tcm obgyn – historical development · 2019. 12. 9. · lei gong, bo gao, yu fu, shao shi, gui yu...
TRANSCRIPT
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TCM OBGYN – Historical Development Integra(veWomen’sHealthProgram
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Introduction
• TCMOBGYNhasarichhistoryofdevelopmentspanningapproximatelythelast2,000years
• Muchofthefocushasbeencenteredaroundconcep(on,pregnancy,andpostpartumcare
• Awealthofknowledgehavebeendocumentedinthe“Classics”
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The Essential Beginning
• TheEarliest-216AD,DrZhangZhongJing张仲景,,3Chapters20-22onPulse,PaYerns,andTreatmentsofDiseasesinPregnancy,PostpartumDisease,andMiscellaneousGynecologicalDiseases.
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To Now - Zhong Yi Fu Chan Ke Xue 中医妇产科学 “TCM Science of OBGYN” • FirstEdi(onPublishedin2001andSecondEdi(onPublishedin2011byPeople’sMedicalPublishingHouseCo.
• EditorsareDr.Liu,MinRu刘敏如,andDr.Tan,WanXin谭万信,andwriYenbyover73wellknownTCMOBGYNdoctors.
• MostcomprehensivetextandthemostwidelyusedforTCMandIntegra(veOBGYN.
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Study Approach to the History and Development of TCM OBGYN • Sincemostinforma(oninclinicalmedicinehasbeenpreservedanddocumentedinthe“Classics”books,ourapproachistogainunderstandingandapprecia(onofthese”Classics”throughachronologicalprocess.
• Therearecountlessbooksthathavecontributedtothisfield.Inthislecture,wewillfocusononesthathavegreaterimpactonthedevelopmentofTCMOBGYN.
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Shan Shui Jing 山水經 Book of Mountains and Seas • Mul(pleunknownauthors,476-221BC,WarringStates
• Itcontainsdescrip(onsofgeologicalfeatures,loca(ons,medicines,andanimals.
• Theearliesttextthatdescribedofmedicinalplantstotreatinfer(lity.
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Huang Di Nei Jing Su Wen 黃帝內經素問 Yellow Emperor’s Classic of Internal Medicine – Simple Questions • Numerousunknownauthors,99-26BC,WarringStatestoHanDynasty
• DiscussionsbetweenHuangDiandhisministerssuchasQiBo,LeiGong,BoGao,YuFu,ShaoShi,GuiYuQu,andShaoYuonmostlyhealthissues.
• ManyreferencestoOBGYNandfirstfundamentalsofFeKe
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Su Wen and Anatomy
• Firsttomen(on:• NvZiBao(FemaleWomb)• BaoMai–WombMeridian• BaoLuo–WombCollateral
• NvZiBao–Ithasfunc(onsofZangandFu.• ItactslikeZangwhenitcantransformJing,QiandBloodtoNourishFetusandCreateMenstrualFlow.
• ItactslikeFuwhenitcanstoreanddischargeJing,Qi,andBlood• ItisthereforeconsideredasanExtraordinaryFuOrgan(QiHengZiFu奇恒之腑)
• BaoMai–ItbelongstotheHeartandconnectstoBao• BaoLuo–ItbelongstotheKidneyandconnectstoBao
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Su Wen and Physiology
• Itdescribed7x7and8x8reproduc(vephysiologyforbothwomanandman.
• Itfirstdescribedthefunc(onandtheimportanceofTianKui,Chong,Ren,andKidneyQiinreproduc(on.
• Italsodescribedtheuniquefemalephysiologyofmenstrua(on,pregnancy,labor,andbreasjeeding.
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Su Wen and Pathology
• Itpointedoutthewomantendstohave“excessiveQianddeficientBlood”.Thispavedthefounda(onforbloodnourishingmethodoftreatments.
• Itdescribedpathologyunderlyingabnormaluterinebleeding,amenorrhea,abnormalvaginaldischarges,infer(lity,ZhengJia(pelvicmass),dysphoniaduringpregnancy,etc.
• “ExcessivesadnessdepletesBaoLuo,YangQimovesinternallyupwardtodisturbtheHeart,theregula(onofBloodisimpaired,causingabnormaluterinebleeding”.Itdescribesforthefirst(meemo(onalfactorcanbeadiseasecausa(vefactor.
