妇科杂病
热入血室证情复杂 治疗主线不离清热
热入血室最早见于仲景《伤寒论》，为中风、伤寒、阳明诸病之热邪随月经适来适断之机侵入血室而出现恶寒发热、寒热如疟、昼日明了、暮则谵语、胸胁小腹满痛的一系列症状．关于血室，古有胞宫、冲脉及冲任脉二种认识。李老遵《类经附翼·求正录》中“子宫者，……医家以冲任之脉盛于此，则血事以时下，故名之曰血室”之说，认为血室为子宫(胞宫)，但又与冲脉、任脉、厥阴肝经相联系，因冲任二二脉皆起于胞中，肝主藏血，故血室为肝所上。
“正气存内，邪不可干”。，本病发病为肝失疏泄，冲任不调，胞宫功能失常，经气虚弱之时外邪乘虚而侵入胞宫， 与血相结，瘀滞肝经、冲任、胞宫而致胸胁小腹满痛，滞于半表半里，少阳枢机不利，故有寒热往来如疟，上扰神明则谵语，热迫血行则经行量多，与血相结则淋沥不净或骤止。其临床表现复杂，以六经辨证为主，治疗大法不离清解邪热。
邪在半表半里之间，症见经水适断，寒热如疟，发作有时，以小柴胡汤加当归、生地、丹皮清热和解。
伤寒热入血分，扰乱神明，昼日明了，夜则谵语，经净而不自愈者，须凉血清热，不拘定方，审证论治，但泄其实，勿犯胃气及中上二焦。
阳明病，下血谵语，但头汗出，或用清热行血汤清热活血。药物有桃红各3克，丹皮、五灵脂、生地各6克，生甘草1．5克，炮甲珠、赤芍各3克。水煎服。以丹皮、生地、生甘草清热，桃红、灵脂、甲珠、赤芍活血以达热除血行、邪去血室安之效。李老治疗此病，在继承仲景小柴胡汤疏解少阳及针刺期门泻实二法基础上进行了发挥，即随证灵活施治，然不离清热，体现了宗古而不泥古的治学思路。
阴痒多系肝肾湿热
阴痒是妇女外阴、阴道瘙痒的证候。因肝脉绕阴器，肾开窍于二阴，故阴痒与肝肾二经密切相关。证从湿热，有因忽视卫生，直接感染病虫，有因肝经湿热下注，有因湿热阻滞于少阴经脉，肾经湿热生虫。治疗以清热化湿、杀虫止痒为主，并内外并治。
临证辨证，以病在何经、湿热孰重为主。病在肝经，湿重者，方用萆蘚渗湿汤加知母、苍术、鹤虱、芜荑，热重者，用龙胆泻肝汤；病在肾经者，方用海藻泻肾丸加知母、黄柏。外用大蒜煎水熏洗等。
五型分治子宫脱垂
子宫脱垂多本虚标实之证，治必补益升提固脱，然急则治标，湿热或寒湿证明显者，必清利湿热或温化寒湿，内外并治。
1．气虚证：症见子宫下垂，劳则加剧，小腹坠，面色少华，少气肢倦，带下量多，舌淡，脉虚细。治宜补气升提。方用补小益气汤加青皮、栀于以舒肝解郁，防肝犯脾。带下量多，质清稀，加鹿角霜、海螵蛸温肾固督；腰酸胀者，加续断、杜仲、桑寄生固肾强腰；兼血虚者，加熟地、鹿角胶滋补营血。
2．肾虚证：症见子宫久脱不复，腰酸小腹坠，头晕耳鸣，性机能减退，舌淡，脉沉弱。治宜补肾固脱。方选六味地黄汤或大补元煎，酌加鹿角胶、紫河车、升麻补精升陷。
3．寒湿证：症见子宫脱垂，带下量多，色白，质清稀，口不下，小便不利，大便稀薄，舌体胖大，苔水滑，脉濡。治宜利水渗湿，温阳化气。方用五苓散加蜀椒、小茴、附子、丹参、川芎、红花，并反佐黄柏内服，助以温阳之味合活血之品以祛除寒湿。外用花椒、苦参、苍术、槐花、芒硝坐浴。外用飞矾180克，铜绿12克， 五味子12克，雄黄1．5克，桃仁9克，制成蜜丸，12克重，雄黄为衣，纳入阴中。
4．湿热证：症见子宫脱出，红肿溃烂，黄水淋沥，阴门肿痛，发热口渴，尿黄赤而痛，舌红，苔黄腻，脉濡滑数。治宜清利湿热。方用龙胆泻肝汤内服，外用蛇床子洗方及猪脂油调藜芦末3克敷涂。
5．气阴两亏证：本病经久不愈，虚极将成痨者，症见子宫脱垂日久，经水不利，消瘦乏力，二便频数，脉虚大。治宜气阴双补。方用温经汤合肾气丸加龟板、鳖甲、蒺藜之类。
附案：
肖某，女，56岁。门诊号：31023。
1960年7月5日初诊：产育6次，子宫脱垂，经期加重，腰困神倦。口干喜冷饮，大便干，舌苔薄白，脉细弱。处方：
生黄芪30克 知母9克 生白芍9克 当归15克 升麻3克 柴胡1．5克 生白术6克 党参15克 肉苁蓉15克 炙草3克
水煎服。
六味地黄丸10丸，五味子30克。每3克五味子煎水送服六味地黄丸]丸。
按：本病起于多产损伤胞络，加之年老体弱，肾元衰惫，肾阴虚而失于滋养胞脉胞络，经行气血下注，加重虚陷，故经期加重。脾为后天，补脾以资先天，故治以脾肾双补。方用补中益气汤合六味地黄丸，方中重用生芪，伍升麻、柴胡补中气，升下陷之气，知母、白芍佐六味滋阴清虚热，五味于补肾并敛收，肉苁蓉温阳，寓阳中求阴之意。全方脾肾双补，升提固涩并用。
妇人阴挺 气虚为本
子宫脱垂，属中医学“阴挺”范畴，为妇人阴中长期有物下坠，甚则挺出阴户之外者。《傅青主女科·带下》中述：“盖带脉通于任督，任督病而带脉始病，带脉者所以约束胞脉之系也，带脉无力，则难以提系。”提示本病属任、督、带奇经失于约束而然，为中气、元气虚而失摄之证。
气虚者，为生产损伤，或素中气不足，兼劳力过度，或便秘努责，致脾虚气陷，冲任不固，失于提摄，脾土衰弱，则生化乏源，荣血不足，宗筋失养而弛张。肾主封藏。司二阴，胞络系于肾，房劳多产损伤胞络致肾亏，或先天不足，封藏失职，任带失圃，或年老体弱，肾元衰惫，肾阴虚而失于涵养胞脉脉络。脾虚水湿不化，肾虚气化不足，湿聚于下，从阳化热，从阴化寒，或阴挺：厂外，磨擦损伤，邪气入侵而病湿热及寒湿二证，为疾病演变过程中的标证。
脏躁养心兼顾肝脾肾
脏有心、肝、脾、肺、肾五脏之说，李老宗《医宗金鉴》所云认为：脏者，心脏也，而心者，五脏六腑之大主，精神之所舍也。五志过极均能损伤心神。心主神明，生理功能正常则精神振奋，神志清楚，思维敏捷，对外界信息的反应灵敏正常；如心主神志的功能失常，太过则喜笑不止，不足则使人易悲。而脏躁之病为妇人精神忧郁，情志烦乱，无故悲伤，哭笑无常，频作呵欠，正为心主神志功能异常之故。然心主神明赖于心主血脉，血液是其物质基础，心气为其功能表现，故脏躁之证为忧愁思虑，情志郁结，损伤心气而然，治之必养心。
心主血，脾统血，脾为气血生化之源，脾之运化功能正常，化生血液充盛，则心有所主；肝藏血，主疏泄，若肝不藏血，疏泄失常，则心无所主；心属火，位居于上，肾属水，位居于下，肾水上济于心，则心气不亢。故治心之时必兼顾肝、肾、脾三脏。
