comments: More info on treating Poor Ovarian Reserve with Chinese Medicine Submitted by tcmlorne (+) on Mon, 2007-08-27 07:15. Ray, Thank you for sharing such great and useful information. This is what i understand the CMT site is all about (Grow, Share and collect). I will definitely send this paper to my Acubalance colleagues for a thorough read. I do not have a lot to offer back to you. But I will after attending Brandon Horns seminar on Chinese Medicine Approach to Treatment of Poor Ovarian Reserve with Brandon Horn & Wendy Yu. For anyone else who want to offer hope to those woman who have been told they cannot conceive any longer (>40 with high FSH) and IVF is not an option either (only donor egg) then this course is for you. Please note it is an advanced seminar. This is the next level after taking one or more seminars on infertility with Bob Flaws, Randine Lewis and Jane Lyttleton. Sorry for the shameless plug but I know how important Brandon and Wendy's 's research is and what Chinese medicine can offer to these otherwise hopeless women. Dec 1 & 2, 2007 in Toronto http://www.pro-d.ca/seminars_0712-TreatmentOfPoorOvarianReserve-Toronto.html January 12 & 13, 2008 in Vancouver, Canada http://www.pro-d.ca/seminars_0801-TreatmentOfPoorOvarianReserve-Vancouver.html If anyone else has good info on POF please share and if you know other people who would benefit from the seminar above, please connect them to the links. Thanks again Ray for posting this wealth of information. I appreciate you taking the time to share. Lorne Wanting to Grow*Share*Connect with like minded TCMers - A different take on POF Submitted by pemachophel (+) on Wed, 2007-08-29 07:59. Here's a slightly different take on POF from a Chinese doctor in Hangzhou. He Sai-ping’s Treatment of Premature Ovarian Failure (POF) abstracted & translated by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK) Keywords: Chinese medicine, Chinese herbal medicine, gynecology, infertility, premature ovarian failure (POF) While standard textbook pattern discriminations of various diseases are useful for beginning students, the next step in the maturation of a Chinese medical practitioner usually entails reading the medical essays and case histories of famous old Chinese doctors, both premodern and contemporary. No textbook can ever convey clinical reality. In addition, textbook authors are often college professors with more teaching than clinical experience. Therefore, one often finds that the experiences of really well-seasoned clinicians is at variance and more revelatory that beginners’ textbook presentations. On pages 345-346 of issue #6, 2007 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), He Sai-ping from the Zhejiang Chinese Medicine & Pharmacology University in Hangzhou published an article titled “An Inquiry into the Treatment of Premature Ovarian Failure Via Stasis.” Because this is an example of a particular doctor’s experiences treating POF as opposed to this condition’s usual textbook presentation, a summary of this article is offered below. After introducing premature ovarian failure from the point of view of Chinese medicine, Dr. He next discusses menarche and menopause from the point of view of the famous passage at the beginning of the Su Wen (Simple Questions) where menarche occurs at two times seven (14 years of age) due to the arrival of the tian kui, the free flow of the ren mai, and the exuberance of chong mai and menopause occurs at seven times seven (49 years of age) due to the ren mai’s becoming vacuous, the chong mai’s debility and scantiness, and the tian kui’s exhaustion. Dr. He then goes on to say that most books emphasize treating this condition by supplementing kidney vacuity. However, besides invigorating and regulating the kidney qi, Dr. He believes that freeing the flow of the ren mai or conception vessel is the most important factor in successfully treating this condition. 