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Healing & Alternative Health: Chinese medicine
A Dialogue on Menstrual Disorders
Part 1
by Kevin O'Neil, L.Ac |
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This is the first in a series of dialogues between Qi Bo (chee bow), the Yellow Emperor's physician, and the Dark Maiden, one of the Yellow Emperor's concubines and sexual advisors. The Yellow Emperor (Huang Di) is a legendary figure in Chinese history, said to have lived about 2400 B.C. Eventually he rose to heaven on the back of a dragon or crane or something, 'in broad daylight.' The Yellow Emperor's Internal Medicine Classic (Huang Di Nei Jing) is probably the most essential text of Chinese Medicine, and is a dialogue between the Yellow Emperor and Qi Bo. This dialogue is a humorous take-off on the style of the classics, but still communicates accurate information. One who does not know Chinese herbs or acupuncture points will be missing a bit of this dialogue, but there should be enough information to make it a worthwhile read.
The Yellow Emperor's Physician speaks privately with the Dark Maiden:
Qi Bo: O, Dark Maiden! In caring for the Emperor and the royal family, I have mainly worked to prevent disease, lest I should lose my head in failure. However, I have occasionally seen, and heard of, a whole class of diseases peculiar to women, as they affect the Cinnabar Grotto, not the Jade Stalk. Since we have some private time together, could please enlighten me as to the diagnosis and treatment of women's diseases?
Dark Maiden: My dearest Qi Bo! Ordinarily such matters are kept in the women's quarters, where we take care of ourselves. Have you ever wondered what the Emperor's women do during the day, when not called for? We certainly don't stay in the Palace all the time, however nice it might be. We arrange for excursions into the countryside and to the mountains, where we play in the fields, sing the songs of the herb pickers, and drink tea with old Taoists. You know some of this for I have often brought you quality herbs from the provinces of the four directions.
Qi Bo: Dark Maiden, your knowledge and radiant health have always astounded me, and now the reasons are clear. Certainly you would be just as much a Sacred Woman in the forest, field, or court. I am grateful for the fine herbs you have given me in the past. They have served the royal family well. With even more admiration than ever, I must say: I am honored to be in your presence.
Dark Maiden: Such bold compliments may even make a Dark Maiden blush! Qi Bo, you are known throughout the country as the Emperor's doctor--the highest privilege known in your profession. How is it that you lack any knowledge or skill, though the area be foreign to you?
Qi Bo: It is doubtful the sun can ever truly know the moon, as the moon is only clearly visible when the sun is down. Women's lives are different when away from men, and their affairs are more closely guarded than the Imperial Army's secrets. A few bits of textbook knowledge, and a basic schooling from my mentors have given me a basic knowledge, but I am curious to add more depth to my understanding of disorders of the Moon.
Dark Maiden: Very well, my dear Qi Bo. I will have the pleasure to initiate you into a deeper understanding of women and their sexual nature. Though promise me this: we must meet privately several times a week, and no one else must know that we are meeting, nor what we are meeting about.
Qi Bo: I promise, O Mistress of the Yin! But, may I ask why we need to be so cautious?
Dark Maiden: You make me smile, Qi Bo. With your long, silky white beard and deep, lake-like eyes, you ask more than you ask, and you know more than you know. I could respond that both our reputations may suffer for being seen together often, but I might just be doing it to enjoy myself with your company, Physician.
Qi Bo: Regardless your motives, I am blessed to be in your company. Your form, your voice, and your movements leave me feeling harmonized as much as a fresh morning's walk in the Gardens.
Dark Maiden: There are many things to discuss, but first, we will begin with the Heavenly Waters: their coming, going, and disorders. At the age of 14, if all is in balance, a girl becomes a woman when the waters come down from Heaven. This, the menarche, is when the moon begins her course in the woman's womb. From then until she is 49, excepting pregnancy, disease, or other abnormality, her blood flows on the same cycle as the moon--28 days. In ancient times, the Dark Moon was the woman's moon, and all the women bled on that day.
