Infertility

Chapter 57 Infertility



AETIOLOGY 685

PATHOLOGY 686
Full versus Empty causes of infertility 686

The Directing and Penetrating Vessels in infertility 688

The cervical secretion 689

The basal body temperature 689

Connections with biomedical causes of infertility 689

Patterns of infertility 689

IDENTIFICATION OF PATTERNS AND TREATMENT 689

EMPTY CONDITIONS 693
Kidney-Yang deficiency 693

Kidney-Yin deficiency 697

Blood deficiency 699

FULL CONDITIONS 701
Cold in the Uterus 701

Dampness in the Lower Burner 704

Blood-Heat 708

Stagnation of Qi 709

Stasis of Blood 712

Damp-Phlegm 714

COMBINED PATTERNS 715
Kidney-Yang deficiency with Damp-Phlegm in the Uterus 715

Kidney-Yang deficiency with Dampness 715

Kidney-Yang deficiency with Blood stasis 716

Kidney-Yang deficiency with Blood stasis and Dampness 716

ANCIENT ACUPUNCTURE PRESCRIPTIONS FOR INFERTILITY 716

MODERN ACUPUNCTURE PRESCRIPTION FOR RETROVERT UTERUS 717

EMPIRICAL PRESCRIPTIONS BY DR XIA GUI CHENG 717

EMPIRICAL PRESCRIPTIONS BY DR LIAN FANG AND DR SUN NING QUAN 718

EMPIRICAL PRESCRIPTIONS BY DR ZHU NAN SUN 719

EMPIRICAL FORMULAE ACCORDING TO WESTERN CONDITION BY DR SHAN DAO WEI 720

EMPIRICAL PRESCRIPTIONS BY THE SHANGHAI COLLEGE OF TRADITIONAL CHINESE MEDICINE 720

PROGNOSIS AND PREVENTION 721

WESTERN VIEW 722

CLINICAL TRIALS 725
Acupuncture 725

Herbal treatment 728

APPENDIX: MALE STERILITY 733

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.



Aetiology




Constitutional weakness


Constitutional weakness of the Kidney-Essence is an important cause of infertility. Such weakness may be due to the woman’s mother having been too old when conceiving her, the parents’ constitution being not good, the parents’ health being not good at the time of conception, etc. Because the Kidney-Essence is the basis for the Tian Gui, the woman cannot conceive.



Overwork


Overwork in the sense of working long hours without adequate rest and with irregular diet for years is a major cause of Kidney-Yin deficiency. Kidney-Yin is the basis for menstrual blood and the uterus and when it is deficient there may be infertility.



Excessive physical work


Excessive physical work or strenuous exercise and sports weaken the Spleen- and Kidney-Yang, especially at puberty time when a young girl’s uterus is in a vulnerable state. At this age, excessive physical work may take the form of playing too much sport, training too hard at ballet or gymnastics, working on a farm, etc.



Sexual activity at too early an age


Sexual activity at too early an age (i.e. before and during puberty and up to about 18) is an important and increasingly frequent cause of disease in Western countries. It seriously weakens the Kidneys and damages the Directing and Penetrating Vessels (Ren and Chong Mai) and may therefore cause infertility later in life.



Invasion of Cold


Invasion of Cold is a very common cause of infertility in young women – indeed, probably the most common cause of primary infertility in young women. If a girl undergoing puberty is exposed to cold and dampness (especially during her period) when exercising or playing sports, Cold invades the Uterus, turns into internal Cold and obstructs the Uterus and the Directing and Penetrating Vessels, preventing fertilization.



Irregular diet


Excessive consumption of cold, iced foods and drinks also leads to Cold in the Uterus as above. Excessive consumption of greasy foods and dairy products leads to the formation of Dampness in the Lower Burner which also prevents fertilization. Dampness in the Lower Burner easily turns into Damp-Phlegm which may obstruct the Uterus preventing implantation of the ovum. Blockage of the fallopian tubes is usually due to their obstruction by Damp-Phlegm; however, it is important to note that Damp-Phlegm obstructing the Uterus may cause infertility whether the tubes are blocked or not.



Pathology


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


• Full versus Empty causes of infertility.

• The Directing and Penetrating Vessels in infertility.

• The cervical secretion.

• The basal body temperature.

• Connections with biomedical causes of infertility.

• Patterns of infertility.


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.


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


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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).


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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.



Connections with biomedical causes of infertility


Although it is not possible to make direct connections between Western pathologies and Chinese medicine patterns, modern Chinese books and journals make such an endeavour. Although one should keep an open mind and rely on a Chinese diagnosis and identification of patterns for treatment, such connections can give broad guidelines. According to such modern connection, absence or irregularity of ovulation often corresponds to a Kidney deficiency; blockage of the fallopian tubes to Damp-Heat, possibly with Toxic-Heat and stasis of Blood; uterine myomas and endometriosis to stasis of Blood, possibly with Phlegm; and pelvic adhesions to Dampness with stasis of Blood.



Patterns of infertility


To get an idea of the statistical incidence of each type, we may refer to a study of 257 cases of infertility reported in Beijing’s Journal of Chinese Medicine.2 Of these 257 cases, the following were the proportions of various patterns:



• Kidney-Yang deficiency: 27.63%.

