About Dr. Sun Wei
Dr. Sun Wei is a senior gynaecologist at Longhua Hospital, affiliated with Shanghai University of Traditional Chinese Medicine — one of China's foremost centres for integrative reproductive medicine and a national reference institution for the TCM management of infertility, polycystic ovary syndrome, endometriosis, and menopausal syndrome. She is recognised for her expertise in cycle-based herbal therapy, acupuncture for reproductive endocrine regulation, and the integrative treatment of complex infertility patients in whom conventional ovulation induction alone has achieved inadequate results. Dr. Sun's clinical philosophy holds that fertility cannot be restored by targeting the ovary in isolation — the entire constitutional pattern that has produced the hormonal dysregulation must be identified and corrected, because a uterus that cannot receive and nourish an embryo will not sustain a pregnancy regardless of whether ovulation has been induced. Her department at Longhua Hospital has established one of Shanghai's most comprehensive integrative reproductive medicine programmes, combining classical herbal cycle therapy, acupuncture, insulin sensitisation, and ovulation induction into a unified care pathway for patients with PCOS-related infertility and reproductive endocrine disorders.
Case Overview
Ms. Emily Walsh (pseudonym), a 28-year-old Australian office worker based in Shanghai, presented with three years of primary infertility and five years of oligomenorrhoea. She had been diagnosed with polycystic ovary syndrome (PCOS) in Australia and had received oral contraceptive therapy (Diane-35) with cycle regulation during treatment but recurrence of oligomenorrhoea on cessation and no conception. Investigations confirmed bilateral polycystic ovarian morphology, LH/FSH ratio greater than 3, elevated testosterone, and insulin resistance on OGTT. TCM diagnosis identified Infertility — Phlegm-Damp Obstruction. Dr. Sun Wei designed an integrative programme combining metformin for insulin sensitisation, Diane-35 for androgen suppression, and clomiphene for ovulation induction with classical cycle-phase herbal therapy (Cangfu Daotang Wan combined with Foshou San, modified with phase-specific additions) and cycle-phase acupuncture. Conception was confirmed by serum HCG in the second stimulated cycle at three months. The patient delivered a healthy full-term infant without obstetric complications.
Patient Background
- Name / Nationality: Ms. Emily Walsh (pseudonym) — Australian; 28-year-old office worker based in Shanghai
- Age / Sex: 28-year-old female
- Chief Complaint: Three years of unprotected intercourse without conception; five years of oligomenorrhoea
- Menstrual history: Menarche at 14; cycles consistently irregular (35–60 days) from onset; oligomenorrhoea developing five years prior with cycles extending to 2–3 months or longer; flow duration 3–5 days; moderate volume; no dysmenorrhoea
- Prior treatment: PCOS diagnosed in Australia; Diane-35 prescribed for cycle regulation — regular cycles during treatment, recurrence of oligomenorrhoea on cessation; no conception achieved
- Past medical history: No diabetes, hypertension, or thyroid disease; no surgery; no drug allergies
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TCM four examinations:
- Inspection: Obese build; facial acne; hirsutism — increased hair density at upper lip, chin, periareolar region, and lower abdominal midline; pale, swollen tongue with tooth marks on lateral borders; white greasy coating
- Auscultation/olfaction: Normal voice; no abnormal odour
- Inquiry: Oligomenorrhoea; hirsutism and acne; easy fatigue; limb heaviness; increased vaginal discharge — thin consistency; loose stools 2–3 times daily; adequate sleep
