Chapter 1　Introduction

Gynecology in Chinese Medicine （CM） is a clinical science comprising the theories and techniques of Chinese medicine to treat and prevent diseases of the female reproductive tract. It includes female anatomy and physiology, as well as the etiology and pathogenesis of gynecological diseases and the process of diagnosis and treatment.

Women and men have the same viscera, qi and blood, and channels, and their functions are basically the same. However, women have a uterus, ovaries and breasts governing the physiological functions of menstruation, pregnancy, childbirth and breast-feeding, as well as the diseases related to them.

Gynecology in Chinese Medicine is often divided into two parts: general discussion and specific discussion. General discussion refers to the basic theory, which covers the anatomy and physiology of the female reproductive organs, etiology, pathogenesis, diagnosis, patern diferentiation, and therapeutic principles. Specifc discussion refers to the diagnoses and treatments of diseases related to menstruation, leukorrhea, pregnancy, the postpartum period, and other miscellaneous gynecologic diseases.

Gynecology in Chinese medicine has been established, enriched and improved over time with the development of traditional Chinese medical sciences. This can be described in several stages.

During this early stage, there are only scatered records associated with obstetrics and gynecology:

The development of Gynecology in Chinese medicine began with special attention to childbearing. For example, Records of the Grand Historian— Annals of the Xia Dynasty （ ShĭJì— Xià Běn Jì, 史记·夏本纪） states that Gun （鲧）’s wife was Xiu Ji （修己）…her chest split open and out came Yu （禹）. Jian Di （简狄） cut her chest open and she gave birth to Qi （契）, the forefather of the clan.”

Records have been found in The Book of Songs （ Shī Jīng, 诗经） which state that “Near the square of the east gate, lú rú （Oldenlandia umbellata） grows on the slope of hill”; “in the valley, there is yì mŭ căo （Herba Leonuri）, which can be dried in the sun.” In A ChineseBestiary （ Shān Hăi Jīng, 山海经）, there are also records about herbs being used for the purpose of bringing about fertilization and contraception. A saying goes that “There were birds… on hills of green trees, with green body, red eyes and red tail, eating it brings on pregnancy”; “on Bozhong Mountain…there were grasses with leaves like spikes and roots like jié gĕng （Radix Platycodonis）,…eating it causes infertility.”

Records found in Biographies of Exemplary Women （ Liè Nǚ Zhuàn, 列女传） says that “Tai Ren （太任）, whom Wang Ji （王季） married as the imperial concubine…, when she was pregnant, her eyes didn’t see bad color, her ears didn’t hear ugly sounds, her mouth didn’t speak proud words. She was good at carrying out prenatal education, and gave birth to King of Wen （文王）.”

（1） The Inner Classic （ Nèi Jīng, 内经）, the first great medical work, established the theoretical basis for traditional Chinese medicine. It records the basic theories of women’s menstrual physiology, pathology, and diagnosis of pregnancy, as well as medication principles, etc. It explains the basic laws of growth and development of the female, as well as their senescence or the aging process. It recognizes the important roles of kidney qi and reproduction stimulating essence （ tiān guĭ, 天癸） in female reproductive physiology, and records the frst gynecological formula, Sì Wū Zéi Gŭ Yī Lú Rú Wán （Four Cutlebone and One Indian Madder Root Pill, 四乌鲗骨一藘茹丸）.

（2） Text on Fetus and Labor （ Tāi Chăn Shū, 胎产书）, is the earliest specialized work on obstetrics and gynecology. It expresses views on healthy practices during each month of pregnancy, as well as the care of the fetus during pregnancy and labor.

（1） Bian Que: Bian Que was a famous physician during the Warring States Period. It is recorded, “Bian Que was well known in the world. When he passed by Handan, he heard that women were respected there; and he came to be a dài xià yī （gynecologist, 带下医）.”Thus, we have the beginning of gynecology in Chinese Medicine.

（2） The earliest women doctors, called rŭ yī （obstetrician, 乳医）, were Yi Ju （义姁） and Chun Yu-yan （淳于衍）. They provided medical care for women living in the imperial harem. Records state that they performed abortions using medicinals, and also surgically removed dead fetuses.

In Essentials from the Golden Cabinet—Women’s Three Chapters （ Jīn Guì Yào Lüè—Fù RénSān Piān, 金匮要略·妇人三篇）, there are specifc chapters on gynecological clinical practice discussing disease patterns and treatment of pregnancy related nausea and abdominal pain, postpartum fever, heat invading the blood chamber, vaginal discharge, amenorrhea, and abdominal mass （ zhēng jiă, 癥瘕） etc. It also recommends the external treatment of vaginal irrigation and insertion of medicinals into the vagina. Many formulas, such as WēnJīng Tāng （Menstruation-Warming Decoction, 温经汤）, Guì Zhī Fú Líng Wán （Cinnamon Twig and Poria Pill, 桂枝茯苓丸）, Dāng Guī Sháo Yào Săn （Chinese Angelica and Peony Powder, 当归芍药散） etc. are included in this book and are still used in clinical practice today.

