CHAPTER 1 History of Gynecology in Chinese Medicine

Like all branches of Chinese medicine, traditional gynecology has a long history. The earliest records of gynecological medical writings date from the Shang dynasty (1500–1000 BC): bones and tortoise shells have been found with inscriptions dealing with childbirth problems. The text Book of Mountains and Seas from the Warring States period (476–221 BC) describes medicinal plants to treat infertility.

The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen) has many references to women’s physiology, anatomy, diagnosis and treatment of gynecological problems. It describes the function of the Uterus and states its connection to the Heart and Kidneys via the Bao Mai (Uterus Vessel) and Bao Luo (Uterus Channel) respectively. For example, the Simple Questions in Chapter 33 says:

In Chapter 47 it says: “The Uterus Channel connects with the Kidneys; the Kidney channel reaches the root of the tongue.”²

The very first chapter of the Simple Questions describes the hormonal changes occurring in women at 7-year intervals and attributes these to the waning and waxing of the Directing and Penetrating Vessels. The Simple Questions also describes the aetiology and treatment of amenorrhoea and menorrhagia.

The first chapter of the Simple Questions mentions for the first time the important substance Tian Gui. Tian Gui is a transformation of Kidney-Essence that occurs at puberty. In men, it is sperm; in women, it is menstrual blood and ova. Chapter 1 of the Simple Questions says: “When a girl is 14, the Tian Gui arrives, the Directing Vessel is open and the Penetrating Vessel flourishing, the period arrives and she can conceive.”³

That gynecology already existed as a speciality during the Warring States period is recorded in the Historical Annals (Shi Ji) which refers to the famous doctor Bian Que as one who ‘treats diseases under the skirt belt’ (Dai Xia Yi), i.e. a gynecologist. During the Han dynasty (206 BC–AD 220), a gynecologist was called a ‘breast doctor’ (Ru Yi) or ‘women’s doctor’ (Nu Yi). The earliest recorded gynecologists under that name were two doctors called Yi Xu and Chun Yu Yan who treated one of the empresses during the Western Han dynasty (206 BC–AD 24).

The famous doctor Zhang Zhong Jing refers in his work Discussion on Cold-induced Diseases (Shang Han Lun) to a previous book entitled Series of Herbs for Obstetrics (Tai Lu Yao Lu) which proves that even before the Han dynasty there were books dealing exclusively with gynecology, but all of these have been lost. The Discussion of Prescriptions of the Golden Cabinet (Jin Gui Yao Lue Fang Lun) by the same author has three chapters on gynecology, i.e. ‘On pregnancy’, ‘Post-partum diseases’ and ‘Women’s miscellaneous diseases’. These chapters discuss disorders of menstruation, leucorrhoea, pregnancy, miscellaneous diseases and post-partum problems. Over thirty gynecological formulae are discussed, e.g. Wen Jing Tang Warming the Menses Decoction, Jiao Ai Tang Donkey’s Hide Glue-Artemisia Decoction, Dang Gui San Angelica Powder, Gan Jiang Ren Shen Ban Xia Wan Zingiber-Ginseng-Pinellia Pill, Gui Zhi Fu Ling Wan Ramulus Cinnamomi-Poria Pill, etc. All these formulae are still widely used nowadays. These three chapters on gynecology represent one of the earliest gynecological treatises and they formed the model upon which subsequent books were based.

The Pulse Classic (Mai Jing, AD 280) by Wang Shu He, a famous doctor of the Jin dynasty (265–420), describes pulse pictures and differentiation of women’s diseases in Volume 9. This book constitutes an assimilation and systematization of the gynecological material from earlier texts, notably the Yellow Emperor’s Classic of Internal Medicine, the Classic of Difficulties and the Synopsis of Prescriptions from the Golden Cabinet. Wang Shu He also added a wealth of comment from his personal experience in the gynecological field. For example, he says that “The Kidneys govern the Uterus, and its condition is reflected at the Rear position of the pulse. If the pulse at this region does not fade on pressure, it indicates pregnancy.”⁴ In another passage he says that “A superficial pulse accompanied by abdominal pain referred to the midline of the lower back, indicates impending labour.”⁵ The book also describes the qualities of the pulse before an imminent miscarriage, normal and abnormal pulses during the post-partum stage and pulses in women with abdominal masses in relation to prognosis.

During the Sui dynasty (581–618), Chao Yuan Fang wrote the General Treatise on the Symptomatology and Aetiology of Diseases (Zhu Bing Yuan Hou Zong Lun, AD 610) which deals with gynecology and obstetrics in Volumes 37 to 44. The book describes 283 syndromes covering diseases of menstruation, leucorrhoea, pregnancy and post-partum diseases.

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