Treatment

Section 1: Pattern Differentiation and Treatment

1) Kidney Vacuity and Phlegm Repletion

Characteristic signs: Scanty menstruation, amenorrhea, excess hair, no pregnancies and obesity are the primary symptoms. Simultaneously you will see fear of cold, dizziness and fatigue, copious Phlegm, sore low back, scanty white vaginal discharge, loose stools, a pale and swollen tongue and a thin pulse, blood LH/FSH>2.5~3, and elevated testosterone levels.

Treatment method: Nourish the Kidneys and transform Phlegm

Representative Prescription: Jin gui shen qi wan modified.

Commonly used herbs: To nourish the Kidneys, select shu di huang, shan yao, shan zhu yu, ba ji tian, yin yang huo, bu gu zhi, and tu si zi. To strengthen the Spleen and transform Phlegm, select huang jing, shan ci gu, and zhe bei mu. To enliven the Blood and transform stasis, select zao jiao ci, tao ren and chuan shan jia.

Basic prescription: Shu di huang, shan yao, yin yang huo, bu gu zhi, tu si zi, huang jing, shan zhu yu, shu fu zi, zao jiao ci, shan ci gu, tao ren – 12 grams each; chuan shan jia – 9 grams. Take one packet each day, decocted in water.

Modifications: For patients who fear cold, add rou gui in order to warm and nourish the Kidney yang. For patients with loose stools, add shan yao and hu lu ba in order to strengthen the Spleen and stop the diarrhea.

2) Kidney Vacuity and Liver Constraint

Characteristic signs: Kidney vacuity and Phlegm repletion signs as above and simultaneously you will see breast distention and vexation or small amounts of breast secretions, blood LH/FSH>2.5, elevated testosterone and prolactin.  

Treatment method: Clear the Liver and tonify the Kidneys

Representative Prescription: Qing gan bu shen tang.

Commonly used herbs: To clear the Liver, select mu dan pi, chai hu, qing pi, zao jiao ci, shan ci gu, chuan shan jia, etc. To nourish the Kidneys, select shu di huang, dang gui, chao zhi zi, xian ling pi, bu gu zhi,  ba ji rou, yin yang huo, and huang jing.

Basic prescription: Mu dan pi, chai hu, qing pi – 6 grams each; shu di huang, dang gui, chao zhi zi, xian ling pi, bu gu zhi, ba ji rou, zao jiao ci, shan ci gu, chuan shan jia – 12 grams each. Take one packet each day, decocted in water.

Modifications: For patients with breast secretions, add sheng mai ya to stop the breast secretions. For excessive hair, add yu zhu and huang jing to moisten dryness and transform Phlegm.

3) Kidney Yin Vacuity, Phlegm Repletion and Blood Stasis

Characteristic signs: Patient normally has high blood pressure or a family history of diabetes, scanty menstruation, amenorrhea, excess hair, infertility and obesity as the main symptoms. Simultaneously you will see dry mouth, vexation, constipation, insatiable appetite, black spiky skin, a dull red tongue and a thin pulse. Blood LH/FSH <2, elevated testosterone levels, blood insulin levels are high or the patient is insulin resistant, and normally not responsive to Clomiphene treatment.

Treatment method: Benefit Kidneys, transform stasis and dispel Phlegm

Representative Prescription: Yi shen hua yu qu tan tang.

Commonly used herbs: Zhi mu, sheng di huang, bai shao, dang gui, tao ren, san leng, e zhu, yin yang huo, tu si zi, bu gu zhi, hu zhang, and huang qin. 

Basic prescription: Zhi mu, sheng di huang, bai shao, dang gui, tao ren, yin yang huo, tu si zi, bu gu zhi, hu zhang, zhe bei mu, tian hua fen and huang qin – 12 grams each. Take one packet each day, decocted in water.

Modifications: For Blood stasis, add san leng and e zhu. For Phlegm and Damp, add xia ku cao, huang yao zi, wang bu liu xing, kun bu, and chuan shan jia to soften the hardness and transform Phlegm.

Nourishing Kidneys and transform Phlegm treatment method can by causing the PCOS patient’s blood FSH levels to increase, the LH/FSH ratio to fall, and by causing an increase in blood E₂ (estrogen) levels and a drop in the T/E₂ (testosterone/estrogen) ratio, allow for follicle development and then ovulation. With clearing the Liver and nourishing the Kidneys treatment method, not only are you able to increase the PCOS patient’s blood FSH levels, but at the same time this causes PRL (prolactin) levels to fall and become normal, an improvement in follicle development and blood E₂ levels to increase. The benefit the Kidneys, transform stasis and dispel phlegm method by enabling lowering of  male hormone levels in the blood, can decrease insulin secretion and simultaneously causing high levels of neuropeptide Y, and the high levels of proopiomelanocortin (POMC) to fall. In one aspect, it produces a satisfied appetite, decreased food intake, and reduced fat accumulation and leptin levels. In another aspect, treatment eliminates the inhibition of GnRH secretion and causes blood FSH and LH to reach normal levels. Ovarian cells proliferate, blood E₂ levels increase, and follicles develop, thereby achieving the effect of ovulation and weight loss.    

Source: Yi, Si Tu and Yang Jia Lin. Gynecological Diseases: Chinese Medicine Clinical Diagnosis and Treatments. Ren Min Wei Sheng Chu Ban She. Beijing, 2005. pp. 583-584. Translation by Todd Flemion.