Herbal Medicine for Adenomyosis With Pelvic Congestion and Pain: TCM Treatment Approaches

Adenomyosis is a benign gynecological condition in which endometrial glands and stroma grow into the muscular wall of the uterus (myometrium). Its exact cause is not yet fully understood, but it is thought to be associated with factors such as estrogen exposure, endometrial injury, and genetic predisposition.

Common symptoms include progressively worsening menstrual cramps, heavy menstrual bleeding, and prolonged periods. Pelvic congestion, pressure, and pain can also occur and may become persistent, significantly affecting a woman's physical and emotional well-being.

Conventional medical treatments may include nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal therapies, or surgery, depending on the severity and individual circumstances. Each approach has potential benefits and limitations. TCM takes a different approach, emphasizing pattern differentiation and individualized treatment. Herbal medicine and other TCM therapies may be used to help manage pain and other symptoms associated with adenomyosis.

How Does TCM Understand Adenomyosis With Pelvic Pain?

From the perspective of Traditional Chinese Medicine, the central pathological factor associated with adenomyosis-related pelvic pain is often described as blood stasis (Xue Yu). Several underlying patterns may contribute to the development and persistence of pain.

1. Qi and Blood Disharmony

In TCM theory, women are traditionally considered to depend on blood as a fundamental substance, while qi supports its movement and circulation.

When emotional stress leads to liver qi stagnation, the normal movement of qi may become impaired, which can interfere with blood circulation and contribute to qi stagnation and blood stasis.

Similarly, prolonged illness, excessive fatigue, or constitutional weakness may result in qi deficiency, making it more difficult for qi to promote normal blood circulation. This may contribute to qi deficiency with blood stasis.

In either pattern, impaired circulation in the uterus and pelvic region is traditionally described as obstruction of the channels. According to the TCM principle of “where there is obstruction, there is pain,” this may contribute to pelvic pain and pressure.

2. Cold Accumulation and Blood Stasis

Exposure to cold, particularly during menstruation or after childbirth, is traditionally considered a possible contributor to cold accumulation in the uterus.

Excessive consumption of very cold foods and drinks is also traditionally believed to contribute to internal cold.

In TCM theory, cold tends to cause contraction and stagnation. This may interfere with circulation in the uterine and pelvic region and contribute to menstrual or pelvic pain.

A typical feature of this pattern is that pain may become worse with exposure to cold and improve with warmth.

3. Damp-Heat Combined With Blood Stasis

Another possible TCM pattern is the combination of damp-heat and blood stasis.

According to TCM theory, dampness and heat may accumulate in the pelvic region, particularly when the body's normal functions are disrupted.

When damp-heat combines with blood stasis, it may further interfere with qi and blood circulation and contribute to pelvic discomfort.

Other symptoms may include:

Increased vaginal discharge

Yellow, thick discharge

Bitter taste in the mouth

Dry throat

Pelvic heaviness or discomfort

The exact TCM pattern varies from person to person and should be determined through individualized assessment.

Oral Herbal Medicine

Oral herbal medicine is one of the traditional approaches used in TCM management of adenomyosis-related menstrual and pelvic pain.

TCM emphasizes pattern differentiation (Bian Zheng Lun Zhi), meaning that different herbal formulas are selected according to the patient's symptoms, constitution, tongue, pulse, and other clinical findings.

1. Qi Stagnation and Blood Stasis

Typical symptoms: Lower abdominal distending or aching pain before or during menstruation, tenderness that worsens with pressure, relatively light or irregular menstrual flow, dark menstrual blood with clots, and pain that may improve after passing clots. Breast or chest-side distension may also occur.

Traditional treatment principle: Regulate qi, promote blood circulation, resolve blood stasis, and relieve pain.

A traditional formula commonly associated with this pattern is Ge Xia Zhu Yu Tang (Below-the-Diaphragm Stasis-Expelling Decoction), which contains herbs such as:

Angelica root

Ligusticum chuanxiong

Red peony root

Peach kernel

Safflower

Bitter orange

Corydalis

These herbs are traditionally used to promote circulation and relieve pain.

When qi stagnation is more pronounced, practitioners may modify the formula with herbs such as Bupleurum (Chai Hu) or Curcuma (Yu Jin).

2. Cold Accumulation and Blood Stasis

Typical symptoms: Lower abdominal pain before or during menstruation that improves with warmth, dark menstrual blood with clots, sensitivity to cold, and cold hands and feet.

Traditional treatment principle: Warm the meridians, dispel cold, promote blood circulation, and relieve pain.

Shao Fu Zhu Yu Tang (Lower Abdomen Stasis-Expelling Decoction) is a traditional formula commonly associated with this pattern. Ingredients may include fennel seed, dried ginger, Corydalis, myrrh, Angelica root, and Ligusticum chuanxiong.

In TCM practice, this approach is traditionally used to warm and promote circulation and address pain associated with cold and blood stasis.

