Infertility is fundamentally the inability to conceive a baby, including the inability of a male to provide normal sperms and the state of a female who is unable to carry a pregnancy to full term [[1]]. The causes of infertility include specific male causes, specific female causes, combined and unexplained infertility (Fig. 2, [1]). On the male side, low semen count and quality due to endocrine problems, drugs, radiation, infection, hormone imbalance, and blockage of the man’s duct system are the common causes. On the female side, egg released not at the optimum time for fertilization, problems of releasing eggs, structural problems in the Fallopian tube, endometriosis, pelvic inflammatory disease, age-related factors, imbalanced hormones and uterine problems are the common causes of infertility. Genetic factors, DNA damages, diabetes mellitus, thyroid disorders, adrenal disease, hypothalamic-pituitary factors, environmental factors (such as toxins, physical and chemical agents and smoking) can cause infertility on either sex. In addition, approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. One in six couples in Australia and New Zealand suffers infertility [[2]]. Worldwide, 3-7% of all couples have an unresolved problem of infertility and 12-28% of all couples experience this problem for at least one year [1]. The infertility is highly related to the age. The older the age, the more problems on the fertility (Fig. 3, [[3]]).
Depending on the causes, infertility can be treated with psychological adjustment [[4]], medicine (Clomid, Pergonal, Follistim, Metformin, Parlodel, etc.) [[5]], surgery (Fallopian tube sterilization reversal, hydrosalpinx removal, testicular sperm aspiration, vasectomy reversal, etc.) [[6]], artificial insemination, or assisted reproductive technology (conception cap, semen collectors, intracervical and intrauterine inseminations, In-vitro fertilization and donor insemination, etc.) [1]. Many times these treatments are combined. One thing is very important for the infertility treatment: when starting the treatment to adjust the molecular metabolisms and functions, the organic diseases of infertility must be excluded.
There is a long recorded history of Traditional Chinese Medicine (TCM) being used in the treatment of infertility. In fact, records indicating herbal treatment of infertility and miscarriage date back to 200 A.D., including mention of formulas that are still used for those same purposes today [[7]]. Since the most situations of infertility are due to the imbalances of the molecular metabolisms and functions, while TCM has advantages at the regulations of functional balances individually, TCM shows many benefits in the treatment of infertility. TCM believes that women infertility is due to the lack of innate endowment, excessive intercourse, deficiency of kidney essence, deficiency of Chong and Ren channels; or deficiency of kidney yin, deficiency and cold of the uterus; or body weak, deficiency of Yin and blood, lack of nourishing womb and pulse; or sluggish emotion, stagnation of liver Qi, dissonance of Qi and blood; or obesity, excessive eating and rich fatty diet, Yang deficiency of spleen and kidney, the development of phlegm dampness, block of Qi, block of Chong and Ren channels; or blood stasis and condensation, accumulation of diseases in womb [[8]]. The followings are the common types of infertility and treatment for women in the clinics [8]:
Kidney Yang deficiency: Infertility for a long time, delayed menstruation, low volume of menstrual flow with light color, or oligomenorrhea, amenorrhea; dark and gloomy complexion, lumbar soreness and leg weakness, sexual apathy, clear urine in large amounts, watery stool, pale tongue with white coating, deep and slow pulse. Treatment: Warming kidney and nourishing liver; Regulating and reinforcing Chong and Ren channels. Recipe: Yu Lin Zhu (毓麟珠, from “Jingyue Encyclopedia”《景岳全书》) plus Zi He Che (紫河车), Dan shen (丹参) and Xiang Fu (香附).
Liver depression: Infertility for years, irregular menstrual cycle, abdominal pain during the period with clogged flow, less volume, dark color, and small blood clots, premenstrual breast distending pain, depression, irritability. Normal or dark red tongue with thin and white coating, stringy-taut pulse. Treatment: Soothing the liver and alleviating the depression; Nourishing blood and strengthening spleen. Recipe: Kai Yu Zhong Yu Tang (开郁种玉汤, from Fu Qingzhu’s Obstetrics and Gynecology, 《傅青主女科》).
