Whether it is a deficiency of Kidney-Yin or Kidney-Yang, the Kidney-Essence is always involved in its Yin or Yang aspect. As discussed in Chapter 2 on physiology, the menstrual function and the Uterus rely on the Yin aspect (which is Post-Natal) and on the Yang aspect of the Essence (which is Pre-Natal). The Yang aspect of the Essence is the Fire of the Gate of Life, also called the Minister Fire, that is formed at conception.

As we have seen in Chapter 2, the Minister Fire is of a special type: a ‘formless’ Fire, it can actually generate Water (rather than drying it up). For fertilization to occur, the Yin and Yang aspects of the Essence need to be perfectly balanced: the Yin in the form of Water, Essence and Blood is the substantial basis for conception to occur, but the Yin needs the warming and fertilizing action of Yang, in the form of Minister Fire.

If the Water, i.e. the Yin aspect, is deficient, there is not enough nourishment to support the fertilized egg (or to produce an egg at all); if the Minister Fire is deficient, there is no ‘spark’ to transform and activate the Water, which therefore cannot fertilize or nourish an egg. Vice versa, if the Minister Fire is excessive and pathological, the Blood in the Uterus may become hot and this creates adverse conditions for the fertilization or support of an egg. Figures 57.1 and 57.2 illustrate these concepts.

Figure 57.1 Yin and Yang aspects of the Essence in relation to the Uterus.

Figure 57.2 Pathological conditions of Yin and Yang aspects of the Essence.

Full conditions

In the case of Full conditions, fertilization cannot occur because pathogenic factors obstruct the Uterus and the Directing and Penetrating Vessels (Ren and Chong Mai). Such pathogenic factors may be Cold (very common in cold and damp countries), Blood-Heat, Dampness, stagnation of Qi, stasis of Blood and Phlegm. Fertilization is a very delicate process fraught with difficulties and any of the above pathogenic factors may prevent it.

Cold is a very frequent cause of infertility: it prevents conception by obstructing the Uterus and its channels. As we have just seen, the Fire of the Gate of Life is essential for the fertilization of the egg: the Essence, in its Yin aspect, provides the basis for conception by producing the eggs, but the Fire of the Gate of Life is essential for the transformation of the egg into a fetus. Cold obstructs the Uterus and dampens the Fire of the Gate of Life, preventing fertilization. Cold can be of the Full or Empty type, depending on how much Kidney-Yang deficiency there is. One of the most important diagnostic factors differentiating Full- from Empty-Cold is the pulse: in Full-Cold the pulse will be Full and Tight, while in Empty-Cold it will be Weak on the whole (although it may also be slightly Tight on the left Rear position).

Blood-Heat also causes infertility, but in the opposite way. Blood and Essence are the basis for conception (the Uterus is also called the Blood Chamber). Thus, if the Blood is hot it may create adverse conditions for the fertilization of the egg. The influence of Cold and Blood-Heat can be compared with a bird’s incubation of an egg; the temperature should be steady, warm, neither too cold nor too hot.

Dampness, to which women are particularly prone, invades the body from the Lower Burner. It prevents the proper movement of Qi and Blood and may therefore lead to stagnation of Qi and/or stasis of Blood. Unable to function properly, the Directing and Penetrating Vessels (Ren and Chong Mai) cannot gather the Essence for the woman to conceive. From a channel perspective, this may due also to a pathology of the Girdle Vessel (Dai Mai) affecting the Directing Vessel (see Ch. 7). From a Western perspective, Damp-Heat often corresponds to pelvic or tubal inflammation.

Liver-Qi stagnation is mentioned in Chinese books as a possible pathology of infertility. In my opinion, it is unlikely that Qi stagnation on its own would cause infertility because Qi is non-substantial and it is unlikely to cause an obstruction such as to lead to infertility. Nevertheless, I will discuss its treatment below.

Blood stasis is a frequent cause of infertility: stagnant Blood obstructs the Uterus and its channels and it prevents the proper functioning of the Directing and Penetrating Vessels so that conception cannot occur. If Blood stasis is severe and longstanding, stagnant Blood can give rise to abdominal masses, endometriosis, ovarian cysts or myomas. In endometriosis, a major factor in infertility, there is always Blood stasis.

Phlegm may cause infertility by obstructing the Uterus and its channels so that the Directing and Penetrating Vessels cannot function properly and the Essence cannot be gathered. Zhu Dan Xi (1281–1358) says in his The Heart and Essence Dan Xi’s Methods of Treatment: “Inability to conceive in fat women is caused by the Fat [i.e. Phlegm] within the body blocking the Uterus.”¹ This is an interesting statement because polycystic ovary syndrome, a major cause of infertility, often occurs in obese women. Modern Chinese doctors relate obesity to Phlegm. Damp-Phlegm is nearly always the main pathogenic factor in polycystic ovary syndrome.

The Directing and Penetrating Vessels in infertility

No matter whether the condition is Full or Empty, in infertility the Uterus and the Directing and Penetrating Vessels (Ren and Chong Mai) are obviously always involved. In case of deficiency, the Uterus and the Directing and Penetrating Vessels lack the necessary nourishment to nurture the fertilized egg or to produce an egg at all; in the case of excess, pathogenic factors obstruct these structures and prevent their proper Qi, Blood and Essence transformation so that fertilization or implantation cannot occur (Fig. 57.3).

Figure 57.3 Causes of infertility.

Treatment of the Penetrating and Directing Vessels is essential in infertility whether in a Full or Empty condition. In Empty conditions, Ren-4 Guanyuan is the best point to use: it nourish Blood, tonifies the Kidneys (both Yin and Yang), nourishes the Essence, strengthens the Original Qi (Yuan Qi); finally, it strengthens both the Directing and the Penetrating Vessels because the latter connects with it internally. In Empty conditions, I often combine Ren-4 with KI-13 Qixue (a point of the Penetrating Vessel).

In Full conditions, the best points to use are Ren-3 Zhongji and KI-14 Siman (a point of the Penetrating Vessel).

Clinical Note

In Empty conditions, Ren-4 Guanyuan is the best point to use: I often combine Ren-4 with KI-13 Qixue (a point of the Penetrating Vessel). In Full conditions, the best points to use are Ren-3 Zhongji and KI-14 Siman (a point of the Penetrating Vessel).

The cervical secretion

When treating infertility, one must always take into consideration the cervical secretion that occurs just before ovulation and that indicates fertility. As discussed in Chapter 2, the cervical secretion is a direct manifestation of Kidney-Essence and its absence (or short duration of 1 day only) indicates a deficiency of Kidney-Essence and a weakness of the proliferative phase. Therefore, one must always ask a woman seeking treatment for infertility to check the cervical secretion every month.

The basal body temperature

The second sign that one must consider is the basal body temperature (BBT) also discussed in Chapter 2. Although the BBT does not give us indications for treatment as the spike in temperature occurs after ovulation, it is important to chart the temperature every month to monitor the progress (or lack of it) of the treatment. If a previously flat chart starts to develop the typical biphasic shape, it is obviously a very good sign. It is also very encouraging for the patients to see the objective improvement in the chart for themselves.