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Two basic types of endometriosis

Last updated: 17 February, 2018
by Steven Clavey, Traditional Chinese Gynaecology

While every patient is unique, we have found that an essential distinction must be made between two basic types of endometriosis, because the treatment is substantially different in approach.

The two types could be simply termed ‘strong endo’ and ‘weak endo’. What is interesting is that these two types are often quite distinct even under laparoscopy.

The strong endo type is the classic endo picture: extensive active lesions all over the pelvis, severe pain which can last all month, heavy clotted periods and numerous attendant symptoms. These patients usually respond well to surgery at first, but may regress quite quickly even with hormone treatment. These are the patients for whom the strong blood-­stagnation­ removing type of herbal endometriosis treatment works best. The first essential step is to eliminate clotting during the period.

The weak endo type is the one that drives surgeons mad. These patients may have severe symptoms, intense pain and debility, but the laparoscopy finds only mild scattered endo, certainly not what they would expect to match the symptoms! Even more annoying from their point of view is that these types of patients frequently feel much worse after surgery, instead of feeling better.

From a Chinese medicine point of view, all of these phenomena are easily explained: a weak patient, one with ‘blood deficiency’, will have a weak blood flow that easily becomes blocked and stagnated. They also have fewer reserves to handle the pain and debility. Typically their periods will be scanty and brown-­coloured, they will be tired most of the time and digestion will also be impaired, so that sufficient blood cannot be produced. This perpetuates the cycle of weak blood.

Furthermore­­—and this weds Chinese with Western viewpoints—their immune system will be weak, so they suffer repeated onslaughts of various problems which keep them down and their endo up. Very often endometriosis patients will report a history of glandular fever: most of these patients have this ‘weak­-type’ endometriosis.

The treatment approach here is quite different to the strong­ type, because strong blood-­stagnation ­removing herbs can be too strong; these types of patients require gentle blood­-nourishing herbs to enhance the flow of blood, balanced by herbs to ensure that the digestion works well enough to 1) absorb the herbs themselves, and 2) begin to restore blood supply through properly­-digested food. If the digestion is judged too weak for decocted herbs, pills may be used initially to build its strength.

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