The Baomai, Obstruction, and Hormonal Birth Control

Corinne Singer, Bing Yang

Editor’s Note: This is a specific expression of the theory of meridians in a holistic concept. All organs, including the uterus, have their own functions of Qi and blood circulation and metabolism. This is the role of meridians, which belong to the structure of their own organs and can also be linked to the relevant major meridians. The “Bao Mai” not only belongs to the function of the uterus itself and the structural channel of Qi movement but also connects with the Heart Qi. When connected with the major meridians, it is defined as the “origin of the One Source, Three Branches,” which refers to the origin of the Ren, Du, and Chong meridians.

An Introduction

The Yellow Emperor’s Inner Classic of Medicine offers incredible wisdom that one could easily spend a lifetime studying and yet only just begin to scratch the surface of. It is difficult for many of us in modern contexts to understand the kind of continuity with nature and all of life that the authors experienced in ancient times. Medicine was a matter of simplicity, while also being endlessly complex. Everything existed in microcosm and macrocosm, a fractal. So, it is almost impossible to argue with what was written from a contemporary standpoint, as it is almost guaranteed that we are not interpreting the full depth and meaning of the text. This article however, will try to engage with the concept of the Bao Mai, or Uterus Vessel.

According to the Nei Jing, the Uterus Vessel must remain unobstructed, or the period will not come and illness will result. However, according to the current biomedical model, one way to treat painful periods is by using hormonal birth control to stop the period from coming, thereby obstructing the Uterus Vessel. This topic is so important today, as many patients come into the acupuncture clinic who are dealing with menstrual and fertility problems. And, many of these patients are on hormonal birth control or are considering it as an option.

The Neijing

In the Neijing, authors emphasize the importance of an unobstructed Bao Mai as a key component of women’s physiology. In Chapter 33, authors write, “The Uterus Vessel pertains to the Heart and extends to the Uterus” and “When the period does not come it means the Uterus Vessel is obstructed” (Ni, 1995). Amenorrhea, thus, is a result of Bao Mai obstruction. Chapter 44 also includes, “Sadness leads to severance of the Uterus Channel: when this is severed Yang Qi is agitated in the Interior and the Heart causes menorrhagia” (Ni, 1995). Although there are many different patterns that may underlie painful periods, this quote emphasizes the fact that the uterus vessel needs to be intact in order for healthy periods to come. If the uterus is “severed,” or obstructed, illness results. Notably, there is also a relationship between the health of the Bao Mai and emotions, or in this case “sadness.” Emotional turbulence has a cyclical relationship with the health of the Bao Mai and uterus. Sadness can sever or obstruct the vessel, just as obstruction may create sadness or shen disturbance.

The Biomedical Approach

Nowadays, many years after the Neijing was written, medical doctors regularly prescribe

hormonal birth control to patients who have painful, or difficult periods. In one study, medical

researchers conducted a systematic review on the use of hormonal birth control in order to treat endometriosis. According to medical researchers, “CHC ［Combined Hormonal Contraceptives］ and POC ［Progestin Only Contraceptives］ treatments were associated with clinically significant reductions in dysmenorrhoea, often accompanied by reductions in noncyclical pelvic pain and dyspareunia and an improvement in QoL ［Quality of Life］” (Grandi, 2018). According to research, using hormonal birth control to alter or stop the periods has shown evidence of improving symptoms for patients experiencing uterine or pelvic pain, including PMS symptoms and emotional disturbance. There are many more studies that draw similar conclusions (Falcone, 2011).

It is important to recognize the way hormonal birth control works. Hormonal birth control “prevents ovulation” from occurring (Johnson, 2023). And, as ovulation does not occur, the period does not come. Even in patients who experience bleeding on their birth control, this is referred to as a “withdrawal bleed,” not a true period (Johnson, 2023). The pharmaceutical drug is inducing bleeding to shed the uterine lining, but it is not a true period, as no egg was ever formed or developed. Supporters of this approach within the biomedical model believe that by inhibiting ovulation and true menstruation, they can resolve patient’s menstrual dysfunction.

The Arguments

In the Nei Jing, the uterus is a sacred organ of utmost importance. It is where the Tian Gui flows and where all of life originates. The Bao Mai, or Uterus Vessel, connects the Uterus to the Heart. This connection hints at how menstruation is so intimately related to shen, our emotions, ourperceptions of the world around us, and the vibrancy of our spirits. A woman’s physiology depends upon the Bao Mai being open with blood flourishing and moving smoothly. Even in the western biomedical model, we may refer to this as the hypothalamuspituitaryovarianaxis, whereby open communication lines between the areas of the brain that produce reproductive hormones and the ovaries must be open in order for healthy menstruation to occur. This philosophy makes clear sense.

