Traditional Chinese medicine gynecologists have known for thousands of years that regulating the menstrual cycle promotes fertility. Modern practitioners have begun to incorporate the knowledge we have of the biological stages of the menstrual cycle to focus on specific fertility issues and increase effectiveness. We now look at four treatment phases to target the parts of the cycle that need adjustment and support for optimal fertility. Although each woman’s primary Chinese medical diagnosis may be different, this type of approach allows for minute changes to be made in the herbal treatment while keeping in mind all of the hormonal shifts occurring in each phase and the various organs involved.
Prescribing teapills, tablets, extract powders or other prepared Chinese medicines is a great way to meet the needs of many patients for ease of use and increase patient compliance. These dosage forms are offered in a range of pre-decocted formulas that can be modular and in the case of extract powders, easily modified to ideally treat specific conditions.
This is intended as a quick reference guide to the treatment of female fertility with Chinese herbal medicine, focused on what is occurring in the four stages of a healthy menstrual cycle. While some possible adjustments to return to the optimal fertile phases are included, it does not take into account more complicated TCM diagnoses, particularly for patients with more significant Blood stagnation and stasis, damp, phlegm, fire, Jing Xu or specic infertility diagnoses. However, most patients can benefit from gentle support of the guiding principles for each phase, even if only as a secondary or follow-up treatment.
Menstruation Phase: cycle day 1 to cycle day 4
Move Qi & Blood
During this phase Yin and Blood gradually decrease with the menstrual flow and the Chong and Ren Mai are relatively empty. Qi and Blood must move smoothly to ensure that the blood flows out without obstruction, both to expel any existing Blood stagnation and to promote the complete shedding of the endometrial lining. New follicles are already growing and need to be nourished.
Timing: From cycle day 1 when they first see blood, to cycle day 4.
Treatment Principle: Gently move and tonify Blood, regulate the menses, encourage the complete shedding of the endometrial lining.
Guiding Formula: Tao Hong Si Wu Tang
Adjustments & Combinations:
- If there is actual Blood stagnation (intense cramping and other Blood stagnation symptoms, BBT could also stay too high), switch to Tong Jin Wan/Calm In the Sea of Life.
- If Blood and Yin are very deficient (Yin Xu symptoms, and possibly BBT staying too high during menses), add ½ to full dose of Zuo Gui Wan/Left-Side Replenishing.
- If Yang is very deficient (Yang Xu symptoms, and BBT very low – consistently under 96.6), add a large dose of Yang Rong Wan/Cultivate Splendor in the morning, and possibly another at mid-day.
- If Shen is disturbed, particularly if sleep is disturbed, add a large dose of Tian Wang Bu Xin Dan Emperor’s (if more Kidney and Heart Yin and Blood Xu) or Gui Pi Wan (if more Heart Blood and Spleen Qi Xu) before bed.
Follicular Phase: cycle day 5 to 1-2 days before ovulation
Nourish Blood & Yin
During this phase the Yin and Blood need to be rebuilt and strengthened to fill the Chong and Ren Mai in preparation for conception by promoting the rise of estrogen, the growth of healthy egg follicles and building a thick uterine lining. The Heart Shen must be calm to communicate effectively with the Uterus via the Bao Mai to orchestrate all of these changes in a timely fashion.
Timing: From cycle day 5 to a day or two before ovulation, which should be around day 8-14 (depending on when they normally ovulate), or when fertile mucus appears, or an ovulation predictor test shows high fertility, they should switch to the ovulation phase herbs.
Treatment Principle: Nourish Blood and Yin, tonify the Kidney, prepare the Uterus, encourage growth of healthy eggs.
Guiding Formula: Zuo Gui Wan/Left-Side Replenishing
Adjustments & Combinations:
- If Blood or Jing-essence is deficient (Blood and Jing Xu symptoms, and possibly BBT without a noticeable difference between follicular and luteal temperatures), add ½ to full dose of Wu Ji Bai Feng Wan/White Phoenix.
