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Over the course of more than twenty years of clinical practice and research, I developed the Five-Step Acupuncture Method for Infertility. Traditionally, classical acupuncture treatment for infertility followed a four-step framework. However, modern patients present new challenges: many women are found to have poor endometrial quality upon examination, and experience dark brown discharge or blood clots at the beginning and end of their menstrual cycles.
To address these issues, I introduced a Five-Step, the second-step applied during the final one to two days of menstruation. This step serves a unique purpose—helping the body to “clear out the old and welcome the new,” thereby improving uterine lining health and creating a more receptive environment for conception. Given today’s lifestyle, environmental, and social factors, I believe the classical four-step method is no longer sufficient.
The Five-Step Method thus represents both an innovation and an extension of the classical tradition, tailored to modern needs. It integrates the wisdom of Traditional Chinese Medicine with contemporary clinical realities, offering a more comprehensive and effective acupuncture protocol for infertility treatment.
Author: Liu Jing
Arizona, USA
Published in: Renowned Doctors, Issue No. 75, August 2019
CN44-1666-R, ISSN 1674-9561
The incidence of infertility in the United States has been on the rise. When modern medical treatments yield unsatisfactory results, acupuncture presents a viable and effective alternative. Based on the pathophysiological characteristics of American infertility patients namely qi and blood deficiency, damage to the Chong and Ren meridians, and visceral dysfunction, the five-step acupuncture method, developed in accordance with the physiological rhythm of the menstrual cycle and guided by basal body temperature (BBT) patterns, has been clinically effective. It regulates the neuroendocrine system, soothes emotional distress, balances yin and yang, and improves the likelihood of conception.
Keywords: Infertility; United States; Acupuncture; Menstrual Cycle; Five-Step Method
In the United States, infertility is defined as failure to conceive after two years of regular unprotected intercourse. The WHO revised the standard to one year in 1995. A U.S. epidemiological study found that between 1982 and 2010, 9% of men and 11% of women of reproductive age experienced infertility. Another study reported that 12–15% of American couples fail to conceive after one year of trying, and 10% still cannot after two years. Thus, infertility has become a modern disease affecting the lives of many young Americans.
From decades of practicing Chinese medicine in the U.S. and treating hundreds of infertility cases with acupuncture, the author has observed both external and internal causes. External factors include pathogenic influences such as cold, especially during harsh winters, which may lodge in the uterus and cause infertility. Internal causes include emotional stress, imbalanced lifestyle, constitutional weaknesses, and excessive sexual activity. Common emotional factors such as anger, anxiety, overthinking lead to irritability and tension, significantly affecting fertility.
Dietary habits such as frequent consumption of rich, greasy foods (e.g., steak, cake) and cold drinks are also contributing factors. In terms of TCM pathogenesis, three main mechanisms are commonly observed in American patients: (1) qi and blood deficiency and disharmony; (2) damage to the Chong, Ren, Du, and Dai vessels, uterus, and uterine collaterals; (3) visceral dysfunction, particularly of the Liver, Spleen, and Kidney. Patients with short disease duration often show qi and blood deficiency, while those with prolonged conditions or advanced age frequently exhibit multi-organ disharmony. Regardless of severity, damage to the extraordinary meridians and uterine system is nearly always present. Treatment should thus focus on replenishing qi and blood, restoring organ function, and unblocking the reproductive meridians.
Modern medicine views reproductive function as dependent on the hypothalamic–pituitary–gonadal (HPG) axis, a delicate endocrine–neural feedback system. Disruption of this axis due to long-term use of birth control, hormone treatments, psychological stress, diet, lifestyle, or excessive intercourse can inhibit hormonal regulation and contribute to infertility.
In clinical observation, BBT charts of American infertility patients can be classified into five types:
– Zigzag-shaped: Often associated with Liver qi stagnation
– Short-High Type: Short cycles (approximately 20 days), earlier ovulation; often related to dual deficiency of qi and blood or yin deficiency with internal heat
– Delayed/Ovulatory Type: Long cycles (>30 days), delayed ovulation; may indicate Spleen-Kidney yang deficiency, phlegm-dampness, or qi stagnation with blood stasis
– Short Luteal Phase Type: Normal follicular phase (13-15 days), but luteal phase <13 days with slow temperature rise; usually Spleen-Kidney yang deficiency
– Prolonged Follicular Phase Type: Ovulation delayed beyond 16 days; often due to phlegm-dampness or Spleen-Kidney yang deficiency
The zigzag pattern can overlay any of the above types. Understanding the BBT pattern helps guide TCM diagnosis and targeted treatment.
