Chapter 5　Outline of Treatment

Treatment of gynecological disease follows the same principles as that of other internal diseases, involving the function of the whole body. The Four Examinations and the Eight Principles should be applied in pattern differentiation to determine the condition of the zang and fu organs, the qi, blood, cold, heat, deficiency and excess before deciding on a definite principle of treatment. Female physiology is based on the blood, whose movement depends on qi. The zang-fu organs are the source of qi and blood production and its transformation. Women are prone to depletion of the blood （from menstruation and delivery）, which creates a relative excess of qi making the mood unstable and easily affecting the liver. Improper diet, overthinking, stress and fatigue harm the spleen and the stomach. A constitutional defciency, early marriage, giving birth to many children or sexual intemperance can all impair the kidney qi. Dysfunction of the zang-fu organs and disharmony of qi and the blood results and the consequent damage to the chong and ren mai will cause diseases of menstruation, leukorrhea, pregnancy and childbirth, amongst other diseases.

Usually, by adopting the methods of supplementing and nourishing the kidney, soothing and nourishing the liver, fortifying the spleen and harmonizing the stomach, and rectifying qi and the blood, the chong and ren mai can be nourished and regulated. These are the basic principles in treating gynecological diseases.

Besides internal treatments, external treatments may be applied to the vagina so that medicinals can reach the location of a disease directly, which will strengthen the therapeutic efect.

Internal treatment in gynecology is based on regulating and nourishing the zang-fu organs, rectifying qi and the blood, stabilizing and strengthening chong and ren mai, dispelling pathogens and draining the excess etc., the goal being to recover the normal physiological functions of menstruation, vaginal health, pregnancy, delivery and lactation. These are the major treatment methods in the clinical practice of gynecology.

The kidney is the congenital basis of life; it stores the essence, which is the basic substance for growth and development and for the reproductive system. Kidney function can be divided into kidney yin and kidney yang. For optimal health it is necessary to maintain an abundant supply of kidney qi and to keep a balance of kidney yin and kidney yang. A deficiency of kidney yang, the essence, and the blood, will cause the disorders of the reproduction-stimulating essence （ tiān guĭ）, the chong and ren mai, and will lead to diseases of menstruation, leukorrhea, pregnancy and childbirth. Therefore, nourishing and warming the kidney is the fundamental treatment. This method describes creation of yang from yin and yin transformation to yang such that yin and yang are perfectly balanced and normal reproductive physiology is maintained. The most common methods used to nourish and warm the kidney are as follows:

Warming and Supplementing Kidney Yang

If kidney yang is deficient, a decline of the fire of mìng mén occurs and cold gathers internally. The symptoms are cold in the lower abdomen and uterus, an aching and cold sensation in the loins and the knees, low libido, thin leukorrhea, irregular menstruation, flooding and spotting, retarded fetal growth, threatened or actual miscarriage, and infertility due to cold in the uterus. Warming the kidney and the uterus should be adopted to supplement the fre of mìng mén. The commonly used medicines are xiān máo （Rhizoma Curculiginis）, yín yáng huò （Herba Epimedii）, bŭ gŭ zhī （Fructus Psoraleae）, bā jí tiān （Radix Morindae Officinalis）, lù róng （Cornu Cervi Pantotrichum）, lù jiăo shuāng （Cornu Cervi Degelatinatum） etc.; and the representative formulas are Yòu Guī Wán （Right-Restoring Pill, 右归丸）, Shèn Qì Wán （Kidney Qi Pill, 肾气丸）, Guì Zhī Fù Zĭ Tāng （Cinnamon Twig and Aconite Decoction, 桂枝附子汤）, Gān Căo Fù Zĭ Tāng （Licorice and Aconite Decoction, 甘草附子汤）.

Warming and Consolidating Kidney

A kidney qi deficiency or kidney qi instability may cause irregular menstruation, flooding and spotting, amenorrhea, vaginal bleeding during pregnancy, habitual miscarriage and uterine prolapse. Warming and consolidating the kidney should be adopted. The commonly used medicines are tù sī zĭ （Semen Cuscutae）, dù zhòng （Cortex Eucommiae） , bā jĭ tiān （Radix Morindae Officinalis）, lù jiăo shuāng （Cornu Cervi Degelatinatum）, yì zhì rén （Fructus Alpiniae Oxyphyllae）, zĭ hé chē （Placenta Hominis）, xiānmáo （Rhizoma Curculiginis） etc.; and the representative formulas are Shòu Tāi Wán （Fetal Longevity Pill, 寿胎丸）, Tōng Mài Dà Shēng Wán （Channel-Unblocking for Life-Promoting Pill, 通脉大生丸） etc.

Warming the Kidney to Arrest Vaginal Discharge

In the case of kidney qi defciency there may be failure to store essence. The yin essence is not contained, and there is a thin discharge. Warming the kidney to arrest vaginal discharge should be adopted. The commonly used medicines are lù jiăo shuāng （Cornu Cervi Degelatinatum）, lù róng （Cornu Cervi Pantotrichum）, shā yuàn jí lí （Semen Astragali Complanati）, tù sī zĭ （Semen Cuscutae）, ròu cōng róng （Herba Cistanches）, sāng piāo xiāo （Oötheca Mantidis） etc.; and the representative formula is Lù Jiăo Tù Sī Wán （Deerhorn and Cuscuta Pill, 鹿角菟丝丸）.

Warming Yang and Promoting Urination

In the case of defciency of the kidney yang there will be failure to transform qi to move water. This will cause edema during menstruation or pregnancy. Warming the kidney yang and promoting urination should be adopted. The commonly used medicines are fùpiàn （Radix Aconiti Lateralis Praeparata）, fú líng （Poria）, guì zhī （Ramulus Cinnamomi） , báizhú （Rhizoma Atractylodis Macrocephalae）, bái sháo （Radix Paeoniae Alba）, shēng jiāng （Rhizoma Zingiberis Recens） etc.; and the representative formulas are Zhēn Wŭ Tāng （True Warrior Decoction, 真武汤） and Jì Shēng Shèn Qì Wán （Life-Saving Kidney Qi Pill, 济生肾气丸）.

Warming the Kidney to Improve Qi Reception

In the case of kidney qi defciency the kidney may fail to receive the qi and coughing and asthma will result. Warming the kidney to improve qi reception should be adopted. The commonly used medicines are hú lú bā （Semen Trigonellae）, yáng qĭ shí （Actinolitum）, bŭ gŭ zhĭ （Fructus Psoraleae）, gě jiè （Gecko）, zĭ hé chē （Placenta Hominis）, ròu cōng róu （Herba Cistanches）, chén xiāng （Lignum Aquilariae Restinatum） etc.; and the representative formula is Hēi Xī Dān （Galenite Elixir, 黑锡丹）.

Nourishing Kidney Yin

Insufficiency of the kidney yin, or consumption of true yin, will cause a deficiency of the essence and blood. This may then lead to many diseases related to menstruation, pregnancy or childbirth such as irregular or short menstrual cycles, fooding and spoting, amenorrhea, infertility, perimenopausal syndrome or during pregnancy there may be vaginal bleeding, retarded growth of the fetus, depression, loss of voice or urinary difculty and after childbirth there may be night sweating and so on. Nourishing the kidney yin, supplementing the essence, and replenishing the marrow should be the treatment used. The commonly medicinals are shēng dì huáng （Radix Rehmanniae）, shú dì huáng （Radix Rehmanniae Praeparata）, huáng jīng （Rhizoma Polygonat）, shān zhū yú （Fructus Corni）, gŏu qĭ zĭ （Fructus Lycii）, shŏu wū （Caulis Polygoni）, ē jiāo （Colla Corii Asini）, guī jiāo （Colla Testudinis Plastri）, nǚ zhēn zĭ （Fructus Ligustri Lucidi）, sāng shèn zĭ （Fructus Mori） and so on. Representative formulas used are: Zuŏ Guī Wán （Lef-Restoring Pills, 左归丸） and YăngJīng Zhòng Yù Tāng （Essence-Nourishing Jade-Planting Decoction, 养精种玉汤）.

