#Herbal #Catsclaw Inhibits the Risk of #AutoimmuneDiseases, Scientists Say

By Kyle J. Norton

In breast cancer patients, Uncaria tomentosa exhibited its bioactive immunomodulators' effects in regulating the immune system against irregular cell growth and inflammation.

Immunomodulatory compounds exerted the above properties found in the cat's claw include ajoene, arctigenin, β-carotene, curcumin, epigallocatechin-3-gallate, ginseng, glabridin, and quinic acid, according to Dr. Baraya YS, the lead researcher.

'
A herbal immunomodulators review, in vitro and in vivo, also suggested cat's claw expressed the regulation of informational molecules such as cytokines through the alternation of immune function. Therefore, the medical plant may be a potential therapeutic modality for the treatment of many different conditions involving cytokine, including inflammation and autoimmune diseases.

Cat's claw found in the tropical jungles of South and Central America, is a genus Uncaria, belonging to the family Rubiaceae, used in traditional medicine for over two thousand years as a tonic, contraceptive, anti-inflammatory, and infectious agent, and to treat diarrhea, rheumatic disorders, acne, diabetes, cancer and diseases of the urinary tract, etc...

Autoimmune diseases are the disorder caused by the immune system attacking the body's healthy cells.
Cat's claw (Uncaria tomentosa) may be the next medical plant used for the treatment of autoimmune diseases through its stimulated immune effects.

Severe dengue is a disease associated with changes in the endothelial barrier function due to the production of inflammatory mediators by immune cells, U. tomentosa exerted antiviral and immunomodulatory activities in the inhibition of antigen and proinflammatory cytokine.

In fact, the significant effect of immunomodulation may introduce Cat's claw, as a promising candidate for clinical application.

The use of this herbal plant should be taken with care as toxicity has been found in some cases of overdoses.

Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How-To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months

Back to Kyle J. Norton's Home page http://kylejnorton.blogspot.ca

Sources
(1) Uncaria tomentosa increases growth and immune activity in Oreochromis niloticus challenged with Streptococcus agalactiae by Yunis-Aguinaga J1, Claudiano GS2, Marcusso PF2, Manrique WG2, de Moraes JR3, de Moraes FR4, Fernandes JB1. (PubMed)
(2) The Immunomodulatory Potential of Selected Bioactive Plant-Based Compounds in Breast Cancer: A Review by Baraya YS1, Wong KK2, Yaacob NS3.(PubMed)
(3) Modulation of cytokine expression by traditional medicines: a review of herbal immunomodulators by Spelman K1, Burns J, Nichols D, Winters N, Ottersberg S, Tenborg M.(PubMed)
(4) Immunomodulating and antiviral activities of Uncaria tomentosa on human monocytes infected with Dengue Virus-2 by Reis SR1, Valente LM, Sampaio AL, Siani AC, Gandini M, Azeredo EL, D'Avila LA, Mazzei JL, Henriques Md, Kubelka CF. (PubMed)
(5) Toxicological aspects of the South American herbs cat's claw (Uncaria tomentosa) and Maca (Lepidium meyenii) : a critical synopsis by Valerio LG Jr1, Gonzales GF. (PubMed)

The Holistic Overview of the Prevention, Management and Treatment of Polycystic Ovarian Syndrome (PCOs)

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome is defined as endocrinologic diseases among reproductive-age women caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries associated with a high risk for metabolic disorder(1) as resulting of enlarged ovaries(2), leading to hormone imbalance(excessive androgen and anti-müllerian hormone (AMH) )(1)(3)(4)(5), induced Hirsutism(6)(7), reproductive disorder(10(12)), risks of type 2 diabetes(9)(10)(11), metabolic syndrome(10)(12) and early cardiovascular disease(8)(13), acne(10)(14), endometrial cancer(18)(19),weight gain and obesity(15)(16)(17). The syndrome affects over 5% of women population or 1 in 20 women.

Unfortunately, according to studies, women with PCOs after the reproductive age, are associated to continuously increase risk of type II diabetes, with no increasing altered glucose tolerance(20), CVD and hypertension(21)


The symptoms

Women with PCOs may experience some of the symptoms below
1. Irregular(22), oligomenorrhea(23)or absent menstrual periods(26)
2. Male pattern hair growth(22)
3. Acne(22)
4. Weight gain(22)
5. Obstructive sleep apnea(27)
Closure of the upper airway, causing stop breathing while sleeping
6. Difficult to conceive(22)
7. Anxiety(23)
8. Emotional disturbance(22)
9. Poor quality of life(22)
10. Menstrual cycle disturbances(22)
11. Depression(24)
12. Autonomic dysfunction(25)
13. Problematic eating(28) and general psychosocial dysfunction(28)
14. Etc.

Risk factors
1. Family history
The risk of PCOs is increasing if your mother or sister has PCOS(29). According to North Staffordshire Hospital, polycystic ovaries are highly prevalent within families as an autosomal dominant trait, in the analysis of 29 polycystic ovary syndrome and 10 control families(30).

2. Reproductive age women
Polycystic ovary syndrome (PCOS) affects 4% to 18% of reproductive-aged women(31)

3. Environment risks
a. Eating plastic-packaged food(32), fruit with pericarp(32) and drinking alcohol(32) were associated with the independent risk factors for PCOS. According to the Second Affiliated Hospital of Nanjing Medical University, risks of PCOs increased with the use of disposable plastic cup for drinking, cooking oil fume and indoor decoration(33).
b. Exposure to industrial products such as Bisphenol A (BPA)(36) was found to exacerbate the clinical course of PCOS(34) as they exhibited impairment of normal reproductive function and metabolic regulation(35).

4. Dietary factor
Over-nutrition with foods in advanced glycated end products (AGEs) is found associated with the risk of PCOs(34).

5. Metabolic perturbations begin early in adolescence are also found to elevate the risk of PCOs(37).

6. Psychotropic medication
The prolonged period uses of psychotropic drugs such as mood stabilizers, lithium is also induced the higher risk of PCOs(38). Women with epilepsy are also at risk of developed polycystic ovary syndrome (PCOS) if treated by valproate sodium (VPA) therapy(39)(40).

7. Genetic mutations
Although it is uncleared, genetic mutation of certain genes may be associated to the risk of PCOs, according to studies, such as the zona pellucida 4 (ZP4)(41) gene, polymorphism of FXIIIVal34Leu gene(42), C/T single nucleotide polymorphism at exon 17(43), single nucleotide polymorphism-56 of calpain-10 gene(44), vaspin rs2236242 polymorphism(45), etc.

The Diagnosis

If you have experienced some of the above symptoms, it is for your benefit to visit your doctor or gynecologist immediately. PCOs is easy to identify through your
1. Medical history, including the question of your symptoms, such as menstrual irregularity, weight change, skin and sleep patterns, as well as all symptoms may contribute to the susceptible PCOs.
a. History of pregnancy including difficulty to conceive, miscarriage, poor neonatal and maternal pregnancy outcomes(46)(47) ...
b. Medication may influence the development of PCOs


2. Physical exam
The aim of the physical exam is to check for PCOs symptoms, such as pelvic exam for enlarge and abnormal ovaries, male pattern hair growth, acne, weight gain, body mass index (BMI)(48)(49) etc., and risk of diseases caused by PCOs, such as hypertension, thyroid abnormality(50)(51).
(Please check citations in the topics of symptoms and risk factors)


3. Pelvic ultrasound
The aim of the test is to check for enlarged ovaries(2) and cysts(52). Unfortunately, many women with PCOs do not show these abnormalities.


4. Blood test
The blood test includes testing of
a. Dehydroepiandrosterone(DHEA), is a test for excess adrenal precursor androgen (APA) production(53)(54) found in approximately 20-30% of women with PCOS(53).

b Abnormal testosterone(55) levels may interfere with the follicle incubation medium(55)(56).

c. Sex hormone-binding globulin (SHBG)(57) is a surrogate marker of insulin resistance
Lower levels of SHBG are found in women with PCOs(58)

d. Follicle-stimulating hormone (FSH)/LH ratio(LH(58) and FSH ratio(58)(59)). Dr. Li Y and the research team at Second Affiliated Hospital of Sun Yat-sen University, said: "PCOS patients with higher LH/FSH ratio are primarily caused by hypothalamic-pituitary dysfunction, while the PCOS patients with normal LH/FSH ratio are mainly caused by metabolic disorders"(60).

e. Thyroid-stimulating hormone (TSH)
The aim of the test is to check for levels of TSH (> or =2.5 mIU/l) as the hormone has shown to significantly alter endocrine and metabolic changes(64)
Thyroid dysfunction is found to be associated with independent risks of ovarian failure and pregnancy-related complications in women with Polycystic ovarian syndrome (PCOS)(61). It is said that both PCOS patients combined with SCH have a higher risk of cardiovascular risk factors(62)and subclinical hypothyroidism (SCH) is more common in women with PCOs(63).

f. IGTT level (fasting insulin)(65)(66) and several other androgens(67)(68) are used to evaluate adrenal function. If there are abnormal secretion of certain hormones, you may be at a high risk of having PCOs.
Low birth weight may contribute to the causation of hyperandrogenism and insulin resistance in adolescents with PCOS, according to the joint study in Italy(64).


The Causes

The causes of the polycystic ovarian syndrome are still unknown(69)(70), but there are some suggestions
1. Genetic predisposition
A genetic predisposition is defined as a genetic mutation of some women who were born predisposed to certain health problems(75). In this case, it is polycystic ovarian syndrome(70)(71)(72)(73)(74).

2. Insulin resistance(82)
Insulin resistance is defined as abnormal levels of insulin in the blood of a person found to be associated with women with PCOs(83). It may be caused by certain health problems such as diabetes(76)(77), abnormal function of pancreas(78)(79) or caused low numbers of the insulin sensitivity of cells(79)(80), which impair the process of glucose in energy conversion(81), induced high blood glucose levels in the body, cause of increasing the risks of ovarian cysts development(83).

3. Obesity(84)
Obesity is defined as a person whose BMI index is over 24. As we are known, obesity women in most cases are associated with the clinical features of insulin resistance(76). According to Università Cattolica del Sacro Cuore, low 25(OH)D levels(86) accompanied by the degree of adiposity may induce the causation of PCOs(85).

4. Hyperandrogenism
Hyperandrogenism is a medical condition characterized by excessive production and/or secretion of androgens leading to male pattern hair growth, probably due to mutation in the polymorphism rs12720071 in women(88). According to Erciyes University, there is a relation between IR(Insulin resistance) and androgenetic alopecia (AGA)(87), male pattern baldness.
Hirsutism develops when follicles in androgen-sensitive areas start to form thick, pigmented hair as opposed to thin, short, non-pigmented hair normally seen in those areas in women with PCOs(89). Evaluating terminal hair growth on the chin or lower abdomen may be a reliable source for predicting hirsutism, according to Ahvaz Jundishapur University of Medical Sciences(90).

5. Environmental chemicals
Environment chemicals endocrine disruptors(91)(92), such as xenoestrogens, and lifestyle(91)(92) can cause overproduction of certain hormone and reduction of others, leading to abnormal function of the reproductive organs including the development of follicles and increasing the risk of PCOs(93).

6. Food adulteration
Food adulteration, including mixing, substituting, concealing the quality of food by mislabeling, putting up decomposed or expired food, and adding toxic substances(94) can lead to hormone imbalance(98) and distort the natural process of women reproductive system(97) and in some cases, result in death(95)(96).

7. Chronic inflammation
Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells which are present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process(99)(100)(101).

8. Disorders of cortisol metabolism
Cortisol is usually referred to as the stress hormone, presented in high levels in patients with schizophrenia and bipolar disorder(104) as it is secreted in large volume for our body to respond to stress and anxiety(103). Disorders of cortisol metabolism are defined as a condition of which cortisol hormone has lost its function in restoring glucose homeostasis(105) in balancing insulin and glucagon in the bloodstream(106)(107). According to University College London Hospitals, altered cortisol metabolism does not seem to be the primary cause of PCOS(102).


Diseases associated with PCOs

1. Hyperprolactinemia
Hyperprolactinemia and polycystic ovary syndrome (PCOS) are on the list of the most frequent causes of female infertility(109).
Prolactin, produced by the anterior pituitary gland primarily plays important breast development during pregnancy and milk production after birth. Hyperprolactinemia in women with polycystic ovary syndrome (PCOS) affects the normal function of the hypothalamus and pituitary gland(110), leading to ovulatory infertility(111), decreasing in menstruation and sometimes lost of menstruation(112) and sexual desire(114). In men, hyperprolactinemia has shown a reduction in seminal volume and total sperm count accompanied by a decrease in libido and lost spontaneous erections. and sexual desire(113). But according to the Medical University of Lodz, and Medical Centre of Postgraduate Education, " Hyperprolactinemia does not seem to be more frequent in PCOS women than in healthy subjects and it should not be considered as a characteristic feature of PCOS - both are distinct clinical entities...."(108).

Chinese medical herbs-Huiru Yizeng Yihao(NO.1 HRYZ), has shown effectively for the treatment of sex hormone disorder of hyperprolactinemia and HMG mice models(149).

2. Vagina bleeding
Women with polycystic ovary syndrome (PCOS) associated with dysfunctional uterine bleeding (DUB) are more common in their extremes of reproductive life(115)(116). According to the study, Oral contraceptive pill has a significant therapeutic effect for treatment in DUB and hemorrhagic forms of PCOS(117)(118). Chinese formulated herbs product (Kuntai) has shown effectively in alleviating menopausal symptoms of irregular bleeding(150).

3. Ovarian cysts
Women with PCOs Have shown to susceptible to dysfunctional follicular development, with small follicles and cysts(119) of which may interfere with normal conception(120)(121)(122), probably due to angiogenic factors and factors of communication of the interactions between luteal vascular and nonvascular tissues(123). Oral contraceptive users have found to have a lower incidence of ovarian cysts(124)(125)(126). Chinese herbs, Penyan Kang (formula for treating pelvic inflammation) showed effectively in treating ovarian cyst with no abnormality and adverse effect(127)(128).
Warming acupuncture plus moxibustion combined with oral administration of Quyu Decoction in Chinese traditional medicine therapy significantly increased the cured rate for ovarian cysts, according to the Shandong Provincial Institute of TCM,(151).

4. Uterine cancer
According to a joint study, PCOS might increase the risk of uterine cancer in a PCOS cohort consisted of 3,566 patients, and the comparison cohort consisted of 14,264 matched control patients without PCOS(129). But according to David Geffen School of Medicine at UCLA, there are insufficient data to evaluate any association between PCOS and vaginal, vulvar and cervical cancer or uterine leiomyosarcoma(130). Therefore, large-scale, well-designed studies are necessary to confirm the association between PCOS and gynecological cancer risk(129). Herbal Scutellaria barbata D. Don (SB) has been found effective in anti-tumor proliferation against human uterine leiomyoma(152).

5. Fatty liver diseases(NAFLD)
Women with PCOs, especially to those women are BMI > 25 kg/m², glucose level > 80 mg/dL, E2/T < 80 and ALT > 19 IU/L (134) have shown to associate with nonalcoholic fatty liver disease(131)(132)(133) as a result of abnormal lipid handling by the liver, due to higher triglyceride and cholesterol and lower HDL level(133). Lifestyle interventions and weight loss, accompanied pharmacologic interventions have shown effectively for the treatment of NAFL(129). Total alkaloids in herbal Rubus aleaefolius Poir (TARAP)(153), Celastrus orbiculatus Thunb. (COT(154), hawthorn fruit(155) showed effectively in ameliorating high-fat diet-induced NAFLD through antioxidant activities.

6. Hypertension
The prevalence of hypertension was 19.2% in women with PCOS, which was much higher than healthy women, in a study of the Han Chinese population(136). Young women with PCOS and higher BMI may be at an increased risk of hypertension, according to the from survey 4 in 2006 (n = 8,612, age of 28-33 years(135) but this result has been challenged by the study at Serviço de Endocrinologia do Hospital das Clínicas da Universidade de São Paulo(137). Certain medical herbs and spices, such as Molle (Schinus molle), Maca (Lepidium meyenii Walp), Caigua (Cyclanthera pedata) and ginger (Zingiber officinale) were found to have highest anti-hypertension through their phenolic profiles, antioxidant activities(156).

7. Insulin resistance(IR)
Epidemiologically(138)(139)(140)(141), strong evidence linking insulin resistance in women with PCOs
may be resulted of pathogenesis involved several associated hormonal pathways(139), including autoimmune thyroid disease(142)(143) or phenotypes(141). Lifestyle interferences, including a modest reduction in dietary carbohydrate, may be beneficial on body composition, fat distribution, and glucose metabolism, according to the University of Alabama at Birmingham(144). Traditional Chinese herbal formula containing Puerariae radix, Lycium barbarum, Crataegus pinnatifida, and Polygonati rhizoma (PLCP), alleviated IR in comparison to metformin, through its actions of phytochemicals puerarin, 3'-methoxypuerarin, daidzin, daidzein, and ononin(157).

8. Cushing's syndrome
PCO and PCOS are common in women with Cushing's syndrome(146). They mimic symptoms such as obesity and insulin resistance, menstrual abnormalities and hyperandrogenism in women with polycystic ovary syndrome (PCOS) and Cushing's syndrome (CS) has caused confusion in diagnosis(147). According to Charles Drew University of Medicine and Science, testosterone levels of <1.39 nmol/L may be useful to discriminate between mild CS and PCOS(148) and hirsutism and menstrual abnormalities were found more common in initial PCOS diagnosis than in CS(145).
(146).

9. Obesity
In the US, 80% of women with PCOs are found to be either overweight or obese, according to statistics (158). Obesity also exhibited complications of some features of PCOS including hyperandrogenism, hirsutism, infertility, and pregnancy (159) and exacerbated many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia(159). According to Karolinska Institutet, lifestyle interventions to induce weight loss and adjuvant pharmacologic treatments may be the most successful strategy to improve symptoms of PCOS(160). Pi transportation, dampness resolving and phlegm expelling herbs (PTDRPEH) in traditional Chinese effectively reduce body weight and TNF-alpha in the adipose tissue, inhibit fat diet-induced obesity and insulin resistance (IR), through attenuating leptin resistance, and elevating serum levels of leptin and adiponectin(161).

10. Amenorrhea
Polycystic ovary syndrome was found to be the most common cause of secondary amenorrhea in Korean women(163) and women in the US.(164) with secondary severe hyperthyroidism. Herbal extracts including Vitex agnus-castus, Cimicifuga racemosa, Tribulus Terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia in TCM has shown more effective in treating polycystic ovary syndrome (PCOS) associated oligo/amenorrhoea and hyperandrogenism than pharmaceutical agents bromocriptine (and Vitex agnus-castus) and clomiphene citrate (and Cimicifuga racemosa)(162).

11. Miscarriages
Epidemiologically, linking miscarriage and recurrent miscarriage to PCOs are inclusive(165)(166)(167), but some researchers still insisted that raising levels luteinizing hormone (LH), one of the complications in women with PCOs may be associated with increased rates of miscarriage(168)(169)(170). According to Net Doctor, Women with raised LH have a 4 fold increased risk of miscarriage (170).

12. Metabolic syndrome
Metabolic syndrome, a collection of symptoms that can lead to diabetes(174)(175) and heart disease(175)(176)(177) has found to be associated to women with PCOs, probably due to genetic mutation of certain genes(171)(172), increased accumulation of adipose tissue and insulin resistance(173). Herbal Coccinia indica and American ginseng, Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal and supplement Chromium may be the alternative options for glucose control in patients with diabetes(178), and TCM herbs and herbal formula Ligusticum chuanxiong Hort., Dalbergia odorifera T. Chen and Corydalis yanhusuo WT Wang may also be effective for the treatment of CVD(179).

13. Infertility
Infertility is a condition of the inability of a couple to conceive after 12 months of unprotected sexual intercourse or can not carry the pregnancy to full term. It affects over 7 million couple alone in the U. S. and many times more in the world, because of unawareness of treatments, only 10% seeks help from professional specialists(181). In fact, approximately 21% - 30% of the infertility of a couple is caused by a male inability to fertilize(182) with men aged 40 years and older. (According to statistics from US Centers for Disease Control and Prevention
* Number of women ages 15-44 with impaired fecundity (impaired ability to get pregnant or carry a baby to term): 6.7 million
* Percent of women ages 15-44 with impaired fecundity: 10.9%
* Number of married women ages 15-44 that are infertile (unable to get pregnant after at least 12 consecutive months of unprotected sex with husband): 1.5 million
* Percent of married women ages 15-44 that are infertile: 6.0%
* Number of women ages 15-44 who have ever used infertility services: 7.4 million)(180).
The infertility rate of women with polycystic ovaries is very high, due to a lack of ovulation and other unknown etiology. Medication used for treatment of PCOs infertility include clomiphene citrate(183)(184)(189), metformin(183)(186), letrozole(184)(85)(186)(189), tamoxifen(185)(189), anastrozole(187)(188)....... Traditional Chinese medicine (TCM) recipes formulated by Shen-replenishing herbs or acupuncture to reinforce Gan-Shen, regulate Chong-Ren Channels are found effective in treating infertile and subfertile PCOs women(191) when they are used alone or in conjunction with Western medicine(190).

14. Irregular menstruation
Menstrual irregularity and/or elevated androgen levels are found to be associated with women with PCOs(192)(193) due to hormone imbalance. According to a self questionnaire survey, irregular menstrual not only already present in adolescence in women with PCOS and but also induced infertility in later life(194). Medication used for the treatment of PCOs irregular menses includes oral contraceptive pill(195) and metformin(195)(196). Herbal extracts such as Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia, may be used for treatment in the regulation of ovulation, improved metabolic hormone profile(196).

15. Diabetes
The prevalence of insulin resistance in women with polycystic ovary syndrome (PCOS), is found to be associated with the critical risk for Type 2 diabetes(198)(199)(200). Insulin-sensitizing medication, such as pioglitazone(202), metformin and thiazolidinediones(203). may be a promising and unique therapeutic option for chronic treatment of PCOS(201). Traditional Chinese acupuncture(204) and herbal formula danzhi xiaoyao pill have shown effectively in reduced PCOs complicated insulin resistance(IR)(205)

16. Acromegaly
Acromegaly is defined as overproduction of growth hormones caused by a benign(some may behave more aggressive(209) tumor of the pituitary gland(208) and in rare case, it may be caused by tumors of the pancreas, lungs, and adrenal glands, leading to excess GnRH(210), resulting in male pattern hair growth(207). According to the University of Athens, polycystic ovary syndrome (PCOS) and PCOS phenotype (PCOSP) are relatively common in women with acromegaly and may account for some of the symptoms related to gonadal dysfunction due to hormone IGF-1 or in combination with growth hormone GH and/or insulin resistance(206).

PCOs Complications


1. Cardiovascular diseases
Besides cancer, heart disease kills more than 2,000 Americans every day. Approximately 60 million Americans have heart disease. Women with PCOs have found to have increased risk of CVD due to hyperandrogenism in aggravation of abdominal obesity(211), insulin resistance forming(211), metabolic syndrome(212), type 2 diabetes(212)(213), altered plasma lipid profile(215), sympathovagal imbalance(216),.... According to the University of Western Australia, treatment in uncorrelated components, such as insulin resistance, dyslipidemia/hypertension or hyperandrogenaemia may be effective to reduce differing cardiometabolic outcomes(214). Non-medical (normalization of weight, healthy lifestyle) and medical (metformin, thiazolidinediones, spironolactone, and statins) interventions were found effectively in reduced long-term risk for cardiovascular morbidity and mortality in women with PCOs(217).

Conflictingly, according to the study by Division of General Internal Medicine, Mayo Clinic, although women with PCOS weighed more than controls, there was no increased prevalence of other CV risk factors(218). The study also insisted that data on the incidence of CV events are lacking in PCOs' population(218)

2. Stroke
Besides cancer and heart diseases, stroke is the third leading cause of death. Approximate 1/4 of all stroke victims die as a direct result of the stroke or its complications. Epidemiological evidence suggested that women with PCOs are at increased risk of stroke(220)(221). According to the review of 1340 articles, 5 follow-up studies published between 2000 and 2008 conducted by Leiden University Medical Center,, risk of stroke of women with PCOs was 2 folds higher in comparison of women with PCOS to women without PCOS(219).

3. Endometrial cancer
The endometrium is the inner lining of the mammalian uterus and very susceptible hormone change, particular to the menstrual cycle. Endometrial cancer is a late adulthood cancer defined as a condition of which the cells of the endometrial lining of the uterus have growth uncontrollable or become cancerous as a result of the alternation of cells DNA. It's the fourth most common cancer among women overall, after breast cancer, lung cancer, and bowel cancer.
women with polycystic ovary syndrome (PCOS) with altered estrogen and/or abnormality of levels progesterone (P4) at gene level(222), mutation gene(223)(227), abnormal levels of hormone (gonadotropins, estrogens, androgens, prolactin, and serotonin and progesterone),(228), hyperandrogenism(224), abnormal menstrual pattern(225), insulin resistance(228) associated with PCOS and obesity(226)(228), may contribute to increased endometrial cancer risk(222). Metformin(229) and a combination of metformin, bromocriptine mesylate, and metformin showed to improve clinical and metabolic syndrome in women with PCOS(230) with metformin alone through up-regulated tumor suppressor gene such as p53, cyclin D2 and BCL-2)(229).

4. Dyslipidemia
Dyslipidemia, one of metabolic syndrome has found to be associated to many patients with polycystic ovary syndrome (PCOS) risk factor(233), characterized by elevated low-density lipoprotein (LDL), triglyceride levels and decreased high-density lipoprotein (HDL)(234), probably different metabolic aetiologies depending on DHEA-S metabolism, independent to insulin concentrations(235).
According to the University of Brescia, Italy, the use of the oral contraceptive for suppressed gonadotropin and androgen values and increased the levels of sex hormone-binding globulin in women with PCOs showed a significant increase in triglycerides, high-density lipoprotein (HDL) cholesterol system(232). Phytochemicals Berberine and monacolin showed effectively in a balanced lipid profile, through improving lipid metabolism in oral contraceptive induced hypercholesterolemia in women with or without PCOS(231).

5. Pregnancy risk
Women with PCOs are associated with a higher rate of early pregnancy loss in comparison to women with reproductive problems(237). According to a joint study conducted by the Norwegian University of Science and St Olavs Hospital, wone with PCOs are associated with preterm delivery in twin pregnancies(236). Treatment with N-acetylcysteine (NAC) showed to enhance higher odds of getting pregnant with live birth(238). In subfertile women with anovulatory PCOS, letrozole improved live birth and pregnancy rates in comparison to clomiphene citrate(239).
Adding phytochemical Cimicifugae Racemosae to clomiphene-induction cycles with timed intercourse significantly improved cycle outcomes and pregnancy rates in women with polycystic ovarian(241). Traditional Chinese formula, Danzhi Xiaoyao Pill (DXP) effectively enhanced the ovulation rate and the clinical pregnancy rate of 60% in anovulation infertility patients with PCOS complicated IR(242).

Dr. Ried K. at the National Institute of Integrative Medicine, Hawthorn, Melbourne, VIC, Australia said: " Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy, including women with PCOS"(240).

6. Infertility(See diseases associated to PCOs)

7. Higher risk of Gestational diabetes
Epidemiological studies, linking a higher incidence of gestational diabetes mellitus (GDM) for women with PCOs have produced inconsistent results (243)(244). Aristotle University suggested a improve properly designed studies are necessary before any recommendation to pregnant women with PCOS in regard to the risk of GDM(245), But according to Imperial College School of Medicine, there is a higher prevalence of polycystic ovarian morphology in women with a history of gestational diabetes(246).

8. Depression
Women with PCOS are found to have a higher rate of depression in comparison group women without(247)(248)(250). Psychologically, according to Institute of Psychology, Eötvös Loránd University, women with PCOs are associated with a great number of psychological symptoms, including (e.g. depression, anxiety, body image dissatisfaction, eating and sexual disorders, and low life satisfaction) due to gynecological disorder of endocrine origin(249).

9. Liver diseases
Women with PCOS are associated with a high risk of NAFLD(251)(252)(253). The suggested that some women with PCOS particularly those with evidence of metabolic syndrome. should be considered to be screened for liver disease at an earlier age(254).

10. Diabetes(See diseases associated to PCOs)


The prevention and management

Polycystic ovary syndrome (PCOS) is unpreventable in Western medicine. Early diagnosis and treatment may reduce the risk of its complications, including infertility, metabolic syndrome, obesity, diabetes, cardiovascular diseases, stroke, etc.

The General Approaches to prevent the unpreventable?

Although PCOS cannot be completely avoided, strengthening immunity has shown a significant reduction of chronic inflammatory diseases(266)(267)(268).
1. Healthy lifestyle(255)(256)(257)(258)
According to Shahid Beheshti University of Medical Sciences, women with an unhealthy lifestyle are associated with increased risk of chronic diseases(260), including PCOs in comparison to those of healthy women(259), probably due to nutrient deficiency effects of immune functioning(261).

2. Balanced diet
Epidemiological data suggest that dietary patterns strongly affect inflammatory processes(265).
Balancing diet(257)(258) with high in veggies and fruits(257) and less in meats not only provides sufficient nutrients to your body but also enhances the immunity in fighting against inflammatory diseases(264), including PCOs(264), irregular cell growth(263) and oxidative stress(262). Reduced intake of trans and saturated fats and increased intake of omega-3 and omega-9 fatty acids(257) and eating anti-inflammatory foods (fiber(272)(273), omega-3 fatty acids(269), vitamin E(270), and red wine(271) should also be emphasized(255)(265).

3. Moderate exercise(257)
Moderate exercise not only increases blood flow to strengthen the body tissues(274)(275) and organs(276), including the reproductive system but also enhances the immunity(277) in fighting against inflammatory process(277)(278) due to irregular cell growth(281)(282) and foreign invasion(279)(280).

4. Yoga
Yoga is a physical, mental, and spiritual practice in Hinduism, Buddhism.
According to studies holistic yoga therapy showed a significant effects in reducing anti-müllerian hormone (AMH-primary outcome), luteinizing hormone (LH), testosterone, hirsutism, and improving menstrual frequency, glucose, lipid, and insulin values(284) with no significant changes in body weight, FSH, and prolactin in adolescent PCOS(283).

