Intractable Hives during night-time have been controlled by Chinese herbs, an e-mail from patient’s Mom顽固性荨麻疹经中药控制（照片和病人妈妈的电邮）

“Incredible, my daughter could sleep well and did not have hives again after first-time drinking of the herbal tea you prescribed. Just very slight in the second and the third day’s night. In one word, she has significant improvement, and will get cured.” the patient’s mom said in an e-mail to Dr.Arthur Fan.

This kid has hives several months, esp. during the night- time. Patient had a lot of hives all over the body, affecting her sleeping. Every interesting, the hives disappeared in morning automatically. During the day-time, patient had hives very occasionally.

 “难以置信，您开的药吃的第一夜我女儿就安睡，没有起荨麻疹。第二天下午有一些，但白天好办，玩儿一会儿引开注意力就没事了。第二夜有一点儿。第三夜好好的，一夜无话。总之明显好转，痊愈在即。

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Arthur Fan has been rated as “Top Acupuncturist” by the Website of www.RateMDs.com.

 

Dr.Arthur Fan has been rated as one of  “top acupuncturists” in Washington DC and northern Virginia area in the Website: www.RateMDs.com.

http://www.ratemds.com/filecache/topTen.jsp?city=WASHINGTON&sid=8 Best Rated Acupuncturists in WASHINGTON, DC 1 Tetsuhiro Ueno – Arlington 2 Yong Chen – Bethesda 3 ARTHUR FAN – VIENNA 4 SUZZANNE LOHR – WASHINGTON 5 ROCCO MANZIANO – SILVER SPRING 6 BK Mudahar – Washington 7 KERRI WESTHAUSER – BETHESDA 8 Wei Peng – BETHESDA

Best Rated Acupuncturists in herndon, VA 1 Tetsuhiro Ueno – Arlington 2 ARTHUR FAN – VIENNA 3 James Larmour – FAIRFAX 4 Rachal Lohr-Dean – Chantilly 5 SATORI POCH – RICHMOND 6 EUGENE ZHANG – FAIRFAX

Best Rated Acupuncturists in mclean, VA 1 Tetsuhiro Ueno – Arlington 2 ARTHUR FAN – VIENNA 3 James Larmour – FAIRFAX 4 SUZZANNE LOHR – WASHINGTON 5 BK Mudahar – Washington 6 SATORI POCH – RICHMOND 7 EUGENE ZHANG – FAIRFAX

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No.56 “Acupuncture baby” saw me today,by Dr.Arthur Fan in Washington Dc & N.Virginia

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Acupuncture helped the recovery of Guillain-Barre Syndrome(Video),by Dr.Arthur Fan in Washington DC & N.Virginia

Acupuncture and Chinese herbal medicine is very effective in Guillain-Barre Syndrome’s recovery in some cases.

Here we have a case record in video, I hope patients with Guillain-Barre Syndrome don’t get frustrated, use acupuncture or/and Chinese herbal medicine as early as possible, in most of cases, very good.http://www.youtube.com/watch?v=6Ngu5WrPDcE&feature=youtu.be

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“Do you think acupuncture could stop my vaginal bleeding during my early stage of pregnancy? ” By Dr.Arthur Fan in Washington DC & N.Virginia

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.

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“Opening Through” the menstruation Tong Jing 通经，by Dr.Xia Guicheng

“Opening Through” the menstruation Tong Jing 通经

from http://chinesemedicinetopics.wordpress.com/2010/05/11/%E2%80%9Copening-through%E2%80%9D-the-menstruation-tong-jing-%E9%80%9A%E7%BB%8F/

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!

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Opening Through [Two]. Original by Dr.Xia Guicheng, a Chinese Gynecologist (Nanjing, China).

Original Article from http://chinesemedicinetopics.wordpress.com/2010/05/11/opening-through-two/(May 11, 2010 by sharon weizenbaum)

 

[This re-post was got kind permission from Ms.Weizenbaum.]

加减通瘀煎 Jia Jian Tong Yu Jian Modified Opening Through Stasis Decoction

“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.

Dr. Xia’s Jia Jian Tong Yu Tang (Modified Open Through Stasis Decoction) is his foundational formula to, for lack of a better analogy, sort of blow the plug out like a spit ball out of a straw.

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.

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Acupuncture in USA 针灸在美国

针灸在美国

From: http://www.wfas.org.cn/en/show.asp?liststate=0&action=&men=3&Position=&id=1616&pageshow=1#

World Federation of Acupuncture-Moxibustion Societies.

