Use of Herbal Medicine in Pregnancy

Has your doctor or midwife told you to stop taking herbs or to not use herbs, especially Dang Gui (sometimes spelled Dongquai) during pregnancy? There are instances where herbal medicine can be safe and beneficial. However, it is best to only use herbs or herbal formulas recommended by a licensed acupuncturist or certified herbalist that specializes in treating women during pregnancy, as they are the only ones with enough expertise to understand the proper application and dosage. Every patient is different and is treated based on individual constitution, health history, and current presentation, and whether the patient is taking medications has to be taken into account. If a patient is on other medications, that is taken into account as well. The herbal formulas discussed below are in no way a general recommendation and should only be used under supervision by your licensed acupuncturist.

Q: Is it safe to use herbs during pregnancy?

A: Some herbs are ok, some are contraindicated, others have to be precisely dosed and combined with other herbs to modify their effects. There are a lot of factors that acupuncturist-herbalists will consider before prescribing herbal medicine.

Chinese herbs go through sometimes years of preparation before they are ready for usage. Pao Zhi is the processing of Chinese herbs that may involve preparatory measures such as washing, soaking, boiling, steaming, fermenting, drying, roasting, honey frying, wine frying, earth frying, vinegar frying, calcining, or other means. This process modifies the action of the herbs from their raw unprocessed form.

Chinese herbs are also almost exclusively used in combination with other herbs (in an herbal formula) and it is this combination that allows for the balancing of the effects of each individual herb. So for example, how Dang Gui (Angelica Sinensis) behaves in the body when used on its own can vary from how it acts when it has gone through preparatory processing and its actions are modified by the actions of other herbs in a formula.

There are select few formulas used during pregnancy. The actions of these formulas are known (and have been for literal centuries) and used for things like bleeding or spotting, pain, cysts, or a history of recurrent pregnancy loss. This is in no way an exhaustive list of indications. Below are two of the most common herbal formulas we use with our patients during pregnancy.

Bu Zhong Yi Qi Tang — Tonify the Middle to Augment the Qi Decoction
The focus of this formula is to strengthen the Spleen’s function of making Qi (energy) and blood, and has an action of directing Qi upward to treat sinking Qi as in prolapses, loose stool, and irregular uterine bleeding (Bensky, 2004, p. 317). Miscarriage could be considered a sinking Qi disorder where the Spleen Qi is insufficient to nourish and hold a pregnancy in place. The ingredients and their actions are as follows.

Huang Qi (astragalus) – Tonify Qi, raises Yang Qi, boosts protective Qi (Immunity), generates flesh, reduces edema. Used for a wide variety of problems related to Spleen Qi deficiency including Qi failing to contain the blood, sinking and collapse of the middle Qi, [Good for uterine muscle weakness after many child births] Used with Chai Hu for excessive uterine bleeding (Scheid, 2009, p. 718).

Ren Shen (ginseng) – “Powerfully tonifies primal Qi…revives from collapse, stops heavy bleeding,” (Scheid, 2009, p. 710).

Bai Zhu (atractylodes) – Tonifies the Spleen Qi, dries dampness, quiets the fetus (Scheid, 2009, p. 726).

Zhi Gan Cao (Honey-prepared licorice) – Preparation method increases its ability to tonify the middle and harmonize the properties of other herbs, (Scheid, 2009, p.734). Tonifies Spleen Qi, moistens the lungs, moderates urgency and toxicity, drains fire (Scheid, 2009, p.732). Moderates and harmonizes the characteristics of other herbs…this herb moderates hot and cold herbs and mitigates harsh properties of other herbs (Scheid, 2009, p.733).

Dang Gui (angelica sinensis)– Tonifies the blood, invigorates the blood, regulates menstruation, alleviates pain (Scheid, 2009, p.750)

Chen Pi (aged tangerine peel) – Promotes the flow of Qi, dries dampness (Scheid, 2009, p.510) Relieves the diaphragm…with such symptoms as epigastric or abdominal distention, fullness, bloating, belching, nausea and vomiting. This herb promotes the movement of Qi in general while specifically directing it downward so it is commonly used to treat nausea and vomiting.

Sheng Ma (black cohosh) – Lifts what has sunken/raises Yang Qi, clears fire toxins. Used in combination with Chai Hu for vaginal prolapse (Scheid, 2009, p. 79).

Chai Hu (bupleurum) – Harmonizes exterior and interior. Soothes Liver Qi and relieves constraint, raises Yang Qi, used with Dang Gui to Harmonize the blood (Scheid, 2009, p. 74-75).

Modified Jiao Ai Tang — Gelatin and Mugwort Decoction (modified)

We have modified this Classic formula so that it is safe for use during pregnancy. The actions of the formula are to nourish blood, stop bleeding, and calm the fetus (Bensky, 2004, p. 610). It is indicated for uterine bleeding (including spotting) during pregnancy, bleeding with abdominal pain, prolonged uterine bleeding after miscarriage, infertility, and postpartum pain. The ingredients and their actions are as follows.

Dang Gui (Tang-kuei) – Tonifies the blood, invigorates the blood, regulates menstruation, alleviates pain (Scheid, 2009, p.750)

E Jiao (Gelatin) – Nourishes blood, stops bleeding, enriches yin (Scheid, 2009, p. 758)

Ai Ye (Artemisia) – Warms the channels, stops bleeding, disperses cold, calms lower abdominal pain, dispels dampness, stops itching. Indicated for restless fetus, vaginal bleeding, infertility due to cold womb.

Combined with E Jiao for restless fetus threatened miscarriage (Scheid, 2009, p. 594)

Shu Di Huang (Cooked Rehmannia) – Enters the Kidney channel, tonifies blood, strongly enriches yin, nourishes blood and tonifies the essences (Scheid, 2009, p. 744).

Bai Shao (Peony) – Nourishes blood, regulates menses, stops pain, preserves yin, softens liver (Scheid, 2009, p. 754).

Gan Cao (Licorice root and rhizome) – Tonifies the Spleen, reinforces Qi. Moderates spasms and alleviates pain. Clears heat, eliminates toxins. Antidote for internal or topical toxic substances, harmonizes other herbs. Also indicated for painful spasms of the abdomen, (Scheid, 2009, p. 732).

Works Cited

Bensky, D. C. (2004). Chinese Herbal Medicine Materia Medica (3rd ed.). Seattle, WA: Eastland Press.
Liangyue, D. Y. (2007). Chinese Acupuncture and Moxibustion (Revised ed.). (C. Xinnong, Ed.) Beijing, China: Foreign Language Press.
Scheid, V. B. (2009). Chinese Herbal Medicine Formulas & Strategies (2nd ed.). Seattle, WA: Eastland Press.