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E & P iii with MIchelle > Infertility > Flashcards

Infertility Flashcards

1
Q

What is the definition of Infertility

A

–inability to produce offspring in a woman who has been trying for two years (TCM)… (one year)–> Western Medicine

–who has a normal sexual life…

–and a partner who has normal reproductive function.

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2
Q

What is the cause of infertility?

A

*Constitutional weakness
–Weakness of Kidney Essence the basis for Heavenly
Water Tian Gui; a congenital weakness of pre-Heaven
Jing

  • Overwork
  • -Inadequate rest, poor diet depletes Kidney Yin

*Excessive physical work weakens SP/KD Yang

*Excessive sexual activity at an early age
–Before and during puberty up until age 18; weakens
Kidneys and damages the Ren and Chong Mai

  • Invasion of Cold
  • Diet
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3
Q

What is Jing?

A

*Jing is translated as “reproductive essence”
*Jing ripens as a young girl reaches puberty, filling the
Chong Mai with Blood, the Ren Mai with Qi and the
periods begin;
*Jing is important in all menstrual cycles that follow, plus
conception and pregnancy
*Jing gets used up with hundreds of menstrual cycles;
life itself exhausts Jing

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4
Q

What is Jing continued?

A

*Jing, Blood and Yin are consumed during pregnancy by
rapidly forming fetus
–Traditionally, Chinese families would wait five years
between pregnancies to replenish Jing
*Jing declines with age

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5
Q

What is Deficiency in Infertility?

A

DEFICIENCY
Lack of vital, essential substances: Blood and/or Essence
Tonify and nourish

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6
Q

INFERTILITY Deficiency patterns

A

KIDNEY YANG DEFICIENCY
KIDNEY YIN DEFICIENCY
BLOOD DEFICIENCY

Kidney Deficiency
Blood Deficiency

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7
Q

INFERTILITY Excess patterns

A 
COLD in UTERUS
DAMP in LOWER JIAO
BLOOD HEAT
STAGNATION of QI
STASIS of BLOOD

Liver Constraint
Phlegm-Damp
Damp Heat
Blood Stasis

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8
Q

Prolonged menstrual cycle, period is scanty or heavy, backache, dizziness, feeling cold, depression, frequent urination
T: Pale, swollen, wet
P: Deep, weak

A

KIDNEY YANG DEFICIENCY

TX: Tonify and warm Kidney Yang, stoke Fire of Gate of Life, strengthen the Uterus
KD 13, KD 3, BL 23, BL 52, CV 4, GV 4, LU 7, KD 6, CV 8

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9
Q

Long term infertility, periods early, scanty, with light colored blood, 5 palm heat, night sweating, dizziness, tinnitus
T: Red without coating
P: Floating Empty or Rapid Fire

A

KIDNEY YIN DEFICIENCY

TX: Nourish Kidney Yin and Essence
CV 4, CV 7, KD 3, KD 13, SP 6, LU 7, KD 6, BL 52
Moxa on KD 3 only if Empty-heat not strong

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10
Q

Scanty periods, pale blood, delayed cycle, tiredness, depression, dizziness, pale complexion, blurred vision
T: Pale and thin
P: Choppy or Fine

A

BLOOD DEFICIENCY

TX: Nourish Blood and Essence, strengthen Liver and Kidneys
CV 4, ST 36, SP 6, KD 13, BL 20, BL 23, BL 17, moxa
Zi Gong: 3 cun lateral to CV 3

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11
Q

Irregular periods, delayed cycle, mid cycle pain, vaginal discharge, long term infertility, adhesions, obesity, feeling of heaviness
T: Sticky coat
P: Slippery

A

DAMPNESS IN LOWER JIAO

TX: Resolve Dampness, remove obstructions from Ren and Chong Mai
CV 3, ST 28, SP 9, SP 6, CV 9, LU 7, KD 6, ST 30, KD 14, BL 32
If Damp Heat in Lower Jiao: GB 41, TW 5, GB 26. For Fallopian tube obstruction: BL 32 - and CV 4 + with EA, patient on lying on side

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12
Q

Early periods (short cycle) up to twice a month, heavy flow, feeling hot during period, thirst, mental restlessness
T: Red
P: Rapid, overflowing

A

BLOOD HEAT

TX: Cool Blood, regulate periods
LI 11, SP 10, KD 2, LIV 3, SP 6, PC 3, BL 17, CV 4, LU 7, KD 6

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13
Q

Irregular periods, pre-menstrual tension, painful periods, breast distention, irritability
T: normal color or slightly Red on sides; if stagnation arises from Blood def.=pale sides
P: Wiry, or choppy if Blood def.

