JOURNAL OF CHINESE MEDICINE NUMBER 38 JANUARY 1992
TCM TREATMENT OF LUTEAL PHASE DEFECT An Analysis of 60 Cases
by Lian Fang. Directed by Sun Ningquan. Nanjing College of Traditional Chinese Medicine
Sixty cases of infertility due to luteal phase defect were treated with herbs to tonify the Kidney and regulate the menstrual cycle. After the treatment, the hyperthermal phase score of basal body temperature (BBT) was markedly increased (P<0.05), the hyperthermal phase 7-8 days after ovulation improved (P<0.001), the transitional period of BBT remarkably shortened, and the pregnancy rate in 32 uncomplicated cases of luteal phase defect was 56%. The close relationship between luteal phase defect and the Kidney deficiency syndrome in TCM was discussed. The key points of the treatment included coordination of yin and yang, regulation of Qi and blood, and combination of tonification with reduction.
Luteal phase defect is one of the important causes of infertility, accounting for 10—15% of infertility cases, and treatment is in general unsatisfactory. Dang Gui Shao Yao San (Powder of Chinese
Angelica and Peony) was reported to result in a pregnancy rate of 33.3%. Professor Sun Ningquan, a well-known traditional medicine gynaecologist, treated the disease with herbs to regulate the menstrual cycle with marked effect, the pregnancy rate being as high as 56%. The following is an analysis of 60 cases.
Analysis of Cases
All 60 cases were outpatients in our clinic from March to October 1988. The age ranged from 25 to 37 years, averaging 31 years, and the duration of infertility from 1.5 to 8 years, averaging 3.5 years. The diagnoses bywestern medicine were as follows: simple luteal defect in 32 cases, luteal phase defect with fallopian tube complications in 21 cases, positive serum antibodies against sperms in 3 cases, and the husbands of 3 cases showed abnormal semen examinations. Of the 60 patients, 11 had a history of spontaneous abortion, 4 had pre-men-strual bleeding, 3 had inter-menstrual bleeding, and 2 had menostaxis.
Typing According to Traditional Chinese Medicine
Of the 60 cases, 18 were of the Kidney yin-deficiency type, manifested by early or delayed menstrual cycles with scanty blood and no clots, and a small amount of thick leucorrhea or no leucorrhea. The tongue was red with scanty coating, and the pulse was deep and thready; 20 cases were of the Kidney yang-deficiency type, manifested by late menarche and delayed menstrual cycles with scanty light coloured blood, sexual hypoesthesia, lumbago and weakness in the legs. The tongue was pale with white coating, and the pulse deep and slow; 6 cases were of the type of deficiency of both Spleen and Kidney, manifested by menostaxis with profuse menstrual blood, pink in colour and containing no clots, profuse thin leucorrhea, with lassitude, weakness in the legs, poor appetite, loose stools, pale tongue with thin white coating, and deep weak pulse; 15 cases were of the Kidney deficiency type with stagnation of Liver-Qi, manifested by delayed or irregular menstrual cycles with either profuse or scanty dark blood containing clots, accompanied by pre-menstrual distension of the breasts, lumbago and dull pain in the lower abdomen during the menstrual period, and profuse leucorrhea either thin or thick; the tongue was pale with thin white coating, and the pulse taut.
METHOD OF TREATMENT
All the patients were treated with Kidney tonifying and menstruation regulating herbs. Post-menstrual treatment: (from the 4th to 11th day of the menstrual cycle) was to tonify the Kidney and regulate Qi and blood with a prescription consisting of Nu Zhen Zi (Fructus Ligustri Lucidi), Han Lian Cao (Herba Ecliptae Prostratae), Dang Gui (Radix Angelicae Sinensis), Dan Shen (Radix Salviae Miltiorrhizae), Xiang Fu (Rhizoma Cyperi Rotundi), Mu Xiang (Radix Saussureae seu Vladimirae) , Wu Yao (Radix Linderae Strychnifoliae) and Ze Xie (Rhizoma Alismatis Plantago-aquaticae).
Inter-menstrual treatment: (3 days before to 3 days after ovulation) was to warm yang and promote the flow of Qi and blood in the channels. The basic prescription consisted of Gui Zhi (Ramulus Cinnamomi Cassiae) , Hong Hua (Flos Carthami Tinctorii), Dang Gui (Radix Angelicae Sinensis), Dan Shen (Radix Salviae Miltiorrhizae), Xiang Fu (Rhizoma Cyperi Rotundi), Mu Xiang (Radix Saussureae seu Vladimirae) , Wu Yao (Radix Linderae Strychnifoliae) and Ze Xie (Rhizoma Alismatis Plantagoaquaticae).
Zhu Yu (Fructus Evodiae Rutaecarpae) were added.
