CHINESSE MEDICINE IN ENDOMETRIOSIS...pdf

endometriosis management in chinesse medicine

1. What is The Role of Traditional Chinese Medicine
in Endometriosis Management
ENDOMETRIOSIS MANAGEMENT, FROM TRADITIONAL CHINESE MEDICINE TO ROBOT SURGERY
THOMAS CAHYONO SUTRISNO

2. CHINESE
MEDICINE

3. History of Chinese Medicine
for Gynecology Diseases
Jin Gui Yao Lue
(Prescriptions of the Golden Chamber)
Zhang Zhongjing (150-219)

4. Hormones
Ultrasonography
X-Ray
Surgery
Tumor markers
Interleukins
Tongue appearance
Radial pulse presentation
Symptoms
Sensitivity to pressure

5. INFERTILITY PAIN
World Health Organization. "Endometriosis." World Health Organization. Last modified March 24, 2023.
https://www.who.int/news-room/fact-sheets/detail/endometriosis.

6. CHRONIC
INFLAMMATION
NEUROGENIC
FACTOR
IMMUNE
DYSREGULATION
Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823. Published 2020 Oct 6. doi:10.3389/fncel.2020.590823
ANGIOGENESIS

7. ENDOMETRIOSIS
PAIN
Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823. Published 2020 Oct 6. doi:10.3389/fncel.2020.590823
Chronic pain
Frequently returns in patients within 12
months of lesion removal, even in the
absence of lesion regeneration

8. ENDOMETRIOSIS
PAIN
Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823. Published 2020 Oct 6. doi:10.3389/fncel.2020.590823
Neurogenic Inflammation
Peripheral sensitization
Cross organ sensitization
Central sensitization

9. ACUPUNCTURE
Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823. Published 2020 Oct 6. doi:10.3389/fncel.2020.590823
Zheng Z, Bai L, O'Loughlan M, Li CG, Xue CC. Does Electroacupuncture Have Different Effects on Peripheral and Central Sensitization in Humans: A Randomized Controlled Study. Front Integr Neurosci. 2019;13:61.
Published 2019 Oct 15. doi:10.3389/fnint.2019.00061
Zhang Q, Zhou M, Huo M, et al. Mechanisms of acupuncture-electroacupuncture on inflammatory pain. Mol Pain. 2023;19:17448069231202882. doi:10.1177/17448069231202882
Lee IS, Cheon S, Park JY. Central and Peripheral Mechanism of Acupuncture Analgesia on Visceral Pain: A Systematic Review. Evid Based Complement Alternat Med. 2019;2019:1304152. Published 2019 May 2.
doi:10.1155/2019/1304152
Ma Q. Somato-Autonomic Reflexes of Acupuncture. Med Acupunct. 2020;32(6):362-366. doi:10.1089/acu.2020.1488
Neurogenic Inflammation
Peripheral sensitization
Downregulation of inflammatory cytokines;
Anti-inflammatory M2 macrophage polarization;
Vagal-adrenal anti-inflammatory axis activation
Rapid activation of local A-fibers
Spinal segmental analgesia
Significant reduction in hyperalgesia

10. ACUPUNCTURE
Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823. Published 2020 Oct 6. doi:10.3389/fncel.2020.590823
Zheng Z, Bai L, O'Loughlan M, Li CG, Xue CC. Does Electroacupuncture Have Different Effects on Peripheral and Central Sensitization in Humans: A Randomized Controlled Study. Front Integr Neurosci. 2019;13:61.
Published 2019 Oct 15. doi:10.3389/fnint.2019.00061
Zhang Q, Zhou M, Huo M, et al. Mechanisms of acupuncture-electroacupuncture on inflammatory pain. Mol Pain. 2023;19:17448069231202882. doi:10.1177/17448069231202882
Lee IS, Cheon S, Park JY. Central and Peripheral Mechanism of Acupuncture Analgesia on Visceral Pain: A Systematic Review. Evid Based Complement Alternat Med. 2019;2019:1304152. Published 2019 May 2.
doi:10.1155/2019/1304152
Ma Q. Somato-Autonomic Reflexes of Acupuncture. Med Acupunct. 2020;32(6):362-366. doi:10.1089/acu.2020.1488
Cross organ sensitization
Central sensitization
Central inhibition via Descending Pain Modulatory System and
enhanced functional activity in Thalamus/Insula;
Modulation of NMDA receptors in dorsal horn.
Activation of the Somato-Visceral Reflex (SVR);
Modulation of the brain-gut axis and autonomic nervous system.

