6. Gynecological Diseases

6. Gynecological Diseases

In addition to the aforementioned ectopic pregnancy, activating blood circulation and removing stasis can also be applied to other gynecological conditions. The Capital Hospital of China used this method to treat 127 cases of pelvic inflammatory disease, achieving good results, with formulas adjusted according to ingredients such as shengdi, red peony root, peach kernel, safflower, raw oyster shell, raw turtle shell, kelp, seaweed, parasites, chuan duan, and summer枯草. Among them, 84 cases of tuberculous pelvic inflammatory disease were treated with activating blood circulation and removing stasis in combination with anti-tuberculosis drugs, all proving effective. There are numerous reports nationwide on the use of activating blood circulation and removing stasis to treat functional uterine bleeding, such as using Guizhi Fuling Wan and Taohong Siwu Tang to treat this condition, with their efficacy already widely recognized in the medical community.

Part I: Academic Thought

Published in collaboration with a book publishing house Pei Zhengxue’s Traditional Chinese Medicine—Discussion on Theory and Clinical Cases

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For cystic diseases, before treatment, the patient’s serum showed elevated levels of hexose and amino-hexose; after treatment, the serum levels of hexose and amino acids decreased significantly, collagen fibers changed from their original thick and swollen state to a finer state, and the skin also softened accordingly.

The Shanxi Institute of Traditional Chinese Medicine in China used a kidney-tonifying decoction with activating blood circulation and removing stasis to treat nephritis, achieving remarkable results. Through experimental research, they induced renal atrophy in rats by injecting uranium into their kidneys, causing the renal parenchyma to undergo interstitial-like proliferative changes. Before the onset of these pathological changes, they administered the kidney-tonifying decoction to these rats, and as a result, 65% of the treated rats did not develop proliferative changes, whereas only 21% of the untreated rats avoided such changes. This demonstrates that activating blood circulation and removing stasis can reduce fibrotic changes in the renal parenchyma and undoubtedly has therapeutic effects on chronic nephritis.

The Shanxi Medical College studied the mechanisms of action of two formulations for treating ectopic pregnancy: Ectopic Pregnancy No. 1 (red peony root, salvia, peach kernel) and Ectopic Pregnancy No. 2 (red peony root, salvia, peach kernel, sanleng, e zhu). Experimental research revealed that Ectopic Pregnancy No. 1 has a certain inhibitory effect on the activity of monoamine oxidase in the blood of white rats. Since monoamine oxidase activity promotes the formation of collagen fibers, it can be confirmed that Formula No. 1 has a certain therapeutic effect on the formation and maturation of blood clots. In contrast, the effect of Ectopic Pregnancy No. 2 is completely different from that of No. 1—it does not inhibit the activity of monoamine oxidase, but rather promotes the activity of collagenase. The purpose of this collagenase activity is to soften matured masses, making them easier to digest or absorb by other enzymes. Therefore, it can be confirmed that Ectopic Pregnancy No. 2 has a promoting effect on the dissolution of matured masses.

(4) Effects on Inflammation

Most activating blood circulation and removing stasis medications have anti-inflammatory effects. Experimental studies have proven that kushen, danpi, chuanxiong, red peony root, and rhubarb can inhibit intestinal pathogens; rhubarb, kushen, red vine, danpi, and red peony root can inhibit Staphylococcus aureus; moreover, rhubarb, danpi, red peony root, chuanxiong, as well as zi cao, di yu, huang yao zi, and zi jing pi also possess antiviral properties. The Nankai Hospital in Tianjin selected commonly used activating blood circulation and removing stasis medications for acute abdominal conditions—danpi, red peony root, angelica, peach kernel, safflower, and yuanhu—and formulated them into intravenous injections. Through experiments on white rat cotton-ball granulomas, castor oil cysts, turpentine oil cysts, formaldehyde arthritis, and rabbit skin capillary permeability tests, it was demonstrated that activating blood circulation and removing stasis medications can reduce capillary permeability and decrease inflammatory exudation, thereby localizing the lesion. Experiments also proved that these medications can increase blood flow in isolated dog intestinal loops, dilate peripheral blood vessels, and promote the absorption of inflammatory exudates. Since the anti-inflammatory effect of activating blood circulation and removing stasis is not merely limited to inhibiting bacteria, but indirectly reduces inflammatory responses by improving capillary permeability and dilating peripheral vessels, the anti-inflammatory effect of activating blood circulation and removing stasis has a unique significance.

