PREMATURE OVARIAN FAILURE (POF):
TREATMENT WITH TRADITIONAL CHINESE MEDICINE

by Ray Rubio, D.A.O.M., L.Ac., Dipl. Ac., Dipl. CH, FABORM

Traditional Chinese Medicine prefers to look at dysfunction of the part as a manifestation of imbalance of the whole. One cannot be separated from the other. Therefore, within the broad categories of patterns of disharmony, attention must be paid to the individual details of the person’s disease signs, symptoms, and history. Although western differential and laboratory diagnoses can help in determining a prognosis for individual cases of premature ovarian failure (POF) – i.e., a patient with POF secondary to chromosomal disorders, such as Turner’s Syndrome, will be more difficult to treat than someone with POF secondary to hypothyroidism – the TCM differential diagnosis/bian zheng is the guiding factor in developing a treatment strategy. Tongue, pulse, skin, hair, complexion, and other physical signs must be interpreted in light of the patient’s own medical and family medical history. However, the patterns of disharmony which occur in patients with POF tend to fall into a few basic categories:

Kidney and Liver yin deficiency with empty heat and dryness of the Chong and Ren

Symptoms and signs: hot flushing, night sweats, insomnia, thirst, malar flush, tidal fever, low back pain, tinnitus, vaginal dryness, amenorrhea, scanty menses, dry skin and eyes, joint pain

Tongue: dry, red, with little or no coating; possible cracks

Pulse: thready, weak in the left guan and chi positions; possibly rapid

Treatment principle: Nourish Kidney and Liver yin, clear empty heat, replenish the Chong and Ren

Acupuncture: Guanyuan (CV 4), Sanyinjiao (SP 6), Zhaohai (KI 6), extra point Zigong, Shenshu (BL 23), Shuiquan (KI 5), Tianshu (ST 25), Chengjiang (CV 24), Yinxi (HT 6)

Chinese Herbal Prescription: Zhi Bai Di Huang Wan (Anemarrhena Phellodendron & Rehmannia Formula) with additions

• Er Di Huang - Shu Di and Sheng Di (Rehmannia),18g
• Shan Yao (Dioscorea), 15g
• Shan Zhu Yu (Cornus), 12g
• Fu Ling (Hoelen), 12g
• Mu Dan Pi (Moutan), 9g
• Ze Xie (Alismatis), 6g
• Zhi Mu (Anemarrhena), 9g
• Huang Bai (Phellodendron), 6g
• Tu Si Zi (Cuscutae), 12g
• Sang Ji Sheng (Loranthus), 9g
• Huai Niu Xi (Achyranthes), 9g
• Mu Li (Ostrea), 30g
• Che Qian Zi (Plantaginis), 9g
• Dang Gui (Angelica), 9g
• Zhi He Che (Placenta), 3g

Kidney and Liver yin and blood deficiency with blood stasis

Symptoms and signs: above-mentioned Kidney and Liver yin deficiency signs plus: painful menses possibly with clotting (if there are menses), dark and lusterless complexion, spider nevi on the Liver and Kidney meridians, pain at ovulation (if there is ovulation), amenorrhea, possible history of ovarian cysts, endometriosis or PID, joint pain

Tongue: red or pale, and dry with pronounced sublingual distension

Pulse: choppy and deficient (in force, width and duration), especially so in the chi position

Treatment principle: Tonify Kidney and Liver blood, eliminate blood stasis

Acupuncture: Sanyinjiao (SP 6), Guanyuan (CV 4), Ququan (LR 8), Xuehai (SP 10), Taixi (KI 3), Shuiquan (KI 5), Dazhu (BL 11), Geshu (BL 17), Ganshu (BL 18), Shenshu (BL 23), extra point Zigong, Neiguan (PC 6)

Chinese Herbal Prescription: Gui Shao Di Huang Wan with additions

• Sheng Di Huang (Rehmannia), 18g
• Shan Yao (Dioscorea), 12g
• Shan Zhu Yu (Cornus), 12g
• Gou Qi Zi (Lycium), 12g
• Fu Ling (Hoelen), 12g
• Mu Dan Pi (Moutan), 9g
• Ze Xie (Alismatis), 6g
• Dang Gui (Angelica), 9g
• Chi Shao (Red Peony), 9g
• Dan Shen (Salvia), 12g
• Ji Xue Teng (Milletia), 12g
• Lu Lu Tong (Liquidamber), 9g
• Shan Zha (Crataegus), 9g
• Tu Si Zi (Cuscutae), 12g
• Lu Jiao (Cornus Cervi), 9g

