In a healthy woman a slight amount of discharge from the vagina is normal; and it is normally colorless, odorless, somewhat viscid and very slight in amount. It forms from the moistening of the vagina under the control of the Ren and Dai Meridians, when kidney-Qi is ample and spleen functions are normal. During the intervals between menstrual periods, especially the days preceding or following menstrual flow, and during pregnancy, it may be somewhat increased.
It is abnormal if its quantity is significantly increased or it has an abnormal color, texture or odor, especially if other symptoms, whether local regional or generalized, accompany the vaginal discharge.
For convenience, the term vaginal discharge is often used to signify abnormal vaginal discharge when the context is clear.
(Note: for vaginal discharge caused by sexually transmitted diseases, an antibiotic is the treatment of choice even in traditional Chinese Medicine hospitals in China.)
Etiology and Pathology
The chief pathological mechanism underlying abnormal vaginal discharge is the Dampness evil affecting the Ren and Dai Meridians, so that Dai has lost its control and Ren has become infirm. Dampness may be exogenous or endogenous. Exogenous Dampness is the Dampness evil invading the body. Endogenous Dampness is generated in the body, usually when the spleen is insufficient and unable to carry out its digestion and transportation functions properly or when the kidney is insufficient and unable to control fluids.
Spleen Insufficiency. Several situations lead to deficiency of spleen-Qi. The most common are improper diet, physical exhaustion, much brooding and emotional depression. Injury to spleen-Qi leads to impairment of the spleen’s functions of transportation and transformation, so that the essences of foods and drinks cannot be extracted and made available for generating blood. Instead, they accumulate and transform into Dampness, which flows downward and injure the Ren and Dai Meridians. Injury to Ren and Dai then leads to the formation of vaginal discharge.
Kidney Insufficiency. Deficiency of kidney-Qi may reflect a chronically weak constitution, inadequate prenatal endowment, overindulgence in sexual activity or multiple childbirth. Injury to kidney-Qi causes failure in its function of secure storage and this leads to downward escape of Yin-fluid. In some patients, kidney-Yin is specifically deficient, so that deficiency Fire arises. The Ren and Dai Meridians become infirm, and vaginal discharge ensues.
Dampness-Heat Poisons. Following menstrual flow or childbirth the uterine channels are empty. In such a circumstance, failure in personal hygiene, living in a cold and damp environment or injury from surgical operations enables exogenous Dampness to invade. If Dampness accumulates and transforms into Heat, it may injure the Ren and Dai Meridians, leading to vaginal discharge. In some patients, Dampness and Heat in the liver meridians flow downward or the poisons from Heat injure the blood channels; these may also lead to vaginal discharge.
Protracted vaginal discharge may injure Yin-fluids. If it is due to exogenous Dampness then the illness may transform into one of mixed strength and deficiency. If it is due to endogenous Dampness then the deficiency may become aggravated. Hence it is important to treat vaginal discharge early.
Clinical Manifestation
Vaginal discharge is abnormal when its volume is significantly increased. In color it may be white, yellow or mixed white and red. In texture it may be thin or viscid. In odor it may be fishy or foul. There may be such additional symptoms as itch or burning pain in the vulva, dark urine, cold limbs, aching weakness in the waist or fatigue.
Herbal Treatment
In the analysis of vaginal discharge, pay particular attention to its quantity, color, texture and odor, and to the main accompanying symptoms. The therapeutic approach is principally to strengthen the spleen, raise Yang, eliminate Dampness, supplemented with firming the kidney, unblocking the liver, cooling Heat and dispelling Cold.
Spleen Insufficiency
Main Symptoms. The discharge is copious and persistent, the color is white or pale yellow, the texture is viscid and there is no foul odor. Additional symptoms include lustrous white or sallow complexion, cold limbs, lassitude, anorexia, loose feces and edema in the feet. The tongue is pale, with a white or greasy coating. The pulse is even but feeble.
Therapeutic Principle. Strengthen the spleen, augment Qi, raise Yang and eliminate Dampness.
Treatment. Wan Dai Tang (Discharge-Resolving Decoction). It has the following composition: baizhu (Atractylodes) 15 g, shanyao (Dioscorea) 30 g, renshen (Panax) 10 g, baishaoyao (Paeonia) 20 g, cangzhu (Atractylodes) 10 g, charred jingjie (Schizonepeta) 10 g, gancao (Glycyrrhiza) 5 g, chenpi (Citrus tangerina) 6 g, chaihu (Bupleurum) 6g, and cheqianzi (Plantago) 10 g.
