Abstract: We analyzed the characteristics of ovulation disorder infertility patients and concluded that the deficiency of true yin, disturbance of phase fire, and unfavorable Tian Kuei caused the ovaries to be deprived of moistening and nourishment, resulting in obstruction of follicle production and discharge. The treatment model revolves around the regulation of Qi and Blood, drawing Yang from Yin, and the use of cycle regulation. Under the guidance of ovulation and early pregnancy monitoring, the basic components of ovulation promotion, pregnancy promotion, and pregnancy stabilization are fully integrated and steadily advanced, which can help shorten the treatment cycle and reduce the occurrence of adverse pregnancies.
Keywords Ovulation disorders, inducing yang from yin, dense waiting, cycle management
Ovulation disorders account for 20% to 40% of patients with infertility and have a complex primary etiology, mostly manifesting as menstrual disorders and phasic amenorrhea. Modern Chinese medicine can achieve better results in the treatment of menstrual disorders by the phased treatment plan of the menstrual cycle, relying on the changes of qi, blood, yin and yang of the menstrual cycle to guide the use of medicine. For infertility patients with ovulation disorders and menstrual disorders, by adopting the method of cycle regulation, the treatment revolves around the mode of regulating Qi and Blood and inducing Yang from Yin, i.e. nourishing the kidneys, benefiting Yin and nourishing Blood, cooling Blood and clearing deficiency heat, and seeking Yang in Yin and Yin and Yang together in a sequential manner, fully combining and harmonizing the basic aspects of regulating menstruation, promoting ovulation and facilitating pregnancy. Practice has shown that this therapy helps to shorten the course of treatment and improve the therapeutic effect. The following is a summary of our experience.
1. Characteristics of the symptoms
Regarding ovulation, Chinese medical theory has already had some budding understanding, such as Yuan Difan said: “Heaven and earth are living creatures, there must be a dense time, all things are born, there must be happy to nurture the marquis… Where a woman’s menstruation once a month, there must be a day of dense… There is a desire to meet the intolerable state, this Hou also. At this time, if you take it against the grain, it will become a dan; if you give it to the ear, it will become a fetus.” Ovulation disorder infertility, the direct manifestation is mostly menstrual disorders. It is difficult to grasp the timing of the “waiting”, and classical medical texts are sparse in discussing how to create the “waiting” and related principles. With the advancement of understanding, modern medical practitioners [1] have proposed, based on scientific research and practice, that in cases of anovulation, there is essentially a deficiency of kidney qi and kidney essence; in cases of dyspareunia, including ovulation of small follicles and luteinization of unruptured follicles, it is related to liver depression and kidney deficiency. If we analyze the physical signs and symptoms of patients, it is not difficult to find clues of kidney qi deficiency and kidney essence deficiency: most patients with polycystic ovary syndrome and hyperprolactinemia present with physical obesity, hirsutism and facial acne. As the water and grain essence in the body cannot transform into essence, blood and fluid, but generate phlegm, it will inevitably cause the kidney to gather unfavorable essence, lack of kidney essence, the phase fire loses its latency and disturbs upward, heat disturbs the spleen and stomach then ingest more diet water and grain to help themselves, water and grain cannot fully transform into essence and produce phlegm and fat, thus creating a vicious circle; the symptoms of baking heat, sweating, pre-menstruation, menorrhagia and other symptoms manifested by poor ovarian storage and premature ovarian failure can also The symptoms of poor ovarian storage and premature ovarian failure, such as baking heat, sweating, pre-menstrual periods and scanty menstruation, can also reflect the deficiency of kidney yin; small follicle ovulation and unruptured follicle luteinization syndrome, which are mostly manifested by pre-menstrual periods, high volume or prolonged periods, are also related to the deficiency of kidney yin and disturbance of phase fire.
