Discussion on the treatment of amenorrhea by"Tihujiegai method"

Xi Yang

1College of traditional Chinese Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250300,China.

Abstract"Tihujiegai method"(lifting a kettle and removing its lid figuratively refers to a method of lifting the'Lung Qi'(It refers to the functional activity of the lungs and also includes breathing gases.)to promote urination.),created by Zhu Danxi(1281-1358),who ranked among the era’s best doctors,is a metaphor for using "Xuanfei method"(A method of promoting the dispersing function of the lung)or "Tiqi method"(A method for treating Qi activity depression),which has been widely used later.The author consulted a large number of relevant essays and found that the "Tihujiegai method" of amenorrhea was also effective.This study mainly discusses the treatment of amenorrhea method theoretically,and opens up ideas for clinical application.

Keywords:"Tihujiegai method";amenorrhea;Lung;"Xuanfei";"Tiqi";discussion

Background

Amenorrhea refers to no menstruation or the established menstrual cycle stops for three cycles.The former is called the primary amenorrhea,and the latter is called secondary amenorrhea[1].In traditional Chinese medicine(TCM),amenorrhea is divided into two types:deficiency syndrome and excess syndrome.Deficient amenorrhea mainly lacks Yin-Blood(Because blood belongs to Yin,it is called..)while the real one is caused by the congestion of pathogenic factors,which can be cured by"Tihujiegai method"(lifting a kettle and removing its lid figuratively refers to a method of lifting the 'Lung Qi'(It refers to the functional activity of the lungs and also includes breathing gases.)to promote urination.)[2].In TCM,"Tihujiegai method" is the embodiment of the application of analogism."The Dictionary of Traditional Chinese Medicine"explains it as a metaphor for using"Xuanfei method"(A method of promoting the dispersing function of the lung)or "Tiqi method"(A method for treating Qi activity depression)[3].In daily life,only when the closed pot lid is opened and put into some air,the water in it can flow out.Zhu Danxi(1281-1358A.D.)uses this analogous therapy to treat urination retention with "Xuanfei method"."Yixueyuanliulun"(Treatise on the origin and debelopment of medicine,1757 C.E.Xu Dachun)describes it as "opening the upper source of water to let it run".Similarly,this approach can also be used for menstrual block.This work mainly discusses and expounds the historical origin,theoretical basis and clinical application of treating amenorrhea by "Tihujiegai method",aiming to better guide the clinical practice.

Overview of"Tihujiegai method"

Historical origin

The records of"Tihujiegai method"originated from"Huangdi Neijing"(Yellow Emperor’s Inner Classic;221 B.C.E.-220 C.E.)."Huangdi Neijing Lingshu"(Yellow Emperor’s Inner Classic:Spiritual Pivot;221 B.C.E.-220 C.E.)records,"When it is freezing cold,our body produces urine and Qi(Qi is considered to be the force that informs and animates all things in Daoism,which is believed to flow through the body along routes known as meridians;illness is attributed to changes in the flow of Qi according to the construct of Chinese medicine.)".On the contrary,when it is burning hot,our body sweats.If the pathogenic factor is blocked inside,the Qi flowing in the body will make water stuck in a specific part of the body."No matter what therapy is used,the essence of treatment is to concentrate on the inner pathogeny"[4].

The theory of"Tihujiegai"created by Zhu Danxi is demonstrated below:"He who has difficulty urinating,there must be phlegm-fluid in his lung.The lung on the top is closed,which means the urinary bladder is blocked".In addition,Zhu elaborated in his book"Danxixinfa"(Danxi’s Mastery of Medicine,1481 C.E.Zhu Zhenheng.)on the treatment of urine:"For the purpose of tonifying Qi(Therapeutic language.It refers to the method of treating Qi deficiency syndrome with tonifying Qi medicine.),Renshen(Ginseng radix et Rhizoma),Huangqi(Astragali Radix)and Shengma(Cimicifuga Rhizomae)are taken to make phlegm-fluid vomited.To intensify blood deficiency,Siwu decoction or Qionggui decoction are both good choices.Erchen decoction is capable of clearing accumulated phlegm-fluid.All of the therapies above embody the"Tantu method".If the sputum gas occluded,Erchen decoction with Mutong(Akebiae Caulis)and Xiangfu(Cyperi Rhizoma)can be taken into consideration"[5].