Women are designed to bleed every month, uninhibited. The uterus is meant to be nourished with blood, qi, and essence, so that a woman may be able to create and sustain life within her in the form of a baby if she chooses.

From the perspective of the biomedical model of pharmaceutical birth control, clinical results are what matter. According to many studies, hormonal birth control has helped patients relieve their painful periods and endometriosis. And, once again, the way that hormonal birth control works is by fundamentally obstructing or shutting down the hypothalamuspituitaryovarian axis, which some may compare to the Bao Mai. 〖JP+1〗One could argue that as long as patients are feeling better, that is all that matters. There does not need to be a philosophical concern about the importance of the Bao Mai, or even a physiological concern about vessel obstruction, as long as the patient feels better.

Conclusion

The philosophy presented in the Neijing directly opposes the philosophy presented by the biomedical model. This poses an incredible challenge for women’s health in the world and in the clinic, as practitioners have to reconcile these two approaches when working with patients and providing recommendations. Strategies of opening and nourishing the Bao Mai and uterus with acupuncture and herbs must now compete with strategies of shutting down women’s physiology and the hypothalamus pituitary ovarian axis with pharmaceutical drugs. But, this tension offers a rich area for further research and discussion, especially as Traditional Chinese Medicine becomes more integrated in hospital settings.

Resources

Falcone, T., & Lebovic, D. I. (2011). Clinical management of endometriosis. Obstetrics and gynecology, 118(3), 691–705. https://doi.org/10.1097/AOG.0b013e31822adfd1

Grandi, G., Barra, F., Ferrero, S., Sileo, F. G., Bertucci, E., Napolitano, A., & Facchinetti, F. (2019).

Hormonal contraception in women with endometriosis: a systematic review. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 24(1), 61–70. https://doi.org/10.1080/13625187.2018.1550576

Johnson, Tracy C. (2023). Birth Control Pills, WebMD. WebMD.

Mashing, Ni. (1995). The Yellow Emperor’s Classic of Medicine: A New Translation of the Neijing Suwen with Commentary. Shambala.

About the Author:

Corinne Singer graduated from the New England School of Acupuncture at the Massachusetts College of Pharmacy and Health Sciences. She is currently licensed as an acupuncturist in the states of Vermont and New Hampshire. Before earning her Master of Acupuncture degree, she graduated from Barnard College of Columbia University with a Bachelor’s degree in Urban Studies and Sustainability. In her clinical work, Corinne is most passionate about treating women’s health and chronic illness.

Bing Yang is an acupuncturist in Massachusetts. She received her bachelors and Master’s degrees in Acupuncture and Chinese Medicine from Beijing University of Chinese Medicine in the 1990s and her Doctoral degree from Massachusetts College of Pharmacy and Health Sciences (MCPHS). Currently she is the associate professor and Director of Chinese Herbal Programs of New England School of Acupuncture, MCPHS. She also maintains a private practice in Boston.

胞脈阻塞與荷爾蒙避孕

科琳·辛格 楊冰

編者按：這是經絡學説在整體觀念上的具體表現，所有臟器，當然包括子宫都有自己的氣血流通和代謝的功能，這就是脈絡的作用，既屬於自己臟器的結構，也可以和相關聯的主要脈絡鏈接。胞脈不但屬於子宫本身的功能和氣機運行的結搆通道同時也可以和心氣相通。在與主要經脈相連那就是“一源三岐”的定義了，也就是“任”“督”“冲”脈的起源之地。

導言

《黄帝内經》藴含着難以想象的智慧，人們可能花費一生時間來研究，却只能勉强觸及其中一小部分。對於我們現代人來説，在現代環境中很難理解古代作者所體驗到的與自然和生命的連續性。醫學既是一門簡單的事務，又是一門無窮無盡的復雜學科。一切存在於微觀和宏觀之間，宛如一個分形。因此，幾乎不可能從現代的觀點來質疑古代文本的内容，因爲幾乎可以確定我們並未解讀出其深度和意義的全部。然而，本文將嘗試探討胞脈的概念。

根據《内經》的記載，子宫脈絡必須保持暢通，否則月經將不會來潮，疾病將會發生。然而，根據當前的生物醫學模型，治療痛經的一種方法是使用荷爾蒙避孕藥來阻止月經來潮，從而阻塞子宫脈絡。如今，這個話題非常重要，因爲許多前來針灸診所就診的患者正在處理月經和生育問題。而且，其中許多患者正在使用荷爾蒙避孕藥，或者正在考慮將其作爲一個選擇。