The Vitamins

1. Vitamin B2
Vitamin B2 required for a wide variety of cellular processes plays a key role in energy metabolism, enhances the digestive system in absorbing nutrients and supports the immune system(285)(286)(287)in fighting against irregular cell growth causes of chronic inflammatory disease(288).


2. Vitamin C
Vitamin C, a water-soluble vitamin and an antioxidant found in high concentrations in immune cells, is not only important in aiding the digestive system in absorbing nutrients, but also enhances the production of white blood cell(289)(290) of the immune system in protection of the body against oxidative stress, harmful bacteria(291) and virus-induced inflammation.

3. Vitamin A
Retinoic acid appears to maintain normal skin health by switching on genes and differentiating keratinocytes (immature skin cells)(292) into mature epidermal cells and helps to detoxify the liver(293) and enhances the immune system(294)(295) in protecting our body through its anti-tumor functions (296).

4. Vitamin E
Vitamin E is fat-soluble compounds that included both tocopherols and tocotrienols. It besides is a polyphenol antioxidant (296)(297)(302) in scavenging free radicals, but also promotes the immune system in enhanced functions of B-cells(298)(299)(300), the immune cells(301)(303) in production of antibodies to destroy irregular cell proliferation.

5. Vitamin D
15 minutes in the Sun daily has shown to provide necessary vitamin D for the body. Over 68% of women with PCOs had vitamin D deficiency. (304). According to the Medical faculty of P.J.Šafarik University Košice, women with vitamin D deficient PCOs are exhibited a significantly higher body mass index (BMI), fasting insulin, and homeostasis model assessment-insulin resistance and borderline higher glycemia in comparison to controls(305).


The Top 5 Anti-inflammatory Foods

According to Medical University Innsbruck, the interactions between diet, immunity, and the microbiota may be necessary for the develop food-based approaches to prevent or treat many diseases(285).
1. Garlic
Garlic (Allium sativum) is a species in the onion genus, belongings to family Amaryllidaceae, native to central Asia, used popularly in traditional and Chinese medicine to treat common cold and flu(306), digestive disorders(313), diabetes(322)(323)(324), atherosclerosis,(325), cardiovascular diseases(326)(327), strengthen immunity(319) against irregular cell growth such as tumors(314)(315)(316)(317)(318), bacterias(310)(311)(312), fungi(310)(311) and virus(320)(321), lower blood pressure(328)(329)(330) and cholesterol levels(310)(331), etc. Recent studies also showed that garlic exhibits its anti-inflammatory effects against chronic inflammatory disease(307)(308)(309) through phytochemical allicin(307) and other mechanisms(308)(309).

2. Ginger
Ginger (Zingiber officinale) or ginger root is the genus Zingiber, belongings to the family Zingiberaceae, native to Tamil, used in traditional and Chinese medicine to treat dyspepsia(332)(333), gastrointestinal disorder(334) such as nausea and vomiting(335), constipation(337), gastric ulcer(338),.... edema(339)(340), difficult urination(340), colic and diarrhea(341), etc.... Strong evidence in Western studies also showed that ginger also induces some mechanisms for the treatment of psychological symptoms, such as anxiety(342). depression(343),..., diabetes(344)(345), hypertension(346), irregular cell growth such as tumors(347)(348)(349), and rheumatoid arthritis(352) and osteoarthritis(336) through its anti-inflammatory, antioxidant and immune-modulatory effects(346)(350)(351), speed up wounding healing(352)(353), etc.

3. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belongings to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional medicine as anti-oxidant(354)(355), hypoglycemia(356)(357), colorant(358), antiseptic(359)(360), wound healing(361) agents, and to treat flatulence(362), bloating(363), and appetite loss(364), ulcers(365), eczema(366), inflammations(367), etc. Epidemiological studies also found that the efficacy of turmeric for treatment for diabetes(369)(370), microbial infection(359)(371)(372), gastrointestinal diseases(359)(373) and irregular cell growth such as cancer(374)(375)(376) through its anti-inflammatory(367)(368), antioxidant(377)(378) and immunomodulatory(379)(380) activities.

4. Green tea
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Green tea has been a precious drink in traditional Chinese culture and used exceptionally in socialization for more than 4000 thousand years. Because of their health benefits, green tea has been cultivated for commercial purposes all over the world. Epidemiological studies suggested that green tea consists many pharmaceutical properties, including anti cancers(381)(382), anti-diabetes(383)(384), induced weight loss(385)(386)anti-aging and longevity(387)(388), anti-allergy(389)(390), anti micro-organisms(391)(392), antilipidemic(393)(394). anti-stroke(385)(396) and cardiovascular diseases, through its antioxidant(397)(398), anti-inflammatory(399)(400) and immune-modulatory(401)(402) activities.

5. Shiitake mushrooms
Shiitake mushroom is an edible mushroom, genus Lentinula, belonging to family Marasmiaceae, native to East Asia and widely cultivated for consumption for its health benefits and commercial purpose in many Asian countries. The herb has been used in traditional medicine as a blood tonic agent and to strengthen the immune system)403)(405), treat colds(407), measles(407), bronchial inflammations(407), etc. Recent studies showed that Shiitake mushrooms are also consisted properties of anti-cancers(403)(404), anti microorganisms(407)(408) such as HIV)410)(411)and hepatitis virus(407)(412), enhanced immune system(403)(405)(406) against inflammation(413)(414) causes of chronic inflammatory diseases(415) and the development of free radicals(414)(416), lowering cholesterol levels(407)(417)(418), treating heart disease(407)(419), diabetes(407)(420), etc....

The Immunity Boosting Minerals

Recent studies showed that deficiencies of zinc, iron, copper, and selenium lower resistance to disease either due to impaired immune response or faulty white blood cells' function(421)
1. Magnesium
The mineral, magnesium plays a key role in the immune response, by acting as a co-factor for immunoglobulin synthesis(422) that significantly increases for both IgA and IgG, the antibody molecules that protect our body against bacterial and viral infections(423) and the lining of the respiratory passages, gastrointestinal and genitourinary tract(423).
The mineral also found to increase neutrophil function and enzyme peroxidase activity and reduce the incidence of health disorders by boosting immunity(424), including chronic inflammatory disease(425)(426). Low serum magnesium (Mg) is often associated with incidences of insulin resistance (IR), cardiovascular problems, diabetes mellitus, hypertension and other components of metabolic syndrome(428) in patients with polycystic ovary syndrome (PCOS)(427).

2. Selenium
Selenium, a trace mineral plays an important and indirect role as an antioxidant(429)(430) by fulfilling its function as a necessary constituent of glutathione peroxidase(431)(432) and in production of glutathione(432), that inhibits the damage caused by oxidation of free radical hydrogen peroxide(433).
Extensively epidemiological studies suggested that selenium also benefits to health aspects, including anti cancers(434)(435), lowering cholesterol(436)(438), hypertension(439)(440), treating heart disease(427)(438), boosting immunity(441)(442) against microbial invasion(443)(444) and anti chronic inflammatory disease(445)(446).

3. Zinc
Zinc besides is an important mineral in boosting immune system activity(447)(449). Its nano-structure zinc(II) coordination compounds, has been used in zinc therapy to treat candida overgrowth(449) by promoting metallothionein (MT)(found in high concentration in intestinal mucosa)synthesis(450) through its anti-inflammatory activity(451), including chronic inflammation(453)(454) via immune-modulatory effects(452)(453)(454).

4. Manganese
Manganese is an essential trace nutrient in all forms of life. It is well known for its role in helping the body to maintain healthy skin(455)(456) and bone structure(457)(458), but also acts as cofactors for a number of enzymes(459) in higher organisms, where they are essential in exhibiting its antioxidant effects against free radicals(450)(451). Recent studies suggested that manganese also benefits in controlling blood glucose(452)(453), alleviating neuro symptoms such as anxiety, and depression(454) and treatment of high cholesterol levels(456), hypertension(455), infertility(457), cardiomyopathy(458), reduced oxidative stress, amyloid deposition, and memory(459) and boosting immune system antimicrobial infections and inflammation(460).
In larger amounts, manganese can be poisoning to neurological damage(451)(462).

5. Iron
A mineral plays a vital role for production of hemoglobin(463)(464)utilised by the body for oxygen transport and energy production(467), for maintaining healthy bones(465) and neurotransmission(466), synthesizing of some hormones and connective tissue(467)(468)(469) and maintaining heart health(470). Deficiency of iron causes a low level of hemoglobin, nervous tension((473)(474)), cognitive dysfunction(471)(476), heart disorders(472)(475), heavy menstrual bleeding(479)(480), iron deficiency anemia, etc.,. Recent studies suggested that trace mineral iron improves immunity(481)(482) fighting against microbial infection(481) and inflammatory disease(483)(484), including certain types of chronic inflammatory diseases(486)(485) due to low levels of hemoglobin impaired cell-mediated immune response and bacterial activity of leukocytes(421).

6. Copper
Copper is vital in maintaining the production of antibodies(487)(488), white blood cells(489)(490), antioxidant enzymes(491)(492), for increasing the immune function in fighting against infection(487)(488) and inflammation(493)(494), including certain chronic inflammatory diseases(495)(496). The mineral also acts as a modulator of neuronal transmission(497), regulates the production of certain hormones(498). Deficiency of copper may cause metabolic liver disease(502), copper deficiency anemia(503),... Excess of copper levels can induce cognitive disorders(504)(505), reduced antioxidant status(506) and deficiency and excess can persuade infertile(499), low libido and sexual issues(500), low-quality sperm production(499)(500), disrupted nervous function(501), etc.,...


The Antioxidants

1. Bilirubin
Bilirubin is a prosthetic group helped to break down molecules into smaller units in releasing energy, excreted in bile and urine. It is a cellular antioxidant(511), by reverting to biliverdin, a green tetrapyrrolic bile pigment, once again when oxidized, it inhibits the effects of mutagens(512). The antioxidant showed to inhibit digestive proteases like trypsin and chymotrypsin(504), benefit heart health(505) and nonalcoholic fatty liver disease(507), reduce the risk of diabetes(506). Recent studies also found that the antioxidant exhibits its anti-inflammatory effects(511) against certain chronic inflammatory diseases, including psoriasis(508), chronic obstructive pulmonary disease(509), .... and enhances immunity activities(510)

2. Carotenoids
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts(513) of plants and some photosynthetic organisms like algae and bacteria(514).
a. Beta-carotene
Beta-carotene, an organic compound classified as a terpenoid, is a strongly-coloured red-orange pigment in plants and fruits, stored in liver for the production of vitamin A. Epidemiological evidence suggested that beta-carotene neutralizes singlet oxygen before giving rise of free radicals(515) which can damage of DNA, leading to improper cell DNA replication(516)(517), causing irregular cells growth, such as cancers(518)(519)(520). The phytochemical also promotes immunity(521)(522) against foreign invasion and symptoms of chronic inflammatory disease(523)(524) and improve low-density lipoprotein cholesterol resistance to oxidation causes of cardiovascular disease-related to atherosclerosis(527) through its antioxidant anti-inflammatory activities(525)(526).....

b. Alpha-carotene
Alpha-carotene, one of the most abundant carotenoids in the North American diet, is a form of carotene with a β-ring at one end and an ε-ring at the other, not only protects cells from the damaging effects of free radicals(526) and enhances the immune system(528) in fighting against bacteria and virus infection and inflammation(529)(530), but also inhibits irregular cell growth(531)(532) cause of benign tumors(531) and cancers(532).

c. Beta-cryptoxanthin
Chemically Beta-cryptoxanthin is a xanthophyll which protects our cells from oxidation(538) and provides a source of vitamin A. The phytochemical showed to enhances the immune system functioning(533)(534) against infectious(537) and inflammatory diseases(535)(536) and reduces insulin resistance(536) and cancers(539)(540) risks

d. Lycopene
Lycopene is a red carotene of the carotenoid group found in tomatoes, watermelons, and grapefruits. This antioxidant is believed to be a powerful fighter against irregular growth(543), such as prostate cancer(541)(542), breast cancer(544)(545) and liver diseases(546)(547). Lycopene has many anti-aging(549) capabilities as well as enhancing immune function(548) against oxidative stress(550)(551) and inflammatory diseases(551)(552).

3. Flavonoids
Flavonoids also are known as Vitamin P and citrin are yellow pigments having a structure similar to that of flavones that occurred in varies plants. used in human history for over thousands of years for breakage of capillaries causes of swelling and obstruction of blood flow(553).
Flavonoids process property as antioxidants for neutralization of many of reactive oxygen species (ROS)(554)(555), including singlet oxygen(556), hydroxyl(557) radicals involved chronic inflammatory diseases(558)(559).
Although nitric oxide is considered a free radical produced by the immune system to destroy bacteria-induced infection(561), overproduction can cause increased peroxynitrite which may attack protein, lipid, and DNA(560). Flavonoids inhibit NO production of peroxynitrite through various antioxidant enzymes(562).
a. Quercetin
Quercetin is a plant-derived flavonoid found in fruits, vegetables, leaves and grains, and studies show that quercetin may have anti-inflammatory(563)(564) and antioxidant(565)(566) properties as a antioxidant, quercetin scavenges free radicals(567), which damage cells (568) and cause mutation of cells with tampering DNA(569)(570).

b. Rutin
Rutin is a citrus flavonoid glycoside found in buckwheat and glycoside of the flavonoid quercetin. It inhibits platelet aggregation(571), decreases the capillary permeability(572), makes blood thinner and improves circulation. As an antioxidant, it also reduces the cytotoxicity of oxidized LDL cholesterol(573) triggered atherogenesis and the risks of other chronic inflammatory diseases(574)(575)(576).

c. Catechin
Catechin is a natural phenol antioxidant and natural anti-bacterial substance. The study showed catechin as good free radical scavenging power inhibits ROS production(577), maybe be useful to the development of alimentary strategies to prevent ochratoxin A (OTA) cytotoxicity in human(578). As an antioxidant, catchin also processes anti-inflammatory effects against many chronic inflammatory illnesses (579)(580)(581)(582).


4. Coenzyme Q10
Coenzyme Q10 is discovered by Dr. Karl Folfers in 1957, serves as fuel for the cells(583) and acts an antioxidant to prevent the generation of free radicals during this process(584) induced numbers of chronic inflammatory diseases, such as diabetes(585)(586), cardiovascular(587)(588) and Parkinson's disease(589)(590). The antioxidant also was found effective timely in the treatment of clomiphene-citrate-resistant PCOS patients through improving ovulation and clinical pregnancy rates when use combination with clomiphene citrate(591).


The Phytochemicals

1. Tanshinone
Tanshinones, a class of phytochemicals found abundantly in Salvia miltiorrhiza (Danshen or Tanshen in Chinese) has shown to process several pharmacological effects including anti-inflammatory(596), antioxidative stress(595)(597), antisenile dementia(598), antiplatelet aggregation(593), anti-atherosclerosis(599), hypertension(600), and ischemic stroke(594) and anticancer activities(592)(593), etc. Recent study if a total of 100 eligible women with PCOs meeting certain criteria recruited from four centers in China, conducted by First Affiliated Hospital of Heilongjiang University of Chinese Medicine, suggested that tanshinones ameliorate excessive androgens by inhibiting steroid hormone produced by the theca cells in the ovary(601)(602) and improve insulin resistance and glucose metabolism(602)(603). Dr. Wenjuan Shen and the research team also said " CHM can regulate and strengthen the hormonal systems of the whole body and is a natural approach for treating PCOS. The significant advantages of CHM are that it provides several options for the safe, effective, multitargeted treatment of various aspects of PCOS including hyperandrogenism and poor quality of life"(604).

2. Berberine
Berberine, a phytochemical found in many herbs, including Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), Berberis aristata (tree turmeric)], Hydrastis canadensis, etc., has been used in traditional medicine over thousand years for treatment of microbial infections(605)(606)(607)(608), trachoma(609), ,leishmaniasis(610).. Epidemiological studies suggested that the phytochemicals may also be effective for the treatment of diabetes(611)(612), dyslipidemias(613)(614), hypertension(615), insulin resistance and the metabolic syndrome(616). cancers(617)(618)(619), etc.
Recent studies also showed that berberine also exerts its health benefits by improving some of the metabolic and hormonal derangements in a group of Eighty-nine subjects with PCOS and IR Chinese women with PCOS(620). When compared to metformin (MET), the phytochemical Berberine showed a decrease in waist circumference and waist-to-hip ratio, fasting plasma glucose, fasting insulin, homeostasis model assessment for IR, area under the curve of insulin, cholesterol, and triglycerides as well as an increase in high-density lipoprotein cholesterol and sex hormone-binding(621). In combination with Letrozole for treatment of PCOs, the phytochemical showed the effectiveness in lowering blood sugar levels in db/db mice and exerted anti-dyslipidemia in human(622)

3. Curcumin
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. (See Turmeric in the top 5 anti-inflammation foods for the use of the herb in traditional medicine).
Immunohistochemical expression of VEGF may be associated with the pathophysiology of PCOS(623) as VEGF concentrations are found to increase in women with polycystic ovaries(624). Curcumin, according to the First Affiliated Hospital, Chongqing Medical University, lowers the expression of VEGF in ovarian tissues of PCOS in high- and low-dose administrative rat models and may have certain therapeutic effect on PCOS(625).


The differentiation of Possible PCOs Diet

1. High Protein Diet with Low-Glycemic-Load Hypocaloric Diet
Diet with 30% of protein is now considered reasonable, high protein diet is the term reserved for consumption of 50% or more.
Suggestions in linking High Protein Diet with Low-Glycemic-Load Hypocaloric Diet to control and combat polycystic ovary syndrome (PCOS) have drawn attention in the scientific community over the last decade. It may be due to its effect in lowing density lipoprotein cholesterol( LDL-C ), reduction of insulin-sensitive and androgen levels in PCO patients(626a). But epidemiological studies focusing on the benefit of diets in treating obese and overweight patients have produced inclusive results. The National Nutrition and Food Technology Research Institute showed that both components may lead to significantly reduced body weight and androgen levels. Compared with a conventional diet, the combination of high-protein and low-glycemic-load foods and Hypocaloric diet also found to be effective in enhanced insulin sensitivity and decreased hsCRP level (626). But the alternation of the metabolic rate of hypocaloric diet in glucose utilization and decreased antioxidant defenses, in some cases may result in life-threatening(634).


2. Hypocaloric diet
Comparison with Metformin in the same subjects, hypocaloric(low calorie) diet showed a reduction of 5-10% of the weight on markers of insulin resistance with equal efficacy with Metformin in decreasing serum hs-CRP levels(627) and improving inflammatory biomarkers and adipokines independently of dietary composition(628). A 20 weeks of a high-protein energy-restricted diet to evaluate the Markers of endothelial dysfunction, including elevated markers of endothelial dysfunction, presented in overweight and obese women with polycystic ovary syndrome, showed an significant weight loss, improved testosterone, sex hormone-binding globulin and the free androgen index (FAI) and insulin resistance(629). Sibutramine(the hydrochloride monohydrate salt) removed from the market because of the concerns of the risk of heart attack and stroke. A comparison test with a hypocaloric diet showed a significant weight loss in overweight and obese women with PCOS and improvement in hyperandrogenemia and insulin sensitivity after 6 months of treatment(630). Clomiphene citrate (CC) used conjunction with a hypocaloric diet with structured exercise training (SET) after 6 weeks in overweight and obese CC-resistant PCOS patients, enhanced the probability of ovulation under CC treatment, through a significant improvement in clinical and biochemical androgen and insulin sensitivity indexes(631).

A comparison of a hypocaloric low-fat diet with those of a very low carbohydrate diet showed the positive effects in both diets in significant improvements in BMI, WC, and menstrual function and induced weight loss through targeting both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS in adolescents(632). Short-term hypocaloric diet including high protein (HP: 30% protein, 40% carbohydrate, and 30% fat) or high carbohydrate (HC: 15% protein, 55% carbohydrate, and 30% fat) showed a significant weight loss reduction and improvement in their reproductive and metabolic abnormalities with no increased benefit to a high-protein diet(633).
Some researchers suggested that Hypocaloric (low-calorie) diets can alter your metabolic rate in glucose utilization and decreased antioxidant defenses, in some case may result in life-threatening(634).

3. Low-carbohydrate diet
A high-fat, adequate-protein, low-carbohydrate diet has been used in medicine primarily to treat difficult-to-control (refractory) epilepsy in children with the purpose to induce the body to burn fat other than carbohydrate. A PCOs women 24 weeks study with limit carbohydrate intake to 20 grams or less per day, showed non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair but improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity(635). According to the University of Padova study, "Epidemiological studies over last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors"(636). Some researchers insisted that the presence of high levels of insulin in the blood causes unnecessary water retention in the body(637) and the diet may produce a short term effect through eliminating excess body fat but may cause dehydration as an early-onset complication(638)

4. Low glycemic index diet
Glycemic index diet originally is developed to help improve blood sugar control in diabetes by choosing foods Low-GI foods (55 and under) for a steadier rise in blood sugar. Twenty-six participants recruited at baseline, 22 commenced and 21 participants completed the low-GI dietary intervention phase, low glycemic diet improved insulin sensitivity, changes of lipids(639). Comparison of the low glycemic index with a conventional healthy diet in overweight and obese premenopausal women, low glycemic index attendants showed to improve more in glucose tolerance through the oral-glucose-tolerance test (ISI(OGTT)), menstrual cyclicity, with serum fibrinogen concentrations significant differences between diets(640). Researchers also suggested that longer-term compliance needs more evaluation in subsequent studies to reduced long term health risks to women with PCOS on a low GI diet(642). In a comparison of low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus, some researchers suggested that the diet containing fewer carbohydrates, the low-carbohydrate, ketogenic diet, was more effective for improving glycemic control than the low glycemic diet(641).

5. High-protein diet
A high-protein diet is a diet mostly recommended for people who want to build muscle and lose fat. A comparison of a high protein (HP) and a normal protein (NP) diet on patients with polycystic ovary syndrome (PCOS) in 8-week randomized trial, showed a significantly reduced body weight, body mass index (BMI), waist circumference, percent of body fat, decreased total testosterone in PCOs(643). In fact, increased dietary protein-to-carbohydrate ratios showed no differences in testosterone, sex hormone-binding globulin, and blood lipids between the groups after 6 months, but adjustment for weight changes led to significantly lower testosterone concentrations in the standard-protein (SP) diet group, according to the University of Copenhagen(644). Unfortunately, some studies showed that consumption of HP diets may cause alterations in renal health status and some metabolic parameters(645) and reduce the level of osteocalcin(646)

6. High monounsaturated fat diet
A high monounsaturated fat diet is a diet high in monounsaturated fatty acids (HMUFA) for a replacement of daily intake of bad fat. A comparison of Carbohydrate-restricted diets high in either monounsaturated fat or protein showed that the magnitude of weight loss was smaller in the LF-HP group than in the HF-SP(647). The Mediterranean diet, a high monounsaturated fat diet is characterized by a high intake of olive oil, plant products, fish and seafood; a low intake of dairies, meat and meat products; and a moderate ethanol intake, but unfortunately, exploring the relationship between the Mediterranean diet and overweight/obesity is complex with inclusive results. Some studies indicated significantly related to less overweight/obesity or more weight loss but many found no evidence of this association(648).

7. Low-fat diet
The low-fat diet restricts the consumption of fat and stresses foods high in carbohydrates, mostly recommended to patients with some gallbladder conditions. A comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome, showed a reduction of free testosterone within 2 hours after both meals, however, the levels of testosterone remained below premeal values for 4 hours after the isocaloric low-fat, high-fiber meal (HIFIB) meal and 6 hours after a high-fat, Western meal (HIFAT) meal. Levels of glucose were higher for 1 hour after the HIFIB meal compared with the HIFAT meal. DHEAS decreased 8%-10% within 2-3 hours after both meals, then increased during the remainder of the study period. Cortisol decreased during the 6-hour period after both meals(649). The suggestion of individuals on a low-fat vegan must ensure adequate intake of vitamin D, vitamin K, folic acid, calcium, magnesium, zinc, vitamin B12, phosphorus, and selenium(650).

Types of Conventional treatments
There is no medical treatment for PCOs (induced weight loss for obese PCOs is the primary objective). If pregnancy is not the concern, oral contraceptive medicine is prescribed. If pregnancy is a concern, the below have found to be the most frequent treatment used in conjunction with artificial insemination.
A. Fertility Drugs
1. Metformin
a) The effectiveness of metformin
Metformin, an oral anti-diabetic drug used to treat type II diabetes(652)(653) used widely in treating PCOs to induce weight loss in subjects with obesity,and infertility, improved insulin resistance(654)(655) by suppressing the production of endogenous glucose(656)(658) by the liver(659)(661) and induced weight loss in obese patients(657)(658) through a reduction in calorie intake(657), as it makes insulin working more effective without changing the level of insulin in the body(659) by enhancing insulin-stimulated glucose disposal in skeletal muscle(659), which can lead to a lowering thyroid-stimulating hormone(660) and improved ovarian angiogenesis and follicular development(664) involved PCOs pregnancy(662)(663).

b) Side effects
i) Gastrointestinal upset(666)(667), especially for patient with disequilibrium of 2 genetic variations in OCT1(665), are mostly diarrhea(666)(667). Some patients may also experience nausea, vomiting, and decreased appetite(669).
ii) Reduce intestinal absorption of group B vitamins and folate in chronic therapy(668), may lead to accelerating the progression of vascular disease(668).
iii) Abdominal pain or cramps(669).
(iv) Metformin may have a growth-static effect on several cancers, including endometrial cancer, according to pre-clinical experiments(671)

2. Clomiphene (Clomid)
a) The effectiveness of clomiphene
It is considered as a fertility medication(670). The effectiveness of clomiphene is to induce ovulation(672) for natural conception for women with or without PCOs with luteal phase defects by stimulating the function of the pituitary gland in series of hormone production(673), including LH, FSH. However, a combination of metformin and clomiphene citrate may have some effects on improved pregnancy rates but not significantly improve the live birth rate over that of clomiphene citrate alone in women with polycystic ovary syndrome(674). Acupuncture, herbal medicine and clomiphene combination used for the treatment of infertility on women with PCOs have shown to improve the pregnancy rate and reduce the early abortion rate (675), according to Zhongguo Zhen Jiu. 2015 Feb;35(2):114-8.

b) Side effects
i) Abdominal pain and cramps(676).
ii) Breast tenderness(676)
iii) Ovaries edema(677)(678)
iv) Central nervous symptoms such as nervousness, sleeplessness, headaches, visual disturbances, vertigo(682), irritability, mood swings, feeling down(680)
v) Bloating(682) and hot flushes(681).
vi) Nausea, vomiting, and dermatitis(683)
(vi) Women with BRCA mutation carriers may be at increased risk of invasive epithelial ovarian cancer (IEOC)(669).
(v) Risk of ovarian cysts(676)
(vi) Risk of ovarian cancer(684)(685)
(vii) Risks of melanoma and thyroid cancer(679).

3. Human Chorionic Gonadotropin (HCG)
a) The effectiveness of HCG
Human Chorionic Gonadotropin (HCG) is a hormone secreted by specialized cells called trophoblasts and later by the placenta following implantation(686)(687). The drug has been used conjunction of IVF for the treatment of infertility to induce ovulation by stimulating the release of a mature egg(688)(689), approximate 36 hours after taking it. HCG not only pinpoint the best time for sexual intercourse with success conception or assisting intrauterine insemination in egg retrieval(690)(691). The medicine also used for treatment to obese women with PCOs for weight loss(692)(693)(694) with controversy.

b) Side effects
Although the side effects of HCG is not common, some women may experience(697)
i) Headaches
ii) Irritability
iii) Restlessness, slight
iv) Water retention
v) Breast tenderness
vi) Depression
Other risks may include
(vii) Obstetrical complications, adverse perinatal outcomes, structural congenital abnormalities, chromosomal abnormalities, imprinting disorders, and childhood cancer(697)
(Vii) Ectopic pregnancy(689)
(viii) Blurred vision and scotomas(695).
(ix) Multiple pregnancies, miscarriage, ovarian hyperstimulation syndrome (OHSS)(696)

4. Human menopause gonadotropin(HMG)(Menotropin)
a) The effectiveness of HMG
HMG contains natural FSH and LH, is a purified form of urine of postmenopausal women(699). By stimulating the production of LH and FSH to the right levels, the drug induces ovulation and develop mature follicles(700). The medication may be also used if clomiphene therapy and other medication have been failed to induce ovulation(701).

b) Side effects
i) Risk of multiple pregnancies, and spontaneous abortion(702)
ii) Ovarian enlargement (Caused by over-stimulation)(705)
iii) Ovarian hyperstimulation syndrome (OHSS)(703)(704)
iv) Risk of miscarriage(704)
v) Risk of ovarian cancer(706)(707)
vi) Shortness of breath, dizziness, pelvic pain, nausea, and vomiting(708).

5. Dexamethasone
a) The effectiveness of dexamethasone
Dexamethasone is a synthetic member of the glucocorticoid class of steroid hormones and a prescribed medication for fertility to induce ovulation(709) for artificial insemination(710)by suppressing the androgen levels(711), resulting in increasing the chance of fertility(710).

b) Side effects
i) Risk of miscarriage(710)
i) Risk of bone growth at different developmental stages(713)
Other side effects, according to Rxlist(712) include
sleep problems (insomnia), mood changes;
acne, dry skin, thinning skin, bruising or discoloration;
slow wound healing;
increased sweating;
headache, dizziness, spinning sensation;
nausea, stomach pain, bloating;
muscle weakness; or
changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

6. Surgery
Surgery is not commonly performed. If necessary, PCOs infertility can be treated by either a laparoscopic surgery also is known as ovarian drilling(714)(715), the surgical procedure is not proven to be effective for women with PCOs infertility if used alone with potential surgical risks(714) or wedge resection(716), only to PCOs patients did not conceive with standard ovulation induction protocols(717). It is to your benefit to forgo this type of expensive treatment in favor of others such as IVF.


B. Oral Contraceptive
Only if pregnancy is not the concerns
1. The benefits of oral contraceptive
a. Reduce total testosterone levels and acne(718)
b. Improve lipid profiles, hsCRP levels, insulin resistance and hyperandrogenism(719)(720)
b. Regular menstrual cycle(720)
c. Lower androgen hormone levels(720) and lessen the amount of excess hair growth (also called “hirsutism”)(720)(721).
d. Decreased menstrual Cramps, or No Cramps(722)
e. Reduce the risk of colorectal and endometrial cancers(723), ovarian cancer(724), and ovarian cysts(725).


