Inflammatory and Atrophic Vaginitis and their treatment with Chinese Medicine
This post regarding Inflammatory and Atrophic Vaginitis is the 4th of a series of posts written by Yuxiang Wang for TCM Practitioners regarding the treatment of Vaginal Infections.
The other articles in this seriess can also be found on this site:
Treating Infections 1 – Bacterial Vaginosis
Treating Infections 2 – Trichomonal Vaginitis
Treating Infections 3 – Yeast Infections (Candidiasis)
Inflammatory Vaginitis
Desquamative inflammatory vaginitis is a clinical syndrome characterized by diffuse exudative vaginitis, epithelial cell exfoliation, and a profuse purulent vaginal discharge. The cause of inflammatory vaginitis is unknown, but Gram stain findings reveal a relative absence of normal long gram-positive bacilli (lactobacilli) and this disorder have a purulent vaginal discharge, vulvovaginal burning or irritation, and dyspareunia. A less frequent complaint is vulvar prutitus. Vaginal erythema is present, and there may be an associated vulvar erythema, vulvovaginal ecchymotic spots, and colpitis macularis. The pH of the vaginal secretions is uniformly higher than 4.5 in these patients. Initial therapy is the use of 2 % clindamycin cream, one applicator full (5 g) intravaginally.
Atrophic Vaginitis
Estrogen plays an important role in the maintenance of normal vaginal ecology. Women undergoing menopause, either occurring naturally or secondary to surgical removal of the ovaries, may develop inflammatory vaginitis, which may be accompanied by an increased, purulent vaginal discharge. In addition, they may note dyspareunia and postcoital bleeding resulting from atrophy of the vaginal and vulvar epithelium. Examination reveals atrophy of the external genitalia, along with a loss of the vaginal rugae. The vaginal mucosa may be somewhat friable in areas. Microscopy of the vaginal secretions shows a predominance of parabasal epithelial cells and an increased number of leukocytes. Atropic vaginitis is treated with topical estrogen vaginal cream.
Atrophic Vaginitis is damp-heat downward or Yin deficiency of the Liver and Kidney
The Treatment of Vaginal Infections with Chinese Medicine
| Atrophic Vaginitis Both have pruritis vulvae and vagina with burning sensation and yellow vaginal discharge. | |||
| Syndrome | Discharge | Other Symptoms | Formula |
| Damp Heat Pouring Down | Excessive vaginal discharge, dilute and watery nature, foul smell | Red tongue, yellow greasy coating, soft rapid pulse | Modified Zhi Dai Tang |
| LV & KI Yin Deficiency | Red tongue less coating, thready rapid pulse | Modified Zhi Bai Di Huang Wan + He Shou Wu, Dang Gui, Fang Feng |
External Treatment for Vaginal Infections:
- Acupuncture: UB 34, SP 10, SP 6, LV 5, RN 2, PC 7.
- Fumigation & Washing: She Zhuang Zi 30g, Guan Zong, Dou Gu Cao, Ku Shen, Huang Bai, Yin Yang Huo, Bai Bu 20g for each, cook liquid for fumigation and washing.
- Hip bath: Bai Bu 30g, She Zhuang Zi 30g, Hua Jiao 30g, Ku Fan 15g, Ku Shen 30g. cook liquid for hip bath. Once a day, 10 days a course.
- Vaginal douche: Qian Li Guang, Yu Xing Cao, She Zhuang Zi, Lu Xian Cao, Dan Shen 30g for each, cook 150 ml liquid for vaginal douche. Once a day, 5 days a course.
General Approach to the Study of Vaginitis
Etiology & Pathology: vaginitis is caused by dampness which impairs the Dai and Ren meridians. Spleen deficiency, Liver Qi stagnation and Kidney deficiency are related with production of internal damp. Chronic vaginitis or recurrent vaginitis is related with accumulation of dampness and Blood stasis as well as deficiency of Spleen and Kidney. Dampness is Yin pathologic factor, which tend to obstruct Qi-Blood.
Treatment: eliminating dampness is main treatment principle. According to the differentiation, modified Zhi Dai Tang is for dampess heat syndrome; modified Wu Wei Xiao Du Yin for Toxin-heat syndrome; modified Wan Dai Tang for Spleen deficiency; modified Nei Bu Wan for Kidney deficiency; modified Zhi Bai Di Huang Wan for Liver and Kidney Yin deficiency.
Herbology: Huang Lian has anti-bacteria, anti-trichomonal and anti-fungal functions and is commonly included in formulas for Vaginal Infections.
- Ku Fan is effective herb for reducing excessive vaginal discharge, and healing ulceration.
- Ding Xiang is an anti-fungal agnet.
- She Zhuang Zi and Ku Shen have function for relieving pruritus.
- Bing Pian and Ku Fan can clear away slough and promote tissue regeneration.
- Bile of pig can kill trichomonas vaginalis.
Yuxiang Wang, R.Ac R. TCMP is dedicated to improving Chinese Medicine Gynecology in North America. She teaches in Toronto, Canada, Online, and leads a yearly intensive/beach holiday in Melaque, Mexico. Details about her course on Treating Menopause in May 2020 are available at learningonvacation.com