Modern Medical Practitioners' Theories on Huang Yuan-You's Use of "Pivotal Movements" in Treating Menstrual Disorders

: Objective: To explore the academic ideas of the famous Qing dynasty physician Huang Yuan-young's "Four Saints' Heart Source" in identifying and treating menstrual diseases. METHODS: We studied Huang Yuan-yu's works, and analyzed the theory, methods, prescriptions and medicines of Huang Yuan-yu in the treatment of menstrual diseases, taking the Four Sages Heart Source as the main object of study. Results: Huang Yuan-yu's academic thought of "one qi flowing around and pivotal movement" was also reflected in the physiopathology of menstruation. It is believed that Spleen Yang and Kidney Water are the basis for the production of menstrual blood, while Lung Gold and Liver Wood regulate the menstrual cycle. He elaborated on menstrual disorders such as closed knots, menorrhagia, late pre-menstruation, purple and black stasis, abdominal pain during menstruation, and heat entering the blood chamber, and proposed that "the first method to regulate menstruation and nourish blood is to give priority to Chong Yang", and founded the formulas of Gui Zhi Dan Pi Tang, Gui Zhi Jiang Ling Tang, Jiang Ling Ah Gao Tang, Ling Gui Dan Shen Tang, Gui Di Peony Tang, and Chai Hu Di Huang Tang, which provided new ideas for clinical practice. Conclusion: Huang Yuan-you's treatment of menstrual diseases is guided by his academic thought of "one qi flowing around, pivotal movement", and proposes a


Introduction
Menstrual diseases are common in gynecology, including dysfunctional uterine bleeding, amenorrhea, polycystic ovary syndrome, dysmenorrhea and other major diseases in Western medicine [1] , and in Chinese medicine, including menstrual irregularities, intermenstrual bleeding, menorrhagia, amenorrhea, dysmenorrhea, pre-and post-menstrual symptoms and other diseases [2] . Huang Yuan-yu, a famous doctor in the Qing Dynasty, founded the academic thought of "one qi flowing around, pivotal movement" in his book "Four Saints' Heart Source" [3] , which guides the clinical diagnosis and treatment of internal and external gynecological diseases and five organs. Through the study of Huang Yuan-yu's works, the academic thoughts of Huang Yuan-yu on the treatment of menstrual diseases are explained in the context of the Four Sages' Heart Source, in terms of the movement of qi and the changes of the elevation function of the internal organs.
to produce gold down, water and fire, the whole circle of movement figure is a disease-free person. The human body is the body of lifting and moving, talking about the spleen, stomach, liver, heart, lung and kidney can not only talk about the flesh, the flesh can not move, the function of the internal organs is the play of the lifting and moving of the internal organs, the internal organs are generated by the lifting and moving of the middle earth, Huang Yuan Yu's thought is elaborated from the level of qi movement, not the flesh of the internal organs themselves.
(3) Qi and blood are biochemically produced by the middle earth. The spleen and stomach produce Qi and blood. Kidney water warms up and turns into liver wood; heart fire clears and lowers to produce lung gold; the power for kidney water to warm up and heart fire to lower comes from the middle earth pivot. Stomach Yang turns right and transforms Qi, which is unified in the Lung and spreads between the internal organs and meridians, and is called Qi in the internal organs and Wei in the meridians. The power of the right turn of the stomach Yang and the left turn of the spleen Yin originates from the rise and fall of the qi of the middle earth, that is, "essence, blood, spirit and qi are really one thing, all due to the change of the middle qi."

The Academic Ideology of the Four Sages' Heart Source in Discerning the Treatment of Menstrual Diseases
Huang Yuan-Yu discusses menstrual diseases from several aspects, including closed knots, menorrhagia, late pre-menstruation, purple and black knots, and abdominal pain during menstruation. Before discussing menstrual diseases, Huang describes the basic aspects of menstrual flow in women in the section on the root of the meridians.

