Chapter 57 Infertility

Infertility is defined as the inability to produce offspring in a woman who has been trying for 2 years with a normal sexual life and, of course, the reproductive function of whose partner is normal.



When discussing the pathology of infertility, there are various aspects to consider:

Full versus Empty causes of infertility

When diagnosing infertility, we should differentiate clearly between deficiency and excess: this is the most important aspect to clarify. We must diagnose clearly whether the woman cannot conceive because of a lack of Blood and/or Essence (in its Yin or Yang aspect) or because there is a pathogenic factor obstructing the Uterus. On the basis of this diagnosis, we must therefore establish whether we need to tonify and nourish the body’s Qi or to eliminate pathogenic factors.

Empty conditions

In case of Empty conditions, infertility is due to a lack of the vital substances that are essential for conception, i.e. Blood and/or Essence. The two main deficiencies are those of Blood or of Kidneys (which may be Kidney-Yin or Kidney-Yang).

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.

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).

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).

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.

Identification of patterns and treatment

Infertility is frequently treated in China according to the four phases of the menstrual cycle as described in Chapter 2, i.e. the period, the post-menstrual, the inter-menstrual and the pre-menstrual phases. The treatment principles in each phase are as follows:

In relation to infertility in particular, the treatment principle can be slightly different because the emphasis is always put on the treatment of the Kidneys (especially in deficiency conditions). Also, the phases are sometimes slightly different, being defined more according to Western physiology. For example, Dr Li Xiang Yun defines the following four phases:

Dr Li recommends the following treatment principles for the above four phases:

The treatment of infertility according to the four phases is always based principally on treating the Kidneys because the phases are a result of the waxing and waning of Kidney-Yin and Kidney-Yang and because the Kidneys are the source of the Tian Gui which is the basis for reproduction. Thus, from a Western perspective, the follicle maturation, ovulation, the ova and the corpus luteum are all manifestations of the fluctuation of Kidney-Yin and Kidney-Yang during the menstrual cycle. For this reason, several of the prescriptions mentioned in this chapter are based on four different formulae according to the above four phases of the menstrual cycle and they are all aimed at establishing a regular menstrual cycle and ovulation by tonifying different aspects of the Kidneys at each different phase.

From an acupuncture perspective, the Governing, Directing and Penetrating Vessels (Du, Ren and Chong Mai) are the basis for follicle maturation, ovulation and corpus luteum development and these channels should therefore always be used to treat infertility. The Directing and Penetrating Vessels are Yin in nature and represent the biological basis for the follicles, ova and corpus luteum, while the Governing Vessel, Yang in nature, is the force of transformation that assists the biological processes involved in fertilization, i.e. the maturation of follicles, the expulsion of the ova and the maturation of the corpus luteum.

The patterns discussed are as follows:

Herbs that nourish the Kidney-Essence

Before discussing the differentiation and treatment of infertility, it is useful to review the herbs that nourish the Kidney-Essence. There is no separate category for Essence-nourishing herbs and they can be found in various categories. Most of them are in the Kidney-Yang tonics category. Some of them ‘stabilize’ the Essence rather than nourish it but they are often combined with Essence-nourishing herbs: for example, Bu Gu Zhi Fructus Psoraleae or Yi Zhi Ren Fructus Alpiniae oxyphyllae. ‘Stabilizing’ the Essence implies an astringent action that is used with symptoms such as nocturnal emissions or spermatorrhoea in men and chronic vaginal discharge in women. A list of herbs that nourish the Essence by category is given in Table 57.1

Nourishing the Essence is essential in infertility, especially of the deficient kind, and particularly that from Kidney deficiency. The majority of these cases of infertility are due to an ovulatory dysfunction and ovulation is an expression of the transformation of the Kidney-Essence into ova. Thus, to promote ovulation, it is necessary to nourish the Essence. Nourishing the Essence transcends tonification of Yin or Yang as the Essence itself has a Yin and a Yang aspect. Its Yang aspect is the Minister Fire which is present from conception, and its Yin aspect is the Essence itself that, at puberty, crystallizes into menstrual Blood and the ova (see Fig. 4.3). Given the importance of the role of the Minister Fire in transforming the Tian Gui into menstrual blood and ova, it is interesting to note that the majority of herbs that nourish the Essence are in the Kidney-Yang tonics category. Some of the herbs listed in Table 57.1 deserve particular comment.

Herb combinations for infertility

Some herb combinations are used particularly frequently in infertility.

