CHAPTER 61 Excessive Vaginal Discharge

AETIOLOGY AND PATHOLOGY 814

IDENTIFICATION OF PATTERNS AND TREATMENT 815

Spleen deficiency 815

Kidney-Yang deficiency 817

Kidney-Yin deficiency 818

Damp-Heat 820

Toxic-Heat 822

Liver-Qi stagnation 823

Ancient acupuncture prescriptions for excessive vaginal discharge 824

Prescriptions by Fu Qing Zhu 825

PROGNOSIS AND PREVENTION 825

WESTERN VIEW 825

Vaginal discharge is called dai xia () in Chinese medicine, literally meaning ‘disease below the Girdle Vessel’. In old times, this term actually referred to all women’s diseases and it was therefore equivalent to ‘gynecology’, and the term dai xia yi meant ‘gynecologist’. Since the Sui dynasty (AD 581–618), this term has come to mean only ‘excessive vaginal discharge’.

A slight vaginal discharge that increases in volume and viscosity at mid-cycle is physiological and does not constitute a disease. If the discharge is excessive or other than colourless, or if its consistency is other than thin, and if it has an offensive smell, it then constitutes a pathological condition: thus, a pathological vaginal discharge implies a change in amount, colour, consistency or smell.

In Chinese medicine, the physiological vaginal discharge is produced, stored and secreted by the Kidneys; transformed and distributed by the Spleen; governed by the Directing Vessel (Du Mai); and controlled by the Girdle Vessel (Dai Mai).

Excessive Vaginal Discharge as a Chinese disease category has always had a predominant and important place in Chinese gynecology, compared with Western gynecology. The reason for this is probably that, in the absence of modern diagnostic means, the ancient Chinese doctors relied on the appearance of a vaginal discharge not only for diagnosis but also prognosis. In Western medicine, we know that an excessive vaginal discharge in most cases reflects a local pathology of the lower genital tract (such as vaginitis from Candida or Trichomonas infection). We also know that, in a few cases, an excessive vaginal discharge may be a symptom of uterine carcinoma and Western gynecology has the means to diagnose this.

In the old times, Chinese gynecologists would not have known that an excessive vaginal discharge from local vaginitis and one from uterine cancer had different pathologies: they did know, however, that some types of vaginal discharges are more serious and indicate a poor prognosis. For example, they differentiated between a vaginal discharge from Damp-Heat and one from Toxic-Heat, the latter denoting a worse prognosis. The ancient gynecologists also knew, for example, that a bloody discharge with pus occurring after the menopause indicates a very poor prognosis: this ties in completely with Western medicine as such a discharge often indicates the possible presence of uterine carcinoma. In conclusion, the careful and detailed observation of the pathology of vaginal discharge developed over centuries gave the ancient Chinese gynecologist very good diagnostic and prognostic means to differentiate between serious and mild conditions.

Aetiology and pathology

Irregular diet, excessive physical work

Excessive consumption of dairy foods, greasy foods and sugar often leads to the formation of Dampness: in women, this easily infuses downwards to the genital system to cause a vaginal discharge. Even if the patient does not consume excessive amounts of dairy or greasy foods, eating irregularly also leads to the formation of Dampness.

Excessive physical work weakens the Spleen which then fails to transform and transport fluids properly: these accumulate into Dampness, infuse to the genital system and cause an excessive vaginal discharge. After some years, Spleen-Yang deficiency leads to Kidney-Yang deficiency, so that the Kidneys cannot store and hold fluids, which leak out in the form of vaginal discharge.

Emotional strain

Worry, anger, irritation, frustration, guilt and resentment may all lead to stagnation of Liver-Qi; stagnant Liver-Qi invades the Spleen and impairs its transformation and transportation of fluids, leading to the accumulation of Dampness. When combined with Liver-Qi stagnation, Dampness may settle in the Liver channel which curls around the genitalia and causes an excessive vaginal discharge.

Overwork

Overwork for several years without adequate rest leads to Liver- and Kidney-Yin deficiency and to weakness of the Directing and Girdle Vessels which cannot hold Yin fluids: this causes an excessive vaginal discharge.

Invasion of external Dampness

External Dampness may invade the leg channels and flow up to settle in the genital system and cause an excessive vaginal discharge. Women are particularly prone to invasion of Dampness especially after childbirth and after each period. After some time, Dampness often combines with Heat to form Damp-Heat. Invasion of external Dampness leads to excessive vaginal discharge especially when there is a concurrent aetiological factor such as irregular diet.

After some time, Damp-Heat may turn into Toxic-Heat which is a more serious type of pathogenic factor and one that is often accompanied by a poor prognosis.

A pathological vaginal discharge must be differentiated in term of amount, colour, consistency and odour.

Amount

A profuse discharge is usually due to a deficiency of the Kidneys, while a white, sticky discharge usually reflects a Spleen deficiency.

Colour

As for colour, four colours are usually distinguished: white, yellow, red and green. A white discharge indicates Cold; yellow, red, or green discharges indicate Heat.

Consistency

A dilute, watery discharge indicates Cold or deficiency and a thick, sticky one denotes Heat or Dampness. A profuse red discharge, whether dilute or sticky, indicates deficiency of Yin with Damp-Heat.

Odour

An odour in general indicates Heat, as does a leathery smell, but a fishy smell may indicate Cold.

Thus, to differentiate between deficiency and excess, a light-coloured, thin, watery discharge without odour indicates deficiency (or Cold), while a dark, thick, dense discharge with an offensive odour indicates Fullness (or Heat). It is often difficult to judge the colour of a discharge because a white discharge usually stains the briefs yellow.

Red vaginal discharge should be differentiated from mid-cycle menstrual bleeding. A red vaginal discharge is sticky and usually smelly and it does not occur with periodicity. Mid-cycle menstrual bleeding occurs with regularity at monthly intervals, is not sticky or turbid, and generally does not have an offensive odour.

