Chinese Herbal Therapy for Uterine Fibroids

7/29/2019 Chinese Herbal Therapy for Uterine Fibroids

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CHINESE HERBAL THERAPY FOR UTERINE

FIBROIDSby Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

BACKGROUNDUterine fibroids are known by many names, including uterine myoma, leioma,

fibroma, fibromyoma, or as hysteromyoma; these are equivalent designations for

benign growths of smooth muscle tissue in the uterine wall. Occasionally, the

fibroid grows outside the uterine wall as an "exterior" mass in the abdominal

cavity. The fibroid masses occur in about 20% of women over the age of 20, with

most frequent occurrence between ages 35 and 45 (affecting 40% of women in

this age range). However, the fibroids frequently go unnoticed until they grow

rapidly during a peri-menopausal phase around age 41-45. Most often, fibroids

decline substantially with menopause. The strategy for non-surgical treatment is

to limit the size and symptoms of the fibroid(s) until spontaneous shrinkage

occurs with menopause, typically just a few years after the initial diagnosis. Only

10-20% of fibroid cases require surgery; interventions such as Chinese medicine

may remove the need for surgery in some of these cases, especially if treated

early.

Small uterine myomas are usually asymptomatic, but larger masses can

cause excessive menstrual bleeding, and very large fibroids can contribute to

miscarriage, abdominal pain, profuse bleeding (with resultant anemia) and othersymptoms for which surgical removal of the fibroids is recommended. Modern

laser surgery and the new non-surgical method of fibroid embolization are

distinct improvements over total hysterectomy or major abdominal surgery, but

women may still seek natural approaches to resolving the masses. It is important

to become familiar with fibroids and the treatment options so that patients can be

properly advised. Many times, the expectations for "alternative" treatments are

excessive: that a brief and convenient treatment without adverse effects will

make even large fibroids vanish. On the other hand, fears of modern medical

treatment are sometimes blown out of proportion; most women recover fully

within weeks of conservative surgery, though there is always a risk of

complications, some of which may be serious.

Chinese doctors believe that uterine myomas up to the size of a goose egg

can be successfully treated with herbs to reduce the size to a comfortable level

and, in many cases, to eliminate them. Larger myomas are usually treated with

surgery in China as they are elsewhere, though pre-treatment with Chinese herbs


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may reduce the complications of surgery. To better understand the sizing of

uterine myomas, the following table is provided; most gynecologists rank the size

in centimeters; this table shows the measurement of some well-known objects. A

"goose egg," as designated in the Chinese literature, is about 6.5 cm; a "fist-

sized" mass is about the 10 cm. In a woman who has never had children, the

average uterus is about 8 cm x 5 cm (and 2.5 cm thick); women who have hadchildren will have a slightly larger uterus. Shrinkage of "grapefruit sized"

fibroids is not usually expected and attempting to do so might be an unnecessary

burden for the patient.

Item Size Item Item

Pea 1 cm Apple/Pear 7.5 cm

Walnut 3 cm Orange 9 cm

Lemon 5.5 cm Grapefruit 11.5 cm

The effectiveness of the Chinese herbal treatments for small to medium size

fibroids has been demonstrated by clinical trials conducted in China and Japan.

American practitioners of Chinese medicine have frequently reported success in

treating fibroids, at least to the extent of alleviating common symptoms and thus

avoiding surgery for their patients.

CHINESE MEDICAL THEORY OF ABDOMINAL MASSES, SUCH ASFIBROIDSThe first depiction of uterine fibroids in the Chinese literature was in the Ling

Shu(ca. 100 B.C.), which definedshijia, a stony tumor (shi = stone;jia = mass).

From this text arose the general concept of abdominal masses aszhengjia, which

denotes two types of masses:zhengrefers to one in fixed position that is painful,

andjia is a mass that can be moved, and only hurts when pressure is applied.

These masses were described in the Ling Shu(1) scroll on water

swellings,zhengcorresponds to uterine masses andjia corresponding to

intestinal masses (bracketed statements are inserted to aid explanation of the

text):

Cold qi is a guest [that is, it takes residence there] in the outer [wall of

the] intestines, and battles with the protective qi. The qi does notreceive nourishment, and because cold qi and protective qi are tied

together [in battle], indigestion comes from internal confusion. The

sick qi then rises [e.g., upward flux of stomach qi], and sick flesh is

born [below]. At the commencement of its birth, the mass is as large

as a chicken's egg. Gradually, it increases its sized until it reaches the

its conclusion with a shape like carrying a child. For a long time, that


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is, with years intervening, if the hand is then used to press [on the

abdomen], it will feel solid, but if it is pushed, it will move [hence, it

is due to an accumulation of stagnated qi]. The menstrual period will

be in accord with the tides [i.e., will be regular]. [These are the

symptoms when the intestines are affectedalternatively,] the

abdominal masses begin in the middle of the womb. Cold qi is a guestat the mouth of the womb. The mouth of the womb is blocked and

obstructed. Qi cannot penetrate. Sick blood should leak out but does

not leak. The bleeding at times is detained and stops, day by day, [the

womb] will increase in size so that the appearance will be like

pregnancy. The menses do not respond to the tides [they are

irregular].

