TCM OBGYN Anatomy and Physiology - Acupuncture CEU Online · TCM OBGYN Anatomy and Physiology Integrave Women’s Health Program ... observaons in TCM focusing on outward signs and

TCM OBGYN Anatomy and Physiology

Integra(veWomen’sHealthProgram

TCM Perspective

•  TCMwasbuiltontheconceptof“theac(vi(esinsideofourbodywillreflectoutward”.Thisestablishedmanyclinicalobserva(onsinTCMfocusingonoutwardsignsandsymptoms.

• Duetotaboosinopeningandexaminingthehumanbody,anatomywasnotdevelopedaswellcomparedtowesternmedicine.

•  Eventhoughtherearemistakesaswellasgeneraliza(ons,manyoftheTCManatomicalandphysiologicalterminologiesares(llusedextensivelytoday.ItwouldbeimportantforthestudentsofTCMOBGYNtohaveacleargraspsoftheseterms.

Zi Gong ⼦子宫 – House of Fetus, Uterus

• NuZiBao女⼦子胞,Bao胞,ZiZang⼦子藏,ZiChu⼦子处,BaoZang胞藏,TaiZang胎藏,XueZang⾎血脏,BaoGong胞宫,etc.

•  ZiGong’smainfunc(onismostlyinreproduc(onincludingimplanta(on,gesta(on,labor,deliveryandtheprocessofmenstrua(on.

Zi Gong ⼦子宫 – House of Fetus, Uterus

•  Theproperfunc(oningofZiGongrequiresnormalac(vi(esof:

•  KidneyQi•  TianKui•  ChongRen

•  SinceZiGongcanbothstoreessenceanddischargemenses,itpossessesthefunc(onofbothZangandFu.ItisthereforeconsideredasExtraordinaryFuOrgan

KidneyQi肾⽓气

TianKui天葵

ChongRen冲任

Zi Gong and Kidney

• Bothhavedirectconnec(onviaJingLuoandreproduc(onfunc(on.

•  ZiGongconnectsdirectlywithKidneyviaBaoLuo.

• KidneystoresJinganditisthesourceforreproduc(on,growthanddevelopment.JingisthesourceforBlood.Bloodisthesourceformenstrua(onandreproduc(on.

KidneyZiGong BaoLuo

Zi Gong and Liver

•  LiverMeridianandRenChannelcrossesatQuGu(RN2)曲骨Point.

•  LiverMeridianandDuChannelCrossesatvertexofthehead.

• BothRenandDuChannelsoriginatesatZiGong,thereforeLiverMeridianhasanindirectconnec(ontotheUterusviaRenandDuChannels.

Zi Gong and Liver

•  LiverstoresBlood,mastersoverpatencyflow,regulatesSeaofBlood.Ithasstronginfluencesovertheregula(onofovula(on,menstrua(onandfer(lity.

Zi Gong and Spleen

•  SpleenMeridianandRenChannelcrossesatZhongJi(RN3)中极,aswellassca_eringandconnec(ngatthetongue.SpleenMeridianthereforehasanindirectconnec(onwithZiGong.

•  SpleengovernsBlood,mastersovertransforma(on,thesourceofQiandBlood.Itdirectlyregulatesmenstrua(onandmaterialnourishmenttothefetus.

Zi Gong and Stomach

•  StomachMeridianandRenChannelcrossesatChengJiang(RN24)承浆.

• ChongChanneliscomposedfrompartsofStomachandKidneyMeridians.ChongandRenChannelsbothoriginatefromZiGong.Thereforethereisadirectconnec(onbetweentheStomachMeridianandZiGong.

Zi Gong and Stomach •  StomachandSpleenareconnectedZangandFu.ItisthesourceofbothQiandBlood.

•  Stomachisthe”SeaofWaterandGrains”.Itmastersoverdiges(on.ItisaFuorganwithabundanceofQiandBlood.

• WhenthisQiandBloodisabundant,theBloodinChongChannelwillbeabundant,guaranteeingtheproperfunc(oningofZiGong.

Zi Gong and Heart

•  ZiGongandtheHearthasadirectconnec(onviaBaoMaiasstatedintheNeiJingSuWen.

• Heartgovernsspirit,clarity,andbloodvessels.TheHeartdirectlyinfluencestheproperfunc(oningoftheZiGong.

Zi Gong and Lung

•  ZiGongandLunghaveindirectconnec(ons.LungMeridianentersthelungwhilethesmallercollateralsspreadintothethroat.ThisiswherethecollateralsoftheLungMeridianmeetstheRenChannel.

