Prior to Conception: the role of an acupuncture protocol in enhancing women's reproductive ...

354 Pages·2013·9.03 MB·English

Prior to Conception:
the role of an acupuncture protocol in enhancing
women’s reproductive functioning

by

Suzanne Cochrane
BSW, DTCM, BAS

A thesis submitted in fulfilment of the requirements for the
degree of Doctor of Philosophy, Centre for Complementary
Medicine Research, School of Science and Health, University of
Western Sydney

16th July 2012
Statement of authentication

I declare that this thesis does not incorporate without acknowledgement any material previously
submitted for a diploma or degree in any university, and that to the best of my knowledge it is
original and does not contain any materials previously published or written by another person
except where due reference is made in the text.

Suzanne Cochrane
July 2012
Preface

This thesis is a work in progress; it is a static time point (perhaps a way-station) in my journey to
understand health and disease, and the contribution Chinese medicine has made and can make to
the relief of human suffering. To practise Chinese medicine is such a privilege: to have a sense
of thousands of careful, caring, thoughtful and insightful physicians throughout Asia (and
beyond), over many centuries building a knowledge base that guides my actions in the immediacy
of this patient at this time, is overwhelming. Their knowledge is felt in my body – how I stand,
how I look at this person requiring my help, how I hold an acupuncture needle, how I touch
another, how I write a herb prescription. On a good day, Sun Simiao, Zhang Zhongjing, Li
Shizhen, Chris Madden, John MacDonald, Drs Guo and Hu from Hangzhou, Jane Lyttleton,
Huang Yinkang, Ding Huiqin, Zhao Shihua (and many more) are all present, and all with
opinions!
I may have remained in clinic plying my chosen trade had not personal losses launched me on an
unknown trajectory. We can be undone by each other.
It is not as if an “I” exists independently over here and then simply loses a “you” over there,
especially if the attachment to “you” is part of what composes who “I” am. If I lose you, under these
conditions, then I not only mourn the loss, but I become inscrutable to myself. Who “am” I, without
you?...At another level, perhaps what I have lost “in” you, that for which I have no ready vocabulary, is
a relationality that is composed neither exclusively of myself nor you, but is to be conceived as the tie by
which those terms are differentiated and related (Judith Butler quoted in (Dumm 2008:143)).
As Dumm goes on to say, grief sets in motion the idea of our dispossession from ourselves (2008:144). An
exploration was begun and part of the expedition became a desire to understand the lack of
congruence between what I understood as a Chinese medical reality and the reality held up as
inviolate by scientific medicine. And, of course, great loneliness is inevitable in such a search –
by definition. And yet the loss of relationality and the absence of a „ready vocabulary‟ at a
personal level are also echoed in the disjunct between the performative knowledge of Chinese
medicine and the empirical dictates of biomedical science. There is so little common language,
there are so few shared spaces, and apparently so few open hearted and minded people willing to
explore this territory. There are two outstanding guides that I have found.
i
One is Professor Francois Jullien, a philosopher standing at the boundaries of Chinese and
„Western‟ thought. He identifies the foundations of Chinese thinking as being deliberately
indeterminate, careful not to construct and define –the tao, buried, is perceived as the hazy bottom of a
deep body of water we gaze into from above (Jullien 2009:29). Existence is an emergence from an
undifferentiated fount.
If the Chinese painter paints not some particular view but an entire landscape simultaneously
emerging-submerging, appearing-disappearing, he does so to shake the beholder free from the cramped
enclosure of an ego-subject constituting an autonomous fate for itself vis-à-vis the consistency of objects
(Jullien 2009:28).
He insists that this „Chinese‟ view is not a different state of reality but at the „far edge of the
sensible‟ – on a continuum of possible visibility. This means that we cannot „inquire after it all the way‟
and that seeing, hearing and touching, escaping the specification of the different sense organs, become
indistinguishable (Jullien 2009:31). I take this to mean that those who follow the standard methods
of science will fail to fully comprehend the vibrational vitality of qi and the relational dynamism
of yin-yang because they cannot look out of the corner of the eye. An understanding of
foundational Chinese medical (and philosophical) concepts requires „non-looking‟ – the way that
can be known is not the way!
Breath-energy deploying in the great primordial void
rises and falls, and moves unceasingly:
such is the mainspring of empty and full, motion and rest,
the starting point of yin and yang, of hard and malleable.
Floating and rising: such is the limpidity of yang;
lowering and descending: such is the disorder of yin.
Through incitement and communication, gathering and dispersal,
wind and rain, hail and snow are formed:
both the flow of the multitude of existents
and the union and fusion of mountains and streams.
Down to the dregs of wine and the ash of the hearth,
there is nothing of that which is not a lesson.
- Zhang Zai (one of the first thinkers of the Song dynasty) quoted and
translated in (Jullien 2009:135).