《金匮要略》以甘麦大枣汤治本病，《妇人大全良方》则以淡竹茹汤治疗妊娠脏躁，李老临证则对二者均有发挥。甘麦大枣汤用之则常酌加枣仁、茯神安神，竹茹、陈皮理气除烦，生地、麦冬滋心肾之阴，白芍敛肝和脾，黑芝麻养肝肾。淡竹茹汤则不拘于妊期，但脏躁兼有痰者，症见神疲肢倦，心烦惊惕，内热口干，恶心干呕，脉虚细数者即可用之．药物组成有人参3～6克，茯苓3～6克，麦冬6～9克，半夏3～4。5克，竹茹4．5～9克，生姜1．5～3克，大枣2～3枚，甘草1．5～3克，达益心脾二脏，除痰和胃之功。
宫外孕
开中西结合治急腹症之先河
创宫外孕非手术疗法之壮举
宫外孕是妇产科急腹症之一，其发病急，演变快，如处理不及时或不得当，很容易危及患者生命。长期以来，宫外孕患者一经确诊即行手术治疗已成定论，手术治疗有其优越性，如直观、治疗周期短等，但同时给患者造成的创伤也较大，并对患者术后再孕造成负面影响。为了减轻患者的痛苦，更好地为患者服务，1958年，山西省中医研究所所长李翰卿老大夫同山西医学院第一附属医院妇产科合作。共同探讨中西医结合治疗宫外孕的新路子。
对于这件工作，李老非常重视，认真制订了“中西医配合治疗宫外孕的计划”。其中李老认为，中医方面必须在手术时亲眼看到手术部分的具体情况，必须调查全国治疗本病的方法和结果，把治疗过程的经验和教训实事求是地、有计划地加以记录和总结，必须在不断发现新的情况下，不断改正缺点，并不断创造新的治疗方法，必须在治疗当中把有效的部分和道理毫无保留地介绍给西医同志并使他们按法试用，以期达到西医学习中医更实际的目的，西医方面也必须同样抱着互相学习、互相帮助的态度，绝对避免各行其是，中西医之间必须定期或不定期地征求对方意见等。
李老是一名中医大夫，对西医解剖学及病理学并不是很熟悉，但他实事求是，谦虚好学，常将自己不懂的东西汜录下来，以备询问。如李老在他的笔记本中曾写到：必须通过参考有关书籍或西医的具体介绍，了解西医对本病的理论认识和治疗经验。询问西医同志1个月的胚胎体积有多大，询问解剖学中有无输卵管的图形，和实物体积大小对比是否相同，卵巢去掉后身体有无异常表现，后穹隆放血能否把溢出的血一次放尽，最多数量有多少，疼痛是否是输卵管破裂的征兆……
通过对宫外孕患者的望闻问切以及对宫外孕解剖、病理认识的深入，李老在思考，中药是否能把在宫外的胚胎消灭掉了输卵管既然能输卵，说明它本身就有一种输送排泄的作用，但宫外的胚胎为什么输送不出去呢?胚胎既然附着在管壁上，不能自然输出，那么辅助一些药品是否可以帮助输送出去呢?随着对这些问题的逐一解答，李老逐步确定了中医治疗宫外孕的基本治疗法则——活血祛瘀法。
诊断分型遵西医 一、宮外孕的诊断 宫外孕的确诊主要依靠西医学制定的诊断标准，即根据病人的病史、症状和体征，配合原尿，或尿浓缩妊娠试验，或阴道排膜检查，作出确诊。随着中西医结合非手术疗法治疗宫外孕工作的深入开展，根据少腹痛的具体情况，中医也有了确诊的初步把握，但毕竟还须经过西医作出最后决定。李老指出，“这是中西医必须认真地结合起来的第一明证”。但诊断虚实寒热的轻重及兼证治疗的主次则必须采用中医方法。
在临床诊断中，应特别重视胚胎死活的判断，因为胚胎继续存活者，随时都有破裂的可能，危险性很大。山西医学院第一附属医院的同志根据临床实践，总结出以下几点诊断依据，但临床中还应综合观察，全面考虑，以便确诊：
(一)阴道出血：一般说来，如病人无阴道出血，应考虑胚胎尚存活，有阴道出血者，胚胎死亡的可能性较大。也有极少数病人，虽有少量阴道出血，但胚胎仍继续存活，应予注意。
(二)阴道排膜：除个别患者(约0．2％左右)外，凡有阴道排膜者，可考虑胚胎已死亡。
(三)自觉症状：如早孕反应持续存在，应考虑胚胎尚存活。如早孕反应消失，且有泌乳现象时，应考虑胚胎已死亡。
(四)尿妊娠试验：如连续两次尿妊娠试验均为阴性，可考虑胚胎已死亡。如尿妊娠试验持续阳性，说明胚胎继续存活的可能性很大。
(五)超声波探测：如显示包块中有活动的胎体或胎心反射，则说明胚胎存活。 二、临床分型 为了便于对病人观察、辨证、治疗和护理。根据病程的不同阶段，山西医学院第一附属医院初步将宫外孕分为未破损和已破损两大类，已破损类又分休克型、不稳定型及包块型。分型标准如下：
(一)未破损类：指宫外孕尚未发生流产或破裂者．
(二)已破损类
1．休克型：指宫外孕破损后引起急性大量腹腔内出血，来院后临床上有休克征象者．
2．不稳定型：指宫外孕破损后时间不长，病情尚不够稳定，有再次发生内出血的可能者。包括内出血量不多，无休克征象者，或内出血量较多，曾有过休克情况，经抢救后病情好转者。
3．包块型：指宫外孕破损时间较长，腹腔内血液已形成血肿包块者。
其中，未破损类最少。此类病人往往无特殊表现，临床上易疏忽而误诊，但随时有破损的可能，如处理不当，可危及生命，故需特别警惕．已破损类中不稳定型最多，临床表现似暂时平稳，但病情最易转化，如处理及时得当，病情向有利方面转化，可迅速平稳，较快治愈；反之，则病情可向不利方面转化，甚至陷于休克。故对此型亦需认真对待。休克型例数虽不多，但其病情较严重，随时都可能发生危险，故除应用中西医各种方法积极抢救外，尚需严密观察，必要时立即手术．
活血祛瘀治本证
辨证要点：宫外孕破损后，以突发性剧烈腹痛，不规则阴道出血，淋沥不断，血色暗红，腹腔内大量游动性血液或／和凝血块，以及腹膜刺激症状等为主要表现。
本病的治疗首先根据以下各个方面认清本病的性质和治疗的方向：
1．表现的症状：少腹部刺痛拒按。
2．发病的时期：都在月经错后时期。
3．手术后看到的病形：为有形实质。
4．药物性能的启示：一切祛瘀药品均有活血通经止痛、破癥除瘕、消肿、催产堕胎等作用。 5．临床实践的经验。 从以上特点不难看出，本病系瘀血内停少腹，气机阻滞所致的少腹血瘀的实证。治疗原则以活血祛瘀消癥为主。
