Endometriosis is responsible for 70% of all chronic pelvic pain cases in women in the United States. This endometriosis case study examines how Traditional Chinese Medicine (TCM) treats women with chronic pelvic pain. A 43-year-old woman diagnosed with endometriosis and fibroids was treated with acupuncture twice a week for six months in Berkley, CA.
Acupoints included CV3, CV4, CV5, ST25, ST36, GV20; LI4, LV3, KI3, SP6, SP9, and Zi Gong Xue. In addition, she took one month of herbal treatment in the form of tea and tea pills. During and after the treatment with acupuncture, the patient experienced less pain and reduced symptoms. Overall, acupuncture had a positive effect on easing her endometriosis.
What is Endometriosis?
Endometriosis is a medical condition where tissue that usually lines the uterus builds up in other pelvic areas outside the uterus. Symptoms include dysmenorrhea (painful periods), infertility, and menorrhagia (heavy menstrual bleeding). Up to 15% of all women of reproductive age experience endometriosis.
Endometriosis Case Study
This article documents the case of a 43-year-old woman with no history of pregnancy who presented with endometriosis and fibroids in late 2016. The woman was diagnosed with endometriosis in her early teens and fibroids in 2016. Her endometriosis caused monthly debilitating pain during the beginning of her menstrual cycle and generally caused her to miss 1 to 2 days of school as a teen and 1 to 2 days of work as an adult.
Furthermore, the pain in her back and lower abdomen radiated down her legs to her ankles and ranged from dull to sharp. Before her fibroid diagnosis, she generally took 400 mg of Motrin together with hot tea and gin or rum for the pain.
Worsening Endometriosis Symptoms
From 2014 to 2016, her pain increased and became more frequent. Instead of occurring only in the first 2–3 days of her menstrual cycle, she started having pain all the time. She described the pain quality as sharp or dull with a “pulling” sensation, which slightly improved with heat. In 2016, an ultrasound scan showed three intramural fibroids. The largest was 2.5 cm in diameter. In addition to the fibroid pain, she generally ached due to fibromyalgia, which she was diagnosed with in 2014.
Western Pain Medications
Following her diagnosis of fibroids and fibromyalgia, the woman in this endometriosis case study took Norco and Flexeril as directed. By the time she sought acupuncture in late 2016, she had tried a single intramuscular 6-month dose of Lupron to stop her menses and shrink her fibroids.
Her menses were regular but heavy, with dark clots at the beginning. Her cycle was normal in length, and she had no spotting between periods. PMS symptoms included breast tenderness, abdominal distension, severe pain in the lower back (described as a level 8–10 when it occurred), and tense wrist muscles. She generally felt cold and had bloating and heaviness in the abdomen. Her pain made it difficult to stand or walk.
In 2016, her diet consisted of standard American meals with the addition of sweets. She often craved high-carbohydrate sweets, especially liked cookies and cakes and had gained 75 pounds between 2014 and 2016. As a result, she claimed she was always tired and physically “hurt.” In addition, many of her female family members had histories of fibroids, but none for endometriosis or fibromyalgia. On physical examination, the patient’s hands were cold to the touch. She had a pale complexion with swollen ankles and feet. Her tongue had a thick white coat, and her pulse was slow, choppy, and wiry.
Acupuncture Case Diagnosis
The patient in this endometriosis case study was diagnosed with Kidney Yang Deficiency, Spleen Qi Deficiency, Blood Stasis, and Liver Blood Deficiency. The treatment plan was to Tonify Kidney Yang, Tonify Spleen, and Tonify and Invigorate the Blood to reduce pain.
Acupuncture Point Prescription
Acupuncture points included CV3, CV4, CV5, ST25, ST36, GV20, LI4, LV3, KI3, SP6, SP9, and Zi Gong Xue. The practitioner manually stimulated all needles on initial insertion and again after 15 minutes, retaining needles for 30–45 minutes.
In addition, the practitioner modified the herbal prescriptions based on the phase of the patient’s menstrual cycle. The formulas included Xue Fu Zhu Yu Wan and Gui Zhi Fu Ling Wan plus Huang Qi. The patient took each formula twice daily during its respective part of her cycle.
Chinese Medicine Study Treatment
The patient in this endometriosis case study received acupuncture twice a week for six months. However, she stopped taking Chinese herbs after one cycle due to non-compliance. The patient made no other lifestyle or dietary changes. She did not want to take supplements, feeling that she had “too many pills to keep track of already.”
Endometriosis Treatment Results
After each treatment, the patient felt a decrease in pain levels. After six months, her pain reduced from 10/10 (where she was immobile and often in the emergency room) to 3/10. At this level, she managed pain better and significantly improved her quality of life. In addition, within six months, she regained mobility. Furthermore, her fibroids shrank, and she was not bleeding as heavily. She also had fewer clots during the first two days of her period.
Herbal Case Analysis
Gui Zhu Fu Ling Wan dissolves masses, invigorates stagnant blood, and reduces pain associated with endometriosis. Furthermore, it warms the channels to smooth the blood flow and break up stagnation. The practitioner added Huang Qi to this formula to aid Gui Zhi in treating painful obstruction due to Qi and Blood Deficiency in the patient’s muscles (evidenced by her weakness and anemia). Huang Qi also Tonifies Qi, Blood, and Spleen and raises the Yang.
Acupuncture Relieves Endometriosis
The patient’s fatigue was also due to Blood Deficiency. She had low hemoglobin levels. In addition, she bled heavily due to her fibroids, and the sudden blood loss led to tiredness. LV8 helped treat her Blood Deficiency and SP6 coupled with LV8 smoothed and Tonified the Liver. ST36 helped give the patient more energy by Tonifying Yang. In addition, LV3 helped with uterine bleeding and to Smooth the Liver since she was often argumentative and angry.
The practitioner utilized CV4 to tonify the Kidneys. In addition, this helped with excessive uterine bleeding. It also helped warm the uterus to alleviate pain in the back. Zi Gong Xue helped stop excessive bleeding. CV 4 and GV 20 were also used to stop excessive uterine bleeding. GV20 calmed her spirit and improved her memory, and since it also lifts Yang Qi, it helped with the bulging disks in the patient’s spine. Finally, ST25 and LI4 helped with digestion and treated her edema and Qi Stagnation.
CONCLUSION
The acupuncture treatment in this endometriosis case study helped reduce the patient’s pain levels while improving her quality of life.
Next Steps
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REFERENCE
Acupuncture for Endometriosis: A Case Study, Article in Medical Acupuncture · November 2019, DOI: 10.1089/acu.2019.1379
Focus Keyphrase: Endometriosis Case Study
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