• Spleen- and Kidney-Yang deficiency: 12.84%.

• Liver- and Kidney-Yin deficiency: 11.67%.

• Kidney-Yin deficiency with Empty-Heat: 5.06%.

• Liver-Qi stagnation: 7.39%.

• Blood stasis: 29.57%.

• Phlegm: 3.11%.

• Cold-Dampness: 2.73%.

As can be seen, if we total up all the various types of Kidney deficiency we obtain a total percentage of 57.20% of Kidney-Deficiency cases, by far the highest one. However, these figures are related to Chinese conditions and may not be exactly the same in other countries. For example, one might infer that the percentage of cases due to Cold and Dampness would be higher not only in cold and damp climates but also in relatively warm countries due to the consumption of iced drinks, especially by young people. Also, in my experience, the percentage of cases of infertility due to Phlegm would be considerably higher.



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:


• Period phase: regulate menstruation (i.e. stop bleeding if period is heavy or invigorate Blood if it is scanty).

• Post-menstrual phase: nourish Blood and tonify the Kidneys.

• Inter-menstrual phase: tonify the Kidneys and consolidate the Directing and Penetrating Vessels. If necessary, resolve Dampness or Phlegm.

• Pre-menstrual phase: tonify Yang and move Liver-Qi. If necessary, resolve Phlegm, invigorate Blood, expel Cold.

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:


1. Follicular development phase: this starts from about the fourth or fifth day after the beginning of the period.

2. Follicular maturity and ovulation phase: this is the inter-menstrual phase when the follicle matures and ovulation occurs.

3. Luteal phase: this is the pre-menstrual phase when the corpus luteum develops and secretes progesterone.

4. Atrophy of corpus luteum phase: this is the period time.3

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


1. Follicular development phase: tonify the Kidneys and nourish Blood.

2. Follicular maturity and ovulation phase: nourish and invigorate Blood.

3. Luteal phase: tonify the Kidneys and consolidate the Directing and Penetrating Vessels.

4. Atrophy of corpus luteum phase: invigorate Blood and regulate menstruation.

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:






Empty


• Kidney-Yang deficiency.

• Kidney-Yin deficiency.

• Blood deficiency.


Full


• Cold in the Uterus.

• Dampness in the Lower Burner.

• Blood-Heat.

• Stagnation of Qi.

• Stasis of Blood.

• Damp-Phlegm.


Combined patterns


• Kidney-Yang deficiency with Damp-Phlegm in the Uterus.

• Kidney-Yang deficiency with Dampness.

• Kidney-Yang deficiency with Blood stasis.

• Kidney-Yang deficiency with Blood stasis and Dampness.

Please note that although the patterns are discussed individually, in practice they will always occur in combination. For example, it is very common for a woman with infertility to suffer from Kidney-Yang deficiency and Dampness (or Damp-Phlegm). It is precisely in these situations that treatment according to the four phases is particularly important.


In the example above of Kidney-Yang deficiency with Dampness, it would be appropriate to tonify Kidney-Yang in phases 2 and 3 and resolve Dampness in phase 4 (or tonify Kidney-Yang in phase 2 and resolve Dampness in phases 3 and 4). For this reason, after discussing individual patterns, I will also discuss some examples of combinations and their treatment. Please note that the patterns given (all with Kidney-Yang deficiency) are only examples: in each case, the woman may be suffering from Kidney-Yin rather than Kidney-Yang deficiency.



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



Table 57.1 Herbs that nourish the Essence by category

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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.




Lu Rong Cornu Cervi pantotrichum, Lu Jiao Cornu Cervi, Lu Jiao Jiao Colla Cornu Cervi and Lu Jiao Shuang Cornu Cervi degelatinatum

These are excellent substances to nourish the Essence because they nourish Yang without drying and nourish the Essence at the same time. They also strengthen the Governing Vessel and therefore activate the Minister Fire that promotes the transformation of Kidney-Essence into menstrual blood and ova. Lu Jiao Jiao is particularly indicated for women as it also nourishes Blood, while Lu Jiao Shuang would be indicated when there is excessive menstrual bleeding.



Tu Si Zi Semen Cuscutae

This herb is very frequently used to nourish the Essence and promote ovulation in infertility. Its advantage lies in its rather neutral quality as, although it does tonify Kidney-Yang, its action is rather mild and it can be used to nourish Kidney-Yin.



Zi He Che Placenta hominis

Being human placenta, this is the substance that is closest to actual Essence. It tonifies Yang and nourishes Blood and the Kidney-Essence.



Herb combinations for infertility


Some herb combinations are used particularly frequently in infertility.



Combinations for deficiency conditions



Tu Si Zi Semen Cuscutae and Gou Qi Zi Fructus Lycii

These are important herbs for Kidney deficiency. The combination is perfectly balanced, being neither too warm or too drying, and it tonifies without cloying. Although this combination tonifies both Yin and Yang, it is primarily for Kidney-Yin deficiency.



