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Disorders of the Vagina

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Prolapse – Yin Ting

Vaginal Itchiness – Yin Yang

Genital Eruptions

Vaginal Pain

Infertility

Prolapse – Yin Ting

Diagnosis

Degrees

1. Cervix falls to pubis symphysis

2. Can possibly see cervix

3. Uterus exits to external

Etiology

            1. Qi ↓ - Qi sinking, Ren & Dai lose consolidation function.

            2. KI Qi/Yang ↓ - can’t help Ren & Dai consolidate Uterus.

            3. Chronic cough

Secondary

            4. Damp/Heat – Damp/Heat arises from other ↓

            5. Injuries

Pathogenesis Differentiation & Treatment

Qi ↓

            1^st & 2^nd degree prolapse, gets worse when tired.

                        Plus – Qi sinking symptoms (see Appendix 1)

                        P/T – nourish Zhong Qi, ascend SP Qi

                        Rx – Bu Zhong Yi Qi Tang (increase dosage of Huang Qi, Dang Shen)

                                                                add – Xu Duan (KI), Jin Ying Zi (astringent rosehips)

                                                                Zhi Qiao (move Qi), Wu Mei (astringent)

KI ↓

            2^nd & 3^rd degree prolapse, cold sore weak low back/knees

                        Plus – KI ↓ symptoms (see Appendix 1)

                        P/T – strengthen KI, consolidate Uterus

                        Rx – Da Bu Yuan Jian

Vaginal Itchiness – Yin Yang

Diagnosis

Genital area has itchiness which is difficult to relieve, this may be complicated w/ leukorrhea & anal itch.

Etiology

            1. Damp/Heat – stagnation in low Jiao, (various infections) → Heat → Wind

            2. LR KI Yin ↓ - Yin ↓ produces dryness → Heat → Wind

            3. LR HT stagnation → Fire – follows LR Jing to genitals → Heat → Wind

Pathogenesis Differentiation & Treatment

Damp/Heat

            itch, leukorrhea that is yellow thick & smelly, red vulva with fluid covering it.

                        Plus – Damp/Heat symptoms (see Appendix 1)

                        P/T – clear Heat, induce diuresis, destroy parasites, relieve itch

                        Rx – Bei Xie Fen Qing Yin  or  Long Dan Xie Gan Tang

LR KI Yin ↓

dry & burning with itchiness, may have leukorrhea w/o odour, may also be pinkish if Heat present.

                        Plus – LR KI Yin ↓ symptoms (see Appendix 1)

                        P/T – nourish LR KI Yin, clear Fire

                        Rx – Zhi Bai Di Huang Wan

LR HT Fire

            itch, emotional neurosis, more itch at night, nothing visual upon examination.

                        Plus – LR HT Fire symptoms (see Appendix 1)

                        P/T – clear LR HT Fire

                        Rx - Dan Zhi Xiao Yao San (more LR)

                                Jia Wei Gui Pi Tang (more HT)

Genital Eruptions

Diagnosis

Genital area has red swollen hot painful skin eruptions, if severe can fill with pus then discharge before healing.

Etiology

            1. Toxic Heat – (most common) external heat invasion → hyper HT or LR fire, poor diet – greasy spicy hot foods, meridians get invaded → eruptions.

            2. Cold stagnation – diet, external cold, weak qi & blood SP ST constitution, can’t lead blood & Qi → pathogens invade → stagnation in Jing → eruptions.

Pathogenesis Differentiation & Treatment

Toxic Heat

acute, 1^st-3^rd  days feeling of swollen pain → turns to a red lump (may affect movement), around 5^th day pus will form & discharge, around 7^th day the wound will start to heal.  Tough area to heal, may become chronic infection.  This pattern is often Herpes.

                        Plus – Toxic Heat symptoms (see Appendix 1)

            P/T – clear Heat, detoxify, promote blood circulation, move stasis

                        Rx – Wu Wei Xiao Du Yin or Xian Fang Huo Ming Yin

                                                          *if chronic add Huang Qi & Jie Geng

Cold stagnation

slow onset, no colour change (unless long term may turn darker purplish), starts as a hard lump → ulceration may occur if left untreated long term, may also discharge pus.  These are very difficult to heal.

            Plus – Qi & blood ↓ symptoms (see Appendix 1)

            P/T – nourish Qi & blood to eliminate toxicity

Stage #1 – hard lumps, no discoloration or pain unless touched, typically the size of a jellybean.

            Rx – Yang He Tang

Stage #2 – ulcer & discharge

            Rx – Tuo Li Xiao Du San

Vaginal Pain

Diagnosis

Pain in vaginal area possibly radiating upwards towards uterus, abdomen, or even to the breasts.

