From Infertility to Fertility

Pregnancy. That spark of life. The ultimate miracle from which all else unfolds. In the past 30 years, statistics show pregnancy has become increasingly difficult to achieve. 1 in 6 couples currently experiences infertility. Infertility is defined as the inability of a woman to conceive after one year of regular unprotected sex. Traditional Chinese Medicine (TCM) has embraced the treatment of infertility wholeheartedly through both acupuncture and herbal formulas. Treatment plans are formulated through pattern diagnosis or in conjunction with phases of the menstrual cycle. Let’s take a look at just four of the many herbal formulas from TCM pattern diagnosis.

TCM tells us that the Kidneys govern reproduction. Kidney energy or Qi is divided into Yang and Yin. Kidney Yang is associated with heat and movement. Kidney Yin is associated with coolness and substance. Kidney Yang and Yin need to be balanced for fertilization and fetal development. A simple example of Yin Yang balance is a hen sitting on an egg. Without Yang’s heat, the egg will not hatch. Without Yin’s substance, the eggshell, the embryo will die. Yin Yang balance permeates nature from the macro to the micro. The origin of the Kidney energies is Jing or Kidney Essence. It forms the basis for growth, reproduction, and development. It too is important for fertility. Most fertility patients have signs of Kidney Yang or Yin deficiency. ⁽¹⁾⁽²⁾

You Gui Wan

This formula was first written down 400 years ago. The translation is “Restore the Right Kidney”. In TCM the right kidney is associated with Kidney Yang. It is said to be the seat of “The Gate of Vitality”. You Gui Wan is used for Yang deficient fertility issues of both sexes. This is the one for infertility and low sperm count. Other symptoms indicating usage are exhaustion, aversion to cold, cold extremities, aching and weak lower back and knees, loose stools, frequent urination, and depression. Menstruation will have a prolonged cycle and the period could be heavy or scanty. The causes of Kidney Yang deficiency are excessive physical work or exercise, particularly during puberty.

You Gui Wan supplies heat to the kidneys which have become cold and worn out. It stokes the Kidney Yang fire, replenishes the Jing, nourishes the Yin and tonifies the blood. Jing is a key component for fertility as it forms the foundation for successful conception and pregnancy. Although this is Yang tonic, balance calls for adding in a little bit of Yin. Well-nourished blood is needed to build and maintain the placenta. Modern-day science supports the TCM usage of You Gui Wan. ⁽²⁾⁽³⁾

Let’s look at some studies…

This first study is egg oriented. Using the serum and mouse eggs, researchers found that You Gui Wan enhances egg maturation and increases egg fertilization.⁽⁴⁾The serum pharmacology method was employed in this study. This means mice were fed the herb formula. Their blood was then collected and the serum separated out. This serum closely resembles a digested herbal formula. The form of the herbs that would be interacting with the tissues of the body.

In another study, You Gui Wan rescued the testicles of rats. Sperm development was chemically suppressed, decreasing cell count. Rats with this induced testicular degeneration were fed You Gui Wan. The supplemented rats showed less degeneration than the control group. You Gui Wan powered rats had higher blood testosterone and estradiol, both indicators of the beneficial effects. ⁽⁵⁾ Estradiol, a form of estrogen, is usually thought of as a female sex hormone. Surprise! Estradiol plays a critical role in male sexual function. Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis.

Yet another study compared You Gui Wan with its sister formula Zou Gui Wan. This study found You Gui Wan was stronger to boost estradiol production than Zou Gui Wan. Estradiol is critical of oocyte development. It is the basis for follicle-stimulating hormone (FSH). This hormone regulates ovulation, the growth and development of eggs in the ovaries. Estradiol is needed as well for luteinizing hormone (LH). This hormone induces the ovary to release an egg. ⁽⁶⁾

Note: You Gui Wan is not the right choice when there is dampness.

