The Holistic prevention, management and treatment of Polycystic Ovarian Syndrome: TCM Herbal Medicine for Kidney Yang deficiency -Di Huang

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                Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome is defined as endocrinologic diseases among reproductive-age women caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries associated with a high risk for metabolic disorder(1) as resulting of enlarged ovaries(2), leading to hormone imbalance(excessive androgen and anti-müllerian hormone (AMH) )(1)(3)(4)(5), induced Hirsutism(6)(7), reproductive disorder(10(12)), risks of type 2 diabetes(9)(10)(11), metabolic syndrome(10)(12) and early cardiovascular disease(8)(13), acne(10)(14), endometrial cancer(18)(19),weight gain and obesity(15)(16)(17). The syndrome effects over 5% of women population or 1 in 20 women.
Unfortunately, according to studies, women with PCOs after the reproductive age, are associated to continuously increase risk of type II diabetes, with no increasingaltered glucose tolerance(20), CVD and hypertension(21).


Management and Treatment according to Traditional Chinese Medicine Perspective

While conventional medicine focus of using synthetic medication to induce ovulation and assisted artificial insemination for infertility couple, if the medicine fail, traditional Chinese medicine views polycystic ovarian syndrome in different approaches.

Polycystic ovary syndrome, according to traditional Chinese medicine is a medical condition characterized by accumulative of fluid over a prolonged period of time causes of dampness and phlegms(1247a)(1247b) build up on the ovaries due to the effects of vary differentiations, affecting not only the women’s menstrual cycle, but also ovulation and fertility(1247a)(1247b).

Depending to differentiation, most common diagnosis of polycystic ovary syndrome can be classified into                

                           Kidney yang deficiency

Along with common symptoms mentioned above, women with PCOs diagnosed with kidney yang deficiency may also experience yang vacuity induced cold expressive syndrome, including
lumbago, cold limbs, fatigue, cold aversion, feverish sensation in chest, palms and soles(1573),
difficulty in urination, enuresis, incontinence, declining libido and edema(1574) as a result of kidneys no longer perform their function in store fluid to moister and warm the body for healthy function in the body's organs and tissues, inducing adrenal insufficient chronic lower back pain(1575)(1580), depression(1575), hypothyroidism(1579)(1575), nephritis(1578)(1575), ...(1575), leading to failure in transform damp heat expression, promoted accentuation of inflammatory development of phlegm(1583).
Kidney yang deficiency has shown to alter carbohydrate and lipid metabolisms (free fatty acids, 1-monolinoleoylglycerol, and cholesterol), gut microbiota metabolism (indole-3-propionic acid), indued anovulatory infertility( 1581) and hypertension(1582) of which related to symptoms of PCOs(1576)(1577).

Herbal medicine for kidney yang deficiency



3. Rehmannia glutinosa Liboschitz var. purpurae(Di Huang)
Di huang can be sheng (raw) or Shu (cooked) and is also known as Rehmannia

Sheng di huang(The bitter, sweet, bitter cold in nature) and Shu di huang (The bitter, sweet, bitter and warm in nature)(1724) has been used in TCM as diuretic(1734), anti hyperglycemicagent(1726), anti cancers(1731)(1732) and to treat cough(1743), asthma(1744)(1746), lung inflammation induced shortness of breath(1745), and wheezing(1746), tinnitus(1747) and hearing loss(17447), poor memory(1741), bronchial contraction)1746), and chest tightness(1746), lower plasma glucose(1725)(1727), enhance heart function(1734)(1735) (small doses constrict the blood vessels and large doses dilate the blood vessel)(1724), and regulate steroid hormone(1736),..... by promoting the functions of heart, kidney, and liver channels(1724).

Chemical constituents(1724)
1. Leonuride
2. Aucubin
3. Catalpol
4. Melittoside
5. Melittoside
6. Rehmannioside A、B、C、D
7. 8-epiloganic acid 8
8. Ajugoside
9. Lysine
10. Histidine
11. Arginine
12. Sapartic acid
13. Glutamic acid)
14. Threonine
15. Serine
16. Gluycine
17. Alanine
18. Valine
19. Isoleucine
20. Leucine
21. Tyrosine
22. Phenylalnine
23. Etc.


Epidemiological studies proposed that rehmannia also displays anti metabolic syndrome(1728), including fatigue(1728), prediabetes(1728)(1737), LDL-C, hypertension(1729), lipid profile(1728)(1737), including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C, LDL-C)(1736)(1737), insulin resistance(1730), waist size(1736) and obesity(1742), through its effects in carbohydrate(1740)(1741) and lipid metabolism(1728) of which reduce risk of diabetes(1728)(1739) and cardiovascular disease(1728)(1736).
According to Kyung Hee University. formula Kyung-Ok-Ko, containing rehmannia, prevented and alleviated dehydroepiandrosterone-induced polycystic ovarian syndrome in rats model(1738).

