Fertility and the Moon

A case study – Roisin Golding

First published by the European Journal Of Oriental Medicine – EJOM- Vol 5 Number 3

Much archaic acupuncture theory is considered ‘superstitious’ by modern practitioners. I wanted to find out if the application of some of the older principles of treatment, as outlined in the Neijing, made any difference to treatment. One principle I was interested in is outlined in Su Wen, chapters 26 and 27.

‘Excess and deficiency are in accord with the sequential order of Heaven and sedation and tonification are to be applied in accord with the phases of the moon.’ Su Wen chapter 26

 Chapters 26 and 27 of Su Wen also describe the needle techniques to be used:

‘Sedation makes use of moments. And moments mean that it should be applied the moment the energy becomes full; the moment the moon becomes full; the moment the day becomes warm; the patient calms down; the needle should be inserted the moment the patient inhales, the needle should be turned the moment the patient inhales a second time and should be withdrawn slowly the moment the patient exhales.

‘Tonification makes use of circles.’ Later the text explains that the needle should be inserted when the patient completes his exhalation, and the needle withdrawn when inhalation is taking place.

I considered that using moon cycles was particularly appropriate in cases of infertility. The statement  ‘During the first quarter of the moon the blood and energy begin to purify;, chapter 26, could apply to an idealised menstrual flow which starts with the new moon.  The first half of the menstrual cycle is the yin phase, which corresponds with the moon getting bigger. During this time one can tonify the blood and yin and energy generally rises.

At the time of the full moon ovulation should then occur. Immediately sedation and downward moving energy can be used. During the waning moon, yin diminishes and yang increases. In an ideal menstrual cycle this corresponds to the luteal phase, as the second part of the menstrual cycle is about movement and transformation. If conception is desired, one helps in releasing the fertilised egg from the follicle, eases the smooth downward flow through the fallopian tubes and into the prepared womb.

In treating amenorrhoea in this manner I sought to create a tidal rhythm of blood and qi, alternately gathering, then dispersing, every 14-15 days.

 My approach

In accordance with Su Wen chapter 16, I needled to a depth depending on the season. In winter the needle was inserted deeply. In Spring it was initially inserted deeply, then withdrawn to a more superficial level in order for the qi which hides in the depths of winter to be pulled out towards the surface. In summer the needling was superficial, and in autumn it would be placed superficially initially, then pushed deeper, in order that the yang qi which had gathered in summer could be used to tonify the yin.

I followed the patient’s natural breath. This takes some patience, especially as some people take quite some time between out-breath and in-breath.

For tonification, I inserted the needle after the patient had exhaled fully and just before they took the next breath. I waited again until the patient had exhaled fully a second time before turning the needle clockwise. The needle is withdrawn, after twenty minutes, when the patient is breathing in.

For sedation I interpreted, ‘the moment the patient inhales,’ as meaning has inhaled fully, given the context, e.g. ‘sedate the moment the moon is full,’ meaning energy has reached its peak and is about to wane. I turned the needle gently anticlockwise on the next breath, and after twenty minutes removed it slowly when the patient started to exhale, removing it finally when exhalation was complete, so that it is aligned with their breath entirely.

Case Study

Patient

Female, Mrs. M, age 29.

Relevant Background and Health History

Mrs M suffered with infertility in association with amenorrhoea for the past 20 months, since coming off the contraceptive pill after 10 years of use. Prior to the pill her periods had been very light with spotting, which lasted 6-7 days.

She was diagnosed with having polycystic ovaries and anovulation

Her hormone levels were on the low side of normal. She had a thin womb lining which did not respond to the use of medical drugs.

Mrs M suffered with Raynaud’s syndrome and the medical staff found it very difficult to take blood samples as her veins easily collapsed.

She was not anaemic. She was prone to headaches, mainly in the occipital and neck region.

She was found to be hypoglycaemic and she had an extremely sweet tooth, but she managed to give up sugar.

