徐志华-经行头晕 – Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle

徐志华 - 经行头晕

Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle
Translated by XU Zhi-jun & J. Heaverlo

经行前后或经期,出现头目眩晕,并伴随月经周期发作者,称 “经行头晕”。徐老着重于”无痰不作眩”,施用半夏天麻自术汤而获效.

Dizziness may develop before, during or after the menstrual period.  When this occurs it is called “dizziness during menstrual cycle”.   Xu Zhi-hua emphasizes the concept “Without phlegm, there can be no dizziness”.  He achieves excellent results with the formulation ban xia tian ma bai zhu tang.

经行头晕责痰障  施用半夏天麻汤
Menstrual cycle dizziness due to phlegm – use ban xia tian ma tang

半夏天麻白术汤
组成:天麻 10g   姜夏 10g    白术10g  神曲lOg   麦芽 lOg    泽泻lOg   党参 10g   夜苓 10g   黄柏 10g   陈皮lOg 于姜 10g   生姜 3 片

Ban Xia Bai Zhu Tian Ma Tang
Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces

功用:健脾燥湿,桂痪降浊。

主治:经行头晕。

Functions:  Strengthens the Spleen and dries damp.  Expels phlegm and descends turbidity

Primary Treatment: dizziness during the menstrual cycle

方解:天麻性味辛微温,善能祛风化痰,为治疗肝风而夹痰湿之眩晕要药;二陈汤加浑泻、黄柏化湿除痰、降逆止呕;党参、白术健脾益气;神曲、麦芽健胃和中;生姜宣散水湿。

Explanation:  Tian ma is acrid and slightly warming.  It can expel wind and transform phlegm.  It serves as the chief herb when there is liver wind and phlegm damp causing dizziness.  This formula also contains er chen tang with ze xie and huang bai.  Together these herbs can transform damp and expel phlegm, descend counterflow and stop vomiting.  Dang shen and bai zhu strengthen the spleen and benefit the qi.  Shen qu and mai ya strengthen the stomach and harmonize the center.  Sheng jiang disperses water dampness.

案例:
例一:女,42岁。初诊日期: 1987 年 5 月5 日。患者近年来每至经行之时即觉头晕,后脑作胀微痛,不能见行驶车辆。发作严重时恶心呕吐,不能起坐。头重如蒙,胸闷纳少,整日昏昏欲睡。月经初潮 15 岁,3 - 5 / 2 6 - 3 0天,量中色红无块,末次月经:  1987 年 4 月 11  日,舌质淡,苔白腻,脉濡。

Case Study 1:
A 42 year old female patient reports, in the past few years, at the time of her menstrual period, she has  dizziness and occipital distention with slight pain.   She cannot even bear to see moving vehicles. When the dizziness worsens she also experiences nausea and vomiting, and cannot sit up.   The head feels heavy and foggy.  She has chest oppression and is unable to eat much.  She feels tired all day and only desires sleep.  Her menstrual cycle began when she was 15 years old.   The cycle lasts 26-30 days and the period is 3-5 days.  It is medium in amount, red in color and without clotting.   Her last menstrual period was 3 weeks prior to the time of diagnosis.   The tongue body is pale-red and the coating is white and greasy.  The pulse is soggy.

此由痰浊蒙蔽清阳,故头晕头重如蒙;痰浊中阻,浊阴不降,气机不利,故胸闷恶心,脾阳不振则少食多寐,加之经行气血下注,其气益虚,清阳不升,痰湿上扰所致。投半夏天麻白术汤。

This condition is due to phlegm turbidity obstructing the clear yang, causing dizziness and a sensation of fogginess and heaviness in the head.  When phlegm turbidity obstructs the center, the turbid yin cannot descend causing the Qi mechanism to become obstructed.  Therefore, there will be chest oppression and nausea.  The spleen yang is unable to ascend, causing diminished appetite and excessive sleepiness.   In addition, during the menstrual cycle, the Qi and blood pour downward, causing the Qi to be even more vacuous.  The clear yang is unable to ascend causing phlegm-damp to harass the upper body. Administer ban xia tian ma bai zhu tang.

天麻 10g,姜夏  10g,臼术 1 g,泽泻  10g,党参 10g夜苓lOg ,干姜 10g,陈皮 10g,黄柏 10g,麦芽10g,神曲10g,生姜 3 片。4 剂。水煎服。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, ze xie 10g, dang shen 10g, fu ling 10g, gan jiang 10g, chen pi 10g, huang bai 10g, mai ya 10g, shen qu 10g, sheng jiang 3 pieces.  4 formulas were administered for decoction.

二诊: 1987 年 5 月 10 日。此次经行已 3 天,精神明显好转,仅觉轻度头晕,尚能坚持正常教学。舌质淡,苔白微腻,脉濡滑。嘱下次经前 5天按上方再服 4 剂。3 月后随访,头晕己愈。

Follow up:  At the time of the second visit (5 days later) the patient was on day 3 of her period.  Her vitality had clearly improved.  Not only was the dizziness less intense but she was able to return to work.  The tongue body was pale-red.  The tongue coating was white and slightly greasy.  The pulse was moist and slippery.  The patient was urged, next time to start taking the herbal formulation 5 days before her menstrual cycle begins.  She was instructed to take 4 formulations at that time.  After 3 months, follow up showed that her dizziness had already recovered.

例二:付某,女,37 岁,干部,已婚。1990 年 11 月 7日初诊。患者经前头晕反复发作 2 年,头晕多在月经前 1 周发作。头晕头重如裹,胸院痞塞,恶心欲呕,纳呆,肢重乏力。末次月经,1990 年 10 月 12 日。舌质淡红,苔白腻而厚,脉滑。证属痰湿中阻,风痰上扰。方用半夏臼术天麻汤:

Case Study 2:
A 37 year old female patient reports dizziness occurring one week before her menstrual cycle begins.  This has been repeatedly occurring for 2 years.  The head feels heavy as if wrapped.  There is a sensation of chest and stomach glomus and blockage, nausea with a desire to vomit, torpid intake, and heavy limbs without strength.  Her last menstrual cycle was 3 1/2 weeks prior.  The tongue is pale-red.  The tongue coating is white, greasy and thick.  The pulse is slippery.  The diagnosis is phlegm-damp obstructing the center with wind-phlegm harassing the upper body.  Administer ban xia bai zhu tian ma tang.

天麻lOg ,姜夏 10g,自术 10g,神曲 10g,麦芽 10g,浑海  10g,党参 10g,夜苓 10g,黄柏 10g,陈皮 10g,干姜10g,生姜 3 片。5 剂。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces.  5 formulas were administered.

二诊: 1990 年 11 月 13 日。头晕减轻,纳可。现月经将至,舌脉同前,原方加泽兰叶lO g,再进 7 剂,经净晕止,一切正常,以后每临经前,继续宗方调治半年,痊愈。

Follow up:  After one month, the dizziness was mitigated and the appetite returned.  At the time of the follow up, the menstrual period was about to begin.  The pulse and the tongue were unchanged.  The same formulation was administered with the addition of ze lan ye 10g.  Seven formulations were prescribed.   After the period, the dizziness stopped and the symptoms were no longer present.  At each follow up visit, prior to the beginning of the menstrual cycle, the same formulation was prescribed.  After 6 months the patient recovered completely.

按1 经行头晕是妇科临床常见症候之一。轻者闭目即止,重者如坐舟车,旋转不定。加之经行之时,营血趋向于下,髓海空虚,肝阳偏亢,阳扰于上,则头目为之昏眩。正如《内经》云:”诸风掉眩,皆属于肝”、”上虚则眩”、”髓海不足则脑旋耳鸣”,     <金匮要略》云:”心下有痰饮,胸胁支满目眩,”刘河间认为眩晕由风火所致;朱丹溪认为”无痰不作眩”,张景岳认为”无虚不作眩”等。因此,眩晕之由,不外风、火、痰、虚。而以风阳上扰及气血亏虚者最为多见。治疗中必须首先审证求因,分清虚实,然后再确立治法。本类患者脾虚水湿失运,聚而成痰,经行痰浊上扰,蒙闭清窍,清阳被遏,故经行头晕。

Discussion:  Clinically, in gynecological medicine, dizziness during the menstrual cycle is a commonly seen condition.  In less severe cases, if the patient closes their eyes the dizziness will stop.  In more severe cases, however, it may feel as if one is riding on a boat, causing a continuous spinning sensation.  In addition, during the menstrual period, the construction blood are moving downward leaving the sea of marrow empty and depleted.  The inclination is for the  liver yang  then to ascend and harass the upper body causing dizziness.  The Nei Jing states “All wind with shaking and dizzy vision is ascribed to the liver.”“when the upper body is vacuous there will be dizziness”, “when the sea of marrow is insufficient there will be dizziness and tinnitus.”.   The Jin Gui Yao Lue states, ” when there is phlegm-rheum below the heart there will be distention in the chest and rib-side, and dizziness.”  Liu He-jian  believes dizziness is caused by wind-fire.  Zhu Dan-xi states ” without phlegm there cannot be dizziness.”  Zhang Jing-yue states “without vacuity there cannot be dizziness”.  Therefore, the causes of dizziness are nothing more than external wind, fire, phlegm and vacuity.  Among these causes the  most commonly seen are due to  the liver yang rising to harrass the upper body and qi and blood depletion and vacuity.  Treatment first must be determined by seeking the root cause and distinguishing between vacuity and repletion.  After this, the correct treatment method can be established.  Typically, these are patients with spleen vacuity and water damp causing loss of transportation.  This allows for the accumulation of phlegm.  At the time of the menstrual cycle, this phlegm turbidity will ascend and harass the upper causing fogginess and obstruction of the clear orifices.  The clear yang will be blocked leading to “dizziness during the menstrual cycle”.

徐老几十年的临床实践中,对东垣指出的”足太阴痰厥头晕非半夏不能疗,眼黑头旋,虚风内作,非天麻不除”体会尤深。遵其所论,以半夏天麻臼术汤加减屡用皆效。《本草从新》称:”天麻入肝经,通血脉,疏痰气,治诸风掉眩, 头眩眼黑”、”半夏体滑性燥,能走能散,治咳逆头眩,痰厥头痛”,浑泻利水行饮下走水道,小便一行,水湿有其出路,三焦阳气通达,表里通畅,故头晕病解。
Xu Zhi-hua has numerous years of clinical practice that has brought about a deep understanding of this condition.  As Li Dong-yuan points out ” ban xia is capable of treating foot tai-yin  phlegm-rheum causing dizziness.  When the eyes are black and the head is spinning, and there is vacuity wind internally occurring, tian ma is indispensable”.  Following this theory, the usage of modified ban xia tian ma bai zhu tang will bring results.   The Ben Cao Cong Xin states, ” tian ma enters the liver channel, opens the blood vessels, dredges the phlegm-qi and thereby treats all wind with shaking and dizzy vision, as well as, dizzy head and dim eyes.  Ban xia is slippery in body and dry in nature.  It is capable of moving and dispersing and can treat cough, counterflow, dizziness, and phlegm reversal  headaches.”  Ze xie opens waterways, moves fluids downward and promotes urination.   Once urination is unblocked,  water-damp finds a passage out and the Yang Qi of the Triple Burner becomes open and free. Thus, both the exterior and interior are open and unblocked and the dizziness can be relieved.

中医养生学的基本理论 – The Basic Theory of Life Cultivation of Chinese Medicine

Translated by XU Zhi-jun & J. Heaverlo

第三章 中医养生学的基本理

        中医养生学继承了传统中医学的理论和古代哲学思想的精华,以“天人相应”和“形神合一”的整体观为出发点.主张从综合分析的角度去看待生命和生命活动。养生方法以保持生命活动的动静互涵、平衡协调为基本准则。主张“正气为本”,提倡“预防为主”,强调辨证思想。要求人们用持之以恒的精神,自觉地、正确地运用养生保健的知识和方法,通过自养自疗,提高身体素质和抗衰防病的能力,达到延年益寿的目的。

Chapter Three:  The Basic Theory of Life Cultivation of Chinese Medicine

The Chinese Medicine study of life cultivation inherited the essence of traditional Chinese medicine theories and ancient philosophical thoughts. It originates from a holistic view that “heaven and man are mutually interactive”, and “the body and the spirit are the unity of opposites”. It holds that life and life’s activities should be treated from the perspective of a comprehensive analysis. The basic principles of life cultivation is to keep life’s activities balanced, coordinated, and in an interdependent state of movement and stillness. It takes “the upright  as the foundation”, advocates “prevention first in medical work”, and emphasizes dialectical thinking. It requests that people apply the life cultivation knowledge and methods persistently, consciously, and correctly, so as to improve their constitution and ability to defy debilitation and prevent disease, and thus, to realize the goal of prolonging life.

第一节 生命

生命是具有生长、发育活力,并按自然规律发展变化的过程。“生、长、壮、老、已”,是人类生命的自然规律。探索生命的规律,对于中医养生学来说,有着极为深远的意义。

一、生命的起源

《内经》认为,生命物质是宇宙中的“太虚元气”,在天、地、日、月、水、火相互作用下,由无生命的物质演变化生出来的。天地之间所以有品类无限多样的物种,都 是物质自己的运动和变化,在时间进行中形成的。《素问·天元纪大论》所说:“太虚廖廓,肇基化元……生生化化,品物咸章”,就是这个意思。人是最高等的动 物,但也不过是“物之一种”,是从万物群生中分化出来的。所以《素问·宝命全记沦》说:“人以天地之气生,四时之法成”。

“人以天地之气生”,是说人类生命的起源,源于天地日月,其中主要源于太阳的火和地球的水。太阳是生命能量的源泉,地球的水(凡其所溶解的各种营养物质)是生命形质的原料。有生命的万物必须依靠天上的太阳和地上的水才能生存,人类当然也不例外。

“四 时之法成”,是说人类还要适应四时阴阳变化的规律才能发育成长。因为人生天地之间,自然界中的一切运动变化、必然会直持或间接地对人体的内环境产生影响, 而人体的内环境的平衡协调和人体外界环境的整体统一,是人体得以生存的基础。在正常情况下,通过人体内部的调节可使内环境与外界自然环境为变化相适应,保 持正常的生理功能。如果人的活动违反自然变化的规律,或外界自然环境发生反常的剧变,而人体的调节功能又不能适应时,人体内、外环境的相对平衡都会遭到破 坏而产生疾病。这说明“适者生存”,仍是生物界不可逾越的客观规律。人类只有认识自然,才能更好地适应自然,改造自然,成为自然的主人。

Section One: Life

Life is a process of growing and developing according to the laws of nature. “Birth, growth, maturity, decline, and death” is the natural law of life. Thus, it is profoundly significant for the Chinese Medicine study of life cultivation to explore the law of life.

