Articles

Endometriosis

Related Health Condition

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Introduction

Endometriosis is a condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. Also referred to as adenomyosis externa and endometriosis externa, endometriosis is a term that has not entered TCM nomenclature; instead, TCM treats symptoms of endometriosis in the categories of tong jing (dysmenorrhea), bu yun (sterility), yue jing bu tiao (menoxenia), and zheng jia (mass in the abdomen), etc.

Etiology/Pathogenesis

According to traditional Chinese medicine, the root cause of endometriosis is blood stasis. There are many etiological factors that give rise to blood stasis in the disease such as accumulation of pathogenic cold-dampness or pathogenic heat, stagnation of liver-qi, or spleen and kidney-qi deficiencies. The stagnation of blood obstructs the Chong-Ren Channels and uterine collaterals, leading to abdominal pain, hypermenorrhea, and infertility. In severe cases, zheng jia (mass in the abdomen) may be found. Clinically, most of the patients are diagnosed with excess syndromes or excess syndromes complicated by deficiencies, whereas pure deficiency syndromes are very rare. (1)

Primary Treatments with Chinese Medicinal Herbs

Gui Zhi Fu Ling Wan

Jin treated 95 cases of endometriosis with modified Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill). The formula was composed of the following single herbs: Gui Zhi (Cinnamon Twigs), Fu Ling (Poria), Tao Ren (Persica), Mu Dan Pi (Moutan), Chi Shao (Peony Red), San Leng (Burreed Tuber), E Zhu (Zedoaria), Chuan Lian Zi (Melia), Yan Hu Suo (Corydalis Tuber), Dan Shen (Salvia), Xiao Ku Cao (Prunella), and Shan Ci Gu (Pleione Rhizome). For patients suffering menorrhagia, San Leng (Burreed Tuber), E Zhu (Zedoaria), Shan Ci Gu (Pleione Rhizome), and Tao Ren (Persica) were substituted with Wu Ling Zhi (Pteropus), Pu Huang Tan (Bulrush Carbon), Qian Cao (Madder), San Qi (Notoginseng), and Wu Zei Gu (Cuttle-bone) during menstruation. One dose of the formula in a decoction was orally administered daily. The results were: 36 cases greatly improved, another 43 cases slightly improved, and the remaining 16 cases did not respond to the treatment with a total effectiveness rate of 83.2%. (2)

Other Treatments with Chinese Medicinal Herbs

Liang Fang Wen Jing Tang

Zhu et al. treated endometriosis with Liang Fang Wen Jing Tang (Effective Channel-warming decoction). Patients were randomly placed into a treatment group or a comparison group, with 30 cases in each. In the treatment group, the following herbs were used: Dang Gui (Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Ligustici Chuanxiong), Chi Shao (Radix Paeoniae Rubra), Tu Si Zi (Semen Cuscutae), Gui Xin (Cinnamon Bark), E Zhu (Zedoaria), Ren Shen (Ginseng), Gan Jiang (dried Ginger), and Da Huang (Rhubarb). One dose of the formula in a decoction was administered orally daily, starting from the last day of a menstrual cycle and continued to the second day of the next cycle. One therapeutic course consisted of 28 consecutive days. After two courses of treatment, the therapeutic results were evaluated. The control group was treated with danazol tablets, 200 mg each time, twice a day, starting on the second day of a menstrual cycle. Three months constituted one course of treatment. The results: of the treatment group, 7 cases were resolved, 14 cases greatly improved, 8 cases improved slightly, and the remaining case did not respond to the treatment. Of the comparison group, 4 cases were resolved, 12 cases greatly improved, another 12 cases slightly improved, and the remaining 2 cases did not respond to the treatment. Although there were no significant statistical differences between the two groups, the treatment group did far better in remedying infertility (P

San Jie Zhi Tong Tang

Cai et al. treated 100 cases of endometriosis with a rectal administration of San Jie Zhi Tong Tang (a decoction for dissolving loops and relieving pain). The formula consisted of Tao Ren (Persica), Hong Hua (Carthamus), Mo Yao (Myrrha), Yan Hu Suo (Corydalis Tuber), Xiao Hui Xiang (Fennel Fruit), Rou Gui (Cinnamon Bark), San Leng (Bureed Tuber), E Zhu (Zedoaria), and Zhi Shi (Immature Bitter Orange). The formula was decocted in water for daily rectal administration. A comparison group of 36 cases was treated with pramiverine tablets. The results: the treatment group had a curative rate of 42.0% and an overall effectiveness rate of 94.0%. The comparison group had a curative rate of 22.0% and an overall effectiveness rate of 80.6%. Moreover, the relapse rate of 4.44% in the treatment group was significantly lower than that of 21.43% in the comparison group (P

