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Archive for the ‘qi and fertility’ tag

Infertility and TCM Part 14: Did Qi Bo Know Best?

By David Kreiner MD

April 15th, 2015 at 11:39 am

photo: stuart miles/

Traditional Chinese Medicine (TCM) evolved over thousands of years as evidenced by several ancient written works including the oldest medical textbook in the history of the world, the Huang-Di Nei Jing (Yellow Emperor’s Cannon of Internal Medicine), dating back to between 300 and 200 BCE.

The book is named for Huang Di, the Yellow Emperor, who lived between 2700 and 2600 BCE.  The legend is that it is a record of the emperor’s conversations with his distinguished physician, Qi Bo.  The Huang-Di Nei Jing consists of 162 articles divided into theory and practice.  The section on theory involves the relationships among the internal organs, the sense organs, and the brain dealing with the concepts of yin and yang as applied to medicine.

In TCM according to the Huang-Di Nei Jing, the yin and yang principle proposes that the bodily organs are interdependent and support each other in harmony.  Disease is defined as a loss of this state of balance both within and among the organs.  Treatment with TCM has always been based on the restoration of the body’s natural harmony with a rebalancing of all the organs.

In all likelihood, the Huang-Di Nei Jing represents a compilation of works drawn from the experience of many TCM leaders over the course of hundreds, if not thousands, of years.  It is reminiscent of the Jewish Talmud which likewise represents contributions from thousands of Rabbis over the course of hundreds of years.  Also, in a fashion similar to the study of TCM, contemporary Jewish scholars study and follow the Talmud much as it was originally written.

The second section of the Huang-Di Nei Jing is a manual on the practice of acupuncture.  Today, this book continues to be used as a reference by contemporary TCM practitioners.

The internal organs are believed according to TCM to be connected by a system of acupuncture points organized along channels (also referred to as meridians) throughout the body.  Each point regulates an aspect of the functional activity related to its channel or associated organ, or sometimes some other channel or organ it may also ultimately connect with or relate to.  Acupuncture points are areas on the surface of the body where the Qi (the body’s life energy) may be accessed as it traverses through one of these channels.  By stimulating or reducing (suppressing or dispersing) at the acupuncture point, the TCM practitioner can regulate the flow of Qi in the channel and/or to a particular organ.

In TCM, pathology may exist secondary to a stagnation of this flow of Qi which disrupts the function of an organ not receiving its normal Qi flow.  Qi may be deficient in which case the treatment would be to increase the Qi in the body and tonify affected organs.  Other pathologies may exist based on excess or deficiency of fluids, heat and blood.  Stagnant blood flow may cause disease, as can excess cold or heat, all of which can affect the flow of Qi as well as the channels and organs in the body.

TCM practitioners often utilize herbs to assist in restoring the harmony in the body and expelling the pathogens which include heat (including summer heat), cold, dampness, dryness and wind which we think of in modern medicine as viruses, bacteria, fungi etc.

In addition to acupuncture, the TCM practitioner may utilize moxibustion which is the application of heat applied to the skin using a vehicle that may include the use of topical herbs.

Cupping, the application of small glass cups or bamboo jars as suction devices on the skin is yet another technique utilized to improve the flow of Qi through the channels in the body.  It is also used to release toxins, clear blockages of Qi and blood, as well as relax muscles.  It can encourage blood flow and sedate the nervous system.  It has been used for cellulite reduction as well as to clear congestion from the common cold or to help patients with asthma.

Modern application of TCM… though based on ancient science, philosophy, and techniques… still resembles that which was performed over 2000 years ago.  I think that… despite its lack of Western scientific explanation, basis, and justification… it remains a viable medical option because of the evidence of cure and palliation that it has brought to so many over the millennia.

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Do you believe there is a place for Eastern medicine practices, blended with Western medicine? Interested in learning more? Post any questions here for Dr. Kreiner.




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Infertility and TCM (Part 5) Channels and Points: TCM’s Gross Anatomy Equivalent

By David Kreiner MD

March 31st, 2014 at 2:05 pm


image courtesy of stuart miles/freedigital


As a new student in Traditional Chinese Medicine (TCM) and acupuncture one of the first and most important classes we must take is called “Channels and Points”. This to a former medical student is the TCM version of Gross Anatomy. Gross anatomy in medical school was my exciting introduction to the human body, essential to the study of medicine.  I owned the classic Gray’s Anatomy text which today is popularized by the TV show of the same name.  The course requires strict memorization of all the bones, nerves, ligaments, vessels and organs in the body.

Likewise, “Channels and Points” requires the memorization of the precise location of 365 points and the corresponding channels of Qi which course throughout the body and can be utilized in the practice of acupuncture.  How these channels and points relate to each other and to the different organs is important as that will also determine their usefulness in different clinical situations.  

It is believed that the location of the channels of Qi and their surface access points was discovered through centuries of observation of the existence of tender spots on the body during the course of disease.  Furthermore, it was observed that symptoms were alleviated when those points were stimulated by massage or heat.  

