Disorders of the Vagina

Prolapse Yin Ting

Diagnosis

Degrees

1. Cervix falls to pubissymphysis
2. Can possibly see cervix
3. Uterus exits to external

Etiology

1.  Qi ↓ – Qi sinking, Ren & Dai lose consolidation function.
2.  KI Qi/Yang ↓ – can’t help Ren & Dai consolidate Uterus.
3.  Chronic cough

Secondary

4.  Damp/Heat – Damp/Heat arises from other ↓
5.  Injuries

Pathogenesis Differentiation & Treatment

Qi ↓ 1^st & 2^nd degree prolapse, gets worse when tired. Plus Qi sinking symptoms (see Appendix 1) P/T nourish Zhong Qi, ascend SP Qi Rx Bu Zhong Yi Qi Tang (increase dosage of Huang Qi, Dang Shen) add Xu Duan (KI), Jin Ying Zi (astringent rosehips) Zhi Qiao (move Qi), Wu Mei (astringent)

KI ↓ 2^nd & 3^rd degree prolapse, cold sore weak low back/knees Plus KI ↓ symptoms (see Appendix 1) P/T strengthen KI, consolidate Uterus Rx Da Bu Yuan Jian

Vaginal Itchiness Yin Yang

Diagnosis

Genital area has itchiness which is difficult to relieve, this may be complicated w/ leukorrhea & anal itch.

Etiology

1.  Damp/Heat stagnation in low Jiao, (various infections) → Heat → Wind
2.  LR KI Yin ↓ – Yin ↓ produces dryness → Heat → Wind
3.  LR HT stagnation → Fire follows LR Jing to genitals → Heat → Wind

Pathogenesis Differentiation & Treatment

Damp/Heat itch, leukorrhea that is yellow thick & smelly, red vulva with fluid covering it. Plus Damp/Heat symptoms (see Appendix 1) P/T clear Heat, induce diuresis, destroy parasites, relieve itch Rx Bei Xie Fen Qing Yin  or  Long Dan Xie Gan Tang

LR KI Yin ↓ dry & burning with itchiness, may have leukorrhea w/o odour, may also be pinkish if Heat present. Plus LR KI Yin ↓ symptoms (see Appendix 1) P/T nourish LR KI Yin, clear Fire Rx Zhi Bai Di Huang Wan

LR HT Fire itch, emotional neurosis, more itch at night, nothing visual upon examination. Plus LR HT Fire symptoms (see Appendix 1) P/T clear LR HT Fire Rx – Dan Zhi Xiao Yao San (more LR) Jia Wei Gui Pi Tang (more HT)

Genital Eruptions

Diagnosis

Genital area has red swollen hot painful skin eruptions, if severe can fill with pus then discharge before healing.

Etiology

1.  Toxic Heat – (most common) external heat invasion → hyper HT or LR fire, poor diet – greasy spicy hot foods, meridians get invaded → eruptions.
2.  Cold stagnation – diet, external cold, weak qi & blood SP ST constitution, can’t lead blood & Qi → pathogens invade → stagnation in Jing → eruptions.

Read More: Disorders during Pregnancy

Pathogenesis Differentiation & Treatment

Toxic Heat

acute, 1^st-3^rd  days feeling of swollen pain → turns to a red lump (may affect movement), around 5^th day pus will form & discharge, around 7^th day the wound will start to heal.  Tough area to heal, may become chronic infection.  This pattern is often Herpes.

Plus Toxic Heat symptoms (see Appendix 1)

P/T clear Heat, detoxify, promote blood circulation, move stasis

Rx Wu Wei Xiao Du Yin or Xian Fang Huo Ming Yin

*if chronic add Huang Qi & Jie Geng

Cold stagnation

slow onset, no colour change (unless long term may turn darker purplish), starts as a hard lump → ulceration may occur if left untreated long term, may also discharge pus.  These are very difficult to heal.

Plus Qi & blood ↓ symptoms (see Appendix 1)

P/T nourish Qi & blood to eliminate toxicity

Stage #1  hard lumps, no discoloration or pain unless touched, typically the size of a jellybean.

Rx Yang He Tang

Stage #2 ulcer & discharge

Rx Tuo Li Xiao Du San

Vaginal Pain

Diagnosis

Pain in vaginal area possibly radiating upwards towards uterus, abdomen, or even to the breasts.

