TCM OBGYN Fundamentals Part II Physiology and Etiology...Zang organ, Its nature included Ministerial...

TCM OBGYN Fundamentals Part II

Physiology and Etiology Integra(veWomen’sHealthProgram

TCM Reproductive Endocrinology

• BasedonHuangDiNeiJing7x7framework

•  FocusedontheinterplaybetweenKidneyQi,TianKui,ChongRen,andZiGong.

Foundation for Reproduction

KidneyQiAbundant

TianKuiArrives

ChongRenOpenandAbundant

Menstrua(onProcess

Fer(liza(onand

Implanta(on

KidneyQiDeficient

ChongRenDeficient

TianKuiDeple(on Menopause Unableto

Conceive

Kidney Qi and Reproduction

KidneyJing

KidneyYin

KidneyYang

KidneyStoresJing

KidneyQi

GrowthDevelopmentAgingReproduc(on

DirectImpact

Formation of Kidney Jing

BeforeHeavenQi

Fer(liza(onand

Implanta(on

AVerHeavenKidneyJingintheoffspring

SpermfromFather

EggfromMother

(KidneyYang)

(KidneyYin)

Ming Men 命⻔门 TheGateofLife

Ming Men – The Gate of Life 命⻔门

•  TheconceptofMingMen–TheGateofLifeorLife-Gate,alongwiththeconceptofXiangHuo-MinisterialFirehavegonethroughstagesofdefini(onsanddevelopment.ItIsyettobefinalizedcompletelytoday.

•  Thefirstsigh(ngsofthistermappearedinHuangDiSuWen,HuangDiLingSuandNanJing–ClassicsofDifficul(es.

• MingMen命⻔门 hasundergonethreedis(nctdefini(ons.RangingfromtheRightKidneyisMingMentoMingMenisapartofbothKidneystoMingMenisin-betweenbothKidneys.

•  ThetermveryfirstappearedbrieflyinNeiJingLingSu 內经素问,“MingMenareoureyes”.

What is Ming Men (The Gate of Life) 命⻔门? Right Kidney is Ming Men? •  <NanJing–36Difficul(es难经36难>“Kidneysarenotallkidneys.LeVKidneyisKidneybutrightKidneyisMingMen.”,“MingMenhousesessenceandspirit,andconnectstotheSourceQi.Itistheplacewheremanstoresessenceandinwoman,itcontrolstheovula(on,pregnancyprocessandconnectstotheZiGong.”

•  “FiveZangisactualSixZangbecauseKidneyhastwo.LeVisKidneyandrightisMingmen.”TheabovestatementthatLeVisKidneyandRightisMingMenisanotherZangorgantomakeSixZanginsteadofFive-Zangorgansystem.

Further Elaboration on the Right Kidney is Ming Men Concept •  <YiXueRuMen医学入⻔门>MingMenishousedinRightKidneyconnectstotheBladderbelowandPericardiumabove,lifeanddeathdependsonit.”

•  <MaiJing–ThePulseClassics脉经>LeVChipulsedetectsKidneyandRightChipulsedetectsMingMen.

RightKidney

MingMen

LeVKidney

Ming Men – Xiang Huo Relationship Subsequent Understandings •  Liu,WanSu:HeartisJunHuo(KingFire)andMingmenisXiangHuo(MinisterialFire).

• MingMenisthebeginningofheavenandearth,storesessenceandproducesblood.

•  LeVKidneyiswater,storingessenceandcontrolsuterus.RightKidneyisfire,wanderingintoSanjiao,warmingupthebody.

•  Liu,WanSuisthefirstphysicianthatestablishedtheMingMenDoctrine

Heart

JunHuo

KingFire

MingMen

XiangHuo

MinisterialFire

Mingmen Liu, Wan Su 刘完素 • MingmenisthesourceofXiangHuo,thebeginningofheavenandearth,storesessenceandproducesblood.

•  Lateryears,Sun,YiKui孙⼀一奎,Zhao,XianKe赵献可,andZhangJingYue张景岳allhavecontributedgreatlytothisdoctrineandcreatedanewZangconcept.

Shift to Ming Men is inclusion in both Kidneys •  <YiXueZhengZhuang医学正传>,“Sincebothkidneysarethesourceoftruebeginning,lifeforcedependsonit.EventhoughitisawaterZangorgan,ItsnatureincludedMinisterialFirewithinit.IbelievebothKidneysareMingMen.”

•  <LeiJingTuYi类经图翼>“MingMenisthehouseofbothwaterandfire.ItisthehouseofbothYinandYang.ItistheSeaofJingQi.ItisthedecisionmakerofLifeandDeath.”

