Gu Jing Wan & The Three Causes of Gynecological Bleeding
by Bob Flaws
In Chinese medicine, there are only three basic causes of any and all uterine bleeding other than due to traumatic injury. These three are qi vacuity failing to manage or contain the blood, evil heat causing the blood to move frenetically outside its vessels, and blood stasis forcing the blood outside of its pathways. Gu Jing Wan (Secure the Menses Pill) is a famous formula created by Zhu Dan-xi for treating the second of these causes of pathological uterine bleeding — evil heat. Zhu Dan-xi was one of the Four Great Masters of the Jin-Yuan dynasties, and this formula comes from his Dan Xi Xin Fa (Dan-xi’s Heart Method). The ingredients in this formula include:
In Chinese gynecology, when we talk about uterine bleeding, we mean any and all of the following: early menstruation, profuse menstruation, prolonged menstruation, mid-cycle bleeding, bleeding with intercourse, fetal leakage (threatened miscarriage), and flooding and leaking. Under heat causing frenetic movement of the blood outside its vessels, there are several subtypes which can cause uterine bleeding. These are:
Replete heat is usually seen in younger, robust females with a yang exuberant habitual body who may also be prone to eating hot, spicy, greasy, fatty foods and drinking alcohol. Vacuity heat is due to yin vacuity failing to control yang which becomes hyperactive and engenders heat internally. Depressive heat is where liver depression qi stagnation depresses the yang qi. Because the qi is inherently warm, this accumulation of depressed qi transforms heat. This heat is thus called either transformative heat or depressive heat. Stasis heat is a slightly different kind of depressive heat. In this case, since qi and blood flow together, blood stasis inhibits the free flow of yang qi. The yang qi becomes depressed and this transforms into heat. Damp heat is a combination of dampness and heat. The dampness and the heat can either be externally contracted or internally engendered. When the heat of damp heat causes pathological uterine bleeding, mostly the dampness and heat are internally engendered. For instance, because qi and water fluids flow together, dampness may also depress the yang qi, thus giving rise to transformative heat which then becomes bound up with the dampness.
Gu Jing Wan treats all of these types of evil heat which may potentially cause unwanted uterine bleeding. Therefore, this formula has a broad scope of application. This makes it a very important formula to remember and keep on hand. Within this formula, Huang Qin and Huang Bai both clear heat. Huang Qin primarily clears replete heat, including replete heat per se as described above, depressive heat, stasis heat, and damp heat. Huang Qin not only clears heat, it also specifically stops bleeding. Huang Bai clears and eliminates damp heat as well as clears vacuity heat. So it treats two of the types of heat described above. Chi Shao is a blood-quickening medicinal which also clears heat from the blood aspect or division. In other words, it cools and quickens the blood. It can be used for any type of uterine bleeding due to evil heat, but, since it also quickens the blood, it is indispensable for stasis heat. Chun Pi clears heat and eliminates dampness. While it does not specifically stop bleeding, it has a special tropism for the large intestine and uterine tract. Because it is astringent by nature, it helps prevent any abnormal flow from the uterus associated with damp heat. Xiang Fu courses the liver and rectifies the qi. Therefore, while it neither clears heat nor stops bleeding itself, it resolves the depression that may transform into heat. Xiang Fu also has the empirical function of regulating menstruation, and most of the above-enumerated types of uterine bleeding are categorized as types of menstrual irregularity in Chinese medicine.
Gui Ban is very interesting in the context of this formula. Today, it is categorized as a yin supplement which nourishes the liver and enriches the kidneys and is considered level or neutral in nature. Therefore, from our contemporary point view, Gui Ban enriches yin supplements the vacuity that leads to vacuity heat. However, in premodern times, practitioners tended to use Gui Ban and Bie Jia interchangeably. Bie Jia’s nature is cold and it clears vacuity heat as well as quickens the blood. Therefore, Bie Jia can be used to treat both the vacuity and stasis heat species of bleeding. If we look at the Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica Classic), it says that Gui Ban breaks concretions and conglomerations, thus suggesting that it does quicken the blood and dispel stasis. In addition, the Yi Lin Zuan Yao (Essential Compilation in the Forest [i.e., Field] of Medicine) says that Gui Ban “treats steaming bones, taxation heat, spitting blood, epistaxis, intestinal wind hemorrhoidal bleeding, conditions of yin vacuity blood heat.” Further, the Ben Cao Jing Shu (Dredging [the Neglected] in Materia Medica Classic) says not to use Gui Ban if the patient has vacuity but no heat. All this suggests to me that Gui Ban does have some ability to clear at least vacuity heat if not any other kind of heat and has some ability to specifically treat bleeding conditions.
Although this formula seems “compact,” if not to say small, nevertheless, we can see that, through its insightful composition, it accomplishes a number of things, thus achieving a lot with relatively a little. This is why I included it when choosing the formulas for the Great Nature line. If you’re not already familiar with and using this formula, I recommend you take a closer look. I think you’ll come to appreciate it.
Copyright Blue Poppy Press, 2010. All rights reserved.