Endometriomas – Chocolate Cysts – In Traditional Chinese Medicine Perspective

I. Definition

Traditional Chinese medicine defines ovarian cyst is a medical condition caused by excess- dampness (caused by blood and fluid stasis) accumulated in the abdomen and gradually coalesces into phlegm, that can manifest as lumps and masses of various kinds, including chocolate cysts, leading to menstrual blood stasis in the ovaries (similar to the retrograde theory in Conventional medicine) attaching to the surface of ovaries and becomes endometriomas/chocolate cysts.

II. Symptoms of endometriomas -chocolate cysts

There is ONLY A SMALL difference between traditional Chinese medicine and conventional medicine when comes to symptoms of endometriomas
1. Progressively increasing menstruation cramps and pain
They are caused by contractions of uterine muscles as resulting of over production of certain hormones of the prostaglandins family from the endometriomas, as her periods become more painful or that the pain begins earlier or lasts longer.

2. Pain during intercourse
The penetration motion of the penis can produce pain in an ovary bound by endometrial implants or adhesion.

3. Severe period pain
It normally happens with over-production of prostaglandins and leukotrient causing the cervix to contract resulting in no escape for the menstrual period.

4. Difficult to get pregnant
If the cyst is presented in the ovary, it will respond to hormone changes in the menstrual cycle causing the cysts to get large every month blocking the normal function of ovaries resulting in infertility.

5. Pain elevate to ward the end of period.
Since the blood cannot escape, it retents in our body causing damage to the organs or any part of the body hosting the endometriosis resulting in severe pain toward the end of the period.

9. Pain in one side of pelvic
Pain on one side of the pelvic during menstrual cycle may be caused by endometrial implants or adhesion to that side of the ovary as a result of blood stagnation.

10. Added on symptoms according to traditional Chinese medicine

a) Pale tongue

b) Fatigue

c) Poor appetite

d) Loose stool

e) Pale face

f) Sweating with little exertion

g) Etc.

III. Causes of endometriomas-chocolate cysts

1. Stress

Since liver is opened to the spirit factors, prolonged period working or living in high stress environment will cause abnormal function of liver in moving blood in the vessels as a result of qi stagnation, leading to blood stasis in the abdomen cavity, including the ovaries.

2. Spleen

Spleen is a vital organ in absorbing food essence and distributing qi and fluid to body organs. If for what ever reason (due to prolong period intake of raw and cold food or working in cold environment, etc.), causing deficiency of kidney in fluid distribution and lung and liver qi in moving blood in the vessels, leading to fluid retention and blood stagnation.

3. Kidney

As kidney no longer received enough qi to move fluids up to nourish the body organs and qi upward, it causes fluids accumulated in the admen, leading to pathogen of excess -dampness, resulting in heat being generated, leading to phlegm, the major causes of lumps and cysts.

4. Liver

If liver function in blood formation and transporting blood to the heart vessels are distorted due to liver qi stagnation, then blood can not move freely and smoothly through the blood vessels, leading to blood stagnation.

5. Lung

Lung receives food qi from the spleen and combines it with air that we breath in to form the lung qi to circulate in all channels in the body. If spleen is weak, it causes weakened lung qi in assisting the liver in moving blood and kidney in moving fluid to the entire body, leading to liver qi and blood stagnation and fluid retention.

IV. Treatments

A. Spleen qi deficiency

A.A. With Chinese herbs

1. Mu Gua (Quince fruit)
Besides helping to increase spleen function in food digestion, it increases the kidney function in qi and fluids regulation, thereby, reducing the dampness accumulated caused by kidney qi stagnation and preventing its the moving downward tendency, causing abdominal pain and spasms during menstrual cycle.

2. Chen Pi (Tangerine peel)
Chen pi is Spleen and kidney tonic herb. It presentation besides improves the Spleen qi function moving downward, thereby, reducing spleen stagnation causes of abdominal distention, fullness, bloating and digestive disorder, it also increases of the function to dry dampness, thus decreasing the kidney congestion, leading to coughs with stifling sensation in the chest.

3. Zhi Shi (Immature bitter orange)
Zhi shi has been used for thousand of years in traditional Chinese medicine in treating qi stagnation in kidney caused by accumulated of phlegm due to kidney deficiency, thereby reducing the dampness causes of abdominal cramps and pain and distention. Since it cool in nature, it helps to improve the abdominal pain and constipation caused by accumulation and stagnant qi.

A.B. With Acupuncture

Suggested acupuncture points

1. CV12 (Zhong wan)

2. ST 36 (Zu xan li)

3. SP6 (San jin jiao)

4. SP3 (Tai bai)

5. UB20 (Pi shu)

6. UB 21 (Wei shu)

7. Etc

A.C. With Foods

1. Whole grains

2. Asparagus

3. Cabbage,

4. Eggplant

5. Apple

6. Cherry

7. Black sesame seeds

8. Tofu

9. Beef,

10. Chicken

11. Tuna

12. Etc.

B. Lung qi deficiency

B.A. With Chinese herbs

1.Ren shen (Ginseng)
Ren shen is considered as one of most powerful herbs in strengthening the original qi in the body. In lung, it enhances the lung qi by moistening the channels, thus reducing the symptoms of asthma, dry cough and preventing the rebellion qi causes of menstrual cramps and pain.

2. Xi yang shen (American ginseng)
Xi yang shen is yin in nature, besides promoting the lung and spleen qi, it also increases the digestive system in absorbing vital energy and reducing the heat causes of qi stagnation by moistening the all qi transportation channels, especially for qi stagnation caused by deficiency of yin.

