PCOS -Traditional Chinese Medicine

Introduction

This article attempts to inform the reader of the causes and manifestations of PCOS and treatment options for those afflicted with this disorder.  Western and Chinese medical treatments will be discussed.  I have tried to explain the terms and concepts presented here in terms that are understandable to the lay person. This article will also be helpful to the acupuncturist/herbalist who is treating patients with this disorder who wish to conceive. If clarification or further explanation is sought, I would be pleased to take your questions. I may be reached at 212-685-0985 or you can email me at acumike@nyct.net.

Through the integration of Western and Chinese medicine the PCOS patient wishing to conceive will have higher success rates than those achieved when using one type of intervention only.  This East meets West approach offers new hope to those whose fertile wellness has been compromised by PCOS. Many patients with PCOS were able to regain regular menses, ovulation, and full term pregnancy.

I have created specific acupuncture and natural herbal medicine protocols for the treatment of PCOS and they will be discussed here. I have not added the quantity of herbs to be used in the formula that I have created because I want, at all costs, to prevent patients from self-medicating because this can be dangerous. The prescription which I present is for illustrative purposes only.

Another thing that I want to be clear about is this: pattern differentiation (diagnosis), is of paramount importance in traditional Chinese medicine. In traditional Chinese medicine there is usually no direct Western diagnostic analogue.  Practitioners of TCM diagnose disorders based on presenting signs and symptoms not just based on the presenting disease. This means that though many patients may present with PCOS for treatment, they all may have different diagnoses according to traditional Chinese medicine. Here is an example of why: there are obese PCOS patients and those with normal body weight. There are those with insulin resistance and those without. There are those who are completely amenorrheic and those than menstruate occasionally. So, how can each of these very different patients be treated with the same acupuncture points or the same herbal medicine prescription? Yet they all  have PCOS.

There are even more complex cases which involve multiple pathologies. For example, the PCOS patient with chronic migraines or the PCOS patient with severe facial hirsutism, or the PCOS patient with blocked fallopian tubes. There are multiple and varied types of presentations and therefore there are multiple and varied treatment approaches.

Though I completely believe in, trust, recommend and value Western medicine, the Western medical approach, though often effective is frequently over-simplified.

For example, every PCOS patient who is trying-to-conceive gets treated with clomid no matter the differentiating factors between patients. 

Traditional Chinese medicine is extremely elegant and empowers the practitioner to exactly address each and every part of the patient and their illness including the emotional aspect. 

Not only are there herbs and acupuncture points that can be employed to address the depression and anxiety that often accompany those facing this and other health challenges, but the doctor of traditional Chinese medicine himself or herself is imbued with healing love and a nurturing soul and is always prepared to bestow this upon his or her patient. The relationship between practitioner and patient is, in and of itself clinically valuable.

Diagnosis according to Traditional Chinese medicine

Each patient is diagnosed according to the ‘Four Examinations’ and the pattern differentiation derived from it; not according to their disease. 

In traditional Chinese medicine, typically, diseases are not treated, but ‘patterns of disharmony’ are. PCOS is a ‘disease’. So, in treating ten women with PCOS, they may all receive different treatment protocols because even though their disease is the same, they may, nonetheless, have ten different patterns of disharmony. This is why ‘one-size-fits-all’ never works in Chinese medicine and generally speaking just doesn’t work clinically.

The clinical expression of this is that an herbal formula ‘in a bottle’ is the worst way to take herbs. This type of herbal remedy cannot be customized for the ‘pattern of disharmony’ being treated and therefore is completely antithetical to the tenets of treatment according the TCM (Traditional Chinese Medicine).

The ‘Four Examinations’ consists of 1) Listening and smelling; 2) Palpating;  3) Observing; and 4) Questioning. 

A. Listening and smelling refers to listening to the timber, strength, speed and clarity of the patient’s speech. Smelling refers to smelling of the breath and of the vagina for foul odors, the existence of which would indicate disease.

The ‘smelling’ aspect is a diagnostic tool which is not usually performed in modern times.

B. Palpating means palpating the pulses of the patient which can reveal insight into the patient’s systemic health.  Palpating also refers to the palpation of parts of the body which may correspond to areas of ill health to help the practitioner to be as accurate as possible in determining what the underlying cause of the main complaint is. For example, if a patient complains of abdominal pain at the right lower quadrant, and upon palpation there is an elicitation of extreme pain, the patient should be referred out to a physician to rule out appendicitis. 

C. Observing refers to the overall observation of the patient including their gait, posture, skin, eyes, hair, whether they make eye contact during the interview and everything else that can be observed. It is amazing what can be learned by careful observation. 

As the practitioner of TCM does not rely on blood work to arrive at a differential diagnosis, an expertise in doing a proper intake is of paramount importance. Further, I am of the opinion that utilizing the Four Examinations in conjunction with information obtained from Western diagnostics allows the practitioner to arrive at the most accurate diagnosis, and thereby, facilitate the best treatment options. 

Let’s use this brief case review as an example:  A patient arrives to her acupuncturist with the main complaint of infertility. She is 24 years old, weighs 105 pounds, is 5’ 3” tall and appears healthy. Her main complaint is primary infertility of 2 years duration and her husband is negative for any sperm anomalies. The acupuncturist, can, of course, through a good intake, arrive at a differential diagnosis but knowing that the patient has PCOS based upon either biological information (for example, an LH to FSH ration of 3:1), or physical findings (polycystic ovaries) derived via an ultrasound will make the acupuncturist’s job easier and will help to refine the acupuncturists diagnosis and treatment plan.  This is why, when being treated for infertility you must choose an acupuncturist who has Western medical knowledge as well as Chinese medical knowledge. 

PCOS

Estimates of the prevalence of PCOS in the general population are approximately 20% to 33%. 

Some of the signs and symptoms of PCOS include irregular periods, obesity, hirsutism, acne, and abnormalities of biochemical profiles including elevated serum concentrations of luteinizing hormone, testosterone, and insulin resistance. Insulin is a hormone that is produced by the beta cells, which are pancreatic cells. Insulin is primarily involved in  metabolism (control) of carbohydrates (sugars and starches), lipids (fats), and proteins.

Insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin. As a result, higher levels of insulin are needed in order for insulin to have its effects.  When there is insulin resistance, there is a good chance that obesity will follow as sugars and fats are not properly metabolized.

PCOS is an interesting disorder in that it is truly a ‘spectrum’ syndrome. This means that one can be mildly affected or severely affected.

Weight gain is associated with a worsening of symptoms while weight loss reduces the endocrine and metabolic profile and symptomatology. 

Raised serum levels of LH and testosterone, in conjunction with low or normal levels of follicle stimulating hormone describe an endocrine profile which is diagnostic of PCOS.

The physical diagnosis of PCOS is achieved by transabdominal ultrasound revealing a polycystic ovary which contains in one plane at least 10 follicles usually between 2 and 8 mm in diameter. But, a diagnosis can be made by biological findings in the absence of physical ones. Women who have normal ovarian morphology in the face of elevated androgen levels and an LH to FSH ratio of 3:1 can be diagnosed with PCOS in spite of the fact that ovarian morphology is normal.

The term polycystic ovaries should really be called poly-follicular-ovaries to reflect a finding that the cysts are actually follicles whose development has been arrested.  