Spleen-liver-rhizoma-uterine regulation axis
Huang Yuan-you has his own unique insights on the regulation of women's menstruation, in which liver, spleen, rhizoma and uterus play an important role in the regulation of women's menstruation. The liver contains blood, blood is unified in the liver, the liver is well regulated, the left ascends smoothly, the liver blood is sufficient, the liver blood reaches the uterus through the rhythm, and menstruation comes on time. Although Huang YuanYu did not directly point out the role of liver wood, but in the "Four Saints' Heart Source -Women's Interpretation -The root of the meridians" pointed out that "gold is the main astringent, wood is the main drainage, gold convergence and wood can not drain, then the period will not come, wood drainage and gold can not converge, then the period will come first. This indirectly points out that liver wood plays an important role in regulating the onset and volume of menstruation. The blood is the sea, Ren is the main twins, "with, the Yin of the Ren vein is strong, with the vein of not lead. The five organs of the Yin essence, are unified in the Ren vein, Ren in the Yang secret, the belt vein horizontal bundle, around the waist like a belt, for the collection of the guide, so the essence convergence and does not leak." (Four Saints Heart Source -Women's Solution -Miscellaneous Diseases Root Origin) Qi and blood belong to the category of Yin essence, Chong Ren also regulates the flow of Qi and blood in the uterus, Chong Ren is the hub of the menstrual pathway, Chong Ren does not work, the menstrual blood is blocked, the menstrual flow is low, dripping incomplete. The spleen earth is the key role in the menstrual flow and regulation: spleen earth is the source of blood, the source of menstrual blood; liver wood is gentle, liver wood is warmed from kidney water, its leftward momentum comes from the left ascension of spleen earth; spleen and kidney yang, the human kidney water is not cold, kidney water is warm and closed, for liver wood, liver blood has the opportunity to rise, "the analogy of the earth, Yang Qi winter, water springs warm, spring wood rise, the freezing thawing The ice disappears, the warmth rises, so all things are born." If the spleen and kidney Yang deficiency is "winter without underground warmth, although there is Yang and the commander, but also into the cold valley is not born." Spleen and kidney Yang deficiency is prone to blood stasis, liver wood infusion of blood in the internal organs and meridians, liver blood warming, the source of its warming is in the spleen and kidney, spleen and kidney Yang deficiency, spleen and earth stagnation trapped, angry suppression, so blood stasis. Spleen and kidney yang deficiency, more down cold, and warm depression, often depressed for heat, in the human body more manifested as upper heat, lower cold, abdominal cold pain, menstrual scarcity and other symptoms. "The method of regulating menstruation and nourishing blood, the first to Chong Yang is also the main" Huang Yuan Yu's understanding of menstruation emphasizes the importance of Spleen Yang.
In the menstrual cycle we can summarize the regulation axis of spleen-liver-rush-uterus. Spleen earth is the essence of qi and blood, the source of qi and blood biochemistry, spleen earth is warm, spleen earth is left, the source of power for liver wood to rise from kidney water; liver wood regulates menstrual flow and stop, too much drainage of liver wood, menstruation first, collapse and leakage, liver wood depression, stripes do not rise, late menstruation, closed knots, stagnation of purple and black; rush-ren is the pivot of menstrual pathway, rush-ren is open, menstruation under water, abdominal pain. The menstrual flow is under water and the abdomen is not painful, but if the flow does not work, the menstrual water stagnates in the uterus and the abdomen is tight and painful. The uterus is the place where menstrual blood accumulates, and the accumulation and drainage of menstrual blood are carried out in the uterus. [4] The spleen yang and kidney water warming are the basic links for the production of blood. The traditional reproductive axis of "kidney -tiankui -zongren -uterus" [ ] is the end of menstruation in women, while the spleen -liver -zongren -uterus axis is the end of menstrual cycle in women, which provides us with new ideas for studying menstrual diseases.