Nourishing the Kidney and Liver

Insufciency of the kidney yin will lead to an insufciency of the liver yin; and this may then lead to an irregular menstrual cycle, amenorrhea, dysmenorrhea, habitual miscarriage, retarded growth of the fetus, pruritus vulvae, infertility and so on. Nourishing the kidney and liver is the treatment method to be adopted. The common medicinals are shēng dì huáng （Radix Rehmanniae）, shú dì huáng （Radix Rehmanniae Praeparata）, shān zhū yú （Fructus Corni）, gŏu qĭ zĭ （Fructus Lycii）, shŏu wū （Caulis Polygoni）, bái sháo （Radix Paeoniae Alba）and so on. Representative formulas used in treatment are Yī Guàn Jiān （Efective Integration Decoction, 一贯煎） and Tiáo Gān Tāng （Liver-Regulating Decoction, 调肝汤）.

Nourishing the Kidney and Clearing Heart Heat

Insufficiency of the kidney yin, inability of water to coordinate with fire, and an exuberance of the heart fre will lead to menopausal symptoms, oral lesions or insomnia during menstruation, depression during pregnancy, and so on. Nourishing the kidney and clearing heart heat are the appropriate treatment methods. The commonly employed medicinals are zhī mŭ （Rhizoma Anemarrhenae）, mài dōng （Radix Ophiopogonis）, wŭ wèizĭ （Fructus Schisandrae Chinensis）, huáng lián （Rhizoma Coptidis）, lián zĭ xīn （Plumula Nelumbinis）, zhú yè xīn （Folium Pleioblasti）, yè jiāo téng （Caulis Polygoni Multiflori）, xuán shēn （Radix Scrophulariae）, shēng dì huáng （Radix Rehmanniae） , shú dì huáng （Radix Rehmanniae Praeparata） and so on. Representative formulas used are Huáng Lián Ē JiāoTāng （Coptis and Donkey-Hide Gelatin Decoction, 黄连阿胶汤） and Xīn Shèn Jiāo Tài Wán （Heart-Kidney Peaceful Interaction Pill, 心肾交泰丸）.

The method of nourishing and warming the kidney has been widely used in the treatment of gynecological diseases. In order to reach the desired efect, a balance of yin and yang in the kidney should be achieved. As Zhang Jie-bin, a famous physician of the Ming Dynasty said in The Complete Works of [Zhang] Jing-yue— Eight New Essential Formulas （ Jĭng Yuè Quán Shū— Xīn Fāng Bā Lüè, 景岳全书·新方八略）: “The person who is good at enriching yang must get yang from yin; with the help of yin, sources of yang are endless. The person who is good at supplementing yin must get yin from yang; with the help of yang, yin increases and the sources are sufficient.” “The theory is very precise and profound; and we should learn to apply it when diferentiating and treating diseases.”

The liver pertains to wood and governs wind. It is yin in property and yang in function, produced from water and nourished from earth. The liver is the organ that stores the blood. Its main property is to disperse and circulate the qi freely and it is related to emotional temperament. If a woman is in a bad mood or experiences stress or disappointment, it will cause a disturbance of qi movement. Many diseases will result from this, especially in women. Blood is essential for women; and the liver is the blood organ, which is related to chong mai and ren mai and the sea of blood. If there is disharmony of qi and blood in the liver channel, the chong and ren mai will be afected leading to many diseases concerning menstruation, vaginal discharge, pregnancy, and childbirth. Therefore, resolving liver dysfunction has very signifcant meaning in the treatment of gynecological diseases. The method of soothing and nourishing the liver is one of the most important treatments in gynecology. There are several common methods of soothing and nourishing the liver.

Soothing the Liver and Resolving constraint

Binding constraint of liver qi and obstruction of chong and ren mai due to bad mood, irritability or anger can lead to irregular menstruation, flooding and spotting, dysmenorrhea, distending pain of the breasts before and during menstruation, infertility and during pregnancy, morning sickness, edema or abdominal pain and then after childbirth, difculty with breast feeding. Qi stagnation should be treated by soothing the liver, rectifying qi, and resolving constraint. The commonly used medicinals are chái hú （Radix Bupleuri）, chuān liàn zĭ （Fructus Toosendan）, qīng pí （Pericarpium Citri Reticulatae Viride）, xiāng fù （Rhizoma Cyperi）, yù jīn （Radix Curcumae）, jú yè （Folium Citri Reticulatae）, bò he （Herba Menthae）, zhĭ qiào （Fructus Aurantii）, and so on. Representative formulas used are Xiāo Yáo Săn （Free Wanderer Powder, 逍遥散） and Chái Hú Shū Gān Săn （Bupleurum Liver-Soothing Powder, 柴胡疏肝散）.

Soothing Liver and Clearing Heat

Diseases such as early or heavy periods, dysmenorrhea, hematemesis and epistaxis during menstruation, and emotional imbalance during pregnancy are due to the transformation of fre from liver qi constraint. The fre can damage the chong and ren mai. It should be treated with the method of soothing the liver and clearing heat. The commonly used medicinals are mŭ dān pí （Cortex Moutan, 丹皮）, jiāo shān zhī （Fructus Gardeniae Nigrum）, dāng guī （Radix Angelicae Sinensis）, chì sháo （Radix Paeoniae Rubra）, bái sháo （Radix Paeoniae Alba）, chái hú （Radix Bupleuri）, bái zhú （Rhizoma Atractylodis Macrocephalae）, bò he （Herba Menthae）, and so on. The representative formula used in treatment is Dān ZhīXiāo Yáo Săn （Moutan and Gardenia Free Wanderer Powder, 丹栀逍遥散）.

Clearing Liver and Draining Heat

Damp heat in the liver channel can cause menorrhagia, dysmenorrhea, pathological discharge, pruritus vulvae, midcycle spoting and urinary difculty during pregnancy and after childbirth, postpartum retention of urine, puerperal fever, prolonged discharge of lochia, acute mastitis, prolapse of the uterus and so on. These should be treated by clearing the liver and draining heat.

The common medicinals used are lóng dăn căo （Radix et Rhizoma Gentianae）, huáng qín（Radix Scutellariae）, jú huā （Flos Chrysanthemi）, yě jú huā （Flos Chrysanthemi Indici）, zhī zĭ （Fructus Gardeniae）, xià kū căo （Spica Prunellae）, jīn qián căo （Herba Lysimachiae）, yīn chén（Herba Artemisiae Scopariae）, mŭ dān pí （Cortex Moutan）, huáng băi （Cortex Phellodendri Chinensis）, and so on. The representative formula prescribed is Lóng Dăn Xiè Gān Tāng （Gentian Liver-Draining Decoction, 龙胆泻肝汤）.

