Posted in Articles from online, Chinese Gynecology, OB / GYN, women health, tagged Acupuncture, acupuncture for vulvodynia, acupuncturist, alexandria, arlington, Best Chinese medicine doctor, Chinese Medicine, 针灸, 马里兰, fairfax, falls church, herndon, Maryland, mclean, northern virginia, pain in pelvic area, tysons corner, vienna, Virginia, Vulvodynia, washington DC, 华盛顿, 外阴痛, 弗吉尼亚, 中医 on September 2, 2012| Leave a Comment »
J Sex Med. 2010 Feb;7(2 Pt 2):981-95. Epub 2009 Nov 12.
Elements of Health Centre, Victoria, Canada.
Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting 12% of women. Treatment modalities vary and although vestibulectomy has the highest efficacy rates, it is usually not a first-line option. Acupuncture has a long history in the traditional Chinese medicine (TCM) system and operates on the premise that pain results from the blockage or imbalance of important channels. The main principle of treatment is to move Qi and blood to cease genital pain.
To explore effect sizes and feasibility in a pilot study of acupuncture for women with PVD.
Eight women with PVD (mean age 30 years) underwent 10 1-hour acupuncture sessions. Specific placement of the needles depended on the woman’s individual TCM diagnosis. TCM practitioners made qualitative notes on participants’ feedback after each session. Main Outcome Measures. Self-reported pain (investigator-developed), pain-associated cognitions (Pain Catastrophizing Scale [PCS], Pain Vigilance and Awareness Questionnaire), and sexual response (Female Sexual Function Index) were measured before and after treatment sessions 5 and 10. Qualitative analyses of TCM practitioner notes were performed along with one in-depth case report on the experience of a participant.
A repeated measures analysis of variance revealed significant decreases in pain with manual genital stimulation and helplessness on the PCS. An examination of effect sizes also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and revealed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.
Effect sizes and qualitative analyses of practitioner-initiated interviews showed overall positive effects of acupuncture, but there were statistically significant improvements only in pain with manual genital stimulation and helplessness. These findings require replication in a larger, controlled trial before any definitive conclusions on the efficacy of acupuncture for PVD can be made.
Posted in Chinese Gynecology, fertility, Infertility, OB / GYN, women health, tagged Acupuncture, acupuncture baby, alexandria, arlington, Chinese Medicine, Dr.Arthur Fan, falls church, fertility, herndon, infertility, Maryland, Miscarriage, northern virginia, Potomac, reston, Rockville, tysons corner, vienna, Virginia, washington DC, woodbridge, 华盛顿, 妇科, 樊蓥, 中医 on December 17, 2011| Leave a Comment »
Posted in Chinese Gynecology, Testimonies or Records, tagged Acupuncture, acupuncturist, alexandria, arlington, Arthur Fan, Best Chinese medicine doctor, clinical experience, 维吉尼亚, 针灸, 阴道出血, 马里兰, fairfax, falls church, fertility, herndon, infertility, Maryland, mclean, Miscarriage, northern virginia, Rockville, tysons corner, Vaginal bleeding, vienna, Virginia, washington DC, 先兆流产, 华盛顿, 弗吉尼亚, 怀孕早期, 樊蓥, 中医 on December 14, 2011| Leave a Comment »
One patient asked Dr.Fan: “Do you think acupuncture could stop my vaginal bleeding during my early stage of pregnancy? ”
My reply is: “Yes. In most of the cases, acupuncture does help the patients to stop mild vaginal bleeding during their early stage of the pregnancy.”
We had at least 8 successful cases since 2007.
Stopping the vaginal bleeding means stabilizing the condition which may induce the miscarriage.
One patient.Ms.T.M. came today, she had brown color-like bleeding in her vaginal discharge 4 days during her pregnancy week 6. After one time acupuncture, the brown color disappeared.
Posted in Chinese Gynecology, fertility, Infertility, OB / GYN, women health, tagged alexandria, arlington, Arthur Fan, Best Chinese medicine doctor, Chinese gynecology, Chinese Medicine, clinical experience, fairfax, falls church, fertility, herndon, infertility, Maryland, tysons corner, Virginia, washington DC, Xia Guicheng on December 13, 2011| Leave a Comment »
May 11, 2010 by sharon weizenbaum
I’ve been away in Taiwan for the last month and have unfortunately neglected this blog while I was away! I hope I didn’t lose your attention! If you are interested in our travels in Taiwan you can click here for the little blog of our trip. Well I’m back and have some interesting material to post that I hope you’ll enjoy! I am going to do a series now, relying heavily on the work of Dr. Xia Guisheng. I’ll start here with a brief introduction to Dr. Xia and and follow this with a discussion of learning some of the subtleties in treatment and the term that I am translating as “opening through”. I’ll follow this with some entries that include the writings of Dr. Xia together with some of my own clinical experience utilizing his insights.
Dr. Xia is the director of the Gynecology Department at the Affiliated Hospital in Nanjing and professor of Gynecology at the Nanjing University of Tradition Chinese Medicine. Bringing over 50 years of experience and insight to his writings, he is not only a highly effective practitioner, he is also a clear teacher/writer. His material is written in a way that guides the student/practitioner through the necessary steps to gain understanding.
