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JOURNAL OF CHINESE MEDICINE NUMBER 61 OCTOBER 1999

When a woman fails to become pregnant after one year of

trying and where the reproductive function of her partner

is normal, the condition is referred to as infertility. In

Chinese medicine the main patterns for infertility areconsidered to be:

1. Congenital deficiency of Kidney qi and deficiency of

Kidney yang which results in failure of yang to warm the

uterus.

2. Deficiency of Kidney essence (jing) and blood with the

result that the Penetrating (Chong) and Conception (Ren)

vessels, and the channels and collaterals of the uterus, fail to

be nourished. If there is Kidney yin deficiency, this may

lead to hyperactivity of fire which will stir up and aggravate

the Liver and the Heart and consequently heat will accumu-

late in the blood.

3. Stagnation of Liver qi which creates disharmony of qi and

blood and injures the Spleen. Disharmony of the Liver and

Spleen will result in the impaired production and flow of qi

and blood which therefore fail to fill up and support the

Penetrating and Conception vessels.

4. Spleen qi deficiency gives rise to both blood deficiency

and the breakdown of transformation and transportation

creating phlegm and dampness in the interior. This affects

qi circulation and can cause blockage in the collaterals of the

uterus, fallopian tubes and ovaries.

5. Blood stagnation arising from incomplete expulsion of

blood from the uterus or residual blood in the pelvic cavity(as in endometriosis). Blood will then coagulate and block

the collaterals of the uterus and reproductive organs.

6. Disharmony between the Heart and Kidney whereby the

Kidney fails to nourish the Heart and the Heart fails to

warm the Kidneys. In cases of disturbance of the spirit

(shen) the Heart qi will not descend and the relationship

between the Heart, Kidney and the uterus breaks down.

7. Impaired function of the Sanjiao. The Sanjiao controls the

pathway of fluids in the body and is therefore essential in

maintaining the flow of qi and blood to and from the Heart,

the Kidneys and the uterus.

8. An impaired uterus, either due to maldevelopment,

flaccidity, prolapse, damaged endometrium, phlegm, heat

or cold in the uterus, and most importantly impairment of

the functions of conserving and eliminating will affect

fertility. Zigong (the uterus) means a palace for the nurtur-

ing of the foetus. It is therefore essential to ensure a healthy

uterus.

The Kidneys however hold the most essential key tofertility. The tian gui is the essence of the Kidneys and

governs maturity and the ability to reproduce, whilst it is

said that menstrual blood issues from the Kidneys. The

baomai (the uterine vessel) directly links the Heart to the

Kidneys. The Heart and Kidneys both belong to shaoyin

and exemplify nothing less than the essential difference

between, and yet utter inter-dependence of, yin and yang,

the Kidney essence and the Heart spirit, the Kidney water

and Heart fire.

Finally the confluence and flow of the Conception and

Governing vessels influence the uterus and maintain the

regularity of the monthly menstrual cycle.

Hormonal changes through the menstrual cycle

During the first half of the cycle (the oestrogen enriching

phase) the yin begins to grow, starting immediately after

the menstrual bleed. It reaches its peak at ovulation and the

transformation from the yin to the yang phase begins. The

progesterone levels then rise and peak around days 20-22,

and then falls towards the end of the cycle. The hormone

levels then drop and the menstrual cycle begins again.

Changes in BBT through the menstrual cycleThe BBT is most accurate if taken at the same time each day

before rising, using the same thermometer and method

each time. The readings are then marked on a fertility chart

starting from the first day of the menstrual cycle.

On day 1 of the menstrual cycle (the first day of bleeding),

the normal BBT is around 36.5C and should remain so until

just before ovulation when it will suddenly drop and

ovulation will occur. After ovulation the temperature will

quickly rise and reach its peak within 2-3 days. The difference

between the pre-ovulatory reading and that of the second

phase should be at least 0.4C. If, for example, the low phase

is too high or the high phase is too low, the difference is toosmall, indicating an incomplete yin phase or incomplete

yang phase respectively.

INFERTILITY AND THE USE OFBASAL BODY TEMPERATURE INDIAGNOSIS AND TREATMENT

by Virginia Wood

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How to use the Basal Body Temperature in Diagnosis

By monitoring the changes in a womans basal bodytemperature (BBT) we can see how her menstrual cycle is

progressing.

36.036.136.236.336.436.536.636.736.8

36.937.037.137.237.337.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

progesterone levels oestrogen levelsBBT

C

days of menstrual bleeding

ovulation new cycle

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

ovulation

If the temperature in the post ovulatory phase rises too slowly or

insufficiently it indicates low progesterone and Kidney yang

deficiency, or may also be due to insufficient yin which is unable

to provide the material basis for yang to rise.

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

If the temperature rises but is not maintained for at least I2 days

and gradually falls, it shows the luteal phase is insufficient and the

yang qi is declining. In such cases there may also be qi deficiency.

There my also be mid-cycle spotting and possibly endometriosis.

If the high phase is less than 10 to 12 days, the severity of Kidney

yang deficiency is indicated by how short this phase of raised

temperature is.

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

ovulation

If the temperature rises, but less than .4C, there is Kidney yang

deficiency with possible qi or yin deficiency, depending on the

symptoms.

If the chart drops then rises again it indicates that the corpus

luteum is not functioning properly and there is possible insuffi-

ciency of Spleen and Stomach qi to support the Kidney.