 

 

 

Health Consequences of Polycystic Ovary Syndrome

Obesity and metabolic abnormalities are recognized risk factors for the development of ischemic heart disease in the general population and these are also recognized features of PCOS. 50% of the time the individual with PCOS presents with a normal (body mass index), BMI.

Normal weight equals a BMI of between 18.5 and 24.9; overweight equals a BMI of between 25 and 29 and obesity is represented by a BMI of 30 or greater. 

You can find out what your BMI is by ‘Googling’ the term BMI. Various BMI calculators are available on the web.

Obesity worsens both symptomatology and the endocrine profile, so obese women (women with a BMI greater than 30) should be encouraged to lose weight by a combination of caloric restriction and exercise, acupuncture and herbal medicine.

Weight loss improves the endocrine profile and the likelihood of ovulation and a healthy pregnancy. Insulin sensitizing agents such as Metformin are typically used in the management of PCOS. 

Women who are characterized by the presence of insulin resistance, central obesity and dyslipidemia (disorders in the lipoprotein metabolism; classified as hypercholesterolemia), and low levels of high density lipoprotein (HDL) cholesterol, are predisposed to premature atherosclerosis (clogging, narrowing and hardening of the large arteries and medium-sized blood vessels), and appear to be at a higher risk of developing diabetes as well as cardiovascular disease. 

The prevalence of hypertension is three times higher in women with PCOS. Woman between the ages of 40 and 59 years old women with PCOS have high concentrations of serum triglycerides and suppressed HDL.  The management of women with PCOS should be focused on the patient's particular symptoms. 

 

 

 

 

 

 

 

 

 

 

 

 

Western medical diagnosis

There are three different ways to make the diagnosis of PCOS

1. Symptomatically

Irregular or absent menstrual cycles.  PCOS patients may report to a physician for lack of menses or extremely variable menstrual cycles.  Hyperandrogenic symptoms such as acne and hirsutism are the hallmark symptoms of PCOS. Fifty percent of PCOS patients are not obese.

2. Hormonally

Laboratory testing is important for diagnosis, but it is crucial to look at multiple values collectively. Blood testing is performed and the results are compared with known normal levels.  In the classic PCOS patient there is a 3:1 LH-FSH ratio. The normal ratio is 1:1.  Typically, there are also elevated androgen levels present.

3. Ultrasound:

Ultrasound of the pelvis is typically performed when the clinician suspects PCOS.

If more than10 cysts are found in either ovary that are less than 10mm, this meets the ultrasound criteria for PCOS. Furthermore, polycystic ovaries are typically 1.5 to 3 times the normal size.  

Just the presence of polycystic ovaries, without symptoms and/or corroborative biologic findings does not confirm a diagnosis of PCOS.

Some individuals will have abnormal findings in all three categories, (symptoms, hormonal values and positive ultrasound) some in only two, and others in just one. The classic findings for PCOS are menstrual cycle abnormalities, increased hair growth, and obesity. Patients typically seek medical care for the menstrual cycle irregularities, infertility, problems of self-esteem arising from obesity, and excess hair growth.

PCOS is relatively common and seen in approximately 6-10% of all females. This equates to almost 5 million American women. Between 5 and 30% of women have some characteristic of PCOS.  This is one of the most common hormonal abnormalities in women of reproductive age and is a leading cause of infertility.

Impaired fertility is a prominent feature of PCOS. This is believed to result from elevated insulin levels that stimulate excess androgen production by the ovaries. This hyperandrogenic state causes premature follicular wasting which causes inconsistent or absent ovulation.  

 

The pathway to deteriorating ovarian function looks something like this: 1) high insulin à

2) elevated androgens  à 3) premature ovarian wasting.

Since we will be discussing this syndrome from the perspective of traditional Chinese medicine in large part, I think some definitions of Chinese medical/philosophical terms would be helpful.

Yin represents night, winter, female, cold, heavy, dark, downward and inward, stasis, receptive, yielding, phlegm, and dampness.

Yang represents day, summer, male, heat, light, upward and outward, motion, dryness.

Yin and yang in the human body may be represented thusly: yang: exterior, the back, bowels, skin and body hair, the immune function, agitation and strength while yin may be seen as the interior and abdomen, viscera, bones and sinews, blood and body fluids, calmness and weakness. 

There are volumes written on the meaning of yin and yang and on the inseparable relationship of the two. For the purpose of this article I feel that this basic information will suffice as a primer. These definitions will come be helpful later on in this discussion.

There are several theories as to what causes PCOS.

First, women with PCOS usually have an increase in LH secretion from the brain. An elevated LH promotes secretion of androgens from the ovaries. In turn, the increased androgen production causes wasting of the developing ovarian follicles and interferes with the production of a dominant follicle.

From a Chinese medicine perspective this state can be referred to as an excess of yang as androgen is a male hormone. Though it is normal that woman have androgen, (yang within yin), an excessive amount represents an imbalance. This underscores the fact that there is always yang within yin and yin within yang, but in the PCOS patient, there is too much yang within yin and therefore a state-of-disease as a result of imbalance manifests. This results in a disruption of normal estrogen (yin) production by the ovaries and the absence of a mid-cycle LH (yang)surge.   

One part of the TCM diagnosis of PCOS is termed: ‘damp accumulation with phlegm congealing’. Damp and Phlegm are yin type pathogens. 

There are other diagnoses in TCM for the PCOS patient based upon pattern differentiation. For example, a PCOS patient who is somatically normomorphic and whose Western diagnosis of PCOS is based upon the biological finding of hyperandrogenism with normomorphic ovaries would not constitute a patient with a diagnosis of Phlegm-Damp syndrome.

Normally, an egg is released from the dominant follicle, but in PCOS, the follicles do not mature properly and instead, develop into ovarian cysts.

According to the theory of traditional Chinese medicine, the kidneys dominate the marrow which fills the brain(this is not  bone marrow), which is where LH is produced. ‘Marrow’ may refer to the functional activity of the brain itself. Thus, energetically, if the kidneys are not functioning properly, this can be causative of increased LH secretion.

Some of the signs and symptoms of Kidney deficiency according to the theories of traditional Chinese medicine(TCM), are chronic lower back ache, frequent urination, urinary incontinence, urinary dribbling, night sweats, hot flashes, craving for salty foods, poor memory, knee pain or weakness which is not related to trauma, ringing in the ears, low libido, feeling cold frequently, especially at the feet, having dark circles under the eyes which are not related to sleep deprivation or heredity, and are not related to allergies and, having undigested food in the stool. It is not necessary to have all of these signs or symptoms to be categorized as a ‘kidney deficient’ patient.

And kidney deficiency can relate to deficiency of kidney yin, yang, qi or essence. Qi can be loosely defined as energy. Keep in mind that entire books can be written about qi in all its manifestations, permutations, functions and pathologies and to define it as I have is a gross oversimplification of its magnitude; but, for the purposes of this article I think that my definition is acceptable. Essence (also oversimplified here) may be loosely defined as sperm in men and the substance in women known as tian gui, which, when commingled with sperm is responsible for fertilization. I suppose a loose anatomical analogue may be the ooctye, or egg in women.

