Infertility, Acupuncture and Natural Fertility Medicine
Auto-Immune & Blood Clotting Disorders
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INFERTILITY, ACUPUNCTURE AND NATURAL FERTILITY MEDICINE |
The Miracle
She was overjoyed. And she was shocked. Donna had been trying to conceive for years. She and her husband had been through the cycles of emotional turmoil that often accompany a long-term effort to conceive - starting with optimism, then frustration, anxiety and ultimately the slide into depression. Finally, they gave up hope that they would become pregnant. They decided to adopt a child. That's when what the "miracle" occurred. "I conceived," Donna exclaimed with utter joy.
It's a story that has been repeated many times. A couple relaxes after the overwhelming cascade of emotions they've experienced while trying to create a child. And, finally, their dreams of conception come true. Stress has been shown in many instances to decrease your chances of conception whether you are a woman or a man. That's why it is so important that you incorporate a stress reduction program into your day-to-day life when you are trying to have a child. The success rates for fertility procedures such as IVF and GIFT increase when you use stress reduction techniques. And, that's why acupuncture, an ancient procedure that helps to reduce stress, and Chinese herbal medicine, can help you. The Berkley Center for Reproductive Wellness is devoted to helping you achieve your goal of conceiving a child.
Who are the patients in our fertility program?
Ninety percent of our patients are women, and 90 percent of those women are between the ages of 30 to 47.
"I just delivered a cute and healthy baby boy last Oct. 28, 2004. I thank God for giving me Mike...."
Why Natural Medicine Works
Natural fertility medicine focuses on an holistic approach to treatment which means treating the whole person not just their ‘illness.’ We treat the underlying cause of a medical issue, not just the symptoms. We treat to affect cure, not to suppress symptoms.
Acupuncture, herbs, nutritional counseling and fertility massage all to help minimize undesired side effects of pharmacological substances.
Acupuncture, herbs, nutritional counseling and fertility massage all strengthen and balance your general health helping to make A.R.T. procedures more effective. Pregnancy is often achievable even in the absence of IUI or IVF. "We work at getting your reproductive environment as healthy as possible and really ready for a successful implantation. At The Berkley Center for Reproductive Wellness, your reproductive function will be significantly improved helping your dream of having a baby become a reality.
Treatment Programs for Infertility...
Approximately 35-40% of our patients conceive after participating in The Berkley Center’s unique treatment regimen. Our proprietary protocol includes acupuncture and herbal medicine formulas developed by Mike specifically for each patients individual needs. It also includes participation in a Fertility Food Plan, under the guidance of our Holistic Health & Nutrition Counselor, Kathie Alli, and, enhanced uterine hemodynamics and uterine repositioning by our fertility massage specialists.
Mike Berkley, the Founder and Director of The Berkley Center for Reproductive Wellness is a specialist in the treatment of infertility. Using acupuncture and natural fertility medicine, Mike has helped to turn many of his patients' lives around. Our clinical experience shows that pregnancies and reduced miscarriage rates are best achieved when combining acupuncture, herbal medicine, fertility massage, and nutritional counseling with Western medical protocols. To find out more about a New York City reproductive endocrinologist who embraces and fully supports acupuncture, herbs, nutrition and fertility massage, click here www.batzofinfertilityservices.com.
Mike is New York State Licensed and Board Certified in Acupuncture. He also is Board Certified in Clinical Herbal Medicine by the National Certification Commission for Acupuncture and Oriental Medicine. He is licensed in the state of Rhode Island. He is also licensed to practice acupuncture in Connecticut.
In addition to being an expert practitioner of acupuncture and natural fertility medicine, Mike has tremendous compassion and empathy for all his patients. His goal is to help each and every patient regain his or her health and vitality by using natural medicine which is extremely effective and powerful and has no harmful side effects.
HIGH FSH
Elevated FSH
Women are born with all the eggs that they will ever have, and they lose them constantly throughout life until menopause when few remain.
The term "ovarian reserve" is useful in the field of reproductive medicine. It is an estimate of the reserve of the woman's ovaries, her remaining egg supply. A woman's ovarian reserve is her remaining fertility potential.
There are several ways to attempt to predict egg quantity and quality as well as trying to estimate chances for conception with various forms of fertility treatment. Female age and day 3 FSH levels are two very important variables. The response of the ovaries to ovarian stimulation with injectable gonadotropins (FSH) is another very important variable that affects the overall chance for conception when in vitro fertilization is attempted.
Blood transports hormones from the endocrine system to target cells or organs within the body, including the hypothalamus, anterior pituitary and ovaries, the three essential organs necessary to achieve pregnancy. At The Berkley Center for Reproductive Wellness, acupuncture, herbal medicine, and fertility massage are used specifically to increase blood flow to the ovaries and the uterine lining thereby improving reproductive rates.
If FSH is elevated, the first order of business should be to increase and enhance blood flow to the reproductive organs so that proper hormonal distribution the pelvic bowl is accomplished. At The Berkley Center for Reproductive Wellness, by employing acupuncture and our proprietary herbal formulas, we have successfully increased blood circulation to the ovaries and lowered FSH levels while simultaneously keeping estradiol (E2) between 25 and 65pg/ml. In other words, our treatments don’t falsely suppress FSH levels, but rather, regulate them.
Further, we have repeatedly seen a reduction in the uterine artery pulsatility index after treatment with acupuncture and herbs. The pulsatility index is a method of determining the amount of blood flow to the uterus via the uterine arteries. The pulsatility index should be < 3 and can be ascertained through a transvaginal ultrasound examination with a color doppler. Your gynecologist or reproductive endocrinologist can often perform this test. Women whose pulsatility index is >3 rarely achieve conception.
Via the release of beta-endorphins from the brain, the sympathetic nervous system is affected and vascular modulation occurs with dilation of the uterine arteries, thereby reducing uterine artery impedance and increasing blood flow to the reproductive environment.
Antral Follicles
Antral follicles are small follicles (about 2-8 mm in diameter) that can be seen, measured and counted with ultrasound. Antral follicles are also referred to as resting follicles. Vaginal ultrasound is the best way to accurately assess and count these small structures. In my opinion, the antral follicle counts (in conjunction with female age) are by far the best tool that is currently available for estimating ovarian reserve and/or a woman’s chances for conceiving with in vitro fertilization.
Presumably, the number of antral follicles visible on ultrasound is indicative of the relative number of microscopic (and sound asleep) primordial follicles remaining in the ovary. Each primordial follicle contains an immature egg that can potentially develop in the future. By stimulating blood flow to these follicles with our proprietary protocols, their health can be improved and their maturation can be facilitated.
As mentioned above, we now have scientific evidence that blood flow to the entire pelvic environment is increased through the utilization of acupuncture, herbal medicine and fertility massage. The consensus of Western physicians is that when there are only a few antral follicles visible, there are less eggs remaining as compared to when there are more antral follicles visible.
Our view, based on clinical experience, is that even though there may be a ‘few’ antral follicles present, only one ‘good’ one is required for conception, and the clinical presentation of poor ovarian reserve (few antral follicles) often coexists with diminished egg-quality. By enhancing blood flow to the ovaries we have repeatedly seen improved egg quality, even in women with low ovarian reserve. Remember, only one good egg is necessary for conception.
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FSH Significance |
Less than 9 |
Reassuring level. Expect a good response to ovarian stimulation. |
9 - 10 |
Fair. Response is between completely normal and somewhat reduced (response varies widely). Overall, a somewhat reduced live birth rate. |
10 - 12 |
Reduced ovarian reserve. Usually show a reduced response to stimulation and some reduction in egg and embryo quality with IVF. Reduced live birth rates on the average. |
12 - 17 |
Generally show a more marked reduction in response to stimulation and usually a further reduction in egg and embryo quality with IVF. Low live birth rates. |
Over 17 |
"No go" level in most clinics. Very poor (or no) response to stimulation. No live births. "No go" levels must be individualized for the particular lab assay and IVF center.
We successfully treat women with FSH levels ranging from 15 to 30! |
Many women who visit us present with high FSH levels, and after three to six months of treatment, their FSH levels normalize without being falsely suppressed.
BLOOD AND FERTILITY
The goal of treatment is to enhance blood circulation to the reproductive organs, helping to balance and normalize their functions. Overall, this increases your ability to conceive and decrease your chances of miscarriage. Blood delivers nutrients from the digestive system to all parts of the body. As a result of inhibited blood flow, one may feel lethargic and weak. Acupuncture, herbal medicine, and fertility massage increase blood circulation, increase digestive function, and enhance pregnancy outcomes.
Blood transports oxygen from the lungs to all parts of the body including the fallopian tubes, ovaries and uterus. Acupuncture and herbal medicine facilitate this transport which will immediately improve the health of these organs, increasing reproductive function. Blood transports carbon dioxide from all parts of the body to the lungs for excretion. Since acupuncture and herbal medicine assist in these 'house-cleaning' functions, the removal of toxic waste from your body is increased, therefore improving both your general and reproductive health.
Blood transports waste products from cells to the external environment, mainly, via the kidneys. These waste products are found everywhere in the body including the fallopian tubes, ovaries and uterus. Acupuncture and herbal medicine are able to assist the kidneys in this process of excreting waste. This action can greatly improve your reproductive health as well.
Blood transports hormones from the endocrine system to target cells or organs within the body, including the hypothalamus, anterior pituitary and ovaries. All three of these essential organs are necessary to achieve pregnancy. If your FSH is elevated or you have excessive androgens, the first thing on the agenda should be to increase and enhance blood flow so that proper hormonal distribution is facilitated. By including acupuncture and herbal medicine into your fertility-enhancement-protocol, there is significant improvement in ovarian function, which, in turn lowers FSH levels and thickens the uterine lining via enhanced estrogen secretion.
Acupuncture and herbal medicine have been shown to be effective in regulating estradiol and progesterone levels. When estrogen levels are low one can experience reduced amounts of mid-cycle cervical mucous and increased vaginal dryness, night sweats and dry skin; all signs of estrogen deficiency due to poor ovarian function or due to estrogen receptor down-regulation. An example of estrogen receptor down-regulation can be seen in the older patient who is given Clomid with repeated IUI’s. In this case, the patient’s lining becomes much thinner and her cervical mucous become more scanty after treatment. We have been able to reverse this difficult dilemma.
Blood defends the body against attack from foreign organisms via white blood cells and antibodies. If you are frequently sick and weak, your fertility quotient is severely diminished. By enhancing blood circulation throughout the body, white blood cells and antibodies are sent out to ward off infections which can be contributing to difficulties in conceiving. Acupuncture and herbal medicine have been shown to improve immune function and increase the fertility quotient.
Blood defends the body against injury or infection via the inflammatory response. As a result of the immune boosting action of acupuncture and herbal medicine, injuries and infections heal more rapidly. One clinical example of this is the reduced time of recovery required in the male patient who undergoes a vericocelectomy. With the application of acupuncture and herbs after this surgery, recovery times are often reduced from six months to four months.
