05-Apr-18
Nurturing Life
Classical Chinese Medicine and Yangsheng in Reproduction
Sydney, Australia April 7, 2018
Outline for this class
1. Intro to Classical Chinese Medicine
2. key classical texts and concepts
3. Sun Simiao and his work
4. Yangsheng
5. Reproduction in classical CM
1 05-Apr-18
Plan for this morning class from 9-12:30, then lunch break until 2
9-10: intro to the instructor, the course, and the question: what is classical chinese medicine?
10-11:30: the key classical texts and their main content:
Shennong bencaojing 神農本草經 (Divine farmer’s classic of materia medica)
Huangdi neijing 黃帝內經 (Inner classic of the yellow emperor): suwen 素問 (Plain questions) and lingshu 靈樞 (divine pivot)
Nanjing 難經 (Classic of difficult issues)
zhang zhongjing 張仲景’s shanghanlun 傷寒論 (treatise on cold damage) and jingui yaolüe 金 匱要略 (essentials from the golden cabinet)
11:30-12:30: Sun Simiao and his work, the Beiji qianjin yaofang 備急千金要方 (essential formulas worth a thousand in gold to prepare for emergencies)
intro to the topic
classics, yangsheng, reproduction: where to even start???
my journey to my current life: academic (EAS and med. anthro), mom, biodynamic goat farmer, professor at a college of classical Chinese medicine, writer on a quiet island in the puget sound
why i do what i do…
2 05-Apr-18
Introductions: My practice of medicine
AND YOURS???
QJF, vol. 26
“Zhang Zhongjing said: ‘When a person’s body is balanced and harmonious, you must merely nurture it well.’ Do not recklessly take drugs, because the strength of drugs assists only partially and causes the persons’ visceral qi to be imbalanced, so that they easily contract external trouble.
All things that contain qi provide food and thereby preserve life. Nevertheless, eating them unawares has the opposite effect (effect of creating loss). The common people use them daily without awareness, and so they hardly recognize when water and fire draw near...
3 05-Apr-18
The classical texts of Chinese medicine
Shennong bencaojing 神農本草經 (Divine farmer’s classic of materia medica)
Huangdi neijing 黃帝內經 (Inner classic of the yellow emperor): suwen 素問 (Plain questions) and lingshu 靈樞 (divine pivot)
Nanjing 難經 (Classic of difficult issues)
zhang zhongjing 張仲景’s shanghanlun 傷寒論 (treatise on cold damage) and jingui yaolüe 金匱要略 (essentials from the golden cabinet)
Shen nong bencao jing 神農本草經
“Divine farmer’s classic” jing 經 (warp) > importance of the text
bencao 本草 “roots and grasses” > materia medica
compiled from oral teachings in the late Han dynasty
originally in three volumes, divided into upper, middle, and lower substances.
edited, expanded, and restructured by Tao Hongjing 陶弘景, a famous daoist hermit (452-536 CE), with information by “famous physicians” 名醫。
organized substances by their natural origin into “precious stones” (yù shí 玉石), “herbs and trees” (cǎo mù 草木), “insects and wild animals” (chóng shòu 蟲獸) and “fruits, vegetables, rice, and grains” (guǒ cài mǐ gǔ 果菜米穀).
4 05-Apr-18
preface
• 上藥一百二十種，為君，主養命，以應天。無毒，多服、久服不傷人 。欲輕身益氣不老延年者本上經。 “Sovereigns”: Nurture “destiny,” resonate with Heaven, are non-toxic and are to be taken over in large quantities for a long time, to lighten the body, boost qi, avoid aging, and prolong life.
• 中藥一百二十種，為臣，主養性，以應人。無毒、有毒，斟酌其宜。 欲遏病補羸者本中經。 “Ministers”: Nurture [inner] nature, resonate with humanity, are partly toxic partly non-toxic, and are used to escape illness and supplement emaciation.
• 下藥一百二十五種，為左、使，主治病以應地。多毒，不可久服。欲 除寒熱邪氣，破積聚，愈疾者，本下經。 “Assistants” and “couriers”: Treat disease, resonate with earth, are mostly toxic, may not be taken over a long period of time, and are used to “expel the evil qi of cold or heat, break up accumulations, and cure disease.”
Example 1: Dang Gui
當歸 dāng guī (Root of Angelica polimorpha) Vol. 2 (Middle Grade) 味甘,溫,無毒。主咳逆上氣,溫瘧、寒熱洒洒 在皮 膚中,婦人漏下,絕子,諸惡創瘍、金創。 煮飲之。 生川谷。 Flavor: Sweet. Nature: Warm. Toxicity: Non-toxic. Alt. names: 干歸 Actions and Indications: Indicated for cough with counterflow and ascent of qì, warm malaria, cold and heat with shivering inside the skin, for women’s vaginal leaking and interruption of childbearing in women, for all malign sores and festering ulcers, and for incised wounds. Additional Information: Boil and then drink it. Grows in valleys with streams.
5 05-Apr-18
Toxicity and efficacy in the SNBCJ
shíliúhuáng 石硫黃 (sulfur) and Máfén (hemp seed; both from middle category) categorized as “toxic” but Dānshā (cinnabar, a.k.a. mercuric sulfide) and Féngzǐ (wasp, both in the highest category) as “non-toxic”!
information on long-term consumption with goals like
“avoiding aging,”
lightening the body 輕身,
通神明 facilitating the breakthrough of spirit illumination > what does this mean???
makes you a spirit immortal 神仙
Yellow Emperor: Facts or Fiction?
reigned 2697 - 2597 BCE one of the mythological founders of Chinese civilization (the so-called “Three sovereigns and Five Emperors”: Fuxi 伏羲, Nüwa 女媧, Shennong 神農, AND the Yellow Emperor 黃帝, Zhuanxu 顓頊, Emperor Ku 嚳, Emperor Yao 堯, and Emperor Shun 舜)
Shamanic rainmaking deity transformed by the zhou people into a historical figure? Granet “historicized legends.” Association of 黃(yellow) with 皇 (“sovereign”, composed of 王 and originally 自 “beginning” on top, according Shuowen) and 尪 wang “rainmaking shaman)
Sarah Allen: subterranean equivalent of the shang ancestors in the sky (association of yellow with the underworld?)
