Gynaecological disorders include endometriosis, infertility, dysmenorrhea, abnormal uterine bleeding, premenstrual syndrome, menopausal syndrome, uterine fibroids, chronic pelvic inflammation and polycystic ovarian syndrome (PCOS).
1. Endometriosis
One of the most prevalent gynecologic conditions affecting women of reproductive age is endometriosis, which is characterized by the presence of viable endometrial tissue outside the uterine cavity. Based on the traditional Chinese medicine philosophy, blood stasis is the cause of endometriosis. As a result of blood stasis, the lower body becomes overheated and experiences a fire syndrome. Blood stasis and heat buildup are the primary pathologic changes in endometriosis patients, as the majority experience pelvic inflammation symptoms.
Acupuncture and Chinese herbal medicine have shown promising results in the treatment of endometriosis. A Chinese herbal remedy with the primary ingredient Radix ec Rhizoma Rhei was used to treat 76 individuals with endometriosis in a clinical study, and the overall success rate was 80.26%. In a different clinical research, 46 endometriosis patients were successfully treated with a total effective rate of 91.3% using the therapeutic concepts of phalange resolution, softening, resolving the lump, and eliminating blood stasis. Chinese medicinal herbs have also demonstrated satisfactory curative effects for patients with post-operational relapsed endometriosis. The application of Yiweining (YWN) to prevent the post-operational recurrence of endometriosis was found to be safe and effective, with an efficacy comparable to that of gestrinone (GT). The study monitored the clinical efficacy and safety of both YWN and GT in treating post-operative patients with stage III endometriosis. The recurrence rates in the YWN group and the GT group were 5.0% and 5.3%, respectively, indicating an insignificant difference between the two groups. Additionally, the adverse reaction rate in the YWN group was lower than that in the GT group. Additionally, endometriosis can be effectively treated with acupuncture. The Shu-Mu acupoints combination group outperformed the other two groups in improving dysmenorrhea, irregular menstruation, lumbago and sacrodynia, and anus engorge. These findings were made in a clinical study comparing the therapeutic effects of using Shu-Mu acupoints in combination with Western medicine treatment and routine needling methods on patients with endometriosis. Additionally, there was a significant drop in the serum CA125 levels in the Shu-Mu acupoints combination group.
2. Primary dysmenorrhea
One typical menstruation problem is primary dysmenorrhea (PD). It is typified by lower abdominal cramps that are followed by tremulousness, headaches, nausea, vomiting, diarrhea, and sweating. With normal pelvic anatomy, all these symptoms typically manifest at the onset of the menstrual cycle. In Australia, PD affects between 45% and 95% of adolescents and young adults who are of reproductive age. This is because the condition's symptoms are subjective and there are multiple diagnostic criteria to choose from. The burden of PD is growing more than that of any other gynecological complaint due to the rise in the number of working women in society and their significant effects on productivity. PD has caused extensive personal and public health problems.
Non-steroid anti-inflammatory drugs (NSAIDs) are still recommended as the first-line treatment for Parkinson's disease (PD) women who do not desire to use birth control. The preferred second-line treatment for individuals in need of contraception is combined oral contraceptives (COCs). However, the common drawbacks of the medications that are currently on the market are their unavoidable side effects and need for periodic dosage. Thus, the field of complementary and alternative therapies for Parkinson's disease has been increasingly appealing.
The reports indicated a clear benefit in terms of pain relief from acupuncture and Chinese herbal medicine (CHM). According to conventional Chinese medicine, dysmenorrhea arises from the accumulation of cold, dampness in the uterine collaterals, which can be brought on by drinking cold beverages, being outside in the rain, or wading. When there is a cold invasion, the blood coagulates, causing the uterine collateral to become unsmooth and frozen and then stagnate, which causes pain. Therefore, warming meridians, spreading cold, and eliminating dampness should be the main therapeutic focuses for dysmenorrhea. Si-Wu-Tang, for example, is a basic prescription in traditional Chinese medicine that is usually taken as a blood-supplementing decoction. Research has shown that it can stimulate blood production, improve blood circulation, control menstruation, and reduce menstrual pain. The mechanism of action of acupuncture, which is superior to Somiton tablets in treating primary dysmenorrhea, may be through controlling the levels of prostaglandin F2 in menstrual fluid. Treatment for dysmenorrhea with acupuncture has been used at acupoints like Taixi and Gongsun, particularly for subjects who are not recommended or cannot take oral contraceptives. In a randomized trial, acupuncture for dysmenorrhea patients was found to be more cost-effective within normal bounds and to improve pain and quality of life when compared to treatment with standard care alone.
