{"paper_id":"d05519a2-cfd8-4207-922b-dd71703d95c1","body_text":"Frontiers in Medical Science Research \nISSN 2618-1584 V ol. 5, Issue 5: 57-62, DOI: 10.25236/FMSR.2023.050509 \nPublished by Francis Academic Press, UK \n-57- \nResearch progress on the understanding and \ntreatment of endometriosis in traditional Chinese and \nwestern medicine \nJiaying Wang1,a, Xia Liu1,b, Xinchun Xiao2,c,*, Xiaoping Cui2,d \n1Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China \n2Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, 712000, Shaanxi, China \nawjy07122023@163.com, b547324109@qq.com, c527486648@qq.com, d874464206@qq.com \n*Corresponding author \nAbstract: For endometriosis (EMs), traditional Chinese medicine (TCM) usually adopts internal \ntreatment and external treatment (acupuncture therapy, enema therapy, acupoint application, etc). It \ncan improve the clinical symptoms of patients, and the adverse reactions are small, and the recurrence \nrate is low after drug withdrawal. Western medicine generally adopts drug treatment and surgical \ntreatment, which can significantly improve symptoms in a short period of time, but it is easy to relapse \nand has many adverse reactions. At present, the diagnosis and treatment standards of endometriosis \nhave not been unified, and there is no unified evaluation mechanism. However, with the deepening of \nresearch, many effective treatment methods have been proposed. In the future treatment process, we \nshould adopt the way of integrated traditional Chinese and western medicine, give full play to its \nadvantages, through a variety of ways of medication, multi -method treatment, so as to alleviate the \nsymptoms, reduce the occurrence of adverse reactions and reduce the recurrence rate. \nKeywords: endometriosis; Traditional Chinese medicine treatment; Western medicine treatment; \nAcupuncture therapy; Acupoint application; Medication \n1. Introduction \nEndometriosis (EMs) refers to a disease caused by the appearance of growth-functional endometrial \ntissue in other parts of the body than the lining of the uterine cavity. The main symptoms include \nchronic pelvic pain, dysmenorrhea, dyspareunia and infertility. The pathogenesis of EMS has not yet \nbeen elucidated. According to its clinical manifestations, it can be classified as \"dysmenorrhea\", \n\"menorrhagia\", \"dysentery\", and \"infertility\". The main pathogenesis of endometriosis is stasis blood, \nwhich causes stasis blood o f the \"leaving menstruation\" and blocks the uterus, Chong meridian, Ren \nmeridian.  In recent years, the incidence of EMs has shown a significant upward trend, which \nseriously affects the quality of life of women. With the continuous in-depth study of EMS in traditional \nChinese and western medicine, more and more reliable treatment methods have been proposed, which \ngreatly relive the suffering of patients. Based on the literature research in recent years, this paper \nexpounds the understanding and treatment research progress of EMs. \n2. Understanding of Western medicine  \n \nFigure 1: Risk factors for endometriosis \n\n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 5, Issue 5: 57-62, DOI: 10.25236/FMSR.2023.050509 \nPublished by Francis Academic Press, UK \n-58- \nEMs can lead to pelvic pain and infertility, which seriously affects the health and quality of life of \nwomen .It is an aggressive and relapsing diseas e, which is very troublesome. Its formation is related to \ngenetic factors, immune and inflammatory factors, environmental factors, angiogenesis factors, etc \n[1].The risk factors are shown in Figure 1.About its origin, there are mainly the theory of retrograde \nblood flow implantation, body cavity epithelial metaplasia, and stem cell theory.  \n2.1. Retrograde blood flow implantation theory \nSampson proposed the theory of implantation in 1921, which suggested that endometrial glandular \nepithelial and stromal cel ls could be retrograde in menstrual blood flow and seeded on the ovary or \nother pelvic organs [2]. It does not explain retrograde menstrual bleeding, which occurs in 90% of \nwomen of reproductive age but in only a minority (10% -15%), nor does it explain ext rapelpelvic \nendometriosis. Lang Jinghe [3] puts forward the \"determinism of eutopic endometrium\", which holds \nthat ectopic endometrium can form lesions in the pelvis and abdomen, and must go through a \"trilogy\" \nof adhesion, invasion and angiogenesis to achieve \"root, growth and disease\". The eutopic \nendometrium is the seed, the allotopic endometrium is the soil, and other factors act as sunlight and \nrain. \n2.2. The theory of body cavity epithelial metaplasia  \nVarious types of cells and tissues metamorphose into ectopic endometrioid tissues under the \nrepeated stimulation of continuous ovarian hormones or menstrual blood and chronic inflammation [4]. \n2.3. Stem cell theory  \nMore and more studies have shown that st em cells have a certain relationship with the occurrence \nof EMs [5]. At first, some scholars thought that menstrual blood reflux, Estrogen therapy and other \nfactors provide a suitable local microenvironment for stem cells from different sources to differen tiate \n[6]. With the deepening of research, it has been found that the abnormal differentiation and proliferation \nof endometrial stem/progenitor cells may lead to the occurrence of endometriosis. The pathogenesis is \nshown in Figure 2.  \n \nFigure 2: The pathogenesis \n3. Understanding of Chinese Medicine  \nThere is no disease name for endometriosis in ancient books. According to its clinical \nmanifestations, it is mostly classified as \"dysmenorrhea\", \"infertility\", \"irregular menstruation\" and \n\"abdominal mass\". Its core pathogenesis is \"blood stasis\", which is closely related to the dysfunction of \nthe liver, spleen, and kidney. The main syndrome types are blood stasis due to Qi stagnation syndrome, \nQi deficiency and blood stasis syndrome, cold coagulation and blood stasis syndrome, kidney \ndeficiency and blood stasis syndrome, dampness -heat and blood stasis syndrome, and phlegm and \nblood stasis syndrome.  \n\n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 5, Issue 5: 57-62, DOI: 10.25236/FMSR.2023.050509 \nPublished by Francis Academic Press, UK \n-59- \n4. Treatment with Western medicine  \nThe fundamental purpose of treating EMs is to \"reduce and remove lesions, relieve and control pain, \ntreat and promote fertility, prevent and Reduce recurrence \".The main treatment methods include \nsurgical treatment and drug therapy, among which drug therapy is curre ntly the preferred way to treat \nthe clinical symptoms of EMs and prevent postoperative recurrence. \n4.1. Drug therapy  \nDrug therapy is mainly divided into hormone therapy and non- hormone therapy. Hormone therapy \nmainly includes the combination of estrogen a nd progesterone, aromatase inhibitors, and GnRH -a. \nNon-hormonal therapy mainly includes immunomodulators, antiangiogenic drugs, and antioxidants. \nThe prominent features of EMs are estrogen dependence and progestin resistance. After natural and \ninduced meno pause, ectopic endometrial lesions can gradually atrophy and be absorbed, so highly \neffective oral progestins combined with small doses of estrogen can be used to achieve a \n\"pseudopregnancy state\"; the mechanism is shown in Figure 3. Multiple studies have shown that \naromatase is not detected in normal human endometrium, while it is overexpressed in both normal and \nectopic endometrium of patients with endometriosis \n[7-10]. The mechanism of aromatase inhibitors is to \ninhibit the activity of aromatase, thereby  