Gynecological Miscellaneous Diseases
Complex Manifestations of Heat Entering the Blood Chamber: The Main Treatment Principle is Clearing Heat
"Heat entering the blood chamber" (Re Ru Xue Shi) was first recorded in Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Pathogenic Diseases). It refers to a series of symptoms such as aversion to cold and fever, alternating chills and fever resembling malaria, clear consciousness during the day but delirium at night, and fullness, distension, and pain in the chest, hypochondrium, and lower abdomen. These occur when pathogenic heat from wind-stroke, cold damage, or Yangming diseases invades the blood chamber coinciding with the onset or interruption of menstruation. Regarding the "blood chamber," ancient texts present two views: one considers it the uterus (Baogong), and the other considers it the Chong Mai (Penetrating Vessel) and the Chong-Ren Mai (Penetrating and Conception Vessels). Master Li follows the statement in *Leijing Fuyi · Qiuzheng Lu*: "The uterus... physicians believe that when the Qi and Blood of the Chong and Ren vessels are abundant here, menstruation flows down regularly, hence it is named the blood chamber." He believes the blood chamber is the uterus (Baogong), yet it is connected to the Chong Mai, Ren Mai, and Jueyin Liver Meridian. Since both the Chong and Ren vessels originate from the Baoyuan (Uterus/Cavity), and the Liver governs the storage of blood, the blood chamber is governed by the Liver.
"When healthy Qi exists within, evil cannot interfere." The pathogenesis of this disease involves the Liver failing to maintain free flow, imbalance of the Chong and Ren vessels, and dysfunction of the uterine cavity. When the Jing-Qi (Menstrual Qi) is deficient, external pathogens invade the uterus vacuously, binding with blood. This causes stasis in the Liver meridian, Chong-Ren vessels, and uterus, leading to chest, hypochondriac, and lower abdominal fullness and pain. The pathogen stagnates between the exterior and interior, causing dysfunction of the Shaoyang pivot mechanism, resulting in alternating chills and fever like malaria. Heat disturbing the mind causes delirium; heat forcing blood to move excessively causes heavy menstruation; if heat binds with blood, it causes prolonged spotting or sudden cessation. The clinical manifestations are complex, primarily differentiated by Six-Channel Syndrome differentiation. The main treatment principle is clearing and resolving pathogenic heat.
