The research progress of Chinese medicinal food therapy on infertility

Zhong Zhang ,Zhe-Feng Liu*

1Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712046,China.

Abstract Infertility is one of the common gynecological diseases,and the incidence has been on the rise in recent years,and according to WHO,infertility will become the third most serious disease after tumor and cardiovascular disease in the 21st century.Food therapy and medicine in China has a long history,Sun Simiao Valuable Prescriptions for emergencies:"If you can use food to calm the disease,release the emotions and dispel the disease,can be said to be good workers",which is also an important embodiment of the Chinese medicine "cure the disease"idea.With the improvement of the living standard of Chinese residents in recent years,food therapy and medicinal food have become popular as a new treatment method because of its efficacy and ease of acceptance.The author summarizes and summarizes the research results of Chinese medicine and medicinal food in the treatment of infertility in recent years in order to provide reference for clinical treatment of infertility.

Keywords:dietary therapy;medicinal food;infertility

Background

Infertility refers to women of childbearing age who have normal sexual intercourse within one year without taking contraceptive measures but do not get pregnant [1],and this disease belongs to the category of "total failure to give birth","extinct birth" and "extinct son"in Chinese medicine.The data show that infertility accounts for 10%to 15% of women of reproductive age worldwide [2].In addition to conventional Western medicine and traditional Chinese medicine,dietary therapy is popular for its ease of use and low side effects.

Etiology and pathogenesis of infertility

Dysfunction of Tiankui,Chongren

Huangdi’s Cannon of Medicine:"two seven,and the Tiankui arrived,the Ren pulse through,Tai Chong pulse Sheng,the monthly events to time down,so impregnation",it means The prerequisite and necessary condition for a woman to have a normal pregnancy is the fullness of the heavenly sperm,the coordination of the impulses and the regularity of menstruation.On the other hand,"seven seven,any pulse is deficient,Tai Chong pulse is weak,the heavenly sap is exhausted,the earth is not accessible,so the form is bad and childless." The exhaustion of the heavenly sap leads to the deficiency of kidney essence and kidney qi,and the imbalance of the Qi and blood of the ramus,which is the main pathogenesis of infertility [3].

Kidney deficiency

Huangdi’s Cannon of Medicine:"The kidney,the main dormant,the essence of the essence of the essence." If a woman is congenitally deficient,or if she has a long illness,or if she has many births,it can lead to deficiency of kidney energy.The development and reproductive function of the reproductive organs of the body are closely related to the strength and weakness of the essence in the kidneys,therefore,deficiency of kidney qi is the main pathogenesis of infertility [4].

Liver depression

Fuqingzhu Gynecology:"If the three veins are depressed,the liver qi will be more depressed because of it,and if the liver qi is depressed,the heart and kidney veins will cause the extreme of depression and cannot be solved." Liver qi depression leads to loss of drainage of the liver,which affects the heart main blood vessels,resulting in poor flow of qi and blood,in addition to affecting the function of the kidneys as the main reservoir of essence,especially affecting the normal reproductive function [5].

Phlegm dampness

Danxi Xinfa:"If a fat woman,endowed with very thick,wanton in the wine and food people,menstrual water is not regulated,cannot become a fetus,called the body fat full overflow,closed womb." If a woman is obese,or if she is not disciplined in her diet,and if she eats fat,sweet and thick,she is prone to the evil of phlegm and dampness,which can block the uterus and lead to infertility [6],and the study of ancient literature by Sun Ranran [7]shows that phlegm and dampness is the soil of infertility development.

Blood stasis

The Treatise on the Origin of Diseases:"Blood stagnates in the uterus,and the qi of yin and yang cannot be applied and transformed,so there is no child." Blood stasis stagnates in the uterus and makes it difficult to conceive if yin and yang are not regulated.In addition,if the stagnant blood does not go away,it is difficult to produce new blood,and if the kidneys are not nourished,it is difficult to produce the reproductive essence,resulting in infertility.Ma Kun [8] considered blood stasis as the basic pathogenesis of tubal infertility.

