Polycystic Ovary Syndrome is a condition where Cysts develop on the Ovaries. It has become the most common hormonal disorder in women of reproductive age.

Main Clinical symptoms:

Menstrual Irregularity:

• Amenorrhea (20%)
• Oligomenorrhea (infrequent menstruation) (70–75%)
• Anovulation
• Infertility

Hyper-androgenism:

• Hirsutism
• Male-pattern balding
• Acne

Other:

• Obesity (up to 50%)
• Skin tags
• Acanthosis nigricans (skin darkening)
• Type II Diabetes

Most common presenting symptoms to a physicians office are Amenorrhea or Irregular menstruation (85–95%), Infertility, and Obesity (50%). However, only 5–10% of women have symptoms. Some reports have shown 18% of women have PCOS, and that 70% were undiagnosed.
Multiple factors can contribute including genetic predisposition, diet and lifestyle. However, two major contributing factors are androgenic hormones and reduced sensitivity of insulin. In addition, higher liver enzyme levels but lower bilirubin and bile acid levels were noted in Chinese women with PCOS.

Blood test will typically show elevation of:

• Serum Lutenizing Hormone
• Estrone
• Fasting glucose and Fasting Insulin
• Free Testosterone
• serum lipids

Estradiol, DHEA and Progesterone are typically normal.
Chronic PCOS has been associated with increased risk of Cardiovascular disease, Depression and Endometrial cancer.

According to TCM, PCOS is caused by one of the following syndromes, in decending order of frequency:

• Kidney Deficiency
• Phlegm-Damp obstruction
• Blood stasis
• Qi Stagnation
• Spleen or Spleen and Kidney Deficiency
• imbalance between Yin and Yang, or Yang Deficiency

Diet & Lifestyle

1. Avoid sugar, refined carbs, soda drinks, packaged juices, processed foods in general
2. Carbohydrates should only be in whole grain form, Basmarti rice is an exception.
3. Fresh fruit, especially Papaya, Pineapple; Vegetables especially green leafy vegetables
4. Use of herbs in cooking: Basil, Oregano, Sage, Rosemary, Ginger, Cinnamon, Turmeric, Cumin and spices in general.
5. Reduce food intake, strictly avoid overeating.
6. Exercise (45 minutes walking per day), Yoga and Pranayama (breathing) are very useful for long-term hormonal health.

Out of over 1400 cases treated by TCM, the most commonly used herbs were as follows:

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Herbs Potentially useful for PCOS

A large scale review of 33 studies on the effectiveness of Herbs for PCOS indicated 6 herbs to be of potential value:

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Ayurvedic Herbs for PCOS

The following are some of the primary Indian herbs associated with PCOS treatment.

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Taiwanese National Health Insurance Stastistics

A large-scale survey through the Taiwan National Health Insurance Program database revealed the most common herbal formula used for PCOS was Dan Zhi Xiao Yao San (aka Jia Wei Xiao Yao San), while the most commonly prescribed single herb was Cyperus rotundus (Xiang Fu). (See research here)

In addition, the simple classical combination of Peony (Bai Shao) and Licorice (Gan Cao) has been found to help in PCOS. In a trial it was shown to reduce testosterone levels in 90% of women while appearing to regulate LH to FSH ratio.

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Differential Diagnosis:

Qi Stagnation

Early stage or smaller PCOS. History of hyper-emotionalism, PMS, breast tenderness before menstruation, maybe slight cramping before menstruation, pulse may feel tight or suppressed.

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Obstruction with Phlegm and Damp

Excess phlegm, low energy, feels heavy, tendancy to overweight or fluid retention, clear discharge, waterish blood.
Thin, greasy tongue coat, wiry and slippery pulse

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Blood Stasis

Uterine pain, painful menstruation, blood clotting or dark blood, prolonged menstruation, pain relieved by warmth, cyanosis of the lips, tongue and nail beds. Pulse is choppy. Dull is dull or cyanotic (purplish).

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Kidney Deficiency

Kidney and lower back pain, weak kness, nocturnal urination.
Yin deficiency: dry mouth and throat, sweating at night
Yang deficiency: also cold, clear urination

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Melancholy

Heavy feeling in the abdomen, with dark clotted menstrual Blood, depression, desire for solitude, dull or dark complexion, a dry tongue and a weak pulse.

 
Other Treatment:

1. Cupping with Bloodletting (‘Wet Cupping’) behind the knee and on the calves is promoted as useful in Unani medicine.
2. Enemas and Douches are useful. Oil enemas settle vitiated Qi.
3. Emetics can be prescribed in Phlegm constitutions.
4. Purgative medicines to purge Phlegm, Damp, open obstructions and resolve Masses (move Blood).