If the pathogen is between the exterior and interior, presenting with sudden cessation of menstruation, alternating chills and fever like malaria with regular paroxysms, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Danggui (Angelica Sinensis Root), Shengdi (Rehmannia Root), and Danpi (Moutan Bark) to clear heat and harmonize.
If cold damage heat enters the blood level, disturbing the spirit, with clear consciousness by day and delirium by night, and no self-healing after menstruation ends, one must cool the blood and clear heat. Do not stick to fixed formulas; instead, differentiate the syndrome and treat accordingly, draining excess without damaging Stomach Qi and the Middle and Upper Jiao.
In Yangming disease, presenting with bleeding from the rectum, delirium, and sweating only on the head, use Qingre Xingxue Tang (Heat-Clearing and Blood-Invigorating Decoction) to clear heat and invigorate blood. Ingredients include Taoren (Peach Kernel) and Honghua (Safflower) 3g each, Danpi 6g, Wulingzhi (Trogopterus Dung) 6g, Shengdi 6g, Sheng Gancao (Raw Licorice Root) 1.5g, Pao Jiazhu (Processed Pangolin Scales) 3g, and Chishao (Red Peony Root) 3g. Decoct in water and take orally. Danpi, Shengdi, and Sheng Gancao clear heat; Taoren, Honghua, Wulingzhi, Pao Jiazhu, and Chishao invigorate blood, achieving the effect of eliminating heat, moving blood, expelling pathogens, and calming the blood chamber. Master Li’s treatment of this disease builds upon Zhang Zhongjing’s methods of using Xiaochaihu Tang to resolve Shaoyang and needling Qimen (LR14) to drain excess. He flexibly applies these based on the syndrome while adhering to the principle of clearing heat, reflecting a scholarly approach that respects tradition without being bound by it.
Yin Itching is Mostly Due to Damp-Heat in Liver and Kidney
Yin itching is a syndrome characterized by itching of the female vulva and vagina. Since the Liver meridian surrounds the genitalia and the Kidneys open into the two yins (anterior and posterior orifices), Yin itching is closely related to the Liver and Kidney meridians. The syndrome belongs to damp-heat. Causes include neglecting hygiene leading to direct infection by parasites/pathogens, downward pouring of damp-heat from the Liver meridian, or damp-heat obstructing the Shaoyin meridians causing parasites to generate from damp-heat in the Kidney meridian. Treatment focuses on clearing heat, transforming dampness, killing parasites, and relieving itching, employing both internal and external therapies.