Phlegm dampness: Inability to conceive a baby for a long time, fat body shape, delayed period or even amenorrhea, increased and thick leucorrhea, pale complexion, dizziness, palpitations, chest distress, nausea. White and greasy tongue coating, slippery pulse. Treatment: Drying damp and eliminating phlegm; Regulating Qi and menstruation. Recipe: Qi Gong Wan (启宫丸, experienced formula) plus Shi Chang Pu (石菖蒲).
Blood stasis: Infertility for a long time, delayed and hypo menorrhea, black and purple blood with clots, or dysmenorrhea, recurrent pain refused to press in the outer part of the lower abdomen. Dark purple tongue or purple dots on the side of the tongue, thready and stringy pulse string. Treatment: promoting blood circulation and removing blood stasis, regulating the menstruation. Recipe: Shao Fu Zhu Yu Tang (少腹逐瘀汤, from “Correction on the Errors of Medical Works” 《医林改错》).
Kidney Yin deficiency: Infertility for a long time, preceded and hypo menorrhea, red without clot, or normal menstruation but with extreme weight loss, soreness and weakness of waist and legs, dizziness, palpitation and insomnia, temperament, dry mouth, burning sensation of five centers, afternoon low-grade fever. Reddish tongue with less coating, thready and rapid pulse. Treatment: Nourishing yin and enriching blood; Regulating Chong channel and replenishing vital essence. Recipe: Yang Jing Zhong Yu Tang (养精种玉汤, from Fu Qingzhu’s Obstetrics and Gynecology,《傅青主女科》) plus Nu Zhen Zi (女贞子), Han Lian Cao (旱莲草).
For male infertility, TCM believes that kidney stores essence and control reproduction; It is the material basis of human growth, development and reproduction. The imbalance of kidney Yin and Yang, especially the kidney deficiency, is one of the main pathological mechanisms of sterility. The other mechanisms include deficiency of Qi and blood, Qi stagnation and blood stasis, damp heat of essence room, liver depression and blood stasis, and so on. The followings are the common types of infertility and treatment for women in the clinics [[9]]:
Kidney deficiency of Yang: Infertility after marriage, low sexual desire, impotence with erectile dysfunction, or a weak erection, chilly seminal fluid, low sperm count with low motility; usually accompanied by lower back pain and knee weakness, psychological fatigue, limb chills, clear urine in large amounts, pale tongue, thin white fur, deep and thready pulse. Treatment can be chosen with Jin Kui Shen Qi Wan (可选用金匮肾气丸), Qiang Shen Pian (强肾片), Ginseng and deer velvet pill (人参鹿茸丸).
Kidney deficiency of Yin: Infertility after marriage, spermatorrhea, premature ejaculation, scarce semen; often associated with lower backache and leg weakness, dizziness, tinnitus, feverishness in palms and soles, dry mouth, insomnia, forgetfulness, red tongue with less coating, thready and rapid pulse. Treatment can be chosen with Wu Zi Yan Zong Wan (五子衍宗丸), and Liu Wei Di Huang Wan (六味地黄丸).
Deficiency of both QI and blood: Infertility after marriage, low sexual desire, thin semen, low sperm count with a low survival rate, pale or sallow complexion, body weakness, lack of Qi and no desire to speak, dizziness, pale tongue with thin and white coating, thin and weak pulse. Treatment can be chosen with Shi Quan Da Bu Wan (十全大补丸), Ren Shen Gui Pi Wan (人参归脾丸).
Damp-heat and blood-stasis obstruction: hypochondriac pain and bitter taste in the mouth, agitated, irritable, moist and hyperhidrosis at scrotum, pruritus vulvae, urethral secretion, decreased libido, impotence, premature ejaculation, excessive dead sperm or non-liquefaction, scanty and brownish urine, red tongue, yellow greasy moss, stringy and rapid pulse. Treatment should be done by clearing heat and removing dampness, with Cheng’s Bi Xie Fen Qing Decoction with addition or subtraction.