Based on these concepts, one of the earliest methods of herb therapy for the

uterine mass was to use the five ingredient formulation called Guizhi Fuling

Wan (Cinnamon and Hoelen Formula), first described in the Jingui Yaolue(ca.220 A.D.). The cold qi is dispelled by using cinnamon twig; the water stagnation

is dispelled by hoelen (poria); the blockage and obstruction of blood flow is

treated by the combination of persica, red peony, and moutan. In the Jingui

Yaolue(2), the situation was described whereby menstrual bleeding would cease

for three months, followed by incessant bleeding indicating that a mass had

formed. This scenario is consistent with the concept that the womb is blocked

and obstructed (hence the lack of bleeding), but then it develops a mass, which

causes the incessant bleeding. The condition was distinguished from pregnancy,

where menstrual bleeding would stop, and a mass would begin to form in the

abdomen, but incessant bleeding would not follow. Guizhi Fuling Wan halts the

incessant bleeding by removing the mass.

In the modern text Practical Therapeutics of Traditional Chinese

Medicine (3), the distinction of the two mass types as understood today is

presented:

Zhengdescribes solid masses (concretions) with defined physical

form and fixed location, accompanied by pain in a specific location.

In these cases, pathological changes have taken place in the visceral

organs; thus, these patterns usually involve the blood.Jia, on theother hand, describes masses without a distinct physical form

(conglomerations), manifesting and dispersing without apparent

pattern. Accompanying pain is not fixed in location. In these cases,

pathological changes have taken place in the bowel organs. Hence,

these patterns involve qi. Despite the differences

betweenzhengandjia, the two are closely related in terms of


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pathogenesis and are difficult to differentiate, hence the use of the

compound termzhengjia.

An extensive review of the theoretical basis for the etiology and treatment of

abdominal masses, including fibroids, is found in the Advanced Textbook of

Traditional Chinese Medicine and Pharmacology (4); it is reproduced herewith only slight editing. Gynecological examinations were not a practice in China

until the recent introduction of modern techniques, so fibroids could not be

specifically identified and differentiated during the development of the theories

outlined here. Fibroids are now frequently diagnosed before they reach a size that

causes pain, which had been one of the first signs of a problem for people lacking

modern routine examinations and an integral part of the ancient description of the

masses.

For the more serious and advanced stage masses described here, symptoms

described, such as pain and loss of appetite (and accompanying weakness andweight loss), may not be presented as significant symptoms by patients today

because analgesics and other therapies already have been skillfully employed to

minimize those effects. Further, some of the cases included in the description

may be cancers of the reproductive or abdominal organs, which produce severe

systemic effects as they progress. The masses are here divided into two broad

groups: qi masses (calledju; these are like the ones referred to asjia) and blood

stasis masses (calledji; like those referred to aszheng). Parenthetical statements

are added for explanation of the original text.

BackgroundThe most marked symptoms of abdominal masses, which are called jiju (that

is:ji-type masses andju-type masses), are abdominal distention and

pain.Ji refers to visible abdominal masses (that is, they cause an observable

protrusion or are easily felt by palpation), which produce pain with a fixed

location. They involve the blood system and are generally caused by disorders of

thezangorgans (e.g., liver, spleen). Sinceji forms over a period of time, the

pathological condition is severe and soji is difficult to cure.Ju refers to invisible

masses that produce pain without a fixed location (generalized abdominal aching,

or pains that occur in different places at different times). It involves the qi

system, and is mostly caused by disorders of thefu organs (e.g., gallbladder andstomach).Ju feels like a mass when qi accumulates, but this mass disappears

when qi disperses. Since this type of mass forms over a short period, its

pathological condition is mild and it is generally easier to deal with thanji.

Abdominal tumors (e.g., fibroids), enlargement of the liver and spleen,

hyperplastic intestinal tuberculosis, functional gastrointestinal disturbances, and


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incomplete intestinal obstructions can be diagnosed and treated according to the

following descriptions.

Etiology and Pathogenesis

Among the causes of abdominal masses are mental depression, an improper diet,

and attacks by pathogenic cold-dampness or toxin-heat. The (underlying) internalcause of abdominal masses is a deficiency in the body's anti-pathogenic qi

(normal qi). Classics on traditional Chinese medicine hold that "People with

strong resistance (those with strong qi) do not have abdominal masses, only weak

people (those with weak qi) are likely to suffer from them." Abdominal masses

gradually develop when the body's antipathogenic qi fails in its struggle against

the attacking pathogenic factors. This disease is principally related to the liver

and spleen. The stagnation of the qi and the blood and phlegm retention play a

major role in the pathogenesis of abdominal masses. The three basic causes are:

1. Mental Depression and Qi and Blood Stagnation. Mental depressioncauses the stagnation of liver qi, which producesju lumps. This leadsto blood stagnation, which over a long period forms masses, thus

producingjimasses.

2. Improper Diet and Production of Turbid Phlegm. An improper dietrefers to voracious eating or overindulgence in alcohol. This

damages the spleen and stomach, producing turbid dampness whose

accumulation forms phlegm; this further results in qi and blood

stagnation. These combine with phlegm to cause abdominal masses.

3. Attack by and Retention of Pathogenic Factors. When pathogeniccold, dampness, heat, or toxins attack, they may remain for a longtime. This impairs the functions of the affectedzangfu organs,

causing qi and blood stagnation and turbid phlegm. Over a long time,

abdominal masses are produced.

Any one or combination of these causes may produce abdominal masses. For

example, abdominal masses can be caused by pathogenic wind-cold combined

with phlegm due to improper diet, or by mental depression coupled with wind-

cold and phlegm.

