Rectal endometriosis

　　Endometriosis is a benign lesion but has the ability to metastasize and implant remotely. Therefore, for many years, many scholars have conducted a large amount of research on the etiology of this disease and have proposed the following theories. The etiology, pathogenesis, and pathological changes of endometriosis are described as follows.

　　First, Etiology

　　1. Theory of Transuterine Migration:As early as 1921, Sampson first proposed the idea of transuterine migration, believing that during menstruation, the shed endometrial fragments can flow back into the fallopian tubes with menstrual blood, then overflow from the fimbriae, transplant onto the surface of tissues such as the peritoneum of the pelvis and ovary, continue to grow, and finally develop into endometriosis. Subsequently, some people have observed menstrual blood in the pelvis during laparoscopic examination or cesarean section, and found endometrial cells in it, and some have done pathological examination to confirm. However, the theory of retrograde menstruation has its limitations, which can only explain the pathogenesis of pelvic endometriosis, but cannot explain the occurrence of endometriosis in retroperitoneal lymph tissue and other gastrointestinal, chest, arm, etc., outside the pelvis.

　　2. Benign Metastasis (Through Lymph and Veins) Theory:So-called benign metastasis refers to the accidental entry of endometrial debris into lymphatic or venous vessels and spread to sites such as retroperitoneal lymph nodes, ureters, lungs, pleura, gastrointestinal tract, lower limbs, hands, arms, etc. In fact, some people have found endometrial tissue in pelvic lymph nodes and veins.

　　3. Theory of Serosal Epithelial Metaplasia:Some scholars have proposed the theory of metaplasia of serosal epithelium, believing that certain tissues in the human body, such as the germinal epithelium on the surface of the ovary, the peritoneum of the pelvis, the umbilicus, inguinal hernia sac, and the vaginal rectal septum, all originate from serosal epithelium and have the potential for metaplasia. Under appropriate conditions, they can metamorphose into endometrium or tissues very similar to endometrium.

　　4. Genetic Theory:Endometriosis is likely a polygenic and multifactorial genetic disease.

　　5. Immune Theory:The implantation or rejection of ectopic uterine fragments is related to the body's immune function. It has been proven that there is a decrease in cellular immune function in rhesus monkeys or humans with ectopic endometriosis. Endometrial antigens mainly exist in the cytoplasm of endometrial glandular epithelial cells, and antibodies can be detected in the serum of patients with ectopic endometriosis.

　　6. Iatrogenic (Direct Transplantation):It refers to the accidental implantation of endometrial tissue by medical personnel during surgery, which can later produce endometriosis within the scar tissue of the incision.

　　Second, Pathogenesis

　　1. Distribution:Endometriosis has a wide distribution, commonly affecting the peritoneum and pelvic organs. To date, endometriosis has not been found in the spleen, which may be related to the spleen's stronger immunological function compared to other abdominal organs.

　　The rectouterine pouch is the lowest part of the pelvis and a common site for endometriosis, hence it is not uncommon to have endometriosis in the rectum and rectum.

　　2. Pathology

　　(1) General Morphology:The lesions of endometriosis often appear as superficial purple-blue spots, resembling 'gunshot burns'.

　　In the lesion, the ovary may present as a 'chocolate cyst' or 'tar-like cyst', closely adherent to the surrounding tissues. Severe patients can form an 'frozen pelvis' of endometriosis like chronic pelvic inflammatory disease.

　　After menopause, unless there is a continuous endogenous or exogenous source of estrogen, the lesion gradually regresses. During pregnancy or hormone treatment, the ectopic endometrium may show decidual-like changes, with the lesion becoming edematous and slightly gelatinous, resembling malignant lesions. Biopsy should be performed to confirm the diagnosis when found.

　　Occasionally, the lesion may show atypical changes, such as: ① a white opaque area of the peritoneum, which may not thicken; ② a red flame-like lesion of the peritoneum, often protruding above the peritoneum; ③ adenomatous hyperplasia on the peritoneal surface; ④ a circular defect in the peritoneum; ⑤ adhesions under the ovary, with hyperpigmented lesions between the peritoneum below the ovary and the ovarian fossa. These conditions are often found during laparoscopic examination, and their diagnostic rate for endometriosis confirmed by biopsy is 45% to 81%.

