by Eric Brand

Yesterday, Bob posted a blog about uterine fibroids, which are also called uterine myomas or leiomyomas. Without a doubt, Bob is correct that there is widespread consensus in the Chinese literature that the type of fibroid and the size of the fibroid greatly affects TCM prognosis and treatment potential. There is also widespread consensus that eliminating fibroids is difficult but controlling symptoms is often successful.

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Integrative textbooks often suggest that fibroids smaller than an 8 week-old fetus are most suitable to treatment with Chinese medicine. Chinese texts typically recommend surgery in cases where the size of the fibroid is equal to or larger than a twelve-week fetus and profuse menstruation cannot be reduced. Surgery is also recommended for cases where the fibroid is growing very rapidly, as well as in cases where the fibroids protrude into the vagina.

Like any biomedical disease, the normal method of TCM diagnosis involves reframing the condition based on TCM disease categories and then pattern differentiation. Traditionally, uterine fibroids themselves fit the category of zheng jia, concretions and conglomerations, and many of the patterns and formulas used for uterine fibroids in an integrative textbook parallel the traditional methods used for zheng jia. However, beyond the category of zheng jia, we should always consider approaching the case through the lens of TCM diseases like profuse menstruation, flooding and spotting, painful menstruation, and infertility. Often the treatment that is best suited to an individual patient is more related to controlling profuse menstruation and other symptoms rather than focusing exclusively on the mass itself.

One interesting thing about fibroid treatment in TCM is that we do see enema therapies mentioned in integrative textbooks. The use of enemas is not a traditional component of Chinese medical treatment. However, enema therapy has seen more widespread use in China in recent years, and is thought to be particularly useful for certain gynecological diseases. Rapid rectal assimilation of medicinal constituents and the proximity of the rectum to the site of the disorder makes enema therapy appropriate for conditions such as uterine fibroids. In actual practice, enemas are still rarely used and most patients are treated based on reducing symptoms rather than attacking the mass, but still I find it interesting that enema therapy is often mentioned in the modern literature.

Below are a few tidbits from the historical Chinese literature relating to the traditional category of zheng jia. Zheng jia included many conditions that are now differentiated with modern medicine, so the ancient category surely encompassed cancer and other conditions beyond uterine fibroids. Interestingly, the treatment of zheng jia hasn't changed much over the history of Chinese medicine. Many of the same formulas and patterns still used today were laid down in pre-modern texts, but our modern understanding of the biomedical diseases and their prognosis has changed dramatically.

Traditional approaches to zheng jia:

New conditions in strong patients may be treated by attacking and breaking, but old illnesses in weaker patients require concurrent supplementation. In general, when the size of the mass is reduced by half, harsh methods should no longer be used to prevent damage to the original qì.

The Huáng Dì Nèi Jīng (“The Yellow Emperor's Inner Canon”) outlined the basic treatment methods for concretions and conglomerations, and the methods that it mentioned are still the basis of therapy today. According to the Nèi Jīng: “Hardness is whittled away, what intrudes is eliminated, lodging is treated by attacking, [and] binding is treated by dissipation.”

Nearly 1600 years later, the original concepts laid down in the Nèi Jīng remained the foundation of medicinal therapy in the Qing Dynasty, China’s final dynastic period. The Qing emperors commissioned the compilation of the Yī Zōng Jīn Jiàn (“The Golden Mirror of Orthodox Medicine”), which summed up much of the useful clinical information that had accumulated throughout Chinese history. The Yī Zōng Jīn Jiàn was an influential text in the development of modern gynecology. It also offers insight into the state of Chinese medical gynecology just prior to the arrival of Western medicine, so it is a fascinating read. The gynecology section of the Yī Zōng Jīn Jiàn was translated and published by Paradigm Publications several years ago, but few Western practitioners are aware of its significance.

It states: “In treating any kind of concretion or accumulation, first ascertain whether the physical body is strong or weak and whether the condition of the disease is mild or urgent, and then treat accordingly. If the patient is vacuous, then her qì-blood is debilitated, and she cannot undergo attacking and quelling therapies; even if the disease is in exuberance, first support the right qì and later treat the disorder. If there is repletion of both physical form and symptoms, attacking the disorder is appropriate. The Nèi Jīng says to reduce great accumulations and great gatherings by half, and then cease applying attacking therapy. This is because of fears that excessive attacking will damage the qì and blood. Luó Tiān-Yì said: ‘Nourishing the right naturally eliminates accumulations.’ He can be praised as one who understands the essence of the Nèi Jīng.”

In the modern day, without question it is our responsibility to know the strengths, weaknesses, and limits of Chinese medical treatment. Chinese medicine has a lot to offer patients with fibroids, but it is important to be realistic and informed about prognosis. Bob covered these issues really well in yesterday's post, so I will not repeat the key points here. However, I want to point out that Bob's assessment is very consistent with everything I've read in the Chinese literature, as well as everything I've seen in the gynecology departments of Chinese hospitals.