| ObjectiveLeukorrheal diseases, also known as "white vaginal discharge", or "filthy flow", mainly refers to the significant increase in the amount of vaginal discharge and the significant change of color, quality and odor, accompanied with the body or local symptoms. It’s equivalent to an increase in vaginal discharge induced by Western Medicine vaginitis, cervicitis, pelvic inflammatory disease, gynecological cancer and other diseases. In TCM, it is a common gynecological clinical syndrome with a high incidence, just as the saying goes,9of10women are with leukorrheal diseases ". In addition to having the characteristics of a high incidence, it has a high recurrence rate, therefore it is second only to Menopathy as the most frequently met diseases in gynecology. It lingers long, recurs often and is difficult to recover soon, accompanied by prolonged menstruation, shortened cycles, irregular bleeding between periods, etc., leading to miscarriage, infertility, intrauterine infection during pregnancy, premature rupture of membranes and other diseases. If treatment is not given timely or completely, it may bring prolonged course of illness, and patients will get insomnia, neurasthenia, anxiety, depression and other neuropsychiatric symptoms which seriously affect women’s health.Physicians from ancient to modern times have made much discussion on leukorrheal diseases, many of which were representative. From the starting point of Yellow Emperor and Synopsis of Golden Chamber to Ming and Qing Dynasties and Modern times, schools of physicians and scholars have contended intensively. The contention during Song and Yuan Dynasties is particularly prominent, new academic points of view emerging, followed by a reform in diagnosis and prescription, enhancing the level of theory and clinical results. Up to the Ming and Qing Dynasties, all kinds of medical works have been unprecedently rich. They were mainly the summarization of former dynasties’ theories. Authors discussed some new ideas and made classified analysis of concepts, disease etiology, syndromes, therapy, prescription and prognostic outcome, such as Nv Ke Jing Lun, Fu Ke Yu Chi, Golden Mirror of Medical Origin and others. The understanding are more comprehensive, closer to clinical practice treatment and the diagnosis and treatment tend to be more systematic and theoretic. Syndrome differentiation of leukorrheal diseases gradually formed into an important theoretical system, and it’s the closest in time to the present time, leaving important influence on future generations of physicians. The modern understanding and research of leukorrheal diseases has become complete, and gradually formed a system of theories. The geographical characteristics of the diagnosis and treatment began to emerge and gradually developed into different schools, which can be described as a new milestone in the history of the development of Gynecology. The knowledge of modern TCM gynecology field on leukorrheal diseases has been deepening. Modern medicine believes leukorrheal diseases are mainly caused by the invasion of bacteria, viruses, protozoa and other invasive infections or reproductive tract flora imbalance. Inflammation may be confined to one area or multiple sites; illness can be slight or serious. The slight cases are asymptomatic and the severe may cause sepsis or septic shock and death. From the treatment methods of leukorrheal diseases, modern medicine mostly uses systemic anti-inflammatory and (or) local anti-inflammatory methods. Although these methods can temporarily kill bacteria or parasites, they often cause reproductive system inflammation due to the reproductive system flora imbalance. How to effectively sterilize while maintain the normal ratio of the flora is the key to the prevention and treatment of leukorrheal diseases in modern medicine. Besides, modern medicine has little effect on leukorrheal diseases caused by non-genital inflammation (known as non-inflammatory leukorrheal diseases).Based on the above results, despite the fact that in the diagnosis and treatment of leukorrheal diseases, TCM has made encouraging progress, there are still many problems. Modern scholars focus on clinical work, especially on drug and acupuncture clinical treatment research and on their efficacy evaluation, lacking of literature discussion of their application evidence.The Chinese ancient literature, for the Chinese people and even for the world, is a huge precious treasure house. This study takes the documents of the diagnosis and treatment of leukorrheal diseases as a whole. Based on the ancient literature, it takes time as the main arbor, and explores leukorrheal diseases’ origin and development from the vertical angle of academic development, and categorizes documents from the horizontal macroscopic angle. It takes the major physicians’ works as the outline, finds out the new problems in their diagnosis and treatment