Infertility is a big problem for many couples these days – up to 15% of American couples are considered to be infertile. Once a couple decides to embark on fertility therapy with conventional Western medicine, they often face years of expensive, time-consuming and frustrating treatments. The introduction and popularization of traditional Chinese medicine in this country, however, provides new options for infertile couples. Chinese medicine has a long tradition of treating infertility in both men and women, and anecdotal success stories are a significant part of Chinese gynecology/obstetrics textbooks.

A standard definition of infertility is: "failure to achieve conception after a year or more of regular sexual activity with no contraceptive use." Infertility is also the inability to carry a pregnancy to full term. As stated above, up to fifteen percent of American couples have fertility problems, and twenty percent of married American women seek medical help for infertility in their childbearing years.

In Western terms, Chinese medicine has a high success rate with functional infertility, which results from factors such as hormone imbalances, endocrine gland disorders, and emotional problems. Chinese medicine can also significantly improve some structural infertility problems, such as pelvic inflammatory disease, endometriosis, vaginitis, ovary dysfunction, and immune-system-related infertility.

In Chinese medical theory, the Kidney is the internal organ which is responsible for reproduction, growth, and aging. When Kidney energy is insufficient to support normal growth and development, or becomes depleted by lifestyle factors such as poor diet, overwork, or excessive sexual activity, many health problems can result, including infertility. Kidney Deficiency is the most common cause of infertility. Other patterns that can result in infertility are Liver Qi Stagnation, Blood Stasis or Deficiency, and Dampness with Phlegm or Heat.

Essentials of Diagnosis

If a female fails to be conceived after marriage while she has been living with her husband and no anti-conceptive measures are taken, a diagnosis of infertility can be definitely established.

In pattern diagnosis, attentions should be paid to the diseased organs involved, changes of qi, blood, cold, heat or deficiency and excess of the condition. Generally speaking, if the patient has a delayed monarch with less blood, accompanied with soreness and weakness of the loins and knees, it is most likely caused by kidney deficiency. If she irregular menstruation which is manifested as either preceded or delayed menstrual flow with either menorrhagia or hypomenorrhea and more emotional manifestations, her condition should be considered a case of stagnation of the liver qi. The pattern of obstruction of phlegm and dampness is mainly seen in a female with over weight, and she usually has delayed menstruation or even amenorrhea. Purple blood clots in the menses with sharp pain and tenderness in the lower abdomen are the key points to make the diagnosis of an infertility due to stagnation of blood. If this condition is caused by blood deficiency, hypomenorrhea or even amenorrhea with dizziness, palpitation are often the main manifestations.

Seven patterns of female infertility are differentiated in traditional Chinese medicine. The causes and clinical manifestations of each pattern are noted, as well as the leading herbal formulas used to treat the pattern.

Chronic illness or long-standing weakness is the origin of this pattern. Clinical manifestations include: delayed menstruation; irregular periods; scanty, light-colored menses; fatigue; dizziness; ringing in the ears; dull-pale complexion; back soreness; lack of sexual desire; cold limbs; loose stools; long-drawn-out urination with a thin stream or dribbling; a thick or puffy tongue body with a white tongue coating; and a thin-soft pulse.

Treatment Principle: Warm up the kidney yang

Herbal Prescriptions : Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)

Rehmannia (Shu Di Huang) 15g

Dioscorea (Shan Yao) 12g

Peony Root (Mu Dan Pi) 10g

Poria (Fu Ling) 10g

Cornus (Shan Zhu Yu) 15g

Alisma (Ze Xie) 10g

Cinnamon (Rou Gui) 6g

Aconite (Fu Zi) 6g

Acupuncture Prescription:

BL23 (Shenshu)

RN4 (Guanyuan)

RN6 (Qihai)

Zigong (Extra)

SP3 (Sanyinjiao)

ST36 (Zusanli)

Explanation: BL23 (Shenshu) is the back-Shu point of the kidney. RN4 (Guanyuan) is a crossing point of the Ren vessel with the spleen, kidney and liver channels. RN6 (Qihai) is a effective point for tonifying primary qi. Zigong (Extra) is a point particularly effective for the disorders of the uterus. DU4 (Mingmen) is the most important point for tonifying the kidney yang. KI3 (Taixi) is the Yuan-source point of the kidney channel. Combined use of the above points can warm the lower burner and disperse cold in the uterus. SP3 (Sanyinjiao) and ST36 (Zusanli) are used to strengthen the spleen and promote the production of qi and blood.

2. Kidney Yin Deficiency Pattern

Constitutional (genetically inherited) weakness is the underlying cause of this pattern. Clinical manifestations include: early menstruation; irregular periods; scanty menses with red color and no clots; palpitations of the heart; fatigue; dizziness; ringing in the ears; back soreness; dry mouth, dry bowl movements; a feeling of heat in the palms, soles of the feet, and the upper chest; low-grade fever in the afternoon; a red tongue body with a thin tongue coating; and a thin and rapid pulse.

