Leukorrhea

Leukorrhea

Women often appear pale and yellowish, with emaciated limbs, palpitations, and lower back pain, and occasionally discharge turbid substances—yellow, red, green, white, or dark—that are caused by damage to the belt-like ligaments, hence the name "belt syndrome." Traditional methods also distinguish a category called "white turbidity" (1), meaning that leukorrhea is a disease of the belt-like ligaments, with mixed colors; white turbidity, however, is a disease of the heart, spleen, and kidneys, with a pure white color, and the prescriptions used are similar, though in fact they are the same disease, both caused by disorders of the belt-like ligaments. To clarify: the five types of white turbidity discharge resemble blood but are actually water from the uterus. When this water is clear, it is Tian Gui, which nourishes menstrual blood, as previously discussed. When this water is turbid, it becomes white turbidity, one of the five types. Turbid water makes blood turbid as well, because the belt-like ligaments connect to the uterus, encircle the body, occupy the center of the body, and belong to the spleen meridian. When the spleen meridian maintains harmony, the belt-like ligaments remain clean, and the water in the uterus remains clear, so three days after menstruation, there is water in the uterus. Yellow like gold, this is the water of Tian Gui in the kidneys, regulated by the spleen meridian, resulting in a golden-yellow hue, indicating the time for seed production and a healthy monthly cycle. If the spleen meridian loses its harmony and cannot regulate the water, the belt-like ligaments are injured, leaking into the uterus, causing belt syndrome, with white turbidity and mixed colors; treatment should focus on harmonizing the spleen to benefit the water. Treating the spleen is treating the belt, and treating the belt is treating the water. Looking at the Kidney-Strengthening Soup, which uses white atractylodes to treat lower back pain as if it were a belt worth five thousand coins, this soup clearly shows that the kidney is affected by water-related issues, which then affect the belt-like ligaments, so treatment should start with the spleen, using earth to regulate water, and the belt-like ligaments will heal themselves. From this, we can see that women's belt syndrome is caused by unclear water, and turbidity is still caused by unclear water, so there is no need to make strict distinctions; the general principle is to harmonize the spleen and benefit the water, with Wei Ling Tang as the main treatment. For those with heat, add gui zhi, huang qin, huang lian, and huang bo; for those with cold, add xi xin, wu yu, and sand ren. When the spleen meridian is stifled by humidity and rot, producing the five types of turbidity—red, white, and mixed colors—regulating the spleen to relieve stagnation is recommended, using Xiao Yao San with fang ji and mu tong as the main treatment. For heat, add dan pi, gardenia, and huang bo; for cold, add tai wu yao, mugwort, and sand ren. Although the above discussion does not cover all aspects of treating turbidity, it has already provided a method, which scholars can further develop: for heat-related cases, nitrate, huang, and gan sui may not necessarily be inappropriate; for cold-related cases, shen, shu, qi, and fu are especially necessary; and for mixed heat-cold cases, prescriptions can be tailored according to the specific situation. For those who cannot fully convey this through paper and pen, it depends on the physician's own understanding.

Bleeding during menstruation refers to blood discharge outside the regular period. When the amount is small, it is called "leakage," and when it is large, it is called "hemorrhage"—excessive blood loss during menstruation, like water flowing uncontrollably, is also considered hemorrhage. Historically, it was called "collapse," meaning that blood was under the jurisdiction of the central region (2), and when the spleen could not control the blood, it collapsed, hence the name "collapse," indicating that treating collapse required addressing the central region. Menstruation is called "trust water," because among the five elements, only earth governs trust; when earth is strong, the monthly water has trust, but when earth is weak, it loses trust and leaks, even leading to collapse. The general principle of treatment is to focus on the spleen—whether due to fatigue damaging the spleen, or worries and hunger damaging the spleen, when the spleen is weak and cannot control the blood, one should use Gui Pi Tang with mugwort, e jiao, and stove-top soil. For those with severe deficiency, Ten Complete Great Tonics with e jiao, chuan duan, sheng ma, pao jiang, zao ren, shan yu rou, and then fish belly, deer horn frost, lotus seeds, and ginger salt stewed dishes should be used to nourish them. Astragalus, glutinous rice, and angelica decocted and taken orally are also great tonics for qi and blood. Six Gentlemen, Yang Rong Tang, and Zhi Gan Cao Tang are all medicines that strengthen the spleen and benefit qi, and can be adjusted accordingly. All cases of collapse are treated properly. There are also cases of treating the liver as a thief of the spleen—when the liver meridian is angry and acts recklessly, wood overcomes earth, fire disturbs and blood becomes unstable, people become easily angered, suffer headaches, have bitter mouths and dizzy eyes, and experience fullness and distension in the ribs, with six pulses sounding tense, which is quite different from the spleen's cold-deficiency symptoms. In such cases, Gui Pi Tang with dan pi, gardenia, bupleurum, white peony, mai dong, and five flavors is recommended to both strengthen the spleen and clear liver fire, or Dan Zhi Xiao Yao San with oysters, e jiao, and pu huang can be used.