of leukorrheal diseases, and summarizes the new theories and achievements; pays attention to the connection between Lingnan leukorrheal disease diagnosis and treatment and other regions; digs the underlying academic views; strengthen the interaction study from the global perspective and regional perspective, refines Lingnan regional rules and provides evidence for today’s clinical workMethodsAdopt literature review and theoretical comment methods to complete the dissertation. Literature review includes literature search, data collection, identification, categorization, assembly and so on. The author focused on reading ancient Chinese medicine works on diagnosis and treatment of leukorrheal diseases and checked the origin of modern literature. The list of the original ancient TCM works includes Chen Ziming’s Compendium of Good Remedies for Women, Xue Ji’s Summary of Gynecolog, Wan Quan’s Wan’s Gynecology, Zhang Jiebin’s Jing Yue’s Complete Works· Regulations for Woman, Fu Shan’s Fu Qingzhu’s Gynecology, Xiao Xun’s Nv Ke Jing Lun, Chen Nianzu’s Gynecology Essence, Shen Yaofeng’s Shen’s Gynecology, Shen Jin’ao’s Fu Ke Yu Chi, Chen Jiayuan’s Secret Gynecological Prescriptions, unknown authors’Secret Books for Gynecology and Selected Inherited Gynecology Experience and Lingnan physician Sheng Duanming’s Selected Liu Cheng Zhai Medical Copies, He Mengyao’s Compilation of Gynecology Essence, Xie Zelin’s Gynecology Handouts, Lv Chubai’s Selected Gynecology Handouts and other books which amount to more than50in total. The author obtains first-hand information from these original ancient books. Therefore, the literature related to leucorrhea diseases in this paper have not been cited before.The author has made full use of ancient Chinese works commented and corrected by people of recent times, such as Must-read Series for TCM Clinical Work by People’s Health Publishing House, Summary of Rare Ancient Chinese Medicine Works by Chinese Ancient Books Publishing House, Rare Collection of Recent TCM Works by Zhejiang Science and Technology Press, A Complete Collection of Famous Physician’s Works in Ming and Qing Dynasties by China TCM Press (medical works collection of13doctors in Ming Dynasty and17doctors in Qing Dynasty), A Complete Collection of Famous Physicians’Works in Tang, Song, Jin and Yuan Dynasties (a total of22physicians’work of four dynasties).In the part of modern famous experienced TCM doctors’academic experience of leukorrheal disease diagnosis and treatment, the author made analysis and categorization of their academic views and clinical experience with reference to A Series of100TCM Clinical Physicians in A Century with Zhang Wenkang as the chief editor published in2000by China TCM Press and Collection of Famous TCM Physicians of Recent Times with Zhu Shizeng as the chief editor published in2009by Shanghai TCM University Press. Besides ancient TCM works, the author also referred to Chinese Biomedical Literature Database (CBM), Chinese Scientific Journals Database (VIP periodical database), Wan Fang Database and manual searches, etc. Local medical literature of Lingnan comes from Medical History Office of Guangzhou University of Chinese Medicine, library of Guangzhou University of Chinese Medicine, Guangdong Provincial Sun Yat-san Library.Theoretical Comment Method:Based on obtaining the original data, the author made comments according to historical period. Features of TCM diagnosis and treatment of leukorrheal diseases are different in each period. The author adopts methods of traditional interpretation, classification and analysis, clinical interpretation and relevant comparison, etc. to comment on ancient physicians’diagnosis and treatment experience as well as explore their academic connotation and clinical value.With literature research and theoretical comment methods, the author completed the thesis consisting of three parts. The first part discusses the history of TCM diagnosis and treatment of leukorrheal diseases. It takes dynasties as the vertical key link and reviews medical works of Qin, West and East Han, Jin, Tang, Song, Jin, Yuan, Ming and Qing dynasties, until the Republic periods, as well as recent and modern times, including Historical Records, Internal Classics, Classic of Difficult Questions, Synopsis of Golden Chamber, etc. The second part categorizes the modern famous TCM physicians’literature with focus on connotation of leukorrheal disease diagnosis and treatment theories, discussing the concept of leukorrheal diseases, pathogen, pathogenesis, differentiation characteristics, prescription, medicine and treatment, medical case examples and prevention, etc. The author selected, classified, and explored representative literature. The third part is the attachment. It is the categorization of Lingnan literature about the diagnosis and treatment of leukorrheal diseases. It is a continuation in modern times of regional academic