Falling Pregnant and Being Pregnant

May 26, 2023

Introduction

Subfertility and infertility rates are high and according to the WHO, infertility affects millions of individuals and couples. It is estimated that approximately one in every six people of the reproductive age experience infertility at some stage in their lifetime. Infertility is defined by a 12 months period of unprotected sex without falling pregnant. There is primary (when there never was a pregnancy) and secondary infertility (when there was at least one pregnancy). The types of the reproduction system “defects” can be related to either sperm, the ovaries, the fallopian tubes, the uterus, or the endocrine system. Many factors can affect pregnancy rates. Whenever our patients are falling pregnant, especially, if they sincerely wanted a child, caring for them during their time of being pregnant is very important. In this article, we want to be look at some herbal formulas to target infertility both male and female and explore pregnancy formulas.

As TCM practitioners, we feel inclined to help patients with both, subfertility issues and pregnancy related complains. TCM also offers one of the gentlest treatments in this situation with low rates of “side effects”. Perhaps this is one of the reasons for a high number of TCM “experts” in this area. However, not every woman wanting to fall pregnant can be helped, unfortunately, and so in my clinic, the first step is always assessing the risks and benefits of helping sub fertile couples. I don’t think, it’s fair to create unrealistic expectations for our patients (and ourselves). As a Jing Fang practitioner, I usually don’t “specialise” in a particular area but I focus on balancing Yin and Yang. As a woman, I feel strongly inclined of wanting more individuals to fall pregnant and more importantly, have healthy pregnancies with life births.

Looking back at some of my patients in this area, the tendency is to assist if there is Polycystic Ovary Syndrome (PCOS), endometriosis or primary/secondary dysmenorrhea, low sperm count or simply unexplained reasons for the lack of conception. I use formulas exclusively from the Shang Han Lun and the Jin Gui Yao Lue. I tend to assist women with acupuncture if they are undergoing ART (Assisted Reproductive Technologies) as their “fertility specialists” often don’t want them to have anything other than the drugs they prescribe, at least in Australia.

The following table is from Xu et al. (Application of traditional Chinese medicine in the treatment of infertility, 2003) which I have extended to match with a classical formula structure suggestion to address female infertility patterns:

TCM patternWestern diagnosis Manifestations TonguePulse Formula
Kidney Yin deficiencyAnovulation

Immunological infertility

Luteal phase defect

Malar flush, sweats, insomnia, dry throat, low grade feverRed, peeled, crackedFloating, empty, rapidShen Qi Wan
Kidney Yang deficiencyAmenorrhoeaCold knees, weak legs, apathy, poor appetitePale, swollenDeep, weak, wetZhen Wu Tang
Liver blood deficiencyPolycystic ovary syndromeDizziness, blurred vision, pale lips, muscle spasm, brittle nailsPale body, dryChoppy, fineDang Gui Jian Zhong Tang
Liver blood stagnationEndometriosisPainful periods, dark and clotted blood, abdominal pain, and massPurple body, spotsWiryGui Zhi Fu Ling Wan

 

Wen Jing Tang

Damp-heat in the liverGenital infection

Tubal factor infertility

Fever, jaundice, bitter taste, nausea, vomiting, abdominal distension, vaginal dischargeRed body, sticky yellow coatSlippery, wiry, rapidHuang Qin Tang
Liver Qi stagnationPremenstrual syndrome (PMS)Depression, sighing, mood swings, painful periods, distension of the breastsNormalWirySi Ni San

Xiao Chai Hu Tang

 

Cold stagnation of the liver channelSexual arousal disorderFullness and distension of the bladderPale, wet, white coatWiry, deep, slowWu Zhu Yu Tang
Deficient spleen QiDysfunctional uterine bleeding

Uterine fibroids

No appetite, tiredness, lassitude, blood in the urine, excessive menstrual flowPale or transverse cracks on sidesFineHuang Qi Jian Zhong Tang

 

Li Zhong Wan

 

 

 

 

The following table is from Xu et al. (2003) which I have extended to match with a classical formula structure suggestion to address male infertility:

TCM patternWestern diagnosis Manifestations TonguePulse Formula
Deficient kidney essenceImpotence

Seminal plasma abnormalities

Poor memory, loose teeth, hair loss, weakness of knees and legs

Sexual dysfunction

Red, peeledFloating, empty, leatheryTian Xiong San

 

Deficient kidney QiAzoospermia (absence of sperm when ejaculating)

Oligozoospermia (low number of sperm in ejaculate)

Asthenozoospermia (reduced sperm motility)

Teratozoospermia (abnormal morphology of sperm)

