In relation to blood stasis – many of my own students don’t come in with much more of an understanding of blood stasis herbs other than that they all move the blood and that they should therefore not be used when there is heavy bleeding or during pregnancy.  And yet, through experience we learn that sometimes we must strongly move the blood in order to stop heavy bleeding and that sometimes moving the blood can help prevent a miscarriage.

I’ve been away in Taiwan for the last month and have unfortunately neglected this blog while I was away!  I hope I didn’t lose your attention!  If you are interested in our travels in Taiwan you can click here for the little blog of our trip.   Well I’m back and have some interesting material to post that I hope you’ll enjoy!  I am going to do a series now, relying heavily on the work of Dr. Xia Guisheng.  I’ll start here with a brief introduction to Dr. Xia and and follow this with a discussion of learning some of the subtleties in treatment and the term that I am translating as “opening through”.  I’ll follow this with some entries that include the writings of Dr. Xia together with some of my own clinical experience utilizing his insights.

Dr. Xia is the director of the Gynecology Department at the Affiliated Hospital in Nanjing and professor of Gynecology at the Nanjing University of Tradition Chinese Medicine.  Bringing  over 50 years of experience and insight to his writings, he is not only a highly effective practitioner, he is also a clear teacher/writer.  His material is written in a way that guides the student/practitioner through the necessary steps to gain understanding.

He has pioneered the articulation of the theories that direct us to work with the ebb and flow or Yin and Yang in relation to the menstrual cycle.  He applies this understanding to all areas of gynecology in great detail.  It is no surprise, after reading his books, to discover that he has become know as a manifestation of Guan Yin, the Chinese goddess who come to the aide of women and children.  Though he is perhaps best known in the West for his work with modifying formulas according the the timing of the menstrual cycle, Dr. Xia pays such close attention to the details of patho-physiology in combination with the function of formulas and the individual herbs within them that his books are really a treasure trove of useful gems.  In this particular series, I will be paying attention to his work with blood stasis and the idea of “opening through” in relation to women’s physiology, patho-physiology and menstruation.  These ideas have many implications in the treatment of women including but going beyond the treatment of dysmenorrhea and infertility.

Most entry level Chinese herbalists have a very limited idea of gynecological blood stasis, it’s diagnosis and treatment.  This becomes very apparent as the practitioner works with women in the clinic and finds that so much of what was learned in school simply doesn’t work or works in a way that is far from ideal.  Poor clinical results can be frustrating but they can also push us to learn more and can help our diagnosis and treatments become more nuanced. For me, less than excellent results have pushed me to research many topics, including the topic of “opening through” in relation to gynecology.  This topic also brings up the concept of a more nuanced use of individual herbs.  In relation to blood stasis – many of my own students don’t come in with much more of an understanding of blood stasis herbs other than that they all move the blood and that they should therefore not be used when there is heavy bleeding or during pregnancy.  And yet, through experience we learn that sometimes we must strongly move the blood in order to stop heavy bleeding and that sometimes moving the blood can help prevent a miscarriage.  We also learn that all blood vitalizing herbs are not equal to each other nor the same as each other.  They range from strong to weak and from cold to hot.  Some are especially good at stopping pain, others are especially good improving the quality of the blood itself.  Here is a bit of a preliminary list just some of the various functions of some individual blood vitalizing herbs:

Stopping pain

Softening hardness

Cracking stasis

Warming the blood

Regulating the Qi within the blood

Stopping bleeding

Harmonizing the blood

Nourishing the blood

Supplement the Kidneys

Descend the Heart blood to the uterus

Cool the blood

Relieve constipation

Open up the chest and breast area

And finally blood vitalizing herbs that function to “open through” the menstruation…..

I first noticed that there was something going on with this idea of “opening through” when I was working beside my teacher Dr. Sheng Yufeng, in Hang Zhou, PRC.  I was constantly trying to figure out why she would use particular herbs in particular situations.  I noticed that there were times she would give a formula for blood stasis and include herbs like Huai Niu Xi or Chuan Niu Xi along with herbs such as Su Mu, Chong Wei Zi and Shan Zha.  I wanted to know when and why she used these herbs.  It was not until I found the writings of Dr. Xia Guicheng that these ideas were fulling articulated for me.  Since studying these writings, the diagnosis and appropriate treatment methods for of some patients in my clinic has become clearer and the treatment results improved.