The Pulse Classic （ Mài Jīng, 脉经） is the frst book that describes the typical pregnancy pulse and abnormally rapid/slow pulse during labor. It says: “The pulse in the chi region, if pressed unceasing, indicates pregnancy.” “The abnormal pulse of the pregnant woman doesn’t necessarily indicate a disease. If the pulse is floating and the abdominal pain radiates to the lower back, delivery is soon to be expected. That’s to say, when a pregnant woman is going to deliver the baby, her pulse becomes abnormal. If she feels abdominal pain at midnight, the delivery will occur during the following day.”

The Treatise on the Origins and Manifestations of Various Diseases （ Zhū Bìng Yuán Hòu Lùn,诸病源候论）, represented a giant step forward in Chinese Medicine Gynecology based on what was stated in Essentials from the Golden Cabinet （ Jīn Guì Yào Lüè, 金匮要略）.

Detailed monthly fetal development is recorded in the book, Methods of MonthlyFetal Nourishment （ Zhú Yuè Yăng Tāi Fă, 逐月养胎法）. It states, “During the frst month of pregnancy, embryo development begins; in the second month, fat develops; and during the third month, the fetus starts to develop. During the fourth month, the fetus takes form; the fifth month, the baby can move; and during the sixth month, tendons and bones are developed. During the seventh month, hair is present; the eighth month, the viscera or internal organs are complete; and in the ninth month, qi of food essence enters the stomach. In the tenth month, the spirit and mind are ready. When the due date arrives, there will be delivery of the fetus.”

This stage is mainly marked by the establishment of medical institutions and the recognition of academic works.

The Imperial Medical Bureau was established during the Tang Dynasty. It was the foremost and most renowned medical institution of learning at that time, and cultivated especially talented physicians. During the Song Dynasty, the Bureau of the King’s Honorary Physician was established. It was divided into nine departments, the Department of Obstetrics and Gynecology being one of them. This was the earliest specialized Department of Obstetrics and Gynecology.

（1） Important Formulas Worth a Thousand Gold Pieces （ Qiān Jīn Yào Fāng, 千金要方） by Sun Si-miao, described pregnancy, the fetus and labor in the initial volume and paid special atention to female diseases.

（2） The book, Arcane Essentials from the Imperial Library （ Wài Tái Mì Yào, 外台秘要）, by Wang Tao comprises 40 volumes, among which gynecology accounts for two volumes. The content of these is comprehensive and complete, including 85 disease paterns and more than 480 formulas and discussions.

（3） Precious Book on Childbirth （ Chăn Băo, 产宝）, also referred to as Valuable Experiencein Obstetrics （ Jīng Xiào Chăn Băo, 经效产宝）, by Zan Yin is the first extant obstetric text. It contains three volumes and includes 41 disease patterns and more than 260 formulas, each with brief discussions on the diagnosis and treatment. Topics covered are common pregnancy related diseases, difficulty during labor, and postpartum diseases, including emergency treatment of postpartum fainting due to hemorrhage.

（4） The Complete Compendium of Fine Formulas for Women （ Fù Rén Dà Quán Liáng Fāng,妇人大全良方） by Chen Zi-ming is the most complete specialized work of obstetrics and gynecology written during the Song Dynasty. It gives a comprehensive coverage of gynecology and obstetrics from theory to clinical practice. It was the first text to put forward the view that “Women are based on blood.” This book promoted the development of obstetrics and gynecology and exerted a great infuence in later generations.

The establishment of independent programs and the emergence of monographs on obstetrics and gynecology during this era signifes the complete formation of gynecology in Chinese medicine.

The four great physicians of the Jin Dynasty and the Yuan Dynasty represented the medical schools. They developed gynecological theory and clinical practice from many and various aspects.

His work, A Collection of Writings on the Mechanism of Disease, the Suitability of Qi, and theSafeguarding of Life as Discussed in the ‘Basic Questions’ （ Sù Wèn Bìng Jī Qì Yí Băo Mìng Jí, 素问病机气宜保命集） paid special atention to the physiological functions of the kidney, liver, and spleen of women of diferent ages, based on their diferent physiological characteristics. It states, “The disorders occurring between childhood and the time prior to the arrival of the reproduction-stimulating essence （ tiān guĭ, 天癸） are mostly caused by a dysfunction of the foot shaoyin kidney channel （KI）. The illnesses appearing afer the reproduction-stimulating essence has arrived are mostly a result of a disorder of the foot jueyin liver channel （LV）. The diseases that occur afer the reproduction-stimulating essence is exhausted belong to a disorder of the foot taiyin spleen channel （SP）.” That is why, when treating the diseases of young girls, special atention should be paid to the kidney; in reproductive age women, the liver; and in older women, the spleen.”

The founder and representative of the school of the Theory of the Spleen and the Stomach stressed “earth is the mother of all things”. He stated the views that “Internal damage of the spleen and the stomach can give rise to all types of diseases.” He frequently applied the methods of supplementing the spleen, boosting qi, staunching bleeding, raising yang, removing dampness and arresting vaginal discharge, etc. in gynecological practice. This brings about good therapeutic efects in treating the diseases of profuse uterine bleeding and pelvic disorders, etc. In addition, he put forward the view that profuse vaginal bleeding is caused by kidney water and yin deficiency being unable to guard the ministerial fre of the uterine collaterals, so the blood fows out, causing hemorrhage. This is of great significance in treating various menstrual diseases and metrorrhagia.

