Treatment of Endometriosis and Fibroids
Randine Lewis, Ph.D., Lic.Ac.
What do endometriosis and fibroids have in common? They both have their place in preventing conception, and both are responsive to estrogen fluctuations. There is no western cure for either, except hysterectomy. Eastern medicine, however, gives them a common denominator - they are both considered processes of inhibited, stagnated uterine blood which doesn't flow freely. The menstruate has become blocked, and the normal process has become obstructed. Women with either of these conditions often experience a sediment-like menstrual flow with dark, brown, clotted, blood which has been allowed to oxidize. The rest of the body responds and the immune system reacts to this silty, old blood. Our neuroendocrine awareness is heightened. Remember, our body's immunologic priority is to keep us safe from external or internal insults. It recognizes the toxic state and mounts chemicals to clean up this debris. It knows that a fetus won't survive in this environment.Luckily, both conditions respond very well to Chinese medicine. Given time and the proper
treatment, the blood flow will
improve, the sediment will clear, and the body will overcome its immunologic
protective mechanisms. Our psycho-neuro-endocrinologic system will settle
down. Our body can relax and allow conception to take place.
Endometriosis is described as the abnormal growth of endometrial tissue outside the endometrium. Endometrial cells are those that are found in the uterine lining. When those cells are found in areas outside of the uterus, the diagnosis of endometriosis is made. Although the disease has been present throughout history, it was first identified in 1860. In 1960 the disease mechanism was first described because of the discovery and use in France of the laparoscope. Endometriosis is therefore a surgical diagnosis. Modern science does not know why endometrial cells are found elsewhere. One theory of its origin is explained by retrograde menstruation. When a woman is supposed to menstruate and blood should be discharged vaginally, it backs up through the tubes and into the abdominal cavity. Yet this happens in most women, and most women do not have endometriosis. Another hypothesis is that anatomic abnormalities such as retroverted uteri and small cervical openings do not allow the blood to pass through freely, and it therefore backs up into other areas of the pelvis.
Another theory of the causative origins of endometriosis is that other cells outside of the uterus are transformed by some unknown stimulus into endometrial cells. Whatever the etiology, the misplaced endometrial cells then respond to hormonal stimulus just like the endometrium is supposed to. But, during menstruation there is no way for this menstrual blood to leave the body. Pain, sometimes very severe, is the result. Prostaglandins are said to be the causative factor in menstrual pain. Painful periods are an indication of possible endometriosis, and women with endometriosis have higher levels of certain of the prostaglandins. The bleeding tissue may also cause adhesions and scar tissue.
Common sites of endometriosis include the cervix, the vaginal-rectal space, ovary, fallopian tubes, colon and bladder wall.
Common accompanying symptoms include dysmenorrhea, pathological uterine bleeding, and bleeding at sites other than the endometrium during menstruation. Some women bleed at sites as distant as the nasopharynx during menstruation and get nosebleeds during the menses. Endometriosis is classified as to its severity.
Mild endometriosis - implants are small, flat patches of endometrial tissue growing outside of their normal location.
Moderate endometriosis - includes "chocolate cysts" of endometriosis may be smaller than a pea or larger than a grapefruit, located within the ovary.
Severe endometriosis - in some cases, bands of fibrous scar tissues (adhesions) bind the pelvic organs together.
Interestingly enough, except for the obvious mechanical obstruction found in severe endometriosis, there seems to be no real correlation between the severity of endometriosis and its impact on fertility. However, as many as half of the women who have been diagnosed with infertility are found to have endometriosis on laparoscopic examination.
Some women, in fact, have no symptoms at all, and diagnosis is only made through laparoscopy. Symptoms which may accompany endometriosis include abnormally heavy bleeding, associated with back pain or severe abdominal cramping, painful intercourse, painful intestinal upset or urination during the menstruation, and the inability to become pregnant.
Western medical treatment usually includes pain relieving medication, laparoscopy and laser removal of the endometrial tissue. Other drugs may be used to control the hormonal stimulation of the endometriosis. As menstruation ceases each month, the misplaced endometrial tissue will be starved of hormonal stimulus, and thus mollify the endometriosis response. Of course, ovulation is also halted in this process, which defeats our present purpose.
The Traditional Chinese Medical View and Treatment of Endometriosis
Endometriosis and Static Blood Endometriosis is not a disease category in Traditional Chinese Medicine. However, our Eastern healers have recognized this disease for far longer than its identification in Western medicine. It is known by its symptoms and is referred to as menstrual movement pain. It is also very amenable to natural forms of treatment.
