TCM Gynecology, Andrology & Pediatrics – Comprehensive Class Notes

Kidney & Pediatric Nocturnal Enuresis

  • Question: frequent night-time urination in children ➜ sign of unprocessed fear and/or Kidney Qi deficiency.
    • Fear injures Kidney (Water element); home instability aggravates.
  • Other contributing factors
    • Premature birth, constitutional weakness, nutrient insufficiency.
    • Treatment strategy
    • Tonify Kidney with pediatric herbal formulas.
    • Scalp / head acupuncture points to calm Shen + strengthen Kidney.
    • Environmental reassurance to reduce fear.

Women’s Health: Four Core Topics

  • Menstruation
  • Vaginal discharge (leukorrhea)
  • Pregnancy
  • Childbirth & postpartum

Normal Female Physiology

  • Governing numbers
    • Female growth cycles follow 7-year increments.
    • First menses (menarche) ≈ 2\times7 = 14 yrs.
    • Menopause ≈ 7\times7 = 49 yrs.
    • Male cycles follow 8-year increments.
  • Normal menstrual parameters
    • Cycle length: \approx28 days (acceptable 25-31).
    • Duration: 3{-}5 days (≤3 ➜ scanty; ≥6 ➜ prolonged).
    • Volume: 50{-}100\,\text{mL} total (≈3-4 pads on heaviest day).
    • Colour: bright red; consistency neither thin nor thick; no clots.
    • Physiologic amenorrhea during pregnancy & lactation
    • Rich Blood/Qi ➜ period may return earlier while breastfeeding.
    • Deficient women may have longer postpartum amenorrhea.

Key Questions at Every Female Visit

  • Date of Last Menstrual Period (LMP);
  • Cycle regularity & length;
  • Duration & flow;
  • Colour / texture / clots;
  • Pain (dysmenorrhea), PMS, mood;
  • Vaginal discharge amount, colour, odour;
  • Obstetric history; contraception.
  • Always confirm not pregnant before acupuncture or certain herbs (teratogenic points/herbs avoided).

Meaning of Cycle Variations

Early Period (≤21 d)

  • Causes: Qi deficiency (fails to hold Blood), Heat (excess Yang), Blood stasis (body purges stagnation early).
  • Differentiate
    • Qi-def: pale, fatigue.
    • Heat: dark-red, restless.
    • Stasis: clots, purplish tongue.

Late Period (≥35 d)

  • Blood deficiency (retarded endometrial shedding);
  • Cold (congeals, retards);
  • Qi stagnation (blocks Chong/Ren).

Irregular / Variable

  • Liver Qi stagnation (wind-like unpredictability);
  • Kidney deficiency (weaker endocrine regulation).

Flow Quantity Abnormalities

  • Heavy/Flooding (>100 mL or >5 pads/d):
    • Blood Heat (fire forces Blood out);
    • Qi deficiency (fails to secure vessels);
    • Blood stasis (body expels stagnation ➜ large clots).
  • Scanty (<50 mL or <3 days):
    • Blood/Essence deficiency;
    • Cold or stasis obstructing flow.
  • Continuous spotting outside menses = Beng Lou ➜ treat as above.

Duration Issues

  • Short (<3 d): Blood deficiency.
  • Long (>5 d): Blood or Qi deficiency (sluggish shedding) or Heat/stasis continuing bleed.

Colour & Consistency Clues

  • Pale/pink ➜ Blood deficiency.
  • Dark-red/thick ➜ Heat.
  • Purple/blue + cramps ➜ Cold congealing causing stasis.
  • Clots:
    • Small normal shedding.
    • Large, unchanged colour = true clots (stasis).
    • Large that float & pale = decidual tissue.

Dysmenorrhea Patterns

  • Pre-/1st day sharp stabbing ➜ Qi/Blood stasis, Cold.
    • Better with warmth ➜ Cold type.
  • Dull ache during/after ➜ Blood or Qi deficiency.
  • Squatting posture relieves Cold cramps (shortens muscle, warms).

Vaginal Discharge (Leukorrhea)

  • Physiologic: scant, clear, egg-white.
  • Pathologic when copious, coloured, odorous.
    • White, thin, odorless ➜ Cold-Damp / Spleen Yang deficiency.
    • Yellow, sticky, smelly ➜ Damp-Heat.
    • Red/bloody ➜ Heat injuring vessels.
  • Remember Damp sinks: genital tract is a major "drain".

