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Xianhui Li

Class 9: Gynecological & Obstetric diseases: Infertility, morning sickness, prolonged labor, malposition of fetus, insufficient lactation, prolapse of uterus. Xianhui Li. Infertility.

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Xianhui Li

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  1. Class 9: Gynecological & Obstetric diseases: Infertility, morning sickness, prolonged labor, malposition of fetus, insufficient lactation, prolapse of uterus Xianhui Li

  2. Infertility • Infertility is defined as the inability to produce offspring in woman who has been trying for two years, who has a normal sexual life, and whose partner has normal reproductive function. It is called primary infertility. If she has a history of delivery or abortion but fail to be conception again in a period of two years without taking any anti-conception measures, it is called secondary infertility.

  3. Etiology and pathology • Kidney deficiency • Liver stagnation • Phlegm and dampness • Blood stasis

  4. Kidney Deficiency • Manifestations • Failure to get pregnant long after marriage, delayed menstruation, sparse and light colored menses or amenorrhea, hyposexuality, dark and lusterless face, soreness of the loins and knees, a feeling of coldness in the lower abdomen, thin and clear leucorrhea, profuse thin urine, loose stools, pale tongue with whitish coating, a deep fine or deep slow pulse. • Treatment principle • Tonify kidney and promote conception • Acupuncture Treatment: KI3, BL23, KI6, Ren4, Ren8, DU4, ST28 shuidao, zigong • BL23, KI3 and KI6 tonify kidney • Ren8, Ren4 and Du4 moxa warm kidney yang • ST28, local point for regulating menstruation. • Zigong: Regulates qi and menstruation • Herbal treatment: yin lin zhu or yang jing zhong yu tang

  5. Liver Qi stagnation • Manifestations • Infertility, Irregular menstruation, premenstrual syndrome, painful period, distension at the hypochondrium region, hot temper, depression, dark red tongue with ecchymosis, wiry pulse. • Treatment Principle • Soothe liver, move qi and promote conception • Acupuncture Treatment: LV3, GB34, PC6, Ren3, PC6, SP4, LV13, LV14, zigong • LV3 and GB34 move qi and blood • PC6 and SP4 open chong mai and regulate blood in the uterus • Ren3, the meeting point of the three foot yin meridians and the chong and ren, is used to adjust the qi of the chong ren vessels • LV13 and LV14 soothe the liver and regulate qi • Zigong: Regulates qi and menstruation • Herbal treatment: kai yu zhong yu tang

  6. Accumulation of Dampness • Manifestations • Obesity, late scanty period or amenorrhea, hirsute, leukorrhagia, dizziness, stuffiness at the chest and epigastrium, nausea, pale swollen tongue, white sticky tongue coaing, slippery pulse. • Treatment Principle • Drain dampness, move stagnation and regulate periods • Acupuncture Treatment: Ren3, Zi Gong, ST28, SP6, SP9, Ren9 • Ren3 is the front mu point of the bladder, combined with ST28 resolve dampness from the lower jiao • Zigong: Regulates qi and menstruation • Ren9, SP9 and SP6 tonify spleen and resolve dampness in the lower jiao • Excessive vaginal discharge adds GB41 zu lin qin eight confluent points o the eight extra meridians linking to dai mai, resolves damp-heat and regulates the girdle vessel, GB26 dai maiResolves dampness in the lower burner, regulates the girdle vessel and the uterus, BL32 ci liao resolve dampness in the uterus • Herbal treatment: qi gong wan

  7. Blood Stasis • Manifestations • Infertility, painful period, menses is dark in color, with clots. Metrostaxis, postcoital bleeding, painful coitus, dark red tongue with spots, thin wiry pulse • Treatment principle • Remove blood stasis, regulate periods and promote conception • Acupuncture Treatment LV3, GB34, BL17, SP10, SP6, ST29, Ren3, zigong • LV3 and GB34moves qi and blood • ST29 regulates the blood in the uterus • SP6 moves blood • SP10 and BL17 quicken the blood and move blood stasis • Ren3, the meeting point of the three foot yin meridians and the chong and ren, is used to adjust the qi of the chong ren vessels • Zigong: Regulates qi and menstruation • Herbal treatment: shao fu zhu yu tang

  8. Morning sickness • Morning sickness is one of the earliest signs of pregnancy (6-12 weeks) which is marked by frequently nausea, vomiting, dizziness, dislike the smell of the foods, poor appetite, anorexia or vomiting right after eating, lassitude and like the sore taste foods.

