Endometriosis

//Western Diagnosis// The presence of functional endometrial tissue outside the uterine cavity Usually on ovaries, ligaments around uterus, LI, ureters, BL, vagina, pleural cavity, surgical scars

Etiology
1. endometrial cells transported to distant sites 2. retrograde flow through fallopian tubes, lymphatic spread, hematogenous spread

Epidemiology
1. familial inheritance 2. 10-15% of women between the ages of 25-40 who are actively menstruating

Signs & Symptoms
1. pelvic pain, pelvic mass, changes in menses, infertility 2. dyspareunia 3. dysmenorrhea that is pre or peri menstrual and midline and that starts after many yrs of pain free menses 4. other sx depending on location in those organs affected keys: cramps - midline pain just before or during menses that starts later, back pain

Diagnosis
1. suspected clinically, esp with pattern of dysmenorrhea 2. visualization of lesionsZ: endoscopy, laparoscopy, cystoscopy 3. biopsy of lesions

Treatment
1. medically suppressing ovarian function 2. surgical excision of implants 3. Management by natural Tx - herbs that decrease the inflammatory process and pain

=
===================================================

Endometriosis
Can consider Gui Zhi Fu Ling Wan

Formula 1: Invigorate Blood & Dispel Blood Stasis
Chai Hu (9g.), Dang Gui (9g.), Pu Huang (12g.), Wu Ling Zhi (12g.), San Leng (9g.), E Zhu (9g.), Xiang Fu (9g.), Yan Hu Suo (5g.), Xu Chang Qing (15g.), Zao Jiao Ci (9g.), Tu Bie Chong (12g.) Modifications: With Qi deficiency: -Chai Hu, Xiang Fu; + Dan Shen (12g.), Huang Qi (12g.), Sheng Ma (9g.) Intolerance to cold: + Gui Zhi (6g.) Constipation: + Zhi Da Huang (6g.) Premenstrual pain: + Qian Cao Gen (15g.), Hai Hua Mi (15g.)

Formula 2:
Pu Huang (12g.), Wu Ling Zhi (12g.), Dan Shen (12g.), Niu Xi (12g.), Ru Xiang (3g.), Mo Yao (9g.), San Leng (9g.), E Zhu (9g.), Liu Ji Nu (15g.), San Qi (0.4g.) Pu Huang (12g.), Wu Ling Zhi (12g.), Hua Riu Shi (30g.), Xiang Fu (9g.), Wu Yao (9g.), Chuan Xiong (6g.), Zhi Da Huang (6g.), Huang Qi (15g.), Rou Gui (3g.) Gui Zhi (9g.), Chi Shao (12g.), Mu Dan Pi (12g.), Tao Ren (9g.), Kun Bu (12g.), San Leng (12g.), E Zhu (12g.), Bie Lia (15g.), Fu Ling (15g.), Suo Yang (15g.), Yin Yang Huo (30g.), Tu Bie Chong (15g.), Wang Bu Liu Xing (12g.)
 * Use just before menstruation**
 * Formula to use during menstruation: Dispel Blood Stasis to control menstruation**
 * Formula to use during other days of the cycle: Soften and Break up masses, dispel blood stasis, tonify the kidneys**

Formula 3 : Nourish Yin in order to subdue fire, redirect the upward flow of blood downward
Sheng Di Huang (15g.), Xuan Shen (12g.), Gou Qi Zi (12g.), Mu Dan Pi (6g.), Dan Shen (12g.), Yu Zhu (12g.), Zhi Zi (12g.), Niu Xi (9g.), Qian Cao Gen (12g.), Yu Jin (9g.)

Formula 4: Subdue fire and dispel blood stasis to relieve the menstrual fever
Zhi Mu (12g.), Qing Hao (12g.), Shi Gao (9g.), Mu Dan Pi (12g.), Zhi Zi (12g.), Bie Jia (12g.), Sheng Di Huang (12g.), Dan Shen (12g.), Pu Huang (12g.), Wu Ling Zhi (12g.), Tao Ren (12g.), Chuan Lian Zi (12g.), Liu Ji Nu (12g.)