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

A common pattern is the saw-tooth effect, which may be seen both

before and after ovulation. After ovulation it indicates Kidney

yang deficiency with Liver and Heart fire. If it appears beforeovulation it indicates Kidney yin deficiency with Liver and Heart

fire. The yin is insufficiently strong to keep the BBT in its cool

nurturing phase. In many cases of infertility, women have been

through IVF (in-vitro fertilisation) cycles or been given ovulation

stimulating drugs such as Clomid. These damage the yin. To what

extent can be seen in the pre-ovulation phase of the BBT e.g. the

saw-tooth pattern.

Note that if the pre-ovulation temperature is higher than 36.5 C

and as high as 37.1C, there is heat in the blood. Alternatively it

could indicate an incomplete discharge of blood, especially if it is

too high directly after the menstrual bleeding has finished. If this

latter pattern shows repeatedly on a womans chart, there is a

possibility of endometriosis.

Normal BBT chart

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

ovulation

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According to western medicine endometriosis is related to

low levels of progesterone, interpreted in TCM as Kidney

yang deficiency leading to blood stasis, since insufficient qi

and yang will hinder transformation, scattering and disper-

sion of blood during menstruation. Alternatively if endome-triosis is already present, this deficiency will result in failure

to reabsorb the extravasated blood. Another common sign of

endometriosis is when the BBT remains too high during

menstruation or drops and then rises again at this time. This

indicates possible Heart and Liver fire with insufficient Kid-

ney yang qi to move the cycle on into the yin phase.

In terms of presenting patterns, if the body temperature

shows very little change throughout the cycle, there is likely

to be a deficiency of both yin and yang, with other signs and

symptoms e.g.:

Kidney yang deficiency: low back pain, coldness, aver-

sion to cold, cold lower abdomen, loss of libido, loose stoolsduring or before period etc.

Kidney yin deficiency: dizziness, five palms heat, night

sweats etc.

Pregnancy

If the BBT is notably unstable during the months prior topregnancy and conception occurs, care must be taken as

there is a greater likelihood of miscarriage. It is therefore

important to continue to measure the BBT for at least twelve

weeks after conception where there has been a history of

repeated miscarriage. If the temperature remains high for

up to 16 to 18 days after ovulation, pregnancy is confirmed.

Once conception has occurred, if the BBT high phase is low

or unstable, Kidney yang and/or progesterone are low, and

treatment to prevent miscarriage can be given. As a generalrule of thumb miscarriage is mainly due to Kidney yang

deficiency, whereas infertility is mainly due to Kidney yin

deficiency and consequent Liver and Heart fire.

Changes in vaginal secretions through the menstrual cycle

It is also important to note vaginal secretion, which should

begin around day 5 and peak at ovulation. Fertile mucus

should be wet, slippery and stretchy, with a clear appear-

ance. Infertile mucus is sticky or tacky, cloudy, yellow or

white and does not feel wet.

Observation of bleedingOnly when menstruation is regular can conception take

place and it is therefore important to evaluate the four

phases of the menstrual cycle and treat accordingly.

Day 1 of cycle; bleeding begins. Check the blood flow,

quantity and quality of blood, presence of mucus or blood

clots, duration of flow.

Day 1: usually light flow; if heavy there is the possibility

of Heart or Liver fire.

Day 2-3: the main blood flow should be bright, red and

fluid.

Day 4-7: bleeding finishes; if the bleeding is longer, or

there is spotting, blood stasis can be suspected, or if accom-

panied by a dragging down sensation, Spleen qi deficiency.

If the period is too light e.g. less than 3 days (changing

pads less than 2 to 3 times a day), then the endometrium is

too thin and will hinder pregnancy. There is likely to be

blood deficiency and it is necessary to tonify the Spleen and

blood to nourish the lining of the endometrium with Culti-

vate the Uterus Decoction (see below).

As bleeding finishes, the yin starts to grow. During men-

struation the extreme yang of the post-ovulatory phase is

transforming to yin, at which point it is important to avoid

blood stasis and ensure complete discharge of old bloodfrom the uterus (failure of this discharge is marked by an

incomplete drop in BBT).

Summary of menstrual phases

Postmenstrual phase yin growing and yang consuming

During the first two to three days after menstruation, the

Liver yin is still low and hormone levels are growing. After

day eight to ten, yin levels suddenly rise and mucus should

increase in quantity and become characteristically stretchy.

When yin grows, yang is consumed and the BBT drops. On

day ten to thirteen, dependent on sufficient growth of yin,

ovulation occurs. Treatment emphasis in the post men-

strual phase is to ensure the sufficient growth of yin in

preparation for ovulation.

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

ovulation

If the post-ovulatory phase is not high enough or the pre-ovulatory

phase is not low enough, or if the increase in temperature after

ovulation is too gradual, we may suspect endometriosis even

before other signs and symptoms occur.

36.0

36.1

36.2

36.3

36.4

36.5

36.6

36.7

36.8

36.9

37.0

37.1

37.2

37.3

37.4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

ovulation

When the menstrual cycle is prolonged, this is generally due to

inability of the yin to grow enough and to promote the change into

ovulation and the yang post-ovulatory phase. This will be detect-

able on the BBT. In cases of amenorrhoea the yin essence does not

grow and the cycle remains in the post-menstrual phase. This will

be seen as a constantly low BBT with possible saw-tooth like

variations indicating Liver and Heart fire. In this case it is necessary

to treat the Kidney and nourish yin and blood paying close atten-

tion to the Heart and Liver fire.

