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THIS ISSUE:
Acupuncture and Reproductive Health
Swedish Institute on-line newsletter for our students, faculty and community.
Submitted by Catherine Parker, M.S., L.Ac.
Client History
A 41-year old female came in with the chief complaint of "infertility". Her husband had had a vasectomy precluding normal conception. She herself had no structural irregularities. She was preparing herself for a final IVF attempt that would take place in 8 weeks. Previously, she had used IVF which, after a second try, had resulted in the birth of a baby girl in 1998. An IVF attempt for a second pregnancy earlier in the year had not been successful.
Assessment and Goals
The patient complained of fatigue, difficulty remaining asleep, anxiety, thirst with a desire for cold fluids and constant hunger with heartburn and nausea, all worse with stress. She had been undergoing different hormonal manipulation for several months.
An assessment of the patient revealed a history of high cholesterol levels, hay fever, an asymptomatic heart murmur, a long term lack of sleep (due to lifestyle and stress), frequent dull headaches wrapping the head, dry eyes, dry brittle nails and dry skin. She at times experienced shortness of breath with chest tightness and low back pain that improved with rest. The teeth were soft. Bowel movements and urination were said to be normal, but she later complained of dry, hard and pebbly stools.
She had had two benign fibroidemas removed from her right breast, one in 1983 and one in 1997, as well as removal of calcitic deposits from her left big toe resulting from a break in the bone six years earlier.
The menses had been a regular 30 day cycle with five days of blood flow with clots, starting and ending with brown blood. Over the years it had become less painful, but she still experienced some emotional lability before her menses with some cramping and breast tenderness. Her periods were irregular now with the hormonal intake.
A visual evaluation of the tongue and palpation of wrist pulses were used to assess energetic function. The patient's tongue body was pale and slightly scalloped; paler on the right side and redder on the left. The front and tip were red with red points. The coating was thick, dry and yellow, more so in two stripes on either side of the center.
From this it was concluded that there was a deficiency of energy (Qi) failing to bring blood to the tongue, and heat due to constrained Liver Qi. The paler right side showed a co-existing deficiency of blood. The accumulation of excess heat and pathological dampness seen in the tongue coat had damaged and blocked the stomach fluids, making the coat dry. Dampness here could be seen as the body's attempt to contain heat.
Her pulse was thin, thready and choppy in the middle Jiao position on the left, and tight and slippery on the middle Jiao position on the right. It was slow to moderate (60 to 64 bpm) but irregular in rhythm, speeding up and slowing down with occasional skipped or double beats.
Overall, her symptoms indicated a deficiency of blood, particularly of the Liver. This concept has an extensive meaning in Chinese medicine, and encompasses hormonal components. For a woman her age a declining hormonal function could be seen as normal. However, she was artificially in hormonal excess due the fertility drugs she was taking, which could greatly influence the damp accumulation, in itself a yin excess.
Because of this excess, Dai Mai (the Belt Channel) was selected as the first of the Eight Extraordinary Vessels to be considered.
Course of Treatment
The patient came about once a week for the next 8 weeks. During the initial consultation, an Earth School treatment was selected,, with the addition of the "Four Gates" points. The intention was to harmonize the Wood and Earth elements, calm the Shen and support Spleen and Stomach's ability to generate post-natal Qi and blood. After this session, the patient was able to sleep through the night undisturbed.
The next two treatments were focused on releasing the Dai Mai and resolving damp heat, which could obstruct the successful implantation of the embryos. Clearing the Dai Mai, which horizontally divides the body around the level of the waist and hips, would facilitate communication between the upper and lower body. This would help the patient align her desires (Heart) and her will power (Kidney). After these treatments, the patient reported both an URTI or "cold" and a bout of diarrhea, which she attributed to food poisoning. In Chinese medicine, however, acute illness is sometimes seen as one of the ways the body uses "sickness" to heal itself; in this case it might have allowed for the discharge of dampness.
For the next two treatments, Ren Mai (Conception Vessel) as selected for its ability to generate fluids, clear heat and further reduce dampness. While most of her symptoms had improved, she had heavy mid-cycle bleeding, which led to restlessness and disturbed sleep with vivid dreaming. The focus then shifted to Chong Mai (Penetrating Vessel) as the Sea of Blood, in order to nourish blood and calm the Heart. After two treatments, her tongue was no longer red on the left side; the red points on the tip were gone and the coat was now thin, dry and white. She was still thirsty, but felt her mental clarity was sharper.
The final treatment was a tonification of Ren Mai to generate fluids, to make blood and support Essence, with the addition of acupuncture point Du 20 added to tonify Yang in order to help retain the embryo and maintain the implantation, a Yang function.
Outcome
The implantation performed the following week resulted in a successful pregnancy and the patient's giving birth to a healthy baby boy nine months later.
Reflection
In the opinion of this practitioner, acupuncture seems to benefit fertility attempts by maximizing the body's functions and thus works best if there is no underlying structural deficiency of the reproductive system, by definition a Jing deficiency. In another case involving a much younger woman with blocked fallopian tubes that had then been surgically severed, acupuncture was not successful in helping her get pregnant. The patient's uterine lining was improved, but the implantation was not retained.
