Hyperprolactinemia (HPRL) infertility is a common and difficult gynecological disease that seriously affects women’s reproductive health. We discuss the Chinese medicine intervention strategy for HPRL infertility from the correlation between HPRL and infertility, and the understanding of Chinese medicine on the etiology and pathogenesis of HPRL infertility. It is believed that the main treatment method is to tonify the liver and kidney, and to use various means and methods such as the idea of “treating the disease before it is diagnosed”, the theory of “constitution”, the cycle therapy of Chinese medicine, the diagnosis and treatment, and the external treatment of Chinese medicine to intervene in this disease, which has a definite therapeutic effect and is worth to be popularized. Keywords: hyperprolactinemia infertility, Chinese medicine, intervention strategy Hyperprolactinemia (HPRL) is a kind of disease resulting from increased secretion of pituitary prolactin (PRL) due to various reasons, and clinically manifests in menstrual disorders (amenorrhea or scanty menstruation), breast overflow, infertility and habitual abortion. According to the literature, HPRL accounts for 15.2% of female infertility, and according to the literature, HPRL accounts for 23.8% of primary infertility, suggesting that HPRL is one of the important causes of infertility, especially primary infertility, which cannot be ignored. WHO requires every infertile woman to be routinely checked for PRL concentration. In recent years, with the increase of various social pressures and the accelerated pace of life, the incidence of this disease has been on the rise. This article aims to discuss the Chinese medicine intervention strategy of HPRL infertility, and is reported as follows. The correlation between HPRL and infertility Prolactin (prolactin PRL) is a protein hormone secreted by the pituitary gland, which mainly stimulates the growth of mammary tissues and the production of milk, and its main inhibitory factor is dopamine. High concentration of PRL in the blood disrupts the function of hypothalamic-pituitary-ovarian axis, increases the synthesis and pulsatile secretion of gonadotropin-releasing hormone (GnRH) in the hypothalamus, and at the same time weakens the sensitivity of pituitary gland to GnRH, leading to low secretion of FSH and LH, which leads to poor follicular development, impaired ovulation, or insufficient function of corpus luteum, resulting in scanty and low volume of menstruation, amenorrhea or infertility. It has been shown that HPRL interferes with gonadal function at two levels: 1. When the level of PRL is >30 ng/mL, the hypothalamus can attenuate or clear the pulsatile secretion of LH and inhibit the positive feedback effect of estrogen on the hypothalamus, thus preventing the occurrence of the peak of LH before ovulation, and affecting ovulation. 2. 2. When PRL level > 30 ng /mL, the ovarian level can inhibit the synthesis of progesterone by granulosa cells, so that the synthesis and secretion of progesterone is reduced. Therefore, HPRL can lead to sexual dysfunction, scanty menstruation, amenorrhea, breast milk overflow, and infertility. In this pathological state of HPRL, there is insufficient secretion of estrogen and progesterone, and there is no obvious LH peak appearing, so that the endometrium lacks the typical cyclic changes, resulting in endometrial dysplasia and asynchrony, which is another important factor of infertility caused by HPRL. TCM’s understanding of the etiology and pathogenesis of HPRL infertility Although there is no record of HPRL infertility in TCM, according to its clinical manifestations, it is equivalent to “late menstruation”, “amenorrhea”, “breast crying”, “infertility”, “breast milk”, “breast milk”, “breast milk”, “breast milk”, “breast milk”, “breast milk”, “breast milk”, and “breast milk”. However, according to its clinical manifestations, it is equivalent to such diseases as “late menstruation”, “amenorrhea”, “lactation” and “infertility” in Chinese medicine. Knowledge of its etiology and pathogenesis, most believe that its onset is closely related to the dysfunction of the liver, spleen and kidney, and the damage of Chong Ren. This disease is mainly manifested in the relationship between breast milk and menstruation, which is a contradiction between upward and downward disorders. The author believes that kidney deficiency is the root of the disease, liver qi stagnation is the key to the development of the disease, and the dysfunction of the liver, spleen and kidney organs caused by dampness, phlegm, depression, stasis is an important pathological factor, which is the cause and effect of each other. 