{"paper_id":"71268458-cd78-4952-bca8-26b899c91106","body_text":"~ 71 ~ \nInternational Journal of Herbal Medicine 2014; 2 (1): 71-80\n \n \n \n \n \n \n \n \n \n \n \n \nISSN 2321-2187  \nIJHM 2014; 2 (1): 71-80  \nReceived: 12-01-2014  \nAccepted: 30-01-2014 \n \n \nElizabeth Ohm, L. Ac., DAOM \n(deceased) \nYo San University of Traditional \nChinese Medicine, Los Angeles, CA, \nUSA  \n \nLawrence J. Ryan, Ph.D \nYo San University of Traditional \nChinese Medicine, Los Angeles, CA \nUSA, 13315 W. Washington Blvd., \nLos Angeles, California USA \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n*Correspondence: \nLawrence J. Ryan, Ph.D \nYo San University, 13315 W. \nWashington Blvd., Los Angeles, CA \n90066, Email: lryan@yosan.edu;  \nTel: +1-310 577-3000 x 111;  \nFax:  +1-310 577-3033 \n \n \n \n \n \n \n \n \n \n \n \n \nThe impact of the herbal formula Qing Bao Zhu Yu Tang \nin the treatment of endometriosis \n \nElizabeth Ohm, L. Ac., DAOM (deceased), Lawrence J. Ryan* \n \n \nABSTRACT \nRetrospective chart review research method was employed to analyze data from 120 cases of women \nwho were treated for endometriosis using an herbal formulation known as Qing Bao Zhu Yu Tang.  \nThe cases were analyzed in thre e categories as per the most common condition accompanying \nendometriosis. The three groups included those where endometriosis was associated with infertility \n(n=53), those with polycystic ovarian syndrome (PCOS) (n=7) and those with ovarian cysts (n=38).  \nData from the charts were analyzed in terms of the impact of the Qing Bao Zhu Yu Tang formula on \nendometriosis and the accompanying conditions.  The results evide nced the positive impact of the \nformula. The pain effectiveness level survey rating for the en tire sample of 120 patient charts shows \nthat 116 patients (96.7% responded with indication of some level of effectiveness. From the total \nsample of 120 patients, the satisfaction survey shows that 111 patients (92/5%) responded in the \n“satisfied” range. The results were discussed regarding implications for practice, and recommendations \nwere made for future related research. \n \nKeywords: Endometriosis, herbals, traditional Chinese medicine; fertility, reproduction \n \n1. Introduction \nThe prevailing theory about t he development of endometriosis is that the condition occurs \nwhen menstrual blood backflows through the fallopian tubes, carrying with it endometrial cells \nthat are then transplanted to ectopic sites, such as the peritoneal cavity, the ovaries, the \nuterosacral ligaments, or the pouch of Douglas, where they implant, proliferate and develop. It \nis a gynecological disorder with clinical symptoms of menstrual pain, pelvic pain and \ninfertility, and is one of the most complex and least understood diseases. The pa in of \nendometriosis is severe and debilitating and can cause significant health problems for women \nduring their reproductive years [6]. Endometriosis is the number one cause of infertility; 38% of \nwomen who are infertile and 70-80% of women with chronic pain have endometriosis [1]. More \nthan 10 million women have endometriosis in the United States [2]. Furthermore, in the U.S., \nannual healthcare costs and costs of productivity loss associated with endometriosis were \nestimated at $22 billion in 2002 [3].  \nIn a review of Western Medicine theories about the causation of endometriosis theories \ninclude: the involvement of hormones, the immune system of the body, inherited immune \ndeficiency, menstrual blood containing endometrial cells flowing back through the fal lopian \ntubes, apoptosis which helps maintain cellular homeostasis during the menstrual cycle, protein \nexpression, sexual intercourse during menstrual period, immunologic abnormalities  and \nantinuclear antibodies (ANA) in the blood of women [4].      \nThe onl y way to identify, for certain, that a patient has endometriosis is to look inside her \nabdomen (direct visualization) for signs of endometrial tissue. This is accomplished during a \nlaparoscopy, which is a minor surgical procedure. For several decades lapar oscopy has been \nthe gold standard for the diagnosis of endometriosis [5]. A definite diagnosis of endometriosis \nonly can be made through histology of lesions removed at surgery. Neither serum makers nor \nimaging studies have been able to supplant diagnostic  laparoscopy for the diagnosis of \nendometriosis.  \nThe objective of this study is to discern and describe the effectiveness of the Qing Bao Zhu Yu \nTang formula on the condition of endometriosis. The discussion with proceed with an overview \nof the Traditiona l Chinese Medicine perspectives regarding the etiology and treatment of \nendometriosis.\n\n\n \n~ 72 ~ \nInternational Journal of Herbal Medicine \n \n1.1Endometriosis from a Traditional Chinese Medicine   \n     Perspective \nTraditional Chinese Medicine does not recognize \nendometriosis as a disease, but instead as a cl uster of symptoms. It \nis referred to as menstrual pain due to accumulation of menstrual \nblood in the lower abdominal cavity (Classic Fu Ren Kyu Pang). \nThe primary pattern, or mechanism, that causes endometriosis is \nblood stasis. Blood stasis can be caused by emotional disturbance, \nchronic illness, exposure to cold temperatures, surgery, and genital \ninfections. When the pattern of disease is blood stasis, the objective \nof the treatment is to invigorate blood and remove stasis, using both \nacupuncture and Chin ese herbal medicine. In addition to blood \nstasis, there are often other disease -causing factors which are part \nof the patterns of endometriosis. Cold, heat, deficiency, or excess \npatterns are frequently part of the mix, and are differentiated based \non the clinical manifestations associated with each case of \nendometriosis.  In the Classic Fu Ren Kyu Pang, endometriosis is \nreferred to as menstrual pain due to accumulation of menstrual \nblood in the lower abdominal cavity (Classic Fu Ren Kyu Pang). \nThis early t heory is not so different from the Western \nunderstanding of endometriosis by Sampson [6] and D’ Hooghe [7]. \nBoth authors suggest the widely accepted theory that the primary \nmechanism of endometriosis is involved from retrograde \nmenstruation and implantation of the endometrial tissue in ectopic \nsites.  \nTraditional Chinese Medicine classifies endometriosis into \nunique categories of stagnation and obstruction: Qi Stagnation and \nBlood Stasis, Qi Deficiency and Blood Stasis, Heat Obstruction and \nBlood Stasis, Cold Retention and Blood Stasis, Kidney Deficiency \nand Blood Stasis. Endometriosis is also known one of abdominal \nMasses are called Ji, Ju (Zheng Jia). The term appears in the \nClassic of Difficulties, which clearly distinguishes two types: \n \n1. Ji (Zheng): Ji (Z heng) indicates actual abdominal masses \nwhich are immovable because it arises from a Yin organ, is \nassociated with pain, its location is fixed and the masses are \ndue to blood stagnation. It is stated in The Golden Cabinet by \nZhang Zhong Jing, “Ji masses ar ise from the Yin organs and \nthey cannot be removed.  \n2. Ju (Jia): Ju (Jia) indicates abdominal masses which come and \ngo, do not have a fixed location and are movable. If there is an \nassociated pain, it comes and goes and changes location. Such \nmasses are due to stagnation of qi, and they are easier to treat.  \nAnother name for abdominal masses is Zheng Jia. Zheng is \nequivalent to Ji, while Jia represents Ju. The terms Zheng Jia \nand Ji Ju are used when referring to abdominal masses in \nwoman, but they do occur in  men, as well. It is stated in the \nSimple Questions in Chapter 60 of Huang Di Nei Jing Classics \nthat Ji Ju refers to non-substantial masses from qi stagnation.  \n \nEmotional dispositions, such as anger, repression or \nfrustration, cause the formation of abdominal masses due to liver qi \nstagnation, leading to stasis of liver blood. Liver blood circulates \nand nourishes a woman’s genital area and uterus. Any interruption \nof the free flow of liver qi eventually causes blood stasis in the \nuterus. The excessive inge stion of raw foods may lead to the \nformation of cold in the lower abdomen. Cold nature interferes with \nthe circulation of qi and, especially, blood; it may lead to stasis of \nblood.  Eating greasy foods excessively impairs the spleen and may \nlead to the for mation of dampness and phlegm lodged in the lower \nabdomen and creating abdominal masses. The interaction between \nphlegm retention and stasis of blood may lead to or aggravate the \nother.  Cold invades the lower abdomen and impairs the circulation \nof blood leading to stasis of blood. Ji masses are due to Cold (The \nSpiritual Axis Chapter 66). Dampness may invade the channels of \nthe legs and then creep up them to settle in the lower abdomen, and \nlater on transforms into phlegm and may cause abdominal masses.  \nThe pathology of endometriosis is characterized by stagnation of qi \nor stasis of blood. The qi stagnation being non -substantial and the \nblood stagnation is substantial masses. In addition to stagnation, \nthere may also be phlegm. Masses from phlegm feel soft on \npalpation and have a fixed location without pain. Additionally, \nblood stagnation may cause blood stasis and become hard and \nfixed with or without pain [8].   \n \n1.2 Treatment of Endom etriosis in Traditional Chinese \nMedicine   \nIn a 1980 hallmark study, researchers at the Obstetrics and \nGynecology Hospital in China published the first report of a large -\nscale clinical trial of Chinese herbs for endometriosis.  The 156 \npatients were divided into three groups according to syndrome, and \ngiven one of three possibl e treatments: Group one was given a \ncombination of sparganium, zedoaria, gleditsia spine, cyperus, \nbupleurum, tang-kuei, bulrush (typha), and pteropus in decoction, \nplus an “endometriosis powder” made with earthworm, tabanus, \ncentipede, and leech. Group tw o was given a similar combination, \nbut the bupleurum, cyperus , and tang -kuei were replaced by \ncodonopsis, astragalus , and cimicifuga. Group three received an \nintravenous drip of salvia extract daily. This rather inconvenient \ntherapy delivers an extract of an herb currently used for \nnormalizing blood circulation. The individuals in this treatment \ngroup would usually also receive some herbs in decoction. Each of \nthe groups received the treatment for two to three menstrual cycles.     \nIn this study 128 of the women (82%) had their symptoms \nmostly or entirely alleviated, while 28 of the women (18%) had \neither no effect or the benefits of the treatment were lost soon after \nstopping use of the herbs. Considerable laboratory analysis was \nalso done, investigating th e condition of the blood contents before \nand after treatment and in different phases of the menstrual cycle, \nbut while the results were suggestive, not enough of the women \nwere analyzed by these means to draw firm conclusions [9]. \nPrior literature reveals a variety of formulas recommended \nfor the treatment of endometriosis. Tao Hong Si Wu Tang is a \nrenowned blood stasis -relieving formula. Four-Substance \nDecoction with Safflower and Persica Seed is used to treat blood \ndeficiency and blood stasis. Ge Xia Zhu Yu Tang, which translates \nto Driving out Blood Stasis below the Diaphragm Decoction , is a \nstagnation/stasis-relieving formula. It is a formula from the famous \nphysician Wang Qing Ren, who practiced in the latter part of the \n19th century and expounded upon the theory of blood stasis for the \ntreatment of endometriosis. The traditional prescription can be \n“updated” for the treatment of endometriosis, but is more \nfrequently used for fullness and distension in the epigastric region. \nXue Fu Zhu Yu Tang  is a formu la from the famous physician \nWang Qing Ren, and pertains to the theory of heat obstruction and \nblood stasis for the treatment of endometriosis.  The theory is that \nqi stagnation occurs first, followed by stagnation of blood. Shao Fu \nZhu Yu Tang is another f ormula by Wang Qing Ren, developed in \nthe latter part of the 19 th century.  Shao Fu Zhu Yu Tang, which \ntranslates to the decoction for driving out blood stasis from the \nLower Abdomen, is used when a blood stagnation syndrome, such \nas endometriosis, is caus ed by a cold syndrome, which may be \ncaused by environmental factors or diet [10]. In one study Shao Fu \nZhu Yu Tang was used for 60 endometriosis patients, and the \n\n \n~ 73 ~ \nInternational Journal of Herbal Medicine \nresults showed 97.5% improvement [11, 12]. Tao Ren Cheng Qi Tang \nis a formulation for treatin g acute abdominal pain based on the \npurgative and blood vitalizing herbs. This formula is used for \nconditions in which a heat syndrome causes the blood to escape and \ncause obstruction. The author of this analysis cited treating a \nwoman with a diagnosis of endometriosis, or “nodules on the \nposterior uterine wall.” With this formula; after three months the \nwoman was relieved of symptoms and became pregnant [10].   \nAnother formula often used in the treatment of \nendometriosis, Dai Deying, was studied in 1982 at  the Shanghai \nCollege of Tr aditional Chinese Medicine. The basic formula for \npatients with endometriosis having dysmenorrhea was bupleurum, \nred peony, moutan, salvia, corydalis, melia, cyperus, saussurea, \npatrinia, prunella, rubus,  oyster shell, bulrush, a nd pteropus. \nAcross 30 cases of endometriosis the effective rate was observed to \nbe 80%. Nei Yi Fang (Endometriosis Formula) was used with 43 \ncases of endometriosis in Shanghai, by workers at the First \nPeople’s Hospital and at the Hangkou District Hospital . The \nformulas were modified according to specific symptoms that were \npresent. The effectiveness rate was 88%, with four of the women \ngetting pregnant [11].  \nIn review of the endometriosis work by Tang [13] with \nexcerpts published in the International Journal of Oriental Medicine \nin 1992, the formula of tripterygium had been used in treating \nendometriosis, with an effective rate of 80%. It functions as an \nimmune-suppressive anti -inflammatory, acting much like \nprednisone. Its success suggests that the autoimmune hypothesis for \nendometriosis is correct. The herb formula was able to “thin the \nblood” reducing the abnormally high viscosity and RBC \nelectrophoretic time. It acts to reduce excess populations of \nimmunoglobulin’s, C3 (complement protein), and T8 cells  in \nperipheral blood. The Shanghai College of Traditional Chinese \nMedicine affiliated hospital reported in 1991 an apparently \nsuccessful treatment for endometriosis with the use of Neiyi Wan \n#1 (Endometriosis pill) three herbs, using turtle shell, vinegar -\ntreated rhubarb, and succinum. The study involved 76 cases of \nendometriosis, with 61 “effectively treated,” a rate of 80%.  \nAlong similar lines, workers at the Xuzhou Medical \nCollege (21) gave endometriosis patients a basic formula of \naconite, evodia, fenn el, dipsacus, dioscorea  , tang -kuei, saliva, \ncorydalis, cnidium, and persica. This formulation would be \nmodified for various syndromes, including the use of epimedium \nand cinnamon bark for kidney yang deficiency, rehmannia and \nligustrum for kidney yin deficiency, pteropus and bulrush for pain. \nOf 54 women treated by this method, 25 were reported cured, and \n26 others showed improvement, with a total effective rate of 94%. \nA report from the Heilongjiang College of Traditional \nChinese Medicine affiliated hospital in Harbin in 1992, once again \nshowed that blood -vitalizing herbs were the key ingredient. The \nstudy involved 64 patients who were treated with a decoction of \nsalvia, pteropus, sparganium, zedoaria, cyperus, corydalis, and \nloranthus. Modifications were made as deemed necessary, and \ntreatment was generally continued for two to three menstrual \ncycles, without interruption. It was reported that 18 were cured \n(28%), 26 markedly improved, 16 patients improved, and 4 did not \nrespond. Blood and plasma viscosity  levels and red blood cell \nelectrophoretic time were noted to be high in women with \nendometriosis before treatment compared to normal values, and \nthese were reduced to near normal levels after treatment.  \nEnglish language information about Chinese medical treatment of \nendometriosis first appeared in 1983, and there have been reports \nin journals and books appearing regularly since about 1988. The \nInstitute for Traditional Medicine has mentioned this literature and \nreceived reports about the experience of tre ating endometriosis \npatients in the early 1990’s. The two endometriosis studies were \norganized by Arthur Shattuck, an acupuncturist and herb specialist.  \nIn the first study, 17 patients participated, all had endometriosis \nconfirmed by laparoscopy, and the total effective rate was 75%. \nNeiyi Wan #1 was produced in tablet form (Turtle Shell Tablets, \nSeven Forests) for evaluation in the United States in 1993. Initial \nreports from ITM’s An Hao Natural Health Care Clinic in Portland, \nOregon were favorable. Arthu r Shattuck initiated a treatment \nprogram involving four sites in 1993 (two in Wisconsin and two in \nIllinois), using the Lindera 15 and Corydalis 5, plus Turtle Shell \nTablets in some patients, 14 clients under care all described a \ndecrease in symptoms during the initial treatment period. He found \nthat many people discontinued treatment after getting some relief, \nso that while the benefits were obvious, the full research project \nwas not completed [14]. \n \n1.3 Qing Bao Zhu Yu Tang Formula \nThe prescription that i s the focus of the current study is \nnamed “Qing Bao Zhu Yu Tang.”  For many years the current \nresearcher has used this formula for the treatment of endometriosis \nand the associated symptoms of menstrual pain, pelvic pain, \ninfertility, complications of ovar ian cysts and others associated \nproblems. The translated meaning of the Qing Bao Zhu Yu Tang \nformula is simply “Clean and Drive out Blood Stasis from Uterus.”  \nThe Qing Bao Zhu Yu Tang formula contains:  Flos Lonicerae \nJaponic (Jin Yin Hua), Semen Coicis Larchryma-Jobi (Yi Yi Ren), \nHerba Cum Racice Patriniae  (Bai Jiang Cao), Radix Dipsaci \nAsoeri (Xu Dan), Rhixoma Cyperi Rotundi  (Xiang Fu Zi), Spica \nPruncelle Vulgaris (Xia Ku Cao), Thallus Algae (Kun Bu), Radix \nNiuxi ( Niu Xi), Radix Angelicae Sinensis  (Dang Gui), Radix \nPaeoniae Rubrae (Chi Shao Yao), Rhizoma Sparagnii Stoloniferi  \n(San Ling), Rhizoma Curcumae Ezhu (E-Zhu), Radix Ligustici \nChuanxiong (Chuan Xiong), Cortex Moutan Radicis (Mu Dan Pi), \nRhizoma Corydallis Yanhusuo (Yan Hu Suo), Excrementum \nTrogopteri Seu Peromi  (Wu Ling Zhi), Fructus Cragrantis (Shan \nZha), Massa Fermentata  (Shen Qu), Fructus Hordei Vulgaris \nGerminantus (Mai Ya), Fructus Immaturus Citri Aurantii (Zhi Ke), \nRadix Glycyrrhizae (Gan Cao).  \nThe chart below describes the formula Qing Bao Z hu Yu Tang, \nincluding each herb’s function [10] and pharmaceutical effect [15].  \n \nThe Function and Pharmacological Effect of Herbs in Qing Bao Zhu Yu Tang \nHerb Contents \n(Pinyin Name) Function of herbs Pharmacological effect & chemical \ncomposition \nFlos Lonicerae \nJaponic \n(Jin Yin Hua) \nClear heat and relieve fire toxicity, \nClear damp heat \nAntibacterial, inhibit bacteria, salmonella, \nantiviral effect \nSemen Coicis \nLarchryma-Jobi \n(Yi Yi Ren) \nClear heat expels pus, clear dam \nheat, treats plantar warts \nEffect on neoplastic cells, also effect on striated \nmuscle, treats mayoma. \nHerba Cum \nRacice Patriniae \nClear heat, relieves toxicity, expels \npus, dispels blood stasis & stops \nTreat mumps, suppurative abscesses, remove \ninternal abscess & remove pain \n\n \n~ 74 ~ \nInternational Journal of Herbal Medicine \n(Bai Jiang Cao) pain \nRadix Dipsaci \nAsoeri \n(Xu Dan) \nPromote blood, alleviates pain, \nstrengthens bones, reduce swelling \n& abscess \nBeta-sitosterol, hedragenin, uroaldehyde, uriolic \nacid & vitamin E effects \nRhixoma Cyperi \nRotundi \n(Xiang Fu Zi) \nRegulate menstruation & alleviates \npain, spread qi \nVolatile oil contains estrogen like substance, \nbeta-pinene etc. \nSpica Pruncelle \nVulgaris \n(Xia Ku Cao) \nClear heat & dissipates nodules, \nlipoma, neck lumps \nIncrease secretion of ACTH, Glucocorticoid, \nantibiotic effect, effect on lipoma. \nThallus Algae \n(Kun Bu) \nReduce phlegm, swelling, softens \nhardness, promotes urination, \nregulate water circulation. \nEffects to ardio vascular, hypoglycemic, serum \ncholesterol and triglyceride. Contains algin, \nlaminine, iron, potassium, iodine. \nRadix Niu xi \n(Niu Xi) \nDispels blood stasis, invigorates \nblood, direct fire down & clear \ndamp heat in the lower burner \nEffect on uterus causes uterine dilation, \ncardiovascular effect by inhibit peripheral \nvasodilation \nRadix Angelicae \nSinensis \n(Dang Gui) \nInvigorate & harmonize blood, \nreduce swelling, expels pus, \ngenerate flesh and alleviates pain \nRelaxes uterus, anti platelet, antibiotic, \nphagocytic, ant-inflammatory by secretion of \nacetylsalicylic acid. \nRadix Paeoniae \nRubrae \n(Chi Shao Yao) \nInvigorate blood, dispels blood \nstasis, clear liver fire, cools blood \nVasodilator effect , anti-inflammatory, antibiotic \nand effect on CNS from strychinine \nRhizoma \nSparagnii \nStoloniferi \n(San Ling) \nForcefully break up blood stasis,  \ndissolve accumulation of severe \nabdominal pain and distension \nAnti-neoplastic, inhibit aggregation of platelets \nand prolong thrombin time \nRhizoma \nCurcumae Ezhu \n(E-Zhu) \nBreak up blood stasis, remove \nmasses, activate circulation and \nrelieves pain. \nAnti-neoplastic, antibiotic, hematological \nfunction. Treat sarcoma and cervical cancer \nRadix Ligustici \nChuanxiong \n(Chuan Xiong) \nInvigorate blood and promotes the \nmovement of qi. Remove \nstagnation of qi & blood stasis \nHypertonic barbiturate effect. Antibacterial, \nantifungal and antihypertensive effect. \nCortex Moutan \nRadicis \n(Mu Dan Pi) \nInvigorate blood & cools blood. \nDispel stasis, drain pus, reduces \nswelling, clear fire from deficiency \n \nInhibitory staphylococcus, bacillus. Reduce \npermeability of the capillaries & has hypnotic \nand tranquilizing effect. \nRhizoma \nCorydallis \nYanhusuo \n(Yan Hu Suo) \nRemove pain due to blood stasis \nsuch as menstrual pain, promotes \nqi and invigorate the blood \nAnalgestic effect as morphine of corydaline. \nHypnotic sedative, acts to cortex of grey mater. \nExcrementum \nTrogopteri Seu \nPeromi \n(Wu Ling Zhi) \nDisperse blood stasis & alleviate \npain, transform stasis and stops \nbleeding, childhood nutritional \nimpairment with focal distention. \nRelieves muscle spasm of smooth muscle. \nContains vitamin A, uric acid, urea, resin \nFructus \nCragrantis \n(Shan Zha) \nRemove meat stagnation from \nalcoholism. Transforms blood \nstasis and dissipate clumps. Stops \ndiarrhea \nRemove Glycoprotein, antihypertensive, \nantibiotic effects. Contains tartaric acide \nMassa \nFermentata \n(Shen Qu) \nReduce food stagnation of \nalcoholism, epigastric fullness \nGastro-intestinal effect release enzyme to \nfacilitate digestion of starches and carbohydrate, \nyeast. \nFructus Hordei \nVulgaris \nGerminantus \n(Mai Ya) \nReduce food stagnation & \nfacilitate stomach qi flow, inhibit \nlactation \nUses for hyper lactic hormone, contains amylase, \nmaltose, Invertase, dextrin. Treat hepatitis \nFructus \nImmaturus Citri \nAurantii \n(Zhi Ke) \nRelives distension, break up \nstagnation, resolve accumulation \nContains Naringin. Effects to cardiovascular, \nrespiratory (synephrine), antiplatelet, and \nantineoplastic(nobiletin) \nRadix \nGlycyrrhizae \n(Gan Cao). \nClear heat & relieves fire toxicity. \nModerate spasm and alleviates \npain, tonifies spleen & arguments \nthe qi. Moisten Lung & stops \ncoughing \nEffects as Mineralocorticoid, glucocorticoid. \nTreat Addison’s disease by excretion of 17-\nketosteriods. Treat diabetes insipidus, chronic \nbronchial asthma, detoxifying effect. \n \nThe value of the above detailed formula is that it not only \ninvigorates the blood and transforms stasis from the wei, qi, ying , \nand xue at all four levels, but it also invigorates blood without \nconsuming it and dispels blood stasis while encouraging the \ngeneration of new blood. The formula is contraindicated during \npregnancy and during excessive menstrual bleeding. The book of \nNei Jing states, “If the qi circulates, then the blood will circulate.” \n \n\n \n~ 75 ~ \nInternational Journal of Herbal Medicine \nThe actions of the Qing Bao Zhu Yu Tang formula can be \nsummarized as follows: \n Invigorates the blood, break up and dissolve \nblood stasis \n Clear heat and expel damp, pus and toxicity \n Dispels blood stasis, dissipates nodules such as \nlumps or nodules  \n Disperses qi stagnation and regulate liver qi  \n Alleviates pain  \n Promote the circulation of blood \n Thins blood viscosity  \n Generates new blood \n Helps digestion and dissolve glycol-protein \n \n1.4 Indications of the Use of Qing Bao Zhu Yu Tang \nThe Qing Bao Zhu Yu Tang formula is most appropriate for the \ntreatment of blood stasis accumulating in the lower abdomen \ncharacterized by palpable masses which may or may not be painful.  \nIt is also indicated in ca ses of  lower abdominal pain without \npalpable masses, lower abdominal distention during menstruation, \nor frequent menstruation (3 -4 times per month) in which bleeding \nis due to blood stagnation and blood stasis. This formula is \nspecifically designed for th e prevention and treatment of \nendometriosis. The formula can also be used to treat patients with \ndiagnoses of ovarian cysts, obstruction of fallopian tubes, \ninflammation of the uterus, vaginal discharges, appendicitis, \nruptured ovarian cyst, polycystic ova rian syndrome, uterus cancer, \ndysmenorrheal, amenorrhea, uterus fibrosis, uterus myoma, high \nplatelet count, thinning blood viscosity. It is also used for the \nprevention of habitual miscarriage and for the prevention of \nendometriosis.   