Selected Writings from Zhu Xiao Nan’s Gynecological Experience
People's Medical Publication House, Beijing, 2005

Pages 165 – 172

Translation by: Diana Hester, Laura Camus, Ryan Kirkby

Chong and Ren are two vessels of the Qi Jing and Ba Mai.  The meaning of Chong is “the main rushing pathway”, (because) the blood of the Zang Fu and Channels are all passing through the Chong vessel, so it is the main thoroughfare for all twelve channels.  It is also the sea of channels and collaterals; therefore it is called the sea of blood. The meaning of Ren is (to be in charge) of generating and nurturing.  Ren vessel is in charge of the generating and nurturing responsibility for the entire body’s Yin vessels. It also relates to women’s pregnancy.  The functions and pathological changes also relate to other various medical specialties.  But its main function is directly connected to the gynecological aspects, especially with menstruation, vaginal discharge, the fetus and delivery.

            The Chinese classic medical texts always state that Chong and Ren are the guiding principle in diagnosis and treating gynecological disease.  For example, <<Fu Ren Liang Fang. Bo Ji Fang Lun Er>> states: “there are thirty three kinds of gynecological disease, they are all due to the exhaustion strain.”  Xu Ling Tai from the Qin dynasty also says in <<Yi Xue Yuan Liu Lun>> : “Both Chong and Ren vessels originate from the uterus, ascend along the interior of the back, they are the sea of vessels, the uterus is the place where blood is generated and the fetus comes from.  Understand the Chong and Ren and one will thoroughly understand the root issue (of disease); when disease happens, no matter how complex it is, one can know where the root problem of the disease is.”

            Chong and Ren have an intimate relationship with the heart, liver and spleen.  This is because heart generates the blood, liver stores the blood, and spleen governs the blood.  Chong and Ren are the sea of the blood.  Ren also generates and nurtures the Yin vessels.  Therefore, the diseases of these organs tend to transmit to Chong and Ren via the Channels and Collaterals.  From the Channels and Collaterals aspect, Chong and Ren have connection with foot Tai Yin, foot Yang Ming, foot Shao Yang, and foot Jue Yin.   In order to understand physiology and pathology of both Chong and Ren, one has to first understand their relationship with the above Channels.  

Chong and Ren and the Spleen and Stomach

The Chong is the sea of blood, the Ren governs the uterus and fetus, yet both supplement each other and are closely linked.  The Chong governs menses, the source of menses is blood, and blood is transformed from the spleen and stomach, therefore the ancients identify the Chong vessel as being subordinate to the Yangming.  Ye Tian Shi says {lin zheng zhi nan yi an} says:  “The Chong and Ren are subordinate to the Yangming,” “the arrival of the menses, goes down from the Chong vessel, and the stomach channel is in charge of this vessel (the Chong).”  Qin Tian Yi summarized Ye Tian Shi’s theory saying: “the Chong vessel is the foundation of the menses, however the transformation of blood and qi is because of food and water; if food and water flourish then blood and qi will also flourish, if food and water decline then blood and qi will also decline, again this sea of water and food depends on the Yangming.  It appears that the Chong and Ren’s blood is always based on the transformation of water and food in the Yangming, furthermore Yangming stomach qi is the root of the Chong vessel.”  The stomach of the Yangming and the spleen of the Taiyin have a mutual interior exterior functioning relationship; the two of them have a relationship required for the creation and transformation of blood.  The Ren governs the uterus and fetus, support and nourishment for the uterus and fetus must depend on the spleen and stomach, therefore Ye Tian Shi says: “obviously the Chong, Ren, and the sea of blood, all belong to and are governed by the Yangming.”  The Chong vessel in relation to the channels and collaterals and foot Yangming stomach channel; “they converge at the genital region, and they meet at Qi Jie (ST-30),” similarly the points follow up the abdomen.  Accordingly the Ren vessel has points that are shared where the spleen and stomach channels both mutually converge:

Ren vessel and the spleen channel meeting points: Ren-3, Ren-4, Ren-10 and Ren-17

Ren vessel and the stomach channel meeting points: Ren-12, Ren-13, Ren-24

Stomach channel and Ren vessel meeting point: St-1

{fu Ren liang fang} says “milk is supplied by the Chong and Ren, if an illness is in a woman’s Chong and Ren the milk will be scant and yellow in color, if she gives birth (will be) weak with lots of illness.”  Li Dong Yuan’s {lan shi mi zang · three discussions of amenorrhea not moving} writing says: “if a woman’s spleen and stomach are chronically vacuous……the sea of blood becomes withered and exhausted, disease is called desiccated blood and exhausted menses.”  From this you can see the intimate relationship between the spleen/stomach and the Ren and Chong.  With spleen vacuity and stomach weakness, there is low appetite, suffering and obstruction of transformation and transportation.  This can cause Chong and Ren blood vacuity; above there will be a lack of milk, below there will be amenorrhea.

