Treatment of Endometriosis and Fibroids

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Article by Randine Lewis, Ph.D., Lic.Ac.

What do endometriosis and fibroids have in common? They both have their place in preventing conception, and both are responsive to estrogen fluctuations. There is no western cure for either, except hysterectomy. Eastern medicine, however, gives them a common denominator - they are both considered processes of inhibited, stagnated uterine blood which doesn't flow freely. The menstruate has become blocked, and the normal process has become obstructed. Women with either of these conditions often experience a sediment-like menstrual flow with dark, brown, clotted, blood which has been allowed to oxidize. The rest of the body responds and the immune system reacts to this silty, old blood. Our neuroendocrine awareness is heightened. Remember, our body's immunologic priority is to keep us safe from external or internal insults. It recognizes the toxic state and mounts chemicals to clean up this debris. It knows that a fetus won't survive in this environment.

Luckily, both conditions respond very well to Chinese medicine. Given time and the proper treatment, the blood flow will improve, the sediment will clear, and the body will overcome its immunologic protective mechanisms. Our psycho-neuro-endocrinologic system will settle down. Our body can relax and allow conception to take place.

Endometriosis

Endometriosis is described as the abnormal growth of endometrial tissue outside the endometrium. Endometrial cells are those that are found in the uterine lining. When those cells are found in areas outside of the uterus, the diagnosis of endometriosis is made. Although the disease has been present throughout history, it was first identified in 1860. In 1960 the disease mechanism was first described because of the discovery and use in France of the laparoscope. Endometriosis is therefore a surgical diagnosis. Modern science does not know why endometrial cells are found elsewhere. One theory of its origin is explained by retrograde menstruation. When a woman is supposed to menstruate and blood should be discharged vaginally, it backs up through the tubes and into the abdominal cavity. Yet this happens in most women, and most women do not have endometriosis. Another hypothesis is that anatomic abnormalities such as retroverted uteri and small cervical openings do not allow the blood to pass through freely, and it therefore backs up into other areas of the pelvis.

Another theory of the causative origins of endometriosis is that other cells outside of the uterus are transformed by some unknown stimulus into endometrial cells. Whatever the etiology, the misplaced endometrial cells then respond to hormonal stimulus just like the endometrium is supposed to. But, during menstruation there is no way for this menstrual blood to leave the body. Pain, sometimes very severe, is the result. Prostaglandins are said to be the causative factor in menstrual pain. Painful periods are an indication of possible endometriosis, and women with endometriosis have higher levels of certain of the prostaglandins. The bleeding tissue may also cause adhesions and scar tissue.

Common sites of endometriosis include the cervix, the vaginal-rectal space, ovary, fallopian tubes, colon and bladder wall.

Common accompanying symptoms include dysmenorrhea, pathological uterine bleeding, and bleeding at sites other than the endometrium during menstruation. Some women bleed at sites as distant as the nasopharynx during menstruation and get nosebleeds during the menses. Endometriosis is classified as to its severity.

Mild endometriosis - implants are small, flat patches of endometrial tissue growing outside of their normal location.

Moderate endometriosis - includes "chocolate cysts" of endometriosis may be smaller than a pea or larger than a grapefruit, located within the ovary.

Severe endometriosis - in some cases, bands of fibrous scar tissues (adhesions) bind the pelvic organs together.

Interestingly enough, except for the obvious mechanical obstruction found in severe endometriosis, there seems to be no real correlation between the severity of endometriosis and its impact on fertility. However, as many as half of the women who have been diagnosed with infertility are found to have endometriosis on laparoscopic examination.

Some women, in fact, have no symptoms at all, and diagnosis is only made through laparoscopy. Symptoms which may accompany endometriosis include abnormally heavy bleeding, associated with back pain or severe abdominal cramping, painful intercourse, painful intestinal upset or urination during the menstruation, and the inability to become pregnant.

Western medical treatment usually includes pain relieving medication, laparoscopy and laser removal of the endometrial tissue. Other drugs may be used to control the hormonal stimulation of the endometriosis. As menstruation ceases each month, the misplaced endometrial tissue will be starved of hormonal stimulus, and thus mollify the endometriosis response. Of course, ovulation is also halted in this process, which defeats our present purpose.

The Traditional Chinese Medical View and Treatment of Endometriosis

Endometriosis and Static Blood Endometriosis is not a disease category in Traditional Chinese Medicine. However, our Eastern healers have recognized this disease for far longer than its identification in Western medicine. It is known by its symptoms and is referred to as menstrual movement pain. It is also very amenable to natural forms of treatment.

The Jin Gui Yao Lue (Essentials from the Golden Cabinet), "Women's Miscellaneous Diseases' Pulse, Pattern & Treatment" chapter, has this description: "The menstrual blood is inhibited and there is (resulting) lower abdominal fullness and pain."
Chinese medicine categorizes endometrial lesions as static blood, or blood which is not flowing as it should, and thus causes problems. This is not so different from our Western understanding of the same disease. Since the maligned blood is located in an vicinity where normal blood flow is often absent or minimal, our body has a tougher time resolving it. The Chinese therefore say that these conglomerations of stasic blood have entered the network vessels, which are more difficult to reach. This is one important aspect in how we will approach this syndrome.

Other countries throughout the rest of the world recognize endometriosis as an autoimmune diasease. The famous gynecologist Dr. Ni reported that in her experience as a M.D. gynecologist in China, most women upon whom she performed laparoscopies had some degree of endometrial tissue outside of the uterus, which was found at various locales throughout the abdominal category. What sets aside women with fertility impaired endometriosis is the "osis" or inflammatory reaction which has resulted from the presence of the endometrial tissue outside its original intended site.

The inflammatory reaction which the body has set up in response to the endometrial tissue in an attempt to "clean it up", makes the immune system reactive to the cells that make up the uterine lining. The fault then begins to reside in the immune system, which is unable to eradicate the misplaced tissue. The immune system then loses its discriminatory control, and can't distinguish between self and non-self. As far as fertility is concerned, this creates a toxic environment in the uterus, not conducive to an implanting embryo.

An immunopharmacological study of an antiendometriotic herbal medicine known as Gui Zhi Fu Ling Wan, was conducted by four researchers at the Osaka City University Medical School in Japan.