  9. Etiology and Pathogenesis • Spleen and stomach deficiency • Liver heat (liver qi stagnation turning into heat, liver overacting on spleen) • Phlegm obstruction

  10. Stomach Deficiency • Clinical Manifestation • Vomiting soon after eating, poor appetite, epigastrium distension, fatigue, lassitude, pale tongue, white coat, weak thin pulse. • Treatment principle • Strengthen spleen, harmonize stomach and stop vomiting • Acupuncture Treatment: ST36, Ren12, Ren13, PC6, SP4, BL20, BL21 • Ren12, the front mu point of the stomach, ST36 the He-sea point of the stomach meridian, the two points used together are effective in pacifying the stomach and activating the descent of qi • PC6 and SP4 one of the pair-points of the eight confluent points, relieve the fullness of the chest and stomach • Ren13 subdues rebellious qi and relieves belching • BL20 and BL21 tonify spleen and stomach, descend the stomach qi • Herbal treatment: xiang sha liu jun zi tang

  11. Disharmony between Liver and stomach • Clinical Manifestation • Nausea, Vomiting with retching and belching, Vomiting of sore fluids, aversion to greasy food, thirsty, dry mouth, bitter taste, dizziness, headache, irritability, distension at the hypochondrium region, pale red tongue, thin yellow coating, wiry and slippery pulse • Treatment Principle • Clear liver, harmonize stomach and descend stomach qi • Acupuncture Treatment LV14, GB34, TB6, LIV3, Ren12, Ren13, PC6, SP4 ST36 • Ren12, the front mu point of the stomach, ST36 the He-sea point of the stomach meridian, the two points used together are effective in pacifying the stomach and activating the descent of qi • PC6 and SP4 one of the pair-points of the eight confluent points, relieve the fullness of the chest and stomach • LV3, the yuan point of the liver meridian, LV14, front mu point of the liver, both can soothe the liver and regulates the function of the liver • GB34, he sea point of the gallbladder, soothe the liver • TB6 jing river point of TB, regulate qi • Ren13 subdues rebellious qi and relieves belching • Herbal treatment: su ye huang lian tang

  12. Phlegm Accumulation • Clinical Manifestation • Vomiting of dilute fluids, dizziness, foggy head, heavy limbs, swollen tongue sticky white tongue coating, slippery pulse • Treatment Principle • Drain dampness, strengthen spleen and descend stomach qi • Acupuncture Treatment ST40, SP9, Ren12, Ren13, ST21 liangmen, PC6, SP4, ST22 guan men, Ren9, BL20 • Ren12, the front mu point of the stomach, ST36 the He-sea point of the stomach meridian, the two points used together are effective in pacifying the stomach and activating the descent of qi • PC6 and SP4 one of the pair-points of the eight confluent points, relieve the fullness of the chest and stomach • Ren9 promotes transform the fluids • BL20 tonify the spleen and resolve the dampness and phlegm • ST40 transform the phlegm, SP9 resolve dampness. • Ren13 subdues the rebellious stomach qi and is used for nuaea or vomiting • ST22 moves stomach qi • ST21 It is local point for all excess pattern of the stomach • Herbal treatment: er chen tang

  13. Insufficient Lactation • This condition consists of scanty or absent breast milk after childbirth. • This disease is characterized by no milk secretion when breeding starts after delivery, thin and little milk which is not enough to feed the baby, or sudden reduce of milk secretion due to emotional changes.

  14. Etiology and Pathology • Weakness of both Qi and Blood • Stagnation of the Liver Qi

  15. Deficiency of Both Qi and Blood • Manifestations • Insufficient secretion of milk after delivery or even absence of milk, no distending pain in the breast, pale complexion, dry skin, palpitation, lassitude, poor appetite, loose stools, pale tongue with little coating, weak and thin pulse. • Treatment Principle • Tonify qi and blood, promote lactic secretion • Acupuncture Treatment SI1, ST18, Ren17, BL20, ST36, SP6, Ren6 • Herbal treatment

  16. Stagnation of the Liver Qi • Manifestation • Sudden reduce of milk secretion due to emotional changes, distending pain in breast, mental depression, chest distress and hypochondriac pain, epigastric distension, loss of appetite, wiry pulse. • Treatment Principle • Soothe liver, free obstruction, and promote secretion of milk • Acupuncture Treatment BL18, LV14, Ren17, ST18, SI1, LV3, PC6 • Herbal treatment

  17. Uterine Prolapse • Prolapse of uterus refers to descent of the uterus into the vagina, or descent of the front wall of the vagina with the uterus.

