Premature ovarian failure (POF) means that a woman's ovaries stop working before she turns age 40. This process results in an increase in follicle-stimulating hormone (FSH > 40 Iu/L) and luteinizing hormone (LH > than 30 Iu/L), and a decrease in estrogen (E < than 25 pg/ml).
However, POF is not the same as menopause. Some women with POF still have occasional periods. Missed periods usually are the first sign of POF. Most women with POF cannot get pregnant naturally. 1 Approximately one in every 1,000 women between the ages of 15 and 29 and one in every 100 women between the ages of 30 and 39 are affected by POF. 2 Although Western medicine currently is helpless in preventing or treating POF, Chinese medicine has helped many women prevent the condition.
The following is a summary of one Chinese doctor's approach to preventing POF. 3 Dr. Zheng Chun of the Hunan Provincial Chinese Medicine & Pharmacology Research Institute Affiliated Hospital describes her opinions on the causes and patterns of POF and her treatments for these patterns.
Disease Mechanisms
According to Dr. Zheng, the main disease mechanism of POF is kidney vacuity (xu, aka, deficiency). This is because the kidneys store the essence and govern reproduction and are closely related to the chong and ren vessels, which play an important role in the governance of menstruation. If the kidney qi is exuberant, the Sea of Blood is full, the menstrual cycle comes on time, and the woman is able to conceive. Normally, the kidneys do not become vacuous and insufficient in females until their late 40s and early 50s.
However, in women with POF, this decline occurs earlier than normal. Dr. Zheng says POF also is closely associated with liver depression, qi stagnation and blood stasis. She points to the tendency of modern women to be under more stress than previously, given job and family demands in an increasingly complex and demanding society. Because of worry, anxiety, too much thinking, fear, anger and frustration, the liver loses its control over coursing and discharge, the qi mechanism becomes repressed and depressed, and enduring depression may produce stasis. In that case, the blood vessels might become static and obstructed.
On the other hand, enduring depression also might transform fire, which exhausts and consumes the qi and blood, thus resulting in qi and blood insufficiency. According to Dr. Zheng, it is this qi and blood vacuity due to liver depression which evolves into the kidney vacuity she views as the proximate cause of POF. Because the liver and kidneys share a common source, this combination of liver depression and kidney vacuity may evolve into liver-kidney dual vacuity.
Pattern Identification
Dr. Zheng identifies seven basic patterns in women with or at risk for POF: 1) kidney yin vacuity; 2) kidney yang vacuity; 3) kidney vacuity with liver depression and blood stasis; 4) kidney vacuity with liver effulgence; 5) heart-kidneys not interacting; and 7) spleen vacuity with phlegm obstruction. There usually are complicated combinations of these seven patterns, such as kidney yin and yang vacuity, liver blood-kidney yin and/or yang vacuity, spleen-kidney dual vacuity with either or both yin and yang vacuity with or without liver depression, blood stasis, and depressive vacuity, phlegm or damp heat. Nevertheless, if one understands the relationships between these seven pathomechanisms, one should be able to understand all of the various permutations of these basic patterns. Further, Dr. Zheng emphasizes that, no matter how complicated the pattern, kidney vacuity needs to be strongly treated in all cases of incipient POF.