The patients with endometriosis were found to have elevated serum levels of Immunoglobulin M antibody titers. A control group was treated with leuproride acetate therapy to suppress hormonal production (a common western approach for endometriosis is to suppress the hormonal stimulus). The treated group was given the antiemdometriotic herbal formula Gui Zhi Fu Ling Wan, which consists of Ramulus Cinnamomi Cassiae, Sclerotium Poriae Cocos, Radis Paeoniae, Cortex Moutan Radicis, and Semen Persicae. This formula was historically used in China to treat bleeding during pregnancy due to blood stasis in the womb, or to prevent miscarriage. Later indications include the treatment of immunologic and inflammatory conditions of the uterus including dysmenorrhea, leiomyomas (uterine fibroids), ovarian cysts, chronic pelvic inflammatoy disease and salpingitis, and endometriosis.

The lupron treated group had lowered levels of estradiol, but no change in the IgM antibody titer. The treated group had no changes in estradiol levels, but the levels of IgM antibody titer were decreased and the patients were kept symptom free for months.

From, "A Study on the Treatment of Primary Dysmenorrhea with Jia Wei Mo Jia Tang (Added Flavors Myrrh & Dragon's Blood Decoction) and Its Affect on Prostaglandins and Related Factors" by Zhu Nan-Sun, Huang Hui, & Chen Hui-Lin, Ahong Yi Za Zhi (The Journal of Traditional Chinese Medicine), #2, 1994, p. 99-101:

This article reports on the treatment of primary dysmenorrhea in 95 women who were divided into two groups. One group received the herbal formula Jia Wei Mo Jie Tang as treatment for their dysmenorrhea and the other group, which acted as a control group, received indomethacin. In addition, serum levels of various prostaglandins were compared before and after treatment with 30 women who were considered normal. The authors begin this report by stating that the disease mechanism related to primary dysmenorrhea is stasis. Therefore, Jia Wei Mo Jie Tang's intended purpose is to invigorate the blood and transform stasis, break the qi and move stagnation. However, from a modern Western medical point of view, this treatment achieves its effect by regulating serum prostaglandins.

All 95 of the women in this study who received treatment suffered from primary dysmenorrhea. The 30 women who were considered normal did not have any period pain and had normal, biphasic basal body temperatures. Of those suffering from painful periods, 87 cases had menstrual cycles which lasted from 25-35 days, while eight cases had menstrual cycles lasting from 35-45 days. Four cases had scanty menses, 56 medium menses, and 35 cases had excessively heavy menses. Ninety women's periods lasted seven days or less and five cases lasted more than seven days. In terms of the disease course, 31 cases had dysmenorrhea for less than five years, 47 cases for five to ten years, and seventeen cases for more than ten years. In addition, 20 cases experienced pain before the onset of their periods, 89 during their periods, and two after their periods. Five had previously had children and 90 had not been able. In terms of the severity of their pain, 61 suffered from severe pain and 34 from moderate pain. And as for their pattern discrimination, there were 49 cases of qi stagnation with blood stasis, 17 cases of qi stagnation with blood stasis and accompanied by cold, 19 cases of qi stagnation with blood stasis and accompanied by heat, and 10 cases of qi stagnation and blood stasis accompanied by vacuity.
Jia Wei Mo Jie Tang consisted of uncooked pollen typhae, Feces Trogpterori Seu Pteromi, Pericarpiuym Citri Reticulatae Viride, Rhizoma Sparganii, Rhizoma Curcumae Zedoariae, Fructus Crataegi, Resina Olibani, Resina Myrrhae, and powdered Sanguis Draconis.

The 63 women in the group which received Jia Wei Mo Jie Tang were given 50 ml of this decoction orally two times per day beginning two weeks before the due date of their period as calculated by the rise in their basal body temperature. Since administration was continued through the first day of their period, the total number of days this decoction was administered each cycle was 15, and one course of treatment equaled three months.

The 32 women in the group which received indomethacin were given this medication beginning three days before the onset of their period or 12 days after their basal body temperature went up. They took 25 mg. of indomethacin orally, three times per day. Since they also took this medication during the first day of their periods, they took imdomethacin for a total of four days per cycle, and one course of treatment also lasted three months. The 30 normal women did not receive any medication during the course of this study.

In the Jia Wei Mo Jie Tang group, before treatment, 39 had severe pain and 24 moderate pain. After treatment, two cases still had severe pain, 17 experienced moderate pain, and 18 cases slight pain. In the indomethacin group, 22 had severe pain and 10 moderate pain. After treatment 1 had severe pain, 9 moderate pain, and 17 slight pain. Thus the amelioration rate for the Jia Wei Mo Jie Tang group was 80.4% as compared to 73.3% for the indomethacin group.

In terms of serum analysis, there was a positive correlation between the severity of dysmenorrhea and PGF 2a and PGE contents in the menstrual blood. Jia Wei Mo Jie Tang substantially decreased the blood contents of and the ratio between PGF 2a and PGE 2. Further, it markedly lowered the content of medium phase E 2 ( a type of estrogen) secreted by the corpus luteum and found in the peripheral blood but markedly increased the content of late phase progesterone secreted by the corpus luteum. Indomethacin, on the other hand, demonstrated no marked effect on estrogen or progesterone.

Categories for treating endometriosis, or dysmenorrhea are further divided as:
* Qi Stagnation
* Damp heat stasis and stagnation
* Spleen qi vacuity
* Kidney yang vacuity
* Blood vacuity
* Mixed Heat & Cold; Vacuity and Repletion - includes qi and or yang vacuity, blood stasis and qi stagnation. [For this category, if it includes digestive complaints and presentation includes a patchy tongue coating (geographic tongue), the Prescription Wu Mei Wan has been found to be emperically effective.]

In each case, the pattern must be treated, using dietary principles, herbal categories and acupressure treatments based upon the diagnostic presentation.
Endometriosis is an enduring disease; stasis entering the deeper, network vessels. When an enduring disease enters the network vessels it is wise to employ the use of resins like frankincense and myrrh with treatment.

The Jing Yue Quan Shu ([Zhang] Jing-yue's Complete Writings), "Women's Regulation: Blood Conglomerations" chapter states:

Static blood which is retained and stagnates eventually becomes concretions. This pattern may be casued during the period or postpartum and may be due to internal damage engendering chill, external invasion of wind cold, rage and anger damaging the liver, qi counterflow and blood stagnation, long-standing taxation, long-standing weakness, and qi weakness not moving [the blood.] Therefore, sometimes the blood stirs and sometimes it has almost nothing. It may also counterflow, thus leading to retention and stagnation which accumulates for days, gradually becoming concretions.