While the current r esearcher’s clinical experience \naffirms the efficacy of the Qun Bao Zhu Yu Tang formula in the \ntreatment of endometriosis, there have been no published studies \nwhich have systematically examined the impact of the Qing Bao \nZhu Yu Tang formula specifically f or the treatment of \nendometriosis. The current study will begin to fill that blind spot in \nthe current literature. \n \n2. Materials and Method \nThe current study used chart review method to obtain data from the \narchived files of 120 patients with the diagnosis  of endometriosis. \nCharts were reviewed and data were systematically gathered from \npatients that had been treated with Qing Bao Zhu Yu Tang or a \nmodification of that formula. The method of retrospective chart \nreview method is a recognized qualitative procedure, was chosen as \nthe means for achieving the research objective of the current study \n[16].   \n \n2.1 Chart Selection \nThe sample used in the current study may be described as a \n“convenience sample.” A convenience sample is not based on \nrandom or probability  selection. Nonetheless, a convenience \nsample has the potential to provide good representation of a \nfocused and defined population. Non - probability sampling is used \nbecause of the very specific inclusion criteria and the location of \nthe current study limi ts the availability of data to clinical charts \nfrom a busy Traditional Chinese Medicine Clinic in Los Angeles. \nThe study began with an analysis of 275 charts of patients who \nsuffered and sought treatment for endometriosis from May 2008 to \nDecember 2010 at the designated Los Angeles clinic. All charts of \nfemale patients who sought treatment for endometriosis were \nscreened for inclusion in the study. Patients’ charts were selected \nfor data collection in the current study according to the inclusion \nand exclusion criteria detailed in the sections below.  \n \n2.2 Inclusion Criteria: \n Women \n Age 18 years old to 45 years old \n Must have intact uterus \n Seen as a patient for the treatment of endometriosis between \nMay of 2008 to December of 2010. \n Treatment included taking the Qing Bao Zhu Yu Tang formula \nfor ten days or longer \n Chart data includes pain and satisfaction survey data \n \n2.3 Data Recording Form \nThe clinical Charts comprised of the intake form, the patient’s \nhistory of treatment, doctor’s notes, diagnosis of tradition al \nChinese medicine, treatment principle regarding each patient, as \nwell as any laboratory test data available in the charts. A two page \ndata collection instrument was developed by the researcher to \ncapture data relevant to the objectives of the current st udy. The \nform that was developed included a patient identification number \nwith no patient names, age of the patient, TCM, Western and other \ndiagnoses, indication of the treatment phase as well as other \nclinical and observational data. A copy of the data co llection \ninstrument is included in the appendix of this study.  \n \n2.4 Procedures   \nUsing the data collection instrument detailed above, the researcher \npulled and examined approximately 275 charts with 120 files \nmeeting the inclusion criteria of the current study. All charts were \nreviewed February 2011 and July 2011. The proposal for the \ncurrent study was reviewed and approved by the Institution Review \nBoard (IRB) of Yo San University. \n \n3. Results  \nOf the 275 female charts reviewed, 120 charts were yielded wi th \nthe diagnosis of endometriosis. Each of the 120 patients had been \ntreated with Qing Bao Zhu Yu Tang or a modification of that \nformula. In the process of treating the patients for endometriosis \neighteen different categories of associated symptoms were \nobserved. Four of the categories of associated symptoms were \nconsidered primary because of the number of cases observed. The \nfour categories include women whose endometriosis was also \nassociated with infertility, polycystic ovarian syndrome (PCOS), \nvaginal d ischarge, and ovarian cysts. For each of the four \ncategories between seven and fifty-three cases were observed. This \nstudy will proceed by analyzing the data that were observed from \nthree of the four primary groups —Infertility, Ovarian Cysts and \nPCOS. Beca use it’s a common and non -specific symptom, data \nregarding the fourth group, the Vaginal Discharge group, were not \nincluded in the statistical analyses conducted in this study. The data \nreported included the age of each patient, as well as the “phases” or \nlength of time that they took the Qing Bao Zhu Yu Tang formula. \nPatients categorized as Phase One patients took the formula for 10 \ndays; Phase Two patients took the formula for 20 days; Phase \nThree patients took the formula for 30 days and Phase Four \npatients took the formula for 40 days. The data are reported \nregarding the original Qing Bao Zhu Yu Tang formula, for the \nQing Bao Zhu Yu Tang modified formula as well as for those \npatients who took both the original as well as the modified Qing \nBao Zhu Yu Tang formulas.  \n3.1 Data Summaries for the Study Variables \n1. Demographic Data-Age:  From the full sample of 120 cases of \nthe age distribution observed the mean age 36.51, SD 7.33, \n\n \n~ 76 ~ \nInternational Journal of Herbal Medicine \nminimum age of 19 year, Maximum age of 45 year. The pain \neffectiveness survey obse rved mean score of 3.87, SD 1.06 \nfrom the scale of minimum 1 to maximum 5. The satisfaction \nsurvey observed mean score was 3.91, SD 0.88 from the scale \nof minimum 1 to maximum 5.  \n2. Formula taken for 10 days and formula taken longer than 10 \ndays: The frequen cy distributions for formula taken 10 days \nfrom the full sample of 120 cases yielded 72 cases (60%); 48 \ncases (40%) took the formula longer than ten days. T -Tests \nwere computed to discern if there were differences between \nthose who took the formula for ten  days, and those who took \nthe formula longer than ten days.  \n \nTable 2: T Test data regarding formula by number days taken \n Ten days N Mean SD T df p-value \nPain effect 10 days 72 3.74 1.05 -1.664 118 .099 \n > 10 days 48 4.06 1.06    \nSatisfaction 10 days 72 3.82 0.84 -1.361 118 .176 \n > 10 days 48 4.04 0.92    \n \nThere was no significant difference between those who took the \nformula for ten days compared to those who took the formula for \nlonger than ten days . However, there was a trend (p < .10) in the \nexpected direction for the reduction in pain to be greater for those \nwho took the formula for longer than ten days. \n \n3. Formula taken alone with no modification to the formula vs. \nthe formula taken with modification: For the formula taken \nalone with no modificat ion 87 cases were observed (72.5%); \nfor the formula taken with any modification there were 33 \ncases (27.5%) (See Table 3). \n \nTable 3:  T-Tests Comparing Those Taking the Formula Alone with Those Taking the Formula with Modifications \n Formula Alone N Mean SD t Df p-value \nPain effect Formula alone, no modification 87 3.83 1.12 -.654 118 .515 \n Formula with any modification 33 3.97 0.88    \nSatisfaction Formula alone, no modification 87 3.86 0.92 -.935 118 .351 \n Formula with any modification 33 4.03 0.77    \nNo significant differences found \n \n4. Pain effectiveness study variance: From the full sample of 120 \ncases the pain effectiveness survey response range was from \n0% to 100%; 4 cases (3.3%) responded at the 0% effectiveness \nlevel; 12 cases (10%) responded at  the 30% effectiveness \nlevel; 16 patients (13.3%) responded at the 50% effectiveness \nlevel; 52 patients (43.3%) responded at the 70% effectiveness \nlevel; 36 patients (30%) responded at the 100% effectiveness \nlevel. The overall effectiveness rating for the entire sample of \n120 patient charts shows that 116 patients (96.7%) responded \nwith indication of some level of effectiveness.  \n \n5. Satisfaction data: From the full sample of 120 cases the \nsatisfaction survey yielded a response range from “not \nsatisfied” to “v ery satisfied” using a rating of 1 for “not \nsatisfied” up to a rating of 5 for “very satisfied. The results \nyielded 2 patients (1.7%) indicating a rating of “not satisfied.”   \nThere were 7 patients (5.8%) indicating “not satisfied - but it \nwas worth try.”  There were 19 patients (15.8%) who indicated \n“moderately satisfied,” and 64 patients (53.3%) who indicated \n“satisfied,” as well as 28 patients (23.3%) who indicated that \n“very satisfied.” Overall from the total sample of 120 patients, \n9 patients (7.5%) res ponded in the “not satisfied” range, and \n111 patients (92.5%) responded in the “satisfied” range. \n \nTable 4: Pearson Correlations-Pain Effect and Satisfaction (n=120) \n  Pain Effect Satisfaction \nAge r 0.017 -.049 \n p-value 0.850 .597 \nPain Effect r  0.852 \n p-value  < .001 \nThere is no significant relationship observed between age and the reduction in pain or level of satisfaction with treatment. As expected there is a highly \nsignificant relationship between the reduction in pain and level of satisfaction with treatment (r =0.852, p <.001) \n \n6. For the four designated study variables subgroups the \nfollowing statements summarize the observed data: \n1) Ovarian Cysts study variable:  From the full sample \nof 120 cases, 38 cases (31.7%) had ovarian cysts \nobserved. All of those cases (100%) reported that they \nwere helped by the formula. Of the 120 cases, 82 \npatients (68.3%) had no ovarian cysts.  \n2) Infertility study variable:  From the full sample of 120 \ncases, 30 (25%) reported that they were trying to get \npregnant, and that the formula helped them to achieve \nthat goal. Of the 120 cases, 23 (19.2%) reported that \nthey were trying to get pregnant, and that the formula \ndid not help. Overall, from the 53 cases trying to get \npregnant, 44.2% had a diagnosis of infertility.  \n3) Vaginal discharge study variable:  From the full \nsample of 120 cases, 19 (15.8%) had vaginal \ndischarge and reported that the formula helped to \nrelieve that symptom. Of the 120 cases, 101(84.2 %) \ndid not have vaginal discharge.  \n4) PCOS study variable:  From the f ull sample of 120 \ncases, 7 (5.8%) had a diagnosis of PCOS, and \nreported that the formula helped. Of the 120 cases \n113 (94.2 %) had no PCOS diagnosis.  \n \n \n \n\n \n~ 77 ~ \nInternational Journal of Herbal Medicine \nTable 5:  Data summaries for Subgroups:  Ovarian Cyst, PCOS, and Vaginal Discharge \n Had ovarian cyst and formula helped \n10 days 17 44.7% \n> 10 days 21 55.3% \nTotal 38 100.0% \n  \n Had ovarian cyst and formula helped \nFormula alone, no modification 21 55.3% \nFormula with any modification 17 44.7% \nTotal 38 100.0% \n Had PCOS and formula helped \n10 days 3 42.9% \n> 10 days 4 57.1% \nTotal 7 100.0% \n   \n Had PCOS and formula helped \nFormula alone, no modification 6 85.7% \nFormula with any modification 1 14.3% \nTotal 7 100.0% \n Had vaginal discharge and formula helped \n10 days 11 57.9% \n> 10 days 8 42.1% \nTotal 19 100.0% \n Had vaginal discharges and formula helped \nFormula alone, no modification 11 57.9% \nFormula with any modification 8 42.1% \nTotal 19 100.0% \n \nComparisons for those trying to get Pregnant (table 5 continued) \n   \nTrying to get \npregnant and \nformula helped \nTrying to get \npregnant and \nformula did not help \nTotal \nLength of time 10 days Count 20 17 37 \n  % 54.1% 45.9% 100.0% \n > 10 days Count 10 6 16 \n  % 62.5% 37.5% 100.0% \nTotal  Count 30 23 53 \n  % 56.6% 43.4% 100.0% \n \nPearson Chi-square = 0.32, df = 1, p = .569 – no significant difference found\n  \n   Trying to get pregnant \nand formula helped \nTrying to get pregnant \nand formula did not help \nTotal \nProtocol Formula alone, no \nmodification \nCount 25 19 44 \n% 56.8% 43.2% 100.0% \nFormula with any \nmodification \nCount 5 4 9 \n%  55.6% 44.4% 100.0% \nTotal  Count 30 23 53 \n  %  56.6% 43.4% 100.0% \n \n3.2 Fisher's Exact Test \nResults of Fisher’s Exact Test yielded a 1.00 value. Slightly more \nof those who  were trying to get pregnant were helped by taking the \nformula (56.6%) compared to those  who were trying to get \npregnant but were not helped (43.4%) by the formula. However, no \nsignificant differences were found based on how long the formula \nwas taken (ten days vs. longer), or regarding whether or not \nmodifications were added to the formula. \n \nTable 6: Frequency Distributions for Study Variable-Length of Time Taking Formula \n   Trying to get pregnant and \nformula helped \nTrying to get pregnant and \nformula did not help Total \nTen \ndays \n10 \ndays Count 20 17 37 \n  % 54.1% 45.9% 100.0% \n > 10 \ndays Count 10 6 16 \n  % 62.5% 37.5% 100.0% \nTotal  Count 30 23 53 \n  % 56.6% 43.4% 100.0% \n \n\n \n~ 78 ~ \nInternational Journal of Herbal Medicine \nTable 7 displays the data that