school.ResultsThe first part discusses the academic origin of TCM diagnosis and treatment of leukorrheal diseases. The following characteristics for the historical periods are classified:①The origin of TCM diagnosis and treatment of leukorrheal diseases can be traced back to the period of Internal Classics. In the chapter of "Gu Kong" in Simple Questions, it says if diseases occur in Ren Channel, men may have seven types of hernia and women have abnormal mass of vaginal discharge. From it on, leukorrheal disease appeared as the official name of disease in medical books; Synopsis of Golden Chamber also adopted this name of disease, pioneering in applying the drug in vaginal tract to cure gynecological diseases; while in Sima Qian’s Historical Records, there is a record of Bian Que, famous physician of the Warring States period, which says when Bian Que traveled across Handan, he smelled a lady and offered treatment to her as a physician of leukorrheal disease. Que was taken as the physician of leukorrheal disease, just like pediatricians as smallpox physicians. Although smallpox was just one of the pediatric disease, it occurs to most people. From this, it can be said that leukorrheal diseases refer to obstetrics and gynecology diseases in a broad sense at that time.②In Wei, Jin, Sui and Tang dynasties, TCM knowledge of diagnosis and treatment of leukorrheal diseases gradually deepened. On one hand, it followed the Qin and Han’s tradition of using leukorrheal diseases to refer to gynecological diseases extensively. In General Treatise on the Cause and Symptoms of Diseases, it has such theories that there are five types of leukorrheal diseases, there are36diseases connected with leukorrheal diseases and it may cause infertility. The etiologies are mainly six evils, seven emotions or fatigue damage. The pathogenesis is Chong and Ren meridian injury. The disease site is in external genital organ and develops into the waist, abdomen, sash and other parts. In diagnosis and treatment, there are special prescriptions and drugs. It also refers to diseases caused by blockage of limbs, meridians, organs caused by pathogenic factors. On the other hand, A Supplement to Recipes Worth A Thousand Gold added sudden onset of leucorrhagia, mixed white and red water to the disease name, so as to be distinguished from dysentery, or mixed white and red phlegm. These three are all feculence from the external genital organs. To this period, dysentery, white phlegm and leukorrheal diseases have been identified from each other gradually.③Medical theory was innovated in Song, Jin and Yuan dynasties. This, to a large extent, developed the theory of TCM diagnosis and treatment of leukorrheal diseases. Four representative physicians in Jin and Yuan dynasties have made a new breakthrough in diagnosis and treatment of leukorrheal diseases. Liu Wansu, Zhang Yuansu and Zhang Zihe believed that it was caused by heat and doctors should clear the heat and attack the evil; Li Dongyuan distinguished leukorrheal diseases with spleen insufficiency, believed it was connected with spleen and stomach insufficiency and yin fire, so the treatment method should be rising yang and reinforcing spleen; Zhu Danxi maintains it was caused by wet phlegm, and treatment should be clearing wet heat, sputum, and insufficiency. These comments have a profound impact on the treatment of leukorrheal. diseases. The disease belongs to a gynecological disease. Chen Ziming’s Compendium of Good Remedies for Women says vaginal discharge is the first disease for women. For woman, blood is the basic element, therefore, the root of treatment lies in the nurturing of blood with modified Decoction of Four Elements. Qi Zhongfu’s A Hundred Questions in Gynecology answers the question of how to identify leukorrheal disease from continuous menstruation:when the dirty fluid and blood and leucorrhea flow together, if it’s cold, it is mostly leucorrhea; if it’s hot, mostly it is blood; if it lasts long, mostly it is continuous menstruation. In Song Dynasty, leukorrheal disease didn’t refer to gynecological disorders extensively, and some physicians have confined it to leucorrhea with bloody discharge and leucorrhea. In Yan Yonghe’s Van’s Prescriptions for Succouring the Sick says people today are mainly suffering from leucorrhea with bloody discharge and leucorrhea.