Effect of Acupuncture and Chinese Herbal Medicine on Female Infertility by Strengthening Natural Menstrual Cycle

The disorders of reproductive and endocrinal function are the common cause of female infertility which can be included from either organic or dysfunctional conditions. In last decade years of my practice, I found more and more ladies with infertility have been had their babies supported by acupuncture and Chinese medicine, through improved their functional disorders, or cured their organic diseases. I recognize: it is a right treating method to use acupuncture and Chinese herbal medicine under guiding of integrated theories from traditional and modern medicines for treating the symptoms and signs which are caused by reproductive and endocrine disorders. If we can make the best function in relevant reproductive organs from the lady in each period time following with menstrual circle, we will support her to be conceived [2].

The female’s physiological function is explained by conventional western medicine

A female should build up a normal menstrual circle, when her sexual hormone and reproductive function have been matured around ten to twelve years old. Under effects of relevant hormones, such as Luteotropic Hormone (LH), Follicle-Stimulating Hormone (FSH), Gonadotropic hormone, which is produced by Pituitary, Hypothalamus, a follicle grows up from her ovary in every month which moves to uterus through a fallopian tube after it matured. If it fertilizes with a vital sperm to make a fertilized egg and plant to endometria of uterus for going to a normal pregnant procedure; if it hasn’t met a vital sperm, it will flow out with some pieces of endometrial tissue for being a menstruation. Following above routine, I classify the menstrual circle to four stages which different functions will be done in each week:
A. In the first week: follicle growth.
B. In the secondary week: follicle is matured at the end of this week and detached out of ovary (ovulation)
C. In the third week: progesterone growth.
D. In the fourth week: preparation of menstruation and menstruation, or protection of foetus. So, I try to manage TCM treatments to follow above routine

Social reasons which cause females with infertility in the West

There are increased incidences to infertilities which are caused by various reproductive and endocrine disorders in the West. The common reasons will be indicated as below:
a) A long-term of stress depresses the pituitary, hypothalamus and ovarian function to cause ovaries maldevelopment, or early failure, such as some girls who suffer from amenorrhea, when she undergoes reading her PHD, or high degree courses, or severe mental disorder.
b) Over-physical works or training when girls were in the puberty cause maldevelopment ovaries or uterus to induce menoxenia, such as some athletes and dancers.
c) Excessive taking contraceptive pills cause imbalance of Oestrogen & Progesterone which their activities have been decreased. Some ladies in the west countries take contraceptive therapies over 10 years, special some young girls who take contraceptive pills in a wrong way, such as continual taking it without a necessary menstruation.
d) Marriage or trying pregnancies in high ages (over than 35 years old).
e) Taking some drugs, or any toxicity.

Reasons above are available to disturb menstrual circle to produce amenorrhea, dysmenorrhoea or menoxenia which are common pathological procedures to cause infertilities. Unexplantional infertility engages near 50% of the total which may be in a gentle stage of some diseases or pre-clinical condition; or just functional disorder without organic diseases which cannot be reached the diagnostic standard by conventional western medicine. Our treatments target to balance of hormone, or to promote ovulation, or to strengthen the organic functions in the particular period following with menstrual circle, so we can not only reregulate each organic function, but also to rebalance the whole body [3,4].

Foundational theory of TCM

Since reading deeply on many academic discussions on various schools of TCM from traditional classical books and taking some theories from modern western physiology and pathology, I find that it is the best way to make a clear and accurate treating direction and method of TCM under guiding of an integrated medical theory. I will manage a TCM treating principle according to the different stage of menstrual circle as below: The kidney deficiency is the main pattern for the ladies with infertility, so tonifying kidney is the key point to strengthen menstrual circle. In general, I clarify the patients into two categories, according to patients’ symptoms and pathological characteristics: the kidney Yin deficiency and kidney Yang deficiencies [5]

In the first weekTo strengthen of kidney and spleen, which are pre-heaven and post-heaven organs to promote follicle growth. TCM recognizes that the kidney is an initial source to produce the original and re-productional Qi; the spleen is an important organ to continuously supply Qi & blood for them. So, I pay more attention to strengthen kidney and spleen in the first stage of menstrual circle.