　　(2) Histological morphology:Under the microscope, the tissue sections of endometriosis can be seen: ① endometrial glands and stroma; ② evidence of bleeding, i.e., red blood cells, macrophages containing a large amount of hemosiderin, and hemosiderin. There are often a large number of inflammatory cells, edema changes, and fibrous connective tissue around the lesion.

　　The findings under the microscope are often related to the location of the lesion, the time of onset, and the influence of ovarian hormones. The ectopic endometrium is also affected by ovarian hormones, but there is no periodic change.

　　3. The structure and function of the malignant ectopic endometrium and the normal endometrium are basically the same:The probability of malignant transformation should be consistent, but the ectopic endometrium rarely undergoes malignant transformation.

　　Patients with rectal endometriosis can have complications such as infertility, periodic bladder stimulation symptoms, and periodic rectal stimulation symptoms. The specific complications are described as follows.

　　1. Infertility:Patients with endometriosis often have infertility. According to reports from Tianjin and Shanghai, primary infertility accounts for 41.5-43.3%, and secondary infertility accounts for 46.6-47.3%. Pelvic endometriosis can often cause adhesions around the fallopian tubes, affecting oocyte retrieval or leading to lumen obstruction. Infertility can also be caused by factors such as poor follicle development or ovulatory disorders.

　　2. Periodic bladder stimulation symptoms:When the endometriotic lesion involves the peritoneal fold or invades the muscle layer of the bladder, symptoms such as urgency and frequency of urination during menstruation may occur simultaneously. If the lesion invades the bladder mucosa (bladder endometriosis), there may be periodic hematuria and pain.

　　3. Periodic rectal stimulation symptoms:Rectum, anal, and perineal坠胀,坠痛,里急后重, and increased frequency of bowel movements. As the lesion gradually worsens, the symptoms become more obvious, while the symptoms after menstruation disappear.

　　Rectal endometriosis has common symptoms of endometriosis and intestinal symptoms.

　　1. Abnormal Menstruation

　　About 80% of patients have menstrual abnormalities, mainly manifested as dysmenorrhea, excessive menstrual bleeding, or irregular menstruation.

　　1. Dysmenorrhea: Secondary dysmenorrhea, that is, dysmenorrhea appears several years after menarche, worsening year by year, and can radiate to the vagina, perineum, anus, or legs. The pain is most severe one day before menstruation and completely disappears after menstruation. The pain is mainly caused by the edema, bleeding, stimulation, or traction of the surrounding tissues of the ectopic endometrium before menstruation.

　　2. Excessive menstrual blood loss or irregular menstruation is related to the invasion and destruction of the endometrium in the ovarian stroma, severe adhesions around the ovary that prevent ovulation, and disorders of ovarian hormone secretion.

　　II. Dyspareunia

　　The symptoms are more obvious before the menstrual period, mostly located in the deep part of the vagina. Due to this, patients may refuse sexual life and have a decreased chance of conception. This may be related to the movement of the uterus stimulated by sexual intercourse, which causes congestion of the pelvic peritoneum.

　　III. Infertility

　　30% to 50% of patients have primary or secondary infertility, and 30% to 50% of infertile patients have ectopic lesions seen during laparoscopic examination. Infertility is related to factors such as tubal obstruction, ovulatory disorders, gamete or fertilized ovum transport disorders, ovarian tissue compression, insufficient luteal function, unruptured follicle luteinization syndrome, follicle maturation and oocyte fertilization disorders, implantation disorders, and the presence of harmful fallopian tubes and peritoneal microenvironment.

　　IV. Intestinal symptoms

　　In the early stages of involvement of the rectum and colon, symptoms such as defecation pain, abdominal discomfort, diarrhea, and other intestinal symptoms may occur. When the lesion is large or invades the intestinal mucosa, symptoms such as constipation and hematochezia may occur. These symptoms are often periodic, worsening one day before or during menstruation, and sometimes there is no menstrual cycle for hematochezia. In advanced patients, it may develop into complete intestinal obstruction.