Pregnancy-Related Syndromes

Morning Sickness (hyperemesis)

  • Etiology: Chong meridian rebellion + Stomach Qi counter-flow.
  • Aggravators: St Qi deficiency, Liver attacking St, Phlegm-Turbidity.
  • Tx: Harmonise Chong & St, descend Qi, calm Liver.

Threatened Miscarriage

  • Kidney deficiency (fails to nourish), Qi/Blood deficiency, Cold in Uterus, Trauma.
  • Secure Ren/Chong, tonify Kid, calm fetus.

Postpartum Conditions

Lochia

  • Normal sequence: red ➜ pink ➜ yellow/white over ≈2 weeks.
  • Abnormal
    • Dark-purple, clots ➜ Blood stasis.
    • Pale/watery ➜ Qi/Blood deficiency.
    • Yellow-green, foul, fever ➜ Infection (Heat-Toxin).
  • Tx accordingly; avoid cold antibiotics unless true toxin.

Postpartum Fever

  • Differential
    • Blood deficiency + Yin empty heat (low-grade);
    • Exterior invasion (sweated, caught cold);
    • Heat-Toxin endometritis (high fever, foul lochia: urgent).
  • Treat: protect Blood, release exterior gently, clear toxin if present.

Male Reproductive Disorders

  • Impotence
    • Deficiency: Kidney Yang, Kidney Jing.
    • Excess: Liver Qi stagnation, Damp-Heat in lower jiao, Blood stasis.
  • Persistent erection (priapism)
    • Excess Liver/Heart fire OR deficient Kidney Yin unable to anchor Yang.
  • Spermatorrhea
    • Heat in lower jiao, Damp-Heat, Heart-Kidney miscommunication, or Kidney Qi not securing Essence.
  • Premature ejaculation
    • Kidney Qi insecurity most common; also Yin deficiency heat, Liver hyperactivity.

Pediatrics Essentials

  • Organs delicate, Qi easily exhausted, Yang exuberant.
  • Rapid onset & change, prone to deficiency.
  • Key etiologies
    • Congenital (Kidney Jing insufficiency; pre-term birth).
    • Diet: over-feeding, improper weaning ➜ Food stagnation (major cause of pediatric illness); foul stool, abdominal distension, fever with mouth odour.
    • Fright/Fear ➜ Liver Wind, convulsions (green veins between brows).
    • External pathogens (cold/heat), but often combined with food stagnation.
  • Observe
    • Milestones: sitting, crawling, teething, speech ("five delays" & "five softs").
    • Finger venule inspection, limited pulse positions.

Diagnostics & Red Flags

  • Always rule out biomedical emergencies (e.g.
    hematuria may indicate tumour – order imaging).
  • Pulse nuances
    • Pre-menses: Chun (cubit) a bit tight = impending bleed (normal).
    • Floating right pulse in elderly ➜ exterior deficiency.
    • Left Chi weak/absent ➜ Kidney Yin deficiency.
  • Tongue
    • Tender, scant coat = Yin deficiency.
    • Thick greasy centre coat = Middle/Lower Jiao Damp.

Treatment Principles Repeated

  1. Clear excess/pathogen FIRST (heat, damp, stasis).
  2. Then tonify deficiency (Qi, Blood, Yin, Yang).
  3. Sequence matters: avoid trapping pathogen.
  4. Distal points open channel before local (esp. trauma/TBI cases).
  5. In pregnancy avoid blood-moving herbs & contraindicated points.

Case-Study Highlights (Class Discussion)

  • Case 1: 88 y F with epigastric fullness, bitter taste, irritability ➜ Shao-Yang disorder + Damp; treat GB/TW, harmonise, then tonify Kidney later.
  • Case 2: 80 y F hematuria x3 yrs, worse after exertion; Yin deficiency with Damp-Heat in Bladder, SP Qi weak; strategy: cool blood, nourish Yin, drain Damp, later tonify Qi.
  • Case 3: Severe poly-trauma & mild TBI; use distal GB, Yang-Qiao, Du points first to move blood & fluids before local head needling; monitor for phlegm misting.

Ethical / Practical Notes

  • TCM practitioners must base chief complaint on TCM-observable symptoms, NOT Western diagnostic labels (e.g.
    fatigue, not "anemia").
  • Cannot claim to treat biomedical diseases without dual licence.
  • Always ask pregnancy status before needling forbidden points.
  • Antibiotics are cold; postpartum over-use can create long-term Bone Damp-Cold (arthritis).

Numerical & Formula References

  • Female life cycle: 7n, menopause at 7\times7=49.
  • Male life cycle: 8n.
  • Normal menses volume 50{-}100\,\text{mL}; heavy >100\,\text{mL}.