In terms of channels, vaginal discharges involve the Spleen, Liver and Kidney channels and, of the Extraordinary Vessels, the Directing and Girdle Vessels (Ren and Dai Mai). In fact, most authors say that the term dai in dai xia, meaning vaginal discharge, is related to the name of the Girdle Vessel, i.e. Dai Mai. When the Girdle Vessel is slack, Qi sinks and Dampness infuses downwards to the genital system causing a vaginal discharge: for this reason, vaginal discharges are a major indication for the use of this vessel. In this type of pathology, the Girdle Vessel is closely connected to the Directing Vessel as the former harmonizes the ascending and descending of Qi which affects the latter: for this reason, a pathology of the Girdle Vessel (being too slack) causes Qi to sink in the Directing Vessel with symptoms of a persistent vaginal discharge. The sinking of Qi in the Girdle Vessel is related to a Kidney deficiency, while the formation of Dampness is due to a Spleen deficiency.

Fu Qing Zhu says:

Excessive vaginal discharge is a Dampness pattern. It is called ‘dai’ due to the inability of the Girdle [Dai] Vessel to bind. The Girdle Vessel communicates with the Directing and Governing vessels and if these are diseased, the Girdle Vessel also is … The Girdle Vessel may be injured not only by falls, sprains or contusions, but also by excessive sexual activity or by excessive drinking of alcohol to the point of complete drunkenness.¹

The points used are its opening points G.B.-41 Zulinqi (on the right) and T.B.-5 Waiguan (on the left), and G.B.-26 Daimai, G.B.-27 Wushu and G.B.-28 Weidao.

Identification of patterns and treatment

The main deficiency pathology centres around Spleen or Kidney deficiency (which may be of Kidney-Yang or Kidney-Yin); the main Full pathology is Damp-Heat or Toxic-Heat. Thus, the treatment principle in deficiency conditions of the Spleen is to tonify, raise (Qi) and dry (Dampness); in deficiency conditions of the Kidneys, it is to tonify the Kidneys and consolidate the Directing Vessel. For Full conditions from Damp-Heat, the treatment principle is to clear (Heat) and transform (Water). For Toxic-Heat, the treatment principle is to drain (Fire) and resolve (Toxin).

Toxic-Heat or Damp-Heat are often accompanied by infestation of what the ancient Chinese called ‘parasites’ (chong ). ‘Parasites’ can cause various diseases in Chinese medicine: apart from the obvious intestinal parasites, tuberculosis (TB) of the lungs and certain types of vaginal discharges are caused by ‘parasites’. As for TB of the lungs, called zhai () or lao zhai (), the ancient Chinese doctors had perceptively understood that it was caused by some pathogenic living organisms which they called ‘parasites’, i.e. chong or lao chong. For example, Zhu Dan Xi (1281–1358) says: “In some syndromes there are parasites inside the Yin organs that bite the heart and lungs: this is called zhai disease.”²

The ancient Chinese doctors had also understood that such ‘parasites’ could be infectious. The Formulae to Aid the Living (1237) says:

Lao Zhai [i.e. tuberculosis] is a serious disease. Those who suffer from it can transmit it to each other; they can have it for many years and all the family members may die of it.³

In the case of vaginal discharges, according to the old doctors, some are caused by parasites (chong): again, the ancient Chinese doctors were very perceptive because we know from modern medicine that fungal or bacterial infections, spread through sexual contact, cause most vaginal discharges. In such cases, the treatment principle is to ‘kill parasites’ (sha chong ), i.e. eliminate bacteria or fungi with herbs that have an anti-bacterial or anti-fungal effect and the majority of which also kill parasites.

From a Western perspective, a vaginal discharge associated with abdominal pain may indicate pelvic inflammatory disease and most of the formulae for Toxic-Heat are particularly suitable to treat this condition.

The patterns discussed are:

• Spleen deficiency

• Kidney-Yang deficiency

• Kidney-Yin deficiency

• Damp-Heat

• Toxic-Heat

• Liver-Qi stagnation.

Spleen deficiency

Clinical manifestations

Excessive vaginal discharge that is white or slightly yellow, sticky, without smell and persistent, dull complexion, tiredness, depression, cold limbs, loose stools. Tongue: Pale with a sticky, white coating. Pulse: Weak and slightly Slippery.

This pattern is characterized not only by deficiency of Spleen-Qi or Spleen-Yang but also by sinking of Spleen-Qi: the persistent vaginal discharge, besides being a symptom of Dampness, is also a symptom of Spleen-Qi sinking.

Treatment principle

Strengthen the Spleen, tonify Qi, raise Yang, resolve Dampness.

Acupuncture

Ren-12 Zhongwan, ST-36 Zusanli, SP-3 Taibai, SP-6 Sanyinjiao, SP-9 Yinlingquan, BL-22 Sanjiaoshu, Du-20 Baihui, Ren-6 Qihai, Ren-3 Zhongji, BL-32 Ciliao, BL-20 Pishu. All with reinforcing method except for SP-9 and SP-6 which should be needled with even method. Moxa is applicable.

Explanation

– Ren-12, ST-36, SP-3 and BL-20 tonify Spleen-Qi or Spleen-Yang. Warming needle on ST-36 should be applied.

– SP-6 and SP-9 resolve Dampness from the Lower Burner.

– BL-22 promotes the transformation of fluids in the Lower Burner and helps to resolve Dampness.

– Du-20 raises Qi. It can be used with a moxa stick.

– Ren-6 tonifies Qi in general.

– Ren-3 and BL-32 resolve Dampness from the genital system.

Herbal treatment

a Prescription

– WAN DAI TANG

– Ending Vaginal Discharge Decoction

Explanation

This formula from Fu Qing Zhu’s Gynaecology is for white vaginal discharge.⁴ The dosages indicated are from the original textbook: I would personally reduce them by at least half. The formula is designed to tonify the Spleen strongly, resolve Dampness and pacify the Liver so that it does not overact on the Spleen and also so that it consolidates the Girdle Vessel.

– Bai Zhu, Shan Yao and Ren Shen tonify Spleen-Qi and Stomach-Qi.

– Bai Shao nourishes Blood, pacifies the Liver and, being astringent, will ‘absorb’ discharges.

