Pathomechanisms of the Blood in TCM Gynecology
Written by:Eric Brand
By Eric Brand
(“Inner Canon, Plain Questions”) states: “The hundred diseases change and arise [when] qì and blood are in disharmony.” In the Líng Shū (“Magic Pivot”), we find the statement: “Women’s lives have a superabundance of qì and an insufficiency of blood.” Harmony of qì and blood is essential for women’s health. Because of the close relationship between blood and qì, complex variations and mixed patterns of repletion and vacuity are very common in the clinic. The primary types of basic disharmony are outlined below:
Pathomechanisms of the Blood
Blood vacuity: Blood vacuity refers to a pathological state of insufficiency of yīn-blood that results in a loss of blood’s nourishing and moistening function. It primarily arises from three mechanisms: 1) Blood may be damaged by profuse bleeding, menstruation, pregnancy, childbirth, and breast-feeding. Profuse menstrual bleeding, flooding, and great bleeding during pregnancy or childbirth are particularly significant causes of blood vacuity. 2) Blood vacuity may arise when qì fails to sufficiently form blood. This is generally due to either spleen-stomach vacuity or poor nourishment. 3) Insufficiency of kidney-essence may cause blood vacuity because essence forms blood.
When blood is vacuous, the thoroughfare (chōng) and controlling (rèn) vessels lack fullness. This may lead to: delayed menstruation, scant menstruation, menstrual block, painful menstruation, abdominal pain during pregnancy, stirring fetus, habitual miscarriage, atrophied fetus, scant breast milk, generalized postpartum pain, infertility, and genital itching.
Blood Stasis: Blood stasis may arise from cold, heat, vacuity, repletion, injury, surgery, bleeding, and enduring illness. It may lead to a variety of gynecological diseases, which may be grouped by the causative factors involved:
Blood cold leading to stasis: Cold congeals the blood; it may result from contracting external cold when the “blood chamber is open,” i.e., during menstruation or after giving birth. It may also arise from consumption of raw and cold foods, or from getting soaked in the rain or wading through water.
Blood heat leading to stasis: Contraction of heat evil or consuming excessive quantities of acrid, hot foods or yáng-assisting medicinals leads to deep-lying heat in the thoroughfare (chōng) and controlling (rèn) vessels. This heat scorches the blood and forms stasis.
Qì vacuity leading to stasis: Vacuous qì lacks the force to move the blood. This causes the blood to flow slowly, leading to blood stasis.
Qì stagnation and blood stasis: Qì is the commander of blood; when qì moves, the blood moves. Internal damage by the seven affects inhibits the qì dynamic and causes qì stagnation, which in turn gives rise to blood stasis.
When blood stasis is formed, it obstructs the uterus, the uterine vessels, the uterine network vessels, and the thoroughfare (chōng) and controlling (rèn) vessels. It may lead to painful menstruation, menstrual block, headache during menstruation, generalized pain, ectopic pregnancy, postpartum abdominal pain, infertility, or concretions and conglomerations. Stasis accumulating over a prolonged time can gradually lead to endometriosis or pelvic inflammatory disease.
Blood Heat: Blood heat refers to heat lying deep within the blood. It causes the blood flow to accelerate, and in severe cases leads to frenetic movement of hot blood. Blood heat may arise from constitutional exuberance of yáng, from excessive consumption of acrid, hot or yáng-assisting foods, as well as from inappropriate use of yáng-assisting and uterus-warming medicinals. When deep-lying heat in the thoroughfare (chōng) and controlling (rèn) vessels leads to frenetic movement of hot blood, it manifests with profuse menstruation, advanced menstruation, flooding and spotting, blood ejection or spontaneous external bleeding during menstruation, fetal spotting, or postpartum heat effusion.
Heat flames upward by nature; if liver depression transforms into heat, it may lead to headache during menstruation, moodiness during menstruation, or advanced menstruation. In patients with constitutional yīn vacuity or damage to yīn-blood from menstruation, pregnancy, childbirth, or breastfeeding, yīn vacuity forms internal heat. This heat harasses the thoroughfare (chōng) and controlling (rèn) vessels, leading to insecurity of the thoroughfare (chōng) and controlling (rèn) vessels; this manifests as advanced menstruation, flooding and spotting, stirring fetus, and persistent flow of the lochia following childbirth.
Blood Cold: When the blood and vessels contract cold, the blood becomes congealed and moves slowly. Blood cold often results when insufficiency of right qì allows contraction of cold evil to occur during menstruation or after childbirth. It may also arise from constitutional yáng vacuity. Blood cold leads to painful menstruation, delayed menstruation, scant menstruation, menstrual block, abdominal pain during pregnancy, abdominal pain or generalized pain following childbirth, or infertility due to uterine cold.