Author: Guo Yong Hong
Translated by Keren Zelicha from Tianjin Journal Of Chinese Medicine, October 2002, 34-35
Women physiology has a close relationship with age and reproductive system. According to Chinese medicine zang fu organs can transform and produce jing, qi, blood, jin, ye and use them to maintain our basic life needs, keeping the normal balance and function between kidney – tian kui – chong , ren – uterus (gynecology system). Nowadays it can be translated as keeping the stability of menstruation cycle, amount of bleeding, pregnancy, birth and lactation.
The woman physiology of menstruation, leucorrhea, pregnancy, birth, and lactation is depended on the balance between qi – blood, harmony of zang fu organs and on keeping the free flow of jing – lou meridians – “When the balance is disturbed 100 diseases can appear or transformed into another “.
This article will try to explain the connection of qi, blood and phlegm in gynecology disorders.
1. Women and blood:
The women’s cycle, pregnancy, delivery and lactation is depended on the condition of blood. Over consumption can damage blood. Therefore it can be said that women often have blood deficiency comparing to qi which is more full (ling shu chapter 65 : “ for a woman her qi is surplus, but her blood is insufficient due to her monthly menstruation” ). Blood disorders contain: blood deficiency, blood stagnation, heat in the blood, cold blood.
1.1 Blood deficiency
Blood deficiency includes deficiency of blood and yin, blood nourishment and moistening function is weak, causing emptiness of the “sea of blood”. The cause of blood deficiency can be divided into 3 aspects:
Chronic bleeding as prolonged menses, or large amount; beng lou; bleeding after delivery; all can damage yin – blood therefore deficiency is seen.
Weak pre-heaven qi, tian kui isn’t functioning, or post-heaven qi isn’t transforming food and drinks into qi & blood.
Chronic diseases, sever illnesses can damage zang fu organs , especially spleen – kidney , jing blood are damaged.
Chong and ren meridians are depended on the nourishment of yin and blood, they are both originated from the uterus therefore when they are empty the following symptoms can appear: oligomenorrhea, scanty menses, amenorrhea, dysmenorrhea, high miscarriage risk, insufficient lactation, infertility.
1.2 Blood stagnation:
Blood stagnation happens when blood and it’s fluids are flowing slowly and not freely.
Cold, heat, deficiency, excess, trauma, emotions, chronic diseases and bleeding can cause obstruction of blood and fluids.
Qi stagnation and blood stagnation:
Qi is the commander of blood, blood movement is depended on the force and movement of qi therefore when qi is stagnated blood is stagnated. If the 7 emotions are imbalanced, liver qi is depressed causing blood stagnation, chong ren are obstructed leading to delayed menstruation, amenorrhea, dysmenorrhea, abdominal pain during pregnancy, infertility etc..
Qi deficiency and blood stagnation:
When qi is weak it doesn’t have the force to move blood, therefore blood flow is slow, finely stagnation is preformed. Spleen-kidney deficiency induces chong and ren inability to control blood, menorrhagia, metrorrhagia and prolonged lochia.
Cold and blood stasis:
According to the nei jing qi and blood prefer warm and hate cold. Cold has the ability to congeal blood causing stagnation. Cold can originate form external cold pathogen attacking at menstruation days or after delivery; cold food damaging middle jiao; prolonged exposure to rain and water environment. Frequent symptoms as dysmenorrhea, amenorrhea, oligomenorrhea, cold uterus- infertility can appear.
Heat and blood stagnation:
Excess heat can obstruct blood movement and cause masses. The source of heat can be from external heat which invades during menses, pregnancy or after delivery; excessive spicy hot food intake; tonifying yang herbs/products. All can promote the existence of heat in chong- ren meridians dry the sea of blood and cause stagnation. Dysmenorrhea, menorrhagia, beng lou, un calm fetus, pelvic inflammation and abdominal masses can appear.
1.3 heat in the blood:
Heat can cause the blood to circulate more quickly, vasodilatation can be seen and in sever cases bleeding occurs. The factors can be due to yang constitution; spicy-hot food intake; over prescription of tonifying yang warming uterus herbs. All influence chong-ren meridians and the heat “boils” the sea of blood, finely breaking the vessels. Symptoms as oligomenorrhea, early menstruation, beng lou, vomiting blood during menses, un calm fetus, and fever during pregnancy or after delivery can appear.
1.4 cold in the blood:
Cold can congeal and obstruct blood movement. During menses and after delivery qi is deficient. External cold evil can attack the body, or a yang deficient constitution ( internal cold), both can block the flow of chong-ren meridians, their function will decrease, therefore dysmenorrhea, delayed menstruation, scanty menses, amenorrhea, stomach pain during pregnancy, body pain and “cold uterus”- (infertility) can occur.
2. Women and qi:
qi disorder are divided into qi deficiency, qi sinking, qi stagnation, and rebellious qi.
2.1 Qi deficiency:
Weakness of qi or small quantity can decrease its function. The causes of qi deficiency is pre-heaven (deficient constitution); post-heaven function; chronic – sever disease that damaged qi; overworking, or lack of kidney-spleen-lung function. All can damage zheng qi, spleen- kidney’s function is declined, qi production is also damaged therefore gynecological diseases can happen. When middle jiao qi and kidney qi are deficient chong-ren meridians are deprive of nourishment, they cant control blood thus causing irregular menses, menses with large quantity of blood, beng lou, un calm fetus, spontaneous lactation.