• RenChanneloriginatesfromZiGong.Lungmastersoverthedistribu(onandtransporta(onoffluids,JingandBlood.

Bao Mai and Bao Luo 胞脉，胞络 • BaoMaiandBaoLuoarechannelsandcollateralsthatconnecttotheZiGong.Theirmainfunc(onistoprovidenourishmentofJing,Qi,andBloodtotheZiGongtoensureproperfunc(oninginmenstrua(onandreproduc(veprocess.

• HuangDiSuWen,“Whenthereiscessa(onofmenstrua(on,itisfrequentlyduetoblockageinBaoMai.BaoMaiisgovernedbytheHeartandhasdirectconnec(onfromtheHearttoZiGong.IfthereisQiblockageintheLung,thiscanaffecttheHeartcausingblockageintheBaoMaiinterferewiththeproperfunc(oningofmenstrua(on.”

•  Therealityisanysitua(onwherethereischangesinbloodflowinthebodycanallhavethepoten(altoaffectthemenstrua(on.

Bao Mai and Bao Luo 胞脉，胞络 • HuangDiSuWen,“BaoLuoconnectsdirectlytotheKidneys.”•  SinceKidneyinTCMdenotesthereproduc(vesystem,BaoLuoisthereforetheconnec(onbetweenallotherreproduc(vesystemstoZiGong.

• Chong,Ren,DuChannelsallhaveorigina(onfromtheZiGongandareconsideredascomponentsofBaoMaiandBaoLuo.

Penetrating Channel Chong Mai 冲脉 TheSeaofTwelveMeridians

TheSeaofBlood

Penetrating Channel (PC) - Origination Chong Mai 冲脉 • PCmainlyrunslongitudinallytoashighastheheadandaslowasthefoot.Ithasdirectandindirectconnec(onstoalltwelvemeridians.Itrunsthroughouttheen(rebodyandgovernstheflowandnourishesQiandBloodtoalltwelvemainmeridians.Therefore,itisfrequentlycalled”TheSeaofTwelveMeridians”.

•  TheChannelhasknowntohave3dis(nctorigina(onpointsorareas:1.  ItbeginsjustbelowtheKidneysalongwithcollateralsfromtheKidney

Meridians.NourishedbytheessencefromtheKidneys.2.  Itbeginsinthegreaterpelvisregion.3.  ItbeginsattheZiGongExtraordinaryFuOrgan.Itregulatesmenstrual

bloodflow.ThereforeitisalsofrequentlycalledtheSeaofBlood.ItalsomeetsQiChongPoint(ST30)⽓气冲穴.NourishedbytheQiandBloodfromtheStomach.

Penetrating Channel (PC) – 1. The Main Branch Chong Mai 冲脉 •  Itscourseismorecomplicatedandencompassesfivebranches.

•  TheMainBranchoriginatesfromZiGong⼦子宫,trackingtheRenChanneldownwardtosurfaceatperineumHuiYin 会阴point(RN1).ItthentravelsbilaterallytomeettheStomachmeridianatQiGong ⽓气冲point(ST30),5cunbelowumbilicusand2cunlateraltomidsagi_alline.ItrunsupwardtrackingtheKidneyChannelsmee(ngHenggui 横骨(K11),Dahe ⼤大赫(K12),Qixue ⽓气穴(K13),Siman 四满(K14),Zhongzhu 中注(K15)pointsandconvergeatYinJiao阴交point(RN7).

Penetrating Channel (PC) – 1. The Main Branch Chong Mai 冲脉 •  Itscourseismorecomplicatedandencompassesfivebranches.

•  FromYinJiao阴交point(RN7),itrunsbilateralagaintrackingKidneymeridianmee(ngHuangShu肓兪(KI16),ShangQu商曲(KI17),ShiGuan ⽯石关(KI17),YinDu 阴都(KI19),TongGu 通⾕谷(KI20),YouMen 幽⻔门(KI21)points.Itthenmovingupwardtodisperseatthechest.

Penetrating Channel (PC) – 2. The Extended Upper Branch of Chong Mai 冲脉 •  TheExtendedUpperBranchcon(nuesfromthechestregionrunningupwardthroughthethroatandcirclearoundthelipsandterminatesatupperthroatandsinusregioncalledGangSang頏颡inChinese.ThispermeatesintotheYangmeridiansoftheface-headandnourishthemwithYinandBlood.

