Female Infertility & Reproductive Gynaecology

This landmark manual is the most complete presentation of the integrated Chinese and biomedical treatment of infertility and reproductive gynaecology in the English language. Although primarily devoted to Chinese herbal medicine, the comprehensive discussions of every aspect of infertility, and the acupuncture protocols given for every pattern, will benefit every practitioner working in the field.

AVAILABLE FROM

Eastland Press North America

China Books Australia/New Zealand

Naturmed Germany/Austria/Switzerland

Journal of Chinese Medicine (all other locations plus read JCM review)

CONTENTS

Foreword by Peter Deadman xvii
Preface by Professor Yuning Wu xviii
Preface by Celine Leonard xx
Chapter One: How to use this book 1
Chapter Two: Basic theories of Chinese medicine gynaecology and infertility 3
Chapter Three: Core strategies for treating female infertility 7


Part One: Disorders of menstruation
Chapter Four: Regulating the period using Tiao Jing Fang (Regulate the Menses Formula) 25
Chapter Five: Disorders of timing – short cycles 29
Chapter Six: Disorders of timing – long cycles 41
Chapter Seven: Disorders of timing – irregular cycles 57
Chapter Eight: Disorders of bleeding – menorrhagia 67
Chapter Nine: Disorders of bleeding – scanty menstruation 79
Chapter Ten: Disorders of bleeding – prolonged menstruation 91
Chapter Eleven: Disorders of bleeding – midcycle bleeding 101
Chapter Twelve: Disorders of bleeding – abnormal uterine bleeding (beng lou) 115
Chapter Thirteen: Miscellaneous disorders – dysmenorrhoea 133
Chapter Fourteen: Miscellaneous disorders – premenstrual syndrome 149


Part Two: Gynaecology and infertility
Chapter Fifteen: Amenorrhoea and anorexia nervosa 167
Chapter Sixteen: Polycystic ovary syndrome 197
Chapter Seventeen: Myoma (fibroids) 217
Chapter Eighteen: Ovarian cysts 233
Chapter Nineteen: Endometriosis and adenomyosis 249
Chapter Twenty: Luteal phase defect 281
Chapter Twenty-One: Luteinised unruptured follicle syndrome 295
Chapter Twenty-Two: Hyperprolactinaemia 311
Chapter Twenty-Three: Tubal infertility 323
Chapter Twenty-Four: Diminished ovarian reserve and premature ovarian failure 339
Chapter Twenty-Five: Recurrent miscarriage 357
Chapter Twenty-Six: Immune infertility and immune recurrent miscarriage 373
Chapter Twenty-Seven: Using Chinese medicine to support assisted reproductive technology treatment 407
Chapter Twenty-Eight: Ovarian hyper-stimulation syndrome 437
Chapter Twenty-Nine: Pregnancy care 453
Appendix 1: Animal and endangered products and herb cautions 463
Appendix 2: Dispensing Chinese herbal medicines 466
Appendix 3: Basic fertility and pregnancy blood test values (with US/European conversions) 467
and explanation of abbreviations Appendix 4: Classical acupuncture prescriptions for gynaecology and infertility 469
Glossary 472

CHAPTER CONTENTS


Chapter 1: How to use this book

Chapter 2: Basic theories of Chinese medicine gynaecology and infertility
3 The fundamental importance of the Kidney in reproductive life
3 The other zangfu
3 Yin yang theory and the menstrual cycle The four stages of the menstrual cycle
4 Stage 1: Purging of blood through the period, days 1-5 (maximum 7 days)
4 Stage 2: Postmenstrual growth of blood and yin (follicular phase), days 6-13
4 Stage 3: Ovulation, days 14-15
4 Stage 4: Premenstrual, luteal phase, days 16-28
5 Notes on using the BBT to refine diagnosis and treatment
5 Common disharmonies of the reproductive system
6 Fundamental treatment strategies with Chinese medicine

