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Expert Advice-Treatment of Endometriosis in Traditional Chinese Medicine(TCM):

A Natural Option for Endometriosis

Endometriosis has become an increasingly common health condition worldwide. One American doctor has labeled it "the career woman’s disease" because there seems to be a strong correlation between endometriosis and the increased stress levels experienced by so many working women today. Health professionals and their patients are raising many questions about endometriosis: "Why do so many women have endometriosis?" "What causes endometriosis?" "Are there any natural treatment options for my endometriosis?" Endometrial tissue occurs naturally in the endometrium – a layer of tissue lining the uterus. With endometriosis, however, this tissue "migrates" to other parts of the reproductive system, or outside of the reproductive organs altogether, and can be found in the uterine wall, ovaries, rectovaginal pouches, uterotsacral ligaments, and even in the abdominal cavity.

The main clinical manifestation of endometriosis is a recurrent, generally cyclical, lower abdominal pain that gets progressively worse. Dysmenorrhea, irregular periods, painful intercourse, fever during menstruation, dysfunctional vaginal bleeding, nipple discharge, abdominal masses, and infertility may also be associated with endometriosis. It is estimated that 15 percent of menstruating women between the ages 25 and 44 have endometriosis. Up to 50 percent of infertile women may have endometriosis, and some studies suggest that this estrogen-sensitive disease may also cause infertility.

A Woman’s Story and Endometriosis
Valerie is a 35-year-old single woman. She began to have unusual menstrual pain about five years ago when she was riding a bicycle while she had her period. Recently, her menstrual pain became severe, spreading to the vagina, anus, hips, and inner side of the thigh. A "sinking" sensation in the anus, with abdominal pain and back soreness accompanied the menstrual pain. Often, the pain was severe enough to trigger bouts of nausea and vomiting, and she became desperate for relief. She went to her regular doctor, who referred her to a gynecologist. The pelvic examination, magnetic resonance imaging and laparoscopy confirmed that she had endometriosis. The gynecologist suggested a hysterectomy, but she refused. She asked for other options. The doctor told her that "acupuncture is effective to relieve pain. Why don’t you try it?" She came to my clinic. After three month’s treatment with acupuncture and Chinese herbal medicine, her endometriosis was under control.

Standard treatment choices for endometriosis include surgery that removes as much misplaced endometrial tissue as possible; hysterectomy (surgical removal of the uterus, often with the fallopian tubes and ovaries); and drugs such as progestins, Danazol, GnRH agonists and combination estrogen-progestin oral contraceptives which suppress the activity of the ovaries and slow the growth of endometrial tissue. Surgery is often only a temporary measure, because endometriosis recurs in most women. Treatment with synthetic hormones will suppress the symptoms of endometriosis, but the disease itself is not cured, and symptoms will often return after discontinuing the hormone therapy. Besides, the side effects with these drugs can be significant.

Blood Stasis Patterns of Endometriosis in Chinese Medicine
A traditional Chinese medical diagnosis is arrived at by discerning a characteristic pattern from the signs and symptoms presented by the patient. In Chinese medicine, the primary pattern, or mechanism, that causes endometriosis is Blood Stasis. Blood Stasis can be caused by emotional disturbance, chronic illness, exposure to cold temperatures, surgery, and genital infections. When the pattern of disease is Blood Stasis, the objective of the treatment is to invigorate Blood and remove stasis, using both acupuncture and Chinese herbal medicine. The most frequently used herbs for dispersing Blood Stasis are: salvia (Dan Shen); red peony root (Chi Shao); persica seed (Tao Ren); safflower (Hong Hua); bur-reed rhizome (San Leng); and zedoary (E Zhu).

In addition to Blood Stasis, there are often other disease-causing factors which are part of the patterns of endometriosis. Cold, Heat, Deficiency, or Excess patterns are frequently part of the mix, and are differentiated based on the clinical manifestations associated with each case of endometriosis. The timing, location, nature, and severity of pain are taken into account, along with associated symptoms. Following are five common patterns of endometriosis, with the differentiating symptoms and the recommended treatment.

