Exploring the clinical approach to obese polycystic ovary syndrome from the perspective of "treating with fragrant eupatorium to remove stagnant qi"

Polycystic ovary syndrome is characterized by reproductive endocrine dysfunction, and metabolic disorders. Patients with obese polycystic ovary syndrome often present with insulin resistance, abnormal lipid metabolism, and chronic inflammation. Based on the theory in the Huangdi Neijing that "treating with fragrant eupatorium to remove stagnant qi," this article summarizes the core pathogenesis of obese polycystic ovary syndrome as disease caused by stagnant qi. It starts with spleen and kidney deficiency and liver qi stagnation, leading to the generation of phlegm, dampness, and blood stasis, which obstruct the thoroughfare channel, conception channel, and the uterus. This results in internal stagnant heat generation, qi consumption, and yin injury, and dysfunction of storage and discharge. Expanding the connotation of "fragrant eupatorium," this article proposes four therapeutic methods centered on "remove stagnant qi:" awakening the spleen with aromatic eupatorium, using Peilan (Eupatorii Herba), Huoxiang (Agastache Rugosa), and Doukou (Amomi Fructus Rotundus) to regulate the middle jiao and eliminate the source of stagnation; drying dampness with bitter eupatorium using Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Banxia (Pinelliae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium) to resolve phlegm and turbidity and disperse the stagnant form; unblocking collaterals with acrid eupatorium using Zelan (Lycopi Herba), Chuanxiong (Chuanxiong Rhizoma), and Jianghuang (Curcumae Longae Rhizoma) to reduce blood stasis and promote ova growth and discharge; and nourishing yin with cool eupatorium using Qinghao (Artemisiae Annuae Herba), Baiwei (Cynanchi Atrati Radix et Rhizoma), Jinyinhua (Lonicerae Japonicae Flos), and Lianqiao (Forsythiae Fructus) to clear stagnant heat, harmonize the uterus, and facilitate conception. These methods can be applied in stages or in combination according to syndrome differentiation. By removing stagnant qi and promoting renewal, the goals are to regulate the menstrual cycle, improve insulin resistance and metabolic abnormalities, promote ovulation, and increase the pregnancy success rate.