▲Wang Mianzhi, Master of Traditional Chinese Medicine (1923-2009)
Wang Mianzhi, the first master of traditional Chinese medicine, was the chief physician of Beijing Guoyitang Hospital of Traditional Chinese Medicine. Wang Mianzhi combined the traditional theory of syndrome differentiation and treatment of traditional Chinese medicine and the physiological and pathological characteristics of women, and put forward his own unique views on the treatment of menstrual irregularities. This article summarizes Wang Mianzhi's treatment rules, prescription addition and subtraction and medication characteristics, as well as Wang Mianzhi's unique clinical treatment experience, as follows.
Menstrual irregularity refers to the abnormality of the period, quantity, color and quality of a woman's menstruation, which is a common gynecological disease. In recent years, with the rapid development of social economy and the gradual increase of life pressure, the incidence of irregular menstruation is on the rise, which seriously affects women's physical and mental health and quality of life.
Dialectical legislation treats the symptoms and the root cause
Wang Mianzhi collected the views of the former sages and believed that women's menstruation mainly involves the kidneys, liver, and spleen. The kidney is the innate foundation, the main essence is stored and the essence is turned into blood, so only when the kidney essence is full can it continuously metabolize yin and blood, and promote menstruation as scheduled; The spleen is the foundation of the acquired nature, the main blood, and the source of qi and blood biochemistry, so the spleen is vigorous and vigorous, and the abundance of qi and blood is closely related to the onset of menstruation. The spleen and kidney provide the material basis for menstrual blood, and it is the liver that plays a decisive role in the scheduled arrival of menstruation. The liver stores blood, and the main drain can regulate the qi and regulate the mood.
With the acceleration of the pace of life, women are tired of the balanced development of work and family, and often neglect their own health maintenance, which is easy to cause yin blood damage. In addition, there are few ways to vent bad emotions, and they are stagnant in the liver, resulting in abnormal liver excretion and affecting the normal flow of menstrual blood. Wang Mianzhi's treatment of menstrual irregularities mainly treats the liver, kidneys and spleen, focusing on soothing the liver and regulating qi, tonifying the spleen and kidneys, and at the same time nourishing blood and regulating the liver as a prerequisite for the treatment of menstrual irregularities, taking into account the acquired nature.
● Menstrual irregularities are treated by the liver
The liver is mainly drained, the qi is regulated, the joy is reached, and the depression is great. Liver stagnation and qi stagnation are easy to produce liver fever, transverse spleen leads to spleen deficiency, and the source of qi and blood biochemistry is insufficient and easy to cause blood deficiency, so patients with irregular menstruation often have liver stagnation and blood deficiency. Siwu decoction is the first prescription of traditional Chinese medicine to replenish blood and regulate menstruation, and is often used to replenish liver deficiency, soothe liver stagnation, clear liver heat, and regulate menstrual blood.
When the liver and blood are deficient, remove the rehmannia in the Siwu soup, add the raw rehmannia root, peony skin, and digu skin, or use ginger qin Siwu soup; When there is a lot of blood in the liver, the four things soup of Qinshu is used; When the liver is depressed and blood is deficient, Jiao Ai Siwu soup is used; When the liver is depressed and the blood flow is not smooth, the cinnamon Siwu soup is used; For those with liver deficiency and blood stasis, use peach red four things soup. If the liver deficiency is severe, it is necessary to add blood tonic drugs, such as angelica sinensis and shengdi, and because the liver itself uses qi and blood interchangeably, it is necessary to add blood tonic drugs at the same time, such as wheat Dong and dendrobium. For those with severe liver and spleen deficiency, Wang Mianzhi is good at using Xiaoyaosan plus and minus Siwu decoction to soothe the liver and nourish blood, Xiaoyaosan has the effect of soothing the liver and strengthening the spleen, focusing on the treatment of liver and spleen blood deficiency. Wang Mianzhi mainly uses Bupleurum to soothe the liver, and uses Yang because of the yin of the liver body, plus a large amount of angelica and white peony to nourish blood and regulate menstruation, and pay equal attention to soothing liver qi and replenishing liver and blood, so that menstruation is accessible.
