On Fu Qingzhu's Wandai Tang for Leukorrhea
Wandai Tang (the Complete-Belt Decoction) is the first formula for the first disease in Fu Qingzhu's Gynecology. It consists of Chao Baizhu (Stir-fried Atractylodes) one liang (now 30 g), Huaishanyaao (Chinese Yam) one liang (now 30 g), Renshen (Ginseng) two qian (now 6 g), Baishao (White Peony) five qian (now 15 g), Chao Cheqianzi (Stir-fried Plantain seed) one qian (now 3 g), Cangzhu (Atractylodes lancea) three qian (now 9 g), Zhigancao (Honey-fried Licorice) one qian (now 3 g), Chenpi (Tangerine peel) five fen (now 1.5 g), Jingjiesui (Schizonepeta spike) five fen (now 1.5 g), and Chaihu (Bupleurum) six fen (now 1.8 g).In Fu Qingzhu's Gynecology, Wandai Tang treats women who, month after month and year after year, discharge a white substance downward "like snivel or spittle, which cannot be controlled and sometimes becomes foul-smelling—this is the so-called white discharge." Fu Qingzhu held that "white discharge arises from excess dampness and declining fire, liver constraint and weakened qi, so that the spleen earth is injured and the damp earth-qi falls downward. Thus the spleen essence is not retained and cannot transform nourishing blood into the menses; instead it turns into a white, slimy substance that pours straight down from the vulva and cannot be stopped." Therefore, he wrote, "the treatment should greatly supplement spleen and stomach qi, slightly assisted by herbs that soothe the liver, so that the wood-wind is no longer blocked within the earth and the earth-qi rises up to heaven; when the spleen qi is strong and dampness is dispelled, white discharge will naturally cease."Wandai Tang is the formula of choice for leukorrhea (excessive vaginal discharge), the most common gynecological complaint. But it does not treat every case of leukorrhea, nor is it limited to leukorrhea: it can also treat digestive disorders such as irritable bowel syndrome and celiac disease in children. How, then, should the formula be used more precisely?According to TCM theory, Baizhu, Huaishanyaao, Renshen, and Gancao in Wandai Tang all fortify the spleen and boost qi; from a modern pharmacological viewpoint these herbs enhance immunity and suit weak, immunocompromised patients. Cangzhu and Cheqianzi drain dampness. Jingjiesui is an exterior-releasing, wind-dispersing herb, but it also treats benglou and fecal occult blood in women. Chaihu both soothes the liver and resolves constraint and treats qi-deficiency collapse; in Buzhong Yiqi Tang, Chaihu and Shengma are used to lift fallen qi. Chenpi fortifies the spleen and moves qi; here it both strengthens the spleen and soothes the liver. Baishao nourishes yin and blood and softens the liver to stop pain; because the other herbs are warm and drying, Baishao prevents excessive warm-drying. These herbs are mostly warm and drying, so Baishao guards against over-warming.Daixia bing (leukorrheal disease) is a condition in women marked by a clear increase in vaginal discharge and abnormalities in its color, texture, or odor. In Fu Qingzhu Nüke Pingzhu (Annotated Commentary on Fu Qingzhu's Gynecology), edited by Xiao Chengzong and others, TCM leukorrheal disease is divided from a modern medical standpoint into two broad categories: inflammatory leukorrhea and non-inflammatory leukorrhea.Inflammatory leukorrhea results mainly from low resistance or direct invasion of the vulva and vagina by pathogens; in other patients, inflammatory secretions of the internal genitalia soak the cervix and vagina. On routine gynecological examination, such patients show abnormal vaginal cleanliness or test positive for Trichomonas, fungi, clue cells, or other specific or non-specific pathogens. Wandai Tang alone has little effect on this inflammatory type.Before using Wandai Tang, patients can buy vaginal swab tests to self-check. If inflammation is present, they should take the appropriate antibiotic according to the pathogen identified. Those whose inflammatory discharge improves on antibiotics but who remain immunocompromised may combine Chinese and Western medicine, using Wandai Tang as an adjunct. Wandai Tang may also be used together with external herbal washes (such as a Sophora-flavescens (Kushen)-based lotion). Wandai Tang alone is not notably effective for inflammatory leukorrhea; this is why many women with excessive discharge get no benefit from it.Reports show that Wandai Tang combined with a Kushen Tang (Sophora Decoction) wash for trichomonal vaginitis (control group: oral metronidazole plus topical acetic acid or lactic acid), and Wandai Tang combined with ozonated water for recurrent vulvovaginal candidiasis (control group: oral itraconazole capsules), both produced results significantly better than the controls.Non-inflammatory leukorrhea is caused mainly by high estrogen or low progesterone with relatively high estrogen, which increases glandular secretion in the mucosa; or by pelvic-congestion conditions such as pelvic tumors and pelvic congestion syndrome, which obstruct venous return and increase tissue exudate. Wandai Tang is mainly used for non-inflammatory leukorrhea.Wandai Tang regulates estrogen and progesterone, so it suits patients with an estrogen–progesterone imbalance. It treats ordinary leukorrhea and may also be the main formula for patients with ovarian tumors, uterine cancer, vaginal cancer, or breast tumors who have high estrogen, dual deficiency of qi and blood, and excessive leukorrhea or loose stools; in clinical use it is modified according to the presenting pattern. Wandai Tang also works well for excessive leukorrhea after gynecological surgery such as loop electrosurgical excision procedure (LEEP).Why does Wandai Tang treat diarrhea or loose stools from digestive disorders such as irritable bowel syndrome, colitis, or celiac disease in children? Looking at its composition, Wandai Tang is essentially Liujunzi Tang (Six-Gentleman Decoction) minus Banxia and Fuling, combined with Pingwei San (Stomach-Calming Powder) minus Houpo, plus Jingjiesui, Cheqianzi, and Chaihu. Moreover, Fu Qingzhu originally created this formula to treat leukorrhea by strongly supplementing the spleen and stomach, so it is no surprise that it treats spleen-stomach disease.In summary, the leukorrhea treated by Wandai Tang is mainly a TCM deficiency pattern; infectious gynecological diseases are classified in TCM as excess or mixed deficiency-excess patterns. Wandai Tang suits leukorrhea and diarrhea of deficiency type (spleen-stomach qi deficiency); for excess-type leukorrhea and diarrhea, Wandai Tang is unsuitable, or should not be used alone.