Notes from the Gyn Department

While working cardiology shifts with East-West mad scientist Doctor Zhou has a been a real window into holistic heart health, his shifts are only on Monday, Wednesday, and Friday.  This leaves me with options a plenty on Tuesdays and Thursdays.   With this extra time I’ve buddied up with my original team of American classmates in the gynecology department.

It’s nice to bounce back and forth between departments and get a sense of how different doctors work.  After all, it doesn’t matter if the doctor is an oncologist or gastroenterologist – at the end of the day, they’re all treating the whole body, whether that means sleep issues, immune support, back pain, you name it.

So, yes, seeing this gynecologist work has been really fun.  He definitely out-nerds me with herbal medicine and I love every minute of it.

Today I’m going to talk about a patient of his who recently underwent surgery for ectopic pregnancy and how the gyn department is using herbal enemas and formulas to aid in her recovery.

Now – quick review – what is ectopic pregnancy?

UpToDate:

Ectopic pregnancy — In an ectopic pregnancy, the developing embryo does not implant on the endometrial wall, but instead attaches to some other surface. For ninety eight percent of pregnancies outside the uterus, that surface is within the fallopian tube. This is also called a tubal pregnancy.

Very rarely, the developing embryo will attach to another site, such as the cervix or an ovary. It can also implant at the site where the fallopian tube and uterus join; this is called an interstitial pregnancy. The embryo can also attach to the abdominal wall.

Why is ectopic pregnancy dangerous? — Embryos that do not implant in the uterine wall are generally unable to develop normally. In addition, an ectopic pregnancy can cause rupture of the organ on which they are implanted, typically the fallopian tube.

Rupture can result in severe internal bleeding, shock, and, rarely, death of the woman. Fortunately, the ability to diagnose, monitor, and treat ectopic pregnancy reduces the risk of these life-threatening complications.

According to UpToDate, a third of patients in the US are treated with a shot of methotrexate, which stops the growth of the embryo.  The other treatment is surgery.

I’m not sure if China has methotrexate as foreign pharmaceuticals aren’t allowed in the country.  Of course, they may have their own methotrexate-like medication, but it appears that surgery – like in the United States – is the go-to therapy.

But what about Chinese herbal medicine?  How does the gynecologist play into all of this?

1. There are herbal treatments for ectopic pregnancy.

2. There are herbal treatments for post-surgery recovery.

Chinese medicine has herbal treatments for ectopic pregnancy.  These treatments were pioneered by a turn of the century doctor named Zhang Xichun who was one of the first traditional physicians to integrate with modern biomedicine / allopathic medicine / Western medicine (whatever).  Long story short, he’s a modern master that a lot of East-West doctors in China are still studying.

His treatment involves using a core four herb combination.

Dan Shen 10-30g

Dang Gui 10-30g

Ru Xiang 10g

Mo Yao 10g

Dang Gui and Dan Shen are the yin and yang of Blood movers as one is cool and the other is warm.  Together they boost circulation in the lower abdomen, generate new Blood, and eliminate stasis.  Ru Xiang and Mo Yao are frankincense and myrrh.  These are heavy duty Blood movers that not only eliminate stasis but also have a quality described as “generating flesh,” which can be understood as aiding wound healing.

To be clear, eliminating stasis here means moving the ectopic embryo from its problematic location.  In other instances, stasis can mean ovarian cysts, tumors, scar tissue, etc.  There are different herbs for different locations and indications.

So this is the OG four herb combination for ectopic pregnancy.  This combination has been researched with modern techniques and testing and was updated in the 1980s, but the update is nothing revolutionary, just some suggestions about modifications for making the formula more powerful.  In clinical practice, there will be even more modifications as the patient could also present with digestive disorders, skin problems, sleep problems, etc.  These four herbs would just be the most emphasized during treatment.

Now, the question is did the gyn doc treat the ectopic pregnancy patient with this combo?

It’s my impression that he didn’t because the patient I met had the surgery two weeks previous and there was no discussion of prescribing the above mentioned formula.

Instead, the gyn doc’s role in this treatment was all about post-surgery recovery.

I don’t have a lot of information on this patient but I can tell you that she was small framed and in her late twenties.  Her tongue was dry and red with a yellow coat toward the throat.  Overall, her pulse was slippery and wiry with some weakness in the Lung / immunity / colon area.

This treatment had two elements.  One was – surprise! – an herbal enema.  Now, I’ve never had an enema before but I do know that enemas are a quick way to move things into the bloodstream. So what did he put in there?

Gui Zhi

Fu Ling

Chi Shao

Mu Dan Pi

Tao Ren

Lu Lu Tong

Ji Xue Teng

Hong Teng

Bai Jiang Cao

The first five herbs are Gui Zhi Fu Ling Wan – the textbook treatment for ovarian cysts (aka Blood Stasis in the pelvis).  On top of that he threw in four herbs.  Hong Teng and Ji Xue Teng is a combo for pelvic inflammation and stasis due to trauma or, in this case, surgery.  Lu Lu Tong has similar actions but moves Qi, meaning it’s lighter than Blood Movers, and also treats lower body, post-surgery pain.  Bai Jiang Cao is cooling so it treats inflammation as well.  It also moves Blood and is used postpartum / post surgery.

Makes sense, right?

There was also a formula prescribed for the patient to take home, cook, and drink.

Dang Gui

Bai Shao

Chuan Xiong

Fu Ling

Ze Xie

Bai Zhu

Chai Hu

Zhi Shi

Jie Geng

Dan Shen

Long Gu Mu Li

Ji Xue Teng

Hong Teng

Within this 13 herb combination are at least two classical formulas.  Si Ni San for bilateral abdominal pain.  Dang Gui Shao Yao San (which he uses all the time) to ease stress on the body, boost digestion, and tonify Blood.  Tonifying Blood is important here as she just had a surgery and finished her period.

A little bit of Jie Geng is added to treat bloating but not as a solo herb.  Jie Geng raises Qi to the upper body.  Zhi Shi descends Qi.  Together they pull in opposite directions to disperses Qi stasis bloating.

Long Gu and Mu Li are heavy substances (oyster shells and fossils – no joke) and their heaviness guides all the other herbs down to the lower abdomen to do their job.

Ji Xue Teng and Hong Teng were also in the enema and prescribed here to the cool inflammation in the pelvic region and move Blood.

Voila!

No doubt, these same Blood moving formulas can be used in the US as a first line therapy before considering  surgery.  The treatment is low-risk, natural and may even benefit pre-existing conditions.  And let’s not forget the post-surgery, recovery therapies for women who are not only left in pain (skip the meds) but also with scar tissue that may influence future pregnancies.

I’m so happy to be here China with professionals who are working with patients and herbs like these everyday.  To people like this gynecologist, using classically indicated formulas is a no-brainer.  They still work as they’ve always worked.  It’s a shame that practitioners in the United States haven’t figured out a way to import these relatively simple treatments and give them the respect they deserve.  The good news is that now is the best time to introduce these kinds of therapies to Americans as more and more people look for new ways to get better, feel better, and stay healthy.

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