Section 1: Anatomy of the Female Reproductive System

Section 1: Anatomy of the Female Reproductive System
The female reproductive system includes both internal and external genitalia, along with related tissues and adjacent organs.
External Genitalia
The external genitalia of women refer to the exposed parts of the reproductive organs, also known as the vulva, which encompasses the area between the inner thighs from the pubic symphysis to the perineum. This includes the mons pubis, labia majora and minora, clitoris, and vaginal vestibule.
II. Internal Genitalia
The internal genitalia of women are located within the true pelvis and include the vagina, uterus, fallopian tubes, and ovaries; the latter two are often referred to as uterine appendages.
Section 2: Special Physiological and Pathological Characteristics of Women

1. Physiological characteristics of each stage of a woman’s life
   The growth and development of women throughout their lives were clearly described in the “Plain Questions · On the Primordial Truth of Ancient Times”: “At the age of seven, a girl’s kidney qi is flourishing, her teeth are changing and growing; at fourteen, the heavenly癸 arrives, the Ren meridian becomes unblocked, the Tai Chong meridian is vigorous, menstruation occurs regularly, thus she can bear children; at twenty-one, the kidney qi is balanced, so her permanent teeth grow to their maximum length; at twenty-eight, her muscles and bones are strong, her hair grows to its maximum length, and her body is robust; at thirty-five, the Yangming meridian declines, her face begins to look aged, and her hair begins to fall out; at forty-two, the three yang meridians decline, her face becomes increasingly aged, and her hair turns white; at forty-nine, the Ren meridian becomes weak, the Tai Chong meridian declines, the heavenly癸 is exhausted, and the path of childbirth is blocked, so her body deteriorates and she can no longer bear children.” This passage divides a woman’s growth and development into different age stages based on the seven-year cycle, representing the earliest recorded description of female physiological characteristics. The flourishing or weakening of kidney qi, as well as the arrival or exhaustion of the heavenly癸, govern the processes of growth, development, reproduction, and aging in women.
2. The physiological phenomenon of menstruation
   Menstruation refers to the periodic shedding of the endometrium and associated bleeding that occurs in conjunction with the cyclical changes of the ovaries. The regular occurrence of menstruation is an important sign of mature reproductive function.
3. Pathophysiological characteristics of obstetric and gynecological diseases
   (1) Dysregulation of self-regulatory functions. Women’s special physiological activities are regulated by the nervous, endocrine, and humoral systems, and can normally maintain a relatively stable state, known as the self-regulating steady state. When the body is subjected to various internal and external pathogenic factors and suffers damage, the body’s self-regulatory functions may become dysregulated, leading to obstetric and gynecological diseases.
   (2) Damage and anti-damage responses. The damage caused by pathogenic factors includes structural damage to tissues, functional impairment, and metabolic disorders. For example, when the defense mechanisms of the reproductive system weaken, bacteria can ascend through the vaginal mucosa and infect the endometrium. If the virulence of the bacteria is strong, it can lead to severe intrauterine infections that quickly spread to the fallopian tubes, ovaries, pelvic peritoneum, and pelvic connective tissue, even causing sepsis or blood poisoning.
   (3) Cause-and-effect transformation during disease progression. During the course of a disease, sometimes the original cause leads to pathological changes in the body, producing certain pathological products. These pathological products, in turn, become new pathogenic factors, meaning that the effect becomes the cause, triggering new lesions and continuously aggravating the condition.
   (4) The relationship between local and systemic aspects during disease progression is an organic whole: local lesions can affect the entire body, and systemic lesions can also impact local areas.
4. Traditional Chinese Medicine’s understanding of the pathogenesis of obstetric and gynecological diseases
   Traditional Chinese Medicine believes that when pathogenic factors act upon the human body, under certain conditions, they can lead to dysfunction of the zang-fu organs, imbalance of qi and blood, injury to the Chong, Ren, and Du meridians, and damage to the uterine cavity, uterine vessels, and uterine collateral channels, ultimately triggering obstetric and gynecological diseases.
