Patient's question:
The results showed: Cleanliness III, BV positive. Because I had been using Medicated Pads before, the doctor used Kebaojing this time. Then, I had my period after 8 days of use. After my period, I went to the hospital for a follow-up check, and the results were the same as before medication, with no improvement at all. The doctor said there are only two medications for treating bacterial infections, and I have used both without any effect. What should I do? I read the instructions for Kebaojing and found it says to use it continuously for 18 days. Could it be that I didn’t use enough of it? But I also stopped because I had my period?History of previous diagnosis and treatment, as well as effectiveness: I originally had right lower abdominal tenderness, and after examination, it was diagnosed as adnexitis. After taking Kunfukang capsules, it improved.
Doctor's answer:
Hello! First of all, I wish you a speedy recovery! Let me talk to you about "Bacterial Vaginosis." Gardnerella is a single-species genus. It is a newly discovered genus. Gardnerella is a Gram-negative rod, some of which vary into coccobacilli. The cells are small, with rounded ends, no capsule, no flagella, and are nutritionally anaerobic, with some being obligate anaerobes. The cell length is 0.3--0.45 μm, width 0.1--0.2 μm, and the shape is smaller than Lactobacillus, showing pleomorphism. The optimal pH for culture is 6.0--6.5, and it cannot grow at a pH value below 4.0. It does not produce amines, nor does it produce catalase or oxidase. The H?O? inhibition test is positive. The main sugar fermentation product is acetic acid. Under the electron microscope, the thin layers of the cell wall show layered structures and contain lipopolysaccharides. The normal vaginal flora is mostly composed of various facultative anaerobic Lactobacillus species, such as Lactobacillus and D?derleinella, which produce lactic acid, hydrogen peroxide, and other important factors in regulating the vaginal flora. Patients with bacterial vaginosis have no or only a small amount of the aforementioned genera in their vaginas.1) Traditional Chinese Medicine (TCM) treatment for bacterial vaginosis is primarily based on the principle of syndrome differentiation and treatment, classifying it into two types according to different clinical manifestations: Liver Channel Damp-Heat Syndrome and Spleen Dampness Descending Syndrome for syndrome differentiation and treatment.
1. Liver Channel Damp-Heat Syndrome—White discharge is gray or light grayish-green, with a foul odor, or accompanied by external genital itching, often with bitter taste in the mouth, thirst, shortness of breath, restlessness, red tongue, yellow coating, and wiry slippery pulse. This is due to Damp-Heat from the Liver and Gallbladder descending, with Damp-Heat pathogens flowing into the Liver Channel, causing gray or light grayish-green white discharge with a foul odor, or accompanied by external genital itching. Bitter taste in the mouth, thirst, shortness of breath, restlessness, red tongue, yellow coating, and wiry slippery pulse are all signs of Liver and Gallbladder Damp-Heat. Treatment should focus on clearing Liver and Gallbladder Damp-Heat. Commonly used formulas include modified Longdan Xiegan Tang: Longdancao 10g, Scutellariae Radix 10g, Bupleuri Radix 10g, Galli Fructus 10g, Plantaginis Semen 10g, Alismae Rhizoma 10g, Clematidis Radix 10g, Angelica Sinensis Radix 10g, Rehmanniae Radix 15g, Bambusae Folium 10g, Glycyrrhizae Radix 6g. In the formula, Longdancao, Scutellariae Radix, Bupleuri Radix, and Galli Fructus clear Liver and Gallbladder Damp-Heat; Plantaginis Semen, Alismae Rhizoma, and Clematidis Radix clear heat and resolve dampness; Angelica Sinensis Radix and Rehmanniae Radix nourish yin, clear heat, and activate blood circulation; Bambusae Folium and Glycyrrhizae Radix clear heart fire, reduce heat, and harmonize the medicine. The entire formula works to clear Liver and Gallbladder Damp-Heat. If the white discharge has a foul odor, Taraxacum and Oldenlandia 30g each can be added; if there is external genital itching, Coptidis Rhizoma 10g and Clematidis Fructus 25g can be added.
2. Spleen Dampness Descending Syndrome—White discharge is thin and abundant, poor appetite, fatigue, weak pulse, and pale tongue. This is due to insufficient Spleen Qi, inability to transport dampness, and downward flow of dampness, causing thin and abundant white discharge. Poor appetite, fatigue, weak pulse, and pale tongue are all signs of insufficient Spleen Qi. Treatment should focus on strengthening the Spleen and resolving dampness. The formula should be modified Sangren Bai Zhu San: Codonopsis 10g, Atractylodis Macrocephalae Rhizoma 10g, Poria 20g, Dolichos Lablab 30g, Coix Seed 30g, Patriniae Herba 30g. In the formula, Codonopsis strengthens the Spleen and Qi; Atractylodis Macrocephalae Rhizoma, Poria, Dolichos Lablab, and Coix Seed strengthen the Spleen and resolve dampness; Patriniae Herba detoxifies and resolves turbidity. The entire formula works to strengthen the Spleen and resolve dampness. If there is blood deficiency, Angelica Sinensis Radix 10g and Millettiae Caulis 30g can be added; if the white discharge is abundant, Fructus Carthami 10g and Atractylodis Rhizoma 10g can be added.
2) Gardnerella is an anaerobic rod, and Western medicine treatment primarily uses antibiotics targeting this condition. Commonly used medications include:
1. Metronidazole—0.2g per time, 3 times daily. Take for 7 days. Can also be administered vaginally.
2. Tetracycline—0.5g per time, 4 times daily orally. Take for 7 days. Can also be administered vaginally with tetracycline, 2 times daily. Avoid in pregnancy.
3. Sulfamethoxazole—A nitroimidazole drug, 1g per time, once daily after meals. Take for 15 days.
4. Amoxicillin—0.5g per time, 4 times daily. Take for 7 days.
5. Cefalexin—0.5g per time, 4 times daily. Take for 7 days.
With any of the above medications, 0.5% lactic acid or acetic acid solution should also be used for vaginal irrigation to restore the acidic environment in the vagina and inhibit the growth of the bacteria.
3) After treatment for bacterial vaginosis, if it remains negative for three months, it is considered cured.
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