1.1 Depression is the cause of this disease’s occurrence In fact, Dr. He believes that depression is the disease cause of this condition. Based on Dr. He’s clinical experience, depression is the disease cause in approximately 90% of POF cases. Here, citing Zhang Jing-yue from his Jing Yue Quan Shu (Jing-yue’s Complete Writings), Dr. He sees depression as due to primarily damage by the seven affects seconded by taxation fatigue. Because the liver is the former heaven in females and its yin nature is one of congelation and binding, the liver easily becomes depressed. In that case, depression leads to qi stagnation and blood stasis. Hence the liver loses its spreading and extending. This cause the qi of the chong and ren vessels to become depressed and not smoothly or easily flowing. Hence the ovaries cannot smoothly or easily expel the ovum and menstruation loses its regulation. As a result, Dr. He says one usually sees signs and symptoms of the liver qi’s loss of regulation in women suffering from POF, such as dizziness, heavy-headedness, chest oppression, heart palpitations, sweating, lack of strength, fatigue and encumbrance of the four extremities, poor psyche, sleep disturbances, and changes in eating and drinking. 1.2 Stasis is the key link Because the qi moves the blood, if depression endures, it will eventually disturb the movement of the blood, and menstrual irregularity will give rise to blocked menstruation or amenorrhea. This is due to network vessel stasis and obstruction which then results in loss of free flow of the chong and ren. According to Dr. He, this is the most important link in POF. Because of the presence of blood stasis, clinically one sees signs and symptoms of the skin’s loss of nourishment, a sooty, black facial complexion, colored macules on the face, and chapped, cracked skin. If stasis endures, the liver loses its nourishment. Because liver yang commonly has a surplus, one sees such signs and symptoms as agitation, easy anger, vexcatious heat in the five hearts or centers, tidal flushing of the malar regions, and hot flashes. While, in a few cases, the tongue may be pale and fat and have white, glossy fur due to kidney yang vacuity or red with scanty fur and fluids due to yin vacuity, mostly the tongue will be dark red or pale purple, and, sublingually, the network vessels will be greenish purple, purple red, crimson purple, or purple black in color, all signs of the presence of blood stasis. 1.3 A mixture of vacuity & repletion is the main result The essence within the kidneys is the body’s root which is also known as the former heaven. However, this nis continuously enriched and nourished by the latter heaven essence qi. This latter heaven essence qi flows out into the body through the channels and vessels to eventually nourish and enrich the viscera. Therefore, if stasis endures and is not dispersed and the network vessels are inhibited, this disturbs the bodyy’s metabolism and leads to a gradual decline in the essence qi within the kidneys. Hence it becomes progressively more difficult to produce the tian kui and maintain one’s reproductive function. The signs and symptoms of kidney vacuity which gradually appear include tinnitus, deafness, impaired memory, confusion and flusteredness, low back sorness and knee limpness, long, clear urination, a lusterless facial complexion, and decreased sexual desire. This can also lead to signs and symptoms of heart and/or spleen vacuity detriment and loss of regulation of their function. For instance, is the heart and kidneys lose their interaction, there will be insomnia and profuse dreams, while spleen-kidney yang vacuity will typically result in loose stools and superficial edema. In addition, as visceral function becomes vacuous and decreased, the by-products of physiology will collect and be retained, thus worsening the symptoms of stasis and also giving rise to phlegm and dampness. If phlegm and stasis mutually bind, this may present as bone nodules, aching, and pain, the body may become fat, and the four limbs may become numb. All these are signs and symptoms of the mixture of vacuity and repletion. 2. Treating POF based on dispelling stasis & freeing the flow of the network vessels According to Dr. He, the main medicinals she commonly uses for dispelling stasis and freeing the flow of the network vessels are: Shui Zhi (Hirudo) Chuan Shan Jia (Squama Manitis) Lu Lu Tong (Fructus Liquidambaris) Tong Cao (Medulla Tetrapanacis) Xi Xin (Herba Asari) All these medicinals are moving and scattering in nature. They break the blood and disperse stasis, free the flow and move the blood vessels. Thus they strongly address the mechanism of POF of vessel and network vessel stasis and obstruction. However, depending on the idiosyncracies of each case, Dr. He combines these medicinals with others which course the liver, supplement the blood, supplement the kidneys, or quicken the blood as appropriate. 