5. Dysfunction of the zang-fu organs
   Disruption of the physiological functions of the zang-fu organs and imbalance of qi, blood, yin, and yang in these organs can all lead to obstetric and gynecological diseases, with the kidneys, liver, and spleen being the most closely related.
   (1) Kidney dysfunction
   ① Kidney qi deficiency: The qi generated by kidney essence is called kidney qi, referring to the functional activities of the kidneys. The rise and fall of kidney qi directly affects the arrival and exhaustion of the heavenly癸, thereby influencing menstruation and pregnancy. Therefore, kidney qi deficiency often leads to amenorrhea and infertility. When kidney qi is insufficient, the sealing function fails, and the Chong and Ren meridians are unstable, resulting in early menstruation, excessive menstrual flow, and metrorrhagia; if the fetus cannot be properly supported, the fetal qi is weak, leading to fetal leakage, fetal movement disturbances, miscarriage, and uterine prolapse.
   ② Kidney yin deficiency: When kidney yin is deficient, essence is depleted and blood is scarce, and the Chong and Ren meridians are insufficient, causing the blood sea to fail to fill up on time, resulting in delayed menstruation, reduced menstrual flow, and amenorrhea; if the Chong and Ren meridians are deficient, they cannot collect essence to form pregnancy, leading to infertility; yin deficiency generates internal heat, which disturbs the Chong and Ren meridians, making the blood sea restless and forcing blood to flow abnormally, resulting in early menstruation, intermenstrual bleeding, and metrorrhagia.
   ③ Kidney yang deficiency: When kidney yang is weak, it cannot warm the uterine cavity, leading to abdominal pain during pregnancy, fetal growth retardation, and infertility; if kidney yang is insufficient, the sealing function fails, and the Chong and Ren meridians are unstable, resulting in metrorrhagia; if kidney yang is deficient, the vaporization and transformation functions fail, unable to warm and transform dampness, leading to excessive leukorrhea, edema during menstruation, swelling of the uterus, and diarrhea during menstruation.
   ④ Kidney yin and yang deficiency: The kidneys are the abode of water and fire, where yin and yang depend on each other and mutually restrain one another. When yin is damaged, yang can be affected, and vice versa. Prolonged illness can lead to kidney yin and yang deficiency, commonly seen in symptoms around menopause.
   (2) Liver dysfunction
   ① Liver qi stagnation: If emotions are harmed internally, liver qi stagnates, and the Chong and Ren meridians are blocked, leading to dysmenorrhea, delayed menstruation, amenorrhea, breast tenderness during menstruation, abdominal pain during pregnancy, and infertility; if the Chong and Ren meridians’ blood sea accumulates abnormally, it can result in irregular menstrual cycles.
   ② Liver qi turning into fire: When liver qi stagnates and turns into heat, the heat damages the Chong and Ren meridians, making the blood sea restless and forcing blood to flow abnormally, leading to early menstruation, excessive menstrual flow, metrorrhagia, hematemesis during menstruation, fetal leakage, and postpartum lochia that does not stop.
   ③ Liver yang excess: When liver yin is insufficient and liver yang is excessively dominant, the Yin blood gathers before menstruation or after pregnancy, while the Yang blood rises, leading to dizziness during menstruation, headaches during menstruation, and fetal dizziness; if yin is deficient and yang is excessive, the liver wind stirs internally, causing eclampsia.
   ④ Liver meridian damp-heat: When liver qi invades the spleen, liver qi stagnates and turns into heat, the spleen becomes weak and produces dampness, and the liver meridian damp-heat accumulates, descending to the Chong and Ren meridians, infiltrating the Chong and Ren meridians, leading to excessive leukorrhea and itching; if damp-heat accumulates in the body, it blocks the Chong and Ren meridians, resulting in infertility, leukorrhea, and tumor scars.
   (3) Spleen dysfunction
   Spleen qi weakness: The spleen is the central earth, responsible for transportation and transformation, governing the middle qi and coordinating blood, and together with the stomach, forming the foundation of postnatal life and the source of qi and blood production. When spleen qi is weak, blood loses control, and the Chong and Ren meridians are unstable, leading to early menstruation, excessive menstrual flow, and metrorrhagia; if the fetus lacks qi support, it can lead to fetal leakage, fetal movement disturbances, miscarriage, and stillbirth; if the spleen is weak and qi sinks, it cannot lift the uterus, leading to uterine prolapse.

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