ENDOMETRIOSIS

GENERAL

Clinical Manifestations	Endometriosis, defined by the presence of viable endometrial tissue outside the uterine cavity, is among the most common gynecologic disorders affecting women of reproductive age.
Treatment Principle
Herb Formulas	For uterine bleeding due to Deficiency: Jiao Ai Tang
Points	For Cold: 1. Moxa or moxa needle REN-3, REN-4, REN-6, SP-6 2. Moxa or moxa needle SP-1, SP-8, SP-9

SPLEEN YANG DEFICIENCY

Clinical Manifestations	Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale C: Thin and white P: Deep and weak
Treatment Principle	Warm the Center Dispel Cold.
Herb Formulas	Fu Zi Li Zhong Tang With constipation: Wen Pi Tang Chinese patent medicines: Fu Zi Li Zhong Wan
Points	Warm-needle UB-20, LIV-13, SP-3, SP-5, SP-6, ST-36, REN-12

SPLEEN AND STOMACH DEFICIENCY COLD

Clinical Manifestations	Chronic, intermittent, dull abdominal pain which is better with warmth and pressure and ingesting warm fluids Waxy, pale or sallow lusterless complexion Anorexia (maybe with vomiting) Easily satiated Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations relieved by warmth Intolerance of Cold Cold limbs Feeling chilled Lethargy Fatigue Mental fatigue Depression Low spirits Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale maybe swollen C: White or Thin and white or White and greasy P: Deep, thready and forceless or Deep and weak or Thready and weak
Treatment Principle	Warm the Middle Jiao Strengthen the Spleen and Stomach
Herb Formulas	Fu Zi Li Zhong Tan Xiao Jian Zhong Tang Li Zhong Tang Chinese patent medicines: Li Zhong Wan With Kidney Yang Deficiency: Jin Kui Shen Qi Wan With Qi and Blood Deficiency: Shi Quan Da Bu Wan
Points	Moxa or moxa needle KI-3, LI-11, REN-4, REN-6, REN-7, REN-12, SP-4, SP-6, ST-25, ST-30, ST-36 With nausea: + PC-6 With severe pain or diarrhea : + strong moxa REN-8 Ear: Abdomen, Large Intestine, Small Intestine, Stomach,Spleen, Shenmen, Adrenal, Sympathetic

COLD STAGNATION IN THE LIVER CHANNEL

Clinical Manifestations	Swelling and pain in scrotum as if testicles were being pulled downward or Swollen or distended testicles or Contractions and cold sensations of scrotum which are alleviated by warmth Pain, distention, fullness and cold sensation in lower abdomen Cold limbs Dislike of cold and preference for warmth Lower abdominal pain radiating to the testicles May be localized sensation of Cold Menstrual pain and hardness Hypochondriac pain Abdominal pain Mobile abdominal masses Flank pain Leukorrhea T: Pale C: White or White and greasy P: Deep and slow or Wiry and tight or Deep and wiry or Slow or Deep and Excess
Treatment Principle	Warm the Liver Dispel Cold.
Herb Formulas	Tian Tai Wu Yao San Nuan Gan Jian
Points	Moxa or moxa-needle REN-4. SP-6, LIV-1

LIVER AND GALL BLADDER DAMP-HEAT

Clinical Manifestations	Yang jaundice (sclera and skin bright yellow) Pain and fullness in ribs on both sides Maybe pain in the right hypochondrium Bitter taste in mouth Nausea Vomiting sour and bitter fluids Anorexia Maybe alternating chills and fever Concentrated, dark urine Abdominal distention Yellow vaginal discharge with foul smell Pruritis vulvae T: Pink C: Yellow and greasy or sticky P: Wiry and rapid or Slippery and rapid
Treatment Principle	Clear Dampness Purge Heat from Liver and Gall Bladder
Herb Formulas	Long Dan Xie Gan Tang
Points	Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48

