Sterility is the inability to produce offspring. In primary sterility, no offspring has ever been produced, while secondary sterility is the inability to produce further offspring after having previously conceived. Both male and female may suffer from this disorder, but only female sterility will be discussed in this section.

Etiology and Pathogenesis

In females, sterility can be grouped into two types, namely, absolute sterility and relative sterility. The former is caused by a congenital defect which cannot be corrected by medicinal treatment, while the latter is a result of acquired diseases and the women of this group still have the possibility of conception. As for the cases due to congenital defects, five kinds were mentioned in the ancient literature, i.e., Luo, Wen, Gu, Jiao, Mai. Luo refers to the maldevelopment of the vagina; Wen, to atresia of the vagina; Gu, to an imperforated hymen; Jiao, to clitorism; and Mai, to primary amenorrhea. As for relative sterility, deficiency of kidney-qi, stagnation of liver-qi, retention of cold dampness and obstruction of phlegm-dampness are the common causes.

Diagnosis and Differential Diagnosis

A diagnosis of sterility can be made for a woman who has failed to become pregnant for more than 2 years after marriage or previous pregnancy without receiving contraceptives and who has had a normal sexual life and the reproductive function of her spouse has been proven to be normal. A detailed history including menstrual history, delivery history, sexual life, leucorrheal history, etc., is essential for the diagnosis. A thorough gynecological examination including tubal insufflation test, ovarian function test, etc., may be helpful.

Syndrome Differentiation and Treatment

A. Kidney-qi deficiency syndrome (frequently seen in cases with maldevelopment of uterus)

Manifestations: delayed menstruation, oligomenorrhea with light colored menses, dull complexion, soreness and weakness of lumbus and knees, hyposexuality, clear urine, loose stool, pale tongue with white coating and deep and slow pulse.

Therapeutic principles: Warm the kidneys, nourish the liver, and regulate the Chong and Ren meridians.

Prescription:

Herba Epimedii 10 g
Radix Morindae Officinalis 10 g
Semen Cuscutae 15 g
Fructus Rubi 12 g
Radix Rehmanniae Praeparata 15 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Alba 15 g
Placenta Hominis 10 g
Fructus Leonuri 15 g
Fructus Lycii 15 g
Fructus Schisandrae 10 g

In addition, proprietary medicines such as Five Seeds Bolus for Reproduction, Pill of Human Placenta and Pill of Dingkun may be employed.

B. Liver-qi stagnation syndrome

Manifestations: Irregular menstrual cycles, difficult menstruation with abdominal pain and blood clots, distending pain over the hypochondria and breasts, mental depression, irritability, normal or dull red tongue with white-thin coating and wiry pulse.

Therapeutic principles: Disperse the stagnated liver-qi, nourish blood, and regulate menstruation.

Prescription:

Radix Bupleuri 10 g
Rhizoma Cyperi Praeparata 10 g
Cortex Albizziae 10 g
Semen Aesculus 12 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Alba 15 g
Radix Rehmanniae Praeparata 15 g
Radix Salviae Miltionhizae 15 g
Flos Rosae Chinensis 10 g
Folium Citri Reticulatae 10 g
Semen Citri Reticulatae 10 g

In addition, proprietary medicines such as Xiaoyao Pill and Babao Kunshun Bolus may be supplemented. Remarks: For cases with an obstruction of the uterine tube attributed to stagnation of qi and blood, apply the following prescription to eliminate blood stasis and mass and dredge the meridians:

Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Salviae Miltiorrhizae 15 g
Semen Persicae 10 g
Squama Manitis 15 g
Ramulus Xylosmae 15 g
Fructus Liquidambaris 10 g
Spina Gleditsiae 10 g
Sargassum 15 g
Pulvis Resina Draconis (taken by mixing with the decoction) 3 g
Radix Bupleuri 10 g
Radix Aucklandiae 6 g

C. Cold-dampness retention syndrome

Manifestations: Delayed menstrual cycles, cold feeling in the lower abdomen, dysmenorrhea with dark purplish menses, leucorrhagia with thin, white discharge, dull-colored tongue with white coating and deep and slow pulse.

Therapeutic principles: Warm the meridians, expel cold, activate blood circulation, and eliminate blood stasis.