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References
(1) Adiposity and metabolic dysfunction in polycystic ovary syndrome by Sam S.(PubMed)
(2) A "kiss" before conception: triggering ovulation with kisspeptin-54 may improve IVF by Young SL.(PubMed)
(3.) Androgen hyperfunction and excessive heterosexual hair growth in women, with special attention to the polycystic ovarian syndrome by Lunde O1.(PubMed)
(4) Expression of anti-Müllerian hormone in letrozole rat model of polycystic ovary syndrome by Du DF1, Li XL, Fang F, Du MR.(PubMed)
(5) [Serum levels of anti-muller hormone in women with polycystic ovary syndrome and healthy women of reproductive age].[Article in Bulgarian] by Parahuleva N, Pehlivanov B, Orbecova M, Deneva T, Uchikova E.(PubMed)
(6) [Current opinions on the etiology and pathophysiology of hirsutism].[Article in Polish] by Krysiak R1, Kedzia A, Okopień B.(PubMed)
(7) The clinical evaluation of hirsutism by Somani N1, Harrison S, Bergfeld WF.(PubMed)
(8) Polycystic ovary syndrome and insulin: our understanding in the past, present and future by Mayer SB1, Evans WS, Nestler JE.(PubMed)
(9) Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome by Dogan BA1, Arduc A2, Tuna MM1, Karakılıc E1, Dagdelen I1, Tutuncu Y1, Berker D1, Guler S1.(PubMed)
(10) Approach to the patient: contraception in women with polycystic ovary syndrome by Yildiz BO1.(PubMed)
(11) Polycystic ovarian syndrome (PCOS): a significant contributor to the overall burden of type 2 diabetes in women by Talbott EO1, Zborowski JV, Rager JR, Kip KE, Xu X, Orchard TJ.(PubMed)
(12) Prevalence of vitamin D deficiency in Slovak women with polycystic ovary syndrome and its relation to metabolic and reproductive abnormalities by Figurová J1, Dravecká I, Javorský M, Petríková J, Lazúrová I.(PubMed)
(13) Role of Insulin Sensitizers on Cardiovascular Risk Factors in Polycystic Ovarian Syndrome: A Meta-Analysis by Thethi TK1, Katalenich B2, Nagireddy P3, Chabbra P4, Kuhadiya N5, Fonseca V1.(PubMed)
(14) Acne in hirsute women by Lumezi BG1, Pupovci HL1, Berisha VL1, Goçi AU2, Gerqari A3.(PubMed)
(15) Obesity and polycystic ovary syndrome by Naderpoor N1, Shorakae S, Joham A, Boyle J, De Courten B, Teede HJ.(PubMed)
(16) Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan by Teede H1, Deeks A, Moran L.(PubMed)
(17) Metabolic Evidence of Diminished Lipid Oxidation in Women WithPolycystic Ovary Syndrome. by Whigham LD1, Butz DE2, Dashti H3, Tonelli M3, Johnson LK1, Cook ME2, Porter WP4, Eghbalnia HR5, Markley JL6, Lindheim SR7, Schoeller DA8, Abbott DH9, Assadi-Porter FM10.(PubMed)
(18) Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis by Barry JA1, Azizia MM1, Hardiman PJ2.(PubMed)
(19) Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study by Gottschau M1, Kjaer SK2, Jensen A1, Munk C1, Mellemkjaer L3.(PubMed)
(20) Polycystic ovary syndrome: metabolic consequences and long-term management by Carmina E1.(PubMed)
(21) Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype by Armeni E1, Stamatelopoulos K, Rizos D, Georgiopoulos G, Kazani M, Kazani A, Kolyviras A, Stellos K, Panoulis K, Alexandrou A, Creatsa M, Papamichael C, Lambrinoudaki I.(PubMed)
(1246) [Clinical study of area of Jiangsu province of polycystic ovarian syndrome correlation distribution of traditional Chinese medicine syndrome type and improper diet]. [Article in Chinese] by Feng Y, Gao YP.(PubMed)
(1247) [Preliminary study on relationship of disease-syndrome-symptom of ovulatory disorder infertility based on factor analysis]. [Article in Chinese] by Li M, Ma K, Shan, J.(PubMed)
(1247a) A Comprehensive Treatment of Polycystic Ovarian Syndrome (PCOS) byLiqin Zhao

