Polycystic Ovary Syndrome

Also called PCOS, Polycystic Ovary Disease

Polycystic Ovary Syndrome is a condition where Cysts develop on the Ovaries. It has become the most common hormonal disorder in women of reproductive age.

Main Clinical symptoms:

Menstrual Irregularity:

• Amenorrhea (20%)
• Oligomenorrhea (infrequent menstruation) (70–75%)
• Anovulation
• Infertility

Hyper-androgenism:

• Hirsutism
• Male-pattern balding
• Acne

Other:

• Obesity (up to 50%)
• Skin tags
• Acanthosis nigricans (skin darkening)
• Type II Diabetes

Most common presenting symptoms to a physicians office are Amenorrhea or Irregular menstruation (85–95%), Infertility, and Obesity (50%). However, only 5–10% of women have symptoms. Some reports have shown 18% of women have PCOS, and that 70% were undiagnosed.
Multiple factors can contribute including genetic predisposition, diet and lifestyle. However, two major contributing factors are androgenic hormones and reduced sensitivity of insulin. In addition, higher liver enzyme levels but lower bilirubin and bile acid levels were noted in Chinese women with PCOS.

Blood test will typically show elevation of:

• Serum Lutenizing Hormone
• Estrone
• Fasting glucose and Fasting Insulin
• Free Testosterone
• serum lipids

Estradiol, DHEA and Progesterone are typically normal.
Chronic PCOS has been associated with increased risk of Cardiovascular disease, Depression and Endometrial cancer.

According to TCM, PCOS is caused one of the following syndromes, in decending order of frequency:

• Kidney Deficiency
• Phlegm-Damp obstruction
• Blood stasis
• Qi Stagnation
• Spleen or Spleen and Kidney Deficiency
• imbalance between Yin and Yang, or Yang Deficiency

General Treatment

Diet & Lifestyle

1. Avoid sugar, refined carbs, soda drinks, packaged juices, processed foods in general
2. Carbohydrates should only be in whole grain form, Basmarti rice is an exception.
3. Fresh fruit, especially Papaya, Pineapple; Vegetables especially green leafy vegetables
4. Use of herbs in cooking: Basil, Oregano, Sage, Rosemary, Ginger, Cinnamon, Turmeric, Cumin and spices in general.
5. Reduce food intake, strictly avoid overeating.
6. Exercise and Yoga is very useful for long-term hormonal health.

Research:
Out of over 1400 cases treated by TCM, the most commonly used herbs were as follows:

A large scale review of 33 studies on the effectiveness of Herbs for PCOS indicated 6 herbs to be of potential value:

A large-scale survey through the Taiwan National Health Insurance Program database revealed the most common herbal formula used for PCOS was Dan Zhi Xiao Yao San (aka Jia Wei Xiao Yao San), while the most commonly prescribed single herb was Cyperus rotundus (Xiang Fu). (See research here)

In addition, the simple classical combination of Peony (Bai Shao) and Licorice (Gan Cao) has been found to help in PCOS. In a trial it was shown to reduce testosterone levels in 90% of women while appearing to regulate LH to FSH ratio.

Simples

Differential Diagnosis:

Qi Stagnation

Early stage or smaller PCOS. History of hyper-emotionalism, PMS, breast tenderness before menstruation, maybe slight cramping before menstruation, pulse may feel tight or suppressed.

Obstruction with Phlegm and Damp

Excess phlegm, low energy, feels heavy, tendancy to overweight or fluid retention, clear discharge, waterish blood.
Thin, greasy tongue coat, wiry and slippery pulse

Blood Stasis

Uterine pain, painful menstruation, blood clotting or dark blood, prolonged menstruation, pain relieved by warmth, cyanosis of the lips, tongue and nail beds. Pulse is choppy. Dull is dull or cyanotic (purplish).

Kidney Deficiency

Kidney and lower back pain, weak kness, nocturnal urination.
Yin deficiency: dry mouth and throat, sweating at night
Yang deficiency: also cold, clear urination

Melancholy

Heavy feeling in the abdomen, with dark clotted menstrual Blood, depression, desire for solitude, dull or dark complexion, a dry tongue and a weak pulse.

 
Other Treatment:

1. Cupping with Bloodletting (‘Wet Cupping’) behind the knee and on the calves is promoted as useful in Unani medicine.
2. Enemas and Douches are useful. Oil enemas settle vitiated Qi.
3. Emetics can be prescribed in Phlegm constitutions.
4. Purgative medicines to purge Phlegm, Damp, open obstructions and resolve Masses (move Blood).

Other Formulas

1. Tribulus and Withania (proven effective, see research below)
2. Tribulus with Cinnamon, Peony Bai Shao, St. John’s wort, Licorice
3. PCOS with Menorrhagia, Symplocos racemosa with Saraca indica, Licorice (Siddha)
4. Agnus Castus, Paeonia Bai Sho, Black Cohosh, Dang Gui
5. Nettle, Carrot seed, Fennel seed (Persian remedy)
6. Picolin
  Cinnamon
  Licorice
  Linseed
  Agnus Castus
This has been studied and found effective. (See here)
7. An Electuary from Unani:
  Fennel seed
  Fennel root
  Black Nightshade
  Rose
  Dried Fig
  Maidenhair
  Swertia
This Unani medicine and is prepared as a Majun (Electuary)
7. A Powder from Siddha:
  Nigella seed
  Radish seed
    Wld Carrot seed
    Fenugreek seed, equal parts
This is a combination from Siddha medicine. It is formed into powder and taken in 4 grams doses.
8. PCOS with Hyperandrogenism
  Fenugreek
  Aloe
  Sphaeranthus indicus
  Indian Spikenard
  Symplocos racemosa
This was found to be effective in studies. (See research here)

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