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       Chinese Herbal Medicine During Pregnancy & Lactation

       Many practitioners and their patients worry about the safety of Chinese herbal medicinals during
       pregnancy and lactation. These are understandable concerns. However, a lot of misunderstanding

       has grown up around them.

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       Prohibited herbs during pregnancy
       When we go to school, we learn that certain Chinese medicinals are prohibited during pregnancy
       and that others are to be used with caution only. Unfortunately, these prohibitions are not as clear-
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       cut and universal as they outwardly seem. Many of these prohibitions are for the “uninitiated,”
       the “outsiders.” If we have studied Chinese medical gynecology, a number of these prohibitions
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       are allowed and even necessary when warranted.

       In order to understand this, we must understand what the word “warrant” means. In law, a
       warrant is permission to do something, which is otherwise illegal. For instance, if the police have
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       a warrant they can “kidnap” a person, i.e., put them in jail against their will. Or, if police have a
       warrant, they can “break and enter” to conduct a search. In order to obtain a warrant, one must
       present evidence that the otherwise prohibited action is necessary or warranted.
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       Let’s take a concrete example from the world of Chinese medicine. Ban Xia (Rhizoma Pinelliae
       Ternatae) is sometimes considered prohibited during pregnancy due to its containing toxins.
       However, it is the main ingredient for harmonizing the stomach and stopping vomiting. This

       means that, without nausea and vomiting, one should not use Ban Xia during pregnancy, but, if
       there is nausea and vomiting during pregnancy, Ban Xia becomes a main and necessary

       ingredient. As an extension of this, as soon as the nausea and vomiting are eliminated, the Ban
       Xia should be discontinued because it is now unwarranted.

       Here’s another example. Dan Pi (Cortex Radicis Moutan) is prohibited during pregnancy due to
       its quickening of the blood. It is assumed that quickening of the blood may lead to miscarriage.

       However, in Chinese gynecology, one of the three causes of miscarriage is blood stasis. (The
       other two are qi vacuity and heat.) Because Dan Pi quickens the blood and dispels stasis, clears

       heat and stops bleeding, its use is warranted during pregnancy when used to forestall a
       miscarriage due to heat stasis. In that case, to avoid using Dan Pi because of the textbook

       prohibition may actually lead to the occurrence of the miscarriage. In other words, the use of Dan
       Pi may not only be warranted but actually necessary, and to avoid its use may lead to exactly the
       thing we were trying to prevent or avoid. Similarly, Qu Mai (Herba Dianthi) and Che Qian Zi
       (Semen Plantaginis) are only prohibited if there is no water swelling and/or strangury, and Mang
       Xiao (Mirabilitum) is only prohibited if there is no constipation due to yang ming heat repletion.
       If there is water swelling and/or strangury or there is constipation due to yang ming replete heat,
       then these medicinals are warranted and should be used.

       The only Chinese medicinals that are always and completely prohibited during pregnancy are
       those that are so toxic they may potentially kill the fetus, such as Xiong Huang (Realgar) and Tian
       Hua Fen (Radix Trichosanthis Kirlowii).

       Chinese herbs during breast-feeding
       There is no discussion in the Chinese medical literature of which I am aware of Chinese herbs
       that are prohibited during breast-feeding. Basically, I would say that the test as to whether a
       Chinese medicinal is OK or not during lactation is the same as above – whether or not it is
       warranted. According to Chinese medical theory, the milk is made out of the mother’s blood. If
       the mother is ill, she is out of balance, and it is logical that this imbalance may reflect itself in the
       quality and composition of the mother’s milk. Therefore, anything, which brings the mother back
       to balance and harmony, should also result in better quality, more healthful milk. Thus, I never

       hesitate to give a lactating woman a particular Chinese herb if that medicinal is indicated by the
       combination of both her disease and her personally presenting pattern. After 25 years in practice,
       I have never seen any problems with this approach.