Ming Men is between both Kidneys

•  Zhao,XianKe赵献可inhisbook<YiGuan医贯>statedthatMingMenisNOTinbothKidneysbutin-betweenbothKidneysrightonthespinalcord.

•  Zhang,JieBin张介宾furtherelaboratedontheMingMenisthesourcefortheforma(onofbothKidneyYinandYang.

MingMen

Mingmen Zhao, Xian Ke 赵献可 • Mingmenresidesinthemiddlebetweenbothkidneys,itisthekingofallZangFu.Itsfunc(onsdominatesoverallZangFu.ItisbeforeheavenwhiletheZangFuisaVerheaven.

• Kidneyhasformsandbelongstowaterelement.Mingmenhasnotformandbelongstothefireelement.OneYangwithinTwoYins(likeKanTrigram坎).OnlywhenthereisYangwithinYincanwehavelife,thereforeMingmenFireisalwaysintheleadingposi(on.

Kan Gua 坎卦 ☵

Ming Men Sun, Yi Kui 孙⼀一奎 • MingmenisthemovingQiofthebody.动⽓气• MingmenisthemovingQibetweenbothkidneys•  Itisnotwateranditisnotfire.•  Itistheswitchfortransforma(onandtherootforYin/Yang.ItistheTaiJiofthebody.Fiveelements(Zangfu)formsfromTaiJi.

Ming Men Zhang, Jing Yue 张景岳 • MingMenistheTaiJiofourbody.ItisthesourceoflifeandgivesrisetoYin-Yang,FiveElements,andessenceandQi.MingmenembracesbothWaterandFireelements.

•  TaiJiisonethatgivesrisetotwo,twotofour,fourtoeight,eighttosixteenandtoinfinity.

Mingmenisposi(onedbetweenUBandLargeIntes(nes

12 governors

• HuangDiSuWen,”HeartistheLeadGovernoroftheBody.Heartistheleaderandoneofthe12governors.WhentheHeartisnotclear,all12governorsareindanger.”SinceHeartisoneofthe12governors,theremustbeanotherorganinplay.5Zang+6Fu=11.Theaddi(onalgovernorisMingMen.”

Zhao, Xian Ke 赵献可 <Yi Guan 医贯>

• HuangDiSuWen,“Atthe7thvertebrae,thereisasmallHeartinthecenter”Thisiscoun(ngfromthebooomofL5upward.

• MingMenislocatedbelow14thvertebraecoun(ngfromthebaseoftheneckontheDuChannel(GV4)andtheKidneysare1.5CunlateraltoMingMen.TheRightKidneyhousesMinisterialFireandtheLeVKidneyhousesTrueWater.

•  TheTrueWaterfollowstheMingMenFire,flowingthroughoutthebodyprovidingYangEnergyfrom5-7amto3-5pm,providingYinEnergyfrom5-7pmto3-5am.Whenitisstagnant,thebodywillgetsick.Whenitstops,thebodydies.

Bao 胞 Embryonic •  Bothwomenandmenhaveasocalled‘Bao’,anenerge(careasituatedintheDanTian(LowerFieldofElixir)approximatelythreecunbelowtheumbilicus.

•  InwomenthiswheretheUterushouses;alsoreferredtoas‘thebloodchamber’(XueShi).Inmenitiscalledthecinnabarfieldor‘theroomofsperm’.

•  ThetermforUterus,whenusedinaChinesemedicinalcontexttranslatesasBaoGongorZiGong,meaning‘baby’swrapperorpalace’;itencompassesthefallopiantubes,ovaries,endometriumandcervix.

•  TheBaoGongissaidtobeconnectedthroughspecialchannelswiththeKidneysandHeart,respec(velytheBaoLuo(Uterus-Channel)andBaoMai(Uterus-Vessel).ExtraordinarymeridiansliketheRen-,Chong-,andDuMai.

Tian Gui 天癸 Heavenly Water •  TianGuiorHeavenlyWaterisamanifesta(onofKidneyJing(Essence).InfemalesTianGuiisthematerialbasisformenstrualblood,inmenforspermproduc(on.

•  ItisformedbyKidneyYinwiththesupportofHeart-Yang.AlsotheLiverandSpleenplayapartinthisprocess,thefirstamongotherthings;bystoringBloodandmovingBloodtotheUterusandthesecondcontributestotheforma(onofBloodandQibytransformingfood/Post-natalQiintoXue.

•  ThearrivalofTianGuiisrelatedtomenarcheandthecessa(onoftheTianGuitomenopause.