Nourishing Blood and Sofening the Liver

Insufficiency of the ying-yin and a deficiency of the liver blood will lead to late or scanty menstrual periods, amenorrhea, midcycle bleeding, premenstrual syndrome, pruritus vulvae, menopausal symptoms and so on. Nourishing the blood and softening the liver is the correct method of treatment. The commonly used medicinals are dì huáng （Radix Rehmanniae）, bái sháo （Radix Paeoniae Alba）, gŏu qĭ zĭ （Fructus Lycii） , ē jiāo （Colla Corii Asini）, guī jiāo （Colla Testudinis Plastri）, nǚ zhēn zĭ （Fructus Ligustri Lucidi）, hànlián căo （Herba Ecliptae）, dāng guī （Radix Angelicae Sinensis）, zhì shŏu wū （Radix Polygoni Multifori Praeparata cum Succo Glycines Sotae）, sāng shèn zĭ （Fructus Mori）, and so on. The representative formulas used in treatment are Yī Guàn Jiān （Efective Integration Decoction,一贯煎）, Èr Zhì Wán （Double Supreme Pills, 二至丸）, and Qĭ Jú Dì Huáng Wán （Lycium Berry, Chrysanthemum, and Rehmannia Pill, 杞菊地黄丸）.

Regulating the Liver and Fortifying the Spleen

Irregular menstruation, flooding and spotting, premenstrual syndrome, infertility, menopausal symptoms and so on may be the result of liver constraint and spleen defciency. They should be treated by regulating the liver and strengthening the spleen. The common medicinals used are the above ones, which soothe the liver, while also fortifying the spleen using medicinals such as dăng shēn （Radix Codonopsis）, bái zhú （Rhizoma Atractylodis Macrocephalae）, shān yào （Rhizoma Dioscoreae）, yì yĭ rén （Semen Coicis）, qiàn shí （Semen Euryales）, and so on. Representative formulas used are Xiāo Yáo Săn （Free Wanderer Powder, 逍遥散）, Tòng Xiè Yào Fāng （Pain and Diarrhea Formula, 痛泻要方）, and Chái HúShū Gān Săn （Bupleurum Liver-Soothing Powder, 柴胡疏肝散）.

Inhibiting the Liver and Harmonizing the Stomach

Vomiting during menstruation or morning sickness can result from the disharmony of the liver and stomach. This should be treated by inhibiting the liver and harmonizing the stomach. The medicinals commonly used are sū yè （Folium Perillae）, wú zhū yú （Fructus Evodiae）, zhú rú （Caulis Bambusae in Taenia）, huáng lián （Rhizoma Coptidis）, jú pí （Pericaipium Citri Reticulatae）, shēng jiāng （Rhizoma Zingiberis Recens）, bàn xià （Rhizoma Pinelliae）, and so on. Representative formulas used Sū Yè Huáng Lián Tāng （Perilla Leaf and Coptis Decoction, 苏叶黄连汤） and Qín Lián Jú Rú Tāng （Scutellaria, Coptis, Tangerine Peel and Bamboo Shavings Decoction, 芩连橘茹汤）.

Calming the Liver and Subduing Yang

Ascendant hyperactivity of the liver yang can cause headaches, hematemesis and epistaxis during menstruation, perimenopausal symptoms, depression or dizziness during pregnancy, etc. Calming the hyperactive liver and subduing yang should be used to treat such diseases. Medicinals commonly used are líng yáng jiăo （Cornu Saigae Tataricae）, gōuténg （Ramulus Uncariae Cum Uncis）, sāng yè （Folium Mori）, jú huā （Radix Paeoniae）, báisháo （Radix Paeoniae Alba）, fú shén （Sclerotium Poriae）, and zhú rú （Caulis Bambusae in Taenia）. The representative formula is Líng Jiăo Gōu Téng Tāng （Antelope Horn and Uncaria Decoction, 羚角钩藤汤）.

Tranquilizing the Liver and Extinguishing Wind

Yin deficiency and malnourishment of the liver gives rise to uncontrolled liver yang which transforms into wind. This can lead to eclampsia during pregnancy. It should be treated by extinguishing wind and stopping the convulsions. The medicinals commonly used are bái sháo （Radix Paeoniae Alba）, shēng mŭ lì （raw Concha Ostreae）, shēng lóng gŭ （raw Os Draconis）, dài zhě shí （Haematitum）, gōu téng （Ramulus Uncariae Cum Uncis）, dìlóng （Pheretima）, and so on. The representative formula is Zhèn Gān Xī Fēng Tāng （Liver-Calming Wind-Extinguishing Decoction, 镇肝熄风汤）.

Malnourishment of the liver in reproductive age women usually occurs after pregnancy, childbirth and breast feeding, all which will consume the blood, leading to many gynecological disorders. Thus, treatment of gynecological disorders should mainly regulate the liver. However, because the liver and the kidney have the same source of essence, we should also supplement the kidney. The medicinals for soothing the liver and rectifying qi are acrid and dry in property. They cannot be taken too often or in large quantities and they should be used with other medicinals which clear, moisten and calm the liver, such as bái sháo （Radix Paeoniae Alba） , jú huā （Flos Chrysanthemi）, yù zhú （Rhizoma Polygonati Odorati）, and so on. Medicinals for nourishing yin tend to be greasy and are beter used together with zhĭ qiào （Fructus Aurantii） and shā rén （Fructus Amomi）, which move qi.

The spleen and stomach are the acquired basis of life, the source of production of qi, blood, and body fuid; and they have the function of commanding the blood. The blood of menstruation is yin blood, and the occurrence or not of the period and the quantity of the fow have a strong relationship with the spleen and the stomach. The chong mai is subjected to the yangming, and so it is said that the spleen and the stomach are the material base of menstruation, pregnancy, delivery and lactation.

Inadequate transformation of nutrients from food results from a dysfunction of the spleen and stomach and will affect the function of the chong and ren mai. This can then cause various diseases of menstruation, leukorrhea, pregnancy and childbirth. Therefore, fortifying the spleen and harmonizing the stomach is a common treatment of gynecological diseases. The specifc treatments are as follows.

Fortifying the Spleen and Boosting Qi

A defciency of the spleen and stomach and the center qi plus disharmony of chong and ren mai leads to a loss of control of the blood.

This may lead to early or heavy periods, flooding and spotting, amenorrhea, pathological discharges, postpartum incontinence of urine, prolapse of the uterus, morning sickness, insufficient breast milk, and so on. Fortifying the spleen and boosting qi is the accepted treatment for such diseases. The medicinals commonly used are dăng shēn （Radix Codonopsis）, huáng qí （Radix Astragali）, bái zhú （Rhizoma Atractylodis Macrocephalae）, rén shēn （Radix et Rhizoma Ginseng）, shān yào （Rhizoma Dioscoreae）, lóng yăn ròu （Arillus Longan）, lián ròu （Semen Nelumbinis）, dà zăo （Fructus Jujubae）, and so on. The representative formulas used are Sì Jūn Zĭ Tāng （Four Gentlemen Decoction, 四君子汤）, LiùJūn Zĭ Tāng （Six Gentlemen Decoction, 六君子汤）, Guī Pí Tāng （Spleen-Restoring Decoction,归脾汤）, and Shēn Líng Bái Zhú Săn （Ginseng, Poria and Atractylodes Macrocephalae Powder, 参苓白术散）.

