Studies Show Chinese Herbs as Effective or Better than Drugs for Endometriosis with Fewer Side Effects

Endometriosis is a condition where endometrial tissue, which normally lines a woman's uterus, is found outside of the uterus. This tissue can grow and shed during a menstrual cycle and cause pain, heavy menstrual bleeding, and infertility. "Medical treatment of endometriosis ranges from symptomatic management with nonsteroidal anti-inflammatory drugs and analgesics to hormonal manipulations that include continual oral contraceptives, progestins, danazol, and gonadotrophin-releasing hormone agonists. However [according to the below study], the benefits are short lived, and symptoms often return to pretreatment levels within six months. Under the best of circumstances, more than a third of patients have symptom recurrence within two or three years after stopping therapy."

Symptoms of endometriosis have been treated with Chinese medicine for hundreds of years. Treatment involving herbal medicine, acupuncture, and dietary therapy have afforded women reduced pain, lighter periods, and restored fertility. While more severe cases of endometriosis may require surgery, Chinese medicine may offer an effective treatment for many women.

Gerry Harringon, Harmony TCM Weblog

Chinese Herbs Show Promise for Endometriosis

By Charles Bankhead, Staff Writer, MedPage Today
Published: July 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

HOUSTON, July 8 -- Chinese herbal medicine provided relief to symptoms of endometriosis that was equivalent or superior to conventional therapies following laparoscopic surgery, a systematic review indicated.

Action Points

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• Explain to patients that Chinese herbal medicine appeared to relieve postsurgical endometriosis symptoms at least as well as conventional medical therapy.



• The findings were based on a retrospective review of a large database and involved a small number of patients.

Herbal medicine achieved symptom relief comparable to that of gestrinone but with fewer side effects, Andrew Flower, PhD, of Southampton University in Ringmer, England, and colleagues reported in the Cochrane Database of Systematic Reviews. The pregnancy rate was similar with either treatment.

Compared with danazol, Chinese herbal medicine led to better postsurgical symptom control with fewer side effects.

"These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis, but at present we don't have enough evidence to generalize the results," Dr. Flower said in a statement.

The authors noted that more rigorous research is needed to assess the potential role of Chinese herbal medicine in treating endometriosis. Investigators initially identified 110 studies for their review. However, all but two had to be excluded because of methodologic flaws.

Medical treatment of endometriosis ranges from symptomatic management with nonsteroidal anti-inflammatory drugs and analgesics to hormonal manipulations that include continual oral contraceptives, progestins, danazol, and gonadotrophin-releasing hormone agonists.

Hormonal therapies provide comparable symptom relief and reduction of endometriosis-related lesions, the authors said.

However, the benefits are short lived, and symptoms often return to pretreatment levels within six months. Under the best of circumstances, more than a third of patients have symptom recurrence within two or three years after stopping therapy, the authors noted.

Additionally, the benefits of conventional therapy have to be balanced against potentially serious adverse effects, the authors continued.

Surgery also carries a risk of serious adverse events, such as bowel perforation and peritonitis, and offers no assurance of long-term symptom relief.

"In summary, current treatments all have high rates of recurrence and their short-term benefits have to be balanced with concerns over immediate and longer-term side effects," they said.

Chinese herbal medicine has a clinical history that dates back to ancient times. Among the medical applications is treatment of symptoms associated with endometriosis.

The origin of Chinese herbs' activity in endometriosis is unclear. Suggested mechanisms have included regulation of endocrine and immune systems, improved circulation, and anti-inflammatory activity.

But no English-language systematic review had been conducted to determine whether Chinese herbal medicine has a role in the treatment of endometriosis.

To address that void, Dr. Flower and colleagues searched multiple databases for randomized controlled trials of Chinese herbal medicine versus placebo, conventional medical therapy, another Chinese herb, or as an add-on to conventional therapy.

Of 110 studies originally considered, only two met the authors' inclusion criteria. All 110 studies were conducted in China and were reported in Chinese.

The two studies involved a total of 158 women whose mean age was 30. Diagnostic criteria included laparoscopic diagnosis, American Fertility Society staging, and vaginal or rectal B-ultrasound.

Additionally, all of the patients had been diagnosed according to traditional Chinese medicine as having stagnation of Qi (vital energy) and blood with an underlying kidney deficiency.

All patients had laparoscopic surgery as primary therapy.

One study compared a Chinese herbal medicine enema and gestrinone. In the second trial, patients were randomized to Chinese herbal medicine pills alone, herbal pills plus an herbal enema, or danazol.

Gestrinone led to a symptomatic relief rate of 93.87% compared with 95.6% for the Chinese herbal medicine enema.

During 24 months of follow-up, 69.6% of women assigned to the enema became pregnant, as did 59.1% of patients treated with gestrinone. Neither difference achieved statistical significance.

No adverse events occurred in patients treated with the Chinese herbal medicine enema. In contrast, 13 of 49 patients treated with gestrinone developed acne, while19 had elevated liver enzymes, and 31 had oligomenorrhea.

