Menstruation, pregnancy, delivery, child feeding and leukorrhea are all related to the viscera and meridians. Thus, visceral dysfunction, disorder of qi and blood, as well as damage to the thoroughfare vessel, conception vessel, governor vessel and belt vessel due to invasion of pathogenic factors may all lead to gynecological disease. 

Blood, essential to the health of woman, is transformed by the spleen and stomach, governed by the heart, stored in the liver and distributed by the lung to the whole body. The disorder of one viscus or the attack of any pathogenic factors on the viscera may lead to woman disease. 

The kidney is essential to life, the bose of primordial qi and connected with the uterine collaterals. Insufficiency of kidney qi or asthenia of kidney yin or declination of kidney yang inevitably leads to woman disease. Deficiency of kidney yin and asthenia of both essence and blood cause delayed menstruation, scanty menstruation or amenorrhea.Relative hyperactivity of asthenia fire in the kidney will drive blood to flow abnormally, eventually resulting in early menstruation, profuse menstruation, metrorrhagia and metrostaxis, uterine bleeding during pregnancy and restless movement of fetus. Blood dryness due to heat may bring about amenorrhea. Insufficiency of kidney yang will lead to interior exuberance of cold, giving rise to sterility, leukorrbogia, abortion and premature delivery, etc.

The liver prefers free action and detests depression. Liver depression and qi stagnation may lead to delayed menstruation, irregular  menstruation, dysmenorrhea, amenorrhea and various symptoms before menstruation.Deficiency of liver yin and hyperactivity of liver yang generate endogenous wind and lead to premonitory signs of eclampsia gravidarum or eclampsia gravidarum. Impairment of the liver may drive liver qi to flow adversely upward and lead to hematemesis and epistaxis. Attack of liver qi on the stomach may bring about morning sickness. 

The spleen (stomach) is the source of transformation and commands blood. Impairment of the spleen and stomach may result in delayed menstruation, scanty menstruation, amenorrbea, sterility and hypngalactia. Asthenia of spleen qi may cause abnormal circulation of blood and lead to profuse menstruation and metrorrhagia and metrustaxis. Sinking of gastrosplenic qi may result in prolapse of the uterus. Failure of spleen yang to transport cereal nutrients may give rise to dampness accumulation, fluid retention, production of phlegm and downward migration of dampness which, in turn, lead to leukorrhagia. Retention ot fluid in the muscular interstices causes edema during pregnancy. Accumulation of dampness into phlegm obstructs the thoroughfare and conception vessels and leads to amennrrhea and sterility. 

Besides, the heart governs blood and the lung governs qi. Overstrain of the heart may lead to deficiency of heart yin, hyperactivity of heart fire and consumption of blood by fire and heat, eventually resulting in amenorrhea. Asthenia of pulmonary qi or obstruction of pulmonary qi affects blood circulation and causes amenorrhea. 

Since there exist relations of mutual promotion, restraint and dependence among the viscera, the disorder of one viscus may involve the others. For example, liver is being promoted by the kidney, so kidney disease may involve the liver. Similarly the kidney is being promoted by the lung, the disorder of the lung will involve the kidney, leading to disorder simultaneously involving the liver and kidney as well as the lung and kidney. Besides, there exists a mutual promoting relationship between yin and yang among the zangfu-organs. Because of such a relationship, the disorder of one zang-organ or fu-organ may affect the other. 

For example, failure of kidney-yang to warm spleen-yang and failure of kidney-yin to coordinate with heart-yin may result in simultaneous disorder of the spleen and kidney as well as the heart and kidney. The disorders of visceracaused by other individual organs also follow such an order. Such an interaction among the viscera is different in principal and secondary symptoms, so the pathological conditions may vary from one disease to another. 

   

Apart from the influence of mutual promotion and restraint among the viscera, visceral dysfunction may gradually transmit and change during the course of a disease. For example, improper diet, overstrain or impairment of the spleen by excessive contemplation may affect the functions of transformation, transportation and distribution of the spleen, leading to abdominal fullness, epigastric distress, loose stool and severe palpitation followed by poor appetite, asthenia of both the spleen and stomach, insufficiency of transformation and emptiness of the uterus, eventually resulting in amenorrhea. 

Asthenia of both the spleen and stomach and lack of proper moistening and nutrition in the lung will bring about cough, dyspnea and shortness of breath. If the lung fails to nourish the kidney due to asthenia and causes exhaustion of qi in the upper and loss of essence in the lower, the pathological condition will be critical. The disorder or dysfunction of any viscus will consequently result in abnormal changes in menstruation, leukorrhea, pregnancy and delivery. However, the disorder or dysfunction of viscera that is most likely to cause woman disease is that of the kidney, heart, liver or spleen 

 Blood is essential to woman and is easy to be constoned by menstruation, pregnancy, delivery and breastfeeding, eventually leading to relative hyperactivity of qi due to deficiency of blood. So the invasion of pathogenic factors is likely to affect qi and blood and cause disease. For example, invasion of exogenous pathogenic heat or excessive intake of pungent and hot foods tends to generate heat, the struggle between heat and blood drives blood to flow abnormally and lead to such problems like early menstruation, profuse menstruation, metrorrhagia and metrostaxis, hematemesis and epistaxis during menstruation, abortion and puerperal fever. 