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Special Formulas

1. Tribulus and Withania (proven effective, see research below)
2. Tribulus with Cinnamon, Peony Bai Shao, St. John’s wort, Licorice
3. PCOS with Menorrhagia, Symplocos racemosa with Saraca indica, Licorice (Siddha)
4. Agnus Castus, Paeonia Bai Sho, Black Cohosh, Dang Gui
5. Nettle, Carrot seed, Fennel seed (Persian remedy)
6. Picolin
    Cinnamon
    Licorice
    Linseed
    Agnus Castus
This has been studied and found effective. (See here)
7. An Electuary from Unani:
    Fennel seed
    Fennel root
    Black Nightshade
    Rose
    Dried Fig
    Maidenhair
    Swertia
This Unani medicine and is prepared as a Majun (Electuary)
7. A Powder from Siddha:
    Nigella seed
    Radish seed
    Wld Carrot seed
    Fenugreek seed, equal parts
This is a combination from Siddha medicine. It is formed into powder and taken in 4 grams doses.
8. PCOS with Hyperandrogenism
    Fenugreek
    Aloe
    Sphaeranthus indicus
    Indian Spikenard
    Symplocos racemosa
This was found to be effective in studies. (See research here)

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Unani Protocol

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Iranian Treatment

A case of successful treatment of Ovarin Cysts with Infertility was reported in the Journal of Evidence Based Complimentary and Alternative Medicine.(Dec. 2016). The patient had a long history of Ovarian Cysts and had had several surgeries prior. In addition she was unable to conceive.

Treatment included 2 tablespoons morning and night of Oxymel of Squill, 2 capsules morning and night of Raha (Vitex Agnus Castus), and 2 capsules of Moshel Samghi (125 mg) nightly starting on the seventh day of menstruation. Three monrths after treatment began the Ovary appeared normal on ultrasound, cysts had reduced in size. A number of folllicles were observed and she was told to attempt conceiving, which she did in the same cycle.

The Oxymel of Squill contained 250mg of Squill per 10 grams of Oxymel (equal parts of Honey and Vinegar). The other formulas used were as follows:

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Research:

–Traditional Persian Medicine and management of metabolic dysfunction in polycystic ovary syndrome
Herbs
–Effect of chamomile capsule on lipid- and hormonal-related parameters among women of reproductive age with polycystic ovary syndrome.
–Effects of chamomile extract on biochemical and clinical parameters in a rat model of polycystic ovary syndrome.
–Effect of soy phytoestrogen on metabolic and hormonal disturbance of women with polycystic ovary syndrome.
–Welsh Onion Root (Allium fistulosum) Restores Ovarian Functions from Letrozole Induced-Polycystic Ovary Syndrome
–Licorice ethanol extract improves symptoms of polycytic ovary syndrome
–The effect of cinnamon on polycystic ovary syndrome in a mouse model.
–Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo controlled clinical trial.
–Preliminary evidence that cinnamon improves menstrual cyclicity in women with polycystic ovary syndrome: a randomized controlled trial.
–Crocetin attenuates DHT-induced polycystic ovary syndrome in mice via revising kisspeptin neurons.
–Effects of metabolic abnormalities, hyperandrogenemia and clomiphene on liver function parameters among Chinese women with polycystic ovary syndrome: results from a randomized controlled trial.
Formulas
–An Analysis of the Clinical Medication Rules of Traditional Chinese Medicine for Polycystic Ovary Syndrome Based on Data Mining
–Investigation on the Use of Traditional Chinese Medicine for Polycystic Ovary Syndrome in a Nationwide Prescription Database in Taiwan.
–Effect of combination of Withania somnifera Dunal and Tribulus terrestris Linn on letrozole induced polycystic ovarian syndrome in rats.
–Xiao-Yao-San, a Chinese Medicine Formula, Ameliorates Chronic Unpredictable Mild Stress Induced Polycystic Ovary in Rat.
–Effect of “DXB-2030,” a Polyherbal Formulation, on Experimental Polycystic Ovary Syndrome Associated with Hyperandrogenism
–Efficacy of a Persian Herbal Remedy and Electroacupuncture on Metabolic Profiles and Anthropometric Parameters in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial.
Diet & Lifestyle
–Lifestyle changes in women with polycystic ovary syndrome
–Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial.
–The Importance of Sleep Hygiene in Polycystic Ovary Syndrome from the View of Iranian Traditional Medicine and Modern Medicine..
–Principles of Nutrition in Patients with Polycystic Ovary Syndrome in Iranian Traditional Medicine and Comparison with Modern Medicine
–Lifestyle and Behavioral Management of Polycystic Ovary Syndrome.