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Introduction:
The traditional Chinese medicine culture has a long history. With proper usage, traditional Chinese medicine can show immediate effectiveness in treating illnesses. Professor Li Xiaobin has been practicing medicine for over 30 years, specializing in using classical and ancient formulas to treat gynecological diseases. Leading the gynecology team at Ersha Island Hospital, he emphasizes the inheritance and innovation of traditional Chinese medicine, applying classical and ancient formulas to treat common gynecological diseases, difficult diseases, and postoperative recovery with outstanding results. Hence, this column is initiated to share his experiences with everyone.
Xiaolin, 28 years old, has been married for over 2 years. Usually, her menstruation is regular, but she has not conceived. In April 2023, she was diagnosed with “blocked fallopian tubes” at a major hospital and underwent laparoscopic surgery, revealing bilateral blocked fallopian tubes. She claimed that the tubes were successfully unblocked. Postoperative pathology showed proliferative endometrium. Immunohistochemistry revealed isolated CD138-positive cells in the endometrial stroma, with approximately 2 hotspots per high power field. She only took anti-inflammatory drugs for a week and did not continue with further treatment.
However, after a year of not using contraception post-surgery, there was still no progress. She started experiencing external genital itching, which was not alleviated by repeated external washing with medications and traditional Chinese internal consumption. In the past 2 months, she also had lower back pain after menstruation.
Thus, on March 25, 2024, she sought treatment from my clinic through a friend’s recommendation. Her menstrual cycle was approximately 30 days with 7 days of clean bleeding, moderate flow, dark-red color with blood clots, lower abdominal distension, lower back pain after menstruation, breast tenderness premenstrually, and normal vaginal discharge. The last menstruation was on March 15.
One
Initial Consultation (March 25, 2024)
During the consultation, she complained of external genital itching, occasional anal itching, wandering stabbing pain in the lower abdomen, feeling cold most of the time, cold hands and feet, easily fatigued, normal appetite, light sleep, easy awakening, and loose stools. Her tongue was pale with teeth marks, thin white coating, tortuous veins at the tongue base, and thin string-like pulse.
Gynecological examination: external genitals reddish, vagina normal, moderate amount of white discharge, thick consistency, slight ectopy of the cervix, anterior position of the uterus with good mobility, no tenderness, slightly thickened right adnexa with slight tenderness, left adnexa normal. AMH test on April 4, 2023: 4.96, sex hormone panel on December 2, 2023: FSH: 9.36, LH: 7.6, E2: 30.6, PRL: 17.6, T: 0.27, P: 0.293.
Diagnosis: 1. Female pelvic inflammatory disease 2. Salpingitis 3. Endometritis
Chinese medicine differentiation: Infertility, leukorrhea (liver stagnation and spleen deficiency, dampness and blood stasis).
Cervical swab for Chlamydia and Mycoplasma; routine examination of vaginal discharge: cleanliness level III, epithelial cells 2+, rods +, white blood cells 2+, some miscellaneous bacteria, bacterial vaginosis (-).
Treatment aimed at soothing the liver, invigorating the spleen, resolving dampness, and promoting circulation. Proposed formula: Wan Dai Tang combined with Danggui Shaoyao San with modifications for 7 doses; Chuanxiong 10g, Yanzexie 15g, Radix Paeoniae Alba 15g, Poria 15g, Angelica Sinensis 10g, Atractylodes Macrocephala 25g, Dioscorea Opposita 25g, Atractylodes Lancea 10g, Desmodium Styracifolium 15g, Resina Ptychotis 5g, Clematis Chinensis 15g, Ilex Pubescens 20g. Prescription drug Fuke Qianjin pill, external medication: Sihuang powder applied to the lower abdomen, Sophora flavescens wash for sitz bath, washing the external genitals, and anal region.
Two
Second consultation (April 1, 2024)
The itching in the external genitals and anus improved after taking the medicine, with occasional scattered stabbing pain in the lower abdomen. She reported a low-grade fever of 37.8°C for the past 2 days, with general body aches, chest fullness, headache, dry and sore throat, phlegm, normal appetite, improved sleep, and loose stools. Pale tongue with teeth marks, thin white coating, tortuous veins at the tongue base, and thin string-like pulse.
Chlamydia and Mycoplasma tests were negative on March 25, 2024. Considering it as wind-cold invasion with external wind-dampness, prescribed Qianghuo Shengshi Decoction with modifications for 3 doses to first dispel wind-dampness, resolve cold to relieve fever, and alleviate pain. Advised to continue the formula if symptoms improved (remove Clematis Chinensis, add 10g of Rhizoma Notopterygii, 15g of Pilose Asiabell Root), for 7 doses.
Three
Third consultation (April 15, 2024)
Menses have not arrived yet; recent sexual activity with obvious alleviation of external genital and anal itching, occasional scattered abdominal pain, persistent lower back pain, excessive tearing, poor sleep, loose stools, urinating 4-5 times at night. Pale tongue with teeth marks, thin white coating, tortuous veins at the tongue base, and thin string-like pulse. Advised the patient to self-check for pregnancy test if menstrual delay exceeds 3 days.