CHAPTER 3: Core strategies for treating female infertility
7 Aetiology and pathogenesis
8 Kidney yang deficiency
10 Kidney yin deficiency
12 Liver qi stagnation
13 Stagnation of phlegm-damp
14 Blood stasis
14 Blood stasis due to cold
16 Blood stasis with heat
17 Clinical notes
17 Biomedicine
17 History and physical examination
17 Ovulatory assessment
18 Menstrual history and BBT
18 Progesterone
18 Urinary luteinising hormone
18 Transvaginal ultrasonography
18 Other evaluations
18 Ovarian reserve
19 Cervical factors
19 Uterine abnormalities
19 Tubal potency
20 Peritoneal factors


Part One: Disorders of Menstruation

Chapter 4: Regulating the period using Tiao Jing Fang (Regulate the Menses Formula)
25 Clinical notes
26 Tiao Jing Fang (Regulate the Menses Formula)
26 Modifications
26 Scanty bleeding
26 Heavy bleeding
27 Dysmenorrhoea

CHAPTER 5: Short cycles
29 Aetiology and pathogenesis
30 General treatment strategy
30 Deficiency of Spleen qi
31 Kidney deficiency
32 Empty heat from Kidney yin deficiency
34 Full heat
35 Clinical notes
35 Modifications for patients wishing to conceive
36 Case study from the clinic of Dr. Yuning Wu: Short cycle with scanty menstruation and secondary infertility
39 Case study from the clinic of Celine Leonard: Short cycle with dysmenorrhoea and lower abdominal pain

Chapter 6: Long cycles
41 Aetiology and pathogenesis
42 General treatment strategy
42 Blood deficiency
43 Kidney deficiency
45 Stagnation of qi and blood
46 Stagnation of phlegm-damp
47 Blood obstructed by cold
49 Case study from the clinic of Dr. Yuning Wu: Long cycle and scanty bleeding
51 Case study from the clinic of Celine Leonard: Long cycle and infertility
54 Case study from the clinic of Esther Denz: Long cycle, unexplained female infertility and PMS

Chapter 7: Irregular cycles
57 Aetiology and pathogenesis
58 General treatment strategy
58 Kidney deficiency
59 Liver qi stagnation
61 Kidney deficiency with Liver qi stagnation
62 Case study from the clinic of Dr. Yuning Wu: Irregular cycle with PCOS and infertility

Chapter 8: Menorrhagia
67 Aetiology and pathogenesis
67 Deficiency of qi
69 Blood heat
71 Blood stasis
72 Clinical notes
72 Case study from the clinic of Dr. Yuning Wu: Menorrhagia and infertility
75 Case study from the clinic of Celine Leonard: Menorrhagia and myoma

Chapter 9: Scanty bleeding
79 Aetiology and pathogenesis
80 Blood deficiency
81 Kidney deficiency
82 Blood stasis
84 Stagnation of phlegm-damp
86 Clinical notes
86 Case study from the clinic of Dr. Yuning Wu: Scanty periods and infertility
88 Case study from the clinic of Dr. Yuning Wu: Scanty periods and infertility

Chapter 10: Prolonged periods
91 General treatment strategy
92 Aetiology and pathogenesis
92 Deficiency of qi
93 Empty heat from Kidney yin deficiency
95 Damp-heat
96 Blood stasis
97 Case study from the clinic of Celine Leonard: Prolonged menstruation and adenomyosis

Chapter 11: Midcycle bleeding
101 Aetiology and pathogenesis
101 Differentiation of patterns
102 Kidney yin deficiency with empty heat
103 Damp-heat
104 Blood stasis
105 Clinical notes
106 Case study from the clinic of Dr. Yuning Wu: Midcycle bleeding and scanty menstruation
108 Case study from the clinic of Celine Leonard: Midcycle bleeding and infertility
111 Case study from the clinic of Celine Leonard: Midcycle bleeding and dysmenorrhoea

