By Rona Wang.

 

Editor’s introduction:

Traditional Chinese Medicine (TCM) is an ancient and sophisticated system of healing.  TCM has its own theory of how the different systems of the body are interrelated.  This theory allows different patterns of dysfunction to be identified and treated accordingly using acupuncture, herbal medicine or other means such as personalised dietary changes. For practitioners who are trained in other systems of medicine and for lay people, the best introductory guide to TCM is Between Heaven and Earth:  A Guide to Chinese Medicine by Harriet Beinfeld and Efrem Korngold.

In the article below, when words such as Spleen and Kidneys etc appear with a capital “S” and “K” they are not referring to the organs, as understood in Western Medicine, but the TCM concept of Spleen and Kidney which encompass the function of these organs but also have special meanings within TCM medical theory.

In TCM, conditions which cause pain are often those that involve “blood stasis” that is, poor circulation or congestion. Interruptions or blockages in the flow of the body’s vital energy or Qi (pronounnced “chee”) such as Qi stagnation are also associated with pain.

The following article by Rona Wang, who qualified with a degree in Traditional Chinese Medicine before emigrating, first to Australia and subsequently to New Zealand shows how one debilitating condition, endometriosis, considered a single disease entity by Western allopathic medicine, has a number a variant syndromes – and how it may be successfully treated using TCM.

A shortened version of this article was first published in the second issue of The New Zealand Journal of Natural Medicine.  This longer version of the article includes comprehensive lists of herbs and acupuncture points designed to help guide practitioners of TCM in the treatment of their patients.

– Katherine Smith

 

Introduction to Endometriosis

Endometriosis is a very common condition which is estimated to affect 89 million women world wide. In endometriosis,  endometrial tissue (which is normally confined to the lining of the uterus) may grow into the uterine muscles (adenomyosis) and/or may grow elsewhere in the pelvic/abdominal cavity, such as in the fallopian tubes, around the ovaries, uterine ligaments, bladder and intestines.    This endometrial tissue can bleed cyclically (in response to the woman’s menstrual cycle) and can cause pelvic cavity inflammation, adhesions and scaring.   Not surprisingly, the condition is often painful.

Endometriosis is also a major cause of  fertility difficulties. (20-40% of women with infertility issues and and 25% of women using IVF have endometriosis.)

Abnormal internal bleeding in women with endometriosis causes pelvic cavity inflammation, adhesions and scars.  Fertility may be adversely affected through a variety of mechanisms including reduction in the ability of the ovary to release an ova (egg), the fimbriated extremity of the fallopian tube being prevented from picking up the egg or by normal pathway through the fallopian tubes being blocked by adhesions.  Implantation of an embryo may also be affected.

Endometriosis is a progressive disease that tends to get worse over time and can reoccur after treatment. Symptoms include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.

Pathogenic mechanisms

The real cause of endometriosis is unknown, but there are five common theories:

1.      Menstrual blood flowing backwards through the fallopian tube into the abdominal cavity, where the tissue implants and grows in response to monthly hormonal changes causing internal bleeding.

2.      Lymphatic & venous disseminated: Endometrial cells can go through lymph and blood circulation which goes to the lungs, skin, muscles, legs etc while period is bleeding.

3.      Coelomic metaplasia theory: The cells of the endometrium and peritoneum share a common origin in the coelomic endothelium.  Inflammation may cause peritoneal cells to transform into endometrial cells, thus causing endometriosis.

4.      Immune theory: Small amounts of endometrial cells may reach the pelvic cavity where immune system cells normally kill them.  However, if the immune system is deficient or there is an overwhelming number of endometrial cells, endometriosis can occur.

5.      Genetic factors:   Simpson points out that a familial tendency to develop the disease has been reported.

Conventional allopathic treatment

The most common approaches are with hormonal therapy, laparoscopic surgery and major surgical management.

There are three main hormone drugs:

1.Oral contraceptives have to be taken on a continuous basis. (These prevent the ovary from producing any ova, so no egg is released and the normal build up of the endometrial tissue does not occur.)

2.Danazol, a steroid androgen, more substantially suppresses the cyclic changes and thereafter causes atrophy of the endometrial sites. (Danazol is an androgen and blocks the activity of female hormones, thus interfering with normal ovarian function.)

3.GnRH agonists (Lupron, Synarel, Zoladex) suppresses the function of the ovaries by blocking the release of pituitary hormones

*Each drug offers specific benefits although all may produce osteoporosis (bone thinning) with prolonged use.

Laparoscopy is useful for diagnosis and surgical treatment of endometriosis. Because endometrisosis often recurs after laser treatment, Chinese medicine is an important therapeutic option, and can result in a pregnancy much higher than that from using hormone drugs.  Moreover long term  of TCM is not harmful for the liver.

TCM Understanding of Endometriosis

In  TCM, endometriosis is classified as ”Tongjing” (dysmenorrhoea)” “Zhengja (masses),”buyun “(infertility),”abnormal bleeding” (period disorder) category.

Pain is a main symptom of endometriosis. TCM theory indicates “tongzebutong, butonzetong” -“通则不通,不通则痛” that means if meridians are blocked this can cause pain syndromes; if meridians are unobstructed then the patient may not expereience any pain.

From a TCM perspective, the main aetiology of endometriosis is “blood stasis”. The specific pathology change is “blood goes out of original place (blood vessels—离经之血) and stagnates in Chong & Ren, blood cannot arrive on time and period disorders occur.  The meridians, “baogong”(uterus) are blocked therefore patients suffer from irregular periods, painfuls period and infertility etc.

From TCM theory, stagnation can come from Kidney deficiency, Spleen deficiency, Liver Qi stagnation, heat coagulating, cold stagnation, and dampness–phlegm blockage; Kidney deficiency plays an important role in endometriosis.

