In my experience, herbal medicine is often the most essential piece for women with endometriosis or adenomyosis. Taken daily, herbs work at a cellular and hormonal level, addressing the underlying terrain that has allowed endometriosis to thrive. This deeper, continuous action is key for sustainable change, and it’s what distinguishes herbal medicine from acupuncture alone.
Below is a guide to the herbs and formulas I commonly work with, and the reasoning behind them. This is not intended as a prescription, as formulas are always tailored to your individual pattern after a thorough consultation, and change as your presentation evolves.
How Chinese medicine understands endometriosis
In Chinese medicine, the core problem in endometriosis is that blood isn’t flowing smoothly through the uterus and pelvis — a pattern called blood stasis. Think of a river that has become sluggish or blocked: instead of flowing freely each month, blood pools and stagnates, causing pain, inflammation and, over time, the formation of masses and adhesions.
Several things can create or worsen this stagnation: chronic stress and tension, exposure to cold (particularly during menstruation), underlying hormonal imbalances, and immune dysregulation. Because each woman’s pattern is different, treatment is always built around what’s specifically driving the stagnation for her.
For pain and cramping
The foundation of most endometriosis formulas is improving blood flow through the pelvis. Dang Gui (Chinese angelica) is traditionally used to support smooth blood flow and relieve cramping, and has been studied for its vasodilatory and antispasmodic properties (1). Chi Shao (red peony root) is traditionally considered cooling, and has been studied for its anti-inflammatory properties via its active constituent paeoniflorin (2).
Together they form the base of many classical formulas, including Gui Zhi Fu Ling Wan — one of the most researched herbal formulas for endometriosis. A 2024 meta-analysis of 9 RCTs involving 897 participants found it was associated with reductions in pain scores, CA-125 levels and the size of endometriotic cysts (3).
For cold-type pain: severe cramping and dark, clotted blood
If you reach for a heat pack the moment your period arrives, and your blood is dark with clots, this is often a cold stagnation pattern. Shao Fu Zhu Yu Tang is a warming formula traditionally used to move blood stagnation in the lower abdomen, with warming herbs such as ginger and cinnamon featured prominently. This formula is particularly well-suited to women whose pain responds clearly to heat.
For the stress-pain connection
Many women find their endometriosis is significantly worse when they’re stressed or depleted. In Chinese medicine, chronic stress constricts the flow of qi and blood — and a contracted, tense system makes period pain much worse. Xiang Fu (cyperus) is traditionally used to regulate the flow of qi and relieve the kind of tension that contributes to pain. Bai Shao (white peony root) has been studied for its antispasmodic and pain-relieving properties via paeoniflorin (2), and works to soften tension and reduce spasms.
When stress, premenstrual irritability and breast tenderness accompany the pain, a formula like Jia Wei Xiao Yao San is often the right fit — it addresses the liver-heat pattern that underlies this presentation.
For heavy bleeding, particularly with adenomyosis
Yi Mu Cao (motherwort) has a long history in Chinese medicine as a gynaecological herb, traditionally used to support uterine function and healthy bleeding patterns. San Qi (panax notoginseng) has been studied for its haemostatic and anti-inflammatory properties, including specifically in the context of endometriosis (4). Both are commonly included in formulas where heavy bleeding or flooding is part of the picture.
For deep, stubborn pain and adhesions
When endometriosis has been present for a long time and the pain is severe, stronger blood-moving herbs may be needed. San Leng (rhizoma sparganii) and E Zhu (zedoary) are traditionally used to address what Chinese medicine calls ‘masses’ — which maps loosely onto the adhesions and deeper lesions characteristic of long-standing endometriosis. These herbs are used judiciously, as part of a broader formula, and only where the pattern clearly calls for them.
How formulas are prescribed
A complete formula typically combines 8–12 herbs, selected and proportioned for your specific constitution and presentation. Formulas may change depending on where you are in your cycle — the days before and during your period often call for a different emphasis than the two weeks after, when the focus shifts from moving blood and relieving pain to recovery and rebuilding.
All herbs are sourced from TGA-approved, quality-tested suppliers. No herbs are prescribed without a thorough initial consultation, and formulas are reviewed and adjusted at each appointment as your pattern evolves. If you would like to understand how acupuncture and Chinese medicine might fit into your treatment picture, and to get your own prescription, I’d love to hear from you – Book a consultation.
As an AHPRA-registered practitioner, I note that herbal medicine is prescribed as complementary support. I take a full medication history at your first appointment and am trained in herb–drug interactions and contraindications.
Written by Dr Mary-Jo Bevin (TCM) | AHPRA-registered Doctor of Chinese Medicine | 20+ years clinical experience in women’s health | Windsor, Melbourne.
References
1. Guo Y, et al. Pharmacological properties of Angelica sinensis (Dang Gui): a comprehensive review. Phytomedicine. 2021;85:153523. https://doi.org/10.1016/j.phymed.2021.153523
2. He S, et al. Paeoniflorin: pharmacology, toxicity and pharmacokinetics. Phytomedicine. 2022;107:154467.
3. Qin Y, et al. Guizhi Fuling pills combined with dienogest for endometriosis: meta-analysis. Medicine. 2024;103(49):e40528.
4. Liang Z, et al. Panax notoginseng saponins and endometriosis: mechanisms of action. J Ethnopharmacology. 2023;304:116080.