Stagnation of Qi and blood stasis: abdominal and perineal pain, seminal vesicle thickening, dragging and distending discomfort on testicle, dark purple tongue, thready and unsmooth pulse. The treatment choice can be promoting blood circulation to dispel blood stasis; dredging the meridians and producing essence by Xue Fu Zhu Yu containing Tao Hong Si Wu Tang (血府逐瘀含桃红四物汤) with addition or subtraction.
Note: Chapter 21 of the Jin Gui Yao Lue (Essential prescriptions of the Golden Cabinet – 金 匱要略) is dedicated to Women’s Miscellaneous Disease and one particular formula Wen Jing Tang (温经汤)stands out: Line 22.9: … [this formula] also governs women’s lesser abdominal cold and chronic failure to conceive; it also helps to eliminate blood from flooding or excessive menstrual bleeding or failure of the menses to arrive [at their proper] time.
Fertility is a complicated procedure of sperms and ova reactions, including spermatogenesis and oogenesis, transportation of gametes, fertilization and fetal development in the precisely regulated molecular environments through the whole procedure. Any imbalance of these molecules may lead to the infertility [[10], [11]]. The recent medical sciences demonstrate that TCM formulas regulate the body molecular balances and lead to the recovery of diseases [[12], [13]]. One study showed that the management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF [[14]]. In addition to the treatments of infertility with western medicine, TCM plays a very important role in helping many many couples to realize their dreams to have a baby.
[4] Alice Domar et al: Understanding the perceptions of and emotional barriers to infertility treatment: a survey in four European countries. Hum. Reprod., Apr 2012; 27: 1073 – 1079.
[10] B Dousset et al: Seminal cytokine concentrations (IL-1beta, IL-2, IL-6, sR IL-2, sR IL- 6), semen parameters and blood hormonal status in male infertility. Hum. Reprod., Jul 1997; 12: 1476 – 1479.
[11] Antonio Cianci et al: Relationship between tumour necrosis factor and sex steroid concentrations in the follicular fluid of women with immunological infertility. Hum. Reprod., Feb 1996; 11: 265 – 268.
[12] Fritz Wieser et al: Evolution of medical treatment for endometriosis: back to the roots? Hum. Reprod. Update, Sep 2007; 13: 487 – 499.
[13] Zhenzhen Zhang et al: Therapeutic Potential of Wenshen Xiaozheng Tang, a Traditional Chinese Medicine Prescription, for Treating Endometriosis. Reproductive Sciences, Oct 2013; 20: 1215 – 1223.
[14] Ried K, Stuart K.: Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review. Complement Ther Med. 2011 Dec;19(6):319-31. doi: 10.1016/j.ctim.2011.09.003. Epub 2011 Oct 5.
Statistics of breast cancer: Breast cancer is a type of cancer originating from breast tissue [[1]]. About 1 in 8 U.S. women (12.38%) will develop invasive breast cancer over the course of her lifetime, while 5.72% of women will develop cancer of the breast between their 50th and 70th birthdays [[2]]. The indidence rate is dropped after 85 years old (Fig.1. [[3]]). This may be due to the interactions of wound and wound healing capacity inside the body [[4]]. In 2011, an estimated 230,480 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S. About 39,520 women in the U.S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness. In 2011, there were more than 2.6 million breast cancer survivors in the US. About 15% of women who get breast cancer have a family member diagnosed with it. About 5-10% of breast cancers can be linked to gene mutations (abnormal changes) inherited from one’s mother or father. Mutations of the BRCA1 and BRCA2 genes are the most common. Women with these mutations have up to an 80% risk of developing breast cancer during their lifetime [[5]]. Worldwide, breast cancer accounts for 22.9% of all cancers (excluding non-melanoma skin cancers) in women. In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women) [1]. From 2006-2010, the median age at diagnosis for cancer of the breast was 61 years of age. In the mean time, the median age at death for cancer of the breast was 68 years of age. The overall 5-year relative survival for 2003-2009 from 18 geographic areas was 89.2% [3].