Hypofunctioning of organ systems in traditional Chinese medicine usually refers to the energetics of the organ(s) in question as opposed to pathology of the organ itself. Kidney deficiency can negatively impact the proper functioning of neuro-hormonal pathways in the brain. According to the theory of TCM, the kidneys are one of the most important organs involved in reproduction. One can make the case theoretically that in every single case of infertility there is a probability of some type of underlying kidney deficiency.

In TCM theory there is a pathological substance referred to as ‘phlegm’. This is not the phlegm that we think of when we have a bronchial infection or a bad cold. There are two main categories of phlegm in TCM: visible and invisible. Visible phlegm can be phlegm causing breast lumps or phlegm spit up by one suffering with a bad cold or having a lipoma. Invisible phlegm is that which can cause severe mental disorders, PCOS, fibroids and other pathologies. Phlegm is a gooky, sticky, viscous obstructing substance which, over time can harden and transform into hard nodules or, can remain soft and present as masses which are not hard but are, nonetheless extremely viscous.   It is caused by ‘dampness’ accumulating over a long period of time. Dampness comes from normal fluids or humors in the body that are not metabolized appropriately and start to ‘pool’ and congeal. 

A Western biomedical analogy is insulin resistance unable to metabolize carbohydrates and fats which, if left untreated will cause morbid obesity or, according to the language of traditional Chinese medicine, will contribute to the accumulation of phlegm-damp. In Chinese medicine the function of the pancreas is subsumed by the Spleen. It is the spleen, which, when hypofunctioning produces obesity and it is the pancreas, which, when hypofunctioning produces obesity. This is a beautiful example of how Chinese and Western physiology often converge.

Dampness is also blocking and congealing, but less so than phlegm.  Dampness, if left untreated, will, over time, transform into phlegm. A good visual example of phlegm can be thought of as leaving a bowl of bacon fat over-night. When the bacon fat is first poured in the bowl it is thick and viscous but can still move; but, when examined the next day it has transformed into a hardened substance. This journey from thick and viscous to ‘hardened’ can be thought of as the process of damp transforming into phlegm. Some examples of phlegm in the TCM sense are fibrocystic breasts, uterine fibroids, goiter, lipomas, pituitary micro and macro adenomas and polycystic ovaries. 

Each organ according to TCM theory has, what is referred to as a channel or meridian which traverses both the interior and exterior aspects of the body. The internal meridian of the liver surrounds the uterus and the ovaries.  So, one part of the diagnosis in TCM for PCOS is: phlegm congealing in the liver channel.  One of the physical manifestations of phlegm congelation in the liver channel is polycystic ovaries.   

One of the ‘responsibilities’ of the kidneys is to transform and transport (metabolize) fluids in the lower part of the body. The lower part of the body coincides with the anatomical area in which the ovaries are situated. So, now we can build further upon the original diagnosis of phlegm congealing in the liver channel by adding ‘kidney qi vacuity’.  Qi here refers to the energy or functionability of the kidneys. If the kidneys are ‘vacuous’ or hypofunctioning they will not be able to transform and transport (metabolize) fluids in the lower part of the body and thus, dampness will accumulate and transform into phlegm.  

Further, kidney qi vacuity with accumulation of phlegm-damp can directly affect the function of the hypothalamous and pituitary via the kidney channels’ connection with the Du mai (another acupuncture meridian) which enters the brain directly at the acupuncture points Du16 and Du20. These acupuncture points are located at the upper neck(sub-occipitally), and at the top of the head respectively.

Additionally, as Kidney yin fails to nourish Liver Blood, the qi of the liver can stagnate. Stagnant liver qi can contribute to the accumulation of dampness and phlegm because the qi of the liver is responsible for, among other things, the free flow of qi. If qi is ‘stuck’, fluids will pool and transform into dampness and, if left untreated, will transform into phlegm.

Another organ which is responsible for metabolism of fluids is the spleen. If the spleen is imbalanced, this too can create an accumulation of dampness. Since the ‘nature’ of dampness is ‘heavy’ it will eventually sink downwards in the body.  In TCM, each organ promotes the function of another and each organ also has a controlling ability on another organ. For example, the spleen ‘controls’ the kidneys. If the spleen cannot control the kidneys then the kidneys won’t function properly resulting  in water ‘overflowing’, pooling, and transforming into dampness which, if left untreated, will eventually congeal into phlegm in the pelvic/reproductive environment as this is the area that the Kidneys dominate.

Yang qi is the energy which is responsible for any functional activity in the body. It is warm in nature. The yang qi of the kidneys supports the yang qi of the spleen. If the yang qi of the kidneys is vacuous, so to, eventually will be the yang qi of the spleen.

Thus, one can see that dual vacuity of spleen and kidney yang qi is almost inevitable if the kidneys remain vacuous for a long period of time. As the nature of yang qi is warm, its vacuity will create an excess of cold in the body.  As cold contributes to constriction,(what happens when a glass of water is left in the freezer?), the presence of inappropriately abundant cold can cause obstruction and congealing of fluids which will contribute to the production of damp and phlegm. According to the theory of Chinese medicine, there is something referred to as the ‘sheng’ or the ‘promoting’ cycle of the organs. This means that each organ promotes the function, dynamics and health of another. The promoting organ is known as the ‘mother’ and the organ being promoted is known as the ‘son’. The kidneys are the mother of the liver. Thus, one can see how when there is vacuity of either the kidneys alone or the kidneys and the spleen and dampness prevails and transforms into phlegm it can affect the liver channel and travel with the channel itself and end up congealing and congesting the ovaries in the syndrome  known as PCOS.  

Also, note that there is a branch of the liver channel which enters the brain and phlegm lodging and congealing in the brain can contribute to, for example, pathology in the pituitary gland which controls the release of, among other things, LH. 

Treatment Principles

Treatment principles are guiding treatment strategies. Without treatment principles, the practitioner is doing surgery in the dark! One TCM treatment principle for PCOS might look something like this: Fortify the kidneys, supplement the spleen, warm and invigorate yang qi; course the liver, quicken the qi, transform phlegm-damp, and scatter nodulation. The ‘nodulation’ mentioned here refers to the actual cysts.  

 

 

Case report

Ovulation After Acupuncture In PCOS Patient

EXETER, ENGLAND — A course of acupuncture was followed by ovulation in a 32-year-old woman with oligomenorrhea (irregular periods), and primary infertility of 6 years' duration, Dr. Jin Xu said at a health care symposium sponsored by the University of Exeter.

Before undergoing acupuncture, the patient had “very infrequent” menstrual periods, and transvaginal ultrasound revealed polycystic ovaries. The patient's luteinizing hormone to follicle-stimulating hormone ratio exceeded 3:1, as is typical in polycystic ovarian syndrome, and her testosterone level was elevated at 3.7 nmol/L.

Five daily sessions of electroacupuncture were performed on acupoints Guanyuan (Ren 4), Zhongji (Ren 3), Zigong (Extra 16), and Sanyinjiao (Sp 6), said Dr. Xu of the University of Oxford (England). Each acupuncture session lasted 25 minutes.

After the course of acupuncture, endometrial thickness increased from 4.5 mm to 8 mm by day 16, and a menstrual bleed was induced, Dr. Xu said.

