According to the four diagnoses and eight principles of Chinese medicine, ectopic pregnancy is a real condition of blood stasis in the abdomen and pain if it does not pass. The principle of treatment is to invigorate blood, resolve blood stasis and eliminate symptoms, and the main method of treatment for this disease is to kill the embryo. Therefore, TCM treatment should start from two aspects: on the one hand, Chinese herbs such as Salvia, Radix Paeoniae and Peach kernel are used to invigorate blood, resolve blood stasis and eliminate symptoms; on the other hand, Chinese herbs such as Trigonella, Curcuma longa, Centipede, Szechuan Oxalis, Ground turtle worm and Smallpox powder are used to kill the embryo. In addition, to improve the success rate and insurance of conservative treatment, western medicines such as methotrexate, 5-fluorouracil, mifepristone and other embryo-killing and embryo-suppressing drugs can be added.
1. Clinical application of common Chinese herbal formulas and additions and subtractions for the treatment of ectopic pregnancy
In order to facilitate observation, identification, treatment and care of patients, ectopic pregnancy is initially divided into unbroken and broken stages according to the different stages of the patient’s disease, and the broken stage is further divided into shock type, unstable type and mass type. Chinese medicine treatment is based on the principle of “treating the symptoms when it is urgent and treating the root cause when it is slow”, and different herbal formulas are used for different ectopic pregnancies with the addition and subtraction of Chinese medicine dialectical evidence.
Commonly used herbal formulas for the treatment of ectopic pregnancy include (Formula of the First Affiliated Hospital of Shanxi Medical College) Ectopic Pregnancy No. Ⅰ (Danshen 15g, Radix Paeoniae 15g, Taoren 9g.) and No. Ⅱ (Danshen 15g, Radix Paeoniae 15g, Taoren 9g, Sanguine and Curcuma 3-6g each.). Among them, Formula I is suitable for shock type and unstable type in the broken stage, and Formula II is suitable for unbroken stage and mass type in the broken stage. Experiments on rabbits proved that both Formula I and II and the single herbs in their formulas have the effect of causing vasodilation in the ear veins of rabbits, but the effects of both Formula I and II are superior to those of the single herbs. In addition, Formula II has the effect of promoting the phagocytosis of macrophages in the blood and accelerating the decomposition and absorption of blood clots in the abdominal cavity of rabbits. Blood biochemical studies have shown that Formula I for ectopic pregnancy can increase plasma fibrinogen and blood viscosity and decrease plasma fibrinolytic activity, which is beneficial to hemostasis, while Formula II can increase plasma fibrinolytic activity and decrease plasma fibrinogen, which is beneficial to the decomposition and absorption of blood clots. These findings provide a theoretical basis for the application of herbal formulas for ectopic pregnancy in clinical treatment.
1.1. Unbroken stage
Main symptoms: There may be a history of menopause, vaginal bleeding, pain in the small abdomen or less abdomen, and early pregnancy reaction. The tongue coating is normal and the pulse is fine and smooth. Gynecological examination: painful lifting and swaying of the cervix, slightly enlarged uterus, palpable mass on one side or posterior side of the uterus. Auxiliary examination: pregnancy test is positive; ultrasound can detect a cystic mass on one side of the adnexa, or there is no gestational sac in the uterus.
Treatment: Invigorate blood circulation and remove blood stasis, eliminate symptoms and kill embryos.
Formula: Ectopic pregnancy Formula II with addition and subtraction.
Radix Salviae Miltiorrhiza 12g, Radix Paeoniae Alba 10g, Peach kernel 9g, Salviae Miltiorrhiza and Curcuma longa 10g each, Boswelliae and Myrrh 6g each, Termites 6g, Plantago ovata 10g, Centipede 3g.
Dosage: Decoction in water in 2 doses, 1 dose daily.
Addition and subtraction: If there is a lot of vaginal bleeding, remove peach kernel and trigon, and add 10g each of wuling fat and pu huang; if the stool is dry, add 10g each of angelica and fire hemp.