Shu Di Huang Radix Rehmannia preparata and Bai Shao Radix Paeoniae alba

This combination tonifies Liver- and Kidney-Yin: it also ‘calms’ and protects the Yin. ‘Calming’ the Yin implies the capacity to stop bleeding from Empty-Heat; ‘protecting’ indicates an ability to prevent leakages of Yin such as occur in persistent vaginal discharges. This combination nourishes Water and irrigates Wood, i.e. it nourishes Kidney-Yin and Liver-Blood.



Shan Yao Rhizoma Dioscoreae and Shan Zhu Yu Fructus Corni

This combination tonifies Liver- and Kidney-Yin: it nourishes also the Kidney-Essence. Neither too hot nor too drying, it tonifies without creating stagnation: it can tonify as well as astringe.



Rou Cong Rong Herba Cistanches and Ba Ji Tian Radix Morindae officinalis

This is an important combination for infertility from deficiency. These two herbs in combination enter the Governing Vessel and they are often combined with Qi and Blood tonics when there is Kidney-Yang deficiency. The characteristic of this combination is to promote transformation by the warming action of Yang but, at the same time, to nourish the Essence. These two herbs are often combined with Yin tonics to nourish the Yin and Yang aspect of the Essence and promote fertility. In such a case, Bai Zi Ren Semen Platycladi is often added to the Yin tonics to nourish Yin, tonify Blood and moisten the Intestines.



Fu Pen Zi Fructus Rubi and Zi Shi Ying Fluoritum

This combination is often used in deficiency-type infertility: it warms without drying and it tonifies Yin within Yang. It tonifies the Kidneys and the Essence.



Zi He Che Placenta hominis and Lu Jiao Cornu Cervi

This combination tonifies Spleen- and Kidney-Yang and nourishes the Essence. Both animal products, they are used according to the two principles that ‘animal products have feeling’ and ‘animal products nourish the Governing, Directing and Penetrating Vessels’. The combination is sweet, salty, warming and nourishing, it strengthens the Uterus and nourishes the Governing, Directing and Penetrating Vessels.



Ba Ji Tian Radix Morindae officinalis and Lu Jiao Cornu Cervi

This combination tonifies Spleen- and Kidney-Yang. Like the above combination, it nourishes the Governing, Directing and Penetrating Vessels; it warms and tonifies the Directing and Penetrating Vessels, nourishes the Kidneys and benefits Yang.



Xian Mao Rhizoma Curculiginis and Yin Yang Huo Herba Epimedii

This combination is pungent and hot and it tonifies the Fire of the Gate of Life. It is frequently used for infertility from pronounced Kidney-Yang deficiency with ovulatory irregularity. Obviously it should not be used in Yin deficiency as both herbs are very hot.



Dang Shen Radix Codonopsis and Huang Qi Radix Astragali

This combination tonifies and raises Qi. Apart from its use in prolapse, it is used for corpus luteum defect. These two herbs are often combined with Kidney-Yang tonics.



Fu Zi Radix Aconiti lateralis preparata and Rou Gui Cortex Cinnamomi

This combination is used for infertility from Kidney-Yang deficiency. These two herbs are hot and pungent: the former moving, the latter ‘calming’. They warm the Uterus and stoke up the Fire of the Gate of Life.



Combinations for excess conditions



Chai Hu Radix Bupleuri and Yan Hu Suo Rhizoma Corydalis

This combination is used for pelvic inflammation and fallopian tube obstruction. These two herbs in combination pacify the Liver, move Qi, eliminate stagnation and stop pain. They are specific to remove or prevent obstructions.



Pu Gong Ying Herba Taraxaci and Hong Teng Caulis Sargentodoxae

This combination can treat acute pelvic inflammation and tubal obstruction. Bitter and cold, these herbs clear Heat, resolve Toxic-Heat, dissipate nodules and dissolve swelling. They are often combined with Bai Jiang Cao Herba Patriniae to enhance their stasis-eliminating and nodule-dissipating effect.



Chuan Lian Zi Fructus Toosendan and Lu Lu Tong Fructus Liquidambaris

This combination can be used for tubal obstruction: it moves Liver-Qi and invigorates Blood.



Lu Lu Tong Fructus Liquidambaris and Di Long Pheretima

This combination can be used for tubal obstruction and hydrosalpinx (accumulation of watery fluid in the fallopian tubes). The herbs clear Heat, transform Water and remove obstructions from the Connecting channels.



Ma Bian Cao Herba Verbenae and Wang Bu Liu Xing Semen Vaccariae

This combination can also be used for hydrosalpinx: it invigorates Blood, removes obstruction from the Connecting channels and transforms Water. These herbs are often combined with Shi Jian Chuan Herba Salviae chinensis.



Xiao Hui Xiang Fructus Foeniculi and Chen Xiang Lignum Aquilariae resinatum

This combination can be used for tubal obstruction occurring against a background of Cold. The herbs move Qi, remove obstructions from the Connecting channels, warm the Kidneys and scatter Cold. Pungent and warm, they may therefore injure Yin: for this reason, they should not be used for longer than 5 days at a time.