Differentiation and Treatment

The pathological changes that occur with ji and ju are different. In

the ju syndrome, the disease is located in the qi system and the basic principle of

treatment is to soothe the liver, regulate and circulate qi, and disperse

accumulation, with the major focus on regulating qi. In the ji syndrome, the

blood system is affected and treatment seeks to activate blood circulation and


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remove stasis, soften hardness and disperse the masses, with the major focuses on

treating the blood.

Ifju syndrome is treated properly in its initial stages, then the symptoms will

improve and the disease may even be cured. A prolonged ju syndrome produces

blood stagnation, thus transforming itself into a ji syndrome. According to theduration of the disease and its pathological manifestations, ji syndrome is divided

into initial, middle, and late stages. Since the abdominal masses are small and

soft during the initial stage, and the resistance (qi) is still strong, treatment aims

at eliminating pathogenic factors. The masses increase in size and become harder

during the middle stage because the body's resistance is weaker than the

pathogenic factors; elimination of the masses must therefore be combined with

reinforcing the resistance. At the late stage, the abdominal mass becomes very

hard and the resistance is greatly damaged. Treatment then focuses on

strengthening resistance; strong drugs for eliminating pathogenic factors should

not be used (as they may further weaken the qi).

Ju Syndromes (Qi Masses)Ju usually involves liver qi stagnation and/or retention of food and accumulation

of phlegm.

Liver Qi Stagnation: Qi accumulates and flows to the chest, hypochondrium,

epigastrium, and lower abdomen, causing pain in these areas. This condition

changes according to the patient's emotional state. Other manifestations include

mental depression, a thin and sticky tongue coating, and a taut pulse. Mental

depression leads to liver qi stagnation, which causes accumulation of qi and its

movement in all directions, resulting in distensive pain. Qi accumulates

following mental depression and disperses when the patient is free of emotional

stress. A taut pulse suggests liver disorders.

An example of herbal treatment isMuxiang Shenqi San (Saussurea Qi-Smoothing

Powder). In the recipe, citrus, blue citrus, chih-ko, saussurea, melia, lindera,

cardamom, atractylodes, cnidium, and cyperus help the qi to circulate and soothe

the liver; cinnamon bark, acrid and warm in nature, disperses cold and helps the

qi to circulate; licorice, sweet and mild, relieves pain in the middle burner. If

there are any indications of heat, such as a bitter taste in the mouth and a red

tongue, then cinnamon bark should not be used andZuojin Wan (comprised ofcoptis and evodia) should be added to dissipate any liver heat. The presence of

grief, weeping, and absent-mindedness is due to liver qi stagnation and heart

deficiency; in this case, the decoction of licorice, wheat, and jujube can be

prescribed to nourish the heart, clam the mind, and relieve qi stagnation.


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Retention of Food and Phlegm: Retained food in the intestinal tract impairs

transportation and transformation, and thus produces phlegm-dampness, which,

combined with retained food, blocks the qi circulation, thereby causing

abdominal pain, constipation, and a poor appetite. When this condition is

combined with stagnant qi, cord-like masses occur in the abdomen; these

disappear when the qi of thefu organs circulates freely and retained food is sentdownwards. An example of treatment isLiu Me Tang(Decoction of Six Ground

Herbs). In this recipe, rhubarb, chih-shih (or chih-ko), and areca seed separate

retained food from stagnant qi by relieving constipation; aquilaria, saussurea, and

lindera circulate qi. If liver qi combines with phlegm to block the throat, Banxia

Houpo Tang(Pinellia and Magnolia Combination) can be added to circulate qi

and resolve phlegm. Although in most cases ju syndrome is caused by an excess

of pathogenic factors, repeated attacks may damage the spleen qi. In this

case,Xiang Sha Liu Junzi Tang(Saussurea and Cardamom Combination) can be

prescribed at the same time as the other herbs to replenish qi and invigorate the

spleen.

Ji Syndromes (Blood-Stasis Masses)

Ji syndromes are divided into three stages: qi and blood stagnation; retention of

stagnant blood; and qi deficiency with accumulation of blood stasis.

Initial Stage: Qi and Blood Stagnation. Stagnant qi and blood form abdominal

masses. At the initial stage, pathogenic factors move to the blood system from

the qi system. The masses have only recently formed and so they are still soft to

the touch. Distensive pain, a blue tongue, and a taut pulse are indications of

stagnant blood caused by liver qi stagnation. An example of herb therapy is DaQiqi Tang(Major Decoction of Seven Qi-Regulating Herbs) combined

with Shixiao San (Powder for Dissipating Blood Stasis). In the former, citrus,

blue citrus, platycodon, and pogostemon circulate qi and disperse masses;

cinnamon twig, sparganium, zedoaria, and cyperus remove vascular obstruction

by providing warmth. In the latter formula, typha and pteropus active blood

circulation, remove stasis, and relieve pain.

Middle Stage: Retention of Stagnant Blood. The protracted presence of

abdominal masses and gradual aggravation of blood stagnation explain the hard

enlarged masses and fixed pain. The stagnation of qi and blood impairs the

ability of the spleen and stomach to transport and transform, giving rise to a darkgray complexion, emaciation, lassitude, and a poor appetite. The accumulation of

stagnant qi and blood causes disharmony between the nutrient qi (yingqi) and the

defensive qi (weiqi) which brings fever (or feverish feeling) and an aversion to

cold. Amenorrhea, a purple tongue, and an unsmooth pulse are all caused by the

internal accumulation of stagnant blood. A taut and smooth pulse suggests liver

hyperactivity.