▲ Peony skin
● Menstrual irregularities are treated by the spleen and kidney
The spleen and stomach are the source of qi and blood biochemistry, if the spleen and stomach are deficient and the power of control is weakened, it will lead to abnormal qi and blood circulation, empty blood and menstrual disorders. When the spleen and stomach are weak, Wang Mianzhi usually uses tonifying the spleen and stomach such as tonifying Zhongyi Qi soup. Buzhong Yiqi decoction focuses on replenishing Zhongqi, which can restore the spleen and stomach to normal reception and transportation, and raise and clear and reduce turbidity; If the spleen is deficient and bleeding, it is necessary to add some astringent and hemostatic drugs on the basis of Buzhong Yiqi decoction. Gui Spleen Decoction is good at treating spleen disunity syndrome, when the patient's spleen is weak and unable to unify blood, resulting in frequent and small amount of bleeding, Wang Mianzhi often uses Gui Spleen Decoction for treatment; If there is a lot of bleeding, or even blood collapse, you also need to add a large amount of qi tonic and astringent medicine; When the patient has spleen and stomach qi deficiency, the Four Gentlemen decoction is used to nourish qi and strengthen the spleen; If the spleen is deficient and the liver is depressed, you can use Xiaoyaosan combined with the Four Gentlemen Soup, or the Six Gentlemen Soup with Astragalus, or the Xiangsha Six Gentlemen Soup.
▲黄芪
The kidneys store sperm and refine blood, so the quality of kidney function is closely related to whether menstruation can come as scheduled. There is true yin and true yang in the kidneys, true yin refers to the essence hidden, which is the material basis for the biochemistry of qi and blood, and true yang refers to kidney qi, which can promote the growth and development of the human body and is the foundation of reproduction. Kidney deficiency is one of the main pathogenesis of menstrual irregularities, which is divided into kidney yin deficiency and kidney yang deficiency. Traditional Chinese medicine generally believes that Liuwei Dihuang Pill is the basic prescription for tonifying kidney yin, but Wang Mianzhi emphasized that Liuwei Dihuang Pill is only a flat tonic prescription, which is used in a situation of deficiency but not urgency. Wang Mianzhi uses Kidney Qi Pills or Yougui Pills for the treatment of Kidney Yang Deficiency, and for those with severe Kidney Qi deficiency, he uses Da Bu Yuan Decoction, and Kidney Yin Deficiency often uses Zuogui Pills or Gui Kidney Pills. However, no matter which of the above formulas is only a basic formula, it needs to be added or subtracted according to the actual situation of the patient.
Dialectical examination of the cause and treatment of the symptoms without forgetting the root cause
According to the theory of traditional Chinese medicine, Zhongjiao is called blood by the subtle substances of Zhongjiao Water Valley plus camp qi in the heart and lungs. Women's menstruation is based on yin blood, yin blood is full, prompting menstruation to come and go as scheduled, if the yin blood is abnormal, it will directly affect menstrual bleeding, resulting in menstrual irregularities and other gynecological diseases. Wang Mianzhi believes that abnormal blood scores are usually divided into four aspects: blood deficiency, blood stasis, blood cold, and blood fever.
● Irregular menstruation due to blood deficiency
Blood deficiency refers to the pathological phenomenon of yin and blood deficiency in the body, which can be caused by excessive blood loss, or long-term illness of yin and blood deficiency, or spleen and stomach dysfunction, and the subtlety of the water valley can not metabolize blood. When a woman's blood is deficient, it often occurs in the late menstrual period, the color becomes lighter, and even the menstrual pause occurs. Blood deficiency needs to replenish blood, but Wang Lao emphasized that even if the menstrual irregularities caused by blood deficiency are simply due to blood deficiency, they should not be completely treated with blood-tonifying drugs, he believes that blood-tonifying drugs generally belong to the thick flavor of the drug, and the thick flavor of the medicine is yin, pure yin without yang, so it is necessary to match aromatic warm drugs in the blood tonic prescription to strengthen the blood tonic effect of the drug through qi.
