Christina Kovalik, NMD, LAc

Chinese medicine looks at female fertility challenges in a different light than conventional medicine. When it is known that the male factor is not an issue for the fertility-challenged couple, it is important to properly diagnose the root cause of the imbalance. Once the correct TCM (Traditional Chinese Medicine) diagnosis is identified, the patient can be treated accordingly. First, it is important to regulate the menstrual cycle before conception can occur. Usually, this takes approximately three months of acupuncture and herbal treatment to balance out. This entails an initial naturopathic consult/examination and if necessary a couples evaluation. The woman is required to chart her BBT/fertility to become more in tune with her own body, time intercourse accordingly, and make the necessary diet and lifestyle changes. Also it is very important energetically to help the woman identify any deep-seated fears that may be hindering the conception process.

Regulating the Menstrual cycle

As stated in the Classics of Chinese medicine, the menses needs to be regulated first by treating the TCM pattern of that imbalance. Once the TCM pattern is distinguished, then that pattern can be treated along with acupuncture points to support the phase of the menstrual cycle. For a 28-day cycle:

1. Blood phase (menstrual phase) is during days 1-7. The chong meridian is empty at that time. BBT is low. Treatment during this time is to regulate menstruation only if it needs support or regulating (heavy bleeding or blood deficiency).
Yin phase (postmenstrual phase) is during days 8-14. Blood and Yin are empty and the chong and ren are depleted (Maciocia G, 1998). BBT may still be low or slowly increasing to prepare for ovulation, indicated by a temperature spike. The treatment is to nourish blood and tonify Kidney yin.
Yang phase (ovulation/intermenstrual phase) is during days 15-21. Blood and Yin fill up in the penetrating (chong) and directing vessels. BBT goes from low to high (transition from Yin to Yang). Treatment is to tonify the Kidney yang and consolidate the governing and conception vessels.
Qi phase (premenstrual phase) is during days 22-28. The chong is full of blood. Yang qi raises and Liver qi moves in preparation for the period. The free movement of Liver qi is essential in order to move liver blood (Maciocia G, 1998). BBT should stay high until days 26-27. The treatment is to move Liver qi and support the chong (Maciocia G, 1998).
Timing of intercourse is a major advantage in optimizing the chances of conceiving. In a study of 100 couples who conceived without fertility awareness, half had done so by 3 months, 75% by 6 months, and over 90% by 12 months (Stanford J et al., 2002). The best time for conception is on days 8, 10, 12, 14, and 16 of the menstrual cycle starting with day 1 as the first day of the period. Another method is to watch for the initial dip on the BBT chart before the elevation (ovulation) and plan to have intercourse three days in a row. It is suggested that with timed intercourse, a Western diagnosis of infertility can be determined in six months (Stanford J et al., 2002). Patient education is essential in optimizing the best outcome in infertility cases. BBT charting may enhance this effort in allowing the patient to be more in tune with her body. It also confirms the TCM pattern that is involved and will allow for treatment of the root imbalance.

Four Common TCM Patterns of Infertility in Women

1. Kidney deficiency may be due to early oral contraceptive pill use, essence deficiency, excessive sexual activity, or late menarche. It may cause primary infertility (never have conceived). Kidney deficiency includes Kidney yang and Kidney yin deficiency. Kidney yin is the jing essence and the substantial part of the Kidney. Kidney yang is the warm, active, and functional part. Since they are dependent on each other, it may be necessary to treat both for infertility (Flaws B, 1989).

Kidney yin deficiency: Depletes the chong meridian resulting in not conceiving due to the generation of heat from depletion of Yin. Ki Yin deficiency is commonly seen in young to middle-aged women and is often combined with other patterns such as liver qi stagnation, liver blood deficiency, or spleen dampness (Flaws B, 1989).

SX: LBP or sore knees, dizziness, tinnitus, palpitations, night sweats, hot flashes, feeling of warm hands and chest area, dark scanty urine, polyuria, vaginal inflammation (normal or sticky discharge). Tongue: red, small, dry with cracks, white or yellow coat, possibly sticky. Pulse: thready, rapid, and deep and weak in Ki yin pulse. BBT: temperature increases at days 18-19 (prolonged hypothermal phase). Menses: short or irregular cycle, normal or reduced amount of flow, red color, no clots (20- to 22-day cycle or long cycle of 32-33 days).

Treatment principle: Nourish Yin and blood (days 5-14 especially), clear heat, harmonize the chong, and promote ovulation.

Acupuncture: Ren 4, Ki 6, Ki 7, Ht3, Ht7, Lv3. For heat—Ki2, P7, Li11. For more tonifying of Yin and blood—Ub11, St37, St39, Lv8 (all sea of blood points).

Herbs: generally Liu Wei Di Huang Wan.