– Cang Zhu, Che Qian Zi and Chen Pi resolve Dampness.

– Jing Jie, charred, stops bleeding and discharges.

– Chai Hu moves Liver-Qi.

– Gan Cao harmonizes.

b Prescription

– YI HUANG TANG

– Change Yellow Decoction

Explanation

This formula from Fu Qing Zhu’s Gynaecology is for yellow vaginal discharge with Spleen deficiency and Damp-Heat.⁵

– Shan Yao tonifies the Spleen and Stomach.

– Qian Shi is astringent and stops discharges.

– Huang Bo and Che Qian Zi resolve Damp-Heat.

– Bai Guo directs the other herbs to the Directing Vessel, as explained by Fu Qing Zhu.

Modifications

• If there is backache and symptoms of Kidney-Yang deficiency, add Du Zhong Cortex Eucommiae and Tu Si Zi Semen Cuscutae.

• If there is abdominal pain, add Xiang Fu Rhizoma Cyperi and Ai Ye Folium Artemisiae argyi.

• If the condition is chronic and the discharge a constant trickle, add Lu Jiao Shuang Cornu Cervi degelatinatum, Wu Zei Gu Endoconcha Sepiae, Qian Shi Semen Euryales, Long Gu Fossilia Ossis mastodi (fried) and Mu Li Concha Ostreae (fried).

Three Treasures remedy

– TONIFY QI AND EASE THE MUSCLES

This remedy is a variation of the formula Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction which tonifies and raises Qi. It is well suited to this condition of vaginal discharge from Qi deficiency and Dampness because it contains herbs that resolve Dampness. The tongue presentation appropriate to this remedy is a Pale body with a sticky, white coating.

Summary

Spleen deficiency

Clinical manifestations

Excessive vaginal discharge that is white or slightly yellow, sticky, without smell and persistent, dull complexion, tiredness, depression, cold limbs, loose stools. Tongue: Pale with a sticky, white coating. Pulse: Weak and slightly Slippery.

Treatment principle

Strengthen the Spleen, tonify Qi, raise Yang, resolve Dampness.

Acupuncture

Ren-12 Zhongwan, ST-36 Zusanli, SP-3 Taibai, SP-6 Sanyinjiao, SP-9 Yinlingquan, BL-22 Sanjiaoshu, Du-20 Baihui, Ren-6 Qihai, Ren-3 Zhongji, BL-32 Ciliao, BL-20 Pishu. All with reinforcing method except for SP-9 and SP-6 which should be needled with even method. Moxa is applicable.

Herbal treatment

Prescriptions

• WAN DAI TANG Ending Vaginal Discharge Decoction

• YI HUANG TANG Change Yellow Decoction

Three Treasures remedy

• TONIFY QI AND EASE THE MUSCLES

Kidney-Yang deficiency

Clinical manifestations

Profuse, white and dilute vaginal discharge resembling water or egg white, dizziness, tiredness, backache, frequent, pale urination, feeling cold. Tongue: Pale and wet. Pulse: Deep, Weak.

Treatment principle

Tonify and warm the Kidneys, consolidate the Directing Vessel, stop discharge.

Acupuncture

BL-23 Shenshu, Ren-4 Guanyuan, KI-13 Qixue, G.B. 26 Daimai, ST-36 Zusanli, SP-6 Sanyinjiao, KI-3 Taixi, Du-20 Baihui. All with reinforcing method; moxa must be used.

Explanation

– BL-23, with moxa cones, tonifies Kidney-Yang.

– Ren-4 and KI-13, with moxa cones, tonify Kidney-Yang and the Original Qi and consolidate the Penetrating Vessel.

– G.B.-26 consolidates the Girdle Vessel to stop vaginal discharge.

– ST-36, SP-6 and KI-3 tonify the Kidneys and Qi in general.

– Du-20 raises Qi. This is necessary to stop the vaginal discharge: a persistent, profuse vaginal discharge with the above symptoms indicates not only deficiency of Kidney-Yang but also sinking of Kidney-Qi in a way similar to and with the same pathology as the sinking of Spleen-Qi.

Herbal treatment

a Prescription

– NEI BU WAN

– Inner Tonification Pill

Explanation

– Lu Rong, Tu Si Zi, Rou Cong Rong and Sha Yuan Zi tonify and warm the Kidneys and consolidate the Essence.

– Huang Qi tonifies and raises Qi.

– Sang Piao Xiao is astringent and stops discharges.

– Rou Gui and Fu Zi warm the Kidneys and the Uterus.

– Bai Ji Li is probably included to regulate the ascending and descending of Qi in combination with Huang Qi. In fact, Huang Qi raises pure Qi while Bai Ji Li subdues ascending Yang: thus the combination of these two actions regulates the ascending and descending of Qi and therefore stops sinking of Qi.

– Zi Wan is probably included to regulate Qi in the chest so as to facilitate the ascending and descending of Qi between the Lower and Upper Burners.

Modifications

• If the patient has loose stools, remove Rou Cong Rong and add Bu Gu Zhi Fructus Psoraleae.

b. Prescription

– WU ZI YAN ZONG WAN Variation

– Five-Seed Developing Ancestors Pill Variation

Explanation

The first five herbs constitute the formula Wu Zi Yan Zong Wan which tonifies Kidney-Yang and consolidates the Essence. The dosages indicated are from the original source and are obviously those for a batch of pills. The dosages indicated of the last two herbs are daily dosages for a decoction.

– Tu Si Zi tonifies Kidney-Yang and consolidates the Essence.

– Wu Wei Zi, an astringent herb, nourishes and consolidates the Essence.

– Gou Qi Zi tonifies the Kidneys and the Essence.

– Fu Pen Zi, also astringent, tonifies Kidney-Yang and stops discharges.

– Che Qian Zi is added to clear any Heat deriving from tonification of Yang.

– Qian Shi, another astringent, is added to stop discharges.

– Ba Ji Tian tonifies Kidney-Yang.

