Diagnosing infertility from a Chinese acupuncture perspective is crucial to formulating a good acupuncture treatment. Infertility can relate to either a Deficiency of the body’s vital energies or to an Excess of Pathogenic Factors. In this discussion I am talking about women’s infertility and hope to add a new page soon to cover men’s fertility. Women’s infertility is defined as the inability to have a baby in a woman who has been trying for 2 years with a normal sex life and with a partner with a healthy reproductive function.
Deficiency relates to either a deficiency of Blood or a Kidney deficiency. Specifically we are talking of Liver Blood deficiency or a Kidney Yin, Yang or Jing deficiency. Liver Blood is common but rarely if ever the sole cause of infertility. Kidney deficiencies are very often critically involved. Often more than one deficiency is involved; commonly associated with a pathogenic factor. If Water (Yin) is deficient there is insufficient nourishment to support egg development or to support a fertilized egg. If Fire (Yang) is deficient there is no “spark” to transform and activate the Water, which therefore cannot fertilize or nourish an egg. If Fire is excessive and pathological, Blood in the Uterus may become hot and provide an adverse environment for fertilization or support of an egg.
Kidney Yang Deficiency
The Kidney in Chinese medicine is the repository of our inherited constitution; Kidney Jing. This primordial material has a Yin and a Yang aspect. Yin is cooling, material, substantive. Yang is warming, and insubstantial; function rather than form. Jing has many correlates in Western science; our genetic coding, the developmental and ageing process, hormonal substance, balance and interaction. Chinese organs encompass the meridians function and locations are cover far broader aspects than their Western counterparts.
Signs and symptoms of Kidney Yang Deficiency:
- Depression (of a more fatigued nature than for Liver Qi Stagnation)
- Feeling Cold
- Prolonged menstrual cycle
- Frequent urination
- The period could be either scanty or heavy
- Tongue – Pale, swollen and wet
- Pulse – Deep and weak
Kidney Yin Deficiency
Kidney Yin is the opposite of Kidney Yang. But nothing in nature is entirely Yin and Yang and the designation is relative. A hot drink is Yang relative to a glass of water at room temperature. But this is Yang relative to an iced-drink; which is relatively Yin.
In my experience Kidney Yin Deficiency often correlates to a high FSH level (High levels of Follicular Stimulating Hormone reflect the fact that the ovaries are ‘tired’ and not responding; a sign of poor ovarian reserve).
Symptoms and signs of Yin Deficiency:
- Night sweating
- 5-Palm Heat (hot palms, soles of feet and upper chest)
- Long-term infertility
- Periods early, scanty, with light colored blood
- Tongue – red without coating
- Pulse – Floating-Empty or Rapid-Fine
Blood in Chinese medicine shares some of the meanings of blood as we know it in the West but as is the case for the organs, discussed above, the Chinese concept of Blood is much broader.
Symptoms and signs of Blood Deficiency:
- Blurred vision
- Dizziness (many of these symptoms show up again and again; care must be taken in diagnosis to relate them to the correct pattern)
- Delayed cycle
- Scanty periods
- Pale Blood
- Tongue: Pale and Thin
- Pulse: Choppy and/or Thin
Excess of Pathogenic Factors
Several Pathogenic Factors may be involved: Cold, Blood-Heat, Damp-Phlegm and Stasis of Blood. Fertilization can’t occur because pathogenic factors block the uterus and Ren & Chong Mai (the two vessels which nourish and regulate the uterus).
Cold in the uterus
Cold obstructs the uterus and dampens ‘The Fire of Ming Men’, preventing fertilization. Cold can be Full or Empty, depending on Kidney Yang Deficiency. An acupuncturist can differentiate between Full and Empty Cold by reading the pulse. In Full Cold the pulse is Full and Tight whilst in Deficient Cold the pulse is weak (also slightly Tight in the left chi position).
Cold in the uterus is more common in younger patients; typically those in their early twenties
Symptoms and signs of a cold uterus are:
- Painful periods: intense, crampy pain
- Primary Infertility
- Scanty period
- Sore back
- Pale face
- Pain helped by heat, such as a hot-water bottle
- Feeling of cold (or colder) during the period
- Small, dark, stringy clots on bright-red blood
- Pale (and possibly wet) tongue, thick-white coating
- Tight pulse. Possibly weak
Blood-Heat in the Uterus
The uterus needs to have a steady warm temperature, neither too hot or too cold. Excessive Heat is as damaging as excessive cold. Both are damaging to a woman’s fertility.
Symptoms and signs of Blood Heat in the Uterus are:
- Painful periods (pain less intense than Cold or Blood Stasis)
- Early periods/short cycle; up to twice a month
- Feeling of Heat (that is worse during the period)
- Agitation, mental restlessness. This may take the form of anxiety or insomnia
- Bright-red or dark-red menstrual blood
- Heavy flow
- Red tongue (with coat = Full Heat; without coat = Empty-Heat)
- Flooding pulse, Rapid
Damp in the Uterus
Damp is a heavy, cloying energy which is associated with an excess of fluids. Women are particularly prone to Damp invading the Lower Burner (pelvic area). Over time Damp can thicken to Phlegm; an even more obstructive pathogen.
Damp blocks proper movement of Qi and Blood and it may lead to stagnation of Qi and/or stasis of Blood. The Ren and Chong Mai are unable to gather the Jing for conception. There is a strong correlation between Damp in the Uterus and Polycystic Ovary Syndrome. Damp-Phlegm in the Uterus corresponds to pelvic or tubal inflammation.
Symptoms and signs of Damp in the Uterus:
- Leucorrhoea (vaginal discharge)
- Mid-cycle problems; slight pain, heaviness, bleeding
- Irregular periods
- Long-term infertility
- Tendency to obesity
- Fullness and heaviness of the abdomen
- Slippery pulse
- Tongue swollen with sticky coat at root
Stagnant Blood obstructs the Uterus.
Stagnant blood prevents the proper functioning of the Ren and Chong Mai so that conception can’t take place. Blood stasis is strongly correlated with endometriosis. If severe and long-lasting it can give rise to abdominal masses, ovarian cysts and myomas.
Symptoms and signs of Stagnant Blood obstructs the Uterus:
- Painful period with intense, stabbing pain. (Cold pain is more crampy, spastic)
- Dark blood with large, dark clots
- Pain alleviated by passage of clots
- Mental restlessness, eg insomnia, irritability, anxiety, worry. Possibly even manic behaviour
- Period that may start and stop
- Period may start or end with brownish discharge
- Tongue: purple; possibly only on the sides. Reddish-purple with Heat; Bluish-Purple with Cold
- Pulse: Choppy, Wiry or Firm