The relationship between the heart and gynecological issues
By Ban Xuiwen, born 1919
From his the text Ban Xiuwen,
Translated by Sharon Weizenbaum
Zhang Zhong Jing said “Yin and blood are the root of the menstruation. There is no Zang that
is without it”. We can see that there is a very close relationship between the 5 Zang and
women’s menstruation, discharges, pregnancy and birth. Though the relationship between the
Heart and gynecology is not well known or discussed in detail, I consider the place of the heart
in relation to gynecology to be very important. When we analyze gynecological pathology and
the rules for prescribing formulas in treatment, the Heart has significance.
Yin and blood are the root of menstruation and the Heart governs the blood
The Heart is the Zang associated with fire and is the ruler of the 5 Zang and 6 Fu. It governs
the blood vessels and commands the Spirit Brightness.
When the Heart functions properly “brightness is governed this causes peace to
descend”. Alternatively, “When brightness is not governed the 12 officials are in chaos”. In
this case, not only do the emotions and blood vessels have pathology, the Zang and Fu also can
become irregular. It is said “The heart beat agitates the 5 Zang and 6 Fu”. Yin and blood are
principle for women. Although the source for the abundant material basis of the blood is the
minute essence of the food and fluids of the Spleen and Stomach, it still must undergo a series
of Qi transformation processes to become what we know as blood fluid. Within this process
there is the Qi transformation action of the Spleen and Stomach and there is also the Qi
transformation process of the Heart Yang. In regard to the generation of blood, the Nei Jing
says “The middle Jiao receives the Qi and obtains the fluid. It then become red as it transforms
into blood”. “Ying Qi secretes the essential fluid and this flows into the vessels and transforms
into blood”. “The Heart generates the blood”. This illustrates that the blood fluid is the
essential fluid that is transformed from the minute essence of the food and fluids and that the
heart guides this process. It is only when the Heart Qi is flourishing and the Heart function is
normal that the blood fluid can be continuously produced. If the Heart Yang is depleted it will
be unable to transform and generate the blood fluid and the sea of blood will be empty. The
blood will be unable to nourish the four limbs and the 100 bones and the source of the
menstruation will dry up.
The Heart and the Uterus are closely linked
The Heart and the uterus have a direct link. The Bao Mai belongs to the Heart and
networks within the uterus” “ The extraordinary vessels of the Chong, Ren and Du together
rise up from within the uterus and rise up, The Chong vessel “arrives in the uterus and
spreads”. The Ren vessel moves the body’s Yin and the Du vessels move the body’s Yang. One
vessel is on the front and the other is on the back. They “Link with the Heart”, “enter the eye”,
“network to the chest”. “The Heart is the residence of Spirit brightness (life force)”. It can be
seen that the uterus opens through to the channels and collaterals. As a matter of fact there is
an intimate connection between the “actual heart organ” and the “Spirit brightness that resides
in the Heart”.
When the clarity of the Heart Spirit stagnates, the flourishing Qi of the Heart declines
and the surplus of the Heart is diminished, this has a direct influence on the function of the
uterus. When the Heart Qi is exuberant, the Heart blood is abundant and the vessels are open
through, the blood fluid then able to move normally in the vessels, flowing without obstruction
to nourish the whole body. When the Heart Yang moves downward, the Heart blood
nourishes the uterus and the sea of blood is completely filled. This will cause the menstruation
to arrive regularly and for the pregnancy to move along with the appropriate timing.
When a woman is gloomy and depressed, prone to over thinking with volatile emotions,
this can result in consumption and darkening of the Heart Yin and insufficiency of the
nourishing Yin and a blockage of the uterine vessels. When the menstruation is not flowing
through properly, there is amenorrhea or difficulty becoming pregnant. Though there can be
many different causes of this, generally it is related to the Heart ruling the Spirit brightness
and the blood vessels.
Though there are many treatment methods, they do not stray far from the
blood.
Many varieties of illness appear in a woman’s clinic. However, none of the illnesses are
beyond the scope of hot/cold and excess/deficiency. Treatment can be separated into
supplementing, discharging, warming and clearing. All of this is related to the idea of
regulating the Qi and blood and promoting harmony.
