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					Treatment of Benign Ovarian Cysts

with Traditional Chinese Medicine




         By Catherine D. (Cat) Calhoun

                      Fall 2010

         Herbal Treatment of Disease 2

                 Instructor: Dr. He




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Table of Contents

Table of Contents ............................................................................................................................ 2

Biomedical Overview ..................................................................................................................... 3

   Functional Ovarian Cysts ............................................................................................................ 3

   Abnormal Ovarian Cysts............................................................................................................. 5

   Etiology ....................................................................................................................................... 7

   Symptoms ................................................................................................................................... 8

   Complications ............................................................................................................................. 9

TCM Overview ............................................................................................................................. 10

   Etiology ..................................................................................................................................... 10

   Pathology .................................................................................................................................. 12

Common Syndromes ..................................................................................................................... 13

   Liver Qi Stagnation ................................................................................................................... 14

   Stagnation of Qi and Blood....................................................................................................... 16

   Blood Stasis .............................................................................................................................. 18

   Kidney Yang Deficiency with Accumulations of Damp and Phlegm ...................................... 20

Biomedical Interventions and Implications for TCM ................................................................... 23

Summary ....................................................................................................................................... 24

Reference list ................................................................................................................................ 25




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Biomedical Overview

An ovarian cyst is any collection of fluid in or on the ovary which is surrounded by a thin-walled

sac and is greater than 2cm in diameter. Ovarian cysts are quite common, affecting

approximately 97% of premenopausal and 14% of postmenopausal women. Ovarian cysts are

also the most common fetal and neonatal tumors, affecting approximately 30% of this population

(Valesky). These cysts are categorized as either functional or abnormal in nature.



Functional Ovarian Cysts

Functional ovarian cysts can be part of the normal cycle of menstruation, usually occur only on

one side, and result from a slight alteration in the function of the ovarian cycle. Cysts forming in

the first half of the menstrual cycle in which an ovum is being prepared for release by the ovary

are called follicular cysts or graafian cysts (“Wikipedia: The Free Encyclopedia”). These occur

when the follicle forms, but the egg is not released. These types of cysts continue to grow and fill

with fluid. Complications of follicular cysts include rupture, hemorrhage of the cyst, and

interruption of the menstrual cycle. Rupture can cause severe acute pain on the affected side and

affect about 25% of women developing these cysts. Hemorrhage occurs when the cyst bleeds

into itself, further enlarging the cyst and causing sharp pain. These types of cysts can interrupt a

normal menstrual cycle because follicles are designed to produce estrogen. The cysts also

continue estrogen production causing irregular and excessive bleeding. This same hormone

release can also trigger hyperplasia of the endometrium or uterine lining, amenorrhea, and

fertility problems (Porth). Seventy to eighty percent of follicular cysts will resolve without

intervention, however, and are often asymptomatic. Small follicular cysts may even be present in

a normal ovary while other follicles are being formed (Stoppler). Ultrasound is the primary
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diagnostic tool used to detect and diagnose these cysts.



Functional ovarian cysts forming in the second half of the menstrual cycle are “corpus luteum

cysts.” During the normal course of menstruation a follicle forms around an egg, the egg is

released at Day 14 of the cycle and the follicle becomes known as a corpus luteum, a temporary

ovarian gland which remains in the ovary while the egg moves to the fallopian tubes and then to

the uterus. The corpus luteum manufacturers progesterone and estrogen after the egg is released

in order to prepare the endometrium (the lining of the uterus) to support a fertilized egg. If no

fertilization occurs it stops secreting and decays after approximately two weeks. If the corpus

luteum does not decay it may fill with blood or fluids and expand into a cyst. These usually only

form on one ovary and are often asymptomatic. Corpus luteum cysts can however grow to up to

10cm (about 4 inches in diameter) and can bleed into themselves and/or twist the ovary. Both of

these events cause pain in the lower abdomen or pelvis. If a blood filled luteal cyst ruptures

internal bleeding results as does acute sharp pain (“Morefocus Media”).



A sub-type of corpus luteum cyst is the theca lutein cyst. These are commonly bilateral and

cause dull pelvic pain. These types of cysts are often associated with excessive ovarian

stimulation such as in pregnancy, pregnancy with the growth of a large placenta, and diabetes.