Fu Qing Zhu 傅青主 on Menstruation •  “MenstrualbloodisnotBloodbutHeavenlyWater,origina(ngwithintheKidneys,itistheEssenceofextremeYinandQiofextremeYang.Itisredlikebloodbutisnotblood.That’swhyitiscalledHeavenlyGui.PeoplenowadaysregardmenstrualbloodasBlood,amistakeperpetuatedfor1000years…infactitisnotcalledBlood-Water(XueShui)butmenstrualwater(JingShui)…thegenera(onofKidneyWater(andthereforemenstrualblood)hasnothingtodowithHeart,LiverandSpleen,butthetransforma(onofKidneyWaterishelpedbyHeart,LiverorSpleen”

Menstruation

• ChineseMedicinedescribesthemenstrualcycleintermsoftheeffectofQiandXueandYinandYangontheUterus.BroadlyvieweditisacyclicwaxingandwaningofYinandYang.

•  YinrelatestotheWesternfollicularphaseofthemenstrualcycleandestrogen.Yangontheotherhandrelatestothelutealphaseorsecretoryphaseandprogesterone.

Uterus and Zang Organs

Uterus

Heart

Liver

Kidney

Spleen

Command

FlowNutri(on

EssenceVia8ExtraViaBaoMaiViaBaoLuo

8Extra and Menstruation

Menstrua(on

Chong

Ren Dai

DuBloodFlow

EssenceOvula(on

RegularityNourishment

ControlClarity

Four Phases of Menstruation

•  FollicularPhase–BloodYinareemptyandbeingrebuilt• OvulatoryPhase–ChongandRenarefilled,asparkofYang•  LutealPhase–YangQirisesandLiverQimoves• MenstrualPhase–FlowofLiverQiandXue

TCM OBGYN 7RingsofClinicalCare

E(ologyandPathology

E(ology

SymptomsandSigns

Pathology

Diagnosis TreatmentPrinciple

Treatments

Preven(on

2 Polarity of Etiology Constitutional Immunity/Factor Zheng-Righteous 正, Xie-Evil 邪

Zheng-Righteous

An(-PathogenicForce

Xie-Evil

PathogenicForce

3 Types of Etiology Exogenous, Endogenous, Others •  Exogenous–InvasionofPathogensfromtheoutsideofthebody

•  SixExogenousPathogens–Wind,Fire,Damp,Dryness,Cold,SummerHeat•  Thoughourbodyiscapableinproducingthesepathogensendogenously.

•  Endogenous–Imbalancescreatedinternally,insideofthebody.•  SevenEmo(ons–Joy,Anger,Anxiety,Thought,Grief,FearandFright.

• Others–DietaryCauses,OverworkingCauses,SexualCauses,Trauma,CutsandLacera(ons,Insects/Animals.

Six Exogenous Pathogens TCM OBGYN

Wind

⻛风邪 Cold

寒邪

Damp

湿邪 Heat

热邪

Wind Pathogen (Feng Xie) ⻛风邪

•  Therearetwotypesofwind–ExternalandInternal• Windaoackswhenthebodyisvulnerable,especiallyduringmenstrua(on,pregnancy,andpostpartumperiod.

• MenstrualCommonCold,MenstrualFever,MenstrualHeadache,MenstrualBodyAches,MenstrualUr(caria,PostpartumFever,PostpartumSeizure,PostpartumBodyAches,etc.

•  ExogenousWindcanalsodisruptnormalfunc(oningofmenstrua(onandovula(on.

Cold Pathogen (Han Xie) 寒邪

• MainEnergyofWinterSeason

ExposuretoRainExposuretoSnow

Forma(onofHanQi(ColdEnergy)

ExcessofHanQi

DeficiencyofWeiYang

Perspira(onwithExposuretoDraV

SubmergedinWater

YangQiBlockageCannotWarm

Body

Qi/BloodFlowSlowedorStopped

CausingSicknessandDisorders

Types of Cold Pathogen 寒邪

•  TwoTypesofColdPathogen–ExogenousColdandEndogenousCold.

ExogenousColdInvasionfrom

Outside

InjuringMuscle,Skin,JingLuo,BloodVessels

EndogenousColdInvasionfrom

Inside

InjuringChongRenandZiGong

DuringMenstrua(onand

Postpartum

EndogenousYangQiDeficiency

MingMenFireWeakening

WarmingFunc(onoftheBodyDecreases

MenstrualFever,MenstrualBodyPain,Dysmenorrhea,ScantyMenstrua(on,Amenorrhea,PostpartumBodyPain,

Infer(lity,etc.