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Su Wen and Diagnosis • Itpointedouttheobserva(onofcolorchangesandotherchangesbelowthenosecanbeanindica(onoffemalereproduc(veorganissuesespeciallythelipsandphiltrum.
• ItdescribedthatthemoreobviousmovementofHand-ShaoYinChannelpulsecanbeanindica(onofpregnancy.
• ItalsodescribedthatweaknessofbothKidney(Chi)pulsescanbeanindica(onofamenorrhea.
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Su Wen and Herbal Therapy
• ItdescribedSiWuZeiGuYiLuRuWan(四乌贼骨⼀一芦茹丸),acombina(onofEndoconchasepiae(WuZeiGu)andRubiacordifolia(QianCao)4:1,oneoftheonly13formula(onsthatappearedinNeijing,usedinirregularmenstrua(on,deple(onofmenstrua(on.
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Shi Ji 史記 Historical Annals • SiMaQian司馬遷,exact(meunknown,Handynasty.
• Descrip(onsofhistoryfromHuangDieratotheHandynasty(221BCto220AD)(440Years)
• DescribedfirstspecialtyofOBGYNBianQue扁鵲.
• Italsodocumentedtwoclinicalcasesofamenorrheaandlacta(ondeficiency.
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Han Shu 漢書 Book of Han • HanShuisahistorybookcoveringthefirstpartoftheHanDynasty(206BCto23AD).
• Itdescribedinstalla(onoffemaleOBGYNspecialtydoctorsintheimperiacourt,thefamousonesareYiXu(义姁),andChunYuYan(淳于衍).
• Theuseofherbstocauseabor(onandabnormalfetushavebeendocumented.
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Hou Han Shu 後漢書 Book of the Later Han • AlsoknownasHistoryoftheLaterHan,isaChinesecourtdocumentcoveringthehistoryoftheHandynastyfrom6to189AD.
• ItdocumentedthefamedphysicianHuaTuo华佗usingMaFeiSan⿇麻沸散andShenGao神膏intheperformanceofabdominalsurgeryandremovalanddeadfetus.
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Tai Chan Shu 胎产书 The Book of Pregnancy, Labor and Postpartum • MaWangDuiexcava(oninChangshadiscoveredover3000culturalrelics.
• TaiChanShuwasoneofthe15medicalrelatedbooksdiscovereddocumen(ngindetail10monthsofgesta(on,laborandpostpartumcareintheHanDynasty.
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Tai Chan Shu 胎产书 The Book of Pregnancy, Labor and Postpartum • Itdescribedwhenitisthebest(metobeginintercoursetoconceive(3daysamerthemenstrua(oniscompletelyclear).
• Itdescribed10monthsofembryologyandtheconceptofYangTai养胎(NourishFetus)
• ItdescribedtheconceptandtheimportanceofTaiJiao胎教(FetalEduca(on)
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Nourish Fetus According to the Gestational Month (Zhu Yue Yang Tai 逐⽉月养胎) FirstMonthForma(onofEmbryo
SecondMonthForma(onofGel
ThirdMonthForma(onofFetus
FourthMonthForma(onofBloodfromWaterEnergy
FimhMonthForma(onofQifromFireEnergy
SixthMonthForma(onoftendonandligamentsfromMetalEnergy
SeventhMonthForma(onofBonefromWoodEnergy
EighthMonthForma(onofSkin,FasciaandMusclesfromEarthEnergy
NinthMonthForma(onofHairfrom”Stone”Energy
TenthMonth–AllOrgansareformed,ReceivingEnergyfromHeavenandEarth,ReadytobeDelivered
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Shen Nong Ben Cao Jing 神农本草经 The Classics of Herbal Medicine • ItwaswriYenintheHanDynasty.• Itlists365differentherbsfortherapy.Itclassifiedherbsintohigher,average,andlowergradesaswellascategorizedherbsintoplants,animals,andminerals.
• ItincludedmanyherbsthatarewidelyusedinOBGYN.
• ItalsorenamedNuZiBaotoZiGong.
• ItstatedthatWindColdaYacktotheZiGonginwomancancauseinfer(lityfortenyears.
