TCM OBGYN – Historical Development Integra(veWomen’sHealthProgram

Introduction

•  TCMOBGYNhasarichhistoryofdevelopmentspanningapproximatelythelast2,000years

• Muchofthefocushasbeencenteredaroundconcep(on,pregnancy,andpostpartumcare

• Awealthofknowledgehavebeendocumentedinthe“Classics”

The Essential Beginning

•  TheEarliest-216AD,DrZhangZhongJing张仲景,,3Chapters20-22onPulse,PaYerns,andTreatmentsofDiseasesinPregnancy,PostpartumDisease,andMiscellaneousGynecologicalDiseases.

To Now - Zhong Yi Fu Chan Ke Xue 中医妇产科学 “TCM Science of OBGYN” •  FirstEdi(onPublishedin2001andSecondEdi(onPublishedin2011byPeople’sMedicalPublishingHouseCo.

•  EditorsareDr.Liu,MinRu刘敏如,andDr.Tan,WanXin谭万信,andwriYenbyover73wellknownTCMOBGYNdoctors.

• MostcomprehensivetextandthemostwidelyusedforTCMandIntegra(veOBGYN.

Study Approach to the History and Development of TCM OBGYN •  Sincemostinforma(oninclinicalmedicinehasbeenpreservedanddocumentedinthe“Classics”books,ourapproachistogainunderstandingandapprecia(onofthese”Classics”throughachronologicalprocess.

•  Therearecountlessbooksthathavecontributedtothisfield.Inthislecture,wewillfocusononesthathavegreaterimpactonthedevelopmentofTCMOBGYN.

Shan Shui Jing 山水經 Book of Mountains and Seas • Mul(pleunknownauthors,476-221BC,WarringStates

•  Itcontainsdescrip(onsofgeologicalfeatures,loca(ons,medicines,andanimals.

•  Theearliesttextthatdescribedofmedicinalplantstotreatinfer(lity.

Huang Di Nei Jing Su Wen 黃帝內經素問 Yellow Emperor’s Classic of Internal Medicine – Simple Questions • Numerousunknownauthors,99-26BC,WarringStatestoHanDynasty

• DiscussionsbetweenHuangDiandhisministerssuchasQiBo,LeiGong,BoGao,YuFu,ShaoShi,GuiYuQu,andShaoYuonmostlyhealthissues.

• ManyreferencestoOBGYNandfirstfundamentalsofFeKe

Su Wen and Anatomy

•  Firsttomen(on:•  NvZiBao(FemaleWomb)•  BaoMai–WombMeridian•  BaoLuo–WombCollateral

• NvZiBao–Ithasfunc(onsofZangandFu.•  ItactslikeZangwhenitcantransformJing,QiandBloodtoNourishFetusandCreateMenstrualFlow.

•  ItactslikeFuwhenitcanstoreanddischargeJing,Qi,andBlood•  ItisthereforeconsideredasanExtraordinaryFuOrgan(QiHengZiFu奇恒之腑)

• BaoMai–ItbelongstotheHeartandconnectstoBao• BaoLuo–ItbelongstotheKidneyandconnectstoBao

Su Wen and Physiology

•  Itdescribed7x7and8x8reproduc(vephysiologyforbothwomanandman.

•  Itfirstdescribedthefunc(onandtheimportanceofTianKui,Chong,Ren,andKidneyQiinreproduc(on.

•  Italsodescribedtheuniquefemalephysiologyofmenstrua(on,pregnancy,labor,andbreasjeeding.

Su Wen and Pathology

•  Itpointedoutthewomantendstohave“excessiveQianddeficientBlood”.Thispavedthefounda(onforbloodnourishingmethodoftreatments.

•  Itdescribedpathologyunderlyingabnormaluterinebleeding,amenorrhea,abnormalvaginaldischarges,infer(lity,ZhengJia(pelvicmass),dysphoniaduringpregnancy,etc.

•  “ExcessivesadnessdepletesBaoLuo,YangQimovesinternallyupwardtodisturbtheHeart,theregula(onofBloodisimpaired,causingabnormaluterinebleeding”.Itdescribesforthefirst(meemo(onalfactorcanbeadiseasecausa(vefactor.