(5) Promotion of Tissue Repair

Numerous experimental studies have demonstrated that activating blood circulation and removing stasis medications are beneficial for tissue repair and regeneration. A collaborative group in the Beijing area observed the impact of the Coronary Heart II formula on the extent of myocardial infarction. Based on qualitative and quantitative histological analysis, as well as electron microscopic observation of tissue morphology, the Coronary Heart II formula significantly reduced the scope of myocardial infarction. Under electron microscopy, the control group’s infarcted myocardium exhibited a series of irreversible changes, including glycogen depletion, severe mitochondrial swelling, spinal dysfunction, nuclear staining condensation, and nuclear membrane rupture. However, in the medicated group, these irreversible changes were considerably less pronounced.

Part I: Academic Thought

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Additionally, the Shanxi Institute of Traditional Chinese Medicine in China used histochemical methods to examine enzyme activity and electron microscopy to observe the ultrastructure of the myocardium, finding that the degree of mitochondrial damage corresponded closely with the degree of ATPase and succinate dehydrogenase activity destruction. In the control group, the activities of ATPase and succinate dehydrogenase in the myocardium were significantly lower than in the group protected by activating blood circulation and removing stasis, indicating that the latter protects mitochondria from damage and thus confirms the inhibitory effect of activating blood circulation and removing stasis on myocardial infarction. Furthermore, extensive clinical trials have also shown that activating blood circulation and removing stasis medications can rapidly restore damaged liver cells, accelerate the healing of ulcers caused by thromboangiitis obliterans, and speed up bone growth. All of these demonstrate that activating blood circulation and removing stasis can promote tissue repair.

(6) Effects on Immune Cells

The Chinese Academy of Traditional Chinese Medicine conducted hemolytic clinical experiments, observing the impact of activating blood circulation and removing stasis formulas designed to prevent ABO-type neonatal hemolysis on antibody-forming cells—B cells. It was found that these medications have a clear inhibitory effect on antibody-forming cells, indicating that activating blood circulation and removing stasis can suppress the antibody–antigen complex reaction—the autoimmune response. The International Maternal and Child Health Association of China also used activating blood circulation and removing stasis to treat the aforementioned hemolysis, achieving good results, and experimental research reached the same conclusion. For this reason, clinical use of activating blood circulation and removing stasis medications to treat autoimmune diseases can yield significant therapeutic effects, such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and nodular periarteritis.

Although the method of activating blood circulation and removing stasis has made considerable progress in both clinical application and experimental research, its underlying principles are still under further investigation. We believe that as long as we persist in following the path of integrated Chinese–Western medicine, continuously practicing and summarizing our experiences, we will surely achieve greater development and improvement of this method, allowing this pearl in the treasure trove of Chinese medicine to shine even more brilliantly and contribute to the health of the general public.

(“Overview of Integrated Chinese–Western Medicine in Gansu,” April 1980)

Exploration of Fever Syndrome Differentiation Pei Zhengxue

Fever is a general term encompassing both cold-induced fevers and heat-induced fevers. Cold-induced fevers are caused by cold pathogens, while heat-induced fevers are caused by heat pathogens; although the two differ, both can lead to fever, hence the collective designation of “fever.” In the study of fever, traditional Chinese medicine has historically been divided into the Cold-Induced Fever School and the Heat-Induced Fever School. The Cold-Induced Fever School focuses on the cold-related causes of fever and the damage to yang energy, emphasizing methods such as pungent-warm exterior-releasing and emergency restoration of yang energy; the Heat-Induced Fever School, on the other hand, emphasizes the heat-related causes of fever and the consumption of yin energy, focusing on pungent-cool exterior-releasing and yin-nourishing, fire-lowering approaches.

