Obstetrics and Gynecology In Chinese Medicine, 2nd Edition

Written by Giovanni Maciocia, probably the most respected Western TCM practitioner and author of TCM texts, this is the most comprehensive test of its kind in the English language. It covers the principles of diseases related to obstetrics and gynecology in TCM and offers a full, clear and detailed exploration of this area. The text adapts Traditional Chinese gynecology to Western conditions and patients, reflected in over 100 case histories.

Chinese medicine has always seemed to me to be especially well suited to the treatment of gynaecological disorders. Its emphasis on understanding root causes and the beauty of its approach to pattern differentiation of course play a great part as well as the clear effectiveness of its treatments. It may also be that it shines in comparison to western medicine which seems to have a culture of dismissing many gynaecological complaints as unavoidable or untreatable, or in other cases readily using extreme therapeutic measures such as hysterectomy. Not that treating gynaecological complaints is easy. Careful and attentive differentiation is required as well as the ability to adapt treatment principles to the different phases of the menstrual cycle. The author says There is a saying in Chinese medicine 'To treat one woman equals treating five men', which means that treating women is more difficult than treating men. The reason for this is presumably that the menstrual function adds complexity to women's pathology and treatment. I personally find quite the opposite. I would say that treating one man equals treating five women! This is because I think that the menstrual function, rather than adding complexity to women's pathology, actually clarifies it. In fact, the additional diagnostic signs deriving from the regularity of the cycle, the amount of bleeding, the colour and consistency of the blood, the pre-menstrual symptoms, and the conditions of pregnancy and childbirth all assist the diagnosis. In many cases, when women are seeking treatment not for gynaecological but for other problems, an analysis of the menstrual symptoms is a 'clinching' factor.

This is a substantial work, the most complete and detailed text on gynaecology and obstetrics yet to appear in the English language and adds to the already considerable corpus of Giovanni Maciocia's written work.

The book begins with a brief history of gynaecology in Chinese medicine with the earliest records dating back to inscriptions on bones and tortoise shells from the Shang dynasty (1500 to 1000 BCE). The first reference to gynaecology as a distinct speciality appears in the Warring States period where the famous doctor Bian Que is referred to as one who 'treats diseases under the skirt belt'. This is followed by a thorough discussion of the physiology of menstruation, conception, pregnancy and menopause and an introduction to female pathology, both sections paying particular attention to disorders of the extraordinary vessels. General diagnostic and treatment principles are covered with discussions on when to tonify and when to reduce, what to do if the gynaecological manifestations contradict the systemic manifestations, how Chinese medicine patterns relate to western disease categories, the basic treatment principles for the zangfu, qi, blood and again the extraordinary vessels. Commonly used herbal prescriptions and individual herbs are explained and compared and there is a long section on the use of the extraordinary vessels in treatment.

From here on, the book is arranged according to diseases categories: i. menstrual irregularities (early, late, painful etc.), ii. problems occurring at the time of the period (breast distention, headaches, tension, oedema etc.), iii. diseases of pregnancy (morning sickness, threatened miscarriage, oedema, retention of urine etc.) with a section on acupuncture and herbal treatment in midwifery, iv. diseases after childbirth (post-natal depression, abdominal pain, fever, milk problems etc.), and v. miscellaneous disorders (infertility, menopausal syndrome, breast lumps, abdominal masses, excessive vaginal discharge, uterine prolapse etc.). Each of these disorders is analysed as to its possible aetiology and pathology, differentiation, acupuncture and herbal treatment, prognosis and prevention. In many cases the western medicine differentiation and treatment is also discussed. The book is completed with appendices on herbal prescriptions and patent remedies, a glossary of terminology, cross-referenced indexes of Chinese disease-symptoms and western medicine diseases and an index. For any practitioner of acupuncture or Chinese herbal medicine who takes seriously the responsibility of treating female patients this book is invaluable and essential.

