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Treatment of Female Infertility
A New Approach in Chinese Medicine
Samuel Wang, Ph.D., L.Ac.
1. Overview
The following synopsis presents a new approach in treating female infertility developed
by Dr. Samuel Wang at Acupuncture Herbal Center, San Rafael, California. The paper in
its entirety was awarded Outstanding Achievement at the Fifth World Conference of
Traditional Medicine in 2000. Dr. Wang is the founder of the latest microcosmic theory
of Chinese medicine. In light of applying the philosophy of Chinese medicine to both
microcosmic and macrocosmic views, he has integrated ancient Chinese medicine and the
most advanced Western medical technologies in the field of female infertility. This new
approach has succeeded in many difficult cases that had failed to respond to either
conventional Western medicine or classical Chinese medicine. According to this new
approach, the diagnostic procedure for female infertility first follows Western medical
diagnosis of disease, and then each Western disease is subdivided into both microcosmic
and macrocosmic patterns of Chinese medicine. For the different microcosmic and
macrocosmic patterns, Dr. Wang has established a series of therapeutic protocols,
including his unique herbal formulas and triple needle technique. His clinical studies
show that this innovative method most effectively treats unexplained infertility in
Western medicine, simple ovulatory dysfunction, luteal deficiency, cervical factors and
immuno factors respectively. It can also effectively treat female infertility caused by
endometriosis, polycystic ovaries, intrauterine factors, premature ovarian failure and
obstruction of Fallopian tubes. Dr. Wang has opened a new avenue to the successful
treatment of female infertility.
2. Introduction
American Couples who experience difficulty in conception are estimated to be as high as
1 in 6, and among these infertile couples, female factors account for more than 60 to 70
percent.
Female infertility is usually defined as failure to achieve pregnancy after one to two years
of regular unprotected intercourse, in a woman during her reproductive age, with her
male partner’s normal reproductive function. In fact, the concept of female infertility may
be confusing. Of child-bearing women who conceived naturally, after the initiation of
unprotected regular intercourse, 68 percent achieved pregnancy within six months, 86
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percent within one year, 96 percent within two years, 98 percent within three years, 99.8
percent within 5 years and an additional 0.2 percent between the fifth and seventh years
according to some reports (Fig.1). Therefore, the optimal length of time for the definition
of infertility is still controversial. Dr. Wang’s opinion is that this time period should be
set at two years for younger women prior to age 30 and at one year for women older than
30, so that patients can receive treatment without delay in case they are unable to
conceive naturally. If an asymptomatic woman aged 30 or older does not conceive one
year after trying to get pregnant, she should be considered clinically infertile and should
consult a fertility specialist. However, if she is under 30, she may wait for two years
before receiving her fertility evaluations. Women with gynecological symptoms such as
dysmenorrhea, serious menstrual cramps and obscure pelvic pain, should consult their
gynecologists as soon as possible
Fig.1 Cumulative pregnancy rates of
child-bearing women who conceived naturally
after initiation of unprotected intercourse
68
86
96
98 99.8
100
50
60
70
80
90
100
110
0.5 year 1 year 2 years 3 years 5 years 7 years
%
o
f c
um
ul
at
iv
e
pr
eg
na
nc
y
ra
te
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3. Female Reproduction in Classical Chinese Medicine
The Yellow Emperor's Classic of Internal Medicine has been the leading literature of
Chinese medicine since it was first completed approximately 2,500 years ago. This
classic believes that female fertility is associated with the Kidney, the Conception
meridian and the Chong meridian, which are necessary for female reproduction. It also
describes that a woman's physiological changes take place every seven years.
At age 7, a girl has sufficient Qi in her Kidney. Her teeth begin to change and her hair
grows longer.
At 14, her Conception meridian begins to circulate and her Chong meridian becomes
strong. As Tiankui arrives and menstruation starts, conception is possible.
At 21, when her Kidney Qi has reached the highest peak, her wisdom teeth and body
have fully developed.
At 28, her tendons and bones are strong, hair has reached full length, the body continues
to flourish, and she remains in the most fertile period in her life.
At 35, her face begins to wrinkle and the hair thins when the energy in the Yang Ming
meridian declines.
At 42, as the Qi and Blood decrease substantially in the three Yang meridians that branch
to her face, her face looks more wrinkled and her hair begins to turn gray.
At 49, when her Conception and Chong meridians become deficient, her Tiankui
exhausts, menstruation ceases, and fertility terminates.
