Gynecology Class 5 Practical Therapeutics of TCM, Wu - PowerPoint Presentation

Slide1

Gynecology

Class

5

Practical Therapeutics of TCM, Wu

Obstetrics & Gynecology in Chinese Medicine,

Maciocia

Slide2

Mammary Abscess

Acute purulent disease of the breast, most often observed in first time mothers during 3-4 week post-partum breast feeding

Western medicine: acute mastitis which recognizes staphylococcal bacteria as its causative agent

Slide3

Etiology & Pathogenesis

Stages

Initial Stage – Coagulation of Milk

Purulent Stage – Formation of Pus

Rupture Stage – Discharge of Pus

Slide4

Initial Stage

Coagulation of Milk

Clinical Manifestations

Swelling, distention, pain and formation of masses in the breast and hindrance of the secretion of milk, often accompanied by aversion to cold, fever, headache, oppression in the chest, nausea, irritability, thirst

Tongue: thin yellow or yellow slimy coating

Pulse: rapid, wiry or rapid, floating

Tx

Soothe Liver, Clear the Stomach, promote lactation, dissipate binds

Slide5

Initial StageCoagulation of

Milk (2)

Acupuncture Rx

Needle with draining: Gb-21; Ren-17; St-36; St-34; St-18; Liv-14; PC-6

Fever and aversion to cold: LI-4; LI-11

Headache: Gb-20

Inability to secrete milk: SI-1

Marked Qi Stagnation: Liv-3

Severe swelling and pain of the breast: GB-41

Slide6

Initial StageCoagulation of

Milk (3)

Herbal Rx

Gua

Lou

Niu

Bang Tang

Gua

Lou,

Niu

Bang

Zi

, Jin Yin

Hua

,

Lian

Qiao

,

Tian

Hua

Fen, Huang Qin, Shan

Zhi

Zi

, Chai Hu, Qing Pi, Chen Pi,

Zao

Jiao

Ci

,

Gan

Cao

Severe redness, swelling and pain of the breast:

chuan

shan

jia

,

wang

bu

liu

xing

,

dan

shen

High Fever: Shi

Gao

,

Zhi

Mu

Marked Qi stagnation:

Ju

Ye, Mai

Ya

Retention of Lochia: Dang

Gui

,

Chuan

Xiong

, Yi Mu Cao

Slide7

Initial StageCoagulation of

Milk (4)

In cases where breast masses fail to disperse after treatment, the overuse of cold

medicinals

has led to stagnation of qi and blood, slight pain in the breast, disappearance of fever, wiry, tardy pulse, thin

whiteh

tongue coating

Si Ni San Modified

Chai Hu,

Bai

Shao,

Zhi

Shi,

Zhi

Gan

Cao

Add: Lu Jiao Jiao,

Chuan

Shan

Jia

Slide8

Purulent Stage

Formation of Pus

Clinical Manifestations

Enlargement of the mammary masses and an increase in breast swelling, redness of the skin of the breast, continuous high fever, thirst and and an increase in the severity of breast pain, which is constant and throbbing, A softening of the center of the masses that elicits a sensation of wavelike motion on palpation is a definite sign of purulence.

***

In cases where masses are deeply situated, a mammary biopsy may be necessary to make a definite diagnosis

***

Slide9

Purulent StageFormation of

Pus (2)

Tongue: yellow coating

Pulse: wiry, rapid

Tx

Clear heat-toxin, quicken the blood, promote lactation, discharge pus

Herbal Rx

Gua

Lou

Niu

Bang Tang

Gua

Lou,

Niu

Bang

Zi

, Jin Yin

Hua

,

Lian

Qiao

,

Tian

Hua

Fen, Huang Qin, Shan

Zhi

Zi

, Chai Hu, Qing Pi, Chen Pi,

Zao

Jiao

Ci

,

Gan

Cao

Slide10

Purulent StageFormation of Pus

(3)

Increase the strength of the prescription to quicken, discharge pus:

chuan

shan

jia

, dang

gui

wei

, chi

shao

In cases of poor constitutions where the pus is not easily discharged:

huang

qi, dang

shen

,

chuan

xiong

Slide11

Rupture Stage

Discharge of Pus

Clinical Manifestations

Discharge of pus from the breast, gradual return of normal body temperature, disappearance of swelling and pain and gradual healing of the superficial lesions

Tongue: thin yellow coating

Pulse: slight rapid or weak

Tx

Regulate qi and blood, clear remaining evils

Slide12

Rupture Stage

Discharge of Pus (2)

Herbal Rx

Si Miao Tang

Huang Qi, Dang

Gui

, Jin Yin

Hua

,

Zhi

Gan

Cao

In cases where discharge of pus is poor, where the swelling and pain have not diminished and when the fever has not subsided, it is possible that pus has invaded other lobules of the mammary gland. In such cases, evils have not been completely discharged and treatment of the initial and purulent stages of mammary abscess should be continued

Slide13

Rupture StageDischarge of Pus

(

3

)

When milk is observed to escape through the lesion after the rupture of a

carabuncle

, the condition is know in traditional Chinese Medicine as mammary fistula.