3. Dang shen (pilose asiabell root)
Dang shen is a spleen and lung tonic herbs. It improves the lung function in moving qi smoothly through its channels and spleen function in absorbing qi after foods entering the stomach. It also helps to restore the qi which is damaged by heat caused by infection, inflammation or heat generated due to excessive fluids accumulation.

4. Tai zi shen (pseudostellaria root)
Besides helping to increase the spleen and lung qi, it also improve the blood transportation and spleen and stomach in absorbing vital energy for our body cells and generates fluids to prevent the heat causes of qi stagnation.

B.B. With Acupuncture

Suggested acupuncture points

1. BL13 (Fei shu)

2. CV6 (Qi hai)

3. LU1 (Zhong fu)

4. LU9 (Tai yuan)

5. ST36 (Zu san li)

7. BL20 (Pi shu)

8. CV12 (Zhon guan)

9. Etc.

B.C. With Foods

1. Whole grains

2. Oats,

3. Roasted barley

4. Sweet rice

5. Pumpkin

5. Potatoes

6. Taro root

7. Squash

8. Carrots

9. Corn

10. Etc.

C. Kidney qi deficiency

C.A. With Chinese herbs

1. Rehmannia glutinosa (shu li huang)
Rehmannia glutinose besides has been used in traditional Chinese medicine in treating kidney disorder, it also helps to restore the balance of yin and yang qi of the kidney resulting in increasing the kidney function in fluid distribution and promoting healthy reproductive organs.

2.Morinda root ( ba ji tian)
Morinda root besides is used in traditional Chinese medicine in improving the kidney abnormal function caused kidney yang qi deficiency, thus enhancing the immune system and promoting sexual desire.

3. Cuscuta (tu si zi)
Cuscuta is a kidney and livertonic medicine, besides helping to tonify the kidney fluid distribution through urinary secretion, it also maintaining the strong the liver qi flow, thereby decreasing the risk of blood stagnation and water retention causes of weight gain and menstrual cramps and pain.

4. Cinnamin bark (rou gui)
Cinnamin bark is qi tonic herb and hot in nature, besides helping the liver in maintaining the smoothing qi flow to the entire body, it also promotes the kidney yang qi circulation and healthy adrenal gland.

5. water plaintain root (ze xie)
Water plantain root helps to release the kidney qi stagnation and improves the kidney in water metabolism, resulting in lessening the symptoms of water retention and weight gain.

C.B. With Acupuncture

Suggested acupuncture poimts

1. BL23 (Shen shu)

2. BL25 (Da chang shu)

3. BL 52 (Zhi shi)

4. DU4 (Governing meridian 4)

5. REN4 (Conception meridian 4)

6. REN6 (Conception meridian 6)

7. KD3 (Tai xi)

8. BL60 (Kun lun)

9. Etc.

C.C. With Foods

C.C.1. Kidney yin deficiency
a) String beans
b) Celery
c) Parsley
d) Grapes
e) Plum
f) Berries
g ) Sea salt
h) Etc.

C.C.2. Kidney yang deficiency
a) Onion
b) Radish
c) Pistachio nuts
d) Walnuts
e) Leek
f) Shrimp and lobster
g) Black pepper
h) Wheat germ
i) Etc.

D. Liver qi and blood stagnation

D.A. With Chinese herbs

1. Angelica (Dong quai)
Angelica is a queen herb for women reproductive tonic, it has been used in traditional Chinese medicine in treating all women productive disorder, including
a) Increasing the liver in blood formation
b) Reducing liver blood stagnation caused over production of certain hormones
c) Releasing the qi stagnation including pre menstrual syndrome.
d) Phytoestrogen
The plant types weak estrogen helps to occupy the estrogen receptor sites, thus improving the liver function in regulating the prostaglandins hormones resulting in lessening the menstrual cramps and pain.

2. Milk thistle seed
Milk thistle seed is a liver tonic herb, besides helping to to restore the qi stagnation caused by environment toxins, it also improves the liver function in blood and qi function by regenerating the liver’s cell.

3. White pony ( bai shao)
White pony is a blood tonic herbs, besides helping to improve the liver function in blood formation, thus reducing the menstrual cramps and pain caused blood deficiency,it also promotes liver yin and yang balancing by calming liver yang and preserving yin.

4. Fennel seed ( xiao hu xiang)
Fennel seed besides help to release the stagnation caused by imbalance of yin yang qi in the liver, it also helps to improve the function of abdominal organ resulting in lessoning the symptoms of menstrual cramps and pain.

5. Yellow dock root
Yellow dock root is a liver tonic medicine, besides helping to detoxify liver by removing any harmful substances accumulated in the liver, it improves the liver function in regulating the production of hormones before and after ovulation.

D.B. With Acupuncture

Suggested acupuncture points

1. BL18 (Gan shu)
2. CV12 (Zhong guan)
3. CV17 (Shan zhong)
4. SP4 (Gong sun)
5. ST36 (Zu san li)
6. BL15 (Xin shu)
7. CV14 (Ju que)
8. LR3 (Tai Chong)
9. Etc.

D.C. With Foods

D.C.1. Liver qi stagnation

a) Tofu
b) Mustard seed
c) Squash
d) Sweet potato
e) Red and black date
f) Rice
g) Caraway seed
h) Mushroom
i) Etc.

D.C.2. Liver blood stagnation
a) Leek
b) Chestnut,
c) Rosemary
d) Cayenne
e) Ginger
f) Cayenne
g) Eggplant
h) White pepper

i) Etc.

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