Although the goals of Complementary medicine and conventional Western medicine are the same, their ideas about what causes a disease, the nature of the disease itself, and the process used to regain health are very different. The physician learns that disease must be cured by prescribing medicine or by surgery. There is nothing inherently wrong with this approach. It often works. But why does Complementary medicine succeed where conventional Western medicine sometimes fails? What is it about acupuncture and herbal medicine that can result in relief of symptoms or even a cure that is often lacking in conventional Western medicine?
Though the ultimate result of Complementary medicine care is to cure the
patient, the doctor of Complementary medicine attempts to do this by treating
the whole person, taking into account the various attributes of an individual
that, when combined, account for an individual’s health status.
A person, according to the tenets of Complementary medicine, is more than
their condition. To treat just the condition may yield results, but, however
impressive, these results are usually temporary.
People are not, according to Complementary medicine, represented solely
by their illness, but by the accumulation of every human interaction engaged
in from the moment of their birth and by the culture they are exposed
to. The emotional experiences, eating habits, work habits, work and living
environment, personal habits, and social network all contribute to their
disease, and are factors that, when changed appropriately, may lead to
The power and effectiveness of Chinese medicine is evidenced by its long
history of continued success. More than a quarter of the world’s
population currently uses Complementary medicine as part of their health-care
regimen. Chinese medicine is the only form of classical medicine that
is regularly and continuously used outside of its country of origin.
The experienced doctor must use his or her own interpretive skills and
consider not only what the patient reports to them about their condition,
but also what they reveal without meaning too and what they don’t
express. This leads to a better understanding of who the patient is and
what the deeper, underlying cause of their condition may be.
The practitioner of Chinese medicine is trained to observe one’s
tone of voice, complexion, eyes (in Complementary medicine, the shen or
sprit of an individual is said to be revealed through the eyes), facial
expression, overall demeanor, and how one walks, sits, and stands, and
to use these observations to arrive at a diagnosis. Before the patient
says one word, the doctor already has some idea of who this person is,
clinically, simply by observing them.
A great doctor is one who can process a mix of medical knowledge with
a personal sensitivity based on experience. The practitioner of Complementary
medicine specializes not just in inserting needles or prescribing herbal
remedies, but in being able to see ‘hidden’ or subtle conditions
that may not been seen or understood by practitioners of other types of
medicine. This ability to see these hidden elements is difficult to master,
and is done without the benefit of modern technology.
The only diagnostic tools used by practitioners of Chinese medicine are
the “Four Examinations”: Observing, Listening/Smelling, Questioning,
and Palpating. This method of diagnosis dates back over 3,000 years, and
although it may seem quite simple, it is far from simplistic. Each of
the Four Examinations can take years to master, and the astute practitioner
uses them to arrive at a differential diagnosis. With the advent of technology—as
amazing, necessary, and beneficial as it is—there seems to be a
direct correlation between advances in technology and a decline in doctor
sensitivity to the patient, and thus, misdiagnosis. The ability to listen
and observe clearly, yields gems that are clues to the cause of disease.
This is the stuff of Complementary medicine.
Proper treatment in Complementary medicine is more than the elimination
of the disease. In addition to attacking a factor that is contributing
to the disease process, it is the responsibility of the practitioner of
Complementary medicine to support the individual in his or her goal of
achieving overall total health, which includes the physical, psychological,
emotional, and spiritual aspects of the patient. This multidimensional
approach is crucial to the process of healing. Without it, practitioner
are merely “chasing” the sickness and forgetting that the
patient is much more than their disease. They are a whole person—the
sum of a lifetime of experiences.
Pathologies are guests (and we hope temporary ones!) in a home that serves
as a gracious host—our physical, emotional, and spiritual selves.
Complementary medicine first is concerned with strengthening the immune
function, which includes balancing the physical, emotional, and spiritual
attributes of the patient, so as to be able to assist the patient in his
or her endeavor to do battle and destroy the “enemy at the gates.”
When people can’t sleep because they are anxious and depressed,
they become chronically exhausted and chronically sick as a result of
a compromised immune system.
