By Ban Xuiwen
Translated by Sharon Weizenbaum
Ban Xiuwen was born in 1919. He is a gynecologist and is well known for his use of classic formulas for women’s health issues. He has written on the Jin Gui Yao Lue as well as on the relationship of the 6 levels and gynecology. I hope to have more writings of his posted here.
Zhang Zhong Jing wrote
Yin and blood are the root of the menstruation. There is no Zang that is without it”. We can see that there is a very close relationship between the 5 Zang and women’s menstruation, discharges, pregnancy and birth. Though the relationship between the Heart and gynecology is not well known or discussed in detail, I consider the place of the heart in relation to gynecology to be very important. When we analyze gynecological pathology and the rules for prescribing formulas in treatment, the Heart has significance.
Yin and blood are the root of menstruation and the Heart governs the blood
The Heart is the Zang associated with fire and is the ruler of the 5 Zang and 6 Fu. It governs the blood vessels and commands the Spirit Brightness. When the Heart functions properly “brightness is governed this causes peace to descend”. Alternatively, “When brightness is not governed the 12 officials are in chaos”. In this case, not only do the emotions and blood vessels have pathology, the Zang and Fu also can become irregular. It is said “The heart beat agitates the 5 Zang and 6 Fu”. Yin and blood are principle for women. Although the source for the abundant material basis of the blood is the minute essence of the food and fluids of the Spleen and Stomach, it still must undergo a series of Qi transformation processes to become what we know as blood fluid. Within this process there is the Qi transformation action of the Spleen and Stomach and there is also the Qi transformation process of the Heart Yang. In regard to the generation of blood, the Nei Jing says “The middle Jiao receives the Qi and obtains the fluid. It then become red as it transforms into blood”. “Ying Qi secretes the essential fluid and this flows into the vessels and transforms into blood”. “The Heart generates the blood”. This illustrates that the blood fluid is the essential fluid that is transformed from the minute essence of the food and fluids and that the heart guides this process. It is only when the Heart Qi is flourishing and the Heart function is normal that the blood fluid can be continuously produced. If the Heart Yang is depleted it will be unable to transform and generate the blood fluid and the sea of blood will be empty. The blood will be unable to nourish the four limbs and the 100 bones and the source of the menstruation will dry up.
The Heart and the Uterus are closely linked
The Heart and the uterus have a direct link. The Bao Mai belongs to the Heart and networks within the uterus” “ The extraordinary vessels of the Chong, Ren and Du together rise up from within the uterus and rise up, The Chong vessel “arrives in the uterus and spreads”. The Ren vessel moves the body’s Yin and the Du vessels move the body’s Yang. One vessel is on the front and the other is on the back. They “Link with the Heart”, “enter the eye”, “network to the chest”. “The Heart is the residence of Spirit brightness (life force)”. It can be seen that the uterus opens through to the channels and collaterals. As a matter of fact there is an intimate connection between the “actual heart organ” and the “Spirit brightness that resides in the Heart”. When the clarity of the Heart Spirit stagnates, the flourishing Qi of the Heart declines and the surplus of the Heart is diminished, this has a direct influence on the function of the uterus. When the Heart Qi is exuberant, the Heart blood is abundant and the vessels are open through, the blood fluid then able to move normally in the vessels, flowing without obstruction to nourish the whole body. When the Heart Yang moves downward, the Heart blood nourishes the uterus and the sea of blood is completely filled. This will cause the menstruation to arrive regularly and for the pregnancy to move along with the appropriate timing.
When a woman is gloomy and depressed, prone to over thinking with volatile emotions, this can result in consumption and darkening of the Heart Yin and insufficiency of the nourishing Yin and a blockage of the uterine vessels. This in turn can lead to irregular menstruation or even amenorrhea and difficulty becoming pregnant. When the menstruation is not flowing through properly, there is amenorrhea or difficulty becoming pregnant. Though there can be many different causes of this, generally it is related to the Heart ruling the Spirit brightness and the blood vessels.
Though there are many treatment methods, none of them stray far from the blood.