3. Abnormal uterine bleeding
In women of all ages, from adolescence to menopause, abnormal uterine bleeding (AUB) is frequent. In Australia, 10-15% of women report experiencing AUB symptoms at some point in their lives. Women's' quality of life and level of activity are also adversely affected by AUB, which has a detrimental effect on health by causing anemia. TCM states that weak constitutions, insufficient kidney Qi, ineffectiveness of the Chong and Ren meridians in regulating menstruation, and excessive sexual activity and multiparity that deplete kidney Qi are the main causes of abnormal uterine bleeding. The length of the illness as well as the quantity, color, and texture changes of the bleeding in relation to the tongue and pulse conditions should be taken into consideration when differentiating the syndrome. Besides, age is also an important factor to be taken into consideration. Insufficiency of kidney Qi, for instance, is typically the cause of puberty patients; liver stagnation and blood heat, on the other hand, are common causes of childbearing age patients; and spleen or liver Qi deficiency, or lack thereof, is the cause of perimenopausal patients.
Clinical trials have provided evidence in favor of the therapeutic effects of CHM for AUB. For instance, the Gong-Fu mixture, a Chinese medicinal formula, is effective in the prevention and treatment of prolonged bleeding.
4. Premenstrual syndrome
PMS, also known as premenstrual syndrome, is a clinical syndrome that affects women and can cause symptoms related to the menstrual cycle. Usually starting five to eleven days prior to the onset of menstruation, symptoms end at that time or shortly thereafter. 95% of women report experiencing one or more premenstrual symptoms at some point in their reproductive life, indicating the prevalence of PMS. While symptoms are usually not very bad, in certain women they can be so bad that they significantly interfere with day-to-day activities. Thus, between 5% and 8% of women experience severe PMS; the majority of these women also fit the criteria for premenstrual dysphoric disorder (PMDD), a condition that is related to PMS. There is proof that PMS may be influenced by elevated levels of inflammatory markers. The cause of PMS is yet unknown.
According to TCM theory, the heart, spleen, and kidney are associated with this syndrome, which is primarily brought on by liver dysfunction. According to the clinical symptoms, this syndrome relates to the conceptions of a headache during menstruation, fever during menstruation, body pain during menstruation, edema during menstruation, diarrhea during menstruation, dizziness during menstruation, abnormal emotional changes during menstruation, and distending pain in the breasts during menstruation in TCM, generally known as symptoms before and after menstruation. PMS was also classified into excess and deficient categories by TCM. Deficits in the kidneys and spleen identify the deficit type. Qi stagnation is a hallmark of excess syndrome. The spleen, the kidney, and the liver are the viscera that are affected. Clinical syndrome differentiation should be carried out in consideration of the tongue and pulse conditions, as well as the time, place, and type of symptoms, given the complexity of clinical symptoms.
Sixty-one women were randomly assigned to two groups within different TCM patterns in a study that looked at the effectiveness of Chinese herbal medicine (CMH) for treating PMS in Australian women within the theoretical framework of TCM. After three months of treatment, there were significant differences between CHM and placebo in premenstrual psychological and physical symptoms like anger, anxiety, and depression, but not in perceived stress. These findings suggest that CHM can effectively reduce the incidence and intensity of PMS symptoms. In addition to CHM, over 20 research studies have documented the effectiveness of acupuncture in treating PMS.
5. Menopausal syndrome
Hot flashes, nocturnal sweats, irregular periods, dry vagina, depression, anxiety, palpitations, headaches, sleeplessness, low energy, difficulty focusing, and dizzy spells are just a few of the vasomotor and psychological symptoms that most postmenopausal women may encounter. Because more women are entering menopause and women's health is becoming more of a focus, management of menopausal syndrome has drawn more attention in recent years. Hormone replacement therapy (HRT) in various forms is the standard treatment for climacteric women; however, many women would rather not take HRT or are unable to do so. After an average follow-up of 5.2 years, a clinical trial called the Women's Health Initiative (WHI) was conducted in July 2002 to shed light on the pros and cons of combination hormone replacement therapy (HRT) for postmenopausal women. The results showed that a combination of progesterone and estrogen, which is commonly prescribed to postmenopausal women in the United States, increased the risk of pulmonary embolism, heart disease, stroke, and invasive breast cancer while lowering the risk of bone fractures and colorectal cancer.