He has pioneered the articulation of the theories that direct us to work with the ebb and flow or Yin and Yang in relation to the menstrual cycle. He applies this understanding to all areas of gynecology in great detail. It is no surprise, after reading his books, to discover that he has become know as a manifestation of Guan Yin, the Chinese goddess who come to the aide of women and children. Though he is perhaps best known in the West for his work with modifying formulas according the the timing of the menstrual cycle, Dr. Xia pays such close attention to the details of patho-physiology in combination with the function of formulas and the individual herbs within them that his books are really a treasure trove of useful gems. In this particular series, I will be paying attention to his work with blood stasis and the idea of “opening through” in relation to women’s physiology, patho-physiology and menstruation. These ideas have many implications in the treatment of women including but going beyond the treatment of dysmenorrhea and infertility.Most entry level Chinese herbalists have a very limited idea of gynecological blood stasis, it’s diagnosis and treatment. This becomes very apparent as the practitioner works with women in the clinic and finds that so much of what was learned in school simply doesn’t work or works in a way that is far from ideal. Poor clinical results can be frustrating but they can also push us to learn more and can help our diagnosis and treatments become more nuanced. For me, less than excellent results have pushed me to research many topics, including the topic of “opening through” in relation to gynecology. This topic also brings up the concept of a more nuanced use of individual herbs. In relation to blood stasis – many of my own students don’t come in with much more of an understanding of blood stasis herbs other than that they all move the blood and that they should therefore not be used when there is heavy bleeding or during pregnancy. And yet, through experience we learn that sometimes we must strongly move the blood in order to stop heavy bleeding and that sometimes moving the blood can help prevent a miscarriage. We also learn that all blood vitalizing herbs are not equal to each other nor the same as each other. They range from strong to weak and from cold to hot. Some are especially good at stopping pain, others are especially good improving the quality of the blood itself. Here is a bit of a preliminary list just some of the various functions of some individual blood vitalizing herbs:
Stopping pain
Softening hardness
Cracking stasis
Warming the blood
Regulating the Qi within the blood
Stopping bleeding
Harmonizing the blood
Nourishing the blood
Supplement the Kidneys
Descend the Heart blood to the uterus
Cool the blood
Relieve constipation
Open up the chest and breast area
And finally blood vitalizing herbs that function to “open through” the menstruation…..
I first noticed that there was something going on with this idea of “opening through” when I was working beside my teacher Dr. Sheng Yufeng, in Hang Zhou, PRC. I was constantly trying to figure out why she would use particular herbs in particular situations. I noticed that there were times she would give a formula for blood stasis and include herbs like Huai Niu Xi or Chuan Niu Xi along with herbs such as Su Mu, Chong Wei Zi and Shan Zha. I wanted to know when and why she used these herbs. It was not until I found the writings of Dr. Xia Guicheng that these ideas were fulling articulated for me. Since studying these writings, the diagnosis and appropriate treatment methods for of some patients in my clinic has become clearer and the treatment results improved.
So, what is this “opening through”? I am translating the character 通, tong1. as “opening through”. The Eastland Press glossary translates this as “unblocks, promotes, pervades”. Wiseman and Ye’s Practical Dictionary of Chinese Medicine, Second Edition translates this term variously as “free, open, restore flow, unstop and connecting. Thinking of this as “opening through” just what gets opened through? This term is used when the Luo vessels, the channels, the Qi, the lactation, the bowels, the nasal passages, the blood vessels, the urination, the Ren vessel and finally, the menstruation are blocked. What I want to point out in relation to all of these functions is that what is being “freed” or “opened” or “connected” all relates to structures in the body that are tubular. This is why the idea of “opening through” is useful. It gives us the image, not only of blockage, but of a tube that is blocked up and needs to be opened. Though the term “unblocking” may suffice, it does not convey the image of a tube that should be open end to end the way that “opening through” does. I have to admit “opening through” is a rather bulky term though, but at least for now, I’d like to use it to effectively illustrate the physiology, patho-physiology, treatment principles and function of herbs.
A bit more about the character tong1 通. It is made up of two parts. The first is this: 甬 yong3 which carries the meaning of path or corridor. The second is 辶 chou4, which carries the meaning of walking or going. So altogether we have the meaning of movement through a corridor or path. When we take the 甬 yong3 corridor or path part of the character and combine it with the disease radical getting 痛 tong4, meaning pain. In other words, when the corridor is pathologically effected, there is pain. The characters 通 and 痛 are the one’s that are in the famous saying 通则不痛，不通则痛, or when there is opening through there is no pain and when there is no opening through there is pain.
So what is this tube that is related to “opening through” the menstruation? This tube is related both to the Ren Vessel and to the Bao Tai, which connects the upper body, especially the Heart and chest, to the uterus. This tube can get blocked up and when it does, it needs to get opened through from end to end. Various symptoms can arise when this tube gets blocked up including amenorrhea, scanty menstruation, lack of free flow of menstruation, painful menstruation, heavy menstruation and infertility. Upper Jiao symptoms can involve the breasts, the head, the emotions or even cause bleeding in the upper warmer as the menstrual blood fails to descend. The blockage can effect the middle Jiao as well. Recently I successfully treated a woman with Achalasia, which involved difficulty swallowing and esophageal spasming that was worse premenstrually, integrating the method of opening through the menstruation. In general, when the menstruation is not open through, a failure of the downward movement of the Qi mechanism can lead to a whole variety of upward rebelling symptomatology in addition to the lower warmer issues.