An acupuncturist steeped in the practice of Taoism will focus on a woman's health as a whole, not focusing solely on the reproductive system and its role in pregnancy, without any regard for the amount of force being used to achieve it, and let nature determine the whether pregnancy takes place or not.
A group of Swedish researchers conducted a study to compare the effects of electroacupuncture to alfentanil therapy when combined with a paracervical block during in vitro fertilization (IVF). Researchers measured the level of pain related to the surgical procedure, need for anesthesia, and experience of abdominal pain and nausea in 75 patients receiving acupuncture and 74 patients receiving alfentanil. In the effects being measured, there were no significant differences between the two groups.
However, the group receiving acupuncture had a higher implantation rate (27.2 percent versus 16.3 percent), higher pregnancy rate (45.9 percent versus 28.3 percent) and higher take-home baby rate (41 percent versus 19.4 percent). Patients receiving acupuncture also reported less fatigue, were more alert during and after the procedure, and experienced less bleeding.
A larger, follow-up study by the same researchers was undertaken to clarify the higher rates in the electroacupuncture group.
Stener-Victorin E., Waldenstrom U., Nilsson L., et. al.: A prospective randomized study of electroacupuncture versus alfentanil as anesthesia during oocyte aspiration in in vitro fertilization, Human Reproduction 14 (10): 2480-4,1999.
Reported in Contemporary Chinese Medicine and Acupuncture by Claire Monod Cassidy, Churchill Livingstone, 2002, page 323.
An article in The New York Times reported on findings by a team of researchers at the Massachusetts General Hospital, who propose that stem cells in the bone marrow communicate with the ovaries via the bloodstream and constantly replenish the ovaries with new eggs (1). The idea contradicts long-established scientific dogma. The controversial theories were reported in a July, 2005 issue of the journal Cell.(2)
If valid, these recent studies by biomedical researchers would lend support to the concept in Chinese medicine that blood and essence, an aspect of the body considered to contain the genetic inheritance, are crucial to reproductive vitality.
(1) Nicolas Wade, "Study Links Stem Cells in Marrow To Fertility",
(2) Joshua Johnson, Jessamyn Bagley, Malgorzata Skaznik-Wikiel, Ho-Joon Lee, Gregor B. Adams, Yuichi Niikura, Katherine S. Tschudy, Jacqueline Canning Tilly, Maria L. Cortes, Randolf Forkert, Thomas Spitzer, John Iacomini, David T. Scadden, and Jonathan L. Tilly. "Oocyte Generation in Adult Mammalian Ovaries by Putative Germ Cells in Bone Marrow and Peripheral Blood", Cell 2005 122: 303-315.
Clara Chan's Manhattan-based practice focuses on wellness for women, using acupuncture for gynecological issues, as well as weight management and skin care. She has been in practice just over a year and has found it easy to grow her patient base strictly through referrals that come from getting results.
One of her patients came with a diagnosis of fibroids. Says Chan of the treatment approach, “I used Classical Chinese Acupuncture, in particular the Ren Mai pathway, one of the Eight Extraordinary Vessels. After two months of treatment, the patient called to tell me that the fibroid had shrunk in size, from 4 cm to 1.5 cm. The patient was encouraged, because she had felt no hope about getting pregnant, but now at least she had hope. I, too, felt encouraged, to see such a positive response.”
Chan credits the diversity of treatment options she learned in the Acupuncture Program to her ability to meet the challenges each patient presents. “I am able to treat each person as an individual,” she says, “there's no one way. Sometimes I use Classical Chinese Acupuncture and sometimes I use a TCM approach. I find that I reflect constantly, and sometimes when I get home I'm still thinking about what I can do for a patient. And my approach continuously changes, to match the patient's progress.”
Chan began her private practice in Manhattan in early 2004, four months after the birth of her son. “I like to say that I gave birth to two babies,” Clara joked, “one was my son and one was my practice.”
Her unique solution for balancing both was to work one day a week until her son was one-year old; now that he is two, she will begin working two days a week. Each day she works for about four hours, seeing two to four patients during that time. Next year, when she works three days a week, she hopes to add a practice in her home borough of Staten Island.
"In classical Chinese acupuncture…the primordial aspects of reproductive vitality are deeper than visible male or female genitals or functions, and are associated with primordial qi and life itself. In sum, in the body ordered around the cardinal channel system, the sexual domain was yin for males and females alike."
Charlotte Furth, A Flourishing Yin, Gender in China's Medical History, University of California Press, 1999, page 29.
The photo at the top of the newsletter, “Rose with Dew”, was taken by Mark Proctor, L.M.T., Chair of the Western Massage Department in the Massage Therapy Program. More of Mark’s photos can be seen at www.markproctorphotography.com.
The original photo "Rose with Dew"
Your comments, suggestions and questions are welcome. Please e-mail me here at the Swedish Institute.
Barbara Goldschmidt, editor.