Pelvic Inflammatory Disease (PID)

Introduction	Back to Top
Pelvic inflammation is a clinical syndrome caused by inflammation of the female reproductive organs above the cervix (including the uterine body, ovarian tubes, and ovaries) and its neighboring connective tissues. The disease is also referred to as pelvioperitonitis or inflammation of the pelvic reproductive organs. Inflammation of the pelvic reproductive organs often results from a retrograde infection. Due to the proximity of the female reproductive organs to one another, infection of any one organ is prone to spread to the other organs, resulting in simultaneous inflammation of multiple organs. According to its progress and clinical manifestations, the disease is classified as acute or chronic types. In traditional Chinese medicine, it belongs to the categories of “abdominal pain”, “lumbago”, “gynecological diseases”, “abdominal mass”, etc.

Etiology/Pathogenisis	Back to Top
Pelvic inflammation is a clinical syndrome caused by inflammation of the female reproductive organs above the cervix (including the uterine body, ovarian tubes, and ovaries) and its neighboring connective tissues. The disease is also referred to as pelvioperitonitis or inflammation of the pelvic reproductive organs. Inflammation of the pelvic reproductive organs often results from a retrograde infection. Due to the proximity of the female reproductive organs to one another, infection of any one organ is prone to spread to the other organs, resulting in simultaneous inflammation of multiple organs. According to its progress and clinical manifestations, the disease is classified as acute or chronic types. In traditional Chinese medicine, it belongs to the categories of “abdominal pain”, “lumbago”, “gynecological diseases”, “abdominal mass”, etc.

Primary Treatments with Medicinal Herbs	Back to Top
Xue Fu Zhu Yu Tang Li treated 60 cases of chronic pelvic inflammation with Xue Fu Zhu Yu Tang (decoction for removing blood stasis in the chest). The formula consisted of Dang Gui (Chinese Angelica Root), Bai Shao (White Peony Root), Chi Shao (Peony Red), Chai Hu (Bupleurum), Tao Ren (Persica), Jie Geng (Platycodon Root), Chuan Xiong (Cnidium), Yan Hu Suo (Corydalis Tuber), Niu Xi (Achyranthes), Gan Cao (Licorice), and Mo Yao (Myrrh). The formula was modified according to the individual patients' symptoms. The results were: 24 cases (54%) significantly improved, 31 cases (8%) had improved, and the remaining 5 cases (8%) did not respond to the treatment, with a total effectiveness rate of 92%.(1)

Other Treatments with Medicinal Herbs	Back to Top
Fu Ke Qian Jin Pian Tan et al. treated 82 cases of acute pelvic inflammation with Fu Ke Qian Jin Pian. A comparison group of 37 cases was treated with Yin Qiao Hong Jiang Jie Du Tang (prepared by Shanghai Traditional Chinese Medicine Institute). The results of the study showed that: In the treatment group, 22 cases significantly improved, 31 cases demonstrated great improvement, another 24 cases showed slight improvement, and the remaining 4 cases did not respond to the treatment, with a total effectiveness rate of 95.1%; of the comparison group, the corresponding numbers were 6, 12, 16, 3, and 91.9%.(2) Jin Gui Da Huang Mu Dan Tang Wang treated 128 cases of both acute and chronic pelvic inflammation with Jin Gui Da Huang Mu Dan Tang. The formula consisted of Da Huang (Rhubarb), Mu Dan Pi (Moutan), Tao Ren (Persica), Dong Gua Zi (Benincasa Seed), Mang Xiao (Mirabilitum), Cang Zhu (Atractylodes), and Huang Bo (Phellodendron). The formula was modified to suit the individual patients' symptoms. One dose of the formula was decocted in water for internal administration daily. After the first three doses, the proportions of Da Huang and Mang Xiao were reduced by 50%, and those of Cang Zhu and Huang Bo were increased by 50%. After the first week, the proportions of Da Huang and Mang Xiao were further reduced by 50%. One course of treatment lasted 2-4 weeks. The results: 86 cases greatly improved, another 30 cases improved, and the remaining 12 cases did not respond to the treatment, with a total effectiveness rate of 90.6%.(3) Liu Huang Tang Lin et al. treated 100 cases of chronic pelvic inflammation with Liu Huang Tang. The formula consisted of Huang Qi (Astragalus Root), Shu Di Huang (cooked Rehmannia), Huang Jing (Polygonatum Root), Huang Qin (Scutellaria), Da Huang (Rhubarb), and Pu Huang (Bulrush). The formula was modified to suit the individual patients' symptoms. A comparison group of 50 cases was treated with penicillin sodium, cephazolin, metronidazole, etc. One course of treatment lasted for 15 days for both groups. The results: of the treatment group, 60 cases greatly improved, another 36 cases improved, and the remaining 4 cases did not respond to the treatment, with a total effectiveness rate of 96%; of the comparison group, the corresponding numbers were 25, 13, 12, and 76%.(4)