Shi Chang Pu Rhizoma Acori tatarinowii and Dan Nan Xing Rhizoma Arisaematis preparatum

This combination can be used for infertility from Dampness and Phlegm. These two herbs resolve Phlegm, open the orifices, arouse the brain and remove Dampness and Phlegm from the Connecting channels. If there is a pronounced Cold condition, these herbs are often combined with Shi Nan Ye Folia Photiniae serrulatae.



Shi Jian Chuan Herba Salviae chinensis and Liu Ji Nu Herba Artemisiae anomalae

This combination can be used for pathological changes of the endometrium and ovarian cysts. The herbs clear Heat, transform Water, remove obstructions from the Connecting channels and dissipate nodules.



Pu Huang Pollen Typhae and Chi Shao Radix Paeoniae rubra

This combination can be used for pathological changes of the endometrium: the herbs invigorate Blood, eliminate stasis and cool Blood.



San Leng Rhizoma Sparganii and E Zhu Rhizoma Curcumae

This combination can be used for pathological changes of the endometrium. These herbs ‘break’ Blood, eliminate stasis, move Qi and stop pain. Since they ‘break’ Blood, they may injure the Original Qi and should therefore be used sparingly.



Ru Xiang Olibanum and Mo Yao Myrrha

This combination can be used for pathological changes of the endometrium. These herbs invigorate Blood, eliminate stasis, dissolve swelling and stop pain: they affect both Qi and Blood.



Xue Jie Resina Daemonoropis and San Qi Radix Notoginseng

This combination can be used for pathological changes of the endometrium. These herbs both remove obstruction and stop fluid and blood leakage; they invigorate Blood, eliminate stasis, stop pain and arrest bleeding.



Sang Ji Sheng Ramulus Sangjisheng and Si Gua Luo Retinervus Luffae fructus

This combination can be used for obstruction of the Fallopian tubes. The herbs tonify Liver and Kidneys but also remove obstructions from the Connecting channels. They are often combined with Sang Zhi.



Zhi Mu Rhizoma Anemarrhenae and Huang Bo Cortex Phellodendri

This combination can be used for pelvic inflammation from Damp-Heat occurring against a background of Kidney-Yin deficiency. The herbs clear Heat and resolve Dampness in the Lower Burner, nourish the Kidneys and clear Empty-Heat.



Empty conditions



Kidney-Yang deficiency



Clinical manifestations


Prolonged menstrual cycle, the period could be either scanty or heavy, backache, dizziness, feeling cold, depression, frequent urination. Tongue: Pale, wet. Pulse: Deep, Weak.



Treatment principle


Tonify and warm Kidney-Yang, stoke up the Fire of the Gate of Life, strengthen the Uterus.



Acupuncture


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.




Explanation


– KI-13, a point of the Penetrating Vessel, nourishes this vessel and also the Directing Vessel, tonifies the Kidneys and strengthens the Uterus.

– KI-3, BL-23 and BL-52 tonify the Kidneys, especially Kidney-Yang. BL-52 also nourishes the Essence.

– Ren-4, with direct moxa cones, strengthens the Uterus and tonifies the Kidneys.

– Du-4, with direct moxa cones, stokes up the Fire of the Gate of Life.

– LU-7 and KI-6 regulate the Directing Vessel and strengthen the Uterus and Kidneys.

– Ren-8 with moxibustion with a moxa stick after filling the navel with salt warms the Kidneys and the Essence. It is recommended by Huang Fu Mi in his ABC of Acupuncture where he says: “For infertility, moxa the centre of the navel and conception will result.”4

– Baomen and Zihu are two points located two cun from Ren-4 Guanyuan, Baomen on the right and Zihu on the left. They are sometimes described as extra points although they coincide with ST-28 Shuidao. They are empirical points with a long history of use for infertility. For example, the Thousand Golden Ducat Prescriptions says:

In women suffering from infertility, abdominal pain and red vaginal discharge, moxa Baomen with 50 cones: it is situated two cun on the left of Ren-4 Guanyuan. On the right, it is called Zihu.5


– These points can be used also for other types of infertility and especially that from Damp-Phlegm.


Special moxibustion prescription


A special moxibustion method for infertility from Kidney-Yang deficiency consists in using moxa on Ren-8 Shenque. The method is as follows: take 2.5 g of moxa wool and add 1 g each of powdered Chuan Jiao Pericarpium Zanthoxyli and Xi Xin Herba Asari, and wet the mixture with a saline solution. Make into a paste. Place this paste in the umbilicus, cover with a thin slice of fresh ginger and apply moxibustion to it with a moxa stick for 30 minutes. After that, leave the paste in the umbilicus, cover with a plaster and remove after 24 hours. Repeat the same procedure for 10 successive days.6



Herbal treatment



a. Prescription



– YU LIN ZHU Variation

– Fertility Pearl Variation


Explanation

The first 12 herbs constitute the formula Yu Lin Zhu which tonifies Kidney-Yang and promotes fertility. The unicorn is a symbol of fertility, hence the name of the formula which means ‘giving birth to the unicorn pearl’. It is from the Complete Works of Jing Yue (Jing Yue Quan Shu, 1624).


