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General Principles of Syndrome Differentiation
In accordance with the principles of the eight principle syndromes, the status
of viscera and qi and blood, the syndrome differentiation of gynecological
diseases is based on the clinical characteristics of menstruation, leukorrhea,
pregnancy and puerperium as well as their general manifestations.
A. Syndrome differentiation of menopathy
The menstrual cycle, the quantity, color, quality and odor of the menses and
symptoms such as lower abdominal distension and pain should be particularly
emphasized in the diagnosis of menopathy.
(a) The menstrual cycle: A short cycle is attributed to blood-heat or qi
deficiency, a delayed cycle to blood deficiency or blood-heat, while a shortened
period is attributed to blood deficiency or blood cold.
(b) The amount of menses: Menorrhagia usually occurs in cases with blood-heat or
qi deficiency, and oligomenorrhea in those with blood deficiency or cold blood.
(c) The color of menses: A bright red or purplish red color is attributed to
heat, a dull red color to cold, a pink color to asthenia, and a dull pale color
to asthenia-cold.
(d) The quality of menses: A thick, viscous menses indicates a sthenia-syndrome,
a thin clear menses denotes an asthenia-syndrome, and a menstrual flow
containing blood clots shows a blood-stasis syndrome.
(e) The odor of menses: A foul odor is attributed to heat, an odorless menses to
cold, and a stinking odor to a serious condition resulting from the putrefaction
of stagnant blood.
(f) The accompanying abdominal pain: Dysmenorrhea relievable by pressure is
attributed to asthenia-syndrome, that aggravated by pressure to
sthenia-syndrome, that relievable by warmth to cold-syndrome, while that
occurring after the menstrual period signifies an asthenia-syndrome. A
preexisting lower abdominal pain which is aggravated during the menstrual period
indicates the retention of dampness-heat and the stagnation of qi and blood.
Lower abdominal distension during the menstrual period denotes the stagnation of
qi.
However, the syndrome differentiation should be based on a comprehensive
analysis of the above conditions. Taking the preceding menstrual cycle as an
example, it should be differentiated as a syndrome of blood-heat and qi
stagnation when it is associated with a prolonged menstrual period, a profuse
discharge of bright red or purplish, foul and viscous menses and lower abdominal
distension; as a qi deficiency syndrome when the menses is profuse, pale and
thin and a bearing-down sensation is experienced in the lower abdomen; and as a
syndrome of yin deficiency and blood-heat when the amount of menstrual flow is
normal or scanty, the menses is bright red and viscous and abdominal pain is
absent.
B. Syndrome differentiation of leukorrhagia
The color, character and odor of vaginal discharge may be observed for this
purpose. Generally speaking, a yellow and viscous discharge indicates a sthenia
or a heat syndrome, while a white and thin discharge indicates an asthenia or a
cold syndrome. A foul odor is a sign of sthenia-heat syndrome, while a
rank-smelling odor, asthenia-cold syndrome. A yellowish or greenish viscous and
foul discharge is attributed to retention of dampness-heat; a whitish, thin
discharge accompanied by fatigue or anorexia to spleen deficiency and downward
attack of dampness; a continuous dripping of bleedy discharge to yin deficiency
and interior-heat with dampness; a profuse thin discharge accompanied by lumbago
and weakness to deficiency of kidney-yang; and a grayish, turbid and foul
discharge to blood stasis.
C. Syndrome differentiation of disorders during pregnancy
Amenorrhea occurring in an adult woman accompanied by symptoms such as nausea,
vomiting, desire for sour taste or special food, fatigue, poor appetite,
somnolence, smooth pulse, etc., and whose previous menstruation has been normal,
is usually a sign of early pregnancy.
Various disorders may occur during pregnancy. Those with excessive movement of
fetus, vaginal discharge of pink and thin blood, spiritlessness, shortness of
breath and weak pulse are attributed to deficiency of qi and blood; those
accompanied by lumbago, fatigue, a bearing-down sensation of the lower abdomen,
to kidney deficiency; those with discharge of dark red color, restlessness,
dryness of mouth, red tongue and smooth and rapid pulse, to blood-heat.
