uun, ano emoryo transponJ.
Nevennetess, Lne 1a1-
lopian tu bes are not affected in all women who
suffer írom endometriosis. Endomelriosis lesions
oíten occur on one or both ovaries. in which ca.se
cysts can develop. mosr notably chocolate cysts.
When these cysts are removed and analyzed. a
brown viscous substance (old menstrual blood) is
found th.ll looks like chocolate. ln addition to the
uterus and peritoneum, endometriosis can also
spread to lhe intestines and lhe bladder. Depend-
ing on lhe severity of eodometriosis, lhe affected
20 Endometrlosl~ JI
The foUowing symptoms can indicate endome-
lriosis:
severe pain during menstruation
lower abdominal pain also independent of lhe
cycle
pain during sexual intercou~
pain during bowel movements
diffuse pain in lhe lower abdomen and/or
slomach and back
menstrual disorders (e.g.. spotting. hyperme-
norrhea)
díffi,cult, also painful urinary voidings, which
arise cydically
■ Endometriosis and Fertility
There are severa! reasons why endometriosis im-
pacts fertility in spite of fallopíal patency. Mobilíry
and patency of the fallopian tubes are, of course,
highly signilicant, but lhe mobility of lhe ovaries is
also important And in women wilh existing en-
dometriosis this is frequently impaired due to its
adhesion to the abdominal wall and uterus.
The uterus itself can also be affected by this
disorder. lts mobility ensures that lhe sperm can
rea.ch the fallopian tubes. This movement can be
impaired. as a result oí which endometrial tissue
ends up in the abdominal cavity, while at lhe same
lime lhe transpor! of semen fails to take place.
When endometrlal tissue enters lhe abdominal
raviry, .an overreaction or the immune system can
result This in turn leads to an íncreased tendency
to inllammations in lhe peritoneum, which over
time causes adhesions.
Biomedlca/ Dlagnasls
Ckcasionally. the gynecologist is able to palpate
areas that are hardened or sensítive due 10 endo-
metriosis. Endometrial cysts can be detected by
ultrasound examinalion as well. Ultimately
though. laparoscopy con.s titutes the rnost precise
diagnostic procedure. This method can determine
bolh lhe extent and the localiz.ttion and activity or
lhe endometriosis. lf endometrial tissue is found, lt
is orteo removed during tbe laparoscopy; bence
lhis method of examination includes a treatment
as well. ln dinic, we have observed repeatedly lhat
264
endomemosis (e. g., pain during menstruation,
lower abdominal pain that occurs aJso indepen-
dently oí the cycle, paln during sexual intercourse
and/or p.ain during bowel movemenis) certainly
indicate a large amount of ql sugnatlon anel
bloocl stasls. ln the dlfferential diagnosis of these
types or paín. we would generally adhere ro lhe
standard disease patterns for ~meoorrhH e•
lll). Bloocl msb will always play a significant role
in this co.ntext, because lhis sragnation causes ob-
~-~~~~-!~ ._r~ç !~C_f_E1!\_1P?)_':.?1JI1 y:r_~!h ir_ f?l[1l__w??r: lpig~<_1~º!-ªgaJÇ_'!~ _t,º ~~
out lhis coodition. while lhe activity oí lhe natural
killer cells is reduced.
Symptoms
lt must be noted here that this condition can run
its cou~ wilhout detectable complaints by the
patient, as a result of which she will frequently
only learn about an existing endometriosis from
a laparoscopic diagnosis in the context of testing
fallopian tube patency.
263
patients became pregnant within 6 months after
this procedure.
By means nf different dassifications (e.g.. lhe
eodoscopic endometriosis dassification. EEC). tbe
eodometriosis is lhen divided ínto four ~ ac-
cording to its severity:
1. minimal
2. mild
3. moderate
4. severe
Some biomedical physicians, however. consider
lhis division as less than ideal because it generally
fails to establísh any correlation witb lhe severity
of pain or witb infertility.
