26 Section 1: Physiology and Pathology · Blood made by the Post-Natal Qi of Stomach and Spleen....

26 Section 1: Physiology and Pathology

The Fire of the Gate of Life is the origin of the ‘form-

less’ Minister Fire which also generates Water, hence

the Kidneys are the source of both Water and Fire. The

Minister Fire is called ‘formless’ because it is a non-

substantial Fire which actually generates Water rather

than overcoming it. It is a pre-natal type of Fire formed

at conception on the Governing/Directing Vessel axis.

In fact, the Golden Mirror of Medicine (1742) says:

The Pre-Natal Tian Gui originates from the mother and

father, the Post-Natal Essence and Blood are derived

from food and water, a girl’s Tian Gui matures at 14,

the Directing Vessel is open, the Penetrating Vessel is

flourishing and the periods arrive 22 ( Fig. 2.20 ).

The commentary then explains:

At 7 the Motive Force [Dong Qi] is flourishing. At 14

the Tian Gui matures: this is the Motive Force [i.e. the

Minister Fire] within the Pre-Natal Water of Tian Gui,

crystallizing in a girl’s uterus. 23

This last passage is interesting as it confirms that the

Motive Force and the Minister Fire are pre-natal and

present before the onset of the periods ( Figs 2.21 and

2.22 ). It also highlights the close integration of the

Minister Fire and the Heavenly Gui (the Yang and Yin

aspects of the Kidneys). Zhang Jing Yue says:

The Gate of Life is the Root of the Original Qi [Yuan Qi]

and the residence of [both] Water and Fire. The Yin of the

5 Yin Organs cannot nourish without it and their Yang

cannot develop without it. 24

This passage clearly shows how the Fire of the Gate of

Life can be the source of both Fire and Water. Thus, the

Minister Fire is the Fire within Water, interdependent

with Water and inseparable from it. The Emperor Fire

is called ‘with form’, i.e. it is a substantial Fire which

KI-WATERprovides ESSENCE

KI-FIRE (Minister Fire)provides FIREUTERUS

BLOOD

Figure 2.19 The Uterus and Kidney-Water and Kidney-Fire.

MINISTER FIRE MATURE JING

JING (IMMATURE)

CONCEPTION

Takes 14–16 years

Figure 2.20 Pre-natal origin of Minister Fire.

REN-1

REN-4 DU-4 =MinisterFire

MOTIVEFORCE

(DONG QI)

DirectingVessel

GoverningVessel

PenetratingVessel

Figure 2.18 The Minister Fire and the Extraordinary Vessels.

Women’s Physiology 27

overcomes Water, is formed after birth and is therefore

post-natal. The Minister Fire pertains to Heaven and

the Emperor Fire to human beings ( Fig. 2.23 ).

Thus, the Kidneys are the origin of both Water and

Fire: the Kidney-Water is the source of menstrual blood

and both Kidney-Water and Kidney-Fire influence the

Uterus which stores Blood. Since Blood is part of Water

but the Uterus is also warmed by the Minister Fire of

the Kidneys, in women a deficiency of the Kidneys very

often involves a deficiency of both Water (Yin) and Fire

(Yang) ( Fig. 2.24 ).

Under pathological circumstances, the Fire of the

Gate of Life can become either deficient or excessive.

When it is deficient, it fails to warm the Uterus, which

becomes obstructed by Cold: this may lead to infertil-

ity, dysmenorrhoea and lack of sexual desire. When it

is excessive, it heats the Blood causing excessive men-

strual bleeding, infertility or miscarriage ( Fig. 2.25 ).

Finally, the Minister Fire plays an important role in

the transformation of Kidney-Water into Tian Gui . We

have stressed above that Kidney-Water is the origin

of Tian Gui : however, the Minister Fire of the Kidneys

plays a role in its formation. One of the ancient texts

says that “ Tian Gui is the crystallization of Kidney-Water

under the influence of the Minister Fire .” The use of the

word crystallization is interesting and it lends itself to MINISTER FIRE

Fire within Water

14 years in girls and16 years in boys

Jing of father

TIAN GUI(sperm and ova)

Jing of mother

MINISTER FIRE

Figure 2.22 The Minister Fire in conception.

MINISTER FIRE(Kidneys)

Heaven – Pre-natalWithout ‘form’

Nourishes Water

Person – Post-natalWith ‘form’

Overcomes Water

EMPEROR FIRE(Heart)

Figure 2.23 Emperor Fire and Minister Fire.

YIN

Kidney-Yin deficiency(primary)

YANG YIN

Kidney-Yang deficiency(primary)

YANG

Figure 2.24 Simultaneous deficiency of Kidney-Yin and

Kidney-Yang.

MINISTER FIRE– YANG ASPECT

OF JING

‘Post-Natal of Pre-Natal’

Matures atpuberty

Activefrom

conception

‘Pre-Natal of Pre-Natal’

JING OF FATHER

SPERM-OVA– YIN ASPECT

OF JING

CONCEPTION– PRE-NATAL JING

OF FETUS

JING OF MOTHER

Figure 2.21 Yin and Yang aspects of Essence (Jing).


an interesting illustration of this principle. If we pre-

pare a saturated solution of water with salt and apply a

source of heat to it, after some time the water will evap-

orate and salt crystals will be formed ( Fig. 2.26 ). In this

analogy, the solution of water and salt is Kidney-Water,

the source of heat is Kidney-Fire (Minister Fire) and the

salt crystals are Tian Gui .

Liver

The Liver has a paramount importance in women’s

physiology and menstruation, mostly through its

relationship with the Uterus and Blood. The Uterus

stores Blood and this is received mostly from the Liver,

hence with regard to menstruation the Uterus and the

Liver’s function of Blood storage are one and the same

(although Liver-Blood has many other non-gynecolog-

ical functions). For this reason, Liver-Blood has a para-

mount importance in menstruation. The Blood stored

in the Liver is both menstrual blood and therefore Tian

Gui deriving from the Kidneys, but also the Post-Natal

Blood made by the Post-Natal Qi of Stomach and Spleen.

For this reason, when nourishing Liver-Blood, we often

need to tonify the Liver itself, the Kidneys (especially in

gynecological conditions) and the Spleen to promote

the formation of Post-Natal Qi and Blood ( Fig. 2.27 ).

Deficient Normal Excessive

Painful periods,endometriosis,

infertility,lack of libido

Heavy periods,infertility,

miscarriage

Figure 2.25 Pathology of Minister Fire.

SUMMARY

Kidneys • The Kidney-Essence is the origin for the formation of

the Tian Gui , the material substance of menstrual blood

• Menstrual blood is called ‘Heavenly Gui ’ because

it represents the descending of Heavenly Gui

materializing into Water

• Fu Qing Zhu (1607–1684) holds that menstrual

blood is not Blood but Heavenly Gui which

originates from the Kidneys

• The Heavenly Gui is found in both men and

women; in men it forms sperm, and in women

menstrual blood

• The Kidneys influence women’s reproductive

systems also through the Governing, Directing and

Penetrating Extraordinary Vessels

• The Fire of the Gate of Life represents the

physiological Fire within the Kidneys: it arises from

the area between the two kidneys and is closely

related to the Original Qi ( Yuan Qi ) and the Motive

Force ( Dong Qi ) from which the Governing,

Directing and Penetrating Vessels originate

• The Fire of the Gate of Life warms the Uterus and

balances the Yin influences: it makes conception

possible because it promotes the maturation of

the follicles and the production of the ova

• The Minister Fire is a pre-natal type of Fire formed at

conception on the Governing/Directing Vessel axis

• The Motive Force and the Minister Fire are pre-

natal and present before the onset of the periods

• The Kidneys are the origin of both Water and Fire,

the Kidney-Water is the source of menstrual blood

and both Kidney-Water and Kidney-Fire influence

the Uterus which stores Blood

• When the Minister Fire is deficient, it fails to

warm the Uterus which may lead to infertility,

dysmenorrhoea and lack of sexual desire

• When it is excessive, it heats the Blood causing

excessive menstrual bleeding, infertility or miscarriage

• The Minister Fire plays an important role in the

transformation of Kidney-Water into Tian Gui

CLINICAL NOTE

To nourish Liver-Blood in gynecological conditions, I generally reinforce Ren-4 Guanyuan, LIV-8 Ququan, ST-36 Zusanli and SP-6 Sanyinjiao. This combination tonifies Kidneys, Liver and Spleen. To nourish Liver-Blood in non-gynecological conditions, one can either reinforce the couple BL-18 Ganshu and BL-17 Geshu or the couple BL-20 Pishu and BL-23 Shenshu to tonify Spleen and Kidneys.