– Ren Shen, Bai Zhu and Fu Ling tonify Qi. Ren Shen also tonifies the Original Qi.

– Bai Shao, Chuan Xiong, Dang Gui and Shu Di Huang nourish and invigorate Blood (they form the formula Si Wu Tang Four Substances Decoction).

– Tu Si Zi, Du Zhong, Lu Jiao Shuang and Chuan Jiao tonify Kidney-Yang and nourish the Governing, Directing and Penetrating Vessels.

– Zi He Che nourishes Blood and the Essence.

– Dan Shen and Xiang Fu invigorate Blood and move Qi to counterbalance all the tonics in the formula.

– Zhi Gan Cao harmonizes.


b. Prescription



– BA ZHEN YI MU TANG Variation

– Leonorus Eight Precious Decoction Variation


Explanation

The first nine herbs constitute the formula Ba Zhen Yi Mu Tang which tonifies Qi and Blood and invigorates Blood. This formula is particularly indicated if, in addition to a deficiency of Kidney-Yang, there is a pronounced deficiency of Blood.


– Xiang Fu and Hong Hua are added to move Qi and invigorate Blood to counterbalance all the tonic herbs in the formula.

– Fu Pen Zi and Yin Yang Huo tonify and warm Kidney-Yang.


c. Prescription



– EMPIRICAL PRESCRIPTION by Dr Shang Xian Min7


Explanation


– Yin Yang Huo, Ba Ji Tian, Tu Si Zi and Fu Pen Zi tonify Kidney-Yang.

– Shu Di Huang, Dang Gui, Bai Shao and Chuan Xiong form the Si Wu Tang Four Substances Decoction which nourishes and invigorates Blood.

– Zi He Che, Gou Qi Zi and Wu Wei Zi nourish the Blood and Essence.

– Yi Mu Cao invigorates Blood and is added to counterbalance the tonic herbs in the formula.

This formula is particularly indicated if there is a pronounced deficiency of Kidney-Essence: with regard to infertility, this would manifest with absent or irregular ovulation.



d. Prescription



– ZHU YUN YU LIN FANG

– Aiding Pregnancy and Giving Birth to Unicorn Formula

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



Formula I (for 7 days after the period)


– Shu Di Huang and Gui Ban tonify the Kidneys, strengthen the Uterus and nourish the Directing and Penetrating Vessels.

– Yin Yang Huo tonifies and warms Kidney-Yang.

– Shi Nan Ye tonifies the Kidneys and also removes obstructions from the channels. It can therefore also eliminate any pathogenic factors from the Uterus (such as Dampness or Cold).

– Huang Jing, apart from tonifying Qi, nourishes the Kidney-Essence.

– Ding Xiang and Gui Zhi warm the channels and the Uterus. Ding Xiang has also a tonifying action on the Kidneys.

– Chuan Niu Xi nourishes the Liver and Kidneys and invigorates Blood.

– Fu Ling drains Dampness.


Formula II (for 8 days during ovulation)


– Shu Di Huang tonifies the Kidneys.

– Shi Nan Ye tonifies the Kidneys and also removes obstructions from the channels. It can therefore also eliminate any pathogenic factors from the Uterus (such as Dampness or Cold).

– Yin Yang Huo, Gou Ji, Rou Cong Rong, Xian Mao and Hu Lu Ba tonify and warm Kidney-Yang.

– Nu Zhen Zi nourishes Kidney-Yin. Notice that this herb is included in the formula for the 8 days during ovulation because, to promote fertility and stimulate the production of ova, it is necessary to nourish Yin and the Essence. The ova are a direct manifestation of the Kidney-Essence in women, just as sperm is a direct manifestation of the Kidney-Essence in men.

– Lu Jiao Shuang tonifies the Kidneys, nourishes Blood and strengthens the Directing and Penetrating Vessels.

– Zi Shi Ying warms the Uterus and is used for infertility from Empty-Cold. It also calms the Mind and subdues rebellious Qi.

– Fu Ling drains Dampness.

Table 57.2 compares and contrasts the formulae for infertility from Kidney-Yang deficiency.



Table 57.2 Comparison of formulae for infertility from Kidney-Yang deficiency

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Women’s Treasure remedy



– UNICORN PEARL

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.



Summary



Kidney-Yang deficiency


Clinical manifestations

Prolonged menstrual cycle, the period could be either scanty or heavy, backache, dizziness, feeling cold, depression, frequent urination. Tongue: Pale, wet. Pulse: Deep, Weak.



Treatment principle

Tonify and warm Kidney-Yang, stoke up the Fire of the Gate of Life, strengthen the Uterus.



Acupuncture

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


Prescriptions



• YU LIN ZHU Variation Fertility Pearl Variation

• BA ZHEN YI MU TANG Variation Leonorus Eight Precious Decoction Variation

• EMPIRICAL PRESCRIPTION by Dr Shang Xian Min

• ZHU YUN YU LIN FANG Aiding Pregnancy and Giving Birth to Unicorn Formula


Women’s Treasure remedy


• UNICORN PEARL


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.



Diagnosis

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.