Fortifying the Spleen and Nourishing Blood

A deficiency of the spleen and stomach will impair the transformation source and there will be insufcient blood produced. The blood in the chong and ren mai will become insufcient, leading to late and scanty periods, amenorrhea, fooding and spoting, vaginal bleeding during pregnancy, threatened miscarriage, and so on. These conditions are treated by fortifying the spleen and nourishing the blood, the commonly used medicinals are dāngguī （Radix Angelicae Sinensis）, bái sháo （Radix Paeoniae Alba）, rén shēn （Radix et Rhizoma Ginseng）, huáng qí （Radix Astragali）, bái zhú （Rhizoma Atractylodis Macrocephalae）, fú líng （Poria） and so on. The representative formula used is Guī Sháo Liù Jūn Zĭ Tāng （Chinese Angelicae and Peony Six Gentlemen Decoction, 归芍六君子汤）.

Spplementing the Spleen to Control Blood

A weakness of the spleen and stomach can lead to an inability to control the blood causing heavy periods, fooding and spoting, and midcycle bleeding, etc. It is appropriate to supplement the spleen to control the blood. Commonly used medicinals are shú dì huáng （Radix Rehmanniae Praeparata）, bái zhú （Rhizoma Atractylodis Macrocephalae）, huáng qí （Radix Astragali）, dāng guī （Radix Angelicae Sinensis） , rén shēn （Radix et Rhizoma Ginseng）, páo jiāng （Rhizoma Zingiberis Praeparatum, 炮姜）, and Gù Bĕn Zhĭ Bēng Tāng （Root-Securing Flood-Stanching Decoction, 固本止崩汤）.

Fortifying the Spleen to Eliminate Dampness

Spleen yang deficiency may lead to internal retention of water-dampness, and an downward migration of water-dampness to the chong and ren mai, giving rise to edema or diarrhoea during menstruation, vaginal discharges, perimenopausal symptoms etc. It is suitable to treat these conditions by fortifying the spleen to remove the dampness. Medicinals commonly used are fú líng （Poria）, cāng zhú （Rhizoma Atractylodis）, bái zhú （Rhizoma Atractylodis Macrocephalae）, chén pí （Pericaipium Citri Reticulatae）, bàn xià （Rhizoma Pinelliae）, dà fù pí （Pericarpium Arecae）, chē qián zĭ （Semen Plantaginis）, yì yĭ rén （Semen Coicis）, chì xiăo dòu （Semen Phaseoli）, shā rén （Fructus Amomi）, huò xiāng （Herba Agastachis）, etc. The representative formula used is Wán Dài Tāng （Discharge-Ceasing Decoction, 完带汤）.

Supplementing the Spleen to Lif Sunken qi

Sinking of the center qi and the inability to raise and lif due to a spleen defciency can result in heavy periods, flooding and spotting, （recurrent） miscarriage, urinary retention during pregnancy, postpartum incontinence of urine, prolapse of uterus, prolonged discharge of lochia, etc. To treat these conditions, it is appropriate to supplement the spleen to lif the sunken qi. Commonly used medicinals are dăng shēn （Radix Codonopsis） , huángqí （Radix Astragali） , chái hú （Radix Bupleuri） , jié gěng （Radix Platycodonis）, and shēngmá （Rhizoma Cimicifugae）. There are several representative formulas used. They are BŭZhōng Yì Qì Tāng （Center-Supplementing Qi-Boosting Decoction, 补中益气汤）, Jŭ Yuán Jiān （Origin-Lifing Brew, 举元煎）, and Guī Pí Tāng （Spleen-Restoring Decoction, 归脾汤）.

Warming and Supplementing Spleen Yang

Spleen yang weakness and the failure of transportation and transformation due to severe spleen-stomach qi defciency can cause diarrhea during menstruation, pathological vaginal discharge, gestational edema and perimenopausal symptoms etc. It is appropriate to fortify the spleen and reinforce yang. Commonly used medicinals are gān jiāng （Rhizoma Zingiberis）, fù zĭ （Radix Aconiti Lateralis Praeparata）, bì bá （Fryctus Piperia Longgi）, wú zhū yú （Fructus Evodiae） and gāo liáng jiāng （Rhizoma Alpiniae Officinarum）. Representative formulas are Lĭ Zhōng Tāng （Center-Rectifying Decoction, 理中汤） and Gān Jiāng Rén ShēnBàn Xià Wán （Dried Ginger, Ginseng and Pinellia Pill, 干姜人参半夏丸）.

Harmonizing the Stomach and Directing Counterfow Downward

Failure of the stomach qi to descend due to a stomach deficiency, invasion of the stomach by liver qi or disharmony between the liver and the stomach can all result in morning sickness. To treat these diseases, it is appropriate to harmonize the stomach to direct the adverse fow of qi downward. The commonly used medicinals are sū yè （Folium Perillae）, bàn xià （Rhizoma Pinelliae）, chén pí （Pericarpium Citri Reticulatae）, shā rén （Fructus Amomi）, and chén xiāng （Lignum Aquilariae Restinatum）, etc. The representative formulas used are Sū Yè Huáng Lián Tāng （Perilla Leaf and Coptis Decoction, 苏叶黄连汤）, and XiāngShā Liù Jūn Zĭ Tāng （Costusroot and Amomum Six Gentlemen Decoction, 香砂六君子汤）.

Nourishing Yin and Harmonizing the Stomach

Stomach heat damaging yin can cause hematemesis and epitasis during menstruation and morning sickness. It is appropriate to nourish yin to harmonize the stomach to treat these conditions. Medicinals used are shí hú （Caulis Dendrobii）, mài mén dōng （Radix Ophiogonis）, yù zhú （Rhizoma Polygonati Odorati）, shā shēn （Radix Adenophorae） etc. The representative formula used is Yù Nǚ Jiān （Jade Lady Decoction, 玉女煎）.

Clearing Heat to Harmonize the Stomach

An accumulation of heat in the stomach or an invasion of pathogenic heat to the interior can cause morning sickness, postpartum constipation, postpartum fever and so on. It is necessary to clear or discharge the heat to harmonize the stomach. Commonly used medicinals are zhú rú （Caulis Bambusae in Taenia）, huáng lián （Rhizoma Coptidis）, dà huáng （Radix et Rhizoma Rhei） and so on. The representative formulas used are Bái Hŭ Tāng （White Tiger Decoction, 白虎汤） and Má Zĭ Rén Wán （Cannabis Fruit Pill, 麻子仁丸）.

Warming the Center and Harmonizing the Stomach

Accumulated cold in the stomach and an inability to eat can result in diarrhea during menstruation, vomiting during pregnancy and so on. It is appropriate to warm the center and harmonize the stomach. Commonly used medicinals are shā rén （Fructus Amomi）, kòurén （Fructus Amomi Rotundus）, huò xiāng （Herba Agastachis）, dīng xiāng （Flos Caryophylli）, páo jiāng （Rhizoma Zingiberis Praeparatum）, wú zhū yú （Fructus Evodiae） etc. The representative formula used is Lĭ Zhōng Tāng （Center-Regulating Decoction, 理中汤）.

All in all, the methods of fortifying the spleen and harmonising the stomach should be based on patern diferentiation and the condition of the patient. Consideration should be given to the spleen and the stomach during the course of treatment, even in the absence of pathogenic factors.

Do not use too many medicinals that are either tonic or atacking to avoid damaging the spleen and stomach and impairing the function of transportation and transformation.

Afer menopause women depend entirely on nourishment from food and water because their kidneys and qi and blood all become weak. Therefore, it is very important to fortify the spleen and to harmonize the stomach in order to replenish the sources of production.