"The Yellow Emperor's Neijing" has a cloud "the owner of people, blood and gas ears". In the Ming Dynasty's "Jingyue Quanshu", there is a cloud that "qi and blood are both subtle and subtle in the water valley, qi belongs to yang, blood belongs to yin, qi is the driving force, blood is the foundation, the two are opposites and unified, and cannot be separated", so Chinese medicine has the saying that "qi is the handsome of blood, blood is the mother of qi, qi is blood, and qi stagnation is blood stasis". "Blood is the mother of qi" means that qi is stored in the blood, that is, blood carries qi, and qi is attached to blood. If blood deficiency reaches a certain level, it will inevitably cause qi deficiency, so patients with blood deficiency are often accompanied by qi deficiency. However, Wang Mianzhi emphasized that it is not necessary to replenish qi to replenish blood, and it is necessary to use qi-replenishing drugs after confirming the patient's qi deficiency, not blindly.
▲ Siwu soup
Siwu soup as the main prescription of blood supplementation, can be used to treat blood deficiency and stagnation, Wang Mianzhi believes that the "stagnation" here is different from "stasis", only the meaning of blood is difficult and stagnant, blood replenishment and camp, focusing on regulating qi and qi, and can not be understood as blood. For example, in the Siwu soup, Angelica sinensis can be combined with the effect of "going up to the top and going down to the sea of blood" of Chuanxiong, so that the blood tonic medicine can be replenished but not greasy, and there is yang in yin, so as to better achieve the purpose of blood replenishment. At the same time, in the process of diagnosis, it is necessary to distinguish the syndrome, distinguish the primary and secondary relationship between blood deficiency and qi deficiency, and then adjust the drug ratio of Siwu decoction accordingly. For example, if blood deficiency is the main thing, it should be used to replenish blood, and the dosage of rehmannia and white peony should be increased; If it is blood deficiency and stagnation accompanied by bleeding symptoms, it is necessary to increase the dosage of rehmannia and white peony, especially white peony, which has the effect of stopping bleeding and aggravating camps; If stagnation is the main one, special attention should be paid to replenishing qi, and the increase of angelica and Chuanxiong drugs should be considered.
● Blood stasis leads to menstrual irregularities
The "stagnation" mentioned above is different from blood stasis, which refers to blood retention or poor blood flow due to various reasons. Patients with blood stasis type often have symptoms such as late menstruation, too little menstrual flow or blood clots, purple or dark menstrual blood color, and blood stasis mainly includes four categories: qi stagnation and blood stasis, blood deficiency and blood stasis, kidney deficiency and blood stasis, and deficiency of cold and blood stasis.
Qi stagnation and blood stasis type, which is believed to be the damage of the seven emotions, liver stagnation and qi stagnation, resulting in damage to the kidney-Tianqi-Chongren-uterine axis, causing menstrual irregularities.
Blood deficiency and blood stasis type, Wang Mianzhi emphasizes equal emphasis on blood nourishment and blood activation, with Siwu decoction to nourish blood and invigorate blood, with peony skin, safflower, peach kernel, salvia and other blood-invigorating and stasis medicines, so that blood nourishment without leaving stasis, blood without injury.
▲ Safflower
Kidney deficiency and blood stasis type and deficiency cold blood stasis type menstrual irregularity, Wang Mianzhi uses Wenjing decoction plus or minus treatment, Wenjing decoction has the effects of smoothing blood vessels, adjusting qi deficiency, strengthening the spleen and invigorating qi. For those with abdominal pain and condensation, increase the preparation of aconite, ginger, cinnamon, and fennel to disperse cold and relieve pain; For those with kidney deficiency and qi stagnation, add turmeric, tangerine peel, psoralen, dodder seed, and mugwort leaves to replenish the kidney and strengthen yang; For those with severe qi deficiency, add astragalus and atractylodes to nourish the spleen and qi.