Normal clotting factors prevent serious hemorrhage. But, occasionally as a result of inhibited blood circulation, (thrombophilic disease, such as antiphospholipid syndrome) increased clotting may be present. Patients with thrombophilic disease (hypercaogualability) repeatedly miscarry. Our protocols help to reduce the effect of thrombophilia and increase full-term pregnancies.
Blood maintains the body's temperature by circulating heat. Do you have cold hands and feet? Do you feel cold frequently? This may be a sign of inhibited or decreased blood circulation, which, in and of itself, may compromise the effort to conceive. It is important to understand, that though one may 'feel' their coldness in their hands, feet and body, one cannot feel the result of inhibited blood flow to the reproductive organs. It is safe to assume, however, that when one has poor circulation to the extremities, one will also have poor circulation everywhere else in the body, including the fallopian tubes, ovaries and the uterus. Acupuncture and herbal medicine as well as fertility massage increase blood flow to these important reproductive organs, improving their function, and, most importantly, for you, significantly increase your chances of conceiving.
ENDOMETRIOSIS
What is Endometriosis?
The name endometriosis comes from the word "endometrium," the tissue that lines the inside of the uterus. If a woman is not pregnant, this tissue builds up and is shed each month. It is discharged as menstrual flow at the end of each cycle. In endometriosis, endometrial tissue is found outside the uterus, usually inside the abdominal cavity. Endometrial tissue residing outside the uterus responds to the menstrual cycle in a way that is similar to the way endometrium usually responds in the uterus. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed.
However, unlike menstrual fluid from the uterus, which is discharged from the body during menstruation, blood from the misplaced uterus has no place to go. Tissues surrounding the effective areas of endometriosis may become inflamed or swollen. This inflammation may produce scar tissue around the area of endometriosis. These endometrial tissue sites may develop into what are called "lesions," "implants," "nodules," or "growths."
Endometriosis is often found on the ovaries, on the fallopian tubes, and the ligaments supporting the uterus, in the internal area between the vagina and rectum, on the outer surface of the uterus, and on the lining of the pelvic cavity. Infrequently, endometrial growths are found on the intestines or in the rectum, on the bladder, vagina cervix, and vulva (external genitals), or in abdominal surgery scars, Very rarely, endometrial growths have been found outside the abdomen, in the thigh, arm, or lung.
How is Endometriosis Related to Infertility?
Endometriosis can cause infertility by three main mechanisms: 1) anatomical distortion of the pelvic organs which may interfere with normal fertilization of the egg by the sperm and 2) ovarian function compromise as a result of adhesions or cysts (endometriomas) on the ovaries and, 3) inflammatory processes which cause harm to the implanting embryo. If you have endometriosis with no anatomical restrictions to the tubes or ovaries than the question which presents is: does this type of endometriosis presentation cause infertility? The answer is very likely yes and here’s why. Remember that endometriosis is an inflammatory disease. As such, it produces pro-inflammatory cytokines (compounds produced by certain cells, which act as messengers to control the action of lymphocytes and other cells in an immune response). These cyokines contribute to inflammation in the pelvic-uterine environment and can make implantation very difficult. This is why we use herbs with anti-inflammatory properties to address endometriosis in the absence of anatomical obstruction. In the event of anatomical obstruction, IVF is the appropriate method of intervention. Acupuncture and herbs however should still be used to help reduce inflammation and to improve uterine receptivity to improve implantation.
According to the theory of traditional Chinese medicine, endometriosis is a disease which is caused by the stagnation of qi and blood with toxic heat manifesting in the reproductive environment. This is actually amazingly similar to the Western medical concept of endometriosis which is an inflammatory as well as an autoimmune disorder. In fact, any women with endometriosis should, based upon my clinical experience, be tested for other autoimmune markers that can negatively affect her chances of getting or staying pregnant. When there is one confirmed autoimmune disease diagnosed, others are often present. Fortunately, all of these disorders can usually be treated with Western medicine and complementary medicine. Our East meets West approach significantly helps to achieve pregnancy and to reduce miscarriage rates. Remember: good medicine is about proper diagnosis, not continued IVFs which fail for ‘no apparent reason.’
"My husband and I tried to conceive for a very long time with no results. I started going to Mike and found out that I had severe endometriosis. The acupuncture and herbal treatments worked very well as I'm now a very happy mother of two!"
"It has taken me 2.5 years to get this point. I went through every kind of treatment I could think of. Then I started with Mike who told me, “Don't worry." I think it was 45 to 60 days later when I got pregnant. I was absolutely shocked! "
AUTO-IMMUNE & BLOOD CLOTTING DISORDERS
We have 30 different types of white blood cells as part of our immune system. In a reproductive immuno-phenoptype panel, eight of the most important ones are tested. Disorders in any of these eight are prognosticators for a future pregnancy loss regardless of how the conception was achieved. Listed below are explanations of some of these cells, representative tests and their significance.
CD-3 cells. Normal range: 63 - 86%.
These are the most important cells in the immune system. They are low when the immune system is poorly functioning (suppressed) and normal when the immune function is normal. Infertile patients and those with repeated pregnancy loss have values in the high normal range. These individuals have immune systems that are very strong or overactive. An overactive immune function is frequently associated with a 5% incidence of autoimmune disease, including but not limited to thyroiditis, lupus, and rheumatoid arthritis.
CD-4 (T – helper cells). Normal range: 31 – 53%
These cells direct the action of other lymphocytes. In women with infertility or miscarriage challenges these cells are high because they are helping CD3 cells.
CD-8 (T – cytotoxic suppressors). Normal range: 17-35%
These cells coordinate how strongly or how weakly the immune system reacts. They are like referees. In women with repeated miscarriage or infertility, these cells are frequently low as they become exhausted negotiating the hyperactive CD – 3 cells and CD – 4 helper cells.
CD-19 (B cells). Normal range: 3-8%
These cells are plasma cells which are white blood cells (called B cells) that have been triggered to make antibodies. IgM is the first antibody produced to fight anything that enters our body that shouldn’t. This antibody stays in the blood and then, as the immune response progresses, it produces IgG (gamma globulin G) and resides in the lymphatic system. IgA, (gamma globulin A), is the last antibody made in an immune response. It resides in and protects the organs, skin and GI tract. When this antibody appears, it means that the immune response is completed and cannot go any further. When IgA responses (organ immunity) are present in any test for reproductive failure it usually means that the patient has an autoimmune process such as lupus, rheumatoid arthritis or other disorders.
CD-19 (B cells) are almost always high-normal or very elevated in women with an immune cause for their infertility or recurrent pregnancy loss. There is frequently a greater than 12% elevation. This is a very important indicator that the immune system is being over-worked. Endometriosis also provokes CD -19 activity.
Immune disorders and/or thrombophilic disorders are responsible for approximately 30% of repeated pregnancy losses.
Antiphospholipid antibodies
Antiphospholipid antibodies (APA) have been linked to poor reproductive performance including infertility and repeated pregnancy loss. The typical treatment for this disorder is heparin or lovenox.
Heparin or Lovenox helps to prevent intravascular thrombosis (blood clotting) from occurring in the early utero-placental vasculature. There are many herbs including but not limited to *dan shen, chuan xiong, tao ren, yi mu cao, hong hua and wang bu liu xing which do the same thing that heparin/lovenox do in the APA+ patient. The difference however, is that the herbs in combination with acupuncture do not cause stomach problems or bleeding problems or ulcers. Additionally, herbs are given in formulas which usually address both the cause and the manifestation of a pathology whereas Western medicine treats only the manifestation.
I am not suggesting that you do not take Western medicine. In fact, I am a huge proponent of Western medicine, and I believe that including Western reproductive medicine with natural remedies significantly improves pregnancy outcomes far greater than when using one of these modalities alone. Acupuncture and herbal medicine have been used successfully for immunoregulation and blood clotting causes of infertility and/or repeated pregnancy loss quite a long time now.
My eleven years of clinical experience has shown that when combining acupuncture and herbs with the appropriate immunosuppressants such as dexamethasone or IVIG, the effect is more pronounced then when using one of these therapies alone. We have seen, for example, many patients who underwent immunosuppressive and/or anticoagulant therapy whereupon pregnancy was not achieved or, pregnancy was attained only to end in miscarriage. Subsequent cycles which included acupuncture and herbs resulted in increased numbers of take-home babies.
A combined approach is recommended because Western immunosuppressive therapies though efficacious, treat the manifestation of the problem and not the underlying cause which means that your chances of conceiving this time will improve but once you stop taking the medicine, the effects will cease. Acupuncture and herbs strive to reach deeply into ones system and strongly alter the causation or etiology of infertility and repeated pregnancy loss; for good.
Acupuncture and herbs function to enhance and regulate the immune function and, offers a longer term solution. Drug therapies such as dexamethasone, prednisone and IVIG (intravenous immunoglobulin therapy) are much stronger than acupuncture and herbs and therefore, have a more immediate effect. But acupuncture and herbs have a gentle, constant and longer term effect. Therefore, combining both therapeutic models will serve to 1) alleviate the immediate cause of infertility and/or repeated pregnancy loss and 2) strengthen and regulate the immune system to make you stronger and help balance and normalize your immune function so that you can increase your future fertility potential.
Natural Killer Cell Activity (cytotoxicity)
NK cells are lymphocytes that are present in endometrium and in the decidua (the pregnant uterus).
Women with recurrent pregnancy loss, endometriosis and primary autoimmune conditions (such as rheumatoid arthritis and systemic lupus erythematosis), have been found to demonstrate elevated levels of NK cells, which can result in failed implantation. Natural Killer cells actually ‘spray’ the embryo with something called tumor-necrosis-factor which attacks and kills embryos as if they were cancer cells. Via the immunomodulatory effect of acupuncture and natural medicine like herbs, natural killer cell activity may be reduced.
Immunoglobulin therapy (IVIG) has an ability to down-regulate and deactivate NKa cells. Though IVIG has been shown to be effective, its effect is manifest only during the treatment and for a short period of time thereafter. Including acupuncture and herbs in the treatment protocol not only enhances the effect of immunomodulation but, by regulating the immune response, has been shown to have longer lasting effect.
Certain acupuncture points such as Stomach 36, Spleen 6, Ren17, and Ren 6, along with certain herbs including but not limited to *huang qi, shan yao, bai zhu, shu di, dang gui and lu rong have been used to successfully complement IVIG therapy via their immunoregulatory activity.
The Berkley Center for Reproductive Wellness is the first natural medicine clinic in the United States that specializes in treating reproductive disorders. All of our practitioners are licensed and board certified, and we have been treating fertility challenges in New York City since 1997.
*These herbs and acupuncture points are listed for illustrative purposes only and I strongly recommend that you do not self medicate. Take herbs only when prescribed by a Board Certified herbalist who specializes in treating infertility.
Breech Presentation (Yikes!)
Moxibustion for correction of breech presentation: a randomized controlled trial.
JAMA 1998 Nov 11;280(18):1580-4
Cardini F, Weixin H
CONTEXT: Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy.
