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Table of Contents
RESEARCH ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 225-231

Scientific study reveals that electroacupuncture technique can treat PCOS symptoms


Life Flow, Ubud, Bali, Indonesia

Date of Submission02-Jun-2020
Date of Decision21-Oct-2020
Date of Acceptance19-Nov-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Dr. Daniela Donoso Paredes
Life Flow, Ubud, Bali
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_43_20

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  Abstract 


The efficiency of traditional Chinese medicine theory and acupoints shows once more its accurate regulatory capacity by improving women biological cycles with the use of electroacupuncture (EA). Results presented in a research study that preformed ovulation induction in women with anovulation due to polycystic ovary syndrome (PCOS), successfully provided data supporting acupuncture as a natural treatment for infertile women, with no significant side effects. The purpose of this study is to demonstrate how EA treatment can induce ovulation related to the hormonal and neuronal system in women affected by PCOS. This study introduces proof of effectivity and improvement based on the research of the University of Gothenburg, Sweden, that presents a study on how EA can be an alternative to ovulation-inducing drugs, to be considered as a possible holistic regulator of PCOS and symptoms. The study covered 24 women with PCOS and oligo-/amenorrhea who received EA in a low frequency of 2 Hz with a total of 14 treatments applied for 3 months. Samples were taken three times during the study to see fluctuations in hormonal, ovulatory, and symptomatic behavior of PCOS. Results demonstrated effective regular ovulatory inductions in more than a third of women.

Keywords: Amenorrhea, irregular menstruation, oligomenorrhea, ovulation, polycystic ovarian syndrome, uterus


How to cite this article:
Paredes DD. Scientific study reveals that electroacupuncture technique can treat PCOS symptoms. Chin Med Cult 2020;3:225-31

How to cite this URL:
Paredes DD. Scientific study reveals that electroacupuncture technique can treat PCOS symptoms. Chin Med Cult [serial online] 2020 [cited 2021 Jan 25];3:225-31. Available from: https://www.cmaconweb.org/text.asp?2020/3/4/225/305181




  Introduction Top


Irregular menstruation, anovulation, and infertility are mostly manifested as characteristic symptoms in polycystic ovary syndrome, and are also recognized as the most common gynecological and metabolic endocrine disorders present in women worldwide. This presents major symptoms such as hyperandrogenism, obesity, and insulin resistance (IR). It is a possible precursor to cardiovascular disease and endometrial cancer. The biological process of this syndrome is determined by a high presence of androgens and luteinizing hormone (LH) and a decrease in sex hormone binding globulin (SHBG).[1]

The etiology of the syndrome is complex and multifactorial. Whether it is caused by a condition in the ovaries or the central nervous system is still open to debate. It is suggested that the excessive presence of estrogens produces high concentrations of LH, damaging the maturation process of the follicles and causing possible oligo/anovulation. The circumstances that can cause these phenomena are diverse, highly affected in the nutritional level by intervention and intake of chemicals, high sugar, genetically modified foods (GMO), and processed food.[2]

The psychological factors that are observed in women come from gender inequality in the general world socio–cultural–historical organization, generating high demands while increasing degrees of stress, arising uncertainty between the biological capacity of procreation and family care, along with the need to develop a professional life career in a masculine labor environment. This situation increases emotional stress states, as well as low self-esteem. Certainly, it is perceived in different degrees, varying from diverse personal aspects from woman to woman, exposing the woman's body to endocrine and neuroendocrine imbalances, finally resulting in hormonal disorder, menstrual disorder, and even sterility.[3]

For this reason, this scientific study is intended to provide support on the use of traditional Chinese medicine (TCM) to help women who are exposed to emotional stress with biological consequences. Evidence of electroacupuncture (EA) to balance hormones regulates the menstrual cycle and the potential improvement of fertility.[2]

The intention of the scientific study carried out by Dr. Elisabet Stener-Victorin at the University of Gothenburg was designed to evaluate the efficiency of EA in women suffering polycystic ovary syndrome (PCOS) and not ovulating regularly or at all.[1]

In order not to lose sight of the dysfunctions during the treatment process, an extensive record of endocrine and neuro-endocrine data related to acupuncture treatment and ovulation was taken into account, revealing results through the measurements of menstrual patterns and basal body temperature (BBT). The purpose of this study was to get general research into the impact of EA on PCOS.[4]

In the study by Dr. Stener, the author made efforts to find the support of alternative treatments with EA that substitute the adverse effects of the pharmacological intervention and its consumption. Attempts are also being made to scientifically support a possible preventive solution with EA to assist women with PCOS and reduce the long-term risk of endometrial cancer, hypertension, and type II diabetes.[3]


  Polycystic Ovary Syndrome in Traditional Chinese Medicine Top


TCM recognizes polycystic ovary syndrome. Unlike Western medicine, this condition has been treated for hundreds of years using a combination of herbs and acupuncture. Its treatment varies according to the identification of syndrome differentiation from the patients' signs and symptoms. There exists a vast diversity of possible syndromes taking into account a combination of pathologies from organs, meridians, qi, blood, and organic fluids.