If Dampness accumulates in spleen insufficiency and transforms into Heat, so that the vaginal discharge is yellow, viscid, lumpy, and malodorous, it is appropriate to strengthen the spleen, eliminate Dampness, cool Heat and stop the discharge. An appropriate formula is Yi Huang Tang (Decoction for Yellow Discharge). It has the following composition: shanyao (Dioscorea) 30 g, Qianshi (Euryale ferox) 15 g, huangbai (Phellodendron) 12 g, cheqianzi (Plantago) 10 g, and baiguo (Ginkgo biloba) 10 g.
Kidney Insufficiency
Kidney-Yang Deficiency
Main Symptoms. The vaginal discharge is white, clear and thin, but copious and dribbling all day long. The waist aches as though broken. There may be a sensation of coldness in the lower abdomen. The urine is clear and increased in volume, especially at night. The feces are loose. The tongue is pale, with thin white coating. The pulse is deep and slow.
Therapeutic Principle. Warm the kidney, support Yang, astringe essence and stop discharge.
Treatment. Nei Bu Wan (Kidney-Restoring Pill). It has the following composition: lujiao (Cervus nippon) 3 g, tusizi (Cuscuta) 15g, tongjili (Tribulus terrestris) 12 g, huangqi (Astragalus) 20 g, rougui (Cinnamomum) 3 g, sangpiaoxiao (Paratenodera) 15 g, roucongrong (Cistanche) 12 g, processed fuzi (Aconitum) 10 g, baijili (Tribulus terrestris) 12 g, and ziwan (Aster tartaricus) 10 g.
If the feces are loose, remove roucongrong and add buguzhi (Psoralea) 15 g and roudoukou (Myristica fragrans) 10 g.
Kidney-Yin Deficiency
Main Symptoms. The vaginal discharge is red and white, slightly viscid and without foul odor. There is a burning sensation in the vulva. Additional symptoms include dizziness and blurred vision, or flushed face, hotness in the five centers, insomnia with dream-filled fitful sleep, constipation and dark urine. The tongue is red with scant coating. The pulse is threadlike and mildly rapid.
Therapeutic Principle. Nourish the kidney, augment Yin, cool Heat and stop discharge.
Treatment. Zhi Bai Dihuang Tang (Anemarrhena-Phellodendron-Rehmannia Decoction) augmented with Qianshi and jiyingzi. The complete composition is as follows: shudihuang (Rehmannia) 15 g, shanyao (Dioscorea) 15 g, shanzhuyu (Cornus) 10 g, fuling (Poria) 20 g, zexie (Alisma) 15 g, mudanpi (Paeonia suffruticosa) 10 g, huangbai (Phellodendron) 12 g, zhimu (Anemarrhena) 10 g, Qianshi (Euryale ferox) 15 g, andjinyingzi (Rosa laevigata) 12 g.
Dampness-Heat
Main Symptoms. The vaginal discharge is copious. The color is yellow or mixed yellow and white. The texture is viscid. The odor is foul. In some patients the discharge is white but like bean curd, and there are vulvar itch and scant dark urine. Some patients have chest tightness, a sticky mouth and reduced appetite. Others have vague pains in the lower abdomen. The tongue coating is yellow and greasy, or thick. The pulse is soft and mildly rapid.
Therapeutic Principle. Cool Heat, eliminate Dampness and stop discharge.
Treatment. Zhi Dai Tang (Discharge-Stopping Decoction). It has the following composition: zhuling (Polyporus) 20 g, fuling (Poria) 30 g, cheqianzi (Plantago) 15 g, zexie (Alisma) 15 g, yinchen (Artemisia scoparia) 15 g, chishaoyao (Paeonia lactiflora) 12 g, mudanpi (Paeonia suffruticosa) 10 g, huangbai (Phellodendron) 12 g, zhizi (Gardenia jasminoides) 10 g, andniuxi (Achyranthes) 10 g.
If Dampness and Heat flow downward from the liver meridians, with copious yellow or yellow-green vaginal discharge that is viscid or foamy and malodorous, vulvar itch or pain, dizziness, blurred vision, a bitter taste, a dry throat, agitation and irascibility, then the appropriate approach is to cool the liver and eliminate Dampness. Use Longdan Xie Gan Tang (Liver-Clearing Gentiana Decoction).