According to the four diagnoses and eight syllabuses of Chinese medicine, ectopic pregnancy is a real condition of blood stasis in the abdomen and pain if it does not pass. The principles of treatment are to invigorate Blood, resolve blood stasis and eliminate symptoms, and the main method of treatment for this disease is to kill the embryo. Therefore, TCM treatment should start from two aspects: on the one hand, Chinese herbs such as Salvia, Radix Paeoniae and Peach kernel are used to invigorate blood, resolve blood stasis and eliminate symptoms; on the other hand, Chinese herbs such as Trigonella, Curcuma longa, Centipede, Szechuan Oxalis, Ground turtle worm and Smallpox powder are used to kill the embryo. In addition, to improve the success rate and insurance of conservative treatment, western medicines such as methotrexate, 5-fluorouracil, mifepristone and other embryo-killing and embryo-suppressing drugs can be added.
1. Clinical application of common Chinese herbal formulas and additions and subtractions for the treatment of ectopic pregnancy
In order to facilitate observation, identification, treatment and care of patients, ectopic pregnancy is initially divided into unbroken and broken stages according to the different stages of the patient’s disease, and the broken stage is further divided into shock type, unstable type and mass type. Chinese medicine treatment is based on the principle of “treating the symptoms when it is urgent and treating the root cause when it is slow”, and different herbal formulas are used for different ectopic pregnancies with the addition and subtraction of Chinese medicine dialectical evidence.
Commonly used herbal formulas for the treatment of ectopic pregnancy include (Formula of the First Affiliated Hospital of Shanxi Medical College) Ectopic Pregnancy No. Ⅰ (Danshen 15g, Radix Paeoniae 15g, Taoren 9g.) and No. Ⅱ (Danshen 15g, Radix Paeoniae 15g, Taoren 9g, Sanguine and Curcuma 3-6g each.). Among them, Formula I is suitable for shock type and unstable type in the broken stage, and Formula II is suitable for unbroken stage and mass type in the broken stage. Experiments on rabbits proved that both Formula I and II and the single herbs in their formulas have the effect of causing vasodilation in the ear veins of rabbits, but the effects of both Formula I and II are superior to those of the single herbs. In addition, Formula II has the effect of promoting the phagocytosis of macrophages in the blood and accelerating the decomposition and absorption of blood clots in the abdominal cavity of rabbits. Blood biochemical studies have shown that Formula I for ectopic pregnancy can increase plasma fibrinogen and blood viscosity and decrease plasma fibrinolytic activity, which is beneficial to hemostasis, while Formula II can increase plasma fibrinolytic activity and decrease plasma fibrinogen, which is beneficial to the decomposition and absorption of blood clots. These findings provide a theoretical basis for the application of herbal formulas for ectopic pregnancy in clinical treatment.
1.1. Unbroken stage
Main symptoms: There may be a history of menopause, vaginal bleeding, pain in the small abdomen or less abdomen, and early pregnancy reaction. The tongue coating is normal and the pulse is fine and smooth. Gynecological examination: painful lifting and swaying of the cervix, slightly enlarged uterus, palpable mass on one side or posterior side of the uterus. Auxiliary examination: pregnancy test is positive; ultrasound can detect a cystic mass on one side of the adnexa, or there is no gestational sac in the uterus.
Treatment: Invigorate blood circulation and remove blood stasis, eliminate symptoms and kill embryos.
Formula: Ectopic pregnancy Formula II with addition and subtraction.
Radix Salviae Miltiorrhiza 12g, Radix Paeoniae Alba 10g, Peach kernel 9g, Salviae Miltiorrhiza and Curcuma longa 10g each, Boswelliae and Myrrh 6g each, Termites 6g, Plantago ovata 10g, Centipede 3g.
Dosage: Decoction in water in 2 doses, 1 dose daily.
Addition and subtraction: for those with excessive vaginal bleeding, remove peach kernel and trigon, add 10g each of wuling fat and pu huang (packet); for those with dry stools, add 10g each of angelica and fire hemp.
1.2. Broken period
1.2.1, Shock type (treat with clinical caution with Chinese medicine)
Main symptoms: Rupture of tubal pregnancy or miscarriage, with heavy intra-abdominal bleeding, pale face, cold extremities, or even cold sweat, dizziness, nausea and vomiting, decreased blood pressure, severe pain in the lower abdomen refusing to press, positive mobile turbid sounds, sunken and weak pulse, or fine and feeble pulse. Auxiliary examination: pregnancy test is positive, ultrasound can detect a cystic mass on one side of the adnexa, a large amount of fluid in the abdominal cavity, or a large pelvic mass, surgical treatment is recommended.
