A Discussion on the Diagnosis and Treatment of Infertility

Wang Zi-Yu (1921 - ) Beijing Traditional Chinese Medicine University Professor

Golden Mirror of Clinical Practice from Famous Doctors of Ancient and Modern Times: Gynecology Book, Volume 2 (1999)
Translated by Mary Beddoe

The causes of infertility are both numerous and complex. However, they can be simplified into the five aspects of: Kidney Vacuity, Blood Vacuity, Liver Depression, Phlegm Dampness, and Blood Stasis. Differentiating these patterns and applying the appropriate treatment can strengthen treatment results.

My clinical experience is summarized as follows:

Kidney Qi Depletion Pattern: signs and symptoms often seen include late menses; scanty, pale menstrual blood; long-term marriage without pregnancy; dark, dull, complexion; sore, weak low-back and knees; low libido; frequent nighttime urination; thin, sloppy stool; pale tongue with a white coat; and a deep, slow pulse. Treatment should primarily warm the kidneys and boost jing, as well as nourish and regulate the Chong and Ren channels. Herbs normally used include xian ling pi (yin yang huo), ba ji tian, shi nan ye, tu si zi, fu pen zi, dang gui, shu di huang, chuan xiong, bai shao, zi he che, chong wei zi, wu wei zi, and gou qi zi. Within the formula, xian ling pi, ba ji tian, and shi nan ye can warm the kidney yang; Si Wu Tang can supplement the blood; tu si zi, chong wei zi, fu pen zi, gou qi zi, and wu wei zi can supplement the kidney and boost jing; zi he che, being of blood and flesh, has jing and can therefore greatly supplement the qi and blood, boost the jing and assist yang; modern knowledge and research of these herbs has shown them to effect the development of the uterus.
Chinese Patent Medicines: Wu Zi Yan Zong Wan, He Che Da Zao Wan, Ding Kun Wan (suitable for kidney essence depletion-blood vacuity-uterine cold infertility)

Blood Vacuity with Loss of Nourishment to the Uterine Vessel Pattern: clinical manifestations include scanty menstrual flow that is pale in color; delayed menstruation; dizziness and blurry vision; withered yellow complexion; fatigued spirit; palpitations and reduced sleep; pale tongue with a thin coat; and a deep, thin pulse. The primary focus of treatment should be to nourish blood and regulate the menses. The treatment should also regulate and supplement the liver and kidney. Herbs normally used include dang gui, chuan xiong, bai shao, shu di huang, chong wei zi, shan yu rou (shan zhu yu), lu jiao jiao, and zi he che. Within the formula, dang gui and bai shao nourish and harmonize the blood; shu di huang, shan yu rou, and chong wei zi supplement the liver and kidney, and boost jing and blood; lu jiao jiao, and zi he che both have the properties of flesh and blood, and therefore function to nourish blood, regulate the Chong, and assist pregnancy. The entire formula has the primary focus of nourishing blood, while simultaneously regulating the liver and kidney. In this way, jing and blood are sufficient to nourish the Chong and Ren, enabling pregnancy.
Chinese Patent Medicines: He Che Da Zao Wan (to be taken after the menses), Wu Ji Bei Feng Wan (to be taken during and after the menses)

Liver Depression, Qi Stagnation Pattern: clinical manifestations include marriage for many years without pregnancy; irregular menstruation; menstruation that is inhibited with abdominal pain; menstrual blood with clots; premenstrual -chest, -ribside, and -breast distention and pain; a depression; vexation and agitation, one who is easily angered; dull, red tongue with a thin white coat; and a stringlike pulse. Treatment should soothe liver depression, nourish blood, and regulate the Chong. Herbs normally used include chai hu, zhi xiang fu, yu jin, ju luo zi, he huan pi, dang gui, bai shao, shu di huang, dan shen, ju ye, ju he, and lu lu tong. Within the formula, chai hu, xiang fu, ju luo zi, yu jin, and he huan pi course the liver and resolve depression; Si Wu Tang and dan shen nourish and harmonize the blood, and regulate the Chong; ju ye and lu lu tong have the function of rectifying the qi, moving the collaterals, and dissipating binds, they are also good at treating breast pain. If there is itching of the nipples, this is stasis heat in the liver channel, for which qing pi and pu gong ying can be used.
Chinese Patent Medicines: Dan Zhi Xiao Yao San, Ba Bao Kun Shun Wan.