Differential syndromes:

1.      Cold uterus and blood stasis:

Main symptoms: Periods are often delayed; patient suffers from dysmenorrhoea and hot water bottle on tummy can reduce pain. Low back & limb pain with coldness, low libido. Clear and profuse vaginal discharge, fatigue, cold hands and feet.  She may have a poor appetite, feel full easily and have a bloated stomach, suffer from oedema, have loose stools and frequently pass clear urine.

Swollen pale and light purple tongue with teeth marks and white watery coating; pulse is weak, slow and deep especially on Chi pulse.

Principal treatment: Warm the uterus by tonify kidney yang, dissipate blood stasis and stop pain.

Formula & herbs: “Aifunuangongwan”

Aiye ( Folium Artemisiae Argyi), xiangfu (Rhizoma Cyperi), wuzhuyu (Fructus Evodiae), rougui (Cortex Cinnamomi), Danggui (Radix Angelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), baishao (Radix Paeoniae Alba), shudihuang (Radix Rehmanniae), zhihuangqi (Baked Radix Astragali ), xuduan (Radix Dipsaci); or plus zhifuzi (Radix Aconiti Lateralis Preparata), zhuling (Polyporus), yanhusuo (Rhizoma Corydalis), ganjiang (Dry ginger).

Explanation:

Herbs to warm uterus:  Aiye ( Folium Artemisiae Argyi), xiangfu (Rhizoma Cyperi), wuzhuyu (Fructus Evodiae), ganjiang (Dry ginger).

Kidney yang tonics:  rougui (Cortex Cinnamomi), zhifuzi (Radix Aconiti Lateralis Preparata),  xuduan (Radix Dipsaci)

Herbs to sooth liver Qi, move blood, regulate menstruation and stop pain:  Danggui (Radix Angelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), baishao (Radix Paeoniae Alba), yanhusuo (Rhizoma Corydalis),

Herbs to eliminate dampness and stop oedema: zhihuangqi (Baked Radix Astragali ), zhuling (Polyporus)

*Laboratory research points out blood moving herbs plus kidney warming herbs can thin blood, reduce fibrinogens(纤维蛋白原) and Hct-hematocrit (血球容积) in blood plasma to improve blood circulation of pelvic cavity to improve pregnancy rate.

Acupuncture treatment: Guanyuan with moxa (RN-4), zhongji (RN-3), Mingmen with moxa (DU-4), Shenshu (BL-23), Diji (SP-8), Guilai (ST-29), Yinlingquan (SP-9), Zusanli (St-36)

 

2.      Liver Qi stagnation and blood stasis:

Main symptoms: Dysmenorrhoea begins before the period begins and persists during menstruation.  Blood is dark red blood with clots, and blood flow may vary and be either scanty or heavy, accompanied by hypochondrium (upper abdominal) pain. She may have swollen breasts, PMT symptoms include feelings of depression or becoming easily upset. Dark purple or ecchymosis or petechiae tongue with thin white coating; pulse is wiry, taut or choppy.

Principal treatment: Soothing the liver, invigorating the blood and moving stasis to stop the pain

Formula and herbs: “Gexiazhuyutang”
Wulingzhi (Faecs Trogopterori), danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), taoren (Semen Persicae), mudanpi (Cortex Moutan), chishao (Radix Paeoniae Rubra), wuyao (Radix Linderae), yuanhu (Rhizoma Corydalis), gancao (Radix Glycyrrhizae), xiangfu (Rhizoma Cyperi), honghua (Flos Carthami), zhiqiao (Fructus Aurantii); or add chaihu (Radix Bupleuri), baishao (Paeoniae Alba), shanyao (Rhizoma Dioscoreae).

Explanation:

Herbs to sooth liver Qi & nourish liver blood: yuanhu (Rhizoma Corydalis), baishao (Paeoniae Alba), xiangfu (Rhizoma Cyperi), zhiqiao (Fructus Aurantii), wuyao (Radix Linderae), chaihu (Radix Bupleuri),

Herbs to remove blood stasis: Wulingzhi (Faecs Trogopterori), danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), taoren (Semen Persicae), mudanpi (Cortex Moutan), chishao (Radix Paeoniae Rubra), honghua (Flos Carthami)

To harmonise the relationship between liver and spleen (stop liver dominating spleen):  shanyao (Rhizoma Dioscoreae), gancao (Radix Glycyrrhizae—and harmonize whole formula).

*Research shows blood moving herbs decrease inflammation and oedema. They improve blood flow to damaged cells, and increase the phagocytosis of white blood cells and the numbers of immunoglobulins. They help dissolve blood clots in disorders of blood clotting such as APAb’s,  those herbs are very good for treating autoimmune system disorder or infertility trigger by endometriosis; herbs like danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), taoren (Semen Persicae), mudanpi (Cortex Moutan), chishao (Radix Paeoniae Rubra) etc.

Acupuncture treatment: Taichong(LR-3), Hegu(LI-4), Diji(SP-8), Xuehai(SP-10), Qimen(LR-14), Geshu(BL-17), Zigong(EX-A-21), Ciliao(BL-32).

 

3.      Qi & blood deficiency with blood stasis:

Main symptoms: Fatigue, dizziness, dysmenorrhoea that is worse after the period with lower abdominal dull ache which feels better when pressure is applied. Scanty periods with blood that is light in colour, thin in texture combined with pale complexion. The patient has a poor appetite with loose stools.  Light coloured tongue with thin white coating, pulse is weak and thin.