In fact, due to the cultural differences and the improvement in both nutrition and living
conditions, women today, on the average, start puberty one to three years earlier, and
menopause two to three years later than those in ancient times. Generally, today’s female
fertility initiates its downturn between the ages of 35 and 38, and undergoes a rapid
decline between 43 and 46.
Although there are minor differences between modern and ancient women, the basic
ideas about the physiology of female reproduction in The Yellow Emperor's Classic of
Internal Medicine are still the important guidelines in today's diagnosis and treatment of
female infertility in Chinese medicine. Any disturbances of the above physiological
process may result in infertility.
4. Diagnosis of Female Infertility
According to Microcosmic Method of Chinese Medicine
Classical Chinese medicine perceives the human body only in the macrocosmic view, so
it assumes that the microcosmic conditions in the human body are always compatible
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with the macrocosmic ones. However, it cannot explain the fact that under certain
circumstances, the differences do exist between microcosmic and macrocosmic
conditions. Since modern Western medicine usually emphasizes the pathological changes
in microcosmic view, classical Chinese medicine is dissociated with the achievements in
modern Western medical sciences. The issue is still related to the research methodology
of Chinese medicine. Dr. Wang has developed a new research methodology of Chinese
medicine: applying the unique dialectical philosophy of Chinese medicine in
microcosmic view to the achievements in modern Western medicine. He has discussed
this new research methodology in detail in his article, The Research Methodology of
Chinese Medicine. In light of this new research methodology, Dr. Wang has successfully
established his innovative microcosmic theory of Chinese medicine, which enables
Chinese medicine to be naturally integrated with modern Western medical sciences.
Chinese medicine is essentially characterized by its dialectical concept, without which it
is not Chinese medicine. However, microcosmic theory or microcosmic method of
Chinese medicine is different from the classical Chinese medicine in some aspects.
Microcosmic method of Chinese medicine not only inherits the essence of the
methodology of classical Chinese medicine, but also absorbs the great achievements in
modern Western medicine. Since its essence is not changed, microcosmic method of
Chinese medicine is still in the category of Chinese medicine, except for its acceptance of
modern medical sciences as well as its application of dialectical philosophy of Chinese
medicine to both macrocosmic and microcosmic views.
In microcosmic method of Chinese medicine, the pattern diagnosis for female infertility
is still based on Eight Entities and Internal Organs, but there are patterns in both
macrocosmic and microcosmic aspects.
The Eight Entities for female infertility are the analysis and classification of Yin and
Yang, Exterior and Interior, Cold and Heat, Deficiency and Excess, to determine the
overall nature of the disease. However, in microcosmic method of Chinese medicine, the
Eight Entities are subdivided into both macrocosmic and microcosmic ones. Yin and
Yang are the general opposite sides in nature: Exterior, Heat and Excess belong to Yang,
while Interior, Cold and Deficiency toYin. Hyper-functions are Yang and hypo-functions
Yin. Yin and Yang are the most essential dialectics in Chinese medicine, opposing and
unifying each other. When Yin and Yang are harmonized both microcosmically and
macrocosmically in a woman’s body during her reproductive years, her Chong and
Conception meridians will function properly and she will not have difficulty conceiving.
However, when Yin and Yang are out of balance, Yin or Yang syndrome will occur. Yin
syndrome refers to the decline of Yang Qi in the body or the excessive Yin Qi,
demonstrating Cold in nature or feebleness in the body' s response. Yang syndrome
means Yang and Qi Excess, suggesting Heat, Excess in nature or exorbitant body
response to the pathogenic factors. In Yang syndrome, the vital Qi is usually intact.
Female infertility is generally divided into these two main categories: Yin syndrome
versus Yang syndrome. According to microcosmic method, sometimes, both Yang
syndrome and Yin syndrome may occur in the same woman’s body at the same time, for
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example, microcosmic view shows Yang syndrome while macrocosmic view
demonstrates Yin condition, or vise versa.
The Exterior and Interior indicate the location of pathological changes and the severity of
disease. Conditions located superficially are considered to be Exterior pattern, which is
usually less severe. However, conditions originating from the viscera and the
pathological changes deeply located in the body belong to Interior pattern, which is
usually more severe. Unfortunately, female infertility is almost always classified as
Interior either in macrocosmic or microcosmic views.
