Figure 5.2 Identification of disease and identification of
pattern: one pattern, many diseases.
many different gynecological diseases such as ‘Heavy
Periods’, ‘Flooding and Trickling’, ‘Painful Periods’,
‘Bleeding between Periods’, ‘Abdominal Masses’, etc.
and its treatment will differ in each case (Fig. 5.2).
However, there is a very important caveat here.
Although I have just said that identification of the
(Chinese) disease and pattern is sufficient to treat any
gynecological condition, this does not mean that we
can ignore the Western diagnosis. This is extremely
important for prognosis. For example, dysmenorrhoea
due to endometriosis is definitely more difficult to treat
than purely functional dysmenorrhoea. Another obvious example would be that of uterine bleeding after the
menopause: since this may be a sign of cervical cancer
it would be totally wrong simply to treat it as menorrhagia without recourse to a proper Western diagnosis.
Yet another example is that of a breast lump: we would
definitely need to know whether it is benign or malignant. A Western diagnosis is also extremely important
to identify cases which Chinese medicine cannot cure.
For example, if heavy menstrual bleeding is due to a
large myoma, it is unlikely that Chinese medicine can
Menarche
The age of menarche ranges between 10 and 16 with
a mean at 12.8. Menarche tends to occur at a younger
age in industrialized countries compared with developing, agricultural societies. Early menarche (i.e. before
about 13) may indicate Blood-Heat while late menarche (after about 16) may indicate Blood and/or Kidney
deficiency.
Diagnosis 99
Why do we need to ask about the menarche and
how the periods were then? It might be argued that
it does not matter how the periods were then because
we must always treat a woman for the condition as it
is at the time of treatment, not years earlier. However,
it is important to ask about the menarche and how the
periods were then. First of all, when forming an opinion about the menstrual history at the time of menarche, we should always ask how the periods were about
2 years after menarche. This is because it takes about
that time for the periods to settle down into some kind
of regular cycle (if there is one). The reason it is important to ask about the menstrual history around the
time of menarche is to form an idea about the menstrual constitution of a woman. This is also important
when there are deviations from this constitution. For
example, if a woman’s periods always lasted 5 days,
then that means that 5 days is her menstrual constitution which has not changed over the years. But say
we see a 40-year-old woman coming to us for infertility
and she tells us that her periods now last 5 days. Five
days is not abnormal and indeed it suggests normality. However, if her periods lasted 7 days when she was
young about 2 years after the menarche and continued
to last 7 days until she was about 32, this suggests that
her menstrual constitution is 7 days and she is now
deviating from this constitution. This indicates that she
suffers from a slight Blood deficiency (because the periods have gone from lasting 7 days to lasting 5 days).
By contrast, if a woman’s periods had always lasted 5
days, then we could not diagnose that she suffers from
Blood deficiency.
SUMMARY
Menarche
• The age of menarche ranges between 10 and 16
with a mean at 12.8
• Early menarche (i.e. before about 13) may indicate
Blood-Heat while late menarche (after about 16)
may indicate Blood and/or Kidney deficiency
• We should always ask how the periods were
about 2 years after menarche
• It is important to ask about the menstrual history
around the time of menarche to form an idea
about the menstrual constitution of a woman
• This is important when there are deviations from
this constitution
Cycle
The length of the cycle is ideally 28 days but it may
vary from this norm but this should not be interpreted too rigidly. The regularity of the cycle is somewhat more important than its absolute value; thus, if
the cycle is consistently of 32 days, this can be deemed
normal and would not be considered as ‘late periods’.
Moreover, an occasional deviation from a regular cycle
should not be considered abnormal as the menstrual
cycle is influenced by many factors such as travelling,
emotional stress, etc. The following are the main areas
of questioning with regard to the cycle:
•
•
•
Always early (i.e. more than 5 days early): either Qi
deficiency or Blood-Heat.
Always late (i.e. more than 5 days late): Blood
deficiency, stasis of Blood or stasis of Cold.
Irregular (sometimes late, sometimes early):
stagnation of Liver-Qi, stasis of Liver-Blood, Spleen
deficiency or Kidney deficiency.
It should be borne in mind that for approximately the
first 2 years from menarche, the menstrual cycle may be
somewhat irregular: this is quite normal. To have an idea
as to how the periods were in the beginning, I therefore
always ask how they were about 2 years after menarche.
The Golden Mirror of Medicine says: “When periods come
early, it is due to Heat, when late, it is due to Blood stasis.”1
SUMMARY
Cycle
• Always early (i.e. more than 5 days early): either
Qi deficiency or Blood-Heat
• Always late (i.e. more than 5 days late) : Blood
deficiency, stasis of Blood or stasis of Cold
• Irregular (sometimes late, sometimes early):
stagnation of Liver-Qi, stasis of Liver-Blood,
Spleen deficiency or Kidney deficiency
Amount
The loss of blood during menstruation can vary
between 30 and 80 ml. A period is defined as ‘heavy’ if
the loss of blood is either profuse or prolonged or both.
A heavy loss of blood is due to either Qi deficiency or
Blood-Heat (depending on colour; see below). If the
period is scanty, it denotes either Blood deficiency, stasis of Blood or Cold in the Uterus.
100 Section 2: Aetiology and Diagnosis
SUMMARY
Amount
• The loss of blood during menstruation can vary
between 30 and 80 ml
• A heavy loss of blood is due to either Qi deficiency
or Blood-Heat
• If the period is scanty, it denotes either Blood
deficiency, stasis of Blood or Cold in the Uterus
Consistency
The normal flow does not coagulate and there are no
clots; the blood is neither dilute nor thick. The following are the main areas of questioning with regard to
the consistency of menstrual blood:
•
•
•
•
•
Clotted, with dark, dull clots: stasis of Blood/Cold.
Clotted, with dark but fresh-looking clots: Heat.
Large clots: stasis of Blood.
Small dark clots, but blood not dark: stasis of Cold.
Watery: Blood or Yin deficiency.
Colour
SUMMARY
The colour of the menstrual blood varies slightly
during the period. In general, it is usually dark-red,
being lighter at the beginning, deep-red in the middle, and pinkish at the end of the period. The following are the main areas of questioning with regard
to colour:
•
•
•
•
•
•
Dark-red or bright-red: Blood-Heat.
Pale: Blood deficiency.
Blackish, very dark: stasis of Blood.
Purplish: Full-Cold.
Brownish like soya bean sauce and dilute: Empty-Cold.
Scarlet-red: Empty-Heat in Blood.
The Golden Mirror of Medicine says:
When the colour [of menstrual blood] is pale and amount
scanty, it is due to Deficiency, the period is not usually
painful; if the colour is dark and the amount heavy and
there is pain, it is due to Fullness.2
SUMMARY
Colour
• The colour of the menstrual blood is usually
dark-red, being lighter at the beginning, deepred in the middle, and pinkish at the end of the
period
• Dark-red or bright-red: Blood-Heat
• Pale: Blood deficiency
• Blackish, very dark: stasis of Blood
• Purplish: Full-Cold
• Brownish like soya bean sauce and dilute:
Empty-Cold
• Scarlet-red: Empty-Heat in Blood
Consistency
•
•
•
•
•
Clotted, with dark, dull clots: stasis of Blood/Cold
Clotted, with dark but fresh-looking clots: Heat
Large clots: stasis of Blood
Small dark clots, but blood not dark: stasis of Cold
Watery: Blood or Yin deficiency
Pain
Apart from a slight discomfort, normally the period
should be almost painless. The main areas of questioning with regard to menstrual pain are as follows:
•
•
•
•
•
•
•
•
•
Pain before the period: stagnation of Qi or stasis of
Blood (the latter is typically relieved by the onset of
the period and especially by the passing of dark clots).
Pain during the period: Blood stasis or Blood-Heat.
Pain after the period: Blood deficiency.
Severe, stabbing pain: stasis of Blood.
Severe, cramping pain, eased by application of heat
(such as a hot-water bottle): stasis of Cold.
Mild pain: either Blood-Heat or deficiency of Blood.
Dragging feeling in the lower abdomen with mild
pain: sinking of Qi.
Feeling of heaviness in the lower abdomen with
pain: Dampness.
Pain on ovulation: Dampness.
SUMMARY
Pain
• Pain before the period: stagnation of Qi or
stasis of Blood
• Pain during the period: Blood stasis or Blood-Heat
Diagnosis 101
• Pain after the period: Blood deficiency
• Severe, stabbing pain: stasis of Blood
• Severe, cramping pain, eased by application of
heat (such as a hot-water bottle): stasis of Cold.
• Mild pain: either Blood-Heat or deficiency of Blood
• Dragging feeling in the lower abdomen with mild
pain: sinking of Qi
• Feeling of heaviness in the lower abdomen with
pain: Dampness
• Pain on ovulation: Dampness
• Headaches before the period: Liver-Qi stagnation
or Liver-Yang rising
• Distension of the breasts: Liver-Qi stagnation
• Breast distension, swelling and pain: Qi stagnation
with Phlegm
• Retention of water with oedema before the
period: Spleen-Yang and/or Kidney-Yang
deficiency
• Pre-menstrual irritability with insomnia and
thirst: Liver-Fire and/or Heart-Fire
Pre-menstrual symptoms
Pre-menstrual tension with irritability, depression, tendency to crying, etc., indicates Liver-Qi stagnation, especially if accompanied by abdominal or breast distension.
Nausea or vomiting before the period denotes
stagnant Liver-Qi invading the Stomach, while premenstrual constipation indicates stagnant Liver-Qi
invading the Intestines and Spleen.
Headaches before the period indicate Liver-Qi stagnation or Liver-Yang rising. Distension of the breasts
denotes Liver-Qi stagnation, but if the breasts become
very swollen and painful, it may denote Phlegm (which,
in pre-menstrual problems, usually combines with Qi
stagnation).
Retention of water with oedema before the period
indicates Spleen-Yang and/or Kidney-Yang deficiency.
Pre-menstrual irritability with insomnia and thirst
may be due to Liver-Fire and/or Heart-Fire.
Other symptoms
Headaches that occur during the period are usually due to Liver-Yang rising or Liver-Fire blazing,
these occurring against a background of Blood-Heat.
Headaches occurring after the period indicate LiverBlood deficiency.
Constipation before the period is due to Liver-Qi stagnation or Cold in the Uterus; during the period, it may
be due to Liver-Fire; constipation after the period is due
to Blood or Kidney deficiency.
Insomnia during the period indicates Blood-Heat,
often with Liver-Fire and/or Heart-Fire. Insomnia after
the period denotes Blood deficiency.
Diarrhoea after the period indicates Spleen-Yang
and/or Kidney-Yang deficiency.
!
SUMMARY
Please note that not all pre-menstrual symptoms are
due to Liver-Qi stagnation.
Other symptoms
SUMMARY
Pre-menstrual symptoms
• Pre-menstrual tension with irritability, depression,
tendency to crying, breast and/or abdominal
distension: Liver-Qi stagnation
• Nausea or vomiting before the period: stagnant
Liver-Qi invading the Stomach
• Pre-menstrual constipation: stagnant Liver-Qi
invading the Intestines and Spleen
• Headaches during the period: Liver-Yang rising or
Liver-Fire blazing
• Headaches after the period: Liver-Blood deficiency
• Constipation before the period: Liver-Qi
stagnation or Cold in the Uterus
• Constipation during the period: Liver-Fire
• Constipation after the period: Blood or Kidney
deficiency
• Insomnia during the period: Blood-Heat, often
with Liver-Fire and/or Heart-Fire
• Insomnia after the period: Blood deficiency
• Diarrhoea after the period: Spleen-Yang and/or
Kidney-Yang deficiency
102 Section 2: Aetiology and Diagnosis
Pain
•
Apart from the pain occurring during the period itself,
many women suffer from lower abdominal pain in
general. From a Western point of view, it is obviously
all-important to distinguish whether the pain is of intestinal or gynecological origin. In Chinese medicine, this
distinction is somewhat blurred and, strictly speaking,
not that important from the point of view of treatment.
What matters most is the correct diagnosis and identification of the pattern according to the basic principles of
Heat, Cold, Full, Empty, Pathogenic Factors and internal organs. Thus, a woman who complains of painful
periods may well suffer from abdominal pain at other
times too, the two types of pain having a common root
(e.g. Qi stagnation, Blood stasis, Dampness, etc.).
As for the significance of the area of pain, the central
area of the lower abdomen below the umbilicus is called
xiao fu, i.e. ‘small abdomen’, whereas the lateral sides
of the abdomen are called shao fu, i.e. ‘lesser abdomen’
(Fig. 5.3). Pain in the central area of the lower abdomen
(the ‘small abdomen’) is usually related to the Kidneys
and the Directing Vessel. Pain in the lateral sides of the
abdomen (the ‘lesser abdomen’) is usually related to the
Liver channel and the Penetrating Vessel.
The following are therefore the main areas of interrogation with regard to abdominal pain:
•
•
•
Dull ache: deficiency-type pain.
Severe pain: excess-type pain.
Pain that is relieved by the application of heat: Cold.
•
•
•
•
•
•
•
•
•
•
•
Pain that is relieved by pressure or massage:
deficiency-type pain.
Pain that is aggravated by pressure or massage:
excess-type pain.
Stabbing pain: stasis of Blood.
Cramping, spastic pain: Cold.
Pain with feeling of heaviness: Dampness.
Ache with a dragging-down feeling: sinking of Qi
(of Spleen and/or Kidneys).
Abdominal pain extending to the back: Kidney
deficiency.
Lower backache extending to the front: Girdle Vessel
pathology (usually deficiency).
Lower abdominal pain radiating to the back: Girdle
Vessel pathology (usually excess in the form of
Dampness).
Umbilical pain along a line with backache radiating
to thighs: Girdle Vessel pathology.
Unilateral abdominal pain with distension and
feeling of masses: Yin Stepping Vessel (Yin Qiao Mai)
pathology, usually stagnation of Qi and/or Blood;
although this type of pain is also related to the Liver
channel, it will respond well to treatment of the Yin
Stepping Vessel.
Lower abdominal pain with a sense of energy
rising towards the chest and a feeling of tightness
there: Penetrating Vessel (Chong Mai) pathology
(rebellious Qi).
SUMMARY
Pain
•
•
•
•
•
•
•
•
•
SHAO FU
XIAO FU
•
•
Figure 5.3 ‘Small abdomen’ and ‘lesser abdomen’.
Dull ache: deficiency-type pain
Severe pain: excess-type pain
Pain that is relieved by the application of heat: Cold
Pain that is relieved by pressure or massage:
deficiency-type pain
Pain that is aggravated by pressure or massage:
excess-type pain
Stabbing pain: stasis of Blood
Cramping, spastic pain: Cold
Pain with feeling of heaviness: Dampness
Ache with a dragging-down feeling: sinking of Qi
(of Spleen and/or Kidneys)
Abdominal pain extending to the back: Kidney
deficiency
Lower backache extending to the front: Girdle
Vessel pathology (usually deficiency)
Diagnosis 103
• Lower abdominal pain radiating to the back:
Girdle Vessel pathology (usually excess in the form
of Dampness)
• Umbilical pain along a line with backache
radiating to thighs: Girdle Vessel pathology
• Unilateral abdominal pain with distension and
feeling of masses: Yin Stepping Vessel (Yin Qiao Mai)
pathology, usually stagnation of Qi and/or Blood
• Lower abdominal pain with a sense of energy
rising towards the chest and a feeling of tightness
there: Penetrating Vessel (Chong Mai) pathology
(rebellious Qi)
This can occur against a background of Stomach deficiency or Stomach-Heat.
Oedema during pregnancy indicates Kidney-Yang
deficiency. High blood pressure denotes a Kidney deficiency with Liver-Yang rising or Liver-Wind: this may
herald a pre-eclampsia state which is also characterized by headache, dizziness and blurred vision. A full
eclampsia state manifests with convulsions which,
from a Chinese perspective, indicate the development
of Liver-Wind from Liver and Kidney deficiency.
SUMMARY
Fertility and pregnancy
Vaginal discharge
• Infertility from deficiency: Blood deficiency or
Kidney deficiency
• Infertility from excess: stasis of Blood, stasis of
Cold or Damp-Phlegm
• Vomiting during pregnancy: rebellious Qi in the
Penetrating Vessel affecting the Stomach channel
• Oedema during pregnancy: Kidney-Yang
deficiency
• High blood pressure: Kidney deficiency with LiverYang rising or Liver-Wind
Leucorrhoea must be differentiated according to
colour, consistency and smell. An increase in vaginal
secretions mid-cycle and during pregnancy is normal.
Colour
•
•
•
•
•
White: Cold. Cold can derive from Spleen- or KidneyYang deficiency, or from Exterior Cold-Dampness.
Yellow: Heat, usually Damp-Heat in the Lower
Burner.
Greenish: Damp-Heat in the Liver channel.
Red and white: Damp-Heat.
Yellow, red with white pus after menopause: ToxicHeat.
Childbirth
The following are the main areas of questioning with
regard to the conditions of labour:
Consistency
•
•
•
•
Watery: Cold-Dampness and/or deficiency
condition.
Thick: Damp-Heat and/or excess condition.
•
Nausea and heavy bleeding after labour: exhaustion
of the Penetrating Vessel.
Sweating and fever after labour: exhaustion of Qi
and Blood.
Post-natal depression: Liver- and Heart-Blood
deficiency.
Post-natal psychosis: stasis of Blood in the Uterus.
Smell
•
•
•
Miscarriage and abortion
Fishy: Cold.
Leathery: Heat.
Fertility and pregnancy
Infertility can be due to many different deficient or
excess conditions. Deficient ones are Blood deficiency
or Kidney deficiency. Full ones are stasis of Blood, stasis
of Cold or Damp-Phlegm.
Vomiting during pregnancy indicates rebellious Qi in
the Penetrating Vessel affecting the Stomach channel.
It is important to ask about miscarriages and abortion as they weaken a woman’s body. There is a saying in Chinese gynecology that states: “Miscarriage is
more serious than childbirth.” It is easy to understand
why this should be so: during a miscarriage there
is usually a heavy loss of blood; moreover, from a
mental–emotional point of view, it means a great loss
to the woman with ensuing sadness and grief, which
are often underestimated.
104 Section 2: Aetiology and Diagnosis
Abortion is also weakening but to a lesser degree
because there is not the loss of blood that occurs during
a spontaneous miscarriage. Therefore, when counting
the number of children a woman has had, if she has
two children and had two abortions and a miscarriage,
that counts as if she had had five children.
Miscarriage before 3 months indicates a Kidney
deficiency, while miscarriage after 3 months denotes
sinking of Spleen-Qi, Liver-Blood stasis or BloodHeat.
PALPATION
Diagnosis by palpation includes feeling the pulse and
skin and palpating the abdomen.
Men have less Yin and more Yang, women have less Yang
and more Yin. South corresponds to Fire and man, the two
Front pulse positions correspond to South and the original
Yang, hence they are big and overflowing while the two
rear positions are weak and soft. Women correspond to
North, and so the two Front pulse positions are fine and
weak while the two rear positions are big.6
It is interesting to note that this situation is hardly
ever encountered in practice in the West as women’s
pulses are, in my experience, more commonly weak on
the Rear position, perhaps indicating a decline of hereditary Kidney strength compared with previous generations. In my practice, out of nearly 2500 patients, I have
found that 21.5% of women have a very weak pulse on
both Rear positions, as opposed to 4.5% of men.
Pulse
All the normal considerations for pulse diagnosis apply
in gynecology. There are, however, some peculiar characteristics to pulse diagnosis in women which will be
discussed below.
Differences between men and women
in pulse diagnosis
There are some differences between the normal pulse
in females and that in males. First of all, a woman’s
pulse is naturally weaker than a man’s assuming
that they are of equal body size (to which the pulse
is related).
In women, the right-side pulse should be slightly
stronger (some say about 8%) than the left. Chapter 7
of the Pulse Classic says: “The left side [of the pulse] is
big in men, the right side is big in women.”3 Also, the Rear
pulses should be stronger than the Front ones. Chapter
19 of the Classic of Difficulties says:
In men the pulse [is found] above the Middle position, in
women below the Middle position. Thus, men’s pulse is
usually weak on the Rear position while women’s pulse is
strong on the Rear position: this is normal.4
Li Shi Zhen says something similar in his book The
Study of the Pulse from the Pin Hu Lake: “There are differences in the Rear position in men and women: in women
the Yang [i.e. the Front position] is weak and the Yin [i.e.
the Rear position] is strong.”5 Qing dynasty’s Chen Jia
Yuan says:
SUMMARY
Differences between men and women in
pulse diagnosis
• A woman’s pulse is normally weaker than a man’s
• In women, the right-side pulse should be slightly
stronger
• Classically, the Rear pulses are stronger than
the Front ones but this is rarely encountered in
practice in the West
Levels of the pulse
If we distinguish three levels of depth in the pulse,
the Middle level acquires particular importance in
women as it corresponds to Blood (the Superficial
level corresponding to Qi/Yang and the Deep level to
Yin). Chapter 18 of the Classic of Difficulties identifies
these three levels, while in Chapter 5 it differentiates
five levels corresponding to the five Yin organs; when it
describes the pressure to be applied to feel the different
levels, it relates this to the weight of beans (the commentary specifies that they are soya beans). It says:
If one feels the pulse applying a pressure equivalent to
three beans, this corresponds to the skin and the Lungs.
Six beans: it corresponds to Blood and the Heart. Nine
beans: it corresponds to the muscles and the Spleen. Twelve
beans: it corresponds to the sinews and the Liver. If one
presses the fingers down to the bone and then lifts them
slightly, it corresponds to the [bones and] the Kidneys.7
Diagnosis 105
Thus, although the text identifies five levels, the principle is the same insofar as the Blood is felt somewhere
in between the superficial level and the deep level.
If the pulse feels rather Weak and Soft at the Middle
level, it indicates Blood deficiency; although the above
passage from the Classic of Difficulties identifies this
level with the Heart, in women, it also reflects LiverBlood. If the pulse feels quite Full and Big at the Blood
level, it denotes Blood-Heat and the possibility of menorrhagia. If the pulse feels Wiry or Firm (lao) at this
level, it denotes Blood stasis.
SUMMARY
Levels of the pulse
• If we distinguish three levels of depth in the pulse,
the Middle level acquires particular importance in
women as it corresponds to Blood
• If the pulse feels rather Weak and Soft at the
Middle level, it indicates Blood deficiency
• If the pulse feels quite Full and Big at the Blood
level, it denotes Blood-Heat
• If the pulse feels Wiry or Firm it denotes Blood
stasis
Rear (Chi) position of the pulse
The Rear position of the pulse assumes particular
importance in women. It corresponds to the Kidneys,
the Fire of the Gate of Life (Ming Men), the Minister Fire
and the Uterus. The two positions as a whole therefore
reflect the state of Kidney-Yin, Kidney-Essence and
Kidney-Yang. As mentioned above, the Rear positions
are very often Weak and Deep in women, indicating a
high incidence of Kidney deficiency.
Although the left side corresponds to Kidney-Yin
and the right to Kidney-Yang, I do not find this distinction always reliable in practice and, in fact, one of the
most common pulse findings in practice in women is a
pulse that is Weak and Deep on both Kidney positions of
left and right. The distinction between Kidney-Yin and
Kidney-Yang deficiency can therefore be made only on
the basis of tongue and symptoms.
A Hollow quality on the Rear pulse in a woman indicates a possible haemorrhage (which may also be urinary) and irregular periods. The Hollow quality may
also appear after a serious haemorrhage.
According to the Pulse Classic, the right Rear position corresponds to the Uterus and the Triple Burner.
In Chapter 7 it says:
The right-Rear position corresponds to the Kidney. Since
this is interiorly–exteriorly related with the Greater
Yang, [the righ Rear pulse] also reflects the Bladder. It
also unites with the Triple Burner to the right of Ren-4
Guanyuan. On the left [of Ren-4] is the Kidney, on its
right the Uterus.8
Dr J H F Shen, however, feels the Uterus on the left
Rear position of the pulse rolling the finger proximally
very slightly (Fig. 5.4). While these two different interpretations are not necessarily mutually exclusive, I find
Dr Shen’s clinically more relevant. Perhaps the description of the pulse position of the Uterus and Triple
Burner by the Pulse Classic is more concerned with
the energetic aspect of the Uterus being linked to the
Motive Force (Dong Qi), which is where the extraordinary vessels start from, and to the concept of the Triple
Burner as the ‘ambassador’ or ‘avenue’ through which
the Fire of the Gate of Life emerges. Dr Shen’s interpretation has more to do with the Uterus as an anatomical
entity. Seen from this point of view, I find the assignment of the proximal part of the left Rear position to
the Uterus verified clinically.
An Empty and Weak quality on the proximal end of
the left Rear position indicates Blood and/or Kidney
deficiency with Emptiness of the Uterus, while a Wiry
quality here indicates stasis of Blood in the Uterus.
A Tight quality denotes Cold in the Uterus.
Front (Cun)
Middle (Guan)
Rear (Chi)
Uterus
Figure 5.4 Uterus position on the pulse.
106 Section 2: Aetiology and Diagnosis
chest and inability to take a supine position. The
Pulse Classic says:
In a girl of 14, if the Rear pulses (both left and right)
are Deep and Hidden, it may indicate amenorrhoea.
SUMMARY
Rear (Chi ) position of the pulse
• The Rear pulse position is very important in women
• It corresponds to the Kidneys, the Fire of the Gate
of Life (Ming Men), the Minister Fire and the Uterus
• The two positions as a whole therefore reflect the
state of Kidney-Yin, Kidney-Essence and KidneyYang
• A Hollow quality on the Rear pulse in a woman
indicates a possible haemorrhage (which may also
be urinary) and irregular periods
• An Empty and Weak quality on the proximal end
of the left Rear position indicates Blood and/or
Kidney deficiency with Emptiness of the Uterus,
• A Wiry quality in the above position indicates
stasis of Blood in the Uterus
• A Tight quality denotes Cold in the Uterus
A tight, thready and long pulse of the excess type at cun
region extending to guan region is the Ren Channel. Its
clinical manifestations include pain around the umbilicus,
seven types of hernia in men, and palpable masses in the
abdomen in women.
•
A solid pulse at the deep level extending to guan region
is due to the Penetrating Vessel. Clinical manifestations
include pain on the sides of the lower abdomen, an
uncomfortable feeling in the heart, hernia, enuresis, and
infertility in women.
•
Dr Chen Jia Yuan’s pulses in gynecology
Dr Chen Jia Yuan gives various pulse findings that
are relevant in gynecology.9 He say that a Deep and
Hidden pulse on both Rear positions indicates amenorrhoea; a Slippery quality on the Rear positions may
indicate leucorrhoea; a Choppy quality on the Middle
positions may indicate early menopause; if the Rear
position pulses are Floating and the Front ones Deep,
the fetus may die and the mother live; if the Rear position pulses are Choppy and the Front ones Hidden, the
mother is in danger and the fetus will live; if the pulse
is Slowed-Down after childbirth, it is a good sign and a
sign of good Stomach-Qi; if the pulse is Slippery after
childbirth, Spleen-Yin has been damaged.
Li Shi Zhen’s pulses of the eight
Extraordinary Vessels
Li Shi Zhen identifies certain pulse qualities with the
Extraordinary Vessels. The main ones, relevant to
gynecology, are as follows:
•
A ball feeling on both Front positions reflects the
Directing Vessel (Ren Mai). Clinical manifestations
of this position include lower abdominal pain,
rebellious Qi attacking the heart, contracture in the
A straight up and down Deep and Firm (lao) pulse
at the Front, Middle and Rear positions reflects
the Penetrating Vessel (Chong Mai): this pulse may
occur on both sides or only on the right. Clinical
manifestations include a feeling of tightness of the
chest. The Pulse Classic says:
•
A Wiry pulse at the Middle position on both sides
reflects the Girdle Vessel (Dai Mai). Its clinical
manifestations include lower abdominal pain
referring to the Fire of the Gate of Life (Ming Men),
amenorrhoea, and infertility in women, contracture
of the lower abdomen and seminal emission in men.
A Wiry pulse at the Rear position on both sides
reflects the Yin Stepping Vessel (Yin Qiao Mai) and
also Yin and Yang Linking Vessels (Yin and Yang Wei
Mai). Its clinical manifestations include epilepsy,
aversion to cold, fever, lower abdominal pain, lumbar
pain, hernia and continuous uterine bleeding.10
SUMMARY
Li Shi Zhen’s pulses of the eight
Extraordinary Vessels
• A ball feeling on both Front positions reflects the
Directing Vessel
• A straight up and down Deep and Firm pulse at
the Front, Middle and Rear positions reflects the
Penetrating Vessel
• A Wiry pulse at the Middle position on both sides
reflects the Girdle Vessel
• A Wiry pulse at the back position on both sides
reflects the Yin Stepping Vessel, Yin and Yang
Linking Vessels
Diagnosis 107
Pulses in pregnancy
During pregnancy, the pulse becomes Slippery; if it lacks
this quality, that is not a good sign. During pregnancy,
both the Rear (third) and the left Front (first) positions
undergo changes. While the whole pulse becomes
Slippery, the Rear position (on both sides) becomes Big
and the left Front position Overflowing. Chapter 7 of
The Simple Questions says when discussing pulse diagnosis: “If Yin [i.e. the Rear pulse] throbs [strongly] and
Yang [i.e. the Front pulse] stands out, this indicates pregnancy.”11 Thus, for the pulse to indicate pregnancy, the
relationship between the Rear and Front positions is
important. It is only when both undergo the changes
described above that pregnancy may be diagnosed.
The Qing dynasty’s gynecologist Chen Jia Yuan specifically says that if the Rear position only is Slippery and Big,
this could simply indicate retention of Dampness in the
Uterus: it is only if the left Front position is Overflowing
that pregnancy may be diagnosed.12 He also refers to
the relative strength of the Liver and Lung pulses: he
says that if the Rear positions are slippery and the Liver
pulse is Big and the Lung pulse small, this indicates pregnancy.13 Yet another sign of pregnancy according to
Dr Chen is a Slippery quality in the left Front position and
a Big quality in the left Rear one; or also a Rapid quality in the left Rear position and a Minute quality on the
left Middle one. The ABC of Acupuncture says: “In examining women, when the pulse of the hand Lesser Yin beats
[strongly], it indicates pregnancy.”14 ‘Hand Lesser Yin’ can
be interpreted as the Heart pulse on the left Front position, or as the pulse of the cubital artery along the Heart
channel: both interpretations are correct.
As for diagnosing the sex of the fetus, opinions vary.
Some doctors relate it to the relative strength of the Rear
position: if the left is stronger it is a boy. Others refer to the
relative strength of the left Front position compared with
the Rear ones: if the left Front position is stronger, it is a
boy. Still others refer to the pulse on the cubital artery on
the Heart channel: if this is strong, it is a boy. Of course,
the difficulty lies in not knowing the strength of the
woman’s pulse before pregnancy, so that, for example,
if she normally has a weak Heart pulse, its Overflowing
quality from a pregnancy might not be so obvious. In any
case, one has a 50% chance of being right!
Dr Chen Jia Yuan also gives other indications for diagnosing the sex of the fetus and even multiple pregnancies.15 He says that if the left Front position feels like a
belt, the fetus is a boy; if the right Front position feels
like a belt, the fetus is a girl. If the left Middle and Rear
positions are Big and the Heart pulse ‘flowing’, it indicates male triplets; if the right Middle and Rear positions are Big and the Heart pulse ‘flowing’, it indicates
female triplets. If the pulses of both left and right are
Slippery, it indicates male twins; if both left and right
pulses are Floating, it indicates female twins.
Apart from the pulse, Wu Qian, author of the Golden
Mirror of Medicine (1742), gives indications for diagnosing
the sex of the fetus according to the shape of the mother’s
abdomen. He says that if the mother is carrying a girl, the
abdomen is small above and large below, like a basket, and
the fetus faces the abdomen with her legs and knees below.
If she is carrying a boy, the abdomen is high and round in
the Middle like an upturned cauldron and the fetus faces
the mother’s back, with his back and spine below.16
Pulses that indicate possible problems with the pregnancy are a pulse that is Deep, Fine and Short, or a pulse
that is very Deep and Weak on both Rear positions and is
Intermittent. Some doctors say that an Intermittent pulse
at 100 days of pregnancy is normal. If the pulse during
pregnancy is Wiry, Hard and Rapid, it indicates the possibility of eclampsia. If the pulse has a Leather quality during pregnancy it indicates the likelihood of miscarriage or
threatened miscarriage. The Leather pulse feels relatively
Wiry and Large on superficial pressure but Empty and
Hollow on a deep pressure. The Synopsis of Prescriptions
from the Golden Cabinet by Zhang Zhong Jing says:
A pulse may be Wiry and Big: Wiry implies a reduced size,
while Big implies Hollow. A reduced size means Cold and
a Hollow pulse Deficiency: a combination of these two
qualities is called Leather pulse. This indicates miscarriage
or threatened miscarriage in women.17
A Hollow and Rapid pulse during pregnancy may
indicate the danger of miscarriage.
SUMMARY
Pulses in pregnancy
• During pregnancy, while the whole pulse becomes
Slippery, the Rear position (on both sides) becomes
Big and the left Front position Overflowing
• Pulses that indicate possible problems with the
pregnancy are a pulse that is Deep, Fine and
Short, or a pulse that is very Deep and Weak on
both Rear positions and is Intermittent
• A Hollow and Rapid pulse during pregnancy may
indicate the danger of miscarriage
108 Section 2: Aetiology and Diagnosis
Pulses in labour
During labour, the pulses of both chi positions become
Tight, Slippery and Rapid. After labour, it is normal
for the pulse to be Weak and Soft. If it is very Fine and
Irregular, it indicates severe deficiency of Qi and Blood.
If it is Floating, Rapid and Full, it indicates Blood-Heat
and infection.
Pulses during menstruation
During menstruation, the pulse is naturally somewhat Slippery, Big and slightly Rapid. Of course, in the
absence of the period, such pulse qualities would indicate Damp-Heat or Blood-Heat.
are hot on the soles, it indicates Kidney-Yin deficiency
with Empty-Heat.
A swelling of the ankles with pitting oedema indicates deficiency of Kidney-Yang and Spleen-Yang. If
the oedema is not pitting, it is due to Qi stagnation.
Abdomen
The temperature of the abdomen should also be
checked as it gives an immediate impression of the state
of the Directing and Penetrating Vessels. If the lower
abdomen feels cold to the touch, it indicates Cold in the
Uterus and in the Directing and Penetrating Vessels. If
the abdomen feels dry to the touch, it indicates Blood
and/or Yin deficiency.
The Hollow pulse in gynecology
A Hollow pulse in women appears after a profuse loss of
blood such as may occur after childbirth, a miscarriage
or a very heavy period in a woman suffering from menorrhagia. Conversely, a Hollow and Rapid pulse during
pregnancy may indicate the danger of miscarriage.
The pulse in menorrhagia
Particular attention should be paid to the pulse in
chronic menorrhagia: during a heavy period the pulse
would be Empty but Big and Wiry, while after the period
it would be Hollow. After many years of chronic menorrhagia the pulse should be Fine, Thin or Choppy; if it
is instead Floating, Overflowing, Hurried or Rapid, this
is not a good sign.
SUMMARY
Skin
Limbs
• Cold arms and legs: Spleen- and/or Kidney-Yang
deficiency
• Cold hands and feet: Liver-Qi stagnation
• Cold, dry hands and feet: Blood deficiency
• Cold hands alone: Heart-Blood deficiency
• Hot dorsum of hands: Full-Heat
• Hot palms: Empty-Heat
• Hot soles of feet: Kidney-Yin deficiency with
Empty-Heat
• Swollen, pitted oedematous ankles: Kidney-/SpleenYang deficiency; without pitting: Qi stagnation
Skin
Abdomen
One should check the temperature, moisture and
possible swelling of the skin.
• The temperature of the abdomen indicates the
state of the Directing and Penetrating Vessels
• A cold abdomen to the touch indicates Cold in the
vessels or Uterus; a dry abdomen indicates Blood/
Yin deficiency
Limbs
Cold arms and legs indicate Spleen- and/or KidneyYang deficiency. If only the hands and feet are cold, it
indicates stagnation of Liver-Qi (this symptom is called
the ‘four rebellious’ and Si Ni San Four Rebellious Powder
is the applicable formula). If only the hands are cold, it
may indicate Heart-Blood deficiency. If the hands and
feet are cold and also dry, it indicates Blood deficiency.
If the hands are hot on the dorsum, it denotes Full-Heat
(in gynecology this could mean Blood-Heat); if they are
hot on the palms, it indicates Empty-Heat. If the feet
Abdomen
One should check the lower abdomen in women as
this reflects the state of the Kidneys, the Uterus and
the Penetrating and Directing Vessels. The abdomen should feel elastic, neither too tight nor too soft.
Compare the lower abdomen with the upper abdomen,
below the xiphoid process: this latter area should feel
softer than the former.
Diagnosis 109
If the lower abdomen feels too soft (as it often is in
women who have had several children) and the practitioner’s hand sinks in very easily when palpating, it
indicates a Kidney deficiency, with exhaustion of the
Directing Vessel if in the centre or the Penetrating
Vessel if on the lateral sides.
If the lower abdomen feels tight and hard, it indicates
stasis of Blood, and if it is distended, it indicates stagnation of Qi: in both cases, the Penetrating Vessel might
be involved (with rebellious Qi). Palpable masses indicate stasis of Blood if they are hard and unmovable,
and Phlegm if they are soft; if they come and go, they
are due to Qi stagnation.
Abdominal pain that improves on palpation or massage is due to a deficiency (usually a Kidney deficiency).
If the abdominal pain is aggravated by pressure or massage it indicates an excess condition, which could be
stagnation of Qi, stasis of Blood or Dampness.
With regard to abdominal masses and palpation, it
should be stressed that the disease-entity of ‘Abdominal
Masses’ (Zheng Jia) in Chinese medicine implies the presence of a mass that can be felt on palpation. Obviously,
doctors in ancient China did not have recourse to
X-rays or scans. Therefore, this raises the question: are
small, non-palpable masses to be considered ‘Abdominal
Masses’? Does a very small myoma in the uterus that is
not palpable from the outside fall into the category of
‘Abdominal Mass’? Or, in other words, is it legitimate to
make a Chinese diagnosis of ‘Abdominal Masses’ on the
basis of Western tests? Opinions on this question vary:
my opinion is that small, non-palpable masses that are
detected only by Western tests such as scans are indeed
‘Abdominal Masses. This means that treatment should
be focused on softening and dissolving masses.
CLINICAL NOTE
In my opinion, it is possible to make a Chinese Bian
Bing diagnosis (identifying the disease category) on
the basis of Western tests.
However, there is an important caveat here.
Although we can treat a small, non-palpable mass as
an ‘Abdominal Mass’, the Chinese identification of patterns is extremely important and our treatment should
be guided by it. In other words, just because a patient
may have a small mass detected by Western tests, that
does not mean that we can go all out in breaking Blood
(assuming the mass is from Blood stasis) and dissolving
masses with strong herbs. We must always use a proper
identification of patterns and, most of all, make a clear
assessment of the relative importance of deficiency or
excess. In other words, assuming that a woman had a
small myoma occurring against a background of Qi
and Blood deficiency, a strong Blood-breaking formula
such as is used for abdominal masses from Blood stasis
would most probably make the patient worse. However,
the presence of a myoma is not entirely discounted and
one might add some Blood-invigorating herbs to whatever formula one uses.
SUMMARY
Abdomen
• The lower abdomen reflects the state of the
Kidneys, Uterus, Penetrating and Directing Vessels
• A very soft lower abdomen indicates Kidney deficiency
with exhaustion of the Directing Vessel if in the centre,
or the Penetrating Vessel if on the lateral sides
• If the lower abdomen feels tight and hard, it
indicates stasis of Blood; if it is distended, it
indicates stagnation of Qi
• Hard and unmovable palpable masses indicate
stasis of Blood; soft ones indicate Phlegm; ones
that come and go are due to Qi stagnation.
• In my opinion, small, non-palpable masses that are
detected only by Western tests such as scans are
also ‘Abdominal Masses’
OBSERVATION
Complexion
All organs obviously influence the complexion, but,
whatever the organ, the complexion shows the state of
the Mind and Spirit. Yu Chang, in Principles of Medical
Practice (1658), calls the complexion the “banner of the
Mind and Spirit” and he says:
When the Mind and Spirit are flourishing, the complexion
is glowing; when the Mind and Spirit are declining,
the complexion withers. When the Mind is stable the
complexion is florid.18
A healthy Mind and Spirit show most of all in a complexion with shen. This implies an indefinable quality of
lustre, glow, glitter and floridity of the complexion, which
indicates a good prognosis even if the colour itself is pathological. Shi Pa Nan in Origin of Medicine (1861) says:
110 Section 2: Aetiology and Diagnosis
The shen of the complexion consists in lustre and body.
Lustre means that the complexion appears clear and bright
from the outside; body means that it is moist and with
lustre in the inside.19
If a complexion has such attributes, even if the
colour is pathological, it indicates that the Mind and
Spirit are stable and unaffected and therefore the prognosis is good.
Shen in a woman’s complexion is closely related to
Blood: a healthy, glowing complexion with shen indicates a healthy state of Blood, apart from denoting a
stable state of the Mind as described above. Conversely,
a complexion lacking in shen and looking dull, somewhat dry and without lustre indicates Blood deficiency,
which could affect the Heart, Spleen or Liver.
The area around the mouth is related to the Liver and
the Directing and Penetrating Vessels: if it is dull, pale
and without lustre, it indicates Liver-Blood deficiency
and Emptiness of the Directing Vessel and/or Penetrating
Vessel; if greenish, it may indicate Liver-Qi stagnation.
Brownish discolourations of the skin on the chin
indicate a deficiency of the Directing Vessel possibly
with Blood-Heat.
The area between and just above the eyebrows is
related to the Heart: if it is pale, dull and dry, it indicates Heart-Blood deficiency.
A dark, greenish complexion indicates Blood stasis;
from a mental–emotional point of view, this type of
complexion often denotes that the cause of the disease
is anger, frustration, resentment, hatred or guilt.
A bright-red flush over the whole cheek indicates BloodHeat; a flush that affects only the cheek bones (malar
flush), Empty-Heat. The latter is, of course, very common
in menopausal hot flushes. However, there are other possible causes of a ‘floating’, flushed, red colour along the
cheek bones, so such a flush should not be automatically
attributed to Empty-Heat from Yin deficiency. It is, in fact,
very common in women of all ages and may be due to
Blood deficiency or even Qi deficiency. Both Blood and Qi
deficiency can give rise to the ‘Empty-Heat’ although this
term is usually applied to Yin deficiency.
!
In women, a malar flush (flushed, red cheek bones)
is not always due to Empty-Heat from Yin deficiency.
A type of ‘Empty-Heat’ in women often arises from
Blood deficiency or even Qi deficiency.
Furthermore, a red, flushed complexion can sometimes be due to rising rebellious Qi in the Penetrating
Vessel: this is merely an imbalance within this vessel
and represents neither Full-Heat nor Empty-Heat. This
phenomenon has been discussed in the Chapter 3 on
pathology.
A bright white complexion indicates Yang deficiency
and Cold. A yellowish complexion that looks also
slightly puffy is a clear sign of Dampness. The more sallow it is, the longer the Dampness’s duration.
A dark, brownish complexion indicates longstanding deficiency of Kidney-Yin.
SUMMARY
Complexion
• The complexion shows the state of the Mind and
Spirit
• Shen in a woman’s complexion is closely related
to Blood: a healthy, glowing complexion with
shen indicates a healthy state of Blood, apart from
denoting a stable state of the Mind
• Conversely, a complexion lacking in shen and
looking dull, somewhat dry and without lustre
indicates Blood deficiency, which could affect the
Heart, Spleen or Liver
• Area around the mouth dull, pale and without
lustre: Liver-Blood deficiency and Emptiness of the
Directing Vessel and/or Penetrating Vessel
• Area around the mouth greenish: Liver-Qi stagnation
• Brownish discolouration of the skin on the chin:
deficiency of the Directing Vessel possibly with
Blood-Heat
• The area between and just above the eyebrows
pale, dull, and dry: Heart-Blood deficiency
• A dark, greenish complexion: Blood stasis
• A bright red flush over the whole cheek: BloodHeat
• Flushed cheek bones (malar flush): Empty-Heat
(from Yin, Blood or Qi deficiency)
• Red, flushed complexion can be due to rising
rebellious Qi in the Penetrating Vessel
• A bright white complexion: Yang deficiency and
Cold
• A yellowish complexion that looks also slightly
puffy: Dampness
• A dark, brownish complexion: longstanding
deficiency of Kidney-Yin
Diagnosis 111
Lips
The lips show the state of the Spleen and Blood. If they
are pale, they indicate Spleen deficiency and Emptiness
of Blood. If they are dark red, they denote Blood-Heat
or Spleen-Heat. If they are bright red, they may indicate Empty Heat (which may also derive from Blood
deficiency apart from Yin deficiency).
Greenish lips indicate Cold, while purplish lips
denote stasis of Blood. Dry lips indicate Spleen-Yin
deficiency.
SUMMARY
Lips
•
•
•
•
The lips show the state of the Spleen and Blood
Pale lips: Spleen deficiency and Emptiness of Blood
Dark red lips: Blood-Heat or Spleen-Heat
Bright red lips: Empty-Heat (which may also
derive from Blood deficiency apart from Yin
deficiency)
• Greenish lips: Cold
• Purplish lips: stasis of Blood
• Dry lips: Spleen-Yin deficiency
Tongue
Tongue diagnosis in gynecology in general does not
differ from that of general internal medicine and I will
summarize the main points chiefly in relation to gynecology.20 The main aspects to discuss are as follows:
•
•
•
Tongue-body colour.
Tongue-body shape.
Tongue coating.
Tongue-body colour
There are three main colours: Pale, Red (which includes
Dark Red) and Purple (which includes Blue).
Pale
A Pale tongue is very common in women and it indicates either Yang deficiency (in which case it would be
slightly wet) or Blood deficiency (in which case it would
be slightly dry and possibly Thin). However, in women
it is extremely common for Blood deficiency to cause a
Pale tongue that is Swollen (instead of Thin) from the
presence of Dampness or Phlegm (see below). A particular type of Pale tongue is one that is also peeled (without coating): this denotes very severe Blood deficiency
(normally a peeled tongue is Red).
Red or Dark Red
By ‘Red’ is meant too Red when compared with a normal Pale Red colour. Red always indicates Heat, and
whenever one sees a Red tongue one should immediately distinguish whether it is with or without a coating
(or with a rootless coating). A Red tongue with coating
indicates Full-Heat, while a Red tongue completely or
partially without coating (or with a rootless coating)
denotes Empty-Heat arising from Yin deficiency. The
Red tongue (with or without coating) is frequently seen
in menorrhagia from Blood-Heat.
The tongue could be Red (or redder) in selected
parts, most commonly the tip and the sides. A Red tip
indicates Heart-Fire or Heart Empty-Heat depending
whether the tongue has a coating or not. This nearly
always indicates the presence of emotional problems,
not only those affecting the Heart but also those affecting other organs. This is because the Heart houses the
Mind (Shen) which alone has the insight to recognize
and feel the emotional stimuli. In fact, stagnation of
Liver-Qi can often cause the tip to become red.
Red sides indicate Liver-Fire or Liver Empty-Heat
depending on whether the tongue has a coating or not;
they are very common in women. Liver-Fire often causes
Blood-Heat (because the Liver stores Blood) and therefore
menorrhagia. If the sides are only slightly Red and the
rest of the tongue is not Red, this may reflect stagnation
of Liver-Qi, typically causing pre-menstrual tension.
Please note that, in women, the sides of the tongue
reflect the Liver but also the Uterus: thus, a Red colour
on the sides may indicate Blood-Heat affecting the
Uterus (which, however, we would treat through the
Liver channel).
If we relate the Red tongue to the theory of the Four
Levels elaborated by the Warm Disease School we can
distinguish three types of Heat syndrome:
1. Heat at the Qi level: the tongue is Red or slightly
Red with a thin, yellow coating. Heat at this level
does not cause Blood-Heat. It is treated by the
method of ‘clearing Heat’ (Qing Re) with cold and
pungent herbs such as Shi Gao Gypsum fibrosum or
Zhu Ye Folium Phyllostachys nigrae to push the Heat
outwards.
112 Section 2: Aetiology and Diagnosis
2. Fire at the Qi level: the tongue is Red or Dark Red
with a thick, yellow, brown or black coating which
is also very dry. Fire is stronger and deeper than
Heat, it dries up the Body Fluids more than Heat, it
dries up the faeces causing constipation with dry
stools, it causes Blood-Heat, it agitates the Mind
more than Heat and it may cause bleeding. To treat
it, drain Fire (Xie Huo) with cold and bitter herbs
such as Huang Qin Radix Scutellariae, Huang Lian
Rhizoma Coptidis, Da Huang Radix et Rhizoma Rhei
and Long Dan Cao Radix Gentianae, most of which
drain Fire downwards by evacuation. It would
be a mistake to treat Heat as Fire with one of the
above herbs. Fire can cause Blood-Heat and lead to
menorrhagia of the Full type.
3. Heat at the Nutritive-Qi or Blood level: the tongue
is Red without a coating (completely or partially)
because the Heat has dried up the Yin fluids and
led to Yin deficiency. Vice versa, it may be that Yin
deficiency has given rise to Empty-Heat. In both
cases, a Red tongue without coating indicates Heat
at the Nutritive-Qi or Blood level. This is treated
by nourishing Yin and clearing Empty-Heat. This
condition can also lead to menorrhagia or may
result from a chronic menorrhagia caused by Fire
leading to Yin deficiency.
COLD
(Pale tongue)
HEAT
(Red tongue)
Stasis of Blood
Bluish-purple
Reddish-purple
Figure 5.5 Purple tongue.
Purple
A Purple tongue always indicates stasis of Blood.
Although some authors say that stagnation of Qi can
also cause the tongue to become Purple, I do not agree;
I feel that the tongue-body colour reflects Blood more
than Qi and I therefore interpret a Purple colour as
always being due to stasis of Blood.
Stasis of Blood can derive from internal Cold obstructing the circulation of Blood, in which case the tongue
is Bluish-Purple, or from Heat condensing Blood,
in which case it is Reddish-Purple. A Bluish-Purple
tongue usually develops from a Pale tongue while a
Reddish-Purple tongue normally develops from a Red
tongue (Fig. 5.5).
A Purple tongue in a woman is always a poor sign as
it indicates longstanding stasis of Blood with the possibility of lumps (benign or malignant), cysts, myomas,
endometriosis, etc., because when Blood stagnates for
a long time it may form masses. If a woman does have
a malignancy, a very purple tongue indicates a poor
prognosis.
Figure 5.6 Chest area on tongue.
Both a Bluish-Purple and a Reddish-Purple are also
seen in chronic dysmenorrhoea.
The ‘chest’ area on the tongue acquires particular importance when it is Purple. The chest area is on
the sides, between the centre and the tip of the tongue
(Fig. 5.6). The chest area reflects pathologies of the
lungs, heart or breast, but in a Western medical sense.
A change in the chest area may involve a change in
colour or body shape. How to differentiate when a
change in the chest area indicates a problem of the
lungs or heart or of the breasts in women? A change
in the chest area indicates a pathology of the breast in
women rather that of lungs/heart:
•
•
in the absence of an obvious lungs/heart pathology
especially when it is unilateral.
Examples of lung pathology manifesting in the
chest area are chronic asthma or chronic emphysema
Diagnosis 113
(in which case the chest area would be Swollen and
possibly Purple). An example of heart pathology is
chronic coronary heart disease (in which case the
chest area would be Purple).
In women, in the absence of obvious lung or heart
disease, a purple colour in the chest area indicates
Blood stasis in the breasts; if it is unilateral, it indicates Blood stasis in the breast of that side. How do we
use this information? If the woman has no diagnosis
of breast cancer, the presence of a purple colour alerts
us to the fact that there is Blood stasis in the breasts
and that we should treat it. Remember that Blood stasis
in the breasts may not necessarily indicate carcinoma
because it may also be related to fibroadenoma.
If a woman has already had breast cancer and comes
to us perhaps after she has had a lumpectomy and
radiotherapy, we should carefully analyse the breast
(or chest) area: if it is not Purple, it is a good sign; if it
is Purple, it is a poor prognostic sign. In such a case,
we should therefore actively invigorate Blood and even
break Blood as if she still has the cancerous lump.
Apart from a Purple colour and a swelling, other possible changes in the chest area are teethmarks that are
confined only to the chest area, Red points or a peeling
of the chest area. Teethmarks that appear only in the
breast area usually indicate a problem in the breast in
women (possible carcinoma) occurring against a background of severe Qi deficiency.
Red points in the breast area indicate Toxic-Heat
in the lungs or, in women only, in the breast. A peeling (absence of coating) in the breast area indicates a
possible problem in the breasts in women occurring
against a background of Yin deficiency.
Bearing in mind that the sides of the tongue reflect
the Uterus as well as the Liver, a Purple colour on the
sides in women is usually related to Blood stasis in the
Uterus.
Red or Dark Red
• Red tongue with coating: Full-Heat
• Red tongue completely or partially without
coating: Empty-Heat arising from Yin deficiency
• Red tip: Heart-Fire or Heart Empty-Heat
• Red sides: Liver-Fire or Liver Empty-Heat
• Red sides may also indicate Blood-Heat affecting
the Uterus
• Red or slightly Red with a thin-yellow coating:
Heat at Qi level
• Red or Dark Red with a thick, yellow, brown or black
coating which is also very dry: Fire at the Qi level
• Red without a coating (completely or partially):
Heat at Nutritive-Qi or Blood level
Purple
• A Purple tongue always indicates stasis of Blood
• Bluish-Purple: stasis of Blood from internal Cold
• Reddish-Purple: Blood stasis from Heat condensing
Blood
• In women, in the absence of obvious lung or heart
disease, a Purple colour in the chest area indicates
Blood stasis in the breasts
• Teethmarks confined only to the chest area:
a problem in the breast in women (possible
carcinoma) occurring against a background of
severe Qi deficiency
• Red points in the breast area indicate Toxic-Heat in
the breast
• A peeling in the breast area: possible problem
in the breasts in women occurring against a
background of Yin deficiency
• A Purple colour on the sides in women may
indicate Blood stasis in the Uterus
Tongue-body shape
SUMMARY
Tongue-body colour
Pale
• A Pale tongue in women indicates either Yang
deficiency (slightly wet) or Blood deficiency
(slightly dry)
• Pale tongue without coating: severe Blood
deficiency
Tongue-body shapes commonly include Swollen, Thin,
Toothmarked, Quivering, Long, Short, Stiff, Deviated,
Moving, Cracked.
Swollen The Swollen tongue is extremely common.
Among my patients, nearly 40% have a Swollen tongue,
which generally indicates Dampness or Phlegm (more
commonly the latter).
A common finding in women is a swelling of the
edges in the central part of the tongue indicating
Spleen deficiency. A thinner swelling all along the sides
114 Section 2: Aetiology and Diagnosis
SUMMARY
Tongue-body shape
Swollen
• Swollen tongue: Dampness or Phlegm
• Swelling of the edges in the central part of the
tongue: Spleen deficiency
• A thinner swelling all along the sides: Liver-Heat
• A Swollen, Red tip: Heart-Heat from emotional problems
Spleen-type swelling
Liver-type swelling
Thin
Figure 5.7 Spleen deficiency and Liver-Heat.
• Either Blood deficiency (Pale) or Yin deficiency
(without coating)
indicates Liver-Fire and is usually seen on a Red tongue.
Figure 5.7 compares a Spleen-type with a Liver-type
swelling. A Swollen tip which is usually also Red indicates Heart-Fire and it means that the emotional problems causing this condition are more severe than if the
tip were only Red.
Thin A Thin tongue indicates either Blood deficiency or
Yin deficiency depending on whether the tongue is Pale
or without coating. Although Blood deficiency is common in women, the Thin tongue is not, because Phlegm
(which makes the tongue Swollen) is also very common.
Toothmarked The tongue with teethmarks is very
common indeed: it indicates Spleen-Qi deficiency.
Quivering The Quivering tongue trembles with movements of a very small range. It also denotes Spleen-Qi
deficiency.
Long The Long tongue indicates Heart-Heat.
Short The Short tongue indicates Cold from Yang deficiency or extreme Yin deficiency depending on whether
the tongue is Pale or without coating.
Stiff The Stiff tongue may indicate Liver-Wind, Yin
deficiency or stasis of Blood. It is usually seen only in
older women.
Deviated The Deviated tongue indicates Liver-Wind:
this also is seen only in older women.
Moving The Moving tongue moves slowly from side
to side with a large and ample movement: it indicates
Liver-Wind and is seen only in older women.
Cracked A cracked tongue generally indicates Yin deficiency. Scattered small cracks or a wide, midline crack
in the central section of the tongue indicate StomachYin deficiency (Fig. 5.8). A deep, midline crack extending from near the root to almost the tip of the tongue
indicates the tendency to Heart patterns and mental–
emotional problems (Fig. 5.9).
Toothmarked
• Spleen-Qi deficiency
Quivering
• Spleen-Qi deficiency
Long
• Heart-Heat
Short
• Cold from Yang deficiency (Pale) or extreme Yin
deficiency (without coating)
Stiff
• Liver-Wind, Yin deficiency or stasis of Blood
Deviated
• Liver-Wind
Moving
• Liver-Wind
Cracked
• A cracked tongue generally indicates Yin deficiency
• Scattered small cracks or a wide, midline crack in the
central section of the tongue: Stomach-Yin deficiency
• A deep, midline crack extending from near the
root to almost the tip of the tongue: tendency to
Heart patterns and mental–emotional problems
Tongue coating
While the tongue-body colour reflects the state of the
Yin organs, the coating reflects the state of the Yang
organs and especially of the Stomach. The coating
is formed as a byproduct of the Stomach activity of
Diagnosis 115
4. Tongue peeled, Red in the centre only: StomachYin deficiency with Stomach Empty-Heat.
5. Tongue peeled, Red all over: Stomach- and KidneyYin deficiency with Empty-Heat.
Figure 5.8 Stomach cracks.
Thus, the absence of coating indicates Yin deficiency.
A thick coating may indicate many different pathogenic
factors such as Cold, Heat, Dampness, Phlegm and retention of food. The thickness of the coating reflects the
strength of the pathogenic factor very directly: the thicker
the coating, the stronger the pathogenic factor. A common type of coating in women is thick with red spots
on the root signifying Damp-Heat in the Lower Burner,
which could be in the Bladder, Intestines or gynecological system.
The colour of the coating reflects the Hot and Cold
nature of the condition: a yellow coating indicates
Heat, a white coating Cold. A grey or black coating
may indicate severe Heat or severe Cold depending on
whether it is dry or wet.
SUMMARY
Tongue coating
Figure 5.9 Heart crack.
rotting and ripening. A thin-white coating with root is
normal and indicates that Stomach-Qi is healthy.
A coating is said to be rootless when it looks as if it
has been added to the tongue surface rather than growing out of it. The rootless tongue indicates Stomach-Qi
deficiency and is the very first step of a long process
leading to a completely peeled tongue. In fact, in the
beginning stages of Stomach-Qi deficiency, the coating
will be rootless. It will next fall off from the centre,
then from the whole surface of the tongue. At the
same time, the tongue will tend to become Red. By the
time the tongue is Red and completely peeled, it indicates Stomach- and Kidney-Yin deficiency with EmptyHeat. The stages leading to this could be summarized as
follows in order of severity:
1. Rootless coating: Stomach-Qi deficiency (beginning
stage).
2. Coating missing in the centre, rootless elsewhere:
Stomach-Qi deficiency.
3. Coating missing everywhere (tongue peeled),
normal body colour: Stomach-Yin deficiency (no
Empty-Heat).
• The coating reflects the state of the Yang organs
and especially of the Stomach
• A thin-white coating with root is normal and
indicates that Stomach-Qi is healthy
• The rootless tongue coating indicates Stomach-Qi
deficiency
• Absence of coating: Yin deficiency
• A thick coating: Cold, Heat, Dampness, Phlegm
and retention of food
• Thick-yellow coating with red spots on the root:
Damp-Heat in the Lower Burner, which could be
in the Bladder, Intestines or gynecological system
• Yellow coating: Heat
• White coating: Cold
• Grey or black coating: severe Heat (dry) or
severe Cold (wet)
Aspects of tongue diagnosis
in gynecology
Apart from the above general indication of tongue diagnosis, a few aspects peculiar to gynecological problems
must be mentioned.
1. Although with Blood deficiency (a very common
condition in gynecology) the tongue should be
116 Section 2: Aetiology and Diagnosis
SPLEEN-QI
deficiency
Fails to make Blood
DAMPNESS
(Swollen tongue)
BLOOD
DEFICIENCY
(Pale tongue)
Figure 5.10 Spleen deficiency, Dampness and Blood
deficiency.
Thin, it very seldom is. This is because it is very
common to have Spleen-Qi deficiency which leads,
on the one hand, to deficiency of Blood, but also,
on the other hand, to Phlegm which makes the
tongue Swollen (Fig. 5.10). For this reason, one
should not be surprised to see very many women
who have symptoms of Blood deficiency but with a
Swollen tongue.
2. The tongue often does not show much indication
of stagnation of Liver-Qi. Only if the condition is
longstanding and severe may the tongue have Red
sides (Red rather than Purple, as Purple indicates
stasis of Blood rather than Qi). It is for this reason
that very many women have many symptoms of
Liver-Qi stagnation such as pre-menstrual tension,
irritability, mood swings, abdominal and breast
distension, without any appreciable change in the
tongue-body colour.
3. Although in theory the Uterus is reflected on the
root of the tongue, conditions such as stasis of
Blood in the Uterus often show only on the sides
of the tongue as this condition is due to stasis of
Liver-Blood. Signs on the root of the tongue such
as a thick, sticky, yellow coating with red spots are
often related to the other parts of the reproductive
organs such as ovaries and tubes.
4. The sides of the tongue in the area between
the tip and centre, which normally reflect the
chest, in women may reflect the breasts (see
Fig. 5.6). If one of these areas is Purple (Bluish
or Reddish) or if both are, it indicates stasis
of Blood in the breast or breasts. This is an
important prognostic sign in breast disease and
especially cancer of the breast: the presence
of a Purple colour in this area indicates a poor
prognosis. Conversely, if this area is not purple
in a woman with breast cancer, this indicates a
good prognosis.
5. The general appearance of the tongue is also an
important prognostic sign in breast cancer. If the
tongue is Dark Red, with a thick, sticky, dry, yellow
coating (signs of Toxic-Heat), it indicates a poor
prognosis, and surgery in such a case may lead to
metastasis.
6. A Pale and peeled tongue (i.e. without coating)
indicates severe deficiency of Blood with the
possibility of amenorrhoea or infertility.
7. The tongue-body colour and coating in women
are important diagnostic signs that allow us
to differentiate Kidney-Yin from Kidney-Yang
deficiency. As mentioned in Chapter 3 on pathology,
in women very often Kidney-Yin and Kidney-Yang
are both deficient. The pulse may not help very
much in differentiating which is predominant
because very often both Rear positions are weak.
The symptoms may also be confusing and present a
mixture of Yin and Yang deficiency. In such cases,
the tongue-body colour and presence or absence
of coating are crucial and absolutely reliable signs
in diagnosing whether Kidney-Yin or KidneyYang deficiency predominates. If the tongue-body
colour is without coating, deficiency of Kidney-Yin
predominates; if it is Pale, deficiency of KidneyYang is preponderant.
8. Although the tongue-body colour shows the true
condition of the patient, it should be remembered
that it does not necessarily show the whole
condition. An example will clarify this concept.
A woman may suffer from Liver-Blood deficiency
leading to Liver-Yang rising, which causes
headaches during her periods. Her tongue may be
Pale reflecting the Blood deficiency and her pulse
Wiry reflecting the rising of Liver-Yang. If she has
other symptoms of Liver-Yang rising, such as a
slightly Red complexion and a dry throat, we may
be baffled by the Pale colour of the tongue: in fact,
most books will say that with Liver-Yang rising
the tongue (or its sides) will be Red. However, if we
understand the principle that the tongue may show
only a part of the configuration of patterns, we
realize that the tongue is reflecting the deficiency
of Liver-Blood and the pulse and symptoms the
rising of Liver-Yang (Fig. 5.11).
9. The tongue coating can be very helpful to confirm
a diagnosis of candidiasis. In this condition, the
tongue coating is usually thin, white and sticky but
rootless.
Diagnosis 117
Liver-Blood deficiency
(Pale tongue)
Liver-Yang rising
(Wiry pulse, red face, etc.)
Figure 5.11 Liver-Blood deficiency and Liver-Yang rising.
SUMMARY
Aspects of tongue diagnosis in gynecology
• The tongue rarely appears Thin with Blood
deficiency
• Liver-Qi stagnation is often not clearly visible on
the tongue
• Conditions such as stasis of Blood in the Uterus
often show only on the sides of the tongue and
not on the root
• The sides of the tongue in the area between the
tip and centre, which normally reflect the chest, in
women may reflect the breasts
• The general appearance of the tongue is an
important prognostic sign in breast cancer
• A Pale and peeled tongue indicates severe
deficiency of Blood
• The tongue-body colour and coating in women
are important diagnostic signs that allow us to
differentiate Kidney-Yin from Kidney-Yang deficiency
• The tongue coating can be very helpful to confirm
a diagnosis of candidiasis
AUSCULTATION
Auscultation includes hearing and smelling.
Hearing
Voice
A weak voice indicates Qi deficiency. Frequent sighing
denotes Liver-Qi or Lung-Qi stagnation; a high-pitched
voice indicates an excess condition or Heat.
Smelling
Menstrual blood
A strong, foul smell usually indicates Heat.
Vaginal discharge
A fishy smell indicates Cold-Dampness while a leathery
smell indicates Damp-Heat.
END NOTES
1. Wu Qian 1977 Golden Mirror of Medicine (Yi Zong Jin Jian
), People’s Health Publishing House, Beijing, Vol. 3, p. 10.
First published in 1742.
2. Ibid., p. 10.
3. Wang Shu He 1988 A Revised Explanation of the ‘Pulse Classic’
(Mai Jing Jiao Shi
), with commentary by the Fuzhou City
People’s Hospital, People’s Health Publishing House, Beijing, p. 16.
First published in AD 280.
4. Nanjing College of Traditional Chinese Medicine 1979 A Revised
Explanation of the Classic of Difficulties (Nan Jing Jiao Shi
),
People’s Health Publishing House, Beijing, p. 50. First published c.
AD 100.
5. Cheng Bao Shu 1988 An Annotated Translation of the Study of the
Pulse of the Pin Hu Lake (Pin Hu Mai Xue Yi Zhu
),
Ancient Chinese Medical Texts Publishing House, Beijing, p. 4. The
Study of the Pulse of the Pin Hu Lake by Li Shi Zhen was first published
in 1564.
6. Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi
Shu Ba Zhong
), Ancient Chinese Medicine Texts
Publishing House, Beijing, p. 153. Chen’s book, written during
the Qing dynasty (1644–1911), was entitled Secret Gynaecological
Prescriptions (Fu Ke Mi Fang
).
7. A Revised Explanation of the Classic of Difficulties, p. 12.
8. A Revised Explanation of the Pulse Classic, p. 79.
9. Eight Secret Books on Gynaecology, p. 82.
10. Wang Luo Zhen 1985 A Compilation of the Study of the Eight
Extraordinary Vessels (Qi Jing Ba Mai Kao Jiao Zhu
),
Shanghai Science Publishing House, Shanghai, p. 111. The Study of
the Eight Extraordinary Vessels (Qi Jing Ba Mai Kao
) by
Li Shi Zhen was published in 1578.
11. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Di Nei Jing Su Wen
), People’s
Health Publishing House, Beijing, p. 56. First published c. 100 BC.
12. Eight Secret Books on Gynaecology, p. 82.
13. Ibid., p. 82.
14. Shandong College of Traditional Chinese Medicine 1980 An
Explanation of the ABC of Acupuncture (Zhen Jiu Jia Yi Jing Jiao Shi
), People’s Health Publishing House, Beijing, p.
1469. The ABC of Acupuncture was written by Huang Fu Mi c. AD
259.
15. Eight Secret Books on Gynaecology, p. 82.
16. Golden Mirror of Medicine, Vol. 3, p. 47.
17. He Ren 1981 A New Explanation of the Synopsis of Prescriptions
from the Golden Cabinet (Jin Gui Yao Lue Xin Jie
),
Zhejiang Science Publishing House, p. 46–47. The Synopsis of
Prescriptions from the Golden Cabinet was written by Zhang Zhong
Jing c. AD 200.
18. Principles of Medical Practice, cited in Wang Ke Qin 1988 Theory
of the Mind in Chinese Medicine (Zhong Yi Shen Zhu Xue Shuo
), Ancient Chinese Medical Texts Publishing House,
p. 56.
19. Shi Pa Nan 1861 Origin of Medicine, cited in Theory of the Mind in
Chinese Medicine, p. 55.
20. For a detailed discussion of tongue diagnosis, see Maciocia G 1995
Tongue Diagnosis in Chinese Medicine, 2nd edn, Eastland Press,
Seattle.
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SECTION 3
METHODS OF TREATMENT
6. PRINCIPLES AND METHODS OF TREATMENT 121
7. TREATMENT OF THE EXTRAORDINARY VESSELS 157
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CHAPTER 6
PRINCIPLES AND METHODS
OF TREATMENT
INTRODUCTION 121
!
When to tonify and when to eliminate 122
Combinations of gynecological and systemic
manifestations 124
Relationship among patterns, Chinese diseases
and Western diseases 125
According to Dr Zhang Jing Yue, treating a woman
is five times more difficult than to treat a man.
My experience shows the opposite is true.
PATHOLOGY OF THE INTERNAL ORGANS 127
Kidneys 127
Liver 132
Spleen 144
Heart 149
QI AND BLOOD PATHOLOGY 152
Qi rebellious 152
Blood-Cold 154
The famous doctor of the late Ming dynasty, Zhang Jing
Yue (1563–1640) said that “To treat one woman equals
treating five men”, which means that treating women is
five times more difficult than treating men. The reason
for this is presumably that the menstrual function adds
complexity to women’s pathology and treatment.
I personally find quite the opposite: I would say that
treating one man equals treating five women! This is
because I think that the menstrual function, rather than
adding complexity to women’s pathology, actually clarifies it. In fact, the additional diagnostic signs deriving
from the regularity of the cycle, the amount of bleeding,
the colour and consistency of the blood, the pre-menstrual symptoms, the conditions of pregnancy and childbirth, all these factors assist the diagnosis. In many cases,
when women are seeking treatment not for gynecological but for other problems, an analysis of the menstrual
symptoms is a ‘clinching’ factor. To give a simple example: a woman who presents with Painful Obstruction
Syndrome is suffering aches and pain in the joints; if the
pain is severe we might suspect stasis of Blood, a diagnosis confirmed if her menstrual blood is dark and clotted.
Another example: suppose a woman presents with
lower abdominal pain and we are unsure about the
diagnosis which may be Dampness, Qi stagnation,
Blood stasis or Cold. If her menstrual blood is dark
with large, dark clots, then her abdominal pain is due
to Blood stasis. In this example, the menstrual symptom made the diagnosis easier, not more difficult.
There are other not-strictly medical reasons why
I find treating women easier that treating men. In general, women tend to be more in touch with their bodies
than men are; they also tend to be more in touch with
their emotions than men are. Some psychotherapists
say that men take on average 9 months to reach the
point in therapy where women start from.
The discussion of principles of treatment will be
carried out according to the following topics:
•
•
•
Introduction.
Pathology of the internal organs.
Qi and Blood pathology.
INTRODUCTION
The steps to a successful treatment are as follows:
•
•
•
•
Correct identification of the Chinese diseasesymptom (bian bing).
Correct identification of the pattern (bian zheng).
Appropriate strategy of treatment: this includes
whether to tonify the body’s Qi or clear pathogenic
factors or both, and timing of treatment.
Appropriate method of treatment: this includes
122 Section 3: Methods of Treatment
choosing the proper method for the pattern, the
disease, the patient’s condition and other factors.
If acupuncture is used, in addition to the above
points, a successful treatment depends on these further
factors:
•
•
A correct and harmonious choice of points,
including correct location.
The proper manipulation of the needles according
to the methods of reinforcing or reducing (or even).
This chapter will discuss the methods of treatment in
herbal medicine and acupuncture for each organ. Before
doing so, it is appropriate to discuss the choices facing us
when deciding whether to tonify the body’s Qi or eliminate pathogenic factors, whether to heat or cool, and
how to approach cases with contradictory symptoms and
signs. This discussion will be conducted in three parts:
1. When to tonify and when to eliminate.
2. Combinations of gynecological and systemic
manifestations.
3. Relationships among patterns, Chinese diseases
and Western diseases.
When to tonify and when
to eliminate
The decision whether to tonify the body’s Qi or to
eliminate pathogenic factors is absolutely crucial particularly when using herbal medicine. Obviously one
should tonify in cases of deficiency and clear in cases
where there are pathogenic factors. In practice, however, the choice is not so simple because in the overwhelming majority of cases a deficiency of the body’s
Qi and the presence of pathogenic factors occur simultaneously, i.e. the condition is characterized by both
Emptiness and Fullness. There are, of course, formulae that can simultaneously tonify and clear but in my
experience it is often preferable to address the Fullness
first by clearing pathogenic factors.
In gynecology, there are many examples of conditions characterized by both Fullness and Emptiness,
e.g. deficiency of the Kidney with Dampness in the
genital system (e.g. in ovarian cysts or polycystic ovary
syndrome), Liver-Blood deficiency with Liver-Qi stagnation or Liver-Blood stasis (e.g. in pre-menstrual
tension), Spleen-Qi deficiency with Dampness (e.g. in
post-partum urinary problems), Spleen-Qi deficiency
with Qi stagnation (e.g. in abdominal pain), Kidney
deficiency with Blood stasis (e.g. in dysmenorrhoea
or endometriosis), Blood deficiency with Cold in the
Uterus (e.g. in infertility), Yin deficiency with EmptyHeat (e.g. in menopausal problems), etc.
If we tonify the body’s Qi (with herbal medicine)
before clearing pathogenic factors, there is always
the danger of clogging the body and aggravating the
obstruction created by the pathogenic factors (because
tonic herbs tend to be ‘cloying’). For example, if we
tonify Qi and Blood with sweet and warm herbs, these
may aggravate any Dampness or Heat that there is. If,
on the contrary, we eliminate pathogenic factors first,
the terrain is cleared for tonification so that tonic herbs
will be more effective. This problem does not usually
arise when only acupuncture is used.
We should not look upon a clearing treatment as
‘weakening’: if the identification of pattern is correct
and a clearing treatment is appropriate, the patient will
actually feel better and have more energy. This is easily explained since eliminating pathogenic factors automatically allows Qi to flow more easily and therefore
perform its function better. For example, eliminating
Dampness will automatically benefit Qi as this will be
able to flow unhampered by the obstruction created by
Dampness. In fact, if the approach of clearing pathogenic factors is used when it is indicated, the patient will
nearly always feel dramatically better. The decision on
whether to tonify the body’s Qi or eliminate pathogenic
factors is usually based on the clinical manifestations,
tongue and pulse. The pulse is particularly important in
assisting this decision: if the pulse is of the Full type in
general (e.g. Slippery, Wiry or Tight), then it is appropriate to eliminate pathogenic factors, while if it is of the
Empty type in general (e.g. Fine, Weak, Empty, Choppy),
it is appropriate to tonify the body’s Qi.
Another possible approach to the treatment of complicated Full–Empty conditions in gynecology is related
to the four phases of the menstrual cycle, i.e. to concentrate on treating the Full condition (i.e. expelling
pathogenic factors) during the pre-menstrual phase
and menstrual phase (phases 4 and 1) and to tonify the deficiency during the post-menstrual or intermenstrual phases (phases 2 and 3).
It should be noted here that the above choices in
treatment strategy apply more to herbal medicine
than to acupuncture as the latter works in a different
way from the former. The choice between eliminating pathogenic factors and tonifying the body’s Qi in
herbal medicine is clearly mirrored in herbal formulae:
some eliminate pathogenic factors without tonifying
Principles and Methods of Treatment 123
(e.g. Long Dan Xie Gan Tang Gentiana Draining the
Liver Decoction) while others tonify the body’s Qi without eliminating pathogenic factors (e.g. Ba Zhen Tang
Eight Precious Decoction). Thus, the choice between
eliminating pathogenic factors or tonifying the body’s
Qi is very clear-cut. There are, of course, formulae
that tonify the body’s Qi and eliminate pathogenic factors simultaneously, but even in those, the emphasis is
always on one aspect of these two choices. For example, the formula Liu Jun Zi Tang Six Gentlemen Decoction
tonifies Qi and resolves Dampness, but its emphasis is
on tonification.
Acupuncture works in a different way from herbal
medicine by regulating the function of the channels
rather than by introducing foreign substances into
the body. Thus, an acupuncture point can have a dual
function in tonifying the body’s Qi and eliminating
pathogenic factors simultaneously. For example, Ren12 Zhongwan tonifies the Spleen but also resolves
Dampness. Of course, a different needling technique
should be used in each case, i.e. reinforcing to tonify the Spleen and reducing to resolve Dampness.
Nevertheless, because acupuncture does not introduce
any foreign substance into the body, it works by harmonizing and regulating the channel system and therefore, although it is still important to adopt the proper
treatment strategy, it has a more ‘neutral’, harmonizing and homoeostatic action than herbal medicine.
Two case histories will clarify the important question
of treatment principles especially in relation to herbal
medicine.
Treatment principle Since there is a Full condition (Blood stasis and Cold in the Uterus) and a
deficiency one (Kidney-Yang deficiency), the practitioner faces a choice in deciding what to do first:
expel pathogenic factors or tonify Kidney-Yang?
The decision depends on the clinical manifestations. In this case, the main presenting problem
was severely painful periods. Since these are due
to Blood stasis (the Manifestation), it is preferable
to concentrate on eliminating pathogenic factors
first, i.e. invigorating Blood, eliminating stasis and
expelling Cold. Another factor that indicates the
need to eliminate pathogenic factors first in this
case is the Tight quality of the pulse. Although the
pulse is Weak on both Rear positions, the Tight
quality indicates the presence of pathogenic factors, so it is preferable to concentrate on eliminating them. Had the pulse been Weak in all positions
and the periods only slightly painful, then it might
have been preferable to concentrate on tonifying
Kidney-Yang.
Case history
A 42-year-old woman had been suffering from
painful periods for 5 years. Her periods came usually late (every 5 weeks) and the menstrual blood
was dark with small clots. The period pain was
intense, of a spastic nature and alleviated by the
application of a hot-water bottle. She also suffered
from backache, dizziness, tiredness, frequent, pale
urination and slight depression. Her tongue was
Pale and wet and her pulse was Deep, Weak on
both Rear positions, and Tight in general.
A 36-year-old woman had been trying to conceive for 4 years. Her menstrual cycle was long
(34–35 days) and getting longer, the period
lasted 5–7 days, it was painful and the menstrual blood was dark with clots. She also experienced abdominal pain before the period. She
had been diagnosed as having endometriosis
and a cyst on the right ovary. She had undergone two IVF treatments without success. She
had also been suffering from night sweating for 5 years, the sweating occurring for 10
days before the period and also during it. On
interrogation, it transpired that she also experienced the following symptoms: dizziness, frequent, pale urination, feeling cold, chilblains,
floaters, poor memory, tingling of limbs, tiredness and thrush. Her tongue was very sightly
Red on the sides and very slightly peeled in the
centre, and had a sticky-yellow coating. Her
pulse was Slippery on the right side and Empty
at the deep level on the left side.
Diagnosis This is a clear case of Blood stasis from
Cold in the Uterus occurring against a background
of Kidney-Yang deficiency.
Diagnosis This patient presents a complex picture
with various patterns, some Empty and some Full in
nature. On the Full side, there is Liver-Qi and Liver-
Case history
124 Section 3: Methods of Treatment
Blood stasis (abdominal pain before the period,
Red sides of the tongue, painful period with dark,
clotted blood), and Dampness (thrush, sticky-yellow coating, ovarian cyst, Slippery pulse). On the
Empty side, there is Kidney-Yang deficiency (late
cycle, frequent, pale urination, tiredness, dizziness,
feeling cold, chilblains), Blood deficiency (floaters, poor memory, tingling of limbs) and the very
beginning of Yin deficiency (tongue peeled in centre, night sweating and Empty pulse at the deep
level).
Treatment principle Faced with such a complex condition, treatment could be approached
from many different angles but the chief choice to
make is whether we want to deal with the Full or
the Empty condition first. I usually prefer to start by
eliminating pathogenic factors first because encumbrances are thus removed and the terrain is prepared on which tonics work better. If we start by
tonifying the body’s Qi, the sweet and sticky nature
of tonic herbs may aggravate the Full conditions. In
this case, I therefore opted for resolving Dampness
and moving Qi first, using a modification of the formula Si Miao San Four Wonderful Powder:
•
•
•
•
•
•
•
•
•
•
•
Cang Zhu Rhizoma Atractylodis 6 g
Huang Bo Cortex Phellodendri 4 g
Yi Yi Ren Semen Coicis 9 g
Chuan Niu Xi Radix Cyathulae 4 g
Chen Pi Pericarpium Citri reticulatae 3 g
Fu Ling Poria 6 g
Ban Xia Rhizoma Pinelliae preparatum 6 g
Xiang Fu Rhizoma Cyperi 6 g
Ze Lan Herba Lycopi 4 g
Dang Gui Radix Angelicae sinensis 6 g
Tu Si Zi Semen Cuscutae 4 g
Explanation
• The first four herbs constitute the formula Si
Miao San Four Wonderful Powder which drains
Damp-Heat from the Lower Burner.
• Chen Pi, Fu Ling and Ban Xia help to resolve
Dampness.
• Xiang Fu moves Qi and eliminates stagnation.
• Ze Lan invigorates Blood and eliminates stasis
and it also helps to resolve Dampness.
• Dang Gui pacifies the Liver and nourishes Blood.
• Tu Si Zi tonifies Kidney-Yang.
Thus, although this prescription contains a Blood
and a Kidney tonic, its main impact is to drain
Dampness and move Qi. After only 15 days of taking this formula, the patient had a period which
came 28 days after the previous one; it was
already less painful and less dark; her night sweating lasted only 2 nights rather than 10. I continued with a modification of this prescription for 3
months until most of the symptoms of Dampness
and stagnation had gone, and then followed it
up with a formula to tonify Kidney-Yang and to
nourish Blood.
Combinations of gynecological
and systemic manifestations
We can distinguish three possible situations: one where
the gynecological and systemic signs simply coexist
with each other, one where there is a causal interaction between them and another where the gynecological signs contradict each other.
Coexistence of contradictory gynecological
and systemic manifestations
Coexistence of contradictory gynecological and systemic manifestations is very common: for example, a
woman may suffer from heavy periods with shortened
cycle and dark red menstrual blood clearly indicating Blood-Heat, but also from tiredness, loose stools,
chilliness, poor appetite, a Weak pulse and a Pale
tongue, indicating Spleen-Yang deficiency. In such
a case, the condition of Blood-Heat and the SpleenYang deficiency simply coexist with no causal relationship between them. This often arises when two
different aetiological factors occur at different stages
of life. For example, Blood-Heat may arise early in life
through emotional problems leading to Liver-Fire,
and Spleen deficiency may arise later in life through
overwork.
The treatment strategy in a case such as the one
above depends on the relative severity of symptoms
and on the history. Obviously, if the periods are very
heavy to the point that the patient needs to stay at
home for 3 or 4 days, then these should be treated first,
ignoring the Spleen-Yang deficiency. Vice versa, if the
periods are heavy but not to the point of interfering
Principles and Methods of Treatment 125
with the patient’s normal life while the symptoms
of Spleen deficiency are severe with a pronounced
tiredness, then it might be preferable to treat the
Spleen deficiency first.
The history of the condition is also important in
deciding upon a treatment strategy. For example, in the
above case, if the patient had been suffering from heavy
periods for a very long time, then it might be preferable
to treat the Spleen deficiency first. On the other hand, if
previously normal periods had suddenly become heavy,
causing great inconvenience, then one should treat the
Blood-Heat first. However, the treatment alternatives
are not necessarily mutually exclusive; in the above
example, one would add one or two herbs to tonify the
Spleen in a cooling-Blood prescription, or one or two
herbs to cool Blood in a Spleen-tonifying one.
Interacting gynecological and systemic
manifestations
An interaction of gynecological and systemic manifestations is also common in gynecological conditions and
it happens when a certain gynecological pathology
leads to a systemic pathology or vice versa. For example, if a woman suffers from heavy periods, say from
Blood-Heat, for many years, the excessive loss of blood
over the years may lead to Blood deficiency and this, in
turn, to Qi deficiency. In such cases, one usually needs
to treat both pathological conditions because there is a
causal relationship between them. Thus, in the above
example, one would have to add Qi and Blood tonics to
a Blood-cooling prescription.
Contradiction among gynecological
manifestations
Contradiction in gynecological manifestations is also
a very common situation. As we discussed in Chapter
5 on diagnosis, the length of the cycle, the amount of
menstrual bleeding and the colour of the menstrual
blood normally agree. For example, if a woman suffers from Blood-Heat, the cycle is short, the period too
heavy and the colour bright red or dark red. Similarly,
if a woman suffers from Blood stasis, the cycle is irregular, the bleeding probably heavy, the menstrual blood
dark with clots and the period painful. However, in
practice, contradictory signs often occur. For example, in the above case, the cycle might be short and the
period heavy but the blood dark with clots rather than
bright red. This would simply indicate that in addition
to Blood-Heat there is also Blood stasis.
Another example of contradictory signs could be that
of a woman suffering from a short cycle with bright red
blood indicating Blood-Heat but with a scanty flow. The
latter could be due to Cold, Blood deficiency or Blood
stasis. As the first two conditions may be excluded, it
simply follows that in addition to Blood-Heat there is
also Blood stasis.
Generally speaking, when contradictory gynecological signs appear, the treatment principle should
be chosen according to the severity of manifestations
and the tongue. Thus, if the period is very heavy
and the blood is bright red, Blood-Heat is indicated;
the cycle may be long, which contradicts this diagnosis, but we can safely treat the patient for BloodHeat despite other contradictory signs. Second, the
tongue-body colour assists the diagnosis of contradictory conditions greatly. In the above example,
if the tongue-body colour were Red, there would be
no doubt about Blood-Heat being the main aspect
of the contradiction, even if the cycle were long.
Similarly, supposing the patient has a short cycle
and the period is heavy (indicating Blood-Heat) but
also painful (indicating Blood stasis), if the tongue
is Purple, we can safely treat Blood stasis first with
a Blood-invigorating prescription modified with the
addition of some Blood-cooling herbs.