Treatment principle

This patient was already receiving acupuncture and had been referred by her acupuncturist: I therefore treated her only with herbs. I used a variation of Yu Lin Zhu Fertility Pearl:


• Ren Shen Radix Ginseng 9 g

• Bai Zhu Rhizoma Atractylodis macrocephalae 6 g

• Fu Ling Poria 6 g

• Bai Shao Radix Paeoniae alba 6 g

• Chuan Xiong Rhizoma Chuanxiong 3 g

• Zhi Gan Cao Radix Glycyrrhizae preparata 3 g

• Dang Gui Radix Angelicae sinensis 9 g

• Shu Di Huang Radix Rehmannia preparata 9 g

• Tu Si Zi Semen Cuscutae 6 g

• Du Zhong Cortex Eucommiae 6 g

• Lu Jiao Jiao Colla Cornu Cervi 6 g

• Gui Ban Plastrum Testudinis 9 g

• Dan Shen Radix Salviae miltiorrhizae 4.5 g

• Qiang Huo Rhizoma seu Radix Notopterygii 3 g


Explanation


• Ren Shen, Bai Zhu and Fu Ling tonify Qi. Ren Shen also tonifies the Original Qi.

• Chuan Xiong, Bai Shao, Dang Gui and Shu Di Huang constitute the formula Si Wu Tang Four Substances Decoction which nourishes Blood.

• Tu Si Zi, Du Zhong and Lu Jiao Jiao tonify Kidney-Yang. Lu Jiao Jiao also nourishes Blood and strengthens the Governing Vessel, which should help her allergic rhinitis, as well as promoting fertility. Tu Si Zi also nourishes the Essence.

• Gui Ban nourishes the Kidneys and strengthens the Directing and Penetrating Vessels.

• Dan Shen invigorates Blood and calms the Mind. This was added because of the Heart crack on the tongue.

• Qiang Huo was added as a herb that enters the Governing Vessel and expels Wind, to treat the allergic rhinitis.

• Zhi Gan Cao harmonizes.

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’:


• Tu Si Zi to tonify Kidney-Yang and calm the fetus.

• Sang Ji Sheng and E Jiao to nourish Blood 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.



Diagnosis

Although there are few symptoms, we can diagnose a Kidney-Yang deficiency from the general cold feeling, cold feet, tiredness, the infertility itself, the miscarriage and the Weak pulse on both Kidney positions. The Kidney deficiency has given rise to some Liver-Yang rising (headaches and Red sides of the tongue) and Heart-Fire (Red tip of the tongue and Overflowing Heart pulse).



Treatment principle

The treatment principle adopted was to tonify and warm Kidney-Yang, promote fertility and clear Heart-Fire. I treated her with acupuncture and a prepared remedy first, then a decoction.



Acupuncture

The acupuncture was very simple and the points selected were:


• ST-36 Zusanli and SP-6 Sanyinjiao with warm needle, to tonify Qi and Yang in general.

• KI-3 Taixi and BL-23 Shenshu, with warm needle to tonify Kidney-Yang.

• P-7 Daling to clear Heart-Fire and calm the Mind.


Herbal treatment

I first gave her the herbal remedy You Gui Wan Restoring the Right [Kidney] Pill which tonifies Kidney-Yang. I later prescribed a decoction for her using a variation of the formula from Dr Shang Xian Min:


• Yin Yang Huo Herba Epimedii 6 g

• Ba Ji Tian Radix Morindae officinalis 6 g

• Tu Si Zi Semen Cuscutae 6 g

• Shu Di Huang Radix Rehmannia preparata 6 g

• Dang Gui Radix Angelicae sinensis 6 g

• Chuan Xiong Rhizoma Chuanxiong 4.5 g

• Bai Shao Radix Paeoniae alba 6 g

• Yi Mu Cao Herba Leonuri 4.5 g

• Gou Qi Zi Fructus Lycii 6 g

• Wu Wei Zi Fructus Schisandrae 3 g

• Huang Qin Radix Scutellariae 4.5 g

• Yuan Zhi Radix Polygalae 6 g

• Mu Dan Pi Cortex Moutan 6 g


Explanation

The first 10 herbs constitute the original formula by Dr Shang Xian Min, minus Zi He Che Placenta hominis and Fu Pen Zi Fructus Rubi.


• Huang Qin and Yuan Zhi were added to clear Heart-Fire and calm the Mind.

• Mu Dan Pi was added to clear Liver-Heat.

I treated her for 4 months with this formula, at the end of which she became pregnant. Since she had had a miscarriage, I treated her during the first 3 months with the following herbs which prevent miscarriage:


• Huang Qin Radix Scutellariae 4.5 g

• Du Zhong Cortex Eucommiae 6 g

• Zi Su Ye Folium Perillae 4.5 g

• Sha Ren Fructus Amomi 3 g

I chose Huang Qin among the fetus-calming herbs because of her pre-existing Heart-Fire and Du Zhong because of the Kidney-Yang deficiency. The other two herbs also calm the fetus to prevent miscarriages. After 9 months, she gave birth to a healthy baby.



