3physiological structures women have special physiological structures like the uterus that affect menstruation, pregnancy, childbirth and lactation.These organs especially need blood and qi to function with the meridians acting as communicating channels.the physiological functions are dependent upon the promotional effects of the organs,meridians, blood and qi working together.
4Zang and fuphysiological functions of the uterus are associated with the heart, liver, spleen and kidneys as well as the Conception and Thoroughfare Vessels.The heart rules the blood.The liver stores the blood.The spleen governs the blood.The kidneys store essence.The Conception and Thoroughfare Vessels control qi and blood in the uterus.
5eight meridiansNormal physiological functioning also depends on the proper regulation of the eight meridians.Because the majority of uterine qi and blood travels within these meridians, the relationship of the uterus and the extra meridian network is extremely close.
6eight meridiansTheir main function is to strengthen the links between the twelve regular meridians and to regulate qi and blood circulation.They have special relationships with the liver, kidney, spleen, uterus, brain and marrow and thus influence these structures physiologically and pathologically.
7Blood and qiMenstruation, pregnancy, childbirth and lactation are unique to women.Blood is the elementary basis of these physiological functions hence there is the saying that "women take blood as primary." \TCM believes that a woman is always in a state of blood insufficiency and is relatively excess qi inside the body.However, the blood and qi mutually generate and depend on each other
8Seven emotionsThe seven emotions exert their effects on various organs significantly.Anxiety and anger damage the liver, which then fails to regulate blood and qi flow.Pensiveness damages the spleen, which then loses its role in consolidating the blood.
9Pattern of chongren’s dieases Cold sydrome in chongrenShaofuzhuyu tangHeat sydrome in chongrenQinliansiwu tang add zhixiangfu- true heatDanzhixiaoyaosan –emotion lead to fireLiangditang—empty yinIndeficiency sydrome in chongrenDangguidihuang tang
10Uncontrol syndrome in chongren stasis syndrome in chong ren Shoutai pillstasis syndrome in chong renGuizhifulin pillZhuyu tang< yilingaicuo>Dampness and blood stasis in chong renBaijiangcao chaohu zhishi shaoyao gancao danshen gegen yimucaoEzhu shenmiren
11Penetrating vessel (Chong mai) The Penetrating vessel influences the supply and proper circulation of blood in the uteruscontrolling the cycle-length, quantity, quality, duration and coloration of menstruation.acts as a reservoir for the blood“sea of blood.”
12One branch—the foot yangming channel which is rich in qi and blood One branch connects the Kidney channel which stores jing which is also an important source of blood.The Penetrating vessel’s pathway flows upwards, connecting these two blood-rich channels.This characteristic makes it possible for the Penetrating vessel to serve as a reservoir for blood, counterbalancing excessive or deficient blood supply to the uterus, and thus regulating menstruation.
13Chinese herbs affect the Penetrating vessel strengthening the Penetrating vesselGui Ban Bie Jia E Jiao ,Zi He CheZhi Mu Xuan Shen Huang BaiSheng Di Huang Gou Qi ZiRegulating its qi.Yan Hu Suo, Chuan Lian Zi, Xiang FuYu Jin , Qing Pi and Xiao Hui Xiang.
14Morning sickness results from rebellious qi in the Penetrating vessel. During pregnancy, especially the first three months, profound changes to the Penetrating vessel take place.The mother’s blood, essence and Kidney energy are diverted to nourish the foetus, so qi and blood become relatively deficient in the Penetrating vessel and its qi rebels upwards towards the Stomach and chest.
15easing morning sickness in pregnant women. subduing rebellious Penetrating vessel qistop morning sicknessMu XiangSha RenChen PiSu Ye
16Case History A 42 year old patient had late periods for three consecutive months.Her menstrual bleeding was pale red in colour, thin in quality, scanty and without clots.She had had a digestive problem for three years with reduced appetite, fullness and copious abdominal gas, alternating constipation and diarrhoeaa pale tongue with a thin white, slightly greasy tongue coating.diagnosis was delayed menstruation.The differentiation was Spleen deficiency.which caused qi and blood deficiency and emptiness of the Penetrating vesselBa Zhen Tang plus E Jiao and Gou Qi Zi
18After three weeks of treatment, her period came on time (and was subsequently regular), and there was a great improvement in digestive function.Ba Zhen Tang is a formula which tonifies qi and blood; E Jiao and Gou Qi Zi tonify blood and are the herbs that strengthen the Penetrating vessel.
19Conception vessel (Ren mai) The Conception vessel is very closely related to the uterus and to the female reproductive function.It regulates qi and blood in all the yin channels.helps to regulate menstruationdirects the development and growth of the foetus,most important during pregnancy
20The function of the Conception vessel is related to its course. It originates from the uterus in women and emerges at Huiyin in the perineum. It runs anteriorly to the pubic region and all the way up to the throat along the midline of the body. From the throat it ascends to curve around the lips and up to the eyes to meet the Stomach channel Along this path, it connects withthe yin channels of the hand and foot, and the Yin Linking(Yin Wei) vessel many times. It connects all the yin channelsof the human body, combining yin, essence and fluids, andso is called “the sea of yin channels.” This means that theConception vessel provides the yin substances for all femalephysiological processes, including puberty, conception,pregnancy, childbirth and menopause.