Before moving on to the entries that include the Dr. Xia’s writings on this topic, I want to include a bit about how he organizes his discussions in his book, Gynecology Formluas and Herbs from Clinical Experience and Study in Fifteen Chapters. In this text, Dr. Xia has a whole chapter devoted to the idea of “opening through”. He divides this chapter into 8 parts, each part being represented by one of his “opening through” experiential formulas. He begins with a basic formula Jia Yu Tong Yu Jian (modified Opening Through Stasis decoction) which is based on Zhang Jingyue’s formula Tong Yu Jian (Opening Through Stasis decoction). He uses this formula as a jumping off place for the deeper, more detailed discussion of the topic. The formulas that follow morph off of the original idea in the variety of ways that Dr. Xia sees most often in his clinical work. By carefully going through each chapter, the practitioner learns, not only about these particular formulas but so much more. We learn how to modify a formula to suit a variety of clinical realities but more importantly, we learn about women’s physiology and patho-physiology in great depth. Finally, we learn about the individual herbs and their nuanced and careful use. It is like looking at an issue through a variety of lenses until we feel we have quite a complete understanding. I’ve not previously seen texts organized in this manner and have found it to be an excellent way to transmit his valuable information.
So, stay tuned! Dr. Xia’s writings will soon be posted here!
Posted in Chinese Gynecology, fertility, Infertility, OB / GYN, women health, tagged alexandria, arlington, Arthur Fan, Best Chinese medicine doctor, Chinese gynecology, 维吉尼亚, 通瘀, 通经, 针灸, 马里兰, fairfax, falls church, fertility, herbology, herndon, infertility, Maryland, mclean, northern virginia, tysons corner, vienna, Virginia, washington DC, Xia Guicheng, 南京, 南京中医药大学, 夏桂成, 弗吉尼亚, 月经病, 樊蓥, 中医, 中医妇科 on December 13, 2011| Leave a Comment »
“it is very important that the lack of free flow is paired with fullness, pain or up-bearing symptoms”
By way of introduction to this first chapter, I’d like to write a bit about women’s physiology and the tubular quality of the Ren vessel and the Bao Tai. Though I have not heard of these pathways written or spoken of as “tubular” per se, thinking of them in this way has helped me to visualize and understand women’s physiology, patho-physiology and the use of herbs in formulas. So, please bear with me…If we think of the Ren vessel/Bao Tai as a tubular pathway extending from the upper body (Heart and chest) to the womb, physiologically, this tube provides the route for the Heart fire to descend to warm the womb and for the Kidney water to ascend to control, moisten and cool the Heart. This pathway allows the communication and interaction of fire and water between the upper Jiao and womb. We can also see that what travels within this tube is the interaction of fire and water which is the red blood. The scenario that requires the use of formulas like Jia Jian Tong Yu Tang (Modified Open Through Stasis Decoction), is characterized by blood in this tube becoming congealed and blocking the tube. If we think about the Qi mechanism and the necessity for there to be a constant free flow of Qi up and down, we can see that a plug in this tube could cause a disruption in this free flow. The Heart Qi and fire may be unable to move down to the womb. This can cause a myriad of upward rebellion symptoms along with the primary pathology of the uterine contents, whether blood, lochia or fetus, failing to move out freely.
What we want to know how to do in the clinic is to recognize when there is this kind of plug in the tube – i.e. how to diagnose this. Additionally we want to know which herbs discharge this manifestation of blood stasis and how to modify a formula for the various presentations we will see clinically. The presentation may vary in terms of aspects such as excess/deficiency or heat/cold and it can also vary in terms of presenting symptoms such as headaches, insomnia or, as I mentioned in the last post, difficulty swallowing. Main complaints can vary from PMS, dysmenorrhea, PCOS, endometriosis and infertility to amenorrhea. We also want to know how to administer the purgative therapy safely – this has to do with careful diagnosis and timing of the treatment.
The main signs I use clinically to diagnose the presence of this “plug” is the combination of lack of free flow of the uterine contents with lower abdominal discomfort and fullness. Lack of free flow by itself can be due to pathologies such deficiency of blood or Yin fluids or cold etc. in which case blowing out the plug would be unsuitable if not detrimental. Lower abdominal fullness and discomfort could also be due to many pathologies such as uterine infection, simple blood stasis that does not block the menstrual flow or other stasis in the lower abdomen.
Lack of free flow of the uterine contents manifests as amenorrhea, scanty menstruation, menstruation the stops and starts, failure of the lochia to discharge or non progression of labor. All of these pathologies can come form other disease factors besides this one and so it is very important that the lack of free flow is paired with fullness, pain or up-bearing symptoms.
The primary herbs that Dr. Xia uses for opening through menstruation here are:
Shan Zha
Qing Pi
Chuan Niu Xi
Ze Lan
Hong Hua
Tao Ren
We will see others in future posts. It is important to notice that these herbs do have this kind of special indication.
Below is Dr. Xia’s writing on the 1st formula in the 7th chapter of his text.