The Zheng Zhi Zheng Sheng (Patterns & Treatments Proven Restraing), "Blood Conglomerations" chapter states (paraphrased):

If there is gathering of blood conglomeration, there will be low back pain and inability to bend, accumulation of qi below the pubic bone, stone-like hardness, tension inside the lower abdomen, bitter pain, upper back spine pain penetrating to and reaching the low back and abdomen, spasms within the vagina, a secluded cervix, menstruation behind schedule. This disease is found in people with infertility. If treatment precipitates the conglomerations, it can be cured.

The above literary cites and endometriosis all share the same symptoms. In endometriosis there is the production of nodulations and lumps within the body. In TCM, this is related to blood gathering becoming stasis, and stasis accumulation becoming concretions and conglomerations. Most often, the greatest method for treating endometriosis is to quicken the blood and transform stasis. In all cases, the underlying pattern must be treated as well.

Endometriosis is also correlated with a scenario of estrogen dominance. Estrogen feeds endometriosis. Many women with endometriosis also have lower levels of progesterone as well. It is therefore important to help the body clear itself if excess estrogens. The liver metabolizes estrogen; therefore using methods which resolve liver qi stagnation will assist the body in clearing excess estrogen. Use stimulation on the acupuncture points Joining Valley, located between the bulge between the base of the thumb and first finger bone on each hand, and Great Rushing, found in the depression on the foot approximately one inch up from the web between the big and second toes.

EMILY

31 year old Emily presented to the clinic with a chief complaint of painful periods and trying to conceive with no luck for five years. She was accompanied by her husband, and appeared very shakey and upset. She had had a diagnosis of endometriosis from her gynecologist. She had two surgeries; a D&C with myomectomy, and laparoscopy to remove adhesions on her ovaries and uterus 13 months lafter the first operation. She had just completed her third intrauterine insemination attempt after twelve cycles of Clomid, all of which failed. She stated that she was very sensitive to the effects of exogenous progesterone. She was discharged from her latest reproductive endocrinologist's protocol because she refused to receive any more injections. She said the stress of the fertility procedures was driving her insane.

Her menses began at age 17 (late menarche indicates a weakness of the kidney's reproductive function); they have always been painful. The pain typically lasted from two to 12 days, beginning soon after ovulation and continuing until the first couple days of menstruation. She bled around five days, the bleeding was heavy, dark red to black in color, with clotting. The menstrual blood got progressively lighter from days one to six, starting off black going to heavy crimson with clots and toward the end became orangey and watery. Then the blood sometimes became brown and scanty at the end, and sometimes remained up to ten days. There was excessive premenstrual tension, breast tenderness, and acne. She often suffered from yeast infections and vaginal discharge. She became extremely fatigued around ovulation to the point of physical exhaustion. She had low back pain before and during menstruation. She experienced loose stools and pain with defacation.

Emily had a very stressful occupation. She also stated that she had excessive facial hair, although none was observed. Her fallopian tubes were clear as per her gynecologist's report. She reported chills, cloudy urine, frequent urination, frequent urinary tract infections, chills, low energy, dizziness, fatigue, excess thirst, insomnia, irritability, unclear mind, anxiety, heart palpitations, fear, sadness, uncontrollable crying, aversion to cold, much phlegm production, nausea, bloating and gas, irregular heart beat, numbness in her arms, cold hands and feet, lack of strength, thin skin, easy bruisability, broken blood vessels, dry skin, brittle nails, and low sexual energy. She got dizzy when when stood up and had poor night vision. Her ears rang occasionally. She had extreme emotional lability.
Emily was thin and appeared frail, but agitated. She clenched her teeth and spoke as if she was going to cry. Her husband was always ready to console her. She wasn't sure if she could handle acupuncture because she was "very sensitive to needles."
Her tongue was pale with pinkish orange edges.

Her pulse was superficial and taut. The kidney aspect of the pulse was very deep and weak.

I diagnosed Emily with liver depression, qi stagnation, depressive heat, spleen qi and kidney yang vacuity, blood stasis, and liver and heart blood vacuity (perhaps due to, but definitely complicated by the stagnated qi and blood). She lived out of town, so we were going to have to devise a treatment plan that would require her presence at the clinic only once per month.

Treatment I decided not to try acupuncture on her, but gave her and her husband instruction on dietary therapy, breathing exercises, and massage techniques.

I gave her a formula consisting of:
* Fructus Meliae Toosendan and Rhizoma Corydalis Yanhusuo to spread and regulate the liver qi, drain heat, and alleviate pain
* Frankincense and Myrrh- to invigorate the blood within the harder to reach, network vessels.
After the first month Emily reported that she had slightly better energy throughout the entire month (as the qi stagnation was resolving), but she still had frequent nighttime urination and a lot of thirst (heat signs). Her pain, though, was diminished. Her pulse was now taut and rapid, but still weak. Her tongue was purplish-red (signs of heat.)

The second month I gave her a formula consisting of:
* Radix Bupleurum
* Radix Angelicae Sinensis
* Radix Paeoniae Lactifloriae
* Rhixoma Atractylodes Macrocephalae
* Sclerotium Poriae Cocos
* Cortex Moutan Radicis
* Fructus Gardeniae Jasminoidis
* Radix Glycyrrhizae


This formula spreads the liver qi, strengthens the spleen, nourishes the blood, and clears heat.

She reported after the second month that she had almost no pain before or during menstruation. She continued to experience improvement over the next three months, until no pain was felt on or after ovulation. Her moods improved as the pain diminished.

Emily began charting her basal body temperature after she began her herbal treatments. Her basal body temperature changed from a sawtooth, erratic pattern to a biphasic, healthy hormonal cycle.

Six months after her treatment began, Emily and her husband decided to try another insemination. She did not experience the extreme emotional libility with this procedure, and they became pregnant. They are now the parents of a healthy young son.

Uterine Fibriod

Uterine Fiboids or myomas are benign tumors found in approximately 20% of women over 35 years of age. Uterine myomas are the most common neoplasm of the female reproductive organs, and are associated with menstrual pain, heavy menstrual bleeding, and fertility problems.


