UTERINE FIBROIDS (UTERINE MYOMA, LEIOMYOMA, FIBROMA, FIBROMYOMA, HYSTEROMYOMA)

Clinical Manifestations
  • Benign growths of smooth muscle tissue in the uterine wall
  • The fibroids frequently go unnoticed until they grow rapidly during a perimenopausal phase around age 41-45
  • Most often, fibroids decline substantially with menopause
  • Small uterine myomas are usually asymptomatic, but larger masses can cause excessive menstrual bleeding, and very large fibroids can contribute to miscarriage, abdominal pain, profuse bleeding (with resultant anemia) and other symptoms for which surgical removal of the fibroids is recommended
  • Uterine myomas up to the size of a goose egg (about 6.5 cm) can be successfully treated with herbs to reduce the size to a comfortable level and, in many cases, to eliminate them
  • Zheng: solid masses (concretions) with defined physical form and fixed location, accompanied by pain in a specific location. These patterns usually involve the blood
  • Jia: masses without a distinct physical form (conglomerations), manifesting and dispersing without apparent pattern. Accompanying pain is not fixed in location. In these cases, pathological changes have taken place in the bowel organs. Hence, these patterns involve Qi.
  • The most marked symptoms of abdominal masses are abdominal distention and pain
  • Ju (Qi Masses):
    Origin: Qi Stagnation, such as emotion-caused Liver Qi disorder or retention of food and phlegm due to overeating and a weak Spleen. External factors, such as Wind-Cold, can contribute.
    Nature: Develops and enlarges with stress; may retreat with calmness. Pain, or mild aching, does not have a fixed site. Involves disorder of the Fu organs (e.g., gallbladder, stomach)
    Manifestations:
    Bloating and distention after eating
    Swelling of the Liver and Spleen
    Intestinal obstruction with constipation
    Early stage fibroids (small uterine swellings)
  • Ji (Blood Stasis Masses):
    Origin: Develops from prolonged Ju, as Blood Stasis occurs secondary to Qi Stagnation. Exposure to Heat-toxins (e.g., viruses, poisonous substances) that are retained for a long time may contribute to transformation of Ju to Ji.
    Nature: Develops over a long period, progressing from soft to hard mass, with fixed site of pain. Involves disorder of the Zang organs (e.g., Liver, Spleen), and with the pathologic influence gradually weakening the Normal Qi.
    Manifestations:
    Ovarian cysts
    Uterine fibroids
    Tumors of the cervix, uterus, bladder, colon, etc;
    Advanced Liver cirrhosis and fibrosis
    Endometriosis
    Surgical adhesions
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Sallow complexion
  • Fatigue
  • Anorexia
  • Four limbs feel tired and heavy
  • Abdominal and epigastric distention after eating
  • Maybe acid regurgitation or vomiting
  • Loose stools
  • Shortness of breath
  • T: Pale and flabby - may have teethmarks
  • C: White
  • P: Even, forceless and Deficient
Treatment Principle
  • Strengthen the Spleen
  • Benefit Qi
Herb Formulas
Points
Clinical Manifestations
  • Protracted, incessant cough
  • Expectoration of copious, clear, watery or white Phlegm
  • Short, weak, breathing
  • Asthma
  • Spontaneous sweating
  • Weak voice
  • Reluctance to speak
  • A general air of sadness or melancholy
  • A waxy, pale complexion
  • Rounded or hunched shoulders
  • Four limbs tired
  • Anorexia
  • General lassitude
  • Distention and pain of the epigastrium and abdomen
  • Loose stools
  • Severe cases:
    Frightens easily
  • T: Pale with a thin crack
  • C: White or White and greasy
  • P: Thready and weak or Floating and weak
Treatment Principle
  • Reinforce the Spleen
  • Benefit the Lungs
  • Descend Lung Qi
  • Disperse accumulation
Herb Formulas
Points
Clinical Manifestations
  • Retained food in the intestinal tract impairs transportation and transformation, and thus produces Phlegm-Dampness, which, combined with retained food, blocks the Qi circulation, thereby causing:
    Abdominal pain
    Constipation
    Anorexia
  • When this condition is combined with Stagnant Qi:
    Cord-like masses occur in the abdomen
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Qi accumulates and flows to the chest, hypochondrium, epigastrium, and lower abdomen
    Pain in these areas
  • This condition changes according to the patient's emotional state:
    Mental depression
    T: Normal
    C: Thin and sticky
    P: Taut
  • Mental depression leads to Liver Qi Stagnation, which causes accumulation of Qi and its movement in all directions:
    Distending pain
    P: Taut
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Distending pain in the lower abdomen
  • Facial color dark and dull
  • Emaciation
  • Sides and ribs distended on both sides (maybe with sharp pain)
  • Enlargement of the Liver and Spleen
  • Suffocating sensation in chest
  • Tendency to sigh
  • Melancholy
  • Depression
  • Irritability
  • Inappropriate anger