Translated by Sharon Weizenbaum
Jia Jian Tong Yu Jian 加减通瘀煎 Modified Opening Through Stasis Decoction
Formula Name:
Tong 通 means to open the flow and Yu 瘀 is stasis and refers to blood stasis. Jian refers to the method of cooking which is to boil. Opening stasis refers to a strong method of transforming stasis. One should use stronger vitalizing blood herbs when the intention is to open the passageways, free the flow of blood stasis, scatter and transform blood stasis. Based on the pathological condition of the patients, I have modified Zhang Jing-yue’s Tong Yu Jian (Open Through Stasis Decoction) into my own experiential formula.
Formula Constituents:
Chao Dang Gui Wei 12 gm
Shan Zha 10 gm
Xiang Fu 9 gm
Hong Hua 6-9 gm
Wu Yao 6 gm
Qing Pi 5 gm
Chuan Mu Xiang 9 gm
Ze Lan Ye 10 gm
Chi Shao 10 gm
Chuan Niu Xi 10 gm
Tao Ren 6-10 gm
Method of Application
One package is for one day, divided into two doses.
Formula Function:
Regulates Qi and vitalizes the blood, opens through stasis and synchronizes the menstruation.
Formula Application
This formula treats blood stasis type late menstruation, scanty menstruation, prolonged menstruation and dysmenorrhea.
Formula explanation:
This formula treats blood stasis type irregular menstrual pathology. This includes blood stasis type dysmenorrhea and amenorrhea presentations. It places Dang Gui Wei in an important position for vitalizing blood and transforming stasis. However, these days pharmacies do not discriminate between Dang Gui Wei, Dang Gui Tou and Dang Gui Shen. Consequently we assist the function of Dang Gui to open stasis with Tao Ren and Hong Hua making this a stronger blood vitalizing formula. Zhang Jing-yue’s original formula contains Hong Hua but is without Tao Ren. Tao Ren must be added. Generally, because of the demands of opening through stasis, I base my formula on Tong Yu Jian (Open Through Stasis Decoction), though, according to the clinical presentation I also add Ze Lan Ye and Chuan Niu Xi to open the pathways of the menstruation. The goal is to vitalize the blood while guiding its flow and opening through the menses. Therefore, in addition to using herbs to vitalize blood and transform stasis, one should also assist with herbs to synchronize and regulate Qi and move stasis. The point is to first give herbs to move the menstrual Qi. It is said that “When menstrual blood does not move, first move the Qi because when the Qi moves, the blood will move. When there is Qi stasis, there is blood stasis and when there is blood stasis, the blood obstructs the Qi movement”. Because of this, I add Xiang Fu, Wu Yao and Mu Xiang. These 3 herb flavors regulate the Qi and synchronize the Qi of the Liver, Kidney and Spleen Zang. When regulating Qi and moving stasis it helps to vitalize blood and open the menstruation and so you can add Qing Pi. This herb helps promote easy flow and discharge and strengthens the regulating and synchronizing of the Liver Qi. Because the Liver stores the blood and governs free flow and discharge, when you want to help the flow and discharge of the menstrual blood and this will regulate Qi and synchronize the menstruation. Therefore when regulating the Qi and synchronizing the menstruation, one should lay stress on the Liver. One can add Shan Zha. Master Zhang uses this not only to vitalize blood and open the menstruation, but also to synchronize and regulate the Qi mechanism. Because of all this, Jia Jian Tong Yu Tang (Modified Open Through Stasis Decoction) is frequently used in the clinic.
Clinical Application
According to Jing Yue Quan Shu: Fu Ren Gui (The Complete Works of Jing Yue: Women’s patterns), Tong Yu Jian (Open Through Stasis Decoction) treats Qi stasis, congealed blood, inhibited menstruation and vessels and extreme abdominal pain. In addition to treating late menstruation, lack of smooth flow of menses and painful menstruation, Jia Jian Tong Yu Jian (Modified Open Through Stasis Decoction) can also treat post partum congealed blood excess pain as well as blood reversal or blood rebellion.
1.Late Menstruation, scanty menstruation and painful menstruation: This formula can be used when there is scanty menstruate that does not flow smoothly. This presents with abdominal pain that resists pressure, purple blood with dark with clots, pain and distention in the abdomen, chest oppression and vexation. The pulse is thin and wiry and the tongue is purple and dark. In this circumstance you can add herbs such as Rou Gui and Ze Lan Ye.
2.Post partum blood stasis abdominal pain: During the post partum time, if the lochia stops too soon or does not flow out smoothly and this is accompanied by purple dark blood with clots, lower abdominal distention and pain, low back soreness and weakness with chest oppression, abdominal distention, purple dark tongue and a thin rough pulse, one should add Ze Lan Ye, Yi Mu Cao and Yan Hu Suo to this formula.
3.Blood stasis blood fainting: This presentation can be due to trauma from an accident, or it can simply manifest when there is scanty menstruation with abdominal pain. The patient suffers from dizziness, fainting, cold limbs, nausea and vomiting, abdominal distention, a thin pulse and a purple dark tongue. In this circumstance you can add herbs such as Shi Chang Pu, Guang Yu Jin, Zhi Mo Yao or Zhi Ru Xiang.
Modifications:
This formula is from the Jing Yue Quan Shu: Fu Ren Gui (The Complete Works of Jing Yue: Women’s patterns and it can be modified as below:
1.If there is cold stasis add Rou Gui and Wu Zhu Yu
2.If there is full fire with inner heat with blood that does not move due to dry blood add Chao Shan Zhi, Dan Pi.