Roel Sterckx: “legendary culture hero”
Associated with yellow, earth, dragon, center, etc. > cycle of dynasties. Or with the underworld (黃泉)
6 05-Apr-18
History of the Neijing
collection of writings from the final centuries BCE (early Han, AFTER Mawangdui 馬王堆), compiled in later Han
Resulted in four books:
Suwen 素問 (plain Questions > theoretical foundations, diagnosis)
Lingshu 靈樞 (Divine Pivot > acupuncture)
nanjing 難經 (classic of Difficulties)
Taisu 太素 (Great Plainness)
Suwen and Lingshu together make up the Neijing in originally 81 chapters each.
Textual History
Ideas and language formed between 400 BCE and 260 CE.
Suwen rearranged, added to, and edited in subsequent centuries, esp. Wang Bing 王冰 in 8th century (Tang). Unschuld claims 1/3 of the text is added by Wang Bing!
collated and printed on woodblock by the Song court under Lin Yi 林 億, Gao Baoheng 高保衡, Su Song 蘇頌 etc. in 11th century > existing modern editions. Lingshu also printed but with no major editing.
Suwen first mentioned by Zhang Zhongjing in his preface.
7 05-Apr-18
Content
Dialogues of Huang Di with advisors, especially Qi Bo 岐伯 (60) and Lei Gong 雷公(7) > used as rhetorical device to link originally separate texts? Different textual layers.
Basic theories: Yinyang 陰陽, Five Phases 五行, Zang and fu organs 臟 腑, blood and qi (營衛), vessels.
pathogenic agents and diseases
diagnosis: inspection, questioning, pulses, etc.
Therapies: bloodletting, piercing, and manipulating qi AND Pharmaceutical treatments, dietetics, and heat
Suwen 2 四氣調身大論
• As such, yīn and yáng and the four seasons are the beginning and end of the ten thousand things, and the foundation of life and death. If you go against them, disaster and harm will be born. If you accord with them, severe illness will not arise. This is what is called “obtaining the Dào.” This Dào! Sages practice it, but fools adorn themselves with it. According with yīn and yáng results in life, going against it results in death.
• For this reason, the sages do not treat what is already diseased but treat what is not yet diseased, and do not put in order what is already in chaos, but put in order what is not yet in chaos. This is what I am talking about.Now to have an illness that has already formed and only afterwards treat it with medication, to have chaos that has already formed and only afterwards put it in order, this is just like being thirsty and then digging a well, or to be in the middle of combat and then forging sharp weapons. Isn’t it too late indeed at this point?
8 05-Apr-18
some gems from suwen 5 “Great Treatise on the resonant manifestations of yin and yang” 陰陽應象大論
Yīn and Yáng! They are the Dào of Heaven and Earth! They are the guide ropes and connecting threads of the Myriad Things, the father and mother of Alterations and Transformations, the foundation and beginning of giving birth and taking life, and the Palace of the shén míng.
To treat disease, you must seek it in the basics.
Thus, accumulated Yáng becomes Heaven; accumulated Yīn becomes Earth. Yīn stills and Yáng agitates; Yáng gives life and Yīn promotes growth; Yáng takes life and Yīn withdraws into storage.
Yáng creates Qì; Yīn completes the Form.
Water is Yīn; Fire is Yáng. Yáng is Qì; Yīn is Flavor…
Yīn Flavor exits from the lower apertures; Yáng Qì exits from the upper apertures. Flavor, when concentrated, is Yīn, but when diluted, is the Yáng aspect of Yīn. Qì, when concentrated, is Yáng, but when diluted, is the Yīn aspect of Yáng. Flavor, when concentrated, results in drainage, but when diluted, in open passage. Qì, when diluted, results in drainage through the surface, but when concentrated, in heat effusion….
In Heaven, there are the Four Seasons and Five Dynamic Agents. By means of these, birth, growth, harvest, and storage take place. By means of these, Cold, Summerheat, Parching, Dampness, and Wind are engendered. In humans, there are the Five Zàng Organs, which transform the Five Qì and by means of these engender happiness, anger, grief, mourning, and fear…
Yīn, being on the inside, is the safe-keeper of Yáng. Yáng, being on the outside, is the executor for Yīn.
9 05-Apr-18
難經 (classic of difficulties)
1-22: On diagnosing the channels by taking the pulse
23-29: The jingluo 經絡; 30-47: zangfu 臟腑; 48-61: on diseases
62-68: on the points (穴, cavities, “transportation holes”)
69-81: explain needling advice from Neijing.