Tuo

Li Xiao Du San

Huang Qi, Jin Yin

Hua

,

Chuan

Xiong

, Dang

Gui

,

Bai

Shao,

Bai

Zhu,

Ren

Shen

, Fu Ling,

Bai

Zhi

,

Zao

Jiao

Ci

,

Jie

Geng

,

Gan

Cao

Slide14

Morning Sickness

Patterns of nausea and vomiting during the first trimester of pregnancy, especially during the morning hours.

Severe cases in Western medicine can lead to dehydration, electrolyte imbalance and acidosis

Etiology & Pathogenesis

Spleen & Stomach Vacuity

Liver & Stomach Disharmony

Slide15

Spleen & Stomach Vacuity

Clinical Manifestations

Nausea and vomiting, or vomiting upon ingestion of food during first trimester of pregnancy, vomiting of clear mucus, bland sense of taste, fullness and distention of the epigastrium and abdomen, tiredness, and drowsiness

Tongue: pale with moist white coating

Pulse: Slippery, forceless

Tx

Fortify the Spleen, Harmonize the Stomach,

Downbear

Qi, Relieve Vomiting

Slide16

Spleen & Stomach

Vacuity (2)

Acupuncture Rx

Needle with Supplementation

St-36;

Ren

-13; Ren-12; Sp-4; PC-6

Needle with even supplementation, even draining

Fullness & distention of the epigastria and abdomen: Ren-10

Cases accompanied by phlegm-rheum: Sp-9; St-40

Slide17

Liver & Stomach

Disharmony

Clinical Manifestations

Vomiting of acid or bitter fluids during early pregnancy, fullness of the chest, costal pain, belching, frequent sighing, distended sensation of the head, dizziness and vertigo, mental depression, thirst, bitter taste in the mouth

Tongue: Slippery yellow coating

Pulse: Slippery, wiry

Tx

Needle w/ draining: PC-6; Liv-3; St-36; Ren-12

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Liver & Stomach

Disharmony (2)

Oppression in the chest and costal pain: Ren-17

Vomiting of bitter fluids: Gb-34

Distended sensation of the head & dizziness: Du-20; Yin Tang

Herbal Rx

Su Ye Huang

Lian

Tang

Zi

Su Ye, Huang

Lian

Assist calming the Stomach & relieve vomiting: Jiang Ban Xia, Chen Pi, Zhu

Ru

, Wu Mei, Huang Qin

Slide19

Liver & Stomach

Disharmony (3)

Severe vomiting with injury to bodily fluids, red tongue, dry mouth: Lu Gen,

Bei

Sha

Shen

, Shi Hu

Frequent vomiting and decreased food intake leading to depletion of both qi & yin, w/ symptoms of emaciation, listlessness, weakness of limbs, dry lips and mouth, decreased urine, dry stools, red tongue w/ thin dry yellow coat or peeled coat, slippery rapid

thready

forceless pulse combine

Sheng Mai Yin

&

Zeng

Ye Tang

Slide20

Liver & Stomach

Disharmony (4)

Sheng Mai Yin

Ren

Shen

, Mai Men Dong, Wu Wei

Zi

Zeng

Ye Tang

Xuan

Shen

, Mai Men Dong, Sheng Di

Add: Chen Pi, Zhu

Ru

,

Tian

Hua

Fen

Slide21

Postpartum

Abdominal Pain

Postpartum lower abdominal pain most frequently observed in first-time mothers

Etiology & Pathogenesis

Blood Vacuity

Blood Stasis

Slide22

Blood Vacuity

Clinical Manifestations

Dull postpartum lower abdominal pain, , softness of the abdomen, pain relieved with pressure, discharge of small amount of light-colored lochia, dizziness and vertigo, tinnitus, hard dry stools

Tongue: pale with thin coating

Pulse:

thready

,

forcelesss

Tx

Supplement the Blood, Boost Qi, Regulate and rectify the Chong and

Ren

, Relieve Pain

Slide23

Blood Vacuity (2)

Acupuncture Rx

Needle with supplementation, add

moxibustion

Ren-4; Ren-6; UB-17; St-36; Sp-6

Dizziness and vertigo: Du-20; Si

Shen

Cong

Hard Dry Stools: Kid-6; Sj-6

Herbal Rx

Chang

Ning

Tang

Dang

Gui

,

Shu

Di,

Ren

Shen

, Shan Yao, E Jiao,

Xu

Duan

, Mai Men Dong,

Zhi

Gan

Cao, Rou

Gui

Slide24

Blood Vacuity (3)