Reviewed by Peter Deadman

Foreword xvii

Preface xix

Acknowledgements xxi

Note on the translation of Chinese medical terms xxiii

Plates

SECTION 1 PHYSIOLOGY AND PATHOLOGY 1

1. History of gynaecology in Chinese medicine 3

2. Women's physiology 7
The Uterus 7
Physiology of Menstruation 8
Menstruation and Internal Organs 11
Kidneys; Liver; Spleen; Heart; Lungs; Stomach
Menstruation and Extraordinary Vessels 15
Penetrating Vessel (Chong Mai); Directing Vessel (Ren Mai); Governing Vessel (Du Mai); Girdle Vessel (Dai Mai); Yin Heel Vessel (Yin Qiao Mai); The relationships and actions of the Extraordinary Vessels
Conception 25
Pregnancy 27
Menopause 28

3. Women's pathology 31
Pathology of the Internal Organs 31
Kidneys; Liver; Spleen; Heart; Lungs; Stomach
Qi and Blood pathology 41
Qi rebellious; Blood-Cold
Pathology of the Extraordinary Vessels 43
Penetrating Vessel; Directing Vessel; Governing Vessel; Girdle Vessel; Yin Heel Vessel; Yin Linking Vessel

SECTION 2 AETIOLOGY AND DIAGNOSIS 51

4. Aetiology 53
Exterior pathogenic factors 54
Cold; Dampness; Heat
Emotional stress 54
Sadness and grief; Worry; Anger; Fear; Shock; Guilt
Diet 57
Excessive physical work/exercise 58
Overwork 59
Pregnancy and childbirth 59
Excessive/insufficient sexual activity 61
Surgery and hysterectomy 65
The contraceptive pill 66
Prevention and hygiene 67

5. Diagnosis 69

Interrogation 70
Menstruation; Pain; Vaginal discharge; Fertility and pregnancy; Childbirth; Miscarriage and abortion

Palpation 73
Pulse; Skin; Abdomen
Observation 75
Complexion; Lips; Tongue

Auscultation 83
Hearing Voice Smelling Menstrual blood; Vaginal discharge

SECTION 3 METHODS OF TREATMENT 85

6. Principles and methods of treatment 87
When to tonify and when to eliminate 88
Contradictions between gynecological and systemic manifestations 90
Contradictions among gynecological manifestations 91
Relationships between patterns, Chinese diseases and Western diseases 91
Note on treatment methods not to be used during periods
Methods of treatment 93
Treatment of Internal Organs 94

Kidneys
Tonify Kidney-Yang; Strongly tonify Kidney-Yang and stoke up the Fire of the Gate of Life; Nourish Kidney-Yin; Nourish the Kidney-Essence; Tonify both Kidney-Yang and Kidney-Yin

Liver
Nourish the Liver; Pacify the Liver and eliminate stagnation of Qi; Pacify the Liver and eliminate stasis of Blood; Clear Liver-Heat by pacifying the Liver; Drain Liver-Fire; Subdue Liver-Yang or Liver-Wind

Spleen
Tonify Spleen-Qi and Spleen-Blood; Tonify Spleen-Yang; Tonify and raise Spleen-Qi; Tonify the Spleen to hold Blood; Harmonize Spleen and Liver; Tonify the Spleen and resolve Dampness

Heart
Heart-Blood deficiency; Heart-Yin deficiency; Heart-Blood stasis; Heart-Fire; Heart-Blood Heat
Qi and Blood pathology and treatment 114
Qi rebellious; Blood-Cold; Treatment of Qi and Blood disharmonies

7. Treatment of the Extraordinary Vessels 117

Penetrating Vessel 122
Directing Vessel 131
Governing Vessel 142
Girdle Vessel 146
Yin Heel Vessel 149
Yin Linking Vessel 150
Gynecological extra points 151
The herbal treatment of the Extraordinary Vessels 152
The principal herbs used with the Extraordinary Vessels; Four pathologies and herbal treatment; Formulae for the Directing and Penetrating Vessels
Directing and Penetrating Vessels Empty; Directing and Penetrating Vessels Unstable; Directing and Penetrating Vessels Deficient and Cold; Full Cold in the Directing and Penetrating Vessels; Empty Heat in the Directing and Penetrating Vessels; Full Heat in the Directing and Penetrating Vessels; Damp-Heat in the Directing and Penetrating Vessels; Stagnant Heat in the Directing and Penetrating Vessels; Dampness and Stasis of Blood in the Directing and Penetrating Vessels