Many varieties of illness appear in a woman’s clinic. However, none of the illnesses are beyond the scope of hot/cold and excess/deficiency. Treatment can be separated into supplementing, discharging, warming and clearing. All of this is related to the idea of regulating the Qi and blood and promoting harmony.
For example, excessive worry will damage the Heart and Spleen and cause palpitations, insomnia and yellowing of the skin. The menstruation may come early, be profuse, be pale, scanty or drip without ceasing. The pulse may be thin and weak, the tongue moss thin and white with a pale tongue body. This is in the category of Heart and Spleen dual deficiency with an inability to absorb blood. Often in this case one wants to nourish the Heart, fortify the Spleen, boost the Qi and supplement the blood, using Gui Pi Tang. This formula contains Ren Shen, Bai Zhu, Huang Qi and Gan Cao to supplement the Spleen. It also uses the sweet, warm and sour herbs, Fu Shen, Yuan Zhi, Suan Zao Ren and Long Yan Rou to supplement the Heart. The goal of this approach is to simultaneously treat the mother and child (fire and earth) and renew the function of the Heart and Spleen so that the function of the Heart governing the blood and the Spleen gathering the blood is protected. When the blood is continuously generated and transformed, it will be able to consolidate and absorb and the menstruation will be regulated.
If there is Beng Lou, this can be caused from blood heat, Qi deficiency or blood stasis. When there is blood heat it is appropriate to clear heat and cool the blood with herbs such as Sheng Di, Dan Pi and Zhi Zi. When there is Qi deficiency it is appropriate to supplement the Qi and absorb the blood with herbs such as Dang Shen and Bei [Huang] Qi. When there is blood stasis it is appropriate to “use opening through methods to open through the cause” with herbs such as Hong Hua, Tao Ren and Pu Huang. There are herbs to cool the blood, herbs to dispel stasis and herbs to supplement the Qi and generate blood. Although these methods are not the same, they all enter the heart and vitalize the blood.
If there is damp heat discharge that is profuse and thick with both red and white mixing together, it is common to use Long Dan Xie Gan Tang to clear the Liver and disinhibit dampness in order to clear the damp heat and stop discharge.
When a woman is unable to become pregnant after marriage this is often thought to be due to chronic deficiency with the nourishing Yin being murky and diminished. The Heart is deficient and the blood is scanty and the Spirit Qi is not peaceful. There are palpitations, late or scanty menstruation or amenorrhea. It is common to use Bu Xin Tang. This formula uses “Ren Shen and Huang Qi to supplement the Heart Qi, Chuan Xiong and Dang Gui to nourish the Heart blood, Fu Ling, Yuan Zhi, Bai Zi Ren and Suan Zao Ren to clear Heart heat and calm the Heart Spirit, Wu Wei Zi to protect the Heart Qi from being scattered, Ban Xia to clear the phlegm rheum that harasses the Heart, Gan Cao to foster the core of the Heart and Chi Gui (red cinnamon) to enter the heart channel. This uses moistness to nourish, warmth to supplement, sour to constrain and fragrance to scatter. In this way, the heart is nourished and full”. In short, Blood is engendered and transformed by the Spleen, brought together by the Heart, stored and received by the Liver, spread and distributed by the Lung and imparted and disseminated by the Kidney” (from the Jing Yue Quan Shu) Clearly, there is a close relationship between the 5 Zang and the Yet the Heart is the abode of the Spirit and it rules the blood vessels of the whole body. It is the center of the whole body’s blood circulation and the integrated movement of the thinking processes and consciousness.
These physiological functions all have an influence on the vital movement of the organs and especially on the blood as the root of women. A long term condition of “Qi surplus with blood deficiency” will have a pathological effect on menstruation, pregnancy, birth and nursing. Consequently, in terms of treating gynecological illnesses, one must pay attention to the comfort and brightness of the Heart spirit and the fullness of the Heart blood. When this is attended to, the different presentation characteristics, the regulating and supplementation will all have twice the effect with half the effort.
