Pelvic inflammation refers to any inflammation of the pelvic organs including metro-endometritis, salpingitis, ovaritis, pelvioperitonitis and inflammation of pelvic connective tissues. It may occur in one area or in several simultaneously. There is not a disease with the nomenclature as pelvic inflammation in traditional Chinese medicine, but the disorder may be seen under the categories of "daixia syndrome," "heat attacking the blood chamber," "abdominal mass in women" and "dysmenorrhea." Pelvic inflammation may be classified into acute and chronic cases, which is often seen in married women, while pelvic tuberculous infection is usually seen in unmarried women.

Etiology and Pathogenesis

The invasion of pathogenic agents into the uterus is considered the common cause of this disorder, which results from sexual indulgence in a women with a weak constitution or weakness of the Bao meridian during menstruation or after childbirth.

Syndrome Differentiation and Treatment

A. Acute pelvic inflammation

Manifestations: Acute onset of fever, chilliness, bitter taste in the mouth, dryness of throat, distending pain and tenderness of the lower abdomen, lumbago, leucorrhagia with yellow, viscous and foul discharge, constipation, oliguria with yellow urine, red tongue with yellow or greasy coating and wiry and rapid pulse. Gynecological examination reveals tenderness over the cervix uteri, corpus uteri and both sides of uterine appendages, as well as thickening or mass formation of the appendages. White cell count is increased in the neutrophils.

Therapeutic principles: Clear away heat and toxic materials, activate blood circulation, and eliminate blood stasis.

Prescription: The Decoction of Clearing Away Heat and Eliminating Toxic Materials

 Flos Lonicerae 15 g
Fructus Forsythiae 15 g
Caulis Sargentodoxae 15 g
Cortex Phellodendri 10 g
Radix Paeoniae Rubra 10 g
Herba Houttuyniae 15 g
Herba Hedyotis Diffusae 15 g
Radix Scutellariae 10 g
Radix et Rhizoma Rhei 10 g
Radix Glycyrrhizae 10 g
Cortex Moutan Radicis 10 g

Remarks: For cases with qi stagnation and abdominal distention, add Fructus Aurantii Immaturus (15 g) and Fructus Toosendan. For cases with loose and foul stools, add Radix Puerariae (10 g), Rhizoma Coptidis (6 g) and omit Radix et Rhizoma Rhei. For cases with severe abdominal pain, add Olibanum (10 g) and Myrrha (10 g). For cases with pelvic abscess, add Herba Patriniae (15 g) and Semen Coicis (15 g). For cases with mass formation due to retention of heat-toxin and blood stasis, add Radix Paeoniae Rubra (10 g), Semen Persicae (10 g), Cortex Moutan Radicis (10 g), Fructus Toosendan (10 g), Herba Hedyotis Diffusae (15 g), Rhizoma Paridis (15 g), Rhizoma Sparganii (10 g), Rhizoma Zedoariae (10 g), Herba Salviae Chinensis (12 g) and Radix Salviae Miltiorrhizae (20 g) to clear away heat, eliminate toxic materials, remove blood stasis and disperse the mass.

B. Chronic pelvic inflammation

(a) Dampness-heat and blood-stasis syndrome

Manifestations: Low fever, bearing-down sensation and distending pain in the lower abdomen, lumbago aggravated by stress and during menstruation, prolongation of menstrual period or menorrhagia, leucorrhagia with yellow and foul discharge, dry or loose stool, oliguria with yellow urine, red tongue with yellow and greasy coating and wiry and rapid pulse. Gynecological exam shows limited passive movement of the uterus, tenderness and thickening and mass formation of the appendages.

Therapeutic principles: Clear away heat and dampness, activate blood circulation, and eliminate blood stasis.

Prescription:

Radix Angelicae Sinensis 10 g
Radix Paeoniae Rubra 10 g
Rhizoma Smilacis Glabrae 15 g
Semen Coicis 15 g
Herba Patriniae 15 g
Rhizoma Zedoariae 10 g
Fructus Toosendan 10 g
Semen Persicae 10 g
Rhizoma Dioscoreae Bulbiferae 10 g
Semen Litchi 12 g
Radix Glycyrrhizae 10 g
Cortex Ailanthi 15 g

Remarks: For cases with severe abdominal pain, add Olibanum (10 g) and Myrrha (10 g). For cases with obstruction of the uterine tube, add Fructus Liquidambaris (12 g), Squama Manitis (15 g) and Spina Gleditsiae (10 g).

(b) Cold-dampness and blood-stasis syndrome

Manifestations: Cold pain and distention in the lower abdomen during menstruation which can be relieved by warmth, lumbago, delayed menstrual cycle and oligomenorrhea with dull-colored menses containing clots, leucorrhagia with thin and odorous discharge, tongue with petechiae and white greasy coating and deep and slow pulse.

Therapeutic principles: Warm meridians, expel cold, dry dampness, and eliminate blood stasis.

Prescription:

Ramulus Cinnamomi 10 g
Poria 10 g
Rhizoma Atractylodis 15 g
Radix Linderae 10 g
Semen Trigonellae 15 g
Cornu Cervi Degelatinatum 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Rubra 10 g
Semen Persicae 10 g
Rhizoma Zedoariae 10 g
Radix Saussureae Lappae 10 g

Remarks: For cases with marked cold pain in the lower abdomen, change Ramulus Cinnamomi to Cortex Cinnamomi (10 g). For cases with severe abdominal distention, add Semen Litchi (12 g). For cases with qi deficiency, add Radix Astragali (30 g). For cases with mass formation, add Rhizoma Sparganii (10 g) and Herba Salviae Chinensis (10 g).

(c) Pelvic tuberculous infection

Manifestations: Insidious onset of symptoms which may be neglected in mild cases; in serious cases, besides infertility, there may be irregular menstruation, oligomenorrhea or even amenorrhea, bearing-down pain in the lower abdomen, lumbago, poor appetite, fatigue, afternoon fever, feverish sensation over the palms and soles, red tongue without coating and thready and rapid pulse.

Therapeutic principles: Tonify yin, clear away heat, regulate qi circulation, and eliminate blood stasis.

Prescription: The Modified Decoction of Six Drugs Containing Rehmanniae Praeparata

Radix Rehmanniae 15 g
Radix Rehmanniae Praeparata 15 g
Poria 15 g
Cortex Moutan Radicis 10 g
Rhizoma Dioscoreae 15 g
Fructus Corni 10 g
Rhizoma Alismatis 10 g
Radix Stellariae 10 g
Rhizoma Picrorrhizae 6 g
Radix Stemonae 15 g
Carapax Trionycis 15 g
Radix Scutellariae 10 g
Radix Salviae Miltiorrhizae 20 g
Radix Paeoniae Alba 15 g

Remarks: For cases with oligomenorrhea, add Fructus Lycii (15 g), Fructus Leonuri (15 g) and Caulis Spatholobi (15 g) to tonify the liver and kidneys and benefit essence and blood. For cases with abdominal mass, add Radix Paeoniae Rubra (10 g), Rhizoma Sparganii (10 g) and Rhizoma Zedoariae (10 g) to eliminate blood stasis and disperse the mass.

Copyright 1995 Hopkins Technology