When a number of points became known, they were linked into groups with common characteristics and effects and hence a pathway for a channel was identified.  Knowledge accumulated over hundreds of generations documented in several ancient texts.  As information regarding the channels and points accumulated, theories evolved and often resulted in modifications of prior beliefs as more experience clarified more accurate placement and function of these channels and points.  

The first document that unequivocally described the channels and points in an organized system of diagnosis and treatment recognizable as acupuncture is The Yellow Emperor’s Inner Classic, dating from about 100 BCE. The information was presented in the form of questions posed by the Emperor, Huang Ti, and replies from his minister, Ch’i-Pai. The source of the text of his answers was likely a compilation of traditions handed down over centuries, presented in terms of the prevailing Taoist philosophy, and is still cited today in support of particular therapeutic techniques. There is evidence that acupuncture utilizing bronze, gold and silver needles was practiced around this time as well as moxibustion.  

A more contemporary view of the concepts of channels in which Qi flowed that was documented through the precise anatomical locations of acupuncture points developed later.  During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. It includes descriptions of the full set of 365 points that represent superficial access to the channels through which needles could be inserted to modify the flow of Qi energy.

Unlike the bones, tendons, nerves and vessels of Gross Anatomy, the channels and points utilized in acupuncture do not have corresponding visible or palpable anatomic structures that may be identified in an effort to memorize.  These channels of Qi are not visible structures nor can they be felt through touching or palpation.  So how does the acupuncturist know where the surface access point is to direct his needle?  

The trained acupuncturist utilizes the surface anatomy such as bones, joints and ligaments to locate these acupoints.  The points typically are found between the ligaments, in bony crevices or between bones. Additionally, the body is divided into units of measure based on an individual’s own bone size.  The most basic unit, cun, is defined as the width of the individual patient’s thumb.  Two cun is the distance from second most distal or middle joint of the forefinger to the tip.  Three cun is the width of the forefinger to the pinky measured at the point of the middle joint of the fingers.  The arms are 9 cun from axilla to the transverse crease of the elbow and 12 cun from the elbow crease to the wrist crease.  The number of cun for every portion of the body is delineated so that the location of the acupoints is based on locating according to the distance by cun units from an identifiable spot on the surface anatomy of the patient and usually are found in between ligaments, bones or in the bony crevices which are palpated by the acupuncturist upon needle placement.  

There are also some points that are identifiable based on particular placement of the fingers and hands of either or both the acupuncturist and patient.  For example, if the acupuncturist places his finger on a patient’s styloid process then has the patient internally rotate his/her hand, the point is located where the acupuncturist’s finger ends up.  This point, currently my favorite, is Small Intestine (SI) 6 with the English name of Support for the Aged because it treats symptoms such as blurry vision, lumbar pain, neck pain and other aches and pains that affect individuals as they get older.  

Another critically important point and therefore given the distinction of being a Command Point for the head and nape of the neck is Large Intestine (LI) 7.  It is located when the acupuncturist places his/her index finger on the dorsal side of the patient’s hand and thumb on the ventral side in between the patient’s thumb and forefinger.  The acupuncturist will locate the point where the tip of his forefinger meets a groove in the anterior portion of the patient’s radius bone.  

How deep to place the needle and in what direction and angle are further issues to be learned another day.

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Are you finding this educational journey into TCM fascinating? Do you have any questions for Dr. Kreiner about this or any other TCM topic he has covered so far?

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TCM and Fertility: The Importance of Vital Substances and Maintaining Balance

By David Kreiner MD

March 20th, 2014 at 2:07 pm


image courtesy of stuart miles/free digital

Traditional Chinese Medicine (TCM) has presented such a challenge to my Western scientific perspective that I neglected to define the basic principles on which TCM is based. 


TCM, and life itself, according to Chinese tradition which developed over the past three thousand years starts with the vital substances, Qi and Essence, in addition to blood and body fluids.  Our human physiological functioning is dependent on these vital substances which the body attempts to maintain in balance between Yin and Yang.  The Qi and Essence, blood and body fluids will interact and perform their essential roles throughout the body dependent on the Zang-Fu and “extraordinary” organs and the states of Yin and Yang while traveling through vessels, channels, and branches that interconnect with each other.

The concept of Qi comes from the Chinese Taoist philosophy that has been described as a “life force” but is actually an aggregate of ideas that we Western thinkers like to separate to better understand.  To our way of thinking it likely is a form of energy, or electric potential that crosses cell membranes as it traverses from one part of the body to another.  Chinese tradition identifies many different forms of Qi each with different functions affecting physiology and life.  The acupuncturist studies the channels through which Qi flows in the body to modify its flow for a particular purpose… whether to eliminate pain or improve an individual’s health, both of which may be impacted by some pathology of Qi level or flow.

Essence (Jing) is considered one of the three treasures of TCM, along with Qi and Shen (spirit).  Jing is stored in the kidneys according to TCM and nourishes and fuels the body.  There is Prenatal Essence which is supposedly inherited much like DNA and cannot be renewed.  It is responsible for an individual’s constitution and congenital illness. Postnatal Essence can be replenished by food, herbs, acupuncture, or exercise such as T’ai Chi.  Total Essence is made up of both Prenatal and Postnatal Essence and is responsible for growth, development, and reproduction.  Effects of aging may be caused by a deficiency or deterioration of one’s Essence.