SECTION 4 MENSTRUAL IRREGULARITIES 159

Introduction to Section 4 161

8. Early Periods 167

Aetiology and pathology 167
Excessive physical work, irregular diet; Overwork, menopausal decline of Kidney-Qi; Irregular diet, invasion of external Heat; Emotional stress; Chronic illness, overwork, too many children, chronic bleeding; Pathology

Differentiation and treatment 169
Qi deficiency Spleen-Qi deficiency; Kidney-Qi not Firm, Blood-Heat
Full Heat (1): Blood-Heat; Full Heat (2): Stagnant Liver-Qi turning into Fire with Blood-Heat; Empty Heat: Liver- and Kidney-Yin deficiency with Empty Heat

Prognosis and prevention 178

9. Late Periods 179

Aetiology and pathology 179
Chronic illness, excessive physical work, chronic bleeding, excessive breast-feeding; Irregular diet, exposure to cold and dampness, invasion of Cold; Hereditary Kidney weakness, overwork, too many children too close together; Emotional stress

Differentiation and Treatment 180
Blood deficiency; Cold in the Uterus; Kidney-Yang deficiency; Qi stagnation

Prognosis and prevention 194

10. Irregular Periods 197

Aetiology and pathology 197
Emotional stress; Overwork, too many children too close together

Differentiation and treatment 198
Liver-Qi stagnation; Kidney-Yang deficiency; Kidney-Yin deficiency; Ancient acupuncture prescriptions for irregular periods

Prognosis and prevention 204

11. Heavy Periods 207

Aetiology and pathology 207
Excessive physical work; Emotional stress, irregular diet, external Heat; Emotional/ stress, surgery, post-partum conditions

Differentiation and treatment 208
Qi deficiency; Blood-Heat; Blood stasis

Prognosis and prevention 215

12. Scanty Periods 217

Aetiology and pathology 217
Chronic illness, haemorrhage, irregular diet; Overwork, hereditary weakness, too many children too close together; Traumas, abdominal surgery, emotional stress, cold; Irregular diet, physical overwork; Contraceptive pill

Differentiation and treatment 218
Blood deficiency; Kidney-Yang deficiency; Kidney Yin deficiency; Stasis of Blood; Phlegm obstructing the Uterus

Prognosis and prevention 227

13. Long Periods 229

Aetiology and pathology 229
Emotional stress; Overwork

Pathological patterns

Differentiation and treatment 230
Qi stagnation and Blood stasis; Kidney-Yin deficiency with Empty Heat

Prognosis and prevention 233

14. Painful Periods 235

Aetiology and pathology 235
Emotional strain; Cold and Dampness; Overwork, chronic illness; Excessive sexual activity, childbirth

Diagnosis 237
Time of onset; Pressure; Heat-Cold; Character of pain; Location of pain; Cycle

Principles of treatment 238

Differentiation and treatment 239
Full types
Stagnation of Qi; Stasis of Blood; Stagnation of Cold; Damp-Heat; Stagnant Liver-Qi turning into Fire
Empty types 252
Qi and Blood deficiency; Yang and Blood deficiency; Kidney- and Liver-Yin deficiency

Ancient acupuncture prescriptions for dysmenorrhoea

Prognosis and prevention 258
Western differentiation 258

15. Bleeding between Periods 261

Aetiology and pathology 261
Overwork, too many children too close together; Irregular diet; Traumas, abdominal operations, post-partum stasis of Blood; Excessive physical exercise

Differentiation and Treatment 262
Liver- and Kidney-Yin deficiency with Empty Heat; Damp-Heat; Blood stasis; Spleen- and Kidney-Yang deficiency

Prognosis and prevention 272

16. No Periods 273

Aetiology and pathology 273 Emotional stress; Excessive physical work or exercise; Hereditary weakness; Diet; Overwork

Differentiation and treatment 276
Empty conditions
Liver and Kidney deficiency; Blood deficiency; Spleen and Kidney-Yang deficiency; Liver- and Kidney-Yin deficiency; Lung-Yin and Blood deficiency; Heart- and Kidney-Yin deficiency; Spleen- and Heart-Blood deficiency