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An example of treatment is Shaofu Zhuyu Tang(Decoction of Lower Palace). In

the formula, persica, carthamus, tang-kuei, cnidium, pteropus, and red peony

activate blood circulation and remove stasis; cyperus, lindera, and corydalis

circulate qi, relieve pain, and assist in the removal of stasis; and licorice

replenishes qi and relieves pain in the middle burner. Melia, sparganium, and

zedoaria can be added to circulate qi and blood. If abdominal masses are hardand produce pain that is aggravated by pressure,Biejiajian Wan (Turtle Shell

Pills; a large formula including many animal materials, indicated for masses with

poor appetite, emaciation, and abdominal pain) can be administered to remove

blood stasis, soften the masses, and relieve pain. In order to eliminate pathogenic

factors and reinforce resistance, the above two formulas can be taken alternately

withLiu Junzi Tang(Six Major Herbs Combination). If the abdominal masses

increase in size and feel hard and painful, eupolyphaga (and other strong agents

for dispersing blood stasis) and sargassum should be added to resolve stasis,

relieve accumulation, and soften the masses.

Late Stage: Anti-Pathogenic Qi Deficiency and Accumulation of BloodStasis. Prolonged accumulation of blood stasis in the vessels gives rise to hard

masses and violent pain. This also damages the spleen and stomach qi and

impairs transport and transformation; thus the appetite is greatly reduced and

emaciation results. Accumulation of blood stasis also prevents the production of

new blood, leading to extreme deficiency of nutrient qi; its symptoms include

sallow or dark-yellow complexion. A purple tongue is the result of blood stasis; a

gray and coarse tongue coating or a red and glossy tongue without coating, a

thready and rapid or taut and thready pulse are indications of fluid depletion and

consumption of qi and blood.

As an example of treatment,Bazhen Tang(Tang-kuei and Ginseng Eight

Combination) combined with Pill for Relieving Masses can be used. In the

former, the ingredients ofSi Junzi Tangand Siwu Tanggreatly replenish qi and

blood. In cases of extreme yin fluid deficiency with signs of a glossy red tongue

without a coating, rehmannia, adenophora, and dendrobium are prescribed to

nourish yin and produce fluids.Xiaoliu Wan (The Pill for Relieving Masses; with

sparganium, zedoaria, cyperus, areca seed, sappan, arca shell, pteropus, etc.)

softens the masses, resolves stasis, and activates blood circulation. This therapy

gradually achieves therapeutic results. In the treatment ofji syndromes at anystage, external application of herbs can also be adopted.

Summary of Concepts Presented by the Advanced Textbook Chapter on

Abdominal Masses

Characteristic Ju(Qi Masses) Ji(Blood Stasis Masses)


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Origin

Qi stagnation, such as emotion-

caused liver-qi disorder or

retention of food and phlegm

due to overeating and weak

spleen. External factors, such

as wind-cold, can contribute.

Develops from prolonged ju, as

blood stasis occurs secondary

to qi stagnation. Exposure to

heat-toxins (e.g., viruses,

poisonous substances) that are

retained for a long time may

contribute to transformation

ofju toji.

Nature

Develops and enlarges with

stress; may retreat with

calmness. Pain, or mild aching,

does not have a fixed site.

Involves disorder of fu organs

(e.g., gallbladder, stomach)

Develops over a long period,

progressing from soft to hard

mass, with fixed site of pain.

Involves disorder of zang

organs (e.g., liver, spleen), and

with the pathologic influence

gradually weakening thenormal qi.

Examples

Bloating and distention after

eating; swelling of the liver and

spleen (modern medicine

designation); intestinal

obstruction with constipation,

early stage fibroids (small

uterine swellings).

Ovarian cysts, uterine fibroids,

tumors of the cervix, uterus,

bladder, colon, etc; advanced

liver cirrhosis and fibrosis;

endometriosis; surgical

adhesions.

Therapy

Aromatic-spicy herbs (e.g.,

citrus, chih-shih, blue citrus,

saussurea, lindera, aquilaria,

cardamom, cyperus) that

regulate qi and soothe the liver

are used as the main therapy.

Digestive aids, such as shen-

chu, atractylodes, and ginger,

may be added.

Strong blood-vitalizing herbsthat remove stasis of qi and

blood, such as sparganium,

zedoaria, and insects; also,

softening agents (such as

seashells and seaweeds) are

used as part of the therapy.

Tonification becomes

important for hard, painful

masses in weakened patients.

Adjustments

Qi dispersing therapies are

usually warm in nature; watch

for heat symptoms and, if

necessary, add cold-natured

herbs such as melia and coptis.

Observe cases of weakness of

As the disease progresses, the

patient's normal qi weakens;

use formulas to reinvigorate the

qi, while vitalizing blood and

dispersing masses. For larger

masses, more emphasis must be


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spleen and treat qi deficiency

that is complicated by

stagnation.

placed on strong stasis-

resolving herbs, usually along

with animal materials; regulate

qi as necessary to halt

progression.

Prognosis

Qi regulating therapies should

have quick effects; success

depends on regulating diet and

learning to control emotions.

Failure to treat successfully can

lead to development of ji-type

mass.

Ji are difficult to treat,

especially as they progress to

form harder masses with

weaker resistance from the

patient. Therapy must be

aggressive and may be

prolonged. Failure to treat

successfully can lead to life-

threatening conditions and may

require surgery and/or toxictreatments.

CLINICAL PRACTICE IN CHINASeveral reports about traditional Chinese medicine treatments for uterine myoma

were published during the period 1980-1993, and relatively few have appeared

since then, probably because of the widespread introduction into China of

surgical methods for treating fibroids and a conclusion that the herb therapies had

been adequately tested to reveal their level of effectiveness. A representative

selection of herbal treatment strategies is presented in the following summary of

descriptions found in books and journals.