The key to cure is to not view curing the disease itself as the be-all
and end-all in treatment, but instead to treat the root of the disease—the
anxiety and depression that causes the insomnia, which facilitates exhaustion,
which lowers the immune function, which leads to chronic illnesses. So
rather than prescribing antibiotics repeatedly, a practitioner of Complementary
medicine might address the patient’s anxiety/depression syndrome
or refer them to a psychotherapist for appropriate intervention while
simultaneously providing Complementary forms of treatment.
Infertility and Complementary Medicine: Mechanisms of Action
Historically, infertility—particularly “functional”
infertility—was attributed to psychological problems of one or both
partners. Preliminary works in the 1940s and 1950s considered “psychogenic
infertility” as the major cause of failure to conceive in as many
as 50% of cases. As recently as the late 1960s, it was commonly believed
that reproductive failure was the result of psychological and emotional
factors. Psychogenic infertility was supposed to occur because of unconscious
anxiety about sexual feelings, ambivalence toward motherhood, unresolved
Oedipal conflict, or conflicts of gender identity.
Fortunately, advances in reproductive endocrinology and medical technology,
as well as in psychological research, have de-emphasized the significance
of psychopathology as the basis of infertility. Stress does, however,
play a part.
A study done at Harvard showed that stress reduces the hypothalamic-anterior-pituitary-ovarian
axis function, and should thus be considered in the infertility workup.
Acupuncture releases endorphins that mitigate one’s response to
stressful stimuli, thus enhancing the possibility of conception. Biologically,
since the hypothalamus regulates both stress responses as well as the
sex hormones, it’s easy to see how stress may contribute to infertility
in some women.
Excessive physical stress may even lead to complete suppression of the
menstrual cycle, and this is often seen in female marathon runners, who
develop “runner’s amenorrhea.” In less severe cases,
it could cause anovulation or irregular menstrual cycles. When activated
by emotional stress, the pituitary gland also produces increased amounts
of prolactin, and elevated levels of prolactin can contribute to irregular
ovulation. The female reproductive tract contains stress-hormone receptors;
stress can affect fertility.
However, more complex mechanisms may be at play, and researchers still
don’t completely understand how stress interacts with the reproductive
system. This is a story that is still unfolding, and during the last 20
years, the new field of psychoneuroimmunology has emerged. This field
focuses on how your mind can affect your body. Research has shown that
the brain produces special molecules called neuropeptides in response
to emotions, and that these peptides can interact with every cell of the
body, including those of the immune system. In this view, the mind and
the body are not only connected, but inseparable, so that it is hardly
surprising that stress can have a negative influence on fertility.
Stress can reduce sperm counts as well. Testicular biopsy specimens obtained
from prisoners awaiting execution (who were obviously under extreme stress)
revealed complete spermatogenetic arrest in all cases.
The stress factors that acupuncture addresses stems from both psychological
and emotional factors as well as physical ones. For example, extremely
painful premenstrual or mid-cycle pain can be debilitating. This type
of physical stress no doubt produces emotional stress as a result of missed
work, interference in activities, and the pain itself, which in turn can
compromise the function of the reproductive system.
The insertion of acupuncture needles has been shown to effectively increase
blood circulation. Enhanced blood flow to the reproductive environment
clearly improves pregnancy outcomes.
A Diagnostic Window: East Meets West
It is becoming more and more prevalent that research conducted by Western
scientists and physicians are highlighting the effectiveness of traditional
Chinese medicine. In an article published in the December 2002 issue of
the medical journal Fertility and Sterility, the authors reviewed existing
evidence regarding the role of acupuncture in the treatment of infertility,
and identified a number of studies indicating that acupuncture can increase
the success rates of infertility treatments, including IVF.
In a study conducted by Dr. Wolfgang Paulus (Christian-Lauritzen-Institut,
Ulm, Germany) and colleagues, half of a group of 160 women who were about
to undergo IVF were randomly assigned to receive acupuncture therapy before
and after embryo transfer. In the women who received acupuncture, the
needles were placed at points believed to influence reproductive factors
(for example, by improving blood flow to the uterus).
The acupuncture group had a higher rate of pregnancy compared with those
not given acupuncture (43% versus 26%), suggesting that acupuncture can
be used to improve pregnancy rates during IVF.
