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Chapter 29 of 29
伤寒杂病论
Overall Paraphrase
This section systematically discusses the pulse manifestations, diagnosis, and treatment of gynecological conditions including menstruation, vaginal discharge, pregnancy, childbirth, and miscellaneous disorders. The following is a vernacular explanation in the original order. All formulas are presented solely as an introduction to classical academic principles and do not constitute any medication advice.
Early Pregnancy and Guizhi Decoction Pattern 🌿
The teacher said: When a woman's pulse is generally calm, with only the Yin pulse (the chi pulse, reflecting the lower jiao and uterus) slightly weak, accompanied by nausea and inability to eat, but without external contraction manifestations such as fever or chills, this often indicates pregnancy. The ancients believed Guizhi Decoction could be used to regulate this condition. According to general principles, such reactions typically appear around sixty days of pregnancy; if a physician treats incorrectly, the course may extend by one month; if emetics or purgatives are mistakenly used, damage to the fetus may occur.
Pre-existing Abdominal Mass with Uterine Bleeding and Guizhi Fuling Pills 🩸
When a woman has a pre-existing abdominal mass (chronic tumor or blood stasis accumulation) and experiences continuous uterine bleeding before reaching three months of amenorrhea, with a sensation of "fetal movement" above the navel, this indicates harm from the chronic mass. If fetal movement is perceived at six months of pregnancy with normal menstruation in the first three months, this is likely normal fetal movement; bleeding occurring after three months of amenorrhea is mostly due to blood stasis. The reason bleeding does not stop is that the accumulated mass has not been resolved. At this point, the mass should be gradually eliminated, and the ancients used Guizhi Fuling Pills.
Fuzi Decoction Pattern in the Sixth or Seventh Month of Pregnancy 🔥
When a woman in her sixth or seventh month of pregnancy presents with a wiry pulse, fever, distending abdominal pain, abdominal pain, aversion to cold, and a sensation of cold wind blowing over the lower abdomen, the ancients considered this to be the uterus opening without proper closure, and prescribed Fuzi Decoction to warm and nourish. Fuzi (Radix Aconiti Lateralis Preparata) is hot in nature, and modern practice holds that its use during pregnancy requires extreme caution and must be determined by a professional physician.
Uterine Clogging and Jiao'ai Decoction 🩺
The teacher said: When a woman has continuous uterine bleeding—whether as spotting, persistent bleeding after miscarriage, or abdominal pain during pregnancy (termed uterine clogging, "Baozu")—(the treatment) is Jiao'ai Decoction. This formula is primarily warming, nourishing, stops bleeding, and calms the fetus.
Pregnancy Abdominal Pain and Danggui Shaoyao Powder 🌿
When a woman experiences cramping and pain in the abdomen during pregnancy, the ancients used Danggui Shaoyao Powder to nourish blood, soften the liver, strengthen the spleen, and resolve dampness.
Unrelenting Vomiting During Pregnancy and Ganjiang Renshen Banxia Pills 💨
For severe, unrelenting vomiting during pregnancy, the ancients used Ganjiang Renshen Banxia Pills. This formula contains Banxia (Pinellia ternata), and modern practice cautions that its use during pregnancy requires careful consideration.
Difficult Urination During Pregnancy and Danggui Beimu Kushen Pills 🌊
When urination is difficult during pregnancy but appetite remains normal, the ancients used Danggui Beimu Kushen Pills. This formula embodies the methods of nourishing blood, moistening dryness, and clearing heat with diuresis.
Edema During Pregnancy and Kuizi Fuling Powder 🌊
When edema develops during pregnancy with difficulty urinating, paroxysmal chills, and dizziness upon standing, the ancients used Kuizi Fuling Powder. Once urination becomes free, the symptoms may resolve. The original text's "Kuizi Huoling Powder" should read "Kuizi Fuling Powder."
Regular Use of Danggui Powder During Pregnancy 🌿
The ancients believed that if no significant illness is present during pregnancy, Danggui Powder may be taken regularly to promote smooth delivery and reduce postpartum ailments.
Cold-Dampness in Pregnancy and Baizhu Powder 🔥
When pregnancy is affected by cold-dampness, presenting with abdominal pain, vexation, heart pain, inability to eat, and pronounced fetal movement, the ancients used Baizhu Powder to warm the middle, resolve dampness, and calm the fetus.
Abdominal Fullness and Inability to Urinate in the Seventh Month of Pregnancy 🩺
When a woman in her seventh month of pregnancy develops abdominal fullness, inability to urinate, and water-like swelling from the waist down, the ancients considered this to be the Taiyin failing to nourish when it should, with heart qi excess, and recommended acupuncture to drain Laogong (PC 8) and Guanyuan (CV 4). Recovery follows once urination becomes free.