A review of the early portion of this literature was presented by Dr. Hong-

yen Hsu in 1984 (5). Herbal therapies involve qi-regulating herbs, herbs to

vitalize blood and dispel stasis, and agents for removing food stagnation and

resolving phlegm masses. First, he mentions the book Essentials of Conformation

in Chinese Medicine and four recommended therapies, laid out here to display

the common categories of herbal effects and overlapping ingredients:

Da Qiqi Tang Xiang Leng WanKaiyu Er chen

Tang*

Kaiyu Zhengyuan

San

Citrus Blue citrus Citrus Citrus

Blue citrus Chih-ko Chih-ko Blue Citrus

Cyperus Saussurea Cyperus Cyperus

Sparganium Sparganium Sparganium Corydalis


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Zedoaria Zedoaria Zedoaria

Platycodon Pinellia Platycodon

Arisaema Clam shell

Alpinia,Pogostemon,

Cinnamon bark,

Licorice

Melia, Fennel,

Clove

Ginger, Hoelen,Areca, Red

Atractylodes,

Licorice

Malt, Shen-chu,Crataegus, Ginger,

Atractylodes,

Cardamon, Hoelen,

Licorice

*Cang Fu Daodan Wan, with areca, zedoaria, and sparganium removed, is

mentioned in this text, but the version of formula presented here is more

commonly recommended.

The first two rows include citrus materials (chenpi, qingpi, zhike) and the

next row the aromatic qi-regulating herbs cyperus or saussurea; all these itemsare used to regulate qi and resolve accumulations. The next two rows allow for

listing of blood-vitalizing herbs (sparganium zedoaria, corydalis); and the next

two rows are for phlegm-resolving herbs (platycodon, pinellia, clam shell, and

arisaema). A final row lists other ingredients, which are mainly those to improve

digestive functions and invigorate circulation of qi. As described in Practical

Therapeutics (3),Da Qiqi Tangis best for cases where qi stagnation

dominates;Xiang Leng San is best for cases where blood stasis dominates, and

the two kaiyu (resolving stagnation) formulations are most suited for cases of

phlegm-damp accumulation. Recommendations similar to these are relayed in

the Encyclopedia of Practical Traditional Chinese Medicine (see Appendix 1).

Hsu also presents treatment options from the bookChinese Obstetrics. It

lists Guizhi Fuling Wan (Cinnamon and Hoelen Formula) as the ancient formula

of choice for use today in both China and Japan. The book also lists the above

formulations, and adds a mass-resolving formula comprised mainly of

sparganium, zedoaria, leech, tang-kuei, persica, rhubarb, calamus gum,

sargassum, cinnamon, aconite, and astragalus. A similar mass-reducing formula

is described in the book as one of the Chinese treatments for ovarian tumors,

which presents initially as a simple lower abdominal mass, like a fibroid:

zedoaria, tang-kuei, red peony, areca seed, laminaria, saussurea, cinnamon, turtleshell, rhubarb, persica, succinum. The combination of turtle shell, rhubarb,

persica, and succinum is also used as a basis for treating endometrial cysts.

In a Japanese book quoted by Hsu, Survey of Chinese Medicine, its authors

point out that "curing egg-sized uterine myomas with Chinese herb formulas is

possible, but a larger size proves difficult to cure. Only in one case that they


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know of was a patient with a fist-sized myoma cured after using Wenjing

Tang(Tang-kuei and Evodia Combination) long term. The cure probably had

something to do with the patient's menopause." Japanese doctors usually

prescribe formulas with cinnamon twig, persica, and moutan for dispelling blood

stasis in the lower abdomen. Examples are Guizhi Fuling Wan (Cinnamon and

Hoelen Formula), Taohe Zhengqi Tang(Persica and Rhubarb Combination),andZhechong Yin (Cinnamon and Persica Combination); rhubarb is included in

treatments when constipation is presented

In the bookAn Illustrated Guide to Antineoplastic Chinese Herbal

Medicine (1990), three formulas for hysteromyoma are outlined. One is used for

toxic syndromes, as occur with malignancies, but the other two are used mainly

for common fibroids. A tested formula is Gong Zheng Tang(Decoction of

Uterine Palace), with the following ingredients:

Zedoaria 12 g Achyranthes 12 g

Sparganium 9 g Cyperus 12 g

Tang-kuei 12 g Prunella 12 g

Persica 12 g Dipsacus 12 g

Pangolin scale 12 g Laminaria 15 g

Vaccaria 9 g Coix 30 g

The original report about Gong Zheng Tang(Decoction of Uterine Palace)

was presented in English in the Journal of the American College of Traditional

Chinese Medicine (6). 136 cases of uterine myoma were treated with that

formula, which might be modified as needed by adding 2-3 herbs (e.g.,codonopsis and pseudostellaria for qi deficiency; millettia and peony for blood

deficiency; atractylodes and hoelen for stomach/spleen deficiency; or lycium,

morus fruit, and eclipta for liver/kidney deficiency). In addition, sparganium

extract was injected intramuscularly for seven days starting with the onset of

menstruation. The course of treatment ranged from 1-8 months. It was reported

that 72 of the cases (53%) were cured and that another 37 cases (26%) were

significantly improved. Of 38 cases where the myoma was the size of a fist, only

6 were cured (16%), but of 98 cases in which the size was that of a goose or duck

egg, 66 were cured (67%). It was stated that "surgical measures are advised for

large tumors." Of 22 cases that did not respond to therapy, half of them resortedto surgery. The cure rates reported here may be somewhat high, since ultrasound

and other definitive tests were not conducted to confirm elimination of the

fibroids; the data mainly refers to alleviation of symptoms and of easily palpable

masses.


