Introduction: 5 pairs of empirical medicinal combinations for treating endometriosis.

Rhubarb, Peach Kernel

【Main Indications and Applications】Activating blood stasis and unblocking the fu organs, used in the treatment of endometriosis.

【Experience and Insights】Experience of Wang Dazeng

The *Compendium of Materia Medica* states that rhubarb is bitter and potent in descending, clearing and unblocking the fu organs, eliminating the old and promoting the new, with effects of dispelling blood stasis and breaking up masses and accumulations. Peach kernel is bitter and neutral, breaking blood stasis and dispelling blood stasis, moistening dryness and lubricating the intestines. The *Ben Jing Feng Yuan* states, "Peach kernel is a specific herb for blood stasis and blood obstruction, using bitterness to drain stagnant blood and sweetness to generate new blood..."

Master Wang believes that endometriosis is located in the pelvic cavity, belonging to the lower jiao. Adhesions and mass formation in the pelvic tissues cause qi stagnation and blood stasis, leading to impaired flow of fu qi in the lower jiao. Pain arises from obstruction. According to the TCM principle that "blood stasis should be transformed, and fu qi should be unblocked," he created the Neiyi No. 1 formula, composed of 6 grams of vinegar-processed raw rhubarb, 9 grams of peach kernel, 12 grams of turtle shell, and 2 grams of amber powder, among others, made into tablets to activate blood stasis and unblock the fu organs.

Dr. Wang is clinically skilled in using rhubarb as the main herb combined with peach kernel. Rhubarb, when paired with peach kernel, specifically enters the blood aspect, working together to break blood stasis and expel stagnant heat, thereby significantly improving endometriosis.

Case: Patient, female, 32 years old, initial consultation on February 12, 1998.

Complains of dysmenorrhea for several years. Last menstrual period was on January 17, with scanty flow and dark red color. Severe lower abdominal distension and pain, anal tenesmus. Usually constipated. Tongue edges show purple stasis, pulse is wiry.

Gynecological examination: Uterus normal in size. Mass-like sensation in the posterior fornix vaginal-rectal septum, larger on the right side than the left, no tenderness.

Ultrasound shows: uterus 4.7cm × 40cm × 35cm, left hypoechoic area 4.9cm × 4.0cm × 2.0cm, right hypoechoic area 5.7cm × 4.5cm × 3.8cm, both with visible echogenic bands, positive for fluid accumulation.

The syndrome belongs to qi stagnation and blood stasis, with obstruction of fu-organ qi. The treatment principle is to activate blood circulation and resolve stasis, unblock the fu organs, and regulate qi.

Prescription: Peach Kernel 9g, Prepared Rhubarb 9g, Salvia Root 8g, Red Peony Root 9g, Costus Root 9g, Corydalis Tuber 9g, Chinese Angelica Root 9g, Szechuan Lovage Rhizome 9g, Ground Beetle 9g, Myrrh 9g. Used in combination with Neiyi No. 1 Formula.

Follow-up after 2 months of administration: Menstrual onset still presents with lower abdominal distension and pain, but tolerable; anal bearing-down pain has decreased.

After continuing to take the modified prescription for 4 months, the follow-up visit showed: no abdominal pain during menstruation, and anal discomfort had resolved. Ultrasound reexamination: uterus measured 5.5cm × 4.5cm × 2.5cm; a 2.9cm × 2.0cm hypoechoic area was seen in the right ovary measuring 3.2cm × 2.7cm, and a 4.3cm × 1.6cm hypoechoic area with septations was seen on the left side. The cysts had reduced in size compared to before.

—Wang Juhua. Selected Clinical Herb Pairs in Gynecology by Wang Dazeng, Industrial and Mining Medical Health, 1999;15(2):102

Leech, Ground Beetle

【Indications and Applications】Used for adnexal masses in pelvic inflammatory disease, as well as masses and dysmenorrhea in endometriosis.

