Women of childbearing age who have been infertile for more than three years after marriage without contraception are referred to as infertile.

This condition, Qianjin Yaofang is called "primary infertility," Maijing refers to it as "childlessness."

Those who have not conceived for three years after a full-term birth or late abortion, premature labor, Qianjin Yaofang is termed "sterility."

bubble_chart Pattern Analysis

1. Kidney Deficiency︰Scanty menstruation with dull-colored blood, delayed menstrual cycles or amenorrhea, cold sensation in the lower abdomen, decreased libido, soreness in the lower back and weakness in the legs, or clear and abundant urine. The tongue appears pale with a white and moist coating, and the pulse is deep and slow. This condition is often caused by constitutional weakness, insufficient kidney qi, and deficiency and decline of the Chong and Ren meridians, leading to an inability to retain essence. Nyuke Jinglun states: "The reason why women fail to conceive is due to insufficiency of the Chong and Ren meridians and kidney qi deficiency with cold." Neijing．Shanggu Tianzhen Lun states: "At the age of fourteen, a woman's reproductive essence arrives, the Ren meridian becomes unobstructed, the Tai Chong meridian becomes abundant, and yin and yang harmonize, thus enabling conception." If the Chong and Ren meridians are insufficient and kidney qi is deficient with cold, they cannot support the uterus, resulting in infertility. There are also cases originating from the husband's illness or the wife's ailments, which should be addressed by identifying and treating the underlying cause." The key diagnostic points are: cold sensation in the lower abdomen, decreased libido, scanty and pale menstrual flow, delayed cycles or amenorrhea, soreness in the lower back and weakness in the legs, or clear and abundant urine. Treatment should focus on warming yang and tonifying the kidneys, as well as regulating and nourishing the Chong and Ren meridians. The recommended formula is Baby-Nurturing Pearl.
2. Deficiency of Both Qi and Blood︰Scanty or excessive menstruation, pale color, often delayed menstrual cycle. Complexion shallow yellow, or with dark spots, dizziness and blurred vision, thin and weak physique, lack of strength. Tongue texture pale, thin white coating, deep and thin pulse. Mostly caused by constitutional weakness, or excessive loss of blood, or deficiency of both spleen and stomach, leading to yin deficiency and insufficient blood, resulting in deficiency of the Chong and Ren meridians, unable to retain essence for conception. Danxi Xinfa. Women: "Human conception is the result of the application of yang essence, which is retained by yin blood. Essence forms the child, blood forms the placenta, and pregnancy is achieved. Nowadays, women's infertility is mostly due to insufficient blood, which fails to retain essence." The key points of differentiation are: complexion shallow yellow, thin and weak physique, lack of strength, dizziness and blurred vision, scanty and pale menstruation, prolonged cycle, tongue texture pale, thin coating, deep and thin pulse. Treatment should focus on tonifying qi and tonifying blood, nourishing the kidneys and essence, using the Yangjing Zhongyu Decoction with Tangshen and Shouwu.
3. Yin Deficiency with Blood Heat︰Advanced menstruation, heavy flow with bright red color, or delayed menstruation, scanty flow with purplish color. Flushed face and lips, dizziness, tinnitus, insomnia, dry mouth and throat, or irritability, or tidal fever with night sweats, or a history of late abortion. Red tongue with thin yellow coating, rapid pulse. Mostly caused by constitutional yin deficiency, prolonged pulmonary tuberculosis, or damage to yin due to warm disease, leading to accumulated heat in the uterus and appendages. Nyuke Jinglun states: "Women who have long been childless often have latent heat in the Chong and Ren meridians. Infertility is due to blood deficiency, which leads to heat. The root cause must be insufficiency of true yin. When true yin is insufficient, yang becomes excessive, causing internal heat. Internal heat then depletes the nutritive blood, resulting in infertility. Nourishing yin and clearing heat will enrich the blood and facilitate conception." The key diagnostic points are: dizziness, tinnitus, dry mouth and throat, flushed face and cheeks, advanced menstruation with heavy bright red flow, or delayed menstruation with scanty dark flow, or tidal fever, night sweats, red tongue with thin coating. Treatment should focus on nourishing yin and clearing heat, using Qingxue Yangyin Tang (Blood-Clearing and Yin-Nourishing Decoction) or Qinggu Zishen Tang (Bone-Clearing and Kidney-Nourishing Decoction). Infertility due to liver qi stagnation is often caused by emotional distress, leading to liver qi stagnation, disharmony of qi and blood, and obstruction of the uterine vessels. Jiyin Gangmu states in "Seeking the Cervical Orifice": "Most cases of female infertility are due to damage from the seven emotions, resulting in blood deficiency and qi excess, irregular menstruation—either advanced or delayed, excessive or scanty, pale as water or purplish as blood clots, or menorrhagia and metrostaxis with leukorrhea, or abdominal pain, or a cold and deficient uterus that cannot conceive." The key diagnostic points are: varying menstrual flow, purplish color with clots, or dysmenorrhea, breast distension and pain before menstruation, irritability, delayed menstruation or irregular cycles. Treatment should focus on soothing the liver and relieving stagnation, nourishing blood, and benefiting the spleen, using Kaiyu Zhongyu Tang (Stagnation-Relieving and Jade-Planting Decoction).
4. Liver Qi Depression︰Irregular menstrual cycles, varying in amount, purplish in color or with small blood clots, or dysmenorrheal. Pre-menstrual breast distending pain, irritability, and easy anger. Tongue texture normal or dark red, coating white or slightly greasy, pulse wiry and thin. $Yin deficiency blood heat infertility and liver depression qi stagnation infertility! Both belong to deficiency and excess mixed syndromes. Yin deficiency blood heat infertility is mostly caused by constitutional yin deficiency, prolonged illness such as pulmonary tuberculosis, or warm disease damage to yin, leading to accumulated heat in the uterus with appendages. Nyuke Jinglun states: "For women who have long been childless, it is due to latent heat in the Chong and Ren meridians. Infertility is due to insufficient blood, and insufficient blood leads to heat. The root cause must stem from true yin deficiency. True yin deficiency results in yang excess and internal heat, internal heat leads to withering of nutrient blood, hence infertility. Nourishing yin and eliminating heat will make the blood flourish and facilitate conception." The key diagnostic points are: dizziness, tinnitus, dry mouth and throat, flushed face and cheeks, advanced menstruation with heavy flow and red color, or delayed menstruation with scanty flow and dark color, or tidal fever, night sweats, red tongue with thin coating. Treatment should focus on nourishing yin and clearing heat, using formulas such as Qingxue Yangyin Tang or Qinggu Zishen Tang. Liver qi stagnation infertility is mostly caused by emotional distress, liver failing to act freely, disharmony of qi and blood, and obstruction of the uterine vessels. Jiyin Gangmu states in "Seeking the Cervical Orifice": "Most cases of female infertility are due to damage by the seven emotions, leading to blood decline and qi excess, irregular menstruation—either early or late, excessive or scanty, pale as water or purplish as blood clots, or menorrhagia and metrostaxis leukorrhea, or abdominal pain, or uterine deficiency and cold, making conception impossible." The key diagnostic points are: menstruation varying in amount, purplish with clots, or dysmenorrheal, pre-menstrual breast distending pain, irritability and easy anger, delayed menstruation or irregular cycles. Treatment should focus on soothing the liver and relieving stagnation, nourishing blood and benefiting the spleen, using formulas such as Kaiyu Zhongyu Tang.
5. Damp Phlegm︰The body is obese, with excessive body hair, amenorrhea or menstrual irregularities, and profuse leucorrhea. Symptoms include dizziness, palpitations, lack of strength, facial and limb edema, chest tightness, and poor appetite. The tongue coating is white and greasy, and the pulse is soggy and slippery. This condition is often caused by constitutional obesity, internal phlegm-dampness, obstructed qi movement, and blockage of the Chong and Ren meridians, leading to infertility. Danxi Xinfa states: "For obese women with a strong constitution and indulgence in alcohol and food, irregular menstruation may lead to infertility, known as 'excessive fat clogging the uterus.' Treatment should focus on draining dampness and drying phlegm." The key diagnostic points are: obesity, amenorrhea or menstrual irregularities, increased leucorrhea, a white and greasy tongue coating, and a slippery pulse. Treatment should emphasize drying dampness and resolving phlegm, supplemented by regulating qi. The recommended formula is Uterus-Activating Pill with degelatined deer-horn and Chinese Angelica.
6. Blood Stasisdampness-heat︰Pain on one or both sides of the lower abdomen, aggravated during menstruation, or with low-grade fever. Menstrual cycle irregularities, or prolonged menstrual bleeding with blood clots and dark purple menstrual blood. Soreness in the lower back, increased vaginal discharge, dark circles under the eyes. Red tongue with thin yellow coating, deep and wiry or slippery and rapid pulse. Often caused by improper care during menstruation or the puerperium, allowing pathogenic toxins to invade the uterus and appendages, leading to stagnation of qi and blood, and accumulation of dampness-heat. The key diagnostic points are: lower abdominal pain, especially during menstruation, low-grade fever, irregular menstruation, or prolonged menstrual bleeding, aching pain in the lumbosacral region, yellow and foul-smelling leukorrhea, or tenderness in the lower abdomen. Treatment should focus on clearing heat and removing toxins, invigorating blood and resolving stasis, using modified Qingre Huayu Decoction or Mirabilite Salt Uterine Decoction.

