abstracted & translated by
Bob Flaws, L.Ac.

On pages 92-93 of issue 5, 2009 of Si Chuan Zhong Yi (Sichuan Chinese Medicine), Deng Ying published an article titled, “Clinical Observations on the Treatment of 200 Cases of High Altitude Region Premature Ovarian Failure with Self-composed Bu Shen Tiao Chong Tang.” The “high altitude region” in question is Qinghai, and the author works at the Qinghai Provincial Chinese Medicine Hospital in Xining. This region of China is inhabited by a mixture of Tibetans and Chinese. It is not clear from the article whether the patients were primarily indigenous Tibetans or “immigrant” Chinese. The fact that the article states that all the women had lived in Qinghai for more than five years suggests that they were immigrant Chinese having to adjust to a “foreign” climate. A summary of this article is presented below.

Cohort description:

The two hundred women in this cohort study were all seen in the Gynecology Department of the Qinghai Provincial Chinese Medicine Hospital between 2005 and 2008. All had lived in the area for five years or more. Based on their medical histories and blood analysis, they all suffered from POF. In terms of clinical complaints, these included scanty menstruation, delayed menstruation, amenorrhea, and/or infertility. Women with pathological changes in the external or internal reproductive organs or those with systemic diseases were excluded from this study. These patients’ ages ranged from 27-39 years and their disease had lasted from three months to seven years. Eighty-six cases suffered from scanty menstruation, 44 from delayed menstruation, 34 from both scanty and delayed menstruation, 28 from amenorrhea, and eight from infertility.

Criteria for diagnosis of POF included 1) being less than 40 years old when experiencing amenorrhea of three months or more in duration, 2) multiple symptoms of perimenopausal syndrome, 3) serum follicle-stimulating hormone (FSH) of more than 40U/L, estradiol (E2) of less than 732mol/L, and luteinizing hormone which was either normal or elevated, and 4) absence of organic pathology.

Treatment method:

Self-composed Bu Shen Tiao Chong Tang (Supplement the Kidneys & Regulate the Chong Decoction) consisted of:

Lu Jiao Shuang (Cornu Degelatinum Cervi), 30g
Tu Si Zi (Semen Cuscutae), 15g
He Shou Wu (Radix Polygoni Multiflori), 15g
Zi He Che (Placenta Hominis), 15g
Shan Zhu Yu (Fructus Corni), 20g
Huang Jing (Rhizoma Polygonati), 20g
Dan Shen (Radix Salviae Miltiorrhizae), 30g
Dang Gui (Radix Angelicae Sinensis), 15g
Bai Shao (Radix Alba Paeoniae), 15g
Gui Zhi (Ramulus Cinnamomi), 10g
Qiang Huo (Radix Et Rhizoma Notopterygii), 3g
uncooked Huang Qi (Radix Astragali), 30g
Gan Cao (Radix Glycyrrhizae), 6g

Additions & subtractions:

If hot flashes and sweating were pronounced, Zhi Mu (Rhizoma Anemarrhenae) and mix-fried Bei Jia ( Carapax Trionycis) were added.

If heart fluster (i.e., heart palpitations) and heart vexation were severe, Gan Mai Da Zao Tang (Licorice, Wheat & Red Date Decoction) was added.

If insomnia was severe, Suan Zao Ren (Semen Zizyphi Spinosae), Ye Jiao Teng (Caulis Polygoni Multiflori), He Huan Pi (Cortex Albiziae), and Fu Shen (Sclerotium Pararadicis Poriae) were added.

One packet of these medicinals was decocted in water and administered warm in two divided doses per day. During menstruation, these medicinals were stopped. Treatment lasted for three months.

Study outcomes:

In those with amenorrhea, cure was defined as the resumption of normal menstruation and disappearance of all symptoms along with normal serum FSH, E2, and LH. Improvement was defined as interrupted occurrence of menstruation along with improvement of symptoms and almost normal FSH, E2, and LH. No effect meant that menstruation had still not occurred after treatment, symptoms had not remitted, and there was no marked change in FSH, E2, and LH.

In those with scanty menstruation, cure was defined as the amount of menstruation or the duration of menstruation becoming normal, disappearance of symptoms, and normalization of FSH, E2, and LH. Improvement was defined as an increase in the amount of the menstruate with a total cycle lasting 21-35 days, improvement of symptoms, and almost normal FSH, E2, and LH. No effect meant that, after treatment, there was no change in the amount and/or the duration of menstruation, no remission of symptoms, and no marked change in FSH, E2, and LH.

