In this article, we discuss infertility from the discussion of conception in the Nei Jing, which states that the basis of conception is the combination of the father’s essence and mother’s blood, the yin and yang, and that there are certain conditions for the intersection of the parents’ essence and blood to form a fetus and pregnancy. The etiology of infertility lies in the influence of the external environment and the imbalance of the internal environment. It is proposed that the treatment of female infertility should be based on two aspects: obstruction of the production of sperm for reproduction and the inability of the two sperms to fight each other.
The Nei Jing is one of the earliest surviving medical classics in China. Based on a holistic view of the four seasons, five organs, yin and yang, it elaborates on the relationship between heaven and man and discusses the physiology, pathology, diagnosis, treatment and health of the human body.
For two thousand years, it is on the basis of the theories, principles, and techniques of the Nei Jing and the methodology it establishes that successive generations of medical practitioners have continued to develop the academic aspects of Chinese medicine through continuous exploration practice and innovation. The book on gynecology covers various aspects of menstruation, dysbiosis, conception, the etiology and pathogenesis of miscellaneous gynecological diseases, and their diagnosis and treatment. It has had a significant impact on the emergence and development of gynecology in Chinese medicine.
A woman who has lived together as a couple for more than two years after marriage, whose spouse has normal reproductive function and has not conceived without contraception, or who has conceived, without contraception, and has not conceived again for more than two years, is called infertile. Infertility is a common and difficult medical condition of worldwide concern. In fact, infertility is not an independent disease, but a sequel and outcome of many obstetrical and gynecological diseases.
Since the evidence of infertility in women was introduced in Suwen Bone and Space, medical practitioners have attached great importance to it, and many medical texts in later times often include special sections on “the heir”, “seeking a son” and “seeds”. In many later medical texts, the topic was often discussed in special chapters such as “Sons and Daughters”, “Seeking Children” and “Seeds”, and many more were played on the basis of the Nei Jing. With its unique theory and method, Chinese medicine has certain advantages and many successful experiences in the treatment of infertility [3]. In this paper, we present a preliminary discussion on infertility from the discussion on conception in the Nei Jing, with the aim of contributing to the theoretical research and clinical study of infertility in TCM gynecology.
1. Physiology of conception
1.1 Basis of conception
The Spiritual Pivot: The Year of Heaven says: “I would like to hear about the first birth of human beings, what gas is built as the foundation? What stand and for J? …… Man Bo said: mother as the base, father as J. “Explain that the formation of the human embryo depends on the father’s essence and mother’s blood, the combination of the two sexes of yin and yang to become. The yin blood is the foundation, the yang qi is the external guard, the yin and yang use each other, thus contributing to the development and growth of the embryo. Thus, the “Spiritual Pivot” says: “When a man is born, he first becomes the essence, and when the essence is formed, the brain marrow is born, the bones are the stem, the veins are the camp, the tendons are the rigid, the flesh is the wall, the skin is firm and the hair is long.”
This points out the importance of male essence and female blood in the conception of the fetus. The “Spiritual Pivot” also says: “Therefore, the birth of the coming is called the essence, and the two essences fighting each other is called the god.” The two sperms are the sperms of yin and yang. The one who fights is also the one who intersects. All things grow in the way, not only the yin and yang cross and then the gods see. Therefore, the birth of man must be combined with the qi of yin and yang, the structure of the parents of the essence, the two essence of the fight, the form of God is formed. As the saying goes, heaven and earth are united with the qi, and the order is also called human. The so-called “essence” and “god” here refer to the basic substances that constitute the human body and maintain life activities, and also refer to the reproductive essence, i.e., the innate essence.
1.2 Conditions for conception
It is not the case that the combination of parents’ essence and blood can produce a fetus at will, but there are certain conditions for the intersection of the two. It requires the normal function of the internal organs of men and women, the enrichment of the kidney energy, the formation of the heavenly sebum, and the prosperity of the rhythm and the normal flow of menstruation. As “Suwen – Shanggu Tianzhen” said: “The woman is seven years old, the kidney is full, the teeth more hair long, two seven years and the day sebum to, the Ren vein through, the Taichong vein Sheng, menstruation to time, so there is a child …… seven seven years, the Ren vein deficiency, the Taichong vein decline less, the day sebum exhausted, the ground is not accessible, so the form is bad and no children.
Husband eight years old, the kidney qi real, hair long teeth more, two eight, the kidney qi Sheng, heavenly sebum to, essence overflow diarrhea, yin and Yang and, so can have a child …… eight eight, heavenly sebum exhaustion, less essence, kidney failure …… now all five organs are declining, tendons and bones decay, heavenly sebum is exhausted. Therefore, hair sideburns, body heavy, walking incorrectly, and no son ear.” That is, both men and women must reach a certain age, before the combination of conception conditions. Therefore, Chu Cheng said: “together with men and women must be when their years, although the male 16 and proficient, must be 30 and married, although the female 14 and day sap to, must be 20 and married. All want yin and yang complete real, and then intercourse and pregnancy, pregnancy and childbirth, childbirth and for the son, strong and strong life.
If you are not old enough, the kidney qi is not yet in full bloom, the heavenly sap has not yet arrived, or beyond a certain age, the kidney qi is exhausted, the heavenly sap is depleted, and the essence and blood are deficient, then although intercourse and can not become pregnant, although pregnant and can not be fertile, although childbirth is not long [5]. This is why Suwen Shanggu Tianzhen said, “Men are not exhausted, women are not exhausted, and the essence of heaven and earth is exhausted.”