bubble_chart Documentation

1. Nyuke Zhengzhi Zhunsheng．Prenatal Gate: "The way of prenatal care begins with seeking a child. The method of seeking a child starts with regulating menstruation. It is often seen that women who cannot conceive have irregular menstruation, either early or late, too much or too little, painful before or after menstruation, or the menstrual blood is purple, black, pale, or clotted and irregular. Irregular menstruation leads to discord in qi and blood, making conception impossible."
2. Jiyin Gangmu．Volume Six．Seeking the Cervical Orifice: "Danxi said that women who cannot conceive often suffer from insufficient blood, which cannot capture the essence. Common doctors often attribute it to a cold uterus and prescribe hot and pungent medicines, which scorch the zang-fu organs, causing the blood and qi to boil, leading to immediate disaster. Some take mugwort, not knowing that mugwort is extremely hot; when burned, it descends, but when taken as medicine, it ascends. Overuse can lead to poisoning, and the consequences are irreversible. ... For thin, timid, and impatient people with irregular menstruation who cannot conceive, it is called a dry and astringent uterus, lacking blood to capture essential qi. It is advisable to cool the blood and reduce fire, or use Four Ingredients Decoction with Cyperus, Skullcap Root, Bupleurum, and other blood-nourishing and yin-nourishing medicines."
3. Bianzheng Lu．Seeking Offspring: "There are six diseases in men that prevent them from having children, and ten diseases in women. The six diseases are: cold essence, weak qi, excessive phlegm, excessive ministerial fire, thin semen, and stagnation of the Six Climatic Factors. ... The ten diseases in women are: cold womb, cold spleen and stomach, tight belt vessel, stagnant liver qi, excessive phlegm qi, excessive ministerial fire, kidney water deficiency, Ren and Du vessel disorders, dysfunctional bladder qi transformation, and qi and blood deficiency preventing the capture of essence."