Women's Health - Gynecology General Information

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Anatomy and Physiology Leukorrhea Pregnancy Delivery Breastfeeding Post-partum Etiology Prevention and Maintenance Diagnosis Principles of Treatment Pulse

Anatomy and Physiology

Jing – Menstruation Dai – Leukorrhea Tai – Pregnancy Chan – Delivery Bao Gong – Uterus, house of the fetus. Zi Men – Cervix Yin Dao – Vagina Ru Fang – Milk House Shen Qi – Kidney Qi, kidneys control Uterus.

The Kidney essence is the origin of the formation of Tian Gui (heavenly water).

Tian Gui – Heavenly water, the material substance of menstrual blood (and sperm).

Chong Mai – Sea of Blood, influences the supply and proper movement of blood in the Uterus and controls menstruation in all its aspects. Starts between Kidneys.

Ren Mai – Sea of Yin, provides the Yin substances for all women’s physiological processes and hormonal gateways, including puberty, conception, pregnancy, childbirth and menopause. Ren starts between the Kidneys also.

The main difference between Ren and Chong in relation to menstruation is that Ren controls Qi and can be used to Tonify and nourish, and Chong controls blood and is used to move Qi and blood and remove obstructions.

Du Mai – Sea of Yang, makes blood come out during menstruation. It is the Yang balance of Ren. Du starts between kidneys.

Dai Mai – Connects to Uterus, binds leg channels, nourishes and lubricates Uterus. Dai also starts between the Kidneys. Liver – The Uterus gets its blood from the Liver where it is stored. Liver also controls the smooth flow of Qi, Blood needs Qi to move.

Spleen – Makes blood from food, and keeps the Uterus from prolapsing.

Heart – Governs blood, connected to the Uterus Via Bao Mai (Uterus Vessel), emotional aspect of the heart can influence women’s function.

Lung – Govern Qi, are affected by sadness and grief, hence it’s effect menstruation. - Sometimes Qi is more in charge of menstruation, sometimes Blood is.

- For men, the equivalent to the Uterus is the ‘Jing Gong’ (Essence House).

- Classically women under 21 with problems need Kidney treatment. Women between 21-42 need Liver blood nourished.

Women over 42 need Spleen nourished. Classic Formula still in use today

- Small Intestine WU TANG – nourish blood Sun Miao said in spring add fang feng, in summer add huang qin, in fall add mai meng dong, and in winter add gui zhi.

Leukorrhea

- Normal vaginal discharge should be thin, clear, and have no odor. Around ovulation it may be a little thicker, like a raw egg white.

- Before period or during pregnancy the amount may be more. - Normal healthy discharge comes from the Kidneys for proper lubrication.

- When old this normal lubricant can dry up due to Kidney Yin Deficiency.

Pregnancy

- After Menarche – until Menopause women are able to conceive.

- The duration of this period of time is closely related to Kidneys, especially the Yin-essence. - Combined with the Yang-essence from men, you have conception.

- Shen enables development to start. - From 1st day of last period, gestation is 280 days, or +/- 10 months. Steps Menses stop, picky for food (sour, tasteless), morning sickness 92 weeks, dizziness, fast slippery forceful pulse, nipples change colour and may get itchy. 12+/- weeks feel Uterus. 16+/- can feel movement. After 20 weeks start to show. 20+/- weeks breasts may get leaky, baby reaches umbilicus. 24 weeks if problems are to come around now is the time – back pain, pee problems, blood def., edema (poor circ.). 30-36 weeks, very careful with diet because of increase in appetite, eat healthy, not too much, less carbohydrates and fats. Normal to gain 20-25 lbs, 40 is too much. 36+/- weeks baby head drops down, treat between 32-36 weeks to turn fetus.

Delivery

- Three things a woman MUST do; relax, get enough sleep, and take it slow and easy. “When the fruit is ready, it will fall.” Pre-delivery

– will start with regular contractions, may start spotting blood when cervix opens. Water breaks for lubrication, if it breaks early before dilation the cord can flow down with the water and wrap around the neck.

Breastfeeding

- 4-24 hours after birth milk should come. - The first milk is absolutely essential for the health of the child. - Initially feed a lot to get the milk ducts flowing freely. - Eat well as to nourish blood for milk production. - Milk will gradually reduce after 6-8 months.

Post-partum

- Mom and baby should rest for I month and take good care of themselves as to restore Qi and Blood. - Wear flat soft shoes. Within first week

– may experience light fever, spontaneous sweat, aversion to cold. Milk starts 4-24 hours after delivery, first milk is slightly yellowish and full of antibodies. 1 week – month, abdominal pain may arise from blood stasis, this is quite normal. Bloody clotty discharge, dark turning to pale from lots to a little happens over 3 weeks. this gradual decline is normal.

