Overworked in Body and Mind
16 Short Gynecology Cases by Hé Yuánzhǎng
As 2024 begins, I find myself looking at a pile of work here at Mulch HQ, most of it having to do with clinic numbers and syllabi and lesson plans and so forth. Which, of course, led me to forget about all of that stuff and read through some old cases. For the last few days, I have been going through the gynecology (nǚ kē) chapter in Hé Yuánzhǎng Yī An [何元長醫案] (Hé Yuánzhǎng’s Medical Cases). I’ve posted some of the cases from Hé last year. I really enjoy them because of their brevity, such economy of words makes it easier for a novice translator such as myself to get through a bunch of them. In addition, I really appreciate his prescription style, with its use of lighter medicinals, and like learning and thinking about his formulas.
So, here are 16 gynecology cases from Hé Yuánzhǎng (1752-1806), with some brief commentary. I have only added the pharmaceutical names of the medicinals at their first mention, in order to help readability and keep the word count manageable.
三十八、女科門（十六方）
Chapter 38, Gynecology (16 prescriptions)
（案1）經阻腹痛。由氣鬱結，血不流行也。治以宜通。
歸鬚 茺蔚子 川楝子 紅花 延胡索 制香附
(Case 1) Obstructed menstruation causing abdominal pain. Its origin is binding depression of qì so the blood does not flow. Unblocking treatment is appropriate.
Guī Xū [Rx Tenuis Angelicae Sinensis], Chōng Wèi Zǐ [Fr Leonuri], Chuān Liàn Zĭ [Fr Melia Toosendan], Hóng Huā [Fl Carthami], Yán Hú Suǒ [Rz Corydalis], Zhì Xiāng Fù [Rz Cyperi Praeparatum].
[Mulch comments: Guī Xū is the whiskers from the Dāng Guī root. See note on Chōng Wèi Zǐ below.]
（案2）身心過勞，月事反旺，血不榮肝，內風煽爍。以致咳逆不已，心神不安。務宜靜養調治。
陳阿膠 麥冬 茯神 生白芍 棗仁 川貝 沙參 陳皮 牡蠣
(Case 2) Overworked in body and mind, her menstrual period was unexpectedly vigorous. Blood was not provisioning the liver, so internal wind fanned and scorched. As a result, she had an incessant counterflow cough and disquieted heart spirit. It is appropriate to treat by gently nourishing and regulating.
Chén Ē Jiāo [Colla Corii Asini Vetum], Mài Dōng [Rx Ophiopogonis], Fú Shén [Poria Pararadicis], Shēng Bái Sháo [Rx Paeoniae Alba Recens], Zǎo Rén [Sm Zizyphi Spinosae], Chuān Bèi [Bulbus Fritillariae Cirrhosae], Shā Shēn [Rx Glehniae], Chén Pí [Pc Citri Reticulatae], Mǔ Lì [Concha Ostreae]
[Mulch comments: Chén Ē Jiāo is aged donkey hide glue.]
（案3）經下頗多，心煩口渴，陰虧陽亢也。六脈不靜，治以滋補。
制洋參 丹皮 白芍 上清膠 麥冬 丹參 生地 茯神 烏鰂骨
(Case 3) Rather profuse menstruation, heart vexation and thirst, yīn depletion with yáng hyperactivity. The six pulses are disquieted, treat by enriching and supplementing.
Zhì Yáng Shēn [Rx Panacis Quinquefolii Praeparatum], Dān Pí [Cx Moutan], Bái Sháo [Rx Paeoniae Alba], Shàng Qīng Jiāo [Colla Corii Asini Praeparatum], Mài Dōng, Dān Shēn [Rx Salviae Militiorrhizae], Shēng Dì [Rx Rehmanniae], Fú Shén, Wū Zéi Gǔ [Os Sepiae].
[Mulch comments: Shàng Qīng Jiāo is the name for Ē Jiāo processed with yellow wine in Sūzhōu, Zhèjiāng and Shànghǎi]
（案4）經期腹痛，帶下不已。乃中虛挾濕，清不勝濁也。從肝胃調治。
制於術 白芍 香附 烏鰂骨 茯苓 上官桂 艾絨 陳皮 歸身
(Case 4) Abdominal pain at the time of menstruation, ceaseless vaginal discharge. This is center vacuity complicated by dampness. Clearing is not enough to prevail over turbidity. Treat by regulating liver and stomach.