(Author: Liu Jin；   source：information center, Published in 2009)

一、 历史的回顾

    据文献载中医药、针灸早在17世纪便由中国传入欧洲，再由欧洲传入美国。最早在美国出版英文版本针灸专书的是一位名叫F．Bache 的美国医师翻译由S．Morant所著的法文针灸 书，该书于1825年在费城出版（ S． Morant： Memair on Acupuncturation）。次年即 1826年 F．Bache。进一步又在北美内科与外科杂志发表 他本人用针灸所治疗的病例报告（F．Bache： North American Medical and Surgical jourrnal l：311-321，1826）。此后便陆续有一些有关针 灸论文在美国发表。经过一百余年后，1942年 E．A．Brav与H．Sigmond曾在美国军医杂志上 报告针灸的疗效，特别强调针刺止痛的疗效 （E.A.Brav：Military Surgeon,9）：545－549， 1942），可见在当时已将针灸疗法逐渐介绍到军医中采用。

    华人先侨随着美国自1848年开始的淘金热、铁路热及采矿热之后而大量涌入美国。不久之后，在旧金山及纽约等地随着华埠的出现便开始有一些老中医及针灸医师悬壶济世治病救人，真正的中医药/针灸医术亦随之在美国出现。但在美国掀起“中医针灸热”的要归功于著名报人赖斯顿（James Reston）。赖氏曾任纽约时报副总编，著作颇丰，蜚声国际。1971年赖氏随尼克松总统访问北京后（Arthur Fan Notes: it is before President Nixon’s visit)，因患急性阑尾炎而入住协和医院进行手术。手术时及手术后曾用 针麻止痛，疗效甚佳。他于7月康复出院后详细着文介绍了亲身经用针刺止痛的经历及中国中医药的发展和中西医结合的情况，加上电视的播放，霎时间中国针灸针麻的奇迹便展现于美国的千家万户，针灸诊所的患者络绎不绝，对中医针灸医师之需要亦随之大增，不久针灸学校应运而生，歧黄医术随之渐盛于美国。

    由于受到美国“中医针灸热”的影响，美国国立卫生研究院（NIH）于1972年7月成立了“针刺疗法特别委员会”，由麻醉学者、神经病学 者及生理学者等人组成。其主要任务是：复习中国有关文献；组织调查研究有关针灸情况以 及举行针灸学术研讨会等。该委员会于1973 年3月在马里兰州比塞大召开了第一次学术会 议。会上有40余项有关针灸方面的初步研究 成果进行了交流。该会主席J．Bonica教授（华盛顿大学医学院麻醉科主任）在总结发言中指出：“现有资料证明针刺疗法是有效的，这对医 学是重要的。针刺作为某些外科手术中的一种 麻醉方法和一些急性和慢性疼痛的治疗手段是 有希望的。但要在美国广泛开展临床针刺治疗 之前，必须进行妥善精密的设计和严加管理的 科学研究（Proceeding NIH Acupuncture Res each Conference，VI，1973）。

      同一时期美国出版了两份国际有名的中医 针灸杂志。一为美洲中国医学杂志（The Americanl ournal of Chinese Medicine ），于 1973年1月出版，为季刊。另一为美国针灸杂 志（Americann Journal of Acupuncture）， 于1973 年3月发行，办为季刊。

    这一时期有些学者还 相继在美国各地成立了有关中医针灸的学术性团体，如美国中国医学会、美国全国针灸研究学会等，都对推动中医药/针灸事业在美国的发展 起了积极的推动作用。

                                    二、美国中医药/针灸的现状

2．1中医药／ 针灸人员的情况

    目前全美国已有34(Arthur Fan notes: currently 44 States,pus DC)个州有针灸立法，颁发针灸执照，全美已有约一万(Arthur Fan notes：At least 3o,000) 名执照针灸医师。 其中约40％分布在加州，约10％分布在纽约州，其余分布在其它各州。另外，约有5000名西医师和3000名脊椎正骨师持有针灸执照，因而可以兼做针灸治疗工作。执照针灸医师由于所在各州立法的不同，职称和行医范围差异很大。例如，在新墨西哥州，州立法规定：凡取得该州针灸执照者，便可 称之为 Doctor of Oriental Medicine（DOM），并 有权写一般西医范围之内的化验单、X线检查 单等等，并可独立诊断疾病，进行医疗鉴定、穴 位注射、激光穴位治疗、指压推拿、开写中药处 方、美国草药、顺势疗法（homeopathic）、物理治 疗，以及给病人开维生素、矿物质、各种脢、氨基 酸等。加州则较特殊，中医与针灸合为一体，两种业务可以兼做。即凡取得针灸执照者，可同 时开写中药处方或给病人中药。对取得针灸执照并有相当医学背景者（即医学学历较高）可称为 Chinese Medicine Doctor（C． M．D）或 Oriental Medicine Doctor（O．M．D．）。佛罗里达州对有针灸执照者，可称为针灸医师（Acupuncture Physician），并允许针灸医师做穴位注射。纽约州针灸立法则规定，除非在中国已获得中医博士学位，广告上不得称自己为Doctor，若有足够的医学背景者亦只能写明： Physician in China， but not in N． Y． S。

    各州之所以有如此大的差异，除了各州情 况有所不同外，主要在于当权者对中医针灸的 理解程度和各州中医针灸工作者的力量，尤其是团结的力量情况而定。也有些州至今针灸执 照是附属于西医委员会之下颁发，如密执安州、 密苏里州及肯萨斯州等。 与针灸日益发展的同时，中医药界的队伍 也在日益壮大。中医诊所和中药店也如雨后春 笋般不断增加，其中不乏有国手及高明的中医 界老前辈。现在中医师及中药店不仅集中在华埠，而且已经不断的逐步深入到主流社会活动与居住地区并受到更多人士的欢迎。现在像在旧金山、洛杉矶、纽约、费城、波士顿、西雅图、亚特兰大等城市的中医诊所和中药店均已达上百家或数百家之多。但是，除加州等少数州中医师已取得合法地位之外，其它各州中医至今尚未立法。中医药到底要不要立法？以及如何立 法？看来需要全美国的中医师首先团结内部达成共识，再进行争取才会有力量。