Principal treatment: Reinforce Qi, nourish blood and invigorate Qi and blood to stop pain

Formula and herbs: “Shengyutang”

Huangqi (Radix Astragali), Dangshen (Radix Codonopsis), danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), baishao (Paeoniae Alba), or add wuyao (Radix Linderae), xiangfu (Rhizoma Cyperi), aiye(Folium Artemisiae Argyi), gaoliangjiang (Rhizoma Alpiniae Offcinarum),duzhong (Cortex Eucommiae)etc.

Explanation:

Qi tonics – Huangqi (Radix Astragali), Dangshen (Radix Codonopsis),

Blood nourishing herbs – danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), baishao (Paeoniae Alba),

Moving Qi & blood stagnation and warm uterus (and kidney) by— xiangfu (Rhizoma Cyperi), wuyao (Radix Linderae), aiye(Folium Artemisiae Argyi), gaoliangjiang (Rhizoma Alpiniae Offcinarum),duzhong (Cortex Eucommiae) etc.

*Research shows Qi, blood and Kidney tonics strengthen the immune system in general. For example, Huang Qi (Astragali Radix) greatly increases cellular immune function, especially T-lymphocytes and the competence of erythrocytes.

Acupuncture treatment: Qihai (RN-6), Xuehai (SP-10),  Baihui (DU-20), Zusanli (ST-36), Guanyuan (RN-4), Diji (SP-8), Yinbai (SP-1), Taichong (LR-3), Hegu (LI-4).

 

4.      Liver and kidney yin deficiency with blood stasis:

Main symptoms: Dysmenorrhoea with dull abdominal pain during and after period; period bleeding can be heavy or light but is red in colour.  Other symptoms include dizziness, tinnitus, lower back empty pain and sore knees; blurry vision, hair loss, poor memory, tiredness.  The tongue is light reddish,  with a thin white tongue coat.  The pulse is deep and thready pulse and especially weak at the Chi point.

Principal treatment: Nourish Liver blood & Kidney yin, regulate menstruation and stop pain.

Formula and herbs:  “Tiaogantang”

Danggui (Radix Angelicae Sinensis), baishao (Radix Paeoniae Alba), shanzhuyu (Fructus Comi), bajitian (Radix Morindae Officinalis), ejiao (Opium), shanyao (Rhizoma Dioscoreae), gancao (Radix Glycyrrhizae); or add shudi (Radix Rehmanniae), huangjiang (Rhizoma POLYGONATI), chishao (Radix Paeoniae Rubra), jixueteng (Caulis Spatholobi), xiangfu (Rhizoma Cyperi)), chuanlianzi (Fructus Toosendan), guiban (Carapax et Plastrum Testudinis – bottom of Tortoise shell), biejia (Carapax et Plastrum Testudinis –Top of Tortoise shell), digupi (Cortex Lycii), duzhong (Cortex Eucommiae).

Explanation:

Give Liver & Kidney yin tonics:  baishao (Radix Paeoniae Alba), ejiao (Opium),  shanzhuyu (Fructus Comi), shudi (Radix Rehmanniae), huangjiang (Rhizoma Polygonati) , guiban (Carapax et Plastrum Testudinis – bottom of tortoise shell), biejia (Carapax et Plastrum Testudinis –Top of tortoise shell), digupi (Cortex Lycii), duzhong (Cortex Eucommiae), bajitian (Radix Morindae Officinalis)

Remove blood stagnation and tonify blood:  Danggui (Radix Angelicae Sinensis), chishao (Radix Paeoniae Rubra), jixueteng (Caulis Spatholobi), xiangfu (Rhizoma Cyperi), chuanlianzi (Fructus Toosendan),

To avoid liver blood deficiency and Liver cannot function and attacking spleen by– shanyao (Rhizoma Dioscoreae), gancao (Radix Glycyrrhizae)

Acupuncture treatment: Ganshu (BL-18), Shenshu (BL-23), Geshu (BL-17), Sanyinjiao (SP-6), Siman (KI-14 ), Taixi (KI-3),Ququan (LR-8), Xuehai (SP-10), Zhongdu (LR-6), Taiyuan (LU-9).

 

5.      Heat in blood with blood stasis:

Main symptoms: Dysmenorrhoea with severe pain, a hot water bottle will make pain worse.  Pain increases with each cycle and before and during period the pain gets worse. Menstrual bleeding is heavy and the blood is dark red with clots.  The menstrual cycle will become shorter and shorter – even as little as three weeks. PMT symptoms may include becoming easily angered with breast and chest distension, restlessness of heart (vexation), palpitations, bitter taste and dry mouth.  Drinks of cold water may be preferred. Tongue is red with dry yellow fur and wiry rapid pulse.

Principal treatment:  Clear heat, cool blood and regularate menstruation to stop pain.

Formula and herbs: “Qingjingtang”

Shengdi (Radix Rehmanniae), digupi (Cortex Lycii), baishao (Radxi Paeoniae Alba), mudanpi (Cortex Moutan), qinghao (Herba Artemisiae), huangbai (Cortex Phellodendri), fuling (Poria); or add shanzhizi (Fructus Gardeniae), diyu (Radix Sanguisorbae), huaihua (Flos Sophorae Immaturus), qiancaogen (Radix Rubiae).

Explanation:

Herbs to clear heat: qinghao (Herba Artemisiae), huangbai (Cortex Phellodendri), shanzhizi (Fructus Gardeniae),

Herbs to cool blood and remove blood stagnation: Shengdi (Radix Rehmanniae), digupi (Cortex Lycii), baishao (Radxi Paeoniae Alba), mudanpi (Cortex Moutan); or diyu (Radix Sanguisorbae), huaihua (Flos Sophorae Immaturus), qiancaogen (Radix Rubiae).

Acupuncture treatment: Xingjian(LR-2), ligou(LR-5), Sanyinjiao(SP-6), Rangu(KI-2), Zhongji(RN-3), Ciliao(BL-32),Hegu(LR-4),chuchi(LI-11),dazhui(DU-14).