Kidney-Yin deficiency



Clinical manifestations


Long-term infertility, periods early, scanty, with light-coloured blood, five-palm heat, night sweating, dizziness, tinnitus. Tongue: without coating; also Red if there is Empty-Heat. Pulse: Floating-Empty or Rapid-Fine (in case of Empty-Heat).



Treatment principle


Nourish Kidney-Yin and Kidney-Essence.



Acupuncture


Ren-4 Guanyuan, Ren-7 Yinjiao, KI-3 Taixi, KI-13 Qixue, SP-6 Sanyinjiao, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), BL-52 Zhishi. All with reinforcing method; generally speaking, no moxa should be used. However, if the tongue is not Red or only slightly Red and the pulse is very Fine, a small amount of moxa (as a warm needle) on KI-3 is beneficial to increase the tonifying effect.




Explanation


– Ren-4 tonifies the Kidneys, nourishes Yin, strengthens the Uterus and the Directing and Penetrating Vessels.

– Ren-7 nourishes Yin.

– KI-3 and SP-6 nourish Kidney-Yin.

– KI-13, a Penetrating Vessel point, tonifies the Kidneys, strengthens the Uterus and nourishes the Penetrating Vessel.

– LU-7 and KI-6 regulate the Directing Vessel and nourish the Kidneys.

– BL-52 nourishes the Kidney-Essence.


Herbal treatment



a Prescription



– YANG JING ZHONG YU TANG Variation

– Nourishing the Essence and Growing Jade Decoction Variation


Explanation

The first four herbs constitute the formula Yang Jing Zhong Yu Tang which tonifies the Kidneys, nourishes the Essence and Blood and promotes fertility. ‘Jade’ has the double meaning of ‘child’, hence the name of the formula.


– Nu Zhen Zi and Han Lian Cao constitute the formula Er Zhi Wan Two Solstices Pill which nourishes Kidney-Yin and clears Empty-Heat.


b Prescription



– EMPIRICAL PRESCRIPTION by Dr Shan Dao Wei


Explanation


– Sheng Di Huang, Bai Shao, Xuan Shen and Mai Men Dong nourish Yin. Xuan Shen also clears Empty-Heat and cools Blood.

– Di Gu Pi and Qing Hao clear Empty-Heat.

– Gou Qi Zi nourishes Blood, Yin and Essence.

– Dan Shen invigorates Blood and calms the Mind.

– Yi Mu Cao invigorates Blood.

Compared with the previous formula, the present one is better at clearing the Empty-Heat that arises from Yin deficiency: it is therefore suitable when the tongue is particularly Red.



c. Prescription



– EMPIRICAL PRESCRIPTION by Dr Zhu Nan Sun9


Explanation


– Dang Gui, Bai Shao and Bai Zi Ren nourish Blood.

– Dan Shen and Chuan Xiong invigorate Blood and eliminate stasis.

– Sheng Di Huang, Shu Di Huang, Xuan Shen, Bei Sha Shen, Mai Men Dong and Shan Zhu Yu tonify Liver and Kidneys and nourish Yin.

– Zi He Che nourishes Blood and the Essence.

– Shan Yao tonifies the Spleen and Kidneys.

– Rou Cong Rong and Ba Ji Tian tonify Kidney-Yang.

Dr Zhu Nan Sun places the emphasis very much on Kidney-Yang for the treatment of infertility and he therefore uses Kidney-Yang tonics even in Yin-nourishing formulae. The formula reflects this approach with the inclusion of Rou Cong Rong and Ba Ji Tian. Compared with the previous two formulae, the present one is better when there is a combined deficiency of Kidney-Yin and Kidney-Yang, albeit with a predominance of Kidney-Yin deficiency.



Women’s Treasure remedy



– GROWING JADE

This remedy nourishes Kidney-Yin, Kidney-Essence and Blood and strengthens the Directing and Penetrating Vessels. The tongue presentation appropriate to this remedy is a Red body without coating.



Summary



Kidney-Yin deficiency


Clinical manifestations

Long-term infertility, periods early, scanty, with light-coloured blood, five-palm heat, night sweating, dizziness, tinnitus. Tongue: without coating; also Red if there is Empty-Heat. Pulse: Floating-Empty or Rapid-Fine (in case of Empty-Heat).



Treatment principle

Nourish Kidney-Yin and Kidney-Essence.



Acupuncture

Ren-4 Guanyuan, Ren-7 Yinjiao, KI-3 Taixi, KI-13 Qixue, SP-6 Sanyinjiao, LU-7 Lieque (on the right) and KI-6 Zhaohai (on the left), BL-52 Zhishi. All with reinforcing method; generally speaking, no moxa should be used. However, if the tongue is not Red or only slightly Red and the pulse is very Fine, a small amount of moxa (as a warm needle) on KI-3 is beneficial to increase the tonifying effect.



Herbal treatment


Prescriptions



• YANG JING ZHONG YU TANG Variation Nourishing the Essence and Growing Jade Decoction Variation

• EMPIRICAL PRESCRIPTION by Dr Shan Dao Wei

• EMPIRICAL PRESCRIPTION by Dr Zhu Nan Sun


Women’s Treasure remedy


• GROWING JADE


Blood deficiency



Clinical manifestations


Scanty periods, pale blood, delayed cycle, tiredness, depression, dizziness, pale complexion, blurred vision. Tongue: Pale and Thin. Pulse: Choppy or Fine.