Treatment Principle: Nourish kidney yin

Herbal Prescription:

Zuo Gui Wan plus (Left Restoration Pill)

Rehmannia (Shu Di Huang) 15g

Dioscorea (Shan Yao) 10g

Cornus (Shan Zhu Yu) 15g

Cyathula (Niu Xi) 15g

Lu Jiao Jiao (Atler’s Horn) 10g

Tortoise Shell (Gui Ban Jiao) 15g

Cuscuta (Tu Si Zi) 15g

Raspberry (Fu Pen Zi) 10g

Schizandra (Wu Wei Zi) 10g

Lycii (Gou Qi Zi) 15g

Plaintain (Che Qian Zi) 10g

Acupuncture Prescription:

KI3 (Taixi)

KI7 (Fuliu)

KI11 (Henggu)

HT6 (Yinxi)

SP6 (Sanyinjiao)

ST36 (Zusanli)

RN2 (Qugu)

Zigong (Extra)

Explanation: KI3 (Taixi), KI7 (Fuliu), KI11 (Henggu) and LR3 (Taichong) are used to nourish the kidney yin and clear empty fire. HT6 (Yinxi) clears fire from the heart to benefit the kidney yin. SP6 (Sanyinjiao) and ST36 (Zusanli) can tomify the qi and blood to regulate menstruation and also benefit the source of the kidney yin. RN2 (Qugu) and Zigong (Extra) are used to clear heat and regulate menstruation.

3. Blood Stasis Pattern

Surgery, emotional trauma, or excessive menstrual bleeding are the origins of this pattern. Clinical manifestations include: infertility; scanty periods; delayed periods with dark purple menstrual blood and blood clots; painful menstruation; frequent abdominal pain; a pale tongue body with purple dots; and a thin-wiry pulse.

Treatment Principle: Activate blood flow and remove stagnated blood

Herbal Prescriptions: Xue Fu Zhu Yu Tang (Driving Out Stasis in the Mansion of Blood Decoction) with modifications.

Persica Seed (Tao Ren) 10g

Safflower (Hong Hua) 10g

Angelica (Dang Gui) 15g

Rehmannia (Sheng Di Huang) 15g

Cnidium (Chuan Xiong) 6g

Red Peony Root (Chi Shao) 10g

Cyathula (Niu Xi) 15g

Platycodon (Jie Geng) 10g

Buplerum (Chai Hu) 6g

Aurantium (Zhi Ke) 10g

Licorice (Gan Cao) 10g

Acupuncture Prescription:

SP6 (Sanyinjiao)

SP8 (Diji)

SP10 (Xuehai)

ST36 (Zusanli)
LI4 (Hegu)

LR3 (Taichong)

BL17 (Geshu)

KI11 (Henggu)

RN2 (Qugu)

Zigong (Extra)

Explanation: SP6 (Sanyinjiao), SP8 (Diji), SP10 (Xuehai) and ST36 (Zusanli) are used to regulate the flow of qi and blood. LI4 (Hegu) and LR3 (Taichong) areused to promote the flow of qi to remove blood stasis. BL17 (Geshu), the influential point of blood, is used to regulate the flow of blood. KI11 (Henggu), RN2 (Qugu) and Zigong (Extra) are used to regulate the lower burner and remove blood stagnation.

4. Liver Qi Stagnation Pattern

Emotional stress is the origin of this pattern. Clinical manifestations include: inability to conceive for many years; irregular periods; abdominal pain with periods; scanty, pale-colored menses; dark-colored menses with clots; painful distention of breasts; depression; irritability before periods; a pale-red tongue body with a white-thin tongue coating; and a wiry pulse.

Treatment Principle: Soothe flow of the liver qi

Herbal Prescriptions: Hei Xiao Yao San (Black Rambling Powder)

Bupleurum (Chai Hu) 10g

Angelica (Dang Gui) 10g

White Peony (Bai Shao) 15g

Atractylodes (Bai Zhu) 12g

Poria (Fu Ling) 10g

Licorice (Gan Cao) 10g

Mint (Bo He) 5g

Ginger (Gan Jiang) 6g

Rehmannia (Di Huang) 15g

Acupuncture Prescription:

LR3 (Taichong)

LR14 (Qimen)

SP6 (Sanyinjiao)

SP10 (Xuehai)

ST36 (Zudsanli)

LI4 (Hegu)

RN2 (Qugu)

RN6 (Guanyuan)

Explanation: LR3 (Taichong) and LR14 (Qimen) are used to relieved depressed liver qi. SP6 (Sanyinjiao), SP10 (Xuehai) and ST36 (Zudsanli) are used to regulate the flow of qi and blood and regulate menstruation. LI4 (Hegu) is used to promote the flow of qi and remove blood stagnation. RN2 (Qugu) and RN6 (Guanyuan) are used to regulate the lower burner and regulate menstruation.

5. Damp-Phlegm Obstruction Pattern

Chronic overweight or the habitual consumption of greasy, oily foods are the origins of this pattern. Clinical manifestations include: infertility; irregular periods; delayed period or absence of period; menses with blood clots; weight gain; white, sticky vaginal discharge; irritability; dizziness; palpitations; chest congestion; nausea; gray tongue body with a white-sticky tongue coating; and a slippery pulse.