For example, excessive worry will damage the Heart and Spleen and cause palpitations,
insomnia and yellowing of the skin. The menstruation may come early, be profuse, be pale,
scanty or drip without ceasing. The pulse may be thin and weak, the tongue moss thin and
white with a pale tongue body. This is in the category of Heart and Spleen dual deficiency with
an inability to absorb blood. Often in this case one wants to nourish the Heart, fortify the
Spleen, boost the Qi and supplement the blood, using Gui Pi Tang. This formula contains Ren
Shen, Bai Zhu, Huang Qi and Gan Cao to supplement the Spleen. It also uses the sweet, warm
and sour herbs, Fu Shen, Yuan Zhi, Suan Zao Ren and Long Yan Rou to supplement the Heart.
The goal of this approach is to simultaneously treat the mother and child (fire and earth) and
renew the function of the Heart and Spleen so that the function of the Heart governing the
blood and the Spleen gathering the blood is protected. When the blood is continuously
generated and transformed, it will be able to consolidate and absorb and the menstruation will
be regulated.
If there is Beng Lou, this can be caused from blood heat, Qi deficiency or blood stasis.
When there is blood heat it is appropriate to clear heat and cool the blood with herbs such as
Sheng Di, Dan Pi and Zhi Zi. When there is Qi deficiency it is appropriate to supplement the
Qi and absorb the blood with herbs such as Dang Shen and Bei [Huang] Qi. When there is
blood stasis it is appropriate to “use opening through methods to open through the cause” with
herbs such as Hong Hua, Tao Ren and Pu Huang. There are herbs to cool the blood, herbs to
dispel stasis and herbs to supplement the Qi and generate blood. Although these methods are
not the same, they all enter the heart and vitalize the blood.
If there is damp heat discharge that is profuse and thick with both red and white mixing
together, it is common to use Long Dan Xie Gan Tang to clear the Liver and disinhibit
dampness in order to clear the damp heat and stop discharge.
When a woman is unable to become pregnant after marriage this is often thought to be
due to chronic deficiency with the nourishing Yin being murky and diminished. The Heart is
deficient and the blood is scanty and the Spirit Qi is not peaceful. There are palpitations, late or
scanty menstruation or amenorrhea. It is common to use Bu Xin Tang. This formula uses “Ren
Shen and Huang Qi to supplement the Heart Qi, Chuan Xiong and Dang Gui to nourish the
Heart blood, Fu Ling, Yuan Zhi, Bai Zi Ren and Suan Zao Ren to clear Heart heat and calm the
Heart Spirit, Wu Wei Zi to protect the Heart Qi from being scattered, Ban Xia to clear the
phlegm rheum that harasses the Heart, Gan Cao to foster the core of the Heart and Chi Gui
(red cinnamon) to enter the heart channel. This uses moistness to nourish, warmth to
supplement, sour to constrain and fragrance to scatter. In this way, the heart is nourished and
full”.
In short, Blood is engendered and transformed by the Spleen, brought together by the
Heart, stored and received by the Liver, spread and distributed by the Lung and imparted and
disseminated by the Kidney” (from the Jing Yue Quan Shu) Clearly, there is a close relationship
between the 5 Zang and the Yet the Heart is the abode of the Spirit and it rules the blood
vessels of the whole body. It is the center of the whole body’s blood circulation and the
integrated movement of the thinking processes and consciousness. These physiological
functions all have an influence on the vital movement of the organs and especially on the blood
as the root of women. A long term condition of “Qi surplus with blood deficiency” will have a
pathological effect on menstruation, pregnancy, birth and nursing. Consequently, in terms of
treating gynecological illnesses, one must pay attention to the comfort and brightness of the
Heart spirit and the fullness of the Heart blood. When this is attended to, the different
presentation characteristics, the regulating and supplementation will all have twice the effect
with half the effort.
Case Studies
1. 36-year-old female named Wei.
