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TCM OBGYN – HistoricalDevelopmentIntegra(ve Women’s Health Program

Introduction TCM OBGYN has a rich history ofdevelopment spanningapproximately the last 2,000years Much of the focus has beencentered around concep(on,pregnancy, and postpartum care A wealth of knowledge havebeen documented in the“Classics”

The Essential Beginning The Earliest - 216 AD, Dr ZhangZhong Jing 张仲景, Jin Gui YaoLue – Essen(al Prescrip(ons ofthe Golden Cabinet 金金匮要略略 ,3 Chapters 20-22 on Pulse,PaYerns, and Treatments ofDiseases in Pregnancy,Postpartum Disease, andMiscellaneous GynecologicalDiseases.

To Now - Zhong Yi Fu Chan Ke Xue 中医妇产科学“TCM Science of OBGYN” First Edi(on Published in 2001and Second Edi(on Published in2011 by People’s MedicalPublishing House Co. Editors are Dr. Liu, Min Ru 刘敏如, and Dr. Tan, Wan Xin 谭万信,and wriYen by over 73 wellknown TCM OBGYN doctors. Most comprehensive text andthe most widely used for TCMand Integra(ve OBGYN.

Study Approach to the History andDevelopment of TCM OBGYN Since most informa(on in clinical medicine has been preserved anddocumented in the “Classics” books, our approach is to gainunderstanding and apprecia(on of these ”Classics” through achronological process. There are countless books that have contributed to this field. In thislecture, we will focus on ones that have greater impact on thedevelopment of TCM OBGYN.

Shan Shui Jing 山水經Book of Mountains and Seas Mul(ple unknown authors,476-221 BC, Warring States It contains descrip(ons ofgeological features, loca(ons,medicines, and animals. The earliest text that describedof medicinal plants to treatinfer(lity.

Huang Di Nei Jing Su Wen 黃帝內經素問Yellow Emperor’s Classic of InternalMedicine – Simple Questions Numerous unknown authors,99-26 BC, Warring States to HanDynasty Discussions between Huang Diand his ministers such as Qi Bo,Lei Gong, Bo Gao, Yu Fu, ShaoShi, Gui Yu Qu, and Shao Yu onmostly health issues. Many references to OBGYN andfirst fundamentals of Fe Ke

Su Wen and Anatomy First to men(on: Nv Zi Bao (Female Womb) Bao Mai – Womb Meridian Bao Luo – Womb Collateral Nv Zi Bao – It has func(ons of Zang and Fu. It acts like Zang when it can transform Jing, Qi and Blood to Nourish Fetus andCreate Menstrual Flow. It acts like Fu when it can store and discharge Jing, Qi, and Blood It is therefore considered as an Extraordinary Fu Organ (Qi Heng Zi Fu 奇恒之腑) Bao Mai – It belongs to the Heart and connects to Bao Bao Luo – It belongs to the Kidney and connects to Bao

Su Wen and Physiology It described 7x7 and 8x8 reproduc(ve physiology for both woman andman. It first described the func(on and the importance of Tian Kui, Chong,Ren, and Kidney Qi in reproduc(on. It also described the unique female physiology of menstrua(on,pregnancy, labor, and breasjeeding.

Su Wen and Pathology It pointed out the woman tends to have “excessive Qi and deficientBlood”. This paved the founda(on for blood nourishing method oftreatments. It described pathology underlying abnormal uterine bleeding,amenorrhea, abnormal vaginal discharges, infer(lity, Zheng Jia (pelvicmass), dysphonia during pregnancy, etc. “Excessive sadness depletes Bao Luo, Yang Qi moves internallyupward to disturb the Heart, the regula(on of Blood is impaired,causing abnormal uterine bleeding”. It describes for the first (meemo(onal factor can be a disease causa(ve factor.

Su Wen and Diagnosis It pointed out the observa(on ofcolor changes and other changesbelow the nose can be anindica(on of female reproduc(veorgan issues especially the lips andphiltrum. It described that the more obviousmovement of Hand-Shao YinChannel pulse can be an indica(onof pregnancy. It also described that weakness ofboth Kidney (Chi) pulses can be anindica(on of amenorrhea.

Su Wen and Herbal Therapy It described Si Wu Zei Gu Yi Lu Ru Wan (四乌贼骨 一芦茹丸), acombina(on of Endoconchasepiae (Wu Zei Gu) and Rubia cordifolia(Qian Cao) 4:1, one of the only 13 formula(ons that appeared inNeijing, used in irregular menstrua(on, deple(on of menstrua(on.

