Traditional Chinese medicine Bak Foong Pills alters uterine quiescence – Possible role in alleviation of dysmenorrhoeal symptoms

Abstract

Since contractility of the uterus appears to be the major source of pain during dysmenorrhoea, alleviation of the contractions is believed to be a possible treatment strategy. Bak Foong Pills, a traditional Chinese formulation for use in gynaecological disorders, has long been thought as effective in the treatment of dysmenorrhoeal symptoms. The present study thus aims to investigate whether ethanol extract of Bak Foong Pills (BFP-Ex) or its constituent herbs may have direct effects on alleviating dysmenorrhoeal symptoms by altering uterine tone. This was investigated using isolated uterine preparations and intracellular messenger analysis of adenylate cyclase, via [(3)H]-adenine assay, and calcium, with fluorometry imaging, in myometrial cultures. BFP-Ex can stimulate uterine relaxation following oxytocin-induced contractions ex-vivo. Attempted inhibition of BFP-Ex's relaxatory response with a nitric oxide inhibitor and adenylate cyclase inhibitor, however, had no significant effect, suggesting that most of BFP-Ex's relaxatory response was not due to increases in NO or cAMP. Further studies on tetramethylpyrazine (TMP), a major active ingredient of BFP-Ex, indicated that TMP could modulate intracellular calcium levels in favour of uteri relaxation. The ability of Bak Foong Pills to alleviate menstrual pain may be due to direct regulation of uterine tone.

Bak Foong pills combined with metformin in the treatment of a polycystic ovarian syndrome rat model

“…The herbs were reasonably combined, and this prescription may adjust the dysfunction of the 'kidney-Tiangui-Chongren-uterus' axis from a whole aspect (26), thus reducing the androgen level, promoting the follicular development and improving the ovulation disorders. The therapeutic mechanisms may include three aspects: Firstly, the TCM acts on the ovary, regulating the functions of the hypothalamus-pituitary-ovarian axis; secondly, it acts on the adrenal gland, regulating the hypothalamus-pituitary-adrenal gland axis; and lastly, its active ingredient, ligustrazine, acts on the uterus, regulating the endometrial fluctuation rhythm, aiding in the recovery of menstruation and embryo implantation (31,32).…”

Bak Foong Pills induce an analgesic effect by inhibiting nociception via the somatostatin pathway in mice

“…Acetic acid-induced writhing in male C57 mice following subchronic treatment with BFP or somatostatin antagonist, c-som *P,0.05, significant difference compared with the vehicle-treated group (n54). Interestingly, despite the possible involvement of reproductive hormones, oestrogen and progesterone, in mediating the anti-dysmenorrhoeal effect of BFP as previously indicated (Rowlands et al, 2009), oestrogen, progesterone or oxytocin receptor mRNA levels were unaltered in spinal cord following BFP treatment. Centrally acting analgesics, such as morphine and clonidine, can also reduce acetic acid-induced writhing without decreasing prostacyclin production, perhaps indicating the involvement of inhibition of centrally acting pain pathways (Doherty et al, 1987).…”

“…The reported anti-dysmenorrhoeal effects of BFP have so far been attributed to the hormonal influences of oestrogen and progesterone, and also the apparent ability of BFP and its component herbs to influence uterine contractility (Rowlands et al, 2009). However, another major factor in the aetiology of the condition is increased perception of pain experienced during menstruation.…”

“…The use of BFP (Bak Foong Pills), which consists of some 20 herbal constituents (see Gou et al, 2003, for full list) as a traditional anti-dysmenorrhoeal in China, is common, with anec-dotal evidence suggesting that it is effective in reducing menstrual pain. As mentioned in our previous publications, BFP may work via stimulating production of oestrogen or progesterone, or may indirectly alleviate abdominal pain via relaxation of the uterus through genomic mechanisms (Rowlands et al, 2009). Indeed, the use of oestrogen in the form of the combined oral contraceptive to treat dysmenorrhoeal pain is also well documented, oestrogen being known to alter the perception of pain and uterine quiescence (Rowlands et al, 2009).…”

“…As mentioned in our previous publications, BFP may work via stimulating production of oestrogen or progesterone, or may indirectly alleviate abdominal pain via relaxation of the uterus through genomic mechanisms (Rowlands et al, 2009). Indeed, the use of oestrogen in the form of the combined oral contraceptive to treat dysmenorrhoeal pain is also well documented, oestrogen being known to alter the perception of pain and uterine quiescence (Rowlands et al, 2009). But there is no evidence of BFP having a direct hormonal action (Wise, 2002;Aloisi, 2003;Czlonkowska et al, 2003).…”