Professor Long Zhao-ling'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), infertility

Long Zhao-ling is a professor at the Hunan University of Chinese Medicine & Pharmacology in Changsha who has more than 30 years clinical experience in Chinese and Western gynecology. During this time, she has gained a good deal of insight based on experience in the treatment of PCOS with Chinese medicine. On pages 10-11 of issue #2, 2007 of Xin Zhong Yi (New Chinese Medicine), Sun Xiao-feng and You Hui published an article titled "An Introduction to the Clinical Experiences of Prof. Long Zhao-ling in the Treatment of Polycystic Ovarian Syndrome." Because PCOS affects 5-10% of women of childbearing age and causes one third of cases of anovulatory infertility, a summary of this article is presented below.

1. Thoughts on diagnosis & treatment

According to Prof. Long, PCOS's main disease causes and mechanisms are: A) natural endowment frailty (or insufficiency) or early marriage and bedroom (or sexual) taxation resulting in the kidney qi suffering detriment; B) a habitually fat body, addiction to greasy, fatty, thick-flavored foods, or unregulated diet resulting in detriment and damage to the spleen and stomach with spleen vacuity internally engendering phlegm dampness; C) menstrual period or postpartum retention of blood whose (discharge) has not yet finished, emotional depression or worry and anxiety damaging the liver with liver qi depression and binding or qi stagnation and blood stasis; and/or D) enduring depression transforming fire with loss of regulation of the qi and blood. These mechanisms may lead to loss of normalcy of the viscera and bowel function, loss of regulation of the qi and blood, uneasy or non-smooth flow of the channels and network vessels, accumulation and gathering of phlegm dampness and adipose tissue, and loss of normalcy of the retention and discharge of the sea of blood, and, therefore, this disease.

Typically, this condition is a mixture of vacuity and repletion, with kidney vacuity the root, and phlegm dampness, liver depression transforming fire, and qi stagnation and blood stasis being the tips or branches. The disease is located in the chong and ren and gradually reaches the liver, spleen, and kidneys. Clinically, Prof. Long divides the patterns of PCOS into 1) kidney vacuity, 2) kidney vacuity with blood stasis, 3) kidney vacuity with phlegm obstruction, 4) kidney vacuity with phlegm and stasis mutually binding, and 5) kidney vacuity with liver depression (transforming fire). Prof. Long believes that the basic treatment principle for this condition is to treat the root and tips or branches simultaneously. Therefore, in addition to supplementing the kidneys to treat the root, one should fortify the spleen, rectify the qi, and transform phlegm, course and resolve liver depression and drain fire, and/or quicken the blood, transform stasis, and regulate the menses in order to treat the tips. Based on the saying, "The kidneys store the essence and govern reproduction," "The menstrual water exits from the kidneys," and "The kidneys are the place of original yin and original yang," supplementation of the kidneys depends on whether kidney yin vacuity or kidney yang vacuity is most dominant. Thus one may have to enrich and supplement kidney yin, warm and supplement kidney yang, or supplement and boost the kidney qi in order to promote the filling and repletion of the kidney essence, the fullness and spreading of the kidney qi, the balancing of kidney yin and yang, the regulation of the chong and ren, the free and easy spreading of the qi and blood.

At the same time, Prof. Long divides PCOS patients into three body types. There are those PCOS patients who are mainly overweight. Then there are those PCOS patients who mainly have high serum testosterone, while the third type is those patients who mainly have high serum prolactin.

2. The distinguishing characteristics of Prof. Long's pattern discrimination & use of medicinals

2.1 Treatment based on the root

Because Prof. Long believes that kidney vacuity with blood stasis is the basic or foundational pattern of PCOS, she usually supplements the kidneys and quickens the blood at the same time. In this case, she believes that supplementing the kidneys can regulate menstruation and treats the root, while quickening the blood can promote ovulation. For these purposes, Prof. Long commonly uses the following formula with additions and subtractions:

Zi Shi Ying (Fluoritum)
Bu Gu Zhi (Fructus Psoraleae)
Suo Yang (Herba Cynomorii)
Fu Pen Zi (Fructus Rubi)
Sang Ji Sheng (Herba Taxilli)
Tu Si Zi (Semen Cuscutae)
Shan Zhu Yu (Fructus Corni)
Di Long (Pheretima)
San Qi (Radix Notoginseng)
Ze Xie (Rhizoma Alismatis)
Ze Lan (Herba Lycopi)

