Fertility Support with Chinese Herbal Medicine Part II: Pattern Diagnosis in Female Infertility

In Western Medicine, between 10% and 50% of infertility cases are categorized as “unexplained.” In cases that do have an explanation, such as fallopian tube blockage or low ovarian reserve, the treatment options are often lacking.

In Chinese Medicine, there is no such thing as “unexplained” infertility. We look at the body from an entirely different perspective, and that allows us to understand and provide treatment that is unlike any other medicine. 

What is Pattern Diagnosis?

In Traditional Chinese Medicine (TCM), we use what is called pattern diagnosis. A pattern diagnosis is different than a disease diagnosis ⸺ and much more useful. I’ll explain.

A disease diagnosis represents a broad description of a problem, whereas a pattern diagnosis is specific. Take insomnia, for example. Primary insomnia is a specific Western disease diagnosis, yet it doesn’t tell us the reason for the problem and it can describe a wide category of people with very different symptoms, presentations, and health histories. A pattern diagnosis provides us with that information. There are at least 10 common TCM pattern diagnoses that Western Medicine would call primary insomnia. Pattern diagnosis allows us to identify the specific causative factors in illness and disease so that we can treat them with precision. This method is how we determine how to choose the appropriate herbal medicine to support fertility in each individual case.

Below we’ll examine the most common TCM patterns in female infertility. 

Traditional Chinese Medicine (TCM) Terminology

TCM Terminology can be strange at first. Keep in mind we are translating an entirely different worldview and system of medical theory. On top of that, the Chinese language is vastly different from English. One Chinese character can mean many different English words depending on the context.

Translations of Chinese characters are not 1:1 equivalents. For example, 肝 Gan is translated as “Liver”. This is not an equivalent to what the word liver means to you. 肝 Gan describes the Liver organ system. An organ system refers to a group of related functions.

肝 Gan does include many of the functions that are associated with modern biomedical understanding of the liver organ, but it also encompasses much more. 

As another example, 肾 Shen is translated as “Kidney.” This is often a confusing translation. The Kidney organ system encompasses the kidney organ and urinary tract, reproductive organs, bones and bone marrow, adrenal glands, low back and lower extremities, and brain. Because it encompasses such a wide range of functions, this can be a particularly confusing term. All of these seemingly separate functions are indeed inter-related.

When ancient Chinese doctors were developing the system of Chinese medicine, they were working from a purely clinical perspective. They observed that when they treated a patient with herbs for low back pain, as that patient's back pain improved so did their reproductive function and cognitive function. The complex organization of organ systems in Chinese medicine can seem strange when examined from a modern perspective, but it is fundamentally very useful and effective, especially in chronic illness. When examining herb properties with modern biochemical analysis, these effects are clear. For example, Yin Yang Huo or Epimedium is a Kidney Yang tonic herb that is used for increasing libido and erection strength, for increasing bone density, and for arthritic joint pain and low back pain.  

TCM Patterns in Female Infertility

These are the most common TCM patterns in female infertility. 

Blood Stagnation

Blood Stagnation is a very common pattern in modern times, and it is one of the most common obstacles to healthy pregnancy. In the context of fertility, Blood Stagnation means there is obstruction of healthy blood circulation which is impairing normal reproductive function. Blood Stagnation is always a factor in fallopian tube obstruction, uterine fibroids, PCOS, and endometriosis. It can affect implantation and impair the egg moving through the fallopian tubes properly even when there is no obvious obstruction. Blood Stagnation is an excess pattern, meaning it is not a problem of the body being deficient in resources, it is a problem of metabolic waste excess that needs to be cleared and metabolized. 

Signs that indicate Blood Stagnation patterns: 

• pain before or during menstruation

• pain during ovulation

• menstrual blood that is dark in color, purple, or brown

• menstrual blood with clots 

• spotting before or after bleeding

• irregular cycles

• heavy bleeding

• headaches and migraines

• cystic acne

• dark circles under the eyes

• spider veins, varicose veins, purple coloration on lower legs and feet

Tongue pattern:  slightly purple, dark, or dusky color to the tongue body. 

Pulse pattern: choppy, wiry, or scattered.

A scattered pulse is difficult to feel. A choppy pulse hits the fingers with uneven force, classically described as “like a knife scrapping bamboo”. A wiry pulse feels tight, hits the fingers forcefully “like a bowstring”. 

As we age, we are increasingly prone to Blood Stagnation. Blood stagnation patterns are worsened by sedentary lifestyles and excess dietary sugar and carbohydrates. 

Kidney Essence Deficiency

Kidney Essence deficiency is the second most common pattern after Blood Stagnation. Kidney Essence describes your body’s deep reserves of resources, especially those related to reproductive function. In simplest terms, when there is Kidney Essence deficiency, the body is tired and lacking in resources. Overwork, overexertion, insufficient sleep, long term stress, and aging all tax the Kidney Essence. Long term vegetarian and vegan diets can also result in Kidney Essence deficiency in some cases. Low ovarian reserve and early menopause are clear indicators of Kidney Essence deficiency, but healthy ovarian reserve does not exclude Kidney Essence deficiency. Kidney Essence deficiency is involved in many infertility patients who are over 35.