OBJECTIVE: To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation.
DESIGN: Randomized, controlled, open clinical trial.
SETTING: Outpatient departments of the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic of China.
PATIENTS: Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation.
INTERVENTIONS: The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks gestation and delivery.
MAIN OUTCOME MEASURES: Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery.
RESULTS: The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (P<.001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P<.001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group (P = .02; RR, 1.21; 95% CI, 1.02-1.43).
CONCLUSION: Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.
If you are presenting with breech presentation, schedule an appointment for you and your husband for moxibustion instruction.
Call 877.965.BABY or 212.685.0985
PCOS
Introduction
This article attempts to inform the reader of the causes and manifestations of PCOS and treatment options for those afflicted with this disorder. Western and Chinese medical treatments will be discussed. I have tried to explain the terms and concepts presented here in terms that are understandable to the lay person. This article will also be helpful to the acupuncturist/herbalist who is treating patients with this disorder who wish to conceive. If clarification or further explanation is sought, I would be pleased to take your questions. I may be reached at 877-965-BABY or you can email me at mikeberkley@berkleycenter.com
Through the integration of Western and Chinese medicine the PCOS patient wishing to conceive will have higher success rates than those achieved when using one type of intervention only. This East meets West approach offers new hope to those whose fertile wellness has been compromised by PCOS. Many patients with PCOS were able to regain regular menses, ovulation, and full term pregnancy.
I have created specific acupuncture and natural herbal medicine protocols for the treatment of PCOS and they will be discussed here. I have not added the quantity of herbs to be used in the formula that I have created because I want, at all costs, to prevent patients from self-medicating because this can be dangerous. The prescription which I present is for illustrative purposes only.
Another thing that I want to be clear about is this: pattern differentiation (diagnosis), is of paramount importance in traditional Chinese medicine. In traditional Chinese medicine there is usually no direct Western diagnostic analogue. Practitioners of TCM diagnose disorders based on presenting signs and symptoms not just based on the presenting disease. This means that though many patients may present with PCOS for treatment, they all may have different diagnoses according to traditional Chinese medicine. Here is an example of why: there are obese PCOS patients and those with normal body weight. There are those with insulin resistance and those without. There are those who are completely amenorrheic and those than menstruate occasionally. So, how can each of these very different patients be treated with the same acupuncture points or the same herbal medicine prescription? Yet they all have PCOS.
There are even more complex cases which involve multiple pathologies. For example, the PCOS patient with chronic migraines or the PCOS patient with severe facial hirsutism, or the PCOS patient with blocked fallopian tubes. There are multiple and varied types of presentations and therefore there are multiple and varied treatment approaches.
Though I completely believe in, trust, recommend and value Western medicine, the Western medical approach, though often effective is frequently over-simplified. For example, every PCOS patient who is trying-to-conceive gets treated with clomid no matter the differentiating factors between patients.
Traditional Chinese medicine is extremely elegant and empowers the practitioner to exactly address each and every part of the patient and their illness including the emotional aspect.
Not only are there herbs and acupuncture points that can be employed to address the depression and anxiety that often accompany those facing this and other health challenges, but the doctor of traditional Chinese medicine himself or herself is imbued with healing love and a nurturing soul and is always prepared to bestow this upon his or her patient. The relationship between practitioner and patient is, in and of itself clinically valuable.
Diagnosis according to Traditional Chinese medicine
Each patient is diagnosed according to the 'Four Examinations' and the pattern differentiation derived from it; not according to their disease.
In traditional Chinese medicine, typically, diseases are not treated, but 'patterns of disharmony' are. PCOS is a 'disease'. So, in treating ten women with PCOS, they may all receive different treatment protocols because even though their disease is the same, they may, nonetheless, have ten different patterns of disharmony. This is why 'one-size-fits-all' never works in Chinese medicine and generally speaking just doesn't work clinically.
The clinical expression of this is that an herbal formula 'in a bottle' is the worst way to take herbs. This type of herbal remedy cannot be customized for the 'pattern of disharmony' being treated and therefore is completely antithetical to the tenets of treatment according the TCM (Traditional Chinese Medicine).
The 'Four Examinations' consists of 1) Listening and smelling; 2) Palpating; 3) Observing; and 4) Questioning.
A. Listening and smelling refers to listening to the timber, strength, speed and clarity of the patient's speech. Smelling refers to smelling of the breath and of the vagina for foul odors, the existence of which would indicate disease.
The 'smelling' aspect is a diagnostic tool which is not usually performed in modern times.
B. Palpating means palpating the pulses of the patient which can reveal insight into the patient's systemic health. Palpating also refers to the palpation of parts of the body which may correspond to areas of ill health to help the practitioner to be as accurate as possible in determining what the underlying cause of the main complaint is. For example, if a patient complains of abdominal pain at the right lower quadrant, and upon palpation there is an elicitation of extreme pain, the patient should be referred out to a physician to rule out appendicitis.
C. Observing refers to the overall observation of the patient including their gait, posture, skin, eyes, hair, whether they make eye contact during the interview and everything else that can be observed. It is amazing what can be learned by careful observation.
As the practitioner of TCM does not rely on blood work to arrive at a differential diagnosis, an expertise in doing a proper intake is of paramount importance. Further, I am of the opinion that utilizing the Four Examinations in conjunction with information obtained from Western diagnostics allows the practitioner to arrive at the most accurate diagnosis, and thereby, facilitate the best treatment options.
Let's use this brief case review as an example: A patient arrives to her acupuncturist with the main complaint of infertility. She is 24 years old, weighs 105 pounds, is 5' 3" tall and appears healthy. Her main complaint is primary infertility of 2 years duration and her husband is negative for any sperm anomalies. The acupuncturist, can, of course, through a good intake, arrive at a differential diagnosis but knowing that the patient has PCOS based upon either biological information (for example, an LH to FSH ration of 3:1), or physical findings (polycystic ovaries) derived via an ultrasound will make the acupuncturist's job easier and will help to refine the acupuncturists diagnosis and treatment plan. This is why, when being treated for infertility you must choose an acupuncturist who has Western medical knowledge as well as Chinese medical knowledge.
PCOS
Estimates of the prevalence of PCOS in the general population are approximately 20% to 33%.
Some of the signs and symptoms of PCOS include irregular periods, obesity, hirsutism, acne, and abnormalities of biochemical profiles including elevated serum concentrations of luteinizing hormone, testosterone, and insulin resistance. Insulin is a hormone that is produced by the beta cells, which are pancreatic cells. Insulin is primarily involved in metabolism (control) of carbohydrates (sugars and starches), lipids (fats), and proteins.
Insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin. As a result, higher levels of insulin are needed in order for insulin to have its effects. When there is insulin resistance, there is a good chance that obesity will follow as sugars and fats are not properly metabolized.
PCOS is an interesting disorder in that it is truly a 'spectrum' syndrome. This means that one can be mildly affected or severely affected.
Weight gain is associated with a worsening of symptoms while weight loss reduces the endocrine and metabolic profile and symptomatology.
Raised serum levels of LH and testosterone, in conjunction with low or normal levels of follicle stimulating hormone describe an endocrine profile which is diagnostic of PCOS.
The physical diagnosis of PCOS is achieved by transabdominal ultrasound revealing a polycystic ovary which contains in one plane at least 10 follicles usually between 2 and 8 mm in diameter. But, a diagnosis can be made by biological findings in the absence of physical ones. Women who have normal ovarian morphology in the face of elevated androgen levels and an LH to FSH ratio of 3:1 can be diagnosed with PCOS in spite of the fact that ovarian morphology is normal.
The term polycystic ovaries should really be called poly-follicular-ovaries to reflect a finding that the cysts are actually follicles whose development has been arrested.
Health Consequences of Polycystic Ovary Syndrome
Obesity and metabolic abnormalities are recognized risk factors for the development of ischemic heart disease in the general population and these are also recognized features of PCOS. 50% of the time the individual with PCOS presents with a normal (body mass index), BMI.
Normal weight equals a BMI of between 18.5 and 24.9; overweight equals a BMI of between 25 and 29 and obesity is represented by a BMI of 30 or greater.
You can find out what your BMI is by 'Googling' the term BMI. Various BMI calculators are available on the web.
Obesity worsens both symptomatology and the endocrine profile, so obese women (women with a BMI greater than 30) should be encouraged to lose weight by a combination of caloric restriction and exercise, acupuncture and herbal medicine.
Weight loss improves the endocrine profile and the likelihood of ovulation and a healthy pregnancy. Insulin sensitizing agents such as Metformin are typically used in the management of PCOS.
Women who are characterized by the presence of insulin resistance, central obesity and dyslipidemia ( disorders in the lipoprotein metabolism; classified as hypercholesterolemia), and low levels of high density lipoprotein ( HDL ) cholesterol, are predisposed to premature atherosclerosis (clogging, narrowing and hardening of the large arteries and medium-sized blood vessels), and appear to be at a higher risk of developing diabetes as well as cardiovascular disease.
The prevalence of hypertension is three times higher in women with PCOS. Woman between the ages of 40 and 59 years old women with PCOS have high concentrations of serum triglycerides and suppressed HDL. The management of women with PCOS should be focused on the patient's particular symptoms.
Western medical diagnosis
There are three different ways to make the diagnosis of PCOS
1. Symptomatically
Irregular or absent menstrual cycles. PCOS patients may report to a physician for lack of menses or extremely variable menstrual cycles. Hyperandrogenic symptoms such as acne and hirsutism are the hallmark symptoms of PCOS. Fifty percent of PCOS patients are not obese.
2. Hormonally
Laboratory testing is important for diagnosis, but it is crucial to look at multiple values collectively. Blood testing is performed and the results are compared with known normal levels. In the classic PCOS patient there is a 3:1 LH- FSH ratio. The normal ratio is 1:1. Typically, there are also elevated androgen levels present.
3. Ultrasound:
Ultrasound of the pelvis is typically performed when the clinician suspects PCOS.
If more than10 cysts are found in either ovary that are less than 10mm, this meets the ultrasound criteria for PCOS. Furthermore, polycystic ovaries are typically 1.5 to 3 times the normal size.
Just the presence of polycystic ovaries, without symptoms and/or corroborative biologic findings does not confirm a diagnosis of PCOS.
Some individuals will have abnormal findings in all three categories, (symptoms, hormonal values and positive ultrasound) some in only two, and others in just one. The classic findings for PCOS are menstrual cycle abnormalities, increased hair growth, and obesity. Patients typically seek medical care for the menstrual cycle irregularities, infertility, problems of self-esteem arising from obesity, and excess hair growth.
PCOS is relatively common and seen in approximately 6-10% of all females. This equates to almost 5 million American women. Between 5 and 30% of women have some characteristic of PCOS. This is one of the most common hormonal abnormalities in women of reproductive age and is a leading cause of infertility.