The Cold and Heat are two aspects to differentiate the nature of a disease. The Yellow
Emperor's Classic of Internal Medicine points out that "Excessive Yin leads to Cold, and
excessive Yang to Heat." and "Yin Deficiency generates Heat, and Yang Deficiency
Cold."
The Deficiency and Excess are two opposites to measure the strength of the defense
mechanisms of the body, as well as the vital Qi. The Yellow Emperor's Classic of Internal
Medicine also states "Exuberant pathogenic factors result in Excess pattern, while
excessive consumption leads to Deficiency pattern." Deficiency pattern is mostly seen in
those patients with insufficient Vital Qi. However, the stagnation of pathogenic factors of
Chinese medicine in meridians and collaterals or in internal organs is in the category of
Excess. So is Qi and Blood stagnation. All the above stagnations are almost always
associated with Excess in microcosmic view, irrespective of the macrocosmic projection
that may show either Excess or Deficiency.
Because female infertility is almost always Internal conditions, Eight Entity pattern
differentiations for female infertility only leave Cold versus Heat and Deficiency versus
Excess. Classical Chinese medicine identifies four different combinations for female
infertility: Excess Cold, Deficiency Cold, Excess Heat and Deficiency Heat respectively,
as it views the Eight Entities macrocosmically only. However, Microcosmic method of
Chinese medicine perceives the Eight Entities in both macrocosmic and microcosmic
views, so it is much more complicated than the way that classical Chinese medicine
perceives the Eight Entities. Theoretically, microcosmic method may recognize up to 16
combinations of Eight Entity patterns for female infertility, i.e., 4 (microcosmic Eight
Entity patterns) x 4 (macrocosmic Eight Entity patterns) = 16 (combinations). Clinically,
for female infertility, the most common forms of Eight Entities in microcosmic method of
Chinese medicine are both microcosmic and macrocosmic Deficiency Heat as well as
both microcosmic and macrocosmic Deficiency Cold, then microcosmic Excess Cold.
Microcosmic Excess Heat may be seen in acute or chronic pelvic inflammation in
women. Furthermore, it is not uncommon that an infertile woman may demonstrate
Excess and/or Heat in microcosmic view, but Deficiency and/or Cold in macrocosmic
projection simultaneously.
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Pattern diagnosis of internal organs is also important in evaluating female infertility.
However, only three organs, the Kidney, the Liver and the Spleen, are most directly
involved in female infertility.
The Kidney is essential to female reproduction. The Kidney is the source of congenital
Essence and the root of life. It has two sides: Kidney Yin and Kidney Yang, which are
the most important material and function of the female reproductive system. The Yin and
Yang of the Kidney should not only be prosperous, but also harmonized. For Kidney
syndrome, there are several pathological patterns: Kidney Yang deficiency, Kidney Yin
deficiency with excess Yang, combination of both Kidney Yin and Yang deficiency,
Kidney Qi deficiency, or Kidney Qi and Yin deficiency. Any of the above patterns in
either macrocosmic or microcosmic views, or in both, may result in malnutrition of
Chong and Conception meridians as well as in Qi and Blood stagnation, subsequently
causing female infertility.
The Liver stores Blood, regulates the normal flow of Qi and Blood, and coordinates the
functions of the viscera. Emotional distress such as anger and depression impairs the
Liver by stagnating the Live Qi. Persistent Liver Qi stagnation will eventually result in
Blood stagnation. Blood stagnation due to stagnation of Liver Qi may be one of the
etiologies of female infertility in Chinese medicine. Clinically, Liver Qi stagnation is so
common that almost every infertile woman suffers from it in different degrees either
microcosmically or macrocosmically.
The Spleen is the source of acquired Essence as well as the source of Qi and Blood,
supplying nutrients to the Five Viscera, the Six Hollow Organs and the female
reproductive system. The Chong meridian also obtains Yuan Qi and Blood from
Yangming Stomach meridian because they are connected to each other. When the Spleen
and the Stomach are functioning properly, the Essence is sufficient, then Qi and Blood
will be abundant. Therefore, a healthy Spleen will sufficiently nourish the Chong and
Conception meridians, ensuring the basic requirements for both conception and gestation.
