Classic symptoms include; pelvic pain, secondary dysmenorrhea infertility, dyspareunia, and presence of endometrium tissue, chocolate cyst or endometrima with laproscopy. It is important to point out that all patients with endometriosis do not present with all the symptoms, in fact some patients are asymptomatic.

The severity of endometriosis has been divided into 4 stages

, stage 1 being the least severe to stage 4 being the most severe case.

It important to point out that the severity is based on the amount of endometrial tissue presence in the pelvic cavity, not the severity of pain.

The etiology of endometriosis is not clear, and may involve retrograde menstruation, vascular dissemination, metaplasia, genetic predisposition, immunologic changes, and hormonal influences; in addition, there is increasing evidence that environmental factors may also play a role, including exposure to dioxin and other endocrine disruptors.

The etiology of endometriosis in TCM can be due to:

In Chinese medicine, endometriosis is a result of blood stasis caused by the cyclical bleeding of ectopic endometrial tissue, which causes fibrosis of the surrounding tissues. The location of the disorder is in the lower jiao, uterus, and uterine collaterals. When the patient is weak, especially in case of kidney deficiency, pathogenic factors can easily invade the body. The kidney is the root of yin and yang; it stores essence and governs reproduction and it has a close relationship to the body’s defensive and reproductive capabilities and it is also involved in the regulation of menstruation. Lack of proper care of the body during menstruation, after childbirth, over-indulgence in sexual activity, or abortions will give pathogenic factors a chance to invade the body; this can lead to blood stasis due to the retention of cold, heat or dampness.

Pattern differentiation of endometriosis in TCM are:

1- Qi stagnation& blood stagnation:
Progressive dysmenorrhea, distending and fixed pain in the lower abdomen before or during menstruation, dribbling menstruation, excessive dark menses with clots, and breast distention. This is the most basic form of diagnosis of endometriosis, and in clinic we will see most patients will almost always have qi and blood stagnation with the underlying deficiency. The treatment protocol is to move qi and blood, sooth liver qi and move blood stagnation in the lower jiao. It is important to consider and treat the underlying problem.

2 – Cold stagnation and blood stasis
Cold pain in the lower abdomen before or during menstruation, menstrual colic, preference for warmth, and spasms which can be relieved by warmth, menstruation is dribbling with scanty dark menses and clots. The complexion is pale, cold limbs and aversion to cold. The best western reference for this TCM diagnosis would be endometriosis which has been caused by surgery, or a trauma. Treatment protocol is to move blood and break up the cold and warm the lower jiao

3 – Qi deficiency and blood stagnation
Multiple pregnancies, abortion, early and excessive menstruation, light colored menses, prolonged menstruation, bearing down pain in the lower abdomen, bearing down of the perineum and anus, frequent urination and stool during menstruation and loose stool. Clinically we will see a lot of patients presenting with the above symptoms, this is a good example of deficiency and excess patterns in one. This could be one the TCM diagnosis for patients with endometriosis due to autoimmunity problems which has been discussed. Spleen qi deficiency will give rise to wei qi deficiency which causes can decrease body’s immunity to pathogens. Also general qi deficiency and wei qi deficiency can cause autoimmunity reaction. In case of endometriosis due to immune problems, patients will show qi deficiency and blood stagnation signs plus heat signs, the treatment protocol is to clear heat, move blood and tonify Qi.

4 – Phlegm& heat binding
This includes blood stasis symptoms and heat symptoms which include dark or purplish red menses, menstrual fever, dry mouth, thirst and constipation. Treatment protocol is to clear heat, promote blood circulation, resolve blood stasis and alleviate pain. This pattern is another excess pattern and clinically very rare, in most cases this excess pattern is caused and combined with a deficient pattern such as qi deficiency and kidney deficiency. In treatments both the excess and deficient patterns have to be addressed.

At Acuwellness center, we offer Acupuncture and Chinese herbal medicine in Encino, Sherman Oaks, and Tarzana area. For more information or to make an appointment, you can contact our office at 818-642-3512.