　　The prevention of rectal endometriosis includes regular examinations, prevention of infection, early treatment of related gynecological diseases, and other specific preventive control measures are described as follows.

　　1. Regular physical examination: To achieve early detection, early diagnosis, and early treatment.

　　2. Pay attention to personal hygiene, especially the hygiene of the vulva during menstruation and postpartum period, to prevent infection.

　　3. Strengthen physical fitness and improve immunity: Pay attention to the combination of work and rest, participate in more physical exercise, and eat more fresh fruits and vegetables rich in vitamins.

　　4. Take appropriate measures to correct various gynecological conditions that may cause retrograde menstruation, such as severe retroverted uterus, lower genital tract obstruction or stenosis.

　　5. Try to prevent the occurrence of iatrogenic endometriosis, avoid performing tubal patency examination before the menstrual period, and performing manual reduction on retroverted uterus to prevent endometrial debris from being pushed into the pelvis through the fallopian tube.

　　6. Try not to use cesarean section as a method to terminate mid-term pregnancy, but instead use drug induction.

　　7. Try not to use artificial abortion as a method of contraception, but instead adopt methods such as placing an intrauterine device or taking birth control pills.

　　8. It is advisable to use gauze to protect the abdominal incision during cesarean section to prevent the implantation of endometrial debris into the abdominal wall tissue. After sutured the peritoneum, clean the abdominal wound with physiological saline and then suture in layers.

　　The examination of rectal endometriosis includes serological examination, rectal examination, ultrasound, MRI examination, and other specific examination methods are described as follows.

　　I. Serum CA125 Detection

　　The serum CA125 level in patients with endometriosis is elevated.

　　II. Serum Placental Protein

　　Placental protein 14 is an antibody secreted by the endometrial tissue of the endometrium, and its serum concentration has a menstrual cycle-like change. The concentration of placental protein 14 in patients with endometriosis is increased. Studies have shown that the lesion tissue can secrete placental protein 14 and CAl25 into the peritoneal cavity, and deeply infiltrative lesions can secrete these substances into the blood.

　　III. Other Auxiliary Examinations

　　1. Rectovaginal Bimanual Examination Masses and adhesions between the rectum and the uterovesical pouch and the uterosacral ligament can be palpated.

　　2. Rectal Examination It can be found that the surrounding tissue of the intestinal wall is significantly thickened, and the rectum is narrowed.

　　3. Rectosigmoidoscopy Patients with colorectal endometriosis may have varying degrees of narrowing, the mucosa is smooth and intact but with contraction and congestion. When it is difficult to distinguish from tumors, tissue should be taken for pathological examination.

　　4. Barium Enema Examination Perform barium enema examination twice during the mid-menstrual period and the second day of the menstrual period to observe the changes in the intestinal narrowing site, which is helpful for diagnosis. During barium enema, the following can be found:

　　(1) There is a long filling defect and narrowing in the rectum and (or) colon, the edge of the narrowing is clear, and the mucosa is intact.

　　(2) The intestines only show mild inflammatory changes, the narrowed part is fixed, has tenderness, slightly irregular, but does not resemble the rigidity or ulceration of a tumor.

　　5. Ultrasound Examination In the diagnosis of endometriosis, ultrasound examination is limited to detecting the increased adenomyoma of the ovary, and has low sensitivity in checking the planting lesions.

　　6. Laparoscopic Examination Early patients with no typical history, symptoms, or signs of endometriosis in clinical practice are mainly diagnosed and staged by laparoscopy. The accuracy of diagnosis under the microscope is related to the operator's understanding of the disease.

　　7. MRI Examination The level of endometriosis mass is high. The accuracy of diagnosing scattered pelvic lesions is higher than that of ultrasound, but the sensitivity is still very low. The role of this examination is:

　　(1) Observe the degree of pelvic adhesions before surgery.

　　(2) Once the diagnosis is successful, it can be used to monitor the therapeutic effect in the future.

　　8. Fine Needle Aspiration Fine needle aspiration cytology can be performed through the vagina to puncture and aspirate the mass in the uterovesical pouch or rectovaginal septum. The aspirated material is subjected to cytological examination. The presence of clumps of endometrial cells, old red blood cells, hemosiderin, etc., is helpful for diagnosis.

