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Cause of PCOS:

Most of the time, PCOS is seen as kidney yang weakness. Kidney yang is like a fire burning near your dantien area (which is also where your ovaries and womb is). Kidney in chinese medicine includes the function of our sexual organs and is used to explain problems related to both men and women. For PCOS-related menstrual disorder, we think of it as the fire not warming well enough, so water and mucus accumulate and stagnate around the area in the form of water-filled sacs - which is what a polycystic ovary has.

You can think of it as things like water and blood and even qi not moving around your body like it should. You can also think of it like your hormonal system not in balance, that means what needs to be secreted is not secreted (usually progesterone), or some other thing is secreted in excess (usually testosterone, the male hormone).

On Cause & Effect:

All this is the result of OR the cause of accumulation of water and mucus…
Sometimes you may also have a stuck liver. The liver in chinese medicine is not just our liver. In tcm, the liver is like a grumpy young girl who loses her temper easily. So if your liver is stuck, you probably have some emotional or hormonal imbalance.

1. Liver Fire: Sometimes this will express as fire, as in when you are angry and burst out.
2. Spleen Weakness: Sometimes this will not express (something like when you’re angry and keep things in your heart and don’t burst but it’s boiling inside and then later just stuck) and create other kinds of stuckness in your qi and blood.

What the Chinese Doctor (zhongyi) does:

First he diagnoses to see what your situation is: What will happen at the zhongyi is that he will ask you questions, look at you, feel your pulse and see your tongue. For this reason, you should go in to see her not just after food because hard to see tongue coating accurately. And also when you’re not in a rush, cos that might affect pulse. Although much can be known from the pulse, the zhongyi needs to ask questions to get better understanding too. It’s an overall approach to diagnosis.

After that she decides on the combination of herbs: In addition to tonifying your kidney, the zhongyi might add herbs to strengthen your spleen (脾) so that any qi that is stuck starts to move again. This spleen is more like the minister of transport. She makes sure that everything is moving smoothly. So if zhongyi thinks your spleen is weak, she’ll strengthen it. If there is any liver fire, she might clear it too. Most important though - not just for PCOS, but for other types of cases related to fertility or menstruation - is herbs to tonify blood (补血) and to move blood (行血). So these herbs are usually added in too. That is why questions about a lady’s menstrual expression are useful to ascertain diagnosis and hence decide on the prescription formula. The pulse and tongue will also tell a lot, although they can’t be the arbiter of why and what.

There is no one fixed way to put together a herbal formula, and different zhongyis will do it differently but above is a standard way of looking at it. It can be even as simple as a two herb formula to reduce testosterone levels in the patients.

Acupuncture treatment:

Acupuncture is recommended as first stage of treatment. The aim to arrive at some kind of hormonal balance. At the clinic where i used to apprentices at in Nanjing, there is also a lady in her late 30s who has been coming, i actually see her water retention improve and her spirit looking better after a period of consistent 3-time-a-week acupunture.

Summary of overall concept:

All the concepts mentioned above definitely deal with mensturation and fertility, the main idea is to regulate your hormonal cycle so that ovulation takes place and the eggs pop out of the follicles ready to meet the sperm.

Acupuncture and Herbal treatment may also deal with other hormones in your body including insulin and your body’s sensitivity to it. There is a strong relation between insulin levels and testosterone levels.

At one level, many methods to help fertility try to treat by suppressing testosterone production or increasing progesterone – overall is to help regulate hormonal balance. This is because the cysts are making testosterone (male hormone), while progesterone is not made, causing menstrual cycles to be irregular or absent.

However, at another level, they try search for a deeper root, which is related to insulin resistance or glucose tolerance, meaning the insulin that you secrete is not effective in taking away the glucose in your blood. This means that maybe your PCOS is caused most fundamentally by an insulin problem.

How it works: After you eat, the food is broken down into glucose, the simple sugar that is the main source of energy for the body’s cells. But your cells cannot use glucose without insulin, a hormone produced by the pancreas. Insulin helps the cells take in glucose and convert it to energy. When the body is unable to use the insulin that is present (often genetic), the cells cannot use glucose. Excess glucose builds up in the bloodstream, setting the stage for diabetes.

The story here is that there might be a bigger problem here that’s related to diabetes and hypertension. That is why a person who comes in for women’s health issues are also asked to take a glucose test.

For infertility (and also irregular cycles), weight reduction is the best way, because there is a link between overweightness and hormonal imbalances. One reason given is that estrogen is stored in fat, and your hormonal system does not take that additional estrogen into account, so gives your normal dosage. However the estrogen in fat may overstimulate the uterus lining, hence heavier periods. Watching your diet and weight is the right thing for both improving fertility and also in preventing the metabolic syndrome (diabetes and hypertension plus other metabolic imbalances).

Labs tests measuring hormone levels are useful, especially checking for testosterone. However, “only half of PCOS patients exhibit high testosterone levels,” so the tests are limited in what they can tell.