Penetrating Channel (PC) – 3. The Posterior Branch of Chong Mai 冲脉 •  ThePosteriorBranchoriginatesfromthepelvisrunningbackwardtothespine.IttracksthespineorDuChannelupward,mostlikelytotheendofDuchannel.(Thereisnoterminaldescrip(oninallclassics).

Penetrating Channel (PC) 4-5. The Lower Branches of Chong Mai 冲脉 •  TheLowerBranchesoriginatesjustbelowtheKidneys,mee(ngatQiChongpoint(ST30)andrunsdownwardalongthemedialaspectsofthethighsintothepoplitealfossa,itthentransversesthemedialmarginofthe(biadownwardtotheposterioraspectofmedialmalleolusandterminatesatthebo_omofthefoot.

•  AnotherbranchoffshootsfromthelowermedialborderofthemedialmalleolusandtravelsintothebigtoetomeetwithFootJueYinLivermeridian.

Penetrating Channel (PC) 4-5. The Lower Branches of Chong Mai 冲脉 •  ThesetwolowerbranchespermeateandwarmtheYinmeridiansoftheFoot–TheLiver,Spleen,andKidneyMeridians.

Penetrating Channel (PC) – The Function of Chong Mai 冲脉 • Chongmeansimportantorcri(cal.Itisa“cri(cal”channelbecauseitgovernsQiandBloodflowtoallregulartwelvemeridians.Thereforeitisfrequentlycalled“TheSeaofTwelveMeridians”or“SeaofBlood–XueHai”.

• Penetra(ngChannelconnectsdirectlywithbothRenandDuChannels,furtherregulatesallYinBloodandYangQiofthebody.

• Penetra(ngChannelconnectswithKidneyandStomachmeridianswhichsupplyJingandBloodtoZiGongtoallowregularovula(onandmenstrua(onprocesses.

•  ThereforewhenChongMaiisweakened,menstrua(onends.

Conception Channel Ren Mai 任脉 TheSeaofYinMeridians

Conception Channel Ren Mai 任脉 • Concep(onChannelencompassesthreebranches.

•  TheMainBranchoriginatesfromZiGong,movingdownwardtosurfaceatHuiYin会阴(RN1),movingupwardtrackingthemidsagi_alline,throughthethroat,windsaroundthemouthtoterminateattheeyes

Conception Channel Ren Mai 任脉 •  TheSecondBranch,justlikethePosteriorBranchoftheChongChannel,itoriginatesfromZiGong,movingbackwardtothespine,thenmovingupwardinsidethespinalcordtrackingtheDuchanneltermina(ngaroundthemouthregion.

Conception Channel Ren Mai 任脉 •  TheThirdBranchisaLuochanneloftheRenChannelwhichbeginsatXiphoidProcessspreadingdownwardintotheepigastricregion.

Conception Channel – The Function of Ren Mai 任脉 •  Renmeanssuppor(ngandnourishing.ThechanneltraversesthroughtheYinpor(onofthebody.ItgovernsallYinchannelsandfrequentlycalled“TheSeaofYinChannels”.

•  RenChannelbeginsinZiGong,thereforeitgovernsovergesta(on.

• Mostcondi(onsofRenChannelincludebutnotlimitedtohernia,vaginalinfec(ons,irregularmenstrua(ons,infer(lity,dysuria,incon(nence,condi(onsofthegenitalias.

Governing Channel Du Mai 督脉 •  Itoriginatesatthepelvis,descendsdownwardtothegenitals.Inwoman,itdescendsdowntotheopeningofthevaginaandurethra.Trackingbackwardthroughtheperineumenteringthespine,itrisesuptothevertexofthehead.Itthendescendsdownwardthroughthefrontofthefaceonthemidlineandterminatesatthe(pofthenoseandphiltrum.

Governing Channel Du Mai 督脉 • AnotherbrancharisefromthepelvisbasicallytracktheRenChannelupward,goingaroundthelips,andendinginthemiddleoftheeyes.

•  Thischannelhasverystrongconnec(onwiththeRenChannelandmostofotherregularMeridians.

•  ItgovernstheQiflowofallYangmeridiansofthebody.

Governing Channel Du Mai 督脉 •  ItisfrequentlycalledtheSeaofYangMeridians.Itregulatesandhaveamorein(materela(onshipwithallregularYangmeridians.

•  Ithasstrongregula(ngfunc(onforthebrain,andbonemarrow.

Belt Channel Dai Mai 带脉 •  BeltChannelrunshorizontallycrossingthetopofthehipbonestotheabdomen.ItoriginatesatZhangMenLR13 章⻔门andmovesforwardtomeetDaiMaiGB26带脉 ,WeiDaoGB28维道,WuShu五枢 GB27andterminatesatumbilicus.