Treatment was repeated in the next menstrual cycle, and the patient subsequently began to have regular periods. Three months later, she conceived and delivered a healthy baby girl at term, Dr. Xu said.

“It is likely that the hypothalamic-pituitary-ovary axis is involved in acupuncture-driven ovulation induction, but the mechanisms involved remain unclear,” he said.

Limited research has been conducted in this area, and it is unclear whether an actual effect on ovulation exists, Dr. Xu cautioned, adding that a clear need exists for randomized, controlled trials.

Another theory regarding the cause of PCOS is believed to be associated with insulin resistance (the cells cannot normally utilize insulin for glucose uptake). Insulin is the hormone that regulates the body's sugar (glucose) levels. With insulin resistance, cells are not as sensitive to insulin and it accumulates in the bloodstream resulting in a condition called hyperinsulinemia.

In PCOS, hyperinsulinemia contributes to excess androgen production within the ovary which causes follicular wasting and anovulation. The elevated androgen levels also contribute to common symptoms of PCOS like acne and hirsutism.  

 

 

 

TCM Explanation of Signs and Symptoms associated with PCOS

Irregular or Absent Periods

From the Chinese medicine perspective, oligomenorrhea or amenorrhea can be caused by stagnation of liver qi. Liver qi is responsible for the free flow of qi. Qi is the ‘commander’ of blood. If qi is stuck, blood has no impetus to move and amenorrhea can ensue. Having a presentation of phlegm-damp congealing and obstructing can be causative of stuck qi as anything ‘blocking’ the flow of qi (energy) will eventually cause stagnation. 

Lack of Ovulation

Ovulation is an activity which requires energy. Energy is yang in nature. Deficiency of kidney yang can be causative of annovulation.  It is the yang energy of the kidneys which facilitates the yang energy of the spleen to produce blood. The spleen is responsible for the post-heaven creation of qi (energy) and post-heaven creation of blood. Post-heaven refers to the state of being ex-utero; in-other-words ‘once one has been born’. The kidney yang that we all possess comes from our parents and so, we frequently see women with annovulation or oligoovulation whose mothers also experienced similar problems. So, one can say that the strength or weakness of one’s fertile wellness stems in part at least from the health and wellness of the kidney’s (yin and yang) of the parents.

Infertility

There are many causes of infertility and miscarriage due to both female and male factors. From the TCM perspective the three main organs involved in the pathomechanism of infertility and repeated miscarriage are the kidneys, liver and spleen. The heart also plays a major role as well.

It is beyond the scope of this article to completely analyze and explain all the pathomechanisms of these organs insofar as how they relate to infertility.   However, I will touch upon a few: the spleen is the organ responsible for the creation of qi (energy) and blood. Blood relates not only to the ‘physical’ aspect of blood but also to its function.  This, in Chinese medicine terms is referred to as ‘substantial’ blood and ‘insubstantial’ blood. Substantial blood referring to the actual substance and insubstantial blood refers to the function of blood. The function of blood includes nourishing, moistening, and cooling.  Nourishing means to nourish the organs as well as the hair, eyes, tendons, sinews, bone and muscles. If blood is deficient or if it is not circulating properly, it’s functionality will be impeded. Inability of an embryo to implant due to a thin endometrium (<5mm) can be attributed to the Chinese medicine ‘pattern of disharmony’ know as ‘vacuity of blood’. 

The Liver is responsible for the free flow of ‘qi’. As qi is the ‘commander’ of blood, if qi is stagnant (due to stress, obesity, depression, injury, chronic emotional upset, dampness, phlegm, or deficiency of other organs) it will not be able to ‘move’ the blood which can end up causing blood stasis. Blood stasis when translated into Western medical terms presents as endometriosis, blocked fallopian tubes, polyps, fibroids, tumors, or thrombophilic disorders such as antiphopholipid syndrome, Lupus like anticoagulant, Factor V Leiden, Protein C and Protein S deficiencies and plasminogen activator inhibitor insufficiency, etc.

The kidneys as mentioned previously are extremely important from the perspective of conception.

The Kidneys promote and nourish the liver, (the liver is the son of the kidney and its function is dependent on the health of its mother) therefore, deficiency of the energy of the kidneys will, over time, necessarily mean that the liver will not be nourished and will hypofunction and not be able to move the qi which moves the blood which will contribute to clotting issues (thrombophilias). Thrombophilas are blood clotting disorders which can contribute to infertility and/or repeated pregnancy loss.

Kidney ‘yin’ is the energetic aspect of the kidneys which is cooling, moistening and nourishing. For example, women with kidney yin deficiency are those who, at a younger age than is appropriate, present with a lack of cervical mucous, or present with night-sweats and/or hot-flashes.  These are considered ‘heat’ signs in TCM. Additional examples of kidney yin vacuity, ‘empty heat’ are early periods (bright red blood), heavy menstrual bleeding and irritability and agitation and afternoon fever and chronic heat in the palms of the hands, the soles of the feet and at the center of the chest.  Premature ovarian failure manifests as a result of both yin and yang vacuity. Kidney yang vacuity prevents the spleen yang from producing enough qi and blood which thus cannot stimulate and/or the ovaries.

Inappropriate heat will, over time, negatively impact the quality of the blood causing its evaporation similar to the effect of leaving a pot of water on a low flame for several days. Eventually, the water will evaporate.  

Obviously, kidney yin deficiency heat will not completely evaporate ones blood but will negatively impact the function of the blood to the extent that circulation will be impeded and, as a result will negatively impact the quality of the lining and the quality of eggs due to reduced delivery of oxygen, hormones, excretion of debris and lack of the other nourishing qualities which blood provides.  

 

 

 

 

Weight gain

Excessive weight is considered to be a ‘dampness’ syndrome. The lungs, spleen and kidneys are the most important organs involved in water metabolism. Each organ according to TCM has functions, responsibilities and even emotional attributes associated with them. The emotion associated with the lungs is grief. It is not uncommon to see someone who has experienced a lot of grief in their life to be overweight. One reason is that the lungs will hypofunction and therefore, will not metaboloize fluids properly and water-dampness will accumulate, and, will over time, transform into phlegm. The biomedical definition of this is morbid weight gain. As mentioned above, each organ promotes the health and vital functionality of another. The lungs promote the kidneys which are also very much involved in the metabolism of water particularly in the lower part of the body. 

When the lungs are under-functioning over a long period of time, it is most likely that the kidneys will also under-function contributing further to the accumulation of damp and phlegm. The yang qi of the kidneys is the motive force for the function of the spleen. It can be thought of like this: the spleen is the pot of water and the kidneys are the fire. If the kidney fire or yang qi is vacuous, then the spleen will not function properly, contributing to the onset of obesity. It is easy to see how one’s overall systemic health will affect the health or lack thereof of one’s fecundity.

Hyperandrogenism can be caused by excessive amounts of circulating luteinizing hormone and can cause acne, male-pattern balding, and hirsutism. 

In fact, PCOS is often referred to as hyperandrogenism accompanied by chronic anovulation.

Masculinization results from the effects of either increased androgen production or enhanced androgen use by target tissues. Blood vacuity often leads to an excess of yang as blood is yin in nature. Yang is masculine, yin is feminine, so, with a deficiency of the feminine nature, one can see how the PCOS patient can present with hirsutism or masuclinization.

