This article will look at some common afflictions women seek treatment for. Women usually seek treatment much quicker than our male friends regarding health. As for consulting a TCM practitioner, women who have higher education, have a higher income and are slightly older would typically make up for most of our patients. However, in recent years, I have seen many younger women who follow an organic (vegetarian, vegan) diet, have an active lifestyle, and perhaps have two or three children. The most common complaints I see now in my clinic are endometriosis, followed by polycystic ovarian syndrome (PCOS), dysmenorrhea (period pain) and mood disorders.

According to the Australian Institute of Health and Welfare, one in 9 women born between 1973-1978 were diagnosed with endometriosis by the age of 40-44 in 2019. Nearly 1 million Australian women suffer from pelvic pain related to this condition. According to Flower et al., the disease involves the presence of endometrial tissue that is located outside the confined uterine cavity. This tissue is stimulated by the hormonal cycle to bleed and contribute to the local inflammation and fibrous adhesions. If this tissue invades the ovaries, it might lead to the formation of endometriomas and chocolate cysts. Depending on size, these structures will further inhibit the normal physiological process and cause other complications. The Australian Institute for Health of Health and Welfare (AIHW) reported around 34,200 endometriosis-related hospitalisations in 2016–17. These hospitalisations are often related to the pain of activated endometrial deposits in cavities other than the uterus.

According to TCM, pain is related to Qi stagnation and blood stasis. I have found, though, that common blood stasis formulas such as Shao Fu Zhu Yu Tang, Xue Fu Zhu Yu Tang, Tao Hong Si Wu Tang, Gui Zhi Fu Ling Wan and others do not always result in a sufficient reduction of the pain. I have one patient in mind who had severe pain for three to four days during her period that did not allow her to work or do anything other than stay in bed and take several painkillers every few hours. I prescribed a slightly modified version of Di Dang Tang in her case. This formula worked well for her, and rather than just taking it during her period, she took it in the second (luteal) phase of her cycle. As a result, the pain was drastically reduced and remained very low after a few cycles without taking the herbs. The formula contains insects; insects are salty and, with this flavour, liquify the blood. However, this explanation is a theoretical concept and not scientific. Always contemplate this formula for endometriosis, or add insects to your prescribed blood statis formula.

PCOS is more common; consequently, I wonder if this condition expresses our modern world. It may affect 1 in 10 females during their reproductive years and is a hormonal imbalance condition. PCOS can manifest with excessive hair growth or alopecia (baldness), ovarian cysts, sub-fertility, irregular or lack of periods, acne and more. It can also cause high blood pressure and diabetes. With the PCOS patients, I always design a strategy in collaboration with the patient and their goal in mind. If those women want to fall pregnant, the approach is different for those who suffer from PCOS but are seeking help with diabetes. I can’t suggest any magic formulas that will solve the problem of PCOS at once, but I can recommend a step-by-step approach. You need to do a pattern differentiation (nothing new) to help you guide your treatment approaches. American Dragon suggests the following pattern differentiations for PCOS. Perhaps this offers an initial guide for the design of a mid-to-long-term multiple-phased strategy:

When choosing a strategy, it’s best to remember to clear excess (phlegm, stasis, stagnation) first, then harmonize and replenish.

According to The Effects of Traditional Chinese Medicine-associated Complementary and Alternative Medicine in Women with Polycystic Ovary Syndrome, diet therapy is essential in treating PCOS. Green tea has been found to have sound effects on the endocrine system, glucose, and fat metabolism. In a study by Tehrani et al., green tea has been associated with weight loss and reduced fasting inulin and testosterone levels. Spearmint tea was associated with anti-androgen effects such as excessive hair growth in another study. Lastly, Marjoram tea has improved insulin levels and adrenal androgens.  

The treatment of period pain is prevalent and underreported because most women anticipate painful periods. But for a TCM practitioner, it’s a sign of imbalance, and it’s important to tell your patients and promote that TCM, in most or many cases, can provide excellent herbal options for dysmenorrhea sufferers. The definition of primary dysmenorrhea is when the cramping or pain occurs in the absence of a pelvic pathology. It is called secondary dysmenorrhea when there might be a relation to endometriosis, pelvic inflammatory disease, or fibroids. This differentiation could be significant for the prescription of herbs.

An article, Chinese herbal formula siwutang for treating primary dysmenorrhea: A systematic review and meta-analysis of Randomized controlled trials concluded that Si Wu Tang showed promising results in treating primary dysmenorrhea. Other formulas that might be beneficial are Tao Hong Si Wu Tang and other blood stasis formulas. As always, the pattern and the formula chosen that fits the pattern need to be assessed. But even blood stasis formulas have different angles, as one blood stasis is caused by deficient blood (a good reason why Si Wu Tang) worked well. Sometimes, blood stasis is due to Qi stagnation, heat, cold or phlegm. It is then a question of what organs or other pathogenic factors contribute to the stagnation or stasis. Further, a decision must be made on which element will be targeted first. Are we treating the root first, are we treating the branch, or do we opt to treat both at the same time?

The differentiation of primary or secondary dysmenorrhea might reveal more information (such as endometriosis) contributing to the pain. In the case of fibroids or inflammation, those aspects must be considered with the pattern differentiation. I consider fibroids more on the side of hot or cold phlegm stagnation. If there is pelvic inflammation, it would be good to know if it is acute (recent) or chronic (more than 12 weeks), as I believe they would require different treatment approaches. Acute inflammation might require more cooling, whereas chronic inflammation is more prone to respond to warming herbs. These are theoretical concepts, and the presenting pattern of the patient will be critical. These are some ideas on how to treat your patient with any of those conditions.

References:

Flower A, Liu JP, Lewith G, Little P, Li Q. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD006568. DOI: 10.1002/14651858.CD006568.pub3. Accessed 25 June 2023.

H. G. Tehrani, M. Allahdadian, F. Zarre, and H. Ranjbar, “Effect of green tea on metabolic and hormonal aspect of

polycystic ovarian syndrome in overweight and obese women suffering from polycystic ovarian syndrome: a

clinical trial,” Journal of Education and Health Promotion, vol. 6, p. 36, 2017.

P. Padfar, “Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. a randomized

controlled trial,” Phytotherapy Research, vol. 24, no. 2, pp. 186–188, 2010.