9/18/16

Four broad mechanisms that lead to

most gynecological disorders
The Five Stagnations
in Gynecology 1.  Insufficient blood affects the regularity and
volume of menses.
2.  Insufficient qi or yang fails to contain blood
and fluids or leads to cold that impedes the flow
Jill Blakeway, DACM, L.Ac. of blood.
3.  Blood heat causes the blood to move
frenetically outside the vessels.
4.  Stagnation of qi or blood or fluids leads to
obstruction of the free flow of the menstruate.

What is the difference between

stagnation, depression, The Six Stagnations of Zhu Dan-xi
constraint & stasis?
yù = Constraint or Depression Qi
Often specific to the liver, or has an emotional
Fire Blood
component.
zhì = Stagnation
Often more general or referring to stagnation Stagnations
unrelated to the liver.
yū = Stasis
Food Damp
Often refers to a condition where there is a
component of blood stasis.
Phlegm

Liu Wan-su’s The Five Stagnations

Theory of Similar Transformation
Qi

1.
Evil qi will Food Blood
2.
Life is 3. become
qi Qi is Guest qi FIRE Stagnations
warm matches
host qi
Phlegm Damp

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Yue Ju Wan(Escape Restraint Pill) Ban Xia Xi Xin Tang (Pinelliae

Treats each of the five stagnations
plus the resulting heat
•  Cang Zhu (Rz. Atractylodes)
•  Chuan Xiong (Rz. Chuanxiong)
•  Xiang Fu (Rz. Cyperi)
•  Zhi Zi (Fr. Gardeniae)
•  Shen Qu (Massa Medicata Fermentata)
Decoction to Drain the Epigastrium)
How addressing stagnation in the middle jiao can
treat a GYN disorder in the lower jiao.
•  Zhi Ban Xia (Rz. Pinelliae Preparatum)
•  Gan Jiang (Rz. Zingiberis)
•  Huang Qin (Rx. Scutellariae)
•  Huang Lian (Rz. Coptidis)
•  Ren Shen (Rx. Ginseng)
•  Da Zao (Fr. Jujube)
•  Zhi Gan Cao (Rx. Glycyrrhizae Preparata)

Sample Acupuncture Prescriptions

The take home…
to Move GYN Stagnation
•  To move liver qi and calms the heart Of the six stagnations, qi
Zhu Dan-xi identified 6
HT7, GB 34, LV14, Ren17 stagnations stagnation leads to stagnation
of blood, phlegm, damp and
•  To move blood in the lower jiao “10,000 illnesses all food (all of which are yin
start with Yu” substances)
Ren9, Ren4, SP6, SP10, LI4
•  To move damp in the lower jiao
Ren5, SP9, LU7, KI7, SP3, 13 According to Liu Treat stagnation
Wan-su’s Theory Zhu Dan-xi’s where you find it
•  To move damp-heat in the lower jiao of Similar formula Yue Ju to correct the
Ren5, SP9, LV8, LI11, LV5 Transformation – Wan treats all six ascending and
Evil Qi will stagnations descending
become fire mechanism of qi

Qi Stagnation: PMS
PMS Possible Causes and Cofactors
A recurring cyclic cluster of physical and behavioral v  Elevated estrogen
symptoms, developing 7-14 days prior to v  Estrogen/progesterone imbalance
menstruation (during the luteal phase) and v  Elevated prolactin
dissipating when menstruation or the follicular
phase begins. Symptoms are only present during v  Hormone allergy
the luteal phase. v  Hypoglycemia
(McPhee & Papadakis, 2010) v  Vitamin B6 deficiency
v  Lowered neurotransmitters
Beyond Xiao Yao Wan (and the 4 gates!)…. v  Stress
v  Family history of PMS

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Chinese Medical Etiology Xiao Yao Wan