Therefore, when nourishing Blood in gynecologi-

cal conditions, we always need to nourish Liver-Blood,

even though, as mentioned above, menstrual blood is

Tian Gui that derives from the Kidneys. Indeed, this is

reflected in Chinese herbal medicine as some herbs have

a dual function of tonifying the Kidneys (and therefore

Tian Gui ) and nourishing Liver-Blood. For example: Shu

Di Huang Radix Rehmanniae preparata , Sheng Di Huang

Radix Rehmanniae and Gou Qi Zi Fructus Lycii .

The Liver has an important influence on menstruation

also through Qi. Liver-Qi has the very important function

of moving Blood via Qi. Especially in the pre-menstrual

phase, Liver-Qi needs to move Blood in preparation for

the period. If Liver-Qi stagnates it may cause irregular

periods, dysmenorrhoea and pre-menstrual syndrome.

Liver-Qi and Liver-Blood are the Yang and Yin part of the

Liver and, as such, they are interrelated. Yin needs to root

and embrace Yang, and if Liver-Blood is deficient it can

cause a secondary stagnation of Liver-Qi: the fact that

it is secondary is evident from the symptoms of Liver-Qi

stagnation together with a Pale tongue and Choppy pulse

( Fig. 2.28 ). A deficiency of Liver-Blood is often at the root

of Liver-Qi stagnation and the formula Xiao Yao San

Free and Easy Wanderer Powder illustrates this principle

in its composition. In fact, in the formula, Chai Hu Radix

Bupleuri and Bo He Herba Menthae haplocalycis move

Liver-Qi while Dang Gui Radix Angelicae sinensis and Bai

Shao Radix Paeoniae alba nourish Liver-Blood.

The Liver also represents the connection between the

menstrual blood (which is part of Tian Gui ) and the ‘nor-

mal’ Blood (the one which nourishes hair, nails, sinews,

eyes, etc.). If Liver-Blood is deficient there may be amen-

orrhoea, scanty periods or late periods together with

other Blood deficiency symptoms related to hair, nails,

MINISTER FIRE

Changes

intoWATER NaClSALT CRYSTALS

(TIAN GUI)WATER (KIDNEY-JING)

Figure 2.26 Analogy between Tian Gui and salt crystals.

CHONG MAILIVER

Is Sea of BloodStores Blood

Figure 2.27 Liver-Blood and the Uterus.

CLINICAL NOTE

Although Liver-Qi stagnation is an important and frequent pathological condition in gynecology, in my opinion it is somewhat overemphasized both in China and in the West.

Breast distension,irritability

Pale tongue,choppy pulse

LIV-QISTAGNATION

Figure 2.28 Interrelationship between Liver-Blood and

Liver-Qi.


sleep, sinews and eyes, such as dry hair, brittle nails,

excessive dreaming, cramps and blurred vision. If Liver-

Blood is hot, there may be menorrhagia ( Fig. 2.29 ).

Spleen

The Spleen makes Blood which is then stored in the

Liver. Therefore the ‘Blood’ of the Liver is both the gyne-

cological blood expression of Tian Gui of the Kidneys

and the Post-Natal Blood deriving from the Post-Natal

Qi of Stomach and Spleen. A deficiency of Liver-Blood

in women therefore may refer to the Tian Gui (in which

case both Liver and Kidneys need to be strengthened) or

to Post-Natal Blood which may also be called ‘Spleen-

Blood’ (in which case Liver and Spleen need to be toni-

fied; see Fig. 2.30 ).

The Secret Records of Master Feng’s Brocade Bag says:

The Spleen is the source of Qi and Blood and the Heart

governs the Blood of all channels. When the Heart and

Spleen function well the periods are normal … Blood is

produced by the Spleen and is transformed into sperm

in men and menstrual blood and breast milk in women.

Although the Heart governs Blood and the Liver stores

Blood, Blood is controlled by the Spleen. To nourish Blood,

one must tonify the Spleen and pacify the Stomach …

the Heart and Spleen should be treated before the arrival

of the Heavenly Gui and the Liver and Kidneys after its

arrival. Menstrual blood and breast milk are both produced

by the Spleen and Stomach. After being digested by the

Stomach, the pure part of water and food goes to the Heart

channel where it changes its colour becoming red, thus

forming Blood. The excess of Blood goes to the Directing

and Penetrating Vessels producing the menses … Soon

after delivery the pure part of food goes to the Lungs and

then flows into the breasts to become milk, which is white

in colour, white being the colour of the Lungs. When

breastfeeding is stopped, the pure part of food turns into

Blood again. 25

This passage is interesting as it says that, to ton-

ify Blood in women, before puberty one should ton-

ify Spleen and Heart and, after puberty, Liver and

Kidneys.

The Spleen influences women’s physiology and

pathology also through Qi. Spleen-Qi has an ascending

movement and it keeps the uterus in place. Thus, sink-

ing of Spleen-Qi may cause prolapse of the uterus or

UTERUS Scanty

periods

Blurred vision,

dry skin, dry hair,

dry nails, cramps,

insomnia, etc.

Eyes

Skin

Hair

Sinews

Hun

TIAN GUI LIVER BLOOD

Figure 2.29 Overlap between menstrual blood (as Tian Gui )

and ‘normal’ Liver-Blood.

UTERUSKIDNEYS LIVER

Tian Gui Menstrual blood

Post-Natal blood

SPLEEN

Figure 2.30 Liver-Blood and Spleen-Blood.

SUMMARY

Liver • The Uterus stores Blood and this is received mostly

from the Liver

• The Blood stored in the Liver is both menstrual

blood and therefore Tian Gui deriving from the

Kidneys, but also the Post-Natal Blood made by

the Post-Natal Qi of Stomach and Spleen

• When nourishing Blood in gynecological

conditions, we always need to nourish Liver-Blood

• Liver-Qi has the very important function of moving

Blood via Qi

• Liver-Qi and Liver-Blood are the Yang and Yin part

of the Liver and, as such, they are interrelated. Yin

needs to root and embrace Yang, and if Liver-Blood

is deficient it can cause a secondary stagnation of

Liver-Qi: the fact that it is secondary is evident from

the symptoms of Liver-Qi stagnation together with

a Pale tongue and Choppy pulse

• The Liver also represents the connection between

the menstrual blood (which is part of Tian Gui )

and the ‘normal’ Blood (the one which nourishes

hair, nails, sinews, eyes, etc.)


bladder. With regard to sinking of Spleen-Qi, it should

be noted that prolapse is not its only manifestation.

Sinking of Spleen-Qi is also a factor in menorrhagia

and chronic urinary symptoms such as interstitial cys-

titis ( Fig. 2.31 ). Moreover, in such gynecological and

urinary conditions, it is not only Spleen-Qi that sinks

but also Kidney-Qi.

Spleen-Qi also ‘gathers’ Blood and, if it is deficient,

Blood may leak out causing menorrhagia: this is a

major cause of deficient-type menorrhagia. Please

note that in gynecology, Kidney-Qi also ‘gathers’

Blood and therefore it should be tonified and lifted in

menorrhagia.