Menstrual disease etiology and pathogenesis
Huang YuanYu wrote in the "Four Saints Heart Source": "The menstrual vessels are closed, due to the depression of liver wood", "wood depression, the development is not in order, then the menstrual blood stagnation, closed knot is born." The cause of the closure is liver wood stagnation, and Huang Yuan Yu further explained the cause of wood depression "water cold soil wet, wood gas does not reach, depression, then the meridians do not pass" pointed out that the spleen and kidney damp cold, wood gas depression, blood stagnation, so the closure is born. The Four Saints' Heart Source says, "The collapse and leakage of the menstrual vessels is due to the trapping of liver wood", "Business is depressed, wood Qi does not reach, the menstrual blood is trapped and flows, then the disease is collapse and leakage." The trapping of liver wood produces the leakage, "because of the growth of B wood in water and earth, the water is strong and the earth is wet, the spleen yang is trapped and defeated, unable to develop the wood qi and lift the menstrual blood, so the liver qi is depressed, and the leakage is also caused by the leakage." Spleen Yang cannot rotate to the left, wood Qi sinks, and menstrual blood flows downward, thus resulting in the leakage of menstrual blood. The Four Sacred Sources of the Heart says, "In the first stage, the wood Qi drains, and the mechanism of disintegration and leakage is also present. In the later stage, the wood Qi is curbed and depressed, and the mechanism of closure. The origin is always due to the spleen dampness and liver trapping, the wood qi is depressed and not allowed to develop, then the menstrual blood is condensed and stagnant, and cannot be smooth, regardless of the first stage and the later stage, the blood will be stagnant and unfavorable." The main pathological factor in the early and late stages is that the spleen is wet and the liver is trapped, and the leakage is the very first stage and the blockage is the very late stage. The Four Saints' Heart Source says, "Menstrual water is stagnant, purple and black, and the blood is cold and astringent." "This is due to the coldness of earth and water and the depression of wood." The menstrual water is stagnant and purple and black, that is, the menstrual flow contains stagnant blood, the earth is wet and water is cold, the blood chamber is cold and clotted, the liver and wood are stagnant, so the menstrual water contains stagnant blood. The "Four Sages Heart Source" "menstrual abdominal pain, liver qi depression and punishment of the spleen. Because of its water and earth wet and cold, B wood suppression, blood coagulation is not smooth, full of blood, menstrual water is not conducive, wood congestion, drainage is not attempted, depression and conflict, ketosis spleen, is the abdominal pain." Menstrual abdominal pain is divided into premenstrual abdominal pain and postmenstrual abdominal pain, premenstrual abdominal pain until after the blood, the pain will stop, while postmenstrual abdominal pain is blood deficiency liver dry, liver wood loss of capacity, blood down after more intensified blood deficiency, so for the postmenstrual pain, whether premenstrual abdominal pain or postmenstrual abdominal pain, the underlying cause are earth wet water cold, liver wood suppression, gram injury to the spleen. From the above descriptions of amenorrhea, leakage, late pre-menstruation, purple and black nodules, abdominal pain on menstruation, water and soil wet and cold, liver depression and wood trap is the main pathological factors of menstrual disease, pivotal movement, water and soil wet and cold, spleen Yang can not left, liver wood depression, liver Qi down, blockage of the meridians, menstrual blood clotting and stagnation, menstrual disease such as amenorrhea, late, premenstruation, leakage, purple and black nodules, abdominal pain on menstruation.

The treatment of menstrual disease and the use of prescriptions
Water, earth, wet and cold, liver and wood are the main pathological factors of menstrual disease, so Huang YuanYu proposed that "the method of regulating menstruation and nourishing blood, the first to Chong Yang is also the main." Chongyang means chongyang of the spleen and kidney. Huang Yuan Yu also made a metaphor for this "analogy in the earth, Yang winter, water springs warm, spring wood development, freezing ice, warmth, so everything is born. Make winter without underground warmth, although there is Yang and the commander, but also into the cold valley is not born." The spleen and kidney yang is strong, the spleen earth left, the stomach earth right, the axis of Qi lift in order, the kidney water warmth has the opportunity to develop, liver wood also rises, heart fire with the stomach earth right down, a gas flow, pivot movement, such as the ring endless, back and forth running. The liver is a major pathological factor in menstrual disease. The liver can be drained to relieve depression, activate blood circulation and remove blood stasis, and regulate the onset of menstruation and the first and last phases. De-stagnation of the liver, clearing heat and cooling the blood, restoring the smooth flow of liver qi, promoting the physiological activities of the internal organs of the body in an orderly manner, the normal transmission of qi, blood and fluid, the body is disease free.