Signs that indicate Kidney Essence Deficiency patterns: 

• fatigue

• low libido or sex drive

• short luteal phase

• pain or weakness in low back and knees

• hair loss, premature graying

• hot flashes

• dark circles under eyes

• difficulty concentrating

Tongue pattern: Tongue pattern can present with a pale tongue body, teeth marks on the tongue margins, with a depression at the root of the tongue. Kidney Essence deficiency does not always show in the tongue in mixed patterns. 

Pulse pattern: deep, weak, slow in the left chi position. 

Recreational drug use, stimulants, and corticosteroid use can contribute to Kidney Essence deficiency. 

Kidney Yang Deficiency

Kidney Yang deficiency and Essence deficiency are both sub-patterns of the broader category of Kidney deficiency, so they share many signs and symptoms. Kidney Yang deficiency patterns will show more pronounced fatigue and aversion to cold, or feeling cold easily. Signs of poor fluid metabolism such edema are also an indicator of Kidney Yang deficiency. 

Signs that indicate Kidney Yang Deficiency patterns: 

• fatigue

• low libido or sex drive

• short luteal phase, luteal phase with early decline, low follicular phase - lowest reading below 96.8 F on basal body temperature (BBT) chart

• pain or weakness in low back and knees

• aversion to cold, feeling cold easily, cold feet, low back or abdomen

• edema, slow metabolism, puffiness

• frequent urination

• dark circles under eyes

• diarrhea before or during menstruation

Tongue pattern: Tongue pattern can present with a pale tongue body, teeth marks on the tongue margins. Tongue coating can be thin, or wet. Kidney Yang deficiency does not always show in the tongue in mixed patterns. 

Pulse pattern: deep, weak, slow in the left chi position. 

Phlegm & Dampness 

Phlegm & Dampness patterns can present alongside Blood Stagnation patterns or Kidney Yang deficiency patterns. Phlegm & Dampness are both patterns of pathological body fluids. These are excess patterns where the body is not properly metabolizing and moving body fluids. Dampness refers to thinner fluids, seen more commonly in edema and water retention. Phlegm refers to thicker pathological fluid, including the mucous you might cough up or blow out your nose. Phlegm also encompasses thick fluids that have transformed into masses, like breast lumps or ovarian cysts. Like Blood Stagnation, Phlegm and Dampness interfere with normal functions. This can include obstructing the egg moving through the fallopian tubes and interfering with implantation. PCOS often presents with a mixed Phlegm and Blood Stagnation pattern. 

Signs that indicate Phlegm & Dampness patterns: 

• ovarian cysts

• delayed ovulation

• thick or ropey menstrual blood

• irregular cycles

• water retention, edema

• tendency to diarrhea, loose stools, or constipation with sticky stools

• acne

• itching skin

Tongue pattern:  puffy tongue, thick tongue coating (white or yellow)

Pulse pattern: slippery, wiry, or soggy especially in left and right guan positions.

A wiry pulse feels tight, hits the fingers forcefully “like a bowstring”. A soggy pulse feels like “a cotton ball floating on water”

Phlegm & Dampness patterns can result from Kidney Yang deficiency, but they are often the result of excessive sugar and carbohydrates in the diet. This is the reason why the drug metformin is used in PCOS patients, because the causative factor driving the pathology is blood glucose being too high for the individual. (This can still be true with a “normal” A1c level)

Dairy products and sugar should be avoided when addressing Phlegm and Dampness patterns, as well as cold and iced food and drinks. 

Liver and Heart Qi Stagnation

Heart and Liver Qi Stagnation are sub-patterns of the broader category of Qi Stagnation. The Heart and Liver are the organ systems which are most often affected. In the context of fertility, Heart and Liver Qi Stagnation patterns present when mental and emotional stresses are interfering with conception. Mental and emotional stresses have obvious physiological effects, and this is a common pattern that can predate the process of trying to conceive. Often this pattern is induced or worsened by the mental patterns around trying to conceive. Qi Stagnation is an excess pattern which is less advanced than Blood or Phlegm Stagnation, and it is more easily resolved. When Qi Stagnation is present for prolonged periods, it will lead to deeper pathologies like Blood and Phlegm Stagnation. 

Signs that indicate Heart and Liver Qi Stagnation patterns: 

• anxiety, worry, depression, irritability, frustration, crying easily

• PMS symptoms including breast tenderness, mood swings

• insomnia

• uneven BBT chart with unexplained valleys and troughs

• irregular cycles

Tongue pattern: Qi stagnation does not always show in the tongue pattern. Long term Liver and Heart Qi Stagnation can present with a red tip, red dots on the tongue body, crack in the center of the tongue, crack in the tip or sides of the tongue, or irregular shape to the tip of the tongue. 

Pulse pattern: wiry, choppy especially in left guan and left cun pulse.

A wiry pulse feels tight, hits the fingers forcefully “like a bowstring”. 

