by Eric Brand

Chinese medicine is very well-known for its applications in gynecology. Gynecology is one of the major success fields in Chinese medicine. The importance of fertility in traditional Chinese culture made gynecology a focal point for centuries, so there is an extensive amount of literature and expertise in this field. By contrast, andrology (men's diseases) is a much smaller niche in Chinese medicine, with far fewer historical and modern texts, as well as far fewer clinical experts. Furthermore, nearly every TCM hospital has a gynecology section, but a special section for andrology is quite uncommon. (Incidentally, my teacher Bob Damone recently published an excellent book on Chinese Medical Andrology. It is the only text in its class for this topic, and in fact its scholarship and scope even exceeds the majority of Chinese sources on the subject. It can be found on the Blue Poppy site at: http://bluepoppy.com/cfwebstorefb/index.cfm?fuseaction=product.display&product_id=1331)

So, on to a brief survey of key historical developments in TCM gynecology:

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Early History

Fertility appears in such ancient classics as the Yi Jing. In fact, fertility is alluded to as early as the oracle bones, China’s first evidence of writing. Oracle bones were generally turtle shells and other bones that date back to the prehistoric Shang dynasty. These shells and bones were inscribed with writing and were put into a fire for purposes of divination- the direction of the lines after the shell cracked from the heat indicated the answer to the question posed. Interestingly, oracle bones were only discovered to be an artifact of a bygone civilization a few hundred years ago, when someone purchasing long gu (dragon bone) in a Chinese pharmacy discovered writing in the fossil. The revelation that oracle bones had been ground up and eaten for 1600 years before their discovery shook the Qing Dynasty Chinese community. Of course, now they are protected and housed in museums, but no one knows how many were lost because of Chinese medicine.

Han Dynasty (206 BC-220 AD)

The Huang Di Nei Jing is believed to be a compilation by a large number of authors in the Han Dynasty (Paul Unschuld's research suggests that it had over 300 contributors). The Nei Jing provides the first true introduction to TCM physiology, pathology, diagnosis, and treatment. A tremendous amount of our modern day understanding of things like 7 year cycles, tian gui, and channel theory comes from the Nei Jing. The Nei Jing also contains the first gynecological formula: si wu zei gu yi lu ru wan (four of cuttlefish to one of madder pill). This is notable because the Nei Jing contains only 13 herbal formulas.

“Essential Prescriptions of the Golden Coffer” (金匱要略Jīn Guì Yào Luè), by Zhāng Jī, had three chapters on women’s health: pregnancy, postpartum, and miscellaneous diseases.
It is the first book to offer separate chapters on women’s health, and covers theory, methods, formulas, and medicinals.

The Jin Gui contains over 30 formulas for diseases of menstruation, pregnancy, postpartum, vaginal discharge, visceral agitation, and concretions and conglomerations. It introduces formulas such as jiao ai tang, gui zhi fu ling wan, and gan mai da zao tang.

Jin and Sui Dynasties (581–618 AD)

The Mai Jing (Pulse Classic) by Wang Shu-He contains 8 chapters on pulses specific to women’s health.

“The Origins and Indicators of Disease” (诸病源候论Zhù Bìng Yuán Hóu Lùn) explains the causes and pathological processes of women’s disorders such as irregular menstruation, abnormal vaginal discharge, prolapse of the uterus, breast disorders, pregnancy, and difficult labor. It has no formulas, just theory, but contains the first mention of induced abortion.

Tang Dynasty (618–907)

Sūn Sī-Miǎo’s attention to women’s illnesses can be found in the first volumes of his text, “A Thousand Gold Pieces Emergency Formulary” (备急千金要方Bèi Jí Qiān Jīn Yào Fāng). It covers fertility, pregnancy, childbirth, lactation, postpartum recovery, supplementing and boosting, menstrual disorders, vaginal discharge, and miscellaneous diseases.

The Tang Dynasty text Jing Xiao Chan Bao (Classically Effective Treasures of Obstetrics) is the earliest extant text that focuses on obstetrics.

Interestingly, by the Song Dynasty, gender was assumed to be fixed at conception. Prior to this, it was thought to be open to influence for the first three months. For example, from the Tang Dynasty: “Take a crossbow string, place it in a crimson bag and have the pregnant woman carry it on her left arm” or to tie it around her waist below the belt. Another prescription calls for an ax to be hidden under the woman’s bed. All of these actions needed to be performed secretly, a common feature in magical prescriptions. There is a curious combination of medical and magical thinking, but even the medicinal prescriptions include such ingredients as dog testicles and the head of a rooster from the top of the eastern gate.

Song Dynasty (960–1279)

The Song Dynasty was the first time that gynecology was established as its own specialty.
Chén Zì-Míng’s “Compendium of Good Remedies for Women” (妇人大全良方Fù Rén Dà Quán Liáng Fāng) is praised as the first comprehensive text on gynecology and obstetrics. It is a summary of the essence of various gynecological classics in the past, his personal clinical experience, and his widely collected formulas, including family remedies passed down for generations.

Chén Zì-Míng claimed that menstruation must be regulated first, if not, myriad illnesses may ensue; if menstruation is regular, the woman will get pregnant. This idea took hold. In addition, difficult labor, “the sitting/resting month” (zuo yue zi, the first month after labor) and postpartum illnesses are well-discussed in his book. The practice of taking a month for rest after labor remains highly developed (if occasionally a bit extreme) in places like Hong Kong and Taiwan.