Relationship among patterns, Chinese
diseases and Western diseases
In our clinical practice, we can identify three types
of clinical interpretation of symptoms and signs:
the Western diagnosis with its categorization into a
Western disease (e.g. ‘ovarian cysts’ or ‘endometriosis’), the Chinese diagnosis with its categorization into
a Chinese ‘disease’ (e.g. Painful Periods or Late Periods)
and the Chinese pattern identification (e.g. Liver-Qi
stagnation or Kidney-Yang deficiency). Let us analyse
first the relationship between the Western diagnosis
and the Chinese diagnosis.
Western diagnosis and its corresponding categorization of Western disease obviously creates a system
of medicine quite different from the Chinese, with an
entirely different philosophy of the human body and disease. The two systems, however, are not contradictory
but simply different because they move from entirely
126 Section 3: Methods of Treatment
different paradigms. In fact, the two systems are perfectly complementary because they are so different and,
for this reason, we should never discount Western diagnosis as in this field the two systems dovetail perfectly.
Chinese medicine can diagnose imbalances of Qi and
Blood but not much in the way of actual organic diseases: for example, if a woman suffers from abdominal
pain deriving from ovarian cysts that are not palpable,
then this problem would fall under the disease category of ‘Abdominal Pain’ in Chinese medicine, but a
Chinese doctor would not know that the pain is due
to the ovarian cysts. So we should take account of
Western diagnosis; in a few cases, it may also signpost a
Chinese disease categorization different from the norm.
For example, a condition is categorized as ‘Abdominal
Masses’ when there are palpable abdominal masses: if
there are internal tumours that are not palpable, then
an ancient Chinese doctor could not have categorized
the condition under this heading. Thus, if a woman
is diagnosed as suffering from ovarian cysts, this condition would belong to the category of ‘Abdominal
Masses’ even though they are not palpable: this is an
example of a case when we should actually rely on a
Western diagnosis as well as on a Chinese one.
Treating according to Chinese diagnosis with its categorization into Chinese diseases and patterns is never
‘wrong’, and, in the above example, if we had diagnosed
the Chinese disease of ‘Abdominal Pain’ and differentiated it correctly, identifying the patterns of, say, LiverBlood stasis and Damp-Heat, our treatment would not
be wrong and would yield some results. However, if we
take the Western diagnosis into account as well, our
treatment will be more effective because, knowing that
we are dealing with actual tumours, we will add herbs
that dissolve lumps and soften masses.
In some cases, however, the Western diagnosis may
not add any useful information to our diagnosis or
treatment strategy. For example, if a patient suffers
from abdominal pain, it will not change our diagnosis
or treatment whether he or she suffers from irritable
bowel syndrome or diverticulitis. However, in many
cases the Western diagnosis is important for prognosis: the most striking example of this is in breast
lumps because the prognosis is obviously very different
according to whether they are benign or malignant.
In any case, in many instances, the patient has had
no Western diagnosis because no Western disease was
found. For example, in my practice, out of a total of
1531 cases, 692, or 45%, had had no Western diagnosis. Finally, the diagnosis of a Chinese disease often
clears a difficult case when there is no corresponding
Western diagnosis. For example, a complex gynecological case, entirely baffling to Western doctors, may be
clearly identified as a Penetrating Vessel disease.
As for the relationship between Chinese disease categories (such as ‘Abdominal Pain’ or ‘Painful Periods’)
and Chinese patterns (such as Liver-Qi stagnation),
this is of great importance. Pattern identification (bian
zheng) is often emphasized to the detriment of (Chinese)
disease identification (bian bing), and yet the latter is
also important. Identifying the Chinese disease properly makes the treatment according to patterns more
focused and ultimately more effective.
Treating according to pattern identification only may
not be enough: for example, we may correctly identify
a pattern of Liver-Yin deficiency in two patients but, if
one suffers from Menopausal Problems and the other
from Atrophy Syndrome, the treatment will be very different in each case. Clavey makes this point eloquently:
If one’s selection of diagnosis is incorrect the focus of
treatment will be skewed, and then even proper identification of the symptom pattern differentiation will only serve
to help the patient in a general way.1
Thus both disease and pattern identification are necessary in Chinese medicine; problems may arise when
a patient suffers from more than one Chinese disease.
For example, it is not unusual for a woman to suffer
from Painful Periods, Pre-Menstrual Syndrome and
Heavy Periods: in such a case, which Chinese disease
should we treat? The answer depends largely on two
factors, i.e. the relative severity of each problem and
the regularity or irregularity of the menstrual cycle.
In the above example of a woman suffering from those
three conditions, obviously if her periods are so painful that she is debilitated for 5 days each month, being
unable to work, then we should treat Painful Periods
as the main disease. Alternatively, should her period
be so heavy and flooding that she must be confined to
the house for over a week each month because of the
flooding rather than the pain, then we should obviously treat Flooding and Trickling as the main disease.
The regularity (or irregularity) of the cycle is also very
important. Often, but not always, an irregularity of
the cycle takes precedence over other conditions. For
example, if a woman’s period comes every 6–7 weeks
and is scanty, it would be totally wrong to treat this as
a case of Scanty Periods; regulating the cycle is more
important. Similarly, if a woman has a period every
Principles and Methods of Treatment 127
2–3 weeks and the period is mildly painful, it would
also be wrong to treat this as a case of Painful Periods;
it is best treated as a case of Early Periods. Very often,
regulating the cycle also regulates other aspects of the
period, such as any pain or pre-menstrual tension. In
any case, if we prescribe herbal medicine we can adapt
any formula that regulates the cycle to treat other
symptoms such as pain or pre-menstrual tension.
However, in some very complicated cases when a
woman suffers from many different symptoms and
Chinese diseases, it might be sometimes necessary to
ignore the various Chinese diseases and simply treat
according to patterns. In conclusion, treating according to Chinese disease identification is important but
it should not become a strait-jacket limiting our therapeutic intervention.
Finally, there are certain treatment methods that
should not be used during the periods. In particular,
one should not cause sweating in case of invasions of
Wind occurring during the period. Thus one should not
use herbs such as Ma Huang Herba Ephedrae, Gui Zhi
Ramulus Cinnamomi, Fang Feng Radix Saposhnikoviae
or Qiang Huo Rhizoma seu Radix Notopterygii. This is
because during the period the blood vessels are ‘open’
and the channels vulnerable; to expel Wind during the
periods, it is preferable to adopt the method of harmonizing Nutritive and Defensive Qi with a formula such
as Gui Zhi Tang Ramulus Cinnamomi Decoction.
PATHOLOGY OF THE INTERNAL ORGANS
I shall discuss the various methods of treatment focusing on each of the Yin organs with the exception of
the Lungs as they do not have a direct influence on
gynecological problems. Lung-Qi deficiency plays an
indirect role in excessive bleeding from Qi not holding
blood, but this is always associated with, and secondary to, Spleen-Qi deficiency. Thus, the discussion will
be conducted according to the following topics:
•
•
•
•
Kidneys.
Liver.
Spleen.
Heart.
Kidneys
Since the Kidneys can only be deficient, the methods
of treatment for this organ consist only in tonification.
They are:
•
•
•
•
•
tonify Kidney-Yang
strongly tonify Kidney-Yang and stoke up the Fire of
the Gate of Life
nourish Kidney-Yin
nourish Kidney-Essence
tonify both Kidney-Yang and Kidney-Yin.
Tonify Kidney-Yang
Tonifying Kidney-Yang is applicable in deficiency of
Kidney-Yang which may cause amenorrhoea, infertility, early periods, heavy periods or miscarriage.
In pure deficiency of Kidney-Yang there will be chilliness,
frequent, pale urination, backache, pale complexion,
slight depression, Pale tongue and Deep-Weak pulse.
Typical herbs are Rou Gui Cortex Cinnamomi, Ba Ji
Tian Radix Morindae officinalis, Yin Yang Huo Herba
Epimedii, Tu Si Zi Semen Cuscutae, Suo Yang Herba
Cynomorii, Fu Pen Zi Fructus Rubi, Du Zhong Cortex
Eucommiae, Xu Duan Radix Dipsaci, etc.
Representative formulae are You Gui Wan Restoring
the Right [Kidney] Pill, You Gui Yin Restoring the Right
[Kidney] Decoction and Jin Gui Shen Qi Wan Golden
Chest Kidney-Qi Pill. Among the Three Treasures formulae, Strengthen the Root tonifies Kidney-Yang. Among
the Women’s Treasure formulae, Unicorn Pearl, Warm the
Palace and Ease the Journey-Yang tonify Kidney-Yang.
The herbs and prescriptions that tonify Kidney-Yang
are obviously warm or hot and care must be taken
that there is no Heat anywhere. In fact, it would not
be unusual for a patient to suffer from Kidney-Yang
deficiency and Damp-Heat in the Bladder: in such a
case, the use of one of the above formulae would be
contraindicated.
There are two methods to tonify Kidney-Yang in gynecology. The first is to tonify Fire from Water, i.e. stoking
up Fire by nourishing Water which means obtaining
Yang from Yin. As mentioned in Chapter 3 on pathology, Water and Fire are inseparable and mutually nourishing, especially so in women. Thus, in order to tonify
Fire it is necessary to nourish Yin as well so that the
newly-generated Fire does not consume Water: if we
recall the metaphor of the oil lamp (see Figure 3.1),
when we increase the flame, the oil is consumed at a
speedier rate.
In applying the method of obtaining Fire from Water,
relatively large amounts of Yang tonics are added to Yin
tonics. This method is clearly reflected in Zhang Zhong
Jing’s Jin Gui Shen Qi Wan Golden Chest Kidney-Qi
Pill which contains the six herbs forming Liu Wei Di
128 Section 3: Methods of Treatment
Huang Wan Six-Ingredient Rehmannia Pill to nourish
Kidney-Yin, plus Rou Gui Cortex Cinnamomi (or Gui
Zhi Ramulus Cinnamomi) and Fu Zi Radix Aconiti lateralis preparata. You Gui Wan (Yin) Restoring the Right
[Kidney] Pill (Decoction) formulated by Zhang Jing Yue
according to this same principle is also widely used.
The second method of tonifying Yang is that of tonifying Yang by strengthening Qi: this is achieved by adding Yang tonics to Qi-tonifying formulae. By so doing,
we tonify both the Spleen and Kidneys for the purpose
of restoring Kidney -Yang. This method is applied when
there is a deficiency of both Spleen and Kidneys and it
is reflected in the formulae Zhen Wu Tang True Warrior
Decoction, and Hua Shui Zhong Zi Tang Transforming
Water and Planting a Seed Decoction, Jian Gu Tang
Strengthening and Consolidating Decoction, Yuan Tu
Gu Tai Tang Helping the Earth and Consolidating the
Fetus Decoction, and Wen Bao Yin Warming the Uterus
Decoction, all in Fu Qing Zhu’s Gynecology (Fu Qing Zhu
Nu Ke). This method of treatment is particularly indicated when, in addition to Kidney-Yang deficiency, the
Spleen is also deficient and there is some Dampness, an
extremely common occurrence in practice.
Acupuncture
The main points to tonify Kidney-Yang are: BL-23
Shenshu, BL-52 Zhishi, KI-3 Taixi, KI-7 Fuliu, Ren-4
Guanyuan, and KI-13 Qixue with moxa. Although various authors differentiate the action of different Kidney
points according to their ability to tonify Kidney-Yin or
Kidney-Yang (e.g. KI-7 Fuliu for Kidney-Yang and KI-6
Zhaohai for Kidney-Yin), in my opinion the most important differentiation in tonifying Kidney-Yin or KidneyYang is in the use of moxa; in other words, any Kidney
point can tonify Kidney-Yang or Kidney-Yin depending on whether one uses moxa or not (obviously moxa
is used for Kidney-Yang deficiency).2 Thus, the abovementioned points should be used with moxa to tonify
Kidney-Yang. The moxa could be used on the needle or
as moxa cones on the skin. The use of moxa cones on
Ren-4 Guanyuan is particularly effective, while KI-3
Taixi is very effective when used with a warm needle
(i.e. moxa on the needle).
The use of BL-23 Shenshu is particularly important as, being on the Yang surface, it does have
a tendency to tonify Yang. The use of the BackTransporting points is particularly important in
chronic diseases.
SUMMARY
Tonify Kidney-Yang
Gynecological symptoms
Amenorrhoea, infertility, early periods, heavy periods
or miscarriage
General manifestations
Chilliness, frequent, pale urination, backache,
dizziness, tinnitus, pale complexion, slight
depression, Pale tongue and Deep-Weak pulse
Herbs
Rou Gui Cortex Cinnamomi, Ba Ji Tian Radix
Morindae officinalis, Yin Yang Huo Herba Epimedii,
Tu Si Zi Semen Cuscutae, Suo Yang Herba
Cynomorii, Fu Pen Zi Fructus Rubi, Du Zhong Cortex
Eucommiae, Xu Duan Radix Dipsaci, etc.
Formulae
Representative formulae are You Gui Wan Restoring
the Right [Kidney] Pill, You Gui Yin Restoring the
Right [Kidney] Decoction and Jin Gui Shen Qi Wan
Golden Chest Kidney-Qi Pill
Three Treasures or Women’s Treasure
formulae
Strengthen the Root, Unicorn Pearl, Warm the Palace
and Ease the Journey-Yang tonify Kidney-Yang
Acupuncture
BL-23 Shenshu, BL-52 Zhishi, KI-3 Taixi, KI-7 Fuliu,
Ren-4 Guanyuan, and KI-13 Qixue with moxa
Strongly tonify Kidney-Yang and stoke
up the Fire of the Gate of Life
Tonifying Kidney-Yang and stoking up the Fire of the
Gate of Life (Ming Men) is used when there is a very
pronounced deficiency of Kidney-Yang and decline of
the Fire of the Gate of Life without any signs of KidneyYin deficiency. The main manifestations are infertility,
amenorrhoea, mental depression, feeling cold, cold
limbs, very frequent and pale urination, incontinence
of urine, nocturia, backache, a feeling of cold in the
back and knees, a very Pale and wet tongue and a Deep,
Weak and Slow pulse.
In this case, there are very pronounced symptoms
and signs of severe Kidney-Yang deficiency and decline
Principles and Methods of Treatment 129
of the Fire of the Gate of Life. One therefore adopts the
method of tonifying and warming the Fire of the Gate
of Life, without nourishing Yin as in the previous case.
Obviously, this method should be used only in the complete absence of any Heat signs.
The main herbs that stoke up the Fire of the Gate
of Life are Rou Gui Cortex Cinnamomi, Lu Rong Cornu
Cervi pantotrichum, Xian Mao Rhizoma Curculiginis
and Fu Zi Radix Aconiti lateralis preparata. Any of the
other Kidney-Yang tonics mentioned above is also
applicable.
Representative formulae are Zan Yu Dan Aiding
Fertility Pill and Tu Si Zi Wan Cuscuta Pill. Among the
Women’s Treasure formulae, Unicorn Pearl, Warm the
Palace and Ease the Journey-Yang tonify Kidney-Yang
and the Minister Fire.
Acupuncture
The main points to stoke up the fire of the Gate of Life
are basically the same as those that tonify KidneyYang: BL-23 Shenshu, BL-52 Zhishi, KI-3 Taixi, KI-7
Fuliu, Ren-4 Guanyuan, and KI-13 Qixue with moxa.
In addition to these, an important point to use is Du-4
Mingmen with moxa: the use of this point with direct
moxa (cones) is the closest acupuncture can get to
using Rou Gui Cortex Cinnamomi and Fu Zi Radix Aconiti
lateralis preparata.
SUMMARY
Strongly Tonify Kidney-Yang and stoke up
the fire of the Gate of Life
Gynecological symptoms
Infertility, amenorrhoea
General manifestations
Mental depression, feeling cold, cold limbs, very
frequent and pale urination, incontinence of urine,
nocturia, backache, a feeling of cold in the back
and knees, a very Pale and wet tongue and a Deep,
Weak and Slow pulse
Herbs
Rou Gui Cortex Cinnamomi, Lu Rong Cornu Cervi
pantotrichum, Xian Mao Rhizoma Curculiginis and
Fu Zi Radix Aconiti lateralis preparata
Formulae
Zan Yu Dan Aiding Fertility Pill and Tu Si Zi Wan
Cuscuta Pill
Women’s Treasure formulae
Unicorn Pearl, Warm the Palace and Ease the
Journey-Yang
Acupuncture
BL-23 Shenshu, BL-52 Zhishi, KI-3 Taixi, KI-7 Fuliu,
Ren-4 Guanyuan, and KI-13 Qixue with moxa
Nourish Kidney-Yin
Nourishing Kidney-Yin is adopted in cases of deficiency
of Yin. There are several variations of this method
according to the condition. They are:
•
•
•
•
•
mildly nourish Yin
strongly nourish Yin
nourish Yin and clear Empty-Heat
nourish Yin and Blood
nourish Yin and astringe.
The main manifestations of Kidney-Yin deficiency are
infertility, menorrhagia, habitual miscarriage, menopausal problems, backache, dizziness, tinnitus, a feeling
of heat, malar flush, night sweating, a Floating-Empty
or Fine-Rapid pulse and a Red tongue without coating.
The main Kidney-Yin tonics used in gynecology are
Sheng Di Huang Radix Rehmanniae, Shu Di Huang
Radix Rehmanniae preparata (this herb nourishes Blood
primarily but it features in many Yin-nourishing formulae), Gou Qi Zi Fructus Lycii, Nu Zhen Zi Fructus
Ligustri lucidi, Tian Men Dong Radix Asparagi and Gui
Ban Plastrum Testudinis.
Herbs that clear Empty-Heat and are especially used
in gynecology include Han Lian Cao Herba Ecliptae, Qing
Hao Herba Artemisiae annuae, Qin Jiao Radix Gentianae
macrophyllae, Di Gu Pi Cortex Lycii, Ze Xie Rhizoma
Alismatis, Xuan Shen Radix Scrophulariae, Zhi Mu Radix
Anemarrhenae and Mu Dan Pi Cortex Moutan.
Herbs that nourish Yin and astringe are Wu Wei Zi
Fructus Schisandrae, Shan Zhu Yu Fructus Corni, Suan
Zao Ren Semen Ziziphi spinosae, Mu Li Concha Ostreae,
Long Gu Fossilia Ossis mastodi and Fu Pen Zi Fructus
Rubi. Astringent herbs are added to Yin-nourishing formulae either to stop bleeding or to stop sweating, especially night sweating. This method is often used in night
sweats from Yin deficiency during the menopause.
130 Section 3: Methods of Treatment
Examples of Yin-nourishing formulae for a mild condition are Liang Di Tang Two ‘Di’ Decoction and Liu Wei
Di Huang Wan Six-Ingredient Rehmannia Pill. Examples
of Yin-nourishing formulae for a severe condition are
San Jia Fu Mai Tang Three-Shell Restoring the Pulse
Decoction and Zuo Gui Wan (Yin) Restoring the Left
[Kidney] Pill (Decoction). Among the Three Treasures formulae, Nourish the Root nourishes Kidney-Yin. Among
the Women’s Treasure formulae, Ease the Journey-Yin,
Female Treasure and Heavenly Empress nourish KidneyYin and clear Empty-Heat while Nourish Yin and Restrain
the Flow and Growing Jade nourish Kidney-Yin.
Examples of formulae that nourish Yin and clear
Empty-Heat are Qing Hao Bie Jia Tang ArtemisiaAmyda Decoction, Qing Gu San Clearing the Bones
Powder and Qing Jing San Clearing the Menses Powder.
Representative formulae that nourish both Yin and
Blood are Gui Shao Di Huang Tang Angelica-PaeoniaRehmannia Decoction, and Yang Jing Zhong Yu Tang
Nourishing the Essence and Planting Jade Decoction.
Acupuncture
The main points to nourish Kidney-Yin are Ren-4
Guanyuan, KI-6 Zhaohai, KI-3 Taixi, KI-13 Qixue,
KI-10 Yingu, KI-9 Zhubin, and SP-6 Sanyinjiao, without moxa. In addition to these, BL-23 Shenshu and
BL-52 Zhishi may also be used even though they may
tend to tonify Kidney-Yang (as explained above): without moxa, they may be used to tonify Kidney-Yin especially when the patient suffers from backache or from a
pronounced physical and mental exhaustion (as these
points strengthen the Will-Power, Zhi).
I use KI-9 Zhubin for its mental effect in Kidney deficiency: it nourishes the Kidneys and calms the Mind,
relieving anxiety.
Herbs
Sheng Di Huang Radix Rehmanniae, Shu Di Huang
Radix Rehmanniae preparata, Gou Qi Zi Fructus Lycii,
Nu Zhen Zi Fructus Ligustri lucidi, Tian Men Dong
Radix Asparagi and Gui Ban Plastrum Testudinis, Han
Lian Cao Herba Ecliptae, Qing Hao Herba Artemisiae
annuae, Qin Jiao Radix Gentianae macrophyllae,
Di Gu Pi Cortex Lycii, Ze Xie Rhizoma Alismatis,
Xuan Shen Radix Scrophulariae, Zhi Mu Radix
Anemarrhenae, Mu Dan Pi Cortex Moutan, Wu Wei
Zi Fructus Schisandrae, Shan Zhu Yu Fructus Corni,
Suan Zao Ren Semen Ziziphi spinosae, Mu Li Concha
Ostreae, Long Gu Fossilia Ossis mastodi and Fu Pen
Zi Fructus Rubi
Formulae
Liang Di Tang Two ‘Di’ Decoction, Liu Wei Di Huang
Wan Six-Ingredient Rehmannia Pill, San Jia Fu Mai
Tang Three-Shell Restoring the Pulse Decoction and
Zuo Gui Wan (Yin) Restoring the Left [Kidney] Pill
(Decoction), Qing Hao Bie Jia Tang Artemisia-Amyda
Decoction, Qing Gu San Clearing the Bones Powder,
Qing Jing San Clearing the Menses Powder, Gui
Shao Di Huang Tang Angelica-Paeonia-Rehmannia
Decoction, and Yang Jing Zhong Yu Tang Nourishing
the Essence and Planting Jade Decoction
Three Treasures or Women’s
Treasure formulae
Nourish the Root, Ease the Journey-Yin, Female
Treasure and Heavenly Empress, Nourish Yin and
Restrain the Flow and Growing Jade
Acupuncture
Ren-4 Guanyuan, KI-6 Zhaohai, KI-3 Taixi, KI-13
Qixue, KI-10 Yingu, KI-9 Zhubin, and SP-6
Sanyinjiao, without moxa
SUMMARY
Nourish Kidney-Yin
Nourish the Kidney-Essence
Gynecological symptoms
Infertility, menorrhagia, habitual miscarriage,
menopausal problems
General manifestations
Backache, dizziness, tinnitus, a feeling of heat, malar
flush, night sweating, a Floating-Empty or Fine-Rapid
pulse and a Red tongue without coating
The Kidney-Essence has a Yin and a Yang aspect and
its deficiency can therefore manifest with symptoms
of either Yin or Yang deficiency. Apart from the manifestations pertaining to a background of Yin or Yang
deficiency, the main manifestations of Kidney-Essence
deficiency are weak knees, poor memory, weak bones,
osteoporosis, loose teeth, falling or prematurely greying
hair, infertility and primary amenorrhoea.
Principles and Methods of Treatment 131
Herbs that nourish the Essence include Wu Wei Zi
Fructus Schisandrae, Tu Si Zi Semen Cuscutae, Huang
Jing Rhizoma Polygonati, Lu Rong Cornu Cervi pantotrichum, Gou Qi Zi Fructus Lycii and Zi He Che Placenta
hominis.
There is no specific category of formulae that nourish the Essence. However, any of the formulae tonifying
Kidney-Yang or nourishing Kidney-Yin can nourish
the Essence if it includes one or more of the abovementioned herbs.
Acupuncture
There are no points that nourish the Essence specifically and any of the points mentioned above may be
used, with or without moxa depending on whether
there is a deficiency of Yang or not: Ren-4 Guanyuan,
KI-6 Zhaohai, KI-3 Taixi, SP-6 Sanyinjiao, BL-23
Shenshu, BL-52 Zhishi, KI-13 Qixue and KI-7 Fuliu. Of
these, the three points that most nourish the Essence
would be Ren-4, KI-13 and BL-52.
SUMMARY
Nourish the Kidney-Essence
Gynecological symptoms
Primary infertility, amenorrhoea
General manifestations
Weak knees, poor memory, weak bones,
osteoporosis, loose teeth, falling or prematurely
greying hair
Herbs
Wu Wei Zi Fructus Schisandrae, Tu Si Zi Semen
Cuscutae, Huang Jing Rhizoma Polygonati, Lu Rong
Cornu Cervi pantotrichum, Gou Qi Zi Fructus Lycii
and Zi He Che Placenta hominis
Formulae
Any of the formulae tonifying Kidney-Yang or
nourishing Kidney-Yin with the addition of herbs
that nourish Kidney-Essence
Acupuncture
Ren-4 Guanyuan, KI-6 Zhaohai, KI-3 Taixi, SP-6
Sanyinjiao, BL-23 Shenshu, BL-52 Zhishi, KI-13 Qixue
and KI-7 Fuliu
Tonify both Kidney-Yang and Kidney-Yin
As explained in Chapter 3 on pathology, a simultaneous deficiency of both Kidney-Yang and Kidney-Yin
is very common in women; however, this is never a
50–50 situation and the deficiency of one will always
predominate. When treating this condition, therefore,
one must make a clear diagnosis of the condition to
decide whether there is a predominance of KidneyYang or Kidney-Yin deficiency. In the former case, one
selects a formula that tonifies Kidney-Yang and modifies it with the addition of some Yin tonics. Vice versa
applies in the case of a predominance of Kidney-Yin
deficiency.
There is no specific category of formulae to tonify
both Kidney-Yang and Kidney-Yin and one would simply add a few Kidney-Yin tonics to a Yang-tonifying
prescription or a few Kidney-Yang tonics to a Yinnourishing prescription. The structure and composition of certain classical formulae, however, are based
on the principle of tonifying both Yin and Yang. For
example, Jin Gui Shen Qi Wan Golden Chest Kidney-Qi
Pill is based on the formula Liu Wei Di Huang Wan
Six-Ingredient Rehmannia Pill which nourishes KidneyYin, with the addition of two Yang tonics, Fu Zi Radix
Aconiti lateralis preparata and Rou Gui Cortex Cinnamomi
(or Gui Zhi Ramulus Cinnamomi). The modern formula
Er Xian Tang Two Immortals Decoction, used for menopausal problems from a deficiency of both Kidney-Yin
and Kidney-Yang, also combines herbs that strongly
tonify Kidney-Yang with herbs that nourish Yin and
clear Empty-Heat.
Among the Women’s Treasure formulae, Ease the
Journey-Yin and Ease the Journey-Yang tonify both Yin
and Yang when there is a predominance of Kidney-Yin
or Kidney-Yang deficiency respectively: they are both
used for menopausal problems.
Acupuncture
Any of the points mentioned above for Kidney-Yang and
Kidney-Yin deficiency may be used: Ren-4 Guanyuan,
KI-13 Qixue, KI-3 Taixi, KI-6 Zhaohai, KI-7 Fuliu,
KI-10 Yingu, KI-9 Zhubin, BL-23 Shenshu and BL-52
Zhishi. These points should all be used without moxa.
In complicated cases of deficiency of both KidneyYang and Kidney-Yin, acupuncture is often better
than herbal medicine because it is more ‘neutral’ as,
for example, simply using KI-3 Taixi will tonify KidneyYang or Kidney-Yin as needed.
132 Section 3: Methods of Treatment
SUMMARY
Tonify both Kidney-Yang and
Kidney-Yin
Gynecological symptoms
Infertility, scanty periods, amenorrhoea,
irregular periods
General manifestations
Dizziness, tinnitus, backache, night sweating, cold
feet, frequent, pale urination, Weak pulse on both
Rear positions
Formulae
Er Xian Tang Two Immortals Decoction
Women’s Treasure formulae
Ease the Journey-Yin and Ease the Journey-Yang.
Acupuncture
Ren-4 Guanyuan, KI-13 Qixue, KI-3 Taixi, KI-6
Zhaohai, KI-7 Fuliu, KI-10 Yingu, KI-9 Zhubin, BL-23
Shenshu, and BL-52 Zhishi
Liver
There are six treatment methods related to the Liver:
1.
2.
3.
4.
5.
6.
Nourish the Liver.
Pacify the Liver and eliminate stagnation of Qi.
Pacify the Liver and eliminate stasis of Blood.
Clear Liver-Heat by pacifying the Liver.
Drain Liver-Fire.
Subdue Liver-Yang or extinguish Liver-Wind.
The above treatment methods are extremely important in gynecology given the importance of the Liver in
all gynecological functions and pathology.
Nourish the Liver
To nourish the Liver means nourishing Liver-Blood or
Liver-Yin. A deficiency of Liver-Blood and/or LiverYin may be at the root of amenorrhoea or infertility.
Clinical manifestations include poor memory, insomnia, blurred vision, dry eyes, dry hair, tingling of the
limbs, a Pale and dry tongue and a Choppy or Fine
pulse.
The chief herb to nourish Liver-Blood is of course
Dang Gui Radix Angelicae sinensis and others include
Shu Di Huang Radix Rehmanniae preparata, Gou Qi Zi
Fructus Lycii, Sang Ji Sheng Herba Taxilli, Bai Shao
Radix Paeoniae alba and Long Yan Rou Arillus Longan.
Formulae that nourish Liver-Blood include Si Wu
Tang Four Substances Decoction, Ba Zhen Tang Eight
Precious Decoction, Dang Gui Shao Yao San AngelicaPaeonia Powder and many others, many of which are
based on Si Wu Tang. The formula Si Wu Tang Four
Substances Decoction forms the basis for endless variations which can treat most menstrual problems. For
example, the book Essential Methods of Dan Xi (1347)
mentions several variations of this formula:
For late periods with scanty blood use Si Wu Tang plus
Dang Shen and Bai Zhu. If there is Phlegm and leucorrhea add Ban Xia and Chen Pi [to Si Wu Tang]. If
there is Blood-Heat and the periods are irregular use Si
Wu Tang plus Huang Lian. If there is Blood-Heat and
the menstrual blood has clots and is painful use Si Wu
Tang plus Xiang Fu and Huang Lian. If there is Blood
deficiency and the periods are late use Si Wu Tang plus
Huang Qi, Chen Pi and Sheng Ma. If there is backache
and abdominal pain during the period with stagnation of
Qi and stasis of Blood use Si Wu Tang plus Hong Hua,
Tao Ren, E Zhu, Yan Hu Suo, Xiang Fu and Mu Xiang.
If there is Heat and the menstrual blood is dark with
clots use Si Wu Tang plus Huang Lian and Chai Hu. If
the Blood is dried up and there is amenorrhoea use Si Wu
Tang plus Tao Ren and Hong Hua. If there is abdominal
pain during the period use Si Wu Tang plus Chen Pi, Yan
Hu Suo, Mu Dan Pi and Gan Cao. If there is Yin deficiency with scanty urination, body aches and amenorrhoea use Si Wu Tang plus Cang Zhu, Niu Xi, Chen Pi
and Gan Cao.3
A formula that nourishes Liver-Yin is Yi Guan Jian
One Linking Decoction. Nearly all the formulae that
nourish Kidney-Yin also nourish Liver-Yin. Among
the Three Treasures formulae, several nourish LiverBlood when this occurs in combination with other
pathologies: Brocade Sinews (with Wind-Dampness
in the joints), Brighten the Eyes (with eye problems),
Glorious Sea (with skin problems), Bend Bamboo
(with Liver-Yang rising), Freeing the Moon (with
Liver-Qi stagnation) and Root the Spirit (with insomnia). Of the Women’s Treasure formulae, Precious Sea,
Warm the Palace, Free-Flowing Sea and Planting Seeds
nourish Liver-Blood (some of these also tonify the
Kidneys).
Principles and Methods of Treatment 133
Acupuncture
The main points to nourish Liver-Blood are: LIV-8
Ququan, Ren-4 Guanyuan, SP-6 Sanyinjiao, BL-18
Ganshu, BL-17 Geshu and ST-36 Zusanli. BL-17 Geshu
nourishes when used with direct moxa and in conjunction with BL-18 Ganshu.
SUMMARY
Nourish the Liver
Gynecological symptoms
Amenorrhoea, scanty periods or infertility
General manifestations
Insomnia, blurred vision, dry eyes, dry hair, tingling of
limbs, a Pale and dry tongue and a Choppy or Fine pulse
Herbs
Dang Gui Radix Angelicae sinensis, Shu Di Huang
Radix Rehmanniae preparata, Gou Qi Zi Fructus Lycii,
Sang Ji Sheng Herba Taxilli, Bai Shao Radix Paeoniae
alba and Long Yan Rou Arillus Longan
Formulae
Si Wu Tang Four Substances Decoction, Ba Zhen
Tang Eight Precious Decoction, Dang Gui Shao Yao
San Angelica-Paeonia Powder, Yi Guan Jian One
Linking Decoction
Three Treasures or Women’s
Treasure formulae
Brocade Sinews (with Wind-Dampness in the joints),
Brighten the Eyes (with eye problems), Glorious Sea
(with skin problems), Bend Bamboo (with Liver-Yang
rising), Freeing the Moon (with Liver-Qi stagnation),
Root the Spirit (with insomnia), Precious Sea, Warm
the Palace, Free-Flowing Sea and Planting Seeds
Acupuncture
LIV-8 Ququan, Ren-4 Guanyuan, SP-6 Sanyinjiao,
BL-18 Ganshu, BL-17 Geshu, and ST-36 Zusanli
Pacify the Liver and eliminate
stagnation of Qi
This is one of the most important methods of treatment
in gynecology as stagnation of Qi is such a pervasive
pathology in this field. Stagnation of Qi is a major and
frequent cause of pre-menstrual tension and dysmenorrhoea. The main clinical manifestations are sighing,
a feeling of distension of the epigastrium, abdomen or
breasts, moodiness, depression, irritability and a Wiry
pulse.
It is important in practice to make a fundamental
distinction between stagnation of Liver-Qi arising by
itself (usually from emotional strain) and that secondary to a deficiency of Liver-Blood. The former is nearly
always caused by emotional strain over a long period of
time; the latter arises from a deficiency of Liver-Blood
and can therefore be caused by overwork and not necessarily emotional problems. The pathological mechanism in the latter case is due to Liver-Blood (the Yin of
the Liver) not rooting or anchoring Liver-Qi (the Yang
of the Liver) which consequently stagnates. The most
important distinguishing features between these two
types of stagnation are the pulse and the tongue. When
stagnation of Liver-Qi is primary and arises independently, the pulse will be all Wiry and the tongue slightly
Red on the sides; when it is secondary and stemming
from Liver-Blood deficiency, the pulse will be generally
Choppy and Fine and only very slightly Wiry, perhaps
on one side only, and the tongue will be Pale.
Herbs that move Liver-Qi are plentiful: Qing Pi
Pericarpium Citri reticulatae viride, Xiang Fu Rhizoma
Cyperi, Mu Xiang Radix Aucklandiae, Wu Yao Radix
Linderae, Zhi Ke Fructus Aurantii, Zhi Shi Fructus Aurantii
immaturus, Da Fu Pi Pericarpium Arecae, Fo Shou
Fructus Citri sarcodactylis, etc. Most of the herbs that
move Liver-Qi are warm and pungent and their prolonged use may tend to injure Yin, but there are a few
that move Liver-Qi without damaging Yin: Chuan Lian
Zi Fructus Toosendan, Mei Gui Hua Flos Rosae rugosae
and Wu Mei Fructus Mume.
As for moving-Qi formulae, one must distinguish
between those that pacify the Liver and move Qi in primary stagnation of Liver-Qi and those that pacify the
Liver by nourishing Liver-Blood. Among the former is
Yue Ju Wan Gardenia-Ligusticum Pill, Ban Xia Hou Po
Tang Pinellia-Magnolia Decoction and Jin Ling Zi San
Melia Powder.
Of the formulae that pacify the Liver by nourishing
Liver-Blood, by far the most important in gynecology is
of course Xiao Yao San Free and Easy Wanderer Powder.
Others include Si Ni San Four Rebellious Powder and Si
Qi Tang Four Seven Decoction. If Liver-Qi stagnation is
associated with Phlegm, one can use Cang Fu Dao Tan
Wan Atractylodes-Cyperus Conducting Phlegm Pill.
134 Section 3: Methods of Treatment
Among the Three Treasures formulae, Break into a
Smile pacifies the Liver and eliminates stagnation (especially for pain), Release Constraint pacifies the Liver and
eliminates stagnation (especially for emotional stagnation). Of the Women’s Treasure formulae, Freeing the
Moon pacifies the Liver, moves Qi and nourishes LiverBlood, and Free Flow and Freeing Constraint pacify the
Liver, move Qi and eliminate stagnation.
Herbs
Qing Pi Pericarpium Citri reticulatae viride, Xiang Fu
Rhizoma Cyperi, Mu Xiang Radix Aucklandiae, Wu
Yao Radix Linderae, Zhi Ke Fructus Aurantii, Zhi Shi
Fructus Aurantii immaturus, Da Fu Pi Pericarpium
Arecae, Fo Shou Fructus Citri sarcodactylis, Chuan
Lian Zi Fructus Toosendan, Mei Gui Hua Flos Rosae
rugosae and Wu Mei Fructus Mume
Acupuncture
Formulae
The main points to pacify the Liver and eliminate
stagnation are: LIV-3 Taichong (this is the principal
one), G.B.-34 Yanglingquan, LIV-14 Qimen, LIV-13
Zhangmen, G.B.-26 Daimai, LIV-5 Ligou, T.B.-6 Zhigou
and P-6 Neiguan. These points should be needled with
reducing or even method.
LIV-3 is the main point to move Liver-Qi and it has
an influence on the whole length of the Liver channel as well as a very good mental–emotional effect.
G.B.-34 Yanglingquan has a similar but less strong
effect and relieves stagnation especially in the epigastrium and hypochondrium. LIV-14 Qimen moves
Liver-Qi and harmonizes Liver and Stomach, while LIV13 harmonizes Liver and Spleen. G.B.-26 Daimai is the
beginning point of the Girdle Vessel and it harmonizes
this Extraordinary Vessel and also resolves Damp-Heat.
LIV-5 Ligou eliminates stagnation in the Liver channel
mostly when it affects the Bladder or the genitals. T.B.-6
Zhigou pacifies the Liver and eliminates stagnation
especially on the sides of the body. P-6 Neiguan indirectly pacifies the Liver and eliminates stagnation on
the strength of its connection with the Liver channel
within the Terminal Yin (Jue Yin): it is particularly effective when there are pronounced emotional problems.
Yue Ju Wan Gardenia-Ligusticum Pill, Ban Xia Hou
Po Tang Pinellia-Magnolia Decoction, Jin Ling Zi San
Melia Powder, Xiao Yao San Free and Easy Wanderer
Powder, Si Ni San Four Rebellious Powder, Si Qi
Tang Four Seven Decoction, Cang Fu Dao Tan Wan
Atractylodes-Cyperus Conducting Phlegm Pill
SUMMARY
Pacify the Liver and eliminate
stagnation of Qi
Gynecological symptoms
Pre-menstrual tension and dysmenorrhoea
General manifestations
Sighing, a feeling of distension of the epigastrium,
abdomen or breasts, moodiness, depression,
irritability and a Wiry pulse
Three Treasures or Women’s
Treasure formulae
Break into a Smile, Release Constraint, Freeing the
Moon, Free Flow and Freeing Constraint
Acupuncture
LIV-3 Taichong, G.B.-34 Yanglingquan, LIV-14
Qimen, LIV-13 Zhangmen, G.B.-26 Daimai, LIV-5
Ligou, T.B.-6 Zhigou and P-6 Neiguan
Pacify the Liver and eliminate
stasis of Blood
Stasis of Blood is usually the consequence of stagnation of Qi over a long period of time and the two conditions often occur together in gynecological problems.
If one were to compare and contrast stagnation of Qi
with stasis of Blood, one could say in a nutshell that
distension is the symptom of the former and pain the
symptom of the latter. Other clinical manifestations
of stasis of Blood, with particular reference to gynecological problems, are painful periods, dark menstrual
blood with clots, abdominal masses, a dark complexion, abdominal pain, a Wiry, Firm or Choppy pulse and
a Purple tongue.
Invigorating Blood is such an important method of
treatment in gynecology and other disorders that Tang
Zhong Hai, author of the Discussion on Blood Syndromes
(1884), said: “In Blood syndromes one must always eliminate stasis of Blood.”4 There are many herbs that eliminate stasis of Blood such as Hong Hua Flos Carthami,
Principles and Methods of Treatment 135
Tao Ren Semen Persicae, Yi Mu Cao Herba Leonuri, Wu
Ling Zhi Faeces Trogopterori, E Zhu Rhizoma Curcumae,
Yu Jin Radix Curcumae, Ze Lan Herba Lycopi, San Leng
Rhizoma Sparganii, Pu Huang Pollen Typhae, Chi Shao
Radix Paeoniae rubra, Mu Dan Pi Cortex Moutan, Chuan
Xiong Rhizoma Chuanxiong, Dan Shen Radix Salviae
miltiorrhizae, Yan Hu Suo Rhizoma Corydalis, Ji Xue
Teng Caulis Spatholobi, San Qi Radix Notoginseng, Si
Gua Luo Retinervus Luffae fructus, Mo Yao Myrrha,
Ru Xiang Olibanum, Chuan Niu Xi Radix Cyathulae,
Wang Bu Liu Xing Semen Vaccariae, Lu Lu Tong Fructus
Liquidambaris, Chuan Shan Jia Squama Manitis, Di Bie
Chong (also called Tu Bie Chong) Eupolyphaga and Su
Mu Lignum Sappan.
The overwhelming majority of the above obviously
belong to the category of herbs that invigorate Blood;
there are, however, herbs in other categories which also
invigorate Blood, such as Pu Huang Pollen Typhae, San
Qi Radix Notoginseng and Qian Cao Gen Radix Rubiae
(all in the Stopping-Bleeding category), and Chi Shao
Radix Paeoniae rubra and Mu Dan Pi Cortex Moutan
(both in the Cooling-Blood category).
The Blood-invigorating effect of these herbs can be
enhanced by steaming the herb in a mixture of water
and wine. Wine, in fact, raises Yang, warms and penetrates the blood vessels, and invigorates Blood: these
actions enhance the Blood-invigorating effect of a herb.
Practically all Blood-invigorating herbs are contraindicated in pregnancy: unless absolutely necessary, it is
strongly recommended that they are not given to a
pregnant patient. The only Blood-invigorating herbs
that might be relatively safe to use in pregnancy are
Chi Shao Radix Paeoniae rubra, Si Gua Luo Retinervus
Luffae fructus, Ji Xue Teng Radix Spatholobi and Dan
Shen Radix Salviae miltiorrhizae.
Since there are so many Blood-invigorating herbs
and given that they play an extremely important role
in gynecology, to classify them in a rational way makes
their use easier. However, classification is fraught with
difficulties as different Chinese books use different terminologies for the same herb. A three-fold classification
around which there is some consensus is between herbs
that invigorate Blood, herbs that invigorate Blood and eliminate stasis and herbs that break up Blood and eliminate
stasis, in ascending order of strength.5 A list of herbs
according to this three-fold classification is as follows:
1. Herbs that invigorate Blood: Chuan Xiong
Rhizoma Chuanxiong, Yan Hu Suo Rhizoma
Corydalis, Yu Jin Radix Curcumae, Ru Xiang
Olibanum, Mo Yao Myrrha, Wang Bu Liu Xing
Semen Vaccariae.
2. Herbs that invigorate Blood and eliminate
stasis: Dan Shen Radix Salviae miltiorrhizae, Yi
Mu Cao Herba Leonuri, Tao Ren Semen Persicae,
Hong Hua Flos Carthami, Chuan Niu Xi Radix
Cyathulae, Ze Lan Herba Lycopi, Su Mu Lignum
Sappan.
3. Herbs that break up Blood and eliminate stasis:
E Zhu Rhizoma Curcumae, San Leng Rhizoma
Sparganii, Shui Zhi Hirudo, Meng Chong Tabanus,
Di Bie Chong Eupolyphaga, listed here in ascending
order of strength. These herbs are particularly
strong and are said to ‘break up’ (rather than
‘invigorate’) Blood. Herbs that break up Blood are
suitable to dissolve masses from stasis of Blood
and should be used with great care and sparingly.
Also, a standing recommendation is that they be
used in a small dose, no more than 6 g per day. Di
Bie Chong is toxic and I personally confine its use
to cases of carcinoma.
A different classification of the Blood-invigorating
herbs differentiates four groups, listed here in ascending order or strength:
1. Herbs that invigorate and nourish Blood: Dan Shen
Radix Salviae miltiorrhizae and Ji Xue Teng Radix
Spatholobi.
2. Herbs that invigorate Blood and promote healing of
tissues: Ru Xiang Olibanum, Mo Yao Myrrha, Di Bie
Chong Eupolyphaga.
3. Herbs that dispel stasis and scatter Blood: San Leng
Rhizoma Sparganii, E Zhu Rhizoma Curcumae.
4. Herbs that break-up Blood: Shui Zhi Hirudo, Meng
Chong Tabanus, Di Bie Chong Eupolyphaga.
Apart from these two classifications (the first of which
is clinically more significant), the Blood-invigorating
herbs can be classified according to various other criteria as follows:
According to nature (hot or cold)
• Hot: Chuan Xiong Rhizoma Chuanxiong, Ji Xue Teng
Radix Spatholobi, Yan Hu Suo Rhizoma Corydalis, Ze
Lan Herba Lycopi, Hong Hua Flos Carthami, E Zhu
Rhizoma Curcumae, Ru Xiang Olibanum, Wu Ling Zhi
Faeces Trogopterori.
• Cold: Dan Shen Radix Salviae miltiorrhizae, Yu Jin
Radix Curcumae, Yi Mu Cao Herba Leonuri, Chi Shao
Radix Paeoniae rubra, Mu Dan Pi Cortex Moutan,
Chuan Shan Jia Squama Manitis, Di Bie Chong
Eupolyphaga.
136 Section 3: Methods of Treatment
Herbs that invigorate Blood and stop bleeding
• Pu Huang Pollen Typhae.
• San Qi Radix Notoginseng.
• Qian Cao Gen Radix Rubiae.
• Su Mu Lignum Sappan.
• Wu Ling Zhi Faeces Trogopterori.
The first three herbs listed pertain to the StoppingBleeding category but they also invigorate Blood. All
the herbs listed above are obviously extremely useful
in menorrhagia and metrorrhagia because not only
do they stop bleeding, but they also invigorate Blood:
since one should always invigorate Blood when stopping bleeding to prevent excessive cloying, herbs that
combine both functions are particularly welcome.
Herbs that invigorate and cool Blood
• Mu Dan Pi Cortex Moutan.
• Chi Shao Radix Paeoniae rubra.
These two herbs are very widely used in gynecology
to cool and invigorate Blood simultaneously.
Blood-invigorating herbs that particularly influence menstruation
• Yan Hu Suo Rhizoma Corydalis, Yi Mu Cao Herba
Leonuri, Ze Lan Herba Lycopi, Chi Shao Radix
Paeoniae rubra, Tao Ren Semen Persicae, Hong Hua
Flos Carthami, San Leng Rhizoma Sparganii, Wang
Bu Liu Xing Semen Vaccariae, Su Mu Lignum Sappan,
Wu Ling Zhi Faeces Trogopterori, Chuan Shan Jia
Squama Manitis.
Yan Hu Suo and Wu Ling Zhi are particularly indicated for menstrual pain.
Blood-invigorating herbs that affect the breasts
and the Connecting (Luo) Channels Some Bloodinvigorating herbs are also said to ‘penetrate the
Connecting (Luo) Channels’: this means that they
move Qi and Blood and remove obstructions from the
Connecting Channels. They can be used for channel
problems, but in gynecology they can also be used for
breast problems. These herbs are: Si Gua Luo Retinervus
Luffae fructus, Chuan Shan Jia Squama Manitis and Lu
Lu Tong Fructus Liquidambaris.
Blood-invigorating herbs that invigorate the
lower back and knees
• Chuan Niu Xi Radix Cyathulae and Ji Xue Teng Radix
Spatholobi.
Chuan Niu Xi is particularly important because,
besides invigorating the lower back and knees, it has
a descending movement and is often used for upwards
bleeding (such as epistaxis, haematemesis or haemoptysis) deriving from stasis of Blood.
Herbs that invigorate Blood and calm the Mind Dan
Shen Radix Salviae miltiorrhizae invigorates Blood
and calms the Mind. It is such an important Bloodinvigorating herb that some doctors say that using Dan
Shen in the proper dosage is like using the formula
Si Wu Tang Four Substances Decoction: this is because,
in small dosages, Dan Shen can also nourish Blood.
According to modern research, this herb also has an
anti-allergic effect.6
Yu Jin Radix Curcumae also calms the Mind and opens
the Mind’s orifices in cases when this is obfuscated by
stasis of Blood or Phlegm. It is especially indicated in
depression.
It may be useful to list the principal secondary actions
(relevant to gynecology and apart from menstruation)
of some of the Blood-invigorating herbs to differentiate
them more easily:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Chuan Xiong Rhizoma Chuanxiong: expels Wind
from the head, for headache.
Dan Shen Radix Salviae miltiorrhizae: calms the
Mind.
Ji Xue Teng Radix Spatholobi: invigorates the lower
back and knees.
Yu Jin Radix Curcumae: opens the Mind’s orifices, for
mental depression.
Ze Lan Herba Lycopi: promotes urination, for postpartum oedema or post-partum urinary difficulty.
Si Gua Luo Retinervus Luffae fructus: benefits the
breasts, ‘penetrates’ the Connecting (Luo) Channels,
for swollen breasts, insufficient lactation.
Chi Shao Radix Paeoniae rubra: cools the Blood,
widely used for Hot and stagnant Blood in
gynecological problems.
Mu Dan Pi Cortex Moutan: cools the Blood, clears
Liver-Heat. This herb actually pertains to the
Cooling-Blood category but it does also invigorate
Blood.
Ru Xiang Olibanum: invigorates Blood in the channels, for chronic Painful Obstruction Syndrome with
stasis of Blood.
Chuan Niu Xi Radix Cyathulae: invigorates the lower
back and knees.
Wang Bu Liu Xing Semen Vaccariae: reduces breast
swelling.
Su Mu Lignum Sappan: stops bleeding, for post-partum bleeding.
Wu Ling Zhi Faeces Trogopterori: stops bleeding, for
uterine bleeding.
Tao Ren Semen Persicae: moistens the intestines and
Principles and Methods of Treatment 137
promotes bowel movement, for post-partum constipation.
It may be useful to classify the Blood-invigorating
herbs according to their target area/organ (Fig. 6.1):
•
•
•
•
•
•
•
•
•
Mind: Dan Shen.
Head: Chuan Xiong.
Breasts: Wang Bu Liu Xing, Mo Yao, Chuan Shan
Jia, Si Gua Luo, Hong Hua.
Chest: Yu Jin, Dan Shen.
Lower back and knees: Ji Xue Teng, Chuan Niu Xi.
Epigastrium: Yan Hu Suo, Yu Jin, Lu Lu Tong, Wu
Ling Zhi.
Uterus: Yan Hu Suo, Yi Mu Cao, Ze Lan, Chi Shao,
Hong Hua, Tao Ren, San Leng, Su Mu, Wu Ling Zhi,
Di Bie Chong.
Lower abdomen: Yan Hu Suo, Tao Ren, San Leng, Di
Bie Chong.
Bladder: Yi Mu Cao, Ze Lan.
Dan Shen
(mind)
Chuan Xiong
(head)
Yan Hu Suo,
Yu Jin,
Lu Lu Tong,
Wu Ling Zhi
(epigastrium)
Yan Hu Suo,
Tao Ren,
San Leng,
Di Bie Chong
(lower abdomen)
Yi Mu Cao,
Ze Lan
(bladder)
Yan Hu Suo, Yi Mu Cao,
Ze Lan, Chi Shao,
Hong Hua, Tao Ren,
San Leng, Su Mu,
Wu Ling Zhi,
Di Bie Chong (uterus)
Yu Jin,
Dan Shen
(chest)
Wang Bu Liu
Xing, Mo Yao,
Chuan Shan Jia,
Si Gua Luo,
Hong Hua
(breasts)
Ji Xue Teng,
Chuan Niu Xi
(back/knees)
Figure 6.1 Target areas/organs of Blood-invigorating herbs.
Finally, something should be said about the complex
pharmacology of the Blood-invigorating herbs which
makes them some of the most useful herbs in the
Chinese pharmacopoeia. The pharmacological actions
of these herbs may be summarized as follows:
•
•
•
•
•
•
•
•
They improve the dynamics of blood flow and
dilate the peripheral, coronary, cerebral, renal and
mesenteric arteries.
They improve microcirculation. Disturbance of
microcirculation causes many diseases such as
coronary heart disease, angiitis, endometriosis, chronic hepatitis, hepatic cirrhosis and
scleroderma.
They improve concentration, coagulation and
accumulation of blood and prevent thrombosis by
inhibiting accumulation of platelets.
They influence connective tissues and can treat
diseases of these tissues such as skin warts, burn
scars and adhesions.
They readjust cellular and humoral immunity.
They have an analgesic effect.
They increase uterine contractions
They combat inflammation and bacterial infection.
The method of invigorating Blood is often combined
with other methods of treatment according to the condition. The main treatment methods combined with
invigorating Blood are:
•
•
•
•
•
•
•
•
move Qi
tonify Qi
nourish Blood
warm the menses and scatter Cold
clear Heat
move downwards
transform Water and resolve Phlegm
open the orifices.
These combinations will now be discussed in detail.
Move Qi The treatment method that combines moving Qi with invigorating Blood is extremely common
and is based on the well-known principle that “Qi is
the commander of Blood: if Qi moves, Blood moves”. It is
for this reason that very many Blood-invigorating prescriptions contain herbs that move Qi. For example,
Dan Shen Yin Salvia Decoction contains Tan Xiang
Lignum Santali albi and Sha Ren Fructus Amomi to
move Qi; Ge Xia Zhu Yu Tang Eliminating Stasis below
the Diaphragm Decoction contains Xiang Fu Rhizoma
Cyperi, Zhi Ke Fructus Aurantii and Wu Yao Radix
Linderae. Very many other examples could be given.
138 Section 3: Methods of Treatment
Another reason for using Qi-moving herbs when
invigorating Blood is that most of the Qi-moving herbs
enter the Liver and stagnation of Qi of this organ is
often at the basis of stagnation of Qi in many areas
and other organs. That is why it is said that “No matter
which channel is affected in stagnation, the treatment cannot ignore the Liver”.
Bearing in mind that, as mentioned above, the
movement of Blood depends on the movement of Qi,
Qi-moving herbs are also used to set the other herbs in
motion by regulating the ascending and descending of
Qi. Two pairs of herbs that are often used for this purpose are Zhi Ke Fructus Aurantii with Jie Geng Radix
Platycodi and Chai Hu Radix Bupleuri with Niu Xi Radix
Achyranthis bidentatae seu Cyathulae: Zhi Ke makes Qi
descend while Jie Geng directs herbs upwards, and Chai
Hu makes Qi ascend while Niu Xi directs herbs downwards. Both pairs of herbs are found in Xue Fu Zhu Yu
Tang Blood Mansion Eliminating Stasis Decoction.
In the context of moving Qi in order to invigorate
Blood, Chuan Xiong Radix Chuanxiong is a particularly
significant herb because it is said to enter the “Qi within
Blood”.
Tonify Qi Stasis of Blood may arise from many different conditions, among which is Qi deficiency. When Qi
is deficient it does not circulate as it should and it therefore fails to invigorate Blood properly. Thus, when there
is stasis of Blood against a background of Qi deficiency,
one should add one or two Qi tonics to the formula.
The formula Bu Yang Huan Wu Tang Tonifying
Yang and Restoring Five-Tenths Decoction is an example of a prescription for Blood stasis occurring against
a background of Qi deficiency, for which the formula
uses a very large dose of Huang Qi Radix Astragali
membranacei.
Nourish Blood It is often necessary to nourish Blood
when invigorating it either because Blood deficiency
may be at the root of Blood stasis or because the latter
may cause the former. This happens because stagnant
Blood obstructs the channels and blood vessels and
prevents new Blood from taking its rightful place. Yet
another reason for nourishing Blood when invigorating it is that many Blood-invigorating herbs are pungent
and may therefore injure Blood and Yin. Thus, some
Blood tonics may be added to Blood-invigorating formulae whether there are signs of Blood deficiency or not.
The combination of nourishing and invigorating Blood
means that Blood tonics will not cause cloying and
Blood-invigorating herbs will not injure Blood or Yin.
Examples of Blood-invigorating formulae that also
nourish Blood are Si Wu Tang Four Substances Decoction
(which can be classified as a Blood-invigorating formula)
and Wen Jing Tang Warming the Menses Decoction.
Warm the menses and scatter Cold The method of
warming the menses and scattering Cold is used when
there is Blood stasis deriving from Cold obstructing
the Uterus. This condition may cause dysmenorrhoea,
infertility or abdominal masses. Examples of herbs that
warm the menses and scatter Cold are Gui Zhi Ramulus
Cinnamomi, Xiao Hui Xiang Fructus Foeniculi, Wu Zhu
Yu Fructus Evodiae, Gan Jiang Rhizoma Zingiberis, Fu Zi
Radix Aconiti lateralis preparata, Ai Ye Folium Artemisiae
argyi and Rou Gui Cortex Cinnamomi.
The use of herbs that warm the menses greatly helps
to invigorate Blood when stasis of Blood derives from
Cold in the Uterus. A good example of this method of
treatment is mirrored in the use of Gui Zhi Ramulus
Cinnamomi and Wu Zhu Yu Fructus Evodiae within
Wen Jing Tang Warming the Menses Decoction. The use
of Pao Jiang Rhizoma Zingiberis preparatum (fried)
within Sheng Hua Tang Generating and Resolving
Decoction and that of Gan Jiang Rhizoma Zingiberis,
Rou Gui Cortex Cinnamomi and Xiao Hui Xiang Fructus
Foeniculi within Shao Fu Zhu Yu Tang Lower Abdomen
Eliminating Stasis Decoction are other examples of this
method.
Warming herbs may be used even when stagnant
Blood is combined with Heat, because, being pungent and penetrating, they can be used as messenger herbs. The formula Tao He Cheng Qi Tang Persica
Conducting Qi Decoction is a good case in point. This
formula, based on Da Huang Radix et Rhizoma Rhei
and Tao Ren Semen Persicae, is for stasis of Blood in
the Lower Burner following childbirth and affecting
the Mind: it invigorates Blood and it clears Heat by
moving downwards. However, it also contains Gui
Zhi Ramulus Cinnamomi which is warm and pungent.
Gui Zhi is used in this formula for two reasons: first
because it penetrates the blood vessels and therefore
assists the other herbs in invigorating Blood, and second because the cold and bitter herbs used to clear
Heat may congeal Blood, and Gui Zhi, being warm
and penetrating the blood vessels, prevents this from
happening. Thus, the use of a warm and pungent
herb within the formula allows us to clear Heat without congealing Blood, and to warm without increasing the Heat. Tang Zhong Hai (1862–1918) says this
about the formula:
Principles and Methods of Treatment 139
The formula is pungent and scattering [with Gui Zhi]:
together with Cang Xiao, Da Huang and Tao Ren it enters
the Lower Burner and breaks up accumulation of Blood so
that stasis is eliminated in no other way than via the two
excretions, with Da Huang and Cang Xiao via defecation
and with Gui Zhi via urination.7
This passage clearly highlights the role and the
importance of Gui Zhi, a warm and pungent herb,
within a formula to invigorate Blood and eliminate
stasis.
Clear Heat Heat is another pathogenic factor that may
lead to stasis of Blood: it does so by condensing Blood
and therefore slowing down its circulation. Wang Qing
Ren said in his book Corrections of Errors in Medicine (Yi
Lin Gai Cuo, 1830): “When the Blood has Heat it is evaporated and forms lumps.”8 On the other hand, long-term
stasis of Blood may also give rise to Heat by itself. Thus,
when Blood stasis is caused by Heat, one must usually
either clear Heat and resolve Toxic-Heat or clear Heat
and cool Blood, adding a few herbs to invigorate Blood
and eliminate stasis. If stasis of Blood derives from Heat,
clearing Heat may resolve the Blood stasis by itself. If,
on the other hand, Heat results from long-term Blood
stasis, the treatment should emphasize invigorating
Blood and eliminating stasis, and only secondarily aim
at clearing Heat and cooling Blood: eliminating stasis
of Blood will in itself mean Heat will go. An example
of the latter method of treatment is the formula Da
Huang Bie Chong Wan Rheum-Eupolyphaga Decoction
which is for long-term stasis of Blood leading to Heat.
In this formula, there are several strong breaking up
substances (insects) plus Huang Qin Radix Scutellariae
and Sheng Di Huang Radix Rehmanniae to clear Heat
and cool Blood.
The formula Xue Fu Zhu Yu Tang Blood Mansion
Eliminating Stasis Decoction is another case in point.
This formula is for stasis of Blood in the Upper Burner
with Heart-Heat deriving from stasis. Accordingly, the
main emphasis of the prescription is on invigorating
Blood and eliminating stasis and only secondarily on
clearing Heat with Sheng Di Huang Radix Rehmanniae
and Chi Shao Radix Paeoniae rubra.
Whether long-term Blood stasis leads to Heat or
whether Heat condenses the Blood and induces Blood
stasis, herbs that simultaneously invigorate and cool
Blood are always applicable: Mu Dan Pi Cortex Moutan,
Chi Shao Radix Paeoniae rubra and Dan Shen Radix
Salviae miltiorrhizae.
Move downwards The method of moving downwards
(i.e. eliminating pathogenic factors through defecation)
is frequently used in conjunction with that of invigorating Blood and eliminating stasis in the treatment of
stasis of Blood in the Middle or Lower Burner (though
not Upper Burner). Tao He Cheng Qi Tang Persica
Conducting Qi Decoction is a good example of this principle: it eliminates stasis of Blood (for which it uses Tao
Ren Semen Persicae coordinated with Gui Zhi Ramulus
Cinnamomi to invigorate Blood for the reasons explained
above) by moving downwards with Da Huang Radix et
Rhizoma Rhei and Mang Xiao Sulfas Natrii. If Da Huang
is cooked for a long time (or for the same time as the
other herbs), its Blood-invigorating effect is enhanced,
and even more so if it is treated with wine. An example
of this principle is the formula Fu Yuan Huo Xue Tang
Restoring the Source and Invigorating Blood Decoction
which invigorates Blood and eliminates stasis, particularly for traumatic injuries: it contains wine-treated Da
Huang, decocted with the other herbs to move downwards and eliminate stasis.
Transform Water and resolve Phlegm There is an
interrelationship between stasis of Blood and Phlegm,
especially in chronic conditions. When Blood stagnates
over many years, the stagnant Blood obstructs the
proper movement of Qi and functioning of the internal
organs and impairs the transformation of Body Fluids,
leading to the formation of Phlegm. This situation is so
common that some doctors say that one may nearly
always treat old people suffering from a chronic, complicated illness for stasis of Blood and Phlegm. Tang
Zong Hai in fact says: “When Blood stagnates for a long
time it gives rise to Phlegm.”9 On the other hand, longterm retention of Phlegm may also cause stasis of Blood
simply because the obstructing Phlegm impairs the circulation of Blood in the channels and blood vessels.
An example of the principle of combining eliminating stasis of Blood with resolving Phlegm is the formula Gui Zhi Fu Ling Wan Ramulus Cinnamomi-Poria
Pill which is for abdominal masses from stasis of Blood.
This formula contains Fu Ling Poria to resolve Phlegm in
combination with Gui Zhi Ramulus Cinnamomi which,
being warm and pungent, helps to resolve Phlegm by
moving Yang.
Another example of this treatment method is the formula Da Huang Mu Dan Tang Rheum-Moutan Decoction
which is for abdominal pain from Heat and stasis of
Blood and contains Dong Gua Ren Semen Benincasae
to resolve Dampness and Phlegm in the Intestines and
140 Section 3: Methods of Treatment
expel pus. Yet another example is the formula Ou Jing
Tang Lotus Stem Decoction which is for Lung-Heat and
Phlegm with stasis of Blood: it contains Dong Gua Ren
Semen Benincasae and Yi Yi Ren Semen Coicis to resolve
Phlegm.
There are also some Blood-invigorating herbs that
transform Water and resolve Phlegm such as Ze Lan
Herba Lycopi and Yi Mu Cao Herba Leonuri; conversely
there are some Water-transforming herbs that also
invigorate Blood such as Mu Tong Caulis Mutong and
Dong Kui Zi Fructus Malvae.
Open the orifices The orifices of the Heart may be
clouded not only by Phlegm but also by stagnant Blood.
Obstruction of the Heart’s orifices may occur with various degrees of severity and in serious cases it causes
total loss of insight giving rise to psychotic episodes.
Stagnant Blood affects the Heart’s orifices because this
organ houses the Mind and governs Blood, and in conditions of not only Heart-Blood deficiency but also of
Blood stasis, the Mind therefore suffers.
A good example of obstruction of the Mind (the
Heart’s orifices) by stagnant Blood is the post-natal
psychosis occurring as a result of stasis of Blood after
childbirth: the formula Tao He Cheng Qi Tang Persica
Conducting Qi Decoction, mentioned above, is precisely
for such a clinical situation. In gynecology, stagnant
Blood obstructing the Mind is often the result of Blood
stasis in the Uterus first: due to the connection between
this and the Heart via the Uterus Vessel, stagnant Blood
in the Uterus may obfuscate the Mind.
For stagnant Blood clouding the Heart’s orifices,
herbs that have an ascending movement are often
added to a Blood-invigorating formula to direct it to the
Upper Burner and head. For example, the formula Tong
Qiao Huo Xue Tang Opening the Orifices and Invigorating
Blood Decoction for stasis of Blood in the head contains
Cong Bai Bulbus Allii fistulosi which acts as a messenger
herb to direct the formula to the head. Another example is the formula Xue Fu Zhu Yu Tang Blood Mansion
Eliminating Stasis Decoction for stasis of Blood in the
Upper Burner, which contains Chai Hu Radix Bupleuri,
Jie Geng Radix Platycodi and Chuan Xiong Rhizoma
Chuanxiong, all of which direct the herbs to the Upper
Burner.
Of the Three Treasures formulae, Red Stirring invigorates Heart-Blood. Of the Women’s Treasure formulae,
Stir the Field of Elixir invigorates Liver-Blood and eliminates stasis from the Uterus and Invigorate Blood and
Stem the Flow invigorates Blood and stops bleeding.
Acupuncture
The main points to pacify the Liver and eliminate stasis of Blood are the same as those that eliminate stagnation of Liver-Qi, i.e. LIV-3 Taichong (this is the main
one), G.B.-34 Yanglingquan, LIV-14 Qimen, LIV-13
Zhangmen, G.B.-26 Daimai, and LIV-5 Ligou. These
points should be needled with reducing or even method.
In addition, two points which specifically invigorate
Blood are BL-17 Geshu (with needle, no moxa) and
SP-10 Xuehai.
In gynecological diseases, Blood is invigorated also
with the use of the Penetrating Vessel (Chong Mai),
i.e. SP-4 on the right and P-6 on the left together with
KI-14 Siman and LIV-3 Taichong.
SUMMARY
Pacify the Liver and eliminate
stasis of Blood
Gynecological symptoms
Painful periods, dark menstrual blood with large,
dark clots, myoma, irregular periods, endometriosis
General manifestations
Abdominal pain, dark complexion, mental restlessness,
Purple tongue, Wiry, Firm or Choppy pulse
Herbs
Hong Hua Flos Carthami, Tao Ren Semen Persicae, Yi
Mu Cao Herba Leonuri, Wu Ling Zhi Faeces Trogopterori,
E Zhu Rhizoma Curcumae, Yu Jin Radix Curcumae,
Ze Lan Herba Lycopi, San Leng Rhizoma Sparganii, Pu
Huang Pollen Typhae, Chi Shao Radix Paeoniae rubra,
Mu Dan Pi Cortex Moutan, Chuan Xiong Rhizoma
Chuanxiong, Dan Shen Radix Salviae miltiorrhizae, Yan
Hu Suo Rhizoma Corydalis, Ji Xue Teng Caulis Spatholobi,
San Qi Radix Notoginseng, Si Gua Luo Retinervus Luffae
fructus, Mo Yao Myrrha, Ru Xiang Olibanum, Chuan Niu
Xi Radix Cyathulae, Wang Bu Liu Xing Semen Vaccariae,
Lu Lu Tong Fructus Liquidambaris, Chuan Shan Jia
Squama Manitis, Di Bie Chong (also called Tu Bie Chong)
Eupolyphaga, Su Mu Lignum Sappan
Formulae
• Move Qi and invigorate Blood: Dan Shen Yin
Salvia Decoction, Ge Xia Zhu Yu Tang Eliminating
Stasis below the Diaphragm Decoction
Principles and Methods of Treatment 141
• Tonify Qi and invigorate Blood: Bu Yang Huan Wu
Tang Tonifying Yang and Restoring Five-Tenths
Decoction
• Nourish Blood and invigorate Blood: Si Wu Tang
Four Substances Decoction and Wen Jing Tang
Warming the Menses Decoction
• Warm the menses and scatter Cold: Wen Jing Tang
Warming the Menses Decoction, Sheng Hua Tang
Generating and Resolving Decoction, Shao Fu Zhu Yu
Tang Lower Abdomen Eliminating Stasis Decoction
• Clear Heat and invigorate Blood: Da Huang Bie
Chong Wan Rheum-Eupolyphaga Decoction, Xue
Fu Zhu Yu Tang Blood Mansion Eliminating Stasis
Decoction
• Move downwards and invigorate Blood: Tao He
Cheng Qi Tang Persica Conducting Qi Decoction,
Fu Yuan Huo Xue Tang Restoring the Source and
Invigorating Blood Decoction
• Transform Water and resolve Phlegm: Gui Zhi
Fu Ling Wan Ramulus Cinnamomi-Poria Pill, Da
Huang Mu Dan Tang Rheum-Moutan Decoction,
Ou Jing Tang Lotus Stem Decoction
• Open the orifices: Tao He Cheng Qi Tang Persica
Conducting Qi Decoction, Tong Qiao Huo Xue
Tang Opening the Orifices and Invigorating Blood
Decoction, Xue Fu Zhu Yu Tang Blood Mansion
Eliminating Stasis Decoction
Three Treasures or Women’s
Treasure formulae
Red Stirring, Stir the Field of Elixir, Invigorate Blood
and Stem the Flow, Harmonizing the Moon
Acupuncture
LIV-3 Taichong, G.B.-34 Yanglingquan, LIV-14
Qimen, LIV-13 Zhangmen, G.B.-26 Daimai, and LIV-5
Ligou, BL-17 Geshu and SP-10 Xuehai
Dou Chi Semen Sojae preparatum, Shan Zhi Zi Fructus
Gardeniae, Zhu Ye Folium Phyllostachys nigrae, Lu Gen
Rhizoma Phragmitis, etc.
The clinical manifestations of Heat deriving from
stagnant Liver-Qi are the same as those of stagnation
of Liver-Qi plus a feeling of heat, a dry throat, a red
face, red sides of the tongue and a slightly Rapid (and
Wiry) pulse. Thus, Heat arising from stagnant Liver-Qi
is treated by pacifying the Liver, eliminating stagnation and lightly clearing Heat with one or two herbs
only. Any of the formulae for moving Qi and pacifying
the Liver can be adapted to clearing Heat that stems
from stagnant Qi. Indeed, the classical variation to
the formula Xiao Yao San, Dan Zhi Xiao Yao San (also
called Jia Wei Xiao Yao San) Moutan-Gardenia Free
and Easy Wanderer Powder (Augmented Free and Easy
Wanderer Powder) is formulated precisely to pacify the
Liver and clear Heat deriving from stagnant Liver-Qi.
This prescription is used very frequently in gynecological problems. Another example of a prescription that
could be used for this purpose is Yue Ju Wan GardeniaLigusticum Pill.
Of the Three Treasures formulae, Release Constraint
(a variation of Yue Ju Wan mentioned above) can be
used to clear Liver-Heat deriving from Liver-Qi stagnation. Of the Women’s Treasure formulae, Freeing
Constraint can also be used to clear Liver-Heat deriving
from stagnation of Qi.
Acupuncture
To clear Heat by pacifying the Liver, the same points
that pacify the Liver and eliminate stagnation may be
used, i.e. LIV-3 Taichong (this is the main one), G.B.34 Yanglingquan, LIV-14 Qimen, LIV-13 Zhangmen,
G.B.-26 Daimai and LIV-5 Ligou. These points should
be needled with reducing or even method. In addition,
to strengthen the Heat-clearing effect, one may add
LIV-2 Xingjian or L.I.-11 Quchi.
Clear Liver-Heat by pacifying the Liver
When Qi stagnates for a long time it tends to give rise to
Heat. The method of treatment for Heat deriving from
stagnant Qi is quite different from that for other types
of Heat such as that deriving from a febrile disease or
from dietary causes. Heat deriving from stagnant Qi
is treated by pacifying the Liver and eliminating stagnation and using only a few herbs that lightly clear
Heat. Examples of herbs that lightly clear Heat are Dan
SUMMARY
Clear Liver-Heat by pacifying the Liver
Gynecological symptoms
Pre-menstrual symptoms, painful periods
142 Section 3: Methods of Treatment
General manifestations
Sighing, a feeling of distension of the epigastrium,
abdomen or breasts, moodiness, depression,
irritability, feeling of heat, a dry throat, a red face,
red sides of the tongue and a slightly Rapid (and
Wiry) pulse
Table 6.1 Comparison between Heat and Fire
HEAT
FIRE
Feeling of Heat
Mild
Pronounced
Thirst
Mild
Intense
Face
Red
Very red
Mind
Mild irritability
Severe irritability,
agitation, insomnia,
slight manic
behaviour
Dan Zhi Xiao Yao San Moutan-Gardenia Free and
Easy Wanderer Powder, Yue Ju Wan GardeniaLigusticum Pill
Urine
Yellow
Dark and scanty
Stools
Normal
Dry, constipation
Three Treasures or Women’s Treasure
formulae
Bleeding
None
There may be
bleeding
Release Constraint, Freeing Constraint
Tongue
Red or only
sides Red
Dark Red, dry
Pulse
Not Rapid or
only slightly
Rapid,
Overflowing
Rapid, Deep, Full
Herbs
Same as Qi-moving herbs
Formulae
Acupuncture
LIV-3 Taichong, G.B.-34 Yanglingquan, LIV-14
Qimen, LIV-13 Zhangmen, G.B.-26 Daimai, and
LIV-5 Ligou, LIV-2 Xingjian, L.I.-11 Quchi
Drain Liver-Fire
‘Liver-Fire’ is quite different from Liver-Heat deriving from stagnant Liver-Qi: the former is a more substantial pathogenic factor while the latter is often the
result of stagnant Qi.10 Liver-Fire is a more substantial
type of Heat occupying a deeper energetic layer than
Heat. It is hotter, it dries up the fluids more, it affects
the Mind more and it tends to cause haemorrhages
(because Fire may invade the Blood). These characteristics explain the clinical manifestations of Fire as
opposed to Heat: because it is hotter, there is a very red
face, a pronounced feeling of heat; because it dries up
fluids more, there is intense thirst, scanty, dark urine
and constipation with dry stools; because it affects the
Mind more, there is intense irritability, agitation and
insomnia; and because it may tend to enter the Blood,
there may be epistaxis, vomiting of blood, blood in
the stools, blood in the urine or menorrhagia/metrorrhagia. Table 6.1 illustrates the differences between
Heat and Fire.
The treatment methods for these two types of Heat
(one of which I call ‘Fire’) are quite different: in the case
of Heat stemming from stagnant Qi, one needs to pacify
the Liver and lightly clear Heat with cool and bland
herbs, while in the case of Liver-Fire, one uses bitter and
cold herbs to drain Fire. ‘Draining Fire’ by bitter and cold
herbs also implies draining Fire by moving downwards,
i.e. via the bowels (because Fire occupies a deeper energetic layer), while ‘clearing Heat’ by cool and bland,
pungent or sweet herbs gets rid of the Heat by pushing it outwards towards the surface. Examples of lightly
Heat-clearing herbs have been given above. Examples of
bitter and cold herbs that drain Fire by moving downwards are Da Huang Radix et Rhizoma Rhei, Huang Qin
Radix Scutellariae, Huang Lian Rhizoma Coptidis, Huang
Bo Cortex Phellodendri, Long Dan Cao Radix Gentianae,
Xia Ku Cao Spica Prunellae, etc. The main formula that
drains Liver-Fire is Long Dan Xie Gan Tang Gentiana
Draining the Liver Decoction.
Of the Three Treasures range, Drain Fire and Settling
the Soul drain Liver-Fire.
Acupuncture
The main point to drain Liver-Fire is LIV-2 Xingjian,
obviously with reducing method and without moxa.
Other points include L.I.-11 Quchi, T.B.-5 Waiguan
and L.I.-4 Hegu.
Principles and Methods of Treatment 143
SUMMARY
Drain Liver-Fire
Gynecological symptoms
Pre-menstrual tension, irregular periods, infertility,
menorrhagia
General manifestations
Irritability, propensity to outbursts of anger, thirst,
red face, blood-shot eyes, dry stools, dark urine,
headaches, Red tongue with redder sides and with
thick-yellow coating, Wiry-Rapid pulse
Herbs
Da Huang Radix et Rhizoma Rhei, Huang Qin Radix
Scutellariae, Huang Lian Rhizoma Coptidis, Huang Bo
Cortex Phellodendri, Long Dan Cao Radix Gentianae,
Xia Ku Cao Spica Prunellae
Formulae
Long Dan Xie Gan Tang Gentiana Draining the Liver
Decoction
Three Treasures formulae
while the symptoms and signs of a full eclampsia state
are typical of Liver-Wind (i.e. convulsions).
The herbs that subdue Liver-Yang tend to be the same
as those which extinguish Liver-Wind, such as Tian Ma
Rhizoma Gastrodiae, Gou Teng Ramulus Uncariae cum
Uncis, Ju Hua Flos Chrysanthemi, Zhen Zhu Mu Concha
Margaritiferae usta, Bai Ji Li Fructus Tribuli, etc.
Representative prescriptions to subdue Liver-Yang
are Tian Ma Gou Teng Yin Gastrodia-Uncaria Decoction
and Zi Shui Qing Gan Yin Nourishing Water and
Clearing the Liver Decoction. Formulae that extinguish
Liver-Wind include Zhen Gan Xi Feng Tang Pacifying
the Liver and Subduing Wind Decoction and Ling Jiao
Gou Teng Yin Cornu Antelopis-Uncaria Decoction.
Of the Three Treasures formulae, Bend Bamboo subdues Liver-Yang and Liver-Wind. Of the Women’s
Treasure formulae, Female Treasure nourishes Liver- and
Kidney-Yin and subdues Liver-Yang.
Acupuncture
The main points to subdue Liver-Yang or extinguish
Liver-Wind are LIV-3 Taichong, G.B.-20 Fengchi, T.B.-5
Waiguan, L.I.-4 Hegu and Du-16 Fengfu.
Drain Fire and Settling the Soul
Acupuncture
LIV-2 Xingjian, L.I.-11 Quchi, T.B.-5 Waiguan
and L.I.-4 Hegu
Subdue Liver-Yang or extinguish
Liver-Wind
Liver-Yang or Liver-Wind may rise from a variety of
causes: from Kidney-Yin deficiency, a simultaneous
Kidney-Yin and Kidney-Yang deficiency, Liver-Yin deficiency or Liver-Blood deficiency. Whatever the cause,
Liver-Yang or Liver-Wind rising are often at the root
of gynecological problems such as headaches related
to the menstrual cycle, eclampsia or menopausal
problems.
The clinical manifestations of Liver-Yang rising
include headaches of a throbbing character, irritability,
a red face and a Wiry pulse. Liver-Wind manifests with
tics, tremors or convulsions (as in eclampsia). From a
Western medical perspective, the symptoms of a preeclampsia state broadly correspond to those of LiverYang rising (hypertension, headache, blurred vision)
SUMMARY
Subdue Liver-Yang or extinguish
Liver-Wind
Gynecological symptoms
Headaches related to the menstrual cycle, preeclampsia or eclampsia, or menopausal problems
General manifestations
Headaches of a throbbing character, irritability, a red
face, and a Wiry pulse. Liver-Wind manifests with
tics, tremors or convulsions (as in eclampsia)
Herbs
Tian Ma Rhizoma Gastrodiae, Gou Teng Ramulus
Uncariae cum Uncis, Ju Hua Flos Chrysanthemi, Zhen Zhu
Mu Concha Margaritiferae usta, Bai Ji Li Fructus Tribuli
Formulae
For Liver-Yang rising: Tian Ma Gou Teng Yin
Gastrodia-Uncaria Decoction and Zi Shui Qing
Gan Yin Nourishing Water and Clearing the Liver
144 Section 3: Methods of Treatment
Acupuncture
Gentlemen Decoction), Spleen-Blood and Liver-Blood.
The formula Gui Pi Tang Tonifying the Spleen Decoction
also tonifies Spleen-Qi and Spleen-Blood and its emphasis is on the Spleen rather than the Liver: it is widely
used to stop bleeding (such as excessive menstrual
bleeding) from Spleen-Qi deficiency.
Among the Three Treasures formulae, Calm the Shen
tonifies Spleen-Qi, Spleen-Blood, Heart-Qi and HeartBlood. Precious Sea is a variation of Ba Zhen Tang.
LIV-3 Taichong, G.B.-20 Fengchi, T.B.-5 Waiguan,
L.I.-4 Hegu and Du-16 Fengfu
Acupuncture
Decoction. Formulae that extinguish Liver-Wind
include Zhen Gan Xi Feng Tang Pacifying the Liver
and Subduing Wind Decoction and Ling Jiao Gou
Teng Yin Cornu Antelopis-Uncaria Decoction
Three Treasures or Women’s Treasure formulae
Bend Bamboo, Female Treasure
Spleen
The treatment methods applicable to the Spleen are:
•
•
•
•
•
•
tonify Spleen-Qi and Spleen-Blood
tonify Spleen-Yang
tonify and raise Spleen-Qi
tonify the Spleen to hold Blood
harmonize the Spleen and Liver
tonify the Spleen and resolve Dampness.
The main points to use to tonify Spleen-Qi are: ST-36
Zusanli, SP-6 Sanyinjiao, Ren-12 Zhongwan, BL-20
Pishu and BL-21 Weishu. These points should be reinforced and moxa is applicable. In fact, the use of the combination ST-36 Zusanli and SP-6 Sanyinjiao with moxa
on the needle is a very simple and very effective way to
tonify Spleen-Qi or Spleen-Yang. This combination is
particularly good for women as the point SP-6 also tonifies Liver and Kidneys and therefore the Uterus.
Tonify Spleen-Qi and Spleen-Blood
SUMMARY
The Spleen, together with the Stomach, is the source
of Post-Natal Qi and Blood. The Food-Qi (Gu Qi) of
the Spleen is transformed into Gathering Qi (Zong Qi)
which, in turn, is transformed into Blood. As we have
seen, the Kidneys play the most important role in the
formation of menstrual blood, being the source of the
Tian Gui, but the Spleen and the Post-Natal Qi play an
important function in supplementing Blood. Thus,
whenever there is a deficiency of Blood in women, three
organs should usually be tonified: the Liver because it
stores Blood, the Spleen because it makes Blood and the
Kidneys because they are the source of the Tian Gui.
By far the most common symptom of deficiency of
Spleen-Qi and Spleen-Blood is tiredness; in addition,
there may be amenorrhoea or scanty periods.
Examples of sweet herbs that tonify Spleen-Qi include
Huang Qi Radix Astragali, Bai Zhu Rhizoma Atractylodis
macrocephalae, Ren Shen Radix Ginseng, Dang Shen
Radix Codonopsis and Shan Yao Rhizoma Dioscoreae.
Herbs that nourish Spleen-Blood are Dang Gui Radix
Angelicae sinensis and Bai Shao Radix Paeoniae alba.
The best example of the treatment principle of tonifying Qi and nourishing Blood is of course the formula
Ba Zhen Tang Eight Precious Decoction which tonifies
Spleen-Qi (because it contains the Si Jun Zi Tang Four
Tonify Spleen-Qi and Spleen-Blood
Gynecological symptoms
Amenorrhoea or scanty periods
General manifestations
Tiredness, poor appetite, loose stools, slight
abdominal distension, Pale tongue, Weak pulse
Herbs
Huang Qi Radix Astragali, Bai Zhu Rhizoma
Atractylodis macrocephalae, Ren Shen Radix
Ginseng, Dang Shen Radix Codonopsis, Shan Yao
Rhizoma Dioscoreae, Dang Gui Radix Angelicae
sinensis, Bai Shao Radix Paeoniae alba
Formulae
Ba Zhen Tang Eight Precious Decoction, Gui Pi Tang
Tonifying the Spleen Decoction
Three Treasures formulae
Calm the Shen, Precious Sea
Acupuncture
ST-36 Zusanli, SP-6 Sanyinjiao, Ren-12 Zhongwan,
BL-20 Pishu and BL-21 Weishu
Principles and Methods of Treatment 145
Tonify Spleen-Yang
Spleen-Yang deficiency is a more serious stage of
Spleen-Qi deficiency: the clinical manifestations
are essentially the same with the addition of a pronounced feeling of cold, cold arms and legs, very
loose stools, slight abdominal pain, a very Pale and
wet tongue and a Deep, Weak and possibly Slow
pulse. In gynecology, Spleen-Yang deficiency may
cause scanty periods, dysmenorrhoea or leucorrhoea. It is frequently associated with Kidney-Yang
deficiency.
Herbs that tonify Spleen-Yang are all sweet herbs
that tonify Spleen-Qi as detailed above. The main
formula to tonify Spleen-Yang is Li Zhong Wan
Regulating the Centre Pill. If there is pronounced
deficiency of Spleen-Yang with Dampness, the formula Li Zhong Wan can be combined with the formula Quan Sheng Bai Zhu San Whole Generating
Atractylodes Powder.
Acupuncture
The points to tonify and warm Spleen-Yang are the
same as those indicated for Spleen-Qi deficiency, except
that moxa should definitely be used.