reducing the local estrogen production [11]. GnRH -a can \npromote the release of LH and FSH in the short term and then continue to inhibit the secretion of \ngonadotropin by the pituitary gland, resulting in a significant decrease in ovarian hormone levels and \ntemporary amenorrhea, but there will be menopausal symptoms such as hot flashes, vaginal dryness, \ndecreased libido and bone loss.Anti -angiogenic drugs mainly inhibit angiogenesis by clearing VEGF \nreceptors and reducing the secretion of VEGF and fibroblas t growth factor, thereby inhibiting the \ngrowth and invasion of EMs lesions. \n \nFigure 3: The mechanism \n4.2. Surgical treatment  \nThe purpose of surgical treatment is to remove the lesion and restore the anatomy. Conservative \nsurgery, which preserves the uterus and at least one ovary, is currently the preferred treatment for \nwomen who wish to have children. According to a study, 11.8% of women who underwent resection of \nEMs lesions reported no improvement in pain, 22.6% of patients underwent further surgery, and the \nincidence of postoperative pain, recurrent pain, and adverse events was not low. Even if the lesions \nwere removed, there was a risk of developing malignant tumors such as ovarian cancer \n[12]. Radical \nsurgery is suitable for patients over 45 years old. Patients who do not receive estrogen supplementation \nafter surgery have almost no recurrence.  \n5. TCM (traditional Chinese medicine) therapy  \n5.1. Internal treatment of TCM  \nThe treatment principle of Qi stagnation and blood stasis type endometriosis is moving Qi to relieve \npain, activating blood to resolve stasis. Through network data mining technology, it was found that \n\n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 5, Issue 5: 57-62, DOI: 10.25236/FMSR.2023.050509 \nPublished by Francis Academic Press, UK \n-60- \nAngelica sinensis and Chuanxiong Rhizoma, Sanling sinensis and Zedoary rhizoma, Wulingzhi \nsinensis and Typhimurium, Radix paeoniae alba and Angelica sinensis appeared frequently [13]. The \ncore drug pairs of Qi deficiency and blood stasis type are Astragalus and  Codonopsis, Atractylodes and \nPoria [14]. Professor Qi Cong's Yiqi Huoxue prescription uses Radix astragali and Codontirhizae radix \nas its prescription to promote Yang circulation, dissipate pathogenic factors, replenish Yang and benefit \nQi. It was found t hat Yiqi Huoxue Prescription can cause morphological changes in ectopic \nendometrioid tissues in the rat EMs model [15]. Cold coagulation and blood stasis type is usually treated \nwith Shaofu Zhuyu decoction and Wenjing decoction [13], the study found that Shaofu Zhuyu decoction \nhad a therapeutic effect on EMs rats with cold coagulation and blood stasis syndrome [16]. The \nmechanism is shown in Figure 4.Kidney deficiency and blood stasis type is mainly treated by tonifying \nkidney and activating blood. Li Xiao found that Bushen Huoxue recipe can effectively reduce the \nclinical symptoms of EMs patients, reduce local inflammatory response, and improve endometrial \nreceptivity \n[17]. The dampness -heat and stasis type mainly uses Chinese herbs with the effects of \nclearing heat, removing dampness and blood stasis, and has the advantages of improving microvascular \ncirculation, anti-inflammatory, analgesic and regulating immune function [18], Zheng Weilin [19] found \nthat the traditional Chinese medicine of clearing heat a nd removing blood stasis could improve \nhemorheology, inhibit platelet aggregation, interfere with angiogenesis and inhibit the production of \ninflammatory mediators. The combination of phlegm and blood stasis is mainly treated by promoting \nblood circulation to remove blood stasis and dissipating phlegm and eliminating symptoms, Liu Xiaojie \n[20] found that Xiaozheng decoction has a good