Translated by P. Unschuld as “nan-ching. Classic of difficult issues” (UC press, 1986), complete with Chinese and japanese commentaries from 3rd c. on)
Full chinese text available on ctext.org
supposedly composed by Bian Que (Warring States) but clearly a Han text, later than the Neijing > 1st-2nd c CE
Unschuld: “significant and innovative work that marks the apex, and also also the conclusion, of the developmental phase of the conceptual system known as the medicine of systematic correspondence. The contents of the Nei-ching texts, in contrast, should be appreciated as a collection of extremely valuable transitory stages in this developmental stage — valuable because the reflect various historical steps as well as a wide range of diverging (and even contradictory) theoretical arguments.
no religion, supernatural elements BUT full-fledged system of five agents agents and yin-yang, sophisticated pulse diagnosis, etiology, organ and channel physiology, needling therapy…
10 05-Apr-18
Difficult Issue 61
六十一難曰：經言望而知之謂之神，聞而知之謂之聖，問而知之謂之工，切脈而知之 謂之巧，何謂也？
然：望而知之者，望見其五色，以知其病。聞而知之者，聞其五音，以別其病。問而 知之者，問其所欲五味，以知其病所起所在也。切脈而知之者，診其寸口，視其虛實 ，以知其病，病在何藏府也。經言以外知之曰聖，以內知之曰神，此之謂也。
The classic says: “To know by looking is called divine, to know by listening is called sage, to know by asking is called craftsmanship, to know by pulse-taking is called ingenious. What does this mean?”
Answer: Looking = see the patient’s five complexion colors to know the disease. Listening = listen to the five sounds to differentiate the disease. Asking = ask their desire for the five flavors, to know where the disease arose and where it’s at. pulse = diagnose the cunkou, observe the empty or full state, to know what zangfu the disease is in.
When the classic says “To know by the outside is to be a sage, to know by the inside is to be divine,” this is what this means.
Shanghan zabing lun
傷寒雜病論 “discussion on cold damage and the miscellaneous diseases”
late han period by Zhang Zhongjing/ji 張仲景／機 (ca. 150-219 CE), governor of changsha 長沙
later split into two texts: shanghanlun 傷寒論(discussion on cold damage, external contractions) and 金匱要略 （essentials from the golden cabinet, internal contractions)
both are translated and published by Paradigm (SHL by Wiseman, Craig mitchell, and Fengye; JG by myself and Wiseman). JG also published in two volumes by the chinese medicine database (myself and Eran Evan). More recently, Liu Guohui’s translation and small historical book on the Shanghanlun by Singing Dragon. Van Nghi’s translation into French.
Texts lost but rescued by Wang Shuhe 王叔和, court physician in the third century, then restored and printed in the Song period.
Huangfu Mi claims in the Zhenjiu jiayijing that the SHZBL is based on yī Yǐn’s Tāng Yè Jīng 湯液經 (classic of decoctions).
11 05-Apr-18
Content of the SHL
etiology focuses on cold and wind invasion
progression through the channels or “Six Conformations”: taiyang, yangming, shaoyang, taiyin, shaoyin, jueyin
diagnosis focuses on recognizing specific patterns (zhèng 証) > six- channel pattern identification 辨證論治 “differentiating pattern to determine treatment”
treatment with formulas to induce sweating, vomiting, precipitation, harmonization, warming, clearing, dispersion, and supplementation
Sun Simiao 孫思邈
China’s Greatest physician?
12 05-Apr-18
Modern view of Sun Simiao
- 581-682
- “King of Medicinals” Yao Wang 藥王 > object of popular worship
- Author of the Qian Jin Fang 千金方 （ Thousand Gold Formulary)
- Founder of medical Ethics (“On the Absolute Sincerity of the Great Physician”), Gynecology, pediatrics..... > Medical innovator
- Recluse on mt. wutai in the company of a tiger and a dragon
Official Biography:
Great intellectual talent; youth prodigy; profound and well-rounded education in Confucian, Daoist, and Buddhist literature; literary skills
Master of highly technical esoteric matters: Calendrical calculations, astrology, and physiognomy. Can foresee the future. Supernatural powers and cosmological insights.
Highest moral standards: refused to serve immoral rulers until the founding of the Tang Dynasty
Political involvement and prestige at imperial court, honored by Tang emperor, illustrious disciples > member of Tang High Society
Reclusive lifestyle after retirement
No reference to medical apprenticeship, activities, or lineage!
13 05-Apr-18
Bei Ji Qian Jin Yao Fang 備急千金要方 （Essential Formulas for Emergencies Worth a Thousand in Gold)
30 scrolls, over 5000 entries (formulas 方 fang with occasional short essays)
Internal applications (medicinal decoctions, pastes, jellies, or wines…)
External applications (ointments, hot compresses and suppositories, fumigations, baths, beauty treatments, physical manipulations, acupuncture moxibustion…)
Religious methods (talismans, exorcistic rituals, spells…)
Qigong, Meditation, diet, regulated sexual intercourse, reclusive life
Outline
Preface women
Children diseases of the seven orifices (i.e., head conditions), wind poison and leg qi4, winds, Cold damage, viscera and bowels, thirst and urinary problems, on abscesses, on hemorrhoids and fistulas, on resolving toxins and various other problems, and on emergency treatments
Dietary therapy
“yang xing” 養性 (nurturing inner nature): Cultivating health and prolonging life, i.e. reclusive lifestyle, massage, regulating qi, dietary methods, “the various prohibitions of the Yellow Emperor” (i.e. sexual taboos and methods), and “supplementing and boosting through sexual intercourse”
Vessel theory and pulse diagnostics acupuncture and moxibustion
14 05-Apr-18
Medical ethics
Qianjinfang 1.1:
論大醫習業
The Professional Practice of the Eminent Physician
Nowadays, there are diseases that are identical on the inside but different on the outside, as well as diseases that are different on the inside but identical on the outside. Therefore, abundance or deficiency in the five viscera and six bowels and the free flow or blockage of blood in the vessels and of construction and defense is certainly not something that can be observed [merely] by eyes and ears. They must first be examined by diagnosing signs...