SUMMARY
Tonify Spleen-Yang
Gynecological symptoms
Amenorrhoea, scanty periods, infertility
General manifestations
Tiredness, poor appetite, loose stools, slight
abdominal distension, a pronounced feeling of cold,
cold arms and legs, Pale and wet tongue, DeepWeak pulse
Dampness, the formula Li Zhong Wan can be
combined with the formula Quan Sheng Bai Zhu San
Whole Generating Atractylodes Powder
Acupuncture
ST-36 Zusanli, SP-6 Sanyinjiao, Ren-12 Zhongwan,
BL-20 Pishu, and BL-21 Weishu. Moxa
Tonify and raise Spleen-Qi
The method of tonifying and raising Spleen-Qi is used
when Spleen-Qi is sinking: this is a type of Spleen-Qi
deficiency characterized by prolapses, a draggingdown or bearing-down feeling, chronic, longstanding
vaginal discharges, or frequency and slight incontinence of urination.
Without an actual prolapse, this condition is fairly
common and it is seen in chronic vaginal discharge,
chronic menorrhagia and chronic interstitial cystitis. However, please note that, in women, all the above
three conditions also involve sinking of Kidney-Qi.
Sinking of Spleen-Qi has also a mental–emotional
aspect: just as the sinking of Spleen-Qi causes Qi to
descend and organs to sag, on a mental–emotional
level it causes depression and low moods. Thus, the
method of tonifying and raising Spleen-Qi may also
be used purely for mental depression and low spirits
(when this occurs against a background of Spleen
deficiency), in the absence of actual Qi sinking on a
physical level.
The relevant herbs to tonify Spleen-Qi have been
mentioned above.
The most apt prescription to tonify and raise
Spleen-Qi is Bu Zhong Yi Qi Tang Tonifying the Centre
and Benefiting Qi Decoction which raises Spleen-Qi both
on a physical and a mental level. Among the Three
Treasures formulae, Tonify Qi and Ease the Muscles tonifies and raises Spleen-Qi.
Herbs
Huang Qi Radix Astragali, Bai Zhu Rhizoma
Atractylodis macrocephalae, Ren Shen Radix
Ginseng, Dang Shen Radix Codonopsis, Shan Yao
Rhizoma Dioscoreae
Formulae
Li Zhong Wan Regulating the Centre Pill. If there
is pronounced deficiency of Spleen-Yang with
Acupuncture
The points to tonify and raise Spleen-Qi are the same
as those mentioned above, i.e. ST-36 Zusanli, SP-6
Sanyinjiao, Ren-12 Zhongwan, BL-20 Pishu and BL-21
Weishu. In addition, Du-20 Baihui should be needled
with reinforcing method or with direct moxa cones. In
case of prolapse of the uterus, the point Ren-6 Qihai
should also be needled with reinforcing method.
146 Section 3: Methods of Treatment
SUMMARY
Tonify and raise Spleen-Qi
Gynecological symptoms
Prolapse of uterus, menorrhagia, metrorrhagia,
chronic urinary symptoms, chronic vaginal discharge
General manifestations
Prolapses, a dragging-down or bearing-down
feeling, chronic, longstanding vaginal discharges, or
frequency and slight incontinence of urination, Pale
tongue, Weak pulse
Herbs
Huang Qi Radix Astragali, Bai Zhu Rhizoma Atractylodis
macrocephalae, Ren Shen Radix Ginseng, Dang Shen
Radix Codonopsis, Shan Yao Rhizoma Dioscoreae
Acupuncture
The points to tonify Spleen-Qi to hold Blood are the
same as those mentioned above for the previous two
methods of treatment. More specifically, Du-20 Baihui
is important to raise Qi and stop bleeding downwards
such as with excessive periods. SP-1 Yinbai with direct
moxa cones is an empirical point to stop bleeding from
the Uterus, even if the bleeding is from Blood-Heat. It
also stops other forms of bleeding such as vomiting of
blood, bleeding from the nose, blood in the urine and
blood in the stools.
SUMMARY
Tonify the Spleen to hold Blood
Gynecological symptoms
Formulae
Heavy periods, menorrhagia, metrorrhagia (beng lou)
Bu Zhong Yi Qi Tang Tonifying the Centre and
Benefiting Qi Decoction
General manifestations
Three Treasures formulae
Tiredness, poor appetite, loose stools, Pale tongue,
Weak pulse
Tonify Qi and Ease the Muscles, Breaking Clouds
Herbs
Acupuncture
Huang Qi Radix Astragali
ST-36 Zusanli, SP-6 Sanyinjiao, Ren-12 Zhongwan,
BL-20 Pishu, BL-21 Weishu, Du-20 Baihui
Formulae
Tonify the Spleen to hold Blood
One of the functions of the Spleen is to hold Blood in
the vessels; to a certain extent this also depends on
Spleen-Qi rising (and not sinking). When Spleen-Qi is
weak and fails to hold Blood in the vessels, there may be
haemorrhages: this is a major cause of bleeding which
is frequently seen in gynecology such as in excessive
periods and flooding (beng lou).
For such cases, the method of treatment indicated
consists in tonifying the Spleen to reinforce its function of holding Blood. The key herb is Huang Qi Radix
Astragali and the representative formulae are Gui Pi
Tang Tonifying the Spleen Decoction and Bu Qi Gu Jing
Wan Tonifying Qi and Consolidating the Menses Pill. Of
the Women’s Treasure formulae, Restrain the Flow tonifies Qi to hold Blood and stop bleeding. Calm the Shen
from the Three Treasures formulae can also be used to
tonify Spleen-Qi to hold Blood and stop bleeding.
Gui Pi Tang Tonifying the Spleen Decoction, Bu Qi Gu
Jing Wan Tonifying Qi and Consolidating the Menses
Pill
Three Treasures or Women’s Treasure
formulae
Restrain the Flow, Calm the Shen
Acupuncture
ST-36 Zusanli, SP-6 Sanyinjiao, Ren-12 Zhongwan,
BL-20 Pishu, BL-21 Weishu, Du-20 Baihui, SP-1 Yinbai
Harmonize Spleen and Liver
This method is used when there is a disharmony
between Spleen and Liver: this occurs when the Spleen
is deficient and Liver-Qi stagnant. Its most common
symptoms are abdominal pain and distension and loose
stools. In the gynecological sphere, it is a very common
pattern in pre-menstrual tension causing irritability,
tiredness, epigastric and abdominal distension and
swelling of the breasts.
Principles and Methods of Treatment 147
The chief formula to harmonize Liver and Spleen
is of course Xiao Yao San Free and Easy Wanderer
Powder. Of the Women’s Treasure formulae, Freeing
the Moon and Free Flow harmonize the Spleen and
Liver.
Acupuncture
The main points to harmonize Liver and Spleen are:
LIV-13 Zhangmen, Ren-12 Zhongwan, ST-36 Zusanli,
SP-6 Sanyinjiao, G.B.-34-Yanglingquan, LIV-3 Taichong, BL-20 Pishu and BL-18 Ganshu. The points to
tonify the Spleen (Ren-12, ST-36, SP-6 and BL-20)
should be reinforced while the others should be needled
with reducing or even method.
SUMMARY
Harmonize Spleen and Liver
Gynecological symptoms
Pre-menstrual tension
General manifestations
Abdominal pain and distension, loose stools,
irritability, tiredness, distension of the breasts
Formulae
Xiao Yao San Free and Easy Wanderer Powder
Women’s Treasure formulae
Freeing the Moon and Free Flow
Acupuncture
LIV-13 Zhangmen, Ren-12 Zhongwan, ST-36 Zusanli,
SP-6 Sanyinjiao, G.B.-34-Yanglingquan, LIV-3
Taichong, BL-20 Pishu and BL-18 Ganshu
Tonify the Spleen and resolve Dampness
Spleen deficiency with Dampness is one of the most
common patterns encountered in practice. Deficient
Spleen-Qi fails to transform and transport food essences
and fluids which accumulate into Dampness. Since
dietary causes of disease are extremely common in our
society, this clinical situation is very frequent indeed.
The clinical manifestations of Spleen deficiency with
Dampness vary according to whether Spleen-Qi deficiency predominates and there is little Dampness, or
Dampness is very obvious and dominant. By far the
most common and pervasive symptom of Spleen-Qi
deficiency is tiredness: a very high proportion of
patients present with this as their main complaint.
Other symptoms and signs include poor appetite, loose
stools, slight abdominal distension and an excessive
vaginal discharge. If there is Dampness, the symptoms
and signs might include a feeling of fullness and heaviness, a sticky taste, a profuse vaginal discharge, poor
digestion with a feeling of fullness, mucus in the stools,
a thick, sticky tongue coating and a Slippery pulse.
In gynecology, Dampness is an extremely frequent
pathogenic factor at the root of many women’s problems. It may, for example, be involved in excessive
vaginal discharges, dysmenorrhoea, mid-cycle pain,
ovarian cysts, cervical cancer (beginning stages) and
infertility. Dampness obstructs the Lower Burner and
the Directing, Penetrating and Girdle Vessels (Ren,
Chong and Dai Mai), in particular the last of these. In
fact, one of the major pathologies of Full conditions
of the Girdle Vessel is Dampness infusing downwards
causing profuse vaginal discharge and a pronounced
feeling of heaviness in the lower abdomen.
The treatment principle varies according to the relative importance of Spleen deficiency or Dampness:
this ranges from dealing with the Root only by purely
tonifying Spleen-Qi, to dealing with the Manifestation
only by purely resolving Dampness. Between these two
extremes lies a third method which consists in treating both the Root and the Manifestation by tonifying
Spleen-Qi and resolving Dampness simultaneously.
According to the treatment principle, the relevant
herbs are therefore ones that tonify Spleen-Qi as mentioned above; sweet, bland herbs Fu Ling Poria and
Yi Yi Ren Semen Coicis which resolve Dampness; and
warm, pungent and aromatic herbs Cang Zhu Rhizoma
Atractylodis and Sha Ren Fructus Amomi which aromatically resolve Dampness; however, prolonged use
may damage Yin.
The representative formula purely to tonify Spleen-Qi
is Si Jun Zi Tang Four Gentlemen Decoction. If SpleenYang is deficient, Li Zhong Wan Regulating the Centre
Pill is used instead. There are very many formulae
that resolve Dampness with varying emphasis. There
are three basic methods to resolve Dampness: draining Dampness via urination, fragrantly resolving
Dampness and drying Dampness. These three methods
are frequently combined within one formula, such as
Huo Po Xia Ling Tang Agastache-Magnolia-Pinellia-Poria
148 Section 3: Methods of Treatment
Decoction. A formula that resolves Damp-Heat and is
frequently used in gynecology is Er Miao San (or San
Miao San or Si Miao San) Two Wonderful Powder (or
Three Wonderful Powder or Four Wonderful Powder).
If the method of tonifying the Spleen and resolving
Dampness simultaneously is adopted, the representative prescription is Shen Ling Bai Zhu San GinsengPoria-Atractylodes Powder. If there is Dampness and
Spleen-Yang, rather than Spleen-Qi, deficiency, the
representative formulae are Quan Sheng Bai Zhu San
Whole Generating Atractylodes Powder used together
with Li Zhong Wan Regulating the Centre Pill, and
the formula Wan Dai Tang Ending Vaginal Discharge
Decoction.
In chronic cases, Spleen-Yin may also become deficient: this pattern is not often mentioned, but does
exist and it always encompasses Spleen-Qi deficiency.
The clinical manifestations of Spleen-Yin deficiency
include all those of Spleen-Qi deficiency plus: dry lips,
dry mouth with desire to drink in small sips, pale, dull
face but with a ‘floating’ red hue, dry stools, a feeling
of heat in the face although the hands and feet may be
cold (from Spleen-Qi deficiency), and a tongue that has
transversal cracks on the sides (Fig. 6.2). Spleen-Yin
deficiency is more common in women and, in gynecology, it may cause amenorrhoea or scanty periods.
The representative prescription for Spleen-Yin
deficiency is Shen Ling Bai Zhu San Ginseng-PoriaAtractylodes Powder with the addition of Bei Sha Shen
Radix Glehniae, Mai Men Dong Radix Ophiopogonis and
Shi Hu Herba Dendrobii; the removal of Sha Ren Fructus
Amomi; and the substitution of Xi Yang Shen Radix
Panacis quinquefolii or Tai Zi Shen Radix Pseudostellariae
for Ren Shen Radix Ginseng.
Spleen disharmonies are often accompanied by
Stomach disharmonies, chiefly that of rebellious
Stomach-Qi, i.e. Stomach-Qi ascending instead of
descending. In the context of gynecology, this often
causes morning sickness during pregnancy and also
nausea and vomiting during the periods. If the case
is one of upward rebellion of Stomach-Qi, the treatment method is obviously to subdue Stomach-Qi. The
representative prescription to achieve this is Xiao Ban
Xia Tang Small Pinellia Decoction in combination with
Ju Pi Zhu Ru Tang Tangerine Peel-Bambusa Decoction
to send rebellious Qi downward and harmonize the
stomach.
Of the Three Treasures formulae, Soothe the Centre
tonifies Spleen-Qi and resolves Dampness and Central
Mansion tonifies Spleen-Qi, Stomach-Qi and StomachYin and resolves Dampness.
Acupuncture
The main points to tonify Spleen-Qi are: ST-36 Zusanli,
SP-6 Sanyinjiao, Ren-12 Zhongwan, BL-20 Pishu, and
BL-21 Weishu, to be needled with reinforcing method.
Those to resolve Dampness are: SP-9 Yinlingquan,
BL-22 Sanjiaoshu, Ren-9 Shuifen, and ST-28 Shuidao,
with reducing or even method.
SUMMARY
Tonify the Spleen and resolve
Dampness
Gynecological symptoms
Chronic vaginal discharge, dysmenorrhoea,
mid-cycle pain, cervical dysplasia, cervical cancer,
chronic urinary symptoms, ovarian cysts, infertility
General manifestations
Tiredness, poor appetite, loose stools, slight
abdominal distension, a feeling of fullness and
heaviness, a sticky taste, a profuse vaginal discharge,
mucus in the stools, a thick-sticky tongue coating
and a Slippery pulse
Herbs
Figure 6.2 Transversal cracks on the tongue from
Spleen-Yin deficiency.
Huang Qi Radix Astragali, Bai Zhu Rhizoma Atractylodis
macrocephalae, Ren Shen Radix Ginseng, Dang Shen
Radix Codonopsis, Shan Yao Rhizoma Dioscoreae,
Fu Ling Poria, Cang Zhu Rhizoma Atractylodis, Sha Ren
Fructus Amomi, Yi Yi Ren Semen Coicis
Principles and Methods of Treatment 149
Formulae
• Tonify Qi: Si Jun Zi Tang Four Gentlemen
Decoction, Li Zhong Wan Regulating the Centre Pill
• Resolve Dampness: Huo Po Xia Ling Tang
Agastache-Magnolia-Pinellia-Poria Decoction, Er
Miao San Two Wonderful Powder
• Tonify Qi and resolve Dampness: Shen Ling Bai
Zhu San Ginseng-Poria-Atractylodes Powder, Quan
Sheng Bai Zhu San Whole Generating Atractylodes
Powder used together with Li Zhong Wan
Regulating the Centre Pill, Wan Dai Tang Ending
Vaginal Discharge Decoction
• Spleen-Yin deficiency with Dampness: Shen
Ling Bai Zhu San Ginseng-Poria-Atractylodes
Powder with the addition of Bei Sha Shen Radix
Glehniae, Mai Men Dong Radix Ophiopogonis,
and Shi Hu Herba Dendrobii; the removal of Sha
Ren Fructus Amomi; and the substitution of Xi
Yang Shen Radix Panacis quinquefolii or Tai Zi
Shen Radix Pseudostellariae for Ren Shen Radix
Ginseng
• Stomach disharmonies, rebellious Stomach-Qi:
Xiao Ban Xia Tang Small Pinellia Decoction in
combination with Ju Pi Zhu Ru Tang Tangerine
Peel-Bambusa Decoction
Three Treasures formulae
Soothe the Centre, Central Mansion
Acupuncture
To tonify Spleen-Qi: ST-36 Zusanli, SP-6 Sanyinjiao,
Ren-12 Zhongwan, BL-20 Pishu and BL-21 Weishu
To resolve Dampness: SP-9 Yinlingquan, BL-22
Sanjiaoshu, Ren-9 Shuifen and ST-28 Shuidao
Heart
The Heart governs Blood and, together with the
Kidneys, plays a role in the formation of menstrual
Blood (see Ch. 2 on physiology). It influences the menstrual function also through its connection with the
Uterus via the Uterus Vessel. In pathological conditions, the menstrual function may be affected by HeartBlood deficiency, Heart-Blood Heat and Heart-Blood
stasis. These may lead to scanty periods, heavy periods
or painful periods respectively.
In addition, some menstrual irregularities are due
to Heart-Qi and Heart-Blood not descending to the
Uterus at the right time (i.e. during bleeding and during ovulation).
The five patterns discussed will be:
1.
2.
3.
4.
5.
Heart-Blood deficiency
Heart-Yin deficiency
Heart-Blood stasis
Heart-Fire
Heart-Blood Heat.
Heart-Blood deficiency
In the context of gynecology, Heart-Blood deficiency
may play a role in causing scanty periods, amenorrhoea, infertility and post-natal depression. The treatment principle consists in nourishing Heart-Blood and
the representative formulae are Gui Pi Tang Tonifying
the Spleen Decoction, Bai Zi Yang Xin Wan Biota
Nourishing the Heart Pill, Yang Xin Tang Nourishing the
Heart Decoction and Yang Rong Tang Nourishing and
Flourishing Decoction.
The method of nourishing Heart-Blood is frequently
combined with tonification of the Kidneys to reestablish communication between Heart and Kidneys.
Only when the Heart is quiet can the balance of Yin
and Yang with the Kidneys be maintained. Harmony
between the Heart and Kidney enables the extraordinary vessels such as the Directing and Penetrating
Vessels (Ren and Chong Mai) to keep a relative balance
of Yin and Yang in the body: thus, a harmonious interrelationship between Heart and Kidneys is very important for a healthy gynecological function.
Dang Gui Radix Angelicae sinensis is the main herb
to nourish Heart-Blood. Also important are the sweet
neutral herbs Bai Zi Ren Semen Platycladi and Suan Zao
Ren Semen Ziziphi spinosae that nourish Blood and calm
the Shen.
The formula Bai Zi Ren Wan from the Complete Works
of Jing Yue (Jing Yue Quan Shu, 1624) has precisely this
function by tonifying the Kidney, soothing the Heart
and regulating the Extraordinary Vessels. The book
Gynecology in Chinese Medicine reports a Ming dynasty’s
classic statement on this subject:
To tonify the Heart, the Kidneys should be strengthened
so that their Water can ascend; to tonify the Kidneys, the
Heart should be calmed down, so that its Fire can descend.11
Of the Three Treasures formulae, Calm the Shen nourishes Heart-Blood and calms the Mind.
150 Section 3: Methods of Treatment
Acupuncture
The main points to nourish Heart-Blood are: HE-7
Shenmen, BL-15 Xinshu, Ren-15 Jiuwei, Ren-14
Juque, ST-36 Zusanli, SP-6 Sanyinjiao and BL-17
Geshu (this last point with direct moxa cones): all with
reinforcing method. ST-36 and SP-6 are used to nourish Blood in general, which is always necessary to do
when nourishing Heart-Blood. BL-17 with moxa also
nourishes Blood.
SUMMARY
Heart-Blood deficiency
Gynecological symptoms
Amenorrhoea, scanty periods, infertility, post-natal
depression
General manifestations
The treatment principle consists in nourishing HeartYin and clearing Empty-Heat and the most effective
herbs are Mai Men Dong Radix Ophiopogonis and Tian
Men Dong Radix Asparagi.
The representative formula is Tian Wang Bu Xin Dan
Heavenly Emperor Tonifying the Heart Pill which is often
used in menopausal problems.
Of the Women’s Treasure formulae, Heavenly Empress
nourishes Kidney- and Heart-Yin, clears Heart EmptyHeat and calms the Mind.
Acupuncture
The main points to nourish Heart-Yin are: HE-7
Shenmen, HE-6 Jinxi, Ren-14 Juque, Ren-15
Jiuwei, SP-6 Sanyinjiao, KI-6 Zhaohai, all with
reinforcing method and no moxa. SP-6 and KI-6
are used to nourish Yin in general and in particular Kidney-Yin which is often at the root of HeartYin deficiency.
Tiredness, palpitations, poor memory, insomnia, Pale
tongue, Choppy pulse
Herbs
Dang Gui Radix Angelicae sinensis, Bai Zi Ren
Semen Platycladi, Suan Zao Ren Semen Ziziphi
spinosae
Formulae
Gui Pi Tang Tonifying the Spleen Decoction, Bai Zi
Yang Xin Wan Biota Nourishing the Heart Pill, Yang
Xin Tang Nourishing the Heart Decoction and Yang
Rong Tang Nourishing and Flourishing Decoction, Bai
Zi Ren Wan from the Complete Works of Jing Yue
(Jing Yue Quan Shu, 1624)
Three Treasures formulae
Calm the Shen
Acupuncture
HE-7 Shenmen, BL-15 Xinshu, Ren-15 Jiuwei,
Ren-14 Juque, ST-36 Zusanli, SP-6 Sanyinjiao,
and BL-17 Geshu (this last point with direct moxa
cones)
SUMMARY
Heart-Yin deficiency
Gynecological symptoms
Scanty periods, amenorrhoea, infertility, post-natal
depression, menopausal problems
General manifestations
Palpitations, poor memory, mental restlessness,
insomnia, night sweating, malar flush, feeling of
heat in the evening, tongue without coating, pulse
Floating-Empty
Herbs
Mai Men Dong Radix Ophiopogonis, Tian Men Dong
Radix Asparagi
Formulae
Tian Wang Bu Xin Dan Heavenly Emperor Tonifying
the Heart Pill
Women’s Treasure formulae
Heart-Yin deficiency
Heart-Yin deficiency may play a role in causing scanty
periods, amenorrhoea, infertility, post-natal depression, post-natal sweating and menopausal problems.
Heavenly Empress
Acupuncture
HE-7 Shenmen, HE-6 Jinxi, Ren-14 Juque, Ren-15
Jiuwei, SP-6 Sanyinjiao, KI-6 Zhaohai
Principles and Methods of Treatment 151
Heart-Blood stasis
Since the Heart governs Blood and is connected to the
Uterus, stasis of Blood of the Heart may influence menstruation contributing to dysmenorrhoea, retention of
placenta, retention of lochiae, etc. In such cases, the
treatment method focuses on relieving Heart-Blood
stasis by conducting Blood downwards. An excellent
herb for this is Dan Shen Radix Salviae miltiorrhizae and
the formula Bai Zi Ren Wan Biota Pill has precisely this
function; note that I am here citing the formula from
Effective Prescriptions for Women (Fu Ren Liang Fang,
1237); there is another formula of the same name in
the book Complete Works of Jing Yue (Jing Yue Quan Shu,
1624), as mentioned above.
Among the Three Treasures formulae, Red Stirring
invigorates Heart-Blood.
Acupuncture
The main points to invigorate Heart-Blood are:
P-6 Neiguan, P-4 Ximen, HE-7 Shenmen, Ren-17
Shanzhong, BL-14 Jueyinshu, BL-17 Geshu, SP-10
Xuehai and KI-25 Shencang, with reducing or even
method. BL-17 and SP-10 invigorate Blood in general,
while KI-25 invigorates Blood in the chest.
SUMMARY
Acupuncture
P-6 Neiguan, P-4 Ximen, HE-7 Shenmen, Ren-17
Shanzhong, BL-14 Jueyinshu, BL-17 Geshu, SP-10
Xuehai, and KI-25 Shencang, with reducing or even
method
Heart-Fire
Women are prone to stagnation of Qi and this often
turns into Fire which affects the Heart; Fire harasses
downwards and disturbs the Directing and Penetrating
Vessels, the Sea of Blood becomes reckless and this
may result in Heavy Periods, Flooding and Trickling or
excessive vaginal discharge.
The key herbs to clear Heart-Fire belong to different categories and as such clear Fire in several different ways. Zhu Ye Folium Phylostachys nigrae clears Heat
and purges Fire; Deng Xin Cao Medulla Junci resolves
Dampness and clears the Fire by promoting urination.
Bitter and cold Lian Zi Xin Plumula Nelumbinis is an
astringent which clears the Heat from the Heart; and
Huang Qin Radix Scutellariae and Huang Lian Rhizoma
Coptidis are bitter and cold herbs which clear Heat and
also dry Dampness.
The representative formulae to drain Heart-Fire are
Huan Lian Jie Du Tang Coptis Expelling Toxin Decoction
and Xie Xin Tang Draining the Heart Decoction. Of the
Three Treasures formulae, Drain Fire drains both Liverand Heart-Fire.
Heart-Blood stasis
Acupuncture
Gynecological symptoms
The main points to drain Heart-Fire are P-7 Daling,
HE-3 Shaohai, Ren-14 Juque, BL-15 Xinshu. Reducing
method, no moxa.
Dysmenorrhoea, retention of placenta, retention of
lochiae
General manifestations
Palpitations, mental restlessness, chest pain, Purple
tongue, Wiry, Firm or Choppy pulse
Herbs
Dan Shen Radix Salviae miltiorrhizae
SUMMARY
Heart-Fire
Gynecological symptoms
Formulae
Heavy periods, Flooding and Trickling (beng lou),
pre-menstrual syndrome, excessive vaginal discharge
Bai Zi Ren Wan Biota Pill from Effective Prescriptions
for Women (Fu Ren Liang Fang, 1237)
General manifestations
Three Treasures formulae
Palpitations, mental restlessness, insomnia, thirst, red
face, feeling of heat, Red tongue with yellow coating
and a redder tip, Full-Rapid or Overflowing pulse
Red Stirring
152 Section 3: Methods of Treatment
Herbs
General manifestations
Zhu Ye Folium Phylostachys nigrae, Deng Xin Cao
Medulla Junci, Lian Zi Xin Plumula Nelumbinis,
Huang Qin Radix Scutellariae, Huang Lian Rhizoma
Coptidis
Palpitations, mental restlessness, insomnia, thirst, red
face, feeling of heat, Red tongue with yellow coating
and a redder tip, Full-Rapid or Overflowing pulse
Formulae
Mu Dan Pi Cortex Moutan, Chi Shao Radix Paeoniae
rubra
Herbs
Huan Lian Jie Du Tang Coptis Expelling Toxin
Decoction, Xie Xin Tang Draining the Heart
Decoction
Formulae
Dao Chi San Eliminating Redness Powder
Three Treasures formulae
Acupuncture
Drain Fire
P-7 Daling, HE-3 Shaohai, Ren-14 Juque, BL-15
Xinshu, L.I.-11 Quchi, SP-10 Xuehai
Acupuncture
P-7 Daling, HE-3 Shaohai, Ren-14 Juque, BL-15 Xinshu
Heart-Blood Heat
Heart-Blood Heat, which may derive from dietary or
emotional aetiological factors, heats the Blood in the
Uterus through the connection of the Uterus Vessel.
Heart-Blood Heat may cause similar gynecological
symptoms to those caused by Liver-Blood Heat, i.e.
heavy periods, infertility or miscarriage.
During pregnancy, Heart-Blood Heat may cause a variety of problems. After conception, Blood is deviated to the
nourishment of the fetus, Fire easily rises, this disturbs the
Heart and causes mental restlessness during pregnancy.
Heart-Blood Heat may be a cause of difficult birth.
Herbs which clear Heat and cool Blood are Mu Dan
Pi Cortex Moutan and Chi Shao Radix Paeoniae rubra.
The representative prescription for Heart-Blood Heat
is Dao Chi San Eliminating Redness Powder.
Acupuncture
The main points to cool Heart-Blood are P-7 Daling,
HE-3 Shaohai, Ren-14 Juque, BL-15 Xinshu, L.I.-11
Quchi, SP-10 Xuehai. Reducing method, no moxa.
SUMMARY
Heart-Blood Heat
Gynecological symptoms
Heavy periods, menorrhagia, metrorrhagia, infertility
or miscarriage
QI AND BLOOD PATHOLOGY
In addition to Yin organ disharmony, a discussion of Qi
and Blood pathology follows below. The possible pathological states of Qi and Blood are:
•
•
•
•
•
•
•
Qi stagnation
Qi sinking
Qi rebellious
Blood deficiency
Blood-Heat
Blood stasis
Blood-Cold.
Apart from Qi rebellious and Blood-Cold, these have
all been discussed under the relevant pathology of the
internal organs. Thus, Qi stagnation, Blood deficiency,
Blood-Heat and Blood stasis have been discussed under
the Liver, while Qi sinking was discussed under the
Spleen. It therefore remains for us to discuss only Qi
rebellious and Blood-Cold.
Qi rebellious
Qi becomes ‘rebellious’ when it flows in a counterdirection to its normal one. Although sinking of Qi is
also a form of counter-flow of Qi, the term ‘rebellious
Qi’ usually applies to Qi that flows upwards instead of
downwards. The Qi of the Lungs and Stomach should
normally flow downwards and the most common forms
of rebellious Qi are those related to these two organs,
manifesting with breathlessness in case of the Lungs,
and nausea, hiccup, belching and vomiting in case of
the Stomach.
Principles and Methods of Treatment 153
The Qi of other organs too can rebel upwards and
notably that of the Liver and Heart. Liver-Yang rising, Liver-Fire blazing and Liver-Wind are all forms of
rebellious Qi. Heart-Qi also should normally descend
and when it rebels upwards it causes anxiety, insomnia, breathlessness and nausea. This last symptom is
usually related to the Stomach but rebellious Heart-Qi
may also cause it: this probably explains the use of
P-6 Neiguan as an important point for nausea and
vomiting.
In gynecology, rebellious Stomach-Qi, Liver-Qi
and Heart-Qi are the most significant. Stomach-Qi
flowing upwards in gynecological problems is usually related to the Qi of the Penetrating Vessel (Chong
Mai) rebelling upwards: this will be discussed in
detail under the section on the Extraordinary Vessels
(Ch. 7). Rebellious Stomach-Qi causes nausea and
vomiting in pregnancy or in connection with the menstrual period (before or during it). Herbs that make Qi
descend include Zhi Shi Fructus Aurantii immaturus,
Shi Di Calyx Khaki, Da Fu Pi Pericarpium Arecae, Chen
Xiang Lignum Aquilariae resinatum, Zi Su Ye Folium
Perillae, Ban Xia Rhizoma Pinelliae preparatum, Lu Gen
Rhizoma Phragmitis, Wu Zhu Yu Fructus Evodiae and
Zi Su Geng Caulis Perillae for rebellious Stomach-Qi.
For rebellious Lung-Qi, most of the herbs that stop
cough and wheezing make Lung-Qi descend but the
main ones are Su Zi Fructus Perillae, Xuan Fu Hua Flos
Inulae, Qian Hu Radix Peucedani and Zhu Ru Caulis
Bambusae in Taeniam. The representative formula for
rebellious Stomach-Qi is Xuan Fu Dai Zhe Tang InulaHaematitum Decoction.
The main symptoms of rebellious Liver-Qi vary
according to the other pathogenic factors with which
it associates, i.e. Liver-Yang rising, Liver-Fire blazing
and Liver-Wind. In case of Liver-Yang rising, the main
symptoms include headache, dizziness and irritability often seen in pre-menstrual tension or during the
menopause; in case of Liver-Fire, the main manifestations are headache, dizziness, severe irritability, thirst,
bitter taste, often seen also in pre-menstrual tension
or menorrhagia; with Liver-Wind, the main manifestations are tics, headache, severe vertigo, often seen in
migraine associated with the menstrual cycle or during
a pre-eclamptic state.
Rebellious Liver-Qi associated with Liver-Fire is
particularly significant in gynecology because it
may cause bleeding upwards: since Qi is the commander of Blood, if Qi rebels upwards it may push
the Blood upwards too causing epistaxis, coughing
of blood or vomiting of blood. Some of these symptoms are seen in gynecology during the menstrual
cycle in endometriosis. The main herbs that subdue
rebellious Liver-Qi are the same as those that subdue Liver-Yang or Liver-Wind, i.e. Tian Ma Rhizoma
Gastrodiae, Gou Teng Ramulus Uncariae cum Uncis, Shi
Jue Ming Concha Haliotidis, Long Gu Fossilia Ossis mastodi, Long Chi Fossilia Dentis mastodi, Zhen Zhu Mu
Concha Margaritiferae usta, Ju Hua Flos Chrysanthemi,
etc. The representative formulae to subdue rebellious
Liver-Qi are Yi Gan He Wei Yin Restraining the Liver and
Harmonizing the Stomach Decoction, Tian Ma Gou Teng
Yin Gastrodia-Uncaria Decoction, Zhen Gan Xi Feng
Tang Pacifying the Liver and Subduing Wind Decoction
and Ling Jiao Gou Teng Tang Cornu Antelopis-Uncaria
Decoction.
Rebellious Heart-Qi may cause pre-menstrual tension and menstrual irregularities. As bleeding and ovulation rely on the descending of Heart-Qi to the Uterus,
premature or late descending of Heart-Qi causes menstrual irregularities.
If rebellious Qi carries blood with it causing bleeding from the nose or the vomiting or coughing of blood,
representative formulae include Ze Lan Tang Lycopus
Decoction and Dao Jing Tang Reversing the Menses
Decoction.
Of the Women’s Treasure formulae, Penetrating Vessel
is specific to subdue rebellious Qi in the Penetrating
Vessel.
Acupuncture
The points to subdue rebellious Qi can be classified
according to the organ involved, i.e. Stomach, Lungs,
Liver or Heart.
The main points to subdue rebellious Stomach-Qi
are: Ren-13 Shangwan, Ren-10 Xiawan, ST-19
Burong and ST-20 Chengman. Ren-13 is the main
one and is indicated for belching, hiccup, nausea and
vomiting. Ren-10 sends Stomach-Qi down: this is not
exactly the same as subduing rebellious Stomach-Qi
as it promotes the descending of Stomach-Qi rather
than forcing rebellious Stomach-Qi downwards.
Because of this, Ren-10 can be used in conjunction
with Ren-13.
For rebellious Lung-Qi, the main points are:
LU-7 Lieque, LU-1 Zhongfu, LU-5 Chize and LU-6
Kongzui.
154 Section 3: Methods of Treatment
The main points to subdue Liver-Yang rising
are: LIV-3 Taichong, G.B.-20 Fengchi and T.B.-5
Waiguan.
The main points to make Heart-Qi descend are HE-5
Tongli, Ren-15 Jiuwei in combination with Ren-4
Guanyuan and KI-16 Huangshu.
Teng Yin Gastrodia-Uncaria Decoction, Zhen Gan Xi
Feng Tang Pacifying the Liver and Subduing Wind
Decoction and Ling Jiao Gou Teng Tang Cornu
Antelopis-Uncaria Decoction
Women’s Treasure formulae
Penetrating Vessel
SUMMARY
Qi rebellious
Gynecological symptoms
Pre-menstrual symptoms, painful periods,
menopausal problems
General manifestations
• Heart-Qi: anxiety, insomnia, breathlessness, chest
distension and nausea
• Stomach-Qi: nausea and vomiting in pregnancy or
in connection with the menstrual period
• Lung-Qi: breathlessness, chest oppression, sighing.
• Liver-Yang rising: include headache, dizziness and
irritability
• Liver-Fire: headache, dizziness, severe irritability,
thirst, bitter taste
• Liver-Wind: tics, headache, severe vertigo
Herbs
• Heart-Qi: Huang Lian Rhizoma Coptidis, Lian Zi Xin
Plumula Nelumbinis
• Stomach-Qi: Zhi Shi Fructus Aurantii immaturus,
Shi Di Calyx Khaki, Da Fu Pi Pericarpium Arecae,
Chen Xiang Lignum Aquilariae resinatum, Zi Su
Ye Folium Perillae, Ban Xia Rhizoma Pinelliae
preparatum, Lu Gen Rhizoma Phragmitis, Wu Zhu
Yu Fructus Evodiae and Zi Su Geng Caulis Perillae
• Lung-Qi: Su Zi Fructus Perillae, Xuan Fu Hua Flos
Inulae, Qian Hu Radix Peucedani and Zhu Ru
Caulis Bambusae in Taeniam
• Liver-Yang or Liver-Wind: Tian Ma Rhizoma Gastrodiae,
Gou Teng Ramulus Uncariae cum Uncis, Shi Jue Ming
Concha Haliotidis, Long Gu Fossilia Ossis mastodi,
Long Chi Fossilia Dentis mastodi, Zhen Zhu Mu Concha
margaritiferae usta, Ju Hua Flos Chrysanthemi
Formulae
Xuan Fu Dai Zhe Tang Inula-Haematitum Decoction,
Yi Gan He Wei Yin Restraining the Liver and
Harmonizing the Stomach Decoction, Tian Ma Gou
Acupuncture
• Stomach-Qi: Ren-13 Shangwan, Ren-10 Xiawan,
ST-19 Burong and ST-20 Chengman
• Lung-Qi: LU-7 Lieque, LU-1 Zhongfu, LU-5 Chize
and LU-6 Kongzui
• Liver-Yang rising: LIV-3 Taichong, G.B.-20 Fengchi
and T.B.-5 Waiguan
• Heart-Qi: HE-5 Tongli, Ren-15 Jiuwei in
combination with Ren-4 Guanyuan and KI-16
Huangshu
Blood-Cold
Blood-Cold is a common pathological condition in gynecology: it may be caused either by invasion of external Cold (in which case it is Full-Cold) or by deficiency
of Yang leading to Empty-Cold. Whether it is Full or
Empty, Blood-Cold affects the Uterus by obstructing it
with Cold. This may cause several gynecological problems such as dysmenorrhoea, infertility or abdominal
masses. Cold in the Uterus usually manifests with small
dark clots in the menstrual blood while the menstrual
blood itself may be bright red.
The main herbs that warm the Uterus are Rou Gui
Cortex Cinnamomi, Gui Zhi Ramulus Cinnamomi, Ai Ye
Folium Artemisiae argyi, Fu Zi Radix Aconiti lateralis preparata and Ding Xiang Flos Caryophylli. A representative formula for Empty-Cold in the Uterus is Ai Fu Nuan
Gong Wan Artemisia-Cyperus Warming the Uterus Pill
or Wen Jing Tang Warming the Menses Decoction and
for Full-Cold Shao Fu Zhu Yu Tang Lower Abdomen
Eliminating Stasis Decoction.
Of the Women’s Treasure formulae, Warm the Palace,
Warm the Menses and Warm the Mansion warm the
Uterus.
Acupuncture
The points that expel Cold from the Lower Burner and
warm the Uterus are situated mainly on the Directing
and Penetrating Vessels (Ren and Chong Mai): Ren-4
Principles and Methods of Treatment 155
Guanyuan, KI-13 Qixue, Ren-3 Zhongji and Qimen
extra point (3 cun lateral to Ren-4 Guanyuan).
Obviously all points should be used with moxa, either
on the needle or direct moxa cones.
SUMMARY
Blood-Cold
Gynecological symptoms
Dysmenorrhoea, infertility, abdominal masses,
endometriosis, bright menstrual blood with small,
dark, stringy clots
(such as in menorrhagia), one should use herbs that
raise Qi. Moreover, it is not advisable to use very sticky
herbs or herbs that have a strong action of elimination,
as the former may cause stagnation of Qi and Blood,
while the latter may damage Qi and Blood.
Harmonizing Qi and Blood is also adapted according to the various phases of the menstrual cycle: for
example, to move Qi and Blood and eliminate stasis,
the patient needs to take the decoction only in the
2 weeks before the periods; to nourish Blood, only in
the 2 weeks after the end of the period (although, of
course, this rule should not be interpreted too strictly,
as obviously it is quite reasonable to take a Blood tonic
throughout the menstrual cycle).
General manifestations
Abdominal pain, feeling cold, cold limbs, feeling cold
or colder during the period, Pale tongue, Tight pulse
Herbs
Rou Gui Cortex Cinnamomi, Gui Zhi Ramulus
Cinnamomi, Ai Ye Folium Artemisiae argyi, Fu Zi
Radix Aconiti lateralis preparata, Ding Xiang Flos
Caryophylli
Formulae
Ai Fu Nuan Gong Wan Artemisia-Cyperus Warming
the Uterus Pill, Wen Jing Tang Warming the Menses
Decoction, Shao Fu Zhu Yu Tang Lower Abdomen
Eliminating Stasis Decoction
Women’s Treasure formulae
Warm the Palace, Warm the Menses and Warm the
Mansion
Acupuncture
Ren-4 Guanyuan, KI-13 Qixue, Ren-3 Zhongji
and Qimen extra point (3 cun lateral to Ren-4
Guanyuan). Moxa
When treating disharmonies of Qi and Blood in
gynecology, it is important to remember Blood while Qi
is treated and Qi while Blood is treated. For example,
when there is bleeding upwards (such as vomiting of
blood), it is important to use herbs that subdue rebellious Qi as well; likewise if there is bleeding downwards
END NOTES
1. Clavey S 1995 Fluid Physiology and Pathology in Traditional Chinese
Medicine, Churchill Livingstone, Edinburgh, p. 121, note 23. Clavey
goes on by reporting the apt story of a beautiful and powerful, if
unruly, horse being taken to market. To someone who called out that
he was galloping in the wrong direction, the rider replied: “I know,
but just look at the speed!”
2. For example, a controversy ‘rages’ in continental Europe as to whether
KI-7 Fuliu tonifies Kidney-Yin or Kidney-Yang. Most traditional
Chinese medicine-based colleges teach that this point tonifies KidneyYang, whereas French and Italian acupuncture colleges all teach that
KI-7 tonifies Kidney-Yin. As mentioned, I personally think that this
controversy is fruitless as this point could tonify both Kidney-Yang
or Kidney-Yin depending on whether moxa is used or not. Of course,
there are certain points which have a definite tendency to tonify Yin
more than Yang or vice versa: for example, it is obvious from most
literature that KI-6 Zhaohai nourishes Kidney-Yin.
3. Zhu Dan Xi 1347 Essential Methods of Dan Xi (Dan Xi Xin Fa) cited
in Zhang Qi Wen 1995 Menstrual Diseases (Yue Jing Bing Zheng
), People’s Hygiene Publishing House, Beijing, p. 42.
4. Cited in Li Fei 1987 Discussion about Formulae to Invigorate
Blood and Eliminate Stasis, Journal of the Nanjing College of
Traditional Chinese Medicine (Nanjing Zhong Yi Xue Yuan Xue Bao
) 1: 44.
5. There are actually several terms used to say ‘eliminate stasis’: qu yu,
hua yu and zhu yu. Qu yu means to ‘eliminate’ or ‘dispel’ stasis, hua
yu means to ‘resolve’ stasis and zhu yu means to ‘drive out’ or ‘expel’
stasis. The first and the third are the same except for a difference
of degree, the latter being stronger. The second, hua yu, ‘resolving
stasis’, indicates a different way of eliminating stasis.
6. Journal of Chinese Medicine (Zhong Yi Za Zhi
) 32(12): 4.
7. Cited in Discussion about Formulae to Invigorate Blood and Eliminate
Stasis, p. 43.
8. Ibid., p. 43.
9. Ibid., p. 44.
10. Of course, not all forms of Heat derive from stagnant Qi. Heat can also
arise independently from Exterior Heat, from dietary irregularities or
from emotional strain. Thus, one can distinguish three types of Heat:
one deriving from stagnant Qi, a second arising independently and a
third, Fire, which is a particularly intense form of Heat.
11. Nanjing College of Traditional Chinese Medicine 1962 Gynaecology
in Chinese Medicine (Zhong Yi Fu Ke Xue
), p. 23.
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CHAPTER 7
TREATMENT OF THE
EXTRAORDINARY VESSELS
INTRODUCTION 157
PENETRATING VESSEL (CHONG MAI) 162
DIRECTING VESSEL (REN MAI) 171
GOVERNING VESSEL (DU MAI) 181
GIRDLE VESSEL (DAI MAI) 185
YIN STEPPING VESSEL (YIN QIAO MAI) 188
YIN LINKING VESSEL (YIN WEI MAI) 189
GYNECOLOGICAL EXTRA POINTS 189
HERBAL TREATMENT OF THE EXTRAORDINARY
VESSELS 191
THE FOUR PATHOLOGIES OF THE EXTRAORDINARY
VESSELS AND HERBAL TREATMENT 193
Disharmony of Yin and Yang 193
Deficiency 193
Excess 193
Rebellious or sinking Qi 193
FORMULAE FOR THE DIRECTING AND
PENETRATING VESSELS 193
INTRODUCTION
Regulating and tonifying the Extraordinary Vessels is
extremely important in gynecology because these vessels influence menstruation, ovulation, conception,
pregnancy and childbirth. Some doctors say no specific treatment is necessary to affect the Extraordinary
Vessels because they are closely linked to the channel
system (as lakes to rivers) and the internal organs.
They say that treating the Liver and Kidney automat-
ically implies treating the Directing and Penetrating
Vessels (Ren and Chong Mai), and that regulating
Yin and Yang necessarily leads to regulation of the
Extraordinary Vessels. For example, when harmonizing Yin and Yang in women, to nourish Blood is often
important as doing so strengthens the Penetrating
Vessel which is the Sea of Blood. However, many doctors, both modern and old (and including myself),
would disagree with this view, maintaining that there
are specific herbal strategies and acupuncture methods
of treatment which affect the Extraordinary Vessels.
The formula Yang Jing Zhong Yu Tang Nourishing the
Essence and Planting Jade Decoction is an example of
such a principle of treatment as it combines tonification of the Kidneys and of the Extraordinary Vessels
with nourishing Blood.
Second, regulating and tonifying of Yin, Yang, Qi
and Blood should be combined with removing obstructions: the combination of these methods in gynecology
also activates the Extraordinary Vessels. For example,
tonifying the Kidneys is often combined with moving
Blood and eliminating stasis in endometriosis; nourishing Kidney-Yin and eliminating stasis during the midcycle phase tonifies and regulates the Extraordinary
Vessels, promotes ovulation and regularizes the periods. The formula Yi Shen Tong Jing Tang Nourishing the
Kidneys and Penetrating the Menses Decoction is an example of such a treatment method.
With acupuncture, of course, the problem does not
arise because it can affect the Extraordinary Vessels
directly. For this reason, acupuncture is extremely effective in treating gynecological problems: there is nothing
more direct than using points such as Ren-4 Guanyuan
to affect the Directing Vessel (Ren Mai) or KI-13 Qixue to
affect the Penetrating Vessel (Chong Mai).
There are several ways of using the points of the
Extraordinary Vessels, including their ‘opening’ points
and points on their trajectory.
158 Section 3: Methods of Treatment
The eight Extraordinary Vessels and their opening
points are:
1. Directing Vessel (Ren Mai) LU-7 Lieque.
2. Governing Vessel (Du Mai) SI-3 Houxi.
3. Penetrating Vessel (Chong Mai) SP-4 Gongsun.
4. Girdle Vessel (Dai Mai) G.B.-41 Zulinqi.
5. Yin Linking Vessel (Yin Wei Mai) P-6 Neiguan.
6. Yang Linking Vessel (Yang Wei Mai) TB-5 Waiguan.
7. Yin Stepping Vessel (Yin Qiao Mai) KI-6 Zhaohai.
8. Yang Stepping Vessel (Yang Qiao Mai) BL-62 Shenmai.
They can be grouped in four pairs of the same polarity (both Yin or both Yang) sharing similar pathways,
and in pairs in which the opening point of one is the
associated point of the other and vice versa, i.e.:
1. Penetrating Vessel and Yin Linking Vessel, SP-4
Gongsun and P-6 Neiguan.
2. Governing Vessel and Yang Stepping Vessel, SI-3
Houxi and BL-62 Shenmai.
3. Girdle Vessel and Yang Linking Vessel, GB-41
Zulinqi and TB-5 Waiguan.
4. Directing Vessel and Yin Stepping Vessel, LU-7
Lieque and KI-6 Zhaohai.
By grouping the vessels in four pairs we get four
pairs of points: I shall call the point related to each
vessel its ‘opening’ point and the point related to the
vessel with which it is paired its ‘associated’ point
(which, itself, is the opening point of the paired vessel). For example, the opening point of the Directing
Vessel is LU-7 Lieque and its associated point is KI-6
Zhaohai: this latter point is the opening point of the
Yin Stepping Vessel with which the Directing Vessel
is paired. Thus, if we needle LU-7 Lieque first followed
by KI-6 Zhaohai, we open the Directing Vessel: if we
needle KI-6 first followed by LU-7, we open the Yin
Stepping Vessel.
These points have always been mentioned as pairs in
the classics, sometimes even without mentioning the
Extraordinary Vessels, and the Extraordinary Vessels
were given family members’ names highlighting their
use as pairs to achieve harmony:
1. SP-4 Gongsun, Penetrating Vessel: father.
2. P-6 Neiguan, Yin Linking Vessel: mother.
3. S.I.-3 Houxi, Governing Vessel: husband.
4. BL-62 Shenmai, Yang Stepping Vessel: wife.
5. T.B.-5 Waiguan, Yang Linking Vessel: son.
6. G.B.-41 Zulinqi, Girdle Vessel: daughter.
7. LU-7 Lieque, Directing Vessel: host.
8. KI-6 Zhaohai, Yin Stepping Vessel: guest.1
Because of this arrangement in pairs, the opening
point of one vessel is usually used in conjunction with
the opening point of the paired vessel. This technique,
called ‘host–guest’, was indicated for the very first time
in the Guide to Acupuncture Channels (Zhen Jiu Jing Zhi
Nan 1295) and later expanded in the Great Compendium
of Acupuncture (Zhen Jiu Da Cheng 1601).2 For example,
when using the Directing Vessel, one would needle LU-7
Lieque and KI-6 Zhaohai in this order, the former being
its opening point and the latter its associated point (and
opening point of its paired vessel, Yin Stepping Vessel).
There are two possible ways of proceeding:
1. Using the Extraordinary Vessel’s opening point
(with or without its associated point).
2. Using a point on the vessel.
Using the opening points achieves two results. First,
it reaches the area governed by that vessel (e.g. the
Directing Vessel, LU-7 Lieque and KI-6 Zhaohai to
reach the mouth and gums). Second, it brings into play
the Extraordinary Vessels’ role as reservoirs of Qi, i.e.
to absorb and regulate excesses and stagnation. This
is particularly necessary when the pulse has the same
quality in different positions (see below).
The effect of using a point on the vessel depends on
the vessel in question and cannot be generalized. To
understand this, we need to distinguish the categories
of Extraordinary Vessels:
The Governing and Directing Vessels These are
quite different than the other six because they have
their own points. They are at once Extraordinary
Vessels and ordinary channels (hence the reference
sometimes to the 14 channels). Therefore using a point
on these two vessels has a powerful effect on them even
without using the opening points.
A point on one of these two vessels can tonify, activate
or move Qi in that particular vessel. For example, using
Ren-4 Guanyuan brings into play the energy of the
Directing Vessel and it can tonify its Blood and Essence. Of
course, very often we use the opening points and a point
on the channel as well. For example, it is very common
to needle LU-7 Lieque on the right and KI-6 Zhaohai on
the left to open the Directing Vessel, together with Ren-4
Guanyuan to strengthen the vessel and the Kidneys.
To give another example, using Ren-6 Qihai moves
Qi in the Lower Burner, even without the Directing
Vessel’s opening points.
The Penetrating Vessel (Chong Mai) Although this
vessel does not have its own points in the same way
Treatment of the Extraordinary Vessels 159
as the Governing and Directing Vessels do, one could
say that it almost does. In fact, the Penetrating Vessel
is closely associated with the Kidney channel flowing
as it does through all the Kidney points between KI-11
Henggu and KI-21 Youmen. Therefore, if we tonify
KI-13 Qixue, we have a profound tonifying effect on
the Penetrating Vessel (nourishing Blood and Essence).
If we needle KI-14 Siman, we strongly invigorate Blood
in the Uterus. We achieve these effects also without
using the Penetrating Vessel’s opening points.
The other five vessels The other five vessels do not
have their own points and they meander from one
channel to the other. The Yang Stepping Vessel (Yang
Qiao Mai) is a good example of this as it meanders
through nearly all Yang channels from the ankle to the
eyes.
In the case of the other five channels, using a point
on the vessel without its opening points will not have
any influence on that vessel. For example, if we needle S.I.-10 Naoshu (on the Yang Stepping Vessel) without its opening points, we would not influence this
vessel in any meaningful way. On the contrary, using
BL-62 Shenmai and S.I.-3 Houxi would open the Yang
Stepping Vessel to perform its function of absorbing
excess of Yang energy in the upper part of the body,
whereas using S.I.-10 Naoshu only would have no
such effect.
Although several practitioners use the opening and
associated point as a couple, not all doctors use the
points in this way and the classics sometimes discuss
the points as pairs and sometimes not. Thus, some doctors would use only LU-7 Lieque to open the Directing
Vessel. The three different ways of using the opening
points of the Extraordinary Vessels can be summarized
as follows:
Above–Below Unilaterally This consists in using
the opening point of the main vessel and its associated
point on the same side. Example: S.I.-3 Houxi on the
left, BL-62 Shenmai on the left. This method is suitable
for unilateral problems of the back and limbs, or unilateral backache, sprains, Painful Obstruction Syndrome
or sequelae of Wind-stroke. When using this method,
one needles only the affected side.
Left–Right Crossing This consists in using the opening point of the main vessel on one side and its associated point on the other. Example: S.I.-3 Houxi on the
left, BL-62 Shenmai on the right. This method is suitable for problems of the head and face and internal
organs. The technique is especially suitable for children,
old people and patients whose body condition is weak or
who suffer from anxiety. One should not use too many
other needles or the needles on one limb cannot move
Qi well (especially if there are scars or boils with pus).
Above–Below Bilaterally This consists in using the
opening points of the main vessel bilaterally and its
associated points also bilaterally. Example: S.I.-3 Houxi
and BL-62 Shenmai both bilaterally. This method has
a very wide application and can basically be used for
both types of problems indicated above.
In my practice I use the second method, i.e. using
the opening point of the main vessel unilaterally and
its associated point on the opposite side. In deciding on
which side to use the opening point of the main vessel, I go by the patient’s sex, i.e. the opening point of
the vessel being treated is needled on the left side for
a man and the right side for a woman, and its associated point (which is the opening point of the paired
vessel) on the opposite side. For example, if using the
Directing Vessel in a male patient, I needle LU-7 Lieque
on the left and KI-6 Zhaohai on the right, inserting the
needles in this order, and would withdraw them in the
reverse order; in a female patient, I would needle LU-7
Lieque on the right and KI-6 Zhaohai on the left, in this
order, and again would withdraw them in the reverse
order.
Although this method of needling according to sex
and laterality is not mentioned in the Great Compendium
of Acupuncture, that book does suggest needling first
the opening point of the chosen vessel and then that of
its associated vessel (e.g. LU-7 Lieque and KI-6 Zhaohai
for the Directing Vessel).3
When I use the opening points of an Extraordinary
Vessel, I do not use any particular technique: I just
obtain deqi and leave the needles in for approximately
20–25 minutes.
When used in such pairs, the Extraordinary Vessels’
points also harmonize Above and Below as the paired
points are always one from the arm and one from the
leg. By using these points as pairs, one transcends
the action of the individual points and brings into
play the energy of the Extraordinary Vessels: it is as
if one needed two keys to open a door. That is why I
prefer to use the points of the Extraordinary Vessels
in pairs. Some doctors in China studied whether the
Extraordinary Vessels work better by using the opening point on its own or with its associated point: they
report a case of a woman suffering from mental illness
for whom they used S.I.-3 Houxi without good results;
160 Section 3: Methods of Treatment
when this point was associated with BL-62 Shenmai,
results improved.4
When paired in this way according to opening and
associated points, the Extraordinary Vessels within a
pair have a common range of action in terms of body
areas:
• Directing Vessel and Yin Stepping Vessel: abdomen,
chest, lungs, throat, face.
• Governing Vessel and Yang Stepping Vessel: back of
legs, back, spine, neck, head, eyes, brain.
• Penetrating Vessel and Yin Linking Vessel: inner
aspect of leg, abdomen, chest, heart, stomach.
• Girdle Vessel and Yang Linking Vessel: outer aspects of leg, sides of body, shoulders, side of neck
(Table 7.1).
Some doctors go so far as saying that there are 360
points in the body with 66 most important ones (the
Transporting Shu points); but the eight confluent
points of the Extraordinary Vessels control all the 66
Shu points.
What guidelines can be given for choosing to use the
Extraordinary Vessels in practice? There are basically
three depending on the nature of the imbalance.
1. Problems of internal organs Use the internal
organs identification of patterns. If the clinical condition reflects very clearly the disharmony of one or
more organs and manifests with clear-cut internal
organ patterns, then it makes sense to treat it according to the internal organs identification of patterns,
without using an Extraordinary Vessel. For example, if
a patient has clear-cut symptoms and signs of Liver-Qi
stagnation, one can simply treat according to the pattern of Liver-Qi stagnation using the relevant points
and disregard the Extraordinary Vessels.
2. Problems of head–limbs–Exterior Use the
main channel identification of patterns. This means
that a channel problem, distributed clearly along a
main channel, is treated according to channel patterns. For example, if a patient suffers from a painful
shoulder, with pain radiating clearly along the Large
Intestine channel, then it is sufficient to treat this problem mainly according to this channel and not use an
Extraordinary Vessel.
3. Problems of several channels simultaneously,
complicated conditions, involvement of an internal organ with a different channel, confusing situations of Heat–Cold and deficiency–excess, some
mental problems, some neurological problems, the
pulse having the same quality in several positions
Use the Extraordinary Vessels. As can be seen from the
above list, the therapeutic range of the Extraordinary
Vessels is very broad indeed. I shall discuss the above
points one by one.
Problems of several channels simultaneously The
Extraordinary Vessels are ideally placed to treat problems involving several channels for two reasons. First
and foremost, this is because they absorb excesses and
stagnation from several main channels (just as several
streams may flow into one lake); for example, the Yang
Stepping Vessel absorbs excesses from all Yang channels. Second, the Extraordinary Vessels do not have
their own points (with the exception of Governing
Table 7.1 Areas of influence of Extraordinary Vessel pairs
MAIN AREA
DISEASES
COMBINED
POINTS
Chong Mai
Abdomen, chest
Rebellious Qi, internal
urgency, heart pain
SP-4
Yin Wei MaI
Abdomen, sides
Heart, chest, stomach,
abdomen, inner aspect
of legs
Dai Mai
Waist
Fullness of abdomen,
‘sitting in water’, hot–cold
Ear, cheek, outer canthus,
shoulder, neck, occiput
G.B.-41
Yang Wei Mai
Head
Du Mai
Back, spine
Inner canthus, neck,
scapula, spine, back, brain
S.I.-3
Yang Qiao Mai
Outer aspect lower
limb, eyes
Stiffness or weakness of
spine, Yang excess, eyes
open
Ren Mai
Chest, abdomen
Hernia, abdominal masses,
Yin excess, eyes closed
Lungs, throat, chest,
diaphragm, abdomen
LU-7
Yin Qiao Mai
Inner aspect of leg, eyes
P-6
T.B.-5
BL-62
KI-6
Treatment of the Extraordinary Vessels 161
and Directing Vessels, of course) and their pathways
cross several different main channels. For example, the
Yang Linking Vessel crosses the Small Intestine, Gall
Bladder, Bladder, Stomach and Governing Vessel. To
give another example, the Yang Stepping Vessel gives
good results in sciatica when the pain seems to be in
between the Bladder and Gall Bladder channels.
Complicated conditions The Extraordinary Vessels
are often implicated in complex pathological conditions due to their influencing so many different
channels and so many different organs. For example, the Penetrating Vessel affects Blood, the Kidneys,
the Kidney-Essence, the Heart, the Sea of Blood, all
the channels in the abdomen, the facial hair, rebellious Qi in the abdomen and chest, the inner aspect
of the leg and big toe, etc. Therefore, a pathology of
the Penetrating Vessel could involve all these different
aspects and the clinical manifestations would be very
difficult to unravel if we referred only to the internal
organ patterns. In fact, very often clinical manifestations that appear extremely complicated when analysed according to internal organ patterns are readily
disentangled when seen from the point of view of an
Extraordinary Vessel’s pathology.
Involvement of an organ and a different
channel For the same reasons explained above, the
Extraordinary Vessels can give rise to symptoms of
one organ and a different channel. For example, the
Penetrating Vessel arises from in between the Kidneys
and can therefore cause symptoms of Kidney deficiency together with symptoms of rebellious Qi in the
Stomach.
Confusing situations of Heat and Cold or of deficiency and excess The pathology of the Penetrating
Vessel is largely responsible for conditions characterized by confusing symptoms of Heat and Cold as
explained in Chapter 3 on pathology. When the Qi of
the Penetrating Vessel rebels upwards, it may cause a
feeling of heat in the face and, because of a deficiency
of Qi in the descending branch of this vessel, cold feet.
The Penetrating Vessel is similarly involved in confusing situations of deficiency and excess: for example, a
Kidney deficiency may not only cause the Penetrating
Vessel to be Empty in the Lower Burner but also cause
Qi to rebel upwards with symptoms of Fullness (stagnation of Qi) in the chest.
Some mental problems The Extraordinary Vessels
are often used for mental–emotional problems, especially the Governing Vessel, the Yang Stepping Vessel,
the Penetrating Vessel and the Yin Linking Vessel, as
explained in Chapter 3 on pathology.
Some neurological problems Some of the
Extraordinary Vessels may be used to treat neurological problems such as neuritis and multiple sclerosis.
This applies in particular to the Governing Vessel and
the Girdle Vessel.
Conditions in which the pulse acquires the same
quality in different positions This means that
the pulse has exactly the same quality, for example,
on both Front positions, or on both Guan positions,
or on all positions of one side. The Study of the Eight
Extraordinary Vessels by Li Shi Zhen describes in detail
certain pulse qualities related to these vessels.5 The
main pulse findings are detailed below:
1. A ball feeling of both Front positions when the
pulse is also Tight, Fine and Long is linked to the
Directing Vessel. This is often related to abdominal
pain and abdominal masses in women.
2. A straight up-and-down Floating pulse at all three
positions, especially on the left, is linked to the
Governing Vessel. This is often related to stiffness of
the back and mental–emotional problems.
3. A straight up-and-down Deep and Firm pulse at
all three positions, especially on the right, is linked
to the Penetrating Vessel. This is often related to
abdominal fullness and a feeling of oppression of
the chest.
4. A Wiry pulse at the Front position on both sides
is linked to the Yang Stepping Vessel. This may be
related to mental agitation.
5. A Wiry pulse at the Middle position on both sides
is linked to the Girdle Vessel. This may be related to
amenorrhoea or infertility.
6. A Wiry pulse at the Rear positions on both sides is
linked to the Yin Stepping Vessel and also to the Yin
and Yang Linking Vessels. This may be related to
abdominal pain and menorrhagia.
Why should a pulse that displays exactly the same
quality in more than one position and usually in corresponding ones (such as both Front positions) be
linked to the Extraordinary Vessels’ function of reservoirs of Qi? If the main channels are like rivers (each
one reflected in individual pulse positions) and the
Extraordinary Vessels like lakes which absorb overflowing energy, it is natural that the state of these vessels
would be reflected in more than one position, much as
an overflowing river loses its shape and floods a whole
area of land.
162 Section 3: Methods of Treatment
The Extraordinary Vessels are also related to the
Four Seas:
•
•
•
•
Sea of Marrow (Brain): Governing Vessel and Yin
and Yang Stepping Vessels. The points are Du-20
Baihui and Du-16 Fengfu (both on the Governing
Vessel).
Sea of Qi (chest): Directing Vessel. The points are
ST-9 Renying and Ren-17 Shanzhong (a point of
the Directing Vessel).
Sea of Food (Stomach): Penetrating Vessel.
The points are ST-30 Qichong (a point of the
Penetrating Vessel) and ST-36 Zusanli.
Sea of Blood: Penetrating Vessel. The points are
BL-11 Dashu, ST-37 Shangjuxu and ST-39 Xiajuxu.
The Sea of Blood is of great significance in gynecology: any menstrual pathology is a pathology of
the Sea of Blood and, in consequence, also of the
Penetrating Vessel.
Axillary artery
Internal mammary
artery
Penetrating vessel
PENETRATING VESSEL (CHONG MAI)
The Penetrating Vessel is probably the most important
of the Extraordinary Vessels and, in relation to gynecology, it has a deep influence on the menstrual function as it is the Sea of Blood. It is therefore related to the
Blood in the Uterus and controls menstruation in all its
aspects. If the Penetrating Vessel is Empty there may be
amenorrhoea, scanty periods or late periods. If Qi and/
or Blood are stagnant in the Penetrating Vessel there
may be dysmenorrhoea.
The Penetrating Vessel also controls the breasts in
several ways. The pathway of this vessel runs from the
lower abdomen along the Kidney channel and then
fans out over the breasts and chest on its way to the
throat and eyes. The major arteries that feed the breast,
i.e. the axillary artery supplying the outer half and the
internal mammary arteries the inner half of the breast,
are controlled by the Penetrating Vessel in two ways:
because this vessel is the Sea of Blood and controls
all blood vessels, and because this vessel spreads over
the breasts in women. For this reason, the Penetrating
Vessel exerts an important influence on pre-menstrual
breast distension, breastfeeding and breast lumps.
Because the Penetrating Vessel is the Sea of Blood and
breast milk is a transformation of Blood, this vessel
influences the supply of breast milk in two ways: if the
Penetrating Vessel is Empty, the Sea of Blood is depleted
and there may not be enough milk. If the Qi of the
Figure 7.1 The Penetrating Vessel and breast arteries.
Penetrating Vessel is stagnant, the breast Connecting
(Luo) channels will be blocked and the milk may not
flow even though it is abundant. Figure 7.1 illustrates
the pathway of the Penetrating Vessel in relation to the
arteries feeding the breast.
To open the Penetrating Vessel in a woman, I needle
SP-4 Gongsun first on the right followed by P-6 Neiguan
on the opposite side: the needles are retained for about
20–25 minutes and withdrawn in the reverse order.
Apart from obtaining the needling sensation (deqi), it is
not necessary to perform any other needling manipulation. Since the subject is gynecology, I shall assume
from now on that the opening point is inserted on the
right side and the associated one on the left (Fig. 7.2).
Using SP-4 Gongsun on the right and P-6 Neiguan
on the left (in a woman) ‘opens’ and regulates the
Penetrating Vessel: this means that the vessel is opened
to perform its function of absorbing excesses or stagnation of Qi and also that these two points will affect
the area influenced by the Penetrating Vessel, i.e. abdomen, chest, heart and throat.
As indicated in Chapter 3, rebellious Qi is a frequent
pathology that affects the Penetrating Vessel. Indeed,
the word chong in Chinese is also used as a verb to
indicate the pathological rising of Qi towards the top.
Treatment of the Extraordinary Vessels 163
P-6
(inserted second)
SP-4
(inserted first)
Figure 7.2 Order of insertion of opening points for
Extraordinary Vessels.
For example, when the Qi of the fetus rebels upwards
and disturbs the mother, it is called tai qi chong yu
shang, i.e. the “Qi of the fetus rebels (chong) upwards”.
The main symptoms and signs indicating such a syndrome are abdominal pain and distension, a feeling of
oppression of the chest and throat, palpitations, a suffocating sensation, a feeling of heat in the head, cold
feet, anxiety and a pulse that is Firm on all three positions of the left side. Not all these symptoms need be
present to use this vessel, but it is usually necessary to
have three or four of these symptoms at different levels
of the trunk to diagnose this syndrome.
Interestingly, the aetiology of this syndrome is attributed to fear and shock, both of which injure the Kidneys.
In practice, this syndrome, and its corresponding rebelling of Qi in the Penetrating Vessel, may be either of
the Full type stemming from stagnation of Liver-Qi or
of the Empty type stemming from a Kidney deficiency.
This latter type is particularly common in women: the
deficient Kidney within the Penetrating Vessel in the
Lower Burner fails to root and anchor Qi so that this
rebels upwards affecting both Kidney and Liver channels and causing a sensation of upsurge towards the
chest and throat. Thus, the syndrome is a complex one,
characterized by a deficiency of the Kidney and stagnation of the Liver with rebellious Qi in the Penetrating
Vessel; in terms of areas, deficiency below (the lower
abdomen) and excess above (the chest, throat and
face). The upsurge of rebellious Qi causes a feeling of
heat in the face, while a deficiency of Qi in the descending branch of the Penetrating Vessel causes cold feet:
this accounts for contradictory symptoms of Heat and
Cold in this syndrome. In gynecology, this syndrome is
very common in women over 40, in menopausal problems, or in dysmenorrhoea.
The opening and associated points of the Penetrating
Vessel (SP-4 Gongsun on the right and P-6 Neiguan on
the left) are excellent to treat this condition. However,
these points are usually associated with points along
the Penetrating Vessel, such as ST-30 Qichong, KI-13
Qixue, KI-14 Siman, KI-16 Huangshu, KI-18 Shiguan,
KI-19 Yindu, KI-20 Futonggu and KI-21 Youmen.
The following is an example of point combinations
to open the Penetrating Vessel for the Empty type of
syndrome of rebellious Qi, i.e. one that derives from a
Kidney deficiency: SP-4 Gongsun on the right (inserted
first), P-6 Neiguan on the left (inserted second), L.I.-4
Hegu on the right, LIV-3 Taichong on the left, KI-13
Qixue, KI-16 Huangshu, KI-21 Youmen, the last three
all bilateral (Fig. 7.3). In this combination, SP-4 and P-6
regulate Qi of the Penetrating Vessel; L.I.-4 and LIV-3
help to regulate the ascending and descending of Qi;
KI-13 tonifies the Kidneys and the Penetrating Vessel;
KI-16 harmonizes Kidneys and Heart and helps to subdue rebellious Qi; KI-21 helps to subdue rebellious Qi.
An example of point combination for the Full type
of Rebellious Qi of the Penetrating Vessel is as follows:
SP-4 on the right, followed by P-6 on the left, L.I.-4
Hegu on the right, LIV-3 Taichong on the left, KI-14
Siman, KI-16 Huangshu, KI-21 Youmen, the last three
all bilateral (Fig. 7.4).
I shall now discuss the actions and indications of
the most important Penetrating Vessel points on the
abdomen and chest with particular emphasis on gynecological problems intended in a broad sense: that
is, I shall include symptoms that, whilst not strictly
164 Section 3: Methods of Treatment
KI-21
KI-21
KI-16
KI-16
KI-13
P-6
P-6
LI-4
LI-4
KI-14
SP-4
LIV-3
SP-4
LIV-3
Figure 7.3 Point combination for rebellious Qi of the
Penetrating Vessel of the Empty type.
Figure 7.4 Point combination for rebellious Qi of the
Penetrating Vessel of the Full type.
‘gynecological’, are frequently associated with gynecological symptoms and that are very common in women,
such as urinary problems, oedema, abdominal pain, etc.
The word chong can also be translated as ‘infuse’
and, in this sense, it indicates that this point is the place
where the three Yang channels (of the leg) infuse outwards, and the three Yin Essences (of the Yin channels
of the leg) infuse inwards.
The fact that the crossing of the Yang and Yin Essences
on their way out and in is on a large artery (femoral)
contributes to the name of ‘Infusing Qi’. This point is
also frequently called Qijie which means ‘Avenues of Qi’:
this is a clear reference to the Penetrating Vessel’s control of all the channels of the abdomen (hence its name
of ‘Sea of the 12 Channels’). In fact, at this point, the
Stomach channel goes in, the Gall Bladder channel
goes out, the Penetrating Vessel emerges; the Liver and
Spleen channels also go through this point; it is thus a
real crossroads of channels on their way to or from the
abdomen and inwards or outwards. All the old books
ST-30 Qichong (Rushing Qi)
ST-30 is an extremely important point of the
Penetrating Vessel because it is here that the vessel
emerges from the Interior, descending from the space
between the kidneys and the uterus.
The chong within the name of this point can be
translated as ‘rushing’ or ‘penetrating’ and is the same
character as that for chong mai, i.e. Penetrating Vessel;
thus, its name clearly indicates its relationship with
this vessel and, at the same time, it suggests the energetic movement as the Qi of this vessel rushes outwards
towards the surface from this point.
Treatment of the Extraordinary Vessels 165
describe this point as being on a ‘big artery’ (the femoral
artery) where a strong beat can be felt. Its location on a
major artery is not a matter of chance as the Penetrating
Vessel, which emerges from this point, is also the Sea of
Blood and controls all channels and blood vessels.
The actions of this point are very wide-ranging. It:
•
•
•
•
•
•
•
•
•
pacifies the Liver
benefits the Kidneys
regulates the menses
promotes fertility
regulates Stomach-Qi
regulates the Penetrating Vessel
promotes the Essence
tonifies the Sea of Food
invigorates Blood.
As can be seen, apart from its action on Stomach-Qi, all
its other actions are of great relevance in gynecology.
The indications are very many indeed and I shall list
only those relevant to the Penetrating Vessel’s pathology and gynecology: infertility, abdominal pain and
distension, Qi of the fetus surging upwards to harass
the Heart (of the mother), swelling and pain of external genitalia, irregular periods, retention of placenta
and dysmenorrhoea.
ST-30 Qichong is an important and powerful point
of the Penetrating Vessel. The main thrust of its action
is related to its being the point from which the Qi of the
Penetrating Vessel emerges from the Interior, hence its
dynamic nature. Furthermore, since ST-30 is a point
of the Sea of Food of the Stomach, it represents an
important connection between the Stomach and the
Penetrating Vessel, i.e. between the Post-Natal and PreNatal Qi, and it can be used to strengthen both the PreNatal and Post-Natal Qi.
Looking at the actions and indications, we can
deduce that this point can be used in Empty conditions
to tonify Qi, Blood and Essence, and in Full conditions
to subdue rebellious Qi and Blood in the Penetrating
Vessel and to invigorate Blood. In its former function, it can treat infertility; in its latter function, it can
treat dysmenorrhoea, abdominal pain and irregular
periods.
The point ST-30 Qichong is frequently combined with
the opening points of the Penetrating Vessel, i.e. SP-4
Gongsun and P-6 Neiguan, for both Empty and Full
conditions as described above. It may also be combined
with ST-39 Xiajuxu and LIV-3 Taichong for numbness
and cold feet, due to deficiency of Qi and Blood in the
descending branch of the Penetrating Vessel.
KI-11 Henggu (Horizontal Bone)
‘Horizontal Bone’ indicates the pubic bone, over which
this point lies.
This point:
•
•
•
•
benefits the Kidneys
tonifies Yang
clears Heat
treats Painful-Urination Syndrome.
Like the previous point, ST-30 Qichong, and like
many of the Penetrating Vessel’s points on the abdomen, this point can be used to tonify in Empty conditions and to clear in Full conditions, hence the apparent
paradox that it can both tonify Yang and clear Heat.
‘Tonify Yang’ means that it can tonify Kidney-Yang
when used with direct moxa cones. ‘Clear Heat’ means
that it can clear Heat or Damp-Heat of the Bladder in
Painful-Urination Syndrome. Thus this point is used for
urinary problems in women more often than for menstrual problems.
Its indications, with particular reference to gynecology, include genital pain, lower abdominal pain, urinary difficulty and Painful-Urination Syndrome.
The point KI-11 Henggu can be combined with ST-27
Daju and LIV-14 Qimen for fullness of the lower abdomen, urinary difficulty and prolapse of the vagina; with
SP-2 Dadu for backache with inability to straighten
up from Qi stagnation; and with KI-16 Huangshu for
chronic Painful-Urination Syndrome.
KI-12 Dahe (Great Flourishing)
Other names include Yinwei (‘Linking Yin’) and
Yinguan (‘Gate of Yin’). The word he means ‘flourishing, luminous, awe-inspiring’: the point is so called
because Yin Qi flourishes here and the Essence accumulates, and also because after conception the uterus
enlargement starts at this place.
The actions of KI-12 are as follows. It:
•
•
•
•
benefits the Kidneys
consolidates the Essence
regulates the menses
promotes conception.
As explained above, this point too can treat either
Empty or Full conditions although it is particularly
indicated for Empty ones. In fact, its indications, with
particular reference to gynecology, include genital pain,
vaginal discharge, prolapse of the uterus, irregular
periods, dysmenorrhoea and infertility. This point is
166 Section 3: Methods of Treatment
frequently encountered in modern prescriptions to
promote ovulation.
It can be combined with KI-2 Rangu for contraction
of the genitals.
KI-13 Qixue (Qi Hole)
Other names include Baomen (‘Door to the Uterus’) and
Zihu (‘Door of the Baby’). There are three explanations for
the meaning of this name: the point is situated near the
opening of the bladder, hence ‘hole’; the Kidneys control
the grasping of Qi and this point is the ‘hole’ into which Qi
is anchored; and the Essence accumulates in this ‘hole’.
The actions of this point are as follows. It:
•
•
•
benefits the Directing and Penetrating Vessels
regulates the two Yin (orifices)
tonifies the Kidneys and the Essence.
The indications specific to gynecology include: irregular periods, white vaginal discharge, Uterus Empty and
Cold, and Directing and Penetrating Vessels Empty.
Like the other points on the Penetrating Vessel,
KI-13 also has a dual function: it can both supplement
a deficiency and clear a Fullness. In Empty conditions,
it is probably the most important tonifying point on
the Penetrating Vessel: it tonifies the Kidneys (Yin or
Yang), nourishes the Essence, strengthens the Original
Qi (Yuan Qi) and fills the Directing and Penetrating
Vessels. It also strengthens the Kidney’s grasping of Qi
and is an important point in treating allergic asthma
from Kidney deficiency or nourishing Kidney-Yin in
menopausal problems.
In Full conditions, KI-13 Qixue is used for rebellious Qi of the Penetrating Vessel causing an upsurge
of energy from the lower abdomen to the chest and
throat. It should be noted, however, that in such conditions it need not necessarily be reduced: if the condition
of rebellious Qi is secondary to a Kidney deficiency and
an Emptiness in the Lower Burner as described above,
then this point should be tonified. The Great Dictionary
of Chinese Acupuncture compares this point with the
keys of a wind musical instrument. It says that it moves
Blood through Qi (Qi being compared with the air in a
wind instrument and the Kidney points on the abdomen presumably corresponding to its keys), and that it
treats the running piglet surging upwards and the beng
lou (Flooding and Trickling) leaking downwards.6
I frequently combine this point with Ren-4 Guanyuan
(through which the Penetrating Vessel also flows) to
tonify the Kidneys, nourish the Essence and strengthen
the Original Qi.
KI-14 Siman (Four Fullnesses)
This point’s other names include Suifu (‘Fu of Marrow’)
and Suizhong (Central Marrow). There are many explanations for the name ‘Four Fullnesses’:
•
•
•
•
•
•
‘Four’ because it is the fourth point after the Kidney
channel enters the trunk.
It lies over the bladder and ‘Fullness’ indicates the
bladder full of urine.
‘Four Fullnesses’ refers to a feeling of fullness in the
abdomen radiating in four directions.
‘Fullness’ indicates hernia for which it is used.
‘Four Fullnesses’ indicates a feeling of fullness in the
abdomen from four stagnations (of Qi, Blood, Food
and Dampness).
The Essence of the four limbs and the hundred
bones collects in the Field of Elixir (Dan Tian), surplus Essence is transformed into Marrow, enters the
bones and then returns to the Extraordinary Vessels;
Essence, Qi and Blood ‘fill up’ in the Field of Elixir
near this point.
The actions of KI-14 Siman are as follows. It:
• regulates Qi
• treats hernia
• regulates the menses
• promotes fertility.
Indications in gynecology include: metrorrhagia,
irregular menstruation, retention of lochiae, vaginal discharge, infertility and lower abdominal
pain.
This point also can be used for both deficiency and
excess but more frequently for the latter. Thus, in a
deficiency, one would prefer KI-13 Qixue but in an
excess KI-14 Siman. From this point of view, KI-14
is a very important point for stagnation of Qi and/
or Blood in the lower abdomen in women. I use it frequently in combination with the opening points of the
Penetrating Vessel for stagnation of Qi or Blood in the
abdomen causing such problems as dysmenorrhoea,
abdominal pain or menorrhagia. Bearing in mind its
name, this point is specific for a feeling of fullness of
the abdomen: this differs from a feeling of distension
insofar as the latter is merely a subjective symptom
while the former is objective too as the abdomen feels
hard on palpation.
As its alternative names indicate, this point can
be tonified to nourish Marrow: for this reason, it
is used during and after the menopause to prevent
osteoporosis.
Treatment of the Extraordinary Vessels 167
KI-16 Huangshu (Transporting Point
of Membranes)
‘Huang’ means ‘membranes’ and ‘Shu’ means
Transporting point (as in the Back-Transporting
points). The point is situated at the border between the
upper and lower abdomen and it therefore lies at the
centre of the ‘membranes’: these include the connective tissue structures lying in the abdomen, i.e. mesentery, omentum and fascia. This point is therefore the
Transporting (Shu) point of these structures. It is also
the point from where the Kidney channel penetrates
deeply into the membranes. These penetrate upwards
to the chest and diaphragm and connect with the Girdle
Vessel. This point, being near the umbilicus which connected the fetus to the mother, controls the origin of
membranes and is like the Original point of all internal
organs. ‘Transporting point of membranes’ also means
that the point is at the centre of membranes, it connects downwards with the Kidneys and upwards with
the Heart, the throat and tongue.
The actions of this point are as follows. It:
•
•
•
•
•
•
regulates Qi
stops pain
moistens dryness
promotes bowel movement
regulates the Penetrating Vessel
harmonizes Kidneys and Heart.
The main gynecological indications are irregular
periods. Other indications, which help us to understand the nature of this point, include umbilical pain,
abdominal distension, constipation, hernia, vomiting,
diarrhoea, Cold in the Large Intestine and a feeling of
‘cold under the heart region’.
As can be seen from the indications, this point is
mainly used for Full conditions characterized by rebellious Qi in the Penetrating Vessel: in gynecology, principally for dysmenorrhoea and irregular periods.
However, there is a deeper significance in that this
point belongs to the Penetrating Vessel and is situated
next to the umbilicus. Through this point, the baby’s
umbilical cord connects with the mother’s placenta;
the Penetrating Vessel is the precursor of all other
Extraordinary Vessels and therefore related to the PreNatal Qi. At conception, the Governing, Directing and
Penetrating Vessels are formed, representing the spark
and organizing force that will give shape to the human
form. In the fetus, the umbilicus, the Original Qi and
the Gate of Life (Ming Men) lie on the same energetic
axis and KI-16, lying right next to the umbilicus and
being on the Penetrating Vessel, is like a Transporting
point not only for the membranes but also for all the
internal organs. Thus, this point can affect the PreNatal Qi, the Kidney-Essence and the Original Qi.
KI-18 Shiguan (Stone Gate)
‘Stone’ here indicates fullness, hardness: this refers
to the main indication for this point, i.e. fullness
and hardness of the epigastrium. ‘Gate’ refers to the
pyloric sphincter of the stomach through which the
digested food passes on its way to the small intestine.
The Great Dictionary of Acupuncture gives a different
interpretation of this name, saying that shi can sometimes mean ‘water’: hence shi here would indicate the
Water of the Kidneys, and the name would mean ‘Gate
of the Kidneys’.7 Yet another interpretation given in
the same dictionary is that ‘Stone Gate’ here refers to
the blockage of stools (the point treats constipation)
and to infertility, i.e. two stone gates are blocking the
passage of stools and sperm.
The main actions of this point are as follows. It:
•
•
•
softens hardness and dissolves fullness
tonifies the Kidneys
promotes conception.
The main gynecological indications are: post-partum
abdominal pain, abdominal pain, infertility, a sensation
of fullness and hardness under the heart region, ‘evil’
blood in the Yin organ (i.e. old, stagnant Blood).
Thus, although this point can be used to tonify the
Kidneys and promote fertility in deficiency conditions,
its more common use is for Full conditions characterized by stasis of Blood in the abdomen and retention
of food in the Stomach and Intestines. The fullness
and hardness can also extend to the Heart because the
Penetrating Vessel flows to the heart region, causing a
feeling of fullness and hardness in this region with a
corresponding mental–emotional state of worry, anxiety and bitterness. On a diagnostic level, an important
sign for the use of this point is a feeling of hardness of
the epigastrium and/or abdomen.
KI-19 Yindu (Yin City)
The abdomen is Yin and this point is on the Kidney
channel which also pertains to Yin: it is Yin within Yin,
hence the name ‘Yin City’. Du indicates an important
city, but also a place where water collects; the Kidneys
168 Section 3: Methods of Treatment
govern Water, hence the name means also ‘Yin-placewhere-Water (Kidneys)-collects’.
The actions of this point are as follows. It:
•
•
•
•
opens the chest
subdues rebellious Qi
regulates Qi
harmonizes the Stomach.
The indications of KI-19 Yindu in the gynecological sphere include: infertility, sensations of heat
and cold (as in menopausal problems), a feeling of
vexation of the heart and old, stagnant Blood in the
viscera.
Because of this point’s action on sensations of
heat and cold and a feeling of anxiety and vexation of the heart, it can be used, combined with the
Penetrating Vessel’s opening points, in menopausal
problems.
KI-20 Futonggu (Abdominal
Penetrating Valley)
‘Fu’ means ‘abdomen’ and is used here only to distinguish this point from BL-66, which is also called
‘Tonggu’. ‘Tong’ means ‘penetrating’ or ‘passing
through’. ‘Gu’ can mean both ‘valley’ or ‘grains’ and, by
extension, ‘food’. Thus the name of this point can be interpreted in two ways. The ‘valley’ is the space between
the muscles of the abdomen (rectus abdominis) where
the point lies. The Qi of the Kidneys and Penetrating
Vessel passes through this space as if through a mountain valley. If we interpret ‘Gu’ as ‘grains’ or ‘food’, the
name of the point means ‘easing the passage of food
through the digestive system’, a clear reference to the
many digestive indications of this point.
The actions of KI-20 Futonggu are as follows. It:
•
•
•
•
strengthens the Spleen
harmonizes the Stomach
opens the chest
calms the Mind.
The indications relevant to gynecology include
abdominal pain and distension, palpitations and
mental confusion. The main use of this point in gynecology is for palpitations, mental confusion and anxiety occurring in menopausal problems. Again, this
point would be used with the opening points of the
Penetrating Vessel (SP-4 Gongsun and P-6 Neiguan)
and, if the problem stems from a Kidney deficiency,
also with such points as Ren-4 Guanyuan and KI-13
Qixue.
KI-21 Youmen (Dark Door)
‘You’ means ‘dark’ and ‘men’ means ‘door’. ‘Dark’
denotes the fact that at this point the Penetrating
Vessel goes deeper and disappears into the chest cavity, hence into ‘darkness’. ‘Door’ indicates that it is the
border between the more superficial abdominal branch
and the deeper thoracic branch of the Penetrating
Vessel. ‘Dark’ also refers to the Yin character of this
point pertaining both to the Kidney channel and to the
Penetrating Vessel.
The actions of KI-21 Youmen are as follows. It:
•
•
•
•
•
strengthens the Spleen
harmonizes the Stomach
subdues rebellious Qi (of the Penetrating Vessel)
stops vomiting
calms the Mind.