Cases with morning sickness, anorexia and slow, smooth, weak pulse are
attributed to deficiency of spleen-qi and stomach-qi; those with vomiting of
bitter or sour fluid and smooth pulse, to adverse flowing of liver-qi and
stomach-qi; those with vomiting of mucus, salivation, distention over the
stomach, soft-floating and smooth pulse, to retention of phlegm-dampness in the
middle-jiao.
Cases with edema, fatigue, epigastric distention and deep and smooth weak pulse
are attributed to spleen deficiency; those with edema, fatigue, epigastric
distention, lumbago, aversion to cold and deep and slow pulse, to insufficiency
of kidney-yang. Those with dizziness, headache, chest upset and nausea appearing
in the late stage of pregnancy are attributed to pre-eclampsia.
D. Syndrome differentiation of puerperal disorder
There are three criteria for the identification of puerperal disorders in
ancient theory. First, the presence or absence of lower abdominal pain is a
criterion to determine whether lochiostasis is present or not. Second, the
frequency of bowel movement is used to identify whether body fluids are
exhausted or not. Third, the amount of milk secretion and appetite are signs
indicating the condition of stomach-qi. Besides, the quantity, color, quality
and odor of lochia and body temperature must also be observed.
A. Damage of the uterus and Chong and Ren meridians by heat-toxic evil: Profuse
and foul lochia, lower abdominal pain and tenderness, fever, headache, thirst
and desire for cold drink, red tongue with yellow coating and full and rapid
pulse.
B. Retention of blood stasis: Prolonged discharge of lochia which is small in
amount, dark purplish in color and contains blood clots and lower abdominal pain
and tenderness.
C. Insufficiency of blood and qi: Discharge of light-colored and thin lochia.
D. Stagnation of liver-qi: Lack of lactation, distending pain and induration of
breasts, distention of the chest and hypochondrium and poor appetite.
E. Deficiency of qi and blood: Soft breasts without distending pain and lack of
lactation with thin and clear milk.
In sum, the principles mentioned above are based on the common manifestations of
menstruation and leukorrhea and during pregnancy and puerperium. In clinical
applications the physique, qi, blood, pulse and general condition of the patient
should all be considered, and the data should be analyzed comprehensively by
means of the basic theories concerning the eight principle syndromes, the
visceral phenomena, the qi and blood and the meridians.
An Outline of Therapeutic Principles
Among the therapeutic principles applied in clinical practice, four of them are
more commonly used in the treatment of gynecological diseases, namely, tonifying
and nourishing the kidneys, dispersing liver-qi and nourishing the liver,
invigorating the spleen and regulating the stomach and regulating qi and blood
circulation.
A. Tonifying and nourishing the kidneys
The kidneys are considered "the basis of innateness" and are where essence-qi is
stored. It is essential for the growth, development and reproduction of the
human body and plays an important role in the maturation of Tiankui and the
activities of the Chong and Ren meridians. In addition, the kidneys are composed
of kidney-yin and kidney-yang, which are the essential substances and motive
forces for bodily development and reproduction, and both of them must be
sufficient and kept in balance in order to maintain the normal condition of the
human body. Any forms of disequilibrium, such as insufficiency of kidney-yang,
deficiency of kidney-yin, yin-deficiency leading to the hyperactivity of yang or
deficiency of both yin and yang, may cause the dysfunction of Tiankui and the
Chong and Ren meridians and various gynecological diseases may ensue. Therefore,
the principle of tonifying and nourishing the kidneys is commonly applied in
gynecology.
For cases with insufficiency or consumption of kidney-yin, the principles of
tonifying the kidneys, nourishing yin and promoting the production of kidney
essence and marrow should be applied. The commonly used drugs are Radix
Rehmanniae Praeparata, Radix Polygoni Multiflori Praeparata, Fructus Ligustri
Lucidi, Herba Ecliptae, Fructus Corni, Colla Plastri Testudinis, Colla Corii
Asini, Fructus Lycii and Fructus Mori. The recommended prescription is Zuogui
Bolus.
For cases with yin-deficiency leading to hyperactivity of yang, the principle of
nourishing yin and suppressing yang should be employed. Decoction of Six Drugs
Containing Rehmanniae Praeparata is usually employed, and Os Draconis, Concha
Ostreae or Carapax Trionycis Praeparata are added.