Zhì Yú Shù [Rz Atractylodis Macrocephalae Praeparata], Bái Sháo, Xiāng Fù [Rz Cyperi], Wū Zéi Gǔ, Fú Líng [Poria], Shàng Guān Guì [Cx Cinnamomi Tubiformis], Ài Róng [Fm Artemisiae Argyi Tritum], Chén Pí, Guī Shēn [Rx Angelicae Sinensis Corpus]
[Mulch comments: Yú Shù is Bái Zhú grown in Yúqián [於潛], Zhèjiāng province. Ài Róng is the prepared moxa floss, as opposed to the crude leaf. Shàng Guān Guì is the shaving off the outer bark of the cinnamon, which curls up into a tube.]
（案5）肝強脾弱，胸痛作脹，癸水不行，脈來細軟。理宜調氣和血。
制於術 紅花 香附 全當歸 赤芍 艾絨 茯苓 茺蔚子 蘇梗
(Case 5) The liver is strong and the spleen is weak, and the chest is painful and distended. Guǐ water does not move, and the pulse arrives thin and soft. The principle is one ought to regulate qì and harmonize blood.
Zhì Yú Shù, Hóng Huā, Xiāng Fù, Quán Dāng Guī [Rx Angelicae Sinensis Integra], Chì Sháo [Rx Paeoniae Rubra], Ài Róng, Fú Líng, Chōng Wèi Zi, Sū Gěng [Caulis Perillae].
[Mulch comments: Guǐ 癸 is stem 10 of the 10 heavenly stems; guǐ shuǐ is a reference to the kidneys. I believe it is also used here as a reference to 天癸 tiān guǐ, the principle of heavenly water or menstruation. Quán Dāng Guī is the whole root of the Dāng Guī.]
（案6）經閉腹痛。恐有敗瘀阻絡，防其大下。
全當歸 延胡索 青皮 元紅花 丹參 蘇梗 茺蔚子 紫石英 澤蘭
(Case 6) Menstrual block with abdominal pain. I fear removing the stasis that is blocking the network vessels, must guard against a massive discharge.
Quán Dāng Guī, Yán Hú Suǒ, Qīng Pí [Pc Citri Reticulatae Viride], Yuán Hóng Huā, Dān Shēn, Sū Gěng, Chōng Wèi Zi, Zǐ Shí Yīng [Fluoritum], Zé Lán [Hb Lycopi]
[Mulch comments: I have not been able to find a reference to Yuán Hóng Huā; I wonder if Yuán 元 was mis-copied from Xī 西, in which case the medicinal would be Xī Hóng Huā, Stigma Croci, the saffron which is both more expensive and more potent than carthamus flower. This addition would fit in with the rather vigorous blood-moving nature of the prescription. I would be a little worried about causing a hemorrhage as well.]
（案7）陰虛內熱，經漏淋漓。仿仲景復脈法。
黨參 阿膠 白芍 烏鰂骨 生地 麥冬 茯神 沙蒺藜 血餘炭
(Case 7) Yīn vacuity internal heat, with postmenstrual spotting and dripping. Imitate the Zhòngjǐng Fù Mài [Restore the Pulse] method.
Dǎng Shēn [Rx Codonopsis], Ē Jiāo, Bái Sháo, Wū Zéi Gǔ, Shēng Dì, Mài Dōng, Fú Shén, Shā Jí Lí [Sm Astragali Complanati], Xuè Yú Tàn [Crinis Carbonisatus]
[Mulch comments: Zhòngjǐng refers to Zhāng Zhòngjǐng, and Fù Mài Tāng is an alternate name for Zhì Gān Cǎo Tāng or Honey-Fried Licorice Decoction. The present formula has some significant differences, though the core treatment principles of supplementing qì, nourishing blood, enriching yīn and warming yáng are all included in its composition. Xuè Yú Tàn is charred human hair and included to stanch bleeding.]
（案8）產後結瘕，少腹脹痛。此屬肝胃絡虛，非有形所阻。況自汗屢泄，六脈無力，豈可投以攻劑？理宜溫通為要。
黨參 香附 紫石英 肉桂 歸身 艾絨 制川附 小茴 陳皮
(Case 8) Postpartum bound conglomeration, with lower abdominal distension and pain. This is categorized as vacuity in the network vessels of the liver and stomach, as there is no tangible form to the blockage. What’s more, there is frequent leakage of spontaneous sweat, the six pulses are not strong, so how can one throw an attacking prescription at it? The treatment principles ought to be warming and freeing, this is very important.