Clinical differentiation focuses on which meridian is affected and whether dampness or heat is predominant. If the disease is in the Liver meridian with predominant dampness, use Bixie Shen Shi Tang (Grassleaf Fern Decoction for Draining Dampness) plus Zhimu (Anemarrhena Rhizome), Cangzhu (Atractylodes Rhizome), Heshi (Nardostachys Root), and Wuyi (Melia Seed). If heat is predominant, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If the disease is in the Kidney meridian, use Haizao Xieshen Wan (Seaweed Kidney-Drilling Pill) plus Zhimu and Huangbai (Phellodendron Bark). External treatments include fumigation and washing with garlic decoction.
Five Types for Treating Uterine Prolapse
Uterine prolapse is mostly a syndrome of root deficiency and branch excess. Treatment must tonify and lift to secure against prolapse. However, in acute cases treating the branch, if damp-heat or cold-damp syndromes are obvious, one must clear-drain damp-heat or warm-transform cold-damp, combining internal and external treatments.
1. Qi Deficiency Syndrome: Symptoms include uterine prolapse, worsening with exertion, lower abdominal bearing-down sensation, lackluster complexion, shortness of breath and limb fatigue, excessive leukorrhea, pale tongue, and deficient-thready pulse. Treatment should tonify Qi and lift. Use Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction) plus Qingpi (Green Tangerina Peel) and Zhizi (Gardenia Fruit) to soothe the Liver and resolve depression, preventing Liver overacting on Spleen. If leukorrhea is profuse and thin, add Lujiaoshuang (Deer Horn Frost) and Haipiaoxiao (Cuttlefish Bone) to warm the Kidney and secure the Du vessel. If there is soreness and distension in the lower back, add Xuduan (Dipsacus Root), Duzhong (Eucommia Bark), and Sangjisheng (Taxillus Twig) to strengthen the Kidney and waist. If accompanied by Blood deficiency, add Shudi (Prepared Rehmannia Root) and Lujiaojiao (Deer-Horn Glue) to nourish Ying-Blood.
2. Kidney Deficiency Syndrome: Symptoms include long-standing uterine prolapse that does not reduce, lower back soreness and lower abdominal bearing-down, dizziness and tinnitus, decreased sexual function, pale tongue, and deep-weak pulse. Treatment should tonify the Kidney and secure against prolapse. Select Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) or Dabu Yuanjian (Great Tonification Decoction), adding Lujiaojiao, Zihewei (Placenta), and Shengma (Cimicifuga Rhizome) to tonify essence and lift sinking.
3. Cold-Damp Syndrome: Symptoms include uterine prolapse, profuse white and thin leukorrhea, absence of thirst, difficult urination, loose stools, enlarged tongue body, slippery-wet coating, and soggy pulse. Treatment should promote urination and leach out dampness, warm Yang and transform Qi. Use Wuling San (Five-Ling Powder) plus Shuzao (Sichuan Pepper), Xiaohui (Fennel Fruit), Fuzi (Prepared Aconite Root), Danshen (Salvia Root), Chuanxiong (Ligusticum Rhizome), and Honghua (Safflower), with Huangbai (Phellodendron Bark) added as a counter-agent internally. Combine warming Yang agents with blood-invigorating products to dispel cold-damp. External sitz bath with Huajiao (Sichuan Pepper), Kushen (Sophora Root), Cangzhu, Huaihua (Sophora Flower), and Mangxiao (Mirabilite). Additionally, make honey pills using Feifan (Alum) 180g, Tonglv (Malachite Green) 12g, Wuweizi (Schisandra Berry) 12g, Xionghuang (Realgar) 1.5g, and Taoren 9g. Each pill weighs 12g, coated with Xionghuang, and insert into the vagina.
4. Damp-Heat Syndrome: Symptoms include protruding uterus with redness, swelling, ulceration, dripping yellow fluid, swollen and painful vulva, fever and thirst, yellow-red painful urination, red tongue, yellow-greasy coating, and soggy-slippery-rapid pulse. Treatment should clear and drain damp-heat. Use Longdan Xiegan Tang internally. Externally, use Shechuangzi Wash (Cnidium Fruit Wash) and apply Lvlu powder (Veratrum Powder) mixed with lard oil (3g) topically.
5. Qi and Yin Dual Deficiency Syndrome: For chronic cases nearing consumptive disease, symptoms include long-standing uterine prolapse, irregular menstruation, emaciation and fatigue, frequent urination and defecation, and large-deficient pulse. Treatment should tonify both Qi and Yin. Use Wenjing Tang (Warming the Menses Decoction) combined with Shenqi Wan (Kidney Qi Pill) plus Guiban (Turtle Shell), Biejia (Softshell Turtle Carapace), and Jili (Tribulus Fruit).
Attached Case:
Patient Xiao, Female, 56 years old. Outpatient No.: 31023.