3.With slight heat and blood deficiency add Bai Shao and Gui Shen.
4.With blood stasis with very scanty blood add Su Mu and Chong Wei Zi
5.With dry knotted stool add Da Huang and E Zhu or add Mang Xiao and Tao Ren.
Clinical Experience
Tong Yu Jian(Open Through the Menses Decoction) is really 3 formulas.
1.Tong Yu Jian (Open Through the Menses Decoction) comes from the (Jing Yue Quan Shu: Fu Ren Gui (The Complete Works of Jing Yue: Women’s patterns). MyJia Jian Tong Yu Tang (Modified Open through the Menses Decoction) was developed based on this formula and my own clinical experience.
2.The second formula is from the Xian Nian Ji (Immortal Collections): Vol. 4. This formula uses Gui Wei, Da Huang, Hong Hua, Su Mu. These are strong herbs for dispelling stasis but in this formula the dosages are light. It is for moving evil blood and is used primarily for dispelling when there is post partum congealed blood and stasis leading to poor flow of the menstruation. This is considered evil blood.
3.The third formula is from Guang Lue Liu Shu: chapter 25. It uses Pu Huang, Wu Ling Zhi, Chuan Yu Jin, Xiao Zhi Shi, Bai Zhu Tang, Jian Ze Xie, Xi Chi Shao, Tao Ren Ni, Ming Hu Bo. This formula is used to treat blood stasis in which the abdomen becomes filled with fluid. The pulse is rough and not smooth. In theFang Lun Xuan Lu (Selected Writings on Formula Theory) it is written: “When blood stasis is not dispersed, the Spleen and Stomach loose their ability to be fortified and to transform and transport the minute essences. The turbid Yin gets stopped up and this leads to abdominal distention and fullness. This is called Blood Tympanites (Gu 臌). Pu Huang cracks congealed blood, it opens the channels and collaterals. Wu Ling Zhi cracks congealed blood and also descends the turbid Yin. Tao Ren cracks the congealed and also moistens dryness. Chi Shao cracks the congealed and also discharges fire. Zhi Shi disperses distention and fullness. [Bai] Zhu Tan fortifies the Spleen Qi. Yu Jin synchronizes the Qi and opens depressive knotting. Ze Xie separates the clear Yang. Hu Bo disperses congealed blood and allows open permeability, allowing the congealed to be transformed and for the Qi to be synchronized. The result is that the Chong vessel is clear and harmonized, the Spleen and Liver Qi transform and the blockage is immediately opened. How could abdominal distention not recede”?
What these formulas treat is not the same. However, the meaning of the formulas is identical. They can be used together in the clinic and adjusted according to the presentation. When I use Tong Yu Jian (Open Through Stasis Decoction) in the clinic, I often add Shi Xiao San (Powder for Loss of Smile), Tao Ren, Ze Lan and Chuan Niu Xi. This strengthens the force of transforming stasis and opening the menstruation. This is because, when the menstruation is blocked and not flowing smoothly, this is usually related to congealed blood and Qi stasis. So we can say that if we want to open the menstruation we must transform stasis. If we want to transform stasis we must assist this by moving the Qi. Qi and blood movement complement each other. Therefore, in relation to illnesses of menstruation, the meaning of opening through stasis is to open through the menses and transform stasis.
In my own clinical practice I see patients who have serious endometritis. This may develop after dilation and curettage surgery and it can give rise to adhesions of the uterine cavity. The degree of adhesions can vary as can the extent to which it influences the menstruation. It may give rise to scanty menstruation or even amenorrhea. In general though, this is due to stasis and obstruction in the uterus with lack of free movement of the blood. Tong Yu Jian (Open Through Stasis Decoction) can treat this but the effect is only good in relatively light cases. For more serious cases surgery must be used to sever the adhesions and this formula can be used after that.
Detailed analysis of the principle herbs in this formula: Hong Hua and Shan Zha.
There are three principle herbs in this formula: Dang Gui Wei, Hong Hua and Shan Zha. Dang Gui Wei is represented by Dang Gui and has been discussed in previous chapters so here I will discuss Hong Hua and Shan Zha.
Hong Hua
Hong Hua is also called Hong Lan Hua. It is pungent and its nature is warm. It enters the Heart and Liver. Its function is to vitalize blood and open through menses. It dispels stasis and stops pain and can be used for congealed blood type amenorrhea and post partum congealed static blood abdominal pain. TheBen Cao Guang Mu (The Grand Compendium of Materia Medica) considers Hong Hua an herb to “vitalize blood, moisten dryness, stop pain, disperse swelling and open through the menses”. It also says “Blood is generated in the heart wrapper, stored in the Liver and belongs to the Chong and Ren vessels. Hong Hua is the likeness of blood and therefore, in men it is able to move the blood vessels and in women it opens through the menstrual water. In large amounts it moves the blood and in small amounts it nourishes the blood. The Ben Cao Hui Yan (Treasury of Words on the Materia Medica) says “Hong Hua cracks the blood, moves the blood, vitalizes the blood and synchronizes the blood. Primarily it is used to treat the 100 diseases of pregnancy and birth in which the blood is damaged. It is also used to treat blood vexation, blood dizziness, unconsciousness with an inability to speak, the lochia striking the Heart, gripping pain around the umbilicus, difficult birth, uterine lining failing to discharge or expired fetus in the abdomen. All of these are presentations of birthing which Hong Hua can treat. If there is post partum blood dizziness, lock jaw with clenched fists or an evil enters the blood chamber with incessant talking to the point of craziness or blood oppression with interior distention and the patient falls over stiffly as if dead. These are all post partum presentations for which Hong Hua cannot help but calm. If there is amenorrhea with no opening through with cold and heat mixed together or late menstruation with abdominal pain and dark purple dripping or traumatic injury with Qi and blood congealed and accumulating – these are all due to a lack of harmony of Qi and blood. How can Hong Hua fail to synchronize”?