Theca lutein cysts developing newborns as a result of gonadotropins passed from the mother to

the newborn. They can also develop as a result of hypothyroidism due to the similarities between

TSH (thyroid stimulating hormone) and human chorionic gonadotropins (Valesky).




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Abnormal Ovarian Cysts

Abnormal ovarian cysts are those which result from abnormal cell growth, most of which are

benign growths. These cysts are cystadenomas, endometrial cysts, and dermoid cysts. Some

women develop large numbers of cysts in the ovaries and suffer from polycystic ovary

syndrome, or PCOS.



Cystadenomas are cysts which develop on the other surface of the ovary. They are either serous

or mucinous in nature and are the most common type of benign ovarian growths (Porth). They

can be attached to the outside of the ovary by a stem. While they are usually asymptomatic, there

is a danger that they can twist on the stem which leads to rupture and acute severe pain on the

affected side (Glenville). They can also become quite large, up to 12 inches or more in diameter,

and interfere with the function of other organs or vascular structures (Slater).



Endometrial cysts occur secondary to the condition of endometriosis (Porth). Endometriosis is a

condition in which the lining of the womb grows in parts of the body other than the uterus.

Endometrial cysts form when endometrial tissue grows on the ovaries. Because endometrial

tissue, regardless of location, responds to menstrual hormonal changes these cysts will fill with

blood which becomes a dark, reddish brown color, prompting the nickname “chocolate cysts.”

Because there is no outflow for the endometrial tissue that grows monthly in these cysts they

tend to get larger and larger, pushing on surrounding tissues and eventually rupturing (Glenville).

Endometrioid cysts may range in size from three quarters of an inch to eight inches in diameter

(Stoppler).



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Teratomas or dermoid cysts are also classified as tumors. They derive from germ cells and per

Porth are “composed of a combination of ectodermal, mesodermal, and endodermal elements.”

They also often contain bits of fatty tissue, hair, skin, fluids, glandular tissue and teeth. They

grow very slowly and generally are asymptomatic until they grow large enough to infringe upon

other tissues or until they rupture, causing severe acute pain. The larger the dermoid cyst, the

more likely the risk for rupture, which spills the contents of the cyst into the peritoneal cavity

resulting in adhesion and severe pain. Most women have them on only one ovary but about 10-

15 % of women will have them on both ovaries. While many types of ovarian cysts will

spontaneously resolve these will not and surgical removal is advised by most western health

professionals. CT or MRI scans are required to detect the presence of dermoid cysts (“Morefocus

Media”).



PCOS or Polycystic Ovarian Syndrome is a condition in which there is not one, but a number of

small egg follicles which are classified as cysts. PCOS is fairly common, affecting 4-7% of

reproductive aged women. Women suffering from PCOS will have enlarged ovaries, often twice

the normal size, with thickened linings along the outer capsule of the ovary. Multiple cysts

within the ovary are only one of the facets of PCOS (Slater). Western medicine often regards this

as an endocrine or hormonal imbalance disorder. Other manifestations are infertility and lack of

ovulation as well as secondary male sex characteristics such as hirsutism, acne, weight gain,

deepened voice and depression. These result from the androgens, normally produced in small

amount in normal ovaries, but produced in higher amounts in polycystic ovaries. A further

complication is the link between PCOS and insulin resistance. The associated insulin resistance

causes an increased risk for type 2 diabetes and hypertension. PCOS is further associated with an

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increased risk of endometrial cancer (Stoppler).



Etiology

Valesky cites the following reasons as causes or possible causes for ovarian cyst disorders:

        Disorders that increase ovarian stimulation. These can include:

           o Gestational trophoblastic disease (GTD).

               This is a tumor disorder with tumors forming from the layer of cells normally

               surrounding the embryo. These are predominantly benign, yet stimulate hormone

               production and increase the likelihood of ovarian cysts.

           o Multiple gestational pregnancies.

               Twins are the most common form of multiple gestational pregnancies.

           o Exogenous ovarian stimulation.

               Hormone and fertility therapies, ovarian stimulation prior to in vitro fertilization

               and embryo transfer, and glandular disorders causing elevated levels of

               gonadotropins are among the most common examples.



        Pregnancy.