Full conditions
Stagnation of Qi and Blood; Damp-Phlegm in the Uterus

Ancient acupuncture prescriptions for amenorrhoea

Prognosis 299

Western differentiation 299

17. Flooding and Trickling 303

Aetiology and pathology 303
Emotional strain; Overwork and excessive sexual activity, Physical overwork, chronic illness; Childbirth

Differentiation and treatment 305

Treatment principles
Harmonize Blood; Treat the Root-cause of bleeding; Astringe; Treat Qi

Three steps in treatment; Herbal treatment; Acupuncture; Summary of patterns

Full conditions
Blood-Heat; Liver-Qi Stagnation turning into Heat, Blood Empty Heat; Stasis of Blood; Damp-Heat in the Uterus

Empty conditions
Spleen not holding Blood; Kidney-Yang deficiency; Kidney-Yin deficiency

Complex patterns
Full with Full; Empty with Empty; Empty with Full Ancient acupuncture prescriptions for Flooding and Trickling

Prognosis and prevention 336

Western differentiation 336

18. Pre-Menstrual Syndrome 339

Aetiology and pathology 339
Emotional strain; Diet; Overwork, excessive sexual activity

Differentiation and treatment 340
Full types
Liver-Qi stagnation; Phlegm-Fire harassing upwards
Empty types
Liver-Blood deficiency; Liver- and Kidney-Yin deficiency; Spleen- and Kidney-Yang deficiency
Ancient acupuncture prescription for Pre-Menstrual Syndrome

Prognosis and prevention 356

Western differentiation 356

SECTION 5 PROBLEMS AT PERIOD TIME 359

19. Pre-menstrual breast distension 361

Aetiology and pathology 361
Emotional stress; Overwork, too many children; Irregular diet

Differentiation and treatment 362
Liver-Qi stagnation; Liver-Blood stasis; Phlegm with stagnation of Qi; Liver -and Kidney-Yin deficiency

Prognosis and prevention 371

20. Headaches 373

Aetiology and pathology 373
Excessive physical work; Emotional stress

Differentiation and Treatment 374
Blood deficiency; Liver-Fire blazing; Liver-Yang rising; Blood stasis

Prognosis and prevention 384

21. Oedema at period time 385

Aetiology and pathology 385
Excessive physical work; Emotional stress

Differentiation and Treatment 386
Spleen- and Kidney-Yang deficiency; Stagnation of Qi; Ancient acupuncture prescriptions for oedema at period time

Prognosis and Prevention 391

22. Diarrhoea 393

Aetiology and pathology 393
Excessive work, irregular diet; Emotional stress; Overwork, too many children too close together

Differentiation and treatment 394
Spleen-Qi deficiency; Liver-Qi stagnant and invading the Spleen; Kidney-Yang deficiency

Prognosis and Prevention 397

23. Body aches 399

Aetiology and pathology 399
Excessive physical work, inadequate diet, chronic illness;
Emotional stress, irregular diet

Differentiation and treatment 400
Blood deficiency (alone or with Yang rising); Blood stasis

Prognosis and prevention 406

24. Fever at period time 407

Aetiology and pathology 407
Emotional stress, diet; Overwork, too many children; Chronic illness, excessive physical work; Emotional stress, surgery

Differentiation and treatment 408
Blood-Heat; Kidney- and Liver-Yin deficiency with Empty Heat; Qi and Blood deficiency with disharmony of Nutritive and Defensive Qi; Blood stasis with Heat

Prognosis and prevention 415

25. Epistaxis or haemoptysis 417

Aetiology and pathology 417
Emotional stress; Overwork, emotional stress

Differentiation and treatment 418
Stagnant Liver-Qi turning into Fire; Lung- and Kidney-Yin deficiency

Prognosis and prevention 421

26. Mouth ulcers 423

Aetiology and pathology 423 Overwork, too many children too close together; Irregular diet

Differentiation and treatment 424
Kidney-Yin deficiency with Empty Heat; Stomach Fire or Stomach Damp-Heat; Stomach Damp-Heat with Spleen deficiency

Prognosis and prevention 427

27. Skin eruptions 429

Aetiology and pathology 429
Overwork, chronic illness, haemorrhage after childbirth; Irregular diet, Yang constitution

