Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Infertility affects approximately 10% of the Philippine population (Philippine Society of Reproductive Endocrinology & Infertility, Inc., 2012) and 15% of reproductive-age couples in the United States (Beckmann et al., 2014).

Traditional Chinese Medicine (TCM) in treating infertility has already recorded in some classics. Fu Qing Zhu Nu Ke pointed out that Yu Lin Zhu decoction treats infertility with Spleen-Stomach cold deficiency pattern in warming Stomach-Spleen and tonifying Heart-Kidney. Of course, the pharmaceutical fertility medicine can increase the levels of certain hormones and release more eggs each cycle, but these extra hormones also can cause damage to the body such as: ovarian hyperstimulation syndrome, high-risk multiple pregnancy, preterm labor and premature infant (Hoffman et al, 2012). TCM is rooted in the holistic concept, not only focusing on the reproductive system, but also balancing the whole body condition, emphasizing on lifestyle modification and proper nutrition of diet at the same time.

This is retrospective research in studying the clinical characteristics and etiology of the 173 infertility cases; the effectiveness, and the application mechanism of Chinese herbal medicine, acupuncture and moxibustion, under the warm-tonifying treatment principle in the Philippines of tropical zone; and emphasizing the treatment principle of different causes with applying the same treatment principle. At the same time, the study points out the importance of balanced diet, harmonized emotional status, and healthy lifestyle to prevent infertility. The study provides a reference value for the future research, prevention, and more effective treatment of infertility; and better promotion of the development of Chinese Medicine in the Philippines.

Methods

One hundred seventy three successful cases under the warm-tonifying treatment principle with acupuncture and Chinese herbal medicine were chosen, from 370 success cases among the 572 followed up cases of 1653 clinically diagnosed infertility cases from January 2006 to July 2014, at St. Francis Natural Health Care, Metro Manila, Philippines, to retrospectively analyse the 173 cases with regard to the causes, the age, the history of infertility condition, and the course of the treatment. 
Among the 173 cases, 98 cases applied acupuncture, moxa and herbal medicine; for the 75 patients who didn't want to take herbal medicine, only acupuncture and moxa were applied.

Herbal formula: Yu Lin Zhu

• Renshen 2-4g
• Baizhu 2g
• Fuling 2g
• Lujiaozhuang 2-4g
• Shudi 2-4g
• Danggui 2g
• Chuanxiong 2g
• Tusizi 2-4g
• Duzhong 2-4g
• Baishao 2g
• Chuanjiao 2g
• Zhigancao 2g

Instruction: one pack per day, divide in two times, take it with warm water. No herbal medicine during the menstrual period.

Modification:

1. Increase the dosage of Yin tonifying herbs during the follicular phase; romove  Danggui, chuanxiong during the Luteal phase, but increase the dosage of Yang tonifying herbs.
2. Add XiaoYao San 4-6g with Liver-Qi stagnation condition.
3. Add Shao Fu Zhu Yu Tang 4-6g dring the Ovulatory period with Blood Stagantion condition.
4. Add You Gui Wan 4-8g with Kidney deficiency and Ming Men fire weak condition.

Acupuncture points

Basic Points: Applied any time of the cycle:
shenting (Ren 24), Baihui ( Du 20), Quchai (Bl 4—bilateral), Taichong (Liv 3—bilateral), Zusanli(St. 36—bilateral with moxa)

Modification Points: Follicular Phase add: Diji (Sp 8),  Zhongwan, ( Ren 12), Tianshu (St. 25—bilateral), Guanyuan (Ren 4),  Zigongxue (Extra 2—bilateral),  Sanyinjiao (Sp6—bilateral), Huanchao and Fuke ( Master Tong points, alternate right & left). Luteal Phase add: Neiguan ( Pc 6—left), Shenmen(Ht7—right),  Zhubin ( Kid 9—bilateral), Gongsun (Sp 4—right), Taixi(Kid3—left). All the points above with even movements in needle technique, 30 minutes per session.

Results

According to Traditional Chinese medicine syndrome differentiation, all of the 173 cases are Spleen and Kidney Yang deficiency. However, according to western medicine, 80 cases were polycystic ovarian syndrome (PCOS), 36 cases were caused by immune condition, 16 endometriosis cases, 27 unexplained cases, and 14 caused by other conditions, which includes uterus fibroids, premature ovarian failure (POF), and fallopian tube problem. Most of these cases were caused by a combination of conditions. All were under the same treatment principle: mainly tonify Spleen and Kidney, warm Yang-Qi; and with soothing Liver Qi or invigorating Blood and eliminating stasis; applied acupuncture, moxibustion and Chinese herbal medicine combine with average 6.5 courses (one month as a course). All conceived successfully.

Discussion

After collating and analyzing the 173 successful cases, under the warm-tonifying treatment principle, the researcher concludes that even in tropical countries, like the Philippines, according to the etiology, the treatment proves to be effective with Spleen and Kidney Yang deficiency pattern of infertility.

Although the 173 cases have different conditions in Western medicine, the same warm-tonifying treatment can be used, applying the concept of combination of syndrome differentiation of Traditional Chinese Medicine and disease differentiation of Western medicine, using Chinese herbal medicine, acupuncture and moxibustion. All of the 173 cases underwent the main treatment principle of warm-tonifying Spleen and Kidney, with the supporting principle of soothing the Liver Qi and invigorating Blood. Through regulating the deficiency or excess of the Zang-Fu function, the balance of Heart-Kidney-Tian Gui-Chong Ren-Uterus axis is reached. It gives full expression to the superiority of Chinese medicine in treating the same disease of different causes, applying the same treatment principle.

References:

1. Philippine Society of Reproductive Endocrinology & Infertility,Inc.(2012), Clinical practice guidelines in the management of infertility. Quezon City, Philippines.
2. Beckmann C.R.B., Casanova R. , Ling F., Chuang A., Herbert W.N.P. …, & Weiss P.M. Weiss (2014). Obsterics and gynecology (7th ed). Lippincott Williams Wilkins, a Wolters Kluwer business, China.
3. Hoffman B. L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D. & Cunningham F.G.C. (2012). Williams  gynecology (2nd ed). China Translation & Printing, Ltd., China.

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Shengrong Liu obtained her Master's degree in Traditional Chinese Medicine at the Academy of Chinese Culture and Health Sciences in Oakland, Calif. in 2004. She is a California Licensed Acupuncturist and a Diplomate of Chinese Medicine (NCCAOM). She has been practicing Chinese Medicine in Manila, Philippines since 2005. She is a certified Acupuncturist by the Philippine Institute of Traditional & Alternative Health Care – an institution under the Department of Health. She completed her Doctoral degree in Acupuncture and Oriental Medicine (DAOM) at Five Branches University in San Jose, Calif. in 2015. She is currently organizing a Traditional Chinese Medicine school, the SMIC Institute of Traditional Chinese Medicine Inc. in Metro Manila, Philippines.

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