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Jin Kui Yao Lue Fang Lun 金匱要略方論 Discussion of Prescriptions of the Golden Chest • Zhang,ZhongJing张仲景,219AD,Handynasty.
• LatereditedbyWang,ShuHe 王叔和,Lin,Yi林林亿,andSun,Qi 孙奇.
• 3volumes,herbalandfoodtherapiesforvarietyofdiseases.
• 3chaptersongynecology,over30formulariesdescribedands(llusedtoday.
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Jin Kui Yao Lue Fang Lun 金匱要略方論 Discussion of Prescriptions of the Golden Chest • GuiZhiFuLingWan桂枝茯苓丸forZhengJia癥瘕 (pelvicmass)
• JiaoAiTang胶艾汤forabnormaluterinebleedingwithpelvicpainsincludingoccurrencesduringpregnancyandameranabor(on.
• DangGuiShaoYaoSan当归芍药散forgesta(onalpelvicpain.
• GanMaiDaZaoTang⽢甘麦⼤大枣汤forZangZao脏躁,depressiveandanxietydisorders
• WenJingTang温经汤formenopausalabnormaluterinebleeding
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Jin Kui Yao Lue Fang Lun 金匱要略方論 Discussion of Prescriptions of the Golden Chest • Introduc(ontotheprac(ceandconceptofvaginaldoucheandsuppository.
• FanShiWansuppository矾⽯石丸forleukorrhea,vaginalinfec(ons,amenorrheaduetostagnantbloodandclots.
• SheChuangZiSan蛇床⼦子散forYin-Coldtypeofleukorrheaandvaginalinfec(ons
• LangYaTang狼牙汤forvaginalparasi(cinfec(onssuchasTrichomonas
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Mai Jing 脈經 Pulse Classic • Wang,ShuHe王叔和,AD280,Jindynasty
• Firstbookthatcreatedasystemicframeworkforpulsediagnosis
• ItalsocollectedandsynthesizedearlierworkssuchasNeiJing,NanJing,andJinKuiinpulsediagnosisanddiagnos(cdifferen(a(ons.
• OBGYNpulsedescrip(onsanddifferen(a(onsappearsinChapter9oftotal10chaptersinthebook.
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Mai Jing 脈經 Pulse Classic • “Chiposi(on,Kidneypulse,whenitispersistentwhenpressed,itispregnancy.”
• “Threelevelsofpulse–floa(ng,middleanddeep;whentheyarecon(nuousandlinkedup,itispregnancy.”
• ItalsodiscussedaboutLiJingMai离经脉–speedinguppulsethatoccursduringlabor.
• Itprovidednewterminologies:• JuJing居经–menstrua(onthatcomeseverythreemonths
• BiNian避年年–menstrua(onthatcomesonceayear
• JiJing激经–menstrua(oncon(nuingevenamerpregnancydiscovery
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Zhu Bing Yuan Hou Zong Lun 諸病源候總論 General Treaties on The Symptomatology and Etiology of Disease • Chao,YuanFang巢元⽅方,imperialphysician,AD610,Suidynasty
• AmajorworkonE(opathology.• Itistheearliestsystemizedworkone(ology,symptoms,andsignsofdiseases.Itclassified67diseasesand1,739syndromes.
• 283syndromescoveringOBGYNprovidedstrongfounda(onone(opathologyunderstanding.
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Zhu Bing Yuan Hou Zong Lun 諸病源候總論 General Treaties on The Symptomatology and Etiology of Disease • “Irregularmenstrua(oniscausedbyoverstrainingconsumingQiandBlood.Thiscausethebodytobeweakened.WeakenedbodyeasilyaYractedWindColdinvasion,causingblockageintheinteriorofBao胞内,damagingChongRenChannels,damagingHandTaiYangandShaoYinchannels”
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Qian Jin Yao Fang 千金要方 Thousand Golden Ducat Prescriptions • Sun,SiMiao,AD652,Tangdynasty.• Collected5300herbalformularies,expandedonZangFutheoriesandotherfundamentals.ItdescribedvariousTCMtreatmentssuchasacupuncture,foodtherapy,massage,DaoYin,etc.
• 3comprehensivevolumesonOBGYN.