Differentiation and treatment 430
Blood deficiency; Wind-Heat invading Blood

Prognosis and prevention 433

28. Dizziness at Period Time 435

Aetiology and pathology 435
Chronic illness, irregular diet, haemorrhage; Emotional stress, overwork; Excessive exercise, irregular diet

Differentiation and Treatment 436
Blood deficiency; Kidney- and Liver-Yin deficiency with Liver-Yang rising; Phlegm with Spleen-Qi deficiency

Prognosis and prevention 439

SECTION 6 DISEASES OF PREGNANCY 441

Introduction to Section 6 443

Problems of pregnancy and their treatment 443
Diet during pregnancy 445
Chinese embryology 446
Fetus education 447

29. Morning Sickness 451

Pathology 451

Differentiation and treatment 452
Acupuncture Stomach channel; Kidney (and Penetrating Vessel) channel; Directing Vessel; Distal points, Patterns of morning sickness and their treatment; Stomach-Qi deficiency with Empty Cold; Stomach Yin deficiency; Stagnant Liver-Qi invading the Stomach; Stomach-Heat; Accumulation of Phlegm; Heart-Qi deficiency; Heart-Fire

Prognosis and prevention 463

30. Abdominal Pain during pregnancy 465

Pathology 465
Blood deficiency; Stagnation of Qi; Empty Cold; Blood stasis
Differentiation and treatment 466 '
Deficiency of Blood; Stagnation of Qi; Empty Cold
Prognosis and prevention 469

Western differentiation 469 Ectopic pregnancy; Spontaneous abortion; Ovarian tumour torsion

Appendix: Ectopic pregnancy 471
Blood stasis; Collapse of Yang; Blood stasis and Qi deficiency

31. Threatened miscarriage 473

Aetiology and pathology 474
Overwork, excessive physical work; Chronic illness, irregular diet;
Emotional problems, irregular diet, febrile disease; Falls, jumps,
traumas; Excessive sex during pregnancy

Differentiation and treatment 475
Kidney deficiency; Qi and Blood deficiency; Blood Heat; Falls, trauma; Expulsion of the products of conception; Acupuncture prescription; Ancient acupuncture prescriptions for threatened miscarriage

Prognosis and prevention 485

Western view 486

32. Fetus not Growing 489

Aetiology and pathology 489

Differentiation and treatment 489
Qi and Blood deficiency; Spleen- and Kidney-Yang deficiency

Prognosis and prevention 492

Western view 492

33. Oedema in pregnancy 493

Aetiology and pathology 493
Irregular diet; Excessive physical work, exercise or lifting; Emotional stress

Differentiation and treatment 494
Spleen-Yang deficiency; Kidney-Yang deficiency;
Stagnation of Qi

Prognosis and prevention 497

Western view 498

34. Anxiety 499

Aetiology and pathology 499
Overwork, Yin-deficient constitution; Emotional problems, irregular diet

Differentiation and treatment 500
Liver-Fire; Empty Heat from Yin deficiency; Phlegm-Fire harassing the Mind

Prognosis and prevention 504

35. Dizziness in pregnancy 505

Aetiology and pathology 505
Overwork; Excessive physical work, irregular diet

Differentiation and treatment 506
Liver- and Kidney-Yin deficiency with Liver-Yang rising; Spleen deficiency with Liver-Yang rising and Phlegm

Prognosis and prevention 508

Western view 508

36. Convulsions in pregnancy 509

Aetiology and pathology 509
Overwork; Irregular diet, emotional problems,

Differentiation and treatment 510
Liver-Wind agitating within; Phlegm-Fire harassing upwards; Empty Wind

Prognosis and prevention 514

Western view 514

37. Feeling of suffocation 515

Aetiology and pathology 515

Differentiation and treatment 515
Stagnation of Qi with disharmony of Liver and Spleen; Stagnation of Qi with deficiency of Blood and Kidneys

Prognosis and Prevention 518

38. Aphonia 519

Differentiation and treatment 519
Kidney-Yin deficiency

Prognosis and prevention 521

39. Cough 523

Aetiology and pathology 523
Overwork; Irregular diet, emotional problems

Differentiation and treatment 523
Lung-Yin deficiency; Phlegm-Fire in the Lungs

Prognosis and prevention 527

40. Painful-Urination Syndrome 529

Aetiology and pathology 529
Emotional problems; Overwork; Irregular diet; Excessive sexual activity during pregnancy

