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Home > Education > Diagnosis > Gynecology

SYNDROME DIFFERENTIATION AND THERAPEUTIC PRINCIPLES IN GYNECOLOGY

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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