1, the kidney is the main reproductive, kidney deficiency for HPRL infertility of the root of menstruation and conception of normal or not, and kidney qi is closely related. The Suwen-Shanggu Tianzhen theory clearly points out the relationship between menstruation, conception and kidney qi. It says: “When a woman is seven years old, her kidney qi is abundant, her teeth and hair are long, and when she is two or seven years old, her deca arrives, her ren vein is open, her tai chong vein is full, and her menstruation takes place at the right time, so she has a child……. When she is seven years old, her ren vein is weak, her tai chong vein is weak, her deca is exhausted, and she has no way to get through the earth, so she is bad and has no children.” It can be seen that the fullness of kidney qi is a prerequisite for menstruation on time and pregnancy. Fu Qingzhu women’s science” cloud: “menstrual water out of the kidneys”. Kidney for the innate nature of this, the kidneys of reproduction, the kidneys of the main collection of essence, essence can produce blood, blood can become essence, the material basis of menstruation, is the necessary conditions for conception, so the seed must first regulate the menstruation, essence is easy to take in the essence of the pregnancy, blood is easy to hold the uterus is easy to accommodate the object. Sufficient kidney essence can provide a material basis for follicular development and maturation, and abundant kidney yang is powerful in gasification, which can provide a driving force for normal follicular discharge, which is a prerequisite for ovulation and fertilization of the ovaries. Kidney qi deficiency and failure of kidney yin loss of nourishment, so it can not be transformed into blood for the decapitation, it is difficult to promote the development of follicles, kidney qi deficiency and failure of kidney yang loss of chemotherapy, the cellular veins lost warmth, can not heavy yin must be Yang and trigger ovulation, can not take in the essence of conception, so no child. Therefore, kidney deficiency, insufficient rushing is the main mechanism of HPRL infertility. 2, the liver for the woman’s innate, liver qi stagnation for HPRL infertility of the key to the onset of the “clinical guide medical case” cloud “women to liver for innate”, because women to blood for use, the liver is the main blood of the reason also. It is also pointed out in Neijing that “Liver stores blood and is the master of emotions and feelings, and it likes to be sparing and organized, so it is closely related to qi and blood”, and Jingyue Quanshu – Woman’s Rules says that “Blood is the mainstay of a woman, and when the blood is strong, the menstruation will be adjusted and the children will be heirs, and all of the body’s prosperity and decline are originated from this”. It can be seen that the liver and the woman’s menstruation, conception and fertilization of the relationship is very close. The liver is the master of detachment and excretion, and its nature likes to be organized and is not depressed. Liver gas can dredge the whole body, so that the organs and meridians of the gas running unimpeded, the normal function of the liver gas drainage, then the gas smooth, fluent meridians, the functional activities of other organs are stable and orderly, so that the body is ready for the activities of conception and fertilization. In this era of information technology, with the accelerated pace of life, work and study, increased pressure, especially modern women, often triggered by mental tension and emotional anxiety, depression and other mood swings. Because of mood disorders, the liver loses detachment, liver qi stagnation, qi dysregulation, then seriously interfere with the function of the “kidney – tianki-chongren – uterus” axis, so it can be seen in the late menstrual period, menstrual bleeding, menstrual bleeding, ovulation disorders, thus affecting menstruation and conception. Liver is the pivot of regulating the menstrual cycle and normal ovulation, and the influence of emotions on ovulation has been confirmed by most research results. Therefore, the author believes that liver-qi stagnation is the key to the pathogenesis of HPRL infertility. Dampness, depression, phlegm and stagnation are important pathologic factors in HPRL infertility. Dysfunction of the liver, spleen and kidney can affect the detoxification function of the liver, regardless of kidney deficiency or spleen deficiency. The operation of the blood and the metabolism of the fluid depend on the qi role of the liver, liver qi excretion, qi carrying blood line, so that the blood without stagnation of the evils of running to the uterus to produce menstrual blood, the sea of