Polycystic Ovary Syndrome
Also called PCOS, Polycystic Ovary DiseasePolycystic 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
- Hirsutism
- Male-pattern balding
- Acne
- 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
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:
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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:
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Agnus Castus Cimicifuga racemosa |
Licorice Paeonia Bai Shao |
Tribulus terrestris Cinnamon |
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.
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Western Tradition |
TCM Classification |
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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.
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Syrup of Mugwort Tincture Against Scirrhus of the Spleen (Mylius) Greater Calamint Powder Troches of Capers (Mesue) Troches of Rhubarb (Mesue) |
Xiao Yao San Dan Zhi Xiao Yao San Chai Hu Shu Gan San |
Excess phlegm, low energy, feels heavy, tendancy to overweight or fluid retention, clear discharge, waterish blood.
Thin, greasy tongue coat, wiry and slippery pulse
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 and lower back pain, weak kness, nocturnal urination.
Yin deficiency: dry mouth and throat, sweating at night
Yang deficiency: also cold, clear urination
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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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). |
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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 syndromeHerbs
–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.