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Chapter 24 of 27
金匮要略
Main Theme of This Chapter: This chapter focuses on miscellaneous diseases in women, with "deficiency, accumulated cold, and bound qi" as the general principles, covering heat entering the blood chamber, visceral agitation, plum-pit qi, menstrual and vaginal discharge abnormalities, abdominal pain, reversed bladder, and disorders of the genital region, among others. It contains sixteen ancient formulas in total. The following is a section-by-section paraphrase in the original order, with modern interpretation.
1. When a woman contracts externally-contracted wind-stroke and reaches the seventh or eighth day, she then develops alternating chills and fever occurring at regular intervals, and her menstruation happens to cease at this time. This is heat entering the blood chamber (heat pathogen invading the blood-related region associated with menstruation and the uterus). Heat and blood bind together, so the condition manifests like malaria with periodic attacks. The ancients used Minor Bupleurum Decoction to harmonize the lesser yang and vent the heat outward.
2. When a woman contracts externally-contracted cold damage with fever, and her menstruation has just begun, she remains clear-minded during the day but delirious in the evening, as if seeing ghosts—this is heat entering the blood chamber. In treatment, one should not recklessly attack the stomach qi or use drugs for the upper and middle burners. By allowing the heat to descend along with the menstrual blood, there is a possibility of spontaneous recovery.
3. In a woman with wind-stroke, fever and aversion to cold, whose menstruation has just arrived, by the seventh to eighth day the fever has subsided, the pulse has turned slow, and the body has become cool. However, she develops fullness in the chest and hypochondrium, resembling chest binding, along with delirious speech. This is heat entering the blood chamber. One should needle the Qimen point (LR-14), draining according to where the pathogenic excess lies.
4. During the course of yang brightness disease, the appearance of lower hemorrhage and delirious speech belongs to heat entering the blood chamber. When only the head sweats, one should needle the Qimen point to drain the pathogenic excess. If there is generalized slight sweating, the disease may resolve favorably.
5. A woman feels as though a piece of roasted meat is stuck in her throat, unable to be spat out or swallowed, with fullness in the chest and hardness below the heart. The ancients used Pinellia and Magnolia Bark Decoction to regulate qi, transform phlegm, direct rebellion downward, and dissipate masses. The original formula consists of Pinellia, Magnolia Bark, Poria, Fresh Ginger, and Perilla Leaf, taken orally three times during the day and once at night according to the ancient method. This is a record from ancient literature, provided for the study of principles and methods only.
6. When a woman suffers from visceral agitation (a condition characterized by emotional sadness with a desire to weep and restless irritability), she frequently grieves and cries without apparent cause, as if possessed by spirits, and constantly yawns and stretches. The ancients used Licorice, Wheat, and Jujube Decoction to sweetly relax and nourish the heart and spleen. The original formula consists of Licorice, Wheat, and Red Dates, and was considered to have the function of supplementing spleen qi. This is not caused by ghosts or spirits but rather represents a manifestation of emotional dysregulation.
7. When a woman spits thin saliva and the physician erroneously applies a purging method, heart-area stuffiness and fullness result. Treatment should first address the spitting of saliva with Minor Green Dragon Decoction; after the saliva stops, then treat the heart-area stuffiness with Drain the Heart Decoction. This embodies the principle of "treating the acute new condition first, then addressing the changes caused by erroneous purgation."
8. Diseases in women mostly arise from the three major causes: "deficiency" (insufficiency of qi, blood, yin, and yang), "accumulated cold" (prolonged accumulation of cold pathogen), and "bound qi" (stagnation of qi movement), leading to cessation of menstruation. Over time, blood that is cold and accumulated binds at the cervical gate (the region of the uterine opening), and cold pathogen damages the channels and collaterals.
In ancient times these were collectively called "belt below" (a broad term for gynecological conditions involving menstruation and vaginal discharge), and it was clearly stated that they are not caused by ghosts or spirits. Over time, there is emaciation, and the pulse becomes deficient and frequently cold. The ancients called these the "thirty-six diseases," with numerous variations. One must examine whether the pulse is yin or yang, deficient or excess, tight or wiry, and then employ acupuncture and medication to turn peril into safety. Even when symptoms are the same, the root causes reflected in the pulse may differ, and careful discrimination is required.
