Part III TREATMENT STRATEGIES: an ancient approach to a rising problem of INFERTILITY

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(They are expecting their first child at the end of November.)

Introduction In this article we are going to make reference to the remaining diseases or disorders that may contribute to infertility and that were not discussed in the previous article. Herbal Medicine
Chinese medicine, when used correctly, can be very successful at treating many gynecological disorders that accompany and contribute to infertility. Some of these disorders include; irregular menstruation, amenorrhea, endometriosis, uterine fibroids, and heavy bleeding due to anovulation. These physical disorders, in addition to hormonal imbalances, can affect chances of conception and pregnancy. It is important to treat the root of the cause for these disorders, bring the body back to harmony, and allow conception to happen naturally.

In this article we will cover amenorrhea, endometriosis, uterine fibroids and heavy bleeding. Some varieties of each one of these conditions may be discussed in future articles. Under our point of view, it is better to know how to treat the most common conditions successfully, than to know a little bit about many conditions. It is essential to follow appropriate protocols for each individual pattern or condition in order to achieve effective results.

Acupuncture
Acupuncture prescriptions will be provided for each of the TCM patterns as relates to infertility. These prescriptions are merely recipes and may be modified according to each individual presentation. It is important to stay in tune with the progress of the patient, as their pattern may change throughout the course of the treatment.

Acupuncture has been proven to enhance fertility and improve chances of conception in many ways, which were mentioned in the previous article. In acupuncture, the points most commonly used to prepare a woman for pregnancy and regulate various conditions are the following:

Note: These are the same points as in the previous article. Some new points have been added. Standard
Zu San Li (St 36) - Rectifies the digestion and supports the defensive qi.
San Yin Jiao (Sp 6) - Influences the liver, kidney and spleen channels and tonifies the blood.
Tai Chong (Lv 3) and He gu (Li 4) - Known as the four gates, strongly courses and rectifies the liver qi.
Di Ji (Sp 8) - Helps to regulate the hormones.
Yin Tang (M-HN-3) - Is used to relax the patient's emotions and spirit or mind.
Specific
Ming Men (GV4) and Fu Liu (KD 7) - Both invigorate kidney yang. They are suitable in cases of cold symptoms or lack of sperm motility in men.
Tai Xi (KD 3) - It is the source point of the kidney channel to supplement qi and yin.
Bai Hui (GV20), Da Dun (Lv 1), Yin Bai (SP1) to upbear and lift the clear yang and contain the blood.
Ear Shen Men to calm the spirit.
Xue Hai (SP 10) to quicken the blood.
Zhong Ji (CV 3), Guan Yuan (CV 4), Qi Hai (CV 6) to course the qi, move it downward and regulate menstruation in women or to increase flow to the testicles in men.
Qu Quan (LV 8) and Tai Chong (LV3) to course the liver and move the qi.
Feng Long (ST40) to transform phlegm
Fu Ke to normalize the period.
Huan Cao to normalize the uterus and any possible defects.
Wai Guan (TW5) to assist fluid circulation
Zi Gong Xue (M-CA-18) to improve ovarian circulation (for endometriosis).
Xin Shu (UB 15), Ge Shu (UB17), Gan Shu (UB18), Pi Shu (UB20), Shen Shu (UB 23) and Da Chang Shu (UB25) to stimulate the endocrine system, stimulate the ovaries and regulate the menstrual cycle. These points will help as well for men to stimulate the pituitary gland and hormones.
Treatment of TCM Patterns in Female Infertility
When treating infertility, a practitioner's number one priority should be to regulate the cycle of the patient. This includes investigating the nature of the cycle in order to detect or interpret any abnormalities and then make appropriate corrections. This process generally takes a minimum of 3 months. After achieving normalization of the cycle the chances for successful conception will greatly increase.

Amenorrhea
Amenorrhea means an absence of menstruation. It could be a condition in which the menstruation has never started or that the menstruation has started but for some reason suddenly fails to occur for more than three consecutive months.