LIVER AND SPLEEN DEFICIENCY WITH BLOOD STAGNATION DUE TO DAMPNESS

Clinical Manifestations	Continuous cramping pain in the abdomen Pain is not severe Pain is relieved by pressure Edema of the feet Urinary difficulty Slight edema (primarily of the lower limbs) Symptoms generally occur during pregnancy Pale face Fatigue Heaviness of head Lassitude Lower abdominal pain Dizziness Tinnitus Lumbago Edema Abdominal pain with edema during pregnancy due to Blood Deficiency and abnormal water circulation Oliguria	Palpitations Cold feet Extreme coldness of the hands and feet Vertigo Weakness and numbness of lower back and legs during pregnancy or postpartum Mal position of the fetus Dysmenorrhea Irregular menstruation Right upper quadrant pain Hepatomegaly Anemia Lack of energy Sore back Thirst with no desire to drink T: Pale or pink maybe petechiae on margin C: Thin or Greasy white P: Deep and weak or Soft, floating, small and slow or Wiry and small or Wiry and rough
Treatment Principle	Nourish Liver Blood Soften the Liver Spread Liver Qi Strengthen the Spleen Resolve Dampness
Herb Formulas	Dang Gui Shao Yao San
Points

KIDNEY YIN DEFICIENCY WITH EMPTY FIRE RISING LEADING TO BLOOD STAGNATION

Clinical Manifestations	Pain in the lower abdomen and pelvic region Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Scanty dark colored menstrual Blood with small clots Low back, knees and legs painful and weak Foot pain Light-headedness Vertigo Tinnitus Diminished hearing Five sole Heat Chronic dry, sore throat Toothache Wasting and thirsting disorder (Xiao Ke) Dizziness Muscular weakness Dry skin Deafness Steaming bones Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation	Lower abdominal pain during menstruation Low back pain Painful urination during menstruation Sometimes no symptoms at all Tidal fevers Loose teeth Dripping urine Thirst Dry tongue Numbness and weakness at the waist and knees Heel pain Dry mouth Dry throat Blurred vision Urinary incontinence Spontaneous and nocturnal emissions Night sweats Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies T:Red or Purple or Purple spots C: Little or none P: Thready and rapid or Choppy
Treatment Principle	Nourish Yin Clear Deficiency Fire
Herb Formulas	Endometriosis #6
Points

KIDNEY YANG DEFICIENCY WITH WATER FLOODING

Clinical Manifestations	Edema of whole body particularly at and below the waist Pitting edema Low back pain, aching and heaviness Abdominal distention with full sensations Oliguria Cold limbs Face gray and congested or pale Feeling nervous and cold with mental weariness In severe cases: Ascites T: Pale and swollen C: Thin, white or Thick, white and sticky P: Deep and thready With Water Flooding the Lungs: Cough with copious, thin watery phlegm Asthma with phlegmy sound (wheezing) Dyspnea Facial edema Edema of limbs Dysuria T: Pale and swollen C: White and moist or White and greasy P: Superficial and tight
Treatment Principle	Warm Kidneys Promote diuresis
Herb Formulas	Zhen Wu Tang
Points	KI-7, REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23, UB-39

KIDNEY YANG DEFICIENCY WITH BLOOD STAGNATION

Clinical Manifestations	The origin of this pattern is either a constitutional weakness, or a history of surgical procedures Pain in the lower abdomen and pelvic region before, during and after menstruation Tenderness and nodulation in the posterior fornix or isthmus of the uterus Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation	Lower abdominal pain during menstruation Menorrhagia Painful urination during menstruation Low back pain Sometimes no symptoms at all Abdominal tenderness A feeling of pressure and pain during or after periods Soreness of the back, legs, and hips Dizziness Scanty periods or spotting Blood clots with periods Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety T: Pale or with spots C: Thin and white P: Deep, thin and choppy
Treatment Principle	Nourish Kidney Yang Invigorate the Blood Eliminate Stasis
Herb Formulas	Gui Shen Wan + Tao Hong Si Wu Tang Wen Jing Tang Sheng Hua Tang Without Yang Deficiency: Endometriosis #10 From the end of menstruation to ovulation: Yun Fang Yi Hao + Nei Yi Fang San Hao From the end of ovulation to premenstruation (3-7 days): Yun Fang Er Hao + Nei Yi Fang San Hao From premenstruation through menstruation: Nei Yi Fang Yi Hao With lower abdominal pain and incessant bleeding:Nei Yi Fang Er Hao
Points	LI-11, REN-6, REN-17, SP-10