The indications of KI-21 Youmen in the gynecological sphere include palpitations, anxiety, poor memory, abdominal fullness and chest pain in women. The
book Acupuncture reports the last symptom from an old
classic: this is interesting as it confirms that this point
treats the Penetrating Vessel in women in conditions of
rebellious Qi.8
KI-21 Youmen is also compared to a door because
all types of Qi go through this point on their way up
through the diaphragm: Food-Qi (Gu Qi), Qi of the
Essence (Jing Qi), Clear Qi (Qing Qi) and Yin and Yang
Qi. This point is said to pacify the five viscera by sorting
out their clear and turbid essences.
Penetrating Vessel: summary and
case histories
To summarize, the major pathology of the Penetrating
Vessel in gynecology is Qi rebelling upwards from the
lower abdomen to the chest and throat, with stagnation of Qi and/or Blood. The condition of Qi rebelling
upwards may be due to a deficiency of the Kidneys
and an Emptiness of the Penetrating Vessel in the
lower abdomen. The deficiency below and rebellious
Qi above account for contradictory symptoms of heat
and cold in women, especially after the age of 40. Since
the Penetrating Vessel is the Sea of Blood, this vessel
is extremely important in the treatment of dysmenorrhoea from stasis of Blood. Because it controls all Blood
Connecting Channels, a deficiency or stasis of Blood in
this vessel may cause aches in the muscles and joints
resembling Painful Obstruction Syndrome.
Treatment of the Extraordinary Vessels 169
Case history
Case history
A 45-year-old woman had been suffering from
tiredness, blurred vision, palpitations, a panicky,
anxious feeling in the chest with a feeling of
energy rising, insomnia, headaches during the
periods, pre-menstrual tension with abdominal
distension, a feeling of heat in the face but cold
hands and feet. Her tongue was Bluish-Purple
and her pulse was Fine but also slightly Firm in
all three positions of the right side (Plate 1).
A 23-year-old woman suffered from painful
periods. The pain occurred during the period
and was very intense and cramp-like. It was
relieved by the application of a hot-water bottle. Her tongue was Pale Purple.
Most of her symptoms are due to rebellious Qi in the
Penetrating Vessel against a background of Blood
deficiency (Fine pulse, tiredness, blurred vision,
insomnia). All the other symptoms (palpitations, a
panicky, anxious feeling in the chest with a feeling of energy rising, headaches during the periods,
pre-menstrual tension with abdominal distension,
Firm pulse in all three positions of the right side)
are due to rebellious Qi in the Penetrating Vessel.
In addition, the stagnation of Qi in the Penetrating
Vessel had given rise to Blood stasis as shown by
the Purple tongue. The contradiction between the
hot feeling of the face and the coldness of the limbs
occurs frequently in women. It is due to a deficiency
in the descending branch of the Penetrating Vessel
(causing cold feet) and to Qi rebelling upwards
(causing a feeling of heat in the face).
The points used were:
• SP-4 Gongsun on the right and P-6 Neiguan on
the left to open the Penetrating Vessel.
• Ren-4 Guanyuan and KI-16 Huangshu, with
direct moxa cones, to strengthen the Penetrating
Vessel and expel Cold from the Uterus.
• LIV-3 Taichong, with warming needle, to move
Blood and stop pain.
The points used were:
• SP-4 Gongsun on the right and P-6 Neiguan
on the left to open the Penetrating Vessel.
• Ren-4 Guanyuan to tonify Blood in the
Penetrating Vessel: this will also have the effect of
subduing rebellious Qi by rooting it downwards.
• KI-13 Qixue to strengthen the Kidneys and
consolidate the root of the Penetrating Vessel.
• SP-6 Sanyinjiao to nourish Liver and Kidneys
and strengthen the root.
• L.I.-4 Hegu on the right and LIV-3 Taichong on the
left to harmonize the ascending and descending of
Qi and calm the Mind. The laterality of these points
was chosen to balance that of the Penetrating
Vessel’s opening and associated points.
This patient was treated along these lines for four
sessions achieving a complete recovery from her
symptoms.
This is an example of obstruction of the Penetrating
Vessel by Cold. The obstruction of the Uterus by
Cold has led to stasis of Blood.
This patient was treated for 9 months along similar
lines after which her periods ceased to be painful.
Case history
A 65-year-old woman complained of hot
flushes every 50 minutes after a total hysterectomy 10 years previously. She could not
have hormone replacement therapy as she
had developed breast cancer (and underwent
a mastectomy) 2 years previously. With the
hot flushes, she also experienced anxiety with
a suffocating feeling in the chest and throat.
She suffered from night sweating and insomnia. Her urination was frequent and pale and
her feet were generally cold. Her pulse was
Deep, slightly Slippery on the right side and
slightly Wiry on the left. Her tongue was of a
normal colour, Swollen, with a yellow coating
and Stomach cracks.
This is an example of rebellious Qi in the
Penetrating Vessel causing the feeling of heat
and anxiety. It is not a typical Empty-Heat pattern
as the tongue is not Red. The cold feet are due
170 Section 3: Methods of Treatment
to the derangement of Qi in the Penetrating Vessel,
rebelling upwards and failing to warm the legs in its
descending branch. The pathology is also complicated by the presence of Phlegm, as evidenced by
the Swollen tongue and Slippery pulse.
The points used were:
• SP-4 Gongsun on the right and P-6 Neiguan on
the left to open the Penetrating Vessel.
• L.I.-4 Hegu on the right and ST-40 Fenglong
on the left to harmonize the ascending and
descending of Qi thus helping to subdue
rebellious Qi, and regulate the Bright Yang to
which the Penetrating Vessel is related. These two
points will also resolve Phlegm from the digestive
system. The laterality of these two points was
chosen to balance that of the Penetrating Vessel’s
opening and associated points.
• Ren-4 Guanyuan to nourish the Uterus,
consolidate the root and strengthen the
Penetrating Vessel.
This patient required a lengthy treatment for about
18 months due to her age and also to the hysterectomy. This surgical procedure always somewhat
hinders treatment in gynecological problems as it
removes the uterus which stores Blood.
Case history
A 45-year-old woman suffered from premenstrual tension manifesting with breast distension, depression, headaches, insomnia, abdominal
distension, a panicky feeling at night accompanied by a feeling of heat, palpitations, cold feet,
heavy and painful periods. Her tongue was Pale,
slightly Bluish and her pulse was Weak.
Diagnosis If we interpret these manifestations
according to patterns, they are very complicated;
but if we see them in the light of channel pathology,
we find that nearly all the manifestations are due
to a pathology of the Penetrating Vessel. The central pathology is Qi of the Penetrating Vessel rebelling upwards, disturbing the chest and harassing the
Mind. In fact, rebellious Qi flowing upwards causes
the abdominal and breast distension; when it flows
to the heart it causes palpitations and the panicky feeling with heat sensation. Since Qi rebels upwards, it
fails to flow in the Penetrating Vessel’s descending
branch to warm the feet. Stagnation of Qi in the
Penetrating Vessel causes the painful periods.
Case history
A 13-year-old girl suddenly experienced a violent abdominal pain. She was taken to hospital and she underwent an appendectomy after
the surgeon diagnosed appendicitis. This diagnosis turned out to be wrong as the appendix
was found to be normal. The abdominal pain
continued after her operation: it was on the
left side, starting under the left hypochondrial
region, radiating to the lower abdomen just
across the symphysis pubis. After two weeks,
her first period arrived and this was painful too. She then experienced a severe headache and visual hallucinations. A week later
she started retching uncontrollably, bringing
up phlegm; again, with hallucinations and
abdominal pain. A week later she experienced
retching again, with a severe abdominal pain
and urinary retention. Her tongue had a sticky
coating and her pulse was Wiry.
Diagnosis Although this condition appears quite
complex, most of the symptoms can be explained
as being due to rebellious Qi in the Penetrating
Vessel. All her symptoms are related to the onset
of the period and the stagnation of Qi and Blood
in the Penetrating Vessel. This vessel arises from
between the kidneys, and flows down to ST-30
Qichong and then up the abdomen along the
Kidney channel to the chest, heart, throat, face and
eyes. Thus, the abdominal pain experienced by this
girl was due to stagnation of Qi of the Penetrating
Vessel in the lower abdomen. At the same time,
the Qi of this vessel rebelled upwards causing the
headache. The Penetrating Vessel is also the Sea
of Blood and stagnant Blood in this vessel follows
rebellious Qi upwards and clouds the Mind causing hallucinations and a headache. This vessel also
flows through the urinary system and Qi stagnation
caused the urinary retention.
Treatment of the Extraordinary Vessels 171
Treatment principle The treatment principle
adopted was to nourish the Kidneys, subdue rebellious Qi, pacify the Penetrating Vessel, move Qi and
invigorate Blood. The points used were:
• SP-4 Gongsun (on the right) and P-6 Neiguan
(on the left) to regulate and harmonize the
Penetrating Vessel.
• BL-51 Huangmen and KI-14 Siman, points of
the Penetrating Vessel, to move Qi in the lower
abdomen.
• L.I.-4 Hegu on the right to regulate the
ascending and descending of Qi, which helps to
subdue its rebellion.
• ST-37 Shangjuxu and ST-39 Xiajuxu on the left
to nourish the Sea of Blood of the Penetrating
Vessel which helps to subdue rebellious Qi.
• SP-6 Sanyinjiao on the right to nourish Blood
and pacify the Liver.
• LIV-3 Taichong on the left to move Qi, subdue
rebellious Qi in the Penetrating Vessel and pacify
the Liver.
After four weekly treatments, she did not experience any recurrence of abdominal pain, headache
or hallucinations, and her periods became painless.
DIRECTING VESSEL (REN MAI)
The Directing Vessel is very widely used in gynecological
problems for a great variety of conditions. It nourishes
Blood and Yin, regulates the Uterus, promotes conception, maintains pregnancy, regulates delivery and
promotes breast milk. Compared with the Penetrating
Vessel, the Directing Vessel controls conception, fertility, pregnancy, puberty and menopause, while the
Penetrating Vessel has more control over the menstrual
cycle itself. Another difference is that the Directing
Vessel is better for nourishing Yin, the Penetrating
Vessel for nourishing Blood (apart from invigorating
Blood). However, these differences are only relative, so
that the Directing Vessel obviously also influences the
menstrual cycle and also can nourish Blood.
In the treatment of gynecological problems, the
Directing Vessel can be used for the following therapeutic aims:
•
•
•
To nourish Blood and strengthen the Uterus.
To regulate the Uterus and the menstrual cycle.
To nourish Kidney-Yin and Kidney-Essence.
Of course, there are other uses for the Directing
Vessel not related to gynecology: for example, it is
excellent for treating asthma from Lung and Kidney
deficiency.
I use the opening and associated points of this vessel
in exactly the same way as for the Penetrating Vessel:
needle the opening point LU-7 Lieque first on the
right side (in women), and the associated point, KI-6
Zhaohai, on the left side, inserted second. The needles
are retained for about 20–25 minutes and withdrawn
in the reverse order. Apart from obtaining the needling
sensation (deqi), it is not necessary to perform any other
needling manipulation.
I nearly always combine the opening and associated points of the Directing Vessel (LU-7 Lieque
and KI-6 Zhaohai) with points on the vessel itself.
The manipulation of these and the use of needles or
moxa depends on the treatment aim. Thus, to nourish Blood and strengthen the Uterus, one would use
Ren-4 Guanyuan with moxa cones. To regulate the
Uterus and the menstrual cycle, one would needle
(no moxa) points such as Ren-4 Guanyuan, Ren-6
Qihai or Ren-7 Yinjiao, although Ren-4 is the main
one. To nourish Kidney-Yin and the Kidney-Essence,
Ren-4 Guanyuan is the most appropriate point: this is
needled without moxa in the case of Kidney-Yin, but
with moxa in the case of Kidney-Essence deficiency
occurring against a background of Yang deficiency.
The Directing Vessel is very effective as a treatment
for menopausal problems by nourishing Yin and
Essence.
I shall now discuss the actions and indications of the
main points on the Directing Vessel, dealing with only
those points which are relevant to gynecology and, for
them, only the gynecological indications; in a broad
sense the discussion will include, for example, some
urinary problems that are very frequently associated
with gynecological conditions.
REN-1 Huiyin (Meeting of Yin)
The meaning of this name is obvious as Ren-1 is the
beginning point of the Directing Vessel which governs all
the Yin of the body. Yin here could also allude to the two
Yin orifices, i.e. anus and urethra, in between which this
point is situated. Ren-1’s other names include Jin Men
meaning ‘Golden Door’ (this point being the ‘door’ into
the Directing Vessel), Hai Di meaning ‘Seabed’ (this point
being the lowermost of the Directing Vessel which pertains
172 Section 3: Methods of Treatment
to Yin and Water, hence the ‘sea’ metaphor), and Gui
Cang meaning ‘Ghost Store’ (which alludes to the old use
of this point for possession by evil spirits; it was, in fact,
one of the 13 ‘ghost points’ of Sun Si Miao).
The actions of this point include the following. It:
•
•
•
•
•
•
promotes resuscitation
stops convulsions
regulates the two lower orifices
tonifies the Kidneys
regulates Directing and Penetrating Vessels
regulates the periods.
Indications in the gynecological sphere include prolapse of the vagina, pain and swelling of the vagina,
amenorrhoea, genital pain and itchiness, irregular
periods.
It is interesting to note that some of the other indications (haemorrhoids, epilepsy, manic-depression (dian
kuang), prolapse of the anus, convulsions, nocturnal
emissions) are related more to the Governing than the
Directing Vessel: this is because both Governing and
Directing Vessels emerge at this point and because there
is a close relation between these two vessels which form
a continuous energetic circuit.
Ren-1 Huiyin can be combined with SP-6 Sanyinjiao
(with moxa stick) for post-partum convulsions; and
with Ren-3 Zhongji and SP-6 Sanyinjiao for urethritis.
Because it is the point from which the Directing Vessel
emerges (and the Penetrating and Governing Vessels
as well), Ren-1 Huiyin is very powerful and should be
used sparingly.
REN-2 Qugu (Crooked Bone)
The name of this point is a clear reference to the pubic
bone on the edge of which it is situated. Other names
include Niao Bao which means ‘urinary bladder’ and
Sui Shu which means ‘transporting point of Marrow’.
The actions of this point are as follows. It:
•
•
•
•
promotes the transformation of urine
regulates the periods
stops pain
resolves Dampness.
The indications in the gynecological sphere include
hypogastric pain, Painful Urination Syndrome, incontinence of urine, vaginal itching, irregular periods,
dysmenorrhoea, red–white vaginal discharge, uterine
myoma, uterine prolapse and Cold in the Uterus.
The point Ren-2 Qugu (used with 7 moxa cones) can
be combined with LIV-3 Taichong, Ren-4 Guanyuan,
KI-7 Fuliu, SP-6 Sanyinjiao and ST-25 Tianshu
(used with 100 moxa cones) for red–white vaginal
discharge.
In addition to stopping vaginal discharges and leakage of urine, this point also stops nocturnal emissions:
thus, it is clear that it has a ‘firming’ action on fluids
in the Lower Burner. In this context, it has an action
that is similar to Ren-1 Huiyin and is a good alternative
when the latter point cannot be used.
REN-3 Zhongji (Central Supreme Ultimate
or Central North Star)
‘Ji’ means either ‘Supreme Ultimate’, i.e. the Dao, or
‘North Star’. All Chinese books explain that this point
is so named because it lies in the exact centre of the
body dividing it into two equal halves, upper and
lower, just as the North Star appears to be an immobile star around which all others revolve. The point’s
central position indicates its importance. However, the
statement that this point lies at the centre of the body
dividing it into two equal halves does not appear to be
verified in practice. In fact, in most people, the vertical
centre falls approximately at the level of Ren-1 Huiyin.
One possible explanation of this discrepancy might
be that Chinese people tend to have shorter legs than
Westerners: however, Chinese acupuncture charts
also show Ren-1 as being approximately at the vertical
centre.
The actions of Ren-3 Zhongji are as follows. It:
•
•
•
•
•
•
tonifies the Kidneys
tonifies Yang
regulates menstruation
stops leucorrhoea
warms the Essence
regulates the Bladder.
Indications in the gynecological sphere for this point
include incontinence of urine, retention of urine,
irregular periods, menorrhagia, infertility, retention of
lochiae, itching of vagina, leucorrhoea and retention
of placenta.
Like the Kidney points on the Penetrating Vessel, this
point can be used in Full or Empty conditions. In Full
conditions, it treats mainly the Bladder and genitals for
urinary problems in women, vaginal discharges and
itching, etc. In Empty conditions, it tonifies the Uterus
Treatment of the Extraordinary Vessels 173
and the Kidneys. However, I tend to use this point more
for its action on the Bladder (for which it is the FrontCollecting point) and genitals; to tonify the Uterus and
the Kidneys in Empty conditions I usually prefer Ren-4
Guanyuan.
The point Ren-3 Zhongji can be combined with many
different points:
•
•
•
•
•
•
•
BL-23 Shenshu, L.I.-4 Hegu and SP-6 Sanyinjiao for
amenorrhoea.
Extra point Zigong (three cun lateral to Ren-3) for
menorrhagia and infertility.
BL-23 Shenshu and SP-9 Yinlingquan alternated
with SP-6 Sanyinjiao and Ren-6 Qihai for frequent
urination.
BL-23 Shenshu, Ren-6 Qihai and SP-6 Sanyinjiao
for irregular periods.
Ren-7 Yinjiao and Ren-5 Shimen for retention
of lochiae.
SP-6 Sanyinjiao for retention of placenta.
G.B.-21 Jianjing for retention of placenta.
REN-4 Guanyuan (Gate Origin)
The word ‘origin’ refers to Original Qi (Yuan Qi), thus the
name indicates that this point can be a ‘gate’ of access
to the Original Qi. Alternatively, because the Defensive
Qi here exits from the Lower Burner, this point is therefore the gate between Interior and Exterior. Ren-4 has
an extraordinary number of alternative names such
as Zi Hu (‘Door of Child’), Dan Tian (‘Field of Elixir’),
Xue Hai (‘Sea of Blood’), Xue Shi (‘Room of Blood’),
San Jie Jiao (‘Three Knots Crossing’), Da Zhong Ji (‘Big
Zhongji’, i.e. Ren-3), Chan Men (‘Door of Childbirth’),
Da Hai (‘Big Sea’), Bao Men (‘Door of Birth’), Chi Shu
(‘Keeping the Pivot’), Kun Lun (‘Kunlun Mountains’),
Niao Shui (‘Urine’), Zi Gong (‘Palace of the Child’), Xia
Ji (‘Lower Rule’), Zi Chu (‘Abode of the Child’) and Xia
Huang (‘Lower Membranes’). All these names highlight
the character and functions of Ren-4 in relation with
the Uterus, Blood, childbirth, the Field of Elixir and
fertility.
The actions of Ren-4 Guanyuan are as follows. It:
•
•
•
•
•
•
tonifies the Original Qi
treats Painful Urinary Syndrome
tonifies the Kidneys
consolidates the Essence
tonifies Yang (with moxa)
nourishes Yin (without moxa)
•
•
•
warms and regulates Blood
nourishes Blood
resolves Dampness.
The indications relevant to gynecology include
abdominal pain, urinary problems in women, irregular periods, amenorrhoea, dysmenorrhoea, leucorrhoea, menorrhagia, retention of lochiae, retention of
placenta, Running Piglet Syndrome in women, Blood
abdominal masses below the navel and pain radiating
from the back to the umbilicus and genitals.
The Penetrating Vessel connects with the Directing
Vessel at this point, and if we analyse the indications
we can see, in fact, that some of them pertain to the
Penetrating Vessel’s pathology: abdominal pain, dysmenorrhoea, retention of lochiae, retention of placenta, Running Piglet Syndrome, pain radiating from
the back to the umbilicus and genitals and, among the
non-gynecological indications, blood in stools.
The importance of this point in gynecology cannot be
overemphasized. It tonifies practically every vital substance: Yang (with moxa), Yin (without moxa), Blood,
Essence, the Uterus and the Original Qi. By tonifying the
root in the Lower Burner, it also has a powerful calming influence on the Mind by making Qi descend to the
Field of Elixir: thus, it is an excellent point for anxiety
and agitation stemming from a Kidney deficiency (with
or without Empty-Heat).
I use this point very frequently in combination with
the opening and associated points of the Directing
Vessel, i.e. LU-7 Lieque on the right and KI-6 Zhaohai
on the left, for a great variety of conditions. Without
moxa, these three points can nourish Kidney-Yin,
regulate the Uterus and nourish Blood in menopausal
problems. If there are pronounced hot flushes, anxiety and sweating, the three points can be combined
with HE-6 Yinxi and KI-7 Fuliu. The points would
therefore be placed as follows: LU-7 Lieque on the
right, KI-6 Zhaohai on the left, Ren-4 Guanyuan,
HE-6 Yinxi on the left and KI-7 Fuliu on the right. The
laterality of the last two points is chosen to balance
the opening and associated points of the Directing
Vessel (Fig. 7.5).
If the Kidneys are severely deficient, the point KI-13
Qixue (bilateral) could be added.
When used with moxa cones, Ren-4 Guanyuan tonifies Kidney-Yang. This can be done in menopausal
problems from Kidney-Yang deficiency even if there are
hot flushes. These are usually due to the simultaneous
174 Section 3: Methods of Treatment
rectus abdominis; thus, its use is indicated if these feel
either very flaccid (Empty conditions) or very tight
(Full conditions).
One of the alternative names of Ren-4 is Xiahuang, i.e.
‘Lower Membranes’: this means that this point controls
all the connective tissue of the abdomen, such as fascia,
omentum and mesenterium. Again, it can be used either
to tonify these structures when they are slack or to relax
them when they are tense: the necessary therapeutic
approach can easily be determined by palpation.
Ren-4
HE-6
LU-7
KI-7
KI-6
Figure 7.5 Combination of Directing Vessel points (1).
deficiency of both Kidney-Yin and Kidney-Yang: if the
tongue is Pale, the point Ren-4 can be warmed with
moxa and this will not aggravate the hot flushes.
Ren-4 combines particularly well with Ren-15 Jiuwei
to tonify the Kidneys and calm the Mind. The latter
point Ren-15 could be added to the above-mentioned
combinations of points where there is pronounced
anxiety and agitation against a background of Kidney
deficiency. These two points Ren-4 and Ren-15 are particularly indicated if the lower abdomen feels flaccid
and the area below the xiphoid process feels hard.
Another good combination is that of Ren-4 with
Du-20 Baihui for mental depression against a background of Kidney deficiency. Other combinations of
Directing and Governing Vessel points will be discussed
shortly when dealing with the Governing Vessel.
As a point of the Penetrating Vessel as well, Ren-4
also influences the ancestral muscles (zong jin), i.e. the
REN-5 Shimen (Stone Door)
There are various explanations for the meaning of this
name. ‘Stone’ symbolizes hardness and one of the indications for this point is ‘hardness and pain of the abdomen’. Another explanation is that, in old China, an
infertile woman was called ‘stone woman’ and the use
of direct moxa on this point supposedly can render a
woman infertile and also terminate a pregnancy. Thus,
‘Stone Door’ indicates a door that cannot be opened,
i.e. the fertilizing sperm cannot penetrate the woman’s
uterus.
According to others, ‘stone’ here refers to cinnabar
as in the ‘Field of Cinnabar’ (dan tian) where this point
is situated. Yet another explanation is that the Qi of
the Directing Vessel goes in and out at this point, like
a door; this last explanation would contradict the previous one according to which a stone door is one that
cannot be opened.
Alternative names for this point include Li Ji (‘Beneficial Mechanism’), Jing Lu (‘Essence’s Dew’), Dan Tian
(‘Field of Elixir’) and Ming Men (‘Gate of Life’), which
clearly reflect this point’s role with regard to Essence,
Gate of Life and Field of Elixir. The name Li Ji can be
interpreted differently because the word li is composed of
the radicals for ‘standing grain’ (ready to be harvested)
and ‘knife’ or ‘reaping hook’, indicating the cutting of
standing grain for reaping and therefore ‘benefiting’.
However, the cutting motion of the knife is also ‘separating’ and the name of this point could therefore also refer
to the separation of fluids in the Lower Burner: in fact,
this point is the Front-Collecting (Mu) point for the Triple
Burner (especially the Lower Burner), one of the main
functions of which is to separate, transport and transform fluids. This interpretation would also be in accordance with the view of this point as the place where the
Qi of the Directing Vessel goes in and out since it is Qi
that separates and transforms fluids.
Treatment of the Extraordinary Vessels 175
The actions of Ren-5 Shimen are as follows. It:
•
•
•
•
•
•
regulates Qi
stops pain
regulates the Water Passages
warms the Kidneys
invigorates Yang
regulates the menses.
The main indications in the gynecological sphere
are abdominal distension, umbilical pain, Running
Piglet Syndrome in women, oedema, urinary difficulty
in women, amenorrhoea, vaginal discharge, menorrhagia and retention of lochiae.
The main emphasis of this point is on separating and
transforming fluids in the Lower Burner: it is therefore
a very important point for women’s urinary problems
(which are often wrongly labelled ‘cystitis’), candida
infections of the vagina and oedema in pregnancy.
However, Ren-5 is the Front-Collecting point of the
Triple Burner, which, in addition to its role in separating and transforming fluids, also acts as the ‘envoy’,
‘avenue’ or ‘ambassador’ of the Original Qi emerging from the space between the two kidneys; thus, the
Triple Burner, and therefore this point, is related to the
Original Qi and the Fire of the Gate of Life.9 This point
can therefore be used to tonify and warm Kidney-Yang
and the Gate of Life: in women, thus for amenorrhoea
occurring against a background of Kidney-Yang deficiency. Obviously one would use moxa to treat Yang
deficiency, contrary to the idea that the use of this
point with moxa would render a woman infertile; however, were this idea possible, it would presumably happen only with a large number of moxa cones used over
a sustained period.
Ren-5 Shimen can be combined with SP-5 Shangqiu
to treat abdominal hardness and pain extending to the
genitals. The Compendium of Acupuncture (1601) states
that this point can be combined with SP-6 Sanyinjiao
when a woman has too many children! This indication
is presumably based on the idea that this point can render a woman infertile or terminate a pregnancy. Ren-5
can be combined with KI-7 Fuliu for Blood Painful
Urination Syndrome in women.
REN-6 Qihai (Sea of Qi)
The point’s name clearly refers to its function as a point
of concentration, or gathering, of Qi. In fact, one of
its alternative names is Xia Qi Hai (‘Lower Sea of Qi’);
xia means ‘lower’, the implication being that there is
an upper Sea of Qi. This is indeed Ren-17 Shanzhong,
which is the Gathering point (hui xue) of Qi.
Other names for Ren-6 include Xia Huang
(‘Lower Membranes’), Huang Zhi Yuan (‘Source of
Membranes’), Bo Yang (‘Navel’) and Ji Yang (‘Small
Navel’). The first two names refer to the statement
in the first chapter of the Spiritual Axis according to
which Ren-6 Qihai is the Source point of Membranes
(huang); assuming the ‘membranes’ are the abdominal fascia, omentum and mesenterium, this point is
the concentration of the pre-natal energy that shaped
these structures and can affect them when they
are too slack or too tight in a way similar to KI-16
Huangshu. Ren-6’s other names of ‘Navel’ and ‘Small
Navel’ presumably refer to the above-mentioned function of influencing ‘membranes’, i.e. since the point is
the source of these structures, in relation to these it is
like a ‘navel’. Bo Yang is actually the name that the first
chapter of the Spiritual Axis uses for the Source point
of Membranes and some authors think this is Ren-8
rather than Ren-6. However, Ren-6’s other names of
‘Lower Membranes’ and ‘Source of Membranes’ seem
to confirm that this point is indeed the Source point
of Membranes.
The actions of Ren-6 Qihai are as follows. It:
•
•
•
•
•
•
•
•
tonifies Qi
tonifies Yang
regulates the periods
consolidates the Essence
tonifies the Original Qi
tonifies the Kidneys
warms the Lower Burner
resolves Dampness.
The indications of this point in the gynecological sphere include abdominal pain, irregular periods,
dysmenorrhoea, amenorrhoea, menorrhagia, leucorrhoea, oedema in women and feeling of cold arising
from the lower abdomen.
This point is a powerful tonic of Qi and Yang.
Comparing it with Ren-4 Guanyuan, one can say that
Ren-6 tonifies Qi and Yang, while Ren-4 nourishes
Blood and Yin (although, with moxa, this latter point
can also tonify Kidney-Yang). However, Ren-6’s importance lies also in the fact that, besides tonifying Qi, it
can move Qi in the lower abdomen: it is therefore very
important in gynecology for abdominal pain from stagnation of Qi and also for fluids pathology in the lower
part of the body (because fluids rely on Qi for their
movement, separation and transformation).
176 Section 3: Methods of Treatment
Similarly to Ren-4 Guanyuan, Ren-6 Qihai is frequently combined with the opening and associated
points of the Directing Vessel, to regulate the Uterus
and either tonify or move Qi, as in cases of abdominal pain and distension in cases of pre-menstrual syndrome. This combination could be used to tonify and
raise Qi and regulate the Uterus in cases of prolapse of
the uterus; it could also be used when the uterus is not
actually prolapsed but there is a bearing-down sensation in the lower abdomen, perhaps frequent urination,
menorrhagia (from Qi not holding Blood) and a chronic
vaginal discharge, all symptoms of deficiency and
sinking of Qi. A possible combination would be: LU-7
Lieque on the right, KI-6 Zhaohai on the left, Du-20
Baihui, Ren-6 Qihai, ST-36 Zusanli (bilateral) and SP-6
Sanyinjiao, also bilateral (Fig. 7.6). This combination
would tonify and raise Qi and strengthen the Uterus.
To move Qi in the lower abdomen in case of abdominal pain and distension, dysmenorrhoea (from Qi
P-6
Ren-6
LU-7
Du-20
KI-6
LIV-3
Figure 7.7 Combination of Directing Vessel points (3).
LU-7
stagnation) and pre-menstrual tension, one might use
the following combination: LU-7 Lieque on the right,
KI-6 Zhaohai on the left, P-6 Neiguan on the left, LIV-3
Taichong on the right and Ren-6 Qihai (Fig. 7.7).
There are several traditional combinations of points
with Ren-6 Qihai:
Ren-6
•
ST-36
•
SP-6
•
•
KI-6
Figure 7.6 Combination of Directing Vessel points (2).
•
•
With LIV-1 Dadun, KI-10 Yingu, LIV-3 Taichong,
KI-2 Rangu, SP-6 Sanyinjiao and Ren-3 Zhongji for
menorrhagia (presumably from Blood-Heat).
With Ren-3 Zhongji, BL-30 Baihuanshu, BL-23
Shenshu for red–white leucorrhoea.
With SP-6 Sanyinjiao for Blood masses after childbirth.
With Ren-3 Zhongji, G.B.-26 Daimai, BL-23
Shenshu and SP-6 Sanyinjiao for irregular periods.
With Ren-4 Guanyuan and Ren-12 Zhongwan for
stubborn Painful Obstruction Syndrome when herbs
do not help.
With Ren-4 Guanyuan for retention of lochiae.
Treatment of the Extraordinary Vessels 177
REN-7 Yinjiao (Yin Crossing)
REN-8 Shenque (Spirit Palace)
The name of this point alludes to the fact that the
three Extraordinary Vessels (Governing, Directing
and Penetrating) all meet here. The Great Dictionary
of Chinese Acupuncture gives a more complicated
explanation:
The name of this point depends on how we interpret
the word que. This word can mean ‘imperial palace’ or
‘two watch towers on either side of a palace gate’. In
this sense the name of the point would be ‘Palace of
Shen’ or ‘Abode of Shen’. This interpretation is certainly
plausible as the Shen of a human being is formed
by the union of the father’s and mother’s Essences and
the newly formed being is linked to the mother via the
umbilical cord: thus the point Ren-8 Shenque is
the place where the Shen of the fetus first resides. The
metaphor of que as ‘imperial palace’ would also suit
the nature of the point as the Shen resides in the Heart
which is the Emperor.
The analogy of the palace is also meaningful as the
point Ren-8 is at the centre of the body and is central to a group of points. Just as there is the triad of
Heaven above, Earth below and Person in the middle,
we have Ren-10 Xiawan and Ren-9 Shuifen above
(‘Heaven’), Ren-4 Guanyuan and Ren-7 Yinjiao below
(‘Earth’) and Ren-8 Shenque in the middle with KI-13
Qixue and KI-16 Huangshu to the left and right sides
(‘Person’) (see Fig. 7.8).
Thus, the umbilicus and Ren-8 are at the centre of
this group of points forming a doorway through which
the Shen communicates with the Pre-Natal Qi. When the
Essences of mother and father unite, the fetus is formed,
and the umbilical cord links it to the mother’s Gate of
The Qi of the Original Yang intersects with Yin. The
essence of ‘Dew-Water’ mixes with Yin Qi, the Water
separates upwards and mixes with the essence of the
Directing Vessel; Yang Qi goes up and down, the Original
Yin infuses into the Field of Elixir, Water and Fire cross,
hence the name Yin Crossing.10
Other names for this point include Shao Guan (‘Lesser
Gate’), Heng Hu (‘Horizontal Door’) and Dan Tian (‘Field
of Elixir’).
The actions of Ren-7 Yinjiao are as follows. It:
•
•
•
•
•
regulates the periods
stops leucorrhoea
promotes Water transformation
resolves oedema
nourishes Kidney-Yin.
The main indications in the gynecological field are
irregular periods, menorrhagia, leucorrhoea, abdominal pain, oedema in women, urinary difficulty, Running
Piglet Syndrome in women, feeling of hardness of the
abdomen, abdominal pain extending to the genitals,
contraction of the limbs in women, infertility, retention
of lochiae, feeling of cold and pain below the umbilicus.
Judging by the actions and indications, this point has
two broad ranges of action: the first in transforming
fluids and resolving oedema, and the second in nourishing Yin. These two functions should not be seen as
contradictory since oedema is a pathological accumulation of fluids and not an expression of normal fluids.
To resolve oedema and transform fluids, Ren-7 should
be used with moxa, while to nourish Yin it should be
needled. I use it particularly for its latter function, i.e. to
nourish Yin, especially in menopausal problems.
Ren-7 Yinjiao can be combined with Ren-5 Shimen
for oedema with hot abdominal skin, dark urine and
feeling of fullness; with Ren-3 Zhongji and extra point
Shiqizhuixia (on the Governing Vessel between L-1 and
the sacrum), all with direct moxa, for malposition of
the fetus; and with ST-36 Zusanli and Ren-9 Shuifen
(with moxa cones) for oedema, abdominal fullness and
a feeling of ‘empty distension’.
Ren-10
Ren-9
KI-16
Ren-8
KI-16
Ren-7
KI-13
KI-13
Ren-4
Figure 7.8 Position of Ren-8 Shenque and surrounding points.
178 Section 3: Methods of Treatment
Life. The Fire of the Gate of Life in the fetus is of pre-natal
origin and gives rise to Water as well as the Kidneys. Like
an unopened lotus flower, the Five Elements come into
being, the mother’s Qi is transformed, in 10 months the
fetus is complete and its Shen infuses through the centre
of the umbilicus and forms the new being.11
However, the word que can have a second interpretation, meaning something that is ‘missing’, ‘incomplete’, ‘absent’, ‘vacant’. Thus, the main feature of this
point is not that it is a ‘gate’ or ‘door’ through which
energies go in and out but that it is like an empty space,
something missing: this is obviously the placenta
which was attached to the fetus via the umbilical cord.
Hence this point is the space formerly occupied by the
placenta and through which the Shen first entered the
fetus and was nourished by the mother’s Essence and
Corporeal Soul (Po). The implication of this is that this
is the point that more than any other connects us to
the Pre-Natal Essence. Thus, the interpretations of
que as an imperial palace or as something ‘missing’
are not contradictory: this is the place where the Shen
first entered through the empty space left by the placenta, but it is also the residence of the Shen during
gestation.
It is also interesting that there is an extra point one
cun either side of the umbilicus called Hun She which
means ‘House of the Ethereal Soul’: it is significant
that this point is so close to Ren-8 as the latter is related
to Shen and the former to the Ethereal Soul which
represents the ‘coming and going of Shen’.
The actions of Ren-8 Shenque are as follows. It:
•
•
•
•
•
warms the Yang
subdues rebellious Qi
promotes Water transformation
rescues from collapse
tonifies the Kidneys.
The main indications in the gynecological field
are oedema in women, umbilical pain, post-partum
abdominal distension, post-partum urinary problems
and fetus too low.
This point is used in gynecology mostly to tonify the
Kidneys and strengthen the Essence and Original Qi in
very deficient conditions, for problems such as menorrhagia (from Kidney-Qi deficiency), amenorrhoea or
infertility. The point also has a mental effect on the Mind
and Spirit, so it can be used in post-natal depression.
One traditional combination of this point (with
27 moxa cones) is with Ren-15 (15 moxa cones) for
excessive sexual activity in young people causing
breathlessness.12
REN-9 Shuifen (Water Separation)
The name of this point clearly refers to the separation
of clear from turbid fluids occurring in the Intestines,
which this point affects.
The actions of Ren-9 Shuifen are as follows. It:
•
•
•
regulates the Water Passages
regulates Qi
stops pain.
This point has no major gynecological indications
but it is frequently used in women to promote the
transformation and separation of fluids in oedematous
conditions. It can be used for fluid retention in any part
of the body. When used for oedema, it is particularly
effective if moxa cones are applied to it.
Among the traditional combinations are the following: with Ren-5 Shimen for hypogastric pain and urinary frequency; with Ren-6 (moxa) for Yang oedema;
with Ren-14 Juque and Ren-6 Qihai for umbilical pain;
with SP-6 Sanyinjiao and BL-20 Pishu for Yin oedema.
I use Ren-9 (often with Ren-12 Zhongwan too) in all
cases of fluids pathology, i.e. oedema, Dampness and
Phlegm. As Ren-9 is in the Middle Burner, it will help
the separation of fluids in the Upper and Lower Burner,
as well as in the Middle Burner itself.
REN-10 Xiawan (Lower Epigastrium)
The name of this point must be correlated with Ren-12
Zhongwan (meaning ‘Central Epigastrium’) and Ren13 Shangwan (‘Upper Epigastrium’). These three points
therefore control the upper, middle and lower part of the
stomach. More specifically, Ren-13 Shangwan controls
the upper part of the stomach, cardia and oesophagus;
Ren-12 Zhongwan the stomach’s body and fundus;
Ren-10 Xiawan, the lower part of the stomach, pylorus
and duodenum. Another name for this point is Xia Guan
which means ‘Lower Tube’ or ‘Lower Duct’, a reference
to the duodenum. Yet another name is You Men which
means ‘Dark Door’, a reference to the passage from the
stomach to the small intestine, i.e. the pylorus.
The actions and indications of this point are not specific to gynecology, but I use it frequently to stimulate
the descending of Stomach-Qi especially in conditions
with Phlegm. One of the main indications for the use
of this point is therefore a feeling of fullness, distension
or stuffiness of the epigastrium. It is a meeting point
with the Spleen channel and it therefore also promotes
the transforming and transporting of the Spleen. I also
find that Ren-10 Xiawan has a pronounced effect on
Treatment of the Extraordinary Vessels 179
calming the Mind when this is disturbed by emotional
problems such as worry and pensiveness affecting the
Spleen and Stomach.
REN-12 ZHONGWAN (Central
Epigastrium)
The name of this point refers to the central part of the
Stomach, which it controls. The ‘central’ in its name
could refer to the Central Qi (Zhong Qi) of the Stomach
and Spleen, to the fact that the point is at the centre
between Ren-15 Jiuwei and Ren-8 Shenque, or to the
Centre in terms of Earth Element. Other names include
Zhong Guan (‘Central Duct’, in analogy with Ren-10
Xiawan being the ‘Lower Duct’), Wei Wan (‘Stomach
Epigastrium’), Xia Ji (‘Upper Regulation’), Tai Cang
(‘Supreme Granary’) and Wei Mu (‘Front-Collecting
Point of the Stomach’).
The actions of this point are as follows. It:
•
•
•
•
•
•
harmonizes the Stomach
strengthens the Spleen
tonifies all Yang organs
makes Qi of all Yang organs descend
calms the fetus
resolves Dampness.
This point does not have specific gynecological indications but it is a major point to tonify Stomach and
Spleen and resolve Dampness. I find also that it has a
calming effect on the Mind, in a similar way to Fu Shen
Sclerotium Poriae pararadicis which resolves Dampness,
mildly tonifies the Spleen and calms the Mind.
REN-14 Juque (Great Palace or
Great Opening)
Ju means ‘great’; que, which is the same character as
in Shenque (Ren-8), already discussed above, is translated as ‘gate’ in most books, the ‘great’ referring to the
Emperor, i.e. the Heart. Others translate que as ‘palace’
and the name would therefore mean ‘Great Palace’ of
the Emperor, i.e. the Heart.
However if we interpret que as an ‘opening’, as ‘something missing’, in the same way as for Ren-8 Shenque,
then the point Ren-14 Juque is the corresponding
point to Ren-8 in the Upper Burner. The Mind (Shen)
depends on the Essence (and therefore Kidneys) which
is controlled by Ren-8. The Mind also resides in the
Heart which is controlled by Ren-14: thus, we could
see Ren-14 Juque as an ‘upper Ren-8 Shenque’ affecting the Mind not through the Kidneys, but through
the Heart.
The actions of this point are as follows. It:
•
•
•
•
calms the Mind
calms the Heart
opens the chest
stops pain.
This point has no specific gynecological indications but I use it frequently in gynecological problems associated with emotional stress such as
sadness, worry, grief and shock affecting the Heart.
It combines well with either Ren-4 Guanyuan or
Ren-8 Shenque: the combination of either of these
points with Ren-14 Juque tonifies the Kidneys, the
Essence and the Original Qi and calms the Mind.
As explained above, the combination of these points
treats both of the main organs that affect the Mind,
i.e. Kidneys and Heart. Interestingly, one of the old
combinations was Ren-14 Juque and KI-9 Zhubin
for kuang disease, i.e. the manic phase of a manicdepressive disorder.
REN-15 Jiuwei (Dove Tail)
‘Dove tail’ probably refers to the Connecting (Luo) channel of the Directing Vessel which starts from this point
and fans out over the upper abdomen, although most
books say that the ‘dove tail’ is the rib-cage. Other names
for this point include Wei Yi (‘Tail Screen’), Shen Fu (‘Fu
organ of the Mind’) and Xin Yan, whose meaning is
ambiguous: xin means ‘Heart’ while yan can mean both
‘be disgusted with, detest, be fed up with’ and ‘be satisfied’. The first interpretation might be significant, indicating the use of this point for emotional problems such
as frustration, anger or indignation affecting the Heart.
The actions of this point are as follows. It:
•
•
•
•
•
calms the Heart
calms the Mind
opens the chest
stops breathlessness
resolves Phlegm from the Heart.
This point does not have specific gynecological indications but I often use it when treating women with
emotional problems due to sadness, worry, grief, shock
or guilt and occurring against a background of Kidney
deficiency and Heart stagnation. The point is extremely
effective when the above emotions manifest themselves
on a physical level with a feeling of oppression or tightness of the chest. It combines particularly well with
Du-24 Shenting to calm the Mind when there is pronounced anxiety; and with Du-20 Baihui when there is
sadness and depression.
180 Section 3: Methods of Treatment
According to the first chapter of the Spiritual Axis,
it is the point of Gao, i.e. fat tissues. These tissues are
of pre-natal origin as the fetus in the first month is
said to be pure Gao. There is an interesting connection
between the relationship of the Directing Vessel with
fat tissues (Gao) and hormone levels. After the menopause some androstanedione is converted to oestrogen in
fat tissues: thus, this confirms the relationship among
fat tissues, Gao, the Directing Vessel and its role in hormone production in women.
Directing Vessel: case histories
Case history
A woman of 41 had had a large fibroid in the
uterus for several years. Her periods were very
heavy and painful and the menstrual blood was
dark. Her lower abdomen was extremely hard
and the fibroid was clearly felt on palpation.
She was treated several times using the opening
and associated points of the Directing Vessel (LU-7
Lieque on the right and KI-6 Zhaohai on the left),
producing a complete normalization of her periods
and a very marked softening of her lower abdomen. The size of the abdominal swelling was also
markedly reduced. Obviously a fibroid of that size
cannot be dissolved, but the use of the Directing
Vessel at least normalized her periods, took the
menstrual pain away and made her lower abdomen
much more comfortable.
Case history
A woman of 38 complained of persistent vaginal candida infection. She experienced itching and a white discharge. Apart from this she
complained of tiredness since the birth of her
first (and only) child 3 years previously, and
of lower backache. Her periods were slightly
delayed, with a cycle of about 35 days. Her
tongue was slightly Red, peeled in patches and
with a thick, slightly yellow coating (Plate 2).
Her pulse was Weak on the left Rear position.
This patient’s condition was clearly due to a deficiency of Kidney-Yin, evidenced by the backache,
the Weak Kidney pulse and the Red and peeled
tongue. In addition, there was Dampness in the
genital system, clearly shown by the symptom of
thrush and the thick tongue coating.
The treatment principle was to nourish KidneyYin and resolve Dampness from the Lower Burner.
Apart from other points over a period of months, I
frequently used the Directing Vessel and the following is an example of a point combination:
• LU-7 Lieque on the right and KI-6 Zhaohai on
the left to open the Directing Vessel and nourish
the Kidneys.
• Ren-12 Zhongwan and ST-28 Shuidao to resolve
Dampness from the Lower Burner.
• Ren-3 Zhongji, SP-9 Yinlingquan and BL-32 Ciliao
to resolve Dampness from the genital system.
After treating her for about 1 year, the vaginal
candida infection did not recur.
Case history
A 35-year-old woman had been suffering from
tiredness and depression since the birth of her
child 11 years previously. She also suffered
from recurrent sinusitis (with a thick, yellow
nasal discharge) and pre-menstrual headaches:
these occurred on the sides of the head (Gall
Bladder channel) and were throbbing in nature.
She also complained of pre-menstrual tension
and the menses were occasionally heavy with
dark, clotted blood. Her tongue was Pale and
Swollen and her pulse was Weak on both Rear
positions.
This woman suffered from a Kidney-Yang deficiency with Liver-Yang and Liver-Fire rising. Apart
from this, nearly all her symptoms indicate a disharmony of the Directing Vessel; the tiredness and
depression after childbirth, the pre-menstrual tension, the heavy period with dark blood and the
headache before the periods. While the headaches are clearly due to Liver-Yang rising, there is
also some Liver-Fire as evidenced by the sinusitis.
Treatment of the Extraordinary Vessels 181
The sinusitis is related partly to the Directing Vessel,
as this vessel flows over the face to the bottom of
the eyes, but also to Liver-Fire rising to the face: the
thick, yellow nasal discharge indicates Liver-Fire as
opposed to Liver-Yang.
The treatment principle was to regulate the
Directing Vessel, tonify and warm the Kidneys, subdue Liver-Yang and clear Liver-Fire. This patient was
treated for several months during which I used the
Directing Vessel several times. The following is an
example of a Directing Vessel combination:
• LU-7 Lieque on the right and KI-6 Zhaohai on
the left to open and regulate the Directing
Vessel.
• Ren-4 Guanyuan to tonify the Kidneys and
strengthen the Directing Vessel.
• P-6 Neiguan on the left and LIV-3 Taichong
on the right to pacify the Liver, subdue Yang,
calm the Mind and settle the Ethereal Soul.
The laterality of these two points is aimed at
balancing that of the opening and associated
points of the Directing Vessel.
• Du-20 Baihui to lift mood and relieve depression.
Although this point would be contraindicated
in Yang rising, it is combined here with Ren-4
Guanyuan which draws Qi down to the Field of
Elixir. The Governing and Directing Vessels form
a continuous, unbroken circuit and Du-20 and
Ren-4 in combination harmonize the ascending
and descending of Qi within it.
GOVERNING VESSEL (DU MAI)
The Directing and Penetrating vessels are Yin in nature,
they regulate menstruation, fertility, conception and
pregnancy and are of paramount importance in women’s physiology, pathology and treatment. These two
vessels both flow in the abdomen and their points are
of fundamental importance in the treatment of gynecological problems as we have just discussed. The
Governing Vessel is somewhat less important in gynecology as it flows along the spine in the back. However,
it is important to remember what was said about the
pathway of the Governing Vessel in Chapter 2 on physiology, i.e. that, before ascending along the spine, the
Governing Vessel also circles around the pubic bone
and vagina and problems in that area in women can be
related to a pathology of this vessel in the presence of
a general deficiency of Yang. Moreover, the abdominal
branch of the Governing Vessel ascending up the midline of the abdomen and, described in the same chapter, would seem to indicate that this vessel can have
an influence on the genital system in women too. The
Golden Mirror of Medicine (Yi Zong Jin Jian, 1742) says:
The Governing vessel arises within the lower abdomen,
externally in the abdomen, internally in the ‘Bao’
[‘Uterus’] … also called Dan Tian in both men and women:
in women it is the uterus, in men it is the Room of Sperm.
The Governing Vessel would be chosen where a
woman shows a marked deficiency of Yang and of the
Fire of the Gate of Life. Thus it could be used for amenorrhoea, delayed cycle or infertility which occur against
a background of pronounced Kidney-Yang deficiency
(manifesting with chilliness, a Pale and wet tongue and
a Deep and Slow pulse).
It should also be remembered that the menstrual
cycle is the result of the ebb and flow of Kidney-Yin and
Kidney-Yang: the former reaches the Uterus through
the Directing and Penetrating Vessels and the latter
through the Governing Vessel. Thus, the Governing
Vessel represents the Yang part of the menstrual cycle:
without it, there would be no menstrual cycle.
The opening and associated points of the Governing
Vessel are S.I.-3 Houxi (on the right) and BL-62
Shenmai (on the left), inserted in this order and withdrawn in the reverse order. In women, very often the
Directing and Governing Vessels can be used together,
needling S.I.-3 Houxi on the right, BL-62 Shenmai on
the left, LU-7 Lieque on the left and KI-6 Zhaohai on
the right, in this order (Fig. 7.9). The needles are withdrawn in the reverse order.
For example, I use the opening and associated points
of both the Governing and Directing Vessels when
treating lower backache in women, but only if the
backache stems from the midline on the spine itself.
In other cases too these two vessels can be combined
in women. For example, when treating a woman suffering from amenorrhoea stemming from a deficiency
of Kidney-Yang, one might use the following combination of points: S.I.-3 Houxi on the right, BL-62 Shenmai
on the left, LU-7 Lieque on the left, KI-6 Zhaohai on the
right, Ren-4 Guanyuan (with moxa cones) retaining
182 Section 3: Methods of Treatment
LU-7
S.I.-3
clinically for depression in gynecology, often combined
with Directing Vessel points. An example of a combination for a woman suffering from Blood deficiency,
Kidney-Yang deficiency and depression is: S.I.-3 Houxi
on the right, BL-62 Shenmai on the left, LU-7 Lieque
on the left, KI-6 Zhaohai on the right, Ren-4 Guanyuan
(with moxa cones) and Du-20 Baihui (Fig. 7.10).
If the patient suffered from Blood deficiency, KidneyYang deficiency, amenorrhoea and anxiety rather than
depression, an example of a possible combination is:
S.I.-3 Houxi on the right, BL-62 Shenmai, LU-7 Lieque
on the left, KI-6 Zhaohai on the right, Ren-4 Guanyuan
(with moxa cones), Ren-15 Jiuwei and Du-24 Shenting
(Fig. 7.11).
I shall now discuss the actions and indications of
the main Governing Vessel points used in gynecology,
restricting myself to indications relevant to gynecological problems, although in a broad sense these may
Du-20
KI-6
BL-62
Figure 7.9 Governing and Directing Vessels in combination.
Ren-4
the needles for about 20 minutes and, after the patient
turns over, BL-23 Shenshu, retained for only 5–10
minutes.
The use of both the Governing and the Directing
Vessels is also helpful in gynecological problems accompanied by mental–emotional problems. This is because
the abdominal branch of the Governing Vessel flows
through the heart, and this vessel has a strong influence
on the mental–emotional state. This is all the more so
because the Governing Vessel connects Kidneys, Heart
and Brain: one could therefore say that it influences
the Mind in three ways, i.e. through the Kidneys (residence of the Essence which is the foundation of Qi and
Shen and of the Will-Power), the Heart (residence of
the Mind) and Brain (residence of the Mind according
to several doctors such as Sun Si Miao, Li Shi Zhen and
Wang Qing Ren). Due to its relation with the Kidneys,
Heart and Brain, the Governing Vessel is often used
LU-7
S.I.-3
KI-6
BL-62
Figure 7.10 Combination of Governing and Directing Vessel
points for depression.
Treatment of the Extraordinary Vessels 183
Du-24
Ren-15
Ren-4
LU-7
S.I.-3
of fetus, sciatica, menorrhagia, incontinence of urine
and dysuria during pregnancy.
This is a very important point on the Governing Vessel.
Although it does tonify the Kidneys, it is more frequently
used to move Qi and Blood. Its use for malposition of
the fetus is very ancient and is first mentioned in the
Thousand Golden Ducats Prescriptions (AD 652) by Sun Si
Miao.13 He suggests using 50 moxa cones on this point.
This point is excellent for lower backache over the sacrum
and can be used also for dysmenorrhoea, especially,
but not exclusively, if the pain extends to such an area.
Shiqizhuixia extends its influence to the Bladder, promoting the transformation of urine: it can therefore be
used for urinary difficulty during pregnancy or urinary
incontinence following childbirth particularly when this
occurs as a consequence of an epidural. Especially for
urinary problems, it is desirable that the needling sensation propagates downwards. In sciatica, this point is
invaluable, especially when the pain and tingling extend
all the way down to the foot along the Bladder channel.
The needle is inserted at a depth of 0.3–0.5 cun.
DU-2 YAOSHU (Transporting Point
of the Back)
KI-6
BL-62
Figure 7.11 Combination of Governing and Directing Vessel
points for anxiety.
include, for example, urinary problems (a frequent
accompaniment to certain gynecological conditions).
SHIQIZHUIXIA (Point Below the 17th
Vertebra)
This is an extra point on the Governing Vessel situated
in the depression between the spinous processes of L-5
and S-1.
The actions of this point are as follows. It:
•
•
•
•
tonifies the Kidneys
benefits the Bladder
stops pain
invigorates the sinews.
The indications of this point in the gynecological
sphere include urinary difficulty, dysmenorrhoea (especially with pain extending to the sacrum), malposition
The name of the point is self-evident, indicating the importance of this point for the lower back. Other names include
Bei Jie (‘Freeing the Back’), Yao Hu (‘Door to the Back’), Sui
Kong (‘Hole of Marrow’) and Sui Fu (‘Fu of Marrow’).
The actions of this point are as follows. It:
•
•
•
•
regulates menstruation
clears Heat
scatters Cold
resolves Dampness.
The main indications in the gynecological sphere
include stiffness of the back, lower backache extending
to the hypogastrium, amenorrhoea and blood in the
urine. The apparent contradiction in this point’s ability
to clear Heat and scatter Cold can be explained by the
choice between moxa and needles: with direct moxa
cones it scatters Cold, while with needle (reducing
method) it can clear Heat. For example, it can be used
in amenorrhoea from Cold, with direct moxa cones.
The main combinations mentioned in the classics include: with Du-16 Fengfu for weakness of the
legs; with Du-1 Changqiang, BL-28 Pangguangshu,
ST-30 Qichong, BL-31 Shangliao, BL-34 Xialiao and
G.B.-29 Juliao for sacral backache. This last combination is useful for sacral backache extending to the
184 Section 3: Methods of Treatment
hypogastrium during the periods. Finally, and intriguingly, the Great Compendium of Acupuncture (1601) combines
this point with BL-13 Feishu for stiffness of the back.14
DU-4 MINGMEN (Gate of Life)
The point is in between the two kidneys where the Motive
Force (Dong Qi) pulsates and where the placenta attaches
to the umbilical cord. It therefore determines our life or
‘destiny’ insofar as it influences our constitution from
conception. In fact, the Fire of the Gate of Life is of prenatal origin as explained in Chapter 2 on physiology.
The actions of this point are as follows. It:
•
•
•
•
•
warms and tonifies Kidney-Yang and the Gate of
Life
relaxes the sinews
stops convulsions
benefits the back
rescues the Yang (in Collapse of Yang).
The main indications in the gynecological sphere
include: leucorrhoea, frequent urination, infertility, forgetfulness (as in menopause) and threatened miscarriage.
The most important thing to note is that this point
tonifies Kidney-Yang and scatters Cold especially when
used with moxa cones: used in this way it is the closest acupuncture equivalent to using Rou Gui Cortex
Cinnamomi and Fu Zi Radix Aconiti lateralis preparata in
herbal medicine. In gynecology, it is therefore used for
a variety of problems such as leucorrhoea, amenorrhoea and dysmenorrhoea, provided they stem from a
deficiency of Kidney-Yang. It also has a strong mental–
emotional effect because when the Fire of the Gate of
Life is weak, the person feels depressed, exhausted and
lacks will-power. Since the Governing Vessel enters the
brain, this point also treats the forgetfulness that sometimes accompanies other menopausal symptoms.
An intriguing combination is this point needled with
a golden needle, together with BL-23 Shenshu with
moxa stick, for backache, frequent urination and a feeling of depression (literally ‘a suffering and exhausted
feeling of the Shen’) experienced if the patient wakes in
the middle of the night.15
Common combinations of Governing
and Directing Vessel points
The points of the Governing and Directing Vessels are
combined very frequently in gynecological problems.
I shall now discuss common combinations.
Du-19 Houding and Ren-15 Jiuwei These points
are used to calm the Mind. Du-19 calms the Mind and
extinguishes (Internal) Wind while Ren-15 calms the
Mind and nourishes the Heart; their combination has
a powerful calming effect. Ren-15 also relieves anxiety that manifests with a feeling of oppression in the
chest. I use this combination frequently to treat menopausal problems involving such feelings as anxiety,
insomnia and a feeling of oppression of the chest.
Du-20 Baihui and Ren-15 Jiuwei These points calm
the Mind and lift mood. Du-20 improves the mood and
lifts depression, Ren-15 calms the Mind, and their combination achieves both simultaneously. Excellent for
mental depression with anxiety, it is, again, frequently
used in menopausal problems.
Du-14 Dazhui and Ren-4 Guanyuan Both are used
with direct moxa cones, to tonify and warm Yang.
Du-14, with moxa, warms all the Yang channels and
the Bladder, while Ren-4, with moxa, tonifies and
warms Kidney-Yang which is the foundation for all
the Yang energies of the body. Thus this combination
tonifies the Bladder and Kidney-Yang and Yang-Qi in
general. I use it for amenorrhoea occurring against a
background of Kidney-Yang deficiency.
Du-16 Fengfu and Ren-24 Chengjiang This combination is used to treat occipital headache.16
Du-20 Baihui and Ren-12 Zhongwan These points
are used to tonify the Stomach and Spleen and to lift
mood. A good combination to lift depression occurring
against a background of deficiency of Stomach and
Spleen, I use it very frequently for gynecological problems stemming from Blood deficiency.
Du-24 Shenting and Ren-4 Guanyuan These
points nourish Kidney-Yin, strengthen the Original
Qi and so calm the Mind. This combination is suitable
for severe anxiety occurring against a background of
Kidney-Yin deficiency. It is particularly indicated for
anxiety as it roots Qi in the Lower Burner and draws it
downwards away from the head and the Heart where
it harasses the Mind. This combination is also used for
menopausal problems occurring against a background
of Kidney deficiency.
Yintang and Ren-4 Guanyuan These points are
used to calm the Mind and nourish the Kidneys: this
combination is similar to the previous one as it roots
Qi in the Lower Burner by nourishing the Kidneys and
strengthening the Original Qi. While the previous combination is better for anxiety and worrying, this one is
better for insomnia.
Treatment of the Extraordinary Vessels 185
Du-20 Baihui and Ren-4 Guanyuan These points
calm the Mind, nourish the Kidneys, strengthen the
Original Qi and lighten the mood. This combination
lifts the mood and relieves depression by nourishing
the Kidneys and strengthening the Original Qi. It is
suitable for depression and anxiety occurring against a
background of Kidney deficiency.
Du-20 Baihui and Ren-6 Qihai These points tonify
and raise Qi. Ren-6 tonifies Qi in general while Du-20
raises Qi: the combination of these two points is excellent to tonify and raise Qi in case of prolapse. However,
its use need not be confined to such conditions; it also
has a powerful mood-lifting effect in depression.
Du-20 Baihui and Ren-3 Zhongji These are used to
tonify and raise Qi and regulate the Bladder. This combination is excellent for frequency of urination without
burning, deriving from sinking of Qi of the Spleen and
Kidneys. It is very frequent in women, especially after
childbirth.
Case history
A 35-year-old woman had been trying to conceive for 4 years. Her periods were regular and
scanty with bright red blood. She suffered
from dull headaches during and after the periods and experienced floaters. She also suffered
from a ‘nagging’ lower abdominal pain, which
was eased by the application of a hot-water
bottle. She had been suffering from allergic
rhinitis since the age of 17, manifesting with
sneezing and a profuse runny nose with a
clear, watery discharge. She occasionally suffered from backache, dizziness, tinnitus and
palpitations. She always felt cold, particularly
her feet. Her tongue was of a normal colour
and Swollen. Her pulse was Weak on both Rear
positions and slightly Wiry on the left side.
Diagnosis From the point of view of patterns, this
patient suffered from Blood deficiency of the Liver
(scanty period, dull headaches with the period and
floaters) and Heart (palpitations), some stagnation
of Qi (abdominal pain, Wiry pulse) and KidneyYang deficiency (infertility, backache, dizziness, tinnitus, allergic rhinitis and Weak pulse on both Rear
positions). From the point of view of channels, the
Governing, Directing and Penetrating Vessels are
all involved. In fact, the allergic rhinitis is due to
a deficiency of the Governing Vessel (which flows
through the nose), the abdominal pain is due to
rebellious Qi in the Penetrating Vessel and the infertility and scanty periods are due to a deficiency of
the Directing Vessel.
GIRDLE VESSEL (DAI MAI)
As discussed in Chapter 3 on pathology, the Girdle Vessel
can be used in gynecology for irregular periods, dysmenorrhoea and leucorrhoea. Because of the Girdle Vessel’s
gynecological sphere of influence, some doctors say that
in terms of energy, it is part of the Directing Vessel.
The symptomatology of the Girdle Vessel in gynecology can be differentiated according to its deficiency or
excess condition. When it is deficient, the Girdle Vessel is
slack and does not restrain the Essence, Spleen-Qi sinks,
and Liver, Kidneys and the Directing and Penetrating
Vessels also become deficient.
When the Girdle Vessel is slack, Qi cannot rise, the
organs sag, the fetus may be miscarried, there are vaginal discharges and prolapses may occur. The treatment principle is to tonify Pre- and Post-Natal Qi, raise
the clear Qi and consolidate the Girdle Vessel.
In excess conditions, the ‘Girdle Vessel is not harmonized’, due to its being ‘tight’. The main symptomatology includes fullness of the abdomen, backache
radiating to the lower abdomen, a feeling of heaviness
of the body, coldness of the back, a feeling as if sitting
in water and a feeling of heaviness of the abdomen
as if carrying 5000 coins. In gynecology, the Girdle
Vessel is very useful for abdominal pain from Fullness,
Dampness in the genital system and dysmenorrhoea.
The opening and associated points of the Girdle
Vessel are G.B.-41 Zulinqi on the right and T.B.-5
Waiguan on the left, inserted in this order and withdrawn in the reverse order. These points are often combined with the beginning point of the Girdle Vessel,
G.B.-26 Daimai. While it is not necessary to apply any
particular manipulation to the opening and associated
points apart from obtaining a needling sensation, when
using G.B.-26 Daimai, it is preferable to obtain a needling sensation that propagates downwards towards
the lower abdomen and hypogastrium. Sometimes it
can also propagate towards the back.
I shall now discuss the actions and indications, in the
gynecological sphere, of all the points of the Girdle
186 Section 3: Methods of Treatment
Vessel, i.e. LIV-13 Zhangmen, G.B.-26 Daimai, G.B.-27
Wushu and G.B.-28 Weidao. As before, I shall include
indications that are not strictly speaking gynecological, such as urinary difficulty, but that are, nevertheless,
very frequently associated with gynecological problems.
LIV-13 Zhangmen (Movement Door
or Chapter Door)
Zhang indicates a movement in music (as in a ‘movement’ of a symphony) and, by extension, a chapter
in a book. The character, however, also implies something that is a whole but coming to its end (again, like
a movement in music). ‘Movement’ here alludes to the
nature of this point as the Gathering point of all the
Yin organs: thus the energy of all the Yin organs gathers here, as in a movement in music, and goes in and
out, hence the ‘door’. The character for ‘door’ in an
acupuncture point always implies a movement of Qi,
in this case a clear reference to the free flow of Liver-Qi,
on whose channel this point lies.
The actions of this point are as follows. It:
•
•
•
•
•
promotes the smooth flow of Liver-Qi
harmonizes Liver and Spleen
relieves retention of food
benefits the Stomach and Spleen
benefits the Gall Bladder.
The indications more relevant to gynecology include
abdominal pain and distension and a cold feeling in
the back. The main relevance of this point in gynecology is from its being on the Girdle Vessel. It can be used
when the Girdle Vessel is either Empty (too ‘slack’) or
Full (too ‘tight’). Since it harmonizes the Liver and
Spleen, moves Liver-Qi and gathers the energy of all
Yin organs, this point can be used, together with the
opening and associated points of the Girdle Vessel, in
pre-menstrual problems related to this vessel: the main
symptoms of this would be distension of the breasts
and hypochondrium and abdominal pain extending to
the loins. One of the indications of this point is also
colourless, turbid urine: it is useful in urinary conditions after childbirth from stagnation of Liver-Qi. An
indication for the use of the Girdle Vessel is a pulse that
is Tight or Wiry on both Middle positions.
G.B-26 Daimai (Girdle Vessel )
The name of this point, the starting point of the Girdle
Vessel, is self-evident.
The actions of this point are as follows. It:
•
•
•
•
regulates the menses
strengthens the Spleen
consolidates the Girdle Vessel
resolves Dampness.
In the gynecological field, the main indications for the
use of this point are irregular periods, red–white vaginal discharge, a feeling as if sitting in water, a feeling
as if carrying a bag of water around the waist, softness
of the lower back and abdomen, backache radiating to
the abdomen, hypogastric pain aggravated by anxiety
in women and weakness of the back.
This point is very frequently used in combination
with the opening and associated points of the Girdle
Vessel to resolve Dampness and move Qi in the Lower
Burner for such symptoms as excessive vaginal discharge, painful periods, a feeling of heaviness of the
abdomen and headaches at period time. For a patient
with the above symptoms stemming from Dampness
and Qi stagnation, an example of a combination of
points would be: G.B.-41 Zulinqi on the right, T.B.-5
Waiguan on the left (opening and associated points
of the Girdle Vessel), G.B.-26 Daimai (bilateral), P-6
Neiguan on the right and LIV-3 Taichong on the left,
inserted in this order (Fig. 7.12).
In this combination, the laterality of P-6 Neiguan
and LIV-3 Taichong balances that of the opening and
associated points of the Girdle Vessel. These two points
will pacify the Liver, move Qi, calm the Mind and settle
the Ethereal Soul. Furthermore, since they pertain to
Terminal Yin (Pericardium and Liver) and G.B.-41 and
T.B.-5 to Lesser Yang, these two pairs of points will harmonize Interior and Exterior.
A traditional combination for the point G.B.-26
Daimai is with Ren-4 Guanyuan, Ren-6 Qihai, SP-6
Sanyinjiao, BL-30 Baihuanshu and P-5 Jianshi for
red–white vaginal discharge.
G.B-27 Wushu (Five Pivots)
‘Wu’ means ‘five’ and, in Chinese numerology, this
number represents ‘change’ and occupies a central
place; thus, in this sense, here it means ‘central’. One
reason this point is the ‘central pivot’ is that it is at the
centre of four points: G.B.-25 Jingmen and G.B.-26
Daimai above, and G.B.-28 Weidao and G.B.-29 Juliao
below. Another reason is that it occupies a more or less
central position in the body at the intersection of a vertical (Gall Bladder) and horizontal channel (the Girdle
Treatment of the Extraordinary Vessels 187
The actions of this point are as follows. It:
•
•
•
•
G.B.-26
P-6
TB-5
regulates menstruation
consolidates the Girdle Vessel
promotes Water transformation
stops pain.
The main indications of this point in the gynecological field are hypogastric pain, prolapse of the vagina,
irregular periods, excessive vaginal discharge and
oedema.
This is an important point to resolve Dampness in the
Lower Burner and promote the transformation of fluids for such symptoms as oedema (of the lower part of
the body) or excessive vaginal discharge.
Case history
A 38-year-old woman had been suffering from
pre-menstrual tension for many years. She also
complained of a persistent vaginal discharge,
abdominal pain extending to the back and a
bearing-down feeling of the abdomen. Her
tongue was Swollen and had a thick, yellow
coating on the root. Her pulse was Weak.
LIV-3
G.B.-41
Figure 7.12 Combination of Girdle Vessel points.
Vessel). Yet another reason is that this point pertains
to the Lesser Yang, which is the ‘hinge’ of the Yang
channels.
The actions of G.B.-27 Wushu are as follows. It:
•
•
•
•
regulates menstruation
consolidates the Girdle Vessel
regulates Qi
stops pain.
The main indications of this point in the gynecological sphere include prolapse of the vagina, red–white
vaginal discharge, cord-like swellings and palpable
masses on the sides of the umbilicus, irregular periods
and hypogastric pain.
G.B-28 Weidao (Linking Path)
‘Linking path’ is an allusion to the Girdle Vessel’s linking of the leg channels it intersects.
This woman’s symptoms indicate a disharmony of the
Girdle Vessel with Dampness infusing downwards.
She was treated for several months during which I
used the Girdle Vessel several times. The following is
an example of a Girdle Vessel’s point combination:
• G.B.-41 Zulinqi on the right and T.B.-5 Waiguan
on the left to open the Girdle Vessel.
• G.B.-26 Daimai to strengthen and ‘tighten’ the
Girdle Vessel.
• ST-28 Shuidao and SP-9 Yinlingquan to resolve
Dampness from the Lower Burner.
Case history
A 45-year-old woman complained of excessive sticky, white vaginal discharge. However,
this was not the chief reason for her seeking
treatment: her main problem was a persistent
pain in the left groin which extended upwards
to the left abdomen and back. The pain was
dull and constant and was associated with a
slight urinary incontinence. On interrogation,
it transpired that she also experienced a feeling
188 Section 3: Methods of Treatment
of heaviness and a bearing-down sensation: in
her words, she felt as ‘if everything wants to
drop out’. Her pulse was very Weak on both
rear positions.
Diagnosis In terms of patterns, there is a clear
pattern of Dampness in the Lower Burner which
causes the bearing-down sensation, the feeling
of heaviness and the excessive vaginal discharge.
In terms of channels, the Girdle Vessel is diseased
by being too ‘slack’: this causes the sinking of Qi
resulting in vaginal discharge and the bearingdown sensation. The groin pain extending to the
lateral abdomen and back also strongly indicates
a pathology of the Girdle Vessel. The weakness
of the pulse on both Rear positions clearly indicates a deficiency of the Kidneys and the sinking
of Qi is related to this deficiency also. Furthermore,
the Girdle Vessel communicates with the Kidney’s
Divergent channel and a deficiency of the Kidneys
affects this vessel.
Treatment principle I used the following points:
• G.B.-41 Zulinqi on the right and T.B.-5 Waiguan
on the left to regulate the Girdle Vessel.
• G.B.-26 Daimai on the left to regulate the Girdle
Vessel and raise Qi.
• SP-12 Chongmen as a local point in the groin.
• KI-4 Dazhong on the left to tonify the Kidneys;
the Connecting point, it was chosen to affect
the Bladder channel in the back.
• Ren-6 Qihai, with 7 moxa cones, to tonify and
raise Qi.
After only one treatment there was already a
marked improvement and four treatments in
total were enough to eliminate her problems
completely.
YIN STEPPING VESSEL (YIN QIAO MAI)
The Yin Stepping Vessel is particularly used in gynecology for Excess patterns of the Lower Burner such
as abdominal masses, lumps, cysts, fibroids, difficult
delivery and retention of placenta. It is also useful to
resolve adhesions following gynecological operations
such as those for endometriosis or hysterectomy.
The opening and associated points of the Yin Stepping
Vessel are KI-6 Zhaohai (inserted on the right) and LU-7
Lieque (inserted on the left), in this order. If I use this
vessel to treat a unilateral pain, then I use the opening
and associated points unilaterally on the same side.
The Yin Stepping Vessel absorbs Excess of Yin and is
therefore mostly used in Full conditions characterized
by stagnation of Qi and/or Blood in the legs (medial
side) and abdomen. Please note that the Yin Stepping
Vessel is used specifically when the abdominal pain is
unilateral. A particular sign indicating the use of this
vessel is when the pulse is Tight or Wiry on both Rear
positions, indicating a stagnation in the Lower Burner.
In gynecology, this vessel is therefore used for dysmenorrhoea (especially when the pain is unilateral), abdominal masses, retention of placenta and
abdominal adhesions following operations such as a
hysterectomy.
Case history
A 41-year-old woman complained of primary
infertility, having tried to conceive for the previous 15 years. She also complained of a stabbing,
sharp abdominal pain in both sides of the groin
around mid-cycle. Her periods were regular and
scanty (they lasted 3 days), not painful and the
menstrual blood was of a normal red colour.
Her tongue was slightly Purple with teethmarks
and her pulse was Weak on the whole but also
slightly Wiry on both Rear positions.
This is a good example of a disharmony of the Yin
Stepping Vessel with slight stasis of Blood in the
Lower Burner, abdominal pain from stagnation and
infertility: the Wiry pulse on both Rear positions is
typical of a Yin Stepping Vessel pathology. Here infertility is caused not by a deficiency (although there is
some Spleen deficiency as evidenced by the Weak
pulse and tongue teethmarks) but by stagnation.
The principle of treatment adopted was to eliminate stasis of Blood and regulate the Yin Stepping
Vessel. I did not consider it necessary to tonify as
the deficiency was secondary to the stagnation.
This patient was treated for 3 months, at the end
of which she became pregnant. I continued treating her during the pregnancy and she delivered a
healthy baby 9 months later. Before she became
Treatment of the Extraordinary Vessels 189
pregnant I used the Yin Stepping Vessel each time
(but not after she became pregnant) and the following is an example of a point combination:
• KI-6 Zhaohai on the right and LU-7 Lieque on
the left to regulate the Yin Stepping Vessel.
• LIV-3 Taichong (bilateral) to move Blood and
eliminate stasis.
Case history
A 55-year-old woman complained of persistent
lower abdominal pain following two abdominal operations: the first for a hysterectomy
and the second for adhesions. Her tongue was
slightly Purple and her pulse was Slow and
Tight on both Rear positions.
I used the Yin Stepping Vessel in succession for 10
fortnightly treatments with very good results. The
points used were:
• KI-6 Zhaohai on the right and LU-7 Lieque on
the left to regulate the Yin Stepping Vessel.
• ST-27 Daju and ST-28 Shuidao to move Qi and
Blood in the abdomen.
YIN LINKING VESSEL (YIN WEI MAI)
The Yin Linking Vessel is excellent to nourish Blood and
calm the Mind in women. It affects the Heart and it can
therefore be used for amenorrhoea, delayed cycle or
scanty periods especially when associated with depression, anxiety and a feeling of tightness of the chest.
The opening and associated points of this vessel are
P-6 Neiguan (inserted on the right) and SP-4 Gongsun
(inserted on the left), in this order. I frequently associate these points to the beginning point of this vessel,
KI-9 Zhubin, needled bilaterally.
The actions of this point are as follows:
•
•
•
•
benefits the Kidneys
calms the Heart
regulates Qi
stops pain.
There are no gynecological indications for this point
apart from hypogastric pain. However, I do use this
point frequently in combination with the opening and
associated points of the Yin Linking Vessel to tonify the
Kidneys, nourish Blood and calm the Mind in women.
The calming effect of this point is also documented
from the old classics, which mention dian kuang (manicdepressive disorders) as one of its main indications.
Case history
A 35-year-old woman complained of tiredness,
insomnia, depression and slight anxiety. Her
symptoms started after the birth of her child 3
years previously. Her periods were regular and
scanty, lasting 3 days. She also complained of
dizziness and blurred vision. Her tongue was
Pale and her pulse was Choppy.
This is a clear example of Blood deficiency. I treated
the Yin Linking Vessel several times in succession
with good results. An example of a Yin Linking
Vessel point combination is:
• P-6 Neiguan on the right and SP-4 Gongsun on
the left to open the Yin Linking Vessel.
• KI-9 Zhubin, beginning point of this vessel, to
open the chest and calm the Mind.
GYNECOLOGICAL EXTRA POINTS
Some extra points on the lower abdomen and back have
an important action on gynecological problems. I shall
now discuss the most important ones.
Jingzhong (Centre of Menses)
KI-9 ZHUBIN (Building for the Guest)
The Kidney channel is the host building for the Yin
Linking Vessel which is the guest. KI-9 is the beginning
point and also the Accumulation point of the Yin Linking
Vessel. Another explanation of the name is that ‘bin’ with
a different radical also means ‘knee-cap’. This point has
this name, therefore, because it strengthens the knees.17
This point is situated three cun from Ren-6 Qihai. It is
specific for irregular periods.
Qimen (Door of Qi)
This point is situated three cun from Ren-4 Guanyuan.
It is particularly effective with moxibustion.
190 Section 3: Methods of Treatment
Qimen regulates the periods and promotes conception. It is used for infertility, threatened miscarriage
(with moxa), menorrhagia, cystitis, retention of urine,
Stone Painful Urination Syndrome and haemorrhaging after childbirth.
It nourishes the Essence and can be used for infertility and prolonged, chronic vaginal discharge.
Finally, two more points situated on the Bladder
channel should be mentioned in connection with
gynecology.
Zigongxue (Uterus Point)
BL-51 Huangmen (Door of Membranes)
This point is situated three cun from Ren-3 Zhongji.
It can be needled and moxa can be used.
Zigongxue regulates the periods, promotes fertility, regulates Qi and stops pain. It is used for infertility,
prolapse of the uterus, irregular periods, dysmenorrhoea and menorrhagia.
The name of this point is related to huang, the
‘membranes’, i.e. the connective tissue of superficial and deep fascia. The point is level with BL-22
Sanjiaoshu, Back-Transporting point of the Triple
Burner. The Qi of the Triple Burner is essential for
the proper movement and transportation of Qi in
all physiological processes and in the membranes,
hence the image of ‘door’ in the point’s name indicates the entering and exiting of the Qi of the Triple
Burner. From this point, the Qi of the Triple Burner
extends upwards to the diaphragm and chest, and
downwards to the point BL-52 Baohuang and
uterus and bladder.
The actions of this point are as follows. It:
Waisiman (Outside Siman)
This point is situated one cun lateral to KI-14 Siman.
It is used for irregular periods deriving from stagnation
of Qi and Blood.
Jueyun (Terminating Pregnancy)
This point is situated three-tenths of a cun below
Ren-5 Shimen. Using this point with needling is
supposed to make a woman infertile. It is obviously
forbidden in pregnancy. For the same reason, the
old texts recommended use of this point to induce
childbirth at full term, used with 7, or a multiple of
7, moxa cones.18
Baomen and Zihu (Door of Uterus
and Door of Baby)
These points are symmetrical and are situated two cun
lateral to Ren-4 Guanyuan, Baomen on the left and
Zihu on the right. Although they coincide with ST-28
Shuidao, for some reason they are sometimes also listed
as extra points.
They are used for infertility, threatened miscarriage
(with moxa cones), retention of placenta (the needle
is reinforced first and then reduced), cold leucorrhoea
(with 30 moxa cones), abdominal masses and difficult
childbirth.
Jinggong (Palace of the Essence)
This point is situated three cun lateral to the space
between the second and third lumbar vertebrae.
It coincides with the point BL-52 Zhishi.
•
•
•
•
regulates Qi
eliminates stagnation
clears Heat
dissolves swelling.
The main indications of BL-51 Huangmen in the
gynecological field are post-partum abdominal pain,
breast lumps and breast pain.
It is interesting that the action of this point extends
upwards to the breast and downwards to the abdomen
as the fascia extend continuously all over the abdomen
and chest. Also, the Triple Burner, to which this point
is related, extends its influence on the movement of Qi
all over the body.
BL-53 Baohuang (Bladder Membranes)
The name of this point is related to the previous one.
The membranes and the Qi of the Triple Burner extend
upwards to the chest and breast, and downwards to
the bladder, uterus and genitals. Thus, although this
point’s name is usually translated as relating to the
urinary bladder, bao also means ‘uterus’; this point
does indeed affect the lower abdomen, bladder, uterus
and genitals.
In gynecology, the two main indications are fullness
and hardness of the lower abdomen and swelling of
external genitalia.
Treatment of the Extraordinary Vessels 191
HERBAL TREATMENT OF THE
EXTRAORDINARY VESSELS
Although the Extraordinary Vessels obviously form
part of any acupuncture treatment strategy, some of
the old doctors did mention herbs and herbal formulae
affecting them and sometimes also referred to certain
foods beneficial to them. As a general principle, meat
tonifies the Extraordinary Vessels and, in particular,
the Governing, Directing and Penetrating vessels.
Two sayings in Chinese medicine state that ‘Blood and
meat nourish Yin’ and ‘Blood and flesh have qing’; qing
here can be translated as ‘feelings’. This means that,
as a food derived from animals, meat has certain qualities that vegetable foods lack: because meat has this
quality of ‘feelings’, it is closer in its nature to human
beings and it therefore nourishes the Extraordinary
Vessels and the reproductive system. Second, looking
at foods in the same way as herbs and analysing their
energy, meat is warm without being drying and tonifies without giving rise to Dampness: a warm, tonic
herb with such characteristics is rare indeed.
I shall list below the main herbs mentioned in connection with each Extraordinary Vessel. For the sake of
completeness I shall include the herbs for Extraordinary
Vessels whose treatment has not been discussed.
Governing Vessel
There are two categories of herbs affecting the
Governing Vessel, one influencing the spine, Marrow
and brain, the other influencing the Yang channels
governed by this vessel. In other words, the former category of herbs affects the Governing Vessel’s substance
itself, i.e. spine, Marrow and brain, while the latter
affects the Governing Vessel only as a channel and consists mostly of herbs that expel Wind.
Spine, Marrow and brain Lu Rong Cornu Cervi pantotrichum, Lu Jiao Cornu Cervi, Lu Jiao Shuang Cornu
Cervi degelatinatum, and the bone-marrow of beef and
goat. For reasons explained above, these ingredients
that affect the very substance of the Governing Vessel
are all of animal origin.19
Yang channels, especially Bladder and Gall
Bladder Fu Zi Radix Aconiti lateralis preparata, Rou
Gui Cortex Cinnamomi, Gan Jiang Rhizoma Zingiberis,
Chuan Jiao Pericarpium Zanthoxyli, Gui Zhi Ramulus
Cinnamomi, Xi Xin Herba Asari and Gao Ben Rhizoma
Ligustici.
These herbs are all hot in energy, in keeping with
the Governing Vessel’s Yang nature. Also, Fu Zi Radix
Aconiti lateralis preparata and Rou Gui Cortex Cinnamomi
warm the Fire of the Gate of Life (Ming Men) which of
course stems from the Governing Vessel. Another interesting observation is that the herbs Gui Zhi Ramulus
Cinnamomi, Xi Xin Herba Asari and Gao Ben Rhizoma
Ligustici all expel Wind-Cold and are indicated in the
treatment of the Greater Yang syndrome of invasion of
Wind-Cold: they are therefore the equivalent of using
Governing Vessel points such as Du-14 Dazhui or Du-16
Fengfu which expel external Wind. A further interesting observation is that these same Wind-expelling herbs
are also used to treat the manifestations of cold or allergic rhinitis (i.e. sneezing and a runny nose), because the
Governing Vessel flows through the nose.
Directing Vessel
The main herbs that nourish the Directing Vessel are:
Gui Ban Plastrum Testudinis, Bie Jia Carapax Trionycis,
E Jiao Colla Corii asini, Zi He Che Placenta Hominis,
Zhi Mu Rhizoma Anemarrhenae, Huang Bo Cortex
Phellodendri, Xuan Shen Radix Scrophulariae, Sheng Di
Huang Radix Rehmanniae and Gou Qi Zi Fructus Lycii.
If we analyse this list of herbs, three categories can
be discerned. The first four substances are animal products which nourish the Directing Vessel for the reasons
explained above. In particular, Gui Ban Plastrum
Testudinis is of prime importance in nourishing the
Directing (and also the Penetrating) Vessel. Sheng Di
Huang Radix Rehmanniae and Gou Qi Zi Fructus Lycii
form a second group of herbs which nourish Kidneyand Liver-Yin. The third group of herbs clears EmptyHeat and pathological Minister Fire from Kidney-Yin
deficiency, i.e. Zhi Mu Rhizoma Anemarrhenae,
Huang Bo Cortex Phellodendri and Xuan Shen Radix
Scrophulariae.
The formula that tonifies the Directing Vessel is Da Bu
Yin Wan Great Tonifying Yin Pill. Of the Three Treasures
formulae, Ease the Journey-Yin and Ease the JourneyYang nourish the Directing Vessel.
Penetrating Vessel
There are two categories of herbs that affect the
Penetrating vessel: the first category serves to strengthen
it, the second to subdue rebellious Qi. For the first category, see the listing given above for the Directing Vessel;
the main herb being Gui Ban Plastrum Testudinis. As to
192 Section 3: Methods of Treatment
the second, the herbs that subdue rebellious Qi in the
Penetrating Vessel are: Yan Hu Suo Rhizoma Corydalis,
Chuan Lian Zi Fructus Toosendan, Xiang Fu Rhizoma
Cyperi, Yu Jin Radix Curcumae, Chen Xiang Lignum
Aquilariae resinatum, Tao Ren Semen Persicae, Dang Gui
Radix Angelicae sinensis, Qing Pi Pericarpium Citri reticulatae viride, Wu Zhu Yu Fructus Evodiae, Cong Bai Bulbus
Allii fistulosi and Xiao Hui Xiang Fructus Foeniculi.
Girdle Vessel
Herbs that affect the Girdle Vessel include those that
infuse to the Lower Burner, consolidate and have an
astringent property. Some of the herbs (such as Sheng
Ma Rhizoma Cimicifugae) have an ascending movement
and may be used to treat pathological conditions of the
Girdle Vessel characterized by the ‘belt’ being too slack
and Qi sinking. The astringent quality of some of these
herbs would treat persistent vaginal discharges which
are a major symptom of this vessel.