(Free Wanderer Powder)
Deficiency Stagnation
of yang or of Qi and or
qi Blood Chai Hu (Bupleuri Radix)
Dang Gui (Angelicae Sinensis Radix)
Leads to Leads to Bai Shao (Paeoniae Radix Alba)
stagnation or weak yang Bai Zhu (Atractylodis Macrocephalae Rh)
of qi or qi
Fu Ling (Poria)
Bo He (Mentha H)
stagnation fluid Sheng Jiang (Zingiberis RH)
of blood accumulation
Gan Cao (Glycyrrhizae Radix)
or fluids
Deficiency of yang or qi
Leads to stagnation of qi
Which leads to stagnation of blood or fluids.
Or
Stagnation of qi and/ or blood
Leads to weak yang or qi
Leading to fluid accumulation.
Si Ni San Dao Shui Fu Ling Tang (Poria
(Frigid Extremities Powder) Decoction to Drain Water)

Fu ling (Poria Rubra) Zi Su Ye (Fol. Perillae)

Chai Hu (Rx. Bupleuri)
Ze Xie (Rz. Alismatis) Deng Xin Cao (Medulla Junci)
Bai Shao (Rx. Paeoniae Lactiflorae) Bai Zhu (Rz. Atractylodis) Chen Pi (Per. Citri Reticulatae)
Zhi Shi (Fr. Citri seu Ponciri Immaturus) Mu Gua (Fr. Chaenomelis) Mu Xiang (Rx. Aucklandiae)
Gan Cao (Rx Glycyrrhizae Uralensis) Bing Lang (Sm. Arecae) Sha Ren (Fr. Amomi)
Mai Men Dong Sang Bai Pi (Cx. Mori)
(Rx. Ophiopogonis) Da Fu Pi (Per. Arecae)

Wen Dan Tang Developing a Point

(Warm the Gallbladder Decoction) Prescription for PMS
Look for the root stagnation in this patient
Ban Xia (Rhizoma Pinelliae Ternatae)
Eg. Epigastric stagnation PC6, R13, SP4
Chen Pi (Pericarpium Citri Reticulatae)
Identify the kind of stagnation and treat the cause
Fu Ling (Sclerotium Poriae Cocos)
Damp stagnation SP3, SP9, R6
Zhu Ru (Caulis Bambusae in Taeniis)
Qi stagnation LV3, LI4, ST36
Zhi Shi (Fructus Citri seu Ponciri Immaturus)
Treat the manifestations of stagnation
Sheng Jiang (Rhizoma Zingiberis)
For breast tenderness LV3, R17, PC6
Gan Cao (Radix Glycyrrhizae Uralensis)
Headache LI2, LI4, R6
Da Zao (Fructus Zizyphi Jujubae)

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PMS: The take home… Blood Stagnation:

Dysmenorrhea
PMS symptoms are Damp stagnation is a factor in Primary dysmenorrhea

often caused by many PMS symptoms such as Normal menstrual cramps that are recurrent
deficiency of qi and breast tenderness, fatigue,
yang as well as cloudy mind, weight gain and and are not due to other diseases

stagnation clumsiness Secondary dysmenorrhea
Pain that is caused by a disorder in the woman's
PMDD is often reproductive organs, - endometriosis,
Don’t forget caused by adenomyosis, uterine fibroids, or infection (PID)
Look beyond about Ban Xia Xi stagnation of
Xiao Yao Wan Xin Tang
cervical stenosis.
and the 4 gates! blood and
(or Si Ni San) phlegm with heat
from stagnation

What Causes the pain? Dysmenorrhea in TCM

•  Uterine contractions Stagnation of blood is always a branch

Due to excessive prostaglandin production diagnosis.
•  Passing clots Look for the root!
•  Structural abnormalities •  Trauma, cold, heat
•  Diet and lifestyle exacerbate the pain •  Qi stagnation, qi deficiency
•  Deficiency of blood, yin or yang