3. Qi Deficiency and Blood Stasis

Typical symptoms: Dull lower abdominal pain during or after menstruation that tends to improve with gentle pressure, heavy menstrual bleeding with pale or thin blood, fatigue, shortness of breath, and low energy.

Traditional treatment principle: Tonify qi, promote blood circulation, resolve blood stasis, and relieve pain.

A practitioner may consider combining Ju Yuan Jian with Tao Hong Si Wu Tang according to the individual's pattern.

Ju Yuan Jian is traditionally used to supplement and raise qi, while Tao Hong Si Wu Tang is traditionally used to promote blood circulation and address blood stasis.

When qi deficiency is pronounced, herbs such as Astragalus (Huang Qi) and Codonopsis (Dang Shen) may be considered. When bleeding is heavy, other herbs may be added according to the patient's condition.

4. Kidney Deficiency and Blood Stasis

Typical symptoms: Lower abdominal pain or heaviness during or after menstruation, pain that improves with gentle pressure, relatively light and dark menstrual blood, lower back and knee weakness, dizziness, or tinnitus.

Traditional treatment principle: Support the kidneys, promote blood circulation, resolve blood stasis, and relieve pain.

A modified combination of Gui Shen Wan and Tao Hong Si Wu Tang may be considered in traditional TCM practice for patients presenting with kidney deficiency combined with blood stasis.

5. Phlegm and Blood Stasis

Typical symptoms: Lower abdominal pain, dark menstrual blood with clots, abundant and thick vaginal discharge, and a tendency toward being overweight.

Traditional treatment principle: Transform phlegm, resolve accumulations, promote blood circulation, and resolve blood stasis.

A practitioner may consider Cang Fu Dao Tan Wan with modifications such as San Leng and E Zhu, depending on the patient's presentation.

Fuyan Pill: A Proprietary Chinese Herbal Formula

Fuyan Pill is a proprietary Chinese herbal formula containing more than 50 herbal ingredients.

Its traditional formulation emphasizes herbs used to promote blood circulation, regulate qi, and relieve pain. Ingredients such as peach kernel, safflower, Trogopterus dung (Wu Ling Zhi), and Corydalis (Yan Hu Suo) are traditionally used for these purposes.

For example:

Peach kernel: Traditionally used to promote blood circulation and resolve blood stasis.

Safflower: Traditionally used to promote circulation and regulate menstruation.

Wu Ling Zhi: Traditionally used to promote blood circulation and relieve pain.

Corydalis: Traditionally used to regulate qi, promote blood circulation, and relieve pain.

The combination of these traditional herbal ingredients is intended to support the management of gynecological pain and discomfort.

Important: Herbal formulas should be selected according to the individual's symptoms and TCM pattern. Adenomyosis can have different causes and clinical presentations, and herbal medicine should not replace appropriate gynecological evaluation.

External TCM Therapies

TCM external therapies are traditionally used to provide supportive treatment by applying herbs directly to selected areas or acupuncture points.

They may be combined with oral herbal medicine when appropriate.

1. Herbal Retention Enema

In some TCM clinical settings, herbal preparations may be administered rectally with the aim of providing local treatment to the pelvic region.

Because this is an invasive procedure, it should only be performed under the supervision of an appropriately trained healthcare professional.

2. Herbal Acupoint Application

Herbal medicines may be prepared into a paste or powder and applied to acupuncture points such as:

Guanyuan (CV4)

Qihai (CV6)

Sanyinjiao (SP6)

According to TCM theory, stimulating these points together with topical herbal ingredients may help warm the meridians, promote circulation, and relieve pain.

3. Herbal Washing and Cupping

Other traditional external therapies include herbal washing or warm herbal sitz baths using ingredients such as:

Mugwort (Ai Ye)

Safflower (Hong Hua)

Chinese motherwort (Yi Mu Cao)

Cupping may also be applied to selected areas of the lower back or abdomen.

These approaches are traditionally used to promote circulation and relax the body and may provide complementary relief for pelvic discomfort.

Final Thoughts

Adenomyosis can cause significant menstrual pain, heavy bleeding, pelvic pressure, and chronic pelvic discomfort. From a TCM perspective, blood stasis is often considered an important component of the condition, while qi stagnation, cold accumulation, damp-heat, qi deficiency, and kidney deficiency may contribute to different clinical patterns.

TCM management emphasizes pattern differentiation and individualized treatment. Depending on the patient's presentation, treatment may include:

Individualized herbal medicine

Acupuncture

Herbal external therapies

Dietary and lifestyle adjustments

Other supportive TCM approaches

The goal is not only to manage pain and menstrual symptoms but also to address the broader pattern identified by the practitioner.

However, adenomyosis is a gynecological condition that requires appropriate medical evaluation. Persistent pelvic pain, heavy menstrual bleeding, anemia, severe menstrual cramps, or rapidly worsening symptoms should be assessed by a qualified gynecologist. TCM and conventional gynecological care can also be considered together when appropriate.