It should be noted that although leukorrhea is a water-related disease, some cases also involve blood stasis, where blood blocks qi and causes turbidity; small adjustments to the menstrual soup can be made according to heat and cold. Although collapse is a blood-related disease, it is actually caused by qi deficiency—when qi sinks, water follows and flows, and water drives blood, so when qi flows, blood flows, and when blood flows, qi flows. Therefore, one should take qi-tonifying medicines to raise the water level, so that when the water rises, the blood rises as well, and strengthening qi can help treat collapse.

Looking at both collapse and leukorrhea together, one is a water-related disease, the other is a blood-related disease, and both men and women have diseases related to blood and water, so they should be viewed holistically.

[Note] (1) White turbidity: same as belt syndrome, but with a pure white color. (2) Central region: "The spleen is the central region" from "Four Difficulties" in the Classic of Difficulties.

[Commentary] Collapse refers to hemorrhage, while leukorrhea refers to vaginal discharge. The main cause of hemorrhage is weakness in the central region, where the spleen cannot control the blood. The treatment for collapse should focus on the spleen. Prescriptions such as Gui Pi Tang with glue and mugwort, Ten Complete Great Tonics with e jiao, chuan duan, and pao jiang, as well as Six Gentlemen, Yang Rong Tang, and Zhi Gan Cao Tang are all medicines that strengthen the spleen and benefit qi. For cases where the liver meridian overcomes the spleen, Xiao Yao San and Gui Pi Tang can be used in combination and adjusted accordingly. As for vaginal discharge, the focus remains on the spleen governing the belt-like ligaments; both leukorrhea and white turbidity are manifestations of disorders in the belt-like ligaments. When the spleen is harmonious, the belt-like ligaments remain clean, and menstruation occurs on schedule; when the spleen is disharmonious, the belt-like ligaments lose control, leading to leakage.

Postpartum blood fainting is caused by blood rising with qi, confusing the mind, resulting in visual hallucinations, and in severe cases, suffocation and muteness, with a cold and confused spirit. Some cases of excessive blood loss leading to fainting are due to deficiency, but the person is merely confused and agitated; treatment should focus on replenishing blood, using Zhi Gan Cao Tang and Ba Zhen Tang with zao ren, long gu, zhu sha, dan pi. Other cases of fainting due to minimal blood loss are caused by lochia rushing to the heart, filling the lower abdomen quickly, causing confusion and muteness, with no awareness of anything around—treatment should focus on breaking up the blood, using dang gui, yan hu suo, xue jie, mei yao, jing jie sui, and jing mo dui hong cu zhi tong bian yin. Cases of blood fainting also occur among those who vomit blood, so physicians should be aware of this.

Postpartum hemorrhage is caused by empty vitality unable to control the return of blood to the uterus, and is mainly treated with Gui Pi Tang. If accompanied by sweating and shortness of breath, it is a dangerous sign of blood loss and qi dispersion, and should be treated with Shen Fu Tang with e jiao, shu di, fu ling, and gan cao. However, there are also cases where anger damages the liver, causing liver qi to run rampant and blood to fail to stay contained; in such cases, Gui Pi Tang with fried gardenia, e jiao, mugwort, and bupleurum, as well as Xiao Yao San with e jiao, oysters, brown charcoal, fried gardenia, lotus leaves, and xiang fu, are all suitable.

Blood poisoning affecting the lungs, with blackened nose and mouth, eggplant-colored face, or nosebleeds, is a dangerous sign of qi rebellion and blood rising. Sometimes there is severe shortness of breath or coughing to death, all due to lung deficiency unable to control the downward flow of qi, allowing blood flowing downward to rise upward; in such cases, Shen Su Yin is recommended. For nosebleeds, add almond; for coughing, add five flavors. Those who vomit blood and have lung poisoning are in the same situation.

Blood poisoning affecting the heart, with closed qi, stiff tongue, confused speech, and ghost-like appearances, should be treated with Gui Xiong Shi Xiao San with dragon brain, zhu sha, xue jie, and mei yao, or with Niu Xi San with zao ren, amber, shu di, and ginseng.

