abstracted & translated by
Bob Flaws, L.Ac.

On page 412 of issue6, 2009 of Shi Yong Zhong Yi Yao Za Zhi (Journal of Practical Chinese Medicine & Pharmacology), Zhang Li et al. published an article titled “Liu Yu-xin’s Experience of Treating Premature Ovarian Failure Via Qi Vacuity.” A summary of this article is presented below.

Introduction:

According to the authors of this article, premature ovarian failure refers to amenorrhea, infertility, and a decrease in serum estrogen (E2) plus an increase in follicle-stimulating hormone (FSH) prior to 40 years of age. In this case, FSH is more than 40IU/L, luteinizing hormone (LH) is more than 30IU/L, and E2 is less than 25pg/mL. In addition, the main clinical manifestations are hot flashes, sweating, vaginal tract dryness, dizziness, emotional lability, insomnia, and decrease libido. Ultrasound shows shrinkage of the ovaries or no organic change. Liu Yu-xin has many years clinical experience and has seen a gradual rise in the rate of POF over those years.

Disease mechanisms:

In Chinese medicine, POF is categorized as jing bi, menstrual block or amenorrhea. While Prof. Liu agrees with other Chinese doctors that kidney vacuity is a definite cause of POF, she believes that most patients do not present a pattern of pure kidney vacuity but spleen-kidney dual vacuity. This is based on her experience that many patients with POF present with amenorrhea accompanied by shortness of breath, disinclination to speak due to fatigue, a somber white facial complexion, lack of strength, and spontaneous perspiration, all qi vacuity signs and symptoms. Hence, she has found that, by only supplementing the kidneys, it is hard to get a fully satisfactory effect in the treatment of this condition.

Within the human body, essence has form (or substance), while qi is formless. However, without form, the qi has nowhere to gather and accumulate. At the same time, it is this gathering and accumulation of qi which produces essence’s form. In other words, essence is able to transform qi. Essence is the source of the qi. However, qi is able to engender essence. It is qi’s transformation which stimulates the production of essence. Thus it is said, “Essence and qi mutually transform.” Based on this theory, Prof. Liu uses the principles of “supplementing the qi and engendering essence” to treat POF.

Treatment method:

In her treatment of POF, Prof. Liu uses a combination of hormone replacement therapy (HRT) with self-composed Chinese medicinal decoctions. Prof. Liu she finds that this integration of Chinese and Western medicines gives quite satisfactory clinical results in the treatment of this condition. In order to artificially regulate the cycle, Prof. Liu prescribes 0.625 milligrams once per day of conjugated estrogen for 21 days. She also prescribes 10 milligrams of progesterone for five days beginning on day 21, after which she stops these medicine for 3-7 days. Typically, this results in the onset of menstruation. She then continues this regime through subsequent cycles. If this regime does not result in menstruation, she still continues this protocol, stopping administration of these medicines for one week between courses.

Based on this foundation, Prof. Liu also prescribes her self-composed Kang Shuai Fu Chao Tang (Combat Decline & Restore the Ovaries Decoction) with additions and subtractions. The basic formula she uses is composed of:

Ren Shen (Radix Ginseng)
Huang Qi (Radix Astragali)
Lu Rong (Cornu Parvum Cervi)
Ji Xue Teng (Caulis Spatholobi)
Shu Di Huang (cooked Radix Rehmanniae)
Dang Gui (Radix Angelicae Sinensis)
Chi Shao (Radix Rubra Paeoniae)
Yi Mu Cao (Herba Leonuri)
Zi He Che (Placenta Hominis)

Within this formula, Ren Shen and Huang Qi are the sovereign medicinals. According to the Ben Cao Jing Shu (The Neglected Classic Materia Medica), “Ren Shen is able to rescue yang qi from its deathbed and drive back vacuity evils in an instant...[and] supplements [all] five viscera.” According to the Zhen Zhu Nang (Bag of Pearls), “Huang Qi supplements whatever is vacuous and insufficient, boosts the source qi, and strengthens the spleen and stomach.” Dang Gui is a qi within the blood medicinal. Hence it both supplements and moves the blood. Shu Di Huang supplements the qi and blood, enriches kidney water, boosts the essence and fills the marrow. Yi Mu Cao and Ji Xue Teng, when used together, quicken the blood and regulate menstruation. Lu Rong and Zi He Che warm and supplement the yang qi, boost the qi and nourish the blood. Chi Shao drains fire, downbears the qi, and moves the blood according to the Dian Nan Ben Cao (Yunnan Materia Medica). Thus, when all these medicinals are used together, they boost the qi, engender essence, and support the source qi, quicken the blood, free the flow of the channels (or menstruate), and treat premature decline.

Representative case history:

The patient was a 31-year-old female who had suffered from amenorrhea for five years. After being married for one year, she had not conceived with normal sexual intercourse. The husband’s sperm had been examined and been found to be normal. This woman’s menarche had come at 15 years of age but had always come late, moving once only every 35 days to three months. The menses lasted fro 2-3 days and were scanty in amount, pale in color, and thin in consistency. She had no dysmenorrhea. Five years before coming to see Prof. Liu, her menses had become blocked and stopped moving for no apparent reason. The patient had been treated at her local hospital for a long time but had not been cured.