2. Risks and side effects
a) Risks
i) Risks of blood clots(728), stroke(728), heart disease(726), cervical cancer(724) and breast cancer(727)(723)
ii) Hypertension(726) and increase heart rate(726) caused by the thickening of blood in arteries.

b) Side effects
i) Bleeding and spotting(729)
ii) Weight gain(730)(731)(732)(inconclusive result)


In Weight Loss Management of PCOs Perspective

Weight loss(733)(734) for obese patients is one of the most vital factors to reduce PCO symptoms(735)(737) and the risk of PCO complications(736)(737). Some researchers found that 5-10% of weight low will improve PCOs features(737) by 25%, including pregnancy(738). How can you lose weight and maintain a healthy body for a healthy conception?

The macronutrients
1. Carbohydrate
Carbohydrate is simple sugar and complex sugar found abundantly in food, such as fruits, veggies, bread, cereals, and other grains.....with major functions in the production of energy for nourish cells, tissues, and organs, through converting to blood sugar by digestive system(739).
a) Simple sugar
It contains food with no more than 2 simple sugar connected together. It can be released quickly into your bloodstream(740)(741).
b) Complex sugar
It contains food with a long chain of simple sugar connected together because most of them contain a high amount of fiber. Foods will be digested slowly and sugars are released slowly into your bloodstream(740)(741).

2. Protein
Protein is important in building our body tissues. Its function is to carry out most of the reactions involved in metabolism and DNA replication, DNA repair, and transcription(742), therefore, it is important element in preparing for the growth of the baby once you are pregnant(743). Dr. Kramer MS1 and Kakuma R. at McGill University said "Balanced energy/protein supplementation improves fetal growth and may reduce the risk of fetal and neonatal death. High-protein or balanced protein supplementation alone is not beneficial and may be harmful to the infant. Protein/energy restriction of pregnant women who are overweight or exhibit high weight gain is unlikely to be beneficial and may be harmful to the infant"(744).

3. Fat
Fat is essential for the digestive system in absorbing several types of vitamins, maintaining healthy skin, hair, body temperature and healthy cell growth(746), stored as energy through its component of glycerol and expression and activity of the lipases of adipose tissue(745). Not all fats are bad(747)(748), by choosing more good fat and limited intake of the bad one, you are ensuring yourself for a healthy pregnancy. Fats include saturated fat, trans fat, monosaturated fat and polyunsaturated fat(749)


The Glycemic index?

Glycemic index is a guide or table which rates all carbohydrates according to how fast they release glucose into the bloodstream. The fastest release one has a high GI index. Preferences for only taking foods with low GI index, if you want to lose weight(751)(750), but following low-GI dietary prescription is difficult(750)

The Best PCOs Diet for weight loss

Most women with PCOs are likely overweight or obese according to the BMI index. Most diet plans require the endurance and determination of the participants(750).
1. A complex carbohydrate, low protein, and only unsaturated fat diet
This is the one which I have made for my diabetic friends, it works well for her. The plan not only helps to stabilize her blood sugar but also maintain her weight within the normal range of BMI index. If you would like to try, please first consult with your doctor.
a) No Simple sugar
b) Only eat vegetables (prefer rainbow colors), nuts, seeds and limited intake of fruits containing high amount of sugar such as melon. Fruits only should be eaten as soon as after each meal.
b) Limited intake of protein to 1/3 of the daily amount. Meat must be lean (prefer chicken breast) and eat together with vegetables and fruits to further delay the release of sugar.
c) Only use unsaturated fat as toping. Stirring is allowed with occasional fried foods and others.
d) Drink at least 8 cups of pure water and milk ( prefer one cup of green tea and a cup of morning coffee with no sugar and a little bit of milk). Since vegetables contain a high amount of fiber, drinking more water can prevent constipation.
e) 1/4 tablespoon of cinnamon each in the morning and evening. It is said that cinnamon stimulates the production of insulin(752) and regulates the blood sugar in the bloodstream(753).
The diet works well for her in maintaining a healthy weight and stabilizing and lowering the blood sugar. Since she does not have PCOs and problems of infertility, it is for your benefit to check with your doctor before applying.

2. Low carbohydrate and high protein diet (Modified diet with a high-protein, low-glycemic-load (30% of daily energy from protein plus low-glycemic-load foods)

This is a type of diet most recommended by a dietitian for women with PCOs and wanted to get pregnant.
a) If you have symptoms of PCOs and absence of period, you must see your doctor before attempting any weight loss program.
b) If you have a kidney problem, do not attempt this program
c) If you have symptoms of PCOs and irregular menstrual period, this diet plan is helpful
The low carbohydrate diet and high protein diet limit daily intake of the number of carbohydrates and encourage you to take a high amount of protein without restricting yourself to the amount of fat intake. With low levels of carbohydrate in the body, your body needs to burn its fat stores for energy, leading to weight loss(754) and lowering the levels of fasting LDL-cholesterol, HDL-cholesterol, glucose, insulin, free fatty acid, and C-reactive protein concentrations(754). In theory, it works well for women with PCOs because by suppressing the levels of insulin(755)(756), The diet improves ovulation(755) and reduce the levels of testosterone(756). It is also recommended that you also engage in moderate exercise to improved the physical fitness level of healthy, pregnant as well(757)(758).

The Common Weight Loss Foods

Epidemiological studies, linking certain foods in reduced weight loss for obese individuals have produced certain positive results(759)(760)(761), but researchers emphasized that weight loss can not be in the expenses of intake of nutrients(762).
1. Oats
Oat is a species of cereal grain grown for its seed and was first cultivated in Europe but is now grown all over the world, especially in Scotland and England. It is one of the good crops to plant in the poor soil after crops are harvested in the Fall(763.
Oat, rich in beta-glucan, may hold a magic power in the regulation of metabolism and liver-protecting effect. According to Chung-Shan MedicalUniversity, consumption of oat reduced obesity, abdominal fat, and improved lipid profiles and liver functions with no adverse effects(764). Whole-grain ready-to-eat oat cereal, in a randomized study of 144 Free-living, overweight and obese adults had favorable effects on fasting lipid levels and waist circumference(765). Another study suggested that at-derived beta-glucan, combined with moderate exercise also improved the lipid profile and caused a decrease in weight(766).

2. Salmon
Salmon is the common name for Salmonidae. They are anadromous, born in freshwater, migrate to the ocean, then travel thousands of miles in the deep sea cold water throughout their life cycle and within to five years returning to the exacted location where they were born to reproduce and die(767).
Dietary salmon oil, in the rat study, showed reduced weight loss in mice model, but induced weight gain in recombinant inbred strains. These findings may suggest that body weight response to salmon oil feeding is controlled by multiple genes(768). A novel oral form of salmon calcitonin (sCT), according to the study at 1Nordic Bioscience, also showed that salmon oil improves fasting and postprandial glycemic control and insulin sensitivity and may be considered as a promising agent for the treatment of obesity-related insulin resistance and type 2 diabetes patients(769)(770).

3. Brown rice
Brown rice or unpolished rice is a kind of whole, natural grain with the very brown color of which only the outermost layer of the rice kernel is removed, thus preventing the loss of nutrients(771).
The study of the weigh effect of brown rice on metabolic parameters in type 2 diabetes, showed a positive effect of consumption of the brown rice (LB) in association with a decreased waist circumference in type 2 diabetic patients(772). Another randomized study of forty women between 20 and 35 years of age in the comparison of white rice and mixed rice of weight control, including brown rice, indicated that meal replacement with mixed rice was superior to replacement with white rice in weight control, improving antioxidant enzyme activity(773).

4. Chicken
Chicken are domesticated fowl belonging to the subspecies of Gallus domesticus and are raised all over the world for its delicious meats and eggs. It can be roasted, broiled, grilled or poached into a very delicious, tasteful and nutritious meal(774).
In the comparison of weight loss and total lipid profile changes in overweight women consuming beef or chicken, researchers at 1Rippe Lifestyle Institute, Shrewsbury showed an interesting result of weight loss and improved lipid profile can be accomplished through diet and exercise, regardless to dietary protein source including lean beef or chicken(775). But the study at the University of Navarra showed an opposite result in the study of frequent consumption of selenium-enriched chicken meat(776), it may be the result of the presence of antioxidants selenium in the meat.

5. Water
According to Virginia Tech, consuming 500 ml water prior to each main meal may lead to greater weight loss than a hypocaloric diet alone in middle-aged and older adults, because of it acutely reduces meal energy intake(EI)(777) but not in younger subjects(778). The Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial, suggested that replacing caloric beverages with water or diet beverages induced 2% to 2.5% weight loss(779).

6. Nuts
Dietary consumption of nuts with rich sources of multiple nutrients is associated with health benefits and weight loss, epidemiologically. but in well-controlled nut-feeding trials, no changes in body weight were observed(780b). Pistachio nuts, a member of the cashew family, can be consumed as a portion-controlled snack for individuals restricting calories to lose weight without concern of weight gain(781b)(782b).

7. Green tea
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Green tea has been a precious drink in traditional Chinese culture and used exceptionally in socialization for more than 4000 thousand years. Because of their health benefits, they have been cultivated for commercial purposes all over the world.
According to Maastricht University, caffeine intake and green tea supplementation are associated with improved weight maintenance, partly through thermogenesis and fat oxidation, in a randomized placebo-controlled double-blind parallel trial in 76 overweight and moderately obese subjects(783b). Catechins the antioxidants found abundantly in green tea, significantly decreased body weight and significantly maintained body weight after a period of weight loss, depending on the moderators of habitual caffeine intake and ethnicity(784b). In a high-protein diet, the green tea-caffeine mixture failed to exert the same effect on body weight maintenance(785b).

8. Coffee
Coffee made from the roasted seeds of the genus Coffee, belonging to the family Rubiaceae native to southern Arabia. Coffee may consist of certain substances.
In a randomized, double-blind, placebo-controlled, linear dose, crossover study, green coffee extract, consistent with human and animal studies and a meta-analysis may be an effective nutraceutical in reducing weight in preobese adults(786b). Mannooligosaccharides (MOS), extracted from coffee, exhibited a potential functional use for weight management and improvement in adipose tissue distribution, but varying in gender(787b)
Unfortunately, green coffee extract (GCE), according to the University of Exeter, in reviews of the effect against weight loss of existed data, showed a significant poor methodological quality and suggested that more rigorous trials are needed to assess the usefulness of GCE as a weight-loss tool(788b). Another study reported a case of Brazil Potent Slimming Coffee and possibly also other weight-loss products may be contaminated with sibutramine which can cause severe adverse reactions, mentally(789b).

The Common Weight Loss Herbs


Epidemiological studies, linking herbal medicine, in the induction of weight loss have been inconclusive.
Some researchers suggested that the intake of certain herbal medicine may enhance appetite suppression. According to the Georgetown UniversityMedical Center, average daily food intake was decreased only with the herbal formulation, not the phenylpropanolamine (PPA) at the low and high doses, in comparison to the effectiveness among herbal formulation and a commonly available(780a). Other researchers insisted that using herbs and supplements to induce weight loss should be taken with care, as a considerable number of reports have been published on hepatotoxicity associated with herbal products attributed with weight-reducing properties(781a)(108)(1043)(1044). The College of Medicine, Ohio State University insisted that various dietary, lifestyle and psychologic factors are involved in the etiology of Prameha, particularly in relation to disturbances in fat and carbohydrate metabolism(1043), without effective management, obtaining a workable weight loss plan may be extremely difficult.
1. Ephedra (Ma Huang)
Ma Huang is also known as ephedra. The acrid, slightly bitter and warm herb has been used in TCM to promote urination and sweating, and rid of cold, sooth wheezing asthma, etc. as it calms dyspnea, asthma, cough, etc., by enhancing the functions of lung and bladder channels(888)
Ephedra sinica, the Chinese herb may be effective in induced weight loss. According to Dongguk University, certain chemicals found in Ephera showed an association with changes of BW and BMI through alteration of gut microbiota varied by indigenous microbiota of each subject(1007). The combined study of a low-calorie diet and Ephera, In 125 otherwise healthy obese women, showed effectively in reducing BMI. RMR changes not compensated for by the herbal medicines tried. Resting metabolic rate (RMR) change seemed to be affected by constitution and body composition rather than by medicine(1008). The Dongeui University study of composition GGEx18( Laminaria japonica, Rheum palmatum, and Ephedra sinica) in high fat diet-induced obese mice suggested that GGEx18 improves obesity through skeletal muscle AMPK and AMPK-stimulated expression of PPARα and its target enzymes for fatty acid oxidation, through inhibited lipid accumulation, and similar activation of genes(1042).

Please note that due to its adverse reactions of palpitations, stress, headache and insomnia and stroke, heart attacks, cardiac arrhythmias, seizures and psychotic, the Dutch Inspectorate for Health Care and the Ministry of Health in Canada have recently requested a market recall of some ephedrine-containing herbal products in response to above adverse reactions. In the Netherlands, the status of Ephedra-containing products is currently reconsidered(790).

2. Ginseng
Ginseng is a slow-growing perennial plant with fleshy roots, the genus Panax, belonging to the family Araliaceae. Depending on the climate where it grows, ginseng can be classified mainly into Panax ginseng Asian ginseng (root), Red ginseng, wild ginseng, American ginseng (root)(791).
In 10 obese middle-aged Korean women who took Panax ginseng extracts for 8 wk, showed effectively in influence on gut microbiota in promoting weight loss but depending on the composition of gut microbiota prior to ginseng intake(792). In mice fed on a high-fat diet, ginseng saponin and ginsenosides not only exerted anti-obesity effects via the modulation of physiological lipid metabolism in vivo or intracellular signaling in cell culture systems but also promoted anti-obesity effects, through abnormal physiology via HFD. Leptin, insulin, and adiponectin, which carry out critical functions in energy and lipid metabolism(793).

3. Zingiber Officinale(Ginger)
Ginger (Zingiber officinale) or ginger root is the genus Zingiber, belonging to the family Zingiberaceae, native to Tamil. It has been used in traditional and Chinese medicine to treat dyspepsia, gastroparesis, constipation, edema, difficult urination, colic, etc.(794).
According to the Tehran University of Medical Sciences, Slimax (extract of several plants including Zingiber officinale and Bofutsushosan) showed a significant decrease in body weight or inhibition of weight gain(795). The composition of multi-ingredient supplements containing primarily raspberry ketone, caffeine, capsaicin, garlic, ginger, and Citrus aurantium, also found the improvements in body composition, waist, and hip girth, in an eight-week diet and exercise weight loss program(796). In a comparison of the weight loss effect of Orlistat, a pharmacological agent promoting weight loss and ginger (Zingiber officinale Roscoe, Zingiberaceae) in male albino rats, researchers at the Ain Shams University Cairo, found that ginger has a great ability to reduce body weight without inhibiting pancreatic lipase level, or affecting bilirubin concentration, with positive effect on increasing peroxisomal catalase level and HDL-cholesterol(797).

4. Cissus quadrangularis (CQ)
Cissus quadrangularis is an ancient herb used to treat a variety of indications, belonging to the grape family, probably native to India or Sri Lanka. A randomized, double-blind, placebo-controlled design involving 123 overweight and obese persons (47.2% male; 52.8% female; ages 19-50). conducted by the University of Yaoundé I, Cissus quadrangularis showed statistically significant net reductions in weight and central obesity, as well as causes of metabolic syndrome(798). In a comparison of the effectiveness of Cissus quadrangularis-only and a Cissus quadrangularis/Irvingia gabonensis combination, on weight loss in overweight and obese human subjects, Cissus quadrangularis-only group showed significant reductions on all variables compared to the placebo group, the Cissus quadrangularis/Irvingia gabonensis combination resulted in even larger reductions(799). CQR-300, a proprietary extract of Cissus quadrangularis, also showed a significant reduction in weight and blood glucose levels, while decreasing serum lipids thus improving cardiovascular risk factors, according to the University of Yaoundé I,(800).

5. Sambucus nigra
Elder also known as Common Elder, is a shrub or small tree of the genus Sambucus of 30 species, belonging to the family Adoxaceae, native to the temperate-to-subtropical regions of both the Northern Hemisphere and the Southern Hemisphere. The herb has been used in traditional and herbal medicine to treat constipation, colic, diarrhea, colds, flu, bronchial and upper-respiratory, irritation of the skin, rheumatism, etc.
The composition of supplement with Sambucus nigra and Asparagus Officinalis study, showed effectiveness in reduced weight, blood pressure, enhanced physical and emotional well-being and the quality of life had significantly improved (ITT analysis)(801). The Tehran University of Medical Sciences, Sambucus nigra study, showed a significant decrease in body weight in numbers of animal studies(802).

6. Asparagus Officinalis
Asparagus is a flowering plant belongs to species the genus Asparagus, native to the western coasts of northern Spain, north to Ireland, Great Britain, and northwest Germany, northern Africa, and western Asia. Asparagus has been used from early times as a vegetable and medicine, because of its delicate flavor and diuretic properties(803). Asparagus Officinalis L. powder tablets provided 19 mg saponins per day study showed the effectiveness of the tablets in reduced mean weight, blood pressure, and enhanced physical and emotional well-being and the quality of life with the rate of very good or good by most of the completers(804). In 12 weeks supplementation of a botanical extract-based weight loss formula, including Asparagus, researchers at the Poznan University of Medical Science, indicated a significant change of the Body Composition Improvement Index (BCI), induce greater weight loss than placebo, probably through a concurrently performed exercise program recommended strategy for lifestyle modification(805).

7. Slimax
Slimax (extract of several plants including Zingiber officinale and Bofutsushosan), in the reviews of the database of studies published, showed a significant decrease in body weight. In 41 animal studies, the formula was found to be effective in significant induced weight loss or inhibited weight gain(806).


The Weight Loss Vitamins C

Vitamin C, also known as L-ascorbic acid, is a water-soluble vitamin, found in fresh fruits, berries, and green vegetables. It is best known for its free radical scavengers activity and regenerating oxidized vitamin E for immune support.

1. Vitamin C deficiency and incidence of obesity
Vitamin C and other nutrients deficiency not only are associated with the risk of Obesity(807) but also enhances the risk of lipids, inflammation and insulin resistance(808). According to the research team at Universidad Autónoma de Querétaro, there is an associated link between Obesity and Zinc and vitamins A and C concentration in women from rural Mexico, in a fasting blood sample analysis (809).

Although genetic susceptibility to obesity is associated with gene polymorphisms affecting biochemical pathways which also impacted by specific foods and nutrients. According to Dr. Johnston CS., vitamin C depletion is associated to positively related to body mass, individuals with adequate vitamin C status oxidize 30% more fat during a moderate exercise bout than individuals with low vitamin C status(810)

2. Vitamin C, the protective effect against obesity
Endothelial dysfunction has found to be associated with the incidence of obesity(811). The study of 76 healthy subjects (50 men and 26 women aged 21-45 years) obese subject, showed a positive effect of vitamin C and indomethacin in reduced oxidative stress contributed to endothelial dysfunction in human obesity(812).

In the evaluation of the potential inhibitory activity on α-glucosidase and pancreatic lipase of Citrus spp. fruits of Spanish origin, grapefruit, containing higher contents of phytochemicals, vitamin C, is found to have a great value for nutrition and treatment of diet-related diseases(813).
L-Ascorbic acid, in the study of whether the vitamin would facilitate the anti-obesity effects of chitosan and psyllium husk in vivo, indicated that addition of vitamin C in diet influences the reduction in body weight gain and food efficiency ratio, and increases in total fecal weight and fecal fat excretion in guinea pigs fed a high-fat diet(814).

Taking all together, deficiency of vitamin C and other nutrients are associated to increase the risk of obese incidence. Vitamin C may be effective in induced weight loss for obese subjects due to its positive interaction in inhibiting oxidative stress causes of endothelial dysfunction. Daily ingestion of high-dose vitamin C may be considered safe, but in rare incidence, overdoses in a prolonged period of time may cause intra-renal oxalate crystal deposition, fatal nephrotoxicity(815)(816).


The Weight Loss Vitamin D

Vitamin D is a fat-soluble secosteroid found in a small amount in few foods, including salmon, mackerel, sardines, and tuna. The vitamin plays an important role in the modulation of cellular proliferation, apoptosis induction, tumor growth suppression and promotion in the absorption of minerals, including calcium, iron, magnesium, phosphate, and zinc.
1. The serum level of vitamin D
Low levels of micronutrients, including vitamin D, are most common among overweight and obese children. According to the study, low serum 25-hydroxyvitamin D3 (25(OH)D) levels not only are associated with insulin resistance and cardiovascular disease risks(817) but also the incidence of obesity(818).

The study of Suspected Nonalcoholic Fatty Liver Disease in Chinese American Children also supported the link of obesity and metabolic syndrome among Chinese American children and suggested that testing for metabolic disorders and low vitamin D levels would be necessary to identify the early indication of NAFLD in childhood will allow for intervention with lifestyle modification, providing a means to reduce the prevalence of NAFLD in children and adults(819).
DR, Peterson CA, and Dr. Belenchia AM. told PubMed "There is a well-established inverse relationship between vitamin D status and obesity; however, it is unknown as to whether vitamin D deficiency contributes to, or is a consequence of obesity"(820). Some researchers suggested that correction of poor vitamin D status through dietary supplementation may be an effective addition to the standard treatment of obesity and its associated insulin resistance(821) as vitamin D deficiency is accounted for the secular trends in the prevalence of obesity and for individual differences in its onset and severity(822).

2,. Vitamin D and adiponectin
A suggestion of association of low levels of Vitamin D and adiponectin is associated with obesity instead of vitamin D itself(823).
Adiponectin is a protein involved in regulating glucose levels as well as fatty acid breakdown.
According to the study by the Università del Piemonte Orientale, in the confirmation Adiponectin tight association with obesity and diabetes mellitus, suggested that multimeric adiponectin may be a key plasma protein that links vitamin D deficiency to pediatric obesity(824).

In support, the link between Vitamin D and adiponectin and obesity, the Ramathibodi Hospital, Mahidol University study showed that circulating adiponectin appears to be inversely related to beta-cell dysfunction in addition to insulin resistance only in obese women(825). Other in the study insisted that since low serum levels of 1α,25-dihydroxycholecalciferol (DHCC) attenuates (monocyte chemotactic protein-1)MCP-1 and adiponectin production in human adipocytes, thereby reducing the expression of both pro- and anti-inflammatory factors may explain the difficulties so far in determining the role of DHCC in insulin sensitivity and obesity in human(826). 

Low serum levels of vitamin D and vitamin D deficiency are associated to increase risk of obesity and obese complications through the involvement of various mechanisms. Overdoses of vitamin D supplements may cause excessive calcium absorption, calcification, Urinary stones, etc. Please make sure to follow the guideline of the Institute of Medicine of the National Academies.

Taking all together, there are subtle differences but correlation between diets, a monounsaturated fat-enriched diet-induced greater weight loss, a low-glycemic index diet enhanced menstrual regularity, a high-carbohydrate diet increased free androgen index, a low-carbohydrate or low-glycemic index diet-induced greater reductions in insulin resistance, fibrinogen, total testosterone, and high-density lipoprotein cholesterol, a low-glycemic index diet improved quality of life, a high-protein diet improved depression and self-esteem for a high-protein diet. Maximize weight loss control is important for women with PCOS regardless of dietary composition which should target all overweight women with PCOS through reducing calories with adequate nutritional intake and healthy food choices irrespective of diet composition(651).

The prevention and management and treatment In Herbal Medicine Perspective

Polycystic ovary syndrome (PCOS) is unpreventable in Western medicine. Early diagnosis and treatment may reduce the risk of its complications, including infertility, metabolic syndrome, obesity, diabetes, cardiovascular diseases, stroke, etc.

Reduce fat intake less than 30% of total calories with a low proportion of saturated fat and high in fiber from predominantly low-glycaemic-index-carbohydrate foods for patients with PCOs(827a). Calorie intake should be distributed between several meals per day with a restricted intake of snacks and drinks(827)(828).

The fertility herbs


Chaste tree berry
Chaste tree berry is a species of Vitex agnus-castus, genus Vitex, belonging to the family Lamiaceae, native to the Mediterranean region used in herbal medicine for thousands of year as an aphrodisiac herb and considered as Queen herb in tonifying female reproductive systems(869), including premenstrual problems(865) and menopause symptoms(866)(867)(868)(869). There was a report that reports chaste tree berry stems and leaves used by women as bedding "to cool the heat of lust" during the time of the Thesmophoria(870),
1. Androstenedione
Chaste berry tree contains androstenedione which is the common precursor of female sex hormone by converting to testosterone and the estrogens. through the enzyme aromatase(871) by acting as a weak partial agonist(872) of the androgen receptor to reduce the risk of hormone imbalance that causes infertility. Unfortunately, Epidemiological evidence suggested that androstenedione may contribute to the worsening of PCOS features as women with PCOs are found to associate to the high concentration of androstenedione(873)(874)(875).

2. Epitestosterone
Epitestosterone is an inactive epimer of the hormone testosterone which has been used to enhance athletic performance for some athletic during the competition(876)(877). The phytochemical is also found to improve sexual development(878), sexual desire and sexual arousal(879) induced fertility.

3. Hydroxyprogesterone and progesterone
Chaste tree contains plant hydroxyprogesterone which is a steroid hormone produced during the synthesis of glucocorticoids and sex steroids(880), including the corticosteroids and the androgens and the estrogens(881). The phytochemical also raises the levels of progesterone if it is loo low and reduces it when it is too high in the women's body(882), induced fertility.

4. Iridoid
The herb also containing iridoid as an intermediator of the biosynthesis of alkaloids improves the immune system in fighting against inflammation(883) and lessens the risks of immune system abnormal function in the production of antibody against sperm invasion(884).

5. Glycoside
Glycoside is a flavonoid acted as an antioxidant in increasing the immune system in fighting against forming of free radical as well as guarding our body against irregular cell growth infection and inflammation(885)(886), and reducing the risk of abnormal function of immune system in production of antibody against sperm invasion(884).

Side effects
According to Drug.com the most common side effects of taking chaste berry tree include
Acne; cramping; diarrhea; hair loss; headache; increased menstrual flow; stomach pain; tiredness, etc....(887).


Angelica Sinensis

Dang Qui (Angelica Sinensis) is a herb of Genus Angelica from the family Apiaceae, indigenous to China, used as a Queen herb in traditional Chinese medicine as anti-inflammatory(889), antispasmodic(890) and vasodilatory agent(891)(890), and to balance the hormones in women for a normal menstrual cycle and menstruation(890), reduce menopausal syndromes(888) and improve digestive system(890) and immunity(890).
1. Reproductive organs tonic
Traditional Chinese medicine views angelica roots as queen herb which has been used to enhance the productive system(892) for treatment of gynecological diseases(897) such as dysmenorrhea, amenorrhoea, menopause and promote menstrual health(892). It is said that angelica roots have the power to restore any deficiency caused by hormone imbalance(894)(895)(896).

2. Blood tonic
A reproductive blood tonic herb(894) not only helps to increase blood production(895) to replace blood loss for women after menstruation(893) but also increases the blood flow to the abdominal region(890)(891), for induction of healthy conception.

3. Digestive system
Bangui consists a digestive system protective effects(898) against gastrointestinal damage, but also increases the digestive system function(890) in absorbing essential vitamins and minerals(890), thereby reducing the risks of infertility caused by nutrients deficiency(899).

4. Blood and qi deficiency
Blood(896) and qi(890)deficiency may lead to the irregular menstrual cycle, absence of period or painful period(896). Angelica roots increase blood and qi flow(890), resulting in normalizing the function of reproductive organs(892)(897).

5. Kidney tonic
It is said that angelica root also helps to improve kidney function not only in regulating water and fluid through urinary extraction(900), but also improving kidney normal function in regulating the natural menstrual process(900) of the reproductive organs, induced fertility.

6. Immune system
Angelica root containing variety chemicals strengthens the immune system(903) in fighting against infection and inflammation(894)(889), thereby decreasing the risk of yeast infection during menstruation(891) as well as forming of irregular cell growth in the reproductive organs(901)(902)(903).

Side effects
1. It may cause skin inflammation and rashes if it is taken in high dose(904)
2. Since angelica root causes uterus constriction, the herb should be used on pregnant(904) unless with the approval of her herbalist(904).


Black cohosh

Black cohosh is a glabrous herbaceous perennial plant, producing large, compound leaves from an underground rhizome and belongs to the family Ranunculaceae used in traditional medicine in treating symptoms of all kinds of gynecological problems(905), including symptoms of premenstrual tension(907) and menopause(906)
1. Phytoestrogen
Phytoestrogen found it black cohosh showed to occupy the estrogen receptor sites in women's body(908), through its antiestrogenic and estrogenic effects(909), to induce hormone balancing may result in improving the chance of ovulation and fertility(910)(911).

2. Immunity
Black cohosh processes anti-inflammatory(913)(914) and antioxidant(914) effect through enhancing the immune system fighting against microbial(915)(916) invasion and irregular cell growth(917)(918) and other inflammatory diseases(913). According to the School of Medicine, WuhanUniversity black cohosh may be beneficiary for patients with coronary heart disease, atherosclerosis, pulmonary heart disease, and thrombosis through its anti-inflammatory effects(912).

3. Metabolic Syndrome
In rat model study, black cohosh and its triterpene-saponins showed to reduce high load with fat tissue in the PFD and in the knee joints, body weight, serum leptin, and cholesterol and glucose levels caused by metabolic syndrome, according to University Medical Center Göttingen(919). The consumption of black cohost also effectively decreases enhanced pituitary LH secretion, attenuates body weight gain, plasma lipids, and intra-abdominal fat (IAF) accumulation, lowers FPI and has no effects on uterine mass(920).

4. Fertility
Use conjunction with clomiphene citrate, black cohosh induced endometrial thickness, serum progesterone, and clinical pregnancy rate and cycle outcomes in some infertile couples(921). According to Assiut University, in the differentiation of relatively low pregnancy rates in CC induction cycles of clomiphene citrate in infertile couple, follicular-phase supplements cimicifuga racemosa or ethinyl oestradiol needed significantly fewer days for adequate follicular maturation, had a thicker endometrium and higher estradiol concentration at the time of human chorionic gonadotrophin injection with better outcome of pregnancy rate(922)(923).