Holding the view point that “Yang is ofen excessive, while yin is ofen insufcient” and that the best method of regulating pregnancy was “clearing heat and nourishing blood”, Zhu Dan-xi advised that the optimal herbs for preventing miscarriage were huáng qín （Radix Scutellariae） and bái zhú （Rhizoma Atractylodis Macrocephalae）.

In Further Discourses on the Acquisition of Knowledge through Profound Study （ Gé Zhì YúLùn, 格致余论）, he said that only when yin and yang fuse, can the embryo form and be planted in the uterus. He vividly described the shape of the uterus with one lower end and two branches at the upper end extending to both sides.

Contributions of Zhang Zi-he to gynecology include diagnostic methods, which are of instructive signifcance. He proposed that “whatever gynecological diseases the patient has, frst inquire as to her menstrual conditions. Whenever treating women’s diseases, do not casually use herbs with the functions of breaking qi and moving blood, in case of possible pregnancy. Whenever coming across postpartum diseases, inquire as to whether the lochia is excessive or scanty. This is most important for treatment in gynecology. ”

During this time, many gynecological monographs and well-known gynecologists emerged. Some signifcant gynecological theories were put forward and developed.

During the Ming Dynasty:

a. Wan Quan （万全） （Mi Zhai, 密斋）:

Essentials of Great Inheritance （ Guăng Sì Jì Yào, 广嗣纪要）, Wan’s Gynecology （ Wàn Shì FùRén Kē, 万氏妇人科）

b. Xue Ji （薛己） （Li Zhai, 立斋）:

Essentials of Gynecology （ Nǚ Kē Cuō Yào, 女科撮要）, Corrections and Annotations to FineFormulas for Women （ Jiào Zhù Fù Rén Liáng Fāng, 校注妇人良方）

c. Wu Zhi-wang （武之望）:

A Compendium of Female Disorders （ Jì Yīn Gāng Mù, 济阴纲目）

d. Zhang Jing-yue （张景岳）:

The Complete Works of [ Zhang] Jing-yue （ Jĭng Yuè Quán Shū, 景岳全书）

During the Qing Dynasty:

a. Fu Qing-zhu （傅青主）:

Fu Qing-zhu’s Gynecology （ Fù Qīng Zhŭ Nǚ Kē, 傅青主女科）

b. Xiao Shen-zhai （肖慎斋）:

Profound Scholarship in Gynecology （ Nǚ Kē Jīng Lún, 女科经纶）

c. Shen Yao-feng （沈尧封）:

A Summary of Gynecology （ Nǚ Kē Jí Yào, 女科辑要）

d. Chen Xiu-yuan （陈修园）:

The Important Meaning of Gynecology （ Nǚ Kē Yào Zhĭ, 女科要旨）

e. Wu Qian （吴谦）:

Golden Mirror of the Medical Tradition （ Yī Zōng Jīn Jiàn, 医宗金鉴）

f. Ji Zhai Ju Shi （亟斋居士）:

Compilation of Achieving the Living （ Dá Shēng Piān, 达生编）

（1） In Essentials of Great Inheritance （ Guăng Sì Jì Yào, 广嗣纪要）, Wan Quan advocated improving birth outcome and child development. He said, “To have a child, the male should be calm with little desire, so as to nourish his sperm; the female should have a tranquil mind and qi to nourish her blood. He also listed for the frst time the fve types of women, who are not suitable for marriage and pregnancy, that is, fve types of female sterility （ wŭ bù nǚ, 五不女）.

（2） In the Grand Compendium of Materia Medica （ Bĕn Căo Gāng Mù, 本草纲目）, Li Shi-zhen gave descriptions of menstruation and explained menstrual periodicity, with the theory of the correspondence between man and nature. He said, “Women belong to the category of yin and have blood as their basis. Their blood corresponds to the greater yin （ tài yīn, 太阴） of the moon in the upper and sea tide in the lower. Since the moon waxes and wanes, while the tide changes with morning and evening, menstruation happens each month accordingly, so it is called monthly water （ yuè shuĭ, 月水）, monthly signs （ yuè xìn, 月信） or monthly rhythm （ yuè jīng, 月经）…Women’s menstruation occurs normally once a month. If it is early or late, unobstructed or obstructed, it is abnormal. However, there are still some exceptions that the ancients did not mention and are considered normal. For example, some women have vicarious menstruation （ nì jīng, 逆经）, which includes bleeding from the mouth, the nose, the ears or the eyes. Some women experience latent menstruation （ àn jīng, 暗经）. They do not menstruate all their life, but they can conceive a child.”

（3） In Ataining Full of Life （ Dá Shēng Piān, 达生篇）, there are six true words describing women in labor, which are sleep, pain bearing, and slow lying in.