Before delving into further lore and legend, let us overview the main disorders of the Valley. There are the following: irregular menstruation, premenstrual imbalances, painful menstruation (dysmenorrhea), lack of menses (amenorrhea), bleeding from the child's palace (uterine bleeding), vaginal discharges (leukorrhea), inability to bear children (dearest Qi Bo, sometimes this is more of a blessing than a disease), and, lastly, menopause.
Qi Bo: Maiden of the Night, this is a vast panorama of knowledge you have spread before me. For today, will you tell me about irregular menstruation?
Dark Maiden: Irregular menstruation has three main types. The ordinary cycle for a woman is between 26 and 31 days. If the cycle is earlier than usual by seven or more days then the cycle is irregularly short, or antedated. If the menses come later than usual by more than 7 days, then the cycle is abnormally long, or postdated. If there is no discernable, steady pattern to the coming of the menses, and the are sometimes short, sometimes long, and sometimes normal (but not more than 7 times in a row), then the menses are said to be irregular.
Qi Bo: Dark Maiden, these different irregularities are clear to me now. But please, tell me which of the factors of disease are most commonly involved in this irregularity?
Dark Maiden: Physician of the Emperor, you, of all people well know that disease is caused by the six external factors, the seven internal emotions, wrong diet, over-straining the body or traumatic injury, lack of exercise, insect and animal bites, and stagnant blood or phlegm. Of the six external factors (wind, cold, summer-heat, damp, dryness, and fire), the most common in causing irregular menstruation are cold, heat, and damp. Of the seven internal emotions (joy, anger, melancholy, worry, grief, fear, and fright), it is worry and repressed anger which are found to contribute to irregular menses. Other common causes are overindulgence in improper sexual activity (the Taoists teach the means to use sexual activity as a force of health and spiritual growth, but that is a different conversation, my dear Qi Bo) and having too many children (Qi Bo, believe it or not, there will come a day when one child per woman is regarded as sufficient, due to a lack of space and food for all people). These various factors lead to a disharmony between the Qi and the Blood and an injury to the Chong and the Ren Meridians.
Qi Bo: Dark Maiden, your exposition is fabulous. Please, will you tell me the various types of antedated menses (short cycle), and how to tell them apart?
Dark Maiden: For the good of all the women and their lovers whom you may treat in this lifetime, I will gladly share this knowledge with you. I know you will pay attention and treasure this information like a pearl in an oyster.
The different causes for a shortened cycle are Heat in the Blood, a Deficiency of Spleen Qi, and Blood Stagnation. The Heat in the Blood may have resulted through dietary factors or through Fire from Stagnant Liver Qi. It injures the Chong and Ren meridians, resulting in short cycles, characterized by dark or bright red blood, which is thick or sticky. The woman with Heat in the Blood will probably also exhibit restlessness, fullness in the chest, a pounding headache, a sense of warmth or fever, a dry mouth, dark yellow or brown urine, constipation, a red flush to the face, or night sweating. The tongue, as in most heat cases, will be red of body, with a thin, yellow coat or perhaps no coat at all. The pulse will be rapid and possibly thready.
Qi Bo: I understand that in this instance we would want to clear heat, cool the blood, regulate the menses, and possibly, depending on the overall diagnosis, enrich the Yin. Formulas which come to mind from my past training and practice are Jing Qin Si Wu Tang (Schizonepeta and Scutellaria Four Substances Decoction), which is the priceless Si Wu Tang, which contains the four herbs Shu Di Huang, Dang Gui, Chuan Xiong, and Bai Shao Yao (which together nourish blood and invigorate blood circulation) plus Jing Jie and Huang Qin to clear heat from the various levels of the body. Jing Jie, when charred, also helps to stop bleeding.
Dark Maiden: O Herbalist of the Stars! What a marvelous formula you have described. But do not forget Gu Jing Wan (Stabilize Menses Pill), which is more useful when there is Yin deficiency and a shortened menstrual cycle. This pill contains Gui Ban, from the tortoise, Chi Shao Yao, Huang Qin and Huang Bai, Chun Pi (Ailanthus bark), and Xiang Fu. When the flow is profuse, thick, and dark red or purple, and there is a dry mouth and constipation, you may either use Gu Jing Wan or Qing Jing San (Clear the Menses Powder). Qing Jing San contains Mu Dan Pi, Bai Shao, Shu Di Huang, Di Gu Pi, Qing Hao, Fu Ling, and Huang Bai. And, please, Qi Bo, make sure to take this as a powder in a draft--consuming the material portion of the herbs helps them to sink to the lower Burner, where they are most needed. To think that they would have the same effect as a decoction is foolishness.