Su Wen and Diagnosis •  Itpointedouttheobserva(onofcolorchangesandotherchangesbelowthenosecanbeanindica(onoffemalereproduc(veorganissuesespeciallythelipsandphiltrum.

•  ItdescribedthatthemoreobviousmovementofHand-ShaoYinChannelpulsecanbeanindica(onofpregnancy.

•  ItalsodescribedthatweaknessofbothKidney(Chi)pulsescanbeanindica(onofamenorrhea.

Su Wen and Herbal Therapy

•  ItdescribedSiWuZeiGuYiLuRuWan(四乌贼骨⼀一芦茹丸),acombina(onofEndoconchasepiae(WuZeiGu)andRubiacordifolia(QianCao)4:1,oneoftheonly13formula(onsthatappearedinNeijing,usedinirregularmenstrua(on,deple(onofmenstrua(on.

Shi Ji 史記 Historical Annals •  SiMaQian司馬遷,exact(meunknown,Handynasty.

• Descrip(onsofhistoryfromHuangDieratotheHandynasty(221BCto220AD)(440Years)

• DescribedfirstspecialtyofOBGYNBianQue扁鵲.

•  Italsodocumentedtwoclinicalcasesofamenorrheaandlacta(ondeficiency.

Han Shu 漢書 Book of Han • HanShuisahistorybookcoveringthefirstpartoftheHanDynasty(206BCto23AD).

•  Itdescribedinstalla(onoffemaleOBGYNspecialtydoctorsintheimperiacourt,thefamousonesareYiXu(义姁),andChunYuYan(淳于衍).

•  Theuseofherbstocauseabor(onandabnormalfetushavebeendocumented.

Hou Han Shu 後漢書 Book of the Later Han • AlsoknownasHistoryoftheLaterHan,isaChinesecourtdocumentcoveringthehistoryoftheHandynastyfrom6to189AD.

•  ItdocumentedthefamedphysicianHuaTuo华佗usingMaFeiSan⿇麻沸散andShenGao神膏intheperformanceofabdominalsurgeryandremovalanddeadfetus.

Tai Chan Shu 胎产书 The Book of Pregnancy, Labor and Postpartum • MaWangDuiexcava(oninChangshadiscoveredover3000culturalrelics.

•  TaiChanShuwasoneofthe15medicalrelatedbooksdiscovereddocumen(ngindetail10monthsofgesta(on,laborandpostpartumcareintheHanDynasty.

Tai Chan Shu 胎产书 The Book of Pregnancy, Labor and Postpartum •  Itdescribedwhenitisthebest(metobeginintercoursetoconceive(3daysamerthemenstrua(oniscompletelyclear).

•  Itdescribed10monthsofembryologyandtheconceptofYangTai养胎(NourishFetus)

•  ItdescribedtheconceptandtheimportanceofTaiJiao胎教(FetalEduca(on)

Nourish Fetus According to the Gestational Month (Zhu Yue Yang Tai 逐⽉月养胎) FirstMonthForma(onofEmbryo

SecondMonthForma(onofGel

ThirdMonthForma(onofFetus

FourthMonthForma(onofBloodfromWaterEnergy

FimhMonthForma(onofQifromFireEnergy

SixthMonthForma(onoftendonandligamentsfromMetalEnergy

SeventhMonthForma(onofBonefromWoodEnergy

EighthMonthForma(onofSkin,FasciaandMusclesfromEarthEnergy

NinthMonthForma(onofHairfrom”Stone”Energy

TenthMonth–AllOrgansareformed,ReceivingEnergyfromHeavenandEarth,ReadytobeDelivered

Shen Nong Ben Cao Jing 神农本草经 The Classics of Herbal Medicine •  ItwaswriYenintheHanDynasty.•  Itlists365differentherbsfortherapy.Itclassifiedherbsintohigher,average,andlowergradesaswellascategorizedherbsintoplants,animals,andminerals.

•  ItincludedmanyherbsthatarewidelyusedinOBGYN.

•  ItalsorenamedNuZiBaotoZiGong.

•  ItstatedthatWindColdaYacktotheZiGonginwomancancauseinfer(lityfortenyears.