First visit on July 5, 1960: Had six births. Uterine prolapse, worsened during menstruation, sore waist and mental fatigue. Dry mouth preferring cold drinks, dry stool, thin-white coating, fine-weak pulse. Prescription:
Sheng Huangqi (Raw Astragalus Root) 30g, Zhimu 9g, Sheng Baishao (Raw White Peony Root) 9g, Danggui 15g, Shengma 3g, Chaihu (Bupleurum Root) 1.5g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 6g, Dangshen (Codonopsis Root) 15g, Rongrong (Cistanche Stem) 15g, Zhi Cao (Honey-fried Licorice Root) 3g.
Decoct in water and take orally.
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pills) 10 pills, Wuweizi 30g. Take 1 pill of Liuwei Dihuang Wan washed down with water decocted from 3g of Wuweizi every 3 doses.
Commentary: This disease originates from damage to the Bao Luo (Uterine Collaterals) due to multiple births, compounded by old age and weakness, leading to exhaustion of Kidney Yuan Qi. Kidney Yin deficiency fails to nourish the Bao Mai and Bao Luo. During menstruation, Qi and Blood descend, exacerbating the sinking deficiency, hence worsening during the period. The Spleen is the Post-Heaven Foundation; tonifying the Spleen supports the Pre-Heaven. Thus, the treatment tonifies both Spleen and Kidney. The formula combines Buzhong Yiqi Tang and Liuwei Dihuang Wan. Heavy use of Sheng Huangqi, combined with Shengma and Chaihu, tonifies Middle Qi and lifts sinking Qi. Zhimu and Baishao assist Liuwei Dihuang in nourishing Yin and clearing deficient heat. Wuweizi tonifies the Kidney and astringes. Rongrong warms Yang, embodying the principle of seeking Yin within Yang. The entire formula tonifies Spleen and Kidney simultaneously, combining lifting/securing with astringency.
Female Yin Ting (Prolapse): Qi Deficiency as the Root
Uterine prolapse belongs to the TCM category of "Yin Ting" (Yin Protrusion), where a woman feels a constant bearing-down sensation in the vagina, sometimes protruding outside the vulva. *Fu Qingzhu Nu Ke · Dai Xia* states: "The Dai Mai (Girdle Vessel) connects with the Ren Mai (Conception Vessel) and Du Mai (Governor Vessel). When Ren and Du are diseased, the Dai Mai becomes diseased. The Dai Mai constrains the Bao Mai system. If the Dai Mai lacks strength, it cannot lift and support." This indicates that the disease results from the loss of constraint by the extraordinary vessels Ren, Du, and Dai, caused by deficiency of Middle Qi and Yuan Qi leading to failure of retention.
Qi deficiency often results from birth trauma or inherent insufficiency of Middle Qi, compounded by overexertion or straining due to constipation, leading to Spleen Qi deficiency and sinking, insecurity of Chong and Ren vessels, and failure of lifting and retaining. Spleen Earth weakness leads to insufficient source of transformation and generation, resulting in inadequate Ying Blood and malnourishment of the Zong Jin (Sinews), causing flaccidity. The Kidney governs sealing and storing, controls the two yins, and the Bao Luo is linked to the Kidney. Sexual excess and multiple births damage the Bao Luo, causing Kidney deficiency, or congenital insufficiency leads to failed sealing and storing, insecurity of Ren and Dai vessels. Or, old age and weakness lead to exhausted Kidney Yuan Qi, where Kidney Yin deficiency fails to nourish the Bao Mai and collaterals. Spleen deficiency fails to transform water-dampness; Kidney deficiency fails to transform Qi. Dampness gathers below, transforming into heat via Yang or cold via Yin. Or, the prolapsed tissue rubs and damages, allowing pathogens to invade, resulting in damp-heat or cold-damp syndromes, which are branch manifestations in the disease evolution.
Zang Zao (Organ Agitation): Nourish Heart, Considering Liver, Spleen, and Kidney
There is a concept of Zang Zao involving the five Zang organs: Heart, Liver, Spleen, Lung, and Kidney. Master Li follows *Yizong Jinjian*, stating: "Zang refers to the Heart. The Heart is the great master of the five Zang and six Fu organs, the residence of Spirit." Extreme emotions can all damage the Heart Spirit. The Heart governs the Spirit. Normal physiological function results in vigorous spirit, clear consciousness, agile thinking, and normal sensitive response to external information. If Heart governance of the Spirit is abnormal, excess leads to uncontrollable laughter, while deficiency makes one prone to sadness. Zang Zao disease in women manifests as mental depression, emotional turmoil, unprovoked crying/sadness, unpredictable weeping/laughing, and frequent yawning, precisely due to abnormal Heart governance of the Spirit. However, Heart governance of the Spirit relies on Heart governance of Blood vessels; Blood is its material basis, and Heart Qi is its functional manifestation. Thus, Zang Zao arises from worry and overthinking, emotional stagnation, and damage to Heart Qi. Treatment must nourish the Heart.