The Jin Gui Yao Lue (Essentials from the Golden Cabinet), "Women's Miscellaneous Diseases' Pulse, Pattern & Treatment" chapter, has this description: "The menstrual blood is inhibited and there is (resulting) lower abdominal fullness and pain."
Chinese medicine categorizes endometrial lesions as static blood, or blood which is not flowing as it should, and thus causes problems. This is not so different from our Western understanding of the same disease. Since the maligned blood is located in an vicinity where normal blood flow is often absent or minimal, our body has a tougher time resolving it. The Chinese therefore say that these conglomerations of stasic blood have entered the network vessels, which are more difficult to reach. This is one important aspect in how we will approach this syndrome.
Other countries throughout the rest of the world recognize endometriosis as an autoimmune diasease. The famous gynecologist Dr. Ni reported that in her experience as a M.D. gynecologist in China, most women upon whom she performed laparoscopies had some degree of endometrial tissue outside of the uterus, which was found at various locales throughout the abdominal category. What sets aside women with fertility impaired endometriosis is the "osis" or inflammatory reaction which has resulted from the presence of the endometrial tissue outside its original intended site.
The inflammatory reaction which the body has set up in response to the endometrial tissue in an attempt to "clean it up", makes the immune system reactive to the cells that make up the uterine lining. The fault then begins to reside in the immune system, which is unable to eradicate the misplaced tissue. The immune system then loses its discriminatory control, and can't distinguish between self and non-self. As far as fertility is concerned, this creates a toxic environment in the uterus, not conducive to an implanting embryo.
An immunopharmacological study of an antiendometriotic herbal medicine known as Gui Zhi Fu Ling Wan, was conducted by four researchers at the Osaka City University Medical School in Japan.
The patients with endometriosis were found to have elevated serum levels of Immunoglobulin M antibody titers. A control group was treated with leuproride acetate therapy to suppress hormonal production (a common western approach for endometriosis is to suppress the hormonal stimulus). The treated group was given the antiemdometriotic herbal formula Gui Zhi Fu Ling Wan, which consists of Ramulus Cinnamomi Cassiae, Sclerotium Poriae Cocos, Radis Paeoniae, Cortex Moutan Radicis, and Semen Persicae. This formula was historically used in China to treat bleeding during pregnancy due to blood stasis in the womb, or to prevent miscarriage. Later indications include the treatment of immunologic and inflammatory conditions of the uterus including dysmenorrhea, leiomyomas (uterine fibroids), ovarian cysts, chronic pelvic inflammatoy disease and salpingitis, and endometriosis.
The lupron treated group had lowered levels of estradiol, but no change in the IgM antibody titer. The treated group had no changes in estradiol levels, but the levels of IgM antibody titer were decreased and the patients were kept symptom free for months.
From, "A Study on the Treatment of Primary Dysmenorrhea with Jia Wei Mo Jia Tang (Added Flavors Myrrh & Dragon's Blood Decoction) and Its Affect on Prostaglandins and Related Factors" by Zhu Nan-Sun, Huang Hui, & Chen Hui-Lin, Ahong Yi Za Zhi (The Journal of Traditional Chinese Medicine), #2, 1994, p. 99-101:
This article reports on the treatment of primary dysmenorrhea in 95 women who were divided into two groups. One group received the herbal formula Jia Wei Mo Jie Tang as treatment for their dysmenorrhea and the other group, which acted as a control group, received indomethacin. In addition, serum levels of various prostaglandins were compared before and after treatment with 30 women who were considered normal. The authors begin this report by stating that the disease mechanism related to primary dysmenorrhea is stasis. Therefore, Jia Wei Mo Jie Tang's intended purpose is to invigorate the blood and transform stasis, break the qi and move stagnation. However, from a modern Western medical point of view, this treatment achieves its effect by regulating serum prostaglandins.
All 95 of the women in this study who received treatment suffered from primary dysmenorrhea. The 30 women who were considered normal did not have any period pain and had normal, biphasic basal body temperatures. Of those suffering from painful periods, 87 cases had menstrual cycles which lasted from 25-35 days, while eight cases had menstrual cycles lasting from 35-45 days. Four cases had scanty menses, 56 medium menses, and 35 cases had excessively heavy menses. Ninety women's periods lasted seven days or less and fivce cases lasted more than seven days. In terms of the disease course, 31 cases had dysmenorrhea for less than five years, 47 cases for five to ten years, and seventeen cases for more than ten years. In addition, 20 cases experienced pain before the onset of their periods, 89 during their periods, and two after their periods. Five had previously had children and 90 had not been able. In terms of the severity of their pain, 61 suffered from severe pain and 34 from moderate pain. And as for their pattern discrimination, there were 49 cases of qi stagnation with blood stasis, 17 cases of qi stagnation with blood stasis and accompanied by cold, 19 cases of qi stagnation with blood stasis and accompanied by heat, and 10 cases of qi stagnation and blood stasis accompanied by vacuity.
