Excessive Vaginal Discharge

CHAPTER 61 Excessive Vaginal Discharge



AETIOLOGY AND PATHOLOGY 814

IDENTIFICATION OF PATTERNS AND TREATMENT 815
Spleen deficiency 815

Kidney-Yang deficiency 817

Kidney-Yin deficiency 818

Damp-Heat 820

Toxic-Heat 822

Liver-Qi stagnation 823

Ancient acupuncture prescriptions for excessive vaginal discharge 824

Prescriptions by Fu Qing Zhu 825

PROGNOSIS AND PREVENTION 825

WESTERN VIEW 825

Vaginal discharge is called dai xia (image) in Chinese medicine, literally meaning ‘disease below the Girdle Vessel’. In old times, this term actually referred to all women’s diseases and it was therefore equivalent to ‘gynecology’, and the term dai xia yi meant ‘gynecologist’. Since the Sui dynasty (AD 581–618), this term has come to mean only ‘excessive vaginal discharge’.


A slight vaginal discharge that increases in volume and viscosity at mid-cycle is physiological and does not constitute a disease. If the discharge is excessive or other than colourless, or if its consistency is other than thin, and if it has an offensive smell, it then constitutes a pathological condition: thus, a pathological vaginal discharge implies a change in amount, colour, consistency or smell.


In Chinese medicine, the physiological vaginal discharge is produced, stored and secreted by the Kidneys; transformed and distributed by the Spleen; governed by the Directing Vessel (Du Mai); and controlled by the Girdle Vessel (Dai Mai).


Excessive Vaginal Discharge as a Chinese disease category has always had a predominant and important place in Chinese gynecology, compared with Western gynecology. The reason for this is probably that, in the absence of modern diagnostic means, the ancient Chinese doctors relied on the appearance of a vaginal discharge not only for diagnosis but also prognosis. In Western medicine, we know that an excessive vaginal discharge in most cases reflects a local pathology of the lower genital tract (such as vaginitis from Candida or Trichomonas infection). We also know that, in a few cases, an excessive vaginal discharge may be a symptom of uterine carcinoma and Western gynecology has the means to diagnose this.


In the old times, Chinese gynecologists would not have known that an excessive vaginal discharge from local vaginitis and one from uterine cancer had different pathologies: they did know, however, that some types of vaginal discharges are more serious and indicate a poor prognosis. For example, they differentiated between a vaginal discharge from Damp-Heat and one from Toxic-Heat, the latter denoting a worse prognosis. The ancient gynecologists also knew, for example, that a bloody discharge with pus occurring after the menopause indicates a very poor prognosis: this ties in completely with Western medicine as such a discharge often indicates the possible presence of uterine carcinoma. In conclusion, the careful and detailed observation of the pathology of vaginal discharge developed over centuries gave the ancient Chinese gynecologist very good diagnostic and prognostic means to differentiate between serious and mild conditions.



Aetiology and pathology




Irregular diet, excessive physical work


Excessive consumption of dairy foods, greasy foods and sugar often leads to the formation of Dampness: in women, this easily infuses downwards to the genital system to cause a vaginal discharge. Even if the patient does not consume excessive amounts of dairy or greasy foods, eating irregularly also leads to the formation of Dampness.


Excessive physical work weakens the Spleen which then fails to transform and transport fluids properly: these accumulate into Dampness, infuse to the genital system and cause an excessive vaginal discharge. After some years, Spleen-Yang deficiency leads to Kidney-Yang deficiency, so that the Kidneys cannot store and hold fluids, which leak out in the form of vaginal discharge.



Emotional strain


Worry, anger, irritation, frustration, guilt and resentment may all lead to stagnation of Liver-Qi; stagnant Liver-Qi invades the Spleen and impairs its transformation and transportation of fluids, leading to the accumulation of Dampness. When combined with Liver-Qi stagnation, Dampness may settle in the Liver channel which curls around the genitalia and causes an excessive vaginal discharge.



Overwork


Overwork for several years without adequate rest leads to Liver- and Kidney-Yin deficiency and to weakness of the Directing and Girdle Vessels which cannot hold Yin fluids: this causes an excessive vaginal discharge.



Invasion of external Dampness


External Dampness may invade the leg channels and flow up to settle in the genital system and cause an excessive vaginal discharge. Women are particularly prone to invasion of Dampness especially after childbirth and after each period. After some time, Dampness often combines with Heat to form Damp-Heat. Invasion of external Dampness leads to excessive vaginal discharge especially when there is a concurrent aetiological factor such as irregular diet.