Invasion of exogenous pathogenic cold or excessive intake of cold and uncooked foods generates cold, the struggle between cold and blood coagulates blood and leads to delayed menstruation, dysmenorrhea, amenurrhea, puerperal abdominal pain, abdominal mass and sterility, etc. Invasion of exogenous pathogenic dampness, or dampness due to spleen asthenia, accumulation of dampness into phlegm and struggle between damp-heat and blood in the meridians and vessels may bring about leukorrhagia, amenorrhea and sterility, etc. Transformation of heat from dampness stagnation and struggle between accumulating damp-heat and blood may result in profuse menstruation, yellowish vaginal discharge and multi-colored vaginal discharge. 

Dampness accumulation and fluid retention in the muscular interstices may cause edema during menstruation. Besides, blood asthenia due to prolonged duration of disease, dysfunction of the viscera and insufficiency of transformation may give rise to delayed menstruation, scanty menstruation, dysmenorrhea, amenorrhea, sterility and hypogalactia, etc. 

Other factors responsible for profuse menstruation, metrorrhagia and metrostaxis as well as hematemesis and epistaxis are consumption of qi by pathogenic heat and abnormal flow of blood due to leakage of qi caused by heat. Invasion of pathogenic cold stagnates qi and blood, consequently leading to oligomenurrhea, dysmenurrhea and amenorrhea. Invasion of pathogenic dampness prevents qi from normal flowing and results in swelling and distension during pregnancy. 

 

The manifestations caused by seven emotional factors are upward flow of qi, slack flow of qi, exhaustion of qi, sinking of qi, disorder of qi, stagnation of qi and consumption of qi which impair the viscera and cause various woman diseases. Qi commands and controls blood. Consumption of qi due to prolonged illness or overstrain will make it unable to command and control blood, leading to profuse menstruation, early menstruation, metrorrhagia and metrostaxis as well as abortion. Sinking of qi usually fails to hold the viscera in the original location e.g. the prolapse of the uterus. 

Impairment of the thoroughfare, conception and governor vessels is the main pathological change in gynecological diseases. The thoroughfare vessel is the sea of blood and is closely related to menstruation. The conception vessel is responsible for providing nutrition during pregnancy and is closely related to pregnancy. The governor vessel governs yang and is connected with the conception vessel. Altogether they maintain a relative balance between yin and yang and are responsible for pregnancy.The belt vessel manages all the meridians and regulates the reproductive system together with the thoroughfare, conception and governor vessels. 

The disorder of the thoroughfare vessel may lead to irregular menstruation, metrorrhagia and metrostaxis, amenorrhea and abortion;the disorder of the conception vessel may result in leukorrhagia due to downward migration of fluid, sterility due to malnutrition during pregnancy and abdominal mass due to stagnation of qi and blood; the disorder of the governor vessel may affect the function of yang-qi and cause sterility; the disorder of the belt vessel may bring about leukorrhagia and prolapse of the uterus. The impairment of these meridians and vessels may be direct or indirect. 

Indirect impairment is caused by disorder of the viscera, qi or blood. For example, insufficiency of kidney qi and deficiency of the thoroughfare vessel may lead to primary amenorrhea; migration of dampness due to spleen asthenia into the conception and belt vessels may result in leukorrhea and pudendal pruritus; weakness of the thoroughfare and conception vessels due to qi asthenia and sinking may bring about profuse menstruation, metrorrhagia and metrostaxis as well as prolapse of the uterus; abnormal flow of blood due to heat and weakness of the thoroughfare and conception vessels may cause profuse menstruation, metrorrhagia and metrostaxis, etc. 

     

Improper sterilization during delivery, abortion and vaginal operation, or lack of proper care or sexual activity during menstruation and after delivery may lead to invasion of pathogenic factors into the uterus and result in such problems like irregular menstruation, dysmenorrhea, puerperal fever, lochiorrhea, leukorrhea, abdominal mass and sterility which can be regarded as the direct impairment of the thoroughfare and conception vessels. Generally speaking, only direct or indirect impairment of the thoroughfare, conception, governor and belt vessels, especially the thoroughfare and conception vessels, can lead to disorders of menstruation, leukorrhagia, pregnancy and delivery. 

Though the diseases caused by dysfunction of the viscera, disorders of qi and blood as well as impairment of the thoroughfare, conception, governor and belt vessels are different in pathogenesis, they also affect each other in pathology. So in the analysis of diseases, trials must be made not only in determining which organs or meridians are invaded by pathogenic factors and whether qi or blood is impaired, but also in analyzing the interaction between them. Such a comprehensive analysis is essential to recognizing the nature and taking proper treatment of the disease in question.