5. Condense Tannins
It also contains condense tannin, a type of proanthocyanidin which has been used as nutritional and therapeutic supplements in Europe in promoting the function of flavonoids as an antioxidants(924)(925) to improve Immunity(926)(927) against autoimmune response induced infertility(962)(933) and microbial invasion(928)(929), but also maintain DNA integrity about irregular cell growth(930)(931).

6. Nervous Symptoms
Back cohost is said to contain chemical agents to bind the activities to serotonin receptors(939) in decreasing the risk of depression(936), anxiety(934), sleep problem(935) and emotional and physical stress(937)induced risk of infertility(938).


Side effects
1. Common side effects include
In high doses of black cohosh may cause abdominal pain, diarrhea, dizziness, headaches, joint pains, nausea, slow heart rate, tremors, visual dimness, vomiting, and weight gain, according to
University of Maryland Medical Center(941)(943)
2. Liver damage
Overdose of black cohosh may cause liver damage(940).
3. Digestive system
Overdose may cause occasional gastrointestinal discomforts, such as diarrhea; nausea and vomiting. sweating; constipation(942).
4. Etc.


Red Clover

Red clover is an herbaceous, perennial plant, native to Europe, western Asia, and northwest Africa, used traditionally in treating whooping cough(945), respiratory problems, and skin inflammations(945). menopause symptoms(945)(946)(947) and inflammatory diseases such as atherosclerosis and cardiovascular disease(944) by purifying the blood and clearing mucus from the lungs(948).
1. Isoflavones
Red clover contains isoflavonoid, one type of phytoestrogen used in regulating the levels of estrogen in the body by occupying the estrogen receptor site(949)(950)(951), through its estrogenic(951) and anti-estrogenic(952) effects in hormonal balancing for a better chance for fertility(953).

2. Neuroprotective effects
Formononetin (FMNT), an isoflavone found in red clover maybe next potential candidate used for neurodegenerative disorders(958)(959) in central nervous system as it significantly attenuated the cell loss induced by N-methyl-D-aspartate (NMDA) in primary-cultured cortical neurons, according to the study by Fourth Military Medical University, Xi'an(954). On the central nervous system, the herb also was found effective in improving anxiety(955)(856), profuse sweating, insomnia, memory loss, decreased sexual drives(956), depression(957), etc.

3. Metabolic syndrome(967)
Women with PCOs are associated with increased risk of metabolic syndromes such as metabolic syndrome risk factors high blood pressure, obesity, high cholesterol, and insulin resistance. Intake of red clover has shown effectively in reduced total serum cholesterol and low-density lipoprotein (LDL) cholesterol levels, triglyceride levels, and increased high-density lipoprotein (HDL) cholesterol(960)(961), lowered cardiovascular risk(962)(963), improved obesity(964) and insulin resistance(965)(966).
\
4. The weight loss of vitamin C
Vitamin C found abundantly in red clover has shown strong evidence epidemiologically in reducing weight loss for the obese population, especially for obese women with PCOs.
See The weight loss of vitamin C for more details
[Vitamin C and other nutrients deficiency not only is associated with the risk of Obesity(807) but also enhances the risk of lipids, inflammation and insulin resistance(808).
According to the research team at Universidad Autónoma de Querétaro, there is an associated link between Obesity and Zinc and vitamins A and C concentration in women from rural Mexico, in a fasting blood sample analysis (809).
Although genetic susceptibility to obesity is associated with gene polymorphisms affecting biochemical pathways which also impacted by specific foods and nutrients. According to Dr. Johnston CS., vitamin C depletion is associated to positively related to body mass, individuals with adequate vitamin C status oxidize 30% more fat during a moderate exercise bout than individuals with low vitamin C status(810)

Vitamin C, the protective effect against obesity
Endothelial dysfunction has found to be associated with the incidence of obesity(811). The study of 76 healthy subjects (50 men and 26 women aged 21-45 years) obese subject, showed a positive effect of vitamin C and indomethacin in reduced oxidative stress contributed to endothelial dysfunction in human obesity(812).
In the evaluation of the potential inhibitory activity on α-glucosidase and pancreatic lipase by Citrus spp. fruits of Spanish origin, grapefruit, contained higher contents of phytochemicals such as vitamin C, is found to have a great value for nutrition and treatment of diet-related diseases(813).
L-Ascorbic acid in the study, whether would facilitate the anti-obesity effects of chitosan and psyllium husk in vivo, showed addition of vitamin C in diet influenced the reduction in body weight gain and food efficiency ratio, and the increase in total fecal weight and fecal fat excretion in guinea pigs fed a high-fat diet(814)]

5. Immunity
Epidemiological studies suggested that red clover processes tenacious antioxidant(968)(969) and anti-inflammatory(970)(971) effects in fighting against bacterial and viral infection(972)(973) and inflammation(974), free radical(975)(976) causes of irregular cell growth(970)(977) and protecting DNA integrity(979).

Side effects
1. There are no side effects from red clover, but people take the herb for the first time may experience headache, nausea, and rash(980).
2. Do not use red clover during pregnancy as the herb may increase the risk for vaginal prolapse before the term(981)
3. Risk of bleeding due to its anticoagulant effects(982).


Licorice


See the common herbs used for the treatment of PCO
[Gan Cao is also known as the Licorice root. The sweet and neutral herb has been used in TCM as anti-allergy(856), anti-inflammation(855), anti-ulcer(857), anti convulsion(858), oxidative stress(858) and to treat stomach weakness, tired and lack of strength, palpitation, and shortness of breath, cough with abundance of phlegm, stomach and solar plexus pain(859), etc., as it tonifies the Spleen, Benefits the Qi, moistens the Lungs, calms cough, deaf or acute pain, by enhancing all 12 channels(859).

1. Licorice, in a review of 33 studies of herbal medicine for the management of polycystic ovary syndrome(PCOS), showed strong evidence in improved metabolic hormone profile and improved fertility outcomes and regulation of ovulation and inhibition of hyperandrogenism in PCOS(860). In model rats experiment, Ganshao Paste (CGP), also decreased serum levels of LH, T, and FSH and increased of serum estradiol (E2), and progesterone (P)(861)(860)(865). According to the University of Natural Resources and Life Sciences Vienna, licorice may have a potential effect on metabolic syndrome(862) in women with PCOs.]

2. Blood flow
Licorice improves the blood flow in the body by exerting its anti-thrombosis(983) and inhibiting the levels of bad cholesterol(984)(985) and triglyceride levels(985) and increasing HDL-cholesterol content(984) in reduced risk of cardiovascular disease(985) and blood stagnation(897) in the abdominal region induced induced infertility(986).

3. Glycyrrhizin
Glycyrrhizin, one of the main ingredients from licorice, exhibited anti-inflammatory effect pharmacologically in the treatment of inflammatory diseases(988)(989)(990), lowered high serum testosterone levels in oligomenorrheic or amenorrheic women, and induced conception in some women(991). As an antioxidant, the phytochemical also inhibits irregular cell growth(992)(993) and microbial invasion(994)(995) causes of cancers(992)(993) and infection and inflammation(994)(995) respectively. in adrenocortical function and behavior, it also regulated the levels of cortisol(996), induced by overproduction of serotonin cause of hormone imbalance(997).

4. Phytoestrogen
See phytoestrogen in black cohosh
[Phytoestrogen found it black cohosh showed to occupy the estrogen receptor sites in women body(908), through its antiestrogenic and estrogenic effects(909), to induce hormone balancing may result in improving the chance of ovulation and fertility(910)(911)].

5. Lecithin
Lecithin is a fat-like substance called a phospholipid improved lipid transfer, cholesterol efflux, HDL genesis and remodeling at the blood-brain barrier (BBB)(998). against cells from oxidation surrounding the brain(999), in reducing psychotic symptoms(1002) such as stress(1000)(1001), and depression(1002).
Side effects
1. It may raise blood pressure(1003)(1004(1006)
2. Long term usage of large dosage can also cause edema(1004)(1006) and hypokalemia(1004)(1005)(1006).
3. Overdose can be toxic(106), in inducing rhabdomyolysis or myoglobinuria(1006).
4. Etc.

White willow

White willow is also known as Salix alba in herbal medicine, native to Europe and western and central Asia, used in traditional medicine as pain reliever(1007)(1008), anticancer(1009)(1010), antimicrobial(1013), antioxidant(1014)(1015), anti-inflammatory(1011)(1012) and fertility-enhancing herb(1016).
1, Antiestrigenic effects
White willow processes antiestrogenic effects(1017) by blocking proliferation in hypersensitive cells (1018) which cause estrogenic diseases, including breast cancer(1019) and metabolism imbalance(1020) diseases, such as obesity and diabetes(1021).

2. Salicylic acid
Salicylic acid, a chemical compound converted from salicin found abundantly in white willow has shown to process anti-acne(1022)(1023) one of many symptoms of PCOs) effects, probably through its antioxidant activity(1026) in blocking elevated production of sebum by hyperactive sebaceous glands and blockage of the follicle(1022). According to Telemark Hospital, the acid may also be beneficiary for increased the clinical pregnancy rate when used conjunction with Vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI)(1024) and protective against fetal losses(1025), through its anti antithrombotic property(1025). The synthetic version of salicylic acid has also shown to consisting of aspirin's cardioprotective effects through its antithrombotic and anti-inflammatory actions(1027).

3. Immune system
The antioxidant(1028)(1029) and anti-inflammatory(1030)(1031) effects of white willow enhance immune system fighting against microbial invasion and guarding our body DNA integrity(1033) against irregular cell growth(1032)(1033) through inhibiting the effect of intermediate enzymes and other mechanisms(1027)

4. Vitamin C
Natural vitamin polypeptide C white willow found in white willow not only is found to consist the weight loss property(See the weight loss vitamin C)[
Vitamin C found abundantly in red clover has shown strong evidence epidemiologically in reducing weight loss for the obese population, especially for obese women with PCOs.
See The weight loss of vitamin C for more details
[Vitamin C and other nutrients deficiency not only is associated with the risk of Obesity(807) but also enhances the risk of lipids, inflammation and insulin resistance(808).
According to the research team at Universidad Autónoma de Querétaro, there is an associated link between Obesity and Zinc and vitamins A and C concentration in women from rural Mexico, in a fasting blood sample analysis (809).
Although genetic susceptibility to obesity is associated with gene polymorphisms affecting biochemical pathways which also impacted by specific foods and nutrients. According to Dr. Johnston CS., vitamin C depletion is associated to positively related to body mass, individuals with adequate vitamin C status oxidize 30% more fat during a moderate exercise bout than individuals with low vitamin C status(810)


Vitamin C, the protective effect against obesity
Endothelial dysfunction has found to be associated with the incidence of obesity(811). The study of 76 healthy subjects (50 men and 26 women aged 21-45 years) obese subject, showed a positive effect of vitamin C and indomethacin in reduced oxidative stress contributed to endothelial dysfunction in human obesity(812).

In the evaluation of the potential inhibitory activity on α-glucosidase and pancreatic lipase by Citrus spp. fruits of Spanish origin, grapefruit, contained higher contents of phytochemicals such as vitamin C, is found to have a great value for nutrition and treatment of diet-related diseases(813).
L-Ascorbic acid in the study, whether would facilitate the anti-obesity effects of chitosan and psyllium husk in vivo, showed addition of vitamin C in diet influenced the reduction in body weight gain and food efficiency ratio, and the increase in total fecal weight and fecal fat excretion in guinea pigs fed a high-fat diet(814)].

but also improves the immune function in fighting against the forming of free radicals(1034) and foreign invasion(1035) but also increases the blood flow to the reproductive organ(1036)(1037)(1038) through reducing oxidant stress, increasing NO bioavailability(1037) of which may reduce risk sexual libido(1038) and enhance the chance of conception(1039)(1040)(1041).


Side effects
1. Risk of anaphylactic reaction to patients with a history of allergy to salicylates(1042).
2. Overdose of white willow may cause digestive disorder such as nausea and stomachache(1044)
3. Do not use the herb(1043)
4. If you are aspirin allergy/sensitivity,
5. If you are taking anticoagulants or "blood thinners," and
6. On children with flu-like symptoms or Reye's syndrome.
(4,5,6) According to the author of the PCOS section in Dr. Romm’s 2010 book Botanical Medicine for Women’s Health (Churchill Livingstone, 2010), Angela Hywood, ND, illustrates the potential that herbs offer for this complex condition by discussing a successful case report.


Insulin resistance improvement and/or anti metabolic syndrome herbs


Astragalus (Astragalus membranaceus)(1045)


Huang Qi or Bei Qi is also known as Astragalus root. The sweet herb has been used as diuretic agent and to lower blood pressure, increase blood pressure, lessens proteinuria, improve endurance, protect liver function, regulate blood sugar, etc. as it tonifies Qi, raises Yang, strengthens the Defensive-Qi and the Exterior, expels toxins, etc. by enhancing the functions of lung and spleen channels(1045).


Ingredients
1. Astragaloside I,
2. Astragaloside II,
3. Daucosterol,
3. Beta-sitosterol,
4. Palmitic acid
5. Astragalus saponin A, B, C
6. Astramenbrangenin
7. Kumatakenin,
8. Choline,
9. Betaine,
10. Folic acid
11. Calyxosin,
12. Formononetin,
13. Cycloastragenol,
14. Astragaloside III, IV
15. Antibacterial ingredient,
16. L-3-hydroxy-9-methoxpterocarpan
17. Etc.


Epidemiological studies showed that Astragalus polysaccharides (APS) ameliorates insulin resistance(1046)(1047) (IR) in rat cells and to elucidate the associated mechanisms, including increasing adiponectin secretion and reducing IL-6 secretion(1046), decreasing myostatin expression(1047), improving beta-cell function(1049), regulating insulin signaling in insulin-resistant skeletal muscle(1047)(1048). insulin resistance-related mRNA expression(1049), etc.
In metabolic syndrome, including increased body weight(1050), mild hypertension(1050), hyperinsulinemia(1050), hypertriglyceridemia(1050), impaired glucose tolerance(1050)(1053) and impaired endothelium-dependent vasorelaxation(1050)(1051)(1052), astragaloside IV, a major constituent found in astragalus showed effectively in ameliorating metabolic syndrome(1050)(1052), probably through its antioxidant(1051), inhibition of abnormal TNF-alpha-induced intracellular free Ca(2+) accumulation in endothelial cells(1052), decreasing the elevated expression and activity in the skeletal muscles(1053).


Alfalfa(1054)


Alfalfa is a flowering plant in the genus Medicago, belonging to the family Fabaceae, It has been cultivated all over the world as hay for cattle feeding. The leaves, sprouts, and seeds to make medicine has been used in traditional medicine over thousands of year to treat high cholesterol, asthma, osteoarthritis, rheumatoid arthritis, diabetes, enhance the digestive system, bleeding disorder, kidney, and urinary tract infection, etc. North American aboriginal has used Alfalfa seed as food, such as making bread and mush(1054).


Nutrients
1. Essential amino acids
2. Calcium
3. Magnesium
4. Potassium
5. Iron
6. Phosphorus
7. Zinc
8. Beta carotene
9. vitamin C
10. vitamins D
11.Vitamin E
12. Vitamin K
13. Flavones
14. Isoflavones
15. Sterols
16. Derivatives of coumarin
17. Etc.


In diabetes, alfalfa exhibited prevention of the onset of developing Type 1 Diabetes(1056)
diabetogenic or anti-diabetic potentials(1055), through its estrogenic activity in the modulation of diabetes(1055), protection against pancreas from autoimmune destruction(1056), antihyperglycaemic(1057), insulin-releasing and insulin-like activity(1057).
The Insulin resistance improvement and/or anti metabolic syndrome herbs: Licorice
See fertility herbs Licorice for more information
[Gan Cao is also known as the Licorice root. The sweet and neutral herb has been used in TCM as anti-allergy(856), anti-inflammation(855), anti-ulcer(857), anti convulsion(858), oxidative stress(858) and to treat stomach weakness, tired and lack of strength, palpitation, and shortness of breath, cough with abundance of phlegm, stomach and solar plexus pain(859), etc., as it tonifies the Spleen, Benefits the Qi, moistens the Lungs, calms cough, deaf or acute pain, by enhancing all 12 channels(859). 

1. Licorice, in a review of 33 studies of herbal medicine for the management of polycystic ovary syndrome(PCOS), showed strong evidence in improved metabolic hormone profile and improved fertility outcomes and regulation of ovulation and inhibition of hyperandrogenism in PCOS(860). In model rats experiment, Ganshao Paste (CGP), also decreased serum levels of LH, T, and FSH and increased serum estradiol (E2), and progesterone (P)(861)(860)(865). According to the University of Natural Resources and Life Sciences Vienna, licorice may have a potential effect on metabolic syndrome(862) in women with PCOs.


2. Blood flow
Licorice improves the blood flow in the body by exerting its anti-thrombosis(983) and inhibiting the levels of bad cholesterol(984)(985) and triglyceride levels(985) and increasing HDL-cholesterol content(984) in reduced risk of cardiovascular disease(985) and blood stagnation(897) in the abdominal region induced induced infertility(986).

3. Glycyrrhizin
Glycyrrhizin, one of the main ingredients from licorice, exhibited anti-inflammatory effect pharmacologically in the treatment of inflammatory diseases(988)(989)(990), lowered high serum testosterone levels in oligomenorrheic or amenorrheic women, and induced conception in some women(991). As an antioxidant, the phytochemical also inhibits irregular cell growth(992)(993) and microbial invasion(994)(995) causes of cancers(992)(993) and infection and inflammation(994)(995) respectively. in adrenocortical function and behavior, it also regulated the levels of cortisol(996), induced by overproduction of serotonin cause of hormone imbalance(997).

4. Phytoestrogen
See phytoestrogen in black cohosh
[Phytoestrogen found it black cohosh showed to occupy the estrogen receptor sites in women body(908), through its antiestrogenic and estrogenic effects(909), to induce hormone balancing may result in improving the chance of ovulation and fertility(910)(911)].

5. Lecithin
Lecithin is a fat-like substance called a phospholipid improved lipid transfer, cholesterol efflux, HDL genesis and remodeling at the blood-brain barrier (BBB)(998). against cells from oxidation surrounding the brain(999), in reducing psychotic symptoms(1002) such as stress(1000)(1001), and depression(1002).
Side effects
1. It may raise blood pressure(1003)(1004(1006)
2. Long term usage of large dosage can also cause edema(1004)(1006) and hypokalemia(1004)(1005)(1006).
3. Overdose can be toxic(106), in inducing rhabdomyolysis or myoglobinuria(1006).
4. Etc.]
Phytochemicals(1058)
1. Glycyrrhizic acid
2. Licochalcone A
3. Licochalcone B
4. Licoflavone
5. Liquiritin
5. Liquiritigenin
7. Isoliquiritigenin
8. Ononis
9. 4′，7-dihydroxyflavone
10. Glycyrrhetinic acid
11. 11-deoxyglycyrrhetinic acid
12. β-sitosterol
13. Etc.
Licorice's phytochemicals, especially glycyrrhizin, have shown effectively in ameliorated insulin resistance(1059)(1061)(1063)(1064), hyperglycemia(1059)(1060), dyslipidemia(1059)(1063) and oxidative stress(1064) in fructose-induced metabolic syndrome(1059)(1061)(1063) in animal(1059)(1060)(1061)models, probably through its interference of the development of visceral obesity(1064) and cellular derailments that are responsible for the development of metabolic syndrome(1062), anti-inflammatory(1062), antioxidant(1062) and an associated with a decrease in tissue lipid deposition(1063) effects.


Green Tea(1065)




Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Green tea has been a precious drink in traditional Chinese culture and used exceptionally in socialization for more than 4000 thousand years. Because of their health benefits, they have been cultivated for commercial purposes all over the world(1065).


Ingredients
1. Epigallocatechin gallate
2. Flavonoids
3. Tannins
4. Caffeine
5. Polyphenols
6. Boheic acid
7. Theophylline
8. Theobromine
9. Anthocyanins
10. Gallic acid
11. Etc.


Epidemiological studies, linking green tea in reduced risk of prevented the development of insulin resistance(1066)(1067) and metabolic syndrome such as obesity(1068)(1069)(1073), hypertension(1070)(1071) hypercholesterolemia and hyperglycemia(1072)(1073), diabetes(1074)(1075)... have produced some statistic results.
In insulin resistance, epigallocatechin gallate (EGCG), the major chemical constituents of green tea effectively modulate of insulin production through inhibited insulin-stimulated glucose uptake(1076)(1078)(1077) via some mechanisms, including attenuated inflammatory cytokine levels(1076), inhibition of the GLUT4(the insulin-regulated glucose transporter found primarily in adipose tissues and striated muscle (skeletal and cardiac).) translocation(1077), AMPK pathways(an enzyme that plays a role in cellular energy homeostasis)(1078)....
In metabolic synfrome, green tea extract, polyphenol epigallocatechin gallate significantly controled abnormalities linked to metabolic syndrome (MS)(1079)(1080)(1083)(1084)(1085) through influence the maintenance of weight loss(1079)(1082)(1084), high-density lipoprotein-cholesterol(1079), triglycerides(1079), and glucose concentrations(1079)(1080), counteracted endothelial dysfunction(1080)(1081) and ameliorated metabolic insulin resistance(1080) in skeletal muscle and liver(1080).




Cinnamon(1086)


Cinnamon is a spice derived from the inner bark of tree, native to South East Asia, of over 300 species of the genus Cinnamomum, belongings to the family Lauraceae used in herbal and traditional medicine as anti-microbial agent(1087) and to improve reproductive organs(1088), prevent flatulence(1089) and menstrual cramping(1087), treat gastrointestinal complaints(1089), diarrhea(1087), bad breath(1090), headache(1087), etc.(1086)(1087).


Ingredients(1087)
1. Cinnamic aldehyde
2.Cinnamyl Acetate
3. Eugenol
4. Aldehyde
5. Pinene
6. Coumarins
7. Cinnzeylanol
8. Cinnzeylanine
9. Safrol
10. Methylhydroxy chalcone polymer (MHCP)


Epidemiological studies suggested that cinnamon consist of a significant anti-insulin resistance(1091)(1092)(1094) and anti metabolic syndrome(1093)(1094)(1095)(1096)(1097) properties, such as lowering total cholesterol(1093), low-density lipoprotein cholesterol(1093) and improving high-density lipoprotein cholesterol(1093), maybe due to its antihyperglycaemic (1091)(1093) and potential to reduce postprandial blood glucose levels(1091)(1092), liver fat(1098) and an improved glucose homeostasis(1098) properties, by regulating the mechanisms of-medicated glucose and lipid metabolism(1099), such as decreased the mRNA expression of inflammatory cytokine(TNF-alpha) in adipose tissue(1100) and upregulated mRNA expression of insulin-regulated membrane trafficking(1100) and whole-body glucose homeostasis(GLUT-4) in skeletal muscle(1100).


The stress response and management herbs


Stress is a natural reaction of human flight or flight response induced by pressure due to such as an environmental condition or a stimulus. Long term stress can cause deleterious and cumulative effects on human body(1104), including emotional or cognitive problems, such as an increased risk of attentional deficit/hyperactivity, anxiety, and language delay(1103), especially for people with chronic illness, including women with Polycystic Ovarian Syndrome (PCOs)(1105).


Ashwagandha (Withania somnifera)


Ashwagandha(Withania somnifera), also known as Indian Ginseng is a nightshade plant belongings to the family Solanaceae, native to India, northern Africa, and the Middle East used in Ayurvedic medicine over 3000 years(1101) as antitumors(1107)(1108), anti ulcers(1111), anti-stress(1112)(1115)(1118), cognition Dysfunction(1109)(1110)(1118), anti-inflammatory(1113)(1116), antioxidant(1114)(1117), immunomodulatory(1120)(1121), anti-aging(1119), etc., herbal medicine.


Phytochemicals(1102)
1. Isopelletierine
2. Anaferine
3. Cuseohygrine
4. Anahygrine
5. Withanolides
6. Withaferins
7. Saponins
8. Sitoindosides
9. Acylsterylglucosides
10. Z-Guggulsterone(1106)
10. Etc.


Epidemiological strong evidences suggested that herbal ashwagandha processes anti stress-related disorders( induced by oxidative stress(1122)(1123) and long term stress(1123) effects, probably through its antioxidant(1123)(1124)(1126), anti-stress(1112)(1115)(1118), anti-inflammatory(1113)(1116), antioxidant(1114)(1117), immunomodulatory(1120)(1121) effects. In rat model, hydroalcoholic extract enhances its antioxidant effect against psychological symptoms(1132) induced by long term stress, such as reduced motor performance(1124), cognitive impairment(1125)(1126, anxiety(1127)(1128), sleep disorder(1129)(1130), depression(1131), etc. In physiological symptoms, the herb has shown to reduce fatigue(1133) risk of hypertension(1134), risk of stroke(1135). risk of diabetes(1136), improve energy(1132), etc.




Ginseng (Panax spp.)


(See Herbal treatment for PCOs for more information)
[ Ginseng Asia is also known as Panax ginseng. Since it has been grown in the cold places in the Asian, Asian ginseng is considered as yang promoting, according to traditional Chinese medicine.
Korean red ginseng extract (KRGE) in the experiment in PCOs induced rodent, improved PCO-related ovarian dysfunction(830). In rat model, induced by injection of estradiol valerate (EV), the extract also regulated sympathetic nerve activity by significantly lower expression of NGF protein (involved in the growth of peripheral nerve cells) and NGF mRNA(the form of RNA that carries information from DNA) involved in the abnormal process caused by steroid-induced PCO(830). Also, in the experiment of Ginseng total saponins (GTS) involved polycystic ovaries induced by a single intramuscular injection of 4 mg estradiol valerate (EV) in rats, GTS decreased the expression of NGF in ovary tissue(831)].


(See herbal medicine for weight loss)
[Ginseng is a slow-growing perennial plant with fleshy roots, the genus Panax, belonging to the family Araliaceae. Depending on the climate where it grows, ginseng can be classified mainly into Panax ginseng Asian ginseng (root), Red ginseng, wild ginseng, American ginseng (root)(791).
In 10 obese middle-aged Korean women who took Panax ginseng extracts for 8 wk, showed effectively in influence on gut microbiota in promoting weight loss but depending on the composition of gut microbiota prior to ginseng intake(792). In mice fed on a high-fat diet, ginseng saponin and ginsenosides not only exerted anti-obesity effects via the modulation of physiological lipid metabolism in vivo or intracellular signaling in cell culture systems but also promoted anti-obesity effects, through abnormal physiology via HFD. Leptin, insulin, and adiponectin, which carry out critical functions in energy and lipid metabolism(793)].


The Phytochemicals
1. Ginsenoside
2. Notoginsenoside
3. Chikusetsuaponin IV
4. Panaxynol
5. Ginsenyne
6. Alpha pansinsene
7. Beta pansinsene
8. Beta farnesene
9. Bicyclogermacrene
10. Beta elemene
11. Gama elemene
12. Alpha neodovene
13. Beta neodovene
14. Alpha humulene
15. Beta humulene
16. Caryophyllene
17. Beta gurjunene
18. Alpha gurjunene
19. Citric acid
20. Isocitric acid
21. Fumaric acid
22. Oleic acid,
23. Linoleic acid
24. Beta sitosterol
25. Stigmasterol
26. Daucosterol
27. Sitosteryl-o-(6-O-fatty acyl)-glucpyranoside
28. Etc.


Panax ginseng, native to Korea, one of most frequent and wonderful used over thousand years in herbal medicine for improvement of male overall health due to aging diminished steroidal hormone in Asian(1138) has found to process significant anti-stress (1137)(1143)(1144), such as adapt to stress(1138) through reverted cholesterol (CL), creatine kinase (CK) activity(1137) anti-oxidative stress(1139)(1142)(1146) through its elevation in catalase (CAT), and superoxide dismutase (SOD) activities as scavenger enzymes(1139). antioxidant effects(1140).
In immobilized mice, orally administered ginsenoside Rb1 found in Panax ginseng exhibited its anti-stress effects through regulation of serum levels of corticosterone(1145) and interleukin (IL)-6(1141).
In a chronic unpredictable mild stress rat model, ginsenosides also ameliorated stress symptoms of depression(1147)(1149)(1150) through significantly suppressed behavioral and biochemical changes(1147) and cognitive impairment, neuroinflammation, and biochemical alterations through improved corticosterone levels; and attenuated oxidative-nitrergic stress(1148).
In stress-induced metabolic syndrome(1151), ginseng' saponins (ginsenosides) are proven effectively for its properties of anti-hyperglycemia, insulin sensitization, islet protection, anti-obesity, and anti-oxidation in many model systems, according to Louisana State University System(1152).


Licorice




(See herbal treatment of PCOs for more information)
[Gan Cao is also known as the Licorice root. The sweet and neutral herb has been used in TCM as anti-allergy(856), anti-inflammation(855), anti-ulcer(857), anti convulsion(858) agent and to treat stomach weakness, tired and lack of strength, cough with abundance of phlegm, stomach and solar plexus pain, and improve cardiac function(855), etc., as it tonifies the Spleen, Benefits the Qi, moistens the Lungs, calms cough, deaf or acute pain, by enhancing all 12 channels(859).
In the treatment of PCOs(862), a combination of licorice and 100 mg spironolactone showed the activation of the renin-aldosterone system in lowering blood pressure and water (fluid) balance(860). reducing the prevalence of side effects related to the diuretic activity of spironolactone(860). In the model rats experiment, Ganshao Paste (CGP), showed the decrease of serum levels of LH, T, and FSH and increase of serum estradiol (E2), and progesterone (P)(861)(865)].

(See The Insulin resistance improvement and/or anti metabolic syndrome herbs: Licorice for more information)
1. PCOs
[ Licorice, in a review of 33 studies of herbal medicine for the management of polycystic ovary syndrome (PCOS), showed strong evidence in improved metabolic hormone profile and improved fertility outcomes and regulation of ovulation and inhibition of hyperandrogenism in PCOS(860). In model rats experiment, Ganshao Paste (CGP), also decreased serum levels of LH, T, and FSH and increased serum estradiol (E2), and progesterone (P)(861)(860)(865). According to the University of Natural Resources and Life Sciences Vienna, licorice may have a potential effect on metabolic syndrome(862) in women with PCOs.