In the secondary week:To nourish Yin, to culture Kidney essence; and to move stagnated Qi & stasis of blood; to nourish kidney Yin to produce essence for strengthening follicles matured; to release stasis blood for detaching the matured egg out of ovary.

In the third week:To warm Yang and nourish Yin to promote progesterone growth: “If you plan to strengthen Yang, you must nourish Yin to treat Yang.” Above quotation from the ancient classic in which explains the treating principle is a key technique on kidney’s tonification of TCM. It means you should use herbs to warm kidney Yang after to nourish kidney Yin or use both of above herbs together. Strengthening Yang in the kidney meridian warms Qi & blood to remove their stagnations of Qi and stasis of blood in ovaries and uterus, which agitates progesterone [6].

In the fourth week:To remove liver Qi and blood to regulate menstruation; or strengthen spleen and kidney to protect foetus.
A. When the lady stays in last week of her menstruation, she easily manifests liver Qi stagnation which makes blood stasis as well to cause dysmenorrhoea. So, it is a necessary treating principle to move stagnated Qi and stasis of blood to release or prevent dysmenorrhoea.
B. If fertilization is successfully done, the lady has been pregnancy. But if she still possesses a deficiency of Qi and blood, she will easily appear a miscarriage; so, the lady who has a miscarriage history or has some symptoms and signs to appear Qi and Blood deficiencies should be kept tonification to prevent the miscarriage until her health pregnancy being confirmed.

Due to TCM’s treatment is used to make the balance well in the body, so we can be easy to manage our treatments weekly who tailor acupuncture points and herbal medicines according to menstrual circle; we need not accurately match up the menstrual circle day by day like western medicine.

Foundational theory and technique of acupuncture

Acupuncture possesses a necessary and no-omission efficacy to infertility and is also a therapy which is accepted more by British population. So, Acupuncture is an important treatment which is firstly selected to the patients with infertility [7].

Acupuncture’s effect

To stimulate and to strengthen the self-regulating functions:Such as some ladies with un-explanation infertility which may be caused by taking contraceptive pill for a long period of time. Due to excessive artificial Oestrogen being taken, the vitality of progesterone in their body has been depressed, or the proportion of vitalities of above hormones is disorder. So, they appear infertility but can’t be found any tests with positive result. Un-explanation infertility has been diagnosed. Acupuncture is good at stimulating the self-regulating function inside of body to balance the hormonal disorder.

To promote ovulation:It has been proved by some research.

To strengthen self-healing function:Such as the lady with endometriosis who may have some damages occurring on her endometria of her uterus from excessive endometrial tissues fell out. Her endometria of uterus are unsmooth with many scar tissues, so it is hard to have the fertilized egg planting in. Acupuncture, special with Moxibustion will strengthen the self-healing function of endometria, so can progress bio-circulation in the lining of uterus and makes it become softer.

a) Acu-points: b) Main points: Moxi at Shenque (Ren8)

c) Needles:Qihai (Ren6), Guanyuan (Ren4)/Zhongji (Ren3), Guilai (St29)/Shuifen (St28)/ Zigong (Ext), Lieque (Lu7), Zhaohai (Ki6)

Associated points are elected according to differentiation of patterns.

A. Priority of kidney Yin deficiency:(Liver Qi stagnation and Kidney Yin deficiency)

Waiguan (Sj5), Zulinqi(Gb41), Yingu(Ki10), Taixi (Ki3), Rangu (Ki2), Taichong(Liv3);

B. Priority of kidney Yang deficiency:(Spleen Qi and Kidney Yang deficiency)

Zusanli (St36), Tianshu (St25), Yinlingquan (Sp9), Sanyinjiao(Sp6) , Taixi (Ki3), Zhaohai (Ki6)

Foundational theory and prescription of herbal medicines

Chinese herbal medicine is used to support acupuncture. Integrated both of above therapies will make the treating level arrive to the purpose which is expected to the individual person. So Chinese herbal medicine is also an important method. Some ladies have been accepting a regular acupuncture only for over a year. She feels better by herself, but she cannot be conceived, due to an insufficiency treating level which she has got, although she has been done in a right way.