Menstrual Irregularity and Infertility

Hyperandrogenism is often associated with chronic anovulation that results in menstrual irregularity (Hull, 1987).  

Hyperandrogenism probably has an impact on fertility in addition to its effect on ovulation. Many studies suggest a decreased conception rate in spite of induced ovulation, and some suggest an increased risk for spontaneous miscarriage in hyperandrogenic women (Balen et al, 1993; Franks, 1995). The mechanisms for this androgen action remain to be determined.  Once again, one can see how an imbalance of yin and yang can result in an altered state of health.

There is general agreement in the medical literature that the diagnosis of PCOS requires the presence of hyperandrogenism (elevated serum androgen levels or definitive clinical evidence of excess androgen effect) and chronic anovulation (fewer than six to nine menses per year) (Zawadski and Dunaif, 1992).   If yang qi is the energy that enables and promotes systemic function then with its deficiency, ovulation (which requires the warmth of yang and the function of qi) will frequently not occur. 

In most cases, women with PCOS are chronically anovulatory, but spontaneous ovulation and conception may occasionally occur.

Usually, menstrual irregularities persist from the time of menarche so that a regular pattern of menses is never established.   In the Classics of Chinese Medicine, written thousands of years ago it is stated: “When treating infertility, the first order of business is to regulate the menstrual cycle”. Acupuncture and herbal medicine are very effective in this regard.

Estrogen secretion in PCOS is derived from the ovary and the extragonadal aromatization (conversion) of androgens. (This is yang transforming into yin.) Estrogen production in PCOS is constant and is not cyclic as it is in the normal menstrual cycle.  This yin is not a physiologic or normal yin but really must be considered a pathogenic yin.

This results in a chronic, unopposed estrogenic effect on the endometrium that can result in endometrial hyperplasia, (Abnormal thickening of the endometrium caused by excessive cell growth), dysfunctional uterine bleeding, and endometrial neoplasia (abnormal cell growth) if left untreated (Jackson and Docherty, 1957).

Excess growth of hair on the face, chest, stomach, thumbs, or toes (Western medicine: masculinization occurs secondary to hyperandrogenism.

According to the theory of traditional Chinese medicine, in males, blood circulation in the upper area of the body is responsible for the production of facial hair and chest hair. In women, blood primarily flows downward to either nourish the fetus or to be released through menstruation or it travels upwards and is transformed into breast milk during pregnancy. In PCOS, since there is no downward flow of the tian gui, (above I defined tian gui loosely as the oocyte, but that definition falls short.) Tian gui can be thought of as the entire functional reproductive system in women. The initial sign of this system is the onset of menses. The menstruate is also part of the tian gui. When a women becomes pregnant, the tian gui is transformed into breast-milk. In the PCOS patient tian gui is not properly sufficient and breast milk is not being created, therefore, the blood innapropriately rebels upwards causing the growth of facial hair and occasionally chest hair.

Various organs ‘manifest’ in various parts of the body. ‘Manifests’ in this case means ‘responsible for a particular area of health or lack thereof on the exterior of the body. For example, the liver manifests in the nails, the spleen manifests in the lips and the heart manifests in the complexion.

I realize that I have given several definitions of tian gui. Please understand that in Chinese medicine, there can be many meanings attributed to one concept. Just as I said previously entire books can be written on the topic of qi. The same is true of the concept of tian gui), travels to the uterus from the heart via the bao mai. The bao mai is a special channel, the function of which is to convey heart qi and blood to the uterus.

According to the Nei Jing Su Wen (Inner Classic Simple Questions –one of the Classics in Chinese medical literature), “failure of arrival of menstruation is due to closure of the bao mai.” Therefore, menstruation proceeds unimpeded when heart qi and blood flow freely and reach the uterus unobstructed. This is one reason that women who are under severe stress or who experience a “broken heart” can become amenorrheic.

The bao luo is a channel which connects the uterus to the kidneys and enables the kidneys to deliver essence to the uterus. Kidney ‘essence’ is the substrate from which blood, along with other factors is derived. The Nei Jing Su Wen states: “The bao luo connect the kidneys to the uterus”.  Menstruation and the ability to conceive are dependent on blood coming downward via the bao mai and essence nourishing the uterus via the bao luo. 

But, due to phlegm-damp accumulation and ovarian distortion  (ovarian cysts),  heart blood counterflows to the face causing facial hirsutism on the one hand, and oligomenorrhea and anovulation on the other.

Acne, oily skin, or dandruff can be construed as dampness blocking and clogging the interstices of the skin causing a lack of proper elimination of toxins though the skin.

Patches of thickened and dark brown or black skin on the neck, groin, underarms, or skin folds which is known as acanthosis nigricans, and is a common characteristic of the PCOS patient is due to the TCM pattern of blood deficiency not nourishing the skin, causing parching and detriment to the fluids.  Biochemically, this occurs as a result of hyperinsulinemia.

PCOS can negatively affect fertility since it can prevent maturation of follicles and ovulation. According the TCM theory, the ovaries are mainly governed by the kidneys. The contents of the ovaries (the ovum) are yin but require activation (yang) for release (ovulation). Thus, kidney yang vacuity is the main culprit of annovulatory cycles in the PCOS patient.

Fertility enhancement

Clomid is one of the selective estrogen receptor modulators (SERM’s), that acts as an anti-estrogen and tricks the pituitary gland into producing more FSH, which, in turn, stimulates the ovary to produce more eggs and follicles.  Many patients with PCOS respond well to clomid and produce many follicles which is beneficial when doing an intra uterine insemination protocol.

Some research also shows that taking low doses of aspirin, which helps to improve hemodynamics (to the ovaries and uterine lining), can improve chances of pregnancy. Acupuncture has been shown to accomplish this as well, proven by observation of reduced uterine artery impendence when visualizing blood flow via a transvaginal ultrasound with a color doppler. This type of examination shows the actual blood flow quantitatively in the endometrium.

Eating a balanced diet low in carbohydrates and maintaining a healthy weight can help lessen the symptoms of PCOS. Regular exercise contributes towards weight loss and also aids the body in reducing blood glucose levels and contributes to a more efficient utilization of insulin.  

A treatment principle in traditional Chinese medicine for weight loss in the PCOS patient might look like this: ‘Fortify the spleen, supplement the kidneys transform phlegm and drain damp’.

Progestins -These medications mimic the action of progesterone (yang qi). Progestins may be used to regulate the menstrual cycle and reduce blood levels of LH. Unfortunately, they are of little benefit in reducing hair growth or metabolic abnormalities. Examples include medroxyprogesterone (Provera®, Cycrin®) and norethindrone acetate (Aygestin®).3

Oral Contraceptives -The ‘pill’ is an effective treatment for PCOS patients not wanting to become pregnant. Oral contraceptives decrease LH and regulate menses. The pill is also used to decrease symptoms associated with high androgen levels (acne and hirsutism).  According to Chinese medicine the oral contraceptive pill causes both stagnation and diminishment of blood. As a result of this there is less blood to counterflow upwards which can result in a temporary cure of facial hirsutsim.

