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Factors that are Salient in Developing a Traditional Chinese Medicine Nutritional

Manual for Women with a History of Endometriosis

By

aren !onchae "ordon

# Capstone $ro%ect

$resented in partial fulfillment of the re&uirements for theDoctor of #cupuncture and 'riental Medicine Degree

!o San (niversity


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)os #ngeles* California

#pril +,-.


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.

Approval Signature Page

This Capstone Project has been reviewed and approved by:

Lawrence J. Ryan, PhD., Capstone Advisor June 10, 2013

Daoshing Ni, PhD., L.Ac. pecia!ty Chair June 10, 2013


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Andrea "#rchison, DA$", L.Ac. June 10, 2013


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Abstract

Endometriosis is a de/ilitating condition characteri0ed /y high recurrence

rates1 The etiology and pathogenesis of endometriosis remain unclear1Typically* endometriosis causes pain and infertility1

This study reviewed the

current literature availa/le concerning the use of Chinese her/al medicine

and traditional Chinese nutrition including her/s and the integrated use of

Chinese nutrition and Western nutrition and medicine to treat women who

suffer from Endometriosis1 2t uncovered the strengths* wea3ness* andlimitations as well as similarities and differences regarding data gathered

from availa/le pu/lished research and other articles* and provided a list of

factors that constitute a /asic foundation for a manual that could specifically

serve patients with endometriosis1 This study concluded that a TraditionalChinese Medicine nutritional manual specifically created for the treatment of

endometriosis could /e developed to aid patients in understanding all

aspects of foods* her/s and supplements1 Such a manual could encouragepatients to consider dietary changes in con%unction with other healing

approaches1 #lso* it could increase awareness of Traditional ChineseMedicine to patients whether or not they have /een e4posed to Traditional

Chinese Nutrition1


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Acknowledgements

2 would li3e to than3 my capstone pro%ect advisor* )arry 5yan* for his

constant encouragement* support* patience and guidance throughout this

capstone pro%ect writing process6 to Carola "ehr3e* for all her support and care in

helping us to stay motivated during this program6 Dr1 7ian for her constant

positive support* love and dedication to our whole group6 and !o San (niversity

li/rarians for their resourcefulness1 2 would also li3e to than3 all my professors*cohort + classmates* my family and friends for all their love and support1


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Table of ContentsChapter -8 2ntroduction999999999999999999999111111111111:

'verview9999999999999999999999999999911:

5esearch "oals999999999999999999999999991:

"lossary of 5elevant Terms999999999999999999911;

Chapter +8 )iterature 5eview 99999999999999999999991-+

'verview 999999999999999999911111111111111111111111111111 -+

Description of Endometriosis99999999999999999911-.

Diagnosis of Endometriosis999999999999999999911-<

Western Drugs for Endometriosis99999999999999991-:

The TCM $erspective 5egarding Endometriosis9999999119-;

Traditional Chinese Nutrition for Endometriosis999919999++

Common Conditions of Stagnant Blood Causing $ain9999911.-

$revention and "ood Ha/its99999999999999999991.+

Caffeine and 5eproduction99999999999999999999.+

#lcohol99999999999999999999999999999911..

)iterature 5eview 2ntegration99999999999999999911.=

Chapter .8 Method 999999999999999999999991111111111111 .:

2ntroduction9999999999999999999999999999.:

Designation of 5esearch Method99999999999999999.:

"rounded Theory99999999999999999999999991.;

5esearch Synthesis Method99999999999999999999>,


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Sampling and Sampling $rocedures 999999999999991111>,

2nstrumentation and Data Collection $rocedure 9999999911>-


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Chapter >8 5esults99999999999999999999999999999>>

'verview9999999999999999999999999999991>.

Endometriosis Diet9999999999999999999999999>>

Endometriosis and Supplements999999999999999999>=

Endometriosis and Her/s99999999999999999999911>=

Endometriosis Western #pproaches99999999999999991>?

Chapter =8 Discussion9999999999999999999999999999>:

Summary of Findings9999999999999999999999991>:

2mplications for Theory and $ractice99999999999999991>;

Factors for 2nclusion in the Nutritional Manual999911999999=-

)imitation of the Current Study99999999999999999991=+

5ecommendations for Future 5esearch9999999999999991=.

Conclusion99999999999999999999999999999911=.

5eferences999999999999999999999999999999999911==

#ppendices

#ppendi4 #8 #rticles (sed for 5esearch Synthesis*)isted in 'rder of Study Num/er999999999991?+

#ppendi4 B8 Characteristics of the 2ncluded Studies'n Nutrition and Diet999999999999999991?>

#ppendi4 C8 Summary of Studies on Nutrition and Diet9999991?? #ppendi4 D8 Summary of Supplements99999999999999911?:


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#ppendi4 E8 )isting of Chinese Her/s@Formulas 'nly Studies999


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#ppendi4 "8 Source Data Chart99999999999999999991 #ppendi4 H8 #rticle #/straction Form999999999999999111


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*

Chapter One: IntroductionOverview

Endometriosis is a reproductive illness affecting an estimated -


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manual to support patients suffering from endometriosis1 Endometriosis is /ecoming a leading cause of infertility8 .: of women who are infertile and 1

This Study will thoroughly discuss the treatment of endometriosis from the

/oth Western and Traditional Chinese Medicine perspectives1 #dditionally* thisstudy will identify and descri/e the factors that need to /e considered in forming a

traditional Chinese nutritional manual for endometriosis1 Finally* this study willfocus on the usefulness of such a manual1

Glossary of Relevant Terms• Abdominal cavity: The cavity within the a/domen* the space

/etween the a/dominal wall and the spine1

AMerriam We/sterGs Medical Dictionary * +,,:

• Adhesion: The union of two opposing tissue surfaces Aoften in

reference to the sides of a wound1 #lso refers to scar tissue strands

that can form in the area of a previous operation* such as within the

a/domen after a laparotomy1


• Cyst: # cyst is an a/normal* closed sacli3e structure within a tissue

that contains a li&uid* gaseous* or semisolid su/stance1 # cyst can occur

anywhere in the /ody and can vary in si0e1 The outer* or capsular*

portion of a cyst is termed the cyst wall1


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• ndometriosis: The presence of tissue that normally grows inside

the uterus Awom/ in an a/normal anatomical location1 Endometriosis

is very common and may not produce symptoms* or it may lead to

painful menstruation1 2t has also /een associated with infertility1

Endometriosis occurs most commonly within the Fallopian tu/es and

on the outside of the tu/es and ovaries* the outer surface of the uterus

and intestines* and anywhere on the surface of the pelvic cavity1 2t can

also /e found* less often* on the surface of the liver* in old surgery scars

or* very rarely* in the lung or /rain1 AMerriam We/sterGs MedicalDictionary * +,,:

• ndometrium: The uterine lining6 the cells that line the uterus Athe

wom/6 the inner layer of the uterus1 This tissue is shed monthly in

response to the hormonal changes of the menstrual period1 The

endometrium then grows /ac3 and slowly gets thic3er and thic3er until

the ne4t period when it is once again sloughed off1 AMerriam We/sterGsMedical Dictionary * +,,:

• strogen: Estrogen is a female hormone produced /y the ovaries1

Estrogen deficiency can lead to osteoporosis1


• Infertility: 2nfertility primarily refers to the /iological ina/ility of aperson to contri/ute to conception1 2nfertility may also refer to thestate of a woman who is una/le to carry a pregnancy to full term1AMerriam We/sterGs Medical Dictionary * +,,:


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• Laparoscopy: # type of minimally invasive surgery in which a small

incision Acut is made in the a/dominal wall through which an

instrument called a laparoscope is inserted to permit structures within

the a/domen and pelvis to /e seen1 The a/dominal cavity is distended

and made visi/le /y the instillation of a/sor/a/le gas* typically* car/on

dio4ide1 # diversity of tu/es can /e pushed through the same incision

in the s3in1 $ro/es or other instruments can thus /e introduced

through the same opening1 2n this way* a num/er of surgical

procedures can /e performed without the need for a large surgical

incision1 Most patients receive general anesthesia during the procedure1


This research study will proceed with a literature review chapter that will

e4plicate prior theory and research regarding endometriosis and its treatment1 # methods chapter that will detail the procedures used to carry out the current

research study will follow that chapter1 The fourth chapter of this study will

include the study results* and will /e followed /y a fifth chapter that will discuss

the findings of the current study1


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Chapter Two: Literature Review Overview

This chapter provides a review of the sources that are the /asis for this

literature review synthesis1 First* a /rief description of the literature review process and the resources used in gathering the relevant literature will /e

provided1 Topics covered in this review will /e an introduction to /oth Westernand Traditional Chinese Medicine approach to understanding and treating

endometriosis1 #nd also reviewed will /e the effects of common Western andTCM nutrition* her/s and supplements that are used to support endometriosis

treatment1 Final section will /riefly summari0e the studies reviewed1This research synthesis study will review literature concerning the use of

Traditional Chinese Nutrition including her/s and the integrated use of Chinese

nutrition and Western nutrition and medicine and supplements to treat women

who suffer from Endometriosis1 Material for the )iterature 5eview was gathered /y primarily utili0ing search engines such as "oogle Scholar* Elsevier $u/Med and

(C)# )i/rary system1 ey Search words and phrases related to the topic to findarticles and studies applica/le to the study were used such as Endometriosis I

Chinese Medicine@Nutrition@Supplement@DietJ* Endometriosis I DrugsJ* Endometriosis her/sJ1


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The search resulted in -,: literatures through the $u/Med* +., from

"oogle Scholar* += from Elsevier and -+. from the (C)# )i/rary system search*


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limited to reviews on the topic of Traditional Chinese her/s* nutrition and

supplements used to support endometriosis1

# total of .. articles@monograph entries e4amining the use of Chinese

her/al medicine and traditional Chinese nutrition including her/s and the

integrated use of Chinese nutrition and Western nutrition and supplements and

drugs to treat women who suffer from Endometriosis satisfied the criteria for

inclusion in this literature review synthesis1 'f these articles* eighteen e4aminedthe use of Chinese her/s and nutrition with /oth Western nutrition and

supplement suggestions and ten mainly e4amined Western nutritional and

supplements without the use of Chinese Medicine6 seven compared the Western

nutrition and supplements mostly and eight compared the effectiveness of

Chinese nutrition and her/s alone versus Western medicine treatment modalities1

This study will serve to uncover the strengths* wea3ness* and limitations as

well as similarities and differences among the availa/le pu/lished research and

other articles* and provide a /asic foundation for a manual that could specifically

serve patients with Endometriosis1

!escription of ndometriosisEndometriosis is a very common de/ilitating disease that occurs in ? to

-, of general female population6 in women with pain* infertility* or /oth* the

fre&uency is .==, A"iudice K ao* +,,>1 #/out += to =, of infertile womenhave endometriosis* and ., to =, of women with endometriosis are infertile

AHummelsho% et al* +,,?1

Endometriosis is a disorder in which the cells that form the lining of the

uterus or endometrium grow outside the uterus1 2t is a noncancerous condition


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and in Western medicine* the cause is un3nown1 Theories as to what causes ita/ound in Western medical te4ts1 The cause of endometriosis is unclear inconventional medicine and there are many theories including three ma%or

perspectives1 The first theory is that small /its of menstrual tissue flow /ac3ward

into the fallopian tu/es and out into the a/dominal cavity where they seed with

hormonal stimulation and /egin to grow1 The second theory is that cells from the

uterine lining may /e transported through the /loodstream into other locations

where they seed and grow1 The third theory is that cells outside the uterus may change into uterine cells with hormonal stimulation in those who are genetically

predisposed1 Each month the endometrium /uilds up in the uterus then /rea3sdown and sheds off* resulting in vaginal /leeding or menstruation1 2t is speculated

that this same cycle occurs with the endometrial tissue located outside the uterus1

However* endometrial tissue outside the uterus that sheds off and /leeds is

trapped inside the /ody and is slowly a/sor/ed1 This process can create pain andinflammation and may lead to the development of local lesions* masses* and larger

amounts of endometriosis1 Common locations for the growth of this a/normalendometrial tissue are the ovaries and ligaments that support the uterus1 )esscommon locations are the outer surface of the colon and small intestines* the

ureters* /ladder* vagina* pleura of the lungs* and pericardium ASperoff* +,,=1

The symptoms of endometriosis depend on where the tissue is growing1

$elvic pain is the most common symptom followed /y heavy menstrual /leeding*

dyspareunia* and pain with /owel movements1 5ectal /leeding is not unusual as a

result of this condition* as is pain with urination1 #lso women with endometriosisare often una/le to conceive1 Women with endometriosis may e4perience pelvic


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pain =


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autoimmune diseases ABallweg* +,,>1

Table %: "igns and "ymptoms of ndometriosis

Definitive diagnosis is usually made through laparoscopic investigation

although recent research suggests that noninvasive symptom evaluation may

have a greater positive prediction value1 The $recise prevalence of endometriosisis unclear /ut there us a /road consensus that /etween = to -= of the female


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population will have signs and symptoms of the disease during their reproductive

years Aage -= to =, years AFlower* )iu* )ewith* )ittle K )i* +,-+1

Endometriosis is increasingly regarded as a comple4* multifactorial

condition of uncertain etiology where immunological* genic* environmental* and

possi/ly even psychological factors com/ine to create a full/lown diseases

ABallweg* +,,>1

2t is estimated that ., to >, percent of women who report infertility

pro/lems have endometriosis1 The most common symptoms of Endometriosis arepain /efore and during periods* pain with intercourse* general* chronic pelvic pain

throughout the month* low /ac3 pain* heavy and@or irregular periods* painful

/owel movements* especially during menstruation* painful urination during

menstruation* fatigue* infertility* diarrhea or constipation1 'ther symptomsinclude headaches* lowgrade fevers* depression* hypoglycemia Alow /lood sugar*

an4iety and suscepti/ility to infections and allergies ABallweg* +,,>1

'ne of the /iggest pro/lems regarding endometriosis is that the signs of

this disease in the early stages appear to /e the normal /odily changes that ta3e

place with the menstrual cycle1 2t is only as time goes /y that a woman /egins tosuspect that what is happening* and the symptoms she feels* are not normal1 Thepain of her menstrual cycle gradually and steadily /ecomes worse and worse as

the months go /y1 These symptoms are only the /eginning of what will /ecome agradual decline in a womanGs general health* as well as the health of her

reproductive system1 However* there are odd instances where some women doactually have endometriosis* /ut they are nearly free of any symptoms1 These

women will only /e diagnosed /y default* for e4ample when they have surgery for


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other issues* and only then is endometriosis found1 That is what ma3es thisdisease so enigmatic* difficult to interpret or understand1 Endometriosis does notfollow any distinct pattern* which is why it is difficult for the medical profession to