Zuo Gui Wan

To restore the left Kidney there is Zuo Gui Wan. The left Kidney is the Yin kidney also called “The Source of the True”. Kidney Yin deficiency is wholly different exhaustion from the Yang type. Both formulas share the indication of the sore and weak lower back. This area is the realm of the Kidney in general. Zuo Gui Wan indications are lightheadedness, tinnitus, vertigo, night sweats, dry mouth, and thirst. Menstruation is characterized by early periods with scanty light-colored blood. Zuo Gui Wan is usually the one for long-term infertility. This being defined as more than two years without conception. Kidney Yin deficiency can be caused by working long hours without adequate rest. Irregular meals can also be a factor. ⁽²⁾

Our first study used a modification of Zuo Gui Wan. Researchers found it restored menstruation for 6 out of 8 Premature Ovarian Failure (POF) patients. Additionally body basal temperatures were consistent with ovulation. ⁽⁷⁾ Premature ovarian failure is the loss of ovarian function in women under the age of 40. Women with POF do not ovulate (release an egg) each month. This loss of function can be due to a less than normal amount of follicles or a dysfunction in the ovaries.

Our next study uses the serum pharmacology method and compared You Gui Wan and Zuo Gui Wan. The latter had more effect on the gene transcription aspect of oocyte development. This is the maturation of the egg cell so that it can develop into a fetus after fertilization. The researchers found that both formulas enhance neo-oogenesis. Whoa what the heck is that? It is generally accepted that female mammals are born with a finite number of oocytes (eggs). However, it has been observed that the ovary has cells capable of generating oocytes. This ability is neo-oogenesis.⁽⁶⁾

Hyperglycemia can be a cause of early miscarriage. Researchers created mouse embryos loaded with high glucose. They found these had compromised sugar metabolism and compromised mitochrondria. Zuo Gui Wan to the rescue. The formula prevented high glucose cell death by upregulating critical genes.⁽⁸⁾

Note: Zuo Gui Wan should used with caution or modified when the digestion is weak. Do not use in cases of heat from fever.

The next formula addresses a medley of menstrual symptoms. It also treats the most common presentation of infertility; Blood and Kidney deficiency with some Liver Qi stagnation.

Fu Ke Zhong Zi Wan

This formula goes by a few names depending on the maunfacturer. Gynecological Ova-Seed Pill, Women’s Seed Planting Pills, Plum Flower Fertile Fields, and, of course, Fu Ke Zhong Zi Wan.

Cold uterus and blood deficiency is a common cause of infertility. Fu Ke Zhong Zi Wan has two Kidney Yang boosters to warm the uterus. This formula is really all about blood. Almost half of the herbs in this formula nourish the blood. It has Xiang Fu which moves the Liver Qi. This unblocks any stagnation and circulates the newly nourished blood. In addition to infertility, indications for use are pelvic pain during intercourse, cold feet, flushed face. Menstrual cramps are the type which are better with warmth. The menstrual cycle could be delayed or absent. The flow can present in two ways, scanty or dark in color. This formula is also appropriate for long-term or heavy bleeding with large clots.⁽⁹⁾

Contraindications: Pregnancy. Do not use long-term or in amounts exceeding the recommended serving size. Do not use if the following are present: diarrhea, indigestion, headache or excessive menstrual bleeding.

Wen Jing Tang

Also addressing a cold uterus, but with less of an emphasis on nourishing the blood is Wen Jing Tang or Flow-Warming Decoction. Indications are painful periods, scanty periods, bleeding between periods, dizziness, hot flashes but feeling cold. The lower abdomen may feel cold and distended. Dry lips and mouth, the tongue may appear slightly purplish. Cold in the uterus is more common with young women. This condition can be caused by excessive work or sports in a cold climate, especially during puberty and menstruation. Overindulgence in cold or iced food and drinks can make the uterus cold.⁽²⁾

