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Chapter 11 of 13
脉经
This volume is divided into nine sections, centering on women's pregnancy and childbirth, menstruation and vaginal discharge, miscellaneous diseases, and pediatric illnesses. The following provides a vernacular paraphrase and theoretical interpretation section by section. The formulas, acupuncture, external treatments, and other content involved in this volume are all explanations of ancient academic principles, intended solely for traditional culture study, and do not constitute any medical diagnosis, medication advice, or treatment recommendations.
This section discusses using pulse signs to determine pregnancy, infer fetal sex, and identify signs of impending labor.
If the pulse is calm but somewhat deficient, it is commonly seen in breastfeeding women. The Inner Canon states, "Yin surging and Yang separate, this is called having a child," meaning that when the chi (foot yin) pulse is strong and clearly distinct from the yang pulse, it reflects the harmonization of qi and blood and the union of yin and yang resulting in conception. Observing a distinct pulse in the Heart Meridian of Hand-Shaoyin is also often regarded as a sign of pregnancy. This is because the heart governs the blood vessels; and the kidneys are related to the "Cellular Gate" and "Child's Door" (uterus and birth passage), with the chi position corresponding to the kidneys. Therefore, a chi pulse that is continuous and unbroken upon palpation is one of the pregnancy pulse patterns. If the three positions have a uniform floating-sinking quality and remain continuous on deeper pressure, pregnancy can also be considered. In early pregnancy, the cun pulse is slightly small, with five beats per breath; by the third month, the chi pulse tends to be somewhat rapid. A pulse that is slippery and rapid but easily scattered with deep pressure indicates about three months of pregnancy; if it does not scatter with deep pressure, and is rapid but not slippery, it indicates about five months.
The ancients also recorded various methods for inferring fetal sex: a rapid pulse on the left side indicates a male; rapid on the right indicates a female; deep Taiyin pulse indicates a male; floating Taiyang pulse indicates a female; deep and firm on the left hand indicates a male; floating and large on the right hand indicates a female; the relative prominence, floating, or depth of the left and right chi pulses are also used. There are also behavioral observation methods, such as having the pregnant woman walk south and then calling her from behind to see which way she turns her head; or the husband calling urgently from behind while she is at the toilet; some even examine whether the husband's breasts have "nodules". Most of these methods belong to ancient empirical observations, and should not be taken as definitive.
Regarding impending labor, if a woman's pulse "leaves its meridian" — that is, it departs from its normal rhythm and appears floating and scattered — accompanied by abdominal pain radiating to the lower back and spine, it indicates delivery is imminent; this "leaving the meridian" state is not pathological at this point. If the "leaving the meridian" pulse appears around midnight, the ancients empirically inferred that the birth might occur around midday.
The core of this section is "assessing the fetus through the pulse" and "assessing the fetus through the channels." Ancients believed pregnancy results from "yang bestowing, yin transforming," meaning the harmonization of yin-yang qi and blood forms the fetus. Determining pregnancy via pulse is essentially observing whether qi and blood are replete, smooth in movement, and whether the chi position has root. Inferring fetal sex is based on yin-yang classifications such as "left corresponds to yang, right to yin" and "floating is yang, sinking is yin," attempting to judge the fetus's yin-yang nature through left/right, floating/sinking, and size.
After pregnancy, blood volume increases and circulation quickens, which can manifest as a slippery or somewhat rapid pulse — this aligns with modern medical understanding of hemodynamic changes during pregnancy. However, methods like using left/right pulse differences, head-turning direction, or husband's breast changes to determine fetal sex lack scientific basis and belong to historical cultural experience; they should not be relied upon. The "leaving the meridian" pulse before labor could be understood as a comprehensive reflection of endocrine, circulatory, and uterine contraction changes near term, but it cannot precisely predict the timing of delivery.
During pregnancy, the focus is on harmonizing qi and blood, maintaining emotional stability, and balanced rest and activity. Regular routine, moderate diet, avoiding fright and overexertion, are beneficial for both fetus and mother. In the late stages, attention should be paid to signs of labor, and one should go to a medical facility for delivery promptly, rather than relying on ancient methods to predict sex and birth time.