External evil

The Treatise on the Origin of Diseases:"If the wind and cold enter the substratum,it makes the organs cold,...,the cold and heat are not regulated,and the wind and cold,which visit the uterus,cause illness in the uterus,or menstruation is astringent and closed,or collapse of the blood and bring down,resulting in disharmony of the qi of yin and yang,and the menstrual blood is misbehaving,so there is no child." A woman who has an external wind-cold infection,which is guest in the uterus,injures the healthy qi,and the qi and blood become unregulated,eventually leading to infertility [9].

Modern studies on infertility patterns have shown [10] that the etiology of infertility patients is mostly based on kidney deficiency type,followed by blood stasis,phlegm-dampness,liver depression and other types.Bai Yiling [11] showed that based on the theory of"kidney deficiency and blood stasis" in Chinese medicine,immune infertility can be treated by tonifying the kidney and invigorating the blood,and it has been proven to be safe and effective.Pan Zimeng[12] showed that phlegm and dampness can affect sex hormones and glucose metabolism,which in turn leads to infertility and is the main causative factor in polycystic ovary syndrome (PCOS) infertility patients.In addition,liver depression and blood stasis are also common cause of infertility [13].

TCM evidence of infertility

Kidney deficiency

Patients with kidney deficiency type are mostly due to congenital deficiency and multiple births due to room strain,and patients are often seen to be infertile after marriage and have soreness and weakness in the waist and knees.Patients with kidney yang deficiency are usually suffering from yang deficiency or due to cold evil injuring the kidney.Patients can see late menstruation with low volume,light color,thin texture,soreness and coldness of the waist and knees,dull complexion,clear and long urine,loose stools,pale tongue with white fur and sunken pulse.Fuqingzhu Gynecology:"The land of cold ice does not produce grass and trees;the abyss of heavy yin does not grow fish and dragons.Now the uterus are cold,how can conception." Fu Shan believes that the cold condensation of the uterus is like the difficulty of growing grass and trees in a cold place,so it is also difficult for such a uterus to conceive.The uterus is the internal organs of extraordinary and has the physiological function of conceiving a fetus,while the innate essence stored in the kidneys is the original material that constitutes the embryo,all of which requires the promotion and warmth of kidney yang.Patients with kidney yin deficiency can see pre-menstruation with low volume,red color,thick texture,irritable heat in the five hearts,insomnia and dreaminess,light or red tongue,little moss and thin pulse.Kidney-Yang deficiency can cause low luteinizing hormone levels or short secretion time,leading to endometrial dysplasia and difficulty in conception [14].Insufficient yin and blood leads to deficiency in the sea of blood and loss of nourishment for the uterus,thus leading to infertility.Liu Zhuo [15].applied the method of nourishing the kidney and filling the sperm to treat patients with kidney yin deficiency in in vitro fertilization-embryo transfer (IVF-ET),and the study showed that the method of nourishing the kidney and filling the sperm significantly improved endometrial tolerance,egg quality and dual microenvironment.

Disorder of Gastric Qi

Patients with Liver-Qi Stagnation type mainly present with irregular menstruation,high or low volume,dark color,blood clots,often accompanied by chest and breast swelling and pain,depression or irritability,light red tongue,thin white fur,and string veins.Liver Qi stagnation leads to loss of drainage of the liver and deregulation of the flushing process,which may lead to infertility after marriage.Ji Yin Gangmu-child-seeking door:women more gas more depression,more gas is fire,more depression is blood stagnation,so the meridians do not work,all diseases,fertility way is blocked."The malfunction of the liver can affect ovulation and menstruation in women,so clinical treatment of gynecological diseases,including infertility,should focus on regulating the liver,so there is aClinical Guide to Medical Cases-Regulating Menstruation:"Women take the liver as the precursor."With the liberalization of the national two-child policy,the proportion of infertility patients with liver qi stagnation type caused by increased psychological stress has increased [16].