Heart

As mentioned above, the Heart influences menstrua-

tion in various ways:

• The Heart governs Blood and therefore has a

general infl uence on Blood.

• The Heart is connected to the Uterus via the Uterus

Vessel ( Bao Mai ): due to this connection, Heart-

Blood plays a role in gynecological conditions.

• According to Fu Qing Zhu, the Kidney-Essence forms

the Heavenly Gui with the help of Heart-Yang.

• The Heart controls the transformation of Yang to

Yin occurring when the period starts and that of

Yin to Yang at ovulation.

• The descending of Heart-Qi to the Uterus promotes

the descending of menstrual blood with the period

and that of the ovum (or ova) at ovulation.

Fu Qing Zhu was not the only gynecologist that

attributed an important function to the Heart with

regard to menstruation. In fact, the Secret Records of

Master Feng’s Brocade Bag (1702) says:

Menstrual Water in women is rooted in four channels: the

Directing and Penetrating vessels, the Small Intestine and

the Heart. The Penetrating Vessel is the Sea of Blood and

the Directing Vessel controls the Uterus and fetus; if these

two vessels are flourishing the woman is fertile. The Small

Intestine channel pertains to a Yang organ which controls

the Exterior and the Yang [energies] , the Heart channel

pertains to a Yin organ and controls the Interior and the

Yin [energies] . Above, these two channels produce breast

milk; below, they produce menstrual Blood. 26

SPLEEN-QI

SINKING

Prolapse uteri Menorrhagia Interstitial cystitis

Figure 2.31 Sinking of Spleen-Qi.

CLINICAL NOTE

Sinking of Spleen- and Kidney-Qi is a factor in menorrhagia and chronic urinary symptoms such as interstitial cystitis. To tonify and lift Spleen- and Kidney-Qi in such conditions, I use LU-7 Lieque on the right together with KI-6 Zhaohai on the left (to open the Directing Vessel) plus Du-20 Baihui and either Ren-4 Guanyuan for menorrhagia or Ren-3 Zhongji for urinary conditions.

SUMMARY

Spleen • The Spleen makes Blood which is then stored in

the Liver

• The ‘Blood’ of the Liver is both the gynecological

Blood expression of Tian Gui of the Kidneys and

the Post-Natal Blood deriving from the Post-Natal

Qi of Stomach and Spleen

• A deficiency of Liver-Blood in women therefore

may refer to the Tian Gui (in which case both Liver

and Kidneys need to strengthened) or to Post-

Natal Blood (in which case Liver and Spleen need

to be tonified)

• Spleen-Qi has an ascending movement and it keeps

the uterus in place. Thus, sinking of Spleen-Qi may

cause prolapse of the uterus or bladder

• Sinking of Spleen-Qi may cause not only

prolapse, as sinking of Spleen-Qi is also a factor in

menorrhagia and chronic urinary symptoms such

as interstitial cystitis

• In such gynecological and urinary conditions, it is

not only Spleen-Qi that sinks but also Kidney-Qi

• Spleen-Qi also ‘gathers’ Blood and, if it is deficient,

Blood may leak out causing menorrhagia: this is a

major cause of deficient-type menorrhagia


This passage is interesting because it connects the

Small Intestine channel with breast milk: this could

explain the use of S.I.-1 Shaoze for agalactia (lack of

milk after childbirth).

The General Treatise on the Aetiology and Sympto-

matology of Diseases (AD 610) says something similar:

The Directing and Penetrating Vessels originate from the Uterus

and they are the Sea of the Channels. The Small Intestine

and Heart channels are exteriorly–interiorly related and they

govern the downward [infusion] of menstrual Blood. 27

The connection between the Heart, the Uterus and

menstruation explains the strong influence of emo-

tional stress on this function. For example, deficiency

of Blood in the Uterus after childbirth can affect the

Heart and cause depression, while stasis of Blood in the

Uterus after childbirth may cause post-natal psychosis.

The influence of the Heart on the menstrual function

can also be seen when an emotional shock affecting the

Heart may lead to amenorrhoea.

Indeed, Heart-Blood affects menstruation in a similar

way to Liver-Blood: Heart-Blood deficiency may cause

scanty periods or amenorrhoea; Heart-Blood stasis

may cause painful periods; and Heart-Blood Heat may

cause menorrhagia.

Lungs

The Lungs have only a minor influence on the men-

strual function. Because they govern Qi, they can

therefore influence some pathological conditions,

such as prolapse of the uterus or menorrhagia, due to

Qi deficiency, usually in conjunction with Spleen-Qi

deficiency. Their influence on menstruation can be

seen in cases when sadness and grief induce a deple-

tion of Qi and stoppage of the menses.

Stomach

The Stomach is connected to the Uterus via the

Penetrating Vessel ( Chong Mai ). In fact, this Extra-

ordinary Vessel arises from the Uterus and goes through

the Stomach, passing through the important Stomach

point ST-30 Qichong. The connection between the

Penetrating Vessel and the Stomach explains the devel-

opment of morning sickness during the early stages of

pregnancy.

The Stomach also influences breastfeeding in nurs-

ing mothers in two ways. First, the Stomach chan-

nel flows through the breast. Second, although breast

milk is a transformation of menstrual Blood occurring

within the Penetrating Vessel, it is supplemented by the

Post-Natal Qi extracted from food which, itself, depends

on the Stomach ( Fig. 2.32 ).

The Stomach is very important in gynecology as it is,

together with the Spleen, the source of Qi and Blood.

The Correct Purpose of Gynecology says:

The Simple Questions says [in Chapter 7 ] “The two

Yang channels affect the Heart and Spleen and their

malfunction causes impotence in men and amenorrhoea

in women”. The two Yang channels are the Stomach

and Large Intestine channels: these channels transform

food and drink and the Heart and Spleen rely on them.

The lower part of the Stomach communicates with the

upper part of the Small Intestine; when the Stomach is

healthy the Small Intestine can transform and transport

[food essences] and therefore Heart-Qi flows properly

and no pathogenic factor can attack it. When the Large

Intestine is healthy it can transform and transport,

food is transformed and digested and the Spleen cannot

be injured. When the two Yang channels [Stomach

and Large Intestine] are diseased, therefore, food is

not digested and transformed and the disease affects

the Heart and Spleen so that Qi and Blood cannot be

produced. 28

SUMMARY

Heart • The Heart governs Blood and therefore has a

general influence on Blood

• The Heart is connected to the Uterus via the Uterus

Vessel ( Bao Mai ): due to this connection, Heart-

Blood plays a role in gynecological conditions

• According to Fu Qing Zhu, the Kidney-Essence

forms the Heavenly Gui with the help of Heart-Yang

• The Heart controls the transformation of Yang to

Yin occurring when the period starts and that of

Yin to Yang at ovulation

• The descending of Heart-Qi to the Uterus promotes

the descending of menstrual blood with the period

and that of the ovum (or ova) at ovulation

• Heart-Blood affects menstruation in a similar way

to Liver-Blood: Heart-Blood deficiency may cause

scanty periods or amenorrhoea; Heart-Blood stasis

may cause painful periods; and Heart-Blood Heat

may cause menorrhagia


This passage illustrates the importance of the

Stomach and the digestive system in general (including

Small Intestine and Large Intestine) for the production

of Qi and Blood: a deficiency of Qi and Blood affects the

Heart (which governs Blood) and the Spleen and may

therefore cause menstrual problems, especially scanty

periods or amenorrhoea.

Figure 2.33 illustrates the connection between the

internal organs and menstruation.