In Chinese medicine the causes of this condition could be the following:

Kidney Yin/Yang/essence Vacuity
Qi Vacuity
Blood Vacuity
Liver Qi Stagnation
Blood Stagnation
Phlegm Obstruction
The treatment of these symptoms should be focused in two ways:

Quicken and tonify the blood and free course the qi, especially the last days of the period when theoretically the period should occur. A formula that is commonly indicated for this is Jing Qian Fang.
After the last days of the period and for the rest of the days of the cycle, the treatment should target the tonification of the kidneys, blood and spleen and free course the liver. A formula that is indicated for this is Ding Jing Fang.
Referring to the first formula above, the herbs that make up Jing Qian Fang are:

Dang Gui which tonifies and quickens the blood; Bai Shao which tonifies the blood, harmonizes the liver, and constrains the yin; Shu Di Huang which tonifies the blood and yin and essence; Gou Qi Zi which tonifies liver yin and blood; Chuan Xiong moves the qi and quickens the blood to transform stagnation; and Xiang Fu that free courses the liver and rectifies the qi, regulating the menstruation.

In summary, the herbs used for this stage of the cycle are mainly focused to tonify and move the blood.

In the second formula mentioned above, Ding Jing Fang, the herbs included are Dang Gui, Bai Shao, Shu Di Huang, Chai Hu, Shan Yao, Fu Ling, Tu Si Zi, Zi Gan Cao, Dang Shen and Ba Ji Tian.

These herbs will help to regulate the hormonal system to activate the ovaries and trigger a regular menstrual cycle with normal ovulation.

Acupuncture points: CV3, 4, 6, GV 20, Sp 10 and/or UB 15, 17, 18, 20, 23, 25, Fu Ke, and Huan Cao.

Endometriosis
Endometriosis is a condition in which parts of the endometrial tissue, which belongs to the uterine lining, start growing outside of the uterus. These abnormal growths follow the same hormonal cycle as the uterus and can bleed according to the cycle timing, which can cause extreme pain or dysmenorrhea. Women with endometriosis have around 40% incidence of infertility. The main symptoms that are related to this condition are pain before and during menses, pain during sexual intercourse, infertility, heavy or irregular menstrual bleeding, fatigue, painful bowel movements, low back pain during menstruation, and diarrhea or constipation.

The main Chinese pattern for endometriosis is blood stasis, therefore the herbs used for this condition are mainly to move the blood. The treatment is aimed at dispelling stasis that belongs to blood build up outside of the uterus, where abnormal tissue growth has occurred, without the possibility of eliminating the menstruation. The main formula used for this condition is Huo Jing Zhong Zi Fang (Quicken the Essence & Plant the Seed Formula).

This formula should be used for the weeks that follow menstruation to circulate the qi and blood, harmonize the liver qi and benefit the spleen. The herbs used for this formula are Dang Gui to nourish and quicken the blood, Chai Hu to free course the Liver and rectify the qi, Dan Shen to move the blood and calm the spirit, Bai Shao to tonify the liver and protect the yin, Fu Ling to tonify the spleen and calm the spirit, Bai Zhu to tonify the spleen and qi, Zhi Ke to correct the qi and Gan Cao to harmonize all the herbs.

The second formula more suitable for this condition is Xiao Zheng Fang, which should be used one week prior to the beginning of menstruation and also during menstruation. This formula contains Ji Xue Teng to tonify and move the blood, San Leng to break the blood and move the qi, E Zhu to move the blood, break blood stasis and rectifying the qi, Mu Dan Pi to move the blood, Dan Shen and Chi Sao to move the blood and break stagnation, Tao Ren to move the blood and moisten the intestines, Zhi Ke to free course the liver and qi, Fu Ling to clear dampness, tonify the spleen and calm the spirit and Bai Shao to tonify the spleen and qi.

Acupuncture points: CV3, 4, Sp 10, LV 8, Fu Ke, Huan Cao and Zi Gong Xue.

Uterine Fibroids
Uterine fibroids or myomas are nodules of smooth muscle cells and fibrous connective tissue that develop in the myometrium, or wall of the uterus. In most cases uterine fibroids are not dangerous and generally are not associated with uterine cancer. Myomas manifest in two ways according to Chinese Medicine.

The first way is characterized by a mass that is fixed in location, hard and painful. These are referred to as purely blood stasis. Masses that are movable, appear and then disappear, and are not palpable, are considered qi stagnation. Therefore the two main patterns for this condition are blood stasis and qi stagnation.

The main symptoms that are related to this condition are heavy or prolonged menstrual bleeding, pain or heaviness in the pelvic area, swelling of the abdomen, frequent urination and infertility caused by blockage of the fallopian tubes or changes in the uterine cavity.