Kidney yang deficiency: Ki Yang deficiency is usually not seen in young women unless there is a history of drug abuse (cocaine), or a chronic spleen deficiency, exhaustion, sexual excess, or a prolonged disease. The Ki Yang aspect is needed for conception; if it is deficient then the uterus is cold (“Nothing grows in ice and snow”).

SX: feelings of cold (cold limbs and feet), LBP, knee weakness, polyuria (clear), watery leukorrhea (clear to white), fatigue, tinnitus, persistent daybreak diarrhea or loose stools, long or irregular cycles, reduced amount of flow or heavy flow, light red color, no clots, sloughing off of endometrial tissue, dysmenorrhea with LBP better with heat. BBT: low luteal phase, may have monophasic, sawtoothed, horse-shaped, shortened hyperthermal phase or prolonged transition to hyperthermal. Tongue: pale, flabby, or swollen, thin white coat or white and slippery coat. Pulse: deep thready, slow, weak in kidney positions.

Treatment principle: tonify kidney, promote yang, warm the uterus, promote ovulation. Treat with acupuncture especially on days 8-10; if treated sooner blood is too deficient.

Acupuncture: Ub23, Du4, Ren4, Zigong, Ki3, St36, Ki11. For cold in the uterus—Ren8, Du3, Du14. For warming the Ki and promote ovulation—Ki14, Huatuojiaji (half cun lateral to L2).

2. Liver qi and blood stagnation: Qi moves the blood. Obstruction of liver qi will impede the free flow of blood to the uterus resulting in stagnation of qi and blood. This may block conception from occurring due to the obstruction of the ren and stagnation of the chong. There may be heat in the chong meridian due to the stagnation creating heat. The chong may become deficient due to heat-depleting yin. The heat from stagnation may also cause a disharmony between the Liver and Heart or the Liver and Spleen. There may also be a combined pattern of Liver qi stagnation with Kidney deficiency. Infertility due to liver stagnation generates heat and may be due to liver blood deficiency.

SX: Lv Qi stagnation—hypochondriac pain, suffocating feeling in the chest, sighing, anxiety, irritability, depression, abdominal distention, constipation, breast tenderness, PMS, HA before the menses, dysmenorrhea, uterine fibroids or cysts, cramping before and during menses, acne, vaginal discharge may be abnormal, increased quantity, white or yellow, may have itching. Lv blood stagnation—the above symptoms plus dark and dull complexion, sharp pain, irregular painful periods. Menses: irregular cycles, quantity of flow may be excessive or insufficient, may have spotting several days before or after menses, color is dark red or dark purple, small or large clots. BBT: hyperthermal, sawtoothed hyperthermal phase or a prolonged transition to hyperthermal phase. Heat may push the temperature up but it falls due to deficiency. Tongue: pale purple or reddish purple, may have purple spots, thin white or yellow coat, may be sticky, may have venous distention under tongue. Pulse: wiry, thready, choppy, liver position is excessive and wiry.

Treatment principle: soothe the liver, remove blood stagnation, clear heat, nourish the blood, and regulate ovulation.

Acupuncture: Lv3, P6, Li4, Sj5, Ki13, Ki8, St36. For blood stagnation—Sp10, Sp4, Ub17, Ub11, St37, St39. For heat in the blood—Lv2, Sp6, Ub17, Ub11, St37, St39. For blood deficiency—Ub17, Lv8, Ren6, Ub11, St37, St39. To smooth the qi and calm the mind—Ht7, Ub15, Ub18 For Kidney deficiency—Ub23, Ren4, Ki3, Ki6.

Herbs: Jia Xiao Yao San, Woman’s Balance/precious.

3. Phlegm damp accumulation: Signifies a Spleen dysfunction. When the spleen isn’t functioning properly, the fluids stagnate or cause dampness or phlegm accumulation in the body. Phlegm blocks the free flow of qi and blood to the uterus inside and out. This may cause the uterus to contract, blocking the pathway of the sperm causing infertility (Flaws B, 1989). It also blocks the chong and ren meridians. “Fat hens don’t lay eggs” refers to the fact that overweight in TCM is common with this pattern or infertility. Obesity or overweight is considered damp/phlegm accumulation because damp is heavy.

SX: edema in the feet and legs, leukorrhea, urinary frequency, dribbling, and incontinence, loose, pasty, sticky stools, mucus in the stools, lower abdominal obesity, feelings of heaviness, excessive mucus or sputum, sticky, thick, sputum-like vaginal discharge, candida infections.

Menses: prolonged cycle, amenorrhea, scanty flow (less and less each month), pale, dark or dull color, clots with mucus.

BBT: prolonged transition to hyperthermal phase due to Ki/Sp yang deficiency. The luteal phase doesn’t reach 98 degrees.

