ASRM2010: Does Traditional Chinese Medicine (TCM) work in endometriosis?

Denver, 27 October 2010

Endometriosis is a challenging medical problem worldwide.   In Western medicine, non-surgical management is disappointing.  Traditional Chinese Medicine (TCM) has over five thousand years of history, and it has been an effective treatment option in managing endometriosis in Asia.  However, its efficacy and mechanisms are not well understood, and it has not been well-accepted in the Western world.

Professor Pamela Stratton and Dr Caihong Ma at the 66th Annual Meeting of the ASRM

Professor Pamela Stratton, who is the chair of the ASRM Endometriosis Special Interest Group (EndoSIG) and a known specialist in the pain mechanisms of endometriosis, set out together with  Dr Caihong Ma, of the Peking University Third Hospital, to outline the basic concepts of TCM and to summarise its mechanisms in the treatment of endometriosis.

The key words throughout their presentations were: “holistic” and “individualisation”.  In fact, “holistic individualisation” is the cornerstone of TCM.

Holistic individualisation

Treatments are based on an understanding, and interpretation, of the whole body as a network of energy:  the interaction of “ying” (= night, cold, stillness) and “yang” (= day, heat, activeness) are absolutely key, and an inbalance between these can create disorders to “Qi” (energy flow), blood and body fluids.  Such disruption may consequently cause disease.  When it comes to “endometriosis”, however, this does not even appear in TCM language, where treatments are geared more towards the symptoms of endometriosis such as dysmenorhoea (period pain), irregular periods, and infertility.

This individualisation makes it so very hard to set “standards” for the practice of TCM in endometriosis,or indeed trials to compare its effectiveness, because it is near impossible to compare treatment outcomes, when these are not carried out “identically” or indeed are treating different symptoms associated with the disease (ie. is the treatment “treating” the symptom(s) or the disease?)

Both acupuncture and Chinese herbs are being used by many women with endometriosis to treat their symptoms.  A 1998 consensus on the use of acupuncture (NIH Consensus Conference, JAMA 1998) illustrated the safety and efficacy in the treatment of pain.  This conference and other scientific reviews of TCM led to the formation of the National Center for Complementary and Alternative Medicine (NCCAM).

Acupuncture

Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-orientated treatment.  This approach offers several different interpretations of common endometriosis symptoms.  Studies have shown, however, that acupuncture does have a biologic basis in terms of its potential to affect pain.

Thus, in women with endometriosis there likely is an important interplay between endometriotic lesions and the central nervous system.  This “communication” likely initiates and then perpetuates, the constellation of pain systems.  When the central nervous system is engaged in women with endometriosis, they have central nervous system sensitisation, a hyperacute sensitivity to pain, and myofascial dysfunction, muscle spasms.  Using acupuncture to address these symptoms is safe; it is unknown, however, whether it will treat these central nervous system changes.

Herbs

In terms of using herbs, a 2009 Cochrane review (Flowers et al, 2009) included only two randomised controlled trials (n=158). When comparing Chinese herbs to Gestrinone there was no difference in symptom outcome, whereas compared to Danazol all women receiving herbal treatment showed a marked improvement in their symptoms.

Does TCM work?

In reality the jury is out on Traditional Chinese Medicine (TCM), but viewing health in terms of balance, and then balancing individual medication to restore that balance, may not be such a bad way to dealing with the symptoms endometriosis.

Perhaps our goal should be:
an individualised holistic approach to balancing health?

We leave you with this thought….!

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