| Background:Polycystic ovary syndrome(PCOS),a common female endocrine disease,is one of the most common pathogenic factors resulting in endocrine disorders and infertility of women of reproductive age.Hyperandrogenism and sustained anovulation are main clinical symptoms because the balanced relation is broken among hypothalamus,pituitary and ovary axis.The PCOS incidence in women of reproductive age is 6%-10%,account for 50%-70%of anovular infertility and 25%of amenorrhea.It has been over 70 years since 7 cases of amenorrhea,birsutism and obesity accompanied with bilateral polycystic and enlarged ovaries,named S-L syndrome,were first reported by Stein and Leventhal.Though continuous studies on PCOS are carried out and new views are constantly created,its pathogenesis remains unknown and no one standardized therapy is established.Both medicine and surgery can not cure PCOS completely and can not persistently eliminate its symptoms.The recurrence of PCOS is possible.PCOS common symptoms include irregular menstrual cycle,amenorrhea,infertility,hirsutism,acne,obesity, acantbosis nigricans and etc.Under the abnormal endocrine environment, women with PCOS are at risk for the following:type 2 diabetes,gestational diabetes,impaired glucose tolerance,central obesity,hyperlipaemia, hypertension,hypercoagulative state and coronary heart disease.The risk of long-term endometrial carcinoma has been increased,which seriously has harmed women health.The PCOS study is one of the extremely complex research hotspots and difficulties for many years.Objective:Syndrome is a specific concept and a core to understand the changes and development of a disease in Traditional Chinese Medicine(TCM). Differentiation of symptoms and signs is a precondition of prescribing an herbal formula and a basis to obtain clinical therapeutic result in TCM. Summarizing and analyzing PCOS cases treated by Prof.Li Guangrong in many years,we studied the regular distribution of TCM syndrome,the relation between correlation parameter and syndrome classification and the correspondence of essential factors of syndrome and herbal formula,which established a basis for study on an evaluating standard of PCOS,objective study of TCM syndrome and study on integration of PCOS and its syndromes. Through the research on the correspondence of essential factors of syndrome and herbal formula,the formula regularity for PCOS patients were explored.Methods:1.Literature review:There was no a disease named PCOS in TCM literature. According to PCOS clinical manifestations,it could be classified into the fields of delayed menstrual cycle,infertility,amenorrhea and uterine bleeding.The ancient TCM doctors believed that the etiology and pathogenesis of these diseases mentioned above were kidney deficiency,phlegm—dampness, liver depression and Qi stagnation involving the following organs:kidney, liver and spleen.Among them,kidney was the major one.Modern TCM doctors held different opinions on etiology and pathogenesis of PCOS.The typical view suggested:A.Function disturbance of liver,spleen and kidney resulted in the broken balance among kidney,tiangui,Chong and Ren.B.Accumulation of Phlegm-dampness and blood stasis was common pathological changes.C. Several etiologies and pathogenesis co-existed.Along with the development of molecular biology and immunological technique and the establishment of animal model,large numbers of basic and clinical studies on etiology, pathogenesis,pathological and physiological changes of PCOS had been done in endocrine field.Medication and surgical therapies had also been further studied.PCOS,however,was a heterogeneity disease with sustained ovulation disturbance and hyperinsulinemia.The disturbances of endocrine and metabolism introduced by PCOS were harmful to many internal organs.No one therapy was invented to cure the abnormal changes caused by PCOS as the etiology remained unknown.2.Clinical studies: A total of 108 PCOS subjects met inclusion criteria were involved in this study in the period of Jan.2002 to Feb.2009 and their data bank was founded. 