Three Postpartum Conditions: Convulsions, Vexation with Clouding, and Difficult Defecation 🩸
Question: New mothers commonly suffer from three types of disorders: the first is convulsions (rigidity of the limbs), the second is vexation with clouding (dizziness, mental oppression), and the third is difficult defecation. Why is this?
The teacher replied: After childbirth, there is blood deficiency and profuse sweating, making one susceptible to wind pathogen, hence convulsions arise; after blood loss and further sweating, cold pathogen predominates, causing vexation with clouding; and with depletion of body fluids and dryness of the gastrointestinal tract, defecation becomes difficult.
Postpartum Vexation with Clouding and Xiao Chaihu Decoction and Da Chengqi Decoction 🩺
When a postpartum woman presents with vexation with clouding, a faint and weak pulse, vomiting with inability to eat, hard stools, and sweating confined to the head only, this results from blood deficiency causing lower extremity cold and isolated yang ascending. Treatment may use Xiao Chaihu Decoction. If after resolution of the vexation with clouding the patient can eat, but fever recurs seven or eight days later, this indicates stomach excess, treatable with Da Chengqi Decoction. Note: Da Chengqi Decoction is a potent purgative; the ancients used it for excess patterns postpartum, but modern practice demands extreme caution.
Various Formulas for Postpartum Abdominal Pain 🩸
Postpartum cramping abdominal pain due to deficiency-cold with insufficiency is treated with Danggui Shengjiang Yangrou Decoction for warming and nourishment.
Postpartum abdominal pain with vexation and fullness preventing lying down should not be treated rashly with purgatives; Zhishi Shaoyao Powder is appropriate to harmonize. If symptoms persist after taking it, this is often due to retained blood stasis in the lower abdomen below the navel, and Xiayuxue Decoction is used.
Seven or eight days postpartum, without taiyang exterior manifestations but with hardness and pain in the lower abdomen (especially over the suprapubic region), this indicates lochia retention; if accompanied by constipation, vexation, fever, and a slightly excess pulse, harmonizing and purging is appropriate; if vexation worsens toward evening, delirium occurs after eating, and symptoms remit at night, the ancients considered Da Chengqi Decoction appropriate.
Various Formulas for Postpartum Wind Stroke 💨
When postpartum wind stroke fails to resolve after dozens of days, presenting with headache, aversion to cold, fever, fullness below the heart, dry retching, and slight sweating, Xiao Chaihu Decoction is used.
For postpartum wind stroke with fever, flushed face, headache, sweating with panting, and a rapid wiry pulse, Zhuye Decoction is used.
Postpartum Restlessness and Zhupi Da Pills 🔥
For postpartum vexation and agitation with nausea and vomiting, without obvious external contraction, the ancients considered this to be deficiency during lactation, and used Zhupi Da Pills. If heat signs are pronounced, the amount of Baiwei can be doubled.
Postpartum Diarrhea and Baitouweng Jia Gancao Ejiao Decoction 🌊
For postpartum diarrhea with an extremely deficient pulse, the ancients used Baitouweng Jia Gancao Ejiao Decoction. This embodies the method of clearing heat to stop diarrhea while simultaneously nourishing blood.
Sensation of a Piece of Dried Meat in the Throat and Banxia Houpo Fuling Shengjiang Decoction 💨
When a woman senses an obstruction in her throat like a piece of roasted meat, commonly called plum-pit qi in later generations, the ancients used Banxia Houpu Fuling Shengjiang Decoction to regulate qi, transform phlegm, descend counterflow, and dissipate masses. This formula name in the original text corresponds to what later generations commonly called the Banxia Houpu Decoction family.
Visceral agitation and Ganmai Dazao Decoction 🌿
For women with visceral agitation (zang zao), who feel sorrowful and want to weep, yawn and stretch frequently, even as if possessed by something, the ancients used Gancao Xiaomai Dazao Decoction. This formula is sweet and gentle, nourishes the heart, moistens dryness, and calms the spirit.
Mistaken Purgation for Salivary Spitting Leading to Distension 🩺
When a woman spits saliva and a physician erroneously applies purgation, leading to a stuffy, full sensation below the heart, the spitting of saliva should be treated first with Jiegeng Gancao Fuling Zexie Decoction; subsequently, the stuffy fullness is treated with Xiexin Decoction. The original text reflects a sequential approach of treating the branch first and the root later, with layered treatment planning.