 2．2中医药／针灸的教育与考试

    目前全美国已有约70所中医针灸学校，其中已被审批合格者有32(不止， 樊蓥注）所，其余正在申请审批中。大部分学校是培养针灸医师的，其学制一般为3年。也有一部份学校是培养针灸与中医师的，其学制多为4年。入学资格一般要求需具有2年大学（College）学历。在校内修完一定学分后可参加全美（N．C．C．A．O．M．）针灸或中医师（或两者全考）资格考试。毕业后也可参加加州针灸（中医）师执照考试，获得执照者可在加州独立开业行医。

    近年有部分中医针灸学校开设针灸或中医学硕士学位课程，也有的正在筹划开设博士（Ph D．）课程。 美国N．C.C.A.O.M.自1985年开始举行美国联邦针灸医师资格考试。每年4月在加州举行，10月在纽约州举行，到目前为止已有6000(现在过万，樊蓥注） 多位针灸医师通过考试。

参加考试的资格限于：

（1）美国国内经3年制或以上针灸（或中医）学历并完成一定学分者；

（2）在美国国外，如中国大陆5年制或以上中医学院毕业各科及格者；

（3）西学中学历要求在5年以上者（中、西医务科相加）；

（4）跟师带徒式学习者，老师资格及学习内容需要公证。

    考试分3天进行（现在可以在各地网上考试，樊蓥注），1天为中医针灸理论 与临床知识笔试。限5个小时内答完200个选 择题；1天为点穴考试；1天为C．N．T．（洁针技 术）考试，包括笔试和操作。考试可用英、中、 日、韩文。自1995年开始N．C．C．A．又增加了中药考试，因此N．C．C．A．亦随之改名为N．C．C．A.O.M。中药考试为1天，在5个小时内要 求用笔答完200个有关中药和方剂的选择题， 其中包括中医基础理论。中药考试条件大体和针灸要求相似。到目前为止大约已有800多位中药师通过考试。 考试通过者由N．C．C．A．O．M．发给合格 证书及考试分数通知。持此合格证书者，说明 具有该科之资格，因此亦可称为资格证书。有 的州对有此证书者即颁发针灸执照证明，有的州对用中、日、韩文考试者，另外要求要有英语托福500分以上的成绩（或在大学修完3个学分的英文课）、毕业证明与所学各科成绩单及绿卡等。

 2．3中医药／针灸学术地位改变情况

    中医药/针灸在美国的学术地位是逐步改变和提高的。每提高一步，便说明国家主流社 会的认可程度亦提高一步。美国国立卫生研究院（NIH）对中医药/针灸一直抱着审慎的客观态度，即对中医药/针灸通过不断的考察研究，不断的提高认识水平。

    NIH于1992年起成立了另类医学办公室（O．A．M．），对包括中医药／针灸在内的所谓另类医学，每年拨款一千万美 元（逐年增加）进行研究。因而像哈佛、耶鲁、斯 坦福及霍普金斯等着名大学均承担了研究任务。通过多年的研究NIH终于在1997年11 月初召开了关于针灸的听证会。

其四点结论是：

Ⅰ针灸在美国已广泛应用并有应用价值；

Ⅱ 需探索更多的适应症；

Ⅲ原理研究已明确了能 释放神经及对内分泌的影响等；

Ⅳ尚需进一步解决的问题有：针灸医师的培训、颁发针灸执 照的标准及医疗保险费的支付等。

    美国国家药品和食品管理总局（FDA）在经过多年肯定针灸疗效的基础上，已于1994年正式通过针灸用针由第三类（实验性）医疗用品器械晋升为第二类（医疗用）器械类并宣布其安 全性。1996年9月第四届世界针灸大会在纽约召开，与会者为来自46个国家和地区的专家学 者，1200余人聚首一堂进行学术交流。克林顿总统曾发来专函向大会祝贺，这是美国中医药／ 计灸史上的一件空前大事。

 2．4 中医药/针灸业界的经济地位

    一个行业在一个国家的社会政治地位是由 经济地位决定的。中医药/针灸事业如要纳入美国主流社会的关键，除了其疗效及科学性被 主流社会认可之外，主要是保险业是否支付中 医药/针灸的医疗费用。直至1995年为止美国医学会负责主编的 通用医疗程序编码》（CPT code）一直拒绝将 针灸列入其中。其所持理由是：针灸在美国还 处于试验阶段。正是这种立场严重阻碍了中医药/针灸纳入美国主流社会的历史进程，使美国 保险业系统一直拒付针灸医师的医疗服务支付。