effect on EMs with phlegm and blood stasis junction, \nand modern pharmacology suggests that Xiaozheng decoction has the effec ts of improving pelvic \nmicrocirculation, regulating immune function, anti -inflammation, analgesia, and inhibiting ectopic \nendometrial hyperplasia. \n \nFigure 4: Mechanism of Shaofu Zhuyu decoction in the treatment of EMs rats \n5.2. External treatment  \n \nFigure 5: The mechanism of acupuncture on pain in EMs patients \n\n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 5, Issue 5: 57-62, DOI: 10.25236/FMSR.2023.050509 \nPublished by Francis Academic Press, UK \n-61- \nAcupuncture for pain relief is one of the characteristics and advantages of traditional Chinese \nmedicine. Studies have found that acupuncture can significantly reduce adverse reactions caused b y \ngestrotriene and improve the levels of IL -1β, TNF-α, VEGF and MMP-2 in patients with EMs [21]; The \nmechanism of acupuncture on pain in EMs patients as shown in Figure 5 [22]. Chinese medicine enema \nis very common in EMs treatment, Zhou Yahong [23] found that traditional Chinese medicine enema \ncould decrease the concentration of CA125 and IL -6 in the peritoneal fluid, reduce the local \ninflammatory reaction, and improve the pain of patients with EMs. The acupoint application method \nhas also achieved good effect in the treatment of EMs. This method not only reduces the occurrence of \nadverse reactions in the treatment of ovarian endometriosis, but also can directly act on the lesion site.  \n6. Summary  \nModern medicine considers EMs as a hormone -dependent disease, and hormone therapy is \ncommonly used. Although it can achieve the therapeutic effect in a short time, there are many adverse \nreactions, such as osteoporosis and infertility. Traditional Chinese medicine believes that the core \npathogenesis of EMS is blood stasis. The basic treatment principle is to promote blood circulation and \nremove blood stasis, and the syndrome differentiation and treatment are carried out according to the \ndifferent symptoms and signs of the patients. In the future, the treatme nt of EMs should be integrated \nwith traditional Chinese medicine and western medicine, through a variety of ways of medication and \nmulti-method treatment, so as to alleviate the symptoms, reduce the occurrence of adverse reactions \nand reduce the recurrence rate. In addition, in the meantime of standardized treatment, maintaining a \ngood lifestyle is also very important for the prevention and rehabilitation of EMs. \nReferences  \n[1] Smolarz B, Szyłło K, Romanowicz H.  Endometriosis: Epidemiology,Classification, Pathogenesis, \nTreatment and Genetics (Review of Literature) [J] . Molecular Sciences, 2021 , 22(19):10554.  \n[2] Sampson JA. Metastatic or Embolic endometriosis, due to the Menstrual Dissemination of Endomet \n-rial Tissue into the Venous Circulation [J]. Am J Pathol, 1927, 3(2):93-110. \n[3] Dai Yi, Lang Jinghe, Zhu Lan, Leng Jinhua . The present and future of diagnosis and treatment of \nendometriosis [J]. (Scientia Sinica), 2021, 51(8):1017-1023. \n[4] Ferguson BR, Bennington JL, Haber SL. Histochemistry of mucosubstances and histology of mixed \nmüllerian pelvic lymph node glandular inclusions. Evidence for histogenesis by müllerian metapl asia \nof coelomic epithelium [J]. Obstet Gynecol, 1969, 33(5):617-25.  \n[5] Cousins FL, O DF, Gargett CE. Endometrial stem/pr ogenitor cells and their role in the \npathogenesis of endometriosis. Best Pract Res Clin Obstet Gynaecol, 2018; 50:27-38.  \n[6] Nikoo S, Ebtekar M, Jeddi -Tehrani M,et al.  Menstrual blood- derived stromal stem cells from \nwomen with and without endometriosis re veal different phenotypic and functional characteristics.  Mol \nHum Reprod, 2014; 20(9): 905-918. \n[7] Bulun SE , Fang Z , Imir G , et al.  