  1. The Origin of Life

According to “The Yellow Emperor’s Inner Canon”, the materials of life evolved from inert matter within the universe, under the interactions of the heavens, the earth, the sun, the moon, the water, the fire, etc. The origins of all the immeasurable and diversified species between heaven and earth are attributed to the movements and evolution of the materials themselves. They formed into their current shapes through the course of time. This accords with what was expressed in “Plain Questions: Great Treatise on the Origins and Principles of Heaven” , “The original motive power exists among The Boundless Great Void…the original  produces and evolves (all of the ten thousand things), which will naturally become prosperous.” Although human beings are the top-level animals, they are still no more than “one of the species”, and similarly, evolved from the ten thousand things. This is why “Plain Questions: Treatise on Treasuring [Heaven’s] Mandate to Preserve the Body” says, “Human beings come into existence by receiving the  between heaven and earth, and mature by following the laws of the four seasons”.

The quote, “Human beings come into existence by receiving the  between heaven and earth”, means that human life originates from the heavens, the earth, the sun and the moon.  Among these, the fire of the sun and the water of the earth are of most importance. The sun is the source of the life energy, and the earth’s water (and the various nutrients dissolved by water) is the raw materials for the matter of life. All the ten thousand living creatures must rely on the sun and the water of the earth for survival. Human beings are certainly not an exception.

The statement, “Human beings mature by following the laws of the four seasons”, means that human beings must adapt themselves to the laws of the yīn yáng changes of the four seasons in order to sustain development and growth. Because human beings exist between heaven and earth, all the movements and changes of the natural world will inevitably influence the inner environment of the human body, directly or indirectly. Therefore, the existence of the human body is based on the holistic unity of its inner and outer environment. Under normal conditions, by adjusting the human body, the inner environment can adapt to the changes of the outside natural environment, and thus to maintain normal physiological functions. If human activities go against the laws of natural change, or the outside natural environment has extreme abrupt changes, and the regulatory function of the human body cannot adjust, the relative balance of the inner and outer environment of the body will be destroyed and thus fall ill. This proves that “the survival of the fittest” is still the impassable, objective law of the natural world. Only by knowing nature can mankind better adapt to nature, transform nature, and to become the master of nature.

二、生命的运动形式

《庄 子·知北游》说:“人之生,气之聚也,聚则为生,散则为死”。这就是说,生命活动是自然界最根本的物质-—气的聚、散、离、合运动的结果,生命是物质运动 的形式。活着的人体,是一个运动变化着的人体。《素问·六微旨大论》进一步指出物质运动的基本形式是“升降出入”,“出入废则神机化灭,升降息则气立孤 危,故非出入,则无以生长壮老已;非升降,则无以生长化收藏,是以升降出入,无器不有”。这就说明,只有运动,才能化生万物,宇宙间的一切吻质,尽管有大 小和生存的时间长短不同,但运动是一致的。

升降出入运动,是人体气化功能的基本形式,也是脏腑经络、阴阳气血矛盾的基本过程。因此,在生理 上人体脏腑经络的功能活动无不依赖于气机的升降出入,如肺的宣发与肃降,脾的升清与胃的降浊,心肾的水火相济,都是气机升降出入运动的具体体现。在预防疾 病方面,同样要保持人体气机升降正常,才能抗御邪气侵犯,免生疾病。

  1. The Form of Life

In the classic“Zhuāng Zĭ:。ZhĪ Běi Yóu”it is put forth, “Human life is the gathering of . Once  gathers together, people live; once  scatters and disappears, people die”. This is to say; life’s activities result from the gathering, scattering, separation and combination of —the most fundamental substance in nature. The living human body is always changing. “Plain Questions, Great Treatise on the Subtleties of Six” further points out that the basic movement of substance is “upbearing, downbearing, inward and outward movement”, “If the inward and outward movement stops, the spirit mechanism (life) will die out; if upbearing and downbearing stops, the established  is in peril. Therefore, without inward and outward movement, there will be no birth, growth, maturity, decline, and death; without upbearing and downbearing, there will be no birth, growth, transformation, receiving, and storage. Thus, no substance is without the movements of upbearing, downbearing, inward and outward.” This is to say that only movement can give birth to the ten thousand things. The most consistent attribute of all matter in the universe, regardless of its size or time of existence, is movement.

Upbearing, downbearing, inward and outward movement is the basic function of  transformation within the human body. It is also the basic process of movement for the viscera, channels and network vessels, yīn, yáng, qì and blood. All the physiological activities of the viscera and the channels and networks vessels rely on the upbearing, downbearing, inward and outward movement of . For instance, the diffusion and downbearing of the lungs, the upbearing of the clear by the spleen, the downbearing of the turbid by the stomach, the mutual assistance between the water and fire of the heart and the kidney…all of these are specific illustrations of the upbearing, downbearing, inward and outward movement of . In terms of disease prevention, only by maintaining a normal state of the upbearing, downbearing, inward and outward movement of  can the human body resist the invasion of evil  and avert the onset of disease.

三、生命的维持和死亡

《素 问·生气通天论》里说:“生之本,本于阴阳”,这就是说,生命的根本,就是阴阳。究其原因,是由于“阳化气,阴成形”,而生命过程就是不断的化气与成形的 过程,即有机体同外界进行不断的物质交换和能量交换的过程。化气与成形,是生命本质自身中的矛盾,两个对立面是不断斗争的,又是统一的。化气与成形,互为 消长;任何一方的太过或不及,均可导致另一方受损。但二者又结合于生命的统一体内,互相依存,互相转化。阳气化为阴精,阴精又化为阳气,否则“孤阳不生, 独阴不长”。

人之所以有生命,在于构成人体的“气”具有生命力。人体生命力的强弱,生命的寿夭,就在于元气的盛衰存在;新陈代谢的生化过 程,称之谓气化生理;生命的现象,本源于气机的升降出入等等,这都反映出气既是构成人体的基本物质,又是人体的生命动力。正因为气是生命活动的根本和动 力。宋《圣济总录》提出:“万物壮老,由气盛衰”的观点,并认为“人之有是形也,因气而荣,因气而病”。张景岳则反复强调气在防病延年中的重大意义,指出 气是人体盛衰寿夭的根本。他说;“盖以大地万物皆由气化;气存数亦存,气尽数亦尽,所以生者由乎此,所以死者亦由乎此,此气不可不宝,能宝其气,则延年之 道也”。同样,精、血、津液亦是构成人体及促进人体生长发育的基本物质,如《灵枢·经脉》篇说:“人始生,先成精,精成而脑髓生,骨为十、脉为营、筋为 刚、肉为墙、皮肤坚而毛发长”,这就说明人体的产生必先从精始,由精而后生成身形五脏,皮肉筋骨脉等。不仅如此,人出生之后,犹赖阴精的充盈,从而维持人 体的正常的生命活动,故《素问·金匮真言论》说:“精者,身之本也”。若阴精充盈,则生命活动旺盛,身健少病;若阴精衰虚,则生命活动减退,早衰多病。

还 有,生命的维持还依赖于神的健康,《灵枢·天年》说:“失神者死,得神者生”。可见,神的得失关系到生命的存亡。从人体来说,神是机体生命活动的总称,整 个人体生命活动的外在表现,无不属于神的范围。它包括精神意识,运动、知觉在内,以精血为物质基础,是气血阴阳对立的两个方面共同作用的产物。

综上所述,人体的生命活动,是以体内脏腑阴阳气血为依据的。脏腑阴阳气血平衡,人体才会健康无病,不易衰老,寿命才能得以延长。这就是《素问·生气通天论》中“阴平阳秘,精神乃治;阴阳离决,精气乃绝”的理论。

但有生必有死,这是不以人们的意志为转移的客观规律。恩格斯说:“生命首先就在于:生命在每一瞬间食它自身,但却又是别的什么。所以生命也是存在于物体和过程本身中的不断自行产生和自行解决的矛盾;这一矛盾一停止,生命亦即停止,于是死就来到”。

  1. The maintenance and life and death

“Plain Questions, Treatise on Vital QÌ Connecting with Heaven” says, “Life is rooted in yīn and yáng”.  This is to say, the root of life is yīn and yáng because “yáng transforms into , yīn becomes form”. The process of life is that of constantly transforming into  and becoming form, in other words, the process in which the organism constantly exchanges matter and energy with the outside world. The transformation of  and materialization are two opposites within the nature of life.  Both are opposing as well as interdependent. Their interaction consists of waxing and waning. The excessiveness or insufficiency of any one side may lead to the injury of the other. However, the two sides combine within the body to form the unity of life, they are mutually interdependent as well as mutually transforming.  The yáng qì transforms into yīn essence and the yīn essence  transforms into yáng qì. Otherwise, “The solitary yáng cannot survive, the solitary yīn cannot grow”.

Life can exist because of the vitality of qì. The exuberance or debilitation of the original  of the human body will dictate whether one’s life is stronger or weaker, longer or shorter. is not only the essential matter constituting human body, but it is also the motive force of life. Just for this reason, “Sages’ Salvation Records” of the Sòng Dynasty puts that “The maturity and death of the ten thousand things all depends on the exuberance and debilitation of ”, and believes that “The human shape becomes healthy or ill because of .” Zhāng  Jǐngyuè repeats again and again the great significance of  in preventing diseases and prolonging life. He points out that  is the root cause of exuberance and debilitation, longer or shorter life. He says, “All the ten thousand things between the Heaven and Earth come into being from . Where there is  there is life, here there is no  there is no life. Life and death are determined by . The  must be treasured, which is the secret of prolonging life”. Similarly, essence, blood, and body fluids are also considered the essential matter that constitutes the human body and promotes its growth and development. “Magic Pivot: Channels” puts, “When a human body comes into being, first to form is the essence,  then brain-marrow develops. The skeleton is the support; the arteries and veins are the places for managing and storing  and blood; the sturdy sinews and joints work to restrain and strengthen the skeleton; the muscles and flesh are the walls to protect the internal organs, sinews, bones, and blood vessels; after the skin becomes firm and tenacious, hair will grow”. This is to say that the forming of human body starts with the essence, followed by the body frame, the five viscera, skin, flesh, sinews, bones, vessels, etc. After birth, the human body still relies on abundant yīn essence to maintain normal life activities. That’s why “Plain Questions, Treatise of the True Doctrine of the Golden Coffer” says, “essence is the root of human body”.  If the yīn essence is abundant, life activities will be vigorous, the body will be strong and healthy; if the yīn essence is feeble and weak, the life activities will decline, and the body will decay early with poor health.

The maintenance of life also relies on a sound spirit. “Magic Pivot:  Natural Life-Span” says, “Those who lose spirit die, those who gain spirit live”. It is thus clear that the gain or lose of spirit is related with life or death. In terms of the human body, spirit is the general name of the activities of all organic life. The external manifestation body belongs to the spirit, which includes spiritual awareness, movement, and consciousness. Based on the essence and the blood, it is the outcome of the interaction of yīn and yáng.

In summation, life activities of the human body are based on the viscera, yīn, yáng, and blood. Only by keeping the balance of the viscera, yīn, yáng, and blood can the human body be healthy and life be prolonged. This accords with the theory in “Plain Questions, Treatise on Vital Qì Connecting with Heaven”, “If the yīn is calm and yáng is sound, the spirit can be vigorous; if yīn and yáng are separated from each other and cannot combine, the spirit and  will be exhausted.”

第二节 天年

一、天年的概念

“天年”,是我国古代对人的寿命提出的一个有意义的命题。天年,就是天赋的年寿, 即自然寿命。人的生命是有一定期限的。古代养生家、医家认为在百岁到百二十岁之间。如《素问·上古天真论》:“尽终其天年,度百岁乃去。”;如《尚书·洪 范篇》:“寿、百二十岁也”,《养身论》亦说:“上寿百二十,古今所同”。此外,老子、王冰也都认为天年为120岁。西德著名学者H.Franke在 1971年提出:“如果一个人既未患过疾病,又未遭到外源性因素的不良作用,则单纯性高龄老衰要到120岁才出现生理性死亡”。事实上,120岁的天年期 限与一般的长寿调查资料相符,自古至今超过这一生理极限的例子,也是不少的。

Section Two:  The Natural Life Span

  1. The Concept of the Natural Life Span

The course of the natural life span is a significant proposition put forward by ancient Chinese people. It refers to the life span endowed by nature, i.e., natural life span. Human life has a time limit. Doctors and ancient experts in life cultivation believed this time limit is between one hundred and one hundred and twenty years. For example, “Plain Questions. Treatise of Heavenly Truth from Remote Antiquity” puts, “(The people from remote antiquity) lived their full span until one hundred years old”; “The Book of History. The Fundamental Laws of Government” puts, “The natural life span is one hundred and twenty years”; “Treatise of Life Cultivation” also says, “The highest life span is one hundred and twenty years. This has been a truth at all times”. Furthermore, both Lǎozǐ and Wáng Bìng believed that the natural life span was one hundred and twenty years. The German scholar, H. Franke, put forward in 1971, “If a person suffers from neither any illness nor any harmful effects by external factors, the physiological death will take place at the age of 120”. As a matter of fact, the life span of 120 conforms with corresponding research materials. From ancient times to present, there have been quite a few examples that went beyond this time limit.