Differentiation and treatment 530
Heart-Fire; Damp-Heat in the Bladder; Kidney-Yin deficiency and Empty Heat

Prognosis and prevention 532

Western view 532

41. Retention of Urine 535

Aetiology and pathology 535
Excessivephysical exercise; Excessive sexual activity, excessive standing or lifting; External Dampness; lrregularr diet

Differentiation and treatment 536
Spleen-Qi deficient and sinking; Kidney-Qi deficiency and sinking; Damp-Heat in the Bladder

Prognosis and prevention 540

42. Constipation during pregnancy 541

Aetiology and pathology 541
Diet; Emotional stress; Lack of exercise; Overwork and childbirth

Differentiation and treatment 542
Blood deficiency; Kidney-Yang deficiency; Kidney Yin deficiency; Liver-Qi stagnation

Prognosis and prevention 546

43. Habitual miscarriage 547

Aetiology and pathology 547

Differentiation and treatment 548
Kidney-Yang deficiency; Kidney-Yin deficiency; Blood-Heat; Spleen-Qi deficiency; Blood deficiency; Blood stasis

Prognosis and prevention 556

Western view 556

44. Acupuncture and herbal treatment in midwifery 559

Origins of acupuncture treatment for delayed labour 559

Acupuncture in labour: a short history 560
The way ahead
Physiology of labour 561
Breech presentation 562

Pathology of labour and post-partum period 563
Acupuncture for analgesia in labour Ear points; Acupuncture in the treatment of difficult labour

Differentiation and treatment; Deficiency of Qi and Blood; Stagnation of Qi and Blood

Retained placenta
Differentiation and treatment; Deficiency of Qi; Cold leading to stasis of Blood

Retention of urine after delivery
Differentiation and treatment; Deficiency of Qi; Deficiency of the Kidneys

Case histories 568

Conclusion 569 Ancient acupuncture prescriptions for difficult labour 570

Herbal treatment 570 Induction of labour; Difficult labour
Deficiency of Qi and Blood; Stasis of Blood and stagnation of Qi

Breech presentation; Retention of placenta
Qi and Blood deficiency; Stasis of Blood and Cold
Disease affecting the fetus 574

SECTION 7 DISEASES AFTER CHILDBIRTH 577

Introduction to Section 7 579
Problems after childbirth and their treatment 579
The Western view 582

45. Post-natal depression 585

Aetiology and pathology 586
Excessive loss of blood during childbirth; Blood stasis after childbirth; Constitutional tendency to mental-emotional problems

Differentiation and treatment 587
Heart-Blood deficiency; Heart-Yin deficiency; Heart-Blood stasis

Prognosis and prevention 593

Western view 593

46. Abdominal Pain after Childbirth 595

Aetiology and pathology 595 Excessive blood loss during childbirth; Exposure to cold, irregular diet; Emotional stress; Irregular diet

Differentiation and treatment 596
Blood deficiency; Blood stasis; Retention of food;

Ancient acupuncture prescriptions for post-partum abdominal pain

Prognosis and prevention 600

47. Persistent Lochial Discharge (retention of lochia) 603

Aetiology and pathology 603
Excessive strain during delivery, long labour; Invasion of cold; Excessive loss of blood during childbirth

Differentiation and treatment 604
Qi deficiency; Blood stasis; Blood-Heat; Ancient acupuncture prescriptions for persistent lochial discharge

Prognosis and prevention 609

Western view 609

Appendix: Retention of lochia 610 Aetiology and pathology; Differentiation and treatment; Qi and Blood stagnation; Stagnation of Cold and stasis of Blood; Ancient acupuncture prescriptions for retention of lochia

48. Urinary Difficulty 613

Aetiology and pathology 613
Excessive strain during labour; Injury to the bladder

Differentiation and treatment 614
Spleen-Qi deficiency; Kidney-Qi deficiency; Injury to the bladder; Liver-Qi stagnation; Bladder-Heat and Kidney-Yin deficiency; Lung- and Spleen-Qi deficiency