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Mid-cycle ovulation phase extreme yin turns to yang

At this stage female hormones are at their highest. The

activity of qi and blood is most active in the Liver and Heart,

and the Conception and Penetrating vessels. This may

cause some abdominal distention and pain which is nor-

mal, but extreme pain may indicate damp or blood stasis inthe ovaries. The sign that the yin has reached its peak is seen

in the larger volume of egg-white like discharge which

should last at least three days.

Pre menstrual phase

At this stage the BBT starts to rise, indicating the onset of the

yang stage. Since yin is the material basis of yang, it is

essential to nourish the yin throughout this stage, in the

same way that yang must be supported throughout the

earlier yin phase of the cycle. The ebb and flow of the

menstrual cycle relies on the inter-consuming of yin and

yang without which there would be no physiological change.Likewise the balance of the two is essential. Often in cases

where women have sufficiently high female hormone lev-

els, without the fine balance between the two (the yin/yang

phase) and the smooth transition from one to the other,

conception will not occur. For example some women have

very high female hormones and yet no conception.

Treatment throughout the cycle

Post menstrual phase

If the yin is deficient it is important to begin to nourish it at

the stage that it begins to grow, which occurs in the latter

part of the menstrual bleed and before the bleeding has

finished. This ensures a good foundation for yin to grow

and gives a better result than starting to treat after the

period. Therefore start to nourish the yin and blood on day

three of the cycle, coupled with treatment to address Heart

or Liver fire if necessary. This will be evident where there is

a saw-tooth pattern in the post-menstrual phase of the BBT

along with evident symptoms and signs of spirit distur-

bance. Too much heat in the Heart or Liver will impede the

effective growth and completion (fruition) of the yin, essen-

tial in this phase. Treatment uses Nourish the Yin toEstablish Yang Decoction (Yang Yin Dian Ji Wan), based

on Gui Shao Di Huang Wan.

Dang Gui (Radix Angelicae Sinensis) 9

Bai Shao (Radix Paeoniae Lactiflorae) 9

Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 6

He Huan Pi (Cortex Albizziae Julibrissin) 9

Huai Niu Xi (Radix Achyranthis Bidentatae) 6

Shan Yao (Radix Dioscoreae Oppositae) 9

Ye Jiao Teng (Caulis Polygoni Multiflori) 6

Sheng Di Huang (Radix Rehmanniae Glutinosae) 9

Mu Dan Pi (Cortex Moutan Radicis) 9

Fu Ling (Sclerotium Poriae Cocos) 9

Notes and modifications

To ensure fulfilment of yin, add either Xu Duan (Radix

Dipsaci) or Tu Su Zi (Fructus Perillae Frutescentis).

Treatment to nourish yin and blood during menstruation

might prevent all the menstrual blood from being com-

pletely discharged. To avoid this, on day 1 and 2 of treat-

ment you can add Chi Shao (Radix Paeoniae Rubrae) or

Shan Zha (Fructus Crataegi) or Yi Mu Cao (Herba LeonuriHeterophylli) only until the period stops.

It is important in both phases of the cycle to quieten the

Heart and soothe Liver qi. If there are any indications of fire

e.g. saw-toothed pattern on the BBT, add Gou Teng (Ramu-

lus Uncariae Cum Uncis).

To promote nourishment of female essence add Gui Ban

(Plastrum Testudinis) or Mu Li (Concha Ostreae) in cases

where there is little fertile mucous or the presence of obvi-

ous signs of yin deficiency.

If there signs of leakage of yin e.g. marked leucorrhoea or

night sweating add Duan Mu Li (Concha Ostreae) and Gan

Cao (Radix Glycyrrhizae Uralensis). In cases of amenorrhoea the woman remains in the post-

menstrual phase in which case promotion of ovulation is

essential.

Ovulation

Many gynaecological problems such as infertility, uterine

bleeding, amenorrhoea, dysmenorrhoea, endometriosis etc.

can be greatly improved by promoting ovulation. Treat-

ment to promote ovulation is usually started around day 10.

In cases of amenorrhoea due to deficiency of yin and blood,

it is important to ensure that sufficient nourishing treat-

ment is given first (observed as normalisation of the BBT

and improvement of other possible symptoms and signs).

The timescale (i.e. the number of days around ovulation)

is short so dosages are increased and acupuncture added.

At ovulation the main principle is to activate circulation of

qi and blood and to promote the transformation of yin into

yang using Bu Shen Cu Pai Luan Tang:

Dang Gui (Radix Angelicae Sinensis) 10

Bai Shao (Radix Paeoniae Lactiflorae) 10

Nu Zhen Zi (Fructus Ligustri Lucidi) 10

Hong Hua (Flos Carthami Tinctorii) 10

Gou Qi Zi (Fructus Lycii Chinensis) 10Mu Dan Pi (Cortex Moutan Radicis) 10

Fu Ling (Sclerotium Poriae Cocos) 8

Xu Duan (Radix Dipsaci) 10

Tu Si Zi (Semen Cuscutae) 10

Dan Shen (Radix Salviae Miltiorrhizae) 10

Chao Xiang Fu (Toasted Rhizoma Cyperi Rotundi)

Notes and modifications

Hong Hua, Dan Shen and Chao Xiang Fu both have a

specific effect on promoting ovulation.

This prescription tonifies the Kidneys to promote ovula-

tion and is particularly effective if there is insufficient

vaginal secretion.

If there are any signs or symptoms of Liver qi stagnation

they must be addressed, preferably with acupuncture.

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It is common to add strong yang tonics to prescriptions to

promote ovulation in order to give motive force to help yin/

oestrogen reach its peak for ovulation to take place, espe-

cially in cases where there is apparent yang deficiency.