Physiologically, the liver and the kidney are the organs that control
lower-jiao. The liver stores blood and the kidneys keep essence, and since the
essence and blood can be mutually produced, it is considered that the liver and
kidneys have a common source. Moreover, the liver and kidneys are the root of
the Chong and Ren meridians, and the disorder of liver and kidneys and the
impairment of the Chong and Ren meridians may influence each other. Therefore,
the principle of nourishing the liver and kidneys may be employed for
gynecological disorders with insufficiency of liver and kidneys or impairment of
Chong and Ren meridians.
For cases with declination of life-gate fire, the principle of warming and
invigorating kidney-yang should be applied. The following drugs are recommended:
Cortex Cinnamomi, Radix Aconiti Lateralis Praeparata, Radix Morindae
Officinalis, Herba Cistanchis, Colla Cornus Cervi, Fructus Psoraleae, Semen
Cuscutae, Cortex Eucommiae, Herba Epimedii, Rhizoma Curculiginis, etc. The
representative prescription is Yougui Bolus.
For cases with deficiency of both kidney-yin and kidney-yang, the principle of
invigorating both yin and yang should be employed, and the drugs mentioned above
may be used in combination.
In sum, tonifying and warming the kidneys are important therapeutic principles
in gynecology. But it should be emphasized that yin and yang are a unity of
opposites and interconvertible and interdependent, so in dealing with one, the
other should be handled simultaneously.
B. Dispersing liver-qi and nourishing the liver
Physiologically, the liver serves to regulate the activity of qi and blood, so
the nourishment of sinews, vessels and joints and the storage and regulation of
blood depend on the liver. Moreover, the Chong meridian is the "blood sea" and
relates to the liver. Whenever the liver is impaired by emotional upsets, the
Chong meridian may dysfunction and diseases may ensue. Hence, dispersing
liver-qi and nourishing the liver are also principles commonly applied in
gynecology.
For cases with stagnation of liver-qi, the principle of dispersing liver-qi to
relieve stagnation is recommended. The commonly used drugs are Radix Bupleuri,
Rhizoma Cyperi, Pericarpium Citri Reticulatae Viride, Fructus Toosendan, Folium
Citri Reticulatae, Rhizoma Corydalis, Radix Linderae, Radix Aucklandiae and
Fructus Aurantii. Xiaoyao Powder is considered the representative prescription.
For cases with stagnated liver-qi complicated by fire formation, the principle
is to disperse liver-qi and clear away heat. Drugs recommended are: Fructus
Toosendan, Herba Artemisiae Annuae, Cortex Moutan Radicis, Fructus Gardeniae,
Radix Scutellariae, etc. The representative prescription is Xiaoyao Powder with
Moutan Radicis and Gardeniae.
In case of retention of heat in the liver meridian with excessive fire in the
liver and gallbladder, the principle of purging liver-fire to remove heat should
be employed. The recommended prescription is the Decoction of Gentianae for
Purging Liver-Fire.
In case of insufficiency of ying-blood with failure of nourishing the liver, the
principles of tonifying yin and nourishing the liver are applied. The common
drugs for this purpose are Radix Angelicae Sinensis, Radix Paeoniae Alba, Colla
Corii Asini, Radix Rehmanniae Praeparata, Fructus Mori, Fructus Lycii, Fructus
Ligustri Lucidi, Fructus Corni, Plastrum Testudinis, etc. The representative
prescriptions are the Modified Decoction of Four Drugs and Yiguan Decoction.
However, drugs of acrid-warm and fragrant-dry in nature should be used
cautiously, otherwise the body fluids and yin may be consumed, the liver-blood
be more deficient and complications occur more readily.
In case of insufficiency of liver-blood with upward attack of liver-yang, the
principles of nourishing blood, softening the liver, supporting yin and
suppressing yang are available. The drugs commonly used are Radix Rehmanniae,
Radix Paeoniae Alba, Radix Scrophulariae, Fructus Ligustri Lucidi, Concha
Haliotidis, Flos Chrysanthemi, Concha Margaritifera Usta, Concha Ostreae, etc.
In case of yin deficiency and fire hyperactivity with liver-wind stirring inside
the body, the principles of tonifying yin, suppressing yang and calming
liver-wind are recommended. The drugs commonly used are Radix Rehmanniae, Colla
Corii Asini, Plastrum Testudinis, Radix Paeoniae Alba, Concha Haliotidis,
Haematitum, Rhizoma Gastrodiae, Ramulus Uncariae cum Uncis, Cornu Saigae
Tataricae, etc. The representative prescription is the Decoction of Cornu Saigae
Tataricae and Uncariae cum Uncis.