现在代表美国广大西医利益的美国医学会 终于承认针灸是一种正式的有效的医疗程序。 自1998年 1月起全美国中医／针灸医师终于可 以使用该程序，向保险公司申请医疗服务。 自1998年1月起牛津保险公司开始承认 并受理中医/针灸保险之后，同年6月蓝十字蓝盾公司也正式宣布接受针灸保险。现在中医药/ 针灸界的最大愿望是，争取国会在本世纪最后 l-2年之内通过中医药/针灸立法，从而促使 医疗补助（Medicaid）和医疗照顾（Medicare）两项全美国最重要的保险项目，开始对中医药／针灸医疗的全部支付。只有这样才能使更多的美 国民众接受中医/针灸医师的医疗服务，而中医 针灸医师社会地位亦会真正的纳入主流社会。

 三、中医药/针灸在美国的今后 展望

                                                                                                                                                          3．1时代的召唤，历史的使命     

    美国是一个年轻的多民族多文化融合的国家，它欢迎一切对其国家和人民有利的事物。 近20多年来中医药／针灸等所谓的另类疗法，得到越来越多的美国人的欢迎，并且正在发展 成为一个富有生命力的确有其存在和发展价值 的医学学科。 当今由于化学疗法对人体的各种副作用和 后遗症的不利影响越来越明显，加上环境污染 导致人类面临严重的生存危机。有证据显示人类由于这些公害的结果，现在生殖能力每况愈下。

    在此人类历史的大潮流之下，有越来越多 的人要求回归大自然。特别是要求回归自然疗法的呼声已经响起。因此，中医药渐灸推拿按摩以及医疗气功等自然疗法正好符合时代的召唤、肩负这一历史的使命。有人经过统计发现， 现在每3个美国人中，就有一个曾经求助过另类疗法。从医治感冒到绝症求医，各种各样的 病人都有。

    另有一项调查显示，有超过半数的 西医医生在使用其专业医疗方法之后没有疗效 时，曾暗示病人可以尝试另类疗法。一些素有 盛名的医科大学，也已经开设了针灸或中西医 结合的诊室、诊所或研究构等。总之，中医药 /针灸现在美国正是发展的大好良机。

3．2提高素质，加强组织建设

    当前中医药/针灸医师队伍的素质显然已经不断得到提高。但是从1996年纽约州中医药界所出现的那一场严峻的六月风暴来看，由 于个别的人违法乱纪（向病人卖假药等），几乎使得整个中医药界蒙受不白之冤。如果当时没 有纽约州针灸委员会出面调停和各方善心人士 的共同支持，尤其纽约中医药学会及各针灸学 会等的努力，后果不堪设想。可见中医药/针灸 业界人士的素质是极端重要的，为此应当首先 加强一的组织建设。 当前中医药/针灸界的学会性组织仍停留 在有如雨后春笋般的状态。这些组织都分别起 过巨大的有益的推动和团结提高的作用，它是 特定历史条件下所必然的产物。

    历史在前进， 时代在变化，现在应该将这些组织联合起来，再 统一组织全国性的中医药／针灸学术组织。西医师之所以力量强大，这与他们具有统一的全 国性或全州（市）性组织有很大关系。只有统一 的组织或组织健全之后，才能及时发现并纠正害群之马一类的事件，也才能更好的提高中医药/针灸业界人士的素质，并使之达到时代所要 求的医术和医德水平，更好地为广大民众服务。

 

3．3 争取与美国传统医学（西医）并驾齐驱

    在美国的主流社会中所认为的传统医学是 西医，他们认为只有西医才是正规的医疗体系。 中医药/针灸、推拿、按摩等只是另类疗法。这是 由于国情和历史条件所造成的。但是，事物总是遵照事实、真理和科学的规律在起变化和发展。相信只要中医药/针灸业同道们的业务水 平进一步提高，医疗水平和医疗效果进一步被 主流社会所认同，在科研、教学、医疗等方面均 能向科学化、客观化、标准化、规范化不断迈进， 医德和个人素质被广大患者所称颂和欢迎，最后必能与美国传统医学各科并驾齐驱。

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Papers & Books of Dr.Xia Guicheng, A Chinese Gynecologist in Nanjing China. Post by Dr.Arthur Fan.

[Dr.Fan notes]: I graduated from Nanjing University of Chinese Medicine in 1986. During my study in that period (1981 to 1986), Dr.Xia Guicheng was my teacher in the class of Chinese Gynecology (Gynecology in Traditional Chinese Medicine), I also had internship under another TCM gynecologist Dr.Sun Ningquan.

Some colleagues asked my if I have Dr.Xia’s book or article, actually, there are several books written by him or his students, available at http://www.amazon.com:

1. Xia Guicheng Practical Chinese Gynecology (Paperback) by 2009 Chinese Medicine Press; 1 edition (October 1 (Paperback – Oct 1, 2009);

2. Gynecology of Traditional Chinese Medicine by Tan Yong (Paperback – 1991)

3. Chinese Gynecology chart solution (paperback) by TAN YONG (Paperback – Sep 1, 2008)

4. Gynecology of Traditional Chinese Medicine (Library of Traditional Chinese Medicine: Newly Compiled Practical … (English and Mandarin Chinese Edition) by Tan Yong(Paperback – 2002)

5. Treatment of Infertility with Chinese Medicine by Jane Lyttleton (Hardcover – May 10, 2004)

6. Obstetrics and Gynecology in Chinese Medicine by Giovanni Maciocia CAc(Nanjing)(Hardcover – May 20, 2011)

7. Xia Guicheng ( hundreds of years of clinical family medicine series) [Paperback]TAN YONG 

Dr.Xia Guicheng also published many academic papers, in Chinese language, some of them already available in English. Here are his papers online.