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The other formulation mentioned in the Illustrated Guide is a modification

of Cinnamon and Hoelen Formula, with sparganium, zedoaria, tang-kuei,

astragalus, and crataegus added. Review articles about treatment of uterine

myoma repeatedly mention Cinnamon and Hoelen Formula as a central therapy.

Four sample reports help illustrate the reliance on this ancient prescription. A

modified version called Gui Ling Xiaoliu Wan (Cinnamon and Hoelen MassReducing Pill) is made by adding turtle shell and pangolin scale (7). The herbs

are powdered, made into honey pills (with about 6.6 grams of herbs per pill) and

taken two pills per day for three months (on all days except during menstruation).

For patients requiring higher doses or modified formulations, a decoction would

be used in place of pills. It was claimed that 18 of 30 patients were cured

(symptoms alleviated, little if any uterine enlargement remaining) and that 5 were

notably improved.

Another example is use of Cinnamon and Hoelen Formula with a variety of

modifications according to syndrome such as (8):

larger fibroids or those resistant to treatment: add turtle shell andpangolin scale

obesity with phlegm-damp syndrome: add pinellia, fritillaria,prunella, sargassum, and laminaria

qi deficiency: add codonopsis, astragalus, and atractylodes blood deficiency: add tang-kuei and gelatin qi stagnation: add blue citrus, bupleurum, sparganium zedoaria,melia, corydalis, typha, and pteropus.

The formulas were administered in decoction form, with typical individual

ingredient amounts of 9 grams (less for cinnamon twig, at 3-6 grams) per daily

dose, given in two divided doses. Treatment time was 3-10 months, and it was

reported that of 28 patients, 12 were cured and 14 others improved.

A similar study relied on the use of Cinnamon and Hoelen formula as a

decoction, modified with the addition of achyranthes, oyster shell, and salvia plus

others according to syndrome; the decoctions would have about 80-120 grams ofherbs (9). There were 100 patients treated with these formulas, and it was

claimed that 46 cases had the mass eliminated, and 34 had it shrunk by at least

half. Treatment time was 1-7 months. In another study (10), a pill of Cinnamon

and Hoelen Formula plus turtle shell, oyster shell, artemisia, blue citrus,

dipsacus, phellodendron, astragalus, and selaginella (often used as an anticancer

herb) was used; the herbs were powdered and formed into pills with honey, about


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6.6 grams of herbs per pill, one pill taken each time, three times daily. Of 60

patients treated, 43 were said to be cured and 11 markedly improved using from

1-9 months of treatment. In several additional clinical reports on fibroid

treatment, three herbs in Guizhi Fuling Tangwere retained: persica, red peony,

and moutan, but the herbs that give the formula its name, cinnamon and hoelen,

were replaced by others that vitalize blood and regulate qi, such as zedoaria andcyperus. In others, the Cinnamon and Hoelen Formula was retained intact, and

herbs were added to address bleeding, anemia, pain, or qi deficiency.

In a Japanese study of the mechanism of action of Cinnamon and Hoelen

Formula, it was mentioned that shrinkage of uterine myoma occurred in 62% of

the 110 cases treated, and that the treatments alleviated excessive menstrual

bleeding and resulting anemia as well as dysmenorrhea (11). There were no

significant changes in plasma levels of several hormones, including LH, FDH,

PRL, and estradiol, indicating that the mechanism of action did not involve

reduction of hormone stimulus to fibroid growth. It was noted that small myomaswith smooth surface generating elevated levels of CA-125 appeared to be most

responsive to treatment; elevated CA-125 often indicates adenomyosis, a fibroid-

like condition with small masses of the uterine wall.

As indicated by these recommendations and studies, a wide range of

formulas, most with qi and blood regulating properties, as well as herbs for

warming the abdomen and herbs for resolving phlegm accumulation, have been

used to accomplish reduction of fibroids. Complete resolution of fibroids has

been reported several times, and substantial reduction of myoma size is

apparently common in all but the largest or most aggressively growing fibroids.Treatment times are typically in the range of 1-8 months, with some lasting up to

10 months.

REFERENCES

1. Wu Jingnuan (translator), L ing Shu, or The Spiritual Pivot, 1993Taoist Center, Washington, D.C.

2. Hsu HY and Wang SY, Chin Kuei You L ueh, 1983 Oriental HealingArts Institute, Long Beach, CA.

3. Yan Wu and Fischer W, Practical Therapeutics of TraditionalChinese Medicine, 1997 Paradigm Publications, Brookline, MA.

4. State Administration of Traditional Chinese Medicine, AdvancedTextbook on Traditional Chinese Medicine and Pharmacology,

(vol. 3) 1996 New World Press, Beijing.


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5. Hsu HY, Chinese herb therapy for uterine myomas, Bulletin of theOriental Healing Arts Institute 1984; 9(6): 294-298.

6. Cheung CS and Carney L (translators),Preliminary report of 136cases of uterine myoma treated by Gong Zheng Tang, Journal of the

American College of Traditional Chinese Medicine 1982 (1): 64-66.7. Pang Huali, Treatment of hysteromyoma with Gui Ling Xiaoliu Wan-

A report of 30 cases, Beijing Journal of Traditional Chinese

Medicine 1989; (6): 31-31.

