Treating Infertility with Acupuncture and Moxibustion: A Clinical Review Juan ZHAO Reginaldo de Carvalho Silva Filho Eduardo Vicente Jofre Fabio Fonseca (ChengDu University of Chinese Medicine; Brazilian School of Chinese Medicine; Brazilian School of Chinese Medicine; Acupuncture Clinical Supervisor of Brazilian School of Chinese Medicine) Abstract: Infertility is becoming a serious problem in recent years, which worries not only the young couple but their whole family. There are so many causes to infertility, so are solutions, however, neither drug therapy nor artificial insemination treatment could guarantee a relatively high effective rate, furthermore, western meditations have lots of unavoidable side effects. Chinese Medicine has a great advantage of more therapeutic effect and less negative consequence, yet it takes courage to persist in having herbs decoction for a really long course, for this reason, acupuncture and moxibustion might be the best substitute therapy for infertility. The objective of this article is to introduce various methods about of acupuncture and moxibustion for the treatment of infertility based on a review of Chinese databases. Key words: infertility; acupuncture and moxibustion therapy; research development
Infertility is treated as a consequence of a series of diseases, and it’s not independent. There are many biological and other causes of infertility, including some that medical intervention can treat. Infertility rates have been increasing on yearly bases, mostly from problems with fecundity due to an increase in age. About 40% of the issues involved with infertility are due to the man, another 40% due to the woman, and 20% result from complications with both partners. The World Health Organization defines infertility as follows: a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (and there is no other reason, such as breastfeeding or postpartum amenorrhea). There are two types of infertility in general. Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause. Infertility have different diagnosis according to different pathogenesis in western medicine, which could be considered as a reference when performing Chinese Medicine treatment based on syndrome differentiation. The goal of this paper is to present a clinical review of the Chinese literature related to acupuncture and moxibustion treatment of infertility in order to demonstrate different possibilities and points of view on this increasing problem on our society. 1. Acupuncture therapy only In Chengdu, Doctor Wu[1] treated anovulatory infertility with “tranquilizing the mind and regulating the menstruation” therapy, which mainly aims at anxious or depressed patients. In this method, the basic acupuncture points are: DU24 (Shen Ting), Si Guan (bilateral of LI4 and LR3), SP6 (San Yin Jiao). For kidney deficiency, add BL23 (Shen Shu), BL20 (Pi Shu), DU4 (Ming Men), RN4 (Guan Yuan), KI3 (Tai Xi), chose one or two of them, next time, chose another ones, using “Shao Shan Huo” manipulation. For Qi stagnation or blood stasis, manipulate the needles in LV9(Tai Chong), SP6 (San Yin Jiao), it is better to lead the needling sensation to the lower abdomen or perineum. For obesity due to phlegm turbidity retention, add BL23 (Shen Shu), BL20 (Pi Shu), DU4 (Ming Men), RN4 (Guan Yuan), ST25 (Tian Shu), SP15 (Da Heng), RN9 (Shui
Fen), RN12 (Zhong Wan), ST36 (Zu San Li), SP9 (Yin Ling Quan), ST40 (Feng Long), etc. In Shandong, Doctor Yang[2] treated ovulatory dysfunction infertility with heated needling therapy. The basic acupuncture points are: RN4 (Guan Yuan), SP6 (San Yin Jiao), EX-CA1 (Zi Gong), BL32 (Ci Liao), add BL23 (Shen Shu) for kidney deficiency and deficient cold in womb; add RN6 (Qi Hai), SP10 (Xue Hai) for blood deficiency at the Chong and Ren Meridians; add ST40 (Feng Long), SP9 (Yin Ling Quan) for stagnation of phlegm-dampness. Therapy started at the fifth day of the menstruation, treat once every other day, five times in a raw, three periods make a course. The results showed there was a higher efficiency in cold syndrome and phlegm-damp stagnation. In Shandong, Doctor Sun[3] treated immunological infertility with the method of “tonifying the liver and kidney” “clearing heat and draining dampness” “activating blood and dredging collaterals” according to the syndrome differentiation. The basic acupuncture points are: BL18 (Gan Shu), BL23 (Shen Shu), KI3 (Tai Xi), LI4 (He Gu), SP10 (Xue Hai), LV9 (Tai Chong), GB34 (Yang Ling Quan), SP6 (San Yin Jiao), ST36 (Zu San Li). Electric acupuncture, moderate intensity continuous wave, 30min a day, 30 days a course, 3 courses. 2. Moxibustion therapy only In Shandong, Doctor Pang[4] treat infertility due to tubal obstruction with moxibustion on the umbilicus. Firstly, make the flour into a strip-shaped bar, circle it around the umbilicus in order to fill enough salt or herbs powder in it. Then, fill in some salt, namely salt interposed moxibustion, for 7 moxa cones. After that, replace the salt with she xiang (powder, 0.1g) at the lowest layer, and then other herbs powder in the middle (Tong Guan San 通管散: fu zi10g, chuan jiao 10g, wang bu liu xing 10g, liu tong 10g, xiao hui xiang 10g, wu yao 10g, yuan hu 10g, hong hua 10g, chuan xiong 10g, wu ling zhi 10g), and few slices of ginger on the top, for 14 moxa cones. It had a better effect on blood stasis due to cold stagnation and deficient syndromes due to cold attacking. For yang deficiency of the kidney syndrome, there was another formula named Zhen Ji San[5] (ba ji tian 10g, chuan jiao 10g, fu zi 10g, rou gui 10g, yin yang huo 10g, zi shi ying 10g, chuan xiong 6g, xiang fu 10g, xiao hui xiang 6g). 