Within this formula, Zi Shi Ying, Bu Gu Zhi, Suo Yang, and Fu Pen Zi warm and supplement kidney yang. Sang Ji Sheng, Tu Si Zi, and Shan Zhu Yu evenly supplement yin or supplement yin and yang together. This is based on the statement:

If one wishes to supplement yang, one must seek yang within yin. Thus, when yang obtains yin's assistance, it is engendered and transformed without limit. If one wishes to supplement yin, one must seek yin within yang. When yin obtains yang's upbearing, its source is inexhaustible.

Di Long, San Qi, Ze Xie, and Ze Lan quicken the blood and disinhibit water, regulate and ease the flow of the chong and ren, thus enabling the ova to be normally discharged. In this formula, Zi Shi Ying is the sovereign medicinal and is used at a heavy dose of 30 grams in order to warm the kidneys and invigorate yang, warm the uterus and invigorate conception. According to the Ben Cao Gang Mu (Detailed Outline of Materia Medica), Zi Shi Ying is a yin and blood aspect medicinal of the hand shao yin and foot jue yin. Above, it is able to settle the heart and heavily eliminates timidity. Below, it is able to boost the liver, and its dampness is able to eliminate withering or desiccation. The heart rules the blood and the liver stores the blood. Zi Shi Ying's nature is warm and it supplements. Therefore, it is appropriate when either the heart spirit is disquieted or liver blood is insufficient and a woman's sea of blood is vacuous and cold and thus the woman is infertile.

2.2 Treatment based on the divisions of the cycle

In the postmenstrual phase, the sea of blood is empty and vacuous and is a time when yin is growing and yang is waning. Therefore, Prof. Long adds:

Dang Gui (Radix Angelicae Sinensis)
Bai Shao (Radix Alba Paeoniae)
Nu Zhen Zi (Fructus Ligustri Lucidi)
Han Lian Cao (Herba Ecliptae)
Gou Qi Zi (Fructus Lycii)
Sheng Di (uncooked Radix Rehmanniae)
Shu Di (cooked Radix Rehmanniae)

This is in order to enrich yin, nourish the blood, and supplement the kidneys so as to promote follicular development. In the ovulatory phase when heavy or double yin turns into yang, Prof. Long

uses mainly yang-supplementing medicinals to encourage proper physiological transformation. In some cases, she also uses medicinals which quicken the blood and transform stasis, rectify the qi and free the flow of the network vessels in order to promote ovulation. Hence during this phase of the menstrual cycle, she mainly supplements the kidneys and quickens the blood. During the premenstruum when yang is growing and yin is waning, she continues to warm and supplement kidney yang to promote proper corpus luteal function. She will also sometimes add blood-quickening, stasis-transforming medicinals during this phase as necessary. During the menstruation itself, the uterine vessels are full and exuberant and the sea of blood is full to overflowing. Prof. Long thinks that treatment during this phase should rectify the qi and regulate the blood, thus promoting the proper discharge of the menstruate. For this, Prof. Long usually uses:

Chai Hu (Radix Bupleuri)
Dang Gui (Radix Angelicae Sinensis)
Chi Shao (Radix Rubra Paeoniae)
Chuang Xiong (Rhizoma Chuanxiong)
Yi Mu Cao (Herba Leonuri)
Niu Xi (Radix Achyranthis Bidentatae)
Su Mu (Lignum Sappan)
Ze Lan (Herba Lycopi)
Ze Xie (Rhizoma Alismatis)
Xiang Fu (Rhizoma Cyperi)

The purpose of these medicinals is to quicken the blood, transform stasis, rectify the qi, and guide the blood to move downward. If amenorrhea has endured for a long time or if the menstruate is scanty with a dark, purplish tongue due to relatively serious blood stasis, Prof. Long uses worm-type ingredients to break the blood, such as Shui Zhi (Hirudo), Tu Bie Chong (Eupolyphaga/Steleophaga), and Di Ling (Pheretima).