2.3 Qi sinking:
Middle jiao’s qi is collapsing uterine-vaginal prolapse, and excessive uterine bleeding can occur.
2.4 Qi stagnation:
The ability of qi to transport blood and it’s fluids is damaged, thus the mechanism of zang-fu organs, qi-blood, jing-luo can not be maintained. If liver qi’s ability of soothing the qi is damaged, chong-ren are blocked influencing dysmenorrhea, amenorrhea, irregular menses, infertility.
Qi stagnation, jin-ye aren’t transformed, damp- phlegm will accumulate causing edema, amenorrhea, infertility. Emotions can cause stagnation which transformed into fire, fire can damage chong-ren producing irregular menses, large amount of blood flow, beng lou, miscarriage.
2.5 Rebellious qi:
When the upward and downward of qi isn’t normal, lung can’t downward qi causing cough during pregnancy. When chong or liver qi attack the stomach its normal flow of qi is disturbed, and goes upward, nausea and vomiting during the first trimester appears.
3. Women and phlegm:
Phlegm is transform due to the thickening of jin ye.
Jin ye originate from food and drinks. Blood is a combination of jin, ye, ying and qi . Jin and blood have a yin function of nourishing and moistening, they are both depended on the ability of qi of warming and transporting. If the balance between jin, qi, blood is damaged stagnation and phlegm can occur. Therefore we can say that phlegm has a close relationship with qi and blood physiology.
3.1 Phlegm and blood relationship:
a. Phlegm and blood stagnation:
In gynecology diseases phlegm and blood stagnation can change one into another, in chronic diseases they are usually seen together and the treatment is considered more difficult. When phlegm is stagnated in jing-luo meridians, qi and blood obstruct causing ectopic pregnancy, ovarian cysts, infertility, uterine fibroids, pelvic inflammation and masses.
b. Phlegm and blood deficiency:
When blood is deficient its fluids accumulates and changes into phlegm which fills chong – ren. Delayed menstruation, yellow leucorrhea, Polycystic Ovary Disease and infertility can happen.
c. Phlegm and heat in the blood:
Heat in blood can congeal jin-ye, thus causing early menses but with little amount, amenorrhea, beng lou, short menses, un calm fetus, fever after delivery etc…
d. Phlegm and cold in the blood:
Cold congeals blood fluids into phlegm. When cold evil attacks or when yang is deficient, qi cant transport water, producing damp which stagnates into phlegm. Another aspect can be that internal cold interferes with the warming of spleen yang and its function of transformation -transportation of food and drinks therefore damp is produced and accumulates as phlegm.
3.2 Phlegm and qi relationship:
Phlegm is developed due to inappropriate upward and downward of qi. Qi is related to yang, phlegm is related to yin, they are both a product of transformation of food and drinks. Qi can produce jin-ye, can transport them and control their amount; fluids can carry with them qi to different parts of the body, the whole procedure is relayed on the normal flow of qi. When qi is blocked the metabolism of water is damaged and they accumulate as phlegm.
Phlegm and qi deficiency:
When qi is weak it won’t transform jin-ye and they will accumulate and change into phlegm. Thus it is said “if qi can transform, phlegm will change into jin-ye, if qi cant transform, jin-ye will change into phlegm” (from zha bing zheng zhi). Related symptoms: early menstruation with large quantity, beng lou, un calm fetus, miscarriage.
b. Phlegm and qi stagnation:
When qi stagnates it is quiet often related to emotional causes that obstruct the free flow of liver qi. Qi stagnation will interfere with the metabolism of water, they first will transform into damp and later to phlegm. A reference can be seen in jin gui yao lu chapter 22-5. There plum pit is discussed: “ a woman feeling suffocation in her larynx the treatment should be with ban xia hou po tang” (moving liver qi eliminating phlegm).
Common symptoms are: irregular menstruation, dysmenorrhea, pre menstrual syndrome, infertility etc..
c. Phlegm and incorrect flow of qi:
Rebelling qi is considered an upward or downward un normal flow of qi. Qi sinking is a sever condition of prolonged qi deficiency. Both are manifestation of improper flow of qi which influence qi’s ability of transformation. Qi is blocked and fluids will accumulate changing into phlegm. Qi rebelling disorders such nausea – vomiting – cough during pregnancy, headache during menses etc.. can be seen. Qi sinking can develop: miscarriage, leucorrhea, prolonged beng lou, uterine-vaginal prolapsed etc.
To summarize it all, gynecology diseases are regarded most of all as blood disorders, but due to the close relation with qi, it is necessary to treat qi and its byproduct – phlegm. Today in the clinic most of the cases are combinations of deficiency, stagnation of qi or blood, with phlegm, resulting menstruation problems, polycystic ovary disease, pelvic inflammation, masses and infertility. Thus the treatment should not include only tonifying yin-yang, qi-blood herbs but also warming and promoting qi circulation to dispel phlegm