Herbs that enter the Girdle Vessel include: Wu Wei
Zi Fructus Schisandrae, Shan Yao Rhizoma Dioscoreae,
Qian Shi Semen Euryales, Fu Pen Zi Fructus Rubi, Sang
Piao Xiao Ootheca Mantidis, Dang Gui Radix Angelicae
sinensis, Bai Shao Radix Paeoniae alba, Xu Duan Radix
Dipsaci, Long Gu Fossilia Ossis mastodi, Ai Ye Folium
Artemisiae argyi, Sheng Ma Rhizoma Cimicifugae and
Gan Cao Radix Glycyrrhizae.
In case of a Girdle Vessel disharmony with a prolapsed
uterus, one can use Liang Shou Tang Two Receiving
Decoction. This is because tonifying the Governing and
Directing Vessels to correct a prolapse is not enough, as
one must also tonify the ‘umbilical area’ by tightening
the Girdle Vessel.
For the same purpose, one can also use Bu Zhong Yi
Qi Tang Tonifying the Centre and Benefiting Qi Decoction
plus Ba Ji Tian Radix Morindae officinalis, Du Zhong
Cortex Eucommiae, Gou Ji Rhizoma Cibotii, Xu Duan
Radix Dipsaci and Wu Wei Zi Fructus Schisandrae to tonify the Extraordinary Vessels, consolidate the Girdle
Vessel and raise clear Qi.
The fetus depends on the Kidneys and the Directing
Vessel, but also on the Girdle Vessel. If the Girdle Vessel
is slack, Qi cannot rise, the fetus is not stabilized and the
mother may miscarry. In such a case, one should tonify
the Girdle Vessel with Shou Tai Wan Fetus Longevity Pill.
If there is a Girdle Vessel disharmony with Dampness
infusing down to the genital system, one can use Gan Jiang
Ling Zhu Tang Glycyrrhiza-Zingiberis-Poria-Atractylodes
Decoction which warms the Spleen, resolves Dampness,
opens the Girdle Vessel and strengthens the back.
For backache radiating to the abdomen, some doctors
use pungent herbs to scatter and sweet ones to moderate urgency such as Yan Hu Suo Rhizoma Corydalis,
Dang Gui Radix Angelicae sinensis, Sang Ji Sheng Herba
Taxilli, Gou Qi Zi Fructus Lycii and Xiao Hui Xiang
Fructus Foeniculi. Dang Gui enters both the Penetrating
and Girdle Vessels.
Dang Gui Shao Yao San Angelica-Paeonia Powder
treats the Girdle Vessel for such symptoms as abdominal pain, irregular periods, oedema and leucorrhoea.
It contains a high proportion of Bai Shao, which treats
abdominal pain from the Girdle Vessel disorder, and
Chuan Xiong, which moves Qi of the Penetrating
Vessel.
Yang Stepping Vessel
Herbs that enter the Yang Stepping Vessel include: Ma
Huang Herba Ephedrae, Fang Feng Radix Saposhnikoviae,
Cang Zhu Rhizoma Atractylodis, Zhi Gan Cao Radix
Glycyrrhizae preparata and Fang Ji Radix Stephaniae
tetandrae.
Yin Stepping Vessel
The herbs that affect this vessel are: Yan Hu Suo
Rhizoma Corydalis, Gua Lou Fructus Trichosanthis,
Ban Xia Rhizoma Pinelliae preparatum, Dan Nan Xing
Rhizoma Arisaematis preparatum , Zhi Mu Rhizoma
Anemarrhenae , Huang Bo Cortex Phellodendri,
Yuan Zhi Radix Polygalae, Suan Zao Ren Semen
Ziziphi spinosae and Shi Chang Pu Rhizoma Acori
tatarinowii.
Formulae that affect this vessel include Si Wu
Tang Four Substances Decoction and Ban Xia Tang
Pinellia Decoction (which is composed only of Ban
Xia Rhizoma Pinelliae preparatum and Shu Mi, husked
sorghum).
Yang and Yin Linking Vessels
Some herbs affect both the Yang and Yin Linking
Vessels. These include: Lu Jiao Shuang Cornu Cervi
degelatinatum, Xiao Hui Xiang Fructus Foeniculi,
Dang Gui Radix Angelicae sinensis, Gui Zhi Ramulus
Cinnamomi, Bai Shao Radix Paeoniae alba and Huang
Qi Radix Astragali.
Treatment of the Extraordinary Vessels 193
Yang Linking Vessel
Excess
Herbs that affect this vessel are those that harmonize Nutritive and Defensive Qi, i.e. Gui Zhi Ramulus
Cinnamomi, Bai Shao Radix Paeoniae alba and Huang Qi
Radix Astragali.
•
•
Yin Linking Vessel
The herbs that affect this vessel are Dang Gui
Radix Angelicae sinensis and Chuan Xiong Radix
Chuanxiong.
THE FOUR PATHOLOGIES OF THE
EXTRAORDINARY VESSELS AND
HERBAL TREATMENT
•
Rebellious or Sinking Qi
•
Disharmony of Yin and Yang.
Deficiency.
Excess.
Rebellious Qi or Sinking Qi.
Disharmony of Yin and Yang
This involves primarily the Yin and Yang Stepping Vessels
(Yin and Yang Qiao Mai) whose role it is to harmonize
the quantity of Yin and Yang and to absorb excesses of
either. A disharmony of Yin and Yang may arise when
“one tonifies, but it is not enough; one expels pathogenic factors, but there is still left over”. The formula to use is Ban
Xia Tang Pinellia Decoction mentioned above.
Upwards:
Penetrating Vessel (Kidney Empty-Heat signs):
Gui Ban Plastrum Testudinis, Huang Bo Cortex
Phellodendri and Zhi Mu Rhizoma Anemarrhenae
• Penetrating Vessel (Stomach-Qi rebellious): Ban
Xia Rhizoma Pinelliae preparatum.
Downwards (sinking Qi): Bu Zhong Yi Qi Tang
Tonifying the Centre and Benefiting Qi Decoction.
•
The herbs used for the Extraordinary Vessels can be
distinguished according to four pathologies:
1.
2.
3.
4.
Yang Linking Vessel (alternation of hot and cold
feeling): Xiao Chai Hu Tang Small Bupleurum
Decoction.
Yin Linking Vessel (chest discomfort):
• Kidneys: Jin Ling Zi Wan Melia Pill
• Liver: Shi Xiao San Breaking into a Smile Powder
• Spleen: Cheng Qi Tang Conducting Qi Decoction.
Governing/Directing/Penetrating Vessels (Kidney
Empty-Heat): Huang Bo Cortex Phellodendri and Zhi
Mu Rhizoma Anemarrhenae.
•
FORMULAE FOR THE DIRECTING
AND PENETRATING VESSELS
Various formulae can be used for different patterns of
the Directing and Penetrating Vessels. All these are
very common in gynecology.
Directing and Penetrating
Vessels Empty
Deficiency
Diseases
•
Delayed periods,
infertility.
•
•
Yang Linking Vessel (alternation of hot and cold
feeling): Huang Qi Jian Zhong Tang Astragalus
Strengthening the Centre Decoction.
Yin Linking Vessel (chest discomfort):
• Kidneys deficiency: Si Ni Tang Four Rebellious
Decoction
• Liver deficiency: Dang Gui Si Ni Tang Angelica
Four Rebellious Decoction
• Spleen deficiency: Li Zhong Tang Regulating the
Centre Decoction.
Governing Vessel: meat (it warms without drying
and tonifies without giving rise to Dampness).
scanty
periods,
amenorrhoea,
Clinical manifestations
Backache, tiredness, depression, dizziness, lower abdomen feels soft on palpation.
Treatment principle
Tonify the Liver and Kidneys, nourish the Directing
and Penetrating Vessels.
194 Section 3: Methods of Treatment
Herbal treatment
Clinical manifestations
– Da Bu Yuan Jian Great Tonifying the Original [Qi]
Decoction.
– Gui Shen Wan Restoring the Kidneys Pill.
– Shou Tai Wan Fetus Longevity Pill.
Abdominal pain that is better with massage and with
application of heat, scanty periods with pale and dilute
blood, cold limbs, Pale and wet tongue.
Treatment principle
Directing and Penetrating Vessels
unstable
This consists not only in a deficiency of these two vessels but also in a state of instability: for this reason, a
deficiency of these vessels may lead to delayed periods,
amenorrhoea or infertility, whereas when the Directing
and Penetrating Vessels are ‘unstable’, in addition to
being deficient, the opposite occurs, i.e. excessive bleeding or bleeding at the wrong time.
Diseases
Early periods, heavy periods, bleeding between periods,
Flooding and Trickling, chronic vaginal discharge, miscarriage, persistent lochial discharge after childbirth.
Tonify Kidney-Yang, expel Cold, warm the Centre and
the Uterus.
Herbal treatment
– Wen Jing Tang Warming the Menses Decoction.
– Dang Gui Jian Zhong Tang Angelica Strengthening the
Centre Decoction.
Full Cold in the Directing and
Penetrating Vessels
Diseases
Late periods with abdominal pain, infertility, abdominal pain after childbirth.
Clinical manifestations
Pallor, tiredness, bearing-down feeling, depression,
backache, feeling cold, frequent urination, Pale tongue.
Treatment principle
Tonify and raise Qi, strengthen the Spleen, tonify the
Kidneys, consolidate the Directing and Penetrating Vessels.
Herbal treatment
– Gu Chong Tang Consolidating the Penetrating Vessel
Decoction.
– An Chong Tang Calming the Penetrating Vessel
Decoction.
– Yi Qi Gu Chong Tang Benefiting Qi and Consolidating
the Penetrating Vessel Decoction.
Clinical manifestations
Pale complexion, abdominal pain that is worse with
pressure and better with the application of heat, scanty
periods with red blood but with dark, small clots, cold
limbs, thick, white tongue coating.
Treatment principle
Warm the Uterus, expel Cold, resolve Dampness, invigorate Blood, stop pain.
Herbal treatment
– Shao Fu Zhu Yu Tang Lower Abdomen Eliminating
Stasis Decoction.
– Wen Jing Tang Warming the Menses Decoction.
Directing and Penetrating Vessels
deficient and Cold
Empty-Heat in the Directing
and Penetrating Vessels
Diseases
Diseases
Irregular periods, abdominal pain, amenorrhoea,
infertility, abdominal pain after childbirth.
Early periods, long periods, Flooding and Trickling,
heavy periods.
Treatment of the Extraordinary Vessels 195
Clinical manifestations
Clinical manifestations
Heavy periods, malar flush, feeling of heat in the
evening, night sweating, five-palm heat, Red tongue
without coating.
White or yellow, sticky vaginal discharge, abdominal
pain, burning on urination, cloudy urine, loose stools
with mucus, yellow, sticky tongue coating.
Treatment principle
Clear Empty-Heat, nourish Yin, consolidate the
Directing and Penetrating Vessels.
Treatment principle
Clear Heat, drain Dampness, consolidate the Directing
and Penetrating Vessels.
Herbal treatment
– Liang Di Tang Two ‘Di’ Decoction.
– Yi Yin Jian One Yin Decoction.
Full-Heat in the Directing
and Penetrating Vessels
Diseases
Herbal treatment
– Long Dan Xie Gan Tang Gentiana Draining the Liver
Decoction.
Stagnant Heat in the Directing and
Penetrating Vessels
Early periods, heavy periods, Flooding and Trickling,
epistaxis during periods, persistent lochial discharge
after childbirth, fever after childbirth.
This is Heat deriving from long-term stagnation of Qi.
Clinical manifestations
Early periods, heavy periods, pre-menstrual syndrome.
Heavy periods with bright red or dark red blood, red
face, feeling of heat, mental restlessness, agitation,
thirst, Red tongue with yellow coating.
Clinical manifestations
Treatment principle
Drain Heat, cool Blood.
Herbal treatment
– Qing Jing San Clearing the Menses Powder.
– Bao Yin Jian Protecting the Yin Decoction.
– Qing Re Gu Jing Tang Clearing Heat and Consolidating
the Menses Decoction.
– Qing Gan Yin Jing Tang Clearing the Liver and Guiding
the Period Decoction.
– Jie Du Huo Xue Tang Expelling Toxin and Invigorating
Blood Decoction.
Damp-Heat in the Directing
and Penetrating Vessels
Diseases
Early periods, heavy periods with bright red blood,
abdominal pain and distension, breast distension,
irritability, Red sides of the tongue.
Treatment principle
Pacify the Liver, clear Heat, move Qi, eliminate stagnation, consolidate the Penetrating Vessel.
Herbal treatment
– Dan Zhi Xiao Yao San Moutan-Gardenia Free and
Easy Wanderer Powder.
– Hua Gan Jian Transforming the Liver Decoction.
Dampness and stasis of Blood in the
Directing and Penetrating Vessels
Diseases
Diseases
Excessive vaginal discharge, abdominal pain that is
worse with pressure, heavy periods, mid-cycle bleeding, long periods.
Irregular periods, painful periods, Flooding and
Trickling, excessive vaginal discharge, abdominal
masses, infertility.
196 Section 3: Methods of Treatment
Clinical manifestations
Abdominal pain of a stabbing nature with fixed location, painful periods with dark blood and clots, Purple
tongue.
Treatment principle
Invigorate Blood, eliminate stasis, drain Dampness,
regulate the Directing and Penetrating Vessels.
Herbal treatment
– Tao Hong Si Wu Tang Persica-Carthamus Four
Substances Decoction.
– Shao Fu Zhu Yu Tang Lower Abdomen Eliminating
Stasis Decoction.
– Qing Re Tiao Xue Tang Clearing Heat and Regulating
Blood Decoction.
– Cang Fu Dao Tan Tang Atractylodes-Cyperus
Conducting Phlegm Pill.
END NOTES
1. Heilongjiang Province National Medical Research Group 1984 An
Explanation of the Great Compendium of Acupuncture (Zhen Jiu Da
Cheng Jiao Shi
), People’s Health Publishing House,
Beijing, p. 643. The Great Compendium of Acupuncture itself was published in 1601.
2. Ibid., pp 641–664, pp 984–992.
3. Ibid., p. 650.
4. Acupuncture Group of the Tianjin College of Traditional Chinese
Medicine 1986 Experience in the Treatment of Depression with the
Crossing Points of the Extraordinary Vessels, Journal of Chinese
Medicine (Zhong Yi Za Zhi
) 27(4): 50.
5. Wang Luo Zhen 1985 A Compilation of the Study of the Eight
Extraordinary Vessels (Qi Jing Ba Mai Kao Jiao Zhu
),
Shanghai Science Publishing House, Shanghai, pp 109–113. The
Study of the Eight Extraordinary Vessels (Qi Jing Ba Mai Kao) by Li Shi
Zhen was published in 1578.
6. Yang Jia San 1988 Great Dictionary of Chinese Acupuncture
(Zhong Guo Zhen Jiu Da Ci Dian
), Beijing Physical
Training College Publishing House, Beijing, p. 243.
7. Ibid., p. 256.
8. Yang Jia San 1989 Acupuncture (Zhen Jiu Xue
), People’s
Health Publishing House, Beijing, p. 361.
9. Clavey proposes a different interpretation of the Classic of Difficulties
passage describing the Triple Burner as the ‘envoy’ (shi) of the
Original Qi. He proposes that the real meaning is “the Triple Burner
makes the Original Qi separate into its different uses around the body”.
See Clavey S 1995 Fluid Physiology and Pathology in Traditional
Chinese Medicine, Churchill Livingstone, Melbourne, p. 21.
10. Great Dictionary of Chinese Acupuncture, p. 418.
11. Ibid., p. 739.
12. Ibid., p. 739.
13. Ibid., p. 14.
14. An Explanation of the Great Compendium of Acupuncture, p. 984.
15. Acupuncture, p. 381.
16. Wang Guo Rui 1329 The Jade Dragon Classic of Spiritual
Acupuncture from Bian Que (Bian Que Shen Ling Zhen Jiu Yu Long
Jing) cited in Chen You Bang 1990 Chinese Acupuncture Therapy
(Zhong Guo Zhen Jiu Zhi Liao Xue
), China
Scientific Publishing House, Beijing, p. 216.
17. Acupuncture, p. 355.
18. Great Dictionary of Chinese Acupuncture, p. 766.
19. Obviously, the spine, marrow and brain of beef should not be eaten
in countries where herds are affected by bovine spongiform encephalopathy (BSE).
SECTION 4
MENSTRUAL IRREGULARITIES
8. EARLY PERIODS 201
9. LATE PERIODS 211
10. IRREGULAR PERIODS 225
11. HEAVY PERIODS 231
12. SCANTY PERIODS 239
13. LONG PERIODS 249
14. PAINFUL PERIODS 255
15. BLEEDING BETWEEN PERIODS 285
16. NO PERIODS 295
17. FLOODING AND TRICKLING 319
18. PRE-MENSTRUAL SYNDROME 357
Menstrual irregularities may involve many different
aspects of menstruation, such as the regularity of the
cycle, duration of the period, amount of bleeding and
pain, or the absence of menstruation altogether.
Irregularities of the cycle include:
•
•
•
•
•
Early Periods (the periods come consistently early).
Late Periods (the periods come consistently late).
Irregular Periods (the periods come sometimes early
and sometimes late).
Bleeding between Periods.
Early or Late Menopause.
Irregularities in the duration of the period itself
include Long Periods (a short period would be classified as Scanty Period). A period is defined as long when
it lasts well over 5 days but the bleeding itself is not
heavy.
Irregularities in the amount of bleeding include:
•
Heavy Periods (the bleeding is heavy but contained
within normal period time).
•
•
Scanty Periods (the bleeding is scanty, either in
duration or in amount).
Flooding and Trickling (menorrhagia or metrorrhagia).
The last category of disease is somewhat different
from the others because it encompasses irregularities
in cycle, duration and amount all at the same time.
In fact, Flooding and Trickling refers to two separate
symptoms called beng lou (
) in Chinese. Beng means
‘flooding’ and it indicates a period that starts suddenly,
is extremely heavy and may come early or last more
than 5 days. Lou means ‘leaking’ or ‘trickling’ and it
indicates a period that may last well beyond the 5 days,
sometimes up to 2 weeks, with a trickle rather than a
flood of blood.
Irregularities in pain include Painful Periods. Absence
of menstruation is called amenorrhoea (which I shall
refer to as No Periods, see Ch. 16).
Figure S4.1 represents some of the menstrual
irregularities graphically.
AETIOLOGY AND DIAGNOSIS
The aetiology of menstrual irregularities includes all
the usual factors such as overwork, emotional stress,
excessive physical work, exposure to cold, too many
children too close together, hereditary Kidney weakness, surgery, etc.
The diagnosis of menstrual irregularities must be
based on a careful analysis of the cycle, amount of
bleeding, colour and density of blood, clots and smell
(see Ch. 5). Of course, it is extremely important to consider factors such as the use of the contraceptive pill or
intra-uterine device which alter the manifestations of
the period substantially.
The differentiation must be based on a careful discrimination of Empty, Full, Cold or Heat conditions.
23 24 25 26
Normal period
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 24 25
Early period
26
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
26
27
28
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
16
17
18
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20
21
22
23 24 25 26
Heavy period
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 24 25 26
Scanty period
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 24 25
Long period
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 24 25 26 27 28
Bleeding between periods
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23 24 25 26
Flooding (BENG)
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
22
23 24 25 26
Trickle (LOU)
27
28
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2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
24
25
Late period
26
Normal amount
Scanty period
Heavy period
Flooding (BENG)
Figure S4.1 Menstrual irregularities.
PRINCIPLES OF TREATMENT
The main principle of treatment, to be used in conjunction with other ones as appropriate, is to ‘regulate
the periods’. In a broad sense, this involves regulating
Yin and Yang and Qi and Blood. In fact, ultimately all
menstrual irregularities can be attributed to a disharmony of Yin and Yang. One could say that when Yang
is in excess, the periods come early (and are usually
heavy) and when Yin is in excess, the periods come late
(and are usually scanty).1 Yin and Yang in the human
body ultimately have their basis in the Original Yang
and Original Yin which reside in the Kidney: hence the
importance of tonifying the Kidneys to regulate the
periods. Harmonizing Qi and Blood, on the other hand,
involves treating the Liver, Spleen, Stomach and Heart.
In a narrow sense, ‘regulating the periods’ encompasses various methods of treatment and primarily:
•
•
harmonizing Qi and Blood
tonifying the Kidneys
•
•
strengthening the Spleen
harmonizing the Liver.
The Complete Works of Jing Yue by Zhang Jing Yue
(1624) says: “To regulate the periods, one must tonify the
Spleen and Kidneys in order to nourish Blood and nourish
the Kidneys in order to calm Blood.”2
From an acupuncture perspective, ‘regulating the
periods’ nearly always involves using the Directing
Vessel (Ren Mai) with LU-7 Lieque on the right and
KI-6 Zhaohai on the left, usually together with Ren-4
Guanyuan.
If the periods are painful, then the Penetrating Vessel
(Chong Mai) is more indicated with SP-4 Gongsun on
the right with P-6 Neiguan on the left, often together
with KI-14 Siman.
Harmonizing Qi and Blood
When harmonizing Qi and Blood, one must distinguish
clearly whether the predominant pathology is of Qi or
of Blood: in the former case, one must regulate Qi, in
the latter, one must invigorate and harmonize Blood.
As a general principle, if the period comes early, one
must regulate Qi first and then regulate Blood; if the
period comes late, one must first of all tonify.
Harmonizing Blood
‘Harmonizing Blood’ generally includes nourishing
and invigorating Blood at the same time. The formula
Si Wu Tang Four Substances Decoction is a prime example of this method of treatment, and for this reason
various modifications of it are incorporated in many
gynecological prescriptions. In fact, Shu Di Huang
Radix Rehmanniae preparata both nourishes Blood and
tonifies the Kidneys; Bai Shao Radix Paeoniae alba both
nourishes Blood and pacifies the Liver; Dang Gui Radix
Angelicae sinensis nourishes Blood and it also moderately invigorates Blood; and Chuan Xiong Rhizoma
Chuanxiong invigorates Blood. Thus, this formula
achieves all the three above methods of treatment, i.e.
harmonizing Blood, tonifying the Kidneys and harmonizing the Liver: this explains its paramount importance in gynecology. There are several variations of
Si Wu Tang, but the main two are one where Sheng
Di Huang Radix Rehmanniae is substituted for Shu Di
Huang, and one where Chi Shao Radix Paeoniae rubra is
substituted for Bai Shao. The former substitution renders the formula suitable to nourish Yin and cool Blood;
the latter enhances the Blood-invigorating power of
the formula.
Tonifying the Kidneys
Tonifying the Kidneys is essential in menstrual irregularities because they are the origin of the Heavenly Gui
that produces menstrual blood. The Kidneys are therefore responsible not only for menarche and menopause
but also, together with the Liver, for the regularity of the
periods and fertility. Their importance in gynecology
derives also from the fact that they are the origin and
foundation of both Water and Fire (in the form of physiological Minister Fire). As we have seen in Chapter 2 on
physiology, the physiological Minister Fire is a ‘formless’
Fire that actually generates Water: Fire and Water are
therefore inseparable and nourish each other. In fact, it
is through the agency of Minister Fire that the ‘periods
Water’ (Jing shui) turns into menstrual Blood.
Strengthening the Spleen
Strengthening the Spleen is also important because the
Spleen is the post-natal source of Blood and it helps the
Liver in storing Blood. Thus, when Blood is deficient in
gynecology, one usually needs to tonify both Liver and
Spleen. Another aspect of the Spleen’s functions that
affects gynecological problems is sinking of Spleen-Qi:
this can cause not only prolapses but also excessive
bleeding or Flooding and Trickling. Thus, strengthening Spleen-Qi includes raising Spleen-Qi.
Harmonizing the Liver
Harmonizing the Liver includes nourishing LiverBlood, moving Liver-Qi and pacifying the Liver. These
functions are closely linked as they correspond to the
Yin and Yang aspects of the Liver, Liver-Blood being
Yin and Liver-Qi being Yang. Regulating these two
aspects is crucial if menstruation is to occur regularly. Whenever an irregularity of the cycle occurs, no
matter what other pathogenic factor may be present,
there is usually an underlying Liver disharmony. This
happens because although the Kidneys are the origin of menstrual Water and of the Heavenly Gui, and
are therefore responsible for menarche and menopause, once the periods have started during puberty
the Liver then ‘takes over’ and brings on the periods
every month. In fact, the Liver stores Blood and provides it to the Directing and Penetrating Vessels for
the periods to occur every month. It is for this reason
that Dang Gui Radix Angelicae sinensis, which nourishes Blood and enters the Liver, is such an important
herb in gynecology. On the other hand, Liver-Qi is also
crucial for the period to occur regularly because in the
pre-menstrual phase it is its free flow that moves Blood
and brings on the period. Bearing in mind the above
principles of treatment, it is easy to see why the formula Xiao Yao San Free and Easy Wanderer Powder is
so important in gynecology: in fact, it nourishes LiverBlood, pacifies the Liver, moves Liver-Qi and strengthens the Spleen.
The Directing and Penetrating Vessels (Ren and
Chong Mai) are crucial for a regular menstruation to
occur as they regulate the Uterus and menstrual blood.
In fact, when the Directing Vessel is open and the
Penetrating Vessel flourishing, the periods occur at the
right time. However, these two vessels are closely linked
to the Kidneys and Liver and therefore by tonifying the
Kidneys, harmonizing Qi and Blood and harmonizing
the Liver we indirectly also regulate the Directing and
Penetrating Vessels.
Important as it is that women’s periods be regulated,
this should not take precedence over the treatment of
other diseases; in fact, if another disease is present, this
should be treated first. For example, if a woman suffers
from a chronic infection due to a residual pathogenic
factor, this should be treated before regulating the periods. Other examples of conditions requiring prior treatment are diabetes, a consumption disease (lao), asthma,
etc. Also, in some cases, a menstrual irregularity may
be the symptom of a systemic disease such as a platelet
deficiency causing heavy periods, or tuberculosis causing scanty periods, or anorexia causing amenorrhoea.
When considering herbs to include in a prescription
for gynecological problems, one must take care not to
injure the Kidneys, Spleen or Liver. Thus, when tonifying
the Kidneys, one must exercise caution and not use too
many tonics that may damage the Spleen. When tonifying the Spleen, one must not use too drying substances
that may injure the Kidneys. When harmonizing Qi and
pacifying the Liver, one must not use too many hot, pungent herbs that may injure Kidney-Yin and Liver-Yin.
From the acupuncture point of view, ‘regulating the
periods’ is best achieved by using the opening points of the
Directing Vessel and a point on this vessel in the lower abdomen. Thus, to regulate the periods, I often use LU-7 Lieque
(on the right) and KI-6 Zhaohai (on the left) together with
Ren-4 Guanyuan: this last point is very effective when
direct moxa cones are applied (unless there is Yin deficiency). If there is a pronounced Kidney deficiency, KI-13
Qixue can be added: this point will also strengthen the
Penetrating Vessel which is the Sea of Blood.
If the periods are painful, I choose the Penetrating
Vessel instead, needling the points SP-4 Gongsun (on
the right) and P-6 Neiguan (on the left), together with
Ren-4 Guanyuan, ST-29 Guilai and KI-14 Siman.
To harmonize Blood, I use ST-36 Zusanli and SP-6
Sanyinjao with reinforcing method to nourish Blood
and LIV-3 Taichong or LIV-8 Ququan with even method
to invigorate Blood and pacify the Liver. ST-36 and SP-6
will automatically also tonify the Spleen.
END NOTES
1. Nanjing College of Traditional Chinese Medicine 1979 Gynaecology
in Chinese Medicine (Zhong Yi Fu Ke Xue
), Nanjing
College of Traditional Chinese Medicine, Nanjing, p. 28.
2. Cited in Luo Yuan Kai 1986 Gynaecology in Chinese Medicine (Zhong
Yi Fu Ke Xue
), Shanghai Science and Technology
Press, Shanghai, p. 36.
CHAPTER 8
EARLY PERIODS
AETIOLOGY 201
PATHOLOGY 202
IDENTIFICATION OF PATTERNS AND TREATMENT 202
QI DEFICIENCY 202
Spleen-Qi deficiency 202
Kidney-Qi not firm 204
Overwork, menopausal decline
of Kidney-Qi
Overwork often causes Kidney-Yin deficiency; because
the deficient Kidney cannot sustain and consolidate
the Directing and Penetrating Vessels (Ren and Chong
Mai), blood leaks out and the period occurs before time.
This is also an Empty type of bleeding and is due to
Kidney-Qi not holding blood.
BLOOD-HEAT 205
Full-Heat: Liver Blood-Heat 205
Full-Heat: stagnant Liver-Qi turning into Fire with
Blood-Heat 206
Full-Heat: Heart-Fire 207
Liver- and Kidney-Yin deficiency with Empty-Heat 208
PROGNOSIS AND PREVENTION 209
Early Periods are defined as periods that come consistently up to 9 days early so that the cycle is less than 28
days long; the definition applies if this happens more
than twice in succession. The amount of bleeding may
be normal, scanty or excessive.
AETIOLOGY
Excessive physical work, irregular diet
Excessive physical work or a diet lacking in nourishment weaken the Spleen; when Spleen-Qi is deficient,
it may fail to hold blood in the vessels and this may leak
out giving rise to a period before the right time. This is
an Empty type of bleeding.
Irregular diet, invasion of external Heat
Excessive consumption of hot, spicy foods and alcohol may lead to Blood-Heat which affects the Directing
and Penetrating Vessels. The blood in these vessels is
agitated, it overflows from the vessels and the period
comes before the right time. This may also occur when
external Heat penetrates the Interior and enters the
Blood portion. This is a Full type of bleeding.
Emotional stress
Emotional stress deriving from anger, repressed anger,
resentment, frustration or guilt results in stagnation of
Liver-Qi and, over time, this may lead to Liver-Fire. Fire
may invade the Blood portion (especially since the Liver
stores Blood) and cause Blood-Heat. Hot Blood pushes
out of the vessels and the period occurs before the right
time. This is also a Full type of bleeding.
The periods may come early also when emotional
stress affects the Heart and the Mind. As we have seen,
the descending of Heart-Qi to the Uterus induces the
start of menstrual bleeding. If the Mind is affected by
emotional stress, it may induce Heart-Qi to descend prematurely. This may happen in case of shock, fear, worry
and guilt.
202 Section 4: Menstrual Irregularities
Chronic illness, overwork, too many
children, chronic bleeding
A long, chronic illness, overwork or having too many
children too close together may cause Liver- and
Kidney-Yin deficiency which eventually creates EmptyHeat. This enters the Blood portion and causes BloodHeat so that the blood pushes out of the vessels and
the period comes before time. This is a mixed Full and
Empty type of bleeding: Full because of the EmptyHeat, Empty because it derives from Yin deficiency. This
situation may also arise from chronic bleeding itself.
For example, a woman may suffer from excessive bleeding from Qi deficiency; after many years, the excessive loss of Blood may lead to Yin deficiency and this to
Empty-Heat. Empty-Heat makes the Blood reckless and
causes the period to come early.
the four phases of the menstrual cycle. For example, in
cases of Qi deficiency, treatment could be given only
during and after the period (first and second phases);
in cases of Full-Heat, it could be administered before
and during the period (fourth and first phases); and in
cases of Empty-Heat, it could be given during and at
mid-cycle (first and third phases).
The patterns discussed are:
•
Qi deficiency:
Spleen-Qi deficiency
Kidney-Qi not firm.
Blood-Heat:
• Full-Heat: Liver Blood-Heat; Stagnant Liver-Qi
turning into Fire with Blood-Heat; Heart-Fire.
• Empty-Heat: Liver- and Kidney-Yin deficiency
with Empty-Heat.
•
•
•
IDENTIFICATION OF PATTERNS
AND TREATMENT
PATHOLOGY
Thus, the pathology of this condition falls into two
broad groups, the first from Qi deficiency, the second
from Blood-Heat. Within the first group is Spleen-Qi or
Kidney-Qi deficiency; within the second group, FullHeat or Empty-Heat (see Fig. 8.1). Deficient Qi (whether
Spleen- or Kidney-Qi) fails to hold blood in the vessels.
Blood-Heat (whether deriving from Full- or EmptyHeat) pushes the blood out of the vessels.
The aetiological factors under the first two situations
given above lead to deficient Spleen-Qi and Kidney-Qi,
respectively, not holding blood. The aetiological factors
under the next two situations lead to Full-Heat and
those under the last situation lead to Empty-Heat.
The pattern of Empty-Heat is more likely to occur in
older women. The treatment can be given according to
All the herbal prescriptions in the following chapters
are detailed in Appendix 1 on p. 937.
QI DEFICIENCY
Spleen-Qi deficiency
Clinical manifestations
Early period, pale and dilute menstrual blood, loose stools,
epigastric distension, tiredness. Tongue: Pale. Pulse: Weak.
Treatment principle
Strengthen the Spleen, tonify and raise Qi, consolidate
the Penetrating Vessel, contain blood.
Acupuncture
Spleen
Qi
deficiency
Kidneys
Early
periods
Heat
Full-Heat
BloodHeat
Empty-Heat
Figure 8.1 Pathology of early periods.
Liver-Qi stagnant
turning into Fire
ST-36 Zusanli, SP-6 Sanyinjao, Ren-12 Zhongwan,
BL-20 Pishu, Du-20 Baihui, Ren-4 Guanyuan, Ren-6
Qihai. All with reinforcing method, moxa is applicable.
Explanation
– ST-36, SP-6, Ren-12 and BL-20 strengthen the
Spleen and tonify Qi.
– Du-20 raises Qi.
– Ren-4 tonifies the Uterus and consolidates the
Directing and Penetrating Vessels.
– Ren-6 tonifies and raises Qi.
Early Periods 203
Herbal treatment
a. Prescription
– GUI PI TANG
– Tonifying the Spleen Decoction
Explanation This famous prescription is widely used
to stop bleeding from Qi deficiency. This is because it
tonifies Qi and it enters the Blood portion.
– Huang Qi, Ren Shen and Bai Zhu tonify and raise Qi.
– Dang Gui nourishes Blood and enters the Blood
portion.
– Fu Shen, Suan Zao Ren, Long Yan Rou and Yuan Zhi
calm the Mind.
– Mu Xiang moves Qi and is added to counteract and
balance the cloying nature of Qi and Blood tonics.
– Zhi Gan Cao, Sheng Jiang and Hong Zao harmonize.
Hong Zao also nourishes Blood.
Comparison of Gui Pi Tang, Ju Yuan Jian and Bu
Zhong Yi Qi Tang To compare and contrast these
three formulae, Gui Pi Tang is particularly suitable if
the patient also suffers from anxiety and palpitation
deriving from emotional problems. The second formula,
Ju Yuan Jian, is very similar to the third, Bu Zhong Yi Qi
Tang, but it is more astringent than the latter and it is
therefore suitable if the period, besides being early, is
also heavy. Bu Zhong Yi Qi Tang, on the other hand, is
better if the patient suffers from depression.
Modifications These modifications apply to all three
prescriptions.
•
•
•
b. Prescription
– JU YUAN JIAN Variation
– Raising the Original [Qi] Decoction Variation
Explanation The original formula, composed of the
first five herbs, tonifies and raises Qi to stop bleeding.
–
–
–
–
Ren Shen, Huang Qi and Bai Zhu tonify and raise Qi.
Zhi Gan Cao harmonizes and also tonifies Qi.
Sheng Ma, in combination with Huang Qi, raises Qi.
E Jiao is added to the original formula to enter the
Blood portion so as to affect the periods.
– Hai Piao Xiao (also called Wu Zei Gu) is astringent
and absorbing, thus helping to prevent bleeding
before the period.
c. Prescription
– BU ZHONG YI QI TANG
– Tonifying the Centre and Benefiting Qi Decoction
Explanation This well-known formula tonifies and
raises Qi. It is suitable to treat Early Periods because it
contains Dang Gui which enters the Blood portion.
– Huang Qi, Ren Shen and Bai Zhu tonify and raise Qi.
– Dang Gui nourishes Blood and enters the Blood
portion.
– Chen Pi resolves Dampness: it is added to counteract
and balance the cloying nature of Qi and Blood tonics.
– Sheng Ma and Chai Hu, in combination with Huang
Qi, raise Qi.
•
If the bleeding is heavy add Long Gu Fossilia Ossis
mastodi and Mu Li Concha Ostreae.
If there is Yang deficiency, add herbs that warm the
Uterus, scatter Cold and stop bleeding such as Ai Ye
Folium Artemisiae argyi, Pao Jiang Rhizoma Zingiberis
preparatum (fried) or Bu Gu Zhi Fructus Psoraleae.
If there is stasis of Blood, add Qian Cao Gen Radix
Rubiae, Yi Mu Cao Herba Leonori and San Qi Radix
Notoginseng.
If the period is scanty and there is a Kidney deficiency with loose stools, add Lu Jiao Shuang Cornu Cervi
degelatinatum and Du Zhong Cortex Eucommiae.
Three Treasures remedies
– TONIFY QI AND EASE THE MUSCLES
This remedy is a variation of Bu Zhong Yi Qi Tang:
it tonifies and raises Qi, enters the Blood portion and
resolves Dampness. It is suitable if the patient suffers
from depression. The tongue presentation appropriate to
this remedy is a Pale body with a sticky, white coating.
– CALM THE SHEN
This remedy is a variation of the formula Gui Pi Tang
which tonifies Qi and Blood of the Spleen and Heart:
it can be used to stop bleeding from Qi deficiency. The
tongue presentation appropriate to this remedy is a
Pale body.
SUMMARY
Spleen-Qi deficiency
Clinical manifestations
Early period, pale and dilute menstrual blood, loose stools,
epigastric distension, tiredness. Tongue: Pale. Pulse: Weak.
204 Section 4: Menstrual Irregularities
Treatment principle
Strengthen the Spleen, tonify and raise Qi, consolidate the Penetrating Vessel, contain blood.
Acupuncture
ST-36 Zusanli, SP-6 Sanyinjao, Ren-12 Zhongwan,
BL-20 Pishu, Du-20 Baihui, Ren-4 Guanyuan,
Ren-6 Qihai. All with reinforcing method, moxa is
applicable.
Herbal treatment
Prescriptions
• GUI PI TANG Tonifying the Spleen Decoction
• JU YUAN JIAN Variation Raising the Original
[Qi] Decoction Variation
• BU ZHONG YI QI TANG Tonifying the Centre
and Benefiting Qi Decoction
Three Treasures remedies
• TONIFY QI AND EASE THE MUSCLES
• CALM THE SHEN
Kidney-Qi not firm
Clinical manifestations
Early period, pale, dilute menstrual blood, lower backache, dizziness, nocturia, feeling cold. Tongue: Pale,
Swollen. Pulse: Deep and Weak.
Treatment principle
Strengthen the Kidneys, tonify Qi, warm Yang, consolidate the Directing and Penetrating Vessels.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), KI-3 Taixi, KI-7 Fuliu, BL-23 Shenshu, ST-36
Zusanli, BL-20 Pishu, Du-20 Baihui, Ren-4 Guanyuan,
KI-13 Qixue, Ren-6 Qihai. All with reinforcing method,
moxa is applicable.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel and
tonify the Uterus.
– KI-3, KI-7 and BL-23 tonify the Kidneys.
– ST-36 and BL-20 tonify the Spleen. When KidneyYang is deficient, it is usually necessary to tonify the
Spleen too.
– Du-20 raises Qi.
– Ren-4 and KI-13 consolidate the Directing and
Penetrating Vessels and strengthen the Uterus. Ren-4
is particularly effective with direct moxa cones.
– Ren-6 tonifies and raises Qi.
Herbal treatment
Prescription
– GUI RONG BU CHONG TANG and SHOU TAI WAN
– Plastrum Testudinis-Colla Cornu Cervi Tonifying the
Penetrating Vessel Decoction and Fetus Longevity Pill
Explanation The first nine herbs constitute the formula Gui Rong Bu Chong Tang, and the last four the
formula Shou Tai Wan. The former tonifies and raises
Qi, consolidates the Directing and Penetrating Vessels,
strengthens and warms the Uterus and stops bleeding.
The second formula tonifies the Kidneys and is usually
prescribed for threatened miscarriage.
– Dang Shen, Huang Qi and Zhi Gan Cao tonify and
raise Qi.
– Lu Jiao Jiao and Gui Ban tonify the Kidneys and
strengthen the Directing and Penetrating Vessels
and the Governing Vessel.
– Ai Ye and Pao Jiang warm the Uterus and stop
bleeding.
– Bai Shao and Wu Zei Gu nourish Blood and, being
astringent and absorbent, they stop bleeding.
– Tu Si Zi and Xu Duan tonify Kidney-Yang and calm
the fetus.
– Sang Ji Sheng and E Jiao nourish Liver-Blood and
calm the fetus in threatened miscarriage.
Modifications If there is Blood and Essence deficiency, add Gou Qi Zi Fructus Lycii and Shan Zhu Yu
Fructus Corni.
Three Treasures remedy
– EASE THE JOURNEY-YANG
This remedy tonifies Kidney-Yang, and strengthens
the Directing and Penetrating Vessels. It can be used
for Early Periods because it contains Mu Li which is
absorbent and can stop bleeding. The tongue presentation appropriate to this remedy is a Pale body.
Early Periods 205
SUMMARY
Kidney-Qi not firm
Clinical manifestations
Early period, pale, dilute menstrual blood, lower
backache, dizziness, nocturia, feeling cold. Tongue:
Pale, Swollen. Pulse: Deep and Weak.
Treatment principle
Strengthen the Kidneys, tonify Qi, warm Yang, consolidate the Directing and Penetrating Vessels.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), KI-3 Taixi, KI-7 Fuliu, BL-23 Shenshu, ST-36
Zusanli, BL-20 Pishu, Du-20 Baihui, Ren-4 Guanyuan,
KI-13 Qixue, Ren-6 Qihai. All with reinforcing
method, moxa is applicable.
Herbal treatment
Prescription
• GUI RONG BU CHONG TANG and SHOU TAI
WAN, Plastrum Testudinis-Colla Cornu Cervi
Tonifying the Penetrating Vessel Decoction
and Fetus Longevity Pill
Three Treasures remedy
• EASE THE JOURNEY-YANG
BLOOD-HEAT
BL-17 Geshu, SP-6 Sanyinjiao, LIV-2 Xingjian, LIV-3
Taichong, KI-2 Rangu, SP-8 Diji. All with reducing or
even method.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel and the
periods.
– Ren-4 strengthens the Uterus.
– L.I.-11, SP-10 and BL-17 clear Heat and cool
Blood.
– SP-6 regulates the periods and cools Blood.
– LIV-2 drains Liver-Fire and therefore helps to cool
Blood as, in this case, Blood-Heat is related to the
Liver.
– LIV-3 and KI-2 in combination cool Blood.
– SP-8, Accumulation point, stops uterine
bleeding.
Herbal treatment
a. Prescription
– QING JING SAN
– Clearing the Menses Powder
Explanation
– Mu Dan Pi cools Blood and stops bleeding.
– Bai Shao ‘calms’ Blood to stop bleeding.
– Shu Di Huang nourishes Blood.
– Di Gu Pi and Qing Hao clear Heat.
– Fu Ling and Huang Bo drain Dampness.
Modifications If the periods are very heavy, add Di Yu
Radix Sanguisorbae, Huai Hua Flos Sophorae immaturus
and Qian Cao Gen Radix Rubiae.
Full-Heat: Liver Blood-Heat
Clinical manifestations
Early period that is heavy with bright red or dark red
blood, anxiety, mental restlessness, red face, thirst,
dark urine, dry stools. Tongue: Red with a yellow coating. Pulse: Rapid, Overflowing, Full and Wiry in the
Middle level.
Treatment principle
Clear Heat, cool Blood, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, L.I.-11 Quchi, SP-10 Xuehai,
b. Prescription
– QIN LIAN SI WU TANG
– Scutellaria-Coptis Four Substances Decoction
Explanation
– Huang Qin and Huang Lian clear Heat.
– Mai Men Dong and Sheng Di Huang nourish Yin
and cool Blood. Sheng Di Huang also calms Blood
and stops bleeding.
– Chuan Xiong, Dang Gui and Bai Shao harmonize
Blood. Bai Shao also calms Blood and helps to stop
bleeding.
This formula is particularly suitable if there is some
Damp-Heat too, as the first two herbs resolve DampHeat.
206 Section 4: Menstrual Irregularities
Women’s Treasure remedy
Acupuncture
– COOL THE MENSES
This remedy clears Heat, cools Blood and stops uterine bleeding. The tongue presentation appropriate to
this remedy is a Red body.
LIV-2 Xingjian, LIV-3 Taichong, Ren-4 Guanyuan, LIV-14
Qimen, L.I.-11 Quchi, SP-10 Xuehai, KI-2 Rangu, SP-6
Sanyinjiao, SP-8 Diji. All with reducing or even method.
Explanation
– LIV-2 drains Liver-Fire.
– LIV-3 and KI-2 in combination cool Blood. LIV-3
also pacifies the Liver.
– Ren-4 tonifies the Uterus.
– LIV-14 pacifies the Liver.
– L.I.-11 and SP-10 cool Blood.
– SP-6 cools Blood and pacifies the Liver.
– SP-8, in combination with LIV-3, clears Heat
deriving from stagnant Liver-Qi and stops uterine
bleeding.
SUMMARY
Full Heat: Liver Blood-Heat
Clinical manifestations
Early period that is heavy with bright red or dark red
blood, anxiety, mental restlessness, red face, thirst,
dark urine, dry stools. Tongue: Red with a yellow
coating. Pulse: Rapid, Overflowing, Full and Wiry in
the Middle level.
Treatment principle
Herbal treatment
Clear Heat, cool Blood, regulate the periods.
Acupuncture
a. Prescription
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left),
Ren-4 Guanyuan, L.I.-11 Quchi, SP-10 Xuehai, BL-17
Geshu, SP-6 Sanyinjiao, LIV-2 Xingjian, LIV-3 Taichong,
KI-2 Rangu, SP-8 Diji. All with reducing or even method.
– DAN ZHI XIAO YAO SAN
– Moutan-Gardenia Free and Easy Wanderer Powder
Herbal treatment
Prescriptions
• QING JING SAN Clearing the Menses Powder
• QIN LIAN SI WU TANG Scutellaria-Coptis Four
Substances Decoction
Women’s Treasure remedy
• COOL THE MENSES
Full-Heat: stagnant Liver-Qi turning
into Fire with Blood-Heat
Clinical manifestations
Early period that is usually heavy with dark blood and
clots, abdominal pain, pre-menstrual breast distension,
irritability, bitter taste, dry throat. Tongue: Red, redder
sides. Pulse: Wiry and Rapid.
Treatment principle
Clear and pacify the Liver, move Qi, clear Heat, cool
Blood, regulate the period.
Explanation This is a variation of the formula Xiao
Yao San Free and Easy Wanderer Powder which moves Qi
and pacifies the Liver. Shan Zhi Zi Fructus Gardeniae and
Mu Dan Pi Cortex Moutan are added to clear Heat. This
variation is specific to clear Liver-Fire when it derives
from stagnant Liver-Qi.
b. Prescription
– QING GAN DA YU TANG
– Clearing the Liver and Eliminating Stagnation Decoction
Explanation This formula is essentially a variation of
Dan Zhi Xiao Yao San mentioned above. It also clears
Liver-Fire, pacifies the Liver and eliminates stagnation:
it is specific for stagnant Liver-Qi turning into LiverFire. To compare this formula with the previous one,
Dan Zhi Xiao Yao San, the present formula has a wider
therapeutic range because it also subdues Liver-Yang
and resolves Dampness.
– Chai Hu and Bo He move Qi and pacify the Liver.
– Dang Gui and Bai Shao nourish Liver-Blood: this is
necessary to pacify the Liver.
– Ju Hua subdues Liver-Yang.
– Shan Zhi Zi and Mu Dan Pi clear Liver-Fire.
– Ju Ye and Chen Pi move Qi and resolve Dampness.
– Zhi Gan Cao harmonizes.
Early Periods 207
c. Prescription
– EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai1
Explanation This formula is used when stagnant
Liver-Qi leads to Heat which damages Liver-Blood.
– Dang Gui, Chi Shao and Chuan Xiong nourish and
invigorate Blood and regulate the periods.
– Chai Hu and Bai Ji Li pacify the Liver, move Qi and
eliminate stagnation.
– Shan Zhi Zi and Huang Qin clear Liver-Heat.
– Ban Xia and Ju Pi Luo harmonize the Centre and
resolve Dampness.
– Fu Ling resolves Dampness.
– Gan Cao harmonizes.
Modifications
• If the periods start and stop and the menstrual
blood has clots (which indicates stasis of Blood), add
Ze Lan Herba Lycopi, Dan Shen Radix Salviae miltiorrhizae and Yi Mu Cao Herba Leonuri.
• If there is abdominal pain, add Xiang Fu Rhizoma
Cyperi, Wu Yao Radix Linderae, Chuan Lian Zi Fructus
Toosendan and Yan Hu Suo Rhizoma Corydalis.
• If the period is heavy, remove Dang Gui Radix Angelicae sinensis.
distension, irritability, bitter taste, dry throat. Tongue:
Red, redder sides. Pulse: Wiry and Rapid.
Treatment principle
Clear and pacify the Liver, move Qi, clear Heat, cool
Blood, regulate the period.
Acupuncture
LIV-2 Xingjian, LIV-3 Taichong, Ren-4 Guanyuan, LIV14 Qimen, L.I.-11 Quchi, SP-10 Xuehai, KI-2 Rangu,
SP-6 Sanyinjiao, SP-8 Diji. All with reducing or even
method.
Herbal treatment
Prescriptions
• DAN ZHI XIAO YAO SAN Moutan-Gardenia
Free and Easy Wanderer Powder
• QING GAN DA YU TANG Clearing the Liver
and Eliminating Stagnation Decoction
• EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai
• TANG SHI SHU JIE FANG Dr Tang’s Pacifying
[the Liver] and Eliminating Stagnation
Formula
d. Prescription
– TANG SHI SHU JIE FANG2
– Dr Tang’s Pacifying [the Liver] and Eliminating
Stagnation Formula
Explanation
– Chai Hu, Xiang Fu, Ba Yue Zha and Mei Gui Hua
pacify the Liver, move Qi and eliminate stagnation.
– Dang Gui and Bai Shao nourish Liver-Blood and
pacify the Liver.
– Mu Dan Pi, Shan Zhi Zi and Xia Ku Cao clear LiverHeat.
– Chuan Xiong invigorates Blood.
Full-Heat: Heart-Fire
Clinical manifestations
Early period, heavy period, palpitations, anxiety, insomnia, mental restlessness, red face, thirst. Tongue: Red
with yellow coating, redder tip with red points. Pulse:
Overflowing, Rapid.
Treatment principle
Drain Fire, clear the Heart, calm the Mind.
Acupuncture
SUMMARY
Full-Heat: stagnant Liver-Qi turning into
Fire with Blood-Heat
Clinical manifestations
Early period that is usually heavy with dark blood
and clots, abdominal pain, pre-menstrual breast
HE-8 Shaofu, HE-5 Tongli, P-7 Daling, Ren-4
Guanyuan, KI-16 Huangshu. The first three with
reducing method; the others with even method.
Explanation
– HE-8 drains Heart-Fire and calms the Mind.
– HE-5 regulates Heart-Qi and regulates its
descending.
– P-7 calms the Mind.
208 Section 4: Menstrual Irregularities
– Ren-4 directs the treatment to the Uterus.
– KI-16 harmonizes the connection of Heart and
Kidneys with the Uterus. It therefore regulates the
descending of Heart-Qi to the Uterus.
Herbal treatment
Prescription
– QING XIN PING GAN TANG Variation
– Clearing the Heart and Balancing the Liver Decoction
Variation
Explanation
– Huang Lian and Mai Men Dong in combination
drain Heart-Fire.
– Bai Shao regulates the Liver.
– Bai Wei clears Liver-Heat.
– Dan Shen regulates the descending of Heart-Qi to
the Uterus and calms the Mind.
– Long Gu and Suan Zao Ren are astringent and help
to stop bleeding.
– Qian Cao Gen stops bleeding.
Liver- and Kidney-Yin deficiency
with Empty-Heat
Clinical manifestations
Early period which may be scanty or heavy, malar flush,
a feeling of heat in the evening, dizziness, tinnitus, fivepalm heat, night sweating. Tongue: Red without coating. Pulse: Floating-Empty or Fine and Rapid.
Treatment principle
Nourish Yin, clear Empty-Heat, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-3 Taixi, LIV-8 Ququan, SP-6
Sanyinjiao, KI-2 Rangu. All with reinforcing method
except for KI-2 which should be needled with reducing
or even method. No moxa.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel,
strengthen the Uterus and regulate the periods.
– Ren-4, KI-3, LIV-8 and SP-6 nourish Liver- and
Kidney-Yin.
– KI-2 clears Empty-Heat.
SUMMARY
Full-Heat: Heart-Fire
Herbal treatment
Clinical manifestations
a. Prescription
Early period, heavy period, palpitations, anxiety, insomnia, mental restlessness, red face, thirst.
Tongue: Red with yellow coating, redder tip with red
points. Pulse: Overflowing, Rapid.
– LIANG DI TANG
– Two ‘Di’ Decoction
Treatment principle
Drain Fire, clear the Heart, calm the Mind.
Acupuncture
HE-8 Shaofu, HE-5 Tongli, P-7 Daling, Ren-4
Guanyuan, KI-16 Huangshu. The first three with
reducing method; the others with even method.
Herbal treatment
Prescription
• QING XIN PING GAN TANG Variation Clearing
the Heart and Balancing the Liver Decoction
Variation
Explanation
– Sheng Di Huang, Xuan Shen and Mai Men Dong
nourish Yin. Both Sheng Di Huang and Xuan Shen
also cool Blood and therefore stop bleeding.
– Di Gu Pi clears Empty-Heat.
– Bai Shao and E Jiao nourish Blood, which helps to
nourish Yin. Both herbs also ‘calm’ Blood and therefore help to stop bleeding.
b. Prescription
– QING JING SAN Variation
– Clearing the Menses Powder Variation
Explanation The first seven herbs constitute the formula Qing Jing San (with Sheng Di Huang substituted
Early Periods 209
for Shu Di Huang) which mostly clears Empty-Heat to
stop excessive or early menstrual bleeding.
– Xuan Shen and Mai Men Dong were added to
nourish Yin.
– Zhi Mu clears Empty-Heat.
tinnitus, five-palm heat, night sweating. Tongue: Red
without coating. Pulse: Floating-Empty or Fine and
Rapid.
Treatment principle
Modifications
• If there are symptoms and signs of Liver-Yang rising (such as headache, irritability and pronounced
dizziness), add Bai Ji Li Fructus Tribuli, Gou Teng
Ramulus Uncariae cum Uncis and Tian Ma Rhizoma
Gastrodiae.
• If the Heat is pronounced, add Nu Zhen Zi Fructus
Ligustri lucidi and Han Lian Cao Herba Ecliptae.
Nourish Yin, clear Empty-Heat, regulate the
periods.
c. Prescription
Herbal treatment
Prescriptions
– DI GU PI YIN (from Golden Mirror of Medicine, Yi
Zong Jin Jian)
– Cortex Lycii Decoction
Explanation This formula is a variation of Si Wu Tang
Four Substances Decoction (the first four herbs). The first
four herbs constitute a variation of Si Wu Tang (with
Sheng Di Huang substituted for Shu Di Huang) which
harmonizes Blood. Sheng Di Huang cools and calms
Blood and stops bleeding.
– Di Gu Pi and Mu Dan Pi clear Heat and cool
Blood.
Women’s Treasure remedies
– EASE THE JOURNEY-YIN
This remedy nourishes Kidney-Yin and clears EmptyHeat. It is suitable for bleeding syndromes because it
contains Mu Li Concha Ostreae and Suan Zao Ren Semen
Ziziphi spinosae which are astringent. The tongue presentation appropriate to this remedy is a Red body without
coating.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-3 Taixi, LIV-8 Ququan, SP-6
Sanyinjiao, KI-2 Rangu. All with reinforcing method
except for KI-2 which should be needled with reducing or even method. No moxa.
• LIANG DI TANG Two ‘Di’ Decoction
• QING JING SAN Variation Clearing the Menses
Powder Variation
• DI GU PI YIN (from Golden Mirror of Medicine,
Yi Zong Jin Jian) Cortex Lycii Decoction
Women’s Treasure remedies
• EASE THE JOURNEY-YIN
• CLEAR EMPTY-HEAT AND COOL THE MENSES
This remedy cools Blood, clears Empty-Heat and
stops bleeding. Its emphasis is on clearing Empty-Heat
rather than nourishing Yin. The tongue presentation appropriate to this remedy is a Red body without
coating.
PROGNOSIS AND PREVENTION
– CLEAR EMPTY-HEAT AND COOL THE MENSES
SUMMARY
Liver- and Kidney-Yin deficiency with
Empty-Heat
Clinical manifestations
Early period which may be scanty or heavy, malar
flush, a feeling of heat in the evening, dizziness,
The problem of early periods and a short cycle can
usually be resolved with acupuncture and/or Chinese
herbs. As usual, it will take a minimum of three menstrual cycles to regulate the cycle. The pattern from
Empty-Heat is more difficult to treat and it may take
several months of therapy.
Women suffering from Spleen-Qi or Kidney-Qi deficiency should pay attention to getting enough rest
and avoiding excessive exercise or lifting; they should
also avoid having excessive amounts of cold, raw
foods and iced drinks. Those suffering from Full-Heat
210 Section 4: Menstrual Irregularities
should avoid eating hot, spicy foods and drinking
alcohol. Patients suffering from Empty-Heat and Yin
deficiency should have adequate rest and avoid working long hours: ‘resting more’ means that they should
take a short rest after lunch (preferably lying down),
do no overtime and pace their activities. In other
words, they should pace themselves so as never to
reach the point of exhaustion.
END NOTES
1. Long Jiajun, Zhang Qi, Shen Kang, Lin Hongyang 1996 Dr Zhang
Jian Zhai’s Experience in Treating Gynaecological Diseases (Zhang
Jian Zhai Zhi Liao Fu Ke Bing Jing Yan), Journal of Traditional Chinese
Medicine (Zhong Yi Za Zhi
), China Academy of Traditional
Chinese Medicine, Beijing, No. 1, p. 16.
2. Hu Xi Ming 1990 Great Treatise of Secret Formulae in Chinese
Medicine (Zhong Guo Zhong Yi Mi Fang Da Quan
),
Culture Publishing House, Shanghai, Vol. 2, p. 211.
CHAPTER 9
LATE PERIODS
AETIOLOGY 211
PATHOLOGY 212
IDENTIFICATION OF PATTERNS AND TREATMENT 212
Blood deficiency 212
Cold in the Uterus: Full-Cold 213
Cold in the Uterus: Empty-Cold 213
Kidney-Yang deficiency 217
Liver-Qi stagnation 220
PROGNOSIS AND PREVENTION 222
The periods are defined as Late Periods when they arrive
late so that the menstrual cycle is longer than 28–30
days consistently (or at least for 3 consecutive months).
It can be up to 40–50 days long. If the periods are only
occasionally late, this may be due to external circumstances such as emotional upsets or travelling. Obviously,
if after always being regular the period is suddenly late
one month, then this might indicate pregnancy.
AETIOLOGY
Chronic illness, excessive physical work,
chronic bleeding, excessive breastfeeding
A long, chronic illness or excessive physical work
weaken the Spleen and often lead to Qi and Blood deficiency. Chronic bleeding (such as in menorrhagia)
may also induce Blood deficiency when it is prolonged.
Breastfeeding for too long (e.g. 2 years) may also lead to
Blood deficiency because breast milk and Blood come
from the same source. Whatever the cause, when Blood
is deficient, the Directing and Penetrating Vessels are
also devoid of Blood and the period cannot occur at the
proper time and becomes consistently late.
Irregular diet, exposure to cold
and dampness, invasion of cold
Excessive consumption of raw, cold foods over a
long period of time leads to internal Cold and possibly Yang deficiency. Excessive exposure to cold and
damp weather or living in a damp environment also
lead to internal Cold and Dampness. Whatever the
cause, Cold can invade the Blood portion and cause
the Blood to congeal, new Blood cannot be generated, the Directing and Penetrating Vessels become
empty, the Sea of Blood cannot fill the Uterus, hence
the periods come consistently late. This is a very
common cause of Late Periods (and also of painful
periods) in girls who are exposed to very cold and
damp conditions by playing sports in shorts in all
weather conditions. Cold and dampness are particularly detrimental in young girls around their puberty
time because the body is then very vulnerable and
easily affected by any cause of disease, be it from the
weather or emotions.
Hereditary Kidney weakness, overwork,
too many children too close together
All the above causes may lead to a Kidney weakness; the
Kidneys fail to nourish the Directing and Penetrating
Vessels, the Kidney-Essence cannot be transformed into
Blood, the Sea of Blood cannot fill the Uterus, hence
the periods come late.
Emotional stress
Longstanding emotional stress may lead to Liver-Qi
stagnation; when this stagnation lasts for a long time it
may induce Blood stasis, the Directing and Penetrating
Vessels become obstructed, hence the periods come
late. The Jade Ruler of Gynaecology (1774) says:
212 Section 4: Menstrual Irregularities
Pensiveness, worry, fear, and preoccupation injure
Heart-Qi, Spleen-Qi loses nourishment, stagnation ensues,
the digestion is impaired, the appetite lessened, hence
Blood becomes deficient and dry, menstrual bleeding is
scanty and the period comes late.1
– Ren-4 nourishes Blood and strengthens the Uterus.
It is particularly effective with direct moxa cones.
– KI-13, a point of the Penetrating Vessel, strengthens
the Uterus and tonifies the Penetrating Vessel.
– LIV-8, ST-36 and SP-6 tonify Qi and Blood.
– BL-20 and BL-23 nourish Blood.
– BL-17 (with direct moxa cones) nourishes Blood.
PATHOLOGY
Herbal treatment
The main pathological factors in Late Periods are:
•
•
•
•
Blood deficiency
Cold in the Uterus (which may be of the Full- or
Empty-type)
Kidney-Yang deficiency
Qi stagnation.
The pattern of Kidney-Yang deficiency occurs more
frequently in older women; all the other patterns can
appear at any age. As explained above, invasion of Cold
and Dampness is probably the most common cause of
Late Periods in young women or girls. As they grow and
develop, this may become complicated by other causes
of disease such as overwork or emotional stress.
IDENTIFICATION OF PATTERNS
AND TREATMENT
Blood deficiency
Clinical manifestations
Late and scanty periods, pale menstrual blood, dull-pale
complexion, blurred vision, dizziness, palpitations, insomnia, tiredness. Tongue: Pale and Thin. Pulse: Choppy.
Treatment principle
Nourish Blood, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-13 Qixue, LIV-8 Ququan,
ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-23
Shenshu, BL-17 Geshu. All with reinforcing method,
moxa is applicable.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel (Ren
Mai), regulate the periods and nourish Yin and
Blood.
a. Prescription
– REN SHEN YANG RONG TANG
– Ginseng Nourishing and Flourishing Decoction
Explanation
– Ren Shen, Bai Zhu and Huang Qi tonify Qi to nourish
Blood.
– Dang Gui, Bai Shao and Shu Di Huang nourish Blood.
– Rou Gui warms the Fire of the Gate of Life.
– Wu Wei Zi nourishes the Essence.
– Yuan Zhi calms the Mind.
– Fu Ling and Chen Pi resolve Dampness.
– Zhi Gan Cao harmonizes.
Modifications
• If there are signs of Yin deficiency, remove Rou Gui
Cortex Cinnamomi and add E Jiao Colla Corii asini and
Mai Men Dong Radix Ophiopogonis.
b. Prescription
– DA BU YUAN JIAN
– Great Tonifying the Original [Qi] Decoction
Explanation This prescription tonifies Qi and Yang
and nourishes Blood, Essence and Yin. It is therefore
suitable if the patient’s condition is very depleted.
– Ren Shen and Shan Yao tonify Qi and the Original Qi.
– Shu Di Huang and Dang Gui nourish Blood.
– Du Zhong tonifies Kidney-Yang and strengthens the
back.
– Shan Zhu Yu and Gou Qi Zi nourish Yin and the
Essence and strengthen Liver and Kidneys. Gou Qi Zi
also nourishes Blood.
– Zhi Gan Cao harmonizes.
c. Prescription
– YI YIN JIAN Variation
– One Yin Decoction Variation
Explanation The first seven herbs constitute the formula Yi Yin Jian which nourishes both Yin and Blood.
Late Periods 213
Table 9.1 Differences among three formulae for Late Periods from Blood deficiency
ACTION
SYMPTOMS
TONGUE
Ren Shen Yang
Rong Tang
Tonify Qi and Blood
Tiredness, blurred vision,
scanty period
Pale and Thin
Da Bu Yuan Jian
Tonify Qi and Yang, nourish
Blood, Essence and Yin,
tonify the Kidneys
Extreme tiredness, very Weak and
Choppy pulse, backache, scanty
period, blurred vision
Pale and Swollen
Yi Yin Jian
Nourish Blood and Yin, clear
Empty-Heat
Tiredness, blurred vision, scanty
period, dizziness, tinnitus, feeling
of heat
Normal coloured or slightly
Red with slightly rootless
coating
This prescription is therefore suitable if the Blood deficiency has begun to turn into Yin deficiency.
Zhi Mu and Di Gu Pi clear Empty Heat and can be
omitted if there is none.
Table 9.1 compares and contrasts the above three
formulae.
Women’s Treasure remedy
– PRECIOUS SEA
This remedy is a variation of the formula Ba Zhen
Tang Eight Precious Decoction which nourishes Blood
and tonifies Qi. It has been modified with the addition
of Kidney tonics. The tongue presentation appropriate
to this remedy is a Pale and Thin body.
ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-23
Shenshu, BL-17 Geshu. All with reinforcing method,
moxa is applicable.
Herbal treatment
Prescriptions
• REN SHEN YANG RONG TANG Ginseng
Nourishing and Flourishing Decoction
• DA BU YUAN JIAN Great Tonifying the Original
[Qi] Decoction
• YI YIN JIAN Variation One Yin Decoction Variation
Women’s Treasure remedy
• PRECIOUS SEA
Cold in the Uterus: Full-Cold
Clinical manifestations
Late periods, scanty bleeding with dark blood and
clots, painful periods, abdominal pain which is
SUMMARY
Blood deficiency
Clinical manifestations
Late and scanty periods, pale menstrual blood, dull,
pale complexion, blurred vision, dizziness, palpitations,
insomnia, tiredness. Tongue: Pale and Thin. Pulse: Choppy.
Treatment principle
Nourish Blood, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-13 Qixue, LIV-8 Ququan,
relieved by the application of heat and worsened by
pressure, feeling cold, abdomen very tight on palpation. Tongue: Pale, thick, white coating. Pulse: Full
and Tight.
Cold in the Uterus: Empty-Cold
Clinical manifestations
Late periods, scanty bleeding with small, dark, stringy
clots, painful periods, abdominal pain that is relieved
by application of both heat and pressure, abdomen
loose on palpation, tiredness, feeling cold. Tongue:
Pale. Pulse: Deep, Weak, Slow.
Treatment principle
Full-Cold: warm the Uterus, scatter Cold, regulate the
periods. Empty-Cold: tonify Yang, expel Cold, regulate
the periods.
214 Section 4: Menstrual Irregularities
Case history
A 22-year-old woman had been suffering from
Late Periods ever since she stopped taking the
contraceptive pill. Her periods came about
every 3 months. She had started taking the
contraceptive pill 3 years before but had to
stop taking it as it caused tiredness, abdominal
distension and fluid retention. Besides coming
every 3 months, the period was also hesitant
in starting, going through a stop–start phase
before starting properly. When it did come,
it was rather scanty and the blood was bright
red. Besides, this, she was still suffering from
abdominal distension which had persisted
after she stopped taking the contraceptive
pill. On questioning, it transpired that she also
suffered from dizziness, occasional tinnitus,
backache, frequent urination, hair falling out,
constipation, blurred vision and brittle nails.
Her complexion was dull-pale. Her tongue
was slightly Pale and her pulse was Weak and
Choppy.
Diagnosis This is a clear case of deficiency of
both Blood and Kidney-Yang. The Blood deficiency manifestations are: late and scanty period,
dull-pale complexion, constipation, blurred vision,
dizziness, hair falling out, brittle nails, Pale tongue
and Choppy pulse. The manifestations of KidneyYang deficiency are: late period, backache, frequent urination, dizziness, tinnitus, Weak pulse.
As can be seen, there is an overlap between
Blood and Kidney-Yang deficiency so that some
manifestations (such as the late period, dizziness
and Pale tongue) can be attributed to either deficiency. In addition, there was also some stagnation of Qi causing the abdominal distension and
some stasis of Blood causing the period to start
hesitantly: however, these are secondary conditions as there are no other manifestations indicating them.
Treatment principle As the Root of the condition was a deficiency of both Blood and KidneyYang, I adopted the treatment principle of
nourishing Blood and tonifying Kidney-Yang. A
secondary aim of treatment was to move Qi and
invigorate Blood.
I treated her with both acupuncture and herbs.
Acupuncture was particularly indicated to move Qi
and Blood so that I could concentrate on tonifying
Blood and Kidney-Yang with the herbs.
Acupuncture The acupuncture points used were
selected from the following:
• LU-7 Lieque on the right and KI-6 Zhaohai on
the left to regulate the Directing Vessel and
strengthen the Uterus.
• Ren-4 Guanyuan with moxa cones, to nourish
Blood, strengthen the Uterus and tonify the
Kidneys.
• ST-36 Zusanli and SP-6 Sanyinjiao to tonify Qi
and Blood.
• KI-3 Taixi, with warming needle, to tonify
Kidney-Yang.
• BL-20 Pishu and BL-23 Shenshu to tonify the
Kidneys and nourish Blood.
It was not necessary to add specific points to move
Qi and Blood as the above points would have that
effect too.
Herbal treatment The prescription used was a
variation of the formula Da Bu Yuan Jian Great
Tonifying the Original [Qi] Decoction.
• Ren Shen Radix Ginseng 3 g
• Shan Yao Radix Dioscoreae 6 g
• Shu Di Huang Radix Rehmanniae
preparata 9 g
• Du Zhong Cortex Eucommiae 6 g
• Dang Gui Radix Angelicae sinensis 6 g
• Shan Zhu Yu Fructus Corni 3 g
• Gou Qi Zi Fructus Lycii 6 g
• Zhi Gan Cao Radix Glycyrrhizae preparata 3 g
• Rou Cong Rong Herba Cistanches 4.5 g
• Tu Si Zi Semen Cuscutae 6 g
• Huang Jing Rhizoma Polygonati 6 g
• Xiang Fu Rhizoma Cyperi 4.5 g
• Yi Mu Cao Herba Leonuri 4.5 g
Explanation The first eight herbs constitute the
original formula which nourishes Blood and tonifies
Kidney-Yang.
Late Periods 215
• Rou Cong Rong and Tu Si Zi were added to
strengthen the Yang-tonifying effect. Rou Cong
Rong also treats constipation.
• Huang Jing tonifies Qi, Blood and Essence.
• Xiang Fu and Yi Mu Cao were added to move
Qi and invigorate Blood.
After prescribing this formula for 1 month, I added
Gui Ban Plastrum Testudinis and Lu Jiao Cornu Cervi
to nourish the Directing Vessel and the Governing
Vessel.
After taking this prescription for a further 2 months,
her period arrived after an interval of 11 weeks.
She continued to take the same formula and her
periods gradually came at shorter intervals, i.e. 9-,
7- and finally 5-week intervals.
Acupuncture
With acupuncture, the same point can treat Full- or
Empty-Cold, the main difference being only in the needle manipulation.
Ren-4 Guanyuan, Ren-6 Qihai, ST-29 Guilai, SP-8
Diji, SP-6 Sanyinjiao, ST-36 Zusanli, Du-4 Mingmen,
BL-32 Ciliao, ST-25 Tianshu. Reducing method in case
of Full-Cold and reinforcing method in case of EmptyCold. Moxa must be used.
Explanation
– Ren-4, with moxa, warms the Uterus.
– Ren-6, with moxa, moves Qi and expels Cold from
the lower abdomen.
– ST-29, with moxa, can expel Cold from the
Uterus.
– SP-8 and SP-6 move Blood and stop pain.
– ST-36 tonifies Qi and helps to scatter Cold.
– Du-4 strongly tonifies the Fire of the Gate of Life
and is more suitable for Empty-Cold.
– BL-32 with direct moxa cones, expels Cold from the
Uterus.
– ST-25, with moxa cones, expels Cold and invigorates
Blood. This action is due to two factors: first, as a
point of the Bright Yang, it is rich in Qi and Blood
and can therefore invigorate Blood; second, as the
Bright Yang is in relation with the Penetrating
Vessel, this point can stimulate this vessel’s Sea of
Blood.
Herbal treatment
Full-Cold
a. Prescription
– WEN JING TANG
– Warming the Menses Decoction
Explanation
– Wu Zhu Yu, Gui Zhi and Sheng Jiang scatter Cold
and warm the Uterus.
– Dang Gui, Chuan Xiong, E Jiao and Bai Shao
nourish and invigorate Blood. This is necessary
because Cold obstructs the Uterus and the vessels
and prevents the generation of new Blood.
– Dang Shen tonifies Qi to nourish Blood.
– Mai Men Dong nourishes Yin. This is necessary as
Blood deficiency can lead to Yin deficiency.
– Mu Dan Pi is added to clear any Empty-Heat
deriving from Blood deficiency.
– Ban Xia is added here not to resolve Phlegm, but
to regulate the Qi of the Penetrating Vessel. In fact,
this vessel, arising from the Uterus, is closely linked
to the Stomach channel (through the point ST-30
Qichong) and is frequently subject to rebellious Qi:
harmonizing Stomach-Qi with Ban Xia will help to
subdue rebellious Qi in the Penetrating Vessel.
– Zhi Gan Cao harmonizes.
b. Prescription
– EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai2
Explanation This formula is essentially a variation
of Wen Jing Tang Warming the Menses Decoction from
which tonics (such as E Jiao Colla Corii asini and Dang
Shen Radix Codonopsis) and cold herbs (such as Mai
Men Dong Radix Ophiopogonis and Mu Dan Pi Cortex
Moutan) have been removed. Compared with Wen Jing
Tang, this formula is less tonifying and has a stronger Cold-expelling action: it is therefore suitable when
the Cold symptoms are pronounced (with a very Pale
tongue and a Slow-Tight pulse) and the periods, besides
being late, are also painful.
– Dang Gui and Bai Shao nourish Blood.
– Fu Ling and Fu Shen drain Dampness.
– Rou Gui, Ai Ye, Sheng Jiang and Wu Zhu Yu warm
the Uterus and expel Cold.
– Chuan Xiong invigorates Blood.
216 Section 4: Menstrual Irregularities
– Ban Xia and Chen Pi harmonize the Centre and dry
Dampness.
– Zhi Gan Cao harmonizes.
Modifications
• If there is abdominal pain with a feeling of masses,
add Pu Huang Pollen Typhae and Wu Ling Zhi Faeces
Trogopterori.
– Du Zhong tonifies Kidney-Yang.
– Niu Xi nourishes the Liver and invigorates Blood.
– Rou Gui expels Cold and tonifies the Fire of the
Gate of Life.
c. Prescription
– YI PI WEN SHEN TANG
– Benefiting the Spleen and Warming the Kidneys
Decoction
Empty-Cold
a. Prescription
– AI FU NUAN GONG WAN
– Artemisia-Cyperus Warming the Uterus Pill
Explanation
– Ai Ye, Wu Zhu Yu and Rou Gui scatter Cold and
warm the Uterus. Rou Gui tonifies the Fire of the
Gate of Life.
– Xiang Fu moves Qi and helps to expel Cold.
– Dang Gui, Chuan Xiong and Bai Shao nourish
Blood. This is necessary because Cold obstructs the
Uterus and prevents the generation of new Blood.
– Huang Qi tonifies Qi to nourish Blood.
– Sheng Di Huang nourishes Yin to help to nourish
Blood.
– Xu Duan tonifies Kidney-Yang.
Explanation This prescription is suitable if the deficiency of Yang predominates over the Cold.
– Ren Shen, Bai Zhu, Shan Yao and Gan Cao tonify Qi
to nourish Blood.
– Ba Ji Tian and Tu Si Zi tonify Kidney-Yang.
– Dang Gui nourishes Blood.
Of the above three formulae for Empty-Cold, Ai
Fu Nuan Gong Wan is the strongest at expelling
Cold. Da Ying Jian is better for nourishing Blood
and warming and is therefore applicable when the
deficiency predominates. The third, Yi Pi Wen Shen
Tang, is better to tonify Spleen- and Kidney-Yang
and is also suitable when the deficiency predominates over Cold.
Table 9.2 illustrates differences among the three
prescriptions for Empty-Cold.
b. Prescription
Women’s Treasure remedy
– DA YING JIAN
– Big Nutritive Qi Decoction
Explanation
– Dang Gui, Shu Di Huang and Gou Qi Zi nourish
Blood. It is necessary to do this for the same reasons
as are given for the previous two formulae.
– Zhi Gan Cao tonifies Qi to nourish Blood.
– WARM THE MANSION
This remedy is a variation of the formula Ai Fu Nuan
Gong Wan Artemisia-Cyperus Warming the Uterus Pill
which warms the Uterus and tonifies Kidney-Yang.
The tongue presentation appropriate to this remedy is
a Pale body.
Table 9.2 Differences among three prescriptions for Late Periods from Empty-Cold
ACTION
MENSTRUAL
SYMPTOMS
SYMPTOMS
TONGUE
PULSE
Ai Fu Nuan
Gong Wan
Warm the Uterus, expel
Cold, nourish Blood, tonify
Qi, tonify Kidney-Yang
Painful period,
small, stringy,
dark clots
Feeling cold, abdominal
pain, tiredness, backache
Pale, wet
Deep,
slightly
Tight, Slow
Da Ying Jian
Nourish Blood, tonify
Kidney-Yang, warm
the Uterus
Scanty period,
pale blood
Tiredness, backache,
dizziness, insomnia, blurred
vision, feeling cold
Pale
Deep, Weak,
Slow
Yi Pi Wen
Shen Tang
Tonify Spleen- and KidneyYang, nourish Blood
Period scanty or
heavy, pale blood
Tiredness, backache, loose
stools, feeling cold
Pale,
Swollen
Deep, Weak,
Slow
Late Periods 217
SUMMARY
Cold in the Uterus
Full-Cold
Clinical manifestations
Late periods, scanty bleeding with dark blood and clots,
painful periods, abdominal pain which is relieved by the
application of heat and worsened by pressure, feeling
cold, abdomen very tight on palpation. Tongue: Pale,
thick, white coating. Pulse: Full and Tight.
Empty-Cold
Clinical manifestations
Late periods, scanty bleeding with small, dark, stringy
clots, painful periods, abdominal pain that is relieved
by application of both heat and pressure, abdomen
loose on palpation, tiredness, feeling cold. Tongue:
Pale. Pulse: Deep, Weak, Slow.
Treatment principle
Full-Cold: warm the Uterus, scatter Cold, regulate the
periods. Empty-Cold: tonify Yang, expel Cold, regulate
the periods.
Acupuncture
With acupuncture, the same point can treat Fullor Empty-Cold, the main difference being only in
Kidney-Yang deficiency
Clinical manifestations
Late periods, scanty, pale blood, sore back, nocturia,
dizziness, tinnitus, frequent, pale urination, feeling
cold. Tongue: Pale. Pulse: Weak, Deep.
Treatment principle
the needle manipulation. Ren-4 Guanyuan, Ren-6
Qihai, ST-29 Guilai, SP-8 Diji, SP-6 Sanyinjiao, ST-36
Zusanli, Du-4 Mingmen, BL-32 Ciliao, ST-25 Tianshu.
Reducing method in case of Full-Cold and reinforcing method in case of Empty-Cold. Moxa must be
used.
Herbal treatment
Full-Cold
Prescriptions
• WEN JING TANG Warming the Menses
Decoction
• EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai
Empty-Cold
Prescriptions
• AI FU NUAN GONG WAN Artemisia-Cyperus
Warming the Uterus Pill
• DA YING JIAN Big Nutritive Qi Decoction
• YI PI WEN SHEN TANG Benefiting the Spleen and
Warming the Kidneys Decoction
Women’s Treasure remedy
• WARM THE MANSION
Explanation
– BL-23 and Du-4 tonify and warm Kidney-Yang,
especially if direct moxa cones are used.
– Ren-4 and KI-3 tonify the Kidneys. If there is a
pronounced Yang deficiency, one should use moxa
on Ren-4.
– LU-7 and KI-6 regulate the Directing Vessel,
strengthen the Uterus and tonify the Kidneys.
– ST-36 and SP-6, with warm needle (moxa on the
needle), tonify Qi and Yang in general.
Tonify Yang, strengthen the Kidneys, warm the Uterus.
Herbal treatment
Acupuncture
a. Prescription
BL-23 Shenshu, Du-4 Mingmen, KI-3 Taixi, Ren-4
Guanyuan, LU-7 Lieque (on the right) and KI-6
Zhaohai (on the left), ST-36 Zusanli, SP-6 Sanyinjiao.
All with reinforcing method. Moxa can be used if there
is a pronounced Kidney-Yang deficiency.
– JIN GUI SHEN QI WAN
– Golden Chest Kidney-Qi Pill
Explanation This well-known formula from the
Discussion on Cold-induced Diseases tonifies and
warms Kidney-Yang.
218 Section 4: Menstrual Irregularities
– Fu Zi and Gui Zhi tonify Yang, expel Cold and
strengthen the Fire of the Gate of Life. Some sources
have Rou Gui Cortex Cinnamomi rather than Gui Zhi
Ramulus Cinnamomi.
– Shu Di Huang nourishes the Kidneys.
– Shan Zhu Yu nourishes the Liver.
– Shan Yao tonifies the Spleen.
– Ze Xie balances Shu Di Huang to clear any Heat that
might derive from it.
– Mu Dan Pi similarly balances Shan Zhu Yu to clear
any Heat from the Liver.
– Fu Ling balances Shan Yao to drain any Dampness
that might derive from it.
b. Prescription
– CONG RONG TU SI ZI WAN
– Cistanche-Cuscuta Pill
Explanation
This formula tonifies Kidney-Yang and nourishes Blood.
– Rou Cong Rong, Tu Si Zi, Fu Pen Zi, and Yin Yang
Huo tonify and warm Kidney-Yang. Tu Si Zi also
nourishes the Kidney-Essence and Rou Cong Rong
warms the Uterus.
– Gou Qi Zi, Dang Gui, Shu Di Huang, Sang Ji Sheng
and Zi He Che nourish Blood. Gou Qi Zi and Zi He
Che also nourish the Essence.
– Ai Ye warms the Uterus.
c. Prescription
Explanation
This formula tonifies Qi and Blood and mildly tonifies
Kidney-Yang.
– Ren Shen, Shan Yao and Zhi Gan Cao tonify Qi. Ren
Shen also tonifies the Original Qi and Shan Yao also
tonifies the Kidneys.
– Shu Di Huang tonifies the Kidneys and nourishes
Blood.
– Shan Zhu Yu tonifies the Liver and Kidneys.
– Yuan Zhi calms the Mind.
– Wu Wei Zi nourishes the Kidneys and the Essence
(as well as the Lungs) and calms the Mind.
– Tu Si Zi tonifies Kidney-Yang and Kidney-Essence.
Modifications
• If there is a pronounced deficiency of Kidney-Yang
with internal Cold, add Fu Zi Radix Aconiti lateralis
preparata, Rou Gui Cortex Cinnamomi and Bu Gu Zhi
Fructus Psoraleae.
To compare and contrast these three formulae, the
first is the strongest at tonifying and warming KidneyYang and is the hottest: therefore it is the best to expel
Cold. The second also tonifies Kidney-Yang but it does
not expel Cold; in addition it nourishes Blood so it is
more suitable for gynecological problems. The third
tonifies both Qi and Blood, strengthens the Directing
and Penetrating Vessels, tonifies the Kidneys and Liver
and calms the Mind: it is specific for menstrual irregularities from Kidney-Yang deficiency (see Table 9.3).
Three Treasures remedy
– GU YIN JIAN
– Consolidating the Yin Decoction
– STRENGTHEN THE ROOT
Table 9.3 Comparison of Jin Gui Shen Qi Wan, Cong Rong Tu Si Zi Wan and Gu Yin Jian, for Late Periods
from Kidney-Yang deficiency
PATTERN
SYMPTOMS
TONGUE
PULSE
Jin Gui Shen
Qi Wan
Kidney-Yang deficiency,
internal Cold, decline
of the Fire of the Gate
of Life
Period scanty and painful, small,
dark clots, feeling very cold, pale
urine, depression
Pale, Swollen, wet
Deep, Weak, Slow
Cong Rong Tu
Si Zi Wan
Kidney-Yang deficiency,
Blood deficiency,
Essence deficiency
Period scanty, pale blood, not
painful, dizziness, insomnia,
blurred vision
Pale, paler on the
sides, Thin
Weak, Choppy
Gu Yin Jian
Qi-Blood deficiency,
Kidney-Yang deficiency
Period could be either scanty
or heavy, pale blood, tiredness,
depression, anxiety, loose stools,
blurred vision, insomnia, dizziness
Pale
Weak
Late Periods 219
This remedy tonifies Qi and Blood, strengthens
Kidney-Yang, warms the Uterus, expels Cold and tonifies the Directing and Penetrating Vessels. The tongue
presentation appropriate to this remedy is a Pale,
Swollen and wet body.
Women’s Treasure remedy
– UNICORN PEARL
This remedy tonifies Kidney-Yang and the KidneyEssence. The tongue presentation appropriate to this
remedy is a Pale and wet body.
SUMMARY
Kidney-Yang deficiency
Clinical manifestations
Late periods, scanty, pale blood, sore back, nocturia,
dizziness, tinnitus, frequent, pale urination, feeling
cold. Tongue: Pale. Pulse: Weak, Deep.
Treatment principle
Tonify Yang, strengthen the Kidneys, warm the Uterus.
Acupuncture
BL-23 Shenshu, Du-4 Mingmen, KI-3 Taixi, Ren-4
Guanyuan, LU-7 Lieque (on the right) and KI-6
Zhaohai (on the left), ST-36 Zusanli, SP-6 Sanyinjiao.
Case history
A 33-year-old woman sought treatment for possible secondary infertility: she had not had any
tests or investigations but she had not been able
to conceive after trying for 1 year (she already
had two children aged 6 and 4). Her husband’s
sperm had been checked and found to be normal. Her periods were consistently late with a
cycle of about 6 weeks. The menstrual blood
was rather pale and she suffered from slight
pre-menstrual tension. Her bowels were usually
loose and she complained of tiredness, backache, dizziness and occasionally tinnitus. Her
tongue was Pale with a sticky, white coating and
her pulse was Weak on the right Rear position.
