Leukorrhea


Introduction

Leucorrhoea is a disease characterized by persistent excessive mucous vaginal discharge.  It covers infections in the reproductive organs such as vaginitis, cervicitis, endometritis and anexitis, etc.

The chief causative factors of leucorrhoea are deficiency of the spleen qi and stagnation of the liver qi, downward infusion of damp heat or kidney qi deficiency, leading to dysfunctions of the Chong, Ren and Dai Meridians, and leucorrhoea. The ancient doctors classified the condition by its color into white, yellow, red, red - white and multicolored leucorrhoea, among which white and yellow leukorrhagia are commonly seen in clinic.

Diagnosis

Normally there is small, unnoticeable amounts of discharge if the KI is strong & the SP is transforming & transporting properly. Discharge is also regulated by Ren & Dai. Regular discharge has no color (clear white), no odor, & is slightly sticky. around ovulation & late Luteal phase there is slightly more, also during pregnancy.

Discharge is abnormal if the amount is ? & the density, color & odor is noticeable.

  • White color, may be large amount, thin or thick, cottage cheese or frothy.
  • Yellow color, amount may be small or large, strong odor, thin or thick (ulcers or inflammation).
  • Red color, pale red, large or small amount, thick or thin, pain/inflamed in the vaginal area, has odor.
  • White & Red, thick sticky, with odor (cervical problems, cancer, cysts etc).
  • Pus, large amount, strong odor, may contain blood.
  • Mixed pus/white/red/yellow or colors appear separately.

 

Etiology and Pathogenesis

  1. Deficiency in the spleen: Improper diet and overstrain hinder the spleen qi from transforming and transporting nutrient particles, which accumulate in the lower jiao and turn to damp and finally leucorrhoea appears.
    SP Qi ↓ - over work, poor diet, liver attack SP → lose T & T of fluids → stagnation & accumulation → turbid dampness → retained in low Jiao → injures Ren & Dai (consolidate & bind) = discharge. (KI Qi or Yang may also impair SP)
  2. Deficiency in the kidney: Constant deficiency of kidney qi, grand multipara, dysfunctions of the Dai and Ren Meridians lead to leucorrhoea.
    KI Yang ↓ - age, sickness, congenital weakness → ↓ Ming Men fire → KI cannot steam & transform dampness → damp/cold accumulates → retained in low Jiao → KI Qi cannot control the gates = discharge.
    KI Yin ↓ - aging, chronic illness, LR ↓ → ↓ Fire impairs Ren & Dai = discharge. When KI Yin ↓ it is easy to be invaded by damp/heat in low Jiao → impairs Ren & Dai = discharge.
  3. Damp heat: The presence of excessive damp due to deficiency in the spleen, changes into heat. Prolonged stagnated liver qi may transform into heat and amalgamate with the damp. The downward infusion of damp heat turns out to be leucorrhoea.
    1. SP ↓? dampness → stagnation turns into heat.
    2. LR attack SP then dampness & Qi stagnation turn into heat ? damp/heat = discharge.
    3. greasy sweet spicy foods & alcohol turn into damp/heat.
  4. External causes – live in Damp environment, summer-heat with damp, lower limb infection is damp/heat which can follow the meridians upward into the low Jiao.
  5. Ø Heat & Damp – poor surgery, certain suppositories may irritate, tampons, sex toys, poor hygiene all can give rise to Ø damp/heat = discharge.

 

Differentiation

 

a) Spleen deficiency:

Main manifestations: Profuse thick, white or light yellow vaginal discharge without smell, pale or sallow complexion, lassitude, poor appetite and loose stools, edema in the lower limbs, pale tongue with white sticky coating, slow weak pulse.

Analysis: On account of deficiency in the spleen, the downward infusion of water and damp form leucorrhoea. With deficiency in the spleen, the sapped yang qi in the middle jiao gives rise to poor appetite, loose stools and edema in the lower limbs, lusterless and pale or sallow complexion, cold extremities and lassitude. Pale tongue with white sticky coating and slow pulse are signs of deficiency in the spleen.

b) Deficiency in the kidney:

Main manifestations: Profuse and continuous discharge of thin and transparent whites, severe soreness of the low back, cold sensation in the lower abdomen, frequent and excessive urine, loose stools, pale tongue with thin coating, and deep pulse.