The relationship between Wen Jing Tang

cold and blood stagnation (Menses Warming Formula)
Ren Shen (Ginseng Radix)
Warmth moves and Dang Gui (Angelicae Sinensis Radix)
cold stops movement. Chuan Xiong (Chuanxiong Rhizoma)
Bai Shao (Paeoniae Radix Alba)
That means that warming can be a helpful Niu Xi (Achyranthis Bidentatae Radix)
part of any general prescription for pain from E Zhu (Curcumae Rhizoma)
stagnation. Rou Gui (Cinnamomi Cortex)
Mu Dan Pi (Moutan Cortex)
Gan Cao (Glycyrrhizae Radix)

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Shao Fu Zhu Yu Tang Regulating the cycle

(Lower Abdomen Stasis Expelling Formula) to treat dysmenorrhea
Dang Gui (Angelicae Sinensis Radix) •  During the menses (days 1 - 7) - Move qi and
Chi Shao (Paeoniae Radix) blood and relieve pain.
Chuan Xiong (Chuanxiong Rhizoma)
SP10, LI4, LV3, R4, SP6
Xiao Hui Xiang (Foeniculi Fructus)
Gan Jiang (Zingiberis Rhizoma) •  After the menses (days 8 - 21) - Supplement
Rou Gui (Cinnamomi Cortex) qi and nourish blood.
Yan Hu Suo (Corydalis Rhizoma) KI3, ST36, Zi Gong Xue, R3, R4
Wu Ling Zhi (Trogopteri Faeces) •  Before the menses (days 22 - 28) - Move qi to
Pu Huang (Typhae Pollen) prevent stagnation.
Mo Yao (Myrrha) ST36, LI4, LV3, SP6, DU20

Endometriosis Endometriosis Symptoms

The presence of endometrial
tissue outside the uterus.
Two types:
• Pigmented (bleeding)
• Non - pigmented (not bleeding)
•  Often asymptomatic
•  Dysmenorrhea
•  Dyspareunia
•  Painful bowel movements
•  Painful urination
•  Menorrhagia or menometrorrhagia
•  Infertility
•  Other
(fatigue, diarrhea, constipation, bloating or nausea,
especially during menstrual periods).

Causes of Endometriosis The most common patterns I observe in

my patients with endometriosis

•  Retrograde menstruation
•  Embryonic cell growth Root
deficiency Stagnant Heat from
•  Post-surgical scars qi, blood
of Spleen stagnation
•  Cell transport qi and/ or or (which may
•  Immune dysfuction Kidney phlegm/ rise)
yang. damp

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Xiao Zheng Fang

Days 25 - 4
(Concretion Dispersing Formula)
Use blood moving herbs
Menstrual Formula (days 25 – 4)
Ji Xue Teng (Spatholobi Caulis)
Acupuncture San Leng (Sparganii Rhizoma)
E Zhu (Curcumae Rhizoma)
SP6, R4, SP8, SP10, Bai Liao, LV8, LI 4, PC5,
Mu Dan Pi (Moutan Cortex)
abdominal ashi (ST28, ST29, SP12, SP13)
Dan Shen (Salviae Miltiorrhizae Radix)
Moxa Chi Shao (Paeoniae Radix Rubra)
Tao Ren (Persicae Semen)
Zhi Ke (Qiao) (Aurantii Fructus)
Fu Ling (Poria)
Bai Zhu (Atractylodis Macrocephalae Rhizoma)

HuoJjing Zhong Zi Fang (Quicken the

Days 5 - 24 Channels to Plant Seeds Decoction)
Tonify qi and yang, move qi and supplement
Post Menstrual Formula for
blood Endometriosis (days 6 – 28)
Dang Gui (Angelicae Sinensis Radix)
Chai Hu (Bupleuri Radix)
Acupuncture
Dan Shen (Salviae Miltiorrhizae Radix)
KI3, St36, SP6, DU20, R3, R4, Zi Gong Xue, Yin Bai Shao (Paeoniae Radix Alba)
Tang Fu Ling (Poria)
Moxa Bai Zhu (Atracrylodis Macrocephalae Rhizoma)
Zhi Ke (Qiao) (Aurantii Fructus)
Gan Cao (Glycyrrhizae Radix)

