Since the mid-20th
century, doctors in the People's Republic of China (PRC) have been
attempting to work out the Chinese medical pattern discrimination
of modern Western diseases. When first advanced, typically in the
Chinese medical journal literature, these pattern discriminations
are only provisional. It is not until broad consensus is subsequently
achieved that a particular method of pattern discrimination becomes
standard for a particular Western medical disease. Premature ovarian
failure (POF) is such a modern Western disease category; and, at
the moment, any suggested methods of its pattern discrimination
are merely provisional. However, on pages 86–87 of Xin
Zhong Yi (New Chinese Medicine)
2008, issue 3, Wang Cui-ping of the First People's Hospital of Luoyang,
Henan, published an article titled "The pattern discrimination
treatment of 40 cases of premature ovarian failure." Since
POF is such a popular topic in contemporary reproductive medicine,
a summary of this article is presented below.
Cohort Description
All 40 subjects enrolled in this cohort study had a confirmed diagnosis
of POF. This meant that they were less than 40 years of age, their
menses had ceased for at least three months, and their serum follicle-stimulating
hormone (FSH) was more than 40 IU/L. Women who were pregnant or
had polycystic ovarian syndrome, high serum prolactin levels, or
other such conditions leading to the cessation of menstruation were
excluded from this study. In fact, all 40 women in this study were
27 to 39 years of age. Twenty-four had been amenorrheic for three
months or more within the previous six months. The other 16 cases
presented with abnormally scanty or infrequent menstruation. All
these women had previously been pregnant and given birth.
Pattern Discrimination
The following three patterns were discriminated for the purposes
of this study:
1. Liver-kidney yin vacuity pattern (19 cases):
The signs and symptoms seen in this case included amenorrhea or
abnormally scanty or infrequent menstruation; scanty vaginal tract
secretions; dry external genitalia; hot flashes; vexatious heat
in the five hearts; night sweats; dizziness; dry eyes; dry mouth;
red tongue with scanty fur; and fine, rapid pulse. In addition,
FSH was abnormally high, but the ratio of FSH to luteinizing hormone
(LH) was less than 2:1.
2. Spleen-kidney yang vacuity pattern (17
cases): The signs and symptoms seen in this case included marked
aversion to cold; spontaneous perspiration; lack of strength; slight
hot flashes; a sallow yellow facial complexion; possible floating
edema in both lower extremities and/or the face and eyes; decreased
sexual desire; insomnia; profuse dreams; a fat, enlarged tongue
with white fur; and deep pulse. Most of the women presenting this
pattern had amenorrhea or delayed, scanty menstruation. Serum FSH
in this group was mostly markedly elevated, and the FSH to LH ratio
was more than 2:1 and as much as 3:1.
3. Liver qi depression and binding (4 cases):
The signs and symptoms in this case included amenorrhea or a lengthy
menstrual cycle; vexation and agitation; irritability; extremely
labile emotions; sweating; hot flashes; insomnia; breast distention
and pain or lumps within the breasts; a red tongue; and a deep,
slippery or deep, bowstring pulse. Serum FSH levels were only slightly
elevated in those who presented this pattern.
Treatment Method
1. Liver-kidney yin vacuity pattern
Formula: Zuo Gui Yin Jia Wei (Restore the Left [Kidney] Beverage
with Added Flavors) in order to enrich yin and supplement the kidneys,
nourish the liver and clear heat
Shu Di Huang (cooked Radix Rehmanniae)
Shan Yao (Radix Dioscoreae)
Gou Qi Zi (Fructus Lycii)
Nu Zhen Zi (Fructus Ligustri Lucidi)
Tu Si Zi (Semen Cuscutae)
Han Lian Cao (Herba Ecliptae)
Di Gu Pi (Cortex Lycii)
Xiang Fu (Rhizoma Cyperi), 15g each
Huang Bai (Cortex Phellodendri)
Mu Dan Pi (Cortex Moutan), 10g each
Dang Gui (Radix Angelicae Sinensis)
Bai Shao (Radix Alba Paeoniae)
Long Gu (Os Draconis), 20g each
Note: Based on an analysis of the ingredients
in this formula, the author recognizes that these women's
main pattern was complicated by liver depression qi stagnation,
blood vacuity, and vacuity heat.
