Jin Gui

Yao Lue -

Essential Prescriptions of the Golden Cabinet

Chapter 20
Womens Pregnancy
Pulses, Signs, Treatments
 OVERVIEW

This and the following two chapters discuss womens diseases

in terms of pulses, signs, and treatments under heading of
Pregnancy (ren shen), Postpartum (chan hou), and
Miscellaneous Disease (za bing).

This section is rich in content, comprising 45 lines and 40

formulas, which address menstrual disorders, vaginal
discharge, pregnancy, delivery, and miscellaneous other
diseases.

It is of great value in terms of both theory and clinical

application, and served as the foundation from which
gynecology was developed several centuries later.
 OVERVIEW

The present chapter deals with commonly occurring

diseases of pregnancy. It includes information on the
early diagnosis of pregnancy, on differentiating
pregnancy from pathological concretions, on treating
common diseases of pregnancy like retching and
vomiting, abdominal pain, vaginal bleeding, difficult
urination, water swelling, and on nourishing and quieting
the fetus.
 OVERVIEW
Emphasis is placed on diagnosing pregnancy early and
on treating pregnancy-related abdominal pain and
vaginal bleeding in accordance with the symptoms,
because these aspects directly affect the development
of the fetus.
Reckless treatment with strong medicinals if pregnancy
is misdiagnosed as disease, or lack of treatment in
cases of abdominal pain or vaginal bleeding during
pregnancy, can all endanger the safety of the fetus
and possibly lead to miscarriage or premature
delivery. Therefore, the text discusses these aspects in
greater detail.
SCHEMATIC OVERVIEW

Diagnosis
1. Diagnosis of early stage pregnancy: No menstrual
period for 60 days, a normal pulse, with thirst, inability
to eat, and no [aversion to] cold or heat [effusion].
2. Differentiating pregnancy from concretion.
a. Concretion: pre-existing concretion disease, with
interrupted menstruation for less than three months,
incessant spotting, and a sensation like stirring fetus
above the umbilicus.
b. Pregnancy: menstruation uninhibited in the three
months before pregnancy and fetal stirring in the sixth
month of pregnancy.
 Malign Obstruction

1. Spleen-Stomach disharmony.
a. Signs: A normal pulse, but with slight weakness in the
yin pulses, and with thirst, inability to eat, and no aversion
to cold or heat.
b. Formula:
Qui Zhi Tang(Cinnamon Twig Decoction)

2. Stomach vacuity and cold rheum.

a. Signs: Incessant retching and vomiting in pregnancy.
b. Formula:
Gan Jiang Ren Shen Ban Xia Wan ( Dried Ginger,
Ginseng, and Pinellia Pill)
 Abdominal Pain

1. Yang vacuity with exuberant cold.

a. Signs: A string like pulse with heat abdominal pain,
and aversion to cold, and the lesser abdomen feeling as if
fanned.
b. Formula:
Fu Zi Tang(Aconite Decoction to warm yang and disperse
cold).

2. Liver-Spleen disharmony.
a. Signs: Tense pain in the abdomen.
b. Formula:
Dang Gui Shao Yao San (Chinese Angelica and Peony
 Uterine Obstruction

1. Concretion with vaginal bleeding.

a. Signs: Pre-existing concretion disease, and with
interrupted menstruation for less than three months, incessant
spotting, and a sensation like stirring fetus above the
umbilicus.
b. Formula:
Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill)

2. Thoroughfare and Governing Vessel vacuity cold.

a. Signs: Vaginal bleeding and abdominal pain (called
uterine obstruction)
b. Formula:
Jiao Ai Tang (Ass Hide Glue and Mugwort Decoction)
 Difficult Urination

1. Blood vacuity and damp-heat with qi

depression transforming into dryness.
a. Signs: Difficult urination with normal eating and
drinking.
b. Formula:
Dang Gui Bei Mu Ku Shen Wan (Chinese Angelica,
Fritillaria, and Flavescent Sophora Pill) to nourish
the blood, disperse binds, and cleat heat.
 Water Swelling

1. Qi transformation obstructed.
a. Signs: Generalized heaviness, inhibited
urination, aversion to cold as if after a soaking, and
dizzy head.
b. Formula: Kui Zi Fu Ling San (Mallow Seed and
Poria Powder) to free the orifices and disinhibit
water.
Stirring Fetus
1. Blood vacuity with damp-heat causing internal
obstruction:
Dang Gui San (Chinese Angelica Powder) to nourish
the blood and fortify the spleen and to clear and
transform damp-heat.

