Chapter 6　Gynecological Disease Prevention and Women’s Health Care

As women’s bodies undergo many changes during the menstrual cycle, and during and after pregnancy, they are vulnerable both to internal imbalance and attack by external pathogens. For this reason, attention to health care particularly during menstruation and pregnancy and after delivery, is extremely important. Chinese medicine attaches great importance to the policy “Prevention comes first” to safeguard women’s reproductive health and avoid the occurrence of disease.

In preparation for and during the menstrual period, the sea of blood （the chong mai） is abundant. Qi and blood flow downward to the uterus （the blood chamber） and it opens to allow menstruation. This makes it very easy for the pathogens to enter and to invade the body.

During this time, the balance of qi and the blood is somewhat disordered. Women’s moods may be unsteady; and their physical resistance to diseases may be somewhat decreased. Inappropriate behavior at this time may allow the development of disease. Thus, during the menstrual period, the following advice should be followed.

Avoiding External Pathogens: During the menstrual period, women should be careful not to get chilled, or to get wet in the rain, or to sit on cold damp ground. Sex, and vaginal douches are generally not advised, neither is swimming.

This is because during this time, the blood chamber is open, yin and blood flows downward. Wei qi or defensive qi is weakened since the loss of blood means decreased qi overall. Pathogens will take the opportunity to invade causing cold diseases including, dysmenorrhea, menstrual irregularity or vaginal discharge.

Proper Diet: During the period, it is advisable for women to stick to light, nutritious foods. Eating too much pungent, spicy, and cold foods or having an excessive intake of alcohol during the menstrual period can affect the normal discharge of menstrual blood. Excessive pungent and spicy foods or alcohol can lead to consumption of yin; and the consequent heat in the blood leads to heavy menstrual flow and other possible menstrual disorders. Excessive cold foods can cause blood coagulation and stagnation in the vessels, leading to dysmenorrhea and a scanty flow.

Regulating Emotions: During menstruation, yin blood flows downward; and thus the liver blood becomes deficient, a situation which can give rise to hyperactivity of liver yang and excessive emotional fluctuations.

Excessive imbalance of the emotions can play a part in the development of menorrhagia, dysmenorrhea or amenorrhea. Therefore, it is important that women should try to regulate their emotions. It is best to rest well and try to remain calm and peaceful and avoid upsetting or tense situations. Any measures to help prevent excessive irritability, melancholy, or fear should be encouraged.

Avoiding Overstrain: During the menstrual period, qi flows out, and is consumed with the loss of menstrual blood. Therefore, strong exercise and heavy labor should not be undertaken. Excessive exertion during the period might result in heavy bleeding or spotting if the qi is unable to control the menstrual flow.

After conception, the yin blood of a woman moves down to the uterus to nourish the fetus. This results in a relative predominance of qi in chong and ren mai.

At the very beginning, the fetus is very vulnerable. Due to these special physical changes, the woman should pay much attention to the following aspects in order to protect the fetus and herself, avoiding an imbalance of yin and yang and pregnancy conditions caused by pathogens.

Avoidance of Sexual Intercourse

Sexual intercourse should be cautioned against in the early and late stages of pregnancy. It is thought that consumption of the kidney essence by sexual activity can lead to a disturbance of the origin of the fetus, which may lead to fetal restlessness, vaginal bleeding, miscarriage or premature birth. It also can risk the introduction of infections.

Proper Balance between Work and Leisure

Pregnant women should be advised to regulate their lifestyle. Getting enough sleep is very important. （although over-sleeping may cause qi stagnation）. Proper exercising, especially during the middle and late stages of pregnancy, will help in the movement of qi and blood and ease the delivery of the baby. Not carrying heavy things and exercising physical caution at all times to avoid the possibility of a fall which may harm the baby is advised. Clothing should be loose so that the abdomen and the breasts are not constrained too tightly.

Proper Diet

During pregnancy, it is important to pay attention to spleen and stomach function, and to maintain regular bowel function. Light and nourishing foods, which are easy digestible, are good choices for the pregnant woman. She should eat a proper amount of food daily, neither too much nor too little, nor restrict food choices too much. Inadequate nutrition can have serious consequences for the development and future health of the baby.

Eating too much cold food may hurt the original qi of the fetus whereas eating too much hot food may easily cause fetal restlessness and vaginal bleeding.