Kidney and Liver yin and blood deficiency with Liver qi stagnation

Symptoms and signs: above-mentioned Kidney and Liver yin deficiency signs plus: pre-menstrual tension, breast tenderness, irregular menses (if there are menses), frequent sighing, constipation, ovulatory pain (if there is ovulation), work-related stress, symptoms worse with stress and emotional lability, patient may have diagnosed pituitary microadenoma/prolactinemia, hypochondriac feeling of distension

Tongue: dusky or reddish with dark edges and possible Liver stagnation spots

Pulse: tense to wiry depending on the patient’s stress level, thin; guan position will be the most tense

Treatment principle: Relax and course the Liver qi, nourish Kidney and Liver yin and blood

Acupuncture: Hegu (LI 4), Taichong (LR 3) – aka “Four Gates”, Qimen (LR 14), Ququan (LR 8), Geshu (BL 17), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Neiguan (PC 6), Sanyinjiao (SP 6), Taixi (KI 3), extra point Yintang and Zigong

Chinese Herbal Prescription: Yi Guan Jian (Linking Decoction) with additions

• Sheng Di Huang (Rehmannia), 18g
• Bei Sha Shen (Glehnia), 12g
• Mai Men Dong (Ophiopogon), 9g
  
• Dang Gui (Angelica), 9g
  
• Chuan Lian Zi (Melia), 9g
  
• Bai Shao (Peony), 9g
  
• Yan Hu Suo (Corydalis), 6g
  
• Gou Qi Zi (Lycium), 12g
  
• Tu Si Zi (Cuscutae), 12g
  
• Xiang Fu (Cyperus), 9g
  
• Yu Jin (Curcuma), 9g
  
• Nu Zhen Zi (Ligustrum), 12g
  
• Han Lian Cao (Eclipta), 9g

Kidney yang and essence deficiency with exhaustion of the Chong and Ren

Symptoms and signs: low back pain, subjective feeling of cold when others are warm, preference for warm weather, cold extremities (particularly the feet and ankles), fatigue, an appearance of being prematurely aged, primary amenorrhea, under-developed sexual characteristics (small hips and breasts), low libido, withdrawn personality, pale/wan complexion, history of delayed onset of puberty

Tongue: pale and dry and tender in appearance

Pulse: deep, slow and absent or hidden in the chi position bilaterally

Treatment principle: Warm the Kidney yang, replenish Kidney essence, fortify the Chong and Ren

Acupuncture (with moxibustion): Shenshu (BL 23), Mingmen (GV 4), Guanyuan (CV 4), Fuliu (KI7), Zusanli (ST 36), Shangjuxiu (ST 37), Pishu (BL 20), Yangqi (TH 4), Shenque (CV 8)

Chinese Herbal Prescription: You Gui Tang (Eucommia & Rehmannia Formula) with additions

• Shu Di Huang (Rehmannia (Prepared)), 20g
  
• Fu Zi (Aconite), 6-9g
  
• Rou Gui (Cinnamon Bark), 6-9g
  
• Shan Zhu Yu (Cornus), 12g
  
• Gou Qi Zi (Lycium), 12g
  
• Shan Yao (Dioscorea), 15g
  
• Du Zhong (Eucommia), 12g
  
• Dang Gui (Angelica), 12g
  
• Tu Si Zi (Cuscutae), 12g
  
• Lu Jiao Jiao (Antler Glue), 20g
  
• Zi He Che (Placenta), 6g
  
• Rou Cong Rong (Cistanches), 15g
  
• Mu Li (Ostrea), 30g

About the Author:

Ray Rubio, D.A.O.M., L.Ac., Dipl. Ac., Dipl. CH, FABORM

Dr. Ray Rubio has been in private practice at Westlake Complementary Medicine in Los Angeles for over a decade, and was on the clinical staff at the Toluca Lake Health Center – a multidisciplinary outpatient medical clinic – for half of that time. Dr. Rubio’s specialty is Women’s Health, with an emphasis in Reproductive Medicine and the treatment of infertility. He works both with patients who would prefer to conceive naturally, and those who will be utilizing Assisted Reproductive Techniques (ART). He speaks to infertility support groups on a regular basis and is a member of the American and Pacific Societies for Reproductive Medicine (ABORM). He is currently in the process of conducting a clinical trial on the treatment of diminished ovarian reserve with Chinese Herbal Medicine in patient undergoing IVF.

To learn more about infertility, Dr. Ray Rubio is speaking on the following topic for Lotus Institute. The class is approved for 8 CEUs/PDAs by the California Acupuncture Board, Illinois Acupuncture Board, and NCCAOM.

Class by the Author:

Male and Female Infertility: Tx Strategies & Clinical Pearls

• 2/8/09 Anaheim, CA
• 8/23/09 Oakland, CA