           Ovarian cysts form most often in the second trimester of pregnancy when β-hCG

           levels peak in the body. β-hCG is also referred to as beta-HCG, HCG, and serum

           HCG. This is human chorionic gonadotropin, a hormone secreted by an embryo

           which stimulates production of estrogen and progesterone. (This is the hormone

           which is detected in home pregnancy tests in the event of a positive result.)



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        Hypothyroidism.

           A component of thyroid stimulating hormone, the alpha subunit, is very similar in

           structure to β-hCG. Because TSH levels increase in hypothyroidism this hormone is

           thought to stimulate the formulation of ovarian cysts.



        Maternal gonadotropins.

           These hormones can stimulate the development of neonatal and fetal ovarian cysts.



        Cigarette smoking and increased Body Mass Index (BMI).

           There is a higher risk of ovarian cysts among women who smoke cigarettes and have

           a higher than average BMI.



        Tubal ligation sterilization.

           This can increase the frequency of functional cysts.



Symptoms

Ovarian cysts can be asymptomatic but often share some commonalities in symptoms regardless

of classification. Dull unilateral pain and/or heaviness in the lower abdomen or pelvis that may

stop or start are common signs. Pain may be sharp, sudden and severe, especially after strenuous

exercise or sexual intercourse. Many women suffering from ovarian cysts will also find sexual

intercourse to be painful or uncomfortable. Tenesmus is another common symptom reported by

patients with ovarian cysts as is pain or pressure felt when urinating or defecating. Heavy or

prolonged menstrual bleeding, vaginal pain, and intermittent spotting are also reported. Sudden,

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sharp, and unilateral pelvic pain is common upon rupture of a cyst and may spontaneously

resolve. Nausea and vomiting are an occasionally reported symptoms.



Complications

The possible complications of ovarian cysts are ovarian torsion, rupture, and malignancy.

Ovarian torsion is a danger with any ovarian cyst, but especially those on the right side of the

body and those that are greater than 4cm in diameter. The sigmoid colon on the left side of the

body tends to obstruct movement of the ovary on that side and torsion is thus a lesser danger.

Ovarian torsion occurs when the weight of the cyst twists or rotates the ovarian pedicle. This

leads to obstruction of the blood vessels nourishing the ovary. The venous structures are

obstructed first, then the arterial flow. This can cause necrosis in the tissues of the ovary. Torsion

is most commonly seen in cases of PCOS and dermoid cysts (Valesky).



Rupture can cause blood spillage into the peritoneum, peritonitis and a drop in blood pressure.

Ruptures are most often associated with corpus luteum cysts and involve the right ovary about

two-thirds of the time. Ruptures of this type tend to occur in the final week of the menstrual

cycle prior to the beginning of the next monthly period. The greatest dangers associated with

rupture are that of hemorrhage and shock, but may also include tachycardia and hypotension if

more severe. Some patients will also experience orthostatic hypotension (Valesky).



Malignancy of cystic tissues is rare, especially in premenopausal women and girls. Pregnancy

patients with simple cysts less than 6 cm in diameter for instance have an only 1% risk of

malignancy. When a cyst is unilocar (contains only one cavity) they are rarely malignant.

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Multiloculated cysts however carry a 36% risk of malignancy. Those that are diagnosed as

malignant there is a 70% chance that there is regional or distant spread. Only 25% of these cases

are limited to stage 1 cancer.




TCM Overview

Ovarian cysts in Chinese medicine are considered to be abdominal masses. Maciocia quotes the

Spiritual Axis stating that this could be the oldest pathology that seems to resemble an ovarian

cyst. The Spiritual Axis calls this “Intestines Deep Mass.”

         External Cold engages in a fight with the Defensive Qi, Qi cannot flourish and

         accumulations develop inside forming a nodule: a perverse Qi rises and decayed flesh

         forms. In the beginning the lump is the size of an egg; gradually it increases in size until

         it becomes the same size as the abdomen of a woman at full term’s pregnancy. After

         some years the lump feels hard on pressure but it is moveable; it fluctuates with the

         menstrual periods.

Fratkin says that TCM defines an ovarian cyst as an enlarged ovary.



Etiology

Maciocia cites the following etiologies for abdominal masses in general which includes ovarian

cysts.