Qi Bo: Your strong words would ordinarily offend my sensibilities, dearest Maiden. But I, too, have struggled with the younger herbalists who don't listen to the knowledge of the ancestors. Indiscriminantly boiling every formula, they are surprised to find the results less than expected. Then they blame their ignorance on the patient, saying that the patient ate something wrong which countered the formula, or that evil spirits are at work against their medicines. If they would simply pay attention to the names of the formulas, and not treat a San like a Tang, they would have no recourse to blaming others for their shortcomings.
Dark Maiden: I am glad we share this perspective, Master of Medicines. But let us not digress into politics when there are many more medical secrets to be communicated. Acupuncture points to use for Heat in the Blood leading to shortened cycles are LI11, CV3, SP10, KD5, KD2, SP6, and KD6. Now we will move on. Another type of shortened cycle is where the profuse menses are light red, or even pinkish, and thin. The woman is likely to be fatigued, with shortness of breath, loose stools, and an empty feeling in the lower Burner.
Qi Bo: Ah! With a pale tongue and a weak pulse, this sounds like a Spleen Qi deficiency. My favorite formula for Spleen Qi deficiency, when blood deficiency is also somewhat involved, is Gui Pi Tang. With Ren Shen, Huang Qi, Dang Gui, and Long Yan Rou, how can the Qi and Blood stay deficient? With Bai Zhu, Mu Xiang, and Fu Ling, how can dampness and stagnation gain hold? With Yuan Zhi and Suan Zao Ren, how can the woman be depressed or mentally disturbed? And when harmonized with Zhi Gan Cao, Sheng Jiang, and Da Zao, how can this formula cause any harm?
Dark Maiden: Surely, Qi Bo, you have taken lessons from Shen Nong himself! This formula is perfect, and works very effectively. Acupuncture points I like to use while the formula is being prepared are CV6, CV4, SP6, BL20, SP3, ST36, and CV12. Of course, other points may be added, such as SP9, 10, etc, depending on the individual manifestations of the condition. Qi Bo, could you please tell me how blood stagnation may lead to shortened menstrual cycles?
Qi Bo: My understanding is that cold or emotional repression can lead to Qi stagnation, which may lead to blood stagnation in time. This injures the meridians and collaterals in the uterus, and forces the blood to flow outside of the Chong and Ren Mai, escaping out the Jade Grotto due to blocked up internal channels.
Dark Maiden: Your understanding of women and their subtle anatomy shows deep sensitivity and caring. But please, remember that the menses will be dark purple with many clots, and there will be stabbing pains in the lower Burner. The tongue will be purple with a thin, white coat, and the pulse will be hesitant or choppy. As there is intense pain, acupuncture should be administered immediately, and herbs should follow. The points to use are Shi Qi Zhui Xia Xue, BL32, ST29, SP10, SP6, LR3, and LI4.
Qi Bo: Tui Na or cupping on the lower back can also aid in relieving stagnation, from my experience. But I would also immediately administer the very effective Jia Wei Shi Xiao San (Augmented Sudden Smile Powder). Shi Xiao San is a simple formula composed of Wu Ling Zhi and Pu Huang, which is rapidly efficacious, especially when taken with warm rice wine. I may modify it with Xiang Fu, Chuan Xiong, or even the entire Si Wu Tang.
Dark Maiden: Excellent choice, Celestial Physician. While they take longer to prepare, Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction), which contains Tao Ren, Hong Hua, Dang Gui, Chuan Xiong, Chi Shao Yao, Chuan Niu Xi, Chai Hu, Jie Geng, Zhi Ke, Sheng Di Huang, and Gan Cao, and Shao Fu Zhu Yu Tang (Dang Gui, Chuan Xiong, Chi Shao Yao, Xiao Hui Xiang, Yan Hu Suo, Wu Ling Zhi, Mo Yao, Rou Gui, Gan Jiang, and Pu Huang) are both excellent formulas to quicken blood, transform stasis, and regulate the menses. So these are the three types of shortened menstrual cycle. Would you like to move on to postdated menses now?