(1724) Di Huang(Complementary and Alternative Healing University)
(1725) Stachyose extract from Rehmannia glutinosa Libosch. to lower plasma glucose in normal and diabetic rats by oral administration by Zhang RX1, Jia ZP, Kong LY, Ma HP, Ren J, Li MX, Ge X.(PubMed)
(1726) Hypoglycemic effect of Rehmannia glutinosa oligosaccharide in hyperglycemic and alloxan-induced diabetic rats and its mechanism by Zhang R1, Zhou J, Jia Z, Zhang Y, Gu G.(PubMed)
(1727) Plasma glucose lowering mechanisms of catalpol, an active principle from roots of Rehmannia glutinosa, in streptozotocin-induced diabetic rats by Shieh JP1, Cheng KC, Chung HH, Kerh YF, Yeh CH, Cheng JT.(PubMed)
(1728) Evaluation of symptom, clinical chemistry and metabolomics profiles during Rehmannia six formula (R6) treatment: an integrated and personalized data analysis approach by van Wietmarschen HA1, van der Greef J, Schroën Y, Wang M.(PubMed)
(1729) The protective effect of Liu-Wei-Di-Huang-Fang in salt-sensitive hypertension rats byYang Q1, He Y, Wang W.(PubMed)
(1730) [Effect of Rehmannia glutinosa water extraction on insulin resistance and gene expression of resistin in type 2 diabetes mellitus rats]. [Article in Chinese] by Lv XF1, Meng QY, Guo XM.(PubMed)
(1731) Catalpol Inhibited the Proliferation of T24 Human Bladder Cancer Cells by Inducing Apoptosis Through the Blockade of Akt-Mediated Anti-apoptotic Signaling by Jin D1, Cao M, Mu X, Yang G, Xue W, Huang Y, Chen H.(PubMed)
(1732) Hot water-extracted Lycium barbarum and Rehmannia glutinosa inhibit proliferation and induce apoptosis of hepatocellular carcinoma cells by Chao JC1, Chiang SW, Wang CC, Tsai YH, Wu MS.(PubMed)
(1733) Oriental medicine Kyung-Ok-Ko prevents and alleviates dehydroepiandrosterone-induced polycystic ovarian syndrome in rats by Jang M1, Lee MJ1, Lee JM2, Bae CS3, Kim SH4, Ryu JH5, Cho IH6.(PubMed)
(1734) Catalpol decreases peroxynitrite formation and consequently exerts cardioprotective effects against ischemia/reperfusion insult byHuang C1, Cui Y, Ji L, Zhang W, Li R, Ma L, Xing W, Zhou H, Chen B, Yu J, Zhang H.(PubMed)
(1735) Saeng-Ji-Hwang has a protective effect on adriamycin-induced cytotoxicity in cardiac muscle cells by Chae HJ1, Kim HR, Kim DS, Woo ER, Cho YG, Chae SW.(PubMed)
(1736) [Effect of dandi tablet on blood lipids and sex hormones in women of postmenopausal stage]. [Article in Chinese] by Liang R1, Chen MR, Xu X.(PubMed)
(1737) Rehmannia glutinosa (Gaertn.) DC. polysaccharide ameliorates hyperglycemia, hyperlipemia and vascular inflammation in streptozotocin-induced diabetic mice by Zhou J1, Xu G2, Yan J2, Li K2, Bai Z2, Cheng W2, Huang K3.(PubMed)
(1738) Oriental medicine Kyung-Ok-Ko prevents and alleviates dehydroepiandrosterone-induced polycystic ovarian syndrome in rats by Jang M1, Lee MJ1, Lee JM2, Bae CS3, Kim SH4, Ryu JH5, Cho IH6.(PubMed)
(1739) Antidiabetic Effects of Carassius auratus Complex Formula in High Fat Diet Combined Streptozotocin-Induced Diabetic Mice by Wang ZH1, Hsu CC2, Lin HH3, Chen JH2.(PubMed)
(1740) Ameliorating effect and potential mechanism of Rehmannia glutinosa oligosaccharides on the impaired glucose metabolism in chronic stress rats fed with high-fat diet by Zhang R1, Zhou J2, Li M2, Ma H3, Qiu J2, Luo X4, Jia Z5.(PubMed)
(1741) d-galactose administration induces memory loss and energy metabolism disturbance in mice: protective effects of catalpol by Zhang XL1, An LJ, Bao YM, Wang JY, Jiang B.(PubMed)
(1742) Rehmannia inhibits adipocyte differentiation and adipogenesis by Jiang L1, Zhang NX, Mo W, Wan R, Ma CG, Li X, Gu YL, Yang XY, Tang QQ, Song HY.(PubMed)
(1743) The effect of a traditional Chinese prescription for a case of lung carcinoma by Kamei T1, Kumano H, Iwata K, Nariai Y, Matsumoto T.(PubMed)
(1744) The effects of the standardized herbal formula PM014 on pulmonary inflammation and airway responsiveness in a murine model of cockroach allergen-induced asthma by Jung KH1, Choi HL2, Park S3, Lee G4, Kim M5, Min JK6, Min BI7, Bae H8.(PubMed)
(1745) [Shengdi injection on rat model of lung inflammation induced by lipopolysaccharides]. [Article in Chinese] by Liu L1, Tang L, Xu DS, Xia HL, Xie QM.(PubMed)
(1746) The effects of the standardized herbal formula PM014 on pulmonary inflammation and airway responsiveness in a murine model of cockroach allergen-induced asthma by Jung KH1, Choi HL2, Park S3, Lee G4, Kim M5, Min JK6, Min BI7, Bae H8.(PubMed)
(1747) Rehmannia glutinosa activates intracellular antioxidant enzyme systems in mouse auditory cells by Yu HH1, Kim YH, Jung SY, Shin MK, Park RK, So HS, Kim KY, Lee DH, You YO.(PubMed)