Dǎng Shēn, Xiāng Fù, Zǐ Shí Yīng, Ròu Guì [Cx Cinnamomi], Guī Shēn, Ài Róng, Zhì Chuān Fù [Rx Aconiti Lateralis Praeparata], Xiǎo Huí [Fr Foeniculi], Chén Pí.
（案9）小產後，結瘕腹痛。由營絡虛寒，惡露未淨也。治以溫通化瘀。
全當歸 艾絨 木香 肉桂 靈脂 小茴 茺蔚子 延胡 青皮
(Case 9) Post-miscarriage, bound conglomeration with abdominal pain. Because of vacuity cold in the yíng-provisioning network vessels, the lochia was not completely [expelled]. Treat by warming, freeing, and transforming stasis.
Quán Dāng Guī, Ài Róng, Mù Xiāng [Rx Aucklandia], Ròu Guì, Líng Zhī [Excrementum Trogopteri], Xiǎo Huí, Chōng Wèi Zi, Yán Hú [Rz Corydalis], Qīng Pí.
（案10）帶下腹痛，脈來細軟。陰虛及陽。法當溫補。
黨參 於術 歸身 白芍 鹿角霜 茯苓 香附 炙草 陳皮
(Case 10) Vaginal discharge with abdominal pain, pulse arrives thin and soft. This is vacuity of yīn as well as yáng. The method must be warming supplementation.
Dǎng Shēn, Yú Shù, Guī Shēn, Bái Sháo, Lù Jiǎo Shuāng [Cornu Cervi Degelatinatum], Fú Líng, Xiāng Fù, Zhì Cǎo [Rx Glycyrrhizae Praeparata], Chén Pí.
（案11）經漏後，脈絡空虛，以致心悸頭暈，筋骨痠軟，及足跗浮腫。非輕候也。必須進補。
熟地 茯神 杜仲 白朮 歸身 狗脊 棗仁 白芍 香白薇
(Case 11) Post menstrual spotting, the vessels and networks are hollow and empty, resulting in palpitations and dizziness, aching and limpness of the sinew and bone, as well as puffy swelling of the instep. It's not a light condition. She needs to have supplementation.
Shú Dì [Rx Rehmanniae Praeparata], Fú Shén, Dù Zhòng [Cx Eucommiae], Bái Zhú [Rz Atractylodis Macrocephalae], Guī Shēn, Gǒu Jí [Rz Cibotii], Zǎo Rén, Bái Sháo, Xiāng Bái Wēi [Rx Cynanchi Atrati]
[Mulch comments: Interesting prescription which combines some qi and blood supplementing with some medicinals to strengthen sinew and bone. Bái Wēi is indicated for blood vacuity fevers so I’m guessing that was part of the clinical picture as well.]
（案12）產後元虛，咳逆痛瀉，自汗不已，漸成脫象。勉擬方以盡人事。
黃耆 五味 杞子 橘白 於術 茯神 山藥 紅棗 麥冬 棗仁
(Case 12) Postpartum original [qì] vacuity, counterflow cough and painful diarrhea, ceaseless spontaneous sweating, gradually becoming a picture of desertion. Must make an effort to draft a formula to do whatever is humanly possible [to achieve a cure].
Huáng Qí [Rx Astragali], Wǔ Wèi [Fr Schisandrae], Qǐ Zi [Fr Lycii], Jú Bái [Pc Citri Reticulatae Album], Yú Shù, Fú Shén, Shān Yào [Rz Dioscoreae], Hóng Zǎo [Fr Jujubae], Mài Dōng, Zǎo Rén.
[Mulch comments: qi, blood and essence supplementation with some calming and securing medicinals in a gentle prescription. Often in patterns involving desertion you see heroic intervention with some heavy-duty warm interior herbs and/or ginseng.]
（案13）月事不調，腰腹作痛。此肝氣鬱而營絡傷也，殊非輕恙。
生地 棗仁 烏鰂骨 沙蒺藜 歸身 茯神 白薇 湘蓮 白芍 香附
(Case 13) Irregular menstruation, aching pain in low back and abdomen. This is liver qì depression as well as damage to the provisioning network vessels, not really a trivial illness.
Shēng Dì, Zǎo Rén, Wū Zéi Gǔ, Shā Jí Lí, Guī Shēn, Fú Shén, Bái Wēi [Rx Cynanchi], Xiāng Lián [Sm Nelumbinis], Bái Sháo, Xiāng Fù.
