TCM & female infertility: damp phlegm accumulation

Manifestations: In this pattern, patients are usually overweight since puberty; Menstruation is delayed, or even amenorrhea for certain period; Thin hair, with a lot of leukorrhea, usually white, sticky but without odor; patients can also experience dizziness, palpitation, shortness of breath and oppression in the chest, nausea, asthenia facial edema, or with pale complexion. Tongue is pale and flabby, with white and sticky tongue coating, and the pulse is slippery. [15]

Damp phlegm accumulation is another main factor that causes infertility. Constitutional Kidney and Spleen Yang deficiency, overthinking, indulgency in food, or Liver Wood restricting Spleen Earth can also weaken the transformation and transportation function of the Spleen, resulting in dampness retention, transforming into phlegm overtime, especially when indulging in high fat, high calorie food and alcohol. The damp phlegm accumulation can block the smooth Qi flow in the uterine area, or resulting in tangible blockage, often seen in blockages in fallopian tubes and Polycystic ovary syndrome. [15]

Syndrome analysis: According to Jing Yue Quan Shu, “The formation of the phlegm is from the Spleen, but the root of the phlegm exists in the Kidney”. When the Spleen and Kidney Qi are weak, the dampness if formed, when left untreated, it will transform into phlegm. Phlegm will block the conception vessel and thoroughfare vessel, as well as the Qi and blood flow in the uterine area, causing delayed menstruation or even amenorrhea, and blocking the penetration of the sperms, resulting in infertility. When the damp phlegm blocks the free flow of Qi, Qi stagnation can result in blood stagnation, so the pathogenic nodes of phlegm and blood stagnation block the conception vessel, thoroughfare vessel and uterus, resulting in infertility. Oppression sensation in the chest, nausea, tongue pale and flabby, with thick white coating are all indications of damp phlegm accumulation. [17]

Dr. Zhu Dan Xi said: “overweight people, plump and fair type, usually have Qi deficiency. Spleen Qi is the Yang Qi that pushes the healthy flow of Qi in the body, it is like the sun in the sky. When Yin damp is blocking everywhere, tonifying the Spleen Qi is the like bringing back the sun in the sky, when the sun is shining, all the Yin, turbid material will dissolve and disappear. He also mentioned in Dan Xi Zhi Fa Xin Yao “overweight and fare people are more likely to contain damp phlegm,” many doctors after him shared and deepened his point of view. For instance,  Dr. Zhang Xu Gu mentioned in Yi Men Bang He “if the body is overweight, skin is fare and tender, muscle is usually loose, and pulse is big and soft, although these type of people eat a lot, but because of the damp phlegm, the energy cannot be optimized, so most of time, they have Yang deficiency. [19]

According to Dr. Zhu Dan Xi, “Damp phlegm, as a pathogenic material, is going up and down together with the flow of Qi, it can be everywhere.” “Damp phlegm is rooted from the circulation of body fluid and blood, when the Qi and blood are harmonized and flowing smoothly, the damp phlegm can hardly be accumulated. Therefore, inner imbalance of Qi and blood and external trauma can cause damp phlegm accumulation.” Once the damp phlegm is formed, it will block the free flow of Qi. Therefore, according to clinic studies and practices, overweight females tend to have fallopian tube blockage, blockages in the ovaries, ovarian cyst or uterine fibroids, excessive amount of leukorrhea. Another common symptom of women of damp phlegm accumulation is fatigue, even without any physical exertion. This is because the damp phlegm blocks the free flow of Qi, patients with damp phlegm accumulation tend not to move a lot, and lack of physical movement makes the condition worse, as in a vicious circle.  [19]

Treatment principles: strengthen spleen Qi, dry dampness and dissolve phlegm, move the stagnation and regulate the menstruation.

Herbal formula and analysis:

The main formula to treat infertility in this pattern is Cang Fu Dao Tan Wan by Dr. Ye Tian Shi from Qing dynasty. This formula was recorded in his book Treating Gynaecological Problems from Dr. Ye, Regulating the Menstruation. This formula is to treat overweight women, with damp phlegm accumulation, and delayed menstruation. It focuses on dissolve damp phlegm and move the Qi, so that the menstruation is regulated. [15]

The composition of the formula include Cang Zhu 30g, Xiang Fu 30g, Chen Pi 20g, Zhi Nan Xing 15g, Zhi Ke 15g, Ban Xia 15, Chuan Xiong 15, Fu Ling 20g, Shen Qu 20g. Zhi Gan Cao 10g

Er Chen Tang (Chen Pi, Ban Xia, Fu Ling, Zhi Gan Cao) is used here to dry dampness and eliminate phlegm; Cang Zhu is to dry dampness and tonify Spleen Qi; Zhi Ke, Xiang Fu are to move the Qi and dissolve phlegm; Dan Nan Xing is to clear heat and dissolve phlegm; Sheng Jiang, Gan Cao are to harmonize the middle Jiao. This formula focuses on treating the main symptoms, and pathogenic factor, damp phlegm, but it is usually added with Xian Ling Pi, Ba Ji Tian, Huang Qi, Dang Shen to tonify the Kidney Qi and Spleen Qi, in order to treat the root cause. So either treating the symptoms first or treating the symptoms and the root cause at the same time depends on the individual condition of the patient. After the damp phlegm is dissolved, tonify the kidney, regulate the menstruation, when the menstruation is regulated, the infertility problem will be solved. [15]

In this pattern, patients are usually seen in uterine fibroids, uterine polyps, Polycystic ovary syndrome. [15]

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