Leukorrhea (Dai Xia Bing)

Diagnosis
Etiology
Pathogenesis Differentiation & Treatment
Western Medicine

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.

Differentiate – over-sexually stimulated by oneself.  

Metrorrhagia.

Etiology

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)
KI Yang ↓ - age, sickness, congenital weakness → ↓ Ming Men fire → KI can’t steam & transform dampness → damp/cold accumulates → retained in low Jiao → KI Qi can’t 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.
Damp/Heat
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.
External causes – live in Damp environment, summer-heat w/ damp, lower limb infection is damp/heat which can follow the meridians upward into the low Jiao.
Ø Heat & Damp – poor surgery, certain suppositories may irritate, tampons, sex toys, poor hygiene all can give rise to Ø damp/heat = discharge.

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

Pathogenesis Differentiation & Treatment

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
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
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   w/ external Damp/Heat add Yi Ren, Cang Zhu, Bei Xie minus Shan Zhu Yu
Damp/Heat – large amount, yellow (w/ 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
Ø Damp/Heat – large amount, pus, green/yellow, strong odor, may be blood, burning vagina, cottage cheese, severe itchy, acute w/ fever, low abdominal pain, thirst w/ 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.

Western Medicine

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