Treatment: Returning the Yang to fix the stagnation, activating blood circulation and removing blood stasis.
Recipe: Ginseng and Radix et Rhizoma combined with Ectopic Pregnancy Formula I. Ginseng 50g, Radix et Rhizoma Polygonati 10g, Medlar 20g, Fructus Schisandrae 20g, Salviae Miltiorrhizae 15g, Radix Paeoniae 15g, Peach kernel 9g.
Dosage: Decoction in water and divided into doses, 2 doses every 3-4 hours daily.
Addition and subtraction: For severe pain, add 6-9g of Yuan Hu, for profuse sweating, add 15-30g of Cornu Cervi Pantotrichum, 30g each of Dragon Bone and Oyster, for constipation, bulging bowel and abdominal distension, with black and greasy moss, add 6g of Raw Rhubarb (later down), 9g of Xuan Ming Powder (punching), 9g of Citrus aurantium; for cold form, with white and greasy moss, add the Nine kinds of Heartache Pills of Jin Kui, taking 3-10 pills each time; for mixed cold and heat, with yellow and white greasy thick moss, add 6g of Raw Rhubarb ( (later down) 6g, Xuanming powder (punch) 9g, cinnamon (later down) 3g.
Precautions: Patients with this type are in serious condition and should be immediately treated with resuscitation measures such as fluid, oxygen, blood transfusion and blood volume supplementation, with special care and close observation until blood pressure is stable. During treatment, if intra-abdominal bleeding is found to increase, blood pressure continues to drop, or blood HCG increases instead of decreasing, or the mass continues to increase, non-surgical treatment should be abandoned immediately and replaced by surgical treatment. It should also be emphasized that non-operative treatment of ectopic pregnancy should not be carried out in medical units lacking technical equipment for resuscitation of shock and ready to perform surgery.
1.2.2. Unstable type
Main evidence: ruptured tubal pregnancy or miscarriage with little or high internal bleeding, and blood pressure has returned to stable after resuscitation. At this stage, the main problem is abdominal pain and distension. During this period, the embryo may still become words, and there is a possibility of internal bleeding again, while reappearing shock type. Or there is a small amount of vaginal bleeding, dark brown. Gynecological examination: a poorly defined cellular mass on one side of the uterus can be palpated. The pulse is thin and slow. Auxiliary examination: pregnancy test is positive, ultrasound can detect a cystic mass acoustic image on one side of the adnexa, and peritoneal fluid, which is significantly less than before.
Treatment: To remove blood stasis and kill the embryo, regulate Qi and relieve pain.
Formula: Ectopic pregnancy Formula I with addition and subtraction.
Radix Salviae Miltiorrhiza 15g, Radix Paeoniae Alba 10g, Peach kernel 9g, may be supplemented with 10g of hyssop and wulin, 3g of centipede, and 9g of made aromatic herb.
Dosage: Decoction in water, 1 to 2 doses daily.
Addition and reduction: For those with excessive bleeding, add Yunnan Baiyao 1g (swallowed), 2 to 3 times daily, or Panax ginseng powder 3g (swallowed), 3 times daily. For weak constitution, add 15g each of Radix Codonopsis and Radix Astragali to replenish Qi to help the flow of Qi and blood. For viable embryos, use smallpox powder injection and centipede to kill embryos.
Note: This type of patient also has the possibility of internal bleeding again, so the early stage should be cared for according to the shock type, and be ready to resuscitate shock and surgery at any time.
1.2.3. Mass type
Main evidence: Stable condition, obvious mass in the pelvis, blood or urine HCG test has turned negative. There is slight distension or pressure pain in the lower abdomen, with a dull and thin tongue and thin pulse.
Treatment: Removing blood stasis and eliminating symptoms, breaking down the firmness and dispersing nodules.
Formula: Ectopic Pregnancy Formula II with addition and subtraction.
Radix Salviae Miltiorrhiza 12g, Radix Paeoniae Alba 10g, Peach kernel 9g, Salviae Miltiorrhiza and Curcuma longa 10g each, Boswelliae Miltiorrhiza and Myrrh 6g each and Ground turtle worm 6g.
Dosage: Decoction in water, 1 dose daily.
