CHAPTER 63 Prolapse of the Uterus
Prolapse of the uterus is always due to Spleen-Qi or Kidney-Qi sinking and it therefore always occurs against a background of Spleen or Kidney deficiency.
Aetiology and pathology
Excessive physical exercise
Excessive physical exercise or sports over a long period of time injures the muscles and leads to Spleen-Qi deficiency. Excessive lifting over a long period of time injures the Kidneys. In both these cases, Spleen- or Kidney-Qi deficiency easily progresses to Qi sinking which causes the prolapse.
Chronic illness
A prolonged illness inevitably leads to a deficiency of the Spleen and/or Kidneys: if this turns into Qi sinking, it causes a prolapse.
Identification of patterns and treatment
The pathology of prolapse of the uterus is always due to Qi deficient and sinking: this may be Spleen-Qi, Kidney-Qi or both. It should be noted that a prolapse of the uterus can cause clinical manifestations even when it is very slight. Symptoms include a feeling of bearing down in the lower abdomen and frequent urination.
From an acupuncture perspective, apart from the Spleen and Kidneys, three Extraordinary Vessels are involved in the pathology of prolapse of the uterus: the Governing, Directing and Girdle Vessels. The Governing and Directing Vessels run along the midline of the body, one Yang, one Yin in nature. As the uterus is centrally located, a weakness of these two vessels may cause a prolapse.
For this reason, a combination of Governing and Directing Vessel points is particularly effective to treat prolapse of the uterus, e.g. Du-20 Baihui and Ren-6 Qihai. The Girdle Vessel is also involved in prolapses because it is the belt that ‘binds’ the lower abdominal organs: when the belt is too slack, the organs sag and prolapses may occur (see Ch. 7). For this reason, points from the Girdle Vessel, such as G.B.-28 Weidao, are also used for uterine prolapse.
Spleen-Qi sinking
Clinical manifestations
Prolapse of the uterus, a feeling of bearing down in the lower abdomen, tiredness, loose stools, poor appetite, depression. Tongue: Pale. Pulse: Weak.
Acupuncture
Du-20 Baihui, Ren-12 Zhongwan, Ren-6 Qihai, ST-36 Zusanli, SP-3 Taibai, BL-20 Pishu, G.B.-28 Weidao, Zigong (extra point). All with reinforcing method, moxa is applicable.
Explanation
Herbal treatment
Three Treasures remedy
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. The tongue presentation appropriate to this remedy is a Pale body.
Spleen-Qi sinking
Clinical manifestations
Prolapse of the uterus, a feeling of bearing down in the lower abdomen, tiredness, loose stools, poor appetite, depression. Tongue: Pale. Pulse: Weak.
Acupuncture
Du-20 Baihui, Ren-12 Zhongwan, Ren-6 Qihai, ST-36 Zusanli, SP-3 Taibai, BL-20 Pishu, G.B.-28 Weidao, Zigong (extra point). All with reinforcing method, moxa is applicable.
Kidney-Qi deficient and sinking
Clinical manifestations
Prolapse of the uterus, frequent urination, a bearing-down feeling in the lower abdomen, backache, depression. Tongue: Pale. Pulse: Deep, Weak.
Acupuncture
Du-20 Baihui, Ren-6 Qihai, ST-36 Zusanli, KI-3 Taixi, BL-23 Shenshu, G.B.-28 Weidao, Du-1 Changqiang, Ren-5 Shimen. All with reinforcing method, moxa is applicable.
Explanation
Herbal treatment
a Prescription
b Prescription
Explanation
Kidney-Qi deficient and sinking
Prolapse of the uterus, frequent urination, a bearing-down feeling in the lower abdomen, backache, depression. Tongue: Pale. Pulse: Deep, Weak.
Ancient acupuncture prescriptions for prolapse of the uterus1
Prognosis and prevention
Both acupuncture and herbal medicine give good results in uterine prolapse. Often, acupuncture alone is enough. However, the prognosis depends on the degree of prolapse (see below). First-degree prolapse can be helped, second-degree prolapse is difficult to treat and third-degree prolapse will not respond to treatment.
Women who have a very slight prolapse or who have been cured of a prolapse should pay great attention to not exercising too much and, in particular, to not running (jogging) or lifting. They should also make sure that they do not overwork and alternate work with periods of rest lying down.
Western view
Prolapse of the uterus develops as a result of weight-bearing during pregnancy and the trauma of delivery. The decrease in oestrogen associated with the menopause is also a factor as this decrease causes a weakening of pelvic tissues.
Prolapse of the uterus is classified in three degrees:
In the early stages, prolapse consists only in an elongated cervix which may reach up to 10 cm in length (instead of a normal 3 cm).
When the striated muscular support of the vaginal canal is weakened by childbirth, coughing, lifting, straining, etc., there may be a marked descent of the anterior vaginal wall and of the base of the bladder, creating a cystocele; if the rectum bulges forward it gives rise to a rectocele. A cystocele will cause a characteristic bearing-down sensation and frequency or incontinence of urine. A rectocele will cause an uncomfortable sensation in the rectum and constipation (see Fig. 63.2)
), Henan Science and Technology Publishing House, p. 458..