Qi and blood constitute the life force and substance which maintains life’s activities. They unceasingly circulate throughout the whole body via the channels and collaterals to supply the needs of body and maintain normal physiological activities. Blood is vital to women, and its movement relies on qi. Therefore, if qi and blood are abundant and harmonious at the same time, they run smoothly nourishing the chong and ren mai and the uterine vessels. Thus people can lead vigorous, healthy, and long lives.

Conversely, if qi and blood are defcient, the source of the chong and ren mai is cut of and the channels are malnourished. Susceptibility to diseases related to menstruation, leukorrhea, pregnancy, and delivery is increased. Hence, supplementing qi and nourishing blood is an important and often used therapy. The following are some commonly used methods.

Supplementing and Rectifying Qi

An insufciency of center qi and an instability of chong and ren mai due to qi defciency can cause early, heavy or prolonged periods, flooding and spotting, dysmenorrhea, infertility, vaginal bleeding during pregnancy, restlessness of fetus, missed miscarriage, urinary retention in pregnancy, retarded intrauterine growth, difcult labour, retention of the placenta, postpartum incontinence of urine, prolonged lochia, prolapse of the uterus etc. The appropriate treatment method is to supplement and rectify the qi. Commonly used medicinals are rén shēn （Radix et Rhizoma Ginseng）, dăng shēn （Radix Codonopsis）, huáng qí （Radix Astragali） and bái zhú （Rhizoma Atractylodis Macrocephalae）. Add shēngmá （Rhizoma Cimicifugae）, chái hú （Radix Bupleuri） and jié gěng （Radix Platycodonis） if the patient is qi defcient or there is sinking of the qi. Representative formulas used in treatment are Rén Shēn Yăng Yíng Tāng （Ginseng Supporting and Nourishing Decoction, 人参养营汤）, Jŭ Yuán Jiān （Origin-Lifing Brew, 举元煎）, and Bŭ Zhōng Yì Qì Tāng （Center-Supplementing Qi-Boosting Decoction, 补中益气汤）.

Supplementing Blood and Nourishing Blood

Menstruation, pregnancy, delivery, and lactation are closely related to the blood since they all consume blood and body fuids. This can result in insufcient blood in the chong and ren mai, causing late and scanty periods, amenorrhea, abdominal pain during pregnancy, retarded intrauterine growth, postpartum abdominal pain, convulsions, fever, or pain, inadequate breast milk etc. To treat these conditions, it is appropriate to supplement and nourish the blood. Commonly used medicinals are dāng guī （Radix Angelicae Sinensis ）, jī xuè téng （Caulis Spatholobi）, shú dì huáng （Radix Rehmanniae Praeparata）, ē jiāo （Colla Corii Asini）, shŏu wū （Radix Polygoni Multifori）, gŏu qĭ zĭ （Fructus Lycii）, sāng shèn zĭ （Fructus Mori） , lóng yăn ròu （Arillus Longan） , dà zăo （Fructus Jujubae）, etc. Representative prescriptions are Dāng Guī Bŭ Xuè Tāng （Chinese Angelica Blood-Supplementing Decoction, 当归补血汤）, Jiāo Ài Tāng （Donkey-Hide Gelatin and Mugwort Decoction, 胶艾汤）, S ì Wù Tāng （Four Substances Decoction, 四物汤） and Rén Shēn Zī XuèTāng （Ginseng Blood-Supplementing Decoction, 人参滋血汤）.

Supplementing Qi and Blood

Deficiency of qi and the blood can result in flooding and spotting, dysmenorrhea, vaginal bleeding during pregnancy, fetus restlessness, miscarriage, retarded intrauterine growth, missed miscarriage, difficult labour, postpartum syncope due to blood loss, insufficient breast milk etc. It is appropriate to supplement qi and blood to treat these conditions. Medicinals used are those listed above for supplementing qi and blood. Typical formulas used inlude Bā Zhēn Tāng （Eight Gem Decoction, 八珍汤）, Shí Quán Dà Bŭ Tāng （Perfect Major Supplementation Decoction, 十全大补汤） and Tōng Rŭ Dān （Lactation-Promoting Elixir, 通乳丹）.

Supplementing Qi and Yin

Lack of qi and blood and prolonged disease can give rise to defciency of qi and yin, resulting in fooding and spoting and morning sickness. It is necessary to supplement qi and yin. Medicinals ofen used are dăng shēn （Radix Codonopsis） , huáng qí （Radix Astragali） ,bái zhú （Rhizoma Atractylodis Macrocephalae） , shā shēn （Radix Adenophorae seu Glehniae）, mài dōng （Radix Ophiopogonis）, yù zhú （Rhizoma Polygonati Odorati）, etc. Representative formulas used are Shēng Mài Săn （Pulse-Engendering Powder, 生脉散） and Shàng Xià XiāngZī Tāng （Up-Down Interdepending Decoction, 上下相资汤）.

Ying-blood is a vital body fuid, circulating continuously in the vessels nourishing the body. Blood in the vessels needs supplementing, and it is important to maintain its smooth circulation. It is only when the blood circulation runs smoothly without obstruction that all the zang-fu organs are in harmony and the channels are clear. Thus the chong and renmai can be abundant, the uterine vessels can be in harmony, and reproductive health is maintained. Excessive cold or heat can interrupt blood circulation and bleeding which is not reabsorbed or scatered can block the vessels. This causes stagnation and stasis. Once stasis occurs, the chong and ren mai become blocked, and the movement in the uterine vessels is afected. Clinical manifestations are irregular menstruation, dysmenorrhea, fooding and spotting, abdominal masses, and other conditions relating to the blood. It is necessary to promote blood flow and to remove stasis to treat these conditions. Commonly used medicinals are táo rén （Semen Persicae）, hóng huā （Flos Carthami）, zé lán （Herba Lycopi）, wŭlíng zhĭ （Faeces Trogopterori）, pú huáng （Pollen Typhae）, sān léng （Rhizoma Sparganii）, é zhú （Rhizoma Curcumae）, dān shēn （Radix et Rhizoma Salviae Miltiorrhizae）, chì sháo （Radix Paeoniae Rubra）, dāng guī （Radix Angelicae Sinensis）, chuān xiōng （Rhizoma Chuanxiong）, yì mŭ căo （Herba Leonuri）, dān pí （Cortex Moutan）, chuān niú xī （Radix Cyathulae）, wángbù liú xíng （Semen Vaccariae）, shān zhā （Fructus Crataegi）, yán hú suŏ （Rhizoma Corydalis）, etc. Representative formulas used are Shī Xiào Săn （Sudden Smile Powder, 失笑散）, TáoHóng Sì Wù Tāng （Peach Kernel and Carthamus Four Substances Decoction, 桃红四物汤）, Xuè Fŭ Zhú Yū Tāng （House of Blood Stasis-Expelling Decoction, 血府逐瘀汤）, Gé XiàZhú Yū Tāng （Expelling Stasis Below the Diaphragm Decoction, 膈下逐瘀汤）, Shēng HuàTāng （Engendering and Transforming Decoction, 生化汤）, and Dà Huáng Zhè Chóng Wán（Rhubarb and Eupolyphaga Pill, 大黄 虫丸）. When preparing these prescriptions, the doctor should add medicinals to remove cold or clear heat, supplement defciency, resolve the constraint, etc. according to the diferent paterns and constitutions.

Qi is the master of the whole body, and circulates throughout the whole body in the manner of ascending, descending, coming in and going out. It can warm the zang-fu organs and nourish the vessels, and is regarded as the source and force of life’s activities. However, it is vital to keep qi running smoothly without blockage. In this case, qi movement is normal, the seven emotions are in harmony, good mood is maintained and menstruation, vaginal discharge, pregnancy, childbirth and lactation are in good condition.