Etiopathology of PCOS in traditional Chinese medicine

In TCM, any dysfunction from the ovaries and the uterus involves organs such as the kidney, spleen, and liver, along with the disturbance of the harmony of the meridians of Chong Mai (Thoroughfare Vessel) and Ren Mai (Conception Vessel); TCM describes PCOS as a “Tian Gui” (menstruation) disorder which is identified as a genetic dysfunction with irregularity of the cycle and infertility due to anovulation, in which usually the main origin is in the kidneys.[5]

It commonly evolves from kidney yang deficiency (poor metabolism). Spleen deficiency is also associated with symptoms of IR and obesity. Its pathological functions affect the metabolism of nutrients in food by its inability to transform, transport, and evaporate fluids in the lower Jiao.

If there is liver stagnation, it can manifest as blood stagnation or excessive heat in the meridians. Blood stagnation in the channels causes the hair follicles to overproduce unwanted thick hair, generating symptoms of hirsutism which is present in 70% of PCOS cases. Excessive heat in the channels also promotes acne.[5]

The energy system of the kidneys is the basis of all yang in the body. Therefore, kidney yang deficiency affects the energy of the spleen yang. Qi as a yang substance allows the deficiency of qi in the spleen to result in internal dampness. Chronic dampness combined with heat due to stagnation of liver qi forms phlegm in the lower Jiao of women and affects the reproductive system, since the liver controls menstrual blood.[6]

PCOS syndrome differentiation in traditional Chinese medicine

The syndrome differentiation comprises qi and yang deficiencies, phlegm-dampness accumulation in the lower Jiao, and blood stagnation.

Studies showed that kidney deficiency with blood stasis syndrome is the most frequent pattern observed in the PCOS patients, followed by spleen deficiency with phlegm-dampness syndrome, spleen-kidney yang deficiency syndrome, and finally kidney yin deficiency syndrome occurred.[7] Another study states that the syndromes tend to manifest in combination, in which kidney deficiency and liver stagnation are the syndromes that occur most frequently.[8]

Kidney deficiency, disharmony between Chong Mai and Ren Mai

This syndrome is most likely to emerge when there is kidney qi deficiency, prolonged disease, excessive sexual activity, or prolonged ingestion of oral contraceptives. For any of these reasons, kidney function may be impaired by depleting kidney yin and/or yang, leading to failure of the body fluids; consequently, there will be pathogenic heat in the uterus and the malnutrition of Chong Mai and Ren Mai.

Therefore, the uterus is unable to receive adequate blood flow, generating prolonged menstrual cycles with little bleeding or amenorrhea.[6]

Kidney yin deficiency

Yin deficiency and yang deficiency often occur together. Kidney yin deficiency also manifests with a short menstrual cycle, scant blood, and spotting between periods, indicating an energy imbalance in the kidney.

Thirst and dry throat become obvious. Patients tend to experience pain and weakness in the lower back and knees periodically, with anxiety and insomnia as common emotion. Stools can be dry and cause constipation.

On the other hand, the body of the tongue appears red, with red spots on the tip or sides, and the coating may peel off. Pulses tend to be fast and tense. Patients may also experience dizziness, tinnitus, a weak waist, periodic hot flashes, and night sweats.[6]

Kidney deficiency with blood stagnation

This pattern is usually due to congenital lack and/or prolonged use of oral contraceptives, causing a restriction or lethargy to kidney qi. The function of the kidney to control the metabolism of fluids is affected. If thisruns on, in time it ends up damaging the kidney yang, which stops heating the uterus. If the uterus cools, blood stagnation begins, causing very long menstrual cycles, the disappearance of the menstrual cycle, and therefore, infertility.

The most common symptoms are observed in very long menstrual cycles, amenorrhea, cold in the lumbar region, hands and feet, cold body feeling or aversion to it, dark complexion, acne on the face, chest, and back, swollen leg. Sometimes obesity, very rapid hair growth, and general feeling of heaviness may be witnessed. The tongue will be pale with a white coating on the top. The pulse will be deep and slippery.[9]

Spleen deficiency

Improper diet and over-activity of the liver are common causes of spleen imbalances. Fatigue, IR, a body mass index (BMI) over 25, or weight gain would be indications of spleen qi deficiency type of PCOS.