Other Treatments	Back to Top
External treatment Ren et al. treated 96 cases of pelvic inflammation by a retention enema with Hong Teng Tang (a common modern formula). One comparison group of 40 cases was treated by a traditional enema with Hong Teng Tang, and a second comparison group of 44 cases was treated with antibiotics and medication made from placenta tissue. The results: the treatment group had superior therapeutic effects than either of the two comparison groups (P<0.05).(5) Zheng et al. treated 30 cases of chronic pelvic inflammation by a retention enema with Shuang Dan Tang. The formula consisted of Jin Yin Hua (Lonicera Flower), Mu Dan Pi (Moutan), Lian Qiao (Forsythia), Pu Gong Ying (Dandelion), San Leng (Burreed Tuber), E Zhu (Zedoariae Rhizoma), Chi Shao (Peony Red), Huang Bo (Phellodendron), Zi Hua Di Ding (Viola), Bai Jiang Cao (Thlaspi), Zao Jiao Ci (Gleditsia Spine), etc. A comparison group of 30 cases was treated with the same formula but by oral administration. The results: the treatment group had a total effectiveness rate of 96.67%, while the comparison group had a total effectiveness rate of 86.64% (P<0.05).(6) Li et al. treated 480 cases of chronic pelvic inflammation by a retention enema with the following herbs: Huang Bo (Phellodendron), Long Dan Cao (Gentiana Root), Yan Hu Suo (Corydalis Tuber), Chuan Lian Zi (Melia), Xiang Fu (Cyperus), E Zhu (Zedoaria), Yi Yi Ren (Coix), and Rou Gui (Cinnamon Bark). The treatment was conducted once daily, and one course of treatment lasted 10 days. The treatment was discontinued during menstruation. The results; 380 cases significantly improved, another 60 cases improved, and the remaining 40 cases did not respond to the treatment, with a total effective rate of 91.7%.(7) Iontophoresis with Chinese herbs Fan et al. treated 92 cases of chronic pelvic inflammation through iontophoresis with the following herbs: Ru Xiang (Mastic), Mo Yao (Myrrh), Xue Jie (Dragon's Blood), Hong Hua (Carthamus), Dang Gui (Dang Gui), Chi Shao (Peony Red), Xiang Fu (Cyperus), Gui Zhi (Cinnamon Twig), Hua Jiao (Zanthoxylum Peel), Bai Hua She She Cao (Oldenlandia), Pu Gong Yin (Dandelion), Bai Jiang Cao (Thlaspi), and Dan Shen (Salvia). The results: 49 cases significantly improved, 25 cases showed great improvement, another 16 cases improved, and the remaining 2 cases did not respond to the treatment, with a total effectiveness rate of 97.9%.(8) Physiotherapy Zhao treated 15 cases of chronic pelvic inflammation by ultra-shortwave therapy. The results: 8 cases (53.33%) greatly improved and the remaining 7 cases improved, with a total effectiveness rate of 100%.(9) Simultaneous internal and external treatments Ling treated 92 cases of chronic pelvic inflammation by simultaneous internal and external treatments. The formula prescribed for internal administration was aimed at cleansing heat, dispelling dampness to promote qi circulation, and remove stasis, and consisted of the following herbs: Bai Jiang Cao (Thlaspi), Huang Qin (Scutellaria), Xiang Fu (Cyperus), Chai Hu (Bupleurum), Chuan Lian Zi (Melia), Dan Shen (Salvia), and Chi Shao (Peony Red). Externally, the patients were treated by an enema with the decoction of the following herbs: Bai Jiang Cao (Thlaspi), Hong Teng (Sargentodoxa Cuneata Rhixoma), Pu Gong Ying (Taraxaci Herba), Jin Yin Hua (Lonicerae Flos), Dan Shen (Salvia), Chi Shao (Peony Red), San Leng (Sparganii Rhizoma), E Zhu (Zedoariae Rhizoma), and Ye Ju Hua (Chrysanthemi Indici Flos). This treatment had a total effective rate of 97.8%.(10) Combined treatment with Chinese and Western medicine Zhu treated 120 cases of chronic pelvic inflammation with Western antibiotics, a retention enema, and external application using Chinese herbs. Herbs used for the enema were a decoction of the following three herbs: Pu Gon

