Polycystic ovarian syndrome (PCOS) is an increasing proportion of gynecological menstrual disorders from a clinical point of view. Cases of PCOS can be seen in adolescent women with menstrual disorders, some women with menopausal disorders, and women of childbearing age. Many patients present with complaints of infertility or menstrual disorders. In the clinical work, because of more diagnosis and treatment of this type of evidence, so the pathophysiology of the disease and the diagnosis and treatment methods to organize, hoping to improve the patient’s understanding of the degree of the disease. 1, PCOS pathophysiology: ① hyperandrogenemia: ② insulin refusal or hyperinsulinemia: ③ anovulation GnRH continuous hypertonic secretion – ” LH high amplitude high frequency secretion – ” LH/FSH ” 2 or 3 or more. ④ Ovarian pathology: development of multiple follicles in bilateral ovaries — luteinization and peritoneal thickening without rupture — endometrium stimulated by estrone — hyperplasia, adenocyst, adenoma or irregular hyperplasia, and even endometrial cancer. The development, maturation and ovulation of follicles is a complex process. Local autocrine and paracrine regulators such as steroid hormones and their receptor synthesis, various cytokines (TNFα, IL-1, INFγ, etc.), growth factors and their receptors (IGFs, EGF, VEGF, TGFβ, etc.), inhibin (INF), activator (ACT) and lactogen, stromal (ECM) and lysosomal enzymes (MMPs) and fibrinolytic activation (tPA /The complex network of gonadal axis hormones and their receptors, including inflammatory chemotaxis, prostaglandins (PG), etc., together with the gonadal axis hormones and their receptors, may lead to abnormal follicular development and ovulation failure. Follicular dysgenesis and anovulation are the core features of reproductive dysfunction in PCOS patients. The basic manifestations of follicular dysgenesis in PCOS patients are excessive follicular recruitment, impaired follicular selection and dominance, and stalled follicular development, leading to anovulation. A smooth ovarian surface with thickened white membranes and many follicles of varying degrees of atresia and atretic follicles with occasional white bodies can be seen beneath the white membranes. The white membranes of the ovaries are markedly collagenized, forming broad bands of collagen fibrils, which are thicker than normal and encircle the ovaries in a lamellar pattern, and eventually anovulation occurs. This pathological outcome is associated with endocrine disorders, insulin resistance and hyperinsulinemia, hyperandrogenemia, and abnormalities in ovarian local regulatory factors, ovarian granulosa cells and follicular membrane cell function that may be regulated by these factors. Abnormal pituitary gonadotropin secretion in PCOS is manifested by a relatively elevated LH and a slightly low or normal FSH, with an increased ratio of the two, secondary to excessive androgen synthesis by the ovaries and adrenal glands. Insulin resistance and concomitant hyperinsulinemia is a prominent manifestation in many obese and non-obese women with PCOS, and insulin resistance may play an early and central role in the pathogenesis of PCOS, a phenomenon that is particularly prominent in adolescent girls with androgenism; insulin enhances ovarian and adrenal steroid hormone (especially androgen) synthesis via its own receptors; and increases the release of pituitary LH ; enhanced insulin inhibits hepatic synthesis of SHBG (sex hormone-binding globulin), causing a decrease in circulating SHBG concentration and an increase in free testosterone concentration, amplifying the effects of androgenemia, and a marked decrease in serum SHBG is a significant sign of insulin resistance from almost all causes; hyperinsulinemia causes abnormal granulosa cell function resulting in impaired dominant follicle formation and anovulation. Hyperandrogenemia in the ovary can thicken the stromal hyperplastic ovarian peritoneum and accelerate follicular atresia, inhibit SHBG synthesis in the liver and increase the conversion of testosterone and androstenedione to dihydrotestosterone and estrone in the periphery, leading to acne and hirsutism in women on the one hand, and no cyclic estrone stimulation on the other hand, further exacerbating the disorder of gonadal axis hormone secretion through feedback and LH/FSH ratio imbalance. obesity in PCOS is associated with insulin resistance and hyperinsulinemia and hyperandrogenemia have some relationship, but the exact interaction or sequential relationship remains to be elucidated. However, it is proved that obesity in PCOS can amplify androgenic effects by the above-mentioned SHBG pathway; adipose tissue enhances the process of aromatization to estrone, which further causes hormonal disorders of gonadal axis and excessive endometrial hyperplasia, and even endometrial carcinoma; obesity also leads to hypertriglyceridemia and very low-density lipoprotein cholesterolemia, which aggravate lipid metabolism disorders and atherosclerosis formation; in some patients, reducing body weight can improve ovulation. This shows that the various pathologies of PCOS are interrelated and form a vicious circle, which eventually leads to a series of clinical manifestations and complications of PCOS, and also leads to treatment difficulties and complications. The ovaries and endometrium also show typical pathological changes: (1) cystic enlargement of the ovaries bilaterally, (2) thickening of the envelope, microscopically visible cystic follicles covered by several layers of granulosa cells or follicular membrane cells, (3) absence of corpus luteum and interstitial luteinization, (4) endometrium, depending on the level and duration of estrogen, may show hyperplasia, cystic glandular or adenomatous hyperplasia, or even combined with endometrial cancer. 