Suitable additions are Ba Ji Tian (Radix Morindae Officinalis),

Tu Si Zi (Semen Cuscutae), Rou Cong Rong (HerbaCistanches), Lu Jiao Jiao (Colla Cornu Cervi) or Yin Yang

Huo (Herba Epimedii). Note that the combination of Tu Si

Zi and Rou Cong Rong is known as Tu Reng San which is

noted for its ability to increase production of sexual hor-

mones.

If the quality of the ovaries is poor (this may only be

known from exploratory surgery or tests done to evaluate

the ovaries) use one or two of the following: Lu Jiao Shuang

(Cornu Cervi Gelatinum), Sheng Di Huang (Radix Reh-

manniae Glutinosae), Yin Yang Huo (Herba Epimedii),

Gou Qi Zi (Fructus Lycii Chinensis).

If there are obvious signs of phlegm or polycystic ovaries,at ovulation you must warm yang, resolve phlegm and

activate qi and blood. Use Wen Yang Hua Tan Tang: Ba Ji

Tian (Radix Morindae Officinalis), Hong Hua (Flos Carthami

Tinctorii), Cang Zhu (Rhizoma Atractylodis), Dan Nan

Xing (Rhizoma Arisaematis cum Felle Bovis), Yin Yang

Huo (Herba Epimedii), Shan Zha (Fructus Crataegi), Fu

Ling (Sclerotium Poriae Cocos) , Xu Duan (Radix Dipsaci),

Zhi Ke (Fructus Citri seu Ponciri), Chen Pi (Pericarpium

Citri Reticulatae); and add two or three of the following: Bie

Jia (Carapax Amydae Sinensis), Wang Bu Liu Xing (Semen

Vaccariae Segetalis), Di Long (Lumbricus) [which pen-

etrates and reduces thickening tissue, resolves adhesions in

the pelvic cavity] and Shan Zha (Fructus

Crataegi)(particularly good for polycystic ovaries).

If there are signs of Spleen qi deficiency and damp, add

Chao Dang Shen (toasted Radix Codonopsis Pilosulae), Bai

Zhu (Rhizoma Atractylodis Macrocephalae) and Shan Yao

(Radix Dioscoreae Oppositae).

If there are obvious signs of Liver and Heart qi stagnation

base the formula on Xiao Yao Wan (Rambling Powder):

Dang Gui (Radix Angelicae Sinensis) 10g, Bai Shao (Radix

Paeoniae Lactiflorae) 10g, Shan Zha (Fructus Crataegi) 10g,

Yu Jin (Tuber Curcumae) 10g, Fu Ling (Sclerotium PoriaeCocos) 6g, Chai Hu (Radix Bupleuri) 6g, Yuan Zhi (Radix

Polygalae Tenuifoliae) 6g, Shi Chang Pu (Rhizoma Acori

Graminei) 10g, Dan Shen (Radix Salviae Miltiorrhizae) 10g,

He Huan Pi (Cortex Albizziae Julibrissin) 10g.

If there is bleeding at ovulation there is likely to be yin

deficiency and hyperactivity of the Liver, in which case add

Han Lian Cao (Herba Ecliptae Prostatae) and Nu Zhen Zi

(Fructus Ligustri Lucidi).

The importance of Heart and Kidney Harmony at ovulation

The Heart rules the blood vessels and their function, which

ensures that the supply of blood and ying (nutritive) qi is

never broken. The bao mai and bao luo, the uterine vessels

and collaterals, fall under the control of the Heart. The

Heart and the Heart spirit therefore play an important role

in the filling and emptying of the uterus. The Su Wen

states that if Heart qi cannot descend, the uterine vessels

will become obstructed and menstruation will stop. In 1612

in Songs Secrets of Gynaecology, it says the Heart controls

the movement of blood, but if it falls into a startled, fearful

state, the spirit has no support and blood scatters whichcauses the menstrual blood to cease moving, often giving

rise to amenorrhoea.

Because the seven emotions injure the Heart, Heart qi

stops and knots up, so blood stops and does not move. One

should regulate Heart qi and open the flow in the Heart

channel to produce blood. Then the period will naturally

flow. Ji Yan Gan Mu (Compendium of the Benefits of Yinby

Zhu Dan-xI, 1620.

Where there is obvious spirit disturbance accompanied

by Heart fire, a good prescription to promote ovulation and

open the uterus is based on Pai Luan Tang: Bai Zi Ren

(Semen Biotae Orientalis) 10g to calm the spirit, Dan Shen(Radix Salviae Miltiorrhizae) 10g to promote ovulation,

Dang Gui (Radix Angelicae Sinensis) 10g, Chi Shao (Radix

Paeoniae Rubrae) 10g, Chuan Xiong (Radix Ligustici Wal-

lichii) 10g, Tu Su Zi (Fructus Perillae Frutescentis) 10g, Xu

Duan (Radix Dipsaci) 10g which in combination with Tu Si

Zi strongly tonifies Kidney yang, Sheng Di Huang (Radix

Rehmanniae Glutinosae) 10g, Niu Xi (Radix Achyranthis

Bidentatae) 10g, Hong Hua (Flos Carthami Tinctorii) 5g,

Gou Teng (Ramulus Uncariae Cum Uncis) l2g and He Huan

Pi (Cortex Albizziae Julibrissin) 12g which in combination

with Gou Teng is very good at calming Liver and Heart fire.