          Emotion

            Specifically, emotional strain. Anger is the most important of the emotions in regard

            to the formation of abdominal masses/ovarian cysts, especially in the form of

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   repressed rage, frustration, resentment or hatred. All of these strongly impact the

   Liver and it’s Qi. Stagnation of Liver Qi and the resulting stasis of Liver blood impact

   the Liver channel rendering it less able to move the Qi of the lower abdomen and the

   circulation of Liver Blood.



 Diet

   Irregular eating, consumption of cold and raw foods, and excessive consumption of

   greasy foods are important dietary factors in regard to the formation of ovarian cysts

   and other abdominal masses.

   o Cold and raw foods

      Encourage the formation of cold in the lower abdomen, causing a condition of

      contraction which impedes the circulation of blood and qi. This causes qi

      stagnation and blood stasis.

   o Greasy and/or sugary foods

      These types of foods impair the Spleen’s functions causing dampness and the

      formation of phlegm by causing Spleen Qi deficiency. Phlegm and damp can

      settle into the lower abdomen creating conditions conducive to the formation of

      abdominal masses and cysts. Formation of phlegm can encourage stasis of blood

      and vice versa.



 External pathogens

   Cold is the most important factor in the formation of abdominal masses, but

   dampness is also cited as a pathogenic factor contributing to the formation of ovarian

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            cysts. Invasion by either during the menstrual period or during the immediate post-

            partum phase can settle in the genital system as the system is vulnerable at these

            periods and prone to invasion by pathogens. External damp can invade the channels

            in the legs then move up to settle in the lower abdomen. This translates into Phlegm

            in the long term.



Pathology

“The pathology of ovarian cysts is always characterized by Phlegm, Dampness (usually Damp

Heat) and stasis of Blood,” per Maciocia. Elaborating further, he states that abdominal masses

are characterized by stagnation of Qi, resulting in masses that come and go and are moveable

upon palpation, and stasis of blood, resulting in substantial masses which are fixed in location,

immoveable upon palpation and feel hard. Pain in the former is equally moveable, but pain in the

case of blood stasis masses is fixed. Masses can also be the result of phlegm accumulation in

which case they are soft upon palpation and fixed, usually without pain. The underlying cause of

all abdominal masses is an underlying deficiency of Qi which fails to transport and transform,

leading to stagnation of Qi and blood.



Maciocia says the treatment principles are therefore to resolve phlegm and damp, clear heat,

invigorate the blood, and eliminate stasis and soften hardness. Fratkin notes that ovarian cysts are

the result of Kidney yang deficiency and/or blood stagnation and/or liver qi stagnation. Kidney

yang deficiency results in water accumulations in the abdominal cavity which are then

transformed into phlegm. Fratkin’s treatment principles include tonifying Kidney yang,

transforming phlegm, enhance the movement of water in the body, dredge and move Liver qi,

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invigorate blood, and break up blood stasis. Fratkin states that these principles apply regardless

of the type of cyst, whether or not it involves polycystic ovaries.



Maciocia agrees that Kidney Yang deficiency can also be a factor in the development of ovarian

cysts and agrees that polycystic ovaries have the same pathogenic factors as the formation of any

ovarian cysts, but stops short of stating that all cysts are the result of Kidney Yang deficiency.

Instead, he feels that polycystic ovaries are the result of a constitutional deficiency of the Kidney

as the base of the development of polycystic ovaries.




Common Syndromes

As with any disease there can be multiple differentiations for ovarian cysts. Treatment in each

case includes moving Qi and Blood. The movement of Qi is the primary goal while blood is

invigorated secondarily. In the case of blood masses the primary focus is the elimination of and

breaking up of stasis. The stage of the disease must be taken into account prior to initiating

treatment.

        Initial stages

             Resolve the pathogenic factor, which is notably weaker in the initial stage than in

             later stages. Move Qi, invigorate blood, resolve phlegm, etc.

        Middle stages

             Pathogenic factors and body Qi must be addressed simultaneously. Pathogenic factor

             expulsion must equal that of the tonification of the Qi.




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        Late stages

           Tonification of Qi and the body are primary at this stage while resolving pathogens is

           secondary.