A

STAGNATION OF QI

TX: Move Qi, eliminate stagnation, pacify Liver, regulate periods
LIV 3, GB 34, TW 6, PC 6, CV 6, CV 4, KD 14, SP 4

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14
Q

Irregular and painful periods, dark blood with clots, irritability, manic behavior, mental restlessness, abdominal pain
T: Purple
P: Wiry or Choppy

A

STASIS OF BLOOD

TX: Invigorate Blood, eliminate stasis, pacify the Liver and the Chong Mai, regulate the periods
LIV 3, GB 34, BL 17, SP 10, SP 6, PC 6, SP 4, TW 6, CV 6, CV 4,
KD 14, ST 29, KD 6

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15
Q

With white vaginal discharge: BL 31
Blood stasis: CV 4
Abdominal pain: ST 30
SP 5, CV 3
GV 4, BL 23, CV 6, CV 3, LIV 11, KD 2, CV 4
Cold Uterus: Baomen L, Zihu R, 2 cun lateral to CV 4, KD 6
SP 6, SP 10, CV 6, GV 4, BL 23, CV 3, CV 4, LIV 11, KD 2, Baomen, Qimen 3 cun below navel, 3 cun lateral, moxa
LIV 8 if blood stasis, ST 36, Bl 67, LI 4, SP 6, CV 2 with 7-77 moxa cones
BL 32, KD 1, SP 5

A

Ancient Acupuncture Rx for Infertility

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16
Q

PROGNOSIS and PREVENTION

Conditions that will not respond to treatment with acupuncture and/or herbs:

A
  • -Adhesions from TB of endometrium
  • -Submucous myoma (if very large)
  • -Congenital malformation or hypoplasia of uterus
  • -Shistosomiasis
  • -TB of the uterus
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17
Q

PROGNOSIS and PREVENTION

A

Blocked fallopian tubes; adhesions and inflammation

Treatment may take at least one year

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18
Q

Easiest pattern to treat

A

Blood deficiency

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19
Q

Most difficult pattern to treat

A

–Dampness, that often corresponds to polycystic
ovarian disease—a complex condition;

–irregularities of the hypothalamic-pituitary-ovarian axis

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20
Q

Western differentiation

A
  • Primary: female partner has never conceived
  • Secondary: when woman has had a pregnancy
  • Incidence:
  • -Hormonal factors of ovulation, 41%
    • Failure to ovulate: 25%
    • Irregular or absent menstruation: 80%
  • -Fallopian tube abnormalities, 32%
  • -Uterine factors, 16%
  • -Cervical factors, 4.7%
  • -No apparent cause, 5%
  • Chinese medicine perspective:
  • -Hormonal disturbances of ovulation
    • Kidney or Blood deficiency
  • -Fallopian tube abnormalities
    • Blood stasis, Blood heat, or Dampness
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21
Q

HORMONAL FACTORS

Ovulatory Failure

A

-Hypothalamus: alteration of function affected by stress
-Pituitary: tumors may cause elevated levels of prolactin
-Ovary: absence of FSH receptors; FSH and follicle
interaction

22
Q

Tubal abnormalities

A

–Salpingitis, from infections after abortion, delivery,
gonorrhea, chlamydia, tuberculosis, IUD’s, pelvic
peritonitis

23
Q

Uterine Hormonal factors

A

uterine myomas if large enough

24
Q

Cervical Hormonal factors

A

: cervical mucus unreceptive to sperm

25
Q

General Hormonal factors

A

Hypothyroidism: lethargy, swelling of ankles, feeling cold, amenorrhea; Kidney Yang deficiency
Hyperthyroidism: Full condition, Blood heat affecting LIV & HT
Endometriosis: peri-tubal or peri-ovarian adhesions

26
Q

MALE STERILITY Caused by

A

Deficient sperm count
Insufficient motility of the sperm
Poor morphology of the sperm

27
Q

MALE STERILITY TCM perspective

A

Kidney deficiency

Damp Heat in genital system

28
Q

Current WHO standards for assessing male infertility:

A

*Volume: more 1 ml
*Count: more than 20 million sperm per ml
*Motility: more than 50% moving vigorously and
purposefully
*Morphology: more than 14% normal forms
(no deformities of the head, mid-piece or tail)

29
Q

Male Infertility patterns

A

*Deficiency of Essential Qi due to Congenital Deficiency
*Essential Qi Deficiency Cold due to Debilitation of Life
Gate Fire
*Phlegm Turbidity and Blood Stasis Obstructing Semen
*Damp-Heat Pouring Downward due to Improper Diet
*Liver Stagnation due to Emotional Disorders
*Qi and Blood Deficiency due to Prolonged Illness of
Taxation