Phlegm resistance

Patients with phlegm-dampness internal obstruction type mainly manifest as late menstruation,excessive amount ofleucorrhea,white and sticky in texture,palpitations and dizziness,vomiting and chest tightness,patients are mostly obese,with a pale fat tongue,white greasy moss and slippery pulse.Bamboo Forest Temple Women's Science Secret Chuan-Volume 4 Seeking Heirson the record:"Phlegm is strong body will be fat,fat is too fat lower body,the uterus shrink into,difficult to fertilize." The authors first point out that patients with internal phlegm and dampness are characterized by an obese form,and that dampness is sticky and heavy,easily obstructing the qi flow and congesting the uterus,making it difficult to conceive.Prof.Xia Guicheng [17] believes that deficiency of kidney yin and sebum is the root cause of spleen deficiency of phlegm and dampness;yin deficiency over time,yin loss and yang,yang deficiency without the ability to warm the spleen and earth,and spleen-yang deficiency leading to phlegm and dampness congestion.

Blood stasis obstructing uterus

Patients with stasis uterus type are mostly seen in the late menstrual period,with high or low volume,purple and black color,blood clots,often accompanied by dysmenorrhea,pain in the lower abdomen or anal swelling and other discomforts on weekdays,with a purple and dark tongue,stasis points on the edge of the tongue,and astringent pulse.Zhang's Medical Generalrecords that "for those who are infertile due to stasis of the uterus,the uterus is not clean,or the menstruation is closed,into the collapse,and the body is deficient in cold and heat,the bureau formula wrinkled blood pill is the special medicine."Internal stagnation of blood stasis,dysregulation of the flushing and the flow of Qi and blood,and blockage of the uterine vessels,thus causing infertility,either due to cold stagnation of blood,or Qi stagnation of blood,or Qi deficiency of blood.Deficiency of kidney essence affects blood production,and blood is the mother of qi;blood deficiency leads to qi deficiency and blood stagnation,thus causing blood stasis[5].