In the second trial, oral Chinese herbal medicine alone or in combination with an herbal enema led to significantly greater symptom relief compared with danazol (RR 5.06, 95% CI 1.28 to 20.05 and RR 5.63, 95% CI 1.47 to21.54, respectively).

Additionally, the combined Chinese herbal medicine reduced dysmenorrheal pain significantly more than danazol and resulted in a significantly higher rate of disappearance or shrinkage of adnexal masses (MD -2.90, 95% CI -4.55 to -1.25, RR 1.70, 95% CI 1.04 to 2.78, respectively).

Four of 16 patients randomized to Chinese herbal pills alone had dry mouth, and one patient developed acne. Among 24 patients randomized to herbal pills and an herbal enema, two had dry mouth, while 11 developed rectal tenesmus during the first two weeks of treatment, and one patient had weight gain of 3 kg.

Of 18 patients treated with danazol, 13 developed acne, while three had weight gain of 3 kg, two gained 2 kg, one gained 1.5 kg, two had elevated liver enzymes, and four had oligomenorrhea.

The authors reported no relevant financial disclosures.

Primary source: Cochrane Database of Systematic Reviews
Source reference:
Flower A et al. "Chinese herbal medicine for endometriosis" Cochrane Database Syst Rev 2009; DOI: 10.1002/14651858.CD006568.pub2.

Should Junk Food Be Sin-Taxed?

Let me take this opportunity to discuss the proposed surtax on soft drinks to help pay the costs of universal health care. First off, I'm for it, and here's why:

If we go to a universal health care plan, that would mean that we are all in the same insurance pool: we all put money in, and the sick and infirm take money out as needed to provide for their health care. That means that those of us who do preventative care, live a healthy lifestyle and cultivate our health are subsidizing the health care expenses of those who do not take care of their health. Obesity is at epidemic proportions in this country, and has been for some years. The costs of obesity in terms of disease has proportionally been on the rise, namely diabetes is now epidemic also. Other obesity related conditions include hypertension and hypercholesterolemia. These diseases lead to increased incidents of strokes, heart attacks and in the case of diabetes, kidney failure (requiring dialysis and transplants), blindness, peripheral neuropathy due to poor circulation, leading to amputations and so on. Obviously the dollar costs of these procedures as well as on going pharmaceutical use to treat these conditions is high: 150-200 billion $/annually in the US. (Smoking, for comparison, costs 120-150 billion annually). In a universal system that gets averaged out to all who pay in, meaning the healthy subsidize these costs as the rates rise for everyone in the system in order to pay out for those requiring the care.

Obesity is caused by poor diet. The cheap junk foods are the cause of the obesity epidemic. The government subsidizes wheat, corn, soy and tobacco. All of these contribute to poor health, and the heavily subsidized foods are used to make junk food cheap. Corn is used to make corn syrup, the cheap sugar substitute heavily utilized in junk food. Junk food is mainly purchased because it is cheap, so price directly correlates to its use. When price increases, usage decreases. As junk food is a direct cause of obesity and it's related diseases (diabetes, hypertension, hypercholestemia), decreasing the use of junk food will have a direct effect of reducing these diseases and the costs to society (under a universal health care system) for treating them. And because folks choose to eat these offending foods largely because they are cheap, one of the most direct results one can have in affecting behavior that causes obesity is too raise the price of the foods that cause it: junk foods. (Which by the way isn't really food: contrary to popular belief soda, red wine, chocolate and potato chips are not the 4 food groups, and corn chips do not count as a serving of vegetables).

Therefore I feel not only that the cost of soft drinks ought to be taxed, but all junk foods: fast food, donuts, pizza, Twinkies, chips, candy and so on, with the proceeds going to pay for the universal health care/insurance, to offset the costs of additional health care that the consumption of those offending foods cause are incurred by society.

It seems to me that in a society that sin taxes smoking and drinking (cigarettes and alcohol) obesity should be similarly sin-taxed by taxing junk foods.

In addition, I advocate for tax breaks to companies and individuals rewarding preventative care, such as gym memberships, healthy foods at cafeterias and menus, weight loss, smoking cessation, acupuncture, chiropractic and nutritional counseling, stress management, meditation, yoga, tai qi and qi gong classes. Tax breaks should be given when healthy foods are displayed prominently at eye level in stores and cafeterias, with junk foods and sodas/alcohol placed at the bottom/floor level of display cases, or high on shelves where children are present. Rather than subsidizing foods that cause disease, thereby increasing costs to the health care system that we all must incur, namely tobacco, soy, corn and wheat (these subsidized foods become the cheap, raw material of junk foods), the government should instead be subsidizing produce and organically grown foods (which have higher nutritional content and incur less cost to the environment). Remembering that fresh produce is often unavailable or entirely unaffordable in impoverished neighborhoods. As the NY Times reports in the article pasted below, the cost of produce has risen 40% in the past 3 decades, while the price of soda (made with government subsidized corn syrup) has fallen 33% during that same time period. Combined with an increasingly sedentary lifestyle and increased use of restaurants and fast food = a fool proof recipe for our obesity epidemic.

