Chinese herbs play a very important part in Traditional Chinese Medicine (TCM). In fact, Chinese herbs are the second most used branch of TCM. Under the umbrella of TCM there are five branches, or tools, that practitioners of TCM use to bring the body back into harmony: acupuncture, herbs, nutrition, movement (QiGong, TaiChi), and TuiNa (massage). The more persistent that a condition is, the more branches of TCM are needed to be integrated in the treatment plan.
Introduction
In Traditional Chinese Medicine the reproductive system is seen as a system-network that requires the perfect balance of Qi, Yin and Yang, and the normal flow of blood to function properly. Subfertility, like many other disharmonies, can stem from multiple root causes. Depending on the root cause, severity and length of the disharmony, different TCM tools can be employed to achieve the desired result.
Background
While there’s a lot of research showing the effectiveness of acupuncture for fertility, not everyone is familiar with Chinese herbs. Chinese herbs are also well researched, very effective, and easy to administer. In TCM, each herb is classified by its temperature (hot, cold, neutral, etc.), its flavor (sweet, sour, salty, etc.) and the organ system that it affects (Liver, Lung, Spleen, etc.). For this reason, almost never is a single herb prescribed, but instead a very careful formula is crafted based on the diagnosis of the patient. For example, a warm herb that affects the Liver system might be good for someone with a cool constitution, but not ideal for someone with a warm constitution. Once a TCM diagnosis has been achieved, the TCM practitioner uses the appropriate herbs to customize an herbal formula that will bring the body back into balance. According to a paper published in 2019 by Nucleic Acid Research, there are over 7,000 Chinese herbs that are used to create herbal formulas, and almost 4,000 herbal formulas that have been created throughout the years – some of these formulas are over 3,000 years old. When creating a formula for a specific patient, most practitioners of TCM use one of the traditional formulas as a starting point and adapt it by adding and/or subtracting herbs to meet the needs of the patient.
Extracting Methods
Several methods exist to extract the active ingredients of each herb, with boiling the herbs for several minutes and drinking the “tea” as a very traditional way of taking herbal medicine. While very potent, the compliance is very low in the United States and other western countries. This is mainly due to the time that it takes to prepare, the taste is not always pleasant, and the boiling process can make the entire house smell strange. To remedy this, tablets have emerged in the market during the past few decades. The active ingredients are extracted the same way as the tea preparation, but instead of drinking the tea, the liquid is dehydrated and what’s left is turned into tablets. Tablets have to go through the entire digestive system before they can release their active ingredients, thus they are not as potent as taking the tea directly.
In the past few years, tinctures have become a preferred way of taking Chinese herbs. Tinctures are liquids where the active ingredients of herbs are extracted by either alcohol, vegetable glycerin, and /or vinegar. The main reason for their popularity is due to their bioavailability – how quickly the active ingredients are delivered to the target area. By bypassing the digestive process, the body absorbs the benefits of the herbs more quickly. Typically a dropperful or two are squirted into one or two ounces of room-temperature water and swallowed. For even a faster delivery of active ingredients, and therefore, a faster effect, the tincture can be squired directly under the tongue. By holding the tincture under the tongue for about a minute or so before swallowing it, the active ingredients are absorbed by the sublingual mucosa and into the circulatory system. It is better to wait about 30 minutes before or after a meal before taking tinctures.
Herbs and Formulas
The practice of gynecology in Traditional Chinese Medicine has been around for over 3,000 years and it is rich with medicinal herbs. Some of these herbs have become very well known in the western world for their effectiveness in the management of the menstrual cycle. For example, Bai Shao (White Peony Root) and Dang Gui (Angelica Sinensis) are essential for nourishing the blood and regulating the menses. These herbs are part of many formulas that address various menstrual conditions, including menstrual pain, irregular cycles, and infertility.
One of the oldest and best-known herbal formulas in Chinese gynecology is Si Wu Tang. This formula, containing only 4 herbs (Dang Gui -Angelica Radix, Chuan Xiong -Chuanxiong Rhizoma, Shao Yao -Paeoniae Radix, and Shu Di Huang -Rehmanniae Radix), was created over 2,500 years ago. Irregular menstrual cycles, short menstrual cycles, lack of energy are all considered general indicators of a blood deficiency in TCM. Blood deficiency is common in women and can be associated with female infertility or ovarian follicular maldevelopment. According to a study published in 2019 by Evidence Based Complement Alternative Medicine, Si Wu Tang can address blood deficiencies and has been shown to promote a normal menstrual cycle in some cases of chronic blood deficiency with menstrual irregularities. In 2021 The Journal of Ethnopharmacology published an animal study to see the effects of Si Wu Tang on mice with Premature Ovarian Failure (POF). The study concluded that: “Si Wu Tang significantly improved estrogen levels, the number of follicles, antioxidant defense, and microvascular formation in POF mice. Moreover, Si Wu Tang significantly activated the Nrf2/HO-1 and STAT3/HIF-1α/VEGF signaling pathways to promote angiogenesis, resulting in a better fertility outcome when compared to the model group”.
“ Si Wu Tang significantly improved estrogen levels, the number of follicles, antioxidant defense, and microvascular formation in POF mice. Moreover, Si Wu Tang significantly activated the Nrf2/HO-1 and STAT3/HIF-1α/VEGF signaling pathways to promote angiogenesis, resulting in a better fertility outcome when compared to the model group”
Frontiers in Pharmacology, a peer-reviewed, open access journal that publishes research across disciplines in pharmacology, published in 2020 a study titled “Evaluating the Therapeutic Efficacy of Si-Wu-Tang Decoction and Concentrated Extract in Follicular Maldevelopment-Related Menstrual Disorders”. The study concluded:
“ In conclusion, Si-Wu-Tang could improve ovarian follicular maldevelopment”
Conclusion
Chinese herbal medicine is an integral part of TCM that has been around for thousands of years. There are several ways of taking the many traditional Chinese herbal formulas that are used to address infertility and gynecological issues. Tinctures, due to their rapid bioavailability, have become the preferred way of taking Chinese herbal medicine. In my clinic, 80% of my herbs and formulas are in tincture form.
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