In the treatment of menstrual disease, Huang Yuan-yu created Gui Zhi Dan Pi Tao Ren Tang, Gui Zhi Jiang Ling Tang, Gui Zhi Jiang Ling Oyster Soup, Jiang Ling Ah Gao Tang, Ling Gui Dan Shen Tang, and Gui Di Shao Yao Tang, which are simple and light in quantity, but effective as a rafter. In Huang Yuan-young's medicine, Gui Zhi, Gan Cao and Fu Ling each 6 times, Dan Pi each 5 times, Paeonia lactiflora, Gan Jiang and Shou Wu each 4 times, Dan Shen each 3 times, Tao Ren, Oyster, Agaricus, Angelica, Di Huang each 1 time, Huang Yuan-you only used 13 herbs for treating menstrual disease, Gan Cao and Gan Jiang earth qi medicine into the spleen and stomach meridian, sweet and warm, Chong Yang tonic fire, Gui Zhi, Dan Pi, Paeonia lactiflora, Agaricus, Tao Ren, Di Huang, Angelica, Dan Shen, Shou Wu wood qi medicine into Liver and gallbladder meridian, sour and pungent, dredge the liver and nourish the blood, poria, oyster water and fire medicine into the heart and kidney meridian, bitter and salty, heavy town to lower the rebellion, diarrhea and cultivate the earth. Huang Yuan Yu uses medicine to promote Yang and cultivate the earth, to support the Yang energy of the whole body, while using a variety of drugs into the liver and gallbladder meridian, warming the meridians, dredging the liver and cooling the blood, so that the wood qi can reach, draining the whole body qi, thus regulating the onset of menstruation and astringency.

Modern theoretical research and clinical application
Modern doctors have studied Huang Yuan-yu's theories, and have researched and discussed "one qi flow", "pivot movement", "earth pivot four elephants", and so on. "According to this theory, good results have been achieved in the treatment of clinical diseases. In modern times, the theory of "One Qi Circulation" is used to treat many diseases.
Medical practitioners treat amenorrhea from the perspective of the spleen and stomach in the earth [5] ; medical practitioners use the theory of "pivotal movement" to treat postpartum depression [6] , according to the academic idea of "pivotal movement", the liver rises to the heart and the spirit develops. "liver blood warming up, up and not already, warming into heat, then the heart fire; ...... God hair in the heart, the party its in the liver, God is not yet prosperous, but also now its Yang soul." liver wood with the movement of the gods, "four saints heart source -labor injury solutionspirit" said: "yin rise and yang fall, the right in the middle qi, the middle qi decay, lifting dereliction of duty, gold and water waste its collection, wood and fire depression of its growth, this spirit so separated and disease also." After a woman gives birth, there is a great deficit of Qi and blood, the spleen and earth is the source of Qi and blood biochemistry, the spleen and earth is deficient, the liver and wood have no source of ascension, the pivot movement has no left rotation, the person's Qi flow movement has no operation, so the woman is depressed after giving birth, according to this, the principle of treatment is to replenish Qi and blood, harmonize the liver and spleen, "the medicine of the doctor, the first in the middle qi" as the formulation idea, Huang Qi, Cornus officinalis Mr. Zhang Xicun on the Huang Yuan Royal doctrine research is quite insightful, the Huang Qi drug play, that [7] : "liver is wood and should be spring, its temperature and sex likes to strip, the nature of Huang Qi warm and rise to the original liver with the same gas sought the wonderful use. Fool since the evidence, where the liver is weak can not reach, with all the liver medicine are ineffective, heavy use of astragalus as the main, and less adjuvant to the Qi products, serve the re-cup that is seen to be effective." It provides a new reference for the treatment of postpartum depression.
The treatment of abdominal pain in pregnancy with Angelica Paeoniae San [8] , based on the academic idea of "pivotal movement", concluded that "wood depression, earth deficiency, water dampness" is the pathogenesis, the fetal body of pregnancy blocks the qi flow, the elevation of the middle earth does not work, forming earth deficiency, water dampness, the middle earth has no elevation, can not be left to rotate According to the mechanism of the disease, we adopt the treatment of tonifying the middle earth, drying dampness and draining the liver, with Paeonia lactiflora draining the depression of wood qi, Fu Ling, Bai Zhu and Ze Xie strengthening the spleen and drying dampness, cultivating the earth and draining water, tonifying the deficiency of earth qi and drying the water dampness of the middle earth, which has opened up new ideas for the treatment of abdominal pain in pregnancy. The treatment of polycystic ovary syndrome [9] is based on the theory of "one qi flowing around the body", taking spleen-kidney damp-cold and phlegmstasis interlocking as the pathogenesis, tonifying the kidney and strengthening the spleen, eliminating phlegm stasis and resolving phlegm as the treatment principle, and creating the original Suppression of Cystic Fertility Soup, which has achieved remarkable efficacy in menstrual disease cycle and reproductive function, improving endocrine metabolism and preventing long-term complications.