After some time, Damp-Heat may turn into Toxic-Heat which is a more serious type of pathogenic factor and one that is often accompanied by a poor prognosis.


A pathological vaginal discharge must be differentiated in term of amount, colour, consistency and odour.



Amount


A profuse discharge is usually due to a deficiency of the Kidneys, while a white, sticky discharge usually reflects a Spleen deficiency.



Colour


As for colour, four colours are usually distinguished: white, yellow, red and green. A white discharge indicates Cold; yellow, red, or green discharges indicate Heat.



Consistency


A dilute, watery discharge indicates Cold or deficiency and a thick, sticky one denotes Heat or Dampness. A profuse red discharge, whether dilute or sticky, indicates deficiency of Yin with Damp-Heat.



Odour


An odour in general indicates Heat, as does a leathery smell, but a fishy smell may indicate Cold.


Thus, to differentiate between deficiency and excess, a light-coloured, thin, watery discharge without odour indicates deficiency (or Cold), while a dark, thick, dense discharge with an offensive odour indicates Fullness (or Heat). It is often difficult to judge the colour of a discharge because a white discharge usually stains the briefs yellow.


Red vaginal discharge should be differentiated from mid-cycle menstrual bleeding. A red vaginal discharge is sticky and usually smelly and it does not occur with periodicity. Mid-cycle menstrual bleeding occurs with regularity at monthly intervals, is not sticky or turbid, and generally does not have an offensive odour.


In terms of channels, vaginal discharges involve the Spleen, Liver and Kidney channels and, of the Extraordinary Vessels, the Directing and Girdle Vessels (Ren and Dai Mai). In fact, most authors say that the term dai in dai xia, meaning vaginal discharge, is related to the name of the Girdle Vessel, i.e. Dai Mai. When the Girdle Vessel is slack, Qi sinks and Dampness infuses downwards to the genital system causing a vaginal discharge: for this reason, vaginal discharges are a major indication for the use of this vessel. In this type of pathology, the Girdle Vessel is closely connected to the Directing Vessel as the former harmonizes the ascending and descending of Qi which affects the latter: for this reason, a pathology of the Girdle Vessel (being too slack) causes Qi to sink in the Directing Vessel with symptoms of a persistent vaginal discharge. The sinking of Qi in the Girdle Vessel is related to a Kidney deficiency, while the formation of Dampness is due to a Spleen deficiency.


Fu Qing Zhu says:



Excessive vaginal discharge is a Dampness pattern. It is called ‘dai’ due to the inability of the Girdle [Dai] Vessel to bind. The Girdle Vessel communicates with the Directing and Governing vessels and if these are diseased, the Girdle Vessel also is … The Girdle Vessel may be injured not only by falls, sprains or contusions, but also by excessive sexual activity or by excessive drinking of alcohol to the point of complete drunkenness.1


The points used are its opening points G.B.-41 Zulinqi (on the right) and T.B.-5 Waiguan (on the left), and G.B.-26 Daimai, G.B.-27 Wushu and G.B.-28 Weidao.



Identification of patterns and treatment


The main deficiency pathology centres around Spleen or Kidney deficiency (which may be of Kidney-Yang or Kidney-Yin); the main Full pathology is Damp-Heat or Toxic-Heat. Thus, the treatment principle in deficiency conditions of the Spleen is to tonify, raise (Qi) and dry (Dampness); in deficiency conditions of the Kidneys, it is to tonify the Kidneys and consolidate the Directing Vessel. For Full conditions from Damp-Heat, the treatment principle is to clear (Heat) and transform (Water). For Toxic-Heat, the treatment principle is to drain (Fire) and resolve (Toxin).


