Endometriosis is a condition that occurs when the endometrium grows in an abnormal location outside the uterine cavity and is collectively referred to as endometriosis.
When the endometrium is ectopic to the ovaries, it is clinically referred to as chocolate cysts; when the endometrium invades the myometrium, it is referred to as uterine adenopathy. Ectopic endometrium can occur in many locations, mainly in the ovaries, uterine ligament, rectovaginal diaphragm and pelvic peritoneum, but also in the umbilicus, hernia sac, vagina, bladder and lymph nodes, etc. It is influenced by the hormones secreted by the ovaries and the symptoms can change periodically. After menopause, the ovarian function disappears and the ectopic endometrial tissue degenerates, atrophies and is gradually absorbed. Gynecological examination: both sides of the adnexal area are normal or thickened, and a mass can be found. Ultrasound suggests that the uterus is enlarged with uneven light spots and the ovaries are cystically enlarged. There is no name for this disease in Chinese medicine, but the description of blood obstruction in the “Treatise on the Origin of Diseases” of Chao Yuan Fang of the Sui Dynasty: “The obstruction is painful to the lower back and cannot be lifted up, there is accumulation of qi under the transverse bones, it is as hard as a stone, there is acute and bitter pain in the lower abdomen, the backbone is painful, it reaches the lower back and abdomen, the lower contraction is in the yin, if there is wind and cold, the menstrual fluid comes from time to time, it does not come at first, this disease makes people childless”, which is similar to some of the symptoms of this disease. There are similarities between some of the symptoms of this disease.
(I) Etiology and pathogenesis
Patients often have a history of abortion, caesarean section, retroflexion of the uterus, pelvic inflammatory disease, etc. Endometrial fragments shed during menstruation may enter the pelvic cavity with menstrual blood and tubal reflux, and then implant in the uterus, rectal sink, ovaries, etc. and develop into endometriosis. Endometrial transplantation may occur in all surgeries that enter the uterine cavity, such as cesarean section, tubal ligation, hysterosalpingogram, abortion, when the operator inadvertently brings the endometrium to the abdominal wall incision for implantation or sends it into the pelvis, resulting in endometriosis. Chinese medicine believes that the essence of the pathology of endometriosis is blood stasis, and as for the mechanism of blood stasis in Y obstruction, Zhang Jiebin’s Jing Yue Quan Shu of Ming Dynasty said, “Only women have blood stasis. The evidence is from menstruation or postpartum, where the internal injury is cold or external wind and cold; or rage and anger injury to the liver, gas reversal and blood stagnation; or worry and thought injury to the spleen, gas deficiency and blood stagnation; or accumulation of labor and weakness, gas weakness does not work, in short, when the blood is moving, the remaining blood is not clean, and there is a reversal, then the stagnation of the month accumulation gradually into Y carry on …… women long Y stay gangrenous, spleen and kidneys must be deficient, evil and positive fight, firm immobility. Qi is infertile when it is linked to the subsonic organs.” Therefore, this disease is often accompanied by infertility. The diagnosis can be confirmed by gynecological examination (including dissection, laparoscopy, pelvic double imaging, B-type ultrasonography, and gynecological triple examination), which can reveal chocolate cysts in both ovaries and nodules in the posterior wall of the uterus.
(II) Clinical manifestations
The main symptoms of endometriosis include progressive abdominal pain, even severe pain, anal pain, or excessive menstruation, or both more and more pain, and more and more pain, and a few are asymptomatic.
1, menstrual pain: clinical symptoms to the most prominent dysmenorrhea, severe pain even reached the unbearable situation, most of this dysmenorrhea in the pre-menstrual episodes, intensified before the menstruation, some cases, the more menstrual blood, the more abdominal pain, continued until after the net only gradually reduced. The nature of the pain is pre-menstrual distension, stabbing pain, spasmodic pain, followed by persistent pain, cramping pain is common.
2.Menstrual excess: This is another prominent symptom of endomorphic disorder, often with excessive menstruation, or even hemorrhage, and sometimes with stasis, even causing severe anemia.
3.Combined symptoms: In addition to the clinical characteristics of menstrual pain and excessive menstruation, it can also be seen as waist pain, anal cramps, breast swelling, excessive belt, premenstrual headache, irritability, painful intercourse, infertility and other symptoms.
4. Physical signs: Patients are found to have enlarged uterus, enlarged ovaries, painful nodules of different sizes in the rectal sink, posterior wall of uterine body or sacral ligament by western gynecological examination.
