Infertility refers to the marriage is not contraception, a normal sexual life, living together for 1 year without pregnancy, which is not pregnant as primary infertility, pregnancy and infertility were called secondary Pregnancy. Infertility is a gynecological common disease, frequently disease, but also clinical refractory disease. In the past few decades, the demographic structure and patterns of each country have undergone great changes. The prevalence of infertility has also changed greatly. With the accelerated pace of life in recent years, the pressure of work Increase, the deterioration of environmental pollution, changes in the structure of the diet, as well as changes in the concept of human fertility, fertility reduction of the problem is gradually shown. 1995 WHO / HRP research results show that the world's infertility couples have reached about 6,000 to 80 million pairs . Infertility has become a global medical and sociological problem that affects the development and health of all mankind. The World Health Organization claims that infertility, like cardiovascular disease and tumor disease, has become the three most important diseases that affect people's normal life and health in today's society. Therefore, to strengthen its etiology research, early prevention has become our urgent problem to be solved. This paper collected nearly 20 years of literature, acupuncture treatment of infertility clinical research overview are as follows.
1. Cognition of infertility in Chinese and Western medicine
1.1 Chinese medicine that the cause of pregnancy, including kidney deficiency (kidney yin deficiency, kidney yang), liver depression, blood stasis, phlegm. Kidney is the innate of the women's menstrual cramps and their regularity of the cycle and the most closely related to the kidney, normal, periodic ovulation and menstruation is a prerequisite for women can conceive. One of the three members of the Jin and Yuan Zhu Zhenheng wrote: "Seeking the way, as if the tone also." Women's long-term menorrhagia, menstrual less, menstrual period from time to time, amenorrhea and other menstrual diseases, can cause the woman's organs dysfunction, blood and not, resulting in any damage and kidney - days Gui - Uterine reproductive axis of the imbalance, lack of days Gui, red blood sea emptiness, over time is caused by the woman can not be fine and pregnant. Chinese medicine that "women with the liver as a congenital", liver catharsis, directly with women's ovulation and menstrual cycle is closely related, therefore, pregnancy must be emotional stability, health as a prerequisite. Phlegm resistance, caused by meridians walking poor, red any two pulse disorders, sick for a long time, phlegm accumulation, blood stasis, and finally lead to infertility. On the collection of nearly 10 years on the cause of female infertility in China 85 (see Appendix II) literature collation, screening, statistics of the etiology of Chinese medicine 1 , the contents of the statistics, the results shown in the table below 1.
|Table 1. The composition of category (Chinese Medicine) in 1186 infertility cases in China|
|Category||Number of Cases||Percent %||Kidney deficiency plus Blood stagnation||280||23.61|
|Liver qi stagnation plus Blood stagnation||226||19.06||Kidney deficiency Plus liver qi stagnation||192||16.19|
|Kidney deficiency and Phlegm dampness||158||13.32||Kidney yang deficiency||70||5.9|
|Liver qi stagnation||55||4.64||Kidney yin deficiency||50||4.22|
|Blood stagnation||45||3.79||Blood stagnation plus Phlegm dampness||40||3.37|
|Liver qi stagnation plus Phlegm dampness||25||2.11||Phlegm dampness||25||2.11|
From Table 1 see: female infertility in the distribution of traditional Chinese medicine to two types of syndrome and folder appear more, which accounted for the highest kidney deficiency and blood stasis, followed by liver depression blood stasis, kidney deficiency, kidney deficiency phlegm, and independent Syndromes are rare, such as kidney yang, kidney yin deficiency, liver depression, blood stasis. In the collection of 1186 cases of female infertility syndromes and a total of 941 cases, the type of card were included in the corresponding syndromes of the corresponding syndromes, the results shown in Figure 1.