2. Spleen Vacuity with cold-damp collecting:

Bai Zhu San(White Atractylodes Powder) to fortify
the spleen and warm the center, and eliminate
dampness and quiet the fetus.
Diagnosis & Treatment :
Womens Pregnancy Pulses, Signs, Treatments

Line 1: (P 542)
Normal Pulse: moderate pulses that indicate no sign
of illness
Yin position: refers to the cubit position; anterior to
the bar is referred to as yang, the posterior is yin.

Gui Zhi Tang

Gui Zhi Tang

Clinical application:
In additional to vomiting in pregnancy, this formula
can be used to in the treatment of habitual
miscarriage, abdomen pain and dribbling urinary
block in pregnancy, leakage of breast mil,
postpartum spontaneous sweating or night sweats,
menstrual pain associated with SP deficiency and
disharmony of Yin and Yang.
 Modification

With vomiting:
+ Chen Pi, Sha Ren, Fa Ban Xia and Zhu Ru

With Qi deficiency:
+ Dang Shen, Huang Qi, Bai Zhu

With habitual miscarriage:

+ Dang Gui, E Jiao, Shu Di Huang
Differentiation & Treatment
Line 2 : P 544
Concretions:
a kind of abdomen mass accompanied by pain and
distention, usually with a definite form and a fixed
location.
Coagulated blood:
refers to stasis blood, dark purple in color, in this case
associated with concretion.

Gui Zhi Fu Ling Wan

Gui Zhi Fu Ling Wan
Gui Zhi
Fu Ling
Mu Dan Pi
Tao Ren
Shao Yao

Clinical Application:
Menstrual pain, lochia, retention of dead fetus (with
pattern of static blood obstructing internally.)
 Modification:
With hysteromyoma:
+San Leng, E Zhu, Mu Li, Bei Jia
With ovarian cysts:
+ Xiang Fu, Ze Lan
With chronic pelvic inflammation with excess fluid:
+ Ze Xie, Yi Yi Ren, Sheng Huang Qi, Yi Mu Cao
With endometriosis:
+Xue Jie, Yang Hu Suo, Chuan Lian Zi, Xia Ku Cao
With ovarian tract blockage:
+ E Zhu, Wang Bu Liu Xing, Guan Zhong, Dan Shen, Zao Jiao Ci,
Lu Lu Tong, Jin Yin Hua, Lian Qiao, Tu Fu Ling
With Amenorrhea:
+ Yu Jin, Ju Luo (Vascular Aurantii), Shi Chang Pu
Case Study (1)
Tubal Lumps with Abdomen Pain
P 546
Disharmony of the LV & SP

Line 5: P 548
Dang Gui Shao Yao San
Dang Gui
Shao Yao (heavy dosage to nourish LV and check P)
Fu Ling
Chuan Xiong (use with caution during pregnancy)
Bai Zhu
Ze Xie
Clinical Application:

Menstrual pain, dizziness, irregular menstruation, and

abdominal pain in pregnancy.

Modification:
With KD deficiency: + Tu Si Zi, Xu Duan, E Jiao, Sang Ji
Sheng
With fetal malposition or threatened miscarriage: + Tu
Si Zi, Xu Duan, Sang Ji Sheng
With Chloasma: + Bai Zhi, Tian Men Dong, Yi Yi Ren, Yu
Zhu
Uterine Obstruction
Line 4: P 551(descent of Blood)
Jiao Ai Tang (Xiong Gui Jiao Tang/ Jiao Ai Si Wu
Tang)
Chuan Xiong
E Jiao
Gan Cao
Ai Ye
Dang Gui
Shao Yao
Gan Di Huang
Jiao Ai Tang
(Xiong Gui Jiao Tang/ Jiao Ai Si Wu Tang)

Spotting: scant uterine bleeding outside the

menstrual period; another related condition is
called flooding, which represents with heavy blood
flow and abnormal vaginal bleeding.
Late Miscarriage: pregnancy for over 3 months
where the fetus is formed but miscarries
spontaneously.
Uterine obstruction: lower abdomen pain in
pregnancy attributed to deficiency of Qi/Blood
with malnourishment of the uterine vessels.
Jiao Ai Tang
(Xiong Gui Jiao Tang/ Jiao Ai Si Wu Tang)

Pathomechanism:
The penetrating vessel is know as the sea of the blood,
and the conception vessel is said to govern the fetus.
Spotting or incessant spotting following late miscarriage
cause depletion of the penetrating and conception
vessels, and failures to secure the fetus results, also
accompanied by abdomen pain. Even these 3 conditions
appear in different biological periods, the
pathomechanism involves deficiency cold in the
penetrating and conception vessels with failure to
contain blood.
Jiao Ai Tang
(Xiong Gui Jiao Tang/ Jiao Ai Si Wu Tang)
Treatment method:
Blood nourishing, blood stanching, channel warming and
fetus quieting.