This section is extensive, covering fetal nourishment month-by-month during pregnancy, and the differentiation of conditions such as pregnancy abdominal pain, vaginal bleeding, edema, and abdominal masses (zheng accumulation).
The ancients proposed "nourishing the fetus month by month": In the first month of pregnancy, the Liver Meridian of Foot-Jueyin governs; second month, Gallbladder Meridian of Foot-Shaoyang; third month, Pericardium Meridian of Hand-Jueyin; fourth month, Sanjiao Meridian of Hand-Shaoyang; fifth month, Spleen Meridian of Foot-Taiyin; sixth month, Stomach Meridian of Foot-Yangming; seventh month, Lung Meridian of Hand-Taiyin; eighth month, Large Intestine Meridian of Hand-Yangming; ninth month, Kidney Meridian of Foot-Shaoyin; tenth month, Bladder Meridian of Foot-Taiyang. Each meridian nourishes the fetus for thirty days. The Hand-Taiyin (Lung) and Hand-Shaoyin (Heart) meridians are not involved in fetal nourishment, but instead govern menstruation and lactation. During pregnancy, one must not casually apply moxibustion or needling to these nourishing meridians, as it could potentially cause miscarriage.
In early pregnancy, if thirst is present but the pulse is instead slow, it may indicate "water manifestation" (water-qi disease); if abdominal pain is also present, miscarriage may follow. During pregnancy, floating pulse with sweating may indicate urinary obstruction; rapid pulse may indicate abscess/sores; in the fifth or sixth month, rapid pulse suggests possible fetal damage; tight pulse may indicate uterine leakage (vaginal bleeding); slow pulse may indicate abdominal fullness and wheezing; floating pulse may indicate edema.
The text uses multiple Q&A formats to discuss pregnancy complicated by fever, diarrhea, bleeding, abdominal pain, and edema. For example: floating-rapid pulse, fever, vomiting/coughing, diarrhea, poor appetite, and cessation of menstruation — ancient physicians considered this a deficient person with pregnancy manifesting "Yang flushed face" pattern, and argued through the Five Phases that the dryness-heat would recede by early autumn. For pregnancy at six or seven months with wiry pulse, fever, and a feeling of cold in the lower abdomen "like fanned", ancients diagnosed the "child's organ opening," and advocated warming methods like Fuzi Tang to warm the organ. At seven or eight months of pregnancy, if the pulse is surging, large, firm, and strong, the prognosis is better; if sunken and fine, the prognosis is poorer. Sudden discharge of significant fluid at six or seven months of pregnancy is called "orphan fluid descending early," which tends to lead to miscarriage.
For twin pregnancy with one fetus dead and one alive, the ancients believed "yin and yang both flourish, thus forming twin bodies." If the Shaoyin pulse is slightly tight, with turbid, congealed blood and incomplete meridian nourishment, one fetus may die in utero; this manifests as coldness and fullness in the lower abdomen, knee and patellar pain, heavy lower back, and difficulty rising. Timely management is required to avert "harming the mother and losing the fetus."
Regarding bleeding: during pregnancy, abdominal pain with leakage is "uterine leakage," for which ancient prescriptions used Jiao-ai Tang; if menstruation ceases for three months during pregnancy but bleeding continues, with fetal movement above the navel, ancient physicians deemed it a combined presence of "zheng" (blood stasis accumulation) and fetus, using Guizhi Fuling Wan to expel the mass. These represent ancient theoretical frameworks, illustrating two different approaches: "stopping bleeding to secure the fetus" versus "removing stasis to secure the fetus."
Subsequent content also discusses the differentiation of "blood manifestation" and "water manifestation": If menstrual cessation occurs first, followed by water disease, it is "blood manifestation," which is harder to treat; if water disease appears first, followed by menstrual cessation, it is "water manifestation," comparatively easier to treat — after promoting diuresis, menses may self-recover. There are also differentiations among amenorrhea, abdominal masses (zheng-ji), and "dwelling menstruation." Ancient physicians used pulse and medical history to determine pregnancy, emphasizing that fluid loss, diarrhea, and postpartum breastfeeding can lead to scanty or absent menses.