Diagnosis The underlying condition is clearly one
of Kidney-Yang deficiency as evidenced by the Pale
tongue, the Weak pulse on the right Kidney position, the infertility, the long cycle, the tiredness,
backache, dizziness and tinnitus. In addition to this
there was also some Spleen-Qi deficiency manifest-
All with reinforcing method. Moxa can be used if
there is a pronounced Kidney-Yang deficiency.
Herbal treatment
Prescriptions
• JIN GUI SHEN QI WAN Golden Chest Kidney-Qi Pill
• CONG RONG TU SI ZI WAN Cistanche-Cuscuta Pill
• GU YIN JIAN Consolidating the Yin Decoction
Three Treasures remedy
• STRENGTHEN THE ROOT
Women’s Treasure remedy
• UNICORN PEARL
ing with loose stools, tiredness and a sticky coating
on the tongue, the last symptom also pointing to
some Dampness.
Treatment principle She was treated with herbs
and acupuncture. I prescribed a variation of the formula Gu Yin Jian Consolidating the Yin Decoction
• Ren Shen Radix Ginseng 3 g
• Shu Di Huang Radix Rehmanniae
preparata 9 g
• Shan Yao Rhizoma Dioscoreae 6 g
• Shan Zhu Yu Fructus Corni 4.5 g
• Yuan Zhi Radix Polygalae 3 g
• Zhi Gan Cao Radix Glycyrrhizae preparata 3219g
• Tu Si Zi Semen Cuscutae 6 g
• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g
• Du Zhong Cortex Eucommiae 6 g
• Xu Duan Radix Dipsaci 4 g
• Zi Su Ye Folium Perillae 4 g
Explanation The first seven herbs constitute the
formula Gu Yin Jian (minus Wu Wei Zi) to tonify Qi
and strengthen Kidney-Yang.
220 Section 4: Menstrual Irregularities
•
•
•
•
Bai Zhu was added to tonify Qi and resolve Dampness.
Du Zhong was added to tonify and warm
Kidney-Yang.
Xu Duan was added to tonify Kidney-Yang and
also to prevent miscarriage. When I treat women
for infertility, I often add to my prescription
herbs that prevent miscarriage so that, if the
patient becomes pregnant while taking the
prescription, some of its ingredients will help to
maintain the pregnancy.
Zi Su Ye was added for the same reason as it
is one of the herbs that ‘calm the fetus’, i.e.
prevent miscarriages.
With acupuncture, I used points to tonify Qi and
resolve Dampness such as:
• Ren-12, Zhongwan and ST-36 Zusanli (with
warm needle) to tonify Qi.
• SP-9 Yinlingquan and SP-6 Sanyinjiao to resolve
Dampness.
I had been treating this woman for only 8 weeks
when she became pregnant. This case is presented
here as an example of Late Periods, although, given
the very short duration, it is unlikely (but not impossible) that it was the treatment that helped her to
conceive.
Liver-Qi stagnation
Clinical manifestations
Late and scanty periods with clots, irritability, depression, abdominal and breast distension for a long time
before the period comes. Tongue: normal coloured or
slightly Red on the sides if the stagnation is pronounced.
Pulse: Wiry.
Treatment principle
Pacify the Liver, move Qi, eliminate stagnation, invigorate Blood, regulate the periods.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the
left), LIV-3 Taichong, LIV-14 Qimen, KI-14 Siman, T.B.-6
Zhigou, SP-6 Sanyinjiao, Ren-4 Guanyuan, Ren-6 Qihai,
P-7 Daling. All with reducing or even method.
Explanation
– SP-4 and P-6 regulate the Penetrating Vessel,
subdue rebellious Qi and invigorate Blood.
– LIV-3, LIV-14 and T.B.-6 pacify the Liver, move Qi
and eliminate stagnation.
– KI-14, a point of the Penetrating Vessel, moves Qi
and eliminates stagnation in the Uterus and the
Penetrating Vessel.
– SP-6 invigorates Blood.
– Ren-4 and Ren-6 can move Qi in the Lower
Burner, eliminate stagnation and strengthen the
Uterus.
– P-7 calms the Mind and settles the Ethereal Soul.
It is selected if there are pronounced emotional
problems.
Prescription from the Great Compendium
of Acupuncture3
– G.B.-41 Zulinqi, SP-6 Sanyinjiao, Ren-3 Zhongji.
Herbal treatment
a. Prescription
– XIAO YAO SAN
– Free and Easy Wanderer Powder
Explanation This formula, already explained, pacifies
the Liver, moves Qi, eliminates stagnation, nourishes
Liver-Blood and tonifies the Spleen. It is particularly
suitable if the stagnation of Liver-Qi is associated with
or derives from Liver-Blood deficiency: in such a case,
the tongue is Pale and the pulse Fine or Choppy and
only slightly Wiry on the left.
b. Prescription
– CHAI HU SHU GAN TANG
– Bupleurum Pacifying the Liver Decoction
Explanation This formula, already explained, pacifies
the Liver, moves Qi, eliminates stagnation and stops
pain. It is therefore prescribed purely for stagnation
of Qi (i.e. not associated with Liver-Blood deficiency
as the previous one was). The tongue will be slightly
Red on the sides (from long-term stagnation) and the
pulse Wiry. This formula is particularly suitable if the
woman experiences a long phase of distension and
pain before the period arrives.
Late Periods 221
c. Prescription
– WU YAO TANG Variation
– Linderia Decoction Variation
Explanation This prescription pacifies the Liver,
moves Qi, eliminates stagnation, stops pain and nourishes Liver-Blood. It is similar in action to the previous
formula Chai Hu Shu Gan Tang but it differs from it
in so far as it also nourishes Liver-Blood. It has also a
somewhat stronger pain-reducing action.
– Xiang Fu, Wu Yao, Mu Xiang, Sha Ren, Yan Hu Suo
and Bing Lang pacify the Liver, move Qi, eliminate
stagnation and stop pain.
– Gan Cao harmonizes and stops pain.
– Dang Gui and Chuan Xiong nourish and invigorate
Blood.
d. Prescription
– QI ZHI XIANG FU WAN
– Seven Prepared Cyperus Pill
Explanation This formula moves Qi and strongly
invigorates Blood. It is therefore used when there are
pronounced signs of Blood as well as Qi stasis, such as
abdominal pain before the period arrives, dark clots, a
Wiry pulse and a Purple tongue. The formula should
be used with caution as it contains herbs that ‘break’
Blood such as E Zhu and San Leng: it may be advisable
to reduce the dosage of these herbs to no more than
6 g each.
– Xiang Fu, Wu Yao and Chai Hu move Qi, pacify the
Liver and eliminate stagnation.
– Dang Gui and Mu Dan Pi nourish and invigorate
Blood.
– E Zhu and San Leng ‘break’ Blood and eliminate
stasis.
– Ai Ye warms the Uterus.
– Chuan Xiong, Yan Hu Suo and Hong Hua invigorate
Blood and eliminate stasis.
e. Prescription
– DING JING TANG Variation
– Settling the Menses Decoction Variation
Explanation The original formula Ding Jing Tang
is composed of the first eight herbs and comes from
Fu Qing Zhu (1607–1684): its variation is proposed
by Cong Chun Yu in Selection of Clinical Experiences in
Chinese Gynaecology.4 This formula moves Qi, eliminates stagnation, pacifies the Liver, nourishes Blood
and tonifies Kidney-Yang. It is essentially a variation of
Xiao Yao San Free and Easy Wanderer Powder. Fu Qing
Zhu recommends this formula both for Early and Late
Periods.
– Bai Shao and Dang Gui nourish Liver-Blood.
– Tu Si Zi, Shu Di Huang and Yin Yang Huo tonify
Kidney-Yang. Shu Di Huang
– also nourishes Blood.
– Chai Hu, and Xiang Fu move Qi, eliminate
stagnation and pacify the Liver.
– Shan Yao and Fu Ling tonify the Spleen and resolve
Dampness.
– Jing Jie stops bleeding. Although this should make it
unsuitable for Late Periods, it can be used for them
when combined with the other herbs.
Modifications
• If there is Empty-Heat, add Di Gu Pi Cortex Lycii.
• If the periods are heavy, remove Dang Gui and
replace it with E Jiao Colla Corii asini.
Table 9.4 compares and contrasts the above five
formulae.
Women’s Treasure remedy
– FREEING THE MOON
This remedy is a variation of Xiao Yao San: it moves
Qi, pacifies the Liver, eliminates stagnation, nourishes Liver-Blood and tonifies the Spleen. Compared
with Xiao Yao San, it has a stronger Blood-nourishing
action and a more pronounced Mind-calming action.
SUMMARY
Liver-Qi stagnation
Clinical manifestations
Late and scanty periods with clots, irritability, depression, abdominal and breast distension for a long
time before the period comes. Tongue: normal
coloured or slightly Red on the sides if the stagnation
is pronounced. Pulse: Wiry.
Treatment principle
Pacify the Liver, move Qi, eliminate stagnation, invigorate Blood, regulate the periods.
222 Section 4: Menstrual Irregularities
PROGNOSIS AND PREVENTION
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on
the left), LIV-3 Taichong, LIV-14 Qimen, KI-14 Siman,
T.B.-6 Zhigou, SP-6 Sanyinjiao, Ren-4 Guanyuan,
Ren-6 Qihai, P-7 Daling. All with reducing or even
method.
Herbal treatment
Prescriptions
• XIAO YAO SAN Free and Easy Wanderer
Powder
• CHAI HU SHU GAN TANG Bupleurum
Pacifying the Liver Decoction
• WU YAO TANG Variation Linderia Decoction
Variation
• QI ZHI XIANG FU WAN Seven Prepared
Cyperus Pill
• DING JING TANG Variation Settling the Menses
Decoction Variation
Women’s Treasure remedy
• FREEING THE MOON
Acupuncture and/or herbal therapy are effective in treating the problem of Late Periods. Perhaps the herbal treatment is slightly more effective, particularly for the Empty
patterns. The most difficult pattern to treat is that of
Kidney deficiency which will therefore take the longest.
An important consideration when treating Late Periods
is the contraceptive pill: if a woman stops taking the contraceptive pill after using it for years, it is very common for
the periods to become late. From this point of view, it therefore seems to induce a deficiency of Blood and a Kidney
deficiency. When the periods are reluctant to come on time
after years of contraceptive pill use, the treatment is more
difficult and will take much longer: the patient should be
encouraged to persevere as it may take several months or
even a year to bring the periods back to a normal cycle.
A patient suffering from Blood or a Kidney deficiency
should make sure that she has an adequately nourishing diet and takes adequate rest. Those suffering from
Cold in the Uterus should absolutely avoid cold-energy
foods and ice-cold drinks. They should also drink a
decoction of fresh ginger and brown sugar every day.
Table 9.4 Comparison of formulae Xiao Yao San, Chai Hu Shu Gan Tang, Wu Yao Tang, Qi Zhi
Xiang Fu Wan and Ding Jing Tang for Late Periods from Qi stagnation
PATTERNS
SYMPTOMS
TONGUE
PULSE
Xiao Yao San
Liver-Qi stagnation,
Liver-Blood deficiency,
Spleen-Qi deficiency
Slight distension before period comes,
period scanty, irritability
Pale sides
Fine or Choppy and
slightly Wiry on
the left
Chai Hu Shu
Gan Tang
Liver-Qi stagnation
Abdominal pain before the period,
painful period, irritability
Slightly Red
sides
Wiry
Wu Yao Tang
Liver-Qi stagnation,
slight Blood stasis
Abdominal pain before the period,
period stops and starts, painful
period, irritability
Red sides
Wiry
Qi Zhi Xiang Fu
Wan
Liver-Qi stagnation,
Blood stasis, Cold in the
Uterus
Severe abdominal pain before the
period, painful period, stops and
starts, dark blood with clots, mental
restlessness
Purple
Wiry
Ding Jing Tang
Liver-Qi stagnation,
Kidney deficiency, Blood
deficiency
Abdominal distension before the
period, scanty period, tiredness,
backache, dizziness
Pale, Swollen
Fine, Choppy or
Weak
Late Periods 223
END NOTES
1. Shen Jin Ao 1774 Jade Ruler of Gynaecology (Fu Ke Yu Chi), cited
in Luo Yuan Kai 1986 Gynaecology in Chinese Medicine (Zhong Yi
Fu Ke Xue
), Shanghai Science and Technology Press,
Shanghai, p. 43.
2. Long Jiajun, Zhang Qi, Shen Kang, Lin Hongyang 1996 Dr Zhang
Jian Zhai’s Experience in Treating Gynaecological Diseases (Zhang
Jian Zhai Zhi Liao Fu Ke Bing Jing Yan), Journal of Traditional Chinese
Medicine (Zhong Yi Za Zhi
), China Academy of Traditional
Chinese Medicine, Beijing, No. 1, p. 16.
3. Heilongjiang Province National Medical Research Group 1984 An
Explanation of the Great Compendium of Acupuncture (Zhen Jiu Da
Cheng Jiao Shi
), People’s Health Publishing House,
Beijing, p. 1107. The Great Compendium of Acupuncture itself was published in 1601.
4. Cong Chun Yu 1989 Selection of Clinical Experiences in
Chinese Gynaecology (Zhong Yi Fu Ke Lin Chuang Jing Yan Xuan
), Chinese Medicine and Pharmacology
Publishing House, Beijing, p. 82.
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CHAPTER 10
IRREGULAR PERIODS
AETIOLOGY 225
PATHOLOGY 226
IDENTIFICATION OF PATTERNS AND TREATMENT 226
Liver-Qi stagnation 226
Kidney-Yang deficiency 227
Kidney-Yin deficiency 228
Ancient acupuncture prescriptions for Irregular Periods 230
PROGNOSIS AND PREVENTION 230
The term ‘Irregular Periods’ refers to periods that
come with an irregular cycle, sometimes early, sometimes late. It is important to note that if the periods
come consistently early or consistently late, they fall
under the categories of Early Periods or Late Periods
respectively: thus, it is only when they are sometimes
late and sometimes early in an unpredictable manner
that they constitute Irregular Periods. An irregularity of the cycle in the time preceding the menopause
is normal; similarly for some months after the
menarche.
When questioning a woman patient, it is important to
make sure that her particular problem does indeed fall
into this category; many women refer to their periods
as being ‘irregular’ when they are in fact consistently
early or consistently late.
Irregular Periods are called Yue Jing Xian Hou Wu
Ding Qi which means ‘an irregular cycle with periods
that come early or late’. In the old literature the condition was also called Jing Luan which means ‘chaotic
periods’.
An irregularity of the cycle is always related to the
Liver and Kidneys (and especially the latter) because
it is the rhythmic ebb and flow of Blood and Essence
that give rise to the periods. Thus, these two organs
are responsible for the internal, biological clock that
determines the menstrual cycle. In fact, Fu Qing Zhu
says in Fu Qing Zhu’s Gynaecology:
The menstrual flow originates from the Kidneys, the
Liver is the Child of the Kidneys, when the Liver stagnates the Kidneys also stagnate. When the Kidneys
stagnate their Qi does not diffuse, early periods, late periods, stoppage or continuation of the periods all relate to
Kidney-Qi being free or obstructed . . . Whether Liver-Qi
is free or obstructed affects whether Kidney-Qi goes or
stays.1
This statement clearly stresses that the regularity of the menstrual cycle depends first and foremost
on Liver and Kidneys: this is because the Liver stores
Blood and the Kidneys are the origin of the Heavenly
Gui. An interesting aspect of the above statement is
Fu Qing Zhu’s reference to Kidney-Qi stagnation, a
condition that is not usually mentioned as one of the
patterns of disharmony but that does, nonetheless,
exist.
AETIOLOGY
Emotional stress
Emotional stress such as anger, frustration or resentment may cause Liver-Qi to become stagnant and the
Directing and Penetrating Vessels (Ren and Chong Mai)
to become obstructed. When Qi stagnates for some
time, Blood also stagnates so that the Sea of Blood
(of the Penetrating Vessel) cannot fill the Uterus and
the periods become irregular.
226 Section 4: Menstrual Irregularities
The Complete Works of Jing Yue (1624) attributes
great importance to emotional problems as a cause of
irregular periods. It says:
Unfulfilled longing and deep pensiveness cause the Qi of
Heart and Spleen to stagnate, this injures the source of the
Directing and Penetrating vessels, and Kidney-Qi declines:
in mild cases the periods become irregular, in severe cases
they may stop altogether.2
Overwork, too many children
too close together
Overwork or having too many children too close
together lead to a Kidney deficiency: when the Kidneys
are deficient, the Directing and Penetrating Vessels
become depleted, the Sea of Blood of the Penetrating
Vessel cannot fill the Uterus and the periods become
irregular.
PATHOLOGY
The pathology of Irregular Periods may be due to:
• Liver-Qi stagnation
• Kidney deficiency (Yang or Yin).
The Liver and Kidneys are therefore the two organs
at the root of this problem. This is understandable
because it is these two organs that are most responsible for the cyclical recurrence of the periods. In fact,
the Liver stores Blood and is closely related to the
Penetrating Vessel and the Kidneys are the origin of the
Heavenly Gui that crystallizes into menstrual blood.
Irregular Periods from Kidney deficiency tend to occur
in older women.
Treatment principle
Pacify the Liver, move Qi, eliminate stagnation, regulate the periods.
Acupuncture
LIV-3 Taichong, T.B.-6 Zhigou, P-6 Neiguan, LIV-14
Qimen, Ren-4 Guanyuan, Ren-6 Qihai, SP-4 Gongsun
(on the right) and P-6 Neiguan (on the left). All with
reducing or even method.
Explanation
– LIV-3, T.B.-6, and LIV-14 pacify the Liver, move Qi
and eliminate stagnation.
– P-6, related to the Liver channel through the
Terminal Yin, moves Liver-Qi, calms the Mind and
settles the Ethereal Soul.
– Ren-4 and Ren-6 move Qi in the Lower Burner and
strengthen the Uterus.
– SP-4 and P-6 regulate the Penetrating Vessel
and subdue rebellious Qi. They are selected if there
are clear symptoms of rebellious Qi of this vessel
such as a feeling of distension of the abdomen that
seems to transmit upwards to the chest, a feeling of
oppression or tightness of the chest with sighing
and a vague feeling of anxiety.
Prescription from the Great Compendium
of Acupuncture (1601)3
– Ren-6 Qihai, Ren-3 Zhongji, G.B.-26 Daimai, BL-23
Shenshu and SP-6 Sanyinjiao.
Herbal treatment
a. Prescription
IDENTIFICATION OF PATTERNS
AND TREATMENT
– XIAO YAO SAN
– Free and Easy Wanderer Powder
Liver-Qi stagnation
Clinical manifestations
Explanation This formula, which has already been
explained, pacifies the Liver, moves Qi, eliminates stagnation, nourishes Liver-Blood and tonifies Spleen-Qi.
Irregular periods usually with scanty bleeding with
some clots, abdominal and breast distension, premenstrual tension, depression, sighing, irritability.
Tongue: normal coloured or, if the stagnation is longstanding, slightly Red sides. Pulse: Wiry.
Modifications
• If there is abdominal pain, add Xiang Fu Rhizoma
Cyperi and Yan Hu Suo Rhizoma Corydalis.
• If stagnant Liver-Qi turns into Fire, add Mu Dan Pi
Cortex Moutan and Shan Zhi Zi Fructus Gardeniae.
Irregular Periods 227
b. Prescription
– DING JING TANG
– Settling the Menses Decoction
Explanation This formula, by Fu Qing Zhu, pacifies
the Liver and tonifies the Kidneys. Since an underlying deficiency of the Kidneys nearly always accompanies Liver-Qi stagnation when the periods are
irregular, this formula is well adapted to treat the type
of patients we see. About irregular periods, Fu Qing
Zhu says:
When the child is ill the mother attends to it. When the
Liver stagnates the Kidneys have compassion; opening or
blockage of Liver-Qi implies going or staying of Kidney-Qi . . .
One must pacify the Liver and open the stagnation of
Kidney-Qi.4
– Tu Si Zi, Shu Di Huang and Shan Yao tonify the
Kidneys.
– Bai Shao and Dang Gui nourish Liver-Blood and
pacify the Liver.
– Fu Ling resolves Dampness.
– Jing Jie stops bleeding.
– Chai Hu pacifies the Liver, moves Qi and eliminates
stagnation.
Women’s Treasure remedy
– FREEING THE MOON
This remedy is a variation of Xiao Yao San Free
and Easy Wanderer Powder, with more emphasis
placed on nourishing Blood and calming the Mind.
The tongue presentation appropriate to this remedy
is a Pale body or a normal-coloured body with Pale
sides.
SUMMARY
Liver-Qi stagnation
Treatment principle
Pacify the Liver, move Qi, eliminate stagnation,
regulate the periods.
Acupuncture
LIV-3 Taichong, T.B.-6 Zhigou, P-6 Neiguan, LIV14 Qimen, Ren-4 Guanyuan, Ren-6 Qihai, SP-4
Gongsun (on the right) and P-6 Neiguan (on the
left). All with reducing or even method.
Herbal treatment
Prescriptions
• XIAO YAO SAN Free and Easy Wanderer
Powder
• DING JING TANG Settling the Menses
Decoction
Women’s Treasure remedy
• FREEING THE MOON
Kidney-Yang deficiency
Clinical manifestations
Irregular periods that are scanty with pale menstrual
blood, no clots, backache, dizziness, tinnitus, feeling cold, frequent, pale urination. Tongue: Pale and
Swollen. Pulse: Weak, Deep.
Treatment principle
Tonify and warm the Kidneys, regulate the periods,
consolidate the Penetrating and Directing Vessels.
Acupuncture
BL-23 Shenshu, Ren-4 Guanyuan, KI-3 Taixi, LU-7
Lieque (on the right) and KI-6 Zhaohai (on the left),
ST-36 Zusanli, SP-6 Sanyinjiao. All with reinforcing
method, moxa must be used.
Clinical manifestations
Irregular periods usually with scanty bleeding with
some clots, abdominal and breast distension, premenstrual tension, depression, sighing, irritability.
Tongue: normal coloured or, if the stagnation is
longstanding, slightly Red sides. Pulse: Wiry.
Explanation
– BL-23, Ren-4 (with moxa cones) and KI-3 tonify
the Kidneys.
– LU-7 and KI-6 regulate the Directing Vessel,
regulate the periods, strengthen the Uterus and
tonify the Kidneys.
228 Section 4: Menstrual Irregularities
– ST-36 and SP-6 tonify Qi and Blood in general. They
are a very effective tonic treatment of Spleen and
Kidneys especially when needled with warm needle.
It also nourishes Blood. The tongue presentation
appropriate to this remedy is a Pale body.
Women’s Treasure remedy
Herbal treatment
a. Prescription
– GU YIN JIAN
– Consolidating the Yin Decoction
– UNICORN PEARL
SUMMARY
Kidney-Yang deficiency
Clinical manifestations
Explanation This formula, already explained, tonifies Qi and Blood and strengthens Kidney-Yang. It is
specific to regulate the period cycle.
Modifications
• If the symptoms and signs of Yang deficiency are
pronounced, add Rou Gui Cortex Cinnamomi and Bu
Gu Zhi Fructus Psoraleae.
Irregular periods that are scanty with pale menstrual
blood, no clots, backache, dizziness, tinnitus, feeling
cold, frequent, pale urination. Tongue: Pale and
Swollen. Pulse: Weak, Deep.
Treatment principle
Tonify and warm the Kidneys, regulate the periods,
consolidate the Penetrating and Directing vessels.
Acupuncture
b. Prescription
– YI SHEN FU YANG TANG
– Benefiting the Kidneys and Supporting the Yang
Decoction
Explanation
– Ren Shen tonifies Qi and strengthens the Original Qi.
– Shu Di Huang, Shan Zhu Yu and Shan Yao tonify
the Kidneys, Liver and Spleen.
– Tu Si Zi and Bu Gu Zhi tonify Kidney-Yang.
– Yuan Zhi calms the Mind.
– Wu Wei Zi nourishes the Essence.
– Zhi Gan Cao harmonizes.
– Fu Zi and Rou Gui strongly tonify the Fire of the
Gate of Life and expel Cold.
This formula differs from the previous one in that it
is much hotter in nature and strongly tonifies the Fire
of the Gate of Life. It is therefore suitable only if the
manifestations of Yang deficiency and internal Cold
are pronounced.
Three Treasures remedy
– STRENGTHEN THE ROOT
This remedy is a variation of You Gui Wan Restoring
the Right [Kidney] Pill which tonifies Kidney-Yang. Its
Yang-tonifying effect lies between that of Jin Gui Shen
Qi Wan and Wu Ji Bai Feng Wan mentioned above.
BL-23 Shenshu, Ren-4 Guanyuan, KI-3 Taixi, LU-7
Lieque (on the right) and KI-6 Zhaohai (on the left),
ST-36 Zusanli, SP-6 Sanyinjiao. All with reinforcing
method, moxa must be used.
Herbal treatment
Prescriptions
• GU YIN JIAN Consolidating the Yin Decoction
• YI SHEN FU YANG TANG Benefiting the
Kidneys and Supporting the Yang Decoction
Three Treasures remedy
• STRENGTHEN THE ROOT
Women’s Treasure remedy
• UNICORN PEARL
This remedy tonifies Kidney-Yang and the KidneyEssence. The tongue presentation appropriate to this
remedy is a Pale and wet body.
Kidney-Yin deficiency
Clinical manifestations
Irregular and scanty periods, dizziness, burred vision,
night sweating, feeling of heat in the evening. Tongue:
without coating; Red, if there is Empty-Heat. Pulse:
Floating-Empty or Fine and Rapid.
Irregular Periods 229
Treatment principle
Nourish Yin, tonify the Kidneys, consolidate the
Directing and Penetrating Vessels.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-3 Taixi, SP-6 Sanyinjiao,
Ren-7 Jinjiao. All with reinforcing method, no moxa.
– Gui Ban Jiao nourishes Kidney-Yin, subdues Yang and
strengthens the Directing and Penetrating Vessels.
Modifications
• If there are pronounced symptoms and signs of
Empty-Heat, add Zhi Mu Rhizoma Anemarrhenae and
Di Gu Pi Cortex Lycii.
Three Treasures remedy
– NOURISH THE ROOT
Explanation
– LU-7 and KI-6 regulate the Directing Vessel,
strengthen the Uterus and nourish the Kidneys.
– Ren-4, SP-6 and KI-3 nourish the Kidneys.
– Ren-7 nourishes the Yin and strengthens the Uterus.
Herbal treatment
This remedy, a variation of Zuo Gui Wan, nourishes
Liver- and Kidney-Yin and Blood and strengthens the
Directing and Penetrating Vessels.
Women’s Treasure remedy
– GROWING JADE
a. Prescription
– LIU WEI DI HUANG WAN
– Six-Ingredient Rehmannia Pill
SUMMARY
Kidney-Yin Deficiency
Explanation This formula, already explained, nourishes Liver- and Kidney-Yin.
b. Prescription
– ZUO GUI WAN
– Restoring the Left [Kidney] Pill
Explanation This prescription nourishes Liver- and
Kidney-Yin and Blood. For gynecological problems
I prefer it to the formula Liu Wei Di Huang Wan because
it has a broader action: in fact it nourishes Blood with
Gou Qi Zi and it specifically strengthens the Directing
and Penetrating Vessels with Gui Ban Jiao. It also has
the additional action of strengthening the back and
knees (with Niu Xi and Lu Jiao).
– Shu Di Huang, Shan Zhu Yu and Shan Yao nourish
Liver and Kidneys.
– Gou Qi Zi nourishes Yin and Blood.
– Chuan Niu Xi nourishes the Kidneys and benefits
the sinews and lower back.
– Tu Si Zi and Lu Jiao tonify Kidney-Yang. Although
the main thrust of the formula is to nourish KidneyYin, tonification of Kidney-Yang is necessary
because, especially in women over 40, both KidneyYin and Kidney-Yang are often deficient.
Clinical manifestations
Irregular and scanty periods, dizziness, blurred vision,
night sweating, feeling of heat in the evening.
Tongue: without coating; Red, if there is Empty-Heat.
Pulse: Floating-Empty or Fine and Rapid.
Treatment principle
Nourish Yin, tonify the Kidneys, consolidate the
Directing and Penetrating Vessels.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-3 Taixi, SP-6 Sanyinjiao,
Ren-7 Jinjiao. All with reinforcing method, no moxa.
Herbal treatment
Prescriptions
• LIU WEI DI HUANG WAN Six-Ingredient
Rehmannia Pill
• ZUO GUI WAN Restoring the Left [Kidney] Pill
Three Treasures remedy
• NOURISH THE ROOT
Women’s Treasure remedy
• GROWING JADE
230 Section 4: Menstrual Irregularities
This remedy nourishes Kidney-Yin and the KidneyEssence. The appropriate tongue presentation is a Red
body without coating.
Ancient acupuncture prescriptions
for Irregular Periods5
1. Ren-6 Qihai, Ren-3 Zhongji, G.B.-26 Daimai
(1 moxa cone), BL-23 Shenshu, SP-6 Sanyinjiao
(Great Compendium of Acupuncture and Moxibustion,
Zhen Jiu Da Cheng
, 1601).
2. Ren-6 Qihai, Ren-3 Zhongji and KI-6 Zhaohai for
irregular periods from stasis of Blood (Illustrated
Supplement to the Classic of Categories, Lei Jing Tu Yi
, 1624).
3. Ren-3 Zhongji, Ren-6 Qihai and BL-33 Zhongliao
(Bian Que’s Jade Dragon Classic of MiraculouslyEffective Acupuncture, Bian Que Shen Ying Zhen Yu
Long Jing
, 1329).
4. Ren-4 Guanyuan for irregular period with a feeling
of cold during the period (Great Compendium of
Acupuncture, Zhen Jiu Da Cheng
, 1601).
5. L.I.-11 Quchi, T.B.-6 Zhigou, ST-36 Zusanli and
SP-6 Sanyinjiao (Great Compendium of Acupuncture,
Zhen Jiu Da Cheng
, 1601).
6. KI-8 Jiaoxin, SP-10 Xuehai and G.B.-26 Daimai
(Experience of Acupuncture and Moxibustion Therapy,
Zhen Jiu Zi Sheng Jing
, 1220).
7. Ren-4 Guanyuan, P-5 Jianshi, KI-6 Zhaohai, ST-25
Tianshu, Ren-5 Shimen (7 to 100 moxa cones)
for irregular periods with Blood masses (Collection
of Acupuncture and Moxibustion, Zhen Jiu Ji Cheng
, 1874).
PROGNOSIS AND PREVENTION
Irregular periods can be quite difficult to treat and the
treatment may take a long time. The pattern of KidneyYin deficiency is the most difficult, that of Liver-Qi
stagnation the least. Again, if the periods have become
irregular because the patient has been using the contraceptive pill, it may take longer to treat. Although
various patterns may cause the periods to become irregular, I always treat the Liver and Kidneys when there is
an irregularity in the cycle. Thus, I would add one or
two Kidney tonics to the formulae for Liver-Qi stagnation. The formulae for Kidney-Yang and Kidney-Yin
deficiency do not need any modifications in this sense
because they already contain Liver and Kidney tonics.
Women suffering from irregular periods from Liver-Qi
stagnation should pay attention to their emotional
life and try to identify what factor in their life is causing Liver-Qi to stagnate. Apart from trying to help the
patient to find out and deal with her emotional issues,
it is often necessary to emphasize the emotional aspect
of the treatment by using points such as P-7 Daling to
settle the Ethereal Soul or BL-23 Shenshu, BL-52 Zhishi
and BL-47 Hunmen to strengthen the Will Power and
regulate the ‘coming and going’ of the Ethereal Soul:
these points will help the patient when she feels disoriented, aimless and depressed.
Those suffering from a Kidney deficiency, usually
older women, should pay attention to having enough
rest and should not overwork.
END NOTES
1. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai,
p. 17. First published in 1827. Fu Qing Zhu was born in 1607 and died
in 1684.
2. Zhang Jing Yue 1624 The Complete Works of Jing Yue (Jing Yue
Quan Shu) cited in Luo Yuan Kai 1986 Gynaecology in Chinese
Medicine (Zhong Yi Fu Ke Xue
), Shanghai Science and
Technology Press, Shanghai, p. 45.
3. Heilongjiang Province National Medical Research Group, 1984, An
Explanation of the Great Compendium of Acupuncture (Zhen Jiu Da
Cheng Jiao Shi
), People’s Health Publishing House,
Beijing, p. 1107. The Great Compendium of Acupuncture itself was
published in 1601.
4. Fu Qing Zhu’s Gynaecology, p. 17.
5. Wang Xue Tai 1995 Great Treatise of Chinese Acupuncture (Zhong
Guo Zhen Jiu Da Quan),
Henan Science and
Technology Publishing House, p. 499.
CHAPTER 11
HEAVY PERIODS
AETIOLOGY 231
PATHOLOGY 232
Trickling is more difficult to treat than Heavy Periods.
Table 11.1 illustrates the main differences between
Heavy Periods and Flooding and Trickling; see also
Fig. S-4.1 (p. 198).
IDENTIFICATION OF PATTERNS AND TREATMENT 232
Qi deficiency 232
Blood-Heat 233
Blood stasis 235
AETIOLOGY
Excessive physical work
PROGNOSIS AND PREVENTION 237
‘Heavy Periods’ means periods that occur regularly
and last the customary 5 days or thereabouts but are
heavier than normal. As mentioned in Chapter 2 on
physiology, the average blood loss during a menstrual
cycle is 30–80 ml. Since the range of blood loss is quite
broad, the definition of a ‘heavy’ period can be rather
subjective and difficult to gauge. Generally speaking, a
period may be called ‘heavy’ if it starts with a gush of
blood, catching the woman unaware and necessitating
an urgent resort to a tampon or sanitary towel (pad),
or if the woman has to make very frequent changes of
these protective devices.
As a category of disease-symptom in Chinese medicine, Heavy Periods (called Yue Jing Guo Duo) should
be differentiated from Flooding and Trickling (Beng
Lou). The former consists of heavy bleeding which
occurs at the proper time and within the proper span
of the periods (approximately 5 days); the latter consists of very heavy bleeding that may both start before
the proper time and continue after it, and may also
trickle on for a long time after the period should have
ended. The distinction between these two conditions
is not too important in terms of pathology and treatment, which are essentially the same, but it matters
from a prognostic perspective: in fact, Flooding and
Excessive physical work, including exercise or sports,
may injure the Spleen, so that deficient Spleen-Qi fails
to hold Blood, the Directing and Penetrating Vessels are
weakened and the period becomes heavy.
Emotional stress, irregular diet,
external heat
Emotional stress leads to Qi stagnation and, if this continues for a long time, stagnant Qi may turn into Fire.
Excessive consumption of hot, spicy foods and alcohol
may also lead to Heat or Fire, which may derive from
external Heat as well. Whatever the cause, if Heat
enters the Blood portion and agitates the Blood so that
it spills out of the blood vessels, this gives rise to heavy
periods.
Emotional stress, surgery,
post-partum conditions
Qi stagnation from emotional stress as described above
may turn into Blood stasis rather than Fire. Abdominal
surgery and post-partum conditions also frequently
lead to Blood stasis. Whatever the cause, when Blood
stagnates, the Directing and Penetrating Vessels
become obstructed, new Blood cannot enter the channels (because they are blocked by stagnant Blood),
bleeding occurs and heavy periods may develop.
232 Section 4: Menstrual Irregularities
Table 11.1 Differentiation between heavy periods
and flooding and trickling
AMOUNT
TIMING
CYCLE
Heavy
Periods
More than
normal
During the normal
period time
Regular
Flooding
and
Trickling
Very heavy,
flooding,
sudden onset,
long trickle
Can occur outside
the normal period
time (before and/
or after)
Irregular
PATHOLOGY
The pathology of Heavy Periods consists of:
•
•
•
Qi deficiency
Blood-Heat
Blood stasis.
Acupuncture
Du-20 Baihui, Ren-12 Zhongwan, Ren-6 Qihai, Ren-4
Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20
Pishu, BL-23 Shenshu. All with reinforcing method;
moxa should be used.
Explanation
– Du-20 raises Qi. This point can be stimulated with a
moxa stick.
– Ren-12, ST-36, SP-6 and BL-20 tonify Spleen-Qi.
– Ren-6 tonifies and raises Qi. It is very effective with
direct moxa cones.
– Ren-4 tonifies the Kidneys and consolidates
Directing and Penetrating Vessels.
– BL-23 is used if there is also a Kidney deficiency.
Herbal treatment
In the first pattern, Blood leaks out because deficient
Spleen-Qi fails to hold it in the vessels. In the second, it
spills over because Heat agitates it and forces it out of
the vessels. In the third, it leaks out because the vessels
are obstructed by stagnant Blood and newly generated
Blood has no place to go to. The pattern of Qi deficiency is therefore primarily related to the Spleen, but
the Kidneys also play their part because Kidney-Qi also
holds Blood in the vessels (especially the blood vessels
of the Uterus). The patterns of Blood-Heat and Blood
stasis are mostly related to the Liver.
a. Prescription
IDENTIFICATION OF PATTERNS
AND TREATMENT
Explanation This formula, already explained, tonifies
and raises Spleen-Qi to stop bleeding. Very similar to
the previous one, it is perhaps more suitable to stop
bleeding because it contains Dang Gui to enter the
Blood portion.
All the herbal prescriptions in this section are detailed
in Appendix 1 on p. 937.
– JU YUAN JIAN
– Raising the Original [Qi] Decoction
Explanation This prescription, already explained,
tonifies and raises Spleen-Qi: this will stop the bleeding
from deficiency.
b. Prescription
– BU ZHONG YI QI TANG
– Tonifying the Centre and Benefiting Qi Decoction
Qi deficiency
c. Prescription
Clinical manifestations
– GUI PI TANG
– Tonifying the Spleen Decoction
Heavy period, pale and dilute blood, pale complexion,
tiredness. Spleen-Qi deficiency: loose stools, slight abdominal distension. Kidney-Qi deficiency: frequent urination,
backache, dizziness. Tongue: Pale. Pulse: Weak.
Treatment principle
Tonify and raise Qi of Spleen and/or Kidneys, contain
Blood, consolidate the Directing and Penetrating Vessels.
Explanation This formula, already explained, tonifies Spleen-Qi and calms the Mind. It is suitable to
stop bleeding because it also contains Dang Gui,
which enters the Blood portion, and is particularly
appropriate if the patient suffers from anxiety and
depression.
Modifications These modifications apply to all three
previous formulae.
Heavy Periods 233
– If the period is very heavy, add E Jiao Colla Corii
asini, Wu Zei Gu Endoconcha Sepiae and Pao Jiang
Rhizoma Zingiberis preparatum (fried).
– If the period is long, add Pu Huang Pollen Typhae
and Yi Mu Cao Herba Leonuri.
– If there are symptoms of Kidney-Yang deficiency,
add Xu Duan Radix Dipsaci and Ai Ye Folium
Artemisiae argyi.
d. Prescription
– JIA JIAN SI WU TANG
– Modified Four Substances Decoction
Explanation This formula, by Fu Qing Zhu, is for
chronic conditions of heavy bleeding from Qi deficiency resulting in Blood deficiency as well. Although
it may seem strange that heavy bleeding occurs when
Blood is deficient, Fu Qing Zhu explains this by saying
that, no matter how deficient Blood is, if it does not
return to the vessels properly, menstruation will be
heavy.1
– Shu Di Huang, Bai Shao, Dang Gui and Chuan
Xiong nourish Blood.
– Bai Zhu tonifies Qi which helps to nourish Blood.
– Jing Jie stops bleeding.
– Shan Zhu Yu and Xu Duan tonify the Liver and
Kidneys, consolidate the Directing and Penetrating
Vessels and stop bleeding.
– Gan Cao harmonizes.
Women’s Treasure remedy
– RESTRAIN THE FLOW
This remedy is specific to stop uterine bleeding from
Qi deficiency. The tongue presentation appropriate to
this remedy is a Pale body.
SUMMARY
Qi deficiency
Clinical manifestations
Heavy period, pale and dilute blood, pale complexion, tiredness. Spleen-Qi deficiency: loose stools,
slight abdominal distension. Kidney-Qi deficiency:
frequent urination, backache, dizziness. Tongue:
Pale. Pulse: Weak.
Treatment principle
Tonify and raise Qi of Spleen and/or Kidneys, contain
Blood, consolidate the Directing and Penetrating
Vessels.
Acupuncture
Du-20 Baihui, Ren-12 Zhongwan, Ren-6 Qihai, Ren-4
Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20
Pishu, BL-23 Shenshu. All with reinforcing method;
moxa should be used.
Herbal treatment
Prescriptions
• JU YUAN JIAN Raising the Original [Qi]
Decoction
• BU ZHONG YI QI TANG Tonifying the Centre
and Benefiting Qi Decoction
• GUI PI TANG Tonifying the Spleen
Decoction
• JIA JIAN SI WU TANG Modified Four
Substances Decoction
Women’s Treasure remedy
• RESTRAIN THE FLOW
Three Treasures remedy
• TONIFY QI AND EASE THE MUSCLES
Three Treasures remedy
– TONIFY QI AND EASE THE MUSCLES
This remedy is a variation of Bu Zhong Yi Qi Tang
Tonifying the Centre and Benefiting Qi Decoction: it tonifies and raises Spleen-Qi and can stop bleeding. It also
resolves Dampness and is therefore suitable if there are
pronounced symptoms of this, which is a very common occurrence. The tongue presentation appropriate
to this remedy is a Pale and Swollen body with a sticky
coating.
Blood-Heat
Clinical manifestations
Heavy period, bright red or dark red, dense blood, mental restlessness, anxiety, a feeling of heat, thirst, dark
urine, headaches. Tongue: Red, redder sides. Pulse:
Rapid, Overflowing. This pattern affects mostly the
Liver and Heart.
234 Section 4: Menstrual Irregularities
Treatment principle
Clear Heat, cool Blood, stop bleeding.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the
left), L.I.-11 Quchi, SP-10 Xuehai, KI-2 Rangu, LIV-3
Taichong, SP-6 Sanyinjiao, BL-17 Geshu, SP-8 Diji. All
with reducing method, no moxa.
Explanation
– SP-4 and P-6 regulate the Penetrating Vessel. This
vessel is the Sea of Blood and is therefore closely
involved in menstrual bleeding from Blood-Heat.
– L.I.-11, SP-10, SP-6 and BL-17 cool Blood.
– KI-2 and LIV-3 in combination cool Blood.
– SP-8, Accumulation point, stops uterine bleeding.
Herbal treatment
a. Prescription
– BAO YIN JIAN Variation
– Protecting Yin Decoction Variation
Explanation The first eight herbs constitute the formula Bao Yin Jian which nourishes Yin and clears
Heat.
– Sheng Di Huang, Bai Shao and Shu Di Huang
nourish Yin and Blood and cool Blood.
– Shan Yao tonifies the Spleen and Kidneys.
– Huang Qin and Huang Bo clear Heat.
– Xu Duan tonifies the Kidneys.
– Gan Cao harmonizes.
– Di Yu and Huai Hua were added to cool Blood and
stop bleeding.
Modifications
• If the period is heavy and long, add Wu Zei Gu
Endoconcha Sepiae, Qian Cao Gen Radix Rubiae, and
Xian He Cao Herba Agrimoniae.
• If there is both Qi and Yin deficiency induced by the
longstanding blood loss, use Liang Di Tang Two ‘Di’
Decoction and Sheng Mai San Generating the Pulse
Powder in combination.
b. Prescription
– AN CHONG TANG
– Calming the Penetrating Vessel Decoction
Explanation This formula is used if longstanding
bleeding has given rise to Yin and Qi deficiency with
symptoms of Qi deficiency such as tiredness, palpitations and shortness of breath.
– Bai Zhu and Huang Qi tonify and raise Qi.
– Long Gu and Mu Li firm Qi, stop bleeding and nourish Yin.
– Sheng Di Huang and Bai Shao nourish Yin and cool
Blood.
– Wu Zei Gu is astringent and stops bleeding.
– Qian Cao Gen cools and invigorates Blood and stops
bleeding.
– Xu Duan tonifies the Kidneys and stops bleeding.
c. Prescription
– JIE DU SI WU TANG Variation
– Expelling Toxin Four Substances Decoction Variation
Explanation This formula is used if external Heat
penetrates the Interior and generates Toxic-Heat and
Blood-Heat which lead to bleeding. The first eight herbs
constitute the formula Jie Du Si Wu Tang.
– Huang Lian, Huang Qin, Huang Bo and Shan Zhi Zi
clear Heat and Dampness, and resolve Toxic-Heat.
– Sheng Di Huang nourishes Yin, cools Blood and
stops bleeding.
– Dang Gui and Bai Shao nourish Blood and ‘calm’
Blood to stop bleeding.
– Chuan Xiong, part of Si Wu Tang, invigorates Blood.
– Bai Jiang Cao resolves Fire-poison and invigorates
Blood.
– Mu Dan Pi cools Blood and stops bleeding.
Women’s Treasure remedy
– COOL THE MENSES
This remedy is specific to reduce uterine bleeding
occurring from Blood-Heat. The tongue presentation
appropriate to this remedy is a Red body with a yellow
coating.
SUMMARY
Blood-Heat
Clinical manifestations
Heavy period, bright red or dark red, dense blood,
mental restlessness, anxiety, a feeling of heat, thirst,
Heavy Periods 235
dark urine, headaches. Tongue: Red, redder sides.
Pulse: Rapid, Overflowing.
Treatment principle
Clear Heat, cool Blood, stop bleeding.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the
left), L.I.-11 Quchi, SP-10 Xuehai, KI-2 Rangu, LIV-3
Taichong, SP-6 Sanyinjiao, BL-17 Geshu, SP-8 Diji. All
with reducing method, no moxa.
Herbal treatment
Prescriptions
• BAO YIN JIAN Variation Protecting Yin
Decoction Variation
• AN CHONG TANG Calming the Penetrating
Vessel Decoction
• JIE DU SI WU TANG Variation Expelling Toxin
Four Substances Decoction Variation
Women’s Treasure remedy
• COOL THE MENSES
–
–
–
–
SP-8 stops bleeding.
SP-6 invigorates Blood.
Ren-6 moves Qi in the Lower Burner.
KI-14, a point of the Penetrating Vessel, eliminates
stagnation in the Lower Burner and Uterus.
– ST-29 invigorates Blood in the Uterus.
– LIV-3 moves Liver-Qi and invigorates Liver-Blood.
Herbal treatment
Prescription
– SI WU TANG and SHI XIAO SAN Variation
– Four Substances Decoction and Breaking into a Smile
Powder Variation
Explanation The first four herbs constitute the formula Si Wu Tang which invigorates Blood. The herbs
Pu Huang and Wu Ling Zhi make up the formula Shi
Xiao San which invigorates Blood, stops bleeding and
stops pain.
– San Qi invigorates Blood and stops bleeding.
– E Jiao stops bleeding and nourishes Blood.
Women’s Treasure remedy
Blood stasis
Clinical manifestations
Heavy period with dark, clotted blood, painful period,
abdominal pain which is worse with pressure and
better after passing menstrual clots. Tongue: Purple.
Pulse: Wiry.
– INVIGORATE BLOOD AND STEM THE FLOW
This remedy is specific to reduce uterine bleeding
from Blood stasis. The tongue presentation appropriate
to this remedy is a Purple body.
Three Treasures remedy
– STIR FIELD OF ELIXIR
Treatment principle
Invigorate Blood, eliminate stasis, stop bleeding, regulate the periods.
This remedy invigorates Blood in the Lower Burner
and stops bleeding. The tongue presentation appropriate to this remedy is a Purple body.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on
the left), SP-10 Xuehai, BL-17 Geshu, SP-8 Diji, SP-6
Sanyinjiao, Ren-6 Qihai, KI-14 Siman, ST-29 Guilai,
LIV-3 Taichong. All with reducing or even method. If
the stasis of Blood derives from Cold, moxa can be used.
Explanation
– SP-4 and P-6 regulate the Penetrating Vessel and
invigorate Blood as this vessel is the Sea of Blood.
– BL-17 and SP-10 invigorate Blood.
SUMMARY
Blood Stasis
Clinical manifestations
Heavy period with dark, clotted blood, painful
period, abdominal pain which is worse with pressure
and better after passing menstrual clots. Tongue:
Purple. Pulse: Wiry.
236 Section 4: Menstrual Irregularities
Treatment principle
Invigorate Blood, eliminate stasis, stop bleeding,
regulate the periods.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on
the left), SP-10 Xuehai, BL-17 Geshu, SP-8 Diji, SP-6
Sanyinjiao, Ren-6 Qihai, KI-14 Siman, ST-29 Guilai,
LIV-3 Taichong. All with reducing or even method. If
the stasis of Blood derives from Cold, moxa can be
used.
Herbal treatment
Prescription
• SI WU TANG and SHI XIAO SAN Variation Four
Substances Decoction and Breaking into a
Smile Powder Variation
Women’s Treasure remedy
• INVIGORATE BLOOD AND STEM THE FLOW
Three Treasures remedy
• STIR FIELD OF ELIXIR
Case history
A 22-year-old woman had been suffering from
very heavy periods ever since the menarche. Her
cycle was up to 6 weeks long, her period lasted
6 days with heavy bleeding and was painful,
and the menstrual blood was rather dark with
clots. Her main reason for seeking treatment,
however, was persistent acne for the previous
2 years. The acne manifested only on the face
with red papules or pustules: some of the papules became purple and took a long time to
go: the skin eruptions were worse before the
period. She had been given a contraceptive pill
to help the acne but this had actually made it
worse. On questioning, it transpired that she
also suffered from backache, slight dizziness,
slight tinnitus and night sweating during the
periods. She was also constipated. Her tongue
was slightly Red and had a sticky coating. Her
pulse was slightly Wiry and very Weak on the
left Rear position.
Diagnosis The main cause of the heavy periods
is stasis of Blood: the painful period and the dark
menstrual blood with clots clearly indicate this.
Stasis of Blood also accounts for the long cycle. It
was obviously not severe since her tongue was not
Purple. Besides this, she also suffered from DampHeat which was the cause of the acne: the DampHeat was also obvious from the tongue which was
Red and had a sticky coating. The condition of
Damp-Heat, however, was linked with her menstrual cycle and Blood because the acne clearly got
worse before the period. Blood affects the state
and lustre of the skin and, for this reason, a woman’s skin problems often become worse before the
period if there is a stagnation of Qi or Blood; this
deterioration is especially marked with acne. She
also had a Kidney-Yin deficiency evidenced by the
backache, slight dizziness, slight tinnitus, night
sweating and very Weak pulse on the left Kidney
position. If she suffered from a Kidney-Yin deficiency, why was her tongue not Red and peeled?
The answer was her age: when young people suffer the beginning of Yin deficiency, the tongue
often does not show it; very often, it shows
other exuberant conditions which are due to the
patient’s youth: in this case, her tongue showed
only Damp-Heat. Thus, her condition was characterized by two Full conditions (stasis of Blood
and Damp-Heat) and an Empty one (Kidney-Yin
deficiency).
Treatment principle I decided to tackle the Full
conditions first, i.e. stasis of Blood and Damp-Heat,
by adopting the treatment principle of harmonizing and invigorating Blood, eliminating stasis,
regulating the periods and resolving Damp-Heat.
Eliminating Blood stasis and resolving Damp-Heat
in this case can be achieved by regulating the periods: thus, one herbal formula can help both the
heavy periods and the acne. Only after the stasis of Blood and Damp-Heat had been eliminated,
would I start to nourish Kidney-Yin.
Acupuncture With acupuncture, I concentrated on
regulating the periods by using the Directing Vessel,
resolving Damp-Heat and invigorating Blood. The
points used over several treatments were chosen
from the following:
Heavy Periods 237
• LU-7 Lieque (on the right) and KI-6 (on the left)
to regulate the Directing Vessel and the periods.
• Ren-6 Qihai to move Qi in the Lower Burner in
order to invigorate Blood.
• KI-14 Siman, a point of the Penetrating Vessel,
to invigorate Blood in the Uterus.
• SP-6 Sanyinjiao to invigorate Blood and resolve
Dampness.
• SP-9 Yinlingquan and L.I.-11 to resolve DampHeat.
• L.I.-4 Hegu to affect the face.
Herbal treatment I used a variation of Qin Jiao Si
Wu Tang Gentiana macrophylla Four Substances
Decoction: although this formula is a variation
of Si Wu Tang for joint pain, it suited this patient
because it regulates the period, invigorates Blood
and resolves Damp-Heat. In fact, Qin Jiao expels
Wind and Dampness and Yi Yi Ren resolves DampHeat and softens spots; in addition, Qin Jiao will
also promote bowel movement. Can Sha was eliminated from the prescription.
• Dang Gui Radix Angelicae sinensis 6 g
• Sheng Di Huang Radix Rehmanniae 6 g
• Chi Shao Radix Paeoniae rubra 4 g
• Chuan Xiong Rhizoma Chuanxiong 6 g
• Qin Jiao Radix Gentianae macrophyllae 6 g
• Yi Yi Ren Semen Coicis 6 g
• Huang Qin Radix Scutellariae 4 g
• Ze Xie Rhizoma Alismatis 4 g
• Bai Xian Pi Cortex Dictamni 4 g
• Gan Cao Radix Glycyrrhizae 3 g
Explanation The formula Qin Jiao Si Wu Tang was
modified by substituting Chi Shao for Bai Shao in
order to invigorate Blood.
• Huang Qin and Bai Xian Pi were added to resolve
Damp-Heat.
•
Ze Xie was added to drain Dampness and also
clear the slight Empty-Heat deriving from Yin
deficiency (night sweating).
After 3 months of treatment along these lines, this
patient reported a good improvement in the periods: they were no longer painful and the menstrual
blood was red without clots. The acne improved
much more slowly and was still a problem, which
did not surprise me since this particular skin condition is quite stubborn to treatment. The patient is
still receiving treatment at the time of writing.
PROGNOSIS AND PREVENTION
Heavy Periods are amenable to treatment with acupuncture and/or Chinese herbs but the treatment may
take several months to show results. The most difficult
pattern to treat is that from Blood-Heat, the easiest that
from Qi deficiency.
A woman suffering from heavy periods because of
Qi deficiency should have adequate rest, especially
lying down, because with heavy menstrual bleeding from Qi deficiency there is always an element of
Qi sinking, which would be aggravated by prolonged
standing. Those suffering from Blood-Heat should
not have too many hot, spicy foods or alcohol, while
those who suffer from Blood stasis should have adequate, moderate exercise to reduce the stagnation in
the Lower Burner.
END NOTE
1. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai, pp
23–24. First published in 1827. Fu Qing Zhu was born in 1607 and
died in 1684.
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CHAPTER 12
SCANTY PERIODS
AETIOLOGY 239
PATHOLOGY 240
IDENTIFICATION OF PATTERNS AND TREATMENT 240
Blood deficiency 240
Kidney-Yang deficiency 241
Kidney-Yin deficiency 243
Stasis of Blood 244
Phlegm obstructing the Uterus 245
PROGNOSIS AND PREVENTION 246
The periods are defined as ‘Scanty Periods’ when the
bleeding is very light (so as to necessitate few changes
of sanitary towels/pads or tampons), or when the
bleeding lasts only 2–3 days or is extremely scanty, like
a small drip. It is important to ask women about the
amount of bleeding in detail as most of them do not
see scanty bleeding as a ‘problem’. Thus, if we ask only
a general question, such as ‘Is the amount of bleeding normal?’, a woman might reply ‘Yes’ although her
periods in fact last only 2 days. Because few women see
scanty periods as a matter of concern, it is seldom the
main presenting problem and is usually treated only
when it accompanies other conditions. For example,
a woman might complain of tiredness as her main
problem; were this due to Blood deficiency, her periods
might be scanty and therefore need treatment.
AETIOLOGY
Chronic illness, haemorrhage, irregular diet
A protracted, chronic illness easily leads to Blood deficiency. So does a serious haemorrhage, such as that
might occur during labour and a slow, continuous
bleeding in menorrhagia. A diet lacking in nourishment
and Blood-forming foods also leads to Blood deficiency:
this can happen when young girls embrace vegetarianism without paying attention to food combinations
that properly replace the proteic value of meat.
Whatever the cause, Blood deficiency is an obvious
cause of scanty periods as the Sea of Blood becomes
Empty, the Directing and Penetrating Vessels depleted
and the period scanty. Please note that, since menstrual blood is Tian Gui which derives from the Kidneys,
a ‘deficiency of Blood’ in gynecology is treated by tonifying both the Liver and the Kidneys.
Overwork, hereditary weakness, too
many children too close together
Overwork in the sense of working long hours under
stress without adequate rest may lead to Kidney-Yin
deficiency. Having too many children is also often a cause
of Kidney deficiency. When Kidney-Yin is deficient, Water
is depleted, Kidney-Essence cannot be transformed into
Heavenly Gui and the periods are or become scanty.
Traumas, abdominal surgery, emotional
stress, cold
Traumas and abdominal surgery can easily lead to
stasis of Blood in the Uterus, especially after repeated
operations that result in the formation of adhesions.
Emotional stress that affects the Liver causes Liver-Qi
stagnation and, after some time, this can result in
Liver-Blood stasis.
Internal Cold obstructs the circulation of Blood and
may lead to Blood stasis in the Uterus. This is a common
cause of scanty periods in young women or in school
girls who have been playing sports in shorts and T-shirts
on cold and damp days. Whatever the cause, when Blood
stagnates in the Uterus, the period may become scanty.
240 Section 4: Menstrual Irregularities
Irregular diet, physical overwork
Excessive consumption of dairy foods and greasy, fried
foods leads to the formation of Dampness and weakens
the Spleen. This organ is also weakened by excessive
exercise, physical work or sports. Phlegm obstructs the
Uterus and the Directing and Penetrating Vessels and
this results in scanty periods. Women suffering from
this pattern are often overweight.
described by women as a brownish discharge. Scanty
bleeding calls for tonification and dry bleeding not only
for tonification but also moistening.2
IDENTIFICATION OF PATTERNS
AND TREATMENT
Blood deficiency
Contraceptive pill
Clinical manifestations
A very common effect of the contraceptive pill is scanty
periods. If a woman stops the contraceptive pill after
taking it for some years, very often the periods are very
scanty or completely absent. In my opinion, this is usually due to Blood deficiency.
Scanty period with pale, dilute blood, may be only a
drip, dizziness, blurred vision, tingling of limbs, insomnia, palpitations, poor memory, dull, pale complexion.
Tongue: Pale and Thin. If, in addition to Blood deficiency, there is Qi deficiency and Dampness (a very
common occurrence), the tongue might be Swollen.
Pulse: Choppy or Fine.
PATHOLOGY
The main pathological factors causing Scanty Periods
are:
•
•
•
•
Blood deficiency (of the Liver)
Kidney deficiency (Yin or Yang deficiency)
stasis of Blood
Phlegm.
Blood deficiency is more common in young women
or girls and it is often a result of prolonged use of the
contraceptive pill. A Kidney deficiency (especially of
Kidney-Yin) can occur either in older women as a result
of overwork or in young women as a consequence of a
hereditary weakness.
Phlegm as a cause of Scanty Periods is often seen
in women suffering from polycystic ovary syndrome:
these women tend to obesity. Some of the old Chinese
gynecology books made a clear and interesting distinction between thin and overweight women, saying that
scanty periods in thin women are due to Blood deficiency and in overweight women are due to Phlegm
and Dampness.1
The Standards of Diagnosis and Treatment (1602)
makes an interesting distinction between periods that
are scanty and those that are ‘dry’ (the actual word
literally means ‘puckering’ or ‘astringent’). ‘Scanty’
means that the amount of blood is scanty but the blood
itself is normal, i.e. neither too dilute nor too thick.
‘Dry’ means that the menstrual blood is not only scanty
but also rather thick and somewhat powdery, often
Treatment principle
Nourish Blood, strengthen the Liver, tonify the Kidneys,
fill the Directing and Penetrating Vessels (Ren and
Chong Mai), regulate the periods.
Acupuncture
LU-7 Lieque on the right with KI-6 Zhaohai on the left (Ren
Mai), Ren-4 Guanyuan, LIV-8 Ququan, ST-36 Zusanli,
SP-6 Sanyinjiao, BL-20 Pishu, BL-23 Shenshu, BL-18
Ganshu. All with reinforcing method; moxa can be used.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel.
– Ren-4 nourishes Blood and strengthens the Uterus;
it is particularly effective with direct moxa cones.
– LIV-8, ST-36 and SP-6 nourish Blood and
strengthen the Liver. They are particularly effective
with warm needle on ST-36 and SP-6.
– BL-20 and BL-23 nourish Blood.
– BL-18, in conjunction with the previous two points,
nourishes Liver-Blood.
Herbal treatment
a. Prescription
– REN SHEN ZI XUE TANG
– Ginseng Growing Blood Decoction
Scanty Periods 241
Explanation
– Ren Shen, Shan Yao and Fu Ling tonify Qi in order
to nourish Blood.
– Shu Di Huang, Dang Gui and Bai Shao nourish Blood.
– Chuan Xiong invigorates Blood.
b. Prescription
– BA ZHEN TANG
– Eight Precious Decoction
Explanation This formula, which has already been
explained, tonifies Qi and nourishes Blood.
Modifications
• If there are some Empty-Heat signs from Blood
deficiency such as slight hot flushes, add Sheng Di
Huang Radix Rehmanniae and Mu Dan Pi Cortex Moutan.
• If the patient has insomnia and palpitations, add Ye
Jiao Teng Caulis Polygoni multiflori and Wu Wei Zi
Fructus Schisandrae.
• If there is Blood deficiency with Liver-Qi stagnation,
add Chai Hu Radix Bupleuri, Chuan Lian Zi
Fructus Toosendan and Xiang Fu Rhizoma Cyperi.
Alternatively, use the formula Xiao Yao San Free and
Easy Wanderer Powder.
• If there is Essence deficiency, add Gou Qi Zi Fructus
Lycii and Shan Zhu Yu Fructus Corni.
• If there is Spleen-Qi deficiency with Dampness,
add Sha Ren Fructus Amomi, Chen Pi Pericarpium
Citri reticulatae and Bai Zhu Rhizoma Atractylodis
macrocephalae.
• If the menstrual blood is somewhat dry and powdery, like a brownish discharge, add Shou Wu Radix Polygoni multiflori preparata, Hei Zhi Ma Semen
Sesami nigrum and Bei Sha Shen Radix Glehniae.
SUMMARY
Blood deficiency
Clinical manifestations
Scanty period with pale, dilute blood, may be only
a drip, dizziness, blurred vision, tingling of limbs,
insomnia, palpitations, poor memory, dull, pale
complexion. Tongue: Pale and Thin. If, in addition
to Blood deficiency, there is Qi deficiency and
Dampness (a very common occurrence), the tongue
might be Swollen. Pulse: Choppy or Fine.
Treatment principle
Nourish Blood, strengthen the Liver, tonify the
Kidneys, fill the Directing and Penetrating Vessels
(Ren and Chong Mai), regulate the periods.
Acupuncture
LU-7 Lieque on the right with KI-6 Zhaohai on the
left (Ren Mai), Ren-4 Guanyuan, LIV-8 Ququan,
ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-23
Shenshu, BL-18 Ganshu. All with reinforcing
method; moxa can be used.
Herbal treatment
Prescriptions
• REN SHEN ZI XUE TANG Ginseng Growing
Blood Decoction
• BA ZHEN TANG Eight Precious Decoction
Women’s Treasure remedy
• PRECIOUS SEA
Women’s Treasure remedy
Treatment principle
– PRECIOUS SEA
This remedy is a variation of the formula Ba Zhen
Tang Eight Precious Decoction which nourishes Blood
and tonifies Qi. The tongue presentation appropriate to
this remedy is a Pale and Thin body.
Tonify Yang, strengthen the Kidneys, nourish Blood,
regulate the periods. It is necessary to nourish
Blood because, when Kidney-Yang deficiency causes
scanty periods, there is always an element of Blood
deficiency too.
Kidney-Yang deficiency
Acupuncture
Clinical manifestations
LU-7 Lieque on the right with KI-6 Zhaohai on the
right, BL-23 Shenshu, Ren-4 Guanyuan, KI-13 Qixue,
LIV-8 Ququan, KI-3 Taixi, SP-6 Sanyinjiao, ST-36
Zusanli, Du-4 Mingmen All with reinforcing method;
moxa must be used.
Scanty period with pale blood, backache, knee ache,
dizziness, tinnitus, frequent, pale urination. Tongue:
Pale and Swollen. Pulse: Deep, Weak.
242 Section 4: Menstrual Irregularities
Explanation
– LU-7 and KI-6 regulate the Directing Vessel (Ren Mai).
– BL-23 tonifies Kidney-Yang.
– Ren-4, with direct moxa cones, tonifies KidneyYang and strengthens the Uterus.
– KI-13, a point of the Penetrating Vessel, tonifies the
Kidneys and strengthens this vessel and the Sea of Blood.
– LIV-8 nourishes Liver-Blood.
– KI-3, SP-6 and ST-36 tonify the Kidneys. Warm
needle can be used on KI-3.
– Du-4, with direct moxa cones, would be used only if
the deficiency of Yang is very pronounced and there
are symptoms of internal Cold.
Herbal treatment
a. Prescription
– DANG GUI DI HUANG YIN
– Angelica sinensis-Rehmannia Decoction
•
If the symptoms of both Blood and Essence deficiency
are pronounced, add Gou Qi Zi Fructus Lycii, Gui
Ban Jiao Colla Plastri testudinis and Zi He Che Placenta
hominis.
Women’s Treasure remedy
– EASE THE JOURNEY-YANG
This remedy tonifies Kidney-Yang and nourishes
Blood. As a secondary aim, it is designed to nourish
Kidney-Yin also. The tongue presentation appropriate
to this remedy is a Pale and Thin body.
Women’s Treasure remedy
– FREE-FLOWING SEA
This remedy nourishes Blood, tonifies KidneyYang and moves Liver-Qi. The tongue presentation
appropriate to this remedy is a Pale body.
Explanation This formula nourishes Blood and
tonifies Kidney-Yang.
SUMMARY
– Dang Gui nourishes Blood and strengthens the Uterus.
– Shu Di Huang, Shan Zhu Yu and Shan Yao, a
nucleus of many formulae to strengthen the
Kidneys, tonify the Kidneys.
– Du Zhong tonifies and warms Kidney-Yang.
– Huai Niu Xi nourishes the Kidneys and strengthens
the back and knees.
– Gan Cao harmonizes.
Kidney-Yang deficiency
b. Prescription
– GUI SHEN WAN
– Restoring the Kidneys Pill
Clinical manifestations
Scanty period with pale blood, backache, knee ache,
dizziness, tinnitus, frequent, pale urination. Tongue:
Pale and Swollen. Pulse: Deep, Weak.
Treatment principle
Tonify Yang, strengthen the Kidneys, nourish Blood,
regulate the periods. It is necessary to nourish Blood
because, when Kidney-Yang deficiency causes scanty
periods, there is always an element of Blood deficiency too.
Acupuncture
Explanation This formula also nourishes Blood
and tonifies Kidney-Yang. Its Kidney-Yang tonifying
power is slightly stronger than the previous formula.
It is therefore suitable when the symptoms of Yang
deficiency and Cold are rather pronounced.
LU-7 Lieque on the right with KI-6 Zhaohai on the
right, BL-23 Shenshu, Ren-4 Guanyuan, KI-13 Qixue,
LIV-8 Ququan, KI-3 Taixi, SP-6 Sanyinjiao, ST-36
Zusanli, Du-4 Mingmen. All with reinforcing method;
moxa must be used.
– Tu Si Zi and Du Zhong tonify Kidney-Yang.
– Gou Qi Zi and Dang Gui nourish Blood.
– Shu Di Huang, Shan Zhu Yu and Shan Yao tonify
the Kidneys. Shu Di Huang also tonifies Blood.
– Fu Ling resolves Dampness and is added to
counteract the cloying action of tonic herbs.
Herbal treatment
Prescriptions
Modifications
• If there is Essence deficiency, add (or increase) Tu Si
Zi Semen Cuscutae and add Ba Ji Tian Radix Morindae
officinalis.
Women’s Treasure remedies
• DANG GUI DI HUANG YIN Angelica sinensisRehmannia Decoction
• GUI SHEN WAN Restoring the Kidneys Pill
• EASE THE JOURNEY-YANG
• FREE-FLOWING SEA
Scanty Periods 243
Kidney-Yin deficiency
Women’s Treasure remedy
Clinical manifestations
– GROWING JADE
This remedy nourishes Kidney-Yin and Blood. The
tongue presentation appropriate to this remedy is a Red
body without coating.
Scanty periods, dizziness, tinnitus, a dry throat, night
sweating. Tongue: without coating (also Red if there is
Empty-Heat). Pulse: Floating-Empty or Fine-Rapid.
Treatment principle
Nourish Kidney-Yin, nourish Blood and Essence, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), KI-3 Taixi, SP-6 Sanyinjiao, Ren-4 Guanyuan,
ST-36 Zusanli. All with reinforcing method. Moxa
can be used as a warm needle on SP-6 and KI-3 unless
there are pronounced signs of Empty-Heat and the
tongue is very Red.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel,
strengthen the Uterus and nourish Yin.
– KI-3, SP-6 and ST-36 nourish Yin and strengthen
the Kidneys.
– Ren-4 nourishes the Kidneys and strengthens the
Uterus.
Herbal treatment
Prescription
– ZUO GUI WAN
– Restoring the Left [Kidney] Pill
Explanation This prescription nourishes KidneyYin and Blood and strengthens the Directing,
Penetrating and Governing Vessels: for this reason, it is suitable to treat Scanty Periods. It is quite
balanced to treat primarily Kidney-Yin but also
Kidney-Yang.
– Shu Di Huang, Shan Zhu Yu and Shan Yao tonify
the Kidneys. Shu Di Huang also nourishes Blood.
– Gou Qi Zi tonifies the Liver and Kidneys and
nourishes Yin, Essence and Blood.
– Chuan Niu Xi nourishes the Kidneys and
strengthens the lower back.
– Tu Si Zi tonifies Kidney-Yang.
– Lu Jiao tonifies Kidney-Yang and strengthens the
Governing Vessel.
– Gui Ban Jiao nourishes Kidney-Yin and strengthens
the Directing and Penetrating Vessels.
Three Treasures remedy
– NOURISH THE ROOT
This remedy is a variation of Zuo Gui Wan Restoring
the Left [Kidney] Pill: it nourishes Kidney-Yin and the
Essence and Blood and strengthens the Directing,
Penetrating and Governing Vessels. The tongue presentation appropriate to this remedy is a Red tongue
without coating.
SUMMARY
Kidney-Yin deficiency
Clinical manifestations
Scanty periods, dizziness, tinnitus, a dry throat,
night sweating. Tongue: without coating (also Red
if there is Empty-Heat). Pulse: Floating-Empty or
Fine-Rapid.
Treatment principle
Nourish Kidney-Yin, nourish Blood and Essence,
regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), KI-3 Taixi, SP-6 Sanyinjiao, Ren-4 Guanyuan,
ST-36 Zusanli. All with reinforcing method. Moxa
can be used as a warm needle on SP-6 and KI-3
unless there are pronounced signs of Empty-Heat
and the tongue is very Red.
Herbal treatment
Prescription
• ZUO GUI WAN Restoring the Left
[Kidney] Pill
Women’s Treasure remedy
• GROWING JADE
Three Treasures remedy
• NOURISH THE ROOT
244 Section 4: Menstrual Irregularities
Stasis of Blood
b. Prescription
Clinical manifestations
– GE XIA ZHU YU TANG
– Eliminating Stasis below the Diaphragm Decoction
Scanty period with dark blood and clots, painful periods, abdominal pain which is better after passing clots.
Tongue: Purple. Pulse: Wiry.
Explanation This formula invigorates Blood and
eliminates stasis in the abdomen. It is stronger in effect
than the previous one. It also stops pain.
Treatment principle
Invigorate Blood, eliminate stasis, regulate the periods.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on the
left), SP-10 Xuehai, BL-17 Geshu, SP-6 Sanyinjiao,
KI-14 Siman, Ren-6 Qihai, Ren-4 Guanyuan, ST-29
Guilai. All with reducing or even method: moxa can be
used if the tongue is Bluish-Purple.
Explanation
– SP-4 and P-6 regulate the Penetrating Vessel
and invigorate Blood as this vessel is the Sea of
Blood.
– SP-10, BL-17 and SP-6 invigorate Blood.
– KI-14, a point of the Penetrating Vessel, invigorates
Blood and moves Qi in the lower abdomen.
– Ren-6 moves Qi in the lower abdomen.
– Ren-4 invigorates Blood and strengthens the
Uterus.
– ST-29 invigorates Blood in the lower abdomen.
Herbal treatment
a. Prescription
– TAO HONG SI WU TANG
– Persica-Carthamus Four Substances Decoction
Explanation
This formula invigorates Blood.
– Shu Di Huang, Dang Gui, Bai Shao and Chuan
Xiong invigorate Blood and eliminate stasis.
– Tao Ren and Hong Hua invigorate Blood and
eliminate stasis.
Modifications
• If there are pronounced signs of Qi stagnation,
especially a feeling of distension, add Xiang Fu
Rhizoma Cyperi and Wu Yao Radix Linderae.
– Dang Gui, Chi Shao, Chuan Xiong, Tao Ren and
Hong Hua are a modified version of the previous
formula Tao Hong Si Wu Tang, with Chi Shao in
place of Bai Shao (to invigorate Blood) and the
removal of Shu Di Huang.
– Wu Ling Zhi, Yan Hu Suo and Mu Dan Pi invigorate
Blood, eliminate stasis and stop pain.
– Xiang Fu, Zhi Ke and Wu Yao move Qi in order to
invigorate Blood.
– Gan Cao harmonizes.
Modifications
• If there are Cold signs and the abdominal pain
is relieved by the application of heat, add Gui
Zhi Ramulus Cinnamomi and Wu Zhu Yu Fructus
Evodiae.
c. Prescription
– SHAO FU ZHU YU TANG Variation
– Lower Abdomen Eliminating Stasis Decoction
Variation
Explanation This formula is used if the stasis of Blood
derives from internal Cold and the tongue is BluishPurple. Pu Huang has been removed because besides
invigorating Blood it also stops bleeding.
– Xiao Hui Xiang, Gan Jiang and Rou Gui warm the
Yang and expel internal Cold. In particular, Xiao
Hui Xiang affects the lateral sides of the lower
abdomen.
– Yan Hu Suo, Mo Yao, Wu Ling Zhi, Dang Gui,
Chuan Xiong and Chi Shao Yao all invigorate Blood
and eliminate stasis.
Table 12.1 compares and contrasts the above three
prescriptions.
Women’s Treasure remedy
– STIR FIELD OF ELIXIR
This remedy is a variation of Ge Xia Zhu Yu Tang
Eliminating Stasis below the Diaphragm Decoction and it
Scanty Periods 245
Table 12.1 Comparison of Tao Hong Si Wu Tang, Ge Xia Zhu Yu Tang and Shao Fu Zhu Yu Tang
PATTERN
SYMPTOMS
TONGUE
PULSE
Tao Hong Si Wu
Tang
Stasis of Blood
(relatively mild)
Scanty period, slight
abdominal pain, not
many clots
Slightly Purple, perhaps
only on the sides
Choppy
Ge Xia Zhu Yu Tang
Severe stasis of Blood
(from Heat), stagnation
of Qi
Scanty period, dark
blood with clots,
abdominal pain, mental
restlessness
Reddish-Purple
Wiry
Shao Fu Zhu Yu Tang
Stasis of Blood from
internal Cold
Scanty period with
dark, small clots,
abdominal pain relieved
by application of heat,
feeling cold
Bluish-Purple
Wiry and/or
Tight
invigorates Blood, eliminates stasis and stops pain. The
tongue presentation appropriate to this remedy is a
Reddish-Purple body.
SUMMARY
Stasis of Blood
Clinical manifestations
Scanty period with dark blood and clots, painful
periods, abdominal pain which is better after passing
clots. Tongue: Purple. Pulse: Wiry.
• GE XIA ZHU YU TANG Eliminating Stasis below
the Diaphragm Decoction
• SHAO FU ZHU YU TANG Variation Lower
Abdomen Eliminating Stasis Decoction
Variation
Women’s Treasure remedy
• STIR FIELD OF ELIXIR
Phlegm obstructing the Uterus
Clinical manifestations
Invigorate Blood, eliminate stasis, regulate the
periods.
Scanty period with a brownish discharge, obesity, a
feeling of oppression of the chest, excessive vaginal discharge, period stops and starts, tiredness, a feeling of
heaviness. Tongue: Swollen. Pulse: Slippery.
Acupuncture
Treatment principle
Treatment principle
SP-4 Gongsun (on the right) and P-6 Neiguan
(on the left), SP-10 Xuehai, BL-17 Geshu, SP-6
Sanyinjiao, KI-14 Siman, Ren-6 Qihai, Ren-4
Guanyuan, ST-29 Guilai. All with reducing or even
method: moxa can be used if the tongue is BluishPurple.
Herbal treatment
Prescriptions
• TAO HONG SI WU TANG Persica-Carthamus
Four Substances Decoction
Resolve Phlegm, dry Dampness, tonify the Spleen, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-6 Qihai, ST-28 Shuidao, Ren-9 Shuifen,
BL-22 Sanjiaoshu, BL-32 Ciliao, SP-9 Yinlingquan,
SP-6 Sanyinjiao, Ren-12 Zhongwan, BL-20 Pishu,
Ren-4 Guanyuan. All with reducing or even method
except for the last three points which should be reinforced. If there are Cold signs, moxa can be used.
246 Section 4: Menstrual Irregularities
Explanation
– LU-7 and KI-6 regulate the Directing Vessel and
strengthen the Uterus.
– Ren-6 moves Qi in the lower abdomen: moving Qi
helps to resolve Dampness and Phlegm.
– ST-28, Ren-9 and BL-22 promote the transformation and excretion of fluids by the Triple Burner.
– BL-32 also promotes the transformation of fluids
and affects the Uterus.
– SP-9 and SP-6 resolve Dampness.
– Ren-12 and BL-20 tonify the Spleen.
– Ren-4 strengthens the Uterus.
Herbal treatment
SUMMARY
Phlegm obstructing the Uterus
Clinical manifestations
Scanty period with a brownish discharge, obesity,
a feeling of oppression of the chest, excessive
vaginal discharge, period stops and starts, tiredness,
a feeling of heaviness. Tongue: Swollen. Pulse:
Slippery.
Treatment principle
Resolve Phlegm, dry Dampness, tonify the Spleen,
regulate the periods.
Acupuncture
Prescription
– CANG FU DAO TAN WAN
– Atractylodes-Cyperus Conducting Phlegm Pill
Explanation
– Fu Ling, Chen Pi and Dan Nan Xing resolve Phlegm
and Dampness.
– Xiang Fu and Zhi Ke move Qi: this helps to resolve
Dampness and Phlegm.
– Shen Qu resolves Food accumulation, which helps
to resolve Phlegm.
– Gan Cao and Sheng Jiang harmonize.
Modifications
• If there are pronounced symptoms of Spleen
deficiency, add Bai Zhu Rhizoma Atractylodis
macrocephalae.
• If there are symptoms of Damp-Heat, add Huang Bo
Cortex Phellodendri and Yi Yi Ren Semen Coicis.
• If there are symptoms of Kidney-Yang deficiency,
add Tu Si Zi Semen Cuscutae and Du Zhong Cortex
Eucommiae.
• If there are ovarian cysts, add Huang Bo Cortex
Phellodendri, Lu Lu Tong Fructus Liquidambaris and
Yi Yi Ren Semen Coicis.
• If the symptoms of Phlegm are pronounced, add
Ban Xia Rhizoma Pinelliae preparatum and Gua Lou
Fructus Trichosanthis.
PROGNOSIS AND PREVENTION
Scanty Periods can be difficult to treat and it may take
several months to get results. The pattern of Phlegm
obstructing the Uterus is the most difficult to treat
and even more so when it is due to polycystic ovarian
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-6 Qihai, ST-28 Shuidao, Ren-9 Shuifen,
BL-22 Sanjiaoshu, BL-32 Ciliao, SP-9 Yinlingquan,
SP-6 Sanyinjiao, Ren-12 Zhongwan, BL-20 Pishu,
Ren-4 Guanyuan. All with reducing or even method
except for the last three points which should be
reinforced. If there are Cold signs, moxa can be used.
Herbal treatment
Prescription
• CANG FU DAO TAN WAN AtractylodesCyperus Conducting Phlegm Pill
syndrome, an abnormality of gonadal function usually
associated with anovulation (lack of ovulation), increase
in luteinizing hormone, ovarian cysts and an increased
production of androgens. Clinically, the patient tends
to be obese (although not necessarily) and to suffer
from hirsutism (excessive body hair): it may also lead to
amenorrhoea. This is a very difficult condition and the
treatment may take years. See Chapter 66 for a detailed
discussion of polycystic ovary syndrome.
The pattern of Blood deficiency is the easiest to treat,
unless it has been brought on by use of the contraceptive pill for some years: in this case, it may take several
months and even up to a year to restore the period to
normal.
Women suffering from Blood deficiency should
make sure they have adequate nourishment and eat
Blood-nourishing foods such as meat, eggs, spinach,
carrots and wood-ear mushrooms. Those suffering
from Kidney deficiency should avoid overwork and
Scanty Periods 247
take adequate rest. Those suffering from Blood stasis
should have regular, gentle exercise to move Qi and
Blood. Those suffering from Phlegm should avoid eating dairy foods and greasy foods which tend to increase
Dampness and Phlegm and should also make sure that
they have regular exercise.
END NOTES
1. Luo Yuan Kai 1986 Gynaecology in Chinese Medicine (Zhong Yi Fu
Ke Xue
), Shanghai Science and Technology Press,
Shanghai, p. 51.
2. Ibid., p. 51.
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CHAPTER 13
LONG PERIODS
AETIOLOGY 249
PATHOLOGY 249
IDENTIFICATION OF PATTERNS AND TREATMENT 249
deficient for a long time, Empty-Heat develops: this agitates the Blood in the Penetrating Vessel and the period
lasts a long time.
Excessive physical work or irregular diet
Qi deficiency 249
Blood-Heat 251
Liver-Qi and Liver-Blood stasis 252
Kidney-Yin deficiency with Empty-Heat 253
Excessive physical work and irregular diet may lead to
Qi deficiency of the Spleen and/or Kidneys.
PROGNOSIS AND PREVENTION 254
Emotional stress and irregular diet
Long Periods are characterized by prolonged bleeding
which may last 7–10 days; the cycle is regular and the
amount of bleeding itself is not excessive. Thus, they
differ from Heavy Periods, in which the amount of
bleeding is excessive, and from Flooding and Trickling,
in which the cycle is somewhat irregular because bleeding can occur before the right time.
Emotional stress leading to Heat and Fire of the Liver
and Heart may cause Blood-Heat: this causes the
blood to spill out of the vessels so that the periods are
long. Heat or Fire may also derive from the excessive
consumption of hot foods and alcohol.
PATHOLOGY
The main pathological factors in Long Periods are:
AETIOLOGY
Emotional stress
Emotional stress, such as that deriving from anger,
worry and guilt, affecting the Liver leads to Liver-Qi
stagnation which, after some years, may lead to LiverBlood stasis. The Directing and Penetrating Vessels
become obstructed, the blood vessels are blocked by
stagnant Blood, new Blood has nowhere to go and so
the period lasts a long time.
Overwork, too many children
too close together
Overwork or having too many children too close
together may cause Kidney-Yin deficiency. When Yin is
•
•
•
•
Qi deficiency
Blood-Heat
Liver-Qi and Liver-Blood stasis
Kidney-Yin deficiency with Empty-Heat.
IDENTIFICATION OF PATTERNS
AND TREATMENT
Qi deficiency
Clinical manifestations
Periods lasting a long time, tapering off with a trickle,
tiredness, poor appetite, slight abdominal distension,
backache, dizziness, frequent, pale urination. Tongue:
Pale. Pulse: Deep-Weak. This is deficiency of Qi of both
Spleen and Kidneys.
250 Section 4: Menstrual Irregularities
Treatment principle
Tonify and raise Qi, strengthen the Spleen and Kidneys,
consolidate the Penetrating and Directing Vessels
(Chong and Ren Mai).
Acupuncture
LU-7 Lieque on the right with KI-6 Zhaohai on the left,
Ren-12 Zhongwan, Ren-6 Qihai, Ren-4 Guanyuan,
KI-13 Qixue, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20
Pishu, BL-23 Shenshu. All with reinforcing method;
moxa can be used.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel.
– Ren-12, ST-36, SP-6 and BL-20 strengthen the
Spleen.
– Ren-4 and BL-23 strengthen the Kidneys.
– KI-13 tonifies the Kidneys and consolidates
the Penetrating and Directing Vessels.
– Ren-6 tonifies and raises Qi.
which enters the Blood portion, and is particularly
appropriate if the patient suffers from anxiety and
depression.
Modifications These modifications apply to all three
previous formulae.
– If the period is very heavy, add E Jiao Colla Corii
asini, Wu Zei Gu Endoconcha Sepiae and Pao Jiang
Rhizoma Zingiberis preparatum (fried).
– If the period is very long, add Pu Huang Pollen
Typhae and Yi Mu Cao Herba Leonuri.
– If there are symptoms of Kidney-Yang deficiency,
add Xu Duan Radix Dipsaci and Ai Ye Folium
Artemisiae argyi.
Women’s Treasure remedy
– RESTRAIN THE FLOW
This remedy is specific to stop uterine bleeding from
Qi deficiency. The tongue presentation appropriate to
this remedy is a Pale body.
Herbal treatment
a. Prescription
SUMMARY
– JU YUAN JIAN
– Raising the Original [Qi] Decoction
Qi deficiency
Explanation This prescription, already explained,
tonifies and raises Spleen-Qi: this will stop the bleeding
from Deficiency.
b. Prescription
Clinical manifestations
Periods lasting a long time, tapering off with a
trickle, tiredness, poor appetite, slight abdominal
distension, backache, dizziness, frequent, pale
urination. Tongue: Pale. Pulse: Deep-Weak.
Treatment principle
– BU ZHONG YI QI TANG
– Tonifying the Centre and Benefiting Qi Decoction
Explanation This formula, already explained, tonifies and raises Spleen-Qi to stop bleeding. Very similar to the previous one, it is perhaps more suitable to
stop bleeding because it contains Dang Gui to enter the
Blood portion.
c. Prescription
– GUI PI TANG
– Tonifying the Spleen Decoction
Explanation This formula, already explained, tonifies Spleen-Qi and calms the Mind. It is suitable to
stop bleeding because it also contains Dang Gui,
Tonify and raise Qi, strengthen the Spleen and
Kidneys, consolidate the Penetrating and Directing
Vessels (Chong and Ren Mai).