Only those who concentrate their mind with refinement and subtlety can even begin to talk about this. Nowadays, however, affairs of the utmost refinement and subtlety are being pursued with a coarse and shallow mind. Is this not dangerous indeed?
... students must absolutely acquaint themselves to the greatest extent with the origins of medicine, studying tirelessly with absolute diligence. They may not recklessly repeat rumors and then claim that this is all there is to the Way of Medicine! Deep indeed is their self-delusion!
15 05-Apr-18
Whenever physicians treat an illness, they must quiet their spirit and settle their will, they must be free of wants and desires, and they must first develop a heart full of great compassion and empathy. They must pledge to devote themselves completely to relieving the suffering of all sentient beings.
If patients suffering from disease come to them seeking help, they may not inquire whether they are nobility or low class or poor or wealthy, old or young, beautiful or ugly,... Chinese or barbarian.... They must treat all of them exactly the same as if they were their closest relative....
Acting like this, they can serve as great physicians for the masses; acting against this, they are gigantic thieves to all sentient beings.
Aspects of Sun’s Medical Ethics?
Warning against causing harm!
self-possession and concentration
dignified appearance
treat all patients equally, no regard for wealth, gender, status, nature of ailment, potential rewards
pure life devoted to easing suffering regardless of personal hardships
abstain from luxuries
do not criticize your colleagues!
STUDY STUDY STUDY!!!!!
16 05-Apr-18
Underlying theme?
- yang sheng 養生 “Nurturing Life”
- important in Sun’s personal life and in classical medicine/elite culture in general
- Sun expands the meaning from a set of personal practices for individual health-cultivation to medical care of others!
LUNCH BREAK! back at 2 please
17 05-Apr-18
Plan for the afternoon class from two to five, with break 4-4:30
2-3:30 yangsheng: classical framework, sun simiao’s ideas, modern applications
3:30-4:30: Application in reproduction
fertility
pregnancy and birth (just briefly)
pediatrics
4:30-5:30: Discussion
cultivation in early China?
養生 …life
養身 》精＋氣＋神...the body> essence, qì, and spirit
養形…the outer form
養性 …the inner/heavenly nature
養命…lifespan/destiny
盡終其天年 etc. living out one’s heavenly alloted years versus 延 年 “extending the years” versus 屍解 “release from the corpse,” transformation from pupa to butterfly
transcendence as a 仙 (“immortals”)
18 05-Apr-18
Individual practices of cultivating health in Sun Simiao’s QIanjinfang
Exercises to cultivate qi: Dao yin (“guiding and pulling”, stretching), Breathing, and meditation
Sexual intercourse
Food: Diet and Drugs
moral cultivation and virtuous actions
lifelong studies
reclusive lifestyle of moderation and regularity, avoiding taxation
vol. 27 yang xing 養性 “nurturing one’s Inner Nature”
19 05-Apr-18
“To be skilled at nurturing one’s nature is to treat disease before it arises.”
“The ancients, in their knowledge of the Dao, followed the pattern of yin and yang, harmonized [their actions] with skills and calculations, were moderate in their food and drink and regular in their living habits, and did not recklessly overexert themselves. Therefore they were able to keep their body and spirit complete and live out their heavenly years to the fullest, only leaving after a hundred years had passed.”
“If a person’s virtue in actions is not abundant, even if they constantly take elixirs of jade and pills of gold, they will be unable to extend their longevity.”
“A person who is skilled at preserving life will not encounter ferocious tigers. This is heaven’s reward for having morality (dao de 道德).”
20 05-Apr-18
...Even if you constantly ingest alchemical preparations but do not know the art of nurturing life, it will still be difficult to extend your lifespan. The way of nurturing life is to constantly strive for minor exertion but never become greatly fatigued and force what you cannot endure! Moreover, running water does not grow stale, the door postdoes not get bug-infested. The reason for this is that they move.
The Way of nurturing life consists of never moving nor standing for a long time, never sitting nor lying for a long time, never looking nor hearing for a long time. Extended looking damages the blood, extended lying down damages the qi, extended standing damages the bones, extended sitting damages the flesh, and extended moving damages the sinews. Avoid overeating, overdrinking, and heavy lifting. Avoid anxiety and worrying, great anger, sorrow and grief, great fear, jumping about, too many words, and great laughter. Avoid eagerly jumping at your desires and avoid holding on to hatred. All of these are harmful to longevity. If you are able not to go against these [warnings], then you will be able to extend your life.
Therefore, a person who is good at preserving life constantly reduces thoughts, ideas, desires, business affairs, speaking, laughter, worrying, joy, happiness, anger, likes, and dislikes. If you can observe these twelve reductions, this is the essence of nurturing life.
This is the root to losing your life. Only a person who has neither too much nor too little [of these] is able to approximate the Way.
21 05-Apr-18
Gynecology
fertility pregnancy birth postpartum
Biomedical/European view of the Female Body derived from Greek medicine
based on ANATOMY, not FUNCTION!
“One-sex body” based on the male as the norm.
Female body as deviation because it has a UTERUS > prone to physical and psychological “disorders” and weakness >> HYSTERIA
Plato: “The womb is an animal which longs to generate children. When it remains barren too long after puberty, it is distressed and sorely disturbed, and straying about in the body and cutting off the passages of the breath, it impedes respiration and brings the sufferer into the extremist anguish and provokes all manner of diseases besides.”
Treatment: Regular pregnancies, uterine fumigations or tight bandages to hold the uterus in place. Later, hysterectomies.
22 05-Apr-18
“Yellow Emperor’s Body
- Charlotte Furth, “A Flourishing Yin” >
- “androgynous body.”
