Gynecology of TCM is a clinical specialty and concentrates on studying the physiological and pathological characteristics, diagnostic and therapeutic principles and specific diseases related to women. Through a long history of two thousand years of practice and improvement,gynecology of TCM has developed a unique theory based on the physiological and pathological characteristics of women which are quite different from those of men.Women are characterized by uterus, uterine collaterals and uterine vessels in anatomy; menstruation, pregnancy, delivery and child-feeding in physiology; and disorders of menstruation, leukorrhea, pregnancy and delivery in pathology. It is just based on the cognition of uterus,menstruation, pregnancy, delivery and child-feeding as well as their relation with the viscera, meridians, qi and blood that gynecology of TCM studies the pathological characteristics of woman disease and the principles for prevention and clinical treatment.
The uterus is located in the pelvis, like an upside down pear, posterior to the bladder and anterior to the rectum. The uterus is responsible for menstruation and conceiving fetus. Under physiological conditions, the uterus is to store essence and blood for menstruation or conception of fetus, demonstrating the "storage" function of the zang organs; and discharge menstruation or deliver baby, manifesting the "excretion" function of the fu organs. That is why it is called "extraordinary fu organ" in Neijing or Canon of Medicine. Such physiological functions of the uterus are closely related to meridians, viscera, qi and blood. The uterus is connected with the heart and kidney through meridians. The heart governs blood and the kidney stores essence. Only when the heart blood is sufficient and kidney essence is abundant can blood and essence flow into the uterus for the preparation of rnenstruation and pregnancy. Besides, the uterus is also closely related to thoroughfare vessel, conception vessel, governor vessel and belt vessel through meridians. Such an extensive relation with the meridians and vessels enables the uterus to connect with the viscera and well accomplish its function in managing menstruation and pregnancy.
Leukorrhea refers to a little whitish or transparent and odorless secretion in the vagina of healthy women for moistening the vagina. Usually leukorrhea is profuse after menstruation or in the period between two cycles of menstruation or during pregnancy. This is physiological leukorrhea and is regarded as normal. Normal leukorrhea is a yin fluid in the body derived from cereal nutrients which are transformed by the spleen and stomach, stored in the kidney, governed by the conception vessel, controlled by the belt vessel and distributed continuously in the uterus.
Pregnancy and puerperiuln
After the occurrence of menarche, woman is still underdeveloped in the body and genitals, but she is able to get pregnant. The organ for pregnancy and delivery is the uterus. The mechanism of pregnancy lies in the combination of the essence from a man and a woman. If a woman is well developed in kidney essence with free flow of the conception vessel and fullness of the thoroughfare vessel,she will be easy to get pregnant when she has sexual intercourse with a man. The development and growth of fetus in the uterus were vividly described in some of the ancient medical canons.
After pregnancy, qi and blood accumulate in the thoroughfare vessel and conception vessel for providing nourishment for the fetus. That is why menstruation stops.But at the early stage of pregnancy, the uterus only stores essence and never excretes. Since the fetus is growing in the uterus and blood and qi are accumulating in the uterus, bi in the thoroughfare vessel is easy to flow upwards. If the liver blood in gravida is insufficient, it will lead to relative deficiency of liver yin, relative hyperactivity of liver yang because blood accumulates in the uterus to nourish the fetus. The liver governs thoroughfare vessel, simultaneous upward flow of liver qi and thoroughfare vessel qi frequently leads to attack on the stomach. That is why at the early stage of pregnancy there are morning dizziness, lassitude, somnolence, preference for sour taste, nausea and vomiting which are physiological changes and usually disappear in three months. Since blood accumulates in the uterus to nourish the fetus, it is already deficient during pregnancy. Hemorrhage during delivery further worsens blood deficiency. Asthenia of yin fails to keep yang inside and leads to leakage of yang,bringing about such symptoms like slight fever, aversion to cold and spontaneous sweating which will disappear automatically after yin and yang are balanced. Besides,blood asthenia and profuse sweating may cause constipation because the consumption of body fluid will deprive the intestines of proper moistening.
After delivery, there will be secretion of nfilk. Usually during the pregnancy, the breasts are gradually enlarged, the areola of mamma is deepened and foremilk is secreted. The milk is transformed from blood and produced by gastric qi. Since blood, propelled by lung-qi, is transformed into milk and stops flowing into the uterus,there is no menstruation during breast feeding period.
Menstruation refers to regular uterine bleeding in women of childbearing age, a manifestation of the normal activity of the reproductive function of women. Normal menstruation occurs once a month. But sometimes under normal conditions menstruation may occur once every other month known as bimonthly menstruation or once three months known as tri-monthly menstruation, or even once a year known as yearly menstruation. If menstruation never occurs in the whole life of a woman, it is called latent menstruation. In some cases menstruation may occur regularly in the first three months of pregnancy without affecting the fetus, it is called menstruation in pregnancy.Such changes in menstruation are regarded as normal phenomena, not morbid.