Internal dampness can evolve from spleen qi deficiency, characterized by vaginal discharge, development of large fluid-filled ovarian cysts, and a feeling of heaviness in the body. In addition, premenstrual syndrome pain is deep, acute, and is relieved with pressure or heat, indicating internal accumulations of cold moisture.

In TCM, this is identified as retention of phlegm in lower Jiao. It most often manifests with symptoms of obesity, weak muscles, facial hair, chronic productive cough caught in the throat, and nausea, and there could be feelings of sleepiness and tiredness.

Poor appetite and loose stools are also present. The tongue shows tooth marks on the sides and a thin layer of grease or thick white coating. Pulse feels slippery.[6]

Spleen deficiency with accumulation of phlegm-dampness

Excessive consumption of fatty and sugary foods, dairy products and alcohol, or excessive worry and physical work can compromise the function of the spleen, causing failures in the transport of liquids and food and their transformation into usable energy. The accumulation of body fluids turns into dampness and phlegm, obstructing the qi and blood circulation in the uterus, blocking Chong Mai and Ren Mai.

As a result, the uterus and ovaries are deprived of blood, leading to poor menstruation and even amenorrhea and infertility.[10]

Blood stagnation

The liver is the basis of the energy circulation of qi throughout the body; stagnation of the liver qi can stagnate the qi in the lower Jiao. Where the qi goes, the blood follows. Long period of qi stagnation can form blood stagnation. On the other hand, it is common in PCOS to have blockage of the flow of qi due to the accumulation of internal moisture.

Blood stagnation is characterized by sharp, fixed pain, severe abdominal pain, dull, or even aching pain that progressively intensifies toward menstruation. The volume of blood during a period varies from light to heavy, tending to be dark red or purple. After clot is discharged, pain reduction is the common result.

The period may be long or with drops of blood that continue after the main menstruation. An important sign for identifying blood stagnation is the discomfort resulting from pushing around the anus and uncomfortable intercourse, especially before, during, or immediately after menstruation. The tongue may be purple with a tight, uneven, and intermittent pulse.

The face may also look red or purple. On palpation, the lower abdomen, especially on the left side, may feel tender. Dizziness, lack of sleep, and palpitations are also possible indications that upport the diagnosis of blood stagnation.[6]

Liver qi stagnation

Prolonged stress, depression, and anxiety can impair the seven emotions, causing liver qi stagnation and stagnation of blood. The invasion of wind or pathogenic cold along with excessive consumption of cold food and drinks will “freeze” the blood. All of them will lead to the obstruction of Chong Mai and Ren Mai that block up menstruation and as a result the presence of amenorrhea.[10]

People with stagnation of liver qi often suffer from stress, restlessness, nervousness, irritability, breast distention, acne on the cheeks, headache, long menstrual cycles, amenorrhea, and infertility, resulting in a blockage of blood and energy in the uterus and causing a shortage of blood in menstruations, even amenorrhea, and emotional disturbances.

The tongue will appear red, with more swollen edges and a thin layer of white coating. Pulse tends to be tense and sometimes thin.[11]

Correlation between traditional Chinese medicine syndromes and hormonal dysfunction in PCOS

A scientific study revealed the correlation between Chinese medicine syndrome patterns of irregular menstruation and anovulation and the biological processes of PCOS.

It is pointed out that there is a positive correlation between follicle stimulating hormone (FSH) levels and spleen and kidney yang deficiency syndrome. On the other hand, dampness and phlegm syndrome by spleen deficiency have shown to be related to high blood sugar, obesity, and hirsutism.

Regarding qi stagnation and blood stagnation, it presents high levels of prolactin and estradiol. In liver, stagnation syndrome and blood heat are linked to high levels of progesterone, FSH, and acne. Finally, an increase in LH is observed in kidney deficiency syndrome and blood stagnation.[12]

Menstruation and the capacity for conception depend on both the abundance of blood in the uterus pumped out from the heart and on the fullness of the essence sent from the kidney. Due to these connections, heart and kidney disorders (including their own disharmony) easily trigger gynecological disorders.[13],[14]

The functions of the uterus, menstruation, and fertility will be affected by the amount of qi and blood that is received. Ren Mai supplies qi to the uterus while Chong Mai supplies it with blood. If the kidney essence is weak, Ren Mai and Chong Mai will be impaired and will alter the functions of the uterus. Internal humidity and other affections can cause blockages manifesting menstrual irregularities, amenorrhea, or fertility problems.[5]


