By: Keren Zelicha
Vaginal discharges are necessary to maintain the health of the vagina’s mucous membrane lining. The amount of vaginal discharge may vary according to the menstrual cycle. Most women produce more white- transparent discharges before ovulation. This is a good symptom that occurs due to elevated Estradiol levels. Vaginal discharges are considered normal if their color is transparent or white, odorless and not accompanied by itching or burning sensation.
When the amount of vaginal discharge increase and the color, quality and smell change, this is regarded as leucorrhea.
Chinese medicine and Vaginal discharge
The term Dai xia 带下 is related in a broad sense to different diseases under the “belt” (the Lower Jiao area) such as PID ( pelvic inflammatory disease), cervix inflammation, ovarian cysts etc. It also has a narrow sense of vaginal discharge (leucorrhea).
Normal leucorrhea is depended on strong kidney qi, spleen T&T and Ren channel. These systems on the one hand need to restrain vaginal discharge amount but on the other hand must moisten them in order to keep them as a clear unsmelly substance.
The disease was first mentioned in the Nei jing : 《素问，骨空论》，”任脉为病，女子带下瘕聚”. Disease in the Ren mai, leucorrhea will gather.”
Etiology & pathology:
The Outline of female Medicine （女科撮要 ）By Xue Ji （ 薛己）explains vaginal discharge etiology:
Vaginal discharge may be due to “six excesses ( external evils), seven emotions; or due to drunkenness, overeating, or bedroom taxation; or due to rich food with concentrated flavors; or caused by taking drying prescriptions. These led to debility of the spleen and stomach with yang qi sinking downward or lead to dampness and phlegm pouring downward. They accumulate and become this, so it is said to be “Dai” discharge.” (Translated by Lorraine Wilcox)
One of the main treatment strategy to approach leucorrhea will be by invigorating the spleen and stomach and ascending yang qi.
In qing dynasty Fu qing zhu nu ke 《傅青主女科》 and even before, in the Zhu Bing Yuan Hou lun 《诸病源候论》, vaginal discharges were classified into five colors: white ( Lung disharmony), yellow ( spleen disharmony), red ( Heart disharmony), green ( liver disharmony) and black ( kidney disharmony). Today in the clinic the most seen is white, yellow and sometimes green color.
Vaginal discharge can be classified as deficiency, stagnation, dampness, or heat condition. The most common cause is dampness invading into the Ren-Dai Mai meridians, blocking the Dai Mai and interrupting the binding effect of the Ren channel.
Dampness can be caused:
- Internally (due to spleen qi deficiency or kidney qi deficiency not binding ).
- Externally (due to invasion of damp pathogen)
Remember, dampness sinking in the Dai mai meridian will always be the most important pathology to be treated. The question we need to ask ourselves is what causes the formation of damp, and it is an excesses or deficiency type.
Chronic leucorrhea can damage yin – fluids, symptoms can be combined of excess & deficiency. The deficiency can even deteriorate more, therefore its important to prevent its happening.
1. 脾虚- spleen qi dificiency:
Etiology: un proper diet; over exhaustion; over thinking; 7 feelings causing liver qi stagnation over attacking the spleen, all can lead to disfunction of Sp T&T. Food and drink not forming into blood, accumulating into damp and sinking into the Lower jiao, harming Ren – Dai meridians and causing leucorrhea.
Symptoms: white or slight yellow leucorrhea, sticky without smell, slight yellow or un clear white face, cold 4 limbs, tiredness, no apatite, soft stools, edema in legs. Tongue- Pale, white coating or sticky, Pulse- slow, weak.
Strategy: 健脾益气，升阳除湿 . Supplement the Spleen, boost qi, raise yang up, expel damp
Formula: Wan dai tang
Bai zhu, Shan yao, Ren shen, Bai shao, Cang zhu, Gan cao, Chen pi, Jing jie sui, Chai hu, Che qian zi.
This formula is treating the Spleen -Stomach & Liver.
Bai Zhu as a chief herb can supplement the spleen and dispel dampness. Cang Zhu has a more drying effect than Bai zhu, it will dispel dampness and turbidity. Shan yao can consolidate the kidneys and arrest vaginal discharge. Chai Hu and Bai Zhu can raise clear yang of the spleen and stomach upwards, combining them with Bai shao to sooth the liver and resolve constraint.
This formula is from Fu qing Zhu Nu Ke’s book. In this book, Jing jie sui is used a lot as a herb that opens and disperses Lung qi, but its applying is different than its ordinary expelling external wind or opening the pores functions. As we know Jing jie is a warm pungent herb, it enters the lung and liver meridians. From a five element aspect, the lungs control liver. If there is a disharmony in the lungs they can affect liver qi circulation and spleen qi transformation & transportation. Therefore when dampness occurs it is important to treat also the lungs due to their influence on liver and spleen organs. In gynecology we sometimes “forget” the lung function of regulating and dispersing qi. When lung qi is obstructed it can influence Liver and spleen qi functionality, leading to stagnation and dampness.
