Wang Dong-mei’s Experiences in the Treatment of Polycystic Ovarian Syndrome (PCOS)

abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, gynecology, polycystic ovarian syndrome (PCOS)

Wang Dong-mei is a teacher at the Affiliated Hospital of Shandong University of Chinese Medicine & Pharmacology in Tianjin. Dr. Wang has treated several hundred cases of PCOS. Her experiences treating this disease have been presented by her students Su Chun-lin and Zhang Jing on page 900 of issue #12, 2006 of the Zhong Yi Za Zhi (Journal of Chinese Medicine) in an article titled, “The Experiences of Wang Dong-mei in the Treatment of Polycystic Ovarian Syndrome.” A summary of this article is given below.

Disease causes & mechanisms:

According to Drs. Su and Zhang, Teacher Wang believes that kidney yang vacuity is the most commonly seen pattern in patients with this condition. The kidneys treasure essence, govern reproduction, and govern the source of life (sheng ming). Essence is able to engender blood, blood is able to transform into essence, and essence and blood share a common source. Together, essence and blood produce the physical substance of the menstruate. The kidneys are the root of yin and yang of the viscera and bowels, having within themselves kidney yin and kidney yang. Within the kidneys, the balance of yin and yang is coordinated, and it is this talent or ability which maintains the normal function of the organism. Among the viscera and bowels, the kidneys and uterus are especially closely related by their channel and network vessel connections, and the function of the uterus is highly dependent on the kidneys. Kidney yang is or makes for life-gate fire. If kidney yang become vacuous, this leads to its warming and shining, qi transformation, and pushing and stirring actions becoming diminished and weak. This then leads to the movement of the qi and blood losing its strength with the creation of stasis and stagnation in the chong and ren and uterine vessels. Thus ultimately, Teacher Wang believes that the main disease mechanisms of PCOS are the combination of kidney vacuity and blood stasis.

Treatment based on pattern discrimination:

Because Teacher Wang believes that the main disease mechanisms of this condition are kidney vacuity and blood stasis, she also believes that treatment of this condition should be based on the principles of supplementing the kidneys and quickening the blood.

However, according to Teacher Wang, there are common differences in secondary disease mechanisms in patients of different ages with this disease. Adolescent females with PCOS mostly menstruate once every 2-3 months with the menstruate being typically scanty in amount. They also typically suffer from acne and their bodies tend to fat. In addition, there is sweating from the four extremities and hirsutism. In terms of serum analysis, their estradiol (E2) tends to be lower than normal, but their testosterone (T) tends to be high. According to Teacher Wang, kidney yang vacuity with blood stasis are the main disease mechanisms in women this age with PCOS. However, because of kidney yang vacuity, qi transformation has no strength and water rheum is not transformed. Instead, fluids gather and produce dampness. Because blood and fluids move together, if blood stasis endures for days, this may also give rise to or aggravate the production of dampness. Therefore, besides supplementing the kidneys and quickening the blood, one should typically also fortify the spleen, disinhibit dampness, and regulate menstruation in adolescent PCOS patients. The formula Teacher Wang usually uses for this is Shi Ying Yu Lin Tang (Amethyst Nourish the Unicorn Decoction) plus Yi Yi Ren (Semen Coicis), uncooked Huang Qi (Radix Astragali), and Dan Shen (Radix Salviae Miltiorrhizae). In addition, Teacher Wang counsels such young women to control their weight.

Women of child-bearing age with this condition are mostly diagnosed with infertility. Mostly, their menses come once every 40-60 days with a moderate amount. These women’s bodies are only somewhat overweight, and they mostly suffer from galactorrhea. Their serum E2 tends to be low and their prolactin (PRL) tends to be high. Besides kidney vacuity and blood stasis, it is Teacher Wang’s experience that most of these women also present with liver qi depression and binding. In these cases, Teacher Wang typically uses Shi Ying Yu Lin Tang plus Zao Jiao Ci (Spina Gleditsiae), Chuan Shan Jia (Squama Manitis Pentadactylis), Mai Ya (Fructus Germinatus Hordei), and Dan Shen (Radix Salviae Miltiorrhizae) to promote ovulation and fertility. For those who are not concerned about fertility, Teacher Wang commonly uses Shi Ying Yu Lin Tang plus Chai Hu (Radix Bupleuri), uncooked Mai Ya (Fructus Germinatus Hordei), uncooked Huang Qi (Radix Astragali), and Li Zhi He (Semen Litchi).