21The Conception vessel can be used to nourish the body’s yin energy, particularly in women after menopause, and toreduce the effects of empty-heat symptoms deriving fromyin deficiency which is a common problem in the menopausalstage. It can also be used for problems relating tomenarche, conception, fertility and pregnancy, especiallyfor pregnancy, because the Conception vessel controls thefoetus.
22Conception vessel has meeting points with the Spleen, Liver and Kidney channels Spleen is the root of qi and bloodLiver is responsible for the free flow of qi and stores bloodKidney stores essence and is responsible for reproduction.
23herbs for nourishing the Conception vessel Gui Ban , Bie Jia, E Jiao, Zi He CheZhi Mu, Xuan Shen, Huang BaiSheng Di Huang Gou Qi ZiThe same to those for nourishing the Penetrating vessel.
24Case History A 45 year old female patient Hot flushes, night sweating and irritability for six months, accompanied by soreness of the lower back,heavy and irregular periods with red blood which was thick in quality with few clots.tongue was red with little coatingPulse was fine and rapid.diagnose as suffering from menopausal syndromedifferentiated as Kidney yin deficiency with empty heat.Zuo Gui Wan plus Gui Ban and Zhi Mu.
25After two weeks of treatment, she felt much better, except for continuing mild night sweats. Zhi Bai Di Huang Wan was then prescribedAbout three months later, she had no further symptoms.Zhi Bai Di Huang Wan and Zuo Gui Wan are traditional formulas for nourishing Kidney yin, and the former can also clear empty heat.Gui Ban and Zhi Mu are the herbs which nourish the Conception vessel and clear empty heat.
26The Governing vesseloriginates in the uterus and descends to Huiyin REN-1. This is common to all three of the Governing, Conception and Penetrating vessels, which is why Li Shi-zhen calls them “three branches of one vessel”.The Governing vessel primary pathway runs posteriorly along the midline of the sacrum, its first branch curls around the vagina and the interior of the spinal column and enters the Kidneys, and its abdominal (second) branch ascends the midline of the abdomen and has an influence on the genital system in women.
27Some herbs Fu Zi Rou Gui Gan Jiang Chuan Jiao Gui Zhi possess heating qualities that are in keeping with the Governing vessel’s yang nature.
28Case History A 34 year old woman in her 31st week of pregnancy,suddenly for no apparent reason felt contraction of her uterus, lower abdominal pain, dull pain and soreness in the lower back that was also occasionally sharp in nature, and excessive thin white odourless vaginal discharge. There was no vaginal bleeding.The tongue was pale red with little coatingthe pulse was slippery and fine;the chi (root) positions of the pulse were weak.Diagnose was preterm labour.The Chinese medicine diagnosis was “restless foetus”differentiated asKidney qi deficiency.Shou Tai Wan add Dang Shen and Bai Zhu
29Three days later, she reported no further pain in the abdomen, with only slight remaining soreness in her lower back.However there was redness at the tip of her tongue which indicated the presence of heat, so this time I added Huang Qin to the formula.
30at her due date she bore a healthy baby. This case is restless foetus caused by Kidney qi deficiency.Shou Tai Wan is a formula for consolidating Kidney qi.Dang Shen and Bai Zhu added to tonify the Spleen and dry dampness in order to treat the excessive vaginal discharge.Because of her red tongue tip showing heat, Huang Qin was added to the formula, especially because Huang Qin and Bai Zhu in combination are very good at calming the foetus.
31Girdle vessel (Dai mai) The Girdle vessel is the only horizontal vessel of the body.It encircles the waist like a belt.The Girdle vessel encircles and influences all the channels in a longitudinal direction,and directly affects female physiology and pathology.
32The Kidney’s functions of storing essence and lowering and holding qi the Spleen’s function of raising qiThe Liver’s function of smoothing the flow of qi all rely on the Girdle vessel’s encircling of the body.Impairment of the Girdle vessel’s function can lead to a decline in the Spleen’s ability to transform and transport food and drink.contributing to dampness which may infuse downwardsand cause excessive vaginal discharge.
33Deficiency of the Girdle vessel results in the sinking of Spleen qi, which can induce a prolapse of the uterus.The foetus depends not only on the Kidneys and the Conception vessel, but also on the Girdle vesselIf the Girdle vessel is slack, it fails to restrain essence, causing an unstable foetus, and the mother may have vaginal bleeding during pregnancy, a restless foetus or even miscarriage.
34The Girdle vessel can be used in gynaecology to treat irregular periods, painful periods (dysmenorrhoea) andexcessive vaginal discharge.Sheng Ma affects the Girdle vessel.has an ascending movement, and can be used to treat pathological conditions of the Girdle vessel.Certain astringent herbs will enter the Girdle vessel, includingWu Wei Zi, Shan Yao, Qian Shi,Fu Pen Zi , Sang Piao XiaoDang Gui, Bai Shao , Xu DuanLong Gu, Ai Ye and Gan Cao.