  18. Etiology and Pathology • Weak constitution, Early physical labor after delivery before qi and blood are fully restored. Exhaustion in delivery, overstrain to counteract constipation, frequent pregnancy and delivery, indulgence in sexual life. • Spleen and kidney deficiency, loss of restriction of daimai

  19. Deficiency of Qi • Manifestations • Drop of the uterus in the vagina, sinking sensation in the lower abdomen, pale complexion, palpitation, lassitude, shortness of breath, frequent urine, leukorrhagia, pale tongue, weak and thin pulse. • Treatment Principle • Tonify qi and restore the prolapsed uterus in place • Acupuncture Treatment DU20, Ren6, Ren12, ST36, ST29, Zigong • DU20 is the meeting point of the governor vessel and the three yang meridians, and qi pertains to yang, subjected to the governor vessel, therefore moxibustion to GV can invigorate yang qi and improve the elevating and contracting function • ST36and Ren12 can reinforce qi for elevation • Ren6 tonify qi • ST29 can lift qi and also is local point for uterus • Zigong regulates qi and menstruation • Herbal treatment: bu zhong yi qi tang

  20. Kidney deficiency • Manifestations • Drop of the uterus in the vagina, sinking sensation in the lower abdomen, sore and weak low back and legs, dryness in the vagina, frequent urine, tinnitus, dizziness, pale tongue, weak and deep pulse. • Treatment Principle • Replenish kidney and keep the uterus in position. • Acupuncture Treatment DU20, Ren6, Ren4, ST29, Zigong, KI3 • DU20 is the meeting point of the governor vessel and the three yang meridians, and qi pertains to yang, subjected to the governor vessel, therefore moxibustion to GV can invigorate yang qi and improve the elevating and contracting function • ST36and Ren12 can reinforce qi for elevation • Ren6and Ren4 tonify qi • ST29 can lift qi and also is local point for uterus • Zigong regulates qi and menstruation • KI3 tonify the kidney • Herbal treatment: da bu yuan jian

  21. Prolonged labor • Parturition lasting over 24 hours is defined as prolonged labour. It is often due to weak contraction of the womb, narrow pelvic fetal and malposition of fetus.

  22. Etiology and Pathology • Deficiency of Qi and Blood • Qi stagnation and blood stasis

  23. Deficiency of Qi and Blood • Manifestations • Dull and paroxysmal labor pains with mild weighing and distending sensation, or profuse hemorrhage in light color, pale complexion, lassitude, palpitation, shortness of breath, pale tongue, weak pulse • Treatment Principle • Replenish Qi and Blood, quicken the delivery. • Acupuncture Treatment: ST36, SP6, BL67 zhi yin • ST36 and SP6 tonify the spleen and stomach that are source of the qi and blood • BL67 is also an empirical point for malposition of the fetus, it can promote labor. • Herbal treatment: nan chan fang

  24. Qi stagnation and Blood stasis • Manifestations • Sharp pain in the waist and abdomen, scanty hemorrhage in dark red color, prolonged delivery course, dark bluish complexion, fullness in the chest and epigastrium, frequent nausea, dark tongue, deep forceful pulse. • Treatment Principle • Activate qi and blood, quicken the delivery • Acupuncture Treatment LI4, SP6, BL67 • LI4, yuan point of the hand yangming meridian and SP6 is an intersecting point of the three foot yin meridians, the two paired together may regulate qi and blood, clear off stasis and speed up the delivery • BL67 is also an empirical point for malposition of the fetus, it can promote labor. • Herbal treatment: cui sheng yin

  25. Retracting Milk • Acupuncture Treatment • GB41 Zulingqi, GB37 Guangming • GB41 stream shu point of GB, it benefits breast • GB37 luo point of GB • Treat once daily for a total of three to five days • Herbs: Mai Ya 200g, Chan Tui 5g

  26. Ru Yong (Acute Mastitis ) • Acute mastitis and breast abscess broadly correspond to the Chinese breast carbuncle. This is characterized by redness swelling, heat and pain in breast, and by red nodules which after some days, rupture with discharge of sticky pus. • The initial stage: acute mastitis • The later stage with the discharging pus of breast abscess

  27. Etiology and Pathology • Liver stagnation and stomach heat • Pathogenic toxicity • Improper feeding and retracting milk