Fibroids may impair conception if they obstruct the uterine cavity or the entrance into the uterus from the fallopian tubes.

One chinese study conducted by Zhongli and Shurong used Traditional Chinese Medicinals to treat 223 cases of uterine fibroids. All patients had conspicuous symptoms and were diagnosed clinically by pelvic examination and confirmed by ultrasonography.

* Treatment was provided according to the diffentiation of the pattern of imbalance, involving the principles of invigorating the blood and eliminating blood stasis, clearing heat, and suftening the induration.
* Those diagnosed with yin deficiency and liver fire were also given herbs to supplement the yin and clear liver fire.
* Those diagnosed with spleen qi vacuity were also given herbs to supplement the spleen qi such as codonopsis and astragalus.
* Medicinal herbs were added for qi and blood stagnation.
* The herbs were administered after menstruation. The authors reported a 72% reduction in the quantity of menstrual blood. Symptoms like abdominal pain, leukorrhea, and backache were improved in 58.8%. The overall effectiveness rate was 92.4%. Myomas completely disappeared in 13% of the cases, were markedly diminished in 29%, slightly reduced in 19%, and unchanged in 28%.
Acupuncture and acupressure are also recommended in the treatment of fibroids, using those points recommended for blood stasis and the uterus. The stimulation provided by the acupuncture has been found to induce the regression of pathologic proliferating cells locally. Humoral factors at a distally stimulated acupoint which control and prevent local overgrowth of regenerating and proliferating cells (those that invigorate the blood) also systemically affect the growth of distant tumors.
As with all Chinese Medical treatments, however, the most efficacious results will result from treating the pattern. I treated a woman for a large fibroid (the size of a grapefruit), and the tumor shrunk, only in response to tonifying her spleen and resolving dampness. When I tried to invigorate the blood, I got no effect at all.


Other Natural Treatments for Endometriosis and Uterine Fibriods
* Rest and wear loose, comfortable clothing
* Perform deep breathing exercises and meditative practices
* Take warm baths (with aromatherapy if you wish.)
* Use essential oils like frankincense, myrrh, clary sage, peppermint, lavendar, rosemary, juniper and thyme.
* Use a heating pad or hot water bottle on your abdomen
* Apply warm castor oil packs on your abdomen to invigorate the blood, assist the lymphatic symptom and balance hormone levels. Apply warm castor oil to the lower abdomen and cover with plastic wrap two to three times per day during the premenstrual and menstrual period.
* Take herbal supplements that invigorate the blood (and those for resolving concomitant patterns as applicable.)
* Avoid all foods which have been treated hormonally.
* Consume soy and soy products like tofu.
* Buy only organic fruits and vegetables.
* Avoid refined, rancid and hydrogenated oils.
* Use only unprocessed plant sources of essential fatty acids.
* Use oils rich in both linoleic and alpha-linolenic fatty acids such as flax-seed, pumpkin-seed and chia-seed oils, but only if they are recently cold-pressed and refined.
* Include dietary spirulina, evening primrose oil, and oil from black currant and borage seeds.
* Avoid sources of arachodonic acid, which comes from animal meats, dairy products, eggs, peanuts and seaweed.
* Decrease the amount of dietary animal products, except fish.
* If you do consume meat, make sure it is at least organic, and not hormonally treated.
* Eat walnuts, dark greens, saffron and cold crimate crops.
* Foods which are especially good for resolving blood stasis include: Kelp, lemons, limes, onions, irish moss, and bladderwrack.

Supplement your diet with antioxidants (vitamins C, E, beta carotene, selenium, zinc) Include super-antioxidants (grape seed extract, pine bark extract, red wine extract, bilberry extract), which contain procyanidins, caffeic and ferulic acid, with demonstrated antiinflammatory and spasmolytic activity (Kohama, M.D., and Suzuki, M.D.)

Fibroids and endometriosis benefit from the use of Omega-3 fatty acids in the diet. Fish oil and linseed oil are good sources of these Omega 3 fatty acids. Fish oil prevents abnormal blood clotting. If your menstrual blood contains clotty tissue, supplement with fish oil, linseed oil and evening primrose oil (which also contain gamma linolenic acid or Omega 6).

Meditation and Visualization for Blood Statis in the Uteru

Exercise 1 - for the follicular phase
Perform this exercise daily, between the first day of menstruation until ovulation only.

Step 1. Lay down, on your back, with your eyes closed. Relax and breathe deeply. Notice any areas of tension you feel in your body from your head to your neck, down your arms and hands, through your torso, down your abdomen, buttocks, thighs, calves and feet. Tense the tight areas in your body even more, one by one. Breathe in, inhaling deeply down into your lower abdomen. Push your stomach out as you breathe in. Focus your attention on the tension in your body, then tighten the muscles in the area even more, and relax them fully as your exhale. Exhale all the way, deflating your abdomen when you breathe out. Breathe the tension in your body out through the breath.

Focus your attention on the tension, the breath, and the relaxation. Nothing more. When the tension in that particular part of your body is gone, move on to the next part. When you feel relaxed throughout your body, and your mind is clear, begin the visualization. Continue the deep breathing exercise, breathing deep into your abdomen and relaxing with each exhalation.

Step 2. Now focus the breathe down into the pelvis. Breathe into your uterus. Let the uterus draw the breath in itself. Let these breaths be cleansing. The uterus has one energetic function. It is downward. It takes the blood and the breath in through the top, and lets them out downward through the bottom. Think of the uterus as a receptive, sponge-like organ. It draws in blood and energy through the breath to prepare a garden-like home for implantation. Picture a lush, green, mossy garden. With every breath in, you bring purifying energy in through the top of the uterus. With every exhalation, breathe out any impurities downward through the bottom of the uterus. Any pain, any toxins, any impurities are released downward, with each breath. You are helping to prepare these luxurious surroundings for implantation. This is a pure, flourishing, abundant home. It is open, receptive, and fertile. It cannot afford to foster toxins. Release them. When your uterus feels pure, open and receptive, you are finished.

Exercise 2 - for the luteal phase
Practice this meditation and visualization from ovulation until menstruation begins.
Perform Step 1 as above. Practice this meditation and visualization from ovulation until menstruation begins.