One alternative medicine diagnosis that exists which may be help to explain
male or female infertility is called Liver qi stagnation. Key identifiers
of an individual with this condition are anger, rage, frustration, depression,
Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and
colleagues recorded the personal characteristics of 156 infertile and
80 fertile couples, and measured their degree of psychopathology. When
the researchers divided the couples according to the nature of the infertility—organic,
functional, or undetermined—they found that anxiety, depression,
and a tendency toward anger suppression could predict the diagnosis of
organic or functional infertility in women with 97% accuracy. For infertile
men, anxiety was also an important independent predictor of functional
infertility, increasing the likelihood of having this form of infertility
five-fold, while depression was more predictive of organic infertility.
However, unlike in women, anger did not appear to influence infertility
in men. These results suggest that, beyond the distress that accompanies
the failure of repeated attempts to conceive a baby, psychological problems
may contribute to functional infertility.
The exact mechanisms of action of herbal medicine intervention are not,
at this time, completely understood. However, herbal medicine has been
used successfully to treat infertility for thousands of years.
Practitioners of Chinese herbal medicine rarely use a single herb in treatment.
Chinese herbs are formula based; many herbs are mixed together to create
the perfect ‘decoction’ specifically designed for the individual patient.
Some formulas contain two herbs and some thirty or more herbs. Each herb
has many functions. Each herb has its own flavor, nature, temperature
and trophism. Prescribing the correct herbal medicinals requires extensive
training and clinical experience.
Self-medicating with herbal medicine presents a dual dilemma. At best
the herbs will be useless, as the key to correct formula prescription
is an accurate differential diagnosis that can only be rendered by a licensed,
Board-Certified, experienced practitioner. In the worst case, self-prescribing
of herbal medicine may prove harmful.
One should take herbs only when they’re prescribed by a Board-Certified
herbalist. Not only is herbal medicine safe, it is highly effective and
free of harmful side effects that often accompany pharmaceutical drugs.
There are more than one million hospitalizations per year as a result
of drug-induced side effects; not so with herbal medicine.
I have prescribed herbal formulas for 14 years to improve egg and endometrial
quality. This is often effective, but, as in all fields of medicine, there
is no guaranty of success. Herbal medicine is also very often used successfully
in treating certain sperm anomalies.
Clearly, further research is needed to fully understand the mechanisms
of action of acupuncture and herbal medicine in treating the infertile
patient. Nevertheless, it is my opinion, based on fourtenn years of clinical
care that the best-case scenario for patient faced with fertility challenges
is to offer them every reasonable option which may serve to address their
underlying condition. The integration of acupuncture and herbal medicine
into the treatment protocol of the infertile patient, from a clinical
perspective, based on current scientific and empirical data makes sense.
1. BMJ 2008;336:545-549 (8 March), doi:10.1136/bmj.39471.430451.BE (published
7 February 2008)
Effects of acupuncture on rates of pregnancy and live birth among women
undergoing in vitro fertilisation: systematic review and meta-analysis
Eric Manheimer, research associate1, Grant Zhang, assistant professor1,
Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia
Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex
M Bouter, professor and vice chancellor (rector magnificus)5
1 Center for Integrative Medicine, University of Maryland School of Medicine,
2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA,
2 Department of Obstetrics, Gynecology and Reproductive Services, University
of Maryland School of Medicine, 3 Department of Physiology and Biophysics
and Medicine, Georgetown University School of Medicine, Washington, DC,
4 Department of Epidemiology and Preventive Medicine, University of Maryland
School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081
HV Amsterdam, the Netherlands
Correspondence to: E Manheimer email@example.com
Objective To evaluate whether acupuncture improves rates of pregnancy
and live birth when used as an adjuvant treatment to embryo transfer in
women undergoing in vitro fertilisation.
Design Systematic review and meta-analysis.
Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database,
hand searched abstracts, and reference lists.
Review methods Eligible studies were randomised controlled trials that
compared needle acupuncture administered within one day of embryo transfer
with sham acupuncture or no adjuvant treatment, with reported outcomes
of at least one of clinical pregnancy, ongoing pregnancy, or live birth.