Qi Bo: Though you are a Maiden of the Dark, you are shedding an amazing amount of light. Please, I am enraptured by your discourse. Let us continue.
Dark Maiden: I am pleased by your enthusiasm and rapt attention, Qi Bo. Let us continue. When the cycle is over 7 days longer than normal, it is considered postdated. The three causes of this are blood deficiency (which leads to an insufficiency of blood in the Chong and Ren Mai), cold in the blood (which impedes the proper flow of blood in the Chong and Ren Mai), and Liver Qi constraint with blood stagnation (which impairs the proper flow of blood, and hinders the sea of blood from being filled on course).
Qi Bo: I know that blood deficiency can come from bleeding, childbirth, improper food habits, or emotions that damage the stomach and spleen, and that emotional repression leads to liver Qi constraint, but I am not sure of the common causes of cold in the blood. Is it due to cold foods and exposure to cold when the woman is vulnerable, such as during her menses?
Dark Maiden: Yes, this is partly the matter. There will usually be Kidney Yang deficiency to some degree with these factors. Now I will tell you how to differentiate these three. You already know the basic symptoms of the three syndromes, but I will tell you about the characteristics of the menses. Blood deficiency exhibits light red, thin menses. Cold in the blood has dark-red, sticky menses. And Liver Qi constrained with blood stagnation has normal or dark-red menses which are thick with clots. Can you again astound me by selecting the proper herbal formulas, Qi Bo?
Qi Bo: I will do my best, dear Darkness. For blood deficiency, Ba Zhen Yi Mu Wan (Eight Treasure Benefit Mother Pill) would be best, as this nourishes liver blood, soothes the liver, and regulates the menses. It contains Ba Zhen Tang, which is Ren Shen, Bai Zhu, Fu Ling, Zhi Gan Cao, Shu Di Huang, Bai Shao, Dang Gui, and Chuan Xiong without the Sheng Jiang and Da Zao, with the addition of Yi Mu Cao. But please note that the Bai Zhu is dry-fried (Chao), the licorice is honey-fried (Zhi), and the Bai Shao is vinegar fried (Cu Chao). The pills are made with honey, and are taken on an empty stomach with honey water or wine.
Dark Maiden: Such a wonderful formula! If I ever develop blood deficiency, I will come to you for this tasty treat! Needling CV4, CV6, and SP6, plus other well known blood building points would also help. The next formula I'm thinking about, for cold in the blood, doesn't taste quite as nice, but it works even more quickly as the pain is much worse in this case. Do you know which formula I'm speaking of?
Qi Bo: The aptly named Wen Jing Tang (Warm the Menses Decoction), no doubt! And the strong taste comes from the 1-2 qian of Wu Zhu Yu. However, the other ingredients moderate the strong taste and function of the 'Shaman's Spirit Talisman': Gui Zhi, Dang Gui, Chuan Xiong, Bai Shao Yao, E Jiao, Mai Men Dong, Mu Dan Pi, Ren Shen, Ban Xia, Sheng Jiang, and Gan Cao. Moxibustion would also be quite helpful, on similar points to those you just mentioned: CV4, CV6, SP6, and ST36.
Dark Maiden: Again, you are correct, physician! As I, too, like talking about herbal formulas, please allow me to discuss the two formulas for liver Qi constraing and blood stagnation combined. The first is Jia Wei Wu Yao Tang (Added Herbs Lindera Decoction). This contains Wu Yao, Sha Ren, Mu Xiang, Yan Hu Suo, Xiang Fu, Gan Cao, and Bing Lang. Subtracted from (Tian Tai) Wu Yao San are Xiao Hui Xiang, Qing Pi, Gao Liang Jiang, Jin Ling Zi, and Ba Dou. Added are Sha Ren, Yan Hu Suo, Xiang Fu, and Gan Cao. It is an extreme modification, but an effective one. The other formula is Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction), which we have already discussed for use with shortened cycles due to blood stagnation. Treating different diseases with the same formulas! What a sublime medicine we practice, Qi Bo!