Eating too much fatty food may damage the spleen and stomach qi, and the baby may grow larger than normal creating difficulty with the birth. During the later stages of pregnancy, over-salty food should not be eaten in order to avoid edema and polyhydramnios （excessive liquid in the uterus）. The drinking of alcoholic drinks and smoking cigarettes should be avoided altogether.

Using Proper Medicines

Despite the fact that most people believe there is no harm in taking herbs, any medicinals should be taken with great caution and following strict prescribing rules especially during the early stages of pregnancy.

Any toxic medicinals, as well as those that move qi and blood or promote urination, are forbidden during pregnancy.

Fetus Education

Traditional TCM texts remind pregnant women to pay attention to what is called “prenatal influence”. By this is meant the influence of the mothers’ emotions and behavior on the growing fetus. Soft music and gentle emotions are an ideal to be aspired to during pregnancy.

Periodical Health Checks

As soon as a woman suspects that she may be pregnant, she needs to go to the clinic for a pregnancy test for confirmation and once pregnancy is confirmed a number of routine health checks and blood tests will be done.

TCM doctors will advise the patient to avoid using certain medicinals or to try and avoid contracting a cold pathogen. They will advise the patient on a proper diet as explained above. After seven months of pregnancy, nipple protection guidance should be given. This includes the nipple cleaning, massaging and the prevention of nipple cracks. First apply moisturizing lotion or cream to the nipple after cleaning it with warm boiled water. Then gently massage the nipple, making the skin thick to increase resilience and friction resistance.

Regular check-ups monthly and then weekly are important for a problem-free pregnancy, a healthy mother and baby and a safe delivery. Any symptoms arising concerning the mother or the fetus during the pregnancy should be investigated immediately by the doctor or antenatal clinic.

The pregnant woman and her family will want to make preparations for the delivery of the baby as the due date approaches.

Knowledge of Pregnancy and Childbirth

Childbirth, or delivery, is a normal and natural phenomenon. Pregnant women should have guidance and instruction from professionals like midwives who will answer all questions and make useful suggestions as to how to make the delivery process more comfortable and easier for all concerned, as well as dispelling any fears and doubts of the mother and those around her.

Requirement of Delivery Room

The delivery room should be tidy, clean, comfortable and quiet, to provide a pleasant place for delivery.

Conserving Energy

When contractions begin, the woman should stay calm and be prepared, as much as possible, to bear some pain.

To avoid a difficult delivery, the laboring woman should not start to push too soon, but follow the three steps of “sleep, pain bearing, slow lying in” stated in Attaining Full of Life （ DáShēng Piān, 达生篇）, which are very helpful.

As labor progresses, uterine contractions become more frequent and stronger. The patient may or may not suffer severe abdominal pain, depending on her level of tolerance for pain, her stamina, and other factors. Therefore, special care and support in necessary at this time.

Observing the Process of Delivery

Attending midwives or doctors need to pay strict attention to the delivery process, monitoring the uterine contractions closely. They will listen to the fetal heart beat, record the time of rupture of the membrane, and measure the blood pressure of the patient. It is better for the process to proceed as naturally as possible without medical intervention and not take action too early or unnecessarily

Assistance in Delivery

When the vaginal orifice opens, the woman will feel acute pain in the local area and the lumbar region and the abdomen, as the qi suddenly descends. The woman should be guided to control the pressure during contractions once the baby’s head is out, and follow the doctors or midwives directions.

After Delivery Attention on the Baby

After the delivery, if there is suffocation, the baby’s respiratory tract should be checked immediately in order for him or her to breathe and to cry.

The doctors need to attend to the cutting of the umbilical cord next. There is a saying in Important Formulas Worth a Thousand Gold Pieces for Emergency （ Bèi Jí Qiān Jīn Yào Fāng, 备急千金要方） that states “Everyone is forbidden to ask whether the baby is a girl or a boy.”This is to protect and to avoid any negative influence on the mother’s emotions at this time. If she is upset it may cause abnormal bleeding.

Delivering the Placenta

Once the placenta leaves the uterus completely, the doctors should check to see whether the placenta and the fetal membranes have been completely discharged, leaving no traces behind in the mother.