ii
The second guide to understanding these marginal „wild‟ lands with glimpses of other ways of
seeing is the scientist Professor Karen Barad (Barad 2003; Barad 2007; Barad 2008). It is she
who has brought me to an appreciation of diffractive methods – a method that focuses on the
relationality rather than the objects. Diffractive methodologies place the „knower‟ or observer
inside what is being sought to be known. Diffraction challenges the notions of objectivity and
subjectivity and suggests that the patterns/configurations/intra-actions that differing ideas or
relationships or bodies or objects make on and between each other is more informative than
representation from an „external‟ independent observer. Representing the object or body as a
fixed thing denies the fluidity of matter and how matter interacts and is understood.

When set free from my (old) life, I found myself standing between Chinese medicine and science,
wanting to honour both through this research project. This is why translating across difference is
the main concern of this thesis. Reproductive health was a topic of both urgency and interest
for the women I worked with in clinic. It is also the area of Chinese medicine practice most
„integrated‟ – that is, where there are overlaps between Chinese and biomedical practice and they
are most in dialogue. This thesis is a search for methodologies – how do we practise research so
that we can work out:
1. Whether Chinese medicine has an intervention (or many) that will assist women with
trouble conceiving?
2. If we can pin down or define Chinese medicine enough, how do we research it? How do
we research it in a way that retains the “Chinese medicine-ness” of its sensibility and
practice?
3. If we can research in such a way as to honour Chinese medicine, how do we report it so
that it will have meaning for biomedicine? Which part of biomedicine do we speak to?
4. What research tools are considered credible or valid for such an endeavour? Were the
tools used in this study useful and to whom?
Barad, K. (2003). "Posthumanist performativity: Toward an understanding of how matter comes to
matter." Signs: Journal of Women in Culture and Society 28(3): 801-831.
Barad, K. (2007). Meeting the universe halfway: Quantum physics and the entanglement of matter
and meaning. Durham, Duke University Press.
Barad, K. (2008). Living in a posthumanist material world: lessons from Schrodinger's cat. Bits of life:
Feminism at the intersections of media, bioscience and technology. A. Smelik and N. Lykke.
Seattle, University of Washington Press.
Dumm, T. (2008). Loneliness as a Way of Life. Cambridge & London, Cambridge University Press.
Jullien, F. (2009). The Great Image Has No Form, On the Nonobject through Painting. Chicago &
London, The University of Chicago Press.

