9.miscellaneous Diseases Infertility

9.
Miscellaneous Diseases
（ Infertility ）
Section 1. Infertility
与分析
1.1 Etiology & Pathogenesis
1.2 Diagnosis & Differential Diagnosis
1.3 Pattern Differentiation and

Treatments
1.4 Acupuncture and Moxibustion

Treatment
2
Section 1. Infertility 与分析
1.5 Chinese Patent Medicines
1.6 Prognosis
1.7 Prevention and Self-Care
1.8 Case Study
3
Infertility （不孕症， Bu Yun Zheng

) is defined as no conception after one
year of active sex , without the use of
contraceptives .
4
If a woman has never become
pregnant , it is referred to as primary
infertility . If there has been a
pregnancy in the past ( including full
term pregnancy , miscarriage , ectopic
or molar pregnancy ) but attempts for
another pregnancy fail after one year
of trying , it is referred to as secondary
infertility .
5
The causes of infertility are associated

with both the man and the woman . In
this chapter we consider female
fertility only .
6
Section 1. Infertility 分析
1.1 Etiology & Pathogenesis
Infertility is mainly related to kidney

deficiency and qi - blood disorder in
chong mai and ren mai . The more
common clinical patterns are : a
deficiency of kidney - qi , liver
stagnation , phlegm dampness and
blood stasis .
7
Kidney deficiency ? What can cause 集
8
liver constraint ?
What can cause 集
9
blood stasis ?
What can cause 集
10
phlegm dampness ? What can cause 集
11
Differential Diagnosis 集与分析
be distinguished from case history
12
The physician should inquire about the
woman’s age, health status, sexual life
and how long she has been trying to
conceive. Information about
menstruation , previous pregnancy
and delivery , abortions or
miscarriages is important .
Differential Diagnosis
13
He or she should also pay close
attention to whether or not there is any
history of pelvic infection , what
contraception method has been used in
the past and if there have been
abdominal ( or other ) surgeries in the
past . Any previous or present
endocrinopathy or tuberculosis is
relevant .
14
Family history might include inherited
diseases , heart disease , diabetes , high
blood pressure , high cholesterol or
mental issues .
15
Differential Diagnosis 集与分析
should be distinguished from

Symptoms
16
Different causes of infertility present with
different symptoms .
In the case of ovulatory dysfunction ,
menstrual disorders may be reported
including, amenorrhea . In the case of
endometriosis , infertility is often
accompanied by dysmenorrhea or
spotting before the period .
17
In the case of salpingitis , there may be
pain in the lower abdomen and excessive
vaginal discharge . A woman with uterine
adhesions may also have scanty or no
periods . In the case of immune
infertility , there may be no obvious
symptoms .
18
Essentials of Pattern Differentiation 集与分
析
Differentiation of
patterns
While the main concern is inability to conceive ,
details of menstrual and gynecological history as
well as general health are relevant .
 Delayed menarche , a consistently late
menstrual cycle with scanty flow , accompanied
by soreness of the waist and weak legs , are
symptoms of a kidney deficiency pattern .
19
析
If there is an irregular menstrual cycle ,

unsmooth menstrual flow , accompanied by a
distending pain in the breasts and
hypochondrium , and disturbed emotions , it is
mostly caused by liver constraint .
 If there is obesity , it indicates phlegm
dampness .
20
析
 If there is pain in the lower abdomen with
scanty menstruation , it belongs to the pattern
of blood stasis .
21
Treatment Principles 集与分析
 The emphasis of treatment is on

warming and nourishing the kidney - qi and
regulating qi and blood and keeping the
menstrual cycle regular . Conception is
then more likely to occur .
22
Treatment Principles 集与分析
 The patient needs to have balanced emotions

and circumstances , to be temperate in sexual
activity , and to be aware of her optimum fertile
period at ovulation as the ideal time for intercourse
and conception .
23
Pattern Differentiation and Treatments 集
与分析
Infertility
1.Kidney deficiency
1.1 Kidney-qi deficiency
[ Main Manifestations ]
Long term infertility , irregular

menstruation , menstrual volume
sometimes being excessive or sometimes
scanty .
24
Infertility
与分析
1.Kidney deficiency
[ Other Signs and Symptoms ]
 Dizziness and tinnitus , soreness of the

waist and weakness of the legs , clear long
urine , fatigue and low spirits .
25
Infertility
与分析
1.Kidney deficiency
 [ Tongue and Pulse ]
A pale tongue with a thin coating ,

and a deep and thready pulse ,
especially in both chi regions.
26
[ Treatment Principles ]
Tonify the kidney and boost qi ,
reinforce the essence and supplement
bone marrow .
[ Formula ]
 Yu Lin Zhu ( Unicorn - Rearing Pill , 毓

