"Any doctor who treats women must first regulate menstruation" and "if the meridians are not regulated, many diseases will arise" ("A Complete Prescription for Women"). Menstrual disease occupies an important position among gynecological diseases. However, tracing back to the source, the Yellow Emperor's Internal Classic, which plays a foundational role in the diagnosis and treatment of menstrual diseases, is the first to be recommended. It is summarized as follows:
1
The Physiology of Menstruation
"Suwen·Ancient Innocence Theory" says: "Women... On the 27th day of the month, when Tian Gui arrives, the Ren channel is open, the Taichong channel is strong, and the menstruation is at the current time, so there is a son... On the 77th day, the Ren channel is weak, and the Taichong channel is weak. If there is less, Tiangui is exhausted and the tunnel is blocked, so the shape is bad and there are no children. "Obviously, the appearance and cessation of menstruation in women are related to Tiangui and Chongren. Gaitiangui is a substance that promotes the development of sexual organs and the maturity of reproductive functions, and "the Chong mei and Ren mei all originate in the cells" ("Lingshu·Five Tones and Five Flavors").
Therefore, if Tiangui and Chongren are abundant and abundant, menstruation will come on time and pregnancy will be possible; conversely, if Tiangui and Chongren are exhausted, menstruation will be absent and pregnancy will not be possible. . In later generations, the so-called "Chong as a sea of ??blood, Ren is in charge of the birth" (Wang Bingyu), Chong and Ren as "the foundation of menstruation" ("Jingyue Complete Book: Women's Regulations") and other understandings obviously came from this.
2
Pathology of Menstrual Disease
"Suwen·Pingre Disease Treatise" says: "If menstruation does not come, the cell veins are closed, and the cell veins are closed. The pulse belongs to the heart and is connected in the cells...the Qi in the lungs is forced upward, and the heart Qi cannot flow down, so the menstruation does not occur. "Su Wen·Yin and Yang Differential Theory" says: "Two yang diseases originate from the heart and spleen. If there is no hidden song, women will not have menstruation. "Su Wen·Zhi Zhen Yao Da Lun" says: "Cold diarrhea, abdominal distention, loose stools, and water retention... The disease is caused by the spleen." It points out that the occurrence of menstrual disease is related to the heart, spleen, and kidneys. The lungs are closely related. The heart governs blood, the spleen governs blood, and the lungs govern qi. The spleen is the foundation of acquired life and the source of qi and blood biochemistry. Western medicine believes that the occurrence of menstruation is related to the hypothalamus-pituitary-ovary axis and is also affected by the cerebral cortex.
"Suwen · Abdominal Theory" says: "Those who are sick and have full chest and hypochondrium branches will hinder their ability to eat. When the disease occurs, they will first smell a fishy odor, produce clear fluid, spit blood first, and have clear limbs and dizziness. , bleeding all the time... The name of the disease is blood dryness. When the patient is young, there will be severe bleeding. If he gets drunk, he will suffer from Qi exhaustion and liver damage, so menstruation will be short and infrequent. "The cause and pathology of amenorrhea are discussed. Features.
"Lingshu·Five Tones and Five Flavors" says: "Today's women's life has more than Qi and less than blood, so the amount of blood is removed." It points out that some pathological characteristics of women are determined by physiological functions. Yes, imbalance of qi and blood is one of the most common pathogenesis of gynecological diseases. Menstruation, pregnancy, childbirth, and breastfeeding all use blood, so it is easy to cause the body's pathological characteristics of insufficient blood and excess Qi.
The main menstrual diseases recorded in the "Huangdi Neijing" are amenorrhea and uterine bleeding, among which there is a rich discussion on amenorrhea. Later generations of doctors divided amenorrhea into two types: blood dryness and blood deficiency, which are caused by this, such as kidney wind and lack of menstruation, two-yang disease and lack of menstruation, blood dryness and amenorrhea, symptoms, causes, pathogenesis and treatment, etc. The discussion of metrorrhagia is mainly found in "Suwen: Yin and Yang Bie Lun" which states that "deficiency of yin and yang is called metrorrhagia." It is pointed out that the pathogenesis of metrorrhagia in women is that yin deficiency causes yang energy to tangle and become hyperactive, and blood heat is excessive. Xing, that is, Yin deficiency and Yang exuberance, explains the situation of Yin deficiency to collapse.