[Mulch comments: Xiāng Lián is the red lotus seed from Húnán.]
（案14）淋帶不止，月事大下。衝任絡傷也，病勢非輕。
熟地 白芍 杜仲 沙蒺藜 於術 制香附 茯神 湘蓮 歸身 烏鰂骨
(Case 14) Dripping vaginal discharge without stopping, big downpour at menstruation. Chōng, rèn, and network vessel damage, the disease condition is not an insignificant one.
Shú Dì, Bái Sháo, Dù Zhòng, Shā Jí Lí, Yú Shù, Zhì Xiāng Fù, Fú Shén, Xiāng Lián, Guī Shēn, Wū Zéi Gǔ.
（案15）類瘧久纏，咳逆咽乾，延至停經，失血後病勢轉甚。此勞怯之基也，殊為棘手重恙。
生黃耆 沙參 茯神 丹皮 阿膠 麥冬 橘白 紫菀 鱉甲 枇杷葉
(Case 15) Malaria-like illness has been bothering her a long time, with counterflow cough and dry throat, deferring menopause, the disease condition becoming severe after losing blood. The basis is taxation timidity, an especially thorny and grave illness.
Shēng Huáng Qí [Rx Astragali Cruda], Shā Shēn, Fú Shén, Dān Pí, Ē Jiāo, Mài Dōng, Jú Bái, Zǐ Wǎn [Rx Asteris], Biē Jiǎ [Carapax Trionycis], Pí Pá Yè [Fm Eriobotryae].
[Mulch comments: An interesting prescription for qi and yin vacuity with some cough-stopping agents. The presence of Biē Jiǎ signals deep-lying vacuity heat.]
（案16）中虛肝鬱，腹脹食減，色脈神少。仿逍遙法。
柴胡 白芍 香附 白朮 茯神 陳皮 歸身 鬱金 紫石英
(Case 16) Center vacuity and liver depression, abdominal distension and decreased food intake, complexion and pulse have little spirit. Imitate the Xiāo Yáo [Free Wanderer] treatment method.
Chái Hú [Rx Bupleuri], Bái Sháo, Xiāng Fù, Bái Zhú, Fú Shén, Chén Pí, Guī Shēn, Yù Jīn [Rx Curcumae], Zǐ Shí Yīng.
[Mulch comments: Xiāo Yáo of course needs no introduction. The prescription includes elements of Chái Hú Shū Gān Tāng, and adds Yù Jīn to quicken blood and lift depression. Topped off with Zǐ Shí Yīng to anchor and calm – see below.]
Use of Medicinals
Hé uses mostly familiar ingredients with some regional variants. Here are some of the less common medicinals that appear frequently in these cases:
Zǐ Shí Yīng紫石英
It is in the category of heavy settlers that calm the spirit; it is sweet and warm, enters the heart, liver, lung, and kidney channels. It quiets and settles, warms the lung, and warms the kidney and uterus. For the latter, it is used to stem flooding and spotting of blood due to yang vacuity cold; it is also an important medicinal for infertility. It is said to enter the chōng mài and rèn mài (Chace & Shima, 2010).
Chōng Wèi Zǐ 茺蔚子
It is the fruit from the motherwort; the aerial portions are known as Yì Mǔ Cӑo. Like Yì Mǔ Cӑo, Chōng Wèi Zǐ is a blood-quickening stasis-transforming herb and is sweet and slightly cold. In addition to regulating blood, it also clears the liver and brightens the eyes, so it may be used for liver heat.
Wū Zéi Gǔ 烏鰂骨
Also known as Hӑi Piāo Xiāo, it is usually classified as an astringent, and is salty and slightly warm, and enters the liver and kidney channels. It secures essence, checks vaginal discharge and stanches bleeding.
And with that, I need to get back to that growing pile of paperwork. As always, thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Chace, C., & Shima, M. (2010). An exposition on the eight extraordinary vessels: Acupuncture, alchemy, and herbal medicine. Eastland Press.
Hé Yuánzhǎng yī àn. (n.d.) https://jicheng.tw/tcm/book/%E8%91%89%E5%A4%A9%E5%A3%AB%E6%9B%B9%E4%BB%81%E4%BC%AF%E4%BD%95%E5%85%83%E9%95%B7%E9%86%AB%E6%A1%88/index.html . Retrieved November 23, 2022
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.