- Palpation: Slippery pulse (滑脉)
Diagnostic Workup
Gynaecological Ultrasound
- Bilateral ovarian enlargement; 12 or more follicles of 2–9 mm diameter per ovary in peripheral array — polycystic ovarian morphology confirmed; no dominant follicle; endometrial thickness 6 mm
Sex Hormone Panel (Day 3)
- FSH 5.2 mIU/mL; LH 18.5 mIU/mL; LH/FSH ratio >3; oestradiol 45 pg/mL; testosterone 1.2 ng/mL (elevated above normal range); prolactin 12 ng/mL (normal) — hyperandrogenaemia and LH/FSH ratio inversion confirmed
OGTT and Insulin Release Test
- Fasting glucose 5.0 mmol/L; 2-hour post-load glucose 7.5 mmol/L; fasting insulin 18 μU/mL (elevated); 2-hour insulin 120 μU/mL (elevated) — insulin resistance confirmed
Thyroid Function
- Within normal limits — thyroid cause excluded
Dr. Sun's pre-treatment assessment: The diagnosis is straightforward — PCOS with insulin resistance, hyperandrogenaemia, and anovulation. But the question is not what the diagnosis is; it is why this patient's body has produced this pattern and what it will take to reverse it durably. The Diane-35 regulated her cycles while she was taking it, but it did not change the underlying physiology — the moment she stopped, the oligomenorrhoea returned. That tells us the constitutional pattern has not been addressed. In TCM, the pulse is slippery — that is Phlegm. The tongue is pale, swollen, and tooth-marked with a greasy coating — that is Spleen deficiency producing Phlegm-Damp. The hirsutism, the acne, the vaginal discharge, the loose stools, the limb heaviness — all of these are Phlegm-Damp manifestations. The Phlegm-Damp is obstructing the Chong and Ren vessels, preventing the normal cyclical movement of Qi and Blood that produces ovulation. The metformin will address the insulin resistance. The herbal formula and acupuncture will address the Phlegm-Damp obstruction. The cycle-phase approach will support each phase of the follicular cycle as it re-establishes itself.
TCM Diagnosis and Integrative Treatment Strategy
The TCM diagnosis established by Dr. Sun Wei was Infertility — Phlegm-Damp Obstruction (不孕症·痰湿阻滞证). The corresponding Western diagnoses were polycystic ovary syndrome and primary infertility.
The treatment principle was: dry Dampness and resolve Phlegm; regulate Qi and regulate menstruation (燥湿化痰，理气调经), with cycle-phase modifications to support follicular development, ovulation, and luteal function.
Herbal prescription — Cangfu Daotang Wan combined with Foshou San, modified with cycle-phase additions: Base formula: Cangzhu 12g, Xiangfu 12g, Chenpi 9g, Banxia 9g, Fuling 15g, Dannanxing 9g, Zhiqiao 9g, Shenqu 12g, Danggui 12g, Chuanxiong 9g, Gancao 6g.
- Follicular phase (Days 5–11): Add Gouqizi 12g, Tusizi 15g, Fupenzi 12g — to nourish Kidney Yin and Blood and support follicular development
- Ovulatory phase (Days 12–16): Add Danshen 15g, Chishao 12g, Taoren 9g, Honghua 9g — to activate Blood and resolve Stasis and facilitate ovulation
- Luteal phase (Days 17–28): Add Duzhong 12g, Xuduan 12g, Sangjisheng 15g — to warm Kidney Yang and support luteal function
One decoction daily, taken warm in two divided doses, with phase-specific formula adjustments throughout the cycle.
Acupuncture — cycle-phase protocol: Primary points: Guanyuan (CV 4), Zhongji (CV 3), Zigong (EX-CA 1), Sanyinjiao (SP 6), Fenglong (ST 40), Yinlingquan (SP 9). Phase-specific additions: follicular phase — Shenshu (BL 23) and Taixi (KD 3) to nourish Kidney and Blood; ovulatory phase — Qihai (CV 6) and Xuehai (SP 10) to activate Blood and unblock the collaterals; luteal phase — Mingmen (GV 4) and Yaoyangguan (GV 3) to warm Kidney Yang. Even needling method throughout; 30-minute retention; daily treatment six days per week; commencing Day 5 of each cycle.