Prognosis and prevention 622

49. Sweating 623

Aetiology and pathology 623
Excessive strain during labour; Excessive blood loss

Differentiation and treatment 624
Qi deficiency; Yin deficiency

Prognosis and prevention 626

50. Constipation and Haemorrhoids after Childbirth 627

Aetiology and pathology 627

Differentiation and treatment 627
Blood deficiency; Kidney-Yang deficiency; Kidney-Yin deficiency

Prognosis and prevention 630

Western View 630

Appendix: Haemorrhoids 631
Differentiation and treatment; Internal haemorrhoids Blood-Heat and Blood deficiency; Toxic Heat, Blood stasis, Dampness; Damp-Heat, Heart-Heat

External haemorrhoids
Blood stasis, Qi stagnation, Blood-Heat, Damp-Heat; Damp-Heat

51. Fever after Childbirth 637

Aetiology and pathology 637
External invasion of Toxin; External invasion of Wind-Heat; Excessive blood loss during labour; Surgery, emotional problems; Retention of Food

Differentiation and treatment 638
Invasion of external toxins; Invasion of external Wind; Blood deficiency; Blood stasis; Steaming Breast; Retention of Food

Prognosis and prevention 649

Western differentiation 649

52. Joint Pain 651

Aetiology and pathology 651
Excessive blood loss during labour; Invasion of external Wind; Emotional problems; Weak body condition

Differentiation and treatment 652
Blood deficiency; Invasion of Wind; Blood stasis; Liver-Blood and Kidney-Yang deficiency

Prognosis and prevention 657

53. Breast Milk not Flowing (including acute mastitis) 659

Aetiology and pathology 659
Excessive blood loss during labour, long labour; Emotional problems

Differentiation and treatment 660
Qi and Blood deficiency; Liver-Qi stagnation; Ancient acupuncture prescriptions for lack of milk

Prognosis and prevention 667

Western view 668

Appendix: Acute mastitis 668

Treatment

54. Spontaneous Flow of Milk 675

Aetiology and pathology 675
Long labour, constitutional Qi deficiency; Emotional upset

Differentiation and treatment 675
Spleen- and Stomach-Qi deficiency; Liver-Fire

Prognosis and prevention 678

55. Collapse 679

Aetiology and pathology 679
Excessive loss of blood during childbirth; Exposure to cold during childbirth

Differentiation and treatment 680
Collapse of Qi with deficiency of Blood: flaccid syndrome; Blood stasis: tense syndrome

Prognosis and prevention 682

Western view 683

56. Convulsions after childbirth 685

Aetiology and pathology 685
Excessive loss of blood during childbirth; Invasion of external Toxin

Differential diagnosis 686

Differentiation and treatment 686
Blood and Yin deficiency with Empty Wind; Exterior invasion of Toxin

Prognosis and prevention 688

Western view 688

SECTION 8 MISCELLANEOUS DISEASES 689

57. Infertility 691

Aetiology and pathology 691
Constitutional weakness; Overwork; Excessive physical work; Excessive sexual activity at an early age; Invasion of cold; Diet

Differentiation and treatment 695
Herbal treatment; Empty types Kidney-Yang deficiency; Kidney-Yin deficiency; Blood deficiency
Full types Cold in Uterus; Dampness in the Lower Burner; Blood Heat; Stagnation of Qi; Stasis of Blood
Infertility prescriptions of Dr Xia Gui Chen; Infertility prescriptions of Dr Lian Fang and Dr Sun Ning Quan; Infertility prescriptions of Dr Zhu Nan Sun; Other formulae, according to Western condition, from Dr Shan Dao Wei, Empirical prescriptions from the Shanghai College of Traditional Chinese Medicine; Ancient acupuncture prescriptions for Infertility; Modern acupuncture prescription for retroverted Uterus

Prognosis and prevention 734

Western differentiation 735
Hormonal factors; Tubal abnormalities; Uterine factors; Cervical factors; General factors