Many forms of Chinese herbal medicines can be selected:

a) Patent herbs:Although we cannot use the patent herbs now, but we can prescribe with a reference from this experienced formula.

b) Concentrated herbal powder and natural dry herbs:Powder and dry herbal forms are able to be prescribed which are suitable to individual case, and is correspondent with different stage of menstrual circle, so they will possess more accurate effects.

Dry herbal form possesses the stronger of treating power than powder, so it is suitable to the organic disease, and severe, complex cases [8].

According to differentiations of syndromes by TCM, herbs will be selected as a sample as below, following different menstrual stages (Table 1).

Table 1:According to differentiations of syndromes by TCM, herbs will be selected as a sample as below, following different menstrual stages.

A. The first day should start since the first day of menstruation.
B. You can prescribe by yourself or follow with the patents’ prescription as a sample.

a) Un-explanation infertility: The Lady cannot be conceived, but who is no clear disease diagnosed by conventional western medicine, even no symptoms are manifested.
b) The early failure of ovary.
c) Polycystic Ovary, or PCOS, and Amenorrhea, or longer menstrual circle which is caused by an ovary’s problem.
d) Ladies expect to quickly be conceived, such as ages, or other personal reason.
e) Ladies plan to do IVF, or any ART treatments, who may fail an or many times of ART in the past, they should be done this treatment for promoting hormonal recovery and general balance of the whole body as a good preparation to accept the next step of ART [9].

Natural pregnancy supported by acupuncture and herbal medicine

Case 1: Un-explanation infertility:Ms C A, 27 years old, who is a physiotherapist. No pregnancy for five years after her marriage. Gynaecological consultant has done all of examinations which are negative results. So, un-explanation infertility has been diagnosed and TCM is referred.

a) Present symptoms:Stress, restlessness, weepy, nervous, worse in the time before her period, minor dysmenorrhoea, and constipation. She has a regular menstrual circle which is 12, 4-5/26-28 with a minor menstrual pain. She had 8 years of history to take contraceptive pills before she tries to be pregnancy. Light red tongue with thin white coating and deep-wiry pulse. Her husband is fit with a normal sperm examination.

b) The pattern of TCM differentiation:Is liver and kidney Yin deficiency, Qi stagnated in the uterus.

c) Treating principle of TCM:to remove the stagnation of Liver Qi and to nourish Liver and Kidney Yin.

d) Treatment:

I. Acup:Moxi at Ren8 (Shenque);

II. Needles:Du20 (Baihui), Ren6 (Qihai), Ext22 (Zigong), Sp9 (Yinlingquan), Sp6 (Sanyinjiao), St36 (Zusanli), Ki3 (Taixi), Ki6 (Zhaohai).

III. Patent herbal medicine:Zhibaidihuang Wan/Xiaoyao Wan are taken from the first of period day to the ovulation.

Renshenguipi Wan/Chaihushugan Wan are taken from the ovulation to before period

e) Explanationdue to some stress as a main symptom, so the removing the stagnated liver Qi is the key treating principle: Xiaoyao Wan which the herbs of removing stagnated liver Qi and strengthen spleen together is used at the first two weeks with Zhibaidihuang Wan which nourish kidney Yin; and Chaihushugan wan which focus removing stagnated liver Qi is used with Renshenguipi which focus strengthening spleen Qi in the secondary two weeks. Following five months of menstrual circle supported by acupuncture and patent herbal medicine. She is naturally conceived and labours a health boy in a full term.

f) Analysis:This is an un-explanation infertility which means no organic disease can be diagnosed by the conventional medicine. She is staying in a pre-clinical condition that belongs to a functional disorder. From the clinic, she manifests only a minor stress and premenstrual tension without many symptoms. This is the best suitable case that should be given the promoting pregnancy technical of TCM. So, she gains a sati factory result after a regular acupuncture with some patent herbal medicine to strengthen her function following her menstrual circle [10].