1.2 Western medicine on infertility awareness
Ovary is an important organ of the female reproductive system, the ovary has reproductive function and endocrine function, is produced and discharged eggs, secrete steroid hormone organs . Normal ovulation provides a material basis for the reproduction of women, but also reflects the reproductive axis of the sound and perfect, if the ovarian any dysfunction or organic disease, such as polycystic ovary syndrome (PCOS), high prolactin Disease, corpus luteum insufficiency, premature ovarian failure caused by abnormal ovarian ovulation, PCOS which is the most common, but also the main factor. PCOS is a pathological change characterized by hyperandrogenism, ovulation abnormality and polycystic ovary . It is a multifactorial, complex pathophysiology and complex clinical manifestations. The etiology of this disease has not yet been fully understood The Studies have shown that environmental pollution, dietary pollution, obesity, increased pressure is a high risk factor. With the rapid development of society, the improvement of living standards, PCOS risk factors and high risk groups continue to increase, and its incidence is gradually younger. This study shows that the incidence of infertility in China ovarian factors, the total incidence of abnormal ovulation was 17.50%, the incidence of PCOS was 8.15%. Domestic literature reported China's female infertility cause abnormal ovulation in 18% to 33%, PCOS accounted for 12% to 25%, and in ovulation abnormalities of women, PCOS accounted for 50% [5-6]. Foreign literature reported that PCOS in female infertility factors accounted for 30% to 40%, while the ovulation abnormalities of 50% to 70%.
Western medicine that infertility and more with tubal disease, ovarian disease, uterine and cervical diseases, genital and vaginal diseases, immune diseases, unexplained diseases, other diseases and so on. Whether it is tubal umbrella picking function abnormalities such as umbrella end of the lock, water, on the move, or fallopian tube mucosal damage caused by tubal obstruction, which will cause infertility; ovaries for women to provide material basis for reproduction, but also Response to the reproductive axis of the sound and perfect, if any dysfunction of ovarian or organic disease, such as PCOS, hyperprolactinemia, corpus luteum dysfunction, premature ovarian failure caused by abnormal ovarian ovulation, and infertility; And cervical lesions will affect the sperm and egg meet, affect the fertilized egg implantation, and ultimately affect the pregnancy; immune factors refers to a variety of reproductive tract antibodies and immune diseases will affect the emergence of sperm into the uterine cavity, interfere with the combination of sperm and egg Conception. Human reproductive immune problems are more complex, a considerable part of the unexplained infertility caused by immune abnormalities . (AAA), anti-chorionic gonadotropin antibody (HcGAb), anti-transparent antibody (ZpAb), anti-adiponectin Anticardiolipin antibodies (AcAb) and other immune antibodies.
According to the famous Chinese medicine books or acupuncture and moxibustion monographs, from the meridians, acupoints, acupuncture and moxibustion methods 4,3 aspects of the Qin and Qing Dynasties to discuss the development trend of acupuncture and moxibustion prescription. 2.1 ancient meridian selection of the law of the search for acupuncture treatment of infertility literature records involving eight meridians. As the frequency of choice of meridians depends on the acupoints, so the choice of acupoints to study the ancient physician treatment of infertility when the trend of choice of meridians. Meridian selection frequency and weight from high to low order in Table 2 . Table 1 meridian selection frequency and weight order sequence
|Table 2. Meridian selection frequency|
|Name of Meridian||Frequency||Percent %||Ren Mai||48||39|
|Kidney Channel||21||17.1||Spleen Channel||13||10.1|
|Urinary Bladder Channel||12||9.8||Stomach Channel||12||9.8|
|Du Mai||3||2.4||Liver Channel||2||1.6|
As can be seen from Table 2, the ancient acupuncture treatment of infertility to Renmai the most commonly used, followed by the kidney, spleen, stomach, bladder by. Du, liver, large intestine is also selected. From the meridian attending function point of view, this treatment ideas and traditional Chinese medicine theory is consistent. It should be noted that the weight arrangement here is only for the meridian selection frequency, not the importance of the order of the order. This is because each meridian was selected the number of acupuncture points and the number of points are different, is bound to affect the acupuncture points, the number of small selection of acupoints and meridians and fewer points to select the number of meridians in the order. But it is certain that regardless of the line from the site, attending function, or the number of selected points and frequency, Renmao are acupuncture treatment of infertility is the only choice.