Treatment Principle: Remove dampness and dissolve phlegm

Herbal Prescriptions: Atractylodes/Cyperus Removing Phlegm (Cang Fu Dao Tan Wan)

Poria (Fu Ling) 12g

Pinellia (Ban Xia) 6g

Tangerine Peel (Chen Pi) 10g

Licorice (Gan Cao) 10g

Lanceagrey Atractylodes (Cang Zhu) 15g

Cyperus (Xiang Fu) 10g

Arisematis (Nan Xing) 10g

Aurantium (Zhi Ke) 10g

Ginger (Sheng Jiang) 6g

Leaven (Shen Qu) 10g

Acupuncture Prescription:

SP6 ( Sanyinjiao)

SP9 (Yinliangquan)

ST36 ( Zusanli)

ST40 (Fenglong)

KI10 (Yingu)

KI11 (Henggu)

RN12 (Zhong wan)

RN2 (Qugu)

RN6 (Guanyuan)

Explanation: SP6 ( Sanyinjiao), SP9 (Yinliangquan), ST36 ( Zusanli) and ST40 (Fenglong) are used to strengthen the spleen and remove phlegm. KI10 (Yingu) is used to eliminate dampness and regulate menstruation. KI11 (Henggu), RN2 (Qugu) and RN6 (Guanyuan) are used to regulate the lower burner and clear damp-phlegm. RN12 (Zhongwan) functions to strengthen the middle burner and dissolve dampness and phlegm.

6. Damp Heat Pattern

This Dampness pattern can also be caused by the habitual consumption of fatty foods and alcohol, and by weak Spleen energy. Clinical manifestations include: failure to conceive after the last delivery; irregular periods; delayed periods; constant spotting; white vaginal discharge; pains in the loins; abdominal pain which is worse with menstruation and fatigue; low-grade fever; pre-menstrual breast distention; a red tongue body with a white-sticky or yellow-sticky tongue coating; and a wiry-rapid pulse.

Treatment Principle: Clear away heat and remove dampness

Herbal Prescriptions: Jie Du Si Wu Tang (Relieving Toxicity Four Substance Decoction).

Coptis (Huang Lian) 10g

Scutellaria (Huang Qin) 10g

Phellodendron (Huang Bai) 10g

Gardenia (Zhi Zi) 10g

Rehmannia (Di Huang) 15g

Angelica (Dang Gui) 10g

White Peony (Bai Shao) 15g

Cnidium (Chuan Xiong) 6g

Acupuncture Prescription:

SP6 ( Sanyinjiao)

SP9 (Yinliangquan)

KI10 (Yingu)

LR8 (Ququan)

KI11 (Henggu)

RN3 (Zhongji)

RN6 (Guanyuan)

BL30 (Baihuan)

BL32 (Cilian)

Explanation: SP6 ( Sanyinjiao) and SP9 (Yinliangquan) are used to strengthen the spleen and eliminate dampness. KI10 (Yingu), LR8 (Ququan), KI11 (Henggu), RN3 (Zhongji), RN6 (Guanyuan), BL30 (Baihuan) and BL32 (Cilian) are used to clear damp-heat in the lower burner.

7. Blood Deficiency Pattern

This pattern can result from loss of blood due to trauma, surgery, or childbirth; and from insufficient blood production due to Deficient Qi or Congealed Blood. Clinical manifestations include: failure to conceive; delayed periods with scanty, light-colored menses, or copious, watery menses; absence of menstruation; pale complexion; a thin, weak body; dizziness; palpitations; breathlessness; insomnia; poor memory; tiredness; a pale tongue body with a thin-white tongue coating; and a thin-soft pulse.

Treatment Principle: Tonify blood

Herbal Prescriptions:

Wen Shen Bu Xue Tang (Warming Kidney/Tonifying Blood Decoction) with modifications

Codonopsis (Dang Shen) 15g

Angelica (Dang Gui) 10g

Millettia (Ji Xue Teng) 10g

Rehmannia (Di Huang) 15g

Psoralea (Bu Gu Zhi) 10g

Epimedium (Xian Ling Pi) 10g

Morinda (Ba Ji Tian) 10g

Curculiginis (Xian Mao) 10g

Placenta (Zi He Che) 20g

Acupuncture Prescription:

SP1 (Yinbai)

SP3 (Taibai)

SP6 (Sanyinjiao)

BL20 (Pishu)

SP10 (Xuehai)

BL17 (Geshu)

RN4 (Guanyuan)

RN6 (Qihai)

LI4 (Hegu)

LR3 (Taichong)

Explanation: SP1 (Yinbai), SP3 (Taibai), SP6 (Sanyinjiao) and BL20 (Pishu) are used to strengthen the spleen and promote the production of qi and blood. SP10 (Xuehai) and

BL17 (Geshu) are used to nourish blood and regulate the flow of blood. RN4 (Guanyuan) and RN6 (Qihai) are used to regulate the lower burner and regulate menstruation. LI4 (Hegu) and LR3 (Taichong) are used together to promote the flow of qi and thus regulating blood circulation.