General Principles for Miscellaneous Gynecological Disorders 🔥
Gynecological disorders frequently arise from deficiency, accumulation, cold, and binding of qi, leading to cessation of menstruation and blood stasis lodging at the uterine gate (cervix). Manifestations may include pain around the umbilicus resembling cold hernia; or pain at Guanyuan with rough skin like fish scales; or twitching pain in the vagina with cold in the lower abdomen; or pulling pain radiating to the lower back and spine; or qi rushing downward to the qi street (groin region). These all fall within the scope of vaginal discharge conditions. In assessment, one must carefully examine the pulse for cold, heat, deficiency, excess, tightness, and wiriness before proceeding with acupuncture and medication, tracing the source of disease.
Bleeding at Age Fifty and Wenjing Decoction 🩸
Question: A woman around fifty years of age has been bleeding for dozens of days without stopping, with evening fever, lower abdominal cramping, abdominal fullness, hot flashes in the palms, and dry lips and mouth. Why?
The teacher replied: This falls under the category of vaginal discharge disorders. It results from a prior miscarriage with retained blood stasis in the lower abdomen, causing dry lips and mouth. Wenjing Decoction is used to warm the channels, disperse cold, nourish blood, and dispel stasis.
Irregular Menstruation and Wangguagen Powder 🌊
When a woman has irregular menstruation with lower abdominal distension and pain, or menstruation occurring twice a month, or vulvar swelling, the ancients used Wangguagen Powder.
Post-Miscarriage Bleeding and Xuanfuhua Decoction, Huangqi Danggui Decoction 🩸
For bleeding after miscarriage or persistent spotting, Xuanfuhua Decoction is used; if the pulse is weak and deficient, Huangqi Danggui Decoction is used.
Downward Collapse of the Chong Channel and Jiaojiang Decoction 🩸
When a woman's menstrual blood collapses downward with dark, clotted spotting, the ancients used Jiaojiang Decoction. The original text's phrase "Jiao Tang Jiang Fang" should read "Jiaojiang Decoction Formula."
Intermingling of Water and Blood and Dahuang Gansui Ejiao Decoction 🌊
When a woman's lower abdomen is distended and full like a mound, with slight difficulty urinating but no thirst, seen after menstruation or childbirth, the ancients considered this to be an intermingling of water and blood binding in the blood chamber, and used Dahuang Gansui Ejiao Decoction. This formula contains Gansui (Kansui root), which is quite toxic and must not be self-administered in modern times.
Menstruation Coming and Going Periodically and Didang Decoction 🩸
When a woman frequently experiences abdominal pain with menstruation irregularly present then stopping, and resuming again, the ancients believed blood stasis was present and used Didang Decoction. This formula contains insect-based stasis-expelling drugs such as leeches and tabanid flies and must be managed by a professional physician.
Amenorrhea with White Discharge and Fanshi Pills 🌊
When a woman's menstruation is obstructed, with a hard mass in the vagina and copious white discharge persistent, the ancients believed there was dried blood within and used Fanshi Pills inserted into the vagina. This is an external treatment method.
Wind Disorders of Sixty-Two Types and Honglanhua Wine 💨
For women suffering from various wind conditions with stabbing pain in the abdomen due to qi and blood stasis, the ancients used Honglanhua Wine to invigorate blood, unblock the channels, and relieve pain.
Various Abdominal Pains in Women 🌿
For various abdominal pains in women, Danggui Shaoyao Powder may be used, or Xiao Jianzhong Decoction.
Uterine Displacement and Shenqi Pills 🌊
Question: When a woman has normal appetite and eating but experiences vexation and fever preventing her from lying down (compelling her to sit upright to breathe), why?
The teacher replied: This is called uterine displacement (zhuanbao), with inability to urinate, due to the twisting and disorder of the urinary bladder system (structures associated with the bladder). Relieving urination will bring recovery, using Shenqi Pills. The original text phrase "Xianqi Pills Formula" should read "Shenqi Pills Formula."
Vaginal Coldness, Vaginal Sores, and Vaginal Flatulence 🩺
For coldness in the vagina, Shechuangzi Powder is inserted into the vagina.
A shaoyin pulse that is slippery and rapid suggests sores and ulceration in the vagina; Lanya Decoction is used for external washing.
For vaginal flatulence—the passage of gas from the vulva with sound like flatulence—the ancients considered the intestinal tract to be in excess and used Zhugao Fajian (Lard and Hair Decoction).
The core academic thought of this chapter can be summarized as: Women are rooted in blood, function through the liver, and commonly manifest deficiency, cold, and stasis.
This content is based on classical Chinese medicine texts and is intended solely for traditional cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.