Chinese Herbal Medicine is a profound tool for helping resolve Heart & Liver Qi Stagnation. It is also important to reduce stress, use tools like meditation, time in nature, yoga, taichi, and qigong. Doing your best to take the pressure off trying to conceive can do wonders for relieving Qi Stagnation. This can include taking a break from all the tracking - BBT, ovulation, hormone testing, and sex calendar. 

Acupuncture can be effective for treating Heart and Liver Qi Stagnation patterns. Women who have success with using only acupuncture in fertility generally have this pattern. Acupuncture is a good tool for treating Heart and Liver Qi Stagnation, but generally not strong enough to address the other common patterns.

Blood Deficiency

In Chinese Medicine, 精 Kidney Essence and 血 Blood are closely related. Blood with a capital “B” refers to exactly what it sounds like, but like most TCM terms it is also broader than that. Like Kidney Essence, Blood refers to the body’s resources in terms of nutritive substance. Blood Deficiency is always present in anemia diagnoses, but it is a very common pattern that extends beyond clinical anemia. Nutritionally deficient diet, excessive blood loss, and digestive malabsorption are the most common routes to Blood Deficiency patterns. Excessive exercise can also induce Blood Deficiency. Long term vegetarian or vegan diets often result in Blood Deficiency patterns. 

Signs that indicate Blood Deficiency patterns: 

• fatigue

• insomnia

• dizziness 

• light menstrual periods, light bleeding or short duration

• feeling worse after menstruation

• low blood pressure

• pale complexion

• weak or brittle nails

• dry skin

• hair loss

• blurry vision, floaters

• constipation with dry stool

• dark circles under eyes

Tongue pattern:  pale tongue body. 

Pulse pattern: deep, weak, choppy especially in the left guan. 

In addition to Chinese herbal medicine treatment, consumption of red meat is often advised to resolve Blood Deficiency patterns. Liver organ meat can be especially helpful as well, whether taken in supplement form or as a regular part of the diet. In cases of heavy menstrual bleeding, treatment is focused on regulating the period to stop excessive blood loss.

Blood Deficiency patterns can arise as a result of Celiac disease, where the body is experiencing an autoimmune response to the gluten protein. Effective treatment in these cases relies on strict avoidance of dietary gluten proteins (in wheat, rye, barley, etc)

Spleen Qi Deficiency

Translation of the character 脾 Pi as Spleen is another challenging translation. This is sometimes thought of as an anatomical mistake, but it is not as simple as that. The 脾 Spleen organ system describes a complex of functions that primarily relate to digestive function, including functions that relate to the modern understanding of the stomach, pancreas, small intestine, and spleen functions. In the context of fertility, Spleen Qi deficiency indicates that the digestive function and assimilation is impaired. When the digestion is not working well enough, the body cannot extract the nutrients it needs to nourish Blood and Kidney Essence which are essential for conception. 

Signs that indicate Spleen Qi Deficiency patterns: 

• fatigue, feeling of heaviness or muscle weakness

• poor appetite

• chronic diarrhea, loose stool, 

• bloating, gas, distention, fullness

• constipation, acid reflux

• bruising easily

• pale complexion

Tongue pattern:  puffy tongue body, tooth marked margins, often pale

Pulse pattern: soggy, deep, weak pulse especially in right guan position.

In addition to Chinese herbal medicine treatment, dietary therapy is often advised to address Spleen Qi deficiency patterns. Avoiding cold and iced foods and drinks is advised. Warm, cooked foods with a balance of protein, green vegetables, and grains. Cook using carminative spices like fresh ginger root, cumin, coriander, and fennel seed. Reduce or avoid dairy consumption. Recommended fermented foods include fermented vegetables (sauerkraut, kimchi, pickles) and water kefir. 

Mixed Patterns

It’s more common than not to have a mixed pattern. In these cases, herbal medicine treatment focuses on all patterns involved, with the treatment weighted towards the patterns in order of importance for each individual. For example, a common clinical presentation is primary Blood Stagnation with minor Phlegm Stagnation and minor Kidney Yang deficiency. In some cases treatment of all existing patterns is done simultaneously, in other cases it is done in sequential stages.

Ready to get started with herbal medicine for infertility treatment?

Visit my herbal clinic page to schedule your first consultation, find more information on the treatment process, cost, herb quality, and more. 

Sincerely, Sean Dugan L.Ac.

Sean Dugan L.Ac. is a licensed and board-certified herbalist and acupuncturist. He holds a Master’s degree in Chinese Medicine from the Oregon College of Oriental Medicine as well as a Diplomate in Chinese Medicine from the NCCAOM. He has studied under many Master Herbalists including Dr. Guohui Liu, Dr. Jimmy Wei-Yin Chang, Dr. Fang Zhang, Dr. Greg Livingston, and Dr. Darren Huckle. Sean’s herbal medicine practice draws from both Traditional Chinese Medicine and Classical Chinese Medicine treatment methods, with a focus on clinical efficacy above all. He has been treating patients with Chinese Herbal Medicine since 2013. 

Sean works with clients all over the US through the Folkwise Herbal Clinic. In-person appointments are available at our Boise, Idaho clinic.