All herbal prescriptions should include herbs to soften masses, a principle that is especially

important when masses derive from blood or phlegm. Some softening herbs cited by Maciocia

are:

            Yi yi ren                                      Zhe bei mu

            Hai zao                                        Kun bu

            Gui ban                                        Mu li

            Jiang can                                      Bia jia

            Wa leng zi                                     Hai dai

            Xia ku cao




Liver Qi Stagnation

Abdominal masses/ovarian cysts which come and go, move with abdominal palpation, present

with distention and/or distending pain, include flank pain or discomfort in the hypochondriac

area and include emotional components such as depression, easy anger or irritability, and

moodiness are likely to have a strong liver qi stagnation component. Other symptoms can

include alternating constipation and diarrhea. Symptoms often increase in the presence of stress,

tension, and other strong emotional situations. The tongue may be red on the sides and can have

a thick coating at the root. The pulse will include a wiry component. Liver Qi stagnation, left

unchecked, can lead to blood stasis in the lower abdomen, and can encourage the formation of

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dampness and phlegm when it over-acts on the Spleen and causes a Spleen Qi deficiency.



The treatment plan for Liver Qi stagnation causing masses is to pacify the Liver, move Qi,

eliminate stagnation and soften/dissolve masses that form as a result. Acupuncture points used to

soothe Liver Qi and smooth the flow of Qi in the lower jiao include Gallbladder 34, Ren 6, Liver

3, San Jiao 6 and Spleen 6. Adding Pericardium 6 also calms the mind and indirectly moves

Liver Qi. Add Lung 7 and Kidney 6 to open the Ren channel which allows for freedom of Qi

movement in the lower jiao. Stimulating the Ren vessel is necessary for the treatment of ovarian

cysts and abdominal masses (Maciocia).



There are a number of formulas that could be used for this differentiation. The primary formula

to use in the event of Liver Qi stagnation causing cysts to form is Xiao Yao San, which moves Qi

in the lower jiao and also nourishes Liver Blood (Maciocia). Bensky’s formula for Xiao Yao San

is:

                         Bo he                                             3g

                         Chai hu                                           9g

                         Dang gui                                          9g

                         Bai Shao                                   9g – 12g

                         Bai zhu                                           9g

                         Fu ling                                           9g

                         Zhi gan cao                                       6g

                         Sheng jiang                                 3 slices



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Xiao Yao San incorporates herbs which nourish the Spleen Qi to eliminate dampness and

phlegm. If there is pronounced dampness and phlegm however, increase fu ling, add sha ren,

cang zhu and huang bo while decreasing the dosage of dang gui. For more stagnation and

pronounced cysts, move more Qi by adding xiang fu and mu xiang, yan hu suo and yu jin.



Cold in the abdomen with blood stasis in addition to Liver Qi stagnation can be addressed with

the formula Xiang Leng Wan, which moves Qi, eliminates stagnation, warms the channels,

scatters cold in the abdomen and breaks up blood stasis. This formula is stronger than Xiao Yao

San and dissolves masses more quickly. Use this formula when there are clear cold signs with a

pale tongue and a tight pulse.



Chai Hu Shu Gan San can be used for Liver Qi stagnation causing ovarian cysts in the absence of

significant signs of blood deficiency. Chai Hu Shu Gan San soothes the Liver Qi, harmonizes the

blood, and alleviates pain (Bensky). This formula is appropriate for a patient with a full, wiry

pulse and red sides on the tongue.



Softening herbs should be used for any masses or cysts of substantial quality. Cysts which are

predominantly Qi based in nature may not have a fixed location or fixed pain. Softening herbs

could be eliminated in this situation.



Stagnation of Qi and Blood

Stagnation of Qi and Blood can prompt the body to form hard, immobile abdominal masses and

cysts. Patients may report abdominal distention and distending pain, cramping, and late periods.

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Stagnation of the blood will cause the tongue to look purplish and the pulse to be wiry or

choppy. The proper treatment is to move the Qi and blood, remove obstructions from the

channels and dissolve masses. Acupuncture points that may be selected include Gallbladder 34

and Ren 6 in combination, Liver 3, San Jiao 6, and Spleen 6 to move and soothe Liver Qi in the

lower jiao. Pericardium 6 will calm the mind and indirectly move the Qi. It will also open up the

chest which can become constricted due to the stagnation of Qi. Liver 3 and Spleen 6 have the

added benefit of moving Liver Blood. Combining Lung 7 and Kidney 6 will open the Ren vessel

and will help with resolution of cysts. Spleen 10 and Bladder 17 will invigorate the blood to help

resolve stagnation and masses.