DISCUSSION OF THE MENSTRUAL CYCLE & THE CYCLE …

homepage.mac.com/sweiz/files/article/67-30.pdf

File Format: PDF/Adobe Acrobat – Quick View
by X Guicheng
Xia Guicheng is one the most eminent gynaecology specialists in China today. In my own practice, I find that adapting the treatment principle to the menstrual …

Fulfilling the Essence: The Handbook of Traditional & Contemporary … – Google Books Result

books.google.com/books?isbn=0936185481…Bob Flaws – 1993 – Health & Fitness – 267 pages

Xia Gui–cheng gives the following account of such correlation in the Shanghai Journal of TCM, October 1992. 10 Xia identifies six types or categories of BBT …

Xia Guicheng – Groupe d’Etude et de Recherche en Acupuncture 

http://www.gera.fr › … › Figures médicales de la Chine contemporaine

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 …

Xia Guicheng « Topics in Chinese Medicine

chinesemedicinetopics.wordpress.com/category/famous…/xia–guiche…

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 …

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Got “News” 5 years later!-“I got pregnant after one acupuncture treatment”. Posted by Dr.Arthur Fan

Last year, I tried to call and e-mail my former patients, who had treatments in our office  due to various infertility conditions, to see exact how many cases of pregnant (and rate) after our treatments of acupuncture, or/and Chinese herbology. I wanted to do a statistical work and give our patients a real data.  However, I found this task seems very difficult -I got frustrated, because some people don’t like to  discuss their personal stuff over the phone or in e-mail.

This week, a patient saw me for her low back pain. She told me she saw me because she feels comfortable with me and my acupuncture. She said she got a pair of twin boys after my one acupuncture treatment 5 years ago–this is really a good news, but I spend 5 years to get it!

There have been over 55 pregnancy success cases after our treatments since January, 2007.  Actually, there may be some more didn’t report to me. I hope I could get the news in time.

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Volvodynia Could be Treated by Acupuncture. Re-posted by Dr.Arthur Fan, in Washington DC & N.Virginia

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.

 

Table 1. Patient Information and Pain Outcomes Pain on Visual Analog Scale (1-10) Patient No. Age, y Duration, mo Before Treatment At 1 mo At 4 mo 1 36 60 10 7 1 2 25 36 8 2 2 3 61 48 10 3 1 4 50 24 7 3 1 5 62 20 10 10 10 6 67 41 4 2 3 7 23 9 9 9 3 8 39 – 9 7 5 9 43 72 10 5 1 10 58 – 10 1 1 11 45 36 10 3 1 12 70 – 8 2 1 13 39 36 8 3 0 Mean 47.5 38.2 8.69 4.38 2.31 (SD) (15.3) (18.62) (2.93) (1.75) (2.66) Median (range) 45 (23-70) 36 (9-72) 9 3 1

 

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).

Figure 1. BL 22 is located in the lumbar region and SP 6 and LV are on the antero-internal and mid-lower side of the leg

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

1. Harlow BL, Wisc LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001;185:545-550.
2. Tovell HMM, Young AW. Classification of vulvar diseases. Clin Obstet Gynecol. 1978;21:955-961
3. Burning vulva syndrome: report of the ISSVD Task Force. J Reprod Med. 1984;29:457.
4. McKay M. Vulvodynia versus pruritus vulvae. Clin Obstet Gynecol. 1985; 28:123-133.
5. McKay M. Dysesthetic (“Essential”) vulvodynia treatment with amitriptyline. J Reprod Med. 1993;38:9-13.
6. Danielsson I, Sjöberg I, Östman C. Acupuncture for the treatment of vulvar vestibulitis: a pilot study. Acta Obstet Gynecol Scand. 2001;80:437-441.
7. Powell J, Wojnarowska F. Acupuncture for vulvodynia. J R Soc Med. 1999; 92:579-581.
8. Stanford Patient Education Research Center Web site. URL: http://patienteducation.stanford.edu/research/painseverity.html. Accessibility verified June 25, 2005.
9. Guevin F, Bossy J, Yasui H. Nosologie traditionnelle chinoise et acupuncture. Paris, France: Masson; 1990.
10. White AR. A review of controlled trials of acupuncture for women’s reproductive health care. J Fam Plann Reprod Health Care. 2003;29(4):233-236.
11. Wesselmann U, Brunett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain. 1997;73(3):269-294.
12. Gisecke J, Reed BD, Haefner HK, Giesecke T, Clauw, DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104(1):126-133.
13. Reed B, Gorenflo DW, Haefner HK. Generalized vulvar dysesthesia vs. vestibulodynia: are they distinct diagnoses? J Reprod Med. 2003;48(11):858-864.
14. Reed B, Advincula AP, Fonde KR, Gorenflo DW, Haefner HK. Sexual activities and attitudes of women with vulvar dysesthesia. J Obstet Gynecol. 2003;102(2):325-331.

