TCM Diet Therapy for Male and Female Infertility

Because women are physiologically responsible for pregnancy and nurturing infants, in the past, some people wrongly attributed the responsibility for infertility solely to women, causing them to suffer unjust accusations for extended periods. It is widely known that pregnancy results from the combination of sperm and egg followed by implantation, and issues at any stage or aspect of this process can lead to infertility. Therefore, in other words, infertility can exist in either the male or female partner. According to research data, among infertile couples, male infertility accounts for 30 to 40 percent, while female infertility accounts for 50 to 60 percent. These statistical figures are relatively objective and align with reality.

I. Causes of Infertility

(I) Reasons related to the male side

Male-related causes of infertility include issues with sperm, such as testicular dysplasia, testicular inflammation, varicocele, etc., leading to azoospermia, oligospermia, poor sperm motility, necrospermia, and teratospermia. There are also factors affecting sperm transport, such as obstruction of the vas deferens and retrograde ejaculation. Problems with semen include non-liquefaction of semen or excessive or insufficient semen volume due to prostatitis. There are also causes related to sexual intercourse wellness, such as an overly large or small genitalia, intersexuality, and severe urethral cleft. Additionally, sexual dysfunction, such as impotence and premature ejaculation, can also contribute to infertility. All of the above situations can lead to infertility.

(II) Reasons related to females

Female-related causes of infertility include ovarian factors: such as ovarian hypoplasia and anovulation due to ovulatory dysfunction. There are also fallopian tube factors: for example, fallopian tube inflammation and blockage helps maintain the passage of eggs. Uterine factors are involved as well: such as poor development of the endometrium and abnormal function, which helps maintain the fertilized egg from implanting. In addition, there are causes related to abnormalities of the reproductive organs: such as a thick hymen, double vagina, etc., which can lead to infertility by interfering with sexual intercourse.

(III) TCM Understanding of the Etiology of Infertility

In traditional Chinese medicine, the causes of infertility are divided into congenital defects and acquired pathologies. Regarding congenital infertility, Wan Quan’s Guang Si Ji Yao mentions the “five types of male infertility”—namely, “Tian (incomplete development of external genitalia), Lou (seminal incontinence), Jian (castration), Qie (impotence), and Bian (hermaphroditism)”—and the “five types of female infertility”—namely, “Luo (twisted vagina), Wen (imperforate hymen), Gu (absence of uterus), Jiao (clitoromegaly), and Mai (amenorrhea).” These mostly pertain to congenital physiological defects that cannot be effectively supports with medication or dietary therapy and thus fall outside the scope of this discussion. Acquired infertility is primarily pathological, with the following etiological and pathogenic mechanisms:

1.Kidney deficiency

In males, it is caused by congenital weakness of constitution, deficiency and coldness of essence qi, or excessive sexual activity leading to the dissipation of essence and blood, resulting in the inability to retain semen. In females, it is due to yang deficiency and decline of the Kidney, which fails to warm the uterus, causing a cold uterus; or deficiency of essence and blood, weakness of the Chong and Ren meridians, and malnourishment of the uterine vessels, making conception impossible.

2.Liver Qi Stagnation

In men, emotional stagnation leads to Liver Qi Stagnation, resulting in impaired regulation of qi movement, Qi Stagnation and blood stasis, and relaxation of the penis, causing infertility. In women, Liver Qi Stagnation leads to disharmony between qi and blood, and the Chong and Ren meridians fail to nourish each other, resulting in infertility.

3.Phlegm-dampness

The body is obese, with excessive consumption of rich and greasy food, leading to the internal generation of phlegm-dampness, which obstructs the flow of qi. This results in the blockage of the spermatic orifice in men, causing infertility. In women, the uterine vessels are obstructed, helps maintain the capture of sperm and conception.

4.Spleen deficiency

In males, prolonged wellness leads to general debility, and overexertion injures the Spleen. When the Spleen fails to perform its transporting and transforming functions properly, the generation of qi and blood lacks a source, resulting in insufficient qi and blood. This, in turn, causes a deficiency of Kidney essence, and the failure to nourish the penis leads to infertility. In females, blood deficiency results in the failure to nourish the uterine vessels, leading to irregular menstruation and an inability to conceive.