2. Blow flow
Licorice improves the blood flow in the body by exerting its anti-thrombosis(983) and inhibiting the levels of bad cholesterol(984)(985) and triglyceride levels(985) and increasing HDL-cholesterol content(984) in reduced risk of cardiovascular disease(985) and blood stagnation(897) in the abdominal region induced induced infertility(986).


3. Glycyrrhizin
Glycyrrhizin, one of the main ingredients from licorice, exhibited anti-inflammatory effect pharmacologically in the treatment of inflammatory diseases(988)(989)(990), lowered high serum testosterone levels in oligomenorrheic or amenorrheic women, and induced conception in some women(991). As an antioxidant, the phytochemical also inhibits irregular cell growth(992)(993) and microbial invasion(994)(995) causes of cancers(992)(993) and infection and inflammation(994)(995) respectively. in adrenocortical function and behavior, it also regulated the levels of cortisol(996), induced by overproduction of serotonin cause of hormone imbalance(997).


4. Phytoestrogen
See phytoestrogen in black cohosh
[Phytoestrogen found it black cohosh showed to occupy the estrogen receptor sites in women body(908), through its antiestrogenic and estrogenic effects(909), to induce hormone balancing may result in improving the chance of ovulation and fertility(910)(911)].

5. Lecithin
Lecithin is a fat-like substance called a phospholipid improved lipid transfer, cholesterol efflux, HDL genesis and remodeling at the blood-brain barrier (BBB)(998). against cells from oxidation surrounding the brain(999), in reducing psychotic symptoms(1002) such as stress(1000)(1001), and depression(1002).
Side effects
1. It may raise blood pressure(1003)(1004(1006)
2. Long term usage of large dosage can also cause edema(1004)(1006) and hypokalemia(1004)(1005)(1006).
3. Overdose can be toxic(106), in inducing rhabdomyolysis or myoglobinuria(1006).
4. Etc.]
Phytochemicals(1058)
1. Glycyrrhizic acid
2. Licochalcone A
3. Licochalcone B
4. Licoflavone
5. Liquiritin
5. Liquiritigenin
7. Isoliquiritigenin
8. Ononis
9. 4′，7-dihydroxyflavone
10. Glycyrrhetinic acid
11. 11-deoxyglycyrrhetinic acid
12. β-sitosterol
13. Etc.
Licorice's phytochemicals, especially glycyrrhizin, have shown effectively in ameliorated insulin resistance(1059)(1061)(1063)(1064), hyperglycemia(1059)(1060), dyslipidemia(1059)(1063) and oxidative stress(1064) in fructose-induced metabolic syndrome(1059)(1061)(1063) in animal(1059)(1060)(1061)models, probably through its interference of the development of visceral obesity(1064) and cellular derailments that are responsible for the development of metabolic syndrome(1062), anti-inflammatory(1062), antioxidant(1062) and an associated with a decrease in tissue lipid deposition(1063) effects].


In chronic unpredictable stress rat model, total flavonoids extract(1153) (licorice flavonoids, LF) and liquidity(1154), a phytochemical found in licorice exerted anti-depressive(1153)(1154)(1155) and anti-cognitive impairment(1156) property through total flavonoids extract neurogenesis protective effect(1153) and defense of liquidity and flavonoids extract against oxidative stress(1154)(1156).
Yokukansan, a traditional Japanese formula, containing licorice showed effectively in amelioration of behavioral symptoms, such as aggressiveness, excitability, and hallucination, through reduced stress increased the serotonin 2A (5-HT2A) receptors density on the plasma membrane of the prefrontal cortex (PFC)(1158).
In high-glucose stress, Glabridin(1159)(1160), an isoflavone from licorice root reduced high-glucose stress(1159)(1160) through its anti-inflammatory activity(1159), up-regulates manganese superoxide dismutase, catalase and paraoxonase 2(1160).
In anti oxidative stress, licorice showed to contribute to their overall health promoting pharmacological effects against free radicals(1161)(1162)(1163)(1164) induced diseases such as cancer(1161), cardiac dysfunction(1162) liver diosease(1164), etc., through its anti-inflammatory(1161)(1163)(1164), anti-oxidant activities(1161)(1162)(1163)(1164).
According to the University of Western Sydney, Glycyrrhiza glabra, one of the Chinese herbs, exhibited strong evidence of neuroprotective activity for the promotion of healthy aging and longevity(1157).

Rhodiola (Rhodiola Rosea)

Rhodiola Rosea, one of the perennial plant grows in coldest region in the world, including the Arctic, is a genus Rhodiola, belongings to the family Crassulaceae, used in traditional medicine as an antiaging(1167) agent, and to treat fatigue(1168)(1169), depression(1170)(1171), anemia(1172), impotence(1173), inflammation(1174), infections(1175), nervous system disorders(1176)(1177), enhance physical endurance(1178), and increase an organism's resistance to stress(1167)(1179).etc.


Phytochemicals(1165)(1166)
1.Salidroside
2. Sosavin
3. Rosin
4. Sosarin
5. Tyrosol
6. Lignan major compounds in the
7. Heterodontoside,
8. Viridoside
9. Mongrhoside
10. Cyanogenic glucoside rhodiocyanoside A
11. Epigallocatechin and gallate
12 . Epiga
13. Etc.


In an evaluating anti-stress effects, Rhodiola rosea, exhibited positive effects on mental and physical performance under stress(1180)(1181), improved attention and cognitive function associated with its antidepressant activity(1180)(1182) and stress-protective effect of adaptogen(1181), through regulation of nitric oxide (NO) and cortisol levels(1180)(1181).
According to Gesundheitsbezirk Bozen,, Rhodiola rosea active substance phenylpropanoid also processed sedative, anti-depressive(1180) and stress-modulated properties through stimulating the distribution of dopamine and serotonin(1182).
In an animal model, the herb showed to display antidepressant(1181)(1182)(1184), adaptogenic(1181)(1184), anxiolytic(1184)(1186), nociceptive(1183)(1185) and locomotor activities(1186) induced by intense physical and psychological stress(1183).
In oxidative stress-induced animal models, Rhodiola is effective in the empowerment of performance(1187), modulation of the immune system(1187) against oxidative damage(1187).
Salidroside (SAL), an active component of Rhodiola rosea protects endothelium(1189) against H2O2-induced endothelial dysfunction(1188)(1189) and oxidative-stress-associated cardiovascular dysfunction(1189) through preventing the overactivation of oxidative stress-related downstream signaling pathways(1188).




Rhaponticum or Maral root

Rhaponticum also known as Maral root, is an herbaceous perennial plant belongings the family Asteraceae, used in traditional Siberian, Russian and Chinese medicine as anti-depressant(1191)(1192), anti-anxiety(1192), anti menopausal complaints(1192)(1193), antioxidant(1194)(1195), immunomodulatory(1194)(1195), anti-cancerogenic(1194)(1196)(1197), antimicrobial(1194)(1195)(1198)(1199) and adaptogen agent(1194) and to treat impotence(1194), enhance mental and physical performance(1194)(1200), support the nervous(1194)(1201) and cardiovascular system(1194)(1202)(1203), improve work capacity(1194), etc.




Phytochemicals(1190)
1. Rosavin
2. Rosin
3. Rosarin
4. Salidroside
5. Ecdysteroids
6. Flavonoids
7. Phenolic acids
8. Polyacetylenes,
9. Sesquiterpene lactones
10. Triterpenoid glycosides
11. Terpenes
12. Etc.


In Wistar rats model, N-feruloylserotonins, isolated from the seeds of Leuzea carthamoides (WILLD.) DC, showed effectively in selective stress-reducing effects against stress-sensitive, such as reduced anxiety in the high-pain(1005).
In AdMax formulas, containing Leuzea carthamoides Iljin, Rhodiola rosea L., Eleutherococcus senticosus Maxim, and from dry berries of Schizandra chinensis Baill, improve response to stimulus and stress, physical endurance and counteract fatigue according to Genext Research, Inc.(1006).
According to Russian Academy of Medical Sciences, herbal rhaponticum also processed anti metabolic syndrome(1204) such as serum lipid profile(1207)(1204), corticosterone, also known as 17-deoxycortisol and 11β,21-dihydroprogesterone,(1208)(1204) and cytokine concentrations(1209)(1204), glucose tolerance(1211)(1204), systolic blood pressure(1212)(1204), triacylglycerol accumulation(1207)(1204)(1204) and its induction of inflammation(1210)(1204), stress(1204)(1214), and hepatic steatosis(1213) in rat model(1004).
In Oxidative(respiratory) burst, is a chain reaction of rapid release of reactive oxygen species (superoxide radical and hydrogen peroxide) from different types of cells, N-feruloylserotonin (N-f-5HT) isomers(1215)(1216)) isolated from seeds of Leuzea carthamoides (Wild) DC, inhibited dose-dependent oxidative burst in human through its pharmacological activity against oxidative stress in ischemia-reperfusion, inflammation and other pathological conditions(1215)(1216).

Schisandra (Wu Wei Zi)


Schisandra also is known as Wu Wei Zi, a twining shrub living its life by climbing on other vegetation, belongings to the family Schisandraceae, native to Asia and North America, The warm, sweet, bitter, sour, acrid, salty herb has been used in traditional Chinese medicine as antioxidant(1218)(1219), anti-stress(1220)(1221), antimicrobial(1224)(1225)(1226) agent and to improve metabolism(1227)(1228), enhance central nervous system(1229)(1230)(1233), treat hypertension(1231)(1232) and hypotension during exhaustion of circulatory function(1217), coughing(1234)(12135), insomnia(1237), premenstrual syndrome (PMS)(1239), menopausal symptoms(1240), depression(1233), irritability(1233), erectile dysfunction (ED)(1238), lower cholesterol(1241) and regulate blood glucose(1233), improve memory(1222)(1223), etc.
by promoting the function of lung and kidney channels(1217).


Phytochemicals(1217)
1. Schizandrin
2. Deoxyschisandrin
3. Gamma-schisandrin
4. Schisandrol
5. Pseudo-gamma-schisandrin
6. Schizandrate B
7. Gomisin A, B, C, F, G
8. Angeloylgomisin H
9. Tigloylgomisin H
10. Benzoylgomisin H
11. Epigomisin O
12. Malic acid
13. Citric acid
14. Tartaric acid
15. Succinic acid
16. A-pinene
17. Camphene
18. B-pinene
19. Byrcene
20. A-terpinene
21. Limonene
22. G-terpinene
23. P-cymene
24. Etc.


In chronic psychological stress male rat model, Schisandra protects against stress-induced complications such as carbohydrate metabolism(1227) and neurosis, psychogenic depression, astheno-depressive states, schizophrenia and alcoholism disorders(1233) and improved mental performance(1233).through its reduction of the levels of corticosterone (CORT) and glucose and protect the structure of the adrenal cortex(1227).
In physiological stress, the herbal medicine also exerted its stress-protective effect against a broad spectrum of harmful factors including heat shock, skin burn, cooling, frostbite, immobilization, swimming under load in an atmosphere with decreased air pressure, aseptic inflammation, irradiation, and heavy metal intoxication(1233).
In oxidative stress-induced damage heart(1242) tissues in animal models, schisandrin B (Sch B), a dibenzocyclooctadiene derivative isolated from the fruit of Schisandra Chinensis attenuated cardiotoxicity via antioxidant and anti-inflammatory effects(1242). In oxidative stress-induced liver damage, oral administration of Schisandra Lignans Extract (SLE)(1243)(1244) or triterpenoid(1245) a chemical constituent from Schisandra Chinensis significantly reduced liver damage(1243)(1244)(1245) in experimental animal model, through its effects of balance of oxidation and reduction in cells(1243) or upregulating cell cycle progression(1244) and anti-tumor antigen(1244), or ameliorating oxidative stress(1245).


the dry regions of India, northern Africa, and the Middle East - See more at http://www.chopra.com/ccl/ashwagandha#sthash.3NRUTGqC.dpuf
the dry regions of India, northern Africa, and the Middle East - See more at http://www.chopra.com/ccl/ashwagandha#sthash.3NRUTGqC.dpuf
the dry regions of India, northern Africa, and the Middle East - See more at http://www.chopra.com/ccl/ashwagandha#sthash.3NRUTGqC.dpuf, used in Ayurvedic medicine for applied externally to treat tumors, tubercular glands, carbuncles, and
Women with PCOS who are under holistic treatment must keep in mind that herbal, nutritional, and lifestyle therapies can take time to achieve the improvement of their symptoms, quality of life, and, the goal to start a family.
“[Women] might notice improvement as early as a month or two,” said Dr. Stansbury, “but since this is shifting your whole hormonal balance and acting on the liver and adrenals and ovarian function and pituitary feedback loops, I give women a six-month to 12-month game plan.”, according to American botanical council(1245a)


The Herbal Treatment for Polycystic Ovarian Syndrome (PCOs)


Epidemically, increased incidence and prevalence of overweight and obesity over 3 decades in the developing world now has spread to the South East Asian population, due to over 20 years of economic prosperity causes of lifestyle changes in populations with very different initial habits. Suggestions of reduced fat intake less than 30% of total calories with a low proportion of saturated fat with high in fiber from predominantly low-glycaemic-index-carbohydrate foods are recommended. Calorie intake should be distributed between several meals per day with a restricted intake of snacks and drinks(1827a)(828).


1. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional medicine as an anti-oxidant, hypoglycemic, colorant, antiseptic, wound healing agent, and to treat flatulence, bloating, and appetite loss, ulcers, eczema, inflammations, etc.
Berberine (BBR), major chemical constituents found abundantly in turmeric and plants exerted its effect in improving some of the metabolic(829) and hormonal derangements in a group of treated Chinese women with PCOS(829).


2. Korean red ginseng
Ginseng Asia is also known as Panax ginseng. Since it has been grown in the cold places in the Asian, Asian ginseng is considered as yang promoting, according to traditional Chinese medicine.
Korean red ginseng extract (KRGE) in the experiment in PCOs induced rodent, improved PCO-related ovarian dysfunction(830). In rat model, induced by injection of estradiol valerate (EV), the extract also regulated sympathetic nerve activity by significantly lower expression of NGF protein (involved in the growth of peripheral nerve cells) and NGF mRNA(the form of RNA that carries information from DNA) involved in the abnormal process caused by steroid-induced PCO(830). Also, in the experiment of Ginseng total saponins (GTS) involved polycystic ovaries induced by a single intramuscular injection of 4 mg estradiol valerate (EV) in rats, GTS decreased the expression of NGF in ovary tissue(831).


3. Aloe vera
Aloe Vera is species of succulent plant in the genus Aloe, belonging to the Family Xanthorrhoeaceae, native to Sudan. It has become very popular for commercial cultivation due to its health benefits. Aloe vera has been used in herbal medicine in treating many kinds of disease, including wound(842), burn healing(835)(836), minor skin infections(837), sebaceous cysts(838), diabetes(839)(840)(843), and elevated of cholesterol(841), etc. It is also one of many popular herbs studied in scientific ways with some conflicting results.
Aloe vera gel (AVG) exhibited significant reduction in plasma triglyceride and LDL cholesterol levels, with an increase in HDL cholesterol(843) and reversion of abnormal estrous cyclicity, glucose intolerance, and lipid metabolizing enzyme activities, to normal in PCOS induced in Charles Foster female rats(833). On Letrozole induced polycystic ovarian, Aloe vera gel formulation exerted a protective effect against the PCOS phenotype by restoring the ovarian steroid status and altering key production of steroids activity(834).


4. Salvia miltiorrhiza (Dan Shen)
Dan Shen is also known as Red Sage Root. The bitter and slightly cold herb has been used in TCM as antithrombotic, anti hypertonic (lowering blood pressure), antimicrobial, antipyretic, anti-inflammatory, sedative agent and to treat dysmenorrhea, amenorrhea, palpable tumors, angina,restlessness, insomnia, irritability, etc., by enhancing the functions of heart and liver(848).
Cryptotanshinone, isolated from Salvia miltiorrhiza, in the experiment involved prenatally androgenized (PNA) rats as a model of polycystic ovary syndrome, improved estrous cycles, reduced 17-hydroxyprogesterone, androstenedione, testosterone, glucose, insulin levels, and lowered AUC-Glu(Measurements were made of the area under the curve of glucose by intravenous glucose tolerance test) and HOMA-IR( a method used to quantify insulin resistance and beta-cell function)(832).


5. Chamomile
Chamomile is also known as camomile, common name of many species daisy-like plants in the family Asteraceae, used in traditional medicine as antispasmodic(844) and anti-inflammatory(845) constituents and for treatments of diarrhea(844), menstrual cramps(844) and sleep disorders(847), reduce cramping and spastic pain in the bowels(844), relieve excessive gas and bloating in the intestine(844), etc.
Intraperitoneal injections of Chamomile alcoholic-extract for ten days in the testing on the biochemical and clinical parameters in a rat model of PCOS not only induced recovery from a PCO induced state in rats(846) but also increased dominant follicles and better endometrial tissue arrangements(846)(849).


6. Spearmint tea
Spearmint tea is a species of Mint belonging to the Lamiaceae, native to Europe and southwest Asia. The herb has been used in folk medicine for treatment of pain reliever(850), loss of appetite(851), common cold(851), bronchitis(851), sinusitis(851), fever(851), nausea(851), vomiting and indigestion(851), etc.
Spearmint tea inhibited the production of the levels or activity of androgen hormones in the human body may be considered as a natural agent for PCOs.(852). In Hirsutism polycystic ovarian syndrome (PCOS), drinking spearmint tea twice a day for a 1 month period, showed significantly reduce total testosterone levels, due to the inhibition of androgen properties(853). In another study of polycystic ovary syndrome and idiopathic hirsutism, steep Spearmint tea for 5 days twice a day in the follicular phase of their menstrual cycles significant decreased in free testosterone and increased in luteinizing hormone, follicle-stimulating hormone, and estradiol(854).


8. Licorice
Gan Cao is also known as the Licorice root. The sweet and neutral herb has been used in TCM as anti-allergy(856), anti-inflammation(855), anti-ulcer(857), anti convulsion(858) agent and to treat stomach weakness, tired and lack of strength, cough with abundance of phlegm, stomach and solar plexus pain, and improve cardiac function(855), etc., as it tonifies the Spleen, Benefits the Qi, moistens the Lungs, calms cough, deaf or acute pain, by enhancing all 12 channels(859).
In the treatment of PCOs(862), a combination of licorice and 100 mg spironolactone showed the activation of the renin-aldosterone system in lowering blood pressure and water (fluid) balance(860). reducing the prevalence of side effects related to the diuretic activity of spironolactone(860). In the model rats experiment, Ganshao Paste (CGP), showed the decrease of serum levels of LH, T, and FSH and increase of serum estradiol (E2), and progesterone (P)(861)(865).


9. HemoHIM

HemoHIM is a herbal formula containing three edible herbs, Angelica Radix, Cnidium Rhizoma and Paeonia Radix approved by the Korean FDA as health functional supplement assisting functions of the immune system(863)(964). In adult PCOs cycling rats induced EV injection and administered orally (100 mg/kg of body weight/day) for 35 consecutive days, the formula lowered the high numbers of antral follicles and increased the number of corpora lutea(864), normalized ovarian morphology and the expression of nerve growth factor (NGF) in PCOs(864).

Traditional Chinese Medicine Perspective in Management and Treatment of PCOs 

While conventional medicine uses synthetic medication to induce ovulation and assisted artificial insemination if the medicine fails, traditional Chinese medicine views polycystic ovarian syndrome in different approaches.
Polycystic ovary syndrome, according to traditional Chinese medicine is a medical condition characterized by accumulative of fluid over a prolonged period of time causes of dampness and phlegms(247a)(247b) build upon the ovaries due to the effects of vary differentiations, affecting not only the women’s menstrual cycle but also ovulation and fertility(1247a)(247b).


Symptoms
According to statistic, most common symptoms of Chinese women with PCOs in traditional Chinese medicine include(1247)
1. Abdomen pain before menstrual onset
2. Obfuscation color
3. Cold lower abdomen
4. Insomnia
5. Fatigue
6. Eyes dark, face dark or ring lip dark, before and after menstruation
7. Chest tightness
8. Irritability
9. Depression
10. Lower abdomen pain during menstruation
11. Breast swelling
12. Etc.


Differentiation
Depending on the differentiation of the diseases, PCOs according to TCM can be classified into
A. General syndrome
1. Kidney deficiency syndrome(1246)
2. Stagnation of Qi and blood stasis(1246)
3. Dampness heat of liver(1246)(1248)
4. Stagnation of phlegm dampness syndrome(1246)
B. Single or combination syndrome
4. Kidney Yang deficiency and blood stasis(1247)
5. Kidney Yang deficiency (1247)(1248)
6. Kidney Yin deficiency and blood stasis(1147)
7. Kidney Yin deficiency and liver Qi stagnation syndrome(1247)
8. Kidney Yang deficiency and phlegm dampness stagnation(1247)
9. Kidney Yin deficiency(147)(1248)
10. Spleen-Yang deficiency (SYD)(1248)

The Dietary Suggestion, Life Style Modification, and Nutritional Supplements according to TCM




According to Angela Warburton(1249), a doctor of Traditional Chinese Medicine practicing in Toronto, Canada, incorporating the proper dietary and lifestyle modifications, may make a BIG difference in the long-term treatment of PCOs.



The Dietary Suggestion according to TCM

1. Eat foods low on the Glycemic Index (GI) such as vegetables and whole grains to improve insulin sensitivity(1250), quality of life(1253)and avoid some long-term health risks of endometrial cancer(1252) as many women with PCOS are not achieving dietary intakes and levels of physical activity(1251)

2. Women with PCOS should completely avoid refined carbohydrates as it showed to elevate the risk of type 2 diabetes(1254) induced collection of metabolic defects including peripheral insulin resistance(1255), elevated hepatic glucose output, and impaired pancreatic insulin secretion(1254), immune-mediated diseases(1256), such as reduced control of infection, increased rates of cancer, and increased risk for allergic and auto-inflammatory disease(1256) and inflammation(1255).

3. Keep blood sugar stable by eating regularly with a small meal (1258), including good fat, such as monounsaturated and polyunsaturated fatty acids(1259) and protein(1261). According to Diabetes Center, Eulji Hospital, in the differentiation of a meal plan using rice bowls of varying sizes, showed that small rice bowl-based meal plan was effective at reducing dietary energy intake (EI), body weight (BW), and blood glucose levels in comparison to regular rice bowl-based meal plan(1257).
Indeed, a high monounsaturated fat hypocaloric diet) or high polyunsaturated fat hypocaloric diet has shown to improve total cholesterol, LDL cholesterol, triglyceride, glucose, insulin and homeostasis model assessment for insulin resistance(HOMA-R) levels(1260).

4. Eating vegetables daily as including vegetables rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats have shown to improve insulin resistance, serum hs-CRP levels, and abdominal fat accumulation(1262). Leafy greens, such as kale, broccoli, collard greens, bok choy, cabbage, rapine, etc.. process the ability in modulation liver fatty acid composition(1263) of which promotes glucose(1264). hormone(1265) regulation and lipids(1264) homeostasis of metabolic dysfunction(1264) probably through the effects of its phytochemical indole-3 carbinol(1266)(1267)(1268). Intake of legumes such as black beans, adzuki beans, mung beans, black-eyed peas, etc., also contributes to beneficial effects of on metabolic features, such as insulin resistance(1269), glycated hemoglobin, triglycerides, and total and HDL cholesterol(1270). According to Complementary and Alternative Healing University, adzuki bean displays a diuretic property, can beneficiary for draining ‘dampness’ from the body. (1271).

6. Eat organic meats only
Grass-fed and grain-fed cattle have shown to significantly improve the fatty acid (FA) composition(1273)(1274) and antioxidant content of beef(1273). According to Norwegian University of Life Sciences, Pig feeds rich in rapeseed products contains high concentrations of EPA, DPA, and DHA of which have shown to benefit to over health for the consumer(1272).

7. Intake of berries has shown to contribute to beneficial metabolic effects in preventing obesity(1275) and related disorders(1275)(1278)(1279), such as ameliorating total cholesterol and LDL-cholesterol(1276), hyperglycemia(1277) and insulin sensitivity(1277), lowering fasting insulin level(1275),......

8. Intake cinnamon daily can improve insulin resistance and PCOs related metabolic syndrome
(See the Insulin resistance improvement and/or anti metabolic syndrome herb: Cinnamon for more information)
[Cinnamon is a spice derived from the inner bark of tree, native to South East Asia, of over 300 species of the genus Cinnamomum, belongings to the family Lauraceae used in herbal and traditional medicine as anti-microbial agent(1087) and to improve reproductive organs(1088), prevent flatulence(1089) and menstrual cramping(1087), treat gastrointestinal complaints(1089), diarrhea(1087), bad breath(1090), headache(1087), etc.(1086)(1087).
Ingredients(1087)
1. Cinnamic aldehyde
2.Cinnamyl Acetate
3. Eugenol
4. Aldehyde
5. Pinene
6. Coumarins
7. Cinnzeylanol
8. Cinnzeylanine
9. Safrol
10. Methylhydroxy chalcone polymer (MHCP)

Epidemiological studies suggested that cinnamon consists a significant anti-insulin resistance(1091)(1092)(1094) and anti metabolic syndrome(1093)(1094)(1095)(1096)(1097) properties, such as lowering total cholesterol(1093), low-density lipoprotein cholesterol(1093) and improving high-density lipoprotein cholesterol(1093), maybe due to its antihyperglycaemic (1091)(1093) and potential to reduce postprandial blood glucose levels(1091)(1092), liver fat(1098) and an improved glucose homeostasis(1098) properties, by regulating the mechanisms of-medicated glucose and lipid metabolism(1099), such as decreased the mRNA expression of inflammatory cytokine(TNF-alpha) in adipose tissue(1100) and upregulated mRNA expression of insulin-regulated membrane trafficking(1100) and whole-body glucose homeostasis(GLUT-4) in skeletal muscle(1100)].

9. Adding bitter Melon and fenugreek into your diet
Epidemiological studies suggested that bitter melon displays a modest hypoglycemic effect(1280)(1281)(1283)and anti related complications in metabolic syndrome(1281)(1282).
Fenugreek not only showed to promote sexual arousal and desire in women, probably through its regulation of total and free testosterone and another hormone (1284) but also exhibited hypoglycemic and hypocholesterolemic effects in a dose-dependent manner(1285)

10. Ensure adequate fiber intake by eating a lot of fresh vegetables and whole grains.
High-fiber diets, especially of the soluble variety, and soluble fiber supplements has been recommended by several national diabetes associations management of the plasma glucose concentration in individuals with diabetes(1286)(1288) as it offers some improvement in carbohydrate metabolism(1287).


Lifestyle Modification according to TCM

1. Say goodbye the Western lifestyle
Western lifestyle characterized by low levels of physical activity, and by an energy-dense diet rich in total and saturated fat and refined carbohydrates(1289) may consist a positive association between risk of breast cancer and subclinical forms of the polycystic ovary syndrome (PCOS)(1289) such as more severe phenotype with regard to insulin insensitivity, increased numbers of antral follicles at midcycle, and decreased circulating luteal phase progesterone levels(1290).

2. Avoid all refined sugars (white and brown sugars, fructose, sucrose, corn syrup) and simple sugars (maple syrup, honey)
Increased consumption of refined dietary sugars not only showed to contribute to a central factor in the rapidly rising rates of obesity(1293) and type 2 diabetes(1291)(1294) but also promoted risk of metabolic syndrome(1291)(1295) such as glucose intolerance(1292) and its complication(1295).
According to a study by Dr. Kozlovsky AS and the research team, diets high in simple sugars not only stimulates Cr losses and may lead to marginal Cr deficiency associated with impaired glucose and lipid metabolism(1296).

3. Say no refined carbohydrate (white bread, pasta, potatoes, white rice, most breakfast cereals, rice cakes, popcorn, or any starchy, low fiber food) (See dietary supplement 2 for more information)
[2. Women with PCOS should completely avoid refined carbohydrates as it showed to elevate the risk of type 2 diabetes(1254) induced collection of metabolic defects including peripheral insulin resistance(1255), elevated hepatic glucose output, and impaired pancreatic insulin secretion(1254), immune-mediated diseases(1256), such as reduced control of infection, increased rates of cancer, and increased risk for allergic and auto-inflammatory disease(1256) and inflammation(1255)].

4. Avoid artificial sweeteners
Artificial sweeteners have shown to induce glucose intolerance by altering the gut microbiome(1297)(1298) associated susceptibility to metabolic disease(1297)(1298).

5. Avoid large size of regular meals. Opt for smaller and more regular meals to moderate glucose load and minimize insulin resistance(see Dietary supplement 3. Keep blood sugar stable by eating regularly with a small meal for more information)
[3. Keep blood sugar stable by eating regularly with small meals (1258), including good fat, such as monounsaturated and polyunsaturated fatty acids(1259) and protein(1261). According to Diabetes Center, Eulji Hospital, in the differentiation of a meal plan using rice bowls of varying sizes, showed that small rice bowl-based meal plan was effective at reducing dietary energy intake (EI), body weight (BW), and blood glucose levels in comparison to regular rice bowl-based meal plan(1257).
Indeed, a high monounsaturated fat hypocaloric diet) or high polyunsaturated fat hypocaloric diet has shown to improve total cholesterol, LDL cholesterol, triglyceride, glucose, insulin, and homeostasis model assessment for insulin resistance(HOMA-R) levels(1260)].

6. Avoid soft drink(soda), sugar-sweetened fruit juice and energy drink
According to the article "An Unintended Consequence Of Diet Soda: Disrupting Friendly Bacteria And Raising Blood Sugar" by Faye Flam, diet Soda due to high content of artificial sweetener may disturb the internal ecosystem and raised blood sugar, thus defeating the purpose of these products by increasing risk for type 2 diabetes and obesity(1299).(See artificial sweetener for more information).
According to participants were 27,585 Japanese men and women aged 40-59 years who had no prior history of diabetes, intakes of soft drink were associated with increased risk of type 2 diabetes(1300).
Sugar-sweetened fruit juice, not 100% fruit juice is associated with the risk of incidence of type 2 diabetes, according to 4 studies with 191,686 participants, including 12,375 with type 2 diabetes(1301).
The energy drink has shown negatively affect the central nervous system induced jitteriness, nervousness, dizziness, the inability to focus, difficulty concentrating, and insomnia(1302) and heightened alertness, altered sleep patterns, arrhythmias and, rarely, seizures(1303).

