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.