Shi Ji 史記Historical Annals Si Ma Qian 司馬遷, exact (meunknown, Han dynasty. Descrip(ons of history fromHuang Di era to the Han dynasty(221 BC to 220 AD) (440 Years) Described first specialty ofOBGYN Bian Que 扁鵲. It also documented two clinicalcases of amenorrhea andlacta(on deficiency.

Han Shu 漢書Book of Han Han Shu is a history bookcovering the first part of the HanDynasty (206 BC to 23 AD). It described installa(on offemale OBGYN specialty doctorsin the imperia court, the famousones are Yi Xu (义姁), and ChunYu Yan (淳于衍). The use of herbs to causeabor(on and abnormal fetushave been documented.

Hou Han Shu 後漢書Book of the Later Han Also known as History of theLater Han, is a Chinese courtdocument covering the historyof the Han dynasty from 6 to 189AD. It documented the famedphysician Hua Tuo 华佗 usingMa Fei San 麻沸散 and ShenGao 神膏 in the performance ofabdominal surgery and removaland dead fetus.

Tai Chan Shu 胎产书The Book of Pregnancy, Labor andPostpartum Ma Wang Dui excava(on inChangsha discovered over 3000cultural relics. Tai Chan Shu was one of the 15medical related booksdiscovered documen(ng indetail 10 months of gesta(on,labor and postpartum care in theHan Dynasty.

Tai Chan Shu 胎产书The Book of Pregnancy, Labor andPostpartum It described when it is the best(me to begin intercourse toconceive (3 days amer themenstrua(on is completelyclear). It described 10 months ofembryology and the concept ofYang Tai 养胎 (Nourish Fetus) It described the concept and theimportance of Tai Jiao 胎教(Fetal Educa(on)

Nourish Fetus According to theGestational Month (Zhu Yue Yang Tai 逐 月养胎)First MonthForma(on of EmbryoSecond MonthForma(on of GelThird MonthForma(on of FetusFourth MonthForma(on of Blood fromWater EnergyFimh MonthForma(on of Qi from FireEnergySixth MonthForma(on of tendon andligaments from MetalEnergySeventh MonthForma(on of Bone fromWood EnergyEighth MonthForma(on of Skin, Fasciaand Muscles from EarthEnergyNinth MonthForma(on of Hairfrom ”Stone” EnergyTenth Month – All Organs are formed, Receiving Energy from Heaven and Earth, Ready to be Delivered

Shen Nong Ben Cao Jing 神农本草经The Classics of Herbal Medicine It was wriYen in the Han Dynasty. It lists 365 different herbs fortherapy. It classified herbs intohigher, average, and lower gradesas well as categorized herbs intoplants, animals, and minerals. It included many herbs that arewidely used in OBGYN. It also renamed Nu Zi Bao to ZiGong. It stated that Wind Cold aYack tothe Zi Gong in woman can causeinfer(lity for ten years.

Jin Kui Yao Lue Fang Lun 金匱要略方論Discussion of Prescriptions of the GoldenChest Zhang, Zhong Jing 张仲景, 219AD, Han dynasty. Later edited by Wang, Shu He 王叔和, Lin, Yi 林林亿, and Sun, Qi孙奇. 3 volumes, herbal and foodtherapies for variety of diseases. 3 chapters on gynecology, over30 formularies described ands(ll used today.

Jin Kui Yao Lue Fang Lun 金匱要略方論Discussion of Prescriptions of the GoldenChest Gui Zhi Fu Ling Wan 桂枝茯苓丸for Zheng Jia 癥瘕 (pelvic mass) Jiao Ai Tang 胶艾汤 forabnormal uterine bleeding withpelvic pains includingoccurrences during pregnancyand amer an abor(on. Dang Gui Shao Yao San 当归芍药散 for gesta(onal pelvic pain. Gan Mai Da Zao Tang 甘麦 大枣汤 for Zang Zao 脏躁, depressiveand anxiety disorders Wen Jing Tang 温经汤 formenopausal abnormal uterinebleeding

Jin Kui Yao Lue Fang Lun 金匱要略方論Discussion of Prescriptions of the GoldenChest Introduc(on to the prac(ce and concept of vaginal douche andsuppository. Fan Shi Wan suppository 矾 石丸 for leukorrhea, vaginal infec(ons,amenorrhea due to stagnant blood and clots. She Chuang Zi San 蛇床 子散 for Yin-Cold type of leukorrhea andvaginal infec(ons Lang Ya Tang 狼牙汤 for vaginal parasi(c infec(ons such asTrichomonas

Mai Jing 脈經Pulse Classic Wang, Shu He 王叔和, AD 280, Jindynasty First book that created a systemicframework for pulse diagnosis It also collected and synthesizedearlier works such as Nei Jing, NanJing, and Jin Kui in pulse diagnosisand diagnos(c differen(a(ons. OBGYN pulse descrip(ons anddifferen(a(ons appears in Chapter9 of total 10 chapters in the book.

