from the Institute for Traditional Medicine February 1996
Chinese herbs have been used in formal clinical trials evaluating their
effectiveness for the treatment of endometriosis since 1979 in China. More
than 1,000 women have participated in such trials in the past 15 years,
with results published in Chinese medical journals. The reported effective
rate (percentage of women showing a favorable response to the therapy)
has averaged about 88%. In recent trials (during the past five years),
a cure rate of about 32% has been achieved, with a cure defined as freedom
from symptoms after a course of treatment followed by no recurrence within
a year.
THE HERBS THAT HAVE BEEN SELECTED
Several herbs, used in the form of complex formulas with from 3 to 18
ingredients, have been used in the successful treatment of endometriosis.
No single herb has yet been identified as essential, and practitioners
of Chinese medicine believe that the most effective treatment is one suited
to the particular needs of the individual. Among the frequently used ingredients
are rhubarb, zedoaria, sparganium, myrrh, frankincense, bulrush, corydalis,
lindera, peony, and cinnamon. These herbs have the property of regulating
blood circulation, and they may have influences on hormones, endorphins,
immune responses, and metabolism. Several of these herbs are also used
in the treatment of uterine myomas (fibroids) that may accompany endometriosis.
METHOD OF CONSUMING CHINESE HERBS
The traditional method of using Chinese herbs, which has been employed
for more than 2,000 years in China, is to combine several herbs together
and either cook them to make a soup and drink it once or twice per day,
or powder them, make the powders into pills, and swallow them with warm
water or tea, two to three times per day. Because cooking the herbs is
time-consuming and produces a tea which has an unpleasant smell and taste,
most people prefer using pills or tablets. In informal clinical trials
in America, tableted herb combinations have been reported effective in
controlling menstrual pain due to endometriosis and other causes.
MECHANISM OF ACTION
Approximately 5-10% of the crude herbal material is physiologically
active (the remainder is mostly starch, cellulose, water, and other relatively
inert ingredients). Each herb contains several active constituents, and
each herbal formula contains several herbs. Therefore, the mechanism of
action is extremely complex and can not be fully known. It is thought that
the herb combinations used in treating endometriosis help reduce autoimmune
responses associated with the disorder and increase the level of pain-relieving
endorphins.
SAFETY OF CHINESE HERBS
The herbs routinely used in herb formulas for treating endometriosis
are non-toxic. However, some ingredients, such as rhubarb, can cause intestinal
cramping and diarrhea. Therefore, it is best to have the herbs prescribed
by a health professional who can select the most appropriate formulation
and make changes if necessary. American practitioners of Chinese medicine
have been treating patients with endometriosis since 1983, when an English-language
review article appeared on the subject.
DOSAGE AND DURATION OF USE OF CHINESE HERBS
The dosage of herb tablets ranges from 6-18 per day, depending on the
formula(s) used (the most common dosage range is 9-15 tablets per day during
most of the menstrual cycle). The standard course of therapy is three months,
and it may necessary to repeat a course of therapy one or more times to
gain a consistent relief from endometriosis before discontinuing treatment.
In a few cases, it may be necessary to use a high dosage form of herbs
(such as teas or dried teas in granule form) for a period of time to gain
the desired results. Since endometriosis is frequently a cause of undesired
infertility, and because restored fertility is common with the treatments,
the use of the herbs may be stopped early by pregnancy. If a woman becomes
pregnant during treatment for endometriosis, she should stop the use of
the herbs and seek further assistance for any herbal therapy that might
be undertaken during pregnancy (an herb combination that reduces the incidence
of miscarriage might be appropriate for those who are past age 35).
NUMBER OF DIFFERENT HERBS USED IN EACH FORMULA
The theory of herb combining in Chinese medical practice is quite complex.
In most cases, application of the theory and extensive Chinese experience
suggests combining 6-18 herbs to make one prescription. In some cases,
two prescriptions are taken simultaneously. The large number of herbs prevents
adverse effects that might arise from taking a large amount of any single
herb and also provides many types of active components. Some simplified
research formulas have only three to four herbs; these often have quick
and powerful action, but a higher potential for adverse effects (not harmful,
but uncomfortable). It may be recommended that two herb formulas be used,
either consecutively or together. Some of the suggested treatment plans
for gynecological disorders, including endometriosis, involve using different
formulas at different times during the cycle; the total number of different
herbs to be consumed throughout the month can be fairly large.
DIGESTION AND ABSORPTION OF HERBS
The tablets are made up of finely powdered herbs which can be digested
and their ingredients absorbed in minutes. The tablets have been tested
in the laboratory using digestive juices; they are shown to break down
into powder completely in about thirty minutes--faster than most vitamin
pills. In the stomach, they are probably broken down even more quickly.