C. Invigorating spleen and regulating stomach
Physiologically, the spleen and stomach are considered as the basis of postnatal
life and the source of qi and blood production. The spleen serves to govern the
transportation and transformation of digested food and to control blood flow.
The stomach serves as a receptor for food and is a fu-organ with plenty of qi
and blood. The Chong meridian is attached to the yangming stomach meridian. When
the spleen and stomach fail to transport and transform the food, to produce
enough blood and qi, to keep the blood in the vessels or to eliminate dampness
and water, the Chong and Ren meridians will be impaired, resulting in various
gynecological diseases such as irregular menstruation, metrorrhagia, amenorrhea,
leucorrhagia, vomiting during pregnancy, edema during pregnancy, prolapse of
uterus, etc.
In case of hypofunction of spleen and stomach with insufficient production of qi
and blood, the principle of regulating spleen and stomach is available. The
drugs commonly used are Radix Codonopsis Pilosulae, Rhizoma Atractylodis
Macrocephalae, Poria, Rhizoma Dioscoreae, Semen Dolichoris, Pericarpium Citri
Reticulatae, Semen Nelumbinis, Fructus Amomi, Fructus Jujubae, etc. The
representative prescription is the Powder of Ginseng, Poria and Atractylodis
Macrocephalae.
In case of deficiency of middle-jiao with stagnation of food, the principles of
invigorating the stomach and relieving dyspepsia are applicable. The herbs which
strengthen the stomach such as Fructus Crataegi, Fructus Oryzae Germinatus,
Fructus Hordei Germinatus, Massa Fermentata Medicinalis, Endothelium Corneum
Gigeriae Galli, etc., may be supplemented.
For cases with collapse of middle-jiao qi, the principles of invigorating
middle-jiao, benefiting qi and lifting up yang-qi are recommended. The drugs
commonly used are Radix Astragali, Radix Angelicae Sinensis, Rhizoma
Atractylodis Macrocephalae, Radix Glycyrrhizae Praeparata, Radix Bupleuri,
Rhizoma Cimicifugae, etc. The Decoction for Strengthening Middle-Jiao and
Benefiting Qi or Juyuan Decoction are the typical prescriptions.
In case of qi deficiency with failure of controlling blood, the principles of
tonifying qi and controlling blood are employed and supplemented with
hemostatics, such as Herba Agrimoniae, Vagina Trachycarpi Carbonisatus, Radix
Rubiae Carbonisatus, Os Sepiellae seu Sepiae, Galla Chinensis, Halloysitum
Rubrum, Limonitum, Nodus Nelumbinis Rhizomatis Carbonisatus, etc.
In case of incoordination between spleen and stomach with adverse rising of
stomach-qi, disease due to stomach-heat is treated with the principles of
clearing away heat and keeping the adverse stomach-qi downwards and drugs like
Caulis Bambusae in Taeniam, Radix Scutellariae, Rhizoma Coptidis, Haematitum,
etc., and the representative prescription is the Decoction of Perillae and
Coptidis; disease accompanied by insufficiency of stomach-yin may be treated
with drugs for benefiting stomach and producing body fluids, such as Radix
Adenophorae Strictae, Herba Dendrobii, Radix Ophiopogonis, Rhizoma Polygonati
Odorati, Rhizoma Phragmitis (raw), etc.; disease due to stomach-cold should be
treated with the principles of warming middle-jiao and keeping the adverse
stomach-qi downwards and drugs like Fructus Amomi, Fructus Myristicae, Rhizoma
Zingiberis, Rhizoma Zingiberis Recens, Fructus Evodiae, Flos Caryophylli, Herba
Agastachis, Rhizoma Pinelliae, etc., and the representative prescription is the
Decoction of Pinelliae and Poria. However, even if there is no damage of the
spleen and stomach, their normal functions should be maintained in the treatment
and the potent and greasy drugs are contraindicated.