6.      Damp-Phlegm and blood stasis:

Main symptoms: Dysmenorrhoea with a dull  abdominal ache accompanied with consistent vaginal clear or white discharge, period can be delayed or irregular with spotting before or after menses, blood flow is dark-brownish with sticky mucus-like clots.  The patient will often complain of tiredness, a heavy and “muddy” head, concentration difficulties and poor memory.  Other symptoms include chest stuffiness with phlegm, heavy body, poor appetite, stomach fullness, loose stools and cloudy urination.  Pulse is soft or slippery and tongue is swollen with teeth marks and greasy, sticky coating.

Principal treatment: Removing blood stasis and clearing damp-phlegm by tonifying Spleen Qi.

Formula and herbs  “Shenlingbaizhusan” + “Gexiazhuyutang”  +

Dangshen (Radix Angelicae Sinensis), baizhu (Rhizoma Atractylodis Macrocephalae), fuling (Poria), gancao (Radix Glycyrrhizae),Wulingzhi (Faecs Trogopterori), danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), taoren (Semen Persicae), wuyao (Radix Linderae), yuanhu (Rhizoma Corydalis) gancao (Radix Glycyrrhizae), xiangfu (Rhizoma Cyperi), honghua (Flos Carthami),zhiqiao (Fructus Aurantii), jixueteng(Caulis Spatholobi).

Explanation:

Herbs to tonity spleen and eliminate dampness: baizhu (Rhizoma Atractylodis Macrocephalae), fuling (Poria) , gancao (Radix Glycyrrhizae), Dangshen (Radix Angelicae Sinensis).

Herbs to regulate Qi, move blood and stop pain: danggui (Radix Agelicae Sinensis), chuanxiong (Rhizoma Chuanxiong), taoren (Semen Persicae), Wulingzhi (Faecs Trogopterori), wuyao (Radix Linderae), yuanhu (Rhizoma Corydalis), xiangfu (Rhizoma Cyperi), honghua (Flos Carthami), zhiqiao (Fructus Aurantii), jixueteng (Caulis Spatholobi).

Acupuncture treatment: Yinlingquan(SP-9), Fenglong(ST-40), Zhongji(RN-3), Zhongwan(RN-12), Zusanli(ST-36),Tanzhong(RN-17), Gongsun(SP-4), Neiguan(PC-6), Xuehai(SP-10), Zigong(EX-A-21), Ciliao(BL-32).

 

7.      Damp-heat with blood stasis:

Main symptoms: Dysmenorrhoea with vaginal yellow, sticky and smelly discharge, abdominal pain can happen at any time but is worse during the intercourse and especially painful with certain positions.  Ultrasound shows “pelvic cavity masses”, often accompanied with lower back and lower abdominal pain.  The patient dislikes like hot water bottles and pressure.  She sometimes feels anus tenesmus pain or a hot or itching sensation in vaginal area. Other symptoms include yellow cloudy urination and sticky, smelly stools or constipation. Pulse is slippery and rapid and she has a reddish tongue with sticky yellow fur.

Principal treatment:  Clear damp-heat and remove blood stasis to stop pain.

Formula and herbs: The formula “Hongtengbaijiangsan” and/or the formula “Wu Wei Xiao Du Yin”

Hong Teng  (Sargentodoxae Caulis), Bai Jiang Cao (Patriniae Herba cum Radice), Yi Yi Ren  (Coicis Semen), Ji Xue Teng  (Spatholobi Caulis), Mu Dan Pi  (Moutan Cortex), Pu Gong Ying  (Taraxaci Mongolici Herba), /or Huang Bai  (Phellodendri Cortex), Jin Yin Hua (Lonicerae Japonicae Flos), Ye Ju Hua  (Chrysanthemi Indici Flos), Zi Hua Di Ding  (Viola Herba cum Radice), with Chun Gen Bai Pi  (Ailanthi Cortex), Bai Hua She She Cao  (Oldenlandiae Diffusae Herba), Ze Xie (Alismatis Rhizoma), Chi Shao  (Paeoniae Rubra Radix), Hong Hua  (Carthami Flos).

Explanation: Both formulae clear heat toxin and eliminate damp, but the former also removes blood stasis. Chun Gen Bai Pi (ailanthi Cortex) clears damp and heat, stops bleeding and profuse discharge. Bai Hua She She Cao (Oldenlandia Diffusae Herba) clears heat toxins and drains damp, Ze Xie (Alismatis Rhizoma) drains damp through urination and clears deficiency heat, Chi Shao (Paeoniae Rubra Radix) clears heat, cools blood and removes blood stasis, and Hong Hua (Carthami Flos) removes blood stasis and regulates the menses.

*Research shows “Herbs which clear damp-heat help to regulate the NK cells and problems of tissue type compatibility” which can treat infertility due to autoimmune system disorder triggered by pelvic cavity inflammation; herbs like “hongteng (Sargentodoxae Caulis)& baijiangcao(Patriniae Herba cum Radice)” etc.

Acupuncture treatment: Xingjian(LR-2), Yinglingquan(SP-9), Chonmen(ST-12), Fushe()SP-13), Sanyinjiao(SP-6), Zhongji(RN-3), Ciliao(BL-32), Xuehai(SP-10), Quchi(LI-11), Geshu(BL-17), Dazhui(DU-14), Taichong(LR-3).

 

TCM cycle treatment of endometriosis:

During the menstrual period it is important to use herbs that can move blood and stop bleeding, such as the formula “Shixiaosan”  with the addition of chaopuhuang (Baked Pollen Typhae),wulingzhi (Faeces Trogopterori); sanqi (Radix Notoginsengi),qiancaogen  (radix rubiae), (Pollen Typhae) etc. It is very important to quickly stop bleeding and let uterus begin to contract. Then the endometrium will shed off quickly and limit internal bleeding.  After the menstrual period; change to blood moving herbs to absorb blood stasis and adhesions and try not allow scars to form.