Classification. Since the high incidence of the breast cancer in the world, research on it is active and many types of breast cancer are classified for its treatments and prognosis.
By histopathology. Breast cancer is usually classified primarily by its histological appearance. Most breast cancers are derived from the epithelium lining the ducts or lobules (Fig.2, [[6]],[[7]]), and these cancers are classified as ductal or lobular carcinoma. Carcinoma in situ is the growth of cancer cells within a particular tissue compartment such as the mammary duct without invasion of the surrounding tissue. In contrast, invasive carcinoma does not confine itself to the initial tissue compartment [1]. If the cancer is ductal carcinoma in situ or has not spread to the lymph nodes, the 5-year survival rates with treatment are up to 98%. If the cancer has spread to the lymph nodes, the 5-year survival rate is about 84%. If the cancer has spread (metastasized) to other sites (most often the lung, liver, and bone), the average 5-year survival rate is 27% [[8]].
By grade. In pathology, grading compares the appearance of the breast cancer cells to the appearance of normal breast tissue. Normal cells in breast line up in an orderly way to make up the milk. Cancerous cells lose that differentiation. Their nuclei become less uniform, their divisions become faster, their shapes become irregular and they grow in all directions without confinement. Pathologists describe cells as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade) as the cells progressively lose the features seen in normal breast cells. Poorly differentiated cancers (the ones whose tissue is least like normal breast tissue) have a worse prognosis [1].
By stage. Breast cancer staging using the TNM system is based on the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, and whether the tumor has metastasized (M) (i.e. spread to a more distant part of the body). Larger size, nodal spread, and metastasis have a larger stage number and a worse prognosis.
The main stages are:
The difference between the two classifications of grade and stage is that the former views the status from pathology and the latter views it from the cancer cell migration.
By receptor status. Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).
Cancer cells with some or all positive receptors may respond to some drugs and generally have a better prognosis. Cells with none of these receptors are called triple-negative . The risk of relapse after treatment on those triple-negative is much higher for the first 3–5 years but drops sharply and substantially below that of hormone-positive breast cancers after that [1].
By genetics. Many gene mutations (For some reason, the normal nucleotide sequence is changed in DNA) account for the risk of breast cancer, including BRCA1/2, p53, PTEN, STK11, CHEK1, ATM, BRIP1 and PALB2 [1]. A woman who has a mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation. However, since family members share a proportion of their genes and, often, their environment, it is possible that the large number of cancer cases seen in these families may be due in part to other genetic or environmental factors. Therefore, risk estimates that are based on families with many affected members may not accurately reflect the levels of risk for BRCA1 and BRCA2 mutation carriers in the general population [[9]].
Metastasis. When the cancer cells migrate from the place where they first started to another place in the body, it is called metastasis (Fig.3, [[10]]).Breast cancer primarily metastasizes distantly to the bone, lungs, liver and brain, with the most common site being the bone. Lymph node metastasis into the sentinel node and few surrounding nodes is regarded as a treatable local event. The prognosis is often poor. Distant metastases are the cause of about 90% of deaths of breast cancer [[11]]. Sometimes the metastasis may be found first but the primary tumor cannot be found, despite extensive tests. As the techniques are constantly improving, the number of cases of this unknown primary origin is going down. Bilateral breast cancer has an overall incidence of 4–20% in patients with primary operable breast cancer [[12]]. The tumors of the two sides can be from the same clone (one metastasized from the other) or two different clones of tumor cells (two primaries). Metastasis occurs more likely than two primary tumors, especially in those synchronous bilateral breast cancers (two sides of breast cancer found at the same time) [[13]].
Risk factors of breast cancer. The cause of cancer, including breast cancer, is not clear. A cancer is the result of an imbalanced metabolism. Many factors may lead to this imbalance, including but not limited to [[14]]:
Gender: Simply being a woman is the main risk factor for developing breast cancer.
Age: Nearly half (48%) of female breast cancer cases is diagnosed in the 50-69 age group [[15]].
