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There is a tradition in Western herbal medicine of using certain herbs at different times during the menstrual cycle in women. This treatment is utilized to help restore balance to hormonal fluctuations.
ere is a tradition in Western herbal medicine of using
certain herbs at different times during the menstrual cycle in
women. is treatment is utilized to help restore balance to
hormonal fluctuations.
The Concept of Multiphasic Prescribing
In women who are having menstrual cycles, regulating these
cycles is often an important part of dealing with various wom-
ens reproductive problems. In addition, sometimes, the cycles
themselves are out of balance, causing distress and other prob-
lems, and need to be rebalanced. One approach to these issues
is to use distinct herbs at different times during the cycle to
bring the cycle back to normal, an admittedly variable state
from individual to individual.
One of our mentors (E.Y.), Silena Heron, N.D. (1947–2005,
formerly a private practitioner in Sedona, Arizona), was one
of several pioneering doctors who frequently used bipha-
sic or triphasic formulas for her patients, and many of the
ideas in this article are heavily influenced by her experiences
and theories.
e multiphasic approach in Western herbal medicine
usually involves two or three distinct formulas (biphasic
or triphasic formulations, respectively). e first formula,
or follicular formula, is generally begun after menstruation
is complete and this formula is continued until just before
ovulation begins. e second, or luteal formula, is begun
at ovulation and continued until menstruation stops. Op-
tionally, a third, or menstrual formula, is given from when
bleeding starts until it stops.
At times, the signals to change formulas are unclear or ab-
sent, such as in women who are amenorrheic or who have
anovulatory cycles. In such situations, the point is to im-
pose switches by changing formulas on whatever the normal
schedule would be for that patient. e idea is to provide
stimuli so that the body will reset to the normal pattern. is
may be particularly important in a world in which many of
the connections to nature (lunar cycles, day/night switching,
changes in the seasons, etc.) that women previously had have
been severed by artificial light, variable and unnatural work or
life schedules, and residing in places outside of nature. In ad-
dition, the widespread use of oral contraceptives has tended
to wreak havoc on normal cycles in many women. In women
with no known normal cycles, or who have been away from
normal cycles for a long time (particularly long-term oral
contraceptive users), one has to chose an arbitrary cycle, gen-
erally either by linking it to the phases of the moon or by
choosing a 28-day cycle.
For example, assume a woman was previously having nor-
mal, pain-free menstrual cycles lasting 28 days with 2 days
of heavy bleeding and 2 days of light bleeding. en she
developed menorrhagia with 35-day cycles, and the timing
of ovulation became very unclear. In such an instance, the
switch from follicular to luteal formulas should be made at
14 days, and the switch to a menstrual formula made at 28
days to mimic the original normal cycle for this woman. If
bleeding does not occur when a switch is made to a men-
strual or back to the follicular formula, then it may be nec-
essary to return to the luteal formula briefly until bleeding
occurs, or to stop all herbs until that point and then restart
the follicular formula.
Often, based on our experience, we have noted that it takes
multiple cycles for multiphasic formulas to have their full and
JUNE 2009
Multiphasic Herbal
Prescribing for
Menstruating Women
Eric Yarnell, N.D., and
Kathy Abascal, B.S., J.D., R.H. (AHG)
15_3ACT.indd 126 5/29/09 4:23:08 PM
complete impact. Most patients should be advised that they
will have to use the formulas for a minimum of two or three
cycles to see results or to gain the totality of benefits.
Follicular-Phase Hormone Regulators
Herbs and foods rich in phytoestrogens, most notably
isoflavones, coumestans, and lignans, are important hor-
mone regulators (see Indications for Multiphasic Prescrib-
ing). Phytoestrogens are most specific to the follicular phase
(see Table 1), particularly when relative or absolute estrogen
dominance is suspected or known. Estrogen dominance can
occur any time during the cycle, when estrogen levels are ex-
cessive, as a result of either absolute high E or relative to low
P levels. Signs and symptoms of estrogen dominance include
water retention, moodiness, breast tenderness, and measured
high levels of endogenous estrogens, particularly relative to
progesterone. ese symptoms may tend to occur during the
luteal phase or in perimenopause but can definitely occur at
any time during the cycle.
Phytoestrogens act primarily as weak estrogen receptor–be-
ta (ERb) agonists.
