| Polycystic ovary syndrome is a common disorder syndrome of reproductive endocrine inwomen of childbearing age. Its pathological changes involve not only in reproductivedysfunction, but also in hyperlipemia, hypertension, diabetes and cardiovascular disease andother complications. It brings great harm to the health of the patients. So finding an effectivetreatment of PCOS blocking the course, preventing the occurrence of complications will beimportant scientific significance and social significance. However, the present treatmentmethods (including modern medicine therapy/traditional Chinese medicine therapy/traditionaland western medicine therapy)limit to the short-term efficacy such as ovulation rate andpregnancy rate, the long-term efficacy and prevention of complications are still nobreakthrough.There isn't the name of PCOS in TCM. According to the clinical manifestation, it is foundin the chapter of "late menstruation", "amenorrhea" and "infertility". Many scholars treatPCOS by BuShenHuoXue therapy or BuShenHuaTan therapy. My supervisor, professor LiGuang-rong is one of the most famous TCM gynecologists of our country. She has been aTCM gynecologist for more than 40 years. She has accumulated a wealth of experience in thetreatment of PCOS by TCM, and has established an unique academic ideas. She stresses theimportance of emotion, and creats BuShenTiaoGan therapy to treat PCOS. In recent years, therepeated testing of professor Li treating PCOS by BuShen TiaoGan therapy is the case. Thetherapy also has the long-term effects. It demonstrates a sign of a breakthrough of TCM inPCOS long-term efficacy. To Certificate the treatment role of BuShen TiaoGan therapy onPCOS and its mechanism, we study from three aspects in this paper: theory, clinical andexperiment. We describe the cause and pathogenesis of PCOS, the utility, the efficacy and themechanism of BuShen TiaoGan therapy. We provide new and more effective therapy.1 Theoretical studies1．1 The recognition of TCM on the cause and pathogenesis of PCOSAccording to the clinical manifestations of PCOS, the similar records scatter among thechapters of late menstruation, amenorrher and infertility in the ancient TCM literature. Wesummarized the recognizations of the ancient doctors to the cause and the pathogenesis about the 3 kinds of diseases in this research. In general, the causes include:emotional disorder,exogenous cold, phlegm and stagnant blood. Phlegm and stagnant blood are eitherpathological products or pathogenic factors. The pathogenesis includes two types ofdeficiency and sthenia syndrome. The deficiency syndromes include:①insufficiency of spleenand stomach, deficiency of Qi and blood;②asthenia of kidney Yin;③Yin deficiency blooddryness;④declination of kidney Yang, cold of insufficiency type internal produce. The stheniasyndromes include:①stagnancy of Qi and blood stasis;②cold stagnation and bloodstasis;③stagnation of phlegm-dampness. The conclusion establishes a theoretical frameworkfor us to study the cause and the pathogenesis of PCOS.1．2 To approach the cause and the pathogenesis of pcos from emotion disorderAccording to its clinical manifestations, PCOS belongs to the area of menstruationdiseases. Menstruation is closely related to liver and kidney. Epidemiological studies haveshown that emotions play an important role in the invasion and the progression of PCOS.Therefore, emotion disorder is one of the causes of PCOS. According to the TCM theory,kidney storing essence; kidney producing marrow; brain as the sea of marrow; kidney doesn'tproduce, and marrow can't be full of; brain is the house of mental activity, it is demonstratedthat the cerebration of brain is related to kidney essence and brain marrow. Somebody who isexposed to pathogens and deficiency of Qi which must be present. Therefore, we think thatmarrow sea vacuity is needed for emotion to cause diseases. Kidney deficiency is the basis foremotion to cause PCOS.Emotion disorder can bring more serious kidney deficiency bycausing the marrow sea disorder. Liver controls emotion. Liver smoothes and regulates theflow of Qi and blood. Emotion disorder can cause stagnation of liver Qi by causing itdisorder for liver to smooth and regulates the flow of Qi and blood, so as to havingpathological products such as phlegm and blood stasis. Stagnation of liver Qi is the result ofemotion disorder. Above all, emotion disorder is the cause of PCOS. Asthenia of kidney andstagnation of liver Qi are the core pathogenesis. This conclusion is the same as the theoryframework that we have built. According to the theory that stagnation of liver Qi can causemore syndrome, it will be exactly suitable to treat PCOS by strengthening kidney andregulating liver. 1．3 The modern medicine basis of emotion disorder causing PCOSAccording to the modern medicine theory, hypothalamus regulates emotions through theautonomic nervous system. It is also a reproductive endocrine organ, regulating thereproductive function by hypothalamic-pituitary-ovarian axis. Therefore, hypothalamus is animportant anatomical structure which contract the emotion and reproductive endocrine offemale. The changes of female's emotion can affect the function ofhypothalamic-pituitary-ovarian axis by changing the functions of endocrine of hypothalamus.The dysfunction of hypothalamic-pituitary-ovarian axis in PCOS is one of pathologicalchanges. Hypothalamic structure and function provide anatomical basis for PCOS emotiondisorder cause. Emotional changes can arouse some neurotransmitters such asdopamine,β-peptide, rennin-angiotensin-aldosterone change. Tension can induce themetabolism of dopamine inactivation, which can inhibit GnRH pulse frequency, leadingluteinizing hormone secretion increased, inducing hyperandrogenism. Anxiety can cause thebloodβ-peptide levels increased, triggering hyperinsulinemia. Renin-angiotensin-aldosteroneabnormal secretion is one of the causes of ovarian androgen excess and folliculardevelopment disturbance. Neurotransmitter changes provide an endocrine basis for PCOSemotion disorder etiology. This conclusion provided strong evidence for PCOS emotiondisorder TCM etiology from the perspective of modern medicine.2 Clinical studies2．