Endometriosis natural treatments: can you use acupuncture and Chinese herbs to treat the symptoms associated with endometriosis?
Acupuncture and Chinese medicine have a long history in working with gynaecological conditions. Of course, the Doctors back then did not know Endometriosis by it’s Western name, but rather by the set of symptoms that women came to them for; painful periods, severe menstrual cramps, vomiting with period, stabbing pain etc.
Treating the symptoms and the mechanism that caused them was their focus – we always talk about mechanism and pathology in terms of qi, blood, yin and yang.
“Traditional Chinese Medicine identifies the energetic cause for each individual and determines a treatment strategy for each patient based on their signs and symptoms”.
Helping to stop severe menstrual cramps and pain as a result of endometriosis, as well as helping to improve menstrual health in order to improve fertility were often two of the main goals of treatment. There has been some modern research published which suggests that this may be possible (1,2).
Whilst the gold standard research for science is the Systematic Review, there has been another recent Clinical Trial published in New Zealand that suggests acupuncture can reduce menstrual pain, with results lasting from three to twelve months after treatment (3).
In relation to research from Systematic reviews for endometriosis, there has been insufficient evidence to date, meaning that there has been insufficient high quality trials and or insufficient or unclear findings. As always, we encourage research in acupuncture to explore more large scale randomised controlled trials to help clarify both the mechanism, and the extent to which acupuncture may help (4).
Endometriosis – The Western View
What is Endometriosis?
In its simplest explanation, the Merck Manual defines endometriosis as “the presence of endometrial tissue in abnormal locations, including the uterine wall, ovaries, or extra-genital sites” (6,7). But what is really happening within your body during the development of endometriosis? Lets have a look at the Western interpretation as well as the Traditional Chinese Medicine (TCM) point of view.
In some women of reproductive age, some of the endometrial tissue which is normally expelled through the menses, manages to travel outside of the uterus and to lodge itself within the tissues of the surrounding pelvic cavity. Common locations include but are not limited to, the outer wall of the uterus, the cervix, the pelvic wall or lining, and the vagina(6,7).
These cells that have left their uterine home to go and deposit themselves somewhere else, respond in the same way to hormones governing your menstrual cycle. So, every month as your hormone levels change, your menstrual cycle is stimulated to thicken the endometrial lining (uterine lining), enlarge and then shed (bleed). The result is a period that comes every 28-32 days – if regulated. This process can actually go reasonably drama-free if the escapee endometrial tissue has lodged itself away from sensitive nerve endings. If the tissue is located close to nerve endings however, the pain felt by the enlarging tissue encroaching onto adjacent nerves can be crippling, making life pretty miserable.
Reasons as to how the tissue leaves its uterine home from a Western perspective have been speculated and proposed, but remain inconclusive (5-7).
Signs and Symptoms:
The common set of signs and symptoms associated with endometriosis have been suffered by women for a long, long time. There are records in old medical texts describing the very set of signs and symptoms associated with the disease today. When you look at the set of signs and symptoms (below) surrounding endometriosis, the most common presentation or symptom is menstrual pain.
Signs and Symptoms of Endometriosis:
sharp stabbing pains,
heavy menstrual bleeding,
abdominal pain and swelling,
vomiting with menstruation,
dull, dragging pain and
a sensation of pressure and bearing down before or during menstruation.
So whilst it appears that the disease (or at least symptoms akin to endometriosis) may have been around for many years, diagnosis has not been easy to achieve until more recent advances in medical devices such as the laparoscope. Laparoscopy has allowed us to actually look within the body in a very non-invasive manner to confirm the presence of endometrial-like tissue outside of the uterus. So whilst the incidence has risen as result of new medical investigative technologies, the disease itself may have been around for centuries.
Laparoscopy, using a fibre-optic instrument that is inserted into the abdomen, is used to allow the doctor to determine the presence of endometrial tissue outside of the uterus (ovaries, peritoneum etc). Biopsy of any endometrial-like tissue found here can then help confirm a diagnosis of endometriosis (6,7).
Endometriosis – The Traditional Chinese Medicine View
Whilst Chinese medicine has no specific disease categorisation of endometriosis per se, it does recognise many of the signs and symptoms associated with the disease. More than this, we look at the mechanism behind the symptoms ( from a TCM perspective). We talk about treating your Yin, Blood, Qi and Yang.
As TCM practitioners, through our long held theories on physiology and pathology, we are able to explain why each of these signs and symptoms arise in a particular woman at a particular time.
“In Chinese medicine we see you as more than just a biological being. We take into account your past and current emotional state, your past and present living environment and your past and present relationships”
This concept stems from the four pillars of diagnostic methods for us: “Observation”, “Palpation”, “Listening” and “Smelling”.