blood on time overflowing, the menstruation as scheduled. If conception occurs, it provides nutrients for the fertilized egg. When the Liver Qi is diverted and drained, the Qi and blood flow to the body, so that the fluid does not gather dampness and produce phlegm. If the liver loss of drainage, qi and blood run out of order, then produce wet, phlegm, depression, stasis of pathological products, blocking the uterus cell veins, so that the kidney – tianjie – Chongren – uterus reproductive axis disorders, menstrual dysfunction, or even can not take in the sperm into the pregnancy, so infertility. Therefore, the author believes that dampness, phlegm and stagnation are important pathological factors in HPRL infertility. Chinese medicine intervention strategy of HPRL infertility 1, Chinese medicine “cure the disease before the disease” thought in HPRL infertility intervention role, Chinese medicine “cure the disease before the disease” theory contains two aspects of the prevention of disease before the disease and the prevention of disease, emphasizing that prevention is more important than treatment. The “Su Wen” cloud: “the saint does not treat the disease to treat the disease, do not treat the chaos to treat the chaos ……”, which reflects the idea of Chinese medicine before the disease prevention. The “Golden Chamber” said: “see the liver disease, know the liver spread the spleen, when the first solid spleen.” This is the specific embodiment of the idea of prevention of disease in Chinese medicine. This disease from the menstrual cycle, menstrual changes, such as late menstruation, menorrhagia until amenorrhea, infertility and other hypothalamic-pituitary-ovarian gonadal axis dysfunction manifestations, generally undergoes a long stage, is a gradual evolution of the process. Especially in the case of HPRL infertility, there are often many pre-existing lesions, such as mood changes, breast distension, breast overflow, menstrual changes, etc. It is important to closely observe the changes in the body at this stage and measure the level of PRL in a timely manner. In the use of tonifying the kidneys and liver, regulating menstruation to help pregnancy treatment at the same time, we must cooperate with psychological regulation, channeling emotions, alleviate the pressure of study and work, pay attention to body regimen, dietary modification, strengthen physical exercise, optimism and cheerfulness, so as to achieve the goal of prevention of “calmness and emptiness, the disease safe and secure from the”. Therefore, Chinese medicine “cure the disease before the disease” idea in HPRL infertility can play an important role in the intervention. 2, Chinese medicine “physique doctrine” in HPRL infertility intervention, physique is the fundamental body, physique is the source of health. The human body’s “TCM constitution” can be divided into nine basic types, each constitution has different signs, common manifestations, psychological signs and adaptability to the external environment, and has a specific tendency to develop. This disease is mostly seen in qi depression quality, so usually according to the physical characteristics of qi depression quality to adjust the body to maintain health, help positive qi, so as to achieve the “positive qi within, the evil can not be dry,” the purpose of disease prevention. Therefore, Chinese medicine “physique theory” in HPRL infertility can play an important role in intervention. 3.Adhere to the clinical idea of TCM cycle therapy and diagnosis and treatment, and take tonifying liver and kidney as the main method of treatment. According to the four phases of menstrual cycle, TCM cycle therapy is based on the different phases of menstrual cycle, and the prescription follows the different phases of menstrual cycle with the addition and subtraction of evidence. In the pre-menstrual period, the formula nourishes the kidney and helps Yang, warms the uterus and helps pregnancy; in the menstrual period, it activates blood circulation and removes blood stasis, regulates Qi and regulates menstruation. In the late menstrual period, i.e. the proliferative phase, with the development of follicles, estrogen secretion gradually increases, and the endometrium proliferates and repairs to prepare for ovulation. Chinese medicine believes that this period is the recovery and nourishment of yin and blood for a long time, the uterus in the role of the kidney qi, to achieve the essence of blood, qi and blood regulation for the menstrual period of the “waiting” to prepare a good material foundation, this period of nourishment of the kidney to nourish the blood, tonifying the kidney and benefiting the essence of the products to promote