2. Etiology and pathogenesis of infertility
2.1 Influence of external environment
Nature has given people the conditions to survive, and people live in nature, so the changes in nature will certainly affect people, and this is also true for conception. For example, the “Spiritual Pivot – evil guest” said: “The earth has four times no grass, people have no children. This human being corresponds to heaven and earth.” Su Wen – five permanent political theory said: “the year there is a fetus pregnant infertility, the treatment of incomplete, what gas caused? Qi Bo said: the six gases and five categories, there is also the system. The same Sheng, the different decay, this is the way of heaven and earth, biochemistry of the normal.” It points out the influence of the natural environment and the five movements and six qi on conception.
2.2 Disorders of the internal environment
The fetus is formed in the uterus, and the five internal organs and six internal organs of the human body are closely related to the uterus through the liaison of the meridians. If the function of the internal organs is normal and the qi and blood are vigorous, the fetus and pregnancy can be formed. If the internal organs are not functioning properly and the source of essence and blood is depleted, it will definitely affect the formation of fetus and pregnancy. The kidney is the main reservoir of sperm and is the basis of reproduction, and deficiency of kidney energy is one of the important factors leading to infertility.
The meridian system of the human body, especially the eight channels of the Qi meridian, the Punch, Ren and Dou channels are directly related to the uterus, for example, “The Ling Shu – Five Sounds and Five Flavors” says: “The Punch and Ren channels both originate in the uterus and follow the dorsal lane, which is the sea of meridians.” Suwen・bone empty theory says: “Governor’s vein, starts in the center of the bone below the less abdomen, the woman into the system Ting Kong, its hole, the end of the drowning hole also, and its contact follows the Yin apparatus …… Governor’s vein for disease …… its women are infertile …….” It can be seen that the deficiency of the meridian qi of the Governor, Ren and Chong veins is also an important factor leading to infertility.
3.Treatment inspiration
Pregnancy is a very complex natural physiological process, which has been basically elucidated by modern reproductive medicine and has been verified numerous times in clinical practice. It includes the production and operation of eggs and sperm, the union of sperm and egg, the transport, implantation, growth, development and maturation of the pregnant egg. Disorders in any of these processes can lead to infertility.
Under the guidance of this theory, in vitro fertilization and embryo transfer have been achieved, and the success of IVF proves the scientific validity of this theory. Chinese medicine should also keep up with the times and learn from these achievements for our use, incorporating them into the theoretical system of Chinese medicine to improve clinical efficacy.
According to the Nei Jing and modern research, infertility in women should be treated in two categories.
3.1 Reproductive sperm production disorders: This is the main cause of infertility. Modern medicine has proven that the female reproductive sperm is microscopically reflected in the maturation and discharge of the egg, and this process is regulated and conditioned by a variety of factors. From the perspective of Chinese medicine, the main causes are kidney deficiency and liver depression. The liver and kidneys are the mother and the liver is the mother of the child.
The main pathogenesis of ovulation disorder infertility is kidney deficiency, liver depression or both. The disease may involve qi, blood, fluid and other internal organs over time, resulting in a complex pathogenesis of qi, blood, fluid and multiple organs being damaged. The former common symptoms include kidney and spleen Yang deficiency, liver and kidney Yin deficiency and kidney deficiency and liver depression, while the latter common symptoms include kidney deficiency and blood stasis and kidney deficiency and phlegm condensation. The clinical treatment should mainly focus on tonifying the kidney and adjusting kidney-yin and kidney-yang, while taking care of the concurrent evidence and being flexible in order to improve the therapeutic effect.
3.2 Inability of the two sperms to fight each other: due to congenital developmental deficiencies or acquired diseases, the inability of the two sperms, yin and yang, to meet and intermingle, or their inability to meet and form together is another important cause of infertility. The congenital developmental factors are disregarded here, and this article focuses on infertility due to disease. According to modern medical research, this type of infertility is mainly due to tubal and immune factors. In the era of the Nei Jing, it was recognized that two sperms could conceive by fighting each other, but there was a lack of microscopic observational evidence of this process, which has been revealed by modern reproductive medicine.
The final outcome of these two factors is that the man’s yang sperm cannot reach the place where it meets the woman’s yin sperm and thus cannot conceive. Through the research of generations of medical practitioners and the continuous efforts of modern TCM practitioners, relatively mature treatment protocols have been summarized. In the case of tubal incompetence, Chinese herbal medicine is mainly used internally to dredge the liver and Qi, remove blood stasis and open the ligaments, and when necessary, mechanical dredging is performed by means of modern medicine, which has achieved better clinical results.
As for immune infertility, there is no unified understanding, and there is a lack of relevant records in ancient texts. Most scholars tend to believe that immune infertility is due to the combination of yin and yang after menstruation and delivery, and the internal invasion of evil toxins, which can damage the flushing of the uterus, and the disturbance of the flushing of qi and blood due to the combination of evil toxins or damp-heat with blood, resulting in infertility; or the deficiency of the kidney in the body, and the damage of the flushing of the uterus due to the multiple births in the room, and the failure of the sperm to follow the normal path.
Kidney Yin deficiency or Kidney Yang deficiency is the root of the disease; heat burns the essence and blood, which leads to coagulation of essence and blood and loss of the normal path of essence; stagnation of phlegm and phlegm in the cell is the symptom of the disease; clinically, actual evidence or mixed evidence of deficiency and reality is common; common types of evidence include kidney deficiency and blood stasis, qi stagnation and blood stasis, and phlegm and stagnation of each other.