Blue Poppy: Wen Jing Tang & Endometriosis

On page 332 of issue5, 2009 of Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Hong Miao-lan published an article titled, “The Treatment of 60 Cases of Endometriosis with Wen Jing Tang.” A summary of this article is presented below.

Altogether, there were 110 cases of endometriosis enrolled in this two-wing comparison study. These 110 cases were randomly divided into a treatment group of 60 cases and a comparison group of 50 cases. In the treatment group, the median age was 28.3 plus/minus 4.8 years, sixteen of these cases suffered mild dysmenorrhea, 28 cases suffered moderate dysmenorrhea, and sixteen cases suffered severe dysmenorrhea. There were 48 cases of infertility, 25 cases of dyspareunia, and 30 cases of menstrual period low back pain. In 35 cases, ultrasound and gynecological examination confirmed the presence of adnexal pressure pain and chocolate cysts. In the comparison group, the median age was 27.7 plus/minus 5.1 years. Fourteen of these cases had mild dysmenorrhea, 24 had moderate dysmenorrhea, and 12 cases had severe dysmenorrhea. There were also 38 cases of infertility, 30 cases of dyspareunia, and 40 cases of menstrual period low back pain. In this group, ultrasound and gynecological examination revealed 30 cases of adnexal pressure pain and chocolate cysts. Therefore, these two groups were deemed statistically comparable for the purposes of this study.

Beginning on the first day of the menstrual cycle, both groups received 12.5 milligrams of mifepristone per day for a continuous three months. In addition, members of the treatment group also received the following version of Wen Jing Tang (Warm the Menses Decoction):

Dang Shen (Radix Codonopsis)
Bai Shao (Radix Alba Paeoniae), 15g each
Dang Gui (Radix Angelicae Sinensis), 30g
Chuan Xiong (Rhizoma Chuanxiong)
Rou Gui (Cortex Cinnamomi)
Mu Dan Pi (Cortex Moutan)
mix-fried Gan Cao (Radix Glycyrrhizae), 10g each
E Zhu (Rhizoma Zedoariae)
Niu Xi (Radix Achyranthis Bidentatae), 12g each

If inflammation and symptoms of blood stasis were relatively severe, Xia Ku Cao (Spica Prunellae), Yi Mu Cao (Herba Leonuri), San Leng (Rhizoma Sparganii), and Zao Jiao Ci (Spina Gleditsiae) were added.

If low back pain was severe, Wu Ling Zhi (Faeces Trogpterori), Shui Zhi (Hirudo), and Pu Huang (Pollen Typhae) were added.

If there was liver depression qi stagnation, Zhi Ke (Fructus Aurantii) and Xiang Fu (Rhizoma Cyperi) were added.

One packet of these medicinals per day was decocted in water two times to achieve 200 milliliters of medicinal liquid. This liquid was divided into two doses and one dose was administered in the morning and the other in the evening each day. This regime was continued for three months.

Cure was defined as complete disappearance of symptoms as well as lumps in the pelvic cavity. In addition, if the patient had been infertile, she conceived and gave birth within two years. Marked effect was defined as basic disappearance of symptoms, shrinkage of pelvic lumps, and at least conception if the patient had been infertile. Some effect was defined as a decrease in symptoms, a slight decrease or at least no growth in pelvic lumps, and no worsening of symptoms within three months of stopping medication. No effect meant that there was no change in the main symptoms or that some of the symptoms got worse. The following table shows the outcomes in the two groups based on these criteria.

Thus, this study showed that the combination of Wen Jing Tang with mifepristone was markedly more effective than mifepristone alone in the treatment of endometriosis. In the treatment group, six cases experienced recurrence, while 29 out of the 48 cases of infertility (60%) conceived. In the comparison group, 11 cases experienced recurrence and only 15 of the 38 cases of infertility (39%) conceived. Therefore, the recidivism rate was considerably less and the conception rate was markedly higher in the treatment group. There were no obvious signs of liver or kidney function impairment or other adverse reactions in either group.

According to Dr. Hong, blood stasis is the main disease mechanism of endometriosis in terms of Chinese medicine. Therefore, the treatment principles on which this study was based were to quicken the blood and dispel stasis. Wen Jing Tang originally comes from Chen Zi-ming’s famous Song dynasty Fu Ren Liang Fang Da Chuan (Great Collection of Fine Formulas for Women). Within it, Dr. Hong says Dang Shen, Dang Gui, Chuan Xiong, and Shao Yao supplement and move the blood. Thus there is supplementation without stagnation and moving within supplementation. Dr. Hong thinks this is important because women commonly suffer from blood vacuity, and this vacuity easily leads to blood stasis. Hence this formula supports the righteous and dispels evils at the same time. Rou Gui warms the menses and scatters cold. E Zhu, Mu Dan Pi, and Niu Xi quicken the blood and move stagnation. As a combination, Bai Shao and Gan Cao relax cramping and stop pain. These two medicinals form the famous formula Sha Yao Gan Cao Tang (Peony & Licorice Decoction) from Zhang Zhong-jing’s late Han dynasty Shang Han Lun (Treatise on Damage [Due to] Cold). Dr. Hong believes that, when the above medicinals are used together, they are an effective prescription for the treatment of cold congelation and blood stasis in the uterus resulting in menstrual pain and infertility.

. Mifepristone is a synthetic steroid compound used as a pharmaceutical. It is used as an abortifacient in the first two months of pregnancy, and in smaller doses as an emergency contraceptive. During early trials, it was known as RU-486. Other medical applications of mifepristone that have been studied in phase II clinical trials include regular long-term use as an oral contraceptive and treatment of uterine fibroids, endometriosis, major depression with psychotic features, glaucoma, meningiomas, breast cancer, ovarian cancer, prostate cancer, and some types of Cushing's syndrome.