二、寿命

寿命是指从出生经过发育、成长、成熟、老化以至死亡前机体生存的时间,通常以年龄作为衡量寿命长短的尺度。

一 般计算年龄的方法又可分为两种,一种是时间年龄,又称历法年龄,是指人出生以后经历多少时期的个体年龄,我国常配以生肖属性,以出生年份来计算其岁数,一 般由虚岁或足岁计算年龄。另一种是生物学年龄,是表示随着时间的推移,其脏器的结构和功能发生演变和衰老情况。在生物学上又可分为生理年龄与解剖年龄。国 外在确定退休准则时,设想应用生理年龄作为指标,可能比时间年龄更胜一筹。因为时间年龄和生物年龄是不完全相同的,前者取决于生长时期的长短,而后者取决 于脏器功能及结构的变化过程。由于每个人的先天性遗传因素与后天性环境等因素不同,因此时间年龄和生物学年龄有时不完全相同。此外,还有“心理年龄”,所 谓“心理年龄”是指由社会因素和心理因素所造成的人的主观感受的老化程度。即主观感受年龄,也称“社会心理年龄”,用以表示随着时间的推移,机体结构和功 能的衰老程度。

由于人与人之间的寿命有一定的差别,因此在比较某个时期、某个地区或某个社会的人类寿命时,通常采用平均寿命。平均寿命常用来反映一个国家或一个社会的医学发展水平。

随着时代的发展,社会的进步,人类的寿命不断增长,但人类的寿命值究竟是多少?还是一个尚未彻底解决的问题。因为它与先天禀赋的强弱,后天的给养、居住条件、社会制度、经济状况、医疗卫生条件、环境、气候、体力劳动、个人卫生等多种因素的影响有关。

  1. Life Span

Life span refers to the time period of the organic existence, which starts with birth, undergoes growth, maturity, aging, and ends with death. It is usually measured by age.

There are two common methods of counting age: one is called chronological age, or calendar age, which counts how many periods (years) a person goes through after birth. In China, this often goes together with the 12 symbolic animals. Age is counted by the year of birth. Age can be counted by nominal age (reckoned by the traditional method, i.e. considering a person one year old at birth and adding a year each lunar new year) or the actual age. The other method of counting age is called biological age, which reflects how the viscera develop and decline in the course of time. It can be further divided into physiological age and anatomical age. Some foreign countries take physiological age as the standard of retirement, which is more reasonable than chronological age. The reason is that chronological age and biological age are not completely identical with each other: the former depends on the length of life, while the latter depends on the changes of the viscera’s functions and structures. “Psychological age” is another dimension. It is the perception of how old one feels due to social and psychological elements.

Because the life span of different individuals vary, average life span is usually adopted to measure the life span during a specific period, in a specific area or society. The average life span is often used to reflect the medical development of a country or society.

With the development and progress of the times, the life span of human beings has been constantly increasing. However, the question how many years can human beings live has not yet been satisfactorily answered. An individual’s life span is influenced by various elements, such as natural endowment, provisions after birth, living conditions, social system, economic conditions, medical conditions, environment, climate, physical labor, personal hygiene, etc.

三、健康人的生理特征

迄 今为止,人们发现,影响人类尽终其天年的因素虽然很多,但有两个是非常重要的,其一是衰老;其二是疾病。那么,推迟衰老的到来,防止疾病的产生是延年益寿 的重要途径。因此,研究健康人的生理特征,就显得很有必要。一般地说,一个健康无病,没有衰老的人,应该具备下列生理特征:

  1. The Physiological Characteristics of Healthy People

Among various elements that prevent people from living their full life span, two have been found to be very important. One is aging, the other one is illness. Thus, postponing aging and preventing illness becomes important to prolonging life. It is quite necessary to study the physiological characteristics of healthy people. Generally speaking, a healthy individual should have the following physiological characteristics:

(一)生理健康特征

1、眼睛有神  眼精是脏腑精气汇集之地,眼神的有无反映了脏腑的盛衰。因此,双目炯炯有神,是一个人健康的最明显表现。

(1)   The characteristics of physiological health

  1. The eyes have spirit

The eyes are where the essence of the viscera converge. Whether the eyes are bright and with spirit is a reflection of the exuberance or debilitation of the viscera. The most evident way of determining an individual’s health is whether the eyes are bright and full of spirit.

2、呼吸微徐 微徐,是指呼吸从容不迫,不疾不徐。《难经》认为:“呼出心与肺,吸入肝与肾”,说明呼吸与人体脏腑功能密切相关。

  1. The breath is slightly unhurried.

“The Classic of Difficult Issues” holds, “Exhalation mainly depends on the heart and lungs; inhalation mainly depends on the liver and kidneys”. This points out that breath is closely related to the functions of the viscera.

3、 二便正常  《素问·五脏别论》说:“魄门亦为五脏使,水谷不得久藏”,是说经过肠胃消化后的糟粕不能藏的太久,久藏则大便秘结。而大便通畅则是健康的反 映。小便是排除水液代谢后糟粕的主要途径,与肺、肾、膀胱等脏腑的关系极为密切。小便通利与否,直接关系着人体的功能活动。

  1. The bowels and urination are normal.

“Plain Questions. A Separate Treatise on the five Viscera” says, “The gate of the corporeal soul (the anus) also functions as an excretory organ, which prevents the grain and water from remaining inside the body for prolonged periods.” This means if the waste from the digestive process remains for prolonged periods within the body, the stool will become bound. Unobstructed bowel movements are considered a reflection of one’s health. Urination is closely related with the lungs, the kidneys, the urinary bladder, plus other viscera. It is the primary route to rid the body of metabolic waste. Whether the urination is uninhibited has a direct relationship with the functions of the human body.

4、脉象缓匀  此指人的脉象要从容和缓,不疾不徐。“脉者,血之腑也”,气血在脉道内运行,所以脉象的正常与否,能够反映气血的运行。

  1. The pulse is moderate and even.

This means that the pulse should be unhurried, moderate, not too slow and not too fast. “The pulse is the house of the blood”, meaning the  and blood move through the pulse channels. Whether the pulse is normal or not, can reflect the movement of the  and blood.

5、形体壮实 指皮肤润泽,肌腠致密,体格壮实,不肥胖,亦不过瘦。因为体胖与体瘦皆为病态,常常是某些疾病带来的后果。

  1. The body is robust.

This means the skin should be moist and glowing, the interstices are fine and compact, and the body is neither too fat nor too thin. Both obesity and excessive thinness are abnormal states, which usually result from some sort of illness.

6、面色红润 面色是五脏气血的外荣,而面色红润是五脏气血旺盛的表现。

  1. The facial complexion is rosy.

The facial complexion is the outward manifestation of the  and blood of the five viscera.  A rosy complexion indicates the  and blood of the five viscera are exuberant.

7、牙齿坚固 因齿为骨之余,骨为肾所主,而肾为先天之本,所以牙齿坚固是先天之气旺盛的表现。

  1. The teeth are strong and firm.

The teeth are considered a surplus of the bones. The kidneys govern the bones.  The kidneys serve as the root of the former heaven essence. Henceforth, strong and firm teeth are a reflection the congenital essence is exuberant.

8、双耳聪敏 《灵枢·邪气脏腑病形篇》说:“十二经脉,三百六十五络……其别气走于耳而为听。”说明耳与全身组织器官有密切关系,若听力减退、迟钝、失听、是脏器功能衰退的表现。

  1. The hearing is acute.

“Magic Pivot:  Forms of Disease from Evil Qi in the Bowels and Viscera” says, “The twelve channels and three hundred and sixty five vessels…through which the  travels to the ears, which makes them able to hear.” This means that the ears are closely related to all organs throughout the body. If the hearing has been lost or is failing, it indicates the functions of the viscera are declining.

9、腰腿灵便 肝主筋、肾主骨、腰为肾之腑、四肢关节之筋皆赖肝血以养,所以腰腿灵便、步履从容,则证明肝肾功能良好。

  1. The lumbar and legs are agile.

The liver governs the sinews, and the kidneys govern the bones. The lumbar is the house of the kidneys.  The liver blood supports the sinews of the four limbs and joints. Therefore agility in the lumbar and legs plus stability in walking can prove the liver and kidneys are functioning properly.

10、声音宏亮 声由气发,《素问·五脏生成篇》说;“诸气者,皆属于肺”,声音宏亮,反映肺的功能良好。

10. The voice is resonant.

The voice comes from the qì. According to “Plain Questions: Treatise on the Engenderment of the Five Viscera”, “The  of the body belongs to the lungs.” A resonating voice indicates that the lungs are functioning well.

11、须发润泽 发的生长与血有密切关系,故称“发为血之余”。同时,又依赖肾脏精气的充养。《素问·六节胜象论》说:“肾者……其华在发”。因此,头发的脱落、过早颁白,是一种早衰之象,反映肝血不足,肾精亏损。

11. The beard and hair are moist and glowing.

The growth of hair is closely related to blood. “Hair is the surplus of the blood.” At the same time, hair relies on the support of the kidneys. “Plain Questions: Treatise on the six Periods and Visceral Manifestation” says, “the kidneys, its bloom is in the hair”. Therefore, hair loss and premature graying is the manifestation of premature debility, which reflects the insufficiency of liver blood and depletion of the kidney essence.

12、食欲正常 中医学认为,“有胃气则生,无胃气则死”,饮食的多少直接关系到脾胃的盛衰。食欲正常,则是健康的反映。

12. The appetite is normal.

According to Chinese medicine, “The body lives by the stomach , the body dies without the stomach ”. The amount of food and drink taken in directly influences the exuberance or debilitation of the stomach. Thus, a normal appetite is a reflection of health.

(二)心理健康特征

1、 精神愉快 《素问·举痛论》说:“喜则气和志达,营卫通利”,可见良好的精神状态,是健康的重要标志。七情和调、精神愉快,反映了脏腑功能良好。现代医学 亦认为,人若精神恬静,大脑皮层的兴奋与抑制作用就能保持正常状态,从而发挥对整体的主导作用,自能内外协调,疾病就不易发生。

(2)  The characteristics of psychological health.

  1. Happy state of mind

“Plain Questions: Treatise on Pain” says, “Happiness leads to harmonious , and the yíng qì and wèi qì will be unblocked”. A happy state of mind is an important sign of one’s health. When the seven affects are harmonious and the state of mind is happy it is a reflection of properly functioning viscera. Modern medicine also believes that a tranquil mind can maintain a normal state within the excitatory and inhibitory function of the cerebral cortex, which plays a leading role in the function of the whole body. Once the interior and exterior are in concert and harmony, it will difficult for the body to contract an illness.

2、记忆良好 肾藏精、精生髓,而“脑为脑之海”。髓海充盈,则精力充沛,记忆力良好;反之肾气虚弱,不能化精生髓,则记忆力减退。

  1. Good memory

The kidneys store essence. The essence produces marrow, and “the brain is the sea of marrow”. If the sea is full, a person will be full of energy and exhibit a good memory. If the kidney  is weak and cannot transform the essence into marrow, the memory will decline.

第三节 衰老

衰老是人类正常生命活动的自然规律,人类的机体在生长发育完成之后,便逐渐进入衰老(或称衰退)的过程。探讨衰老的概念、原因和衰老时的生理、病理改变,以至防止衰老的措施,是十分重要的。

衰 老可分为两类,即生理性衰老及病理性衰老。生理性衰老系指随年龄的增长到成熟期以后所出现的生理性退化,也就是人体在体质方面的年龄变化,这是一切生物的 普遍规律。另一类为病理性衰老,即由于内在的或外在的原因使人体发生病理性变化,使衰老现象提前发生,这种衰老又称为早衰。

Section Three: Aging

Aging is a normal human life activity within the laws of nature. After the human body reaches maturity, it gradually enters the process of aging. It is therefore, very important to explore the concepts and causes of aging, as well as the physiological and pathological changes, so as to prevent the process of aging.

Aging can be divided into two types: physiological and pathological. Physiological aging refers to the physiological decline that takes place after the maturity of the body, namely, the constitutional changes of the human body with age. This is common to all living creatures. Pathological aging refers to the pathological changes of the human body due to internal or external elements, which causes aging to occur earlier than normal. It is also called premature aging.

一、衰老的原因

中医学在对衰老原因的认识上,非常重视脏腑功能和精气神的作用,又很强调阴阳协调对人体健康的重要意义。兹简述如下。

1、肾阳亏虚 肾为先天之本,人的生长发育衰老与肾脏的关系极为密切。《素问·上古天真论》中“女子七七”、“丈夫八八”的一段论述,即是以肾气的自然盛衰规律,来说明人体生长、发育、衰老的过程与先天禀赋的关系,从而提示衰老的关键在于肾气的盛衰。

肾属水,主藏精,为元气之本,一身阴阳生化之根。肾的盛衰影响着元气的盛衰和生化功能的强弱,肾虚则元气衰,元气衰则生化功能弱,人的衰老就会加速到来。

  1. The reasons of aging

In terms of aging, Chinese medicine attaches great importance to the functions of the viscera and the roles of the essence, , and spirit. It also emphasizes the significance of balancing yīn and yáng for the health of human body.

  1. Kidney vacuity

The Kidneys are the root of the former heaven essence. The growth, maturity, and aging of the human body have an exceedingly close relationship with the kidneys. “Plain Questions:  Treatise of Heavenly Truth from Remote Antiquity” expounds “The essence  becomes exhausted at the age of 49 for females and 64 for males.” This tells the relationship between the process of growth, maturity, and aging of the human body and the former heaven essence through discussing the natural exuberance and debilitation of the kidney , so as to reveal that the key reason of aging lies in the exuberance and debilitation of the kidneys.

The kidney belongs to water and governs the storage of the essence. It is the root of the original , and of yīn and yáng engenderment and transformation. The exuberance or debilitation of the kidneys influences the exuberance and debilitation of the original  and its engendering and transformation functions. Thus, kidney vacuity leads to original  vacuity, which further weakens engenderment and transformation, and therefore the body experiences premature aging.

