By Andrew Gaeddert
In this second part of a series of articles on questions that practitioners commonly ask, 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 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 in combination 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 Berry 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 Two, which moves Liver Qi and contains tonifying herbs such as Ginseng (Ren Shen) and Cinnamon Twig (Gui Zhi). Ease Two 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 night sweats 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 pills of each formula QID). The aim of Woman’s Balance was to regulate Qi and of 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 pills 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 by the flu, 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.
Is it alright to recommend herbs to nursing mothers? Can Postpartum be used during pregnancy?
In general yes, herbs can be recommended although it should be remembered that the baby will also receive the herbs through the mother’s milk. Thus, herbs should be taken at a reduced dosage. For example, I once treated a mother who contracted a parasitic infection in India. I suggested that she not take herbs during her pregnancy, but that she could take them after she gave birth. She was given Postpartum and Aloe 22, the former for her deficiency and the latter for her constipation. At a dosage of three capsules TID of Aloe 22, the mother no longer had constipation. The dosage of Aloe 22 was then reduced to one capsule TID, and four weeks later both mother and baby were having normal stools. Postpartum is a good general formula for women who have just given birth. This formula can be used during nursing.
Can herbs be administered to pregnant women?
According to Chinese medicine, there are herbs that ought to be used cautiously, and herbs that are contraindicated, during pregnancy. However, in light of current biomedical advice to avoid medications, alcohol, and nicotine, and to restrict caffeine, we think it wise to repeat that Health Concerns does not advocate the use of herbs during pregnancy. This has always been our policy, even though certain herbs may be safe and effective for pregnant women. Because approximately 20 percent of pregnancies result in miscarriage or other pregnancy complications, we cannot condone the use of herbs in this increasingly litigious climate.
HERBS CONTRAINDICATED DURING PREGNANCY
Aconiti Carmichaeli Praep., Radix: Fu Zi
Achyranthis Bidentatae, Radix: Tu Niu Xi
Aloes, Herba: Lu Hui
Arisaematis, Rhizoma: Tian Nan Xing
Belamcandae Chinensis, Rhizoma: She Gan
Bovis, Calculus: Niu Huang
Bufonis, Secretio: Chan Su
Calomelas: Qing Fen
Camphora: Zhang Nao
Carthami Tinctorii, Flos: Hong Hua
Corydalis Yanhusuo, Rhizoma: Yan Hu Suo
Curcumae Zedoariae, Rhizoma: E Zhu
Daphnes Genkwa, Flos: Yuan Hua
Dianthi, Herba: Qu Mai
Draconis, Sanguis: Xue Jie
Euphorbiae Kansui, Radix: Gan Sui
Euphorbiae seu Knoxiae, Radix: Da Ji
Eupolyphagae seu Opisthoplatiae: Tu Bie Chong
Sennae, Folium: Fan Xie Ye
Gleditsiae Sinensis, Fructus: Zao Jia
Guanzhong, Rhizoma: Guan Zhong
Hailong: Hai Long
Hippocampus: Hai Ma
Hirudo seu Whitmaniae: Shui Zhi
Leonuri Heterophylli, Herba: Yi Mu Cao
Liquidambaris Taiwanianae,: Fructus Lu Lu Tong
Mirabilitum: Mang Xiao
Momordicae Cochinchines, Semen: Mu Bie Zi
Moschus moshiferi, Secretio: She Xiang
Moutan Radicis, Cortex: Mu Dan Pi
Mutong, Caulis: Mu Tong
Mylabris: Ban Mao
Myrrha: Mo Yao
Pseudoginseng, Radix: San Qi
Olibanum, Gummi: Ru Xiang
Ophicalcitum: Hua Rui Shi
Persicae, Semen: Tao Ren
Pharbitidis, Semen: Qian Niu Xi
Plantanginis, Semen: Che Qian Zi
Portulacae Oleraceae, Herba: Ma Chi Xian
Realgar: Xiang Huang
Rosae Chinensis, Flos et Fructus: Yue Ji Hua
Sappan, Lignum: Su Mu
Scolopendra Subspinipes: Wu Gong
Serpentis, Periostracum: She Tui
Sparganii Stoloniferi, Rhizoma: San Leng
Strychonotis, Semen: Ma Qian Zi
Sulphur: Liu Huang
Testudinis, Plastrum: Gui Ban
Tinosporae Sinensis, Ramus: Kuan Jin Teng
Trichosanthis Kirilowii, Radix: Tian Hua Fen
Typhonhii Gigantei, Rhizoma: Bai Fu Zi
Vaccariae Segetalis, Semen: Wang Bu Liu Xing
HERBS TO BE USED CAUTIOUSLY DURING PREGNANCY
Abutiloni seu Malvae, Semen: Dong Kui Zi
Amydae Sinensis, Carapax: Bie Jia
Borneol: Bing Pian
Cicadae, Periostracum: Chan Tui
Cinnamomi Cassiae, Cortex: Rou Gui
Citri seu Ponciri Imm., Fruc.: Zhi Shi
Coicis Lachryma-jobi, Semen: Yi Yi
Ren Curcumae, Tuber: Yu Jin
Equiseti Hiemalis, Herba: Mu Zei
Haematitum: Dai Zhe Shi
Halloysitum Rubrum: Chi Shi Zhi
Oldenlandiae Diffusae, Herba: Bai Hua She She Cao
Lophatheri Gracilis, Herba: Dan Zhu Ye
Lycopi Lucidi, Herba: Ze Lan
Magnoliae Officinalis, Cortex: Hou Po
Massa Fermentata: shen Qu
Pruni, Semen: Yu Li Ren
Rhei, Radix et Rhizoma: Da Huang
Rhinoceri, Cornu: Xi Jiao
Talcum: Hun Shi
Tetrapanacis Papyriferi, Med.: Tong Cao
Tribuli Terrestris, Fructus: Bai Ji Li
Trogopterori seu Pteromi, Excre.: Wu Ling Zhi
Typhae, Pollen: Pu Huang
Vespertilii Murini, Excre.: Ye Ming Sha
Zanthoxyli Bungeani, Fructus: Chuan Jiao
Zingiberis Officinalis, Rhizoma: Gan Jiang
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, if 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.
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* followed by the application of red tiger balm. She said that the compresses were too time consuming and the tiger balm too smelly. 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.
*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.
Andrew Gaeddert is the author of Chinese Herbs in the Western Clinic: A Guide to Prepared Herbal Formulas.