Menstruation is discharged from the uterus, but its production is in close relation with the normal functions of the viscera, exuberance of qi and blood as well as smooth circulation of meridians. Among these factors, blood is one of the substantial bases fur menstruation. But blood is produced from the cereal nutrient transformed by the viscera and transported to the uterus by the meridians.
The production of menstruation is related to the viscera, meridians, qi and blood, especially to the sufficiency of kidney qi and normal functions of the thoroughfareand conception vessels. Kidney qi is key to the physiological development of women all through the life. According to Neijing, at the age of 7 female is gradually rich in kidney qi, starting to change teeth and growing long hair; at the age of 14, reproductive substance has well developed,conception vessel is smooth in circulation, thoroughfare vessel is in predomination, menstruation occurs regularly and pregnancy is possible; at the age of 27, her kidney qi is sufficient and she has reached the age of bearing baby;at the age of 28, her body has perfectly developed; but at the age of 35, yangming meridian begins to decline and her face starts to change and her hair begins to lose; at the age of 42, her body declines further, her face becomes withered and her hair starts to turn grayish; at the age of 49, the conception vessel becomes deficient, the thoroughfare vessel declines, reproductive substance has been exhausted and menstruation stops. At this period, woman is changed in physical building, declines in sex glands and loses reproductive ability.
Viscera, qi, blood, meridians and their relations with physiologicalactivities of women
Physiologically the viscera in women mainly function to produce essence and transform qi and blood. The heart governs the blood, the liver stores the blood, the spleen commands the blood and is also the source of the blood; the lung controls qi and qi moves the blood; the kidney stores the essence, and the essence and blood share the same origin. The zang-organs and fu-organs, interiorly and exteriorly related to each other, together control the production, storage and regulation of the essence, qi and blood, also closely related to menstruation, leukorrhea, pregnancy and childbirth. Among the zang-organs and fuorgans, the kidney, liver and spleen (stomach) are the most important ones.
The main function of the kidney lies in kidney qi composed of kidney yin and kidney yang which depend on each other and restrain each other. It is the key factor for maintaining vital functions and visceral physiological activities. The conditions of kidney qi is directly related to the physical development and reproduction of woman. When kidney qi becomes exuberant, the tiangni, reproductive essence, in the kidney will be fully developed, the conception vessel will transport qi freely and the thoroughfare vessel will be abundant in content. Under such a condition menstruation occurs regularly and pregnancy is possible.
The kidney-qi functions to consolidate and astringe,and the kidney is connected with the uterine collaterals.After pregnancy, the fetus in the uterus depends on the nourishment of kidney yin and warmth of kidney yang to develop normally.
The kidney also governs water as well as opening and closing activities. If the kidney is abundant in qi and normal in closing and opening, yin fluid will constantly flow into the conception and belt vessels to lubricate the vagina and produce physiological leukorrhea.
The spleen and the stomach function to transform food and transport cereal nutrients, known as the postnatal bose of life and the source of qi and blood. Menstruation, nourishment of the fetus and production of milk all depend on the spleen and stomach to transform and transport cereal nutrients to nourish qi and blood. The spleen also controls blood to flow inside the vessels. Normal functions of the spleen ensure normal production, transportation and command of blood which are key to menstruation, pregnancy, delivery and breast-feeding.
The liver stores blood and governs distribution and conveyance of qi and blood, pertaining to yin physically and to yang functionally. Blood stored in the liver nourishes all viscera and skeleton and also flows into the thoroughfare vessel. That is why it is said that "the liver govenls the thoroughfare vessel" and "the liver is the congenital base of life for women". The liver also plays an important role in the production of menstruation. The storage, circulation and regulation of blood in the liver depend on the distribution and conveyance of liver qi. Only when the distribution and conveyance functions of the liver is normal can sufficient blood flow into the uterus regularly. Besides, the liver meridian starts from the big toe
and moves upwards along the inner line of the lower limbs to the genitals and lower abdomen, connected with the liver, gallbladder and diaphragm, distributing over the hypochondria and rib-side, finally reaching the vertex. Liver qi is also significant in distributing and conveying gastrosplenic qi and bile. The normal distribution and conveyance functions of liver qi are prerequisite to the reception and digestion of food by the stomach, the normal transformation and production of essence by the spleen,smooth transportation of bile from the gallbladder and constant production of qi and blood. The dysfunction of the liver in distribution and conveyance affects the normal functions of the spleen, stomach and gallbladder, leading to epigastric oppression, hypochondriac pain, bitter taste in the mouth, anorexia, abdominal distension and loose stool which are commonly encountered in gynecology. Since the liver meridian distributes over the breasts, lower abdomen and genitals, the functions of liver qi and the conditions of liver blood are closely related to states of lactation and the nourishment of the genitals.
