An Introduction to Gynaecology & Female Health in Clinical Practice
Dysmenorrhoea, Abnormal Uterine Bleeding & Shen Disorders
by Robin Marchment
Traditional Chinese Medicine – Sophisticated Simplicity
Chinese medical theory is very simple; it is only in its application that we find difficulty. The essence of effective TCM treatment is a sophisticated approach to fundamental theory and the refinement of diagnostic skill. This means we must have insight into the patient's condition and a clear understanding of the various interconnections which illuminate the pathogenesis, in order to clarify our treatment principles. Chinese Medicine is simple in its basic tenets, but highly discriminating in its clinical application.
Focus on You Female Patients
Women form the largest patient group in alternative or Complementary Medicine practice, and on that basis, many Practitioners choose to specialise in women's health issues. Chinese Medicine is particularly well-placed to treat a range of female reproductive disorders, including those that are considered by conventional medical approaches, to be more difficult to manage. Its strength lies in its differential diagnosis, its focus on aetiology, including emotional factors, and the protocols of treating both the ben (root) or underlying pattern of the disorder, and the biao (manifestation) or symptoms.
Pattern Recognition for Managing Multiple Symptoms
The fact that, as Traditional Chinese Medicine Practitioners, we diagnose and treat according to the pattern and not the disease name is not only highly effective but clinically relevant. The practical reality is that patients often present with more than one disorder, and inmost cases multiple complaints will stem from the same underlying pattern. This means that we can treat irregular or painful periods and simultaneously address the issue of heavy bleeding and short cycles or, perhaps, headache. We can treat anxiety or fatigue and at the same time treat short cycles. We can treat insomnia at the same time that we treat eczema or constipation or infertility - all by following the traditional principles of Chinese Medicine.
This is reflected in the use of formulas which are able to treat a range of illnesses. Xiao Yao San [Bupleurum & Dang Gui Formula] is often recommended for period pain, but is by no account restricted to the treatment of menstrual problems. It is equally useful to treat headache or indigestion, providing the underlying cause is a liver-spleen disharmony. Equally, two people may be suffering from a cough, but are prescribed different formulas. For this reason, the modern tendency to name some formulas 'Cough' or 'Insomnia' is misleading and potentially risky, insofar as it encourages erroneous prescription by those who do not understand Chinese Medicine diagnosis. It is important to understand disease processes from the modern bio-scientific perspective as this understanding can often enhance our understanding of the patient's condition. Nevertheless, to be effective, it is essential to remain true to the principles of differential diagnosis, and not be distracted by disease names.
Differential Diagnostic Skills for Female Reproductive Conditions
Differential diagnosis is the jewel in the crown of Chinese Medicine. Modern 'integrative medicine' can sometimes fall short of the 'ideal of true integration if it fails to acknowledge this strength of Chinese Medicine. In my up-coming seminar, TCM differential diagnosis will be a major focus. We will review the practical application of these principles in the treatment of dysmenorrhoea (painful periods), abnormal uterine bleeding and shen disorders.
Common Patterns in Female Reproductive Conditions
In Chinese Medicine, period pain is categorised according to zangfu pattern, according to the channels affected, and according to the time the pain occurs. If the patient is qi deficient, the pain will often occur towards the end of the period and present as an empty dragging sensation. Naturally, the pattern will be confirmed by general observation, by tongue and pulse examination, as well as questions regarding the stool, sleep, energy levels, etc.
More often, period pain is seen to be the result of liver qi constraint: 通則不痛, 痛則不通 (tong ze bu tong, tong ze bu tong) - "If there is free-flow then there is no pain, if there is pain then there is no free-flow".
Apart from leading to blood stasis, stagnation of qi can generate heat and heavy bleeding can be an associated feature of dysmenorrhoea. Liver excess can impair spleen function, in which case there may be heavy bleeding due to spleen qi deficiency.
To treat excessive uterine bleeding, even with the presentation of a Kidney deficiency pattern, it would usually not be enough to prescribe a formula such as Liu Wei Di Huang Wan [Rehmannia Six Formula]; additional herbs would be needed to stop bleeding.
If the bleeding is due to yin deficiency, then Han Lian Cao [Eclipta] and other appropriate herbs can be added. If due to excess Heat, then such herbs as Di Yu and