④The theory and clinical experience in Ming and Qing Dynasties of TCM diagnosis and treatment of leukorrheal diseases have become more mature. Four concepts of menstruation, leucorrhea, pregnancy and birthgiving formed. Leukorrhea disease was confined to the limit of mixed white and red leucorrhea, red leucorrhea and white leucorrhea. Multiple channels and ways were adopted for syndrome differentiation of leucorrhea diseases. School aggregation phenomena appeared, such as Xue Ji’s Summary of Gynecology, Zhang Jiebin’s Jing Yue’s Complete Works· Regulations for Woman, Zhao Xianke’s Handan manuscripts and Wan Quan’s Wan’s Gynecology. They believed that leukorrhea diseases were caused by deficiency of Spleen and Kidney Qi, so doctors should warm and reinforce spleen and kidney. Xiao Xun’s Nv Ke Jing Lun believed it was caused by wind cold and Ren Channel deficiency and warm heat. Fu Shan’s Fu Qingzhu’s Gynecology believed it was brought about by dampness plus spleen qi deficiency, liver qi stagnation, dampness and heat invasion. Febrile disease expert Wang Mengying believed leukorrheal diseases in most cases were not caused by deficiency or coldness, so in treatment, Ye Tianshi always used phellodendron bark. It can be clearly seen the academic tendencies of clearing heat in treating leucorrhea diseases. Ming and Qing physicians also found famous prescriptions with definite clinical effect, such as Wan Dai Decoction in Fu Qingzhu’s Gynecology and prescriptions in Chen Jiayuan’s Secret Gynecological Prescriptions.⑤Republic Period. With the introduction of modern Western medical knowledge, Tang Rongchuan, Zhang Xichun and Zhang Shouyi, etc. were advocates of integration of modern Western Medicine and TCM. Tang Rongchuan proposed the slogan of "integration of modern Western Medicine and TCM". Zhang Xichun in his Records of Tradition Chinese and Western Medicine in Combination proposed integrating two kinds of medicine for leucorrhea disease treatment and recorded that Western Medicine believes if there’s white dysentery, there is large intestine disease; if there’s leucorrhea, there’s uterus disease. Apply water of catechu, alum, pomegranate bark and Aleppo gall to clean. Zhang Shanlei conducted TCM education and compiled Correction for Shen’s Gynecology which was used as a popular textbook. Gynecological diseases, including leucorrhea diseases in Republic period also adopted gynecological examination skills and doctors communicated their experience through academic journals. The second part focuses on sorting out academic research experience of modern gynecology doctors, including33famous TCM Physicians like Ye Xichun, Po Fuzhou, Zou Yunxiang, Wang Weichuan, Wang Shenxuan, Zhu Xiaonan, Gong Zhixian, Cheng Menxue, Han Bailing, Qiu Xiaomei, Zhao Fen, Xu Rongzhai, Ha Litian, Huang Zongxu, Qiu Maoliang, Xu Yushan, Huang Shengwu, Zhu Chenyu, Yu Shenchu, Zheng Kuishan, Ban Xiuwen, Pang Panchi, He Zihuai, He Ren, Wang Ziyu, Cai Xiaosun, Chai Haoran, Ding Qihou, Xu Zhihua, Xia Guichen, Zhang Liangying and Men Chengfu, etc. Modern concept of leucorrhea disease covers pelvic inflammatory disease, cervicitis, vaginitis, pruritus vulvae and other modern diseases involving vaginal discharge volume, color, quality and smell abnormalities; in etiology and pathogenesis, syndrome differentiation and treatment of leucorrhea disease, modern famous experienced physicians mainly follow previous theories, for example they followed Fu Shan’s law that white leucorrhea is caused by fire deficiency due to excess dampness, qi weakness due to liver stagnation, spleen qi injury and decline of spleen qi which leads to leucorrhea instead of nurturing blood. However, modern understanding of differentiation types is more mature. It believes it’s a dampness disease, and the treatment should focus on dampness, including external and internal dampness. Internal dampness is caused by dysfunctional organs, while external dampness is caused by dampness evil invasion which leads to dysfunctional Ren and Dai Channel. Leukorrheal diseases’ pathogenesis lies mainly in the spleen, kidney, liver, and external dampness and dampness poison. Or it is caused by Ren and Dai Channel dysfunction because of spleen qi injury, the spleen disorders, and aggregated nutrition and body fluid which are not able to be distributed. Or it is caused by Ren and Dai Channel dysfunction because of kidney yang and essence qi of Lower Jiao deficiency, or by liver qi stagnation and spleen function disorder. Or it is caused because of living in damp places, or being invaded by dampness poison or filth. However, the key cause is still dampness evil, causing injury of Chong and Ren Channels. In the treatment of leukorrheal diseases, doctors all agree and emphasize analyzing the quality, quantity, color, shape, and smell of leucorrhea and most cases are in combined type of deficiency and excess with few complete deficiency or excess cases. Treatment should focus on modulating the spleen, kidney, liver, and also the Chong, Ren and Dai Channels. In clinical medicine, modern physicians mostly advocate the oral intake of medication assisted by smoked lotion and topical drug and the combination helps shortening the course of treatment. TCM herbs and acupuncture may be applied in multiple points, resulting in multiple effect. But if no effect is achieved for a long period of time, further examination is needed to rule out organic causes.As the Attachment, the third part is the literature and academic