Chinese Medicine in Fertility Disorders Edited by Andreas A. Noll Overseas Visiting Professor (Chengdu University of TCM/China) Practice for Chinese Medicine and Naturopathy Munich, Germany Sabine Wilms, PhD Sinologist, Translator, and Lecturer Ranchos de Taos New Mexico, USA With contributions by Simon Becker, Young-Ju Becker, Stefan Englert, Kerstin Friol, Walter Geiger, Christian Gnoth, Dagmar Hemm, Annette Jonas, Andrea Kaffka, Karin Kielwein, Barbara Kirschbaum, Gudrun Kotte, Andreas A. Noll, Jacqueline Peineke, Karin Rudzki, Ruthild Schulze, Hans-Joachim Stelting, Fransiscus Sulistyo-Winarto, Beatrice Trebuth, Sabine Wilms, Yuning Wu Translated by Sabine Wilms, PhD 40 illustrations Thieme Stuttgart · New York Library of Congress Cataloging-in-Publication Data Important note: Medicine is an ever-changing science Chinesische Medizin bei Fertilitätsstörungen. English undergoing continual development. Research and Chinese medicine in fertility disorders / edited clinical experience are continually expanding our by Andreas A. Noll, Sabine Wilms ; knowledge, in particular our knowledge of proper with contributions by Simon Becker . . . [et al.] ; treatment and drug therapy. Insofar as this book translated by Sabine Wilms. mentions any dosage or application, readers may p. ; cm. rest assured that the authors, editors, and publishers Includes bibliographical references and index. have made every effort to ensure that such references ISBN 978-3-13-148991-3 (alk. paper) are in accordance with the state of knowledge at the 1. Infertility–Alternative treatment. 2. Medicine, time of production of the book. Chinese. I. Noll, Andreas. II. Wilms, Sabine. III. Title. Nevertheless, this does not involve, imply, or ex- [DNLM: 1. Infertility–therapy. 2. Medicine, press any guarantee or responsibility on the part of Chinese Traditional–methods. WP 570 the publishers in respect to any dosage instructions C539c 2010a] and forms of applications stated in the book. Every RC889.C4513 2010 user is requested to examine carefully the manufac- 616.6'92–dc22 turers’ leaflets accompanying each drug and to check, 2009035836 if necessary in consultation with a physician or spe- cialist, whether the dosage schedules mentioned therein or the contraindications stated by the manu- facturers differ from the statements made in the pre- This book is an authorized and revised translation of sent book. Such examination is particularly important the German edition published and copyrighted 2008 with drugs that are either rarely used or have been by Hippokrates Verlag in MVS Medizinverlage, Stutt- newly released on the market. Every dosage schedule gart, Germany. or every form of application used is entirely at the Title of the German edition: Chinesische Medizin bei user’s own risk and responsibility. The authors and Fertilitätsstörungen: Erfolgreiche Behandlung bei un- publishers request every user to report to the pub- erfülltem Kinderwunsch. lishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product Illustrator: Helmut Holtermann, description page. Dannenberg, Germany © 2010 Georg Thieme Verlag, Some of the product names, patents, and registered Rüdigerstrasse 14, 70469 Stuttgart, Germany designs referred to in this book are in fact registered http://www.thieme.de trademarks or proprietary names even though speci- Thieme New York, 333 Seventh Avenue, fic reference to this fact is not always made in the New York, NY 10001, USA text. Therefore, the appearance of a name without http://www.thieme.com designation as proprietary is not to be construed as a representation by the publisher that it is in the Cover design: Thieme Publishing Group public domain. Typesetting by Druckhaus Götz GmbH, This book, including all parts thereof, is legally pro- Ludwigsburg, Germany tected by copyright. Any use, exploitation, or com- Printed in India by Replika Press PVT LTD mercialization outside the narrow limits set by copy- right legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in parti- ISBN 978-3-13-148991-3 1 2 3 4 5 6 cular to photostat reproduction, copying, mimeo- graphing, preparation of microfilms, and electronic data processing and storage. IV Contributors Simon Becker, Dipl Ac and CH Gudrun Kotte, PhD (SBO-TCM, NCCAOM) Sinologist President Berlin, Germany Swiss Professional Organization for TCM Waedenswil, Switzerland Andreas A. Noll Overseas Visiting Professor Young-Ju Becker, Dipl Ac and CH (Chengdu University of TCM/China) (SBO-TCM, NCCAOM) Practice for Chinese Medicine and Naturopathy Private Practice for TCM Munich, Germany Waedenswil, Switzerland Jacqueline Peineke, Heilpraktiker / Stefan Englert, MD