by Bob Flaws

Vaginal discharge disease (dai xia bing) is one of the four basic disease categories of traditional Chinese gynecology. It refers to any condition where an erroneous vaginal discharge is the main clinical symptom. This broad category of conditions is then usually subdivided into three, five, or more types identified primarily by their color. In other words, there is white vaginal discharge (bai dai), yellow vaginal discharge (huang dai), red and white vaginal discharge (chi bai dai), etc. In terms of modern Western medicine, vaginal discharge diseases most commonly correspond to vaginal infections, such candidiasis and trichimoniasis. While modern Western medicine typically treats these conditions with fungicides and antibiotics, Chinese herbal medicine can be a very effective treatment with none of the usual side effects of such harsh Western medicines. This is especially so when internal treatment per os (by mouth) is combined with “external” treatment of the vaginal tract.

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Wan Dai Tang ("End Vaginal Dischaege Decoction") is the most famous Chinese herbal formula for the treatment of vaginal discharge disease. Wan Dai Tang comes from one of the most important pre-modern texts on Chinese gynecology, Fu Qing-Zhu’s Gynecology (Fu Qing Zhu Nu Ke, available in English translation through Blue Poppy Press), published in the Qing dynasty. If a practitioner knows only one Chinese herbal formula for the treatment of abnormal vaginal discharge, this is certainly the one to know (and use!).

This formula consists of the following ingredients:

Bái Zhú  (Rhizoma Atractylodis Macrocephalae), earth stir-fried

Shān Yào (Rhizoma Dioscoreae), stir-fried

Rén Shēn (Radix Ginseng)

Bái Sháo (Radix Alba Paeoniae)

Chē Qián Zǐ (Semen Plantaginis), wine stir-fried

Cāng Zhú (Rhizoma Atractylodis)

Gān Cǎo (Radix Glycyrrhizae)

Chén Pí (Pericarpium Citri Reticulatae)

Jīng Jiè (Herba Schizonepetae), charred

Chái Hú (Radix Bupleuri)

Treatment principles: Supplements the center and fortifies the spleen, transforms dampness and stops vaginal discharge.

Indications: Spleen vacuity and liver depression, with damp-turbidity pouring downward. White or pale yellow vaginal discharge that is thin, clear, and without foul odor accompanied by bright white facial complexion, fatigue, and loose stools, a pale tongue with white fur, and a moderate or soggy, weak pulse.

Formula analysis:  Vaginal discharge diseases mostly commonly occur in sexually active young women. Typically, as women age, they have less and less of these kinds of infections, and the single most common pattern of disharmony in women of this age group is a liver-spleen disharmony. In this case, due to a combination of liver depression checking the spleen and faulty diet (usually too much sugar and refined carbohydrates), there is a marked spleen vacuity. The vacuous spleen is thus not able to properly control the movement and transformation of water fluids. These water fluids accumulate in the middle burner. However, because they are heavy, they tend to seep downward from the middle to the lower burner where they manifest as excessive vaginal discharge. (There is a saying in Chinese medicine that, “[If there is] no phlegm dampness, [there is] no abnormal vaginal discharge.”) If there is little or not depressive or damp heat, this discharge is white. If there is a little more heat, this discharge is pale yellow.

Within this formula, Bia Zhu, Cang Zhu, Shan Yao, Chen Pi, and Che Qian Zi all transform and eliminate phlegm and dampness. Bai Zhu, Cang Zhu, Shan Yao, and Chen Pi aromatically dry and transform dampness, while Che Qian Zi seeps dampness. Ren Shen, Shan Yao, Bai Zhu, and Gan Cao all fortify the spleen and supplement the qi, thus addressing the root of the engenderment of the phlegm dampness. Shan Yao also supplements the kidneys which govern water movement and transformation in the lower burner, while Gan Cao also harmonizes all the other ingredients in the formula, thus making it more easily digestible. Jing Jie and Chai Hu course the liver and rectify the qi. They both also clear an element of heat, in this case, depressive heat. Bai Shao nourishes the blood and harmonizes the liver. Bai Shao also astringes yin, and abnormal vaginal discharge is a species of yin discharge. In terms of this formula’s harmonizing the liver and spleen, its emphasis is on spleen vacuity and dampness.