The Chong the Ren and the Liver

The Chong the Ren and the liver have a very intimate relationship.  The liver stores blood, the Chong vessel is again the sea of blood, therefore the function of the liver organ can be exuberant or decline and become insufficient, this influences whether the sea of blood is full or empty.  The liver wants to be open, it easily becomes depressed, when there is liver stasis there is qi stagnation and can lead to blood stasis, which can influence the Chong vessel, this results in solid masses in the uterus.  Similarly the {Nan Jing · chapter 29} states “when the Ren is diseased, then internal pain binds, the male will reflect with seven Shan (disorders), the female reflects with lower abdominal masses” Liver depression over time can transform into fire.  This is the cause of pregnancy morning sickness, this frequently causes liver channel depression, depressed fire affects the Chong vessel and leads to ascending counterflow, similarly Tang Rong Chuan {zhong xi hui tong yi jing jing yi} states: “all counterflow including vomiting, cough, choking, nausea etc., originally this is Chong vessel qi counter flow, the head, eyes, throat and area within the chest suffer disease, without exception this is heart and liver fire forcing the Chong vessel to have upward movement.”  Ye Tian Shi says: “Chong vessels upward surging attacks the stomach and causes vomiting.”

From the channels and collaterals perspective, the Chong and Ren rise from within the uterus and the vagina is encircled by the foot Jueyin liver channel therefore the relationship is very close; but the Ren vessel and the liver channel have mutual meeting points, for example Ren-2, Ren-3, Ren-4 etc.

Chong, Ren, and Kidney

The relationship of the Chong, Ren, and Kidney is (of the) most intimate (nature).  The physiological aspect is as the Su Wen (Shang Gu Tian Zhen Lun) says: “A woman’s Kidney Qi, at 7 years, is flourishing/vigorous, the teeth come in and the hair grows.  By 14 years of age Tian Gui (female reproductive essence) reaches its peak, the Ren Mai is open/flowing, the Great Chong vessel is flourishing, the menses begins (to flow), and therefore (she) can bear a child.” 

<<Nan Jing * 36^th Difficulty>>  Identifies the function of the Kidney as: “In males used to store essence (jing), in females to link to the uterus.”  Clarification: * Qian Guo Bin says: “Menses are rooted in the Kidney, they flourish in the Chong and Ren vessels.”

<<Nu Ke Jing Lun>> says “(the) 8 (extraordinary) vessels belong to the Kidney.” All (above examples) clarify the close relationship between the two of them (Kidney and Chong/Ren).

From the Jing Luo (channels and network vessels) perspective, the Chong vessel is: “(the) pouring (of) Foot Shao Yin Kidney Channel’s great Luo (vessel)”.  At the abdominal area (the Chong) also comes together with (has points along) the stomach channel, around the navel area and above, moreover the Chong Mai itself does not have acupuncture points (shu xue); a large portion of the points are overlapping the Kidney Channel’s points.

As for Ren Mai, it is governing the uterus and the fetus, Kidney again is linking to the uterus, moreover it also has some acupuncture points that intersect with the Kidney channel points:

Chong Mai points shared with the Kidney channel: Heng Gu (Kid 11), Da He (Kid 12), Qi Xue (Kid 13), Si Man (Kid 14), Zhong Zhu (Kid 15), Shang Qu (Kid 17), Huang Shu (Kid 16), Shi Guan (Kid 18), Yin Du (Kid 19), Tong Gu (Kid 20), You Men (Kid 21).

(Hui) Meeting points of the Ren Mai and Kidney: Zhong Ji (Ren 3), Guan Yuan (Ren 4), Yin Jiao (Ren 7), Shan Zhong (Ren 17).