麟珠） .
27
与分析
Infertility
1.Kidney deficiency
1.2 Kidney-yang deficiency
Long term infertility , late scanty

pale periods or amenorrhea ,
excessive vaginal discharge .
29
Infertility
与分析
1.Kidney deficiency
[ Other Signs and Symptoms ]
A cold abdomen and limbs , low sexual

desire , frequent urination or incontinence ,
dark and dull complexion .
30
与分析
Infertility
1.Kidney deficiency
 [ Tongue and Pulse ]
A pale tongue with a white , moist

coating , and a deep , slow , thready or
weak pulse .
31
Warm the kidney and assist yang ,

dissolve dampness and consolidate
essence .
32
[ Formula ]
Wen Bao Yin ( Uterus - Warming

Decoction , 温胞饮） .
33
与分析
Infertility
1.Kidney deficiency
1.3 Kidney-yin deficiency
Long term infertility , delayed , scanty and

light red menstrual periods .
35
与分析
Infertility
1.Kidney deficiency
Dizziness and tinnitus , soreness of the waist

and weakness of the legs , blurred vision ,
palpitations , sallow , yellowish complexion .
36
与分析
Infertility
1.Kidney deficiency
[ Tongue and Pulse ]
 A pale tongue with a thin coating ,

and a deep , thready pulse .
37
nourish the kidney and the blood,

regulate and tonify chong mai and ren
mai.
38
[ Formula ]
Yang Jing Zhong Yu Tang （养精种玉

汤， Essence - Nourishing Jade -
Planting Decoction ).
39
与分析
Infertility
2. Liver constraint
 Infertility for more than a year ,

delayed menstrual cycle , variable
menstrual volume , breast distention
premenstrually .
41
Infertility
与分析
2. Liver constraint
 Discomfort in the chest and

hypochondrium , distending pain in the lower
abdomen , emotional depression or restlessness
and irritability .
42
与分析
Infertility
2. Liver constraint
A red tongue with a thin coating , and a wiry

pulse .
43
Infertility
2. Liver constraint
Soothe the liver and relieve
constraint , and regulate the blood and
menstruation .
[ Formula ]
Kai Yu Zhong Yu Tang （开郁种玉汤，

Depression - Opening Jade - Planting
Decoction )
44
与分析
Infertility
3. Phlegm - damp
 Infertility for a long time , obesity ,

delayed menstrual cycle or amenorrhea ,
excessive vaginal discharge , whitish in
color and sticky in nature without odor .
46
Infertility
与分析
3. Phlegm - damp
 Dizziness and palpitations , chest distress

and nausea , bright white complexion .
47
与分析
Infertility
3. Phlegm - damp
A tongue with a white greasy coating , and a

slippery pulse .
48
Infertility
3. Phlegm - damp
Dry the dampness and dissolve the
phlegm , regulate qi and
menstruation .
[ Formula ]
 Qi Gong Wan （启宫丸， Uterus -

Opening Pill ).
49
与分析
Infertility
4. Blood stasis
 Infertility for many years , a delayed

menstrual cycle , variable menstrual
volume , dark purple in color , unsmooth
flow with blood clots .
51
Infertility
与分析
4. Blood stasis
 Pain in the lower abdomen aggravated

with pressure , increasing before and during
menstruation .
52
与分析
Infertility
4. Blood stasis
A dark purple tongue , or a tongue with

petechiae at the edge of the tongue , and a
wiry and choppy pulse.
53
Infertility
4. Blood stasis
Invigorate the blood and dissolve stasis
, warm the vessels and unblock the
collaterals .
[ Formula ]
 Shao Fu Zhu Yu Tang （少腹逐瘀汤，