This formula can be and often is used all on its own. However, it can also be used as a “module” along with either Xiao Yao San (Rambling Powder) or Dan Zhi Xiao Yao San (Moutan & Gardenia Rambling Powder). It can be used with Xiao Yao San if liver depression and blood vacuity are more prominent, or it can be used with Dan Zhi Xiao Yao San if there is more depressive heat. In either case, one can adjust the relative proportions of each formula depending on whether spleen vacuity with dampness or liver depression with or without heat is most prominent. This formula can also be combined with Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) is spleen qi vacuity is more pronounced and there is a marked element of downward falling of the central qi.

In real life, most abnormal vaginal discharge diseases, and especially those involving white or light yellow discharges) are associated with faulty diet. This means that the woman is eating too many sweets and refined carbohydrates as well as possibly too many fermented foods, such as alcohol, bread, and cheese. However, of all of these, sugar is the main culprit, with many women reporting a definite correlation between the amount of sugar they eat and the amount of their discharge. In these cases, it is extremely important to explain the Chinese medical mechanisms responsible for this connection between faulty diet and abnormal vaginal discharge. Otherwise it is difficult or impossible to get a marked clinical effect with the herbs alone.

If the abnormal vaginal discharge is accompanied by external vaginal itching, an “external” treatment of the vaginal tract may be combined with internally administered Chinese medicinals. Such external treatments may be administered in the form of douches, pessaries, or suppositories. Because there are a number of such formulas correlated to the various shades of a liver-spleen disharmony with or without heat, practitioners should see their basic Chinese gynecology textbooks for such formulas. Of course, one can also combine internally administered Chinese herbs. In that case, local points, such as the Bai Liao (Bl 28-32), Zhong Ji (CV 3), Guan Yuan (CV 4), and Qi Hai (CV 6), and distant points, such as San Yin Jiao (Sp 6), Yin Ling Chuan (Sp 9), Tai Chong (Liv 3), and/or Xing Jian (Liv 2), are commonly used.

Note:  The signs and symptoms give above are the standard textbook signs and symptoms given for this formula. However, because there can be varying degrees of liver depression, depressive and/or damp heat,  blood vacuity, spleen vacuity, and phlegm dampness, these textbook signs and symptoms are only suggestive. For instance, if there is more dampness, the facial complexion may be more yellowish. If there is less qi vacuity but an element of concomitant blood vacuity, the facial complexion may be merely pale and possible dry. If there is marked liver depression, the pulse may be fine and bowstring (wiry) as opposed to soggy and weak. In most Western patients, the tongue will be somewhat swollen with teethmarks on its edges. Because a liver-spleen disharmony tends to get worse in women during the premenstruum, the vaginal discharge and any accompanying signs and symptoms, such as fatigue and loose stools, may only only become obvious during that phase in the patient’s menstrual cycle. Further, due to the concomitant liver depression qi stagnation that most women with this condition experience, there are usually signs and symptoms of that pattern, such as premenstrual breast distention and pain, irritability, and possible lower abdominal cramping and pain, which are not mentioned under the pure textbook signs and symptoms above. Hence, the practitioner cannot rely solely on such textbook signs and symptoms. Rather, it is most important to understand the patterns and their mechanisms at play in such conditions and then be able to posit the various signs and symptoms that may actually occur depending on the various strengths and weaknesses of those disease mechanisms.

In any case, if you treat young adult females, you should definitely keep this formula on hand. Even if you rarely prescribe it all by itself, it is a very useful adjunct to other formulas when abnormal vaginal discharge is part of a woman’s overall symptom/sign picture.

Copyright Blue Poppy Press, 2011. All rights reserved.