Toxic-Heat or Damp-Heat are often accompanied by infestation of what the ancient Chinese called ‘parasites’ (chong image). ‘Parasites’ can cause various diseases in Chinese medicine: apart from the obvious intestinal parasites, tuberculosis (TB) of the lungs and certain types of vaginal discharges are caused by ‘parasites’. As for TB of the lungs, called zhai (image) or lao zhai (image), the ancient Chinese doctors had perceptively understood that it was caused by some pathogenic living organisms which they called ‘parasites’, i.e. chong or lao chong. For example, Zhu Dan Xi (1281–1358) says: “In some syndromes there are parasites inside the Yin organs that bite the heart and lungs: this is called zhai disease.”2


The ancient Chinese doctors had also understood that such ‘parasites’ could be infectious. The Formulae to Aid the Living (1237) says:



Lao Zhai [i.e. tuberculosis] is a serious disease. Those who suffer from it can transmit it to each other; they can have it for many years and all the family members may die of it.3


In the case of vaginal discharges, according to the old doctors, some are caused by parasites (chong): again, the ancient Chinese doctors were very perceptive because we know from modern medicine that fungal or bacterial infections, spread through sexual contact, cause most vaginal discharges. In such cases, the treatment principle is to ‘kill parasites’ (sha chong image), i.e. eliminate bacteria or fungi with herbs that have an anti-bacterial or anti-fungal effect and the majority of which also kill parasites.


From a Western perspective, a vaginal discharge associated with abdominal pain may indicate pelvic inflammatory disease and most of the formulae for Toxic-Heat are particularly suitable to treat this condition.


The patterns discussed are:


• Spleen deficiency

• Kidney-Yang deficiency

• Kidney-Yin deficiency

• Damp-Heat

• Toxic-Heat

• Liver-Qi stagnation.


Spleen deficiency



Clinical manifestations


Excessive vaginal discharge that is white or slightly yellow, sticky, without smell and persistent, dull complexion, tiredness, depression, cold limbs, loose stools. Tongue: Pale with a sticky, white coating. Pulse: Weak and slightly Slippery.


This pattern is characterized not only by deficiency of Spleen-Qi or Spleen-Yang but also by sinking of Spleen-Qi: the persistent vaginal discharge, besides being a symptom of Dampness, is also a symptom of Spleen-Qi sinking.



Treatment principle


Strengthen the Spleen, tonify Qi, raise Yang, resolve Dampness.



Acupuncture


Ren-12 Zhongwan, ST-36 Zusanli, SP-3 Taibai, SP-6 Sanyinjiao, SP-9 Yinlingquan, BL-22 Sanjiaoshu, Du-20 Baihui, Ren-6 Qihai, Ren-3 Zhongji, BL-32 Ciliao, BL-20 Pishu. All with reinforcing method except for SP-9 and SP-6 which should be needled with even method. Moxa is applicable.




Explanation


– Ren-12, ST-36, SP-3 and BL-20 tonify Spleen-Qi or Spleen-Yang. Warming needle on ST-36 should be applied.

– SP-6 and SP-9 resolve Dampness from the Lower Burner.

– BL-22 promotes the transformation of fluids in the Lower Burner and helps to resolve Dampness.

– Du-20 raises Qi. It can be used with a moxa stick.

– Ren-6 tonifies Qi in general.

– Ren-3 and BL-32 resolve Dampness from the genital system.


Herbal treatment



a Prescription



– WAN DAI TANG

– Ending Vaginal Discharge Decoction


Explanation

This formula from Fu Qing Zhu’s Gynaecology is for white vaginal discharge.4 The dosages indicated are from the original textbook: I would personally reduce them by at least half. The formula is designed to tonify the Spleen strongly, resolve Dampness and pacify the Liver so that it does not overact on the Spleen and also so that it consolidates the Girdle Vessel.


– Bai Zhu, Shan Yao and Ren Shen tonify Spleen-Qi and Stomach-Qi.

– Bai Shao nourishes Blood, pacifies the Liver and, being astringent, will ‘absorb’ discharges.

– Cang Zhu, Che Qian Zi and Chen Pi resolve Dampness.

– Jing Jie, charred, stops bleeding and discharges.

– Chai Hu moves Liver-Qi.

– Gan Cao harmonizes.


b Prescription



– YI HUANG TANG

– Change Yellow Decoction


Explanation

This formula from Fu Qing Zhu’s Gynaecology is for yellow vaginal discharge with Spleen deficiency and Damp-Heat.5


– Shan Yao tonifies the Spleen and Stomach.

– Qian Shi is astringent and stops discharges.

– Huang Bo and Che Qian Zi resolve Damp-Heat.

– Bai Guo directs the other herbs to the Directing Vessel, as explained by Fu Qing Zhu.


Modifications


• If there is backache and symptoms of Kidney-Yang deficiency, add Du Zhong Cortex Eucommiae and Tu Si Zi Semen Cuscutae.

• If there is abdominal pain, add Xiang Fu Rhizoma Cyperi and Ai Ye Folium Artemisiae argyi.