Lesser Abdomen Stasis - Expelling
Decoction )
54
[ CASE STUDY ]
Ms . Zhai , age 28, a nurse .
Chief Complaint : Inability to conceive

for three years , with regular sexual
activity and no contraceptive use .
56
[ CASE STUDY ]
History of Present Illness: The patient

had been married for three years , with
a normal sexual life , not using any
form of contraception ; but she was
unable to conceive .
57
[ CASE STUDY ]
History of Present Illness: Her body

weight gradually increased . Her
menstruation lasted for 3-4 days with a
32-37 day cycle . The menses were
scanty with no dysmenorrhea . There
was also slight leakage of breast milk .
Previous examination at another
hospital revealed increased prolactin in
the blood . Other hormone levels were
normal .
58
[ CASE STUDY ]
History of Present Illness: Previous

intermittent treatment with
bromocriptine showed no significant
effects . After adding metformin ,
breast milk leakage was reduced , but
so was menstrual flow . The menses
were red and slightly pale . At the first
visit , the patient ' s menstruation had
been absent for two months .
59
[ CASE STUDY ]
History of Present Illness: There was

no abdominal pain or other
discomfort . The patient was obese with
a flushed complexion . The tongue was
pale with a white greasy coating , and
her pulses were thready and slippery .
60
[ CASE STUDY ]
Histories of menstruation , leucorrhea ,

pregnancy and delivery:
Her menarche occurred at age 14,
lasting for 3-4 days , with a cycle of 32-
37 days , and a scanty volume .
61
[ CASE STUDY ]
Past History:
She was healthy in the past with no
special disease history .
62
[ CASE STUDY ]
Gynecological Examination:
The vulva and vagina were normal ,
with moderate , light yellow vaginal
discharge. The cervix was smooth and
glossy . The uterus was anteverted , of
normal size , good mobility and no
tenderness . There was no tenderness in
both adnexa . No obvious mass was
palpated .
63
[ CASE STUDY ]
TCM Diagnosis
① Infertility due to internal

obstruction of phlegm - dampness . ②
Delayed menstrual cycle due to
obstruction of phlegm - dampness .
64
[ CASE STUDY ]
Pattern Differentiation
The patient has an improper diet , which
impairs the function of the spleen and the
stomach . Spleen deficiency leads to a
failure in transportation , which gives rise to
retention of water dampness . The collected
dampness transforms into phlegm and
obstructs qi movement , leading to qi
stagnation and blood stasis .
65
[ CASE STUDY ]
Pattern Differentiation
Phlegm binds with stasis to obstruct the
chong and ren mai , resulting in infertility .
The obstruction of the chong and ren mai
leads to delayed menstruation or
amenorrhea . The pale tongue with a white
greasy coating , and thready slippery pulses
are signs of spleen deficiency with phlegm
obstruction .
66
[ CASE STUDY ]
Treatment Principles
Invigorate the spleen and tonify the

kidney , dry the dampness and resolve the
phlegm , and invigorate the blood and
regulate menstruation .
67
[ CASE STUDY ]
Formula
 Modified Qi Gong Wan （启宫丸，

Uterus - Opening Pill )
68

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9.

1.2 Diagnosis & Differential Diagnosis

1.3 Pattern Differentiation and

1.4 Acupuncture and Moxibustion

1.7 Prevention and Self-Care

1.8 Case Study

Infertility （不孕症， Bu Yun Zheng

The causes of infertility are associated

Infertility is mainly related to kidney

be distinguished from case history

should be distinguished from

If there is an irregular menstrual cycle ,

 The emphasis of treatment is on

 The patient needs to have balanced emotions

Long term infertility , irregular

 Dizziness and tinnitus , soreness of the

A pale tongue with a thin coating ,

 Yu Lin Zhu ( Unicorn - Rearing Pill , 毓

Long term infertility , late scanty

A cold abdomen and limbs , low sexual

A pale tongue with a white , moist

Warm the kidney and assist yang ,

Wen Bao Yin ( Uterus - Warming

Long term infertility , delayed , scanty and

Dizziness and tinnitus , soreness of the waist

 A pale tongue with a thin coating ,

nourish the kidney and the blood,

Yang Jing Zhong Yu Tang （养精种玉

 Infertility for more than a year ,

 Discomfort in the chest and

A red tongue with a thin coating , and a wiry

Kai Yu Zhong Yu Tang （开郁种玉汤，

 Infertility for a long time , obesity ,

 Dizziness and palpitations , chest distress

A tongue with a white greasy coating , and a

 Qi Gong Wan （启宫丸， Uterus -

 Infertility for many years , a delayed

 Pain in the lower abdomen aggravated

A dark purple tongue , or a tongue with

 Shao Fu Zhu Yu Tang （少腹逐瘀汤，

Ms . Zhai , age 28, a nurse .

Chief Complaint : Inability to conceive

History of Present Illness: The patient

History of Present Illness: Her body

History of Present Illness: Previous

History of Present Illness: There was

Histories of menstruation , leucorrhea ,

① Infertility due to internal

Invigorate the spleen and tonify the

 Modified Qi Gong Wan （启宫丸，

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