Treatment Based on Pattern Identification
When it comes to treatment, Dr. Zheng presents five basic protocols based on four predominant patterns. For liver-kidney yin vacuity, she uses modified Gui Shen Wan (Restore the Kidneys Pills):
shu di (cooked Radix rehmanniae)
shan zhu yu (Fructus corni)
gou qi zi (Fructus lycii)
shan yao (Radix dioscoreae)
bai shao (Radix alba paeoniae)
dang gui (Radix angelicae sinensis)
gui ban (Plastrum testudinis)
bie jia (Carapax trionycis)
zi he che (Placenta hominis)
san shen (Fructus mori)
For kidney vacuity with liver depression and blood stasis, she modifies with a combination of You Gui Yin (Restore the Right Beverage), Xiao Yao San (Rambling Powder) and Tao Hong Si Wu Tang (Persica and Carthamus Four Materials Decoction):
shu di (cooked Radix rehmanniae)
dan pi (Cortex moutan)
ze xie (Rhizoma alismatis)
shan yao (Radix dioscoreae)
dang gui (Radix angelicae sinensis)
bai shao (Radix alba paeoniae)
chai hu (Radix bupleuri)
yu jin (Tuber curcumae)
xiang fu (Rhizoma cyperi)
xian ling pi (Herba epimedii)
xian mao (Rhizoma curculiginis)
chong wei zi (Semen leonuri)
zi he che (Placenta hominis)
tao ren (Semen persicae)
hong hua (Flos carthami)
chuan shan jia (Squama manitis)
For heart-kidneys not interacting, Dr. Zheng recommends modifications of Gui Shen Wan (Restore the Kidneys Pills), plus E Jiao Huang Liang Tang (Donkey Skin Glue and Coptis Decoction) and Er Zhi Wan (Two Ultimates Pills):
sheng di (uncooked Radix rehmanniae)
shan zhu yu (Fructus corni)
shan yao (Radix dioscoreae)
gou qi zi (Fructus lycii)
xian ling pi (Herba epimedii)
huang lian (Rhizoma coptidis)
E jiao (Gelatinum corii asini)
nu zhen zi (Fructus ligustri lucidi)
han lian cao (Herba ecliptae)
yuan zhi (Radix polygalae)
suan zao ren (Semen zizyphi spinosae)
long chi (Dens draconis)
mu li (Concha ostreae)
For kidney yin and yang dual vacuity, Dr. Zheng uses modifications of Gui Shen Wan (Restore the Kidneys Pills) and Er Xian Dan (Two Immortals Elixir):
shu di (cooked Radix rehmanniae)
he shou wu (Radix polygoni multiflori)
dan pi (Cortex moutan)
shan yao (Radix dioscoreae)sang shen (Fructus mori)
lu jiao shuang (Cornu degelatinum cervi)
zi he che (Placenta hominis)
chong wei zi (Semen leonuri)
xian ling pi (Herba epimedii)
xian mao (Rhizoma curculiginis)
ba ji tian (Radix morindae officinalis)
For spleen vacuity with phlegm obstruction, Dr. Zheng recommends the following:
fu ling (Poria)
shan yao (Radix dioscoreae)
bai zhu (Rhizoma atractylodis macrocephalae)
ban xia (Rhizoma pinelliae)
chen pi (Pericarpium citri reticulatae)
zhu fu (Caulis bambusae in taeniam)
che qian Zi (Semen plantaginis)
gui zhi (Ramulus cinnamoni)
tu si zi (Semen cuscutae)
gou qi zi (Fructus lycii)
dan shen (Radix salviae miltiorrhizae)
niu xi (Radix achyranthis bidentatae)
Dr. Zheng also uses a basic acupuncture protocol consisting of: da zhui (GV 14), tao dao (GV 13), shen zhu (GV 12), ling tai (GV 10), zhiu yang (GV 9), yong quan (Ki 1), guan yuan (CV 4), zhong ji (CV 3), zi gong (Child Palace, non-channel), and shen shu (Bl 23). The purpose of this protocol is to regulate and balance the hypophysial-pituitary-ovarian axis and normalize the reproductive endocrine system.
Using the above methods, Dr. Zheng says the goal is to regulate the woman's menstrual cycle. If it's too long, the blood is too scanty or there is amenorrhea, the cycle should be shortened or re-established and the amount of the menses increased. In addition, accompanying symptoms associated with ovarian decline such as hot flashes, sweating and insomnia, also should be specifically addressed. Furthermore, for best results, in addition to supplementing the kidneys, nourishing and quickening the blood, and coursing the liver, the woman should receive psychological counseling and regulate her diet and lifestyle.
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