The theory of"Tihujiegai method"

The Physiological characteristics and function of the lung.In the theory of the five elements,the lung represents gold,and the sharing aspect of Yang.Lung stores the soul,dominates the emotion of sorrow,governs in the skin,is in charge of the hair,opens at the nose,regulates nasal discharge,interrelates with the cold air and breeze of autumn,and stands in interior-exterior relationship with the large intestine[6].

Physiological properties of the lung make a difference to its functions.Like a cover,the lung locates at the highest part of the chest,covering the viscera,for which it can govern disseminating,cleansing and descending on the body surface,"Lingshu "records,Wei Qi(In the body surface of the Qi,mainly refers to the defense of the immune system and the elimination of foreign body endogenous function.)warms the muscles,spreads Wei Qi,adjusts "Couli tissues"(space between skin and muscle)opening and closing,protects the"evil"from external invasion[7].Lung is easily devastated.delicate and fragile,the lung has a low resistance to cold,heat,and deadly pathogens,and it is often easy to be infected by exogenous pathogenic factor Liu Yin(Etiology and pathology noun.Wind,cold,heat,dampness,dryness,fire six diseases.).Also,other viscus affects the lung readily.These factors in the lung accumulate,then lead to a fatal disease.The lung governs diffusion,purification and descending,which allows the Qi to move upward and downward,in and out the body.

The lung physiologically functions well.It governs Qi and performs respiration."Huangdi Neijing Suwen"(Yellow Emperor’s Inner Classic:Plain Questions;221 B.C.E.-220 C.E.)says that:"Qi originates from the lung"[8].It is recognized that the lung takes charge of Qi and controls breathing.The origination and flow of Qi in the body relies on the adjustion of the lung.As body breaths,fresh air is inhaled while turbid air is exhaled.The Qing Qi(Refers to the thin and subtle part of the essence of water grain,as opposed to the turbid air.)then combined with the Shuigu Zhiqi(The gas of water valley is valley gas,generally refers to dietary nutrition.)extract from spleen and stomach digestion in the lung and transferred into Zong Qi(assisting heart to promote blood circulation and sustaining respiratory function of lung),which influences the Qi in the body.As for the body fluid,the lung regulates the waterway.It is recorded that after food and water have entered the stomach,they are digested and transformed into food essence and then,transmitted upward to the spleen,which disperses the essence upward to the lung and the lung regulates water pathways downward to the urinary bladder.And by doing so,body fluid is finally disseminated to all parts of the body along all the meridians and collaterals.Moreover,the lung connecting all vessels,Above can be summed up as the lung plays a vital role in dominating and regulating Qi,Blood,and body fluid(Dietary subtle through the stomach,spleen,lung,San Jiao and other organs of the role of nutrition.Of,relating to,or constituting blood.).

The lung’ s physiological characteristics and function ensures that it is a breakthrough point in"Tihujiegai method".

Physiological explanation of "Tihujiegai method".Niu believes that the underlying natural scientific principle in the "Tihujiegai method" is whether the air pressure inside and outside is in balance[9].

Like a cup closed cup,when the pressure inside is lower than the outside,water in it can not be poured out.Similarly,the pores on the lung and skin are seen as cup caps,which would make triple energizers(i.e.,Sanjiao)(Chinese medicine noun.One of the six prefectures.Its main function is dredging waterways and presiding over gasification.)stuck.If this happens,harmful materials will retent in the body.But when the lid is opened,the inside and outside the air pressure is equal,the water can be poured out.As body sweats when treated with"Tihujiegai method",the pores open while air pressure inside and outside the human reached a perfect balance,which got Sanjiao back on track,improved urination,then accelerate edema regression.