Etiology

1.  LR KI ↓ – can’t nourish Jing Luo, leads to Fire which injures Jing Luo
2.  LR Fire – long term LR Qi stagnation → Fire w/ pain swallowing the Jing to the genitals, can also go to breasts.
3.  Damp/Heat in low Jiao – LR SP dysfunction, KI ↓, Damp/Heat go to low Jiao
4.  SP Qi sink – can’t control local tendons → flaccidity &/or heavy pulling pain.
5.  Wind/Cold stagnation – after delivery Wind/Cold invades → blocks LR Jing & produces pain.

Pathogenesis Differentiation & Treatment

LR KI ↓

Older women, dryness with burning pain, local area may be shrunken or shriveled. Plus LR KI ↓ symptoms (see Appendix 1) P/T nourish LR KI ↓, clear Heat Rx Zhi Bai Di Huang Wan

LR Fire

Vaginal pain radiate to abdomen & possibly nipple Plus LR Fire symptoms (see Appendix 1) P/T soothe LR, purge Fire Rx Dan Zhi Xiao Yao San

SP Qi sinking

local heavy pulling downward pain, thin clear vaginal discharge

Plus SP Qi ↓ symptoms (see Appendix 1)

P/T nourish mid Jiao Qi

Rx Bu Zhong Yi Qi Tang or Ju Yuan Jian

Damp/Heat

swollen pain, ↑ yellow thick smelly leukorrhea, local ulcerations or inflammation

Plus Damp/Heat symptoms (see Appendix 1)

P/T clear Heat, induce diuresis

Rx Long Dan Xie Gan Tang or Yi Huang Tang

Wind/Cold stagnation

Postpartum, can be very severe swollen pain, no inflammation or redness & burning

Plus Wind/Cold symptoms (see Appendix 1)

P/T  expel Wind/Cold to harmonize Luo & relieve pain

Rx Qu Feng Ding Tong Tang

Infertility

Diagnosis

When have had normal sexual activity for 2-3 years, there is nothing wrong with the male sperm, yet still can’t achieve pregnancy.  May have irregular menses, leukorrhea, dysmenorrhea.  Instruct woman to go and see gynecologist to have full examination.  Educate patient on fertility charting & other methods to check if ovulation is happening (mucous, temperature, saliva, new checking devices).  Also ask what types of birth control has been used in the past.

Etiology

1.  KI ↓ – KI ↓ of any type can inhibit conception, Ming Men ↓ – cold uterus, Yin ↓ – lack of Essence can create Heat & dryness.
2.  LR Qi stagnation – LR blood ↓ – try so hard to get pregnant that it stresses the emotions, disharmony between Ren & Chong Mai.
3.  Phlegm-Damp – tubal blockage, overweight, cold invades during menses.
4.  Blood Stasis – any reason that causes stagnation in Jing Luo, Chong & Ren Mai are not clear & open.

Pathogenesis Differentiation & Treatment

KI Yang ↓ delayed scanty pale menses, # of cycles/year is reduced

Plus KI Yang ↓ symptoms (see Appendix 1)

P/T warm KI Yang, strength & nourish Ren & Chong

Rx Yu Ling Zhu

KI Yin ↓

early scanty or delayed scanty menses, red in colour

Plus  KI Yin ↓ symptoms (see Appendix 1)

P/T nourish KI Yin/blood to regulate Ren & Chong Mai

Rx Yang Jing Zhong Yu Tang (after menses)

LR Qi stagnation

PMS, irregular cycles with clotted blood

Plus LR Qi stagnation symptoms (see Appendix 1)

P/T soothe LR, nourish blood

Rx Kai Yu Zhong Yu Tang (open stagnation plant egg soup)

– omit Tian Hua Fen

Phlegm-Damp

(polycystitis), overweight, male characteristics, pubic hair thinning, may skip periods but have heavy flow when arrive, or delayed scanty, amenorrhea, heavy thick leukorrhea

Plus Phlegm-Damp symptoms (see Appendix 1)

P/T dry Damp, dissolve Phlegm

Rx Qi Gong Wan (open uterus pill)

Blood Stasis

clotted purple dark menses that are delayed with dysmenorrhea, low back/abdominal pain, PID, endometriosis

Plus Blood Stasis symptoms (see Appendix 1)

P/T promote circulation, remove Stasis, regulate Ren & Chong Mai

Rx Shao Fu Zhu Yu Tang (remove stasis then try to get pregnant after)