Whole-person approaches to polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a poorly understood disorder with no tests to diagnose it definitively. Women commonly seek medical help because of irregular periods or androgen-excess symptoms like hirsutism, acne, and male-pattern baldness. However, for many women, they don’t find out they have PCOS until they have trouble conceiving. If left untreated, this disorder can increase the risk of type 2 diabetes, high cholesterol, and heart disease.

Traditional Chinese Medicine (TCM) excels at addressing complex health issues and treating the root cause of illnesses because the approach is to customize therapies based on the individual. As a result, TCM has been used to treat women’s hormonal health issues, including PCOS, for thousands of years.

Even though PCOS includes the word “polycystic,” not all those with PCOS have cysts. Further, the “cysts” patients experience are not actual cysts, but rather enlarged follicles. If a woman doesn’t produce enough hormones for a follicle to break open and release an egg, the fluid inside the follicle can build up. These fluid-filled sacs can then increase androgen production, causing more hormonal imbalance. It is also possible for women to have many ovarian cysts without having PCOS.

According to TCM, a main cause of these fluid-filled follicles is too much Dampness and Phlegm. Other symptoms of Dampness and Phlegm depend on where they accumulate, but include poor digestion, loose stools, bloating, weight gain, fatigue, foggy-headedness, sensation of fullness in the abdomen or chest, nasal congestion, acne especially if combined with Heat, and high cholesterol.

Cang Fu Dao Tan Tang is also a great formula for those with Phlegm and Dampness as a dominant pattern. Its herbs cang zhu, fu ling, zhi ban xia, and dan nan xing all work to help drain or transform Dampness and dissolve Phlegm. Xiang fu helps to alleviate pain and regulate the period. Shen qu, sheng jiang, and chen pi all support the Spleen and digestion, while zhi ke keeps the Qi moving and gan cao helps all the herbs work together.

Because one of the Spleen’s main functions is to transform Dampness, it can be helpful to choose foods that strengthen this organ, such as moderate amounts of root vegetables, pumpkin, and squash. Beneficial grains include millet and barley, which nourish the Spleen while also draining Dampness. It is best to limit raw, cold foods, focusing instead on soups, stews, slow-cooked or pressure-cooked meals, and cooked vegetables instead of salads. The patient should also avoid dairy, greasy fried foods, processed foods, and too much sugar, all of which can contribute to more Dampness.

If Spleen Qi deficiency is present, common signs and symptoms include bloating, diarrhea, undigested food in the stool, feeling weighted down, prolapse, fatigue, anemia, easy bruising, overthinking and worry, and problems concentrating. In addition, the Spleen is often called the Spleen/pancreas because, in addition to being important for digestion, it also helps regulate blood sugar, so if the Spleen Qi is deficient, blood sugar and insulin issues can arise. Si Jun Zi Tang, Bu Zhong Yi Qi Tang, and Shen Ling Bai Zhu San are three well-recognized TCM formulas to consider.

Since the biomedical cause of the accumulation of fluid-filled follicles is that there are not enough hormones to stimulate ovulation, getting the follicles to release their eggs, as they are supposed to, will help manage this hormonal imbalance. The Kidneys have connection with the ovaries, with DNA, and with the eggs themselves. Because Yang is the energy that is involved with movement and activation, the lack of release of the egg from the follicle can be a sign of insufficient Kidney Yang.

To see if this pattern fits the patient, consider if they also tend to feel cold, suffer from low back pain, have joint pain especially hips, knees, ankles, and feet made worse by cold weather, appear pale or puffy, feel fatigued, and may have been told they have adrenal fatigue. They may have hit puberty a bit late and feel they have a slow metabolism, tending to be overweight.

One herbal formula to restore Kidney Yang is You Gui Wan. Practitioners should note, however, that traditionally it contains the herb lu jiao jiao, which is a gelatin made from deer antler, so it is not suitable for vegans and those who don’t want animal herbs. It can be substituted out for yin yang huo or ba ji tian. Keeping the low back and abdomen warm and steering clear of burning the candle at both ends helps protect the Kidney Yang.

TCM textbooks report the most common pattern associated with PCOS as a combination of Kidney Yang deficiency along with Dampness-Phlegm accumulation. It manifests as no periods or very small amount of menstruation, infertility, excessive vaginal discharge, a feeling of pressure in the chest and heaviness in the abdomen, and a pale tongue with a thick, sticky white coating. Using a mixture of the herbs can address this combination pattern.

Case Study

In clinic, I have seen several young women who appeared to have PCOS, but for whatever reason, did not meet the diagnostic requirements for that label. That may not be surprising to some researchers, as PCOS is thought to be significantly underdiagnosed, with one study reporting roughly 68 percent of PCOS cases remain undiagnosed.

One 17-year-old patient, Sara, sought help for her anxiety and depression, but it quickly became apparent that she had a significant hormonal imbalance. She got her first period at age 14 and it never became regular, with a maximum of only four periods per year, and those periods were very light. She was overweight even though she was overly restrictive with her food and very active with daily workouts. She was also always tired, felt mentally fatigued, struggled with frequent urination, had around seven urgent bowel movements per day, had cold hands and feet, and displayed hirsutism. She had had blood tests and an abdominal ultrasound, but nothing significant was noted.

Her pattern was the classic Kidney Yang deficiency with Phlegm-Dampness accumulation (along with some Spleen Qi and Yang deficiency). I prescribed the formula Yu Shi Wen Bu Fang. This formula contains herbs that tonify the Kidneys, boost Yang Qi, move Blood, and dissolve Phlegm. To help calm her nervous system, I added fu shen (a part of the herb fu ling, which drains Dampness), ling zhi (reishi), and yuan zhi. For digestive support and to improve her energy, I included chen pi, dang shen, huang qi, and bai zhu. It will take at least a few months of herbs, modified as her symptoms change, to expect significant shifts, but along with counselling and the support of her family, she is on her way to healing.

References 

March, W., Moore, V. (2021) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/19910321/