9. Question: When a woman around fifty years of age experiences diarrhea that does not stop for several tens of days, with evening fever, cramping discomfort in the lower abdomen, abdominal distension, heat in the palms and soles, and dry lips and mouth, why is this?
Master says: This condition belongs to the category of "belt below." The cause is a previous miscarriage with static blood retained in the lower abdomen that has not been eliminated. How does one know? By observing her dry lips and mouth, it is known that there is static blood internally. The Wen Jing Tang (Warm the Channels Decoction) should be used as the primary treatment.
The original formula contains Evodia Fruit, Angelica Sinensis, Chuanxiong Rhizome, Peony, Ginseng, Cinnamon Twig, Ass-Hide Gelatin, Fresh Ginger, Moutan Bark, Licorice, Pinellia, and Dwarf Lilyturf Tuber. The ancients considered this formula to warm the channels, dispel cold, nourish blood, and dispel stasis, while also regulating the Chong and Ren vessels. The literature also records its use for women with cold lower abdomen, prolonged inability to conceive, uterine bleeding, excessive menstruation, or delayed menstruation. This is for study purposes only and is not intended as medication guidance.
10. For "belt below" conditions with irregular menstruation, distension, fullness, and pain in the lower abdomen, and menstruation occurring twice in one month, the ancients used Trichosanthes Root Powder. The original formula contains Trichosanthes Root, Peony, Cinnamon Twig, and Ground Beetle, which invigorate blood and unblock the menses. The original text "Tu Gua Ji San" should be read as "Tu Gua Gen San"; "zhe chong" refers to the ground beetle. The literature also records its use for treating swelling of the genitals.
11. At the Cun opening, the pulse is wiry and large. A wiry pulse indicates decline of yang qi; large and hollow describes the hollow pulse; wiry with diminished force indicates cold, and hollow and large indicates deficiency. When cold and deficiency combine, this is called the leather pulse. When women manifest this pulse, they are prone to miscarriage or unremitting drip bleeding. The ancients used Inula Flower Decoction. The original formula contains Inula Flower, Scallion, and Newly Dyed Crimson Silk, capturing the meaning of moving qi, unblocking the collaterals, and invigorating blood.
12. When a woman has sunken menses (menses sinking downward with leakage), with continuous leakage of black-colored blood, the ancients used Gelatin and Ginger Decoction. However, collators note that this formula is missing from the original text and suspect it may be the same as the E-Jiao Tang from the previous pregnancy chapter. Since the formula is not recorded, no specific explanation can be provided.
13. When a woman has lower abdominal distension and fullness like a dun (an ancient grain vessel, narrow at the top and bottom while bulging in the middle), with slight difficulty in urination but no thirst, and this occurs after childbirth, it results from water and static blood binding together in the blood chamber. The ancients used Rhubarb and Euphorbia Kansui Decoction to attack and expel the water and blood. The original formula contains Rhubarb, Euphorbia Kansui, and Ass-Hide Gelatin, and the literature records that after taking it, "the blood will be discharged." Euphorbia Kansui is a potent drastic purgative for dispelling water and must never be used on one's own initiative.
14. When a woman has irregular menstruation with failure of menstrual blood to descend, the ancients used Di Dang Tang (Resist the Proper Decoction) to break blood and expel stasis. The original formula contains Leeches, Gadflies, Peach Kernel, and Rhubarb, constituting a potent and fierce formula for invigorating blood and breaking stasis. In the original text, "shui wa" should be read as "shui zhi" (leech). It is also recorded for treating men with bladder distension, urgency, and static blood.
15. When a woman has amenorrhea or irregular menstruation, with a hard mass in the uterus that does not resolve, containing dried blood internally, and also experiencing white vaginal discharge, the ancients used Alum Pill as a pessary inserted into the vagina. The original formula uses Calcined Alum and Apricot Kernel, refined with honey into pills of jujube-kernel size. This constitutes an ancient external treatment and is not intended as a guide for modern medication use.
