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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