Dysmenorrhea and Endometriosis. Damp Stagnation:

The take home… Chronic Pelvic Inflammatory Disease
PID is caused by a bacterial infection
in the upper female genital tract.
Stagnation of blood is Warmth moves and cold stops There are 3 main ways that an infection can occur.
always a branch movement. That means that
warming can be a helpful part 1.  From the lower genital tract to the upper: Often from
diagnosis. Look for the of any general prescription for sexually transmitted bacterias, but also from
root! pain from stagnation gynecological procedures such as insertion of IUD,
D&C, abortion and endometrial biopsy.
2.  From infection of surrounding organs: Infection of
In fact warmth Non-pigmented When treating the bladder, appendix or other surrounding organs can
moves so well endometriosis is endometriosis also lead to Pelvic Inflammatory Disease
that you may more likely to give blood
need less blood 3.  From transfer of bacteria through the circulatory or
cause infertility moving herbs
movers – think because of the during the lymphatic system: Bacteria from the respiratory
Wen Jing Tang. presence of damp menses. system such as pneumonia can travel through the body
and cause PID.

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Chinese Medicine’s View on the

The Three Stages of PID
Etiology of Chronic PID
Deficiency of External evils
righteous qi (hot or cold) Early stage, acute PID
•  Damp-heat-toxin
Evils accumulate in the lower jiao
and obstruct the qi dynamic, Leading to qi
and blood stagnation obstructing the
Chong and the Ren. Middle stage, chronic PID
Damp-heat and blood stagnation
The qi and blood stagnation, combined with the
external pathogen, causes damp stagnation, Late stage, chronic PID
which can become damp-heat due to stagnation. Spleen qi and yang vacuity with
All of which is exacerbated by underlying spleen qi qi and blood stagnation and
deficiency (which leads to more damp) or kidney yang either damp-heat or damp-cold
vacuity (which leads to more blood stagnation).

Late Stage, Chronic PID Treatment Wan Dai Tang

Strategy in Order of Priority (Discharge Ceasing Decoction)
1. Treat the underlying deficiency For PID with underlying Spleen Qi Vacuity
Ren Shen (Rx Ginseng)
Spleen qi vacuity
Shan Yao (Rh. Dioscoreae)
Kidney yang vacuity Bai Zhu (Rh. Atractylodis Macrocephalae)
2. Treat the stagnation Bai Shao (Rx Paeoniae Alba)
Qi stagnation Chai Hu (Rx. Bupleuri)
Blood stagnation Cang Zhu (Rh Atracylodis)
Chen Pi (P. Citri)
Damp stagnation
Che Qian Zi (S. Plantaginis)
3. Clear heat and toxicity (if appropriate) Jing Jie (H. Schizonepetae)
Gan Cao (Rx. Glycyrrhizae)

Nei Bu Wan Liu Jun Zi Tang

(Internal Supplementation Pill) (Six Gentlemen Decoction)
For PID with underlying kidney yang vacuity To support the spleen, if the patient is
Lu Rong (Cervi Cornu) receiving antibiotic treatment.
Tu Si Zi (S. Cuscutae) Ren Shen (Rx Ginseng)
Sha Yuan Zi (S. Astragali) Bai Zhu (Rh. Atractylodis Macrocephalae)
Rou Cong Rong (H. Cistanches) Fu Ling (Poria)
Rou Gui (C. Cinnamomi) Gan Cao (Rx. Glycyrrhizae)
Huang Qi (Rx. Astragali) Chen Pi (P. Citri)
Ci Ji Li (Fr. Tribuli) Ban Xia (Rh. Pinelliae)
Sang Piao Xiao (Ootheca Mantidis)
Zhi Fu Zi (Rx. Aconite preap.)
Zi Wan (Rx Asteris)

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Vaginal Douche for Chronic PID Acupuncture for Chronic PID