The spleen also governs the distribution of body fluid and transformation of water and dampness. Normal functions of the spleen will maintain normal distribution and conveyance of body fluid which ensure constant production of leukorrhea and lubrication of the vagina. On the contrary, dysfunction of the spleen affects the distribution and conveyance of body fluid, leading to the production of phlegm due to accumulation of fluid and leukorrbogia due to infusion of fluid into the conception and belt vessels.
Both the heart and the lung are located in the upper energizer, the former controls blood and the latter guyeros qi, both playing an important role in the transportation, circulation and regulation of blood. Menstruation,pregnancy, delivery and lactation in women are all related to qi and blood. The heart governs blood and vessels, the propelling of which depends on heart qi. Sufficiency of heart blood and smooth circulation of heart qi will enable blood to flow into the uterus to produce menstruation.The lung governs qi, connecting with all vessels and distributing cereal nutrients down to the uterus to influence menstruation. The heart governs the mind, the liver manages strategy, the spleen controls contemplation and the kidney stores conscience. Such mentaI activities also play an role in the regulation of menstrution.
The stomach, a fu organ characterized by sufficient qi and blood, governs reception and digestion of food and manages blood and qi production with the spleen. The stomach meridian moves downward to meet with the thoroughfare vessel at Qijie. Only when food and water in the stomach is sufficient can blood in the thoroughfare vessel and uterus be full enough to produce menstruation. Since the stomach meridian distributes downwards through the middle line of breast, the stomach influences the production of milk. So only when stomach qi is sufficient can blood and qi be abundant and the production of milk be constant.
Apart from direct influence on menstruation, leukorrhea, fetus and delivery, the kidney, liver, spleen, heart and lung are also connected with the twelve meridians through the relations of the meridians with zang and fu organs, uniting the viscera, qi, blood and meridians into an integrity to maintain and regulate the physiological functions of woman.
Qi and blood
Blood is the essential base of life for woman because menstruation is transformed from blood, fetus depends on blood to nourish and milk relies on blood to produce. As to the relation between qi and blood, blood depends on qi to produce, circulate and control, while qi relies on blood to nourish and protect. That is why it is said that qi is the commander of blood and blood is the mother of qi.
Meridians refer to the routes along which qi and blood flow. The meridians that are closely related to the physiological activities of woman are the thoroughfare, conception, governor and belt vessels in the eight extraordinary vessels. The functions of the extraordinary vessels in the human body are to store the qi and blood transported by the twelve meridians and to send out qi and blood for the nourishment of the twelve meridians and viscera. Among the thoroughfare, conception, governor and belt vessels, the thoroughfare and conception vessels are most important in the physiological functions of the reproductive system of women.
The thoroughfare vessel originates from the uterus and moves together with the kidney meridian to the lower abdomen and upward along the navel. It is the region where qi and blood converge, that is why it is called "sea of the twelve meridians", "sea of blood" and "sea of five zang and six fu organs". When woman is well developed, the thoroughfare vessel will be abundant in content and qi and blood from the viscera will flow into the uterus to produce menstruation. The thoroughfare vessel moves upward to connect with the stomach meridian at Qichong(ST 30). So it also governs the production of milk. It is obvious that the thoroughfare vessel is closely related to menstruation, pregnancy and lactation in woman.
The conception vessel starts from the uterus, moving out from perineum and upward along the middle line of abdomen to connect with all yin meridians. The conception vessel governs essence, blood and body fluid. It is the base of pregnancy. That is why it governs pregnancy. The smooth circulation of qi and blood in the conception vessel, in combination with the thoroughfare vessel, is responsible for menstruation and pregnancy.
The governor vessel also starts from the uterus,moving out from the perineum and posteriorly upward along the middle line of the spine to the vertex. It is connected with the spinal cord, brain and all yang meridians.So it is called "the sea of yang meridians". Its branch moves anteriorly and posteriorly from the genitals. The anterior branch is connected with the conception vessel from Cbangqiang (GV 1) point and the posterior branch is connected with the kidney meridian at the end of sacrum and continues to move upward in the spine. The thoroughfare, conception and governor vessels all start from the uterus, the thoroughfare vessel is the sea of blood and the conception vessel governs uterus and fetus. The governor vessel controls all yang meridians and the conception vessel controls all yin meridians. The balance of yin and yang as well as smooth circulation of qi and blood together
maintain normal conditions of menstruation, pregnancy, delivery and lactation.
The belt vessel starts from the hypochondria and moves around the waist like a belt. Its function is to control the meridians moving upward and downward so as to strengthen the connections of meridians. It is significantly related to the thoroughfare, conception and governor vessels which all start from the uterus, together constituting a system in direct relation with the physiological functions of woman. Such a system, in cooperation with the activities of the viscera, not only influences menstruation and pregnancy, but also plays an important role in leuknrrhea and lactation.