TREATING INFERTILITY with CHINESE MEDICINE by Cindy Micleu, L.Ac
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TREATING INFERTILITY WITH CHINESE MEDICINE By Cindy Micleu, L.Ac. Throughout the menstrual cycle, changes in repro- Hunt, a research biologist at Washington State ductive physiology are matched by energetic changes, University, has shown that repeated small exposures to with fluctuations of yin, yang, qi, and blood reflected in these chemicals found in everyday life specifically target the various phases of the cycle. Examining these the reproductive system and can cause severe genetic changes in the follicular, ovulatory, luteal, and menstru- abnormalities in egg cells.1 al phases, allows for a detailed view of a woman's repro- Statistics show one in eight people in the U.S. have ductive cycle. In the diagnosis and treatment of infertili- an infertility problem (Resolve: The National Infertility ty with Chinese medicine, the AOM perspective is Organization). This is a quickly growing patient popula- assessed with special regard for reproductive health, and tion. There has been a great deal of research on the use the normal functioning of each specific stage of the men- of Chinese medicine in conjunction with ART (assisted strual cycle is supported as needed. reproductive technology) with significantly positive out- Treating the menstrual phases is also a strategy com- comes, which has led many fertility clinics to refer monly employed in cases of "unexplained infertility," a patients to Chinese medicine. Patients are often spending diagnosis frequently given when there are no specific a great deal of money on fertility technology, with expo- problems detected in a Western sure to high levels of chemical hor- medicine infertility evaluation. In CHONG RELEASE FORMULA mones. There is also the long-term these cases, the ovarian follicles are Spatholobus Ji Xue Teng . 15% emotional stress inherent in the developing normally on ultrasound process. For many reasons, Chinese Mimosa Tree Bark He Huan Pi . 15% evaluation, hormone levels are in medicine practitioners are in a White Peony Bai Shao . .12% normal range, and ovulation seems unique position to be important and to be occurring properly. Pelvic Codonopsis Dang Shen . .. .12% effective health care providers for organs are structurally sound and White Atractylodes Bai Zhu . .12% these patients. free of endometriosis and fibroid Angelica Sinensis Dang Gui . 10% tumors, the endometrial lining Red Peony Chi Shao . 10% TREATING FEMALE builds adequately, and sperm Ligusticum Chuan Xiong . 6% INFERTILITY THROUGH parameters are within normal range. Persica Seed Tao Ren. 5% THE MENSTRUAL Advanced age is often the assumed Carthamus Hong Hua . .3% CYCLE problem in these infertility cases. Menstrual Phase In a Chinese medicine evaluation, more subtle cues Day 1 of the menstrual cycle is the first day of the of imbalance may be detected, but not always. menstrual period. The actual definition of which day is Sometimes infertility patients are seemingly robust and designated as "day 1" can vary from source to source. healthy, and often fairly young, yet they have significant Generally it is the first day of significant menstrual problems conceiving. In fact, women in their 20's have bleeding, not just spotting. If the period begins in the the fastest growing infertility rate of any age group, evening or during the night, from about 6pm-midnight, according to the National Center for Health Statistics. In "day 1" is considered to be the following day. Oriental medicine, the kidney and liver dominate repro- During menstruation, the endometrial lining of the duction, yet patients may have little or no symptoms of uterus is shed. A quick drop in progesterone usually pre- low back pain, nighttime heat, excessive dryness, or cedes the beginning of the period, and on day 1 both the fatigue, and their menstrual cycle and flow may be rela- estrogen and progesterone levels are relatively low. tively normal. They may have few complaints and no From a Chinese medicine point of view, with the clear diagnostic imbalance, though their liver and/or kid- loss of blood during menstruation, the ren and chong ney pulses are weak. gradually empty, and by the time the menses is over the In recent times, the term "reproductive health" has ren and chong, kidney yin, and liver blood are at their been used to distinguish a person's general state of health lowest in the cycle. Problems during the menstrual peri- from that of their reproductive system. From a Western od are most commonly indicative of problems with qi medicine point of view, researchers are increasingly sus- and blood flow, while problems that occur or are worse picious of the role that environmental toxins play on ris- towards the end of the menses are generally associated ing infertility rates. Referred to as "endocrine disruptors" with blood deficiency. because they interfere with hormone function, some Treatment of infertility