Endometriosis is defined as a disease in which functioning endometrial tissue is improperly present in sites outside the uterine cavity. Common symptoms and signs include pelvic pain; pelvic masses; alterations of menses; and infertility.

Other clinical manifestations include abdominal bloating; rectal bleeding during menses; and pain with urination and defecation. The purposes of this formula are to address both the causes and symptoms of endometriosis by removing the abnormal endometrial tissue, relieving pain, and reducing the mass(es).

Chinese Herbs from a Western Perspective

Many herbs have remarkable pain-relieving properties. Of these herbs, corydalis (yan hu suo) offers the most potent and consistent relief of pain. It works on the central nervous system and is effective in relieving both external and internal pain. With appropriate dosage levels, the analgesic effect of corydalis has been measured to the effect of morphine. Corydalis has many fewer side effects and complications (such as development of tolerance and dependence) than morphine, but morphine has a proportionately stronger analgesic effect and faster onset of action.¹ The analgesic effect of corydalis can be further enhanced when combined with electroacupuncture.²

In addition to corydalis, there are many other herbs with strong analgesic effects. Mastic (ru xiang) and myrrh (mo yao) are effective against pain of skeletal muscles;³ cnidium (chuan xiong) is effective against neurogenic pain;⁴ and bupleurum (chai hu), angelica (bai zhi) and licorice (gan cao) have generalized analgesic effects.^5,6,7

Tang kuei (dang gui) has long demonstrated effectiveness in treating disorders of the uterus. Administration of tang kuei is associated with both stimulating and inhibiting effects on uterine tissues. Laboratory studies have shown that water and alcohol extracts of tang kuei tend to stimulate the uterus, while the essential oil tends to inhibit the uterus.⁸ Furthermore, clinical studies have shown that when the uterus is in a state of relaxation, tang kuei can induce contraction. On the other hand, if the uterus is in a state of contraction, then tang kuei can induce relaxation.⁹ This dual action of the herb explains its therapeutic effect of relieving spasms and stopping pain.

Other herbs with marked effectiveness in treatment of gynecological disorders include bulrush (pu huang) and perilla (zi su ye). In a clinical study, 31 women with abnormal uterine contractions and continuous bleeding with blood clots were treated with three grams of bulrush three times daily for three consecutive days. Most women reported satisfactory result with a gradual decrease in both bleeding and clots.¹⁰ In another clinical study, patients with bleeding from the uterus or the cervix were treated with perilla topically. Of 108 patients treated, 86 (79.63%) reported satisfactory results.¹¹

Chinese Herbs from an Eastern Perspective

In addition to the herbs discussed above, many herbs have shown excellent results in treating endometriosis but without laboratory or clinical studies to support their effect. Nonetheless, they are quite effective according to historical and traditional uses and applications. Below is a list of herbs with excellent effects according to traditional Chinese medicine explanations.

Corydalis, the strongest analgesic herb in the materia medica, is the king herb for pain relief in this formula. Bulrush, a blood regulator, and pteropus (wu ling zhi), a blood invigorator, are commonly used to ease painful menstruation. To treat the root of endometriosis, blood stagnation must be resolved. Mastic and myrrh are often paired together, as are scirpus (san leng) and zedoaria (e zhu). In this formula, both pairs are used synergistically to remove blood stasis in both the organs and channels. They are used in this formula to break up blood stasis in the lower burner (jiao) in the chong and ren channels. The chong channel is the point of emergence of all 12 regular channels, and is also considered to be the "sea of blood." Cnidium is commonly used to treat gynecological disorders, in part because its descending function is to enter the chong channel to regulate qi and blood circulation and normalize menstruation. Red peony (chi shao) enters the blood (xue) level to break up blood stagnation. It also assists the heat-clearing herbs in this formula to relieve inflammation of the pelvic cavity.

Pangolin scales (chuan shan jia) and cinnamon twigs (gui zhi) are strong herbs used to break up blood stagnation and open the channels and collaterals. Qi-regulating herbs such as lindera (wu yao), saussurea (mu xiang), magnolia bark (hou po) and fennel seed (xiao hui xiang) are used to address symptoms such as bloating and colicky pain associated with endometriosis. Besides relieving pain, these qi-regulating herbs assist the blood-invigorating herbs in dispersing stagnation. Aurantium (zhi ke) relieves distention; areca seed (bing lang) disperses stagnation and promotes the movement of qi. Bupleurum enters the liver and helps regulate menstruation.

Cautions

Many herbs commonly used to treat endometriosis have marked effects in activating blood circulation and eliminating blood stagnation. Similarly, these herbs also have marked anticoagulant and antiplatelet properties. If herbs and drugs of similar effect are taken together, the overall effects of both will be potentiated, leading to increased risk of bleeding and bruises.¹² Therefore, such herbs should not be used for patients who are taking drugs that modify the clotting mechanism, such as antiplatelet and anticoagulant medications.

Clinical Note

• Endometriosis may interfere with conception due to blood stagnation causing obstruction. Herbs may be used as the first formula to treat infertility due to endometriosis. After the obstruction is cleared, other formulas may be prescribed if necessary to restore appropriate balance and enhance fertility.
• Pain due to endometriosis is usually sharp and sudden in nature, which denotes blood stagnation.
• Pain due to inflammation is usually persistent and dull in nature, except in acute exacerbation.

Lifestyle Instructions

• Adequate intake of vitamins and minerals on a daily basis is important. Vitamin E helps with hormone balance, while vitamin K is essential for normal blood clotting. Both are readily available in a balanced and diverse healthy diet, with vitamin K enhanced by moderate skin exposure to moderate sunlight. Iron is also needed, as heavy monthly bleeding contributes to iron deficiency.
• Advise the patient to avoid alcohol; caffeine; animal fats; butter; dairy products; fried foods; all hardened (hydrogenated) fats; junk food; fast foods; red meats; salt; shellfish; and sugar.¹³ If you eat poultry, select products from birds raised on organic food, without the administration of antibiotics or hormone supplements.

References

1. Pharmacology and Applications of Chinese Herbs, 1983, p. 447.
2. Acupuncture Research 1994;19(1):55-8.
3. Chinese Herbology 1998;539-540.
4. Hebei Journal of Chinese Medicine 1982;4:34.
5. Journal of Shenyang University of Medicine 1984;1(3):214.
6. People's Republic of China Journal of Chinese Herbology 1991;16(9):560.
7. Chinese Herbology Journal 1993;558.
8. Chinese Journal of Medicine 1954;40(9):670.
9. Chinese Herbology 1998;815:823.
10. Shanghai Journal of Chinese Medicine and Herbology 1963;9:1.
11. Journal of Traditional Chinese Medicine 1998;8:49.
12. Chen J. Recognition and prevention of herb-drug interactions. Medical Acupuncture, vol. 10, p.9.
13. Balch J, Balch P. Prescriptions for Nutritional Healing, 2nd ed. Avery Publishing Group, 1997.

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