《内經》

在《内經》中，作者强調暢通的胞脈作爲女性生理的關鍵組成部分的重要性。在第33章中，作者寫道：“子宫脈者，屬心，下至子宫”以及“月不往來者，子宫脈阻也”（倪文祥，1995年）。因此，閉經是胞脈阻塞的結果。第44章中還胞括： “憂惱令子宫脈斷，脈斷則陽氣内動，心氣令崩”（倪文祥，1995年）。盡管可能有許多不同的模式可以解釋痛經，但這一引用强調了子宫脈絡需要完整，以保持健康的月經。如果子宫“斷裂”或受阻，就會導致疾病。值得注意的是，胞脈的健康與情緒，或在這種情况下是“憂傷”，之間存在着關係。情緒的波動與胞脈和子宫的健康之間存在着循環關係。憂傷可以斷裂或阻塞脈絡，就像阻塞可能會引起憂傷或神氣紊亂一樣。

生物醫學方法

如今，在《内經》寫作多年之後，醫生們經常向痛經或月經困難的患者開處方，以使用荷爾蒙避孕藥。在一項研究中，醫學研究人員對使用荷爾蒙避孕藥治療子宫内膜异位症的情况進行了系統性回顧。根據醫學研究人員的研究，“聯合荷爾蒙避孕藥和單一孕激素避孕藥的治療與痛經明顯减輕有關，通常伴隨非週期性盆腔疼痛和性交痛的减少以及生活質量的改善”（格蘭迪，2018年）。根據研究，使用荷爾蒙避孕藥改變或停止月經已經顯示出改善子宫或盆腔疼痛、經前期綜合征症狀和情緒紊亂的證據。還有許多其他研究得出了類似的結論（法爾科尼，2011年）。

需要認識到荷爾蒙避孕藥的工作原理。荷爾蒙避孕藥“阻止排卵”（約翰遜，2023年）。由於没有排卵，月經也就不會來。即使在使用避孕藥的患者中出現了出血，這被稱爲“撤退性出血”，而不是真正的月經（約翰遜，2023年）。藥物誘導出血以排除子宫内膜，但這不是真正的月經，因爲没有卵子形成或發育。生物醫學模型内的支持者認爲，通過抑制排卵和真正的月經，他們可以解决患者的月經功能障礙。

論點

在《内經》中，子宫是至關重要的神聖器官。它是天癸流注之處，也是生命的根源。胞脈，或子宫脈絡，將子宫與心臟相連接。這種連接暗示了月經與神，我們的情感，我們對周圍世界的感知以及我們精神活力的密切關係。一個女性的生理狀况取决於胞脈的通暢，血液蓬勃流動。即使在西方生物醫學模型中，我們也可以將其稱爲下丘腦-垂體-卵巢軸，這意味着産生生殖激素的大腦區域與卵巢之間的通信綫路必須保持開放，以便進行健康的月經。這種哲學觀點是清晰合理的。

女性的生理搆造是每個月都會不受約束地出血。子宫應該以血液、氣和精進行滋養，使女性能够選擇在自己體内創造和維持生命，形成一個嬰兒的形式。

從荷爾蒙避孕藥的生物醫學模型的角度來看，臨床結果是最重要的。根據許多研究，荷爾蒙避孕藥已經幫助患者緩解了痛經和子宫内膜异位症的症狀。而且，再次强調，荷爾蒙避孕藥的工作方式基本上是通過根本性地阻塞或關閉下丘腦-垂體-卵巢軸，這與胞脈可能存在某種相似之處。可以提出這樣的論點：只要患者感覺更好，那就是最重要的。無需對胞脈的重要性産生哲學上的擔憂，甚至無需對脈絡阻塞産生生理上的擔憂，只要患者感覺更好即可。

結論

《黄帝内經》所闡述的哲學觀與生物醫學模型中的哲學觀直接相悖。這爲全球婦女健康以及臨床診所帶來了巨大挑戰，因爲從業者在與患者合作並提供建議時必須調和這兩種方法。通過針灸和草藥來開啓和滋養胞脈和子宫的策略現在必須與使用藥物來關閉女性生理和下丘腦垂體卵巢軸的策略競争。然而，這種緊張關係爲進一步的研究和討論提供了豐富的領域，尤其是隨着中醫在醫院環境中變得更加融合。

作者簡介

科琳·辛格 (Corinne Singer) 2023年畢業於美國馬薩諸塞州藥學與健康科學學院新英格蘭針灸學院，她目前在佛蒙特州和新罕布什爾州獲得針灸師執照。在獲得針灸碩士學位之前，她畢業於哥倫比亞大學巴納德學院，獲得城市研究和可持續發展學士學位。在她的臨床工作中，主要方向爲治療女性健康和慢性疾病。

楊冰，中醫師，九十年代畢業於北京中醫藥大學， 獲中醫學學士、碩士學位，後於美國麻省藥科與健康科學大學獲博士學位。現爲麻省藥科與健康科學大學新英格蘭中醫學院教授，中醫係主任，並在波士頓行醫。