Western pharmacotherapy: Metformin 0.5 g three times daily to reduce insulin resistance and improve endocrine metabolism. Diane-35 one tablet daily for 21 days with 7-day interval, for three cycles, to suppress androgens and regulate cycle. Following hormonal normalisation: clomiphene 50 mg daily from Day 5 for five days with serial ultrasound follicle monitoring; HCG 5,000–10,000 U intramuscular when dominant follicle reached 18–20 mm to trigger ovulation; timed intercourse advised.
Lifestyle intervention: Diet: low-calorie, low-fat, high-fibre; reduced animal fat, refined carbohydrate, and fried foods; increased vegetables, fruit, and whole grains; Phlegm-Damp constitution dietary support — yam, coix seed, hyacinth bean, and winter melon incorporated. Exercise: aerobic activity (jogging, swimming, yoga) at least five times weekly, 30 minutes per session, to reduce weight, improve insulin sensitivity, and regulate endocrine function. Emotional regulation: stress reduction through music, reading, and leisure; avoidance of anxiety and emotional tension, which impair hypothalamic-pituitary-ovarian axis function.
Treatment Course and Outcomes
At One Month
- Fatigue and limb heaviness improved; bowel habit normalised
- Testosterone reduced to 0.8 ng/mL; LH/FSH ratio reduced to 2.5
- Ultrasound: bilateral small follicle count reduced; endometrial thickness 7 mm
At Three Months
- Menstrual cycle regularised at 30–35 days
- Second stimulated cycle: dominant follicle development confirmed on serial ultrasound; successful ovulation triggered with HCG
- Serum HCG positive 14 days post-ovulation — pregnancy confirmed
Pregnancy and Delivery
- Regular antenatal care throughout pregnancy; normal foetal development on serial ultrasound
- No gestational diabetes or gestational hypertension
- Full-term spontaneous vaginal delivery of a healthy female infant
Dr. Sun's clinical reflection: The conception in the second stimulated cycle is a good outcome, but what I find more significant is the trajectory of the hormonal and ultrasound parameters over the three months. The testosterone came down, the LH/FSH ratio normalised, the follicle count reduced, the endometrium thickened — the ovarian environment was genuinely improving, not just being temporarily overridden by the clomiphene. That is the difference between treating the pattern and suppressing the symptom. The metformin addressed the insulin resistance that was driving the androgen excess. The herbal formula and acupuncture addressed the Phlegm-Damp obstruction that was preventing the Chong and Ren from functioning normally. By the time we triggered ovulation, the uterine environment was ready to receive the embryo — and it did.
Expert Commentary — Dr. Sun Wei
1. PCOS as a TCM Phlegm-Damp Disorder: The Constitutional Framework
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age, affecting 8–13% of the global female population, and it is also one of the conditions in which the TCM constitutional framework provides the most clinically useful diagnostic and therapeutic guidance. The dominant TCM pattern in PCOS — Phlegm-Damp obstruction of the Chong and Ren vessels — maps with remarkable precision onto the modern understanding of PCOS pathophysiology. In TCM, Spleen deficiency impairs the transformation and transportation of food essence, producing Phlegm-Damp; Phlegm-Damp accumulates in the lower jiao, obstructing the Chong and Ren vessels and preventing the normal cyclical movement of Qi and Blood that produces ovulation. In modern endocrinology, insulin resistance — which is present in 50–80% of PCOS patients regardless of body weight — drives compensatory hyperinsulinaemia, which stimulates ovarian androgen production, suppresses sex hormone-binding globulin, and disrupts the normal LH pulsatility that drives follicular development. The Spleen deficiency that produces Phlegm-Damp in TCM corresponds to the metabolic dysfunction that produces insulin resistance in modern endocrinology; the Phlegm-Damp obstruction of the Chong and Ren corresponds to the hyperandrogenaemia and anovulation that result. The herbal formula Cangfu Daotang Wan — designed specifically for Phlegm-Damp infertility — has been shown in modern pharmacological studies to reduce insulin resistance, lower androgen levels, and improve ovarian follicular development in PCOS patients, providing a biological mechanism for its classical therapeutic action.
