Using Chinese Herbal Medicine to Treat Polycystic Ovarian Syndrome (PCOS)
By Dr. Jessica Ward, DACM, LAc.
Polycystic Ovarian Syndrome (PCOS) is a common reproductive and endocrine disorder that affects women of childbearing age. Women with PCOS often have long or irregular menstrual cycles, infrequent ovulation, or anovulation, as well as small cysts developing on the ovaries that can be seen via ultrasound (Lyttleton, 2013).
Standard treatment for PCOS usually starts with lifestyle changes, like diet and exercise, to promote weight loss and improve metabolic function. Pharmaceuticals are used to regulate menstruation, treat infertility, alleviate symptoms related to excess androgens, and treat metabolic syndromes. There is no single medication used for the treatment of PCOS, and many of the therapeutics often prescribed come with their own adverse events.
When considering treatment for PCOS, there are many Chinese herbal formulas that may be advantageous for women with PCOS and recently, TCM has become an increasingly more common approach for the treatment and management of this condition. We do hope that the following information will provide some context for when herbal medication is prescribed as well as we do not intend the following information to be used without talking with a licensed TCM herbalist.
Jia Wei Xiao Yao San
One formula that should be considered is Jia Wei Xiao Yao San. In TCM, Jia Wei Xiao Yao San is prescribed when there is Liver Qi stagnation causing heat with underlying Spleen and Liver Blood deficiency. Clinical manifestations include irritability, short temper, afternoon fever, anxiety and palpitations, depression, somnolence as well as insomnia, painful or difficult urination, lower abdominal pain, and distention (Scheid & Bensky, 2015). It also is used for menstrual issues such as increased menstrual flow, early menstruation, uterine bleeding, infertility, PMS, and irregular menstruation (Scheid & Bensky, 2015).
Chen et al. (2014) found that Jia Wei Xiao Yao San was the most prescribed formula for the treatment of premenstrual syndrome (PMS) and reported that in animal models, it exhibited an anti-anxiety and anti-depressant effect.
Insulin resistance has been associated with PCOS and Western medications like Metformin have been prescribed to lower blood glucose and manage insulin levels in women with PCOS. In an article on CHM and diabetic retinopathy, Jia Wei Xiao Yao San was considered the most common CHM formula for women with type 2 diabetes and the researchers found that the cumulative probability of diabetic retinopathy was lower in the group of women who took compared to the group that did not take any CHM formulas (Tsai et al., 2017).
The formula Xiao Yao San is a variation of Jia Wei Xiao Yao San that excludes the heat-clearing herbs Mu Dan Pi and Zhi Zi. The potential pharmacological mechanism of Xiao Yao San for the treatment of PCOS revealed a reduction in the expression of interlukin-6 inflammatory cytokines, an inhibited effect of oxidative stress, improvement of the inflammatory state of cell tissues (reduced production of reactive oxygen species), reduced symptoms of insulin resistance, regulated steroid biosynthesis, and promoted epithelial cell production (C. Zhu et al., 2020). This suggests the mechanism of Xiao Yao San plays an important role in the inflammatory response, cell proliferation, and human reproductive and sexual development involved in PCOS (C. Zhu et al., 2020).
Gui Zhi Fu Ling Wan
Gui Zhi Fu Ling Wan focuses on invigorating the Blood, transforming Blood Stasis, and reducing fixed abdominal masses (Scheid & Bensky, 2015). The indications for Gui Zhi Fu Ling Wan include menstrual disorders such as short or long cycles, amenorrhea, dysmenorrhea, uterine bleeding, infertility, PMS, and has been used in the treatment of PCOS, habitual miscarriage and fibrocystic breasts (Scheid & Bensky, 2015). One study that looked at the effects of Gui Zhi Fu Ling Wan on insulin sensitivity and gut microbiota in PCOS model rats found that Gui Zhi Fu Ling Wan may have a positive influence on regulating the gut microbiome by inhibiting the release of inflammatory factors thus improving insulin resistance (Y. Zhu et al., 2020). This is significant because women with PCOS often have insulin resistance, and insulin resistance can cause hyperinsulinemia. Hyperinsulinemia disrupts the hypothalamic-pituitary-ovarian axis, leading to hyperandrogenemia and ovulatory dysfunction (Ong et al., 2017).
Wen Jing Tang
The common formula, Wen Jing Tang, has TCM actions including warming the blood vessels, dispelling cold, nourishing the Blood, and dispelling Blood Stasis (Scheid & Bensky, 2015). The formula is primarily used for the treatment of irregular menstruation such as uterine bleeding, early or late menstruation, extended or continuous menstrual flow, bleeding between periods, pain and distention in the lower abdomen that improves with warmth, and infertility (Scheid & Bensky, 2015).
In a small study, Ushiroyama et al. (2006) investigated the effect of switching to Wen Jing Tang for an 8-week treatment after taking either Dan Gui Shao Yao San or Gui Zhi Fu Ling Wan (prescribed using TCM diagnostics) for an 8-week treatment in women with PCOS. After the 8-week treatment with Wen Jing Tang, the researchers found plasma LH levels were decreased by 58.2% (p < 0.0001) in the group that switched from Dang Gui Shao Yao San and 49.4% (p = 0.0005) in the group that switched from Gui Zhi Fu Ling Wan (Ushiroyama et al., 2006). The researchers also noted a significant increase in ovulation rate in those that switched to Wen Jing Tang (59.3%) compared to those who continued the use of the original formula prescribed (7.4%) suggesting that Wen Jing Tang is more beneficial, regardless of TCM diagnosis, in women with PCOS and ovulation dysfunction (Ushiroyama et al., 2006).
