Tinier than Autumn Down
Chen Ziming on the Pivotal Role of Blood and Menstruation in Gynecology
(Originally published January 24, 2020)
In honor of the transition to the New Year of the Metal Rat and my final writing efforts of the Pig Earth year, here is little taste from the Introduction to my forthcoming Channeling the Moon, Part Two: A Translation and Discussion of Qí Zhòngfǔ’s Hundred Questions on Gynecology, Questions 15-50, which addresses miscellaneous conditions of gynecology. The following is the literal translation of a quotation from Chén Zìmíng’s 陳自明 introductory essay of the Fùrén dàquán liángfāng 《婦人大全良方》 (Compendium of Excellent Formulas for Women) composed in 1237 CE. It spells out the pivotal role of blood and menstruation in women’s physiology and pathology, paraphrasing Qí Zhòngfǔ’s discussion of the tiānguǐ in Question Four (without giving him credit):
岐伯曰︰女子七歲腎氣盛，齒更髮長；二七而天癸至，任脈通，太沖脈盛，月事以時下。天，謂天真之氣降；癸，謂壬癸，水名，故云天癸也。
然沖為血海，任主胞胎，腎氣全盛，二脈流通，經血漸盈，應時而下。所以謂之月事者，平和之氣，常以三旬一見，以像月盈則虧也。
若遇經脈行時，最宜謹於將理。將理失宜，似產後一般受病，輕為宿疾，重可死矣。蓋被驚則血氣錯亂，經脈斬然不行，逆於身則為血分、癆瘵等疾。若其時勞力，則生虛熱，變為疼痛之根。若恚怒則氣逆，氣逆則血逆，逆於腰腿，則遇經行時腰腿痛重，過期即安也。逆於頭、腹、心、肺、背、脅、手足之間，則遇經行時，其證亦然。若怒極則傷肝，而有眼暈、脅痛、嘔血、瘰癧、癰瘍之病，加之經血滲漏於其間，遂成竅穴，淋瀝無有已也。
凡此之時，中風則病風，感冷則病冷，久而不愈，變證百出，不可言者。所謂犯時微若秋毫，感病重如山嶽，可不畏哉﹗
Qí Bó said: “When girls reach the seventh year of life, their kidney Qì is exuberant, their adult teeth come in, and the hair on the head grows long. At two times seven, the tiānguǐ arrives, the flow in the Rènmài goes through, and the flow in the Great Chōngmài is exuberant. The monthly period descends on time.” Heaven refers to the descent of the Qì of heavenly perfection; guǐ refers to rénguǐ, which is the name of water. Thus we call it tiānguǐ.
This being so, the Chōngmài is the Sea of Blood, while the Rènmài is in charge of the womb. When kidney Qì has reached its peak, the two vessels stream and flow through. The menstrual blood gradually builds up and descends in response to its proper timing. The reason why we call it “monthly affair” is that it normally appears once every three ten-day cycles, just like the moon’s waxing and waning.
At the time when the menses flow, you must be most circumspect in regard to healthcare and recuperation from illness. When these are not carried out properly, it is like contracting an illness after childbirth: A mild illness will become a chronic condition, while a severe illness will result in death! If the woman is exposed to panic, the blood and Qì become chaotic, and the movement in the channels is abruptly cut off. Counter-current movement in the body then leads to the formation of illness in the blood aspect and conditions like consumption. If the woman taxes her physical energy during this time, this engenders vacuity heat, which transforms into the root of pain. Rage and anger result in Qì moving counter-current, which in turn results in blood moving counter-current. Counter-current movement in the lumbus and legs results in severe pain there at the time of the menstrual flow, which eases off when the period is over. Counter-current movement in the head, abdomen, heart, lungs, back, rib-sides, and hands and feet results in the same kind of sign at the time of the menstrual flow. If the rage is extreme, it damages the liver, and you have the diseases of dizziness, rib-side pain, retching blood, scrofula, and welling-abscesses with sores. When this is complicated by menstrual blood oozing and leaking into these spaces, it subsequently forms openings and cavities, and dribbling that has no end.
Any time this situation occurs, being struck by wind results in falling ill with wind disease, and contracting cold results in falling ill with cold disease. When this persists for a long time with no cure, it will transform into a hundred patters to emerge in unspeakable variety. How could you not dread this situation that is described as “tiny like autumn down feathers at the time of the violation but more serious than the highest mountain peaks when the disease breaks out”!
A few lines further down, Chén continues by citing a truism that should still be memorized by every Chinese medicine student in their first year of education:
大率治病，先論其所主。男子調其氣，女子調其血。氣血，人之神也，不可不謹調護。
然婦人以血為基本，氣血宣行，其神自清。所謂血室，不蓄則氣和；血凝結，則水火相刑。
As a general guideline for the treatment of any condition, first you discuss what the patient is governed by. In men, you attune their Qì; in women, you attune their blood. Qì and blood! These are the spirit of the human, and you must never fail to protect them with great care!
This being so, women have blood as their foundation, and when Qì and blood flow freely, their spirit is naturally clear. What we refer to as the Blood Chamber, if nothing is hoarded there, the Qì is harmonious. But if the blood congeals and binds [there], then water and fire torture each other.
Isn’t this beautiful? So simple and yet so complex and powerful!