Physiologic doses from diets rich in phy-
toestrogenic foods provide sufficiently high levels of phyto-
estrogens to have these effects in humans.
In a setting of
high endogenous estrogen levels, the net effect of phytoe-
strogens seems to be antagonism of the negative effects of
estradiol and similar native estrogens, apparently by maxi-
mizing protective ERb activation by the phytoestrogens and
minimizing harmful ERa activating by estradiol.
If estrogen
dominance is believed to exist in the luteal phase, which is
often related to insufficient progesterone production (rela-
tive estrogen dominance), then phytoestrogens may still oc-
casionally have a role to play during that time as well.
Overdose of phytoestrogens can, on occasion, lead to estro-
gen-excess symptoms. is rarely occurs in someone who is us-
ing liquid herbal extracts and is generally only seen in patients
who are taking capsules with concentrated phytoestrogen ex-
tracts and eating a diet very high in phytoestrogen-rich foods.
Otherwise, these substances are extremely safe.
Table 1. Herbs Used in the Follicular Phase
Foeniculum vulgare (fennel) fruit
Glycine max (soy) fruit and all other legumes to varying
Glycyrrhiza glabra (licorice) root
Humulus lupulus (hops) strobile
Linum usitatissimum (ax) fruit
Medicago sativa (alfalfa) leaf
Pimpinella anisum (anise) fruit
Pueraria montana var lobata (kudzu) root
Punica granatum (pomegranate) seed
Trifolium pratense (red clover) leaf and ower
Trifolium repens (white clover) leaf and ower
Trifolium subterraneum (subterranean clover) leaf and ower
Possible phytoestrogens
Panax ginseng (Asian ginseng) root
Panax quinquefolium (American ginseng) root
Estrogen-metabolism optimizers
Brassica oleracea (cabbage, broccoli, cauliower, etc.) leaf
and/or ower
Hormone regulators with follicular anity
Angelica sinensis (dang gui, dong quai) prepared root (de-
nitely to be avoided in menorrhagia during follicular phase)
Polygonum multiorum (he shou wu) prepared root
Notes: Formidcyclespottingorbleeding,useastringents(seelistinherbsused
in menstrual phase).
Formittelschmerz (pain associated with ovulation), use spasmolytics (see list in
herbs used in menstrual phase).
Glycine max (soy) ower. Drawing ©2009 by Kathy Abascal,B.S., J.D., R.H.
Trifolium pratense (red clover).
15_3ACT.indd 127 5/29/09 4:23:12 PM
As examples, Trifolium pratense (red clover), T. repens (white
clover), and T. subterraneum (subterranean clover) are isofla-
vone- and coumestan-rich herbs that have been fairly well-
studied for use as phytoestrogens. e idea that these herbs
could be simple replacements for endogenous estrogen was not
borne out by the largest, negative clinical trial on T. subterra-
neum extract in perimenopausal women.
Some smaller trials
have suggested that T. subterraneum extracts can provide relief
from hot flashes or improve high-density lipoprotein (HDL)
cholesterol levels in perimenopausal women.
Although it
has not yet been proven in humans, extracts of these herbs also
consistently show anticancer activity in vitro and in animal
Much work remains to be done to parse the detailed
actions and effects of these herbs. Detailed discussions on the
other phytoestrogenic herbs can be found elsewhere.
Coupled with knowledge about phytoestrogens, there is
growing awareness of the need to optimize catabolism of
estrogen. Studies now show fairly consistently that elevated
levels of 16-a hydroxy-metabolites of estradiol and estrone
are associated with many of the negative effects of estrogens,
while the 2-hydroxy-metabolites are much safer and possibly
even protective.
A simple urine assay can quickly determine if an individual
patient has an imbalanced 2-OH-E2/16-a-OH-E
Cruciferous vegetables contain various glucosinolates, including
indole-3-carbinol, that promote metabolism of estrogens toward
the 2-hydroxylation pathway. In a clinical trial, consuming cab-
bage was associated with increased 2-hydroxylation and reduc-
tion of recurrent respiratory papillomatosis, a condition known
to be aggravated by 16-a-hydroxylation metabolites.
indole-3-carbinol has also shown excellent activity against con-
ditions, such as cervical dysplasia, that are associated with high
levels of 16-a-hydroxy estrogen metabolites; these metabolites
also stimulate human papillomavirus (HPV) activity.
