The main points of the fourth diagnosis of traditional Chinese medicine gynecology

Wangwenwenqi four diagnosis is the basic diagnosis method of TCM gynecology. Women’s characteristics in physiology and pathology determine that they also have special features in diagnosis. If necessary, they can cooperate with gynecological examinations and laboratory examinations.

◆ Inspection

1. Looking at the complexion The chlorosis of the complexion is due to blood deficiency; the pale or pale complexion is due to deficiency of qi; the dark complexion is due to blood stasis; the dull complexion is due to weakness of kidney qi; flushing of the cheeks is due to deficiency of yin and fire.

2. Look at the color of the tongue. Bright red tongue means blood heat; light red means blood deficiency; pale white and no flower or fragrant moss fat on the side with tooth marks, which means both qi and blood loss. Little or peeling or cracking of the moss is due to yin deficiency, and the yellow and greasy moss at the base of the tongue is due to damp heat and scorching in the lower part. A dull red tongue or a bruise spot on the side of the tongue is blood stasis.

3. Looking at the lip color, red and purple are blood heat, bright red and dryness are yin deficiency and body damage; pale color is spleen deficiency and blood loss; dark blue is mainly pain; light blue is mainly deficiency and cold.

4. Looking at the claws. Most pale ones have blood deficiency or deficiency of both qi and blood; the color of blue and purple is cold and pain.

5. Looking for menstruation

(1) Quantity: Too much is due to qi deficiency or blood heat; too little is due to blood deficiency or cold coagulation; sometimes too much is due to qi depression or kidney deficiency.

(2) Color: bright red or dark red is blood heat; light red is blood deficiency or deficiency of both qi and blood; color purple and dark is blood stagnation.

(3) Quality: stickiness is heat; thinness is deficiency and cold; blood clots are stasis.

6. Look at the belt. Thin white color is spleen deficiency; thick yellow color is hot and humid betting. Variegated colors and foul odor are mostly malignant tumors of the reproductive tract.

7. Looking for lochia, the continuous quantity is large, the color is bright red and thick is bloody heat; the dark color is thick and smelly is damp and hot; the color purple dark has blood clots as stasis and cold.

◆ Inquiry

1. Asking age Gynecological diseases are closely related to age. In puberty, the kidney qi is beginning to flourish, the Chong-Ren function is not yet complete, and the symptoms of menstrual irregularity, dysmenorrhea and dysfunctional dysfunction are prone to occur. During the reproductive period, the qi and blood are easily consumed due to fetal delivery and breastfeeding, which can cause menstrual disorders, amenorrhea, and miscarriage. Menopause is due to the gradual decline of kidney qi and loss of balance between yin and yang, which often results in menstrual disorders, uterine bleeding, and pre- and post-menopausal syndromes. It is also a period when tumors are prone to occur, which should be paid attention to.

2. Asking the medical history According to the condition of the disease, the medical history should be asked mainly about the date of onset, the cause of the disease, the symptoms, the whole process of the development and change of the disease, including the course of treatment and the history of surgery. For those with suspicious tumors or a history of habitual miscarriage, family history is still required.

3. Ask about menstruation. Ask about menarche and menopausal age, menstrual cycle, menstrual period, menstrual volume, color, quality, date of last menstruation, and symptoms before and after menstruation. Also, ask about contraceptive measures and whether they affect menstruation.

4. Ask about the color, quality, quantity, smell, pruritus and other accompanying symptoms and gynecological examinations and laboratory examinations of the tapes.

5. Ask about pregnancy. Ask about the date of the last menstrual period, whether there is nausea and vomiting, edema, fetal movement, vaginal bleeding, lower abdomen pain and backache, etc. Also asked about the birth history, delivery status, delivery method and history of postpartum hemorrhage, and what kind of family planning measures should be taken.

6. Ask about the amount, color, quality, smell of the postpartum lochia and whether there is fever, sweating, abdominal pain and other symptoms. In addition, you should also ask about the amount and quality of milk.

7. Ask whether there are symptoms such as swelling, backache, swelling, vulvar itching, swelling, pain, and vaginal lumps.

