A TCM APPROACH TO TREATING INFERTILITY

     Infertility is an increasingly common disorder affecting thousands of women in North America.  The disappointment of repeated negative pregnancy tests, miscarriages and failed IVF (In Vitro Fertilization) attempts can be emotionally and physically devastating to a woman trying to conceive.  While western medicine diagnoses infertility as a "disease", Traditional Chinese Medicine (TCM) considers it an imbalance, something to be corrected or restored within the body.   Rather than viewing the body as a collaboration of "parts" (uterus, ovaries, etcetera), TCM recognizes that each system in the body is interconnected and, therefore, interdependant upon each other.

     Before exploring the Chinese medicine approach to treating infertility we must first understand the concepts which comprise the basis for TCM.  Chinese medicine is based on the philosophy of yin and yang, which represents balance within the body and in life.  Certain physical qualities and character traits are associated with both yin and yang.  Yang is associated with fire and heat, daytime, movement, and extrovertedness.  An individual with an excess of yang energy may be loud or boisterous.  They tend to feel hot and sweat easily, especially in the daytime.  An individual deficient in yang energy would tend to feel cold, especially in the hands and feet and suffer from chronic low energy as well as a low libido.  Yang energy is connected to male energy and, therefore, governs testosterone and progesterone production.  Yin represents qualities such as cold, water and fluids, night, stillness and introvertedness.  A typical yin constitution might feel cold with a shy personality with physical or emotional symotoms that tend to be worse in the evening.  If a person is deficient in Yin energy the fluids in the body will dry up and no longer be sufficient enough to keep the body cool.  This type of heat, known as deficient or "empty" heat will result in increased thirst, hot flashes, as well as night sweats, dry skin, and constipation.  This pattern is commonly seen in women during their menopausal years and governs estrogen production.  The goal is not to be predominantly Yin or predominantly Yang, but to have a balance between the two.

     Another important concept in TCM is the theory that the energy sustaining the body is known as a force called "qi".  This force is not visible to the human eye but has been mapped out by the Chinese in the form of "meridians" or "channels".  These channels can be compared to energetic blood vessels which distribute qi, rather than blood, throughout the body in order to maintain a state of balance.  There are twelve primary or main meridians found throughout the body, most of which correspond to a specific organ.  These are the Heart, Pericardium, Lung, Liver, Gallbladder, Large Intestine, Small Intestine, Spleen, Stomach, Bladder and Kidney meridians.  The other primary meridian is known as the San Jiao channel which harmonizes the energy of the lower, middle and upper sections of the body.  The most commonly affected meridians related to infertility are the Kidney, Spleen and Liver channels.  An imbalance in any of these meridians can affect a woman physiologically and emotionally indifferent ways and greatly affect her ability or inability to become pregnant and carry a fetus to full term. 

     A TCM practitioner diagnoses the individual based on an extensive evaluation of the person's previous and present health conditions, as well as an evaluation of the tongue and pulse.  This will help to determine imbalances between Yin and Yang as well as any blockages or deficiencies along the meridians.  It will also allow the practitioner to form a treatment protocol specific to the individual's needs so that the body can perform at an optimal level of health.  In order to do this, the practitioner must first classify the patient's symptoms to determine which Chinese syndrome best represents their current health status.  TCM classifies symptoms into the following syndromes when treating fertility issues:

Liver Qi Stagnation - A woman suffering from Liver Qi Stagnation may have irregular periods and pains along the sides of her ribcage.  She likely suffers from PMS symptoms such as breast tenderness or swelling, irritability and mood swings.  The pulse will be taut.

Spleen Qi Deficiency - Spleen Deficiency symptoms may manifest as low energy, poor appetite, muscle tenderness, a craving for sweets, and early or scanty periods.  The person will often have problems digesting and may feel bloated after eating and suffer from loose stools.  The tongue will be swollen and pale with a weak pulse.The Spleen, according to Chinese medicine, is responsible for holding the qi and organs in place.  So if a woman is diagnosed with a prolapsed uterus or has had one or more miscarriages it could indicate the Spleen Qi is not strong enough to hold the organs or fetus in   place. 