35Case History A 34 year old woman suffered from excessive vaginal discharge for four months.The discharge was white, occasionally slightly yellow in colour, thick in quality and odourless.She had a bearing-down sensation in the vagina, a sallow complexion, cold limbs, oedema of the medial aspect of the ankles, lassitude and loose stools.The tongue was pale with a thin white greasy tongue coatingsoggy and weak pulse.examined by a gynaecologist, and no positive signs were found.The diagnosis was deficiency and sinking of Spleen qi.Wan Dai Tang add Sheng Ma and Long Gu
36After one week of treatment, the patient felt much better. Three weeks later, she recovered totally.Wan Dai Tang is a formula which treats the Spleen qi deficiency pattern of leucorrhoea;Sheng Ma directs the flow of Spleen qi upward, and Long Gu consolidates the Girdle vessel and astringes the leucorrhoea.
37menopauseTCM doesn't recognize menopause as one particular syndrome. Instead, it aims in treating the particular symptoms that are unique to each individual. For example, if ten women are treated with TCM for hot flashes and night sweats, each of these ten women will likely receive a unique, customized treatment with different acupuncture points, different herbs, and different lifestyle & diet recommendations. This gives a very effective result.
38Diagnosis of menopause +/- 49 years young, menses stop. Around this time symptoms & signs start to appear. Cycle becomes irregular, dizziness, blurred vision, tinnitus, hot flashes, red complexion coming & going in waves, very emotional (anger, irritated, sadness, anxiety, etc.), edema, low back & knee weakness / pain, digestive problems, cold limbs, & urinary disorders.These do not come all at once, some women only get a few & some women encounter many. This may last for weeks to years in some cases.
39TCM diagnosis can be divided into 3; 1. menstrual cycle gets very irregular, bleed a lot, may be serious hemorrhage. Then may experience very occasional menses until they cease completely. May lose hair from blood ↓.2. ↓ Yang symptoms → Yang rises due to Yin ↓ (relative Yang ↑). WM says this is due to blood vessels contraction. Sudden heat → break sweat (hot flashes), dizziness, palpitations & rapid pulse.3. emotional imbalances → easy to anger, sadness etc.. Manic behavior, depressed, abnormal, violence, & insomnia are all common. A blood test may show high FSH meaning ovary function has ceased.
40Etiology1. KI Yin ↓ - pregnancy, menses, breastfeeding & abortions consume Essence & Tian Gui, Chong & Ren can’t be nourished. This creates hyper Yang rising.2. KI Yang ↓ - use of a lot of KI Qi for pregnancy, menses, breastfeeding & abortion consume the Ming Men Fire → KI Yang is ↓ --cold signs.
41Pathogenesis Differentiation & Treatment 1. KI Yin ↓ - occasional menses → scanty → cease completely. Vaginal dryness & itchinessPlus – Yin ↓ sym. dizzy, tinnitus, insomnia, night sweats, afternoon heat feelings, back/knee pain/weakness, hot flashes w/ sweating, whole body itchiness.T- red w/ scanty coat P- thin rapidP/T – nourish KI YinZou Gui Wan (essence) or…Liu Wei Di Huang Wan + Huang Bai, Zhi M= Zhi Bai Di Huang Wan+ E Jiao, Gui Ban, Bie Jia, He Shou Wu, Nu Zhen Zi
42KI Yang ↓HEAVY periods, irregular uterine bleeding, then gradually finish menses completelyT- pale P- deep thinPlus – Yang ↓ sym. cold, soft stools, ↑ frequency of urine, incontinence,low back/knee weakness/pain, Edema of lower limbs &/or face.P/T – warm KI Yang – strengthen SPYou Gui Wan + Li Zhong Wan
43Usually KI Yin & Yang deficiencies are complicated… P/T – nourish KI Yin & YangEr Xian Tang (this may be taken long term)EMERGENCY HEMORRHAGEShen Fu Tang+ stop bleeding herbs (Xian He Cao, Ai Ye Cao, Bai Ji, Han Lian Cao)
44Benefits of TCM for Fertility Increases blood flow to the uterusCan regulate hormones and entire endocrine systemPromotes ovulationHelps thicken the lining of the uterus if it is too thinRelaxes the uterusImproves function of the ovariesReduces stressStrengthens the immune systemSupports a healthy pregnancy and prevents miscarriagesTreats the side effects of western pharmaceutical medicationsFor men, it improves the quality and quantity of sperm
45Causes of infertility Kidney Deficiency This kind of infertility involves irregular menstruation with scanty light flow. It is accompanied with general fatigue, dizziness, tinnitus, and lower back & knees soreness.Blood DeficiencyThis kind of infertility involves scanty flow of light red blood and delayed cycles. It is accompanied by loss of weight, dull complexion, dizziness, and general fatigue.
46Cold in the UterusSometimes the menstruation is delayed with dark red flow with clots. The flow is often dilute. It is accompanied by cold extremities, cold pain in lower abdomen alleviated by warmth, and frequent profuse urination.Phlegm-DampnessThis is often in overweight people with prolonged menstruation or even no periods and profuse discharge of sticky leucorrhea.