In those with infertility, cure was defined as conception occurring within one year of treatment. No effect meant that there was no conception within one year of treatment.

Based on these criteria, in the 86 women with scanty menstruation, 39 were cured, 45 improved, and two got no effect. In the 44 women with delayed menstruation, 28 were cured and the other 16 improved. In the 34 cases of both scanty and delayed menstruation, 25 were cured and the other 19 improved. In the 28 cases of amenorrhea, 20 were cured and eight got no effect. In the eight cases of infertility, three conceived. Therefore, the total cure rate was 56%, the total effectiveness rate was 96%, and the conception rate was 26.7%.

The following table shows changes in mean hormone levels from before to after treatment.

 
Thus mean E2 increased significantly, mean FSH decreased by almost half, and mean LH also decreased.

Discussion:

According to Dr. Deng, modern medicine (i.e., Western medicine) mainly treats POF via hormone replacement therapy (HRT). Although the effects are relatively good, the recidivism rate after cessation of treatment is high and HRT does have its side effects. In addition, a significant portion of women treated with HRT experience psychological disturbances. Therefore, increasingly this condition is being treated with Chinese medicine or integrated Chinese-Western medicine.

In Chinese medicine, this condition is categorized as scanty menstruation, delayed menstruation, blood dessication, amenorrhea, and infertility. According to the first chapter of the Su Wen (Simple Questions), 
“[At] seven years in females, the kidney qi is exuberant, and [therefore,] the teeth grow... [But, at] seven [times] seven [years], the ren vessel is vacuous, the supreme chong vessel is depleted and scanty, the tian kui is exhausted, the pathways of the earth are no [longer] freely flowing, [and] therefore, the form [or body] is spoilt and [the woman can] no [longer have] children.” The kidneys are the former heaven root, while the spleen is the latter heaven root. Thus treatment of this condition should mostly supplement the kidneys, fortify the spleen, and regulate the chong.

However, because Dr. Deng’s patients live in a high altitude region which is cold and chilly and oxygen is low, Chinese medical theory also suggests that their clear qi is scanty while their turbid qi is profuse. It is the clear qi received from heaven plus the grain qi which fill the body and strengthen and boost the function of the qi aspect. If, by nature, the clear qi is scanty, then the body’s qi aspect must be vacuous. The qi governs shining, while the blood governs sprinkling. If the qi is vacuous, movement lack strength and the blood vessels must automatically be congested and stagnant. In addition, cold governs congelation and stagnation, constriction and contraction. If cold evils attack and assail the channels and vessels and struggle with the blood, this results in static blood stopping or collecting internally. Therefore, symptoms of qi vacuity, blood stasis, and cold congelation are relatively marked in this area.

Because Chinese medicine takes into account such environmental factors when discriminating patterns and stating treatment principles, Dr. Deng believes that it is necessary to heavily supplement and boost the qi, nourish and quicken the blood, and free the flow of the network vessels on top of a basis of supplementing the kidneys and fortifying spleen in patients with POF living in this kind of environment. Therefore, within her formula, Lu Jiao Shuang and Zi He Che, being bloody, meaty ingredients, warm and nourish the governing vessel, supplement and boost the chong and ren, and thus promote the free flow and regulation of yin water. Tu Si Zi supplements the kidneys and nourishes the liver. Shu Di Huang, Shan Zhu Yu, He Shou Wu, and Huang Jing supplement the liver and kidneys, boost the essence and blood. Huang Qi supplements the spleen and boosts the qi. Dang Gui, Chi Shao (Radix Rubra Paeoniae, sic), and Dan Shen nourish and quicken the blood. Qiang Huo enters the liver where if diffuses and frees the flow of the vessels and network vessels. Combined with Gui Zhi, together these medicinals warm, free the flow, and strengthen yang. When used altogether, these medicinals supplement the kidneys and boost the essence, boost the qi and nourish the blood, regulate and supplement the chong and ren. Hence the formula gets a good effect treating the scanty menstruation, delayed menstruation, blood dessication, amenorrhea, and infertility of POF when modified with additions and subtractions based on the patient’s pattern discrimination.

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