QI DEFICIENCY WITH BLOOD STAGNATION

Clinical Manifestations	The origin of this pattern is chronic illness or weakness. Pain in the lower abdomen and pelvic region Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Low back pain Painful urination during menstruation Sometimes no symptoms at all Periods that are either heavy or scanty, with light-colored, watery menses Sometimes no symptoms at all A preference for warmth	Feels better with pressure on the abdomen or Dislikes pressure Large clots Fatigue Bloating Heavy pressure on the anus A "dropping" sensation of the anus Soft bowel movements A pale complexion Lethargy Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies T: Pale and Swollen with teethmarks and/or Purple C: White P: Deep, thin and weak or Thin, soft and weak
Treatment Principle	Nourish Qi to move Qi and Blood
Herb Formulas	Bu Yang Huan Wu Tang Huang Qi Jian Zhong Tang modified
Points	Du-20, REN-6, UB-20, ST-36, UB-32, Zigong, GB-36 With a heavy painful anus: DU-1

QI STAGNATION LEADS TO BLOOD STAGNATION

Clinical Manifestations	The origin of this pattern lies in emotional stress and anxiety. Pain in the lower abdomen and pelvic region Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Sometimes no symptoms at all Painful urination during menstruation	Low back pain Abdominal tenderness Pressure and pain before or during periods Breast distention before periods Distending pain under the rib cage before periods Aversion to pressure on the abdomen Blood clots with periods The pain is relieved after the periods Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies T: Dark purple with spots C: Thin and white P: Wiry and choppy
Treatment Principle	Circulate Qi Activate the Blood
Herb Formulas	Xue Fu Zhu Yu Tang Ge Xia Zhu Yu Tang Si Ni San + Ge Xia Zhu Yu Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	Pain that is fixed, stabbing and /or severe or Pains that move around Distending sensation of the breasts and abdomen Depression Irritability Pan is worse with pressure Dark complexion Fixed, palpable masses Bleeding with clots Purple lips Purple nails Dry skin Blue, dark or purplish discoloration of the skin in small or large areas Varicose and spider veins Cold hands and feet Lower abdominal pain before, during and after menstruation which may be severe Tendency to hemorrhage dark blood or clots T: Dark or Purple, possible purple or red spots Red purple if there is Heat Blue purple if there is Cold C: White P: Choppy or Wiry and choppy
Treatment Principle	Activate the Blood Break up Stagnation
Herb Formulas	Endometriosis #9 With Qi Stagnation predominant: Si Ni San modified With Blood Stagnation predominant: Tao Hong Si Wu Tang modified Tong Jing Fang Shi Xiao San
Points	GB-40, GB-41, LIV-3, LIV-14, PC-6, SJ-6, SP-6, SP-10, ST-36, UB-17, UB-18, UB-40 LIV-3, REN-6, SP-6, ST-25, ST-29

QI AND BLOOD DEFICIENCY WITH BLOOD STAGNATION

Clinical Manifestations	Patches of endometrial tissue that are normally found only in the uterine lining grow the uterus, usually in the abdominal cavity (ovaries, uterine ligaments, intestines, ureters , bladder, vagina, surgical scars ) It may appear in other parts of the body (chest lining, brain). It quite commonly is attached to the outside of internal organs and most often adheres to the ovaries and uterine ligaments. This tissue still keeps the same traits it would have if it still were present inside the uterus; grows and builds mid cycle, and bleeds during menstruation. This causes pain of varying degrees in different women. When this continues for some time, the misplaced tissue may cause scarring that leads to an adhesion of internal surfaces The origin of this pattern is chronic illness or weakness. Pain in the lower abdomen and pelvic region Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Low back pain Painful urination during menstruation Sometimes no symptoms at all Periods that are either heavy or scanty, with light-colored, watery menses Sometimes no symptoms at all A preference for warmth Feels better with pressure on the abdomen or Dislikes pressure Large clots Fatigue Bloating Heavy pressure on the anus A "dropping" sensation of the anus Soft bowel movements A pale complexion Lethargy Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies T: Pale and Swollen with teethmarks and/or Purple C: White P: Deep, thin and weak or Thin, soft and weak
Treatment Principle	Tonify Qi Nourish the Blood Invigorate the Blood Break up Stasis
Herb Formulas	With Qi Deficiency predominant: Huang Qi Jian Zhong Tang With Blood Deficiency predominant: Dang Gui Jian Zhong Tang With Cold complications: Fu Zi Li Zhong Wan With Qi Deficiency fever during menstruation: Bu Zhong Yi Qi Tang
Points