Jin Kui Yao Lue Fang Lun 金匱要略方論 Discussion of Prescriptions of the Golden Chest •  Zhang,ZhongJing张仲景,219AD,Handynasty.

•  LatereditedbyWang,ShuHe 王叔和,Lin,Yi林林亿,andSun,Qi 孙奇.

•  3volumes,herbalandfoodtherapiesforvarietyofdiseases.

•  3chaptersongynecology,over30formulariesdescribedands(llusedtoday.

Jin Kui Yao Lue Fang Lun 金匱要略方論 Discussion of Prescriptions of the Golden Chest • GuiZhiFuLingWan桂枝茯苓丸forZhengJia癥瘕 (pelvicmass)

•  JiaoAiTang胶艾汤forabnormaluterinebleedingwithpelvicpainsincludingoccurrencesduringpregnancyandameranabor(on.

• DangGuiShaoYaoSan当归芍药散forgesta(onalpelvicpain.

• GanMaiDaZaoTang⽢甘麦⼤大枣汤forZangZao脏躁,depressiveandanxietydisorders

• WenJingTang温经汤formenopausalabnormaluterinebleeding

Jin Kui Yao Lue Fang Lun 金匱要略方論 Discussion of Prescriptions of the Golden Chest •  Introduc(ontotheprac(ceandconceptofvaginaldoucheandsuppository.

•  FanShiWansuppository矾⽯石丸forleukorrhea,vaginalinfec(ons,amenorrheaduetostagnantbloodandclots.

•  SheChuangZiSan蛇床⼦子散forYin-Coldtypeofleukorrheaandvaginalinfec(ons

•  LangYaTang狼牙汤forvaginalparasi(cinfec(onssuchasTrichomonas

Mai Jing 脈經 Pulse Classic • Wang,ShuHe王叔和,AD280,Jindynasty

•  Firstbookthatcreatedasystemicframeworkforpulsediagnosis

•  ItalsocollectedandsynthesizedearlierworkssuchasNeiJing,NanJing,andJinKuiinpulsediagnosisanddiagnos(cdifferen(a(ons.

•  OBGYNpulsedescrip(onsanddifferen(a(onsappearsinChapter9oftotal10chaptersinthebook.

Mai Jing 脈經 Pulse Classic •  “Chiposi(on,Kidneypulse,whenitispersistentwhenpressed,itispregnancy.”

•  “Threelevelsofpulse–floa(ng,middleanddeep;whentheyarecon(nuousandlinkedup,itispregnancy.”

•  ItalsodiscussedaboutLiJingMai离经脉–speedinguppulsethatoccursduringlabor.

•  Itprovidednewterminologies:•  JuJing居经–menstrua(onthatcomeseverythreemonths

•  BiNian避年年–menstrua(onthatcomesonceayear

•  JiJing激经–menstrua(oncon(nuingevenamerpregnancydiscovery

Zhu Bing Yuan Hou Zong Lun 諸病源候總論 General Treaties on The Symptomatology and Etiology of Disease • Chao,YuanFang巢元⽅方,imperialphysician,AD610,Suidynasty

• AmajorworkonE(opathology.•  Itistheearliestsystemizedworkone(ology,symptoms,andsignsofdiseases.Itclassified67diseasesand1,739syndromes.

•  283syndromescoveringOBGYNprovidedstrongfounda(onone(opathologyunderstanding.

Zhu Bing Yuan Hou Zong Lun 諸病源候總論 General Treaties on The Symptomatology and Etiology of Disease •  “Irregularmenstrua(oniscausedbyoverstrainingconsumingQiandBlood.Thiscausethebodytobeweakened.WeakenedbodyeasilyaYractedWindColdinvasion,causingblockageintheinteriorofBao胞内,damagingChongRenChannels,damagingHandTaiYangandShaoYinchannels”

Qian Jin Yao Fang 千金要方 Thousand Golden Ducat Prescriptions •  Sun,SiMiao,AD652,Tangdynasty.•  Collected5300herbalformularies,expandedonZangFutheoriesandotherfundamentals.ItdescribedvariousTCMtreatmentssuchasacupuncture,foodtherapy,massage,DaoYin,etc.

•  3comprehensivevolumesonOBGYN.

•  Ametalknifeshouldneverusedtocutumbilicalcord.