Kidney Deficiency - Kidney Qi Deficiency symptoms may manifest as fatigue, late and scanty periods, low back or knee pain, and frequent urination.  The tongue will be pale with a thick white coat and the pulse will be weak.  One may have a Kidney Yang Deficiency, which will have the above-mentioned symptoms   plus cold signs such as cold hands and feet, or a Kidney Yin Deficiency, which will show the above signs of heat such as hot flashes and night   sweats.

Blood Deficiency -  Blood Deficiency signs show up as late, scanty or absent periods with a pale complexion, nails and tongue.  The patient is often tired and may suffer  from dizziness.  The pulse will be weak.

Blood Stagnation - Blood stagnation will often show up as late and painful periods, with sharp stabbing cramps and clots in the menstrual blood.  The individual may also suffer from sharp pains elsewhere in the body, such as migraine headaches.  The tongue will be a purplish colour and the pulse may be "choppy"or uneven.

Phlegm - Also known as Damp, Phlegm is associated with irregular periods and excessive vaginal discharge.  Often, the individual struggles with excess weight and digestive problems.  They may feel a heavy sensation over their entire body or feel sluggish, and feel thirsty yet do not drink.  Fibrocystic breasts are often a sign of Damp. The tongue will be moist with a thick, greasy coating and the pulse will have what the Chinese call a "slippery" quality.  A person may have signs of Damp Heat, such as the burning irritation and discharge of a yeast or bladder infection, or Damp with Cold signs such as the above-mentioned Damp symptoms with a general feeling of cold and a cold abdomen.

     The Chinese believe that fertility is a woman's natural right and that difficulty conceiving merely involves correcting one of these imbalances through a combination of acupuncture, acupressure, herbs, and dietary recommendations to alleviate excesses or tonify deficiencies along the affected meridians.  Often, as practitioners, we will see a combination of syndromes.  This is to be expected, as each meridian is connected to the others in various ways.  Each system must be working in harmony together.  If one meridian becomes imbalanced it may eventually disrupt the balance of the other meridians. 

How Does Chinese Medicine Work to Treat Infertility?

     Different acupuncture points stimulate various effects throughout the body, such as stimulating the nervous system to release endorphins to alleviate pain and induce a state of relaxation.  Other points may cause changes on a cellular level, affecting brain chemistry and improving circulation.  When treating infertility, the stimulation if specific acupuncture points can cause a release of prostaglandins into the bloodstream.  This stimulates the nervous system to transmit messages to the hypothalamus.  the hypothalamus is and area of the brain which controls hormonal activity, ovulation, menstruation and pregnancy.  Once the message has been received, Neurotransmitters convert and release GnRH (gonadotropin-releasing hormones) which governs ovary, adrenal and thyroid activity, as well as stimulating the production of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), all essential in the body's ability to conceive and maintain a healthy pregnancy.  Similar treatments can also be used to treat men by improving the motility of sperm and increasing sperm count.

     There are other methods besides acupuncture to stimulate acupuncture points, most of which can be applied by the woman herself in the privacy of her own home.  Acupressure involves applying finger pressure directly on the points for approximately 2-3 minutes at a time.  You can also purchase magnets and apply them to the points best suited to the individual's particular pattern of symptoms.

     Heat is another wonderful method that can easily be applied at home if cold is an issue.  Soaking you feet in a warm foot bath is excellent for increasing circulation throughout the body, including the reproductive organs.  This method is especially useful if the person suffers from cold hands and feet.  You can also apply a heating pad or hot water bottle to the lower abdomen.  This method should only be performed before ovulation, as increased heat in this area may interfere with the implantation of an embryo once ovulation has begun.  A TCM practitioner will commonly use a technique known as moxibustion, which involves burning specific herbs over the kidneys, lower abdomen and specific acupuncture points to warm the organs or meridians and increase circulation.