Conversely, qi movement may be inhibited or obstructed causing adverse flow or stagnation of qi. In this case we ofen see irregular menstruation, dysmenorrhea, abdominal masses, and so on. It is suitable to rectify qi and to remove stagnation when treating the above conditions. Commonly used medicinals are xiāng fù （Rhizoma Cyperi）, hòu pò（Cortex Magnoliae Ofcinalis）, yù jīn （Radix Curcumae）, jú hé （Semen Citri Reticulatae）, lìzhī hé （Semen Litchi）, chén xiāng （Lignum Aquilariae Resinatum）, wū yào （Radix Linderae）, etc. Representative formulas used are Wū Yào Săn （Lindera Powder, 乌药散）, Yuè Jū Wán （Constraint-Resolving Pill, 越鞠丸）, Jīn Líng Zĭ Săn （Toosendan Powder, 金铃子散）, and XiāngLéng Wán （Cyperus and Sparganium Pill, 香棱丸）. Rectifying qi and removing stagnation is always combined with relieving qi stagnancy of the liver. Rectifying qi is ofen combined with blood quickening because qi stagnation and blood stasis always appear in the same time.

Phlegm retention and qi coagulation, or the combination of phlegm and dampness may lead to conditions such as abdominal masses, breast lumps, breast cancer, acute mastitis and so on. The treatment principle is to sofen the hardness, and dissipate masses. Medicinals commonly used are mŭ lì （Concha Ostreae）, zào jiăo cì （Spina Gleditsiae）, hăi fúshí （Pumex）, guā lóu （Fructus Trichosanthis）, jú hé （Semen Citri Reticulatae）, xià kū căo （Spica Prunellae）, lì zhī hé （Semen Litchi）, bèi mŭ （Bulbus Fritillaria）, hăi zăo （Sargassum）, kūn bù （Thallus Laminariae）, biē jiă （Carapax Trionycis）, and so on. Typical formulas used are CāngFù Dăo Tán Wán （Atractylodes and Cyperus Phlegm-Abducting Pill, 苍附导痰丸） and Biē JiăJiān Wán （Turtle Shell Decocted Pill, 鳖甲煎丸）. When the treatment also aims to dissipate stasis, break qi, resolve constraint and dissolve phlegm, the therapeutic effect may be increased.

Contraction of external warm pathogens or dysfunction of the zang-fu organs may give rise to yang predominance and hyperactivity of some body functions. Internal heat is generated scorching the chong and ren mai, causing profuse menstruation, flooding and spotting, menstrual hematemesis and epistaxis （vicarious menstruation）, vaginal bleeding during pregnancy, prolonged lochia and postpartum fever. When the pathogenic heat blazes and steams within, disturbing the ying-blood, we should clear the heat and cool the blood immediately. The commonly used medicinals are shéng dì huáng （Radix Rehmanniae） ,dān pí （Cortex Moutan）, chì sháo （Radix Paeoniae Rubra）, huáng băi （Cortex Phellodendri Chinensis）, huáng qín （Radix Scutellariae）, huáng lián （Rhizoma Coptidis） , zhī zĭ （Fructus Gardeniae） , bái wēi （Radix et Rhizoma Cynanchi Atrati）, and lián qiáo （Fructus Forsythiae）. Typical formulas used are Qīng Jīng Săn （Menstruation-Clearing Powder, 清经散）, Băo YīnJiān （Yin-Safeguarding Brew, 保阴煎）, Qín Lián S ì Wù Tāng （Scutellaria and Coptis Four Substances Decoction, 芩连四物汤） and Qīng Rè Gù Jīng Tāng （Heat-Clearing Menses-Securing Decoction, 清热固经汤）.

Cold is a turbid yin pathogen that can easily damage yang. Cold can be categorized as internal cold, external cold, defciency cold or excess cold. When cold lodges in the uterus, obstructing the uterine vessels, it may cause stagnation in the chong and ren mai, inhibiting the flow of qi and blood. This can result in diseases in menstruation, vaginal discharge, pregnancy and childbirth. Clinically, an irregular menstrual cycle, dysmenorrhea, amenorrhea, infertility or leukorrhea is often seen. We should warm the channels and dissipate the cold to treat these conditions. The commonly used medicinals are ròu guì （Cortex Cinnamomi） , fù zĭ （Radix Aconiti Lateralis Praeparata）, ài yè （Folium Artemisiae Argyi）, wú zhū yú （Fructus Evodiae） , gān jiāng （Rhizoma Zingiberis）, bŭ gŭ zhĭ （Fructus Psoraleae） , xiăo huí xiāng （Fructus Foeniculi）, and chuān jiāo （Pericarpium Zanthoxyli）. The representive formulas used are Jīn Guì Wēn Jīng Tāng （Golden Cabinet Channel-Warming Decoction, 金匮温经汤）, Ài Fù Nuăn Gōng Wán （Mugwort and Cyperus Palace Warming Pill, 艾附暖宫丸 ）, Fù Zĭ Lĭ Zhōng Wán （Aconite Center-Regulating Pill, 附子理中丸）, Wú ZhūYú Tāng （Evodia Decoction, 吴茱萸汤）, and Dāng Guī Sì Nì Tāng （Chinese Angelica Frigid Extremities Decoction, 当归四逆汤）.

Dampness is a yin pathogen which is heavy, turbid and sticky. When dampness accumulates, it hinders yang qi and afects the movement of the qi of the whole body. If at this time movement of yang qi is not successfully facilitated, disease will occur. The term dampness includes both damp cold and damp heat. When the yang qi is hindered, forming cold-damp, the patterns seen in clinic are leukorrhea, diarrhea before menstruation, gestational edema, and polyhydramnios. The medicinals commonly used are cāng zhú （Rhizoma Atractylodis）, shēng jiāng pí （Cortex Zingiberis Rhizomatis）, căo guŏ （Fructus Tsaoko）, bái zhú （Rhizoma Atractylodis Macrocephalae） , wú zhū yú （Fructus Evodiae） ,chuān jiāo （Pericarpium Zanthoxyli） , bì bá （Fryctus Piperia Longgi） , wŭ jiā pí （Cortex Acanthopanacis）, and so on. The representative formulas used are Jiàn Gù Tāng （Fortifying and Securing Decoction, 健固汤）, Fú Líng Dăo Shuĭ Tāng （Poria Water-Abducting Decoction茯苓导水汤）, Líng Guì Zhú Gān Tāng （Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction, 苓桂术甘汤） and Quán Shēng Bái Zhú Săn （Life-Saving Atractylodes Macrocephalae Powder, 全生白术散）.

If dampness lingers a long time, it may transform into damp-heat, causing pathological vaginal discharge and pruritus vulvae. Treatment should dispel phlegm and remove dampness. Commonly used medicinals are bài jiàng căo （Herba Patriniae）, mián yīn chén （Herba Artemisiae Scopariae）, chē qián căo （Herba Plantaginis）, chuān bì xiè （Rhizoma Dioscoreae Hypoglaucae）, zhū líng （Polyporus）, zé xiè （Rhizoma Alismatis）, yì yĭ rén （Semen Coicis）, and mù tōng （Caulis Akebiae）. The representative formulas are Bì Xiè Shèn ShīTāng （Fish Poison Yam Dampness-Percolating Decoction, 萆薢渗湿汤） and Zhĭ Dài Tāng （Leukorrhea-Stopping Decoction, 止带汤）.