• Ametalknifeshouldneverusedtocutumbilicalcord.
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Formation of Imperial Medical System
• DuringTangDynasty618–907AD,establishmentofimperialmedicaldepartment.
• Itisthefirstformalizededuca(onalins(tu(ontotraindoctorsfortheloyalfamilyaswellasforthegovernmentofficials.
• Duetotheeduca(onalinfluences,therearenowmorepublishedbooksonOBGYNduringthisperiodof(me.
• Notablesare:• BeiJiQianJinYaoFang备急千⾦金金要⽅方 Prescrip(onsWorthaThousandinGoldforEveryEmergency
• WaiTaiBiYao外台秘要 Medicalsecretsofanofficial
• JingXiaoChanBao經效產寶TreasureofObstetrics
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Bei Ji Qian Jin Yao Fang 备急千金要方 Prescriptions Worth a Thousand in Gold for Every Emergency
• Sun,SiMiao孙思邈• AuthoredBeiJiQianJinYaoFangin652AD.(ItisfrequentlyabbreviatedasQianJinFang)
• 30chaptersonclinicalmedicine,acupuncture,dietarytherapy,preven(on,andsanita(on.Itcollected5,300+herbalformula(ons.
• 3chaptersonOBGYN,collected540herbalformula(onsinthesethreechapters.
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Bei Ji Qian Jin Yao Fang 备急千金要方 Prescriptions Worth a Thousand in Gold for Every Emergency
• Hepointedoutforthefirst(methatinfer(litycanbecausedproblemsfrombothmanandwomanandnotjustwomanalone.
• Hewroteextensivelyonantepartum,intrapartum,andpostpartumcare.Heexpandedontreatmentsfordifficultlaborsinbothherbalandacupuncturetherapies
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Wai Tai Bi Yao 外台秘要 Medical Secrets of an Official
• Wang,Dao王焘• Aclinicaltherapybookthatincluded40chapters,andover6,000herbalformula(ons.
• TherearetwochaptersonOBGYNaround85differenttypeofcondi(onsandover480herbalformula(ons.
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Jing Xiao Chan Bao 經效產寶 Treasure of Obstetrics • Zan,Yin昝殷,853AD,Tangdynasty.
• 41chapters,374formularies,onpregnancy,laborandpostpartumissues.
• FirsspecialtybookonTCMObstetrics
• Itdescribedmaternalcare,laboranddelivery.
• Itdescribedcareforpreeclampsiaandeclampsia.
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Earliest TCM Medical School for the public • SongDynasty,960-1279AD• ImperialMedicalCollege,Staffedbytotalof300physicians,ninedepartmentswhichincludedtheOBGYNdepartment,andlisted10obstetricphysicians.
• Thisistheearliestofspecialtyeduca(onforOBGYNintheworld.• S(mulatedfurtherrefinementanddevelopmentinTCMOBGYN.
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Shi Chan Lun ⼗十产论 Discussion of Ten Labors • Yang,ZiJian杨⼦子建,1098AD• Discussionontendifferentfetalposi(onsincludingfoo(ngbreech,transversebreech,frankbreech,umbilicuscordwrapping,etc.
• Italsodiscussedtheuseofhandtechniquesincorrec(ngsuchbreechduringlaboraswellastheintakeofherbs.
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Wei Shen Jia Bao Chan Ke Bei Yao 卫⽣生家宝产科备要 • Zhu,RueZhang朱瑞章,1184AD• 8chapterstotal.7chaptersonlaboranddelivery.
• Itdiscussedtheimportanceofhavingcleanenvironmentfordeliveryaswellasproperinfantcaremethods.
• Itdiscussedofthreepostpartumcondi(onsofChongXin冲⼼心,ChongWei冲胃,andChongFei冲肺.(EclampsiaSeizure,HELLP-microangiopathichemoly(canemia,cardiomyopathy)
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Nv Ke Bai Wen 女科百问 Hundred Questions in OBGYN • Qi,ZhongPu齐仲莆,1220AD• 50ques(onsongynecology• 50ques(onsonobstetrics• Providedmoreclearexplana(onofe(ologiesandpathologies
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Fu Ren Liang Fang Da Quan 婦人良方大全 Great Treatise of Useful Prescriptions for Women • Chen,ZiMing陳自明,1237AD,SouthernSongdynasty.
