Traditional Chinese Medicine and Uterine Fibroids
Traditional Chinese Medicine and Uterine Fibroids
April 2001; Volume 4; 43-45
By Judith L. Balk, MD
Traditional Chinese medicine (TCM) includes herbal preparations, acupuncture, acupressure, qigong, oriental massage techniques, as well as other approaches.1 Although a long tradition exists in TCM for treating gynecological problems, a MEDLINE search for all years, using all combinations of the terms myoma, leiomyoma, uterine fibroid, and hysteromyoma with acupuncture, herb, and TCM revealed only eight articles, three of which were in English. None are randomized controlled trials.
History
The earliest records of TCM use in gynecology date back to the Shang dynasty, 1500-1000 BC.2 Bones and tortoise shells have been found with inscriptions dealing with childbirth problems, and the use of medicinal plants as a treatment for infertility was described as early as 476-221 BC.
TCM and Fibroids—Philosophy
The TCM view of physiology greatly differs from the Western perspective. In TCM, disease is caused by an imbalance or obstruction of vital energy or qi. Western medicine does not recognize qi, meridians, or diagnosis by imbalances of yin and yang.
In TCM, the organs have different functions than in Western medicine. For instance, in TCM, the spleen is considered to be the principal organ of digestion. It transforms food into nourishment and transports nourishment and fluid throughout the body. The spleen also is thought to govern blood and hold blood inside its proper vessels. If the spleen is deficient, blood leaks from blood vessels and manifests as petechiae, melena, hematamesis, or menorrhagia. A deficient spleen will not be able to transform food fully into nutrients and energy, and the remaining liquids and solids will accumulate and form dampness.
Pathophysiology
According to TCM, the pathophysiology of uterine fibroids is as follows: Deficient spleen energy allows dampness to accumulate. The dampness stagnates and becomes phlegm, which congeals into a tumor in the uterus, known as a uterine fibroid or leiomyoma.3 Western medicine views the spleen markedly differently, and no connection between the spleen and leiomyomata is obvious. TCM can explain the presence of leiomyomata as the result of a deficient spleen. But can TCM treat fibroids?
Basic Science
No definitive studies have been conducted on mechanism of action. Electrical characteristics of acupuncture points differ between patients with uterine cancers and fibroids and those of control patients. A correlation between temporal parameters of electrical response of acupuncture points and the activity of uterine proliferation has been described by Russian investigators.4
One theory that has been suggested for acupuncture’s effects on fibroids is based on the theory that regression of experimental tumor cells may be induced by local tissue destruction and repair. The authors postulated that "humoral factors at a stimulated acupoint which control and prevent local overgrowth of regenerating and proliferating cells may systemically affect the growth of distant tumors." If these humoral factors are present, and do indeed control cell growth, it is possible that a mechanism such as this could affect fibroid growth.5
Some herbal products have estrogenic or antiestrogenic effects. Phytoestrogens, for instance, are plant estrogens that have both estrogen agonist and antagonist properties.6 An estrogen antagonist could have beneficial effects on leiomyomata.
Clinical Studies—Acupuncture
No randomized controlled trials have been conducted to evaluate the effects of acupuncture on fibroids.
One case report on the use of acupuncture for fibroids and secondary infertility has been published.5 A 35-year-old woman had large fibroids, dysmenorrhea, menorrhagia, and secondary infertility. The patient had had multiple in vitro fertilization (IVF) procedures without success, and as a last resort, accepted acupuncture treatment. The patient was treated for five weeks, twice per week, and then for 20 weeks, once per week. The size of the fibroids decreased from 12-14 weeks size to 7-8 week size, documented by ultrasound. The patient then had repeat IVF and successfully became pregnant, delivering healthy twins.
A Chinese abstract describes treating fibroids with acupuncture, with Chinese and Western medical approaches as controls.7 The authors note that acupuncture treatment gave a "total effective rate" of 98% and a "cure rate" of 73%. Other details are unavailable.
Herbal Medicines
No randomized controlled trials of herbal approaches to fibroids have been published. However, several large case series do exist.
One Japanese case series enrolled 110 premenopausal women with fibroids less than 10 cm diameter.8 All patients were treated with an herbal preparation of Kuei-chihfuling-wan (Keishi-bukuryo-gan, KBG) daily for at least 12 weeks. The average age of the subjects was 43 years old, and all patients were symptomatic from their fibroids. Hypermenorrhea and dysmenorrhea were improved in roughly 95% of all patients. Patients had ultrasounds every two weeks during the study. Fibroid size decreased in 62% of cases and increased in 4% of cases. Hormonal assays and liver function did not differ between groups.
The authors note that in young women who wish to remain fertile and in middle-aged women before menopause, KBG treatment may be a first choice as it is safe and inexpensive. However, given the lack of a control group, it is impossible to make statements on efficacy. These authors previously had reported that KBG might act as an LH-RH antagonist and a weak anti-estrogen on the uterine DNA synthesis in immature rats. The combination KBG is one of the traditional Chinese herbal preparations that has been used frequently for the treatment of many gynecological disorders thought to be related to "venous congestion of pelvis." KBG is composed of five herbal drugs: cassia bark (Keihi), roots of the herbaceous peony, peach kernels, herbaceous fungus, and root bark of the peony. All patients received the same treatment.