Step 2. Breathe in very deeply, and concentrate on bringing your breath from your nose and down the midline of your body, between the breasts, down the abdomen, and eventually focusing your breath down to the region two inches below your navel. This is called the Dan Tien. Let the breath energy pool here.

At the end of inhalation, bring the focus from the area below your navel down to the uterus. Breathe in cleansing, purifying breaths to the uterus and then down to the perineal muscles. Perform a kegel exercise, tightening the perineal muscles. This should be a smooth, continuous movement, with cleansing breaths inward. Concentrate on the uterine lining. It is pure, lush, and fertile. It is receptive. Each breath brings fresh, clear energy into the uterus, reviving it with healthy, fertile lining. When you release the kegel, begin exhalation.

During exhalation, turn the focus of your attention from the uterus back to the tip of your tailbone, then up the spine to the top of the head. Your concentration now is on the upward movement. Exhalation should end focusing your attention down the midline of the head and out the nose. Repeat from the beginning of step 2 with each new inhalation, until the process becomes one smooth, continuous movement.

Stress and Unexplained Infertility

Article by Randine Lewis, Ph.D., Lic.Ac. of FertileSoul.com

Unexplained infertility translates to mean there is no medical reason the doctors can apply within the realm of modern scientific understanding to explain why conception isn't occurring. Chinese medicine is particularly effective in treating this otherwise devastating diagnosis.

Luteal phase defects may be slight enough so that the laboratory hormonal assays still report to be "within the normal range," yet still grave enough to prevent conception. Many cases of "unexplained infertility" involve patterns whereby the hormones are considered "normal", yet the uterine lining fails to respond appropriately to the hormone which dominates the luteal phase, progesterone. When the endometrium is primed, progesterone will cause a series of events to occur within the endometrium, causing it to exhibit the appropriate proteins, enzymes and mucins that must be present for the fertilized embryo to recognize the signals which allow it to adhere and implant. If the individual has indications of spleen qi vacuity or kidney yang deficiency, and these are addressed, the luteal phase defect should correct itself and allow conception to occur.

If the menstrual blood is abnormal in amount, color, and consistency, this likely indicates a problem within the uterine lining. If the blood flow is too scanty and all other signs lead to blood deficiency, tonifying the blood during the follicular phase will correct the imbalance which caused the underlying syndrome. The blood flow will become heavier and the endometrial lining will be shown to be thicker. If the menstrual blood is scant in amount, is black or very dark in color, and is accompanied by stabbing pain, the use of dietary and herbal modifications and local application of warm castor oil packs may resolve the blood stasis and its accompanying toxic residue, and allow the uterine lining to respond with fresh, healthy endometrial tissue. Embryos prefer this type of environment when searching for a home. When we apply the methods of Traditional Chinese Medical gynecology to resolve the bleeding disorder, the endometrium responds accordingly and implantation occurs.

The first step is always to begin to address the manifestation of the problem.

If the menstrual flow itself is normal, the next question is the menstrual cycle. Is it shorter than average or longer than average? Does it even have a pattern? If the menstual cycle is shorter than 26 days, we must work to lengthen it. If the follicular phase preceding ovulation is only eight or nine days, and there are signs of yin vacuity heat such as night sweats and vaginal dryness, we must supplement yin and clear heat during the first half of the menstrual cycle. The estrogen deficiency signs will then resolve. If the luteal phase is shorter than ten days we must work to lengthen it. When apply the principles of pattern differentiation to the end of the luteal phase, we often find symptoms of spleen qi or kidney yang vacuity. Many women report that their temperatures fall early, accompanied by low back pain, and loose stools. They are usually cold in nature, with especially cold feet, wake up at night to urinate, and have relatively low libido. Right away we know that the kidney yang is not abundant enough to support a 14 day luteal phase. Employing dietary and herbal modifications which supplement the kidney yang will correct the underlying imbalance which caused the luteal phase defect. The cycle will lengthen, the signs of kidney yang vacuity will diminish, and pregnancy will occur.

A condition known as a "cold uterus" means that the uterine lining has not responded appropriately to the warming hormone (progesterone). The vessels which supply blood to the uterus are constricted as a result of this "cold" response. Women with this diagnosis often have a combination of patterns of kidney yang (the warming energy) vacuity and blood stasis. They will often have premenstrual low back pain, cramps which respond to heating pads, and clotty menstrual blood. Prescribing warming herbs and invigorating the blood will help resolve this pattern.

Monitoring the basal body temperature gives immense information regarding where the imbalance occurs as well. Temperatures which exhibit no biphasic pattern at all and are relatively low (around 97 degrees farenheit) and are accompanied by cold signs reveal a diagnostic pattern of kidney yang vacuity. Remedy: supplement kidney yang. A biphasic, ovulatory pattern will begin to emerge, and reproducive hormones respond accordingly. A monophasic pattern of high temperatures which are accompanied by heat signs will respond to yin supplementation and clearing of vacuity heat.

A sawtooth, erratic pattern of temperatures means there is not enough hormonal regulation occurring to normalize the temperatures. Most often this will be accompanied by symptoms of liver depression qi stagnation, a pattern which occurs as a result of maladaptation to stress. Women who exhibit no pattern at all to their menstrual cycles often have liver qi stagnation as well. One month the cycle may last 35 days, and the next month it is 26 days. There are severe premenstrual signs some months, and other months there are almost none. The problem most assuredly lies in the liver qi (i.e., stress.) and its associated endocrine effects, and the remedy will be to course the liver and rectify the qi. What does stress do to the body?

What About Stress

Adrenalin is a hormone which is released by the adrenal glands during conditions of stress. Although it helps us to escape from danger, it also inhibits our ability to utilize progesterone, a very important consideration for fertility.

Prolactin, a hormone which is released by the pituitary gland, is usually discharged in order to stimulate lactation in preparation for nursing. However, also under times of stress, the pituitary gland emits more prolactin - in order to impair fertility.

Our bodies know that we should not be pregnant when we are under tremendous stress. Its first priority is keeping us out of danger. Taking care of a fetus when we are experiencing a precarious or tense situation is not an optimum physiological response. The optiumum physiological response, as far as our bodies' preservation instinct is concerned, is to flood the skeletal muscles, dilate the pupils, and remain acutely aware of our surroundings. Our bodies' know that we shouldn't be tired and nauseous and accomodating a pregnancy. Yet, when the stressor is only one of perception, or when we are responding inappropriately to stress with nervous tension, we must retrain our bodies and let them know that we are not in immediate danger, regardless of our environmental situation.