• 25chapters,1118formularies,48cases,thefirstcomprehensivetextonTCMOBGYN.
• Profoundinfluenceonthedevelopmentofobstetricsandgynecologyinsubsequentdynas(es.
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Fu Ren Liang Fang Da Quan 婦人良方大全 Great Treatise of Useful Prescriptions for Women • Lateredi(onbyXueJi薛⼰己 whichincludedmanycommentariesaswellascasestudiesinMingDynasty.
• ItemphasizedthatLiverandSpleenarethesourcesformenstrua(on,andallOBGYNdisordersoriginatesfromChongRenchannelsandBaoGong.
• Again,itbecameadefactotextbookofOBGYNformanygenera(ons.
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Jin Yuan Four Schools
• Liu,WanSu,Li,DongYuan,Zhu,DanXi,andZhangZiHe.• Liu,WanSu–Firepathology• Li,DongYuan–Earthschool• Zhu,DanXi–“YangisomenexcessiveandYinisfrequentlydeficient”• ZhangZiHe–Swea(ng,Purge,andEme(cMethods
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Liu Wan Su 刘完素 1110 – 1200 AD • Contributed“Fire-HeatPathology”
• BelievedthatFire-Heatisthemaine(ologyformanydiseases
• RecommendedCoolingandColdherbstoreduceHeartFire,benefitKidneyWater.
• LaterhasbeenrecognizedastheHeJianDoctrine,namedforwherehewasborn.
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OBGYN Contributions
• “Whenthereisamenorrhea,firsttoreduceHeartFire.OnceHeartFirereduced,themenstrua(onwilloccur.
• “Vaginaldischargesarethecondi(onsoftheRenChannel”
• “WhenthereistoomuchDampHeatinthelowerRenChannel,therewillhavevaginaldischarges”
• “focusontheKidneyswithyoungwoman,focusontheLiverswithmiddle-agedwomen,focusonSpleen
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Zhang, Cong Zheng 张从正 1156-1228 AD • “Whennourishlife,usefood;whentreatdiseasesaYackwithmedicine.”
• “Onecannottonifyun(lallpathogensareeradicated.”
• Hefocusesontheuseofdiaphore(cs,eme(cs,andpurga(vestoridofpathogens.
• Heisthereforeknownastheini(atorofAYackingDoctrine
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OBGYN Contributions
• Commonlyuseseme(candpurgingmethodstobringonmenstrua(ons,mainlyforexcesstypeofpa(ents.
• Butusesfoodtonourishdeficientpa(ents• BygeungofPhlegm,themenstrua(onwillreappear,establishedphlegmconges(onasoneofthecauseforamenorrhea,whichhelptoestablishthePhlegm-Dampe(ologyinPCOSpa(ents.
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Zheng Zhi Zhun Sheng 証治準繩 Standards of Diagnosis and Treatments • Wang,KenTang王肯堂,1602AD,Mingdynasty
• 44volumesdividedintosixspecial(es–MiscellaneousDisorders,MiscellaneousFormularies,ShangHan,YangDiseases,Pediatrics,OBGYN.
• ComprehensiveTextofthe(me
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Nu Ke Zuo Yao 女科撮要 Summary of Gynecology and Obstetrics • Xue,Ji 薛⼰己,1548AD,Mingdynasty
• Animperialphysicianwithvastamountofclinicalexperience.
• ComprehensivebookonOBGYNreflec(nguniquelyhowDr.Xueapproacheswoman’shealth.
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Guang Si Ji Yao 廣嗣紀要 Summary of Fertility • Wan,Quan万全,1549AD,Mingdynasty.
• 16chaptersdescribingtreatmentsforinfer(lity,pregnancycare,postpartumcare,andpediatriccare.
• Manshouldclearhisheartandcontrolsexualdesiretonourishtheessence
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Ji Yin Gang Mu 濟陰綱目 Compendium of Therapy of Women’s Diseases • Wu,ZhiWang武之望,1620AD,Mingdynasty.