5.Blood stasis

If, during a woman’s menstrual period or after childbirth, residual blood has not been completely eliminated and she is exposed to cold pathogens, the cold can coagulate the blood in the vessels, obstruct the uterine vessels, and helps maintain the combination of the two types of essence, leading to infertility. In men, if there is blood stasis obstructing the vessels and the spermatic orifices are blocked, it can result in infertility.

II. Syndrome Differentiation and Dietary Therapy

(I) Syndrome Differentiation and Classification and Dietary Therapy for Male Infertility

1.Kidney Deficiency with Essence Depletion

The Kidney stores congenital essence and serves as the foundation for reproduction. Kidney deficiency with essence depletion leads to reproductive dysfunction, presenting with signs of imbalance such as soreness and weakness of the waist and knees, low libido, impotence and premature ejaculation, spermatorrhea and frequent urination, fatigue and lack of strength, dizziness and blurred vision, thin semen or overly viscous semen, low sperm count, and weak sperm motility. In cases with a predominance of yang deficiency, additional signs of imbalance include a pale complexion, aversion to cold with cold limbs, pale tongue with a white coating, and a deep and slow pulse. In cases with a predominance of Yin Deficiency, additional signs of imbalance include heat sensation in the palms and soles, restlessness, thirst, insomnia, red tongue with a scanty coating, and a thin and rapid pulse. The supports principle is to nourish the Kidney and replenish essence.

(1) Those with partial Kidney yang deficiency can take Ginseng Venison Soup.

(2) Those with partial Kidney Yin Deficiency can take Weibu Decoction.

In addition, dietary therapy prescriptions for warming the Kidney and strengthening yang and for nourishing yin and replenishing essence can be selected respectively for consumption.

2.Deficiency of qi and blood

Essence and blood share the same origin and mutually nourish each other. When qi and blood are deficient, the transformation source of essence is lost, leading to infertility. signs of imbalance include sallow complexion, shortness of breath and reluctance to speak, physical weakness, insomnia and palpitations, dizziness, poor appetite and loose stools, low semen volume, insufficient sperm count, and poor sperm motility, pale tongue with white coating, and a deep and feeble pulse. The supports should focus on replenishing both qi and blood, and Buqiyangxue Jiu (Qi and Blood Tonifying Wine) can be taken.

Formula and Preparation Method: Psoralea Fruit (Buguzhi), Rehmannia Root (Prepared, Shudi), Rehmannia Root (Raw, Shengdi), Ophiopogon Root (Tiandong), Lily Bulb (Maidong), Ginseng (Renshen), Chinese Angelica Root (Danggui), Ligusticum Rhizome (Chuanxiong), White Peony Root (Baishao), Poria (Yunling), Platycladus Seed (Baiziren), Amomum Fruit (Sharen), Grassleaf Sweetflag Rhizome (Shichangpu), Polygala Root (Yuanzhi) 30 grams each, Aucklandia Root (Muxiang) 15 grams. Crush the above 15 ingredients, store them in a white cloth bag, place it in an earthenware vessel, and soak in high-quality wine.

2000 grams. Boil it over fire, strain out the dregs, and let it cool. Store it for future use. Take 10 to 20 milliliters daily without strict dosage restrictions.

In the formula, Bazhen Decoction (Si Jun Zi Tang and Si Wu Tang) replenishes qi and nourishes blood, Psoraleae Fructus (Bu Gu Zhi) tonifies the Kidney, Ophiopogonis Radix (Mai Dong) and Asparagi Radix (Tian Dong) nourish yin, Acori Tatarinowii Rhizoma (Shi Chang Pu), Polygalae Radix (Yuan Zhi), and Platycladi Semen (Bai Zi Ren) nourish blood and calm the mind, Amomi Fructus (Sha Ren) strengthens the stomach, and Aucklandiae Radix (Mu Xiang) promotes the flow of qi. The entire formula replenishes both qi and blood and takes into account the Heart, Spleen, and Kidney, making it an excellent formula for replenishing qi and nourishing blood.

In addition, one may choose to consume dietary therapy prescriptions that replenish qi and nourish blood.

