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.
Standard treatment choices for endometriosis in Western medicine 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.
Etiology and Pathogenesis
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. In addition to Blood Stasis, there are often other disease-causing factors which are part of the patterns of endometriosis, such as emotional stress, anxiety, constitutional weakness, a history of surgical procedures, exposure to cold – either cold temperatures, or the habitual consumption of cold foods -- especially during menstruation, chronic illness or weakness, a history of genital infections. Blood Stasis plus these other disease-causing factors result in five patterns of endometriosis in traditional Chinese medicine:
Emotional stress and anxiety is the origin of Qi Stagnation and Blood Stasis; a constitutional weakness, or a history of surgical procedures is the origin the pattern of Kidney Deficiency and Blood Stasis; a history of exposure to cold – either cold temperatures, or the habitual consumption of cold foods -- especially during menstruation is the origin of the pattern of Cold Retention and Blood Stasis; chronic illness or weakness is the origin of the pattern of Qi Deficiency and Blood Stasis; a history of genital infections (which in Chinese medicine is considered to be an accumulation of Heat toxins in the body) is the origin of Heat Obstruction and Blood Stasis.
Essentials of Diagnosis
A traditional Chinese medical diagnosis is arrived at by discerning a characteristic pattern from the signs and symptoms presented by the patient. Blood Stasis is the essential part of any pattern. 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.
Pattern Differentiation and Treatments
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). Following are five common patterns of endometriosis, with the differentiating symptoms and the recommended treatment.
1. Qi Stagnation and Blood Stasis
Clinical Manifestations: 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.
Treatment Principle: Dredge flow of the liver qi and remove stagnated blood
Herbal Prescription: Ge Xia Zhu Yu Tang (Driving Out Blood Stasis below the Diaphragm Decoction) with modifications
Dang Gui 9g
Chuan Xiong 9g
Chi Shao 9g
Tao Ren 9g
Hong Hua 6g
Zhi Ke 9g
Yan Hu Suo 12g
Wu Ling Zhi 9g
Mu Dan pi 9g
Wu Yao 6g
Xiang Fu 9g
Gan Cao 6g
Xue Jie 3g
Analysis: In this formula, Zhi Ke, Wu Yao and Xiang Fu function to regulate flow of qi to relieve pain; Dang Gui nourishes blood and harmonizes blood flow; Chuan Xiong, Chi Shao, Tao Ren, Hong Hua and Mu Dan Pi activate blood flow and remove stagnated blood; Yan Hu Suo and Wu Ling Zhi remove stagnated blood and relieve pain; Gan Cao relieves muscular spasm and harmonizes other ingredients in this formula, and Xue Jie removes stagnated blood and relieves pain.
Modifications
Acupuncture Prescription:
SP4 (Gongsun)
SP6 (Sanyinjiao)
SP8 (Diji)
SP10 (Xuehai)
ST36 (Zusanli)
RN2 (Qugu)
Zigong (Extra)
LR3 (Taichong)
LI4 (Hegu)
Explanation: SP4 (Gongsun) is a one of the eight confluent points communicating with the Chong vessel. SP6 (Sanyinjiao) is a crossing point of the spleen, liver and kidney channels. SP8 (Diji) is the XI-cleft point of the spleen channel. Use of the above points with SP10 (Xuehai) and ST36 (Zusanli) can promote the flow of qi and blood, thus relieving pain. RN2 (Qugu), a crossing point of the Ren vessel with the liver channel, is used together with Zigong (Extra) to relieve spasm and pain. LR3 (Taichong) and LI4 (Hegu ) are used to promote the flow of qi and remove blood stagnation.
2. Kidney Deficiency and Blood Stasis
Clinical Manifestations: 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.
Treatment Principle: tonify the kidney, activate blood flow and remove stagnated blood
Herbal Prescriptions: Da Ying Jian (Great Nutritive Decoction)
Dang Gui 12g
Shu Di Huang 9g
Gou Qi Zi 12g
Zhi Gan Cai 6g
Du Zhong 12g
Niu Xi 12g
Rou Gui 6g
Dan Shen 15g
Xian Ling Pi 15g
Yan Hu Suo 12g
Ji Xue Teng 15g
Xiang Fu 12g
Analysis: Dang Gui, Shu DI Huang and Gou Qi Zi are used to tonify the liver and kidney and nourish blood; Du Zhong tonifies the liver and kidney to strengthen the tendons and bones; Rou Gui and Xian Ling Pi supplement fire to assist yang, and warm up meridians to promote blood flow; Niu Xi activates meridians to move blood, Dan Shen, Yan Hu Suo, Ji Xue Teng and Xiang Fu also functions to activate blood flow and remove blood stasis, but they are also used to regulate flow of qi to relieve pain.
Modifications:
For cases with qi deficiency, add Dang Shen 15g and Huang Qi q5g to supplement qi.
For cases with loose stool, remove Dang Gui from the formula and add Bu Gu Zhi 12g and Rou Dou Kou 12g to warm up the kidney and relieve diarrhea.
