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Traditional Chinese Medicine

Although the goals of Traditional Chinese Medicine (TCM) and allopathic medicine are the same, their ideas of etiology of disease, disease itself and the process used to regain health are decidedly different.  The allopathic physician learns that disease must be cured by prescribing medicine which kills bacteria or renders a virus ineffective; at times surgical intervention is a necessity.

There is nothing inherently wrong with this approach. It often works. The question worth exploring is why TCM succeeds when allopathic medicine fails? What is the mechanism of action of acupuncture and herbal medicine which results in palliation or cure that is not manifest in biomedicine? 

Though the goal of TCM is to cure a patient, the doctor of TCM attempts to do this not by treating the disease but rather by treating the whole person which takes into account the various attributes of an individual which, when combined, account for an individual being sick or healthy. A person, according to the tenets of TCM is more than their pathology. To treat just the pathology may yield impressive though usually, temporary results. 

People are not, according to TCM, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of birth including the values of and the culture from which the individual develops. The emotional experiences, eating habits, work habits, work and living environment, personal habits and the social milieu are factors which contribute to disease and are factors which, when changed appropriately may lead to regained health.  

Though the methodology of research of Chinese medicine has not, to date, been arrived at by the Western scientific community, the veracity and efficaciousness of this medical modality is nonetheless proved by its long history of continued success. More than a quarter of the world’s population regularly uses TCM as part of their health care regimen. Chinese medicine is the only form of classical medicine which is regularly and continuously used outside of its country of origin.

The experienced doctor must utilize his or her own interpretive skills, which takes into consideration not only what the patient verbalizes and presents with, but also what they reveal without meaning too and, what they don’t express during the intake process for reasons which may reveal themselves after a trusting relationship develops, leading to a better understanding of who this patient is and what the deeper etiology of their presenting pathology may be. The empty spaces can contain more important information than the filled ones. The tone of the voice, the complexion, the condition of the eyes (in TCM, the Shen or spirt of an individual is said to be revealed through their eyes. Who can deny the clinical efficacy of this?), the facial expression, the overall demeanor, how one walks, sits, and stands are all observed and utilized by the doctor of Chinese medicine as part of the information required to arrive at a differential diagnosis.

 Before the first words are spoken by the patient, the doctor already has some idea of who this person is merely by observing.

The doctor must be able to note and sense inconsistencies in an individual that are expressed by the patient even without the patient being cognizant of the chasms which exist between what they verbally express and what their spiritual presentation divulges.

A great doctor is one who can process a mix of factual knowledge of medicine with a personal sensitivity based on experience. The doctor of TCM specializes not just in inserting needles or prescribing herbal formulae but in being able to divine ‘hidden’ or subtle pathology which may not been seen or understood by practitioners of other types of medicine. In fact, a patient’s main complaint may be only one of several pathologies which are present though the patient herself is only aware of the one which is most acute at the time of examination. This ability of divination though quite difficult to master is ascertained without the benefit of modern technology. The only diagnostic tools we have at our disposal are the ‘Four Examinations’.

This method of diagnosis dates back over three thousand years. Observing, Listening and Smelling (Listening and Smelling are counted as one of the Four Examinations), Questioning and Palpating make up the ‘Four Examinations’.  This method of diagnosis, though seemingly quite simple, is far from simplistic. It allows the astute practitioner to arrive at a differential diagnosis.  With the advent of technology, as amazing, necessary and beneficial as it is in relation to medical intervention, there seems to be a direct correlation between advancement in technological wonders with an increasing decrease in doctor sensitivity to the patient, and thus, under diagnosis or misdiagnosis.  Each of the ‘Four Examinations’ can take years to master. When is the last time, you really observed and listened to your patient with a clear mind and without a preconceived diagnosis and etiology arrived at ten minutes after the intake?  It is difficult to listen and to observe, but the ability to do so, clearly, yields gems which are clues to the individual who sits before us! This is the stuff of TCM.

Proper treatment in TCM is more than the elimination of pathological processes. In addition to attacking a pathological factor(s), it is the responsibility of the TCM doctor to support the individual in his or her goal of achieving overall total health which includes the physical-psycho-emotional and spiritual aspects of health. This paradigmatic approach is an inexorable part of the process of healing. Without it, we are merely chasing the sickness and forgetting about the patient who must be seen as a whole person, the sum of a lifetime of experiences if you will; not just an embodiment of pathology.