Compared with the previous formula, the present one is more astringing than tonifying, while the former is much warmer in nature and its emphasis is on tonifying and warming the Kidneys. Another difference is that the former prescription, Nei Bu Wan, tonifies the Governing Vessel, while the latter, Wu Zi Yan Zong Wan, tonifies the Directing Vessel. Nei Bu Wan is therefore indicated when there are pronounced symptoms of Kidney-Yang deficiency, with backache, and of interior Cold.

c Prescription

– EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai⁶

Explanation

– Ba Ji Tian and Sang Ji Sheng tonify the Kidneys.

– Gui Zhi warms Yang.

– Huang Qi tonifies Spleen-Qi.

– Qiang Huo and Fang Feng resolve Dampness.

– Bai Shao harmonizes the Liver.

– Ban Xia and Chen Pi harmonize the Centre.

– Fu Ling and Fu Shen resolve Dampness.

– Zhi Gan Cao harmonizes.

Three Treasures remedy

– STRENGTHEN THE ROOT

This remedy is a variation of the formula You Gui Wan Restoring the Right [Kidney] Pill which tonifies and warms the Kidneys and strengthens the Governing Vessel. It is somewhat similar in action to the above formula Nei Bu Wan Inner Tonification Pill. The tongue presentation appropriate to this remedy is a Pale and wet body.

Summary

Kidney-Yang deficiency

Clinical manifestations

Profuse, white and dilute vaginal discharge resembling water or egg white, dizziness, tiredness, backache, frequent, pale urination, feeling cold. Tongue: Pale and wet. Pulse: Deep, Weak.

Treatment principle

Tonify and warm the Kidneys, consolidate the Directing Vessel, stop discharge.

Acupuncture

BL-23 Shenshu, Ren-4 Guanyuan, KI-13 Qixue, G.B.-26 Daimai, ST-36 Zusanli, SP-6 Sanyinjiao, KI-3 Taixi, Du-20 Baihui. All with reinforcing method; moxa must be used.

Herbal treatment

Prescriptions

• NEI BU WAN Inner Tonification Pill

• WU ZI YAN ZONG WAN Variation Five-Seed Developing Ancestors Pill Variation

• EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai

Three Treasures remedy

• STRENGTHEN THE ROOT

Kidney-Yin deficiency

Clinical manifestations

White vaginal discharge that is dilute in consistency and without odour, dizziness, tinnitus, five-palm heat, a feeling of heat in the evening. Tongue: without coating; Red if there is Empty-Heat. Pulse: Floating-Empty.

Treatment principle

Nourish Yin, strengthen the Kidneys, clear Heat, consolidate the Essence.

Acupuncture

Ren-4 Guanyuan, KI-13 Qixue, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), SP-6 Sanyinjiao, KI-3 Taixi, Du-20 Baihui. All with reinforcing method, no moxa.

Explanation

– Ren-4 and KI-13 nourish the Kidneys, strengthen the Directing Vessel and consolidate the Essence.

– LU-7 and KI-6 regulate the Directing Vessel and nourish Kidney-Yin.

– SP-6 and KI-3 nourish the Kidneys.

– Du-20 raises Qi. This point is added for the same reasons as for the previous two patterns, i.e. to raise Qi, stop Qi from sinking and stop discharges. In this case, it combines well with the opening points of the Directing Vessel, LU-7 and KI-6, to balance all the Yin points with a Yang one.

Herbal treatment

a Prescription

– ZUO GUI WAN

– Restoring the Left [Kidney] Pill

Explanation

This formula, already explained, nourishes Kidney-Yin.

b Prescription

– ZHI BO DI HUANG WAN Variation

– Anemarrhena-Phellodendron-Rehmannia Pill Variation

Explanation

The first eight herbs constitute the formula Zhi Bo Di Huang Tang, already explained, which nourishes Kidney-Yin and resolves Damp-Heat.

– Qian Shi and Jin Ying Zi are two astringent herbs that stop discharges and consolidate the Essence.

c Prescription

– EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai⁷

Explanation

This formula is for vaginal discharge from Kidney-Yin deficiency with Empty-Heat and Damp-Heat infusing downwards. It is therefore suitable when the tongue is Red and without coating in the centre, but with a thin, sticky yellow coating on the root.

– Dang Gui and Chai Hu pacify and regulate the Liver.

– Mu Li, Nu Zhen Zi, Shu Di Huang and Bai Shao nourish Yin.

– Chi Xiao Dou, Ren Dong Teng, Ze Xie and Che Qian Zi drain Damp-Heat.

– Mu Dan Pi clears Empty-Heat.

– Huai Niu Xi conducts Dampness downwards.

– Gan Cao harmonizes.

d Prescription

– BU GAN YI SHEN TANG⁸

– Tonifying the Liver and Benefiting the Kidneys Decoction

Explanation

The first six herbs constitute the formula Liu Wei Di Huang Wan Six-Ingredient Rehmannia Pill which nourishes Liver- and Kidney-Yin.

– Huang Bo resolves Damp-Heat from the Lower Burner.

– Bai Shao nourishes Yin.

– Wu Wei Zi nourishes Yin.

– Shen Qu promotes digestion.

Three Treasures remedy

– NOURISH THE ROOT

This remedy is a variation of the formula Zuo Gui Wan Restoring the Left [Kidney] Pill which nourishes Kidney-Yin. It is well suited to treat vaginal discharge from Kidney-Yin deficiency because it contains Lu Jiao Shuang, an ‘absorbent’ herb, and Shan Zhu Yu which is astringent.

Summary

Kidney-Yin deficiency

Clinical manifestations

White vaginal discharge that is dilute in consistency and without odour, dizziness, tinnitus, five-palm heat, a feeling of heat in the evening. Tongue: without coating; Red if there is Empty-Heat. Pulse: Floating-Empty.

Treatment principle

Nourish Yin, strengthen the Kidneys, clear Heat, consolidate the Essence.

Acupuncture

Ren-4 Guanyuan, KI-13 Qixue, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), SP-6 Sanyinjiao, KI-3 Taixi, Du-20 Baihui. All with reinforcing method, no moxa.