Orthomolecular Treatment
-Omega-6



=
=========================================================================


 * IBIS:**

Definition:
The ectopic occurrence of endometrial tissue.

Etiology:
A common problem which has no known etiology but a higher occurrence is seen in women who defer pregnancy until later in life.

Fiberoptic laparoscopic techniques allow a direct look at the problematic tissue.

Nutrition:
eating principles: • vegan diet • fruit and vegetable fast for 1 week

therapeutic foods: » for Stagnant Liver Qi or Stagnancy in the Liver channel type: • foods that invigorate the Qi, Liver foods, sour foods, Dispersing foods, foods that open channels • citrus peel • liver-cleansing foods: beets, carrots, artichokes, lemons, parsnips, dandelion greens, watercress, burdock root • Magnesium-rich foods

fresh juices: • carrot (Walker, p. 146) • carrot and spinach (Walker, p. 146) • carrot, beet, and cucumber (Walker, p. 146) • lemon juice in warm water

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods

Botanicals
• Achillea millefolium: anti-spasmodic, uterine sedative, emmenagogue (Nissim, p. 22) • Alchemilla vulgaris: pelvic congestion, heavy menses, menstrual headache (Nissim, p. 22) • Anemone pulsatilla (toxic): for nervous women with debility and faulty nutrition of nerve centers; depression, irritability, melancholy, tendency for weeping, best for suppressed menses (Felter, p. 583) • Helonias dioica • Hydrastis canadensis (Felter, p. 417) • Lithospermum officinalis: diuretic, pituitary inhibitor, progesterone precursor (Nissim, p. 137) • Medicago sativa (Stansbury) • Salix alba: pelvic sedative, anti-inflammatory, anti-spasmodic (Nissim, p. 137; Stansbury) • Silybum marianum: add soaked and ground seeds to food freely (Heron) • Trifolium pratense (Stansbury) • Vitex agnus castus: pelvic sedative, anti-spasmodic, progesterone precursor (Nissim, p. 137)

herbs which ameliorate hyperestrinism: (Nissim, p. 136) • Achillea millefolium • Alchemilla vulgaris • Angelica sinesis • Hyssopus officinalis • Lithospermum officinalis • Ribes nigrum • Vitex agnus castus

anodynes: (Nissim, p. 136) • Angelica spp. (essential oil) • Chamomilla spp. (essential oil) • Crataegus oxyacantha • Hamamelis virginiana • Hydrastis canadensis • Hyssopus officinalis • Lavandula officinalis (essential oil) • Rosmarinus officinalis (essential oil) • Rubus idaeus • Salix spp. • Symphytum officinale (toxic) • Trifolium pratense