8. Zhang Zhuen, et al., Clinical observation of 28 cases ofhysteromyoma healed by integrated traditional and western

medicine, Chinese Journal of Integrated Traditional and Western

Medicine 13(3): 180-181.

9. Yang Shenshan,A modified Ghuzhi Fuling Wan for the treatment of100 cases of hysteromyoma, Zhejiang Journal of Traditional ChineseMedicine 1984; 19(4): 180.

10.Huang Chunduan, Guizhi Fuling Wan in treating 60 cases ofhysteromyoma, New Traditional Chinese Medicine 1982; (10): 24-

26.

11.Sakamoto S, et al.,Pharmacotherapuetic effects of Guizhi FulingWan on human uterine myomas, American Journal of Chinese

Medicine 1992; 20 (3-4): 313-317.

12.Xu Xiangcai (chief editor), The English-Chinese Encyclopedia ofPractical Traditional Chinese Medicine, (vol. 12) 1989 HigherEducation Press, Beijing.

13.Shao Nianfang, The Treatment of Knotty Diseases with ChineseAcupuncture and Chinese Herbal Medicine, 1990 Shandong

Science and Technology Press, Jinan.

APPENDIX 1. Additional Descriptions of Fibroid Treatment Strategies

The English-Chinese Encyclopedia of Practical Traditional ChineseMedicine (12) presents uterine fibroids in three categories: qi stagnation, blood

stasis, and phlegm-dampness. The recommended formulas include two

mentioned previously, namelyXiang Leng Wan (which is indicated in this text

for cases where qi stagnation dominates, rather than blood stasis) andKaiyu

Erchen Tang(which is indicated for phlegm-dampness). The formula

recommended for blood-stasis dominating is:


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Huoyu Sanjie FangZedoaria

Sparganium

Cnidium

Chih-ko

Prunella

CyathulaCinnamon twig

Persica

Red peony

Tang-kuei

Salvia

Oyster shell

Modifications recommended include:

For copious menses and abdominal pain, remove prunella and oystershell, but add typha and pteropus;

For persistent bleeding, remove sparganium and zedoaria but addpseudostellaria and san-chi.

The formulas are presented in this text with dosage recommendations for

preparation as decoctions, where the amount of each ingredient is typically 6-12

grams, except high doses of oyster shell and salvia, each at 30 grams. The total

dosages range from 75-150 grams for a one day dose of the decoction, which is

to be divided into two servings, one taken in the morning and one in the evening.

The formula is similar toXiao Liu Fang(see Appendix 2), the main

difference is inclusion of ingredients from Cinnamon and Hoelen Formula here:

cinnamon, persica, and red peony, and the replacement of rhubarb by salvia. A

similar prescription was recommended by Shao Nianfang in his book on

treatment of difficult diseases (13). For uterine myomas that originate with liver

qi stagnation and develop as a blood stasis mass, he recommended a formula

similar to that above, with zedoaria, sparganium, citrus, blue citrus, bupleurum,

cyperus, cnidium, persica, melia, corydalis, red peony, and moutan; the formula

details to be adjusted as needed, with some added herbs. He commented:Excessive menstrual bleeding is a common symptom of uterine

myoma, and is due to stagnation. To resolve stagnation will arrest

bleeding. Therefore, be not afraid to use drugs to soften the hardness,

to activate the blood and resolve stagnation, such as zedoaria,

sparganium persica, and typha, assisted with some hemostatic herbs.

San-chi is very precious because of its effect, combining activating


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blood, resolving stagnation, and hemostasis. In chronic cases, with

deficiency of spleen and kidney, with qi unable to control blood flow,

be brave to use reinforcing in those cases, that is, to restore the qi and

the capacity to resolve stagnation thereby.

In other words, use blood-vitalizers even though there is bleeding, and usetonics even though there is accumulation, so long as the differential diagnosis

indicates the appropriate underlying cause.

APPENDIX 2: Xiao Liu FangA clinical study about treatment of uterine fibroids with tracking of results by

ultrasound was published by Jiang Xinglei and Luo Xianchu (Clinical

observation on Xiao Liu Pian applied to treat 30 cases of hysteromyoma ,

Chinese Journal of Integrated Traditional and Western Medicine 1992; 12(3):

185-186). The formula ingredients are aimed at strongly dispersing both qi and

blood stagnation. Thirty patients (ages 26-50) were treated. TCM diagnosisrevealed 22 cases suffering from a combination of qi and blood stagnation and 8

cases with qi deficiency with blood stagnation. In general, the tongues of the

patients looked dark, and the pulses felt deep, or string-like, small, and uneven.

As a result of herbal therapy, 15 patients experienced either elimination of the

fibroid or substantial reduction in fibroid size, and 13 more had some degree of

fibroid shrinkage with symptoms alleviated. Of 21 cases examined by ultrasound,

the average myoma size was 6.35 cm before treatment and only 3.54 cm after

treatment. Symptoms associated with the fibroids included excessive bleeding,

pain, and a bloated feeling, and these were virtually eliminated in all but 2 cases.