Formation of Imperial Medical System

•  DuringTangDynasty618–907AD,establishmentofimperialmedicaldepartment.

•  Itisthefirstformalizededuca(onalins(tu(ontotraindoctorsfortheloyalfamilyaswellasforthegovernmentofficials.

•  Duetotheeduca(onalinfluences,therearenowmorepublishedbooksonOBGYNduringthisperiodof(me.

•  Notablesare:•  BeiJiQianJinYaoFang备急千⾦金金要⽅方 Prescrip(onsWorthaThousandinGoldforEveryEmergency

•  WaiTaiBiYao外台秘要 Medicalsecretsofanofficial

•  JingXiaoChanBao經效產寶TreasureofObstetrics

Bei Ji Qian Jin Yao Fang 备急千金要方 Prescriptions Worth a Thousand in Gold for Every Emergency

•  Sun,SiMiao孙思邈•  AuthoredBeiJiQianJinYaoFangin652AD.(ItisfrequentlyabbreviatedasQianJinFang)

•  30chaptersonclinicalmedicine,acupuncture,dietarytherapy,preven(on,andsanita(on.Itcollected5,300+herbalformula(ons.

•  3chaptersonOBGYN,collected540herbalformula(onsinthesethreechapters.

Bei Ji Qian Jin Yao Fang 备急千金要方 Prescriptions Worth a Thousand in Gold for Every Emergency

• Hepointedoutforthefirst(methatinfer(litycanbecausedproblemsfrombothmanandwomanandnotjustwomanalone.

• Hewroteextensivelyonantepartum,intrapartum,andpostpartumcare.Heexpandedontreatmentsfordifficultlaborsinbothherbalandacupuncturetherapies

Wai Tai Bi Yao 外台秘要 Medical Secrets of an Official

• Wang,Dao王焘• Aclinicaltherapybookthatincluded40chapters,andover6,000herbalformula(ons.

•  TherearetwochaptersonOBGYNaround85differenttypeofcondi(onsandover480herbalformula(ons.

Jing Xiao Chan Bao 經效產寶 Treasure of Obstetrics •  Zan,Yin昝殷,853AD,Tangdynasty.

•  41chapters,374formularies,onpregnancy,laborandpostpartumissues.

•  FirsspecialtybookonTCMObstetrics

•  Itdescribedmaternalcare,laboranddelivery.

•  Itdescribedcareforpreeclampsiaandeclampsia.

Earliest TCM Medical School for the public •  SongDynasty,960-1279AD•  ImperialMedicalCollege,Staffedbytotalof300physicians,ninedepartmentswhichincludedtheOBGYNdepartment,andlisted10obstetricphysicians.

•  Thisistheearliestofspecialtyeduca(onforOBGYNintheworld.•  S(mulatedfurtherrefinementanddevelopmentinTCMOBGYN.

Shi Chan Lun ⼗十产论 Discussion of Ten Labors •  Yang,ZiJian杨⼦子建,1098AD• Discussionontendifferentfetalposi(onsincludingfoo(ngbreech,transversebreech,frankbreech,umbilicuscordwrapping,etc.

•  Italsodiscussedtheuseofhandtechniquesincorrec(ngsuchbreechduringlaboraswellastheintakeofherbs.

Wei Shen Jia Bao Chan Ke Bei Yao 卫⽣生家宝产科备要 •  Zhu,RueZhang朱瑞章,1184AD•  8chapterstotal.7chaptersonlaboranddelivery.

•  Itdiscussedtheimportanceofhavingcleanenvironmentfordeliveryaswellasproperinfantcaremethods.

•  Itdiscussedofthreepostpartumcondi(onsofChongXin冲⼼心,ChongWei冲胃,andChongFei冲肺.(EclampsiaSeizure,HELLP-microangiopathichemoly(canemia,cardiomyopathy)

Nv Ke Bai Wen 女科百问 Hundred Questions in OBGYN • Qi,ZhongPu齐仲莆,1220AD•  50ques(onsongynecology•  50ques(onsonobstetrics• Providedmoreclearexplana(onofe(ologiesandpathologies

Fu Ren Liang Fang Da Quan 婦人良方大全 Great Treatise of Useful Prescriptions for Women • Chen,ZiMing陳自明,1237AD,SouthernSongdynasty.

