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Treating Vulvodynia with Chinese Herbs

By Sharon Weizenbaum

Though vulvodynia is a broad term applied to a wide variety of vulvar

conditions, the primary symptoms are chronic vulvar itching, burning

and/or pain. The pain associated with this condition can be stinging,

raw or irritated. Women frequently have difficulty fully locating the

pain. Often the pain extends to the urethral opening causing symptoms

that resemble urinary tract infection such as urinary frequency,

urgency and dysuria. This is an invisible handicap, which causes

immense suffering and isolation.

The cause of vulvodynia is unknown from a western medical perspective

though there are some recognized causative factors. These include

injury from surgery, childbirth, ruptured disk or sports. It is

thought to be possibly neuropathic in nature, which simply means that

the nerves exhibit pathology. Some are exploring the link between

herpes and vulvodynia.

Diagnosis of vulvodynia is largely a process of exclusion. Yeast

infections, urinary tract infections or sexually transmitted diseases

are ruled out. Though the meaning of the term vulvodynia simply means

that the vulva is painful, which the woman knew at the start, often

the diagnosis brings a sense of relief to patients. This is often

because there is acknowledgment that the pain is real and that the

condition is neither malignant nor contagious.

Allopathic treatment offers no real relief for women who suffer from

this condition. Women are recommended to avoid close fit clothing.

Tricyclic antidepressants may bring some relief but only partial and

as soon as the medication is discontinued, the symptoms will flare.

Anticonvulsants are also prescribed.

Perhaps the Chinese Medical perspective has something to offer in

this illness. I have treated women successfully who have been

diagnosed with vulvodynia in my practice. I have also successfully

treated women who probably would have been diagnosed with it had they

gone the allopathic route. Below is a case study, which illustrates

the thinking and method I have used.

Alice came to me in the summer of 2001 with a diagnosis of

vulvodynia. Alice was 44 when she first came to see me. She first

noticed symptoms in 1996, five years previously, after the birth of

her second child. She gave birth in May of 1996 and began swimming in

our very cold swimming hole soon after. In early June she began to

have symptoms of redness and rawness in the vulva. She was treated

with antibiotics to no avail but the symptoms went away after 6

months.

Three years later during a hot August, Alice was on vacation. Each

day she rode her bike 4 miles and then went for a swim in the ocean.

Then she rode her bike back again. She developed symptoms of

extremely painful burning and urinary frequency. Estrace estrogen

cream was ineffective. In the autumn of that same year she also

developed nausea after each meal which continued for months.

In November 1999 she was diagnosed with vulvodynia and was given a

prescription for Elavil. She took 10 mg of Elavil daily, at acute

flare-ups increasing this dose to 20 mg for one year. In January 2001

she was given Neurontin, 100mg/day but had side effects of severe

mental confusion, depression, numbness in legs as well as sudden

returning of vulvar symptoms. She discontinued this and was currently

taking 10 mg of Elavil when we met.

Alice's current symptoms were vulvar burning and pain that was worse

with sitting (as a therapist, she had a very difficult time making it

through her day) She felt relieved to go running and then jump in the

cold pond. She also had urinary frequency and occasionally burning

urination.

Other symptoms Alice experienced were dry mouth, low libido,

grogginess in the morning (related to Elavil), difficulty falling

asleep, cold hands and feet (diagnosed with Reynaud's) and occasional

nausea after meals. Her menstrual cycle arrived early after 21 days.

She experienced bad cramping with a heavy baring down pain. She would

be woken in the night with pain. She took Advil with every

menstruation. Her menstrual blood contained clots. She also

complained of fatigue, which she related to her condition. She

expressed that though she is depressed about her condition, she

doesn't feel generally depressed. Alice also had low back pain that

was worse when she was tired.

Alice's tongue was slightly red with small cracks. Some of the veins

under her tongue appeared congested. Her pulse was thin and wirey.

When I met Alice, I remembered a case my teacher had written about.

In this case, a peasant woman had journeyed over hills and valleys in

the heat and then sat on a cold rock. As my teacher described it, the

woman heated herself up, especially in the unventilated area between

her legs and then suddenly closed up all the pores by sitting on a

cold rock. This patient developed a condition very similar to

Alice's. I saw that the etiology of Alice's condition was similar as

well!

