Editor's Note: Part one of this article ran in the May 2008 issue.
Ovulatory Phase
The primary treatment plan during this phase is to help the eggs mature and promote ovulation.
Herbal Treatment
ba ji tian (Radix rorindae officinalis)
bai shao (Radix paeoniae alba)
dang gui (Radicis angelicae sinensis)
gou qi zi (Fructus lycii)
lu jiao shuang (Cornu cervi degelatinatium)
shan zhu yu (Fructus corni)
shu di huang (Radix rehmanniae preparata)
suo yang (Herba cynomorii)
tu si zi (Semen cuscutae)
xiao hui xiang (Fructus foeniculi)
xu duan (Radix dipsaci)
yi mu cao (Herba leonuri)
yin yang huo (Herba epimedii)
The ovulatory stage is when kidney yin is turning into yang and ovulation occurs with a peak in temperature. To facilitate ovulation, mild blood-moving herbs also are added. Suo yang (Herba cynomorii) traditionally is used for infertility, low libido, lack of kidney jing (essence) and other kidney yang deficiency conditions. It is used with yin yang huo (Herba epimedii), lu jiao shuang (Cornu cervi degelatinatium), xu duan (Radix dipsaci) and ba ji tian (Radix rorindae officinalis) to boost the yang and promote ovulation.
Tu si zi (Semen cuscutae) tonifies both kidney yin and yang and is an essential herb for treating infertility. Xiao hui xiang (Fructus foeniculi) warms the kidney and the womb in preparation for pregnancy. Shu di huang (Radix rehmanniae preparata), gou qi zi (Fructus lycii), bai shao (Radix paeoniae alba) and shan zhu yu (Fructus corni) support the kidney yin for two purposes. They enhance the effects of the yang tonics (kidney yin and yang should always be tonified together for maximum effect) and prevent the yang tonics from creating deficiency in kidney fire. Yang tonics promote the release of the egg. Dang gui (Radicis angelicae sinensis) tonifies blood, and yi mu cao (Herba leonuri) moves the blood. This increases blood supply to the ovaries to induce contraction of the muscles pulling the ovaries closer to the fallopian tubes, thus facilitating the movement of the egg into the fallopian tube.
Administration of dang gui (Radicis angelicae sinensis) is associated with both stimulating and inhibiting effects on the uterus, thereby regulating menstruation.31 Because of this effect, dang gui (Radicis angelicae sinensis) is beneficial and can be used before, during and after menstruation. To regulate ovulation, many herbs are used to promote the production and secretion of various hormones. For example, use of shu di huang (Radix rehmanniae preparata) has a marked stimulating effect on the endocrine system, with the mechanism of action attributed to inhibiting negative feedback signals to the pituitary gland.32
According to another study, administration of ba ji tian (Radix rorindae officinalis) also stimulates the endocrine system and increases the production and release of hormones.33 Most importantly, use of yin yang huo (Herba epimedii) stimulates the endocrine system by increasing production and secretion of endogenous hormones such as corticosterone, cortisol and testosterone.34 Finally, this formula uses many herbs to facilitate and enhance the overall effect of therapy. Gou qi zi (Fructus lycii) and yi mu cao (Herba leonuri) both stimulate the reproductive organs (namely the uterus) to prepare for conception.35,36
Luteal Phase (week before menstruation onset)
The focus during this phase is to regulate liver qi, treat any possible premenstrual syndrome and ensure proper flow of qi and blood in the liver, chong (thoroughfare) and ren (conception) channels. When patients are more relaxed, conception is more likely to happen.
Herbal Treatment
bai shao (Radix paeoniae alba)
bai zhu (Rhizoma atractylodis macrocephalae)
chai hu (Radix bupleuri)
chuan niu xi (Radix cyathulae)
chuan xiong (Rhizoma ligustici chuanxiong)
dang gui (Radicis angelicae sinensis)
fu ling (Poria)
gan cao (Radix glycyrrhizae)
he huan pi (Cortex albiziae)
ju he (Semen citri rubrum)
lu lu tong (Fructus liquidambaris)
xiang fu (Rhizoma cyperi)
yi mu cao (Herba leonuri)
yu jin (Radix curcumae)
Regulating liver qi is the most important treatment strategy during this stage. Liver qi stagnation is characterized by irregular menstruation, abdominal bloating, irritability, emotional instability, short temper and breast distension. This formula is designed to relieve PMS, release tension and stagnation, and prepare the uterus for proper shedding the following week.
Chai hu (Radix bupleuri) and xiang fu (Rhizoma cyperi) smooth the liver qi and disperse qi stagnation. He huan pi (Cortex albiziae) relieves liver qi stagnation and reduces anxiety and irritability. Dang gui (Radicis angelicae sinensis) tonifies blood and relieves pain. Bai shao (Radix paeoniae alba) nourishes the blood to soften the liver and relieve distention and pain. Bai zhu (Rhizoma atractylodis macrocephalae) and fu ling (Poria) tonify the spleen and dispel dampness to facilitate the transportation and transformation of nutrients. Gan cao (Radix glycyrrhizae) supplements qi and helps bai shao (Radix paeoniae alba) soften the liver to relieve pain. Yu jin (Radix curcumae), chuan xiong (Rhizoma ligustici chuanxiong), lu lu tong (Fructus liquidambaris) and yi mu cao (Herba leonuri) break blood stasis in the lower jiao and help it to ensure proper shedding of the endometrial lining during the period. Chuan niu xi (Radix cyathulae) and ju he (Semen citri rubrum) are channel-guiding herbs that help direct the effect of the formula to the lower jiao.