2、 脾胃虚衰 脾胃为后天之本,水谷皆入于胃,五脏六腑皆禀气于胃。若脾胃虚衰,饮食水谷不能被消化吸收,人体所需要的营养得不到及时补充,便会影响机体健 康。从而加速衰老,甚至导致死亡。《内经》明确指出阳明为多气多血之经,而“阳明脉衰,面始焦、发始堕”是衰老的开始表现。

脾胃属土,为一身气机升降之中枢,脾胃健运,能使心肺之阳降,肝肾之阴升,而成天地交泰。若脾胃虚损,五脏之间升降失常,就会产生一系列的病变,从而影响健康长寿。

  1. Spleen and Stomach vacuity debilitation

The spleen and stomach are the root of the latter heaven essence. All grains and water enter the stomach. The five viscera and six bowels receive  from the stomach. If the spleen and stomach become vacuous and debilitated, food and drink will not be properly digested, the nutrition required by the body will not be properly provided, and the health of the physical body will be affected, In this way the aging process will accelerate and may even lead to death. “The Yellow Emperor’s Inner Canon” clearly points out that the yáng brightness channel has copious  and copious blood, and “if the yáng brightness pulse becomes debilitated, the face begins to turn sallow, and the hair begins to fall”, this marks the beginning of aging.

The spleen and stomach belong to earth.  They serve as the body’s pivot for governing the upbearing and downbearing of the  mechanism throughout the body. When the spleen and stomach’s function of movement is fortified it will be able to assist the heart and lung yáng  to downbear, and the liver and kidney yīn qì to upbear.  This will promote a peaceful interaction between heaven and the earth. If the spleen and stomach vacuity-detriment leads to abnormal upbearing and downbearing of the five viscera, it will produce a series of diseases thus affecting the health and life span.

3、心脏虚衰 心藏神,主血脉,《素问·灵兰秘典论》称其为“君主之官”。心为生命活动的主宰,协调脏腑、运行血脉。心气虚弱,会影响血脉的运行及神志功能,从而加速衰老,故中医养生学尤其重视保护心脏。认为“主明则下安,以此养生则寿,……主不明则十二官危”。

  1. Heart Vacuity and Debilitation

The heart stores the spirit and governs the blood vessels. The heart is named “the office of the monarch” in “Plain Questions: Treatise of the Arcane Book of the Orchid Chamber of the Spirit Tower”. The heart governs the life activities, coordinates the viscera, and propels the blood through the vessels. Heart  vacuity affects the movement of the blood through the vessels and the spirit-mind thus accelerating the aging process. For this reason Chinese Medicine life cultivation studies pay special attention to the protection of the heart. According to Chinese Medicine, “if the monarch is sagacious, the subjects will be secure”. If one follows this principle of life cultivation the life will be long.  If the monarch is not sagacious, the twelve officials (the twelve organs) will be in danger”.

4、肝脏衰惫 肝藏血,主疏泄,在体为筋,关系到人体气机的调畅,具有贮存和调节血量的作用。如《素问·上古天真论》说:“七八,肝气衰,筋不能动”,即说明人体衰老的标志之一——活动障碍,是由肝虚而引起的。

  1. Liver Debilitation and Exhaustion

The liver stores the blood and governs free coursing. It manifest within the sinews of the body. The liver is related to the unimpeded regulation of the body’s  dynamic.  It also possesses the ability to store and regulate the blood. As “Plain Questions: Treatise of Heavenly Truth from Remote Antiquity” says, “at the age of 56, the liver  declines, and the sinews cannot move”. This illustrates that hindered movement may result from liver vacuity.

5、肺脏衰弱 肺主一身之气,《素问·六节藏象论》说:“肺者,气之本”。肺气衰,全身机能都会受到影响,出现不耐劳作,呼吸及血液循环功能逐渐减退等衰老表现。

  1. Lung Debilitation and Weakness

The lungs govern the  of the whole body. “Plain Questions: Treatise on the Six Periods and Visceral Manifestation” says, “The lungs are the root of  ”. Lung  debilitation will affect the function of the whole body, which may manifest such aging signs as decreased stamina, a gradual decline of respiration and blood circulation, etc.

6、 精气衰竭 精气是人体生命活动的基础,人的四肢、九窍和内脏的活动以及人的精神思维意识,都是以精气为源泉和动力的。因此,尽管人体衰老的因素繁多,表现 复杂,但都必然伴随着精气的病变,精气虚则邪凑之,邪势猖獗则精损之,如此恶性循环则病留之。《素问·阴阳应象大论》曰:“年四十,而阴气自半也,起居衰 矣;年五十,体重、耳目不聪明矣;年六十,阴痿、气大衰、九窍不利、下虚上实、涕泣俱出矣”。具体阐述了由于阴精阳气的亏损,人体会发生一系列衰老的变 化。

  1. Exhausted  and Essence

The  and essence are the basis of life activities. They are the motive source of the limbs, the nine orifices, the internal organs, the spirit, thoughts and consciousness. Although there are various factors for ageing, all are inevitably accompanied by a pathology of the  and essence. Where there is vacuity of the  and essence evil collects; rampant evil further depletes the essence; the disease compounds within this vicious cycle. “Plain Questions: Great Treatise on the Correspondences and Manifestations of Yīn and Yàng ” says, “at the age of 40, half of the yīn qì has waned, and the activities of daily life start to decline; at the age of 50, the body feels heavy, the ears and eyes are no longer acute and bright; at the age of 60, the yīn wilts, the kidney  greatly declines, the nine orifices are inhibited, the lower body becomes deficient and the upper body becomes replete.  There will be frequent tearing and nasal discharge”. This expounds that the body will undergo a series of changes due to the yīn essence and yàng qì depletion.

7、阴阳失调 阴阳的盛衰是决定寿命长短的关键,保持阴阳运动平衡状态是延年益寿的根本。《素问·阴阳应象大论》中就明确指出人的衰老 同阴阳失调有关,即“能知七损八益,则二者可调,不知用此,则早衰之节也”。可见,阴阳失调能导致衰老,而调节阴阳就有抗衰老的作用,人到中年以后,由于 阴阳平衡失调,机体即可受到各种致病因严的侵袭,从而疾病丛生,出现衰老。

  1. Yīn Yàng Disharmony

The exuberance or debilitation of yīn and yàng is the key to one’s life span. Maintaining a balanced state within the movements of yīn and yàng is at the root of prolonging life. “Plain Questions: Great Treatise on the Correspondences and Manifestations of Yīn and Yàng clearly points out that aging has a direct relationship with the disharmony of yīn and yàng. It states, “If the sevenfold reduction and eightfold boost is realized, yīn and yàng can be regulated; ignorance of this will lead to premature senility”. It can be seen that a yīnyàng disharmony can lead to aging, and harmony between yīn and yàng can resist aging. Because of a yīnyàng disharmony, middle-aged people are susceptible to the attack of various diseases, which further results in aging.

二、早衰的原因

(一)社会因素

《素问·疏五过论》指出:“故贵脱势,虽不中邪,精神内伤,身必败亡”。由于社会地位的急剧变化,会给人带来精神和形体的衰老。

现 代医学研究表明,很多精神疾病和躯体疾病,都与激烈的竞争,过度紧张的社会生活有直接关系,如美国综合医院门诊部对病人进行随机研究,发现65%的病人, 与社会逆境、失业、工作不顺利、家庭不和等因素有关。不合理的社会制度、恶劣的社会习俗、落后的意识形态,以及人与人之间种种斗争矛盾等,都可使人体代谢 功能紊乱,导致早衰。

II.  Reasons of early aging.

  1. Social factors

“Plain Questions: Treatise Explaining the Five Errors” points out, “When high-ranking officials lose their power, even without contraction of evil, their spirits will be internally damaged and their bodies are bound to be destroyed”. This illustrates that drastic changes within social positions can influence premature aging in both body and spirit.

Modern medical research has proved that many diseases, mentally and physically, are directly related with intense competition and excessive stress. According to the statistics by an American general hospital outpatient clinic, 65% of patients are associated with factors such as adverse social circumstances, unemployment, work conflicts, family disharmony, etc. Unreasonable social systems, contemptible social customs, regressive ideologies, and various conflicts amongst people can cause metabolic disorders that lead to premature aging.

二,自然环境

《素问·五常政大论》中指出:“高者其气寿,下者其气夭”。高,是指空气清新,气候寒冷的高山地区;下,是指平原地区。因为“高者气寒”,生物生长缓慢,生长期长,寿命也就长。而“下者气热”,生物生长较快,寿命就相应短促。

现 代研究认为,自然环境对人体健康影响很大。当有害的环境因素长期作用于人体,或者超过一定限度,就要危害健康,促进早衰。如空气污染造成空气中过氧化物增 加,衰老是和体内过氧化脂质的生成同时发展的。此外,污染的空气中可含有功多的致癌物质,如苯胼蓖、朕苯胺、α-萘胺等。有些工业废水上百万吨倾入江湖, 以致出现鱼类大量死亡;严重水污染造成人慢性铅、砷、镉中毒等。

  1. Natural environment

Plain Questions: Great Treatise on the Five Normal Rules” points out, “Those who live in high places have longer life; those who live in low places have shorter life”. High places refer to the high mountainous areas where the air is fresh and the climate is cold; low places refer to the plains. Because “it is cold in high places”, living beings will have a slower and longer growth  period, and thus will have prolonged life. Because “it is hot in low places”, living beings will mature more rapidly and thus have a shorter life span.

According to modern research, the natural environment has a tremendous influence on the health of the human body. It can be harmful to one’s health if one endures detrimental environmental factors for an extended amount of time or exceeds certain limits. For example, while air pollution increases peroxide levels, ageing takes place with the generation of lipid peroxidation. Furthermore, polluted air may contain large amounts of carcinogens, such as benzopyrene,benzidine,and α-naphthylamine。Millions of tons of industrial waste water is dumped into the rivers and lakes, which results in the death of multitudes of fishes. Serious water pollution can lead to chronic lead, arsenic and cadmium poisoning, plus others.

三,遗传因素

大量事实证明,人类的衰老和遗传有密切关系, 因遗传特点不同,衰老速度也不一样。正如王充在《论衡·气寿篇》中所说;“强寿弱夭,谓禀气渥薄也……夫禀气渥则其体强,体强则寿命长;气薄则其体弱,体 弱则命短,命短则多病寿短”,“先天责在父母”,先天禀赋强则身体壮盛,精力充沛,不易变老。反之,先天禀赋弱则身体憔悴,精神萎靡,变老就提前或加速。

  1. Hereditary factors

A host of facts indicate that aging is closely related to hereditary factors. The rate of aging varies due to different hereditary characteristics. As Wángchōng says in “Lùn Héng: Treatise on Life Span”, “If the body is strong, the life is longer; if the body is weak, the life is shorter. This depends on how much  one has been endowed …the body is strong with more , which results in a longer life; the body is weak with less , which results in a shorter life”, “all these are congenitally decided by the parents”. If the natural endowment is strong, the body is strong and energetic; if the natural endowment is weak, the body is weak and the spirit is dejected, and thus the aging process arrives early.

四,七情太过

此 指长期的精神刺激或突然受到剧烈的精神创伤,超过人体生理活动所能调节的范围,就会引起体内阴阳气血失调,脏腑经络的功能紊乱,从而导致疾病的发生,促进 衰老的来临。我国民间有“笑一笑,十年少”,“愁一愁,白了头”的谚语,就是这个道理。正如《吕氏春秋》中所说的:“年寿得长者,非短而缓之也,毕其数 也。毕数在乎去害。何谓去害?……大喜、大恐、大忧、大怒、大衰,五者损神则生害矣”。

  1. Excess of the seven affects

Long-term mental stimuli or a sudden traumatic experience, if exceeding the range the human body’s regulatory capabilities, will lead to the disharmony of yīn, yàng , , and blood, plus the functional disorder of the viscera and channels, and thus result in illness and ageing. There is a popular saying in China that “laughter can make people ten years younger”, “Worry can make people’s hair turn gray”. “Lǚ’s Spring and Autumn” says, “Long life means being able to live out one’s full span instead of trying to prolong a short life. The key to living one’s full span is to get rid of harm. How can one rid the self of harm?  Excessive joy, fear, worry, anger, and sorrow, these five can injure one’s spirit and produce harm”.

五,劳逸失度

《素问·上古天真论》曰:“以妄为常……故半百而衰也”,这里明确指出,把妄作妄为当作正常的生活规律,只活到五十岁就已显得很衰老了。所谓妄作妄为,是指错误的生活方式,它包括范围很广,如劳伤过度,房劳过度,过于安逸等等。

  1. ­Imbalance of work and rest

Plain Questions: Treatise of Heavenly Truth from Remote Antiquity” says, “Taking an irregular life as normal, that’s why the present people become old and feeble at the age of 50”. “Taking an irregular life as normal” refers to the living an improper life style, which includes many aspects, such as damage from over exertion, excessive sexual taxation, or excessively easy and comfortable living, etc.

施今墨的降血压十法 - SHI Jin-mo’s 10 methods for reducing blood pressure

Translated by XU Zhi-jun & J. Heaverlo

高血压是以特续性动脉压增高为主要表现,久而久之,可导致心,脑,肾等重要器官损害,其临床病状归于祖国医学“眩晕”,“头痛”病的范畴。其病因复杂,尤其与精神因素(忧思,恼怒等)关系密切,此外,禀赋不足,脏腑虚损,饮食劳卷等诸多因素均可引起阴阳失调,气血紊乱,络道不畅,血脉瘀滞。为了提高生活质量,健康长寿,务必降低血压,使其维持在一定的水平甚为重要。施今墨将降压之法概括为十法,分述如下.

The chief manifestation of high blood pressure is a continued elevation of arterial blood pressure.  Over time, this can lead to damage of the heart, brain, and kidneys, as well as other vital organs.  Its clinical symptoms belong to the Chinese medicine category of “dizziness” and “headache”.  The disease etiology is complex, especially when psychological factors (such as anxiety and anger) are intimately related.  In addition, natural endowment insufficiency, zàng fǔ organ vacuity and damage, exhaustion of food and drink, plus many other factors can lead to yīn yáng imbalance, qì and blood disorder, and blood stasis of the luò pathways.
In order to enhance the quality of life, health and longevity, it is necessary to lower the blood pressure and important to maintain a certain level.  Below is a summary of  SHĪ Jīnmò’s ten methods for reducing (blood) pressure.