Studies in the literature on Chinese medicinal dietary therapy for infertility

reinforcing kidney essence

Zhang Yi [18] classified infertility patients into evidence types such as spleen and kidney deficiency and kidney deficiency and blood cold by identifying the evidence.Patients with kidney deficiency and blood coldness were treated withCervus nippon Temminck(Lurong) with golden silver abalone,Ginsen Radix Et Rhizoma Rubra(Hongshen) andPoria Coco(Fuling),Atractylodes Macrocephala Koidz(Baizhu) stewed with beef tendon for patients with spleen and kidney deficiency,andAmerican ginseng(Huaqishen) andLilii Bulbus(Baihe) stewed with water duck for patients with liver and kidney deficiency.Ye Xiuying[19].treated polycystic ovary syndrome infertility by using the dietary therapy pot 1 formula with black-bone chicken and pork ribs to nourish yin and fill essence to nourish the bubble in patients with identified kidney deficiency type of infertility.The medicinal use of black-bone chicken has a long history,from the ancientClassic of Materia Medicato the contemporaryJournal of Traditional Chinese Medicine,and the "Black Chicken and White Phoenix Pill",which uses black chicken as the main medicine,originated from thePuji Formulain the Ming Dynasty and is still a common gynecological remedy today[20].In terms of consumption,Pan Rixin.[21] analyzed the composition and content of amino acids in black-bone chicken,and the meat contained 17 amino acids,13 of which were higher than those of common white chicken,and the total amino acid content was also higher than that of common white chicken,especially the content of cysteine.Liu Yinglian [22] selected 78 patients with ovulatory dysfunctional kidney deficiency evidence of infertility in PCOS as the study subjects,and randomly divided into 39 cases each in the control and experimental groups.The control group was given letrozole oral treatment,and the experimental group was given letrozole orally combined with warming ovary pot with the following herbs:Hedysarum Multijugum Maxim(Huangqi) 15 g,Rhizoma Dioscoreae(Shanyao) 15 g,Polygonati Rhizoma(Huangjing) 15 g,Dendrobium(Shihu) 10 g,Morindae Officinalis Radix(Bajitian) 8 g,Notoginseng Flos(Sangqihua) 5 g.The ingredients:quail 100 g.Comparing the efficiency,ovulation rate and pregnancy rate of the two groups,the experimental group was superior to the control group.Professor You Zhaoling [23] in clinical practice treated patients with IVF-ET failure with a medicinal diet that helps follicle growth and development with significant results,and the patients became pregnant spontaneously the following year.Nourishing bubble pot:above removePolygonati Rhizomaand addRhizoma Dioscoreae15 g;warming ovary pot:1Corayceps(Dongchongxiacao),2Dendrobium officinale(Tiepishihu),15 g ofPolygonati Rhizoma,100 g of quail or squab;studies have shown that the advantages of natural squab are high protein,high fat,and contain special amino acids at special physiological stages,in addition to unmeasured enzymes,growth factors,and other unmeasured bioactive substances [24].In the book ofRites and Rites of Qu,quail is said to be "a gift for the upper dafu",it is a high protein,low fat food,with a higher protein content per 100 g than pork,beef and lamb,and a lower fat content than the above meat [25],in addition,quail is rich in inosinic acid,which is a source of "fresh taste" [26].Wu Yuanfei[27] randomly grouped 134 patients who had failed IVF-ET and were to undergo frozen-thaw embryo transfer(FET),66 in the control group and 68 in the observation group.Patients in the control group were given conventional nursing interventions,and patients in the observation group were given comprehensive nursing interventions such as conventional nursing combined with medicinal diets.The formula of the medicinal diet group:6 g ofPseudostellariae Radix（Tàizǐ shēn),10 g ofRhizoma Dioscoreae,10 g ofLycii Fructus(Gouqi),6 g ofJujubae Fructus(Dazhao).comparing the results,the pregnancy rate of the observation group was higher than that of the pair (60.82% vs.53.03%),and the miscarriage rate was lower than that of the control group (5.88% vs.16.67%),and the differences were all statistically significant (P＜0.05).Li Yao [28] randomly divided 60 patients with ovulatory disorders of infertility into observation and control groups with 30 cases in each group.Both groups were treated with letrozole,and the observation group was treated with Chinese herbal medicine and medicinal food,and the medicinal food group recipe:Polygonum multiforum Thunb(Heshouwu),Lycii Fructus,Achyranthis Bidentatae Radix(Niuxi),Polygonati Rhizoma,Cistanches Herba(Roucongrong),and Quail.Comparing the results such as total effective rate and pregnancy rate,the observation group was better than the control group (P＜0.05).

Reconciliation of the heart and spleen

Kang Jia [29] proposed the use of medicinal dishes for the treatment of heart and spleen deficiency type decreased ovarian reserve function(DOR) infertility.Congee to help pregnancy:Hedysarum Multijugum Maxim15 g,Rhizoma Dioscoreae15 g,Rehmanniae Radix Praeparata(Shudihuang) 15 g,Lycii Fructus15 g,Cistanches Herba15 g,Nelumbinis Plumula(Lianzixin) 3 g,glutinous rice 50 g;Yimu drink:Nelumbinis Plumula,Lilii Bulbus,Dimocarpus longan Lour(Longyan) 15 g each,rock sugar,black soybean milk in appropriate amount;Heart nourishing soup:Jujubae Fructus,Hedysarum Multijugum Maxim,Poria cocos15 g,1 pig heart;pig heart is rich in protein,and the protein content is twice that of pork,while the fat content is about one-tenth that of pork,which has the effect of nourishing the heart and replenishing blood,calming and calming the mind [30].

De-stressing the liver

Zhang Yi [18] usedCitri Sarcodactylis Fructus(Foshou)Rose Rugosae Flos(Meiguihua) stewed with lean meat to treat kidney deficiency and liver depression type of infertility.Rose Rugosae FlosandCitri Sarcodactylis Fructusare both qi-regulating herbs and both belong to the liver,spleen,and lung meridians,and the combination of the two herbs has the effect of relieving depression in the liver and relieving pain.The Ming Dynasty'sFood Materia Medicarecords that "rose is good for the lungs and spleen,beneficial to the liver and gallbladder,and wards off evil spirits".Modern research shows [31] thatRose Rugosae Flosis rich in vitamin C,glucose,malic acid,a variety of amino acids,etc,with antioxidant,antibacterial,antiviral,antitumor,hypoglycemic effect.The Ming DynastyDian Nan Ben Caorecorded the efficacy ofCitri Sarcodactylis Fructusas:tonifying the liver and warming the stomach,stopping vomiting,eliminating cold phlegm from the stomach home,treating stomach gas pains,stopping cold pains in the face,harmonizing the middle and moving the qi [32].Modern studies [33] have shown thatCitri Sarcodactylis Fructushas expectorant,cough suppressing,asthma calming and anti-inflammatory effects,and its volatile oil also has antidepressant effects [34].