I knew Alice had blood stasis for sure because of her extreme

menstrual pain, the clots in her menstruate and the distended

sublingual veins. This blood stasis was primarily in her pelvic area.

This helps explain the poor circulation in her pelvic area, which may

account for her difficulty in recovering. This also gives us an

etiological explanation for the pent up heat in her pelvis. When the

blood fails to move, the Qi gets congested and turns to heat. This

depressive Qi helps explain her cold hands and feet since, when Qi is

trapped inside, it can't warm the extremities.

I knew Alice had internal pelvic heat for sure because of her

symptoms of vulvar redness and burning and burning urination. This

diagnosis of heat helps explain her dry mouth and frequent urination.

I knew Alice suffered from Kidney deficiency because she had low back

pain that was helped by rest. I knew it was Kidney Yin deficiency

because her tongue had small cracks on it. This diagnosis also helps

explain the heat in her lower body, her dry mouth and frequent

urination.

The heat Alice experienced was from two causes. First it was from

depressive heat which is heat that develops from lack of movement of

Qi. This was first caused when cold suddenly shut down her Qi

mechanism and was exacerbated by her poor pelvic circulation.

Secondly, Alice suffered from empty heat from Kidney Yin deficiency.

Both of these forms of heat were effecting Alice's Heart, causing

insomnia.

In short my diagnosis of Alice was the following: Blood stasis in the

lower body with depressive and empty heat trapped internally. Kidney

Yin deficiency.

My treatment principle then had to be the following: Vitalize the

blood, unblock depressive Qi in order to release depressive heat.

Enrich the Kidney Yin and clear empty heat from the lower body and

calm the Heart. I also wanted to regulate menstruation and stop

menstrual pain.

I gave Alice two formulas. The first was for her premenstrual time.

That is the best time to vitalize blood and open depression so the

formula emphasized that method. Postmenstrually I emphasized clearing

empty fire and enriching the Kidney Yin. In both cases I gave the

heat a way out through the urination.

Note: dosages are in Chinese Qian ( 1 qian=3 gm.) One bag is for one

week.

Premenstrual Formula

Modified Long Dan Xie Gan Tang and Zhi Zi Dou Chi Tang

Zhi Zi Gardenia 9

Chai Hu Bupleurum 9

Huang Qin Scutellaria 9

Mu Tong Akebia 9

Dang Gui Sinensis 12

Fu Shen Poria (spirit) 12

Dan Zhu Ye Lophanthus 9

Sheng Di Raw Rehmannia 12

Huang Bai Phellodendron 9

Gan Cao Licorice 6

Dan Dou Chi Prepared Soybean 9

Tu Fu Ling Smilax 15

Pu Huang Cattail Pollen 9

Wu Ling Zhi Flying Squirrel Feces 15

Postmenstrual Formula

Modified Liu Wei Di Huang Tang

Sheng Di Raw Rehmannia 20

Dang Gui Sinensis 15

Gan Cao Licorice 6

Mu Tong Akebia 9

Dan Zhu Ye Lophanthus 9

Che Qian Zi Semen Plantaginis 9

Mu Dan Pi Tree Peony 12

Tu Fu Ling Smilax 15

Fu Ling Poria 9

Ze Xie Alismas 9

Shan Yao Dioscoria Yam 12

Hua Shi Talcum 15

Alice's next menstruation came after 27 days and was pain free. She

noticed improvement in the vulvar and urinary symptoms right away.

After another 2 months her symptoms decreased from what she described

as a 10 to a 2. Her menstruation has remained regular and pain free

through three cycles. She went off the Elavil with no exacerbation.

Our next plan is to reduce the herbs slowly to consolidate the result.

Discussion: Most often, allopathic medicine offers medication to help

manage the condition of vulvodynia as well as many other conditions.

Chinese medicine on the other hand works toward alleviation of the

illness. Once Alice's blood is vitalized, her Qi circulated and the

empty heat cleared, it should be gone. She will be able to

discontinue herbs eventually. My guess would be in another few

months.

Allopathic medicine does not have a concept for circulation of Qi and

Blood nor for internal heat. In some cases, such as this one, this is

a tremendously useful terminology.