How we see Endometriosis in TCM:
Before we look at the disease as seen from the view point of TCM, its useful to have a very quick look at some of the methods we use to help come to a diagnosis.
To help make a diagnosis in Chinese Medicine, we use what we know as the ‘four diagnostic methods’. They are –
Observation – looking and observing the patient – size, colour, walk, posture etc)
Listening and Smelling – listening to their speech, listening for rattles and rails etc within their lungs, smelling their breath)
Palpation – including abdominal palpation and by taking the pulse felt at the radial position of each wrist, and finally,
Questioning – asking questions which allow us to ‘code’ symptoms and attribute them to disharmony in one of the organ systems, such as the liver, spleen, heart etc.
To make a diagnosis in Chinese Medicine, we most often will start with a disease classification, such as ‘Headache’ for example. From here we want to find out what type of headache it is – this is where we differentiate your headache between say a full and hot headache (with a red face and throbbing distending pain), or an empty cold headache (which is mild, constant and better for rest).
This is called pattern differentiation.
In the case of endometriosis, the disease itself has no classification (such as Headache or Nausea), so mostly we will begin with a classification such as Painful Periods – given painful periods is the most common presenting symptom. From here, we are able to use the four diagnostic methods in order to differentiate the type of pain you are experiencing, and the source of the internal imbalance that is creating the pain.
The most common cause of the type of pain involved when there is endometriosis present is sharp pain – represented as a ‘blood stagnation’ type of pain in TCM. Recent research that we can have a positive affect on pain reduction (2,3).
So what is blood stagnation and why has your blood become stuck?! In order to understand this, lets quickly talk about the relationship between your energy, Qi, and your blood.
Qi is seen as a lighter, mobile type of energy and is closely associated with your Yang energy. The free flow of Qi throughout your body and organs is mostly under the direction of the Liver. It is the Livers role to deal with frustration, anger, resentment and emotional stress and to allow these emotions to be dealt with in such a way that doesn’t tie up your Qi. Easier said than done huh! We all to some degree have an element of stuck Qi – living in a western world with all of its demands on us sees our Liver Qi put to the test every day.
One of the most important tenets of Chinese medicine is that Qi leads the blood. If Qi becomes a little stuck, blood becomes a little stuck. Qi stagnation leads to blood stagnation. Blood stagnation equals sharp pain.
This is not to say that every case of endometriosis is caused by emotional stress ( although there is often a component of this due to the pain that it brings ), but it is an aspect that we as TCM practitioners, take note of and strive to resolve through acupuncture and Chinese herbs. There are other aspects of your energy that can also cause the qi and blood to stagnate.
“Blood deficiency can also contribute to endometriosis in Chinese Medicine – a factor that we treat routinely with acupuncture and Chinese Medicine “
Blood deficiency is a common cause; how can I be deficient in blood? Does this mean that I am anaemic? Well sometimes, yes. But not always. The Chinese construct of blood-levels is quite different to that of Western medicine. We see blood as part of your Yin energy – cooling, nourishing, supporting and calming. It relies heavily on the spleen, heart and kidneys for its manufacture. A deficiency in any one of these organs can lead to a relative state of blood deficiency. When there is not enough blood to flow, blood stagnation can sometimes result. It’s a bit like seeing a river that was once flowing full of water which now only flows along parts of the river bed, with puddles of water cut off from the main flow of water. This is another fairly common cause of endometriosis from a TCM point of view. Common blood deficiency signs and symptoms are things like – floaters in the vision, brittle nails, postural dizziness, pale lack lustre skin, dry or lifeless hair, scanty menstrual blood, heart palpitations and anxiety. Any of these symptoms is a clue to me that we need to start asking questions as to why your blood levels are low enough to cause symptoms.
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1 Cochrane S et al, March 2014 Volume 2014: 6 Pages 313—325 International Journal of Women’s Health
2 Kong S et al, Volume (2014), Article ID 146383, 16 pages Evidence-Based Comp and Alternative Medicine
3 Armour M, Dahlen HG, Zhu X, Farquhar C, Smith CA (2017) The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture:An exploratory randomised controlled trial. PLOS ONE 12(7): e0180177.https://doi.org/10.1371/journal.pone.0180177
4 McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review (Revised Edition). Brisbane: Australian Acupuncture and Chinese Medicine
5 Lim CED et al, Aust J Acupunct Chin Med 2009;4(2):12-17. Australian Journal Acupuncture and Chinese Medicine
6 MSD Professional version Endometriosis http://www.msdmanuals.com/en-au/professional/gynecology-and-obstetrics/endometriosis/endometriosis (accessed 20 November 2016)
7 Endometriosis Australia http://www.endometriosisaustralia.org/about-endometriosis (accessed 21 November 2016)