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Typical Case Presentation

• A 28-year-old female presents with an absence of menses for the last 3 months, and tests confirm she is not pregnant.
• Lab and imaging results rule out cancerous or endocrine etiologies.
• The patient denies anorexia and also does not exercise excessively.
• Hemoccult is negative with a normal red cell distribution width.
• Hemoglobin, ferritin, and B12 are all slightly below the normal reference range.
• The patient is pale, thin, but not gaunt, generally weak, and complains of significant fatigue.
• Low mood that borders on depression, lowered libido, but maintains employment and a healthy emotional relationship.
• Bowel movements are regularly loose with occasional undigested food.
• Significant bloating after meals is reported
• Reports regularly feeling dizzy when standing up
• Falls asleep easily, however sleep is restless, along with increasingly anxiousness.

Outcome Measures for Treatment

• Polycystic Ovary Syndrome (PCOS), Fibroids, Endometriosis are hormone patterns that result in excess.
• A 26-year-old female diagnosed with PCOS presents with irregular cycles (24-42 days), painful cramping before flow, and heavy menses with clots.
• The patient has no history of oral contraceptive use or pregnancy
• The patient manages menstrual cramping with extra-strength Tylenol
• Mild signs of androgen excess are present, including a square jaw, strong build, increased libido, and mild acne along the jawline
• Reinstate regular menstrual flow.
• Improve mood and emotional stability.
• Resolve co-presenting symptoms, especially digestive.

Featured Herbs and Actions

• Actaea racemosa (Black cohosh): Emmenagogue, anti-inflammatory, endocrine modulator, parturient, mild alterative. Useful for PCOS, dysmenorrhea, fibroids, and more. Considered safe but not recommended during pregnancy except to stimulate labor, and useful during menopause to treat hot flashes
• Caulophyllum thalictroides (Blue cohosh): Alterative, hepatic, hypoglycemic actions. Parturient, emmengogue, laxative, female endocrine modulator. Useful for labor induction, fibroids, menstrual irregularities, PCOS, and endometriosis. May show signs of toxicity in large doses.
• Cinnamomum zeylanicum (Cinnamon): Diaphoretic, astringent, antimicrobial, antispasmodic, carminative, endocrine modulator (diabetes). Useful for uterine hemorrhage, diarrhea, nausea, vomiting, and URTI.
• Dioscorea villosa (Wild yam): Anti-inflammatory, antispasmodic, antirheumatic, possible female endocrine modulator. Useful for arthritic conditions, GI inflammation, vertigo, and more.
• Galega officinalis (Goat's rue): Galactagogue, hypoglycemic, diaphoretic. Useful for insufficient breast milk production, blood sugar dysregulation, and PCOS.
• Iris versicolor (Blue flag): Alterative, hepatic, lymphatic, cholagogue, and endocrine modulator. Useful for eczema, psoriasis, recurring infections, and hypothyroid conditions.
• Mitchella repens (Partridge berry): Female endocrine modulator, parturient, emmenagogue, and astringent. Useful to stimulate and support labor, regulate menses, stimulate menses, PMS, recurrent miscarriages, and post-delivery convalescence.
• Paeonia lactiflora (Peony): Female endocrine modulator, alterative, antispasmodic, mild adaptogen and anti-inflammatory, emmenagogue, and nootropic. Used to cool the liver and support smooth flow and is useful in dysmenorrhea.
• Pimpinella anisum (Anise): Carminative, antispasmodic, galactagogue, female endocrine modulator, relaxing expectorant, and mild antimicrobial. An excellent carminative and eases spasms of smooth muscle. capable of acting at estrogen receptors and acts to improve milk supply.
• Rubus idaeus (Red raspberry): Astringent and parturient. strengthens and tone uterus, tonify digestion, gargle for sore throat, lowered libido in both men and women
• Schisandra sinensis (Schizandra): Adaptogen, astringent, hepatoprotective, alterative, expectorant, nervine, and parturient. An excellent tonic, particularly for the feminine aspect
• Serenoa repens (Saw palmetto): Endocrine modulator (male), decongestant, diuretic, and possible libido tonic. It is thought of as specific for BPH.
• Smilax officinalis (Sarsaparilla): Adaptogen, alterative, anti-inflammatory; useful for eczema, psoriasis, BPH, waning libido, RA, gout.
• Trifolium pratense (Red clover): Alterative, lymphatic, mild female endocrine modulator (phytoestrogen), mild diuretic and anti-inflammatory. Useful alterative, especially in female endocrine conditions including acne and irregular menses.
• Viburnum opulus (Cramp bark): This is not listed with more detail, see above herbs for general information for study
• Viburnum prunifolium (Black haw): Antispasmodic, nervine, hypotensive, vascular tonic; useful for cramping of the uterus, threatened miscarriage, uterine congestion.
• Vitex agnus-castus (Chasteberry): Female endocrine modulator, androgen normalizer, alterative, and galactagogue. A true endocrine modulator and may be thought to act as both progesterone and prolactin.