Impaired fertility is a prominent feature of PCOS. This is believed to result from elevated insulin levels that stimulate excess androgen production by the ovaries. This hyperandrogenic state causes premature follicular wasting which causes inconsistent or absent ovulation.
The pathway to deteriorating ovarian function looks something like this: 1) high insulin 
2) elevated androgens 3) premature ovarian wasting.
Since we will be discussing this syndrome from the perspective of traditional Chinese medicine in large part, I think some definitions of Chinese medical/philosophical terms would be helpful.
Yin represents night, winter, female, cold, heavy, dark, downward and inward, stasis, receptive, yielding, phlegm, and dampness.
Yang represents day, summer, male, heat, light, upward and outward, motion, dryness.
Yin and yang in the human body may be represented thusly: yang: exterior, the back, bowels, skin and body hair, the immune function, agitation and strength while yin may be seen as the interior and abdomen, viscera, bones and sinews, blood and body fluids, calmness and weakness.
There are volumes written on the meaning of yin and yang and on the inseparable relationship of the two. For the purpose of this article I feel that this basic information will suffice as a primer. These definitions will come be helpful later on in this discussion.
There are several theories as to what causes PCOS.
First, women with PCOS usually have an increase in LH secretion from the brain. An elevated LH promotes secretion of androgens from the ovaries. In turn, the increased androgen production causes wasting of the developing ovarian follicles and interferes with the production of a dominant follicle.
From a Chinese medicine perspective this state can be referred to as an excess of yang as androgen is a male hormone. Though it is normal that woman have androgen, (yang within yin), an excessive amount represents an imbalance. This underscores the fact that there is always yang within yin and yin within yang, but in the PCOS patient, there is too much yang within yin and therefore a state-of-disease as a result of imbalance manifests. This results in a disruption of normal estrogen (yin) production by the ovaries and the absence of a mid-cycle LH (yang)surge.
One part of the TCM diagnosis of PCOS is termed: ‘damp accumulation with phlegm congealing’. Damp and Phlegm are yin type pathogens.
There are other diagnoses in TCM for the PCOS patient based upon pattern differentiation. For example, a PCOS patient who is somatically normomorphic and whose Western diagnosis of PCOS is based upon the biological finding of hyperandrogenism with normomorphic ovaries would not constitute a patient with a diagnosis of Phlegm-Damp syndrome.
Normally, an egg is released from the dominant follicle, but in PCOS, the follicles do not mature properly and instead, develop into ovarian cysts.
According to the theory of traditional Chinese medicine, the kidneys dominate the marrow which fills the brain(this is not bone marrow), which is where LH is produced. ‘Marrow’ may refer to the functional activity of the brain itself. Thus, energetically, if the kidneys are not functioning properly, this can be causative of increased LH secretion.
Some of the signs and symptoms of Kidney deficiency according to the theories of traditional Chinese medicine( TCM ), are chronic lower back ache, frequent urination, urinary incontinence, urinary dribbling, night sweats, hot flashes, craving for salty foods, poor memory, knee pain or weakness which is not related to trauma, ringing in the ears, low libido, feeling cold frequently, especially at the feet, having dark circles under the eyes which are not related to sleep deprivation or heredity, and are not related to allergies and, having undigested food in the stool. It is not necessary to have all of these signs or symptoms to be categorized as a ‘kidney deficient’ patient.
And kidney deficiency can relate to deficiency of kidney yin, yang, qi or essence. Qi can be loosely defined as energy. Keep in mind that entire books can be written about qi in all its manifestations, permutations, functions and pathologies and to define it as I have is a gross oversimplification of its magnitude; but, for the purposes of this article I think that my definition is acceptable. Essence (also oversimplified here) may be loosely defined as sperm in men and the substance in women known as tian gui, which, when commingled with sperm is responsible for fertilization. I suppose a loose anatomical analogue may be the ooctye, or egg in women.
Hypofunctioning of organ systems in traditional Chinese medicine usually refers to the energetics of the organ(s) in question as opposed to pathology of the organ itself. Kidney deficiency can negatively impact the proper functioning of neuro-hormonal pathways in the brain. According to the theory of TCM , the kidneys are one of the most important organs involved in reproduction. One can make the case theoretically that in every single case of infertility there is a probability of some type of underlying kidney deficiency.
In TCM theory there is a pathological substance referred to as ‘phlegm’. This is not the phlegm that we think of when we have a bronchial infection or a bad cold. There are two main categories of phlegm in TCM : visible and invisible. Visible phlegm can be phlegm causing breast lumps or phlegm spit up by one suffering with a bad cold or having a lipoma. Invisible phlegm is that which can cause severe mental disorders, PCOS, fibroids and other pathologies. Phlegm is a gooky, sticky, viscous obstructing substance which, over time can harden and transform into hard nodules or, can remain soft and present as masses which are not hard but are, nonetheless extremely viscous. It is caused by ‘dampness’ accumulating over a long period of time. Dampness comes from normal fluids or humors in the body that are not metabolized appropriately and start to ‘pool’ and congeal.
A Western biomedical analogy is insulin resistance unable to metabolize carbohydrates and fats which, if left untreated will cause morbid obesity or, according to the language of traditional Chinese medicine, will contribute to the accumulation of phlegm-damp. In Chinese medicine the function of the pancreas is subsumed by the Spleen. It is the spleen, which, when hypofunctioning produces obesity and it is the pancreas, which, when hypofunctioning produces obesity. This is a beautiful example of how Chinese and Western physiology often converge.
Dampness is also blocking and congealing, but less so than phlegm. Dampness, if left untreated, will, over time, transform into phlegm. A good visual example of phlegm can be thought of as leaving a bowl of bacon fat over-night. When the bacon fat is first poured in the bowl it is thick and viscous but can still move; but, when examined the next day it has transformed into a hardened substance. This journey from thick and viscous to ‘hardened’ can be thought of as the process of damp transforming into phlegm. Some examples of phlegm in the TCM sense are fibrocystic breasts, uterine fibroids, goiter, lipomas, pituitary micro and macro adenomas and polycystic ovaries.
Each organ according to TCM theory has, what is referred to as a channel or meridian which traverses both the interior and exterior aspects of the body. The internal meridian of the liver surrounds the uterus and the ovaries. So, one part of the diagnosis in TCM for PCOS is: phlegm congealing in the liver channel. One of the physical manifestations of phlegm congelation in the liver channel is polycystic ovaries.
One of the ‘responsibilities’ of the kidneys is to transform and transport (metabolize) fluids in the lower part of the body. The lower part of the body coincides with the anatomical area in which the ovaries are situated. So, now we can build further upon the original diagnosis of phlegm congealing in the liver channel by adding ‘kidney qi vacuity’. Qi here refers to the energy or functionability of the kidneys. If the kidneys are ‘vacuous’ or hypofunctioning they will not be able to transform and transport (metabolize) fluids in the lower part of the body and thus, dampness will accumulate and transform into phlegm.
Further, kidney qi vacuity with accumulation of phlegm-damp can directly affect the function of the hypothalamous and pituitary via the kidney channels’ connection with the Du mai (another acupuncture meridian) which enters the brain directly at the acupuncture points Du16 and Du20. These acupuncture points are located at the upper neck(sub-occipitally), and at the top of the head respectively.
Additionally, as Kidney yin fails to nourish Liver Blood, the qi of the liver can stagnate. Stagnant liver qi can contribute to the accumulation of dampness and phlegm because the qi of the liver is responsible for, among other things, the free flow of qi. If qi is ‘stuck’, fluids will pool and transform into dampness and, if left untreated, will transform into phlegm.
Another organ which is responsible for metabolism of fluids is the spleen. If the spleen is imbalanced, this too can create an accumulation of dampness. Since the ‘nature’ of dampness is ‘heavy’ it will eventually sink downwards in the body. In TCM , each organ promotes the function of another and each organ also has a controlling ability on another organ. For example, the spleen ‘controls’ the kidneys. If the spleen cannot control the kidneys then the kidneys won’t function properly resulting in water ‘overflowing’, pooling, and transforming into dampness which, if left untreated, will eventually congeal into phlegm in the pelvic/reproductive environment as this is the area that the Kidneys dominate.
Yang qi is the energy which is responsible for any functional activity in the body. It is warm in nature. The yang qi of the kidneys supports the yang qi of the spleen. If the yang qi of the kidneys is vacuous, so to, eventually will be the yang qi of the spleen.
Thus, one can see that dual vacuity of spleen and kidney yang qi is almost inevitable if the kidneys remain vacuous for a long period of time. As the nature of yang qi is warm, its vacuity will create an excess of cold in the body. As cold contributes to constriction,(what happens when a glass of water is left in the freezer?), the presence of inappropriately abundant cold can cause obstruction and congealing of fluids which will contribute to the production of damp and phlegm. According to the theory of Chinese medicine, there is something referred to as the ‘sheng’ or the ‘promoting’ cycle of the organs. This means that each organ promotes the function, dynamics and health of another. The promoting organ is known as the ‘mother’ and the organ being promoted is known as the ‘son’. The kidneys are the mother of the liver. Thus, one can see how when there is vacuity of either the kidneys alone or the kidneys and the spleen and dampness prevails and transforms into phlegm it can affect the liver channel and travel with the channel itself and end up congealing and congesting the ovaries in the syndrome known as PCOS.
Also, note that there is a branch of the liver channel which enters the brain and phlegm lodging and congealing in the brain can contribute to, for example, pathology in the pituitary gland which controls the release of, among other things, LH.
Treatment Principles
Treatment principles are guiding treatment strategies. Without treatment principles, the practitioner is doing surgery in the dark! One TCM treatment principle for PCOS might look something like this: Fortify the kidneys, supplement the spleen, warm and invigorate yang qi; course the liver, quicken the qi, transform phlegm-damp, and scatter nodulation. The ‘nodulation’ mentioned here refers to the actual cysts.
Case report
Ovulation After Acupuncture In PCOS Patient
EXETER, ENGLAND — A course of acupuncture was followed by ovulation in a 32-year-old woman with oligomenorrhea (irregular periods), and primary infertility of 6 years' duration, Dr. Jin Xu said at a health care symposium sponsored by the University of Exeter.
Before undergoing acupuncture, the patient had “very infrequent” menstrual periods, and transvaginal ultrasound revealed polycystic ovaries. The patient's luteinizing hormone to follicle-stimulating hormone ratio exceeded 3:1, as is typical in polycystic ovarian syndrome, and her testosterone level was elevated at 3.7 nmol/L.
Five daily sessions of electroacupuncture were performed on acupoints Guanyuan (Ren 4), Zhongji (Ren 3), Zigong (Extra 16), and Sanyinjiao (Sp 6), said Dr. Xu of the University of Oxford ( England). Each acupuncture session lasted 25 minutes.
After the course of acupuncture, endometrial thickness increased from 4.5 mm to 8 mm by day 16, and a menstrual bleed was induced, Dr. Xu said.
Treatment was repeated in the next menstrual cycle, and the patient subsequently began to have regular periods. Three months later, she conceived and delivered a healthy baby girl at term, Dr. Xu said.