- Functionally equivalent along a yin- yang continuum
- “Diagram of the Inner Landscape” in Lei Jing Tu Yi, 1624
Yang and yin in the Body
Up --- down
Outer --- inner
6 Viscera 臟 --- 5 Bowels 腑
Male --- female
Youth/Growth/expansion --- aging/decline/contraction
Qi --- blood/essence
Yang channels --- yin channels
Dry hot climate and diet --- damp cold climate and diet
Activity --- rest
23 05-Apr-18
yin blood vs. yang essence, but yin essence vs. yang shen or qi
old age, storage, passivity and receiving, yin organs, yin channels
dampness (internal, external)
天地 tian di - heaven vs. earth.
inner and lower vs. outer and upper
kidneys/water/generativity
陰處／陰器
yin flavor vs. yang qi
yin outer body 形 vs. yang qi but yin 臟internal zang organs vs. yang fu organs 腑 or outer body (skin/flesh)
kidney water vs. heart fire
Gender in the Early medical classics
Huangdi Neijing 黃帝內經 (“Yellow Emperor’s Inner Classic”)
Jingui Yaolüe 金匱要略 (“Essentials from the Golden Cabinet”) by Zhang Zhongjing 張仲景
Zhubing Yuanhou lun 諸病源候論 (“Discussion of the Origins and Symptoms of the Various Diseases”) by Chao Yuanfang 巢元方, early 7th c.
24 05-Apr-18
Suwen “Plain Questions” Qíbó said: When girls are in their seventh year of life, their kidney qi is exuberant and their teeth change and the hair on their head grows long.
In their fourteenth year, the tiān guǐ arrives, the flow in the Rènmài penetrates, the great Chōngmài is exuberant, and the menses descend in a timely manner. Therefore they can have children.
In their twenty-first year, the kidney qi is balanced and even. Therefore the true [i.e., wisdom] teeth are born and growth reaches its limit.
In their twenty-eighth year, the sinews and bones are firm, the growth of head hair has reached its limit, and the body is exuberant and strong.
In their thirty-fifth year, the Yángmíng vessel weakens, the face becomes scorched, and the hair begins to fall out.
In their forty-second year, the three yang vessels weaken above, the face is scorched all over, and the head hear begins to turn white.
In their forty-ninth year, the Rènmài is empty (xū), the great Chōngmài is weakened and reduced, the tiān guǐ is exhausted, and the Dào of the earth is impenetrable. Therefore their physical body has gone bad and they can no longer have children.
Jin Gui Yao Lüe 金匱要略 (Essentials of the Golden Casket)
2nd c. CE by Zhang Zhongjing 張仲景
First text with special section on women’s formulas at very end (ca. 10% of total): 3 scrolls on
pregnancy: diagnosis, differentiation, treating pregnancy disorders esp. vaginal bleeding, nourishing and quieting the fetus, i.e., preventing miscarriage)
postpartum: vacuity > blood collapse (seizures, yu mao depression and veiling, difficult defecation) = Damage to liquid, dual vacuity of qi and blood, insecure interstices, vacuity of the hundred joints, abdominal pain due to stasis, incomplete elimination of 惡露 (lochia), susceptibility to external invasion
miscellaneous disorders
“Women’s disorders in the upper and middle sections of the body should be treated with general formulas. Only diseases “below the girdle” (i.e. digestive and reproductive) are specific to women and mentioned in the section at end.”
25 05-Apr-18
Zhu bing yuan hou lun 諸病源候論 (On the origins and symptoms of the various diseases)
By Chao Yuanfang 巢元方, early 7th c., a few decades before the Qianjinfang 千金方
Collection of diseases with etiologies and symptoms.
9 scrolls on women’s disorders (out of 50) at the very end
Definition of women’s diseases:
1: related to reproduction (pregnancy, obstetrics, postpartum)
2: related to women’s particular anatomy (uterus, vagina, and breasts); and
3: diseases that are particularly common in women (wind strike, digestive disorders, intercourse with ghosts, and abdominal masses)
Key Pathology:
“Leaking in Five Colors” lou wu se 漏五色
What does this mean???
26 05-Apr-18
Vaginal discharge is formed when excessive taxation damage injures and stirs up the blood in the channels, causing vacuity in the body and contraction of wind cold, which enters the uterin network vessels and strikes the blood there.
The chong and renmai are the sea of the channels and network vessels. When the renmai is diseased, a woman suffers from vag. discharge. The hand Taiyang is the Small intestine channel, and the hand shaoyin is the heart channel. The heart is a zang organ and in charge of the interior, while the SI is a fu organ and in charge of the exterior. The blood in these two chanels in women makes breast milk above and menstrual fluids below. This process is controlled by the chong and renmai.
The chong and ren start inside the uterus and when yin and yang are excessive, this damages the uterine network vessels. Wind evil seizes this vacuity and enters the womb, injuring the chong and ren, damaging the blood in the taiyang and shaoyin. This causes filthy fluids in the space of the uterine network vessels to combine with blood, connect to the dai (belt?) and then descend. When cold, it is mostly white, when hot, it is mostly red. Hence it is called daixia.
Leaking of fluids from the vagina > vaginal discharge and menstrual fluids
Cause: Childbirth > Taxation > Damage to qi and blood (勞傷血氣, 損動衝脈任脈） > Physical depletion > Susceptibility to wind/cold, which lodge in the uterus.
COLD: makes blood congeal. “Stoppage means pain” and blocks the uterus > menstrual block, infertility.
WIND: injures the channels that transport blood
>> Both affect the flow of female blood as
menstrual fluid, descending every month
nourishment to the fetus during pregnancy
breast milk, ascending into the breasts to nourish the baby.
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Sun’s view of women?
