1/15/2010
Enhance Fertility using Chinese
Herbal Formulas guided by Basal
Body Temperature
Dagmar Ehling, MAc, LAc, DOM(NM), Dipl OM, FABORM
Oriental Health Solutions, LLC
Durham, NC, USA
919-286-9595
www.orientalhealthsolutions.com
©Dagmar Ehling, www.orientalhealthsolutions.com
Life Cycle:
Quantitatively
Huang Di Nei Jing Su Wen
42 y/o
Guardian:
Mid-Life
42 - 64
Mother:
Young Adult
21 - 42
21 y/o
64 y/o
Crone:
Older Wise
Woman
64 - 84
Maiden:
Childhood &
Adulthood
0 - 21
Birth 0 84 y/o
©Dagmar Ehling, www.orientalhealthsolutions.com
1
1/15/2010
Life Cycle:
Qualitatively
Matsumoto K,
Euler D. Clinical
Strategies, Vol 1,
2004
©Dagmar Ehling, www.orientalhealthsolutions.com
Fertility signals
1
Cervical Fluid (CF)
2
Vaginal feeling
3
Position of cervix
4
Basal Body Temperature curve
(C) Dagmar Ehling, www.orientalhealthsolutions.com
2
1/15/2010
Fertility Awareness (FA) History
• 1930’s: Rev Wilhelm Hillebrand, a Catholic priest
in Germany, used BBT’s for PG avoidance.
• 1950’s: Dr. John Billings discovered the
relationship between cervical fluid (CF) and
fertility. Billings Method mostly relies on CF Family of the Americas 1977, and Pope Paul VI
Institute 1985 – both teach CF only aka Creighton
Model.
• 1971: Founding of Couple to Couple League
International: BBT, CF, cervical position.
©Dagmar Ehling, www.orientalhealthsolutions.com
Yin and Yang – Menstrual cycle
Day 15 – 21
Day 8 – 14
Yin
Yang
Blood
Qi
Gui-sheng X. Use of BBT in pattern
discrimination for patients with infertility
and amenorrhea. Shang Hai Zhong Yi
Yao Za Zhi (Shanghai J of Chin
Medicinals). 1992;10:18-19.
Flaws: Gynecology Certification Course
1993-94
Day 1 – 7
Day 22 – 28
©Dagmar Ehling, www.orientalhealthsolutions.com
3
1/15/2010
4. Basal Body Temperature Curve (BBT)
Ovulation
Qi
Before or during
ovulation often
mild temperature
drop -- extreme
Yin-Excess or
estrogen/CF Peak.
Luteal phase about
12-16 days.
32
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
1
Day 15
4
Day 13
Day 9
Yang
Day 11
Day 7
Day 5
6 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood Yin
Days
Proof of ovulation: Three measurements that are about 0.4°-1.0° F (0.2°-0.5° C) or more
higher than the previous six measurements. At time of period temperature should drop by at
least 0.4°F.
©Dagmar Ehling, www.orientalhealthsolutions.com
4. How to measure BBT’s
• A basal thermometer (calibrated to detect lower temps) is
best but a digital one usually works fine.
• Do not change thermometer brands mid-cycle.
• Upon waking before going to the bathroom or any excessive
talking while still in bed place thermometer under tongue.
Once it beeps record temperature on chart.
• It is recommended to take the temperature at the same time.
Can be tricky for women on night shifts or insomnia.
• Factors that affect accuracy: mouth breathing, snoring,
alcohol consumption, traveling through various time zones,
anti-inflammatory, or sleep aid drugs.
• Mark days of intercourse/moodiness/menses/other events.
©Dagmar Ehling, www.orientalhealthsolutions.com
4
1/15/2010
4. BBT‘s: Chinese & Western Views
• Blood: Fullness of Chong meridian,
nutritious, blood-filled endometrium: Blood
deficiency and/or stasis possible.
• WM: Sufficient FSH encourages estradiol
production
• Yin: Ripening of follicle, abundant Blood
creates abundant yin: Yin deficiency possible.