(一)苦寒降压法
肝胆火旺,炎至于上,气血沸腾,并走于脑,遂有头疼如裂,青筋怒张,面红耳赤,烦热易怒,大便硬结,小便短赤,舌红,苔黄腻。治宜清肝泻火,苦寒折逆。方用三黄石膏汤,龙胆泻肝汤。药用黄芩,黄连,知母,生石膏,槐花, 蔚子,夏枯草,知母,黄柏等。

(1) Method of using bitter and cold medicinals to reduce pressure

Use bitter and cold medicinals when there is liver and gall bladder effulgent fire, upward flaring fire, qì and blood seething upward towards the brain.  Hence, there will be splitting headaches, sudden distention of veins, red complexion and ears, easy to anger, heat vexation, bowels which are hard and bound, urination that is short and dark colored, tongue that is red with a thin, yellow coating.
The appropriate treatment is to the drain liver and gall bladder with bitter and cold medicinals.  The exemplar formulas are sān huáng shí gāo tāng, and lóng dǎn xiè gān tāng.  The medicinals used are huáng qín, huáng lián, zhī mǔ, shēng shí gāo, huái huā, wèi zi, xià kū cǎo, zhī mǔ, huáng bǎi.

(二)调气降压法
按“气为血之师,血随气行,行有一息之不运,血有一息之不行”之理,运用降气,顺气之法亦是降压有效治法。方用旋覆花,代赭石,桔梗,枳壳,杏仁,薤白,佛手,香橼等。

(2)  Regulate the qì to reduce blood pressure

It is said that “qì is the commander of the blood, when qì moves blood moves, when qì stops  blood stops”.  To regulate the qì is an effective method for treatment.  Medicinals used are xuán fù huā, dài zhě shí, jié gěng, zhǐ ké, xìng rén, xiè bái, fó shǒu, xiāng yuán.

(三)息风降压法
适用于肝风内动,眩晕面赤,烦躁不宁,夜卧不安。治宜熄风降压。方用天麻够腾饮。药用够腾,天麻,槐花,菊花,羚羊角,水牛角等。

(3)     Extinquish wind to reduce blood pressure

This method is appropriate for use with liver wind internally stirring, with dizziness and a red complexion, vexation and agitation, restlessness, and inability to rest in the evening.
The appropriate treatment is to extinguish wind to reduce the blood pressure.  The exemplar formula is tiān má gòu téng yǐn.  Medicinals used include gòu téng, tiān má, huái huā, jú huā, líng yáng jiǎo, shuǐ niú jiǎo.

(四)镇逆降压法
适用于肝阳亢盛,血压甚高,头脑血管过于充盈诸症。治宜贝石重镇之品,以引血下行。方用镇肝熄风汤等。药用紫贝齿,紫石英,青龙齿,石决明,磁石,铁落,珍珠母,磁朱丸等。

(4) Settle counterflow to reduce blood pressure

This method is appropriate to use when there is liver yáng exuberance.  The blood pressure will be exceedingly high and the blood vessels of the head are excessively full.  The correct method of treatment is to select stones and heavy substances to settle, thereby, leading the blood downward.
The exemplar formula is zhèn gān xí fēng tāng.  Medicinals used are zǐ bèi chǐ, zǐ shí yīng, qīng lóng chǐ, shí jué míng, cí shí, tiě luò, zhēn zhū mǔ, cí zhū wán.

(五)化痰降压法
痰浊中阻,升降失常,眩晕头痛,头胀如裹,胸膈满闷,肢体麻木,言语不利,呕吐痰涎,苔白腻,脉弦滑。治宜和胃降浊,化痰降压。方用半夏白术天麻汤,十味温胆汤。药用半夏,竹茹,茯苓,白术,橘皮,远志,菖蒲,枳实,胆南星等。

(5)    Transform phlegm to reduce blood pressure

Transform phlegm to reduce blood pressure when there is turbidity obstructing the center causing abnormal upbearing and downbearing, dizziness, headaches, distention headaches as if bound, chest and diaphragm fullness and oppression, numbness of the limbs, inhibited speech, and vomiting of phlegm.  The tongue coating will be white and greasy.  The pulse will be bowstring and slippery.
The appropriate treatment is to harmonize the stomach, descend turbidity, and transform phlegm to reduce the blood pressure.  The exemplar formulas are bàn xià bái zhú tiān má tāng, and shí wèi wēn dǎn tāng.  Medicinals used are bàn xià, zhú rú, fú líng, bái zhú, jú pí, yuǎn zhì, chāng pú, zhǐ shí, dǎn nán xīng.

(六)滋阴降压法
肝肾阴虚,水不涵木,肝阳上扰,血随气升,血压增高。治宜滋阴降压。方用知柏地黄汤,杞菊地黄汤。药用枸杞子,菊花,白蒺藜,沙苑子,女贞子,旱莲草,知母,黄柏,生熟地,砂仁,杜仲,怀牛膝等。

(6) Enrich the yīn to lower blood pressure

When there is liver and kidney yīn vacuity, water will not be able to moisten wood and liver yáng will rise to harass the upper body.  The blood will follow the ascension of the qì thereby causing the blood pressure to increase.  The appropriate treatment is to enrich the yīn to decrease the blood pressure.  The exemplar formulas are zhī bǎi dì huáng tāng and qǐ jú dì huáng tāng.  Medicinals used would be gǒu qǐ zi, jú huā, bái jí lí, shā yuàn zi, nǚ zhēn zi, hàn lián cǎo, zhī mǔ, huáng bǎi, shēng shú dì, shā rén, dù zhòng, huái niú xī.

(七)通便降压法
适用于实热内积,升降失常(清阳不升,浊阴不降),腑行不畅。治宜通调腑气,泻热降压。方用承气汤。药用生川军,芒硝,瓜蒌,风化硝,枳实,厚朴,晚蚕砂,炒皂角子等。

(7) Open the bowels to reduce blood pressure

This method is appropriate for replete heat internally accumulating with abnormal upbearing and downbearing (the clear yáng will be unable to ascend while the turbid yīn will not be able to descend)  the bowels, therefore, will become blocked.
The appropriate treatment would be to open and regulate the bowel qì, drain heat to descend the blood pressure.  The exemplar formula would be chéng qì tāng.  Medicinals used are shēng chuān jūn, máng xiāo, guā lóu, fēng huà xiāo, zhǐ shí, hòu pǔ, wǎn cán shā, chǎo zào jiǎo zi.

(八)利水降压法
适用于气血紊乱,久久不愈,以致水液代谢障碍,兼见下肢水肿。治宜利水降压。方用真武汤,五苓散,二草丹。药用猪苓,冬瓜皮,冬瓜字,车前子,车前草,旱莲草,赤茯苓,赤小豆等。

(8) Disinhibit water to reduce blood pressure

This method is appropriate when the qì and blood have become chaotic with prolonged recovery.  Therefore, the water and fluids will become obstructed.  There will be concurrent lower limb swelling.  It is appropriate to disinhibit water to reduce blood pressure.  The exemplar formula is zhēn wǔ tāng, wǔ líng sàn, or èr cǎo dān.  Medicinals used are zhū líng, dōng guā pí, dōng guā zì, chē qián zi, chē qián cǎo, hàn lián cǎo, chì fú líng, and chì xiǎo dòu.

(九)通络降压法
络脉以通为顺,高血压之人,多有络脉不活之征,俗云:“久病入络”即是明证。治宜通络降压。方用六藤煎等。药用够藤,忍冬藤,海风藤,络石藤,青风藤,鸡血藤,桑寄生,桑枝,丝瓜络,炮甲珠等。

(9) Open the luò vessels to decrease blood pressure

The luò vessels can flow smoothly when they are unobstrcuted .  Among high blood pressure patients, many have improper circulation of the luò vessels.  It is said: “chronic disease enters the luò vessels”, (here) this is evident.  The appropriate treatment is to open the luò vessels to descend the (blood) pressure.  The exemplar formula is Six Vine Decoction (liù téng jiān).  The medicinals used are gòu téng, rěn dōng téng, hǎi fēng téng, luò shí téng, qīng fēng téng, jī xuè téng, sāng jì shēng, sāng zhī, sī guā luò, and pào jiǎ zhū.

(十)活血祛瘀降压法
高血压晚期多有血脉瘀滞征象,治宜活血祛瘀降压。方用血府逐淤汤等。药用桃仁,红花,当归,川芎,丹参,葛根,茺蔚子,夏枯草等。

(10) Quicken the blood and expel stasis to decrease blood pressure

In the later stages of high blood pressure many (patients) will exhibit signs of stasis in the blood vessels.  The appropriate treatment is to quicken the blood and expel stasis to reduce the blood pressure.  The exemplar formula is xuè fǔ zhú yū tāng.  The medicinals used are táo rén, hóng huā, dāng guī, chuān xiōng, dān shēn, gé gēn, chōng wèi zi, and xià kū cǎo.

加减法:眩晕加白薇汤(当归,党参,白薇,甘草);欲作中风者,加天麻,够藤,菊花,地龙;失眠,证属心肾不交者,加远志,菖蒲,酸枣仁,液交藤;心悸,心动过速者,加朱砂,琥珀,珍珠母,紫石英,仙鹤草,卧蛋草;心前区疼痛者,加檀香,降香,丹参,三七,蒲黄,五灵脂,蜈蚣,全蝎,乳香,没药等。

Methods for additions and subtractions:  If there is dizziness add bái wēi tāng (dāng guī, dǎng shēn, bái wēi, gān cǎo); if treating wind stroke add tiān má, gōu téng, jú huā, dì lóng; if there is insomnia and the pattern belongs to heart and kidney not communicating add yuǎn zhì, chāng pú, suān zǎo rén, yè jiāo téng; if there is palpitations or tachycardia, add zhū shā, hǔ pò, zhēn zhū mǔ, zǐ shí yīng, xiān hè cǎo, wò dàn cǎo; if there is precordial pain add tán xiāng, jiàng xiāng, dān shēn, sān qī, pú huáng, wǔ líng zhī, wú gōng, quán xiē, rǔ xiāng, mò yào.

古代医家对不孕症的认识 – The Ancient Chinese Doctors Understanding and Treatment of Infertility

古代医家对不孕症的认识

许淑怡’,叶骞’,叶平2壤 2009年4月第29卷第4期 JiLin Journey of Traditional Chinese Medicine 2009.v01.29.No.4

Translated by XU Zhi-jun & J. Heaverlo

[摘要]

中医对不孕症的认识源远流长,在中医古籍中,不孕症的病名有不孕、无子、绝产、断 绪、全不产等称谓。概括其对病因病机的认识有肾虚、瘀血、痰湿、经络为病、月经不 调、外感内伤等。辨证论治包括从肾论治、从气血论治、从瘀论治、从痰论治、从郁论 治,还有针灸疗法、外治法。在预防调护方面,有“男养精,女养血”“合男女必当其年” 的记载,并提倡调情志、节嗜欲。

The Ancient Chinese Doctors Understanding and Treatment of Infertility

Abstract:

Chinese medicine has a long history of understanding and treating infertility. In the ancient books of Chinese medicine, infertility syndrome is also referred to as “infertility”, “without offspring”, “breaking lineage”, and “complete infertility”. The causes of infertility and it’s pathomechanisms are summarized as: kidney vacuity, static blood, phlegm-damp, disease of the channel and network vessels, menstrual irregularities, and external contraction with internal damage. Pattern identification for determining treatment includes treating the kidneys, qi and blood, stasis, phlegm, and depression. Besides acupuncture and moxibustion, additional external treatments may also be applied. In regards to prevention and regulation, it is written that “a man should nourish his essence and a woman should nourish her blood”, as well as, “both men and women should begin sexual activity at an appropriate age.” It is also advocated to regulate one’s affect-mind and control one’s sensual desires. Key Words: infertility; pathomechanism; kidney vacuity; static blood; phlegm-damp; external contraction ________________________________________________________________________________________________ 不孕症是妇科的常见病,近年来全世界的不孕人数有增加的趋势。进入2l世纪的人类,更加关注自身的生殖健康和生育的权利,使不孕症的研究亟待深入。中医对不孕的认识源远流长,早在公元前11世纪《易经·爻辞》中即有“妇孕不育” “妇三岁不孕”等关于不孕不育的最早记载。现就古代医家对不孕的认识论述如下。

In gynecological medicine, infertility is a commonly seen disease. In recent years, the number of infertility cases globally has continued to increase. As we enter into the 21st century, men and women are increasingly paying more attention to their reproductive health, as well as, their right to pro-create. Therefore, infertility research has begun to search for a deeper understanding of this syndrome. Chinese medicine has a long history of understanding and treating infertility. The earliest writings about infertility and sterility can be found in the Yì Jīng·Yáo Cí 《易经·爻辞》(“Book of Changes-Trigrams”) from the 11th century B.C, where it describes: “the woman who carries a child but does not bring it forth” and “for three years the woman cannot carry a child”. This paper is intended to explore how ancient Chinese doctors understood and treated infertility.

1。病名追溯

《周易》最早提出不孕病名及不孕年限的界定。在中医古籍中,不孕的病名有不 孕、无子、绝产、断绪、全不产等称谓。如《素问·骨空论》云:“督脉者⋯⋯此为病⋯⋯其女子不孕”⋯。《素问·上古天真论》云:“七七,任脉虚,太冲脉衰少,天癸 竭,地道不通,故形坏而无子”。《脉经》云:“妇人少腹冷,恶寒久,年少者得 之,此为无子,年大者得之,绝产。”《诸病源候论》专列“无子”一条,对本病之病因加以探讨。《千金方》记载“妇人立身已来全不产,及断绪久不产三十年者”,将不孕分为全不产和断绪,前者即“原发性不孕”,后者相当于“继发性不孕”。

1. The evolvement of the disease name

The Yì Jīng《易经》(“Book of Changes”) was the first text to employ the name “infertility” and the first to define the age limit of infertility. In the ancient books of Chinese medicine, infertility is also referred to as “childless”, “without offspring”, “breaking lineage”, and “complete infertility”. For example, the Sù Wèn-Gú Kōng Lùn《素问·骨空论》(“Plain Questions· Treatise on Bone Hollow”) states, “When there is disease in the Governing Vessel…the woman cannot carry a child”. The Sù Wèn·Shàng Gǔ Tiān Zhēn Lùn 《素问·上古天真论》(“Plain Questions-Treatise of Heavenly Truth from Remote Antiquity”), states, “At the age of 49, the controlling vessel becomes vacuous, the great thoroughfare vessel starts to debilitate, the menstruation becomes exhausted, and the pathway becomes obstructed. Therefore, the body declines and cannot bear children”. The Mài Jīng《脉经》(“The Pulse Canon”) states, “If a woman has cold in the abdomen, feels aversion to cold for a long time, and is still in her youth, this will result in infertility. If she is older it will result in complete infertility.” In Zhū Bìng Yuán Hòu Lùn《诸病源候论》(“The Origin and Indicators of Disease”), the author recorded “infertility” as an entry and further explored the causes of this disease. The Qiān Jīn Fāng《千金方》(“Thousand Gold Pieces Formulary”) describes “a woman who physically is incapable of pregnancy”, and “a woman whom for more than thirty years has been unable to conceive”. Here it is divided into “complete infertility” and “breaking lineage”. The former is “primary infertility” and the latter is “secondary infertility”.