Nanning factory worker: Previously her menstruation had been fundamentally normal with no
discomfort. Her husband was transferred and they moved to Yong for work. Starting at that
time and for the last half year, she had not menstruated. She did not feel any discomfort and
her sleep, appetite and bowels were normal. Her pulse was thin and rapid but with strength
and her tongue had a thin white moss with a normal body.
This patient had always had a normal menstruation until after the work transfer. Actually the
changes had been sudden and her routines, life style and personal life were all different. In
these circumstances, it would be difficult to avoid emotional viscitudes. It is said that
“excitement causes the Qi to become retarded” and that “worry causes the Qi to become
knotted”. The result of this is that the Heart Yang Qi is then unable to travel down to the
uterine vessels. The uterine vessels become obstructed and therefore the menstruation does not
flow. Because there are no other complaints, we can know that this illness is one of the Shen
and not one of the form. I gave her I applied the method of using fragrant and acrid flavors to
open and warmth to open through the vessels. I gave her 3 packages of Tong Qiao Huo Xue
Tang modified:
Dang Gui
9 gm
Chuan Xiong
5 gm.
Tao Ren
6 gm.
Hong Hua
6 gm.
Lao Cong
9 gm.
Gui Zhi
6 gm.
Fou Shou
9 gm.
Shi Chang Pu
5 gm.
Yuan Zhi
5 gm.
Yi Mu Cao
15 gm.
Zhi Gan Cao
5 gm
2. 28-year-old female named Zhao. She was a cadre at the Nanning University.
She had been married for half a year and was two months pregnant when she began to have
slight vaginal bleeding. The color of the blood was pale. She was able to sleep at night but had
many dreams. Her low back was sore and weak. Her bowels were dry and knotted, moving
only once every three days. Her urination was normal, her pulse thin and rapid and her tongue
had scanty moss with a red tip.
When a woman bleeds at two months of pregnancy, this is an indication of fetal dripping.
Only after taking into account the pulse in relation to the presentation could I say that this was
an over abundance of fire with Kidney water insufficiency. These conditions lead to pathology
in which the Kidneys lost their ability to envelope and store. The Chong and Ren were unable
to consolidate. Using the method of enriching Yin and relieving fire, I gave her modified Liang
Di Tang.
Sheng Di Huang
20 gm.
Xuan Shen
20 gm.
Hang Bai Shao
10 gm.
Mai Men Dong
15 gm.
Di Gu Pi
10 gm.
Zhu E Jiao
10 (wrapped and melted in)
Bai Zi Ren
10 gm.
Xian He Cao
15 gm.
After 3 packages the vaginal bleeding stopped. After this she took 6 packages of Shou Tai Wan
with the addition of Du Zhong, Fu Pen Zi and Chuan Zhi Zi to consolidate the effect. She gave
birth after a normal period of pregnancy.
Summary:
The role of the Heart in gynecology is very important. This by no means minimizes the
importance in gynecology of the Kidneys storing the Jing, the Liver storing the blood, the
Spleen enveloping the blood or the Lungs governing the Qi and sending it to the 100 vessels.
Are not these functions inseparable? One must stress treating the blood and treating the Heart
simultaneously and pay attention to the relationship between the Zang Fu.
For example, if the Heart blood is insufficient, there is not only pathology of the Heart itself
but also the Spleen may be deficient or the Liver blood may be weak. One should elect to treat
the Heart but also treat the Spleen and Liver using a formula like Gui Pi Tang or Si Wu Tang.
If the Heart fire is unable to descend downward to the Kidney and instead flares upward,
often the Kidney Yin is unable to flow upward to relieve this and this results in a lack of
communication between the Heart and the Kidneys. The treatment method should be directed
to enrich water to control fire. In the clinic I use Dang Shao Di Huang Wan (Tang), which will
enrich the Kidney Yin while moistening and nourishing the Heart blood. This simultaneously
treats the Heart and Kidney.
The pattern has a primary and secondary aspect, which can be observed simultaneously.
One must weigh out the seriousness vs. the lightness of the illness as well as the acute vs. the
chronic nature of the illness. When the Heart is a leading issue, choose the formula and give
the herbs to gently hit the mark. In this way, you can obtain the expected results.