follicular growth. Intermenstrual period is the period of ovulation, with the development of follicle maturity, estrogen secretion peak, thereby stimulating the pituitary gland to secrete a large amount of luteinizing hormone, and the formation of pre-ovulatory peak, resulting in the rupture of mature follicles, ovulation. During this period, the yin essence of the kidney is further enriched and transformed under the action of kidney yang, which is the “waiting” stage of yin and yang alternation and the transformation of yin to yang, and this period is the key stage of the cycle therapy of traditional Chinese medicine, which is to induce the mature follicle to rupture and ovulate by tonifying the kidney and assisting yang, and by promoting the circulation of qi and activating the blood. Premenstrual period is the secretion period, this is the stage of luteal maturation and degeneration, the endometrium continues to thicken, in order to adapt to the conception of the bed. At this time, yin full yang long, kidney yang gas is gradually strong, the uterus is warm to be pregnant, if the two men and women coitus pregnancy, then the blood in the role of the kidney yang convergence of the Chong Ren, moistening the fetus yuan. Therefore, at this time to nourish the kidneys to help Yang, warm the uterus to help the pregnancy of the main products to promote luteal maturation, for the fetus pregnancy or the next menstrual cycle to prepare. Menstruation, due to the body’s sex hormone levels plummet, the endometrium can not get the support of sex hormones, so the endometrium bleeding, necrosis and shedding, the formation of menstruation. Chinese medicine believes that this period of yang to the full, heavy yang to yin stage, due to the body of yang, blood sea on schedule full, in the role of the kidney yang, under the discharge and make menstrual blood, the new menstrual cycle and start. Whether the menstrual blood can be discharged smoothly, the key in the “through”, the old blood does not go to the new blood is not born. Therefore, this treatment emphasizes the use of products that activate blood circulation, remove blood stasis, regulate qi and regulate menstruation. Chinese medicine cycle therapy is to improve the function of gonadal axis by regulating the balance between “kidney – Chong Ren – Tian Jie – Uterus”, in order to correct the disorder of “hypothalamus – pituitary – ovary gonadal axis” caused by HPRL and play the role of regulating menstruation and assisting pregnancy. At present, the clinical diagnosis of this disease is complicated, according to its clinical manifestations, the main types of this disease are liver depression and qi stagnation, liver and kidney deficiency, spleen deficiency and dampness obstruction, liver depression and heat, kidney deficiency and liver depression. Clinically, liver depression and qi stagnation is the most common type, but the etiology of HPRL infertility is complex, the course of the disease is long, and clinically, more patients manifested as a mixture of deficiencies and realities, and cold and heat, of which kidney deficiency and liver depression are the most common type. Therefore, Chinese medicine treatment should be based on the treatment of liver and kidney, to tonify the liver and kidney as the main method of treatment, dredge the liver, nourish the liver and kidney, especially dredge the liver and nourish the liver, accompanied by strengthening the spleen and drying dampness, eliminating blood stasis and resolving phlegm. Nourishing the kidneys focuses on tonifying kidney yin and yang to restore their relative balance, and the treatment is carried out in a peaceful manner. Depending on the deficiency of kidney yin and yang, either nourishing kidney yin and nourishing yin, or tonifying kidney yin and yang to support yang, or tonifying both kidney yin and yang to bring them into balance on a new basis. At the same time, the combination of tonifying the kidney and nourishing the liver, tonifying the kidney and detoxifying the liver is emphasized to tonify the liver and kidney, and the representative formula is Ding Jing Tang (定经汤). 