Blood moving herbs are divided into different group like those below:

1.      Cooling blood and moving blood—Mudannpi, chishao, zicao.
2.      Eliminate dampness and moving blood—zelan, chixiaodou.
3.      Clearing heat &damp and moving blood—dahuang, huzhang, hongteng, baijiangcao.
4.      Stop bleeding and moving blood – sanQi, qiancao, huaruishi.
5.      Promoting digestion and moving blood – shanzha.
6.      Kidney or blood tonics and blood moving herbs – lujiaoshuang, jixueteng.
7.     Invigorate blood and movie blood stasis – chuanxiong (Thiazoma Chuanxiong) etc but they have different natures such as:

Cold in nature –yujin, huzhang, zhechong,

Cool in nature – danshen, yimucao, chuanshanjia, mangchong, lengxiaohua.

Warm in nature—chuangxiong, ruxiang, yanhusuo, jianghuang, ezhu, jixueteng, honghua, wulingzhi, jiangxiang, zelan, yuejihua, liujinu, ganqi.

Neutral in nature—moyao, sanleng, taoren, niuxi, shuizhi, zirantong, wangbuliuxing,sumu.

Caution: During period use herbs for moving blood and to stop bleeding, some herbs cannot be used too big dosages like Sanqi which can cause heavy bleeding.  I generally use 3 gram of Sanqui and use 6-9 gramme Qiancaogen and it has to  be based on your TCM differential syndrome diagnosis, for example Spleen Qi deficiency type has to using “King herb” – Huangqi30 gram etc.

 

Acupuncture cycle treatment:

Points often used in first phase (After period): Qixue (KI-13), Guanyuan (RN-4), Ququan (LR-8), Sanyinjiao (SP-6), Zusanli (ST-36) – for reinforcing KI & LR yin and blood;

Second phase (Before ovulation):  Guanyuan (RN-4),Zigong (Ex-21), Yinjiao (Ren-7), Taichong (LR-3), Hegu (LI-4), Jiaoxin (KI-8), Qichong (ST-30), – for kidney (yin & yang) & liver blood tonics and soothing liver Qi and moving blood circulation to help egg release.

Third phase (After ovulation): Guanyuan (RN-4), Qihai (RN-6), Sanyinjiao (SP-6), Xuehai (Sp-10), Qixue() or Mingmen (DU-4), Shenshu (BL-23), Ganshu (BL-18), Taixi (KI-3), Diji (SP-8) for KI yin and yang tonics and regulate blood.

Fourth phase (Before period): If not for pregnant treatment use Guilai (ST-29), Zhongji (RN-3), Ciliao (BL-32), Qichong (ST-30), Sanyinjiao (SP-6).

If patient wants to become pregnant this month then continue third phase plus calm “shen” such as Shenmen (HT-7); soothing liver and calming the mind such as Qimen (LR-14); To calm spirit I often use “Yintang” (EX-2).

1.    Enemas

Enemas are an effective method to use for endometriosis. It is close to the diseased area which is in the pelvic cavity. During a retention enema the constituents of herbs are absorbed through the large intestine much more quickly than when herbs are taken orally.   Using enemas also reduces unnecessarily strong stimulation of the stomach. It is good for pelvic cavity blood circulation; dissipating blood masses or inflamed cysts etc.  Retention enemas should not be used during menstruation.

The formulas often used are strong Qi and blood moving herbs like sanleng (RhizomaSparganii), ezhu (Rhizoma Curumae), shuizhi (Hirudo),zhechong (), dahuang (Radix Angelicae Sinensis), chuangshanjia  (Squama Manitis), sanqi (Radix Notoginseng), zaojiaoci (Fructus Gleditsiae), taoren (Semen Persicae), honghua (Flos Carthami), xuejie (Resina Draconis), danshen (Radix Salviae Miltiorrhizae); or some herbs for dissolve phlegm or dissipate masses like fabanxia (Rhizoma Pinelliae),  haizao (Sargassum), kunbu (Thallus Laminariae), muli (Concha Ostreae); or some herbs for clear damp-heat toxin like xiahucao (Spica Prunellae), hongteng (Sargentodoxae Caulis), baijingcao (Patriniae Herba cum Radice), huzhang (Rhizoma Polygoni Cuspidati),  loulu (Radix Rhapontici), jinyinhua (Flos Lonicerae), lianqiao (Fructus Forsythiae); or yang tonic and herbs to warm meridians herbs like Rougui (Cortex Cinnamomi), zhifuzi (Radix Aconiti Lateralis Preparata).  Animal products are not available in NZ but in are widely used in China.

2.    Umbilical attach method:

This method comes from DR Jinlimin (China) practice: Total effective rate is 90%.

Herbs Xuejie (Resina Draconis), ruxiang (Olibanum), moyao (Myrrha), xixin (Herba Asari), Rougui (Cortex Cinnamomi), paojiang (Charcoal ginger ), hupo (Succinum) shengdahuang (Raw  Radix et Rhizoma Rhei) mangxiao (Mirabilitum) 10 grams each—-wrap heated & grinded thick powder onto umbilicus and keep warm 30-45 minutes 2-3 times/per day.

Acupuncture and Chinese herbs used in conjunction with IVF treatment

Before IVF treatment it is better to have three months Chinese medicine treatment (TCM) artificial cycle treatment. It is very important to use the formula Shixiaosan during menstruation to move blood stagnation and stop pain and to improve the condition of the pelvic cavity, letting lesions heal and scars soften. It is also important help the uterus prepare for pregnancy by improving the condition of the endometrium by using kidney tonics and blood moving treatments.

