Fu Qingzhu's Qinggan Zhilin Tang for Red Vaginal Discharge
White vaginal discharge is common in women, and red discharge (chidai) is no rarity. By "red discharge" we mean red, non-menstrual vaginal discharge that drips continuously, or a mixture of red and white discharge, with a normal or foul odor. It may herald a more serious gynecological disease, such as cervical or endometrial lesions; it may also result from cervicitis or vaginitis; and in some patients the cause is unknown.
Patients with red discharge and a family history of gynecological tumors (breast, uterine, or ovarian cancer) should especially undergo regular gynecological tumor screening and watch tumor markers such as CA125, CA153, and CEA. Those who can afford it may have genetic testing for BRCA1 and BRCA2; mutations warrant preventive vigilance.
Fu Qingzhu held that red discharge is a damp disorder with accompanying fire-heat. He explains the mechanism: "Women whose worry and brooding injure the spleen, and whose anger and constraint injure the liver, develop internal raging of the liver's constrained fire, which overacts on the spleen earth. The spleen cannot transform and transport, so damp-heat accumulates among the belt vessel; the liver also fails to store blood, which leaks into the belt vessel. All arises because the spleen qi is injured and transport weak; the damp-heat, carried by qi downward, flows out together with blood, so a substance that looks like blood but is not blood appears in the discharge. In fact blood and dampness cannot be separated; the vulgar notion that red discharge belongs to heart fire is wrong. Treatment must clear liver fire and support spleen qi, and then it may be cured. Use Qinggan Zhilin Tang."
Qinggan Zhilin Tang consists of: Baishao (White Peony) one liang (vinegar-fried), Danggui (Angelica) one liang (wine-washed), Shengdi (Raw Rehmannia) five qian (wine-fried), Ejiao (Donkey-hide Gelatin) three qian (fried in wheat flour), Fen Danpi (Moutan) three qian, Huangbai (Phellodendron) three qian, Niuxi (Achyranthes) two qian, Xiangfu (Cyperus) one qian (wine-fried), Hongzao (Jujube) ten pieces, and Xiaoheidou (Black soybean) one liang. One liang here converts to 30 g and one qian to 3 g.
Fu Qingzhu says Qinggan Zhilin Tang gives "one dose and it lessens, two doses and it lessens further, four doses and it is cured, ten doses and it never recurs"—so when the pattern matches, it works quickly and patients need not take it for years. Because the causes of red discharge are complex and treatment is tricky, Qinggan Zhilin Tang does not produce such rapid results for every patient. Endometriosis, for example, may cause years of bloody discharge that this formula treats imperfectly; for that condition, simply decocting 30 g of Miangengen (Urena root) may work better. In my view, this formula probably works best for chronic diseases such as vaginitis and cervicitis, and less well for endometriosis.
Fu's formula focuses on nourishing blood, soothing the liver, and clearing heat and draining dampness. Baishao, Danggui, and Shengdi are the Four-Substance Decoction minus the warm-drying Chuanxiong (Ligusticum); Ejiao and Hongzao also nourish blood. TCM holds that Xiaoheidou nourishes liver and kidney yin. Qinggan Zhilin Tang therefore primarily supplements liver and kidney yin-blood, then uses Danpi, Huangbai, and Niuxi to clear and drain damp-heat and Xiangfu to soothe the liver and resolve constraint. The combination suits women with long-standing bloody discharge. Some women, long plagued by red discharge, are already anemic; blood deficiency causes fatigue, pallor, and dizziness, which blood-nourishing herbs can relieve.
The remaining herbs—Danpi, Huangbai, and Niuxi—work well on gynecological inflammation; modern formulas for gynecological inflammation, Er Miao Wan and San Miao Wan, contain Huangbai and Niuxi as key ingredients.
Qinggan Zhilin Tang is thus essentially the blood-nourishing Four-Substance Decoction combined with San Miao Wan (for gynecological disease from damp-heat pouring downward), then modified. Once broken down this way, Fu's design principle becomes easy to understand.