Shan Zha
Shan Zha is sweet and sour and its nature is slightly warm. It enters the Spleen, Stomach and Liver channels. Its function is to disperse food and fortify the Stomach. When we analyze the pharmo-dynamics of Shan Zha we see that it increases the secretion of the digestive enzymes and is also able to promote the digestion of fats. This is accompanied by an ability to strengthen Heart function and lower the blood fat. This can be used for presentations that include indigestion, post partum congealed obstructed abdominal pain, hernia and chest obstruction heart pain. The Shen Nong Ben Cao Jing Shu (Commentary on ‘Shen Nong’s Classic of the Materia Medica) says “Shan Zha enters the foot Yang Ming and Tai Yin channels. The Ben Jing Classic of Materia Medica says that the flavor is sour and the Qi is cold. That this is able to disperse the digestion and move congealed blood indicates that it is not cold. Shan Zha is able to enter the Spleen and Stomach, scatter abiding accumulated stasis and water dysentery with post partum blocked pain in the abdomen. Generally Shan Zha is thought to transform food and fluids, fortify the Spleen and Stomach, move knotted Qi and disperse congealed blood. Because of this it is a suitable food for children and birthing women. The Ben Jing Classic of Materia Medicaalso says that this is cold and so it has a function as a wash for scabies. We can see that fundamentally Shan Zha fortifies the Spleen and disperses food stasis. It also functions to vitalize the blood, transform stasis and disperse accumulated stasis.
Practical Experience
Tong Yu Jian (Open Through the Menses Decoction) is a formula I use frequently in the clinic for lack of free flow of the menstruation. I often use it with Yue Ju Wanor Wu Wei Tiao Jing San (Tang). The results are quite good. For acute abdominal pain use Hong Hua Jiu and the pain will stop. The Jin Gui (Essentials From The Golden Cabinet) discussed early on that the single flavor Dang Gui in Dang Gui Wan (San) is used for painful menstruation. The Xian Dai Zhong Yao Xue Da Ci Dian (The Modern Great Dictionary of Chinese Herbs) says that as a principle herb, Shan Zha treats functional dysmenorrhea. Use 30 gm without the pit, Sunflower seed with the husk 15 gm. After roasting, grind these into a powder and add 60 gm of brown sugar. Take one package a day divided into 2 doses or decoct. Every time before the menses take two packages and do this for 2 cycles. I treated 105 patients: 30 had a cure, 50 improved and 25 were without effect. The effect was good for those with blood stasis and deficiency cold.
I treated one case of long cycle. Ms. Zhang was 35 and her menstruation was scanty and did not flow smoothly. The color was purple red with small clots and there was lower abdominal acute pain. When she bled this pain lasted for 12-15 days. She had an IUD. Her gynecology and bi-manual check-up revealed no abnormalities and the position of the IUD was normal. It had been there for 5 years. Her menstruation had lengthened for the last 5 months. Her pulse was thin and wiry and her tongue body was dark red with a yellow sticky moss. On the first day of her menstruation, I gave her 7 packages of Jia Jian Tong Yu Jian(Modified Open Through the Menses Decoction). She stopped bleeding after 8 days. At the next menstruation I again gave her 7 packages of Jia Jian Tong Yu Jian (Modified Open Through the Menses Decoction). She bled for 7 days and on day 2 and 3 the amount of blood increased. She then resumed a normal menstrual cycle.
Posted in Chinese Gynecology, fertility, Infertility, OB / GYN, women health, tagged Acupuncture, acupuncturist, alexandria, Arthur Fan, arthur yin fan, article, Best Chinese medicine doctor, book, Chinese Medicine, 维吉尼亚, 针灸, 马里兰, fairfax, falls church, fertility, Gynecologist, herndon, infertility, Maryland, mclean, northern virginia, tysons corner, vienna, Virginia, washington DC, Xia Gui Cheng, Xia Guicheng, 华盛顿, 南京中医药大学, 夏桂成, 女科, 妇科, 孙宁铨, 弗吉尼亚, 樊蓥, 中医 on December 12, 2011| Leave a Comment »
Xia Gui–Cheng (1932 -) is a professor of gynaecology at Nanjing TCM College, and has been involved in teaching, research and clinical treatment for over 30 …
May 11, 2010 – Posted in Famous Doctors, Xia Guicheng on May 11, 2010 | Leave a Comment ». Dr. Xia is the director of the Gynecology Department at the …
Posted in Chinese Gynecology, OB / GYN, women health, tagged Acupuncture, acupuncturist, alexandria, arlington, Arthur Fan, Best Chinese medicine doctor, Chinese Medicine, clinical trial, 维吉尼亚, 针灸, 马里兰, fairfax, falls church, Maryland, mclean, northern virginia, pelvic bottom dysfunction, pelvic pain, reston, Rockville, tysons corner, vienna, Virginia, Vulvodynia, washington DC, 华盛顿, 弗吉尼亚, 中医 on December 10, 2011| 3 Comments »
Vulvodynia And Acupuncture
France Guevin, BS, Marc Steben, MD, Yves Lepage, PhD, Bernard Lambert, MD
Original article from http://www.medicalacupuncture.org/aama_marf/journal/vol17_1/article3.html
ABSTRACT
Background Vulvodynia, characterized by burning sensation, pain, and pruritus, is often treated with antidepressants. Recent studies indicate that acupuncture may be an effective modality.