Angelica sinensis (dang gui, dong quai) prepared root is a
nonphytoestrogen hormone regulator.
Although it does not
have a particular action that would make it more indicated
during the follicular phase, there is a reason this herb is of-
ten avoided during the luteal phase. Dang gui is described as
a “Blood mover” in traditional Chinese herbal medicine and
may increase menstrual bleeding. us, dang gui is generally
avoided during the follicular and menstrual phases, particu-
larly if menorrhagia is already a problem. If amenorrhea or oli-
gomenorrhea is the main issue, then dang gui may actually be
indicated. Polygonum multiflorum (he shou wu) prepared root is
another nonphytoestrogen hormone regulator that appears to
have more affinity for the follicular phase, although this affin-
ity is not well-understood.
Luteal-Phase Hormone Regulators
Very little work has been done to investigate the effect of
herbs on hormonal levels during the luteal phase exclusively.
Several herbs are traditionally considered to be hormone bal-
ancers with an affinity for the luteal phase, (see Table 2) al-
Table 2. Herbs Used in the Menstrual Phase
Astringents (for menorrhagia)
Alchemilla vulgaris (ladys mantle) leaf
Lamium album (white deadnettle) leaf
Mitchella repens (partridge berry) leaf and fruit
Rubus spp. (blackberry, raspberry) root or leaf
Trillium ovatum (Pacic trillium) root*
Trillium grandiorum (bethroot) root*
Emmenagogues (for oligo- or amenorrhea)
Artemisia vulgaris (mugwort) leaf
Hedeoma pulegioides (American pennyroyal) leaf
Mentha pulegium(Europeanpennyroyal)leaf
Paeonia suruticosa (mu dan pi, tree peony) bark
Ruta graveolens (rue) leaf
Salvia ocinalis (sage) leaf
Styptics (for menorrhagia)
Capsella bursa-pastoris (shepherd’s purse) herb
Panax notoginseng (tienchi ginseng) root
Spasmolytics (for dysmenorrhea)
Dioscorea villosa (wild yam) root
Ligusticum walichii (chuan xiong) root
Paeonia lactiora (chi shao, red peony) root with bark
Viburnum prunifolium (blackhaw) leaf and bark
Viburnum opulus (crampbark) leaf and bark
*Threatened in the wild, use sparingly if at all.
Table 3. Herbs Without Cyclic Components
Uterine tonics
Aletris farinosa (true unicorn) rhizome
Caulophyllum thalictroides (blue cohosh) root
Chamaelirium luteum (false unicorn) root (however, Dr.
Hypothalamic–pituitary-hormone regulators
Actaea racemosa(blackcohosh)root(however,Dr.Heron
considered this primarily a follicular tonic)
Paeonia lactiora (bai shao, white peony) root without bark
Vitex agnus-castus (chaste tree) fruit
Hormone regulator
Smilax spp. (sarsaparilla) root (may be a luteal-phase tonic),
mechanism unknown
Pelvic lymphagogues (almost always indicated)
Ceanothus greggii (red root) root
Fouquieria splendens (ocotillo) bark
Liver tonics (almost always indicated)
Arctium lappa (burdock) root
Silybum marianum (milk thistle) fruit
Taraxacum ocinale (dandelion) root
If amenorrhea or oligomenorrhea is
the main issue, then dang gui may
be indicated.
15_3ACT.indd 128 5/29/09 4:23:12 PM
though these have not been documented. ese include Smilax
spp. (sarsaparilla) root, Mitchella repens (partridge berry) herb,
and Alchemilla vulgaris (ladys mantle) herb.
It is our opinion that most purported luteal-phase tonics can
be explained better by other actions that are not specialized
to the luteal phase. erefore, the main approach to the luteal
phase is essentially to remove herbs that are more focused on
the follicular phase, to maintain hormone regulators without a
cyclic component, and to manage any other symptoms. is is
also often a time when herbs are included to ensure they are
present at good levels in the body prior to the onset of menses,
particularly when premenstrual syndrome or dysmenorrhea is
a major issue.