7 syndromes,that is,kidney Qi deficiency,kidney Yang deficiency,kidney Yin deficiency,spleen deficiency,phlegm-dampness,blood stasis and liver depression were designed as basic syndromes.All subjects were differentiated and analyzed based on these basic syndromes and distribution difference,in different syndromes,of symptoms and index such as acne, hirsutism,weight change,emotion factor and sexogen were observed and tested as well.Prof.Li' s specialties on herbal application in the PCOS treatment were summarized at last,which would provide a clue for founding a therapeutic regularity of herbal medicine in clinical practice.Results:1.Syndrome distribution:The number of syndromes of liver depression combined with kidney deficiency and liver depression combined with spleen deficiency were maximum in the subjects.The number of other syndromes was in sequence of kidney deficiency combined with blood stasis＞spleen and kidney Yang deficiency＞liver depression＞Qi stagnation combined with blood stasis＞kidney Yang deficiency＞phlegm-dampness,spleen deficiency combined with phlegm-dampness＞spleen deficiency,kidney Qi deficiency＞blood stasis＞kidney Yin deficiency.The number of subjects with simple syndrome was much less than the complicated syndrome,occupied 32.41%and 67.59%respectively. The syndromes correlated to kidney deficiency included kidney Qi deficiency, kidney Yang deficiency,kidney Yin deficiency,liver depression combined with kidney deficiency,kidney deficiency combined with blood stasis,spleen and kidney Yang deficiency,reaching 52.78%of total.The syndromes correlated to liver depression included liver depression, liver depression combined with kidney deficiency,liver depression combined with spleen deficiency and Qi stagnation combined with blood stasis, reaching 46.30%of total.The syndromes correlated to spleen deficiency included spleen deficiency,liver depression combined with spleen deficiency, spleen and kidney Yang deficiency,reaching 35.19%of total.The syndromes correlated to blood stasis included blood stasis,kidney deficiency combined with blood stasis and Oi stagnation combined with blood stasis,reaching 24.07%of total.The syndromes correlated to phlegm-dampness included phlegm-dampness and spleen deficiency combined with phlegm-dampness, reaching 9.26%of total.The percentage of syndromes correlated to kidney deficiency＞syndromes correlated to liver depression＞syndromes correlated to spleen deficiency＞syndromes correlated to blood stasis＞syndromes correlated to phlegm-dampness.Therefore,functional disturbances of kidney,liver and spleen were the root cause of PCOS and the kidney deficiency was a leading one.1.Correlated syndrome distribution:Syndromes of liver depression combined with spleen deficiency,spleen and kidney Yang deficiency and spleen deficiency combined with phlegm-dampness,which were syndromes correlated to spleen deficiency,were more common in the subjects with obesity and obvious weight gain symptoms, occupying 60%(P＜0.01).Syndromes of liver depression combined with spleen deficiency,spleen deficiency combined with phlegm-dampness and spleen and kidney Yang deficiency,which were syndromes correlated to spleen deficiency,were more common in the subjects with hirsutism,occupying 59.09%(P＜0.01).Syndromes of liver depression,Qi stagnation combined with blood stasis and liver depression combined with spleen deficiency,which were syndromes correlated to liver depression,were more common in the subjects with acne, occupying 76.92%(P＜0.01).24 subjects with emotional disturbance inducement accounted for 22.22% of total subjects.Liver depression was the most common syndrome in these subjects(P＜0.01).Detecting the endocrine indexes of subjects,taking LH/FSH≥3 as a standard,its difference among all of the syndromes was P＞0.05, indicating that no difference among all of the syndromes.There were 49 subjects with increased testosterone and its distribution was irregular, P＞0.05,suggesting that no difference among all of the syndromes.3.Herbal application analysisA.Herbs with high frequent applicationStatistic process showed that a total of 211 formulas for 108 clinical PCOS subjects involved in 81 herbs and applied totally 2776 times.High frequent used herbs were in a very small range,indicating obvious characteristics and regularities in herbal application.An herbal data bank was consisted of herbs with high frequency of usage,say,over 50%,and those herbs were applied totally 1934 times,accounting for 69.67%of total application of all herbs.Those herbs were,from higher frequent used to lower frequent used,Dang Gui,Bai Shao,Yi Mu Cao,Chai Hu,Tu Si zi,Ze Lan,Fu Ling,Xian Ling Pi,Bai Zhu,Ba JI Tian,Chuan Niu Xi and Zi He Chu.In my opinion,these herbs could be used in PCOS treatment in future clinical practice.B.Herbal functional classificationHerbs applied in the formulas were classified into 12 groups;the biggest group among them was kidney-nourishing group with 17 different herbs and usage of 825 times.The second big group was liver adjusting group with 12 different herbs and usage of 720 times.The third one was activating blood and dissolving stasis group with 17 different herbs and usage of 571 times. Next one was spleen-nourishing group with 9 different herbs and usage of 379 times.Nourishing kidney Yang herbs were most numerous in kidney-nourishing group,reaching 64.73%.Liver-adjusting herbs covered those with functions of relieving liver Qi stagnation,soothing liver and regulating Qi,clearing liver