The following article from today's Sunday magazine section of the NY Times: Fat Tax by David Leonhardt lays out a well reasoned argument for surtaxing soft drinks. He postulates such a tax to lower the epidemic obesity and related diseases, such as diabetes, facing our country. These diseases are expensive to treat, increasing costs for everyone thru medicare, medicaid and raising private insurance premiums as the aggregate health care costs increase. Leonhardt argues that sodas (and i would say all junk food) have similar public health costs by causing obesity as cigarettes in causing lung cancer. KB

3 Tempeh Recipes

Occasionally patients mention that they would like to try tempeh, but aren't sure how to cook it. Tempeh is a soy product, made with fermented soybeans and formed into cakes. Often times other ingredients are added, such as grains or seaweed (sea veg). Tempeh has a strong flavor and needs to be marinated or cooked in sauces to moderate the taste. Here are 3 of my favorite tempeh recipes, taken form Peter Berley's cookbook "The Modern Vegetarian Kitchen". Berley is a vegetarian chef who cooked for many years at Angelica's Kitchen, one of New York's original and favorite veg restaurants. I love his cookbook and all of the recipes in it.

In his book Peter recommends using unpasteurized tempeh, which he claims is available in the freezer section. I have never seen it in Asheville. He praises its' texture and ability to absorb marinades.



Barbecued Tempeh

I have brought this to pot lucks and the plate always comes home empty. Non-vegs like to try it and always like it.

1lb tempeh
1/2 C cider vinegar
1/2C soy sauce (i use tamari)
1/2C olive oil
1/3C pure maple syrup
2t ground cumin
2t ground chipoti chili (i sub a Koren red chili i have on hand)
1t dried thyme
1t sweet paprika

I usually double this and bake it in a 9x12 pan.

Preheat oven to 350 degrees.

Slice each block of tempeh in half horizontally, then slice each piece in half. Use a baking dish that will hold the slices in a snug, single layer.

Whisk together the liquids and spices. Pour half the marinade in the baking dish. Place the tempeh on top and cover with remaining marinade. Cover dish with foil, shiny side down, creating a tight seal. Bake 35min in a convection oven or 45-50min in a conventional oven, until most of the marinade is absorbed. Uncover and bake an additional 10 min (conventional oven). Convection: turn off oven and bake additional 9min, until well browned.

Remove and cool. If you are bringing it to a bar-be-que, i like to thrown it on the grill for a few min.

Peter recommends making Bar-be-qued Tempeh into sandwiches with toppings such as: chopped lettuce, sliced kirby or pickling cucumber, clover spouts, watercress and shredded carrots.

I like it as a main dish, served over a bed of brown basmati rice and steamed veggies on the side.

This dish freezers well. Peter advises that it keeps up to 10 days in the refridge.




Apple-Mustard Baked Tempeh Sandwich Filling

I generally double this recipe. The Natural Import Store in Asheville as wonderful, high quality sesame oil, avail mail order or pick-up. I have a link to their website on the bottom of the Resources page of my website www.AcupunctureAsheville.com



1lb tempeh
1 1/3C apple juice or fresh cider
1/3C olive or light sesame oil
3T soy sauce (i use tamari)
3T mustard (i use brown)
1t ground caraway seeds
1t ground cumin (i have successfully subbed curry pwd for the spices)
1/4 t black pepper
Sour kraut


Preheat oven to 350 degrees.

Slice each block of tempeh in half horizontally, then slice each piece in half. Transfer to a steamer and steam over boiling water for 8min.

Whisk together the liquids and spices. Place the tempeh a baking dish that will hold the slices in a snug, single layer. Pour the marinade over the tempeh and bake uncovered 28min in a convection oven or 35-40min in a conventional oven, until most of the marinade is absorbed and tempeh is nicely browned.

To serve, spread tahini and mustard (i use brown) on sandwich bread. Top with tempeh, sour kraut, and spouts or lettuce (i like dandelion greens). I think this makes great summer sandwiches.



Tempeh Simmered in Broth

This simple dish is surprisingly lite. Peter suggests adding a few chopped veggies and some leftover grains or pasta to the broth for a one-pot meal. I like to serve it over a bed of rice with steamed vegs on the side.

1lb tempeh, sliced in bite sized pieces
4C water
3T soy sauce (i use tamari)
1T olive oil
3-4 garlic cloves, lightly bruised with the side of the knife (apparently bruising affects the taste of garlic)
2-3 quarter-sized ginger root slices
1 sprig rosemary
1 sprig thyme
thinly sliced green onions (scallion) for garnish

Combine all ingredients, excepting scallion) in a pot and bring to boil. Reduce to simmer, cover and cook 30min. Remove herb sprigs and serve with sprinkled scallion.

4-6 servings