Addition and reduction: If the package is hard, add 9g of Andrographis paniculata and 9g of Chuanxiu Knee to strengthen the effect of dissipating the symptoms. If the body is weak, add Astragalus and Radix Codonopsis each 15g to support the symptoms and remove the evil. For low fever, add Dan Pi 9g, Tortoise Plate 18g, and Di Bone Bark 12g to nourish Yin and replenish Blood, resolve blood stasis and clear heat. For those with infection, add 15g of honeysuckle, 10g of forsythia, 30g each of red vine and sorrel; for constipation, add 6g of raw rhubarb (later down), or 9g of senna leaf to make tea.
It was reported that 50 cases of ectopic pregnancy were treated with Ectopic Pregnancy Formula II plus reduction, 41 cases were cured, accounting for 82%, 6 cases improved, accounting for 12%, with an overall efficiency of 94%, and 3 cases were invalid, accounting for 6%, which were later changed to surgical treatment. There is also a report that 28 cases of ectopic pregnancy were treated with ectopic pregnancy formula II plus reduction, 11 cases were cured in the first course, 8 cases in the second course, and 4 cases in the third course, with a cure rate of 82.14%. 3 cases had sudden severe abdominal pain and increased internal bleeding during treatment, and emergency surgery was performed, and tubal pregnancy rupture was confirmed during surgery. 2 cases had persistent positive urine pregnancy test, enlarged pelvic mass, and fetal heartbeat was seen on ultrasound during treatment. In two cases, the urine pregnancy test continued to be positive, the pelvic mass increased in size, and fetal heartbeat was seen on ultrasound. The cure rate of 41 cases of ectopic pregnancy treated with Chinese herbal medicine was 80.95%, the tubal patency rate was 76.47%, and the pregnancy rate was 52.84%. These studies show that herbal medicine is effective and safe in the treatment of ectopic pregnancy, but one should be prepared for resuscitation shock and surgery at any time.
2. Other herbal treatments
2.1. Smallpox Powder Smallpox powder is a traditional Chinese medicine extracted from the withered rhizome of Cucurbitaceae. It was first used to induce labor in midterm pregnancy with success. Extensive necrosis of the placental villi trophoblast was seen in the pathological sections of successful induction of labor, suggesting that smallpox powder has a strong embryocidal effect, and later it was used for the treatment of ectopic pregnancy, also with success. Although smallpox powder is less toxic, but there are liver and kidney insufficiency or low levels of white blood cells and platelets, active tuberculosis and severe anemia are contraindications to this drug. Since the drug is a preparation of vegetable proteins that can cause allergic reactions, it is important to know if there is a history of allergy before using the drug. It is prohibited for allergic persons and those who are allergic to penicillin. Also make a skin test before using the drug, if the skin test is negative, then inject a test dose. Observe for two hours, if there is no reaction, then inject smallpox powder protein 1.2-2.4mg intramuscularly or cervically. 48 hours after the drug is administered, the patient is asked to stay in bed, and the patient’s pulse, blood pressure and general condition are observed every 6 hours. The side effects such as fever, headache, sore throat and joint pain will start 8h after the drug is administered and will subside naturally after 48 hours. In order to reduce the side effects and possible allergic reactions, the addition of dexamethasone 5mg twice daily for four times half an hour before using smallpox powder can significantly reduce the side effects. Pregnancy reaction and abdominal pain gradually decreased 12 hours after smallpox powder was used, and the blood or urine HCG titration decreased day by day. If the blood HCG does not decrease on the 7th day, or increases instead, abdominal pain does not decrease, and the adnexal mass does not decrease but increases, it is a failure case. It was reported that in 89 cases of ectopic pregnancy treated with smallpox powder 1.2-1.8 mg intramuscularly alone, 87 cases (97.75%) were cured, and only 2 cases were treated with surgery instead. 87 patients who were successfully cured had their serum β-HCG decreased to normal in 7-28 days, respectively. The patency rate was 70% with subsequent iodine oil imaging of both fallopian tubes. It was also reported that the application of smallpox powder 2.4 mg intramuscularly treated 22 cases of ectopic pregnancy, 20 cases (90.9%) were successfully treated, and only 2 cases failed to be treated with surgery instead. There is also a report on the application of smallpox powder protein in the cervical local 2 points and 10 o’clock each injection 1.2mg, a total of 2.4mg treatment of 31 cases of ectopic pregnancy, all successful. In Shanghai Ruijin Hospital, smallpox powder protein was used to treat ectopic pregnancy, and blood β-HCG and progesterone were measured before and after treatment, and the surgical group was used as a control. The hormone levels in both groups decreased linearly after the 3rd and 7th day of treatment, respectively. It has also been reported that 14 cases of ectopic pregnancy were cured by slowly injecting 2.4 mg of smallpox powder into the uterine cavity through a plastic tube with a diameter of 1 mm, and the serum β-HCG decreased to normal in 7-15 days, and the mass disappeared within six months of follow-up. In conclusion, smallpox powder injection for ectopic pregnancy has a success rate of more than 90%, indicating that its killing effect on trophoblast cells is very strong and effective in treating ectopic pregnancy, but attention should be paid to allergic reactions.