If the spleen fails to transform and transport, fluid accumulates and forms phlegm, which pours down and obstructs the uterine vessels, leading to leukorrhea, amenorrhea, infertility and so on. The treatment should be drying dampness and resolving phlegm. The commonly used medicinals are dăn nán xīng （Arisaema cum Bile）, bàn xià （Rhizoma Pinelliae）, jú pí （Pericaipium Citri Reticulatae）, and bái jiè zĭ （Semen Sinapis）. The representative formulas used are Cāng Fù Dăo Tán Wán （Atractylodes and Cyperus Phlegm-Abducting Pill, 苍附导痰丸） and Dí Tán Tāng （Phlegm-Flushing Decoction,涤痰汤）.

Declining kidney yang, unable to warm fluids and clear phlegm, leads to phlegm stagnation and vaginal discharge. The treatment should be to warm the kidney and fortify the spleen. The commonly used medicinals are fù zĭ （Radix Aconiti Lateralis Praeparata）, ròu guì （Cortex Cinnamomi）, guì zhī （cinnamomi twig）, yín yáng huò （Herba Epimedii）, qiàn shí （Semen Euryales）, lián zĭ （Semen Nelumbinis）, and shēng jiāng （Rhizoma Zingiberis Recens）. The representive formulas used are Nèi Bŭ Wán （Internal Supplementing Pill, 内补丸）, Jiàn Gù Tāng （Fortifying and Securing Decoction, 健固汤）, and Zhēn Wŭ Tāng （True Warrior Decoction, 真武汤）.

If damp-heat in the vagina is untreated, it may lead to dampness toxins over time. When the pathogenic heat is combined with blood, it results in static heat, also referred to as a toxin. If the dampness toxin persists, worms may appear in the vagina. The treatment should be clearing the heat and resolving toxins, removing the dampness and killing the worms. The commonly used medicinals are yín huā （Caulis Lonicerae）, lián qiáo （Fructus Forsythiae）, zĭ huā dì dīng （Herba Violae）, yě jú huā （Flos Chrysanthemi Indici）, bái huā shé shécăo （Herba Hedyotis Difusae）, tŭ fú líng （Rhizoma Smilacis Glabrae）, pú gōng yīng （Herba Taraxaci）, bài jiàng căo （Herba Patriniae）, bàn zhī lián （Herba Scutellariae Barbatae）, yú xīngcăo （Herba Houtuyniae）, chuāng xīn lián （Herba Andrographis）, xióng dăn （Fel Ursi）, kŭ shēn （Radix Sophorae Flavescentis）, shé chuáng zĭ （Fructus Cnidii）, băi bù （Radix Stemonae）, xiónghuáng （Realgar）, liú huáng （Sulphur）, hè shī （Fructus Carpesii）, bái fán （Alumen）, etc. The typical formulas used are Wŭ Wèi Xiāo Dú Yĭn （Five Ingredients Toxin-Removing Beverage,五味消毒饮）, Yín Huā Jiě Dú Tāng （Lonicera Toxin-Resolving Decoction, 银花解毒汤）, and BìXiè Shèn Shī Tāng （Fish Poison Yam Dampness-Percolating Decoction, 萆薢渗湿汤）.

Pathogenic toxins and worms are noxious. They not only can afect the whole body, but they can also corrode local areas. The combination of internal and external treatment can increase the efectiveness of the treatment.

Chong, ren and du mai all have their origin in the uterus and and their end in the vagina. They are three branches of one source, and are all controlled by the du mai. The chong mai is the sea of blood and the ren mai governs the uterus. Both the chong and ren mai play a key role in regulating menstrual cycles, gestation of the fetus, formation of leukorrhea, and transformation of milk. Gynecological diseases develop when there is a impairment of the chong or ren mai function, from direct or indirect causes. Therefore, regulating chong and ren mai is one of the most important ways to treat gynecological diseases. The methods are discussed below.

Nourishing Chong and Ren Mai

Conditions such as menstrual irregularities, flooding and spotting, amenorrhea, infertility, vaginal bleeding during pregnancy or miscarriage are caused by an insufciency of chong and ren mai and inadequate nourishment of the uterine vessels. In such cases we should nourish the chong and ren mai. The commonly used medicinals are gŏu jí （Rhizoma Cibotii）, bŭ gŭ zhī （Fructus Psoraleae）, xù duàn （Radix Dipsaci）, zĭ shí yīng （Flouritum）, lù jiăojiāo （Colla Cornus Cervi）, zĭ hé chē （Placenta Hominis）, gŏu qĭ zĭ （Fructus Lycii）, nǚ zhēn zĭ （Fructus Ligustri Lucidi）, hàn lián căo （Herba Ecliptae）, guī băn （Plastrum Testudinis）, dāngguī （Radix Angelicae Sinensis）, bái sháo （Radix Paeoniae Alba）, ē jiāo （Colla Corii Asini）, and so on. Representive formulas are Wēn Chōng Tāng （ Chong Mai-Warming Decoction, 温冲汤 ）, Jiāo Ài Tāng （Donkey-Hide Gelatin and Mugwort Decoction, 胶艾汤 ）, and Shòu Tāi Wán （Fetal Longevity Pill, 寿胎丸）.

Fortifying and Securing the Chong and Ren Ma i

Conditions such as early or heavy periods, irregular menstrual cycles, flooding and spoting, leukorrhea, vaginal bleeding during pregnancy and miscarriage may be caused by qi defciency and instability of the chong and ren mai. In these cases we should fortify and secure the chong and ren mai. Commonly used medicinals are shān zhū yú （Fructus Corni）, fùpén zĭ （Fructus Rubi）, qiàn shí （Semen Euryales）, jīn yīng zĭ （Fructus Rosae Laevigatae）, yì zhì rén （Fructus Alpiniae Oxyphyllae）, lóng gŭ （Fossilia Ossis Mastodi）, mŭ lì （Concha Ostreae）, sāng piāo xiāo （Oötheca Mantidis）, wŭ bèi zĭ （Galla Chinensis）, chūn gēn pí （Cortex Ailanthi）, zhù má gēn （Radix Boehmeriae）, dù zhòng （Cortex Eucommiae）, sāng jì shēng （Herba Taxilli）, xù duàn （Radix Dipsaci） and huáng qí （Radix Astragali）. The representive formulas are BŭShèn Gù Chōng Wán （Kidney-Supplementing Chong Mai-Securing Pill, 补肾固冲丸） and ĀnChōng Tāng （ Chong Mai-Calming Decoction, 安冲汤）.

Regulating Chong and Ren Mai

Menstrual irregularities, amenorrhea, dysmenorrhea, fooding and spoting, leukorrhea, vaginal bleeding during pregnancy, and miscarriage can be caused by disorders of qi and blood of the chong and ren mai. In these cases we should adopt the method of regulating the chong and ren mai. The commonly used medicinals are xiāng fù （Rhizoma Cyperi）, chuān xiōng （Rhizoma Chuanxiong）, dāng guī （Radix Angelicae Sinensis）, wū yào （Radix Linderae）, yì mŭ căo （Herba Leonuri）, zé lán （Herba Lycopi）, dān shēn （Radix et Rhizoma Salviae Miltiorrhizae）, niú xī （Radix Achyranthis Bidentatae）, sū gĕng （Caulis Perillae）, wú zhū yú （Fructus Evodiae）, and so on. Representative formulas are Jiā Wèi Wū Yào Tāng （Supplemented Lindera Decoction, 加味乌药汤） and Sū Yè Huáng Lián Tāng （Perilla Leaf and Coptis Decoction, 苏叶黄连汤）.