1 The PCOS therapy study on professor Li Guang-rongOn the basis of the theory study, we proposed that BuShen TiaoGan therapy is the basictreatment of PCOS. In this study, we will regard the old Chinese structured clinicalinformation collection system as a technology platform. The original cases and prescriptionsof my supervisor are analyzed from multiple perspectives. The results showed that:①BuShenTiaoGan therapy is the most common treatment of PCOS of my supervisor.②According tothe analysis of medicine, the most commonly used drugs of my supervisor to treat PCOS arestrengthening kidney drugs, regulating liver drugs and promoting blood drugs.③Drugscommonly used frequency analysis showed that 19 pieces of drugs most commonly used bymy supervisor can also be divided into four categories, that is strengthening kidney drugs,regulating liver drugs, promoting blood drugs and invigorating spleen drugs. The most commonly used drugs are Radix angelicae sinensis, Radix paeomiae alba and Herba epimedii.The treatment and medication analysis show that BuShen and TiaoGan therapy are the mostcommonly used methods for my supervisor to treat PCOS. Because of the complexpathogenesis, my supervisor combined the two methods to treat PCOS. The study shows thatBuShen TiaoGan therapy of PCOS belongs to the famous old Chinese experience in a clinicalbackground.2．2 DUONANG decoction treat PCOS 50 cases clinical summaryWith more than 40 years of clinical practice, continuing review of clinical experienceand repeating drug screen, my supervisor summarized BuShen TiaoGan experienceprescription-DUONANG decoction to treat PCOS. To a more systematic and comprehensiveassessment of BuShen TiaoGan therapy efficacy, we will summarize the clinical efficacy of50 cases which my supervisor treated by DUONANG decoction in this study. The resultsshowed:①50 patients, treated 414 months of a total, menstruation appears 263 times, via ratecycle is 63．5%.39 patients appear biphasic basal body temperature, 26 patients appearovulation, the rate of restore ovulation is 52%.There are 26 infertility patients, 19 patientspregnant during treatment or withdrawal within 6 months. Among the 19 patients,3 patientsabortion, pregnancy success rate is 61．5%.②The patients menstruation is better aftertreatment than before.③13 patients ,who have restored ovulation after treatment and stoppedtreatment, maintained better about menstruation than treatment before.④DUONANGdecoction can lower serum luteinizing hormone(LH),testosterone(T) and LH/follicularstimulating hormone(FSH).⑤DUONANG decoction has no effects on the uterus and ovaryvolumn. The results show that DUONANG decoction has good short-term efficacy and somelong-term efficacy.3 Experimental studyIn experimental study of this paper, we create polycystic ovary (PCO) rat models byPoretsky' way, by RIA, ELISA, histopathology, immunohistochemistry, situ hybridization,Western-blotting, to explore the mechanism of DUONANG decoction from thewhole-cell-molecular levels. The results showed:①DUONANG decoction can increase PCO rat models' serum E2, lower T, regulate thesecretion of FSH,LH,and restore reproductive function. ②The serum IGF-1 level of PCO rat models are significantly decreased, differing fromthe PCOS patients pathological changes. DUONANG decoction can increase PCO rat models'serum IGF-1, TGF-β1level,lower TNF-αlevel. But the changes of PCO rat models' IGF-1,TGF-βhave no impact on the serum T and E2．③DUONANG decoction improve the PCO rat models' ovarian organizational structure,by the way of promoting PCO rat models' follicles development and granulose cellproliferation, differentiation, thinning the theca cell layer and ovarian capsule.④DUONANG decoction can increase PCO rat model FSH receptor protein expressionof granulose cells that is related to E2 synthesis, reduce LH receptor protein expression oftheca cells which is related to T synthesis.⑤DUONANG decoction can increase the PCO rat model ovaries' aromatase mRNA andprotein expression which is related to E2 synthesis, reduce Cytochrome P450c17 mRNA andprotein expression which is related to T synthesis.4 Conclusion①Theoretical studies indicate that emotion disorder is one of the TCM causes of PCOS,Asthenia of kidney and stagnation of liver Qi are the core pathogenesis. strengthening kidneyand regulating liver is the basic treatment of PCOS.②Clinical studies show that BuShen TiaoGan therapy is the most commonly method thatmy supervisor treats PCOS and has its clinical background. DUONANG decoction has goodshort-term and certain long-term efficacy on PCOS.③Experimental studies have shown that DUONANG decoction can promote E2synthesis by increasing FSH receptor protein expression, aromatase mRNA and proteinexpression of granulose cells, inhibiting T synthesis by decreasing LH receptor proteinexpression, Cytochrome P450c17 mRNA and protein expression. DUONANG decoctionregulates the ratio of E2 and T by affecting the synthesis of them so as to improve theorganization structure and play a role in the treatment of PCOS.④The objectivity has been confirmed for BuShen TiaoGan therapy to treat PCOS in thisstudy. It has been shown that the physiological function that synthesizes and secrets E2 and Tis one of the foundation of kidney dominating reproduction, liver and kidney having acommon source theory. 5 Innovations①We first proposed that emotion disorder is the TCM cause of PCOS, asthenia ofkidney and stagnation of liver Qi are the core pathogenesis, strengthening kidney andregulating liver is the basic treatment of PCOS. We prove the objectivity in theory, clinicaland animal experiments. The similar report was not found.②Combining TCM theoretical with advanced technique, we study the mechanism howTCM treating PCOS from the aspects of E2 and T synthesis. the physiological function thatsynthesizes and secrets E2 and T is one of the foundation of kidney dominatingreproduction ,liver and kidney having a common source theory. This study elevated theinvestigation in TCM treating PCOS to advanced level from theory to practice.
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