• WM: In order to have an LH surge we need
an estradiol peak cervical glands CF
©Dagmar Ehling, www.orientalhealthsolutions.com
4. BBT‘s: Chinese & Western Views
• Yang: warms uterus, keeps fallopian tubes patent
during ovulation: Kidney yang deficiency & Liver
depression, qi stagnation possible.
• WM: In order to make progesterone we need an LH
surge Corpus luteum produces progesterone
• Qi: Movement of the egg or embryo through
fallopian tube: Liver depression, qi stagnation &
Kidney yang deficiency possible.
• WM: At the end of the cycle we need estradiol &
progesterone to drop in order to release FSH for the
next cycle.
©Dagmar Ehling, www.orientalhealthsolutions.com
5
1/15/2010
5.1. BBT Imbalances:
Short Follicular, Stable Luteal Phase
Blood Yin Yang
Qi
Possible
WM: none
98.6
98.4
Temp
98.2
98.0
97.8
97.6
97.4
97.2
97.0
1
2
3
4
5
6
7
8
9 10
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Day
CM: yin def.,
empty heat;
excess heat,
potential
incomplete
ripening of
follicle
*Ehling D, Singer K. Gauging a Woman’s Health by her Fertility Signals: Integrating Western with Traditional
Chinese Medical Observations. Altern Ther Health Med. 2001;7(4):71-82.
*Lyttleton J. Treatment of Infertility with Chinese Medicine, Elsevier 2004.
*Gui-sheng X. Use of BBT in pattern discrimination for patients with infertility and amenorrhea. Shang Hai Zhong Yi
Yao Za Zhi (Shanghai J of Chin Medicinals). 1992;10:18-19. Flaws: Gynecology Certification Course 1993-94.
©Dagmar Ehling, www.orientalhealthsolutions.com
5.2. BBT Imbalances:
Long Follicular, Stable Luteal Phase
Yin
Yang
Qi
Possible WM:
not paid
attention to
Days
Day 31
Day 33
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood
CM: KID
yin/yang/jing/
blood def. These
patients may
also have cold
temps with a
sluggish rise
(only 0.2-0.3°F)
©Dagmar Ehling, www.orientalhealthsolutions.com
6
1/15/2010
5.3. BBT Imbalances: High Follicular Temps
during Menses, Stable Luteal Phase
Blood
Yin
Yang
Possible WM: high
temps early on might
indicate
endometriosis, cysts
and/or incomplete
shedding of menstrual
blood
Qi
98.4
98.2
98.0
Temp
97.8
97.6
97.4
97.2
97.0
96.8
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
CM: blood stasis.
Imbalance in
transition from Yang
to Yin.
Day
Look for supporting
symptoms, otherwise
disregard.
©Dagmar Ehling, www.orientalhealthsolutions.com
5.4. BBT Imbalances:
Anovulation - Monophasic
Day 33
Possible WM:
anorexia, high
prolactin levels,
PCOS, luteal phase
issues. BCP’s
disrupting
hypothalamicpituitary-ovarian axis,
esp Depo-Provera
Day 31
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Days
Day 29
Qi
Yang
Day 13
Day 9
Day 11
Yin
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood
CM: KID yin/yang
def.; jing def; SP qi
def, Blood def;
©Dagmar Ehling, www.orientalhealthsolutions.com
7
1/15/2010
5.5. BBT Imbalances: Unstable Luteal Phase
(possible mid-cycle or premenstrual spotting)
Possible WM: Mid-cycle
spotting: low estrogen/low
progesterone temporary
endometrial shedding; low
thyroid, IUD, irreg BCP use;
fibroids, polyps, cancer, injury,
secondary to cervical
cauterization, after CONE biopsy,
injury to vagina. Premenstrual
spotting: low progesterone/
unstable corpus luteum
Day 31
Day 29
Day 27
Day 25
Day 23
Qi
Day 21
Day 19
Day 17
Day 15
Yang
Day 13
Day 11
Day 9
Yin
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood
Days
CM: KID yang def, SP qi def.