In Chinese philosophy, the concept of Yin and Yang is used to describe opposite yet complementary forces that are both interdependent and interconnected and give rise to each other.  Yin and Yang interact in a dynamic way.  Whenever one quality reaches its peak, it will naturally transform into the other.  In TCM, good health is directly related to the balance between Yin and Yang qualities within oneself. If Yin and Yang become unbalanced, one of the qualities is considered be either deficient or in excess… which can lead to illness and disease.

The traditional Chinese concept of human organs, known as Zang-Fu and “extraordinary organs”, are not primarily based on anatomical considerations.  They instead are defined as functional entities with a general location in the upper, middle, or lower Jiao separated by the diaphragm and the umbilicus.  The three Jiao (San Jiao) together is considered a functional organ in TCM and… in addition to separating the other organs into three cavities including chest, upper abdomen and lower abdomen… it functions in the transport of Qi and body fluids.  These Zang-Fu and additional “extraordinary” organs are interconnected with each other through channels of Qi in addition to vessels containing blood and body fluids.  As a result, a problem in one organ can affect the functioning of another.

TCM differs from Western Medicine mostly in its holistic approach as compared to our Western reductionist way of scientific thinking.  Disease and illness according to TCM is a result of a disharmony in the functions of Yin and Yang, Qi and its pathways or meridians, the organs (Zang-Fu and “extraordinary”), Essence, and/or the interaction between the individual and his/her environment.  Therapy is based on which disharmony pattern is identified and may include behavioral modifications including diet and exercise, treatments including herbs, acupuncture, and moxibustion, as well as other interventions.


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What TCM concept explained above is most fascinating to you? Which would you like to learn more about?



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To Qi or not to Qi? That is the Question

By David Kreiner MD

February 1st, 2014 at 5:27 pm


credit: StuartMiles/freedigital

It has been a month since I started my studies in Traditional Chinese Medicine and Acupuncture at the New York College of Health Professions in Syosset, NY. 

Why does this 58 year old Reproductive Endocrinologist want to go back to school for an additional career after practicing for 27 years you may ask?  Is it because I am jealous of my younger daughter starting the University of Michigan this past fall and I want to enjoy the Greek life?  Eh…I cannot deny the coincidence is suspicious.

However, my interest in Traditional Chinese Medicine (TCM) dates back to my own college days. While I bought a copy of the “Barefoot Doctor’s Manual”, the thick red book sat on a shelf for years.  I never got past a few lines about “dampness in the lower burner” and treating “excess phlegm”.  After all, my goal was to become a physician and I liked wearing my clogs back then anyway.

TCM appears quite strange to a Western-trained physician.  The language is unique to TCM and bears little resemblance to the medical physiology that we are familiar with.  As I become more knowledgeable about the fundamentals of TCM, I am fascinated by the elaborate construct of ideas on which TCM is based. 

Unlike modern Western Medicine which is based on scientific study and experimentation, the wisdom of TCM was built upon hundreds of generations of experience by the wise healers of China.  Observations of thousands of cases led to the development of theories regarding disease, illness and healing.  To my physician friends who question the concept of treating pain and illness by impacting channels of Qi, a form of life energy, I ask them: Who are we to question the collective wisdom and experience of hundreds of generations of the wisest healers of China when Modern Medicine has been helping more people than it has been hurting only for the past 80 years or so?  I personally have seen many examples of accepted “Medical Truths” rejected and disproved since graduating medical school in 1981.

My goal is to help my patients any way I can.  Yes, I am a Western-trained physician but more than that I am my patients’ healer who is helping them in their journeys to build their families.  We have great tools in Western Medicine including gonadotropin medications, intrauterine insemination (IUI) and in particular In Vitro Fertilization.  But sometimes they may not be enough. 

I am reminded of the book and movie “Life of Pi”.  The protagonist, Piscine or Pi,tells his story about how he survived 227 days after a shipwreck while stranded on a lifeboat in the Pacific Ocean with a Bengal tiger named Richard Parker.  The official representatives investigating the incident reject his story as unbelievable and insist on hearing the “truth”.  Pi then offers them a second story in which he is adrift on a lifeboat not with zoo animals, but with the ship’s cook, a Taiwanese sailor with a broken leg, and his own mother. The cook amputates the sailor’s leg for use as fishing bait, then kills the sailor and Pi’s mother for food. Pi then kills the cook and dines on him. 

Pi points out that neither story can be proven and neither explains the cause of the shipwreck and in the end of each story the outcome is the same… that he still lost his family.  We are left without an answer as to which story is real. Why does it matter which story was true?  We are asked which story we preferred.

Similarly, with TCM, if we can achieve the desired outcome…in my specialty, the much sought after pregnancy and healthy baby, why does it matter if we do not fully understand the science or principles behind the therapy? The story we choose for that much desired baby…for our “journey to the crib”… can include TCM if it could help us to attain our goal. 


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Do you think the blending of TCM and Western medicine principles could benefit infertility patients? Have you ever used or considered using TCM in your own fertility journey?

Photo credit: Stuart Miles


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