She was of slender build, and I suspected that she had been extremely underweight as a teenager.

Mrs. M had undergone one failed IVF cycle the previous month. In that cycle eight eggs had been produced, five were fertilised, and two transferred to her womb. Both failed. Her womb lining did not respond to conventional drugs.

Signs and Symptoms

Temperature: she feels extremely cold except in hot weather when she becomes very hot internally, but stays cool to the touch.

Sleep: her sleep is interrupted every night (she lives under a flight path and says this disturbs her sleep.)

Appetite: good – she ate three meals a day.

Diet: Organic, eggs, meat, fish, vegetables and fruit. No alcohol, no coffee, no cigarettes.

Bowels: regular.

Thirsty. 

Urination:  she has frequent urination and nocturia.

Pulse

64 bpm. Left side stronger than the right. Right side very thready overall.

Tongue

Pink, normal coating, quivering. Hammer shaped, i.e. flat front, no tip.

Diagnosis

TCM: ki xu, both yin and yang, spleen qi xu, blood and ying xu.

Stems and branches: weak earth and weak kidneys. Also, heart governor and liver would be good meridians to use, as was yang ming as a pair (i.e. if stomach was used, colon should be used also.)

Points used

I used a selection of points from these meridians, such as St 36, Ren 12, St 37 and 39, and LI 10. Also Bl 11, 17, 23, 20, 18, Ki 13, P 5, P 7, Sp 3, Sp 2.

Treatment Principles

I focused on building up ying qi  initially because I felt this was an underlying cause of her disturbance and that the kidney had not been replenished by postheaven qi. Choosing points in accordance with the month, the season and the time of day was also given high priority.

Treatment description

Mrs M first came to see me in July 2003. This case has three distinctive phases.  

Phase one – assisted IVF.  (July to November 2003)

The first phase did not incorporate moon cycles as Mrs  M wanted assistance with orthodox fertility treatment. When a patient is having fertility treatment there is no point whatsoever in aligning a women’s cycle with the moon as it is being manipulated by drugs.  She had already started on a new IVF regime by the time she came to see me. I gave her two acupuncture treatments a fortnight apart. However, this cycle failed to produce follicles and the womb lining remained poor. She did not bleed after stopping medication and so she was administered drugs to induce a bleed.

She started a new IVF cycle in late September.  Her pulses were overall empty, particularly at the ying level. Points to support her kidney and to bring blood and qi to the womb were used. St 36, LI 4, Ren 10 and 7, and St 25 produced a good pulse change. Ki 13, Sp 6, Sp 10 were used, with moxa over Ren 4 and 6.

This cycle was complicated by the development of a cyst and she was admitted to hospital to have it removed.  She continued with fertility drugs. Despite this, she developed 15 eggs, 13 of which fertilised. Two embryos, grade one at eight cells, were put back, but the womb lining remained thin. This cycle ended in failure at the end of November 2003 and she produced a period.

Phase two – to establish regular menstrual cycle. (November 2003 to June 2004).

Thankfully Mrs M decided to suspend drug treatment for six months to see if she could get a normal menstrual cycle with the help of acupuncture, since orthodox treatment had failed. This phase consisted of four months of almost weekly treatment, ending with fortnightly treatments.

Waxing moon phase: – tonify and send energy upwards

1. Bl 23, Ki 3, P 7, P5. (these last two points were particularly energised at that specific time according to stems and branches theory.)

2. Yin chiao – used in waxing moon to send kidney and Earth creative energy (asin Heaven and Earth) upwards. This improves ovarian function, and increases cervical fluid. Also Ki 2 In Mrs M’s stem chart was weak, and this is a point of yin chiao.

 Waning moon phase: – sedation and send energy downwards.

 3. Sp 6, St 37, 39, P 7, all dispersed! This was a difficult decision, since Mrs M was obviously deficient. However, when a vessel is totally empty one needs to remove any stagnant material in order to create and store new material. Sp 6 has a strong downward action, which can bring on periods when they are due, or bring on ovulation. 