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

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Vulvodynia and Acupuncture Treatments, by Dr.Arthur Fan in Washington DC & N.Virginia

Recently, I treated the third patient with Vulvodynia with acupuncture. The result is very encouraging.

Ms. D.  a middle age Caucasus woman came to see me because she has been frustrated with various treatments for her IC (Interstitial cystitis), she heard I had treated a IC patient very successfully with acupuncture. She had urinary tract bacteria infection, which was recovered after the extensive antibiotic treatments, however, after that, she still has urinary frequency and strong burning pain when urination. She has been diagnosed as Interstitial cystitis, and then secondary developed Vulvodynia and pelvic bottom dysfunction.

When Ms.D. started to see me, she told me her physical therapist had treated her for several months. She had many trigger points and knots around the tail bone, anus and both sides of vulva(esp. right), both  inner sides of thighs.

After six sessions’ acupuncture, included in local A’shi / trigger point treatments and adjusting liver, spleen, kidney meridians, patient’s pain has been improved 60%, most of trigger points and knots at both thigh and around tail bone disappeared. The urinary frequency still there, but the burning pain decreased. Patient is very happy and still under our treatment, twice a week.

Notes on 08/20/2012: patient’s overall health condition has been improved, the thighs’ pain no longer exist. The pain around tail-bone, anus, and vaginal only 5-10% left. Most of days seem no a lot of pain. The uncomfortable in bladder area, and urine urgency better, but there has not been improved much. This means: her IC issue didn’t get big improvement, but the vulvodynia and leg pain, pain around anus close to clinically cured.

Here is another article from online, for your information.

Vulvodynia and Acupuncture Treatments

By Maryann Child, Acupuncture Physician
www.coralspringsacupuncture.com 

http://www.vulvodyniasupport.com/acupuncture.html

Vulvodynia is a condition, which few in the medical profession have yet to resolve or even understand. Little research exists and little is known about its origins or how best to treat it. What does seem apparent is that for those women who do have it, it is a constant daily dis-ease. Characteristics of Vulvodynia may vary from woman to the next, what is very certain is that there is usually pain and possible burning of the vulva. The level of pain can change from mild to severe. The etiology behind the condition may vary from one woman to the next, so differential diagnosis is essential for individual patient care. This differential diagnosis is what sets Chinese Medicine aside from Western Medical approach. Two women with the same diagnosis may have completely different disharmonies, so treatment is very unique to the patient’s personal body care.

Acupuncture may be a treatment option for Vulvodynia and Vestibulitis. In the proceedings workshop sponsored by the US Dept of Health in collaboration with the National Institutes of Health, National Institute of Child Health and Human Development, Office of Research on Women’s Health, and the National Office of Rare Diseases on April 14-15, 2003, discussion on the lack of understanding and research on the subject of vulvodynia was addressed. Dr. Elizabeth Stewart, of Harvard University had stated that physical therapy might alleviate the vulvar pain that was referred from the ligaments and joints in the spine and pelvis. One study did confirm that patients that used acupuncture to alleviate the pain showed improvement, and over all quality of life. She also did state that surgery for Vestibulitis was highly controversial because of the lack of clear pathophysiology for vulvar pain. There was great concern over cosmetic results. The overall consensus is that there is a relationship to the pudendal nerve being pinched. In Europe and in pain centers in the US, decompression of the nerve is attempted. Acupuncture is a great alternative to relieve compression of this nerve, and to strengthen overall system health.

Acupuncture is part of an ancient system of healing which incorporates all aspects of the physical and non-physical bodies. It is part of a larger doctrine called Oriental Medicine or Traditional Chinese Medicine. The belief is there is a vital energy that surrounds all living things. We call this “qi” or “prana”. It seems that just about every ancient culture has a name for it. We all recognize it as being real and existing. Even allopathic, western medicine has a name for it “vitality”. It is within this energy that the practitioner works his or her art. Constantly changing and creating harmony where there is disharmony, tonifiying what has been depleted and rectifying what has been in exuberance. The I ching states that all things are constantly changing and that nothing stays the same. This is the beauty of life. Every practitioner counts on this change to occur. After every treatment one anticipates the positive change in the body, hoping to rectify its disharmony. Acupuncture points are small areas of energy that spiral round, each with a different action and indication. These small energy spirals travel a pathway, which for the most part connect to an internal body organ. However there are other pathways that do not connect to any organ, these are referred to as extra ordinary pathways. Then lastly there are smaller pathways that diverge from the larger ones and cross the body. These smaller pathways allow for even the smallest communication between energy and body. The insertion of a needle into an acupuncture point creates communication between the function of the point and the body’s energetics. The formulation of points creates a reaction in the body. The body accepts the information and begins a cycle of change. Cycles of change can vary from one body to the next. Gradual improvement of symptoms is what is expected.