during the menstrual phase chemicals such as phthalates and bisphenol A (in many focuses on clearing any stagnation that may impede the plastics) have been implicated in rising rates of cancer, quality and movement of qi and blood in the following miscarriage and both male and female infertility. Patricia 2 INFERTILITY cycle. Clearing blood stasis facilitates the complete dis- Secondarily, heat may be a problem during this charge of menstrual blood so that the new endometrial phase, as it easily causes damage to the yin, and can lining can grow on a smooth, clean base. Some practi- enter the blood prompting it to move recklessly at ovu- tioners will use herbs to "flush" the uterine lining blood lation or menstruation. Heat can cause follicles to grow during menstruation, encouraging the complete dis- too quickly, resulting in poor egg quality, and may cause charge of the endometrium, even if there are no overt early ovulation and the shortening of the entire menstru- symptoms of blood stasis. But in particular, if there are al cycle. signs of stasis such as clotting, cramping, or irregular Heat in the follicular phase is commonly due to yin bleeding, this may be a particularly useful strategy. deficiency or stagnation of the heart and liver qi. Patients A base formula used during the menstrual phase is with fertility problems frequently experience a great deal Chong Release Formula (Jia Wei Tao Hong Si Wu of stress when month after month they are unable to con- Tang). Shu di was omitted from the traditional formula ceive. In these cases, heat from stagnation may disturb due to its cloying nature, while herbs to support the the steady building of yin and blood, and is often seen in spleen were added to reinforce the ability of the qi to upward spikes in the basal body temperature. expel the blood effectively and to support the production Nourish Ren & Chong Formula (Jia Wei Gui Shao of blood after the loss during menstruation. Di Huang Wan) is a very effective formula for the follic- ular phase, nourishing both the yin and blood. The heart Follicular Phase and liver may be addressed with The follicular phase begins on NOURISH REN & CHONG FORMULA additions or modifications to the day 1 of the menstrual cycle when formula. Chinese Yam Shan Yao. 12% new follicles, containing eggs, With the use of yin and blood begin their growth. Clinically, we Angelica Sinensis Dang Gui . 12% tonifying herbs, fertility signs often generally begin support of this White Peony Bai Shao . .12% show clear improvement. Long or phase after the major menstrual Cured Rehmannia Root Shu Di Huang. .10% short follicular phases regulate, cer- blood flow is over, usually around Cornelian Cherry Shan Zhu Yu . 9% vical mucus increases, menstrual day 4. Lycium Fruit Gou Qi Zi . .9% blood quantity and quality improves, During the follicular phase, Salvia Dan Shen . .8% and basal body temperature charts the hypothalamus and the pituitary Gardenia Zhi Zi. 8% become more even. Correspondingly, interact, stimulating the pituitary Tree Peony Root Bark Mu Dan Pi . 5% western lab tests often show to release FSH (follicle stimulating improvement in follicle and endome- Poria Fu Ling . 5% hormone), that in turn stimulates trial lining development. Asian Water Plantain Ze Xie . 5% the maturation of the ovarian folli- Ovulatory Phase cles. One of these follicles will Tangerine Peel Chen Pi . 5% When the main developing follicle grow to become the largest, or dom- becomes large enough and estrogen reaches a certain inant follicle, and will release its egg at ovulation. level, ovulation will occur. Prior to ovulation, the hypo- The regeneration of the endometrium, or uterine lin- thalamus and pituitary gland again play a major role as ing, begins about 2 days after the onset of menstruation, LH (luteinizing hormone) is released. This causes the even though menstrual bleeding still continues. This "LH surge" which occurs about 24 hours prior to ovula- process includes tissue repair of the uterus where the lin- tion and is detected by an ovulation predictor kit. ing has shed, as well as the development of estrogen and In a normal, healthy ovulation, the basal body tem- progesterone receptors in the new tissue. Estrogen is the perature chart will show a quick rise in temperature with dominant hormone during this phase, and as the levels the LH surge, and temperatures will then stay relatively gradually rise, proliferation of the endometrium and its high throughout the second half of the cycle. This is dense vascular network is stimulated. It also causes the indicative of the quick change from yin dominance in cervix to produce cervical fluid. the follicular phase to yang dominance in the luteal From a Chinese medical perspective, follicle devel- phase. Ovulation itself depends on the yin and blood opment is a yin process, dependent on yin, blood and being at their fullest, and the ensuing transformation of essence. In the follicular phase, the Ren and Chong are full yin to yang.