Excessive+Vaginal+Discharge+(Leukorrhea)

Concept: Physical Leukorrhea vs. Pathological Leukorrhea

produce, store & secrete - by kidneys transform & distribute - by spleen govern - by Ren meridian control - by Dai meridian

TCM Etiology and Pathogenesis
-Spleen Deficiency -Kidney Deficiency -Damp-Heat -Toxic Heat

Differentiation of Disease
Diagnosis of the disease is mainly based on abnormal changes of the leukorrhea in color, amount, consistency and smell Normal, physiological leukorrhea tends to be light (pads unnecessary), clear or slightly white, watery & odorless May have increase in vaginal discharge at time of ovulation

Differentiation Diagnosis
-Distinguish intermenstrual bleeding and metrostaxis from red leukorrhea

Relevant Western Diseases
-Infection/Inflammation (candida albicans, richomonas vaginalis, Gardnerella vaginalis and chlamydia trachomatis) -Foreign body (tampon, intrauterine device) -Neoplasm (cervical, endometrial or vaginal carcinoma) -Cervical erosion -Fistulae -Non-genital causes (urinary incontinence, urinary tract fistulae)

Pattern Identification and Treatment Principles
1) Differentiation Quantity, Color, consistency, smell Dark color (yellow, red, green) thick, offensive smell Bright color (light white, light yellow), dilute, or with fishy smell

2)Treatment principles Damp-heat: clear eat & eliminate dampness Deficiency of both spleen and kidney: tonify spleen and kidny, treat spleen wit raising qi ad drying dampness methods; treat kidney with tonifying and astringing methods

3) Combination with the external treatment

Spleen Deficiency
Excessive vaginal discharge, white or slight yellow color, odorless, thick Pale complexion or sallow face, cold limbs, swelling in face and feet, lassitude, poor appetite, loose stools [Chao Bai Zhu (15g.), Chao Shan Yao (15g.), Ren Shen (6g.), Cang Zhu (6g.), Chai Hu (3g.), Bai Shao (8g.), Chen Pi (3g.), Che Qian Zi (6g.), Charred Jing Jie Sui (3g.), Gan Cao (3g.)]
 * Tongue:** pale tongue; white or greasy coat
 * Pulse:** soggy, weak
 * Treatment Principles:** Strengthen the Spleen, supplement qi, raise yang & expel dampness
 * Acupuncture:** //GB-26, CV-6, BL-30, SP-6, ST-36//, SP-9, BL-32, CV-3, ST-30
 * Herbal Treatment:** Wan Dai Tang (End Discharge Decoction)

Kidney Yang Deficiency
Profuse and persistent leukorrhea which is white color and as thin as water, severe soreness of the loins Coldness & bearing down sensation in the lower abdomen, tinnitus, frequent profuse & clear urination esp. during the night, loose stools [Lu Jiao Shuang (15g.), Tu Si Zi (15g.), Du Zhong (12g.), Bai Zhu (12g.), Lian Xu (8g.), Qian Shi (12g.), Bai Guo (10g.), Mu Li (15g.)]
 * Tongue:** Pale tongue; thin white coat
 * Pulse:** Deep & Weak
 * Treatment Principles:** Nourish Kidney, consolidate essence, and stop leukorrhea
 * Acupuncture:** //CV-4, BL-23, BL-32, GB-26, SP-6, GV-4//, KI-3, KI-7, KI-13
 * Herbal Treatment:** Lu Jiao Tu Si Zi Wan

Kidney Yin Deficiency
Yellow or white and pink leukorrhea which is sticky and odorless, burning dryness sensation in the vagina Flushed face, dizziness, vertigo, 5-palm heat, insomnia w/ dream-disturbed sleep, dry mouth & throat, dark urine, dry stools
 * Tongue:** Red w/ little coat
 * Pulse:** Fine, rapid
 * Treatment Principles:** Nourish Yin & clear fire
 * Acupuncture:** //BL-23, KI-3, KI-6, SP-6//, CV-4, KI-13, GB-26, BL-32
 * Herbal Treatment:** //Zhi Bai Di Huang Wan//
 * External Wash:** [Yin Hua Teng (30g.), Wei Ling Xian (30g.), Be Xie (30g.), Qin Jiao (30g.), Gan Cao (30g.)]

Damp Heat
Profuse leukorrhea, yellow or red color and sticky with offensive color Pruritis, chest fullness, poor appetite, sticjy feeling in the mouth, scanty & dark urine, loose stools which are difficult to discharge, yellow urine or burning sensation, low fever [Yin Chen Hao (15g.), Huang Bai (12g.), Zhi Zi (10g.), Mu Dan Pi (10g.), Chi Shao (10g.), Zhu Ling (10g.), Fu Ling (12g.), Che Qian Zi (to be wrapped)(15g.), Ze Xie (10g.), Niu Xi (6g.)]
 * Tongue:** Red tongue; yellow and greasy tongue coat
 * Pulse:** Slippery, rapid OR wiry, rapid
 * Treatment Principles:** Clear heat and eliminate dampness
 * Acupuncture:** //GB-41, TW-5, GB-26, CV-3, SP-9//, SP-6, BL-32, GB-34
 * Herbal Treatment:** //Zhi Dai Fang// (Stop Leukorrhea Decoction)
 * External Wash:** [Yin Hua Teng (30g.), Da Huang (30g.), Ku Shen (30g.)]

Toxic Heat
Profuse leukorrhea which is yellow, or white mixed with yellow or multiple colors, foul or offensive odor, sticky, burning sensation in the vagina Pain in lower abdomen, vexation, thirst or fever, scanty and dark urine, dry stools [Jin Yin Hua (20g.), Pu Gong Ying (15g.), Zi Hua Di Ding (15g.), Tian Kui Zi (15g.), Ye Ju Hua (15g.)] 1) [Jin Yin Hua Teng, Hong Teng, Pu Gong Ying, Yin Chen Hao, Sheng Ma, Zi Hua Di Ding, Da Qing Ye, Chun Gen Pi, Jie Geng] 2) [Da Huang (50g.), Jin Yin Hua (50g.), Guan Zhong (50g.), Ye Ju Hua (50g.)]
 * Tongue:** Red tongue; yellow & dry coat
 * Pulse:** Rapid
 * Treatment Principles:** Clear heat, detoxify, and expel dampness
 * Acupuncture:** //GB-26, CV-3, SP-9, LR-2//, BL-34, GB-43, LR-5, LR-3
 * Herbal Treatment:** //Wu Wei Xiao Du Yin// (Five-ingredient Decoction to Eliminate Toxin)
 * External Wash:**

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