• If the condition is chronic and the discharge a constant trickle, add Lu Jiao Shuang Cornu Cervi degelatinatum, Wu Zei Gu Endoconcha Sepiae, Qian Shi Semen Euryales, Long Gu Fossilia Ossis mastodi (fried) and Mu Li Concha Ostreae (fried).


Three Treasures remedy



– TONIFY QI AND EASE THE MUSCLES

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. It is well suited to this condition of vaginal discharge from Qi deficiency and Dampness because it contains herbs that resolve Dampness. The tongue presentation appropriate to this remedy is a Pale body with a sticky, white coating.



Summary



Spleen deficiency


Clinical manifestations

Excessive vaginal discharge that is white or slightly yellow, sticky, without smell and persistent, dull complexion, tiredness, depression, cold limbs, loose stools. Tongue: Pale with a sticky, white coating. Pulse: Weak and slightly Slippery.



Treatment principle

Strengthen the Spleen, tonify Qi, raise Yang, resolve Dampness.



Acupuncture

Ren-12 Zhongwan, ST-36 Zusanli, SP-3 Taibai, SP-6 Sanyinjiao, SP-9 Yinlingquan, BL-22 Sanjiaoshu, Du-20 Baihui, Ren-6 Qihai, Ren-3 Zhongji, BL-32 Ciliao, BL-20 Pishu. All with reinforcing method except for SP-9 and SP-6 which should be needled with even method. Moxa is applicable.



Herbal treatment


Prescriptions



• WAN DAI TANG Ending Vaginal Discharge Decoction

• YI HUANG TANG Change Yellow Decoction


Three Treasures remedy


• TONIFY QI AND EASE THE MUSCLES


Kidney-Yang deficiency



Clinical manifestations


Profuse, white and dilute vaginal discharge resembling water or egg white, dizziness, tiredness, backache, frequent, pale urination, feeling cold. Tongue: Pale and wet. Pulse: Deep, Weak.



Treatment principle


Tonify and warm the Kidneys, consolidate the Directing Vessel, stop discharge.



Acupuncture


BL-23 Shenshu, Ren-4 Guanyuan, KI-13 Qixue, G.B. 26 Daimai, ST-36 Zusanli, SP-6 Sanyinjiao, KI-3 Taixi, Du-20 Baihui. All with reinforcing method; moxa must be used.




Explanation


– BL-23, with moxa cones, tonifies Kidney-Yang.

– Ren-4 and KI-13, with moxa cones, tonify Kidney-Yang and the Original Qi and consolidate the Penetrating Vessel.

– G.B.-26 consolidates the Girdle Vessel to stop vaginal discharge.

– ST-36, SP-6 and KI-3 tonify the Kidneys and Qi in general.

– Du-20 raises Qi. This is necessary to stop the vaginal discharge: a persistent, profuse vaginal discharge with the above symptoms indicates not only deficiency of Kidney-Yang but also sinking of Kidney-Qi in a way similar to and with the same pathology as the sinking of Spleen-Qi.


Herbal treatment



a Prescription



– NEI BU WAN

– Inner Tonification Pill


Explanation


– Lu Rong, Tu Si Zi, Rou Cong Rong and Sha Yuan Zi tonify and warm the Kidneys and consolidate the Essence.

– Huang Qi tonifies and raises Qi.

– Sang Piao Xiao is astringent and stops discharges.

– Rou Gui and Fu Zi warm the Kidneys and the Uterus.

– Bai Ji Li is probably included to regulate the ascending and descending of Qi in combination with Huang Qi. In fact, Huang Qi raises pure Qi while Bai Ji Li subdues ascending Yang: thus the combination of these two actions regulates the ascending and descending of Qi and therefore stops sinking of Qi.

– Zi Wan is probably included to regulate Qi in the chest so as to facilitate the ascending and descending of Qi between the Lower and Upper Burners.


Modifications


• If the patient has loose stools, remove Rou Cong Rong and add Bu Gu Zhi Fructus Psoraleae.


b. Prescription



– WU ZI YAN ZONG WAN Variation

– Five-Seed Developing Ancestors Pill Variation


Explanation

Related posts:

  1. Vaginal Itching (and Trichomonas and Candida Infections and Genital Eczema)
  2. Abdominal Pain after Childbirth
  3. Habitual Miscarriage
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Excessive Vaginal Discharge

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