Hong Teng 15g (Caulis Sargentodoxae) •  Open the Dai, Ren and or Chong
Bai Jiang Cao 15g (Herba Patriniae) GB41, SJ5, LU7, KI6, PC6, SP4
Pu Gong Ying 15g (Herba Taraxaci) •  Support the spleen and kidney
Ru Xiang 6g (Gummi Olibani) KI7, SP3, ST36, R6
Mo Yao 6g (Myrrh) •  Move blood and qi
San Leng 5g (Rhizoma Sparganii) SP10, LV5, SP6
E Zhu 5g (Rhizoma Curcumae )
•  Clear damp and heat
Mu Dan Pi 3g (Cortex Moutan)
LV8, SP9, ST44
Cook the herbs in water to make a 100ml thick
decoction and use as a retained douche (retain •  Local points
for 20 minutes 1 x a day) Zi Gong Xue, R3, R4
•  Moxibustion

Chronic PID. The take home…
PID is the most common
cause of female infertility
and ectopic pregnancy.
About 1 million women a
year suffer from it
Phlegm Stagnation:
Polycystic Ovarian Syndrome (PCOS)
Early stage = Damp-heat-toxin The Rotterdam Criteria
Middle stage = Damp-heat and Two out of three of the following
blood stagnation
Late stage = Spleen qi and yang
vacuity with qi and blood biochemical signs of
stagnation and either damp-heat hyper-androgenism
or damp cold

Chronic PID is Chronic PID If there is ongoing PCOS

resistant to responds best to a antibiotic treatment
antibiotic therapy formula like Wan
because the use Liu Jun Zi
spleen qi and Dai Tang because Tang to support the
kidney yang have it supports the spleen and clear irregular and/or appearance of small
been compromised spleen damp no ovulation cysts in the ovaries

Biomedical Understanding of PCOS What causes phlegm?

•  Fluids become phlegm when they are unable to
prompt the ovary to move.
ü Excess insulin
increase androgen •  Therefore phlegm can have it’s roots in:
ü Low grade inflammation
ü Ovarian cysts
production •  Qi or yang vacuity or
•  Qi or blood stagnation
elevated androgens •  Phlegm thickens due to
block follicular development •  Cold constricting or
alter HPO Axis feedback Impedes •  Heat congealing
ovulation and •  Blood and fluids move together
makes
elevated estrogen endometrium
“To treat phlegm it is essential to treat the blood.
Decreased FSH less
Quickening the blood leads to transformation of phlegm”
Increased LH & testosterone hospitable
- Zhu Lian-chun