In some formulations, one or more of the herbs have been extracted in hot
water and then dried. This material quickly reconstitutes as a liquid in
the stomach. Absorption of active constituents occurs after the material
has entered the upper intestinal tract.
SIMULTANEOUS USE OF OTHER THERAPIES
No adverse reactions have been reported from using Chinese herbs with
other kinds of therapy. In fact, Chinese herbs are frequently used to reduce
the side-effects of Western drugs. The herbs may be used in conjunction
with drug therapies for endometriosis, although this is probably not necessary
(herbs alone may be sufficiently effective). One can also use nutritional
interventions, such as administration of magnesium and B vitamins.
RESULTS OBTAINED THUS FAR
U.S. evaluations of Chinese herbs for dysmenorrhea and endometriosis
have revealed an effective rate (substantial relief of menstrual pain)
of 75% or more. In addition to relieving pain, the herbs have helped to
regulate menstrual cycles and have reportedly produced other health benefits.
Thus far, only about 50 women have participated in such trials, but many
individuals have received treatment and considered the results satisfactory.
In a letter (1993) to the Endometriosis Association, one patient wrote:
"Several years ago I was fortunate enough to be pointed toward Edie Vickers,
the acupuncturist associated with the Institute for Traditional Medicine
in Portland, Oregon. At the time, I was adamant that under no circumstances
would I subject myself to Danazol. Through regular acupuncture and Chinese
herbal treatments, I was able to delay my second endometriosis surgery
for a year and a half, at which time the technology and knowledgeable and
experienced doctor were available to take care of the majority of my problem
via surgical technique. At this time I was 37 years old...I am now 41 years
old and consider myself lucky that I still have my uterus, have never taken
Danazol or Lupron, and my pain is reduced to ibuprofen-relieved cramps
lasting no longer than 18 hours a month...I think the herbs are greatly
helpful and I always felt they were really working well. Chinese medicine
takes patience, faith, and time, and sometimes lifestyle changes--but,
in the final analysis, it works."
THE COST OF USING CHINESE HERBS
The cost of herbal therapy will depend upon the protocol that is followed.
Typical herb treatments used in the U.S. have a cost of about $25 to $60
per month. Sometimes, Chinese herbs are prescribed along with a protocol
of acupuncture treatment, which typically has a cost of $35 to $65 per
treatment. A three month standard course of therapy can cost from as little
as $150 (if a low dose herbal combination and an initial office visit is
all that is needed) to as much as $1,000 (if a high dose herbal combination
plus weekly acupuncture is needed).
ENDOMETRIOSIS
Endometriosis is a common problem in the West, being one of the major
causes of menstrual pain and a significant
contributor to female infertility. Yet, this disorder has been mentioned
only rarely in the Chinese medical reports which are
otherwise nearly replete with therapies for gynecologic disorders.
It is possible that endometriosis is much less frequent in
the Orient. Interestingly, however, endometriosis is most common in
women who delay childbirth for several years, which is
the standard practice in China. The delays in the West tend to be much
longer than in China, with most cases of
endometriosis arising after age thirty; this difference might lead
to a difference in incidence rates. Endometriosis is often
relieved by a pregnancy and is sometimes benefited by regular use of
hormone-based contraceptive drugs.
The Chinese medical literature consistently cites one treatment for
endometriosis--the purified plant drug gossypol--
which is successful in some instances. This is the active component
of cotton roots that is being used extensively as a male
contraceptive in China as well as for treating female gynecologic disorders
such as uterine myoma and menopausal
bleeding. Gossypol has some side-effects and is not readily available
for use in the West. It should be noted, however, that
cotton roots have been utilized in the southern part of the United
States in folk medicines to treat dysmenorrhea,
amenorrhea, uterine tumors, and to induce abortions.
During the past few years, discussions of endometriosis treatments
have finally appeared in the Chinese literature,
though the reported number of women treated remains relatively small.
One of the first reports on the subject was by Cao
Ling Xian, which was published in English in the Journal of the American
College of Traditional Chinese Medicine (1983).
Using a traditional style Chinese medical analysis, the symptoms of
endometriosis were correlated with the conditions of
menstrual pain and lower abdominal lumps as described in ancient literature.
These conditions are understood as having to
do with stagnated blood circulation and accumulation of old blood,
thus preventing the generation of new blood.