Before embryo transfer, using acupuncture will improve circulation to the uterus, preparing it to provide a nourishing environment for the embryo.  After the embryo has been implanted using acupuncture can help uterus calm and avoid contraction and expelling the embryo.   IVF patients need very special care in the first twelve weeks of pregnancy, including kidney yin and yang tonics.

Acupuncture points that I often use:

Before embryo transfer — Guilai (ST-29), Zigong (EX-21), guanyuan (RN-4), xuehai (SP-10), sanyinjiao( SP6) to promote uterine blood circulation.

Explanation: Guilai (ST-29) – return blood to uterus; Zigong (EX-21) – acupuncture brings qi and blood to baby palace;  xuehai (SP-10) – acupuncture leads blood from the “sea of blood” to uterus; guanyuan (RN-4) – reinforces kidney yin and yang and warms uterus from Ren meridian (the source of the essence of the body); sanyinjiao (SP6) – Crossing point of liver, spleen and kidney to prepare yin for baby, research shows strong stimulate this point can making uterus contraction which bring blood goes to uterus endometrum.

Method and direction: Except Guanyuan (RN-4) use reinforce, others all use reduce method; all needles direction toward uterus.

After embryo implantation – Shenmen (HT-7), guanyuan (RN-4), sishencong (EX-H-1), Zusnali (ST-36), Baihui (DU-20). To calm “shen” and hold Qi.

Explanation: Guanyuan (RN-4) – Reinforce kidney yin and yang, warm uterus to support luteal phase and keep temperature staying high; Shenmen (HT-7), Sishencong( EX-H-1) – calm mind to avoid uterus contraction; Baihui (DU-20), Zusnali (ST-36) – tonifying Qi and holding Qi to prevent Qi collapse causing miscarriage, strengthen spleen and  stomach Qi to avoid diarrhoea too (due to large intestine and uterus are all belong to smooth muscle, diarrhoea can cause miscarriage)

*Cautions about Guanyuan point:

1. The needle should just reach muscle level – don’t put it too deep.

2. Don’t stimulate too much, just slightly reinforce its action. Ifyou are not confident with it, don’t force yourself to use it as over stimulation of the points might cause miscarriage.

3. Choose a thin needle like 20mmX 30 mm

4. If you use TDP lamp, don’t put too close to lower abdominal & don’t allow patient to feel too hot in lower abdominal area.

After embryo implantion I also like give Chinease medicine to avoid miscarriage.  too, herbs like ejiao (Colla Corii Asini), baishao (Radix Paeoniae Alba), gancao (Radix Glycyrrhizae), and sometimes I use “Shisantaibao” patent medicine which is kidney tonic formula that helps to reduce the risk of miscarriage.

 

Special dietary and lifestyle considerations for women with endometriosis:

Treatment should be accompanied by changes in diet and lifestyle. Improve immune system to avoid sickness, infection, allergy, autoimmune system disorder etc.

1.      Avoiding sex, gynecological examinations, swimming and violent exercises during the menses is very important because contractions of the uterus and vagina during orgasm cause an upward reverse flow of blood and increase the risk of pooling of blood outside the uterus, which in turn increases the risk of endometriosis and also can trigger of autoimmune system disorder due to blood/sperm barrier being damaged, therefore increasing the chance of infertility.
2.      IUDs and vaccum extraction abortions may contribute to endometriosis by causing strong uterine contractions that may cause endometrial cells to be forced updwards through the fallopian tubes from where they may “seed” the peritoneal cavity.
3.      Avoid cold food during menstruation and also keep warm at this time.
4.      Try to not have abortions, D&Cs or caesarean operations
5.      If patient has a large chocolate cyst (>7cm)  she should not become over-tired or do too much physical exercise
6.       Allergic triggers such as wheat and dairy products may need to be removed from the diet, especially when the Stomach and Spleen are weak.
7.      Chemical additives and residues in food and exposure to solvents overload the white blood cells in their battle to eliminate toxins and put the immune system in a constant state of alert.  They should be avoided as much as possible.
8.       Red meat and the saturated fats found in fast-food have an inflammatory effect, as does smoking which can exacerbate blood clotting disorders through its inflammatory effects on the blood vessels.
9.      A diet rich in anti-oxidants and essential fatty acids has an anti-inflammatory effect.
10.  It is important to drink sufficient water to flush out toxins.
Although this is a well-known general principle for good health, being well-hydrated means a good blood flow in the small capillaries feeding into the endometrium and placenta. It is especially important in those women with blood clotting disorders to maintain the circulation as they already have the tendency to blood stagnation in these capillaries, and as the body becomes dehydrated the circulation in the smallest capillaries is the first to become sluggish. (The exception to this is someone whose spleen Qi is very deficient and feels bloating in stomach when she drinks too much).
11. Patients who have severe depression may benefit from counseling. Referral to a doctor is appropriate for patients have severe endometriosis (such as large masses and severe adhesions) and for those patients want to quick relief from pain and discomfort. But after surgery we should as soon as possible give Chinese holistic treatment and maintain a much healthier life.
12.  Finally, the benefits of a calm mind have long been known in TCM to strengthen and quieting the immune system.

Conclusion:

1.      Endometriosis is a difficult condition to treat, but TCM has long term effective results and improves all aspects of patients’ condition.

2.   Supporting IVF treatment with acupuncture and herbal medicine improves pregnancy rates.

3.      Kidney tonics and blood-moving treatments are important in endometriosis.

4.      Lifestyle factors are very important in the prevention of endometriosis.

5.      The principal treatment of endometriosis is to invigorate the blood, tonify the Kidney, move blood stasis and stop pain, but during period have to add herbs or acupuncture to stop bleeding as well. (The aim is let the endometrial lining shed quickly and shorten the duration of bleeding, endometriosis lesions become as smaller as possible); after period as soon as possible to move blood stasis and let lesion heal with less scaring).