Chinese Formulae
Usually requires about three month course of treatment with follow-up therapy for up to one year recommended. • Pteropus and Lindera C. (Ge Xia Zhu Yu Tang): Xue Yu (Blood Stasis): severe pain, palpable abdominal masses with fixed pain (Yeung, p. 106; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 316) • Cinnamon and Bulrush C. (Shao Fu Zhu Yu Tang): Xue Yu (Blood Stasis) and Cold: palpable masses which may or may not be painful, lower abdominal pain without masses, lower back pain and lower abdominal distention during menses, frequent menses with dark blood and clots (Yeung, p. 195; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 316) • Pteropus and Bulrush F. (Shi Xiao San); Wu Jin Wan (patent): more severe Xue Yu (Blood Stasis): irregular menstruation, dysmenorrhea, acute colicky pain in the lower abdomen, severe pain in the middle abdomen or epigastric pain (Pteropus: Hsu, 1980, p. 583; Yeung, p. 211; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 316; Wu Jin: Zhu, p. 250) • Cinnamon and Hoelen F.: Xue Yu (Blood Stasis): immobile masses in lower abdomen with pain and tenderness, amenorrhea with abdominal distention and pain, dysmenorrhea, choppy pulse (Hsu, 1980, p. 423; Yeung, p. 113; Bensky and Barolet, p. 322) • Cinnamon and Rehmannia (patent) (Dharmananda, 1992, p. 81) • Persica and Salvia C.: Xue Yu (Blood Stasis) with Xue (Blood) Heat: shortened cycle, constipation (Dharmananda, 1986, p. 326) • Fu Ke Zhong Zi Wan (patent): Xue Yu (Blood Stasis) (Zhu, p. 253) • Tang Kuei, Evodia and Ginger C. (Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang): Xue Yu (Blood Stasis) with Cold in the Channels: extreme stagnancy and weakness: purplish lips/extremities, loose stools, extremely thin pulse (Hsu, 1980, p. 319; Yeung, p. 78; Dharmananda, 1986, p. 323; Bensky and Barolet, p. 217) • Chih-ko and Curcuma C. (patent) plus Lindera 15 (patent): Qi Stagnation with Xue Yu (Blood Stasis) (Dharmananda, 1990: Chih-ko and Curcuma, p. 41: Lindera, p. 49) • Tang Kuei and Evodia C. (Wen Jing Tang): Xue Yu (Blood Stasis) with Chong Mo and Ren Mo Xu (Deficiency) and Cold: weak and cold patient, dry Upper Warmer, irregular menstruation, extended or continuous menstrual flow, bleeding between periods; pain, cold and distention in the lower abdomen; infertility, warm palms and soles (Hsu, 1980, p. 588; Yeung, p. 242; Dharmananda, 1986, p. 323; Bensky and Barolet, p. 324)

Acupuncture
after assessing the person and palpating, consider these patterns: Liver Xue Xu (Blood Deficiency); Liver Qi Stagnation; Liver Xue Yu (Blood Stasis); Qi Stagnation and/or Xue Yu (Blood Stasis) in Lower Warmer; dysfunction of the Chong Mai (Penetrating Vessel) and/or Ren Mai (Conception Vessel); Xu (Deficiency) of the Yang Qiao Mai (Yang Motility Vessel) and/or Shi (Excess) of the Yin Qiao Mai (Yin Motility Vessel)

» illustrative combinations: • St-28, St-29 and St-30 (=): regulate menstruation; transform Damp-Heat; relieve Xue Yu (Blood Stasis); warm Lower Warmer Cold; consolidate Jing (Essence) • GB-26, Sp-8, Sp-6 and CV-3 joined to CV-2 for endometritis (Shanghai, p. 187) • CV-3 and Sp-6: regulate the Qi function of the Lower Warmer and the function of the genital organs - Sp-6 sends Qi up; CV-3 sends it deep (Finkelstein, p. 84) • Lu-7 and Kd-6: open the Ren Mai (Conception Vessel) which nourishes the Uterus and regulates menstruation; usually indicated by head and neck pain, abdominal distension, vaginal discharge and other symptoms of congestion • Sp-4 and PC-6: open the Chong Mai (Penetrating Vessel) for which menstrual disorders are a symptom of Shi (Excess) and reproductive disorders are a general symptom of dysfunction • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which gynecological problems are a Xu (Deficiency) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which gynecological problems are a Shi (Excess) symptom