Dampness Poison
Main Symptoms. The vaginal discharge is copious. The color is either mixed red and white or multi-colored. The texture is viscid, sometimes pus-like. The odor is foul, sometimes putrid foul. Additional symptoms include lower abdominal pain, restlessness, a dry mouth, dizziness especially in the afternoon, foul-smelling and dry feces and scant dark urine. The tongue is red, with dry yellow coating. The pulse is rapid.
Therapeutic Principle. Cool Heat, detoxify poison and eliminate Dampness.
Treatment. Wu Wei Xiao Du Yin (Five-Ingredient Detoxification Drink) augmented with baihuasheshecao, tufuling and yiyiren. The augmented composition is as follows: pugongying (Taraxacum) 20 g, jinyinhua (Lonicera) 15 g, yejuhua (Chrysanthemum indicum) 12 g, zihuadiding (Viola) 12 g, tiankuizi (Semiaquilegia adoxoides) 10 g, baihuasheshecao (Oldenlandia diffusa) 12 g, tufuling (Smilax glabra) 15 g, and yiyiren (Coix) 20 g.
Vulvar Itch
If the patient has vulvar itch in addition to vaginal discharge, topical treatment may be applied in addition to appropriate treatment for the condition. Topical treatment may be in the form of wash or powder application.
Ta Yang Tang (Itch-Stopping Decoction) has the following composition: heshi (Carpesium abrotanoides) 30 g, kushen (Sophora) 30 g, weilingxian (Clematis) 30 g, danggui (Angelica) 15 g, shechuangzi (Cnidium monnieri) 15 g, and langdu (Euphorbia fischeriana) 15 g. Use the decoction to wash once daily, usually for 10 days. Adding the contents of two hog gallbladders at the time of application makes the wash even more efficacious. Note: if there is ulceration do not apply.
Shechuangzi San (Cnidium Powder) has the following composition: shechuangzi (Cnidium monnieri) 15 g, huajiao (Zanthoxylum bungeanum) 15 g, mingfan (alum) 15 g, kushen (Sophora) 15 g, and baibu (Stemona) 15 g. Use the warm decoction to steam the vulva, then bathe in it. Treat once daily for 10 days. Note: if there is ulceration remove huajiao from the formula.
The following medicinal powder is designed for vulvar itch with ulceration. It has the following composition: zhenzhu (pearl) 3 g, Qingdai (Baphicacanthus cusia) 3 g, xionghuang (realgar) 3 g, huangbai (Phellodendron) 9 g, ercha (Areca catechu) 6 g, and bingpian (Dryobalanops) 0.03 g. Grind together into a fine powder and apply topically. (Note: ercha is the juice pressed from the center of the herb binglang.)
Acupuncture Treatment
For vaginal discharge in general, select the acupoints Daimai (GB-26), Baihuanshu (BL-30), Qihai (RN-6) and Sanyinjiao (SP-6).
For Dampness-Heat, add the acupoints Xingjian (LR-2) and Yinlingquan (SP-9). For spleen and kidney insufficiency, add the acupoints Guanyuan (RN-4) and Zusanli (ST-36).
Case Study
The patient was a 27-year old unmarried woman, who had a history of late onset of menarche. She now presented with vaginal discharge of 6 months’ duration. The discharge was thin but profuse. Her menses were decreased in volume. She also had dizziness, aching in the waist, cold limbs, and a pale complexion. Her tongue was plump, and her pulse threadlike and forceless. Gynecological examination was entirely normal.
Diagnosis. Vaginal discharge due to kidney-Yang deficiency.
Therapeutic Principle. Strengthen the kidney and stop discharge.
Treatment and Course. The prescribed formula had the following composition: lujiao slices (Cervus nippon) 15 g, roucongrong (Cistanche) 15 g, tusizi (Cuscuta) 30 g, shudihuang (Rehmannia) 10 g, fupenzi (Rubus chingii) 12 g, haip-iaoxiao (Sepiella maindroni) 12 g, jinyingzi (Rosa laevigata) 24 g, gouji (Cibotium barometz) 12 g, shanzhuyu (Cornus) 10 g, and gancao (Glycyrrhiza) 6g.
After seven daily doses, the patient returned for follow-up. The discharge had decreased markedly and her menstrual period came at its due time with a normal amount of menses. She felt much better overall. The same formula was continued for a while to consolidate therapeutic gains.
