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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:
Dang Gui (56%)
Dodder seed (Tu Si Zi (49%)
Poria Fu Ling (46%)
Cyperus Xiang Fu (43%)
Atractylodes Bai Zhu (39%)
Codonopsis Dang Shen (38%)
Ligusticum Chuan Xiong (36%)
Licorice (35%)
Rehmannia Shu Di Huang (35%)
Paeonia Bai Shao (33%)
Achyranthes Niu Xi (31%)
Epimedium Yin Yang Huo (30%)
Citrus Chen Pi (29%)
Dioscorea Shan Yao (28%)
Dipsacus Xu Duan (27%)
A large scale review of 33 studies on the effectiveness of Herbs for PCOS indicated 6 herbs to be of potential value:
Agnus Castus
Cimicifuga racemosa
Licorice
Paeonia Bai Shao
Tribulus terrestris
Cinnamon
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.

Western Tradition
TCM Classification
Simples
Marjoram
Camomile
Cinnamon
Tribulus
Asparagus racemosa
Turmeric
Turpeth
Rue
St. Johns wort
Licorice
Nigella seed
Withania
Myrrh / Bdellium
Agaric
Dang Gui
Paeonia Bai Shao
Poria Fu Ling
Atractylodes Bai Zhu
Ligusticum Chuan Xiong
Dodder Tu Si Zi
Paeonia Mu Dan Pi
Cyperus Xiang Fu
Codonopsis Dang Shen
Rehmannia Shu Di Huang
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)
9. A Unani course of treatment for PCOS, as given by Dr. Shaikh Nikhat involves 2 primary classical Unani formula: Mujun Muqil with Majun E Dabul Ul Ward. Majun Saras and distilled waters being taken also.

A representative version of Majun Muqil (Unani Pharmacopoeia of India):
  Triphala, or all 5 Myrobalans, 9 grams each
  Turpeth, 12 grams
  Mastic, 5 grams
  Bdellium, 35 grams
Other medicines added into some versions include Lesser Cardamon, Fennel seed, Mesua ferrea, Long Pepper, Ginger etc. It is anti-inflammatory, deobstruent, and clears Blood stasis, principally used for Hemorrhoids and Joint pain.
Majun E Dabul Ul Ward
The basic formula is:
  Indian Spikenard, Mastic
    Saffron, Cinnamon, Asarum
    Costus, Chicory seed, Celery
    seed, Dodder seed, Tabahseer,
    Madder, Lacca, Aloeswood
    Clove, Lesser Cardamon           10 grams each
In a base of Honey (600 grams) and Rose water (200 grams), boiled to form a syrup to which the powders are added. It is diuretic, anti-inflammatory, deobstruent, and regarded as a Blood tonic.

10. Interestingly, a similar combination of formulas given by Wirtzung for Uterus pain may also be useful for PCOS. He prescribed Compound of Turbith (Turbith, Ginger and Mastic) with Mugwort Decoction (similar to Compound Syrup of Mugwort).
Bushen Huoxue Huatan Tang
    Paeonia Bai Shao 24 grams
    Curcuma Yu Jin 12 grams
    Salvia miltiorrhiza Dan Shen 30 grams
    Dang Gui 24 grams
    Scutellaria Huang Qin 9 grams
    Rose (Mei Gui) 12 grams
    Acorus Shi Chang Pu 15 grams
    Gleditsia Zao Jiao Ci 12 grams
Prepare a Decoction, the above being used each day.
This has been studied and found to work in a number of different ways to help treat PCOS. This compound was also used in a clinical trial with good results. (see here)
 
Polycystic Ovary Formula #1
    Peach kernal (Tao Ren)
    Salvia Dan Shen
    Dang Gui
    Ligusticum Chuan Xiong
    Poria Fu Ling
    Paeonia Mu Dan Pi
    Cyperus Xiang Fu
    Bitter Orange (Zhi Ke)
    Gleditsia Zao Jiao Zi
    Self Heal (Xia Ku Cao)
    Sargassum Hai Zao
    Fritillaria Zhe Bei Mu
Used for Blood stasis with Phlegm-Heat.


Polycystic Ovary Formula #2
    Dodder seed (Tu Si Zi)
    Epimedium Yin YAng Huo
    Rehmannia Shu Di Huang
    Cornus Shan Zhu Yu
    Cinnamon twig (Gui Zhi)
    Poria Fu Ling
    Atractylodes Bai Zhu
    Pinellia Ban Xia
    Cyperus Xiang Fu
    Fritillaria Zhe Bei Mu
Used for Yang deficiency with Phlegm-Damp.
Research:
–Traditional Persian Medicine and management of metabolic dysfunction in polycystic ovary syndrome

Herbs
–Effect of chamomile capsule on lipid- and hormonal-related parameters among women of reproductive age with polycystic ovary syndrome.
–Effects of chamomile extract on biochemical and clinical parameters in a rat model of polycystic ovary syndrome.
–Effect of soy phytoestrogen on metabolic and hormonal disturbance of women with polycystic ovary syndrome.
–Welsh Onion Root (Allium fistulosum) Restores Ovarian Functions from Letrozole Induced-Polycystic Ovary Syndrome
–Licorice ethanol extract improves symptoms of polycytic ovary syndrome
–The effect of cinnamon on polycystic ovary syndrome in a mouse model.
–Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo controlled clinical trial.
–Preliminary evidence that cinnamon improves menstrual cyclicity in women with polycystic ovary syndrome: a randomized controlled trial.
–Crocetin attenuates DHT-induced polycystic ovary syndrome in mice via revising kisspeptin neurons.
–Effects of metabolic abnormalities, hyperandrogenemia and clomiphene on liver function parameters among Chinese women with polycystic ovary syndrome: results from a randomized controlled trial.

Formulas
–An Analysis of the Clinical Medication Rules of Traditional Chinese Medicine for Polycystic Ovary Syndrome Based on Data Mining
–Investigation on the Use of Traditional Chinese Medicine for Polycystic Ovary Syndrome in a Nationwide Prescription Database in Taiwan.
–Effect of combination of Withania somnifera Dunal and Tribulus terrestris Linn on letrozole induced polycystic ovarian syndrome in rats.
–Xiao-Yao-San, a Chinese Medicine Formula, Ameliorates Chronic Unpredictable Mild Stress Induced Polycystic Ovary in Rat.
–Effect of “DXB-2030,” a Polyherbal Formulation, on Experimental Polycystic Ovary Syndrome Associated with Hyperandrogenism
–Efficacy of a Persian Herbal Remedy and Electroacupuncture on Metabolic Profiles and Anthropometric Parameters in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial.

Diet & Lifestyle
–Lifestyle changes in women with polycystic ovary syndrome
–Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial.
–The Importance of Sleep Hygiene in Polycystic Ovary Syndrome from the View of Iranian Traditional Medicine and Modern Medicine..
–Principles of Nutrition in Patients with Polycystic Ovary Syndrome in Iranian Traditional Medicine and Comparison with Modern Medicine
–Lifestyle and Behavioral Management of Polycystic Ovary Syndrome.