TCM has been demonstrated to have few negative effects and to provide quite satisfactory relief of postmenopausal symptoms in a number of clinical and experimental studies. According to TCM theory, deficiencies in the Chong and Ren meridians, the near exhaustion of Tiangui, the decline of kidney Qi, or the insufficiency of blood and essence before and after menopause are the main causes of menopausal syndrome. Menopausal syndrome can be effectively treated by applying the kidney reinforcement principle. In a pilot study, postmenopausal women with climacteric symptoms were compared to the clinical effects of Jia-Wei Shu-Yau San (JWSYS), a traditional Chinese herbal prescription, and a continuous combined hormone replacement therapy (HRT). The results showed that JWSYS effectively relieved most menopausal symptoms with no significant differences from the HRT, and that JWSYS had a relatively lower discontinuation rate due to side effects, particularly breast tenderness and bleeding. Women who have had oophorectomy experience a significant improvement in their perimenopausal symptoms after receiving acupuncture. A randomized clinical study that treated menopausal hot flashes, sleep issues, and mood swings found that site-specific acupuncture reduced the mean monthly intensity of hot flashes in the experimental acupuncture treatment group.
6. Uterine fibroids
About 25% of Australian women of reproductive age and up to 30%–40% of women over 40 have uterine fibroids, the most common benign tumor of the female reproductive tract. Infertility, pain, pressure symptoms, irregular menstruation, and other symptoms can all be signs of symptomatic fibroids. Gonadotropin-releasing hormone (GnRH) agonists and hormonal therapies are two examples of the pharmaceutical options and surgical techniques used in current treatment. Nonetheless, there remains a risk of operative death and morbidity with surgery. GnRH agonists help reduce symptoms associated with bleeding and bulking, but they may also have serious menopausal adverse effects. Thus, safer treatment for uterine fibroids is required.
Uterine fibroids are often treated with traditional Chinese herbal medicine in China. TCM distinguishes between three patterns of uterine fibroids: Liver Qi Stagnation and Spleen Deficiency; Yin Deficiency and Empty-Fire Blazing; and Qi Stagnation and Blood Stasis. Studies revealed that Chinese herbal remedies may be able to reduce the size of oyinibroids and relieve symptoms without causing any negative side effects. According to ongoing trials, Guizhi Fuling Formula arr useful in treating uterine fibroids by decreasing the size of the uterus or fibroids. The intricate feedback loops between growth factors and sex steroid hormones control the growth of uterine fibroids. Acupuncture regulates the pituitary gland, thyroid gland system, and central nervous system without posing pharmacological risks or having long-term effects.
7. Chronic pelvic inflammation
A common condition in the female genital tract is chronic pelvic inflammation. While acute pelvic inflammation that has not been fully cured accounts for the majority of cases of chronic pelvic inflammation, some patients do not have a history of acute inflammation. The primary clinical signs and symptoms are dysmenorrhea, sterility, irregular menstruation, mild temperature, and lassitude. An examination of gynecology reveals that the appendices on both sides are frequently noticeably swollen, and that the uterus is frequently in a posterior position with restricted movement or adhering to the circumferential tissues, resulting in lump formation.
According to TCM, the main causes of chronic pelvic inflammation are dampness interweaving with heat, accumulation of heat in the liver channel, and stagnation of liver-qi, which affects the spleen. A chronic illness may cause blood clots in blood vessels, obstructing Qi and blood circulation and resulting in lumps. For mild cases with brief courses, TCM decoction works right away. For those with severe and chronic ailments, however, moxibustion and acupuncture are appropriate forms of treatment.
8. PCOS
PCOS, or polycystic ovarian syndrome, is a common disorder affecting the reproductive and metabolic systems. The most common symptoms of PCOS are hyperandrogenism, persistent anovulation, and irregular menstrual cycles. Based on the Rotterdam criteria, there is a 10% prevalence of PCOS and a 28% prevalence of polycystic ovaries. There isn't a single proven treatment for this disorder because its pathophysiology is still unknown, despite the likelihood that it has epigenetic roots. For PCOS, several pharmacological therapies have been suggested. Unfortunately, they have drawbacks as well, like side effects, poor patient compliance with long-term medication regimens, ineffectiveness, and occasionally contraindications. Complementary therapies may therefore be appropriate substitutes.
Chinese herbal medicines have long been used to treat infertility in PCOS patients as well as gynecological issues. Not only may herbal formulae help with reproductive dysfunctions, but they also offer very interesting benefits when it comes to harmonizing hormone status and menstruation frequency in PCOS. Comparing the overweight PCOS patients with the herbal formula adjuvant group to the controls, the clinical results showed a decrease in oligomenorrhea and other noteworthy improvements, including pregnancy rates and quality of life.
A lot of clinical research has been conducted in the last ten years to look into how acupuncture affects PCOS. They discovered that the way acupuncture affects polycystic ovary syndrome (PCOS), a condition characterized by excessive sex hormone function, is probably through encouraging the release of β-endorphin and blocking the hypothalamus's ability to produce gonadotropin-releasing hormone (GnRH), which lowers the levels of FSH and LH in the blood. In addition to relieving pain and mental stress, acupuncture helps patients experience less anxiety and/or depression by increasing the release of β-endorphin, endomorphins, enkephalins, serotonin, and other neurochemical substances.
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