2. Spleen-kidney yang vacuity pattern
Formula: You Gui Wan (Restore the Right [kidney] Pill) combined
with Er Xian Tang (Two Immortals Decoction) with additions and subtractions
to boost the kidneys and foster essence, warm yang, and fortify
the spleen
Yin Yang Huo (Herba Epimedii)
Xian Mao (Rhizoma Curculiginis)
Fu Zi (Radix Lateralis Praeparata Aconiti)
Xiang Fu (Rhizoma Cyperi)
Shan Zhu Yu (Fructus Corni)
Tu Si Zi (Semen Cuscutae)
Shan Yao (Radix Dioscoreae)
Dang Gui (Radix Angelicae Sinensis), 15g each
Du Zhong (Cortex Eucommiae)
Lu Jiao Pian (Cornu Parvum Cervi), 10g each
Dan Shen (Radix Salviae Miltiorrhizae)
Fu Ling (Poria)
Yi Mu Cao (Herba Leonuri)
Suan Zao Ren (Semen Zizyphi Spinosae), 20g each
Note: Based on an analysis of the ingredients
in this formula, the author recognizes that these women's
main pattern was complicated by liver depression qi stagnation and
blood stasis, as well as possible or even probable blood vacuity.
3. Liver qi depression and binding pattern
Formula: Xiao Yao San Jia Wei (Rambling Powder with Added Flavors
to course the liver and rectify the qi, quicken the blood, and fortify
the spleen
Chai Hu (Radix Bupleuri)
Zhi Qiao (Fructus Aurantii)
Dang Gui (Radix Angelicae Sinensis)
Bai Shao (Radix Alba Paeoniae)
Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Ci Ji Li (Fructus Tribuli)
Yin Yang Huo (Herba Epimedii)
Tu Si Zi (Semen Cuscutae)
Ji Nei Jin (Endothelium Corneum Gigeriae Galli)
Ye Jiao Teng (Caulis Polygoni Multiflori), 15g each
Fu Ling (Poria)
Mai Ya (Fructus Germinatus Hordei)
Dan Shen (Radix Salviae Miltiorrhoizae), 20g each
Yu Jin (Tuber Curcumae), 10g
Note: Based on an analysis of the ingredients
in this formula, the author recognizes that these women's main pattern
was complicated by spleen and kidney vacuity, as well as blood vacuity
and possible blood stasis.
One packet of these medicinals was decocted in water and administered
per day for a continuous 20 days. Then 10 milligrams of medroxyprogesterone
acetate was given once per day for five continuous days. Then Tao
Hong Si Wu Tang Jia Wei (Persica & Carthamus Four Materials
Decoction with Added Flavors) was administered at a rate of one
packet per day decocted in water two times. My assumption is that
these medicinals were administered beginning on the 26th day of
treatment and continuing to day 30 or day 2 of the new cycle. This
formula was meant to quicken the blood and transform stasis in order
to promote the endometrium and uterus and improve the blood circulation
of the ovaries. Outcomes were assessed after three such courses
of therapy.
Study Outcomes
"Cure" was defined as disappearance of clinical symptoms
and resumption of normal menstruation, which was also normal in
amount as well as FSH levels. "Marked effect" was defined
as a marked decrease in the clinical symptoms, the occurrence of
menstruation after the administration of the medroxyprogesterone
acetate, and almost normal FSH levels. "Some effect"
was defined as remission of the main symptoms and a lowering of
FSH levels, and "no effect" meant that there was no
obvious improvement in the clinical symptoms. Based on these criteria,
10 cases were considered cured, 17 experienced a marked effect,
7 others got some effect, and 6 got no effect. Therefore, the total
effectiveness rate was given as 85%.
Discussion
Based on the idea that "the kidneys govern reproduction,"
Wang believes that this root of the treatment of this condition
should be to foster kidney essence and regulate the chong and ren,
and that regulating the chong and ren means that one must regulate
the viscera and bowels and harmonize the qi and blood. However,
in this case, special attention must be placed on the liver, spleen,
and kidneys. This is because the liver governs the storing of blood
and is a woman's former heaven. The kidneys govern the storing of
essence and are the root of the essence and blood. The spleen governs
movement and transformation and is the origin of the engenderment
and transformation of the qi and blood. If the function of these
three viscera is regulated and harmonious, then the qi and blood
are automatically enriched and the chong and ren are automatically
regulated. Modern research has shown that enriching yin and supplementing
the kidney medicinals can increase estrogen levels, while at the
same time decreasing FSH levels. In addition, medicinals that fortify
the spleen and supplement the kidneys, foster the essence and boost
the marrow, course the liver and rectify the qi, and quicken the
blood and transform stasis are good at improving pituitary and ovarian
function.
Readers should note that the author, beyond suggesting a threefold
pattern discrimination for POF, is also suggesting that these three
patterns can be correlated with FSH levels and/or FSH:LH ratios.
This attempt at integrating Chinese and Western medicines and the
establishment of objective biological markers for Chinese medical
patterns is a major movement in Chinese medicine in the PRC.
Copyright © Blue Poppy
Press, 2008. All rights reserved.
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)
www.bluepoppy.com
|