D. Tonifying blood and benefiting qi
Physiologically, woman is specially related to blood and blood is closely
connected with qi, so that dysfunction of qi and blood occurs frequently in
gynecological diseases. Hence, tonifying blood and benefiting qi is one of the
chief therapeutic principles in gynecology. Furthermore, because the heart is
the governor and the source of qi and blood, tonifying heart and spleen is a
supplemental principle for gynecological diseases in order to promote the
coordination of qi and blood and normalize the functions of Chong, Ren, Du and
Dai meridians.
For cases with deficiency and collapse of qi and weakening of Chong and Ren
meridians manifested as menorrhagia, tonifying qi, lifting up yang-qi and
stopping bleeding are the recommended principles. The commonly used drugs are
Radix Ginseng, Radix Astragali, Radix Glycyrrhizae Praeparata, Rhizoma
Atractylodis Macrocephalae, Rhizoma Cimicifugae, etc., and the Jiuyuan Decoction
is considered the representative prescription.
For cases with insufficiency of middle-jiao qi and deficiency and collapse of qi
manifested with prolapse of uterus, tonifying and lifting up of qi is the
available principle. Radix Astragali, Rhizoma Cimicifugae, Radix Ginseng,
Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae Praeparata and Radix
Bupleuri are the drugs applied, and the Decoction for Strengthening Middle-Jiao
and Benefiting Qi is the prescription employed.
For cases with deficiency of spleen and stomach, insufficiency of middle-jiao qi
and failure of controlling blood manifested by prolonged menorrhagia, the
principles of benefiting qi, invigorating spleen, warming meridians and stopping
bleeding should be employed. The commonly used drugs are Radix Ginseng, Radix
Codonopsis Pilosulae, Radix Astragali, Rhizoma Atractylodis Macrocephalae,
Poria, Radix Angelicae Sinensis (fried), Rhizoma Dioscoreae, Semen Nelumbinis,
Receptaculum Nelumbinis Carbonisatus, Radix Glycyrrhizae Praeparata, Fructus
Jujubae and Rhizoma Zingiberis Carbonisatus. The Decoction for Invigorating the
Spleen and Nourishing the Heart is considered the representative prescription.
For cases with blood deficiency, yin-blood consumption and emptiness of the
blood sea manifested by amenorrhea or oligomenorrhea, nourishing blood,
tonifying liver and regulating menstruation are the applicable principles. The
drugs recommended are Radix Angelicae Sinensis, Radix Rehmanniae Praeparata,
Radix Paeoniae Alba, Rhizoma Chuanxiong, Fructus Lycii, Radix Polygoni
Multiflori Praeparata and Arillus Longan, and the Decoction of Four Drugs should
be employed.
For cases with deficiency of both qi and blood manifested by amenorrhea or
delayed menstrual cycle, benefiting qi, invigorating spleen, nourishing blood
and regulating menstruation are the principles available. The commonly used
drugs are Rhizoma Chuanxiong, Poira, Radix Paeoniae Alba, Rhizoma Atractylodis
Macrocephalae, Radix Glycyrrhizae Praeparata, Radix Codonopsis Pilosulae, Radix
Angelicae Sinensis, Radix Rehmanniae Praeparata, Radix Astragali, etc. The
representative prescription is Eight-Ingredient Decoction for Tonifying Qi and
Blood.
For cases with deficiency of both qi and blood but manifested as menorrhagia,
benefiting qi and promoting blood production are the principles selected. The
Angelicae Sinensis Decoction for Enriching Blood is the typical prescription.
E. Activating blood circulation and dissipating blood stasis
This principle is applicable to gynecological diseases caused by the stagnation
of blood such as amenorrhea, oligomenorrhea, dysmenorrhea, metrorrhagia,
abdominal mass, etc.
For cases with retention of blood stasis and obstruction of meridians manifested
with oligomenorrhea, activating blood circulation and eliminating blood stasis
are the applicable principles. Semen Persicae, Flos Carthami, Radix Angelicae
Sinensis, Radix Salviae Miltiorrhizae, Rhizoma Chuanxiong, Radix Paeoniae Rubra,
Herba Leonuri and Herba Lycopi are the drugs commonly employed, and the
Decoction of Four Drugs with Persicae and Carthami is the representative
prescription.