Case 2: Infertility caused by the early failure of ovaries: Mrs. J W, 32 years old, who is a medical researcher with PHD degree, has irregular menstruation for all of her life. She has to take oestrogen pills to make her regular period. After her marriage plans pregnancy, she has not had her period for more than two years after she stops her oestrogen pill. Her oestrogen level: <50, this is menopause level. So, she is diagnosed as an early failure of ovaries by Gynaecologist. Present symptoms: depression, insomnia, nervous, restlessness etc. pale complexion, light tongue with thin white coating and weak pulse. Due to being a medical researcher, she initially has not enough confident to TCM. After trying acupuncture weekly at first, then patent herbs being added for three months, she finds that her oestrogen level increases to 65. So, she expects to try the best way in TCM. I change her from patent herbal form to the dry herbal prescription and keep her regular acupuncture weekly [11]

a) The pattern of TCM differentiationis Kidney Yang deficiency with Qi stagnation and blood stasis.

b) Treating principle:To strengthen Qi and to warm Yang, to remove Qi stagnation and blood stasis.

c) Treatment:

I. Acup :Moxi at Ren8 (Shenque),

II. Needles :Du20(Baihui), Du24 (Shenting), Ren4 (Guanyuan), Ren6 (Qihai), St29 (Guilai), Sp9 (Yinlingquan), Sp6 (Sanyinjiao), Ki 10 (Yingu), Ki3 (Taixi), Ki2(Rangu), Sj5 (Waiguan), Gb41 (Zulinqi)

III. Herbal medicine prescription :Aiye10, Xianmao10, Yinyanghuo 15-30, Heshouwu10, Danggui10, Chishao10, Tusizi 10, Zishiying 10, Chuanxiong 10, Xiangfu10.

Taoren10, Honghua10 are added around of ovulation, Chaihu10, Wuyao10 are added before period. A minor variation is made in each week according to her general condition.

d) Explanation:Aiye, Erxian Tang (Xianmao and Yinyanghuo) and Tusizi warm and strengthen kidney Yang, Dangui and Heshouwu nourish kidney yin; Chishao and Chuanxiong remove the blood stasis; Zishiying promote the ovulation; Xiangfu pushes the stagnated liver Qi moving through. Taoren and Honghua are added in the secondary week to emphasize the blood circulation to promote egg’s ejaculation but stop to use after the third week; Chaihu and Wuyao are added in last week to emphasize removing and warm liver Qi. Her oestrogen level has increased to 165 after three months and she has her period every other month since. Until being pregnant, she has been accepted TCM for eleven months. A health baby boy has been laboured on term and given eight months of breast-feeding. She starts her regular period, and then she has another pregnancy in a natural way after 18 months of her labour.

e) Analysis:this is the case with the early ovaries failure that belongs to an organic disease, so the treatment with only acupuncture at initial, although with patent herbal medicine after are too weak to target her problem. But due to some efficacy from acupuncture and patent herbal medicine are gained, the patient starts to have some confident to accept TCM treatment, so she is given a regular acupuncture and prescribed the herbal decoction form following her menstrual circle which is needed to give a stronger enough treatment until her menstrual circle recovery and got a successful natural pregnancy. After a normal pregnancy when she has been preceded a hormonal rebalance, she has been cured from her early failure of ovaries. So, she has a natural pregnancy again without any support treatment after she breasts feeding and gives a natural birth in her secondary labour.

Case 3: Infertility caused by polycystic ovary:Ms H W, 32 years old, who is a medical researcher, has an irregular menstruation for five to six years. Amenorrhea occurs in sometimes which her menstrual circles always lasts 2-3 months. Polycystic ovary has been diagnosed from an ultrasound examination. She also suffers from a bad back pain. Pale tongue with less white coating, deep weak pulse [12].

a) The pattern of TCM differentiationBoth deficiency of Spleen and Kidney Qi and Yang, blood stasis engaged in the uterus.

b) Treating principle:to strengthen spleen and kidney Qi / Yang; to warm uterus, and to remove the blood stasis in there.

c) Treatment:

i. Acup:Moxi at Ren8 (Shenque),

ii. Needles:Du20 (Baihui), Gb20 (Fengchi), Bl18 (Ganshu), Bl20 (Pishu), Bl23 (Shenshu), Du4 (Mingmen), Bl31-34 (2 pairs of Baliao in each time), Ki3 (Zhaohai), Ki2 (Yingu), Sj5 (Waiguan), Gb41 (Zulinqi).

iii. Patent herbal medicine:Wujibaifeng Wan / Xiaoyao Wan are taken in the first two menstrual weeks.