Analysis: Deficient kidney yang causes Dai and Ren Meridians to slacken its restriction of essence, resulting in the continuous vaginal discharge. The dimmed fire in the Mingmen is too weak to warm up the bladder and spleen and brings on frequent urine in large volume and loose stools. Sore low back is due to a weakened kidney that is situated here. When the weak kidney yang fails to keep the uterus warm, there appears a cold sensation in the lower abdomen. Pale tongue with thin white coating and deep pulse are signs of deficiency of the kidney yang.

c) Damp heat:

Main manifestations: Sticky, viscous and stinking yellow leucorrhoea: in large quantity, itching in the vulva, dry stool, scanty and yellow urine, soft and rapid pulse, sticky yellow coating, or leucorrhoea: in reddish yellow color, bitter taste in the mouth, dry throat, irritability with a feverish sensation, palpitation, insomnia, yellow coating, string - taut and rapid pulse.

Analysis: The downgoing damp and heat hurt the Ren and Dai Meridians. This is the cause of leukorrhagia. The pathogenic heat amalgamated with damp gives rise to the yellow color, viscosity and stench of the whites and the itching in the vulva. The internal accumulation of the pathogenic damp is the cause of dry stools and scanty yellow urine. Soft rapid pulse and yellow sticky tongue coating are signs of damp and heat. There appear irritability, bitter taste in the mouth and dry throat, when the pathogenic heat is transformed from the stagnated liver qi. Heat in the blood causes reddish leucorrhoea. When heat disturbs the mind there present irritability, feverish sensation, palpitation and insomnia. The string - taut rapid pulse and yellow coating imply accumulated heat in the Liver Meridian.

 

Differentiation and Treatment Overview

 

Principle of Treatment – eliminate damp, strengthen SP (do not use dry hot herbs).

  1. SP Qi ↓ - white, large amount, thick, sticky, no odor
    1. Plus – SP ↓ symptoms T-pale
    2. P/T – strengthen & ascend SP Yang Qi to transform dampness
    3. Rx – Wan Dai Tang
  2. KI Yang ↓ - large amount, egg white (clear sticky), or watery
    1. Plus – KI Yang ↓ symptoms T-pale P-weak
    2. P/T – nourish KI Yang – consolidate essence
    3. Rx – Jin Suo Gu Jing Wan
  3. KI Yin ↓ - may be pink-red with white, thick, dry burning around vagina
    1. Plus – KI Yin ↓ symptoms T-red, no coat P-thin rapid
    2. P/T – nourish KI Yin – clear ? heat
    3. Rx – Zhi Bai Di Huang Wan.
      With external Damp/Heat add Yi Ren, Cang Zhu, Bei Xie minus Shan Zhu Yu
  4. Damp/Heat – large amount, yellow (with pink-red), thick, strong odor, side abdominal pain, dislike touch, may have burning vagina
    1. Plus – damp/heat Lin, constipation, loose stoo T – red, damp coat P- slippery rapid
    2. P/T – clear heat induce diuresis
    3. Rx – Long Dan Xie Gan Tang
  5. Ø Damp/Heat – large amount, pus, green/yellow, strong odor, may be blood, burning vagina, cottage cheese, severe itchy, acute with fever, low abdominal pain, thirst with no desire to drink, scanty yellow urine, dry stools.
    1. Plus – red, yellow-greasy P- slippery rapid
    2. P/T – clear heat, detox, eliminate damp
    3. Rx – Bei Xie Fen Qing Yin + clear heat detox herbs (hong tong, bai jiang cao, ku shen, pu gong ying), → [anti-inflammatory for low Jiao]
      Also for external wash.

 

 

Treatment

 

a) Spleen deficiency:

Method: Main points are selected from the Ren, Foot - Taiyin and Yangming Meridians. Acupuncture with the reinforcing method and moxibustion is used to build up the spleen and remove damp, regulate Ren Meridian and stabilize Dai Meridian.