(iii) Empirical prescription
In the treatment of endometriosis, the main method is to regulate qi and promote stagnation, activate blood circulation and remove blood stasis. At the same time, we should pay attention to overall identification and combine treatment with etiology in order to adjust the physiological functions of internal organs, qi and blood, yin and yang.
1. Symptomatic treatment: Three basic prescriptions for symptomatic treatment are established according to the main clinical symptoms.
A. Internal Variation I Formula
[Composition] Fried Angelica Sinensis 10g, Salviae Miltiorrhiza 12g, Radix Achyranthes Bidentatae 10g, Radix Aromaticus 10g, Rhizoma Ligustici Chuanxiong 6g, Radix Paeoniae Alba 10g, Radix Myrrh 6g, Radix Yanhuosuo 12g, Radix Phellodendron Bupleurum (decoction) 12g, Radix Wulingxian 10g, Radix Blood Dried 3g.
[Functions] Promoting blood circulation, resolving blood stasis, regulating menstruation and relieving pain.
[Indications] Abdominal pain during menstruation caused by stagnation, tumbling and restlessness, or even severe pain and refusal to press, unbearable to the point of fainting; or irregular or excessive menstrual flow, with abdominal pain slightly reduced after the lowering of stasis masses, or the more menstrual flow, the more painful it is. This symptom is mostly seen in endometriosis, due to internal stasis and accumulation of stagnation for a long time. The coating is thin and slightly greasy, with purple spots on the sides, and the pulse is sunken and stringent or tight.
[Formula Explanation] This formula is based on Siwu Tang with addition and reduction. Radix Angelicae Sinensis and Rhizoma Ligustici Chuanxiong are pungent, nourishing Blood to regulate menstruation and relieve pain; Radix Paeoniae Alba clears blood stasis, activates Blood circulation and relieves pain; Radix Salviae Miltiorrhizae dispels blood stasis, expels blood stasis and breaks up knots; Radix Aromaticus and Myrrh regulate menstruation and relieve pain; Radix Phellodendron and Wulingxin promote Blood circulation, move blood stasis and relieve pain; Radix Haematobium disperses blood stasis, activates Blood circulation and relieves pain.
[If the menstrual flow is too scanty and difficult to discharge, add safflower and trigon; if the abdominal pain is very distended, add frankincense and sumac; if the pain is very vomiting, add light wu yu; if the pain is very cold and the limbs are clear, add cinnamon stick; if each menstrual flow is accompanied by fever, add dandan bark and use it together with red peony; if the mouth is dry, add smallpox powder; if constipation is present, add raw rhubarb.
B. Internal Variation II Formula
[Composition] Radix Angelicae Sinensis 10g, Radix Rehmanniae 10g, Radix Salviae Miltiorrhiza 10g, Radix Paeoniae Alba 10g, Radix Aromaticus 10g, Radix Phellodendron (decoction) 30g, Radix Flos Lactis 20g, Radix Juntan 10g, Radix Panax Quinquefolium (swallowed) 2g, Radix Zhen Ling Dan (decoction) 12g.
[Functions] Promoting blood circulation and regulating menstruation, resolving blood stasis and stopping menorrhagia.
[Indication] Excessive menstrual flow caused by Blood stasis, or excessive menstrual flow caused by uterine fibroids, endometriosis, etc. The blood is dark purple in color and thick in texture, with large lower stasis mass. There is pain in the abdomen, or even constipation, or bleeding is incessant, with dark red or purple tongue and petechiae on the side, and sunken string pulse.
[This formula is based on Siwu Tang with addition and reduction to nourish Blood and regulate menstruation. Chuanxiong is removed and Dan Shen is used to remove stasis and regenerate new blood without the harmful effects of pungency; Xiang Shen regulates Qi and menstruation to help resolve stasis; Sheng Pu Huang and Hua Rui petrify stasis and stop bleeding; Shu Jun Tan cools blood and fire, dispels stasis and stops bleeding; San Qi resolves stasis and stops pain to stop bleeding; Zhen Ling Dan resolves stasis and stops pain and stops bleeding by sedation. If the blood collapse is caused by stasis, it is not effective to simply stop the bleeding, but even counterproductive, the more it is stopped, the more abdominal pain. If blood stasis does not go, new blood will not be generated, and blood does not return to the menstruum, then bleeding will not stop, so it is not effective to attack rather than to stop.
[If there is excessive bleeding and Qi deficiency, add Radix Codonopsis and Radix Astragali; if abdominal pain is severe, add fried Yanhuosuo in vinegar; if the stool is thin, remove Shujun char and add Ginger char; if the chest is stuffy, add Guang Yujin.