Therefore, menstrual disease is often caused by dysfunction of the internal organs and imbalance of qi, blood, yin and yang.
3
Causes of menstrual disease
1. External causes
"Suwen·Lihe Zhenxie Lun" says: "Heaven and earth are gentle. When the weather is cold and the ground is freezing, the water will condense; when the weather is hot and the earth is hot, the water will boil and overflow; when a storm arises, the water will surge up and rise." It pointed out the impact of natural climate changes on the human body, and explained it with changes in cold and heat. The causes of menstrual diseases are: cold is yin evil, which is responsible for contraction and stagnation. Cold causes menstrual water to condense and weep, and heat causes menstrual water to boil and overflow. For example, early menstruation and metrorrhagia are mostly caused by blood heat, mainly due to deficiency syndrome, and are functional. Dysmenorrhea is more common due to deficiency and cold, which has important guiding significance for later generations of doctors in treating menstrual diseases.
2. Internal factors
Among the seven emotions, worry, anger, sadness, and fear are particularly influential. These are discussed more in the "Huangdi Neijing". Depression and anger damage the liver, and the liver qi cannot be regulated smoothly and becomes reversed, which can cause menstrual disorders, dysmenorrhea, menorrhagia, and vomiting during menstruation. Worrying too much will damage the spleen. The spleen is the source of Qi and blood biochemistry and the organ that governs blood. Depletion of spleen can lead to menstrual disorders, amenorrhea, metrorrhagia, etc. Too much sadness will damage the lungs. The lungs govern the body's qi. If the airway is not clear, the blood will not be smooth, which can lead to irregular menstruation and other diseases.
"Su Wen·Yin and Yang Differentiation" says: "The disease of the two yangs affects the heart and spleen, and there is no hidden disease, and women are not menstrual..." "Su Wen·Antiology" says: "Sadness is too great, then Absence of cellular collaterals. If the cellular collaterals are exhausted, the Yang Qi will move internally, leading to collapse of the heart and frequent urination." It is pointed out that emotional factors such as excessive worry and excessive sadness can lead to the onset of irregular menstruation and metrorrhagia. The original text of the above two paragraphs explains that the same emotional changes can cause different menstrual diseases, such as menorrhagia, metrorrhagia, oligomenorrhea, and amenorrhea. This mainly depends on the patient's physical factors. When treating, the same disease must be treated differently. Flexible application of treatment methods that treat different diseases.
"Suwen: Different Treatise on the Five Internal Organs" says: "The brain, marrow, bones, pulses, gallbladder, and female cells, these six are generated by the earth's energy. They are all hidden in the yin and resemble the earth. Therefore, it is stored but not discharged, so it is called the Qiheng Fu organ. "The Nei Jing" refers to the uterus as the Qiheng Fu organ, because its function is like a viscera and its shape is like a fu organ. It has the dual function of storing and releasing. If the uterine function is abnormal, it will cause The occurrence of menstrual diseases and pregnancy diseases.
4
Medications for the treatment of menstrual diseases
"Suwen · Fu Zhong Lun" records the first gynecological prescription "Four cuttlefish bones and one reed." "Wan", cuttlefish bone is the main ingredient in the prescription, which has the function of tonifying the kidneys and stabilizing astringency; Lu Ru, also known as madder, is mainly used to disperse bad blood, and can produce blood and stimulate menstruation; it is mixed with sparrow eggs to replenish essence and blood, and abalone juice can replenish yin qi and unblock blood vessels. It pioneered the method of tonifying the kidney and activating blood circulation in obstetrics and gynecology. The whole prescription is used to nourish essence, qi, and blood, strengthen the lungs, liver, and kidneys, activate blood circulation and stimulate menstruation, and can treat various diseases such as blood dryness and essence deficiency, metrorrhagia, leucorrhea, and abdominal mass.