Herbal treatment

Prescriptions

• ZUO GUI WAN Restoring the Left [Kidney] Pill

• ZHI BO DI HUANG WAN Variation Anemarrhena-Phellodendron-Rehmannia Pill Variation

• EMPIRICAL PRESCRIPTION by Dr Zhang Jian Zhai

• BU GAN YI SHEN TANG Tonifying the Liver and Benefiting the Kidneys Decoction

Three Treasures remedy

• NOURISH THE ROOT

Damp-Heat

Clinical manifestations

Profuse yellow or brown discharge that is sticky in consistency and with an odour, loose stools. Tongue: sticky, yellow coating on the root with Red spots. Pulse: Slippery.

Treatment principle

Clear Heat, resolve Dampness.

Acupuncture

G.B.-41 Zulinqi (on the right) and T.B.-5 Waiguan (on the left), Ren-3 Zhongji, Ren-2 Qugu, G.B.-26 Daimai, SP-9 Yinlingquan, SP-6 Sanyinjiao, BL-33 Zhongliao, BL-22 Sanjiaoshu, BL-53 Baohuang, BL-30 Baihuanshu. All with reducing or even method, no moxa.

Explanation

– G.B.-41 and T.B.-5 regulate the Girdle Vessel which stops vaginal discharges. A persistent vaginal discharge, especially one from Damp-Heat, is considered to be due to a ‘slackening’ of the Girdle Vessel which allows Dampness to infuse downwards.

– G.B.-26 stops vaginal discharges and consolidates the Girdle Vessel. Ideally, the needling sensation should propagate towards the lower abdomen and even the genitals.

– Ren-3 and Ren-2 regulate the Directing Vessel and resolve Dampness.

– SP-9 and SP-6 resolve Dampness from the Lower Burner.

– BL-33 resolves Dampness and treats genital problems.

– BL-22 promotes the transformation of fluids in the Lower Burner and helps to resolve Dampness.

– BL-53 treats genital problems.

– BL-30 drains Damp-Heat from the lower genital system.

Herbal treatment

a Prescription

– BI XIE SHEN SHI TANG

– Dioscorea Draining Dampness Decoction

Explanation

– Bi Xie, Yi Yi Ren, Ze Xie, Fu Ling, Tong Cao, Hua Shi and Huang Bo drain Damp-Heat from the Lower Burner and the genito-urinary system.

– Mu Dan Pi clears Heat from the Liver channel.

b Prescription

– MIE DI ZHI YANG TANG⁹

– Killing Trichomonas and Stopping Itching Decoction

Explanation

This formula, almost the same as the previous one, is proposed by Dr Cong Chun Yun as specific for the treatment of infections from Trichomonas vaginalis. The dosages indicated are those proposed by Dr Cong, which I would personally reduce proportionally.

– Bi Xie, Huang Bo, Yi Yi Ren, Fu Ling, Ze Xie, Cang Zhu and Hua Shi drain Dampness from the Lower Burner.

– Mu Dan Pi clears Heat from the Liver channel.

– Zhi Mu clears Empty-Heat in the Lower Burner.

– He Shi kills parasites.

c Prescription

– ZHI DAI WAN

– Stopping Vaginal Discharge Pill

Explanation

– Zhu Ling, Fu Ling and Ze Xie resolve Dampness.

– Che Qian Zi, Yin Chen Hao, Huang Bo and Shan Zhi Zi resolve Damp-Heat.

– Chi Shao and Mu Dan Pi invigorate Blood and clear Heat. They also treat Liver channel Heat which might be causing the vaginal discharge.

– Niu Xi is a messenger herb to direct the formula to the Lower Burner.

d Prescription

– LONG DAN XIE GAN TANG

– Gentiana Draining the Liver Decoction

Explanation

This formula, already explained, drains Liver-Fire and resolves Damp-Heat from the Upper and Lower Burners. It is suitable when there are pronounced signs of Liver-Fire and the Damp-Heat in the genital system is related to the Liver channel. Thus, the main manifestations indicating the use of this formula are headaches, red eyes, red face, irritability, thirst, dark urine, constipation, a Red tongue with redder sides and a sticky, yellow coating, and a Wiry pulse.

e Prescription

– YI HUANG TANG

– Change Yellow Decoction

Explanation

This formula, already explained, is used if Damp-Heat is accompanied by Spleen and Kidney deficiency.

Table 61.1 illustrates the differences among the above four formulae (considering a and b as one).

Table 61.1 Comparison and differences among formulae for vaginal discharge from Damp-Heat

External treatment

a Prescription

– Ku Shen Radix Sophorae flavescentis 30 g

– Wei Ling Xian Radix Clematidis 15 g

– Dang Gui Radix Angelicae sinensis 15 g (‘tail’ only)

– She Chuang Zi Fructus Cnidii 90 g

– Jin Yin Hua Flos Lonicerae 90 g

Explanation

– Ku Shen drains Dampness and has an anti-fungal and anti-Trichomonas effect.

– Wei Ling Xian expels Wind-Damp.

– Dang Gui invigorates Blood.

– She Chuang Zi kills parasites.

– Jin Yin Hua resolves Toxic-Heat.

These herbs should be boiled for half an hour in 3–4 pints of water and the resulting liquid divided into three equal doses, to be used one per day. One dose is then diluted in cold water and is either applied to the vagina or poured into a shallow bath in which the woman should sit for 20 minutes. This external prescription is given by Dr Cong Chun Yun as a treatment for infection from Trichomonas vaginalis.¹⁰

b Prescription

– Jin Yin Hua Flos Lonicerae 90 g

– Huo Xiang Herba Pogostemonis 60 g

– She Chuang Zi Fructus Cnidii 90 g

– Tu Fu Ling Rhizoma Smilacis glabrae 90 g

Explanation

– Jin Yin Hua and Tu Fu Ling resolve Toxic-Heat.

– Huo Xiang resolves Dampness.

– She Chuang Zi kills parasites.