MENSTRUATION AND THE

EXTRAORDINARY VESSELS

The menstrual function depends on the three

Extraordinary Vessels: the Governing, Directing and

Penetrating Vessesls ( Du , Ren and Chong Mai ). The

Governing Vessel governs the Yang within the menstrual

cycle, the Directing Vessel the Yin and the Penetrating

Vessel the Blood. All three vessels arise from the space

between the Kidneys where the Motive Force throbs

and they then flow through the uterus in women (and

the ‘Room of Sperm’ in men). These three vessels can

be considered as three branches of the same vessel. The

Mirror of Medicine abstracted by Master Luo says:

The Penetrating, Directing and Governing Vessels are

three branches from the same source. The Penetrating

Vessel is the Sea of Blood, the Directing Vessel governs all

Yin channels and the Governing Vessel governs all Yang

channels. The Blood of the Internal Organs flows to the

Penetrating Vessel which is the foundation of the menses.

However, the flourishing of the Penetrating Vessel depends

on the Stomach which is its foundation. For this reason,

all Blood disorders should be treated with sweet and warm

herbs as bitter and cold herbs may damage Stomach-Qi. 29

Figure 2.34 illustrates the connection between the

Extraordinary Vessels, the Motive Force, the Uterus, the

Kidneys and Heart.

Penetrating Vessel ( Chong Mai )

The Penetrating Vessel is probably the most impor-

tant of the Extraordinary Vessels and could be con-

sidered the origin of them all. It has a deep influence

on menstruation both because it originates from the

Kidneys and because it is the Sea of Blood. This vessel

Figure 2.32 The Penetrating Vessel and the transformation of

menstrual blood into breast milk.

SUMMARY

Stomach • The Stomach is connected to the Uterus via the

Penetrating Vessel ( Chong Mai ) which arises from

the Uterus and goes through the Stomach, passing

through the important Stomach point ST-30 Qichong

• The connection between the Penetrating Vessel and

the Stomach explains the development of morning

sickness during the early stages of pregnancy

• The Stomach also influences breastfeeding in

nursing mothers in two ways:

• First, the Stomach channel flows through the breast

• Second, breast milk is supplemented by the

Post-Natal Qi extracted from food

• The Stomach is very important in gynecology as it is,

together with the Spleen, the source of Qi and Blood


influences the supply and proper movement of Blood in

the Uterus and controls menstruation in all its aspects.

The trajectory of the Penetrating Vessel is quite com-

plex ( Fig. 2.35 ). It starts in the area between the kid-

neys where the Motive Force ( Dong Qi ) throbs. Passing

through the uterus, it flows down to Ren-1 Huiyin; this

part of its trajectory is common to all three vessels –

Penetrating, Governing and Directing – which is why

Li Shi Zhen calls them “three branches of one vessel” .

From Ren-1, the Penetrating Vessel emerges at ST-30

Qichong and then flows with the Kidney channel up to

KI-21 Youmen (some authors say up to KI-27 Shufu).

It continues its flow up to the throat, circles around the

mouth and goes up to the forehead where it “oozes into

the Yang and irrigates the Yin” . 30 From Ren-1, a branch

flows inside the spine (some authors say up to the level

of BL-23 Shenshu). Another branch flows down from

ST-30 in the inner side of the leg to the medial side of

the foot, where it splits into two branches following the

Kidney and Spleen channels (the latter reaching the big

toe). Thus the Penetrating Vessel influences the whole

body except the arms.

The spinal branch of the Penetrating Vessel explains

how a woman can experience menstrual pain in the

sacrum and lower lumbar vertebrae. The descending

branch of the Penetrating Vessel explains how menstrual

pain can sometimes irradiate down to the inner thighs.

The changes that take place in the Governing,

Directing and Penetrating vessels determine the

hormonal changes that occur in women at intervals of

KIDNEY ESSENCE

Penetrating Vessel

Directing Vessel

Governing VesselM

EN

ST

RU

AT

ION

Essence is biological basis formenstrual blood (Heavenly Gui)

Minister Fire is origin of both Fire and Water.Fire warms and activates

Provides Blood to Uterus

LIV-Qi moves Blood for menstruation to occur

Governs Blood. HE-Blood goes downto Uterus (Uterus Vessel)

Goes down to Uterus and Kidneys andcontributes to forming Heavenly Gui

LU-Qi contributes to making Blood

Connected to Uterus via the Penetrating Vessel

Makes Blood

SP-Qi holds blood in vesselsand Uterus in place

MINISTER FIRE

LIVER BLOOD

QI

QI

HEART

HE-YANG

SPLEEN

LUNGS

STOMACH

Figure 2.33 Internal organs and menstruation.


7 years or thereabouts, as described in the first chapter

of the Simple Questions which says:

At 14 the Heavenly Gui comes into play, the Directing Vessel

circulates strongly, the Penetrating Vessel is flourishing, the

menses come at regular intervals and the girl can conceive

… at 49 the Directing Vessel becomes deficient and the

Penetrating Vessel depleted, the Heavenly Gui dries up,

menstruation stops and she can no longer conceive. 31

Some authors say that the Penetrating Vessel is the

Sea of Blood and, for this reason, the Sea of Blood points,

BL-11 Dashu, ST-37 Dajuxu and ST-39 Xiajuxu, are

Penetrating Vessel points ( Fig. 2.36 ). Being the Sea of

Blood, it has a paramount importance in the menstrual

function. It provides and moves Blood, oozes into the

Yang and irrigates the Essence.

The Penetrating Vessel is related to Blood and body

hair. When its Blood is abundant it moistens the skin

and promotes the growth of body hair. Chapter 35 of

the Spiritual Axis says:

The Penetrating and Directing Vessels go to the throat, lips

and mouth. If both Qi and Blood are abundant the skin is

filled and the muscles warmed, if only Blood is abundant it

will penetrate into the skin and beard grows. Women have

more Qi than Blood because they lose some of it with the

periods, hence the Penetrating and Directing Vessels carry

less Blood to chin and lips and therefore no beard grows. 32

The Penetrating Vessel, together with the Directing

Vessel, regulates the uterus and menstruation and it

nourishes and moves Blood. It can be used in such con-

ditions as dysmenorrhoea, irregular periods, pre-men-

strual tension and menorrhagia. If the Penetrating

Vessel is Empty, there may be amenorrhoea, scanty

periods or late periods. Stagnant Qi and/or Blood in the

Penetrating Vessel may cause dysmenorrhoea.

The Classic of Categories has an interesting summary

of the energetic sphere of action of the Penetrating

Vessel and explains more in depth the meaning of this

vessel’s being the ‘Sea of the 12 Channels’:

The Penetrating Vessel is the Sea of the 12 Channels,

it goes upwards to connect with BL-11 Dashu and

downwards to connect with ST-37 Shangjuxu and ST-39

Xiajuxu. The Penetrating Vessel goes down to ST-30

Qichong and up to connect with the Kidney channel. It

goes up to the eyes and head and down to the feet; it goes

to the back [in the lumbar spine] and to the front in the

abdomen. It goes into the Interior in the rivers and valleys

[the big and small muscles of the abdomen] and into

Exterior in the skin and muscles. It therefore connects with

both Yin and Yang and both Interior and Exterior … 100

diseases originate from the Penetrating Vessel because it

is the most ‘penetrating’ [of the channels] . It controls the

Qi and Blood of the 12 Channels which nourish the whole

body and for this reason it is called the Sea of the 5 Yin and

6 Yang Organs. 33

This energetic sphere of action is illustrated in

Figure 2.37 .

REN-1

MOTIVEFORCE

(Source ofextraordinary

vessels)

HE-YANG

GoverningVessel

DirectingVessel

GoverningVessel

DirectingVessel

PenetratingVessel

Descendsto Kidneys

UTERUSBLOOD

HEAVENLY GUI

Transformedinto Blood (withhelp of Liverand Spleen)

REN-4Pre-natalEssenceaccumulateshere atconception

DU-4Minister

Fire

KI-ESSENCE

Figure 2.34 The Extraordinary Vessels and the Uterus.