The General Record of Sheng Ji has long pointed out that “women are childless due to deficiency of the flushing and weakness of the kidney qi”. This essential kidney deficiency is worthy of deeper understanding: the kidney is the main reservoir of essence, the main growth and development, the main reproduction, the main bone and marrow production, and the upper passages to the brain. It can be inferred that the function of the female kidney reflects all the endocrine regulation related to reproductive physiology. Tiankui is a product derived from the kidney, and the maintenance of its material properties is dependent on the essence stored in the kidney. Some scholars [2] pointed out that tiankui is equivalent to the regulatory function of pituitary gonadotropins. If we further analyze the endocrine characteristics of women with ovulation disorders: abnormally high pituitary hormone levels are commonly present in polycystic ovary syndrome and hyperprolactinemia; poor ovarian storage is a precursor manifestation of ovarian decline, which also has the characteristics of pituitary hypergonadotropic hormone; small follicular ovulation is associated with inadequate follicular development, and pituitary prolactin above the physiological range and high-frequency and low-amplitude pituitary luteinizing hormone are the basic The endocrine features of these disorders are: luteinization syndrome of unruptured follicles, which also occurs in association with abnormally elevated pituitary hormones during the follicular phase. Therefore, it is tentatively assumed that these diseases have the commonality of kidney-yin deficiency, phase fire disturbance, and unfavorable Tiankui.
2.Mechanism analysis
Zhu Danxi pointed out; “A woman who has been childless for a long time is also suffering from volatile heat in the Punch and Ren veins. The infertility is due to blood deficiency, and blood deficiency is heat, which must originate from the deficiency of true yin, and the deficiency of true yin is the result of Yang Sheng and internal heat, and internal heat is the result of the withering of the blood, therefore, infertility. Liao Zhongchun also believes that “women who are infertile also have yin deficiency and fire and cannot receive sperm and blood”. It is clear that kidney yin deficiency is directly related to ovulation disorders, and the relevant mechanisms are basically manifested in the following aspects; congenital factors, lack of fetal endowment and loss of nourishment; diseases, diet and injury to the spleen and stomach, or loss of blood and depletion of blood, which is detrimental to sperm production; prolonged illness and injury to fluid and depletion of yin essence; liver depression and fire, straining the mind and heart, moving the fire of the ruling phase and burning the lung heat, etc., which injures yin and depletes fluid; heat illness or excess Yang heat in the body, which injures fluid and depletes fluid; stasis of blood and blood blockage Insufficient blood and stagnant blood, blocking the pulse channels, blocking the flow of fluid, blood and essence and preventing them from reaching the kidneys; Qi deficiency, loss of fluid distribution, gathering phlegm, insufficient essence production, phlegm blocking the pulse channels, poor conduction of fluid, blood and essence. Many factors lead to deficiency of kidney essence, deficiency of true yin, disturbance of the phase fire, unfavorable Tian Kuei, deficiency of Chong Ren, emptiness of the cellular channels, and loss of ovarian nourishment, resulting in obstruction of follicular production and discharge. In the “Women’s Science”, it is said in the “Sheng Ji Jing” that “the virtue of the sky and the qi of the earth, the yin and the yang are in harmony, and the flow is one”. And the dense metaphor is the Taiji judgment and not yet divided, the state of muddy sprouting, as the so-called Taiji invisible, invisible gas to produce tangible things, and born in the Yang into the Yin, born in the Yin into the Yang. Due to the shortage of true yin and the disturbance of phase fire, the yin essence cannot be refined, it is full but not satisfied, it is moving but not dwelling, it is difficult to brew the true yang energy, and it is difficult to build a dense and harmonious, vibrant taiji state.
Modern Chinese gynecology [3] broadly summarizes the regular ovulatory menstrual cycle as follows: the late menstrual cycle (follicular phase) is the process of yin and essence gathering and filling; the intermenstrual phase (ovulation phase) is the transition from yin to yang; the premenstrual phase (luteal phase) is the period when yang is gradually flourishing to the extreme; the menstrual phase is the period when yin and yang essence declines to the extreme, and the old and new change from the end of the previous cycle to the beginning of the next cycle. Ovulation as the joint point of transformation of yin and yang is a more appropriate reflection of the general rule of Taiji change of menstrual cycle.
The clarification of this Yin-Yang transformation pattern makes the process of menstrual regulation more justified. “However, for treatment aimed at promoting pregnancy, it is necessary to further explore the changes of yin and yang during the process of ovulation to pregnancy and even fetal development: before and after ovulation, the yin and yang changes from yin to yang and gradually to true yang; when it enters the luteal phase, it turns to be dominated by yang. However, the yang is born in the yin, not just a single yang growth, but the joint growth of yin and yang, still following the general law of yin and yang growth, so that the yin and yang wings of the peak of the corpus luteum are clearly distinguished, and it becomes a special period of yin and yang exchange and induction, which is also the special breakthrough period for the formation of the fetal element to grow to stand after the intercourse of the two sexes in the dense period, and it is more appropriate to call this period the fetal breeding period for the promotion of pregnancy, and it can be achieved by the smooth application. The fetus element can be achieved if it is applied smoothly. Therefore, unlike the general change of yin and yang in the menstrual cycle, the yin and yang in the luteal phase (fetus-making phase) is only the basic prosperity of the monthly menstrual cycle of the mother, but only the basic level of yin and yang for the October cycle of the fetus, and the mother has to accumulate more yin and yang essence to meet the needs of the growing fetus.