The above herbs are prepared in the same way as the previous formula except that the above dosages are for 1 week’s treatment, in which case the strained liquid should be kept in the fridge. This formula is proposed by Dr Cong Chun Yun as a treatment for infection from Candida.¹¹

Women’s Treasure remedy

– DRAIN THE JADE VALLEY

This remedy drains Dampness from the genital system and has an anti-fungal and anti-bacterial action. The tongue presentation appropriate to this remedy is a sticky, yellow coating that is thicker on the root.

Three Treasures remedy

– DRAIN FIRE

This remedy is a variation of the formula Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction: it drains Damp-Heat from the Lower Burner and specifically from the Liver channel in the genitals area. It is suitable for a sticky, yellow vaginal discharge occurring against a background of other Liver-Fire symptoms such as thirst, dry mouth, constipation and dark urine. The tongue presentation appropriate to this remedy is a Red body with redder sides and with a yellow coating on the root with Red spots.

Summary

Damp-Heat

Clinical manifestations

Profuse yellow or brown discharge that is sticky in consistency and with an odour, loose stools. Tongue: sticky, yellow coating on the root with Red spots. Pulse: Slippery.

Treatment principle

Clear Heat, resolve Dampness.

Acupuncture

G.B.-41 Zulinqi (on the right) and T.B.-5 Waiguan (on the left), Ren-3 Zhongji, Ren-2 Qugu, G.B.-26 Daimai, SP-9 Yinlingquan, SP-6 Sanyinjiao, BL-33 Zhongliao, BL-22 Sanjiaoshu, BL-53 Baohuang, BL-30 Baihuanshu. All with reducing or even method, no moxa.

Herbal treatment

Prescriptions

• BI XIE SHEN SHI TANG Dioscorea Draining Dampness Decoction

• MIE DI ZHI YANG TANG Killing Trichomonas and Stopping Itching Decoction

• ZHI DAI WAN Stopping Vaginal Discharge Pill

• LONG DAN XIE GAN TANG Gentiana Draining the Liver Decoction

• YI HUANG TANG Change Yellow Decoction

Women’s Treasure remedy

• DRAIN THE JADE VALLEY

Three Treasures remedy

• DRAIN FIRE

Toxic-Heat

Clinical manifestations

Profuse yellow, blood-stained or five-colour discharge that is sticky in consistency and with an odour, a feeling of heat, thirst, dark urine. Tongue: Red with a sticky, yellow or brown coating with Red spots. Pulse: Slippery and Rapid.

Treatment principle

Clear Heat, resolve Toxin, resolve Dampness, stop discharge.

Acupuncture

L.I.-11 Quchi, SP-9 Yinlingquan, SP-6 Sanyinjiao, Ren-3 Zhongji, Ren-2 Qugu, SP-10 Xuehai, KI-2 Rangu, LIV-3 Taichong. All with reducing or even method, no moxa.

Explanation

– L.I.-11 clears Heat and resolves Toxin.

– SP-9 and SP-6 resolve Dampness from the Lower Burner.

– Ren-3 and Ren-2 resolve Dampness from the genital system.

– SP-10, KI-2 and LIV-3 cool Blood.

Herbal treatment

a Prescription

– WU WEI XIAO DU YIN Variation

– Five-Ingredient Dissolving Toxin Decoction Variation

Explanation

All the ingredients of this formula resolve Toxic-Heat. This formula can treat acute or chronic pelvic inflammatory disease.

b. Prescription

– ZHI MEI JING YIN SAI JI¹²

– Anti-fungal Vaginal Cleansing Formula

Explanation

All the ingredients of this formula have an anti-parasitic and anti-fungal effect. This formula is best taken as a powder.

c Prescription

– PEN QIANG JIE DU TANG¹³

– Pelvic Eliminating Toxins Decoction

Explanation

– Hong Teng, Bai Jiang Cao, Pu Gong Ying and Tu Fu Ling resolve Toxic-Heat.

– Dan Shen, Mu Dan Pi and Chi Shao invigorate Blood and eliminate stasis.

– Yi Yi Ren drains Damp-Heat and resolves Toxic-Heat.

– Chuan Lian Zi moves Qi and eliminates stagnation.

– Gan Cao resolves Toxic-Heat.

This formula is suitable to treat chronic pelvic inflammatory disease from Toxic-Heat and stasis of Blood.

d Prescription

– PEN QIANG LING¹⁴

– Pelvis Efficacious [Formula]

Explanation

– Dang Gui nourishes and invigorates Blood.

– Chi Shao, Dan Shen, Yan Hu Suo and San Leng invigorate Blood and eliminate stasis.

– Xiang Fu and Wu Yao move Qi and eliminate stagnation.

– Hong Teng, Bai Jiang Cao and Gan Cao resolve Toxic-Heat.

This formula, like the previous one, is suitable to treat chronic pelvic inflammatory disease. It is similar to the previous formula, but it puts the emphasis on invigorating Blood rather than on resolving Toxic-Heat.

External treatment

Prescription

– She Chuang Zi Fructus Cnidii 15 g

– Ku Shen Radix Sophorae flavescentis 15 g

– Bai Bu Radix Stemonae 15g, Di Fu Zi Fructus Kochiae 15 g

– Bai Xian Pi Cortex Dictami 15 g

– Ming Fan Alumen 10 g

Boil these ingredients for half an hour, strain and pour into a shallow bath for the patient to sit in for 15 minutes.

Women’s Treasure remedy

– DRAIN THE JADE VALLEY

This remedy, already mentioned under the previous pattern, drains Dampness and resolves Phlegm from the genital system. The tongue presentation appropriate to this remedy is a sticky, yellow coating that is thicker on the root.

Summary

Toxic-Heat

Clinical manifestations

Profuse yellow, blood-stained or five-colour discharge that is sticky in consistency and with an odour, a feeling of heat, thirst, dark urine. Tongue: Red with a sticky, yellow or brown coating with Red spots. Pulse: Slippery and Rapid.

Treatment principle

Clear Heat, resolve Toxin, resolve Dampness, stop discharge.

