Treating Infertility with Chinese Herbs
By Jake Paul Fratkin, OMD, LAc
Chinese medicine delineates several patterns in infertility. At its core, tonification of blood and kidney qi is necessary in most cases. Further pattern differentiation can be made for deficiency of kidney yang, yin or jing; liver qi stagnation, blood stasis, or accumulation of phlegm and dampness.
In evaluating for patterns, paying close attention to the menstrual history offers the best clues. Irregular periods or premenstrual syndrome (irritability, breast distension, abdominal distension) indicate
qi stagnation; dysmenorrhea indicates blood stasis or exogenous cold into the uterus; amenorrhea or light, scanty periods confirm blood deficiency; and obesity involves stagnation of phlegm and dampness.
Frequent miscarriage often accompanies infertility, and in modern medicine is correlated with low levels of progesterone. The Chinese blood and kidney builders suggested here can boost progesterone levels. Some women with frequent miscarriage will benefit by combining Chinese herbal formulas with bioidentical progesterone. The best way to determine progesterone levels is by lab testing. After the age of 39, however, the viability of the woman's eggs come into question, and is a common reason for first-trimester miscarriage in older women. Chinese herbs cannot strengthen the life-force or integrity of the egg.
For fertility, the formulas described here boost blood and kidney qi. In cases with liver stagnation (irregularity, PMS), management requires addressing qi stagnation during the pre-menstrual phase, from ovulation until the first day of bleeding. A formula like Jia Wei Xiao Yao San is quite adequate. Then, a fertility blood tonic would be used at the end of menses until ovulation, or continued until the period starts. For cases with dysmenorrhea, it is important to use an appropriate formula starting either a day or so before cramping begins, or at least once cramping begins, and until cramping and clot expulsion is finished. Effective formulas include Tong Jing Wan or Shao Fu Zhu Yu Tang. In some patients, it may be necessary to work with three formulas: pre-menstrual, menstrual and post-menstrual.
Achieving a successful pregnancy may be quick, within one or two months, or prolonged over 6-8 months. The best sign of progress is that any menstrual problem becomes better and more normal. This particularly applies to irregular periods or amenorrhea. It is helpful to continue with blood tonics during the first trimester, to boost progesterone and prevent miscarriage. These formulas are also appropriate as post-partum tonics, and of course can be used for treating amenorrhea and irregular periods without fertility as a goal.
The Formulas.
1. Fu Ke Zhong Zi Wan, "Gynecology Seed Pill". Author: Xiang Tian-Rui. Source text: Tong Shou Lu ("Common Longevity Records"), 1762. Availability: Fertile Fields Teapills (Plum Flower); Fu Ke Zhong Zi Wan (Minshan); Nuan Gong Yun Zi Wan (Tanglong).
Ingredients (from Minshan): shu di huang (Radix Rehmanniae Praep, 23.5%), du zhong (Cortex Eucommiae, 11.8%), xiang fu (Rhizoma Cyperi, 11.8%), chuan xiong (Rhizoma Ligustici Chuanxiong, 8.8%), dang gui (Radix Angelicae Sinensis, 8.8%), xu duan (Radix Dipsaci, 8.8%), ai ye (Folium Artemisiae Argyi, 8.8%), huang qin (Radix Scutellariae, 5.9%), e jiao (Colla Corii Asini, 5.9%), bai shao (Radix Paeoniae Alba, 5.9%).
Of the 10 herbs in Fu Ke Zhong Zi Wan, the blood nourishing herbs make up 44% of the formula, and include shu di huang (23%) with dang gui, e jiao and bai shao. Du zhong and xu duan boosts kidney yang (21%), and xiang fu moves liver qi (12%). This is a common presentation in infertility, that is, blood and kidney deficiency with some liver stagnation.
Herbal Times has a Zhong Zi Wan, with a very different formula. Containing 18 herbs, the major herbal categories break down as follows: herbs to boost kidney (25%); herbs to move blood and break stasis (25%); herbs to tonify qi (17%); herbs to tonify blood (10%). This formula addresses infertility with a history of dysmenorrhea due to cold in the uterus, using the warm herbs tu si zi (Semen Cuscutae), xian mao (Rhizoma Curculiginis), xu duan (Radix Dipsaci), yin yang huo (Herba Epimedii) and lu rong (Cornu Cervi Pantotrichum). Due to the inclusion of ji xue teng (Caulis Spatholobi/Millettiae), the formula is technically prohibited during pregnancy, even though its application in the first trimester might be warranted.
2. Wen Jing Tang, "Warm the Menses Decoction". Author: Zhang Zhong-Jing. Source text: Jin Gui Yao Lue ("Golden Cabinet Essential Summary"), 220. Availability: Taiwan extract companies, Plum Flower, Tanglong, Herbal Times, Kan.
12 ingredients (from the Taiwan classical formula): ban xia (Rhizoma Pinelliae, 13.2%, mai men dong (Radix Ophiopogonis, 13.2%), wu zhu yu (Fructus Evodiae, 10%), gan jiang (Rhizoma Zingiberis, 10%), dang gui (Radix Angelicae Sinensis, 6.7%), chuan xiong (Rhizoma Ligustici Chuanxiong, 6.7%), bai shao (Radix Paeoniae Alba, 6.7%), ren shen (Radix Ginseng, 6.7%), gui zhi (Cinnamomi, 6.7%), mu dan pi (Cortex Moutan, 6.7%), gan cao (Radix Glycyrrhizae, 6.7%) and e jiao (Colla Corii Asini, 6.7%).
This prescription treats infertility complicated by cold in the uterus. Warming herbs include wu zhu yu, gui zhi, gan jiang, e jiao and ren shen, and make up 33% of the formula, while warming blood-nourishing herbs make up 20% of the formula.