2. Cycle-Phase Therapy: Aligning Treatment with Reproductive Physiology
The cycle-phase approach to TCM gynaecology — 周期疗法 — is one of the most sophisticated contributions of modern TCM to reproductive medicine. Rather than prescribing a fixed formula throughout the cycle, the cycle-phase approach adjusts the herbal prescription and acupuncture protocol at each phase of the menstrual cycle to support the specific physiological processes occurring at that phase: Kidney Yin and Blood nourishment in the follicular phase to support follicular growth; Blood activation and Qi movement in the ovulatory phase to facilitate the surge and release; Kidney Yang warming in the luteal phase to maintain the endometrial environment for implantation. This approach recognises that the menstrual cycle is not a static state but a dynamic process of Yin-Yang transformation — the follicular phase is a Yin-dominant phase of growth and nourishment; the ovulatory phase is the Yin-to-Yang transition; the luteal phase is a Yang-dominant phase of warmth and consolidation. Aligning the herbal and acupuncture treatment with this dynamic process produces a synergistic effect that a fixed formula cannot achieve. In PCOS patients, where the normal Yin-Yang cycle has been disrupted by Phlegm-Damp obstruction, the cycle-phase approach provides the therapeutic scaffolding on which the normal cycle can re-establish itself as the constitutional pattern is corrected.
3. Acupuncture for Ovarian Function: Neuroendocrine Mechanisms
The evidence base for acupuncture in PCOS and ovulatory infertility has expanded substantially over the past decade, with multiple randomised controlled trials and mechanistic studies elucidating the neuroendocrine pathways through which acupuncture influences ovarian function. Acupuncture at points including Guanyuan, Zhongji, Zigong, and Sanyinjiao has been shown to modulate hypothalamic GnRH pulsatility, reduce sympathetic nervous system activity in the ovary, lower circulating androgen levels, and improve ovarian blood flow — all of which directly address the pathophysiological mechanisms of PCOS-related anovulation. The reduction in ovarian sympathetic tone is particularly significant: elevated sympathetic activity in the polycystic ovary contributes to androgen hypersecretion and impaired follicular development, and acupuncture-mediated sympathetic inhibition has been demonstrated to reduce ovarian androgen production and improve follicular maturation in both animal models and clinical studies. The cycle-phase acupuncture protocol used in this case — with phase-specific point additions targeting Kidney Yin in the follicular phase and Kidney Yang in the luteal phase — aligns the neuroendocrine effects of acupuncture with the specific hormonal requirements of each cycle phase, producing a more physiologically coherent intervention than a fixed acupuncture protocol applied uniformly throughout the cycle.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Ms. Walsh and her partner from initial consultation through delivery, including: priority appointment coordination with Dr. Sun Wei at Longhua Hospital with bilingual review of all prior gynaecological records, hormone panels, and ultrasound reports from Australia; bilingual interpretation throughout all TCM four-examination consultations, cycle-phase treatment planning discussions, and Western pharmacotherapy review sessions; coordination of gynaecological ultrasound, sex hormone panel, OGTT, insulin release test, and thyroid function with bilingual results communication and clinical summary for the patient's gynaecologist in Australia; bilingual pharmacy support for herbal decoction preparation, cycle-phase formula adjustment schedule, and concurrent medication instructions; serial follicle monitoring coordination with bilingual ultrasound results and HCG trigger timing communication; pregnancy confirmation and antenatal referral coordination with bilingual obstetric summary provided to the patient's obstetrician in Shanghai and GP in Australia; and delivery outcome documentation communicated to the patient's overseas medical team.
For international patients with PCOS, infertility, endometriosis, or reproductive endocrine disorders seeking integrative TCM care in Shanghai, Dr. Sun Wei's team at Longhua Hospital offers a clinically rigorous, evidence-informed approach — combining classical cycle-phase herbal therapy, acupuncture, and Western reproductive medicine to restore hormonal balance and achieve conception. CMCS ensures that expertise is accessible: in the patient's language, with overseas physicians informed at every step, from the first integrative consultation through delivery and beyond.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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