2.2.Chinese herbal medicine enema method: Comfrey 30g, Centipede 2g, Huaiyuqi 10g, Danshen 15g, Red peony 12g, Peach kernel 10g, Angelica sinensis 10g, Pollen 30g, Trigon 10g, Nanxing 30g. Decoct in water, concentrate to 150mL, medicine temperature 30-40℃, 100-~150mL each time, enema once a day. This formula is suitable for treating ectopic pregnancy because it can activate blood circulation and eliminate blood stasis, eliminate symptoms and kill embryos, disperse nodes and relieve pain.
2.3.Patching method: 6g of camphor, 9g of blood, 9g of rosin, 9g of silver Zhu and 0.06g of musk. The first four medicines are finely ground together and heated into a paste, then musk is spread on the surface of the medicine and applied to the abdominal pain while it is hot. It has the effect of breaking blood stasis and eliminating symptoms, and is suitable for ectopic pregnancy with internal blood stasis; it can also be used for old ectopic pregnancy. This medicine is prohibited if the mass is infected with inflammation.
2.4.Mixed therapy: Tiger battle, gypsum, ice chips, finely grinded and made into medicinal cakes, applied externally to the lower abdomen; at the same time, electro-acupuncture is applied to the feet three miles and the three yin jiao (both sides), and the needles are kept for 20 min, twice a day, with tonics, ectopic pregnancy No. I for shock type and unstable type, and No. II for mass type.
There are also some proprietary Chinese medicines such as Broken Blood Flow Tablets taken orally 3 times a day, 2~3 tablets each time; Wind Wheel Hemostasis Tablets, 3 times a day, 1~2 tablets each time; all have the effects of cooling the blood, stopping bleeding, fixing flushing and resolving blood stasis.
For early ectopic pregnancy, by using Ectopic Pregnancy I or II treatment, it can kill embryo and eliminate symptoms, invigorate blood circulation and remove blood stasis, and the success rate is higher. However, sometimes the embryocidal effect of traditional Chinese medicine is not as rapid as that of western medicine, thus increasing the possibility of internal bleeding and the risk of treatment. Therefore, it can be combined with the application of western medicine such as MTX (methotrexate) or 5~Fu (5-fluorouracil) or RU486 (resting crypt) to inhibit gestational trophoblast cells, so as to facilitate the degeneration and necrosis of embryonic tissues as soon as possible, thus increasing the insurance of successful non-surgical treatment. The efficacy and safety of pharmacological treatment of ectopic pregnancy are basically established; nevertheless, further research is needed to refine and improve pharmacological treatment. Hopefully, in the near future, pharmacologic therapy will become the standard of care for early ectopic pregnancy.
However, no matter what method we use to treat ectopic pregnancy, patient safety should be our first priority. During non-surgical treatment, blood pressure, pulse, abdominal pain, and changes in hemoglobin, red blood cell count, and blood β ~ HCG should be closely observed, and if necessary, fluids, blood transfusion, and blood volume should be supplemented, and if there are changes in the condition, surgical treatment should be switched in time to avoid delaying the condition and causing adverse consequences.