Acupuncture

L.I.-11 Quchi, SP-9 Yinlingquan, SP-6 Sanyinjiao, Ren-3 Zhongji, Ren-2 Qugu, SP-10 Xuehai, KI-2 Rangu, LIV-3 Taichong. All with reducing or even method, no moxa.

Herbal treatment

Prescriptions

• WU WEI XIAO DU YIN Variation Five-Ingredient Dissolving Toxin Decoction Variation

• ZHI MEI JING YIN SAI JI Anti-fungal Vaginal Cleansing Formula

• PEN QIANG JIE DU TANG Pelvic Eliminating Toxins Decoction

• PEN QIANG LING Pelvis Efficacious [Formula]

Women’s Treasure remedy

• DRAIN THE JADE VALLEY

Liver-Qi stagnation

Clinical manifestations

Profuse white or yellow, sticky vaginal discharge without odour, hypochondrial pain, irritability, depression. Tongue: slightly Red on the sides. Pulse: Wiry.

This discharge is due partly to stagnant Liver-Qi invading the Spleen and impairing its transportation and transformation function, and partly to stagnation of the Liver channel in the genital system.

Treatment principle

Pacify the Liver, move Qi, eliminate stagnation, strengthen the Spleen.

Acupuncture

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, LIV-5 Ligou, SP-6 Sanyinjiao, ST-36 Zusanli, SP-9 Yinlingquan, BL-20 Pishu, BL-18 Ganshu, G.B.-26 Daimai, G.B.-41 Zulinqi (on the right) and T.B.-5 Waiguan (on the left). All with reducing or even method except for BL-20, ST-36 and SP-6 which should be needled with reinforcing method.

Explanation

– T.B.-6, G.B.-34 and LIV-3 pacify the Liver, move Qi and eliminate stagnation.

– LIV-5 pacifies the Liver and eliminates stagnation from the Liver channel in the genital system.

– BL-20, ST-36 and SP-6 tonify the Spleen.

– SP-9 resolves Dampness from the genital system.

– BL-18 moves Liver-Qi.

– G.B.-41 and T.B.-5 regulate the Girdle Vessel and resolve Damp-Heat.

– G.B.-26 consolidates the Girdle Vessel to stop vaginal discharges.

Herbal treatment

Prescription

– XIAO YAO SAN Variation

– Free and Easy Wanderer Powder Variation

Explanation

The first eight herbs constitute the formula Xiao Yao San which pacifies the Liver, moves Qi, eliminates stagnation, nourishes Blood and tonifies Spleen-Qi.

– Yi Yi Ren and Bian Dou resolve Dampness.

– Xiang Fu moves Qi and eliminates stagnation.

Women’s Treasure remedy

– FREEING THE MOON

This remedy pacifies the Liver, moves Qi, eliminates stagnation, tonifies Spleen-Qi, resolves Dampness and nourishes Liver-Blood. The tongue presentation appropriate to this remedy is a body that is slightly Pale on the sides.

Summary

Liver-Qi stagnation

Clinical manifestations

Profuse white or yellow, sticky vaginal discharge without odour, hypochondrial pain, irritability, depression. Tongue: slightly Red on the sides. Pulse: Wiry.

Treatment principle

Pacify the Liver, move Qi, eliminate stagnation, strengthen the Spleen.

Acupuncture

T.B.-6 Zhigou, G.B.-34 Yanglingquan, LIV-3 Taichong, LIV-5 Ligou, SP-6 Sanyinjiao, ST-36 Zusanli, SP-9 Yinlingquan, BL-20 Pishu, BL-18 Ganshu, G.B.-26 Daimai, G.B.-41 Zulinqi (on the right) and T.B.-5 Waiguan (on the left). All with reducing or even method except for BL-20, ST-36 and SP-6 which should be needled with reinforcing method.

Herbal treatment

Prescription

• XIAO YAO SAN Variation Free and Easy Wanderer Powder Variation

Women’s Treasure remedy

• FREEING THE MOON

Ancient acupuncture prescriptions for excessive vaginal discharge

1. From the ABC of Acupuncture, Zhen Jiu Jia Yi Jing (AD 259):

• For white vaginal discharge with infertility: BL-31 Shangliao.¹⁵

• For red and white vaginal discharge with a feeling of distension below the heart: BL-32 Ciliao.¹⁶

• For red vaginal discharge that is white at times, retention of urine from Qi stagnation and scanty periods: BL-33 Zhongliao.¹⁷

• For greenish vaginal discharge or incessant red vaginal discharge, with itching and pain of the vagina extending to the hypogastrium and inability to bend forward or backward: BL-34 Xialiao.¹⁸

2. G.B.-26 Daimai, Ren-4 Guanyuan, Ren-6 Qihai, SP-6 Sanyinjiao, BL-30 Baihuanshu, P-5 Jianshi (Great Compendium of Acupuncture, Zhen Jiu Da Cheng, 1601).¹⁹

3. For red and white vaginal discharge: G.B.-26 Daimai, Ren-4 Guanyuan, Ren-6 Qihai, SP-6 Sanyinjiao, BL-30 Baihuanshu, P-5 Jianshi (Miraculous Classic, Shen Ying Jing, 1425).

4. For red and white vaginal discharge: Ren-2 Qugu (seven moxa cones), LIV-3 Taichong, Ren-4 Guanyuan, KI-7 Fuliu, SP-6 Sanyinjiao and ST-25 Tianshu (100 moxa cones) (Collection of Acupuncture and Moxibustion, Zhen Jiu Ji Cheng, 1874).

5. For red and white vaginal discharge: Du-4 Mingmen, Ren-14 Shenjue and Ren-3 Zhongji, all with seven moxa cones (Illustrated Supplement to the Classic of Categories, Lei Jing Tu Yi, 1624).

Prescriptions by Fu Qing Zhu

The formulae used by Fu Qing Zhu for vaginal discharge are as follows.

– WAN DAI TANG²⁰

– Ending Vaginal Discharge Decoction (see above)

This is for white vaginal discharge due to Dampness and Spleen deficiency.

– JIA JIAN XIAO YAO SAN²¹

– Modified Free and Easy Wanderer Powder

– YI HUANG TANG

– Change Yellow Decoction (see above)

This formula is for yellow vaginal discharge from Damp-Heat with a background of Spleen and Kidney deficiency.