Homeopathy
• Apis mellifica: stinging thrusting pains, similar to those arising from the sting of a bee; < right side; metrorrhagia, profuse with heavy abdomen and tightness; great tenderness over abdomen and uterus; absence of thirst; scanty urine; dyspnea • Arsenicum album: burning in ovarian area, < least movement causing fatigue; menses profuse and early; burning, throbbing, lancinating pains; restlessness and anguish, with a fear of death; thirst, but cold drinks make her worse; wants to be wrapped up; metritis in childbed with signs of dissolution of blood • Aurum muriaticum natronatum: chronic with prolapse; uterus fills whole pelvis; ulcerations of vagina and cervix; indurated ovaries and cervix; hypertension from nervousness • Belladonna: burning, stitching, clutching pains; pains come on suddenly and disappear suddenly; involuntary flow of urine; sleeplessness and drowsiness • Calcarea carbonica: before menses headache, colic, chilliness and leukorrhea; menses too early, too profuse, too long; burning and itching before and after menses • Cantharis: inflammation of ovaries after suppressed gonorrhea; inflammatory suppuration of the womb with extreme tenderness; puerperal metritis with inflammation of bladder • Carbo animalis: menses too early, frequent, long-lasting followed by great exhaustion and weakness; flow only in morning; burning in vagina and labia • Cimicifuga racemosa: pain immediately before menses, radiates hip to hip; ovarian neuralgia shooting up and down ant part of thigh; menses irregular, profuse, dark, coagulated, offensive, with backache and nervousness • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Gelsemium: sensation as if uterus squeezed; pain extending to back and hips along with chills; dysmenorrhea with scanty menses • Helonias dioica: too frequent, too profuse; parts hot, red, swollen with burning and itching • Hydrastis canadensis: erosion of cervix, menorrhagia; pruritus vulva with profuse leukorrhea • Iodium: wedge-like pain from ovary to uterus, esp. right side; great weakness with menses; acrid leukorrhea, thick, slimy corroding the undergarments • Lac caninum: parenchymatous metritis with extreme soreness and tenderness that made every motion, position and breathing painful; ovaralgia; erratic pains alternating sides • Lac Humanum: history of difficult mother-daughter relationship; issues of nourishment • Lachesis: chronic metritis with hypertrophy, menses too scanty and difficult; soreness about the pelvic region; < pressure of clothes; pains relieved by flow; sensation as if pains ascend to the chest; ovaritis; puerperal metritis with fetid discharge • Lycopodium: cutting pain across hypogastrium from right to left; ovaritis; metritis; discharge of blood from genitals during stool • Mercurius corrosivus: labor-like pain in vagina and abdomen; pale yellow leukorrhea with nauseous sweet odor or watery mucus tinged with blood; menses too soon, increased • Mercurius vivus: profuse menses with abdominal pain; leukorrhea excoriating, greenish and bloody, sensation of rawness in abdomen; stinging pain in ovaries; itching and burning < urinating, > cold water • Pulsatilla: menses suppressed from wet feet, nervous debility; menses scanty, thick, dark clotted, changeable, intermittent flow; diarrhea before or after menses; tensive cutting pains in uterus which is very sensitive to touch and during coitus; metritis and ovaritis after getting feet wet or from suppression of lochial discharge; chilliness and thirstlessness • Sabina: pains from sacrum to pubis and shooting up the vagina < least movement; menses profuse, bright; mid-cycle spotting with sexual excitement; leukorrhea after menses; acute metritis; metritis hemorrhagica • Secale cornutum: menstrual colic with coldness and intolerance of heat; burning pains; menses irregular, copious, dark, continuous oozing until next menses; inflammation caused by suppression of lochia or menses; discharge of thin, black blood; a kind of sanies, with tingling in the legs and great debility • Sepia: bearing-down sensation; menses too late, scanty or early and profuse; pain sharp and clutching; dyspareunia • Silicea: discharge of blood between periods; paroxysms of icy coldness over whole body during menses; milky acrid leukorrhea during urination • Terebinthina: intense burning in uterine region; metritis, puerperal peritonitis; urine cloudy and dark, having a muddy appearance; tongue dry and red • Veratrum viride: colic before appearance of menses with strangury; suppressed menses with congestive headache

Subtle Support
• notes: A, A#, B, C, C#, D, E, F, G, G#

• chords: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

Mind/Body
• Associated with anorgasmia and sterility. (Rossi and Cheek, p. 297) • Unresolved issues around femininity, sexuality, or conception. (Harrison, p. 14) • May be a form of self-punishment. (Rossi and Cheek, p. 297) • Female problems represent a rejection of the feminine principle; denial of the self; rejecting femininity. (Hay, 1984, p. 165) • Anger at mate; sexual guilt; need for punishment. (Hay, 1984, p. 187) • Menstrual cramps represent fear, tension, gripping, holding on, guilt, rejection of femininity, belief that genitals are sinful or dirty. (Hay, 1984, p. 160, 174) • Women who have painful periods often find it painful to be a woman, a protest against this self-surrender. (Dethlefsen, p. 185)