If you exhibit a pattern consistent with a hypersympathetic nervous system, you are likely supplying less blood flow to the uterus and ovaries, thereby impairing their optimal functioning. If you tend to sweat more than normal, have cold, sweaty or clammy hands and/or feet, especially under stress, or if you sweat when you feel anxious, or have night sweats, these symptoms are indications to supplement with herbs like Semen Tritici Aestivi Levis and Radix Ephedrae (this is the root of the Ephedra plant, not to be mistaken for Herba Ephedrae, the stem, which has the ephedrine stimulant effect. They are not interchangeable.)

Stress, however, is not the only factor. There are many subtle endocrine and hormonal factors which effect our ability to conceive. Most women with irregular menstrual cycles who are unable to conceive are given the diagnosis of "unxplained infertility" because their laboratory blood analyses still show hormonal levels within the "normal" range. Of course, receiving this diagnosis, by itself puts the body into a higher state of stress, because now all we know is that nobody knows what is wrong.

Be assured, treating the pattern will resolve the hormonal imbalance! If you have all the signs and symptoms indicative of liver depression qi stagnation, you now know how to begin addressing the imbalance. First alleviate as much external stressors in your life as you are able to control. Then turn the attention to yourself. What can you take control of to assuage your response to the remaining internal stress (or your perception of stress)?

* Exercise
* Meditate
* Breathe
* Sit down when you eat
* Eat frequent, small meals, to keep the blood sugar level more stable and inhibit the release of adrenalin.
* Chew your food sufficiently, mixing enough saliva with the food to neutralize and make digestion easier.
* Drink a lot of water, but don't drink during a meal.
* Do not drink alcohol or caffeine or smoke cigarettes.
* Eat foods which move the qi like peppermint, rosemary, spearmint, turmeric, and thyme.
* Supplement with herbs which resolve liver qi stagnation.
* If your prolactin levels are high, take Hordeum Vulgare.
* Perform the acupressure techniques to rectify the liver qi.

Case History

Cindy was an attractive, 36 year old professional woman. She was married to Mark, who appeared very angry and cold. He would often answer her questions for her, but would look away when I talked to him. I could tell he wasn't very happy about Cindy seeking "alternative" treatments. They had married when Cindy was 28. She always had very heavy menstrual cycles, and when she was 30, she was found to have three fibroids within the uterus and moderate endometriosis throughout her pelvis. The fibroids and endometriosis were surgically removed and had not recurred. During the last six years she reported normal menstrual cycles, although they varied in length. Her shortest cycles were 30 days in length, longer cycles lasted up to 38 days. They had tried to conceive every month for the last eight years. All laboratory tests were normal. She had tried Clomid for six cycles, and although she had good egg production and a thick uterine lining, she did not conceive. She said the Clomid made her very anxious and gave her severe headaches and acne.

Cindy (in Mark's presence) was not comfortable answering questions regarding her menstrual cycles. She said the blood flow was normal in amount, there was very little pain, very little PMS, very little breast tenderness, etc. She listed no other symptoms. She reportedly had no difficulty with circulation, digestion, elimination, sleeping patterns, or moods. I decided not to press the questioning further, and got right to her pulse, which had a fine but taut quality. Her tongue (which she scraped daily) had a slightly grayish hue to it. She did, however, monitor her basal body temperatures over the last month, after our initial telephone conversation. The pattern was extremely erratic.

I made the correct assumption that there was an element of liver depression qi stagnation, and treated her accordingly. The couple did not have enough trust in me to suggest any dietary or lifestyle modifications, so I used acupuncture employing the "four gates" technique to open up the liver channels and resolve stagnant qi. I needled the spirit point within the ear, and the point between the eyebrows to calm the spirit. I prescribed an herbal formula to nourish the spirit and resolve liver qi stagnation.

Over the next couple of months, I found out more about Cindy in retrospect. She reported that her periods were becoming much less painful, she was sleeping better, and she was feeling less crazy premenstrually. Every suggestion I made she incorporated. She started walking every day during her lunch break at work. She did breathing exercises every day at work. She changed her (and Mark's) diet.

Within four months, Cindy said she was happier. She made a few comments about Mark, and said she didn't let him "get to her" anymore. We became much closer. She noticed that she quit grinding her teeth at night. She rearranged her bedroom so she felt more comfortable in it. Each month her cycle stabilized a little more as we got closer to the source of her disharmony.

As I incorporated medicinals to clear liver and heart heat, she responded dramatically.

Within six months Cindy and Mark were pregnant. Mark called me the day their son was born to thank me.

Case History

Sonja was a 32 year old secretary married to a school teacher. They had been trying to conceive for two years. She had a psychiatric history of depression for which she was treated with three different medications. She was pleasant and attractive, and had no outward signs of angst. She spoke of the fear of her depression more than the depression itself.

Her menstrual cycles were about 32 days in length, and the blood flow lasted about five days. She had some menstrual discomfort, and some breast distension, but no significant symptoms of premenstrual tension. She said she felt tense and irritable all the time. She did not notice any signs of increased fertile vaginal discharge mid cycle, but said she felt pains in her ovaries during the middle of the month.

She was constipated most of the time, but blamed this on her medication. She didn't sleep well, and most of her symptoms revealed themselves in the mood category. She started to monitor her basal body temperatures and they were monophasic and sawtoothed. She appeared to be anovulatory.

She came for acupuncture once a week, but we did not use any herbs. She was afraid to interfere with her antidepressant regimen. I taught her qi gong breathing for the purpose of regulating her hormonal cycles and relaxing her, and she said she did it every time she got upset. She performed the exercise sitting at her desk, talking on the phone, and every night to help her sleep. Her patterns began to stabilize, and she ovulated.

She talked to her psychiatrist about reducing her medication as she started to feel better, and by the time she ovulated she was off two of the drugs she had been relying on for most of her adult life. She still took one selective serotonin reuptake inhibitor (SSRI) which was safe to take during pregnancy. She conceived shortly thereafter and had an uncomplicated pregnancy. She did experience post-partum depression and the last I heard from her she went back on one of her other anti-depressant medicines.

ACUPUNCTURE - A CURE FOR INFERTILITY?