“It is likely that the hypothalamic-pituitary-ovary axis is involved in acupuncture-driven ovulation induction, but the mechanisms involved remain unclear,” he said.
Limited research has been conducted in this area, and it is unclear whether an actual effect on ovulation exists, Dr. Xu cautioned, adding that a clear need exists for randomized, controlled trials.
Another theory regarding the cause of PCOS is believed to be associated with insulin resistance (the cells cannot normally utilize insulin for glucose uptake). Insulin is the hormone that regulates the body's sugar (glucose) levels. With insulin resistance, cells are not as sensitive to insulin and it accumulates in the bloodstream resulting in a condition called hyperinsulinemia.
In PCOS, hyperinsulinemia contributes to excess androgen production within the ovary which causes follicular wasting and anovulation. The elevated androgen levels also contribute to common symptoms of PCOS like acne and hirsutism.
TCM Explanation of Signs and Symptoms associated with PCOS
Irregular or Absent Periods
From the Chinese medicine perspective, oligomenorrhea or amenorrhea can be caused by stagnation of liver qi. Liver qi is responsible for the free flow of qi. Qi is the ‘commander’ of blood. If qi is stuck, blood has no impetus to move and amenorrhea can ensue. Having a presentation of phlegm-damp congealing and obstructing can be causative of stuck qi as anything ‘blocking’ the flow of qi (energy) will eventually cause stagnation.
Lack of Ovulation
Ovulation is an activity which requires energy. Energy is yang in nature. Deficiency of kidney yang can be causative of annovulation. It is the yang energy of the kidneys which facilitates the yang energy of the spleen to produce blood. The spleen is responsible for the post-heaven creation of qi (energy) and post-heaven creation of blood. Post-heaven refers to the state of being ex-utero; in-other-words ‘once one has been born’. The kidney yang that we all possess comes from our parents and so, we frequently see women with annovulation or oligoovulation whose mothers also experienced similar problems. So, one can say that the strength or weakness of one’s fertile wellness stems in part at least from the health and wellness of the kidney’s (yin and yang) of the parents.
Infertility
There are many causes of infertility and miscarriage due to both female and male factors. From the TCM perspective the three main organs involved in the pathomechanism of infertility and repeated miscarriage are the kidneys, liver and spleen. The heart also plays a major role as well.
It is beyond the scope of this article to completely analyze and explain all the pathomechanisms of these organs insofar as how they relate to infertility. However, I will touch upon a few: the spleen is the organ responsible for the creation of qi (energy) and blood. Blood relates not only to the ‘physical’ aspect of blood but also to its function. This, in Chinese medicine terms is referred to as ‘substantial’ blood and ‘insubstantial’ blood. Substantial blood referring to the actual substance and insubstantial blood refers to the function of blood. The function of blood includes nourishing, moistening, and cooling. Nourishing means to nourish the organs as well as the hair, eyes, tendons, sinews, bone and muscles. If blood is deficient or if it is not circulating properly, it’s functionality will be impeded. Inability of an embryo to implant due to a thin endometrium (<5mm) can be attributed to the Chinese medicine ‘pattern of disharmony’ know as ‘vacuity of blood’.
The Liver is responsible for the free flow of ‘qi’. As qi is the ‘commander’ of blood, if qi is stagnant (due to stress, obesity, depression, injury, chronic emotional upset, dampness, phlegm, or deficiency of other organs) it will not be able to ‘move’ the blood which can end up causing blood stasis. Blood stasis when translated into Western medical terms presents as endometriosis, blocked fallopian tubes, polyps, fibroids, tumors, or thrombophilic disorders such as antiphopholipid syndrome, Lupus like anticoagulant, Factor V Leiden, Protein C and Protein S deficiencies and plasminogen activator inhibitor insufficiency, etc.
The kidneys as mentioned previously are extremely important from the perspective of conception.
The Kidneys promote and nourish the liver, (the liver is the son of the kidney and its function is dependent on the health of its mother) therefore, deficiency of the energy of the kidneys will, over time, necessarily mean that the liver will not be nourished and will hypofunction and not be able to move the qi which moves the blood which will contribute to clotting issues (thrombophilias). Thrombophilas are blood clotting disorders which can contribute to infertility and/or repeated pregnancy loss.
Kidney ‘yin’ is the energetic aspect of the kidneys which is cooling, moistening and nourishing. For example, women with kidney yin deficiency are those who, at a younger age than is appropriate, present with a lack of cervical mucous, or present with night-sweats and/or hot-flashes. These are considered ‘heat’ signs in TCM. Additional examples of kidney yin vacuity, ‘empty heat’ are early periods (bright red blood), heavy menstrual bleeding and irritability and agitation and afternoon fever and chronic heat in the palms of the hands, the soles of the feet and at the center of the chest. Premature ovarian failure manifests as a result of both yin and yang vacuity. Kidney yang vacuity prevents the spleen yang from producing enough qi and blood which thus cannot stimulate and/or the ovaries.
Inappropriate heat will, over time, negatively impact the quality of the blood causing its evaporation similar to the effect of leaving a pot of water on a low flame for several days. Eventually, the water will evaporate.
Obviously, kidney yin deficiency heat will not completely evaporate ones blood but will negatively impact the function of the blood to the extent that circulation will be impeded and, as a result will negatively impact the quality of the lining and the quality of eggs due to reduced delivery of oxygen, hormones, excretion of debris and lack of the other nourishing qualities which blood provides.
Weight gain
Excessive weight is considered to be a ‘dampness’ syndrome. The lungs, spleen and kidneys are the most important organs involved in water metabolism. Each organ according to TCM has functions, responsibilities and even emotional attributes associated with them. The emotion associated with the lungs is grief. It is not uncommon to see someone who has experienced a lot of grief in their life to be overweight. One reason is that the lungs will hypofunction and therefore, will not metaboloize fluids properly and water-dampness will accumulate, and, will over time, transform into phlegm. The biomedical definition of this is morbid weight gain. As mentioned above, each organ promotes the health and vital functionality of another. The lungs promote the kidneys which are also very much involved in the metabolism of water particularly in the lower part of the body.
When the lungs are under-functioning over a long period of time, it is most likely that the kidneys will also under-function contributing further to the accumulation of damp and phlegm. The yang qi of the kidneys is the motive force for the function of the spleen. It can be thought of like this: the spleen is the pot of water and the kidneys are the fire. If the kidney fire or yang qi is vacuous, then the spleen will not function properly, contributing to the onset of obesity. It is easy to see how one’s overall systemic health will affect the health or lack thereof of one’s fecundity.
Hyperandrogenism can be caused by excessive amounts of circulating luteinizing hormone and can cause acne, male-pattern balding, and hirsutism.
In fact, PCOS is often referred to as hyperandrogenism accompanied by chronic anovulation.
Masculinization results from the effects of either increased androgen production or enhanced androgen use by target tissues. Blood vacuity often leads to an excess of yang as blood is yin in nature. Yang is masculine, yin is feminine, so, with a deficiency of the feminine nature, one can see how the PCOS patient can present with hirsutism or masuclinization.
Menstrual Irregularity and Infertility
Hyperandrogenism is often associated with chronic anovulation that results in menstrual irregularity ( Hull, 1987).
Hyperandrogenism probably has an impact on fertility in addition to its effect on ovulation. Many studies suggest a decreased conception rate in spite of induced ovulation, and some suggest an increased risk for spontaneous miscarriage in hyperandrogenic women (Balen et al, 1993; Franks, 1995). The mechanisms for this androgen action remain to be determined. Once again, one can see how an imbalance of yin and yang can result in an altered state of health.
There is general agreement in the medical literature that the diagnosis of PCOS requires the presence of hyperandrogenism (elevated serum androgen levels or definitive clinical evidence of excess androgen effect) and chronic anovulation (fewer than six to nine menses per year) (Zawadski and Dunaif, 1992). If yang qi is the energy that enables and promotes systemic function then with its deficiency, ovulation (which requires the warmth of yang and the function of qi) will frequently not occur.
In most cases, women with PCOS are chronically anovulatory, but spontaneous ovulation and conception may occasionally occur.
Usually, menstrual irregularities persist from the time of menarche so that a regular pattern of menses is never established. In the Classics of Chinese Medicine, written thousands of years ago it is stated: “When treating infertility, the first order of business is to regulate the menstrual cycle”. Acupuncture and herbal medicine are very effective in this regard.
Estrogen secretion in PCOS is derived from the ovary and the extragonadal aromatization (conversion) of androgens. (This is yang transforming into yin.) Estrogen production in PCOS is constant and is not cyclic as it is in the normal menstrual cycle. This yin is not a physiologic or normal yin but really must be considered a pathogenic yin.
This results in a chronic, unopposed estrogenic effect on the endometrium that can result in endometrial hyperplasia, (Abnormal thickening of the endometrium caused by excessive cell growth), dysfunctional uterine bleeding, and endometrial neoplasia (abnormal cell growth) if left untreated (Jackson and Docherty, 1957).
Excess growth of hair on the face, chest, stomach, thumbs, or toes (Western medicine: masculinization occurs secondary to hyperandrogenism.
According to the theory of traditional Chinese medicine, in males, blood circulation in the upper area of the body is responsible for the production of facial hair and chest hair. In women, blood primarily flows downward to either nourish the fetus or to be released through menstruation or it travels upwards and is transformed into breast milk during pregnancy. In PCOS, since there is no downward flow of the tian gui, (above I defined tian gui loosely as the oocyte, but that definition falls short.) Tian gui can be thought of as the entire functional reproductive system in women. The initial sign of this system is the onset of menses. The menstruate is also part of the tian gui. When a women becomes pregnant, the tian gui is transformed into breast-milk. In the PCOS patient tian gui is not properly sufficient and breast milk is not being created, therefore, the blood innapropriately rebels upwards causing the growth of facial hair and occasionally chest hair.
Various organs ‘manifest’ in various parts of the body. ‘Manifests’ in this case means ‘responsible for a particular area of health or lack thereof on the exterior of the body. For example, the liver manifests in the nails, the spleen manifests in the lips and the heart manifests in the complexion.
I realize that I have given several definitions of tian gui. Please understand that in Chinese medicine, there can be many meanings attributed to one concept. Just as I said previously entire books can be written on the topic of qi. The same is true of the concept of tian gui), travels to the uterus from the heart via the bao mai. The bao mai is a special channel, the function of which is to convey heart qi and blood to the uterus.
According to the Nei Jing Su Wen (Inner Classic Simple Questions –one of the Classics in Chinese medical literature), “failure of arrival of menstruation is due to closure of the bao mai.” Therefore, menstruation proceeds unimpeded when heart qi and blood flow freely and reach the uterus unobstructed. This is one reason that women who are under severe stress or who experience a “broken heart” can become amenorrheic.