Acupuncture & Acupressure	Back to Top
Combined treatment with Acupuncture and Herbs Li treated 28 cases of chronic pelvic inflammation with acupuncture and herbs. All patients received acupuncture treatment at Zi Gong (Extra 16), Shen Shu (UB 23), Qi Hai (Ren 6), San Yin Jiao (Sp 6), Xue Hai (Sp 10), and Feng Long (St 40). In addition, the patients received supplemental acupuncture treatment as follows: patients with liver or kidney insufficiency were treated at Tai Xi (K 3); patients with spleen or stomach insufficiency were treated at Zu San Li (St 36); and patients with depressed liver-qi were treated at Tai Chong (Liv 3). The acupuncture treatment was conducted once daily, and one course of treatment lasted 10 days. The patients rested for one week between the courses of treatment, and the treatment discontinued during menstruation. At the same time, the patients were administered the decoction of the following herbs: Hong Teng (Sargentodoxa Cuneata Rhixoma), Bai Jiang Cao (Thlaspi), Bai Shao (White Peony Root), Dang Gui (Dang Gui), Chi Shao (Peony Red), Yan Hu Suo (Corydalis Tuber), Tao Ren (Persica), Hong Hua (Carthamus), Dan Shen (Salvia), Fu Ling (Hoelen), Gan Cao (prepared Licorice), and Mu Xiang (Saussurea). The results: 18 cases were resolved, 4 cases greatly improved, another 3 cases improved, and the remaining 3 cases did not respond to the treatment, with a total effectiveness rate of 89.28%.(11) Acupoint Treatment Jiang treated 120 cases of chronic pelvic inflammation by an acupoint injection. Selected for treatment were the acupoints located at the lower abdomen and in the lumbosacral region, such as Guan Yuan (Ren 4), Zhong Ji (Ren 3), Gui Lai (S 29), Shui Dao (S 28), Zi Gong (Ren 19), etc. The solutions used for the injection were a Yu Xing Cao (Houttuynia) injection, placental tissue fluid, Penicillin G sodium, and Cefazolin sodium. Each session treated two acupoints, and the acupoints on the front and back alternated in receiving treatment. Ten sessions constituted one course of treatment, and the patients rested 2-3 days between the courses of treatment. The results: 48 cases greatly improved, and the remaining 72 cases improved.(12) Zhu et al. treated 45 cases of pelvic inflammation with a DF-III computer-aided bionic therapeutic apparatus. The acupoints selected for treatment were Zhong Ji (Ren 3), Guan Yuan (Ren 4), and San Yin Jiao (Sp 6), Shui Dao (S 28), Gui Lai (S 29), and Zi Gong (Ren 19) (the latter four being supplemental points). The current intensity was set at the patient's tolerance level. Each session lasted 30 minutes, and 10 sessions constituted one course of treatment. The results: 30 cases were resolved, 8 cases greatly improved, another 5 cases had improved, and the remaining 2 cases did not respond to the treatment, with a total effectiveness rate of 95.6%.(13) Sun et al. treated 186 cases of chronic pelvic inflammation by a external acupoint application with Qian Jin Fu Yan Gao (a gynecological inflammation paste). A comparison group of 186 cases were treated by IV injection of antibiotics. The results: the treatment group had a total effectiveness rate of 89.20%, and the comparison group had a total effectiveness rate of 60.10% (P<0.05).(14)

Footnotes	Back to Top
¹ Li Zheng Qing. 60 cases of chronic pelvic inflammation treated with Xue Fu Zhu Yu Tang (Decoction for removing blood stasis in the chest). Gansu Journal of TCM. 1995;8(4):34. ² Tan Pu Yun, et al. 82 cases of acute pelvic inflammation treated with Fu Ke Qian Jin Pian. Hunan Journal of TCM. 1999;15(5):44. ³ Wang Yu Xia. Treating pelvic inflammation with Jin Gui Da Huang Mu Dan Tang. Journal of Traditional Chinese Medicine Information. 1999;16(6):41-42. ⁴ Lin Ying Ling, et al. 100 cases of chronic pelvic inflammation treated with Liu Huang Tang. Journal of Zhejiang College of TCM. 1999;23(6):33. ⁵ Ren Su Xia, et al. Treating chronic pelvic inflammation by retention enema with Hong Teng Tang. Journal of Nursing. 2000;15(7):428-429. ⁶ Zheng Song, et al. Treating chronic pelvic inflammation by retention enema with Shuang Dan Tang. Hubei Journal of TCM. 2000;22(2):10-12. ⁷ Li Ya Ping, et al. Treating 480 cases of chronic pelvic inflammation with retention enema using Chinese herbs. Journal of Modern TCM. 1999;12(4):11-12. ⁸ Fan Mei Xia, et al. Treating 92 cases of chronic pelvic inflammation by iontophoresis with Chinese herbs. Shanxi Journal of TCM. 2000;16(2):60. ⁹ Zhao Jian Chang. 15 cases of chronic pelvic inflammation treated with microwave therapy. Journal of Zhangjiakou Medical College. 1990;16(2):110. ¹⁰ Ling Chun Bo. 92 cases of chronic pelvic inflammation treated with a combination of oral administration and external application of Chinese herbs. Shaanxi Journal of TCM. 1999;20(12):531. ¹¹ Li Xiu Xia. 28 cases of chronic pelvic inflammation treated with acupuncture and Chinese herbs. Journal of Acupuncture Clinical Application. 1999;15(9):26. ¹² Jiang Guo Qing. 120 cases of pelvic inflammation treated with acupoint injection. Journal of Acupuncture Clinical Application. 1999;15(10):32. ¹³ Zhu Mei, et al. Treating 45 cases of pelvic inflammation with DF-III computer-aided bionic therapeutic apparatus. Jilin Journal of TCM. 1999;19(6):32. ¹⁴ Sun Xin Yi, et al. Treating chronic pelvic inflammation with Qian Jing gynecological inflammation paste. Journal of Xinxiang College of Medicine. 2000;17(3):193-194.