Endometriosis

The endometriosis is characterized by detection of endometrial stoma and glands beyond uterus with pathological changes and symptoms. When endometrium exists in myometrium, it is called internal endometriosis or adenomyoma; while when endometrium is displaced to any region externally from the uterus wall (including cervix and serous layer), they are called external endometriosis. If the endometrium is displaced to the ovary, clinically, it is known as chocolate cyst (endometriotic cyst). There are 3 main clinical signs of endometriosis other than symptoms of pathological area: (1) continuous and progressive menstrual pain mainly at lower abdomen or lumbar region. When pathological process invades vagina or rectovaginal septum, it can induces pain during sexual intercourse and intense during menses. (2) menstrual irregularities or menorrhagia. (3) 50% of patients with infertility. This is a polyetiological disease, the main reason for its occurence may due to regurgitation or implantation theory of fallopian tube; other important factor is metaplasia of coelomic epithelium (metaplastic theory); there is bigger possibility of benign transformation if the endometriosis occurs outside pf pelvic cavity; while endometriosis in abdominal wall is usually due to iatrogenic factor e.g Casaeran section. The diagnosis of endometriosis is done according to history and clinical signs. Basically, the clinical diagnosis can be established if the young woman has continuous or progressive menstrual pain, or menstrual irregularities with infertility, obvious and painful small nodules on uterosacral ligaments or rectouterine excavation (Douglas cul-de-sac) during gynecological examination. But, the confirmation is received by endoscopy or dissection of pathological area and performing tissue biopsy. The treatment of this disease depends on the degree of severity, area of pathological changes, age, fertility demand and other factors; those young women that require fertility uses hormonal therapy or conservative surgical method while those old patients which do not require fertility uses radical surgical intervention -- complete cervicectomy with resection of other female organs. The traditional chinese medicine (TCM) studies categorized endometriosis as zheng jia (lump in abdomen) and tong jing (menstrual pain). The main pathological changes is bruise, the main pathological secretion is bruise blood clot of menstrual blood which stays in nodules and turns into lump. Therefore, the TCM treatment principle will be invigorating the blood, eliminating of bruise and nodules. Some said that the weak kidney is the main internal pathological reason (sex hormonal disturbances), so treatment is done by invigorating kidney as well as the blood and eliminating bruise. Usually, bruise is formed due to stagnant and accumulation of Qi (energy) as a result of weak spleen, liver and kidney; it may also cause by external factor such as cold, moist, heat accumulation or stagnant or struggling among them. Qi stagnant causes bruise, clinically resemble by menstrual pain. When there is decreased of liver s regulation, weak spleen and kidney with struggle between moist and heat, these will resulted in menstrual irregularities and infertility.Clinical treatment resultThere were 256 cases adopted TCM; 210 cases completely recovered (all symptoms disappeared), 25 cases shown effectiveness (basically symptoms disappeared, diminishing of pathological area, pressing pain disappeared, or pregnancy in infertile patients), 21 cases turned out better (improved and stabilized of symptoms). Total efficiency 100%.