6.      TCM cycle treatment basic differential diagnosis and four phases are focus on deferent aspects. It is very useful for improving pregnancy rate.

 

Case histories:

Case one:  “Paula”

Paula (her name is a pseudonym) is a Chinese woman who had emigrated to NZ.  When she presented for treatment she was 37 years old.  She had been diagnosed with endometriosis and pelvic cavity inflammation when she was 25.  She had tried to conceive a baby without success for 12 years.

Her first visit was in January 1999 for infertility treatment.

Her gynecological history:  Paula married at age 24. One night she had severe abdominal pain, fainted and was sent to the emergency department of the hospital by her husband.  The diagnosis was a left fallopian tube ectopic pregnancy and right ovary chocolate cyst. She had an operation to cut out left tube and remove the chocolate cyst on her right ovary. Since then she has been tried all different sorts of medicine but had no luck in becoming pregnant.  She began to suffer from depression and also pelvic cavity inflammation due to endometriosis.

When she came to see me (in January 1999) her symptoms were as follows:

Her complexion was was dull and dark. She was suffering from depression due to failure to become pregnant.  She had lower back pain and complained of feeling cold.  She also had a slightly yellow smelly discharge.  Her abdominal abdominal pain was variable and was sharp at times and dull at others. It could occur at any time but was worse during her period or from sex in certain positions. She had to take painkillers to relieve the pain.  Sleep or rest also helped to relieve the pain. Her menstruation was dark and brownish with blood clots and pain worse with each cycle.  Her period was often delayed around 37 -40 days and 3-5 days bleeding, She felt  tired easily and had headaches often around temple with either a sharp or dull ache. She was afraid of sexual activity due to pain but still persisted with having sex to meet her husband’s needs – and because she wanted to have a baby.

Her tongue was pale purple swollen with ecchymosis patches on right side.  Its coating was thin, greasy and slightly yellow.  Her  pulse was thin, weak and slippery.  Her Chi pulse was particularly weak.

Diagnosis:  Kidney and spleen deficiency with liver Qi, blood and damp stagnation. (A bit heat comes from liver qi stagnation transformed)
Principal treatment: Tonify kidney and spleen Qi,  eliminate damp, soothing liver Qi and remove blood stasis.
Formula and Herbs:  The formula “Aifunuangongwan” plus additional
Danggui 12g (Radix Angelicae Sinensis), chuanxiong 9g (Rhizoma Chuanxiong), baishao 12g (Radix Paeoniae Alba), xiangfu 9g (Rhizoma Cyperi), wuyao 6 (Radix Linderae), rougui 6g (Cortex Cinnamomi), huangjiang 12g (Rhizoma Polygonati), zhihuangqi 12g (Baked Radix Astragali ), xuduan 12g (Radix Dipsaci),  Fuling 12g  (Poria),  yanhusuo 9g (Rhizoma Corydalis), huangbai 3g, zhigancao 3g (Radix Glycyrrhizma).

*Before ovulation:  Continue to use “Aifunuangongwan” but also add Zaojiaoci 6g, xianlingpi 3g; after ovulation add tusizi 12g; (Danggui* 12g (Radix Angelicae Sinensis) for patients with heavy bleeding., chuanxiong 9 (Rhizoma Chuanxiong) and add chaopuhuang 9g (Stir backed Pollen Typhae), chaowulingzhi 9g (Stir backed Faeces Trogopterori), aiyetan 12g (Charcoaled Folium Artemisiae).  *during periods do not use Danggui if the patient has heavy bleeding.

Enemas: In NZ is very hard to get patients to do enemas, for this patient I told her if she could do enema her treatment will more effective, so patient got equipment from China and did this  every day except during her period.

Formula: Sanlen 30g (Rhizoma Sparganii), Ezhu 30g (Rhizoma Curcumae), honghua 9g (Flos Carthami), Hongteng 30g (Sargentodoxae Caulis),  Zaojiaoci 15g (Fructus Gleditsiae), baihuasheshecao 30g (Herba Hedyotidis Diffusae) Aiye 30g ( Folium Artemisiae Argyi), rougui 15g (Cortex Cinnamomi)

* After five months treatment, Paula became pregnant and delivered a boy at full term, he is now 9 years old.

In China enemas are very commonly used, but in NZ she is my only patient who has used enemas. I have included this case so that this technique will become better known in NZ.

Analysis:

1.      To this patient, I have to say “Thank you for trusting me and Chinese medicine”. It wouldn’t have been successful without her consistently taking the herbs and doing enemas for months.
2.      I used big dosage of herbs in the tea for use in enemas to break up blood stasis and masses, as well as strong herbs for cleaning external damp-heat (inflammation). Herbs are absorbed through intestine are more effective due to it being closer to the diseased area – results are faster and come without the risk of damaging the stomach and spleen.
3.      Internal medicine is very important for her to soften masses and let old lesions heal, reproduces system working again, “Chong”, “Ren”,” Baogong” fill up fresh blood; Qi and blood start to move freely, making her body ready for her baby!

 

Case two: Sandra

Sandra (her name is a pseudonym), is a NZ woman who has endometriosis. Her laparoscopy shows “moderate endometriosis” on her pelvic cavity; fallopian tube angiography shows both side are blocked.  In June of 2005, she had IVF in an attempt to get pregnant, but it was unsuccessful.

Sandra first visited me in March 2006.  She was 39 years old at the time.

