**6. Acupuncture and moxibustion**

As with TCM formulas and single Chinese herbal therapy, acupuncture and moxibustion have also been used to treat clinical manifestations of PCOS for hundreds of years. Traditionally, acupuncture and moxibustion were performed by inserting needles into or burning moxa sticks upon specific points (acupoints) on the meridians of the body surface. Acupuncture and moxibustion work by regulating energy flow, also called Qi in Chinese, over the meridians. Newer therapeutic methods include electro-acupuncture (EA), laser-acupuncture, burning moxa granules on the top of the needle, points pasting, and far-infrared moxibustion.

Clinical effects of acupuncture are mediated by activation of somatic afferent nerves innervating the skin and muscle, which, via modulation of the activity in the somatic and autonomic nervous system, may regulate metabolic and endocrine functions in patients with PCOS [89]. One analysis showed that the acupoints of Sanyinjiao (SP 6), Guanyuan (CV 4), Zigong (EX-CA 1), Zhongji (CV 3), and Qihai (CV 6) are most frequently used in the clinical management of acupuncture for patients with PCOS [90]. This report also demonstrated the meridians of the main acupoints are the conception vessel, stomach meridian of the foot-yangming, and the spleen meridian of foot-taiyin. The main acupoints are distributed in the lower limbs, lower abdomen, and back [90]. In the special points, usage of front-mu points, five-shu points, and back-shu points are more frequently used and the prescription is usually an average of five to seven acupoints [90].

**Author details**

Yen-Nung Liao1

Taiwan

**References**

acem/61987

jc.2006-0178

DOI: 10.1016/j.fertnstert.2016.05.003

, Wen-Long Hu1,2,3 and Yu-Chiang Hung1,4\*

3 Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan

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1 Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung,

Complementary Therapy with Traditional Chinese Medicine for Polycystic Ovarian Syndrome

http://dx.doi.org/10.5772/intechopen.71654

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4 School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan

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[5] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility. 2004;**81**:19-25. DOI: 10.1016/j.fertnstert.2003.10.004

[6] Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. Androgen Excess Society. Positions statement: Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: An Androgen Excess Society guideline. Journal of Clinical and Endocrinology Metabolism. 2006;**91**:4237-4245. DOI: 10.1210/

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\*Address all correspondence to: hungyuchiang@gmail.com

2 Fooyin University College of Nursing, Kaohsiung, Taiwan

One prospective clinical study investigated responses to 5 weeks of EA in overweight-obese women with PCOS [91]. The results showed that HbA1c levels and circulating and adipose tissue androgens were significantly decreased, together with modulation of vagal activity and adipose tissue sympathetic activity [91]. A systematic review and meta-analysis demonstrated that manual acupuncture (MA) or EA can improve clinical pregnancy rates and ongoing pregnancy rates, and lower the risk of ovarian hyperstimulation syndrome (OHSS) in women with PCOS undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) [92]. Another RCT revealed that serum androgens decreased and menstrual frequency increased after 16 weeks of EA intervention, while the acne improved after the 16-week follow-up in the EA group compared to the exercise group [93]. The other RCT showed that serum levels of AMH were significantly decreased in the EA group compare with the change in the exercise group after 16 weeks of intervention, but there was no difference in the exercise group and the no intervention group at 32 weeks follow-up [94]. An earlier RCT found that abdominal acupuncture for obese patients with PCOS can reduce BMI and WHR and increase menstrual frequency more effectively, and with fewer adverse effects, than metformin after a 6-month trial [95].

True (EA group) and sham (Park sham device group) acupuncture (EA V.S. Park sham device) may have similar effects on mean ovulation rates and reproductive endocrine changes, but the true acupuncture group could show lower fasting insulin and free testosterone levels after 8 weeks of intervention [96]. Another RCT showed that the utilization of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births in patients with PCOS [97]. A recent systematic review and meta-analysis demonstrated that acupuncture may be more likely to improve ovulation rates and menstruation frequency than no acupuncture in patients with PCOS [98]. This report also noted that acupuncture could be as an adjunct to medication with regard to LH, LH/FSH ratio, testosterone, fasting insulin, and pregnancy rates [98]. Another study revealed that there were very few RCTs have been reported and there was deficient evidence to support the use of acupuncture for management of ovulation problems in patients with PCOS [99].