2.1 Treatment based on coursing the liver, dispelling stasis & freeing the flow of the network vessels This method combines stasis-dispelling and network vessel freeing medicinals with those which course the liver, such as: Chai Hu (Radix Bupleuri) Yu Jin (Tuber Curcumae) Qiang Huo (Radix Et Rhizoma Notopterygii) Jiang Huang (Rhizoma Curcumae Longae) Lu Mei Hua (Flos Mume) Xiang Fu (Rhizoma Cyperi) Dr. He most often uses these medicinals at the beginning stage of POF when the woman is still menstruating even if erratically or not regularly. In this case, the menses may be scanty, the menstrual cycle may be long, and the menses may stop for -3 months. Estradiol (E) and progesterone are low but follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are still within normal parameters. If such treatment is given in a timely manner, it is able to stop the decline in ovarian function and return menstruation to normal. In addition, this treatment will also correct any other symptoms associated with loss of regulation of the liver’s function of coursing and discharge. This includes even such vacuity symptoms as dizziness, heavy-headedness, sweating, heart palpitations, lack of strength, encumbrance and fatigue of the four extremities, poor psyche, and sleep disturbances. In terms of formulas, Dr. He most commonly uses Xiao Yao San (Rambling Powder) or Si Ni San (Four Counterflows Powder) combined with medicinals which dispel stasis and free the flow of the network vessels. In addition, if there is vacuity, one must also supplement that vacuity. 2.2 Treatment based on supplementing the qi and blood, dispelling stasis & freeing the flow of the network vessels In this case, Dr. He combines medicinals to dispel stasis and free the flow of the network vessels with medicinals to supplement the qi and blood, such as: Dang Gui (Radix Angelicae Sinensis) Bai Shao (Radix Alba Paeoniae) Shu Di (cooked Radix Rehmanniae) Huang Qi (Radix Astragali) Dang Shen (Radix Codonopsis) He Shou Wu (Radix Polygoni Multiflori) Dr. He mostly uses these in cases where there is liver qi counterflowing horizontally along with qi and blood depletion and scantiness. Because “the liver’s body is yin [but its] function is yang,” if the liver has a surplus, this can consume and damage the yin and blood of the liver. It can also assail the spleen and thrust up into the heart, thus leaving the transformation and engenderment of qi and blood without a source. In addition, if the qi is vacuous, the qi does not move the blood. If this becomes more serious, then it gives rise to stasis and obstruction. Patients with this scenario typically do not have menstruation for several months at a time or the amount of the menses is reduced and its color is dark but pale. In this case, E2 and progesterone (P) are low while FSH and LH are slightly high. One will also see such signs and symptoms of qi and blood insufficiency as a lusterless facial complexion, insomnia, lack of strength, and dark, purplish lips. Ultrasound may show small follicles. However, those follicles are not dominant or preponderant. Using the above method, it is Dr. He’s experience that it can restore normal menstruation. 2.3 Treatment based on supplementing the kidneys, dispelling stasis & freeing the flow of the network vessels In this method, Dr. He combines medicinals which dispel stasis and free the flow of the network vessels with medicinals which supplement the kidneys, such as: Xian Mao (Rhizoma Curculiginis) Xian Ling Pi (Herba Epimedii) Ba Ji Tian (Radix Morindae Officinalis) Rou Cong Rong (Herba Cistanchis) Suo Yang (Herba Cynomorii) Tu Si Zi (Semen Cuscutae) The intention of supplementing the kidneys is to recuperate the essence qi within the kidneys so as to produce the tian kui which here Dr. He equates with follicular development. Dieplling stasis refers to here to easing or smoothing and freeing the flow of the chong and ren which Dr. He says normalizes the expulsion of the ovum. Dr. He uses these two methods together in many cases of ovarian failure where the menses do not move for several months at a time. In such cases, E2 and P are low, FSH and LH are high, and both ovaries are atrophied or shrunken in size. Here, Dr. He says it is usually best to use a combination of Chinese