7. Avoid milk and dairy products (cheese and yogurt)
According to traditional Chinese medicine, milk and dairy products are considered as "very cold and damp foods" in nature, as they can overload the digestive system, inducing production of phlegm, the main cause of PCOs(1304)(1305)(1306). Replacement of cow milk with (unsweetened) almond milk may contribute to many health aspects for women with PCOs. According to researches, almond milk not only be an efficacious substitute of cow milk in infant with cow-milk allergy/intolerance(1307) but also induces production of probiotics, which have a positive effect on fasting blood sugar(1310) and serum of insulin(1310) in in PCOS patients, through its fermentation stage(1308). According to the University of California at Davis, intake of almonds containing 31 g of total fat per day for 6 weeks had beneficial effects on plasma lipids and androgens in PCOS(1309).

8. Moderate exercise (yoga, pilates, walking etc)
(See The General Approaches to prevent the unpreventable?)
[Moderate exercise not only increases blood flow to strengthen the body tissues(274)(275) and organs(276), including the reproductive system but also enhances the immunity(277) in fighting against inflammatory process(277)(278) due to irregular cell growth(281)(282) and foreign invasion(279)(280).]
[Yoga is a physical, mental, and spiritual practice in Hinduism, Buddhism.
According to studies holistic yoga therapy showed a significant effects in reducing anti-müllerian hormone (AMH-primary outcome), luteinizing hormone (LH), testosterone, hirsutism, and improving menstrual frequency, glucose, lipid, and insulin values(284) with non significant changes in body weight, FSH, and prolactin in adolescent PCOS(283).]
In metabolic syndrome, a constellation of metabolic abnormalities, such as abdominal obesity, insulin resistance, atherogenic dyslipidemia, elevated blood pressure, a prothrombotic profile, and inflammation(1311), physical exercise has shown to improve the lipid profile(1312). insulin resistance (IR)(1312) in obese boy and, bodyweight(1313), atherogenic lipid profiles(1313), insulin resistance(1313), blood pressure(1313) and anthropometric factors(1313) if used conjunction with standard diet therapy in the Japanese population.

9. Lose some weight
Obesity and particularly visceral fat excess in PCOs women have shown to involve stimulating ovarian androgen(1315) induced alternation of ovarian physiology(1314)(1315) associated with ovulatory disturbances(1314)(1315) and negative effects on the endometrium(1314) in contribution to fertility(1314), implantation failure(1314) and miscarriage(1314).
(Read more information of benefits of weight loss for women with PCOs in the section PCOs in weight loss perspective)
The macronutrients and Glycemic index
The Best PCOs Diets for weight loss
The Common Weight Loss Foods
The Common Weight Loss Herbs
The Weight Loss Vitamin C
The Weight Loss Vitamin D

10. Protect your Liver
Liver diseases such as nonalcoholic fatty liver disease (NAFLD) associated to 41% increased risk in women with PCOs(1320), is tightly associated with obesity and the metabolic syndrome induced physiopathology of fibrosis development and progression(1316) affecting the liver function not only in blood storing and formation(1318) and but also liver in transportation of blood and fluid to kidney and heart in fluid and blood distribution to our body(1318) and liver metabolism(carbohydrate metabolism (glycolysis and glycogen synthesis) and triglyceride synthesis (lipogenesis))(1319) in regulating insulin resistance associated with excessive fat accumulation in ectopic tissues, inflammation and endoplasmic reticulum stress(1317).
Vitamin B complex has shown to exhibit hepatoprotective effect(1321) through inhibition of lipid metabolic disorder)1321), oxidative damage(1321)(1322) and nitrosative stress(1322).
According to Auburn University, consumption of green leafy vegetables (GLVs) may reduce the risks associated with cardiovascular(1323) and liver diseases(1324) such as hepatocellular carcinoma(1324) through modulating liver fatty acid composition(1323).
Liver disharmony can contribute to emotional depression(1318)(1324), exacerbating the psychological symptoms in women with PCOs(1325).

11. Weekly acupuncture
Suggestions for acupuncture for the treatment of PCOs symptoms have been well established(1326)(1329)(1328), but larger example size and multicenter studies are necessary to provide more reliable and valid scientific evidence(1336). Dr. Ren LN and research team said: "acupuncture combined with Chinese herbal medicines or with moxibustion treatment has advantages in reducing serum luteinizing hormone/follicle-stimulating hormone (LH/FSH), insulin resistance (IR), testosterone (T), and body mass index (BMI)"(1327). Acupuncture has also shown to regulate menstrual dysfunction and induce ovulation in women with PCOs(1330).
In fact, acupuncture also lowers perceived stress at the time of embryo transfer for an improved pregnancy rate(1331), significantly reduce pain intensity and analgesic consumption during oocyte aspiration in IVF treatment(1332), the occurrence of ovarian hyperstimulation syndrome (OHSS) in vitro fertilization and embryo transplantation(1333).....Combined with clomiphene, acupuncture effectively improves HCG day cervical mucus, endometrial thickness, and morphology for a normal pregnancy(1334). The study by the University of Adelaide preliminary data suggested that acupuncture improves self-efficacy and psychological coping for women experiencing delays with falling pregnant(1335).



Nutritional Supplements according to TCM


1. Chlorophyll (Best for the syndrome of Stagnation of Qi and blood stasis(1246) and Dampness heat of liver PCOs patients)
Chlorophyll, a water plant has been conferred to a wide range of health benefits, including anti cancers(1337)(1338), immune-modulating(1339), improve anemia(1341), anti hypoxia(1342), antioxidant(1343)(1340), anti-inflammation(1344)(1345), etc. According to Lund University, thylakoids, chlorophyll-containing membranes in chloroplasts may constitute to weight loss over time, through its efforts in reduced food intake and prevented compensational eating later in the day(1345) and hypoglycemia induced weight gain in overweight women(1345). "Chlorophyll processed a property in detoxification of the liver"(1346)(1347), according to Dr. Janet Starr Hull of alternative health and nutrition said, of which improve liver function in carbohydrate and lipid metabolism. (see protect your liver in lifestyle modification according to TCM for more information)
[Liver diseases such as nonalcoholic fatty liver disease (NAFLD) associated to 41% increased risk in women with PCOs(1320), is tightly associated with obesity and the metabolic syndrome induced physiopathology of fibrosis development and progression(1316) affecting the liver function not only in blood storing and formation(1318) and but also liver in transportation of blood and fluid to kidney and heart in fluid and blood distribution to our body(1318) and liver metabolism(carbohydrate metabolism (glycolysis and glycogen synthesis) and triglyceride synthesis (lipogenesis))(1319) in regulating insulin resistance associated with excessive fat accumulation in ectopic tissues, inflammation and endoplasmic reticulum stress(1317).
Vitamin B complex has shown to exhibit hepatoprotective effect(1321) through inhibition of lipid metabolic disorder)1321), oxidative damage(1321)(1322) and nitrosative stress(1322).
According to Auburn University, consumption of green leafy vegetables (GLVs) may reduce the risks associated with cardiovascular(1323) and liver diseases(1324) such as hepatocellular carcinoma(1324) through modulating liver fatty acid composition(1323).
Liver disharmony can contribute to emotional depression(1318)(1324), exacerbating the psychological symptoms in women with PCOs(1325).]

2. Probiotics (the healthy bacteria found in your intestinal tract)
( Best for PCOs patient diagnosed with spleen yang deficiency(1248))
Foods promote the growth of beneficial bacteria in the intestinal tract include whole grains, onions, bananas, garlic, honey, leeks, artichokes, and some fortified foods, excluding milk and milk products.
(See Avoid milk and dairy products (cheese and yogurt) in lifestyle modification according to TCM for more information)
[According to traditional Chinese medicine, milk and dairy products are considered as "very cold and damp foods" in nature, as they can overload the digestive system, inducing production of phlegm, the main cause of PCOs(1304)(1305)(1306). Replacement of cow milk with (unsweetened) almond milk may contribute to many health aspects for women with PCOs. According to researches, almond milk not only be an efficacious substitute of cow milk in infant with cow-milk allergy/intolerance(1307) but also induces production of probiotics, which have a positive effect on fasting blood sugar(1310) and serum of insulin(1310) in in PCOS patients, through its fermentation stage(1308). According to the University of California at Davis, intake of almonds containing 31 g of total fat per day for 6 weeks had a beneficial effect on plasma lipids and androgens in PCOS(1309)].
According to studies, probiotics has shown to contribute to many health aspects, including anti gastrointestinal diseases(1354)(1355)(1356) anti antibiotic(1348)(1349), anti antibiotic resistance(1350)(1351), improved immune(1352)(1353), antidiabetic(1357)(1358), anti obese(1359)(1360), anti metabolic dysfunctional,(1361)(1362), antioxidant(1363), anti-inflammatory(1364)(1365), anti-cancerous(1366)(1367), anti-infective activities, etc. According to Isfahan University and Isfahan University of Medical Sciences, Probiotics also processes significantly improve serum insulin levels, among 72 women aged 15-40 years old diagnosed with PCOS in a randomized double-blind placebo-controlled clinical trial(1370).

3. Cinnamon
( Best for PCOs patient diagnosed with spleen yang deficiency(1248) and kidney yang deficiency(1247)(1248))
(See the Insulin resistance improvement and/or anti metabolic syndrome herb: Cinnamon for more information)
[Cinnamon is a spice derived from the inner bark of tree, native to South East Asia, of over 300 species of the genus Cinnamomum, belongings to the family Lauraceae used in herbal and traditional medicine as anti-microbial agent(1087) and to improve reproductive organs(1088), prevent flatulence(1089) and menstrual cramping(1087), treat gastrointestinal complaints(1089), diarrhea(1087), bad breath(1090), headache(1087), etc.(1086)(1087).


Nutritional ingredients(1087)
1. Cinnamic aldehyde
2.Cinnamyl Acetate
3. Eugenol
4. Aldehyde
5. Pinene
6. Coumarins
7. Cinnzeylanol
8. Cinnzeylanine
9. Safrol
10. Methylhydroxy chalcone polymer (MHCP) Epidemiological studies suggested that cinnamon consist a significant anti-insulin resistance(1091)(1092)(1094) and anti metabolic syndrome(1093)(1094)(1095)(1096)(1097) properties, such as lowering total cholesterol(1093), low-density lipoprotein cholesterol(1093) and improving high-density lipoprotein cholesterol(1093), maybe due to its antihyperglycaemic (1091)(1093) and potential to reduce postprandial blood glucose levels(1091)(1092), liver fat(1098) and an improved glucose homeostasis(1098) properties, by regulating the mechanisms of-medicated glucose and lipid metabolism(1099), such as decreased the mRNA expression of inflammatory cytokine(TNF-alpha) in adipose tissue(1100) and upregulated mRNA expression of insulin-regulated membrane trafficking(1100) and whole-body glucose homeostasis(GLUT-4) in skeletal muscle(1100)].

4. Flaxseed oil
(Best for PCOs patient diagnosed with kidney yin deficiency(1247)(1248))
Flaxseed oil is extracted from the seeds of the flax plant (Linum usitatissimum) contained both omega-3 and omega-6 fatty acids. Flaxseed oil generally contains 50% of the omega-3 fatty acid - alpha-linolenic acid and 25 % of the omega-6 fatty acid linolenic acid, 15 % of mainly monounsaturated oleic acid and trace amounts of palmitoleic acid and eicosenoic acid(1371).


Nutritional ingredients
1. Alpha-linolenic acid (ALA)
2. Palmitic acid
3. Stearic acid
4. Arachidic acid
5. Palmitoleic acid
6. Oleic acid
7. Eicosenoic acid
8. Linoleic acid
9. Etc.(1371)


Epidemiological studies of health benefit are well established, including reduced blood pressure(1372)
(1373) and cholesterol(1374)(1375), risk of irregular cell growth(1376)(1377), diabetes(1378)(1379) and osteoporosis(1380)(1381), benefit cardiovascular system(1382)(1383), menopause symptoms(1384)(1385), cyclic mastalgia (breast pain)(1390), patients with Sjogren’s syndrome(1386) and inflammatory bowel disease (IBD(1387)(1388), use of natural laxative(1389)(1390), human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS)(1390), etc., probably due to the the efficacy of alpha-linoleic acid(1390) and its antioxidant(1391)(1392)(1393)(1394) and anti-inflammatory(1392)(1395)(1396) activity.
Recent studies also suggested that flaxseed oil processes anti-insulin resistance(1397)(1398) and metabolic syndrome(1400)(1401), confers health benefits in obesity(1400) due to its effect on adipocyte function(1399) activities due to the effects of monounsaturated fatty acids (MUFAs) and n-3 polyunsaturated fatty acids (PUFAs)(1400)(1401).

5. Navy bean (White kidney bean)extract
(Best for PCOs patient diagnosed with kidney yin deficiency(1247)(1248))
The small, white kidney bean, also called pea bean or haricot, popular in both dry and green forms, is very popular in Britain and the US, native to Peru. It is now grown and consumed across the world, due to its numerous health benefits(1402).

Nutritional ingredients
1. Carbohydrate
2. Protein
3. Dietary fiber
4. Vitamin A
5. Vitamin B1
6. copper
7. Iron
8. Manganese
9. Phosphorus
10. Magnesium(1402)
11. Catechin derivatives(1403)
12. Proanthocyanidins(1403)
13. Catechin glucoside(1403)
14. Etc.

Epidemiological studies, linking navy bean as a functional health foods, may be due to its phenolic composition in reduced the incidence of several chronic diseases(1402)(1411) that shared an inflammatory component(1403), including irregular cell growth(1406)(1407), diabetes(1402)(1407), CVD(1407), glycemic response(1404)(1405)(1407), aid digestion(1404)(1405), sleep disorder(1402), irritable bowel syndrome(1402) and constipation(1402), infertility(1402), neurotransmitter dysfunction(1402), colitis(1408), improved colon health(1408)(1409). etc. probably through its total phenolic content effects on antioxidant(1410)(1411) and anti inflammatory activities(1411) and other mechanism.
According to studies, white kidney bean also processes certain properties against PCOs related syndrome including the effect on diabesity, a collection of obesity/overweight, type 2 diabetes mellitus and insulin resistance(1412), GI index(1413) through its carb blockers(1413) mimicked the beneficial effects of fibers(1412). Its extract, according to studies, also induced blood glucose levels(1415) and weight loss(1414)(1415) through blocking carbohydrate absorption(1414), and regulating hypoglycemic and anorexigenic activities of an alpha-amylase inhibitor(1415).


6. Micronutrient supplements
6.1. B Vitamins
[Vitamin B1 (thiamine), Vitamin B2 (riboflavin), Vitamin B3 (niacin or nicotinic acid), Vitamin B5 (pantothenic acid), Vitamin B6 (pyridoxine, pyridoxal, pyridoxamine), Vitamin B7 (biotin), Vitamin B9 (folic acid) and Vitamin B12 (various cobalamins; commonly cyanocobalamin or methylcobalamin in vitamin supplements)](1416)


B vitamins, a class of water-soluble vitamins, coexisted in the same foods, play an important role in cell metabolism, found in many foods, including legumes (pulses or beans), whole grains, potatoes, bananas, chili peppers, tempeh, nutritional yeast, brewer's yeast, and molasses(1416). According to studies, deficiency of certain members of B vitamins may disrupt cell metabolism, leading to a risk of cancers(1417)(1418)(1419)(1420) and metabolic syndrome(1428).
a. Vitamin B1 (thiamine)
Deficiency of vitamin B1 may contribute to dyslipidemia(1421)(1427) and induce vascular complications in clinical diabetes(1421)(1422)(1423), metabolic defect(1424), cardiovascular diseases(1245), hypertension(1426), insulin resistance(1427), etc....


b. Vitamin B2 (riboflavin)
Deficiency of vitamin B2 has shown to decrease immune efficiency(1429)(1430) and anti oxidant status(1429), induce abnormal blood glucose level(1431), migraine(1432)(1433), various skin diseases(1434), hypertension(1435), hyperlipidemia(1436), etc...


c. Vitamin B3 (niacin or nicotinic acid)
Deficiency of vitamin B3 may contribute to low-grade chronic inflammation (metaflammation)(1437), reduce the effects on metabolic regulation(1437), including type 2 diabetes(1437), obesity(1437), and cardiovascular disease(1437), pigmentary disorders(1438) and acne(1438), etc....


d. Vitamin B5 (pantothenic acid)
Deficiency of vitamin B5 has shown to induce acne vulgaris(1439), hypertension(1440)(1441), a decrease in total antioxidant status(1442), insulin-sensitive(1443), reduced diabetic cardiovascular function and cardiac performance(1444), etc...


e. Vitamin B6 (pyridoxine, pyridoxal, pyridoxamine)
Deficiency of vitamin B6 may display sensorimotor peripheral neuropathy(a decreased ability to move or feel (sensation) due to nerve damage)(1445), hyperhomocysteinemia, a possible risk factor of morbidity and mortality associated with cardiovascular disease(1446), abnormal glucose levels(1431), endothelial dysfunction(1447), diabetes(1447) and inflammation(1447), reduce sympathetic activity and insulin-response, etc...


f. Vitamin B7 (biotin)
Deficiency of vitamin B7 has shown to contribute to genetic instability causes of DNA damage(1448) inducing cancers(1449) and a risk a factor in some neurodegenerative diseases(1449)m diffuse hair loss(1450), periorificial or acral dermatitis(1451), insulin sensitivity(1452) and glucose uptake(1452), risk of diabetes(1452), etc...


g. Vitamin B9 (folic acid)
Folic acid has shown to process the property in reduced risk of endothelial dysfunction(1457), CHD(1453) and CVD(1454)(1455), produced blood cells,(1456) secured cell division(1456), and growth(1456), improved antioxidant stasis(1458), lowered risk of diabetes(1459), etc,... Folic acid deficiency may induce the risk of early onset of diabetes(1460), a metabolic syndrome associated with increased risk for diabetes and cardiovascular disease(1460), depressed cell-mediated immunity(1461).


h. Vitamin B12 (various cobalamins; commonly cyanocobalamin or methylcobalamin in vitamin supplements)
Epidemiological studies suggestion that vitamin B12 exhibits anti-insulin resistance(1465) and endothelial dysfunction(1465), depression(1468)(1469) effects, etc,... Deficiency of vitamin B12 induced risk of neurocognitive disorders(1462)(1463), and decline(1462), obesity and overweight(1464), altered lipid profile in the prediction of metabolic risk(1466), a cardiovascular disease associated to hyperhomocysteinemia(1467).


6.2. Magnesium
Magnesium, a micronutrient and trace mineral found abundantly in spices, nuts, cereals, cocoa and vegetables such as spinach. Today approximately 5% - 15% of the world population are found to have a low level of serum ofMg(1470), probably due to reduced dietary magnesium intake associated with food refining and modern fertilizers that contain no magnesium(1471). In the US, 68% of the population is found to have a dietary intake of Mg below recommended levels(1472).
Deficiency of Magnesium may cause learning and memory deficiency(1473), reduced metabolisms(1474)(1475)(1476), hormone imbalance(1476), altered the gut microbiota(1477) in the digestive system and anxiety(1477)(1478), sleep disorders(1479)(1480), coronary artery vasospasm(1481),arrhythmias(1481)(1490), ischemic damage(1481) and cardiac failure(1481), etc....


Epidemiological studies suggested that magnesium also exhibits anti cancer(1500)(1501)(1502) anti metabolic syndrome(1482(1485)(1484) effects such as hypertension(1483)(1487), obesity(1486)(1487), elevated fasting plasma glucose(1488)(1489), high serum triglycerides(1488)(1491), and low high-density lipoprotein (HDL) levels(1488)(1490), etc,... and reduces risk insulin resistance(1482)(1484)(1490), cardiovascular disease(1482) and diabetes(1483)(1484), migraine headache(1492)(1493)(1495), premenstrual syndrome(1494)(1495), depression(1478)(1496), stress(1497)(1498), etc,... of which may be helpful for management and treatment of women with PCOs.


6.3. Chromium
Chromium, a micronutrient and trace mineral, found abundantly in whole grain products and certain fruits and vegetables such as broccoli, potatoes, grape juice, and oranges, and lean meats, poultry, fish, beans, eggs, and nuts,(1504) plays an important in the metabolism and storage of fats, carbohydrates, and protein in the body(1503).
The US dietary guidelines for adequate daily chromium intake were lowered in 2001 from 50–200 µg for an adult to 30–35 µg (adult male) and to 20–25 µg (adult female), according to Journal of academic of nutrition and dietetics(1505).
Chronic chromium deficiency may cause symptoms of severely impaired glucose tolerance(1506)(1507), weight loss(1506)(1508), and a metabolic encephalopathy like confusional state(1506), induce risk of prediabetes(1509)in predicted diabetes(1509)(1510)(1513) and atherosclerosis(1510),...


Strong evidences from epidemiological studies suggested that chromium exhibits anti metabolic syndrome(1511)(1514)(1515) and cardiovascular disease(1511)(1512)(1513) including hypertension(1516)(1517), obesity(1518)(1519), elevated fasting plasma glucose(1520)(1521), high serum triglycerides(1522)(1523), and dyslipidaemia(1510)(1521), etc,, , anti insulin resistance(1510)(1519), anti depression, anti diabetes(1513)(1512), etc,.... effects.


6.4. Lipoic acid (LA)
Lipoic acid, also known as alpha-lipoic acid(ALA), an organosulfur compound derived from octanoic acid, play an essential for aerobic metabolism to turn nutrients into energy and remove wastes through cellular respiration(1524),found abundantly in spinach, broccoli, yams, potatoes, yeast, tomatoes, Brussels sprouts, carrots, beets, rice bran, especially in organic red meat, etc,....... The supplement has shown to be effective in ameliorate blood glucose(1531)(1532) through reduced suppression of insulin expression in β-cell(1535), reduced nerve damage induced diabetes(1533)(1534), neurodegeneration disease(1558)(1559), skin aging(1560)(1561), improved antioxidant(1527)(1528)(1530), anti-inflammatory(1526)(1528) and immune status(1525)(1526)(1527)(1528), reduced symptoms of vitamin E deficiency(1529), etc,....


According to studies, LA also processes anti-cancer(1570)(1571)(1572), anti-insulin sensitivity(1532)(1564), and anti metabolic syndrome(1532)(1563)(1562), such as hypertension(1564)(1565), obesity(1566)(1567), elevated fasting plasma glucose(1568)(1569) and dyslipidaemia(1556)(1557), etc,... effects of which may contribute to management and treatment of women with PCOs, depending to differentiation.

PCOs Treatment according to traditional Chinese medicine


Depending on differentiation, the most common diagnosis of polycystic ovary syndrome can be classified into


Kidney yang deficiency


Along with common symptoms mentioned above, women with PCOs diagnosed with kidney yang deficiency may also experience yang vacuity induced cold expressive syndrome, including
lumbago, cold limbs, fatigue, cold aversion, feverish sensation in chest, palms, and soles(1573),
difficulty in urination, enuresis, incontinence, declining libido and edema(1574) as a result of kidneys no longer perform their function in-store fluid to moister and warm the body for healthy function in the body's organs and tissues, inducing adrenal insufficient chronic lower back pain(1575)(1580), depression(1575), hypothyroidism(1579)(1575), nephritis(1578)(1575), ...(1575), leading to failure in transform damp-heat expression, promoted accentuation of inflammatory development of phlegm(1583).
Kidney yang deficiency has shown to alter carbohydrate and lipid metabolisms (free fatty acids, 1-monolinoleoylglycerol, and cholesterol), gut microbiota metabolism (indole-3-propionic acid), indued anovulatory infertility( 1581) and hypertension(1582) of which related to symptoms of PCOs(1576)(1577).




Spleen Yang Deficiency


Spleen yang deficiency is a severe form of spleen qi deficiency, characterized by a condition of the inability of the spleen in the distribution of fluid and nutrient to the body organs, in the removal and descend the turbid(2072), causing malfunctions functions of the organs and fluid retention. Prolong period of spleen yang deficiency may induce the development of phlegm, including women with PCOs.
Women with PCOs diagnosed by spleen yang deficiency may also experience yang vacuity impelled cold expression of additional symptoms of abdominal pain(2074), lack of appetite(2076), fatigue(2075), lightheadedness(2075) and headache(2075), weakness of the four limbs(2077), diarrhea(2073)(2076), chilliness(2077), edema(2074), pale, swollen, wet tongue(2076) and weak, slow, deep pulse(2072),....
In the review of the Database provided by PubMed, spleen qi deficiency may alter certain metabolic pathways, such as the energy, protein, and glycolytic metabolisms(2078), body weight and motor behavior(2079), skeletal muscle function(3080), blood glucose, lipid metabolism and fat-islet axis.(2081),.....


Liver Qi and Blood stagnation


According to traditional Chinese medicine, the function of the liver is to maintain the flow of qi and moisturize the body organs and formation, transportation and storage of blood. Liver blood stagnation may be resulted in prolonging period of liver qi stasis, if qi is stasis it can not move blood.
Women with PCOs diagnosed with syndrome of liver qi and blood stagnation may experience additional symptoms, beside of those mentioned above, including premenstrual syndrome(2327), delay menstrual cycle(2331), irregular periods(2331), haemorrhages(2333), depression(2326)(2332), anxiety(2326), abdomen pain before menstrual onset(2332), obfuscation colour(2332), cold lower abdomen(2332), insomnia(2332), fatigue(2332), eyes dark(2332), face dark or ring lip dark(2332), before and after menstruation breast swelling(2332)(2326), chest tightness(2332), irritable insomnia(2332), lower abdomen pain during menstruation(2332),........
According to the database of PubMed, liver qi and blood stagnation may alter reproductive hormones production(2330), leading ovarian hyper-stimulation (COH) and in the process of ovarian hyper-stimulation(2328), ovulatory disorder infertility(2329),......




Foods for kidney yang, Spleen yang deficiency, and Liver qi stagnation, according to TCM

Kidney yang and spleen deficiency and liver qi stagnation can be managed and treated in part with a diet of fresh and cooked warming foods.


1, Garlic
Garlic (Allium sativum) is a species in the onion genus, belonging to family Amaryllidaceae, native to central Asia. It has been used popularly in traditional and Chinese medicine in treating common cold(1587)(1588) and flu(1589)(1590), blood pressure(1591)(1592), cholesterol levels(1593)(1594), natural antibiotic(1595)(1596), cancers(1597)(1598)(1599) etc....(1585).
According to traditional Chinese medicine, the acrid, warm herbal da suan expresses its tonification of yang through enhancing the function of the large intestine, lung, spleen, stomach channels(1586).

Chemical constituents(1586)
1. Allyl methyl sulfide
2. Diallyl sulfide
3. 6-methyl-1-thio-2
4. 4-cyclohexadiene
5. Dimethyl sulfide
6. Divinyl sulfide
7. Dimethyl disulfide
8. Allyl methyl disulfide
9. Dithiocyclopentene
10. 5-methyl-1
11. 2-dithio-3-cyclopentene
12. Allyl propyl disulfide
13. 2-dithio-3-cyclopentene
14. 4-methyl-1
15. 3-vinyl-1
16. 2-dithio-4-cyclohexene
17. 3-vinyl-1
18. 2-dithio-5 cyclohexene
19. Cysteine,
20. Histidine
21. Lysine
22. Etc.


Epidemiological literature suggested that garlic also displays anti metabolic syndrome(1602)(1603), including obesity(16000)(1601), elevated blood pressure(1591)(1592), elevated fasting plasma glucose(1604)(1605), high serum triglycerides(1604)(1602), and low high-density lipoprotein (HDL)(1593)(1594)(1604) levels, insulin resistance(1606)(1607), proinflammation(1609)(1608) and renal damage(1610)(1611), reduced risk of cardiovascular disease(1612)(1613) and diabetes, probably through its effects on carbohydrate and lipid(1601) modulation via anti-inflammatory(1606) and antioxidant(1603)(1606) mechanisms. All these factors may be the reasons for which garlic was recommended by modern traditional Chinese medicine doctors for management and treatment of PCOs' women who were diagnosed with kidney yang deficiency.

2. Ginger(1616)
Jiang is also known as Ginger root. The acrid and warm herb has been used in TCM as an anti-inflammation(1618)(1619)(1620), anticoagulation of platelets(1621)and anti-thrombotic(1622), anti-allergy(1625)(1626), anti tumors(1627)(1628) and anti-hair growth(1629)(1630) lower back  pain(1623)(1624), functional bowel disorders (FBD(1631), etc., as it warms the middle burner and lungs, rescues yang, transforms phlegm by enhancing the functions of lung, spleen and stomach channels(1617).


Chemical constituents
1. 2-heptanol
2. 1,3,3-trimethyltricyclo[2,2,1,0] heptane
3. Tricycline
4. β-fenchene
5. β-pinene
6. 5-hepten-2-one-6-mehtyl
7. Myrcene
8. Octanal
9. α-thujene
10. Zingiberol
11. Zingiberene
12. α-curcumene
13. linalool
14. Cineole
15. Phellandrene
16. Camphene
17. Etc.(1617)


Strong evidence from epidemiological literature suggested that ginger also consist the properties of anti-obesity(1632)(1636), anti-insulin resistance(1632)01636), anti (1634)(1636), anti dyslipidaemia(1634)(1636), anti-diabetes(1635)(1637) and reduced risk the metabolic syndrome causes of cardiovascular complications(1634), etc,....
Its major chemical component, [6]-gingerol analogue (6G), and extracts in rat study exhibited the protective effect against the development of metabolic syndrome(1633)(1636), through significantly reduced body weight gain(1633)(1636), fat accumulation(1633)(1636), and circulating levels of insulin(1636)(1633) and leptin(1633).
Through its warm in nature and effects on metabolic syndrome, ginger is recommended to the daily diet of PCOs' women diagnosed with kidney yang deficiency by traditional Chinese medicine.