Her symptoms were painful sexual activity and often tenesmus of anus.  Her menstrual cycle is 28-30 days with dark red blood and very painful periods.  Sometimes she had spotting for days and she also had bleeding with blood clots that looked brownish (indicative of blood stasis) and mucus for three days.  Her tongue was normal red with a bit dark spots thin white coating; her pulse was thin wiry. (Liver Qi & blood and dampness stagnation).

She felt everything was OK except for her painful periods and pain during sex. She is a positive woman and exercises regularly. She didn’t like taking herbs and prefered acupuncture treatments.

She went to an IVF programme.

One day before embryo transformed, she came to me for acupuncture.

Points: Zigong (EX-21), Guanyuan (RN-4), Hegu (LI-4), Sanyinjiao (SP-6), with a bit strong stimulation and all direction towards to uterus and patient feels warm or shooting sensation at low abdomen for 30 minutes.

The day after embryo implanted, she came to my clinic straight after hospital for acupuncture treatment.

Points: Shenmen(HT-7), Sishencong (EX-1), Qimen (LR14), guanyuan (RN-4), susanli (ST-36), Baihui (DU-20). With TDP magic lamp (Just let patient feel low abdominal warm – not hot!)

I persuaded her to take the patent medicine “Shisantaibao” to avoid miscarriage. Her pregnancy was successful with a little girl.

Analysis: For those patients who don’t want to take Chinese herbs it is OK, but it is important to talk to them to let them know how Chinese medicine can benefit them.  As, always, the final decision is up to the patient.

 

Afterword: Research shows Chinese medicine is very effective in treating endometriosis:

1. Jane Lyttleton’ search on internet (2008) statistic: (success rate)

*Method of removing blood stasis and resolving phlegm, softening and resolving the lump (46 patients)

Dysmenorrhea 98%; Anal tenesmus 94%; Pain on intercourse 88%; Reduced mass size 87%; 6 of 10 infertility patients pregnant;

*Method removing blood stasis and purgation (76 patients)—

Using Dahuang (Radix et Rhizoma Rhei).

Dysmenorrheal 89%; Pelvic pain 67%; Pain on intercourse 72%; Reduced mass size 22%; 3 0f 22 infertility patients pregnant.

Using “Xuefuzhuyutang” modified (Kidney yin & yang, Spleen Qi tonics etc) + enema

83 women were treated.

40 were considered cured:  of these 23 became pregnant the rest had the signs and symptoms of their disease resolved.
In 27 women, the size of masses reduced by over 50% and their was a reduction in their other symptoms. (The treatment result for these women was rated as “good”.)
In a further 10 women, masses reduced by 33% and their other symptoms were also somewhat improved. (The treatment result for these women was rated as “effective”.)
In five women, there was no change in their condition and the treatment was rated as “ineffective”.

2.      Research shows: kidney tonics and blood circulation herbs are more effective in the treatment of endometriosis is shown in research from:

1/. Nanjing Chinese Medical University (2006):

Observation: To observe the influence of Tonifying kidney and regulating Menstrual cycle on the dysmenorrhea score, infertility, ovarian endometrial cysts and hemorrheology, endocrine and to explore new effective method for treatment of endometriosis.

Methods: 40 patients with endometriosis after ultrasound were treated by tonifying kidney and regulating menstrual cycle. Changes of symptoms, signs and hemorrheology, endocrine were assessed.

Results: 85% of patients’ conditions were significant approved.

 

Note to practitioners: Chinese TCM women’s specialist Dr Lijimei has a famous formula which we can use for reference.

Her formula is danshen15 (Radix Salviae Miltiorrhizae), Chishao12 (Radix Paeoniae Rubra), Chuanxiong10 (Rhizoma Chuanxiong), Sanleng12 (Rhizoma Sparganii), Ezhu12 (Rhizoma Curcumae), Zamuzhi10榨木枝, Shijianchuan10 (Herba Salviae Chinensis),Yimucao15 (Herba Leonuri), Jixueteng15 (Caulis Spatholobi), Xianmao12 (Rhizoma Curculiginis), Shudi12 (Radix Rehmanniae), Gouqizi12 (Fructus Lycii), Shengpuhuang12 (Herba Taxilli), Zishiying10(Fluoritum);

Qi deficiency add Dangshen(Radix Codonopsis), Huangqi(Radix Astragali), Shengma(Rhizoma Cimicifugae); Yin deficiency add nvzhenzi(Fructus Ligustri Lucidi), digupi(Cortex Lycii), Diyu(Radix Sanguisorbae); masses or chocolate cyst add Zaojiaoci(Fructus Gleditsiae), Huaruishi(Ophicalcitum), Biejia(Carapax Trionycis); abdominal pain add Chuanlianzi(Fructus Toosendan), Ruxiang(Olibanum), Moyao(Myrrha), Sanqipowder(Radix Notoginsheng).

About the author:

Rona Wang graduated from Beijing University of TCM in 1983. She then worked in the Gynaecology Department of Guang An Men Hospital, a hospital in Beijing that uses both Traditional Chinese Medicine and Western medicine and includes a research academy. In 1989 she moved to  Tiantan Hospital for further training and worked in the Department of Gynaecology, Obstetrics and Neonatal care.

In 1992 Rona moved to Sydney, Australia and opened her own practice in the suburb of Glebe. She also lectured at the Sydney College of TCM. After moving to New Zealand in 1998, Rona opened her clinic in Birkenhead, Auckland. She currently lectures in gynecology at the New Zealand College of Chinese Medicine.

She has published articles in Australian and New Zealand TCM publications, and recently gave a lecture called “TCM treatment of Male Infertility” at the Oceania Chinese Medicine Forum which was held in Auckland in June 2011.

 

Editor’s note: The NZ Journal of Natural Medicine features article about a diverse range of natural and traditional therapies as well as vital information to help people who are already healthy to stay that way.

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