Desired Botanical Actions

• Primary herb action desired: adaptogen.
• Secondary herb actions desired: endocrine modulator and alterative.
• Other herb actions to consider: carminative and demulcent.

Key Actions

• Alterative and Hepatic
• Adaptogen, warming carminative (Build Qi and Blood) is beneficial
• Pain relief.

Key Treatment Principles

• Clear accumulation
• Rebuild and recover

Pro Tip

• Use stronger herbs at stronger doses for shorter duration
• Set realistic expectations because if menses have been absent for months, it could be 6+ months before menses returns.

Dosage

• Tincture or powder is optimal as a tincture
• Take 1-2 tablespoons (15–30 mL) per day any time, ideally in a mug of hot water.
• For PCOS and Endo, prescribe in combo on D12-D3 of the cycle

Decoction

• Add 4 tablespoons to 5 cups (1.2L) of water and simmer on low for 60 minutes, or simmer on low overnight in a slow cooker, and drink throughout the day.

Duration

• Ideally continued for three full cycles, however may be used long term if needed.

Herb Selection and Formula

• Chasteberry (Vitex agnus-castus): 25 parts
• White peony (Paeonia lactiflora): 25 parts
• Blue cohosh (Caulophyllum thalictroides): 15 parts
• Mitchella (Mitchella repens): 20 parts
• Anise (Pimpinella anisum): 15 parts
• Total: 100 parts

Alternative Herb Selections or Formulas

• An alternative approach is to directly treat the hormones and the hormone production systems.
• Chasteberry (Vitex agnus-castus) at 40 parts
• White peony (Paeonia lactiflora) at 40 parts
• Licorice root (Glycyrrhiza glabra) at 20 parts
• The total parts is 100

Other Effective Therapies

• Keep sugar, dairy, and soy to a minimum for PCOS, also avoid alcohol and wheat.
• Fibroids and endometriosis respond better to castor oil packs than PCOS.
• The most effective approach is to replenish the deficiency, ensure complete nutritional balance of macro and micronutrients.
• Warm, well-cooked foods and treatments supporting digestion and absorption are also well indicated.

TCM Integration

• Menstrual blood (Tian gui, or Heavenly Dew) is a manifestation of Jing.
• Kidneys produce Tian gui from Jing, a combination of Liver Blood and Jing activated by Heart yang.
• Liver oversees process; Kidneys, Heart, and Liver must all be nourished and in balance, while the Penetrating Vessel (Chong mai) must be functioning smoothly.
• Primary TCM patterns in Excess conditions arise from Liver Qi stagnation and Liver blood stasis
• Most cases of PCOS, endometriosis, and fibroids are patterns of Damp Heat and Blood Stasis
• Treat with Gui zhi Fu ling wan, Long Dan Xie Gan Tang, or Xiao yao san TCM formulas
• The discussed case represents a pattern of Qi and blood deficiency, affecting the Liver and Heart.
• Undigested food in stool and lowered libido suggests Qi deficiency moving into a yang deficiency, injuring the Spleen and Kidney.
• This is Spleen failing to build Liver and Heart blood, and Spleen Qi deficiency progressing to Yang deficiency that is injuring the Kidney yang.
• Continuing blood deficiency will also progress into a Yin deficiency.
• Where there is pain, there is stagnation, with stagnation likely from a lack of source Qi, leading to deficient Zang-fu (organ) Qi for the Liver.
• Resolving Qi and Blood deficiency will help with stagnant pain, while symptomatic treatment should also be part of approach.
• Consider: Ba zhen tang, Gui pi tang and Xiao yao san TCM combinations.

Explore herbal treatments for hormonal imbalances such as PCOS, fibroids and endometriosis, focusing on Actaea racemosa (Black cohosh) for regulating menstrual cycles and reducing cramps. Learn about its uses, safety considerations, and effects on acne and androgen excess.