Preface to the Second Edition
I finished writing the first edition of Obstetrics and Gynecology in Chinese Medicine in 1997. Now, 13 years later, I have had the chance to treat many more women and to appreciate even more how effective Chinese medicine is in treating gynecological problems.
The main features of the second edition of this text compared to the first are as follows:
As for the first edition, I have chosen to name the gynecological conditions in the traditional Chinese way, for example ‘Painful Periods’ rather than ‘Dysmenorrhoea’, ‘Flooding and Trickling’ rather than ‘Metrorrhagia’, ‘Heavy Periods’ rather than ‘Menorrhagia’, ‘No Periods’ rather than ‘Amenorrhoea’, etc. Please note that these are disease entities (which I call ‘disease-symptoms’) in Chinese medicine although not in Western medicine. For example, in Western medicine, ‘painful periods’ is not a disease but a symptom; endometriosis is a ‘disease’ which could cause the symptom of painful periods.
A Chinese gynecologist would always diagnose the disease before diagnosing the pattern. Diagnosing the disease (e.g. Flooding and Trickling) is called bian bing while diagnosing the pattern is called bian zheng. It may be argued by some that diagnosis of the (Chinese) disease is not that important because we treat according to patterns. This is not so for two main reasons. The first is that one should be clear about the disease being treated. For example, a woman might complain of ‘heavy periods’ and we might diagnose ‘Flooding and Trickling’ when, on close observation, she suffers from ‘Mid-Cycle Bleeding’. Second, simply treating according to pattern is not enough. For example, the Blood stasis occurring in ‘Flooding and Trickling’ is treated differently (and therefore with different formulae) than the Blood stasis in ‘Painful Periods’. Even more so, the Blood stasis in ‘Abdominal Masses’ is treated very differently than the Blood stasis in ‘Painful Periods’.
As in all my other texts, the acupuncture points given under each pattern are not combinations of points (with a few exceptions) but a range of points from which the practitioner can choose. Whenever points do form a combination, it is called ‘Ancient Prescription’. The principles of combination of points is discussed at length in The Channels of Acupuncture.
The reader should be alerted to the fact that some of the formulae contained in this book may contain substances that are illegal in certain countries, either because they are protected species of plants or animals or because the substance is deemed to be toxic (in some cases wrongly so). The reader is therefore urged to familiarize himself or herself with the laws governing the use of herbs (and minerals and animal products) of their particular country. The prescriptions containing potentially illegal substances have been retained in this book for two reasons. First, since the book is sold all over the world, laws governing the use of such substances vary from country to country; for example, the use of Fu Zi Radix Aconiti lateralis preparata is illegal in Europe but not in the USA. Second, the formulae have been given as they appear in old and modern Chinese books to highlight the thinking and treatment strategy behind a particular formula. Once we understand the rationale of a formula’s composition, we are in a position to modify it by making substitutions for some of its ingredients. If we did not know the original ingredients, we could not make a rational substitution.
For example, if a formula contains Fu Zi Radix Aconiti lateralis preparata we know that it is meant to heat the body strongly and expel Cold and so, should we decide to eliminate Fu Zi from the formula, we need to substitute another herb (or possibly more than one) in a dose that is high enough to mimic the action of Fu Zi. In this example, Rou Gui Cortex Cinnamomi would be a possible substitution. Another example is that of Quan Xie Buthus Martensi (scorpion): a formula that contains this animal product is meant to have a strong Wind-extinguishing action and, if we want to replace it, we know that we need to use a herb (or possibly more than one) that has a similar strong action.
On the subject of toxicity and the law regulations, I would like particularly to draw attention to Mu Tong and Aristolochia. There are several species that are called ‘Mu Tong’ in Chinese (and some of them are not Aristolochia, e.g. Akebia) and the use of Aristolochia is not allowed in Europe due to its alleged renal toxicity. As there has been an exceptional level of attention dedicated to this herb following cases of renal toxicity, I strongly advise practitioners against using this herb (in any country). Indeed, authorities are so strict on this that they do not allow the use of any herb called ‘Mu Tong’ even if it not Aristolochia (e.g. Caulis Akebiae) due to the possibility of mistaken identification. Again, the reason this herb has been retained in the old formulae is to allow the practitioner to make a rational substitution. In particular, a frequent substitution for Mu Tong is Tong Cao Medulla Tetrapanacis.
The material in this book is gathered from many old and modern Chinese texts, from the teaching of various Chinese teachers and from my own experience. Whenever I write something that reflects my experience, I make that clear by saying ‘according to my experience’. The two main texts used as sources are Gynaecology in Chinese Medicine by Cong Chun Yu (Zhong Yi Fu Ke Xue) 1989 Ancient Chinese Medicine Texts Publishing House, Beijing, and Luo Yuan Kai’s Gynaecology in Chinese Medicine (Zhong Yi Fu Ke Xue) 1986 Shanghai Science and Technology Press, Shanghai.
Please note that the dosages indicated in the herbal prescriptions are those from the original texts. In my practice, I generally use low dosages and certainly lower than those used in modern China. For example, my dosages for a decoction range generally from 3 to 9 grams per herb daily whereas doctors in China tend to use 10 grams or usually more. Thus, whenever a source does not specify the dosages within a prescription, I have indicated the dosages that I would use.
Compared to the first edition, I have removed all Chinese patent remedies due to the unverifiable quality controls of Chinese patent remedies.
Finally, each chapter includes the differentiation of the disease-symptom discussed in Western medicine: e.g. the possible causes of painful periods in Western medicine. Of course, this is not intended to replace a good book on Western gynecology (some are mentioned in the bibliography): it is simply meant to provide the practitioner in a clinical setting with a quick check list of the possible Western causes of that particular symptom. This is important because we should know when to refer a patient to a Western gynecologist for a further diagnosis.
For example, a patient may come to us presenting with post-menopausal uterine bleeding and we should know when to suspect uterine carcinoma. Another reason for familiarizing ourselves with the Western differentiation of symptoms is prognosis. Although Chinese medicine is excellent at providing not only a diagnosis but also a reasonable prognosis by carefully examining symptoms, signs, tongue and pulse, in many cases the prognosis depends also on the Western diagnosis; it makes a considerable difference to prognosis, for example, if excessive uterine bleeding is merely functional or is caused by a large myoma.
The last 13 years of practice (since the publication of the first edition) have confirmed to me even more the importance of a Western diagnosis in many gynecological conditions, e.g. breast lumps (possible breast cancer), uterine bleeding (possible myoma), painful periods (possible endometriosis), amenorrhoea (possible polycystic ovary), etc.