　　Patients with rectal endometriosis should eat more tonifying and invigorating food, and avoid spicy and刺激性 and cold foods. The specific dietetic and dietary precautions are as follows.

　　I. Dietetic Recipe for Rectal Endometriosis

　　1. Osmanthus Heart Rice Congee:60 grams of rice is cooked with 600 milliliters of water to make congee, and when it is half-cooked, 5 grams of osmanthus heart powder is added and cooked until the congee is done. Start 2 days before the menstrual period, take 1 dose per day, and take for 1 week. It is used to treat cold and dampness syndrome of endometriosis; symptoms include menstrual pain, pain reduced by warmth, and pale or purple complexion.

　　2. Danshen Drink:Boil 30 grams of Danshen with 500 milliliters of water, then simmer over low heat for 30 minutes to make a decoction. Add 30 grams of brown sugar and drink it as tea. Start taking it 3 days before the period, and take for 10 days consecutively. It is used to treat blood stasis type endometriosis.

　　3. Chicken Soup:Cut 100 grams of Astragalus into pieces and put them into the belly of a male black-bone chicken (1-1.5 kilograms), add water to cover the surface of the chicken, bring to a boil and then simmer over low heat until tender, season and eat. Start taking it 3 days before the period, finish in 5 days, and reheat overnight. It is used to treat Qi and blood deficiency type endometriosis.

　　4. Double Ear Drink:Soak 15 grams of silver ear and black fungus in water until they are soft, then boil them until they are soft and烂，add brown sugar to adjust the taste. Take 1 time per day, take for a month. It is used to treat blood stasis obstruction type endometriosis.

　　5. Fungus Soup:Boil 15 grams of black fungus and an appropriate amount of brown sugar together with 500 milliliters of water to make it soft and烂食。Take 2 times, 1 dose per day. It is used to treat blood stasis type endometriosis.

　　6. Yangqishi Cow Kidney Porridge:Wrap 30 grams of Yangqishi in gauze, add 1.5 liters of water, and boil for 1 hour. Take the clear decoction, add 1 cow kidney and 50 grams of rice, add an appropriate amount of water, and cook like a porridge. After the porridge is cooked, add oil, salt, and seasonings to eat. Take 1 time per day. It is used to treat Yang deficiency and blood stasis type endometriosis.

　　7. Egg and Chuanxiong Wine Drink:Boil 2 eggs and 9 grams of chuanxiong with 600 milliliters of water together. After the eggs are cooked, remove the shell and boil slightly, add some yellow wine, eat the eggs and drink the soup. Start taking it 3 days before the period, 1 dose per day, for 5 days per course. It is used to treat Qi stasis and blood stasis type endometriosis; symptoms include abdominal pain during menstruation and discomfort due to distension.

　　8. Lychee Core Drink:Roast the core of lychee and fragrant osmanthus to black, grind into fine powder. Take 3 grams per dose, taken with warm wine. Start taking it 3 days before the period, twice a day, until the period ends. It is used to treat Qi stasis and blood stasis type endometriosis.

　　9. Motherwort and Egg Boiled:Boil 45 grams of motherwort, 15 grams of Corydalis, 2 eggs, and 800 milliliters of water together. After the eggs are cooked, remove the shell and boil slightly, remove the medicinal residue, eat the eggs and drink the soup. Start taking it 2 days before the period, once a day, and take for 5 days. It is used to treat blood stasis type endometriosis.

　　10. Black Soybean and Safflower Drink:Boil 30 grams of black soybeans, 30 grams of brown sugar, and 6 grams of safflower together in a pot with 2 liters of water, then remove the juice after boiling for 10 minutes. Take 10-20 milliliters as a drink, instead of tea. It is used to treat blood stasis type endometriosis.

　　11. Glutinous Rice and Scallion White Porridge:Boil 60 grams of glutinous rice and 10 grams of scallion white with 1 liter of water to make porridge. Take 1 time each morning, starting before the period, and take for a week. It is used to treat Qi stasis and blood stasis type endometriosis; symptoms include abdominal pain during menstruation and discomfort due to distension.