The formula indicated for this condition is Xiao Zheng Fang.

In case there are additional indications of qi stagnation, and when appropriate, it is possible to add Chai Hu, Xiang Fu, Qing Pi and Li Zhi He.

Acupuncture points: Sp 10, Sp 9, LV 8, St 40, Fu Ke, Huan Cao and TW 5.

Excessive Uterine Bleeding
Excessive bleeding which is called menorrhagia, can occur during a woman's menses, or in between menstrual periods which is called metrorrhagia. In some cases abnormal uterine bleeding that is heavy may be caused by an absence of ovulation which results in infertility.

The main patterns considered in Chinese medicine for these conditions are the following:

Spleen Qi Vacuity (Qi is not able to hold the blood within its vessels)
Kidney Vacuity (Essence, which contributes to the formation of the blood not being secure)
Blood Stasis which (prevents the blood vessels form constricting)
Heat in the Blood (Blood moves frenetically outside the vessels)
The main formula for this condition is Gong Xue Fang. It containing Dang Shen to tonify the qi and control and contain the blood within the vessels, Bai Zhu to tonify the spleen and help to control the blood, Xu Duan to tonify Kidney yang, and Shan Zu Yu to tonify kidney yin and essence to strengthen the blood.

The administration of Gong Xue Fang should be followed by a formula that will regulate the menstrual cycle and prevent the abnormal bleeding from re-ocurring. A formula that may be used is Ding Jing Fang.

FEMALE INFERITILITY FORMULAS

Acupuncture points: CV6, 8, GV 20, Sp 1, St 36, LV 1 and/or UB 15, 17, 18, 20, 23, 25

Conclusion
It is important to remember that when treating infertility to consider disorders within both the male and female partners. This will increase the percentage of success in pregnancy exponentially. The disorders presented in this article may require a good observation of the patient symptoms to modify the most suitable formula.

It is important to let the patient know that the priority is in the restoration process of the conditions mentioned above, first and foremost, to regulate the cycle. To have a regular menstrual cycle means that the body is working in optimal condition. This means total body harmony, a perfect state of wellbeing that is ideal for conception and pregnancy to occur.

Bibliography
1 The Infertility Book, A Comprehensive Medical and Emotional Guide, Harkness, Carla, 2nd edition 1992, Celestial Arts, P.O. Box 7327 Berkeley, California. (510) 845-8414

2. Infertility: A guide for the Childless Couple, Menning, Barbara Eck, New York, Prentice Hall rev. 1988.

3. You Can Have A Baby, Everything you need to Know about Fertility, Bellina, Joseph H., M.D., Ph.D., Wilson, Josleen New York, Crown Publishers Inc., 1985.

4. Endometriosis & Infertility and Traditional Chinese Medicine, Flaws, Bob, CO, Blue Poppy Press, 1989

5. Endometriosis as Treated by Traditional Chinese Medicine, Cao Ling-xian & Tang Ji-fu,,trans. C,S,. Cheung, M.D., & Carolyn Atkinson, J. Amer. College of TCM. S. F., CA, Vol. 1, No. 1, 1983, p. 54-57.

6. A Woman's guide to Endometriosis, Older, Julia, Charles Scribner's Sons, NY,1984.

7. Handbook of Chinese Herbs and Formulas, Vol. I & II, Him-che Yeung, Los Angeles, 1985

8. Chinese Herbal Patent Formulas, A Practical Guide, Jake Fratkin, Shya Publications, 1986

9. Chinese Tonic Herbs, Ron Teeguarden, Japan Publications, Inc. 1985

10. Wise Woman Herbal For the Childbearing Years, Weed, Susun, New York, Ash Tree Publishing, PO Box 64, Woodstock, NY 12498, 1986.

11. Infertility Statistics (source: Wayne Sinclair, M.D. & Richard W. Pressinger, (M.Ed.).

12. Acupuncture & CVF, Liang, OMD, Lifang, Colorado, Blue Poppy Press, 2003.

13. Obstetrics & Gynecology in Chinese Medicine, Maciocia, Giovanni, Harcurt Bruce and Company Limited, 1998.

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By Kelsey Fernandez, MSOM, L.Ac. and Alejandro Fernandez, MSOM, L.Ac.

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