gynecology examination-Therapeutic principies forgynecological diseases
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The therapeutic methods for gynecological diseases are basically the same as those for the diseases of other clinical specialties. Pathologically gynecological diseases are mainly related to the kidney, liver, spleen, stomach, qi and blood as well as the thoroughfare and conception vessels. In terms of the causes, gynecological diseases are usually caused by cold, heat, dampness and emotional factors. So therapeutically, differentiation must be made of the external and internal, cold and heat, asthenia and sthenia as well as yin and yang in order to decide whether the disease in question is due to the disorder of the kidney, liver, spleen, heart or qi and blood. Only by making such a careful analysis can proper treatment, prescription and use of herbs be made.
Regulating the liver
The liver is significant in storing blood, controlling blood sea, maintaining close contact with the thoroughfare vessel and managing conveyance and dispersion. The liver physically pertains to yin and functionally to yang. It prefers free action and detests depression. Dysfunction of the liver in conveyance, or stagnation of qi transforming into fire, or stimulation of liver fire due to rage may consume liver yin and lead to hyperactivity of liver yang, or asthenia of yin and hyperactivity of yang which will all affect the thoroughfare vessel and bring about such disorders like irregular menstruation, metrorrhagia and metrostaxis, dysmenorrhea, amenorrhea, morning sickness and eclampsia gravidarum. So regulation and nourishment of the liver is also one of the important therapeutic methods for the treatment of gynecological diseases. In the middleaged women, menstruation, pregnancy, delivery and breast-feeding frequently impair blood and tend to result in asthenia of liver blood and exuberance of liver qi. So regulation and nourishment of the liver is especially important for the treatment of middle-aged woman. However, in actual treatment, the therapeutic method should be selected according to the conditions of the patient. For example, failure of the liver to convey should be treated with dispersing therapy; liver depression transforming into fire or liver fire due to rage can be treated by clearing and purgative therapy; consumption of liver yin or deficiency of liver blood can be treated by softening and nourishing therapy; hyperactivity of liver yang can be treated by suppressing therapy. In a word, the purpose of regulating the liver is to balance liver qi and make liver blood sufficient.
Invigorating the kidney
The kidney and the liver are all located in the lower energizer; the kidney essence and liver blood share the same origin. So kidney yin can nourish liver yin and prevent liver yang from becoming hyperactive. Liver blood and kidney essence are closely related to menstruation, pregnancy, delivery and breast-feeding. Clinically deficiency of kidney yin may lead to asthenia of both liver and kidney yin, eventually resulting in irregular menstruation or even amenorrhea and menopausal syndrome; deficiency of kidney yin fails to nourish wood and leads to hyperactivity of liver fire, consequently bringing about profuse menstruation, metrorrhagia and metrostaxis, or even dizziness during menstruation due to liver yang transforming into wind; failure of the liver to convey and disperse may lead to consumption of yin by stagnant fire with the involvement of the kidney, frequently resulting in liver stagnation and kidney asthenia which bring about scanty menstruation, delayed menstruation, amenorrhea and dysmenorrhea. Such disorders should be treated by regulating both the liver and the kidney.
The kidney is the prenatal base of life, source of reproduction and connected with the thoroughfare and conception vessels. Only when kidney qi is sufficient, can menstruation come, the conception vessel be free in circulation and the thoroughfare vessel keep predominant. Such a condition is also essential to the physiological activities of menstruation, pregnancy, delivery and breastfeeding. Insufficiency of kidney qi or consumption of kidney yin or decline of kidney yang or asthenia of both yin and yang will prevent tiangui from occurring or lead to senilism and disturbance of the thoroughfare and conception vessels, consequently resulting in disorders related to menstruation, leukorrhea, pregnancy, delivery and lactation. So kidney-invigorating is the basic therapeutic method in treating gynecological diseases, especially for the treatment of young woman whose kidney qi is not sufficient yet. Kidney-invigorating methods include warming kidney to reinforce yang, nourishing kidney to enrich yin, fostering yin to suppress yang or nourishing both yin and yang that are selected according to the pathological conditions.
Invigorating the spleen
The functions of the stomach and spleen in reception, digestion, transformation and transportation are in close relation with the conveyance of liver qi and warming function of kidney yang. Failure of the liver in conveyance and dispersion may affect the functions of the spleen in transformation and transportation and the function of the stomach in reception, leading to chest oppression, vomiting, epigastric and abdominal distension and hypochondriac distension and pain due to disharmony between the liver and spleen or disharmony between the liver and stomach. Such dysfunctions are commonly seen in irregular menstruation and morning sickness. Such disorders should be treated by soothing the liver, regulating the spleen or suppressing the liver and harmonizing the stomach. If fire in mingmen (gate of life) declines and fails to warm the spleen to promote transformation and transportation, it may lead to diarrhea and edema during menstruation and edema during pregnancy or thin leukorrhagia which should be treated by warming and nourishing the spleen and kidney.
