Research On Treating Puerperal Diseases Based On Deficiency Or Excess

[Intentions]Traditional Chinese medicine has been proven efficacious for recuperation of puerperium and treatment of puerperal diseases. The article is intended to review the knowledge on puerperal physiology and pathology given by medical masters of different ancient dynasties and thus analyze the keypoints for treating puerperal diseases in light of deficiency or excess, expecting to give some help to those who are interest in this subject. There are obviously different points of views on the therapies of puerperal diseases based on deficiency or excess among ancient doctors. For example, Zhu Danxi suggested that qi and blood are the key factors for puerperal diseases, so tonifying qi and blood should be predominantly emphasized, and other therapies are just subsidiary; which has been embraced by many medical practitioners afterwards, whereas Zhang Zihe thought that puerperal diseases should not be regarded as deficiency, and he proposed to treat puerperal diseases based on theory of excess. Those had brought on disputes for dynasties about the therapeutics of puerperal diseases. Compared to the western medicine that has not provided good treatment for puerperal diseases such as inadequacy of lactation after childbirth, puerperal exhaustion, puerperal excessive sweating and puerperal persistent lochia and so on, traditional Chinese medicine has been proven greatly effective with more than two thousand years of accumulation of knowledge on puerperal convalesce and treatment, which has been the positive complement of the western medicine. The article is expected to give some contribution to the puerperal theoretical system and therapeutics and offer new clinical ideas , by way of further exploring the view of points on treating puerperal diseases in light of deficiency or excess through analyzing puerperal pathogenesis and formula held by ancient medical books.[Methods]The article is written mainly based on Corpus on Gynecology and Obstetrics (ed.: Ancient Traditional Chinese Medicine Books Publishing Company, Jan. 1999), which was compiled by Xiao Xun in about 1648, Kangxi 23rd year of Qing dynasty. The book, consisting of eight volumes in total, Vol.5 and 6 about department of puerperium thereinto, included more than 100 books ranging from The Yellow Emperor's Internal Classic to those written in Qin dynasty, especially many books about gynecology made in Yuan and Ming dynasties inclusive, involving doctrines of various schools of medicines of different periods, such as the classic-formula school, the school of contemporary prescriptions, the cold and cool medical school, purgationist school, the school of invigorating the spleen earth, and nourishing yin school. Guiding principles about diagnosis and treatment were given by collecting the analysis on pathogenesis and syndromes made by ancient medical practitioners. As far as writing style of the article is concerned, firstly, puerperal pathogenesis given by Essential Prescriptions of the Golden Chamber written in Han dynasty, Invaluable Prescriptions for Ready Reference written in Tang dynasty , Effective Prescriptions Corpus for Women's Diseases written in Song dynasty, Danxi's Mastery of Medicine written in Yuan dynasty, Medical Book for serving the Seniors written in Jin dynasty , which were mentioned in Vol.5 of Corpus on Gynecology and Obstetrics, is collected and analyzed in light of deficiency, excess and both combined, and the academic thoughts and corresponding formula found in the above-mentioned books are investigated from their origins, wherein those formula are classified into three groups based on their own functions as tonifying, purging and both combined. Those results are found to confirm each other about conclusions made by ancient medical practitioners. Then, the descriptions on puerperal diseases given by Chen Su'an Gynecology Complements, Treatise on Three Categories of Pathogenic Factors, Fu Qingzhu's Obstetrics and Gynecology, Principles on Treating Women' diseases, Ye's Gynecology, Regulations on Gynecology, Essentials of Gynecology and Obstetrics, Pregnancy and Child-birth Guideline , Experience on Gynecology, Experience on Medicine, Keypoints of Gynecology, and A Treatise on Blood Troubles and so on are collected in the article, as well as works made by doctors in recent times, and comparison between the former and the later is made. Literatures and works are obtained mainly through consulting books of TCM related to puerperal diseases collected by the Library of China Medicine University (Class No.: LCMU No.413 (Gynacology)) and internet databases as CQVIP and CNKI, complemented by consulting periodicals and journals by hand .[Results and Conclusion] Women after child-birth often suffer from puerperal diseases because of deficiency and stagnation of qi and blood. It can be seen from description of puerperal diseases made by ancient doctors of different periods that most of, but not all of those are attributed to deficiency, as given by Zhang Jingyue, who suggested that puerperal diseases would be classified into three groups based on deficiency, excess and both combined, and thought that tonifying qi and blood when a puerperal disease occurred was not always proper, it depended on its syndromes. In conclusion, puerperal diseases are attributed to deficiency of qi and blood initially, then, with development of those diseases, blood stasis, external wind and cold, and stagnation, especially blood stasis, which is emphasized by doctors of periods, who stressed that blood stasis should be cleared off prior to carry out tonifying qi and blood. Tonifying qi and blood is mainly used in the treatment of puerperal diseases, subsidiary with dispelling wind and cold or promoting digestion and relieving stasis, according to viewpoints of ancient doctors, while therapeutics based on diagnosis and overall analysis of one patient's disease, with the principle of superficiality first for acute-care and etio first for chronic-care , was stressed by doctors in recent times, who held that puerperal diseases were attributed to loss of blood and body fluid, and deficiency and stagnation of qi and blood.