Adenomyosis (AM) is a refractory chronic gynecological disease characterized by menorrhagia, dysmenorrhea, uterine enlargement, and reduced fertility. In severe cases, it may lead to infertility.1 Pathologically, it is defined by the invasion of endometrial glands and stroma into the myometrium, predominantly in a diffuse pattern. Histologically, the uterine wall exhibits significant thickening and hardening, with thickened muscle fiber bands and microcystic formations. Recent studies have indicated that various pathological changes—including abnormal structural and functional alterations in the myometrium, changes in endometrial characteristics, localized uterine inflammatory reactions, and immune dysfunction—may individually or collectively contribute to infertility. Among these, alterations in endometrial receptivity have emerged as a critical challenge in the field of assisted reproductive technologies.2 Epidemiological data reveal that as modern women delay their first pregnancy, the incidence rate of adenomyosis among younger patients has significantly increased.3 This trend toward earlier onset exacerbates the dual threat of the disease to women’s reproductive health: physiologically, progressively worsening dysmenorrhea severely impairs quality of life; psychologically, patients with adenomyosis are more susceptible to symptoms such as anxiety and depression compared to the general population.4 Given the multiple detrimental impacts of adenomyosis on women's health, it poses an increasing burden on both patients and society. Consequently, it is imperative to conduct further therapeutic research and optimize clinical management strategies for this condition.

Currently, hysterectomy remains the sole definitive curative intervention for adenomyosis. However, given that most women retain reproductive desires, conservative treatment is the preferred approach in clinical practice. This includes non-steroidal anti-inflammatory drugs (NSAIDs), gonadotropin-releasing hormone agonists (GnRH-a), the levonorgestrel intrauterine sustained-release system (LNG-IUS), dinoprostone (PGE-2) , short-acting contraceptives, and other therapeutic modalities. Nevertheless, evidence indicates that hormonal therapies exhibit notable limitations, including a high recurrence rate and diverse adverse effects, such as gastrointestinal disturbances and hypoestrogenemia.5 Consequently, an increasing number of scholars in traditional Chinese medicine (TCM) have turned their attention to exploring novel therapeutic approaches for adenomyosis in recent years. These efforts aim to alleviate patient symptoms, reduce pain, and decrease infertility rates, thereby providing a more comprehensive solution for preserving women’s reproductive and mental health.

Modern TCM scholars classify the clinical manifestations of adenomyosis (AM) using TCM terminology, including “dysmenorrhea,” “menorrhagia,” and “infertility.” TCM offers a unique perspective and therapeutic benefits in the treatment of adenomyosis, identifying blood stasis as the primary pathogenesis. Clinically, adenomyosis is often characterized by a prolonged and refractory course. The renowned Qing Dynasty physician Ye Tianshi proposed, “Initial disease resides in the meridians; chronic disease penetrates the collaterals.” This theory is applicable to the clinical treatment of adenomyosis. The collaterals branch off from the twelve primary meridians in the limbs, gradually becoming finer as they extend inward to deep tissues and outward to the skin surface.6 They interweave to enhance the connection between exterior and interior qi and blood, forming a network-like structure that permeates the organs and tissues, including the uterus. This intricate system tightly links various organs and facilitates the transport of qi, blood, and body fluids to the organs and muscles. When the collaterals are obstructed, pathological substances can block the meridians, resulting in pain, which may manifest as dysmenorrhea. Furthermore, obstruction of the collaterals and impaired blood flow can lead to menorrhagia. The nutrients, including qi, blood, and body fluids, are transported and distributed to the viscera and muscles through the collaterals. Meanwhile, the qi, blood, and body fluids within the viscera and muscles can also permeate into the meridians via the collaterals. This cyclical process is essential for maintaining the normal physiological functions of the human body. In Traditional Chinese Medicine (TCM) theory, the physiological roles of the collaterals in material transport and metabolic exchange bear a striking resemblance to the microcirculation system in modern medicine. Microvessels serve as the primary sites for material exchange between blood and tissues, supplying energy and adequate oxygen to surrounding cells. Research has demonstrated that the process of endometrial invasion into the myometrium is consistently correlated with abnormal vascular growth, and the capacity for endometrial vascular proliferation in patients with adenomyosis exceeds that of normal endometrium.7 Treatment strategies based on the theory of collaterals offer innovative perspectives and approaches for the diagnosis and management of adenomyosis. By employing methods to remove stasis and unblock collaterals, the meridians are cleared, stasis is eliminated, and qi and blood are harmonized, effectively alleviating dysmenorrhea and menorrhagia in patients with adenomyosis (AM). To our knowledge, no cases of AM patients who found adopted a combined treatment of acupuncture and herbal medicine from traditional Chinese medicine have been reported.

In this case, we present a patient with adenomyosis whose treatment, which combined both internal and external therapies of Traditional Chinese Medicine, successfully alleviated dysmenorrhea and systemic symptoms.