C. Internal variation III formula
[Composition] Yun Fu Ling 12 g, Gui Zhi 3 g, Red Peony lO g, Dampi 10 g, Peach kernel 10 g, Saponaria 30 g, Roasted A piece of 9 g, Stone see through 20 g, Curcuma 10 g, Leech 6 g.
[Functions] Removing blood stasis and dispersing nodules, searching and clearing ligaments.
[Indications] This formula is mainly used for endometriosis. Endometrial tissue grows in an abnormal position outside the uterine cavity for various reasons, causing irregular or excessive menstruation, dysmenorrhea, painful intercourse, infertility and other conditions. It can be prescribed separately during menstruation. After menstruation is purified, use the above to resolve stasis and disperse the knots. Thin moss or dark red in texture with purple spots on the sides, with string pulse.
[This formula is an addition to Gui Zhi Fu Ling Formula. Gui Zhi Fu Ling Wan treats stasis, lowering Y block; Soapberry spur is pungent, warm and sharp, directly reaching the disease, collapsing swelling and dispersing nodules; Stone see through to invigorate the blood and subdue swelling; Shanjia piece disperses blood, opens the ligaments, subdues swelling and discharges pus; Curcuma longa moves Qi and breaks blood, eliminates accumulation and disperses nodules; Leech expels bad blood, breaks stasis and disperses nodules. The treatment of endometriosis is to control the symptoms during menstruation and to eliminate the lesions after menstruation.
[If it is necessary to enhance the activation of blood circulation and remove blood stasis, San Ling can be added; if there is pain in the abdomen, Myrrh can be added; if there is pain and distension, Boswellia can be added; if there is constipation, Raw Rhubarb can be added; if there is severe constipation, Yuan Ming Powder can be added; if there is spleen deficiency, Atractylodes Macrocephala can be used as a restraint; if there is posterior weight and anal distension, Chuan Niu Knee and Chicken Blood Vine can be added.
2. Identify the cause of the symptoms and add and subtract for each type.
A. Qi stagnation type: abnormal menstruation, distension and pain in the abdomen leading to the waist, pain in the anus, chest tightness and low abdomen. Thin white fur, thin and astringent pulse. Add Wu Yao, Mu Xiang, Su Mu and Qing Chen Pi.
B. Liver-depression type: Qi stagnation is also seen in premenstrual breast distension and irritability, headache and dizziness or accompanied by infertility, with thin and greasy moss and slightly astringent pulse; choose to add Chai Hu, Dan Pi, Liuxiangzi, Neem, and Yi Yao Wan. If the headache is severe, add Tribulus terrestris, hooked vine, stone cassia, etc.
C.Qi deficiency type: blood collapse or menstrual leakage for a long time, atrophy and dizziness, swelling of the face and limbs, loose stools, shortness of breath and lazy speech, light tongue with thin coating and tooth marks, weak and astringent pulse, add Radix et Rhizoma Ginseng, Rhizoma Atractylodis Macrocephalae, Radix Astragali, Poria, Radix et Rhizoma Huaiyang.
D. Cold coagulation type: severe menstrual pain, cold form and cold limbs, pale face, loose stools, or uterine cold infertility, thin white moss and sunken tight pulse. Choose to add Wu Zhu Yu, ginger, mugwort, etc.
E. Damp-heat type: menstrual disorders, dripping menstruation, stabbing pain in the abdomen, swelling and pain, or bleeding in the middle of the menstrual period, redness between the band on weekdays, itching and frequent urination, dullness and bitterness, thin and greasy moss and slippery pulse, with optional addition of Tsubaki root bark, Cockscomb, White Hibiscus, rice seeds, etc.
F. Heat knot type: Excessive menstruation, dark red, thick and lumpy, red face and dry mouth, dry stool and yellow urine, yellowish band, thin and greasy moss, smooth pulse, remove cinnamon stick, and add septoria, duck plant, rhubarb and scutellaria.
G. Yin deficiency: abnormal menstruation, pain in the abdomen before and after menstruation, palpitations and sleeplessness, hot flashes in the afternoon, dry mouth and stool, or infertility, soreness and weakness of the waist and legs, etc., with less moss and red pulse, remove Gui Zhi and add Radix et Rhizoma Polygonati, Radix et Rhizoma Macrocephala, Radix et Rhizoma Polygonati, Radix et Rhizoma Polygonati, Radix et Rhizoma Polygonati, Radix et Rhizoma Polygonati, etc.