©Dagmar Ehling, www.orientalhealthsolutions.com
5.6. & 5.7. BBT Imbalances: Unstable Luteal
Phase
Qi
Blood Yin Yang Qi
Days
WM: unstable corpus luteum,
low progesterone
Day 31
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Day 31
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 11
Day 9
Day 7
Day 5
Day 3
Temp
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood Yin Yang
Days
possible premenstrual spotting
CM: KID yang def, SP qi def.
©Dagmar Ehling, www.orientalhealthsolutions.com
8
1/15/2010
5.8. BBT Imbalances: Unstable Luteal Phases:
Horseback-shaped or Saw-toothed Luteal P.
Blood
Yin
Yang
Qi
Possible WM: usually low
progesterone, unstable
corpus luteum
98.4
98.2
98.0
Temp
97.8
97.6
97.4
97.2
97.0
96.8
Day 27
Day 25
Day 23
Day 1
CM: KID yang def; LIV/H qi
imbalance
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 21
Temp
Day
Day 19
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Day 17
8
Day 15
7
Day 13
6
Day 9
5
Day 11
4
Day 7
3
Day 5
2
Day 3
1
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
5.9. BBT Imbalances: Short Luteal Phase
Yin
Yang Qi
Day 31
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Possible WM:
short luteal
phase d/t low
progesterone
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood
CM: KID yang
or KID yang def
from inadequate
KID yin
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
9
1/15/2010
5.10. BBT Imbalances: Cold Overall Temperatures
Blood
Yin
Yang
Qi
Possible WM:
hypothyroidism,
look for supporting
sn/sx, run labs, run
TPO/TAA.
98.5
98.0
Temp
97.5
97.0
96.5
96.0
95.5
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
CM: KID & SP
yang def.
Day
See also: Broda Barnes Foundation, http://www.brodabarnes.org/
©Dagmar Ehling, www.orientalhealthsolutions.com
5.11. BBT Imbalances: Warm Overall
Temperatures
Qi
WM: Maybe hyperthyroidism,
look for supporting sn/sx, run
labs.
Day 31
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Day 3
CM: Yin deficiency, empty heat;
excess heat; Liver depressive heat
Day 1
Temp
Blood Yin Yang
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
10
1/15/2010
6. BBT: Pregnancy Curve
Yang
Qi
Days
Day 31
Day 33
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
Blood Yin
WM: In rare cases
this curve can be
seen with a
hormone
producing cyst.
PG should be
verified.
CM: In the chart
we need at least 18
high temperatures
to verify PG.
Consider KID
yang & Blood
tonics & raise SP
qi herbs
©Dagmar Ehling, www.orientalhealthsolutions.com
Phase-dependent Treatment Principles
Ovulation
Day 15 - 21
Day 8 - 14
Nourish Blood &
Kid yin, regulate
qi & Blood, fill
Chong
Yin
Yang Yin:
Blood
move
qi, quicken Blood,
clear damp (if nec),
nourish Heart (if
nec), nourish Blood
Day 1 - 7
Yin Yang:
nourish & warm
KID yang, regulate
qi & Blood, clear
damp (if nec),
balance H/LIV
Yang
(if nec)
Nourish & warm
Qi
KID yang, regulate
qi & Blood, clear
damp (if nec),
move LV qi, balance
H/LIV (if nec)
Menstruation
Day 22 - 28
Gui-sheng X. Use of
BBT in pattern
discrimination for
patients with
infertility and
amenorrhea. Shang
Hai Zhong Yi Yao Za
Zhi (Shanghai J of
Chin Medicinals).
1992;10:18-19.