3.Liver Qi Stagnation and Blood Stasis

Emotional stagnation leads to Liver qi constraint, resulting in impaired regulation of qi movement, Qi Stagnation and blood stasis, which may cause impotence or anejaculation, ultimately leading to infertility. signs of imbalance include fullness and distension in the chest and hypochondrium, restlessness and insomnia, bitter taste in the mouth and irritability, a dark red tongue with petechiae, a thin tongue coating, and a choppy or wiry pulse. The supports principle is to soothe the Liver and promote qi circulation, activate blood and unblock the collaterals. Rose Hawthorn Cyathula Wine or Peach Kernel Porridge can be taken.

5.Internal accumulation of phlegm-dampness

Excessive intake of rich and sweet foods leads to endogenous production of phlegm-dampness, which obstructs the flow of qi, resulting in impaired function of the spermatic orifices, inability to ejaculate, or infertility due to thick and unliquefied semen. signs of imbalance include a虚胖 (虚胖 can be translated as “flabby and overweight”) physique, fatigue and shortness of breath, limb heaviness and lassitude, possibly accompanied by impotence, dizziness, palpitations, a pale tongue with a white and greasy coating, and a deep and thin pulse. The supports principle is to dry dampness and resolve phlegm, promote the flow of qi and unblock the orifices. Zhi Zhu Fan can be taken.

Formula and Preparation Method: 10 grams of Fructus Aurantii Immaturus (Zhi Shi), 30 grams of Rhizoma Atractylodis Macrocephalae (Bai Zhu). Decoct each herb separately three times, strain out the dregs. Use the combined decoction to cook 150 grams of japonica rice. When the rice is nearly cooked, cover it with a clean lotus leaf and continue cooking until the rice is fully done. Consume it daily for breakfast or dinner.

In the formula, Fructus Aurantii Immaturus regulates qi, resolves phlegm and eliminates fullness and distention; Rhizoma Atractylodis Macrocephalae strengthens the Spleen and resolves dampness; Folium Nelumbinis elevates and nourishes stomach qi to assist Rhizoma Atractylodis Macrocephalae; Oryza Sativa L. strengthens the Spleen and replenishes qi. Together, they achieve the effect of strengthening the Spleen, promoting diuresis and resolving phlegm. If an additional 5 grams of Semen Sinapis Albae is added to the formula to promote qi circulation, dissipate nodules, unblock the collaterals and helps with occasional pain, the therapeutic effect will be even better.

One can also take Chunyi Pill Wine. Formula and preparation method: 30 grams each of Rhizoma Atractylodis Macrocephalae, Rhizoma Dioscoreae, and Semen Euryales, 20 grams of Coicis Semen, 10 grams of Cinnamomi Cortex, 6 grams of Fructus Amomi, and 500 milliliters of yellow rice wine. Put the herbs into the wine and soak for one week before consumption. Take 10 – 20 milliliters each time, once in the morning and once in the evening.

This is a formula from Shishi Milu. Atractylodis Macrocephalae Rhizoma, Dioscoreae Rhizoma, Euryales Semen, and Coicis Semen can strengthen the Spleen, dry dampness, and resolve phlegm. Amomi Fructus harmonizes the stomach and promotes the flow of qi. Cinnamomi Cortex warms and unblocks the meridians. For men with internal accumulation of phlegm-dampness leading to infertility, regular consumption of this formula can indeed be effective.

(II) Syndrome Differentiation and Classification and Diet Therapy for Female Infertility

1.Infertility due to Kidney deficiency

Kidney deficiency causes malnourishment of the Chong Meridian [LR1] and Ren Meridian [RN4], along with insufficiency of the blood sea, leading to delayed menstruation or amenorrhea and, consequently, a prolonged inability to conceive after marriage. In cases of predominant Kidney yang deficiency, the complexion appears dull, accompanied by soreness and weakness in the lower back and legs, diminished sexual desire, clear and profuse urine, loose stools, a pale tongue with a white coating, and a deep, thin or deep and slow pulse. In cases of predominant Kidney Yin Deficiency, the individual becomes emaciated, with soreness and weakness in the lower back and legs, dizziness and blurred vision, palpitations and insomnia, irritability, dry mouth, five-center heat, a red tongue with a scanty coating, and a thin and rapid pulse.