So, what is this “opening through”?  I am translating the character 通, tong1. as “opening through”.  The Eastland Press glossary translates this as “unblocks, promotes, pervades”.  Wiseman and Ye’s Practical Dictionary of Chinese Medicine, Second Edition translates this term variously as “free, open, restore flow, unstop and connecting.  Thinking of this as “opening through” just what gets opened through?  This term is used when the Luo vessels, the channels, the Qi, the lactation, the bowels, the nasal passages, the blood vessels, the urination, the Ren vessel and finally, the menstruation are blocked. What I want to point out in relation to all of these functions is that what is being “freed” or “opened” or “connected” all relates to structures in the body that are tubular.  This is why the idea of “opening through” is useful.  It gives us the image, not only of blockage, but of a tube that is blocked up and needs to be opened.  Though the term “unblocking” may suffice, it does not convey the image of a tube that should be open end to end the way that “opening through” does.  I have to admit “opening through” is a rather bulky term though, but at least for now, I’d like to use it to effectively illustrate the physiology, patho-physiology, treatment principles and function of herbs.

A bit more about the character tong1 通. It is made up of two parts. The first is this: 甬 yong3 which carries the meaning of path or corridor.  The second is 辶 chou4, which carries the meaning of walking or going.  So altogether we have the meaning of movement through a corridor or path.   When we take the 甬 yong3 corridor or path part of the character and combine it with the disease radical getting 痛 tong4, meaning pain.  In other words, when the corridor is pathologically effected, there is pain.  The characters 通 and 痛 are the one’s that are in the famous saying 通则不痛，不通则痛,  or when there is opening through there is no pain and when there is no opening through there is pain.

So what is this tube that is related to “opening through” the menstruation?  This tube is related both to the Ren Vessel and to the Bao Tai, which connects the upper body, especially the Heart and chest, to the uterus.  This tube can get blocked up and when it does, it needs to get opened through from end to end.  Various symptoms can arise when this tube gets blocked up including amenorrhea, scanty menstruation, lack of free flow of menstruation, painful menstruation, heavy menstruation and infertility.  Upper Jiao symptoms can involve the breasts, the head, the emotions or even cause bleeding in the upper warmer as the menstrual blood fails to descend.  The blockage can effect the middle Jiao as well.  Recently I successfully treated a woman with Achalasia, which involved difficulty swallowing and esophageal spasming that was worse premenstrually, integrating the method of opening through the menstruation.  In general, when the menstruation is not open through, a failure of the downward movement of the Qi mechanism can lead to a whole variety of upward rebelling symptomatology in addition to the lower warmer issues.

 

Before moving on to the entries that include the Dr. Xia’s writings on this topic, I want to include a bit about how he organizes his discussions in his book, Gynecology Formluas and Herbs from Clinical Experience and Study in Fifteen Chapters. In this text, Dr. Xia has a whole chapter devoted to the idea of “opening through”.  He divides this chapter into 8 parts, each part being represented by one of his “opening through” experiential formulas.  He begins with a basic formula Jia Yu Tong Yu Jian (modified Opening Through Stasis decoction) which is based on Zhang Jingyue’s formula Tong Yu Jian (Opening Through Stasis decoction). He uses this formula as a jumping off place for the deeper, more detailed discussion of the topic.  The formulas that follow morph off of the original idea in the variety of ways that Dr. Xia sees most often in his clinical work.  By carefully going through each chapter, the practitioner learns, not only about these particular formulas but so much more.  We learn how to modify a formula to suit a variety of clinical realities but more importantly, we learn about women’s physiology and patho-physiology in great depth.  Finally, we learn about the individual herbs and their nuanced and careful use.  It is like looking at an issue through a variety of lenses until we feel we have quite a complete understanding.  I’ve not previously seen texts organized in this manner and have found it to be an excellent way to transmit his valuable information.

So, stay tuned!  Dr. Xia’s writings will soon be posted here!