Article written by Catherine Donaldson-Evans (fox news)

At 36, Lucy Appert has suffered through two miscarriages, a stillbirth at 8 1/2 months and, because of a rare pregnancy-related liver dysfunction, intensive illness and surgery.

Yet after enduring five painful years of trying to have their own baby, Appert and her husband Edward finally saw their dream come true last month when their son Henry was born — premature, but healthy.

For all the fertility treatments, technologies and prenatal care available to women today, Appert credits the success of her pregnancy to an ancient Chinese secret.

"I recommend acupuncture (search) to everyone," Appert said. "It does work. I did everything possible for years to have a baby. I almost lost hope."

The millennias-old Asian medical practice — in which the acupuncturist places tiny needles in various pressure points, or "Qi" (Chee), in the body to improve circulation and reduce stress — has been around in the United States for years as an "alternative" treatment for numerous ailments.

But recently, acupuncture has been picking up steam as a possible remedy for female infertility, with a handful of American and European studies showing that it enhances the success rate of in vitro fertilization (IVF) (search).

“Do I believe in it? Absolutely,” said Dr. Paul C. Magarelli, an infertility doctor at the Reproductive Medicine & Fertility Center in Colorado Springs, Colo., and co-author of an ongoing study into the use of acupuncture with IVF with Dr. Diane K. Cridennda. Cridennda is a licensed acupuncturist with a master's degree in Oriental medicine from the International Institute of Chinese Medicine (search) who owns East Winds Acupuncture, also in Colorado Springs.

Magarelli said he joined the study at the urging of Cridennda, who had approached him about using acupuncture with IVF based on her knowledge of its history as an Eastern fertility treatment. A skeptic at first, Magarelli said he dismissed the idea for a while before signing on.

"I thought, this is rubbish — it can't be true," Magarelli said. "But no matter how I look at this data, I see an improvement. ... I'm pretty much a convert."

In general, studies seem to indicate that doing acupuncture about 30 minutes before and after in vitro fertilization can increase the chance that the embryo will be implanted successfully and reduce the chance of miscarriage.

There are also indications that the effectiveness of the IVF drugs and procedure may improve if acupuncture is done about once a week in the month or two leading up to the start of IVF and then continued regularly — once or twice a week — during the whole cycle.

And, as in Appert's case, there is anecdotal evidence that acupuncture can help with other fertility and pregnancy problems. Appert didn't need IVF to conceive, but she was told she probably couldn't carry a healthy baby to term because of her liver disorder.

But some doctors caution that there is no "magic pill" for fertility, pregnancy and IVF troubles — whether it's acupuncture or something else.

"The jury is still out on that," said Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology (SART) (search), who has a practice at the Colorado Center for Reproductive Medicine. "I don't think we have good data to show that acupuncture before and after the embryo transfer is truly beneficial."

And they warn against making too much of claims that acupuncture can help with having babies.

"It's impossible to say at this point," said Dr. Robert Schenken, president of the American Society for Reproductive Medicine (ASRM) (search), who has a practice at the University of Texas Health Science Center. "In the absence of any controlled data, I don't think we can come to a firm conclusion."

Promising Research

Acupuncture seems to help some women because it improves circulation to the ovaries (search) — which makes for healthier eggs — and to the uterus (search), which increases the chances that the lining will be strong enough to hold those eggs to full-term.

"Acupuncture provides better circulation and better blood flow to the womb," said Dr. Raymond Chang, director of New York's Meridian Medical Group, who has been incorporating acupuncture into fertility treatments for the past decade. "It will give a better chance for the eggs to be nourished and therefore carried."

There's also the fact that acupuncture can be a stress-reliever during an emotional time.

"Trying to get pregnant is incredibly stressful," said Victoria Koos, the acupuncturist who treated Appert at Yin and Tonic Acupuncture in New York. "They're crossing their fingers. The longer they're trying to get pregnant, the worse it gets ... Part of [acupuncture's success] is simply relaxation. When the body is relaxed, all systems function better."

The Colorado study Magarelli and Cridennda presented at a conference this fall is one of a series the pair have done with acupuncture and in vitro.

That one looked at 114 patients who had a good chance of IVF being effective, some who did acupuncture and some who didn’t. It found, among other things, that there were fewer miscarriages, more pregnancies and a 7 percent higher birth rate among those who got acupuncture treatment over those who didn’t, according to Magarelli.

It piggybacked off other research the team did on 147 “poor responders” to IVF, which found that the pregnancy rate was 40 percent, with 11 percent more babies born, among those who did acupuncture with in vitro fertilization compared to those who didn’t.

In March, Magarelli and Cridennda released findings in Italy involving patients with an average prognosis for IVF success. Those yielded clear numbers that the pregnancy rate increased with acupuncture by 24 percent, according to Magarelli.

“What got us was that now we were seeing a firm trend toward getting more people pregnant,” he said.

The Colorado research seems to support some findings of two earlier studies, one in Germany by lead researcher Dr. Wolfgang E. Paulus — published in ASRM's “Fertility and Sterility” (search) in April 2002 — and one in Sweden by lead researcher Elisabet Stener-Victorin in the 1990s.

Of course, even those who believe in acupuncture concede that while the existing studies have yielded good information, there still isn't sufficient evidence, or a broad enough sample of patients tested, to call acupuncture a proven remedy.

"We are convinced, but scientifically you need proof — or so-called proof," Chang said. "There is a whole set of proof from lab experiments and animal studies to human studies, but it's very difficult to do human studies."

Schenken noted that even though there might be one set of data showing positive results, "it really needs to be corroborated, preferably with several different studies and different patient populations." For example, there can be bias when the entire study sample comes from the same clinic, or when patients know they're doing something different from usual.

Schenken said he doesn't get asked about acupuncture often, but when patients do, "we don't recommend it, but we do not discourage it."

Surrey takes a similar approach. In his opinion, the data "is not bad" on the theory that acupuncture can help when administered before IVF, but as far as acupuncture generally improving fertility or helping after the embryo transfer in IVF, "there really isn't a whole lot of data on that."

But at the very least, "there is absolutely nothing to show that it's harmful if it's done with a trained and appropriately skilled acupuncturist," he said. It's a notion that nearly everyone in the medical field — whether they believe in needles and Qi or not — seems to agree upon.