(1) For those with a predominance of yang deficiency, the supports should focus on warming the Kidney, replenishing qi, nourishing blood, and regulating and tonifying the Chong and Ren Meridians. They can consume Lycium barbarum and mutton porridge.

Formula and Preparation Method: 100 grams of Lycium chinense seedlings, 1 sheep Kidney finely chopped, 50 grams of lamb meat chopped, 30 grams of scallions, and 250 grams of japonica rice. Cook them together to make porridge, add an appropriate amount of salt, and consume in divided doses.

In the formula, wolfberry seedlings are combined with warm-natured and Kidney-tonifying mutton and lamb Kidney to warm and tonify Kidney yang, nourish blood, and replenish essence. If an additional 10 grams of Chinese angelica root and 20 grams of astragalus root are wrapped in gauze, placed in a pot, and boiled together with wolfberry and mutton porridge, the effect will be even better.

In addition, one can also choose to consume dietetic therapy prescriptions that warm the Kidney and strengthen yang.

(2) For those with Yin Deficiency, the supports should focus on nourishing yin and blood, replenishing essence, and regulating the thoroughfare vessel. They can consume cuttlefish stewed with chicken.

Formula and Preparation Method: Stew 250 grams of cuttlefish, one soft-shelled turtle, and one black-bone chicken together until thoroughly cooked, season with salt, and consume the meat and soup.

In the formula, cuttlefish nourishes yin and blood, soft-shelled turtle meat nourishes yin and cools blood, and silky fowl replenishes essence and fills marrow. When combined, they work together to achieve the effects of nourishing yin and blood, replenishing essence, and regulating the thoroughfare vessel.

In addition, one can also choose food therapy prescriptions that nourish yin and replenish essence for consumption.

2. Infertility due to Liver Qi Stagnation

Emotional distress leads to the Liver losing its smooth flow, disrupting the balance of qi and blood, and helps maintain the thoroughfare and conception vessels from nourishing each other. This results in long-term infertility, with signs of imbalance such as irregular menstruation, painful periods with obstructed flow, scanty and dark-colored blood with clots, breast distension before menstruation, mental depression, irritability, a normal or dark-red tongue with a thin white coating, and a wiry pulse. The supports should focus on soothing the Liver to helps with occasional depression and nourishing blood to regulate the Spleen. Chenpi Beverage or Kumquat Tea can be consumed.

3.Infertility due to phlegm-dampness

The patient has a stout physique or indulges in rich and fatty foods. Spleen deficiency leads to impaired transportation and transformation, resulting in the internal production of phlegm-dampness. This obstructs the flow of qi, blocks the uterine vessels, and helps maintain the capture of sperm for conception. As Zhu Danxi said, “For women with a robust physique and abundant constitution who indulge in alcohol and food, irregular menstruation occurs, making conception impossible. This is called ‘body fat overflowing and blocking the uterus’.” signs of imbalance include delayed menstruation or even amenorrhea, abundant leukorrhea with a thick and sticky quality, pale complexion, dizziness, palpitations, chest oppression, nausea, a white and greasy tongue coating, and a slippery pulse. The supports principle is to dry dampness and resolve phlegm, regulate qi, and harmonize menstruation. Babao Porridge can be taken.

Formula and Preparation Method: 6 grams each of gorgon fruit (Euryale ferox Salisb.), Chinese yam (Dioscorea opposita Thunb.), poria (Poria cocos (Schw.) Wolf), lotus seed (Nelumbo nucifera Gaertn.), coix seed (Coix lacryma-jobi L. var. ma-yuen (Rom.Caill.) Stapf), white hyacinth bean (Dolichos lablab L.), codonopsis root (Codonopsis pilosula (Franch.) Nannf.), and atractylodes macrocephala (Atractylodes macrocephala Koidz.). Wrap the last two ingredients in a cloth bag, place all ingredients together in a pot, add an appropriate amount of water, decoct, then remove the cloth bag containing the herbs. Add 150 grams of rinsed rice, cook into porridge, and consume in divided servings.