　　12. Crucian Carp Soup:Take 10 grams of dragon's blood and frankincense, put them into the belly of a crucian carp (about 250 grams) and add 500 milliliters of water to boil the soup. Eat the meat and drink the soup. 1 time per day, take for 3-5 days. It is used to treat Qi stasis and blood stasis type endometriosis.

　　13. Persimmon Rice:Persimmon seeds 15 grams are pounded and soaked in water, then the juice is strained and mixed with 50 grams of glutinous rice. Add 500 milliliters of water, cook over low heat to make a thin porridge, and adjust the amount of brown sugar to taste. Take 1 dose every other day, once in the morning and once in the evening. It is used to treat blood stasis type endometriosis.

　　2. What to eat for rectal endometriosis that is good for the body

　　1. Eat more tonifying Qi and invigorating food. It can help Qi circulation and blood, and can alleviate pain. It is especially suitable for those with endometriosis and Qi and blood deficiency.

　　2. Dried fruits are not taboo and can be eaten at any time. They can nourish the body and promote blood circulation, while walnuts can warm Yang, and dates and longans can benefit Qi and nourish blood, which are more suitable.

　　3. Poultry, livestock, eggs, milk, and fresh fish can generally be eaten, and are beneficial for replenishing Qi and blood, especially for those with Qi and blood deficiency.

　　4. Cereals, legumes, and tubers can be eaten as staple foods, and there is no need to avoid them.

　　5. Chive white can disperse wind and cold, unblock the liver meridian, and is beneficial to eat. Black fungus has the effect of harmonizing blood, and can be eaten more.

　　6. In the diet for endometriosis, alcohol can warm Yang and activate meridians, and can be taken appropriately to achieve the effect of removing blood stasis and alleviating pain. Herbs like芥末, fennel, Sichuan pepper, and white pepper are also warming and promoting. Rosa rugosa can regulate Qi and relieve depression, harmonize blood, and can be used for seasoning. Red sugar boiled with ginger, with the sweetness of red sugar to benefit Qi and relieve the middle, and the warmth of ginger to help remove blood stasis, can be taken daily for great benefit.

　　3. Foods to avoid for rectal endometriosis

　　1. Acrid and astringent foods can easily lead to Qi stagnation and blood stasis, and should be avoided. Spicy and warm herbs are beneficial for circulation and can be eaten, but not excessively, as excessive spiciness can worsen pain.

　　2. In the diet for endometriosis, vegetables such as rapeseed, xiaocai, baiye, kelp, cucumber, loofah, winter melon, eggplant, chive white, bamboo shoots, and lotus root are cool in nature. It is better to eat less before and after menstruation, and it is not advisable to eat them raw.

　　The treatment of rectal endometriosis with traditional Chinese medicine includes Chinese herbs, acupuncture, and massage. The specific treatment methods are described as follows.

　　1. Traditional Chinese Medicine Treatment

　　1. Qi stagnation and blood stasis

　　Chief symptoms: Distension and pain in the lower abdomen before or during menstruation, resistance to palpation, menstrual flow not smooth with clots, pain reduced after clot expulsion, or infertility, breast distension and pain before menstruation, distension and pain in the two sides of the ribs, depression or irritability, purple and dark tongue with ecchymosis, wiry or slippery pulse.

　　Treatment method: Relieving liver Qi and promoting Qi, and activating blood circulation to remove blood stasis.

　　Prescription: Gexia Zhuyu Decoction. Angelica Sinensis 20g, Red Peony 15g, Chuanxiong 10g, Peach Kernel 15g, Safflower 15g, Zhishexiang 15g, Yuanhu 15g, Lingzhi 15g, Danpi 10g, Wu Yao 15g, Xiangfu 15g, Zhigancao 10g. If Qi stagnation is the main issue, and distension is more severe than pain, add Chuandizhi 15g; if blood stasis is the main issue, and pain is more severe than distension, add Puhuang 15g, and increase Lingzhi 20g; for severe pain, add Quanxie 3 pieces, Sanlie 15g, and Aiye 15g; for symptoms of mass, add Xuejie 15g, Chuanshanjie 15g, Zaojiao Ci 20g, Sanlie 15g, and Aiye 15g; for increased menstrual flow, add Puhuang 15g, Qiancao 159, and Sanqi powder 10g (to be taken with water).