3now that a woman has the disease1 Some of the symptoms will mimic those of

other health pro/lems* including ovarian cysts* ectopic pregnancy* pelvic

2nflammatory disease* irrita/le /owel syndrome* ovarian cancer* fi/roid tumors*

colon cancer and appendicitis ASperoff* +,,=1

!iagnosis of ndometriosisEndometriosis is diagnosed through a laparoscopy1 This procedure allows

the surgeon to see inside the a/dominal cavity through a tinylighted optical tu/e

that is inserted through a small incision in the navel1 $art of the pro/lem thatcauses the delay in diagnosis of endometriosis is that many people in the medical

profession are not fully aware of the e4tent of this disease today1

There are a variety of methods that can /e used to assess whether a woman

has endometriosis* /ut laparoscopy is the only relia/le way to confirm the

presence of the disease is /y visually inspecting the a/dominal organs1 Before alaparoscopy is done a full gynecological evaluation should /e done covering the

patientGs medical history1 Diagnosis methods of endometriosis can include

physical e4amination and a pelvic e4amination1 These e4aminations involve thephysician feeling and loo3ing for a/normalities that are associated with

endometriosis1 $hysical findings depend on the severity and location of the

disease1 There may /e palpa/le nodules or tenderness in the pelvic region*

enlarged ovaries* a tipped/ac3 Aretrodisplaced uterus* or lesions on the vagina

or on surgical scars1 Dana0ol Aderivative of the synthetic steroid ethisteron is


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ta3en for ? wee3s prior to an operation to shrin3 the endometrial growths and

ease the surgical removal1 Following surgical removal of endometrial tissue* /irthcontrol pills may /e prescri/ed that contain /oth estrogen and progesterone* to /e

ta3en continuously for up to nine months1 This procedure will induce a pseudo

pregnancy* with the aim to allow the /ody time to rest and heal ASperoff* +,,=1

&estern !rugs for ndometriosis'ral contraceptives or /irth control pills regulate the growth of the tissue

that lines the uterus and often decrease the amount of menstrual flow1 2n general*

the therapy contains two hormones* estrogen and progestin1 2t often wor3s aslong as you ta3e the pills1 'nce you stop the treatment* your a/ility to getpregnant returns* and your symptoms of endometriosis may also return1 Some women ta3e /irth control pills continuously* without using the sugar pills that

signal the /ody to go through menstruation1 When /irth control pills are ta3en in

this way* the menstrual period may stop altogether* which can reduce pain or get

rid of it entirely ASperoff* +,,=1

Some /irth control pills contain only progestin* a progesteroneli3e

hormone1 Women who canGt ta3e estrogen use these pills to reduce menstrualflow1 Some women may not have pain for several years after stopping treatment1$rogesterone and progestin improve symptoms /y reducing a womanGs period or

stopping it completely1 #s a pill ta3en daily* these hormones will reducemenstrual flow without causing the lining of the uterus to grow1

"n5H agonist is used daily in a nose spray* or as an in%ection given once a

month or every three months1 Most health care providers recommend thatpatients stay on the "n5H agonist for a/out si4 months1 #fter that time* the /ody


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will come out of the menopausal state1 #fter women stop ta3ing "n5H agonistsfor si4 months* a/out =, percent have some return of their endometriosis

symptoms1 These medications also have side effects* including hot flashes*tiredness* pro/lems sleeping* headaches* depression* /one loss* and vaginal

dryness A'live et al* +,,>1

Current research is e4ploring the use of other hormones in treating

endometriosis and pain related to endometriosis1 Some of these include "n5Hantagonists* selective progesterone receptor modifiers* and selective estrogen

receptor modulators* also 3nown as SE5Ms1 Some women also have less painfrom endometriosis after pregnancy* /ut the reason for this is unclear1

5esearchers are trying to determine whether it is /ecause the hormones released

/y the /ody during pregnancy also lessen the growth of endometriosis* or if

pregnancy causes changes in the uterus or endometrium that lessen the growth of

endometriosis A'live et al* +,,>1

The TC$ 'erspective Regarding ndometriosis2n China* endometriosis is called Neiyi* meaning internal lump descri/ing

Western term endo1 2n TCM it is called Lheng ia* meaning a/dominal mass andthe incidence of endometriosis in China* li3e that in the (nited States* is reported

increasing ADharmananda* +,,+1

2n Traditional Chinese medicine* endometriosis is understood /ased on the

differentiated clinical manifestations associated with each individual1 2t isimportant in TCM to diagnose the patient according to his or her own specific

pattern1 Each individual has a pattern that mar3s the foundation and progression

of the disorder1 Traditional Chinese medicine ATCM* including acupuncture and


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her/s has /een used successfully in treating a wide range of female health

disorders including endometriosis1 The primary aim of the TCM doctor in the

treatment of endometriosis has always /een to remove /lood stagnation1

Endometriosis is a Western medical la/el and not a TCM term1

However* the

scientific medical understanding of this diseases has contri/uted to the notion

that this is a diseases characteri0ed /y /lood /eing where it shouldnGt and una/le

to escape the /ody1 Symptoms such as severe sta//ing period pain* clotty

menstrual flow and palpa/le nodules or masses in the a/domen appear to verify

the diagnosis of stagnation /lood A)yttleton* +,,>1

2n China* doctors found that more pregnancies resulted if treatment of

women with endometriosis targeted the 3idney for endometriosis lesions that can

produce secretions which clog up the system Aphlegm damp in TCM also /oosting

idney !ang is generally rather effective at clearing such phlegm damp1 2n TCM*more attention is paid to moving /lood* clearing stasis and /rea3ing up masses

during the period and fortifying the idney !ang and moving /lood at ovulation1

2f there is such severe stagnation that a pregnancy is impossi/le* then treatment

will focus on the stagnation during the entire cycle1

We 3now that menstrual /lood travels not only downwards from the uterus

and out through the cervi4 /ut also upwards through the fallopian tu/es and out

into the peritoneal cavity1 This small &uantity of /lood carries with it /its of discarded endometrium1 Women with strong uterine cramps due to )iver 7iStagnation are more li3ely to close more menstrual flow upwards through the

tu/es A)yttleton* +,,>1


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The /lood and the tissue will either /e rea/sor/ed or will remain and

esta/lish itself somewhere in the pelvic cavity1 2f idney !ang is strong* thenmovement of 7i in the pelvis will mo/ili0e the menstrual de/ris* which shouldnGt

/e there and it will /e rea/sor/ed1

So Wea3ness of idney !ang will allow the

accumulation of /lood and tissue* which creates stagnation1 The pattern thatsuggests endometriosis is when temperature does not drop very much when the

period comes* or if it does drop it may start to go up again after -+days1 Thesepatterns indicate that the switch to !in from !ang has not /een on time or

complete1 These patterns all indicate inade&uate idney !ang function A)yttleton*+,,>1

#ccording to the )yttletonGs Treatment of 2nfertility with Chinese

MedicineJ* the treatments would /e divided into three phases* postmenstruation*

ovulation and post ovulation1 During postmenstruation* /uild /lood andreinforce the !in1 For a/dominal masses with strong patient with no desire forconception* clear ) 7i Stagnation with Damp and treat S$ 7i Deficiency

A)yttleton* +,,>1

Diet changes can help reduce the symptoms of endometriosis1 #ccording to Endometriosis DietJ /y )evett* Carolyn* increasing omega. fatty acids* fi/er and

avoiding meat* dairy products* wheat and sugar* modulate estrogen1 #lso avoidcaffeine and alcohol* refined foods* additives* minimi0e or avoid soy products

seem to help patients with Endometriosis1 #d%usting eating ha/its could havemany positive physical and meta/olic changes A)evett* +,-,1