TCM Practitioner Professor Private Practice Private Practice Berlin, Germany Ravensburg, Germany Karin Rudzki, MD Kerstin Friol, MD Private Practice Private Clinic Hamburg, Germany Grevenbroich, Germany Ruthild Schulze, Heilpraktiker / TCM Practitioner Walter Geiger, MSc (TCM/USA) Berlin, Germany Private Practice Hamburg, Germany Hans-Joachim Stelting, Heilpraktiker / TCM Practitioner Christian Gnoth, MD Private Practice Private Clinic Hamburg, Germany Grevenbroich, Germany Fransiscus X. Sulistyo-Winarto, MD Dagmar Hemm, PhD, Heilpraktiker / Private Practice TCM Practitioner Dormagen, Germany Private Practice Munich, Germany Beatrice Trebuth, Heilpraktiker / TCM Practitioner Annette Jonas, Heilpraktiker / TCM Practitioner Private Practice Private Practice Lübeck, Germany Hamburg, Germany Sabine Wilms, PhD Andrea Kaffka, PhD (Hangzhou University, China) Sinologist, Translator and Lecturer Private Practice Ranchos de Taos Munich, Germany New Mexico, USA Karin Kielwein, MD Yuning Wu, MD University Clinic Bonn Beijing Hospital of TCM Bonn, Germany Beijing, China Barbara Kirschbaum, BAc, FRCHM UK Private Practice Hamburg, Germany V Foreword Foreword I have great pleasure in writing the foreword for a Western and traditional Chinese medical per- Chinese Medicine in Fertility Disorders; my congrat- spective. It also explores the issues of fertility ulations to these authors on their valuable con- within a traditional social and cultural context, as tribution to this field of Traditional Chinese Med- well as discussing the present day ethical dilem- icine (TCM). mas faced by practitioners working in this In 2002 acupuncture research published in a challenging area of medicine. Western medical fertility journal attracted atten- The depth of knowledge, diversity, and rich ex- tion from both medical professionals and the gen- perience of the authors shines through their chap- eral public. This interest has continued with ters. By allowing each author to explore their sub- further research published in reputable journals ject in such depth this text is unique, with indivi- raising awareness amongst medical personnel dual chapters that not only examine in detail acu- about the benefits of working with acupuncturists, puncture and herbal treatments but also qi gong, and website information stimulating interest from tui na, moxibustion, and Chinese dietetics. couples undergoing fertility treatment. It bodes well for the development of TCM as a This has raised challenges for practitioners profession to have chapters on historical texts, working in this area of TCM. While research has shen, and sexuality alongside chapters on treat- raised the profile of acupuncture, the dilemma for ment for menstrual disorders, the issues sur- many practitioners has been that of successfully rounding couples undergoing the procedures tech- integrating the true potential of TCM within a nology has to offer, including guidelines on assist- medical system that would prefer to focus on acu- ing couples undergoing the latest assisted repro- puncture point protocols as a method of treatment. ductive medicine procedures. This comprehensive What this book does so well is to offer practi- approach continues through to chapters on treat- tioners a pathway for integration. It does this in ing stress and supporting couples in successful and two very different but equally important ways: failed fertility treatment. firstly, integration with the Western medicine As a profession it will be up to those practicing treatment our patients seek out, assisting practi- TCM to use the publicity generated from acupunc- tioners to understand and bridge this medical ap- ture research treatment protocols to promote the proach. Secondly, within TCM itself; exploring the full potential of our medicine. To shift public per- richness of our past, the relevance of this literature ception and medical interest from assisting con- to modern clinical practice, and an approach ception to assisting couples to achieve maximum throughout that emphasizes the value of using reproductive health. To shift the focus from be- TCM as a whole system—rather than focusing coming pregnant to one that also promotes opti- solely on the use of acupuncture. It is very exciting mal health during a pregnancy. TCM has the addi- to see such a comprehensive range of work within tional benefit of helping couples to cope when one text, with scholars of historical texts and ex- their desire for children is not achieved. This perienced practitioners within the field of fertility timely text offers practitioners the knowledge, medicine working together to offer such a wide