•  AnotherbranchoftheBeltChannelrunsfromDaiMaiGB26backwardandupwardtomeetShenShuBL23肾兪andterminatesatL2spine.

Belt Channel Dai Mai 带脉 •  Itsmainfunc(onistocontrolandregularalllongitudinalchannelsofthebody.

•  Thecondi(onsofDaiMaicanincludebutnotlimitedtoabdominalpain,lumbago,vaginalinfec(ons,lowerlimbatrophies.

Chong, Ren, Du, Dai In General •  Thesefourextraordinarychannelshavedirectconnec(onstoeachother.

•  TheyaffecteachotherstronglyespeciallyinOBGYNcondi(ons.

•  Theyregulatemanyofthebody’sfunc(onsinwoman.Theyspecificallyregulateoverreproduc(on,gesta(on,andlacta(on.

冲 仁

督 带

Chong, Ren, Du, Dai Specifically •  ChongMaiprovidesQiandBloodnourishmenttothereproduc(veorgans.Itregulatestheproperfunc(oningofovariesanduterus.

•  RenMaidominatesovergesta(on.Itregulatesandisresponsibleforpropergrowthanddevelopmentofthefetus.

•  DaiMaigovernsovertheflowofQiandBloodtothereproduc(veorgans.Italsoregulatesoverfluidmetabolismandstrengthenimmunityandfightsinfec(ons

•  DuMaigovernsMingMen(GateofLife)orYangfunc(on.ItregulateshormonesandtheendocrinesystemandtheHypothalamus-Pituitary-Ovarian(HPO)Axis.

冲 仁

督 带

Other Terminologies

•  ZiMen⼦子⻔门–FetalGate–theopeningtotheuterus–thecervix

•  YinDao阴道–YinWay–wheretheYinfluids,menstrua(on,wherethespermtravelsandfetusbeenborn–thevagina

•  ZiChang⼦子肠–FetalIntes(nes–ZiGongandthevaginacombined

•  YinMen阴⻔门orChanMen产⻔门–vaginalopening

•  YinHu阴户–femaleexternalgenitalia

•  YinQi阴器–externalgenitalias

TCM OBGYN Physiology ZangFu

Uniqueness of TCM OBGYN

• DominatedbyXue,leadbyQi.• NourishbyYin,andfor(fiedbyYang.• Uniquephysiologicalprocessesofmenstrua(on,pregnancy,labor,andbreasneeding.

• Monthlymenstrualcyclescorrespondingtotherisesandfallsofthe(deorYin-Yang

Kidney

• Kidneystoresessence(Jing),JingtransformstoQi.JingandQiarethesourceYangandYinrespec(vely.ItisalsocommonlynamedasKidneyYinandKidneyYang.ItisthesourceofYinandYangofthebody.

• KidneyisthesourceofTianKui.Itisthefounda(onforChongRenChannels,dominatesoverreproduc(on,bodyfluid,connectswithbrain.LiverandKidneysharesthesameessencesource.SpleenandKidneynourisheachother,HeartandKidneysupporteachother,LungandKidneygovernstogethertheQiflowinthechannels,.ThereforetheKidneyisthesourceofjing,Qi,andBlood.Itisalsothefounda(onforgrowth,development,andreproduc(on.

Kidney

•  TianKuicanonlybesecretedwhenthereisabundanceofKidneyQiandthebalancebetweenKidneyYinandYang.

• OnlywhenthereisanabundanceofKidneyQicantheChongRenchannelscanbeproperlyfilledandfunc(onal.WhenChongRenisabundant,ovula(onandmenstrua(oncanoccurregularly.

•  ThereforeKidneyZangisthemostimportantorganinTCMOBGYN.

Liver

•  Liverstoresbloodandmastersoverpatencyflow.Liverbloodnotonlynourishesthebody,italsofillstheSeaofBlood(XueHai)whereSeaofBloodprovidesthefounda(onformenstrua(on.

•  Liverchannelrunsaroundexternalgenitalia,stomach,pelvic,breast,vertexofheadandprovidesnourishmentandregula(ontogrowthofexternalgenitaliahair,menstrua(on,breastmilkproduc(on.

Spleen and Stomach

•  SpleenisthesourceofQiandBlood,transformingfoodessences.Theproperfunc(oningofovula(on,menstrua(on,gesta(on,lacta(onalldependsonnormalfunc(oningofSpleen.