2 病因病机

2.1 肾虚

自《素问·上古天真论》提出“女子七岁,肾气盛,齿更发长,二七而天癸至,任脉 通,太冲脉盛,月事以时下,故有子”以来,肾为生殖之本的论点就为历代医家所认同。《圣济总录》云:“妇人所以无子者,冲任不足,肾气虚寒故也”,说明胞宫失于温煦,宫寒不能摄精成孕而成本病。傅青主也认为不孕之本在肾口,种子门载有不孕病因十条:“身瘦不孕、胸闷不思食不孕、下身冰冷不孕、胸满少食不孕、少腹急迫不孕、嫉妒不孕、肥胖不孕、骨蒸夜热不孕、腰酸腹胀不孕、便涩腹胀足浮肿不孕”,其中有6条论及肾,如“妇人有下身冰冷,非火不暖⋯⋯胞宫既寒,何能受孕⋯⋯胞胎之寒凉,乃心肾二火之衰微也。”指出肾火不足、胞宫寒冷致不孕。又有云:“况瘦人多火⋯⋯此阴虚火旺,不能受孕。”指出肾阴虚所致不孕;及肾气不足、膀胱气化不利致“便涩腹胀浮肿不 孕”等。

2. The Disease Causes and Pathomechanisms

2.1 Kidney Vacuity

As the Sù Wèn 《素问·上古天真论》(“Plain Questions· Treatise of Heavenly Truth from Remote Antiquity”) points out, “When a female reaches the age of seven, her kidney qì becomes exuberant, her teeth change and her hair grows. At the age of 14, her reproductive ability arrives, the controlling vessel opens, the great thoroughfare vessel becomes exuberant, the menstruation comes regularly, and she is able to bear children.” Since the time of the Sù Wèn《素问》(“Plain Questions”), the theory that the kidneys act as the root of reproduction has been widely accepted by the ancient physicians. The Shèng Jì Zǒng Lù《圣济总录》 (“Sages’ Salvation Records”), states, “A woman is childless because her thoroughfare and controlling vessels are insufficient and her kidney qì is vacuous and cold”. This seeks to explain that infertility is due to the uterus’s lack of warmth, and therefore, uterine cold leads to infertility. Fù Qīngzhǔ (傅青主) also agreed the root cause of infertility lies within the kidneys. Zhǒng Zǐmén (种子门) listed ten causes for infertility: “A woman can’t become pregnant if her body is thin; if she feels oppressed in the chest and does not want to eat; if her lower body is icy-cold; if she feels full in the chest and eats too little; if her lesser abdomen is distressed; if she is envious; if she is obese; if she has steaming bone syndrome and night fevers; if she has an aching lumbar and abdominal distention; or if she has difficult urination, abdominal distention and floating edema of the feet”. Among these, six causes have a relationship with kidneys. For example, “If the woman’s lower body is icy-cold and can’t become warm without fire…how can she become pregnant with uterine cold… uterine cold results from the debilitation of heart and kidney fire”. This clearly states that kidney fire insufficiency and uterine cold lead to infertility. It further reads “thin people have more fire. This is yīn vacuity with fire effulgence, which creates the inability to conceive.” This further points out kidney yīn vacuity leads to infertility; and insufficient kidney qì and inhibited bladder qì transformation leads to “infertility because of difficult urination, abdominal distention and floating edema”.

2.2 瘀血

《针灸甲乙经》提出瘀血是不孕之因,“女子绝子,坏血在内不下”。《医宗金鉴》云:“不子之故伤冲任⋯⋯或因积血胞寒热。”说明气血失和导致瘀血内阻,胞脉受 阻,冲任不通不能成孕口。《傅青主女科》云:“疝瘕碍胞胎而外障,则胞胎必缩于疝瘕之内,往往精施而不能受。”《石室秘录》云:“任督之间倘有瘕瘕之症,则精不能施,因外有所障也”,明确指出瘀血等有形之物可以阻碍精子通过胞络而影 响受孕。《张氏医通·妇人门》云:“因瘀积胞门,子宫不净,或经闭不通,成崩中不止,寒热体虚而不孕者。”又云:“妇人立身以来全不产。⋯⋯此胞门不净,中有瘀积结滞也。”亦持瘕瘕积聚可致不孕之观点。王清任善用活血化瘀之法,其从瘀论治不孕获奇效,从而论证瘀血确为不孕致病之因。

2.2 Blood stasis

Zhēn Jiū Jiǎ Yǐ Jīng 《针灸甲乙经》 (“The Systematized Canon of Acupuncture and Moxibustion”) proposes that blood stasis is the cause of infertility. “Female infertility results from the internal retention of spoiled blood”. Yī Zōng Jīn Jiàn《医宗金鉴》(“The Golden Mirror of Medicine”) states, “Infertility is because the thoroughfare and controlling vessels are injured… or because the uterus is both cold and hot due to accumulated blood.” This explains that infertility results from a disharmony of qì and blood, which leads to internal static blood obstruction of the uterine vessels, and of the thoroughfare and controlling vessels.  Fù Qīng Zhǔ Nǚ Kē《傅青主女科》(“Fù Qīngzhǔ: Gynecology”) states, “Mounting-conglomeration impedes the uterus, which leads to external obstruction, and thus the uterus must retract into the mounting-conglomeration. More often than not, even though the semen is without defect, the uterus cannot be fertilized.” The Shí Shì Mì Lù 《石室秘 录》(“Secret Record in the Stone Chamber”) states, “If conglomerations exist between the controlling vessel and the governing vessel, the semen will be inhibited due to the external obstruction.” It is explained clearly that the tangible matter, such as blood stasis, is likely to impede the semen from passing through the uterine network vessels and thus affect the fertility. Zhāng Shì Yī Tōng·Fù Rén Mén 《张氏医通·妇人门》 (“Zhang’s Clear View of Medicine·On Women”), also supports the viewpoint that conglomerations can lead to infertility. “Some women can’t become pregnant because stasis accumulates at the uterine gate, the uterus is not clear, or because the menstruation is blocked and incessant flooding happens, furthermore, the constitution is weak due to cold and heat.” It again states, “A woman cannot be pregnant at all …because the uterine gate is not clear, and there is blood stasis accumulation within.” Wáng Qīngrèn (王清任) used the method of blood-quickening, stasis-transforming to treat infertility from blood stasis. Using this method he was able to obtain miraculous results. This exemplifies that blood stasis is indeed one of the main causes of infertility.

2。3 痰湿

朱丹溪首先提出痰湿可致不孕,《丹溪心法》指出:“若是肥盛妇人,禀受甚厚,恣于酒食之人,经水不调,不能成胎,谓之躯脂满溢,闭塞子宫”,他认为“肥盛妇 人,主脂膜塞胞”和“冲任伏热”都是导致不孕的原因。《济阴纲目》提出“痰饮不孕”和“胸中有实痰”的证治。傅青主亦有云:“妇人有身体肥胖,痰涎甚多,不能受孕者⋯⋯乃脾土之内病也⋯⋯不知湿盛者多肥胖,肥胖者多气虚,气虚者多痰涎⋯⋯夫脾本湿土,又因痰多,愈加其湿,脾不能受,必浸润于胞胎,日积月累且肥胖之妇,内肉必满,遮隔子宫,不能受精,此必然之势也。”

2.3 Phlegm-damp

Zhū Dānxī (朱丹溪) was the first to point out that phlegm-damp is likely to cause infertility. In the Dān Xī Xīn Fǎ《丹溪心法》(“Dān Xī’s Heart-Methods”) Zhū Dānxī (朱丹溪) points out, “Women who are overweight and thick, and those who indulge in wine and food, suffer from menstrual irregularities and cannot establish a pregnancy. This is because too much body fat will overflow and block the uterus.” According to Zhū Dānxī (朱丹溪) , “The fat layer of overweight women can congest the uterus”, as well as,“latent heat lies in their thoroughfare and controlling vessels”, both of which are causes of infertility. The Jì Yīn Gāng Mù《济阴纲目》(“Compendium of Helping Yīn ”) put forward the patterns and treatments of “phlegm-rheum leading to infertility” and “replete phlegm in the chest”. The Fù Qīngzhǔ Nǚ Kē《傅青主女科》(“Fù Qīng Zhǔ: Gynecology”) also states, “If a woman cannot become pregnant, it is due to obesity and too much phlegm-drool, which originates from the internal disease of spleen-earth. Most of those with damp encumbrance are overweight, most of those who are overweight have qì -vacuity, and most of those who have qì vacuity have too much phlegm-drool. The spleen itself is damp, and too much phlegm will intensify this dampness. This will be too much for the spleen to bear and the fetus will be infiltrated. If occurring over a long period of time, the internal flesh will certainly become full; the uterus will be blocked and will not be able to become fertilized. This is an inevitable outcome.”

2.4 经络为病

《素问》云:“督脉生病,女子不孕。”提出不孕与经络的联系。《格致余论》主“血海太热。”《女科经纶》引朱丹溪言“妇人久无子者,冲任脉中伏热也⋯⋯内热则荣血枯。”经络之中,尤以冲任二脉最为重要,“冲为血海”“冲为十二经脉之海”。 能调节十二经的气血,“任主胞胎”,冲任损伤必然导致妇科诸疾。

2.4 Diseases of the channels and network vessels

The Sù Wèn《素问》(“Plain Questions”) states, “A female with the disease of the governing vessel cannot become pregnant.” This points out the relationship between infertility and the channels and network vessels. The Gé Zhì Yú Lùn《格致余论》 (“Further Treatises on the Properties of Things”) states, “The sea of blood is too hot.” The Nǚ Kē Jīng Lún《 女科经纶》(“The Classics of Gynecology”) quoted Zhū Dānxī (朱丹溪), “A woman will suffer from chronic infertility due to latent heat in the thoroughfare and controlling vessel, while internal heat leads to the desiccation of the luxuriant blood.” The thoroughfare and controlling vessels are the most important among the channels and network vessels. “The thoroughfare vessel is the sea of blood”, and “the thoroughfare vessel is the sea of the twelve channels, which can regulate the qì and blood of the twelve channels.” “The controlling vessel governs the uterus”. Damage to the thoroughfare and controlling vessels will inevitably result in gynecological diseases.

2.5 月经不调

不孕与月经不调关系密切,朱丹溪有言:“妇人无子者,多由血少不能摄精,经水不调,不能成胎”。《济阴纲目》较具体地论述了不孕与月经不调的表现:“每见妇人之无子者,其经必或前或后,或多或少,或将行作痛,或行后作痛,或紫或黑或 淡,或凝而不调,不调则血气乖争,不能成孕矣。”《景岳全书·妇人规》突出了月经与孕育的关系,提出“妇人所重在血,血能构精,胎孕乃成”及“妇人之病,当以经血为先”“经调则子嗣”的理论。清代医家王宏翰”1认为:“阴失其道而不能受胎者,乃气胜血衰故也,衰则寒热乘之,气凝血滞,营卫不和,则月水先后不调。”对女性不孕指出是“气盛血衰”所致,女性属阴,以血为主,血虚则不孕。

2.5 Menstrual irregularities

Infertility is closely related to menstrual irregularities. Zhū Dānxī (朱丹溪) once said, “In many cases, females cannot become pregnant because they suffer from blood scantiness and thus cannot receive essence, the menstrual flow becomes irregular and the woman is unable to conceive”. The Jì Yīn Gāng Mù 《济阴纲目》 (“Compendium of Helping Yīn”) gives a relatively specific exposition on the symptoms of infertility and menstrual irregularities, “Each time we see a female who is unable to conceive, it will be likely her menstruation is too early or too late, too heavy or too light, or there is pain before or after menstruation. The menstrual blood will be purple, black or pale, or congealed with clotting and irregular. Irregularity leads to the disharmony of blood and qì therefore leading to infertility.” The Jǐng Yuè Quán Shū·Fǔ Rěn Guī《景岳全书 ·妇人规》(“Jǐng Yuè’s Complete Compendium· Discourses on Women”), emphasizes the relationship of menstruation and pregnancy. It sates, “What is important to women is blood. Blood has the ability to create essence, henceforth pregnancy,” and “gynecological diseases are derived, firstly from menstrual blood”, “when there is regular menstruation, this will produce offspring.” According to Wáng Hónghàn (王宏翰), physician of the Qīng Dynasty, “When yīn loses its path, conception cannot occur. This is because qì is exuberant and the blood is depleted. Once debilitated, cold and heat break through, the qì will congeal and the blood will become stagnant, leading to the construction and defensive to become disharmonious. This leads to irregular menstrual flow.” This quotation illustrates how infertility results from “exuberant qì and debilitated blood”. Women are of yīn and are governed mainly by blood. Therefore, blood vacuity may lead to infertility.