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Ta/le +8 Endometriosis in Western and Traditional Chinese Medicine

Traditional Chinese (utrition for ndometriosis #ccording to The Tao Of Nutrition /y Maoshing Ni and Cathy McNease*

ancient people were much more aware of the environment and how their /odies

reacted to their surroundings1 The system of Chinese Nutrition is a healingsystem of its own and it adapts to every individualGs needs /y treating the whole

person instead of the disease1 Chinese Nutrition differs from the modern Westernnutrition in that it does not rely on analy0ing the chemical constiruents of each

food6 rather* it determines the properties of energies of each food and

com/ination* ta3ing consideration of season* method of preparation and

Types of lesion Action Treatment

(on)pigment lesions $roduce secretion whichmay clog the fim/rial end of fallopian tu/eCauses possi/le infertility

Boost D !ang and invigorateS$ 72 to remove $hlegmDamp

'igmented lesions Causes pain and /leedingin pelvic cavity

5esolve Blood stagnation withBloodregulating her/s and /oost D !ang to $romotedispersal of stagnant Blood

Cysts+ nodules and

masses

Causes pain and possi/leinfertility due to distortionof tu/es or ovaries

5esolve Blood stagnation withBlood/rea3ing her/s and /oost D !ang to promotedispersal of stagnation


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geographical location* and utili0es the information according to the natural

principle of life and /alance ANi K McNease* +,,>1


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Chinese Nutrition differs from Western Nutrition in that it does not tal3

a/out the /iochemical nature of food /ut it deals on an energetic level where

/alance is the 3ey1 Foods are selected according to their energetic &ualities suchas warming* cooling* drying* or lu/ricating1

Thus* Chinese Nutrition would see3 to

warm the coldness* cool the heat* dry the dampness* and lu/ricate the dryness1 By carefully studying the individualGs im/alances* one would choose the appropriate

foods to /ring a/out a /alanced state of health1 For e4ample* for an e4cessiveindividual who is e4hi/iting conditions of heat in the /ody* cooling food would /e

appropriate1 For a deficient individual who tends toward coldness* warming foods would /e chosen1 This is way health is achieved1 Foods all have specific &ualitiesinherent within* determined /y the effect the food has on the /ody1 Then themethod of preparation either enhances or neutrali0es the foods1 "enerally spea3ing* warming raise meta/olism and cooling food lower meta/olism1 Balance

in the diet is essential for good health1 #ccording to the Chinese point of view* the /ody is loo3ed at as a whole* wor3ing together in harmony ANi K McNease* +,,>1


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Table ,: ndometriosis in &estern and Traditional Chinese $edicine

#ccording to Traditional Chinese Medicine ATCM* the human /eing is an

intricate whole* made up of these essential components8 Chi Avital energy* life

force* /odyGs networ3* pathway and also called meridians* /lood* /ody fluids* ing

Afound in the sperms* eggs* /one marrow and the /rain and Shen ASpirt1 TCM views the /ody organ as couples consisting of a !in organ and !ang organ1 Eachpair of organs is associated with one of five energies called the Five Elements8

Wood* Fire* Earth* Metal and Water1

Types of lesion Action Treatment

(on)pigment lesions $roduce secretion whichmay clog the fim/rial end of fallopian tu/eCauses possi/le infertility

Boost D !ang and invigorateS$ 72 to remove $hlegmDamp

'igmented lesions Causes pain and /leedingin pelvic cavity

5esolve Blood stagnation withBloodregulating her/s and /oost D !ang to $romotedispersal of stagnant Blood

Cysts+ nodules and

masses

Causes pain and possi/leinfertility due to distortion

of tu/es or ovaries

5esolve Blood stagnation withBlood/rea3ing her/s and

/oost D !ang to promotedispersal of stagnation


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Table -: .asic /ive lement Chart #ccording to The Tao of Nutrition /y Ni and McNease* premenstrual

symptoms resem/ling endometriosis symptoms may /e characteri0ed /y

a/dominal cramps* /loating* /ac3ache* irrita/ility* low energy and mood swings1

This is partially due to the large consumption of cold foods and drin3s in this

country that in turn cause the /lood to stagnate1 2n Chinese terminology*premenstrual symptoms A$MS is a condition of disharmony in the /lood

stagnant /lood* not enough /lood* or heat in the /lood6 and stagnation of Chi1

#cupuncture* acupressure* her/s* diet* and Chi A7i "ong e4ercises are all very

/eneficial for relieving the symptoms and correcting the disharmony1 The /oo3 suggests ginger* green onions* fennel* orange peel* spinach* walnuts* hawthorn

/erries* cinnamon* and /lac3 pepper* Chinese date* Dang "ui A#ngelica sinensis

to /e used a wee3 /efore the menstruation1 #nd cold foods* raw foods* e4cessiveconsumption of fruit* vinegar* all shellfish* coffee* stimulants* sugar* dairy

&ood /ire arth $etal &ater

/lavers Sour Bitter Sweet $ungent Salty

0ang

Organ#1in

)iver Heart Spleen )ung idney

/u Organ#1ang "allBladder

S1 2ntestine Stomach )1 2ntestine (rinary

Bladder

"enses Organ Eye Tongue Mouth Nose Ear


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products* and smo3ing should /e avoided ANi K McNease* +,,>1


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#ccording to Chinese Natural Cures /y Henry )u* female infertility pro/lems such as endometriosis and dysmenorrhea could /e treated /y addressing

spleen deficiency* 3idneys yang deficiency* deficiency of energy A7i and /lood*

3idneys yang deficiency* yin deficiency* cold and deficient wom/* hot /lood* liver

energy A7i congestion Astagnation and dampnesssputum1 )u states that fortreating spleen deficiency with chronic diarrhea* chronic dysentery* lac3 of firm

erection* poor appetite* prolapsed of any internal organ* prolapsed of anus and

shortness of /reath* apply treatment principle to tone energy and strengthen the

spleen /y using the formula Bu Lhong !i 7i Tang1 Dietary recommendations forfood cure included fish* apple cucum/er* gold carp* carrot* chestnut* cornco/*

%o/Gstears* 2rish potato* rice* royal %elly* string /ean* yam* /eef and red and /lac3

date A)u* +,,=1

For 3idneys yang deficiency with cold feet* cold loins and legs or cold

sensation in the genitals* diarrhea /efore dawn* diarrhea with stic3y muddy stool*

di00iness* edema* e4cessive perspiration* fatigue* fre&uent urination at night*

panting* perspiration on the forehead* retention of urine* ringing in ears* scant

urine* seminal emission and shortness of /reath* apply treatment principle to

warm the 3idneys and reinforce 3idneys yang energy /y using formula !ou "ui

Wan mainly1 Food cure recommendations are 3idney /eans* lo/ster* sardine*shrimp* sparrow* clove* dill seed* fennel* pistachio nut* sparrow egg* cra/ apple*

rasp/erry and walnuts A)u* +,,=1

For energy and /lood deficiency with symptoms of /leeding of various

3inds with /lood in light color* often seen in consumptive diseases* di00iness*

fatigue* flying o/%ects seen in front of the eyes* insomnia* irregular menstruation*