Flaws: Gynecology
Certification Course
1993-94
©Dagmar Ehling, www.orientalhealthsolutions.com
11
1/15/2010
Short Follicular Phase, Stable Luteal Phase
•TxP: nourish yin; clear heat or clear excess heat
•
•
•
•
•
•
Possible Follicular:
Zhi Bai Di Huang Wan +
Nu Zhen Zi
Dang Gui
Gou Qi Zi
Bai Shao
• Long Dan Xie Gan Tang +
Blood tonics, or
• Xiang Qi Tang
• Possible Luteal:
• Jin Gui Shen Qi Wan (-Fu
Zi) + Xiao Yao San (if
PMS d/t LIV qi stagn) +
• Any of these: Du Zhong,
Xu Duan, Ba Ji Tian, Xian
Mao, Yin Yang Huo, Shan
Zhu Yu, Shu Di Huang,
Tu Si Zi
• Can be given just 1 wk bef
period
©Dagmar Ehling, www.orientalhealthsolutions.com
©Dagmar Ehling, www.orientalhealthsolutions.com
12
1/15/2010
1. Case: Heather, 31 (2005)
• Very irregular menses since menarche age 15.
• Took BCP‘s for 5 yrs, stopped 2 yrs ago, since
then amenorrhea, anovulation; diagnosis: PCOS,
since then on glucophage which hasn‘t had much
impact.
• Chronic HA since 3 yrs, can be extreme.
• Overweight by 45 lbs, acne with dry, peeling,
reddish cheeks (using metrogel), < alcohol,
acanthosis nigricans positive in elbow crease and
posterior neck region, hirsutism.
©Dagmar Ehling, www.orientalhealthsolutions.com
1. Case: Heather, 31
• Diet: fast food, lots of aspartame & splenda,
sodas, french fries, intense sugar cravings.
Eats salads and raw foods, ice water or tea,
canned foods heated in the microwave.
• Other Sx: night heat with cold extremities,
depressed, bilateral knee pain since weight
gain.
©Dagmar Ehling, www.orientalhealthsolutions.com
13
1/15/2010
2. Case: Heather, 31
• T: red, swollen, TM, thick white coat
• P: weak, thin
• TCM: SP qi deficiency w/ damp and phlegm,
Blood deficiency, Kid yin/yang def.
• TxP: Boost SP qi, clear damp, resolve phlegm
nodulation, nourish Blood, nourish Kid yin
and warm yang.
©Dagmar Ehling, www.orientalhealthsolutions.com
1. Case: Heather, 31
ultrasound
MRI
©Dagmar Ehling, www.orientalhealthsolutions.com
14
1/15/2010
Day 31
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 11
Day 9
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
1. Case: Heather, 31
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
1. Case: Heather, 31
• Liu Jun Zi Tang, Zhi Bai
Di Huang Wan modif.
•
•
•
•
•
•
•
•
•
•
•
Dang Shen, Rx Codonopsis
Bai Zhu, Rh Atractylodis
Fu Ling, Scl Poriae C.
Gan Cao, Rx Glycyrrhizae
Ban Xia, Rh Pinelliae
Chen Pi, Per Citri R.
Zhi Mu, Rh Anemarrhenae
Huang Bai, Co Phellodendri
Sheng Di, Rx Rehmanniae
Shan Yao, Rx Dioscoreae
Shan Zhu Yu, Fr Corni
•
•
•
•
•
•
•
•
•
•
•
Mu Dan Pi, Co Moutan Radice
Ze Xie, Rh Alismatis
+ Ai Ye, Fo Artemisiae
Yin Yang Huo, H Epimedii
Zao Jiao Ci, Spina Gleditsiae
Shi Hu, H Dendrobii
Yi Mu Cao, H Leonuri
Wu Jia Pi, Rx Acanthopanacis
Xuan Shen, Rx Scrophulariae
Yi Yi Ren, Sm Coicis
Huang Qin, Rx Scutellariae
©Dagmar Ehling, www.orientalhealthsolutions.com
15
1/15/2010
Day 31
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
• After 2 months (seeing
her q 3 wks) of
treatment her
menstruation started
coming with irregular or
weak ovulation.
• She lost about 15 lbs
after dietary changes.
• Still struggling with
cookies...