If there are obvious signs of Heart-Kidney disharmony,

add Jiao Tai Wan (The Great Connector) to the prescription:

Huang Lian (Rhizoma Coptidis) 6-8g, and Rou Gui (Cortex

Cinnamomi Cassiae) 3g. This prescription is applicable

when the Kidney yang is unable to provide for the Heart

yang, or likewise when the yin of both the Heart and Kidney

are deficient.

It is said that the uterine vessels relate above to the Heart

and below to the Kidneys. The uterus is in-between. It is

therefore essential to firm the Kidneys before tonifying the

Heart and likewise to pacify the Heart before tonifying the

Kidneys. Where there is poor ovarian and pituitary func-tion, one should always suspect the problem is based in the

Heart. Using the BBT one can tell whether heat from the

Heart or the Liver is becoming excessive and thus patho-

genic, disturbing the harmony between Heart and Kidney

and hindering the consolidation of blood and yin in the first

half of the cycle and also the growth and maintenance of

yang in the premenstrual phase. For this reason it is impor-

tant to remain relaxed when trying to conceive. If the Heart

or Liver qi rebels upwards, the qi will not sink to the uterus

and the fallopian tubes, affecting fertility. When calming

the Heart and Liver, sweet flavours are helpful. Gan Mai Da

Zao Tang (Licorice, Wheat and Jujube Decoction) can be

incorporated into the prescription: Gan Cao (Radix

Glycyrrhizae Uralensis) 9g, Fu Xiao Mai (Semen Tritici

Aestevi Levis) 12g, Da Zao (Fructus Zizyphi Jujubae) 10g.

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The uterus will open both at ovulation: the time of the

dynamic yin/yang interaction, but also when the Heart

spirit is in emotional harmony - where the intertwining of

two spirits combine to create form. At this point (where

there is emotional harmony between both participants) the

central nervous system can reach such excitation and sostimulate the endocrine system to provoke an additional

ovulation resulting in pregnancy.

Premenstrual Treatment

The main treatment principle is to tonify yang and help qi

which will have the effect of raising the progesterone level.

It is important to understand the principle of tonifying fire

within water, without which it is difficult for yang to reach

the high levels required for conception and the continua-

tion of pregnancy during the luteal phase. The prescription

is therefore based on You Gui Wan (Restore the Right

Kidney Pill):Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) l0g

Lu Jiao Shuang (Cornu Cervi Gelatinum) 9g (helps main-

tain high phase of the cycle and also activates blood).

Tu Su Zi (Fructus Perillae Frutescentis) 10g

Rou Cong Rong (Herba Cistanches) 9g

Shan Yao (Radix Dioscoreae Oppositae) l0g

Ba Ji Tian (Radix Morindae Officinalis) 10g

Mu Dan Pi (Cortex Moutan Radicis) 10g

Shan Zhu Yu (Fructus Corni Officinalis) 9g

If there are signs of poor luteal phase shown on the BBT or

through medical tests, the best prescription to use is Zhu Yu

Tang (Help Conception Decoction), which addresses both

yang and blood by warming the uterus and maintaining its

motive force on the one hand, and nourishing blood on the

other.:

Dang Gui (Radix Angelicae Sinensis)

She Chuang Zi (Fructus Cnidii Monnieri)

Bai Shao (Radix Paeoniae Lactiflorae)

He Huan Pi (Cortex Albizziae Julibrissin)

Gou Teng (Ramulus Uncariae Cum Uncis), or

Chai Hu (Radix Bupleuri)

Du Zhong (Cortex Eucommiae Ulmoidis)

Lu Jiao Shuang (Cornu Cervi Gelatinum)Yin Yang Huo (Herba Epimedii)

Shan Yao (Radix Dioscoreae Oppositae)

Fu Ling (Sclerotium Poriae Cocos)

Mu Dan Pi (Cortex Moutan Radicis)

Xu Duan (Radix Dipsaci)

Tu Su Zi (Fructus Perillae Frutescentis)

It is also crucial to treat close to menstruation. The yang

has already peaked and may have stirred up fire in the

Heart and Liver, giving rise to breast distention, stuffy

chest, restlessness, headache, insomnia and irritability. Treat-

ment is to maintain vigorous yang, but also to clear fire from

the Heart and Liver. If a woman has an unstable BBT in the

high (post-ovulation) phase, you must be careful, when

clearing heat, not to damage the yang qi. Base the prescrip-

tion on Dan Zhi Xiao Yao San (Augmented Rambling

Powder), monitoring the BBT to ensure the yang phase

remains high.

If there are signs of qi stagnation, tonify yang by promot-

ing qi with Zhen Wu Tang (True Warrior Decoction):

Dang Shen (Radix Codonopsis Pilosulae) 12g

Ba Ji Tian (Radix Morindae Officinalis) 10gYi Yi Ren (Semen Coicis Lachryma-jobi) 15g


Lu Jiao Shuang (Cornu Cervi Gelatinum) l0g

Xiang Fu (Rhizoma Cyperi Rotundi) 6g

Bai Zhu (Rhizoma Atractylodis Macrocephalae) 10g

Shan Yao (Radix Dioscoreae Oppositae) 10g

If there is premenstrual abdominal or breast distention

add Chai Hu (Radix Bupleuri), Qing Pi (Pericarpium Citri

Reticulatae Viride) and He Huan Pi (Cortex Albizziae

Julibrissin).