  1. Qi Stagnation and Blood Stasis. The origin of this pattern lies in emotional stress and anxiety. Symptoms of this pattern include: abdominal tenderness; pressure and pain before or during periods; breast distention before periods; distending pain under the rib cage before periods; aversion to pressure on the abdomen; blood clots with periods; pain relieved after the periods; a dark purple tongue with spots and a thin-white tongue coating; and a wiry-choppy pulse. A stagnation/stasis-relieving formula, Driving Out Blood Stasis below the Diaphragm Decoction (Ge Xia Zhu Yu Tang), is used for this pattern.
  2. Kidney Deficiency and Blood Stasis. The origin of this pattern is either a constitutional weakness, or a history of surgical procedures. Symptoms of this pattern include: abdominal tenderness; a feeling of pressure and pain during or after periods; soreness of the back, legs, and hips; dizziness; irregular periods, scanty periods or spotting; blood clots with periods; failure to conceive a baby or habitual miscarriage; a pale tongue color, or a tongue with spots and a thin-white tongue coating; and a deep-thin-choppy pulse. An herbal combination which includes a famous kidney tonic formula, Restoring the Kidneys Decoction (Gui Shen Wan), and a renowned Blood stasis-relieving formula, Four-Substance Decoction with Safflower and Persica Seed (Tao Hong Si Wu Tang), is most appropriate for this pattern.
  3. Cold Retention and Blood Stasis. The origin of this pattern is a history of exposure to cold – either cold temperatures, or the habitual consumption of cold foods -- especially during menstruation. Symptoms of this pattern include: abdominal tenderness; pressure and pain before or during periods; a preference for warmth; an aversion to cold; blood clots with periods; pain relieved after the periods; pale complexion; nausea or vomiting with severe menstrual pain; a pale, purplish tongue with spots and a white tongue coating; and a wiry-tight pulse. A formula that reduces stasis, Driving Out Blood Stasis in the Lower Abdomen Decoction (Shao Fu Zhu Yu Tang), is used for this pattern.
  4. Qi Deficiency and Blood Stasis. The origin of this pattern is chronic illness or weakness. Symptoms of this pattern include: abdominal tenderness; pressure and pain during or after periods; a preference for warmth; feeling better with pressure on the abdomen; a "dropping" sensation of the anus; soft bowel movements; pale complexion; lethargy; periods that are either heavy or scanty, with light-colored, watery menses; thick-pale tongue body with tooth-marks on the sides and a white-thin tongue coating; and a thin-soft-weak pulse. A traditional Yang tonic formula, Tonifying the Yang to Restore Five Decoction (Bu Yang Huan Wu Tang), is used for this pattern.
  5. Heat Obstruction and Blood Stasis. The origin of this pattern is a history of genital infections (which in Chinese medicine is considered to be an accumulation of Heat toxins in the body). Symptoms of this pattern include: abdominal tenderness; pressure, pain, and fever before, during, or after periods (the more severe the pain, the higher the fever); a preference for cold temperatures; aversion to pressure on the abdomen; a bitter taste in the mouth; dry throat; anxiety; anger; constipation; painful intercourse; red tongue tip or purple spots on the sides of the tongue, with a thin-yellow tongue coating; and a wiry-rapid pulse. The formula, StagnationEASE (Xue Fu Zhu Yu Tang), is used for this pattern.
Treating Endometriosis with Acupuncture and Diet
Scientific studies are suggesting that endometriosis is a neuro-immuno-endocrine related disease. Acupuncture can improve the functioning of the immune system and increase the flow of energy through the meridians, or energy pathways, in the body. Acupuncture can also stimulate the nervous system to release hormones, and is very effective at relieving pain. For these reasons, acupuncture is a viable and effective treatment modality for dealing with endometriosis. The use of specific acupuncture points and herbal formulas for each pattern of endometriosis listed above can produce dramatic improvements.

Diet is also an important factor in controlling endometriosis. A low-fat, high-fiber, dairy-free diet is recommended, along with the addition of certain foods such as Daikon radish (moves Qi) and kelp (dissolves masses and stasis). Avoiding cold foods and drinks is also very helpful.