Directing Vessel ( Ren Mai )

The Directing Vessel is very closely related to the Uterus and

to the whole female reproductive system including internal

and external genitalia in women. All problems of cervix,

vagina and vulva are related to the Directing Vessel.

Kl channel

ST-30

Figure 2.35 The Penetrating Vessel.

SUMMARY

Penetrating Vessel ( Chong Mai ) • The Penetrating Vessel has a deep influence on

menstruation both because it originates from the

Kidneys and because it is the Sea of Blood

• This vessel influences the supply and proper

movement of Blood in the Uterus and controls

menstruation in all its aspects

• The changes that take place in the Governing,

Directing and Penetrating Vessels determine

the hormonal changes that occur in women at

intervals of 7 years or thereabouts, as described in

the first chapter of the Simple Questions

• The Penetrating Vessel is the Sea of Blood and, for

this reason, the Sea of Blood points, BL-11 Dashu,

ST-37 Dajuxu and ST-39 Xiajuxu, are Penetrating

Vessel points

• Being the Sea of Blood, it has a paramount

importance in the menstrual function

• The Penetrating Vessel is related to Blood and

body hair. When its Blood is abundant it moistens

the skin and promotes the growth of body hair

• The Penetrating Vessel, together with the

Directing Vessel, regulates the uterus and

menstruation and it nourishes and moves Blood


The Directing Vessel starts from the space between

the kidneys where the Motive Force throbs. Passing

through the uterus, it emerges at Ren-1 Huiyin. It then

flows upwards through all the Directing Vessel’s points

up to Ren-24 Chengjiang. It then circles the mouth and

enters the eyes from ST-1 Chengqi ( Fig. 2.38 ).

In terms of energies, the Directing Vessel is con-

nected to Yin, Essence and fluids (as opposed to the

Penetrating Vessel, which is related mostly to Blood

and Qi); in fact, it is called the ‘Sea of the Yin channels’.

This means that the Directing Vessel provides the Yin

substances (including Essence, Blood and fluids) for all

women’s physiological processes and hormonal gate-

ways, including puberty, conception, pregnancy, child-

birth and menopause. The Penetrating Vessel, on the

other hand, is related more to Blood and menstruation

BL-11

ST-37

ST-39

Sea ofBlood

CHONG MAI

Figure 2.36 The Penetrating Vessel and the points of the Sea

of Blood.

BL-11 Eyes

KI channel

Exterior

(skin, muscles)

ST-37

Feet

ST-30

ST-39

Abdomen Spine

Interior

(abdomen)

Penetrating Vessel(Chong mai)

Figure 2.37 Energetic sphere of the Penetrating Vessel.

Figure 2.38 The Directing Vessel.


and its pathology is dominated by Blood stasis and Qi

stagnation.

The Directing Vessel can be used to nourish the Yin

energy of the body, particularly in women after meno-

pause, and to reduce the effects of Empty-Heat symp-

toms deriving from Yin deficiency.

The main difference between the Penetrating Vessel

and the Directing Vessel in relation to menstruation is

that the former controls Qi and can be used to tonify

and nourish, whereas the latter controls Blood and is

mostly used to move Qi and Blood and remove obstruc-

tions. Thus the Directing Vessel has more responsibil-

ity for conception, fertility, menarche, pregnancy and

menopause, the Penetrating Vessel for menstruation

and most of its irregularities.

Governing Vessel ( Du Mai )

The Governing Vessel also arises from the space

between the kidneys. Passing through the uterus, it

emerges in the perineum at Ren-1 Huiyin. From here

it goes to Du-1 Changqiang and flows up the spine to

the base of the skull where it enters the brain. From

the vertex, it flows in the midline down to the upper

lip ending at Du-28 Yinjiao. However, its internal

pathway is more complex than this outline may sug-

gest. There is a contradiction between the Classic of

Difficulties , which has the Governing Vessel running

upwards, and the Spiritual Axis ( Ch. 16 ), which has it

running downwards as a branch of the Liver channel

and which, after describing the pathway of the Liver

channel, says:

… its separating branch travels upwards to the forehead,

then to the vertex, then downward in the midline of the

occiput, travelling along the spine to enter the sacrum:

this [separating branch] is the Governing Vessel. It then

flows to the genitals, passing upward through the pubis

to enter the umbilicus, moving upwards in the abdomen

to enter the clavicle area and downward to enter the

lungs. 34

Thus this pathway of the Governing Vessel flows not

only down the spine but also up the abdomen.

Chapter 60 of the Simple Questions has the follow-

ing pathway for the Governing Vessel: it starts near

the uterus and goes down to the pubic bone and, in

women, to the vagina. Its connecting channel goes

around the vagina, passes to the perineum, then the

buttocks, down to meet the Kidney and Bladder chan-

nels inside the upper thighs; it then rises up the spine

to wrap around the kidneys ( Fig. 2.39 ). In men it goes

around the penis and then the perineum. The ‘main

vessel’ starts in the abdomen and goes up to the umbi-

licus, past the heart, throat and chin, and around the

lips to reach the eyes ( Fig. 2.40 ). 35 Some see this ‘main

vessel’ as being the Directing Vessel, others as a branch

of the Governing Vessel; in fact, Li Shi Zhen considered

it a branch of the Governing Vessel flowing with the

Directing Vessel:

SUMMARY

Directing Vessel ( Ren Mai ) • The Directing Vessel is very closely related to the

Uterus and to the whole female reproductive

system including internal and external genitalia

• All problems of cervix, vagina and vulva are related

to the Directing Vessel

• The Directing Vessel is connected to Yin, Essence

and fluids

• The Directing Vessel provides the Yin substances

(including Essence, Blood and fluids) for all

women’s physiological processes and hormonal

gateways, including puberty, conception,

pregnancy, childbirth and menopause

Figure 2.39 Genital branch of the Governing Vessel.


Another branch [of the Governing Vessel] starts in the

lower abdomen, comes up the abdomen, to the umbilicus,

the heart, enters the throat, goes to the chin and to the

centre of the eyes, following the pathway of the Directing

Vessel. 36

Figure 2.41 illustrates the secondary channels of the

Governing Vessel from the Simple Questions ( Ch. 60 )

and from the Study of the Eight Extraordinary Vessels by

Li Shi Zhen.

The implication of the above pathway is that the

Governing and Directing vessels are almost like two

branches of the same vessel, one Yang and one Yin,

intersecting inside. Li Shi Zhen says:

The Directing and Governing Vessels are like midnight and

midday, they are the polar axis of the body … there is one

source and two branches, one goes to the front and the

other to the back of the body … we can make connections

between them. When we try to divide these, we see that

Yin and Yang are inseparable. When we try to see them as

two, we see that it is an indivisible whole. 37

Literally translated, the last sentence says: “ They are

one but two, they are two but one. ” Thus the ‘main vessel’

that the Simple Questions describes may be seen either

as the Directing Vessel or as a branch of the Governing

Vessel and, given the close connection between these

two vessels, in practice it does not make much differ-

ence which one it is.

However, the important implication of the above

pathways in gynecology is that the Governing Vessel

extends a branch to the front of the body curling

around the vagina; when a woman has problems of the

genitalia the Directing Vessel is the obvious choice but

the Governing Vessel can be used too, and if there is a

marked deficiency of Kidney-Yang, it should be chosen

in preference to the Directing Vessel.

In relation to menstruation, the Governing Vessel

influences the tide of Yang (Kidney-Yang) that

decreases with the onset of the period and increases

Figure 2.40 Abdominal branch of the Governing Vessel.

Through brain

Through heart

To vagina

To BL and Kl

channels in thigh

Figure 2.41 The secondary channels of the Governing Vessel.


from ovulation. In other words, arising from the

uterus like the Directing and Penetrating vessels, it

represents the Yang aspect of women’s reproduc-

tive functions. As we have seen above, the Governing

Vessel represents the influence of the Fire of the Gate

of Life ( Ming Men ) and the Minister Fire in women’s

physiology.