The bao luo is a channel which connects the uterus to the kidneys and enables the kidneys to deliver essence to the uterus. Kidney ‘essence’ is the substrate from which blood, along with other factors is derived. The Nei Jing Su Wen states: “The bao luo connect the kidneys to the uterus”. Menstruation and the ability to conceive are dependent on blood coming downward via the bao mai and essence nourishing the uterus via the bao luo.
But, due to phlegm-damp accumulation and ovarian distortion (ovarian cysts), heart blood counterflows to the face causing facial hirsutism on the one hand, and oligomenorrhea and anovulation on the other.
Acne, oily skin, or dandruff can be construed as dampness blocking and clogging the interstices of the skin causing a lack of proper elimination of toxins though the skin.
Patches of thickened and dark brown or black skin on the neck, groin, underarms, or skin folds which is known as acanthosis nigricans, and is a common characteristic of the PCOS patient is due to the TCM pattern of blood deficiency not nourishing the skin, causing parching and detriment to the fluids. Biochemically, this occurs as a result of hyperinsulinemia.
PCOS can negatively affect fertility since it can prevent maturation of follicles and ovulation. According the TCM theory, the ovaries are mainly governed by the kidneys. The contents of the ovaries (the ovum) are yin but require activation (yang) for release (ovulation). Thus, kidney yang vacuity is the main culprit of annovulatory cycles in the PCOS patient.
Fertility enhancement
Clomid is one of the selective estrogen receptor modulators (SERM’s), that acts as an anti-estrogen and tricks the pituitary gland into producing more FSH, which, in turn, stimulates the ovary to produce more eggs and follicles. Many patients with PCOS respond well to clomid and produce many follicles which is beneficial when doing an intra uterine insemination protocol.
Some research also shows that taking low doses of aspirin, which helps to improve hemodynamics (to the ovaries and uterine lining), can improve chances of pregnancy. Acupuncture has been shown to accomplish this as well, proven by observation of reduced uterine artery impendence when visualizing blood flow via a transvaginal ultrasound with a color doppler. This type of examination shows the actual blood flow quantitatively in the endometrium.
Eating a balanced diet low in carbohydrates and maintaining a healthy weight can help lessen the symptoms of PCOS. Regular exercise contributes towards weight loss and also aids the body in reducing blood glucose levels and contributes to a more efficient utilization of insulin.
A treatment principle in traditional Chinese medicine for weight loss in the PCOS patient might look like this: ‘Fortify the spleen, supplement the kidneys transform phlegm and drain damp’.
Progestins - These medications mimic the action of progesterone (yang qi). Progestins may be used to regulate the menstrual cycle and reduce blood levels of LH. Unfortunately, they are of little benefit in reducing hair growth or metabolic abnormalities. Examples include medroxyprogesterone (Provera®, Cycrin®) and norethindrone acetate (Aygestin®). 3
Oral Contraceptives - The ‘pill’ is an effective treatment for PCOS patients not wanting to become pregnant. Oral contraceptives decrease LH and regulate menses. The pill is also used to decrease symptoms associated with high androgen levels (acne and hirsutism). According to Chinese medicine the oral contraceptive pill causes both stagnation and diminishment of blood. As a result of this there is less blood to counterflow upwards which can result in a temporary cure of facial hirsutsim.
Anti-Androgens - These can only be used in women using adequate contraception because these medications pose a risk to the developing fetus. The value for use in PCOS is to improve skin conditions and to decrease other symptoms such as male-pattern baldness and hirsutism. Examples include spironolactone (Aldactone®), flutamide (Eulexin®), finasteride (Proscar®). Androgens may be considered ‘yang’ in nature. As ‘yang’ is masculine in nature one can see how, when yang is repressed in the PCOS patient, male pattern baldness may occur. Hair is nourished by kidney essence and liver blood. But in the PCOS patient, the kidneys and liver are severely non-functioning and so this nourishment is absent.
GnRH agonists - Gonadotropin-releasing hormone (GnRH) agonists are synthetic versions of the natural GnRH and are up to 60 times more potent. They are similar in molecular structure to the natural hormone. They cause release of LH and FSH from the pituitary gland in the brain, but with prolonged use, will deplete the pituitary gland of LH and FSH. This is important because women with PCOS usually have an increase in LH, which eventually leads to menstrual irregularities and/or infertility. Side effects of the GnRH agonists are like those experienced by menopausal women, including bone loss, hot flashes, decreased libido and vaginal dryness. This is due to the eventual deficiency of estrogen caused by a decrease in FSH. As estrogen can be considered to be ‘yin’ in nature and, as yin is deemed to be more feminine than yang, one can see how deficiency of yin can produce signs and symptoms of female aging. Loss of bone mass can be reversed after cessation of medication. Examples of GnRH agonists include leuprolide acetate (Lupron®), goserelin (Zoladex®) and nafarelin acetate (Synarel®).
In PCOS, normal follicular growth and ovulation are disrupted. Fertility drugs may be used in order to induce ovulation. Clomiphene citrate (Clomid®) is typically the first agent prescribed to stimulate ovulation. If clomiphene is unsuccessful, more potent medications along with artificial insemination or in vitro fertilization may be recommended.
Surgical therapy - Two surgical options are available:
a) Ovarian wedge resection
In ovarian wedge resection, a portion of the ovary is removed and then sewn back together. This procedure has been effective in decreasing LH and androgen
production, and reestablishing regular menses in over 75% of patients. Pregnancy rates following ovarian wedge resection vary, but have been reported to be
as high as 60%.
Unfortunately, a major complication of this procedure is the formation of pelvic adhesions in 30% of patients.
b) Laparoscopic ovarian drilling
Laparoscopic ovarian drilling is another surgical alternative for PCOS. This procedure involves making small holes with a laser into the ovary. Ovarian
drilling can be performed during the time of a laparoscopy and is very effective in reducing androgenic hormone production. Laparoscopic ovarian drilling
may be an effective treatment in clomiphene-resistant anovulatory women with PCOS.
Treating the insulin resistance associated with PCOS targets the cause rather than the symptoms of the disorder. Approximately 75% of obese patients with PCOS are insulin resistant and have elevated amounts of insulin in their bloodstream. These patients have an increased incidence of type II diabetes, hypertension, and atherosclerosis (blockage/thickening of the arteries which could lead to a heart attack or stroke). Insulin-sensitizing therapy enhances the body's sensitivity to insulin and therefore, helps to normalize the hormonal abnormalities associated with PCOS. The following medications have shown promise in the treatment of PCOS when hyperinsulinemia is present:
Metformin (Glucophage®)
Metformin is mainly used in non-insulin dependent diabetes and helps enhance the body's sensitivity to insulin. It does not cause hypoglycemia (low blood
sugar) which is important to prevent unwanted side effects. Some patients have experienced weight loss, improved lipid profiles, lowered blood pressure,
return of menstruation, and achieved pregnancy while taking metformin. This drug is considered relatively safe. The most frequently occurring side effect is
gastrointestinal upset (diarrhea or more frequent bowel movements). Stomach upset occurs more frequently after a fatty meal or dessert.
Pioglitazone (Actos®):
Pioglitazone works by allowing the body to utilize insulin more efficiently. Some common side effects with this drug include edema (swelling), weight gain,
and headache.
Rosiglitazone (Avandia®):
Rosiglitazone is in the same class of insulin-sensitizers as Actos, so it works in a similar manner. Common side effects of Avandia include slight weight
gain and headache.
Case review:
Biomedical diagnosis: Infertility secondary to PCOS
Traditional Chinese medicine discussion
Nancy is a 30 years old female whose height is 5’5” and whose weight is 180lbs. She has been trying-to-conceive for 2.5 years.
Her husband’s sperm is normal. She presents with acne, facial hirsutism and low libido. She complains of frequently feeling cold especially at the hands and feet. Her bowel movements are loose with undigested food evident in the stool. She is polyuric and urinates once per hour. The color of the urine is clear and moderate in amount. She presents with occasional urinary incontinence upon laughing, coughing and/or sneezing. She complains of being emotionally depressed status-post a diagnosis of infertility. She complains of having low self-esteem based upon her physical appearance. Her tongue body is fat and tooth-marked with a greasy, moist, white coat. There are stasis-macules (small purple bumps) on the sides of the tongue. Her uterine lining thickness is 5-6mm.
Discussion: Liver-Wood controls the spleen-Earth. When the liver is disturbed as a result of emotional depression and frustration it may transversely attack the spleen presenting a clinical picture of liver depression qi stagnation overacting on the spleen. This results in spleen qi vacuity. As a result of chronic hypofunctioning of the spleen, the transformation and transportation of fluids has been negatively impacted leading first to an accumulation of dampness and then, progressively, to phlegm-damp congealing and obstructing.
The ovaries, the homologue to the testes, are related to the kidneys primarily and secondarily to the liver. Phlegm congealing in the ovaries will thus be injurious to the kidneys. This is an interesting pathological dilemma. The spleen controls the kidneys and it is ultimately the vacuity of the spleen’s qi that has caused the presentation of the phlegm-damp and nodulation. But, it is the kidneys that provide the yang qi, or energy (fire) which is the motive force of the functionality of the spleen. Thus we have a cyclic event where spleen qi deficiency causes vacuity of kidney yang and kidney yang insufficiency further contributes to deficiency of spleen qi. This dual vacuity of the kidneys and spleen further maintains the status-quo of phlegm-dampness congelation.
For the uterine lining to be thick and functional yin and yang qi must be present and abundant. The free flow of qi and blood must also be adequate. As the commander of blood, if qi is stuck or vacuous, (it is not uncommon for qi to be both stuck and deficient), blood will not flow patently, presenting with the pathology of stasis of blood in the uterus or blood vacuity engendering stasis. In this case, we have qi vacuity engendering vacuity and stasis of liver blood; thus, nourishment and growth of the endometrium will be denied.
To effectively treat this patient, the liver must be coursed, the qi regulated and rectified; the spleen must enjoy dryness and its yang qi warmed and it’s function enhanced by boosting it against attack from the liver and by supplementing the kidneys and invigorating yang qi. One must boost the spleen to nourish and fill the (blood) vessels (because spleen qi is responsible for the creation of blood) and course the liver to quicken qi, invigorate the blood and transform stasis. To supplement the kidneys and spleen one must disperse damp and transform phlegm with warm and acrid herbs. This is a complex pathology with ‘excess’ manifesting as a result of ‘deficiency’.
Traditional Chinese medicine diagnosis: Stagnation of liver qi and vacuity of spleen and kidney yang with vacuity and stasis of blood in the uterus; phlegm-damp congealing in the lower jiao. (The ‘lower jiao’ is a TCM term which describes the area in which the ovaries reside.)
Treatment principle: Course the liver and boost the spleen, supplement the kidneys and warm yang qi; nourish the blood, fill the vessels, quicken the blood and transform stasis; rectify qi, drain damp and transform phlegm.
This formula is my creation and is shown here for the express purpose of enabling the reader to see what a real Chinese herbal medicine prescription looks like and what the functions of each herb are. Only take herbs when prescribed by a Board certified herbalist and never self medicate.