Specific Acu-points for Treating Infertility

Ren 4 - This point, located on the Conception Vessel along the upper midline of the body about three inches below the navel, is called the "Gate of Origin".  It rests over the uterus and aids conception by tonifying the kidneys, warming the spleen and strengthening the uterus.

Ren 6 - Also on the Conception vessel along the upper midline, this point is located approximately 1 1/2 inches below the navel and is called the "Sea of Qi".  It tonifies the kidneys, especially Kidney Yang, and dispels cold in the uterus to treat uterine bleeding, irregular or painful menstruation, and infertility.

Kidney 3 (Taixi) - Known as the "Supreme Stream", Kidney 3 is the Yuan Source point of the Kidney meridian.  This makes it one of the primary points for tonifying the Kidney qi.  This point nourishes both Kidney Yin and Kidney Yang as well as Kidney essence to nourish the reproductive qi.

Spleen 6 (Sanyinjijao) - This point is located on the inner side of the leg, about three inches above the inner ankle, just behind the shin bone.  If you run your finger with   light pressure upwards from the ankle it should fall into a slight depression and will likely feel a little tender.  It is known as the "Joining of the
Three Yin" and connects all of the yin channels in the leg which include the Kidney, Spleen and Liver meridians.  It tonifies the Spleen, eliminates  Damp, tonifies the Kidneys and balances the Liver Qi.  It is an excellent point for treating all reproductive disorders and encourages ovulation.  As this point is very stimulating to the uterus it should NEVER be stimulated during pregnancy.
 
Liver 3 (Taichong) - Liver 3 is located between the big toe and second toe, in the hollow space about 1 1/2 inches above the web.  This is a very important point for moving the Liver Qi and tonifying Liver Blood.  It is a great point to use when treating any menstrual disorder such as irregualr or painful periods, as   well as PMS symptoms like tender breasts, headaches, irritability and depression. This point may also increase sperm count in men.

Liver 8 (Ququan) - Liver 8 is located on the inside of the knee, about an inch above the inner knee crease.  It is usually quite tender to touch.  This point nourishes the blood (the liver stores blood in Chinese medicine), clears Damp-Heat from the lower part of the body, tonifies the uterus and increases circulation to the reproductive organs.

Pericardium 6 (Neiguan) - Neiguan can be found in the centre of the inner arm, about two inches above the wrist crease.  This points primary function is to calm the spirit. It is well known that stress is a major contributing factor to infertility so it is very important to address this issue and reduce stress levels as  much as possible.  This point is also commonly used to ease an upset stomach, including nausea due to morning sickness.

Ear points - Ear acupuncture, also known as Auricular Therapy, is a system developed primarily by the French.  It takes a more western approach by needling points directly targeting an organ, endocrine system or disease.  For example, there are ear points called simply "lower blood pressure", "hip" point, "constipation" point, and "diabetes" point.  There are dozens of these points within and around the ear that the French have identified.  These are the points which are commonly used to treat dependancies such as smoking and drug abuse, as well as for weight loss.   There are a number of points inside the ear that can be stimulated to enhance fertility such as "adrenal" point, "shen men" (to calm the spirit), "uterus" point, "endocrine" point, as well as the "thyroid" and "ovary" points.

Herbs

Herbal therapy plays a huge part in Chinese medicine.  While most people in the west think of acupuncture when referring to Chinese medicine, in China herbs actually play a much greater role when treating most health disorders:

Liu Wei di Huang Wan - This combination of Chinese herbs in tablet form, known as a patent remedy, can be easily found in most health stores and Chinese groceries. It is a classic Chinese formula for tonifying the Kidney Yin to clear deficient-heat symptoms such as nightsweats and flushing.