Blood poisoning affecting the spleen, with vomiting and abdominal distension, inability to eat, and Sheng Hua Tang with ban xia, fu ling, zhi ke, and hou pu, can be used. If it develops into edema, it is the same as blood transforming into water, just like blood turning into pus—so when blood turns into water, treat it as water. Use Wu Ling San with pu huang and dan pi to facilitate this.

In summary, blood flows downward naturally, while qi flows upward against nature. Once you understand that postpartum blood flowing upward is a disease, you will also understand that vomiting blood is a disease of blood flowing upward. However, the causes of vomiting blood and postpartum blood are different, so the treatments are also different. In addition, there are several other conditions that frequently occur after childbirth and are also relevant to vomiting blood, so they can be discussed together, listed as follows:

Postpartum shortness of breath is the most dangerous symptom, caused by a sudden depletion of vital energy and a lack of support for defensive qi, resulting in blood loss and qi dispersion; Shen Fu Tang is recommended, and Si Mo Tang can also be used. If it is caused by blood poisoning affecting the lungs, with blackened eyes and smoke coming from the nose, it is a sign that lung qi is about to collapse, and Shen Su Yin can be used for treatment. These two conditions—one is kidney qi depletion with yang qi rising, the other is lung qi depletion with blood rising—both rely on ginseng, which generates abundant water, and water is the mother of qi, so the prescription focuses on replenishing qi, using ginseng to nourish water, and nourishing water is equivalent to replenishing qi. For those with yang qi rising, add fu zi to guide it back to its roots; for those with blood rising, add su mu to speed up its descent. Truly a good remedy for saving lives after childbirth, and men experiencing blood qi depletion should also understand this principle. Postpartum sweating, with a slight perspiration on the body, is considered auspicious. This is because postpartum blood deficiency leads to a situation where mild sweating allows qi to follow and nourish the blood, with yang harmonizing with yin. Since sweat is essentially water derived from qi, and postpartum blood is insufficient while qi remains abundant, a small amount of qi is released to harmonize with the blood—this is the most favorable sign. However, if yin is deficient and internal yin is weak while external yang is excessive, profuse sweating occurs⁽³⁾, which is different from mild sweating. In such cases, treatment should focus on tonifying yin and guiding yang; Sheng Yu Tang combined with Fuzi, Wu Wei Zi, Mai Dong, and Long Gu can be used for this purpose. If there is massive sweating leading to yang collapse, the sweat flows like water, indicating that vital energy has been dispersed. Qi is essentially water, so when qi is depleted, large amounts of sweat result; only a large dose of Shen Fu Tang can restore yang. There is also a condition where sweat appears only on the head, stopping at the neck⁽⁴⁾, which arises from disharmony between blood and qi, with qi stagnating and rising upward, causing sweat to appear only on the head. Zhang Zhongjing referred to this as "yu mao" and treated it with Xiao Chai Hu Tang. For night sweats due to yin deficiency, Dang Gui Liu Huang Tang is indicated. These conditions share similarities with other sweat-related symptoms in patients with hematemesis or epistaxis, so readers are advised to consult relevant literature.

Postpartum fever arises from sudden loss of yin blood, leaving yang without support. The correct treatment is Si Wu Tang combined with Pao Jiang to guide yang back to yin, which is the standard therapeutic approach. If headache, chills, and fever occur, it indicates an external pathogenic factor, and should not be treated as ordinary cold. Instead, Si Wu Tang combined with Jing Jie and Chai Hu, along with scallions, should be used to resolve the exterior and nourish the blood, thereby achieving recovery. For fever caused by food stagnation, symptoms such as distension, belching, and vomiting will invariably appear. Yi Gong San combined with Shan Zha, Shen Qu, Mai Ya, Hou Pu, and Sheng Jiang can be used for treatment. If fever results from blood stasis, symptoms such as stabbing pain in the body and abdomen will manifest, and Sheng Hua Tang is indicated. If too much blood is lost, resulting in irritability, thirst, and facial flushing, Dang Gui Bu Xue Tang is recommended. When yin deficiency leaves yang unsupported and causes isolated yang to surge outward, leading to fever, Shen Fu Tang should be administered immediately to rescue the situation. The "Jin Jian" section provides a brief overview of both deficiency and excess patterns of postpartum fever, with similar treatment principles applied to men experiencing blood loss and subsequent fever. However, blood loss in men involves upward movement of blood, whereas postpartum blood loss involves downward movement, creating a subtle difference between the two scenarios.

There are numerous miscellaneous postpartum conditions, and the few examples provided here all have mutual insights with hematemesis. Other conditions are not covered in detail here, but can be found in specialized obstetric texts.