2.6 外感内伤

不孕亦与外感六淫、内伤七情、房劳相关。明代薛己在《薛氏医案》中提出“妇女之不孕,亦有因六淫七情之邪,有伤冲任”的观点。《济阴纲目》云:“婢妾多郁,情不宣畅,经多不调,故难成孕”。《景岳全书》则阐述了情志致病的机理:“产育 由于气血,气血由于情怀,情怀不畅则冲任不充,冲任不充则胎孕不受”。清代陈修园《女科要旨》谓:“妇人无子,皆由内有七情之伤,外有六淫之感。或气血偏盛,阴阳相乘所致。”《冯氏锦囊秘录·女科精要》论述“妇人不孕亦有六淫七情之邪伤冲任,子宫虚冷,⋯⋯或血中伏热,⋯⋯或有积血积痰凝滞胞络”,指出情志可致本病,胞络受阻乃是不孕的一个主要成因。此外,生活失度亦可致不孕。《济阴纲目》指出“合男子多则沥枯虚人,产乳众则血枯杀人”。

2.6 External contraction and internal damage

Infertility is also related to external contraction of the six excesses, internal damage by the seven affects, and sexual taxation. During the Míng Dynasty, Xuē Jǐ(薛己) in his text Xuē Shì Yī Àn《薛氏医案》(“Xuè’s Case Histories”) points out, “In some cases, women’s infertility results from the evil of the six excesses and the seven affects, which injure the thoroughfare and controlling vessels. The Jì Yīn Gāng Mù《济阴纲目》(“Compendium of Helping Yīn”) states, “The concubines have excessive depression, their affect-minds are blocked, they have excessive menstruation which cannot be regulated, hence it is difficult to become pregnant”. Jǐng Yuè Quán Shū《景岳全书》(” Jǐng Yuè’s Complete Compendium”) expounds the mechanism that the affect-mind can cause disease, “Childbirth depends on qì and blood, qì and blood depend on the affect-mind. If the affect-mind is not smooth this leads to insufficiency of the thoroughfare and controlling vessels, which leads to infertility.” During the Qīng Dynasty, Chén Xiū Yuán (陈修园), in Nǚ Kē Yào Zhǐ《女科要旨》(“The Main Points of Gynecology”) he states, “All infertility results from the internal damage of the seven affects and the external contraction of the six excesses, or from abnormal exuberance of qì and blood, and overwhelming of yīn and yáng.” In Féng Shì Jǐn Náng Mì Lù ·Nǚ Kē Jīng Yào《冯氏锦囊秘录·女科精要》(“Féng’s Embroidered Bag of Secret Records- Essentials of Gynecology”) expounds, “In some cases, infertility results from the damage of the thoroughfare and controlling vessels by the six excesses and the seven affects, the uterus is cold and vacuous, or there is latent heat in the blood, or accumulated blood and phlegm stagnating the uterine network vessels”. This points out that the affect-mind can bring about disease. Blockage of the uterine network vessels is one of the main causes of infertility. Furthermore, an intemperate lifestyle is also likely to cause infertility. Jì Yīn Gāng Mù《济阴纲目》(“Compendium of Helping Yīn”) points out, “Excessive sexual activity exhausts the blood and weakens the body, excessive breastfeeding withers the blood and can lead to death”.

3 辨证论治

3.1 从肾论治

肾主生殖,从肾论治不孕者,如《千金翼方》云:“夫求子者⋯⋯并服紫石门冬丸,则无不得效矣。”《太平圣惠方》云:“治妇人血海久积虚冷,无子,阳起石丸方。” 紫石门冬丸、阳起石丸均为温肾暖宫之方,适宜肾阳虚衰,宫寒不孕者。傅青主则从。肾阴阳水火出发,提出补血生精、益气生精、温润添精、气中补阳、固摄肾精及阴阳并顾等治疗法则,《傅青主女科》云:“治法必须大补。肾水而平肝木,木旺则血旺,⋯⋯不特补血而纯于填精,精满则子宫易于摄精,血足则子宫易于容物,皆有子之道也。”又云有一类小孕妇人“饮食少思,胸膈满闷,终日倦怠思睡,一经房事,呻吟不已,人以为脾胃之气虚也,谁知是肾气不足乎⋯⋯治法必以补肾气为主,但补肾而不兼以补脾胃之品,则肾之水火二气,不能提于至阳之上也。”

3. Pattern Identification As The Basis For Determining Treatment

3.1 Determining treatment according to kidney patterns

The Kidneys govern reproduction. Some doctors put forward the viewpoint of treating infertility according to the kidneys. For example, the Qiān Jīn Yì Fāng《千 金翼方》(“Wings of the Thousand Gold Pieces Formulary”) states, “Those who want children have no reason to fail if taking together Zǐ Shí Mén Dōng Wán (紫石门冬丸).” While the Tài Píng Shèng Huì Fāng 《太平圣惠方》(“The Great Peace Sagacious Benevolence Formulary”) states, “Yáng Qǐ Shí Wán (阳起石丸) should be adopted to treat women’s enduring accumulated vacuity cold in the sea of blood causing childlessness.” Both Zǐ Shí Mén Dōng Wán (紫石门冬丸) and Yáng Qǐ Shí Wán (阳起石丸) are formulas that warm the kidneys and uterus. This is a suitable treatment for those who suffer from infertility due to debilitation of kidney yáng and uterine cold. Fù Qīngzhǔ (傅青主) from the perspective of kidney yīn and yáng, water and fire, put forward the principles of treatment of supplementing the blood to engender the essence, boosting qì to engender the essence, warming and moistening to replenish the essence, center the qì to supplement yáng, secure and contain the kidney’s essence, as well as yīn and yáng. Fù Qīngzhǔ Nǚ Kē《傅 青主女科》(“Fù Qīng Zhǔ: Gynecology”) states, “Infertility must be treated by greatly supplementing the kidney water and calming the liver-wood. Effulgent wood makes effulgent blood. This is not only for supplementing blood but also for replenishing essence. Sufficient essence and blood make it easier for the uterus to become fertilized. All of these are ways to aid conception.” The text further explains, some women who suffer from infertility “have little thought of food and drink, a sensation of fullness, oppression of the chest, fatigued and drowsy all day long, and groan incessantly after having sexual intercourse. This has been ascribed to qì vacuity in the spleen and stomach, when in fact it is actually due to kidney qì insufficiency and must be treated by supplementing the kidney qì. However, if you do not simultaneously supplement the spleen and stomach, the qì of the water and fire within the kidneys cannot rise up to the top of zhì yáng (阳之) (GV 9-extremity of yáng).”

3.2  从气血论治

从气血论治,调经为先者,如朱丹溪云:“求子之道,莫如调经。”《万氏妇人科》亦云“女子无子,多因经候不调⋯⋯调经为女子种子紧要。”《景岳全书》立“育麟珠”用于补气血调经,极效。《宋氏妇科秘书》立“百子建中丸”治“妇人久冷,赤白 带下,肚腹疼痛,经水不调”,方以“温中暖脐、调经开郁、开胃”为法,“服至半 月,必有孕矣”。王肯堂论不孕亦强调气血平和,调经种子,谓“滞者香附、缩砂、 木香、槟榔、桃仁、延胡。滞久而沉痼者吐之下之。脉证热者四物加芩连⋯⋯值至积去滞行虚回,然后血气平和能孕子也。”《沈氏女科辑要》也说:“求子全赖气血充足,虚衰则无子”。《妇科玉尺》认为“求嗣之术,不越男养精、女养血两大关键”,而“养血之法,莫先调经”,可用香附末醋丸、琥珀调经丸等治疗。傅青主疗不孕,亦重调护气血”,认为“不损天然之气血”“妊娠一门总以补养气血为主”。

3.2 Determining treatment according to qì and blood

Some doctors place regulation of the menses as the primary objective when determining treatment according to qì and blood diagnosis. For examples, Zhū Dānxī (朱丹溪) says, “No other method is better than regulating menstruation in order to become fertile.” Wàn Shì Fù Rén Kē《万氏妇人科》(“Wàn’s Gynecology”) also states, “In most cases, a woman cannot conceive because of irregular menses. Regulating menstruation is the vital point for a woman to become pregnant.” Jǐng Yuè Quán Shū《景岳全书》(“Jǐng Yuè’s Complete Compendium”) uses ” Yù Lín Zhū ” (育麟珠) to supplement qì and blood in order to regulate the menses, thereby achieving optimal results. The Sòng Shì Fù Kē Mì Shū《宋氏妇科秘书》(“Sòng’s Secret Book of Gynecology”) treats “women’s enduring cold, red and white vaginal discharge, abdominal pain, and irregular menstrual flow” with Bǎi ZǐJiàn Zhōng Wán (百子建中丸) (“Bǎi ZǐStrengthen the Center Pill”). The text suggests using the method of warming the center and navel, regulating menstruation and opening depression, as well as regulating the stomach in order to increase the appetite”. The text further states, “After taking for this prescription for half a month, pregnancy must occur”. Wáng Kěntáng (王肯堂), on the topic of infertility, also places emphasis on calming and harmonizing qì and blood and regulating menstruation. He says, “If qì and blood are stagnant, use xiāng fǔ (相府), suō shā (縮砂), mù xiāng(木香), bīn láng (槟榔), táo rén (桃仁), and yán hú (延胡). If the stagnation is enduring and chronic, let it vomited and precipitated. If the pulses and symptoms indicate heat then use these four agents with qín lián (芩连), then qì and blood will be calm and harmonious allowing for conception.” Shěn Shì Nǚ Kē Jí Yào《沈氏女科辑要》(“The Summary of Shěn’s Gynecology”) also states, “Pregnancy all depends on sufficient qì and blood. Debilitation leads to infertility”. According to the Nǚ Kē Yù Chǐ《妇科玉尺》(“The Jade Ruler of Gynecology”), “The methods to become pregnant do not contain more than two points: the male nourishes his essence and the female nourishes her blood.” “The first thing to do in order to nourish blood is to regulate menstruation”, xiāng fú mò cù wán (香附末醋丸) (Cyperus Rotundus Vinegar Pills) and hǔ pò diào jīng wán (琥珀调经丸) (“Amber Regulate the Menses Pill”) can be used for treatment. Fù Qīngzhǔ (傅青主) also attaches great importance to regulating and protecting the qì and blood. He warns, “Do not injure qì and blood”, “The first objective for fertility is to supplement and nourish qì and blood”.

3.3  从瘀论治

从瘀论治者,如《千金方》云:“女服紫石门冬丸及坐浴、荡胞汤,无不有子”“二三十年全不产育者,胞中必有积血,主以荡胞汤”,荡胞汤乃祛瘀血下积聚之药,在《千金方》为妇人求子第一方,“主妇人断绪二、三十年,及生来无子,并数数失 子”。王清任善用活血化瘀之法治疗诸多疾病,其论治不孕亦获奇效。

3.3 Determining treatment according to blood stasis

The Qiān Jīn Fang《千金方》(“Thousand Gold Pieces Formulary”) states, “No woman will fail to become pregnant if she takes zǐ shí mén dōng wán (紫石门冬丸) (Flourite and Ophiopogon Pill) along with the medicinal soak dàng bāo tāng,(荡胞汤) (Uterus Sweeping Decoction)”. The text continues to state, “those who have been infertile for 20 or 30 years…their uterus must have accumulated blood…which should be primarily treated with dàng bāo tāng (荡胞汤) (Uterus Sweeping Decoction)”, dàng bāo tāng (荡胞汤) (Uterus Sweeping Decoction) is for dispelling blood stasis and precipitating accumulation, which is taken as the first method for infertility according to the Qiān Jīn Fāng《千金方》(“Thousand Gold Pieces Formulary”). This formula is used for “treating those women who break lineage for 20 or 30 years, or who cannot become pregnant from birth, or who have miscarriages again and again”. Wáng Qīngrèn (王清任) was adept at treating many forms of diseases by using the method of quickening the blood and transforming stasis. He also gained extraordinary efficacy on treating infertility with this approach.

3.4 从痰论治

从痰湿论治者,朱丹溪首倡“躯脂满溢,闭塞子宫,宜行湿燥痰”。《冯氏锦囊秘录》立“启官丸”治“妇人肥盛,子宫脂满壅塞,不能孕育”,指出痰湿型应以启宫丸为主方,药简而效佳。《傅青主女科》云:“治法必须以泄水化痰为主。然徒泄水化 痰,而不急补脾胃之气,则阳气不旺,湿痰不去,人先病矣”,提出补脾化痰治不孕之法。

3.4 Determining treatment according to phlegm accumulation

Zhū Dānxī (朱丹溪) was the first to advocate “When the body is exuberant with fat, the uterus will be blocked. In this case, the method of moving dampness and drying phlegm should be adopted”. Féng Shì Jǐn Náng Mì Lù《冯氏锦囊秘录》(“ Féng’s Embroidered Bag of Secret Records”) lists qǐgōng wán (启官丸) (Uterus-Opening Pill) to treat “the infertile woman whose uterus is exuberant with fat and congestion”. It further points out that phlegm-damp infertility should be treated chiefly with qǐgōng wán (启官丸) (Uterus-Opening Pill), which is a simple but effective medicine. Fù Qīng Zhǔ Nǚ Kē《傅青主女科》(“Fù Qīngzhǔ: Gynecology”) states, “this must be treated with the method of discharging water and transforming phlegm”.

3.5 从郁论治

情志不畅亦可致不孕,《济生方》提出疏肝解郁,养血理脾治女子不孕,云“妇女血衰而气旺,是谓夫病妇疹,皆使人无子。治疗之法,女子当养血抑气,以减喜怒。”《傅青主女科》云:“肝木不舒,必下客脾土而致塞”,使“胞胎之门必闭”而不能受 孕,“解肝气之郁,宣脾气之困,而心肾之气亦因之俱舒,所以腰脐利而任带通达,不必启胞脉之门,而胞脉自启”,并立“开郁种子汤”治疗嫉妒不孕。

3.5 Determining treatment according to depression

If the affect-mind is unsmooth, this can also lead to infertility. The text Jì Shēng Fāng《济生方》(“Life-Saving Formulas”) put forward the method of coursing the liver and resolving depression, nourishing the blood and rectifying the spleen to treat infertility. It states, “That when a women’s blood is debilitated and her qì is exuberant. This is referred to as “Fū Bìng Fù Zhěn” (夫病妇疹) (see foot note). This will certainly lead to infertility. As to the method of treatment, the female should nourish her blood and repress her qì, so as to reduce excess joy and anger.” Fù Qīng Zhǔ Nǚ Kē《傅青主女科》(“Fù Qīngzhǔ: Gynecology”) states, “If the liver-wood is constrained, it will descend to invade the spleen-earth, leading to congestion”, thus “closing the uterine gate” making it unable to achieve pregnancy. If the depression of the liver qì is resolved and the encumbrance of the spleen qì is diffused, consequently, the qì of the heart and the kidney will also be soothed. Therefore, the waist and navel will become uninhibited, freeing the controlling vessel. The uterine vessel will then effortlessly open by itself”. The book also lists Kāi Yù Zhǒng Zǐ Tāng (开郁种子汤) (Depression-Opening Seed-Planting Decoction) for treating infertility due to jealousy.