Jinguishenqi Wan / Chaihushugan Wan are taken in the secondary two menstrual weeks.

d) Explanation:Due to a back pain associated, so she is given acupuncture points at the back: Bi18 and Bi 20 nourish liver and spleen Yin and strengthen spleen Qi; Bi23 and Du4 reinforce kidney Qi and Yang; Bi31-34 are changeable used to strengthen kidney and back; Ki2 and 3 strengthen kidney and remove the dampness in low burner; Sj5 and Gb41 remove the stagnated Qi in general. Xiaoyao Wan and Chaihushugan Wan remove the stagnated Qi from liver and general which is good at treating stagnated Qi and relax spasm muscle; Wujibaifeng Wan is used in the first twoweek support kidney Yang to feed the follicle growing up in the ovary; Jinguishenqi Wan is used in the last two weeks to support conceiving occurrence. She has been given regular acupuncture and patent herbs until her period regularly. Then she is conceived and laboured a healthy baby boy. After two years she has another pregnancy from some TCM supports.

e) Analysis:This is a case with gentle stage of polycystic ovary syndrome, so she is giving a regular acupuncture and patent herbal treatment to regulate her menstrual circle until her regular period comes which means her function of ovaries have been strengthened, so she is successfully conceived and get one again.

Case 4: Infertility caused by endometriosis, with IVF failed:Mrs. C W, 29 years old, who is a clerk, suffers from an endometriosis which causes a dysmenorrhoea. After double failed to IVF, she seeks the help from TCM. She complains stress, depression, insomnia, all of symptoms getting worse before her period. She has a dropping blood with period pain in the first period day, then getting a heavy blood and severe pain since the secondary menstrual day. She has to take some painkillers to bear in a regular work and daily life during her period. Light red tongue with red at the tip and thin white coating, wiry and tendon pulse.

a) The patterns of TCM differentiation:Liver Qi stagnation and blood stasis in the uterus.

b) Treating principle:To remove the stagnation of liver Qi and to expel the blood stasis at the first stage; then the nourish kidney Yin is added until her pregnancy occurrence.

c) Treatment:

i. Acup:Moxi at Ren8 (Sheque)

ii. NeedlesDu20 (Baihui), Ren4 (Guanyuan), Ren6 (Qihai), St28 (Shuidao), Sj5 (Waiguan), Gb41 (Zulinqi), Sp9 (Yinlingquan), Sp6 (Sanyinjiao), Gb34(Yanglingquan), Ki3 (Taixi), Ki2 (Rangu)

iii. Patent herbal medicine:Xiaoyao Wan/Taohongsiwu Wan in the first two week; Chaihushugan Wan/ Bazhenyimu Wan in the secondary two week

Yueyue Shu Sachet (Relaxation every period, in which Honghua and Danshen remove the stasis blood; Rougui warms kidney and original Qi; Dangui nourishes blood; Sanleng, Ezhu and Wulingzhi are stronger herbs to release menstrual pain; Yanhusuo releases the abdominal spasm; Muxiang pushes the stagnated Qi through in the low burner.) is taken during the period; Tiaojingcuyun Wan (Reregulating menstrual circle and promoting pregnancy Pills in which Xianmao, Yinyanghuo and Xuduan warm and strengthen kidney Yang; Tusizi, Fupenzi and Guoqizi reinforce kidney Essence and promote ovulation; Huangqi and Shanyao reinforce spleen Qi; Baishao, Danshen, Chishao and Jixueteng remove stasis blood; Fuling and Gouteng calm down and relax the mind etc) is used after menstrual pain is less.