Acupuncture Prescription
SP6 (Sanyinjiao)
SP10 (Xuehai)
ST36 (Zusanli)
KI3 (Taixi)
BL23 (Shenshu)
RN4 (Guanyuan)
LR3 (Taichong)
Zigong (Extra)
Explanation
SP6 (Sanyinjiao), SP10 (Xuehai) and ST36 (Zusanli) are used to tonify qi and blood to benefit the kidney. regulate the flow of blood. These points are also effective for regulating the flow of qi and blood, thus removing blood stagnation. KI3 (Taixi), BL23 (Shenshu), RN4 (Guanyuan) and LR3 (Taichong) are used to tonify the kidney. Zigong is a extra point, particularly effective for the uterine disorders.
3. Cold Retention and Blood Stasis
Clinical Manifestations: 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.
Treatment Principle: Disperse cold and remove stagnated blood
Herbal Prescription: Shao Fu Zhu Yu Tang (Driving Out Blood Stasis in the Lower Abdomen Decoction) with modifications
Xiao Hui Xiang 6g
Gan Jiang 9g
Yan Hu Suo 12g
Mo Yao 6g
Dang Gui 9g
Chuan Xiong 6g
Rou Gui 3g
Chi Shao 9g
Sheng Pu Huang 9g
Wu Ling Zhi 9g
Analysis: In this formula, Rou Gui, Gan Jiang and Xiao Hui Xiang warm up meridians to disperse cold, Dang Gui, Chuan Xiong and Chi Shao activate blood flow and remove stagnated blood; Yan Hu Suo, Mo Yao, Pu Huang and Wu Ling Zhi regulate flow of qi and remove stagnated blood to relieve pain.
Modifications:
Acupuncture Prescription
RN2 (Qugu)
RN4 (Guanyuan)
Zigong (Extra)
DU4 (Mingmen)
KI 3 (Tiaxi)
SP6 (Sanyinjiao)
SP10 (Xuehai)
ST36 (Zasanli)
LR3 (Taochong)
Shiqizhui (Extra)
Explanation: RN2 (Qugu), RN4 (Guanyuan), Zigong (Extra), DU4 (Mingmen) and KI3 (Tiaxi) function to warm the kidney yang and disperse cold. SP6 (Sanyinjiao), SP10 (Xuehai) and ST36 (Zasanli) function to promote the flow of qi and blood. LR3 (Taichong) is used to promote the flow qi and relieve spasm. Shiqizhui (Extra) is point particularly effective for dysmenorrhea.
4. Qi Deficiency and Blood Stasis
Clinical Manifestations: 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.
Treatment Principle: Invigorate qi and remove stagnated blood
Herbal Prescription: Bu Yang Huan Wu Tang (Tonifying the Yang to Restore Five Decoction) with modifications
Huang Qi 60g
Dang Gui 6g
Chi Shao 6g
Di Long 3g
Chuan Xiong 3g
Tao Ren 3g
Hong Hua 3g
Analysis: In this formula, Huang Qi is used to invigorate qi; Chuan Xiong and Hong Hua promote flow of blood, Chi Shao and Tao Ren remove stagnated blood, and Dang Gui nourishes blood and removes the stagnated blood.
Acupuncture Prescription
ST36 (Zusanli)
SP6 (Sanyinjiao)
RN4 (Guanyuan)
RN6 (Qihai)
SP8 (Diji)
SP10 (Xuehai)
BL17 (Gesghu)
LI4 (Hegu)
LR 3 (Taichong)
Explanation: ST36 (Zusanli) are SP6 (Sanyinjiao) are mainly used to strengthen the spleen and tonify qi. RN4 (Guanyuan) and RN6 (Qihai) are used to tonify the primary qi. SP8 (Diji), SP10 (Xuehai) and BL17 (Gesghu) are used to regulate the flow of qi and blood and eliminate blood stasis. LI4 (Hegu) and LR 3 (Taichong) are used together to promote the flow of qi and blood and and relieve pain.
5. Heat Obstruction and Blood Stasis
Clinical Manifestations: 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.
Treatment Principle: Clear heat and remove stagnated blood
Herbal Prescriptions: Si Miao San and Tao Hong Si Wu Tang in Combination
Cang Zhu 9g
Huang Bai 9g
Yi Yi Ren 12g
Chuan Niu Xi 9g
Dang Gui 12g
Chuan Xiong 6g
Sheng Di 9g
Chi Shao 9g
Tao Ren 9g
Hong Hua 6g
Mu Dan Pi 9g
Hong Teng 15g
Bai Jiang Cao 15g
Analysis: Cang Zhu, bitter in taste and warm in nature, dries dampness, Huang Bai, bitter and cold, clear damp heat, Tao Hong Si Wu Tang is used to activate blood flow and remove stagnated blood, and Dan Pi clears heat, cools blood and removes stagnated blood.
Modifications:
Acupuncture Prescription
LR2 (Xingjian)
GB43 (Xiaxi)
LR14 (Qimen)
SP6 (Sanyinjiao)
SP10 (Xuehai)
SP8 (Diji)
RN2 (Qugu)
Zigong (Extra)
Explanation: LR2 (Xingjian), GB43 (Xiaxi) and LR14 (Qimen) function to clear blood heat. SP6 (Sanyinjiao), SP10 (Xuehai) and SP8 (Diji) function to promote the flow of qi and blood to remove blood stasis. RN2 (Qugu) and Zigong (Extra) function to relive pain.
Dietary Recommendations
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 eliminate phlegm) and kelp (dissolves masses and stasis). Avoiding cold foods and drinks is also very helpful.