2.2 ancient acupoints selection of the law of the acupuncture treatment of infertility literature records involving 29 acupoints, a total of 124 points. In addition to Quanmen, Li Quan (the three points), the valve (2 points), green beads head, Huabin, Yin Qiao (1 points) is no clear positioning, the other acupoints are located in Ren, Spleen, stomach, bladder, Du, liver, large intestine. The use of frequency and weight of the acupoints, acupoints Division see Table 3 . Table 3 acupoints use frequency and weight acupoints division law
|Table 3. Acupuncture points frequently used for infertility treatment in classic Chinese Medicine literature|
|Point Location||Point Name||Frequency||%||Stomach||ZhongJi - CV3||18||14.6|
|Stomach||GuanYan - CV4||17||13.8||Leg||RanGu - K12||10||8.1|
|Stomach||ShuiDao - ST28||9||7.3||Stomach||SanYinJiao - SP6||8||6.5|
|Stomach||ZiGong - EX8 *||6||6.9||Leg||YinLian - LR11||5||4.1|
|Stomach||ShangQiu - SP5||5||4.1||Stomach||YinJiao - CV7||4||3.3|
|Stomach||ShiMen - CV5||4||3.3||Stomach||QiHai - CV5||3||2.4|
|Back||MingMen - GV4||3||2.4||Back||ShangLiao - BL31||3||2.4|
|Back||ShenShu - BL23||3||2.4||Stomach||QiChong - ST30||3||2.4|
|Leg||YongQuan - KI1||3||2.4||Leg||ZhaoHai - KI6||3||2.4|
|Stomach||ShenQue - CV8||2||1.6||Leg||QuQuan - LR8||2||1.6|
|Stomach||SiMan - KI14||2||1.6||Back||ZhongLiao - BL33||2||1.6|
|Back||CiLiao - BL32||2||1.6||Stomach||ShiGuan - KI18||1||0.8|
|Leg||ZhuBin - KI19||1||0.8||Leg||ShuiQuan - KI15||1||0.8|
|Leg||KunLun - BL60||1||0.8||Leg||ZhiYin - BL67||1||0.8|
|Arm||HeGu - LI4||1||0.8||Leg||XueHai - SP10||1||0.8|
|*location of ZhiGong - EX8: 3 Cun lateral to CV3|
From the table can be seen, acupuncture treatment of infertility acupoints to choose the pole, Guan Yuan, Ran Valley, waterways, Sanyinjiao, uterus, Yin Lian, Shangqiu, Yin Jiao, Shimen most commonly used, weight total of 70%. The division of the acupoints from Table 2 shows that the selected acupoints concentrated in the abdomen, lower limbs, back and upper limbs. The weight of the abdomen and lower extremity were 56.6%, 32.2% were the most commonly used, followed by the back of the acupoints and upper limb acupoints, the weights were 10.4%, 0.8% respectively.
2.3 ancient acupuncture and moxibustion method used to retrieve the acupuncture treatment of infertility 98 literature records, only 45 records contain the contents of acupuncture and moxibustion. Specific acupoints acupuncture methods and frequency of use in Table 4. Table 4 acupuncture and moxibustion methods and frequency of use
|Table 4: Acupuncture and Moxibustion frequency in infertility treatment recorded in classic Chinese medicine literature|
|GuanYuan(CV4)||Acu(2), Mox(10)||ZhiYin(BL67)||Mox(1)||ShiMen(CV5)||Acup(with reducing method)+Mox (1), Mox(1)||SanYinJiao(SP6)||Mox(2)|
|ShenQue(CV8)||Mox(2) - one of them using cushion of salt and ginger||ShangQiu(SP5)||Acu(1), Mox(2)||QiHai(CV6)||Mox(1)||ShuiDao(ST28)||Mox(7)|
The above data suggest that the ancients treatment of infertility moxibustion-based and dominant therapy, and acupuncture or acupuncture plus moxibustion treatment, while the book repeatedly pointed out that the efficacy of acupuncture alone less than moxibustion.