d) Explanation:Endometriosis is appeared a Qi stagnation and blood stasis, so acupuncture points and herbs are used to mainly remove stagnated Qi and blood stasis; Sp6, 9 nourish spleen Yin which are good at treating constipation accompany with Endometriosis; Ki2,3 nourish kidney Yin and remove dampness; when better of her menstrual pain, ki6, 7 are added to strengthen reinforcing kidney Yang. Xiaoyao Wan and Chaihushugan Wan also remove liver Qi, plus Yue Yueshu emphasizes removes blood stasis and releasing the menstrual pain; Taohongsiwu is stronger to remove blood stasis, Bazhenyimu is gentler removing blood, but reinforcing Qi and blood are involved in it. After her pain eases, Yueyueshu can be replaced by Tiaojingcuyun Wan to make a pregnancy support. A regular acupuncture and patent herbal medicines have been given to make her completely recovery from IVF and release the dysmenorrhoea. Then she is successfully conceived to labour a baby girl in a nature way.

e) Analysis:This is a case with endometriosis which manifests her symptoms in the clinic, such as unsmooth bleeding with dysmenorrhoea have proved her diagnosis. Due to endometriosis, there are many endometrial tissues retrograde to move out of uterus by fallopian tubes which plant in the pelvic. These tissues can stimulate the peritoneum to cause the menstrual pain around and during the period; and some wounds and scar tissues are produced on the lining of endometrium due to some pieces on it moving out which induces the constriction of uterus to cause menstrual pain. Meanwhile, the wounds and scar tissues on the endometrium can disturb the fertilized egg to plant in to cause infertility. If this condition of uterus is not corrected, she is hard to be conceived although IVF is done. Over a regular acupuncture treatment, she is given patent herbal medicine to focus moving the blood stasis and increase the bio-circulation on her endometrium and pelvic to release her menstrual pain following with her menstrual circle and then a nourishing kidney is added until her successful natural pregnancy.

Case 5: Habitual miscarriages are caused by excessive prolactin:Mrs C F, 35 years old, who is a secretary, has had three times miscarriages during last three years. She is found high prolactin. Gynaecological consultant believes that excessive prolactin may be related with stress. She is not fit to accept hormonal treatment, so she is referred to try alternative and complementary treatment.

a) Present symptoms:She comes to see me just after last her miscarriage 2-3 days ago; she is stressful, depression, weepy, insomnia and abdominal pain. From another inner ultrasound examination, multiple cysts are found on both of her ovaries which are removed from a laparoscope. She manifests a red tongue with thin white coating and wiry-fine pulse.

b) The pattern of TCM differentiation:Liver Qi stagnation, Spleen Qi deficiency with blood stasis.

c) Treating principle:to move the stagnation of Liver Qi, to nourish and to move blood.

d) Treatment:

i. Acup:Moxi at Ren8 (Shenque)

ii. NeedlesDu20 (Baihui), Du24 (Sheting), Ren4 (Guanyuan), Ren6 (Qihai), Ext22 (Zigong), Gb34 (Yanglingquan), Sp10 (Xuehai), Sp9 (Yinlingquan), Sp6 (Sanyinjiao), Sj5 (Neiguan), Li4 (Hegu), Ki3 (Taixi), Liv3 (Taichong).

iii. Patent herbal medicine:Jiaweixiaoyao Wan / Renshenguipi Wan

e) After her emotion calms down, she is given a treatment with the herbal menstrual circle support technique. Jiaweixiaoyao Wan/Zhibaidihuang Wan in the first two weeks; Jiaweixiaoyao Wan/ Liuweidihuang Wan in the secondary two weeks; A Sachet of Tiaojingcuyun Wan is added in every night.

f) Explanation:Due to last miscarriage, she is still manifesting stress, weepy and abdominal pain which belong to liver Qi stagnation and blood stasis; many times of miscarriages are occurred, tiredness, fatigue’s appearing, so spleen Qi deficiency is diagnosed. Acupuncture and patent herbs are given following this principle until her healed from miscarriage and calmed down in her mind, a menstrual supporting treatment of kidney Yin deficiency is given until her pregnancy again. She is conceived in a half year and continues to accept treatment of foetus protection. She has a baby girl when she arrives in a full term.