In addition, for cases with inter-menstrual bleeding, herbs to remove heat from the Liver and blood were added, such as Sheng Di Huang (Radix Rehmanniae Glutinosae), Dan Shen (Radix Salviae Miltiorrhizae), Mu Dan Pi (Cortex Moutan Radicis), Ju Hua (Flos Chrysanthemi Morifolii) and E Jiao (Gelatinum Asini).
For cases with pre-menstrual bleeding, higher dosage of the Kidney-warming drugs should be used plus herbs to replenish Qi, such as Huang Qi (Radix Astragali), Dang Shen (Radix Codonopsis Pilosulae), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Sheng Ma (Rhizoma Cimicifugae) and E Jiao (Gelatinum Asini).
When the menstrual period exceeded 7 days and the menstrual blood was dark with clots, stasis relieving and haemostatic herbs such as charred Dang Gui (Radix Angelicae Sinensis), charred Dan Shen (Radix Salviae Miltiorrhizae), charred Ce Bai Ye (Cacumen Biotae Orientalis) and charred Ou Jie (Nodus Nelumbinis Nuciferae Rhizomatis) were added to the prescription used during menstruation.
When the menstrual period was prolonged with dripping of light coloured blood, Qi-replenishing and haemostatic herbs such as Huang Qi (Radix Astragali), Dang Shen (Radix Codonopsis Pilosulae), prepared Bai Zhu (Rhizoma Atractylodis Macrocephalae), Sheng Ma (Rhizoma Cimicifugae) and E Jiao (Gelatinum Asini) were added.
For cases with history of spontaneous abortion, Du Zhong (Cortex Eucommiae Ulmoidis), Xu Duan (Radix Dipsaci), Sang Ji Sheng (Ramus Loranthi seu Visci) and Gou Ji (Rhizoma Cibotii Barometz) were added to the prescription for pre-menstrual treatment to warm the Kidney and consolidate the Chong Channel.
Results of Treatment
Treatment during one menstrual cycle was regarded as one course of treatment. Of the 60 cases, 37 were treated for 3 months, 14 for 4 months, 6 for 5 months and 3 for 6 months.
Relationship between Luteal Phase Defect and Kidney Deficiency in Traditional Chinese Medicine
All the 60 patients had manifestations of Kidney deficiency according to TCM. After treatment with Kidney tonifying and menstruation regulating herbs, all indicators showed improvement in various degrees. So there was evidently some relationship between luteal phase defect and Kidney-deficiency.
Traditional Chinese medicine holds that the Kidney is in charge of reproduction, and exuberant Kidney function is a prerequisite for menstruation and pregnancy. In western medicine, luteal phase defect associated with hyposecretion of gonadotropic hormones is regarded as an important cause of infertility. Modern pharmacological studies show that Kidney-tonifying herbs have a gonadotropic action.
Recent investigations on the theory of “adaptation of the human body to the natural environment” and on biorhythms have revealed that the four menstrual phases are the result of transformation of Kidney-yin and Kid-ney-yang. A balanced coordination between Kidney-yin and Kidney-yang is important for normal transformation of the four menstrual phases. In the 60 cases of this series, BBT revealed that the four menstrual phases were abnormal with clinical manifestations of Kidney-defi-ciency. Therefore the prescription of herbs to regulate and tonify Kidney-yin and Kidney-yang was logical.
Relationship between the Changes of BBT and the TCM Diagnoses
The normal changes of BBT from low to high during the four menstrual phases seem to be related with the transformation of Kidney-yin and Kidney-yang. In the post-menstrual period, there is a growth of Kidney-yin and BBT is in the hypothermal phase; in the intermenstrual period, there is transformation of the Kidney-yin into Kidney-yang and BBT rapidly rises; in the premenstrual period, both yin and yang are exuberant and BBT persists in a hyperthermal state; in the menstrual period both yin and yang become insufficient and BBT turns to a hypothermal state. In the 19 patients with deficiency of the Kidney-yin and the 6 cases with deficiency of both the Spleen and the Kidney in this series, the hypothermal
Table: HPS of the 60 cases before and after treatment
and transitional phases of BBT were prolonged; the hyperthermal phase in 20 patients with deficiency of the Kidney-yang persisted less than 12 days; among the 15 patients with deficiency of Kidney and stagnation of the Liver, 13 had prolonged transitional phase, and 14 had hyperthermal curves that fluctuated more than 0.1 °C .
Patients with luteal phase defect had abnormal BBT changes in the post-menstrual, inter-menstrual and premenstrual periods. In the post-menstrual period patients with deficiency of the Kidney-yin or Qi-deficiency of the Spleen had prolonged hypothermal period of BBT; in the inter-menstrual period patients with deficiency of the Kidney-yin, deficiency of the Kidney-yang, and deficiency of the Spleen or stagnation of the Liver showed prolonged transitional period of BBT; in the pre-men-strual period patients with deficiency of Kidney yang or stagnation of the Liver could not maintain a normal hyperthermal phase.
Points of Note in the Treatment
This article was first published in The Journal of Traditional Chinese Medicine, Beijing, June 1991.