Jin-Yuan Dynasties (1115-1368)

The Jin-Yuan Dynasties were host to four important figures in Chinese medicine. They are collectively called the "four great masters of the Jin-Yuan dynasty" and each was known for developing medical theory in a different direction, each of which has had lasting significance. The four great masters are Liu Wan-Su, Li Dong-Yuan, Zhu Dan-Xi, and Zhang Zi-He. Their many contributions can fill a book, so I am just mentioning of few ways in which they contributed to gynecology.

Liu Wan-Su (Liu He-Jian) is known for using different formulas during different seasons for women:
Spring: Fang Feng Si Wu Tang with double chuan xiong
Summer: Huang Qin Si Wu Tang with double bai shao
Fall: Tian Men Dong Si Wu Tang with double shu di
Winter: Gui Zhi Si Wu Tang with double dang gui
Also recommended draining heart fire for amenorrhea, as he believed heat and fire are the major causes of disease

Li Dong-Yuan (Li Gao) advocated supplementing the spleen and raising clear yang, and he applied this to gynecology as well. He is also well known for his theories on yin fire. Bob Flaws has written extensively about Li Dong-Yuan and his theories, so interested parties can find endless resources at Blue Poppy, including articles, books like the Pi Wei Lun, continuing education courses, and even prepared herbal formulas inspired by Li's perspectives.

Zhu Dan-Xi observed that “yang is often in superabundance and yin is often insufficient,” which continues to influence practitioners today. Also emphasized bai zhu and huang qin for quieting fetus.

Zhang Zi-He was known for saying that “to nourish life, use food to supplement. To treat disease, attack with medicinals.” He believed that phlegm and water often content with qi and blood, and appropriate treatments should use vomiting, purging, and sweating.

Ming Dynasty (1368–1644)

Zhang Jing-Yue was a very important figure in Chinese medicine. He created many of the mainstay formulas that we use in modern gynecology today, such as you gui wan and zuo gui wan, and gui shen wan. Zhang Jing-Yue laid the foundation for pattern identification with his comprehensive text “Jing-Yue Quan Shu” (Jing-Yue’s Complete Compendium). This incredibly vast and important book has never been translated into English, but it informs our everyday practice.

Interestingly, The Jing-Yue Quan Shu also contains the first clear evidence of knowledge of sexually transmitted disease. In exploring the pathomechanisms of syphilis in his text, he states: “…most of these pathoconditions are engendered following the transmission of licentious (sexual) toxins. Following the discharge of essence, the qì of this foul licentious toxin follows the essence pathway, exploiting vacuity to penetrate directly into the life gate before pouring into the controlling (ren) vessel. It goes to all the places that the controlling vessel reaches, the skin and body hair in the outer body, and the bones and marrow in the inner body; there is no place that it does not reach.”

Qing Dynasty (1644-1911)

Fu Qing-Zhu’s Gynecology (Fu Qing Zhu Nu Ke) is one of the most important texts in gynecology, emphasizing the role of the liver, spleen, and kidney, as well as qi and blood and the chong and ren vessels.

Fu Qing-Zhu's Gynecology contains both theory and formulas, and is a particularly good source for discussions on vaginal discharge. It is available in English by Blue Poppy, and can be found at: http://bluepoppy.com/cfwebstorefb/index.cfm?fuseaction=product.display&product_id=396

The “Golden Mirror of Orthodox Medicine” (Yi Zong Jin Jian) is a comprehensive, 90-volume compendium of medical theory and practice that was compiled by court physicians in 1742. It was used as a textbook for the Imperial Medical School in the Qing Dynasty.

In the six-volume gynecology section, the most common topics related to women’s health are presented. Chapters are structured with verses followed by annotations and are dedicated to menstruation, fertility, pregnancy, childbirth and postpartum care. Altogether, one hundred and sixty one classical formulas and their variations are contained within. This book, Heart Approach to Gynecology: Essentials in Verse, is available from Paradigm Publications.

Interesting Changes Over Time

Some pathomechanisms have received different degrees of emphasis over time, while others have expanded in their application.

For example, plum-pit qi was initially thought to be a disease that affected women exclusively. It was first described in the Jin Gui Yao Lue (“Essential Prescriptions of the Golden Coffer”), which stated that women suffered from this condition and ban xia hou po tang (Pinellia and Magnolia Bark Decoction) governed it. (This is also historically the first mention of the pathomechanism of liver depression with phlegm binding in the throat.) 1800 years later, the authoritative Imperial compilation known as the Yi Zong Jin Jian (“The Golden Mirror of Orthodox Medicine”) explicitly pointed out that this pattern existed in men as well as women.

Were women historically thought to be more prone to liver qi depression? In the gynecology section of the Yi Zong Jin Jian, there are a number of instances where the authors of the text indicated that the gender hierarchy present in the Qing Dynasty contributed to women’s diseases.

For example, in the Fu Ke Xin Fa Yao Jue (“Heart Approach to Gynecology: Essentials in Verse”), the section on internal causes of menstrual disorders states: “Women must follow others and do not control all aspects of their own lives. The resulting anxiety, thought, rage, anger, and depressed qi can all cause damage. Thus, most menstrual disorders are due to damage from the seven affects.”

From the same book:

In a section entitled “Women’s Illnesses are Difficult to Treat,” the text states: “Kou Zong-Shi said that he would rather treat ten men than one woman, meaning that women’s disorders are usually not easy to treat. Because women are sequestered, they are melancholic, anxious, indignant, suspicious, and confused about their preferences. They do not get what they want, and they are stubborn and obstinate.” It goes on to discuss the cultural prohibitions on physical inspection, which further complicated diagnosis.

Wow! Sequestering can't be good for anyone...