Prescription: The Modified Decoction for Removing Blood Stasis in the Lower Abdomen

Fructus Foeniculi (fried) 10 g
Cortex Cinnamomi 10 g
Fructus Evodiae 10 g
Radix Linderae 10 g
Herba Epimedii 12 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Pollen Typhae 10 g
Faeces Trogopterori 10 g
Radix Paeoniae Rubra 10 g
Rhizoma Corydalis 10 g
Rhizoma Atractylodis 12 g
Rhizoma Zingiberis Praeparata 6 g

Remarks: For cases with retention of dampness-heat and obstruction of blood stasis manifested as stabbing pain over the lower abdomen, lumbago, preceded cycles, distending pain of the breasts, leucorrhagia with yellow and foul discharge, abdominal pain aggravated during the menstrual period, low fever, red tongue with yellow and greasy coating and wiry and rapid pulse, usually occurring in the case of secondary sterility caused by pelvic inflammation or adnexitis, the Modified Powder for Regulating the Liver and Spleen Combined Toosendan Powder should be employed to clear away heat and promote diuresis, activate blood circulation and eliminate blood stasis.

Radix Bupleuri 10 g
Fructus Aurantii Immaturus 12 g
Radix Paeoniae Rubra 10 g
Radix Glycyrrhizae 6 g
Rhizoma Corydalis 10 g
Fructus Toosendan 10 g
Caulis Sargentodoxae 15 g
Herba Patriniae 15 g
Radix et Rhizoma Rhei 6 g
Rhizoma Dioscoreae Bulbiferae 10 g
Fructus Liquidambaris 10 g
Rhizoma Paridis Polyphylla 15 g

D. Phlegm-dampness obstruction syndrome

Manifestations: Obesity, delayed menstrual cycles, amenorrhea, leucorrhagia with viscous discharge, pale complexion, dizziness, palpitations, chest oppression, abdominal distention, white and greasy tongue coating and smooth pulse.

Therapeutic principles: Warm the kidneys and strengthen yang, eliminate phlegm and dampness, activate blood circulation, and regulate menstruation.

Prescription:

Fructus Crataegi 30 g
Rhizoma Curculiginis 12 g
Herba Epimedii 15 g
Semen Cuscutae 20 g
Fructus Rubi 15 g
Rhizoma Arisaematis 10 g
Rhizoma Pinelliae 10 g
Poria 15 g
Rhizoma Cyperi Praeparata 10 g
Fructus Aurantii 12 g
Rhizoma Atractylodis Macrocephalae 15 g
Rhizoma Chuanxiong 10 g
Herba Lycopi 10 g

Remarks: For cases with insufficiency of kidney-qi and retention of phlegm-dampness leading to the obstruction of meridians and manifested by obesity and hirsutism, the following prescriptions should be used to warm kidney-yang, eliminate phlegm and regulate the Chong meridian.

Prescription I:

Herba Epimedii 15 g
Radix Morindae Officinalis 10 g
Cornu Cervi (slice) 10 g
Semen Cuscutae 20 g
Rhizoma Dioscoreae 12 g
Rhizoma Atractylodis 12 g
Rhizoma Atractylodis Macrocephalae 12 g
Semen Sinapis Albae 12 g
Rhizoma Cyperi Praeparata 10 g
Radix Angelicae Sinensis 15 g
Rhizoma Acori Graminei 10 g
Rhizoma Arisaematis 10 g
Sargassum 15 g
Herba Leonuri 15 g

This prescription should be taken beginning from the fifth day of the menstrual period, one dose a day for six successive days.

Prescription II:

Radix Angelicae Sinensis 15 g
Radix Salviae Miltiorrhizae 30 g
Rhizoma Chuanxiong 20 g
Radix Paeoniae Rubra 10 g
Herba Artemisiae Anomalae 15 g
Caulis Spatholobi 15 g
Herba Lycopi 10 g
Rhizoma Cyperi Praeparata 10 g
Herba Leonuri 15 g
Flos Carthami 10 g
Cortex Cinnamomi 6 g
Spina Gleditsiae 10 g

This prescription should be taken beginning from the 12th day of the menstrual cycle, one dose a day for six successive days.

Copyright 1995 Hopkins Technology