  • Irregular menses
  • Dysmenorrhea
  • Breast distention and pain before and during menses
  • T: Dark purple (maybe purple spots on edge of tongue) or Red with petechiae on the edges
  • C: Thin and white
  • P: Wiry, choppy and slow or Wiry and thready
Treatment Principle
  • Invigorate Blood circulation
  • Move Qi
  • Soften hardness
Herb Formulas
Points
Clinical Manifestations
  • Submucosal or intramural fibroids or
  • Multiple fibroids
  • Patients present with mixed Excess and Deficiency patterns that change from predominant Excess at the onset of the disorder to increasing Deficiency over time
  • The cycle tends to be normal or long with increased bleeding often accompanied by clotting
  • There may be a dragging down sensation in the lower abdomen
  • Diarrhea
  • A thin discharge following menstruation
  • T: Pale
  • C: White and thick or thin
  • P: Soggy and thin or Thin and wiry
Treatment Principle
  • Circulate Qi
  • Tonify Qi
  • Strengthen the Spleen
Herb Formulas
Points
Clinical Manifestations
  • Submucosal or intramural fibroids or
  • Multiple fibroids
  • A burning sensation in the chest or
  • A feeling of Heat in the lower abdomen
  • Pain in the nipples or
  • A stabbing pain and distension and pain in the entire breast before the period
  • After the period a reddish-white or yellowish-white discharge
  • Dizziness
  • Tinnitus or deafness
  • Poor memory
  • Aching, soreness or weakness of the low back
  • Aching in the bones
  • Aching in the leg and heel
  • Dry mouth
  • Thirst
  • Night sweats
  • Five sole Heat
  • Malar flush
  • Low grade fever in the afternoon
  • Dry throat, maybe recurrent sore throat
  • Dry stools and/or
  • Constipation
  • Urine short and red
  • Heightened libido
  • If Heart Fire also Flares:
    Insomnia
    Frequent dreams
    Palpitations
  • If Liver Yang also Rises:
    Dizziness
    Blurred vision
  • T: Red
  • C: Little or None or Thin and yellow
  • P: Thready and rapid or Thready and wiry
Treatment Principle
  • Nourish Yin
  • Subdue Fire
Herb Formulas
Points
Clinical Manifestations
  • Irregular menstruation
  • Profuse, lingering menstrual flow
  • Dizziness
  • Tinnitus
  • Cold body and limbs
  • Spontaneous sweating
  • Low back and leg weakness and pain
  • Frequent nocturnal urination
  • T: Light red
  • C: White and slippery
  • P: Deep and weak
Treatment Principle
  • Nourish the Kidneys
  • Regulate the Chong and Ren
  • Invigorate the Blood
  • Dispel Stasis
Herb Formulas
Points
Clinical Manifestations
  • Hard masses
  • Violent pain
  • Premenstrual breast distention and pain
  • Dysmenorrhea with hesitant flow and clots
  • Irritability
  • Anorexia
  • Sallow or dark-yellow complexion
  • T: Purple or Red and glossy
  • C: Gray and coarse tongue or None
  • P:Thready and rapid or Taut and thready or Wiry
Treatment Principle
  • Tonify Qi
  • Invigorate the Blood
  • Break up Stasis
Herb Formulas
Points
Clinical Manifestations
  • Subserosal or intramural fibroids
  • The masses have only recently formed and so they are still soft to the touch
  • The period is frequently normal, though in severe cases the
    Penetrating and Conception vessels will be damaged leading to heavy periods
  • There may be lower abdominal distension or
  • Latent pain and a dragging sensation in the rectum
  • T: Blue or Dark red and the sides may show purple stagnation spots
  • C: Little or None
  • P: Taut or Deep and wiry or Thin and choppy
Treatment Principle
  • Circulate Qi
  • Activate the Blood
Herb Formulas
Points
Clinical Manifestations
  • Facial color dark and dull
  • Emaciation
  • Sides and ribs distended on both sides (maybe with sharp pain)
  • Enlargement of the Liver and Spleen
  • Suffocating sensation in chest
  • Tendency to sigh
  • Melancholy
  • Depression
  • Irritability
  • Inappropriate anger
  • Irregular menses
  • Dysmenorrhea
  • Breast distention and pain before and during menses
  • Anorexia
  • Edema
  • Abdominal distention
  • Chest and hypochondriac distention
  • Dizziness
  • Nausea
  • Vomiting
  • Thirst with no desire to drink
  • Maybe no thirst
  • Palpitations
  • Shortness of Breath
  • T: Varies from Normal to Dark purple (maybe purple spots on edge of tongue)
  • C: Thick and slippery
  • P: Wiry, choppy and slow or Slippery, full and maybe wiry
Treatment Principle
  • Circulate Qi
  • Activate the Blood
  • Break up Stasis
  • Eliminate Phlegm
  • Warm Cold
Herb Formulas
Points
Clinical Manifestations
  • Hard enlarged masses
  • Fixed pain
  • A dark gray complexion
  • Emaciation
  • Lassitude
  • Anorexia
  • Fever (or feverish feeling)
  • Aversion to Cold
  • Amenorrhea
  • T: Purple
  • P: Choppy or Taut and smooth
Treatment Principle
  • Activate the Blood
  • Break up Stasis
Herb Formulas
Points
Clinical Manifestations
  • The origin of this pattern is a history of exposure to Cold, either cold temperatures, or the habitual consumption of cold foods, especially during menstruation.