The Governing and Directing vessels can be seen

as two branches, one Yang and one Yin, of the same

continuous energetic circuit arising from the space

between the kidneys, flowing through the uterus,

emerging at the perineum and flowing upwards, one

at the back, the other at the front, to reach the head

and the brain, connecting with the heart on the way

( Fig. 2.42 ). Thus, from a Chinese perspective, these two

vessels connect the Uterus with the Kidneys, the Heart

and the Brain, which goes some way to explaining the

influence of mental–emotional problems on the men-

strual and ovarian functions and vice versa. In terms

of vital substances, the Governing and Directing

vessels’ circuit connects the Essence (Kidneys), Blood

(Uterus and Heart), Marrow (spine and Kidneys) and

Sea of Marrow (Brain). Seen from a Western perspec-

tive, the Governing and Directing Vessels clearly repre-

sent the hypothalamus–pituitary–ovarian axis which

is responsible for ovulation ( Fig. 2.43 ).

Girdle Vessel ( Dai Mai )

The Girdle Vessel is the only horizontal channel of

the body. Its pathway is simply a belt-like channel

encircling the waist and passing through G.B.-26

Daimai, G.B.-27 Wushu and G.B.-28 Weidao. Some

authors say it also connects with LIV-13 Zhangmen.

In the back, it intersects the Kidney divergent chan-

nel ( Fig. 2.44 ).

The Girdle Vessel has an important influence in

women’s physiology and pathology. Encircling the leg

channels, it interrelates with and restrains the Liver’s

smooth flow of Qi (through LIV-13 Zhangmen), and

REN-1

Figure 2.42 Circuit of Governing and Directing Vessels.

SUMMARY

Governing Vessel ( Du Mai ) • The Governing Vessel also arises from the space

between the kidneys

• The Governing Vessel has a branch going to the

front of the body in the genital area: it goes to the

vagina in women and penis in men

• The Governing Vessel also has an abdominal

branch that follows the same pathway as that of

the Directing Vessel

• The Governing and Directing Vessels are almost

like two branches of the same vessel, one Yang

and one Yin, intersecting inside

• In relation to menstruation, the Governing Vessel

influences the tide of Yang (Kidney-Yang) that

decreases with the onset of the period and

increases from ovulation

• Arising from the uterus like the Directing and

Penetrating Vessels, the Governing Vessel

represents the Yang aspect of women’s

reproductive functions

• The Governing Vessel represents the influence of

the Fire of the Gate of Life ( Ming Men ) and the

Minister Fire in women’s physiology


harmonizes the ascending and descending of both

Spleen and Kidneys. Hence the Kidney’s nourishment

of the Essence and descending of Qi, the Spleen’s rais-

ing of Qi and the Liver’s smooth flow of Qi all rely on

the Girdle Vessel being ‘relaxed and stretched’: these

are all very important aspects of women’s physiol-

ogy and pathology. Because of this, the Girdle Vessel

guides and supports the Qi of the Uterus and the

Essence. If the Girdle Vessel does not exercise enough

restraint, Damp-Heat, usually deriving from a chronic

Spleen deficiency, may infuse downwards causing

leucorrhoea.

Because the Girdle Vessel connects with LIV-13

Zhangmen (Front-Collecting point of the Spleen)

and BL-23 Shenshu (Back-Transporting point of the

Kidneys), it connects the Post-Natal with Pre-Natal Qi

(in a similar way to that of the Penetrating Vessel).

Because of the gynecological sphere of influence

of the Girdle Vessel, some doctors say that in terms

of energy it is part of the Directing Vessel and the

Penetrating Vessel: its deficiency pathology is related

to the Directing Vessel while its excess pathology

is related to the Penetrating Vessel. Deficiency of

the Girdle Vessel makes it too ‘slack’. This slackness

leads to Kidney and Liver deficiency. The Girdle Vessel

fails to restrain the Essence, Spleen-Qi sinks and the

Post-Natal Qi is unsupported, so that the Directing,

Governing and Penetrating Vessels all become

deficient.

When the Girdle Vessel is slack, Qi cannot rise, the

organs sag and there may be prolapse of the uterus or

miscarriage, due to long-term Qi deficiency, Post- and

Pre-Natal Qi deficiency and clear Qi descending. The

fetus depends not only on the Kidneys and the Directing

Vessel, but also on the Girdle Vessel. If the Girdle Vessel

is slack, Qi cannot rise, the fetus is not stabilized and

the mother may miscarry.

The Governing and Directing vessels cut across

the Girdle Vessel linking it with the Heart above, the

genital system below, the umbilicus in front and the

Penetrating Vessel in the middle. This emphasizes why

these four vessels (Governing, Directing, Penetrating

and Girdle) are interlinked for the production, circula-

tion, discharge and regeneration of the Essence. When

these vessels are blocked, the Essence cannot be pro-

duced properly and all kinds of gynecological problems

ensue. Figure 2.45 illustrates the relationship among

the Governing, Directing, Penetrating and Girdle ves-

sels in gynecology.

Hypothalamus

Pituitary

Figure 2.43 Governing and Directing Vessels as

hypothalamus–pituitary–ovarian axis.

Joins KI divergent channel

(level of BL-23)

Figure 2.44 Girdle Vessel.


Yin Stepping Vessel ( Yin Qiao Mai )

The Yin Stepping Vessel starts from KI-6 Zhaohai. It

ascends along the medial surface of the leg and thigh

and then goes over the abdomen, passing through the

external genitalia, and ascending to the chest, the cla-

vicle, the throat and face to end at the inner canthus of

the eye ( Fig. 2.46 ).

The Yin Stepping Vessel influences the reproduc-

tive system and the lower abdomen in women. It is

Figure 2.46 The Yin Stepping Vessel.

SUMMARY

Girdle Vessel ( Dai Mai ) • The Girdle Vessel is the only horizontal channel of

the body

• Its pathway is simply a belt-like channel encircling

the waist and passing through G.B.-26 Daimai,

G.B.-27 Wushu and G.B.-28 Weidao

• Encircling the leg channels, the Girdle Vessel

interrelates with and restrains the Liver’s smooth

flow of Qi (through LIV-13 Zhangmen), and

harmonizes the ascending and descending of both

Spleen and Kidneys

• The Kidney’s nourishment of the Essence and

descending of Qi, the Spleen’s raising of Qi and

the Liver’s smooth flow of Qi all rely on the Girdle

Vessel being ‘relaxed and stretched’

• If the Girdle Vessel does not exercise enough

restraint, Damp-Heat, usually deriving from a

chronic Spleen deficiency, may infuse downwards

causing leucorrhoea

• Its deficiency pathology is related to the Directing

Vessel while its excess pathology is related to the

Penetrating Vessel

• Deficiency of the Girdle Vessel makes it too

‘slack’. This slackness leads to Kidney and Liver

deficiency. The Girdle Vessel fails to restrain the

Essence, Spleen-Qi sinks and the Post-Natal Qi is

unsupported, so that the Directing, Governing and

Penetrating Vessels all become deficient

BRAIN/HEART

Pen

etra

ting

Ves

sel

GoverningVessel

DirectingVessel

UTERUS

REN-1

Girdle Vessel

Figure 2.45 Relationship among Governing, Directing,

Penetrating and Girdle vessels.


particularly used for excess patterns of the Lower

Burner such as abdominal masses, fibroids, difficult

delivery and retention of placenta. Since it passes

through the external genitalia, it may also be used for

problems that occur in this area, provided there is a

background of excess.

Figure 2.47 summarizes the interrelationship among

the internal organs, the Vital Substances, the Uterus

and the Extraordinary Vessels.