Combinations for deficiency conditions

Combinations for excess conditions

Empty conditions

Kidney-Yang deficiency


KI-13 Qixue, KI-3 Taixi, BL-23 Shenshu, BL-52 Zhishi, Ren-4 Guanyuan, Du-4 Mingmen, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), Ren-8 Shenque-Baomen, Zihu. All with reinforcing method; moxa should be used.

Herbal treatment

d. Prescription

This prescription consists of two formulae, one to be taken for 7 days after the period and the other for 8 days during ovulation.

Women’s Treasure remedy

This remedy tonifies Kidney-Yang, nourishes Blood and Essence and strengthens the Governing Vessel. The tongue presentation appropriate to this remedy is a Pale and wet tongue.

Case history

A 35-year-old woman had been trying to conceive for 2 years. Her periods were regular but scanty, lasting only 2 days. The menstrual blood was bright red and there were no clots. She also complained of dull headaches on the vertex, floaters and dizziness. On interrogation, it transpired that she had also suffered from allergic rhinitis since the age of 17, manifesting with sneezing attacks and a clear, watery nasal discharge. She also complained of backache, occasional tinnitus, feeling cold in general and cold feet. Her tongue was slightly Pale and Swollen with a Heart crack, and her pulse was Weak on both Rear positions and slightly Choppy in general. Her complexion was dull and pale.


There are two main patterns: one is Blood deficiency and the other Kidney-Yang deficiency. The symptoms of Blood deficiency are dull and pale complexion, floaters, scanty periods, dull headaches on the vertex, Choppy pulse and Pale tongue. The manifestations of Kidney-Yang deficiency are feeling cold, cold feet, occasional tinnitus, Weak Kidney pulses and Swollen tongue. I relate allergic rhinitis also to a Kidney-Yang deficiency and specifically a deficiency of what I call ‘Kidney Defensive Qi system’ (see Ch. 6 of the Practice of Chinese Medicine8). From a channel point of view, allergic rhinitis also involves a weakness of the Governing Vessel, which is consistent with a deficiency of Kidney-Yang. On the other hand, the Blood and Kidney-Yang deficiency involves a deficiency of the Directing and Penetrating Vessels: thus, in her case, there is a deficiency of the three main Extraordinary Vessels that control fertility, conception and pregnancy.


After one course of this prescription (1 month) she felt better in general and the rhinitis got better as well. I continued treating her with similar prescriptions for 7 months after which she became pregnant. As she had quite a severe deficiency of Blood and Kidney-Yang, I treated her during the first few months of pregnancy to prevent miscarriage with a simple formula to tonify Kidney-Yang and ‘calm the fetus’:

Because I usually prefer not to give herbs in the first 3 months of pregnancy at all, I kept the number to a minimum. I chose the above three herbs, using 6 g each, because they would address her two main deficiencies and calm the fetus, i.e. prevent miscarriage. After 9 months, she gave birth to a healthy baby.

Case history

A 35-year-old woman had been trying to conceive for 2 years. She had conceived but miscarried 3 months previously. Her periods were regular, they lasted 4–5 days and the menstrual blood’s colour was normal. She often felt cold, especially in her feet. She also tired easily and occasionally suffered from headaches. Her tongue was of a normal colour, except for being Red on the tip and sides, and the tongue body was Thin. Her pulse was Weak on both Rear positions and relatively Overflowing on the left Front position.

Kidney-Yin deficiency

Herbal treatment

Blood deficiency

Herbal treatment

Women’s Treasure remedies

This remedy is a variation of the formula Ba Zhen Tang Eight Precious Decoction which nourishes Blood. The tongue presentation appropriate to this remedy is a Pale and Thin body.

Case history

A 33-year-old woman had been trying to conceive for 4 years. She had been told that her failure to conceive was due to an ovarian irregularity. She had had IVF treatment twice but both times she miscarried (at 10 and 12 weeks). After her second miscarriage her period did not come for 6 months. Her periods were regular but scanty, lasting only 2 days, with bright red blood. She also complained of constipation and anaemia. Her tongue was Pale and Short and her pulse was Choppy.

Case history

A 32-year-old woman had been trying to conceive for 2 years. She had become pregnant 2 years previously but had a miscarriage at 26 weeks. Her periods were regular and rather heavy, lasting 1 week. There was no pain and the blood was bright red. She also suffered from dizziness and blurred vision. Her tongue was Pale and Swollen and her pulse was Rapid and Empty.

Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Infertility

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