Patient's question:
The results showed: Cleanliness III, BV positive. Since I had been using Jia Xiao (a type of antiseptic) previously, the doctor used Ke Bao Jing 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 Ke Bao Jing, which says it should be used 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, which was diagnosed as adnexitis. After taking Kun Fu Kang 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 genus of a single species. 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 obligately anaerobic. 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 less than 4.0. It does not produce amines, nor does it produce catalase or oxidase. The H2O2 inhibition test is positive. The main sugar fermentation product is acetic acid. Under the electron microscope, the thin layers of the cell wall show a layered structure and contain lipopolysaccharides. The normal vaginal flora is mostly composed of various facultative anaerobic Lactobacillus species, such as Lactobacillus and Doderleinella, which produce lactic acid, hydrogen peroxide, and other important factors in regulating the vaginal flora. Patients with bacterial vaginosis have none or only a small amount of the aforementioned genera in their vagina.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 Lowering Syndrome for syndrome differentiation and treatment.
1. Liver Channel Damp-Heat Syndrome—White discharge is gray or light gray in color, 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 flowing downward, with Damp-Heat toxic flowing into the Liver Channel, causing gray or light gray 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: 10g Radix Gentianae, 10g Scutellariae Radix, 10g Bupleuri Radix, 10g Gardeniae Fructus, 10g Platycodonis Radix, 10g Alisma Rhizoma, 10g Aristolochiae Caulis, 10g Angelica Sinensis Radix, 15g Rehmanniae Radix, 10g Bambusae Folium, and 6g Glycyrrhizae Radix. In the formula, Radix Gentianae, Scutellariae Radix, Bupleuri Radix, and Gardeniae Fructus clear Liver and Gallbladder Damp-Heat; Platycodonis Radix, Alisma Rhizoma, and Aristolochiae Caulis 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 and harmonize the herbs. The entire formula works to clear Liver and Gallbladder Damp-Heat. If the discharge has a foul odor, add 30g Taraxaci Radix and 30g Oldenlandiae Herba. For external genital itching, add 10g Coptidis Rhizoma and 25g Tripterygium Wilfordii.
2. Spleen Dampness Lowering 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, resulting in 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. Suitable formulas include modified Sanzhuan Bai Zhu San: 10g Codonopsis Radix, 10g Atractylodis Macrocephalae Rhizoma, 20g Poria, 30g Dolichos Lablab, 30g Coix Lacryma-Joungi Semen, and 30g Patriniae Herba. In the formula, Codonopsis Radix strengthens the Spleen and Qi; Atractylodis Macrocephalae Rhizoma, Poria, Dolichos Lablab, and Coix Lacryma-Joungi Semen strengthen the Spleen and resolve dampness; Patriniae Herba detoxifies and resolves turbidity. The entire formula works to strengthen the Spleen and resolve dampness. For accompanying blood deficiency, add 10g Angelica Sinensis Radix and 30g Milkvetch Root. For abundant discharge, add 10g Fructus Schizonepetae and 10g Cinnamomi Cortex.
2) Gardnerella is an anaerobic rod, and Western medicine treatment primarily uses antibiotics targeting this condition. Commonly used drugs 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 concurrently, 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 drugs, 0.5% lactic acid or acetic acid solution should also be used for vaginal irrigation to restore the acidic environment of the vagina and inhibit the growth of the bacteria.
3) After treatment for bacterial vaginosis, if the test remains negative for three months, it is considered cured.
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