Patient”s name :Axxxx  Kxxxx

Date of Birth : 29-07-1979

Sex : Female

Marital status : Married

Occupation : Special needs Co-ordinator

Chief  Complaint  : Difficulty  falling  pregnant , poly cystic ovaries , IBS  , Aching of knee .

Date of first consultation and treatment : 31-07-2006

Present symptoms of illness : Amenorrhea about two months , depressed , anxiety , mood up and down , Chest tightness ,  insomnia , abdominal pain and bloating , tired and pain in the both knees .

History of current illness :  The patient had first menstruation when she was nine years old and she has had irregular menstruation for all of her life , some times her menstruation continued none stop for one month , some time as little as 4 days , also the color of her blood is light , her menstruation has been regular since taken the pill for three years , when she stopped using the pill two years ago , her menstruation has been irregular again , some times menstruation has been none stop for seven weeks , the color of her blood is often dark and heavy , There are many blood clots , the abdominal area is cold to touch and painful , the breasts are tender , her last menstruation was two months ago. The Gynecological consultant has done many examinations which were all negative apart from left polycystic ovaries , but she needs to go back again for final check next month to confirm the diagnosis . recently she suffered mood swings and chest tightness , her hands and feet often felt cold , especially in the winter , she has had IBS for the past ten years , she often gets diarrhoea and abdominal pain , but symptoms are minor . both of her knees have felt painful for the past four years , it is worse in the winter .

Family medical history : mother has depression .

Modern medical diagnoses : infertility .

Traditional Chinese medicine diagnoses : infertility ,

Some additional check : Blood pressure 120/75 mmhg , Heart rate 80 t/m , Temperature 36.5c .

Tongue inspection : tongue is red , thin coating , but thick coating at the back , white color .

Pulse condition : deep and weak

Syndrome differentiation : deficiency of spleen qi and kindey  yang , stagnation of cold and damp in the Uterus .and liver qi stagnation .

Treatment principles :strengthen spleen qi and kidney yang , warm up yang qi and remove damp , regulate and nourish  the chong ren channels , expel cold and warm up the Uterus , soothe liver qi and regulate menstruation .

Prescription :

Acupuncture and electric needle points : ST25 , SP8 , ST29 , SP10 , L14 , REN2 , EX-HN3 , DU20 , HE7 , LIV3 , BII7 , BII8 , L14, BI20 , BI23 .

Electric needle on EX-LE2 , EX-LE4,5 .

Herbs prescription : Dang shen , xiang fu , dan shen , dan gui , chi sao , yu jin , fu ling , bai zhu , ban xia , yi mu cao , he huan hua , gan cao .

Others : cai hu shu gan wan , ba zhen yi mu wan . .

Analysis : due to this patient’s body condition , the patient needs to regulate her menstruation and soothe liver qi first , when the patient’s menstrual cycle has been regulated back to normal , the treatment principle should be according to the woman’s four different phase of her cycle and yin-yang pattern , qi –blood transformation , to promote ovulation and support conception .

Follow –up /Course of treatment (one week later )

Second consultation : The patient had a menstruation after taking three bags of herbs , The patient suffered abdominal pain and the colour of blood is dark and is light , her body feels more comfortable and relaxed and sleeping better and her knees are pain free .

Tongue inspection : tongue is red , thin coating , white color .

Pulse condition : wiry pulse .

Prescription :.

Acupuncture points : ST25 , SP8 , ST29 , SP10 , L14 , REN2 , EX-HN3 , DU20 , HE7 , LIV3 , BII7 , BII8 , L14, BI20 , BI23 . REN3 , EX-CA1 .

Herb prescription : dang gui wan and tao hong si wu wan .

Analysis

Due to the patient’s continued menstruation the color of the blood is dark and she suffers abdominal pain , This means that the blood stasis in the uterus needs to be removed, so I prescribed dang gui wan .and tao hong si wu wan to remove blood stasis and soften the uterine tissues , strengthen the uterine self-healing function and improve general well-being . this creates a welcoming environment in the uterus for the eggs to be fertilized and implanted .

Third weeks consultation :

The menstruation has stopped and the patient feels much better .

Tongue inspection : tongue is red , thin coating , white color .

Pulse condition : wiry pulse .

Prescription :.

Acupuncture points :  BI20 , BI23 . REN3 , EX-CA1 . UB20 , UB23 , DU4 , REN4 , ST36 , KI3 , CV3 , SP10 , SP6

Herb prescription : dang shen , huang qi , shu di , chuan xiong , xiang fu , dang gui , bai shao , wu zhu yu , rou gui , shang ji sheng , mu xiang , xian mao , xian ling pi , gancao .

Other herbs : nuan gong yun zi wan , cong rong bu shen wan .

Analysis : warm and nourish kidney yang to promote progesterone’s growth .

Fourth weeks consultation :

The patient felt warm and very comfortable on her lower abdomen , her cold feeling has disappeared , sleeping has improved , her emotional feeling is happy , energy is much better , even IBS symptom are better ,there is no abdominal pain or bloating .

Tongue inspection : tongue is red , thin coating , white color .

Pulse condition : wiry pulse .

Prescription :

Acupuncture points :  BI20 , BI23 . REN3 , EX-CA1 . UB20 , UB23 , DU4 , REN4 , ST36 , KI3 , CV3 , SP10 , SP6

Herbs prescription: dang shen, huang qi, shu di, chuan xiong, xiang fu, dang gui, bai shao, wu zhu yu, rou gui, shang ji sheng, mu xiang, xian mao, xian ling pi, gancao.

Other herbs: nuan gong yun zi wan, cong rong bu shen wan.

Analysis:

Due to this patient having taken contraceptive pills for many years which has resulted in the suppression of the qi of kidney, impair the normal function of spleen and kidney, and the disharmony of the chong and ren channels. as a consequence, the uterus is unable to get adequate blood supply to cause infertility. After acupuncture and taking the herbs, the qi of kidney yang has warmed up, so the patient felt comfortable, keeping this formula is therefore effective.

Fifth weeks consultation:

The patient has had her second period since treatment, the color is red and normal, there is no pain or bloating to the abdomen only a few blood clots, also her mood is more serene before the menstruation .

Prescription:

Acupuncture points: ST25, SP8, ST29, SP10, L14, REN2, EX-HN3, DU20, HE7, LIV3, BII7, BII8, L14, BI20, BI23. REN3 , EX-CA1.

Herbs prescription: dang gui wan and tao hong si wu wan .

Analysis

The patient’s menstruation has become regular, due to her kidney yang function being back to normal, this is to promote the growth of follicles. I still prescribed her dang gui wan and tao hong si wu wan to remove blood stasis and soften the uterine tissues.

Six, seven, eight and nine weeks consultation:

The patient feels healthy and I recommended her to keep the same treatment as third week.

At end of nine weeks the patient told me that her pregnancy had been confirmed.

Discussion :

Infertility is not only getting more and more common today, but also much more complicated, since women are trying to conceive later in life, taking the contraceptive pill as a common solution for stopping unexpected conception happening , consequently interfering with their endocrine function and causing infertility later on in their life when they want a family, their condition therefore could be rather complex since they are often extremely stressed with their situation, however TCM has demonstrated that it can help these women conceive with or without assisted fertility treatment .

This case supports the foregoing treatment to the menstrual cycle inducing the ovarian cycle with regular acupuncture and herb medicine is an effective treatment for infertility, not only is it able to support female conception by improving their reproductive function, raising hormonal levels and harmonizing the whole system .