Etiology

            1. LR KI ↓ - can’t nourish Jing Luo, leads to Fire which injures Jing Luo

            2. LR Fire – long term LR Qi stagnation → Fire w/ pain swallowing the Jing to the genitals, can also go to breasts.

            3. Damp/Heat in low Jiao – LR SP dysfunction, KI ↓, Damp/Heat go to low Jiao

            4. SP Qi sink – can’t control local tendons → flaccidity &/or heavy pulling pain.

            5. Wind/Cold stagnation – after delivery Wind/Cold invades → blocks LR Jing & produces pain.

Pathogenesis Differentiation & Treatment

LR KI ↓

            older women, dryness with burning pain, local area may be shrunken or shriveled.

                        Plus – LR KI ↓ symptoms (see Appendix 1)

                        P/T – nourish LR KI ↓, clear Heat

                        Rx – Zhi Bai Di Huang Wan

LR Fire

            vaginal pain radiate to abdomen & possibly nipple

                        Plus – LR Fire symptoms (see Appendix 1)

                        P/T – soothe LR, purge Fire

                        Rx – Dan Zhi Xiao Yao San

SP Qi sinking

            local heavy pulling downward pain, thin clear vaginal discharge

                        Plus – SP Qi ↓ symptoms (see Appendix 1)

                        P/T – nourish mid Jiao Qi

                        Rx – Bu Zhong Yi Qi Tang or Ju Yuan Jian

Damp/Heat

            swollen pain, ↑ yellow thick smelly leukorrhea, local ulcerations or inflammation

                        Plus – Damp/Heat symptoms (see Appendix 1)

                        P/T – clear Heat, induce diuresis

                        Rx – Long Dan Xie Gan Tang or Yi Huang Tang

Wind/Cold stagnation

            postpartum, can be very severe swollen pain, no inflammation or redness & burning

                        Plus – Wind/Cold symptoms (see Appendix 1)

                        P/T – expel Wind/Cold to harmonize Luo & relieve pain

                        Rx – Qu Feng Ding Tong Tang

Infertility

Diagnosis

When have had normal sexual activity for 2-3 years, there is nothing wrong with the male sperm, yet still can’t achieve pregnancy.  May have irregular menses, leukorrhea, dysmenorrhea.  Instruct woman to go and see gynecologist to have full examination.  Educate patient on fertility charting & other methods to check if ovulation is happening (mucous, temperature, saliva, new checking devices).  Also ask what types of birth control has been used in the past. 

Etiology

            1. KI ↓ - KI ↓ of any type can inhibit conception, Ming Men ↓ - cold uterus, Yin ↓ - lack of Essence can create Heat & dryness.

            2. LR Qi stagnation – LR blood ↓ - try so hard to get pregnant that it stresses the emotions, disharmony between Ren & Chong Mai.

            3. Phlegm-Damp – tubal blockage, overweight, cold invades during menses.

            4. Blood Stasis – any reason that causes stagnation in Jing Luo, Chong & Ren Mai are not clear & open.

Pathogenesis Differentiation & Treatment

KI Yang ↓

            delayed scanty pale menses, # of cycles/year is reduced

                        Plus – KI Yang ↓ symptoms (see Appendix 1)

                        P/T – warm KI Yang, strength & nourish Ren & Chong

                        Rx – Yu Ling Zhu

KI Yin ↓

            early scanty or delayed scanty menses, red in colour

                        Plus – KI Yin ↓ symptoms (see Appendix 1)

                        P/T – nourish KI Yin/blood to regulate Ren & Chong Mai

                        Rx – Yang Jing Zhong Yu Tang (after menses)

LR Qi stagnation

            PMS, irregular cycles with clotted blood

                        Plus – LR Qi stagnation symptoms (see Appendix 1)

                        P/T – soothe LR, nourish blood

                        Rx – Kai Yu Zhong Yu Tang (open stagnation plant egg soup)

                                    - omit Tian Hua Fen

Phlegm-Damp

(polycystitis), overweight, male characteristics, pubic hair thinning, may skip periods but have heavy flow when arrive, or delayed scanty, amenorrhea, heavy thick leukorrhea

                        Plus – Phlegm-Damp symptoms (see Appendix 1)

                        P/T – dry Damp, dissolve Phlegm

                        Rx – Qi Gong Wan (open uterus pill)

Blood Stasis

            clotted purple dark menses that are delayed with dysmenorrhea, low back/abdominal pain, PID, endometriosis

                        Plus – Blood Stasis symptoms (see Appendix 1)

                        P/T – promote circulation, remove Stasis, regulate Ren & Chong Mai

                        Rx – Shao Fu Zhu Yu Tang (remove stasis then try to get pregnant after)

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