Anti-Androgens -These can only be used in women using adequate contraception because these medications pose a risk to the developing fetus. The value for use in PCOS is to improve skin conditions and to decrease other symptoms such as male-pattern baldness and hirsutism. Examples include spironolactone (Aldactone®), flutamide (Eulexin®), finasteride (Proscar®).   Androgens may be considered ‘yang’ in nature. As ‘yang’ is masculine in nature one can see how, when yang is repressed in the PCOS patient, male pattern baldness may occur. Hair is nourished by kidney essence and liver blood. But in the PCOS patient, the kidneys and liver are severely non-functioning and so this nourishment is absent.

GnRH agonists -Gonadotropin-releasing hormone (GnRH) agonists are synthetic versions of the natural GnRH and are up to 60 times more potent. They are similar in molecular structure to the natural hormone. They cause release of LH and FSH from the pituitary gland in the brain, but with prolonged use, will deplete the pituitary gland of LH and FSH. This is important because women with PCOS usually have an increase in LH, which eventually leads to menstrual irregularities and/or infertility. Side effects of the GnRH agonists are like those experienced by menopausal women, including bone loss, hot flashes, decreased libido and vaginal dryness. This is due to the eventual deficiency of estrogen caused by a decrease in FSH. As estrogen can be considered to be ‘yin’ in nature and, as yin is deemed to be more feminine than yang, one can see how deficiency of yin can produce signs and symptoms of female aging. Loss of bone mass can be reversed after cessation of medication. Examples of GnRH agonists include leuprolide acetate (Lupron®), goserelin (Zoladex®) and nafarelin acetate (Synarel®).

In PCOS, normal follicular growth and ovulation are disrupted. Fertility drugs may be used in order to induce ovulation. Clomiphene citrate (Clomid®) is typically the first agent prescribed to stimulate ovulation. If clomiphene is unsuccessful, more potent medications along with artificial insemination or in vitro fertilization may be recommended.

Surgical therapy -Two surgical options are available:  

a)    Ovarian wedge resection

In ovarian wedge resection, a portion of the ovary is removed and then sewn back together. This procedure has been effective in decreasing LH and androgen production, and reestablishing regular menses in over 75% of patients. Pregnancy rates following ovarian wedge resection vary, but have been reported to be as high as 60%.

Unfortunately, a major complication of this procedure is the formation of pelvic adhesions in 30% of patients.

b) Laparoscopic ovarian drilling

Laparoscopic ovarian drilling is another surgical alternative for PCOS. This procedure involves making small holes with a laser into the ovary. Ovarian drilling can be performed during the time of a laparoscopy and is very effective in reducing androgenic hormone production. Laparoscopic ovarian drilling may be an effective treatment in clomiphene-resistant anovulatory women with PCOS.

Treating the insulin resistance associated with PCOS targets the cause rather than the symptoms of the disorder. Approximately 75% of obese patients with PCOS are insulin resistant and have elevated amounts of insulin in their bloodstream. These patients have an increased incidence of type II diabetes, hypertension, and atherosclerosis (blockage/thickening of the arteries which could lead to a heart attack or stroke). Insulin-sensitizing therapy enhances the body's sensitivity to insulin and therefore, helps to normalize the hormonal abnormalities associated with PCOS. The following medications have shown promise in the treatment of PCOS when hyperinsulinemia is present:  

Metformin (Glucophage®)

Metformin is mainly used in non-insulin dependent diabetes and helps enhance the body's sensitivity to insulin. It does not cause hypoglycemia (low blood sugar) which is important to prevent unwanted side effects. Some patients have experienced weight loss, improved lipid profiles, lowered blood pressure, return of menstruation, and achieved pregnancy while taking metformin. This drug is considered relatively safe. The most frequently occurring side effect is gastrointestinal upset (diarrhea or more frequent bowel movements). Stomach upset occurs more frequently after a fatty meal or dessert.

Pioglitazone (Actos®):

Pioglitazone works by allowing the body to utilize insulin more efficiently. Some common side effects with this drug include edema (swelling), weight gain, and headache.

Rosiglitazone (Avandia®):

Rosiglitazone is in the same class of insulin-sensitizers as Actos, so it works in a similar manner. Common side effects of Avandia include slight weight gain and headache.

Case review:

Biomedical diagnosis: Infertility secondary to PCOS

Traditional Chinese medicine discussion

Nancy is a 30 years old female whose height is 5’5” and whose weight is 180lbs. She has been trying-to-conceive for 2.5 years.

 

Her husband’s sperm is normal. She presents with acne, facial hirsutism and low libido. She complains of frequently feeling cold especially at the hands and feet.  Her bowel movements are loose with undigested food evident in the stool. She is polyuric and urinates once per hour. The color of the urine is clear and moderate in amount.   She presents with occasional urinary incontinence upon laughing, coughing and/or sneezing.  She complains of being emotionally depressed status-post a diagnosis of infertility. She complains of having low self-esteem based upon her physical appearance. Her tongue body is fat and tooth-marked with a greasy, moist, white coat. There are stasis-macules (small purple bumps) on the sides of the tongue. Her uterine lining thickness is 5-6mm.

Discussion: Liver-Wood controls the spleen-Earth. When the liver is disturbed as a result of emotional depression and frustration it may transversely attack the spleen presenting a clinical picture of liver depression qi stagnation overacting on the spleen. This results in spleen qi vacuity. As a result of chronic hypofunctioning of the spleen, the transformation and transportation of fluids has been negatively impacted leading first to an accumulation of dampness and then, progressively, to phlegm-damp congealing and obstructing.  

The ovaries, the homologue to the testes, are related to the kidneys primarily and secondarily to the liver. Phlegm congealing in the ovaries will thus be injurious to the kidneys. This is an interesting pathological dilemma. The spleen controls the kidneys and it is ultimately the vacuity of the spleen’s qi that has caused the presentation of the phlegm-damp and nodulation. But, it is the kidneys that provide the yang qi, or energy (fire) which is the motive force of the functionality of the spleen. Thus we have a cyclic event where spleen qi deficiency causes vacuity of kidney yang and kidney yang insufficiency further contributes to deficiency of spleen qi. This dual vacuity of the kidneys and spleen further maintains the status-quo of phlegm-dampness congelation.

For the uterine lining to be thick and functional yin and yang qi must be present and abundant. The free flow of qi and blood must also be adequate.  As the commander of blood, if qi is stuck or vacuous, (it is not uncommon for qi to be both stuck and deficient), blood will not flow patently, presenting with the pathology of stasis of blood in the uterus or blood vacuity engendering stasis. In this case, we have qi vacuity engendering vacuity and stasis of liver blood; thus, nourishment and growth of the endometrium will be denied. 

To effectively treat this patient, the liver must be coursed, the qi regulated and rectified; the spleen must enjoy dryness and its yang qi warmed and it’s function enhanced by boosting it against attack from the liver and by supplementing the kidneys and invigorating yang qi. One must boost the spleen to nourish and fill the (blood) vessels (because spleen qi is responsible for the creation of blood) and course the liver to quicken qi, invigorate the blood and transform stasis. To supplement the kidneys and spleen one must disperse damp and transform phlegm with warm and acrid herbs. This is a complex pathology with ‘excess’ manifesting as a result of ‘deficiency’.