The Introductory Essay to Vols. 2-4 “Formulas for Women“ 婦人方
“The reason for the existence of separate formulas for women is that they are different because of pregnancy, childbirth, and collapse damage [i.e. vaginal hemorraging]. Therefore, women’s disorders are ten times more difficult to treat than men’s...
From the age of fourteen on, [a woman’s] yin qi floats up and spills over, [causing] a hundred thoughts to pass through her heart. Internally, it damages the viscera; externally, it injures the outward appearance. The retention and discharge of menstrual fluids is alternatingly early or delayed, stagnant blood lodges and congeals, and the central pathways are interrupted and cut off...
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…Her intake of food and drink might have been immoderate, causing not just one injury and damage. Or she may have had sexual intercourse before [vaginal] sores have healed. Or she may have squatted over the privy without proper care, [allowing] wind to enter from below and thereby giving rise to the twelve intractable diseases. For these reasons, separate formulas have been established women…
…women’s predilections and desires exceed men’s, and they contract illness at twice the rate of men. In addition, when they are affected by compassion and attachment, love and hatred, envy and jealousy, and worry and rancor, these become firmly lodged and deep-seated. Since they are unable to control their emotions by themselves, the roots of their diseases are deep and it is difficult to obtain a cure in their treatment.
Therefore, a specialist in the art of nurturing life should particularly instruct his sons and daughters to study these three scrolls of formulas for women until they comprehend them thoroughly. Then what would there be to worry or fear even in the face of a harvest of unexpected surprises? Now the Four Virtues are the pivot around which daughters set up their life. Bearing children is the adult role in women’s destiny and fate…
Causes of Women’s Vulnerability stresses of childbirth > taxation, loss of blood > depletion, physical exhaustion excess of yin qi associated with sexual maturation > emotional instability, damage to the internal organs, menstrual disorders, and irregular flow of blood and qi in the channels. openness of the body after childbirth (compounded by depletion) > invasion of wind and cold > congeal and stop flow of blood
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INterpreting the formulas in the Qianjinfang
Lists of symptoms and ingredients reflect clinical application of theory
Need to look at contemporaneus (not modern!) understanding of medicinal ingredients
>>> Primary concern = restoring healthy flow of blood, especially postpartum with elimination of “e lu” (malign dew)
Choice of Medicinals
I. SUPPLEMENTING AND BOOSTING (tonifying):
yuyuliang,
renshen
longgu
lurong
danggui
baishao
II. BLOOD-MOVING:
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Qianjinfang on “nurturing the Fetus”
short essay on “fetal education”: proper maternal behavior, esp during third month of pregnancy when “the fetus changes and transforms in response to things and its disposition and character are not yet fixed”
list of dietary prohibitions
xu Zhicai’s month-by-month prescriptions for nurturing the fetus
five “prescriptions for making the fetus slippery” 滑胎藥
Importance of Postpartum Care
1 of 3 scrolls on “women’s prescriptions”
danger of “e lu” and lack of blood flow
depletion, exhaustion, and loss of blood and qi
openness > susceptibility to cold and wind
religious observances: zuo yue zi 坐月子 “sitting out the month”
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Master Sun on Post-Partum Bleeding
“Incessant leaking of blood may be caused by recent damage to the fetus [i.e., bleeding during pregnancy] or the fact that the residual blood after childbirth has not dispersed but become solidified, preventing the entrance to the uterus from closing and causing dribbling bleeding for several days or months without stopping.
In treatment, you may not yet use the various decoctions for interrupting the blood flow. . . .
When the solidified blood has been dispersed, then the dribbling bleeding will stop on its own [since it is] also gradually being transformed, dispersed, and reduced.”
Menstrual Attunement tiao jing 調經 one of the key fields for the treatment of female patients by male physicians with medicinal decoctions and pills a window into the health of the female body menstrual diagnosis: timing of the cycle and of the period within the cycle; duration; consistency, color, amount of menstrual fluid; accompanying systems... strictly speaking, only 11%, but in larger sense together with vaginal discharge: 25% of “women’s formulas” in the Qian Jin Fang importance for fertility and general well-being
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Menstrual Diagnosis
[Female] patient determines the symptoms and explains them to the [male] physician > power!
yue jing bu tong 月經不通 (stopped menstrual flow) > alternative interpretation of absent menstruation due to pregnancy
treatment: tong xue 通血 (disinhibiting blood) > treats blocked menstruation, whether due to cold, depletion, or pregnancy.
> see formula for Ganjiangwan: first formula in chapter on stopped menstruation in vol. 4.
female bleeding weakening and destabilizing BUT MORE IMPORTANTLY a SIGN OF HEALTH!
essential for eliminating stale blood and cleansing the uterus
symbolizing cyclical regularity in the cosmos that is necessary for generating new life
free and healthy flow > absence of blockages
proper balance of blood and qi
sign of abundance of blood in the body.
>> Key pathology in women = LACK of blood flow
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Chinese Gynecology
development of a genuine medical specialization of gynecology (婦科 fu ke) as distinct from obstetrics (產科 chan ke) during the Song period (960- 1279)!
Medical field respected by the elite > production of literature.
Diagnosis and treatment of male bodies focused primarily on qi, BUT female bodies are associated with Blood: “In women, one first regulates Blood, and in men, one first regulates qi.”
“Men think of the bedroom when their essence is exuberant; women crave pregnancy when their Blood is exuberant.”
>> Development of Chinese gynecology centered around “menstrual attunement” (yue tiao 月調) as the key to both treatment and prevention of female illness.