Noncyclic Hormone Regulators
A number of hormone-modulating herbs do not have a
clear cyclic component (see Table 3). e best-understood
of these is probably Vitex agnus-castus (chaste tree*) fruit.
is herb has been shown to have dopaminergic eects in
the pituitary gland, suppressing prolactin levels, which are
often associated with premenstrual syndrome, as well as
correcting luteal-phase defects often seen in patients with
infertility and menstrual disorders.
ere is some evidence
for vitex specifically promoting corpus-luteum formation or
function shown in clinical trials.
e often-proclaimed
idea that chaste tree acts by affecting luteinizing hormone
(LH) or follicle-stimulating hormone (FSH) levels does not
have well-documented support in humans. One recent rat
study did show that chaste tree can lower LH levels.
historical use of chaste tree for both galactorrhea and insuf-
*For more information on chaste tree, see “Chaste Tree Extract in
Womens Health: A Critical Review by Tieraona Low Dog, M.D.,
in this issue.
Taraxacum ocinale (dandelion).
The Chinese Herbal Articial Cycle
A concept similar to biphasic prescribing also exists in modern
tioner reported* using four distinct formulas to support normal
menstrual cycles in women with infertility issues, coupled with
acupuncture treatments. This practitioners treatment program
is outlined briey below.
Phase 1, postmenstrual (proliferative), Follicle
Stimulation Formula
Curculigo orchoides (xian mao) rhizome
Cuscuta chinensis (tu si zi) seed
Dioscorea opposita (shan yao) root
Polygonum multiorum (he shou wu) prepared root
Angelica sinensis (dang gui) prepared root
Ligustrum lucidum (nu zhen zi) seed
Dipsacus asperoides (xu duan) root
Rehmannia glutinosa (shou di huang) steamed root
Lycium barbarum (gou qi zi) fruit
Epimedium spp. (yin yang huo) herb
Note: Most of these herbs are Kidney yin or yang tonics or
other tonifying herbs.
Phase 2, midcycle, Ovulation Stimulation Formula
Curculigo orchoides (xian mao) rhizome
Cnidium monnieri (dong chuan xiong) fruit
Lycopus lucidus (ze lan) herb
Epimedium spp. (yin yang huo) herb
Leonurus heterophylla (chong wei zi) seed
Achyranthes bidentata (niu xi) root
Paeonia lactiora (chi shao) root with bark
Carthamnus tinctoria (hong hua) ower
Liquidamber spp.
Angelica sinensis (dang gui) prepared root
Cyperus rotundus (xian fu) rhizome
Vaccaria segetalis (wang bu liu xing) seed
aswellasherbstoregulateLiverqi ow.
Phase 3, premenstrual (secretory), Corpus Luteum
Stimulation Formula
Rehmannia glutinosa (shou di huang) steamed root
Angelica sinensis (dang gui) prepared root
Dioscorea opposita (shan yao) root
Epimedium spp. (yin yang huo) herb
Cistanche deserticola (rou cong rong) herb
Codonopsis pilosula (dang shen) root
Curculigo orchoides (xian mao) rhizome
Cuscuta chinensis (tu si zi) seed
Glycyrrhiza uralensis (gan cao) root
Cinnamomum cassia (rou gui) bark
Rubus chingii (fu pen zi) fruit
Phase 4, Menstruation Regulation Formula
Angelica sinensis (dang gui) prepared root
Prunus persica (tao ren) seed
Lycopus lucidus (ze lan) herb
Paeonia lactiora (chi shao) root with bark
Carthamnus tinctoria (hong hua) ower
Achyranthes bidentata (niu xi) root
Cnidium monnieri (dong chuan xiong) fruit
Cyperus rotundus (xian fu) rhizome
Leonurus heterophylla (chong wei zi) seed
Rehmannia glutinosa (shou di huang) steamed root
Citrus reticulata (qing pi) immature peel
Citrus reticulata (chen pi) mature peel
15_3ACT.indd 129 5/29/09 4:23:14 PM
ficient lactation strongly suggests that chaste tree has a bal-
ancing action on hypothalamic and/or pituitary secretions,
or at least on prolactin.
Although Actaea racemosa (black cohosh) root was long be-
lieved to be a phytoestrogen, and although Dr. Heron consid-
ered this herb to be primarily a follicular tonic, there is now
fairly good evidence that black cohosh actually acts in the
hypothalamus and/or pituitary gland to regulate hormone
levels in the body.