If there are signs of heat add Chuan Lian Zi (Fructus

Meliae Toosendan). If endometriosis is a problem, add two or three of the

following blood-stagnation removing herbs: Chuan Xiong

(Radix Ligustici Wallichii), Xiang Fu (Rhizoma Cyperi

Rotundi), Dang Gui Wei (Extremitas Radix Angelicae

Sinensis), Chi Shao (Radix Paeoniae Rubrae), Tao Ren (Se-

men Persicae), Yan Hu Suo (Rhizoma Corydalis Yanhusuo),

Hong Hua (Flos Carthami Tinctorii).

During menstruation The mutual flux of yin and yang

The mutual flux of yin and yang depends on the harmoni-

ous function of the Heart-Kidney-uterus axis with essence

and spirit acting as one. If the menstrual flow is heavy on

day 1, this is pathological. It should normally take a day

after the temperature has dropped to generate the qi to push

the blood. Good flow should start on day 2. If it starts too

fast, this indicates excessive heat or Spleen qi deficiency

losing control of blood.

If treatment is given during the first three days of men-

struation, for example in case of uterine fibroids, endome-

triosis or other cases of severe blood stasis, the primary

principle is to regulate qi and blood as well as to benefit the

Kidneys:

Dang Gui (Radix Angelicae Sinensis) 9gShan Zhu Yu (Fructus Corni Officinalis) 6g

Chi Shao (Radix Paeoniae Rubrae) 9g

Chuan Niu Xi (Radix Achyranthis Bidentatae) 6g


Hong Hua (Flos Carthami Tinctorii) [especially in cases of

dysmenorrhoea] 6g

Yi Mu Cao (Herba Leonuri Heterophylli) 6g


Zhi Xiang Fu (honey-fried Rhizoma Cyperi Rotundi) 6g

If there is blood deficiency, you must always address the

Spleen, in which case add Dang Shen (Radix Codonopsis

Pilosulae) and Bai Zhu (Rhizoma Atractylodis

Macrocephalae), (both dry fried to work better on the

middle jiao) to the prescription.

If there is disruption in the Sanjiao pathway it may

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prevent Heart fire from warming the Kidney, or Kidney yin

from nourishing the Heart. Possible manifestations include

palpable heat in the upper jiao and coldness in the lower

jiao, or weak pulses on right chi position. The treatment

principle is to open the Sanjiao passages by adding one or

two of the following: Yuan Zhi (Radix Polygalae Tenuifoliae),Shi Chang Pu (Rhizoma Acori Graminei) [reconnects the

Heart to the Kidneys], Ba Ji Tian (Radix Morindae

Officinalis), Ban Xia (Rhizoma Pinelliae Ternatae).

The uterus

The importance of the uterus when treating infertility is

often overlooked in Chinese medicine. The main function

of the uterus is to dominate menstruation and conception.

It both stores and eliminates, like the other extraordinary fu.

The opening and closing of the uterus relies upon the Heart

and the Kidneys. The Kidneys store the essence and control

the function of closing and storage of the uterus to preventmiscarriage. The opening of the uterus relies upon the

Heart. If the Heart yang moves and is not quiet, it can cause

the opening of the uterus during pregnancy causing mis-

carriage. Likewise if Heart yang is stagnant there will be no

opening of the uterus thus obstructing fertility.

There are two types of uterine vessels, the bao mai and the

bao luo. The bao mai is a single vessel which links the Heart

to the uterus: If the Heart blood and Heart qi smoothly

descend to reach the uterus. menstruation and pregnancy

can occur without incident (Su Wen chapter 47). The bao

luo are uterine collaterals which link the Kidneys to the

uterus and are the route by which the Kidneys transport

essence directly to the uterus.

Some miscarriages may occur within the 14 days follow-

ing ovulation due to an inadequate luteal phase, which

arises from yang deficiency in the uterus and therefore the

uterus expels more than it conserves, and these cases should

be treated by warming the yang, increasing qi and adding

herbs to strengthen the holding-in function. In such cases

(where it is not always evident that miscarriage has oc-

curred) as well as in cases of an evident history of repeated

miscarriage, the later stages of the BBT (after day 21) should

be monitored to ensure that the temperature remains highand continues to do so until at least 12 weeks into the

pregnancy. In patients with a history of repeated miscar-

riage, the recommended prescription is Shu Gong Tang

(Bind the Uterus Decoction). Note that if conception should

occur during the course of treatment, Ren Shen should be

removed and substituted with Dang Shen and all the doses

reduced. Once the danger period has passed the precription

can be stopped.

Ren Shen (Radix Ginseng) 10g


Lu Jiao Shuang (Cornu Cervi Gelatinum) 10g

Tu Si Zi (Fructus Perillae Frutescentis) 10g


Wu Wei Zi (Fructus Schisandrae Chinensis) 6g

Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10g

Bai Shao (Radix Paeoniae Lactiflorae) 10g

Contrarily, if the uterus conserves more than it expels, for

example where there is amenorrhoea and infertility due to

absent or poor ovulation, and inadequate production of

fertile mucus, then there is uterine yin deficiency. Here we

could use Yang Gong Tang (Cultivate the Uterus Decoction).Dang Gui (Radix Angelicae Sinensis) 10g


Chong Wei Zi (Semen Leonuri Heterophylli) 15g



Rou Cong Rong (Herba Cistanches) 10g

Mu Li (Concha Ostreae) 20g

Other miscellaneous factors giving rise to infertility

If the temperature is above 38C with signs of abdominal

pain and distention, thick yellow leucorrhoea and a thick

yellow tongue-coating, you can suspect pelvic inflamma-tory disease, which must be treated accordingly until the

temperature drops to below 37.5C in acute cases, and back

to 37C in chronic cases.

