Infertility refers to a situation where a married couple desires to have children, has lived together for more than two years, the man has normal reproductive function, yet the woman has not conceived. If a woman has never conceived since marriage, it is called “primary infertility”; if she has previously given birth or had a miscarriage but has not conceived again for more than two years, it is called “secondary infertility.”
I. Etiology, Pathogenesis, and Primary Symptoms
The causes of infertility include kidney deficiency, blood deficiency, blood stasis, liver qi stagnation, and phlegm-dampness. These causes may occur individually or in combination.
Kidney Deficiency Type: This is often due to congenital insufficiency, weak kidney qi, or early marriage and excessive sexual activity, which deplete essence and qi. It can be divided into Kidney Yang Deficiency and Kidney Yin Deficiency. If Kidney Yang is deficient, the Chong and Ren meridians become insufficient, and the uterine vessels are deprived of nourishment; consequently, the body cannot retain semen to achieve conception. Clinical manifestations include late menarche, delayed menstrual cycles, scant menstrual flow, dark-colored blood, soreness and weakness in the lower back and knees, low libido, and clear, copious urine. If cold is contracted during menstruation and lodges in the uterus, it leads to uterine cold and infertility. In cases of kidney yin deficiency—resulting from the depletion of essence and blood, deficiency of kidney yin, and the generation of heat due to yin deficiency—blood dryness causes infertility. Clinical manifestations include scanty menstrual flow, red and thick blood, prolonged spotting that is difficult to resolve, heat in the palms and soles, dizziness, tinnitus, insomnia, night sweats, soreness in the lower back and weakness in the legs, a red tongue with little or no coating, and a fine, rapid, and weak pulse.
Blood Deficiency Type: Insufficiency of yin and blood, deficiency of the Chong and Ren meridians; with insufficient blood, the essence cannot be retained to achieve pregnancy. Manifestations include scanty menstruation, pale-colored blood, delayed menstruation, eventually leading to amenorrhea; a sallow complexion; frail and weak physique; mental fatigue and exhaustion; dizziness and vertigo; a pale tongue with a thin white coating; and a deep, fine pulse.
Blood Stasis Pattern: During menstruation or the postpartum period, blood deficiency leads to blood stasis. Pathogenic factors invade the uterus, obstructing the meridians and causing stagnation in the uterine vessels.
Liver Qi Stagnation Type: Due to emotional distress, the liver fails to maintain smooth flow, blood circulation is impaired, and the Chong and Ren meridians are deprived of nourishment, resulting in infertility. Symptoms include prolonged infertility despite marriage, irregular menstrual cycles, premenstrual abdominal pain, irregular menstrual flow (which may be scanty or delayed), or premenstrual breast and flank distension and pain, mental depression and unhappiness, or irritability and short temper. The tongue is dark red or normal in color, with a thin white coating, and the pulse is string-like.
Phlegm-Dampness Pattern: Due to obesity, phlegm and dampness are generated internally, obstructing the flow of qi and blocking the uterus, thereby preventing the conception of a child. Symptoms include prolonged infertility despite marriage, obesity, delayed menstruation, or even amenorrhea; thick and profuse leukorrhea; a dull or pale complexion; dizziness and palpitations; heaviness in the limbs; or chest tightness and nausea; a white, greasy coating on the tongue; and a slippery or string-like and slippery pulse.
II. Treatment of Infertility
Traditional Chinese Medicine (TCM) can achieve good results in treating infertility. TCM treatment is tailored to the specific underlying causes. The following is a description of the different subtypes based on their etiology:
Kidney-deficiency-type infertility is further divided into Kidney Yang Deficiency and Kidney Yin Deficiency. For Kidney Yang Deficiency, treatment should focus on tonifying Qi and warming Yang, as well as regulating and tonifying the Chong and Ren meridians. Right Return Pill (You Gui Wan) is prescribed for this condition. For Kidney Yin Deficiency, the treatment should focus on nourishing the Kidney and replenishing Yin, using Left Return Pill (Zuo Gui Wan).
For Blood Deficiency-Type Infertility, treatment should involve nourishing Yin and blood, as well as regulating and tonifying the Liver and Kidney; Nourishing Essence and Cultivating Jade Decoction (Yang Jing Zhong Yu Tang) with appropriate modifications may be used. In cases of both Qi and Blood Deficiency, Warm Earth and Nurture the Unicorn Decoction (Wen Tu Yu Lin Tang) is recommended.
For infertility due to blood stasis, treatment should focus on promoting blood circulation and resolving stasis; Gexia Zhuyu Decoction with appropriate modifications should be administered.
For infertility due to liver qi stagnation, treatment should involve soothing the liver and relieving depression, supplemented by strengthening the spleen; Xiaoyao Powder or Shengyu Zhongyu Decoction (Angelica sinensis, Atractylodes macrocephala, Paeonia lactiflora, Poria cocos, Moutan bark, Cyperus rotundus, Polygonatum odoratum, etc., decocted in water) should be used.
Treatment for infertility due to phlegm-dampness should focus on strengthening the spleen, drying dampness, and resolving phlegm. Modified Qigong Pills (processed Pinellia, Atractylodes, Cyperus, Shenqu, Poria, Tangerine Peel, Ligusticum, Sargassum, Kelp, and Acorus; decocted in water) may be used.