- If Shen is disturbed, particularly if sleep disturbed, add a large dose of Tian Wang Bu Xin Dan/Emperor’s (if more Kidney and Heart Yin and Blood Xu) or Gui Pi Wan (if more Heart Blood and Spleen Qi Xu) before bed.
- If there is Liver Qi stagnation (Qi stagnation symptoms, and possibly BBT erratic up and down) switch from Zuo Gui Wan to Liu Wei Di Huang Wan/Six Flavor and add ½ to full dose of Xiao Yao Wan/Free & Easy Wanderer.
- If there is Liver and Heart heat (Qi stagnation and heat symptoms, and possibly BBT erratic up and down) switch from Zuo Gui Wan to Liu Wei Di Huang Wan/Six Flavor and add ½ to full dose of Jia Wei Xiao Yao Wan/Free & Easy Wanderer Plus.
Ovulation Phase: 1-2 days before ovulation (around cycle day 8-14)
Move Qi & Blood, Strengthen Yang
During this phase the Yin must be at its zenith in order to promote the Yin/Yang transformation of ovulation when the Kidney Yin dominance of the follicular phase shifts into the Kidney Yang dominance of the Luteal phase. Qi and Blood need to move smoothly for this shift to occur easily and quickly. Finally, the Shen must also be calm so that the Heart Qi can initiate this change via the Bao Mai, resulting in the timely release of the dominant egg.
Timing: A day or two before ovulation, around cycle day 8-14 (depending on when they normally ovulate), or when fertile mucus appears, or ovulation predictor test shows high fertility through ovulation as confirmed by a 4/10th rise in BBT, ovulation predictor test, or other method.
Treatment Principle: Warm the Uterus, nourish Kidney Jing-essence, gently move Qi and Blood, promote ovulation
Guiding Formula: Fu Ke Zhong Zi Wan/Fertile Fields
Adjustments & Combinations:
- If there is significant Liver Qi stagnation (Qi stagnation symptoms, and possibly delayed ovulation or a slow rise in temperature after ovulation) add ½ to full dose of Xiao Yao Wan/Free & Easy Wanderer.
- If Yang is very deficient (Yang Xu symptoms, and BBT very low – consistently under 96.6), add ½ to full dose of You Gui Wan/Right-Side Replenishing.
Luteal Phase: From ovulation through the confirmation of pregnancy, or menstruation
Boost Qi & Yang
During this phase Yang is dominant. Sufficient Kidney Qi and Yang keeps progesterone levels high. This will dry the lining of the fallopian tubes to facilitate the movement of the fertilized egg and warm the Uterus to encourage endometrial receptivity for implantation. Phlegm and damp need to be monitored to prevent their gumming up the fallopian tubes. The Qi movement also needs to be smooth and the Shen calm in order to promote the easy movement of a fertilized egg through the fallopian tube and allow timely implantation. As the Qi and Yang build, stagnation may occur easily, and may cause smoldering heat, both of which may disturb this delicate process.
Timing: From ovulation (as confirmed by a 4/10th rise in BBT, ovulation predictor test, or other method) through the confirmation of pregnancy, or menstruation.
Treatment Principle: Strengthen Kidney Yang, warm the Uterus, encourage the smooth movement of Liver Qi
Guiding Formula: You Gui Wan/Right Side Replenishing & ½ dose of Xiao Yao Wan/Free & Easy Wanderer
Adjustments & Combinations:
- If there is dual Spleen and Kidney Yang (Spleen Yang Xu symptoms, and BBT very low – consistently under 96.6), switch from You Gui Wan to Yang Rong Wan/Cultivate Splendor.
- If there is excess phlegm or damp, add a ½ dose of Er Chen Wan.
- If there is significant Liver Qi stagnation (Qi stagnation PMS-like symptoms, and possibly delayed ovulation or a slow rise in temperature after ovulation) increase to full dose of Xiao Yao Wan Free & Easy Wanderer.
- If there is Liver Qi stagnation with smoldering heat (Qi stagnation symptoms with irritability, frustration, etc. and possibly delayed ovulation or a slow rise in temperature after ovulation), switch from Xiao Yao Wan to Jia Wei Xiao Yao Wan Free & Easy Wanderer Plus.