– LI HUO TANG²²

– Drain Fire Decoction

– QING GAN ZHI LIN TANG²³

– Clearing the Liver and Stopping ‘Lin’ Decoction

This formula is for red vaginal discharge from Damp-Heat and Liver-Fire.

Prognosis and prevention

Both acupuncture and herbal medicine are effective for excessive vaginal discharge but the results will definitely be slow because this condition can be very stubborn. Herbal medicine is more effective than acupuncture especially for the Full patterns because herbs are better at resolving Dampness and Toxic-Heat. The pattern from Toxic-Heat is the most difficult to treat and the one from Spleen deficiency and Dampness the easiest (or rather, least difficult).

A woman suffering from excessive vaginal discharge should definitely refrain from eating excessive amounts of dairy and greasy foods and sugar: in severe conditions, complete abstention from eating these foods would be recommended.

Western view

A slight vaginal discharge is physiological: this is clear in colour and consists of cervical mucus, vaginal transudate, bacteria and squamous epithelial cells. The physiological discharge varies in amount according to individual variations, pregnancy, sexual response and menstrual cycle (being thicker during mid-cycle). A physiological discharge will have no odour and will not be accompanied by itching or burning, and the vaginal pH will be normal (i.e. less than 5).

The possible causes of an excessive vaginal discharge are:

• infection/inflammation

• foreign body

• neoplasm (including cervical, endometrial or vaginal carcinoma)

• cervical erosion

• fistulae

• non-genital causes.

Infection can take place in the lower genital tract giving rise to vaginitis, or in the upper genital tract. The two main infections, from Candida albicans and Trichomonas vaginalis, are discussed in Chapter 62 on vaginal itching. Candidiasis is characterized by a thick, white discharge with itching but without odour. The presence of an odour suggests bacterial vaginosis, a fistula or a foreign body such as a tampon. A dark discharge may indicate a neoplasm, a foreign body or a fistula. An intra-uterine device may cause infection of the upper genital tract, but it may also cause a non-infectious, mucus, clear discharge.

Cervical erosion may be characterized by a mucoid discharge. Cervical carcinoma may manifest with a watery, dark, offensive discharge and endometrial carcinoma with a brown, watery, offensive discharge.

Non-genital causes of excessive vaginal discharge include urinary incontinence and urinary tract fistulae.

The sudden onset of a discharge suggests infection which can be associated with the end of a pregnancy, the contraceptive pill, a course of antibiotics or a new sexual relationship.

In 90% of cases, excessive vaginal discharge is caused by infection from one of three agents: Candida albicans, Trichomonas vaginalis and Gardnerella vaginalis. The first two are discussed in Chapter 62. Gardnerella vaginalis is a bacterial infection of the vagina which causes a foul-smelling, thin, greyish discharge, sometimes with tiny bubbles.

Another possible cause of vaginal discharge is infection with Chlamydia trachomatis which is classified as a bacterium but is actually an obligate intracellular parasite. Infection with Chlamydia is often symptomless but the long-term consequences of its untreated infection are potentially serious, including pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, infertility and perinatal transmission to infants. In the USA, 30–50% of cases of pelvic inflammatory disease are due to infection with Chlamydia. When symptoms do occur they may include a vaginal discharge, dysuria and lower abdominal pain.

The incidence of infection from Chlamydia in women with genito-urinary symptoms in the UK varies between 6% and 9%.

End notes

1.

Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology (Fu Qing Zhu Nu Ke ), Shanghai People’s Publishing House, Shanghai, p. 1. First published in 1827. Fu Qing Zhu was born in 1607 and died in 1684..

2.

Cited in Chinese Medicine Research Institute and Guangzhou College of Traditional Chinese Medicine 1980 Concise Dictionary of Chinese Medicine (Jian Ming Zhong Yi Ci Dian ), People’s Health Publishing House, Beijing, p. 983..

3.

Ibid., p. 414..

4.

Fu Qing Zhu’s Gynaecology, p. 2..

5.

Ibid., p. 4..

6.

Long Jiajun, Zhang Qi, Shen Kang, Lin Hongyang 1996 Dr Zhang Jian Zhai’s Experience in Treating Gynaecological Diseases (Zhang Jian Zhai Zhi Liao Fu Ke Bing Jing Yan), Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi ), China Academy of Traditional Chinese Medicine, Beijing, No. 1, p. 17..

7.

Ibid., p. 17..

8.

Cong Chun Yu 1994 Selection of Clinical Experiences in Chinese Medicine Gynaecology (Zhong Yi Fu Ke Lin Chuang Jing Yan Xuan ), Chinese Pharmacology Publishing House, Beijing, p. 146..

9.

Ibid., p. 144..

10.

Ibid., p. 144..

11.

Ibid., p. 145..

12.

Hu Xi Ming 1990 Great Treatise of Secret Formulae in Chinese Medicine (Zhong Guo Zhong Yi Mi Fang Da Quan ), Culture Publishing House, Shanghai, Vol. 2, p. 117..

13.

Ibid., p. 145..

14.

Ibid., p. 145..

15.

Shandong College of Traditional Chinese Medicine 1980 An Explanation of the ABC of Acupuncture (Zhen Jiu Jia Yi Jing Jiao Shi ), People’s Health Publishing House, Beijing, p. 1471. The ABC of Acupuncture was written by Huang Fu Mi c. AD 259..

16.

Ibid., p. 1471..

17.

Ibid., p. 1471..

18.

Ibid., pp 1471–1472..

19.

Heilongjiang Province National Medical Research Group 1984 An Explanation of the Great Compendium of Acupuncture (Zhen Jiu Da Cheng Jiao Shi ), People’s Health Publishing House, Beijing, p. 1107. The Great Compendium of Acupuncture itself was published in 1601..

20.

Fu Qing Zhu’s Gynaecology, p. 2..

21.

Ibid., p. 3..

22.

Ibid., p. 5..

23.

Ibid., pp 6–7..