*Note: the diagnosis of ‘crazy’ is excluded in this article for many reasons, mostly because women are beautiful and their intricacies deserve more credit… which is why both Chinese Medicine and Western Medicine have gynecology as a field unto itself.  So here is the TCM guide to helping understand women better though diagnosing.

Diagnosis in Western Medicine is always an asset to treating in Chinese Medicine.  For example, if a woman presents with painful or heavy periods, having a diagnosis of endometriosis or fibroids can be invaluable information to have for treatment purposes.  The trouble with Western Medicine treatments is that they can be painful, have long lasting side effects, be invasive and can be less likely to provide long lasting results.  Though, in order for the treatments to work to their full potential, a thorough intake and accurate diagnosis is needed, including detailed questioning.  According to Maciocia, there are six different areas that should be examined for diagnosing a woman: menstruation, pain, vaginal discharge, fertility, pregnancy, childbirth, miscarriage, and abortions.  Please see Maciocia’s Obstetrics & Gynecology in Chinese Medicine for more details.

 

Diagnosing via Menstruation

Menarche: Menses generally begin between the ages of 10 – 16.  Menstruation that begins before the age of 13 may indicate Blood heat, while late menarche may indicate Blood and/or Kidney deficiency.

Cycle: The general cycle length is 28 days.  There are differing opinions as to whether a cycle may be slightly longer or shorter as long as it is regular, for example a cycle of 32 or 35 days instead of 28.  An occasional variation is not generally considered abnormal.

If the cycle length is short (<21 days), this can indicate Qi deficiency or Blood heat.  If the cycle length is long (>35 days), this may show to be Blood deficiency, Blood stasis, or stagnation of cold.  Irregular cycle length often indicates stagnation of Liver Qi or Blood, or deficiency of the Spleen or Kidney.

Amount: the amount of blood loss per period is usually between 30ml and 80ml.  Blood loss can either be profuse or prolonged and is due to Qi deficiency or Blood heat.  Scanty menses are often due to Blood deficiency or stasis of heat or cold.

Colour: the colour of the blood usually changes through the cycle, starting light red, becoming a deeper red mid-cycle, and ending a pinkish colour.  Dark or bright red may indicate Blood heat, pale blood indicates Blood deficiency, black or dark blood indicates Blood stasis, purplish blood indicates excess type cold, brownish and dilute indicates deficiency type cold, and scarlet red indicates deficient heat in the Blood.

Clotting: blood should flow smoothly but not too freely.  Bleeding with clots that are dark and dull indicate Blood stasis or stagnation of cold, bleeding with clots that are dark and fresh indicated heat, large clots indicate stasis, small and dark clots without dark blood indicates cold stagnation, and watery bleeding indicates Blood or Yin deficiency.

Pain: menstruation should be virtually painless.  If there is pain before the onset of menses, this indicates Qi stagnation or Blood stasis, pain during menses indicates Blood heat or stasis, pain after menses indicates Blood deficiency.  If the pain is severe and stabbing, this indicates Blood stasis, if the pain is severe with cramping and is alleviated with warmth, this indicates cold stagnation.  Mild pain can be either Blood heat or Blood deficiency.  A dragging feeling in the lower abdomen indicates Qi sinking, while a feeling of heaviness in the lower abdomen indicates damp heat.  Pain on ovulation also leads to diagnosing damp heat.

PMS: Liver Qi stagnation is generally the cause of any premenstrual syndromes, as the stagnation attacks surrounding organs.  PMS includes:

  • Nausea/Vomiting: Liver Qi invades the Stomach
  • Constipation: Liver Qi invades the Spleen & Intestines
  • Headaches: stagnation or Liver Yang rising
  • Breast Distention: stagnation, maybe with phlegm
  • Water Retention: Spleen or Kidney Yang deficiency

 

Shang Dynasty (1500-1000 BCE): tortoise shells and bones were found with inscriptions about child birth.

Diagnosing via Vaginal Discharge

A small amount of discharge that is white and odorless, and increases slightly after ovulation is quite normal.  Otherwise, aberrant conditions might include colour, consistency, and smell.

Colour: if there is quite a bit of white coloured discharge, this indicates cold which may be due to Spleen or Kidney deficiency or cold damp invading from the exterior.  Yellow discharge is usually damp heat in the lower burner, greenish discharge is damp heat in the Liver channel, red and white discharge is damp heat, and yellow with red and white pus after menopause indicates toxic heat.

Consistency: a thick discharge is usually an excess condition such as damp heat.  A watery discharge is often a deficient condition or cold damp.

Smell: a fishy smell is often due to cold, while a leathery smell is generally due to heat.

 

Diagnosing Fertility

Infertility can occur for a wide variety of reasons and a thorough intake that helps to determine underlying and co-existing conditions is necessary to determine if the cause for the infertility is due to an excess or deficient condition.  Excess conditions include: Blood stasis, cold stagnation, and damp heat.  Common deficient conditions include: Blood deficiency or Kidney (Yin, Yang, Qi, or a combination) deficiency.

Pregnancy

There are a variety of conditions commonly associated with pregnancy:

  • Vomiting: morning sickness is due to a condition of rebellious Qi
  • Edema: swelling is generally due to a deficiency of Kidney Yang
  • High Blood Pressure: this is often associated with both a deficiency (Kidney) and excess (Liver Yang Rising).

 

Childbirth, Miscarriage & Abortion

A history of any complications during childbirth is also relevant.  Childbirth is generally always seen as a traumatic event and there can be considerable stress and loss of blood causing a state of deficiency in the body.  A deficiency of Qi and Blood can cause sweating and fever after delivery, and a deficiency of the penetrating meridian can cause nausea and heavy bleeding after delivery.  If the condition becomes organ specific, such as with Liver Blood or Heart Blood deficiency, symptoms such as post natal depression can arise.  Less frequently there are excess conditions such as Blood stasis in the Uterus which leads to post natal psychosis.

According to TCM, miscarriage is considered as traumatic- if not more so- than childbirth.  This is due to the increased risk of blood loss and mental-emotional reactions.  Miscarriage can be a very difficult time for the woman.  If a miscarriage happens before three months, it is usually due to a Kidney deficiency, while after three months it is due to Spleen Qi sinking, Liver Blood stasis, or Blood heat.

Any complications of childbirth or the event of a miscarriage can easily alter a woman’s body for a long time.  In an intake, questions surrounding childbirth should always be asked.

 

People are often surprised at the depth of a TCM intake, which is one of the reasons TCM works so well – not only does it treat symptoms; it regulates the body as a whole.

If you have any questions or comments, please feel free to contact us!  If you are a alternative medicine practitioner and would like to know more about TCM diagnosis, check out our upcoming courses.

 

Caroline Prodoehl, R.Ac., R.TCMP