g) Analysis:this case is higher Prolactin which may be the reason to cause her multiple miscarriages; and many times of failed pregnancy may increase her stress which is also disturbing the Prolactin. (Gynaecologist also finds higher Prolactin relates with emotional disorder). TCM believes multiple miscarriages cause Liver Qi stagnation and spleen Qi deficiency; if the deficient Qi has not been building up which should cause increased Qi stagnation, so this lady is keeping crying and emotional swing. The group of Xiaoyao wan (Happy pill’s group: Chaihushugan Wan, Xiaoyao wan, Jiaweixiaoyao Wan and so on) has been a matured treatment to reduce the Prolactin. This lady is given a menstrual circle supporting treatment after under of control to her emotional disorder; she has gained a natural pregnancy. Due to her still suffering from minor signs of miscarriage, such as slight abdominal pain and pink vaginal discharge which make her nervous, and panic to occur miscarriage again during the early stage of her pregnancy, so a dry herbal prescription with tonifying kidney, reinforcing spleen and foetus protection has been given to her until the 12th pregnancy week. She has finally got her health baby girl.

Successful IVF, supported by TCM

Case 1: After three times of failed IVF, a successful pregnancy with a triplet has been supported by TCM:Mrs. T F, 27 years old, who is a trainer, has been no-result when she tries pregnancy for more than five years. She is diagnosed a blockage on left fallopian tube and cysts on left ovary. Her husband is found some antibodies in his sperm which can’t be fertilized with his wife’s egg. A laparoscope has been done to take cysts away, but both of fallopian tubes have been blockages, she is told. Both of them accept TCM treatments. The wife accepts regular acupuncture and concentrated herbal powders for making a regular menstrual circle.

a) The pattern of TCM differentiation:Liver Qi stagnation and blood stasis.

b) Treating principle:to move the stagnated liver Qi and blood stasis.

c) Treatment:

i. Acup:Moxi at Ren8 (Shenque)

ii. Needles:Du20 (Baihui), Ren6 (Qihai), Ren4 (Guanyuan), Ext22 (Zigong), Sj5 (Waiguan), Li4 (Hegu), St36 (Zusanli), Sp6 (Sanyinjiao), Ki3 (Taixi), Ki6 (Zhaohai), Liv3 (Taichong)

iii. Concentrated herbal powder:Chaihu10, Xiangfu10, Zhiqiao10, Chishao10, Chuanxiong10, Danggui10, Yimucao10, Ezhu10, Wangbuliuxing10, Taoren10, Honghua10

iv. Variation:Nvzhenzi10, Hanliancao10 and Heshouwu10 are added after period; Yueyueshu Sachet is added around of ovulation for 3 days; Baishao10, Ejiao10 are added after ovulation.

d) Explanation:The liver Qi stagnation and blood stasis are the communist patterns to the ladies with infertility, so acupuncture points and patent herbs also at first follow this treating principle. So Chaihu, Xiangfu, Zhiqiao remove the liver Qi, Dangui, Chishao and Chuangxiong remove the blood stasis which are better not only to push the blockage in the fallopian tubes through, but also soft the lining tissue at the uterus to promote pregnancy. Erzhi Wan and Heshouwu nourish kidney Yin in the first week to feed the follicle’s growing up in the ovary; Yueyueshu is used around of ovulation to push egg’s ejaculation; Ejiao and Baishao are used in last week to nourish embryo if she is conceived.

e) Husband takes some patent herbs for improving his sperm condition:Chaihushugan Wan is given to remove stress and release the adhesions in the testacies which may have some chronic inflammation there; Wuziyanzong Wan (Sangshenzi, Tusizi, Nvzhenzi, Goujizi and Shechuangzi which all of seeds are) are used to reinforce kidney Essence and strengthen the sperm. After two years of treatment, she gets the fourth IVF with a successful multiple pregnancies and is done a caesarean to have a triple of two girls and one boy who are in the health conditions.

f) Analysis:This case is diagnosed as blockage of both fallopian tubes. Although the promoting menstrual circle is given, it still is very difficult to make her blocked tubes through in a short time, so IVF may still be the best way to them. But after many times of failed IVF and the hormonal treatment during the IVF, she manifests many symptoms, special emotional disorder, so I give her acupuncture to make her calm down and manage the herbal power to regulate her off-balance of hormone. And it is important that a course of patent herbs is given to her husband to strengthen the quality of his sperm. After the fourth IVF treatment, they are conceived with a triple and caesarean to have two girls and one boy of three health children due to a good general condition which she has gained from TCM treatment.