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low energy* low voice* menstrual flow in light red color* mentally depressed*

regular menstruation /ut with very scant flow lasting for one or two days only*

num/ness of lim/s* pale comple4ion and lips* pale nails* palpitation apply

treatment principle to tone the energy and the /lood simultaneously and to tone

the 3idneys /y using formula called Ba Lhen !i Mu Wan1 Food curerecommendations for this condition included a/alone* asparagus* cuttlefish*

chic3en egg* duc3 egg* white fungus* /eef liver* grape* mandarin fish* oyster*

mil3* /eef* cherry* clam* maltose* 2rish potato* sweet rice* apple cucum/er* /og

/ean* gold carp* carrot* chestnut* ham* horse /ean* hyacinth /ean* o/Gstears*

5oyal %elly* string /ean* whitefish* yam* red and /lac3 date* mutton* s&uash* and

roc3 sugar A)u* +,,=1

For yin deficiency symptoms with /leeding from gums* constipation*

di00iness* dry and scant stools* dry sensation in the mouth or dry throat* fatigue*

headache in the afternoon* low fever in the afternoon* menstrual flow in dar3

color* night sweat* nose/leed* pain in the throat also red and swollen* palms of

hands and soles of feet are /oth hot* palpitations with insecure feeling* regular

menstruation with scant flow lasting for half day or one day* short and reddish

streams of urine* sleeplessness* swallowing difficulty* toothache* underweight*

vomiting of /lood or nose/leed during menstrual periods apply treatment

principle to nourishAwater the yin and clear the heat and to nourish the /lood

and regulate the menstruation /y using the formula !ang ing Lhong !u Tang*

7ing "u Li Shen Tang or 7ing ue !ang !in Tang1 Food Cures recommendationincluded /ird nest* cheese* 3idney /ean* a/alone* asparagus* chic3en egg*

cuttlefish* duc3* duc3 egg* white fungus* oyster* por3 and royal %elly A)u* +,,=1


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For cold and deficient wom/ with symptoms of cold pain or cold sensation

in the lower a/domen or genitals* dar3 /lac3ish menstrual flow* failure of the

fetus to grow* fetus motion* fre&uent miscarriage* functional distur/ances of the

ovary* ha/itual miscarriage* pale comple4ion* poor appetite* thin and watery

menstrual flow in light color and underdevelopment of the wom/* treatment

principle is to warm the wom/ /y using fomula #i Fu Nuan "ong Wan1 Foodcure recommendations include cinnamon* 3idneys* lo/ster* sheep mil3* sardine*

shrimp* star anise* red and /lac3 dates A)u* +,,=1

For hot /lood Aheat in the /lood with symptoms of a/dominal pain that

occurs at onset of menstrual periods* deep red or violet menstrual flow* discharge

of /lood from anus /efore periods* fever after child/irth* irregularity of menstrual

periods* menstrual flow somewhat heavy* menstrual flow with a /ad smell*

nose/leed* plentiful menstrual flow* premature menstrual periods which may /e

more than -, days early or two periods within one month* red and plentiful

menstrual flow* s3in ulcers* vaginal /leeding* vomiting of /lood or nose/leed

during menstrual periods* treatment principle is to clear heat in the /lood /y

using formula 7ing ing Tang1 Food cures include /lac3 fungus* salt* spinach*straw/erry* /anana* cucum/er and licorice A)u* +,,=1

For liver energy A7i congestionAstagnation with a/dominal pain*

convulsion* irregularity of menstrual periods* menstrual pain* morning sic3ness*

num/ness* pain in the upper a/domen* premature periods or overdue periods*

shortage of mil3 secretion after child/irth* stomachache* su/%ective sensation of

o/%ects in the throat* vomiting of /lood and whitish vaginal discharge apply

treatment principle to rela4 the liver and disperse energy congestion /y using


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iao !ao San or De Sheng Dan1 Food cures for this condition are /rown sugar*

garlic* turmeric* 3um&uat* /eef* cherry* /ird nest* /utterfish* chic3en* coconut

meat* date* tofu* mustard seed* sweet rice* goose meat* mutton* %ac3fruit* s&uash*

sweet potato* red and /lac3 date* rice* roc3 sugar* caraway seed* spearmint*

common /utton mushroom* oregano* red /ean* am/ergris* dill seed* sweet /asil

and saffron A)u* +,,=1

For dampnesse4cess of sputum with discharge of sputum that can /e

coughed out easily or discharge of white watery sputum* di00iness* e4cessive

whitish vaginal discharge* fre&uent cough during pregnancy that are prolonged

and cause motion of fetus* headache* hiccups* light red menstrual flow* menstrual

periods overdue fre&uently* morning sic3ness* tur/id and stic3y menstrual flow*

pain in the chest* panting* plentiful menstrual flow* prolonged di00iness* sleep a

lot or sleeplessness* suscepti/le to morning sic3ness during pregnancy*

suppression of menses* vomiting and white sliding sputum that can /e cleared

from throat easily apply treatment principle to strengthen the spleen and dry up

dampness and use 7i "ong Wan1 Food cures for this condition are ad0u3i /ean*am/ergris* /arley* common carp* cucum/er* mung /ean* seaweed* shepherdGs

purse* star fruit* /am/oo shoot* crown daisy* date* fresh ginger* leaf or /rown

mustard* /lac3 and white pepper* white or yellow mustard seed* asparagus and

pear A)u* +,,=1

Healing with Whole Foods /y $aul $itchford e4plains that main cause of womenGs diseases such as endometriosis is due to stagnant /lood1 #ccording to$itchford* stagnant /lood is a /lood that coagulates or congeals* and is /rought

a/out either /y in%uries to the tissue of the /ody or /y &i energy insufficient to


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push the /lood through the vessels1 Signs of stagnant /lood include sta//ing painthat is fi4ed in one place* fre&uent /leeding* /leeding with dar3 purple clots* dar3

purple tongue with red spots* and unnaturally dar3 comple4ion1 When /lood isstagnant* clots tend to develop6 chronic stagnation generates tumors* cysts*

nodules* and hard immo/ile lumps1 Women are often afflicted with stagnant /lood* particularly in the lower a/dominal Areproductive area1 2n fact* a largeportion of all gynecological pro/lems* especially those of a painful nature are

related to stagnant /lood1 E4amples of womenGs diseases commonly caused /y stagnant /lood are amenorrhea Aa/sence of menstruation* dysmenorrhea Apainful

menstruation* uterine hemorrhage* uterine tumors* fi/roids* cancer* and ovarian

cysts A$itchford* +,,+1

Clearing stagnant /lood is easiest in the early stages* /efore masses form1

2n all cases* one must improve the circulation of &i energy6 when the liver is the

cause of stagnation* the remedies outlined earlier for stagnant liver &i are

appropriate1 #nother approach to treating stagnant /lood involves improving the&uality of the /lood itself1 Blood filled with to4ins* waste matter* and fat is muchmore li3ely to /ecome stagnant and congealed1 For healthy* vital /lood* thespleenpancreas must /e maintained at pea3 performance* since its function has

a great effect on /lood formation A$itchford* +,,+1

2n the West* dampness and mucus are the two main factors which wea3endigestion and the spleenpancreas* there/y causing tur/id /lood6 in damp@mucus

conditions* one should restrict the cold Ain temperature* very sweet* and highly

mucusforming foods including meat* dairy* eggs* and ice cream1 2n every case of stagnant /lood* regardless of its cause* proper eating ha/its such as thorough