In the treatment of menstrual disorders, Guo Chengjie [10] , a master of Chinese medicine, emphasized "taking the liver as the pivot". In the treatment of menstrual disorders, he used Angelica sinensis, Radix Aromaticus and Radix et Rhizoma Yanhuo as the core drugs in the formula, which mainly enter the liver meridian, which is consistent with the treatment concept of "taking the liver as the pivot" and also in line with Huang Yuangyu's It is also consistent with Huang Yuan Yu's pathological factor of "wood depression". The "clinical guide to medical cases" said: "Women with liver as the first, Yin condensation, easy to brush depression, depression is also stagnant Qi and blood. Wood disease will affect the earth, so the second emphasis on the spleen and stomach". Famous veteran Chinese medicine doctor Zheng Huifang [11] gynecological diseases advocate the earth as the basis "earth is the mother of all things" and combined with the region, the modern environment proposed gynecological diseases to warm tonic for the method, warm tonic kidney, warm tonic spleen and stomach, which coincides with the theory of Huang YuanYu tonic earth heavy yang. The practitioner used the method of tonifying the kidneys and warming the yang to remove stasis to treat the kidney deficiency type of unruptured follicular luteinization syndrome [12] with good results, which also reflects the important role of kidney yang in gynecological diseases. Dr. Lv Hujun, chief physician [13] , emphasized the spleen and stomach in treating menstrual diseases, focusing on regulating the liver and the relationship between the five organs on menstruation, which is in line with Huang Yuan-yu's treatment of regulating menstruation and nourishing blood by tonifying the earth and regulating the liver. The experience of the famous old Chinese medicine doctor Xin Hao Yi [14] in treating menstrual disease, starting from regulating the liver, advocated that the method of tonifying the liver and spleen, nourishing the blood and blood should be used throughout the menstrual disease, and flexibly used Zhuangyao Wan plus or minus to treat menstrual disorders, which created more treatment ideas for Zhuangyao Wan, and Huang Yuan Yu's idea of "wood yu" was also given full play. Xiao Longyou [15] , one of the "Four Famous Doctors in Beijing" in the "Xiao Longyou Medical Collection -Gynecological Cases", in the chapter of "Menstrual Disorders", the most drugs attributed to the liver meridian, followed by drugs attributed to the spleen meridian, the treatment of menstrual disorders focus on regulating the liver, strengthening the spleen, spleen and kidney at the same time. Huang Yuan-young's treatment of menstrual diseases "water-cold, earth-damp, wood-depressed" and the method of regulating menstruation and nourishing blood, mainly based on Chong-yang, provided a wealth of reference experience for later medical practitioners to treat menstrual diseases. The modern healer Zhang Jian [16] used Ling Gui Dan Shen Tang with reduced foot bath to treat primary dysmenorrhea with excellent results, and used Huang Yuan Yu's own prescription to treat menstrual disorders and added a foot bath to this in an innovative way. The healer Wu Meiling [17] treats menstrual disease and dysmenorrhea from the spleen theory; the healer Xu Shoutian treats dysmenorrhea [18] and menorrhagia [19] from the spleen theory; the healer Luo Yuxue [20] treats premature ovarian failure from the spleen theory; the healer Lin Qiu [21] treats menorrhagia from the kidney theory, emphasizing the consolidation and restoration of the old, with the tonification of the kidney and the consolidation of the original; the healer Jia Liping [22] treats endometriosis from the method of tonifying the kidney and regulating the circumference and the method of eliminating stasis and eliminating symptoms, combining the use of eliminating stasis on the basis of tonifying the kidney, which is an innovation in the treatment method Many modern doctors treat gynecological diseases from internal organs such as spleen, liver and kidney, and put forward their own unique insights from theories, treatment rules, prescriptions and methods of treatment on these internal organs, which are in line with Huang Yuan-you's pathological factors of "water cold, wood depression and earth dampness", and modern doctors have given better play to the "pivot movement The theory of "pivot movement" has been better developed by modern doctors.

Summary
Huang Yuan-young's theory of "one qi flowing around, pivotal movement" has been applied to many diseases, and can also be used in the discussion of gynecological diseases. Although the location of menstrual disease is in the uterus, dampness and cold in the spleen and kidney, and depression of liver qi are important pathological factors. He proposes the treatment principle of tonifying fire with Yang and relieving liver qi, and has created the original formulas of Gui Zhi Dan Pi Tao Ren Tang and Gui Zhi Jiang Ling Tang, which can provide new ideas and guidance for the diagnosis and treatment of modern gynecological diseases.