The Heart governs Blood; the Spleen controls Blood. The Spleen is the source of Qi and Blood production. If Spleen transportation and transformation are normal, generating abundant Blood, then the Heart has something to govern. The Liver stores Blood and governs free flow. If the Liver fails to store Blood and free flow is disordered, the Heart has nothing to govern. The Heart belongs to Fire, located above; the Kidney belongs to Water, located below. Kidney Water ascends to moisten the Heart, preventing Heart Qi from becoming hyperactive. Therefore, when treating the Heart, one must consider the Liver, Kidney, and Spleen.
*Jingui Yaolue* uses Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) to treat this disease. *Furen Daquan Liangfang* uses Danzhuru Tang (Bamboo Shave Decoction) for gestational Zang Zao. Master Li expands on both in clinical practice. When using Ganmai Dazao Tang, he often adds Zaoren (Semen Ziziphi Spinosae) and Fushen (Poria with Hostwood) to calm the spirit, Zhuru (Bamboo Shavings) and Chenpi (Aged Tangerina Peel) to regulate Qi and relieve vexation, Shengdi and Maidong (Ophiopogon Tuber) to nourish Heart-Kidney Yin, Baishao to astringe the Liver and harmonize the Spleen, and Heihema (Black Sesame Seed) to nourish Liver-Kidney. Danzhuru Tang is not limited to pregnancy. It can be used for Zang Zao complicated by Phlegm, presenting with mental fatigue, limb heaviness, heart vexation, palpitations, internal heat, dry mouth, nausea, dry vomiting, and deficient-thready-rapid pulse. Ingredients include Renshen (Ginseng Root) 3-6g, Fuling (Poria) 3-6g, Maidong 6-9g, Banxia (Pinellia Tuber) 3-4.5g, Zhuru 4.5-9g, Shengjiang (Fresh Ginger) 1.5-3g, Dazao (Jujube Fruit) 2-3 pieces, Gancao 1.5-3g. This benefits the Heart and Spleen, resolves Phlegm, and harmonizes the Stomach.
Ectopic Pregnancy
Pioneering Integrated Chinese and Western Medicine for Acute Abdominal Conditions
Creating a Bold Non-Surgical Therapy for Ectopic Pregnancy
Ectopic pregnancy is one of the gynecological acute abdominal conditions. It has an acute onset and rapid progression. If not handled timely or appropriately, it easily endangers the patient's life. For a long time, surgical treatment upon diagnosis became the established norm. Surgical treatment has advantages, such as direct visualization and short treatment cycles, but it also causes significant trauma and negatively impacts future fertility. To alleviate patient suffering and serve them better, in 1958, Old Doctor Li Hanqing, Director of the Shanxi Institute of Traditional Chinese Medicine, collaborated with the Obstetrics and Gynecology Department of the First Affiliated Hospital of Shanxi Medical College to explore new paths for integrated Chinese and Western medicine treatment of ectopic pregnancy.
Master Li attached great importance to this work and carefully formulated the "Plan for Integrated Chinese and Western Medicine Treatment of Ectopic Pregnancy." Master Li believed that the Chinese medicine side must personally observe the specific situation of the surgical site during surgery, investigate nationwide treatment methods and results for this disease, record and summarize experiences and lessons from the treatment process realistically and systematically, continuously correct shortcomings and create new treatment methods as new situations arise, unreservedly introduce effective parts and principles to Western medicine colleagues for trial, aiming for more practical Western learning from Chinese medicine. The Western medicine side must also adopt an attitude of mutual learning and assistance, absolutely avoiding acting independently, and regular or irregular consultation between Chinese and Western medicine sides is necessary.
Although Master Li was a TCM doctor and not very familiar with Western anatomy and pathology, he was realistic, humble, and eager to learn, often recording things he did not understand for inquiry. For example, he wrote in his notebook: One must understand the Western medical theoretical understanding and treatment experience of this disease by referring to relevant books or specific introductions from Western medicine. Ask Western medicine colleagues how large a 1-month embryo is, ask if there are diagrams of fallopian tubes in anatomy, whether they match actual physical size comparisons, whether removing ovaries causes abnormal bodily manifestations, whether posterior fornix drainage can completely remove spilled blood at once, what the maximum quantity is, and whether pain is a sign of fallopian tube rupture...
Through observation, listening, questioning, and pulse-taking of ectopic pregnancy patients, and through deepening understanding of ectopic pregnancy anatomy and pathology, Master Li pondered: Can Chinese herbal medicine eliminate the extrauterine embryo? Since the fallopian tube transports eggs, it inherently has a transport and excretion function. Why can't the extrauterine embryo be transported out? Since the embryo attaches to the tubal wall and cannot be naturally expelled, could auxiliary medications help transport it out? With the step-by-step resolution of these questions, Master Li gradually determined the basic treatment principle for TCM management of ectopic pregnancy—the method of Invigorating Blood and Resolving Stasis.
