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Endometriosis and Chinese medicine

Last updated: 12 February, 2018
by Steven Clavey, Traditional Chinese Gynaecology

Endometriosis as such is diagnosed surgically (eg via laparoscopy) and therefore is not a traditional disease category in Chinese medicine. Women suffering from this very common disorder would have been treated for period pain (痛经 tòng jīng) or abdominal pain (少腹痛 shào fù tòng).

With the joining of Chinese and Western medicine in modern China, however, the condition is well-recognised and now has its own category in traditional Chinese medicine as practiced throughout China.

The category is called 子宫内膜异位症 zǐ gōng nèi mó yí wèi zhèng. It is described as resulting from the slowdown and stagnation of blood flow in the pelvis, according to Chinese medicine. This stagnation gradually becomes visible by laparoscopy as endometrial lesions.

Blood stagnation in Chinese medicine

This sluggishness in blood flow can be caused by a number of factors, and so during consultations Chinese doctors often ask about many seemingly unrelated issues (e.g. ‘Do you become cold easily?’).

This is because every individual case will be individually prescribed for, even though the basic underlying pathological mechanism remains ‘blood stagnation’.

There are usually other complicating factors in individual patients such as poor digestion, weakness in certain parts of the body, especially the Kidneys (which in Chinese medicine thought supports the whole reproductive system), general tiredness and tension.

Chinese doctors have learned that if these ‘other’ issues are not addressed, a patient may have a temporary improvement, but is quite likely to have a relapse sooner or later, because these factors may have been part of the precipitating scenario in the first place (eg ‘Cold slowing the blood flow’ or ‘digestive weakness failing to supply sufficient blood’).

Again, the habit of holding stress in the abdomen is an important factor in the cause of blood stagnation because the act of tensing the muscles tends to slow the flow of energy ­­ the ‘qi’ (‘chee’) ­­ which itself is involved in ensuring blood movement. Even low­-grade tension, if frequent enough, can cause reduction in the flow of qi and finally sluggishness in blood flow resulting in eventual stagnation in the pelvis.

Why the pelvis?

The next question to answer, then, is why in the pelvis, and not in the shoulders, where so many other people get soreness and aches from tension?

The Chinese medicine answer is that the Liver, which is sensitive to stress and responsible for moving qi throughout the body, has itself an acupuncture channel which runs directly over the ovarian area and then encircles the genitals before it runs down the thigh. Any impediment to energy flow here will cause backup across the numerous other channels that traverse the area, exactly like the traffic jam that results if a major traffic conduit becomes backed up.

Why not men?

Well, why not men? Men will tend to reflect this tension more in prostate and impotence problems, but it is the constant ’emptying and filling’ of the ‘uterine vessels’ during menstruation that makes blood stagnation so much more of a problem with women.

So we suggest stress is a major factor. But what can we do about stress? It is out there, it is not something medicines can eliminate, so what can we do? Chinese medicine agrees that stress is part of life, but one’s reaction to it can be more or less under control. A Chinese doctor will try to assist, with herbs or acupuncture, the coping abilities of a patient, while advising them to try to eliminate all unnecessary stress. In many cases the patient is able to significantly reduce their level of perceived stress, which we believe will also reduce the chance of further blood stagnation occurring.

Different types of endometriosis

There are two basic types of endometriosis, viewed through the lens of Chinese medicine theory. See more about that topic here.

Do Chinese medicine and Western medicine conflict or complement?

Read about that here.

How long is a consultation?

You can read about that here.

What kind of treatment is it?

Herbal and/or acupuncture. The options available are discussed with the patient and chosen by mutual consent.

Acupuncture would involve at least weekly sessions; herbal consultations are usually monthly, although with severe cases they may be more frequent.

The herbal treatments that patients report the most benefit from are through a decoction, which means boiling individually-­prescribed raw herbs and then drinking the resulting soup. Not always very palatable. (The taste of the herbs, as well as the time involved in cooking them, is often a major factor in patient compliance; the more convenient but rather less effective alternative of using pre­made pills or powders is a negotiable option).

What about diet?
Specific information is available during consultation. In general, a good common sense balanced diet is best; Chinese medicine rarely advocates severe or overly­-strict diets, but does recommend that cold or raw foods are reduced in favour of warmer, easier-­to-­digest things.

How long is a reasonable course of treatment?
At least 6 months, although patients should be improving as they progress. The most recent symptoms to appear are usually the first to go, and the most common statement heard in the early stages of treatment is ‘I just feel better in myself!’. As a very general rule of thumb in Chinese medicine, we say that one year of problem will require one month of treatment.

Will the endometriosis come back after TCM treatment?
Recent research (2017) indicates a low recurrence rate of endometriosis after Chinese medicine treatment. In my experience, patients have shown clear of endo on laparoscopy following herbal treatment, and remained symptom free; while some others have had recurrences after several years. Feedback in this regard can be difficult because once patients feel normal again they are understandably loath to have another laparoscopy just to check the state of the endometriosis.

Recent research supports the long term effect of Chinese medicine treatment for endometriosis (see research on Chinese medicine and endometriosis).

If prior menstrual irregularities are the major precipitating cause of the endometriosis, restoring a normal menstruation (i.e. pain­-free, smooth-­flowing, regular cycle) that persists after treatment is completed is a good prognostic sign. Clotting is an early warning sign requiring follow­up.

On the other hand, Chinese medicine holds that lifestyle is an important factor in endometriosis development, and that includes a patient’s method of dealing with stress, diet, work patterns, etc. If problem areas can be identified and addressed, the chances are better that the endometriosis will not recur.

How much does it cost?
Herbal consultation and treatment average $150-250/month, but this cost is not yet rebatable except with a few private health funds (usually the smaller ones). The initial consultation is longer and therefore more costly. Acupuncture is $95 a session, and is usually performed in a course of six treatments: once per week for three weeks, then a break, then once a week for three weeks. This scheme may be altered to fit your personal needs.

Can I get pregnant while taking Chinese herbs?

As Chinese medicine does not aim at stopping the menstrual cycle, but rather at regularising it, trying to get pregnant is fine.

Plans in this area should be made clear at the first consultation.

Advantages & disadvantages of Chinese treatment

Disadvantages:

  • Expense (Chinese medicine is not covered by Health Benefits)
  • Taste
  • Discomfort (eg in acupuncture)
  • Time taken to cook up herbs
  • No way to tell without surgery whether the endo itself is reducing.

Advantages:
A coherent explanation of the relationship between the patient’s sensations and the nature of the disease can be provided. Although this explanation is not couched in Western medical terms, it provides insight and indications as to where lifestyle changes may be beneficial, and allows the patient to understand and trust the signals which their body manifests. This by itself is an important step toward the patient’s regaining a sense of control over their own health.

Linked to this is the important factor of taking responsibility, and taking active part in, the patient’s own treatment. A patient has to work very hard with Chinese herbs, cooking and then drinking them, and monitoring their response. Not everyone is up to it, but many (even most) of those who are capable of sticking with it find Chinese herbs a rewarding process above and beyond the therapeutic results.

Research on endo and Chinese medicine can be viewed here.

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