11. ENDOMETRIOSIS
Iwabe T, Harada T, Tsudo T, et al. Tumor necrosis factor-alpha promotes proliferation of endometriotic stromal cells by inducing interleukin-8 gene and protein expression. J Clin Endocrinol Metab.
2000;85(2):824-829. doi:10.1210/jcem.85.2.6335
Abramiuk M, Grywalska E, Małkowska P, Sierawska O, Hrynkiewicz R, Niedźwiedzka-Rystwej P. The Role of the Immune System in the Development of Endometriosis. Cells. 2022;11(13):2028. Published
2022 Jun 25. doi:10.3390/cells11132028
Liu J, Zhu Q, Pan Y, et al. Electroacupuncture alleviates intrauterine adhesion through regulating autophagy in rats. Mol Hum Reprod. 2023;29(11):gaad037. doi:10.1093/molehr/gaad037
Immune Dysfunction
Macrophage Polarization
Imbalance (M1 dominance)
Defective Immune Surveillance
(Reduced NK cell cytotoxicity)
Elevated Pro-inflammatory
Cytokines
Aberrant NF-B Activation

12. Iwabe T, Harada T, Tsudo T, et al. Tumor necrosis factor-alpha promotes proliferation of endometriotic stromal cells by inducing interleukin-8 gene and protein expression. J Clin Endocrinol Metab.
2000;85(2):824-829. doi:10.1210/jcem.85.2.6335
Abramiuk M, Grywalska E, Małkowska P, Sierawska O, Hrynkiewicz R, Niedźwiedzka-Rystwej P. The Role of the Immune System in the Development of Endometriosis. Cells. 2022;11(13):2028. Published
2022 Jun 25. doi:10.3390/cells11132028
Liu J, Zhu Q, Pan Y, et al. Electroacupuncture alleviates intrauterine adhesion through regulating autophagy in rats. Mol Hum Reprod. 2023;29(11):gaad037. doi:10.1093/molehr/gaad037
Macrophage Polarization
Imbalance (M1 dominance)
Elevated Pro-inflammatory
Cytokines
ACUPUNCTURE
Downregulation of M1 secretion;
Suppression of NF-B activity
Promotion of M1 M2 polarization
(Anti-inflammatory shift)

13. Iwabe T, Harada T, Tsudo T, et al. Tumor necrosis factor-alpha promotes proliferation of endometriotic stromal cells by inducing interleukin-8 gene and protein expression. J Clin Endocrinol Metab.
2000;85(2):824-829. doi:10.1210/jcem.85.2.6335
Abramiuk M, Grywalska E, Małkowska P, Sierawska O, Hrynkiewicz R, Niedźwiedzka-Rystwej P. The Role of the Immune System in the Development of Endometriosis. Cells. 2022;11(13):2028. Published
2022 Jun 25. doi:10.3390/cells11132028
Liu J, Zhu Q, Pan Y, et al. Electroacupuncture alleviates intrauterine adhesion through regulating autophagy in rats. Mol Hum Reprod. 2023;29(11):gaad037. doi:10.1093/molehr/gaad037
Defective Immune Surveillance
(Reduced NK cell cytotoxicity)
Aberrant NF-B Activation
Enhancement of NK cell cytotoxic activity and
proliferation (via IL-2)
Suppressed gene expression of inflammatory cytokines
ACUPUNCTURE

14. ANGIOGENESIS
IN
ENDOMETRIOSIS
VEGF
Bo C, Wang Y. Angiogenesis signaling in endometriosis: Molecules, diagnosis and treatment (Review). Mol Med Rep. 2024;29(3):43. doi:10.3892/mmr.2024.13167
FGF
HIF-1 a
IL-1 B
IL-6
IL-8
IL-10
IL-17
TNF- alfa
MMIF
COX-2
Ang

15. Chinese herbal medicines  
Latin name/Chinese name
Anti-angiogenesis targets
Curcuma longa (Jianghuang)
Rhizoma Curcumae (Zedoariae) (E'zhu)
Rhizoma sparganii (Sanleng)
Radix Curcumae (Yujing)
VEGF↓
MVD↓
FGF↓
PDGF↓
TNF-α↓
Radix ginseng 
(Renshen)
VEGF↓
VEGFR-2↓
Salvia miltiorrhiza (Danshen)
VEGFR2 ↓
TNF-a↓
Paeonia lactiflora (Chishao) HIF-1α↓
Zheng W, Cao L, Xu Z, Ma Y, Liang X. Anti-Angiogenic Alternative and Complementary Medicines for the Treatment of Endometriosis: A Review of Potential Molecular
Mechanisms. Evid Based Complement Alternat Med. 2018;2018:4128984. Published 2018 Oct 1. doi:10.1155/2018/4128984

16. Formula Component/herb Latin name/ Chinese name Angiogenesis targets
Guizhi Fuling Wan
Cinnamomum cassia (Guizhi)
Poria cocos (Fuling)
Moutan Cortex (Mudanpi)
Prunus persica (Taoren)
Paeonia lactiflora (Chishao)
CD31↓
VEGF↓
HIF-1α↓
Shaofu Zhuyu Decoction
Foeniculi Fructus (Xiaohuixiang)
Zingiberis Rhizoma (Ganjiang)
Corydalis Rhizoma (Yanhusuo)
Commiphora myrrha (Moyao)
Ligusticum chuanxiong (Chuanxiong)
Angelica sinensis (Danggui)
Paeonia lactiflora (Chishao)
Cinnamomum cassia (Rougui)
Typha angustifolia (Puhuang)
Trogopterus xanthipes (Wulingzhi)
MVD ↓
HIF-1α ↓
CD34 ↓
Zheng W, Cao L, Xu Z, Ma Y, Liang X. Anti-Angiogenic Alternative and Complementary Medicines for the Treatment of Endometriosis: A Review of Potential Molecular
Mechanisms. Evid Based Complement Alternat Med. 2018;2018:4128984. Published 2018 Oct 1. doi:10.1155/2018/4128984

