The study of women’s diseases, as in Western Medicine, is a field of study on its own. While the syndrome differentiations and treatment principles often stay in line with Traditional Chinese Medicine differentiations and principles, the diagnosis and sometimes the treatment for gynecological conditions can be quite different. To treat women’s diseases effectively, the diagnosis must be accurate and general questions as well as a thorough and detailed questioning is essential. According to Maciocia, there are six different areas that should be examined: menstruation, pain, vaginal discharge, fertility & pregnancy, childbirth, and miscarriages. Please see Maciocia’s Obstetrics & Gynecology in Chinese Medicine for more details.
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 indicates 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
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.
Fertility conditions are determined based on groups of symptoms, not necessarily a specific type of infertility. Deficient conditions include Blood or Kidney Deficiency. Blood deficiency infertility would include symptoms such as amenorrhea, scanty periods, late periods, blurred vision, tingling of the limbs, dry skin and hair, dizziness, and insomnia. Kidney Deficiency would include symptoms such as many types of period problems from menorrhagia, late periods, early periods, leucorrhea, diarrhea with periods, to scanty periods, amenorrhea, and miscarriage. Other symptoms include backache, cold hands and feet, frequent pale urination, hot flushes, possibly night sweating, dizziness, tinnitus, backache, feeling of heat.
Fertility problems can also be due to excess type conditions such as Blood stasis, cold stagnation, or damp-heat. Blood stasis presents with symptoms such as painful periods with dark clots and premature menopause along with dark complexion, abdominal pain, abdominal masses and insomnia. Cold stagnation usually presents with many types of period problems such as late periods, scanty periods, dilute periods, or periods with small dark clots, painful periods and leucorrhea, with a feeling of cold, abdominal pain and a (dull) pale complexion. Damp Heat often presents as vaginal itching, vaginal discharge, and occasional pain on intercourse, along with restlessness, irritability, insomnia and dark urine.
One of the most common symptoms during pregnancy is nausea and vomiting, which is generally due to rebellious Qi in the Penetrating vessel that attacks the Stomach meridian, which can be due to Stomach deficiency or Stomach heat. Otherwise, pregnancy edema indicates Kidney Yang deficiency, high blood pressure shows Kidney deficiency with Liver Yang rising. High blood pressure can be an early indicator of eclampsia, a serious condition that presents with seizure activity.
This refers to conditions that occur just after labor. Nausea with heavy bleeding indicates exhaustion of the Penetrating vessel, sweating with fever indicates exhaustion of Qi and Blood, post natal depression is due to Liver and Heart Blood deficiency, and post natal psychosis is due to Blood stasis in the uterus.
According to Chinese Medicine, miscarriage can be more draining for the body than labour itself. There can be a significant amount of blood loss, along with the mental-emotional aspects of such an event. If miscarriage happens before three months, it is due to a Kidney deficiency. If miscarriage occurs after three months, this can be due to Spleen Qi sinking, Liver Blood stasis, or Blood heat. Habitual miscarriage (3+ miscarriages) denotes Kidney Yang deficiency, Kidney Yin deficiency, Blood heat, Spleen Qi deficiency, Blood deficiency, or Blood stasis.
These types of questions should be asked of all women. For women, their menstrual cycle is their basis and anything related to this should be examined in detail.
Caroline Prodoehl, R.Ac, R.TCMP
Maciocia, Giovanni (1998). Obstetrics & Gynecology in Chinese Medicine. Churchill-Livingstone. New York, New York.