Kidney links to the uterus, Kidney qi weakness often affects Chong and Ren leading to spotting (bleeding) from uterus, miscarriage and other diseases of pregnancy.  (If) Kidney qi is flourishing, then Chong and Ren (will be) flowing and flourishing, and then menses can occur; If Kidney is in decline, and pre-heaven (essence) is not sufficient, both Chong and Ren vessels also can continuously take in and receive influences (external pathogens), it (then) occurs that menses will not come at the age when should have menses, and diseases of insufficient growth and development will occur.

Disease mechanism of Chong and Ren

The emergence of gynecological disease and imbalance of Chong and Ren function has (a) close relationship, but (with) further investigation of the form of Chong and Ren pathological changes, (one) may divide (it) into two parts:

One is the pathological changes of Zang Fu, Qi, blood, and other channels and collaterals, (which) influences the function of Chong and Ren.  The other is each type of factor (that) results in disease (Three causes – external factors, internal factors, and neither external nor internal factors) (and) directly causes Chong and Ren harmful changes and influences Zang Fu, Qi, Blood, and other channels and collaterals and produces disease.

Specific manifestations are listed in the following table:

1. Menses  -  Chong and Ren suffer damage, menses lose regulation (see <Zhu Bing Yuan Hou Lun>)

2. Discharge – Ren Mai damp heat, (leading to) occurrence of yellow discharge (see <Fu Qing Zhu Nu Ke>); Chong and Ren vacuity and damage, discharge is pure white (see <Zhu Zhi Zhun Sheng>)

3. Pregnancy  -  Liver fire mixed with upward counterflow of Chong vessel, (leading to) occurrence of morning sickness (see <Zhong Xi Hui Tong Yi Jing Qing Yi * Xia Juan * Zhu Bing Suo Zhu Pian> ); Chong and Ren Qi Vacuity, (leading to) occurrence of uterine bleeding during pregnancy (see <Zhu Bing Yuan Hou Lun>).

4. Delivery/labor -  Chong and Ren damage, result in post-delivery persistent flow of the lochia and severe flooding (uterine bleeding) (see <Fu Ren Mi (bi) Ke>); Chong and Ren have disease, result in insufficient lactation (see <Fu Ren Da Quan Liang Fang>).

5.  Other –  Chong and Ren is diseased, (leading to) women’s infertility (See Li Shi Zhen <Qi Jing Ba Mai Kao * Chong Ren Wei Bing>, Yin Wang Shu He <Mai Jing>); “Ren Mai is diseased, ….  Woman have vaginal discharge with masses” (See <Su Wen * Gu Kong Lun>)

On the basis of the above-mentioned sources, (one) can see that:

(1) Always as a result of Zang Fu pathological changes Chong and Ren’s (function/health) is influenced, and can carry out diagnosis according to location of symptom occurrence.

For example the symptom of (lou) uterine bleeding: if they tend to have it during the early part of pregnancy, and have lower back pain/aches, and the fetus is restless, and other symptoms, it belongs to Kidney vacuity type (syndrome); In the event of late pregnancy spotting red (blood) being present, then it belongs to Chong and Ren’s lack of power to solidify/consolidate.

(2) Always as a result of three causes directly influencing the Chong and Ren’s (function/health), for example having sex while menstruating giving rise to Beng Lou (flooding and spotting), scraping the uterus (DNC?) afterwards leads to small abdomen pain and vaginal bleeding, etc., both are belonging to Chong and Ren damage or vacuity types of syndromes.

Herbs that enter the Chong and Ren

            There are herbs that enter all 12 Channels.  However, on the issue of herbs that specifically treat the Chong and Ren, ancient physicians have three opinions as follow.

1). One opinion is that there is no herb specific for the Chong and Ren, for example Qin dynasty’s Liu Bao Yi states in Liu Xian Si Jia Yi An: “there is no disease that specifically belongs to extraordinary vessels in the history, therefore, there is no herbs that specifically enter extraordinary vessels either.  From textual research of the internal channels, eight extraordinary vessel pathways and previous specialist’s discussion, they all said if there is Qi and blood surpluses in the 12 channel, it will over flow to the extraordinary vessels.  If there is disease, it will also worsen over the time.  The disease invades from the main channels.  Therefore, one should focus on the main channel when using the medicine to treat the disease.                 

2). Another viewpoint is that there are herbs particular for the Chong vessel.  For example, Xu Ling Tai, form Qin dynasty says in the commentary of Lin Zheng Zhi Nan Yi An: “the extraordinary vessels are the overflow of the main 12 vessels which can govern the extraordinary vessels.  Only the Chong vessel is the sea of the blood.   All matters of women and vaginal discharge are relying on it.