Pathologies are guests (and we hope temporary ones!) in a home which serves as a gracious host – our physical, emotional and spiritual selves. TCM first is concerned with strengthening the immune function which includes homeostasis of the physical, emotional and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the enemy at the gates (or inside them). When people are chronically exhausted because they can’t sleep because they are anxious and depressed and they chronically get sick as a result of a lowered immune system the key to cure is to not view the acute presentation (the branch, in TCM) as the be all and end all in treatment, but instead, to treat to etiology (the root in TCM) which is the anxiety and depression which causes the insomnia which facilitates exhaustion which lowers the immune function which leads to chronic illnesses. So, rather than prescribing antibiotics repeatedly, we might address the patient’s anxiety/depression syndrome or refer them out to a psychotherapist for appropriate intervention while simultaneously proving treatment.

Infertility and TCM - Mechanisms of Action

It was shown in a study done at Harvard that stress reduces the hypothalamic-anterior pituitary-ovarian axis function, thus being a factor to be considered in the infertility work-up.

Acupuncture releases endorphins which mitigate ones response to stressful stimuli thus enhancing the possibility for conception.

[i] “Historically, infertility, particularly "functional" infertility, was attributed to abnormal psychological functioning on the part of one or both members of the couple. Preliminary works in the 1940s and 1950s considered "psychogenic infertility" as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved oedipal conflict, or conflicts of gender identity. Fortunately, advances in reproductive endocrinology and medical technology as well as in psychological research have de-emphasized the significance of psychopathology as the basis of infertility, and modern research shows that there is little evidence to support a role for personality factors or conflicts as a cause of infertility. This perspective unburdens the couple by relieving them of the additional guilt of thinking that it is their mental stress that may be responsible for their infertility.

Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress could cause infertility in some women. Excessive stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop “runner’s amenorrhea". In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin could cause irregular ovulation. Since the female reproductive tract contains catecholamine receptors catecholamines produced in response to stress may potentially affect fertility, for example, by interfering with the transport of gametes through the Fallopian tube or by altering uterine blood flow. However, more complex mechanisms may be at play, and researchers still don't completely understand how stress interacts with the reproductive system. This is a story which is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged, which focuses on how your mind can affect your body. Research has shown that the brain produces special molecules called neuropeptides, in response to emotions, and these peptides can interact with every cell of the body, including those of the immune system. In this view, the mind and the body are not only connected, but inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.

Stress can reduce sperm counts as well. Thus, testicular biopsies obtained from prisoners awaiting execution, who were obviously under extreme stress, revealed complete spermatogenetic arrest in all cases. Researchers have also showed significantly lower semen volume and sperm concentration in a group of chronically stressed marmoset monkey, and these changes were attributed to lower concentrations of LH and testosterone (which were reduced in the stressed group). However, how relevant these research findings are in clinical practice is still to be determined.”

The stress factors that acupuncture addresses stems from both psycho-emotional factors as well as physical etiologies. For example, extremely painful pre-menstruum or mid cycle pain can be debilitating. This type of physical stress, no doubt produces emotional stress as a result of missed work, manifest pain and other life-style factors resulting from such extreme pain; all can mitigate the function of the reproductive system.

Aceto corticotropic hormone is released as a response to acupuncture needle stimuli. ACTH has an antiinflammatory mechanism which may for example, help with tubal factor based infertility as a response to pelvic inflammatory disease.

The insertion of acupuncture needles has been shown to effectively increase blood circulation. Acupuncture is very effective in treating, for example, Reynaud’s Syndrome. Enhanced microcirculatory patency to the uterine lining does, undoubtedly contribute to a healthier and more growth oriented endometrium, especially when utilizing electrical stimulation on inserted acupuncture needles on points known as zigongxue which reside superior to the ovaries. The points zigongxue are located 3 inches inferior to the umbilicus and three inches bilateral to the anterior midline.

[ii]“…”They reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can be beneficial as an adjunct to other infertility treatments, including IVF. Only one randomized controlled study examined the independent effect of acupuncture on IVF outcomes, but this indicated a positive effect.

The review authors also highlight evidence that shows the effects of acupuncture may be mediated through neuropeptides that influence gonadotropin secretion, which could in turn affect the menstrual cycle. The technique can also reduce stress, which is known to adversely affect fertility, and has been implicated in the regulation of uterine blood flow.”