and Western medicines. Western medical hormones are used to artificially restore the menstrual cycle, while Chinese medicinals to supplement the kidneys, dispel stasis, and free the flow of the network vessels are used to restore ovarian function. Once the ovaries are able to expel the ovum, Dr. He stops the Western drugs but continues the Chinese medicinals. Clinically, this method achieves pretty good therapeutic effects. Representative case history: The patient was 37 years old and had been diagnosed with POF. She had had amenorrhea for the last year. Here E2 and P were low, while her FSH was 78mIU/ml. The woman had already been treated with hormone therapy for one-half year. At the same time, the woman was administered Chinese medicinals. A half month after stopping taking the Western drugs, her menses ceased. When the patient came to see Dr. He, she had not menstruated for three months. When Dr. He examined the patient, her tongue was dark with obviously static and stagnant sublingual veins. Her lips were dark and blackish and her pulse was choppy and bowstring. Therefore, Dr. He used the methods of supplementing the kidneys, dispelling stasis, and freeing the flow of the network vessels. After administering 20 packets of medicinals based on these principles, the woman’s menses came. Dr. He continued administration of these medicinals for four months, and each month the menses arrived on time. The woman’s basal body temperature chart was biphasic and her ovulatory function gradually returned to normal. In this case, there was a combination of vacuity and repletion and simply supplementing would not have been effective. If simple supplementation had been used, it would have made the stasis and stagnation worse. Instead, Dr. He used attacking and supplementing simultaneously, and this was what achieved the successful outcome. According to Dr. He, these three treatment methods or protocols address three different degrees or severities of POF. However, Dr. He also says that to achieve the best therapeutic effects one should also use different medicinals at different times in the menstrual cycle. For instance, During menstruation (day 1-4), Dr. He says one should add qi-supplementing and blood-quickening medicinals, such as: Huang Qi (Radix Astragali) Dang Shen (Radix Codonopsis) Ze Lan (Herba Lycopi Lucidi) Yi Mu Cao (Herba Leonuri) If the qi is effulgent and the blood moves, this promotes the expulsion, discharge, free flow, and smooth, normal flow of the menses. During the follicular phase (days 4-11), Dr. He says to add blood-supplementing medicinals, such as: Dang Gui (Radix Angelicae Sinensis) He Shou Wu (Radix Polygoni Multiflori) Ji Xue Teng (Caulis Spatholobi) Shu Di (cooked Radix Rehmanniae) According to Chinese medical theory, at this point in the cycle, the sea of blood is empty and vacuous. According Dr. He, supplementing the blood at this juncture promotes the growth of the endometrial lining and the growth and development of the follicle. During ocvulation (days 12-16), Dr. He says to increased the dosage of the medicinals for quickening the blood and freeing the flow of the network vessels. This includes medicinals such as: Lu Lu Tong (Fructus Liquidambaris) Chuan Shan Jia (Squama Manitis) Xi Xin (Herba Asari) This promotes the ripening of the follicle and hastens its expulsion. During the luteal phase (days 17-30), Dr. He says to add yang-supplementing medicinals, such as: Tu Si Zi (Semen Cuscutae) Suo Yang (Herba Cynomorii) Ba Ji Tian (Radix Morindae Officinalis) According to Chinese medical theory, yang is growing during this phase of the cycle and kidney yang gradually become effulgent. The essence qi is stored and not discharge. Dr. He believes that supplementing yang during this phase promotes the function of the corpus luteum and also promotes the normal development of the endometrial membranes. In sum, Dr. He believes that the onset of POF is due to a mixture of depression, stasis, and vacuity and counsels that the earlier the treatment, the more successful its outcome will be. Ultimately, Dr. He believes that dispelling stasis and freeing the flow of the network vessels is the “great method,” i.e., the main method of treating this condition, and that supplementing the kidneys is actually secondary. Copyright © Blue Poppy Press, 2007. 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