Warming and Nourishing Chong and Ren Mai

Late or scanty periods, dysmenorrhea, amenorrhea, abdominal pain during pregnancy or afer delivery, and infertility are caused by cold invading the chong and ren mai, resulting in inhibited blood fow and obstructed uterine vessels. In this case we should warm and nourish the chong and ren mai. The commonly used medicinals are ài yè （Folium Artemisiae Argyi）, xiăo huí xiāng （Fructus Foeniculi）, wú zhū yú （Fructus Evodiae）, guì zhī （Ramulus Cinnamom）, bŭ gŭ zhĭ （Fructus Psoraleae）, and so on. Representative formulas are Wēn JīngWán （Channel-Warming Pill, 温经丸 ）, and Ài Fù Nuăn Gōng Wán （Mugwort and Cyperus Palace Warming Pill, 艾附暖宫丸 ）.

Clearing and Nourishing Chong and Ren Mai

Early, heavy or prolonged periods, flooding and spotting, vaginal bleeding during pregnancy, and excess lochia are caused by heat in chong and ren mai harassing the sea of blood and making the blood flow frenetically. In this case we should use the method of clearing and nourishing the chong and ren mai. Commonly used medicinals are shēng dìhuáng （Radix Rehmanniae）, dān pí （Cortex Moutan）, dì gŭ pí （Cortex Lycii）, chì sháo （Radix Paeoniae Rubra）, huáng qín （Radix Scutellariae） , huáng băi （Cortex Phellodendri Chinensis）, zhī zĭ （Fructus Gardeni）, fú líng （Poria） , kŭ shēn （Radix Sophorae Flavescentis）, and so on. Representative formulas are Qīng Jīng Săn （Menstruation-Clearing Powder, 清经散 ）, Băo YīnJiān （Yin-Safeguarding Brew, 保阴煎）, and Liăng Dì Tāng （Rehmannia and Lycium Root Bark DecoctionDecoction, 两地汤）.

External treatment, is one of the therapeutic methods in Chinese medicine and has a long history. Methods stated on the silk manuscripts of Formulas for Fify-two Diseases （ WŭShí Èr Bìng Fāng, 五十二病方）, a medical book unearthed from Mawangdui, a tomb of the Han Dynasty in Changsha, include cauterization, fumigation, steaming, hot medicated compress, stone needle therapy, moxibustion and massage etc. with directions for gynecological diseases. External treatment methods now in common use in clinic include fumigation and washes, vaginal suppositories, hot medicated compresses, enemas and direct application of herbs to the skin .

Gynecological external treatments are most commonly used for conditions of external genitalia. These lesions are local but can affect the whole body. Sometmes, they are actually local manifestations of a systemic disease. Therefore, external treatment should be combined with internal treatment to get optimal therapeutic effect. Special attention should be paid to the medicinals which are to be applied directly to the affected part. They should be properly prepared and sterilized before use and used only in accordance with instructions. External treatments should be used with caution during menstrual periods, pregnancy and the puerperium. The bladder should be emptied and the afected area cleaned and disinfected before treatment. Sex and tub bathing are forbidden during treatment, and also several days before and afer the treatment. The main external treatment methods used in gynecology are described below:

Fumigation and Washes

Fumigating-washing is a method of dealing with the afected area to clear heat, reduce swelling, relieve pain and kill parasites to relieve itching. It is indicated for itching, eczema, swelling and sores of the pudendum.

Directions: Boil the medicinal herbs while wrapped for 20-30 minutes, place the resulted decoction in a container while it is warm, and fumigate the pudendum with steam from the decoction, then sit and soak in the decoction to wash the external genitals for 5-10 minutes; this is done twice daily, once in the early morning, once in the evening, seven days being a course of treatment. If there is ulceration, the genitals should not be soaked in the decoction.

Irrigation or Douche

Douching is a method used to wash out the vagina and pudendum with a medicated fuid. It is mainly used for itching of pudendum and abnormal vaginal discharge. However women with an infamed or swollen vagina should use this method carefully. Women who have a fever and stomachache or vulval sores should not use irrigation.

Directions: Boil the wrapped herbs for 20-30 minutes and transfer the decoction to an appropriate irrigating instrument such as a douche when the decoction is body temperature. Wash out the vagina using one pack of herbs a day and two irrigations daily, one in the early morning, one in the evening, seven days being a course of treatment.

Vaginal Suppository

This refers to methods of puting medicine deep into the vagina to achieve the functions of clearing heat, relieving toxicity, killing parasites to relieve itching, eliminating dampness to stop leucorrhea and promoting tissue regeneration. It is indicated for pruritus vulvae, cervical erosion, cervical hyperplasia and cervical cancer. Contraindications are the same as those for vaginal irrigation.

Directions: Make the required amount of medicine into suppositories, ointment, or powder and sterilize it for external use. Put it into the vagina afer the vulva and vagina have been cleaned. This method can be conducted by the patient herself. Ointment can be put on disinfected gauze and powder onto a coton ball; both should be applied to the afected area by professionals. Application is once a day or once every other day, 7-10 days being a course of treatment.

Intra-Uterine Injection

Intra-uterine injection is a method of intrducing a certain medicine into the uterus with a specifc instrument. It is commonly indicated for adhesions or infection causing infertility and ulceration within the uterus.

Directions: Inject the liquid medicine into the uterine with a catheter according to proper procedures. The patient should lie in bed half an hour to one hour afer the injection; application is once every 2 to 3 days, 10 times being a course of treatment.

Enema

An enema is the method of introducing suppositories or decoction into the rectum through the anus, in order to achieve the purpose of moistening the intestines, dredging the bowels, clearing heat, resolving toxins and eliminating dampness. It is indicated for postpartum fever and excess bowel movement, or vaginal fatulence （noisy expulsion of gas from the vagina）. Its use is generally prohibited during pregnancy.

Directions: Treatment should be carried out afer the rectum and bladder are emptied. Put one dose of liquid medicine in an enema device, （temperature should not exceed 37 degrees） and introduce it into the anus for retention enema.

Hot Medicated Compress

Hot medicated compress is a method of ironing the afected area with hot medicated bags to invigorate the blood and dispel stasis, reduce swelling and relieve pain, or warm the channels and quicken the collaterals. First moisten the herbs with warm water and place in a cloth bag. Heat the bag up and stroke the afected part with it. Wax, mud, salt （stirfried hot）, sand （stir-fried hot）, water bags or electrical equipments can also be used as a hot compress. This method is indicated for pain caused by qi stagnation due to congealing cold in gynecology.

Directions: Stroke the afected area while the medicinal pack is hot, but be careful not to burn the skin.

Application Therapy

Application therapy is a method of pasting or sticking a decoction, powder or paste composed of herbs directly on certain parts of the body with a disinfected gauze. It is mainly indicated for vulval or breast conditons with swelling, ulceration or abscesses. It is also used in acute mastitis or in the case of milk backfow.

Directions: Soak a sterile gauze in the herbal decoction and apply to the skin while warm. A paste made from herbs can be put on gauze frst and then applied to the infected area. Sterile powdered herbs can be used directly on broken or ulcerated skin. Finally, cover the part with a piece of gauze and secure it. Repeat once a day or once every other day, until recovery.