A traditional formula for abdominal pains and lumps is Persica and
Achyranthes Combination. The theory of treatment
is that qi stagnation occurs first, followed by stagnation of blood;
the prescription thus combines Bupleurum and Chih-shih
Formula to treat constrained liver qi, and Persica and Carthamus Combination
to vitalize the blood, with some slight
modifications. Alternatively, a cold syndrome can cause the blood circulation
to stagnate, and in such cases, the Cnidium
and Bulrush Combination is used. It dispels the cold with dry ginger,
fennel, and cinnamon bark, and activates the blood
with tang-kuei, red peony, cnidium, typha (bulrush), myrrh, corydalis,
and pteropus. Although other causes of blood stasis
can exist, such as heat inducing the blood to escape from the vessels,
or qi deficiency, the problems of qi stagnation and
cold are considered dominant in causing excessive growth of endometrial
tissue. The author cited only one case, a woman
who had a diagnosis of "nodules on the posterior uterine wall," who
was treated with a modified Persica and Red Peony
Combination (Taoren Zhengqi Tang), containing the blood vitalizing
herbs red peony, moutan, persica, rhubarb, tang-kuei,
artemisia anomala, salvia, corydalis, and achyranthes. After three
months, the woman was relieved of symptoms and
became pregnant. Five clinical reports since this initial analysis
demonstrate the basic validity of the methods suggested
here.
A report from the Sichuan Medical College (1985) describes treatment
of 42 cases of endometriosis. The prescriptions
given were varied according to needs, but made up of herbs from two
basic categories: warming tonics for kidney and
spleen (morinda, epimedium, dipsacus, cuscuta, codonopsis, and astragalus)
and qi and blood vitalizing and stasis removing
herbs (cyperus, moutan, persica, carthamus, typha, rubia, red peony,
myrrh, and frankincense). The herbs were given as a
decoction, taken after menstruation, 15-20 batches per menstrual cycle,
used for three to six months depending on the
development of the case. After that, the herbs might be continued for
several months with less frequent use, as needed. Most
patients consumed about 100 batches of herbs. Results were moderate:
five patients were said to be cured (with one
pregnancy), 23 were markedly improved (with six pregnant), 11 were
somewhat improved. After one year, three cases had
recurrence of the original disorder.
A report from Anhui College of Traditional Chinese Medicine (1988)
described the use of a formula that promotes
circulation of qi and blood, the Tongjin San, made with tang-kuei,
peony, moutan, carthamus, cyperus, curcuma, melia,
zedoaria, lindera, corydalis, and cnidium. The herb powder was decocted,
with modifications as deemed necessary, and
taken a few days after beginning menstruation, continued for seven
to ten batches. Thirty patients were treated for six
months following this method: nine of them were markedly improved (with
four pregnant), 18 were improved, and three
showed no effect.
The Chaozhou Hospital issued a report (1990) on treatment of 30 women
with endometriosis, using Shixiao Guijie
Tang, composed of typha, pteropus, calamus gum, san-chi, and tang-kuei.
This formula contains none of the qi regulating
herbs and retains only the blood vitalizing therapies. It was reported
that 12 cases were cured, 16 cases showed
improvement, and two cases did not respond. This treatment had one
of the highest "cure" rates (40%), though the small
number involved makes this figure less reliable as a predictor for
effects with larger numbers of patients.
The Shanghai College of Traditional Chinese Medicine affiliated hospital
reported (1991) an apparently successful
treatment for endometriosis comprised of just three herbs--the Neiyi
Wan #1 formula, with turtle shell (which dissolves
masses), rhubarb, and succinum. These materials were powdered, made
into pills, and taken in the amount of 2.5 grams
each time, twice daily. The study, the largest yet reported, included
76 cases of endometriosis, with 61 "effectively treated."
Blood analysis showed that the herb formula was able to "thin the blood"
and reduce excess populations of T8 cells and
immunoglobulins. The herbs were taken for three months, and could be
continued during menstruation.
The most recent report on the subject, from the Heilongjian College
of Traditional Chinese Medicine affiliated hospital
(1992), involved 64 patients, treated with a decoction of salvia, pteropus,
sparganium, zedoaria, cyperus, corydalis, and
loranthus. Modifications were made as deemed necessary, and treatment
was generally continued for two to three menstrual
cycles, without interruption. It was reported that 18 were cured, 26
markedly improved, and 16 improved.