Nei Yi Wan

Pei et al. treated 2,000 cases of endometriosis with Nei Yi Wan (a mixture for endometriosis). Depending on the syndrome differentiation-based diagnosis, patients were given two different versions of the formula: For blood stasis due to accumulation of pathogenic cold, the following herbs were used: Tu Bie Chong (Eupolyphaga), Ju He (Citrus Seed), Sha Ren (Amomum Fruit), Gui Ban (prepared Tortorise Plastron), Wu Yao (Lindera), Yuan Hu (Corydalis Tuber), Li Zhi He (Lychee Exocarp), Zhi Bie Jia (processed Tortoise Plastron), Chuan Shan Jia (Anteater scales), Xiao Hui Xiang (Fennel Fruit), Gan Cao (Licorice), Jin Yin Hua (Lonicera Flower), Zao Jiao Ci (Gleditsia Spine), She Tui (Snake Slough), Dang Gui (Chinese Angelica Root), Dong Chong Xia Cao (Cordyceps), and Xue Jie (Dragon Blood). For blood stasis due to damp-heat accumulation, the following herbs were given: Huang Lian (Coptis), Ge Gen (Pueraria), Dang Gui (Chinese Angelica Root), Sha Ren (Amomum Fruit), Ji Nei Jin (Membrane of Chicken’s Gizzard), Wu Wei Zi (Schizandra), Mai Ya (Malt), Zhi Gui Ban (processed Tortoise Plastron), Zhi Bie Jia (Carapax Trionycis preparata), Chen Xiang (Aquilaria), Chuan Shan Jia (Anteater scales), Dong Chong Xia Cao (Cordyceps), Bing Pian (Borneol), Hu Po (Succinum), Jin Yin Hua (Lonicera Flower), Gan Cao (Licorice), Yan Hu Suo (Corydalis Tuber), and Xue Jie (Dragon Blood). One dose of the formula in a decoction was orally administered daily. The results: after treatment during one menstrual cycle, dysmenorrhea subsided; after treatment for 3-4 menstrual cycles, pelvic masses disappeared or reduced in size, as shown by ultrasonography and gynecological examinations, and dysmenorrhea was basically resolved. (3)

Other Treatments

Moxibustion combined with Acupoint Hydro-injection
Wang et al. applied herbal-based moxibustion combined with acupoint hydro-injection in the treatment of 37 cases of endometriosis. The herbs used were made into paste and applied to the acupuncture points. Then moxa was applied on top of the herbal paste. The herbs used in moxibustion therapy function was to warm yang, dissolve mass, and activate blood. Acupoints Guan Yuan (CV 4) and Ci Liao (UB 32) were selected alternatively for the moxibustion treatment, one point each day. In addition, 2ml of the compound Dan Shen Injection was injected every other day at two of the following points: Ci Liao (UB 32), Zu San Li (ST 36), Di Ji (SP 8), San Yin Jiao (SP 6), and Feng Long (ST 40). The results: the treatment had a 85.70% effectiveness rate for treating dysmenorrhea, 90.00% for menstrual irregularity, 90.90% for pelvic tender nodule, 71.42% for ovarian cyst, 57.50% for adenomyosis, and 37.50% for infertility. Overall, the treatment had an effectiveness rate of 81.08% for treating endometriosis. (4)

References

  1. Peng Shu Feng, et al. Advances in TCM differentiation treatment of endometriosis. Journal of Gansu College of TCM. 2000;17(2):56-57.
  2. Jin Ji Ling. Treating 95 cases of endometriosis with modified Gui Zhi Fu Ling Wan. Liaoning Journal of Traditional Chinese Medicine. 1994;21(6):271-272.
  3. Pei Yu Huan, et al. Treating 2000 cases of endometriosis with Nei Yi Wan. China Journal of TCM Theories. 1999;5(11):49-50.
  4. Wang Hui Ming, et al. Acupuncture treatment of endometriosis. Journal of Acupuncture. 2000;25(2):148-150.