Genetic risk factors: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. Other gene mutations can also lead to inherited breast cancers, including ATM, TP53, CHEK2, PTEN, CDH1, STK11, etc.
Family history of breast cancer: Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk. This could be from the similar lifestyles and similar genetic responses to the risk factors.
Dense breast tissue: Women with dense breasts (more more glandular and fibrous tissue and less fatty tissue) may have a higher risk of breast cancer than women with less dense breasts.
Certain benign breast conditions, such as breast benign tumors, cyst, fat necrosis, calcification, Radial scar, atypical hyperplasia, etc.
Menstrual periods: Women who have had more menstrual cycles have a slightly higher risk of breast cancer.
Having children: Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk.
Birth control and hormone therapy after menopause: Drugs for birth control and menopause may increase the risk of breast cancer.
Breastfeeding: Breastfeeding may slightly lower breast cancer risk.
Alcohol and smoke: The use of alcohol and tobacco smoke is linked to an increased risk of developing breast cancer. The risk increases with the amount consumed.
Obese and exercise: Obese is a risk factor of breast cancer. Appropriate exercise lowers the risk.
Diet: About 50% of cancer incidences and 35% of cancer mortality in the U.S., represented by cancers of the breast, prostate, pancreas, ovary, endometrium, and colon, are reported to be associated with Western dietary habits [[16]]. Due to the difficulties of study with a limitation on a certain food for a long time, the results may show an inconsistency. If there is a link, a diet high in fat, high in red meat and processed meat, and low in fruits and vegetables might lead to health problems, including to the risk of breast cancer.
Chemicals in the environment: Pesticides on vegetables and fruits, preservatives in foods, some chemicals in drinking water, breathing air, plastics, certain cosmetics and personal care products may increase risk of cancer in animal tests. These could in theory affect breast cancer risk. Unfortunately, studying such effects in humans is difficult.
Stress: Although the difficulty of measuring stress makes it difficult to demonstrate a tangible relationship between stress and breast cancer, studies reveal that stress is related to breast cancer in various ways [[17]].
Chinese herbs on breast cancer. The current standard therapies for breast cancer are surgery, chemotherapy and radiation therapy. The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is found. Table-1 shows the overall 5-year survival rates under the current technology. The early discovery of the breast cancer is very important for its prognosis. The standard therapies are the most effective methods to remove and inactivate the breast cancer mass. They earn the time for body’s natural healing power to adjust the imbalanced metabolisms back to normal. However, to prevent the recurrence and metastasis after the standard therapies, the cancer survivor must limit the above risk factors as much as possible to avoid the imbalanced metabolisms. In this situation, Traditional Chinese Medicine (TCM), can play very important roles in breast cancer treatments, including relief of side effects and complications from standard therapies, increasing the quality of life and especially the prevention of recurrence and metastasis (Table-2), since TCM can adjust the formulas according to the TCM indications, leading the metabolisms to the homeostasis. A normal metabolism is the guarantee of free cancer status inside the body.
Cancer courses
TCM indications [[18]] and Chinese herbs to treat them (in parenthesis)
Before operation
1. Liver Qi depression and phlegm stasis syndrome (Tiao Shen Gong Jian Tan, 调神攻坚汤 [[19]]),2. Turbid phlegm and blood stasis (Xue Yu Zhu Yu Tang and Xiao Yao Lou Bei San, 血瘀逐瘀汤合逍遥娄贝散 [[20]])3. Chong-Ren imbalance syndrome (Er Xian Tang, 二仙汤 [[21]]).4. Deficiency of the vital principle and poison blazing (BA Zhen Tang, 八珍汤 [[22]]).
After operation
1. Syndrome of incoordination between spleen and stomach (Si Jun Zhi Tang, 四君子汤[[23]])2. Two deficiency syndrome of Qi and blood (Yin), (BA Zhen Tang, 八珍汤 [[24]])3. Qi deficiency and blood stasis (Yi Qi Huo Xue Tang, 益气活血汤 [[25]]).