3. Clinical manifestations: (1) Menstrual disorders: sporadic menstruation, low menstrual flow or even amenorrhea, a few of them also show excessive menstruation. (2) Hairiness and obesity: they often occur together, and their hair distribution has the tendency to be masculine, such as increased hair on the upper lip, next to the nipple, in the midline of the abdomen, around the anus and the limbs, etc., and thick and black pubic hair. (3) Infertility: due to menstrual disorders and anovulation. Occasionally ovulation or luteal failure, if pregnancy is possible, it is very easy to miscarry. (4) Ovarian enlargement: bilateral symmetrical polycystic enlargement of 2 to 4 times, or 1/3 to 1/4 of the uterine volume for polycystic. 20% to 30% are not enlarged. (5) Gynecological examination: longer and denser vulvar hairs, which can be spread to the perianal area, lower abdomen and abdominal midline. (6) Comorbidities: ① Endometrial cancer: 19-25% of patients with endometrial cancer less than or equal to 40 years old have PCOS, and 14% of PCOS progress to endometrial cancer within 14 years. ②30-40% of patients with hyperprolactinemia. (iii) Combination of absolute (complete) insulin refusal syndrome and hyperinsulinemia. In addition to the symptoms and signs of PCOS, there are also acanthosis ni-gricans, i.e., brownish-black pigmentation of the skin at the back of the neck and axilla (type A and B), which is caused by defective insulin receptors. 4, treatment (1) ovulation treatment: early conception is the key to the treatment of the disease, but some clinical cases still reappear after delivery PCOS symptoms. There are many methods of ovulation treatment, which can be simple to complicated, and gradually deepen, and pay attention to ovarian hyperstimulation signs and other side effects. (2) Chinese medicine treatment: The efficacy of Chinese medicine treatment for this disease is certain, but one must have patience. The method of menstrual regulation treatment may differ from one doctor to another, but restoration of regular menstruation, periodic ovulation, successful conception, etc. are the objectives and results of treatment. (3) Combination of Chinese and Western medicine: This is a treatment method often used and a very effective way to improve the efficacy. Chinese medicine regulates menstruation to cure the root of the problem, restores ovulation in the ovaries, achieves lower insulin and androgen levels, and normalizes endocrine metabolism; Western medicine mainly adopts ovulation promotion, improves insulin resistance, lowers prolactin or androgen levels, improves ovulation success rate, reduces complications, etc. Combination of Chinese and Western medicine is the best way to treat this disease. (4) Surgical treatment: The aim is also to restore the normal rhythm of endocrine regulation and to achieve the goal of restoring ovulation. However, the problem of ovarian fibrosis after surgery must be taken seriously. (5) Patience and proper treatment are the basis for curing this disease. We have accumulated a lot of experience in basic research, clinical research and clinical work for the treatment of PCOS and other pathologies. In some cases, the disease is relatively superficial, and the combination of Chinese and Western medicine, ovulation promotion or endocrine regulation treatment is effective and relatively simple. Some cases are stubborn and persistent, and do not respond well to ovulation treatment. In such cases, a longer period of Chinese herbal treatment is needed, followed by ovulation treatment, or a longer period of ovarian rest, followed by ovulation treatment, which is more effective. The combination of Chinese and Western medicine has unique significance in the treatment of PCOS, which cannot be ignored and cannot be replaced. Polycystic ovary syndrome is a complex disease with more differences between individuals and various manifestations. Menstrual regulation and improvement of ovarian and endocrine function are the core of the treatment. A good attitude, positive cooperation and meticulous communication will also be more effective when the more accurate and in-depth the judgment of the pathophysiological state or the Chinese medical evidence is. Many aspects and manifestations of disease are often interconnected, such as prostaglandin system, endocrine and metabolism, inflammation – coagulation network, inflammation and insulin resistance, inflammation and fibrosis or decreased ovarian sensitivity, aromatase system, and even digestive function, and other aspects of the body or between the various types of symptoms, there will be some connection, this connection, Western medicine is called pathophysiological state, Chinese medicine is called symptoms The deeper we go, the better, especially the interconnection of molecular or factor networks, which can be wonderfully related to the chain of TCM symptoms. According to the longitudinal and transversal aspects, prudent formulation of the program, to achieve clarity and order, the treatment will be more standardized and closer to science and less blind. No matter how in-depth the doctor is, it is still far from enough compared to the complexity of the disease. Therefore, treatment is always a slow process.