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For a long time, the two schools have each held their own views and stood in opposition to one another, giving rise to the famous "Shanghan–Wenbing Controversy" in the history of Chinese medicine. However, with the development of modern medical science, people have gradually come to realize that Shanghan and Wenbing both belong to exogenous febrile diseases; for the same febrile disease, it may simultaneously exhibit characteristics of both Shanghan and Wenbing, or its clinical manifestations may alternate between those of Shanghan and Wenbing. Therefore, strictly separating the diagnostic methods of Shanghan and Wenbing is clearly not conducive to the objective needs of clinical diagnosis. Whether we can organically integrate the diagnostic and therapeutic approaches of the two, thereby forming a unified diagnostic method for febrile diseases in traditional Chinese medicine, is a glorious yet arduous task facing all practitioners of TCM. The author, without undue modesty, hereby offers some superficial views on this issue.

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In particular, Liu Shouzhen of the Song–Jin period (1110–?) provided especially detailed elaborations on febrile diseases. He expanded the scope of the nineteen fire-heat syndrome patterns outlined in the Inner Canon, emphasizing the relationship between fire-heat syndromes and the five qi—wind, cold, dampness, dryness, and summer heat—thereby establishing the view that “all six qi ultimately transform into fire.” In terms of treatment, he strongly advocated the method of clearing heat and draining fire, while also pointing out the drawbacks of relying solely on pungent-warm exterior-releasing therapies. This achievement of Liu’s objectively compensated for the shortcomings of the Shanghan Lun, creating the preconditions for the emergence of the Wenbing school of thought. During the Ming dynasty, Wang Andao (1332–1391) was the first to clearly distinguish between Shanghan and Wenbing. He stated: “It is only because people indiscriminately refer to Wenbing as Shanghan… and then use warm-hot medicines that such practices confuse name with reality and endanger lives. Shouldn’t we correct this naming?” Wang further expounded on the differences between Wenbing and Shanghan from the perspectives of symptoms, pathology, and treatment methods, thus enabling the Wenbing school to begin to stand out on its own. In light of this, later generations rightly regard Wang as the founder of the Wenbing school of thought. Subsequently, during the Ming dynasty, Wang Shishan (1463–1539) proposed the concept of “newly acquired Wenbing,” stating: “If one is injured by cold in winter… and the illness breaks out in spring… this is latent-Wenbing; but if one does not suffer cold injury in winter yet still develops Wenbing, this is simply the influence of spring warmth, which can be called ‘spring Wenbing,’ just like winter’s Shanghan, autumn’s dampness, and summer’s heatstroke—this is newly acquired Wenbing.” From this point onward, latent and newly acquired forms became the two major categories of Wenbing onset.

At the end of the Ming dynasty, in the Xinsi year of the Chongzhen reign (1641), epidemics of warm-fever swept through provinces such as Shandong, Henan, Hebei, and Zhejiang. Physicians treating these cases with Shanghan methods found them ineffective, whereas Wu Youke’s treatments based on Wenbing were often successful. Wu believed that epidemics fundamentally belonged to the category of warm-fever, entirely distinct from Shanghan, and thus wrote the book On Warm-Fever Epidemics, expanding the scope of Wenbing to encompass all febrile infectious diseases. Later, another prominent Wenbing scholar, Ye Tianshi (1666–1745), authored On Warm and Hot Diseases, introducing the differentiation of Wei-Qi-Ying-Xue and summarizing the principles of diagnosing and treating febrile diseases. He said: “Generally speaking, after Wei comes Qi, and after Qi comes Ying. It is acceptable to sweat out pathogenic factors at the Wei level, but only when they reach Qi can they be cleared; once they enter Ying, they can still disperse heat and transform Qi, using substances such as rhino horn, radix scrophulariae, and moutan cortex. However, once they enter Xue, there is a risk of depleting blood and causing bleeding, so one must cool and disperse blood instead, using ingredients like rehmannia root, moutan cortex, donkey-hide gelatin, and red peony root.” Wu Jutong (1736–1820), who inherited Ye’s teachings, wrote Detailed Analysis of Warm Diseases, proposing a three-jiao-based framework for diagnosing Wenbing—three-jiao differentiation—on the basis of the Wei-Qi-Ying-Xue system. He stated: “Warm diseases enter through the mouth and nose; nasal qi connects to the lungs, while oral qi connects to the stomach. If lung disease spreads upward, it affects the pericardium; if upper-jiao disease is left untreated, it spreads to the middle jiao, affecting the spleen and stomach; if middle-jiao disease remains untreated, it spreads to the lower jiao, affecting the liver and kidneys; starting from the upper jiao and ending at the lower jiao.” Thus, the Wenbing school of thought had now formed a complete system of theory, methods, prescriptions, and medications.