Appendix: Male sterility 738
Kidney-Yang deficiency; Damp-Heat

58. Menopausal Syndrome 741

Aetiology 742
Emotional stress; Overwork, too many children too close together

Pathology and treatment

Differentiation and treatment 743
Kidney-Yin deficiency; Kidney-Yang deficiency; Kidney-Yin and Kidney-Yang deficiency; Kidney and Liver-Yin deficiency with Liver-Yang rising; Kidneys and Heart not harmonized; Accumulation of Phlegm and stagnation of Qi; Stasis of Blood

Prognosis and Prevention 759

Western View 759

59. Breast Lumps 763

Aetiology 764
Emotional problems; Disharmony of Directing and Penetrating Vessels; Diet; Overwork

Pathology and principles of treatment 766

Diagnosis 770
Channels
Differentiation and treatment 771
Stagnation of Liver-Qi; Spleen-Yang Deficiency with Phlegm; Disharmony of Directing and Penetrating Vessels; Stagnant Liver-Qi turned into Fire; Toxic Heat; Liver- and Kidney-Yin deficiency; Other herbs and formulae according to symptoms and signs

Prognosis and prevention 784
Herbal treatment; Acupuncture; Prognosis

Western differentiation 786

60. Abdominal Masses: Ovarian cysts, polycystic ovary disease, cervical dysplasia 791

Aetiology and pathology 792
Emotional strain; Diet; External pathogenic factors

Differentiation and treatment 792
Qi masses
Liver-Qi stagnation; Retention of Food and Phlegm
Blood masses
Stagnation of Qi and Blood; Stasis of Blood knotted in the Interior; Deficiency of Upright Qi and stasis of Blood

Prognosis and prevention 803

Western differentiation 804

Appendix I: Ovarian cysts 806
Aetiology and pathology
Herbal treatment

Appendix II: Polycystic ovary disease 808
Differentiation and treatment
Deficiency of Kidney-Yang with Dampness/Phlegm; Deficiency of Kidney-Yang, Phlegm and stasis of Blood
Appendix III: Cervical dysplasia 812
Treatment
Acupuncture; Herbal treatment

61. Excessive Vaginal Discharge 817

Aetiology and pathology 818
Irregular diet excessive physical work; Emotional strain, Overwork; Invasion of external Dampness

Differentiation and treatment 819
Spleen deficiency; Kidney-Yang deficiency; Kidney Yin deficiency; Damp-Heat; Toxic Heat; Liver-Qi stagnation; Prescription by Fu Qing Zhu; Ancient acupuncture prescriptions

Prognosis and prevention 833

Western differentiation 833

62. Vaginal Itching: Trichomonas and Candida infections, genital eczema 835

Aetiology and pathology 835
Emotional problems; Irregular diet; Excessive physical work; Overwork

Differentiation and treatment 836
Damp-Heat in the Liver channel; Dampness and Spleen-Qi deficiency; Liver -and Kidney-Yin deficiency; External treatments; Ancient acupuncture prescriptions for vaginal itching

Prognosis and prevention 840

Western differentiation 841

Appendix I: Trichomonas and Candida Infections 841
Trichomonas vaginalis infection; Candida infection
Appendix II: Genital eczema 842
Differentiation and treatment
Damp-Heat in the Liver channel; Blood deficient and dry
External treatment

63. Prolapse of the uterus 845

Aetiology and pathology 845

Excessive physical exercise; Chronic illness; Childbirth; Prolonged coughing

Differentiation and treatment 845
Spleen-Qi sinking; Kidney-Qi deficient and sinking; Ancient acupuncture prescriptions for prolapse of the uterus.

Prognosis and prevention 848

Western view 848

64. Vulvar Sores 851

Aetiology and pathology 851
Invasion of External Dampness; Irregular Diet; Emotional strain; Excessive use of Yang tonics.

Differentiation and treatment 852
Toxic Heat with Liver-Fire and Damp-Heat; Retention of Cold

Prognosis and prevention 856

Western differentiation 856
Red lesions; White lesions; Dark lesions; Ulcerative lesions

Appendix I: Prescriptions 859
Empirical prescriptions (by order of chapter) 904

Appendix II: Patent remedies 913

Glossary of Chinese terms 923

Bibliography 929

Cross-reference of Chinese disease-symptoms and Western diseases 933

Cross-reference of Western diseases and Chinese disease-symptoms 937

Index 941