If it is indeed menstrual irregularities or even amenorrhea caused by empirical blood stasis, Wang Mianzhi will treat it according to the severity of the disease in combination with Xia Yu Xuexue, Xuefu Zhuyu Tang, Rejuvenation and Activating Blood Soup, Shao Abdomen Zhuyu Tang or Taohong Siwu Tang on the basis of menstrual stasis. "You can't blindly seek kindness, in order to get rid of stasis and invigorate blood, if you live too much blood, it will hurt the qi and blood in vain and aggravate the condition.
● Blood cold and blood fever lead to menstrual irregularities
Blood cold often has irregular menstrual sequence, poor menstruation or continuous menstruation, etc., which generally refers to Ren Chong's pulse cold. Chong is a sea of blood, the liver is the organ that hides blood, and the main drain is discharged, so it is often treated with warm liver and liver thinning. When menstruating, the blood chamber is open, if there is too much food and cold, or less clothing, the cold evil invades the Chong Ren vein, resulting in blood stasis, the flow of qi and blood is blocked, the menstruation is not smooth and even amenorrhea, Wang Mianzhi uses warm meridian soup to disperse cold and regulate menstruation. Poor blood flow or blood stasis caused by blood cold may cause fever in the body after reaching a certain level. In the process of treatment, it is necessary to treat the root cause, that is, to treat blood cold, and use Wenjing decoction with Wu Danshen and Astragalus membranaceus to treat; If the cold and heat alternate, then use the ten perfect tonic soup plus tangerine peel and bupleurum species.
▲ tangerine peel
Blood fever has prolonged menstrual time, and even dripping and other manifestations, which are generally caused by Chong Ren Qi deficiency and loss of appointment, restlessness in the sea of blood, and blood fever in vain. For those with blood fever, use Jingqin Siwu soup or Zhibai Siwu soup; If the blood fever is worse and the bleeding is excessive, Jiao Ai Siwu soup is used; If there is excessive bleeding accompanied by stasis, use peach red Siwu soup with incense; If the bleeding time is too long, it needs to be combined with warm supplements.
epilogue
Wang Mianzhi's treatment of menstrual irregularities focuses on syndrome differentiation legislation, treating the symptoms and treating the root cause: the overall regulation of the liver, kidney, and spleen to treat menstrual irregularities in patients. Pay attention to syndrome differentiation and examination of causes, and treat symptoms without forgetting the roots: regulate abnormalities such as blood deficiency, blood stasis, blood cold, and blood fever, and treat menstrual irregularities in patients. In addition, Wang Mianzhi also has a lot of research on the compatibility of prescriptions and drugs, focusing on nourishing blood without leaving stasis, invigorating blood without harming righteousness, thinking ingeniously, and using drugs accurately. The prescription application and drug compatibility in the above review are highly summarized by Wang Mianzhi's clinical diagnosis and treatment experience, and the specific drug compatibility of Wang Mianzhi varies from person to person and syndrome, and truly achieves "rope and ink are knotty, flexible and moderate". ■
Zheng reiterates:
Since each person's constitution and condition are different, the prescription and dosage in this case are only applicable to the patient's condition at that time. Without TCM syndrome differentiation diagnosis and treatment, the prescription and dosage in this case must not be copied. If necessary, readers should go to a regular hospital for diagnosis and treatment to avoid delaying their condition.
[Source: China Traditional Chinese Medicine News, content compiled from: "China Traditional Chinese Medicine News" October 27, 2021 fifth edition, author: Duan Dongmei, Second Medical Center of the General Hospital of the People's Liberation Army of Chinese, Wang Tan and Wang Xu, Beijing University of Chinese Medicine】