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Basic Content of Shanghan–Wenbing Differentiation

1. Shanghan Differentiation (Six Meridians Differentiation)

Using the metaphor of “worn-out cotton” (“Shanglun Pian”) to describe its imperfections. These earlier viewpoints provided the author with great inspiration, leading to the formulation of the “Six-Stage Differentiation” for febrile diseases, which adopts the yang portion of the Shanghan six meridians, designating Taiyang as the first stage, Shaoyang as the second, and Yangming as the third, while discarding the yin portion for use in differentiating internal injuries and miscellaneous diseases.

2. Incorporating the Ying-Xue Differentiation’s Ying and Xue Components

Due to the limitations imposed by the prevailing conditions at the time, the Shanghan six meridians primarily employed pungent-warm exterior-releasing and emergency yang-restoring methods, while insufficient attention was paid—or no attention at all—to the differential diagnosis and treatment of features specific to febrile diseases, such as yin deficiency, wind movement, blood rushing uncontrollably, and heat invading the pericardium. Consequently, in terms of legislation and medication, applications related to “clearing heat and detoxifying,” “nourishing yin and cooling blood,” and “extinguishing wind and opening orifices” were relatively lacking. In this respect, the Ying-Xue differentiation of Wenbing precisely made up for these deficiencies, with the key being the Ying and Xue components, since in the Ying-Xue differentiation, the Wei-level syndrome represents surface heat, while the Qi-level syndrome represents interior heat—both sharing significant commonalities with the Taiyang and Yangming aspects of the Shanghan six meridians. Only the Ying-Xue-level syndrome fully captures the characteristics of yin deficiency, blood rushing, wind movement, and heat invading the pericardium in febrile diseases. In light of this, the “Six-Stage Differentiation” for febrile diseases incorporates the Ying and Xue components of the Ying-Xue differentiation, placing them sequentially after Taiyang, Shaoyang, and Yangming, making them the fourth and fifth stages of the progression of febrile diseases (see Figure 1).

3. Adopting Certain Aspects of the Three-Jiao Differentiation

Upper-jiao syndromes represent the early clinical manifestations of febrile diseases; the upper jiao includes the heart and lungs, which are closely linked and mutually influential. Wu Jutong pointed out that upper-jiao diseases encompass both the surface heat of the lung Wei and the mental confusion caused by heat invading the pericardium, thus integrating the notion of “warm pathogens initially attacking the lungs and then spreading to the pericardium” with clinical practice. For acute febrile diseases such as meningococcal meningitis, sepsis, and bacillary dysentery, at the onset of the illness, surface heat and mental confusion often appear together; applying the three-jiao differentiation to observe such cases reveals typical upper-jiao syndromes. Wu Jutong stated: “The heart is the master of the body and should not be invaded by pathogens, as it is protected by the pericardium. Therefore, when pathogens invade, the pericardium takes the brunt of the attack.” It is evident that “spreading to the pericardium” refers to heat from the lungs spreading to the heart. In the “Six-Stage Differentiation,” following the three types of wind-cold, Shanghan, and Wenbing under the Taiyang section, the reverse spread to the pericardium is listed as the fourth type (see Figure 1).