1.2.1, shock type (clinical caution with Chinese medicine treatment)
Main symptoms: rupture of tubal pregnancy or miscarriage with heavy intra-abdominal bleeding, pale face, cold extremities, or even cold sweat, dizziness, nausea and vomiting, decreased blood pressure, severe pain in the lower abdomen, refusal to press, positive mobile turbid sounds, sunken and weak pulse, or fine and weak pulse. Auxiliary examination: pregnancy test is positive, ultrasound can detect a cystic mass on one side of the adnexa, a large amount of fluid in the abdominal cavity, or a large pelvic mass, surgical treatment is recommended.
Treatment: Returning the Yang to fix the stagnation, activating blood circulation and removing blood stasis.
Recipe: Ginseng and Radix et Rhizoma combined with Ectopic Pregnancy Formula I. Ginseng 50g, Radix et Rhizoma Polygonati 10g, Medlar 20g, Fructus Schisandrae 20g, Salviae Miltiorrhizae 15g, Radix Paeoniae 15g, Peach kernel 9g.
Dosage: Decoction in water and divided into doses, 2 doses every 3-4 hours daily.
Addition and subtraction: For severe pain, add 6-9g of Yuan Hu, for profuse sweating, add 15-30g of Cornu Cervi Pantotrichum, 30g each of Dragon Bone and Oyster, for constipation, bulging bowel and abdominal distension, with black and greasy moss, add 6g of Raw Rhubarb (later down), 9g of Xuan Ming Powder (punching), 9g of Citrus aurantium; for cold form, with white and greasy moss, add the Nine kinds of Heartache Pills of Jin Kui, taking 3-10 pills each time; for mixed cold and heat, with yellow and white greasy thick moss, add 6g of Raw Rhubarb ( (later down) 6g, Xuanming powder (punch) 9g, cinnamon (later down) 3g.
Precautions: Patients with this type are in serious condition and should be immediately treated with resuscitation measures such as fluid, oxygen, blood transfusion and blood volume supplementation, with special care and close observation until blood pressure is stable. During treatment, if intra-abdominal bleeding is found to increase, blood pressure continues to drop, or blood HCG increases instead of decreasing, or the mass continues to increase, non-surgical treatment should be abandoned immediately and replaced by surgical treatment. It should also be emphasized that non-operative treatment of ectopic pregnancy should not be carried out in medical units lacking technical equipment for resuscitation of shock and ready to perform surgery.
1.2.2. Unstable type
Main evidence: ruptured tubal pregnancy or miscarriage with little or high internal bleeding, and blood pressure has returned to stable after resuscitation. At this stage, the main problem is abdominal pain and distension. During this period, the embryo may still become words, and there is a possibility of internal bleeding again, while reappearing shock type. Or there is a small amount of vaginal bleeding, dark brown. Gynecological examination: a poorly defined cellular mass on one side of the uterus can be palpated. The pulse is thin and slow. Auxiliary examination: pregnancy test is positive, ultrasound can detect a cystic mass acoustic image on one side of the adnexa, and peritoneal fluid, which is significantly less than before.
Treatment: To remove blood stasis and kill the embryo, regulate Qi and relieve pain.
Formula: Ectopic pregnancy Formula I with addition and subtraction.
Radix Salviae Miltiorrhiza 15g, Radix Paeoniae Alba 10g, Peach kernel 9g, may be supplemented with 10g of hyssop and wulin, 3g of centipede, and 9g of made aromatic herb.
Dosage: Decoction in water, 1 to 2 doses daily.
Addition and reduction: For those with excessive bleeding, add Yunnan Baiyao 1g (swallowed), 2 to 3 times daily, or Panax ginseng powder 3g (swallowed), 3 times daily. For weak constitution, add 15g each of Radix Codonopsis and Radix Astragali to replenish Qi to help the flow of Qi and blood. For viable embryos, use smallpox powder injection and centipede to kill embryos.
Note: This type of patient also has the possibility of internal bleeding again, so the early stage should be cared for according to the shock type, and be ready to resuscitate shock and surgery at any time.
1.2.3. Mass type
Main evidence: Stable condition, obvious mass in the pelvis, blood or urine HCG test has turned negative. There is slight distension or pressure pain in the lower abdomen, with a dull and thin tongue and thin pulse.
Treatment: Removing blood stasis and eliminating symptoms, breaking down the firmness and dispersing nodules.
Formula: Ectopic Pregnancy Formula II with addition and subtraction.