A smaller case series enrolled 38 women with fibroids, ages 36-52, and treated each patient for three months.9 The treatment, "Tumor-Resolving Decoction" medication, was based on TCM principles. The therapeutic principle was to "promote blood circulation, remove blood stasis, and resolve hard lumps." Basic ingredients of the decoction are shown in Table 1.
| Table 1: Ingredients in TCM tumor-resolving decoction9 | |
| Dong Quai (Radix Angelicae Sinensis) | 10g |
| Chi Shao (Radix Paeoniae Rubra) | 10 g |
| Zhe Bei Mu (Bulbus Fritillariae Thunbergii) | 10 g |
| Hai Zao (Sargasum) | 12 g |
| Kun Bu (Thallus Ecloniae) | 12 g |
| Bie Jia (Carapax Trionycis Preaeparata) | 12 g |
| Mu Li (Concha Ostreae) | 12 g |
| San Leng (Rhizoma Sparganii) | 6 g |
| E Zhu (Rhizoma Zedoariae) | 6 gr |
The formula was individualized based on the modifications shown in Table 2. In contrast with the KBG study, treatment was individualized. The investigators followed serial ultrasounds and physical exams.
| Table 2: Modifications (additions) of ingredients in TCM tumor-resolving decoction9 | |
| Indication | Modification (Additions to basic formula) |
| Blood stasis | Dan Shen (Radix Salviae Miltiorrhizae) and Chuan Xiong (Rhizoma Ligustic Chuanxiong) |
| Blood stasis with qi stagnation | Chuan Lian Zi (Fructus Meliae Toosendan) and Yuan Hu (Rhizoma Corydalis) |
| Blood stasis with qi deficiency | Dang Shen (Radix Codonopsis Pilosulae) and Huangqi (Radix Astragali seu Hedysari) |
| Profuse uterine bleeding with severe anemia | Buzhong Yigi Tang, Ce Bai Ye (Cacumen Biotae) and Di Yu (Radix Sanguisorbae) |
| After bleeding stops | Dang Shen (Radix Codonopsis Pilosulae) and Huangqi (Radix Astragali seu Hedysari) |
Roughly 3% of patients were cured, 42% had a marked effect on size and menstruation, 37% had improved menstruation and no change in uterine size, and 19% had no change in menstruation or fibroid size. Uterine dimensions were statistically significantly changed from before treatment to after treatment. Again, however, the lack of a control group severely limits the utility of these findings.
Diet and Lifestyle Guidelines
No published studies have evaluated the effects of a traditional Chinese diet on leiomyoma size or growth patterns. However, dietary and lifestyle recommendations based on TCM principles for treatment of fibroids do exist.2
For instance, one textbook notes that patients should avoid the excessive consumption of cold-energy foods, especially cold drinks, as these tend to lead to stasis in the lower abdomen. Another recommendation is to avoid exposure to cold and dampness during the menstrual period and after childbirth. Positions for meditation and guidelines for exercise and sexual activity are also given. Those trained in Western medicine will find these recommendations to be without scientific justification. No research is published that either proves or disproves these recommendations.
There is (Western) evidence that diet may affect the risk of fibroids.10 The diet that appears to be protective of fibroids is also a diet that is more likely to be consumed by people in Asian countries than in Western ones. For instance, an Italian case-control study found that fibroids were positively associated with intake of beef and ham. High intake of green vegetables was protective against fibroid formation. However, this study is limited by lack of an ultrasound in the control patients. A traditional Asian diet has a low intake of red meat and a relatively high intake of green and sea vegetables. However, no case-control studies report the use of a traditional Asian diet to reduce the risk of fibroids. A study of soy in American premenopausal women with fibroids is currently ongoing.
Conclusion
The data presented here are inadequate to recommend acupuncture, herbal approaches, or lifestyle approaches for treatment and prevention of uterine leiomyomata. One case-control study found that dietary differences may point to useful information, but the study design limits its utility. Prospective, randomized, and controlled trials are necessary to evaluate the effectiveness of TCM in the treatment of uterine leiomyomata.
Recommendation
TCM has a long history of treating uterine fibroids, but no adequate data exist on the efficacy. Herbal approaches are not recommended because of lack of regulation in the herbal industry and concerns about safety and contamination. Acupuncture has not been proven to be effective, and one textbook notes that uterine myomas can be dispersed only if they are very small, less than 2 cm in diameter.2
Dr. Balk is Assistant Professor, Department of Obstetrics/Gynecology at the University of Pittsburgh.
References
1. Alternative Medicine: Expanding Medical Horizons. Washington, DC: U.S. Government Printing Office; 1992:372.
2. Maciocia G. Obstetrics and Gynecology in Chinese Medicine. New York: Churchill Livingstone; 1998:959.
3. Helms J. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, CA: Medical Acupuncture Publishers; 1995:757.
4. Botwin MA, et al. Electric characteristics of acupuncture points in patients with benign and malignant uterine tumors [in Russian]. Akush Ginekol 1989;4:27-30.
5. Sternfeld M, et al. The effect of acupuncture on functional and anatomic uterine disturbances: Case report-secondary infertility and myomas. Am J Acupuncture 1993;21:5-7.
6. Murkies AL, et al. Clinical review 92: Phytoestrogens. J Clin Endocrinol Metab 1998;83:297-303.
7. Yan H, Wang J. The clinical study on hysteromyoma treated with acupuncture [in Chinese]. Zhen Ci Yan Jiu 1994;19:14-16.
8. Sakamoto S, et al. Pharmacotherapeutic effects of kuei-chih-fu-ling-wan (keishi-bukuryo-gan) on human uterine myomas. Am J Chin Med 1992;20:313-317.
9. Sun L. 38 cases of hysteromyoma treated with tumor-resolving decoction. J Tradit Chin Med 1995;15:273-276.
10. Chiaffarino F, et al. Diet and uterine myomas. Obstet Gynecol 1999;94:395-398.
April 2001; Volume 4; 43-45
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