I treated a competition bicyclist for infertility. While reporting dysmenorrhea, her case was complicated by riding her bicycle during her menses in cold weather. This allowed cold to enter the uterus, and only by addressing the cold was the case able to resolve successfully.
3. Wu Ji Bai Feng Wan, ""Black Chicken, White Phoenix Pill". Author: Gong Ting-Xian. Source text: Shou Shi Bao Yuan ("Long Life Protect the Source"), 1615. Availability: patent medicine from Tianjin Drug Manufactory; Plum Flower; Herbal Times.
10 ingredients (from Tianjin Drug Manufactory): wu ji (Galli Nigroscei, 33.9%), shu di huang (Radix Rehmanniae Praep, 12.9%), sheng di huang (Radix Rehmanniae, 12.9%), lu jiao shuang (Cornu Cervi Degelatinatum, 6.5%), dang gui (Radix Angelicae Sinensis, 6.4%), bai shao (Radix Paeoniae Alba, 6.4%), ren shen (Radix Ginseng, 6.4%), bai zhu (Rhizoma Atractylodis Macrocephalae, 6.4%), xiang fu (Rhizoma Cyperi, 6.4%), and huang qi (Radix Astragali, 1.6%). This is a popular patent medicine used in China as a post-menstrual blood builder. It is one of the best formulas to tonify blood in infertility due to blood deficiency, relying on wu ji, the black chicken with white feathers. The Tianjin and Plum Flower versions contain 34% wu ji, with toal blood builders totally almost 60%. The Herbal Times version, a larger formula of 19 herbs, contains 25% wu ji, and total blood builders at 45%.
4. Bu Xue Tiao Jing Wan. There are 2 Bu Xue formulas available, but with different formulas and applications. The Herbal Times version basically adds yi mu cao (Herba Leonuri) to si wu tang , consisting of shu di huang (Radix Rehmanniae Praep), dang gui (Radix Angelicae Sinensis), bai shao (Radix Paeoniae Alba) and chuan xiong (Rhizoma Ligustici Chuanxiong). Besides providing strong blood building support, the addition of yi mu cao helps break blood stasis and invigorate the blood in the uterus. It is applied in blood deficiency with mild dysmenorrhea.
The second version, Butiao Tablets, is a Chinatown patent medicine that addresses cold-damp accumulation in the uterus, with signs of watery spotting and cramps. It is an unusual and complex formula of 17 herbs, of which five are so uncommon that they are not listed in either Chen or Bensky. Its herbal ingredients can be categorized as follows: 25% to support kidney qi; 18% to dispel wind-damp; 15% to move blood and break stasis; 10% to tonify spleen qi; 9% to soothe liver qi; 8% to stop bleeding; and 4.5% to clear heat. Because it contains ji xue teng (Caulis Spatholobi/Millettiae), it is contraindicated during pregnancy.
5. Yang Rong Wan. Source: modern patent medicine, available from Plum Flower, Minshan and Tanglong.
16 ingredients (from Minshan): dang gui (Radix Angelicae Sinensis, 11.4%), shu di huang (Radix Rehmanniae Praep, 11.4%), bai zhu (Rhizoma Atractylodis Macrocephalae, 11.4%), bai shao (Radix Paeoniae Alba, 8.5%), chuan xiong (Rhizoma Ligustici Chuanxiong, 8.5%), xiang fu (Rhizoma Cyperi, 8.5%), yi mu cao (Herba Leonuri, 8.5%), du zhong (Cortex Eucommiae, 5.7%), huang qi (Radix Astragali, 5.7%), ai ye (Folium Artemisiae Argyi, 5.7%), fu ling (Poria, 2.9%), mai men dong (Radix Ophiopogonis, 2.8%), gan cao (Radix Glycyrrhizae, 2.8%), chen pi (Pericarpium Citri Reticulatae, 2.8%), e jiao (Colla Corii Asini, 2.8%) and sha ren (Fructus Amomi, 0.6%).
This formula primarily tonifies blood (34%), supported by tonification of qi (20%), moving of blood (17%) and moving of qi (11%). The formula is often confused with Ren Shen Yang Rong Tang, which is a combination tonic of qi, blood, yin and yang. Yang Rong Wan is formulated for blood deficiency infertility, without containing any herbs that strengthen kidney yang.
These formulas offer a variety of approaches for addressing infertility. In straight up deficiency, most can be given throughout the month. When there is co-existing liver stagnation, adding in or substituting another formula for the two weeks prior to the period is helpful. In cases of menstrual cramping, adding in a formula during or before cramping is also necessary. My own success rate in infertility in woman under age 39, without structural complications such as fallopian tube fusing or endometriosis, is above 85%. Besides the formulas listed here, American companies offer a number of products that specifically address woman's fertility.
Jake Fratkin, OMD, LAc, has been in the practice of Oriental medicine since 1978. Following undergraduate and graduate training at the University of Wisconsin in Chinese language and philosophy and pre-medicine, he pursued a seven-year apprenticeship in Japanese and Korean style acupuncture with Dr. Ineon Moon and a two-year apprenticeship in Chinese herbal medicine with Drs. Zhengan Guo and Pak-Leung Lau in Chicago. He also spent a year in Beijing hospitals interning in advanced herbal medicine, specializing in gastrointestinal and respiratory disorders, and pediatrics. Dr. Fratkin is the author of several books, including Chinese Herbal Patent Medicines: The Clinical Desk Reference, and is the editor-organizer of Wu and Fischer's Practical Therapeutics of Traditional Chinese Medicine. In 1999, he was named the "Acupuncturist of the Year" by the American Association of Oriental Medicine.