Objective To evaluate the short-term effect of acupuncture on vulvodynia.
Design, Setting, and Patients A convenience sample of 13 patients in a private clinic setting.
Intervention Acupuncture at 3 main points for all patients: BL 22, SP 6, and LV 5, alternatively on the left and right meridians, in 4 weekly
treatments.
Main Outcome Measure Pain measured on a 10-point visual analog scale (VAS) before and at the end of treatment, and 3 months later (at 4 months).
Results Significant differences (at P<.001) were observed between pretreatment, and 1 and 4 months later, from a VAS mean of 8.69 to 4.38 and 2.31, respectively.
Conclusions Acupuncture appears to be a possible alternative to antidepressant treatment for vulvodynia. A longer surveillance period is
needed to verify our results.
KEY WORDS
Vulvodynia, Acupuncture, Vulvar Dysesthesia, Vulvar Pain, Visual Analog Scale (VAS)
INTRODUCTION
The prevalence of vulvodynia, or generalized vulvar dysesthesia, is largely unknown in the general population.1 It was described by Tovell and Young in 19782 as an undetermined disorder in 26 patients (2.6%) in a series of 877 consecutive cases. The diagnosis was founded on an eliminatory basis for skin lesions. Patients were distressed by a burning sensation, pain, and pruritus, and the term “pudendagra” was used. The concept of vulvodynia or chronic vulvar discomfort was accepted in 1984.3 McKay4 differentiated pruritic symptoms, as associated with skin changes, thus confirming vulvodynia as an exclusion syndrome associated to a disorder of unmyelinated C fibers. Tricyclic antidepressants amitriptyline and desipramine are typically first-line therapies5 but recently, new avenues have been evoked in 2 pilot studies on acupuncture for the simplicity of use and rapid clinical response.6,7
Danielsson et al,6 using a visual analog scale (VAS), noted significant changes (P=.01) for negative quality of life at 3 months following treatment: from a score of 7.2 to 3.2 in a series of 14 women. Pain at coitus was included in the sample of vulvar vestibulitis. Powell and Wojnarowska7 reported in 1999 a clinical response in 12 patients: 2 of the cases were stratified as cured, 3 cases with partial improvement, and 4 slightly improved.
In order to verify the possible action of acupuncture on vulvodynia, we reviewed 13 cases of generalized vulvar dysesthesia, without any coital pain or sexual interference.
METHODS
Thirteen patients with general vulvar dysesthesia filled out the Stanford pain visual questionnaire (VAS, 1-10) in an office setting with us.8 Verbal consent was obtained from all patients. No double-blind intervention or controls were used; this pilot study was strictly an evaluation of acupuncture effectiveness on vulvodynia patients. Patients were seen by their physician before and after acupuncture; they were informed about the technique and mechanisms on all spheres of their body, nervous system, Qi/xue, body, and mind. Our inquiry included patient age, duration of disease, and pain score before acupuncture, at 1 month, at the end of 4 weekly treatments, and at 4 months, or 3 months after the end of the treatment. All patients were screened by us and screening included a negative Q-Tip test, wet smears, vaginal cultures, and a negative clinical vulvar examination. An acupuncturist performed all the treatments. Dermatological lesions such as eczema, psoriasis, lichen simplex sclerosis and atrophicus, and planus were excluded. Cyclic yeast vaginitis, human papillomavirus, vulvar intraepithelial neoplasia, and localized dysesthesia (vestibulodynia) were also excluded. Patients did not receive antidepressive or antiepileptic medication at the acupuncture treatment or for 4 months thereafter.
Acupuncture is defined as an insertion of a needle on precise points of the body.9 The rationale is based on Traditional Chinese Medicine (TCM), covering Yin-Yang, Five Elements, Baguang, Meridians theories, and reflexology. According to the age of the patient and the duration of the problem, we referred to Liver (Shu Jueyin) and Bladder (Shu Taiyang) meridians (young persons, few months to a year of discomfort). Also, the Chong and Tae Mo (Curious Meridians) were considered. If symptoms were present for longer than a year, the diagnosis of Liver and Kidney Yin deficiency was considered, with apparent Fire or false Fire. In reference to the nervous system, neuralgia appeared stronger at the T2-T5 levels and lighter on L1-L5, including sacral holes painful pressure points. Literature sources are the confluence of French, Chinese, and American studies.9
Stainless steel needles from 2-6 cm and 0.25 mm diameter (#32), and 6 cm and 0.25 mm diameter (#32) were used (Suzhou Shenlong Medical Apparatus Co Ltd, China). They were individually packed in an aluminum and plastic plate of thin needles, then sterilized and discarded after a single use.