Maciocia recommends Jin Ling Zi San combined with Shi Xiao San to treat this differentiation

for ovarian cysts. This combination consists of the following herbs:



                          Chuan lian zi                                   30g

                          Yan hu suo                                      30g

                          Pu huang                                          6g

                          Wu ling zhi                                       6g



Chuan lian zi and yan hu suo move Liver qi and blood while pu huang and wu ling zhi invigorate

blood and alleviate pain in the lower jiao.



When stagnation of qi and blood in the lower abdomen are associated with or are derived from

cold, use Da Qi Qi Tang to move qi, harmonize the Stomach, warm the lower burner, and

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dissolve masses. As cysts due to a stagnation of Qi and blood tend to form more substantial

masses than Qi stagnation does, add softening herbs such as yi yi ren, hai zao, or kun bu.



Blood Stasis

Blood stasis is a more severe, chronic form of blood stagnation. Cysts formed will be hard,

immovable and obvious. They will be painful with fixed prickling pain caused by the obstruction

of the adjacent meridian passages, obstructing the smooth passage of Liver Qi. Cysts due to

blood stasis are more likely to cause ovarian torsion. This is called Shao Fu Zheng Jia or blood

mass in the lower abdomen in TCM (Qu, and Zhou 134-136). A patient with this differentiation

is likely to have a dark complexion and dry skin also. She may also feel cold, not due to an

internal cold, but due to lack of proper blood circulation (Maciocia, Fratkin).



The treatment plan for blood stasis knotted into an ovarian cyst or mass is to break up the blood

and eliminate the stasis. The practitioner should also use herbs to soften hardness and dissolve

masses. Finally, a good treatment plan will regulate the Spleen in order to encourage the

nourishment of blood which is needed after the old blood is moved out of it’s stasis in the lower

abdomen.



Acupuncture points chosen toward these goals would include previously mentioned points to

move Qi and blood such as Gallbladder 34 and Ren 6. Spleen 4 and Pericardium 6 should also be

used in combination to open the Chong vessel. The Chong vessel is the reservoir of blood and

regulates blood. Combine this with Spleen 10 and Bladder 17 to invigorate the blood generally

and Stomach 29 to invigorate blood in the lower abdomen. Liver 3 and Spleen 6 will invigorate

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Liver Blood specifically while Liver 8, Stomach 36 and Bladder 20 will nourish the blood.

Stomach 36 and Bladder 20 nourish the Spleen which is the origin of blood.



Ge Xia Zhu Yu Tang is the recommended formula for stasis of blood in the lower abdomen. This

formula invigorates blood, eliminates stasis, stops pain, and dissolves the masses and cysts in the

lower abdomen.



                            Dang gui                                      9g

                            Chuan xiong                                   9g

                            Chi shao                                      6g

                            Hong hua                                      9g

                            Tao ren                                       9g

                            Wu ling zhi                                   9g

                            Yan hu suo                                    3g

                            Xiang fu                                      3g

                            Zhi ke                                        5g

                            Wu yao                                        6g

                            Mu dan pi                                     6h

                            Gan cao                                       9g



Liu Jun Zi Tang can be added to this formula to tonify the Spleen and the body’s qi in this later

stage of abdominal mass presentation.



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San leng, e zhu, and ze lan can be added for greater effect to break up blood and dissolve masses.

Use zhe bei mu, bie jia, chuan shan jia, yi yi ren, xia ku cao, hai zao, or kun bu to help soften the

hard nature of these cysts. If however, there is an added component of blood deficiency which is

not uncommon with these types of cysts, increase dang gui, leave out yan hu suo, and add shu di

huang.



Yi yi ren will not only help soften the masses for easier elimination from the body, but can also

be added if there is vaginal discharge. Add bai zhi to further relieve vaginal discharge. Yan hu

suo can be increased if there is severe abdominal pain and ze lan can be added to it for greater

effect. Gui zhi and fu ling can also be added to penetrate into the channels and blood vessels, in

effect guiding the blood invigorating herbs down to the lower burner.