Of the nearly 250 women treated in these studies, the results suggest
that about 20% were cured, 10% were unaffected
by treatment, and the remaining 70% had varying degrees of positive
response. The implication is that with use of Chinese
herb formulas a cure is possible, but not highly likely; that improvement,
including substantial reduction of symptoms and
possibility of pregnancy for infertile women, is to be expected. Required
treatment times are three to six months, and though
decoctions are the main form of therapy, pills made from powdered herbs
appear to work as well. The preferred herbs for
treatment are the blood vitalizing herbs such as typha, pteropus, zedoaria,
carthamus, red peony, myrrh, frankincense,
salvia, and corydalis, and there is some limited use of qi regulating
herbs, mainly cyperus, lindera, melia, and curcuma (the
latter being a qi and blood regulating herb).
According to experience of American practitioners, after initiating
treatments, the first menstrual cycle is often more
painful than previous ones, the second menstrual cycle involves discharge
of large clots, and the third and subsequent cycles
begin to show the alleviation of symptoms. The experiences during the
first two cycles of treatment tend to be discouraging
and may lead to unnecessary changes in therapy or cessation of the
method. It is possible that some of these reactions might
be reduced by formula modifications, such as inclusion of herbs to
address cold syndrome or increased use of pain-
relieving, blood vitalizing herbs, such as pteropus.
A formula available in the West, Lindera 15, contains many of the desired
herbs (lindera, cyperus, melia, sparganium,
corydalis, tang-kuei, achyranthes, red peony, persica, moutan, cnidium
cinnamon bark, and carthamus) and is recommended
to be taken in doses up to five tablets three times daily. It can be
combined with Corydalis 5, a formula containing three of
the herbs often used in the Chinese treatments--corydalis, pteropus,
and zedoaria. Or, it could be combined with Myrrh
Tablets (containing many of the same blood vitalizing herbs as in Lindera
15, but adding myrrh and frankincense). Initial
reports of endometriosis treatments at a center in Chicago where these
herbs are used indicate prompt favorable response.
Since fully curative effects appear relatively infrequent, regular
treatment to resolve stagnation of qi and blood may be
necessary. Long-term application of these strong vitalizing herbs is
thought to eventually produce adverse effects unless
tonics are also taken; therefore, the inclusion of a qi and blood nourishing
formula after about three months of therapy is
recommended. Ingredients such as astragalus, ginseng (or codonopsis),
atractylodes, tang-kuei, peony, and rehmannia, are
likely to be helpful in those cases.
STRAIGHT FROM CHINA
TREATMENT OF ENDOMETRIOSIS WITH REMOVING BLOOD-STASIS METHOD from:
Chinese Journal of Integrated Traditional and Western Medicine 1 (9):
524-526 edited and
translated by Fu Kezhi, March 1992
Recipe: NEI Yl WAN #1
Rhubarb: 40%
Turtle shell: 40%
Succinum: 20%
Prepare as powder, blend with vinegar, then make pills. Take 2.5 grams
each time, twice
per day, before meals. Administer continuously (including during menstruation),
for three
months.
Subjects of study:
76 out-patients were consulted over a period of 15 months. Age range
was 21 to 44,
average age 36. Nearly one-third of the patients (22) were infertile,
about one-third had a
history of having at least one abortion. The average duration of suffering
from
endometriosis prior to this treatment was three years. Symptoms included
menstrual pain,
pelvic pain, coitus pain, irregular menstruation, and pelvic cyst.
Some patients had been
treated with Western medicine (including surgery) without success,
but no Western
medical treatments were used for half a year prior to beginning the
herb therapy. The
diagnosis of endometriosis was based on standards of the All China
Symposium of
Integrated Traditional and Western Medicine (1986) and the influence
of the treatment was
evaluated on the basis of standards presented at the same symposium.
Results:
Of the 76 cases treated, 61 were classified as being effective (80%).
By symptom, the
proportion of those initially reporting the symptom who experienced
improvements or
resolution with the herb therapy was:
Menstrual pain: 89%
Pelvic pain: 67%
Coitus pain: 72%
Pelvic cyst or fornix node tenderness: 22%
Infertility: 14%
Blood measurements before and after herb treatment conducted for 57
of the patients
showed normalization of sedimentation rates and plasma viscosity. Also,
of 73 patients
checked for immunoglobulins, 53 showed abnormal levels of IgG, IgA,
and IgM, but these
normalized after the herb treatment (declined). Measurement of T-cell
sub-populations
showed no change in T4, but a notable normalization of T8 (an increase)
in 41 patients
monitored. PGE2 and PGF2 measures declined markedly (465 before to
340 after and 346
before to 101 after, respectively).
Commentary:
This herb formula, taken in low dosage, appears to have affected several
blood
parameters that might help to explain changes in endometrial growth.
In particular, the
indicators are consistent with an auto-immune type of process that
is alleviated by the
herbs.