Etiology

External Cold – Impairs Ren and Chong function, especially during menstruation and after delivery. Avoid cold, especially swimming. Can cause infertility, Dysmenorrhea, irregular menses, blood stasis, can occur w/ damp that goes down to the lower Jiao. Heat

– Heavy or irregular bleeding, during menses may vomit blood, have nosebleeds, fever, and may cause miscarriage Damp

– External invasion of turbid Damp or Spleen dysfunction makes dampness accumulate in the Lower Jiao, this impairs the Ren and Dai function causing leukorrhea, diarrhea during menses, watery blood, tiredness, pain around period, and edema. (Phlegm/Damp can cause obesity, infertility, and amenorrhea). Dai and Ren are involved in Dampness. Internal Overwork

– Should rest more during menses and pregnancy. Easily injure Spleen KI. Diet

– Not enough nutrients = not enough Qi and Blood. Do not overeat, this will injure Spleen/Stomach or produce pathogenic factors (dampness from Spleen def.).

Sex – Having sex too early in life, having too much sex, too many birth close together,and trying to get pregnant too soon after miscarriage can all adversely affect health.

Trauma – During pregnancy do not do many little things you may not think of that require slight bending, this strains the uterus.

Emotions – 5-element emotional imbalance can cause mental confusion during menses, irritability, irregular menstruation, infertility, and many other problems. Anger – Qi upsurge, Joy – Makes Qi slow, Sadness – dissolves Qi, Fear – sinks Qi, Shock – scatters Qi, Worry/over-think – Qi stag/knot. These effect Qi---Zang fu---4 meridians---female disorders.

Internal Heat – Accumulation of heat, toxic heat, heat in blood. Toxic is high fever, loss conscious, delirium, eruptions, deep red tongue, reproductive cancers.

After delivery – heavy bleeding, spotting w/ yin deficiency signs. Strong odour yellow discharge.

Blood Stasis – Qi stagnation leads to blood stasis. Cold or injury can also lead to blood stasis. This can cause menstrual disorders, bleeding, masses, infertility, and pain.

General condition – History of women in family (pre-heaven essence), original Qi and Tian Gui not strong. Body type – overweight = Qi def., and accumulation of Tan/Damp.

This blocks meridians and makes it difficult to get pregnant. Ovarian cysts (polycystic ovary syndrome) are more common in obese women.

Thin – Yin/blood def., delayed menses, no hips makes for difficult labor. Depression causes Liver Qi Stagnation – irregular menses. Dull dark complexion = Kidney def.

Prevention and Maintenance

Menstruation - No swimming, bathing, sex - watch getting cold - take it easy, sleep enough - try to balance emotions before/during

Pregnancy - get enough sleep/rest - proper exercise should be done…

- water exercise - breathing, yoga - diet- not quantity, quality

– frequent small amounts - no sex in 1st trimester or 3rd trimester

- 7 months and after, do warm cloth nipple massage - get your western tech checks Post-partum

- stay at home, prevent invasion, comfy temperature and fresh air

- eat easily digestible food

- no sex for 1st month - clean breast every time you feed baby

- feed every 3-4 hours (approx.)

Diagnosis

Late menarche – Kidney (probably from mom) Early menopause Kidney Liver When did menses stop The time to check breasts is 3+/- days after period. Age 35-55 is the common time for women to develop reproductive cancers.

History - menses, leukorrhea, pregnancy, delivery details, family history.

-Complexion and Tongue shows strength of Qi and blood -pale and puffy face and tongue Qi w/ Tan -dull yellow skinny face and body blood -red cheeks Yin .,

menopausal -purple on face and purple on tongue blood stasis

-Leukorrhea - colour, amount, consistency, odor -Cold or Hot -very bad smell = cancer tumor -Body hair – pubic hair thin and small amount = Kidney -Too much hair = Kidney Pulse - Early pregnancy and close to menses = slippery, rapid or slippery, wiry

-If too forceful = heat -If too deep, thin = cold Pregnancy the pulse should be clear slippery in both Kidney positions(and uterus position)

Principles of Treatment

1. ***Nourishing Kidneys (major treatment method)

2. Always treat Liver and Kidney for blood (LR is the root of woman)

3. Sooth Liver – main method for menstrual disorders

4. Strengthen Spleen/Stomach – common for woman’s disorders

Pulse

*1 day before menses and beginning of period - wiry, slippery - slippery, rapid

*During menses – forceful *Deep, retarded (delayed) – cold in Chong *Thin, rapid and late period – Heat *Big, empty and during menses – Qi (heavy bleeding will come)

Principle of Treatment: strengthen Qi to regulate blood

Pregnancy – blood and Yin accumulate - smooth, slippery (in Kidney position)

*Close to delivery – Labor will start soon- Kidney position becomes floating, rapid, rushing (like water) - seems to start under middle finger and go in both directions. Palpation – 6 months uterus @ umbilicus - 7 months uterus @ 3 fingers above umbilicus - 9 months uterus @ 2 fingers down from Xiphoid angle