Diagnosis and Typing Follow Western Medicine
I. Diagnosis of Ectopic Pregnancy
Confirmation of ectopic pregnancy mainly relies on diagnostic standards established by Western medicine, i.e., making a definitive diagnosis based on the patient's medical history, symptoms, and signs, combined with urine tests, concentrated urine pregnancy tests, or vaginal membrane discharge examinations. With the deepening development of integrated non-surgical therapy for ectopic pregnancy, based on specific lower abdominal pain, TCM has gained preliminary confidence in confirmation, but ultimately requires final decision by Western medicine. Master Li pointed out, "This is the first clear evidence that Chinese and Western medicine must be seriously combined." However, diagnosing the severity of deficiency/excess and cold/heat, and prioritizing the treatment of accompanying syndromes must adopt TCM methods.
In clinical diagnosis, special attention should be paid to judging embryo viability, as a surviving embryo carries a high risk of rupture at any time. Colleagues from the First Affiliated Hospital of Shanxi Medical College summarized the following diagnostic criteria based on clinical practice, but comprehensive observation and consideration are still needed in clinical settings for accurate diagnosis:
(1) Vaginal Bleeding: Generally, if the patient has no vaginal bleeding, the embryo should be considered alive. If there is vaginal bleeding, the possibility of embryo death is higher. There are very few cases where, despite slight vaginal bleeding, the embryo continues to survive, which warrants attention.
(2) Vaginal Membrane Discharge: Except for individual patients (about 0.2%), those with vaginal membrane discharge can be considered to have dead embryos.
(3) Subjective Symptoms: If early pregnancy reactions persist, the embryo should be considered alive. If early pregnancy reactions disappear and lactation occurs, the embryo should be considered dead.
(4) Urine Pregnancy Test: If two consecutive urine pregnancy tests are negative, the embryo can be considered dead. If the urine pregnancy test remains positive, it indicates a high probability that the embryo continues to survive.
(5) Ultrasound Detection: If active fetal body or fetal heart reflexes are shown in the mass, it indicates embryo survival.
II. Clinical Typing
To facilitate observation, differentiation, treatment, and nursing of patients. Based on different stages of the disease course, the First Affiliated Hospital of Shanxi Medical College initially divided ectopic pregnancy into two major categories: Unruptured and Ruptured. The Ruptured category is further divided into Shock Type, Unstable Type, and Mass Type. Typing standards are as follows:
(1) Unruptured Category: Refers to ectopic pregnancy that has not yet undergone abortion or rupture.
(2) Ruptured Category
1. Shock Type: Refers to acute massive intra-abdominal hemorrhage caused by ectopic pregnancy rupture, presenting with clinical signs of shock upon arrival at the hospital.
2. Unstable Type: Refers to cases where not much time has passed since rupture, the condition is not yet stable, and there is a possibility of recurrent internal bleeding. This includes cases with little internal bleeding and no shock signs, or cases with significant internal bleeding and previous shock, whose conditions improved after rescue.
3. Mass Type: Refers to cases where rupture occurred a long time ago, and blood in the abdominal cavity has formed a hematoma mass.
Among these, the Unruptured category is the least common. Such patients often lack special manifestations, making them prone to oversight and misdiagnosis clinically. However, they are always at risk of rupture. Improper handling can endanger life, so special vigilance is required. Among the Ruptured category, the Unstable Type is the most common. Clinical manifestations seem temporarily stable, but the condition is most prone to transformation. If handled timely and appropriately, the condition can transform favorably, stabilizing quickly and healing faster; conversely, it can transform unfavorably, even leading to shock. Thus, this type also requires serious attention. Although the number of Shock Type cases is not large, their conditions are severe, and danger can occur at any time. Therefore, besides actively rescuing with various Chinese and Western medicine methods, close observation is necessary, and immediate surgery may be required if necessary.
Invigorating Blood and Resolving Stasis to Treat the Root Syndrome
Key Points of Differentiation: After rupture of ectopic pregnancy, the main manifestations are sudden severe abdominal pain, irregular vaginal bleeding that drips continuously, dark red blood color, large amounts of mobile blood or/clots in the abdominal cavity, and peritoneal irritation symptoms.
Treatment of this disease first requires recognizing the nature of the disease and the direction of treatment based on the following aspects:
1. Manifested Symptoms: Stabbing pain in the lower abdomen, refusing pressure.
2. Time of Onset: Always during delayed menstruation periods.
3. Pathological Form Seen After Surgery: Tangible solid mass.
4. Inspiration from Drug Properties: All blood-breaking/stasis-resolving drugs have effects such as invigorating blood, unblocking menses, relieving pain, breaking masses, removing growths, reducing swelling, inducing labor, and aborting fetuses.
5. Experience from Clinical Practice.
From the above characteristics, it is clear that this disease is a excess syndrome of Blood Stasis in the lower abdomen caused by stagnant Blood inside the lower abdomen and obstructed Qi mechanism. The treatment principle focuses on Invigorating Blood, Resolving Stasis, and Dissolving Masses.