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Chinese Medicine and PCOS
Kidney Jing Deficiency
Kidney yang vacuity
Disrupts flow in Ren and Chong
Spleen qi vacuity
Ø  Damp
Ø Phlegm
Liver qi stagnation
Ø  Blood stagnation
Ø Heat
Ø Congeals phlegm
Stagnation of qi, phlegm and blood disrupt the
Chong and Ren leading to irregular menses and
anovulation.
Acupuncture Points for PCOS
During menses
Sp10, LI4, LV3, R4, SP6, Yin Tang, SP9
Follicular phase
PC6, SP4, ST36, DU20, Zi Gong Xue, SP9, LI4, Yin
Tang
Ovulation
LI4, SP6, KI7, Zi Gong Xue, R3, R4, Yin Tang, SP9
Luteal phase
St 36, SP9, KI7, DU20, Yin Tang
Zhong Yao Ren Gong Tiao Qi Zu Fang
(Formula to Regulate the Menstrual
Cycle) Number 1 (for after the period)
Xian Mao (Rhizoma Curculiginis orchioidis)
Yin Yang Huo (Herba Epimedii)
Dang Gui (Radix Angelicae sinensis)
Shan Yao (Radix Dioscoreae oppositae)
Tu Si Zi (Semen Cuscutae chinensis)
Ba Ji Tian (Radix Morindae officinalis)
Rou Cong Rong (Herba Cistanchis deserticolae)
Shu Di Huang (Radix Rehmanniae)
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PCOS Treatment Principals
Tonify Kidney jing, qi and/or yang
to regulate the Ren and the Chong
Support the Spleen
to address damp and phlegm
Move liver qi and harmonize the spleen and liver
to clear heat from stagnation
Dietary Therapy for PCOS
•  Swap sugar and refined carbohydrates for
small portions of complex whole grains.
•  Avoid sweeteners
•  Eat lean protein
•  Plenty of slightly cooked vegetables
•  Avoid cold foods and dairy products
•  Eliminate alcohol and caffeine
Zhong Yao Ren Gong Tiao Qi Zu Fang
(Formula to Regulate the Menstrual
Cycle) Number 2 (for ovulation)
Dang Gui (Radix Angelicae sinensis)
Dan Shen (Radix Salviae miltiorrhizae)
Tao Ren (Semen Persicae)
Hong Hua (Flos Carthami tinctorii)
Ji Xue Teng (Radix et Caulis Jixueteng)
Yi Mu Cao (Herba Leonori heterophylli)
Xu Duan (Radix Dipsaci)
Xiang Fu (Rhizoma Cyperi rotundi)
Gui Zhi (Ramulus Cinnamomi cassiae)
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Zhong Yao Ren Gong Tiao Qi Zu Fang
(Formula to Regulate the Menstrual
Cycle) Number 3 for the luteal phase
E Jiao (Gelatinum Corii Asini)
Gui Ban Jiao (Colla Plastri testudinis)
Dang Gui (Radix Angelicae sinensis)
Shu Di Huang (Radix Rehmanniae praeparata)
Wu Yao (Radix Linderae strychnifoliae)
Tu Si Zi (Semen Cuscutae chinensis)
Xu Duan (Radix Dipsaci)
Xiang Fu (Rhizoma Cyperi rotundi)
Gui Zhi (Ramulus Cinnamomi cassiae)
Zhong Yao Ren Gong Tiao Qi Zu Fang
(Formula to Regulate the Menstrual
Cycle) Number 4 (during the period)
Dang Gui (Radix Angelicae sinensis)
Shu Di Huang (Radix Rehmanniae praeparata)
Dan Shen (Radix Salviae miltiorrhizae)
Chi Shao (Radix Paeoniae rubrae)
Ze Lan (Herba Lycopi lucidi)
Chuan Xiong (Radix Ligustici Chuanxiong)
Yi Mu Cao (Herba Leonori heterophylli)
Xiang Fu (Rhizoma Cyperi rotundi)

Food Stagnation
PCOS. The take home…
Hypothalamic Amenorrhea
Rotterdam Criteria is two out HA occurs when the hypothalamus, slows or stops
of three of the following: releasing gonadotropin-releasing hormone (GnRH), the
PCOS is a complex
syndrome affecting the Signs of hyperandrogenism hormone that starts the menstrual cycle. Common
endocrine system and Irregular and/or no ovulation characteristics of women suffering from HA include:
metabolism
A chain of small cysts in the •  Low body weight or low percentage of body fat
ovaries
•  Very low intake of calories or fat
•  Strenuous exercise that burns more calories than are
A 5-7% weight
reduction can reduce
taken in through food
Disruption to the This disruption is
Ren and the hyperandrogenism, •  Deficiency of leptin, a protein hormone that regulates
the result of weak improve insulin
Chong causes appetite and metabolism
anovulation and kidney function sensitivity, and
irregular menses and stagnation restore ovulation in •  Emotional stress and some medical conditions
75% of women with
PCOS

Bao He Wan (Preserve Harmony Pill)

The Five Stagnations
Can be used to help underweight women gain
weight and therefore restore the menses in Gynecology
Shan Zha (Fr. Crataegi)
Shen Qu (Massa Medicata Fermentata)
Lai Fu ZI (Sm. Raphani)
Chen pi (Per. Citri Reticulatae) Jill Blakeway, DACM, L.Ac.
Ban Xia (Rz. Pinelliae Preparatum)
Fu Ling (Poria)
Lian Qiao (Fr. Forsythiae)

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