Currently in the luteal phase, pregnancy not ruled out. Treatment aimed at nourishing the kidneys and consolidating essence; proposed formula Bawei Shenqi Pills with modifications: Yanzexie 15g, Dioscorea Opposita 15g, Cornus Officinalis 15g, Rehmannia Glutinosa 30g, Poria 15g, Paeonia Lactiflora 10g, Cortex Cinnamomi 5g, Eclipta Prostrata (pre-decoction) 10g, Lycium Chinense 10g, Semen Plantaginis 10g.
Four
Fourth consultation (April 22, 2024)
The patient happily informed us of a positive self-reported pregnancy test result. Early pregnancy panel on April 20: HCG: 5748.35 IU/L, P: 59.62 nmol/L, E2: 938 pg/ml. Abdominal ultrasound on April 21 at an external hospital showed intrauterine pregnancy equivalent to 5-week gestation, with no obvious embryonic echo or fetal heartbeats. Pelvic effusion observed. Combination of traditional Chinese and Western medicine prescribed for fetal safety treatment. Follow-up indicated the patient’s uneventful pregnancy, and she was referred to the obstetrics department for routine antenatal care.
Fallopian Tube Blockage
The majority of fallopian tube blockages are caused by infections, most commonly pelvic inflammatory diseases.
Pelvic inflammatory diseases refer to infectious diseases occurring in the female reproductive tract, including endometritis, salpingitis, and pelvic peritonitis. Common symptoms include recurrent lower abdominal pain, soreness and pain in the lumbosacral region, irregular menstruation, increased vaginal discharge, pelvic mass, and severe cases can lead to infertility.
The causative agents of pelvic inflammatory diseases can be divided into exogenous and endogenous pathogens. Common exogenous pathogens include Chlamydia trachomatis and Neisseria gonorrhoeae, often seen in infections due to unhygienic sexual practices. Endogenous pathogens are normal vaginal microbiota that, under certain conditions, could cause pelvic inflammation, and infections in other areas may also spread to the pelvis, triggering inflammation, such as appendicitis, pulmonary tuberculosis, etc. Therefore, when receiving a patient, it is essential to first rule out infections caused by external pathogens and promptly treat if detected.
Fallopian tube blockage and pelvic inflammatory diseases fall under the categories of “abdominal pain in women,” “leucorrhea disease,” “zhengjia,” “infertility” in traditional Chinese medicine. These are generally believed to be related to dampness, stasis, qi stagnation, liver and kidney deficiency. Common clinical differentiations are qi stagnation and blood stasis syndrome, cold-dampness blood stasis obstruction syndrome, qi deficiency blood stasis syndrome, blood stasis kidney deficiency syndrome, etc.
Commentary
In this case, the patient has a history of pelvic inflammatory disease, fallopian tube blockage, and unblocking, with symptoms of lower abdominal pain and lower back pain after menstruation. Combining the gynecological examination, the diagnosis was “female pelvic inflammatory disease,” even though the fallopian tubes were unblocked surgically, the lack of follow-up treatment prevented improvement in the pelvic and uterine environment, making conception a challenge. Based on the patient’s symptoms, the four consultations, and pattern identification, liver stagnation and spleen deficiency, dampness, and blood stasis were identified, and treatment was focused on Danggui Shaoyao San combined with Wan Dai Tang. Danggui Shaoyao San is from the “Synopsis of Prescriptions of the Golden Chamber,” where it is stated: “For women with various abdominal pains, use Danggui Shaoyao San as the main treatment,” commonly used for treating pregnancy abdominal pain, pelvic inflammatory diseases, dysmenorrhea, infertility, endometritis, characterized by liver-spleen imbalance, stagnant qi, and blood stasis.
The original formula consists of 6 herbs: Angelica Sinensis, Paeonia Albiflora, Atractylodes Macrocephala, Alisma Plantago-aquatica, Poria Cocos, and Ligusticum Chuanxiong, with Angelica Sinensis nourishing and invigorating the blood circulation, Paeonia Albiflora nourishing the blood and soothing the liver to relieve pain, and it works together for blood circulation and pain relief; Atractylodes Macrocephala, Poria Cocos invigorate the spleen and resolve dampness aiding in the production and transformation of qi and blood, adjustment in the middle energizing then removing damp turbidity. In the initial consultation, replacing Paeonia Albiflora with Paeonia Corailifera, alleviating pain promptly while enhancing blood circulation, adding Dioscorea Opposita, Atractylodes Rhizome, Plantago Asiatica Seed, Clematis Chinensis matched with the initial formula “Wan Dai Tang”, promoting the spleen’s clean qi to reduce damp turbidity; Verbena Officinalis is an empirical drug, and modern pharmacological research has shown that it has a clear antibacterial and anti-inflammatory effect, commonly used in the treatment of pelvic inflammatory diseases. Centipeda minima promotes blood circulation and relieves pain.