Two reviewers independently agreed on eligibility; assessed methodological
quality; and extracted outcome data. For all trials, investigators contributed
additional data not included in the original publication (such as live
births). Meta-analyses included all randomised patients.
Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation
were included in the meta-analyses. There was little clinical heterogeneity.
Trials with sham acupuncture and no adjuvant treatment as controls were
pooled for the primary analysis. Complementing the embryo transfer process
with acupuncture was associated with significant and clinically relevant
improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval
1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials),
ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials),
and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because
we were unable to obtain outcome data on live births for three of the
included trials, the pooled odds ratio for clinical pregnancy more accurately
represents the true combined effect from these trials rather than the
odds ratio for live birth. The results were robust to sensitivity analyses
on study validity variables. A prespecified subgroup analysis restricted
to the three trials with the higher rates of clinical pregnancy in the
control group, however, suggested a smaller non-significant benefit of
acupuncture (odds ratio 1.24, 0.86 to 1.77).
Conclusions Current preliminary evidence suggests that acupuncture given
with embryo transfer improves rates of pregnancy and live birth among
women undergoing in vitro fertilisation.
2. Acupuncture and IVF Study Shows Early Promise for Increased Take Home
Posted on: Tuesday, 12 August 2008, 15:00 CDT
Dr. Paul C. Magarelli, a nationally noted specialist in the field of reproductive
endocrinology and infertility, and Dr. Diane K. Cridennda, a recognized
authority on acupuncture and Traditional Chinese Medicine, have announced
early results of an ongoing study linking acupuncture to positive in-vitro
fertilization (IVF) outcomes. The study, which includes the largest-ever
participant pool for a study of its kind, explores the increase in take
home baby rates associated with combined Eastern and Western medicine
Drs. Magarelli and Cridennda's ongoing research shows an astonishing
15 percent increase in pregnancies, with a 23 percent climb in actual
births in IVF patients treated with acupuncture. In addition, of the 578
patients Magarelli has co-treated at the Reproductive Medicine & Fertility
Centers and East Winds Acupuncture from 2003 to 2008, 26 percent more
patients became pregnant with acupuncture treatments added to IVF, saving
them the costs and heartache of having to repeat an IVF cycle. This savings
would decrease the national IVF fertility costs by more than $150,000,000
per year in the United States alone.
"Infertility is a condition that affects more than 7.3 million people
nationwide, and many of those couples are unaware of the potential that
acupuncture holds for them," said Dr. Magarelli. "Our study
demonstrates that acupuncture increases uterine blood flow, reduces stress
and has an overall positive impact on our IVF patients. And the results
really speak for themselves: one of every four of our patients who have
used acupuncture in conjunction with IVF has not had to repeat an IVF
cycle to create their families."
A three-part exploration of Drs. Magarelli and Cridennda's ongoing
breakthrough acupuncture and IVF study will be published in Fertility
Today magazine later this year. ABOUT DR. PAUL C. MAGARELLI
Dr. Paul Magarelli, MD., Ph.D., a member of the GENESIS Network for Reproductive
Health (www.genesisivf.com), recently won the Practicing Physicians Award
from the Pacific Coast Reproductive Society for his groundbreaking research
on the impact of acupuncture on IVF pregnancies. Not only is he known
for his instrumental work in creating new pricing structures to provide
cost-effective, competent IVF care for the average wage earner, but he
is best known to his patients for applying high-tech procedures with a
personal touch. In addition to co-founding the Corona Institute for Reproductive
Medicine & Fertility, he is the medical director of the Reproductive
Medicine and Fertility Centers in Colorado and New Mexico, where he specializes
in infertility and all aspects of hormonal pathology in women. Dr. Magarelli
has been interviewed as an expert source for MSNBC, Fertility & Sterility
and PregnancyandBaby.com. To learn more, visit www.ColoradoSpringsIVF.com
ABOUT DR. DIANE K. CRIDENNDA
Diane K. Cridennda, L.Ac., (FABORM) is Board Certified in the field of
Reproductive Oriental Medicine. She graduated from the International Institute
of Chinese Medicine in l995 with her Masters of Oriental Medicine degree.