  28. Pattern and Treatment • Manifestations: • After delivery with symptoms of breast: redness, swelling, heat and pain in the breast, accompanied by red nodules which, after some days, rupture with the discharge of sticky pus. • The main treatment principle • clear heat, dissolve toxins, pacify liver, clear stomach heat and resolve pus • Acupuncture Treatment GB41 Zulingqi, ST44 Neiting, LV2 Xingjian, LI11 Quchi, ST9 Renying, SP6 Sanyinjiao, ST40 Fenglong, ST18 Rugen, PC6 Neiguan, TB6 Zhigou • GB41 benefits for the breast, for severe swelling and pain of the breast • Herbal treatment: gua lou niu bang tang

  29. Habitual Miscarriage (Slippery fetus) • Habitual miscarriage refers to the situation of three or more successive occurrence of miscarriage. In Chinese medicine it is called “Slippery Fetus”. Females with a history of habitual miscarriage must be cared well when she gets a pregnancy in order to fulfill the whole process of pregnancy.

  30. Etiology and Pathogenesis • Failure of fetus to be attached and carried due to deficiency of both the spleen and the kidney. • Loss of nourishment and carrying of fetus due to deficiency of both qi and blood. • Unconsolidation of fetus due to yin deficiency and blood heat.

  31. Deficiency of Both Spleen and Kidney • Manifestations • Treatment Principles • Acupuncture Treatment • Pishu BL20, Shenshu BL23, Baihui DU20, Qihai REN6, Mingmen DU4, Taixi KI3, Zusanli ST36, Zhongwan REN12, Zhaohai KI6, Lieque LU7 • Herbal Treatment • Bu Shen Gu Chong Wan ( Tonifing Kidney and Consolidating Penetrating Vessel Pill) • Jia Jian Cong Rong Tu Si Zi Wan (Modification of Cong Rong Tu Si Zi Wan)

  32. Deficiency of Both Qi and Blood • Manifestations • Treatment Principle • Acupuncture Treatment • Lieque LU7, Zhaohai KI6, Ququan LV8, Ganshu BL18, Pishu BL20, Zusanli ST36, Gehsu BL17, Baihui DU20 • Herbal Treatment • Tai Shan Pan Shi San

  33. Blood Heat Due to Yin Deficiency • Manifestations. • Treatment Principles • Acupuncture Treatment • Xuehai SP10, Geshu BL17, Quchi LI11, Quze PC3, Rangu KI2, Taichong LV3, Zhaohai KI6, Xingjian LV2 • Herbal Treatment • Liang Di Tang adding Shu Di, Zhi Mu • Jia Jian Yi Yin Jian

  34. Case Study • Female, 28 • Chief complaint: shortened menstrual cycle for 4 months • Present illness: the patient stated that she had two menstrual periods each month with profuse, purplish-red flow and clots. Each periods covered 2-7days. She also suffered distention and occasional pain in the lower abdomen, a premenstrual feeling of suffocation, restlessness and distending pain in the breasts. Other manifestations included thirst, a bitter taste in the mouth, poor sleep, constipation. Deep-yellow urine, a red tongue with thin yellow coating and wiry rapid pulse

  35. Case Study • Female, 22 • Chief complaint: delayed menstruation for half a year • Present illness: she had been taking contraceptive pills for 3 years and suffers from late periods since she stopped taking the contraceptive pill. Period occurs about every 60 days with scanty blood light red in color. Abdominal dull pain during and after period which is alleviated by pressure, aversion to cold, dizziness, occasional tinnitus, backache and sore knees, frequent urination, hair falling out, blurred vision and pale complexion. Pale swollen tongue with tooth mark at both sides. Weak and deep pulse

  36. Case study • Female 32 • Main complaint: dysmenorrhea for 12 years • Present illness: the patient often liked to eat cold and cold drinks. On the first day of her menstrual period, she often experienced severe abdominal pain radiating to the lower back which was colicky in nature and alleviated by warmth. She presented with purplish menstrual flow with clots, normal amount. Pale red tongue with thick white coating. Wiry pulse

  37. Case study • Female, 25 • Main complaint: amenorrhea for one year. • Present illness: the patient lost much blood in an induced abortion one year ago. Since then, menses ceased. She also presented with dizziness tinnitus, palpitation, poor memory, soreness in the lumbus and weakness in the knees, lassitude, poor appetite, a sallow complexion, emaciation. A pale tongue with thin coating, and a thready weak pulse

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