In Traditional Chinese Medicine the body is viewed as having patterns of harmony and disharmony. A practitioner pays very careful attention to what the condition of the body is. One examines closely what the blood is doing, what the “qi” is doing, and what it is not. The practitioner further seeks to determine where the patterns of disharmony exist. Differential diagnosis is attained and treatment to restore the body is begins. Women’s bodies are so diverse, that there are no two bodies alike. With treating Vulvodynia, I have noticed that even though there may be some similarities between patient’s symptoms, their etiologies or rather the root cause of the disorder is very different.

I first became aware of this disharmony about five years ago around the year 2000. I began treating a young patient who complained of sheer fire burning of her external genitalia. I remember feeling a bit puzzled because I had not heard of such a condition, so naturally I began to do some research. Very few of my colleagues had even heard of it. No one in my area had ever treated it. With this I began her treatment protocol.

The response that I have seen from my patients, lead me to believe that VV is completely treatable and I will explain why. I will cite two examples of patients that were treated with Acupuncture. What follows are two brief patient cases that were treated with Acupuncture. I’d like to mention that both patient’s are still receiving treatment, and are still obtaining very favorable results.

Mrs. P is a 35-year-old non-smoking married woman who was recently given a name to her burning and stinging of the vulva. For the past two years she has been treated for urinary tract infections. She has a history of low back pain and migraines. Although her migraines were a big concern for treatment, even more so was the constant irritation of the vulva. Mrs. P had a total of four treatments over the course of one month before significant results were obtained. Currently Mrs. P still comes in for treatment one time a month occasionally twice a month. Mrs. P is still undergoing treatment and is about 60 to 70 percent improved. There are many days where she is free from burning and stinging. She can remain free of discomfort for many weeks at a time.

Miss. M is a 49 year old, non-smoking non-married woman who was diagnosed
with Vulvodynia over the summer of 2004. The pain started in 2003, but was recently given a diagnosis. Her major complaint is pain of the vulva. The pain is drawing in nature. The pain is worse while sitting and better lying down. Mrs. was initially treated with Chinese herbal formulas that were modified specifically for her disharmony. Three weeks into treatment she began to feel improvement of her symptoms. Initially her improvement was minimal, then gradually began to feel better. Currently Mrs. M is treated every 4 to 6 weeks.

I wish to express my very concern for the lack of study on VV and treatment. Many women that I have seen have informed me of different experimental procedures that their Dermatologist, Gynecologist and Neurologists have mentioned. I say experimental because there is no significant data to show proof of success. I have even heard of a new use for botox. Injecting botox was the latest that I have heard this week. This is a desperate attempt in the medical world. Although there is no concrete evidence of a cure, in any medical model, all physicians would like to see a resolution of Vulvodynia. I hope if nothing else to bridge the gap between a woman and her options for treatment.

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How to chose a Chinese Medicine doctor?

The best way to choose a TCM doctor is to ask questions.

First ask friends whether they have a herbalist, and if so, would they recommend him/her? Using Chinese medicine practitioner’s website is usually the best way to get detail information about TCM doctor and his / her personality, as well as practice.

There are also many online registries of Chinese medicine practitioners, such as NCCAOM— the national board for acupuncture and Chinese medicine in USA,  which handles national examinations and issues certificates which are required for licensing in most of States to practice of acupuncture, Chinese herbal medicine, tuina – Chinese therapeutic massage in the USA. Currently, there are over 10,000 professionally qualified TCM practitioners registered with NCCAOM ,which provides Chinese medicine practitioners contact information by state.

You should ask the provider some questions to decide how helpful the TCM doctor is.

For example:

*Does this TCM doctor assure you that the body heals itself and that the Chinese medicine give opportunity to heal?

*Does this TCM doctor make you feel that you can trust him or her?

*Can this TCM doctor answer your questions to your satisfaction?

*Does this TCM doctor teach you why you might be ill in the first place?

*Does this TCM doctor listen to you or understand you ( Some Chinese may be  poor in spoken English)?

*Do you feel uncomfortable with your TCM doctor?

Remember–lack of trust can hinder the healing.

Remember–any healthcare professional, that offers a quick fix to all problems, is not offering healthcare. There are no magic bullets or miracle cures. Take care!

And if a provider’s fee schedule is very low (based on your common sense ), you should question the quality of his / her practice.

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Dr.Fan saw a deep coma patient in INOVA Fairfax Hospital: A clinical note, by Arthur Fan, CMD, PhD, LAc

On November 21, 2011, Dr.Fan got a special call from a patient’s close friend, invited Dr.Fan to see a deep coma patient in INOVA Fairfax hospital neuroscience ICU ward. The visit was approved by that facility and its attending doctor.

The patient is a 67-years old gentleman who is a main minister of a local Indian Sikh temple. He got a hemorrhagic stroke in his brain stem area seven days ago when he did some home repairing.  The hematoma was large and he had an emergency surgery when he was sent to ER by an ambulance. When I saw him, he had no any reflection and no any reaction to strong stimulation. His respiration was irregular and had to use breath machine. He had fever, 102 degree F. He was under antibiotics and respiration stimulating medication.

Considering: Stroke, Bi Pattern(闭证）.

I gave him An Gong Niu Huang pills(dissolve in warm water, once every 8 hours, i.g.), and did acupuncture for him.