“HUndred questions on gynecology”
importance of eliminating old stale blood to prevent disease and supporting the process of building new blood
importance of utmost care around menstruation and postpartum for long-term health with even tiny symptoms
Danger of blood desiccation 血枯
emotional aspect in women’s disorders > treat the heart as the ruler of blood and the seat of the shen.
regular menstruation as an expression of balance between qi and blood, yin and yang, as well as general physical abundance (esp. kidney)
connection of menstruation to cycles, to constancy, the wonders of nature like the tides and the moon and other cycles. “The qi of true heaven flows in communication with it. Therefore the menses flow once a month.” 天真之氣與之流通，故一月一次行
Need to diagnose menstrual disorders for either yin or yang prevailing over the other, heat or cold, blood or qi > “ harmonize the woman’s yīn and yáng and attune her qì and blood, so as to achieve the blessing of balance!”
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key channels:
Chongmai = sea of blood,
renmai in charge of uterus and fetus,
Hand taiyang (small intestine) and
shaoyin (heart) inhibited menstruation:
wind and/or cold, affecting the uterine network vessels in particular
blood desiccation or binding, instead of flowing freely
fright or fear, falling > affects the heart and therefore the shen > blood scatters
taxation damage (esp. sex and drink) > liver! > blood desertion
chronic taxation with physical lumps and slowly progressing emaciation > violent anger, fright and fear damaging the liver.
sexual taxation consuming jing and causing sudden emaciation > kidney
pediatrics
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故今斯方﹐先婦人、小兒﹐而後丈夫、耆老 者﹐則是崇本之義也。
“Now the present collection of treatments is arranged by placing the treatments for women and children first, and those for husbands and the elderly afterwards. The significance of [this structure] is that it venerates the root.”
Classical Chinese pediatrics
Sun Simiao’s work is not an isolated masterpiece! quotes many other texts that are now lost.
in the Sòng period (960-1279), it became a respected specialization, like gynecology! with many specialized textbooks, physicians and professors specializing in pediatrics, course of education etc.
see the following introduction to vol. 5 of the Qianjinfang:
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“Among the Daos for engendering humans (生人之道 shēng rén zhī dào), none fail to produce the big by nurturing the small (莫不以養小為大). Without attention to the small, death ensues before the big is completed. For this reason, the Yì Jīng 易經 (“Classic of Changes”) says: ‘[Enable] that which is small to come together so as to complete that which is big….’
…the force of qì is still feeble in small children, and medical masters (醫士) need to take great care to rescue and cure them and meritoriously offer their services to help them recover from serious conditions.
The majority of present-day students fail to hold on to this intention. For this reason, when infants in swaddling clothes are concerned, surrounded by the foul stench of breast milk, how dare we look down on those doctors who perform heroic acts?
But in reference to [those doctors who] withdraw [from caring for babies], all I can do is sigh deeply!…
養小之術 >> Connection to 養生 “nurturing life” >> high estimation of pediatrics and gynecology (including fertility and prenatal and postnatal care) in Chinese medicine to this day!!!
Suwen 5: 治病必求于本。”To treat disease, we must return to the root!”
importance of nurturing processes at their inception, in the formative stage!
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Qianjinfang, vol. 5
balances his repeatedly stated preference for “treating disease before it arises” (治未病 zhì wèi bìng) and his desire to address the real practical needs of his readers to “prepare for critical situations” (備急 bèi jí) > combination of preventative care and treatment of urgent conditions!
13 essays, 289 formuals, 39 moxibustion methods, 2 incantations, and some other techniques.
more essays than in other volumes with mostly just lists of formulas >
greater focus on prevention and early diagnosis?
fragility of kids > actual medical treatment too dangerous and harsh?
Personal speciality of Sun Simiao?
Content outline
1: Preface, neonatal development, transformations and steamings, selecting a wet nurse
2: neonatal care: cutting the cord, swaddling, treating the navel, breastfeeding, bathing, thrush, sudden neonatal death, foretelling the baby’s life.
3: Fright seizures (Diagnosis + treatment with formulas and moxibustion)
4: Intrusive upset and possession (Diagnosis + treatment with formulas, moxibustion, and spells
5 and 6: Cold damage and cough
7: abdominal accumulations (aggregations, binds…)
8: skin conditions
9: miscellaneous other treatments
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32 days: Transformation“transformations I and Steamings”
64 days: Transformation(變蒸 II + steaming biàn zhēng)
96 days: Transformation III
128 days: Transformation IV + steaming
160 days: Transformation V
192 days: Transformation VI + steaming
224 days: Transformation VII
256 days: Transformation VIII + steaming
288 days: Transformation IX
>> ten transformations and five minor steamings.
then three major steamings on
days 384, 448, and 576: spaced 64 days later, another 64 days, then 128 days.
“In all cases, there are ten transformations and five minor steamings, and then three major steamings, which take place within a total of 576 days [after birth]. When the major and minor steamings are all finished, [the baby] has become a human being.
The reason why babies pass through these transformations and steamings is so as to make their blood and vessels thrive and alter their five zàng organs. For this reason, as soon as the first transformation is finished, you can sense a difference in their condition right away.”
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What are they?
Chao Yuanfang: “they signify the growth of blood and qì. transformations means the ascent of qi, while steaming means generalized heat. The key sign by which to differentiate transformations and steamings from conditions of heat or cold damage is that the body is hot but the ears and buttocks are cold.”
Sun simiao quotes this, then continues:
Transformations and steamings can be mild or severe.
Mild: Generalized heat with mild fright, cold ears and buttocks, white blisters breaking out on the upper lip and head that resemble fish eyes or pearls, and slight sweating.
severe: vigorous generalized heat with a disordered pulse, sweating or no sweating, lack of appetite, vomiting right after nursing, and slight redness in the white of the eye and slight whiteness in the black of the eyes.
