June 8, 2011

A Case of Infertility

In keeping with the theme of using classical formulas to treat conditions they are not typically indicated for, I offer a translation of an interesting case of infertility treated with Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi). The importance of treating the presentation and not getting too attached to the disease at hand rings true once again.

Liu Du-Zhou’s Clinical Experience in the use of Classical formulas
Journal of the Beijing University of Chinese Medicine, (Volume 17-5: 1994)
Written by Liu Bao-Hua

On December 20, 1989, a 30 year old female presented at the clinic complaining of an inability to conceive for over four years. She was diagnosed in the gynecology department with primary infertility, and has taken numerous formulas to date without any positive outcomes. Her cycle arrived every forty days or so, and would be complicated by lower abdominal and lumbar pain, scanty flow mixed with clots, and she was easily constipated. Her pulse was slippery-rapid and strong, tongue coat was thin-yellow, and the tongue body was bluish-purple. The diagnosis was binding of heat and blood, with obstruction of the chong and ren vessels, causing difficulty in conceiving.

Treatment principle: Discharge heat, and move static (blood), in order to eliminate the old to make room for the new. A powerful formula needs to be used in order to positively treat this obstinate condition.

The formula used was Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi):

Tao Ren 15g
Da Huang 4g
Mang Xiao 4g (added to strained decoction)
Gui Zhi 10g
Zhi Gan Cao 6g

After taking five packages of the formula she reported that her bowels were looser, and she had also discharged relatively copious amounts of black menstrual blood. Her lower abdominal and lumbar pain had settled, and her cycle arrived on schedule. On follow up six months later, she reported that she was indeed pregnant and went on to have a healthy baby girl.

Commentary: Tao He Cheng Qi Tang is basically Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the qi decoction) with the addition of Tao Ren, and Gui Zhi. Tiao Wei Cheng Qi Tang is used to discharge heat, and break binds. Tao Ren is moistening and disinhibiting, and is very good at expelling and eliminating static blood. Combined with Mang Xiao, and Da Huang the action of eliminating static blood and stagnation is strengthened. Gui zhi is used to free and move the defensive qi, following the adage of ‘when the qi moves, the blood will follow’, which will invariably strengthen the overall blood moving effect of the formula. In addition the warm nature of Gui Zhi moderates the cooling nature of both the Mang Xiao and Da Huang. 

6 comments:

Ray Rubio, DAOM, L. Ac. (FABORM) said...

I wish my Fertility Practice was made up of 30-year olds...

Still, it's a good reminder to continuously study and recite the indications and presentations for the classical formulas.

Eran Even said...

You're right Ray, if it were only that easy :)

My purpose for putting this case up was simply out of fascination that Tao He Cheng Qi Tang was used for fertility. I love the obscure, random uses of classic formulas.

Jason Blalack said...

Can I ask who the commentary is from?

Eran Even said...

Hey Jason,

the commentary was written by Liu Bao-hua (刘宝华).
Possibly one of Liu Du-Zhou's students, but judging by the name, maybe a relative? I'll have to look into that one.

Ray Rubio, DAOM, L. Ac. (FABORM) said...

Eran -

I also love the way that "Old Docs" have such a familiarity with the classical formulas and their indications, pulse, etc. that they can use them with so many different conditions.

I had an old Chinese Doc as a supervisor in TCM clinic who prescribed Wu Mei Wan for a female patient with axorexia nervosa, and it totally transformed her physically and emotionally. I asked him if he thought a parasite was the cause of her eating disorder, hence the choice of Wu Mei Wan, and he said no. He said that he prescribed it because her condition at that time matched very closely the indications for Wu Mei Wan.

Eran Even said...

Hi Ray,

It's exactly this flexibility is using classic formulas that I strive to learn. Otherwise, if we waited for the 'perfect-formula presentation' patient to walk through our doors, we may end up waiting a life time, and never get to use certain formulas.

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