•  StomachisaFuorganwithabundanceofQiandBlood,StomachChannelandChongChannelmeetsinthepelviswhereStomachprovidestheBloodtotheChongChannel.StomachChannelalsoprovidesdirectnourishmenttothebreastthereforetheproduc(onofbreastmilkisdirectlyrelatedtothestrengthofStomach.

• BothOvula(on-Menstrua(onandLacta(onprocessesrequirethenourishmentfromSpleenandStomach

Heart

• Heartmastersoverblood,hasdirectconnec(ontoBaoMaiandtoZiGong.ItensuresthatBaoMaiisfunc(oningproperlywhichaffectstheproperovula(onandmenstrua(on.

• HeartdominatesoverSpirit(Shen)andconnectswithKidney.AlongwithKidney,theyregulatebothspiritandessenceofthebody.

Lung

•  LungmastersoverQi,overthetransforma(on,transporta(onofQithroughoutthebody.Lungalsodominatesover“waterways”ofthebody,makingsurefluidsarewelldistributedthroughoutthebody.Lungalsohasthefunc(onofensuringQiflowinallchannelsandcollateralsareproper.TheproperflowandabundanceofQiaffectsfemalephysiologicalfunc(onsofmenstrua(on,gesta(on,lacta(on.

Women’s Reproductive Physiology

•  ThephysiologyofwomencanbetracedasfarbackastheHuangDiNeiJing(bookoftheYellowEmperor)wri_enabout5000yearsago,whichdiscussesthedevelopment,growth,anddeclineoffemale-lifeinsevenyearcycles(formenineightyearcycles).

•  SuWenChapter1states:HuangDiasked:Whenonegrowsold,onecannothavechildren.Isitbecauseone’senergyhasalreadybeenexhaustedorduetoanaturalphenomenon?

7 x 1 = 7

•  7years• QiBoreplied:Foragirl,herKidneyEnergy(Qi)becomesprosperouswhensheisseven,asKidneysdeterminesthecondi(onofthebones,andteetharethesurplusofbone,hermilkteethfalloffandthepermanentteethemergewhenherKidneyEnergyisprosperous;ashairistheextensionofBloodandtheBloodistransformedfromKidneyEssence(Jing),herhairwillgrowwhentheKidneyisprosperous.

7 x 2 = 14

•  14years.• HerTianGui天癸 appearsattheageoffourteen(2x7).Atthis(meherRenMaibeginstoputthrough,andherChongMaibecomesprosperousandhermenstrua(onbeginstoappear.Asallherphysiologicalcondi(onsbeingmature,shecanbepregnantandbearachild.

7 x 3 = 21

•  21years.•  ThegrowthofKidneyEnergyreachesthenormalstatusofanadultbytheageoftwentyone(3x7).Herwisdomteethhavegrownupbythisstage,andherteetharecompletelydeveloped.

7 x 4 = 28

•  28years.• Attwenty-eight(4x7)herVitalEnergyandBloodbecomesubstan(al,herextremi(esbecomestrong,thedevelopmentof(ssuesandhairofherwholebodyareflourishing.Inthisstageherbodyisinthestrongestcondi(on.

7 x 5 = 35

•  35years.• Arerthirty-five(5x7)thephysiqueofwomenturnsgraduallyfromprosperitytodecline.So,bythis(me,herYangmingchannelturnstodebility,herfacebecomeswitheredandherhairbeginstofall.

7 x 6 = 42

•  42years.• Bytheageofforty-two(6x7)herthreeYangchannels(Taiyang,Yangming,Shaoyang)allbegintodecline.Herfacecomplexionbecomeswane,andherhairbeginstoturnwhite.

Fecundity Rate by Age

7 x 7 = 49

•  49years.• Arertheageofforty-nine(7x7),herRenandChongchannelsarebothdeclining,hermenstrua(onceasesasherTianGuibeingexhausted.Herphysiqueturnoldandfeebleandshecannolongerconceive.

General Physiology of Women in TCM

• Xue(Blood)isthebasisofwomen,Qiofmen.• Duringthereproduc(veyearsthereisasuperabundanceofQiandXue.Atthesame(meXueismonthlyreleasedviamenstrua(on.

• Orduringapossiblepregnancyitnourishesthefetusandarerbirthit’sbeingtransformedintobreastmilk.

• ButXueisslowlydecreasingwith(me.SinceYangming(BrightYang)isabundantwithQiandXue,itwillbethefirsttoexhibitsignsofdecline

•  slowlystar(ngatage35,theonsetofpre-menopause.• Age49averagemenopausearrives.