  Electroacupuncture Treatment in Gynecology Top


TCM is conceived as something within the holistic concept; therefore, treatments are focused on influencing all aspects of the patient's life including diet, lifestyle, nutritional supplements, medicinal herbs, and acupuncture sessions.[15]

The main objective to be addressed in this study is ovulation regulation and induction. Therefore, the main organs to attend to in this condition are the kidney, the spleen, and the liver.[5] To see positive results, the treatment procedures for women with PCOS usually last 3 months, with a continuity of 2-3 times per week, 30 minutes per session. TCM organizes a treatment plan depending on the syndrome.

Treatments using the diagnosis of TCM are known for being very successful in inducing ovulation, with the primary use of a combination of acupuncture, EA, and moxibustion. It has proven their efficiency in treating PCOS.[5]

Acupuncture has been shown to improve menstrual frequency and decrease circulating testosterone in women with PCOS. Another study conducted also at the University of Gothenburg in Sweden[6] showed that PCOS patients have higher sympathetic nervous system (SNS) activity than other women. The study demonstrated that the activity in the SNS and testosterone was lowered in women who received the EA treatment. Elevated testosterone levels are closely related to increased activity in the SNS of women with PCOS.[16] Favorable results have guided professionals to use EA as an additional tool to support and amplify the therapeutic power of acupuncture.

EA stimulates the points associated with the symptoms; it supports the regulation and activation of qi flow. The needles are placed at the acupoints; electrode clasp is attached to the needles connecting them with a machine that sends electrical impulse stimulation through the needle to the acupuncture points. It is an alternative to manipulating acupuncture needling by hand, and it shares the same range of indications as the manual style of filiform stimulation. This can be used for a wide spectrum of conditions. EA is intended to help enhance the potential healing effects of standard acupuncture.[17]

Existent Studies have shown the possibility of improving ovulation regulation with effective results for PCOS symptoms and signs, such as the one mentioned above at the University of Gothenburg in Sweden. The study proposed a treatment with acupuncture points, although the intention of their selection was to choose those points in somatic segments common to the innervation of the ovary and uterus.

The following were the acupoints chosen for the study: Shen Shu (肾俞 BL23), Pang Guang Shu (膀胱俞 BL 28), San Yin Jiao (三阴交 SP 6), Yin Ling Quan (阴陵泉SP 9), Nei Guan (内关 PC6), Wai Guan (外关 TE 5), and Bai Hui (百会 GV 20).[6] For more specifications, please refer to [Table 1].
Table 1: Acupuncture points, anatomic position, and innervation

Click here to view



  Methodology Top


The Study at the University of Gothenburg in Sweden[6] showed that EA can help women with PCOS and oligo-/amenorrhea by inducing and regulating ovulation. A prospective, longitudinal, and nonrandomized study was applied to 24 women, aged 24-40 years, suffering from PCOS and oligo/amenorrhea.

The selection parameters required for the diagnosis of PCOS are women with oligo-/amenorrhea experiencing four or fewer annual spontaneous hemorrhages, presence of multifollicular ovaries and thickened ovarian stroma in ultrasound examination. 19 of the 24 women showed resistance to clomiphene, without being able to ovulate after 150 mg of clomiphene citrate was taken for 5 running days. All ultrasound examinations were done by transvaginal ultrasound.[6]


  Study Period Top


The study started 3 months before the EA. There was no hormonal treatment intake 3 months before or during the study; therefore, it lasted for a total of 6 months without hormonal treatment before EA. The study period was defined as the period that extends from 3 months before the first treatment of EA, to 3 months after the last treatment of EA, with a total of 9 months.

Menstrual and ovulatory patterns were verified through the recording of vaginal bleeding and the daily measurement of BBT. Blood samples were collected three times: 1 week before the first EA, 1 week after the last EA, and 3 months after the EA.

Two groups of women were formed: The first group – those who experienced a good effect if the BBT can show repeated ovulations (or pregnancy) during the treatment period and 3 months afterward; and the second group – those who have not experienced any effect if the ovulatory pattern did not have positive changes before, during, or after treatment.[6]

Electroacupuncture treatment

In the administration of EA treatment, two treatments per week were provided for 2 weeks and then a single treatment per week, resulting in a total of 10 to 14 treatments.

The needle insertion method was intramuscular with a depth of 15–40 mm at selected acupuncture points in somatic areas common to the innervation of the ovary and uterus. The same location and needle stimulation were applied to all the women in question.