Alternatively: whiteness of the eyes signifies severity, while redness or blackness signifies mildness. When the transformations and steamings are finished, the eyeballs become bright! This is the evidence [that this stage is over].
Transformations are mild on their own but can be more acute when combined with steamings.
Steamings normally abate in 5 days but may last 10 days.
max. 5 days before and 5 days after (the specific day) > heat is expelled
Timing: may be early or late.
“Furthermore, at the time of the onset of transformations, there are some cases where the heat is severe and fails to subside, in violation of the number of days. Calculate the days of transformations and steamings precisely as the correct times when you should see heat and mild fright. Beware: You must not treat [this with medications] or apply moxibustion or acupuncture! Only keep them company and observe them.”
“During this time, protect babies from fright, activity, and crowds of people.”
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Differential treatment seasonal warm disease, whether as a complication of steamings or on its own, is distinguished by pervasive heat, including in the ears and buttocks, and the absence of white blisters above (or “in the top of”?) the mouth. in such cases, give “black powder” to promote sweating and eliminate the heat through downward movement (i.e., urination and defecation) with “purple pills” (see below). complication with cold: bending and twisting and incessant crying. Applying a hot compress with result in instant recovery.
“Transformations and steamings are similar to severe warmth seen in cold damage. it is not a case of a transformation or steaming, you will see generalized heat with heat in the ears and also in the buttocks. This signifies that it is a different condition, which you may manage with additional treatment.
If you have identified the condition as a transformation or steaming, you may not administer additional treatment.”
“Fright” 驚 jīng
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Do not let them hear loud noises and, when holding them in your arms, be still and gentle. Do not let them be frightened or startled!
Moreover, when there is thunder in the sky, plug the children’s ears and at the same time make some other subtle noises in order to distract them.
Whenever you are rearing small children, always expose them to mild fright, in order to lengthen their blood vessels, but you do not want to expose them to great fright.
[If they have been exposed to] great fright, apply moxibustion to the fright vessels.
> Suwen 28: “Needle seizures with fright in the vessels in five places: Needle the hand’s Tàiyīn five times, needle the Tàiyáng channel five times, needle once to the side of the hand’s Shàoyīn channels and network vessels, needle once on the foot’s Yángmíng, and needle three times by the ankle, five cùn above.”???
Instability of the heart
In all cases of small children suffering from any illnesses forming in the abdomen, generalized cold and heat result. As the result of the cold and heat, the blood stirs in the vessels, and as the result of this stirring, there is instability in the heart.
Instability of the heart then results in a tendency to contract fright, and the fright then results in the speedy outbreak of seizures.
seizures are malign and mean disaster if the doctor is not called in in time. BUT “for qi to erupt on the inside, there must be [external] signs beforehand. so “constantly scrutinize the jingshen and pick up on the signs”!
Black coloring in the vessel in the white flesh of the hand at Yuji (LU-10) > seizures
red vessel at yuji > heat
green-blue and enlarged > cold. Green-blue and fine > health!
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Seizures
Etiology
In Childhood: 臟氣不平 “visceral qi is not even/level/balanced.” right at birth: 五臟不收斂﹐血氣不聚﹐五脈不流﹐骨怯不成也。“The Five zàng organs fail to contract, the blood and qi do not gather, the five vessels do not flow, and the bones are timid and incomplete.”
Suwen 3: When yang is too strong and cannot be kept close together, yin qi is cut off. When yin is level and yang is held back, the jīngshén (“essence and spirit”) can be treated. When yin and yang dissociate, jīng and qì are cut off.” children are pure yáng. if the yáng aspect of their zàng qì (qì also being yáng) is not consolidated, it can flow in fits.
Timid bones: timidity is associated with the gallbladder. Foot shaoyang GB channel is associated with the bones. Suwen 25: “earth obtains wood and thereby breaks through to the surface” (土得木而達). Here: Yáng wood is not functioning right (“timid bones”) > association with liver, wood, spring/generation etc, and also with WIND!
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From Month 1 to first birthday: can also be due to unstructured breastfeeding or care, disharmony of qi and blood, or being struck by wind evil!
yáng seizures: generalized heat, then tugging and slackening, fright with wailing and crying, and THEN outbreak of seizures > still in the fu organs and skin > easy to treat.
yīn seizures: generalized cold, no fright, tugging, or crying, THen outbreak with sunken pulse > progressed to zàng organs, bones and marrow > difficult to treat.
Differentiating 癇 and 痙 xián: “seizures”, often translated as “epilepsy,” but that should be 癲癇 diān xián. jìng: “tetany” xián: when the body goes limp and the patient regains consciousness in due time (時 醒). jìng: when the patient does not regain consciousness in due time (不時醒) > arched- back rigidity, body rigid and straightened.
In Jìng, if the spine is lifted so far off the floor that you can place a hand sideways in adults or 3 fingers in kids > untreatable. differentiate:
pulse: floating vs. sunken and then large vs. small, slippery vs. rough, vacuous vs. replete, slow vs. rapid.
disease location: yin vs. yang, exterior vs. interior
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Sabine’s concerns
Sun Simiao mentions over and over the need to avoid drastic measures, to upset the body’s balance, the danger of causing death by wrong treatment!
35 formulas on cough alone > need for very careful differential treatment. no mention of acupuncture whatsoever, but some moxibustion and many washes and some massage pastes. eliminate pathogens, especially heat and retained food, but without weakening a very fragile and extremely vulnerable newborn body. dangers of external intrusion due to weakness of external defenses.
>>> Need for protective measures, preventative care, careful and EARLY diagnosis, and immediate action. the formulas here are “Emergency formulas” so don’t use unless you have to!
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