Dang Gui Shao Yao San
Dang Gui Shao Yao San is a formula composed of Dang Gui, Chuan Xiong, Bai Shao, Bai Zhu, Fu Ling, and Ze Xie. This formula’s TCM actions include nourishing the Liver Blood, spreading the Liver Qi, strengthening the Spleen, and resolving Dampness (Scheid & Bensky, 2015). Biomedical indications for Dang Gui Shao Yao San include obstetrical and gynecological disorders such as dysfunctional uterine bleeding, polycystic ovaries, threatened and habitual miscarriage, pre-eclampsia, postpartum depression, peri-menopausal syndrome, and infertility (Scheid & Bensky, 2015).
Shao Fu Zhu Yu Tang
The formula Shao Fu Zhu Yu Tang is indicated when there is pain in the lower abdomen (with or without palpable masses), pain in the lower back, lower abdominal distention during menstruation, or frequent menstruation (3-5 times per month) with dark or purple menstrual blood, usually with clots, or abnormal uterine bleeding with lower abdominal pain and discomfort (Scheid & Bensky, 2015). In an article comparing herbal prescriptions, the researchers found that Gui Zhi Fu Ling Wan, Wen Jing Tang, Shao Fu Zhu Yu Tang, and Dang Gui Shao Yao San may be beneficial in the treatment of PCOS due to their functions of regulating menstruation and promoting blood circulation to alleviate pain caused by stagnation (Lin et al., 2019).
Bu Shen Tian Jing
Bu Shen Tian Jing is another formula that has been considered for the treatment of PCOS. In a cohort study, Pan et al. (2022) analyzed the effects of Bu Shen Tian Jing for women with PCOS undergoing IVF. The CHM group (n=54) achieved a higher clinical pregnancy rate of 87% compared to the non-CHM group (n=57) of 47.4% suggesting that CHM resulted in positive effects on the outcomes of IVF in patients with PCOS (Pan et al., 2022).
Formulas that invigorate the Blood
Formulas that invigorate the Blood and dispel Blood Stasis have been used for the treatment of menstruation problems and infertility. In TCM, Blood Stasis can be characterized as palpable, immobile masses, abscesses and ulcers, loss of hair or brittle nails, and localized pain that may have a sharp or stabbing quality (Scheid & Bensky, 2015). Patients with PCOS may experience some of these symptoms, such as lower abdominal pain and hair loss. Common formulas from this category for PCOS treatment include Gui Zhi Fu Ling Wan, Wen Jing Tang, Shao Fu Zhu Yu Tang and Dang Gui Shao Yao San.
In a cohort study, Liao et al. (2019) determined that the CHM formulas Jia Wei Xiao Yao San, Gui Zhi Fu Ling Wan, Dang Gui Shao Yao San, Wen Jing Tang, and Shao Fu Zhu Yu Tang for women with PCOS showed a decreased risk in developing type 2 diabetes compared to women with the same condition who did not take CHM.
Insulin Resistance CHM
In addition to Jia Wei Xiao Yao San, Liu Wei Di Huang Wan was also found to have a beneficial effect on insulin resistance (Qiu et al., 2020). Both Liu Wei Di Huang Wan and Metformin normalized the morphological changes of the uterus and ovaries, improved the ovary pathology, reduced insulin resistance, increased levels of FSH and estradiol, reduced levels of LH and testosterone, and alleviated insulin resistance in the PCOS rat models (Qiu et al., 2020). The researchers also discovered increases in serum progesterone occurred only when a high dose of Liu Wei Di Huang Wan was administered (Qiu et al., 2020). This suggests Liu Wei Di Huang Wan functions similarly to Metformin, and both play a role in regulating hormones in PCOS-induced rat models, and that a high dose of Liu Wei Di Huang Wan had a beneficial effect on serum progesterone levels.
Understand these Research Limitations
One limitation of this research is that many of these formulas contain the same herbs, and it is unclear whether the individual herbs are the reason for changes or the synergistic qualities of the formula. Another limitation is many of these studies used PCOS-induced rats as models, their methods are reasonable, however the research may not be as robust as human subjects.
How you should understand this piece:
PCOS is a complex reproductive and metabolic disorder that affects women of childbearing age. Chinese herbal formulas may provide relief for women with PCOS, especially for the following issues:
Formulas like Jia Wei Xiao Yao San, Xiao Yao San, Gui Zhi Fu Ling Wan, and Liu Wei Di Huang Wan may be advantageous in controlling insulin levels.
The formulas Gui Zhi Fu Ling Wan, Wen Jing Tang, Shao Fu Zhu Yu Tang, and Dang Gui Shao Yao San may help regulate menstruation and promote blood circulation to alleviate pain caused by stagnation (Lin et al., 2019).
In a small study, Wen Jing Tang had a greater effect on improving ovulation when compared to Gui Zhi Fu Ling Wan and Dang Gui Shao Yao San (Ushiroyama et al., 2006).
Women with PCOS undergoing IVF may have an increased chance of successful pregnancy rate when combined with Bu Shen Tian Jing (Pan et al., 2022).
However, more research is necessary to support the use of CHM for the management and treatment of PCOS and none of these CHM should be taken without a prescription from your herbalist.
References
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