The formula that was used in a clinical trial, which was called Xiao Liu Pian

(Mass Reducing Tablets), had the following ingredients reported:

Salvia

Eupolyphaga

Pangolin scale

Rhubarb

Prunella

Bupleurum

Blue citrus

Cyperus

Ginseng, white

San-chi

Gelatin

Cremastra


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In this formulation, salvia, eupolyphaga, pangolin scale, and rhubarb serve to

vitalize blood circulation and remove stasis; prunella bupleurum, blue citrus, and

cyperus regulate qi and overcome qi stagnation that forms masses; ginseng

tonifies qi; oyster shell softens masses; san-chi and gelatin help restrain excessive

bleeding; cremastra (maocigu orshancigu) is an "antitumor" herb used to resolve

a toxin that contributes to formation of the lump. According to the report, theherbs were prepared as an extract (using "appropriate amounts"), with the

resulting material formed into tablets with 0.3 grams extract per tablet. The

tablets were administered at a dosage of 20 each time, three times daily

(providing a total of 18 grams of extract, derived from about 100 grams of raw

materials). This formula was administered continuously (except during

menstruation) for three months.

For the past 10 years, ITM has made available to U.S. practitioners a related

formula,Xiao Liu Fang. The clinical response to this formula in the hands of

Western practitioners and patients is not known because there has not been ameans of formal reporting. However, to attempt to attain results comparable with

the Chinese report, one should observe the following:

1. In the Chinese clinical trial, the dosage of extracted herb materialwas 18 grams per day (6 grams, three times daily).Xiao Liu

Fang(orHuayu Sanjie Fang, also available), as provided by ITM, is

in the form of loose powders that were made by extracting the herbs

into hot water and then spray-drying the concentrated liquid. To

match the amount of herbs used in the clinical trial, the dosage

should be 6 grams each time, three times daily. A teaspoon of thepowder is approximately 3 grams; so the dosage is 2 teaspoons each

time, three times daily. For convenience, a patient could take 3

teaspoons twice daily. The powder is placed in a cup, boiled water is

added, the mixture is stirred, and then consumed as a tea.

2. San-chi (sanqi) is not readily available as an extract and is normallynot prepared as an extract in China.Xiao Liu Fangdoes not include

this ingredient. San-chi may help prevent fibroid bleeding; bleeding

can worsen during the use of blood-vitalizing herbs, so the inclusion

of san-chi may be helpful. ITM has san-chi (also known as tien-chiginseng) available in a tablet form (Pine Mountain brand), which is

to be taken 2-4 tablets each time along with the dose of herb powder,

for a total of 6 tablets/day.

3. The formula should be taken daily, except during menstruation, for athree-month period. For larger fibroids, Turtle Shell Tablets, made

with additional blood-vitalizing herbs, can be used as an adjunct. For


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women with cold-damp symptoms, a second granule formula,

Cinnamon and Hoelen Formula, can be taken along with Xiao Liu

Fang. After the three-month course of therapy, the patient should

continue taking herbs to consolidate the effects. A more convenient

tablet-to replace the granules-may be used for this follow-up

treatment, relying on a formulation such as Sparganium 12 (SevenForests, see below). This tablet is initially taken at the dosage of 6

tablets (or more for those of large body weight), three times daily,

and then the dosage may be tapered when fibroid symptoms have

been absent for at least one month. This formula should be used for

about three months and may need to be taken for longer periods.

4. Symptom alleviation is an expected result of therapy, but fibroidshrinkage may be limited. In the Chinese women who were

monitored for fibroid size, the average amount of shrinkage was

slightly less than 50%. Although some women experienceddisappearance of fibroids, this was not the general case. Fibroids

tend to shrink spontaneously after menopause, so that if the fibroid

size is not too large and symptoms are not a significant problem until

menopause, surgery is unnecessary.

Xiao Li u Fang Sparganium 12

Sparganium 10% Sparganium 12%

Zedoaria 10% Zedoaria 12%

Oyster shell 8% Oyster shell 8%

Bupleurum 8% Bupleurum 8%

Cyperus 8% Cyperus 8%

Blue citrus 8% Blue citrus 8%

Prunella 8% Tang-kuei 8%

Dandelion 8% Persica 8%

Rhubarb 8% Vaccaria 8%

Salvia 8% Achyranthes 8%

Arca Shell 8% Dipsacus 8%

Gelatin 8%Cinnamon

twig4%

In derivingXiao Liu FangfromXiao Liu Pian, white ginseng was deleted as

a non-essential ingredient (qi tonification should be applied as a separate formula

if needed and can be given in pill form); the insect eupolyphaga is replaced by

sparganium and zedoaria (two herbs that are commonly used for blood-stasis

masses, especially fibroids); pangolin scale, not currently available, is replaced

by arca shell, which is reputed to vitalize blood and resolve masses; and

cremastra, a rarely-used herb that is not available in the U.S. as an extract, is


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replaced by dandelion (both serve as "anti-toxin" herbs).Xiao Liu Fang,

likeXiao Liu Pian, regulates qi (with bupleurum, blue citrus, cyperus), cracks

static blood (sparganium, zedoaria, rhubarb, salvia, arca shell), and resolves

masses (prunella, oyster shell). Sparganium 12, which is the tablet that can be

used in follow-up therapy, is similar toXiao Liu Fang, but has added tonic herbs

(tang-kuei, achyranthes, and dipsacus) for nourishing the liver and kidney; theseherbs also vitalize blood circulation. This formula does not include herbs for

cleaning toxin and controlling bleeding, the problems that should have been

resolved by the initial therapy withXiao Liu Fang. For additional information

about bleeding with fibroids, see the article: "The qi keeps the blood within the

vessels: the story of Gui Pi Tang."

September 2003

http://www.itmonline.org/arts/fibroids.htm
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Chinese Herbal Therapy for Uterine Fibroids

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