The passage beginning with "若宫里张氏不瘥" in the original text contains textual omissions/errors; later collations have flagged it as doubtful. No forced interpretation is offered here.
The core of this section is "differentiating pregnancy from pathologies":
The theory of monthly fetal nourishment has historical value, but the absolute claim that "needling/moxibustion on those meridians will cause miscarriage" does not apply to modern practice. Conditions like bleeding, abdominal pain, fever, and sudden fluid discharge during pregnancy require modern medicine to rule out miscarriage, ectopic pregnancy, infection, placental abnormalities, and hypertensive disorders of pregnancy. These should not be managed based solely on pulse diagnosis and ancient formulas. Though formulas like Jiao-ai Tang, Guizhi Fuling Wan, Danggui Beimu Kushen Wan, Kuizi Fuling San, Danggui San, and Wenjing Tang have seen later use, they must be applied under the guidance of licensed practitioners. This text provides no medication recommendations whatsoever.
During pregnancy, avoid external contraction of wind-cold-damp pathogens, maintain emotional stability, keep a light and moderate diet, and exercise appropriately. If abdominal pain, bleeding, fever, significant edema, abnormal fetal movement, or fluid discharge occur, seek medical attention promptly. Do not self-medicate or rely on ancient methods for prenatal care.
This section focuses on common postpartum illnesses. Ancient physicians summarized three major diseases of newly delivered women: tetany-like convulsions, depression/syncope (yu mao), and difficult defecation. Tetany results from excessive blood loss and sweating after childbirth, making the woman susceptible to wind pathogens; depression/syncope results from blood loss combined with sweating, allowing cold pathogens to invade vacuity; difficult defecation results from fluid depletion and dryness of the intestines and stomach.
Postpartum depression/syncope manifests as a faint-weak pulse, vomiting with inability to eat, hardened stools, and sweating confined to the head only. The mechanism is blood vacuity causing qi reversal; qi reversal then leads to dizziness and clouded sensorium. Relief often occurs following profuse sweating, because with yin blood vacuous, yang qi becomes dominant alone; sweating temporarily restores yin-yang equilibrium. For hard stools with vomiting and inability to eat, the ancients used Xiaochaihu Tang; after seven or eight days, if fever transforms into stomach-qi excess, they used Chengqi Tang. Both are ancient therapeutic rationales.
Prolonged postpartum wind-stroke that does not resolve — with mild headache, aversion to cold, intermittent fever, chest rigidity below the heart, dry retching, and sweating — was considered by the ancients as a persisting "Yangdan pattern," treatable with Yangdan Tang (i.e., a Guizhi-type formula). For postpartum wind-stroke with fever, facial flushing, wheezing, and headache, Zhuye Tang was used. For postpartum abdominal pain, Danggui Yangrou Tang. For postpartum abdominal pain with vexation, fullness, and inability to lie down, Zhishi Shaoyao San; if unrelieved, it was considered that dried blood (stasis) was lodged below the navel, using Xiayuxue Tang. For seven or eight days postpartum with hardness and pain in the lower abdomen, incomplete lochia, constipation, fever, restlessness, and delirious speech, the ancients considered interior heat bound in the bladder, and Chengqi Tang could be used. For postpartum middle-void vexation, restlessness, and vomiting, Zhupi Da Wan; for postpartum heat diarrhea, tenesmus, and general debility, Baitouweng Jia Gancao Tang.
The postpartum period is characterized by "multiple vacuity and multiple stasis": on one hand, blood loss and fluid damage result in qi-blood vacuity; on the other, unexpelled lochia makes the body susceptible to external pathogens and stasis-heat. Treatment must both support the upright and dispel pathogens, without using drastic purgatives. The three postpartum diseases encapsulate the typical states of blood loss, fluid deficiency, and external contraction.