 Shi Ying Yu Lin Tang (Amethyst Nourish the Unicorn Decoction) consists of:

Zi Shi Ying (Flouritum)
Yin Yang Huo (Herba Epimedii)
Tu Si Zi (Semen Cuscutae)
Xu Duan (Radix Dipsaci)
Dang Gui (Radix Angelicae Sinensis)
Chuan Niu Xi (Radix Cyathulae)
Chuan Xiong (Rhizoma Chuanxiong)
Gou Qi Zi (Fructus Lycii)
Bai Shao (Radix Alba Paeoniae)
San Leng (Rhizoma Sparganii)
E Zhu (Rhizoma Zedoariae)
Xiang Fu (Rhizoma Cyperi)
Hua Jiao (Pericarpium Zanthoxyli)

Within this formula, Zi Shi Ying and Yin Yang Huo supplement the kidneys and invigorate yang and are the sovereigns for warming the uterus. Xu Duan and Tu Si Zi supplement the kidneys. Dang Gui and Chuan Niu Xi nourish and quicken the blood. These are the ministers within this formula. Gou Qi Zi and Bai Shao nourish yin and supplement the blood. San Leng and E Zhu quicken the blood and transform stasis, soften the hard and scatter binding. Dang Gui and Xiang Fu nourish the blood and rectify the qi. These are the assistant medicinals within this prescription which further strengthen the effects of supplementing the kidneys, quickening the blood, and regulating menstruation. Hua Jiao enters the governing vessel. Its functions of warming the kidneys and supplementing fire aid the other medicinals. In addition, Huang Qi supplements and boosts the qi of the spleen and kidneys, disinhibits water and transforms dampness. Taken as whole, this formula mainly supplements the kidneys and quickens the blood assisted by nourishing the blood and moving the qi. Thus it promotes the coordinated balance of yin and yang within the kidneys. When the qi and blood flow is regulated and easy, then the essence is able to gather and produce pregnancy.

Representative case history:

Drs. Su and Zhang end their article with the presentation of one of Teacher Wang’s representative PCOS case histories. The patient was a 28 year-old female who was first examined on June 7, 2004. The patient said that her menstrual periods had been late for 10 years. She only menstruated for 1-2 days every 2-3 months. However, she had times when she only menstruated once every half year. Prior to menstruation, the patient experienced breast distention. The woman’s last menses had occurred on March 20, 2004. By the fifth day, the menses had completely stopped. The patient had not avoided pregnancy but still had not conceived for two years. There was sweating from the four extremities and hirsutism. However, her pubic hair was not excessive and there was no galactorrhea. Multiple utrasounds had shown that the woman had PCOS. Her serum E2 was 31.74pg/mL, T was 0.81ng/mL, follicle-stimulating hormone (FSH) was 4.96mIU/mL, luteinizing hormone (LH) was 14.25mIU/mL, PRL was 322.9µIU/mL, fasting insulin (INS) was 20.22µIU/mL, and fasting blood glucose (Glu) was 6.55mmol/L. Therefore, the patient was prescribed Shi Ying Yu Lin Tang plus:

Chai Hu (Radix Bupleuri), 9g
Bu Gu Zhi (Fructus Psoraleae), 15g
Huang Qi (Radix Astragali), 15g
Li Zhi He (Semen Litchi), 15g

One packet of these medicinals was decocted in water and administered per day. After taking this formula for three months, the patient’s serum E2 was 79.66pg/mL, T was 0.45ng/mL, FSH was 6.46mIU/mL, LH was 7.52mIU/mL, PRL was 344.6µIU/mL, INS was 13.32µIU/mL, and Glu was 5.73mmol/mL. After continuing treatment for another four months, the patient conceived in January 2005 and subsequently gave birth to a child.

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