Consensus on the integrated traditional Chinese and Western medicine criteria of diagnostic classification in polycystic ovary syndrome (draft).

Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder of women, with complex pathogenesis and heterogeneous manifestations. Professor Jin Yu recently wrote an article entitled "Proposal of Diagnosis and Diagnostic Classification of PCOS in Integrated Traditional Chinese and Western Medicine."From this, the Obstetrics and Gynecology branches of the Chinese Association of Integrative Medicine and the China Association of Chinese Medicine collaborated with the Gynecology branch of the Chinese Association for Research and Advancement of Chinese Medicine to draft a report on the consensus of criteria for the diagnosis and classification of PCOS in integrated traditional Chinese and Western medicine. The diagnosis for PCOS includes all three features: (1) oligo-ovulation or anovulation; (2) clinical and/or laboratory evidence of hyperandrogenism;(3) PCOS is classified into four types: types Ia,Ib, IIa, and IIb. Syndrome differentiation types for PCOS in traditional Chinese medicine are as follows: Kidney deficiency with phlegm blockage syndrome, Kidney Yin deficiency with phlegm blockage and blood stasis syndrome, and Kidney deficiency with Liver Qi stagnation syndrome.

[Professor SHI Yin's experience of staging, classification and sorting method for polycystic ovary syndrome].

The clinical experience of professor SHI Yin for polycystic ovary syndrome (PCOS) was summarized. According to the main pathogenesis of PCOS, the tonifying kidney should be taken as essence with synchronous treatment on liver, spleen and heart, presenting staging, classification and sorting method for PCOS. In the staging method, the regulation on follicle development should be taken as treatment core to comply with the rules of yin and yang. A four-stage method was proposed, where "regulating method" was suitable in menstrual period, "tonifying method" in follicular phase;"dredging method" in ovulatory period and "adjustment and tonifying " in luteal phase. In the classification and sorting method, attention was paid on individualized treatment, and treatment was based on fat type, thin type and non-fat type as well as childbearing. Besides, psychological counseling and life adjustment for patient was essential, and the unity of body and mind could enhance curative effect.

[The Chinese medicine syndrome typing mode at the same level is the key point to explore the syndrome laws of disease. An inspiration from studying Chinese medicine syndrome laws of polycystic ovarian syndrome].

Chinese medicine (CM) syndrome typing methods not only provides information on the diagnosis and treatment of diseases, but also embodies the whole process of their occurrence, development, and prognosis. Standard syndrome typing methods can provide a testing platform for clinical efficacy assessment and scientific research work. By my 16 years' clinical experience, inter-group comparison of polycystic ovarian syndrome (PCOS) patients of different CM syndrome types at the same level (reproductive endocrinology and metabolism) was conducted. They were also compared with the healthy subjects. Results showed that homogeneity and heterogeneity exist in PCOS patients of different CM syndromes in the reproductive endocrine and metabolic characteristics, which is important to understand the laws between the pathological changes and syndrome types of PCOS. It is also a good inspiration to understand and clarify the correlation between the asthenia of Zang-Fu organs in CM theories and PCOS. Therefore, I believe that it is necessary to explore the laws of each CM syndrome type at the same level of syndrome typing, thus finding out the pathogenesis of PCOS. Only in this way could the clinical efficacy and the research level of integrative medicine be effectively improved.

[Correlation between Chinese medicine syndrome types of polycystic ovary syndrome and ovulation induction effect].

OBJECTIVE: To study the correlation between Chinese medicine syndrome types of polycystic ovary syndrome (PCOS) and ovulation induction effect, and its clinical significance. METHODS: Eighty patients with clinically confirmed PCOS were syndrome differentiated as four types, i.e., Shen-yin deficiency syndrome (21 cases), Shen-yang deficiency syndrome (18 cases), phlegm-dampness accumulation syndrome (19 cases), and Gan-stagnancy transformed heat syndrome (22 cases). They all took 100 mg clomiphene as the ovulation induction for 5 successive days. Results of ovulation in all patients were analyzed and compared. RESULTS: Ovulation induction and the conception rate were sequenced from high to low as follows: Shen-yang deficiency syndrome (66.7%, 22.2%), Gan-stagnancy transformed heat syndrome (59.1%, 18.2%), Shen-yin deficiency syndrome (28.6%, 9.5%), and phlegm-dampness accumulation syndrome (26.3%, 5.3%). Significant difference was shown in ovulation induction results when compared Shen-yang deficiency syndrome with Shen-yin deficiency syndrome and phlegm-dampness accumulation syndrome (P<0.05) as well as when compared Ganstagnancy transformed heat syndrome with Shen-yin deficiency syndrome and phlegm-dampness accumulation syndrome (P<0.05). Significant difference was shown in the conception rate between Shen-yang deficiency syndrome and phlegm-dampness accumulation syndrome (P<0.05). CONCLUSION: The effects of ovulation induction in patients of phlegm-dampness accumulation syndrome and of Shen-yin deficiency syndrome were poorer than those in patients of Shen-yang deficiency syndrome and Gan-stagnancy transformed heat syndrome, which indicated the reproduction endocrine abnormality or the metabolism abnormality degree of the former two syndrome types were more server than the latter two syndrome types.

Different phenotypes of polycystic ovary syndrome by Rotterdam criteria are differently steroidogenic but similarly insulin resistant.

In traditional Chinese medicine, polycystic ovary syndrome (PCOS) is considered an anovulation disorder related to ovarian insulin resistance. The three phenotypes of PCOS, according to the Rotterdam criteria, are differently steroidogenic but similarly insulin resistant, suggesting a similar involvement of insulin resistance/hyperinsulinemia in different compartments of the PCOS ovary, namely, overactive theca and/or granulosa cells.