•  25chapters,1118formularies,48cases,thefirstcomprehensivetextonTCMOBGYN.

• Profoundinfluenceonthedevelopmentofobstetricsandgynecologyinsubsequentdynas(es.

Fu Ren Liang Fang Da Quan 婦人良方大全 Great Treatise of Useful Prescriptions for Women •  Lateredi(onbyXueJi薛⼰己 whichincludedmanycommentariesaswellascasestudiesinMingDynasty.

•  ItemphasizedthatLiverandSpleenarethesourcesformenstrua(on,andallOBGYNdisordersoriginatesfromChongRenchannelsandBaoGong.

•  Again,itbecameadefactotextbookofOBGYNformanygenera(ons.

Jin Yuan Four Schools

•  Liu,WanSu,Li,DongYuan,Zhu,DanXi,andZhangZiHe.•  Liu,WanSu–Firepathology•  Li,DongYuan–Earthschool•  Zhu,DanXi–“YangisomenexcessiveandYinisfrequentlydeficient”•  ZhangZiHe–Swea(ng,Purge,andEme(cMethods

Liu Wan Su 刘完素 1110 – 1200 AD • Contributed“Fire-HeatPathology”

• BelievedthatFire-Heatisthemaine(ologyformanydiseases

• RecommendedCoolingandColdherbstoreduceHeartFire,benefitKidneyWater.

•  LaterhasbeenrecognizedastheHeJianDoctrine,namedforwherehewasborn.

OBGYN Contributions

•  “Whenthereisamenorrhea,firsttoreduceHeartFire.OnceHeartFirereduced,themenstrua(onwilloccur.

•  “Vaginaldischargesarethecondi(onsoftheRenChannel”

•  “WhenthereistoomuchDampHeatinthelowerRenChannel,therewillhavevaginaldischarges”

•  “focusontheKidneyswithyoungwoman,focusontheLiverswithmiddle-agedwomen,focusonSpleen

Zhang, Cong Zheng 张从正 1156-1228 AD •  “Whennourishlife,usefood;whentreatdiseasesaYackwithmedicine.”

•  “Onecannottonifyun(lallpathogensareeradicated.”

• Hefocusesontheuseofdiaphore(cs,eme(cs,andpurga(vestoridofpathogens.

• Heisthereforeknownastheini(atorofAYackingDoctrine

OBGYN Contributions

• Commonlyuseseme(candpurgingmethodstobringonmenstrua(ons,mainlyforexcesstypeofpa(ents.

• Butusesfoodtonourishdeficientpa(ents• BygeungofPhlegm,themenstrua(onwillreappear,establishedphlegmconges(onasoneofthecauseforamenorrhea,whichhelptoestablishthePhlegm-Dampe(ologyinPCOSpa(ents.

Zheng Zhi Zhun Sheng 証治準繩 Standards of Diagnosis and Treatments • Wang,KenTang王肯堂,1602AD,Mingdynasty

•  44volumesdividedintosixspecial(es–MiscellaneousDisorders,MiscellaneousFormularies,ShangHan,YangDiseases,Pediatrics,OBGYN.

• ComprehensiveTextofthe(me

Nu Ke Zuo Yao 女科撮要 Summary of Gynecology and Obstetrics • Xue,Ji 薛⼰己,1548AD,Mingdynasty

• Animperialphysicianwithvastamountofclinicalexperience.

• ComprehensivebookonOBGYNreflec(nguniquelyhowDr.Xueapproacheswoman’shealth.

Guang Si Ji Yao 廣嗣紀要 Summary of Fertility • Wan,Quan万全,1549AD,Mingdynasty.

•  16chaptersdescribingtreatmentsforinfer(lity,pregnancycare,postpartumcare,andpediatriccare.

• Manshouldclearhisheartandcontrolsexualdesiretonourishtheessence

Ji Yin Gang Mu 濟陰綱目 Compendium of Therapy of Women’s Diseases • Wu,ZhiWang武之望,1620AD,Mingdynasty.

•  5chapters,comprehensivetextcollec(ngworksbeforeMingdynastyintheareaofOBGYN

Jing Yue Quan Shu 景岳全書 Complete Works of Jing Yue •  Zhang,JieBin張介賓,1624AD,Mingdynasty.