Additionally, it is worth noting that postpartum qi tends to descend, leading to more instances of qi depletion, whereas hematemesis involves qi ascending, resulting in fewer cases of depletion. All cases of qi depletion in hematemesis should be addressed by descending qi, while those in postpartum should be addressed by ascending qi—these are fundamentally different approaches.

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[Notes]

(1) Zhuo Ji Lun: Discussing matters solely based on superficial appearances.

(2) Ji: Urgent.

(3) Jian Jian Han Chu: Sweat flowing like water.

(4) Qi Jing Er Huan: Refers to Article 236 of the "Shang Han Lun," which states, "It stops at the neck." Here, "qi" means "to align," implying that the sweat stops below the neck.

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[Commentary]

Although this section is titled "Postpartum Blood Conditions," it actually refers to various complications occurring before and after childbirth. A woman's pregnancy and delivery are always driven by the interplay of qi and blood. The author believes that the fetus is blood, while the amniotic sac is qi. During delivery, the amniotic sac comes out first, followed by the fetus, reflecting the simultaneous movement of qi and blood, with blood following qi. He uses this perspective to explain all postpartum and prenatal complications and applies it to guide clinical medication practices. Labor pains indicate that qi wants to move while blood does not; if the pain is severe, it often signifies blood stasis. Using Fo Shou San to activate blood circulation and remove stasis allows blood and qi to flow smoothly, facilitating natural delivery. Postpartum lower back and abdominal pain suggests qi stagnation and blood stasis, which can be alleviated by using Gui Xiong Shi Xiao San and Sheng Hua Tang to dissolve stasis and promote qi flow, thus relieving pain. Dissolving stasis is also an important measure to promote new blood production; this approach combines tonification with elimination, making it widely used in clinical practice. Postpartum blood syncope occurs when blood rises with qi, confusing the mind and spirit—this is due to blood deficiency and inability to maintain stability. Treatment involves tonifying blood with Ba Zhen Tang or Fu Mai type formulas. Additionally, postpartum lochia that rises to the heart can cause blood syncope, requiring activation of blood circulation and removal of stasis using ingredients such as Dang Gui, Yuan Hu, and Xue Jie. Postpartum hemorrhage can be categorized into two types: one caused by spleen qi deficiency unable to control blood, treated with Gui Pi Tang; the other caused by liver qi rebellion unable to contain blood, treated with Xiao Yao San. Postpartum shortness of breath and coughing to the point of near-death are due to qi reversal and blood rising, leading to lung damage. Treatment involves Shen Su Yin. Confusion and delirium stem from blood damaging the heart, treated with Gui Xiong Shi Xiao San combined with Long Nao, Zhu Sha, and Ni Xi San, or with Niu Xi San combined with Zao Ren and Hu Po. Vomiting and abdominal distension result from blood damaging the spleen, treated with Sheng Hua Tang combined with Ban Xia and Hou Pu. Edema arises when blood transforms into water, treated with Wu Ling San. Furthermore, the author discusses the clinical emergencies of postpartum dyspnea accompanied by dark vision and massive sweating leading to yang collapse. The former involves blood loss and qi dispersion, as well as blood damage to the lungs, while the latter must be distinguished from general conditions such as mild sweating, spontaneous sweating, and sweating only on the head. Blood loss and qi dispersion represent kidney qi deficiency, treated with Shen Fu Tang or Si Mo Tang; blood damage to the lungs indicates lung qi exhaustion, treated with Shen Su Yin; massive sweating leading to yang collapse signifies a complete separation of yin and yang, with vital energy dispersing—a condition that requires immediate intervention with large doses of Shen Fu Tang. From a modern medical perspective, these two emergencies may correspond to respiratory failure and circulatory failure. The author emphasizes the danger of these conditions in clinical practice and employs Shen Fu Tang and Shen Su Yin to restore yang, a highly valuable insight. It demonstrates that traditional Chinese medicine, in treating postpartum complications, not only effectively manages common conditions such as bleeding and leukorrhea, but also accurately identifies and addresses severe, life-threatening situations.

This section also discusses postpartum fever: when yin blood is suddenly lost and yang has no support, Si Wu Tang combined with Pao Jiang is used; if fever is accompanied by headache and chills, it indicates an external pathogenic factor, treated with Si Wu Tang combined with Jing Fang; if fever is accompanied by bloating and belching, it indicates food stagnation, treated with Yi Gong San combined with Shan Zha, Mai Ya, and Hou Pu. For fever caused by blood stasis, symptoms such as body and abdominal pain often appear, treated with Sheng Hua Tang. At the end of the section, the statement "Postpartum qi descends, leading to more cases of qi depletion, while hematemesis involves qi ascending, leading to fewer cases of depletion" reflects the author's valuable experience and can serve as a reference for clinical practice.

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