Chapter 12: Abnormal uterine bleeding (beng lou)
115 Aetiology and pathogenesis
116 General treatment strategies
116 Kidney yin deficiency with empty heat
117 Kidney qi deficiency
119 Spleen qi deficiency
120 Blood heat
121 Blood stasis
123 Clinical notes
123 Puberty
123 Women of reproductive age
123 Perimenopause
123 Menopause
124 Case study from the clinic of Dr. Yuning Wu: Abnormal uterine bleeding and irregular periods
126 Case study from the clinic of Dr. Yuning Wu: PCOS, abnormal uterine bleeding (beng lou) and infertility

Chapter 13: Dysmenorrhoea
133 Aetiology and pathogenesis
134 Differentiating menstrual pain: overview, timing, quality, location of pain
135 Stagnation of qi and stasis of blood 136 Excess cold leading to blood stasis 138 Damp-heat blocking the lower jiao
139 Deficiency of qi and blood
140 Deficiency of the Kidney and Liver 142 Clinical notes
142 Modified Tiao Jing Fang (Regulate the Menses Formula)
143 Case study from the clinic of Celine Leonard: Dysmenorrhoea and infertility

Chapter 14: Premenstrual Syndrome
Premenstrual emotional symptoms
149 Aetiology and pathogenesis of premenstrual emotional symptoms
150 Premenstrual emotional symptoms due to Heart blood deficiency
151 Premenstrual emotional symptoms due to stagnation of Liver qi/Liver fire
152 Premenstrual emotional symptoms due to phlegm-fire disturbing the mind
Headaches associated with the menstrual cycle

Part Two: Gynaecology and infertility

Chapter 15: Amenorrhoea, Anorexia nervosa
Amenorrhoea
167 Aetiology and pathogenesis 168 Kidney yang deficiency
169 Kidney yin deficiency
171 Deficiency of qi and blood
172 Stomach dryness due to yin deficiency
173 Stagnation of qi and blood
175 Accumulation of phlegm-damp 176 Clinical notes
Biomedicine
176 Causes of amenorrhoea
177 Anatomical defects
177 Evaluation of the patient
177 Physical examination
177 Blood tests, normal values
177 High FSH, low AMH
177 TSH
177 Elevated prolactin levels
178 Normal or low FSH levels
178 Hypothalamic amenorrhoea (anorexia nervosa)
178 Adrenal hyperplasia
178 Case study from the clinic of Dr. Yuning Wu: Amenorrhoea and primary infertility
181 Case study from the clinic of Dr. Yuning Wu: Amenorrhoea and polycystic ovary syndrome
183 Case study from the clinic of Celine Leonard: Amenorrhoea
185 Case study from the clinic of Celine Leonard: Amenorrhoea and infertility Anorexia nervosa
187 Aetiology and pathogenesis
187 Deficiency of Spleen qi and Heart blood
189 Stagnation of Liver qi and deficiency of Spleen qi 190 Liver qi stagnation with accumulation of phlegm
191 Clinical notes
192 Case history from the clinic of Esther Denz: Amenorrhoea, anorexia nervosa and infertility
194 Case study from the clinic of Esther Denz: Anorexia nervosa and infertility

Chapter 16: Polycystic ovary syndrome (PCOS)
197 Aetiology and pathogenesis
198 Kidney deficiency with stagnation of phlegm-damp 201 Kidney deficiency with blood stasis
203 Stagnation of phlegm-damp
205 Liver qi stagnation with phlegm-fire 207 Clinical notes
207 Combining Chinese medicine and biomedicine
Biomedicine
208 Diagnosis
209 Fertility treatment
209 Case study from the clinic of Dr. Yuning Wu: PCOS and infertility
211 Case study from the clinic of Esther Denz: PCOS with irregular and long cycles and infertility
213 Case study from the clinic of Esther Denz: PCOS with amenorrhoea

Chapter 17: Myoma
217 Prognosis
217 General treatment strategy 218 Aetiology and pathogenesis 218 Stagnation of qi and blood
220 Stagnation of phlegm and blood 222 Accumulation of damp-heat
223 Clinical notes
225 External treatments
Biomedicine
225 Menorrhagia
225 Infertility Treatment
226 Medication
226 Surgical treatment of myomas 226 Prognosis
227 Case study from the clinic of Dr. Yuning Wu: Myoma and infertility

