Polycystic ovarian syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a syndrome caused by disturbances in feedback mechanism of hormonal regulation. The clinical manifestations are anovulatory menstrual abnormalities (including amenorrhea, oligomenorrhea or uterine functional bleeding), infertility, hirsutism, obesity and so on. The signs are such as pelvic cavity inspection with external pathological changes, single-phase of body basal temperature, the consistent quantity and degree of maturity of shedded vagina cells, and persistent (no phases changes) condition of uterine cervix grading by ultrasound (1nsler law). There is bilateral enlargement of the ovaries demonstrated radiographically. In the ultrasound or laparascopy examination, there is cortical stromal hyperplasia(stromal hyperthecosis) with numerous of subcortical cystic follicles underneath; in histological examination of ovary, there is no luteal body (corpora lutea) but presents of subcapsular follicles, atrophy of granular layer, hyperplasia of follicular layer and cortical stroma; clinically, it must be accompanied with ratio of luteinizing hormone(LH) to follicle stimulating hormone(FSH) by more than 3, ratio of estrone (E1) to estradiol (E2) more than 1 for diagnostic purpose. Generally, some people thought that excessive secretion of androgens (from adrenal or ovary) will later converted into estrogens and direct the hypothalamus and pituitary to secrete excessive of LH, causing dysbalance in LH:FSH ratio, makes the ovary to secrete more androgens and therefore affects the maturity of follicles and resulted in anovulation. Some also thought that this disease is related to the impairment of hormonal regulation of the central nervous system or the adrenal glands. There are some patients with elevated level of dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (17OH-progesterone) and 17-hydroxysteroid. In the treatment aspect, the usage of clomiphene,combination of Chinese and western medicine, gonadotrophic hormones and so on have increased the ovulatory rate up to 70-80%. While the wedge resection of ovary is seldom used due to the possibility of adhesion. Some patients has elevated prolactin level in blood, it can be reduces after introduction of bromocriptine or traditional chinese medicine (TCM). The prognosis of this disease is often satisfied after treatment, while without treatment or prolonged anovulatory patients must be aware of increased risk of endometrial cancer. The TCM has various understanding about menstrual irregularities and infertility of PCOS, but the main point is still the insufficiency of kidney Qi (energy). The TCM theory said that,kidney Qi is high in 7 years-old female, so teeth and hair grow better; later menstrual is in progress, opening of ren mai ( a point in acupunture), high energy in tai chong mai (a point in acupunture), occurence of menstruation and then fertile to have child." And " chong ren (2 points) is from bao gong (uterus), and connected to liver and kidney", "kidney stores Jing (one of vital element), jing produces marrow, brain as the sea of marrow"(this phrase means having sufficient kidney Jing will affect brain, thus having flexible movements and good hearing and vision functions), "the kidney also acts according to thinking or will, positive mind yields good condition", " fear(emotions) will affect the kidney". Thus, the kidney is not only related to pituitary gland and ovary, but also closely conneted to other parts of the body including the development of the brain, it is also influences by thinking, emotions, environment and other factors. Therefore, internal and external factors both can affect the menstrual regulation through kidneys. At the same time, according to TCM-- "liver and kidney are of the same source"; so, in some cases of menstrual irregularities, it may due accumulation of heat in the liver other than kidney s qi insufficiency. The PCOS is characterized by obesity and enlargement of ovaries, it confirms to weaknesses of kidney and appearance of phlegm in TCM due to weak kidneys cannot regulate fluid and accumulated to become phlegm. In cases of oligomenorrhea or amenorrhea, there is bruise (disturbances) in jing mai (a point in acupunture) in addition to kidney insufficiency. As a conclusion for now, generally this disease is belongs to weakness of kidney with liver dullness, phlegm and bruises. Clinical treatment resultThere were 285 cases adopted TCM, ovulation occured within 3 months and 272 cases got pregnant within 3 years.