All the herbs in the formula can strengthen the Spleen and replenish qi. Among them, Poria (Fuling), Coicis Semen (Yiyiren), and Dolichoris Semen (Biandou) can also promote diuresis and resolve dampness. If a small amount of White Radish (Bailuobo) is added to promote digestion and move qi downward, the effects of drying dampness and resolving phlegm, regulating qi, and harmonizing menstruation will be more pronounced.

4.Stagnation of static blood

Stagnation of the seven emotions leads to Qi Stagnation, which in turn causes blood stasis. Alternatively, cold invading the lower energizer results in blood stasis due to the congealing nature of cold and impaired blood circulation. Blood stasis obstructing the uterine vessels leads to prolonged inability to conceive after marriage. signs of imbalance include delayed and scanty menstruation with dark purple blood and clots, often accompanied by dysmenorrhea, a dark purple tongue or petechiae on the tongue edges, and a deep and hesitant pulse. The supports principle is to promote blood circulation to remove stasis and regulate menstruation. Rose Hawthorn Wine with Safflower can be taken.

Formula and Preparation Method: 15 grams of Rosa rugosa flower, 30 grams of Crataegus pinnatifida (hawthorn fruit), 10 grams of Carthamus tinctorius (safflower), add 500 grams of wine and an appropriate amount of rock sugar. Soak for one week, shake once daily. Drink 10 to 20 milliliters before bedtime each day.

In the formula, Flos Rosae Rugosae (rose) promotes blood circulation to remove blood stasis and regulates qi to helps with occasional depression; Fructus Crataegi (hawthorn) can promote blood circulation and remove blood stasis; Flos Carthami (safflower) promotes blood circulation to regulate menstruation and removes blood stasis to helps with occasional pain; wine can unblock blood vessels to enhance the efficacy of the herbs. When these herbs are combined, they work together to achieve the effects of promoting blood circulation, removing blood stasis, regulating qi, and regulating menstruation.

One can also consume Safflower Fertility Egg. Recipe and preparation method: 1 egg, 1.5 grams of Carthamus tinctorius (safflower), and an appropriate amount of brown sugar. First, make a small opening in the egg, place the safflower inside, stir well, and steam until cooked. Start taking it on the first day after menstruation ends, consuming one egg per day for 9 to 15 consecutive eggs. Then, wait until the next menstrual cycle begins before starting to take it again. Each time, take it with brown sugar water.

In the formula, egg nourishes yin and blood, safflower (Carthamus tinctorius L., Hong Hua) promotes blood circulation to remove blood stasis, unblocks the meridians, and helps with occasional pain. Hainan agarwood (Aquilaria sinensis (Lour.) Gilg) can also be added for quicker results. This is a widely circulated folk empirical formula. It was reported that one patient became pregnant by using only local grass safflower. According to syndrome differentiation, if the patient has a tendency towards deficiency-cold, cinnamon (Cinnamomum cassia Presl, Rou Gui) can be added; if there is a tendency towards phlegm-dampness, atractylodes (Atractylodes lancea (Thunb.) DC., Cang Zhu) can be added; if there is a tendency towards blood deficiency, Chinese angelica root (Angelica sinensis (Oliv.) Diels, Dang Gui) can be added; if there is a tendency towards Liver stagnation, white peony root (Paeonia lactiflora Pall., Bai Shao) can be added; if there is a tendency towards blood heat, rehmannia root (Rehmannia glutinosa (Gaertn.) Libosch. ex Fisch. et C.A.Mey., Sheng Di) can be added. This will lead to more ideal results.

5.Uterine cold leading to infertility

A constitution of yang deficiency and decline of the fire of the Mingmen (Gate of Vitality); or exposure to cold during menstruation leading to the lodging of cold pathogens in the uterus, can both result in uterine cold and infertility. As Fu Qingzhu said, “In cold and watery lands, no vegetation grows; in deep and dark abysses, no fish or dragons thrive. When the uterus is cold, how can conception occur?” signs of imbalance include a cold sensation in the lower abdomen, delayed menstruation, dark purple menstrual blood with clots, cold pain in the lower abdomen during menstruation that is helps with occasional by warmth, a pale tongue with a white coating, and a deep and slow pulse. The supports should focus on warming the meridians to dispel cold, warming the uterus and promoting blood circulation, and the formula Xian Shu Tang (Immortal Art Decoction) with hawthorn can be administered.

