In this second part of a series of articles on commonly asked practitioner questions, we explore frequently encountered gynecologic issues in administering herbal formulas.
What is a good general herbal protocol for American women who are non menopausal?
According to Chinese medicine, prior to menstruation, women tend to have Qi stagnation. During menstruation Blood can become stagnant, and following menstruation, Blood is usually deficient. Thus, for women who continue to have their periods, consider using the formula Woman’s Balance or Heavenly Water premenstrually to promote the movement of Qi and blood, and Eight Treasures postmenstrually to tonify the Qi and blood. For menstrual cramps use Crampbark Plus, and if the pain is acute, Channel Flow can be administered. For a preponderance of Heat, the formula Unlocking can be used alone or be combined with Channel Flow.
What is the difference between Woman’s Balance and Heavenly Water? What herbs treat premenstrual syndrome (PMS)?
Both formulas regulate Qi and treat PMS. However, Woman’s Balance contains more heat clearing and blood-moving herbs, while Heavenly Water is more tonifying. The latter formula also contains a western herb called chaste tree berries that is used for balancing the hormones. Unlike Woman’s Balance, Heavenly Water does not contain bupleurum (chai hu). Another formula that can be administered for the treatment of PMS is Ease 2, which moves liver qi and contains tonifying herbs such as ginseng (ren shen) and cinnamon twig (gui zhi). Ease 2 may be more suitable for women who have loose stools and signs of spleen qi deficiency in addition to PMS and irritability. For those affected by nightsweats and other signs of long-term yin deficiency, Nine Flavor Tea can be used. For excess heat signs and liver fire, Coptis Purge Fire can be added to any of the above regimens.
As an example, I once treated a woman stockbroker who was experiencing mood swings, particularly before menstruation. She also suffered piercing pain behind her eyeballs, and complained of constipation and insomnia. Her pulse was wiry and rapid, and her tongue was red and dry. I recommended that she take Woman’s Balance, plus Coptis Purge Fire (two of each formula QID). The aim of Woman’s Balance was to regulate Qi and Coptis Purge Fire to drain heat. Two months later, after the heat symptoms were resolved, she was switched to a regimen of Woman’s Balance and Calm Spirit (two of each formula QID). As a result, her headache was totally relieved, and the constipation and irritability greatly improved.
I am uncertain about giving herbs to menstruating women. What is advisable?
Herbs should not be given during menstruation if they are not necessary. When the patient is weak or deficient, has menstrual cramps, or is affected by a cold or the flu, then the appropriate herbs and/or formulas can be used to address such patterns. However, herbs that invigorate the blood such as tang-kuei (dang gui) and ligusticum (chuan xiong), and the like should either be avoided or used with caution as menstrual flow could be increased. Women who are suffering excessive uterine bleeding should have proper biomedical diagnosis before starting an herbal regimen.
Can herbs be administered to pregnant women?
We do not recommend any herbs during pregnancy. Because of liability concerns, practitioners should be aware of herbs that ought to be used cautiously and those that are contraindicated, during pregnancy. There was a case of a pregnant woman who took herbs and then sued both practitioner and herbal supplier when the baby was not born in good health, despite the fact that the formula was prescribed correctly.
Is it alright to recommend herbs to nursing mothers?
To err on the side of caution, and to reduce practitioner liability, we suggest that nursing mothers use a reduced dosage of herbs, and watch closely for any changes in baby’s skin, stool, and alertness.
One of my fibromyalgia patients says that Channel Flow is no longer working for her. She has been on the formula for six months and initially had excellent results. Did its effect wear off?
When used alone, Channel Flow’s effect is short-term. To be used long-term, it should be combined with other formulas. In this particular case, we reassessed the patient’s situation and found that her pain worsened in cold and damp weather. We also discovered that she was not complying with the instructions of applying AC-Q hot herbal compresses*. She said that the compresses were too time consuming. She was also not adhering to the suggested daily walking schedule. In treating fibromyalgia successfully, both internal and external herbs must be used together. Additionally, regular reevaluation of the herbal regimen is necessary because of changes in the weather and/or season, as well as in emotion.
Since this patient was already convinced that the formula was no longer effective, we decided to add Mobility 3 to address the pain and to rebuild her confidence in the herbal program. With regard to developing a tolerance to herbs, this is a normal response and is all the more reason to continually reassess the patient’s presenting syndrome. After all, disease is a dynamic process and treatment should be ever changing as well.
What formulas treat endometriosis, cysts, and fibroids?
Endometriosis responds well to herbal treatment. For signs of heat and stagnation, the formula Unlocking can be administered with results in as quickly as one week. If there is intense pain, Channel Flow can be considered, and for signs of Coldness, add Backbone. For uterine fibroids, I usually use a combination of Bupleurum Entangled Qi with Cramp Bark Plus, or with Unlocking (two of each formula QID) for signs of Heat. With multiple fibroids it is probably unrealistic to expect complete elimination of the fibroids, although we can see a reduction in size usually in about three months, when the patient is faithful to the regimen. A larger fibroid such as the size of a grapefruit can take about six to eight months of treatment before a substantial reduction in size is seen. Again, for cold signs, Backbone should be administered. The same protocol can be used for ovarian cysts. Breast fibroids can be treated with Bupleurum Entangled Qi. For stronger blood-moving effects, combine Bupleurum Entangled Qi with the formula Regeneration.
My patient has menopausal symptoms and a history of breast cancer. Can she be given the formula Three Immortals?
Yes, since none of the herbs in this formula, such as tang-kuei (dang gui) has been found to have estrogenic effects. Also, from a traditional viewpoint, Three Immortals is helpful in reducing hot flashes, nightsweats, and in strengthening the kidney.
*Empty 3-5 capsules of AC-Q, add water and bring to a boil for 1 minute. After suitable cooling, apply the warm herbal liquid with a face towel as a warm compress to tender joints and/or muscles. Reapply the compress for up to one half hour, one or more times daily. When refrigerated, the herbal liquid will keep for up to one week.