2.3 Additions & subtractions following the symptoms 

If the patient's body is overweight and hyperpilosity is marked, Prof. Long adds Shan Ci Gu (Bulbus Pleinonis/Cremastrae), Xia Ku Cao (Spica Prunellae), Zao Jiao Ci (Spina Gleditsiae), and Shi Chang Pu (Rhizoma Acori Tatarinowii) to transform phlegm and free the flow of the network vessels.

If the ovaries are obviously enlarged (due to cysts), she adds Kun Bu (Thallus Algae), Hai Zai (Sargassium), San Leng (Rhizoma Sparganii), E Zhu (Rhizoma Zedoariae), and Xia Ku Cao (Spica Prunellae) to soften the hard and scatter binding, transform stasis and disperse concretions.

If there is accompanying maldevelopment of the uterus, she adds Zi He Che (Placenta Hominis), He Shou Wu (Radix Polygoni Multiflori), Rou Cong Rong (Herba Cistanchis), and Yin Yang Huo (Herba Epimedii).

If there is premenstrual vexation and agitation and breast, chest, and/or rib-side distention, she adds Chai Hu (Radix Bupleuri), Yu Jin (Tuber Curcumae), Yan Hu Suo (Rhizoma Corydalis), Chuan Lian Zi (Fructus Toosendam), Lu Lu Tong (Fructus Liquidambaris), and Wang Bu Liu Xing (Semen Vaccariae) to course the liver, free the flow of the network vessels, and scatter binding.

If low back pain is severe, she adds Du Zhong (Cortex Eucommiae), Xu Duan (Radix Dipsaci), Sang Ji Sheng (Herba Taxilli), and Gou Ji (Rhizoma Cibotii).

If there is accompanying fallopian tube blockage, Prof. Long adds Hong Teng (Caulis Sargentodoxae), Bai Jiang Cao (Herba Patriniae), Jin Yin Hua (Flos Lonicerae), Lian Qiao (Fructus Forsythiae), Chi Xiao Dou (Semen Phaseoli Calcariti), Yi Yi Ren (Semen Coicis), Lu Lu Tong (Fructus Liquidambaris), Tu Bei Mu (Bulus Fritillariae Thunbergii), Xia Ku Cao (Spica Prunellae), Di Long (Pheretima), Shui Zhi (Hirudo), Bai Zhi (Radix Angelicae Dahuricae), and/or Zao Jiao Ci (Spina Gleditsiae).

For overweight patients with high serum prolactin, she commonly uses He Ye Di (Calyx Folii Nelumbinis). This medicinal's nature and flavor are bitter, level or neutral, and nontoxic. It has a special tropism for the breast and its nature is especially to free the flow. It promotes the free flow of the menses (or channels) and the movement of qi. Therefore, phlegm and fat are automatically eliminated. Prof. Long believes that this medicinal's effect is seemingly magical.

If there is accompanying galactorrhea, she adds stir-fried Mai Ya (Fructus Germinatus Hordei).

If there is infrequent menstruation which is scanty in amount and dark in color or, if more severe, there is amenorrhea, Prof. Long uses uncooked Ji Nei Jin (Endothelium Corneum Gigeriae Galli). This is based on Zhang Xi-chun's Qing dynasty Yi Xue Zhong Zhong Can Xi Lu (Records of Heart-felt Experience in Medicine with Reference to the West) in which Zhang says, "Ji Nei Jin is an essential medicinal for the treatment of women's dry blood consumption." Prof. Long believes that women's dry blood disease refers to a type of intractable amenorrhea. In this case, Ji Nei Jin's effect is to fortify the spleen in order to strengthen the source of engenderment and transformation. This makes the engenderment and production of qi and blood effulgent and exuberant. These then pour upward to the lungs, remembering that the lungs face the hundreds of vessels. From there, they are transported all around the body and to the five viscera and six bowels, eventually pouring below into the sea of blood. When the sea of blood is full and exuberant, it spills over and thus amenorrhea is automatically cured. Further, when there is stasis and stagnation not freely flowing, this medicinal can also quicken the blood. Therefore, stasis is automatically dispelled. According to Prof. Long, Ji Nei Jin does not just disperse and eliminate spleen-stomach accumulation. No matter what viscus or bowel, channel or network vessel has accumulation, Ji Nei Jin is able to disperse them all. Thus Prof. Long believes that Ji Nei Jin's treatment of amenorrhea is broad-based.

Copyright © Blue Poppy Press, 2007. All rights reserved.