Chapter 18: Ovarian cysts
233 Aetiology and pathogenesis
234 Type 1: uncomplicated or simple cysts
234 Spleen qi deficiency with stagnation of phlegm-damp
Ovarian cysts continued/uncomplicated or simple cysts
235 Accumulation of phlegm and blood stasis
237 Damp-heat mixed with blood stasis
239 Type 2: echoic cysts containing solid matter
239 Stagnation of qi and blood
241 Accumulation of phlegm-damp and blood stasis
242 Damp-heat mixed with blood stasis 244 External treatment for ovarian cysts 244 Lifestyle advice
Biomedicine
245 Functional cysts
245 Pathological or ‘inclusion’ cysts 245 Epidemiology
245 Types of ovarian cysts 245 Clinical symptoms
245 Treatment
246 Caution: ovarian cancer
246 Case study from the clinic of Dr. Yuning Wu: Ovarian cyst and infertility

Chapter 19: Endometriosis and adenomyosis
Endometriosis
250 Prognosis
250 Aetiology and pathogenesis
251 Stagnation of qi and blood 253 Blood stasis due to cold 255 Blood stasis due to heat
257 Combined stagnation of phlegm and blood 258 Blood stasis due to qi deficiency
260 Kidney deficiency and blood stasis 262 Treating during the period
263 Promoting fertility
264 Clinical notes
265 External treatments for endometriosis and adenomyosis
Biomedicine
266 Aetiology and pathogenesis
266 Retrograde menstruation
267 Metaplasia
267 Immunologic factors 267 Pathology
267 Clinical presentation
267 Pelvic pain
267 Infertility
267 Other symptoms 267 Diagnosis
268 Classification
268 Treatment
268 Medical treatment
268 Surgical treatment – laparoscopy
268 Other surgery for endometriosis associated pelvic pain
269 Surgery for the management of infertility
269 Ovarian stimulation and IVF in endometriosis related infertility
269 Integrating Chinese medicine and biomedicine Adenomyosis
269 Symptoms and prevalence 270 Diagnosis
270 Treatment
270 Surgery
270 Fertility
270 Case study from the clinic of Dr. Yuning Wu: Endometriosis and infertility
272 Case study from the clinic of Dr. Yuning Wu: Adenomyosis, adenomyoma and infertility
275 Case study from the clinic of Esther Denz: Endometriosis with dysmenorrhoea and heavy bleeding

Chapter 20: Luteal phase defect
281 Definition
282 Aetiology and pathogenesis 282 Kidney yang deficiency
284 Kidney yin deficiency
286 Kidney deficiency with Liver qi stagnation 287 Clinical notes
Biomedicine
288 Definition
288 Prevalence and incidence 288 The corpus luteum
288 Pathophysiology
289 Poor follicle production
289 Corpus luteum failure
289 Poor endometrial response
289 Other causes 289 Diagnosis
289 Endometrial biopsy
289 Serum progesterone levels
289 BBT chart 290 Treatment
290 Progesterone supplementation
290 Onset and duration of treatment with progesterone
290 Ovulation induction for inadequate folliculogenesis
290 Monitoring treatment effect
291 Case study from the clinic of Dr. Yuning Wu: Luteal phase defect and recurrent spontaneous miscarriage

Chapter 21: Luteinised unruptured follicle syndrome
295 BBT chart
296 Aetiology and pathogenesis
296 Kidney deficiency with blood stasis
298 Liver qi stagnation with Kidney deficiency 300 Deficiency of the Liver and Kidney
302 Damp-heat with blood stasis
304 Clinical notes
Biomedicine
305 Definition
305 Diagnosis
305 Incidence
305 Aetiology and pathogenesis
305 Treatment
306 Case study from the clinic of Dr. Yuning Wu: LUFS, PCOS and hyperprolactinaemia