Acupuncture
LU-7 Lieque on the right with KI-6 Zhaohai on
the left, Ren-12 Zhongwan, Ren-6 Qihai, Ren-4
Guanyuan, KI-13 Qixue, ST-36 Zusanli, SP-6
Sanyinjiao, BL-20 Pishu, BL-23 Shenshu. All with
reinforcing method; moxa can be used.
Herbal treatment
Prescriptions
• JU YUAN JIAN Raising the Original [Qi] Decoction
Long Periods 251
• BU ZHONG YI QI TANG Tonifying the Centre and
Benefiting Qi Decoction
• GUI PI TANG Tonifying the Spleen Decoction
Women’s Treasure remedy
• RESTRAIN THE FLOW
Modifications
• If the period is heavy and long, add Wu Zei Gu
Endoconcha Sepiae, Qian Cao Gen Radix Rubiae, and
Xian He Cao Herba Agrimoniae.
• If there is both Qi and Yin deficiency induced by the
longstanding blood loss, use Liang Di Tang Two ‘Di’
Decoction and Sheng Mai San Generating the Pulse
Powder in combination.
Blood-Heat
Clinical manifestations
Long periods that tend also to be heavy, dark blood,
irritability, thirst, red face, feeling of heat. Tongue: Red
with yellow coating. Pulse: Firm or Overflowing.
Treatment principle
Clear Heat and cool Blood, clear the Liver and Heart,
regulate the Penetrating Vessel.
Acupuncture
SP-4 Gongsun on the right with P-6 Neiguan on the
left, KI-14 Siman, L.I.-11 Quchi, SP-10 Xuehai, LIV-3
Taichong, KI-2 Rangu.
Explanation
– SP-4 and P-6 regulate the Penetrating Vessel.
– KI-14 cools Blood in the Uterus.
– L.I.-11 and SP-10 in combination cool Blood.
– LIV-3 and KI-2 cool Blood.
Herbal treatment
a. Prescription
– BAO YIN JIAN Variation
– Protecting Yin Decoction Variation
Explanation The first eight herbs constitute the formula Bao Yin Jian which nourishes Yin and clears
Heat.
– Sheng Di Huang, Bai Shao and Shu Di Huang
nourish Yin and Blood and cool Blood.
– Shan Yao tonifies the Spleen and Kidneys.
– Huang Qin and Huang Bo clear Heat.
– Xu Duan tonifies the Kidneys.
– Gan Cao harmonizes.
– Di Yu and Huai Hua were added to cool Blood and
stop bleeding.
b. Prescription
– AN CHONG TANG
– Calming the Penetrating Vessel Decoction
Explanation This formula is used if longstanding
bleeding has given rise to Yin and Qi deficiency with
symptoms of Qi deficiency such as tiredness, palpitations and shortness of breath.
– Bai Zhu and Huang Qi tonify and raise Qi.
– Long Gu and Mu Li firm Qi, stop bleeding and
nourish Yin.
– Sheng Di Huang and Bai Shao nourish Yin and cool
Blood.
– Wu Zei Gu is astringent and stops bleeding.
– Qian Cao Gen cools and invigorates Blood and stops
bleeding.
– Xu Duan tonifies the Kidneys and stops bleeding.
c. Prescription
– JIE DU SI WU TANG Variation
– Expelling Toxin Four Substances Decoction Variation
Explanation This formula is used if external Heat
penetrates the Interior and generates Toxic-Heat
and Blood-Heat which lead to bleeding. The first
eight herbs constitute the formula Jie Du Si Wu
Tang.
– Huang Lian, Huang Qin, Huang Bo and Shan Zhi
Zi clear Heat and Dampness, and resolve ToxicHeat.
– Sheng Di Huang nourishes Yin, cools Blood and
stops bleeding.
– Dang Gui and Bai Shao nourish Blood and ‘calm’
Blood to stop bleeding.
– Chuan Xiong, part of Si Wu Tang, invigorates
Blood.
– Bai Jiang Cao resolves Fire-poison and
invigorates Blood.
– Mu Dan Pi cools Blood and stops bleeding.
252 Section 4: Menstrual Irregularities
Women’s Treasure remedy
Acupuncture
– COOL THE MENSES
This remedy is specific to reduce uterine bleeding occurring from Blood-Heat. The tongue presentation appropriate to this remedy is a Red body with a yellow coating.
SP-4 Gongsun (on the right) and P-6 Neiguan
(on the left), SP-10 Xuehai, BL-17 Geshu, SP-8 Diji,
SP-6 Sanyinjiao, Ren-6 Qihai, KI-14 Siman, ST-29
Guilai, LIV-3 Taichong. All with reducing or even
method. If the stasis of Blood derives from Cold, moxa
can be used.
Explanation
–SP-4 and P-6 regulate the Penetrating Vessel and
invigorate Blood as this vessel is the Sea of Blood.
– BL-17 and SP-10 invigorate Blood.
– SP-8 stops bleeding.
– SP-6 invigorates Blood.
– Ren-6 moves Qi in the Lower Burner.
– KI-14, a point of the Penetrating Vessel, eliminates
stagnation in the Lower Burner and Uterus.
– ST-29 invigorates Blood in the Uterus.
– LIV-3 Taichong moves Liver-Qi and invigorates
Liver-Blood.
SUMMARY
Blood Heat
Clinical manifestations
Long periods that tend also to be heavy, dark blood,
irritability, thirst, red face, feeling of heat. Tongue:
Red with yellow coating. Pulse: Firm or Overflowing.
Treatment principle
Clear Heat and cool Blood, clear the Liver and Heart,
regulate the Penetrating Vessel.
Acupuncture
SP-4 Gongsun on the right with P-6 Neiguan on the left,
KI-14 Siman, L.I.-11 Quchi, SP-10 Xuehai, LIV-3 Taichong,
KI-2 Rangu. All with reducing or even method.
Herbal treatment
Prescriptions
• BAO YIN JIAN Variation Protecting Yin Decoction
Variation
• AN CHONG TANG Calming the Penetrating
Vessel Decoction
• JIE DU SI WU TANG Variation Expelling Toxin
Four Substances Decoction Variation
Women’s Treasure remedy
• COOL THE MENSES
Liver-Qi and Liver-Blood stasis
Clinical manifestations
Long periods that are scanty with dark blood and clots,
depression, irritability, abdominal pain and distension.
Tongue: Purple. Pulse: Wiry.
Treatment principle
Move Qi, invigorate Blood, eliminate stagnation, regulate the periods.
Herbal treatment
a. Prescription
– SI WU TANG and JIN LING ZI SAN
– Four Substances Decoction and Toosendan Powder
Explanation The formula Si Wu Tang invigorates
Blood and regulates the periods.
– Jin Ling Zi moves Liver-Qi.
– Yan Hu Suo moves Qi, invigorates Blood and stops
pain.
Modifications
– If Blood stasis is very pronounced and the tongue
very Purple, add Tao Ren Semen Persicae, Hong Hua
Flos Carthami and Qian Cao Gen Radix Rubiae.
– If bleeding goes on for a long time, add Pu Huang
Pollen Typhae and San Qi Radix Notoginseng.
– If there is abdominal pain, add Wu Ling Zhi
Faeces Trogopteri.
b. Prescription
– GUO QI YIN
– Beyond Phase Decoction
Explanation This formula, from the Golden Mirror
of Medicine (1742), is specific for Long Periods from
stagnation of Qi and Blood with an underlying Cold
Long Periods 253
condition. It is therefore suitable if the tongue is PalePurplish.
The first six herbs constitute the formula Tao Hong Si
Wu Tang Persica-Carthamus Four Substances Decoction
which nourishes and invigorates Blood.
–
–
–
–
Kidney-Yin deficiency with
Empty-Heat
Clinical manifestations
Long periods with scanty blood, a dry throat, malar
flush, night sweating, dry stools. Tongue: Red without
coating. Pulse: Floating-Empty.
Xiang Fu and Mu Xiang move Qi and eliminate stasis.
E Zhu invigorates Blood.
Rou Gui expels internal Cold.
Mu Tong removes obstructions from the Connecting
channels. Please note that the use of this herb is
illegal: it can be replaced with Tong Cao Medulla
Tetrapanacis.
– Gan Cao harmonizes.
Nourish Yin, strengthen the Kidneys, clear EmptyHeat, stop bleeding, regulate the periods.
Women’s Treasure remedy
Acupuncture
– STIR FIELD OF ELIXIR
This remedy invigorates Blood in the Lower Burner
and stops bleeding. The tongue presentation appropriate to this remedy is a Purple body.
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-3 Taixi, SP-6 Sanyinjiao,
KI-2 Rangu, SP-8 Diji. All with reinforcing method
except for KI-2 and SP-8 which should be needled with
even method. No moxa.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel, nourish
Yin and strengthen the Uterus.
– Ren-4, KI-3 and SP-6 nourish the Kidneys and
strengthen the Uterus.
– SP-8 stops uterine bleeding.
– KI-2 clears Empty-Heat.
SUMMARY
Liver-Qi and Liver-Blood stasis
Clinical manifestations
Long periods that are scanty with dark blood and
clots, depression, irritability, abdominal pain and
distension. Tongue: Purple. Pulse: Wiry.
Treatment principle
Treatment principle
Herbal treatment
Move Qi, invigorate Blood, eliminate stagnation,
regulate the periods.
Prescription
Acupuncture
– LIANG DI TANG and ER ZHI WAN
– Two ‘Di’ Decoction and Two Solstices Pill
SP-4 Gongsun (on the right) and P-6 Neiguan (on
the left), SP-10 Xuehai, BL-17 Geshu, SP-8 Diji, SP-6
Sanyinjiao, Ren-6 Qihai, KI-14 Siman, ST-29 Guilai, LIV-3
Taichong. All with reducing or even method. If the stasis
of Blood derives from Cold, moxa can be used.
Herbal treatment
Prescriptions
• SI WU TANG and JIN LING ZI SAN Four
Substances Decoction and Toosendan Powder
• GUO QI YIN Beyond Phase Decoction
Women’s Treasure remedy
• STIR FIELD OF ELIXIR
Explanation The formula Liang Di Tang, already
explained, nourishes Kidney-Yin and Blood, clears
Empty-Heat, stops bleeding and regulates the periods.
– Nu Zhen Zi and Han Lian Cao nourish Kidney-Yin, clear
Empty Heat, stop bleeding and treat night-sweating.
Modifications
• If bleeding is very prolonged, add Wu Zei Gu
Endoconcha Sepiae and Qian Cao Gen Radix Rubiae.
These two herbs are frequently combined in gynecological bleeding syndromes because the former
is astringent and the latter is moving (as well as
stopping bleeding): thus, in combination, these two
herbs invigorate Blood, stop bleeding without causing stasis and consolidate the Lower Burner.
254 Section 4: Menstrual Irregularities
Women’s Treasure remedy
– EASE THE JOURNEY-YIN
This remedy nourishes Kidney-Yin, strengthens the
Directing and Penetrating Vessels, stops bleeding and
regulates the periods.
KI-2 Rangu, SP-8 Diji. All with reinforcing method
except for KI-2 and SP-8 which should be needled
with even method. No moxa.
Herbal treatment
Prescription
• LIANG DI TANG and ER ZHI WAN Two ‘Di’
Decoction and Two Solstices Pill
SUMMARY
Women’s Treasure remedy
Kidney-Yin Deficiency with Empty-Heat
• EASE THE JOURNEY-YIN
Clinical manifestations
Long periods with scanty blood, a dry throat, malar
flush, night sweating, dry stools. Tongue: Red
without coating. Pulse: Floating-Empty.
Treatment principle
Nourish Yin, strengthen the Kidneys, clear EmptyHeat, stop bleeding, regulate the periods.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, KI-3 Taixi, SP-6 Sanyinjiao,
PROGNOSIS AND PREVENTION
Long Periods are relatively easily treated by acupuncture and/or Chinese herbs. The pattern from KidneyYin deficiency is more difficult to treat.
Women suffering from Yin deficiency should not
overwork and should have adequate rest. Those suffering from stagnation of Liver-Qi should pay some attention to their emotional life and, if necessary, enlist the
help of a counsellor or psychotherapist.
CHAPTER 14
PAINFUL PERIODS
AETIOLOGY 256
PATHOLOGY 256
DIAGNOSIS 257
TREATMENT PRINCIPLES 258
IDENTIFICATION OF PATTERNS AND TREATMENT 259
FULL CONDITIONS 259
Stagnation of Qi 259
Stasis of Blood 261
Stagnation of Cold 264
Damp-Heat 268
Stagnant Liver-Qi turning into Fire 269
EMPTY CONDITIONS 270
Qi and Blood deficiency 270
Yang and Blood deficiency 271
Kidney- and Liver-Yin deficiency 273
Ancient acupuncture prescriptions for Painful Periods 274
PROGNOSIS AND PREVENTION 274
move adequately. Proper movement of Blood relies on
the free flow of Liver-Qi and of the Qi of the Penetrating
Vessel.
As we have seen in Chapter 2 on physiology, four
different phases may be identified in each menstrual cycle. During the pre-menstrual phase, Yang
rises and Liver-Qi moves in preparation for moving
Blood during the period. Thus, a proper movement
of Liver-Qi and Liver-Blood is essential for a painfree period. If Liver-Qi stagnates, it may cause pain,
especially before the period, while if Liver-Blood stagnates, it causes pain during the period. Stagnation is
therefore the most important pathological condition
causing painful periods: even in deficiency conditions
when the pain is mild, it is some element of stagnation
that causes it.
The earliest mention of Painful Periods is probably in
the Synopsis of Prescriptions of the Golden Cabinet which
says: “If a woman has irregular periods with abdominal
pain and fullness, and the periods are irregular, use Tu Gua
Gen Powder”.1
Another passage in the same book appears to describe
an episode of severe dysmenorrhoea from Cold:
WESTERN VIEW 275
CLINICAL TRIALS 276
Acupuncture 276
Herbal treatment 281
Painful Periods indicates menstrual pain that occurs
before, during or after menstruation. The pain may
occur in the lower abdomen or sacral region and sometimes extend to the legs. In severe cases, there may be
nausea and vomiting or even fainting.
The Liver, Penetrating Vessel and Directing Vessel are
responsible for the physiology of menstruation. For a
normal period to occur, Blood must be abundant and
When Cold invades the Lower Burner the menses may
become scanty and painful with a dragging pain in the
vagina and a feeling of cold in the abdomen … there is an
acute pain on Qichong [ST-30] … there may be sudden
vertigo and the woman may pass out … this is a gynaecological problem and is not due to an attack of evil spirits …2
AETIOLOGY
Emotional strain
Emotional strain is a very important aetiological factor in painful periods. Anger, frustration, resentment,
256 Section 4: Menstrual Irregularities
worry and guilt all may lead to Liver-Qi stagnation. In
women, Liver-Qi stagnation causes Blood to stagnate
in the Uterus leading to painful periods. In some cases,
stagnant Liver-Qi may turn into Liver-Fire and this, in
turn, may lead to Blood-Heat. Blood-Heat often combines with Damp-Heat in the Uterus.
External Cold and Dampness
Excessive exposure to Cold and Dampness, especially
during the puberty years, may cause Cold to invade
the Uterus. Cold contracts and causes stasis of Blood
in the Uterus and therefore painful periods. In cold and
damp countries where young girls dressed in shorts
play school sports and games, this is a very common
cause of painful periods. During puberty, the body is in
a vulnerable state because it is undergoing profound
changes, and it is therefore very likely to be affected
by pathogenic factors. Invasion of Cold in the Uterus
is the most common cause of painful periods in adolescent girls.
Women are also prone to invasion of Cold in the
Uterus during and soon after the period when the
Uterus and Blood are in a relatively weakened state. At
this time, therefore, they should take particular care not
to be exposed to cold and dampness. Fu Qing Zhu says:
The Liver pertains to Wood, it stores Blood and it hates
wind and cold most of all. During menstruation the space
between skin and muscles (cou li) is wide open, when this
is invaded by wind and cold Liver-Qi stagnates and the
passages of the menses become obstructed.3
Women with a pre-existing condition of Yang deficiency
are obviously more prone to invasion of external Cold.
Overwork, chronic illness
Physical overwork or a chronic illness leads to deficiency of Qi and Blood, especially of Stomach and
Spleen. Deficiency of Blood leads to malnourishment of
the Penetrating and Directing Vessels so that the Blood
has no force to move properly thus causing stagnation
and pain.
Excessive sexual activity, childbirth
The Liver and Kidneys are weakened by excessive
sexual activity (which affects women somewhat less
than men), too many childbirths too close together,
and sexual activity starting too early. A deficiency
of Liver and Kidneys induces Emptiness of the
Penetrating and Directing Vessels so that they cannot move Qi and Blood properly, thus causing painful periods.
PATHOLOGY
Thus, stagnation of Qi and/or Blood, which may arise
by itself or be caused by Cold in the Uterus, is the most
important factor in painful periods. Even deficiency
types of painful periods, caused by Blood or Liver/
Kidney deficiency, involve an element of stagnation as
the deficient Blood fails to move properly.
The main patterns causing Painful Periods are
therefore:
•
•
•
•
•
•
•
•
stagnation of Qi
stasis of Blood
stagnation of Cold (of the Empty or Full type)
Damp-Heat (with Blood-Heat)
stagnant Liver-Qi turning into Fire
Qi and Blood deficiency
Yang and Blood deficiency
Kidney- and Liver-Yin deficiency.
Stagnation of Qi and stasis of Blood are very common patterns occurring in Painful Periods. They very
often accompany other patterns. For example, a deficiency of Qi and Blood may occur in combination
with some stagnation of Qi and/or Blood. Similarly,
Cold obstructing the Uterus obviously leads to stasis
of Blood. In gynecology, stagnation of Qi and of Blood
is always related to the Liver and the Penetrating
Vessel.
A free-flowing Liver-Qi is essential to move Blood
before and during the period; if Liver-Qi stagnates,
Blood does not move properly and pain results. The
Penetrating Vessel is also usually involved in painful
periods from stagnation as it is the Sea of Blood and
it flows through the Uterus: for this reason, stasis of
Blood in the Uterus is often due to stagnation in this
vessel. Of all the extraordinary vessels, the Penetrating
Vessel is the most important one in the pathology of
Painful Periods.
When the periods are painful from stagnation of
Qi, the pain is accompanied by a pronounced feeling of distension of the abdomen, typically occurring
especially before the periods. Other symptoms may
include pre-menstrual tension, irritability, depression
Painful Periods 257
and a Wiry pulse. Many books list a Purple tongue
as a sign of Qi stagnation: I tend to disagree as the
tongue-body colour reflects more the state of Blood
than Qi so that, if it is Purple, I relate that to Blood
rather than Qi stagnation. In Qi stagnation, the
tongue-body colour may be normal, except in severe
and longstanding cases when it may be Red on the
sides.
Stagnation of Liver-Qi is often secondary to or accompanied by Liver-Blood stasis (as discussed at length in
Chapter 3 on pathology): when this is the case, the
pulse may not be Wiry at all but Fine or Choppy (and
perhaps slightly Wiry on one side) and the tongue may
be Pale (from Blood deficiency).
When stasis of Blood is predominant, the pain is
more intense, is stabbing in character and is typically
relieved by the passing of dark clots. A dark menstrual blood with clots is an essential and sufficient
symptom to diagnose stasis of Blood, i.e. by itself it
validates a diagnosis of Blood stasis, even if there
are no other indications. Another important sign is
a Purple colour of the tongue body although, if the
stasis of Blood is fairly recent and not too severe, the
tongue may not show this sign. Another symptom of
Blood stasis is that the period may be hesitant, i.e. it
may start and stop.
Stagnation of Cold is a common cause of Painful
Periods especially in young girls living in cold and damp
countries. With stagnation of Cold, there is always stasis of Blood as Cold obstructs the Uterus and the vessels
preventing a proper flow of blood. It is for this reason
that with Cold, too, there are clots in the menstrual
blood: however, if Cold is the cause, the menstrual
blood is typically red and the clots are dark and rather
small or stringy, whereas if stasis of Blood is the cause,
the blood itself is dark and the clots are rather large.
The pain from stagnation of Cold is very intense and
cramping in character and typically alleviated by the
application of heat.
Blood-Heat does not usually cause intense menstrual pain; often associated with Damp-Heat (for
this reason these two pathogenic factors will be discussed together), it tends to make the periods heavy.
Other symptoms include a feeling of heat, thirst, a
Red tongue and a Rapid pulse. If Damp-Heat is present, there will also be a feeling of heaviness, an excessive vaginal discharge, a bearing-down sensation, a
sticky-yellow coating on the tongue and a Slippery
pulse.
Deficiency of Qi and Blood and Liver and Kidneys
usually causes only mild menstrual pain. The latter
pattern is seen more in older women. As mentioned
before, even in Empty conditions there is some element
of stagnation as deficient Qi and Blood fail to move
Blood properly and this leads to some stagnation. In
fact, Zhang Jing Yue in the Complete Works of Jing Yue
(1624) says:
In women with painful periods, in many cases there is an
intrinsic Deficiency and purely Excess types are few …
when Qi and Blood are deficient Blood does not move … Qi
is deficient and Blood stagnates.4
DIAGNOSIS
Time of onset
Pain before and during the period is usually of the
Full type, while pain after the period is of the Empty
type.
Pressure
If the pain is made worse by pressure, it indicates
Fullness, while if the patient gets relief from pressing
the lower abdomen, it indicates Emptiness. Patients
are not sure how to answer this question if it is not
asked in a sensible way. Thus, instead of enquiring
whether the “pain is better with pressure or not”,
we should ask the patient whether she perhaps likes
to hold her abdomen or whether she dislikes to be
touched on the abdomen at that time. Women often
find that a hot-water bottle on the abdomen relieves
the pain, but sometimes they like the pressure rather
than the heat of the bottle.
Heat-Cold
If the pain is relieved by the application of heat (such as
a hot-water bottle), it indicates either a Cold condition
or stasis of Blood from Cold. It should be kept in mind,
however, that this sign is not always indicative of Cold,
as other conditions, such as stagnation of Qi or Blood,
may also be alleviated by the application of a hot-water
bottle. Furthermore, a sensation of heat is often comforting in itself without really indicating that the pain
is due to Cold. If the pain is aggravated by heat, it indicates Blood-Heat.
258 Section 4: Menstrual Irregularities
Character of pain
•
•
•
•
•
•
•
•
Pain better after passing clots: stasis of Blood.
Pain with a pronounced feeling of distension: stagnation of Qi.
Burning pain: Blood-Heat.
Cramping pain: Cold in the Uterus.
Stabbing pain, not moving: stasis of Blood.
Pulling pain: stasis of Blood.
Bearing-down pain before the period: stasis of
Blood.
Bearing-down pain after the period: Kidney deficiency.
Location of pain
•
•
•
Pain on both sides of lower abdomen: Liver channel.
Pain in lower abdomen, central: Kidney channel
and Penetrating Vessel.
Pain on sacrum: Kidney channel, deficiency.
Cycle
If the cycle is long (i.e. the periods come consistently
late) and the menstrual blood is dark and clotted, it
indicates stasis of Blood. If the menstrual blood is red
with small dark clots, it indicates Cold in the Uterus.
If the cycle is short, the period heavy and the blood
bright red, it indicates Blood-Heat.
TREATMENT PRINCIPLES
From the point of view of Manifestation (Biao) the
central pathology of Painful Periods is a disharmony
of the Penetrating Vessel and Sea of Blood. Hence the
main principle of treatment for the Manifestation is
to regulate the Qi and Blood of the Penetrating Vessel.
As discussed in Chapter 3 on pathology, the Penetrating
Vessel is the Sea of Blood. It arises from the Uterus and is
therefore always involved in Painful Periods. This vessel
is particularly prone to stagnation of Qi and Blood in the
abdomen and many of its points (especially KI-14 Siman)
eliminate stagnation. The Qi of the Penetrating Vessel is
prone to rebel upwards from the abdomen towards the
chest giving rise to a feeling of oppression of the chest.
Since this vessel is also closely related to the BrightYang channels via the important point ST-30 Qichong,
a stagnation in the Penetrating Vessel often causes
Qi to rebel in the Bright Yang: this explains the nausea and vomiting experienced by some women suffering from painful periods. To treat stasis of Blood in
the Penetrating Vessel, I often use the vessel’s opening
points, i.e. SP-4 Gongsun on the right and P-6 Neiguan
on the left together with other points on the vessel such
as KI-14 Siman, KI-12 Dahe or KI-16 Huangshu.
Other points related to the Penetrating Vessel in treating painful periods are LIV-3 Taichong, ST-42 Chongyang
and ST-30 Qichong. LIV-3 Taichong is the most important
one to affect the Penetrating Vessel: by moving Liver-Qi,
it regulates the Penetrating Vessel, subdues its rebellious
Qi and invigorates Blood. The association between this
point and the Penetrating Vessel is so close that sometimes the old classics call this vessel Taichong. In fact, the
very first chapter of the Simple Questions, in describing
the 7-year cycles of women, says: “At 14, the Heavenly
Gui arrives [i.e. the menses], the Directing Vessel is open and
the Taichong vessel is flourishing.”5 The ‘Taichong vessel’ is
the Penetrating Vessel. ST-42 Chongyang also regulates
Blood within the Penetrating Vessel and eliminates stasis due to the relationship between this vessel and the
Bright Yang. ST-30 Qichong is one of the most important
points on the Penetrating Vessel and strongly moves Qi
and Blood in the abdomen. Its other name, Qijie, means
‘avenues of Qi’, referring to the channels and vessels of
the abdomen which the Penetrating Vessel influences.
To treat the Root in Painful Periods, one must differentiate clearly between Heat, Cold, deficiency and
excess. First identify the prevailing pattern, then treat
it in order to treat the Root: this may involve moving Qi,
invigorating Blood, expelling Cold, resolving Dampness,
clearing Heat, tonifying Qi and Blood or strengthening
Liver and Kidneys.
The most important differentiation is that between
Full and Empty types of painful periods. Full types are
much more common than Empty, and clinically are
more important as they are characterized by more
intense pain. Moreover, even in Empty types of painful
periods there is an element of stasis of Blood as deficient Blood fails to move properly. For this reason, even
for Empty types of painful periods, some Blood-moving
herbs are added to the prescription used.
The treatment principle is often changed according to
the time of the menstrual cycle. During the period one
concentrates on treating the Manifestation, i.e. invigorate Blood and stop pain. At other points in the cycle
one treats the Root, i.e. according to the main pattern.
Painful Periods 259
A deficiency, in particular, is best treated during the 2
weeks, or thereabouts, that follow the period.
IDENTIFICATION OF PATTERNS
AND TREATMENT
Explanation The first eight herbs constitute the Xiao
Yao San which moves Qi and is specific for menstrual
problems, especially from emotional strain.
– Wu Yao, Xiang Fu, Zhi Ke and Yan Hu Suo move Qi
more strongly and stop pain.
Women’s Treasure remedy
FULL CONDITIONS
Stagnation of Qi
Clinical manifestations
Lower abdominal pain during the period, or 1 to 2 days
before the period, a pronounced feeling of distension of
the abdomen and breasts, hesitant start to the period,
menstrual blood dark without clots, pre-menstrual
tension and irritability. Tongue: Normal coloured or
slightly Red on the sides. If there is deficiency of Blood,
the tongue may be Pale. Pulse: Wiry. The pulse may be
Choppy if Liver-Blood deficiency predominates.
Treatment principle
Move Qi and Blood, eliminate stagnation, stop pain.
Acupuncture
LIV-3 Taichong, Ren-6 Qihai, G.B.-34 Yanglingquan,
SP-8 Diji, ST-29 Guilai, SP-10 Xuehai, SP-6 Sanyinjiao,
SP-4 Gongsun and P-6 Neiguan, SP-14 Fujie. Reducing
or even method.
Explanation
– LIV-3 moves Qi and Blood and stops pain.
– Ren-6 moves Qi in the lower abdomen.
– G.B.-34, in combination with Ren-6, moves Qi in
the lower abdomen.
– SP-8 regulates Blood in the Uterus and stops pain.
– ST-29 regulates Blood in the Uterus.
– SP-10 invigorates Blood.
– SP-6 helps to invigorate Blood and stop pain.
– SP-4 (on the right) and P-6 (on the left) regulate the
Penetrating Vessel and regulate Blood in the Uterus.
– SP-14 moves Qi and Blood in the lower abdomen.
Herbal treatment
Prescription
– XIAO YAO SAN Variation
– Free and Easy Wanderer Powder Variation
– FREE FLOW
This remedy is a variation of the formula Xiao Yao
San Free and Easy Wanderer Powder which pacifies
the Liver, moves Qi, eliminates stagnation, nourishes
Liver-Blood and tonifies Spleen-Qi. The formula has
been adapted with the addition of herbs that move Qi
and stop pain. The tongue presentation appropriate to
this remedy is a normal-coloured body or slightly Pale
on the sides; if the stagnation of Qi is severe, it could be
slightly Red on the sides.
SUMMARY
Stagnation of Qi
Clinical manifestations
Lower abdominal pain during the period, or 1 to
2 days before the period, a pronounced feeling of
distension of the abdomen and breasts, hesitant
start to the period, menstrual blood dark without
clots, pre-menstrual tension and irritability. Tongue:
Normal coloured or slightly Red on the sides. If there
is deficiency of Blood, the tongue may be Pale.
Pulse: Wiry. The pulse may be Choppy if Liver-Blood
deficiency predominates.
Treatment principle
Move Qi and Blood, eliminate stagnation, stop pain.
Acupuncture
LIV-3 Taichong, Ren-6 Qihai, G.B.-34 Yanglingquan,
SP-8 Diji, ST-29 Guilai, SP-10 Xuehai, SP-6
Sanyinjiao, SP-4 Gongsun and P-6 Neiguan, SP-14
Fujie. Reducing or even method.
Herbal treatment
Prescription
• XIAO YAO SAN Variation Free and Easy
Wanderer Powder Variation
Women’s Treasure remedy
• FREE FLOW
260 Section 4: Menstrual Irregularities
Case history
A 32-year-old woman had been suffering
from painful periods for 2 years. The pain
occurred during the period in the hypogastrium, lateral abdomen and sacrum. It was
dull in character and associated with a bearing-down sensation. Her periods were regular and the menstrual blood was slightly dark
with a few clots. She also suffered from premenstrual tension with a pronounced distension of breast and abdomen and irritability.
She had been on the contraceptive pill for 10
years and the periods became painful when
she stopped taking it. She had been given a
progesterone pill but this had not helped the
dysmenorrhoea at all. Apart from the menstrual problems, she also suffered from the
so-called irritable bowel syndrome causing
her a spastic pain in the abdomen and alternation of constipation and diarrhoea: she had
had this problem for 10 years. On interrogation, it transpired that her vision was sometimes blurred, she was occasionally dizzy and
experienced tingling of the limbs. Her tongue
was slightly orangey on the sides, and her
pulse was Fine on the right side and Fine but
also slightly Wiry on the left.
Diagnosis This is a very clear example of stagnation of Liver-Qi associated with (or caused by)
Liver-Blood deficiency. The symptoms of Liver-Qi
stagnation are very obvious: pre-menstrual tension with distension and irritability, painful periods, Wiry pulse on the left, abdominal pain with
constipation and diarrhoea. The symptoms of
Liver-Blood deficiency are also equally clear: the
dull character of the menstrual pain, the blurred
vision, the tingling and dizziness, the orangey
colour of the sides of the tongue and the Fine
pulse. I am inclined to think that, in this case,
stagnation of Liver-Qi derived from Liver-Blood
deficiency and this was, in turn, probably caused
by the contraceptive pill.
Treatment principle This patient was treated with
acupuncture and herbal remedies. The acupuncture
points used were selected from the following:
• LU-7 Lieque (on the right) and KI-6 Zhaohai (on
the left) to regulate the Directing Vessel and
strengthen the Uterus.
• L.I.-4 Hegu, in combination with LIV-3 Taichong,
to regulate the ascending and descending of Qi
and calm the Mind.
• LIV-3 Taichong to pacify the Liver, move Qi,
eliminate stagnation, calm the Mind and settle
the Ethereal Soul.
• ST-36 Zusanli and SP-6 Sanyinjiao with warm
needle to tonify Qi and Blood.
• Ren-4 Guanyuan to nourish Blood and
strengthen the Uterus.
• ST-29 Guilai to move Qi and Blood and stop pain.
An example of a point combination in one treatment would be: LU-7 (on the right) and KI-6 (on
the left), L.I.-4 on the left, LIV-3 on the right, Ren4, ST-36 and SP-6 bilaterally; the last three points
with reinforcing method, the others with even
method.
The herbal remedies used were the Three
Treasures’s Brighten the Eyes to nourish LiverBlood and Freeing the Moon to pacify the Liver
and eliminate stagnation. The latter remedy (a
variation of Xiao Yao San Free and Easy Wanderer
Powder) also nourishes Liver-Blood, and, in addition, pacifies Liver-Qi and tonifies Spleen-Qi. The
patient took Brighten the Eyes for 2 weeks after
the period and Freeing the Moon from then until
the beginning of the next period.
This patient reacted exceedingly well to the
treatment, improving even after the first session.
After only three acupuncture sessions (over a
period of 1 month) and use of the remedies, she
reported experiencing no menstrual pain with
her last period and no abdominal bowel pain,
and feeling very much better in herself. Such a
quick reaction is rather unusual as it normally
takes at least 3 monthly cycles to affect a menstrual irregularity.
Painful Periods 261
Stasis of Blood
Explanation The first six herbs constitute the Tao
Hong Si Wu Tang which invigorates Blood.
Clinical manifestations
– Yan Hu Suo, Xiang Fu and Niu Xi move Qi and
Blood in the lower abdomen and stop pain.
Intense, stabbing pain before or during the period, dark
menstrual blood with large clots, mental restlessness,
pain relieved after passing clots. Tongue: Purple. Pulse:
Wiry.
Treatment principle
Invigorate Blood, eliminate stasis, stop pain.
Acupuncture
LIV-3 Taichong, Ren-6 Qihai, G.B.-34 Yanglingquan, SP-8
Diji, ST-29 Guilai, SP-10 Xuehai, SP-6 Sanyinjiao, SP-4
Gongsun and P-6 Neiguan, BL-17 Geshu, KI-14 Siman,
ST-25 Tianshu. All with reducing or even method.
Explanation
– LIV-3 moves Qi and Blood, stops pain and regulates
the Sea of Blood of the Penetrating Vessel.
– Ren-6 moves Qi in the lower abdomen.
– G.B.-34, in combination with Ren-6, moves Qi in
the lower abdomen.
– SP-8 regulates Blood in the Uterus and stops pain.
– ST-29 regulates Blood in the Uterus.
– SP-10 and BL-17 invigorate Blood.
– SP-6 helps to invigorate Blood and stop pain.
– SP-4 (on the right) and P-6 (on the left) regulate the
Penetrating Vessel and regulate Blood in the Uterus.
– KI-14, a point of the Penetrating Vessel, moves Qi
and Blood in the abdomen and eliminates stasis
from this vessel.
– ST-25, Front-Collecting point of the Stomach, invigorates Blood in the Penetrating Vessel. The Bright
Yang is full of Qi and Blood and, because of its relationship with the Penetrating Vessel, can invigorate
Blood. The ABC of Acupuncture (AD 259) by Huang
Fu Mi says: “For women with pain in the uterus and
periods that do not stop, use ST-25 Tianshu.”6
Herbal treatment
a. Prescription
– TAO HONG SI WU TANG Variation
– Persica-Carthamus Four Substances Decoction
Variation
b. Prescription
– GE XIA ZHU YU TANG
– Eliminating Stasis below the Diaphragm Decoction
Explanation This formula, which has already been
explained, is specific to invigorate Blood in the lower
abdomen. It is stronger than the previous one and is
therefore selected when pain is more intense.
c. Prescription
– TONG JING YIN
– Painful Menses Decoction
Explanation This formula is used if, together with
stasis of Blood, there is some Cold.
– Dang Gui and Bai Shao nourish and invigorate
Blood.
– Chuan Lian Zi, and Wu Yao move Qi and eliminate
stagnation.
– Yan Huo Suo, Chuan Xiong and Yi Mu Cao
invigorate Blood and eliminate stasis.
– Xiao Hui Xiang expels Cold.
– Gan Cao harmonizes.
Modifications
• If there is pain before the periods, add Qing Pi
Pericarpium Citri reticulatae viride.
• If there are pronounced symptoms of Cold, add Pao
Jiang Rhizoma Zingiberis preparatum (fried).
• If there is pain after the period, add Shu Di Huang
Radix Rehmanniae preparata.
d. Prescription
– NEI YI FANG7
– Endometriosis Formula
Explanation
– Dang Gui nourishes and invigorates Blood.
– Dan Shen, Chi Shao, Xue Jie, Chuan Niu Xi, and E
Zhu invigorate Blood and eliminate stasis.
– Xiang Fu moves Qi, which helps to invigorate Blood.
– Gui Zhi warms the blood vessels and thus helps to
invigorate Blood.
– Hai Zao dissolves swellings.
262 Section 4: Menstrual Irregularities
This formula has a stronger Blood-invigorating
action and is suitable to treat endometriosis.
– Wu Ling Zhi and Pu Huang form the prescription
Shi Xiao San Breaking into a Smile Powder which
invigorates Blood and stops bleeding.
e. Prescription
This formula is specific for endometriosis.
Modifications
• If there is abdominal pain and pain in the anus, the
author of this formula, Dr Cai Xiao Sun, recommends
adding insect substances such as Di Bie Chong
Eupolyphaga or Jiang Can Bombyx batryticatus.
– HUA YU DING TONG TANG8
– Eliminating Stasis and Stopping Pain Decoction
Explanation
– Dang Gui and Chuan Xiong nourish and invigorate
Blood and, given their pungent taste, scatter and
remove obstructions.
– Dan Shen invigorates Blood and generates new Blood.
– Chuan Niu Xi invigorates Blood.
– Chi Shao cools and invigorates Blood.
– Xue Jie, Mo Yao and Yan Hu Suo invigorate Blood,
eliminate stasis and stop pain.
– Xiang Fu and Su Mu move Qi to help to invigorate Blood.
Women’s Treasure remedy
– STIR FIELD OF ELIXIR
This remedy is a variation of Ge Xia Zhu Yu Tang and
it invigorates Blood in the Uterus and Lower Burner.
The tongue presentation appropriate to this remedy is
a Purple body.
SUMMARY
Stasis of Blood
Clinical manifestations
Intense, stabbing pain before or during the period,
dark menstrual blood with large clots, mental
restlessness, pain relieved after passing clots. Tongue:
Purple. Pulse: Wiry.
Treatment principle
Invigorate Blood, eliminate stasis, stop pain.
Acupuncture
LIV-3 Taichong, Ren-6 Qihai, G.B.-34 Yanglingquan, SP-8
Diji, ST-29 Guilai, SP-10 Xuehai, SP-6 Sanyinjiao, SP-4
Gongsun and P-6 Neiguan, BL-17 Geshu, KI-14 Siman,
ST-25 Tianshu. All with reducing or even method.
Case history
A 29-year-old woman had been suffering from
painful periods ever since the menarche. The
pain occurred during the period and the menstrual blood was dark with some clots. The
period started hesitantly and there was not
much distension. The pain was alleviated by the
application of a hot-water bottle.
She also suffered from thrush with itching of the vagina
and a white, sticky discharge. She felt generally tired
and her stools were loose. She had a lower backache,
her memory was poor and she felt always cold. Her
Herbal treatment
Prescriptions
• TAO HONG SI WU TANG Variation PersicaCarthamus Four Substances Decoction Variation
• GE XIA ZHU YU TANG Eliminating Stasis below the
Diaphragm Decoction
• TONG JING YIN Painful Menses Decoction
• NEI YI FANG Endometriosis Formula
• HUA YU DING TONG TANG Eliminating Stasis and
Stopping Pain Decoction
Women’s Treasure remedy
STIR FIELD OF ELIXIR
tongue was Pale and her pulse was Weak on the Liver
and right Kidney positions and slightly Slow (68).
Diagnosis My diagnosis was painful periods from
mild stasis of Blood occurring against a background
of Liver and Kidney deficiency (the tiredness, cold feeling, backache, poor memory and tongue and pulse all
pointed to the latter). Besides this, she also suffered
from Spleen deficiency (loose stools) and Dampness in
the Lower Burner (vaginal itching and discharge).
Treatment principle This case is given here as an
example of adopting the wrong principle of treatment. As I came to the conclusion that the main
Painful Periods 263
aspect of the condition was a deficiency (of Liver,
Kidneys and Spleen) with only a mild and secondary
excess (stasis of Blood and Dampness in the Lower
Burner), I adopted the principle of tonifying and
warming the Kidneys and nourishing the Liver.
Herbal treatment I therefore chose a variation
of the formula You Gui Wan Restoring the Right
[Kidney] Pill:
• Shu Di Huang Radix Rehmanniae preparata 9 g
• Shan Yao Rhizoma Dioscoreae 6 g
• Shan Zhu Yu Fructus Corni 3 g
• Tu Si Zi Semen Cuscutae 6 g
• Gou Qi Zi Fructus Lycii 6 g
• Du Zhong Cortex Eucommiae 4 g
• Dang Gui Radix Angelicae sinensis 6 g
• Lu Jiao Jiao Colla Cornu Cervi 6 g
• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g
• Fu Ling Poria 6 g
• Xiang Fu Rhizoma Cyperi 4 g
• Yi Mu Cao Herba Leonuri 4 g
• Zhi Gan Cao Radix Glycyrrhizae preparata 3 g
Explanation The first eight herbs constitute a variation of You Gui Wan to tonify and warm the Kidneys and
nourish the Liver.
• Bai Zhu and Fu Ling were added to tonify the Spleen.
• Xiang Fu and Yi Mu Cao were added to move Qi
and Blood and stop pain.
• Zhi Gan Cao harmonizes.
After 10 packets of this decoction, she was no better at all. I therefore reassessed the diagnosis and
principle of treatment and came to the conclusion
that, although there was a pronounced deficiency,
it would be better to eliminate pathogenic factors
first. I did this by giving her first 10 packets of a
decoction to resolve Dampness, and then 10 packets of a further decoction to invigorate Blood and
eliminate stasis. The first decoction was a variation
of Si Miao San Four Wonderful Powder:
• Cang Zhu Rhizoma Atractylodis 4 g
• Huang Bo Cortex Phellodendri 4 g
• Niu Xi Radix Achyranthis bidentatae seu Cyathulae 4 g
• Yi Yi Ren Semen Coicis 9 g
• Dang Gui Radix Angelicae sinensis 6 g
• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g
• Fu Ling Poria 6 g
• Hong Hua Flos Carthami 4 g
• Tao Ren Semen Persicae 6 g
• Tu Si Zi Semen Cuscutae 4 g
Explanation The first four herbs represent the Si
Miao San.
• Dang Gui and Tu Si Zi were added to nourish
Liver and Kidneys.
• Bai Zhu and Fu Ling were added to tonify the Spleen.
• Hong Hua and Tao Ren were added to invigorate
Blood, eliminate stasis and stop pain.
She improved considerably after this decoction which was then followed by a variation of
Ge Xia Zhu Yu Tang Eliminating Stasis below the
Diaphragm Decoction to invigorate Blood and
eliminate stasis:
• Wu Ling Zhi Faeces Trogopteri 4 g
• Dang Gui Radix Angelicae sinensis 6 g
• Chuan Xiong Radix Chuanxiong 4 g
• Tao Ren Semen Persicae 4 g
• Hong Hua Flos Carthami 4 g
• Chi Shao Radix Paeoniae rubra 4 g
• Wu Yao Radix Linderae 4 g
• Yan Hu Suo Rhizoma Corydalis 4 g
• Xiang Fu Rhizoma Cyperi 4 g
• Gan Cao Radix Glycyrrhizae 3 g
• Zhi Ke Fructus Aurantii 4 g
• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g
• Tu Si Zi Semen Cuscutae 6 g
This is a variation of Ge Xia Zhu Yu Tang with the
addition of Bai Zhu to tonify the Spleen and Tu Si Zi
to tonify the Kidneys and the removal of Mu Dan Pi
Cortex Moutan, too cooling for her condition.
After 20 packets of this decoction, she was much
better and her periods were painless. Even though
neither of the above two formulae is tonifying,
she had more energy. After 20 packets of this last
decoction, the treatment principle reverted to the
original one of tonifying Kidneys and Liver with You
Gui Wan. This time, she felt well on it.
This case history is given to illustrate the importance
of adopting a correct principle of treatment: even
if the diagnosis is correct, adoption of the wrong
principle of treatment will not yield results. This
case also shows the importance, in mixed excess
and deficiency conditions, of eliminating pathogenic factors before tonifying: this approach is particularly important when herbs are used, less so if
only acupuncture is used.
264 Section 4: Menstrual Irregularities
Stagnation of Cold
Clinical manifestations
Lower abdominal pain before or after the period, pain central, pain relieved by the application of heat, menstrual
blood rather scanty and bright red with small, dark clots,
feeling cold, sore back. Tongue: Pale-Bluish or BluishPurple. Pulse: Deep and Choppy or Deep and Wiry.
Treatment principle
Warm the Uterus, expel Cold, invigorate Blood.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, Ren-6 Qihai, ST-29 Guilai,
KI-14 Siman, SP-8 Diji, SP-6 Sanyinjiao, ST-36
Zusanli, ST-28 Shuidao. Reducing method except
on ST-36 which should be reinforced. Moxa must be
used.
Explanation
– LU-7 and KI-6 regulate the Directing Vessel and
strengthen the Uterus.
– Ren-4, with moxa, warms the Uterus.
– Ren-6, with moxa, moves Qi and expels Cold from
the lower abdomen.
– ST-29 and KI-14 invigorate Blood.
– SP-8 and SP-6 invigorate Blood and stop pain.
– ST-36 tonifies Qi and helps to scatter Cold.
– ST-28, with moxa cones, expels Cold from the
Uterus. The ABC of Acupuncture says: “For fullness,
distension and pain of the hypogastrium radiating to
the genitals, ache in the lower back during menstruation, accumulations and Cold in the Uterus … use ST-28
Shuidao.”9
Herbal treatment
Empty-Cold
a. Prescription
– WEN JING TANG
– Warming the Menses Decoction
Explanation This is a famous formula from the Synopsis
of Prescriptions from the Golden Cabinet by Zhang Zhong
Jing (AD 220), which is primarily for Cold obstructing
the Uterus. The rationale behind it is as follows. When
Cold obstructs the Uterus, it makes Blood stagnate.
When Blood stagnates, new Blood has nowhere to go
and it cannot be contained in the Uterus: this induces
a deficiency of Blood. A longstanding Blood deficiency
may give rise to some Empty-Heat signs, which may mistakenly be interpreted as Heat signs; but the Pale-Purple
colour of the tongue clearly indicates that this is not so.
In fact, the original text refers to a parched mouth and
lips as the symptoms of Empty-Heat from Blood deficiency.10 When used for its proper pattern of longstanding internal Cold occurring against a background of
deficiency and leading to stasis of Blood, this formula
is very effective. An essential sign for its use is that the
tongue-body colour be Pale or Bluish-Purple.
– Wu Zhu Yu, Gui Zhi and Sheng Jiang warm the
Uterus and expel Cold.
– Dang Gui, Chuan Xiong and Bai Shao nourish and
invigorate Blood, which is necessary because the
obstruction of the Uterus by Cold prevents new
Blood from taking its proper place there.
– Dang Shen tonifies Qi to nourish Blood.
– Mai Men Dong and E Jiao nourish Blood and Yin.
– Mu Dan Pi clears any Empty-Heat which might
arise from Blood deficiency.
– Ban Xia harmonizes the Uterus via the Stomach
channel to which it is connected through the
Penetrating Vessel.
– Gan Cao harmonizes.
b. Prescription
– AI FU NUAN GONG WAN
– Artemisia-Cyperus Warming the Uterus Pill
Explanation
–Ai Ye, Wu Zhu Yu and Rou Gui warm the Uterus and
expel Cold.
– Xiang Fu moves Qi in the lower abdomen.
– Dang Gui, Chuan Xiong and Bai Shao nourish and
invigorate Blood.
– Huang Qi tonifies Qi in order to help to produce
more Blood.
– Sheng Di Huang nourishes Blood and Yin.
– Xu Duan tonifies the Kidneys to help to nourish
Blood.
Compared with the previous formula, this is more
warming and more tonifying. It is therefore suitable if
there is a more pronounced Kidney-Yang deficiency,
while the former is better if there is a Blood deficiency.
Painful Periods 265
The two formulae are similar in action. The main difference between them is that the former, Wen Jing Tang,
which addresses the situation when the deficiency of
Blood is a consequence of Cold obstructing the Uterus,
is applicable for a deficiency of Blood and Yin with
some symptoms of Empty-Heat such as a malar flush
and a feeling of heat; the latter, Ai Fu Nuan Gong Wan,
is used when a deficiency of Kidney-Yang and Blood
leads to internal Cold.
Modifications These variations apply to both
formulae.
•
•
If symptoms of Cold are very pronounced, add (or
increase if already in the formula) Fu Zi Radix Aconiti
lateralis preparata and Ai Ye Folium Artemisiae argyi.
If there is Dampness as well as Cold add, Cang Zhu
Rhizoma Atractylodis and Fu Ling Poria.
c. Prescription
Vessel controls the Uterus and is the Blood Chamber …
the menses spring from these two vessels, when these
are obstructed by Cold and Dampness a struggle between
these two causes pain; the pathogenic factors are victorious and the Upright Qi declines. Cold generates turbidity and, because of this, the menstrual blood looks like
black-bean juice. The treatment must be aimed at resolving Dampness and expelling Cold [with warm herbs] to
eliminate the pathogenic factors from the Directing and
Penetrating Vessels.11
– Bai Zhu benefits the Qi of the back and umbilicus.
– Fu Ling resolves Dampness.
– Ba Ji Tian and Bai Guo remove obstructions from
the Directing Vessel.
– Bian Dou, Shan Yao and Lian Zi protect the
Penetrating Vessel.
d. Prescription
– WEN QI HUA SHI TANG
– Warming the Umbilicus and Resolving Dampness
Decoction
Explanation This prescription is from Fu Qing Zhu’s
Gynaecology. It is for long-term retention of Cold and
Dampness in the Uterus leading to deficiency of Qi and
Yang and painful periods. Fu Qing Zhu says:
Some women have pain below the umbilicus 3–5 days
before the period, the pain is stabbing and the period is
like black-bean juice … who would say that this is due to
Cold and Dampness in the Lower Burner! … The Directing
and Penetrating Vessels are in the Lower Burner, the
Penetrating Vessel is the Sea of Blood and the Directing
– WEN SHEN FU YANG TANG
– Warming the Kidneys and Supporting Yang Decoction
Explanation
– Ren Shen, Bai Zhu and Shan Yao tonify the Spleen
and the Original Qi.
– Shu Di Huang and Shan Zhu Yu tonify Liver and Kidneys.
– Wu Zhu Yu, Rou Gui and Fu Zi warm the Uterus and
expel Cold.
– Tu Si Zi and Bu Gu Zhi tonify Kidney-Yang.
This formula is the most tonifying of the four for
painful periods from Empty-Cold. The four formulae
are compared and contrasted in Table 14.1.
Table 14.1 Comparison of four formulae for Painful Periods from Empty-Cold
PATTERN
SYMPTOMS
TONGUE
PULSE
Wen Jing
Tang
Empty-Cold in the Uterus,
Blood deficiency, slight EmptyHeat from Blood deficiency
Painful periods, red blood with small,
dark clots, chilliness, flushed face
Pale or BluishPurple
Choppy
Ai Fu Nuan
Gong Wan
Empty-Cold in the Uterus,
Kidney-Yang deficiency
Painful periods, red blood with small,
dark clots, backache, tiredness,
frequent, pale urination
Pale or BluishPurple
Deep, Weak
Wen Qi
Hua Shi
Tang
Spleen-Qi deficiency, KidneyYang deficiency, Dampness
and Empty-Cold in the
Uterus
Painful periods, dark, turbid, watery
blood
Pale, slightly
Bluish
Deep, Weak and
slightly Slippery
Wen Shen
Fu Yang
Tang
Spleen-Qi deficiency, KidneyYang deficiency, Empty-Cold
in the Uterus
Painful periods with red blood and small
clots, tiredness, backache, dizziness,
frequent, pale urination, depression
Pale, wet,
slightly Bluish
Deep, Weak
especially on both
Rear positions
266 Section 4: Menstrual Irregularities
Women’s Treasure remedy
– Lower Abdomen Eliminating Stasis Decoction
– WARM THE MENSES
This remedy is a variation of the formula Wen Jing Tang
Warming the Menses Decoction which expels Cold, warms
the Uterus and nourishes Blood. The tongue presentation
appropriate to this remedy is a Pale or Bluish-Purple body.
Explanation
– Xiao Hui Xiang, Gan Jiang and Rou Gui warm the
Uterus and expel Cold.
– Yan Hu Suo, Mo Yao, Pu Huang and Wu Ling Zhi
invigorate Blood and stop pain.
– Dang Gui, Chuan Xiong and Chi Shao nourish and
invigorate Blood.
Full-Cold
Prescription
– SHAO FU ZHU YU TANG
Modifications
• If there is Dampness, add Cang Zhu Rhizoma
Atractylodis and Fu Ling Poria.
SUMMARY
Stagnation of cold
Clinical manifestations
Lower abdominal pain before or after the period,
pain central, pain relieved by the application of heat,
menstrual blood rather scanty and bright red with
small, dark clots, feeling cold, sore back. Tongue: PaleBluish or Bluish-Purple. Pulse: Deep and Choppy or
Deep and Wiry.
Treatment principle
Warm the Uterus, expel Cold, invigorate Blood.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, Ren-6 Qihai, ST-29 Guilai,
KI-14 Siman, SP-8 Diji, SP-6 Sanyinjiao, ST-36 Zusanli,
ST-28 Shuidao. Reducing method except on ST-36
which should be reinforced. Moxa must be used.
Case history
A 42-year-old woman had been suffering from
painful periods for 15 years. Her cycle was short,
with a period coming every 21–25 days. She
experienced severe pain during the period and
the blood was red with small dark clots. She
felt cold in general, but especially so during the
period. She also suffered from backache and dizziness. Her tongue was Pale and slightly Swollen.
Her pulse was very Slow (52), Choppy, Weak on
the left Rear position and had no wave.
Herbal treatment
Empty-cold
Prescriptions
• WEN JING TANG Warming the Menses Decoction
• AI FU NUAN GONG WAN Artemisia-Cyperus
Warming the Uterus Pill
• WEN QI HUA SHI TANG Warming the Umbilicus
and Resolving Dampness Decoction
• WEN SHEN FU YANG TANG Warming the Kidneys
and Supporting Yang Decoction
Women’s Treasure remedy
• WARM THE MENSES
Full-Cold
Prescription
• SHAO FU ZHU YU TANG Lower Abdomen
Eliminating Stasis Decoction
Diagnosis The painful periods themselves are due
to Cold obstructing the Uterus. This is Cold of the
Empty type as is clearly shown by the Weak and
Choppy pulse. Besides this, there is an underlying
deficiency of Kidney-Yang as shown by the Slow
and Weak pulse on the left Rear position, Pale and
Swollen tongue, dizziness, cold feeling and backache, and some deficiency of Qi and Blood as evidenced by the Choppy pulse.
Treatment principle The treatment principle
adopted was to tonify and warm Kidney-Yang,
Painful Periods 267
scatter internal Cold, nourish Blood and stop
pain. She was treated with both acupuncture
and herbs.
Acupuncture The acupuncture points, used
with even method to scatter Cold and reinforcing
method to tonify the Kidneys and nourish Blood,
were selected from the following:
• LU-7 Lieque and KI-6 Zhaohai to open the
Directing Vessel, regulate Qi and Blood in the
Uterus and stop pain.
• ST-29 Guilai, with moxa, to invigorate Blood,
scatter Cold and stop pain.
• Ren-6 Qihai and Ren-4 Guanyuan, with moxa,
to tonify Qi and Blood and strengthen KidneyYang.
• BL-23 Shenshu, with needle and moxa, to
tonify and warm Kidney-Yang.
• SP-6 Sanyinjiao and ST-36 Zusanli to tonify Qi
and Blood.
Herbal treatment The formula used was a variation of Ai Fu Nuan Gong Wan Artemisia-Cyperus
Warming the Uterus Pill:
• Ai Ye Folium Artemisiae argyi 9 g
• Wu Zhu Yu Fructus Evodiae 4.5 g
• Rou Gui Cortex Cinnamomi 3 g
• Xiang Fu Rhizoma Cyperi 6 g
• Dang Gui Radix Angelicae sinensis 9 g
• Chuan Xiong Rhizoma Chuanxiong 6 g
• Bai Shao Radix Paeoniae alba 9 g
• Huang Qi Radix Astragali 6 g
• Sheng Di Huang Radix Rehmanniae 9 g
• Xu Duan Radix Dipsaci 6 g
• Wu Yao Radix Linderae 6 g
• Yan Hu Suo Rhizoma Corydalis 6 g
Explanation The first 10 herbs constitute the
root formula which scatters Cold, warms the
Uterus, tonifies Qi and Blood and tonifies and
warms Kidney-Yang.
• Wu Yao and Yan Hu Suo move Qi and Blood
and stop pain.
This patient was treated with acupuncture every
2 weeks and took the above decoction, with
slight variations, for 6 months. After this time, her
cycle became regular and the menstrual pain was
reduced by about 80%.
Case history
A 35-year-old woman had been suffering
from painful periods from the age of 14 which
were now getting worse. The pain was central
in the lower abdomen and occurred mostly
on the first day: severe and cramping, it was
relieved by the application of a hot-water
bottle. When she had the pain, she liked to
curl up and she felt cold and turned pale. The
menstrual cycle was 30 days long, the period
lasted 5 days and the blood was dark with
small clots.
Her complexion was pale, her tongue was slightly
Pale with a white coating and her pulse was very
slightly Tight on the left and Weak on both Rear
positions.
Diagnosis This is a clear example of painful periods from Empty-Cold. The Cold is evident from
the severe, cramping nature of the pain, its alleviation with heat, the cold feeling and pale complexion during the period, the small, dark clots and the
Tight pulse. That the Cold is of a deficient nature is
evident from the desire to curl up, from the Weak
pulse on both Rear positions and from the fact
that the pulse is only very slightly Tight on the left.
Apart from the Empty-Cold, there is a deficiency of
Kidney-Yang as shown by the Weak pulse on both
Kidney positions.
As for the cause of this problem, as a schoolgirl
in Yorkshire (a county in the North of England
with a cold and damp climate) she played lots of
sports and did cross-country running. This had
obviously led to the invasion of external Cold in
the Uterus; as explained in Chapter 4 on aetiology, the genital system in young girls is particularly vulnerable and prone to invasion of external
Cold.
Treatment principle This patient was treated only
with herbs as she lived quite a long way away. I
selected a variation of Wen Jing Tang Warming the
Menses Decoction, using the whole original decoction plus:
268 Section 4: Menstrual Irregularities
• Xiang Fu Rhizoma Cyperi and Yan Hu Suo
Rhizoma Corydalis to move Qi and invigorate
Blood.
Herbal treatment
The results in this case exceeded every expectation as, after only seven packets of the above
decoction, her next period was totally pain free
and, at the time of writing (4 months later),
her periods are still so. In subsequent decoctions, I added Du Zhong Cortex Eucommiae to
tonify Kidney-Yang.
– QING RE TIAO XUE TANG
– Clearing Heat and Regulating Blood Decoction
a. Prescription
Explanation
– Dan Pi and Sheng Di clear Heat and cool Blood.
– Huang Lian resolves Damp-Heat.
– Dang Gui and Bai Shao harmonize Blood.
– Chuan Xiong, Hong Hua, Tao Ren and E Zhu
invigorate Blood.
– Xiang Fu and Yan Hu Suo move Qi and stop pain.
Yan Hu Suo also invigorates Blood.
Damp-Heat
Clinical manifestations
b. Prescription
Hypogastric pain before the period and sometimes on
mid-cycle, burning sensation extending to the sacrum,
feeling of heat, menstrual blood red with small clots,
vaginal discharge, scanty, dark urine, thirst, mental restlessness. Tongue: Red, sticky-yellow tongue
coating. Pulse: Slippery.
– EMPIRICAL PRESCRIPTION
Treatment principle
Clear Heat, resolve Dampness, eliminate stasis.
Acupuncture
SP-9 Yinlingquan, SP-6 Sanyinjiao, LU-7 Lieque on
the right and KI-6 Zhaohai on the left, Ren-3 Zhongji,
ST-28 Shuidao, BL-32 Ciliao, BL-22 Sanjiaoshu, Ren-9
Shuifen, L.I.-11 Quchi, SP-10 Xuehai, KI-2 Rangu,
LIV-3 Taichong. Reducing or even method.
Explanation
– SP-9 and SP-6 resolve Dampness in the Lower
Burner. SP-6 also moves Blood.
– LU-7 and KI-6 open the Directing Vessel and
regulate the Uterus.
– Ren-3 and ST-28 resolve Dampness from the Lower
Burner and Uterus.
– BL-32 resolves Dampness in the Uterus.
– BL-22 promotes the transformation of fluids and
resolves Dampness from the Lower Burner.
– Ren-9 promotes the transformation of fluids.
– L.I.-11 and SP-10 cool Blood.
– KI-2 and LIV-3 in combination, cool Blood. LIV-3
also invigorates Blood.
Explanation Compared with the previous formula, the
present prescription aims more at resolving Damp-Heat,
the former more at clearing Heat and cooling Blood.
– Qu Mai, Bian Xu, Mu Tong and Che Qian Zi drain
Dampness via urination.
– Huang Qin resolves Damp-Heat.
– Chi Shao and Di Gu Pi clear Heat and cool Blood.
– Chuan Lian Zi and Yan Hu Suo move Qi and stop pain.
– Gan Cao harmonizes.
c. Prescription
– ER MIAO SAN Variation
– Two Wonderful Powder Variation
Explanation
– Cang Zhu and Huang Bo form the Er Miao San
which resolves Damp-Heat from the Lower Burner.
– Bai Jiang Cao resolves Fire-poison, invigorates Blood
and stops pain.
– Yan Hu Suo invigorates Blood and stops pain.
Women’s Treasure remedy
– DRAIN REDNESS
This remedy is a variation of the formula Qing Re
Tiao Xue Tang Clearing Heat and Regulating Blood
Decoction which clears Heat, cools Blood, resolves
Dampness and stops pain. The tongue presentation
appropriate to this remedy is a Red body with stickyyellow coating.
Painful Periods 269
SUMMARY
Damp-Heat
Treatment principle
Clear Heat, pacify the Liver, eliminate stagnation, stop
pain.
Clinical manifestations
Hypogastric pain before the period and
sometimes on mid-cycle, burning sensation
extending to the sacrum, feeling of heat,
menstrual blood red with small clots, vaginal
discharge, scanty, dark urine, thirst, mental
restlessness. Tongue: Red, sticky-yellow tongue
coating. Pulse: Slippery.
Treatment principle
Clear Heat, resolve Dampness, eliminate stasis.
Acupuncture
SP-9 Yinlingquan, SP-6 Sanyinjiao, LU-7 Lieque
on the right and KI-6 Zhaohai on the left, Ren-3
Zhongji, ST-28 Shuidao, BL-32 Ciliao, BL-22
Sanjiaoshu, Ren-9 Shuifen, L.I.-11 Quchi, SP-10
Xuehai, KI-2 Rangu, LIV-3 Taichong. Reducing or
even method.
Herbal treatment
Prescriptions
• QING RE TIAO XUE TANG Clearing Heat and
Regulating Blood Decoction
• EMPIRICAL PRESCRIPTION
• ER MIAO SAN Variation Two Wonderful Powder
Variation
Women’s Treasure remedy
• DRAIN REDNESS
Stagnant Liver-Qi turning into Fire
Clinical manifestations
Abdominal pain before or during the period, dark
menstrual blood, heavy period, irritability, propensity to outbursts of anger, thirst, feeling of heat,
dry stools. Tongue: Red with yellow coating, redder on the sides. Pulse: Rapid, Wiry. This is LiverFire deriving from long-term stagnation of Liver-Qi.
It is treated not by draining Fire with bitter-cold
herbs but by clearing Heat through eliminating
stagnation.
Acupuncture
LIV-3 Taichong, LIV-2 Xingjian, LIV-14 Qimen, Ren-6
Qihai, Ren-4 Guanyuan, KI-14 Siman, SP-10 Xuehai,
L.I.-11 Quchi, T.B.-6 Zhigou, G.B.-34 Yanglingquan.
All with reducing or even method. No moxa.
Explanation
– LIV-3 pacifies the Liver and eliminates stagnation. It
also harmonizes the Qi of the Penetrating Vessel and
stops pain.
– LIV-2 clears Liver-Fire.
– LIV-14, T.B.-6 and G.B.-34 pacify the Liver, move Qi
and eliminate stagnation.
– Ren-6 moves Qi in the lower abdomen.
– Ren-4 invigorates Blood and strengthens the Uterus.
– KI-14 moves Qi and Blood and harmonizes the Qi of
the Penetrating Vessel.
– SP-10 invigorates Blood and stops pain.
– L.I.-11 clears Heat.
Herbal treatment
a. Prescription
– XUAN YU TONG JING TANG
– Dispersing Stagnation and Penetrating the
Menses Decoction
Explanation This formula is from Fu Qing Zhu’s
Gynaecology. He explains that it is for abdominal pain
before the period with dark, clotted blood, due to stagnant Liver-Qi turning into Fire. He says that to treat
this, it is important to eliminate the stagnation; to clear
Heat without eliminating the stagnation that creates it
is like lopping off a branch (the Heat) but not the root
(the stagnation).12
Unfortunately, Fu Qing Zhu does not explain the reason for the interesting inclusion of Bai Jie Zi in the formula: in fact, this herb expels Cold, warms the Lungs
and resolves Cold-Phlegm from the Lungs. One possible
explanation is that Bai Jie Zi is used to regulate Qi in the
diaphragm, thus helping to pacify Liver-Qi; another,
that this very pungent herb is coordinated with the bitter herbs, such as Huang Qin, according to the principle of using ‘the pungent taste to open the passages,
270 Section 4: Menstrual Irregularities
and the bitter taste to make Qi descend’: this sounds
good but it is a method that is actually used to resolve
Dampness, not to pacify the Liver!
–
–
–
–
Bai Shao and Dang Gui pacify the Liver.
Mu Dan Pi, Shan Zhi Zi and Huang Qin clear Liver-Heat.
Bai Jie Zi: see above.
Chai Hu, Xiang Fu and Yu Jin pacify the Liver, move
Qi and eliminate stasis.
– Gan Cao harmonizes.
EMPTY CONDITIONS
Qi and Blood deficiency
Clinical manifestations
Dull hypogastric pain towards the end of or after the
period, dragging sensation in the lower abdomen, pain
relieved by pressure and massage, scanty bleeding, pale
complexion, tiredness, slight dizziness, loose stools.
Tongue: Pale. Pulse: Choppy.
b. Prescription
– DAN ZHI XIAO YAO SAN
– Moutan-Gardenia Free and Easy Wanderer Powder
Explanation This formula, already explained, is
specific to clear Liver-Heat when it derives from stagnation of Liver-Qi. It is milder than the previous prescription and is therefore suitable when the symptoms
of Heat are not pronounced and those of stagnation
predominate.
Treatment principle
Tonify Qi, strengthen the Spleen, nourish Blood.
Acupuncture
Treatment principle
Ren-4 Guanyuan, Ren-6 Qihai, ST-36 Zusanli, SP-6
Sanyinjiao, SP-8 Diji, BL-20 Pishu, SP-10 Xuehai, BL-54
Zhibian, BL-32 Ciliao. All with reinforcing method
except for SP-10, BL-54 and BL-32 which should be
needled with even method. Moxa is applicable.
Explanation
– Ren-4 nourishes Blood and the Uterus.
– Ren-6 tonifies and moves Qi in the lower abdomen.
– ST-36 and SP-6 tonify Qi, strengthen the Spleen and
nourish Blood.
– SP-8 stops pain.
– BL-20 strengthens the Spleen and nourishes Blood.
– SP-10 invigorates Blood and stops pain.
– BL-54 and BL-32 invigorate Blood and affect the
lower genital system. They are indicated when the
period pain occurs in the sacrum area.
Clear Heat, pacify the Liver, eliminate stagnation,
stop pain.
Herbal treatment
Acupuncture
a. Prescription
LIV-3 Taichong, LIV-2 Xingjian, LIV-14 Qimen, Ren-6
Qihai, Ren-4 Guanyuan, KI-14 Siman, SP-10 Xuehai,
L.I.-11 Quchi, T.B.-6 Zhigou, G.B.-34 Yanglingquan.
All with reducing or even method. No moxa.
– SHENG YU TANG
– Sage-like Healing Decoction
SUMMARY
Stagnant Liver-Qi turning into Fire
Clinical manifestations
Abdominal pain before or during the period, dark
menstrual blood, heavy period, irritability, propensity
to outbursts of anger, thirst, feeling of heat, dry
stools. Tongue: Red with yellow coating, redder on
the sides. Pulse: Rapid, Wiry.
Herbal treatment
Prescriptions
• XUAN YU TONG JING TANG Dispersing
Stagnation and Penetrating the Menses Decoction
• DAN ZHI XIAO YAO SAN Moutan-Gardenia Free
and Easy Wanderer Powder
Explanation
– Ren Shen and Huang Qi tonify Qi.
– Dang Gui, Chuan Xiong, Shu Di and Bai Shao nourish and invigorate Blood.
b. Prescription
– BA ZHEN YI MU TANG
– Eight Precious Leonorus Decoction
Painful Periods 271
Explanation This is the Ba Zhen Tang Eight Precious
Decoction, which has already been explained, with the
addition of Yi Mu Cao Herba Leonori to invigorate Blood
and stop pain.
c. Prescription
• BA ZHEN YI MU TANG Eight Precious Leonorus
Decoction
• SHI QUAN DA BU TANG Ten Complete Great
Tonification Decoction
Women’s Treasure remedy
• PRECIOUS SEA
– SHI QUAN DA BU TANG
– Ten Complete Great Tonification Decoction
Explanation This formula is used if there are symptoms of Cold.
Modifications Even in painful periods of a deficiency
type, there is always an element of stagnation, so in
order to move Qi and Blood and stop pain, add Xiang Fu
Rhizoma Cyperi and Yan Hu Suo Rhizoma Corydalis.
Women’s Treasure remedy
– PRECIOUS SEA
This remedy is a variation of the formula Ba Zhen
Tang Eight Precious Decoction which nourishes Blood
and tonifies Qi. The tongue presentation appropriate to
this remedy is a Pale and Thin body.
Yang and Blood deficiency
Clinical manifestations
Dull abdominal pain after the periods, scanty with pale
blood, no clots, abdominal pain relieved by pressure
and application of heat, dull headache, blurred vision,
feeling cold, depression, dizziness. Tongue: Pale and
Swollen. Pulse: Fine and Deep. This is due to a deficiency
of Spleen-Yang and deficiency of Liver-Blood.
Treatment principle
Warm the Yang, nourish Blood, strengthen the Centre
and stop pain.
SUMMARY
Acupuncture
Qi and Blood deficiency
BL-20 Pishu, Ren-12 Zhongwan, ST-36 Zusanli, SP-6
Sanyinjiao, Ren-4 Guanyuan, LIV-8 Ququan. LU-7
Lieque (on the right) and KI-6 Zhaohai (on the right),
BL-54 Zhibian, BL-32 Ciliao. All with reinforcing
method, except for BL-54 and BL-32 which should be
needled with even method; moxa should be used.
Explanation
– BL-20, Ren-12, ST-36 and SP-6, with moxa, nourish
Blood, tonify the Spleen and warm the Yang.
– Ren-4 and LIV-8 nourish Blood.
– LU-7 and KI-6 regulate the Directing Vessel and
strengthen the Uterus.
– BL-54 and BL-32 invigorate Blood and affect the
lower genital system. They are indicated when the
period pain occurs in the sacrum area.
Clinical manifestations
Dull hypogastric pain towards the end of or after the
period, dragging sensation in the lower abdomen,
pain relieved by pressure and massage, scanty
bleeding, pale complexion, tiredness, slight dizziness,
loose stools. Tongue: Pale. Pulse: Choppy.
Treatment principle
Tonify Qi, strengthen the Spleen, nourish Blood.
Acupuncture
Ren-4 Guanyuan, Ren-6 Qihai, ST-36 Zusanli, SP-6
Sanyinjiao, SP-8 Diji, BL-20 Pishu, SP-10 Xuehai, BL-54
Zhibian, BL-32 Ciliao. All with reinforcing method
except for SP-10, BL-54 and BL-32 which should be
needled with even method. Moxa is applicable.
Herbal treatment
Prescriptions
• SHENG YU TANG Sage-like Healing Decoction
Herbal treatment
a. Prescription
– DANG GUI JIAN ZHONG TANG
– Angelica Strengthening the Centre Decoction
272 Section 4: Menstrual Irregularities
Explanation This is a variation of the formula Xiao Jian
Zhong Tang Small Strengthening the Centre Decoction.
– Dang Gui and Bai Shao nourish Blood.
– Yi Tang and Da Zao tonify Qi.
– Gui Zhi and Sheng Jiang warm the channels and
expel Cold.
– Zhi Gan Cao harmonizes.
Modifications
• If symptoms of Cold are pronounced, add Rou Gui
Cortex Cinnamomi.
• If there is a deficiency of Kidney-Yang, add Ba Ji
Tian Radix Morindae officinalis and Tu Si Zi Semen
Cuscutae.
• If the deficiency of Blood is pronounced, add Shou
Wu Radix Polygoni multiflori preparata and Shu Di
Huang Radix Rehmanniae preparata.
• If menstrual pain is severe, add Yan Hu Suo Rhizoma
Corydalis.
• If bleeding is profuse, add Ai Ye Folium Artemisiae
argyi.
• If the deficiency of Spleen-Yang is pronounced, add
Bai Zhu Rhizoma Atractylodis macrocephalae and Gan
Jiang Rhizoma Zingiberis.
b. Prescription
– YI SHEN TONG JING TANG
– Benefiting the Kidneys and Penetrating the
Menses Decoction
Explanation
– Shan Yao tonifies the Kidneys and Spleen.
– Ba Ji Tian tonifies and warms Kidney-Yang.
– Dang Gui, Shu Di Huang and Bai Shao nourish Blood.
– Xiang Fu and Chai Hu pacify the Liver, move Qi and
eliminate stagnation.
– Yu Jin and Dan Shen invigorate Blood and
eliminate stasis.
Compared with the previous formula, this formula
has a stronger Blood-invigorating effect and is therefore suitable when pain is more intense.
c. Prescription
– YU SHEN HUA YU TANG13
– Generating the Kidneys and Transforming Stasis Decoction
Explanation
– Ba Ji Tian, Yin Yang Huo, Xu Duan and Tu Si Zi
tonify and warm Kidney-Yang.
– Dang Shen and Dang Gui tonify Qi and Blood.
– Mu Dan Pi, Tao Ren, Hong Hua, Pu Huang and Chi
Shao invigorate Blood and eliminate stasis.
– Xiang Fu moves Qi, which helps to invigorate
Blood.
Women’s Treasure remedy
– WARM THE PALACE
This remedy is a variation of the formula Dang
Gui Jian Zhong Tang Angelica Strengthening the Centre
Decoction which tonifies Kidney-Yang and nourishes
Blood. The tongue presentation appropriate to this
remedy is a Pale body.
SUMMARY
Yang and Blood deficiency
Clinical manifestations
Dull abdominal pain after the periods, scanty with
pale blood, no clots, abdominal pain relieved by
pressure and application of heat, dull headache,
blurred vision, feeling cold, depression, dizziness.
Tongue: Pale and Swollen. Pulse: Fine and Deep.
Treatment principle
Warm the Yang, nourish Blood, strengthen the
Centre and stop pain.
Acupuncture
BL-20 Pishu, Ren-12 Zhongwan, ST-36 Zusanli, SP-6
Sanyinjiao, Ren-4 Guanyuan, LIV-8 Ququan. LU-7
Lieque (on the right) and KI-6 Zhaohai (on the right),
BL-54 Zhibian, BL-32 Ciliao. All with reinforcing
method, except for BL-54 and BL-32 which should
be needled with even method; moxa should be used.
Herbal treatment
Prescriptions
• DANG GUI JIAN ZHONG TANG Angelica
Strengthening the Centre Decoction
• YI SHEN TONG JING TANG Benefiting the
Kidneys and Penetrating the Menses Decoction
• YU SHEN HUA YU TANG Generating the Kidneys
and Transforming Stasis Decoction
Women’s Treasure remedy
• WARM THE PALACE
Painful Periods 273
Kidney- and Liver-Yin deficiency
Clinical manifestations
Dull hypogastric pain towards the end of or after the
period, sore back, dizziness, scanty bleeding, pain
relieved by pressure and massage, tinnitus, blurred
vision, exhaustion. Tongue: without coating; Red if
there is Empty-Heat. Pulse: Floating-Empty.
Treatment principle
Nourish Yin, benefit the Kidneys, nourish the Liver.
Acupuncture
BL-23 Shenshu, BL-18 Ganshu, Ren-4 Guanyuan,
SP-6 Sanyinjiao, KI-3 Taixi, ST-36 Zusanli, LU-7 Lieque
(on the right) and KI-6 Zhaohai (on the left), BL-54
Zhibian, BL-32 Ciliao. Reinforcing method, except for
BL-54 and BL-32 which should be needled with even
method. A small amount of moxa may be used if the
tongue is not too Red.
Explanation
– BL-23 and BL-18 tonify Kidneys and Liver.
– Ren-4 nourishes Yin and tonifies the Kidneys and the
Uterus.
– SP-6 and KI-3 nourish the Kidneys and Liver and
regulate Blood.
– ST-36 tonifies Qi and Blood and regulates the Uterus
Connecting channel.
– LU-7 and KI-6 regulate the Directing Vessel,
strengthen the Uterus and nourish Yin.
– BL-54 and BL-32 invigorate Blood and affect the
lower genital system. They are indicated when the
period pain occurs in the sacrum area.
Herbal treatment
a. Prescription
– TIAO GAN TANG
– Regulating the Liver Decoction
Explanation
– Dang Gui and Bai Shao nourish and move Blood.
– Shan Yao tonifies Stomach and Kidneys.
– E Jiao nourishes Blood.
– Shan Zhu Yu nourishes Liver-Yin.
– Ba Ji Tian tonifies Kidney-Yang and Kidney-Essence.
– Gan Cao harmonizes.
Modifications
• If there is Damp-Heat, remove E Jiao and Ba Ji Tian
and add Yi Yi Ren Semen Coicis, Ze Xie Rhizoma
Alismatis and Bai Jiang Cao Herba Patriniae.
• If there is stasis of Blood, add Yan Hu Suo Rhizoma
Corydalis and Chi Shao Radix Paeoniae rubra.
b. Prescription
– GUI SHAO DI HUANG TANG
– Angelica-Paeonia-Rehmannia Decoction
Explanation This formula nourishes Blood as well
as Yin and it is therefore used when there is deficiency of Blood as well as of Yin. It is a variation
of Liu Wei Di Huang Tang Six-Ingredient Rehmannia
Decoction.
– The first six herbs constitute the Liu Wei Di Huang
Tang which nourishes Liver- and Kidney-Yin.
– Bai Shao and Dang Gui nourish Blood.
SUMMARY
Kidney- and Liver-Yin Deficiency
Clinical manifestations
Dull hypogastric pain towards the end of or after the
period, sore back, dizziness, scanty bleeding, pain
relieved by pressure and massage, tinnitus, blurred
vision, exhaustion. Tongue: without coating; Red if
there is Empty-Heat. Pulse: Floating-Empty.
Treatment principle
Nourish Yin, benefit the Kidneys, nourish the Liver.
Acupuncture
BL-23 Shenshu, BL-18 Ganshu, Ren-4 Guanyuan,
SP-6 Sanyinjiao, KI-3 Taixi, ST-36 Zusanli, LU-7 Lieque
(on the right) and KI-6 Zhaohai (on the left), BL-54
Zhibian, BL-32 Ciliao. Reinforcing method, except for
BL-54 and BL-32 which should be needled with even
method. A small amount of moxa may be used if the
tongue is not too Red.
Herbal treatment
Prescriptions
• TIAO GAN TANG Regulating the Liver Decoction
• GUI SHAO DI HUANG TANG Angelica-PaeoniaRehmannia Decoction
274 Section 4: Menstrual Irregularities
Case history
A 33-year-old woman had been suffering from
painful periods for 10 years. The pain occurred
during the period and the blood was bright
red and rather scanty. She felt cold in general
and colder during the period. She had had
four miscarriages. She also suffered from backache, dizziness, tinnitus, poor memory, a dry
mouth at night and night sweating. Her urination was frequent and occasionally it dribbled.
She felt always very tired and her knees ached.
Her tongue was of a normal colour but without spirit on the root. Her pulse was generally
Weak and, on the left side, very Fine and Empty
at the deep level.
Diagnosis This is a complicated condition characterized by a deficiency of both Kidney-Yin and
Kidney-Yang. The symptoms of Kidney-Yin deficiency are: dizziness, tinnitus, dry mouth at night,
night sweating, poor memory, tongue root without
spirit and pulse Empty at the deep level. The symptoms of Kidney-Yang deficiency are: feeling cold,
achy knees and frequent and dribbling urination.
The miscarriages were due to the Kidney deficiency.
Thus, this is a deficiency type of painful periods.
Treatment principle The treatment principle
adopted was to nourish Kidney-Yin and warm and
tonify Kidney-Yang. The emphasis was put on nourishing Kidney-Yin as when both Yin and Yang are
deficient, it is important to nourish the substance
first (Kidney-Yin) rather than the function (KidneyYang). The very Fine pulse which is also Empty at the
deep level also indicates the importance of nourishing the Yin primarily. However, secondary tonification of Kidney-Yang should not be overlooked.
Herbal treatment
The formula used was a variation of Tiao Gan Tang
Regulating the Liver Decoction:
•
•
•
•
•
•
•
Dang Gui Radix Angelicae sinensis 9 g
Bai Shao Radix Paeoniae alba 9 g
Shan Yao Rhizoma Dioscoreae 6 g
E Jiao Colla Corii asini 6 g
Shan Zhu Yu Fructus Corni 6 g
Ba Ji Tian Radix Morindae officinalis 4 g
Zhi Gan Cao Radix Glycyrrhizae preparata 3 g
•
•
•
•
•
Chi Shao Radix Paeoniae rubra 6 g
Yi Mu Cao Herba Leonuri 6 g
Gou Ji Rhizoma Cibotii 4 g
Gou Qi Zi Fructus Lycii 9 g
Sheng Di Huang Radix Rehmanniae 12 g
Explanation The first seven herbs constitute the
Tiao Gan Tang which nourishes Liver and Kidneys.
• Chi Shao and Yi Mu Cao move Blood and stop
pain.
• Gou Ji was added to tonify Kidney-Yang and
strengthen the back and knees.
• Gou Qi Zi was added to nourish Liver-Yin.
• Sheng Di Huang was added to nourish Kidney-Yin.
This patient was treated with this decoction (with
slight variations) for 6 months, producing a cure
in the painful periods. After a further 6 months of
treatment with the same decoction taken on alternate weeks, she conceived and delivered a healthy
baby.
Ancient acupuncture prescriptions
for Painful Periods14
1. Ren-4 Guanyuan for Cold in the Penetrating Vessel
(Simple Questions, Huang Di Nei Jing Su Wen,
Ch. 39).
2. ST-28 Shuidao for distension, fullness and pain
in the lower abdomen, lumbosacral pain during
menstruation, palpable masses and Cold in the
Uterus with pain radiating to the thighs (ABC of
Acupuncture, Zhen Jiu Jia Yi Jing, AD 259).
3. KI-6 Zhaohai, SP-6 Sanyinjiao, ST-44 Neiting and
L.I.-4 Hegu for dizziness and pain on the lateral sides
of the abdomen during the period; or KI-6 Zhaohai,
G.B.-35 Yangjiao, ST-44 Neiting and L.I.-4 Hegu (Great
Compendium of Acupuncture, Zhen Jiu Da Cheng, 1601).
4. ST-28 Shuidao and ST-27 Daju (Thousand Golden
Ducat Prescriptions, Qian Jin Yao Fang, AD 652).15
5. ST-25 Tianshu and P-5 Jianshi (Experience of
Acupuncture and Moxibustion, Zhen Jiu Zi Sheng Jing,
1220).
PROGNOSIS AND PREVENTION
Both acupuncture and Chinese herbs either singly or
in combination give excellent results in painful periods
Painful Periods 275
and the overwhelming majority of cases can be cured.
The Empty types are easier to treat than the Full types.
Of the Full types, the one from Damp-Heat is the most
difficult to treat while the one from stagnation of Qi
and Blood is the easiest. Of course, in many patients
there is a mixed condition of deficiency and excess,
in which case one concentrates on treating the stagnation in the 2 weeks before the periods and the deficiency in the 2 weeks after. In some cases, it is better to
eliminate pathogenic factors before tonifying: see case
history above.
In any menstrual problem, it takes a minimum
of three menstrual cycles to regulate Blood and the
Directing and Penetrating Vessels. Three months is
therefore the shortest possible time for the treatment
to be successful.
If dysmenorrhoea is due to endometriosis (see
below), the treatment will take considerably longer
than for functional painful periods. Dr Su Xin Ming, my
acupuncture teacher in Nanjing, used to say that acupuncture should give very good results in painful periods: if it does not, it probably means the woman has
endometriosis.
WESTERN VIEW
Western medicine differentiates primary from secondary dysmenorrhoea.
Primary dysmenorrhoea starts during adolescence
and is not associated with any organic disorder. From
the Chinese point of view, this is often due to invasion
of Cold in the Uterus when young girls are exposed to
cold during puberty either because they often play outdoor games during cold and wet winters, or because
they have been engaged in physical work (such as
farming) outdoors.
Secondary dysmenorrhoea starts later in life and may
be associated (although not necessarily) with organic
diseases such as endometriosis, pelvic inflammatory
disease or myomas.
Studies show that primary dysmenorrhoea is associated with uterine hypercontractility: during contractions, endometrial blood flow is reduced and there is
a correlation between minimal blood flow and maximal colicky pain, favouring the idea that ischaemia
due to hypercontractility causes primary dysmenorrhoea.16 This ties in well with the Chinese idea that
stagnation of Qi and Blood is a factor in most types of
dysmenorrhoea: indeed, one of the many actions of
Blood-invigorating herbs is to improve circulation of
blood and relieve ischaemia.