Case 2: The lady who is near menopause has been supported by TCM to have a boy through IVF:Mrs. S M, 49 years old, is a teacher. She was pregnancy when she was 23 years old but met an inevitable abortion in 40 days. She has never been conceived again since then. After she is 40 years old, she starts to worry on her reproductive function and seeks diagnosis and treatment. She is found blockages on both of her fallopian tubes and failed two times of IVF. She visits me when she is 49 years old who has missed two months of her menstruation. Due amenorrhea’s occurrence, Gynaecologists refuse another IVF to her. She also manifested exhaustion, hot flashes, depression tinnitus, insomnia and other symptoms with red tongue and wiry-fine pulse.

a) The pattern of TCM differentiation:Kidney Yin deficiency, Liver Qi stagnancy and Spleen deficiency.

b) Treating principle:To nourish kidney Yin, to move stagnated liver Qi and to reinforce spleen Qi.

c) Treatment:

i. Acup:Moxi at Ren8 (Shenque)

ii. Needle:Du20 (Baihui), Du24 (Shenting), Ren4 (Guanyuan), Ren6 (Qihai), St29 (Guilai), Li4 (Hegu), Liv3 (Taichong), Ki10 (Yingu), Ki3 (Taixi), Ki2 (Rangu), Sp6 (Sanyinjiao), St36 (Zusanli).

iii. Patent herbal medicine:Zhibaidihuang Wan / Jiaweixiaoyao Wan

d) Explanation:She is given a typical supporting treatment with the priority of kidney Yin pattern. Zhibaidihuang Wan reinforces kidney Yin and possesses Estrogen effect, and Jiaweixiaoyao Wan removes the liver Qi stagnation and excessive heat from liver and kidney Yin deficiency. A regular acupuncture stimulates her weaker menstrual function. After her period comes back, she is given a promoting menstrual circle treatment for a half year, then she has a pregnancy with a successful IVF and labour a healthy boy in the end of term.

e) Analysis:The lady has been 49 years old who expects to be conceived, but her hormonal level has been in the end stage which has made her amenorrhea for two more months. After she is given acupuncture which stimulates her reproductive function, and herbal medicine which has a bigger job of reinforcing Qi and Yin to kidney and spleen, she has been her menstrual circle back. But her hormonal level may still not be higher enough to make a natural pregnancy, but she is accepted by gynaecologists due to her regular menstrual circle back, so an IVF is given and a successful result happen to her.

That menstrual circle is supported by regular acupuncture and herbal medicine is an effective therapy to successfully promote pregnancy. Not only it is able to support female be a natural conceive, according to improve their ovary function; rise hormonal level, correct the endometric state in the uterus and harmony whole reproductive system; also raise the successful rate of IVF by a good preparation. By a way of analogy: If you want to well plant, you have to plough the soil softer before you put seeds into it. So, if you want to be conceived easily, you have to make the lining of endometrium softer and good circulation in the location. Acupuncture and herbal treatment look like ploughing which make the uterus and whole abdominal cavity be in a good condition. If patient in a good general and local condition, she will also easily be conceived by her husband in a natural way, or doctors with an IVF. Although the promoting the menstrual circles with acupuncture and herbal medicines is a good treating model, it may still possess some limitation: such as for a severer amenorrhea such as be caused by Premature Ovaries Insufficiency (POI) with higher FSH, or caused by polycystic ovary syndrome with higher Androgen, herbs may still appear weaker. The patients may need a longer phase of TCM treatment or accept an integrative approach of conventional drugs with TCM together.

Management of TCM therapies-acupuncture and Chinese herbal medicine according to the menstrual circles for regulating menstrual disorder to promote the conceive is a significant treating model. We need a larger sample to confirm its accurate effect.

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