A Sample from the Hundred Questions: Diarrhea with Stopped Menstrual Flow
The following is just a little sample from my current work on translating the “Hundred Questions on Gynecology” by Qi Zhongfu (1220 CE), the first part of which I published this spring as “Channeling the Moon.”
Enjoy (but keep in mind that this is just a draft of a work in progress that I am only sharing with my Imperial Mentees)….
What is the Reason for Disinhibition Below but With a Paradoxical Interruption in the Flow of the Menstrual Fluids?
Answer: When grain enters the stomach, the vessel pathways flow. When water enters the channels, their blood is completed. The stomach is the sea of water and grain.
In a situation where the intestines and stomach are weak, they get overwhelmed by the Qì of wind evil, coolness, and heat, so that they are unable to decompose food. First there is leakage, then this transforms into disinhibition below. Contraction of heat results in red coloration, vacuity cold in white coloration. Because of the internal depletion of grain Qì and diminishment of fluids, there is disinhibition below but then a paradoxical interruption in the flow of the menstrual fluids.
The classic states: When the disinhibition stops, menstruation must descend again on its own accord. For this reason, you should first treat the disinhibition.
Any reader who knows even a little bit of classical medical Chinese is bound to wonder why I have chosen the awkward term “disinhibition” instead of the much more common and elegant “diarrhea,” to translate the Chinese term 利 lì, or here sometimes in the compound 下利 xià lì “disinhibition below,” in this question. My reason for this somewhat awkward and unconventional translation is that I want to make sure that the reader understands the conundrum that is posed in this question by the paradoxical symptoms of diarrhea and interrupted menstruation. From a biomedical perspective, there may not be anything strange about this relationship, and most clinical practitioners are likewise familiar with loose bowels as a fairly common side effect of the menstrual period. It is only when we look at both of these processes, diarrhea and interrupted menstruation, as pathological manifestations of two similar forms of necessary and physiological downward movements of substances in the body, which in the first case is pathologically disinhibited but in the second case pathologically inhibited, that we understand the paradoxical nature of this question.
The stomach is the “sea of water and grains,” or in other words, the container that must hold solid and liquid foods and process them through decomposition. As the result of this process, grain Qì and fluids can be extracted from all ingested substances, to nourish the body and, among many other important processes, provide fuel and moisture for the formation of the blood. When the external evils of wind, cold, or heat impede this process so that the ingested substances leak or drain out instead of being processed and absorbed, blood lacks its basic building blocks and its flow is interrupted as a result.
The “classic” referred to in the last line most likely refers to the Màijīng, which contains the following passage in an almost literal quotation. The only addition is the explanation that stopped diarrhea means that the fluids have a chance to recover, as a result of which the menstrual flow returns on its own accord:
Question: Why is it that women fall ill with disinhibition below but with a paradoxical interruption in the flow of the menstrual fluids?
The teacher answered: You must only stop the disinhibition, and menstruation must descend again on its own accord. Do not consider this strange. The reason why disinhibition that is not stopped leads to interruption in [the flow of] blood is merely that disinhibition below collapses the fluids, and therefore the menstrual period is interrupted. When the disinhibition is stopped, the fluids recover, and the menstrual period must descend again on its own accord.
In terms of clinical treatment, the take-away here is that while traditional Chinese gynecology places great emphasis on restoring the free flow of menstrual fluid, it is always essential to diagnose carefully what the cause of the interruption is and to treat that cause, rather than just prescribing medicinal or manual treatments that restore the bleeding. In the present case, for example, prescribing drastic formulas to “break the blood” or “free the flow,” known in Chinese as 通經藥 tōngjīng yào (“medicinals to free the menstrual flow,” or emmenagogues in biomedical terminology), would be a tempting approach for a mediocre medical practitioner who only sees the stopped menstruation and misses the root condition of weakness in the digestive system compounded by the presence of external evils. Such a treatment might succeed in temporarily restoring the menses and thus perhaps even satisfy an unsuspecting patient, but at what price? These drastic medicinals would surely aggravate the weakness in the stomach and intestines and further deprive the body of the fluids that it needs for its healthy functioning. And without additional treatment of the root condition, the problem of the interrupted menses would only be bound to return in the following month. If such a patient had originally consulted the practitioner because of fertility issues, it is clear that a harsh treatment of forcibly restoring the menstrual flow would have the opposite long-term effect of only further weakening this patient’s digestive system and worsening the collapse of fluids.