YinColdIncreasesandSpreads

MostlySpleenYangDefOrKidneyYangDef

Endogenous Cold Pathogen 内寒邪 The Causes – Two Paths

SpleenYangDeficiency

KidneyYangDeficiency

LackofWarming,

ContractureofBloodVessels

SlowedDownFlowofBlood

DecreaseinQiHuaFunc(on

YangDoesnot

TransformYin

YinColdDevelops

WaterDamp

PhlegmDamp

Accumulates

Amenorrhea,Infer(lity,ZhengJia,

DelayedMenstrua(on,Dysmenorrhea,

DisordersofVaginalDischarges,

ZiZhongcondi(ons,etc.

Clinical Considerations In Treating Cold Pathogenic Conditions • CloseConnec(onbetweenExogenousColdandEndogenousCold•  ExogenousColdmainlyofColdSymptoms,WhileEndogenousColdmainlyofDeficiencySymptoms.

•  LongTermInvasionofExogenousColdcancauseYangQidamage,thereforeYangQiDeficiency

• ChronicYangDeficiencyInteriorColdpa(entstendtoaoractExogenousColdInvasionduetotheweaknessintheinterior.

Heat Pathogen (Re Xie) 热邪 Characteristics

YangPathogen TendstoRise HighFever,AversiontoCold Bleeding

DisturbancetoShenMing

HeatPathogenTendstoConsume

BodyFluid

DamagetoTrueQi

Deple(onofFluid DecreaseinOverallBodyFunc(ons

ExtremeHeatTendstoCreateWindandMove

Blood

SeizuresandSpasms

Hypermenorrhea,AUB,Persistent

PostpartumLochia

DirectAoackofChongRenZiGong

CausesPID,PostpartumFever

Heat Pathogen (Re Xie) 热邪

•  TwoTypesofHeatPathogen–ExogenousHeatandEndogenousHeat.•  ExogenousHeat(WaiReXie)外热邪Invasion:

ExogenousHeatInvasionfrom

OutsideInjuringChongRen

andZiGongDuring

Menstrua(on,Pregnancy,andPostpartum

MenstrualFever,MenstrualHeadache,EarlyMenstrua(on,Hypermenorrhea,AUB,VaginalInfec(ons,VaginalItchiness,

Gesta(onalBladderInfec(ons,PostpartumFever,Mas((s,PID,Hemorrhages

Heat Pathogen (Re Xie) 热邪 •  EndogenousHeat(NeiReXie)内热邪:

ExtremeEmo(ons

TransformingtoFire

StagnantBloodTransformingto

Heat

YinDeficiencyCrea(ngInterior

Heat

QiStasisTransformingto

Heat

Stagna(onofSixPathogens

TransformingtoHeat

ExcessYangHyper

Func(oning

EndogenousForma(onofHeatandFire,

InjuryChongRen

EarlyMenstrua(on,Hypermenorrhea,

MenstrualVomi(ng,Epistaxis,MenstrualHeadache,MenstrualMoodiness,NVP,Gesta(onalVaginalBleeding,Gesta(onalMoodiness,Seizure,PostpartumFever,VaginalUlcera(ons

Clinical Considerations In Treating Heat Pathogenic Conditions •  ExogenousHeatcomesfromoutsideofthebody,heatsymptomsaremoresevere.

•  EndogenousHeatiscreatedfrominsideofthebody,heatsymptomsarelesssevere.

• ChronicInteriorHeatpa(entstendtoaoractExogenousHeatInvasion.

• Heatpathogenicdiseasesanddisorderstendtobeacuteandrequiresmoreurgentcare.

Damp Pathogen (Shi Xie) 湿邪

YinPathogen S(ckyinNature

HeavyinNature EasytoBlockQiFlow DamageYangQi

DisturbanceinAscendingand

DescendingFunc(onsofQi

ClearyangDoesNotRise

TurbidYinDoesNotSink

SpleenLostTransforma(onandTransporta(on

Func(ons

WaterDampRetainsInteriorly

TendstoAffectLowerPartoftheBody

PersistentCondi(on

TakesaLongerTimetoResolve

ProductofDampPathogenTendstobeThickandPersistentVaginalDischarges

Damp Pathogen (Shi Xie) 湿邪

•  TwoTypesofDampPathogens:ExogenousandEndogenous•  ExogenousDampPathogen:

ClimateMoistwithFrequentRain

ExposuretoWaterDampDuring

Menstrua(onorPostpartum

LongTermLodginginDampGroundand

Environment

VaginalInfec(on,Leukorrhea,Itchiness

Damp Pathogen (Shi Xie) 湿邪 •  EndogenousDamp(NeiShiXie)内湿邪:

DecreaseinSpleen’s

Transforma(onand

Transporta(onFunc(ons

DampPathogenTendstobe

TangibleandNotFormless

MenstrualEdema,Diarrhea,Ver(go,DisordersofVaginalDischarge,ZiZhong,ZiMan,PostpartumBodyPains,ZhengJia,Infer(lity,VaginalItchiness

Reten(onofWaterDampandTurbidPhlegm

FurtherBlockingSpleenYang

CausingViciousCycleofIncreasingDampnessReten(on

Clinical Considerations In Treating Damp Pathogenic Conditions •  ExogenousDampandEndogenousDampPathogenstendtostrengtheneachother.