emerged from the current study that \nwere subjected to statistical analyses. While there were four \ncategories of data collected, only data from three categories (the \nInfertility, PCOS and Ovarian Cyst groups) were subjected to  \n \nstatistical analysis. As indicated above, because the Vaginal \nDischarge group represents a very common and non - specific \nsymptom, the data f rom that group were not included in the \nstatistical analysis summarized in Table 7. \n \nTable 7: Frequency Distribution for Formula Alone and Formula Modified\n10 days  Frequency Percent \n 10 days 72 60.0 \n > 10 days 48 40.0 \n Total 120 100.0 \nFormula Alone  Frequency Percent \n    \n Formula alone, no \nmodification 87 72.5 \n Formula with any \nmodification 33 27.5 \n Total 120 100.0 \nPain Effect  Frequency Percent \n 0% 4 3.3 \n 30% 12 10.0 \n 50% 16 13.3 \n 70% 52 43.3 \n 100% 36 30.0 \n Total 120 100.0 \nSatisfaction  Frequency Percent \n Not satisfied 2 1.7 \n 2 7 5.8 \n Moderately satisfied 19 15.8 \n 4 64 53.3 \n Very Satisfied 28 23.3 \n Total 120 100.0 \nOvarian Cyst  Frequency Percent \n Had ovarian cyst and \nformula helped 38 31.7 \n NA 82 68.3 \nTotal  120 100.0 \n \nPregnancy  Frequency Percent \n \nTrying to get pregnant \nand \nformula helped \n30 25.0 \n \nTrying to get pregnant \nand \nformula did not help \n23 19.2 \n Total 53 44.2 \n NA 67 55.8 \nTotal  120 100.0 \nPCOS    \n  Frequency Percent \n Had PCOS and formula \nhelped 7 5.8 \n NA 113 94.2 \nTotal  120 100.0 \n \nThe sample included a total of 98 cases that constituted the three \nsubgroups designated for analysis (Ovarian Cysts, PCOS and \nInfertility). Those 98 cases had an observed mean age of 36.57 \nyears. For the infertility subgroup the mea n age was 37.26 years. \nFor the ovarian cyst subgroup the mean age was 38.84 years, and \nfor the PCOS subgroup the mean age was 32.14.  \n \nEndometriosis: For the 120 cases observed, 87 were treated with \nthe original formula alone, and 33 were treated with the modified \nformula. For those patients who were treated with the original \nformula for ten days, the largest number, 72, appears in phase 1 \n(ten days) followed by 48 in phase two (twenty days).  \nInfertility: Patients in the sample who also had a diagnosis of \ninfertility constituted the largest group with 53 cases observed. \nBecause these patients in this sub -group also had the diagnosis of \ninfertility, and expressed a desire to become pregnant, additional \ndata regarding full term pregnancy were gathered. Of the  53 cases, \nthe review of charts manifested 30 cases that experienced a full \nterm pregnancy. Of the thirty who experienced a full term \npregnancy, 19 had taken the Qing Bao Zhu Yu Tang original \nformula for phase one. All of the other phases were low (not mor e \nthan three). The data regarding the infertility sub -group are \nreported in Table 5. \n \n\n \n~ 79 ~ \nInternational Journal of Herbal Medicine \nOvarian Cysts: Patients in this group had the accompanying \ncondition of ovarian cysts. There were 38 cases in this subgroup, \nand for each of the 38 cases, chart review in dicated verification of \nthe resolution of the ovarian cysts. For these groups there were ten \ncases each at the Phase 1 and Phase 2 level. For the modified and \nthe combined original and modified groups there were no more \nthan 4 cases observed. See Table 5. \n \nPCOS: There were seven cases where patients had the \naccompanying condition of polycystic ovarian syndrome (PCOS). \nFor all seven of the cases the chart review manifested resolution of \nthe PCOS condition. For this sub -group the highest number \nobserved in an y one phase was three in Phase 2. Because the \nnumber in this category was so small, it is difficult to make any \ndefinitive statements. See Table 5. \n \n4. Discussion \nSince the Qing Bao Zhu Yu Tang formula is new and not widely \nused in Traditional Chinese Medi cine practice, the findings of the \ncurrent study have implications for herbal formula practice and \napplication, especially in terms of the impact of the formula on \ninfertility, ovarian cysts, PCOS, the removal of blood stagnation \nand blood stasis, relievin g menstrual pain during and before the \nmenstrual period starts and uterine tract infections. \nInfertility is the most common associated byproduct of \nendometriosis. Forty percent of endometriosis cases also include \nthe presence of infertility. In the current  study, 53 of the 120 \nendometriosis patients (44.2 %) also had infertility. In the current \nstudy with the use of the Qing Bao Zhu Yu Tang formula, 30 of the \n53 (56%) patients were able to get pregnant. The results of the \ncurrent study complement the work o f Marrs [17] Ling [1] and \nFarquhar [18] by providing a preliminary systematic study showing \nthat the effective treatment of endometriosis using herbals can \nresult in pregnancy. \nThe condition of ovarian cysts was observed in 38 of 120 cases \n(31.7%) in the cu rrent study.  Every one of the 38 cases reported \nimprovement with treatment using the Qing Bao Zhu Yu Tang \nformula. The data observed in the current study are consistent with \nthe data yielded in the study by Flower et al., (2010) which showed \nthat 40% of e ndometriosis cases also manifested the condition of \novarian cysts. The results of the current study have strong \nimplications for TCM practitioners who treat women with \nendometriosis with accompanying ovarian cysts. Practitioners \nshould give careful conside ration to the use of the Qing Bao Zhu \nYu Tang formula when dealing with similar cases. This is an area \nthat has not been engaged in prior literature. As a result, the \nfindings of the current study are groundbreaking in relation to the \ntreatment of endometriosis cases when ovarian cysts are present.  \nWhile in the current study the number of cases of endometriosis \nthat also included the condition of PCOS was small (n=7), the data \nshow that each of those seven cases reported that the PCOS \ncondition disappeared or was helped significantly by the treatment \nwith the Qing Bao Zhu Yu Tang formula. Even though the numbers \nwere small regarding the impact of the formula on the condition of \nPCOS, there is clear indication that further research is needed in \nthis area. Fu rther research is important in this area since PCOS is \nnot only associated with infertility, but also with a higher incidence \nof insulin resistance (Type 2 Diabetes), no ovulation, amenorrhea \nand hyper-secretion of androgen (testosterone). \nBecause it is su ch a commonly occurring and often non -specific \nsymptom, data regarding the symptom of vaginal discharge were \nnot formally analyzed in the current study. However, in the current \nstudy, 19 charts of endometriosis patients also included the \nsymptoms of excess ive vaginal discharge. Again the implications \nof TCM theory are much clearer in treatment of endometriosis than \nWestern Medicine. The Qing Bao Zhu Yu Tang formula provides a \nviable alternative for treating both non -specific and endometriosis \nrelated excessive vaginal discharge. \n \n4.1 Limitations \nA limitation of the current study is the limited sample size used, as \nwell as the geographic factor of the location of the clinic where the \nchart review originated. Because all samples come from one clinic \nin Los Ang eles, there is the possibility that those who sought \ntreatment at this clinic might not reflect the general population. \nHowever this factor is not likely since the patients seen at the \ndesignated clinic represent a wide range of ages, ethnicities and \npresenting problems. \n \n4.2 Recommendations for Future Research \nSince the current study involved chart review method, the next step \nin the path of research would be to design and conduct single blind \nand possibly double blind studies regarding the use of the form ula. \nThose studies should include placebo and no treatment groups to \nverify the effectiveness of the Qing Bao Zhu Yu Tang formula. \nAdditional research needs to be done with further control for the \nfactor of ethnicity. Further, more controlled clinical stud ies will be \nneeded to clarify the clinical efficacy of natural medicinal herbs in \nthe treatment of endometriosis -associated pain and investigate \nherb–herb and, the interaction of Traditional Chinese Medicine \nwith hormones drug –herb interactions and other t oxicities. It is \ncritical to establish streamlined registration procedures for natural \nmedicinal products, particularly herbal ones that have a long \ntradition of safe use. \n \n5. Conclusions \nAs indicated by the data generated in the current study it is \nobserved that the Qing Bao Zhu Yu Tang formula is effective in \nthe treatment of endometriosis. It is also effective in the treatment \nof infertility, PCOS and ovarian cysts, vaginal discharges. \nConsistent with the findings of the current study, TCM \npractitioners who treat ob -gyn cases should consider using the \nQing Bao Zhu Yu Tan formula. \n \n6. References \n1. Ling FW. Randomized trial of depot leuprolide in patients with \nchronic pelvic pain and clinically suspected endometriosis - A Pelvic \nPain Study Group. Obstetrics and Gynaecology 1999; 93:51-58.  \n2. Verkauf BS. Incidence, symptoms and signs of endometriosis in \nfertile and infertile women. Journal of the Florida Medical \nAssociation 1987; 74:671-675. \n3. Ballweg M. Impact of endometriosis on women's health: Comparative \nhistorical data show that the earlier the onset, the more severe the \ndisease. Best Practice & Research in Clinical Obstetrics and \nGynecology 2004; 18(2):201-218. \n4. Vercellini P, Somigliana E, Vigano P, Barbara G, Crosignani PG. \nEndometriosis: current therapies and new pharmacological \ndevelopments. Drugs 2009; 69(6):649-675.  \n5. Brosens IA, Brosens JJ. Is laparoscopy the gold standard for the \ndiagnosis of en endometriosis ? European Journal of Obstetrics & \nGynecology and Reproductive Biology 2000; 88(2):117-119. \n6. Sampson JA. Peritoneal endometriosis due to menstrual \ndissemination of endometrial tissue into the peritoneal cavity. \nAmerican Journal of Obstetrics and Gynecology 1927; 14:422-469.  \n7. D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and \nsub-fertility: Is the relationship resolved? Se minars in Reproductive \nMedicine 2003; 21:243-254. \n8. Maciocia G. Diagnosis in Chinese Medicine: A comprehensive guide, \n\n \n~ 80 ~ \nInternational Journal of Herbal Medicine \nLondon, Churchhill Livingstone, 2004. \n9. Shao GQ. Clinical and experimental research on 156 cases of \nendometriosis treated by therapy of promoting blood circulation and \nremoving stasis. Shanghai Journal of Traditional Chinese Medicine, \n1980; 3:4–6. \n10. Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica: \nEastland Press. Seattle, Washington, 2005.  \n11. Cao LX. Endometr iosis as treated by traditional Chinese medicine. \nJournal of the American College of Traditional Chinese Medicine \n1983; 1:54-57. \n12. Lin YQ. An approach to treatment of endometriosis by traditional \nChinese medicine. Fujian Journal of Traditional Chinese Medici ne \n1988; 19(6):21-23. \n13. Tang B J. Traditional Chinese herbal and acupuncture treatment for \nfemale infertility (part II). International Journal of Oriental Medicine \n1991; 16(3):151-161. \n14. Dharmananda S. Chinese Herbal Therapy for endometriosis. Internet \nJournal of the Institute for Traditional Medicine and Preventive \nHealth Care, Web posting, May 2002.  \n15. Chen JK, Chen TT. Chinese medical herbolgy and pharmacology. Art \nof Medicine Press Inc: City of Industry, California, 2004. \n16. Gearing R, Mian I, Barber J. A methodo logy for conducting \nretrospective chart review research in child and adolescent psychiatry. \nJournal of the Canadian Academy of Child and Adolescent Psychiatry \n2006; 15(3):126-134. \n17. Marrs RP. The use of potassium -titanyl-phosphate laser for \nlaproscopic removal of ovarian endomitrioma. Am J Obstet Gynecol \n1991; 164:1622-1628. \n18. Farquhar CM. Endometriosis. British Medical Journal 2007; \n334(7587):249–253. \n \n \nAppendix A: \nCopy of Data Collection Instrument \n Was the patient treated for endometriosis with Chinese herbs? Yes No \n Was the patient satisfied with the treatment process? Yes No \n Did the patient experience symptom relief? Yes No \n Was the patient taking hormones?  Yes No \n Did the patient have a diagnosis of endometriosis previously? Yes No \n Did the patient had surgery previously? Yes No \n Is this treatment for recurrent condition? Yes No \n Was the patient taking pain medication?  Yes No \n Write the name of pain medication?  \n Modified Qing Bao Zhu Yu Tang  Formula alone Yes \nModified according to constitution Yes \n Questions about Pain Pelvic pain \n \nDuring sexual intercourse Yes No \nBefore menstrual period Yes No \nDuring menstrual period Yes No \nAfter menstrual period Yes No \nDuring defecation  Yes No","source_license":"CC0","license_restricted":false}