Modern obstetrics also emphasizes postpartum hemorrhage, infection, venous thrombosis, constipation, mood disorders, and fever. The ancients' use of Xiaochaihu Tang and Chengqi Tang reflects syndrome-differentiated treatment, but managing postpartum conditions today requires clear etiology — infection needs antibiotics, hemorrhage needs identification of its cause, etc. Self-administration of these formulas is not appropriate. The mention of "Yangdan pattern" and Guizhi-class formulas indicates ancient approaches to postpartum external contraction but is not a medication directive.
After childbirth, keep warm and avoid wind, but do not overly insist on sweating. Maintain adequate hydration and nutrition, and keep the bowels regular. Seek timely medical attention in cases of abnormal lochia, fever, or worsening abdominal pain. Rest adequately and avoid premature overexertion.
"Vaginal discharge" (dai xia) had a broad meaning in ancient medical texts, potentially referring to various gynecological conditions involving menstruation and discharge. This section discusses discharge, infertility, amenorrhea, and "dwelling menstruation."
Diseases with vaginal discharge can present with a floating pulse with intestinal sounds and abdominal fullness; a tight pulse with abdominal pain; a rapid pulse with vaginal itching, pain, and sores; a wiry pulse with pulling pain in the vulvar region. The ancients divided discharge into three "gates": postpartum women belong to the "Cellular Gate"; those who have never given birth belong to the "Dragon Gate"; unmarried women belong to the "Jade Gate." For unmarried girls, three situations predispose to disease: exposure to wind and cold while sexually stimulated during first menses; washing with cold water; or fright triggered by the sight of red discharge.
For discharge disorders, the ancients determined whether the disease was in the upper, middle, or lower burner by asking about eating: aversion to food and smell of grain indicates upper jiao; slight appetite or eating and not eating is possible indicates middle jiao; normal eating and drinking indicates lower jiao, which belongs to discharge disease. With discharge associated with inhibited menstruation, lower abdominal fullness and pain, and menstruation occurring twice monthly, Tuguagen San was used; discharge with floating pulse, aversion to cold, and uterine bleeding carries a poorer prognosis.
In terms of menstrual irregularities: if amenorrhea for one year occurs shortly after menarche in young girls, it was called "avoiding the year," deemed not alarming, with menses expected to return spontaneously later. Cold in the lower abdomen, long-standing aversion to cold — in younger women may indicate infertility; in older women, permanent cessation of menses; faint-weak-rough pulses suggest the same judgment. Overweight individuals with fine pulses and cold uterus have few children. A forty-nine-year-old woman bleeding from the lower body for dozens of days without stopping, with evening fever, lower abdominal cramping pain, abdominal fullness, hot palms and soles, and dry lips and mouth — the ancients considered this a discharge-related condition caused by retained blood stasis following a late-term miscarriage, using Wenjing Tang.
Regarding "dwelling menstruation," the ancients referred to menses arriving once every three months, or a few months apart — which could be physiological or pathological. If menstruation ceases due to diarrhea causing fluid damage, once diarrhea stops and fluids recover, menses may spontaneously resume. If the pulse is faint-rough, with both qi and blood vacuous, in younger women it may be blood loss; in breastfeeding women with diarrhea it may be understandable; otherwise, it could be dwelling menstruation. For a woman around fifty experiencing "clear blood" for two to three days without stopping, some ancients judged this dwelling menstruation requiring no treatment — but this demands great caution today, and organic lesions must be ruled out first and foremost.
The core of this section is "differentiating discharge through the three gates" and "differentiating menstrual conditions by vacuity and repletion." The ancients believed that menstrual and discharge pathologies are closely tied to cold, dampness, stasis, and vacuity; through pulse, symptoms, age, obstetrical history, and diet, they sought to locate the disease in which organ/burner. Treatment strategies included warming meridians and dispersing cold, quickening blood and percolating dampness, and fortifying the spleen and harmonizing the stomach.