Herbs have ‘temperatures’, ‘flavors’, ‘trophisms’, and individual ‘characteristics’. The four temperatures of herbs are cold, cool, hot and warm. Some herbs however, are neither hot nor cold and are considered to be ‘neutral’. The five ‘flavors’ of herbs are ‘pungent’, ‘sour’, ‘bitter’, ‘salty’ and ‘sweet’. Some herbs are considered ‘bland’ and some ‘aromatic’. All herbs have at least one flavor and some have two or three.
The ‘flavors’ have clinical relevancy and have the following clinical strengths:
- Pungent herbs are moving and dispersing and as such can dispel wind, heat, cold and dampness. In Chinese medicine it is said that Wind is the carrier of the 100 diseases (meaning all exterior pathogenic factors). So, one who has a flu will exhibit ‘Heat’ signs such as fever and perhaps aches and pains in various joints throughout the body. So it can be said that this individual is afflicted by a ‘Wind-Heat-Damp’ invasion, and as part of his herbal medicine prescription, pungent herbs will be used.
- Sour herbs are astringent. Sour herbs are used to prevent the inappropriate extravasation of body fluids including blood, saliva, sweat, urine, semen, and vaginal discharge. A person who presents with hyperhidrosis (excessive sweating) would take, as part of her herbal prescription, sour herbs. Another example of the use of sour herbs is when a patient presents with dysfunctional uterine bleeding. Sour herbs can be used to stop the bleeding while the underlying cause is being simultaneously treated. This is referred to in TCM as treating the branch and the root.
- Bitter herbs are drying and have a downward moving trophism. Bitter herbs can dry dampness and dissolve phlegm. So, if a patient has bronchitis with an abundance of phlegm, bitter herbs would be included in that patient’s formula. Another example of the use of bitter herbs would be in the treatment of a woman with chronic yeast infections.
- Salty herbs are softening and reducing in nature. So, herbal formulae that are used to treat diseases like goiter, scrophula or polycystic ovarian syndrome would contain salty herbs.
- Sweet herbs are tonifying and nourishing to the body. A patient who has chronic fatigue syndrome or who is constantly short of breath with even the slightest exertion is treated with herbs that are sweet. A women whose ovaries are functioning weakly and, as a result, has elevated fsh will also, as part of her treatment regimen, be treated with sweet herbs.
- Bland herbs promote urination. These herbs are used within formulae which treat urinary retention and edema as well as painful urination.
- Aromatic herbs are similar in nature to pungent herbs. These herbs are useful when treating ‘damp’ conditions in the spleen and stomach. Aromatic herbs have the capacity to move and disperse and as such can be used to reduce the stagnation of qi and blood. These herbs may be used for example, in formulae which treat endometriosis or headaches of a ‘piercing’ nature, or sharp, stabbing pain in the abdomino-pelvic region as a result of adhesions stemming perhaps from pelvic inflammatory disease, or internal scarring which may be presenting as a result of an appendectomy, or even a hydrosalpynxed fallopian tube.
Sample Herbal Medicine Prescription for PCOS:
Cu chao xiang fu, (Cu chao means to fry in vinegar. This method of herbal modification increases the capacity of xiang fu to invigorate liver qi and resolve stagnation. This is done because we want to enhance the free flow of qi or energy in the body in general and at the ovaries in particular. Remember, the liver channel traverses the ovaries.
The trophism of cu chao xiang fu is the liver and the sanjiao. The sanjiao channel interestingly, is another channel or meridian which has a lot to do with fluid metabolism. The properties of xiang fu are acrid, bitter and sweet. Its acridity spreads and regulates liver qi and it regulates the menses via invigoration of qi. Through the proper movement of qi, transformation of damp and phlegm occur. Its sweetness is tonifying without being cloying. The bitterness of xiang fu also assists in the ‘percolation’ of dampness. Percolation here refers to the herbs ability to rectify and dispel damp.
Mu xiang
The trophism of mu xiang is to the gallbladder, large Intestine, spleen and stomach channels.
Its properties are acrid, bitter and warm. Acridity disperses (dampness and phlegm); bitterness drains (damp) and its warmth tonifies. So there is supplementation in the midst of draining. It functions to move qi, and to strengthen the spleen. Especially useful when the transportation and transformation function of the spleen is weak.
Chen pi
The trophism of chen pi is to the lungs, spleen, and stomach
It’s properties are acrid, bitter and warm, Chen pi regulates qi; improves the transportation and transformation function of the spleen; dries damp and transforms phlegm.
Ba ji tian
The trophism of ba ji tian is to the kidneys and liver. Its properties are acrid and sweet. The property of ba ji tian is warm.
Ba ji tian tonifys the kidneys and warms the yang qi.
Hu lu ba
The trophism of hu lu ba is to the kidneys.
Its property is warm.
Hu lu ba warms the kidneys, disperses dampness, and dispels cold.
Xian mao
The trophism of of xian mao is to the kidneys and liver. It is a hot herb Xian mao tonifies the kidneys, fortifies yang and eliminates dampness.
Nu zhen zi
The trophism of nu zhen zi is to the kidneys and the liver.
It’s properties are bitter, sweet and cool.
Nu zhen zi tonifies the liver and kidney yin.
Though Nu zhen zi is nourishing and tonifying it is not cloying. It is always necessary to nourish yin when trying to warm yang. Nu zhen zi not only nourishes and tonifies the liver and kidneys but also serves to protect the yin from the use of hot herbs such as xian mao.
Bai shao
The trophism of bai shao is to the liver and spleen its properties are bitter, sour (sour herbs go to the liver), and cool.
Bai shao nourishes liver blood, harmonizes the relationship between the liver and spleen, restrains yin and also protects the yin from hot herbs. It also helps to regulate the menses.
Jiang zhi shu di. NOTE: Shu di is contraindicated in those with phlegm because of its ‘cloying’ or sticky nature. Using it would actually contribute to the creation of more phlegm and damp in a patient with this pre-existing pathology. ‘Jiang zhi’ means to dry-fry with water and sliced raw ginger. This process mitigates the cloying property of shu di and is then appropriate to use in patients who present with phlegm pathologies.
The trophism of shu di is to the heart, liver and kidneys.
It’s properties are sweet and warm.
It tonifies blood, nourishs yin and tonifies essence.
Ziao jiao ci
The trophism of ziao jiao ci is to the liver, stomach and lungs Its properties are acrid, and warm. Ziao jiao ci draws out toxicity, discharges pus, invigorates blood and reduces swellings. It warms and transforms phlegm. Zao jiao ci also invigorates the movement of blood. It is especially good for weight loss. Weight loss is one of the most important therapeutic goals of the PCOS patient who is morbidly obese. Obesity increases insulin resistance and androgen production and contributes to the arrest of ovulation. A 10% reduction in body fat significantly improves ovarian function in the obese PCOS patient. It is important to note that this formula is for the morbidly obese patient with PCOS as opposed to the PCOS patient whose weight is within normal range.
Fu ling pi
The trophism of fu ling pi is to the heart, spleen, kidneys and lungs. It’s properties are sweet, bland and neutral. Fu ling pi is the outer layer of the fungal node. It promotes urination and reduces edema. In the Classic, the ‘Grand Materia Medica’, it was written that fu ling pi “primarily treats edema and facilitates the waterways”. Though we are not treating edema we are treating a pathology of water metabolism which manifests as pooling and conglomerating. Therefore fu ling pi is a clinically effective herb for the treatment of PCOS. Fu ling pi, via its relationship to the heart, indirectly benefits the spleen through the promoting cycle as the heart promotes the function of the spleen. And, through its relationship with the kidneys and lungs it easy to see how this herb is clinically effective in improving the function of the main organs that are responsible for water metabolism.
Fu ling pi is harmonious and neutral in nature. It is more draining than tonifying; it is a strong diuretic, but does not exhaust the qi.
She gan: The trophism of she gan is the lungs. It’s properties are bitter and cold.
Its effect on phlegm is so strong that it is combined with warming herbs in treating obstruction and clogging due to phlegm-cold. Chao she gan (dry fried or baked) mitigates it’s cold properties and it can be used in deficient patients.
Fu zi: Fu zi goes to the heart, kidneys and spleen. Its properties are acrid, hot and toxic. Toxicity is an issue only if one prescribes above the normal dosage range which is between 3-15grams. This is a widely prescribed herb and is generally well tolerated.
It is often used to mitigate the cold properties of She gan. Fu zi expels cold-damp and warms the Fire (kidney yang). It is used for any problem related to yang vacuity of the heart, kidney and/or spleen yang. It also has the ability to guide other warming herbs into the lower burner to expel cold and damp.
Li zhi he
Li zhe he travels to the Liver and the Stomach.
Its properties are warm and sweet.
Li zhe he is specifically used for bulging disorder (hernia) in the liver channel, for testicular pain and swelling, and for ovarian cysts. The quality of this herb is to dredge and disperse. It is used here to guide the other herbs in the formula to the ovaries and to stimulate functional activity in the ovaries as well. The ovaries are homologous to the testicles.
Bai zhu,
Bai zhu’s properties are bitter, sweet and warm.
The channel trophism of baizhu is to the spleen and stomach.
Baizhu tonifies the spleen and augments the qi, dries damp and promotes water metabolism.
Wang bu liu xing
The properties of wang bu liu xing are bitter and neutral.
Wang bu liu xing goes to the liver and stomach. The liver channel traverses the ovaries and therefore this herb serves to ‘invigorate’ or stimulate their function.
Wang bu liu xing “disperses clumping ” (read as cysts), and “disperses stasis” (also read as cysts). This herb also “unblocks menstruation”
Its function is to invigorate blood, reduce swelling and to unblock the menses.
This herb facilitates the yangming channel, the chong and renmai, and the sea of blood(the liver, chongmai and bao gong)
Xiao hui xiang
Xiao hui xiang is warm and acrid.
It travels to the liver, kidney, spleen and stomach.
It disperses cold, warms the lower burner, and encourages movement in the liver channel.
Yuan zhi
The properties of yuan zhi are bitter, acrid and warm
It’s trophism is to the heart and lungs.
Yuan zhi expels phlegm; reduces abscesses and dissipates swelling. Additionally yuan zhi settles the heart and calms the spirit which which means that it has the effect of reducing anxiety. It is appropriate when treating a PCOS patient who especially wishes to conceive and is going through the attendant emotional difficulties associated with infertility.
Chao suan zao ren
Suan zao ren goes to the gallbladder, liver, heart and spleen channels. It’s properties are sweet, sour and neutral. Suan zao ren is used to calm the emotions, treat insomnia, palpitations, anxiety and dream-disturbed sleep. Using yuan zhi and suan zao ren together is an often used strategy to treat someone who is suffering from symptoms of anxiety and depression.
Kun bu
Kun bu goes to the kidney, liver and stomach channels. Its properties are salty and cold. Remember that salty herbs have the ability to soften and reduce. So, herbal formulae that are used to treat diseases like goiter, scrophula or polycystic ovarian syndrome would generally contain salty herbs.