BLOOD DEFICIENCY WITH BLOOD STAGNATION

Etiology	Patches of endometrial tissue that are normally found only in the uterine lining grow the uterus, usually in the abdominal cavity (ovaries, uterine ligaments, intestines, ureters , bladder, vagina, surgical scars ) It may appear in other parts of the body (chest lining, brain). It quite commonly is attached to the outside of internal organs and most often adheres to the ovaries and uterine ligaments. This tissue still keeps the same traits it would have if it still were present inside the uterus; grows and builds mid cycle, and bleeds during menstruation. This causes pain of varying degrees in different women. When this continues for some time, the misplaced tissue may cause scarring that leads to an adhesion of internal surfaces
Clinical Manifestations	Pain in the lower abdomen and pelvic region Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Low back pain Painful urination during menstruation Sometimes no symptoms at all Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies
Treatment Principle	Nourish and Invigorate the Blood
Herb Formulas	Tao Hong Si Wu Tang Si Wu Tang modified Endometriosis #2 modified Si Wu Tang Jian Wei Dang Gui Jian Zhong Tang Xue Beng Fang
Points

BLOOD STAGNATION

Clinical Manifestations	Pain in the lower abdomen and pelvic region Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Low back pain Painful urination during menstruation Sometimes no symptoms at all Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies T: Purple or Purple spots C: Normal P: Choppy
Treatment Principle	Invigorate the Blood Dispel Stasis
Herb Formulas	Shi Xiao Gui Jie Tang Nei Yi Wan #1 Endometriosis #1 Zhe Chong Yin Shao Fu Zhu Yu Tang Xue Fu Zhu Yu Tang modified Ge Xia Zhu Yu Tang Gui Zhi Fu Ling Wan modified Shi Xiao San Endometriosis #8 With Phlegm Stagnation: San Jie Fang Endometriosis #2 Endometriosis #3 use just before menstruation Endometriosis #5 use between periods Di Dang Tang Dai Di Dang Wan modified For cyclical hematemesis: Xue Fu Zhu Yu Tang modified For cyclical hematemesis with Heat: Da Huang Huang Qin Xie Xin Tang For cyclical hematemesis with Deficiency Cold: Huang Tu Tang Rectal enema: Rectal Enema #1 For rectal administration: San Jie Zhi Tong Tang
Points	For hematemesis: Ahshi points, PC-4, PC-6, REN-12, SP-4, SP-10, ST-21, UB-17, UB-21 With severe pain: LI-4, LIV-5 With irritability or depression: + LIV-1, Yintang or LIV-3 Ear: Stomach, Duodenum, Large Intestine, Small Intestine, Liver, Adrenal, Subcortex, Shenmen

BLOOD STAGNATION DUE TO COLD

Clinical Manifestations	A history of exposure to Cold, either cold temperatures, or the habitual consumption of cold foods, especially during menstruation. Cold pain in the lower abdomen and pelvic region before, during or after menstruation Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Painful urination during menstruation Fatigue Tenderness and nodules in fornix and isthmus of the uterus	Abdominal swelling Aversion to Cold Cold limbs Low back pain Sometimes no symptoms at all Abdominal tenderness Pressure and pain before or during periods A preference for warmth Blood clots with periods The pain relieved after the periods Pale complexion Nausea or vomiting with severe menstrual pain Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies T: Pale and purplish with spots C: White P: Wiry and tight
Treatment Principle	Invigorate the Blood Break up Stasis Warm Cold
Herb Formulas	Zhe Chong Yin Yang He Tang Nei Yi Wan Liang Fang Wen Jing Tang Endometriosis #11 For Excess Cold: Shao Fu Zhu Yu Tang
Points	Heavy moxa on REN-1, REN-4, REN-6, REN-8, GB-26, ST-25, KI-12

BLOOD STAGNATION DUE TO COLD-DAMPNESS

Clinical Manifestations	Pain in the lower abdomen and pelvic region Heavy and/or irregular periods Spotting between periods or before periods Infertility Difficulty conceiving Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Low back pain Painful urination during menstruation Sometimes no symptoms at all Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia Anxiety Susceptibility to infections and allergies
Treatment Principle
Herb Formulas	Shao Fu Zhu Yu Tang Zhe Chong Yin
Points

COLD AND BLOOD STAGNATION IN THE CHANNELS

Clinical Manifestations	Abdominal pain with icy cold hands and feet Extremities are cyanotic and difficult to warm up P: Thready or Imperceptible
Treatment Principle	Warm the channels Disperse Cold Nourish the Blood Unblock the channels
Herb Formulas	Dang Gui Si Ni Tang
Points