Step 1 – Menstrual Phase (Days 1–7): Use electroacupuncture or warm needle to promote blood circulation and dispel cold. Supplement with qi, blood, and Kidney yin tonics.
Step 2 – Post-Menstrual Phase (Days 7–12): For early ovulation: nourish yin and reduce internal heat. For delayed ovulation: tonify both yin and yang, warm the Spleen, and resolve phlegm.
Step 3 – Ovulatory Phase (Days 12–14): Assist ovulation by tonifying both yin and yang to balance the system.
Step 4 – Luteal Phase (Days 15–25): Maintain progesterone secretion, focus on Kidney yang supplementation to support luteal function.
Step 5 – Pre-Menstrual Phase (Days 25–28): Continue Kidney yang support; start invigorating blood on Day 26 to prepare for the next cycle.
In summary, the follicular phase emphasizes nourishing yin, the luteal phase focuses on warming yang ultimately achieving balance between the two.
Primary Points (alternating sets):
– Group 1: PC6 (Neiguan), SP6 (Sanyinjiao)
– Group 2: PC6, Yintang, SP6
Supplementary Points Based on Patterns:
– Liver qi stagnation: CV17, Four Gates (LI4 + LV3), HT7
– Spleen-Kidney yang deficiency: BL20, BL23, GV4
– Qi-blood deficiency: GV20, CV6, CV4, ST36, ST25
– Liver-Kidney yin deficiency: SP10, KI3
PC6 (Neiguan) is a confluent point of the Yin Linking Vessel and regulates Chong and Ren meridians while calming the mind suitable for emotional tension in infertility. SP6 intersects the Liver, Spleen, and Kidney channels, nourishing essence and blood. Yintang helps calm the spirit, enhancing emotional balance.
In the U.S., many infertility patients seek TCM only after exhausting other treatments. This method has shown superior outcomes compared to conventional acupuncture, shortening treatment cycles by 4–6 weeks and significantly improving pregnancy rates.
Patient: Linda, Female, born Dec 1970 (Age 41)
Diagnosis: Infertility for 8 years; failed multiple Western treatments
Symptoms:
– Menstrual cycle 24 days, light flow (2–3 days), pale color
– Palpitations, fatigue, cold limbs, lower back/knee soreness
– Low libido for 2 years
– Tongue: pale, swollen, scalloped; coating thin and white
– Pulse: deep, weak at right Chi position
Western Findings:
– Uterus, ovaries, and fallopian tubes normal
– FSH: 16, AMH: 0.84
– BBT pattern: prolonged follicular and short luteal phase
TCM Diagnosis: Spleen-Kidney yang deficiency with Heart qi deficiency
Treatment: Warm and tonify Spleen and Kidney, tonify Heart qi, nourish blood, regulate menstruation
Acupuncture Points:
– Primary: PC6, SP6
– Front: GV20, CV6, CV4, ST36, ST25, KI7
– Back: BL15, BL20, BL23, GV4
Frequency: 4 times/week, both front and back
Outcome:
– After 8 weeks: FSH dropped to 6.6, AMH increased to 1.27, symptoms improved
– After 8 more weeks: conceived in March 2013
– Delivered a healthy baby boy in January 2014
Using the Five-Step Acupuncture Method based on the menstrual cycle not only improves local uterine and ovarian function but also regulates the whole-body balance of yin, yang, qi, and blood. This holistic regulation of the neuroendocrine system enhances reproductive organ function, significantly increasing pregnancy rates. As a safe and effective method, it is worthy of broader application and promotion in the United States.
Figure 2 | Linda’sBasal Body Temperature (BBT) Chart
The green curve represents the month before treatment (Nov), the purple curve shows the first month after acupuncture treatment (Jan), and the red curve illustrates the third month after treatment (Mar), during which the patient successfully conceived.
Fig. 2 | Cycle–Hormone–Lining: Estrogen builds the ‘soil’ in the follicular phase; LH surge triggers ovulation; progesterone ‘waters’ the lining and creates the implantation window.
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