TCM Treatment of Polycystic Ovary Syndrome (PCOS)

Western View
TCM Pathology
Pattern Differentiations
Research
References

Western View

Polycystic ovary syndrome (PCOS) is a luteal phase defect typified by anovulation, hyperandrogenism, insulin resistance and obesity. It affects 5 - 10% of women.
PCOS is generally defined as several small cysts located within the ovaries and chronic failure to ovulate. PCOS often occurs with one or more of the following factors:
• Inappropriate estrogen misbalancing the hypothalamus-pituitary-ovarian (HPO) axis.
• Imbalances in sugar metabolism and insulin levels.
• A predisposition for diabetes.
• Obesity.
• Increased lipid levels.
• Higher prolactin levels.

PCOS involves a lack of communication between the gonadotropin releasing hormones and hormones of the hypothalamus and pituitary glands. A dysfunction of the endocrine and metabolic systems often results in a poor response to hormone stimulating fertility drugs. Many PCOS patients resist ovulation stimulating drugs, which hyperstimulate the ovaries and create a multitude of side effects.
Typically, the ovaries are much larger than average, with multiple rows of cysts, covered with a thick, slimy, waxy or hard outer coating. These cysts produce male hormones that block follicles, causing them to degenerate. An overproduction of estrogen or an increase in insulin levels can cause androgen factors, like high testosterone, which in turn causes excess body or facial hair or a thinning hairline.

The HPO axis affected with too much estrogen and not enough progesterone raises the luteinizing hormone (LH) and testosterone. Western diagnoses evaluate via ultrasound and blood tests for LH, follicle stimulating hormones (FSH) and testosterone. It is possible to have either long cycles with heavy bleeding or no ovulation or light cycles with little bleeding.

PCOS can combine menstrual disorders such as amenorrhea, oligomenorrhea, dysfunctional uterine bleeding, infertility, hirsutism, and obesity. The uterine lining fails to shed each month, thereby increasing the possibility of endometrial cancer. Western treatment includes such medications as:
• Clomid to promote ovulation.
• Gonal-F or Pergonal (gonadotropins).
• Human chorionic Gonadotropin (hCG).
• Gluchophage, Metformin or Actos to control insulin resistance.
• Steroids to balance the androgen hormonal effects, which, over the long term, can cause liver damage and a reduction of bone density.

TCM Pathology

PCOS is a Yang disorder with imbalances affecting the second half of the menstrual cycle. Involved organ systems include the Spleen, Lungs, Liver and the Kidneys. Generally, PCOS derives from a deficiency of Kidney Yang, in its inability to transform, transport and evaporate fluids in the lower body. The accumulation of water in the pelvic cavity enlarges the ovaries, leading to Phlegm/Dampness or Blood stagnation.

Pattern Differentiations

Phlegm/Dampness:
• Amenorrhea, light periods or infertility.
• A need to frequently “clear your throat,” which is caused by stress or emotions.
• Abdominal fullness or distention.
• Joint inflammation or aching.
• Heaviness in the chest, abdomen area or body in general.
• Feeling sleepy or lethargic after a meal.
• Obesity.
• Hirsutism.
• Sinus congestion, lipomas, yeast infections or excessive vaginal discharge.
• Diarrhea or foul smelling stools (indicates heat).
• Mucus-like menstrual blood or stools.
• Pale, swollen tongue body.
• White and sticky or greasy tongue coating.
• Weak or slippery pulse.
Blood stagnation:
• Amenorrhea, light periods, infertility.
• Heaviness, discomfort or pain in the chest or abdomen.
• Excessive vaginal discharge.
• Hirsutism.
• Pale-purple or bluish-purple, swollen tongue body.
• Sticky, white tongue coating.

Research

Stenor-Victorin (2000) regulated ovulation in rats with electro-acupuncture (EA). This study proved that EA inhibits the hyperactivity of the sympathetic nervous system. Chen (1997) showed that acupuncture normalized dysfunction of the hypothalamus- pituitary- ovarian (HPO) axis, and that EA may promote the activity of the body and senses sensitive mechanisms normalizing GnRH, LH, and estrogen.

The sympathetic nervous system (SNS) is one of three parts of the autonomic nervous system. It mobilizes the body’s resources under stress and is constantly active at a basal level to maintain homeostasis. It is responsible for the up and down regulating of many of the homeostatic mechanisms. Fibers from the SNS innervate almost every organ system from L-2 toT-2. It provides very diverse regulatory functions affecting the ovaries, adrenals, pancreas, liver, and the endocrine system. The longitudinal organizations of the meridians corresponding to L-2 to T2 help you understand why acupuncture is so effective in inhibiting this major nerve system. There is a correspondence between the SNS, segmental neural structures, the collateral vessels, and nodal pathways. The Kidney, Liver, Heart, and Brain (HPO) systems directly affect the SNS. This may partially explain why EA is so effective in treating PCOS. The ability to calm the SNS, and open up the flow of Qi and Blood through these acupuncture meridians, resolves pathology that Western medicine can’t yet comprehend.

Yoshimoto (1989) used the Chinese herbal formula, “Wen Jing Tang” in a combined gonadotropin therapy resulting in ovulation in 43.8% of cases without ovarian hyper- stimulation. Wen Jing Tang is a formula used in cases of Deficiency and Cold in the Conception and Penetrating vessels; with stasis, and slight yin deficiency. It countered the effects of the Western medications resulting in ovulation.

Useful Acupuncture Points

Lu 7 (R) and K6 (L) regulate the Ren, HPO axis, strengthen the Uterus and dissolve masses. SP 6 connects the three Yin channels (Liver, Kidney, Spleen). Du 4 is the “life gate” equated with the womb and useful in treating leucorrhea. Sp 9 is the water point on the Spleen channel. These points treat Kidney Yang deficiency leading to phlegm dampness.
Lu 7 and Ki 6 are also used for Blood stasis, in that they open the Ren and control water balance. St 29, Sp10, and UB 17 are useful for all Blood issues. Lv 14 treats stagnant Qi.

References

Cai, X. (1997). Substitution of acupuncture for HCG in ovulation induction. Journal of Traditional Chinese Medicine, 17(2), 119-121.
Chen, B. Y. (1997). Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupuncture & Electro-therapeutics Resources. International Journal, 22(2), 97-108.

Stener-Victorin, E., Lundeberg, T., Waldenstrom, U., Manni, L., Aloe, L., Gunnarsson, S., et al. (2000). Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biology of Reproduction, 63, 1497-1503.

Stener-Victorin, E., Waldenstrom, U., Anderson, S., & Wikland, M. (1996). Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Human Reproduction, 11, 1314-1317.

Yoshimoto, Y., Miyake, A., Tasaka, K., Aono, T., & Tanizawa, O. (1989). Ovulation following combined therapy with wen-jing-tang and clomiphene citrate therapy in anovulatory women. American Journal of Chinese Medicine, 17, 243-244.