Chemotherapy
1. Syndrome of incoordination between spleen and stomach (Sen Lin Bai Zhu San, 参苓白术散 [[26]])2. Two deficiency syndrome of Qi and blood (Yin) (BA Zhen Tang, 八珍汤 [24])3. Deficiency of liver and kidney (Liu Wei Di Huang Wan, 六味地黄丸 [[27]])4. Deficiency of spleen and kidney (Jin Kui Shen Qi Wan, 金匮肾气丸 [23])
Radiation therapy
1. Two deficiency syndrome of Qi and yin (Sheng Mai San, 生脉散 [[28]])2. Syndrome of yin deficiency and depletion of fluid (Sha Shen Mai Dong Tang and Da Bu Ying Wan, 沙参麦冬汤及大补阴丸 [[29]])3. Yin deficiency and fire-toxicity syndrome.
Period of consolidation
1. Two deficiency syndrome of Qi and blood (Yin) (Yi Qi Yang Rong Tang, 益气养荣汤 [21]),2. Deficiency of spleen and kidney (Jin Kui Shen Qi Wan, 金匮肾气丸 [23])3. Chong-Ren imbalance syndrome (Er Xian Tang, 二仙汤 [21]).
Table-2. TCM indications of breast cancer and Chinese herbs for them.
[12] Dawson LA et al: Evolving perspectives in contralateral breast cancer. Eur J Cancer 1998;34:2000-9.
[13] Soo Jung Gong et al: Bilateral Breast Cancer: Differential Diagnosis Using Histological and Biological Parameters. Jpn J Clin Oncol. 2007 Jul;37(7):487-92. Epub 2007 Aug 1.
Menopause literally means the “end of monthly cycles” (the end of monthly periods aka menstruation), from the Greek word pausis (cessation) and the root men- (month). A woman’s period, once every 28 days on average, starting from around 14 years (menarche) and ending at around 50 years old (menopause), is a series physiological changes for the preparation of impregnation. It involves the organs/tissues of hypothalamus, pituitary, ovary and uterus. In terminology, menopause is recognized after 12 months of amenorrhea (absence of menstruation). Perimenopause is for describing the transition from reproductive life to menopause, characterized by irregularities in menstrual cycle, with the average age of 45 to 47. The terms of menopause and postmenopause are often used interchangeably [[i], [ii]]. By the time of a girl’s menarche, there is an average of about 400,000 oocytes (eggs) in the ovary. However, by the time of menopause, only fewer than 10,000 eggs left. Furthermore, as menopause approaches, the remaining eggs become more resistant to the stimulation of follicle-stimulating hormone, and the ovaries dramatically reduce their production of a hormone called estrogen, leading the less menstrual cycle and the natural menopause eventually [[iii]]. The other causes of stopping menstruation are the pathological menopause due to the congenital or acquired hypothalamic – pituitary – ovarian axis lesions (ovarian dysgenesis, cancer, inflammation, injury, radiation, drugs, etc.) and systemic diseases (thyroid, adrenal disease, diabetes, anemia, tuberculosis and nutrition poor, etc.) that involve the axis [[iv]].
Natural menopause is a natural process along with a woman’s normal aging process, not a disease or illness. However, due to the cycle decrease of menstruation related hormones, especially estrogen, some women may have the physical and emotional symptoms since estrogen affects many parts of the body, including the blood vessels, heart, bone, breasts, uterus, urinary system, skin, and brain [3]. The signs and symptoms of menopause may include irregular periods, hot flashes — flushing of face and chest (may be accompanied by heart palpitations), dizziness, headaches, night sweats, cold hands and feet, vaginal dryness, insomnia, mood changes—depression, irritability, tension (usually happens with sleep problems), and gain in abdominal fat (Fig.1, [[v], [vi]]).
Perimenopause is a natural stage of life for a woman. It is not a disease and therefore it may not need any medical treatment at all. However, if the symptoms are strong enough that they significantly disrupt the everyday life of the woman, palliative medical therapy may sometimes be appropriate, including hormone replacement therapy (HRT), DHEA, Antidepressants, blood pressure medicines and alternative medicines [1]. However, due to HRT is hard to mimic the nature changes of the hormones, and actual outcomes of HRT might pose more risks than benefits, including an increased risk of breast cancer, heart disease, stroke, and blood clots [5].