In patients with ovulation disorders, there is a lack of Yin and kidney essence, and during the process of ovulation promotion, the initial replenishment of fluid, blood and essence has not yet reached the level of true Yin filling and flourishing, so after barely stimulating the dense marquis, on the one hand, the pure true Yang Qi initially sprouts, but on the other hand, the vastness of the flush is still disturbed, the Qi and blood of the uterus is turbulent, and it is difficult for the Yin and Yang essence to flow freely, so even though there is the first breeding of the fetal element, it is difficult for it to grow, and in severe cases, the fetal element is born. The first birth is meteoric (modern medicine called biochemical pregnancy), or abortion and miscarriage; light fetal atrophy does not grow, the legacy of the next day. As Fu Qingzhu said: “If the ground of Yin cold, certainly not biological, and arid days, can not be long… Department of life is connected to the kidney, the kidney is also yin, is the yin in the yang, yang in the yin, so through the change, or the birth of boys and girls, all from this out, but must be yin and yang concord, not biased not withered, can change the living, otherwise not carry on.”
3.Outline of treatment
The method of menstrual cycle regulation [4] is based on the general rule of changes in qi and blood, yin and yang of the menstrual cycle, and the treatment plan is adjusted at any time according to the four phases of the menstrual cycle, namely, the late menstrual period is based on nourishing the kidneys, benefiting yin and nourishing blood; the intermenstrual period is based on activating blood circulation, removing blood stasis and unblocking flushing, and supporting kidney yang to promote ovulation; the premenstrual period is treated by seeking yang in yin, warming the kidneys and warming the uterus; the menstrual period is based on activating blood and promoting menstruation, and unblocking qi and blood. The cycle of menstrual regulation revolves around the promotion of ovulation during the intermenstrual period. A large number of clinical practices have confirmed that this treatment is effective in improving menstrual status and has direct guidance for ovulatory infertility. However, treatment aimed at promoting pregnancy is different from general menstrual regulation, and how to promote the benign occurrence of “the hou” is the primary problem in promoting pregnancy.
In combination with the basic pathological changes of phase fire and true yin deficiency, on the basis of nourishing the kidneys and nourishing the blood, the late menstrual period should also be used to cool the blood and clear the deficiency heat, so as to calm the unsettled phase fire. For ovulation disorders with irregular menstrual cycles, the intermenstrual phase is not easy to induce, and even more cycles only stop in the late menstrual phase, it is necessary to nourish the kidney, benefit the Yin and nourish the Blood, cool the Blood and clear the deficiency heat, so that only when the disturbed phase fire is sufficiently pacified, the true Yang can be smoothly sprouted, which is similar to the descending mediation process before ovulation promotion in modern medicine; for those who do not develop to the intermenstrual phase but have natural menstruation, treatment of the menstrual phase and the next late menstrual phase is carried out Those who do not develop intermenstrual phase but have not had menstruation for more days than the previous relatively regular cycle, use the intermenstrual phase treatment program for one week; those who have no signs of ovulation and have not had menstruation, give the blood to promote menstruation and enter the next cycle at the right time; those who have dense intermenstrual phase, instruct intercourse, and carry out the treatment of the fetal phase according to the program of seeking yang in yin and warming the kidney and uterus, and those who are not pregnant continue the menstrual phase and the next cycle program; If pregnancy is confirmed, it is still necessary to nourish the kidneys, benefit Yin and nourish Blood, help Yang and calm the fetus, and promote the growth of the fetus until it is confirmed that the embryo has the vitality before stopping the treatment.
4. Application of prescriptions and medicines
Following the basic principle of “strengthen the main body of water to control sunlight” and establishing the mode of inducing yang from yin, we use the formula of Nourishing Essence and Seeding Jade Soup in combination with Qing Bone and Kidney Soup with addition and reduction as the basic formula for promoting follicular development in the late menstrual period.