whatever their background and preferred mode spectrum of therapeutic approaches. of practice, to meet this challenge. A quick glance at the contents page illustrates With this diverse and informative approach the scope of practice that this book covers and the Chinese Medicine in Fertility Disorders stands out experience of the contributing authors, reflecting as a leading text in this field, providing value for the diversity and potential of Traditional Chinese both students and experienced practitioners. Hav- Medicine as it is being used in practice today. ing read this book, I have no hesitation in recom- Chinese Medicine in Fertility Disorders offers mending it as an essential text for any practitioner practitioners the information to work confidently working in the area of fertility and reproductive within a Western medical environment—with ex- medicine. tensive chapters covering the physiology and Debra Betts pathology of fertility and reproduction from both Wellington, New Zealand VI Preface Preface Ding Tian Li Di (頂天立地—to achieve the extraor- the individual to be an essential factor for life dinary) and health in and of itself. In contrast to Western Touching heaven with the head while standing on medicine, though, and due at least partly to its earth traditional, vastly different way of looking at the body, on the other hand, it falls short in certain This Chinese figure of speech vividly illustrates the aspects of both diagnostics and therapy that are purpose of this book. The modern methods of re- related to the concrete anatomical structures. productive medicine have found human—and Both medical systems have their advantages— therefore earthly—ways of solving a problem that and for the benefit of potential future parents and had previously been entrusted to heaven: the pas- their child, we should and can make use of both of sage of time, the dao, gods, and saints had the them; at different stages and with different prio- power to make the wish for a child come true. At rities, but in both cases with a common goal: to all times and in all places, medicine was left with fulfill the wish for a child. This book is meant to the task of preparing as fertile a ground as possible assist the therapist in the evaluation of those prio- for the seed, which then finally fell out of the sky. rities and in choosing the best tools from both And now it seems possible to intervene even here, medical systems for this purpose. in the area of new life, in the one aspect—with the This book is concrete proof of the progress that exception of death—that had previously been im- has been made in the integration of Chinese med- possible to influence. icine with biomedicine and of the powerful re- The extremely creative field of reproductive wards that all therapists, whether they come medicine is developing new methods at breakneck from a traditional Chinese or biomedical back- speed, methods whose refinement appears to ground, can reap when they open their eyes and vouch irresistibly for their safety and justifiable are willing to explore options outside their origi- hopes. Nevertheless, modern biomedicine is at nal field of expertise. The fact that this book is a risk of defining the reproductive process exclu- collection of essays by a large variety of practi- sively in its biological and technical dimension. tioners and scholars furthermore indicates the Therapists and patients believe in these new pos- level of sophistication that the topic of fertility sibilities and capabilities, cherish enormous hopes, treatment has reached, making it too large an and then experience corresponding bitter disap- area to be covered exhaustively by any single in- pointment. dividual. Traditional Chinese Medicine (TCM) holds In each chapter, we invite you to look at this within it the traditions of a medical system that fascinating topic from a different angle, shaped by has integrated different concepts of health and ill- the specific academic and clinical experiences of ness from the past 3000 years. It utilizes methods each contributor. The selection of topics covered for cultivating health or life (yang sheng 養生), that in this book has been conscious and purposive. is, for preserving health, and for treating the Chapters range from historical and anthropologi- human body as a “holistic system” in a variety of cal research on the cultural dimensions of Chinese ways, in order to restore harmony, not only within medical notions about fertility to cutting-edge bio- the individual but also between the individual and medical knowledge and clinical research on TCM the external environment. Harmony, the