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chewing and preparation of simple meals are essential1 Furthermore* those foodsand spices which disperse stagnant /lood should /e added to the diet1 #ddingone such item to each meal is an effective dietary aid in con%unction with her/al*

acupuncture* or other treatments1

For milder conditions* these dietary remedies

may /e sufficient /y themselves A$itchford* +,,+1

Each food and spice in the following are warming* with the e4ception of

eggplant Acooling* white pepper Acooling* adu3i /ean Aneutral* and peach seed

Aneutral1 The warming remedies* particularly garlic and ginger* should /e usedcarefully* if at all* in cases mar3ed /y signs of heat Aaversion to heat* sensation of

feeling too hot* flushed face* /loodshot eyes* deep red tongue with possi/le yellow

coating* and @or great thirst for cold fluids or signs of deficient yin Atidal fever*

hot palms and soles* fresh red chee3s and tongue* fre&uent light thirst* and@or

night sweat1 Eggplant specifically relieves stagnant /lood conditions of theuterus* /ut may wea3en the uterus when /lood is not stagnant A$itchford* +,,+1

Common Conditions of "tagnant .lood Causing 'ain When the condition includes pain* the pain is invaria/ly fi4ed in one place6

pain that moves around is not caused /y stagnant /lood1 Blac3 fungus Awood earand seaweeds are also especially helpful for dissolving fi/roid and other uterine

tumors* and these can /e added to the diet for this purpose1 Chives and cayenneare additional e4cellent remedies for in%uries with signs of /lood stagnation1 They wor3 internally when added generously to the diet1 For e4ternal use* chive greensand@or roots are cut finely* then %uiced /y wringing the pulp through muslin or

similar cloth* or /y e4pressing with a %uicer1 The %uice can then /e soa3ed intocotton cloth and applied as a compress* or ru//ed on directly as a liniment1


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# cayennevinegar liniment is also very effective1 To prepare* simmer oneta/lespoon cayenne pepper in - pint applecider or ricewine vinegar for -,

minutes in a covered container6 /ottle hot and unstrained1 #pply on the in%uredsite without ru//ing too much1

This liniment is also useful for lung congestion*

and for pain of arthritis and rheumatism1

'revention and Good 2abits Women who eat a /alanced diet* get ade&uate e4ercise and sunshine* and

wor3 toward emotional clarity seldom have menstrual pro/lems1 #t the time of menstruation* the deeper hormonal@emotional &ualities surface* while their

physical corollary is discharged O the heat/earing /lood that results from a

natural purification1 This is a fragile state O surfacing aspects from the interior* yin* hormonal parts of the /eing are delicate and sensitive* and need protection

from the yin climates Acold and damp and physical and emotional e4tremes1

During the menses* it is therefore important to avoid heavy physical wor3*

emotional stress* and overe4posure to cold and damp conditions6 for e4ample*

3eep the legs and feet warm* 3eep covered when in cold places and during the cool

seasons* and avoid wor3ing with the hands in cold water1 #lso avoid constipation*get plenty of rest* and a/stain from se4 during menstruation AChavarro K Willett*

+,,;1

Caffeine and Reproduction #ccording to The Fertility Diet /y Chavarro K Willett A+,,;* the process of

meta/oli0ing caffeine changes throughout her menstrual cycle1 There is a mar3edslowdown during the luteal phase* which /egins the day after ovulation that may

lead to higher levels of caffeine in the /ody during the period of fertili0ation*


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implantation* and early em/ryonic development1 #nother pro/lem may /egenetic O some women /rea3 down caffeine faster than others and so may /e less

prone to any possi/le negative effects1 # cup of coffee delivers mostly water1Ta3en /lac3 without sugar* it is nearly calorie free1 2t is /rimming with

antio4idants and other /iologically active su/stances* including caffeine1 Severallongterm studies have shown that coffee drin3ers are less li3ely to develop type +

dia/etes* gallstones and 3idney stones* and possi/ly colon cancer1 The maindownsides of coffee drin3ing are caffeine addiction and the fats and calories that

come with the sugar* cream* whipped cream* caramel* and other toppings and

flavoring now put in and on coffee1 Chavarro K WillettGs A+,,; findingse4plained that almost half of the women in the NursesG Health Study say they

drin3 coffee every day1 2n the fertility study* the coffee drin3ers werenGt any moreor less li3ely to have had trou/le getting pregnant than women who didnGt drin3

coffee1 'vulationrelated infertility was similar across the spectrum of coffeedrin3ing* as was infertility due to other causes* such as endometriosis or tu/al

pro/lems1 However* pro/lems with study design ma3e it impossi/le to 3now if this is a true causeandeffect relationship AChavarro K Willett* +,,;1

Alcohol

Heavy drin3ing is indisputa/ly harmful O for general health* mental health*

relationships* and reproduction1 2t can halt menstrual periods* stop ovulation*throw off the hormone cycles needed for conception and the implantation of a

fertili0ed egg* end a pregnancy with miscarriage* and trigger early menopause1

#lcohol a/use can endanger a new life from the moment of conception until after

/irth1 Do0ens of study have loo3ed at the impact of moderate drin3ing on fertility


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and fetal development1 AChavarro K Willett* +,,;1 The results are all over themap1 Some show that women who are moderate drin3ers ta3e longer to getpregnant than nondrin3ers1 2n a study conducted among women undergoing2F* those who dran3 alcohol in the month /efore the 2F cycle produced fewer

eggs and had lower pregnancy rates1 2n another study* moderate drin3ing did notaffect fertility among women under age .,* /ut did get in the way of pregnancy for

older women1 2n a Danish study* women who were moderate drin3ers averaging adrin3 a day got pregnant faster than teetotalers1 2n another study* women whodran3 wine got pregnant faster than nondrin3ers or those who dran3 /eer or

spirits AChavarro K Willett* +,,;1

5esults from the NursesG Health Study provide another piece of the pu00le*

/ut only for very moderate drin3ing* up to one drin3 a day1 2nfertility due topro/lems with ovulation was no more common among nurses who had a drin3 a

day than it was among those who did not drin3 alcohol at all1 The same was truefor infertility due to endometriosis* /loc3ed fallopian tu/es* and other causes1 2tdid not matter what 3ind of alcoholic /everages the women preferred1 # daily glass of wine* /eer* or spirits did not seem to help or hinder getting pregnant1

Heavy drin3ing can derail pregnancy with a miscarriage or a still/irth1 2t can alsoharm a fetus in several ways1 #lcohol passes &uic3ly through the placenta1 #nun/orn /a/y /rea3s down alcohol much more slowly than its mother* so the

alcohol level in its /lood can reach high levels even when the motherGs is still o31

This can lead to fetal alcohol syndrome* a condition that causes lifelong physical

and mental disa/ilities1 Heavy drin3ing can also lead to more su/tle pro/lems


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with thin3ing s3ills and /ehavior1 No one really 3nows if moderate* responsi/ledrin3ing has similar effects on pregnancy and the development of a new life1