  • Pain in the lower abdomen and pelvic region
  • Heavy and/or irregular periods
  • Spotting between periods or before periods
  • Infertility
  • Difficulty conceiving
  • Pain during sexual intercourse
  • Abdominal swelling
  • Painful bowel movements, especially during menstruation
  • Bleeding from the rectum during menstruation
  • Lower abdominal pain during menstruation
  • Low back pain
  • Painful urination during menstruation
  • Sometimes no symptoms at all
  • Abdominal tenderness
  • Pressure and pain before or during periods
  • A preference for warmth
  • An aversion to Cold
  • Blood clots with periods
  • The pain relieved after the periods
  • Pale complexion
  • Nausea or vomiting with severe menstrual pain
  • Other symptoms may include:
    Headaches
    Low grade fevers
    Depression
    Hypoglycemia
    Anxiety
    Susceptibility to infections and allergies
  • T: Pale and purplish with spots
  • C: White
  • P: Wiry and tight
Treatment Principle
  • Activate the Blood
  • Break up Stasis
  • Warm Cold
Herb Formulas
Points
Clinical Manifestations
  • The origin of this pattern is a history of genital infections.
  • Pain in the lower abdomen and pelvic region
  • Heavy and/or irregular periods
  • Spotting between periods or before periods
  • Difficulty conceiving
  • Pain during sexual intercourse
  • Abdominal swelling
  • Painful bowel movements, especially during menstruation
  • Bleeding from the rectum during menstruation
  • Lower abdominal pain during menstruation
  • Low back pain
  • Painful urination during menstruation
  • Abdominal tenderness, pressure, pain, and fever before, during, or after periods (the more severe the pain, the higher the fever)
  • Sometimes no symptoms at all
  • Infertility
  • Irregular menses
  • A preference for cold temperatures
  • Dislikes pressure
  • Large clots
  • Heat shows more during menstruation
  • Trichomonas infection
  • A bitter taste in the mouth
  • Thirst
  • A dry throat
  • Constipation
  • Anxiety
  • Anger
  • Other symptoms may include:
    Headaches
    Low grade fevers
    Depression
    Hypoglycemia
  • T: Red or Red tip or Purple spots on the sides of the tongue
  • C: Thin and yellow
  • P: Wiry and rapid
Treatment Principle
  • Clear Heat
  • Nourish Yin
  • Invigorate the Blood
  • Dispel Blood Stasis
Herb Formulas
Points
Clinical Manifestations
  • Dull pain in the lower abdomen
  • Profuse, sticky vaginal discharge
  • Pruritis vulva with a foul odor
  • Lassitude
  • Thirst with no desire to drink
  • T: Red
  • C: Yellow and sticky
  • P: Slippery and rapid
Treatment Principle
  • Clear Heat
  • Resolve Dampness
  • Invigorate the Blood
  • Break up Stagnation
Herb Formulas
Points
Clinical Manifestations
  • Retention of the lochia with Cold, hardness and pain in the lower abdomen
  • The pain is worse with pressure
  • May be masses in the sore area
  • The Blood is dark purplish
  • T: Pale and purple or Pale with purple spots
  • C: Normal
  • P: Deep and choppy
Treatment Principle
  • Activate the Blood
  • Transform and dispels Blood Stasis
  • Warm the menses
  • Warm the channels
  • Alleviate pain
Herb Formulas
Points
Clinical Manifestations
  • Mild, persistent uterine bleeding of purple and black blood during pregnancy
  • Dull abdominal pain that is worse with pressure
  • Abdominal spasms and tension
  • Immobile masses in the lower abdomen with pain and tenderness
  • Scanty menstrual flow
  • Delayed menstruation or
  • Amenorrhea with distention and pain
  • Dysmenorrhea
  • Headache
  • Sinus congestion
  • Constipation
  • Excess weight in the pelvis
  • Lower back ache