3). The third opinion suggests there are specific treatment methods for 8 extraordinary vessels.  Ye Tian Shi documented many experiences using the concepts of extraordinary vessels in treating gynecological diseases.  He uses formulas and herbs in treating damage to the 8 extraordinary vessels that are different from ordinary tonify spleen, liver and kidney herbs.

There is not a record of herbs entering extraordinary vessels in the Divine Husbandmen’s Classic of the Materia Medica or other ancient classical medicine text.  After Tang dynasty, physicians accumulated and collected valuable clinical experience, and gradually came out with the conclusion about the herbs that enter the 12 vessels.  As for the 12 vessels, and the herbs that enter Chong and Ren, these are also recorded in Ben Cao series (of texts).  For example, Wang Hao Gu for Yuan dynasty says in汤液本草, under the section of Wu Zhu Yu says: “if the Chong vessel has disease with counter flow of Qi and internal urgency, it will be suitable to use it (which means Wu Zhu Yu).  In “The Grand Materia Medica” under the section of Ba Ji Tian it records: “tonify sea of the blood”.  In De Pei Ben Cao it also has statements like: “Lu Rong enters Chong, Ren and Du vessel, and greatly tonifies blood.  There is no comparison between grass and trees which don’t have consciousness, with the strength of Lu Rong”.  Another example in Fu Qing Zhu Nu Ke says: “use Ba Ji Tian and Ba Guo to open up the Ren vessel”.

Not only are there herbs that enter Chong and Ren vessels, but also particular formulas for treating disease of Chong and Ren.  In Ji Yin Gang Mu, the formulas for treating gynecological disease, it clearly indicates the formulas for treating Chong and Ren are: Si Wu Tang, Rong Fu Tang, Duan Xia Tang, Fu Long Gan San, Shen Xian Ju Bao Dan, Tiao Sheng Wan, Qin Gui Wan, Nan Yue Wei Fu Ren Ji Yin Dan, Nei Bu Wan, Da Sheng Ce Lan San and other formulas.  Yu Jia Yan in Yu Yi Cao records experience of using Long Hui Wan in treating Yang family’s oldest daughter’s amenorrhea.  He claims “it (Long Hui Wan) can collect blood and let it down flow in to Chong vessel.  Therefore, the heat will be cleared and menses will flow”.  Wang Meng Ying even has a formula of warming and nourishing extraordinary vessels.  In (“Wang Shi Yi An Yi Zhu. Juan Jiu”) commentary of Zhao’s case: Gui Ban, Lu Jiao Shuang, Dang Gui, Fu Ling, Gou Ji Zi, Gan Cao, Shao Yiao, Wu Zei, Rou Cong Rong, Pu Tao. In addition, Gui Lu Er Xian Jiao is commonly known as a famous formula to tonify both Chong and Ren.

Herbs that enter the Chong Mai

Tonify Qi of the Chong Mai:

Wu Zhu Yu (<Ben Cao Gang Mu>  Yin Wang Hao Gu Yan)

Ba Ji Tian (<Ben Cao Gang Mu>)

Gou Qi Zi

Gan Cao

Lu Xian (<De Pei Ben Cao>)

Lu Rong (<Nu Ke Yao Zhi>)

Zi He Che

(Rou) Cong Rong

Zi Shi Ying (fluorite)

Du Zhong (<Lin Zheng Zhi Nan Yi An>)

Tonify Blood of Chong Mai

Dang Gui

Bie Jia

Dan Shen

Chuan Xiong (<De Pei Ben Cao>)

Descend Counterflow of Chong Mai

Mu Xiang

Bing Lang (<De Pei Ben Cao>)

Consolidate Chong Mai

Shan Yao

Lian Zi (<Fu Qing Zhu Nu Ke>)

Herbs that enter Ren Mai

Tonify Qi of Ren Mai

Lu Rong (<Nu Ke Yao Zhi>)

Fu Pen Zi (<Lin Zheng Zhi Nan Yi An>)

Zi He Che (<Xing Xuan Yi An *Ji Lu>)

Tonify Blood of Ren Mai

Gui Jia

Dan Shen (<De Pei Ben Cao>)

Consolidate Ren Mai

Bai Guo (<Fu Qing Zhu Nu Ke>)