2.4 Ancient acupuncture treatment of infertility selection time analysis
Acupuncture treatment of infertility according to different symptoms, the choice of treatment time is also different, access to literature after acupuncture treatment of infertility time summarized as follows: menstrual clean about 5 days after the start of treatment, the interval (ovulation About the beginning of treatment, menstrual cycle in the treatment, treatment time can be once a day, or every other day, usually 10-15 days for a course of treatment, each treatment interval of 3 to 5 days. The data collected from the literature are summarized as follows :
|Table 5: Acupuncture treatment frequency vs. Infertility Category and Menstrual Cycle|
|Infertility Category||Start treatment from the 5th day of cycle||Start treatment from the mid-day of cycle||Treatment during the whole cycle||Kidney differency||13||16||12|
|Blood stagnation in uterus||5||8||21||Phlegm dampness||2||5||10|
|Liver qi stagnation||3||5||9|
The results show that: acupuncture treatment of infertility symptoms are emphasis on the entire menstrual cycle, in order to achieve conditioning Chong Ren, tampering to help the effect. Kidney deficiency type more emphasis on the beginning of menstruation, or menstrual clean 3 to 5 days after the start.
2.5 acupuncture treatment characteristics
(68), drugs (41), moxibustion (26), acupoint injection (12), electroacupuncture (9), ear (6), acupuncture, (1), acupressure (1), acupoint ion penetration (1), massage (1), acupressure (1), acupoints 1). From the treatment methods, mainly to acupuncture, but also the use of comprehensive therapy. Acupuncture use of flattening diarrhea or virtual fill the main method of diarrhea, comprehensive therapy with acupuncture with traditional Chinese medicine (Warming kidney yang mainly), also use moxibustion, moxibustion moxa moxibustion (4), moxibustion 3), ginger moxibustion (3), moxa moxibustion (1), salt moxibustion (1), mine fire moxibustion (1). Data show that clinical drug treatment accounted for 36.7% of the total number of cases .
Analysis on the Regularity of Modern Acupuncture Treatment of Infertility
The role of acupoints, mainly reflected in the role of near governance, far from the role and regulation of the role of governance points, not only to the treatment of the local by the disease, but also to treat the organs of the disease. The following points from the acupuncture treatment of acupuncture treatment of infertility selection of the law .
2.6.1 from the meridian treatment of acupuncture treatment of infertility points selected mainly concentrated in the Ren, spleen, stomach, outside the odd points, kidney, bladder, liver, Du, mainly to the treatment of kidney, conditioning Chong Ren-based, and spleen Qi, Shugan Jieyu, depending on the different types of choice focus on different points
2.6.2 selected from the site treatment of infertility lesions for the uterus, according to the needle near the law, so the choice of acupuncture points to the main points of the abdomen, such as: Guan Yuan, in the extreme, gas sea, uterus, big And so on, conditioning Chong Ren, kidney meridian palace points. And then according to the principle of acupuncture far governance method, select the lower limb and back and back points, lower limb main selection of the face of the three parts of the face, such as: blood sea, Sanyinjiao, Zusanli, Hong Leong and other foot Is with the card plus or minus to regulate the blood, spleen dehumidification. The back of the bladder to the back of the bladder by the point and the main point of Du, aimed at kidney yang .