Prescription:

  • [BL26 - RN6 - BL30 - SP9 - ST36].
  • [RN6 - BL30 - GB26 - BL20 - SP6] (Spleen deficiency with damp)

Modifications

  • poor digestion: RN12, ST25
  • low limb edema: SP9, ST36

Explanation: BL26, an intersecting point of the Dai and Foot - Shaoyang Meridians, stabilizes the Dai Meridian and is a cure for leukorrhagia. RN6 regulates qi, resolves damp, adjusts the Ren Meridian and stabilizes the Dai Meridian. BL30 is selected as an adjacent point to check leukorrhagia. SP9 and ST36, major points in this prescription, are paired to build up the spleen and remove damp.

 

b) Kidney deficiency:

Method: Select points mainly from the Ren and Foot - Shaoyin Meridians. Acupuncture with the reinforcing method and moxibustion are used to promote yang qi, tonify the kidney and stabilize the Ren and Dai Meridians.

Acupuncture

  • [BL23 - RN4 - KI12 - BL26 - KI7]
  • [BL23 - KI3 - SP6 - BL32 - GB26]                  (KI yin deficiency)
  • [BL23 - DU4 - RN4 - GB26 - BL32 - ST36]      (KI yang deficiency)
  • Dizziness, palpitation, insomnia: LR3, HT7     (KI yin deficiency)
  • Abdominal cold pain: moxa zi gong, RN3        (KI yang deficiency)

Explanation: BL23, RN4, KI12 and BL26, a combination of adjacent and distal points, are applied together to promote yang qi and tonify the kidney so as to restore its storing function, and stabilize the Ren and Dai Meridians, and finally check leukorrhagia. BL26 is selected aiming at leukorrhagia. [BL32 - GB26] stops discharges.

 

c) Damp heat:

Method: Mainly select points from the Ren and Foot - Taiyin Meridians. Acupuncture with the reducing method is employed to clear heat, remove damp, adjust the Ren Meridian and stabilize the Dai Meridian.

Prescription:

  • [RN3 - BL32 - SP6 - LR3].
  • [RN3 - BL32 - GB26 - SP9]

Supplementary points:

  • Itching in the vulva: LR5, GB 43.
  • Reddish leucorrhoea: SP10.
  • Excessive heat: LI11.

Explanation: RN3 is the Front-Mu Point of the bladder. It works to clear damp heat of the lower jiao when it is applied with the reducing method. BL32 clears heat and resolves damp to check leukorrhagia. SP6, an intersecting point of the three yin meridians of foot tonifies the spleen, removes dampa nd reduces the fire. The above points grouped together serve the purpose of clearing heat, resolving damp, adjusting the Ren Meridian and stabilizing the Dai Meridian. LR5 cures the itching in the vulva by removing damp and heat away from the Liver Meridian. SP10 eliminates reddish leucorrhoea: by clearing heat from blood. In case of excessive heat, LI11 is used to clear the heat. The right usage of the auxiliary point can enhance the therapeutic results.

 

Western Medicine

  1. Trichomonas vaginalis (protozoa)- frothy grey bubble – white discharge with odor, itchy, red dots on area.
  2. Candida Albicans (fungi)- cottage cheese, sticky, very itchy, white layer covers area.
  3. Senior Vaginitis – old people, burning in area, yellow, small amount, mixed with pink-red, ulcers, tender skin area.
  4. Cervical Erosion – pus, yellow or white, erosion around cervical area, may have low back ache.
  5. Pelvic Inflammation – pus, pink/white, low abdominal pulling pain, exam gives pain, inflamed Uterus, Ovaries.
  6. Cancer – cervical, bloody watery discharge with odor, easy to bleed, irregular bleeding. cyst – round moveable / cancer – fixed cauliflower
  7. Gonorrhea Vaginitis – STD bacteria (gonococcus neiseria), pus, UTI (Lin)
  8. Submuscularis Uterine Fibroids – watery discharge, longer heavy period, blood ? symptoms.
  9. Non-specific vaginitis – local area injury, yellow with odor.

 

Alternative Treatment Methods

  • auricular: internal reproductive organs, adrenal, TH, SP, LR, KI, Shenmen