Treatment principle


Nourish Blood and the Essence, strengthen the Liver and Kidneys.



Acupuncture


Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, KI-13 Qixue, BL-20 Pishu, BL-23 Shenshu, BL-17 Geshu, abdomen Zi Gong (three cun lateral to Ren-3). All with reinforcing method; moxa is applicable.




Explanation


– Ren-4 nourishes Blood and strengthens the Uterus.

– ST-36 and SP-6 nourish Blood.

– KI-13, a point of the Penetrating Vessel, tonifies the Kidneys and strengthens the Uterus.

– BL-20 and BL-23 tonify the Spleen and Kidneys to nourish Blood.

– BL-17, with direct moxa cones, nourishes Blood.

– Zi Gong nourishes the Essence, strengthens the Uterus and promotes fertility.


Herbal treatment



Prescription



– BA ZHEN TANG

– Eight Precious Decoction


Explanation

This formula, which has already been explained, nourishes Blood.



Women’s Treasure remedies



– PRECIOUS SEA

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.



Summary



Blood deficiency


Clinical manifestations

Scanty periods, pale blood, delayed cycle, tiredness, depression, dizziness, pale complexion, blurred vision. Tongue: Pale and Thin. Pulse: Choppy or Fine.



Treatment principle

Nourish Blood and the Essence, strengthen the Liver and Kidneys.



Acupuncture

Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, KI-13 Qixue, BL-20 Pishu, BL-23 Shenshu, BL-17 Geshu, abdomen Zi Gong (three cun lateral to Ren-3). All with reinforcing method; moxa is applicable.



Herbal treatment


Prescription



• BA ZHEN TANG Eight Precious Decoction


Women’s Treasure remedy


• PRECIOUS SEA


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.



Diagnosis

This is a very clear case of Blood deficiency as evidenced by the Choppy pulse, Pale tongue, scanty period and infertility itself. The tongue is Short because the Blood deficiency deprives it of fluids: this makes it less supple and therefore it does not protrude as far as usual. The shortness of the tongue indicates that the Blood deficiency is severe. The fact that the periods did not come for 6 months after her second miscarriage also indicates Blood deficiency.



Treatment principle

I treated this patient only with herbs and used my own prescription as follows:


– Shu Di Huang Radix Rehmannia preparata 9 g

– Bai Shao Radix Paeoniae alba 6 g

– Dang Gui Radix Angelicae sinensis 6 g

– Shan Zhu Yu Fructus Corni 6 g

– Gou Qi Zi Fructus Lycii 6 g

– Shou Wu Radix Polygoni multiflori preparata 6 g

– Tu Si Zi Semen Cuscutae 6 g

– Huang Jing Rhizoma Polygonati 6 g

– Nu Zhen Zi Fructus Ligustri lucidi 6 g

– Sang Ji Sheng Herba Taxilli 6 g

– Ji Xue Teng Caulis Spatholobi 6 g

– Zhi Gan Cao Radix Glycyrrhizae preparata 3 g


Explanation


• Shu Di Huang, Bai Shao, Dang Gui, Gou Qi Zi, Shou Wu and Sang Ji Sheng nourish Blood. Shu Di Huang, Gou Qi Zi and Shou Wu also nourish the Essence.

• Huang Jing tonifies Qi and Blood and nourishes the Essence.

• Shan Zhu Yu nourishes the Liver and Kidneys and the Essence.

• Tu Si Zi nourishes the Essence and promotes ovulation.

• Nu Zhen Zi nourishes Liver- and Kidney-Yin and promotes ovulation.

I added a Yin tonic (apart from Gou Qi Zi which is also a Yin tonic) for two reasons: first of all, ‘promoting ovulation’ implies nourishing the Essence and especially its Yin aspect; second, the shortness of her tongue shows that the deficiency of Blood is very severe and is bordering on Yin deficiency.


• Ji Xue Teng nourishes and invigorates Blood.

• Zhi Gan Cao harmonizes.

I treated her with variations of this formula for nearly a year, after which she became pregnant and later gave birth to a healthy baby.



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.



Diagnosis

This is a clear case of Qi and Blood deficiency even though she has few symptoms. Qi deficiency causes her periods to be heavy, the tongue Swollen and the pulse Empty. The Blood deficiency is evidenced by the Pale tongue, dizziness and blurred vision. I interpreted the Rapid pulse as being due to shock: this was apparent also from the look of her eyes which were dull and rather unstable.



Treatment principle

I treated this patient with acupuncture and herbs. The acupuncture was very simple and the points used were selected from the following:


• ST-36 Zusanli and SP-6 Sanyinjiao to tonify Qi and nourish Blood.

• HE-7 Shenmen to calm the Mind after the shock.

• Ren-4 Guanyuan to nourish Blood.

I used a variation of the formula Ba Zhen Tang Eight Precious Decoction:


• Dang Gui Radix Angelicae sinensis 9 g

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