BLOOD STAGNATION DUE TO HEAT

Clinical Manifestations	The origin of this pattern is a history of genital infections. Pain in the lower abdomen and pelvic region Pain may be relieved by Cold Heavy and/or irregular periods Spotting between periods or before periods Pain during sexual intercourse Abdominal swelling Painful bowel movements, especially during menstruation Bleeding from the rectum during menstruation Lower abdominal pain during menstruation Low back pain during menstruation Painful urination during menstruation Abdominal tenderness, pressure, pain, and fever before, during, or after periods (the more severe the pain, the higher the fever)	Difficulty conceiving Sometimes no symptoms at all Infertility Irregular menses A preference for cold temperatures Dislikes pressure Large clots Heat shows more during menstruation Trichomonas infection A bitter taste in the mouth Thirst A dry throat Constipation Anxiety Anger Other symptoms may include: Headaches Low grade fevers Depression Hypoglycemia T: Red or Red tip or Purple spots on the sides of the tongue C: Thin and yellow P: Wiry and rapid
Treatment Principle	Clear Heat Nourish Yin Invigorate the Blood Dispel Blood Stasis
Herb Formulas	Shao Fu Zhu Yu Tang Xue Fu Zhu Yu Tang Zhe Chong Yin Endometriosis #7 For dysmenorrhea with fever: Xiao Chai Hu Tang + Gui Zhi Tang For abdominal pain with Heat in the Stomach and Intestines and constipation: Tao He Cheng Qi Tang For long duration: Wu Mei Wan With Damp-Heat: Nei Yi Wan #2
Points	LI-11, SJ-6, UB-17, SP-6, SP-10, Zigong, LIV-5, REN-1 LI-4, LIV-2, SP-10, ST-25, ST-29

YANG DEFICIENCY WITH COLD STAGNATION

Clinical Manifestations	Localized painful swellings without a head that bleed into the surrounding tissues and do not affect the color or texture of the skin The swellings are not hot to the touch No thirst Swollen and painful joints Wasting of the muscles of the thigh and calf T: Very pale or Pale-pink C: White P: Thready and forceless or Deep and slow
Treatment Principle	Warm the Yang Tonify the Blood Disperse Cold Eliminate Stagnation
Herb Formulas	Yang He Tang modified
Points

COLD ACCUMULATION IN THE UTERUS

Clinical Manifestations	Lower abdominal pain and coldness Pain alleviated by warmth and pressure Irregular menstruation Dysmenorrhea Purple or clotted menstrual Blood Infertility or This type of pain during the second or third trimester T: Normal C: White P: Retarded
Treatment Principle	Warm the uterus Supplement the Blood Calm the fetus if necessary
Herb Formulas	Ai Fu Nuan Gan Wan
Points	Moxa or moxa needle REN-4, REN-6, SP-6, needle SP-10, ST-30

POSTPARTUM COLD AND BLOOD STAGNATION

Clinical Manifestations	Fixed lower abdominal pain in postpartum women Incomplete expression of the placenta Continual discharge of purple clotted lochia T: Pale-purple
Treatment Principle	Activate the Blood Break up Stasis Warm the Uterus Stop pain
Herb Formulas	Sheng Hua Tang
Points

DEFICIENCY COLD OF THE CHONG AND REN CHANNELS

Clinical Manifestations	Mild persistent uterine bleeding Irregular menstruation (either early or late) Prolonged menstruation Skipped period Metrorrhagia Extended or continuous menstrual flow Pain Lower abdominal distention Lower abdominal Cold Lower abdominal pain Infertility Dry lips Dry mouth Spermatorrhea Pale complexion Leukorrhea Amenorrhea Bleeding between periods Low grade fever at dusk Irritability Five sole Heat No desire to drink Distending breast pain Low back coldness and pain Loose stools Cold limbs Aversion to Cold T: Purple with petechiae P: Thready and choppy
Treatment Principle	Warm the menses Regulate menstruation Dispel Cold Warm the channels Nourish the Blood Dispel Blood Stasis
Herb Formulas	Wen Jing Tang Xiong Gui Jiao Ai Tang For incessant bleeding: Nei Yi Fang Er Hao
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ENDOMETRIOSIS

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