"Lingshu·Five Tones and Five Flavors" says: "When a woman is born, there is more than Qi but not enough blood, so she sheds blood according to the number." Because menstruation occurs at the right time every month, blood will be released during pregnancy. Due to the special nature of gathering fetuses, women often have insufficient blood. The so-called "more than qi" is relative to "less than blood". It is not a true excess. qi and blood interact with each other, and blood deficiency will lead to qi deficiency over time. Careful reading of the scriptures aims to emphasize the characteristic of often insufficient blood. This theory had a great influence on later generations, such as "women are based on blood" ("Women's Complete Prescriptions"), "women are based on blood" ("Jingyue Complete Book: Women's Regulations"), etc. are all derived from this.
It is natural that nourishing and regulating blood and Siwu Decoction have become the basic treatment methods and commonly used prescriptions in gynecology. It is even said that "Siwu Decoction is a universal prescription for women who have given birth and all blood diseases." ("Yizong Jinjian: Key Points of Gynecological Heart Methods"), even Liu Wansu, who is famous for his "cold and cool" medicine, also said that the treatment of miscellaneous gynecological syndromes should be based on four things, "Chuanxiong in spring, peony in summer, and rehmannia in autumn." , Angelica sinensis in winter...Four herbs of spring parsnip, four herbs of summer skullcap, four herbs of autumn door and winter, and four herbs of cinnamon twigs in winter. These four times should be taken regularly according to the symptoms."
In addition to the six evils and seven emotions, the causes of gynecological diseases also include many factors such as physical weakness or sexual fatigue. Li Dongyuan, a later physician, discussed infertility in amenorrhea in "The Secret of the Orchid Chamber·Women's Gate". He quoted the words of "Suwen·Yin and Yang Differentiation" as "diseases of the two yangs attack the heart and spleen, and there is no hidden disease, and women do not have menstruation", pointing out that "women have no menstruation". A person's spleen and stomach have been deficient for a long time, or the qi and blood are weakened, resulting in the cessation of menstruation... The name of the disease is blood dryness and menstruation. It is advisable to purge the dryness and heat in the stomach, replenish qi and blood, and the menstruation will stop on its own." Regarding menstrual leakage in women, it is believed that "it is all caused by deficiency of the spleen and stomach, which sinks in the kidneys, is in harmony with the element of fire, and is forced by dampness and heat, resulting in persistent menstrual leakage... It is advisable to greatly nourish the spleen and stomach to increase the blood and qi." This method is still effective in treating metrorrhagia today.
"Su Wen·Ba Zheng Shen Ming Lun" says: "When the moon is born, the blood and Qi begin to be refined and the Wei Qi begins to flow. If the moon is full, the blood and Qi will be strong and the muscles will be strong; if the moon is empty, the muscles will be reduced. , the meridians are deficient, the defensive qi disappears, and the body is alone, so the blood and qi are adjusted according to the weather... There is no diarrhea when the moon is born, there is no nourishment when the moon is full, and there is no cure when the moon is empty. This is said to be adjusted according to the time of the day. Under the guidance of the theory, different treatment methods should be used for gynecological diseases according to the moon's birth, full moon and no moon conditions.
For example, in the process of regulating menstruation, when the "month is born", the person's blood and Qi are in the stage from weak to strong. The treatment should focus on cultivating and replenishing Qi, blood, essence and fluid, not You can randomly use purgative methods such as promoting blood circulation, dispersing blood stasis, and reducing blood stasis; when the moon is full and "full", you cannot use tonic drugs indiscriminately, and should mainly treat diarrhea; when the moon is completely empty, the qi and blood have declined, and it is difficult to use them. Drugs such as those used to attack, activate blood circulation and remove blood stasis should be used more cautiously. Therefore, the impact of the moon on the human body should be taken into consideration when treating women during their menstrual cycle.