Radix Paeoniae Alba 20g Cornu Cervi Pantotrichum 15g Radix Angelicae Sinensis 20g Radix Rehmanniae 15g Peony Bark 15g Mai Dong 15g Dendrobium 10g Fructus Schisandrae 5g Radix Chasteberry 10g Rhizoma Polygonati 10g Atractylodes Macrocephala 15g.
The two formulas were originally used for the treatment of thinness and infertility and night fever of the bones, as stated in the formula’s introduction: “It is not only for replenishing blood, but purely for filling the essence, as the essence is full, the uterus is easy to take in the essence, and the blood is sufficient, the uterus is easy to hold things, all the way to have a child. It is also stated with certainty that after three months or ninety doses of the medicine, pregnancy will be achieved. This formula focuses on solving the fundamental problem of ovulation disorder by combining the herbs with each other to benefit the liver and kidney, nourish the true yin, and clear the astringent and subdue the delusional phase fire, so that the true yin can be hidden and accumulated. The specific application should take into account other etiological factors: ginseng and astragalus are added for Spleen Qi deficiency and unfavorable biochemistry of Qi and Blood; Chai Hu, Yu Jin and Citrus Aurantium are added for Liver Qi stagnation and Qi Qi Qi disorder; Acanthopanax, Sour Jujube and Yuan Zhi are added for anxiety and anxiety; Sha Shen, Radix Platycodon and Agaricus are added for lung dryness and Yin injury and fluid disorder; Chuan Xiong and Dan Shen are added for blood stasis and pulse disorder; Han Xia, Poria and Chen Pi are added for phlegm and turbidity and pulse obstruction. Fu Ling and Chen Pi.
Combine with the law of transformation of yin and yang in the menstrual cycle, and try to touch and stimulate the dense Qi in the intermenstrual period, add or reuse ginseng, astragalus, Chuanxiong and peach kernel in the basic formula in the late menstrual period, and add cinnamon 5
g, to promote the transformation of true yin by tonic qi, to promote the smooth flow of blood vessels to facilitate the coalescence of true yin, to warm yang by cinnamon to help fire, to induce fire to return to its source, to further calm the disturbed phase fire, and to realize the transition from yin to yang by the growth of yin and yang. During the period of fetal development, we add cuscuta, Chuansui, dulcimer, sangfroid and aconite to the basic formula, and add kidney-supporting yang drugs to the large team of yin-nourishing products, focusing on seeking yang in yin, yin and yang together, warming the kidneys and warming the uterus, and achieving fetal origin; continue to apply the front after pregnancy is confirmed to calm the fetus and grow. If menstruation comes, give Plus Flavor Prosperity Pill or Blood Mansions and Stasis Pill as appropriate to promote the downward flow of menstrual blood.
During the course of continuous treatment, prepare urinary ovulation (LH) test paper for self-monitoring, and ultrasound check follicles at any time if there are signs of ovulation, and adjust the treatment plan according to the monitoring results. For those with persistent anovulation and longer menopause, according to ultrasound and urine pregnancy (HCG) test, pregnancy can be ruled out and then the cycle can be repeated by progesterone withdrawal bleeding.
5.Conclusion
With the deepening understanding of female reproductive endocrine mechanisms in modern medicine and the application of scientific ovulation function testing techniques, the process of TCM treatment for the purpose of promoting pregnancy has become more easily grasped. Since the 1960s, menstrual regulation by cycle has been gradually established and is becoming more and more refined in clinical practice. In contrast, the treatment of ovulation disorders, which is also based on ovulation promotion, still adheres to the traditional pattern of treatment by type, and the specific medication is difficult to take into account the overall needs of ovulation promotion, pregnancy promotion, and fetus stabilization, and some prescriptions even have adverse effects on the implantation environment of the uterine cavity and embryo implantation and development. On the other hand, the cycle-by-cycle Yin-Yang mode of pregnancy promotion addresses the root of the disease as much as possible, and follows the rules of Qi and Blood Yin-Yang changes in the whole process of follicle development, ovulation, embryo formation, implantation and growth, and progresses steadily under the guidance of ovulation and early pregnancy monitoring, resulting in significantly shorter treatment cycles and fewer adverse pregnancies. Through clinical observation, the efficacy of the method of inducing yang from yin to yang in treating ovulation disorders caused by various primary pathologies is similar, and there is no great difference in pregnancy rate, which indicates that these diseases have extremely similar pathogenesis, indicating that actively exploring the fit between Chinese medicine and modern basic pathological research is of great significance to give full play to the clinical advantages of Chinese medicine.