For cases with stagnation of qi and blood manifested as dysmenorrhea or
amenorrhea, the principles of activating blood circulation, regulating qi and
dissipating blood stasis are available. The drugs commonly applied are Radix
Angelicae Sinensis, Radix Paeoniae Rubra, Rhizoma Chuanxiong, Semen Persicae,
Flos Carthami, Fructus Aurantii, Rhizoma Corydalis, Faeces Trogopterori, Radix
Salviae Miltiorrhizae, Radix Linderae, Rhizoma Cyperi, Fructus Toosendan, etc.
The typical prescription is the Decoction for Removing Blood Stasis Under the
Diaphragm.
For cases with impairment of spleen-yang by stagnation of cold and blood with
involvement of the Chong, Ren and Dai meridians manifested as dysmenorrhea or
amenorrhea, expelling cold, activating blood circulation and promoting
menstruation are the recommended principles. The commonly-used drugs are Radix
Aconiti Lateralis Praeparata, Ramulus Cinnamomi, Fructus Evodiae, Fructus
Foeniculi, Rhizoma Zingiberis Praeparata, Pericarpium Zanthoxyli, etc. The
representative prescription is the Decoction for Warming Meridians.
F. Regulating qi and blood
Before using this therapy, it is necessary to determine whether qi or blood is
predominantly involved. In cases where qi is chiefly affected, the therapy for
regulating qi should be employed and supplemented by that for regulating blood.
In general, the deficient qi should be tonified, the collapsed qi lifted up, the
stagnated qi dispersed and the adverserising qi lowered. For cases with
stagnation and sluggish movement of qi, the principles of activating qi
circulation and dispersing stagnation are employed. The commonly-used drugs are
Rhizoma Cyperi, Fructus Aurantii, Cortex Magnoliae Officinalis, Radix
Aucklandiae, Radix Linderae, Pericarpium Citri Reticulatae Viride, Pericarpium
Arecae, Semen Citri Reticulatae, Semen Litchi, etc. The representative
prescription is the Modified Decoction of Linderae. As for cases with both
deficiency and adverse rising of qi, the applicable principles and drugs have
been introduced in the section dealing with tonifying the spleen and stomach.
In case where blood is predominantly involved, the therapy for activating blood
is the chief measure used and that for regulating blood is applied as a
supplemental measure. In general, a tonifying therapy is used for blood
deficiency, a dissipating therapy for blood stagnation, a warming therapy for
blood-cold and a heat-clearing therapy for blood-heat.
For cases with consumption of ying-blood, tonifying and nourishing blood are the
principles recommended. The commonly-used drugs are Radix Angelicae Sinensis,
Radix Paeoniae Alba, Radix Rehmanniae Praeparata, Colla Corii Asini, Fructus
Lycii, Radix Polygoni Multiflori Praeparata, Arillus Longan, etc. The typical
prescriptions are the Decoction of Four Drugs and the Decoction for Invigorating
the Spleen and Nourishing the Heart.
For cases with retention of blood stasis, activating blood circulation and
dissipating blood stasis are the applicable principles. The commonly-used drugs
are Radix Angelicae Sinensis, Rhizoma Chuanxiong, Herba Leonuri, Pollen Typhae,
Faeces Trogopterori, Radix Salviae Miltiorrhizae, Herba Lycopi, Herba
Selaginellae, Radix Notoginseng, Flos Carthami, etc. The representative
prescriptions are the Decoction of Four Drugs with Persicae and Carthami and the
Decoction for Removing Blood Stasis in the Lower Abdomen.
For cases with abdominal mass resulting from accumulation of blood stasis,
removing blood stasis, dissipating and softening the mass and dispersing
stagnation are the available principles. The drugs commonly applied are Semen
Persicae, Rhizoma Sparganii, Rhizoma Zedoariae, Radix Achyranthis Bidentatae,
Olibanum, Herba Artemisiae Anomalae, Myrrha, Lignum Sappan, Semen Vaccariae,
Carapax Trionycis, Concha Ostreae, etc., and the representative prescription is
the Pill of Rhei and Eupolyphaga seu Steleophaga.
For cases with accumulation of heat in xuefen and extravasation of blood,
clearing away heat, cooling blood and stopping bleeding are the principles
employed. The commonly used drugs are Radix Rehmanniae, Radix Paeoniae Alba,
Radix Ophiopogonis, Radix Scrophulariae, Cortex Moutan Radicis, Fructus
Gardeniae Carbonisatus, Radix Scutellariae, Radix Sanguisorbae Carbonisatus,
Cacumen Biotae Carbonisatus, etc. The recommended prescriptions are the Powder
for Clearing Away Heat in the Meridians and the Liangdi Decoction.