Soreness and weakness of the lumbar region, urinary incontinence, enuresis, nocturnal urinationPale, white coatWeak or threadyZhen Wu Tang

 

Shen Qi Wan

 

 

 

Liver blood stagnationVaricocoelePainful or irregular abdominal pain

“mass” in the abdomen

Purple body, spotsWiryFu Ling Gan Cao Tang

 

Gui Zhi Fu Ling Wan

 

Dang Gui Si Ni Tang

 

Damp-heat pouring downwardMale accessory gland infection

Immunological infertility

Swelling and cramps in the perineum and lower abdomen, thirst, bitter taste in the mouthRed with yellow, greasy coatingString-like and slipperyHuang Qin Tang

 

I assist many women in pregnancy too. My rule of thumb is, that I see them once a month if their pregnancy is going well and I will treat them with acupuncture. However, if problems arise, I will also prescribe herbs. Initially, I did not have the confidence to treat pregnant women with herbs, but since spending time with the use and application of classical formulas, I now confidently prescribe herbs. Did you know that there is an entire chapter in the Jin Gui Yao Lue dedicated to problems during pregnancy (chapter 20)? Those formulas worked for at least two millennia and I would use the basic structure of them (not all herbs are always available) and tailor them to the individual. I also advice women to have regular weekly acupuncture sessions starting from week 36 or 37 in preparation of labour.

 

Common Jin Gui Yao Lue formulas that I would use during pregnancy are:

NameChapter, line, and reference
Bai Zhu SanJG 20.10: For nourishing the foetus during pregnancy, Bai Zhu San governs. For toxic pain under the heart, augment Chuan Xiong to double.
Dang Gui Bei Mu Ku Shen WanJG 20.7: For difficult urination during pregnancy, with normal food and water intake, Dang Gui Ku Shen Wan governs.
Dang Gui SanJG 20.9: For pregnant women, it is indicated to often take Dang Gui San.
Dang Gui Shao Yao SanJG 22.17: For all types of abdominal pains in women, Dang Gui Shao Yao San governs.

JG 20.5: For pregnant women, with twisting dull ache in the abdomen, Dang Gui Shao Yao San governs.

Gui Zhi Fu Ling WanJG 20.2: For women who have pre-existing mass disease, and the interruption of the period has not yet reached three months, after which there is incessant leakage, with foetal movement above the umbilicus, then it is damage to consolidated mass. When in pregnancy there is stirring at six months, and the three months prior to the pregnancy was uninhibited, then this is the foetus. If there is bleeding. If there is bleeding after the menses had stopped for three months it is due to bad blood. The reason why the bleeding does not stop is because the mass is not expelling. For one should purge the mass, and Gui Zhi Fu Ling Wan governs.

 

Even when there is unexplained sub-fertility, there isn’t always success in helping these women become pregnant. It’s heart breaking that especially in cases, where everything seems perfect, conception does not occur. It’s hard for us practitioners to admit that our treatments in that respect were not successful. It is even more difficult for women despairingly wanting to start a family or having another baby, not being able to fulfil their wish. Things sometimes do not happen the way we would like or expect them. It’s wholesome to have that view on life in general.

References:

Xu X, Yin H, Tang D, Zhang L, Gosden RG. Application of traditional Chinese medicine in the treatment of infertility. Human Fertility 2003; 6(4): 161-8

Wiseman N, Willms S, Ye F. Jin Gui Yao Lue-essential prescriptions of the golden coffer. Summer: Paradigm Publications 2009

Brigitte Linder
Brigitte Linder was born in Zurich and has lived near Melbourne on the south coast of Australia since 2008. She operated Safflower – Chinese Herbs Expertly Dispensed until mid-2023. Safflower is an herbal dispensary business operating under the banner of the Therapeutic Goods Administration (TGA). It was issued a GMP licence. Acuneeds acquired the company in January 2024 and intended to offer all services to practitioners in Australia and New Zealand.Brigitte completed a master's degree in 2023 with NICM Health Research (Western Sydney University). Her thesis involved creating a case report guideline for Chinese herbal medicine. In 2019, she published her first book and has since mentored TCM graduates to better transition to full-fledged practitioners. She has been consulting patients for 20 years and enjoys working with children and patients with complex conditions. She is a diplomat of the Institute of Classics in East Asian Medicine (ICEAM) and prescribes Eastern Han-era herbal formulas, namely Shang Han Lun and Jin Gui Yao Lue. Brigitte has always been interested in uniting a strong, cohesive TCM community. She continues to invest time and effort to ensure practitioners and the profession receive support and recognition.
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