In Traditional Chinese Medicine (TCM), the symptoms of menopause are mainly considered from the kidney deficiency and the imbalance of Yin and Yang [[vii]]. Depending on the syndrome differentiation, TCM treatments can be divided into three types [[viii]]:
(1) Syndrome of deficiency of kidney yin: Clinical manifestations are: menstrual disorders, shortened menstrual cycles, with less or more menstrual flow than usual, dizziness, tinnitus, flushing of face, sweating, pains on waist and knee, heel pain, dry skin, dry mouth, constipation, oliguria with yellow color, red tongue with less coating, thready and rapid pulse. The general prescription is Zuo Gui Wan (左归丸) and Er Zhi Wan (二至丸). If there are dry eyes, give Qi Ju Di Huang Wan (杞菊地黄丸) with addition or subtraction; if upset and inquietude, insomnia and dreaminess, giving Bai He Di Huang Tang (百合地黄汤) or Gan Mai Da Zao Tang (甘麦大枣汤) and Huan Lian E Jiao Tang (黄连阿胶汤) with addition or subtraction.
(2) Syndrome of deficiency of kidney Yang: Clinical manifestations are: more menstrual flow than usual, depression, dark complexion, lower back pain and cold, clear and abundant urine, nocturia, or swollen face and limbs, thin and white tongue coating, deep, thready and weak pulse. Prescription with You Gui Wan (右归丸) with addition or subtraction.
(3) Syndrome of deficiency of kidney Yin and Yang: Clinical manifestations are: menstrual disorders, dizziness, tinnitus, forgetfulness, lower back pain and cold, pale tongue with thin coating, deep and weak pulse. General prescription is Er Xian Tang (二仙汤) and Er Zhi Wan (二至丸). The commonly used Chinese patent herbal medicines can be selected with addition or subtraction according to symptoms. If there are obvious symptoms of kidney deficiency, select the group of Di Huang Wan (地黄丸), such as Liu Wei Di Huang Wan (六味地黄丸), Qi Ju Di Huang Wan (杞菊地黄丸), Mai Wei Di Huang Wan (麦味地黄丸), Zhi Bai Di Huang Wan (知柏地黄丸), Ba Wei Di Huang Wan (八味地黄丸). If obvious with symptoms of insomnia and irritability, select the group of sedative pills, such as Zhu Sha An Shen Wan (朱砂安神丸), Bai Zi Yang Xin Wan (柏子养心丸), Tian Wang Bu Xin Dan (天王补心丹), An Shen An Zhi Wan (安神安志丸). If obvious with symptoms of depression, select the group of Jia Wei Xiao Yao San (加味逍遥散).
Infertility is fundamentally the inability to conceive a baby, including the inability of a male to provide normal sperms and the state of a female who is unable to carry a pregnancy to full term [[1]]. The causes of infertility include specific male causes, specific female causes, combined and unexplained infertility (Fig. 2, [1]). On the male side, low semen count and quality due to endocrine problems, drugs, radiation, infection, hormone imbalance, and blockage of the man’s duct system are the common causes. On the female side, egg released not at the optimum time for fertilization, problems of releasing eggs, structural problems in the Fallopian tube, endometriosis, pelvic inflammatory disease, age-related factors, imbalanced hormones and uterine problems are the common causes of infertility. Genetic factors, DNA damages, diabetes mellitus, thyroid disorders, adrenal disease, hypothalamic-pituitary factors, environmental factors (such as toxins, physical and chemical agents and smoking) can cause infertility on either sex. In addition, approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. One in six couples in Australia and New Zealand suffers infertility [[2]]. Worldwide, 3-7% of all couples have an unresolved problem of infertility and 12-28% of all couples experience this problem for at least one year [1]. The infertility is highly related to the age. The older the age, the more problems on the fertility (Fig. 3, [[3]]).