Timing is one issue1 2t is possi/le* though not proven* that alcohol prevents nervesfrom ma3ing essential connections in the growing /rain at certain critical

moments of fetal development /ut has little or no effect at other times1 # motherGsmeta/olism is another un3nown1 Women whose /odies /rea3 down alcohol&uic3ly may /e a/le to drin3 safely throughout pregnancy* while those who

meta/oli0e it more slowly may need to a/stain1 Some studies have reported that women with endometriosis tend to drin3 more alcohol than those without the

disease A"rodstein et al1* -;;>6 Missmer and Cramer* +,,.1

Literature Review Integration #/out ., percent to >, percent of women with endometriosis are infertile*

ma3ing it one of the top three causes of female infertility1 Some women donGt find

out that they have endometriosis until they have trou/le getting pregnant AN2H*

+,,+6 Speroff* +,,=1 Endometriosis treatment using hormonal therapies is mostoften not a permanent solution and often unsatisfactory* and surgical removal or

aspiration of endometrial cysts usually provides only temporary /enefits and may

cause secondary pro/lems* including persistent a/dominal pain due to adhesions

and infertility ACottreaual et al1* +,,?1

Many studies suggest that higher inta3e of green vegeta/les Aall types and

fresh fruit Aall types can lower the ris3 of endometriosis1 Conversely* inta3e of /eef or red meat and ham can increase the ris3 A$ara00ini et al1* +,,>1 # study conducted in the (1S1 on ovarian endometrioid cysts reported elevated ris3s of

endometrioisis for higher inta3es of polyunsaturated and vegeta/le fats* /ut no


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reduction in ris3 for high inta3e of vegeta/les and fruits ABritton et al1* +,,,1

There are however* some indications that a diet poor in vegeta/les and fruits and

rich in fat increases the ris3 of endometrial cancer A#rmstrong* -;1 Fore4ample* for endometrial and ovarian cancer and fi/roids* there was a direct

association with the fre&uency of consumption of meat and ham in this 2talian

population* whereas high inta3e of vegeta/les and fruits conferred some

protection ABritton et al1* +,,,1 2n /iological terms* it may influenceprostaglandin concentrations* which may affect ovarian function ASmith* -;:?1

There were foods that overlapped /ut also grouped in apposing ways1 5eviewingthe studies also revealed that hormonal factors are a potential lin3 /etween diet

and endometriosis* since the ris3 may /e increased /y e4posure to unopposed

estrogens* and a diet rich in fat increases circulating unopposed estrogens

A#rmstrong et al1* -;:-6 "oldin et al1* -;:+6 "or/ach and "oldin* -;: reported the incidence of endometriosis is >, less among females who

consumed more fresh fruit and green vegeta/le1 Females with a high inta3e of /eef* ham or other red meat* increased their ris3 of endometriosis /y :,-,,1


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2n most of the nutrition and diet studies showed connection /etween diet and

endometriosis1 2n many studies* proper attention was given to researchcomparing the effectiveness of Western medicine treatment alone versus a

com/ination of nutrition and Chinese her/al medicine and Western medicine* and

Chinese her/s alone versus Western medicine alone1 2n most of the studies using Western medicine* Dana0ol or analogs of "n5H such as )upron* Synarel* or

Lolade4 were the treatment choice followed /y omega. supplementation1 )astly*many of the her/s overlapped and common Chinese formulas emerged among the

studies1 Chinese formula* "ui Lhi Fu )ing Wan was most effective treatmentmodality in improving overall cases of endometriosis1 There were foods thatoverlapped in many of studies as well1

While there has /een a good deal of writing and research that pertains to

nutritional recommendations for women suffering from endometriosis* therehave /een no studies which have /rought the findings of research and theory into

a single user manual to assist endometriosis sufferers in ma3ing nutritional

choices that will facilitate the remediation of their conditions1 #s a result theree4ists a gap or /lind spotJ in the current literature1 2t will /e the purpose of thecurrent study to /egin to fill that gap /y assem/ling the most salient nutritional

factors that should /e incorporated into a manual specifically designed for women

who suffer from endometriosis1


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Chapter Three: $ethod

Introduction

The Method section will provide information pertaining to the research

design* selection of data sources* procedures and rationale of data collection* data

instruments and data analysis* and finally methodological limitations of this

literature review synthesis1 This study will review the current literature availa/leconcerning the use of Chinese her/al medicine and traditional Chinese nutrition

including her/s and the integrated use of Chinese nutrition and Western nutrition

and medicine to treat women who suffer from Endometriosis1 2t will serve touncover the strengths* wea3ness* and limitations as well as similarities and

differences among the availa/le pu/lished research and other articles* and provide

a /asic foundation for a manual that could specifically serve patients with

endometriosis1

!esignation of Research $ethodThis retrospective study used a &ualitative literature synthesis research

method to review* analy0e* compare and generate appropriate and emerging

themes and ideas from the availa/le literature A#ronson* -;;>1 The researcherdiscerned that the thematic style of analysis was appropriate for this literature

review synthesis /ecause this style helped to /etter identify themes and patterns

within all of the ., studies that were collected for this research1 This study engaged the methods of grounded theory and literature synthesis to achieve its

stated research o/%ective1 #s a &ualitative research method* grounded theory is


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effective in uncovering potential connections and identifying factors that may /e

followed up /y additional and more controlled research studies ABowen* +,,?1

Grounded Theory "rounded theory is a &ualitative and systematic research method that

results in the generation of theory from the synthesis of many sources of data1 2tis an inductive approach that proceeds from specific data to result in generali0ed

theory1 # grounded theory is generated /y themes* the themes emerge from thedata during analysis* capturing the essence of the meaning or e4perience drawn

from varied situation and conte4t and the progress is toward saturation until the

variation is e4hausted ABowen* +,,?1 The grounded theory method of researchprovides a systematic means for information analysis and has /een used

e4tensively in the social and nursing research arenas AChiovitti K $iran* +,,.6

Weed* +,,=6 $andit* -;;?1 "rounded theory emerged as a research method inthe last few decades* and has gained respect as a method for &yalitative research1

#n area of in&uiry is put forth and data gathered via various methods generally

including /oo3s* research studies* interviews and email e4changes1 The data

collection and coding of what is found performed to group ideas and themes that

emerge in the process1 This process is continued until all new avenues or leads aree4hausted1 These data groups are further coded into themes* and those themesinto larger categories1 The names of these types of codes are open coding Athela/eling and categori0ing of data elements* a4ial coding Athe development of main

categories and their su/categories and selective coding Athe integration of the

categories developed from the previous coding events A$andit* -;;?1


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Research "ynthesis $ethod5esearch synthesis method is the process through which two or more

research studies are assessed with the o/%ective of summari0ing the evidence

relating to a particular &uestion1

This method is retrospective study /y using

&ualitative research method to review* analy0e* and generate appropriate and

emerging theme and ideas relating to the availa/le literature A#ronson* -;;>1

"ample and "ampling 'roceduresThe source of data for this study includes research articles that have /een

e4tracted from a num/er of traditional Chinese medicine and Western medicine

literatures* te4ts* %ournals and articles1 The online research data/ases $u/Med*"oogle Scholar* EBSC' host and the (C)# online %ournal data/ase were used to

search for research articles and collect data pertaining to my capstone topic1 Thesearch was done in the principal investigatorGs house* at the (C)# Biomed li/rary*

or at the !osan (niversity )i/rary1 # com/ination of following 3ey words wasused in the search8 endometriosis* Chinese her/s* diet* nutrition* supplement* and

Traditional Chinese Medicine and TCM nutrition1 "rounded theory researchmethod of systematically categori0ing* assessing* collecting data and developing a

theory or conclusion from availa/le data will /e used in the literature review

synthesis A"lasser and Strauss* -;?