3. Walnut
Walnut, nut of tree, including Brazil nuts, cashews, hazelnuts (filberts), macadamia nuts, pecans, pine nuts, pistachios, etc,.. is the genus Juglans belongings to the family Juglandaceae, used in traditional medicine to soothe skin(1647)(1650), and to treat toothache(1648), rheumatism(1648), fungal infections(1648)., anti neuro-aging(1649), allergic dermatitis(1651), etc,... Its bark is also claimed to promote blood purifying(1652), anticancer(1652), depurative(1652), diuretic(1652) and laxative(1652) activities, according to Jamia Hamdard (Hamdard University).


Phytochemical constituents
1. Ferulic acid
2. Vanillic acid
3. Coumaric acid
4. Syringic acid
5. Myricetin
6. Regiolon
7. Ellagic
8. Gallic acid
9. Alpha-linoleic acid (ALA)
10. Arginine
11. Histidine
12. Isoleucine
13. Leucine
14. Lysine
15. Methionine
16. Phenylanine
17. Threonine
18. Tryptophan
19. Valine
20. Etc. (1638).


Consumption of walnuts and other nuts have been found to be associated with reduced risk of metabolic syndrome, including lowered total cholesterol and non-high-density lipoprotein cholesterol levels(1639), probably through its effects related to inflammation, oxidative stress, and endothelial function(1639), enhanced weight loss(1640), increased high-density lipoprotein cholesterol levels(1640), reduced systolic blood pressure(1641) and fasting blood sugar (FBS)(1642), etc,.. and its complications including diabetes(1643)(1644) and cardiovascular disease(1645)(1646).




4. Royal jelly
Royal jelly is produced by the worker bees and fed to bee larvae for 3 days to stimulate healthily and rapid growth and life for the queen to ensure the endless production of eggs, used in traditional Chinese medicine to treat malnutrition in children(1653), cognitive decline(1654) and sarcopenia due to ageing(1655), leukopenia(1656), liver diseases(1657)(1658)(1659), ulcer(1660)(1661), bronchial asthma(1662)(1663), diabetes(1664)(1665), high blood pressure(1666)(1667), cognitive impairment(1668), functional uterine abnormality(1669) through its estrogenic activities(1670), irregular menses(1571) and functional infertility(1672) by enhancing function of spleen, liver and kidney channels(1653).


Chemical constituent(1653)
1. Inositol
2. 6-Biopterin
3. Flavin adenine dinucleotide
4. Flavin mononucleotide
5. Kynurenine
6. Albumin
7. β and γ globulin
8. Insoluble protein
9. Acetylcholine
10. Stearin
11. Phospholipid
12. Adenine nucleotides
13. Arginine
14. Aspartic acid
15. Glutamic acid
16. Lysine
17. Proline
18. β-alanine
18. Etc.


Epidemiological studies suggested that royal jelly also displays certain metabolic syndrome effects, such as glucose tolerance(1673), anti insulin resistance(1677)(1679), anti hypertension(1677), anti-hypercholesterolemic(1654)(1675) and anti-hyperglycemic(1654)(1678), induced weight loss(1676) and reduced risk of symptoms of fatigue( 1682), depression(1683) and anxiety(1683) and complication, such as diabetes(1678), breast cancer(1684)(1685) through anti-inflammatory(1654), anti-oxidative(1654) and immune defense(1674) activities.
According to joint study by Urmia University and Kermanshah University of Medical Sciences, royal jelly also improved reproductive parameters(1680)(1681) such as testicular weight, sperm count, viability, motility, deformity, DNA integrity, chromatin quality, serum testosterone and testicular tissue MDA levels in male diabetic rats(1680).


5. Coriander
Coriander is an annual herb, genus Coriandrum in the family Apiaceae, native to southern Europe and North Africa to Southwestern Asia. All parts of the plant are edible, but the fresh leaves and the dried seeds are the parts most commonly used in cooking. It has been found to process certain health effects on skin(2083)(2084) and menstrual disorder(2085)(2086)[due to high concentration of carotenoids], oxidative stress(2087)(2088), liver damage(2089)(2090), cognitive degeneration(2091) and degenerative symptoms(2092)(2093)[such as anxiety, depression and memory loss], impairment(2091)(2092), cholesterol(2094)(2095), gastrointestinal disorders(2096)(2097)(2098), hypertension(2096), infection(2099) and inflammation(2098)(2099), anemia(2100), immune respond(2101),...........
.
Phytochemical constituents
1. Monoterpenes
2. α-pinene,limpnene
3. γ- terpinene
4. P-cymene
5. Borneol
6. Citronellol
7. Camphor
8. Peraniol
9. Pyrazine
10. Pyridine
11. Isocoumarins
12. Coriandrin
13. Dihydrocoriandrin
14. Flavonoids,
15. Phenolic acids
16. Sterols(2082).
17. Etc.


Epidemiological studies suggested that coriander may comprise a strong evidence as the food to be used for treatment of metabolic syndrome(2102) and its complications of diabetes(2102)(2110) and cardiovascular disease(2102) due to its antioxidants(2104)(2106), anti inflammatory(2107)(2108) and immunomodulatory(2109) effects in hypoglycemia(2102)(2103)(2104) and hypolipidemia(2102)(2104)(2105), glucose level(2102), insulin resistance(2102), hypertensive(2096), obesity(2111)....

6. Cinnamon
(See anti-insulin resistance and anti metabolic herbal medicine for more detail)
[Cinnamon is a spice derived from the inner bark of tree, native to South East Asia, of over 300 species of the genus Cinnamomum, belongings to the family Lauraceae used in herbal and traditional medicine as anti-microbial agent(1087) and to improve reproductive organs(1088), prevent flatulence(1089) and menstrual cramping(1087), treat gastrointestinal complaints(1089), diarrhea(1087), bad breath(1090), headache(1087), etc.(1086)(1087).


Ingredients(1087)
1. Cinnamic aldehyde
2.Cinnamyl Acetate
3. Eugenol
4. Aldehyde
5. Pinene
6. Coumarins
7. Cinnzeylanol
8. Cinnzeylanine
9. Safrol
10. Methylhydroxy chalcone polymer (MHCP)


Epidemiological studies suggested that cinnamon consist a significant anti-insulin resistance(1091)(1092)(1094) and anti metabolic syndrome(1093)(1094)(1095)(1096)(1097) properties, such as lowering total cholesterol(1093), low-density lipoprotein cholesterol(1093) and improving high-density lipoprotein cholesterol(1093), may be due to its antihyperglycaemic (1091)(1093) and potential to reduce postprandial blood glucose levels(1091)(1092), liver fat(1098) and an improved glucose homeostasis(1098) properties, by regulating the mechanisms of-medicated glucose and lipid metabolism(1099), such as decreased the mRNA expression of inflammatory cytokine(TNF-alpha) in adipose tissue(1100) and upregulated mRNA expression of insulin-regulated membrane trafficking(1100) and whole-body glucose homeostasis(GLUT-4) in skeletal muscle(1100)].


Its phytochemical coumarins also are found to process anti heart disease(2112), diabetes(2112)(2013), and high blood pressure(2112) properties through its effect on vary mechanism(2112), including inhibited insulitis, increased pancreatic islet number(2113), enhanced lipolysis of adipocytes in lipid abnormalities(2014).
According to the University of Karachi and the University of Malaysia, cinnamon cinnamic acid and cinnamaldehyde may be the next potential candidate for the treatment of II diabetes, due to their effects on improving glucose tolerance in vivo and stimulating insulin secretion in vitro(2015).
In cardiovascular disease, according to Dr, Rao PV and Gan SH. cinnamic aldehyde and cinnamic acid, cinnamaldehyde, may be effective for the treatment of cardiovascular disease through activation of endothelial cells(2016); blocking the activity of thromboxane A2 (TXA2) receptor in inhibition of thromboxane receptor-mediated vascular smooth muscle cell proliferation(2016); reduced hypertension by abridging vascular contractility respectively(2016)


7. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional Chinese medicine for its effect on high lipids (2118)(2119), pain(2120)(2121), rheumatoid arthritis inflammation(2122)(2123), periodontitis(2124)(2125), tumors(2126)(2127)(2128), herpes(2129)(2130), coronary atherosclerosis(2131)(2132), neurodegeneration(2133)(2134), leukemia(2135)(2136),.............. as the acrid, bitter, aromatic, warm food enhances the stomach, liver, spleen channels(2117).


Phytochemical constituents(2117)
1. Berberine
2. Tumerone
3. Dihydroturmerone
4. Curcumin
5. Demethoxycurcumin
6. Bisdemethoxycurcumin
7. Borneol
8. Zingberene
9. Arabic gum
10. Curcumol
11. Zingiberen
12. Phellandrene
13. Eucalyptol
14. Etc.


In metabolic syndrome differentiation(2137)(2138), turmeric has shown to reduce risk of complications of diabetes and cardiovascular disease(2145) through attenuated expression of, lipid-profile (cholesterol, HDL-cholesterol, LDL-cholesterol and TG)(2137)(2138), fasting glucose(2137)(2138) hypoglycemia(2139)(2140)(2142) and hypolipidemia(2139)(2141)(2142), weigh loss(2138)[body mass index and waist circumference)], insulin resistance(2144)(2143), hypertension(2145)(2146), obesity(2147), c-reactive protein (CRP)(2137)....via glucose and lipid metabolic (2148)(2149), antioxidants(2150)(2151)(2152) and anti inflammatory(2153)(2154)(2155) pathways.
Berberine (BBR), its major chemical constituents also exerted the effect in improving some of the metabolic(829) and hormonal derangements in a group of treated Chinese women with PCOS(829).

8. Carrot
Carrot is a root vegetable with orange color normally, a subspecies of Daucus carota, belongs to the family Apiaceae, native to Asian and Europe.


Nutritional Benefits
1. Carbohydrates
2. Sugars
3. Fiber
4. Fat
5. Protein
6. Vitamin A
7. Thiamine (VittaminB1)
8. Riboflavin (Vitamin B2)
9. Niacin (Vitamin B3)
10. Vitamin B6
11. Folate (Vitamin B9)
12. Vitamin C 13. Vitamin K
14. Calcium
15. Iron
16. Magnesium
17. Molybdenum
18. Phosphorus
19. Potassium
20. Sodium
21. Major chemical compositions include carotenoids(alpha- and beta- carotene, beta-cryptoxanthin, and lutein), anthocyanins, phenolic acids,......


In the effects of metabolic syndrome and its complications, anthocyanins, phenolic acids and carotenoids, the major chemical constituents found in carrot have exhibited anti metabolic syndrome activity through the anthocyanins effects on lipid metabolism(2160) such as dyslipidaemia(2157)(2158)(2159)[LDL- and HDL-cholesterol concentrations], and glucose metabolism(2160) such as glucose tolerance(2157)(2160), hypertension(2157)(2160) and insulin resistance(2160)(2157); the phenolic acids effects in protected against CVD(2157)(2161)(2162) and diabetes(2162) and carotenoids effects in protected against oxidative processes(2157)(2167), cardiovascular disease(2163)(2164)(2165), hypertension(2166)(2167), insulin sensitivity(2168)(2169), plasma lipid profile(2170), through lipid metabolism(2171)(2172).




9. Black pepper
Black pepper is a flowering vine in the family Piperaceae, cultivated for its fruit, which is usually dried and used as a spice and seasoning. According to traditional Chinese medicine, black pepper has been used as anti-platelet(2173) anti-cancer(2174)(2175)(2176), antioxidant(2175)(2176). anti-inflammatory(2176)(2173), antispasmodic(2177)(2178), laxative(2178) advocate and to improve blood circulation(2179) through lowering blood pressure and inhibition of high K+ pre-contractions and treat gastrointestinal disorders(2178) including constipation, diarrhea and abdominal pain........., as it enhances the large intestine and stomach channels.


Phytochemical constituents(2180)
1. Piperine and piperitone
2. Sabinene
3. Beta-pinene
4. Limonene
5. Terpinene
6. Alpha-pinene, myrcene
7. Delta3-carene
8. Monoterpene derivatives
9. Sesquiterpene
10. Beta-caryophyllene
11. Humulene
12. Beta-bisabolone
13. Caryophyllene oxide
14. Phenylether
15. Etc.


Piperine, the major chemical compound found in black paper has exhibited anti metabolic syndrome(2181)(2182) and reduced risk of complications of diabetes(2184)(2185)(2189) and cardiovascular disease(2182)(2186) effects on lipid profile(2182)[LDL-non-HDL-C, total cholesterol, triglycerides and Lp(a), and elevating HDL-C concentrations], obesity(2183), glucose intolerance(2183), and oxidative stress(2183), body weight(2187), insulin and leptin sensitivity(2187)
through its antihyperglycemic(2183)(2189) and hypolipidemic(2183)(2188) metabolisms and antioxidant(2188) and anti-inflammatory activities(2181).




10. Pomegranates
Pomegranates is a fruit-bearing small tree, genus Punica, belonging to family Lythraceae, native to Iran but has been cultivated in Asian since ancient times. The peel has been used in traditional Chinese medicine as anti-cancer(2192)(2193)(2194), antimicrobial(2192)(2195), neuroprotective(2196)(2197), antioxidant(2192)(2193) and anti-inflammatory(2192)(2194) agents and to treatment of abdomen pain(2198)(2199). chronic myeloid leukemia(2191), coccidiosis(2200) and helminthiasis(2200), ...... by enhancing the function of the large intestine(2190).


Phytochemical constituents(2190)
1. Granatin
2. Punicalin
3. Punicalagin
4. Elaidic aicd
5. Cyanidin-3-glucoside
6. cyanindin-3
7. 5-diglucosede
8. Pelargonidin-3-glucoside
9. pelargonidin-3
10. 5-diglucoside
11. Tetrameric gallic acid(2190)
12. Isoquercetrin
13. Ellagitannins
14. Flavonoids,
16. Anthocyanidins
17. Anthocyanins
18. Estrogenic flavonols
20. Flavones(21))
21. Eic.


According to the data base of PubMed, pomegranate (Punica granatum) also exhibited anti metabolic syndrome(2201)(2202) and reduced risk of complications of diabetes(2203)(2204) and cardiovascular disease through the effects on weigh gain(2203), obesity(2207)(2208), fasting blood sugar(2204)(2205)(2206), lipid profiles(2204), lipoprotein oxidation(2204), hypertension(2210)(2211), insulin resistance(2205)(2206)(2207), pancreatic islets(2205), hyperglycemia(2205), hyperlipidedmia(2209)(2211),........through antioxidant(2192)(2193) and anti inflammatory(2192)(2194) pathways.






Herbal Medicine for kidney yang, Spleen yang deficiency, and Liver qi stagnation, according to TCM


1. Cortex Radicis Moutan (Mu Dan Pi)
Mu dan pi also known as peony, the acrid, bitter, mildly cool herb has been used in traditional Chinese medicine as antimicrobial(1687)(1688), anti-inflammatory(1690)(1691)(1692)(1694), antioxidant(1693), antihypertensive(1690), antiseptic(1690), improved thrombocyte coagulation(1690), immune (1704) and central nervous systems(1705) agents and for treatment of gastric erosion(1695), allergenic rhinitis(1689)(1692),... by enhancing functions of heart, liver, kidney channels(1686)..


Chemical constituents
1. Paeonol
2. Paeonoside
3. Paeonolide
4. Apiopaeonoside
5. Paeoniflorin
6. Ozypaeoniflorin
7. Benzoylpaeoniflorin
8. Benzoyl-oxypaeoniflorin
9. Gallic acid
10. 1,23,4,6-pentagalloylglucose
11. Etc.


In management of women with PCOs, moutan exhibited anti oligo/amenorrhoea and hyperandrogenism(16996), reduced luteinising hormone (LH)(1696), prolactin(1696), fasting insulin(1696) and testosterone(1696). anti high blood pressure(1690)(1697), anti insulin resistance(1698)(1699), improved carbohydrate(1703) and lipid metabolism(1700), anti obesity(1702)(1703) and anti complications of diabetes(1701)(1704) and cardiovascular disease(1706)(1707)(1708).


2. Poria cocos
Poria cocos also known as fu ling, the sweet, bland, neutral herbal medicine has been used in TCM for treatment of cancer(1709)(1710), headache(1712), dizziness(1714), palpitations(1711), insomnia(1715)(1716), neurodegenerative disease(1717)(1718), chronic gastritis(1714), chronic inflammation(1712) and to strengthen the body(1711), improve body weight(1719), kidney functions(1712)(1713) and protect against lipid peroxidation of red blood cells(1720), etc.... by enhancing the functions of heart, spleen, lung, kidney channels(1711).


Chemical constituents(1711)
1. Pachymose
2. B-pachyman,
3. B-pachymanase
4. Pachymic acid
5. Tumulosic acid
6. Eburioic acid
7. Pinicolic acid
8. β-amprin acetate
9. B-hydroxy lanosta-7
10. Poricoic acid
11. Caprylic acid
12. Undecanoic acid
13. Lauric acid
14. Dodecenoic acid
15. Palmitic acid
16. Etc.


Epidemiological studies also suggested that poria cocos may be used for treatment of women with PCOs due to its effects on prevented and alleviated dehydroepiandrosterone-induced polycystic ovarian syndrome(1721), decreased serum follicle-stimulating hormone (FSH)(1719) and luteinizing hormone (LH)(1719) levels, weight gain(1719) through up-regulation of estrogen receptor α (ERα) and estrogen receptor β (ERβ)(1719), improved metabolism(1722), reduced risk of PCOs' complications of diabetes(1723).




3. Rehmannia glutinosa Liboschitz var. purpurae(Di Huang)
Di huang can be sheng (raw) or Shu (cooked) and is also known as Rehmannia
Sheng di huang(The bitter, sweet, bitter cold in nature) and Shu di huang (The bitter, sweet, bitter and warm in nature)(1724) has been used in TCM as diuretic(1734), antihyperglycemic agent(1726), anti-cancers(1731)(1732) and to treat cough(1743), asthma(1744)(1746), lung inflammation induced shortness of breath(1745), and wheezing(1746), tinnitus(1747) and hearing loss(17447), poor memory(1741), bronchial contraction)1746), and chest tightness(1746), lower plasma glucose(1725)(1727), enhance heart function(1734)(1735) (small doses constrict the blood vessels and large doses dilate the blood vessel)(1724), and regulate steroid hormone(1736),..... by promoting the functions of heart, kidney, and liver channels(1724).


Chemical constituents(1724)
1. Leonuride
2. Aucubin
3. Catalpol
4. Melittoside
5. Melittoside
6. Rehmannioside A、B、C、D
7. 8-epiloganic acid 8
8. Ajugoside
9. Lysine
10. Histidine
11. Arginine
12. Sapartic acid
13. Glutamic acid)
14. Threonine
15. Serine
16. Gluycine
17. Alanine
18. Valine
19. Isoleucine
20. Leucine
21. Tyrosine
22. Phenylalnine
23. Etc.




Epidemiological studies proposed that rehmannia also displays anti metabolic syndrome(1728), including fatigue(1728), prediabetes(1728)(1737), LDL-C, hypertension(1729), lipid profile(1728)(1737), including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C, LDL-C)(1736)(1737), insulin resistance(1730), waist size(1736) and obesity(1742), through its effects in carbohydrate(1740)(1741) and lipid metabolism(1728) of which reduce risk of diabetes(1728)(1739) and cardiovascular disease(1728)(1736).
According to Kyung Hee University. formula Kyung-Ok-Ko, containing rehmannia, prevented and alleviated dehydroepiandrosterone-induced polycystic ovarian syndrome in rats model(1738).


4. Lycium chinense(Qi Zi)(1759)
Gou Qi Zi or Qi Zi is also known as wolfberry fruit. The sweet and neutral herb has been used in TCM as anti-cancer(1748)(1749)(1750), antiviral(1751), and anti-inflammatory(1751) agent and to treat weakness(1768) mental acuity(1768), shortness of breath(1768), memory and neurogenesis impairments(1752), relieve pain(1753) improve vision(1754)(1755), anemia(1754), diabetes(1756), promote antiaging(1757), enhance immune system(1751), heart function(1751), lower blood lipids(1751), modulate estrogen receptors(1750) etc., as it nourishes and tonifies liver and kidneys by enhancing the functions of liver, lung and kidney channels(1758).


Chemical constituents(1758)
1. Betaine
2. β-sitosterol
3. Linoleic acid
4. Physalien
5. Cryptoxanthin
6. Atropine
7. Hyoscyamine
8. Scopoletin
9. Amino acids
10. Physalein
11. Zeaxanthin
12. Dipalmitate
13. Carotene
14. Etc.




Epidemiologically, wolfberry also processed anti oxidant(1763)(1762) and anti inflammatory(1765)(1764), anti insulin resistance(1760)(1761), anti depression(1767), sleep disorder(1768), anti stress(1768), anti mental deficits(1768) and anti metabolic syndrome(1766), through its enhanced carbohydrate(1770), lipid(1766) and other metabolic(1766) mechanisms, including fasting glucose(1770), hypertensive(1771)(1772), anti hyperglycaemic(1769)(1770)(1774), anti hyperlipidemic(1773)(1774), weight gain(1770), obesity, ,,, of which induced protective effects against the development of diabetes(1775)(1776) and cardiovascular disease(1777)(1751)(1778).


5. Panax ginseng(Ren Shen)(1779)
Ren Shen is also known as Ginseng, panax ginseng. The smells aromatic, tastes sweet and slightly warm herbs had been used in TCM as improved immune system(1781)(1782), anti-cancer(1783)(1784)(1785), anti-aging(1786)(1787), anti-stress(1788)(1789), antioxidant(1790)(1791), anti-inflammatory(1792)(1793),...... agent and to generate body liquids and allay thirst(1794), treat
nervous disorders(1794)(1795)(1796), anemia(1797)(1798), dyspnoea(1799)(1800), forgetfulness(1801) and confusion(1802), decreased libido(1803)(1804), chronic fatigue(1805)(1806), angina(1807), nausea and vomiting(1808),......as it strongly tonifies original qi, the spleen and lungs, by enhancing the functions of spleen and lung channels(1780).


Chemical constituents(1779)(1780)
1. Saponins
2. Panaxynol
3. Ginsenyne
4. Alpha pansinsene
5. Beta pansinsene
6. Beta farnesene
7. Bicyclogermacrene
8. Beta elemene
9. Gama elemene
10. Alpha neodovene
11. Beta neodovene
12. Alpha humulene
13. Beta humulene
14. Ccaryophyllene
15. Beta gurjunene
16. Alpha gurjunene
17. Alpha selinene
18. Beta selinene
19. Gama selinene
20. Selin-4, alpha guaiene
21. Gama cubebene
22. Beta patchoulene
23. Hepatadecanol-1
24. Etc.


Epidemiological literature found in data base of PubMed also suggested that panax ginseng also processes anti metabolic syndrome(1809)(1810)(1811), through its effect on insulin resistance(1812)(1813), fasting blood glucose(1814)(1815), hyperglycemia(1816)(1817), hyperlipidemia(1818)(1819)(1820), hypertension(1821)(1822), weight control(1823) and obesity(1823)(1824)(1825),.....as well as reducing risk of diabetes(1827)(1826)(1828) and cardiovascular disease(1829)(1830)(1831).
According to the research article dated 29 April 2014, the king of the herb has also found effective for the treatment of infertility of both sexes, including women with Polycystic ovary syndrome through lowering high numbers of antral follicles and increased the number of corpora lutea in the polycystic ovaries(1832).


6. Fructus Schisandrae (Wu Wei Zi)
(See stress management herbs in herbal medicine for more information)
[Schisandra also is known as Wu Wei Zi, a twining shrub living its life by climbing on other vegetation, belongings to the family Schisandraceae, native to Asia and North America, The warm, sweet, bitter, sour, acrid, salty herb has been used in traditional Chinese medicine as antioxidant(1218)(1219), anti-stress(1220)(1221), antimicrobial(1224)(1225)(1226) agent and to improve metabolism(1227)(1228), enhance central nervous system(1229)(1230)(1233), treat hypertension(1231)(1232) and hypotension during exhaustion of circulatory function(1217), coughing(1234)(12135), insomnia(1237), premenstrual syndrome (PMS)(1239), menopausal symptoms(1240), depression(1233), irritability(1233), erectile dysfunction (ED)(1238), lower cholesterol(1241) and regulate blood glucose(1233), improve memory(1222)(1223), etc.
by promoting the function of lung and kidney channels(1217).


Phytochemical contituents(1217)
1. Schizandrin
2. Deoxyschisandrin
3. Gamma-schisandrin
4. Schisandrol
5. Pseudo-gamma-schisandrin
6. Schizandrate B
7. Gomisin A, B, C, F, G
8. Angeloylgomisin H
9. Tigloylgomisin H
10. Benzoylgomisin H
11. Epigomisin O
12. Malic acid
13. Citric acid
14. Tartaric acid
15. Succinic acid
16. A-pinene
17. Camphene
18. B-pinene
19. Byrcene
20. A-terpinene
21. Limonene
22. G-terpinene
23. P-cymene
24. Etc.


In chronic psychological stress male rat model, schisandra protect against stress-induced complications such as carbohydrate metabolism(1227) and neurosis, psychogenic depression, astheno-depressive states, schizophrenia and alcoholism disorders(1233) and improved mental performance(1233).through its reduction of the levels of corticosterone (CORT) and glucose and protect the structure of the adrenal cortex(1227).
In physiological stress, the herbal medicine also exerted its stress-protective effect against a broad spectrum of harmful factors including heat shock, skin burn, cooling, frostbite, immobilization, swimming under load in an atmosphere with decreased air pressure, aseptic inflammation, irradiation, and heavy metal intoxication(1233).
In oxidative stress-induced damage heart(1242) tissues in animal models, Schisandra B (Sch B), a dibenzocyclooctadiene derivative isolated from the fruit of Schisandra Chinensis attenuated cardiotoxicity via antioxidant and anti-inflammatory effects(1242). In oxidative stress-induced liver damage, oral administration of Schisandra Lignans Extract (SLE)(1243)(1244) or triterpenoid(1245) a chemical constituent from Schisandra Chinensis significantly reduced liver damage(1243)(1244)(1245) in experimental animal model, through its effects of balance of oxidation and reduction in cells(1243) or upregulating cell cycle progression(1244) and anti-tumor antigen(1244), or ameliorating oxidative stress(1245).]


In metabolic syndrome, beside protecting against depression(1233), irritability(1233), high level of bad cholesterol(1241) and fluctuation of blood glucose(1233), memory lose(1222)(1223),... Schisandra also exhibited anti insulin resistance(1834)(1835), anti lipid disorder metabolism(1836) induced hypercholesterolemia(1837), anti hypertension(1838)(1839). suppressed carbohydrate disorder metabolism(1842) induced hyperglycemia(1843), obesity(1840)(1841),...... causing complications of diabetes(1844)(1845) and cardiovascular disease(1838)(1846)(1847).


7. Licorice (gancao)
(See stress management in herbal medicine for more information)

(See The Insulin resistance improvement and/or anti metabolic syndrome herbs: Licorice for more information)
1. PCOs
[ Licorice, in a review of 33 studies of herbal medicine for the management of polycystic ovary syndrome (PCOS), showed strong evidence in improved metabolic hormone profile and improved fertility outcomes and regulation of ovulation and inhibition of hyperandrogenism in PCOS(860). In model rats experiment, Ganshao Paste (CGP), also decreased serum levels of LH, T, and FSH and increased serum estradiol (E2), and progesterone (P)(861)(860)(865). According to the University of Natural Resources and Life Sciences Vienna, licorice may have a potential effect on metabolic syndrome(862) in women with PCOs.


2. Blood flow
Licorice improves the blood flow in the body by exerting its anti-thrombosis(983) and inhibiting the levels of bad cholesterol(984)(985) and triglyceride levels(985) and increasing HDL-cholesterol content(984) in reduced risk of cardiovascular disease(985) and blood stagnation(897) in the abdominal region induced induced infertility(986).


3. Glycyrrhizin
Glycyrrhizin, one of the main ingredients from licorice, exhibited anti-inflammatory effect pharmacologically in the treatment of inflammatory diseases(988)(989)(990), lowered high serum testosterone levels in oligomenorrheic or amenorrheic women, and induced conception in some women(991). As an antioxidant, the phytochemical also inhibits irregular cell growth(992)(993) and microbial invasion(994)(995) causes of cancers(992)(993) and infection and inflammation(994)(995) respectively. in adrenocortical function and behavior, it also regulated the levels of cortisol(996), induced by overproduction of serotonin cause of hormone imbalance(997).


4. Phytoestrogen
See phytoestrogen in black cohosh
[Phytoestrogen found it black cohosh showed to occupy the estrogen receptor sites in women body(908), through its antiestrogenic and estrogenic effects(909), to induce hormone balancing may result in improving the chance of ovulation and fertility(910)(911)].


5. Lecithin
Lecithin is a fat-like substance called a phospholipid improved lipid transfer, cholesterol efflux, HDL genesis and remodeling at the blood-brain barrier (BBB)(998). against cells from oxidation surrounding the brain(999), in reducing psychotic symptoms(1002) such as stress(1000)(1001), and depression(1002).
Side effects
1. It may raise blood pressure(1003)(1004(1006)
2. Long term usage of large dosage can also cause edema(1004)(1006) and hypokalemia(1004)(1005)(1006).
3. Overdose can be toxic(106), in inducing rhabdomyolysis or myoglobinuria(1006).
4. Etc.]


Phytochemicals(1058)
1. Glycyrrhizic acid
2. Licochalcone A
3. Licochalcone B
4. Licoflavone
5. Liquiritin
5. Liquiritigenin
7. Isoliquiritigenin
8. Ononins
9. 4′，7-dihydroxyflavone
10. Glycyrrhetinic acid
11. 11-deoxyglycyrrhetinic acid
12. β-sitosterol
13. Etc.


Licorice's phytochemicals, especially glycyrrhizin, have shown effectively in ameliorated insulin resistance(1059)(1061)(1063)(1064), hyperglycemia(1059)(1060), dyslipidemia(1059)(1063) and oxidative stress(1064) in fructose-induced metabolic syndrome(1059)(1061)(1063) in animal(1059)(1060)(1061)models, probably through its interference of the development of visceral obesity(1064) and cellular derailments that are responsible for the development of metabolic syndrome(1062), anti-inflammatory(1062), antioxidant(1062) and an associated with a decrease in tissue lipid deposition(1063) effects].