Aromatase and endometriosis [J] . Semin Reprod Med,  2004, \n22(1):45-50. \n[8] Noble LS, Simpson ER, Johns A, et al. Aromatase expression in endometriosis[ J]. Clin Endocrinol \nMetab, 1996, 81(1): 174-179. \n[9] Kitawaki J , Noguchi T, Amatsu T, et al. Expression of aromatase cytochrome P450 protein and \nmessenger ribonucleic acid in human endometriotic and adenomyotic tissues but not in normal \nendometrium[J]. Biol Reprod, 1997, 57(3): 514-519. \n[10] Velasco I , Rueda J, Acién P. Aromatase expression in en dometriotic tissues and cell cultures of \npatients with endometriosis [J]. Mol Hum Reprod, 2006, 12(6): 377-381. \n[11] Gheorghisan -Galateanu AA, Gheorghiu ML. Hormonal therapy in women of reproductive age \nwith endometriosis: an update. Acta Endocrinol (Buchar), 2019, 15(2):276-281.  \n[12] Singh SS , Gude K , Perdeaux E, et al . Surgical outcomes in patients with endometriosis: a \nsystematic review [J]. Obstet Gynaecol Can, 2019. pii: S1701-2163(19) 30730-3. \n[13] Ni Jianli, Shen Yu.  Laws of Compound Traditional Chinese Medicine in the Treatment of \nDysmenorrhea Based on Data Mining [J]. (Jilin Journal of Chinese Medicine), 2019,0(3):385-388. \n[14] Gan Dongling.  Discussion on syndrome -medicine law of traditional Chinese medicine treatin g \nendometriosis based on Data Mining Technology  [D]. Guangxi University of Traditional Chinese \nMedicine,2021. \n[15] Hu Tianqi. Study on the Therapeutic effect and Mechanism of Yiqi Huoxue recipe on \nEndometriosis Model Rats [D]. Shanghai University of Traditional Chinese Medicine, 2020. \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 5, Issue 5: 57-62, DOI: 10.25236/FMSR.2023.050509 \nPublished by Francis Academic Press, UK \n-62- \n[16] Chen Yuanhuan, Mao Hai yan, Wu Quan sheng, Zhang Xiaoh ua, Shen Jian, Feng Peng, Huang \nCancan, Ji Xiu jia. Mechanism of Shaofu Zhuyu Decoction in treatment of endometriosis -associated \ndysmenorrhea with syndrome of cold coagul ation and blood stasis based on MSK1/2[J].( China \nJournal of Chinese Materia Medica), 2022,47(17):4674-4681. \n[17] Li Xiao, Zhou Yanyan. Bushen Huoxue recipe on endometrial receptivity in patients with kidney \ndeficiency and blood stasis type of endometriosis-induced infertility [J].(Shaanxi Journal of Traditional \nChinese Medicine), 2018,39(3):341-344. \n[18] Yang Dongxia, Wang Ning, Huo Yuxia, Shen Ruxia, Jing Jiaxin, Wu Manli, Li Hongmei, Ma \nBaozhang. Research Progress in Treatment of EMs from Damp ness-Heat and Blood Stasis  [J].(Acta \nChinese Medicine and Pharmacology), 2021,49(7):116-120. \n[19] Zheng Weilin, Liang Xuefang, Xu Zheng, Cao Lixing . Neuroangiogenesis Mechanism of \nEndometriosis-associated Pain in Traditional Chinese and Modern Medicine  [J].(Chinese Archives of \nTraditional Chinese Medicine), 2018,36(9):2138-2142. \n[20] Liu Xiaojie. Clinical Study on the Curative Effect of XiaoZheng Decoction in Treating \nEndometriosis [D]. Shandong University of Traditional Chinese Medicine, 2011. \n[21] Zuo Dongdong, Han Fengjuan, Peng Yan, Guo Xuman, Fu Yang.  Effect of Acupoint Catgut \nEmbedding on the Levels of IL -1β,TNF-α,VEGF and MMP-2 in Patients with Endometriosis of Kidney \nDeficiency and Blood Stasis[J].(Journal of Clinical Acupuncture and Moxibustion), 2020,36(4):44-49. \n[22] Sun Kefeng, He Meirong, Li Na, Shi Simao. Pain Mechanism of EMs and Analgesic Mechanism of \nAcupuncture and Moxibustion in Treating Ems [J]. (Journal of Clinical Acupuncture and Moxibustion), \n2019, 35(11):91-95. \n[23] Zhou Yahong, Mao Liyun, Wen Lina.  Clinical Observation on Curative Effects of Retention \nEnema with Chinese Medicine in Treating Endometriosis and Influence on CA125 and IL -6 in \nPeritoneal Fluid [J]. (Journal of Nanjing University of Traditional Chinese Medicine), 2014,  30(6): \n516-519.","source_license":"CC0","license_restricted":false}