Jia Wei Mo Jie Tang consisted of uncooked pollen typhae, Feces Trogpterori Seu Pteromi, Pericarpiuym Citri Reticulatae Viride, Rhizoma Sparganii, Rhizoma Curcumae Zedoariae, Fructus Crataegi, Resina Olibani, Resina Myrrhae, and powdered Sanguis Draconis.
The 63 women in the group which received Jia Wei Mo Jie Tang were given 50 ml of this decoction orally two times per day beginning two weeks before the due date of their period as calculated by the rise in their basal body temperature. Since administration was continued through the first day of their period, the total number of days this decoction was administered each cycle was 15, and one course of treatment equaled three months.
The 32 women in the group which received indomethacin were given this medication beginning three days before the onset of their period or 12 days after their basal body temperature went up. They took 25 mg. of indomethacin orally, three times per day. Since they also took this medication during the first day of their periods, they took imdomethacin for a total of four days per cycle, and one course of treatment also lasted three months. The 30 normal women did not receive any medication during the course of this study.
In the Jia Wei Mo Jie Tang group, before treatment, 39 had severe pain and 24 moderate pain. After treatment, two cases still had severe pain, 17 experienced moderate pain, and 18 cases slight pain. In the indomethacin group, 22 had severe pain and 10 moderate pain. After treatment 1 had severe pain, 9 moderate pain, and 17 slight pain. Thus the amelioration rate for the Jia Wei Mo Jie Tang group was 80.4% as compared to 73.3% for the indomethacin group.
In terms of serum analysis, there was a positive correlation between the severity of dysmenorrhea and PGF 2a and PGE contents in the menstrual blood. Jia Wei Mo Jie Tang substantially decreased the blood contents of and the ratio between PGF 2a and PGE 2. Further, it markedly lowered the content of medium phase E 2 ( a type of estrogen) secreted by the corpus luteum and found in the peripheral blood but markedly increased the content of late phase progesterone secreted by the corpus luteum. Indomethacin, on the other hand, demonstrated no marked effect on estrogen or progesterone.
Categories for treating endometriosis, or dysmenorrhea are further divided as:.
In each case, the pattern must be treated, using dietary principles, herbal categories and acupressure treatments based upon the diagnostic presentation.
Endometriosis is an enduring disease; stasis entering the deeper, network vessels. When an enduring disease enters the network vessels it is wise to employ the use of resins like frankincense and myrrh with treatment.
The Jing Yue Quan Shu ([Zhang] Jing-yue's Complete Writings), "Women's Regulation: Blood Conglomerations" chapter states:
Static blood which is retained and stagnates eventually becomes concretions. This pattern may be casued during the period or postpartum and may be due to internal damage engendering chill, external invasion of wind cold, rage and anger damaging the liver, qi counterflow and blood stagnation, long-standing taxation, long-standing weakness, and qi weakness not moving [the blood.] Therefore, sometimes the blood stirs and sometimes it has almost nothing. It may also counterflow, thus leading to retention and stagnation which accumulates for days, gradually becoming concretions.
The Zheng Zhi Zheng Sheng (Patterns & Treatments Proven Restraing), "Blood Conglomerations" chapter states (paraphrased):
If there is gathering of blood conglomeration, there will be low back pain and inability to bend, accumulation of qi below the pubic bone, stone-like hardness, tension inside the lower abdomen, bitter pain, upper back spine pain penetrating to and reaching the low back and abdomen, spasms within the vagina, a secluded cervix, menstruation behind schedule. This disease is found in people with infertility. If treatment precipitates the conglomerations, it can be cured.
The above literary cites and endometriosis all share the same symptoms. In endometriosis there is the production of nodulations and lumps within the body. In TCM, this is related to blood gathering becoming stasis, and stasis accumulation becoming concretions and conglomerations. Most often, the greatest method for treating endometriosis is to quicken the blood and transform stasis. In all cases, the underlying pattern must be treated as well.
Endometriosis is also correlated with a scenario of estrogen dominance. Estrogen feeds endometriosis. Many women with endometriosis also have lower levels of progesterone as well. It is therefore important to help the body clear itself if excess estrogens. The liver metabolizes estrogen; therefore using methods which resolve liver qi stagnation will assist the body in clearing excess estrogen. Use stimulation on the acupuncture points Joining Valley, located between the bulge between the base of the thumb and first finger bone on each hand, and Great Rushing, found in the depression on the foot approximately one inch up from the web between the big and second toes.