16. When women are affected by various types of wind pathogens, and experience stabbing pain in the abdomen due to unsmooth blood flow, the ancients used Safflower Wine. Hong Lan Hua is safflower, used as a single ingredient decocted in wine, to invigorate blood and dispel wind. An original annotation expresses doubt that this is a Zhong-Jing formula.
17. For various cramping pains in a woman's abdomen, the ancients used Angelica and Peony Powder to harmonize the liver and spleen, nourish blood, and promote diuresis. The formula is found in the Pregnancy chapter.
18. For deficiency-cold type abdominal pain in women, the ancients used Minor Construct the Middle Decoction to warm the middle, supplement deficiency, and relieve urgency and pain. The formula is found in the Consumptive Disease chapter.
19. Question: When a woman has normal appetite and food intake, but experiences vexation, heat, and an inability to lie flat, requiring her to breathe in an upright position, why is this?
Master says: This is called reversed bladder, with inability to urinate. It is caused by the "bladder cord being twisted and irregular." So long as urination is promoted, there will be improvement. Shen Qi Wan (Kidney Qi Pill) is appropriate. The original formula contains Dried Rehmannia, Chinese Yam, Cornus Fruit, Alisma, Poria, Moutan Bark, Cinnamon Twig, and Processed Aconite. The ancients believed that Shen Qi Wan warms the kidneys, transforms qi, and thereby promotes urination. This condition resembles the inability to urinate during pregnancy or after childbirth, but the specific cause requires modern medical evaluation.
20. Cnidium Seed Powder is a pessary for warming and nourishing the interior of the genital region. Cnidium seed kernels are ground into powder, mixed with a small amount of white powder, formed into pills the size of jujubes, wrapped in cotton, and inserted into the vagina, to warm and dissipate cold-dampness. This is an ancient external treatment and is not intended as a guide for modern medication use.
21. When the lesser yin pulse is slippery and rapid, it indicates the presence of ulceration and erosion in the genital region. The ancients used Wolf's Fang Decoction for external washing. The original formula uses wolf's fang (a medicinal plant material) decocted in water, with cotton wrapped around a tendon, dipped in the medicinal liquid, and allowed to drip into the genital region, four times daily. This is an ancient external treatment; in modern times, the infectious cause should be clearly identified before standardized treatment.
22. When stomach qi discharges downward and gas exits from the anterior yin with sound (vaginal flatulence), the ancients considered this to be caused by "excess of grain qi" and used Paste and Hair Decoction to guide it out. The formula is found in the Jaundice chapter. In modern understanding, this is often associated with pelvic floor muscles, vaginal laxity, or rectovaginal fistula, and medical evaluation should be sought.
23. The formula for pediatric gan worms eroding the teeth carries an original annotation expressing doubt that it is a Zhong-Jing formula. Realgar and Lepidium Seed are ground into powder, melted in twelfth-month (lunar winter) lard, wrapped in cotton around a locust branch, dipped in the mixture, and used to cauterize the affected area. This constitutes an ancient external treatment for dental caries or oral problems. As realgar is toxic, it must not be replicated in modern times.
1. "Deficiency, accumulated cold, and bound qi" serve as the general principles for miscellaneous gynecological conditions.
Deficiency means insufficiency of qi, blood, yin, and yang; accumulated cold means cold congealing in the uterus; bound qi means qi stagnation and blood stasis. The three frequently interact with one another, leading to menstrual blockage, abnormalities in menstruation and discharge, abdominal pain, and many other pathological changes. This constitutes the theoretical core of the entire chapter.
2. Heat entering the blood chamber emphasizes the relationship between external contraction during menstruation and the blood aspect.
When menstruation has just arrived or just ceased, the blood chamber is relatively vacuous, allowing external pathogens to take advantage and enter, binding with blood. This manifests as alternating chills and fever resembling malaria, fullness in the chest and hypochondrium, and delirious speech. Treatment emphasizes not damaging stomach qi and the upper two burners, or needling Qimen to drain excess, reflecting the principle that externally contracted diseases in gynecology require protecting the menstrual blood.