　　2. Blood stasis due to cold

　　Chief symptoms: Cold pain in the lower abdomen before or during menstruation, relieved by warmth, with light menstrual flow, dark and black blood clots, pain reduced after clot expulsion, feeling cold, pale complexion, severe pain may cause nausea or vomiting, or infertility, dark tongue, white coating, wiry and tense pulse.

　　Treatment Method: Warm the meridians and disperse cold, activate blood circulation and remove blood stasis.

　　Herbal Medicine: Shaofu Zuyu Decoction. Foeniculum vulgare 15g, dried ginger 15g, Corydalis yanhusuo 15g, Borneol 15g, Myrrha 15g, Ligusticum chuanxiong 10g, Angelica sinensis 20g, Commiphora 15g, Cinnamomum cassia 15g, white peony root 15g. If abdominal pain is severe, add 15g of Sichuan pepper, 10g of prepared Aconitum carmichaelii, and 10g of prepared Aconitum kusnezoffii; for yang deficiency and internal cold, add 15g of Panax ginseng, 15g of prepared Aconitum carmichaelii, and 20g of Epimedii; for heavy dampness, with chest stuffiness and abdominal distension, white greasy fur, add 15g of Atractylodes macrocephala, 10g of Citrus reticulata, 15g of Zelania, and 20g of Poria.

　　3. Qi deficiency and blood stasis

　　Main Symptoms: Abdominal pain during or after menstruation, preference for pressure and warmth, anal distension, loose stools, fatigue, pale complexion, menstrual blood quantity varying from light to heavy, pale and dark color, thin consistency, with clots, thick tongue, pale purple tongue quality with petechiae, thin white fur, thin and weak pulse.

　　Treatment Method: Strengthen the Qi and invigorate the Yang, activate blood circulation and remove blood stasis.

　　Herbal Medicine: Buzhong Yiqi Decoction. Astragalus 30g, Angelica sinensis 20g, white peony root 15g, Pseudoscorpion 20g, Ligusticum chuanxiong 10g, Prunus persica seed 15g, Carthamus tinctorius 15g. For sweating and aversion to cold, add 15g of Cinnamomum cassia and 15g of white peony root; for severe abdominal pain, add 15g of Mugwort, 15g of Foeniculum vulgare, 15g of Myrrha, and 15g of Borneol; for nausea and vomiting, add 15g of Evodia rutaecarpa, 10g of dried ginger, and 10g of Pinellia ternata; for loose stools, add 15g of Myristica fragrans, 15g of Luffa operculata, and 20g of Psoralea corylifolia.

　　4. Heat retention and blood stasis

　　Main Symptoms: Fever before or during menstruation, pain in the abdomen that is resistant to pressure, and in severe cases, high fever during menstruation, which gradually returns to normal after menstruation; menstrual blood is dark red, thick, with clots, menstrual cycle is advanced or menstrual period is prolonged, quantity is heavy, bitter throat and dry mouth, irritability and anger, dry stools, sexual intercourse pain, red tongue, or petechiae and ecchymosis on the edge of the tongue, yellow fur, wiry and rapid pulse.

　　Treatment Method: Clear heat and nourish the blood, activate blood circulation and remove blood stasis.

　　Herbal Medicine: Modified Xuefu Zhuyu Decoction. Prunus persica seed 15g, Carthamus tinctorius 15g, Angelica sinensis 20g, raw Rehmannia 30g, white peony root 20g, Ligusticum chuanxiong 10g, Bupleurum chinense 10g,枳壳10g, Achyranthes bidentata 10g, Glycyrrhiza uralensis 10g, Platycodon grandiflorus 10g, Salvia miltiorrhiza 20g, Peony root 15g. For fever during menstruation, add Scutellaria baicalensis 15g and Artemisia annua 15g; for dry and hard stools, add 15g of rhubarb and 10g of Zhizi; for abdominal pain, add 20g of Houttuynia cordata, 15g of Armadillidium vulgare, and 15g of Nux vomica; for bitter throat and dry mouth, irritability, and anger, add 15g of Gardenia jasminoides and 15g of Scutellaria baicalensis.

