Part two of a two part series
Traditional Chinese Medicine explains in its own manner the theories and pathologies of endometriosis. Endometriosis does not have a common name in TCM, rather its signs and symptoms are a combination of disease categories within Chinese medicine, but it may be referred to as Neiyi or internal lump. This ‘lump’ may be caused by unremoved dead cells or xue (blood) that has stagnated and caused pain. In Eastern and Western medicine blood nourishes the body, removes dead cells, and should not get stuck anywhere.
Endometriosis is characterized by qi yu (stagnation of energy), and yu xue (blood stasis) or congealed blood manifesting as dysmenorrhea and abdominal masses. Most symptoms such as dysmenorrhea, bowel problems, and lumbago are worse during menses. Focal bleeding from endometrial implants may be called extravasation of blood caused by blood stasis/stagnation. Pain caused by inflammatory cytokines in the peritoneal cavity are considered to be heat in the lower jiao. Irritation or direct infiltration of nerves in the pelvic floor, as in pelvic distortion, are considered qi stagnation or blood stasis in the lower jiao. (1) Overall presentations may be referred to as rebellious qi (energy)/blood with hidden re (heat) in the li (interior) and xue yu (blood stagnation) or stasis. Some Eastern and Western practitioners say that unresolved cases of dysmenorrhea may be endometriosis. (5)
TCM Diagnosis and Treatment
Endometriosis has no specific category in TCMand diagnosis is based on the symptoms that a patient currently presents. Diagnosis is arrived at and confirmed via directed questions, palpation, and tongue diagnosis. The information gathered is utilized to create an appropriate treatment plan.
Treatments in TCM will depend on individual cases. They include the use of acupuncture and herbal medicines. When herbs are administered they are introduced via decoctions, which are stronger and can be pao zhi (enhanced) via different cooking methods. Later patients are switched to powders, or pills for easier administration. With the growing evidence that Chinese herbs have anti-inflammatory and pain alleviating properties more patients and related health care providers are more open to utilizing their benefits.
InTCM patients present differently and have overlapping presentations according to external factors or environment, stage of disease, constitution and lifestyle. Here are some of the many possible causes of endometriosis and herbal treatments appropriate to each condition.
- Surgery, blood stagnation and stasis
- Seven Emotions: anger, mania, pensiveness, grief and sadness, fear and fright
- Cold Uterus
Indirect transplantation of endometrial cells can occur with c-sections, or other pelvic surgeries. This relates to qi stagnation and blood stasis with internal heat due to internal trauma. Over time this may evolve into a kidney deficiency. This condition is treated by moving qi and blood, resolving stagnation and transforming stasis, clearing heat and cooling blood.
Stressors, and the seven emotions they manifest, are contributing factors to the development of endometriosis.
- Anger is manifestation of the Liver and related to the Wood element.
- Mania is a manifestation of the Heart and related to the Fire element.
- Pensiveness is a manifestation of the Spleen and related to the Earth element.
- Grief and sadness are manifestations of the Lung and related to the Metal element.
- Fear and fright are manifestations of the Kidney and related to the Water element.
In anger stagnant liver qi transforms into fire (huo) and becomes rebellious by rising upwards. Blood follows the qi, since qi is the commander of blood, resulting in qi stagnation and blood stasis transforming into heat. Symptoms may manifest as ovulation pain, delayed ovulation, irregular periods, with irritability and anger, restlessness, a red face, bitter taste in mouth, headaches and distending pain in the hypochondria. The tongue is red and pulse is rapid and wiry.
When mania occurs it causes heat in the Heart and it can directly become blood heat. The Heart and the Liver are related via blood. The Heart governs blood, while the Liver stores it. If there is Heart fire causing blood heat, this may cause blood heat in the Liver. Hot blood can extravasate and rebel upwards facilitating ectopic implantation of endometrial tissue. (1) Accompanying symptoms may present as anxiety, insomnia, palpitations and irregular ovulation.
Pensiveness, over-thinking, constant worry, and anxiety can weaken the Spleen. When the Spleen is weak, the Liver’s opportunistic nature will attack. This interrupts the production of post-heaven qi (from food) and blood. As a result the qi may rebel upwards, carrying just enough blood with it to facilitate ectopic implantation of blood. Over time, this will transform into heat. A decreased qi production results in an inherent hypo-immune state.
The Spleen produces blood which is stored in the Liver and Liver blood is transformed into Kidney essence. If Kidney essence is constantly undernourished, then the Kidneys will become weak and unable to support the Spleen and the Kidney’s function of creating yuan (source) qi, allowing ectopic endometrial tissue to thrive without resistance. (1)
In grief and sadness weak lungs will cause weak Kidneys, while weak Kidney function will cause insufficiency of Spleen qi. Spleen qi deficiency will create a hypo-immune response and blood deficiency. Blood deficiency creates blood stasis which will transform into heat and a weakened immune function allows the deposition of ectopic endometrial tissue in the body.
Fright can scatter qi and fear causes it to descend. These shifts in energy may contribute to dysmenorrhea, delayed periods, infertility, frequent urination, or back ache.
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. Cold uterus may present 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 coating; and a wiry, tight pulse.
Acupuncture and Herbal Medicine
Acupuncture is an important part of treatment protocol for endometriosis and its presentation. Symptoms are varied and there are no empirical points, rather there are acupuncture points and point combinations unique to the individual case. (6) All presentations of endometriosis have commonly overlapping symptoms and all herbal formulas are modifiable based on patient presentations.
By learning about the Eastern causes of endometriosis such as stress management, diet, and lifestyle, changes could be made to prevent and manage this and similar conditions. Flaws references the following guidelines from Han Bai-ling’s Gynecology (5) :
- Avoid fear, anger and excessive emotions.
- Avoid fatigue just prior to and during menstruation.
- Do not dwell on negative thoughts.
- Avoid cold and raw foods prior to or during periods.
- Avoid sex during periods.
- Avoid strong vigorous movement or exercise during menstruation.
- Eat and drink moderately, avoid spicy foods, maintain regular waking and sleep hours and be happy.
Additionally, diet should include an intake of green vegetables and fruit and a reduction of red meats and processed meats.
- Berkley, M. (April 2010) Endometriosis: Diagnosis and Treatment Options. AAAOM, Bernalillo, NM.
- Chek, P. (2005) Abdominal Wall Function and Organ Health. Video series. SD, CA.
- Chen, J. and Chen, T. (2009) Chinese Herbal Formulas and Applications. City of Industry, CA: Art of Medicine Press, Inc.
- Endo-Online The Voice of the Endometriosis Association http://www.endometriosisassn.org/endo.html
- Flaws, B. (1989) Endometriosis, Infertility and Traditional Chinese Medicine A Laywoman’s Guide. 1st Ed. Boulder, CO: Blue Poppy Press.
- Lyttleton. J. (2007) The Treatment of Infertility with Chinese Medicine. Pro Seminars. Sydney, Australia.
- Maciocia. G. (1998) Obstetrics & Gynecology in Chinese Medicine. Churchill Livingston. 258-259.
- Porth, C. (2005) Pathophysiology 7th Ed. PA: Lippincott Williams & Wilkins.
- Werner, Ruth. (2005) A Massage Therapist’s guide to Pathology 3rd Ed. Lippincott Williams & Wilkins.