"Dai xia" roughly corresponds to a range of modern gynecological issues, such as abnormal vaginal discharge, pelvic inflammatory disease, cervical diseases, and endocrine disorders. Classifying "five-colored discharge" by color, texture, and odor continues to some extent in Chinese gynecology lineage, but modern practice also requires confirmatory tests such as discharge examination, ultrasound, and cytology to establish etiology. So-called "avoiding the year" or "dwelling menstruation" may correspond to adolescent infrequent ovulation or perimenopausal menstrual changes, but without examination they cannot be casually judged physiological. Abnormal bleeding especially around age fifty requires ruling out endometrial pathology. The formulas in the text are explanatory academic content and constitute no medical advice.
During menstruation and the postpartum period, keep warm, avoid getting caught in rain, wading in water, cold-water washing, and exposure to cold. Maintain emotional well-being. Keep the external genital area clean. If menstrual cycle or bleeding volume is markedly irregular, consult a gynecologist.
This section discusses depression/syncope, five types of flooding, uterine leakage, inhibited/closed menstruation, and lower abdominal pain in women.
Sweating therapy applied while menstruation is present can create vacuity in both the exterior and the interior, manifesting as depression/syncope with loss of consciousness. If the woman has seizure-like depression symptoms, occurring more than twenty times a day, with a soggy-tight pulse, the ancients speculated that it may be associated with excessive sexual activity during youth when menses was present, the ming-men opening upon excitement, blood vacuity from menstrual bleeding, and cold pathogens taking advantage of vacuity to enter the nutritive and defensive layers; cold accumulating in the dantian, qi rushing upward to the chest, with increased drooling, dizziness, and episodic attacks of heat rushing along the inner thighs, easily misdiagnosed as epilepsy; improper moxibustion may worsen it.
When a woman suffers bitter qi rushing upward to the chest, dizziness, drooling of foam, and heat surging through the thighs during interior flushing — with a sunken-slight pulse — the ancients classified this as "blood reversal": defensive qi collapses, nutritive qi is exhausted, blood is depleted, injuring the channels and collaterals, and cold pathogens accumulate upward; the face is red, akin to drunkenness, body seems swollen yet is actually floating vacuity. Mistaken adminstration of purgatives or long needles exacerbates the condition.
Five types of flooding are classified by color and form of discharge: white flooding like nasal mucus/snot; red flooding like deep red fluid; yellow flooding like rotten melon; green flooding with a bluish color; and black flooding like blood. A woman age forty-nine whose menstruation should have ceased but does not, the ancients felt could lead to vacuity. A wiry-large-frail (kou)-leather pulse indicates previous late-term miscarriage or uterine bleeding — the ancient formula associated is Xuanfuhua Tang; for continuous black leakage, Jiaojiang Tang; for inhibited menses, Didang Tang; for amenorrhea, dried blood, and discharge of white matter, Fanshi Wan; for various lower abdominal pains, Danggui Shaoyao San; for abdominal pain in general, Xiaojianzhong Tang.
The core of this section pertains to the patterns of "blood deficiency with cold congealing" and "static blood obstructing the collaterals" causing various gynecological conditions such as menstrual and vaginal discharge disorders, mental-spiritual derangements, and abdominal pain. Conditions like dizziness/vertigo (yumao), blood syncope, and psychospiritual symptoms are incorporated into the framework of qi and blood, the extraordinary vessels, and the life-gate. The "five types of uterine bleeding" (wubeng) are distinguished by five colors corresponding to the five viscera, representing the ancients' classification method for abnormal uterine bleeding.
Conditions such as exterior contraction during menstruation, dizziness following sweating, and emotional fluctuations warrant attention in modern times to potential anemia, hypotension, hypoglycemia, or infection. Recurrent episodes of "yumao" or "manic-like" presentations should prompt evaluation for neurological, psychiatric, or endocrine disorders; mistaken moxibustion or purgation must be avoided. "Five beng" broadly corresponds to abnormal uterine bleeding, necessitating investigations like ultrasound, hormonal assays, and endometrial pathology. Medications mentioned in the text, such as Di Dang Tang and Fan Shi Wan, represent ancient methods for breaking blood stasis and drying dampness to stop vaginal discharge; they must not be self-administered.