Severe depletion of bodily fluids with dry stools: (Delete: Rou

Gui

) Add: Rou Cong

Rong

In cases of vacuous blood w/ cold, pale greenish complexion, lower abdominal pain – relieved when heat applied, cold extremities, slow,

thready

pulse

Dang

Gui

Jian

Zhong

Tang

Dang

Gui

,

Gui

Zhi

,

Bai

Shao,

Zhi

Gan

Cao, Sheng Jiang, Da

Zao

, Yi Tang

Slide25

Blood Stasis

Clinical Manifestations

Postpartum lower abdominal pain worse with pressure, sometimes relieved with heat; discharge of a small volume of dark purple lochia, clots, distention and pain of the chest and hypochondria

Tongue: Dark colored w/ white coating

Pulse: Deep, tight or rough, wiry

Tx

Quicken the Blood, Dispel Stasis, Dissipate Cold, Relieve Pain

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Blood Stasis (2)

Acupuncture Rx

Needle with draining; add

moxibustion

UB-17; Sp-10; Sp-6; Ren-3; Liv-3

Predominant signs of cold: Ub-23; Ren-17

Distention of the chest &

hypochondrium

: Liv-14; Ren-17

Inability to pass lochia: Ren-6; Ren-7

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Threatened Miscarriage

In TCM, threatened miscarriage refers to two different conditions:

Leaking fetus: uterine bleeding during pregnancy

Stirring fetus: frequent fetal movement, abdominal pain, bearing down sensation, slight vaginal bleeding

Etiology & Pathogenesis

Kidney Qi Depletion

Qi & Blood Vacuity

Blood Heat

Traumatic Injury

Slide28

Kidney Qi Depletion

Clinical Manifestations

Slight vaginal bleeding during pregnancy, dark discharge, lower backache, and in some cases, a bearing down sensation and pain in the abdomen, dizziness, vertigo, tinnitus, frequent urination, polyuria at night, urinary incontinence in severe cases.

In some cases, a history of frequent

miscarraiges

Tongue: pale with white coating

Pulse: deep, weak, slippery

Tx

Secure the Kidney, Boost Qi, Calm the Fetus

Slide29

Kidney Qi Depletion (2)

Herbal Rx:

Shou

Tai Wan

Tu

Su

Zi

, Sang

Ji

Sheng,

Xu

Duan

, E Jiao

Fortify Spleen & Boost Qi: Dang

Shen

,

Bai

Zhu

Urinary Incontinence: Yu

Zhi

Ren

, Fu Pen

Zi

Slide30

Qi & Blood Vacuity

Clinical Manifestations

Slight vaginal bleeding during pregnancy, discharge that is thin and pale, red, and in some cases, pain and bearing down sensation of the lower back and abdomen, with

tirednes

, fatigue, pale complexion, palpitations, shortness of breath

Tongue: pale with thin white coating

Pulse:

Thready

, slippery

Tx

Supplement Qi, Nourish the Blood, Secure the Kidney, Quiet the Fetus

Slide31

Qi & Blood Vacuity (2)

Herbal Rx

Tai Yuan Yin Modified

Ren

Shen

,

Shu

Di,

Bai

Zhi

, Du

Zhong

,

Bai

Shao, Chen Pi,

Zhi

Gan

Cao, Dang

Gui

Delete: Dang

Gui

Add: Huang Qi, E Jiao

Slide32

Blood Heat

Clinical Manifestations

Vaginal bleeding during pregnancy, discharge that is bright red in color, pain, distention and bearing down sensation of the lower back and abdomen, irritability, dry mouth and throat, dark, scanty urine and constipation

Tongue: Red with dry yellow coating

Pulse: Rapid, slippery or wiry, slippery

Tx

Nourish Yin, Cool the Blood, Clear Heat, Quite the Fetus

Slide33

Blood Heat (2)

Herbal Rx

Bao

Yin

Jian

Sheng Di,

Shu

Di, Huang Qi, Huang

Bai

,

Bai

Shao, Shan Yao,

Xu

Duan

,

Gan

Cao

Cool the Blood, Relieve Bleeding, Quiet the Fetus: Zhu Ma Gen

Heavy Vaginal Bleeding: E Jiao, Han

Lian

Cao

Lower Backache:

Tu

Su

Zi

Slide34

Traumatic Injury

Clinical Manifestations

History of falling, twisting the back of overstrain during pregnancy, resulting in vaginal bleeding; or lower backache and abdominal distention and bearing down sensation

Tongue: Normal; in some cases dark

Pulse: Slippery, forceless

Tx

Supplement Qi, Regulate Blood, Quiet Fetus

Slide35

Traumatic Injury (2)

Sheng Yu Tang

Huang Qi,

Ren

Shen

, Dang

Gui

,

Chuan

Xiong

,

Shu

Di, Sheng Di

Secure the Kidney & Quiet the Fetus:

Tu

Su

Zi

, Sang

Ji

Sheng,

Xu

Duan

Heavy Vaginal Bleeding: (Delete: Dang

Gui

,

Chuan

Xiong

) Add: Ai Ye; E Jiao

Slide36