8. Ask about occupational life. To understand occupation, life and hobbies, you should also ask whether there is a history of exposure to chemical poisons, work or room dryness and wetness, eating habits, sexual intercourse, and whether there is a history of rain and cold during menstruation.

◆ Smell and diagnosis

1. Listen to the sound Low and thin voice is due to qi deficiency, and sighing and warm qi are qi depression from time to time. Low voice or inability to speak during pregnancy is pregnancy aphonia. Constantly yawning during childbirth is a sign of blood loss and qi collapse.

2. Smell the smell of menstrual blood is hot, vaginal bleeding or accompanied by strange smell, can be malignant tumors. Those who bring foul smells are mostly hot and humid. A person who smells rotten apples during pregnancy is acidosis. Fetal movement disappears after pregnancy, the abdomen does not increase, and the fetal death is more common in people with bad breath.

◆ Clinic

【Pulse diagnosis】

Women’s veins are soft and evenly regular.

1. Menstrual veins: When menstruation comes, all six veins show great smoothness; early menstruation, excessive menstruation or nausea during menstruation, more slippery pulses or chords, it is blood heat; late menstruation, too few or reading menstruation, pulse Shen thin or slow, it is blood cold; Kong pulse is seen in excessive blood loss.

2. With lower pulse The number of chords or slippery pulses is under the humid tropics; the pulse is heavy and thin or weak, which is under the kidney deficiency; the pulse of xuanhua is more common in gall and inflammation.

3. Pregnancy pulse The slippery pulse of Cunkou is the pulse of premature pregnancy, with slippery, counting and moving sensations under the fingers. People who are frail have all six meridians, and those who have an endless chi pulse are also pregnant pulses. After pregnancy, the six pulses are heavy, thin, short, and astringent, or the two-foot pulse is weak and intermittent, mostly due to weak qi; the disappearance of the Huamai after pregnancy, accompanied by heavy vaginal bleeding, may be the death of the fetus.

4. Parturient pulse: The pregnancy is full-term, and the ulnar pulse turns anxiously, such as cutting a rope, turning a bead, or a floating pulse, which is the pulse of labor. Or the pulse on both sides of the middle finger is the pulse of labor.

5. Postpartum pulse The postpartum pulse should be weak and smooth. If the postpartum hemorrhage does not stop, fine astringent pulses can be seen, and fine pulses can be seen in postpartum night sweats.

【Abdominal Examination】

Focus on the lower abdomen. If it has a lump but is hard when pressed, it will not dissipate when pushed, and most painful ones are usually blood stasis; if there is no lump or the pain is reduced, it is blood deficiency; if there is a lump, push it will disperse as Qi stagnation.

◆ Key points of syndrome differentiation of gynecological diseases

【Menstrual Diseases】

Mainly distinguish menstrual cycle, menstrual period, menstrual volume, menstrual color, menstrual quality abnormalities and various symptoms that accompany the menstrual cycle

【Bring it down】

Mainly distinguish the abnormal quantity, color, quality, smell, and accompanying local or systemic symptoms.

In addition, the five internal organs are deficient in semen, even with dryness, lack of semen fluid, weak and dry pulse, so there is no secretion, dry vagina, or burning pain, indifference in libido, sparse menstruation, infertility and other symptoms.


After the parturient gives birth, the turbid liquid of the remaining blood in the uterus is discharged from the vagina called lochia. The syndrome differentiation of lochia is mainly abnormal in quantity, color, quality, blood clot and abdominal pain.

【Lower abdominal pain】

The syndrome differentiation of lower abdominal pain in gynecology should be based on the time, nature, location and degree of the abdominal pain, combined with meridians, bands, lochia, moss, and pulse.

【Differentiation of viscera, qi and blood and gynecological diseases】

The viscera, qi and blood are closely related to gynecological diseases. Among the viscera, the liver, spleen and kidney are most closely related to gynecological diseases. Syndrome differentiation of viscera and qi and blood are commonly used methods in the diagnosis of gynecological diseases.

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