Fallopian tube obstruction, perhaps with a history of

salpingitis or acute or chronic pelvic inflammatory disease,

may give rise to mucus or blood clots in the menstrual

blood. The following prescription may be used for at least

ten days after the end of menstrual bleeding (alternatively

it can be taken throughout the non-bleeding part of the

cycle):

Wei Ling Xian (Radix Clemetidis Chinensis) 12g

Huang Qi (Radix Astragali) 20g

Xia Ku Cao (Spica Prunellae Vulgaris) 12g

Zhe Bei Mu (Bulbus Fritillariae Thunbergii) 12g

Zhi Ke (Fructus Citri seu Ponciri) 9g

Pu Gong Ying (Herba Taraxaci Mongolici cum Radice) 15g

Dan Shen (Radix Salviae Miltiorrhizae) 12g

Gui Zhi (Ramulus Cinnamomi Cassiae) 9g

Lu Lu Tong (Fructus Liquidambaris Taiwanianae) 15g

Shui Zhi (Hirudo seu Whitmaniae) 9g

Xue Jie (Sanguis Draconis) 6g

Zao Jiao Ci (Spina Gleditsiae Sinensis) 12g

Notes and modification

Wei Ling Xian is good for pains in the legs which may

occur in cases of severe dysmenorrhoea. Care should be

taken not to use too high a dose as it can damage the zheng

qi. Huang Qi increases qi movement. Xia Ku Cao and Zhe

Bei Mu are both good for clearing phlegm. Pu Gong Ying

has an anti inflammatory action. Dan Shen moves the

blood. Gui Zhi moves yang to move the blood, and if

combined with Fu Ling (Sclerotium Poriae Cocos) is able to

dredge the fallopian tubes).

If there is excessive vaginal discharge with no signs of pelvic

or vaginal infection, tonify Kidney yang by adding Lu Jiao

Shuang (Cornu Cervi Gelatinum), Xu Duan (Radix Dipsaci),

Hu Zhang (Radix et Rhizoma Polygoni Cuspidati) etc.

If there are signs of heat and damp use Bai Jiang Cao

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(Herba cum Radice Patriniae), Gan Cao (Radix Glycyr-

rhizae Uralensis), Ze Xie (Rhizoma Alismatis Plantago-

aquaticae), Bai Hua She She Cao (Herba Oldenlandiae

Diffusae) and Hong Teng (Caulis Sargentodoxae Cuneatae).

The addition of herbal compresses is often more effective

for blocked tubes and can be used as well as taking aninternal prescription.:

Da Huang (Rhizoma Rhei) 30g

Hong Teng (Caulis Sargentodoxae Cuneatae) 30g

Ji Xue Teng (Radix et Caulis Jixueteng) 30g

Chao Ai Ye (Folium Artemisiae) 30g

Dang Gui Wei (Extremitas Radix Angelicae Sinensis) 30g

Ze Lan (Herba Lycopi Lucidi) 15g

Bai Zhi (Radix Angelicae) 15g

Chuan Jiao (Pericarpium Zanthoxyli Bungeani) 15g

Hu Zhang (Radix et Rhizoma Polygoni Cuspidati) 15g

Chuan Xiong (Radix Ligustici Wallichii) 15g

Xiao Hui Xiang (Fructus Foeniculi Vulgaris) 15gGui Zhi (Ramulus Cinnamomi Cassiae) 15g

San Leng (Rhizoma Sparganii) 15g

E Zhu (Rhizoma Curcumae Zedoariae) 15g

Wu Yao (Radix Linderae Strychnifoliae) 6g

Xi Xin (Herba Asari cum Radice) 6g

Wu Tou (Radix Aconiti) 6g

Chuan Wu (Radix Aconiti) 6g

Jiang Xiang (Lignum Dalbergiae Odoriferae) 6g

Bing Pian (Borneol) 3g

Crush all the ingredients. Put 75g in a cloth with 50% water

and 50% gin. Place on the abdomen over the fallopian tubes

with a hot water bottle on top. The pungent herbs will

penetrate the skin via the alcohol. Use for ten days after each

period. Each 75g batch of herbs can be used again as long as

it is still fragrant. A towel may be placed between the hot

water bottle and the herbs.

Case historiesThis method of using the BBT for diagnostic purposes can

also be helpful when treating disorders such as cycle

related migraines, skin conditions (particularly acne), and

growth and sexual maturity problems at puberty, as well

as the more obvious gynaecological complaints. Alongwith the pulse, tongue and personal impressions the chart

can give valuable information about the status of the yin

and yang, Heart and/or Liver fire, and more. It may also be

helpful as a guideline to recovery in some cases, by observ-

ing how the chart changes.

Case history 1: Sarah 34, infertilitySarah has been trying since 1994 to conceive. She previously

used the contraceptive pill for 10 years. She had one preg-

nancy at the age of 21, which was terminated. For 18 months

after coming off the pill her period came every 31 days (a

classic sign of long term use of the contraceptive pill dam-aging yin and blood). The menstrual flow contains some

blood clots and is painful. She also suffers from acne, a low

sex drive, feels very run down, and suffers from premen-

strual tension, bloating, soreness in the breasts and around

the site of the right ovary, thrush, a tendency to constipation

and dizziness on sudden standing. She is now obsessed

with becoming pregnant and gets very low and depressed

about it. She has been taking Prozac for one year. She had an

unsuccessful IVF cycle in 1996. Her tongue is pale with athick yellow coating, and her pulse is thin and wiry.