Clinical Application:
A number of gynecological bleeding disorders including
functional uterine bleeding, threatened abortion, and
habitual abortion when associated with patterns of
deficiency cold in the penetrating and conception
vessels with Qi and Blood dual deficiency
Modification:
For spotting without abdomen pain, remove Chuan
Xiong
With profuse menstruation, reduce the dosage of
Dang Gui; + Di Yu
With Qi deficiency, + Huang Qi, Dang Shen
With Uterine spotting, stirring fetus: + Du Zhong,
Sang Ji Sheng
With aching of the limbs and Lumbus: + Xu Duan,
Du Zhong, Sang Ji Sheng
Case study (2)
P 553
 SUMMARY

Disease Associated Signs and Principles of Formula

Pattern Pathomechanisms Symptoms Treatment
Abdominal Kidney yang depletion, Abdominal pain, Warm yang, dissipate Fu Zi Tang (Aconite
Disease of
Pain yin-cold/ false heat aversion to cold, cold, warm the Decoction)
Pregnancy heat effusion, uterus, quiet the fetus
wiry pulses
Abdominal Liver-spleen Abdominal Nourish blood, Dang Gui Shao Yao
Pain disharmony hypertonicity harmonize the liver, San(Chinese
and pain strengthen the Angelica and Peony
spleen, eliminate Powder)
damp
Uterine Blood descent, Incessant Nourish blood, stanch Xiong Gui Jiao Ai
obstruction deficiency cold in the spotting, bleeding, warm the Tang (Ligusticum,
penetrating and abdominal pain, channels, quiet the Chinese Angelica,
conception vessels. dizziness, fetus Donkey-Hide
blurred vision, Gelatin, and
fatigue Mugwort
Decoction)
 SUMMARY

Disease Associated Signs and Principles of Formula

Pattern Pathomechanisms Symptoms Treatment
Concretions Concretions, static blood, Incessant Dispel stasis, Gui Zhi Fu Ling Wan
Disease of
blood failing to stay in spotting, disperse (Cinnamon Twig and
Pregnancy the vessels abdominal pain concretion, Poria Pill)
and distention, stanch bleeding
masses
Malign Cold rheum obstructing Incessant Warm the Gan Jiang Ren Shen
obstruction the middle, stomach vomiting, nausea, middle, dissipate Ban Xia Wan (Dried
deficiency cold, qi aversion to food cold, downbear Ginger, Ginseng, and
disharmony counter-flow Pinellia Pill)
Strangury in Blood deficiency, Difficult urination, Nourish blood, Dang Gui Bei Mu Ku
pregnancy constrained heat, damp- yellow urine, clear heat, Shen Wan (Chinese
heat brewing in the distending relieve Angelica, Fritillaria,
bladder abdominal pain constraint, and Flavescent
eliminate damp- Sophora Pill)
ness
Water Fetus obstructing bladder Generalized Disinhibit water, Kui Zi Fu Ling San
swelling qi transformation, water- heaviness, invigorate yang (Mallow Seed and
damp accumulation, clear inhibited Poria Powder)
yang failing to upbear urination,
aversion to cold,
 SUMMARY
Disease Associated Signs and Principles of Formula
Pattern Pathomechanisms Symptoms Treatment

Stirring Blood Deficiency with Movement of the Nourish blood, Dang Gui San
Disease of
Fetus damp-heat, liver-spleen fetus, abdominal strengthen the spleen, (Chinese Angelica
Pregnancy disharmony pain, retching, clear heat, eliminate Powder)
nausea, history of dampness
miscarriage
Stirring Spleen deficiency cold- Abdominal and Strengthen the spleen, Bai Zhu San
Fetus damp epigastric pain, no warm the middle, dispel (Atractylodes
appetite, profuse dampness, quiet the Macrocephala
vaginal discharge, fetus Powder)
movement of the
fetus, vomiting
Fetal Exuberant heart fire, Abdominal Clear heart fire, resolve Needle guan yuan
damage heart-fire exploiting fullness, inhibited water-damp, invigorate (CV-4) and lao gong
lung-metal urination qi and blood (PC-8)
heaviness below
the lumbus