Formula and Preparation Method: 1000 grams of flour, 50 grams of hawthorn fruit, and 30 grams each of fennel, dried ginger, cinnamon bark, and atractylodes rhizome. Grind the above herbs into fine powders separately, then mix them evenly with the flour and salt, and stir-fry until cooked. Take 50 grams each time, dissolve it with boiling water, and consume.

In the formula, foeniculum vulgare (xiaohuixiang), dried ginger (ganjiang), and cassia bark (rougui) can warm the meridians to expel cold, promote the circulation of qi to helps with occasional pain; atractylodes rhizome (cangzhu) dries dampness and warms and nourishes the middle qi; hawthorn fruit (shanzha) promotes blood circulation to remove blood stasis. Therefore, taking this formula can warm the uterus, remove blood stasis, normalize menstruation, and naturally enable conception.

One can also take ginger-sugar paste. Formula and preparation method: 500 grams of fresh ginger and 500 grams of brown sugar. It is best to make this paste during the dog days of midsummer. First, wash the fresh ginger, slice it, and mash it into a paste. Mix in the brown sugar, place it in a pot, and steam for 1 hour. Then, take it out and expose it to sufficient sunlight for 3 days. After that, steam and sun it again. Repeat this process of steaming 9 times and sunning 9 times in total, that is, steaming and sunning 9 times during each dog day period. The medication should be started on the first day of menstruation. Take one tablespoon each time, once a day, for 1 consecutive month without interruption. Sexual intercourse is prohibited during the medication period.

In the formula, both fresh ginger and brown sugar can dispel cold, expel wind, warm the uterus, and activate blood circulation. After being steamed nine times and sun-dried nine times, their effects become even more remarkable. Therefore, it can be used for female infertility caused by a cold uterus.

In addition, food therapy recipes for warming meridians and dispersing cold can also be selected for consumption.

III. External Folk and Proven Prescriptions

1. Jin Dan for External Use in Men for Procreation can warm the Kidney and strengthen yang, and is mainly indicated for impotence, premature ejaculation, cold Kidney with cold semen, and long-term infertility. Prescription: 3 Pheretima (choose those with white collars, which are male, remove the mud and dry them in the sun), 3 grams each of Asarum (ground and stir-fried), Hyphae of Pterocladia (dried in the sun and ground), Chebulae Fructus Immaturus (the flesh), Os Draconis, Cinnamomi Cortex, Venenum Bufonis (soaked in wine and dried in the sun), Cnidii Fructus, Curculiginis Rhizoma (dried in the sun), Epimedii Herba, Aconiti Lateralis Radix Praeparata (dried in the sun), 1.5 grams of Caryophylli Flos, 7 male Bombyx Mori (remove the wings and feet, those with sharp tails are male), and 10 peppercorns. Grind all the above herbs into a fine powder, make pills with grain alcohol, and coat with yellow wax. Usage: Dissolve with grain alcohol at the Shen hour (3 – 5 p.m.), apply to the penis, wash off with hot water in the evening. One pill can be used twice without the need for dissolution. Avoid drinking grain alcohol; drinking it will cause impotence without ejaculation.

2. For women, external application of Yishou Bitian Ointment can strengthen tendons and bones, replenish essence and marrow. It is mainly indicated for female infertility due to uterine cold, irregular menstruation, and leucorrhea with red and white discharges. It is also used to supports male impotence, premature ejaculation, spermatorrhea, coldness in the lower part of the body, weakness and numbness in the waist and knees, fatigue, asthenia, asthma, and cough. Prescription: Velvet Antler, Radix Aconiti Lateralis Preparata (peeled and umbilicus removed), Radix Achyranthis Bidentatae, Tiger Shinbone (roasted until crisp), Fructus Cnidii, Semen Cuscutae, Dipsaci Radix, Radix Polygalae, Herba Cistanches, Radix Asparagi, Radix Ophiopogonis, Semen Armeniacae Amarum, Radix Rehmanniae, Radix Rehmanniae Preparata, Cortex Cinnamomi, Fructus Toosendan (stone removed), Fructus Corni, Radix Morindae Officinalis, Psoraleae Fructus, Eucommiae Cortex (outer coarse bark removed), Semen Momordicae.