Dang gui
Dang gui goes to the heart, liver and spleen. Its properties are warm, acrid, sweet and bitter. Though it moves blood it also benefits the spleen and nourishes blood.
Acupuncture prescription
Large intestine 4 and Liver 3 This combination moves qi to help facilitate the transformation of damp and phlegm and to enliven the commander of blood to facilitate circulation of blood to the ovaries.
Ren 12 and Liver 13 to harmonize the relationship between yang and yin.
Zigongxue to stimulate ovarian function.
Stomach 30 to stimulate ovarian function and access the chongmai which, due to its close relationship with the liver and kidneys helps to quicken blood and benefit kidney yin and yang.
Ren 17 and Ren 6 to boost and invigorate qi and to regulate the proper acsent and descent of qi and blood which is absent in the PCOS patient. I also like to use Ren 17 to stimulate the flow of heart blood to the uterus via the bao mai vessel.
Stomach 36 and Stomach 40 to regulate and harmonize the stomach and spleen which will help drain damp and transform phlegm. As Stomach 40 also enters the brain, this point is helpful in calming the shen, (spirit).
Spleen 9 and Spleen 6 to drain damp, transform phlegm and to tonify the spleen, kidneys and liver as spleen 6 is a crossing point for these three channels.
Kidney 3 to facilitate passage of essence from the kidneys to the uterus and ovaries via the bao luo vessel.
How do acupuncture and herbal medicine treatment protocols differ?
Primarily, acupuncture (in my opinion) does little more than stimulate the flow of qi and blood throughout the body. Don’t misunderstand: this is a necessary and powerful clinical tool without which herbal medicine would not be as efficacious as it is. Herbs (like Western medicine) have systemic effects. That is to say they actually change organ function. In order for herbs to be properly disseminated throughout the body they are supported by the qi and blood invigorating effect of acupuncture. Clinically, the best outcomes are achieved when acupuncture and herbs are used together.
The goals of this combination of acupuncture and herbs are:
- Regulation of menses
- Regulation of ovulation
- Improved egg and lining quality
We have seen improved pregnancy outcomes in PCOS patients when including acupuncture and herbal remedies in conjunction with Metformin and/or Clomid. Clomid can help to facilitate the generation of multiple follicles but acupuncture and herbs improves oocyte quality and endometrial lining quality. Additionally, acupuncture and herbal medicine can often have a regulatory effect on the hypothalamic-pituitary-ovarian axis which is what is needed for the PCOS patient suffering with infertility. Used together, the ‘East meets West’ approach is giving new hope to PCOS patients desiring to conceive.
You can conceive. We are here for you!
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MALE FACTOR
A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. READ MORE>>
Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. READ MORE>>
SMOKING & INFERTILITY
The health risks of tobacco smoking are well known with regard to diseases of the heart, lungs, and blood vessels. Substantial harmful effects of cigarette smoke on fertility have become apparent, but are not generally appreciated. Cigarette smoking has a negative impact on the ability to become pregnant and carry a pregnancy to term.
Impact of cigarette smoking on reproduction in women:
Virtually all scientific studies support the conclusion that smoking has an adverse impact on fertility. The prevalence of infertility is higher, and the time it takes to conceive is longer in smokers compared to nonsmokers. Active smoking by either partner has adverse effects, and the impact of passive cigarette smoke exposure is only slightly smaller than for active smoking. Research indicates that cigarette smoking is harmful to a woman’s ovaries and the degree of harm is dependent upon the amount and the period of time a woman smokes. Smoking appears to accelerate the loss of eggs and reproductive function and may advance the time of menopause by several years. Components in cigarette smoke have been shown to interfere with the ability of cells in the ovary to make estrogen and to cause a woman’s eggs (oocytes) to be more prone to genetic abnormalities. Smoking is strongly associated with an increased risk of spontaneous miscarriage and possibly ectopic pregnancy as well. Pregnant smokers are more likely to have low birth weight babies and premature birth. The incidence of sudden infant death syndrome (SIDS) also increases in households where someone smokes.
Impact of cigarette smoking on assisted reproductive therapy outcomes: Nearly twice as many in vitro fertilization (IVF) attempts are required to conceive in smokers than in nonsmokers. Studies of IVF have reported that female smokers require higher doses of gonadotropins to stimulate their ovaries, have lower peak estradiol levels, fewer oocytes obtained, and more canceled cycles, lower implantation rates, and undergo more cycles with failed fertilization than nonsmokers. Miscarriage rates are also increased. The adverse effect of cigarette smoking is more noticeable in older women. Overall, the reaction in natural fertility associated with smoking may not be overcome by assisted reproductive technologies.
Impact of cigarette smoking on reproduction in men:
Men who smoke cigarettes have a lower sperm count and motility and increased abnormalities in sperm shape and function. The effect of smoking on male fertility, however, is more difficult to discern because it is difficult to create studies to address that question. Although the effects of cigarette smoking on male fertility remain inconclusive, the harmful effect of passive smoke on the fertility of female partners and the evidence that smoking adversely affects sperm quality suggest that smoking in men should be regarded as an infertility risk factor.
Smoking cessation as a treatment issue in couples undergoing fertility therapy:
One important investigation showed that cessation of smoking for at least two months before attempting IVF significantly improved chances for conception. Although long-term cigarette smoking can have an irreversible effect on ovarian function, the harmful effect on treatment outcome may, in part, be reversed if smoking is discontinued prior to entering into fertility therapy.
Summary: The best available scientific data indicate that cigarette smoking strongly contributes to infertility. Smoking should be discouraged for both male and female partners in couples with a history of infertility or recurrent miscarriage. Smoking cessation may improve natural fertility and success rates with infertility treatment.
At The Berkley Center for Reproductive Wellness we have a smoking-cessation program in place which encompasses acupuncture, herbal medicine and life-style counseling. We continue to see successful outcomes using our proprietary approach.
A LETTER TO ACUPUNCTURISTS
On The Diagnosis of Infertility and Traditional Chinese Medicine
15% of Americans are afflicted with infertility. Certainly this is a disorder that can be effectively treated with Chinese medicine. But our success can be greater with a shift in attitude.
As practitioners of Chinese medicine we must be able to understand not only pathological factors but etiologies too. For example, a pathology leading to male factor infertility is low sperm count. Many TCM practitioners will automatically render treatment based upon the TCM diagnosis arrived at through the four examinations. This is all well and good and appropriate according the context of our training. There is, however, an inherent problem with this type of diagnosis.
Let's use a case history for illustrative purposes: A forty-five year old male presents with the main complaint of low sperm count. His constellation of signs and symptoms include mild erectile dysfunction, dribbling urination status-post voiding, he craves salty foods and has tinnitus and has a chronic sore knees secondary to unresolved childhood Osgood-Schlatter disease. We may conclude perhaps that there is a dual vacuity of kidney qi and essence, and treat accordingly.
Many practitioners of Chinese medicine would be happy to diagnose this case as I have illustrated above yet their treatments would not yield the desired outcome. Why? Because the etiology of this pathology is manifest as a result of a varicocele of long standing. As a result of this varicocele, qi has stagnated, blood has become static and heat has become trapped in the liver channel locally at the level of the affected testicle. It is important to note that there are no signs or symptoms in this patient of blood stasis or heat. Not in the tongue and not in the pulse and not in any other signs and/or symptoms. This type of presentation is not uncommon. I refer to it as a 'hidden pathology'.
It is a standard method of operation that one must arrive at a differential diagnosis no matter how confusing the case, and treat accordingly. If the treatment is ineffective, dig deeper, look more closely, re-analyze, change the diagnosis and try another approach. This is a clumsy approach, and with greater knowledge our system of diagnosis can become more economic and more accurate.
In China, one hundred or five hundred or three thousand years ago, the doctors did not have the distinct advantage that we, as modern day practitioners have. That is, Western medical science. If for example, the modern day TCM doctor did his or her full intake on the above patient and simply inquired "have you been evaluated by a urologist?" the answer to the riddle would have been instantly revealed if the patient had and come back to your office with a Western diagnosis of a vericocele. Thus, as a result of a urological examination we are able to state with certainty that the TCM diagnosis is stagnation and binding of liver qi and stasis of liver blood transforming heat; not kidney vacuity! If the patient had not been worked-up by a urologist we would be treating uselessly.
Greater knowledge affords greater treatment options. As the Spanish saying goes: "saber es poder", "knowledge is power"! What we have at our finger tips today that Chinese practitioners of even fifty years ago were deprived of is the availability of a knowledge-base that can positively affect our diagnoses and our treatment outcomes.
I am not suggesting that there is a direct clinical analogue from a Western medical diagnosis to a TCM pattern differentiation in every case, but frequently, there is.
Let's say that we have a patient whose main complain is azoospermia. Once again, we treat according to the probable diagnosis of jing-essence vacuity. But if the patient was diagnosed as having Klinefelter's syndrome one could say with confidence that the diagnosis is pre heaven jing-essence vacuity and detriment which, in my opinion, in this case, is untreatable, as the pathomechanism is genetically derived. So, now we have treated this patient with herbs and acupuncture for six months to no avail. If you treated him for six years, results would not differ. We have taken his money, raised his hopes and proceeded in a way which could negatively impact the reputation of Chinese medicine.
Here is another all too familiar classic story: A thirty-three year old female patient presents at the clinic with the main complaint of primary infertility. She is afraid of Western doctors and really believes in 'alternative' medicine and has heard wonderful things about your skills. In fact, you helped a good friend of hers to become pregnant. So, you treat the patient; and treat her, and treat her some more. You use many point protocols and many herbal formulas. You supplement the kidneys and boost the spleen. You sooth the liver and nourish the blood. You fail. Why? Because this patient has severe bilateral adhesions on the salpinges secondary to pelvic inflammatory disease. You cannot help this patient and your advice at the first interview should have been to visit a Reproductive Endocrinologist and have a full work-up.
I highly recommend that we, as healthcare providers absorb the useful diagnostic data which is available to us from Western medicine. Until we do, we will not truly be practitioners of integrated medicine.
Having an understanding of Western medical science will improve our analytic and diagnostic skills and will improve the results of our treatments; and, of equal importance, will enable us determine who is treatable and who isn't.
Mike Berkley, L.Ac
Founder and Director, The Berkley Center for Reproductive Wellness
Our Limitations
We apologize for our limitation in that we only treat individuals with fertility challenges.
We don’t treat neck pain, back pain, headaches, eczema, tennis elbow or any other health-related problems.
The Berkley Center for Reproductive Wellness is 100% committed to treating reproductive disorders. That’s all we do, have ever done, and will ever do.
Our value is found in over 10 years of experience in treating reproductive challenges. We have treated twenty-five thousand infertile patients.
Be sure that which ever acupuncturist you place your trust in has a long history of experience, credibility, and success in reproductive medicine. After all, your family is at stake.
Best wishes on your journey to family. All of us at The Berkley Center for Reproductive Wellness are rooting for you!