The middle jiao of the three jiao involves the spleen and stomach; here there is the stomach fire of the Foot-Yangming meridian, the spleen dampness of the Foot-Taiyin meridian, and the combined damp-heat of the spleen and stomach. The stomach is dry, the spleen is damp; if pathogens invade the middle jiao and lean toward the stomach, Yangming real heat manifests; if they lean toward the spleen, Taiyin cold-dampness appears; and if they affect both the spleen and stomach, damp-heat syndrome emerges. Given that the Yangming syndrome in the six meridians only emphasizes the aspect of stomach fire, the “Six-Stage Differentiation” adds the damp-heat syndrome as the third type under the Yangming section, following the meridian and腑syndromes (see Figure 1).

4. Yin Deficiency and Yang Deficiency Represent the Final Stages of Febrile Diseases

“The Plain Questions·On the Natural Flow of Vital Energy”: “When yin is balanced and yang is concealed, spirit is well-regulated”; “When yin and yang separate, vital energy ceases.” It is clear that yin deficiency and yang deficiency are critical conditions in febrile diseases. For febrile illnesses, Shanghan often presents with yang deficiency as an emergency, while Wenbing frequently calls for help due to yin deficiency; in short, yin deficiency and yang deficiency undoubtedly mark the final stages of febrile disease progression. Clinically, yin deficiency manifests as pale complexion, cold extremities, profuse cold sweat, and a barely perceptible pulse; yin deficiency, on the other hand, shows high fever, rapid breathing, dry skin, restlessness and delirium, with hands and feet still warm. From a modern medical perspective, the former corresponds to shock and collapse—circulatory failure—and the latter may involve respiratory failure and dehydration. Both respiratory and circulatory failure are inevitable steps on the road to death, signaling that the body’s vital centers are about to cease functioning normally—this aligns quite closely with the TCM concepts of yin deficiency and yang deficiency. When febrile diseases are left untreated or mismanaged, they eventually enter the stages of yin deficiency and yang deficiency; sometimes yin deficiency precedes yang deficiency, and sometimes the reverse occurs. In any case, the two often cause each other—this is why “isolated yin cannot arise” and “isolated yang cannot grow.”

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References

① Wang Andao·“Collection of Medical Classics Revisited”·People’s Health Edition, 1956, p. 52

② Shanghai College of Traditional Chinese Medicine·“Lectures on Warm Diseases”·Shanghai Science and Technology Edition, 1959, p. 11

③ Jiangsu New Medical College·“Interpretation of Warm Disease Studies”·Shanghai People’s Edition, 1973, p. 174

④ Wu Jutong·“Detailed Analysis of Warm Diseases”·People’s Health Edition, 1958, p. 56

⑤ Yan Derun·“Commentary on the Shanghan Lun”·People’s Health Edition, 1956, p. 9

⑥ Shi Yiren·“Shanghan and Wenbing”·Upper Health Edition, 1955, p. 28

⑦ Lu Yuanlei·“Modern Interpretation of the Shanghan Lun (Volume 8)”·Qianqing Hall, 1953, p. 4

⑧ Jiangsu New Medical College·“Interpretation of Warm Diseases”·Shanghai People’s Edition, 1973, p. 161

⑨ Nanjing College of Traditional Chinese Medicine·“Teaching Reference Materials on Warm Disease Studies”·Jiangsu People’s Edition, 1959, p. 47

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Discussion on Zangfu Differentiation Pei Zhengxue

Zangfu differentiation, which uses the zang-fu organs as the guiding principle for diagnosis and treatment, is a fundamental component of TCM diagnostic and therapeutic practice and serves as the primary method for diagnosing internal injuries.

Pei Zhengxue’s Traditional Chinese Medicine—Contemporary Discussions on TCM Theory and Clinical Cases, No. 104 Published by Hefei Book Publishing House

II. Analysis of Zangfu Differentiation Content