【Experience Insights】You Zhaoling's Experience

Leech, with its salty nature, can move and soften hardness to dissipate masses, and its bitter nature can descend and purge. It enters the liver meridian and the blood aspect, excelling at breaking blood stasis, promoting menstruation, and resolving masses. Ground beetle, with its salty and cold nature, enters the blood aspect, excelling at breaking blood stasis, dissipating masses, and resolving masses. Therefore, when these two herbs are combined in the blood aspect, their ability to break blood stasis and dissipate masses is greatly enhanced.

— Yin Xianghua, Kuang Jilin, Liu Wen'e. A Summary of Professor You Zhaoling's Experience in Skillfully Using Herb Pairs to Treat Chronic Pelvic Inflammatory Disease, Journal of Traditional Chinese Medicine, 2005;23(9):1572

Angelica pubescens, Cynanchum paniculatum

【Indications and Applications】Endometriosis.

【Clinical Experience】Experience of Cao Lingxian

Du Huo (Radix Angelicae Pubescentis) is a medicinal herb for dispelling wind-dampness, enters the kidney meridian, and functions to dispel wind, overcome dampness, unblock impediment, and relieve pain. It is mainly used for wind, cold, and damp impediments that predominantly affect the lower half of the body. Xu Changqing (Radix Cynanchi Paniculati) functions to dispel wind and relieve pain, as well as detoxify and reduce swelling.

From the perspective of the local lesions of endometriosis, there are inflammatory reactions such as edema and adhesions. Professor Cao uses these two herbs with the aim of dispelling wind and overcoming dampness, thereby enhancing the analgesic effect. The clinical application yields remarkably excellent results.

——"Famous Doctors' Legacy: Selected Papers of Academic Successors from Shanghai's 'National Third Batch of Master-Apprentice Program'"

Salvia chinensis (Shijianchuan), Euonymus alatus (Gui jian yu)

【Main Indications】Promoting blood circulation and resolving masses.

【Experience Insights】Experience of Cai Xiaosun

The combination of these two herbs promotes blood circulation and resolves masses. It can be used for ovarian cysts, uterine fibroids, endometriosis, adenomyosis, etc.

—— *Inheritance of Renowned Physicians: Selected Papers of Academic Successors from the "Third National Master-Apprentice Program" in Shanghai*

Ground beetle, centipede, scorpion

【Indications and Applications】Activates blood circulation, breaks stasis, and dissipates masses.

【Experience Insights】Yang Zongmeng's Experience

The three herbs are dried, ground into fine powder, and encapsulated. Elder Yang refers to this as the "Three Insects Resolving Mass Capsule." Clinically, it is used for chronic pelvic inflammatory disease, inflammatory pelvic masses, old ectopic pregnancies, unruptured ectopic pregnancies, endometriosis, and other conditions. In traditional Chinese medicine, it is indicated for syndromes characterized by qi stagnation and blood stasis, as well as dampness accumulation and phlegm coagulation, with reliable efficacy.

Insect-based drugs promote blood circulation and break up stasis, searching through the meridians and clearing the collaterals. The formation of the aforementioned conditions is the result of prolonged accumulation over months and years, leading to chronic illness, stagnation of qi, deep-seated blood stasis, and congealed phlegm-dampness that solidifies into masses. Ordinary medications are often ineffective in treating such conditions, and only insect-based drugs are capable of undertaking this task.

Therefore, Elder Yang said, "Once a mass has formed, it is deeply rooted and firmly established. Using insect-based medicines to break through the hard mass is like splitting bamboo with a sharp knife—swift and unstoppable, akin to the wind sweeping away scattered clouds or sunlight piercing through dark haze."

If the disease course is prolonged and the body's vital energy is depleted, yet the use of such medicines is unavoidable, they must be combined with tonifying agents to support the body's vitality. One must never violate the principle of "depleting the already deficient."