Expelling dampness and strengthening the spleen

"Spleen liking dryness and disliking dampness" is a physiological characteristic of the spleen,and it is stated inHuangdi’s Cannon of Medicinethat "all dampness,swelling and fullness belong to the spleen".Yang Hongwei [35] applied the method of strengthening the spleen to treat infertility,using duck kidney stewed withMalt (Maiya)andValley sprouts(Guya) to eliminate dampness and strengthen the spleen,using pork tripe stewed withLablabSemenAlbum(Baibiandou),Coicis Semen (Yirenmi) andPoria Cocosto eliminate dampness and strengthen the spleen,and using beef stewed withCodonopsis Radix(Dangshen),Poria Cocos,Atractylodes Macrocephala Koidzto benefit qi and strengthen the spleen,which was obtained by adding and subtracting Sijunzi Tang,in clinical practice,Professor Luo Songping [36] specializes in using Si Jun Zi Tang with addition and reduction to benefit Qi and strengthen the spleen,which promotes the thickening of the endometrium and nourishes the ovum to promote pregnancy.Pan Ru [37] concluded that Hougong congee has the effect of strengthening the spleen,drying dampness,and resolving phlegm,with the following herbs:10 g ofArum Ternatum Thunb(Banxia),10 g ofPoria Cocos,10 g ofAtractylodes Lancea(Thunb.)Dc（Cangzhu),Citrus Reticulata(Chenpi),20 g ofCyperi Rhizoma(Xiangfu),20 g ofMedicated leaven(Shenqu),6 g ofChuanxiong Rhizoma(Chuanxiong),and 100 g of rice,this composition of this prescription was obtained by addition and subtraction of Qigong Pill.Studies have shown that Qigong Pill can help pregnancy by improving the levels of FSH,LH[38] and increasing endometrial thickness [39] in infertile patients.Zhang Yi[18] usedPanax Notoginseng(Sangqi)andPoria Cocosstewed with bamboo silk chicken to treat patients with kidney deficiency and phlegm-dampness,and the bamboo silk chicken used in the recipe is one of the species of black-bone chicken,whose nutrient composition is similar to that of the previously mentioned black-bone chicken[40].

Invigorating blood circulation and removing blood stasis

Feng Xinying[41].usedScorpion(Quanxie)boiled withPhaseoli Semen(Chixiaodou) andThalluslaminariae(Kunbu) to treat infertility of blood stasis uterus type.Scorpionis a high-protein,low-fat drug or food [42].Yan Shiming [43] showed that deficiencies in trace elements such as iron,zinc,and manganese can lead to infertility,and consumption of kelp can supplement these trace elements to help pregnancy [44].Hao Xiaoyun [45] showed that whole scorpion extract can activate blood circulation and remove blood stasis by inhibiting thrombosis,and the mechanism was clarified [46].

Conclusion

In the treatment of infertility,medicinal food is mostly used to treat infertility patients with kidney deficiency,and the formula is mostly based on soup and boiling,which is convenient to use and easy to digest and absorb.From the perspective of the same source of medicine and food,a reasonable and scientific combination of medicinal food can also have a therapeutic effect of supporting the righteousness and eliminating the evil,which can be combined with traditional medicine treatment to achieve twice the effect with half the effort.It can be seen from the literature that,with the improvement of people's quality of life and the deepening of the concept of treating the disease in Chinese medicine,therapeutic food is no longer just a health care tool,but is gradually used in clinical practice with significant effects,and it is worthwhile to continue in-depth research to provide new ideas for clinical treatment of infertility.