[iii]“Using acupuncture during assisted reproduction may improve pregnancy rates, say researchers. However, they acknowledge that the mechanism behind this effect is unclear, and the team plans to carry out further studies to confirm, and further investigate, their findings.

Noting that acupuncture has been shown to affect the autonomic nervous system, Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues postulated that the therapy could increase endometrial receptivity via control of related muscles and glands.

The researchers randomly assigned 160 women receiving assisted reproductive therapy to undergo IVF with or without acupuncture, before and after embryo transfer. In acupuncture subjects, the needles were placed at points believed to influence reproductive factors, for example by improving blood flow to the uterus.

Paulus et al report that the acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43 percent versus 26 percent). They conclude, therefore, that acupuncture could be "a useful tool" for improving pregnancy rates during certain infertility treatments.”

A Diagostic Window. East Meets West

One TCM diagnosis which exists which may be etiologic for male or female infertility is called Liver qi stagnation. One of the key identifiers of an individual with the pattern differentiation of Liver qi stagnation is anger, rage, frustration, depression and anxiety.

[iv]“Symptoms of depression, anxiety, and anger may help in determining the nature of infertility experienced by some couples, and identify those who would benefit most from psychological counseling, suggest researchers.

Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology.

When the researchers divided the couples according to the nature of the infertility—organic, functional, or undetermined—they found that the triad of anxiety, depression, and a tendency toward anger suppression successfully predicted the diagnosis of organic or functional infertility in women, with 97 percent accuracy.

For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, unlike in women, anger did not appear to influence infertility in men.

The results suggest the possibility of identifying a subgroup of infertile subjects where, beyond the distress that is consequent to the failure of repeated attempts to conceive a baby, there is also a poorly adaptive psychological functioning, which is likely to play an important role in the onset and course of functional infertility," the team concludes.

It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the veracity and effectiveness of Traditional Chinese Medicine.

Herbal medicine

The exact mechanisms of action of herbal medicine intervention are not, at this time completely understood. That in and of itself however, does not in any way negate its efficacy. The mechanism of action of tricyclic antidepressants is not fully understood either in its effect on chronic pain; fibromyalgia, for example, but its efficacy has been maintained. 

Herbal medicine has been used successfully to treat infertility for thousands of years.

Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘decoction’ specifically designed for the individual patient.

Some formulae contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism. Prescribing the correct herbal medicinals requires extensive training and clinical experience. 

Self medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis which can only be rendered by a licensed, board certified, experienced practitioner. At the worst case, self prescribing of herbal medicine may prove harmful or fatal.

A good example of this is Ma Huang/Ephedra. Ma Huang is an herb prescribed on a daily basis by hundreds of TCM practitioners to thousands of patients daily, safely. 

That several people have died as a result of taking Ma Huang has very little to do with the dangerous properties of the herb inasmuch as it has to do with the fact that in all cases of fatalities the individuals were self-medicating. Aspirin can prove fatal if taken by a hemophiliac. This is not an indication that Aspirin should be banned or that it is a dangerous drug.  It is totally safe if used appropriately.

One should take herbs only when they’re prescribed by a Board Certified herbalist.

Not only is herbal medicine safe, it is highly effective in treating much pathology without the concomitant harmful side-effects which often accompany pharmaceutical drugs.  There are greater than one million hospitalizations per year as a result of drug induced side-effects; not so with herbal medicine.

I have used herbal formulae repeatedly to lower elevated FSH levels, to regulate irregular menstrual cycles, to mitigate pain in the endometriosis patient; to mitigate pain in the patient who presents with ovulation and/or menstruation related migraines; to thicken an unresponsive endometrium; to treat the amenorrheic patient, the oligomenorrheic patient; to treat patients with partial tubal occlusion, and the patient who presents with idiopathic infertility. Additionally, I have successfully treated male factor infertility which include presentations such as low sperm count and poor motility.

I want to be clear in stating that not all patients respond to TCM, but lets face it, IVF is successful at best, 25 to 30 percent of the time. 

Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion that the best case scenario for the infertile patient or for any patient is to offer them every reasonable option which may serve to address their pathology.  The integration of acupuncture and herbal medicine into the treatment protocol of the infertile patient, from a clinical perspective, based on the long standing empirical evidence, makes sense.

berkleycenter.com

[i] Domar, Alice

[ii] Fertility and Sterility 2002; 78: 1149-53

[iii] Fertility and Sterility 2002; 77: 721-724

[iv] Human Reproduction 2002; 17: 2986-94