Tongue: swollen with teeth marks, pale or dull red color, slippery/greasy or white sticky coat. Pulse: slippery/rolling, deep thready, wiry or soft. Forceless in the spleen position.

Treatment principle: dry dampness, resolve phlegm, strengthen the spleen, regulate qi and blood, and promote ovulation.

Acupuncture: Ren12, Ren9, St28, St40, Sp3, Sp4, P5, Sj5, GB41, GB26. With spleen deficiency—Ub20, Sp6, St36. To activate metabolism and san jiao channel—Sj4, Lv3, Ren12, Ren9.

Herbs: varies, Gui Pi Tang.

4. Stagnation of damp heat in the lower jiao: Damp heat invades the body from the lower burner (jiao), which prevents the proper movement of qi and blood. This obstruction directly affects the directing (ren) and penetrating (chong) vessels resulting in a deficiency of gathering the Kidney essence. This is mostly due to an imbalance in the dai (girdle, belt) vessel. When the dai is deficient, it is slacked. It does not restrain the essence, spleen qi sinks, kidneys and the chong and ren also become deficient. If it is excess, the belt is too tight. When the dai isn’t harmonized it may result in dampness in the genital area or cause dysmenorrhea (Maciocia G, 1998). Dampness may be due to inflammation, PID, D&C, IUD, ectopic pregnancy, or intercourse during the menses (an external pathogen may injure the blood). The high temperature due to the inflammation is thought to kill the sperm (Wallach P, 2002).

SX: adhesions, obesity, feelings of heaviness, increased quantity of white or yellow, sticky or cheesy consistency vaginal discharge with an offensive or fishy odor, vaginal itching or burning, scant yellow urine, lower abdominal pain, fever or alternating chills, poor appetite, bitter taste in the mouth. Menses: irregular cycles, delayed cycles, short or long cycles, dark red blood, scanty or normal flow with clots, increased pain in sacral area. BBT: varies. Tongue: red or pale, swollen with teeth marks, white or yellow sticky coating, dirty and thick at the root of the tongue. Pulse: wiry, rolling/slippery, soft or thready.

Treatment principles: eliminate damp heat, regulate qi and blood, normalize the chong and ren channels to regulate ovulation.

Acupuncture: Li5, Lv5, GB41, Sj5, St28, Zigong, Ren6, Sp9, Sp6, St40, Sp4, P6. For more heat—Li11, Lv2, Sp2, Li4. For blood stasis—Sp10, Li9, GB26.

It is important to understand and properly diagnose both the Western and the TCM diagnoses in treating female infertility. Know that the herbal formulas are suited for each individual presenting a TCM pattern. There may be a time when referral to a reproductive endocrinologist is required. If age is a factor for the female patient, then six to eight months of natural methods is sufficient.

References

Chang R et al: Role of acupuncture in the treatment of female infertility, Fertil Steril 78(6):1149-52, 2002.

Flaws B: Endometriosis, Infertility and Traditional Chinese Medicine, Boulder, CO, 1989, Blue Poppy Press, pp 9-13.

Flaws B: Fulfilling the Essence: A Handbook of Traditional and Contemporary Chinese Treatments for Female Infertility, Boulder, CO, 1993, Blue Poppy Press.

Maciocia G: Obstetrics and Gynecology in Chinese Medicine, New York, 1998, Churchhill Livingstone, pp 691-739.

Ni Y: Diagnosis and Treatment of Infertility with Traditional Chinese Medicine. Lecture from Pacific Symposium. Pacific College of Oriental Medicine. San Diego, CA, August 24-27, 1995.

Singh A: Reproductive Endocrinologist. Internship in Fertility. Mayo Clinic Thunderbird. Scottsdale, AZ, March 2003.

Stanford J et al: Timing intercourse to achieve pregnancy, Obstet Gynecol 100(6):1333-41, 2002.

Sterner VE et al: Effects on electro-acupuncture on anovulation in women with PCOS, Acta Obstet Gynecol Scand 79(3):180-8, 2000.

Wallach P: Lecture on Infertility and the Menstrual cycle. Phoenix Institute of Herbal Medicine and Acupuncture. Phoenix, AZ, November 2002.

Yang-Shou-Zhong, Liu Da-Wei: Fu Qing-Zhu’s Gynecology, Boulder, CO, 1995, Blue Poppy Press, ch. 3, pp 29-54.

Christina Kovalik, ND, LAc, is a graduate of Southwest College of Naturopathic Medicine and the Phoenix Institute of Herbal Medicine and Acupuncture. Her general naturopathic practice focuses on women’s health, specifically infertility, PMS, menstrual irregularities, menopause, endometriosis, and gynecology. She worked with an OB/GYN as a physician’s assistant for more than a year and understands the importance of integration. She also wrote her master’s thesis on acupuncture and female infertility. Contact: [email protected].