At the time of Prof. Liu’s initial examination, the patient presented with low back soreness and abdominal chill, dizziness, tinnitus, lassitude of the spirit, lack of strength, a dry vaginal tract, no sexual desire, and poor sleep at night. Her body was thin and she was 1.60 meters in height. Her facial complexion was pale yellow and her breasts tended to be flat, had no discernable aureoles, and her nipples were relatively small. Her tongue was pale red with thin, white fur, while her pulse was deep and fine. Gynecological examination revealed very sparse pubic hair and poorly developed external genitalia. Her vaginal tract was open and unobstructed, but its secretions were decreased and pale in color. Her cervix  was thin and small and its surface was glossy. The edges of the adnexa were indistinct. The left ovary was 1.3 centimeters x 0.9 centimeters, while the right ovary was 1.4 centimeters x 0.6 centimeters. Although the uterus was small, its shape was normal. Serum E2 was 14pg/mL, FSH was 91.17mIU/mL, LH was 19.7mIU/mL, testosterone (T) was 2ng/mL, progesterone (P) was 0.19ng/mL, and prolactin (PRL) was 2.91ng/mL. The patient’s thyroid function was normal. She had never conceived, never been pregnant, and had never terminated a pregnancy. She did have a history of parotitis or mumps.

Based on the foregoing, Prof. Liu’s pattern discrimination was kidney essence depletion and detriment with spleen-kidney yang vacuity, qi and blood insufficiency, and premature decline of the tian kui which had resulted in the woman’s amenorrhea. Therefore, Prof. Liu’s treatment principles were to boost the qi and engender yang, supplement the kidneys and warm the governing (vessel), and simultaneously quicken the blood and free the flow of the channels (or menses). The medicinals she used for these purposes included:

Ren Shen (Radix Ginseng), 10g
Huang Qi (Radix Astragali), 20g
Lu Rong (Cornu Parvum Cervi), 5g
Ji Xue Teng (Caulis Spatholobi), 15g
Shu Di Huang (cooked Radix Rehmanniae), 15g
Dang Gui (Radix Angelicae Sinensis), 15g
Chi Shao (Radix Rubra Paeoniae), 15g
Yi Mu Cao (Herba Leonuri), 15g
Zi He Che (Placenta Hominis), 10g
She Chuang Zi (Fructus Cnidii), 15g
Bu Gu Zhi (Fructus Psoraleae), 15g
Chong Wei Zi (Semen Leonuri), 15g

Prof. Liu prescribed nine packets of these medicinals, each packet to be decocted in water and taken in two divided doses per day. After two weeks’ administration of these medicinals, the patient’s vaginal discharge had increased and her breasts had grown. Her sexual desire was also higher than before. However, there was still no sign of menstruation. Repeat gynecological examination showed no changes. Her tongue was pale red with thin, white fur, and her pulse was deep, fine, and forceless. Therefore, Prof. Liu add 15 grams each of Gou Qi Zi (Fructus Lycii), Shan Zhu Yu (Fructus Corni), and He Shou Wu (Radix Polygoni Multiflori) to the base formula described above.

After taking this formula for one month, the woman menstruated. Her menses were scanty in amount, pale in color, and thin in consistency. They only lasted one day and then stopped. Menstruation was accompanied by low back soreness, lower abdominal downward sagging, and breast distention and fullness. The patient’s breasts had grown a little, the aureoles were more distinct, and the nipples were larger than before. The patient’s tongue was pale red with thin, white fur, and her pulse was bowstring and moderate (probably meaning slightly slow). Gynecological examination showed that the subdermal fat of her external genitalia had increased from previously. Therefore, Prof. Liu prescribed her original base formula plus 15 grams each of Xian Mao (Rhizoma Curculiginis), Bu Gu Zhi (Fructus Psoraleae), Chong Wei Zi (Semen Leonuri), and Ji Xue Teng (Caulis Spatholobi) and 20 grams each of Xian Ling Pi (Herba Epimedii) and Shu Di Huang (cooked Radix Rehmanniae). At the same time, the patient was also administered the HRT regime of estrogen and progesterone described above.

For the next three months, the woman’s menses came regularly. Their amount was still scanty and their color was pale, but they lasted four days. All the woman’s symptoms had disappeared. Her breasts were markedly distended and painful and they had increased in size. Gynecological examination showed that her pubic hair had become denser and the development of her external genitalia were now normal. Her vaginal secretions were now abundant and their color was pale. The uterus had grown in size to 4.2 x 2.8 x 3.1 centimeters, up from 3.4 x 1.1 x 2.6 centimeters originally. Her left ovary was now 2.2 x 1.9 centimeters, and her right ovary was 1.9 x 1.8 centimeters. On day three of her menstrual cycle, her E2 was 124pg/mL, FSH was 6.58mIU/mL, and LH was 14.36mIU/mL. The patient continued taking the basic formula above for four more months, after which she conceived, carried full-term,  and eventually gave birth normally to a baby girl.

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