The diagnostic methods and key points for syndrome differentiation of gynecological diseases are, though similar to those of the diseases in internal medicine, unique in some aspects. The general conditions of the patient are studied first with the four diagnostic methods. Then the cause and location of disease, the relation between the pathogenic factors and healthy qi as well as the development and variation of the principal and secondary aspects of disease can be correctly differentiated. The diagnosis and syndrome differentiation in gynecology mainly focus on the aspects of menstruation, leukorrhea, pregnancy and delivery of child.
Inquiry in gynecology includes the following aspects:
Inquiry of leukorrhea: Including quantity, color,thick or thin texture and odor of leukorrhea.
Inquiry of pregnancy and delivery: Inquiry of pregnancy and delivery includes whether there are pregnancy, delivery, abortion (including artificial abortion),times of delivery, the last deliver and abortion date;whether there are dystocia, operation, massive postpartum hemorrhage, lactation after delivery, puerperal fever and abdominal pain as well as the quantity, color, nature and odor of lochia; whether there is contraception and what kind of measures are taken; months or weeks of pregnancy and morning sickness as well as whether there are symptoms of edema, dizziness and headache should be inquired when inquiring a pregnant woman.
Inquiry of menstruation: Inquiry of menstruation includes age of menarche, cycle, duration, quantity, color and nature of menstruation; whether there is blood clot and foul odor; whether there are such symptoms like distension and pain in the lower abdomen, waist and sacrum,chest and hypochondria as well as breast before and during menstruation; the date of last menstruation and the date of menstruation before the last period; whether there are dizziness, lassitude, nausea, vomiting and partiality in food as well as distension and pain in the waist, sacrum and lower abdomen in the case of amenorrhea.
Complexion: Pale or bright-whitish complexion indicates qi asthenia or yang asthenia; sallow complexion indicates blood asthenia or spleen asthenia; grayish complexion or'blackish periorbit indicates decline of kidney qi; blackish spots on the forehead, nose bridge and upper lip are known as pregnant macules that are not pathological.
Lips and tongue: Bright-reddish color indicates asthenia heat; light-reddish color indicates blood asthenia;purplish color or petechiae on the tongue indicates blood stasis; and light, tender and blackish color indicates yang asthenia.Pulse taking
Pulse in woman is usually feebler and softer than that in man, which is normal. In menstruation, leukorrhagia, pregnancy and delivery, there are some special pulse conditions.
Listening and olfaction
Listening to voice is the same as that in the other clinical specialties. Smelling of odor is mainly for understanding the special odor of menses, leukorrhea and lochia to confirm what the patient has described.
Menstruation: leukorrhea and Iochia: Cares should be taken to differentiate the changes in the quantity, color and nature.
Before or during menstruation, if pulse over the curt region is floating and full or floating and slippery without the symptoms of fever, headache and bitter taste in the mouth, it is normal pulse in menstruation. If the pulse is taut and rapid or slippery, rapid and powerful, it indicates accumulation of heat in the thoroughfare and conception vessels, usually seen in early menstruation, profuse menstruation and metrorrhagia and metrostaxis. Deep and slow or thin and slow pulse indicates interior cold due to yang asthenia and insufficiency of the thoroughfare and conception vessels, usually seen in delayed menstruation and scanty menstruation. Thin and scattered pulse indicates interior heat due to yin asthenia, usually seen in profuse menstruation and dripping vaginal bleeding. Thin and unsmooth pulse indicates asthenia of both the liver and kidney as well as deficiency of essence and blood, often seen in scanty menstruation and dysmenorrhea. Taut and unsmooth pulse indicates qi stagnation and blood stasis,frequently seen in delayed menstruation or dysmenorrhea. Thin and unsmooth pulse in amenorrhea without pregnancy indicates blood asthenia. Slippery and uneven pulse signifies blood sthenia and qi stagnation.
Profuse leukorrhea with taut and slippery or deep and scattered pulse may indicate internal accumulation of damp-heat; slippery and powerful pulse may signify interior retention of phlegm-dampness; deep and slow or weak pulse over the chi region on both hands may suggest insufficiency of kidney yang; soft and slow pulse may be the sign of downward migration of pathogenic dampness due to spleen asthenia.
Pulse after delivery
The pulse just after delivery is usually short and immediately turning into moderate and smooth due to sudden asthenia of blood and predomination of yang-qi. If the pulse under such a condition is large, or accompanied by fever and headache, it indicates failure of blood to be restored or invasion of exogenous pathogenic factors.
In general, the data collected by using the four diagnostic methods should be comprehensively analyzed in clinical treatment. For some special cases, syndrome differentiation has to be made according to the conditions of the pulse other than the syndrome or vice versa.
Preference for sour taste and vomiting 2 or 3 months after amenorrhea, accompanied by moderate pulse conditions over the six regions, or with slippery chi pulse or slippery cun pulse, may suggest pregnancy.After pregnancy, deep and thin or short and unsmooth pulse over the six regions or weak pulse over the chi region may indicate deficiency of qi and blood or insufficiency of kidney qi, cares should be taken to prevent abortion.