experience categorization of the diagnosis and treatment of leukorrheal diseases of physicians in Lingnan Region, where the author lives. Ge Hong’s Prescriptions for Emergent References in Jin Dynasty described the diagnosis and treatment methods of leukorrheal diseases and drugs, which proves that there are at least1,600years for Lingnan TCM doctors’diagnosis and treatment of leukorrheal diseases with TCM and herbs. The academic characteristics of Lingnan ancient physicians’diagnosis and treatment of leukorrheal diseases are listed as follows in this thesis:①Syndrome of leukorrheal diseases were caused by damp heat and spleen deficiency due to excess dampness. Damp heat develops into leucorrhea and accumulates and lingers in Dai Channel, so the disease will disappear if heat and dampness are removed. Sheng Duanming of Ming Dynasty, He Mengyao of Qing Dynasty, Lv Chubai and Xie Zelin of recent times and Cai Yanggao and Zheng Dingliang of modern times basically held this academic point of view. Lingnan doctors researched on the cause of leukorrheal diseases from the angle of damp heat, which is inseparable from the hot and humid local climate. Modern famous TCM doctor Liang Jianbo stressed treating yellow luekorrhea by removing the dampness evil. Professor Luo Yuankai classified lelukorrhea into types of damp heat, and damp evil. The damp heat of leukorrheal diseases comes from Lingnan steamed and humid climate, easily becoming the breeding ground for the poisonous insects and virus.②For the diagnosis and treatment of leukorrheal diseases, it is suggested to nurture kidney, spleen and liver, or strengthening the vital essence and kidney yin. On one hand, Lingnan doctors recognized that heat, dampness and damp evil may cause leukorrheal disease, so they applied the therapy of removing dampness, heat and poison and adopted the corresponding herbs. On the other hand, they also recognized that women’s deficiency of spleen and kidneky and liver yin is another part of the pathogen, so they emphasized strengthening the vital essence and kidney yin. Liu Yuan of Qing Dynasty and Luo Yuankai of modern times inherited Zhang Jingyue’s doctrine and applied method of nurturing kidney, spleen and liver to treat the leukorrheal diseases of deficiency type. In Chapter8of Pan Lanping’s Ye An Kuo Yao, it says doctors should pay attention to strengthening the vital essence and kidney yin in the diagnosis and treatment of leukorrheal diseases since Lingnan people’s constitution are mostly Qi deficiency, Yin deficiency and both Qi and Yin deficiency or blood heat.③In clinical treatment, Lingnan doctors are adept at applying special prescription and drugs (including herbs) and external treatment method. Xie Zelin of recent period recommended Fu Qingzhu’s Wan Dai Decoction. Cai Yanggao of modern times invented several medicine for TCM diagnosis and treatment of leukorrheal diseases, including Fu Pi Sheng Shi Decoction, Modified Wan Dai Decoction and Secret Pill for Leukorrhea. For topical medicine, Osthol Decoction is applied to wash the vagina for continuous leukorrhea. Commonly used Lingnan herbs are radix fici hirtae roots, millettia root, cherokee rose root and Chinese knotweed. Cherokee rose in Professor Luo Yuankai’s self-designed Yin Chen Bai Jiang Decoction and Euphorbia sampsoni Hance in the smoked lotion prescription are both Lingnan herbs.ConclusionReseach on ancient Chinese medicine lilterature about the diagnosis and treatment of leukorrheal diseases is an important and indispensable part of gynecological study. Taking both horizontal and vertical angles, this study categorizes, digs and summarizes the documents of Qin, West and East Han, Jin, Tang, Song, Jin, Yuan, Ming and Qing dynasties, until the Republic periods, as well as recent and modern times. It enriches Chinese medicine diagnosis and treatment of leukorrheal diseases and summarizes its concepts, pathogenesis, syndrome type, treatment, therapies and the prognosis. It completes the system of diagnosis and treatment of leukorrheal diseases. It is innovative by the research of local literature:1. this study classifies the academic development of TCM diagnosis and treatment of leukorrheal diseases into five academic periods, describes each period’s features and comments on the ancient academic writings. In these aspects, no other detailed work is found which is one of the innovation of this study;2. this study takes the academic experience of modern famous TCM physicians (including Lingnan famous TCM physicians) as the key in the research of modern literature. It categorizes the concept, pathogenesis, diagnosis and treatment, medical case, prescriptions and academic features. It especially categorizes the documents and academic experience of Lingnan physicians. This is unprecedented in the past, therefore it is the second innovation of this study. |
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