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi and Xue (Blood); has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry skin and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis) and Xue (Blood) Heat. » Qi Stagnation contributes to Xue Yu (Blood Stasis). Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)
 * Chinese psychophysiology:**

• Kidney ~ stores Jing (Essence) and governs birth, growth, reproduction, development, and aging, particularly the internal aspects of the reproductive organs; houses the Zhi (Will); expresses ambition and focus; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance.

Integrative Therapies
Endometriosis occurs when cells from the uterus lining attach to other places such as the fallopian tubes and the ovaries. During menstruation, these cells tend to accumulate since they cannot pass out of the body with the rest of the menstrual flow. This can cause severe pain in the pelvic area during menstruation and sexual intercourse, and an unusually heavy menstrual flow, irregular periods, and infertility.

Regular gynecological checkups (at least once per year or more) are recommended. Many times, there is a history of sexual abuse. Seek counseling if you suspect that this may be a factor.

THE FOLLOWING SUPPLEMENTS ARE USED FOR ENDOMETRIOSIS AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Beta-carotene – 150,000 Units per day. Women who become pregnant should not take more than 15,000 Units per day. 2. Vitamin C – 1,000 milligrams, 4 to 5 times per day. Reduce the dose if diarrhea occurs. 3. Vitamin E – 800 Units per day. 4. Linseed or Flaxseed oil – 2 to 3 tablespoons per day. 5. Natural Progesterone oil – 1/4 teaspoon per day.

REGARDING THE PROPER DIET FOR ENDOMETRIOSIS: • Eliminate dairy products from the diet. This includes milk, yogurt, sour cream, ice cream, and cheese. • Eliminate or reduce the consumption of meat. Replace protein from meat with protein from fish and beans. Use only meat that is certified as hormone and additive free. • Maintain an overall healthy diet – Use fresh foods as close to the natural state as possible, avoiding prepackaged and processed foods. Eat daily servings of leafy green vegetables, whole grains (such as brown rice and rolled oats), fresh fruit, and proteins with a minimum of animal fat. Avoid sugars (such as pastries and candy) and refined carbohydrates (such as white bread and white rice). Drink at least 8 cups of fluids daily. For more information listen to our program on healthy diet (number 343). • Reduce the use of fats such as butter, margarine, vegetable oils, and mayonnaise. Nuts and nut butters also have a high fat content and need to be limited. • Decrease or eliminate consumption of caffeine, found mostly in coffee, black tea, chocolate, and some over-the-counter medications.

HERBS USED FOR ENDOMETRIOSIS: • Dandelion Root, Wild Yam, and Angelica – These can be used as a tea. Measure 1 tea-spoon of each herb per 2 cups of water. Simmer for 5 minutes then steep for 20 minutes. Drink 3 cups per day. They can also be used as a tincture, which is a liquid herbal extract – 20 drops of each 3 times per day in a little water. • For heavy periods and heavy bleeding – Shepards Purse and Cramp Bark for the 2 weeks preceding the period. These can be taken as a tea or a tincture, prepared the same as the previously mentioned herbs and taken in the same dosage.

PHYSICAL THERAPY MEASURES FOR ENDOMETRIOSIS ARE AS FOLLOWS: • Castor oil packs – Moisten a thin cotton cloth with castor oil and place on the lower abdomen. Cover with a plastic bag and then a dry cloth. Leave in place and rest for an hour. A heating pad or hot water bottle can be put on top to heighten the effect. • Acupuncture can be helpful in controlling pain. You may want to look for a licensed acupuncturist in your area.

HOMEOPATHY • Sabina 6C: For uterine bleeding or heavy menstrual periods. Dissolve 3 pellets under the tongue 3 times a day between meals while symptoms are present. Note: A wide range of homeopathic medicines can be helpful for individuals with this condition. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.