Mai Jing 脈經Pulse Classic “Chi posi(on, Kidney pulse,when it is persistent whenpressed, it is pregnancy.” “Three levels of pulse – floa(ng,middle and deep; when they arecon(nuous and linked up, it ispregnancy.” It also discussed about Li JingMai 离经脉– speeding up pulsethat occurs during labor. It provided new terminologies: Ju Jing 居经 – menstrua(on thatcomes every three months Bi Nian 避年年 – menstrua(on thatcomes once a year Ji Jing 激经 – menstrua(oncon(nuing even amer pregnancydiscovery

Zhu Bing Yuan Hou Zong Lun 諸病源候總論General Treaties on The Symptomatologyand Etiology of Disease Chao, Yuan Fang 巢元 方,imperial physician, AD 610, Suidynasty A major work on E(opathology. It is the earliest systemized workon e(ology, symptoms, and signsof diseases. It classified 67diseases and 1,739 syndromes. 283 syndromes covering OBGYNprovided strong founda(on one(opathology understanding.

Zhu Bing Yuan Hou Zong Lun 諸病源候總論General Treaties on The Symptomatologyand Etiology of Disease “Irregular menstrua(on iscaused by overstrainingconsuming Qi and Blood. Thiscause the body to be weakened.Weakened body easily aYractedWind Cold invasion, causingblockage in the interior of Bao胞内, damaging Chong RenChannels, damaging Hand TaiYang and Shao Yin channels”

Qian Jin Yao Fang 千金要方Thousand Golden Ducat Prescriptions Sun, Si Miao, AD 652, Tang dynasty. Collected 5300 herbal formularies,expanded on Zang Fu theories andother fundamentals. It describedvarious TCM treatments such asacupuncture, food therapy,massage, Dao Yin, etc. 3 comprehensive volumes onOBGYN. A metal knife should never used tocut umbilical cord.

Formation of Imperial Medical System During Tang Dynasty 618 – 907 AD,establishment of imperial medicaldepartment. It is the first formalized educa(onalins(tu(on to train doctors for theloyal family as well as for thegovernment officials. Due to the educa(onal influences,there are now more publishedbooks on OBGYN during this periodof (me. Notables are: Bei Ji Qian Jin Yao Fang 备急千 金金要 方 Prescrip(ons Worth a Thousand inGold for Every Emergency Wai Tai Bi Yao 外台秘要 Medicalsecrets of an official Jing Xiao Chan Bao 經效產寶Treasure of Obstetrics

Bei Ji Qian Jin Yao Fang 备急千金要方Prescriptions Worth a Thousand in Gold for Every Emergency Sun, Si Miao 孙思邈 Authored Bei Ji Qian Jin Yao Fang in652 AD. (It is frequentlyabbreviated as Qian Jin Fang) 30 chapters on clinical medicine,acupuncture, dietary therapy,preven(on, and sanita(on. Itcollected 5,300 herbalformula(ons. 3 chapters on OBGYN, collected540 herbal formula(ons in thesethree chapters.

Bei Ji Qian Jin Yao Fang 备急千金要方Prescriptions Worth a Thousand in Gold for Every Emergency He pointed out for the first (methat infer(lity can be causedproblems from both man andwoman and not just womanalone. He wrote extensively onantepartum, intrapartum, andpostpartum care. He expandedon treatments for difficult laborsin both herbal and acupuncturetherapies

Wai Tai Bi Yao 外台秘要Medical Secrets of an Official Wang, Dao 王焘 A clinical therapy book thatincluded 40 chapters, and over6,000 herbal formula(ons. There are two chapters onOBGYN around 85 different typeof condi(ons and over 480herbal formula(ons.

Jing Xiao Chan Bao 經效產寶Treasure of Obstetrics Zan, Yin 昝殷, 853 AD, Tangdynasty. 41 chapters, 374 formularies, onpregnancy, labor and postpartumissues. Firs specialty book on TCMObstetrics It described maternal care, laborand delivery. It described care for preeclampsiaand eclampsia.