Kidney Yang Deficiency with Accumulations of Damp and Phlegm

As previously stated, this differentiation is specifically associated with polycystic ovaries

(Maciocia, Fratkin). When the Kidney yang is chronically deficient over a long period of time

Kidney fire which normally helps to evaporate and transform fluids fails and damp/phlegm build

up in the lower jiao. This is considered to be a constitutional deficiency of the Kidney and the

root cause for the development of polycystic ovaries. One must tonify the Kidney Yang and

simultaneously resolve damp and phlegm. There can also be a component of blood stasis in this

differentiation, so it is necessary to address this as well.



In the case of Kidney Yang deficiency with damp and phlegm, the client will likely have no

periods or scanty periods, infertility, obesity, chest oppression, a sense of heaviness in the

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abdomen or lower abdomen, heavy vaginal discharge, and an excess of body hair (hirsutism).

There can also be some secondary male sex characteristics such as a deepened voice in addition

to the excess body hair. Acne is also seen in many patients and is attributed biomedically to and

increase in testosterone with a decrease in estrogen (Maciocia). The tongue will be pale and

swollen indicating the fluid buildup and the lack of yang. The coating will likely be sticky and

white. The pulse will be weak and may be slippery. The treatment principle is to tonify and

warm Kidney yang while resolving damp and phlegm.



Acupuncture points can include Lung 7 and Kidney 6, Ren 3 and 4, Kidney 3, Bladder 23, and

Du 4, Spleen 9 and Stomach 40. Moxa is also applicable.



The basic herbal formula for this differentiation is Yu She Wen Bu Fang which nourishes blood,

tonifies Kidney essence and Kidney yang, resolves phlegm, and softens masses. This formula

includes:

            Shu di huang                                                             9g

            Huang jing                                                               9g

            Xian ling pi                                                             6g

            Bu gu zhi                                                                6g

            Chuan shan jia (or wang bu liu xing)                                     6g

            Zao jiao ci                                                              6g

            Yi yi ren                                                                9g

            Zhe bei mu                                                               6g



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Add huang bo if there is damp heat present.



Kidney Yang deficiency coupled with phlegm and blood stasis will manifest with the same

symptoms as previously noted with the addition of abdominal pain due to the blood stasis. The

tongue will be pale and purple or perhaps bluish purple, swollen, and will have a thick white

coating. The pulse will be slippery and weak. The treatment principle is the same as previously

mentioned with the added component of the elimination of stasis. The formula listed above is

applicable with the addition of herbs to assist with blood stasis such as san leng, ji xue teng, tao

ren, and hong hua. Herbs for softening masses should be added also.



Fratkin recommends the following as a general formula given for Kidney Yang deficiency driven

ovarian cysts.

            Shu di huang                                                            12g

            Shan yao                                                                12g

            Huang jing                                                              12g

            Yin yang huo                                                            12g

            Bu gu zhi                                                               12g

            Chuan shan jia (or wang bu liu xing)                                     9g

            Zao jiao ci                                                             12g

            Chuan bei mu                                                            12g

            Dang gui                                                                12g

            Tao ren                                                                 12g



                          Cat Calhoun – Herbal Treatment of Disease 2 – Fall 2010

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Chuan shan jia is an herb from an animal that is on the endangered species list, so it is unlikely to

be available. Wang bu liu xing can be substituted for this herb. Add fu zi and rou gui for cold

signs. For liver qi stagnation leave out zao jiao ci and chuan bei mu, but add mu dan pi, zhi zi,

chai hu, and qing pi.




Biomedical Interventions and Implications for TCM

Treatment depends on the size of the cysts and the associated symptoms. Small asymptomatic

cysts are often treated with a wait and see approach. These cysts can be treated with TCM

without worry and should improve the patient’s condition.



The symptom which prompts most women to seek treatment and relief is the pain caused by

cysts. Commonly, pain relievers such as NSAIDS and acetaminophen are most frequently

prescribed. Less frequently narcotic pain relievers are prescribed. In some cases oral

contraceptives are used to prevent the formation of follicles that turn into cysts or to shrink an

existing cyst (“Wikipedia: The Free Encyclopedia”). Large and persistent cysts are often

surgically removed, especially in the case of ovarian torsion. One or both ovaries may be

removed in the process of this surgery.