Case Study One
A 36-year-old female named Wei. Nanning factory worker: Previously her menstruation had been fundamentally normal with no discomfort. Her husband was transferred and they moved to Yong for work. Starting at that time and for the last half year, she had not menstruated. She did not feel any discomfort and her sleep, appetite and bowels were normal. Her pulse was thin and rapid but with strength and her tongue had a thin white moss with a normal body. This patient had always had a normal menstruation until after the work transfer. Actually the changes had been sudden and her routines, life style and personal life were all different. In these circumstances, it would be difficult to avoid emotional viscitudes. It is said that “excitement causes the Qi to become retarded” and that “worry causes the Qi to become knotted”. The result of this is that the Heart Yang Qi is then unable to travel down to the uterine vessels. The uterine vessels become obstructed and therefore the menstruation does not flow. Because there are no other complaints, we can know that this illness is one of the Shen and not one of the form. I gave her I applied the method of using fragrant and acrid flavors to open and warmth to open through the vessels. I gave her 3 packages of Tong Qiao Huo Xue Tang modified:
Dang Gui 9 gm Chuan Xiong 5 gm. Tao Ren 6 gm. Hong Hua 6 gm. Lao Cong 9 gm. Gui Zhi 6 gm. Fou Shou 9 gm. Shi Chang Pu 5 gm. Yuan Zhi 5 gm. Yi Mu Cao 15 gm. Zhi Gan Cao 5 gm
Case Study Two
A 28-year-old female named Zhao. She was a cadre at the Nanning University. She had been married for half a year and was two months pregnant when she began to have slight vaginal bleeding. The color of the blood was pale. She was able to sleep at night but had many dreams. Her low back was sore and weak. Her bowels were dry and knotted, moving only once every three days. Her urination was normal, her pulse thin and rapid and her tongue had scanty moss with a red tip.
When a woman bleeds at two months of pregnancy, this is an indication of fetal dripping. Only after taking into account the pulse in relation to the presentation could I say that this was an over abundance of fire with Kidney water insufficiency. These conditions lead to pathology in which the Kidneys lost their ability to envelope and store. The Chong and Ren were unable to consolidate. Using the method of enriching Yin and relieving fire, I gave her modified Liang Di Tang.
Sheng Di Huang 20 gm. Xuan Shen 20 gm. Hang Bai Shao 10 gm. Mai Men Dong 15 gm. Di Gu Pi 10 gm. Zhu E Jiao 10 (wrapped and melted in) Bai Zi Ren 10 gm. Xian He Cao 15 gm.
After 3 packages the vaginal bleeding stopped. After this she took 6 packages of Shou Tai Wan with the addition of Du Zhong, Fu Pen Zi and Chuan Zhi Zi to consolidate the effect. She gave birth after a normal period of pregnancy.
Summary: The role of the Heart in gynecology is very important. This by no means minimizes the importance in gynecology of the Kidneys storing the Jing, the Liver storing the blood, the Spleen enveloping the blood or the Lungs governing the Qi and sending it to the 100 vessels. Are not these functions inseparable? One must stress treating the blood and treating the Heart simultaneously and pay attention to the relationship between the Zang Fu. For example, if the Heart blood is insufficient, there is not only pathology of the Heart itself but also the Spleen may be deficient or the Liver blood may be weak. One should elect to treat the Heart but also treat the Spleen and Liver using a formula like Gui Pi Tang or Si Wu Tang. If the Heart fire is unable to descend downward to the Kidney and instead flares upward, often the Kidney Yin is unable to flow upward to relieve this and this results in a lack of communication between the Heart and the Kidneys. The treatment method should be directed to enrich water to control fire. In the clinic I use Dang Shao Di Huang Wan (Tang), which will enrich the Kidney Yin while moistening and nourishing the Heart blood. This simultaneously treats the Heart and Kidney. The pattern has a primary and secondary aspect, which can be observed simultaneously. One must weigh out the seriousness vs. the lightness of the illness as well as the acute vs. the chronic nature of the illness. When the Heart is a leading issue, choose the formula and give the herbs to gently hit the mark. In this way, you can obtain the expected results.