Reducing Bleeding

Sometimes 10 u of oxytocin may be used intramuscularly to help complete delivery of the placenta and stop uterine bleeding.

The doctors should deal with the wound （a tear or an episiotomy） quickly to reduce the bleeding.

At the same time, vaginal bleeding should be continually monitored.

Total recovery of all the organs of the mother’s body, （with the exception of the breasts）takes a long time and the next 6 to 8 weeks （known as the childbed period） is an important time of rest and care. The new mother is deficient in yin and blood after the delivery and the blood chamber is open as it discharges the lochia. The lying-in mother is vulnerable to external disease and should consider the following advice.

Moderate Temperature

The house of the new mother should have fresh air circulating and be of a moderate temperature. During summer she should wear light clothes and at all times she should avoid wind and cold pathogens by staying out of drafts.

Moderate Rest and Work

The lying-in woman should have enough sleep. Early- or over-exercising may lead to persistent lochia and a prolapse of the uterus.

Controlled Diet

Since qi and the blood were both consumed when delivering the child, the lying-in woman needs optimum nutrition to generate breast milk to feed the baby. Foods that are nutritious and easily digestible should be eaten often. Foods that are cold or that contain too much fat, spices, or salt can damage the spleen and the stomach and should be avoided. Pleasant Emotions

Since anger or anxiety may cause qi stagnation, abdominal pain, and a lack of breast milk for the baby, the lying-in woman should try to maintain a steady mood.

Cleanliness

Tears or episiotomy sutures in the vagina and perineum need to be disinfected and carefully attended to. Since the blood chamber is open and is discharging lochia, pathogens can enter easily. Pads should be changed often.

After the recovery of any tears or cuts, warm boiled water should be used to wash the vaginal area.

The lying-in woman can start to breast-feed the infant 30 minutes after delivery. The period of lactation usually lasts anywhere from 12 to 24 months. Supplementary food can be given to the infant when he/she is six months old. The mother’s breast milk is the best food for a baby because of its nutritional content, which is easily digestible, and contains antibodies to pathogens. In order to ensure successful lactation, the new mother should pay attention to the following suggestions.

Cleaning of the Breast Prior to Feeding

The mother’s nipples and areola should be cleaned with warm water before feeding the baby, especially the first time. This is to protect the baby from ingesting any pathogens. At the same time, the mother needs to wash her hands well prior to feeding. Massaging the breast is important to avoid blocked ducts or mammary abscess. If there is a wound on the breast, measures to clean and disinfect it must be taken immediately.

Correct Lactation Method

When the baby is suckling on the breast, the mother should rest on her side or be sitting in a chair. There is no need for scheduled breast feeding, just attend to the requirements of the baby’s needs. A period of 10 to 15 minutes per breast is optimum.

The baby suckling for too long a time may lead to a soreness of the nipples. Be sure to empty the breast of its milk completely each time to ensure sufficient milk for the next feeding.

Menopause is a period when female make the physical transition from prosperity to decline. In this period, kidney qi is declining, tiān guĭ （reproduction-stimulating essence）is becoming exhausted, and the ren and chong mai are deficient. Women’s reproductive functions have greatly decreased and menstruation has ended. Bodily degeneration is quite obvious. At this time, women tend to lose balance of yin and yang, as a result they tend to develop menopausal syndrome and gynecological tumors can easily become malignant.

（1） Hygiene Publicity and Education

It is important to educate all women about the natural physiological process of menopause to relieve unnecessary worries and fears. In addition, we should be more understanding and caring to females in their menopausal period. Menopause is the time when tumors tend to develop. Periodical examinations to detect breast cancer and carcinoma and timely treatment of nipple discharge and irregular vaginal bleeding or profuse leucorrhea are all very important.

（2） Necessary exercises

Women in menopause should avoid staying at home all day and should be positive about participating in community activities. They also should take appropriate exercises to stay healthy and age without becoming feeble. Activities and exercises create a diversion of attention and can help women get smoothly through the perimenopausal period.

（3） Regular daily schedule and habits

In this period, women should keep regular living habits and prevent the invasion of external pathogens. They should adjust their diets by avoiding the ingestion of food that is acrid, dry or dissipating.

（4） Good mood and moderate sex

Women should be relaxed and happy, and avoid getting angry. They should be moderate in their sex life to preserve the spirit during menopause.