Acupuncture points were: Ren Zhong, Yin Tang, Feng Chi, He Gu, Qu Chi, Ba Xie, Ba Feng, Zu San Li, Yong Quan. The stimulation was about one hour.

November 22, 2011: seemed have some effects. patient very occasionally move his leg slightly when I stimulated his Yong Quan points.

November 23, 2011: patient had more reaction to acupuncture, the frequency of moving his leg, fingers, head, slight more than one day ago.

November 24, 2011: condition was same as before. The tube from skull to test ICP removed.

November 25, 2011(5th treatment): patient was still in deep coma, responding to acupuncture stimulation more often, seem every 5-10 stimulation he could have a responding.  Stopping use antibiotics and respiration stimulating medication. The iv tube to central vein was removed and only used iv tube in arm vein.

November 26, 2011(6th treatment): patient was moved to Intermediate Unit from ICU. The condition was not good as yesterday. The doctor there discussed patient’s condition with his family members, suggested that this patient was still in very critical condition and his future was not so optimistic. Patient’s family members seemed considering give-up.

I did not give patient more treatments since then.

During six days I involved in his treatments, I feel Chinese medicine, included in An Gong Niu Huang Pills and acupuncture did show some effects, such as some responds to pain stimulation(relection recovered a little bit). However, this patient’s condition is too severe, he didn’t recover from the deep coma.

Although this invitation was by patient’s family and close friends, the facility and doctor in ICU did allow the doctor or practioner in Chinese medicine /acupuncture to see and treat patient. This is much open than a few years ago.

I remember, I saw a coma patient in Johns Hopkins Hospital two years ago, that facility did not allow patient to use Chinese herbal medicine, which needs special approval by hospital administration (the procedure would take half-year).

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Acupuncture stoped the sexual pain in woman

Yesterday, one of my patients reported “acupuncture is wonderful”–she no longer has the abdominal pain post her sex activities, that problem already existed for 5 years.

The pain was cramping-like, esp. after her getting orgasm. The reason is unknown.

The main acupuncture points were Ba-liao. Effectiveness is after two sessions’ acupuncture.

 

Painful Sex Still a Painful Secret

From ABC News Medical Unit, Feb. 25, 2008

Women who suffer from chronic painful sex often have stories that seem 60 years out of date: stories of secrets, of fear, of ignorance, of condescending doctors and foolish sex advice. 

Instead of sex that feels good, women report “a stinging, a stretching,” or say it feels “like something too big coming out of something too small” or “like it’s ripping you apart.”

While the pain is horrible, struggling to find treatment may be worse. Even top gynecologists agree that training on chronic sexual pain is minimal. 

“The curriculum is jammed with the explosion of knowledge, so there’s very little room to put [painful sex] in,” said Dr. Elizabeth Stewart, director of the Vulvovaginal Service at Harvard Vanguard Medical Associates and an assistant professor atHarvardMedicalSchool. 

“At any point 16 percent of women are walking around with pain for various reasons, and they’ve seen five doctors without a diagnosis,” said Stewart, who has written a book titled “The V Book” on the subject. 

With all the female-friendly pop culture encouraging women to say the V word — “Oprah,” “Sex in the City,” “The Vagina Monologues” — it’s hard to believe that such a lack of openness or knowledge would exist. But it does. 

After struggling for years to find treatment, a few women who’ve successfully overcome painful sex have begun to tell their private stories to help others.

Pain With No Common Name

“I didn’t really know it had a name for a really long time,” said Cynthia S., 36, who requested that her last name not be disclosed. 

“The pain was so bad, I couldn’t imagine putting a Q-tip in there,” said Cynthia. “During my pap smear I came close to passing out, it was awful.”

Cynthia believes her pain has something to do with being sexually abused as a child, but knowing the source and finding information to treat it are two separate things.

Cynthia was married for six years before finally finding a Web site (not a doctor) that described her condition. “Whoever is responsible for women’s health issues should definitely know this,” she said. 

“This” has a name, several actually, but medical doctors and psychiatrists don’t all agree. The simplest term to use, dyspareunia, literally means painful sex; however that term is loaded with psychological undertones. 

Dyspareunia first appeared in the Diagnostic and Statistical Manual of Mental Disorders, a handbook for mental health professionals, in 1968. By 1980, the term was introduced as one of two terms for sexual pain disorder. 

But while some painful sex disorders may indeed be purely psychological problems, the majority are not, says Sheryl A. Kingsberg, chief of behavioral medicine atUniversityHospitalsCaseMedicalCenterinCleveland,Ohio. 

“The key question is, is the pain sexual, or is the sex painful?” said Kingsberg, noting that this distinction is one that has been put forward by Irv Binik, an expert in sexual pain from McGill University in Canada. 

“Oftentimes we pathologize women and say it’s a sexual problem, when it is pain,” she said. 

A term with less psychological undertone is vulvodynia, which means pain of the vulva. But, experts say, this doesn’t help diagnose the cause of painful sex either. 

“We’ve named a disease based on a symptom,” said Dr. Andrew K. Goldstein, director of the Centers for Vulvovaginal Disorders inWashingtonD.C.andNew York City.

 

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