Traditional Chinese medicine diagnosis: Stagnation of liver qi and vacuity of spleen and kidney yang with vacuity and stasis of blood in the uterus; phlegm-damp congealing in the lower jiao. (The ‘lower jiao’ is a TCM term which describes the area in which the ovaries reside.)

Treatment principle: Course the liver and boost the spleen, supplement the kidneys and warm yang qi; nourish the blood, fill the vessels, quicken the blood and transform stasis; rectify qi, drain damp and transform phlegm

This formula is my creation and is shown here for the express purpose of enabling the reader to see what a real Chinese herbal medicine prescription looks like and what the functions of each herb are. Only take herbs when prescribed by a Board certified herbalist and never self medicate.

Herbs have ‘temperatures’, ‘flavors’, ‘trophisms’, and individual ‘characteristics’. The four temperatures of herbs are cold, cool, hot and warm. Some herbs however, are neither hot nor cold and are considered to be ‘neutral’.  The five ‘flavors’ of herbs are ‘pungent’, ‘sour’, ‘bitter’, ‘salty’ and ‘sweet’. Some herbs are considered ‘bland’ and some ‘aromatic’. All herbs have at least one flavor and some have two or three.

The ‘flavors’ have clinical relevancy and have the following clinical strengths:

1. Pungent herbs are moving and dispersing and as such can dispel wind, heat, cold and dampness. In Chinese medicine it is said that Wind is the carrier of the 100 diseases (meaning all exterior pathogenic factors). So, one who has a flu will exhibit ‘Heat’ signs such as fever and perhaps aches and pains in various joints throughout the body. So it can be said that this individual is afflicted by a ‘Wind-Heat-Damp’ invasion, and as part of his herbal medicine prescription, pungent herbs will be used.
2. Sour herbs are astringent. Sour herbs are used to prevent the inappropriate extravasation of body fluids including blood, saliva, sweat, urine, semen, and vaginal discharge.   A person who presents with hyperhidrosis (excessive sweating) would take, as part of her herbal prescription, sour herbs. Another example of the use of sour herbs is when a patient presents with dysfunctional uterine bleeding. Sour herbs can be used to stop the bleeding while the underlying cause is being simultaneously treated. This is referred to in TCM as treating the branch and the root.

1. Bitter herbs are drying and have a downward moving trophism.  Bitter herbs can dry dampness and dissolve phlegm. So, if a patient has bronchitis with an abundance of phlegm, bitter herbs would be included in that patient’s formula. Another example of the use of bitter herbs would be in the treatment of a woman with chronic yeast infections.
2. Salty herbs are softening and reducing in nature. So, herbal formulae that are used to treat diseases like goiter, scrophula or polycystic ovarian syndrome would contain salty herbs.
3. Sweet herbs are tonifying and nourishing to the body.  A patient who has chronic fatigue syndrome or who is constantly short of breath with even the slightest exertion is treated with herbs that are sweet. A women whose ovaries are functioning weakly and, as a result, has elevated fsh will also, as part of her treatment regimen, be treated with sweet herbs.
4. Bland herbs promote urination. These herbs are used within formulae which treat urinary retention and edema as well as painful urination.

1. Aromatic herbs are similar in nature to pungent herbs. These herbs are useful when treating ‘damp’ conditions in the spleen and stomach. Aromatic herbs have the capacity to move and disperse and as such can be used to reduce the stagnation of qi and blood. These herbs may be used for example, in formulae which treat endometriosis or headaches of a ‘piercing’ nature, or sharp, stabbing pain in the abdomino-pelvic region as a result of adhesions stemming perhaps from pelvic inflammatory disease, or internal scarring which may be presenting as a result of an appendectomy, or even a hydrosalpynxed fallopian tube.

Sample Herbal Medicine Prescription for PCOS: 

Cu chao xiang fu, (Cu chao means to fry in vinegar. This method of herbal modification increases the capacity of xiang fu to invigorate liver qi and resolve stagnation. This is done because we want to enhance the free flow of qi or energy in the body in general and at the ovaries in particular. Remember, the liver channel traverses the ovaries.

The trophism of cu chao xiang fu is the liver and the sanjiao.  The sanjiao channel interestingly, is another channel or meridian which has a lot to do with fluid metabolism. The properties of xiang fu are acrid, bitter and sweet. Its acridity spreads and regulates liver qi and it regulates the menses via invigoration of qi. Through the proper movement of qi, transformation of damp and phlegm occur.  Its sweetness is tonifying without being cloying. The bitterness of xiang fu also assists in the ‘percolation’ of dampness. Percolation here refers to the herbs ability to rectify and dispel damp.

Mu xiang

The trophism of mu xiang is to the gallbladder, large Intestine, spleen and stomach channels.

Its properties are acrid, bitter and warm.  Acridity disperses (dampness and phlegm); bitterness drains (damp) and its warmth tonifies.  So there is supplementation in the midst of draining.   It functions to move qi, and to strengthen the spleen. Especially useful when the transportation and transformation function of the spleen is weak. 

Chen pi

The trophism of chen pi is to the lungs, spleen, and stomach

It’s properties are acrid, bitter and warm,

Chen pi regulates qi; improves the transportation and transformation function of the spleen; dries damp and transforms phlegm

Ba ji tian

The trophism of ba ji tian is to the kidneys and liver. Its properties are acrid and sweet. The property of ba ji tian is warm.

Ba ji tian tonifys the kidneys and warms the yang qi.

Hu lu ba

The trophism of hu lu ba is to the kidneys

Its property is warm

Hu lu ba warms the kidneys, disperses dampness, and dispels cold.

Xian mao

The trophism of of xian mao is to the kidneys and liver.  It is a hot herb

Xian mao tonifies the kidneys, fortifies yang and eliminates dampness.

Nu zhen zi

The trophism of nu zhen zi is to the kidneys and the liver.

It’s properties are bitter, sweet and cool.

Nu zhen zi tonifies the liver and kidney yin.

Though Nu zhen zi is nourishing and tonifying it is not cloying. It is always necessary to nourish yin when trying to warm yang. Nu zhen zi not only nourishes and tonifies the liver and kidneys but also serves to protect the yin from the use of hot herbs such as xian mao.

Bai shao

The trophism of bai shao is to the liver and spleen its properties are bitter, sour (sour herbs go to the liver), and cool.

Bai shao nourishes liver blood, harmonizes the relationship between the liver and spleen, restrains yin and also protects the yin from hot herbs. It also helps to regulate the menses.

Jiang zhi shu di. NOTE: Shu di is contraindicated in those with phlegm because of its ‘cloying’ or sticky nature. Using it would actually contribute to the creation of more phlegm and damp in a patient with this pre-existing pathology. ‘Jiang zhi’ means to dry-fry with water and sliced raw ginger. This process mitigates the cloying property of shu di and is then appropriate to use in patients who present with phlegm pathologies.

The trophism of shu di is to the heart, liver and kidneys.

It’s properties are sweet and  warm.

It tonifies blood, nourishs yin and tonifies essence.