I don’t know about you but when I hear Polycystic Ovary Syndrome (PCOS) I think Wen Jing Tang. After reading the next study you will too. Sixty-four anovulatory* women diagnosed with PCOS were given one of two formulas that matched their TCM presentation. They took the formulas for 8 weeks. At the end of 8 weeks, fifty-four women failed to ovulate. Half of these were given Wen Jing Tang. The ovulation rate after switching to Wen Jing Tang was 60%. The authors concluded Wen-jing-tang improved ovulation in patients with PCOS regardless of their TCM presentation. Additionally, they concluded it could be used to treat PCOS of any TCM presentation.⁽¹⁰⁾

Another study shows Wen Jing Tang helping with ovulation. Clomiphene citrate (clomiphene) is the go-to medication for anovulation. This therapy does not work for 20 to 40% of patients. However, research reveals that with the addition of Wen Jing Tang close to half of the subjects ovulated. (11)

Note: contraindicated in cases of abdominal masses from blood stasis from excess.

Serving size: For all the formulas mentioned consume according to label directions or instructions from your knowledgeable healthcare practitioner.

Disclaimer: Use herbs wisely. If you have questions or special considerations, work with your practitioner. If symptoms worsen or you have concerns, contact a knowledgeable practitioner. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

*menstruating but not ovulating

References
1 Maciocia, G., The Foundations of Chinese Medicine, Churchill and Livingstone, 1989

2 Maciocia, G., Obstetrics & Gynecology in Chinese Medicine, Churchill Livingstone 1998

3 Bensky, Scheid, Ellis, Barolet Formulas and Strategies. Portable 2nd edition. Eastland Press Inc. 2015

4 Xiao-Hui Jiang, Yan-li Deng, 1 Hua Lu, Heng Duan, Xia Zhen, Xiang Hu, Xin Liang, Shang-mian Yie , Effect of Rat Medicated Serum Containing You Gui Wan on Mouse Oocyte In Vitro Maturation and Subsequent Fertilization Competence, Evid Based Complement Alternat Med. 2014

5 Ping Dong Zheng Zheng Li Mao Bin Gong Takako Yokozawa Hikokichi Oura Experimental study of the therapeutic effect of You‐Gui‐Wan on hypogonadism in rats, Phythotherapy Research, November 1995

6 Xiang Hu, Hua Lu, Yan-li Deng, Qian Wan, Shang-mian Yie, Effect of Rat Medicated Serum Containing Zuo Gui Wan and/or You Gui Wan on the Differentiation of Stem Cells Derived from Human First Trimester Umbilical Cord into Oocyte-Like Cells In Vitro, Evidence Based Complementary Medicine, 2015

7 Chao SL, Huang LW, Yen HR, Pregnancy in premature ovarian failure after therapy using Chinese herbal medicine, Chang Gung Medical Journal, 2003 Jun;26(6):449-52

8 Qi Liang, Zhipeng Qu, Yu Liang, QianJin Feng, Xin Niu, Temaka Bai, Yingli Wang, Qiang Song, David L. Adelson, Zuo Gui Wan Alters Expression of Energy Metabolism Genes and Prevents Cell Death in High-Glucose Loaded Mouse Embryos Evidence-Based Complementary and Alternative Medicine, Volume 2018

9 Fratkin, J., Chinese Herbal Patent Formulas, Shya Publications, 1986

10 Ushiroyama, et al. (2006) Effects of Switching to Wen-Jing-Tang (Unkei-To) from Preceding Herbal Preparations Selected by Eight-Principle Pattern Identification on Endocrinological Status and Ovulatory Induction in Women with Polycystic Ovary Syndrome. The American Journal of Chinese Medicine, Vol. 34, No. 2, 177–187

11 Yasuhiro Yoshimoto, M.D., Akira Miyake. M.D., Keiichi Tasaka, M.D., Toshihiro Aono, M.D.• and Osamu Tanizawa, MD, Ovulation Following Combined Therapy With Wen-Jing-Tang and Clomiphene Citrate Therapy in Anovulatory Women, American Journal of Chinese Medicine, 1989, Vol. XVII NOs. 3-4, pp. 243-244