17. Zheng W, Wu J, Gu J, et al. Modular Characteristics and Mechanism of Action of Herbs for Endometriosis Treatment in Chinese Medicine: A Data Mining and Network
Pharmacology-Based Identification. Front Pharmacol. 2020;11:147. Published 2020 Mar 6. doi:10.3389/fphar.2020.00147
Chinese herbs
target anti-
inflammatory
pathways
NF-κB
MAPK
PI3K-Akt Toll-like receptor
HIF-1

18. CHINESE
MEDICINE
CLINICAL STUDIES
ENDOMETRIOSIS

19. Reducing the severity of menstrual pain and overall pelvic pain
when compared to non-specific acupuncture, usual care
Giese N, Kwon KK, Armour M. Acupuncture for endometriosis: A systematic review and meta-analysis. Integr Med Res. 2023;12(4):101003.
doi:10.1016/j.imr.2023.101003
ACUPUNCTURE FOR ENDOMETRIOSIS:
A SYSTEMATIC REVIEW AND META-ANALYSIS
Reductions in pelvic pain severity were clinically relevant, with
reductions in VAS scores for pelvic pain >20 %
Greater reductions in analgesic usage in the acupuncture versus
the comparison groups

20. CHINESE HERBAL MEDICINE FOR ENDOMETRIOSIS:
PAIN
Dysmenorrhea superiority vs Danazol
Flower A, Liu JP, Lewith G, Little P, Li Q. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD006568.
DOI: 10.1002/14651858.CD006568.pub3.
Lesion Regression superiority vs Danazol
Comparable efficacy for post surgical symptoms management vs Gestrinone

21. CHINESE HERBAL MEDICINE FOR ENDOMETRIOSIS:
RECURRENCE PREVENTION
Superiority in Recurrence Prevention vs Danazol
Wang X, Shi Y, Xu L, et al. Traditional Chinese medicine prescription Guizhi Fuling Pills in the treatment of endometriosis. Int J Med Sci. 2021;18(11):2401-2408.
Published 2021 Apr 16. doi:10.7150/ijms.55789
Enhanced Efficacy in Combination Therapy with radiofrequency ablation
Inflammation marker suppression (CA125, VEGF, IL-6, and TNF-α)

22. Promoting Natural Conception Post-Surgery
Adjunctive in Assisted Reproductive Technology (ART)
CHINESE HERBAL MEDICINE FOR ENDOMETRIOSIS:
FERTILITY AND REPRODUCTIVE
Zhao RH, Hao ZP, Zhang Y, et al. Controlling the recurrence of pelvic endometriosis after a conservative operation: comparison between Chinese herbal medicine
and western medicine. Chin J Integr Med. 2013;19(11):820-825. doi:10.1007/s11655-012-1247-z
Wang SC, Tsai LM, Chen PM, Hsu YM, Wang SC, Chang CH. The Effectiveness of Live Birth Rate of Traditional Chinese Medicine Intervention for Infertile Women
Undergoing a Second Round of IVF Is Influenced by Age. In Vivo. 2025;39(3):1625-1637. doi:10.21873/invivo.13963
Dong P, Ling L, Hu L. Systematic review and meta-analysis of traditional Chinese medicine compound in treating infertility caused by endometriosis. Ann Palliat Med.
2021;10(12):12631-12642. doi:10.21037/apm-21-3425

23. EFI ≤ 4
Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010;94(5):1609-1615.
doi:10.1016/j.fertnstert.2009.09.035
EFI 5-6
EFI ≥7
Immediate ART recommendation
Early ART consideration (6-12 months)
Extended expectant management
possible (12-24 months)

24. EFI ≤ 4
EFI 5-6
EFI ≥7 Maintain high spontaneous pregnancy potential, minimize recurrence risks.
Functional optimization of Least Functional Score components (Endometrial
Receptivity, HPO axis, sperm motility) to achieve spontaneous pregancy before
ART referral
Adjunctive TCM to enhance ovarian response and endometrial receptivity for
optimal ART outcomes.
CHINESE MEDICINE FOR ENDOMETRIOSIS:
FERTILITY AND REPRODUCTIVE - THERAPEUTIC GOALS

25. Role of Chinese Medicine in
Endometriosis Management
Pain management without hormonal supression
Inhibiting endometriosis progression and recurrence
Significantly improving pregnancy rates, and abortion rates
when integrated into infertility treatment protocols

26. Chinese Medicine should be considered as part of
long term management of Endometriosis