For cases with blood-cold syndrome, warming meridians and expelling cold are the
recommended principles. However, in the therapy of regulating qi and blood,
drugs of a greasy nature and consuming action should not be overused, otherwise
qi and blood may be stagnated and damaged.
G. Clearing away heat and cooling blood
This principle is indicated for the cases with bleeding due to retention of heat
in xuefen.
For cases with preceded menstrual cycle and menorrhagia due to blood-heat,
clearing away heat and cooling blood are the available principles. The commonly
used drugs are Cortex Moutan Radicis, Cortex Lycii Radicis, Radix Paeoniae Alba,
Radix Rehmanniae, Herba Artemisiae Annuae, Cortex Phellodendri, etc. The Powder
for Clearing Away Heat in the Meridians is the typical prescription.
For cases with metrorrhagia due to blood-heat, clearing away heat, cooling blood
and stopping bleeding are the principles employed. The drugs commonly applied
are Radix Rehmanniae, Cortex Lycii Radicis, Plastrum Testudinis Praeparata,
Concha Ostreae Usta, Colla Corii Asini, Radix Scutellariae, Nodus Nelumbinis
Rhizomatis, Fructus Gardeniae (fried), Radix Sanguisorbae, Vagina Trachycarpi
Carbonisatus, Radix Glycyrrhizae, etc. The representative prescription is the
Decoction for Clearing Away Heat and Checking Uterine Bleeding.
H. Warming meridians and expelling cold
Cold is a yin-type pathogenic agent of an astringent and stagnant nature, which
is liable to impair yang-qi and impede the circulation of blood and qi. When
cold is retained in the uterus, the Chong and Ren meridians may be obstructed
and menopathy may result.
A cold-syndrome may be classified as asthenia-cold or sthenia-cold. For
sthenia-cold syndrome, the recommended principles are those of warming meridians
and removing stagnation; and for asthenia-cold syndrome, those of nourishing
blood and warming meridians. The drugs commonly used for this purpose are Cortex
Cinnamomi, Radix Aconiti Lateralis Praeparata, Ramulus Cinnamomi, Herba Asari,
Folium Artemisiae Argyi, Fructus Foeniculi, Fructus Evodiae, Rhizoma Zingiberis
Praeparata, Fructus Psoraleae, etc. The prescription recommended is the
Decoction of Warming Meridians, which may be modified according to whether the
asthenia or the sthenia syndrome is predominant.
I. Clearing away heat and toxic materials
This principle is mainly applicable to cases due to an attack of exogenous heat
resulting in the formation of toxic materials. The drugs commonly used are Flos
Lonicerae, Herba Taraxaci, Herba Violae, Herba Patriniae, Rhizoma Paridis, Herba
Houttuyniae, Caulis Sargentodoxae, Radix Sophorae Flavescentis, Rhizoma
Coptidis, Cortex Phellodendri, Rhizoma Smilacis Glabrae, Flos Chrysanthemi
Indici, etc. The recommended prescriptions are the Antiphlogistic Decoction of
Five Ingredients and the Antiphlogistic Decoction with Lonicerae, Forsythiae and
Sargentodoxae.
Since yin is readily impaired by heat, it is advisable to add some drugs with
yin-nourishing and heat-clearing actions such as Radix Rehmanniae, Radix
Scrophulariae, etc., to protect yin. Moreover, for the cases with retention of
heat-toxin resulting in consumption of qi and blood with mass formation, drugs
to activate blood circulation, eliminate blood stasis, soften masses and
disperse stagnation should be added, such as Radix Angelicae Sinensis, Radix
Paeoniae Rubra, Rhizoma Chuanxiong, Cortex Moutan Radicis, Semen Persicae,
Olibanum, Myrrha, Carapax Trionycis, Thallus Eckloniae, Sargassum, etc.
J. Dispelling dampness and promoting diuresis
Clinically, disorders caused by dampness usually involve the spleen and kidneys.
For cases with retention of fluid and dampness due to spleen deficiency,
tonifying spleen, lifting up yang-qi, dispelling dampness and promoting diuresis
are the principles available. The commonly used drugs are Rhizoma Atractylodis
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