PELVIC INFLAMMATORY DISEASE THERAPIES
1. From a TCM’s point of view, what are the imbalances associated with Pelvic Inflammatory Disease?
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs which occurred when sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes or ovaries. Chronic PID is a common dysfunction characterized by lower urinary tract symptoms and abdominal pain (one sided, both sides or central part), hence accounting for 20% of outpatient appointments in China’s traditional Chinese medicine’s gynecological clinics.
From a TCM’s point of view, PID happens due to internal pathogenesis of disharmony of yin-yang and the insufficiency of healthy Qi, and the external is that the heat-dampness and heat toxins invaded the thoroughfare and conception vessels, uterus, and uterine vessels causing blood blockages and blood stasis. TCM categories PID into acute (急性) and chronic (慢性). Acute PID are usually associated with the invasion of pathogenic toxins (感染邪毒) and development of noxious heat (热毒炽盛); which chronic PID are associated with imbalances in the body’s internal accumulation of heat-dampness (湿热), cold-dampness (寒湿) and Qi-&-Blood stagnation (气滞血瘀) in Chong-Ren meridians.
Acute PID most commonly brings about symptoms such as fever and usually develops from STIs transmitted during sex while menstruating or at early stages of post-birth; while chronic PID is categorized with symptoms of pain and disorders in the lower abdomen (uterus, ovaries, fallopian tubes, and cervix), irregular menstruation, dysmenorrhea, increased in vaginal discharge, pain during urination, immunological dysfunctions, and mental disorders, and is caused by factors linked to infections, autoimmunity, prolonged hours of standing, overworking, hectic lifestyle, increased sexual activity, and poor blood circulation etc.
2. How can TCM and acupuncture help to address this issue?
Acute PID may require hospitalization and emergency use of antibiotics or surgery. On the other hand, a combination of acupuncture and Chinese herbal prescription has been proven to be an effective resolution of chronic PID.
Acupuncture has been broadly used to treat acute and chronic pelvic inflammation with the effect of promoting metabolism circulation, balancing and improving immunity, purifying meridians, harmonizing Qi and Blood, stimulate blood circulation, improve permeability of the cellular membranes, and accelerate absorption of inflammation. Patients will be able to have a reduction or elimination of abdominal pain, lower abdominal bloating, vaginal discharge, menstrual pain, irregular menstruation, fatigue etc.
When acupuncture is coupled with the use of herbal Chinese medicines, research[1] has also shown that it provides significant improvements or elimination of endometrial hyperplasia, pelvic masses, vaginal secretion leukocyte count, and the serum leukocyte and neutrophil count. Subsequent follow up reviews also confirms the combined treatment maintain lasting results and prevent relapses of PID.
Common acupoints used during acupuncture includes: SP6 Sanyinjiao (三阴交), CV6 Qihai (气海), CV4 Guanyuan (关元), ST29 Guilai (归来), SP10 Xuehai (血海), SP9 Yinlingquan (阴陵泉), CV3 Zhongji (中级), ST28 Shuidao (水道), KD3 Taixi (太溪), KD7 Fuliu (复溜), BL23 Shenshu (肾俞).
According to the various syndrome diagnosed, common herbal Chinese medicines used are:
Acute PID (感染邪毒): 金银花、当归、赤芍、连翘、红藤、败酱草、红花、桃仁、枳壳、甘草 etc
Acute PID (热毒炽盛): 丹参、黄连、麦冬、丹皮、赤芍、生地、玄参、竹叶心、水牛角粉 etc
Chronic PID (湿热): 金银花、败酱草、延胡索、川楝子、连翘、红藤、薏仁、丹皮、赤芍、黄柏、栀子、乳香、没药 etc
Chronic PID (寒湿): 薏苡仁、败酱草、附子、川芎、苍术、茯苓、桂枝、炮姜 etc
Chronic PID (气滞血瘀): 牡丹皮、延胡索、川楝子、桃仁、茯苓、白芍、桂枝、香附 etc
Moxibustion can also be applied for patients experiencing cold-dampness syndrome. It stimulates the blood circulation through its warmth, promotes the inflammation to subside, and has the effect of bidirectional regulation on the body function state[6]. It has also been found that moxibustion can adjust the function of our main organs, promote metabolism, change the amount of blood composition, increase the phagocytosis of red blood cells, white blood cells, and haemoglobin, enhance immunity and improve health[7]. Acupoints selected will include CV6 Qihai (气海), CV4 Guanyuan (关元), CV3 Zhongji (中级), EX-CA1 Zigong (子宫), BL23 Shenshu (肾俞), BL27 Dachangshu (大肠俞), BL30 Baihuanshu (白环俞), and BL32 Ciliao (次髎).
3. What are the risks of Pelvic Inflammatory Disease?
PID is the leading cause of infertility (due to residual scarring or congealed exudate) and ectopic pregnancy, and is related to an increased risk of ovarian borderline tumor[2]. Patients with chronic PID often suffer from acute attack or immune deficiency, and inappropriate antibiotic management may result in endometritis, oophoritis, tubo-ovarian abscess or peritonitis[3].
Patients with PID can also experience leukorrhea, painful intercourse or irregular menstruation[4], or may even result in depression or insomnia[5].
4. Are these treatment options safe for use by everyone?
Yes, the treatment options are generally safe for use by everyone, but it is still recommended that patients seek treatment from professional TCM Physicians to a proper overall diagnosis and embarkment on the right treatment process.
References:
[2] Rasmussen CB, Faber MT, Jensen A, Høgdall E, Høgdall C, Blaakær J, Kjaer SK: Pelvic inflammatory disease and risk of invasive ovarian cancer and ovarian borderline tumors. Cancer Causes Control. 2013, 24: 1459-1464. 10.1007/s10552-013-0216-y.
[3] Ozel S, Arslan H, Tufan ZK, Uzunkulaoğlu T, Akarsu D, Seven A: Acupuncture in the treatment of chronic pelvic pain secondary to pelvic inflammatory disease. Acupunct Med. 2011, 29: 317-318. 10.1136/acupmed-2011-010080.
[4] Mitchell, C; Prabhu, M (December 2013). Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment [J]. Infectious disease clinics of North America. 27 (4): 793–809.
[5] Graziottin A, Skaper SD, Fusco M (2013) Inflammation and Chronic Pelvic Pain: A Biological Trigger for Depression in Women? [J]. Depress Anxiety 3:142.
[6]. Wang L, Li XW, Zhang L. Advances of studies on mechanisms of moxibustion therapy at home and abroad. Chin Acupun Moxibust 2001;21:56770.
[7]. Lan L, Chang XR, Shi J, et al. Advances of the mechanism of moxibustion. Chin Archiv Tradit Chin Med 2011;29:261620.