Radix Salviae Miltiorrhiza 12g, Radix Paeoniae Alba 10g, Peach kernel 9g, Salviae Miltiorrhiza and Curcuma longa 10g each, Boswelliae Miltiorrhiza and Myrrh 6g each and Ground turtle worm 6g.
Dosage: Decoction in water, 1 dose daily.
Addition and reduction: If the package is hard, add 9g of Andrographis paniculata and 9g of Chuanxiu Knee to strengthen the effect of dissipating the symptoms. If the body is weak, add Astragalus and Radix Codonopsis each 15g to support the symptoms and remove the evil. For low fever, add Dan Pi 9g, Tortoise Plate 18g, and Di Bone Bark 12g to nourish Yin and replenish Blood, resolve blood stasis and clear heat. For those with infection, add 15g of honeysuckle, 10g of forsythia, 30g each of red vine and sorrel; for constipation, add 6g of raw rhubarb (later down), or 9g of senna leaf to make tea.
It was reported that 50 cases of ectopic pregnancy were treated with Ectopic Pregnancy Formula II plus reduction, 41 cases were cured, accounting for 82%, 6 cases improved, accounting for 12%, with an overall efficiency of 94%, and 3 cases were invalid, accounting for 6%, which were later changed to surgical treatment. There is also a report that 28 cases of ectopic pregnancy were treated with ectopic pregnancy formula II plus reduction, 11 cases were cured in the first course, 8 cases in the second course, and 4 cases in the third course, with a cure rate of 82.14%. 3 cases had sudden severe abdominal pain and increased internal bleeding during treatment, and emergency surgery was performed, and tubal pregnancy rupture was confirmed during surgery. 2 cases had persistent positive urine pregnancy test, enlarged pelvic mass, and fetal heartbeat was seen on ultrasound during treatment. In two cases, the urine pregnancy test continued to be positive, the pelvic mass increased in size, and fetal heartbeat was seen on ultrasound. The cure rate of 41 cases of ectopic pregnancy treated with Chinese herbal medicine was 80.95%, the tubal patency rate was 76.47%, and the pregnancy rate was 52.84%. These studies show that herbal medicine is effective and safe in the treatment of ectopic pregnancy, but one should be prepared for resuscitation shock and surgery at any time.
2. Other herbal treatments
2.1. Smallpox Powder Smallpox powder is a traditional Chinese medicine extracted from the withered rhizome of Cucurbitaceae. It was first used to induce labor in midterm pregnancy with success. Extensive necrosis of the placental villi trophoblast was seen in the pathological sections of successful induction of labor, suggesting that smallpox powder has a strong embryocidal effect, and later it was used for the treatment of ectopic pregnancy, also with success. Although smallpox powder is less toxic, but there are liver and kidney insufficiency or low levels of white blood cells and platelets, active tuberculosis and severe anemia are contraindications to this drug. Since the drug is a preparation of vegetable proteins that can cause allergic reactions, it is important to know if there is a history of allergy before using the drug. It is prohibited for allergic persons and those who are allergic to penicillin. Also make a skin test before using the drug, if the skin test is negative, then inject a test dose. Observe for two hours, if there is no reaction, then inject smallpox powder protein 1.2-2.4mg intramuscularly or cervically. 48 hours after the drug is administered, the patient is asked to stay in bed, and the patient’s pulse, blood pressure and general condition are observed every 6 hours. The side effects such as fever, headache, sore throat and joint pain will start 8h after the drug is administered and will subside naturally after 48 hours. In order to reduce the side effects and possible allergic reactions, the addition of dexamethasone 5mg twice daily for four times half an hour before using smallpox powder can significantly reduce the side effects. Pregnancy reaction and abdominal pain gradually decreased 12 hours after smallpox powder was used, and the blood or urine HCG titration decreased day by day. If the blood HCG does not decrease on the 7th day, or increases instead, abdominal pain does not decrease, and the adnexal mass does not decrease but increases, it is a failure case. It was reported that in 89 cases of ectopic pregnancy treated with smallpox powder 1.2-1.8 mg intramuscularly alone, 87 cases (97.75%) were cured, and only 2 cases were treated with surgery instead. 87 patients who were successfully cured had their serum β-HCG decreased to normal in 7-28 days, respectively. The patency rate was 70% with subsequent iodine oil imaging of both fallopian tubes. It was also reported that the application of smallpox powder 2.4 mg intramuscularly treated 22 cases of ectopic pregnancy, 20 cases (90.9%) were successfully treated, and only 2 cases failed to be treated with surgery instead. There is also a report on the application of smallpox powder protein in the cervical local 2 points and 10 o’clock each injection 1.2mg, a total of 2.4mg treatment of 31 cases of ectopic pregnancy, all successful. In Shanghai Ruijin Hospital, smallpox powder protein was used to treat ectopic pregnancy, and blood β-HCG and progesterone were measured before and after treatment, and the surgical group was used as a control. The hormone levels in both groups decreased linearly after the 3rd and 7th day of treatment, respectively. It has also been reported that 14 cases of ectopic pregnancy were cured by slowly injecting 2.4 mg of smallpox powder into the uterine cavity through a plastic tube with a diameter of 1 mm, and the serum β-HCG decreased to normal in 7-15 days, and the mass disappeared within six months of follow-up. In conclusion, smallpox powder injection for ectopic pregnancy has a success rate of more than 90%, indicating that its killing effect on trophoblast cells is very strong and effective in treating ectopic pregnancy, but attention should be paid to allergic reactions.