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       Exercises (see appendix IV for answers to the case questions)

       Case 1: Female, 32 years old
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       The patient presents with a threatened spontaneous abortion or miscarriage. She is eight weeks
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       pregnant and has had at least one previous miscarriage six months before. There is lower
       abdominal pain, which is fixed in location as well as leakage of pinkish, dilute blood. The patient
       has a pale, fat tongue with thin, white fur and a fine, forceless, bowstring pulse. The leakage is
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       worse when she stands up and was initiated by over-work. The patient says she is generally
       fatigued. She has a pale but dusky facial complexion as if she had soot on her face. She says that
       she has a long history of painful menstruation. Whenever her menses aren’t painful, she has bad
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       1. What are the three main mechanisms of any and all types of gynecological bleeding?
       2. What is this patient’s Chinese medical disease diagnosis?
       3. What are the patient’s patterns associated with her threatened miscarriage?

       4. What signs and symptoms indicate what patterns?
       5. What are the treatment principles for those patterns?

       6. What Chinese medicinal stops bleeding at the same time as it quickens the blood?
       7. Do you think you can use this medicinal in this case?

       8. If not, what medicinal(s) do you propose?
       9. If yes, how long do you propose to use it?

       Case 2: Female, 39 years old

       The patient is also eight weeks pregnant and has severe “morning sickness.” She is nauseous all
       day long and sometimes desires to vomit. However, when she tries to, all she does is dry heave.

       Her nausea is worse at night. The patient has a dry mouth and is thirsty, but all she can do is sip.
       In the past, the woman has had to use steroids for long periods of time because she suffers from
       relapsing/remittent lupus erythmatosus. The woman feels a gnawing hunger in her stomach, but
       cannot eat anything except small bits at a time. In addition, the woman tends to have a flushed
       facial complexion, dry skin and hair, and dry, brittle nails. Her tongue is dry, red, and almost
       completely denuded of fur, while her pulse is fine, slippery, and rapid.

       1. What is this patient’s Chinese medical disease diagnosis?
       2. What is/are her presenting pattern(s)?
       3. What are the treatment principles for this/these pattern(s)?
       4. Which of the two Chinese medicinals will you choose for this woman, Tian Hua Fen (Radix
       Trichosanthis Kirlowii) or Mai Men Dong (Tuber Ophiopogonis Japonici), and why?
       5. Please write a representative Chinese herbal formula for this woman.
       6. Should this woman take her Chinese herbs in powdered extract or decoction form? Why?
       7. If you choose to give this woman her Chinese meds in decoction, at what dosage and intervals?
       8. If she says that the smell of the Chinese meds makes her nauseous what might you advise?
       9. Must this woman take her decocted Chinese herbs warm or not? Why?
       Case 3: Female, 27 years old

       The patient is a breast-feeding mother with a three-month-old child. She suffers from chronic,
       recalcitrant psoriasis, which has gotten worse during pregnancy and breast-feeding. The woman
       has had psoriasis ever since she was a teenager. The lesions consist of dry patches of silvery

       scales surrounded by dark red, angry-looking margins. The woman wants treatment for her
       condition but is worried about taking Chinese herbs while she is breast-feeding.

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       1. What are the disease mechanisms associated with this woman’s psoriasis?
       2. What are the treatment principles?
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       3. Do you think external application of Chinese medicinals will be adequate to control or
       eliminate this situation?
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       4. If not, based on the above treatment principles, are there any medicinals you are worried might
       harm the baby?
       5. Are any of the disease mechanisms associated with this condition of the mother’s transferable
       to the child via the milk according to Chinese medical theory? If so, what are they? What are the
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       medicinals typically used in Chinese medicine to treat skin diseases associated with this/these
       6. Is treatment of the mother for any of her disease mechanisms likely to have a salutary effect on
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       the child via the breast milk? If so, which ones and why or how?
       7. Is treatment of the mother for any of her disease mechanisms likely to have a deleterious effect
       on the child via the breast milk? If so, which ones and why or how?

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