4 其他疗法

4.1 针灸疗法

针灸能治疗部分功能性不孕症,如《医心方》载“治无子法:灸中极穴”。《千金要方》云:“妇人绝嗣不生,胞门闭塞,灸关元三十壮”。《针灸甲乙经》云:“绝子,灸脐中,令有子”。《针灸大成》云:“子宫二穴,在中极两旁各开三寸,针二寸,灸二七壮,治妇人久无子嗣”。《医学入门》载三阴交主“妇人月水不调,久不成孕”。《类经图翼》语:“阴廉:若经不调未有孕者,灸三壮即有子”。古人用针灸治疗的不孕证,以寒证为多,热证为少。对于寒证和虚证,则有使用灸法的倾向。《类经图翼》载:“神阙:妇人血冷不受胎者,灸此永不脱胎”。采用隔物灸者, 《医学入门》所隔之物为“彭祖固阳固蒂长生延寿丹”,用以治疗“久无生育,子宫极冷”之证,其组成药物具有温阳益气,行气走窜,活血壮肾,散寒祛风等作用,加上大剂量的灸疗,直至“遍身大汗”,故能取得一定疗效。

4. Other Methods of Treatment

4.1 Acupuncture and moxatherapy

Acupuncture can treat various situations of functional infertility. As Yī Xīn Fāng《医心方》(“Heart-Treating Formula”) states, “Method for treating infertility: moxa zhōng jí xué (中极穴)(CV 3-Central Pole Point)”. The Qiān Jīn Yào Fāng 《千金要方》(“A Thousand Gold Pieces Prescriptions”) states, “The reason a woman cannot give birth is because her uterine gate is blocked. Burn 30 cones of moxa at guān yuán (关元) (CV 4-Pass Head)”. Zhēn Jiū Jiǎ Yǐ Jīng《针灸甲乙经》(“The Systematized Canon of Acupuncture and Moxibustion”) states, “As to infertility, moxa qí zhōng (脐中) (CV 8-Center of the Navel) to allow for pregnancy”. Zhēn Jiū Dà Chéng《针灸大成》 (“The Great Compendium of Acupuncture and Moxibustion”) states, “Locate the two acupuncture points of the uterus, three inches beside zhōng jí (脐中) (CV 3-Central pole). Needle the two inch-point, and burn 27 cones of moxa. This method can treat a woman who has had no offspring for a long period of time”. According to the record of Yī Xué Rù Mén《医学入门》(“The Gateway to Medicine”), sān yīn jiāo (三阴交) (SP 6-Three Yīn Intersection) is in charge of “women’s chronic menstrual irregularities and infertility”. The Lèi Jīng Tú Yì 《类经图翼》(“The Illustrated Wings of the Classified Canon”) says, “If one cannot become pregnant because of irregular menstruation, burn 3 cones of moxa at yīn jí (壮即) (LV 11-Yīn Corner) and one will surely conceive”. Ancient Chinese practitioners more often treated cases of infertility due to cold patterns than those of heat patterns. They did so by administering acumoxatherapy. It is therefore intended to administer moxa to treat patterns of cold and vacuity. Lèi Jīng Tú Yì 《类经图翼》(“The Illustrated Wings of the Classified Canon”) records, “If the woman cannot become pregnant because of blood cold, moxa shén quē (神阙) (CV 8, Spirit Gate Tower) and then miscarriage won’t happen at all”. In Yī Xué Rù Mén 《医学入门》(“The Gateway to Medicine”), the formulation used is péng zǔ gù yáng gù dì chǎng shēng yán shòu dān (彭祖固阳固蒂长生延寿丹) (“stalk securing and life-extending elixir”), which can treat the symptoms of chronic infertility and extreme uterine cold. This formula has the effect of warming yáng and boosting qì, moving qì and penetrating, quickening blood and invigorating the kidneys, dissipating cold and dispelling wind. In addition, apply a great amount of moxa. The patient will “sweat profusely”. This is precisely why it is so effective.

4.2 外治法

《干金翼方》的记载说明当时已有阴道用药治疗不孕,“女服荡胞汤,及坐药,并服紫石门冬丸,则无不得效矣。”书中还详细记载了坐导药方的组成,使用方法。《外台秘要·求子法及方》所引《经心录》茱萸丸、《女科要旨》所载“广嗣方”,均为 阴道用药治疗不孕。古代还有“兜肚方”治疗不孕的记载,出自《医学入门》与《古今医统》两书,分别日:“久不受孕者,惟有孕者忌之”“兼丹田、神阙,令人有 子”。《古今医统》载有“保真种子膏”,将此膏“贴。肾俞,暖丹田,子午既济,百病自除,一膏能贴六十日,金水生时,用功即孕,大有奇效”,“贴六十日揭去,入房即孕”。

4.2 External method of treatment

The recording in Qiān Jīn Yì Fāng《干金翼方》(“Wings of the Thousand Gold Pieces Formulary”) illustrates that during this period, applications of external medicinal baths had been used to treat infertility. “The female won’t fail once taking dàng bāo tāng (荡胞汤) (Uterus Sweeping Decoction), together with zǐshí mén dōng wán (紫石门冬丸) (Flourite and Ophiopogon Pill). The book also records in detail the formula composition and instructions. Wài Tái Mì Yào·Qiú Zǐ Fǎ Jí Fāng 《外台秘要·求子法及方》(“Essential Secrets from Outside the Metropolis·The Methods and Formulas for Seeking Offspring”) quotes zhū yú wán (茱萸丸) (Evodiac Fructus Pill) from Jīng Xīn Lù《经心录》(“Records of Managing Heart”) to be used for cases of infertility. guǎng sì fāng (广嗣方) (Formula for Extending Descendants) is recorded in Nǚ Kē Yào Zhǐ 《女科要旨》 (“The Main Points of Gynecology”). Both of these treat infertility with the method of using external medicinal baths. In addition, dōu dǔ fāng (兜肚方) (Abdomen-Covering Formula) is also recorded to treat infertility. The formula can be found in Yī Xué Rù Mén 《医学入门》(“The Gateway to Medicine”) and Gǔ Jīn Yī Tǒng《古今医统》(“The Complete Compendium of Medical Works; Ancient and Modern”). They state respectively, “Those who cannot become pregnant for a long time will surely conceive”. They further project, “Treating dān tián (丹田) (Cinnabar Field) and shén quē (神阙) (Spirit Gate Tower) makes people pregnant”. The Gǔ Jīn Yī Tǒng《古今医统》(“The Complete Compendium of Medical Works; Ancient and Modern”), also records bǎo zhēn zhǒng zǐ gāo (保真种子膏) (True-Safeguarding Seed-Planting Paste) for external application. “Attach this paste on shèn shù (肾俞) (BL-23-Kidney Transport) to warm dān tián (丹田) (Cinnabar Field). Since selection of the zǐ wǔ (子午) (Midday-Midnight/Stem and Branch points) will have mutual benefits, once utilized, the hundreds of diseases will all be eliminated naturally”. One application can remain for up to sixty days. Once metal and water engenders, pregnancy will take place with little effort, thus proving to be extraordinarily effective.

5预防调护

《妇科玉尺》云:“求嗣之术,不越男养精、女养血两大关键。盖男精女血,因感而会,精成其子”,提出蓄精养血以利受孕。《褚氏遗书》提出男女双方应适龄而婚:“合男女必当其年。男虽十六而精通,必三十而后娶;女虽十四而天癸至,必二十而嫁”,其道理在于“皆欲阴阳完实,然后交合,则交而孕,孕而育,育而为子,坚壮强寿”,若“未笄之女,天癸始至,”就过早交合,则“交而不孕,孕而不育,育而子脆不寿”,指出了早婚对生育的危害性,提倡男女适龄而婚,为后世医家所认同。但婚育又要及时,不可过晚,《济生方》言:“男女婚姻,贵乎及时,夫妇贵乎强壮,则易于受形也”,并提倡调情志,节嗜欲,言:“女子应养血抑气,以减喜怒,男子益肾生精,以节嗜欲⋯⋯阴阳和平,则妇人乐有子矣。”《万氏妇人科》提出节欲以养 精:“故种子者,男则清心寡欲以养其精,女则平心定气以养其血。”《女科准绳》引袁了凡言:“天地生物,必有氤氲之时,万物化生,必有孕育之时⋯⋯凡妇女一月经行一度,必有一日氤氲之候,于一时晨间⋯⋯此的候也⋯⋯顺而施之则成胎矣。”指出欲受孕者,当交合有时。《性原广嗣》云【4 J:“凡夫妇交会之际,勿嗔怒而骄傲,勿醉饱,勿用房术,勿动邪恶之心。”告诫世人交合时要选择好时间、地点,要有好心情,男女融洽,自然而然,尤其强调不用房术,在四季、阴阳、寒暑、雷霆风雨变化时,对男女双方的心理和生理上产生影响,情绪受到干扰导致脏腑功能紊乱,对受胎不利。

5. Prevention and Regulation

Fù Kē Yù Chǐ 《妇科玉尺》(“The Jade Ruler of Gynecology”) states, “The way to seek descendants does not require more than two key points: men need to nourish their essence and women need to nourish their blood. Males’ essence and females’ blood will come together because of this interaction. It is the essence that makes the child”. The book puts forward the opinion that essence-amassment and blood-nourishment is primary to pregnancy. Chǔ Shì Yí Shū 《褚氏遗书》 (“Chǔ’s Collected Writings”) puts forward the idea that a man and a woman should marry at the correct age. “The male and the female must start sexual intercourse at the correct time. Although, starting to produce essence at the age of sixteen, a man must wait to marry until the age of thirty; even though the first menstruation arrives at the age of fourteen, a woman must wait to marry until the age of twenty”. This is because “if waiting to begin sexual intercourse until after both yīn and yáng are completely mature, the intercourse will be able to lead to pregnancy, the pregnancy can lead to childbearing, and the child will be strong and long-lived”. If “the under age female begins to have sexual intercourse at the time of the first menstruation”, “the intercourse cannot lead to pregnancy, the pregnancy cannot lead to childbearing, and if it does, the child will be fragile and short-lived”. The book points out the perniciousness of marrying too early in regards to childbearing, and advocates that both males and females should marry at the appropriate age. This idea has been widely accepted by physicians of later generations. Although marriage and childbearing should occur within an appropriate amount of time, it should also not occur too late. Jì Shēng Fāng《济生方》(“Life-Saving Formula”) states, “Marriage is valued for its timeliness, husbands and wives are valued for their robustness, which allows for ease in obtaining pregnancy”. The book also advocates to regulate one’s affect-mind and to control one’s sensual desires, “Females should nourish blood and repress qì in order to reduce excess joy and anger; males should boost the kidneys and engender essence in order to control sensual desires. If yīn and yáng are calm and harmonious, a woman will happily conceive.” Wàn Shì Fù Rén Kē 《万氏妇人科》(“Wàn’s Gynecology”) holds that essence should be nourished by controlling one’s desires: “the male should be pure of heart and have few desires in order to nourish his essence, the female should keep the heart and mind calm in order to stabilize her qì and nourish her blood.” Nǚ Kē Zhǔn Shéng《女科准绳》(“The Level-Line of Gynecology”) quotes from Yuán Liǎowán (袁了凡), “There must be a time of yīn-yáng interaction for the generation of heaven and earth. There must be a time of pregnancy for the transformation of the ten thousand things of creation. All women, who have regular monthly menstruation, must have one day of ovulation, which happens within a two-hour period. This is the period of ovulation. Taking advantage of this period of time for sexual intercourse leads to pregnancy.” This quotation points out that those who desire to conceive should have sexual intercourse at a very distinct and appropriate time. Xìng Yuán Guáng Sì《性原广嗣》(“The Principle of Sex and Descendants Extention”) states, “While having sexual intercourse, the husband and wife should refrain from anger and conceit. They should not be drunken and full. They should refrain from the use of fáng shù (房术) (intercourse techniques). They should also take care as to not have evil thoughts.” This exhorts couples to have intercourse at a good time and a good location. Both individuals should be in a happy mood, be on good terms, and maintain a natural approach, and absolutely refrain from using fáng shù (房术) methods. Also, sexual intercourse, in relation to the changing of the four seasons, yīn and yáng, cold and heat, thunder and lightening, wind and rain, are likely to affect the psychology and physiology of both men and women. Disturbed emotions are likely to result in the dysfunction of the bowels and viscera, which is unfavorable for pregnancy.

6 结语

不孕症涉及到每个婚姻、家庭的幸福,也同样是世界性的生殖健康问题。不孕症的发病原因多且复杂,古代先贤们对此形成了各家独到的认识,为我们积累了诸多宝贵的经验。临床对不孕症的治疗,除先天生理缺陷者以纠正缺陷为主要治疗外,多以辨证为本,借鉴古代医家的经验,综合考虑多方面的因素,改善全身状况,内外调适,身心同治,以达到助孕成胎目的。

6. Conclusion

Fertility is directly related to the happiness of every marriage and every family. It can be furthered considered a worldwide health issue. The causes of infertility are various and complicated. The ancient physicians, with their accumulated experience, established and put forth their original theories. Clinically, excluding those with genetic physiological defects, the treatment of infertility is mainly based on pattern identification. The best approach is to utilize the experience of the ancient physicians as a reference and comprehensively consider various factors. Treatment should be aimed to improve the state of the whole body, regulate both the internal and external, and treat both the body and mind, so as to attain the goal of conception and maintain a healthy pregnancy.