Ziao jiao ci

The trophism of ziao jiao ci is to the liver, stomach and lungs Its properties are acrid, and warm. Ziao jiao ci draws out toxicity, discharges pus, invigorates blood and reduces swellings. It warms and transforms phlegm. Zao jiao ci also invigorates the movement of blood.  It is especially good for weight loss. Weight loss is one of the most important therapeutic goals of the PCOS patient who is morbidly obese. Obesity increases insulin resistance and androgen production and contributes to the arrest of ovulation.  A 10% reduction in body fat significantly improves ovarian function in the obese PCOS patient. It is important to note that this formula is for the morbidly obese patient with PCOS as opposed to the PCOS patient whose weight is within normal range.

Fu ling pi

The trophism of fu ling pi is to the heart, spleen, kidneys and lungs. It’s properties are sweet, bland and neutral. Fu ling pi is the outer layer of the fungal node. It promotes urination and reduces edema. In the Classic, the ‘Grand Materia Medica’, it was written that fu ling pi “primarily treats edema and facilitates the waterways”. Though we are not treating edema we are treating a pathology of water metabolism which manifests as  pooling and conglomerating. Therefore fu ling pi is a clinically effective herb for the treatment of PCOS. Fu ling pi, via its relationship to the heart, indirectly benefits the spleen through the promoting cycle as the heart promotes the function of the spleen. And, through its relationship with the kidneys and lungs it easy to see how this herb is clinically effective in improving the function of the main organs that are responsible for water metabolism.

 Fu ling pi is harmonious and neutral in nature. It is more draining than tonifying; it is a strong diuretic, but does not exhaust the qi.

She gan: The trophism of she gan is the lungs. It’s properties are bitter and cold.

Its effect on phlegm is so strong that it is combined with warming herbs in treating obstruction and clogging due to phlegm-cold.  Chao she gan (dry fried or baked) mitigates it’s cold properties and it can be used in deficient patients.

Fu zi: Fu zi goes to the heart, kidneys and spleen. Its properties are acrid, hot and toxic. Toxicity is an issue only if one prescribes above the normal dosage range which is between 3-15grams. This is a widely prescribed herb and is generally well tolerated.

It is often used to mitigate the cold properties of She gan. Fu zi expels cold-damp and warms the Fire (kidney yang). It is used for any problem related to yang vacuity of the heart, kidney and/or spleen yang. It also has the ability to guide other warming herbs into the lower burner to expel cold and damp. 

Li zhi he

Li zhe he travels to the Liver and the Stomach.

Its properties are warm and sweet.

Li zhe he is specifically used for bulging disorder (hernia) in the liver channel, for testicular pain and swelling, and for ovarian cysts. The quality of this herb is to dredge and disperse. It is used here to guide the other herbs in the formula to the ovaries and to stimulate functional activity in the ovaries as well. The ovaries are homologous to the testicles.

Bai zhu,

Bai zhu’s properties are bitter, sweet and warm.

The channel trophism of baizhu is to the spleen and stomach.

Baizhu tonifies the spleen and augments the qi, dries damp and promotes water metabolism.

Wang bu liu xing

The properties of wang bu liu xing are bitter and neutral.

Wang bu liu xing goes to the liver and stomach. The liver channel traverses the ovaries and therefore this herb serves to ‘invigorate’ or stimulate their function.  

Wang bu liu xing “disperses clumping ” (read as cysts), and “disperses stasis” (also read as cysts). This herb also “unblocks menstruation” [2]

Its function is to invigorate blood, reduce swelling and to unblock the menses.

This herb facilitates the yangming channel, the chong and renmai, and the sea of blood(the liver, chongmai and bao gong)

Xiao hui xiang

Xiao hui xiang is warm and acrid.

It travels to the liver, kidney, spleen and stomach.

It disperses cold, warms the lower burner, and encourages movement in the liver channel.

Yuan zhi

The properties of yuan zhi are bitter, acrid and warm

It’s trophism is to the heart and lungs.

Yuan zhi expels phlegm; reduces abscesses and dissipates swelling. Additionally yuan zhi settles the heart and calms the spirit which which means that it has the effect of reducing anxiety. It is appropriate when treating a PCOS patient who especially wishes to conceive and is going through the attendant emotional difficulties associated with infertility.

Chao suan zao ren

Suan zao ren goes to the gallbladder, liver, heart and spleen channels. It’s properties are sweet, sour and neutral. Suan zao ren is used to calm the emotions, treat insomnia, palpitations, anxiety and dream-disturbed sleep. Using yuan zhi and suan zao ren together is an often used strategy to treat someone who is suffering from symptoms of anxiety and depression.

Kun bu

Kun bu goes to the kidney, liver and stomach channels. Its properties are salty and cold. Remember that salty herbs have the ability to soften and reduce. So, herbal formulae that are used to treat diseases like goiter, scrophula or polycystic ovarian syndrome would generally contain salty herbs.

Dang gui

Dang gui goes to the heart, liver and spleen. Its properties are warm, acrid, sweet and bitter. Though it moves blood it also benefits the spleen and nourishes blood.

Acupuncture prescription

Large intestine 4 and Liver 3 This combination moves qi to help facilitate the transformation of damp and phlegm and to enliven the commander of blood to facilitate circulation of blood to the ovaries.

Ren 12 and Liver 13 to harmonize the relationship between yang and yin.

Zigongxue to stimulate ovarian function.

Stomach 30 to stimulate ovarian function and access the chongmai which, due to its close relationship with the liver and kidneys helps to quicken blood and benefit kidney yin and yang.

Ren 17 and Ren 6 to boost and invigorate qi and to regulate the proper acsent and descent of qi and blood which is absent in the PCOS patient. I also like to use Ren 17 to stimulate the flow of heart blood to the uterus via the bao mai vessel.

Stomach 36 and Stomach 40 to regulate and harmonize the stomach and spleen which will help drain damp and transform phlegm. As Stomach 40 also enters the brain, this point is helpful in calming the shen, (spirit).

Spleen 9 and Spleen 6 to drain damp, transform phlegm and to tonify the spleen, kidneys and liver as spleen 6 is a crossing point for these three channels.

Kidney 3 to facilitate passage of essence from the kidneys to the uterus and ovaries via the bao luo vessel.

How do acupuncture and herbal medicine treatment protocols differ?

Primarily, acupuncture (in my opinion) does little more than stimulate the flow of qi and blood throughout the body. Don’t misunderstand: this is a necessary and powerful clinical tool without which herbal medicine would not be as efficacious as it is. Herbs (like Western medicine) have systemic effects. That is to say they actually change organ function. In order for herbs to be properly disseminated throughout the body they are supported by the qi and blood invigorating effect of acupuncture. Clinically, the best outcomes are achieved when acupuncture and herbs are used together. 

The goals of this combination of acupuncture and herbs are:

1.    Regulation of menses

2.    Regulation of ovulation

3.    Improved egg and lining quality

We have seen improved pregnancy outcomes in PCOS patients when including acupuncture and herbal remedies in conjunction with Metformin and/or Clomid. Clomid can help to facilitate the generation of multiple follicles but acupuncture and herbs improves oocyte quality and endometrial lining quality. Additionally, acupuncture and herbal medicine can often have a regulatory effect on the hypothalamic-pituitary-ovarian axis which is what is needed for the PCOS patient suffering with infertility.  Used together, the ‘East meets West’ approach is giving new hope to PCOS patients desiring to conceive.

You can conceive. We are here for you!

877-965-BABY

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