2.6.3 from the point of acupuncture treatment of acupuncture treatment of infertility points with the main points through the meridian method, the upper and lower points with the method, before and after the distribution method, the table with points method. Which Guanyuan, in the pole, Shenshu and other points to select acupuncture points through the acupuncture points, that is: a certain organs, meridians when the disease, through the selection of its local and distant acupoints; Shenshu, Belong to the table with points method, that is: when the yinbang when sick, with the table with the meridian points, the sun by the disease, with the table of the meridian points, viscera sick, In the relevant acupoints; Guan Yuan, Zusanli belong to the upper and lower points of the method, that is: refers to the waist above the acupoints and waist with the following acupoints with the application of the method. In the pole, life door is before and after the distribution method, such as the waist and back waist with the acupoints with the application of the method .
2.6.4 from the cause of the disease on the treatment of future physicians summed up the experience of predecessors, infertility is divided into kidney deficiency type, liver qi stagnation type, fatigue, uterine type and phlegm resistance type, according to different symptoms, each physician in the choice Acupoints focus on the various types of symptoms to tune the body to help pregnancy, such as kidney deficiency more severe Shenshu, life door, too Creek and other kidney fill points, liver qi stagnation and more emphasis on too red, liver and other liver qi acupuncture points and so on.
3 acupuncture treatment of infertility advantage
3.1 acupuncture treatment costs low, simple and safe, easy to operate Acupuncture treatment to avoid the drug processing process, so that the treatment process easier to operate and control, while reducing the high risk of surgical treatment, costly shortcomings, in short, simple and safe acupuncture treatment , Cheap and easy to operate, not only reduces the economic burden of patients, but also to ease the fear of patients.
3.2 acupuncture treatment to avoid the side effects of Western medicine treatment (such as: ovarian hyperstimulation syndrome, etc.) and dependent Western medicine in the treatment of disease at the same time, it inevitably brought its negative impact. As in the treatment of ovulation disorders caused by infertility, CC can induce ovulation, but also the risk of ovarian hyperstimulation syndrome, and the emergence of multiple pregnancies also make the use of Western medicine is limited. At the same time, in the treatment of anovulatory dysfunctional uterine bleeding, estrogen and progesterone sequential therapy, although the menstrual cycle can make the tide, but after the symptoms are often easy to repeat .
3.3 acupuncture treatment can reduce infertility patients after pregnancy abortion rate acupuncture treatment is from the whole body on the human organs, yin and yang, blood regulation, in the treatment of infertility, not only to enable patients to conceive, but also for reproductive endocrine The system plays a whole regulatory role, so that the improvement of systemic symptoms, hormone levels are improved, so that after pregnancy patients can better continue to pregnancy, to avoid the simple promotion of pregnancy from a side, and the overall symptoms have not improved, so abortion Greater than acupuncture treatment in patients . A clinical case review of acupuncture and moxibustion treatment of infertility
4.1 conventional acupuncture: Pingyin County, Shandong Province, Chinese medicine hospital Sun Xingliang, Zhang Ruosheng and Luo Guangsheng and others with acupuncture treatment of immune infertility in 57 cases, 14 cases were cured, markedly effective in 16 cases, effective in 20 cases, 7 cases, the total effective rate 87.7% .
4.2 electroacupuncture: strict, etc.  with electric acupuncture treatment of follicular maturation but not ovulation 83 cases, the main point to take Guan Yuan, in the pole, Zusanli, Sanyinjiao. And with the disease with points, acupuncture points prescribed patients emptying urine, acupuncture in the pole, Guan Yuan, uterine cave, the needle oblique down, strong stimulation, acupuncture Sanyinjiao, Zusanli and other points are Ping Ping Diarrhea method. After the needle was added to the electrode, with dense waves, the frequency of 16 to 18 times min, plus power needle 30min, effective in 65 cases, the effective rate of 78.31%.