Needles were placed according to the chosen locations and the person’s size, at a depth of 2-10 mm, perpendicularly or longitudinally, with different angles. Needles remained in place for 20-30 minutes in a comfortable position. We use needles without any manual or electric stimulation. Treatment was repeated weekly for 4 sessions. (Patients may indicate a pinch when skin is pierced. A feeling of numbness may be experienced near the site of puncture but it disappears with the removal of the needle, with some variations to the patient’s pain threshold.) Three main points were used for all patients: BL 22, SP 6, and LV 5, alternatively on the left and right meridians (Figure 1). No Qi response or T-witch response was used . Other interventions were: moxibustion below the navel segment level, according to the season, age, and general condition of the patient, and recommendation to avoid cold at all levels of food, clothing, and space. This study was undertaken in a private clinic setting.
A single-factor analysis of variance with repeated measures followed by a contrast analysis using paired t test with Bonferroni correction was used to study the pain level before the treatment, after 1 month, and after 4 months. The association between the ages of the patients, the duration of pain, and the pain level was studied with Pearson correlation.
RESULTS
Patients’ mean (SD) age was 47.5 (15.3) years (range, 23-70 years) (Table 1). Mean symptom duration was 38.2 (18.6) months in 10 completed questionnaires. Mean pain score levels varied from 8.69 (1.75) in the pretreatment period to 4.38 (2.93) at 1 month to 2.31(2.66) at 4 months. These mean levels were significantly different (F=37.49, P<.001). Significant mean differences were observed between pretreatment and at 1 month (P<.001), and pretreatment and the end of the survey at 4 months (P<.001), and at 1 and 4 months (P=.02). One patient did not achieve any improvement, and another had a partial response (pain score reduced from 9 to 5). There were no treatment complications.
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There wasn’t any significant linear relationship observed between age and duration (r=0.108, P=.77), age and pain levels at pretreatment (r=–0.230, P=.45), age and pain levels at 1 month (r=–0.327, P=.28) age and pain levels at 4 months (r=0.147, P=.63), duration and pain levels at pretreatment (r=0.195, P=.59), duration and pain levels at 1 month (r=–0.301, P=.40), and duration and pain levels at 4 months (r=-0.450, P=.19). The difference between the pain levels at 4 months and pretreatment was also not linearly related to age (r=0.259, P=.39) and duration (r=–0.502, P=.14).
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DISCUSSION
We are unaware of any controlled trials of acupuncture treatment for vulvodynia.10 A controlled trial comparing acupuncture with amitriptyline would be challenging, especially with medium and long-term follow-up. Neuropathic pain mechanisms in vulvodynia remain unclear.11Recently, quantitative sensory testing showed increased vulvar pain presence and peripheral body regions12 with the evocation of a possible central control mechanism. Reed et al13emphasized minimal differences between general vulvar dysesthesia and vestibulodynia, with no significant differences between both groups. They could be the variant of the same pathophysiological mechanism.
Sexual activities appeared similar between vulvodynic patients and controls,14 although frequency of intercourse or orgasm was less frequent in the affected group. Our study could be extended to vestibulodynia without the aid of physiotherapy or sexual therapy. A longer period of evaluation of up to 12 months is deemed optimal with inclusion of amitriptyline as control. However, our study raises hopes in the short-term management of a challenging and often undetected syndrome.
CONCLUSIONS
Acupuncture may be a possible alternative to antidepressant treatment for vulvodynia. A longer surveillance period is needed to verify our results.
ACKNOWLEDGEMENT
Many thanks to Bruno St-Pierre for Figure 1.
REFERENCES
AUTHORS’ INFORMATION
Ms France Guevin is an Acupuncturist in Montreal.
France Guevin, BS, d’Ac, MOAQ
415 Blvd Saint-Joseph East
Montreal QC H2J 1J6
Canada
E-mail: f.guevin@bellnet.ca
Dr Marc Steben is a Physician at the Vulvar Diseases Clinic at the Notre Dame Hospital Chum Montreal.
Marc Steben, MD
Vulvar diseases clinic, Hôspital Notre-Dame CHUM Montreal
1560 Sherbrooke E.
Montreal QC H2L 4M1
Canada
Fax: 514-528-2452 • E-mail: marc.steben@sympatico.ca
Yves Lepage, PhD, is a Professor of Mathematics at the University of Montreal.
Yves Lepage, PhD
Department of Mathematics and Statistics
C.P. 6128, Succursale Centreville University of Montreal
Montreal QC H3C 3J7
Canada
Fax: 514-343-5700 • E-mail: yves.lepage@umontreal.ca
Dr Bernard Lambert is an Obstetrician-Gynecologist, and Associate Professor of Obstetrics and Gynecology at the University of Montreal.
Bernard Lambert, MD, FRCSC, FACOG*
Dept of Gynecology, Hôtel-Dieu CHUM, University of Montreal
3840 St-Urbain
Montreal QC H2W 1T8
Canada
Phone: 514-890-8000, #12685 • Fax: 514-412-7213
E-mail: bernardlambert@vif.com
Virginia Institute of Traditional Chinese Medicine 