heat and nourishing blood and liver.Herbs with functions of relieving liver Qi stagnation and nourishing blood and liver were used more frequently and accounted for 80.69%.Activating blood and dissolving stasis herbs covered those with functions of promoting blood circulation to restore menstrual flow,clearing heat and activating blood,promoting blood and Qi circulation,activating blood to cure injury and breaking blood stasis to resolve lumps.Herbs with functions of promoting blood circulation to restore menstrual flow were used with high frequency and occupied 88.09%.It was obvious that the therapies of kidney-nourishing,liver- adjusting, activating blood and dissolving stasis were strongly focused on in the clinical practice,which was showed from numerous applications of herbs with functions of kidney-nourishing,liver-adjusting and activating blood and detailed classification to herbal functions.So it could be said that therapies of kidney-nourishing,liver-adjusting,activating blood and dissolving stasis were the most common therapeutic methods in PCOS treatment.C.Herbs in different syndromesHerbs with the highest usage rate(top 4) in kidney Yang deficiency syndrome were Tu Si Zi,Xian Ling Pi,Ba Ji Tian,Chuan Niu Xi.Herbs with the highest usage rate(top 4) in liver depression syndrome were Chai Hu,Dang Gui,Bai Shao,Xiang Fu.Herbs with the highest usage rate(top 4)in spleen deficiency syndrome were Fu Ling,Dang Gui,Bai Zhu,Bai Shao.Herbs with the highest usage rate(top 4)in kidney deficiency and blood stasis syndrome were Dang Gui,Ze Lan,Xian Ling Pi,Yi Mu Cao.Herbs with the highest usage rate(top 4)in phlegm-dampness syndrome were Fu Ling,Bai zhu,Ban Xia, Zhi Nan Xing.Discussion:The formulas were designed based on the differentiations to the symptoms and signs,as the unity of theory,principle of treatment,formula and herbs was TOM principle in the differentiation and treatment of a disease.Prof. Li believed that PCOS could be covered in menstruation diseases in TCM.It had close association with organs of kidney,liver and spleen.The complicated and changeable PCOS pathogenesis,caused by the physiological generation and restriction and pathological affection and transmission among these 3 organs,increased the difficulty in PCOS treatment.Prof.hi obtained satisfied therapeutic results for she made accurate differentiation on symptoms and signs,grasped the developing regularities of PCOS and applied the adjusting therapies of kidney,liver and spleen.To simultaneously adjust these 3 organs functions was the key of PCOS treatment.Chai Hu was applied to relieve liver Qi stagnation and adjust menstruation.Dang Gui was applied to enrich and activate blood.Yi Mu Cao and Ze Lan were applied to activate blood,alleviate water and adjust menstruation.Bai Shao was applied to nourish blood,sooth liver and adjust menstruation.Tu Si Zi was applied to warm kidney,nourish liver and tonify spleen.Chuan Niu Xi was applied to activate blood,promote menstruation, tonify liver and spleen.Fu Ling was applied to nourish spleen,clear dampness and promote diuresis.Bai Zhu was applied to invigorate Qi and spleen and deprive the dampness.Xian Ling Pi and Ba Ji Tian were applied to warm kidney to invigorate Yang.Zi He Che was applied to warm kidney,tonify essence, nourish Qi and blood.The combination of the herbs mentioned above treated both symptoms and root causes of PCOS.In conclusion,emotional factors were PCOS inducement;functional disturbances of kidney,liver,and spleen were PCOS root causes and blood stasis and phlegm-dampness were PCOS symptoms.Blood stasis and phlegm-dampness were pathological products of organs functional disturbances and secondary pathogenic factors as well.The therapies of nourishing kidney,adjusting liver,tonifying spleen,activating blood, dissolving stasis,drying dampness and resolving phlegm were basic PCOS treatment methods.Because of the complicated pathogenesis,Prof.Li suggested,PCOS should be treated with a comprehensive therapy.Combining therapies of nourishing kidney,adjusting liver and tonifying spleen,that is,treating kidney,liver and spleen simultaneously was the key treatment of PCOS.Clinical subjects showed that the therapeutic results were significant,though no one therapy in conventional medicine could improve the abnormal changes introduced by PCOS.The TCM soul-- holism concept, syndrome differentiation and treatment,was also its characteristics. Through adjusting organs' function,the balance and stable state of kidney-tiangui-Chong and Ren-uterus axis could be reached,which could further not only treat irregular menstruation,amenorrhea and infertility of POCS but also play a decisive role in keeping PCOS patients' health and improve the symptoms of long-term complications. |
PDF Full Text Request