She trained in Beijing, China to explore the root of this ancient healing
art. She is NCCA certified, licensed in Colorado and is a member of Resolve,
a national infertility support group. She has also had extensive training
in Traditional Chinese Herbal Medicine. For more than seven years, Diane
has been working with Reproductive Endocrinologists using a combination
of Eastern and Western medicine therapies for the treatment of infertility.
To learn more, visit
3. Fertility & Sterility Journal Volume 85, Issue 5, Pages 1347-1351
Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic
sperm injection: a randomized, prospective, controlled clinical study
Stefan Dieterle, M.D.a , Gao Ying, M.D.ab, Wolfgang Hatzmann, M.D.a, Andreas
4. Can acupuncture boost my fertility?
Skrivet för BabyCentre UK
The BabyCentre Editorial Team svarar:
Research suggests that acupuncture may be helpful to couples undergoing
in-vitro fertilisation (IVF), but the verdict is still out on whether
it can improve fertility in general. Although smaller studies show promising
results, more research is needed before we can say for sure that this
age-old therapy can help you get pregnant.
Acupuncture is based on the theory that vital energy (or "qi,"
pronounced "chee") flows through the body along certain pathways.
Acupuncturists try to balance this energy and restore health by stimulating
specific points along the pathways with thin needles. Although it has
been a staple of Chinese medicine for some 5,000 years, acupuncture has
only gained acceptance in the Western medical community in the past few decades.
In 2002, a team of German researchers discovered that acupuncture significantly
increased the odds of pregnancy among a group of 160 women who were undergoing
IVF treatment. Forty-two per cent of the women who received acupuncture
got pregnant, compared to 26 per cent of those who didn't receive
Since then, more research has given support to the benefits of acupuncture
for women undergoing IVF. One study, also in Germany, reported that conception
and ongoing pregnancy rates were higher for women who had acupuncture
treatment in the the second part of their menstrual cycle (the luteal
phase) following IVF or ICSI. While a Danish study found that conception
rates were best improved by having an acupuncture treatment on the day
the embryos were transferred into the uterus. Their findings showed that
having an additional acupuncture treatment two days later did not improve
the chances of conception or ongoing pregnancy.
So how does it work? Nobody really knows, but researchers think that acupuncture
may help increase blood flow to the uterus and relax the muscle tissue,
giving the embryos a better chance of implanting.
Acupuncture may also help male infertility. Regular treatments have been
shown to improve sperm counts and motility (the strength with which the
sperm swim) for men with fertility problems but not always significantly.
To improve the chances of pregnancy by natural means, acupuncture treatment
would need to increase a man's sperm count over the threshold needed
for conception. This means a minimum of 10 to 12 million moving sperm
per ejaculate, and the men in these studies didn't get up to those levels.
However, for couples considering assisted conception, acupuncture can
help by improving the quality of the sperm. In a study published in 2005,
researchers analysed sperm samples from men with infertility of unknown
cause before and after acupuncture treatments. They found that acupuncture
was associated with fewer structural defects in sperm and an increase
in the number of normal sperm.
Most experts believe that we need larger and better studies, ideally random
and double blind trials, using fake needles for some patients and real
ones for others, in order to really know whether acupuncture is effective.
In some of the studies mentioned above, the patients and healthcare providers
knew that acupuncture was performed, so the studies weren't "blind"
and the success of the treatment might have been due to what's known
as the placebo effect. Perhaps it was the patients' belief in acupuncture,
rather than the acupuncture itself, that accounted for the treatment's success.
However, in the end it doesn't matter that much whether the success
of acupuncture is a placebo effect or not. The bottom line is that acupuncture
is relatively safe, and if it improves fertility, even if it's only
because you think it does, it may be worthwhile.
The best first step to treating any fertility problem is to contact a
specialist. If you do decide to try acupuncture, look for a registered
acupuncturist, some of whom are also medical doctors. The British Acupuncture
Council (www.acupuncture.org.uk) can help you find one near you.
Reviewed May 2007
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Dieterle S, Ying G, Hatzmann W, Neuer A. 2006. Effect of acupuncture on
the outcome of in vitro fertilization and intracytoplasmic sperm injection:
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Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005.
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Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. 2006.
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