unim- treatments as applied in Chinese clinics today. Not peded flow of qi through its conduits and its ab- ignored either are the particular ethical concerns sorption and production in the internal organs that modern fertility treatment in all its capabil- (zang viscera and fu bowels) is hence also the ities and shortcomings brings to the table in our most important prerequisite for creating new life modern society. It is our hope that the inclusive- —and thereby new qi. Different from Western ness and breadth with which we have chosen to medicine, Chinese medicine—which as a whole in- approach the complex topic of fertility treatment cludes much more than just modern TCM—consid- in the first part of the book will indeed allow ers functioning relationships within and outside therapists to “touch heaven,” while the concrete VII Preface clinical information and advice presented in the Wilms would like to thank her father, Dr. Klaus second half will enable them to remain “standing Wilms, for the inspiration to reach for the sky in on earth,” all for the benefit of the patient. the seemingly Herculean task of translating Chi- We would like to express our deep gratitude to nese medical literature, and her daughter Momo the authors who have here shared their knowl- for insisting on a healthy balance between work edge and often decades of experience in fertility and play, thereby keeping her feet firmly planted treatment with the professional public. By doing in the ground. Andreas Noll is deeply grateful to so, we have succeeded in building a bridge be- his parents and his by now grown children and tween two medical systems—knowing full well grandchildren for the wonderful experience that that this is the only way to ensure the best patient made the writing of this book possible in the first care possible. In addition, we would like to thank place. How important it is for life not only to have Thieme Publishers, in particular the Editor Ange- roots but also later become a root itself! lika Findgott and Editorial Assistant Anne Lampar- ter, for their unwavering commitment and encour- Andreas A. Noll agement in the production of this book. Sabine Sabine Wilms VIII Contents Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 Fertility Treatment—Its Social and Cultural Context . . . . . . . . . . . . . . . 2 Reduced Fertility—Epidemiology—Causes . . 2 In the East—Confucianism, Buddhism, Daoism, and Modern China . . . . . . . . . . . . 5 Reproduction and Sexuality . . . . . . . . . . . . 4 Integration: TCM . . . . . . . . . . . . . . . . . . . . 6 In the West—Christianity, Enlightenment, and the “Pill” . . . . . . . . . . . . . . . . . . . . . . . 4 2 Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Human Dignity . . . . . . . . . . . . . . . . . . . . . 8 Love, Sex, and Reproduction . . . . . . . . . . . 11 Circumstances of Conception—Criteria . . . . 8 Developments . . . . . . . . . . . . . . . . . . . . . . 12 Instrumentalization—Intervention in Fertility Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 10 3 Guanyin—Goddess of Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Introduction . . . . . . . . . . . . . . . . . . . . . . . . 13 Song Zi Niang Niang—The Woman Who Can Bestow Children . . . . . . . . . . . . . . . . . 14 Starting a Family in China . . . . . . . . . . . . . 13 Legend—Who is Guanyin and Where Does Times of Prayer . . . . . . . . . . . . . . . . . . . . . 15 She Come From? . . . . . . . . . . . . . . . . . . . . 13 Willingness and Openness . . . . . . . . . . . . . 16 Goddess of Compassion . . . . . . . . . . . . . . . 14 Transmitting Symbolism to the West . . . . . 16 Guanyin—A Mother Goddess . . . . . . . . . . . . 14 4 The Wish for Sons—Woman and Family in Imperial China—Qiu Zi (求子) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 The Status of Women . . . . . . . . . . . . . . . . 18 The Economic Aspect . . . . . . . . . . . . . . . . . 22 The Family . . . . . . . . . . . . . . . . . . . . . . . . . 18 Who Would Want Girls? . . . . . . . . . . . . . . 22 Transition to Patriarchy . . . . . . . . . . . . . . . 19 Men’s Special Privileges . . . . . . . . . . . . . . . 23 Legitimization by the Philosophers . . . . . . 19 No Escape for the Woman . . . . . . . . . . . . . 23 Rules for Women . . . . . . . . . . . . . . . . . . . . 20 Causes of Childlessness . . . . . . . . . . . . . . . 23 Physically Tied by Bound Feet . . . . . . . . . . 20 Conception and Sexuality . . . . . . . . . . . . . . 25 The Life of a Girl . . . . . . . . . . . . . . . . . . . . 21 Couldn’t It Have Been Different? . . . . . . . . 26 Continuation of the Family in the Afterlife . 21 IX