Waxing moon: – tonify and send energy upwards

 4. Bl 11. This used with no other points, to open the sea of blood.

5. There was still no sign of period, after almost six weeks, but a full moon was due in two days time and so I thought it unlikely that a period would arrive until the day after the full moon. I ventured to suggest that this might be the case (this was the first mention of the moon as Mrs M was a sceptic.) Bl 17, 18, 23, 20.

 Waning moon: – sedation and send energy downwards.

 6. Her period did arrive the day after the full moon, and lasted three days. One and a half days of good bleed, the rest light. Sp 6, Co 4, Liv 4 all sedated. She later visited a new fertility hospital and a scan revealed that the cyst had disappeared, but unsurprisingly her womb lining remained thin.        

Treatment continued in this manner for a couple more treatments. Another light period arrived again six weeks after the previous one, a day after the new moon.  However, she remained unconfident that ovulation was taking place or would ever take place.

By now her pulses were filling a little but were more choppy. I thought her energies were too weak to circulate blood adequately. She had a third period after six weeks, this time one day before the full moon on the 4th April. I hoped that the next period would be in four weeks time and that ovulation would occur in good time.

Four weeks later she had some spotting of blood, occurring two days after the full moon which was also the time of an eclipse,. Two weeks after that, (six weeks after her third full period) at her follow up appointment at her new fertility hospital, she discovered during the scan that she was in fact already 5- 6 weeks pregnant! Her womb lining was very thick. Her consultant recommended that she start taking aspirin and progesterone with immediate effect .

I suggested Women’s Precious pills, a blood and qi tonic, as an alternative. She decided to take both. Her pulses were good on the left side but very weak on the right. I stopped dispersing and just gathered energy.

Mrs M had a scan on 4th June 2004 which showed a normal sized foetus with a heartbeat. She suffered a number of episodes of spotting and unfortunately miscarried 10 days later – at approximately 10 weeks of pregnancy. After a D and C Mrs M had a prolonged bleed.

Although Mrs M’s pulses had picked up during the pregnancy, they were initially extremely weak and I was not confident that she could carry the child. Later she confessed that she had felt extremely shocked, physically and emotionally, by discovering that she was pregnant at the infertility hospital. She had remained highly anxious and unconfident throughout her pregnancy, and initially had suffered with insomnia.

Phase three -trying for pregnancy (July 2004).

I treated on average every two weeks. I used gathering and dispersing according to moon cycles as before. The extra meridians were emphasised more. Chong mai and yin chaio, as well as Ren were used. A Chinese herbal remedy, Growing Jade, to tonify kidney jing was tried for two weeks only during the waxing moon, but she did not want to continue taking herbs.

Monthly periods became established immediately, always within two days of the new moon. After her third period, which started one day after the new moon, she became pregnant again. She then had monthly acupuncture until her twelve week scan showed that everything was fine. She had another treatment at six months.  Besides one treatment for a heacache, she did not require any further treatment. Her pulses were good, she was more confident, and a baby girl was born 4th July, 2005, two days before the new moon (a little over-due.) 

Comment 

 After four months of trying conventional fertility treatment alongside acupuncture we changed the aim of treatment to establish natural cycles. Three menstrual cycles at six weekly intervals were produced without delay.  Mrs. M concieved in the third cycle.   

This pregnancy happened far too quickly and I was not confident in its viability. Unfortunately Mrs. M miscarried at 10 weeks.

 After the miscarriage  three monthly interval menstrual cycles were established without delay, followed by the second pregnancy taken to full term and a beautiful baby daughter was born.

Conclusion: incorporating Daoist concepts of time brings a whole new dimension to holistic acupuncture practise.  Using the moon phases to help regulate menstrual cycles for women with no or very poorly regulated cycles is beneficial. Correct needle technique is paramount, and paying lip service to the phases of the moon or just using the correct points will not have the same effect.