Endometriosis
In endometriosis, ectopic endometrium is implanted
in adjacent pelvic organs such as ovaries, Fallopian
tubes, pelvic ligaments, vagina, sigmoid colon, rectum, ureters or bladder. The most common symptom associated with endometriosis is pelvic pain
which usually starts 1–2 days before the period and
lasts throughout it. There may also be rectal pressure, pain on defaecation, lower backache radiating to the anterior thigh and dyspareunia (pain on
intercourse). However, there is no direct correlation between the severity of the pain and the extent
of endometriosis: in fact, some women with severe
endometriosis may have no symptoms and, vice
versa, women with very slight endometriosis may
suffer severe pain.
The differential diagnosis of endometriosis is very
difficult because many other diseases present with
symptoms very similar to those of endometriosis:
these include primary dysmenorrhoea, pelvic inflammatory disease, ovarian tumours, uterine myomas
and gastrointestinal disorders such as irritable bowel
syndrome.
The diagnosis of endometriosis is also fraught with
difficulties and is affected by subjectivity. Although
a laparoscopy may seem an objective and conclusive diagnostic technique, it suffers from inherent
faults: the main one, that it relies entirely on the
visual and very subjective assessment of the pelvis
by the operator and consequently is prone to misinterpretation and subjectivity; often microscopic
disease is not detected. Laparoscopy is also associated with significant morbidity.17 Endometriosis
is on the increase and it has become the commonest cause of secondary dysmenorrhoea. It is also a
major cause of infertility: 30–70% of women investigated for infertility are found to have endometriosis in varying degrees of severity. However, as it
occurs in other cases, this association does not necessarily prove that there is a causal link between
endometriosis and infertility, except in cases of
gross disease of the pelvis.
Endometriosis may cause lack of ovulation, the
luteinized unruptured follicle syndrome (i.e. the follicle responds to the luteinizing hormone surge but
276 Section 4: Menstrual Irregularities
fails to rupture) and luteal phase deficiency: each of
these conditions may cause infertility. The treatment
for endometriosis in women over 40 is radical surgery,
i.e. hysterectomy, bilateral salpingo-oophorectomy
and resection of all residual disease. In women under
40, danazol is usually prescribed: this is a derivative
of 17α ethinyl testosterone that acts on ovarian steroidogenesis and with an antigonadotropic effect. The
side effects of danazol are largely androgenic and they
include weight gain, reduction in breast size, mood
changes, depression, acne, decreased libido, headaches, muscle cramps, hot flushes, oily skin, oedema,
hirsutism, nausea and a deep voice. This last change is
often permanent and irreversible when the medication
is discontinued.
From a Chinese perspective, this disease falls under
the category of ‘Painful Periods’ or ‘Abdominal Masses’.
Endometriosis is discussed in detail in Chapter 65.
Myoma
Myomas do not usually cause pain. However, if
there is torsion they may cause dysmenorrhoea.
Dysmenorrhoea due to myomas may be helped even
if they cannot be dissolved. Invigorating Blood and
eliminating stasis will ease the dysmenorrhoea and in
general make the abdomen feel more comfortable in
spite of the myomas.
Very small myomas (up to about 2 cm in diameter)
may be dissolved with acupuncture and Chinese herbs.
If the diagnosis of myomas is definitely confirmed, then
the formulae used should include strong herbs which
‘break’ Blood such as E Zhu Rhizoma Curcumae, Ze Lan
Herba Lycopi and San Leng Rhizoma Sparganii.
A particularly good formula for myomas from stasis of
Blood is Gui Zhi Fu Ling Tang Ramulus Cinnamomi-Poria
Decoction which contains Gui Zhi Ramulus Cinnamomi,
Fu Ling Poria, Tao Ren Semen Persicae, Chi Shao Radix
Paeoniae rubra and Mu Dan Pi Cortex Moutan.
The treatment of myomas is discussed in detail in
Chapter 67.
CLINICAL TRIALS
Acupuncture
The effects of auricular acupressure and
nitric oxide on menstrual symptoms for
women with primary dysmenorrhoea
– Journal of Alternative and Complementary
Medicine 2009 15(3): 235–242.
– Wang M C, Hsu M C, Chien L W, Kao C H, Liu C F.
– Department of Nursing, National Taipei College of
Nursing, Taipei, Taiwan.
Objective
The aim of this study was to evaluate the effects of
auricular acupressure on relieving menstrual symptoms and decreasing nitric oxide (NO) for women with
primary dysmenorrhoea.
Methods
This was a randomized clinical trial comparing the effects
of auricular acupressure by seed-pressure method and
placebo adhesive patch. The trials took place at colleges
in northern and central Taiwan. A total of 71 college
women took part with a diagnosis of primary dysmenorrhoea confirmed by the presence of serum CA125
testing. Thirty-six women were randomly allocated to
the acupressure group and 35 to the control group.
The acupressure group received auricular acupressure by seed-pressure method on the Liver, Kidney and
Endocrine points. The control group had a plain adhesive
patch placed on the same points with no seed attached.
The protocol included massaging each point 15 times,
three times a day, for a total of 20 days. Outcomes measures were: a primary short-form Menstrual Distress
Questionnaire (MDQ), and secondary NO blood samples. Assessments of both were performed at baseline
and within the first 2 days of the next menstrual cycles
(after completion of 20 days of acupressure).
Mittelschmerz
Results
Mittelschmerz consists of pain in mid-cycle. It is probably due to the rupture of a follicular cyst. The pain
occurs in either lateral region of the lower abdomen
and does not usually last more than 24 hours. From
the Chinese point of view, it is often due to Dampness.
In the acupressure group, the overall menstrual symptoms and the two subscales, menstrual pain and
negative affects, revealed that menstrual symptoms
decreased significantly after auricular acupressure by
the seed-pressure method (P < 0.05). NO level increased
Painful Periods 277
in the acupressure group, although this difference did
not achieve statistical significance (P > 0.05).
Conclusion
This study supports the effects of auricular acupressure by seed-pressure method in improving menstrual
symptoms, and offers a non-invasive complementary
therapy for women with primary dysmenorrhoea.
The influence of ginger-partitioned
moxibustion on serum nitric oxide
(NO) and plasma endothelin-1 levels in
patients with primary dysmenorrhoea
due to Cold-Damp stagnation
– Zhen Ci Yan Jiu, Acupuncture Research 2008
33(6): 409–412.
– Yang J J, Sun L H, She Y F, Ge J J, Li X H, Zhang R J.
– College of Chinese Medicine, Hebei Medical
University, Shijiazhuang, China.
Objective
To explore the mechanism of ginger-partitioned moxibustion in the treatment of cold-damp stagnation primary dysmenorrhoea (PD) patients.
Methods
A total of 209 PD outpatients with a diagnosis of colddamp stagnation from three hospitals were randomized into two groups. The moxibustion group (n = 105)
was treated with ginger-partitioned moxibustion, and
the control group (n = 104) was given Yueyueshu Tang
(Menstruation Calming Decoction). Ginger-partitioned
moxibustion was applied to Ren-8 Shenque and Ren-4
Guanyuan from the start of the menstrual period
onwards for the first course and 3 days before the start
for the second and third course. At baseline and after
the treatment, plasma endothelin-1 (ET-1) and serum
nitric oxide (NO) levels were compared with those of
women (n = 20) experiencing a normal menstrual
period and were determined by radioimmunoassay and
nitrate reductase methods.
Results
After treatment, of the 105 and 104 cases in the moxibustion and control groups, 58 and 32 were cured, 37
and 33 saw markedly effective results, 5 and 24 saw
effective results, and 5 and 15 failed, with the effective rates being 95.24% and 85.58% respectively. The
therapeutic effect of the moxibustion group was significantly better than that of control group (P < 0.05).
At baseline, in comparison with the normal group,
plasma ET-1 contents in both the moxibustion and control groups were significantly higher (P < 0.01), while
serum NO contents in these two groups were markedly
lower (P < 0.01). After the treatment, comparison of
both the moxibustion and control groups showed that
plasma ET-1 decreased significantly and serum NO levels increased considerably (P < 0.05, P < 0.01), and the
therapeutic effect of the moxibustion group was markedly superior to that of the control group in lowering
plasma ET-1 (P < 0.01).
Conclusion
Ginger-partitioned moxibustion is effective in relieving
the pain of PD. This may be closely associated with the
actions of the moxibustion in lowering plasma ET-1
level and raising serum NO contents.
The acupuncture treatment of
dysmenorrhoea which is resistant to
conventional medical treatment
– Evidence Based Complementary and Alternative
Medicine 2008 5(2): 227–230.
– Iorno V, Burani R, Bianchini B, Minelli E, Martinelli
F, Ciatto S.
Objective
To evaluate the effect of acupuncture on non-steroidal
anti-inflammatory drug (NSAID)-resistant dysmenorrhoea-related pain.
Methods
Fifteen patients received 8 weekly acupuncture treatments at KI-3 Taixi, LIV-3 Taichong, SP-4 Gongsun,
ST-36 Zusanli, ST-25 Tianshu, ST-29 Guilai, ST-30
Qichong, Ren-4 Guanyuan, Ren-6 Qihai, BL-62
Shenmai, HE-7 Shenmen, L.I.-4 Hegu, P-6 Neiguan
and Zigong. The patients were allowed to continue
taking painkillers. Pain was measured according to
the visual analogue scale (VAS) and was measured at
278 Section 4: Menstrual Irregularities
baseline (T1), mid-treatment (T2), end of the treatment (T3) and 3 months (T4) and 6 months (T5) after
the end of the treatment.
Results
Pain levels and NSAID use were substantially reduced
in 13 out of 15 patients (87%). The pain intensity was
significantly reduced with respect to baseline (average VAS = 8.5), by 64%, 72%, 60% and 53% at T2,
T3, T4 and T5 respectively. A greater reduction of pain
was observed for primary as compared with secondary
dysmenorrhoea. The average pain duration at baseline (2.6 days) was significantly reduced by 62%, 69%,
54% and 54% at T2, T3, T4 and T5 respectively. The
average NSAID use was significantly reduced by 63%,
74%, 58% and 58% at T2, T3, T4 and T5 respectively,
and ceased completely in 7 patients, who were still
asymptomatic 6 months after the treatment.
given Somiton tablet orally. The treatment course was
three menstrual cycles. The pain-relieving effect was
evaluated using a numerical rating scale (NRS) at baseline and after treatment and change of PGF2α content
in menstrual fluid was tested.
Results
After treatment, the NRS score and the PGF2α level in
the acupuncture group and the massage group were
significantly lower than that in the control group (both
P < 0.01), but without significant difference between
the acupuncture and massage group (P > 0.05)
Conclusion
Acupuncture and massage have a reliable therapeutic
effect on primary dysmenorrhoea, which is superior
to that of Somiton. The mechanism might be due to
regulation of the PGF2α level in menstrual fluid.
Conclusion
The findings suggest that acupuncture may be indicated to treat dysmenorrhoea-related pain, particularly for patients who refuse or have contraindications
for NSAIDs or oral contraceptives.
A clinical observation of the treatment
of primary dysmenorrhoea with
acupuncture and massage
– Zhongguo Zhong Xi Yi Jie He Za Zhi, Chinese
Journal of Integrated Traditional and Western
Medicine 2008 28(5): 418–420.
– Lin L L, Liu C Z, Huang B Y.
– Acupuncture College of Beijing University of
Chinese Medicine, Beijing, China.
Acupuncture at the Siguan (4 gates)
points for the treatment of primary
dysmenorrhoea
– Zhongguo Zhen Jiu, Chinese Acupuncture and
Moxibustion 2008 28(3): 187–190.
– Li C H, Wang Y Z, Guo X Y.
– Luohe High Medical Training School, Henan, China.
Objective
To observe the therapeutic effect of acupuncture, using
the Qinglong Baiwei (Green Dragon Swaying its Tail)
method at the Siguan points, on primary dysmenorrhoea (PD).
Methods
Objective
To observe the clinical therapeutic effect of acupuncture massage for primary dysmenorrhoea and the
influence of acupuncture on prostaglandin F2α level in
menstrual fluid.
Methods
Ninety women with primary dysmenorrhoea were
assigned to an acupuncture group (n = 30), a massage
group (n = 30) and a control group (n = 30) which was
One-hundred and eighty women with PD were randomly divided into group A, group B and group C, with
60 cases in each group. Group A was treated by acupuncture at L.I.-4 Hegu and LIV-3 Taichong using the
Qinglong Baiwei method; group B was treated by routine
acupuncture with SP-6 Sanyinjiao and BL-32 Ciliao as
the main points; and group C was treated by oral administration of Yueyueshu Tang (Menstruation Calming
Decoction). After 3 months of treatment, the therapeutic
effects were analysed, and changes of haemorrheologic
indices and the prostaglandin level were observed.
Painful Periods 279
Results
The cured rate and the total effective rates were 75%
and 100% in group A, 60% and 95% in group B, and
25% and 90% in group C respectively, group A and B
being significantly better than group C (P < 0.01). The
analgesic effects within 30 minutes of treatment in
both groups A and B were significantly better than that
in group C (P < 0.01), and that in group A was significantly better than that in group B (P < 0.01).
Conclusion
Acupuncture at the four gates using the Qinglong
Baiwei method has a significant therapeutic effect on
primary dysmenorrhoea. It is suggested that the points
work by relieving pain by improving blood circulation
and inhibiting production of prostaglandin.
Acupuncture in patients with
dysmenorrhoea: a randomized study
on clinical effectiveness and costeffectiveness in usual care
– American Journal of Obstetrics and Gynaecology
2008 198(2): 166.e1–8.
– Witt C M, Reinhold T, Brinkhaus B, Roll S, Jena S,
Willich S N.
– Institute for Social Medicine, Epidemiology, and
Health Economics, Charité University Medical
Centre, Berlin, Germany.
Objective
To investigate the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhoea.
Methods
In this randomized controlled trial plus non-randomized cohort, 201 patients with dysmenorrhoea were
randomized to receive acupuncture (15 sessions over 3
months) or to a control group (no acupuncture). A total
of 649 women participated (mean age 36.1 ± 7.1 years)
of whom 201 were randomized. Patients who declined
randomization received acupuncture treatment. All
subjects were allowed to receive usual medical care.
Results
After 3 months, the average pain intensity on a scale
of 0–10 was lower in the acupuncture compared to the
control group: 3.1 vs. 5.4 which was a significant difference (P < 0.001). The acupuncture group had better
quality of life scores.
Conclusion
Additional acupuncture in patients with dysmenorrhoea was associated with improvements in pain and
quality of life as compared to treatment with usual
care alone. Although acupuncture treatment in addition to usual care incurs additional costs, the improvement to a patient’s quality of life can be considered as
cost-effective.
An observation on retained seeds at
auricular acupuncture points for the
treatment of primary dysmenorrhoea
– Zhongguo Zhen Jiu, Chinese Acupuncture and
Moxibustion 2007 27(11) 815–817.
– Wu R D, Zhang H D, Lin L F.
– Rehabilitation Section, Yongchun Hospital of
Quanzhou City, Fujian, China.
Objective
To observe the therapeutic effect and prognosis of
using ear seeds for primary dysmenorrhoea.
Methods
One-hundred and fourteen women were randomly
divided into an ear seed group (n = 60) and a
Western medication group (n = 54). The ear seed
group was treated at the points: Shenmen, Uterus,
Endocrine, Subcortex, Sympathetic and Kidney
using Vaccaria seeds which were retained with an
adhesive plaster. The Western medication group
was treated orally with Indomeixin enteric tablets.
(Enteric tablets use a special coating which prevents release and absorption of the active ingredients until the tablets reach the intestines.) The
therapeutic effects were assessed after treatment of
three menstrual cycles.
Results
The total effective rate was 91.7% in the ear seed group
and 77.8% in the Western medication group with a significant difference between the two group (P < 0.05);
280 Section 4: Menstrual Irregularities
and the long-term therapeutic effect in the ear seed
group was better than that in the Western medication
group.
Conclusion
Using ear seeds has significant therapeutic effect on
primary dysmenorrhoea.
A randomized controlled study on the
analgesic effect of superficial needling
plus electrostimulation of SP-6 Sanyinjiao
for primary dysmenorrhoea
– Zhen Ci Yan Jiu, Acupuncture Research 2007
32(5): 342–346.
– Zhi L X.
– Eye-Ear-Nose-Throat Hospital of Jiaozuo Coal
Corporation, Jiaozuo, China.
Objective
To evaluate the analgesic and therapeutic effects of
superficial acupuncture followed by electrostimulation
(ESA) of SP-6 Sanyinjiao for treating primary dysmenorrhoea (PD).
Methods
One-hundred and seventy-one patients were randomly
divided into ESA (n = 57), superficial acupuncture (SA;
n = 57) and medication (n = 57) groups. Patients in the
SA group were needled bilaterally at SP-6 Sanyinjiao
and patients in the ESA group were needled at SP-6
Sanyinjiao bilaterally before electric stimulation of 60
Hz (2–3 V) was applied for 30 minutes. Patients in the
medication group took Brufen sustained-release capsules 0.3 mg, b.i.d., for 3 days, then again 3 days before
the start of menstruation for 5 days. The cumulative
score of clinical symptoms was evaluated before and
after the treatment.
Results
Comparison among the three groups showed that there
was a significant difference from baseline scores to posttreatment scores in both the ESA and SA groups and
these were significantly larger than that of the medication group (P < 0.001). In the ESA group, during the
first menstrual cycle, the number of patients who saw
complete relief from their symptoms after 30 minutes
of stimulation was significantly more than those of the
SA group (P < 0.05). Results of intention-to-treat (ITT)
analysis showed that out of the ESA, SA and medication groups, the cured cases were 40, 38 and 10, the
markedly effective were 9, 10 and 27, the effective were
5, 4 and 7, and the failed were 3, 5 and 13 respectively
with the total effective rates being 94.74%, 91.23%
and 77.19% respectively. The effective rates of ESA and
SA groups were significantly higher than that of medication group (P < 0.01), and the results of per-protocol
analysis were similar to those of ITT analysis.
Conclusion
The analgesic effect of both ESA and SA at SP-6
Sanyinjiao for PD patients is significantly better than
that of oral administration of Brufen.
Ascertaining the efficacy of acupuncture
for the treatment of primary
dysmenorrhoea
– Gynakologisch Geburtshilfliche Rundschau,
Gynaecologic and Obstetric Review 2003 43(4):
250–253.
– Habek D, Cerkez Habek J, Bobi-Vukovi M, Vuji B.
– Clinical Department of Gynaecology and Obstetrics,
Clinical Hospital, Osijek, Croatia.
Objective
The aim of this study was to evaluate the effect of acupuncture in the treatment of primary dysmenorrhoea (PD).
Methods
This clinical prospective, placebo-controlled trial
included 57 women with primary dysmenorrhoea.
Of these, 30 were treated with real acupuncture at
the points Du-20 Baihui, bilateral L.I-4 Hegu, Ren-3
Zhongji, Ren-4 Guanyuan, Ren-6 Qihai, bilateral
G.B-34 Yanglingquan, bilateral BL-23 Shenshu, bilateral SP-6 Sanyinjao and auricular acupuncture at
Shenmen; 27 women were treated with placebo acupuncture. Acupuncture treatments were considered
successful if PD did not occur any more, medication
for PD became unnecessary or if PD symptoms did not
occur for 2 years after the acupuncture treatment.
Painful Periods 281
Results
Women in the real acupuncture group had a significant decrease in medication compared with the placebo
group (P < 0.0001). After 1 year, the success rate for
the treatment of PD symptoms was 93.3% in the real
acupuncture group vs. 3.7% in the placebo group.
Conclusion
Real acupuncture was proved effective in the treatment of the symptoms of primary dysmenorrhoea
and this effect lasted until at least 1 year following the
treatment.
Herbal treatment
The therapeutic effects of Chiljeh
Yangbuh Wan on primary dysmenorrhoea:
a randomized, double blind, placebocontrolled study
– Complementary Therapies in Medicine 2009 17(3):
123–130.
– Jang J B, Yoon Y J, Park J H, Jeong H G, Cho J H, Ko S
G et al.
– Department of Korean Oriental Gynaecology, Kyung
Hee University, Hoegi dong,Dongdaemun-gu, Seoul,
Republic of Korea.
Objective
This clinical study was conducted to investigate the
efficacy and safety of Chiljeh Yangbuh Wan (CYW), a
herbal medicine native to Korea, in treating primary
dysmenorrhoea.
who passed the screening test was divided into either
the placebo or CYW group. These two groups were further split into smaller subsets (indication, non-indication, and unspecified group) according to Korean
Oriental medical diagnosis.
Results
In the non-indication group, the placebo and CYW
group did not show significant difference in VAS, VRS
and MVRS scores at baseline (first VAS, first VRS, first
MVRS), or after medication (second VAS, second VRS,
second MVRS). In the indication group, the placebo and
CYW group showed significant difference in change in
VAS and MVRS scores. No evidence of toxicity could be
found, and no serious adverse reactions to CYW were
reported.
Conclusion
The results suggest that Chiljeh Yangbuh Wan is effective and safe in treating primary dysmenorrhoea
when prescribed appropriately under Korean Oriental
medical diagnosis.
The clinical efficacy of Kampo medicine
(Japanese traditional herbal medicine) in
the treatment of primary dysmenorrhoea
– Journal of Obstetrics and Gynaecology Research
2008 34(5): 898–908.
– Oya A, Oikawa T, Nakai A, Takeshita T, Hanawa T.
– Department of Obstetrics and Gynaecology, Nippon
Medical School, Kitasato University, Yama, Tokyo,
Japan.
Methods
Objective
One-hundred patients with primary dysmenorrhoea
who visited Kyung Hee University Korean Oriental
Medicine Hospital between 19 July 2004 and 27 August
2004 were recruited. Secondary or drug-related dysmenorrhoea was screened out through interviews and
examination. The patients were randomized to receive
either CYW or a placebo formula for one menstrual
period in a double-blind model. Visual analogue scale
(VAS), Verbal rating scale (VRS), and multidimensional
verbal rating scale (MVRS) were used to evaluate the
severity of the dysmenorrhoea. A total of 71 patients
To evaluate the clinical efficacy of Kampo medicine in
treating primary dysmenorrhoea.
Methods
A retrospective evaluation of Kampo treatment in 176
subjects with dysmenorrhoea during the previous 12
years was performed. In order to minimize the subjective discretion of the severity of symptoms, classification
of the severity level of abdominal pain during menstruation was applied by considering the requirement
282 Section 4: Menstrual Irregularities
for non-steroidal anti-inflammatory drugs (NSAIDs)
and disturbance of daily activities. Severity levels at
baseline and after Kampo treatment were defined in
108 patients. The following severity levels were used:
no abdominal pain (level 0), abdominal pain with no
requirement of NSAIDs (level 1), abdominal pain with
no daily activity disturbances with use of NSAIDs (level
2), and painful menstruation which required absenteeism even with use of NSAIDs (level 3).
following the cessation of menstrual bleeding, for two
consecutive menstrual cycles. The comparison group
was provided with a similar intervention as soon as
menstrual bleeding was noted. The degree of menstrual pain was recorded daily using a visual analogue
scale and the duration of pain was also recorded during menstrual bleeding for five consecutive menstrual
cycles.
Results
Results
The numbers of cases in levels 0, 1, 2 and 3 changed
from 0 (0%), 0 (0%), 47 (43.5%) and 61 (56.5%) to 5
(4.6%), 42 (38.9%), 51 (47.2%) and 10 (9.3%) respectively (P < 0.0001). There were 25 kinds of Kampo
formulae prescribed in effective cases.
Conclusion
Kampo medicine prescribed according to Kampo diagnosis reduced the severity of primary dysmenorrhoea
and is therefore suggested to be beneficial in improving
quality of life.
A traditional Chinese herbal medicine
used to treat dysmenorrhoea among
Taiwanese women
– Journal of Clinical Nursing 2008 17(19):
2588–2595.
– Cheng J F, Lu Z Y, Su Y C, Chiang L C, Wang R Y.
– Department of Nursing, China Medical University
and China Medical University Hospital, Tai-Chung,
Taiwan.
Objective
The purposes of this study were two-fold: first, to ascertain the relative effectiveness of the Chinese herbal formula Si Wu Tang Four Substances Decoction (SWT) for
dysmenorrhoea, and second, to compare two different
timings for consumption of SWT in terms of menstrual
pain.
Methods
A total of 49 participants was alternately assigned
into two study groups. The experimental group was
administered 15 g of SWT daily for 7 consecutive days,
The results indicated that the decrease in menstrual
pain levels and the duration of pain between the experimental group and the comparison group was not significant. However, the decrease in menstrual pain and
the duration of pain over the five menstrual cycles
within the experimental group (from 2.07 to 1.42;
2.71 to 1.21; P < 0.05) and within the comparison
group (from 1.94 to 1.23; 2.66 to 1.68; P < 0.05) were
significant (P < 0.05).
Conclusion
Si Wu Tang has been continuously standardized for
effective use as part of menstrual health and can be
integrated as a complementary therapy within Western
medicine.
Chinese herbal medicine for primary
dysmenorrhoea
– Cochrane Database of Systematic Reviews
2008, Issue 2. Art. No.: CD005288. DOI:
10.1002/14651858.CD005288.pub3.
– Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA.
– Chinese Medicine Program, University of Western
Sydney, Centre for Complementary Medicine
Research, Bankstown Campus, Sydney, New South
Wales, Australia.
Objective
To determine the efficacy and safety of Chinese herbal
medicine for primary dysmenorrhoea when compared
with placebo, no treatment and other treatment.
Search strategy
The following databases were searched:
•
The Cochrane Menstrual Disorders and Subfertility
Painful Periods 283
•
•
•
•
•
•
•
Group Trials Register (to 2006), MEDLINE (1950 to
January 2007).
EMBASE (1980 to January 2007).
CINAHL (1982 to January 2007).
AMED (1985 to January 2007).
CENTRAL (The Cochrane Library Issue 4, 2006).
China National Knowledge Infrastructure (CNKI,
1990 to January 2007).
Traditional Chinese Medicine Database System
(TCMDS, 1990 to December 2006).
The Chinese BioMedicine Database (CBM, 1990 to
December 2006).
Citation lists of included trials were also reviewed.
Selection criteria
Any randomised controlled trials involving Chinese
herbal medicine versus placebo, no treatment, conventional therapy, heat compression, another type of
Chinese herbal medicine, acupuncture or massage
were assessed. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the
use of an intra-uterine contraceptive device.
Conclusion
The review found promising evidence supporting the
use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.
The effect of Tong Jing Ning
Dysmenorrhoea pill on primary
dysmenorrhoea
– Zhongguo Zhong Xi Yi Jie He Za Zhi, Chinese
Journal of Integrated Traditional and Western
Medicine 2005 25(7): 608–611.
– Song Z M, Xing S L, Lou M Y, Sun S, Ha X, Zhu L.
– Research Centre of Traditional Chinese Medicine,
Tianjin College of Traditional Chinese Medicine,
Tianjin, China.
Objective
To study the effect of Tong Jing Ning (TJN) on primary
dysmenorrhoea.
Data collection and analysis
Methods
Quality assessment, data extraction and data translation were performed independently by two review
authors. Attempts were made to contact study authors
for additional information and data.
One-hundred and twenty primary dysmenorrhoea
patients were treated with TJN and 40 patients were
treated with aspirin as controls. The levels of serum
oestrogen (E2) and progestin (P) content in the luteal
metaphase and anaphase (MI/AI) as well as endothelin
(ET) and calcitonin gene related peptide (CGRP) in the
metaphase and menstrual stage before and after treatment were determined.
Results
Thirty-nine randomized controlled trials (RCTs) involving a total of 3475 women were included in the review.
A number of the trials were of small sample size and
poor methodological quality. Results for Chinese herbal
medicine compared to placebo were unclear in three
RCTs. Chinese herbal medicine resulted in significant
improvements in pain relief in 14 RCTs, improvement
in overall symptoms in six RCTs and use of additional
medication in two RCTs when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief
in 18 RCTs, in overall symptoms in 14 RCTs and use of
additional medication in five RCTs after up to 3 months
of follow-up when compared to commonly used
Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture in two RCTs and heat compression in one RCT.
Results
The therapeutic effect, and the curative markedly effective rate and improvement rate of the main accompanying symptoms of severe and moderate primary
dysmenorrhoea patients in the treated group were superior to those in the control group (P < 0.01). The level of
E2 and ET were significantly decreased, and the content
of P and CGRP respectively were significantly increased
in the treated group after treatment (P < 0.01).
Conclusion
In patients with primary dysmenorrhoea, Tong Jing
Ning pill may not only regulate ovarian hormone, ET
284 Section 4: Menstrual Irregularities
and CGRP, but improve the mental–emotional state,
and improve homoeostasis thus consolidating the therapeutic effect.
A novel anti-dysmenorrhoea therapy
with cyclic administration of 2 JapaneseChinese herbal medicines
– Clinical and Experimental Obstetrics and
Gynaecology 2003 30(2–3): 95–98.
– Tanaka T.
– Department of Obstetrics and Gynaecology,
Wakayama Medical University, Kimi-idera,
Wakayama, Japan.
Objective
To evaluate the effect of two Japanese–Chinese herbal
medicines on the treatment of dysmenorrhoea.
Methods
Seventeen patients were administered Shakuyakukanzoto (SK) (Shao Yao Gan Cao Tang Peony and
Licorice Decoction) and Tokishakuyakusan (TS) (Dang Gui
Shao Yao San Angelica Paeonia Powder) alternately within
the menstrual cycle (SK/TS cyclic therapy).
Results
All of the 17 patients suffering from dysmenorrhoea
(including recurrent endometriotic and adenomyotic
patients following treatment with gonadotropin-releasing hormone agonists or Danazol) obtained complete
relief within 3 months when treated with the SK/
TS cyclic therapy. Nine of 12 patients treated with
the SK/TS cyclic therapy ovulated as determined by
biphasic changes in basal body temperature patterns.
All the three secondary amenorrhoea patients with
moderate levels of serum oestradiol, but not the three
secondary amenorrhoea patients with little serum
oestradiol, ovulated during the SK/TS cyclic therapy.
One of the treated patients, who had a history of 10
repetitive spontaneous abortions, carried the eleventh
pregnancy to term resulting in a healthy newborn.
Conclusion
The SK/TS cyclic therapy can be a conservative antidysmenorrhoea therapy for endometriotic and adenomyotic patients who desire pregnancy.
END NOTES
1. He Ren 1981 A New Explanation of the Synopsis of Prescriptions from
the Golden Cabinet (Jin Gui Yao Lue Xin Jie
), Zhejiang
Science Publishing House, p. 188. The Synopsis of Prescriptions from
the Golden Cabinet was written by Zhang Zhong Jing c. AD 200.
2. Ibid., p. 187.
3. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai,
p.19. First published in 1827. Fu Qing Zhu was born in 1607 and
died in 1684.
4. Zhang Jing Yue 1986 The Complete Works of Jing Yue (Jing Yue Quan
Shu
), Shanghai Science and Technology Press, Shanghai,
p. 641. First published in 1624.
5. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple
Questions (Huang Di Nei Jing Su Wen
), People’s
Health Publishing House, Beijing, p. 4. First published c. 100 BC.
6. Shandong College of Traditional Chinese Medicine 1980 An
Explanation of the ABC of Acupuncture (Zhen Jiu Jia Yi Jing Jiao Shi
), People’s Health Publishing House, Beijing, p.
1476. The ABC of Acupuncture was written by Huang Fu Mi c. AD
259.
7. Hu Xi Ming 1990 Great Treatise of Secret Formulae in
Chinese Medicine (Zhong Guo Zhong Yi Mi Fang Da Quan
), Culture Publishing House, Shanghai, Vol. 2,
p. 203.
8. Zhou Cui Zhen 1996 Titbits from Dr Cai Xiao Sun Experience in
Treating Difficult Gynaecological Diseases, Journal of Traditional
Chinese Medicine (Zhong Yi Za Zhi
) 37(2): 80.
9. An Explanation of the ABC of Acupuncture, p. 1476.
10. A New Explanation of the Synopsis of Prescriptions from the Golden
Cabinet, p. 188.
11. Fu Qing Zhu’s Gynaecology, pp 22–23.
12. Ibid., p. 20.
13. Great Treatise of Secret Formulae in Chinese Medicine, p. 204.
14. Wang Xue Tai 1995 Great Treatise of Chinese Acupuncture (Zhong
Guo Zhen Jiu Da Quan
), Henan Science and
Technology Publishing House, p. 452.
15. Chen You Bang 1990 Chinese Acupuncture Therapy (Zhong
Guo Zhen Jiu Zhi Liao Xue
), China Scientific
Publishing House, Beijing, p. 884.
16. Ann McPherson 1993, Women’s Problems in General Practice,
Oxford University Press, Oxford, p. 185.
17. Ibid., p. 300.
CHAPTER 15
BLEEDING BETWEEN PERIODS
AETIOLOGY 285
PATHOLOGY 286
IDENTIFICATION OF PATTERNS AND TREATMENT 286
Liver- and Kidney-Yin deficiency with Empty-Heat 286
Damp-Heat 287
Blood stasis 289
Spleen- and Kidney-Yang deficiency 290
PROGNOSIS AND PREVENTION 292
An irregularity of the cycle is menstrual bleeding that
occurs consistently at about the mid-point of the cycle.
The bleeding may last 1–2 days or even longer; if it lasts
much longer and is relatively heavy, this condition may
be mistakenly interpreted as being Early Periods. The
main factors are usually a disharmony of Yin–Yang,
imbalance of Qi and Blood, stasis of Blood or DampHeat.
Bleeding between Periods should be differentiated
from Early Periods, Flooding and Trickling (Beng Lou)
and Red or White–Red Leucorrhoea. Early Periods are
characterized by bleeding some time before the normal;
the amount of bleeding is normal or profuse. Flooding
and Trickling is characterized by either very heavy
bleeding at or before the right time or long trickling of
blood after the period. Red or Red–White Leucorrhoea
is characterized by a persistent discharge, unrelated
to the cycle, but which, especially in the case of Red
Leucorrhoea, may be mistaken for menstrual blood.
An important feature of Bleeding between Periods
is that the bleeding occurs roughly at mid-cycle, i.e.
at ovulation time. Ovulation is due to the fluctuation of Kidney-Yin and Kidney-Yang under the control of the Directing and Penetrating Vessels: thus, the
underlying cause of such irregularity of bleeding is a
disharmony of the Kidneys, no matter what other pat-
tern there might be (such as stasis of Blood or DampHeat). The mid-cycle phase is the ovulatory phase in
Western medicine. The ancient Chinese doctors called
this phase ‘heat’. Yuan Liao Fan, author of Jade Ruler of
Gynaecology, says:
Living things in the universe all have ‘heat’. Female cats
and dogs run and yell ferociously during this period.
Women have a menstrual period each month. There must
be one day of ‘heat’ when she feels hot and stuffy with an
intolerable desire to have sex.1
The occurrence of ‘heat’ in a woman is related to
the fluctuation of Yin and Yang of the Kidney and
the ebb and flow of Qi and Blood in the Directing and
Penetrating Vessels. It is for this reason that most
causes of bleeding between periods involve some
Heat.
AETIOLOGY
Overwork, too many children
too close together
Overwork in the sense of working long hours without adequate rest or having too many children in a
short space of time may injure Liver- and Kidney-Yin;
this may lead to Empty-Heat which agitates the Blood,
makes the Directing and Penetrating Vessels unstable
and therefore causes bleeding at mid-cycle.
Irregular diet
Excessive consumption of greasy foods or dairy
foods weakens the Spleen and leads to Dampness.
This mixes easily with Heat forming Damp-Heat.
Heat agitates the Blood and leads to bleeding at
mid-cycle.
286 Section 4: Menstrual Irregularities
Traumas, abdominal operations,
post-partum stasis of Blood
Traumas, abdominal surgery and post-partum conditions may all cause stasis of Blood. This leads to
obstruction of the Directing and Penetrating Vessels;
the new blood that is formed has nowhere to go and
leaks out, causing bleeding at mid-cycle.
while the amount of flow is based on the condition
of Water. Thus a shortened menstrual cycle with
profuse flow indicates hyperactive Fire and abundant
Water; a shortened menstrual cycle with scanty flow
indicates hyperactive Fire and insufficient Water … In
treatment, Fire is not to be reduced, but Water should be
strengthened. Once Water becomes sufficient, Fire will be
extinguished spontaneously. The formula Liang Di Tang
is recommended.3
Excessive physical exercise
Excessive physical exercise or sports, or excessive lifting
(be it at work or in the gym) weaken the Spleen- and
Kidney-Yang, the Directing and Penetrating Vessels
are injured and bleeding occurs because Qi fails to hold
blood.
PATHOLOGY
The main pathological conditions in Bleeding between
Periods are:
•
•
•
•
Liver- and Kidney-Yin deficiency with Empty-Heat
Damp-Heat
Blood Stasis
Spleen- and Kidney-Yang deficiency.
Deficiency of Kidney-Yin leads to hyperactivity of
the Minister Fire which may damage the Directing and
Penetrating Vessels and impair their functions in controlling blood: this results in bleeding. This condition
was described in the book Fu Qing Zhu’s Gynaecology
which says:
In some women with heavy menstrual bleeding the eyes
become black and dark … Everybody believes this is due
to Fire agitating the Blood; however, this is not Full Fire
but Empty Fire. People use stop-bleeding herbs with some
results at times, but if one does not use Yin tonics this
allows the Empty Fire to rebel … Therefore one should
never use stopping-bleeding herbs on their own but one
should also nourish Yin in order to stop heavy uterine
bleeding.2
In another chapter, Fu Qing Zhu says:
People may think that shortened menstrual cycle with
one or two spots of blood is due to extreme Heat in
the Blood. Who would say that it is due to hyperactive
Fire in the Kidneys and deficient Kidney Water? …
A shortened menstrual cycle is the result of Fire,
This condition is more likely to occur in older
women.
Damp-Heat damages the Directing and Penetrating
Vessels and may cause bleeding. Stasis of Blood in
the Lower Burner may also damage the Penetrating
Vessel (which is the Sea of Blood) and cause
bleeding.
When Spleen- and Kidney-Yang are deficient, the
Kidneys fail to store the Essence and the Spleen fails
to control Blood. This weakens the Directing and
Penetrating Vessels and leads to bleeding of the deficient type.
IDENTIFICATION OF PATTERNS
AND TREATMENT
Liver- and Kidney-Yin deficiency
with Empty-Heat
Clinical manifestations
Bleeding at mid-cycle that is scanty, scarlet red and
without clots, no abdominal pain, dizziness, tinnitus,
night sweating, backache, dark urine, feeling of heat
in the evening. Tongue: Red without coating. Pulse:
Floating-Empty or Fine-Rapid.
Treatment principle
Nourish Yin, tonify Liver and Kidneys, clear EmptyHeat, consolidate the Directing and Penetrating Vessels,
stop bleeding.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, Ren-7 Yinjiao, KI-5 Shuiquan,
KI-13 Qixue, KI-3 Taixi, SP-6 Sanyinjiao, L.I.-11 Quchi,
SP-10 Xuehai, KI-2 Rangu, SP-8 Diji. All with reducing
or even method. No moxa.
Bleeding Between Periods 287
Explanation
– LU-7 and KI-6 regulate the Directing Vessel,
strengthen the Uterus and nourish Yin.
– Ren-4, KI-3 and SP-6 nourish the Kidneys.
– Ren-7 nourishes Yin and strengthens the Uterus.
– KI-5, Accumulation point, stops bleeding. All
Accumulation points, especially those of Yin
channels, have this property.
– KI-13, a point of the Penetrating Vessel, strengthens
this vessel and tonifies the Kidneys.
– L.I.-11 and SP-10 cool Blood and stop bleeding.
– KI-2 clears Empty-Heat.
– SP-8 stops uterine bleeding.
Herbal treatment
a. Prescription
– LIANG DI TANG and ER ZHI WAN
– Two ‘Di’ Decoction and Two Solstices Pill
Explanation The first six herbs constitute the formula Liang Di Tang which nourishes Yin, clears EmptyHeat and cools Blood, while the last two herbs form the
prescription Er Zhi Wan which nourishes Yin, clears
Empty-Heat and stops bleeding from Empty-Heat.
– Sheng Di Huang and Mai Men Dong nourish Yin.
– Di Gu Pi clears Empty-Heat.
– Xuan Shen nourishes Yin, cools Blood and stops
bleeding,
– Bai Shao and E Jiao nourish Blood which helps to
nourish Yin. They also ‘calm’ Blood to stop bleeding.
– Nu Zhen Zi and Han Lian Cao nourish Heat, clear
Empty-Heat and stop bleeding.
b. Prescription
– LIU WEI DI HUANG WAN
– Six-Ingredient Rehmannia Pill
Explanation This prescription, which has already been
explained, nourishes Liver- and Kidney-Yin. Compared
with the previous formula, it only nourishes Yin and
does little to clear Empty-Heat, nor does it cool Blood. It
is therefore suitable when the deficiency of Yin occurs
without much Empty-Heat.
Modifications
• If there is Yin deficiency with Damp-Heat, use the
Liu Wei Di Huang Wan plus Xiao Ji Herba Cirsii, Ce
Bai Ye Cacumen Platycladi and Yi Yi Ren Semen Coicis.
• If there is backache and a pronounced Kidney
deficiency, add Du Zhong Cortex Eucommiae and Tu
Si Zi Semen Cuscutae.
Women’s Treasure remedy
– EASE THE JOURNEY-YIN
This remedy is a variation of Zuo Gui Wan Restoring
the Left [Kidney] Decoction. It nourishes Yin and clears
Empty-Heat. It is suitable to treat bleeding because it
contains herbs that are astringent and tend to stop
bleeding (such as Mu Li and Suan Zao Ren).
Damp-Heat
Clinical manifestations
Mid-cycle bleeding that may be heavy or scanty, sticky,
viscous blood, no clots, fatigue, joint aches, feeling of
oppression of the chest, poor appetite, scanty, dark
SUMMARY
Liver- and Kidney-Yin deficiency
with Empty-Heat
Clinical manifestations
Bleeding at mid-cycle that is scanty, scarlet red and
without clots, no abdominal pain, dizziness, tinnitus,
night sweating, backache, dark urine, feeling of heat
in the evening. Tongue: Red without coating. Pulse:
Floating-Empty or Fine-Rapid.
Treatment principle
Nourish Yin, tonify Liver and Kidneys, clear EmptyHeat, consolidate the Directing and Penetrating
Vessels, stop bleeding.
Acupuncture
LU-7 Lieque (on the right) and KI-6 Zhaohai (on the
left), Ren-4 Guanyuan, Ren-7 Yinjiao, KI-5 Shuiquan,
KI-13 Qixue, KI-3 Taixi, SP-6 Sanyinjiao, L.I.-11
Quchi, SP-10 Xuehai, KI-2 Rangu, SP-8 Diji. All with
reducing or even method. No moxa.
Herbal treatment
Prescriptions
• LIANG DI TANG and ER ZHI WAN Two ‘Di’
Decoction and Two Solstices Pill
• LIU WEI DI HUANG WAN Six-Ingredient
Rehmannia Pill
Women’s Treasure remedy
• EASE THE JOURNEY-YIN
288 Section 4: Menstrual Irregularities
urine, vaginal discharge. Tongue: sticky-yellow coating.
Pulse: Slippery.
Treatment principle
Clear the Liver, strengthen the Spleen, resolve
Dampness, stop bleeding.
Acupuncture
SP-9 Yinlingquan, SP-6 Sanyinjiao, Ren-9 Shuifen,
Ren-3 Zhongji, G.B.-41 Zulinqi (on the right) and T.B.-5
Waiguan (on the left), ST-28 Shuidao, ST-29 Guilai,
SP-1 Yinbai (with moxa cones), BL-22 Sanjiaoshu,
BL-32 Ciliao, SP-8 Diji. All with reducing or even
method. Generally speaking, no moxa (except on SP-1);
however, this pattern can often occur against a background of Yang deficiency, in which case some moxa
can be used.
Explanation
– SP-9, SP-6, ST-28, Ren-9 and BL-22 resolve
Dampness.
– Ren-3 resolves Dampness and strengthens the Uterus.
– G.B.-41 and T.B.-5 regulate the Girdle Vessel and
resolve Damp-Heat from the Liver channel. This vessel
affects the genitals and hypogastrium in general.
– ST-29 drains Dampness from the Lower Burner and
regulates Blood.
– SP-1 is an empirical point to stop bleeding, with
direct moxa cones. Moxa cones can be used even if
there is Heat.
– BL-32 drains Dampness from the genitourinary
system.
– SP-8 stops uterine bleeding.
Herbal treatment
a. Prescription
– QING GAN ZHI LIN TANG Variation
– Clearing the Liver and Stopping ‘Lin’ Decoction Variation
Explanation The first 10 herbs constitute the original prescription from Fu Qing Zhu’s Gynaecology. Please
note that the dosages are taken from the source text
and in my own practice I would probably reduce them
by at least a half. Since this formula is originally for red
vaginal discharge (rather than intermenstrual bleeding) it may seem strange that it concentrates so much
on nourishing Blood rather than draining Dampness.
Fu Qing Zhu gives an interesting explanation:
The emphasis of the prescription is in nourishing LiverBlood rather than draining Dampness from the Spleen. This
is because the cause of red leucorrhoea is Fire primarily
with little Dampness. Since Fire prevails when Blood is
deficient, nourishing Blood is sufficient to clear Fire. In red
leucorrhoea, Water and Blood are mixed together and it is
difficult to distinguish whether there is Dampness or not,
Dampness has become red and transformed into Blood:
thus, treating Blood also eliminates Dampness.4
It is because this formula concentrates on treating Blood that it is suitable to treat intermenstrual
bleeding.
– Dang Gui, Bai Shao, Sheng Di Huang, Hei Xiao Dou
and E Jiao nourish Blood.
– Mu Dan Pi clears Liver-Heat.
– Huang Bo drains Dampness.
– Huai Niu Xi directs the formula to the Lower Burner.
– Xiang Fu moves Qi and enters the Liver channel, thus
directing the formula to the Liver channel.
– Hong Zao harmonizes.
– Fu Ling has been added to drain Dampness.
b. Prescription
– BA ZHENG TANG Variation
– Eight Corrections Powder Variation
Explanation The first seven herbs constitute the formula Ba Zheng Tang minus Da Huang: this formula
drains Damp-Heat from the Lower Burner.
– Sheng Di Huang was added to cool and ‘calm’ Blood
so as to stop bleeding.
– Bai Mao Gen and Qian Cao Gen stop bleeding. Qian
Cao Gen also cools and invigorates Blood.
Modifications
• If Damp-Heat is pronounced, add the whole formula
Si Miao San Four Wonderful Powder plus Xiao Ji Herba
Cirsii.
c. Prescription
– EMPIRICAL PRESCRIPTION by Dr Liu Geng Wu
Explanation
– Qu Mai and Bian Xu resolve and drain Damp-Heat.
– Chuan Lian Zi moves Liver-Qi.
– Yan Hu Suo and Chi Shao invigorate Blood and
eliminate stasis.
– Pu Gong Ying and Bai Jiang Cao resolve ToxicHeat.
Bleeding Between Periods 289
– Bai Shao ‘calms’ Blood and helps to stop bleeding.
This formula is suitable if Damp-Heat is accompanied by stasis of Blood and Toxic-Heat.
Blood stasis
Women’s Treasure remedy
Bleeding between periods that may be scanty or profuse, dark blood with clots, lateral abdominal pain,
mental restlessness. Tongue: Purple. Pulse: Wiry, Choppy
or Firm.
– DRAIN THE JADE VALLEY
This remedy drains Damp-Heat from the Lower
Burner. The tongue presentation appropriate to this
remedy is a sticky-yellow coating that is thicker on the
root, possibly with red spots.
Clinical manifestations
Treatment principle
Move Qi, invigorate Blood, eliminate stasis, stop bleeding.
Acupuncture
SUMMARY
Damp-Heat
Clinical manifestations
Mid-cycle bleeding that may be heavy or scanty,
sticky, viscous blood, no clots, fatigue, joint aches,
feeling of oppression of the chest, poor appetite,
scanty, dark urine, vaginal discharge. Tongue: stickyyellow coating. Pulse: Slippery.
Treatment principle
Clear the Liver, strengthen the Spleen, resolve
Dampness, stop bleeding.
Acupuncture
SP-9 Yinlingquan, SP-6 Sanyinjiao, Ren-9 Shuifen,
Ren-3 Zhongji, G.B.-41 Zulinqi (on the right) and
T.B.-5 Waiguan (on the left), ST-28 Shuidao,
ST-29 Guilai, SP-1 Yinbai (with moxa cones), BL-22
Sanjiaoshu, BL-32 Ciliao, SP-8 Diji. All with reducing or even method. Generally speaking, no moxa
(except on SP-1); however, this pattern can often
occur against a background of Yang deficiency, in
which case some moxa can be used.
Herbal treatment
Prescriptions
• QING GAN ZHI LIN TANG Variation Clearing the
Liver and Stopping ‘Lin’ Decoction Variation
• BA ZHENG TANG Variation Eight Corrections
Powder Variation
• EMPIRICAL PRESCRIPTION by Dr Liu Geng Wu
Women’s Treasure remedy
• DRAIN THE JADE VALLEY
SP-4 Gongsun (on the right) and P-6 Neiguan (on the
left), Ren-6 Qihai, ST-29 Guilai, SP-10 Xuehai, KI-14
Siman, BL-17 Geshu, SP-6 Sanyinjiao, SP-1 Yinbai,
SP-8 Diji. All with reducing or even method. Moxa can
be used if the tongue is Bluish-Purple.
Explanation
– SP-4 and P-6 regulate the Penetrating Vessel,
invigorate Blood and subdue rebellious Qi.
– Ren-6 moves Qi in the Lower Burner.
– ST-29 invigorates Blood in the Lower Burner.
– SP-10, BL-17, and SP-6 invigorate Blood.
– KI-14, a point of the Penetrating Vessel, moves Qi
and Blood in the Uterus and generally the Lower
Burner.
– SP-1 is an empirical point to stop bleeding.
– SP-8 stops uterine bleeding.
Herbal treatment
Prescription
– ZHU YU ZHI XUE TANG
– Eliminating Stasis and Stopping Bleeding Decoction
Explanation This formula from Fu Qing Zhu was
intended for menstrual bleeding deriving from injuries
and falls.
– Sheng Di Huang and Dang Gui nourish and cool
Blood. Only the ‘tail’ of Dang Gui is used here to
invigorate Blood.
– Zhi Ke moves Qi to invigorate Blood.
– Da Huang, Chi Shao, Mu Dan Pi and Tao Ren
invigorate Blood and eliminate stasis.
– Gui Ban is in the formula to enter the Directing and
Penetrating Vessels and direct the formula to the
Uterus to stop uterine bleeding.
290 Section 4: Menstrual Irregularities
Modifications
• If the symptoms and signs of Blood stasis are pronounced, add the formula Shi Xiao San Breaking into
a Smile.
• If the stasis of Blood derives from Cold, add Ai
Ye Folium Artemisiae argyi and Gui Zhi Ramulus
Cinnamomi or use Gui Zhi Fu Ling Wan Ramulus
Cinnamomi-Poria Pill instead.
• If stasis of Blood is mixed with Damp-Heat, add
Cang Zhu Rhizoma Atractylodis, Yi Yi Ren Semen Coicis, Bai Jiang Cao Herba Patriniae and Ze Xie Rhizoma
Alismatis.
Spleen- and Kidney-Yang deficiency
Women’s Treasure remedies
Clinical manifestations
– STIR FIELD OF ELIXIR
Bleeding between periods that may be scanty or profuse, red blood without clots, no abdominal pain, dizziness,
tinnitus, backache, kneeache, loose stools, tiredness,
depression, feeling cold, frequent urination. Tongue: Pale
and Swollen. Pulse: Weak, Deep.
This remedy invigorates Blood and stops bleeding.
The tongue presentation appropriate to this remedy is
a Purple body.
– INVIGORATE BLOOD AND STEM THE FLOW
This remedy invigorates Blood and stops bleeding.
The tongue presentation appropriate to this remedy is
a Purple body.
Herbal treatment
Prescriptions
• ZHU YU ZHI XUE TANG Eliminating Stasis and
Stopping Bleeding Decoction
Women’s Treasure remedies
• STIR FIELD OF ELIXIR
• INVIGORATE BLOOD AND STEM THE FLOW
Treatment principle
Strengthen the Spleen and Kidneys, tonify Yang, warm
the Uterus, contain Blood.
SUMMARY
Acupuncture
Blood stasis
BL-20 Pishu, BL-23 Shenshu, Ren-4 Guanyuan,
Ren-6 Qihai, Ren-12 Zhongwan, ST-36 Zusanli, SP-6
Sanyinjiao, SP-8 Diji. All with reinforcing method;
moxa should be used.
Explanation
– BL-20, Ren-12, ST-36 and SP-6 tonify the Spleen.
Warm needle on ST-36 is particularly effective to
tonify the Yang.
– BL-23 and Ren-4 tonify the Kidneys and strengthen
the Uterus. Direct moxa cones should be used on
Ren-4 to warm the Uterus.
– Ren-6 tonifies and raises Qi and helps to tonify Qi to
contain Blood.
– SP-8, Accumulation point, stops uterine bleeding.
Clinical manifestations
Bleeding between periods that may be scanty or profuse, dark blood with clots, lateral abdominal pain,
mental restlessness. Tongue: Purple. Pulse: Wiry,
Choppy or Firm.
Treatment principle
Move Qi, invigorate Blood, eliminate stasis, stop
bleeding.
Acupuncture
SP-4 Gongsun (on the right) and P-6 Neiguan (on
the left), Ren-6 Qihai, ST-29 Guilai, SP-10 Xuehai,
KI-14 Siman, BL-17 Geshu, SP-6 Sanyinjiao,
SP-1 Yinbai, SP-8 Diji. All with reducing or even
method. Moxa can be used if the tongue is BluishPurple.
Herbal treatment
a. Prescription
– GU BEN ZHI BENG TANG Variation
– Consolidating the Root and Stopping Flooding Decoction
Variation
Bleeding Between Periods 291
Explanation The first six herbs constitute the formula Gu Ben Zhi Beng Tang which has already been
explained. This formula tonifies Spleen- and KidneyYang and nourishes Blood and is specific for menstrual
bleeding from Yang deficiency.
– Du Zhong and Xu Duan were added to tonify
Kidney-Yang and firm Qi to stop bleeding.
b. Prescription
– JIN GUI SHEN QI WAN
– Golden Chest Kidney-Qi Pill
Explanation This formula, already explained, tonifies Kidney-Yang and expels Cold. Compared with the
previous formula, it does not tonify the Spleen as much
and is hotter in nature. It is therefore suitable when the
Cold symptoms are pronounced and the tongue is very
Pale and wet.
Acupuncture
BL-20 Pishu, BL-23 Shenshu, Ren-4 Guanyuan,
Ren-6 Qihai, Ren-12 Zhongwan, ST-36 Zusanli, SP-6
Sanyinjiao, SP-8 Diji. All with reinforcing method;
moxa should be used.
Herbal treatment
Prescriptions
• GU BEN ZHI BENG TANG Variation
Consolidating the Root and Stopping Flooding
Decoction Variation
• JIN GUI SHEN QI WAN Golden Chest Kidney-Qi Pill
Three Treasures remedy
• STRENGTHEN THE ROOT
Women’s Treasure remedy
• UNICORN PEARL
Three Treasures remedy
– STRENGTHEN THE ROOT
This remedy tonifies Spleen- and Kidney-Yang and
nourishes Blood. The tongue presentation appropriate
to this remedy is a Pale body.
Women’s Treasure remedy
– UNICORN PEARL
This remedy tonifies Kidney-Yang and the KidneyEssence. The tongue presentation appropriate to this
remedy is a Pale and wet body.
SUMMARY
Spleen- and Kidney-Yang deficiency
Clinical manifestations
Bleeding between periods that may be scanty or
profuse, red blood without clots, no abdominal
pain, dizziness, tinnitus, backache, kneeache, loose
stools, tiredness, depression, feeling cold, frequent
urination. Tongue: Pale and Swollen. Pulse: Weak,
Deep.
Treatment principle
Strengthen the Spleen and Kidneys, tonify Yang,
warm the Uterus, contain Blood.
Case history
A 50-year-old woman had been suffering
from bleeding in between periods for 3 years.
The bleeding occurred for 3 days at midcycle, with fresh, red, scanty blood. The periods were regular, lasted 4 days and caused
her no problems. She actually sought treatment for a different condition which was a
left abdominal pain extending towards the
left loin: this pain was worse at night and
when her bladder was full. Although she
had all kinds of investigations for this pain,
including the gynecological system, intestines, kidneys and bladder, no cause had
been found. On interrogation, it transpired
that she suffered from backache and dizziness and that in the past she had tried conceiving unsuccessfully. Her tongue was Pale
and Swollen. Her pulse was Slippery on the
left, Rapid, Full and slightly Overflowing on
the left Middle positions, and Weak on the
right Rear position.
Diagnosis I thought that the bleeding derived
from deficiency of the Spleen- and KidneyYang, being unable to hold Blood. This was confirmed by her previous infertility, the Pale tongue,
292 Section 4: Menstrual Irregularities
the Weak pulse on the right Kidney position and
the backache and dizziness. However, her pulse was
interesting for its rapidity, which could not be reconciled with the Pale tongue and Yang deficiency,
its Slipperiness and its Overflowing quality on the
left Middle position. A pulse that is Slippery and Full
on the Middle level, especially on the left side, indicates a pathology of the Penetrating Vessel, and I at
first thought this was the case here. Such a pathology could also have accounted for the rapidity of
the pulse, due not to Heat but to rebellious Qi in
the Penetrating Vessel. For this reason, I used the
opening points of the Penetrating Vessel in the
first treatment. However, after the first treatment,
reassessing the pulse, I realized that it was Full and
slightly Overflowing only on the left Middle position. I attributed this to a Girdle Vessel pathology:
this was also confirmed by the Slippery quality of
the pulse, the swelling of the tongue and the type
of abdominal pain (abdominal pain that extends
to the loins and towards the back is typical of a
Girdle Vessel pathology). This pathology is characterized by Dampness infusing downwards and this
was confirmed by the swelling of the tongue and
the Slipperiness of the pulse. I concluded that her
infertility in the past must also have been due to a
pathology of Dampness in the Girdle Vessel.
Treatment principle Apart from the first treatment,
when I had treated the Penetrating Vessel points, I
followed the principle of regulating the Girdle Vessel,
resolving Dampness and tonifying Spleen- and KidneyYang. I treated this patient only with acupuncture.
Acupuncture In the first treatment I used the following points:
• SP-4 Gongsun (on the right) and P-6 Neiguan
(on the left) to regulate the Penetrating Vessel
and subdue rebellious Qi.
• L.I.-4 Hegu on the right, to regulate the
ascending and descending of Qi.
• LIV-3 Taichong on the left, to subdue rebellious
Qi in the Penetrating Vessel. Thus, these two
points L.I.-4 and LIV-3 were crossed over with
the opening points of the Penetrating Vessel,
SP-4 and P-6.
• KI-14 Siman, a point of the Penetrating Vessel,
on the left, to move Qi and eliminate stagnation
in this vessel in the lower abdomen.
•
•
•
ST-28 Shuidao on the left to resolve
Dampness.
ST-29 Guilai on the left, to move Qi and Blood in
the lower abdomen.
G.B.-25 Daimai to regulate the Girdle Vessel and
treat the left loin pain.
In the second and third treatments I used:
G.B.-41 Zulinqi (on the right) and T.B.-5
Waiguan (on the left) to regulate the Girdle
Vessel and expel Dampness in the Lower
Burner.
• G.B.-25 Daimai on the left, to regulate the
Girdle Vessel and treat the left abdominal
pain.
• LIV-13 Zhangmen, a point of the Girdle Vessel,
on the left to harmonize Liver and Spleen and
help to resolve Dampness.
• G.B.-34 Yanglingquan on the left to move Qi
in the lower abdomen and treat the abdominal
pain.
• ST-27 Daju to resolve Dampness in the lower
abdomen and treat the abdominal pain.
• SP-6 Sanyinjiao, with warm needle, bilateral, to
tonify Spleen-Yang.
• BL-23 Shenshu, bilateral, to tonify Kidney-Yang.
•
After only three treatments, her abdominal pain
disappeared and the mid-cycle bleeding stopped.
I have since followed up her case and learned that
it has not recurred. Although I concentrated more
on treating the abdominal pain than the mid-cycle
bleeding, the latter was also helped by treating
the Girdle Vessel and by concentrating on resolving Dampness and moving Qi. This proved that,
although the bleeding was caused by a deficiency
of Kidney-Yan, Dampness also played a role in its
pathogenesis.
PROGNOSIS AND PREVENTION
Bleeding between periods may take a fairly long time to
treat. Both acupuncture and herbal therapy are effective either singly or in combination. The pattern from
Kidney-Yin deficiency will take the longest to treat, followed by that of Damp-Heat. However, it is not at all
unusual for these patterns to be combined, especially
the pattern of Damp-Heat together with a Kidney
Bleeding Between Periods 293
deficiency, be it of Yin or Yang. In such cases, the treatment is more complicated and the condition will take
even longer to cure.
When Dampness is combined with a Kidney deficiency, I generally prefer to concentrate on eliminating
Dampness first, with one of the formulae listed above.
Only when the symptoms and signs of Dampness have
receded would I proceed with a Kidney-tonifying prescription. Alternatively, the treatment can be given
in accordance with the four phases of the menstrual
cycle: the woman could take a Dampness-draining formula during the third and fourth phases of the cycle
(i.e. mid-cycle and before the period) and a Kidneytonic formula during the second phases (i.e. after
the period). It is essential for women suffering from
Kidney-Yin deficiency to try to have more rest and
avoid overworking. Those suffering from Damp-Heat
should avoid dairy foods and greasy foods, and those
suffering from Yang deficiency too many raw, cold
foods and iced drinks.
END NOTES
1. Cited in Luo Yuan Kai 1986 Gynaecology in Chinese Medicine (Zhong
Yi Fu Ke Xue
), Shanghai Science and Technology Press,
Shanghai, p. 58.
2. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke
), Shanghai People’s Publishing House, Shanghai, p. 8.
First published in 1827. Fu Qing Zhu was born in 1607 and died in
1684.
3. Ibid., p. 15.
4. Ibid., p. 7.
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CHAPTER 16
NO PERIODS
AETIOLOGY 295
PATHOLOGY 296
IDENTIFICATION OF PATTERNS AND TREATMENT 298
EMPTY CONDITIONS 298
Liver and Kidney deficiency 298
Blood deficiency 300
Spleen- and Kidney-Yang deficiency 303
Liver- and Kidney-Yin deficiency 304
Lung-Yin and Blood deficiency 306
Heart- and Kidney-Yin deficiency 307
Heart- and Spleen-Blood deficiency 308
FULL CONDITIONS 309
Stagnation of Qi and Blood 309
Damp-Phlegm in the Lower Burner 312
Ancient acupuncture prescriptions for amenorrhoea 314
PROGNOSIS AND PREVENTION 314
WESTERN VIEW 315
CLINICAL TRIALS 316
Herbal treatment 316
stopping of the menses for 1 or 2 months as a consequence of sudden environmental or living condition
changes. If a woman presents with secondary amenorrhoea, it is of course very important to exclude pregnancy first of all because, were the patient treated for
amenorrhoea, one might prescribe herbs which are
contraindicated in pregnancy. I shall call this condition
‘No Periods’ rather than ‘amenorrhoea’.
A basic differentiation must be made between No
Periods from a deficiency and No Periods from an
excess. No Periods from a deficiency includes Blood
deficiency, Spleen and Kidney deficiency, and Liver
and Kidney deficiency. It should be further differentiated between that from a pre-natal weakness and
that from a post-natal weakness. Obviously primary
amenorrhoea is more likely to be due to a deficiency
of the Pre-Natal Essence and secondary amenorrhoea
to a deficiency of the Post-Natal Qi. No Periods from
excess is usually due to stagnation of Qi and/or Blood,
Phlegm or Cold.
In the Yellow Emperor’s Classic, No Periods was called
“woman having no moon” (i.e. no monthly flow) or
“moon affair not coming”, indicating the early connection of menstruation with the moon phases.
AETIOLOGY
The absence of periods (amenorrhoea) is called Bi Jing
in Chinese: jing means menstruation and bi means
‘shut’ or ‘closed’. Western medicine distinguishes
between primary amenorrhoea which occurs when
a woman has not had a period by the time she is 18,
and secondary amenorrhoea, which occurs when a
woman has had periods but they have stopped for at
least 3 months.
Obviously, the temporary interruption of the menses
that occurs after childbirth and during breastfeeding
is not considered amenorrhoea, nor, similarly, is the
Emotional stress
Anger, intended in a broad sense to include frustration, resentment, hatred and irritation, may cause
stagnation of Qi which, with time, may lead to stasis of
Blood: this causes an excess type of No Periods.
Sadness and grief are very common factors in
the development of amenorrhoea. They deplete Qi
of the Lungs and Heart: the Lungs govern Qi, the
Heart governs Blood, and when Qi cannot make or
move Blood and Heart-Blood cannot descend to the
296 Section 4: Menstrual Irregularities
Uterus, the menses stop. The Secret Prescriptions for
Gynaecological Patterns and Treatment by Ye Tian Shi
says:
The Heart governs Blood and the Spleen is the Root of
Qi and Blood. Worry and pensiveness injure the Heart
making Heart-Qi depleted; this cannot generate Blood,
the Spleen is the child of the Heart and [therefore]
loses its nourishment, the appetite declines which cuts
off the Root of generation and transformation [i.e. the
Spleen].1
when girls are likely to adopt a slimming diet or a vegetarian diet that fails to substitute for the meat protein
a judicious combination of vegetable types of protein.
Excessive consumption of dairy foods and greasy foods
leads to the formation of Dampness and Phlegm: these
can obstruct the Lower Burner and lead to amenorrhoea. These women are often overweight. The Chinese
Medicine Gynaecology says: “Amenorrhoea in overweight
women is due to Dampness and Phlegm obstructing the
Membranes.”3
Overwork
Worry and pensiveness affect Lungs and Spleen
and may lead to deficiency and stagnation of Qi
simultaneously. Deficient Qi fails to make Blood while
stagnant Qi fails to move Blood leading to stasis of
Blood. Amenorrhoea can therefore result from a
simultaneous deficiency and stasis of Blood. Chen
Jia Yuan says in his Secret Gynaecological Prescriptions
(Qing dynasty):
Worry injures the Lungs, pensiveness depletes the Spleen,
since Lungs and Spleen are injured Qi and Blood stagnate,
the woman becomes irritable and resentful and develops
palpitations and a feeling of distension and oppression, and
eventually amenorrhoea.2
Excessive physical work or exercise
This weakens the Spleen which fails to make Blood
and, when occurring at puberty time, it may also cause
stagnation of Qi and Blood in the Lower Burner, thus
causing primary amenorrhoea. In this case, the amenorrhoea is due to a deficiency (of Blood) complicated by
an excess condition (stagnation of Qi and Blood in the
Lower Burner).
Hereditary weakness
A hereditary Kidney weakness can of course cause
primary amenorrhoea. In this case, there is a
deficiency of Kidney-Essence and usually also of
Liver-Blood.
Diet
A diet poor in nourishment leads to depletion of Qi
and Blood and therefore secondary amenorrhoea from
Blood deficiency and Spleen deficiency. This becomes a
cause of disease especially if it occurs at a young age
Overwork in the sense of working long hours without adequate rest for many years leads to deficiency of
Liver- and Kidney-Yin which, in turn, may cause secondary amenorrhoea.
Contraceptive pill
Very often, when a woman comes off the contraceptive pill after being on it a long time, the periods do
not return for a long time. I have seen this happen in
practice many times when a woman’s periods may
not return for over a year after being on the pill for a
number of years.
My experience is that the contraceptive pill causes
a Blood deficiency and a Kidney deficiency and those
are the reasons why the periods do not return.
PATHOLOGY
From a pathology point of view, the main distinction
to be made is that between deficiency and excess types
of amenorrhoea. The two main deficiency types are
Qi and Blood deficiency and Liver and Kidneys deficiency. The two main excess patterns are Qi and Blood
stagnation and retention of Dampness and Phlegm.
The pathology of these patterns will be discussed
briefly.
Liver and Kidney deficiency
Liver and Kidney deficiency involves a deficiency of
Kidney-Essence and Liver-Blood, which in turn leads
to emptiness of the Penetrating and Directing Vessels.
It can be caused by hereditary weakness of the KidneyEssence, too many childbirths too close together or
overwork.
No Periods 297
The Kidney-Essence is the origin of menstrual Blood
and the Liver stores Blood: a deficiency of these two
organs therefore leads to a malnourishment of the
Uterus and of the Penetrating and Directing Vessels.
The True Transmission of Medical Theory (Yi Xue Zheng
Chuan, 1515) says: “The menses are a transformation
of Kidney-Water, when this is deficient, menstrual Blood
dries up.”4
The deficiency of Kidney-Essence could also take the
form of Kidney-Yang deficiency; this leads to the formation of Cold which obstructs the Uterus and causes
amenorrhoea.
Qi and Blood deficiency
A deficiency of Qi and Blood stems primarily from a
weakness of the Spleen and Stomach which fail to
make Blood. A deficiency of Heart-Blood is often also
involved as Heart-Blood plays a role in the making of
menstrual blood. Apart from this, of course a deficiency of Liver-Blood is a frequent cause of amenorrhoea. The Simple Questions says in Chapter 40:
Dryness of Blood may be caused by a severe loss of blood
which occurred at a young age or by entering the bedroom
[i.e. having sexual intercourse] in a drunken state. This
will exhaust Qi and injure the Liver so that the period does
not come.5
A deficiency of the Spleen and Stomach is of course
primarily caused by dietary factors such as a diet
lacking in nourishment and Blood-producing foods.
A deficiency of Heart-Blood can result either from
a failure of Spleen and Stomach in making Blood, or
from emotional problems. There are, however, several
other causes of Stomach and Spleen deficiency such
as a long, severe disease, repeated miscarriages and
breastfeeding for too long. The Secret Collection of the
Orchid Room (Lan Shi Mi Cang, 1271) by Li Dong Yuan
(celebrated author of the Discussion on Stomach and
Spleen) says: “When in a woman Stomach and Spleen are
deficient for a long time, Qi and Blood become depleted and
menstruation ceases.”6
Yin deficiency, Blood dried up
A primary deficiency of Liver- and Kidney-Yin, resulting from overwork, a long, chronic disease or too many
children too close together, leads to a drying up of Yin
and Blood and therefore the cessation of the menses,
as the Sea of Blood of the Penetrating Vessel becomes
Empty. In such cases, the disease may also pertain to
the Chinese category of Exhaustion (Xulao) with amenorrhoea as a secondary symptom.
The Complete Book of Jing Yue (Jing Yue Quan Shu,
1624) says: “When Yin is depleted and Blood dried up …
there may be cough with a feeling of heat at night … and
amenorrhoea …”.7
Qi stagnation and Blood stasis
Qi stagnation and Blood stasis result from emotional
stress such as anger, irritation, frustration, resentment,
worry, guilt or anxiety. Although ‘anger’ is always
mentioned as the emotion that may lead to stagnation
of Liver-Qi, other emotions such as worry, anxiety or
even sadness may affect the Liver. Long-term stagnation of Liver-Qi in women easily leads to stasis of Blood:
stagnant Blood obstructs the Uterus, the Penetrating
Vessel’s Qi cannot flow to produce the menses, hence
amenorrhoea results. This is an excess type of amenorrhoea as the period fails to arrive not because the Blood
is deficient but because it is stagnant.
Damp-Phlegm obstructing the Uterus
Damp-Phlegm is usually associated with Spleen deficiency and it is caused by the excessive consumption of
cold foods (such as iced water or ice-cream), raw foods,
dairy foods or greasy foods. Dampness obstructs the
Lower Burner and the Uterus so that Blood cannot flow
in the Uterus vessel and amenorrhoea develops. Cold is
also an important pathogenic factor in the pathogenesis of amenorrhoea: it obstructs the Uterus and this
leads to stasis of Blood: obstruction of the Uterus Vessel
and Uterus Channel prevents the Blood from flowing
and the period from coming.
The Synopsis of Prescriptions of the Golden Cabinet says:
In gynaecological diseases, deficiency, accumulation of
Cold and stagnation of Qi cause the cessation of the period
which may last for over one year. The Blood becomes cold,
the Uterus door is knotted and Cold injures the channels …
When Cold is in the Lower Burner, the period is scantier
than normal.8
The General Treatise on the Aetiology
Symptomatology of Diseases (AD 610) says:
and
298 Section 4: Menstrual Irregularities
When the period does not come, it is due to injury of Qi
and Blood. When the body is a weakened state, WindCold invades the Uterus and injures the Directing and
Penetrating vessels and the Small Intestine and Heart
channels; the Uterus Channel is severed and Blood
cannot get through. The Directing and Penetrating
vessels originate from the Uterus and are the Sea of the
Channels. The Small Intestine and Heart channels are
exteriorly–interiorly related and govern the downward
[infusion] of menstrual Blood. Wind-Cold injures
the menstrual Blood. When Blood is warm it flows
well, when it is cold it shuts down because Cold causes
stagnation. When Blood is knotted inside the period does
not come.9
Differentiation from pregnancy
Obviously No Periods should be differentiated from the
symptoms and signs of the very early stages of pregnancy: Table 16.1 highlights the main differential
points.
Summary of patterns
The patterns discussed below are as follows:
Empty
• Liver and Kidney deficiency.
• Blood deficiency.
• Spleen- and Kidney-Yang deficiency.
• Liver- and Kidney-Yin deficiency.
• Lung-Yin and Blood deficiency.
• Heart- and Kidney-Yin deficiency.
• Heart- and Spleen-Blood deficiency.
Full
Stagnation of Qi and Blood.
Damp-Phlegm in the Lower Burner.
•
•
IDENTIFICATION OF PATTERNS
AND TREATMENT
EMPTY CONDITIONS
Liver and Kidney deficiency
Clinical manifestations
Table 16.1 Differential signs of amenorrhoea
and early stage of pregnancy
Symptoms
and signs
Pulse
Gynecological
examination
AMENORRHOEA
EARLY PREGNANCY
The periods
stop after
having been
irregular for
some time;
they may also
stop suddenly
but in this
case there is
abdominal pain
Normally regular
periods stop suddenly,
there is nausea, possibly
a strange attraction
to or dislike of certain
foods, desire to lie
down
Deep, Choppy
or Fine
Slightly Slippery,
relatively strong on the
Rear position
No signs of
pregnancy
Uterus feels soft, cystic
and round (after 5–6
weeks), enlarged (only
after 8 weeks), breasts
enlarged with veins
appearing on their
surface, Montgomery’s
tubercles (enlargement
of sebaceous glands
around the edge of the
areolae)
Menses not started by 18, or stopped after becoming
scanty, tiredness, lower backache, knee-ache, dizziness,
depression, mentally tired, lack of will-power, feeling
cold. Tongue: Pale. Pulse: Deep, Weak. This is essentially a deficiency of Kidney-Yang and Liver-Blood
not filling the Penetrating and Directing Vessels. This
pattern occurs more frequently in young women.
Treatment principle
Tonify the Kidneys, nourish the Liver, regulate the periods.
Acupuncture
BL-18 Ganshu, BL-23 Shenshu, BL-52 Zhishi, Ren-4
Guanyuan, LU-7 Lieque (on the right) and KI-6
Zhaohai (on the left), LIV-8 Ququan, SP-6 Sanyinjiao,
ST-36 Zusanli, KI-3 Taixi, KI-13 Qixue, Xuefu (extra
point), Ren-17 Shanzhong, Ren-6 Qihai. All with reinforcing method. Moxa is applicable.
Explanation
– BL-18 and BL-23 tonify Liver and Kidneys.
– BL-52 tonifies the Kidneys and the Essence.
– Ren-4, with direct moxa, tonifies Kidney and the
Uterus.
No Periods 299
– LU-7 (on the right) and KI-6 (on the left) regulate
the Directing Vessel and strengthen the Uterus.
– LIV-8, SP-6, ST-36 and KI-3 tonify the Kidney and
nourish Liver-Blood.
– KI-13, a point of the Penetrating Vessel, strengthens
the Kidneys and nourishes the Essence.
– Xuefu tonifies the Kidney-Essence. This point is level
with BL-23 Shenshu, four cun lateral to the midline.
– Ren-17 and Ren-6 are often used in combination
especially when the periods have stopped after an
emotional upset.
– Dang Gui nourishes Liver-Blood.
– Du Zhong tonifies Kidney-Yang and strengthens the
Governing Vessel.
– Huai Niu Xi nourishes Liver and Kidneys.
– Gan Cao harmonizes.
Modifications The following modifications apply to
both of the above formulae.
•
•
Herbal treatment
a. Prescription
– GUI SHEN WAN
– Restoring the Kidneys Pill
Explanation
– Tu Si Zi and Du Zhong tonify Kidney-Yang. Tu Si Zi,
a more neutral herb that tonifies Kidney-Yang, also
promotes ovulation and nourishes the Essence.
– Gou Qi Zi and Dang Gui nourish Liver-Blood. Gou Qi
Zi also nourishes the Essence.
– Shu Di Huang, Shan Yao and Shan Zhu Yu tonify
Kidneys and Liver. These three herbs form the
nucleus of several gynecological formulae to tonify
Liver and Kidneys (e.g. You Gui Wan Restoring
the Right [Kidney] Pill, You Gui Yin Restoring the
Right [Kidney] Decoction, Zuo Gui Wan Restoring
the Left [Kidney] Pill, Zuo Gui Yin Restoring the Left
[Kidney] Decoction, Liu Wei Di Huang Wan SixIngredient Rehmannia Pill, etc.).
– Fu Ling resolves Dampness to counteract the
cloying nature of the tonic herbs.
– Ji Xue Teng and Shou Wu were added to the original
formula to increase its Blood-nourishing effect.
b. Prescription
– DANG GUI DI HUANG YIN
– Angelica-Rehmannia Decoction
Explanation This prescription, simpler than the
previous one, nourishes Liver-Blood and tonifies
Kidney-Yang. Compared with the previous prescription,
it tonifies Kidney-Yang more than Liver-Blood.
– Shu Di Huang, Shan Yao and Shan Zhu Yu tonify
Liver and Kidneys.
If there are symptoms and signs of Yin deficiency
and Empty-Heat (e.g. dry mouth, feeling of
heat, night sweating, etc.) add Zhi Mu Rhizoma
Anemarrhenae and Di Gu Pi Cortex Lycii.
If there is insomnia and poor memory add Suan
Zao Ren Semen Ziziphi spinosae, Wu Wei Zi Fructus
Schisandrae and Ye Jiao Teng Caulis Polygoni
multiflori.
c. Prescription
– SAN CU TANG10
– Three Promotions Decoction
Explanation This formula is composed of three separate formulae to be administered for about 1 week each,
the idea being that the first is taken for a week before
ovulation, the second for a week during ovulation and
the third for a week after ovulation. Obviously, since in
this case the woman has no periods, these three formulae are to be taken for 3 consecutive weeks followed by a
break of 1 week in order to establish a menstrual cycle.
The first formula nourishes Kidney-Yin, the second
nourishes and invigorates Blood and the third tonifies
Kidney-Yang and Blood.
d. Prescription
– ZHONG YAO REN GONG TIAO QI ZU FANG11
– Chinese Herbal Formula to Artificially Regulate the
Menstrual Cycle
Explanation This formula is composed of four prescriptions: for the follicular phase, ovulation, the luteal
phase and the menstrual phase. For each phase, there
are two alternative formulae, one for Kidney-Yang and
the other for Kidney-Yin deficiency. As explained in the
chapter on Infertility (Ch. 57), the menstrual cycle is
a manifestation of the waxing and waning of KidneyYin and Kidney-Yang and treatment of this organ is
therefore essential to restore the regularity of menstruation. This formula is specific for amenorrhoea
due to polycystic ovary syndrome. In the follicular
300 Section 4: Menstrual Irregularities
phase, the treatment principle is to tonify the Kidneys;
in the ovulation phase, to tonify the Kidneys, nourish
and invigorate Blood; in the luteal phase, to tonify the
Kidneys and nourish Blood; and during menstruation,
to tonify the Kidneys and invigorate Blood. Obviously,
in this case the patient has no periods and these formulae are therefore taken for 1 week each consecutively in
order to establish a menstrual cycle.
Three Treasures remedy
– STRENGTHEN THE ROOT
This remedy tonifies Kidney-Yang and Liver-Blood
and is particularly indicated for women.
Blood deficiency
Clinical manifestations
Menstruation stops after several months of decreasing periods, dizziness, blurred vision, numbness and
tingling, poor memory, insomnia, palpitations, slight
anxiety, depression, dull, pale complexion, dry skin,
dry hair, falling hair, dry eyes, tiredness. Tongue: PaleThin (unless there is also Spleen-Qi deficiency and
Dampness in which case it would be Swollen). Pulse:
Choppy or Fine.
Treatment principle
Nourish Blood, tonify Qi, strengthen the Liver.
SUMMARY
Liver and Kidney deficiency
Acupuncture
Clinical manifestations
LIV-8 Ququan, ST-36 Zusanli, SP-6 Sanyinjiao, KI-3
Taixi, Ren-4 Guanyuan, BL-17 Geshu, BL-18 Ganshu,
Zigong (extra point), Ren-17 Shanzhong, Ren-6 Qihai.
All points with reinforcing method; direct moxa on
BL-17 and BL-18. Moxa can be used on other points
too unless there are symptoms of Empty-Heat from
Blood deficiency.
Explanation
– LIV-8 nourishes Liver-Blood.
– ST-36 and SP-6 nourish Blood.
– KI-3 is used to help the Liver to nourish Blood even
if there is no Kidney deficiency.
– Ren-4 nourishes Blood and tonifies the Uterus.
– BL-17 and BL-18 with direct moxa tonify LiverBlood.
– Zigong strengthens the Uterus, tonifies the
Penetrating Vessel and nourishes Blood. This
point is four cun below the navel (level with
Ren-3 Zhongji) and three cun lateral to the
midline.
– Ren-17 and Ren-6 are often used in combination
especially when the periods have stopped after an
emotional upset.
Menses not started by 18, or stopped after becoming
scanty, tiredness, lower backache, kneeache,
dizziness, depression, mentally tired, lack of willpower, feeling cold. Tongue: Pale. Pulse: Deep, Weak.
Treatment principle
Tonify the Kidneys, nourish the Liver, regulate the
periods.
Acupuncture
BL-18 Ganshu, BL-23 Shenshu, BL-52 Zhishi, Ren-4
Guanyuan, LU-7 Lieque (on the right) and KI-6
Zhaohai (on the left), LIV-8 Ququan, SP-6 Sanyinjiao,
ST-36 Zusanli, KI-3 Taixi, KI-13 Qixue, Xuefu (extra
point), Ren-17 Shanzhong, Ren-6 Qihai. All with
reinforcing method. Moxa is applicable.
Herbal treatment
Prescriptions
• GUI SHEN WAN Restoring the Kidneys Pill Variation
• DANG GUI DI HUANG YIN Angelica-Rehmannia
Decoction
• SAN CU TANG Three Promotions Decoction
• ZHONG YAO REN GONG TIAO QI ZU FANG
Chinese Herbal Formula to Artificially Regulate the
Menstrual Cycle
Three Treasures remedy
• STRENGTHEN THE ROOT
Herbal treatment
a. Prescription
– BA ZHEN TANG Variation
– Eight Precious Decoction Variation
No Periods 301
Explanation
The first seven herbs are a variation of Ba Zhen Tang
Eight Precious Decoction with the omission of Zhi Gan
Cao and the use of Chi Shao instead of Bai Shao Radix
Paeoniae alba. These herbs tonify Qi, nourish Blood and
strengthen the Liver.
– Sang Ji Sheng and Gou Qi Zi nourish Liver-Blood.
– Xiang Fu moves Liver-Qi: this is necessary to
counterbalance the cloying effect of the Liver-Blood
tonics.
b. Prescription
– REN SHEN YANG RONG TANG
– Ginseng Nourishing and Flourishing Decoction
Explanation
– Ren Shen tonifies the Original Qi.
– Bai Zhu and Huang Qi tonify Qi: the method of
tonifying Qi is often used when nourishing Blood.
– Dang Gui, Bai Shao and Shu Di Huang nourish
Blood and strengthen the Liver.
– Rou Gui tonifies the Yang aspect of the Original Qi,
warms the Gate of Life and strengthens the Kidneys.
– Wu Wei Zi and Yuan Zhi strengthen the Heart
and calm the Mind. These two herbs are added for
deficiency of Heart-Blood and palpitations.
– Fu Ling and Chen Pi resolve Dampness and counterbalance the many tonic herbs in the prescription.
– Zhi Gan Cao harmonizes.
This formula is indicated if Blood deficiency occurs
against a background of Yang deficiency and the
tongue is Pale and Swollen.
Modifications These modifications apply to both the
above prescriptions.
•
•
If amenorrhoea occurs after childbirth during
which there was severe loss of blood leaving the
woman seriously depleted in Blood, Yin and Essence,
add Lu Rong Cornu Cervi pantotrichum, Lu Jiao
Shuang Cornu Cervi degelatinatum and Zi He Che
Placenta hominis.
If there is a strong emotional component in the
aetiology with Heart-Blood deficiency, add Bai
Zi Ren Semen Platycladi, Dan Shen Radix Salviae
miltiorrhizae and E Jiao Colla Corii asini.
c. Prescription
– EMPIRICAL PRESCRIPTION by Dr Zhang
Jian Zhai12
Explanation
– Huang Qi, Dang Shen and Zhi Gan Cao tonify Qi to
nourish Blood.
– Dang Gui, Bai Shao and Sheng Di Huang nourish Blood.
– Suan Zao Ren, Yuan Zhi and Fu Shen nourish the
Heart and calm the Mind.
– Fu Ling drains Dampness and counterbalances the
cloying effect of Blood tonics.
– Mu Xiang, Ban Xia and Chen Pi harmonize the Centre.
This formula is particularly indicated when emotional problems underlie the Blood deficiency.
d. Prescription
– DA TIAO JING WAN
– Great Regulating the Period Pill
Explanation
– Dang Gui, Bai Shao and Sheng Di Huang nourish
Blood.
– Shan Yao, Bai Zhu and Ren Shen tonify Qi.
– Xiang Fu and Wu Yao move Qi and prevent stagnation.
– Rou Gui stimulates the production of Qi and Blood.
– Dan Shen and Chuan Xiong invigorate Blood and
prevent stasis.
– Xu Duan tonifies the Kidneys, stre