The chart indicated the presence of Heart and Liver fire(too

high and saw-toothed post-menstrual phase) and defi-

ciency of Kidney yang (erratic initial rise in the post-ovula-tory BBT). The symptoms and signs also reflected the

presence of dampness, damp-heat, blood deficiency and

blood stasis.

Treatment principle: tonify blood, resolve stasis, clear damp

and tonify Kidney yang. She also had acupuncture to calm

Liver/ Heart fire.

Premenstrual prescription: to regulate blood and maintain

the high phase:

Lu Jiao Jiao (Colla Cornu Cervi) 6g

Dang Gui (Radix Angelicae Sinensis) 6g

He Shou Wu (Radix Polygoni Multiflori) 6gFu Ling (Sclerotium Poriae Cocos) 6g



Du Zhong (Cortex Eucommiae Ulmoidis) 6g



Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 6g

Ban Xia (Rhizoma Pinelliae Ternatae) 6g

Da Zao (Fructus Zizyphi Jujubae) 2 pieces

Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 3g

Postmenstrual prescription: to nurture the yin and promote

ovulation:Lu Jiao Jiao (Colla Cornu Cervi) 3g


Fu Ling (Sclerotium Poriae Cocos) 6g


He Shou Wu (Radix Polygoni Multiflori) 6g

Hong Hua (Flos Carthami Tinctorii) 6g

Tu Si Zi (Semen Cuscutae) 6g

Yin Yang Huo (Herba Epimedii) 6g

Shan Zha (Fructus Crataegi) 6g



Da Zao (Fructus Zizyphi Jujubae) 2 pieces


After one cycle her periods were already less painful and

clotted. Her eyes were brighter and she had much more

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energy. She took the herbs for ten weeks and became

pregnant the following month.

Case history 2: Fiona 38. Infertility with fibroids

Fiona has been trying to conceive for ten years. She took the

contraceptive pill in her mid-twenties for five years. Shewas prescribed Clomid (a fertility drug) for one year, seven

years ago. Last year she had a successful IVF cycle but

miscarried at three months due to a fibroid. She has had six

operations in the last six years for fibroids and fallopian

tube adhesions, as well as D&Cs. Her cycle is 28 days and

she experiences sharp stabbing pains in the lower abdomi-

nal area which come and go throughout the month, as well

as severe pain during ovulation. Her period is characterised

by heavy and clotted flow and accompanied by sharp

stabbing pains. She is obviously anxious and upset about

her infertility and the possibility of a hysterectomy due to

the fibroid.Her tongue is darkish red with a thin yellow coating and her

pulse is rapid, and slippery on the right side.

Note: during the first two days of the cycle, the temperature

is still high, indicating insufficient expulsion of blood. This

is followed by a saw-tooth effect indicating heat in the blood

(Liver and Heart fire). After ovulation the yang phase fails

to develop properly, at which point yang stimulating herbs

must be given.

According to the evidence of the chart and her symptoms

and signs, the treatment principle was to tonify yang, clear

damp heat in the lower jiao and break down blood stagna-

tion to treat the fibroid.

Premenstrual prescription


Tu Su Zi (Fructus Perillae Frutescentis) 8gBai Zhu (Rhizoma Atractylodis Macrocephalae) 8g



Lu Jiao Shuang (Cornu Cervi Gelatinum) 6g

Yi Yi Ren (Semen Coicis Lachryma-jobi) 12g

Shan Zha (Fructus Crataegi) 6g

Pu Huang (Pollen Typhae) 10g ( last two both for fibroids)



During menstruation prescription

Dang Gui Wei (Extremitas Radix Angelicae Sinensis) 9g

Chuan Xiong (Radix Ligustici Wallichii) 8g

Tao Ren (Semen Persicae) 6g

Hong Hua (Flos Carthami Tinctorii) 6g

Dan Shen (Radix Salviae Miltiorrhizae) 9g

Ji Xue Teng (Radix et Caulis Jixueteng) 9g

Xiang Fu (Rhizoma Cyperi Rotundi) 6g


Pu Huang (Pollen Typhae) 9g

Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 8g

Gan Cao (Radix Glycyrrhizae Uralensis) 3gBefore ovulation prescription



Gou Teng (Ramulus Uncariae Cum Uncis) 15g

Nu Zhen Zi (Fructus Ligustri Lucidi) 9g



Xu Duan (Radix Dipsaci) 6g

Yan Hu Suo (Rhizoma Corydalis Yanhusuo) 6g

Lu Jiao Jiao (Colla Cornu Cervi) 4g (to activate blood)

Mu Xiang (Radix Saussureae seu Vladimirae) 6g

Pu Huang (Pollen Typhae) 9gGan Cao (Radix Glycyrrhizae Uralensis) 3g

Her treatment is currently continuing. So far the pains have

improved, indeed have virtually disappeared, and the blood

flow improved. She feels less anxious in herself.

ReferencesThe material in this article is gathered from a number of

sources and from my own clinical experience. I am espe-

cially indebted to the following sources:

Excerpts from Dr. Xia Gui Sheng lectures, Exploring Infertility,

Sydney 1995.

Clinical work with Dr. Xia Gui Sheng at Nanjing University

Hospital 1997.

Steven Clavey's newsletter ACMERC vo2:3. On the Uterus

taken from Jane Lyttletons work with Dr. Xia Gui Sheng.

Notes take from Steven Claveys lecture On Endometriosis,

London 1998.

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Virginia Wood practised Chinese medicine in Norwich for twelve

years, more recently specialising in gynaecology. She spent six months

working in a gynaecology clinic in New Zealand and then in China

with Dr Xia. She now lives and practices in Tuscany, Italy.

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