The openness of Shangjiao(Shangjiao is one of the three and is the upper part of the Sanjiao.Generally refers to the chest above the diaphragm,including the heart,lungs and throat.)can urge vomiting rather than be limited to diffuse the lung.Also,opening Lower Jiao(lower part of body cavity housing the bladder,kidneys and bowels,etc.).is not limited to urinating,but also increases faeces and activates blood to run down freely.

Pathogenesis of "Tihujiegai method".The lung is closely related to other body systems.It is recorded in"Huangdi Neijing",that "the cell arteries and veins belong to the heart and run from the heart down through the diaphragm and the venation is in the uterus"[10].If the cellular vessels flow upward and backward,they will press the lung,thus affecting the decline of Heart Qi(H eart Qi generally refers to the functional activities of the heart,including the essence and Qi stored in the heart and the function of promoting blood.).The heart is in charge of the blood vessels,thus leading to non-menstruation.Women don't come to menstruation,which is the reason for the blocked pulse.Pulse belongs to the heart,moisture upward compression lung,make the heart Qi can downward and ventilation,and the heart is mainly controlled by blood,pulse is also dominated by the heart,the blood of the pulse also relies on the heart's blood to provide nutrition;if there is a lack of painstaking effort,there is nothing to give nutrition.If the deficiency of Heart Qi occurs,then there is no energy to supply blood and painstaking effort is insufficient to replenish and nourish blood,only the body has no practical effect.Therefore,it can be seen that the"Tihujiegai method"has its theoretical basis for the treatment of menorrhagia.

Medication characteristics and precautions of "Tihujiegai method" in the treatment of menstrual stop

Application of commonly used medicine of"Tihujiegai method"

Li Zhiqiang combined with his own experience,the commonly used drugs when applying the"Tihujiegai method"were mainly Mahuang(Herba Ephedrae),Fuping(Herba Lemnae)and Xiangru(Herba Elsholtziae),which could disperse Lung Qi and promote urination,thus achieving the purpose of"Tihujiegai method"[11].Other Chinese medicines such as Xingren(Semen Armeniaca),Jiegeng(Radix Platycodi),Sangye(Folium Mori),Ziyuan(Radix Asteris)and Pipaye(Folium Eriobotryae)can regulate Lung Qi and open the channels closed by meridians of the lung.The medicines such as Chaihu(Radix Bupleuri),Rhizoma Cimicifugaeand Gegeng(Radix Puerariae)have the effect of promoting.We can achieve the purpose of"Tihujiegai method"by improving the ventilation of the lung and opening the source to smooth flow.Xu Zhanshuai discovered through sorting out and studying the works of ancient physicians such as Zhu Danxi and Wang Kentang(1552-1638 A.D.)that using the Exploratory Method of Vomiting(It means to stimulate the patient's throat to cause vomiting)to treat the blockage below could also improve the ventilation ability of the lung[12].In addition,some scholars pointed out that the Sneezing Method(It means to stimulate the nasal cavity of a patient to sneeze continuously)can also achieve the purpose of"uncovering".

Commonly used drugs when applying"Tihujiegai method"

In the treatment of patients using the method of"Tihujiegai method",the commonly used prescriptions to enhance the Lung Qi to achieve the purpose of "removing the lid" were classic ancient prescriptions Mahuang decoction,Yuebi decoction,Sangju decoction,etc.Chen Ming believed that Mahuang decoction was the best therapy among the treatments[13].He used the Mahuang decoction to treat urinary obstruction,constipation,amenorrhea and male ejaculation disorder,and achieved good results.When patients are treated by the method of"Tihujiegai method",the commonly used prescription for ventilation of the lung to achieve the purpose of"uncovering" is classic ancient prescription Shengxian decoction.Huangqi is the principal drug of Shengxian decoction.It can invigorate Zong Qi and make it and blood sufficient,so the lung can recover spontaneously.

Clinical application

Bao Yanju once recorded a successful case of the treatment of amenorrhea by"Tihujiegai method"in his council[14].

Chen,female,35 years old.

First Visit:

Date:August 9,2011.