4.3 pick needle: Fang Liming  needle picking treatment of anovulation or corpus luteum insufficiency infertility in 8 cases, take the first, the first 10 thoracic vertebrae Jia Tuo Jiaji points, edge edge points, routine local disinfection with a special pick Acupuncture needle into the point, 7 ~ 10d treatment 1, 9 to 12 times for a course of treatment. Function severely weakened, plus Codonopsis, Rehmannia and other drugs, the results of all effective.
4.4 acupoint injection: Tu Guochun  with gonadotropin (HMG) acupuncture injection treatment of 36 cases of ovarian disorder infertility, and the control group of 26 cases. The treatment group began oral administration of clomiphene, 50mg daily, for 5 days, 7,9,11,13 d with HMG 1 into the Guanyuan, gas sea, the pole, uterus, Sanyinjiao, Shenshu points, each election 1 acupuncture, acupuncture into the local swelling or downward release when the injection of drugs. The control group began to take clomiphene on the second day, the amount and time with the treatment group. On the 5th day, HMG1 was injected intramuscularly for 7 days. The pregnancy rate was 61.1% in the treatment group and 57.7% in the control group.
4.5 moxibustion: side Paul Ling  with umbilical moxibustion treatment of anovulatory infertility 109 cases, the method is to use salt 30g, Morinda officinalis, pepper, aconite, epimedium, cinnamon and other 10g, Chuanxiong, small Fennel each 6g, a total of research to fine, musk 0.1g single release. The patient supine, with warm water to mix the flour, made of noodles, around the umbilical 1 week, the salt filling the umbilical to slightly higher 1 ~ 2cm, set the big leaves on the salt, a total of moxibustion 7 strong. Remove the salt, the first put the musk, and then put the rest of the drug, the shop ginger slices, and then moxibustion 14 strong, starting on the 6th day of menstruation, 2d moxibustion 1, 6d for a course of treatment, the effective rate of 61.5%.
4.6 comprehensive therapy: Shagui E  the use of acupuncture treatment of ovarian dysfunction in 84 cases of infertility, the effect is satisfactory. Acupuncture points off the yuan, the pole, the big He, the main points of the uterus, liver and kidney Yin plus Sanyinjiao, Yanglingquan, liver Yu, Yin Xi, complex slip, spleen and kidney yang, Warm acupuncture, the results were 71.4%. Zheng Lixia et al  acupuncture combined with the treatment of anovulatory infertility 64 cases, the treatment is the treatment group according to TCM syndrome differentiation, oral Chinese medicine 1 day. Acupuncture main points is Guan Yuan, the pole, the uterus, Sanyinjiao and so on, and with the disease with points, blood deficiency with blood, liver depression with Neiguan, too red. Acupuncture Guan Yuan, the pole, uterus, Sanyinjiao and other abdominal acupuncture points down, strong stimulation of the needle, acupuncture and drug use, menstrual period disabled, once every 3 menstrual cycle for a course of treatment. Effective rate of 79.13%. And the control group P <0.05, there was a significant difference.
According to the clinical literature of acupuncture and moxibustion, acupuncture and moxibustion treatment of ovarian dysfunction infertility has the following characteristics: ① traditional methods and modern methods and see: methods are both traditional acupuncture, medicine moxibustion, pick the needle, acupuncture and moxibustion, Modern acupoints, electroacupuncture, etc., but the traditional method based. ② has the advantages of simple operation, small side effect and remarkable curative effect. ③ selected points regularity: to Ren pulse, stomach, spleen, kidney by the main, Sanyinjiao, Guan Yuan, by the external points of the uterus for the first commonly preferred choice. ④ choice of treatment: the doctor according to the different clinical experience, choose different time as the starting point. Some scholars in the menstrual cycle began treatment on the 14th day, but also in the first 6 days of menstruation treatment. ⑤ clinical reports, the mechanism of less research: from the collection of information to see, clinical reports, the mechanism of less research to explore the mechanism of acupuncture treatment of this disease should be the focus of future research.
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