PCOS Acupuncture Protocols
Polycystic ovary syndrome (PCOS) is an endocrine diseases in those assigned female at birth in menstruating years with a global prevalence of 4-12% (Chen et al., 2023). PCOS affects reproductive health, metabolism, and mental health with symptoms that include: irregular menstruation, acne, thinning hair on the scalp, hirsutism (excess facial, chest and back hair), ovulation dysfunction infertility, polycystic ovaries, insulin resistance, weight gain and pelvic pain. A review of systemic analyses showed that combining acupuncture with medications can effectively improve the clinical pregnancy rate (CPR) and ovulation rate, and reduce luteinizing hormone/follicle-stimulating hormone ratio, homeostasis model assessment of insulin resistance and BMI (Yang et al., 2023). Furthermore, when compared with no intervention, acupuncture had a better effect in promoting the recovery of the menstrual cycle and reducing BMI (Yang et al., 2023). Most common points referenced in the studies included: CV3, CV4, CV6, ST29, SP6, LI4, ST36, SP9, SP10, UB 29 and Zigong.
TCM Pattern: Damp Phlegm with underlying Kidney Yin Deficiency and Blood Stasis
Presentation: Obesity, hirsutism, excess vaginal discharge, fullness / heaviness of the abdomen, irregular menstruation, scanty menstruation, amenorrhoea, dysmenorrhea with dark-clotted blood, abdominal pain, backache, dizziness, tinnitus, feeling cold, cold knees and back, fatigue.
Tongue: Swollen, sticky-rootless coating or without coating, slightly Purple sides
Pulse: Weak and slightly Slippery or Firm
Treatment Plan: 1x/wk, 3 months, face up and face down treatments within 1 session
Phase 1 - Menstruation: Invigorate Blood to Move Stasis
Acupuncture Point Selection - Face Up
Spleen 10 - Sea of Blood—Moves stagnation of blood, cools blood, keeps the blood in the vessels, reducing technique
Stomach 29 - The Return—Used for blood stasis, used to warm cold menstrual disorders, stops pain, reducing technique
Kidney 14 - Four Full—Regulates the Chong and CV, moves accumulation of blood, reducing technique
Conception Vessel 6 - Sea of Qi—Regulates qi, tonifies yuan qi, raises yang qi, circulates qi, reducing technique
Conception Vessel 4 - First Gate - Mu of Small Intestine, intersecting Point: SP, LV, KD -Tonfies yin and yang, tonifies kidney yang, qi, jing, tonifies yuan qi, warms uterus, tonification
Acupuncture Point Selection - Face Down
Bladder 17 - Diaphragm Shu - Influential Point of Blood -Regulates blood, add BL19 to tonify Qi and Blood of Whole body “Four Flowers, (could consider BL18, BL20 to Tonify Qi + Blood with Moxa “Magnificent 6”), reducing technique
Spleen 4 and Pericardium 6 - Opens the Chong mai, move blood stasis, tonification technique
Herbal Selection: Stir Field of Elixir - Used to move blood and eliminate stasis in the lower burner
Phase 2: Post Menstrual: Tonify Kidney Yin
Acupuncture Point Selection - Face Up
Kidney 3 - Greater Mountain Stream - Source Point -Tonifies kidney yang, qi, yin, essence, regulates uterus, tonification technique
Conception Vessel 7 - Yin Intersection- Intersection of Chong, CV and Kidney, balances uterus and menstrual flow, tonification technique
Spleen 6 - 3 Yin Crossing- Invigorates (and cools) blood, Nourishes KD Yin, Blood, used for gynecology and genital pain problems, supports the spleen to revolve dampness, support blood formation, prolapse, tonification technique
Kidney 6 - Illuminated Sea - Confluence Points of Yin Qiao- Nourishes Kidney Yin, tonification technique (could add HT 6 to nourish both KI and HT yin together)
Liver 8 - Crooked Spring - He Sea, Water Point - Tonify LV yin and blood, tonification technique
Acupuncture Point Selection - Face Down
Bladder 23 - Kidney Shu
Tonifies the kidney yin, supports all yin organs, useful for back pain, tonification technique
Bladder 52 - Will Chamber
Reinforces Kidney Shu, tonifies kidney yin, supports the kidney on spiritual emotional level, supports fertility, tonification technique
Governing Vessel 3 - Loins Yang Border -Warms cold in the lower burner, tonify kidney yin, tonification technique
Herbal Selection: Growing Jade - Used to nourish Kidney Yin, nourish the Essence and strengthening the Chong and Ren
Phase 3 and 4: Mid Cycle / Ovulation and Premenstrual: Resolve Damp / Phlegm
Acupuncture Point Selection - Face Up
Conception Vessel 9 - Water Division- Promotes transformation of fluids, moves water stagnation, reducing technique or estim
Spleen 9 - Yin Mound Spring - He Se, Water- Resolves damp in lower jiao, regulates water passages, reducing technique or estim
Stomach 28 - Water Path-Opens water passages, moves fluid stagnation, regulates lower jiao, benefits uterus, reducing technique or estim
Stomach 40 - Abundant Splendor - Luo - master point of phlegm, reducing technique or estim
Conception Vessel 12 - Middle Duct - Mu of ST, Hui of Fu - Creates harmony between the stomach and spleen, resolves damp, influential point of all Fu Organs, reducing technique or estim
Acupuncture Point Selection - Face Down
Bladder 22 - San Jiao Shu- Water metabolism and utilization to drain damp, reducing technique or estim
Lung 7 and Kidney 6 - tonify the Ren, drain damp, reducing technique or estim
Herbal Selection - Clear the Palace -Resolves phlegm, drains damp, invigorates blood
It is important to note that there are some recent studies looking specifically at the efficacy of electroacupuncture and fertility. In one study, There were significant differences in follicle growth on days 2, 6, 8, 10, and 12 in the PCOS+Lifestyle Management group versus the PCOS Lifestyle Management+EA group, suggesting that EA improves oocytes' growth in patients with PCOS (Budihastuti et al., 2019). EA could be an important part of treatment for fertility impacted by PCOS.
References:
Chen, H., Deng, C., Meng, Z., & Meng, S. (2023). Effects of TCM on polycystic ovary syndrome and its cellular endocrine mechanism. Frontiers in Endocrinology, 14. https://doi.org/10.3389/fendo.2023.956772
Yang, H., Xiao, Z., Yin, Z., Yu, Z., Liu, J., Xiao, Y., Zhou, Y., Li, J., Yang, J., & Liang, F. (2023). Efficacy and safety of acupuncture for polycystic ovary syndrome: An overview of systematic reviews. Journal of Integrative Medicine, 21(2), 136–148. https://doi.org/10.1016/j.joim.2022.12.002
Lyttleton, J. (2004). Treatment of infertility with Chinese medicine. Churchill Livingstone.
Maciocia, G. (2011). Obstetrics and gynecology in chinese medicine. Churchill Livingstone.
Kim, H. (2007). Handbook of Oriental Medicine.
Su Wen Herbs | Herbal Formulas by Giovanni Maciocia®. (2018, August). Su Wen Herbs®. https://suwenherbs.com
Budihastuti, U. R., Melinawati, E., Sulistyowati, S., & Nurwati, I. (2019). Electroacupuncture effect on polycystic ovary syndrome to improve oocytes’ growth. Medical Acupuncture, 31(6), 379–383. https://doi.org/10.1089/acu.2019.1354