30
Q

Deficiency of Essential Qi due to

A

Congenital Deficiency

31
Q

Kidney stores

A

Essence

32
Q

Kidney governs

A

reproduction

33
Q

Kidney stores Essence and governs reproduction

A

Essence can transform into Qi. When Kidney Qi becomes abundant, tian gui arrives to enter Chong and Ren Mai. Essence can mature only when these vessels become abundant:

		- Menstruation in women
		- Seminal fluid production in men
34
Q

Essential Qi Deficiency Cold due to Debilitation of Life Gate Fire

A

*Excessive sexual activity consumes essence and Qi,
even during adolescence. Over time this leads to
Kidney Qi deficiency and debilitation of life gate fire.
*Without warmth, essential Qi becomes Cold and
deficient
*Results in a decline of both sperm production and
sexual function

35
Q

Phlegm Turbidity and Blood Stasis Obstructing Semen

A

*Excessive consumption of alcohol, greasy food
damages the SP & ST, especially in overweight and
obese
*Phlegm moves downward, inhibiting the production and
transformation of semen, and also obstruct its orifice
*Prolonged illness or physical injury that results in blood
stasis. Blood may block seminal vessel, semen
production decreases, ejaculation inhibited, seminal
fluid accumulates internally

36
Q

Qi and Blood Deficiency due to Prolonged Illness of Taxation

A

*Qi and Blood may become deficient due to insufficient
Spleen Qi, SP & ST damage, constitutional deficiency or
poor recovery from illness
*Essence is derived from Blood

37
Q

Damp-Heat Pouring Downward due to Improper Diet

A

*Excessive consumption of alcohol or greasy and spicy
foods damages SP and ST causing damp-heat and
phlegm that pours downward affecting the quality of
seminal fluid

38
Q

Liver Stagnation due to Emotional Disorders

A

*Damage by the seven affects leads to Liver
Qi stagnation
*Early stages affect the Qi dynamic;
Later stages affect changes in essence and
blood because the viscera have been
affected
*Excessive sadness most often leads to sexual
dysfunction
*Sexual frustration is often followed by a
libidinal decline that can cause impotence

39
Q

Pathogenesis

A

Deficiency, excess, cold, heat, phlegm, stasis or constraint, imbalance of Yin and Yang

40
Q

most affected and is directly related to the functioning of the Liver, Spleen and Heart

A

KIDNEY

41
Q

Essentially: infertility

A

results from Kidney Qi deficiency with a failure of Yin essence transformation

42
Q

Treatment of Male Infertilty

A
  • The key to male infertility lies in the Kidney

* Tonify Kidney, nourish Essence

43
Q

Specific treatments may be applied to regulate

A

Kidney Yin and Yang, nourish Kidney Essence, and course the passage of Kidney Essence

44
Q

Treatment continued:

Deficiency at the Root, Excess at the Branch

A

–Root Tx: Kidney and Spleen
–Branch Tx: Invigorate Blood, transform stasis, clear
heat, disinhibit dampness, transform phlegm

45
Q

Male Immune Infertility

A

Tonify LIV & KD, invigorate blood, free the collaterals

  • -BL 18, BL 23, LV 3
  • -Modification: BL 15, BL 17, BL 22, HT 7
46
Q

Abnormal Semen

A

Tonify KD and essence, regulate Yin and Yang

–CV 4, KD 12, SP 6

47
Q

Low Sperm Count

A

Fortify SP, tonify KD, invigorate blood, dispel dampness

–BL 23, CV 4, BL 20, ST 36

48
Q

Prognosis

A

*Male infertility should not be viewed as a single
condition, but rather as the manifestation of a number of
possible male reproductive system disorders—16
separate disorders, each with distinct differences in
etiology, pathogenesis and treatment.

*Proper identification of the disorder is critical

*Prognosis is good for men with normal testes and the
ability to generate sperm, and no structural disorders

49
Q

Preventive Healthcare

A

*Smokers and drinkers have lower sperm count
–Nicotine shown to decrease sexual hormone secretion
–Alcohol can reduce seminal fluid by 50%
*Sleep at least 8 hours per day
*Proper Nutrition
–Zinc, copper, phosphorus, calcium, vitamins A & E
*Avoid lounging in hot baths, steam baths
–Particularly when planning pregnancy
–More than 30 minutes in hot water, 40ºC can lower
sperm counts

50
Q

Preventive Healthcare

A

*Excessive sexual activity and interrupted intercourse
can both lead to congestion of urethra and prostate
gland.
*Standing for long periods of time causes local
congestion of the genital organs
*Psychological state is important in production of
seminal fluid
–Depression, anxiety show reduced sperm count
–Optimism improves reproductive health
*Particularly seminal fluid production

E & P iii with MIchelle (9 decks)

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