Main Appeal:Chief Complaint:The patient suffered amenorrhea for 3 months.3 months ago,the patient underwent pain in the back and loin,occasionally with aversion to wind.Since then,the patient had often felt pain in the back and loin and was averse to wind,as if she"wore nothing".There was no sweat.Amenorrhea gradually appeared,occasionally with lower abdomen discomfort.The patient saw a doctor in the department of gynecology of a hospital.No obvious organic lesion was seen in various examinations.She saw a doctor in the department of gynecology of a TCM hospital,and took TCM decoction for promoting blood circulation,dispersing blood stasis and regulating menstruation,but her period didn’t arrive.The current symptoms include:dry mouth in the morning,the period hasn’t arrived for 3 months,with a dull pain in the right side of lower abdomen,a pain in the back and loin,occasionally with aversion to wind.She often feels like"wearing nothing"at the loin.No sweat,appetite and sleep are passable,and the stool is slightly dry,once every two days.The tongue is red,with white coating,and the pulse is floating,smooth and powerful,which is especially prominent in Cun Pulse(one of three parts of Cunkou Pulse).

Traditional Chinese medicine diagnosis:Amenorrhea.

Syndrome Differentiation:Wind cold fettering the Exterior,together with blood embarrassment in Lower Jiao.

Treatment:To relieve Exterior syndrome and dispel cold,clear heat and remove blood stasis.The prescription selected is Gegeng decoction and Didang decoction,to increase or decrease according to the symptoms.

Prescription:Gegeng(Pueraria)15g,Mahuang(Raw Ephedra)10g,Guizhi(Cassia Twig)10g,Baishao(White Peony Root)10g,Zhigancao(Honey-fried Licorice Root)5g ,Fresh Shengjiang(Gingers)3,Dazao(Jujubes)3,Shuizhi(Leech)6g,Tubiechong(Ground Beetle)6g,Taoren(Peach Kernel)15g.5 doses,decocted in water,1 dose per day.Avoid tobacco and alcohol,spicy,irritating,fat,greasy,raw and cold food.Second Visit(August 12,2011):

The patient complained that her period arrived at the third dose(i.e.,the third day of medication).At that time,many black blood clots were discharged,accompanied by transient abdominal pain.The pain in the back and loin vanished as if it didn’t exist.The patient was advised to stick to the medication,continue to discharge more blood clots.After the second visit,she was administered public preparation,classic ancient prescription Guizhi Fuling pill,Danggui Shaoyao powder,Sini powder and Xiaoyao powder,etc.,conditioned for 1 month,and followed up for 1 year.The patient’s menstrual cycle and menstrual volume were basically normal and there was no obvious discomfort.

This case reflects the idea of"Tihujiegai method".Gegeng decoction was administered to ventilate lung,relieve exterior syndrome,to make the Qi in Shangjiao unobstructed,and the blood clots in Lower Jiao easily dispersed,that is,"to open the upper source and facilitate the lower circulation".The patient underwent amenorrhea after suffering from a cold.Administering the TCM decoction for promoting blood circulation,dispersing blood stasis and regulating menstruation alone didn’t take effect,suggesting that in the Shangjiao,the activities of Qi(It refers to the movements or functional activities of Qi)was stagnant and clogged,while in the Lower Jiao,the activities of Qi was obstructed,and the blood clots can hardly be dispersed.At the same time,it can be understood that this patient is suffering from a disease involving both the exterior and interior.If we simply treat the interior symptoms and ignore the exterior symptoms,it is often impossible to solve the interior symptoms.The cold-induced exterior excess syndrome described in the ancient Chinese medicine book"Shanghan Lun"(Treatise on Cold Pathogenic;Around AD 205)has nothing to do with the course of disease and season.As long as there are symptoms like"aversion to cold,no sweat,with or without fever,floating and tense pulse",the syndrome should be identified as cold-induced exterior excess syndrome.Mahuang decoction or Gegeng decoction can be used to dispel cold and relieve exterior syndrome.

Conclusion

As one of the most common types of gynecological disease,amenorrhea seriously endangers humans,especially women’s health.With the guidance of the concept of holism of TCM and"Quxiangbilei Method",the study demonstrates the possibility of using"Tihujiegai method"to treat amenorrhea,which provides a new idea for clinical treatment to make huge breakthroughs in TCM.