CONCEPTION

As described above, conception relies on an abun-

dant supply of Blood and Essence, the flourishing

of Kidneys and Liver, and healthy Penetrating and

Directing Vessels, factors which depend on the mother;

other factors depend on the father. Thus both the Pre-

Natal Qi, in the form of Essence, and the Post-Natal

Qi, in the form of Blood, are essential for conception

to occur. However, Blood and Essence are only the Yin

essences of the body and conception depends also

on the Yang energies of the Fire of the Gate of Life.

This is the formless Minister Fire which is intrinsically

and indissolubly related to Water. The Minister Fire

(related to the Governing Vessel) provides the spark

necessary for the Essence and Blood to form a new

being ( Fig. 2.48 ).

However, the Essence of the mother is only one aspect

of the necessary energies for conception to occur. The

mother’s Corporeal Soul ( Po ) also plays an important

role in conception. A physical type of soul that pertains

to Earth, it is Yin in nature, is stored in the Lungs and

comes from the mother; it dies with the body at the end

of a life. The Corporeal Soul interacts closely with the

Essence: it could be said that it brings the Essence into

Governs

Makes

Mother

Commands

Makes

Replenishes

Makes

Free-flow

Stores andmoves

Governs

Stores

QI

BLOOD UTERUS

Penetrating

Blood is ‘lower source’ of milk

Uterus Channel

Uterus Vessel

Directing

Governing

Vessels

ESSENCE

Menarche

Menstruation

Pregnancy

Delivery

Lactation

Menopause

LUNGS

SPLEEN

LIVER

HEART

KIDNEYS

Figure 2.47 Interrelationship among the internal organs, the Vital Substances, the Uterus and the Extraordinary Vessels.

Heavenly‘GUI’

(Pre-natal)

BLOOD(Post-natal)

MINISTERFIRE

CONCEPTION

Mother’s

ESSENCE

Father’s

ESSENCE

Figure 2.48 Factors in conception.


play in all physiological processes. In fact, Chapter 8 of

the Spiritual Axis says: “ The Corporeal Soul is the enter-

ing and exiting of the Essence. ” 38 In particular, the fetus’s

Corporeal Soul is formed at conception from the moth-

er’s: thus the father plays no role in this particular aspect

of conception. Thus, from this point of view, the influ-

ence of the mother’s energies on conception is stronger

than that of the father. This also implies that the heredi-

tary constitution of a baby depends not only on the par-

ents’ Kidneys, but also on the mother’s Lungs.

PREGNANCY

Pregnancy is a time of change. As a result of the stop-

ping of the menses, the Penetrating and Directing

Vessels undergo many changes, which are typical of

pregnancy and do not occur at other times. During

pregnancy there is an abundance of Yin, because

there is no longer a monthly loss of blood and because

there is a gradual increase in fluids (amniotic fluid);

there is also a plethora of Yang, because the absence

of periods leads also to an accumulation of Minister

Fire (as the Water and the Fire within the Kidneys are

inseparable).

After conception, Blood is gradually transformed into

milk and also transfers its location from the Lower to

the Upper Burner. During the first 3 months, because

of the profound changes taking place in the Penetrating

Vessel and because of the transformation of Blood into

milk with its upward movement to the breasts, rebel-

lious Qi often goes up in the Penetrating Vessel. This

causes not only morning sickness in the first 3 months

but also a general feeling of heat above and distension

of the breasts.

From an energetic point of view, pregnancy has a

dual effect on the Kidneys. On the one hand, it poses

a strain on the Kidneys as their Qi and Essence go to

feed the fetus. However, the stoppage of the menses

also means that menstrual blood (which is not actu-

ally ‘Blood’ as seen above, but Tian Gui ) can now go

to feed the body itself (as well as the fetus). It could be

said that during pregnancy, Blood is transformed into

Essence which nourishes the body (and the fetus). In

fact, under normal circumstances and a healthy preg-

nancy, a pregnant woman looks very florid and healthy

and not at all Blood deficient (especially between the

fourth and seventh months).

The transformation of Blood into Essence during

pregnancy is mirrored, from a Western point of view,

by the secretion of large amounts of oestrogen, pro-

gesterone and chorionic gonadotropin by the placenta,

which explains why some women are healthier in preg-

nancy and others deteriorate; the difference depends

both on the pre-existing state of Kidney-Qi and on how

well the woman looks after herself during the preg-

nancy. Two examples of health problems that often

improve during pregnancy are asthma and migraine.

The increased pigmentation along the midline of the

body and round the nipples is due to changes occurring

in the Directing Vessel.

Another change taking place during pregnancy is a

certain increase in Heat. The Qing dynasty gynecolo-

gist, Chen Jia Yuan, explains:

During pregnancy the Emperor and Minister Fire

gradually nourish the fetus and there is normally a

feeling of heat and a certain restlessness [in the mother] .

The Heart governs Blood [during pregnancy] , Blood

protects the fetus and cannot irrigate the Sea of Blood. 39

This passage is interesting because it confirms that

Blood deficiency can cause hot flushes and a feeling of

heat in a similar way to Yin deficiency. The passage is

interesting also because it states that during pregnancy,

although the Blood is abundant (as the menses stop),

it is directed to nourish and protect the fetus rather

than flowing into the Sea of Blood. This may explain

the fact that, from a Western point of view, although

during pregnancy there is a substantial increase in the

volume of fluids, including those in the plasma (to a

total of about 3300 ml), a 30% increase in the volume

of blood and an increase in the total absolute number

of red blood cells (by about 20%), there is a decrease

in the haemoglobin content because the haemoglobin

concentration and the red blood cell count fall in rela-

tion to the large increase in blood volume.

Seen from a Chinese perspective, these physiological

changes of pregnancy are mirrored in the idea that the

Blood increases (because the menses stop) but it is devi-

ated away from the Sea of Blood to nourish and protect

the fetus. Hence, while from a Western point of view

the mother may be said to suffer from anaemia (due to

the fall in red cell count and haemoglobin in relation to

the increased volume of blood), she cannot be said to

suffer from Blood deficiency in a Chinese sense.

Interestingly, a study conducted on 153 602 preg-

nant women by three English medical colleges showed

that women with low haemoglobin levels were more


likely to carry the pregnancy to full term and give birth

to healthy babies. In fact, risks of a pre-term baby or

one born with a low birth weight increased seven times

in women whose haemoglobin levels failed to fall dur-

ing pregnancy. In other words, the widely seen drop in

iron blood levels in pregnant women is perfectly nor-

mal, signifying good expansion in blood volume, not

anaemia. 40 This confirms what was said above, i.e. that

the haemoglobin level of pregnant women is lower only

in relation to the increased blood and fluid volume.

Birth weight is the single biggest determinant of

mortality in the first year of life and is therefore a

good indicator of the efficiency with which a woman

has supported her fetus. The authors of the above-

mentioned study conclude that the mechanism by

which expansion of the plasma volume enhances

fetal growth is not known, but it may be that reduced

blood viscosity favours blood flow in the low-veloc-

ity flow system of the maternal intervillous space.

This last observation ties in well with Chinese views

as, although the mother’s Blood goes to nourish

the fetus, there is more of it due to the cessation of

menses.