Temp
1. Case: Heather, 31
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
1. Case: Heather, 31
• Follicular Phase:
• Ba Zhen Tang + Liu Wei Di Huang Wan,
Ban Xia, Chen Pi, Ai Ye, Zao Jiao Ci, Yi Mu
Cao, Yu Jin, Yi Yi Ren.
• Luteal Phase:
• Er Xian Tang + Yi Mu Cao, Ai Ye, Huang
Qin, Ban Xia, Chen Pi, Du Zhong, Xu Duan,
Xuan Shen.
©Dagmar Ehling, www.orientalhealthsolutions.com
16
1/15/2010
Day 40
Day 38
Day 34
Day 36
Day 32
Day 30
Day 28
Day 26
Day 24
Day 22
Day 20
Day 18
Day 16
Day 14
Day 12
Day 8
Day 10
Day 6
Day 4
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 2
Temp
1. Case: Heather, 31
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
1. Case: Heather, 31
• By May 2005 lost 36 lbs.
• Follicular Phase:
• Ba Zhen Tang + Liu Wei Di Huang Wan,
Ban Xia, Chen Pi, Ai Ye, Zao Jiao Ci, Yi Mu
Cao, Yu Jin, Yi Yi Ren.
• Luteal Phase:
• Er Xian Tang + Ai Ye, Huang Qin, Ban Xia,
Chen Pi, Du Zhong, Xu Duan, Xuan Shen,
Gu Sui Bu, Suo Yang.
©Dagmar Ehling, www.orientalhealthsolutions.com
17
1/15/2010
Day 35
Day 31
Day 33
Day 29
Day 27
Day 25
Day 23
Day 21
Day 19
Day 17
Day 15
Day 13
Day 9
Day 11
Day 7
Day 5
Day 3
100.0
99.8
99.6
99.4
99.2
99.0
98.8
98.6
98.4
98.2
98.0
97.8
97.6
97.4
97.2
97.0
96.8
Day 1
Temp
1. Case: Heather, 31
Days
©Dagmar Ehling, www.orientalhealthsolutions.com
1. Case: Heather, 31
•
•
•
•
•
•
After 6 months of treatment her period came every 35 – 38 days,
headaches/migraines had gone away, and on 6/15/05 she was 6
weeks pg.
She had lost a total of 40 lbs at the time of conception.
Jiao Ai Tang during the 1st trimester.
While she had morning sickness she received: Jiao Ai Tang +
Xiang Sha Liu Jun Zi Tang.
Happy baby boy!!!
2009 Update: Patient visited presenting her 6 months old
daughter which she conceived without any treatment!
©Dagmar Ehling, www.orientalhealthsolutions.com
18
1/15/2010
Summary
• Teaching our patients about FAM
empowers patients
• Charting doesn’t cost anything
• Determines further TCM imbalances from
their BBT charts that we might overlook
from their histories and examination further custom-tailor our treatments
• Q&A
©Dagmar Ehling, www.orientalhealthsolutions.com
Enhance Fertility using Chinese Herbal Formulas guided by Body Basal Temperature and Cervical Fluid Signals:
Dagmar Ehling
Februray 7, 2010 8:30am-11:30am PST (11:30am-2:20pm EST)
$74.99 USD
3 CEU/PDA's
Fertility and Embryology in Early Chinese Medicine:
Sabine Wilms PhD
Februray 7, 2010
12:00pm - 2:00pm PST (3:00pm - 5:00pm EST)
$49.99 USD
2 CEU/PDA‘s
Developing a Working/Productive Relationship with a Medical RE&I Clinical Practice:
Paul Magarelli, MD, RE&I and Diane Cridennda L.Ac
Februray 7, 2010
2:30pm - 4:30 pm PST (5:30pm - 7:30pm EST)
$49.99 USD
2 CEU/PDA‘s
Polycystic Ovarian Syndrome -TCM Case Studies:
Shiao Ting Jing
Februray 7, 2010
5:00pm - 7:00 pm PST (8:00 pm - 10:00pm EST)
$49.99
2 CEU/PDA‘s
www.healthstream.tv
©Dagmar Ehling, www.orientalhealthsolutions.com
19