Avoid vigorous sweating, overexertion, and intemperate sexual activity before and during menstruation. Maintain emotional stability. Seek early medical attention for any abnormality in menstrual blood volume, color, or odor. Women in the perimenopausal period should undergo regular check-ups.
This section discusses women's throat foreign body sensation, emotional grief, heat entering the blood chamber (uterus), and lower abdominal fullness.
If a woman feels as if there is a piece of roasted meat or decaying matter stuck in her throat, which she can neither spit out nor swallow down, the ancients used Ban Xia Hou Po Tang. For the woman's "visceral dryness" (zangzao), characterized by a tendency towards sadness and crying, as if disturbed by spirits, and frequent yawning, the Gan Cao Xiao Mai Tang (Licorice and Wheat Decoction) was used.
When external contraction and menstruation appear concurrently, the ancients proposed "heat entering the blood chamber":
For lower abdominal fullness shaped like a mound, slight urinary difficulty but without thirst, particularly in postpartum women — this signifies concurrent stagnation of water and blood in the blood chamber. The ancient prescription Da Huang Gan Sui Tang is used.
This section embodies two significant gynecological miscellaneous disease models:
"Throat foreign body sensation" can be seen in chronic pharyngitis, globus hystericus, or gastroesophageal reflux disease. "Visceral dryness" resembles depression, anxiety, or perimenopausal mood disorders. "Heat entering the blood chamber" is an ancient pathological concept for genital tract infection or systemic stress response during menstruation. While there may be aspects worth exploring concerning the altered immune state and increased susceptibility to infection during menstruation, it cannot be simply equated with modern pathologies. The acupuncture at Qimen and herbal formulas are provided for academic discussion only, not as treatment recommendations.
Emotional well-being significantly impacts throat foreign body sensation and mood swings. During menstruation and postpartum, exposure to cold and overexertion should be prevented. If fever, bleeding, or mental confusion occurs during menstruation, seek medical attention promptly. Always maintain regular sleep, moderate exercise, and stress relaxation.
This section discusses women's vaginal coldness, Zhuan Bao (turning of the bladder / urinary retention related to uterine displacement), Yin Chui (vaginal wind/flatus), sores within the vagina, and prolapse/descensus.
If a woman finds her genitals cold, the ancients used warming suppository medications, such as the She Chuang Zi San (Cnidium Powder). Even worse, using strong medications to force menstruation can lead to pain around the orbits, heel pain, and a suspended, uncomfortable feeling centrally (chest xiphoid)/heart.
Zhuan Bao refers to a woman who has normal eating/drinking but suffers from vexation, heat, and inability to lie down, being forced to sit propped up to breathe. The mechanism is described as "tether torsion/scrambling of the uterine packet" ("胞系了戾" - implying torsion/displacement involving structures connecting the urinary bladder and uterus), leading to urinary stoppage. The Shen Qi Wan (Kidney Qi Pill) is used.
Yin Chui describes audible vaginal flatus/passing of gas. Ancients thought it related to the downward discharge of stomach qi, insufficiency of central qi, or repletion of grain qi, using an ointment and hair derivative known as the Gaofa Dao method.
For women with vaginal sores and a slippery-rapid pulse, the Lang Ya Tang (Asian Lilac / ... ) decoction became a wash or sit-bath.
If the visceral swelling is the size of a melon, and the internal-lower pain pulls up leading to lumbar pain, then use the Xing Ren Tang wash. If the Shao Yin pulse is string-like, it indicates "白肠必挺核" ("white intestine must protrude as a mass" - likely endometriosis/lumps pressing?). If the Shao Yin pulse floats and moves, then women get prolapse/descends downhill/ (tuo xia) likely generally referring to uterus prolapse; the shao yin mai fu erg dong ze furén tuo xia.
The core of this section involves differentiation of lower burner conditions: vaginal coldness, urinary obstruction, flatulence from the vagina, sores/masses, and prolapse all bear upon Kidney, Bladder, the uterus, Spleen-stomach middle qi diagnosis.
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