In Chinese medicine, pregnancy is considered to last

10 lunar months (roughly equivalent to 9 calendar

months) and each month corresponds to an internal

organ as follows:

1. Liver

2. Gall Bladder

3. Pericardium

4. Triple Burner

5. Spleen

6. Stomach

7. Lungs

8. Large Intestine

9. Kidneys

10. Bladder.

The use of points on a particular channel in theory

was prohibited in the relevant month, but this rule is

not followed nowadays. The correspondence between

the tenth month and the Bladder is interesting: this

would provide an explanation for the use of the point

BL-67 Zhiyin in the last month of pregnancy to turn

the fetus. The fact that it has the effect of moving the

fetus would confirm the idea that, under normal cir-

cumstances, points from that channel should not be

used in the tenth month and, by inference, neither

should the other channels be needled in the relevant

months. However, the Qing dynasty gynecologist Chen

Jia Yuan has a different correspondence between the

months of pregnancy and internal organs:

1. Gall Bladder

2. Liver

3. Pericardium

4. Heart

5. Stomach

6. Spleen

7. Large Intestine

8. Lungs

9. Bladder

10. Kidneys.

The Thousand Golden Ducat Prescriptions of the Tang

dynasty describes the changes occurring at each

month of pregnancy. It says that in the first month the

conceived being is called embryo (some ancient doctors

compared it to ‘dew’), in the second month ‘fat’ ( Gao ),

in the third month ‘fetus’ ( Bao ); in the fourth month it

acquires a body shape, in the fifth it can move, in the

sixth the sinews and bones are formed, in the seventh

the skin and hair are formed, in the eighth the organs

are fully formed, in the ninth the Food Qi ( Gu Qi ) enters

the Stomach, in the tenth month the Shen is fully estab-

lished and childbirth occurs. 41

MENOPAUSE

Chapter 1 of the Simple Questions says:

At 49 [in a woman] the Directing Vessel becomes deficient,

the Penetrating Vessel depleted, the Tian Gui dries up, the

fluids in the channels are exhausted, her body becomes old

and she can no longer become pregnant. 42

Thus, the most important change occurring around

this age is a decline of the Kidney energy and the

Directing and Penetrating Vessels, together with a gen-

eral drying up of fluids and Blood. This is consistent

with the symptoms of menopausal problems.

‘Menopause’ indicates the complete or permanent

cessation of menstruation: an interval of 6 to 12

months is usually necessary to establish the diagnosis.

‘Climacteric’ indicates the phase in a woman’s life dur-

ing which she makes the transition from a reproductive

to a non-reproductive stage: this transition is a period

of declining ovarian function which usually spans 2 to

5 years around the menopause. Thus, when we refer to

the discomfort and symptoms appearing during these


years, it would be more appropriate to call them climac-

teric syndrome rather than menopausal syndrome : how-

ever, since the latter term is more generally used and

understood, I shall use it throughout this book.

Menopause usually occurs between the ages of 48

and 55 and the median age in industrialized countries

is about 51. It will be remembered that the very first

chapter of the Simple Questions describes the 7-year

cycles of women, according to which menopause

occurs at 49 (7 × 7): this is not far from the above-

mentioned median age of 51. Furthermore, data anal-

yses indicate that the menopausal age has remained

unchanged for centuries. 43 Indeed, the mean age at

menopause is just over 50 and this is remarkably con-

stant not only throughout the Western world but also

other countries. A survey of Malaysian women showed

a mean age at menopause of 50.7 years, and another

of seven Asian countries found that most women

reached menopause at around 50. 44

The primary basis for the progressive decline of

reproductive power in women is in the ovary itself,

as ovarian follicles are greatly depleted by the time of

the menopause. There are about 300 000 follicles at

menarche and about 10 000 at the time of the meno-

pause. As the follicle activity decreases and then ceases,

there is a lack of oestrogen and therefore a cessation of

the menses.

Menopause is not a disease, it is the normal physiologi-

cal transition in a woman’s life from a reproductive to a

non-reproductive age: indeed, many women experience

no ‘symptoms’ during this time. From a Chinese perspec-

tive, menopausal symptoms (if there are any) are gener-

ally due to a decline of Kidney-Essence in its Yin or Yang

aspect; however, within this basic pathology there can

be many variations of pattern. Moreover, the deficiency

of the Kidneys may often be combined with excess pat-

terns, especially Phlegm, stagnation of Qi, stasis of

Blood, Empty-Heat, or Liver-Yang rising ( Fig. 2.49 ).

For a discussion of menopausal problems, see

Chapter 58 .

END NOTES

1. Elementary Medicine ( Yi Xue Ru Men ) 1575 cited in Zhang Qi

Wen 1995 Menstrual Diseases ( Yue Jing Bing Zheng ),

People’s Hygiene Publishing House, Beijing, p. 10.

2. Feng Tao Zhang 1702 Secret Records of Master Feng’s Brocade Bag

( Feng Shi Jin Nang Mi Lü ) cited in Menstrual Diseases, p. 13.

3. Cited in Chinese Medicine Research Institute and Guangzhou College

of Chinese Medicine 1980 Concise Dictionary of Chinese Medicine

( Jian Ming Zhong Yi Ci Dian ), People’s Health

Publishing House, Beijing, p. 186.

4. 1979 The Yellow Emperor’s Classic of Internal Medicine – Simple

Questions ( Huang Di Nei Jing Su Wen ), People’s

Health Publishing House, Beijing, p. 259. First published c. 100 BC.

5. Ibid., p. 197.

6. Ann McPherson 1993 Women’s Problems in General Practice,

Oxford University Press, Oxford, p. 201.

7. Whincup P H, Gilg J A, Odoki K et al 2001 Age of Menarche in

Contemporary British Teenagers: Survey of Girls Born between

1982–1986, British Medical Journal 322: 1095–1096.

8. Chumlea W C, Schubert C M, Roche A F et al 2003 Age at Menarche

and Racial Comparisons in US Girls, Pediatrics 111: 110–113.

9. Wu Da Zhen 1994 Hundred Methods for the Treatment, Prevention

and Dietary Therapy of Menstrual Irregularities ( Yue Jing Bing Fang

Zhi He Shi Liao 100 Fa 100 ), China

Medicinal Herbs Scientific Publishing House, Beijing, p. 12.

10. Ibid., p. 194.

11. Simple Questions, p. 5.

12. Chen Zi Ming 1237 Great Treatise of Beneficial Formulae for Women

( Fu Ren Liang Fang Da Quan ) cited in Menstrual Diseases, p. 10.

13. Fu Qing Zhu 1973 Fu Qing Zhu’s Gynaecology ( Fu Qing Zhu Nu Ke

), Shanghai People’s Publishing House, Shanghai,

p. 27. First published in 1827. Fu Qing Zhu was born in 1607 and

died in 1684.

14. Ibid., p. 27.

15. Simple Questions, p. 5.

16. Chen Zi Ming 1237 Great Treatise of Beneficial Formulae for Women

( Fu Ren Liang Fang Da Quan ) cited in Menstrual Diseases, p. 10.

17. Fu Qing Zhu’s Gynaecology, p. 27.

18. Ibid., p. 27.

19. Ibid., p. 55.

20. Pei Zheng Xue 1980 A Commentary on the Discussion of Blood

Syndromes ( Xue Zheng Lun Ping Shi ), People’s

Health Publishing House, Beijing, p. 159. The Discussion of Blood

Syndromes ( Xue Zheng Lun ), by Tang Zong Hai was origi-

nally published in 1885.

21. Cong Chun Yu 1989 Chinese Medicine Gynaecology ( Zhong Yi Fu Ke

Xue ), Ancient Chinese Medicine Texts Publishing

House, Beijing, p. 11.

22. Wu Qian 1977 Golden Mirror of Medicine ( Yi Zong Jin Jian

), People’s Health Publishing House, Beijing, Vol. 3,

p. 7. First published in 1742.

23. Ibid., p. 7.

YIN

Kidney-Yin deficiency(primary)

Night sweating, feeling of heat,hot flushes, tongue without coating(red in severe cases), cold feet,frequent urination

YANG

Empty–Heat

Other patterns:• Phlegm• Qi stagnation• Blood stasis• Empty heat• Liver-Yang rising

YIN

Kidney-Yang deficiency(primary)

Backache, feeling cold,cold feet, frequent urination,

hot flushes, pale tongue

YANG

Empty–Heat

Figure 2.49 Pathology of menopause.

26 Section 1: Physiology and Pathology · Blood made by the Post-Natal Qi of Stomach and Spleen....

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