Chapter 22: Hyperprolactinaemia
311 Aetiology and pathogenesis
312 Liver qi stagnation with Liver fire
313 Stagnation of phlegm and blood stasis
315 Kidney yin deficiency with Liver yang rising 316 Deficiency of qi and blood
317 Clinical notes
Biomedicine
318 Definition
318 Incidence and causes
318 Idiopathic
318 Prolactinoma
319 Hypothyroidism
319 Other causes of hyperprolactinaemia 319 Evaluation of the patient
319 Examination
319 Blood test
319 CT or MRI scan 319 Treatment
320 Case study from the clinic of Dr. Yuning Wu: Hyperprolactinaemia

Chapter 23: Tubal infertility 

323 Aetiology and pathogenesis 324 General treatment strategy
324 Pregnancy
325 Stagnation of qi and blood
327 Blood stasis combined with phlegm-damp 328 Blood stasis and fire toxin
330 External treatment
330 Herbal enemas
331 Herbal compresses
331 Prognosis
Biomedicine
332 Causes of tubal infertility
332 Infections and pelvic inflammatory disease (PID)
332 Other causes 332 Diagnosis
333 Complete blockage of the fallopian tubes at one or more points
333 Adhesions/scarring causing partial blockage
333 Complete damage of the tubal mucosa and muscular wall (pansalpingopathy) 333 Treatment
333 Microsurgery
333 IVF
333 Combination of IVF and microsurgery
333 Other considerations
333 Case study from the clinic of Dr. Yuning Wu: Tubal infertility

Chapter 24: Diminished ovarian reserve (DOR) and premature ovarian failure (POF)
339 Aetiology and pathogenesis
340 Kidney yang deficiency with blood stasis
342 Kidney yin deficiency and empty heat with blood stasis 342 Qi and blood deficiency with blood stasis
346 Clinical notes
347 Prognosis Biomedicine 349 Incidence
347 Aetiology and pathogenesis
349 Autoimmunity
349 Environmental factors
349 Genetic causes
349 Diagnosis and assessment of POF 349 Reversible POF
350 Treatment of infertility in POF
350 Case study from the clinic of Dr. Yuning Wu: Premature ovarian failure 353 Case study from the clinic of Dr. Yuning Wu: Premature ovarian failure 353 Case study from the clinic of Dr. Yuning Wu: Premature ovarian failure

Chapter 25: Recurrent miscarriage
358 Aetiology and pathogenesis 358 Deficiency of Kidney qi
360 Deficiency of qi and blood
361 Empty heat due to yin deficiency
362 Blood stasis blocking the uterine collaterals 365 Clinical notes
Biomedicine
365 Definition
365 Genetics and age
366 Hormonal and metabolic factors 366 Infections
366 Uterine anomalies
367 Inherited thrombophilias
367 Male factors
367 Lifestyle, environmental and occupational factors
367 Antiphospholipid syndrome and other autoimmune and alloimmune factors 367 Case study from the clinic of Dr Yuning Wu: Recurrent miscarriage

Chapter 26: Immune infertility and immune recurrent miscarriage
Immune infertility
374 Aetiology and pathogenesis
374 Kidney yin deficiency with empty heat
377 Kidney and Spleen yang deficiency with damp and blood stasis 378 Accumulation of damp heat and toxins
380 Clinical notes
381 Lifestyle advice Immune-related miscarriage 381 Autoimmunity
382 Aetiology and pathogenesis 383 General treatment strategy
383 Kidney deficiency with blood stasis
385 Qi and blood deficiency with blood stasis 387 Toxic heat and blood stasis
389 Clinical notes
Alloimmunity
390 Aetiology and pathogenesis 391 Kidney and Spleen deficiency
392 Kidney and Liver yin deficiency with empty heat 394 Patient trials
394 Pharmacological research
Biomedicine
395 Anti-sperm antibodies (ASA) 395 Anti-ovarian antibodies (AOA)
395 Beta-cell antibodies (in Diabetes Type I)
396 Anti-thyroid antibodies (ATA) – Hashimoto’s thyroiditis 396 Anti-endometrial antibodies (AEA)
396 Anti-phospholipid antibodies (APA)
396 Clinical criteria
396 Laboratory criteria 394 Alloimmune factors
397 Case study from the clinic of Dr. Yuning Wu: Autoimmune-related recurrent miscarriage
399 Case study from the clinic of Dr. Yuning Wu: Alloimmune-related recurrent miscarriage, blocking antibody defect (BAD)
402 Case study from the clinic of Esther Denz: IVF failure and unexplained infertility, later confirmed autoimmune infertility

