From "In Touch Zhejiang" magazine, April 2006

No matter where I have practiced medicine, women always make up the majority of my patients. This is not because women are more often sick than men, but, I believe, because women are generally more concerned with their health. It may also be that men tend to play down their discomfort due to macho tendencies, and/or fear of doctors. Whatever the case, in general, if women feel there is a problem with their health they will seek help in a timely manner and on their own accord, whereas many men have to be falling apart before they go to a doctor, and even then some will have to be dragged in kicking and screaming. And so, I have always had more female patients.

This suits me just fine. I like women (I’m married to one, in fact), and Chinese medicine (CM) has a lot to offer women. Thus I have been led to study a lot of CM gynecology. You may wonder, what exactly is CM gynecology? Gynecology is the study of women’s health, and CM gynecology is the study of women’s health from a Chinese medicine perspective. Simple. Well, not really.

CM has been discussing, researching and treating women’s health problems for over two thousand years, so there’s a lot of information on the subject. The result of this long history of interest has led to an extremely profound understanding of gynecology and to many effective means to treat various gynecological complaints.

As always, one of the main strengths of CM is its holistic understanding of physiology. This allows the practitioner to unravel the often complex etiology of gynecological disorders and get to the root of the problem. It also empowers patients by giving them an understanding of their condition, by which they are all too often baffled. There are many occasions where WM is unable to determine the cause of someone’s ailment, and even though the explanation that CM is able to give is somewhat esoteric and possibly odd sounding, there is something common and natural about it that allows even a layperson to grasp.

For example, a typical presentation might be as follows. Female, mid-thirties, chief complaints are fatigue, dizziness, menstrual irregularities, and emotional disturbances. History reveals long periods with heavy menstrual bleeding from menarche until several years ago, but now menstruation is scant and irregular with moderately severe PMS; appetite is so-so; easily bloated and tired after meals; bowel movements are dry and difficult; frequent insomnia and dream disturbed sleep; bruises easily. Patient also complains of occasional bouts of anxiety with palpitations, a short temper, and inability to concentrate. Hair is thin and often comes out in clumps, fingernails are thin and brittle, skin is dry, complexion is pale. Tongue is pale and puffy with a thin coating, and pulse is thin, weak, and deep, the Liver pulse is particularly weak. Her WM doctor served a valuable purpose by running various tests to rule out severe illness, diagnosed her as anemic and gave her iron pills, but taking them leads to increased constipation and no significant improvements. The MD has no explanation or solution for the emotional and menstrual complaints. The patient is confused as to why she feels this way and is desperate for a solution.

After doing an intake, I always take time to explain and discuss the diagnosis and etiology of the problem with patients, then we discuss treatment options. For this part, I explain, one must not confuse CM anatomy and physiology (designated here by capitalization: Liver, Heart, Spleen, Blood, Qi, etc.) with the modern understanding--they are not the same.

This patient has a textbook case of Liver and Heart Blood Deficiency, Spleen Qi Deficiency, and Liver Qi Stagnation. Let’s discuss the etiology. The heavy menstrual bleeding from menarche was likely caused by Spleen Qi Deficiency, one function of Qi being to “control” the blood, maintaining its place in the blood vessels, and in the case of menstruation, regulating the amount of blood loss. Insufficiency of Qi led to an inability to “control” the blood, and accounts for the heavy bleeding and easy bruising. The Spleen also manufactures Qi and Blood, making these from the food we eat. Spleen Qi deficiency led to decreased production of Qi and Blood, which combined with the heavy menstrual periods eventually led to Liver Blood Deficiency, and the WM diagnosis of anemia. The Liver Blood is the source of the menstruation, and insufficiency eventually led to scant and irregular menstrual periods. Liver Blood Deficiency causes the Liver Wood to become inflexible, leading to Liver Qi Stagnation, which accounts for the PMS and short temper. According to Five Phase Theory, Liver (Wood) is the Mother of the Heart (Fire), and the Spleen (Earth) is the Son of the Heart. Insufficiency of the Mother leads to malnourishment of the Son, and insufficiency of the Son depletes the Mother. Here, Liver and Spleen insufficiency led to Heart Blood deficiency, resulting in anxiety with palpitations, insomnia, and poor concentration. Blood nourishes the hair, skin and nails, and deficiency led to dry hair falling out in clumps, thin nails, and dry skin. Blood is a type of body fluid, and deficiency of fluids caused the stool to be dry and difficult. The combined Qi and Blood Deficiency caused the fatigue and dizziness. The pale tongue and thin, weak, deep pulse confirm the diagnosis of Qi and Blood Deficiency.

Upon learning there is an explanation for the condition, the patient usually feels relieved-- the problem is not “all in the head” as some may have hinted (an incredibly belittling and frustrating suggestion), and a solution is at hand. And so we discuss treatment. Treatment is aimed at strengthening the Spleen, nourishing the Liver and Heart Blood, and regulating the Liver Qi. This is done primarily with herbs, but acupuncture is complimentary and can be performed in addition if the patient is agreeable. Dietary and lifestyle recommendations are also implemented. After a couple weeks the patient feels noticeably better, but treatment continues for a few more months until the condition is resolved, at which point the dietary and lifestyle changes are maintained to help prevent relapse and promote general wellbeing.

This is a very typical case and I see variations of these sorts of problems on a regular basis. It is also a relatively simple case, but CM is capable of addressing far more serious and complex problems. In fact, CM can treat the entire range of gynecological problems, from minor PMS and menstrual irregularities, to uterine fibroids, endometriosis, and infertility. That is not to say that CM can cure all of these conditions. Some can be cured, some not, but in almost all cases a measurable benefit can be derived. CM gynecology is a wonderful treasure and I hope that more and more women around the world will become aware of and benefit from its brilliance.

copyright©2006 Greg A. Livingston