I’d like to share two clinical cases for each diagnosis discussed in part 1 [published in the August issue]:
Case #1
A 28-year-old female started metformin (500 mg) twice a day after being diagnosed with PCOS, but her HbA1c level was in a normal range. She has had an irregular period for her whole life and cannot predict her next period.
Symptoms:
TCM Findings:
Treatment Result:
Within four weeks of taking SQDBT, she confirmed with ultrasound that her ovary morphology became normal.
The period became regular and predictable: ovulation around 28th day and menstruation around 42nd day from the previous period. For the first time, she confirmed her ovulation with an ovulation strip and ultrasound.
When she exercised, she felt hot easily and sweated more than usual. Cold feet and knees were relieved.
The patient’s weight consistently decreased, even though her hunger and portion size increased. She and her family noticed a change in her body shape.
Extreme fatigue and constipation were relieved. Acne along the jawline had improved up to 90%.
The increased metabolism gave her enough energy to go through the day without an energy drop and made her lose weight faster. She was advised to contact her gynecologist to discontinue metformin. The next treatment plan is to shorten the follicular phase by bringing ovulation early.
Case #2
A 34-year-old female PCOS patient who had always taken monthly progesterone pills to induce a menstrual period due to irregularity. She came to see a fertility specialist to try to conceive with intrauterine insemination (IUI).
The patient started acupuncture during her first IUI cycle. During her IUI cycle, the patient’s anxiety was improved, and night urination was relieved, but IUI was unsuccessful. She was advised to take a break for one or two months to prepare for the second IUI while taking herbs.
Symptoms:
TCM findings:
Treatment Result:
The month she switched to taking Ba Wei Di Huang Wan, she naturally conceived and ultimately had a full-term and healthy baby. Herbs were stopped after confirmed pregnancy. She was diagnosed with gestational diabetes during the pregnancy, but no other complications. I believe the gestational diabetes could also have been preventable if she had a chance to have a longer treatment before she became pregnant. Her thyroid became normal after her first pregnancy.
Discussion
Unexperienced practitioners may face confusion with two factors while treating PCOS. First, even though the lean PCOS patients don’t seem to have damp/phlegm blockage, they actually do. You will notice that lean PCOS patients have relatively bigger abdomens where dampness accumulates, compared to their thin extremities. This also implies insulin resistance that is strongly related to central abdominal (intra-abdominal plus abdominal subcutaneous) fat.3
Second, the heat symptoms such as acne, red face, sleep disorder, anxiety, and irritability in the upper jiao can disguise the cold-damp in the low jiao. Once the heat symptoms are relieved with treatments, patients suddenly notice how cold they really are. We should look for the cold-damp blockage hidden inside.
I cannot stress enough the importance of dietary and lifestyle changes in supplementing PCOS treatment in addition to Chinese herbal remedies. It is a must for PCOS patients to limit refined sugar and processed foods, avoid icy-cold foods and ice water, regularly exercise until sweating, and get full sleep at night in order to restore reproductive health.
Supplements such as inositol and N-acetyl cysteine (NAC) are also helpful in regulating glucose levels and improving ovarian function.4
As acupuncturists and herbalists, we have powerful tools in our hands to stop the huge population that is relying on birth control pills and metformin. Let’s help them by addressing the root causes – not only to restore their current reproductive health and fertility, but also to prevent PCOS-related health risks in the future, including diabetes and cardiovascular disease.
Editor’s Note: References support the in-text citations for both parts of this article. Pt. 1 appeared in the August issue.
References
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
There’s no doubt that many of your patients visit your practice because they are in pain. And there’s certainly no doubt that curcumin from turmeric (Curcuma longa) can be incredibly effective in stopping that pain, whether due to chronic conditions like arthritis or acute pain from intensive workouts. But your patients may also benefit from curcumin for other reasons.
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Low back pain is defined as pain the posterior superior iliac spine (PSIS), and it can be acute or chronic, localized or radiating. It is a common ailment for adults in the United States, with a lifetime prevalence as high as 65-80%. Whether or not an MRI is available to provide definitive knowledge of a structural issue, acupuncture can be an effective treatment for low back pain.
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