Chapter 27: Using Chinese medicine to support assisted reproductive technology treatment
407 How Chinese medicine helps patients undergoing ART 408 General treatment strategy
408 Supporting IUI cycles with Chinese medicine
408 Natural IUI cycles
409 Medicated IUI procedures
409 Clomiphene citrate IUI cycles
410 Aromatase inhibitor IUI cycles
410 HMG/FSH with IUI
411 Supporting IVF/ICSI cycles with Chinese medicine
411 The six stages of treatment to accompany IVF/ICSI
411 Adapting treatment to match the IVF protocol
410 Preparation: Regulating (tiao)
410 Down-regulation: Nourishing (bu)
414 Menstruation: Purging (tong)
415 Stimulation: Promoting (cu)
416 Egg collection: Relaxing (song)
417 Consolidating: Astringing (gu)
417 When ART cycles fail: guidelines for treatment
419 Repeated failed cycles
419 Treatment of ‘poor responders’
420 Treatment for patients who produce many poor quality eggs
420 Treatment for a thin endometrium
421 Treat the Kidney
421 Treat post-natal qi
421 Treat blood stasis
Biomedicine
421 Drugs for ovulation induction
421 Clomiphene citrate
422 Aromatase inhibitors
423 Gonadotropins
423 Intrauterine insemination (IUI) 424 IVF/ICSI treatment
424 Long agonist (down regulation)
424 Short agonist (down regulation, flare protocol)
424 Ultra-long agonist (down regulation for patients with endometriosis/adenomyosis)
424 Antagonist
425 Response prediction
425 Luteal phase support
425 Side-effects of ART treatment 425 Chromosomal screening
425 Patients with advanced reproductive age 425 Poor responders
426 Severe male infertility
426 Case study from the clinic of Dr. Yuning Wu: Repeated IVF failure, PCOS, PMS, OHSS
428 Case study from the clinic of Dr. Yuning Wu: Repeated implantation failure (RIF) and diminished ovarian reserve (DOR)
430 Case study from the clinic of Dr. Yuning Wu: IVF failure, thin endometrium
431 Case study from the clinic of Dr. Yuning Wu: IVF failure, advanced age, diminished ovarian reserve

CHAPTER 28: Ovarian hyper-stimulation syndrome (OHSS)
437 Aetiology and pathogenesis
439 Deficiency of Kidney and Spleen yang with retention of fluid 440 Liver qi stagnation with blood stasis and retention of fluid
442 Kidney and Liver yin deficiency with damp-heat and blood stasis 440 Clinical notes
Biomedicine
445 Pathophysiology
445 Risk factors
445 Clinical features
445 Management
446 Prevention
446 Case study from the clinic of Dr. Yuning Wu: OHSS, ovarian cyst, PCOS and infertility

CHAPTER 29: Pregnancy care
453 Clinical guidelines
454 Aetiology and pathogenesis
454 Kidney and Spleen yang deficiency 456 Deficiency of Kidney and Liver yin
457 Acupuncture for nausea and vomiting of pregnancy 458 Myoma in pregnancy
458 General advice to patients in pregnancy 459 Guidance for using herbs in pregnancy
459 Herbs forbidden in pregnancy
460 Herbs used with caution during pregnancy
460 Herbs which are contraindicated when trying to conceive or in early pregnancy 456 Assessing research
461 How to deal with the contraindicated herbs 461 Clinical conclusions