In chronic unpredictable stress rat model, total flavonoids extract(1153) (licorice flavonoids, LF) and liquiritin(1154), a phytochemical found in licorice exerted anti-depressive(1153)(1154)(1155) and anti-cognitive impairment(1156) property through total flavonoids extract neurogenesis protective effect(1153) and defense of liquiritin and flavonoids extract against oxidative stress(1154)(1156).
Yokukansan, a traditional Japanese formula, containing licorice showed effectively in amelioration of behavioral symptoms, such as aggressiveness, excitability, and hallucination, through reduced stress increased the serotonin 2A (5-HT2A) receptors density on the plasma membrane of the prefrontal cortex (PFC)(1158).

In high-glucose stress, Glabridin(1159)(1160), an isoflavan from licorice root reduced high-glucose stress(1159)(1160) through its anti-inflammatory activity(1159), up-regulates manganese superoxide dismutase, catalase and paraoxonase 2(1160).

In anti oxidative stress, licorice showed to contribute to their overall health promoting pharmacological effects against free radicals(1161)(1162)(1163)(1164) induced diseases such as cancer(1161), cardiac dysfunction(1162) liver disease(1164), etc., through its anti-inflammatory(1161)(1163)(1164), anti-oxidant activities(1161)(1162)(1163)(1164).
According to the University of Western Sydney, Glycyrrhiza glabra, one of the Chinese herbs, exhibited strong evidence of neuroprotective activity for the promotion of healthy aging and longevity(1157).]

According to studies, licorice also is effective in preventing and ameliorating diabetes(2222)(2224), abdominal obesity(2222)(2223) in rat model study.

On metabolic syndrome's complication of cardiovascular disease, licorice, and its phytochemicals exerted cardioprotective effect(2227) in the prevention of incidence of fatal ventricular arrhythmia from ischemia/reperfusion injury(2225), myocardial infarction(2226) by amelioration of oxidative stress and modulation of cardiac function(2226).


8. Cordyceps militaris(Dong Chong Xia cao)
Dong chong xia cao, the sweet and warm herb also known as Cordyceps Sinensis, used in traditional Chinese medicine as immune enhancer(2229)(2230), antimicrobial(2231)(2232), antioxidant(2233)(2234), anti-inflammatory(2235)(2236), anti-cancer(2237)(2238), cardio-protective(2239)(2240)(2241) agent and for treatment of cirrhosis(2242)(2243), lower back pain (due to it analgesic property)(2244), chronic cough and asthma(2245)(2246), ... as it tonifies yang, nourishes lung yin, transforms phlegm, by enhancing the function of kidney and lung channels(2229).


Phytochemical constituents(2228)
1. Cordyceps polysaccharide
2. Ergosterol
3. Cordycepic acid
4. Amino Acids
5. Lysine
6. Aspartic acid
7. Threonine
8. Taurine
9. Etc.


On metabolic syndrome, in diabetics rat model, Dong chong xia cao inhibited significantly the level of glucose metabolic disorders(2250)(such as hyperglycemia(2251)(2252) by enhancing the glyconeogenesis in serum glucose and lipid profiles(2247), by promoting anti-lipid peroxidation activities and inhibit accumulation of cholesteryl ester in macrophages via suppression of LDL oxidation(2253), regulating the expression of lipoprotein lipase (LPL) and hepatic lipase (HL) activity(2253) and activating protein kinase (AMPK)(2254), improved insulin sensitive(2248)(2249) by inhibiting the activity of human protein tyrosine phosphatase 1B (PTP1B) activity(2249) though metabolism of glucose and lipid(2247)(2248), the microcirculation disturbance(2247)(2248) and the oxidative stress(2247).

On obesity, dong chong xia cao has found to improve the obesity(2255)(2256) through decreased body weight and improved energy uptake(2255) by inhibiting alpha-glycosidase(2255) and adipogenic(2256) and lipid accumulation(2256) activity.

On metabolic syndrome's complications, the herbal medicine reduced risk of diabetes(2259)(2260) and cardiovascular disease(2259) through inhibition of low grade inflammation(2259)(2260) and platelet activation(2263)via immunomodulatory(2259)(2260) and antioxidant activity(2261)(2262).

According to Jenteh Junior College of Medicine and Nursing Management and National Cheng Kung University Medical College, dong chong xia cao improved sex desire(2257), and fertility(2258) through increasing serum testosterone and estradiol-17 (E2) concentrations in production of quality of maturing oocyte, respectively without effecting follicle-stimulating hormone (FSH), luteinizing hormone (LH) or prolactin(2257).


9. Huang qi (Astragalus, Astragalus membranaceus)(1045)
(See The Insulin resistance improvement and/or anti metabolic syndrome herbs for more information)



Chemical constituents
1. Astragaloside I,
2. Astragaloside II,
3. Daucosterol,
3. Beta-sitosterol,
4. Palmitic acid
5. Astragalus saponin A, B, C
6. Astramenbrangenin
7. Kumatakenin,
8. Choline,
9. Betaine,
10. Folic acid
11. Calyxosin,
12. Formononetin,
13. Cycloastragenol,
14. Astragaloside III, IV
15. Antibacterial ingredient,
16. L-3-hydroxy-9-methoxpterocarpan
17. Etc.(1045)


Epidemiological studies showed that Astragalus polysaccharides (APS) ameliorates insulin resistance(1046)(1047) (IR) in rat cells and to elucidate the associated mechanisms, including increasing adiponectin secretion and reducing IL-6 secretion(1046), decreasing myostatin expression(1047), improving beta-cell function(1049), regulating insulin signalling in insulin-resistant skeletal muscle(1047)(1048). insulin resistance-related mRNA expression(1049), etc.
In metabolic syndrome, including increased body weight(1050), mild hypertension(1050), hyperinsulinemia(1050), hypertriglyceridemia(1050), impaired glucose tolerance(1050)(1053) and impaired endothelium-dependent vasorelaxation(1050)(1051)(1052), astragaloside IV, a major constituent found in astragalus showed effectively in ameliorating metabolic syndrome(1050)(1052), probably through its antioxidant(1051), inhibition of abnormal TNF-alpha-induced intracellular free Ca(2+) accumulation in endothelial cells(1052), decreasing the elevated expression and activity in the skeletal muscles(1053).

On obesity, triterpene aglycone derived from Radix astragali and the whole herb alleviated obesity, through regulating intracellular calcium(2276), improving impaired endothelial dysfunction(2277) respectively.

On complications of diabetes, astragalus polysaccharides may be the next generation extract for the treatment of diabetes due to its effects on correcting the imbalance between the Th1/Th2(T lymphocyte) cytokines(2278), downregulating ROS-ERK-NF-κB pathway(2279) and antioxidant activity(2280).

and on cardiovascular disease, Astragalus polysaccharide (APS), astragaloside IV and total flavone of astragalus (TFA) attenuated Iso-induced cardiac hypertrophy(2281)(2282) and cardiac inflammation(2282), ischemia/reperfusion injury(2283) respectively trough vary mechanisms


10. Mu Xu(Alfalfa)
Alfalfa is a flowering plant in the genus Medicago, belonging to the family Fabaceae, cultivated all over the world as hay for cattle feeding. The leaves, sprouts, and seeds to make medicine has been used in traditional medicine over thousands of year for treatment of high cholesterol(2284)(2285), atherosclerosis(2286)(2287), cancer(2288)(2289), hyperglycemia(2290)(2291) and menopausal symptoms(2292)(2293) and as neuroprotective(2294)(2295), antioxidant(2295)(2296), antiulcer(2295), antimicrobial(2295)(2297), estrogenic(2295)(2298) and anti estrogenic(2299) agent. North American aboriginal has used Alfalfa seed as food, such as making bread and mush(1054).


Nutrients
1. Essential amino acids
2. Calcium
3. Magnesium
4. Potassium
5. Iron
6. Phosphorus
7. Zinc
8. Beta carotene
9. vitamin C
10. vitamins D
11.Vitamin E
12. Vitamin K
13. Flavones
14. Isoflavones
15. Sterols
16. Derivatives of coumarin
17. Etc.


In diabetes, alfalfa exhibited prevention of the onset of developing Type 1 Diabetes(1056)
diabetogenic or anti-diabetic potentials(1055), through its estrogenic activity in the modulation of diabetes(1055), protection against pancreas from autoimmune destruction(1056), antihyperglycaemic, insulin-releasing and insulin-like activity(1057).
In insulin resistance, dietary of alfalfa exhibited insulinemic effects, according to the University of Leipzig(2300) and Kitasato University(2301) in animal studies.
In cardiovascular disease, the was found effective in the prevention of the onset of heart disease and stroke(2302), through its nutrient and phytochemical compositions(2302), enhancement of cholesterol efflux in the liver(2303) and this reduced of cholesterol depositions(2303)(2304).
Intake of mordanted alfalfa fiber has also shown to affect body weight and in contribution to anti-obesity activity in an animal study(2305)(2306).




11. Du Zhong(Cortex Eucommiae Ulmoidis)
Du zhong, the sweet, slightly acrid, and warm herb, also known as eucommia bark used in traditional Chinese medicine as immune enhancer(2308)(2310), diuretic(2311), sedative(2312), anti-inflammatory(2313)(2314) advocate,....... and for treatment of chronic pain in lower back and knees, lack of strength, dizziness, impotence, irregular menses and frequent urination, unstable pregnancy, chronic pain in lower back and excessive movements of fetus,... as its tonifes the kidney and liver and enhances the functions of kidney and liver functions(2307).


Chemicals constituents(2309)
1. Betulin
2. Byringin
3. Pervoside A
4. Glucosyringic acid
5. Vanillic acid-beta-glucoside
6. Geniposide acid
7. Aucubin
8. Geniposide
9. Pinoresinol-4,4'-di-O-beta-D-glucopyranoside
10. Syringaresinol di-O-beta-D-glucopyranoside
11. Medioresinol di-O-beta-D-glucopyranoside
12. Sucrose
13. Ethyl beta-glucopyranoside
14. Etc.


In metabolic syndrome, du zhong showed to attenuate hypertension(2316)(2319)(2321) through exhibiting beta-adrenergic blocking activity(2319) and regulating NO and renin-angiotensin system (RAS) and directly relaxing artery(2321); obesity(2316)(2317)(2318) and improve insulin resistance(2318) or hyperlipaemia(2318)(2316), through suppressed increases body weight(2317), white adipose tissue weight(2317), plasma triglyceride levels(2317) and free fatty acids level(2317) and through secretion and regulation of adipocytokines(2318); hyperglycemia(2323),
sexual dysfunction(2316), and complications of diabetes(2316)(2324) through antioxidant(2324) activity and altered the plasma and hepatic lipid levels by lowering the cholesterol and triglyceride concentrations, while elevating the plasma HDL-cholesterol level(2125).

Dr. Park and research team at the Yeungnam University said "Du-zhong extract is potentially beneficial for the prevention and management of complications of type 2 diabetes"(2324); and cardiovascular disease(2320) through reversed hypertensive vascular remodelling(2320)(2322)(2323) and inhibited angiotensin II (Ang II) expression in stimulated extracellular matrix biosynthesis in mesangial cell(2322)(2323).

According to study, compound FF16, compatibility of Rhodiola crenulata, Cordyceps militaris, and Rheum palmatum, was found effective in enhanced glucose-stimulated insulin secretion through increased islet amount, the enlarged islet area by protecting the pancreatic beta-cells(2315).


The TCM Management and Treatment of PCOs induced by Kidney yin deficiency


Along with common symptoms mentioned above, women with PCOs diagnosed with kidney yin deficiency may also experience yin vacuity induced cold expressive syndrome, including soreness of waist and knees(1848), lassitude(1848) and fatigue(1848), short breath(1848), poor appetite(1848), aversion to cold(184), cold extremities(1848), ringing in the ears(1850), migraine(1849), hearing problems(1850), a dry mouth and throat(1851), pale fingernails(1851), tidal fever(1851)and night sweating(1851), soles(1851) and chest(1851), constipation(1852),,......... as the kidneys no longer perform their functions of regulating fluid in moistening and nourishing organs and tissues of the body. According to TCM, too much cold/raw foods can aggravate the condition.


Foods for Kidney yin deficiency
List of foods suggested by TCM doctors for management and treatment of PCOs' women diagnosed with kidney yin deficiency, including


1. Navy bean
(See nutritional supplement suggested by TCM)
[Navy bean (White kidney bean)extract
The small, white kidney bean, also called pea bean or haricot, popular in both dry and green forms, is very popular in Britain and the US, native to Peru. It is now grown and consumed across the world, due to its numerous health benefits(1402).


Nutritional ingredients
1. Carbohydrate
2. Protein
3. Dietary fiber
4. Vitamin A
5. Vitamin B1
6. copper
7. Iron
8. Manganese
9. Phosphorus
10. Magnesium(1402)
11. Catechin derivatives(1403)
12. Proanthocyanidins(1403)
13. Catechin glucoside(1403)
14. Etc.


Epidemiological studies, linking navy bean as a functional health foods, may be due to its phenolic composition in reduced the incidence of several chronic diseases(1402)(1411) that shared an inflammatory component(1403), including irregular cell growth(1406)(1407), diabetes(1402)(1407), CVD(1407), glycemic response(1404)(1405)(1407), aid digestion(1404)(1405), sleep disorder(1402), irritable bowel syndrome(1402) and constipation(1402), infertility(1402), neurotransmitter dysfunction(1402), colitis(1408), improved colon health(1408)(1409). etc. probably through its total phenolic content effects on antioxidant(1410)(1411) and anti inflammatory activities(1411) and other mechanism.

According to studies, white kidney bean also processes certain properties against PCOs related syndrome including the effect on diabesity, a collection of obesity/overweight, type 2 diabetes mellitus and insulin resistance(1412), GI index(1413) through its carb blockers(1413) mimicked the beneficial effects of fibers(1412). Its extract, according to studies, also induced blood glucose levels(1415) and weight loss(1414)(1415) through blocking carbohydrate absorption(1414), and regulating hypoglycemic and anorexigenic activities of an alpha-amylase inhibitor(1415)].


2. Flaxseed oil
(See nutritional supplements suggested by TCM)
Flaxseed oil is extracted from the seeds of the flax plant (Linum usitatissimum) contained both omega-3 and omega-6 fatty acids. Flaxseed oil generally contains 50% of the omega-3 fatty acid - alpha-linolenic acid and 25 % of the omega-6 fatty acid linolenic acid, 15 % of mainly monounsaturated oleic acid and trace amounts of palmitoleic acid and eicosenoic acid(1371).


Nutritional ingredients
1. Alpha-linolenic acid (ALA)
2. Palmitic acid
3. Stearic acid
4. Arachidic acid
5. Palmitoleic acid
6. Oleic acid
7. Eicosenoic acid
8. Linoleic acid
9. Etc.(1371)


Epidemiological studies of health benefit are well established, including reduced blood pressure(1372)
(1373) and cholesterol(1374)(1375), risk of irregular cell growth(1376)(1377), diabetes(1378)(1379) and osteoporosis(1380)(1381), benefit cardiovascular system(1382)(1383), menopause symptoms(1384)(1385), cyclic mastalgia (breast pain)(1390), patients with Sjogren’s syndrome(1386) and inflammatory bowel disease (IBD(1387)(1388), use of natural laxative(1389)(1390), human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS)(1390), etc., probably due to the the efficacy of alpha-linoleic acid(1390) and its antioxidant(1391)(1392)(1393)(1394) and anti-inflammatory(1392)(1395)(1396) activity.


Recent studies also suggested that flaxseed oil processes anti-insulin resistance(1397)(1398) and metabolic syndrome(1400)(1401), confers health benefits in obesity(1400) due to its effect on adipocyte function(1399) activities due to the effects of monounsaturated fatty acids (MUFAs) and n-3 polyunsaturated fatty acids (PUFAs)(1400)(1401)].


3. Salmon(1860)
Salmon is the common name for Salmonidae. They are anadromous, born in freshwater, migrate to the ocean, then travel thousands of miles in the deep sea cold water throughout their life cycle and within to five years returning to the exacted location where they were born to reproduce and die.


Nutrients
1. Protein
2. Omega-3 fatty acids
3. B vitamins
4. Vitamin D
5. Astaxanthin
is a potent antioxidant that stimulates the development of healthy fish nervous systems and enhances the fish's fertility and growth rate.
6. Selenium
7. Tryptophan
8. Magnesium
9. Phosphorus
10. Etc.

Epidemiological studies suggested that low-molecular-weight peptides(1862) and long-chain polyunsaturated ω3 and ω6 fatty acids(1863) of salmon can alleviate metabolic syndrome (MetS)(1862)(1863) due to its effects on glucose tolerance(1862)(1864)(1866), fasting glucose(1866), hypertension(1868)adipose tissue inflammation(1862)(1865), insulin resistance(1865), body weight(1865), obesity(1866), lipid homeostasis(1862)(1867), and hepatic insulin signaling(1862) of which reduce risk of diabetes(1871) and cardiovascular disease(1870)(1872).


4. Organic soy products and whole food
Made from organic soybean has induced many controversies due to the conflict of Western cancer studies. Readers in the Western world should consult their caregivers before taking any of these products.
Soybean is genus Glycine, the family Fabaceae, one of the legumes that contains twice as much protein per acre as any other major vegetable or grain crop, native to Southeast Asia. Now, it is grown worldwide massively in a suitable climate for commercial profit and healthy food (1873). According to GMO Compass, in 2113, 79% of soybean production was genetically modified(1874).


Nutrients
1. Carbohydrates
2. Dietary fiber
3. Fat
4. Protein
5. Essential amino acid
6. Vitamin A
7. Vitamin B6
8. Vitamin B12
9. Vitamin C
10. Vitamin K
11. Calcium
12. Iron
13. Magnesium
14. Phosphorus
15. Potassium
16. Sodium
17. Zinc
18. Etc.


According to the data base from PubMed, organic soy bean has shown to inhibit certain effects in metabolic syndrome, including hypertension(1875)(1884), hypercholesterolemia(1875)(1876)(1877), dyslipidemia(1878)(1884) inflammation(1875)(1883), insulin resistance(1876)(1884), impaired fasting glucose(1880)(1881), prediabetes(1884)(1885), hyperglycerolemia(1887), weight control(1888)(1889) and obesity(1876)(1886) as well as reduced risk of diabetes(1885) and cardiovascular disease(1875)(1877)(1892), probably due to its protein(1876) and phytochemicals(1883)(1893) effects on lipid(1890)(1891)(1893) and glucose(1893) metabolism andin regulation of insulin-mediated glucose homeostasis in adipose tissue(1882).


5. Mushroom(1894)
Mushroom is a standard name of white button mushroom, the fleshy, spore-bearing fruiting body of a fungus produced above ground on soil or on its food source, It is a genus A. Muscaria, belongings to the family Amanitaceae, cultivated in many cultures all over the world for foods and health benefits. According to studies, mushroom has shown effective in treatment of cancer(1895)(1896)(1897), improved immunity(1896)(1897), weight management(1898) and satiety(1899), asthma(1900), rheumatoid arthritis(1900), stroke(1901), microbial infection and inflammation(1896)(1903),....... probably due to its chemical compositions, such as polysaccharides, terpenoids, phenolic compounds(1902) and nutrients in antioxidant(1896) and anti-inflammatory(1902) expressions.


Nutrients
1. Carbohydrates
2. Protein
3. Thiamine (Vitamin B1)
4. Riboflavin (Vitamin B2)
5. Niacin (Vitamin B3)
6. Pantothenic acid (Vitamin B5)
7. Calcium
8. Phosphorus
9. Potassium
10. Sodium
11. Selenium
12. Iron
13. Copper
14. Zinc
15. Etc.


In metabolic syndrome, mushroom inhibited effectively central obesity(1904)(1906), hyperglycaemia(1904)(1907), hypercholesterolemia(1904)(1906)(1910), hyperleptinemia(1905), insulinemia(1905)(1910) and hypertension(1904),(1908) glucose tolerance(1905)(1907), fasting glucose plasma(1909), insulin resistance(1905)(1911) and its complication such as diabetes(1906)(1912) and cardiovascular disease(1895), through expression of its phytochemicals such as polysaccharide fractions, eritadenin, triterpenes, sterols and phenolic compounds(1904).




TCM Herbal Medicine for Treatment of PCOs induced by Kidney yin deficiency


1. Sheng Di Huang(See kidney yang tonified herbal medicine)


Chemical constituents(1724)
1. Leonuride
2. Aucubin
3. Catalpol
4. Melittoside
5. Melittoside
6. Rehmannioside A、B、C、D
7. 8-epiloganic acid 8
8. Ajugoside
9. Lysine
10. Histidine
11. Arginine
12. Sapartic acid
13. Glutamic acid)
14. Threonine
15. Serine
16. Gluycine
17. Alanine
18. Valine
19. Isoleucine
20. Leucine
21. Tyrosine
22. Phenylalnine
23. Etc.




Epidemiological studies proposed that Rehmannia also displays anti metabolic syndrome(1728), including fatigue(1728), prediabetes(1728)(1737), LDL-C, hypertension(1729), lipid profile(1728)(1737), including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C, LDL-C)(1736)(1737), insulin resistance(1730), waist size(1736) and obesity(1742), through its effects in carbohydrate(1740)(1741) and lipid metabolism(1728) of which reduce risk of diabetes(1728)(1739) and cardiovascular disease(1728)(1736).
According to Kyung Hee University. formula Kyung-Ok-Ko, containing Rehmannia, prevented and alleviated dehydroepiandrosterone-induced polycystic ovarian syndrome in rats model(1738).


2. Lycium chinense(Qi Zi)(1759)
See kidney yang tonified TCM herbal medicine


Chemical constituents(1758)
1. Betaine
2. β-sitosterol
3. Linoleic acid
4. Physalien
5. Cryptoxanthin
6. Atropine
7. Hyoscyamine
8. Scopoletin
9. Amino acids
10. Physalein
11. Zeaxanthin
12. Dipalmitate
13. Carotene
14. Etc.




Epidemiologically, wolfberry also processed anti oxidant(1763)(1762) and anti inflammatory(1765)(1764), anti insulin resistance(1760)(1761), anti depression(1767), sleep disorder(1768), anti stress(1768), anti mental deficits(1768) and anti metabolic syndrome(1766), through its enhanced carbohydrate(1770), lipid(1766) and other metabolic(1766) mechanisms, including fasting glucose(1770), hypertensive(1771)(1772), anti hyperglycaemic(1769)(1770)(1774), anti hyperlipidemic(1773)(1774), weight gain(1770), obesity,........ of which induced protective effects against the development of diabetes(1775)(1776) and cardiovascular disease(1777)(1751)(1778).




3. Shiitake mushroom
Shiitake mushroom is an edible mushroom, genus Lentinula, belongings to family Marasmiaceae, native to East Asia and widely cultivated for consumption for its health benefits and commercial purpose in many Asian countries(1944). The sweet and neutral herb has been used in traditional Chinese as anti-inflammatory(1951)(1952), antioxidative(1952)(1953)(1954), immunomodulatory(1949)(1950)(1961), anti-androgenic(1955), antiviral(1960) and anti-cancer(1956)(1957)(1958) agent and for treatment of hepatitis B(1960), leukemia(1961), lymphoma(1962), frequent flu and colds(1967),....... by enhancing the functions of Lung, Kidney, Liver, Heart, Spleen, Stomach channels(1943).


Chemical Constituents
1. Ganodermic acid G
2. Lucidone A
3. Fungal lysozyme
4. Pachymic acid C
5. Stellasterol
6. OPolyporenic acid
7. Pterocarpin
8. Trifolirhizin
9. Kuraridin
10. Kuraridinol
11. Oxalic acid
12. Etc.(1945)




Shiitake mushroom may be the next potential pharmaceutical target in producing a beneficial medicine for treatment of women with PCOs, as the herb has exhibited anti metabolic syndrome(1946) such as, plasma lipid profiles(1963)(1964), fat deposition(1963)(1966), energy efficiency(1963), fasting glucose(1968), insulin-sensitive(1947), lipid abnormality(1948), hypertensive(1967)(1969), antihyperglycaemic(1968)(1969), antihyperlipidemic(1964)(1965)(1968), weight control(1970), obesity(1966)(1971), through its carbohydrate and lipid metabolism(1965).......induced complications of diabetes(1969)(1971) and cardiovascular disease(1967).


4. Xi yang shen(Panax quinquefolium L., American ginseng)
North America Ginseng is also known as P. quinquefolius American ginseng (root), is considered as yin promoting, as the roots are grown from a hot area, according to traditional Chinese medicine(1972). Ginseng North America has been used in TCM as anti cancers(1974)(1975)(1976), antipsychotic(1977)(1979), anti-inflammatory(1980)(1981) and antioxidant(1979)(1982), immunomodulatory(1983)(1984), CNS protective(1979)(1978)(1981), wound healing(1979) advocate and to relieve pain(1991)(1992) and treat sexual dysfunction(1985)(1986), quench thirst(1973), heal deficiency of lungs(1973)and chronic asthma(1987) and to treat fatigue(1988)(1989), chronic fever(1990),... by enhancing heart, lung and kidney channels(1973).


Chemical constituents(1973)
1. Octanol
2. Hexanoic acid
3. Pindecane
4. Pinocarveol
5. Octanoic acid
7. Dodecane
8. 3-phenylhexane
9. 1-phenylhexane
10. Pulegone
11. Beta-farnesene
12. Alpha-curcumene,
13. Alpha-cedrene
14. Beta-bisabolene
15. Beta-caryophyllene
16. Caproic acid
17. Heptanoic acid
18. Caprylic acid
19. Nonanoic acid
20. Palmitic acid
21. stearic acid
22. octadecenoic acid
23. Linoleic acid
24. Etc.


Xi yang shen containing a similar ingredients of panax gingseng with opposite cool and warm in nature has found no difference for prevention and treatment of metabolic syndrome in pharmaceutical single or combined ingredient withdrawal(1994)(1995), The whole herb has exhibited positive effects on islet protection(1994) insulin sensitive(1994)(1995)(1996), hypertensive(1993)(1996), antihyperglycaemic(1993)(1994), antihyperlipidemic(1993)(1996), , obesity(1993)(1994), through its carbohydrate(2001)(2003) and lipid metabolism(2002)(2003).......induced complications of diabetes(1999)(2000) and cardiovascular disease(1997)(1998)(1981) through enhancement of stroke volume, ejection fraction, cardiac output, and left ventricle pressure(2003).


5. Reishi mushroom
Reishi mushroom or Lingzhi is a fungal species in the genus Ganoderma, belongings to the family Ganodermataceae, native to Asia. The herb has been used in traditional medicine as anti-cancers(2004)neuro protective(2005)(2006) and anti-inflammatory(2007)(2008), antioxidant(2010)(2013)(2011), neuroprotective(2009)(2012) agent and to enhance immune function(2014)(2015), treat liver injury(2016)(2018) and diseases(2017)(2018), protect against neuron degeneration(2019)(2020),..... by enhancing the functions of Lung, Kidney, Liver, Heart, Spleen, Stomach. channels(2021).


Chemical constituents(2021)
1. Ganodermic acid G
2. Lucidone A
3. Fungal lysozyme
4. Pachymic acid C
5. Stellasterol
6. Polyporenic acid
7. Pterocarpin
8. Trifolirhizin
9. Kuraridin
10. Kuraridinol
11. Oxalic acid
12. Etc.


Epidemiological studies suggested that reishi mushroom may be used for prevention and treatment of metabolic syndrome(2022)(2023) and its complications of diabetes(2022)(2024) and cardiovascular disease(2022)(2023)(2024) due its effects on fasting glucose(2028)(2029), insulin sensitve(2029)(2030), lipid abnormality(2031), hypertensive(2032)(2033), anti hyperglycaemic(2010)(2024)(2025), anti hyperlipidemic(2026)(2027), weight control(2034)(2035), obesity(2036).


6. Huang lian
Hu huang Lian or Huang Lian is also known as Coptis rhizome. The bitter and cool herb has been used in TCM as anti palette coagulation(2037)(2038), anti-arrhythmia(2039)(2040), anti heart failure(2039), antidiabetic(2041)(2042), anti-cancer(2044)(2045)(2046), anti-inflammatory(2049)(2050) and antioxidant(2048)(2047) advocate and to relief heat toxicity(2051)(2052), indigestion(2053), inflammation of small intestine(2053), diarrhea(2054)(2055), fever(2054), jaundice(2054), insomnia(2056) and relieve pain(2055),,,,,,,,,, as it eliminates empty-Heat and Damp-Heat, clears Heat, etc., by enhancing the functions of heart, large intestine, liver, and stomach channels(2043)


Chemical Constutuents(2043)
1. Berberine
2. Colchicine
3. Coptisine
4. Worenine
5. Palmatine
6. Jatrorrhizine
7. Magnoflorine
8. Kutkin
9. Etc.


Berberine and chemical compound found in huang lian and the whole itself have shown a positive effect in reduced risk of diabetes(2041)(2042) and cardiovascular disease(2057)(2039)(2040)(2058) in women with kidney yin deficiency-induced PCOs due to their glucose and lipid metabolism responds(2061) on metabolic syndrome(2064)(2069), including glucose level(2061)(2062), insulin resistance(2059)(2060)(2062), hypertensive(2065)(2066), hyperglycaemia[total cholesterol, triglyceride levels, urinary protein excretion, serum creatinine (Scr) and blood urea nitrogen (BUN)](2062)(2063)(2064) antihyperglycaemic(2042)(2064), obesity(2064)(2067)(2068),.......via immunomodulatory(2070)(2071), antioxidant(2041)(2047)(2048)and anti-inflammatory activities.

Unfortunately, according to Shanghai University of Traditional Chinese Medicine, increasing the systemic exposure of Rhizoma coptidis alkaloids(2071) and overdoses of all alkaloids, especially berberine(2072) may induce the risk of the acute toxicity.

Taken altogether, the aforementioned analysis may be considered functional therapies for the prevention and an adjunct therapy combined with the primary medicine for the treatment of PCOs, but a larger sample size and multicenter study are necessary to validate the claims.

Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You. How-To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months
Sources can be viewed at
From 1 - 699 https://kylejnorton.blogspot.com/2015/07/the-holistic-prevention-management-of_51.html
From 700 - 1499 https://kylejnorton.blogspot.com/2015/07/the-holistic-prevention-management-of_59.html
From 1500 - 2333 https://kylejnorton.blogspot.com/2015/07/the-holistic-prevention-management-of_5.html