Yin Yang Huo (Epimedium), Du Zhong (Eucommia bark)and Man Jing Zi (Chaste Tree berry) - all tonify the Kidney Yang.  Epimedium is indicated for a low libido with low  back pain and frequent urination.  Du Zhong is great for low back and knee pain and also tonifies the Liver, while Chaste Tree berry indirectly increases the body's levels of progesterone and lowers prolactin production, which inhibits ovulation.

Huang Qi (Astragalus) - Most notable in the west for it's cancer-fighting properties, this Chinese herb is a qi tonic which is said to raise the qi (good for preventing miscarriages) and treating auto-immune diseases, which can attack the fetus mistaking it for an invading pathogen.

Ginseng (Korean, Chinese or American) - Ginseng is the most well-known Chinese herb for tonifying the overall qi of the body.  The type of ginseng one would take depends on the individual's constitution.  Korean and Chinese ginseng is, by far, the most stimulating but it is also very warming and must be
avoided if there are heat symptoms.  American Ginseng is much less potent than it's Asian cousins but imparts a cooling quality and is more
appropriate if heat signs are present.  Ginseng may be more appropriate for men struggling with fertility issues as it raises testosterone levels and increases sperm counts.  It can also be used by women to combat fatigue and help the body adapt to stress but it must be discontinued once the
woman becomes pregnant.

Xiao Yao Wan - Another patent remedy, Xiao Yao Wan is the classic Chinese formula for soothing Liver Qi Stagnation.  Herbs like Chai Hu (Bupleurem), Dang Gui and peppermint ease PMS symptoms, headaches, and help reduce the emotional effects of stress on the body.

Dang Gui - A popular blood mover and tonic, Dang Gui is now used quite commonly in the west as a blood tonic to treat irregular and painful menstruation.  Since it tonifies and moves the blood, this herb should be avoided by women with a heavy menstrual flow or those taking blood thinners.

Bai Zhu, Fu Ling, and Huang Bai -  These herbs are all used to clear damp from the body.  Bai Zhu and Fu Ling tonify the spleen qi and help treat digestive disorders while Huang Bai clears damp heat from the lower body, such as yeast or bladder infections.

     As you can see, infertility is an extremely complex issue and there are so many other factors to take into consideration.  Factors such as nutritional deficiencies and stress, among others, play a huge role and must be addressed.  Supplementing with the appropriate vitamins and minerals such as folic acid, zinc and magnesium, as well as eating the foods which are suitable for your constitution, can increase the risk of becoming pregnant while decreasing the risk of birth defects.  Western herbs such False Unicorn Root, Mexican Wild Yam, Damiana and Oatstraw (to name a few) are also very useful when used appropriately.  There are so many ways of approaching this sensitive issue holistically and most of them can be used in conjunction with conventional western methods such as IVF and ART (Assisted Reproductive Technology) and, in many cases, enhance the effects of western treatments.  There have been many documented research studies where acupuncture has significantly increased the success rate of these modern treatments, often after several previously failed attempts.  If you wish to look further into natural ways of enhancing fertility, particularly with Chinese medicine, I would recommend the best-selling book "The Infertility Cure", By Dr. Randine Lewis. Dr. Lewis directs Fertile Soul Retreats in Texas and is one of the leading experts in this field in North America. The methods one chooses to enhance their ability to have children is a very personal choice, and one must choose whichever methods they feel is appropriate for their individual situation.  Whatever feels right in your heart is the best road to take and will always bring the greatest success. 

Carolyn Lowe is the founder of Kian Holistic Health Clinic in Bedford.  She is a Traditional Chinese Medical Practitioner, Registered Acupuncturist, Clinical Herbalist and Nutritional Consultant.  She also specializes in Hair Tissue Mineral Analysis to determine nutritional imbalances and heavy metal toxicity.  Visit Kian's website at www.kianclinic.com or phone 452-4551 for information or to book an appointment.