•  ExogenousDamppathogenicInvasiontendstocauseSpleendysfunc(onwhichfurtherenablemoreDampnesscrea(on.

•  ExcessiveEndogenousDamppa(entstendtoaoractmoreexogenousDampinvasions.

Seven Emotions – Endogenous Etiology •  SevenEmo(ons–Joy,Anger,Anxiety,Thought,Grief,FearandFright.

•  Itishumanexpressionreac(ngtoourenvironment.ItisalsoourZangFu’sexpressioninitsnormalfunc(oning.

•  Appropriateemo(onalexpressionsisapartofnormalZangFuFunc(ons

•  Sudden,extreme,persistentemo(onalexpressionwhenexceedsourabilitytoselfrecovercancausedysregula(onofQi/Blood,Zang/Fu,Jing/Luo.

•  Thisdysregula(oncanaffectChongRen,ZiGongnormalfunc(oningtocauseOBGYNdisorders.

Seven Emotions Etiology •  TCMConceptofUnionofBodyandMind(Heart)⾝身⼼心统⼀一.• HuangDiNeiJingSuWen,“HundredDiseasesComefromQiDysregula(on.AngerCausesQitoRise.JoyCausesQitoSlow.GriefCausesQitoVanish.FearCausesQitoSink.FrightCausesQitoDerange.ThoughtCausesQitoKnot…”

•  Therewasnomen(oningofGriefinthispassage.•  “GriefCausesQitoBecomeDespondent”忧则⽓气乏• HuangDiNeiJingSuWen,”JoyinjuresHeart,GriefinjuresLung,FearinjuresKidney,AngerinjuresLiver,ThoughtinjuresSpleen.”

Seven Emotions in the Classics •  <SuWen>,“Hiddenemo(onalissuescancauseamenorrhea”•  <JinGuiYaoLue>,“CauseofOBYGNcondi(onsarefromdeficiencies,coldaccumula(on,andknooedQi.”

•  <FuRenMingZhuan妇⼈人秘传>,“Extremeemo(onscausesLiverQitoreverseandrebellious.WoodexcessandEarthweak,Spleenlosestransforma(onandtransporta(onfunc(onscausingpersistentvaginaldischarges,yelloworred.”

•  <FuQingZhuNvKe傅青主女科>illustratedthedirectconnec(onsforemo(onstocauseOBGYNdisorderssuchasdepressioncausesvaginalhemorrhage,angercausesearlypregnancyloss,extremeangercausesearlylabor,reversalofQicausesdifficultlabor,depressioncauseslacta(ondifficulty,infer(lity,etc.

Emotional Causes of Diseases Modern Context • Hundredsofstudiesexploretheemo(onalrootsofdiseases• ACEstudyinthe1990swithover17,000pa(entsdocumen(ngAdverseChildhoodExperiences(ACE),morethanhalfofthepar(cipantshadoneormoreACEs.

•  Thosewith4-50(mesofACEaremorelikelytohaveanadversehealthcondi(onordiseaseasanadult.

• Heartdisease,fracture,diabetes,obesity,alcoholism,andmore.•  Thisconfirmsthattrauma(cchildhoodemo(onalexperienceshavedirectandstrongimpacttohealth.

Emotional Causes of Diseases Modern Context •  Fromthisstudy,wecansafelyinferthatemo(onaltraumasdoaffectourhealthandtheycanbediseasecausing.

•  Emo(onalstress,whenexcessive,hasbeenknowntocausedisturbancetoourLimbicSystemwhichincludesimportantmidbrainstructureslikeolfactorybulb,hippocampus,hypothalamus,amygdala.

•  Especiallywhenhypothalamusisdisturbed,wecanseesuddendisappearanceofmenstrua(on,abnormaluterinebleeding,habitualmiscarriages,andinfer(lity.

• Also,whenapa(entisalreadysickwithOBGYNcondi(ons,anyaddi(onalemo(onalstresscanaggravatethecondi(ons.

End