Phlegm Damp Obstruction Type: clinical manifestations include long-term marriage without pregnancy; obesity; delayed menstruation, or if extreme-amenorrhea; copious vaginal discharge that is thick and pasty; bright, white complexion; dizziness and palpitations; chest obstruction and abdominal distention; a white and greasy tongue coat; and a slippery pulse. The treatment method is to warm the kidneys, strengthen the yang, transform phlegm and eliminate dampness. Herbs normally used include xian ling pi (yin yang huo), xian mao, lu jiao shuang, tu si zi, fu pen zi, dan nan xing, ban xia, fu ling, zhi xiang fu, zhi ke, cang zhu, bai zhu, chuan xiong, ze lan, and zhi shan zha. Within the formula, xian ling pi, xian mao, lu jiao shuang, tu si zi, and fu pen zi warm and supplement the kidney yang; dan nan xing, ban xia, fu ling, cang zhu and bai zhu transform phlegm, fortify the spleen, and disinhibit dampness; zhi ke rectifies the qi; chuan xiong, ze lan, and shan zha quicken the blood and regulate the menses. If the patient is infertile, obese, and has excess body hair, they have insufficient kidney qi with phlegm damp internal accumulation and uterine vessel obstruction. The treatment should warm the kidney yang; transform phlegm; regulate the Chong; and assist pregnancy. Herbs normally used include xian ling pi (yin yang huo), ba ji tian, lu jiao pian, tu si zi, shan yao, cang zhu, bai zhu, dang shen, zhi xiang fu, dang gui, shi chang pu, tian nan xing, hai zao, and yi mu cao. This treatment is suitable for spleen and kidney yang vacuity, with phlegm dampness obstructing the channel and leading to infertility. Polycystic Ovarian Syndrome is often included in this pattern. This pattern cannot be treated short term and receive quick results. It requires long-term treatment in order to obtain results.

Blood Stasis Type: clinical manifestations include lower abdominal distention and pain with menses; numerous menstrual blood clots; dull colored menstrual blood; premenstrual headache; breast and lower abdominal distention and pain; maybe stabbing pain; brown macules on the face; a tongue that is purple and dull colored, maybe with stasis dots; and a stringlike and inhibited pulse. Examination may reveal uterine myoma, ovarian cysts, and the patient may have concretions and clots. Treatment should quicken the blood, transform stasis, soften hardness and dissipate binds. Herbs normally used include gui zhi, fu ling, tao ren, chi shao yao, dan shen, e zhu, san leng, hai zao, shi jian chuan, and liu ji nu. If there is a myoma, the menses will be heavy with large blood clots, therefore remove from the formula san leng and e zhu, and add san qi powder, ma chi xian, and chao mian zi. If there are ovarian cysts, to the previous formula add zhu ling, and cu chao yuan hua. Pelvic Inflammatory Disease is frequently seen with this pattern. The disease causes stasis and obstruction of the channels and collaterals, and upon examination, the fallopian tubes are often obstructed. Treatment should transform stasis; free the collaterals; attack hardness; dissipate binds; course the liver and rectify the qi. Herbs normally used include dang gui wei, chuan xiong, chi shao yao, tao ren, dan shen, zuo mu zhi, chuan shan jia, lu lu tong, zao jiao ci, hai zao, xue jie, chai hu, and guang mu xiang.

In short, the causes of infertility are numerous and complicated. Before assuming the pattern, one must employ the four methods of diagnosis to examine the pattern and find the cause. Then, by obtaining the differential diagnosis and appropriate treatment, these methods can achieve results.