The material of the needles was stainless steel. They were inserted and rotated to generate “de qi” . Known as the “needle sensation or arrival of qi”, it is explained as a sensation of variable tension, numbness, tingling, and pain reflecting activation in the afferent muscular nerve in delta-A fibers and possibly fibers C. These manually stimulated needles were rotated five times during each treatment session.

At the time, four needles were placed at the thoraco-lumbar and sacrum level, and four other needles in the calf muscles. They were given electrical stimulation for 30 min with low-frequency pulses (2 Hz) of 0.5 ms interval. The intensity was high enough to cause local muscle contractions without pain.[6]

Temperature measurement

For the measurement of skin temperature, a digital infrared thermometer was used to take the temperature in between the acupuncture needles applied to the sacrum and the forehead, both in the midline. These measurements were taken during the 1st, 5th, and 10th EA treatment.

Measurements were made in each treatment after 10 min of rest and just before EA as “baseline” values. Actual measurements were taken every seven minutes during the EA and one minute after the EA, making sure that the room temperature remained constant during the three experimental sessions.[6]

Body mass index and waist-to-hip ratio measurement

Measurements of BMI (weight in kilograms divided by square of height in meters = BMI) and waist-to-hip circumference (waist-to-hip ratio [WHR]) were applied. It was measured with a soft tape at the level of the navel and the upper anterior iliac spine while standing. The measurements were taken before the EA treatments and after the study period.[6]

Biochemical measurements

Blood samples were taken from an antecubital vein, on three occasions;

  • 1 week before the first EA treatment
  • 1 week after the last EA treatment
  • 3 months later.


Serum and plasma concentrations of gonadotropins, prolactin, steroids, and neuropeptides were measured from the selected samples [Table 2].
Table 2: Mean and standard deviation for serum and plasma concentrations of gonadotropins, prolactin, steroids, and neuropeptides from samples taken before, within a week after, and 3 months after electroacupuncture treatment in all women (n=24)

Click here to view


Statistical measures

For the statistical study, Fisher's permutation test was used for group comparison (good effect versus no effect) in regards to BMI, WHR, hormones, steroids, neuropeptides, and skin temperature.

Fisher's paired comparison test was used to analyze the difference before EA versus 1 week after EA and 3 months after EA, whose targeted persons include:

  1. All women
  2. In women with good effect
  3. In women with no effect on ovulation, hormones, steroids, and neuropeptides.


All tests were two-tailed and the differences were considered statistically significant when P < 0.05. The confidence interval (CI) was given when P < 0.05.[6]


  Results and Conclusions Top


The most important results in the study showed that repeated treatments of EA with low frequency (2 Hz) worked positively in more than a third of the women with PCOS, inducing regular ovulations in their menstrual cycles.[6]

After EA, there was a curious decrease in the LH/FSH ratio, testosterone, and b-endorphin concentrations. In contrast, an increase was found in the skin temperature of the forehead of women with PCOS.

It is possible to infer that additional treatments of EA may produce higher success rates. Further scientific research to be done is suggested so as to deepen the understanding of the exact mechanism of EA.

In the induction of ovulation, it is recommended to support EA as an alternative therapy to perforation and gonadotropin treatment, considering the evidence that 7 out of 9 women who were resistant to clomiphene experienced a good ovulation effect.

The study also found that the induction of ovulation by EA does not cause serious side effects or multiple pregnancies compared with side effects seen in pharmaceutical drugs used with the same intention. It is evident that EA restores the sympathetic system, acting on the levels of the hypothalamus and brain stem through b-edorfinergic mechanisms.[18]

On the other hand, a subgroup of women with PCOS who had shown good ovulation effect was found to have relatively low serum concentrations of BMI, WHR, basal insulin, and testosterone, but high serum SHBG concentrations. However, they all had common characteristics such as less pronounced altered metabolism and less presence of androgen level.

In the same group, a significant increase in serum prolactin was evidenced in response to EA. During the EA period, all women with good ovulation results responded with such serum prolactin increase except for one. It was also observed that 2 women from the same group showed disappearance of multi-follicular ovaries in the ultrasound images, which they took 3 months after the EA period.

The authors at the University of Gothenburg thus concluded that there is a need to verify the results with additional randomized and comparative studies together with ultrasound, to accurately identify events at the ovarian level and rule out nonspecific effects. Even by taking into account all the nonspecific effects, it is notable that the results are impressive.

All in all, EA is potentially more effective in treating women with PCOS with little metabolic alteration. This is an alternative to pharmacological drug-induced ovulation, and it can support effective fertility.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2]



 

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