  • Irregular menstruation
  • Nervousness
  • Fatigue
  • Fetal instability
  • Skin eruptions
  • Scanty menstrual flow
  • Scaly, dry skin
  • Retention of lochia
  • Headache
  • Shoulder stiffness
  • Vertigo
  • Cold low body and feet
  • Flushed face
  • Protruding abdomen
  • T: Dark purple or with echymoses or petechiae or pale with purplish spots
  • C: White or White and sticky
  • P: Choppy or Tense, deep and slow or Slow and slippery
Treatment Principle
  • Invigorate the Blood
  • Transform Blood Stasis
  • Soften lumps
  • Reduce pain
Herb Formulas
Points
Clinical Manifestations
  • Delayed menstruation or
  • Amenorrhea
  • Menses are decreased, light in color and viscid
  • Scanty periods
  • Palpitations of the Heart
  • Shortness of breath
  • Epigastric fullness
  • Lassitude of limbs
  • Profuse sputum in the throat
  • Loose stools
  • Obesity
  • Infertility
  • Leukorrhea
  • Dizziness
  • A heavy sensation in the head
  • Chest oppression
  • Nausea
  • Increased vaginal discharge
  • T: Pale and plump
  • C: White and greasy
  • P: Slippery
Treatment Principle
  • Resolve Phlegm
  • Eliminate Dampness
  • Regulate Qi
  • Regulate menstruation
Herb Formulas
Points
Clinical Manifestations
  • Irregular menstruation
  • Painful menstruation
  • Lower abdominal pain during menstruation
  • Lower back pain during menstruation
  • Amenorrhea
  • Abdominal accumulations due to Blood Stasis
  • Headache
  • Postpartum bleeding or pain
  • Post-miscarriage bleeding or pain
  • Vertigo
  • Dysmenorrhea
  • T: Maybe purplish spots
  • C: Normal
  • P: Choppy, Knotted and rapid
Treatment Principle
  • Transform accumulations
  • Dispel Stasis
  • Stop pain
  • Activate the Blood
  • Regulate menstruation
Herb Formulas
Points
Clinical Manifestations
  • Acute lower abdominal pain
  • Incontinence of urine
  • Night fevers
  • Delirious speech
  • Irritability
  • Restlessness
  • Thirst
  • May be mania (severe)
  • Dysmenorrhea
  • Amenorrhea
  • Hard stool
  • Dark red complexion
  • Headache
  • Vertigo
  • Tinnitus
  • Insomnia
  • Palpitations
  • Constipation
  • Frequent urination
  • Emotional instability
  • Chills in the waist and feet
  • Tremors
  • Excruciating abdominal pain with cold
  • Black stool
  • May be chills and fever
  • Hemoptysis
  • Hematuria
  • Red eyes
  • Pain and distention of the head
  • Toothache
  • Irregular menstruation
  • Lochioschesis
  • Severe wheezing
  • Distention of the chest
  • T: Red and dry
  • C: Yellow
  • P: Deep and forceful or Choppy
Treatment Principle
  • Drain Heat
  • Break up Blood Stasis
Herb Formulas
Points
Etiology
  • Poor food after menstruation, leading to cold
Clinical Manifestations
  • A hard, fixed lump in the abdomen
  • The lump increases in size rapidly
  • P: Deep and slippery
Treatment Principle
Herb Formulas
Points
Etiology
  • Wind-Cold attacks the Blood after menstruation, leading to Zong Qi Deficiency
Clinical Manifestations
  • A hard lump in the abdomen that cannot be moved
  • The abdomen and flanks are swollen and painful
  • The lump moves when pressed
  • Heat internally
  • Anxiety
  • P: Hard
Treatment Principle
  • Circulate Qi
  • Activate the Blood
  • Break up Stasis
  • Tonify Qi
  • Soften masses
Herb Formulas
Points

JIA

Etiology
  • Wind-Cold attacks the body after menstruation, leading to Qi and Blood Stagnation
  • Jia attacks the upper body causing pain in the lower body
Clinical Manifestations
  • A hard lump in the abdomen that moves when pressed
  • P: Deep and tight
Treatment Principle
  • Circulate Qi
  • Activate the Blood
  • Break up Stasis
  • Tonify Qi
  • Soften masses
Herb Formulas
Points