Lung qi deficiency: Huang qi
Kidney qi deficiency: Tu si zi, Du zhong.
Cold causing pain: Xiang fu, Ai ye.
Chronic leucorrhea: Jin ying zi, Long gu, Mu li, Qian shi.
Damp transforming into heat: Yi huang Tang: Shan yao, Qian shi, Huang bai, Che qian zi, Bai guo -(astringent stop leucorrhea).
2. 肾虚 kidney deficiency:
Etiology: low constitution; Yuan qi deficiency; over sex; many labors, all damaging kidney’s ability of controlling yin- fluids. The loss of yin as leucorrhea may lead to yin deficiency, in addition fire becomes excess causing the yin to be more deficient. Ren – Dai channels can’t bind, fire turns leucorrhea into red color.
· 肾阳虚：kidney yang deficiency:
Symptoms: watery clear leucorrhea, large amount, unstopping drips, lumbar pain, cold in Lower Jiao, clear long urine especially at night, soft stools, Tongue- pale, white coating, Pulse- deep slow.
Strategy: 温肾培元，固涩止带. Warm kidney, maintain yuan qi, bind and stop leucorrhea.
Formula: Nei bu wan:
Lu rong, Tu si zi, Tong ji li, Huang qi, Rou gui, Sang piao xiao, Rou cong rong, Fu zi, Bai ji li, Zi wan.
Soft stools: omit Rou cong rong, add Bu gu zhi, Rou dou kou.
· 肾阴虚 Kidney yin deficiency :
Symptoms: red white leucorrhea, sticky without smelling, heat feeling, dizziness, red face, 5 palm heat, insomnia, dreaming, yellow urine. Tongue- red little coating, Pulse- thready fast.
Strategy: 益肾滋阴，清热止带 boost kidney, enrich yin, clear heat, stop leucorrhea.
Formula: Zhi mu di huang tang + Qian shi, Jin ying zi.
One of the frequent used herbs that benefits the yin and bind leakages is Mu li ( Concha Ostreae). According to the Shen Non Ben cao jing, Mu li is salty and balanced, it can treat cold damage, cold and heat, Malaria and chills, fright, rage and anger, “rat fistula” and in female it can treat red and white vaginal discharge. By analysing its function, we can understand that Mu li transforms phlegm, soften hardness, dispels nodules, clams the Shen.
Mu li works on the Gall bladder since it transforms phlegm and dispels nodules, it is indicated for scrofula, thyroid cysts, nodules in the lymph glands and tumors. It is a shell- a “heavy” herb, therefore influences the Liver organ as it anchor the Liver yang and calms anger. The salty taste strengthens the kidneys and anchors the yang to the lower jiao. Since it is a salty shell, it can support the kidney’s ability to prevent leakages of fluids. It benefit the kidney yin, stops sweating from yin or qi deficiency, treats spermatorrhea or red vaginal discharge due to yin deficiency and empty heat. I recommend using Mu li for chronic vaginal discharge with spleen qi and kidney yin deficiency symptoms. The dosage of Mu li is 10-30 gr.
3. 湿热（毒） Damp heat (toxic)
Etiology: Damp area; after operation; after delivery or menstruation, when uterus is empty and deficient, toxic damp evil can enter, obstruct and cause fire damaging Ren-Dai channel and leucorrhea appears. The main etiology is liver damp heat, or, fire toxic obstructing damaging blood, causing red white leucorrhea.
· 湿热： Damp heat:
Symptoms: many leucorrhea, sticky smelly yellowish or white yellow color, chest obstruction,
Strategy: 清利湿热 clear urinate damp heat. Sticky mouth, poor apatite, pain in lower abdomen, or, white discharge tofu like, itches in vagina. Tongue- Thick yellow color sticky. Pulse- Rolling, fast
Formula: Zhi dai fang:
Cang zhu, Fu ling, Che qian zi, Ze xie, Yin chen hao, Chi shao, Dan pi, Huang bai, Zhi zi, Niu xi.
Liver qi stagnation with damp heat in the lower jiao use Long dan xie gan tang.
· 热毒 Heat toxic:
symptoms: large amount of leucorrhea, red white color ,or, all 5 colors, sticky or mucus like, smelly, or, tofu like, lower abdomen pain, irritability, dry mouth, dizziness especially in afternoon(heat damage fluids & yin), dry stools, yellow urine. Tongue- Red, yellow dry coating, Pulse – fast.
Strategy: 清热解毒 clear heat expel toxic.
Formula: Wu wei xiao du yin + Bai hua she she cao, Bai zhu, Chun gen pi
Wu wei xiao du yin: Pu gong ying, Jin yin hua, Ye ju hua, Zi di ding, Tian kui zi.
Smelly leucorrhea add Tu fu ling, Ku shen