Administration of dang gui (Radicis angelicae sinensis) has both stimulating and inhibiting effects on the uterus, thereby exhibiting an overall regulatory effect on menstruation.37 Furthermore, use of dang gui (Radicis angelicae sinensis) in essential oils form was effective in relieving menstrual pain, with a 76.8 percent rate of effectiveness among 112 patients.38 This action is attributed in part to the herb's analgesic and anti-inflammatory effects, which are similar to or stronger than acetylsalicylic acid.39
Herbs with analgesic effect to relieve pain include xiang fu (Rhizoma cyperi),40 gan cao (Radix glycyrrhizae),41 chai hu (Radix bupleuri),42 and bai shao (Radix paeoniae alba).43 Herbs with anti-inflammatory effects to reduce swelling and inflammation include gan cao (Radix glycyrrhizae),44 chai hu (Radix bupleuri)45 and bai shao (Radix paeoniae alba)46 Herbs with muscle-relaxant effects to relieve spasms and cramps include bai shao (Radix paeoniae alba) and gan cao (Radix glycyrrhizae).47,48 In addition, fu ling (Poria) is added for its mild sedative effect to relieve the general pain and discomfort associated with PMS.49
Yi mu cao (Herba leonuri) has been used specifically to treat irregular menstruation and hypermenorrhea.50 Furthermore, this formula uses many herbs to treat menstruation-related complications. For example, fu ling (Poria) and bai zhu (Rhizoma atractylodis macrocephalae) have diuretic effects, and are used to drain water accumulation and treat edema.51-53 Chuan xiong (Rhizoma ligustici chuanxiong), yi mu cao (Herba leonuri) and bai zhu (Rhizoma atractylodis macrocephalae) have anti-platelet effects, and are used to prevent clotting and pain before and during menstruation.54-56 Finally, yi mu cao (Herba leonuri) has a stimulating effect, while xiang fu (Rhizoma cyperi) has an inhibiting effect on the uterus. The regulatory effects of these two herbs ensure proper and smooth transition throughout changes in the menstrual cycle.57,58
Nutrition
Foods that are cold or sour (all citrus) should be avoided one week before and during menstruation, as they create stagnation and cause pain. More nuts and seeds should be eaten. Avoid overly spicy and pungent foods, as they may cause excessive bleeding. Decrease processed food and increase organic food. Avoid alcohol, coffee and cigarettes.
Lifestyle Instructions
Because there is only one window of opportunity to become pregnant each month, it is important to be patient and to give the herbs enough time to bring the body back to balance. Try not to feel anxious, nervous, depressed or worried. Engage in yoga, meditation, Tai chi chuan or other activities that help with relaxation and focus on something other than constantly thinking about trying to become pregnant. A positive attitude and low stress level can contribute greatly to a successful pregnancy.
Clinical Notes
There are many causes of infertility, all with a corresponding TCM diagnosis. For example, an inability to ovulate often indicates kidney yang deficiency, while tubal obstruction means qi, blood or phlegm stagnation. A specific diagnosis is necessary in selecting the right herbal formula for the patient.
One course of treatment is three months. Efficacy ranges from one to three courses. The couple should not try excessively to become pregnant during the first month of herbal treatment. The liver qi should be relaxed. Proper preconception care enables the body to be at optimal health and is extremely important to ensure healthy conception and pregnancy.
In cases in which the period is irregular and there is no clear distinction of the phases, treat the underlying cause first by using a supplementary formula. When a pattern establishes, use the herbal formulas accordingly. Women who were on oral contraceptives previously may not become pregnant as quickly, because the body needs a period of time to readjust and begin to secrete hormones regularly without the interference of contraceptives. Herbs will help speed up this process.
Cautions
Women who take these fertility formulas may experience more bleeding during their period, which is normal. These formulas are designed to treat infertility. They do not offer any protection against sexually transmitted diseases. These herbs are ineffective for infertility caused by immune dysfunction.
Female infertility is a complicated disorder that has numerous causes. In Western medicine, those with disorders such as irregular or absence of ovulation usually are treated with the drug Clomid (clomiphene), which has side effects such as hot flashes, abdominal swelling, breast tenderness, nausea, vision disturbance and headaches. Those with problems with the fallopian tubes or cervix are treated with physical interventions, such as surgery, intrauterine insemination and in vitro fertilization. Although these methods are effective, they are more invasive, expensive and risky.
Continuous and persistent use of these four fertility formulas will regulate menstruation, balance hormones, and strengthen the underlying condition. Not only will they significantly improve the possibility of successful fertilization, but they also will increase the probability of a smooth pregnancy with minimal complications.
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34. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1989; 9(12):737-8,710.
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