• 5chapters,comprehensivetextcollec(ngworksbeforeMingdynastyintheareaofOBGYN
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Jing Yue Quan Shu 景岳全書 Complete Works of Jing Yue • Zhang,JieBin張介賓,1624AD,Mingdynasty.
• 64chaptersonTCMfromDrZhang’sexperienceespeciallyrela(ngtotheMingmenDoctrine.
• ContributedgreatlytoKidneytonifica(onmethods
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Fu Qing Zhu Nv Ke 傅青主女科 Fu Qing Zhu’s Gynecology • Fu,QingZhu傅青主,1607-1684AD,Qingdynasty.
• Thebookwaspublished1690AD.• EmphasizedontreatmentsofSpleen,LiverandKidneyinOBGYNcondi(ons.
• Createdmanyherbalformula(onsthataresmallformula(onsandeasytouse.
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Yi Zong Jin Jian 医宗⾦金金鉴 Golden Mirror of Medicine • Wu,Qian吴谦,1742AD,Qingdynasty.
• 90chapters,asummarycollec(onofTCM.ItwasdirectedbytheEmperorandwriYenbyanimperialphysician.
• Easytoreadandunderstandwithsimplifiedvolumes.
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Da Sheng Bian 达⽣生编 Treatise on Obstetrics • JiZhaiJuShi亟斋居⼠士,1715AD,Qingdynasty.
• Pennamedpublica(on,incorporatedmorescien(ficinforma(onandapproachtoobstetrics.
• Clearandconcise,amoremodernfavoritebooktoobstetrics.
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Yi Lin Gai Cuo 医林林改错 Correcting the Errors in the Forest of Medicine • In1830,Dr.Wang,QingRen王清任,wriYenthisbookamerreviewingandexaminingcadavers.HeemphasizedtheimportanceoflearninganatomyforTCMphysicians,
• HesharedhisdeepinsightinStagnantBloodcondi(onandusingAc(va(ngBloodRelievingStagna(onmethodtotreatit.
• HisseriesofZhuYuTang逐瘀汤hasbeenwidelyusedforOBGYNbloodstagna(oncondi(onsandcon(nuetoenjoypopularitytoday.
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Xue Zheng Lun ⾎血证论 Discussion on Blood Syndromes • Tang,ZongHai唐宗海海,1885AD,Qingdynasty.
• Anuniquepublica(ondiscussingBloodpathologyanditsrela(onshipwithQi.
• “OldBloodthatdoesnotdischargeisStagnantBlood.””RidofOldBloodallowsNewBloodtocomeonandregulatemenstrua(on”
• BloodflowisregulatedbyChong,Ren,Daichannels.ChongRenDaichannelsareregulatedbyLiver.ThereforetotonifyBloodistotonifyLiver.
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Yi Xue Zhong Zhong Can Xi Lu 医学衷中参⻄西录 Records of Combined Chinese and Western Medicine • Zhang,XiChun,1918AD,Qingdynasty.
• 30chapters,combiningbothChinesemedicalandwesternmedicalperspec(veswithformularies,herbs,theories,discussions,andcases.
• FirstmajoraYemptinbridgingbothChineseandWesternMedicines.
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Yi Xue Zhong Zhong Can Xi Lu 医学衷中参⻄西录 Records of Combined Chinese and Western Medicine • CreatedAnChongTang安冲汤andGuChongTang 固冲汤forexcessivemenstrualfloworabnormaluterinebleeding.
• LiChongWan理理冲丸andLiChongTang 理理冲汤foramenorrheaandZhengJia.
• ShouTaiWan寿胎丸fortonifyingKidneyandpreventmiscarriage.
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Major Texts of TCM Universities and Colleges • TCMGynecology• ZhongYiFuKeXue• Luo,YuanKai,罗元恺,1984,1986AD
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Zhong Yi Fu Chan Ke Xue 中医妇产科学 “TCM Science of OBGYN” • FirstEdi(onPublishedin2001andSecondEdi(onPublishedin2011byPeople’sMedicalPublishingHouseCo.
• EditorsareDr.Liu,MinRu刘敏如,andDr.Tan,WanXin谭万信,andwriYenbyover73wellknownTCMOBGYNdoctors.
• MostcomprehensivetextandthemostwidelyusedforTCMandIntegra(veOBGYN.