BIOIMdlcal Theropy
ln general. lhe reconirherided treatment for
women with fenility problems who su~r from
endometriosis is laop,11roscopy with simultaneous
remova! of the endometriosis lesions. lí necessary.
hormonal defidendes are balaonc:ed. Very fre-
quently, ln vitro fertlllzatlon (IVF) is suggesled
and carried ouL
■ Clinica! Picture and Therapy
from the TCM Perspective
Endometriosis as such is not mentioned in the
TCM dassics. We can hence see it as a "modem•
disease because it can only be detected by means
of biomedical diagnostics ( ultrasound., laparos-
copy). Wilh regani to a differential diagnosis, lhe
clinical picture is composed of:
• paioful menstruation (dysmenorrhea. 1ong jing
•&l and
• abdominal masses Ui ju ~!lll)
As usual, we examine and evaluate the signs and
symptoms of female patients specifically in rela-
tion to the menstrual cycle. Nevertheless. the con-
temporary practitioner cannot do wí1hou1 the bio-
medical findings and will attempt to in1erpre1 lhe
nature of lhe dispersed endometrial tissue from
tbe TCM perspective and treat accorrlingly. As
such, the di'l!'rse rypes or pain that are caused by
Clin/ml Pldure and Therapy from Ih• TCM 1'erspt!c1M?
Some modem physicians in the People's Re-
public of China who have completed a biomedical
education in addition to their TCM training are
trying to lind a correlalion between lhe biomedi-
cally understood macroscopic and microscopic
íindings anel TCM. ln order to add lhe missing
aspects in lhe caiegory of dysmenorrhea e•&).
Let us brieny desaibe this perspective here. With
regard to detecting lhe activity levei of peritoneal
or ovarian endometriosis (see Schweppe 2002 in
color
 Biomedical Dlagnosls
Occ.ision.-.Jly, lhe gynecologisl is able 10 palpale
areas lha! are hardened or sensitive due 10 endo-
mecriosis. Endomecrial cysts can be de1ec1ed by
ultr,1sound examinarion as well. Ul1ima1ely
1hough. laparoscopy constitutes the most precise
diagnosric procedure. This method can determine
both lhe ex1en1 and the localization and activity of
lhe endomecriosis. If endome1Tial tissue is found, i1
is often removed during lhe laparoscopy; hence
lhis melhod of examination includes a crea1men1
as well. ln dinic, we have observed repealedly lha!
264
endomeariosis (e.g., pain during menscruation,
lower abdominal pain lhat ocrurs also indepen-
dently or the cycle, pain during sexual interrourse
and/or pain during bowel movements) certalnly
indicale a large amount of q/ sugMtion anel
blood smls. ln the differenrlal diagnosís ar 1hese
1ypes of pain. we would generally adhere 10 the
standard disease patterns for dysmenorrhea <•
&). Bloocl susl5 will always play a significant role
in lhis contexl, beca.use lhis siagnalion causes ob-
structions in lhe u1erus and its vessels, wbicb in
tum alTects lhe normal functioning or lhe ren mai
and chong mai with regard 10 conception.
Because blood stasis is generally triggered by
other pathologies, lhe prac1i1ioner musl look for
signs and symptoms that point to lhe roo1 pattem.
These indude:
• stagna.tion due 10 rold
• re1en1ion ar damp-heat (with hea1 in the blood)
• liver ql congestion
• insuffi-ciency of ql and blood
• insuffi-ciency of liver and k:idney yín
Alas, it is possible 1ba1 this differenlialion and the
resultant creatrnen1 scrategies might not lead to
lhe desired treatrnent success since dinical experi-
ence has s hown lhat the t reatment ar endometri-
osis in accordance with the above-lis1ed pallerns
írequently fails to alleviale t.he pain or abnormal
bleedlng to our satisfaction. Accordlng to our ex-
perience, women wlth endometriosis often suffer
írom an ilCcumulatlon of phlegm thal binds with
lhe blood. Phlegm can form d irectly as a result or
blood stasis. The jin íluids and essence Uing) can
rongeal and 1ransform into phlegm, which lhen
blocl<s lhe channels and network vessels.2 11 is in-
teresling to note tbat ia some womeo witb endo-
rnetriosis a whitlsh mucous rnembran.e can be
seen on the underside ar lhe tangue. giving it a
milky appearance, instead of the ronges1ed sublin-
gual veíns 1hat we would expect as a siga of blood
stasi.s .
The entanglement of phlegm and blood leads
us to a complíca1ed pathology lha! is very difficult
10 resolve, while at the sarne time causing a pro-
nounced blockage or lhe qi ílow ln lhe channels
and network vessels, which leads to extreme pain,
cyst form.ltion, and adhesions.