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This research synthesis was &ualitative in nature1 # summary and overallcomparison of the results and findings among and /etween different research

studies was engaged* and common themes and patterns found among the various

studies emergee during the research process1

This research loo3ed for various

influences that different foods* supplements and her/al medicines have on

endometriosis1 These common themes were identified and analy0ed to assist indeveloping a Traditional Chinese Nutritional manual for endometriosis1 The validity and relia/ility of the research articles used in my research synthesis

pro%ect varied depending on the study design and methodology of each individual

study1

Instrumentation and !ata Collection 'rocedureTa/les and charts were used to organi0e* e4tract and summari0e

information pertaining to each article selected1 The information o/tained fromthese ta/les and charts was used to esta/lish themes that were analy0ed to arrive

at the conclusions that formed are detailed in the final 5esults and Discussion

sections of this paper1 Throughout the process* ta/les were used for trac3ing andreviewing the ., articles selected and analy0ed to constitute the &ualitative data

for this study1 This process modified the ta/les and as a result other chart* ta/lesand categories of information was also created1 This procedure was repeated asneeded and a final review of the articles* data analysis ta/les* and result findings

were conducted for consistency1 2n order to affirm the validity andtrustworthiness of my data analysis techni&ue* a sample of the studies werereviewed and researched /y my supervisor1 Ta/les were constructed to assist inthe organi0ation and analysis of the data collected for this study1


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#n article a/straction form was used to assess and summari0e each

research article that will /e used for this research synthesis1 # copy of the articlea/straction form used in this study is included in #ppendi4 H of this document1

The form contained the following sections to /e discerned /y the researcher8

• title of study

• authors

• source

• o/%ective

• research design

• language@setting

• participants

• participant selection method

• treatment interventions

• outcome measures

• procedures

• results

• conclusion1

The conclusions section includes comments or o/servations made /y theresearcher regarding main points* 3ey ideas* as well as gaps and strengths of the

study1 The article a/straction form assisted in identifying the ma%or themes*categories of information* and conclusions that are descri/ed in the 5esults andDiscussion sections of the Capstone $ro%ect paper1

The fourth chapter of this study includes the study results* and is followed

/y a fifth chapter that discusses the findings of the current study1


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Chapter /our: ResultsOverview

This chapter will summari0e the findings of the current studies on

treatment options for endometriosis including* nutrition* Chinese her/s and

Western medicine1 The coding process was a naturally thematic analysis in style1The research articles collected for this study were categori0ed according to the

themes that emerged and coded into thematic categories previously descri/ed in

the Methods section for grounded theory analysis1 #ppendi4 B refers toappendices that show the initial categori0ation of articles according to general

emergent themes of each article that have /een found1 #ppendi4 C furthercategori0es in /roader in nature with the thematic groups1 #ppendi4 D* E* F and" were formed to support this study also /y using selective coding into further

related themes1

Data collected were analy0ed using thematic content analysis* such as

finding themes within the data* categori0ing the varia/les* and finding and

discussing similarities and differences1

Table 3 : Overview of Articles


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ndometriosis !ietMany studies suggest that higher inta3e of green vegeta/les Aall types and

fresh fruit Aall types can lower the ris3 of endometriosis1 Conversely* inta3e of /eef or red meat and ham can increase the ris3 A$ara00ini et al1* +,,>1

# study conducted in the (1S1 on ovarian endometrioid cysts reported

elevated ris3s of endometrioisis for higher inta3es of polyunsaturated and

vegeta/le fats* /ut no reduction in ris3 for high inta3e of vegeta/les and fruits

ABritton et al1* +,,,1 There are however* some indications that a diet poor in vegeta/les and fruits and rich in fat increases the ris3 of endometrial cancer

A#rmstrong* -;1 For e4ample* for endometrial and ovarian cancer and fi/roids*there was a direct association with the fre&uency of consumption of meat and ham

in this 2talian population* whereas high inta3e of vegeta/les and fruits conferred

some protection ABritton et al1* +,,,1 2n /iological terms* it may influenceprostaglandin concentrations* which may affect ovarian function ASmith* -;:?1

Hormonal factors are a potential lin3 /etween diet and endometriosis* since the

ris3 may /e increased /y e4posure to unopposed estrogens* and a diet rich in fat

increases circulating unopposed estrogens A#rmstrong et al1* -;:-6 "oldin et al1*

-;:+6 "or/ach and "oldin* -;:


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women with endometriosis tend to drin3 more alcohol than those without the

disease A"rodstein et al1* -;;>6 Missmer and Cramer* +,,.1

ndometriosis and "upplementsNew studies including the studies pu/lished in the %ournal

Human

$eprodu%tion* seem to suggest that paying attention to what we eat and put on

our /odies could significantly reduce the ris3 of developing endometriosis1 2n astudy loo3ing at endometriosis and the types of fat women eat* while total fat

consumption was not associated with endometriosis ris3* the women who ate the

most omega. fatty acids were ++less li3ely to /e diagnosed with endometriosis

when compared to the group that ate the lowest amount1

The unhealthy fats such as trans fats increased the ris3 of developing

endometriosis /y nearly =, percent1 Most of the study reviewed had findings were similar in that women with the lowest fifth of longchain omega. fatty acid

consumption were less li3ely to /e diagnosed with endometriosis1 2n addition*

those in the highest &uintile of transunsaturated fat inta3e were more li3ely to /e

diagnosed with endometriosis1 #lso many studies indicate that [email protected] mighthave positive influence on pain1

ndometriosis and 2erbs # total of . formulas and her/s included in these formulas were used across

many studies to treat endometriosis1 The formula which used with greatestfre&uency was "ui Lhi Fu )ing Wan and others included Tao He Cheng 7i Tang

and Shao Fu Lhu !u Tang with similar positive outcome1

2n study ? ADong et al* +,,. o/served that "ui Lhi Fu )ing Capsules plays

an important role in the regression of endometriotic implants /y immunological


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regulation in the rat model1 2n this study* they used the rat model of surgically induced endometriosis to test the effect of the immunological regulation of "ui

Lhi Fu )ing Capsules1 This formula has /een used clinically for the therapy of endometriosis for a long time and the clinical date has shown the protective effects

on women endometriosis as well1 2n this study* the volume of endometriosis wassignificantly reduced in "ui Lhi Fu )ing Capsule treatment group1

ndometriosis 4&estern ApproachesMedical treatment of endometriosis relies on drugs that suppress ovarian

steroids and induce hypoestrogenic state that causes atrophy of ectopic

endometrium1 "onadotrophinreleasing hormone A"n5H anaolgues* Dana0ol*$rogestogens and estrogenprogestin com/ination have all proven effective in

relieving pain and reducing the e4tent of endometriotic implants1 However*symptoms often recur after discontinuation of therapy and hypoestrogenism

related side effects limit longterm use of most medications1 Furthermore* thesetherapies are of limited value in patients with a desire to /ecome pregnant /ecause

they inhi/it ovulation1

Study -- AHarel* +,,+ compared the effectiveness of nonsteroidal anti

inflammatory drugs ANS#2Ds and oral contraceptive pills com/ined with estrogen

and progestin to treat dysmenorrhea which is most commonly lin3ed with

endometriosis1 This study suggested that most common pharmacologic treatmentfor dysmenorrhea is dose of NS#2Ds and it should /e used Atypically twice the

regular dose as initial treatment for dysmenorrhea in adolescents followed /y a

regular dose until symptoms a/ate1 #dolescents with symptoms that do not respondto treatment with NS#2Ds for three menstrual periods should /e offered com/ined


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estrogen@ progestin oral contraceptive pills for three menstrual cycles1 #dolescents

with dysmenorrhea who do not respond to this treatment should /e evaluated for

secondary causes of dysmenorrhea1

Study +=, Aestrogen synthetase in the

endometrium of women with the endometriosis and impaired inactivation of

estrogen may lead to elevated local estrogen concentrations which leads to

endometriosis1


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factors that are salient in developing a traditional chinese medicine nutritional manual for women...

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