2013, Pages xix–xx
Introduction
- Available online 8 April 2013
The first edition of this text was written more than 10 years ago – a long time in a rapidly developing field like reproductive medicine, where advances sit at the cutting edge of medical technology – but a very short time in Chinese medicine. I am grateful that in this complex and ever changing world, the goalposts don’t keep shifting in Chinese medicine! However, the context in which we apply it does keep changing. And this is especially the case in reproductive medicine. Hence, some chapters of the first edition warranted significant updating.
While this text aims to cover all the different aspects of infertility treatment, including essential background theory and professional, philosophical and ethical considerations, it also aims to be a useful clinical reference book. To facilitate this, the new edition features an easy to find symbol (
) located on the top of those pages that contain the treatment protocols and guidelines you might want to access quickly when you are in the clinic with your patient.
) located on the top of those pages that contain the treatment protocols and guidelines you might want to access quickly when you are in the clinic with your patient.
The basic premise of treating functional infertility with TCM remains unchanged. As I outline in Chapter 2, it requires a deep understanding of menstrual and reproductive physiology. And then, as outlined in Chapter 4, it requires a thorough familiarity with the ways we can affect these processes with Chinese medicine. This doesn’t change. However, our medical understanding of some gynecological disorders, which we discuss in Chapter 5, such as polycystic ovarian syndrome and endometriosis, has developed a little and this further informs our TCM analysis and treatment of these conditions.
Polycystic Ovarian Syndrome (PCOS) is now a much more commonly diagnosed cause of infertility than it was 10 or more years ago. This condition is an extremely challenging one on many fronts, since it adversely affects not only the reproductive system but also several other physiological systems. We are a long way from completely unravelling the PCOS puzzle but here, we examine the many ways it can present in the clinic, what we currently know about the condition and what causes it, and how we as doctors of Chinese medicine can approach its treatment holistically.
Endometriosis is another common cause of infertility and while surgical techniques for managing this disease are improving all the time, medical treatments are not. TCM steps into this breach effectively for many women and we shall discuss in some expanded detail, different approaches to treatment according to circumstance.
Treatment of male infertility has largely been made redundant by the advent of IVF techniques, whereby healthy active sperm are no longer necessary for fertilization of an egg. This alarms some urologists and andrologists, and some TCM doctors. Fortunately, there has been some very convincing research demonstrating that acupuncture can produce significant improvements in sperm health. We look at these and other updates in Chapter 7.
Chapter 8, which examines miscarriage, its causes and prevention, now includes more discussion of immune infertility and the role that acupuncture and Chinese medicine may play. At this stage of our medical knowledge, autoimmune disease presents more questions than answers but Chinese medicine, because it influences multiple body systems simultaneously holds enormous potential in this area.
The treatment of IVF patients with Chinese medicine has become much more commonplace in the last 10 years, and it is timely for us to closely examine this phenomenon. We need to be clear about what it means to apply a traditional medicine ‘on top of’ an induced iatrogenic state, and the ethics and philosophical questions it poses. Recognizing that this is uncharted territory (or ‘coalface’ medicine), Chapters 9, 10 and 11 Chapter 9 Chapter 10 Chapter 11 take the time to examine the values, context, and therapeutic techniques inherent in the different approaches of IVF and TCM and out of this understanding, suggest some guidelines for clinical protocols.
There is much focus now on aspects of our environment and lifestyle and how that impacts our reproductive health and capacity. I have tried to include all current information in Chapter 12, although by the time this book is in print there will no doubt be more!
TCM treatment of functional infertility is not a simple topic and adding ART techniques to what is already complex can present a considerable clinical challenge. I have attempted to come up with strategies that are manageable for both the practitioner and the patient, and I look forward to more developments in this area as more and more doctors of Chinese Medicine explore treatment strategies that will help the IVF patient.
2012
Copyright © 2013 Elsevier Ltd. All rights reserved.