•  64chaptersonTCMfromDrZhang’sexperienceespeciallyrela(ngtotheMingmenDoctrine.

• ContributedgreatlytoKidneytonifica(onmethods

Fu Qing Zhu Nv Ke 傅青主女科 Fu Qing Zhu’s Gynecology •  Fu,QingZhu傅青主,1607-1684AD,Qingdynasty.

•  Thebookwaspublished1690AD.•  EmphasizedontreatmentsofSpleen,LiverandKidneyinOBGYNcondi(ons.

•  Createdmanyherbalformula(onsthataresmallformula(onsandeasytouse.

• 

Yi Zong Jin Jian 医宗⾦金金鉴 Golden Mirror of Medicine • Wu,Qian吴谦,1742AD,Qingdynasty.

•  90chapters,asummarycollec(onofTCM.ItwasdirectedbytheEmperorandwriYenbyanimperialphysician.

•  Easytoreadandunderstandwithsimplifiedvolumes.

Da Sheng Bian 达⽣生编 Treatise on Obstetrics •  JiZhaiJuShi亟斋居⼠士,1715AD,Qingdynasty.

• Pennamedpublica(on,incorporatedmorescien(ficinforma(onandapproachtoobstetrics.

• Clearandconcise,amoremodernfavoritebooktoobstetrics.

Yi Lin Gai Cuo 医林林改错 Correcting the Errors in the Forest of Medicine •  In1830,Dr.Wang,QingRen王清任,wriYenthisbookamerreviewingandexaminingcadavers.HeemphasizedtheimportanceoflearninganatomyforTCMphysicians,

•  HesharedhisdeepinsightinStagnantBloodcondi(onandusingAc(va(ngBloodRelievingStagna(onmethodtotreatit.

•  HisseriesofZhuYuTang逐瘀汤hasbeenwidelyusedforOBGYNbloodstagna(oncondi(onsandcon(nuetoenjoypopularitytoday.

Xue Zheng Lun ⾎血证论 Discussion on Blood Syndromes •  Tang,ZongHai唐宗海海,1885AD,Qingdynasty.

•  Anuniquepublica(ondiscussingBloodpathologyanditsrela(onshipwithQi.

•  “OldBloodthatdoesnotdischargeisStagnantBlood.””RidofOldBloodallowsNewBloodtocomeonandregulatemenstrua(on”

•  BloodflowisregulatedbyChong,Ren,Daichannels.ChongRenDaichannelsareregulatedbyLiver.ThereforetotonifyBloodistotonifyLiver.

Yi Xue Zhong Zhong Can Xi Lu 医学衷中参⻄西录 Records of Combined Chinese and Western Medicine •  Zhang,XiChun,1918AD,Qingdynasty.

•  30chapters,combiningbothChinesemedicalandwesternmedicalperspec(veswithformularies,herbs,theories,discussions,andcases.

•  FirstmajoraYemptinbridgingbothChineseandWesternMedicines.

Yi Xue Zhong Zhong Can Xi Lu 医学衷中参⻄西录 Records of Combined Chinese and Western Medicine • CreatedAnChongTang安冲汤andGuChongTang 固冲汤forexcessivemenstrualfloworabnormaluterinebleeding.

•  LiChongWan理理冲丸andLiChongTang 理理冲汤foramenorrheaandZhengJia.

•  ShouTaiWan寿胎丸fortonifyingKidneyandpreventmiscarriage.

Major Texts of TCM Universities and Colleges •  TCMGynecology•  ZhongYiFuKeXue•  Luo,YuanKai,罗元恺,1984,1986AD

Zhong Yi Fu Chan Ke Xue 中医妇产科学 “TCM Science of OBGYN” •  FirstEdi(onPublishedin2001andSecondEdi(onPublishedin2011byPeople’sMedicalPublishingHouseCo.

•  EditorsareDr.Liu,MinRu刘敏如,andDr.Tan,WanXin谭万信,andwriYenbyover73wellknownTCMOBGYNdoctors.

• MostcomprehensivetextandthemostwidelyusedforTCMandIntegra(veOBGYN.