The herbal formula targets the disease mechanisms, thus showing swift effectiveness. After enduring a year of ineffective surgical and conventional medical treatment, the ailment was resolved within a month, illustrating the advantages of using classical formulas and integrated traditional Chinese medicine in treating tubal infertility. It also demonstrates the surprise of classical formula treatment leading to recovery.
Department Introduction
Department Introduction
Ersha Island Hospital Department of Gynecology at Guangdong Provincial Hospital of Chinese Medicine is a key national specialty, specializing in menopause, gynecological tumors, reproductive endocrinology, menstrual regulation, and pelvic floor disorders. It offers comprehensive services including chronic management of endometriosis, polycystic ovary syndrome, menopausal syndrome, preventive healthcare, and clinical treatment.
The department has an excellent team of professionals with high medical ethics, superb medical skills, and rich clinical experience. It performs challenging and high-risk fourth-level minimally invasive gynecological surgeries, such as laparoscopic extensive uterine resection, staged surgery for ovarian cancer, retroperitoneal lymph node dissection beside the abdominal aorta, laparoscopic uterine/vaginal sacral fixation surgery, total pelvic floor reconstruction surgery, mid-urethral tension-free suspension surgery, all reaching advanced domestic levels. The department’s single-incision laparoscopic surgery has received unanimous praise from patients due to its small incision, rapid recovery, and aesthetic benefits.
During the perioperative period, a combination of traditional Chinese and Western medicine methods are used to adjust and treat according to the patient’s constitution, including TCM syndrome differentiation treatment, integrated use of acupuncture and herbal medicine, dietary therapy, psychological counseling, and postoperative patients can recover quickly, significantly reduce postoperative complications, and prevent disease recurrence.
Expert Profile
Xiaoyun Wang
National leader in traditional Chinese medicine talent “Qihuang Scholar,” renowned TCM practitioner in Guangdong Province, doctoral supervisor, postdoctoral co-supervisor. The first generation academic heir to Professor Lu Zhizheng, a “Master of Traditional Chinese Medicine”, guidance teacher for the fifth and seventh batches of national old TCM experts, guidance teacher for the national famous old TCM physician inheritance studio, leading figure in the gynecology discipline of Guangzhou University of Chinese Medicine, academic leader in the big gynecology field of Guangdong Provincial Hospital of Chinese Medicine. President of the Gynecology Branch of the China Ethnic Medicine Association.
Specialty: Treatment of gynecological reproductive endocrine diseases such as premature ovarian failure, menopausal syndrome, infertility, recurrent miscarriage, depression, severe sleep disorders, recurrent endometriosis, and late-stage gynecological malignant tumors with traditional Chinese medicine treatment emphasizing combined acupuncture and medication, holistic treatment.
Consultation time: Monday, Wednesday afternoon
Location: Ersha Island Hospital of Guangdong Provincial Hospital of Chinese Medicine
Expert Profile
Xiaobin Li
Chief TCM physician, master’s supervisor, senior grade II, distinguished middle-aged TCM expert of the Chinese Academy of Sciences, renowned physician at Guangdong Provincial Hospital of Chinese Medicine, famous physician in Lingnan, third edition of Guangzhou’s Good Doctor, excellent clinical talent of Guangdong Province, top talent at Guangdong Provincial Hospital of Chinese Medicine. Director and committee chairman of the sixth Obstetrics and Gynecology Professional Committee of the Guangdong Society of Integrated Chinese and Western Medicine, vice-chairman of the Gynecology Professional Committee of the China Ethnic Medicine Association.
Specialty: Integrated Chinese and Western medicine treatment of infertility, menstrual disorders, gynecological tumors, and gynecological endocrine diseases. Abdominal and vaginal surgeries for gynecological tumors, hysteroscopic and laparoscopic minimally invasive surgery. Complete resection of malignant tumor, pelvic lymphadenectomy, total pelvic reconstruction surgery for malignant tumors.
Consultation time: Monday, Wednesday, Thursday afternoon
Location: Ersha Island Hospital of Guangdong Provincial Hospital of Chinese Medicine
Author Profile
Yijun Yang
Physician at Gusheng Tang Haizhu Baogang Branch, master’s graduate of Guangzhou University of Chinese Medicine, supervised by Professor Guo Xiquan, fortunate to have followed many gynecological experts (such as Professor Wang Xiaoyun, Professor Li Xiaobin, Professor Huang Jianling). Advocates for integrating acupuncture with Chinese medicine, treating the body and mind simultaneously, and focuses on achieving comprehensive treatment through various methods guided by efficacy. Specializes in integrated acupuncture and traditional Chinese medicine for gynecological diseases (such as menstrual disorders, dysmenorrhea, polycystic ovary syndrome, pelvic inflammatory diseases), common internal medicine diseases (such as colds, indigestion, urticaria, herpes zoster, etc.).
Contributed by: Ersha Island Hospital of Guangdong Provincial Hospital of Chinese Medicine, Yijun Yang and Xiaobin Li
Executive Editor: Yunqi Li
Proofreading: Junfei Wang
Responsible Editor: Jiajia Chen