OVaTian cysts, which are rommon in endome-
criosis and can contain not only bloody but also
runny or sticky íluld, are certainly a sign of accu-
mulatlng dampness and phlegm that has rurlher-
more cormbined with blood.
20 E.ndometriosls-----Nel /1
caused lhe stagnation can be responsible for this
problem.
lf the biomedical diagnosis shows that 1he fal-
lopian 1ubes are occluded, we can assume that a
mentlon of damp-heat ln lhe 1 - , abdomen is o r
was presem. ln the context of an underlying blood
stasis. the physiological íluids can congeal and the
blood n ow can be further impaired. as a result of
uthirh nn-l11Hrf-Klrnn1:.r.n P11,C.c m :m nrn1r
• painful menstruation (dysmenorrbea. Long jing
•ii!Jand
• a bdominal masses Ui ju l!Hll)
As usual, we examine and evaluate lhe signs and
symptoms of female patients speciíically in rela-
tion 10 the menstl'\Jill cycle. Nevertheless, the con-
tempomy practitioner cannot do without the bio-
medical lindings and will attempl to in1erpret 1he
nature or lhe dispersed endometrial tissue rrom
the TCM perspective and treat acrordingly. As
such, lhe diverse types of pain lhat are caused by
Clinicai Pictur, and Thempy (mm the TCM Plerspeclive
Some modem physicians in lhe People's Re--
public or China who have completed a biomedical
educatlon in addition to their TCM training are
trying to lind a rorrelation between the biomedi-
cally understood macroscopic and microscopic
findings and TCM, in arder to add the missing
aspects in lhe category of dysmenorrhea ca&).
Ler us brieíly deso-ibe 1his perspective here. With
regard to detecting lhe activiry l.evel or peritoneal
or ovarian endometriosis (see Schweppe 2002 in
Feige3), active lesions show a pale red 10 red calor
while in.-.clive lesions in the abdominal cavity ap-
pear blacl< or brown.
From lhe TCM perspective, this aclive pale red
coloration could possibly correspond to the blood
that is leaving the channels due to lhe underlying
blood stasis. The bl.ick inactlve lesions indic.ite
thal the blood that h.is left lhe channels has trans-
formed into ·dead" blood. 801h conditions belong
to the category ar blood s1asis in the u1eru.s and in
1he lower abdomen. An important aspect of 1he
therapy wiU lherefore ronsist of quickening and
moving blood as well as trealing the cause of stag-
nation. The "dead" blood bas thus assumed a
shape, which brings us to the category ar mdom-
lnal masses (l!!JII:). As far as the patient's vitaliry
permits, we now have to integrate lhe strategy or
"breaking blood" in10 lhe prescription.
lnleresting in this context is also lhe descrip-
tion or lhe dlsorder by me.ins of macroscopic cri-
teria (according 10 Schweppe, 1984 in Fe ige3). Ac-
cording to this approach, nodular lesions are dark
red to blue-black. They are mostly palpable as
rough and solid hardenings lha1 are sensitive 10
pressure. The descriplion a r 1his pathologically
changed lissue accords with tbe TCM definilion
for masses due to blood stasis. These nodular le--
sions are responsible for a serious symptom pic-
1ure acrording to biomedlcine as well. ln TCM.
blood stasis pallerns rela1ed to the menstrual
cycle are seen .is responslble for severe paln.
Both blood stasís and phlegm accumulatlon
le ad to a repletlon state ln the lower bumer. lf
this pathology persis1s for a long time. ovarian
cysts, endometrial tissue, or uterlne myomas de--
velop. PWegm and blood stasis preveot qi, blood,
and essence from reaching the uterus and can
thereby lead 10 an irnpairment of lhe fallopian
tubes. Tbe ren mai and chong mal are unable to
rulfill 1heir function or storing essence and prepar-
ing tbe uterus for fertilization. Fertillty is lhererore
ímp.icted considerably also from the TCM perspec-
tive, beca.use deep-lying dlsease patterns lha! have
265
Ne'\lerlheless. in our experience the aipplication
of acupuncture alone appears not to be effective
enough as a proven t reatment of endometriosis.
Under ali circumstances, the use of Chlnese medlc-
lrws is indicated here. lf the patient's symptorns
only occur before and/or during menstruation,
treatment wilh Chinese medicinais should begin
in mid-cycle.