iii
Acknowledgements
Although a thesis dissertation is inevitably a solitary endeavour, it is also a collective project that
requires an army of helpers to bring to fruition. My primary supervisor has been Associate
Professor Caroline Smith, a very experienced acupuncture researcher. It is difficult to
acknowledge clearly how important her guidance and support have been. Firstly, she gave me
the „gig‟! Secondly, she has been actively and thoughtfully engaged with this research task. I know
I have been a challenge to her and I have valued her ability to have me focus on the task at hand
– again and again – and also to allow me to explore non-quantitative methodologies. If there is
value in what I have produced she deserves a significant share of the credit. Dr Alphia
Possamai-Inesedy has to be the gentlest yet most rigorous supervisor and qualitative researcher
created. Her immediate acceptance of the request to join my supervisory panel speaks to her
openness to work across the science-social science divide. I owe much to her preparedness to
think outside her own „square‟. The rest of my supervisory panel comprised Professor Alan
Bensoussan and Jane Lyttleton. Alan, although too busy to be very hands-on, created the space
that allowed my research to happen – literally, by creating the Centre for Complementary
Medicine Research and by facilitating a grant from the National Institute of Complementary
Medicine that became the scholarship for my doctoral studies. And Alan has been at the
forefront of bringing Chinese medicine and biomedicine to dialogue. Jane Lyttleton is my
mentor. Without Jane my Chinese medicine life would have been diminished. She rescued me,
as a beginning student from a disintegrating teaching institution. And on several occasions since,
she has intervened to such good effect in my life. Jane does not need to do more than be herself
for me to be in awe – she is the model of a Chinese medicine practitioner in the West without
equal.
There are many people whom I want to acknowledge for their support of me and this project in
these last few years (in no particular order and for many reasons): Anne Traynor, Vanessa
Traynor, David Traynor, Rory O‟Brien, Mary Dimech, Annie Parkinson, Sue Bowrey, Annie
Pfingst, Lynne Keevers, Lynne Dooley, Barbara Bloch, Alissar Gazal, Lyndal Sullivan, Ruth Ley,
Sharon Callaghan, Kylie Willis, Luo Haiou, Zhu Xiaoshu, Kerry Carmody, Trudy Zipf, Volker
Scheid, Cinzia Scorzon, Suzanne Grant, Stef Penkala, Rebecca Olsen, Dr Paul Fahey, Jan
Jamieson and the Splendids. And I wish to acknowledge wholeheartedly the importance and
generosity of the 56 women who volunteered to participate in this study. Without them and
their open engagement none of this would have been possible.
iv
For very specific assistance I would like to thank Dr Ben Colagiuri (the expert communicator
who is doomed to be the stats person – for me at least!), Micki MacDonald and Ros Priest (for
their endless helpfulness and know-how) and Sandra Sewell (for her ongoing support and for her
tireless patience copy editing this thesis). Heather Crawford was a great help as a research
assistant and participating acupuncturist. I am very grateful for her data entry expertise. Tony
Chianese and Helio Acupuncture Supplies provided the acupuncture needles for the clinical trial
and are perennially supportive of acupuncture research and practice. Lastly I want to
acknowledge my canine support, Sadie, my loved and loving companion through so much. And,
of course, ABC Classic FM radio station for (nearly) everything they broadcast, and the Madura
tea company for their sustenance.

v
Prior to Conception: the role of an acupuncture
protocol in enhancing women’s reproductive
functioning

by Suzanne Cochrane BSW, DTCM, BAS

A thesis submitted in fulfilment of the requirements for the degree
of Doctor of Philosophy, Centre for Complementary Medicine
Research, School of Science and Health, University of Western
Sydney
January 2013
[1]
Statement of authentication
I declare that this thesis does not incorporate without acknowledgement any material previously
submitted for a diploma or degree in any university, and that to the best of my knowledge it is
original and does not contain any materials previously published or written by another person except
where due reference is made in the text.
Suzanne Cochrane

July 2012
[2]
Contents
List of Tables ............................................................................................................................................... 7
List of Figures and Illustrations ................................................................................................................ 8
Abbreviations .............................................................................................................................................. 9
Abstract ...................................................................................................................................................... 10
Chapter 1: Setting the Context............................................................................................................... 12
Introduction ........................................................................................................................................... 12
The research opportunity .................................................................................................................... 12
Epidemiology of infertility and subfertility ................................................................................................... 13
Causes and risk factors ..................................................................................................................................... 13
Determinants of fertility and infertility ......................................................................................................... 14
Main Categories of Infertility .............................................................................................................. 16
Ovulatory disorders .......................................................................................................................................... 16
Tubal problems ................................................................................................................................................. 17
Endometriosis ................................................................................................................................................... 18
Premature ovarian failure ................................................................................................................................ 18
Unexplained infertility ...................................................................................................................................... 19
The impact on fertility of lifestyle, diet and exercise ....................................................................... 19
Conventional treatment and management options .......................................................................... 21
Primary Care ...................................................................................................................................................... 21
Periconception Care ......................................................................................................................................... 24
Reproductive management of PCOS ............................................................................................................ 26
Reproductive management of Endometriosis ............................................................................................. 26
Reproductive management of ovarian failure .............................................................................................. 27
Reproductive management of tubal blockages ............................................................................................ 27
Assisted Reproduction ..................................................................................................................................... 27
Experience of Infertility ....................................................................................................................... 28
CAM use for fertility ............................................................................................................................ 34
Overview of thesis ................................................................................................................................ 35
Chapter 2 An overview of the role of Chinese medicine and the management of fertility ........... 37
Introduction ........................................................................................................................................... 37
[3]