3. Emotional disorders are treated through the angle of qi and the heart and spleen.
"Something like grilled meat stuck in the throat" is qi stagnation with phlegm congelation; "visceral agitation" is insufficiency of the heart and spleen with emotional instability. The ancients already recognized the close relationship between emotions and gynecological symptoms, using Pinellia and Magnolia Bark Decoction to regulate qi and dissipate masses, and Licorice, Wheat, and Jujube Decoction to sweetly relax and nourish the heart.
4. Static blood and cold deficiency run throughout the pathogenesis of menstrual and vaginal discharge conditions.
The Wen Jing Tang pattern emphasizes the retention of static blood from previous miscarriage; Tu Gua Gen San, Di Dang Tang, and Da Huang Gan Sui Tang in sequence reflect static blood and water-blood binding at different degrees. Invigorating blood and resolving stasis, warming the channels, and dispelling cold are important treatment methods.
5. The diversity of external treatments in gynecology.
Alum Pill, Cnidium Seed Powder, and Wolf's Fang Decoction all represent topical applications, reflecting the ancient diversified approach to external gynecological treatment, but modern use must undergo strict disinfection and pattern identification.
6. Pulse-taking is emphasized in differentiation, with the same disease arising from different sources.
The general discourse clearly states "examine whether the pulse is yin or yang, deficient or excess, tight or wiry" and "although the diseases are the same, the origins in the pulse differ," emphasizing the importance of pulse diagnosis in miscellaneous gynecological conditions. The leather pulse indicating miscarriage and dripping bleeding, and the slippery-rapid lesser yin pulse indicating genital sores, both serve as models for correlating pulse and manifestations.
1. Heat entering the blood chamber
This may be understood as an ancient description of infection during menstruation or the postpartum period, pelvic inflammatory disease, or infectious fever accompanied by neuropsychiatric symptoms. The ancients used the "blood chamber" to summarize the uterus, Chong and Ren channels, and related regions. Needling the Qimen point constitutes a superficial stimulation therapy. In modern practice with fever, delirium, and lower hemorrhage, the infectious source should first be identified and standardized treatment administered.
2. Plum-pit qi and visceral agitation
"The sensation of grilled meat in the throat" is similar to modern globus pharyngeus or globus hystericus, often associated with emotional anxiety and gastroesophageal reflux. "Visceral agitation" bears similarity to perimenopausal mood disorders, depression, and anxiety. These suggest the role of psychological and emotional factors in gynecological symptoms but do not replace professional psychiatric and psychological evaluation.
3. Classical formulas such as Wen Jing Tang and Di Dang Tang
Modern research has explored the value of the principles underlying Wen Jing Tang in treating deficiency-cold and static-blood types of menstrual irregularity and infertility. Di Dang Tang and Da Huang Gan Sui Tang, which break blood and expel stasis, are also used for severe static blood conditions. However, these formulas have complex compositions, some containing potent or harsh ingredients, and must be used under a physician's guidance—they should never be self-prescribed.
4. Reversed bladder and vaginal flatulence
Reversed bladder resembles urinary retention during pregnancy or the postpartum period; vaginal flatulence relates to pelvic floor dysfunction, rectovaginal fistula, and related conditions. Traditional Chinese medicine explains these through "kidney qi failing to transform" and "excess of grain qi," while modern practice should integrate pelvic floor rehabilitation and surgical evaluation.
5. Historical limitations
Names such as "sixty-two types of wind" and "gan worms eroding teeth" carry the coloring of their era. Certain substances such as realgar, Euphorbia Kansui, leeches, and gadflies are toxic or drastic in action and must not be used on one's own. The original text's explicit statement that "there are no ghosts or spirits" demonstrates that the ancients already possessed a plain materialistic viewpoint, excluding superstitious explanations—an aspect worthy of affirmation.
——Bu Gua
This content is based on a classical Chinese medicine text and is provided solely for the study and appreciation of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice; if you feel unwell, please seek medical attention promptly.