Introduction

Subfertility and infertility rates are high and according to the WHO, infertility affects millions of individuals and couples. It is estimated that approximately one in every six people of the reproductive age experience infertility at some stage in their lifetime. Infertility is defined by a 12 months period of unprotected sex without falling pregnant. There is primary (when there never was a pregnancy) and secondary infertility (when there was at least one pregnancy). The types of the reproduction system “defects” can be related to either sperm, the ovaries, the fallopian tubes, the uterus, or the endocrine system. Many factors can affect pregnancy rates. Whenever our patients are falling pregnant, especially, if they sincerely wanted a child, caring for them during their time of being pregnant is very important. In this article, we want to be look at some herbal formulas to target infertility both male and female and explore pregnancy formulas.

As TCM practitioners, we feel inclined to help patients with both, subfertility issues and pregnancy related complains. TCM also offers one of the gentlest treatments in this situation with low rates of “side effects”. Perhaps this is one of the reasons for a high number of TCM “experts” in this area. However, not every woman wanting to fall pregnant can be helped, unfortunately, and so in my clinic, the first step is always assessing the risks and benefits of helping sub fertile couples. I don’t think, it’s fair to create unrealistic expectations for our patients (and ourselves). As a Jing Fang practitioner, I usually don’t “specialise” in a particular area but I focus on balancing Yin and Yang. As a woman, I feel strongly inclined of wanting more individuals to fall pregnant and more importantly, have healthy pregnancies with life births.

Looking back at some of my patients in this area, the tendency is to assist if there is Polycystic Ovary Syndrome (PCOS), endometriosis or primary/secondary dysmenorrhea, low sperm count or simply unexplained reasons for the lack of conception. I use formulas exclusively from the Shang Han Lun and the Jin Gui Yao Lue. I tend to assist women with acupuncture if they are undergoing ART (Assisted Reproductive Technologies) as their “fertility specialists” often don’t want them to have anything other than the drugs they prescribe, at least in Australia.

The following table is from Xu et al. (Application of traditional Chinese medicine in the treatment of infertility, 2003) which I have extended to match with a classical formula structure suggestion to address female infertility patterns:

 

TCM pattern	Western diagnosis	Manifestations	Tongue	Pulse	Formula
Kidney Yin deficiency	Anovulation Immunological infertility Luteal phase defect	Malar flush, sweats, insomnia, dry throat, low grade fever	Red, peeled, cracked	Floating, empty, rapid	Shen Qi Wan
Kidney Yang deficiency	Amenorrhoea	Cold knees, weak legs, apathy, poor appetite	Pale, swollen	Deep, weak, wet	Zhen Wu Tang
Liver blood deficiency	Polycystic ovary syndrome	Dizziness, blurred vision, pale lips, muscle spasm, brittle nails	Pale body, dry	Choppy, fine	Dang Gui Jian Zhong Tang
Liver blood stagnation	Endometriosis	Painful periods, dark and clotted blood, abdominal pain, and mass	Purple body, spots	Wiry	Gui Zhi Fu Ling Wan   Wen Jing Tang
Damp-heat in the liver	Genital infection Tubal factor infertility	Fever, jaundice, bitter taste, nausea, vomiting, abdominal distension, vaginal discharge	Red body, sticky yellow coat	Slippery, wiry, rapid	Huang Qin Tang
Liver Qi stagnation	Premenstrual syndrome (PMS)	Depression, sighing, mood swings, painful periods, distension of the breasts	Normal	Wiry	Si Ni San Xiao Chai Hu Tang
Cold stagnation of the liver channel	Sexual arousal disorder	Fullness and distension of the bladder	Pale, wet, white coat	Wiry, deep, slow	Wu Zhu Yu Tang
Deficient spleen Qi	Dysfunctional uterine bleeding Uterine fibroids	No appetite, tiredness, lassitude, blood in the urine, excessive menstrual flow	Pale or transverse cracks on sides	Fine	Huang Qi Jian Zhong Tang   Li Zhong Wan

 

The following table is from Xu et al. (2003) which I have extended to match with a classical formula structure suggestion to address male infertility:

TCM pattern	Western diagnosis	Manifestations	Tongue	Pulse	Formula
Deficient kidney essence	Impotence Seminal plasma abnormalities	Poor memory, loose teeth, hair loss, weakness of knees and legs Sexual dysfunction	Red, peeled	Floating, empty, leathery	Tian Xiong San
Deficient kidney Qi	Azoospermia (absence of sperm when ejaculating) Oligozoospermia (low number of sperm in ejaculate) Asthenozoospermia (reduced sperm motility) Teratozoospermia (abnormal morphology of sperm)	Soreness and weakness of the lumbar region, urinary incontinence, enuresis, nocturnal urination	Pale, white coat	Weak or thready	Zhen Wu Tang   Shen Qi Wan
Liver blood stagnation	Varicocoele	Painful or irregular abdominal pain “mass” in the abdomen	Purple body, spots	Wiry	Fu Ling Gan Cao Tang   Gui Zhi Fu Ling Wan   Dang Gui Si Ni Tang
Damp-heat pouring downward	Male accessory gland infection Immunological infertility	Swelling and cramps in the perineum and lower abdomen, thirst, bitter taste in the mouth	Red with yellow, greasy coating	String-like and slippery	Huang Qin Tang

 

I assist many women in pregnancy too. My rule of thumb is, that I see them once a month if their pregnancy is going well and I will treat them with acupuncture. However, if problems arise, I will also prescribe herbs. Initially, I did not have the confidence to treat pregnant women with herbs, but since spending time with the use and application of classical formulas, I now confidently prescribe herbs. Did you know that there is an entire chapter in the Jin Gui Yao Lue dedicated to problems during pregnancy (chapter 20)? Those formulas worked for at least two millennia and I would use the basic structure of them (not all herbs are always available) and tailor them to the individual. I also advice women to have regular weekly acupuncture sessions starting from week 36 or 37 in preparation of labour.

 

Common Jin Gui Yao Lue formulas that I would use during pregnancy are:

 

Name	Chapter, line, and reference
Bai Zhu San	JG 20.10: For nourishing the foetus during pregnancy, Bai Zhu San governs. For toxic pain under the heart, augment Chuan Xiong to double.
Dang Gui Bei Mu Ku Shen Wan	JG 20.7: For difficult urination during pregnancy, with normal food and water intake, Dang Gui Ku Shen Wan governs.
Dang Gui San	JG 20.9: For pregnant women, it is indicated to often take Dang Gui San.
Dang Gui Shao Yao San	JG 22.17: For all types of abdominal pains in women, Dang Gui Shao Yao San governs.  JG 20.5: For pregnant women, with twisting dull ache in the abdomen, Dang Gui Shao Yao San governs.
Gui Zhi Fu Ling Wan	JG 20.2: For women who have pre-existing mass disease, and the interruption of the period has not yet reached three months, after which there is incessant leakage, with foetal movement above the umbilicus, then it is damage to consolidated mass. When in pregnancy there is stirring at six months, and the three months prior to the pregnancy was uninhibited, then this is the foetus. If there is bleeding. If there is bleeding after the menses had stopped for three months it is due to bad blood. The reason why the bleeding does not stop is because the mass is not expelling. For one should purge the mass, and Gui Zhi Fu Ling Wan governs.

 

Even when there is unexplained sub-fertility, there isn’t always success in helping these women become pregnant. It’s heart breaking that especially in cases, where everything seems perfect, conception does not occur. It’s hard for us practitioners to admit that our treatments in that respect were not successful. It is even more difficult for women despairingly wanting to start a family or having another baby, not being able to fulfil their wish. Things sometimes do not happen the way we would like or expect them. It’s wholesome to have that view on life in general.

 

References

Xu X, Yin H, Tang D, Zhang L, Gosden RG. Application of traditional Chinese medicine in the treatment of infertility. Human Fertility 2003; 6(4): 161-8.

Wiseman N, Willms S, Ye F. Jin Gui Yao Lue-essential prescriptions of the golden coffer. Summer: Paradigm Publications 2009