Qi Bo: Yes, the wisdom of the ancients is evidence of a Golden Past when Humans were more connected to the powers of the Heaven and Earth. Today we must struggle to even understand our predecessors, much less add to their knowledge. Enough reminiscing! The points to use for liver qi stagnation and blood stagnation leading to postdated menses are ST29, PC6, SP8, KD13, LR14, and LR3, are they not?
Dark Maiden: Yes, indeed those points are among the most efficacious. But never forget, Qi Bo, to use the lunar, Yin force of intuition in your acupuncture, especially when dealing with women's diseases. Let us take a break from this scholarly talk and enjoy a walk together in the gardens. Later we will talk about general irregular menses.
Qi Bo: Yes, some fresh air and fragrant flowers will aid this new knowledge to go to the place in my heart where it can do the most good. I thank you for sharing this, and look forward to the rest of the discourse.
ghosts and demons as signs of mercury poisoning. The Environmental Protection Agency has this definition of the symptoms of long-term mercury exposure: "People with chronic mercury poisoning often also have wide swings of mood, becoming irritable, frightened, depressed or excited very quickly for no apparent reason. Such people may become
extremely upset at any criticism, lose all self-confidence, and become apathetic. Hallucinations, memory loss and inability to concentrate can occur." (http://www.epa.gov/seahome/mercury/src/chronic.htm) Hearing voices, paranoid thoughts, and "seeing things" are all also described in the literature of mercury poisoning. Ko Hung exhibited many of these characteristics, including a great distrust of "unbelievers" and a paranoid belief in the need for strict ritual purification before eating more mercury. Ko Hung's writings are still very valuable documents from their time, and it is particularly impressive that he was such a prolific writer given the toxic load he must have had from working with and consuming mercury, arsenic, lead, etc.
Not devoid of humor, Ko Hung addresses the carb-free diet of 400 C.E.: "I should like to inquire whether a man can attain [immortality] by merely dispensing with starches...?Ko: By dispensing with starches a man can only stop spending money on grains..." (Ware, p. 243)
So here we are in 2004. I thought that I would be writing a positive, celebratory column on the history of Taoist Alchemy and Chinese Medicine. But no, once again I have slipped into a skeptical analysis of historical mystical traditions based upon science and common sense. It is the dedication and experimental attitude which inspire me in my study of the natural causes and cures of disease. I don’t feel a need to over-glorify the past. There are many historical secret remedies that were lost due to natural selection. They can stay that way. The sensible, common, and well-established herbs, acupuncture techniques, and nutritional systems are a great gift. There’s no need to completely avoid grains, seek out alchemical preparations, or practice sexual vampirism in order to be healthy and happy. The simple way of accepting and flowing with the changes of nature—which includes good days and bad days, youth and old age, and eventually death—can lead to a deeper contentment, wisdom, and happiness than those methods.
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Kevin O'Neil,
Licensed Practitioner of Acupuncture & Oriental Medicine
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Kevin O'Neil, Licensed Acupuncturist, began his Chinese Medicine training in Chinatown, Victoria, B.C. at the International College of Traditional Chinese Medicine, with Henry Lu, Ph.D. .
After one year, Kevin transferred to the Oregon College of Oriental Medicine in Portland, where he spent 3 years completing his Master's Degree of Acupuncture and Oriental Medicine.
Upon graduation, Kevin went to China and interned in the HeiLongJiang Chinese Medicine University Hospital, before moving to Tainan, Taiwan to continue his studies of Chinese Medicine, language, and culture.
Upon 'repatriation,' he chose to embrace the Taoist tradition of living in the mountains where the pace of life is more relaxed and the air is clean and clear. Finding Klamath Falls, Oregon to suit these characteristics, Kevin opened his clinic there in Spring, 1999.
Ancient Way Acupuncture & Herbs, Inc.
Medical/Dental Building
905 Main St #409
Klamath Falls, OR 97601
541-884-6377
www.ancientway.com |
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