The spleen is the postnatal base of life and the source of qi and blood. The spleen manages transformation and transportation as well as commanding blood. The stomach that is internally and externally in relation with the spleen governs reception of food and is an organ with sufficient qi and blood. The thoroughfare vessel also pertains to yangming meridian. Normal functions of the spleen and stomach in woman ensure sufficient blood in the uterus for normal menstruation and pregnancy. Dysfunction of the spleen and stomach, weakness in reception, transformation and transportation may lead to either insufficiency of the source for transformation, or failure in commanding blood, or retention of dampness, which may further impair the thoroughfare and conception vessels and lead to such disorders like irregular menstruation, metrorrhagia and metrostaxis, amenorrhea, leukorrhagia, morning sickness, edema during pregnancy and prolapse of uterus. So strengthening the spleen and harmonizing the stomach is also one of the important therapeutic methods in treating gynecological diseases. Such a treatment is especially important for the treatment of menopausal syndrome in the aged women whose kidney qi has declined and both qi and blood have become asthenic. Since these women mainly depend on cereal nutrients, spleen-invigorating therapy for promoting transformation is essential to them. The general therapeutic principles are nourishing therapy for the asthenia syndrome, promoting therapy for the stagnation syndrome, warming therapy for the cold syndrome, clearing therapy for the heat syndrome, elevating therapy for the sinking syndrome and soothing therapy for the adverse syndrome. Cares should be taken to avoid using warming therapy with excessive acrid and dry herbs to treat cold syndrome, clearing therapy with excessive herbs of bitter taste and cold nature to treat heat syndrome and nourishing therapy with excessive tonic herbs to nourish yin lest yin be consumed by acridness and dryness, yang be damaged by tonic elements and the spleen be restrained by herbs of bitter taste and cold nature. Such errors in using herbs will all seriously impair the spleen and stomach.
The spleen and the heart are closely related to each other. The heart governs blood and the spleen produces blood, both of which depend on the spleen to transform and transport cereal nutrients. The function of heart yang in transporting blood in the vessels relies on the spleen qi to command. Insufficiency of transformation may lead to deficiency of heart blood, and resulting in palpitation, insomnia, or scanty menstruation and amenorrhea. Failure of the spleen in commanding blood may lead to profuse menstruation, metrorrhagia and metrostaxis which consume blood and cause palpitation and insomnia. So asthenia of both the spleen and the heart is common in disorders of menstruation and should be treated by nourishing both the heart and the spleen.
Regulating qi and blood
Blood is essential to woman, but menstruation, pregnancy, delivery and breast-feeding tend to consume blood and damage qi, eventually leading to gynecological diseases. So regulating of qi and blood is also one of the main therapeutic methods used to treat gynecological diseases. In syndrome differentiation, it must be made sure whether the diseases involves qi or blood and whether they are of cold or heat, or of asthenia or sthenia. Qi and blood depend on each other, so qi must be regulated together with blood and vice versa. If the disease mainly involves qi, the treatment focuses on regulating of qi supplemented by balancing blood. The asthenia syndrome is treated by reinforcing therapy and the stagnation syndrome is treated by promoting therapy with the supplementation of nourishing blood or activating blood. If the disease mainly involves blood, the treatment mainly concentrates on regulating of blood with the supplementation of harmonizing qi. Blood asthenia syndrome is treated by supplementing blood and nourishing blood; blood stasis is treated by activating blood and resolving stasis; blood heat is treated by clearing away heat and cooling blood; blood cold is treated by warming meridians to disperse cold; massive bleeding or continuous bleeding is treated by astringing blood to stop bleeding. If diseases involve both qi and blood, they should be treated by proper application of the therapeutic methods mentioned above. For the asthenia of both qi and blood, it should be treated by nourishing both qi and blood; for the disorder of qi asthenia and blood stasis, it can be treated by supplementing qi combined with activating blood and resolving stasis; for the disorder of blood asthenia and qi stagnation, it may be treated by supplementing blood combined with regulating qi and dredging stagnancy. In such a way, the supplementation of asthenia will not lead to stagnation of pathogenic factors and the attack on pathogenic factors will not damage qi.
Regulating the thoroughfare and conception vessels
Gynecological diseases are mainly caused by impairment of the thoroughfare and conception vessels. So regulating the thoroughfare and conception vessels is one of the basic treatments for gynecological diseases. However,in the past dynasties, the treatment of gynecological disease usually focused on the treatment of the heart, liver,kidney, spleen and stomach, though the impairment of the thoroughfare and conception vessels is emphasized. This is due to the fact that qi, blood, essence and fluid in the thoroughfare and conception vessels all come from the heart, liver, kidney and spleen. Obviously the kidney,liver, spleen and stomach meridians are closely related to the thoroughfare and conception vessels. That is why the treatment of the kidney, liver, spleen and stomach is effective in regulating the thoroughfare and conception vessels. As to the relation of drugs with the meridians,some of the drugs working on the kidney, liver, spleen and stomach meridians also act on the thoroughfare and conception vessels, especially the drugs working on the liver and kidney meridians. That is why doctors in the past dynasties usually used drugs working on the liver and kidney meridians to treat the disorders of the thoroughfare and conception vessels. Regulating the thoroughfare vessel, stabilizing the thoroughfare vessel, strengthening the thoroughfare vessel and warming the thoroughfare vessel are the therapeutic methods for regulating the thorough-fare and conception vessels developed by Zhang Xichun in the early 20th century based on the characteristics of gynecology.
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