3. Combined Acupuncture and Moxibustion therapy In Beijing, Doctor Qian[6] reported a case of hydrosalpinx infertility treating by both acupuncture and moxibustion. The patient was diagnosed as cold syndrome in the lower Jiao due to deficiency and dampness obstructing the womb. Group 1: needles for SP9 (Yin Ling Quan), KI7 (Fu Liu) and heavy moxibustion for RN4 (Guan Yuan). Group 2: needles for Back-Shu of five zang-organ, BL17 (Ge Shu) and heavy moxibustion for BL23 (Shen Shu). Two groups for alternate use. Five times a week, it cost 30 min each time. Three months later, the pain in the lower abdomen alleviated, the amount of leucorrhea decreased. Treated for another three months, the patient got pregnant. In Zhejiang, Doctor Song[7] reported a clinic trial on treating ovulatory dysfunction infertility. The experimental group was given acupuncture therapy in RN3 (Zhong Ji), RN4 (Guan Yuan), EX-CA1 (Zi Gong), ST36 (Zu San Li), SP6 (San Yin Jiao); and over skin moxibustion in RN8 (Shen Que), SP6 (San Yin Jiao). Therapy started at the fifth day of the menstruation, it cost 30 min each time, ten times in a raw, three periods made a course. In this case, the control group was given clomiphene as conventional therapy, which proved had lower pregnancy rate and higher
miscarriage rate than the experimental group. In Shandong, Doctor Zhang[8] treated infertility due to PCOS with needles and moxibustion at RN8 (Shen Que). This therapy consisted of four stages. Stage 1: right after menses and before ovulation. Acupoints: RN4 (Guan Yuan), RN6 (Qi Hai), EX-CA1 (Zi Gong), ST36 (Zu San Li), BL23 (Shen Shu), BL43 (Gao Huang), SP4 (Gong Sun), LU7 (Lie Que). Formulas for moxibustion: yin yang huo 15g, bu gu zhi 12g, rou cong rong 15 g, sheng di huang 10 g, shu di huang 10g, shan zhu yu 6g, shan yao 15g, dang gui 20g, gui ban 12g, bie jia 12 g, chi shao 15 g, dan shen 20g, nv zhen zi 20g, han lian cao 20g. Stage 2: around ovulatory period. Acupoints: LI4 (He Gu), GB9(Tai Chong), SP10 (Xue Hai), SP6 (San Yin Jiao), BL17 (Ge Shu). Fornulas for moxibustion: yin yang huo 15g, bu gu zhi 12g, rou cong rong 15g, wu yao 6g, chuan lian zi 3g, chai hu 3g, chuan xiong 15g, tao ren 6g, dang gui 20g, gui zhi 12g, shao yao 15g. Stage 3: after ovulation and before menses. Acupoints: RN4 (Guan Yuan), RN6 (Qi Hai), LR2 (Xing Jian), SP6 (San Yin Jiao). Fornulas for moxibustion: bu gu zhi 15 g, rou gui 10 g, fu zi 6 g, lu jiao jiao 12 g, tu si zi 12 g, du zhong 15 g, xiang fu 15 g, chai hu 3 g, dang gui 6 g, su mu 12 g. Stage 4: in the middle of menses. Use moxibustion for blood stasis due to cold stagnation, otherwise, stop the treatment temporarily. 4. Acupuncture combined with other external treatment In Tianjin, Doctor Chen[9] treated tubal infertility with embedding needle therapy, which in Chinese Medicine was differentiated as syndrome of blood stasis. Basic acupuncture points: SP6 (San Yin Jiao), ST36 (Zu San Li), BL17 (Ge Shu), RN4 (Guan Yuan), SP10 (Xue Hai), BL23 (Shen Shu), EX-CA1 (Zi Gong), GB9(Tai Chong). For cold coagulation, add RN12 (Zhong Wan), RN6 (Qi Hai);for kidney deficiency, add KI3 (Tai Xi); for damp-phlegm, add ST40 (Feng Long), BL20 (Pi Shu); for damp-heat, add SP9 (Yin Ling Quan), LI11 (Qu Chi). Twice a month, each therapy lasted for 10 days. Standardized manipulation was conducted in this kind of therapy. Besides, there were two groups for moxibustion. Group 1: SP6 (San Yin Jiao), RN4 (Guan Yuan), EX-CA1 (Zi Gong), SP10 (Xue Hai). Group 2: BL17 (Ge Shu), ST36 (Zu San Li), BL23 (Shen Shu), GB9(Tai Chong). Choose one set of acupuncture points for 30 minutes’ moxibustion, and choose another next day. Five times in a raw, then suspend for three days, one month made a course. In Guangzhou, Doctor Huang[10] also treated anti-sperm immune infertility with embedding needle therapy, which achieved good results, too. Conclusion: Treating women infertility with Acupuncture and Moxibustion has not only turned out to be effective in the clinic practicing all these years, but also have lots of records in ancient Chinese Medicine literature. Treatment based on syndrome differentiation is the essence of Chinese Medicine, and people are enjoying the benefits while taking proper use of this principle. In The Yellow Emperor’s Inner Classic (Huang Di Nei Jing 黄帝内经), there is a saying in The Spiritual Pivot (Ling Shu 灵枢): “If needling therapy were not proper for a disease, which must be cured by moxibustion (针之不为,灸之所宜《官针》) ”. The directions for acupuncture and moxibustion we have found by now, are only few drops in the ocean of Chinese Medicine, and we are looking forward to explore more secret from the treasury house of Chinese Medicine.
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