4, combination of Chinese and western, internal and external treatment, comprehensive intervention, complement each other, highlighting the advantages of traditional Chinese medicine HPRL infertility treatment process must be excluded from pituitary tumors, hyperthyroidism, renal insufficiency, and drug factors, physiological factors caused by HPRL. causes of infertility are many, the use of medication need to be excluded before the other factors caused by ovarian dysfunction infertility, such as PCOS caused by infertility and tubal infertility, immune infertility, and other factors caused by infertility. Infertility caused by other factors such as PCOS, tubal infertility, immunologic infertility, etc. Adhering to the clinical idea of combining western medicine and Chinese medicine, combining with the results of modern Chinese medicine pharmacological research, adding and subtracting according to the evidence, the therapeutic effect is complementary to each other. Modern pharmacological research has proved that: kidney tonic Chinese medicines have the ability to enhance intrauterine blood flow and perfusion, increase the level of estrogen and progesterone, adjust the function of hypothalamus-pituitary-ovarian axis, improve the cervical mucus and endometrial proliferation and secretion, and have a clear role in promoting follicular development, luteinizing body function, and promoting ovulation. Modern pharmacological studies have shown that white peony with licorice has a significant reduction of PRL, animal experiments have confirmed that it can stimulate the anterior pituitary dopamine receptors, normalize the blood PRL. Total glucoside of Paeonia lactiflora (TGP) is the main active ingredient extracted from the dried root of Paeonia lactiflora. In addition to anti-inflammatory, analgesic, anti-stress and immunomodulatory effects, TGP also has a significant effect on the endocrine function of the hypothalamic-pituitary-adrenal axis (HPAA). In the treatment of HPRL patients, a large dose of Paeonia lactiflora (30-100 g), together with Chinese herbs for tonifying the kidney and strengthening the spleen, nourishing blood and regulating menstruation, suppressing breast milk, resolving phlegm and lowering lipids, etc., can regulate the function of the endocrine gland-axis of the HPAA and inhibit the excessive secretion of PRL by dredging the liver and nourishing the blood and regulating the Chong Ren, and the effect has been obvious. Malt contains ergot compounds, which have the effect of inhibiting PRL secretion like dopamine. The external treatment method of Chinese medicine is a characteristic therapy of Chinese medicine. On the basis of adhering to the diagnosis and treatment of Chinese medicine, it adopts a comprehensive therapy combining internal and external treatment, which has a better curative effect. That is to say, combining external treatment methods such as acupuncture, moxibustion and acupoint drug application while taking Chinese medicine orally to recognize the evidence and treat the disease, and intervening in a comprehensive way. Acupuncture and moxibustion can activate the dopamine system in the brain, adjust the brain-pituitary gland-ovarian self-projectile function, so that the reproductive endocrine to restore the normal physiological state, and from then on to achieve the function of regulating menstruation to help pregnancy. Conclusion HPRL infertility is a common and difficult disease in gynecology, which seriously affects women’s reproductive health, so how to prevent and control the occurrence of this disease is of great clinical significance. Modern medicine believes that HPRL interferes with the hypothalamic-pituitary-ovarian axis, affecting the secretion of sex hormones, resulting in infertility due to poor follicular development, ovulation disorders or luteal insufficiency, endometrial dysplasia and asynchrony. Although the efficacy of bromocriptine in the treatment of HPRL has been confirmed, a significant percentage of patients with HPRL corrected by bromocriptine are still infertile. According to the literature, about 12% of patients stopped taking bromocriptine because they could not tolerate the adverse effects of bromocriptine, especially those who became pregnant during the use of the drug, and some of them chose to terminate their pregnancies. Chinese medicine has a unique advantage in the prevention and treatment of this disease, clinical use of Chinese medicine “treatment of the future disease” idea, the “doctrine of constitution”, Chinese medicine cycle therapy, identification of evidence-based treatment, Chinese medicine external treatment method and other means and methods to intervene comprehensively in this disease, and has achieved good results, worth promoting. It has achieved good therapeutic effects and is worth popularizing. However, since the clinical typing of HPRL infertility in Chinese medicine, the evaluation method of therapeutic efficacy have not yet been standardized, and there is a lack of large-sample multicenter clinical research and other problems have yet to be solved, the prevention and treatment of HPRL infertility is still a long way to go and further in-depth clinical research is needed in order to achieve better therapeutic efficacy.