Some Eastern medicine-Western medicine rivalry may come into play with how to treat reproductive problems, but Chang said he sees more resistance with the use of Chinese herbs — which are ingested — than he does with acupuncture. Often, it's the in vitro specialists themselves who refer their patients to him for acupuncture after a couple of failed IVF attempts.

As for the couples trying to bring a child into the world — particularly through a complicated, invasive procedure like IVF— anything that helps the process along is welcome.

“IVF is so technical that patients feel like they’re being pushed and pulled … with acupuncture, they’re in a sense taking some control,” Magarelli said. "Acupuncture isn't a needle, it's an environment."

Added Koos: "They're on these incredibly strong drugs that make the poor women crazy. They're running around like Catwoman. This is to help them stay sane while they're going through the process."

The emotional cost of infertility comes with a hefty financial price tag as well — in vitro fertilization can cost anywhere from $10,000 to $20,000 a cycle and generally isn't covered by insurance; acupuncture ranges from about $30 to over $200 per treatment — Koos and Chang charge about $90 a pop — and certain health plans do cover at least a portion of it.

Meanwhile, researchers and experts in the field are excited at what they're seeing in the studies. Chang said he's currently working with NYU Medical Center on a trial that looks at IVF with and without acupuncture.

Appert, for her part, was at the end of her rope and felt she had nothing to lose. She started acupuncture with Koos about two months before she began trying to conceive — with needles in her toes and a couple of liver points — and continued with the treatments throughout the pregnancy.

"The first time I went, I was completely terrified. My husband went with me and held my hand," she said. "I could feel the muscles in my liver jump and an electric current going through my body. It was very strange but also felt right."

She said being monitored by both her obstetrician and Koos helped reassure her about what was going on during her high-risk pregnancy.

"She would tell me things about how I was doing physically and then I would go to the doctor and he would tell me the same thing," remembers Appert, who works as a professor.

When she got sick late in the pregnancy, both Koos and Appert's OB/GYN were able to detect when her liver went dangerously haywire and get her to the hospital for delivery six weeks early, before the problem harmed the fetus and caused another stillbirth.

Regardless of the skeptics, Appert said she's relieved that she was finally able to have a nearly full-term baby of her own. At 4 pounds, 6 ounces, Henry has been in intensive care but otherwise is doing "fine."

"It really was a miracle," the new mom gushed. "It's one of these weird things that Western medicine can't explain."

Learn more about our infertility program by visiting www.acupunctureforinfertility.net

Air Force to train combat docs to use acupuncture

By KAMALA LANE Associated Press Writer

WASHINGTON -- Chief Warrant Officer James Brad Smith broke five ribs, punctured a lung and shattered bones in his hand and thigh after falling more than 20 feet from a Black Hawk helicopter in Baghdad last month.

While he was recovering at Walter Reed Army Medical Center in Washington, his doctor
suggested he add acupuncture to his treatment to help with the pain.

On a recent morning, Col. Richard Niemtzow, an Air Force physician, carefully pushed a short needle into part of Smith's outer ear. The soldier flinched, saying it felt like he "got clipped by something." By the time three more of the tiny, gold alloy needles were arranged around the ear, though, the pain from his injuries began to ease.

"My ribs feel numb now and I feel it a little less in my hand," Smith said, raising his injured arm. "The pain isn't as sharp. It's maybe 50 percent better."

Acupuncture involves placing very thin needles at specific points on the body to try to control pain and reduce stress. There are only theories about how, why and even whether it might work.

Regardless, the ancient Chinese practice has been gradually catching on as a pain
treatment for troops who come home wounded.

Now the Air Force, which runs the military's only acupuncture clinic, is training doctors to take acupuncture to the war zones of Iraq and Afghanistan. A pilot program starting in March will prepare 44 Air Force, Navy and Army doctors to use acupuncture as part of emergency care in combat and in frontline hospitals, not just on bases back home.

They will learn "battlefield acupuncture," a method Niemtzow developed in 2001 that's
derived from traditional ear acupuncture but uses the short needles to better fit under combat helmets so soldiers can continue their missions with the needles inserted to relieve pain. The needles are applied to five points on the outer ear. Niemtzow says most of his patients say their pain decreases within minutes.

The Navy has begun a similar pilot program to train its doctors at Camp Pendleton in
California.

Niemtzow is chief of the acupuncture clinic at Andrews Air Force Base. He's leading the new program after training many of about 50 active duty military physicians who practice acupuncture.

The U.S. military encountered acupuncture during the Vietnam War, when an Army surgeon wrote in a 1967 edition of Military Medicine magazine about local physicians who were allowed to practice at a U.S. Army surgical hospital and administered acupuncture to Vietnamese patients.

Niemtzow started offering acupuncture in 1995 at McGuire Air Force Base in New Jersey. Several years later, he became the first full-time military medical acupuncturist for the Navy, which also provides health care for the Marines.

Later, he established the acupuncture clinic at the Malcolm Grow Medical Center at
Andrews, and he continued to expand acupuncture by treating patients at Walter Reed and other Air Force bases in the country and in Germany. Niemtzow and his colleague Col. Stephen Burns administer about a dozen forms of acupuncture - including one type that uses lasers - to soldiers and their families every week.

Col. Arnyce Pock, medical director for the Air Force Medical Corps, said acupuncture comes without the side effects that are common after taking traditional painkillers. Acupuncture also quickly treats pain.

"It allows troops to reduce the number of narcotics they take for pain, and have a better assessment of any underlying brain injury they may have," Pock said. "When they're on narcotics, you can't do that because they're feeling the effects of the drugs."

Niemtzow cautions that while acupuncture can be effective, it's not a cure-all.
"In some instances it doesn't work," he said. "But it can be another tool in one's toolbox to be used in addition to painkillers to reduce the level of pain even further."

Smith says the throbbing pain in his leg didn't change with acupuncture treatment but that
the pain levels in his arm and ribs were the lowest they've been since he was injured. He also said that he didn't feel groggy afterward, a side-effect he usually experiences from the low-level morphine he takes.

Ultimately, Niemtzow would like troops to learn acupuncture so they can treat each other while out on missions. For now, the Air Force program is limited to training physicians. He says it's "remarkable" for the military, a "conservative institution," to incorporate acupuncture.

"The history of military medicine is rich in development," he said, "and a lot of people say that if the military is using it, then it must be good for the civilian world."