These treatments require further consideration on the part of the TCM practitioner. NSAIDS and

acetaminophen can stress the liver and kidneys. Practitioners should verify that the herbs given

do not further stress these organs. If the patient also has constipation this should be addressed

first as the toxins released by treatment, both biomedical and herbal, need to have a route out of

                         Cat Calhoun – Herbal Treatment of Disease 2 – Fall 2010

                                                23 of 25
the body. In the event of surgery, TCM herbs can be given to strengthen the body for surgery,

reduce the loss of blood, and speed recovery. In the event of the removal of the ovaries TCM

herbal therapy can be used instead of hormone replacement therapy to bring balance back to the

hormones.




Summary

Ovarian cysts due to Qi stagnation are far easier to treat and disperse than are cysts due to Blood

stagnation, accumulation, or stasis. The prognosis for Qi masses and cysts is better and it may be

possible to treat them with acupuncture alone. Blood masses, however, require both acupuncture

and herbal treatment. As a general rule ovarian cysts can only be dispersed if they are small, 2cm

or less. Prognosis is far better with treatment than without in most cases. As previously stated,

many small functional cysts will resolve without intervention, but abnormal cysts are less likely

to resolve without treatment.



Recurrence of cysts is fairly common, but is less likely with changes in lifestyle. Maciocia

recommends avoiding excess ingestion of cold foods and drinks, avoiding cold or damp

environments and activities during the menstrual cycle, after sexual intercourse and after

childbirth. He also recommends that women who meditate do so in standing positions rather than

sitting positions which encourages stagnation in the lower abdomen. Moderate exercise such as

walking and tai chi will also assist in moving the Qi of the lower abdomen. Patients who follow

such recommendations are less likely to experience further cyst formation.




                         Cat Calhoun – Herbal Treatment of Disease 2 – Fall 2010

                                                24 of 25
Reference list

Valesky, Walter. "Ovarian Cysts." e-Medicine. Medscape, 11 Aug 2009. Web. 3 Jun 2010.

       <http://emedicine.medscape.com/article/795877-overview>.

Stoppler, Melissa. "Ovarian Cysts." eMedicine Health. WebMD, Inc., n.d. Web. 3 Jun 2010.

       <http://www.emedicinehealth.com/ovarian_cysts/article_em.htm>.

"Ovarian Cysts." Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc., 17 May 2010.

       Web. 1 Jun 2010. <http://en.wikipedia.org/wiki/Ovarian_cyst>.

Porth, Carol. Pathophysiology. 7th ed. Philadelphia, PA: 2005, 2005. 1080-1081. Print.

"Types of Ovarian Cysts." Ovarian Cysts.com. Morefocus Media, n.d. Web. 3 Jun 2010.

       <http://www.ovarian-cysts.com/articles/ovarian-cyst-types/index.php>.

Glenville, Marilyn. "Ovarian Cysts." Natural Health Website for Women. Dr. Marilyn Glenville,

       n.d. Web. 3 Jun 2010. <http://www.marilynglenville.com/general/cysts.htm>.

Slater, William. "Ovarian Cysts." Natural Health Solutions for PCOS. William Slater, n.d. Web.

       3 Jun 2010. <http://www.ovarian-cysts-pcos.com/ovarian-cysts.html>.

Maciocia, Giovanni. Obstetrics and gynecology in Chinese medicine. London, England: Elsevier

       Health Sciences, 1998. 792. Print.

Fratkin, Jake. "Ovarian Cysts and Polycystic Ovarian Syndrome." Acupuncture Today 10.04

       (2009): n. pag. Web. 1 Jun 2010.

       <http://www.acupuncturetoday.com/mpacms/at/article.php?id=31921>.

Bensky, Scheid, Volker, Andrew Ellis, and Randall Barolet. Chinese Herbal Medicine. Eastland

       Pr, 2009. Print.

Qu, Fan, and Jue Zhou. "Pedicle Torsion of Ovarian Cyst and Acupuncture: A Case Report."

       Acupuncture in Medicine. 3.24 (2006): 134-136. Print.
                          Cat Calhoun – Herbal Treatment of Disease 2 – Fall 2010

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