2.2.Chinese herbal medicine enema method: Comfrey 30g, Centipede 2g, Huaiyuqi 10g, Danshen 15g, Red peony 12g, Peach kernel 10g, Angelica sinensis 10g, Pollen 30g, Trigon 10g, Nanxing 30g. Decoct in water, concentrate to 150mL, medicine temperature 30-40℃, 100-~150mL each time, enema once a day. This formula is suitable for treating ectopic pregnancy because it can activate blood circulation and eliminate blood stasis, eliminate symptoms and kill embryos, disperse nodes and relieve pain.
2.3.Patching method: 6g of camphor, 9g of blood, 9g of rosin, 9g of silver Zhu and 0.06g of musk. The first four medicines are finely ground together and heated into a paste, then musk is spread on the surface of the medicine and applied to the abdominal pain while it is hot. It has the effect of breaking blood stasis and eliminating symptoms, and is suitable for ectopic pregnancy with internal blood stasis; it can also be used for old ectopic pregnancy. This medicine is prohibited if the mass is infected with inflammation.
2.4.Mixed therapy: Tiger battle, gypsum, ice chips, finely grinded and made into medicinal cakes, applied externally to the lower abdomen; at the same time, electro-acupuncture is applied to the feet three miles and the three yin jiao (both sides), and the needles are kept for 20 min, twice a day, with tonics, ectopic pregnancy No. I for shock type and unstable type, and No. II for mass type.
There are also some proprietary Chinese medicines such as Broken Blood Flow Tablets taken orally 3 times a day, 2~3 tablets each time; Wind Wheel Hemostasis Tablets, 3 times a day, 1~2 tablets each time; all have the effects of cooling the blood, stopping bleeding, fixing flushing and resolving blood stasis.
For early ectopic pregnancy, by using Ectopic Pregnancy I or II treatment, it can kill embryo and eliminate symptoms, invigorate blood circulation and remove blood stasis, and the success rate is higher. However, sometimes the embryocidal effect of traditional Chinese medicine is not as rapid as that of western medicine, thus increasing the possibility of internal bleeding and the risk of treatment. Therefore, it can be combined with the application of western medicine such as MTX (methotrexate) or 5~Fu (5-fluorouracil) or RU486 (resting crypt) to inhibit gestational trophoblast cells, so as to facilitate the degeneration and necrosis of embryonic tissues as soon as possible, thus increasing the insurance of successful non-surgical treatment. The efficacy and safety of pharmacological treatment of ectopic pregnancy are basically established; nevertheless, further research is needed to refine and improve pharmacological treatment. Hopefully, in the near future, pharmacologic therapy will become the standard of care for early ectopic pregnancy.
However, no matter what method we use to treat ectopic pregnancy, patient safety should be our first priority. During non-surgical treatment, blood pressure, pulse, abdominal pain, and changes in hemoglobin, red blood cell count, and blood β~HCG should be closely observed, and if necessary, fluids, blood transfusion, and blood volume should be replenished, and if there is any change in the condition, surgical treatment should be changed in time to avoid delaying the condition and causing adverse consequences.