If the Spleen is deficient, it cannot properly transport wastewater, resulting in Damp
accumulation. Sooner or later, Excessive Damp will become Phlegm, which will
subsequently obstruct the Chong and Conception meridians as well as the female pelvic
organs — uterus, Fallopian tubes and ovaries. In microcosmic view of Chinese medicine,
this process is the pathogenesis of uterine fibroids, endometriosis, polycystic ovaries,
ovarian cysts and certain types of dysmenorrhea. Furthermore, because of the above
process, the lack of acquired Essence may be the direct cause of female infertility. The
Deficiency in the Spleen is usually a macrocosmic condition in female infertility, but the
consequences of Spleen Deficiency, such as the accumulation of Damp and Phlegm, can
be a microcosmic condition. Evidently, macrocosmic and microcosmic conditions can
influence each other.
In addition to complete physical examinations, modern Western medicine employs
various special diagnostic techniques (sonogram, hysterosalpingogram, endoscopy and
laboratory tests) to make a Western diagnosis for female infertility. The common causes
of female infertility in modern Western medicine include simple ovulatory dysfunction,
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luteal deficiency, Fallopian tube obstruction, cervical factors, immunological factors,
uterine fibroids, other intrauterine factors, endometriosis, and premature ovarian failure.
Clinically, about 10-18% of infertile women may fail to have a positive Western medical
diagnosis even though they have gone through all the sophisticated Western medical
examinations available. In Western medicine, these patients belong to the category of
unexplained infertility.
In order to obtain the best treatment results from Chinese herbs and acupuncture, the
integration of both Chinese medical pattern diagnosis and Western medical diagnosis of
disease is extremely important. According to microcosmic method of Chinese medicine,
the diagnostic procedure is first based on the modern Western medical diagnosis of
disease, and then each Western disease is subdivided into both microcosmic and
macrocosmic patterns of Chinese medicine. When Western medicine is unable to reach a
definite diagnosis, such as unexplained infertility, microcosmic method of Chinese
medicine can still make a pattern diagnosis in either macrocosmic or microscopic view.
Generally, in the macrocosmic aspect, the microcosmic method of Chinese medicine is
quite similar to classical Chinese medicine, emphasizing the coordination of the whole
body. However, in the microcosmic aspect, this method is focused on the local
pathological changes or on the functional disturbances of a specific system of the body.
Clinically, tongue, pulse and facial complexions of a patient usually reflect the
macrocosmic patterns of Chinese medicine, but the individual Western medical diseases
mostly correlate with the microcosmic patterns of Chinese medicine. Accordingly, in the
same patient, the microcosmic patterns of Chinese medicine may not always be
compatible with the macrocosmic ones. For example, endometriosis or polycystic ovary
fits in Blood stagnation and Phlegm, definitely indicating Excess pattern in microcosmic
view, but the pulse, tongue and facial complexion of the patient with endometriosis or
polycystic ovary may show Deficiency pattern as long as the patient’s macrocosmic
conditions are deficient.
5. Treatment of Female Infertility
Using Microcosm Method of Chinese Medicine
Since the microcosmic patterns of Chinese medicine are connected to certain Western
pathological changes or Western functional disturbances as mentioned previously, the
treatment principles of Chinese medicine for female infertility are discussed below in
accordance with the Western terminology of diseases.
Simple Ovulatory Dysfunction
Simple ovulatory dysfunction is one of the most common causes of female infertility. In
microcosmic method of Chinese medicine, the Kidney regulates the reproductive
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functions through its axial system: Kidney — Chong and Conception meridians. This is
similar to the concept of modern Western medicine that physiological functions of
reproduction are regulated by the central axis: hypothalamus-hypophysis-ovary-uterus.
In modern Western reproductive pathophysiology, the dysfunctions of the axial system of
hypothalamus-hypophysis-ovary-uterus often disturb the ovulation. The periodical
change of serum estrogen level, mainly Estradiol (E2) is the key in regulating ovulatory
cycle. If E2 level is not high enough to trigger the surge of LH secretion before ovulation,
ovulatory dysfunction occurs. Anovulatory patients are categorized into two main groups:
low estrogen level group and relatively high estrogen level group. In microcosmic view
of Chinese medicine, the former group is usually associated with Kidney Yang
Deficiency, while the latter with Kidney Yin Deficiency. In addition to Kidney Yin
Deficiency, many anovulatory patients with relatively high estrogen levels manifest
microcosmic Liver Qi congestion. In general, anovulatory patients with high estrogen
levels should be treated primarily by both nourishing the Kidney Yin and soothing the
Liver, whereas those with low estrogen levels by warming the Kidney Yang.
For kidney Yin def