　　5. Kidney deficiency and blood stasis

　　Main Symptoms: Abdominal pain during or after menstruation, lumbar ache and distension, menstrual blood quantity varying from light to heavy with or without clots, infertility, dizziness and dizziness, loose stools, frequent urination, pale and dark tongue with petechiae or ecchymosis, thin white fur, deep and thin pulse.

　　Treatment Method: Tonify the kidney and regulate the menstrual cycle, activate blood circulation and remove blood stasis.

　　Herbal Medicine: Guishen Wan combined with Taohong Siwu Decoction. Prepared Rehmannia 20g, Chinese yam 20g, Prunus mume seed 15g, Poria 20g, Angelica sinensis 20g, Chinese wolfberry 20g, Eucommia ulmoides 15g, Cuscuta chinensis 25g, Prunus persica seed 15g, Carthamus tinctorius 15g, Ligusticum chuanxiong 10g, white peony root 20g. For severe lumbar and back pain, add 20g of Epimedii and 15g of Toosendan; for loose stools, add 20g of Psoralea corylifolia and 20g of Haematite.

　　Two, Prescriptions

　　1. Metastatic Powder:Dilong, Tuchong, Zhichong, Wugong, Shuizhi, etc., in equal proportions, ground into powder, stored in bottles for use or encapsulated for use, take 2-3g each time, twice or three times a day. Suitable for endometriosis, combined with oral medication treatment.

　　2. Blood-Activating and Blood-Removing Formula:Three notoginseng 15g, rhizoma Curcumae 15g, raw Pohuashou 12g, Suanbaishu 12g, Taoren 9g, decocted in water, one dose per day. Suitable for dysmenorrhea and infertility in endometriosis.

　　3. Eliminating Blood Stasis and Dredging Bowel Pill:Processed with vinegar, raw Dahuang, processed with vinegar, and prepared with Biejia, amber, and ground into powder in a 2:2:1 ratio to make pills. Take 2.5g each time, twice a day, taken before meals with boiled water. Continue to take the medicine during the menstrual period, and take for 3 months as one course. Suitable for those with实证 of endometriosis.

　　Three, Patent Medicines

　　1. Women's Dysmenorrhea Pill:It has the effect of regulating qi, promoting blood circulation, removing blood stasis, and relieving pain. It is mainly used for dysmenorrhea, suitable for qi stagnation and blood stasis type dysmenorrhea. Take 30 pills twice a day, taken orally.

　　2. Shaofu Eliminating Blood Stasis Pill:It has the effect of promoting blood circulation, removing blood stasis, warming meridians, and relieving pain. It is mainly used for dysmenorrhea, suitable for cold blood stasis type dysmenorrhea. Take one pill twice a day, taken orally.

　　3. Tuning Menstruation and Motherwort Tablets:It has the effect of clearing heat and dissipating blood stasis. It is mainly used for dysmenorrhea, suitable for blood stasis type dysmenorrhea. Take 20-30 pills or 5-8 pieces, twice or three times a day, taken orally.

　　Four, Acupuncture and Moxibustion Therapy and Massage Therapy

　　1. Body Acupuncture:Take the Guanyuan, Zhongji, Hegu, and Sanyinjiao points, once a day for 7 consecutive days, each time leaving the needle for 20 minutes, for treatment before or during the period.

　　2. Ear Acupoint Seed Pressing:Take the uterus, endocrine, and liver points, apply magnetic beads or Wangbuluxing to the acupoints, and press and stimulate multiple times a day, used for treating dysmenorrhea.

　　3. Massage along the Ren Meridian:Starting from the Shenque point, massage the Qihai, Guanyuan, Tianshu, Siman, Guilai, uterus, and Qichong points in turn, massaging each point for 1 minute. Start 7 days before the period and stop 3 days after the period, suitable for those with dysmenorrhea as the main symptom.