Studies have suggested that black cohosh
may have serotonergic effects.
It is clinically quite helpful
in many instances when there is hormonal imbalance, though
this herb is most indicated for patients with concomitant ar-
thritis or myalgia.
Paeonia lactiflora (bai shao, white peony) root without
bark, and probably P. lactiflora (chi shao, red peony) root with
bark, are also apparently generic sex-hormone (estrogen and
progesterone) balancers without having hormonal compo-
nents, perhaps even extending to balancing androgens.
ese herbs are also useful analgesics, spasmolytics, and in-
flammation modulators.
e indigenous U.S. herb P.
brownii (Browns peony) root is believed to have similar ac-
tions according to the late, great herbalist Michael Moore
(1942–2009), formerly of the Southwest School of Botanical
Medicine, in Bisby, Arizona.
Miscellaneous Supportive Herbs
Herbs that support normal uterus tone and function are
often important for helping resolve chronic issues with this
organ (see Comparison of Views of Womens Herbs). ese
herbs should be included throughout the menstrual cycle.
ere is no research on these herbs, so their use is based solely
on traditional practice. Aletris farinosa (true unicorn) rhizome,
Caulophyllum thalictroides (blue cohosh) root, and Chamaeliri-
um luteum (false unicorn) root are three classic uterine tonics.
(Although Dr. Heron considered false unicorn to be primarily
a follicular tonic, there is no clear understanding of why she
had this idea). False unicorn is threatened in the wild as a result
of slow growth, overharvesting, habitat loss, and overgrazing
by deer, and should only be obtained from cultivated or sus-
tainably harvested sources.
Indications for Multiphasic Prescribing
An eort should be made to identify and correct the cause(s)
of each patient’s problem and not just use herbal prescribing
as that could mask symptoms and cause recurrent or chronic
problems. Problems with many possible causes on the list below,
such as menorrhagia or infertility, are assumed to be benign,
idiopathic, and with no discernable pathologic causes (or with
known causes but with the cycle still imbalanced despite treat-
ing those causes).
Anovulatory cycles
Premenstrual syndrome
Dysmenorrhea—sometimes the follicular formula is
Uterine broids
Support after discontinuation of oral contraceptives
Any other conditions associated with a dysregulated menstrual
Humulus lupulus (hops).Paeonia lactiora (paeonia; white peony) ower. Photo ©2009
15_3ACT.indd 130 5/29/09 4:23:23 PM
Pelvic lymphagogues are also almost always indicated in
women with chronic reproductive problems. e mechanism
of action of these herbs is also unknown; the herbs are used
based on empirically derived knowledge. Fouquieria splendens
(ocotillo) bark from the desert southwestern United States/
northern Mexico is the most important of these herbs, al-
though Ceanothus greggii (red root) root can be used when this
herb is not available.
Naturopathic physicians and herbalists commonly pre-
scribe liver tonics to women with dysregulated cycles or
conditions related to these, on the premise that these ton-
ics help the liver to metabolize sex hormones properly. One
Comparison of Views of Womens Herbs
There is some dierence of opinion among scholars and practitioners about the primary actions and eects of various herbs used
primarily for womens health. The chart below highlights this and supports the strength that comes from diversity within the profession of
native herb), this is indicated.
Opinions on the Primary Actions of Herbs
Herb Trickey
Achillea millefolium Antihemorrhagic Antihemorrhagic Spasmolytic, Antihemorrhagic,
antihemorrhagic, spasmolytic
Actaea racemosa Hormonebalancer Hormonebalancer Spasmolytic, Hormoneregulator
(A. arguta) uterine tonic
Alchemilla vulgaris Antihemorrhagic Antihemorrhagic Anodyne, Antihemorrhagic,
(A. occidentalis) antihemorrhagic spasmolytic
Aletris farinosa Uterine tonic Digestive tonic
Angelica sinensis Uterinetonic Femaletonic Circulatorystimulant, Uterinetonic
hormone balancer
Artemisia vulgaris Emmenagogue Bitterdiaphoretic Emmenagogue Emmenagogue
(A. ludoviciana)
Capsella bursa-pastoris Antihemorrhagic Anti-hemorrhagic Antihemorrhagic Antihemorrhagic
Caulophyllum thalictroides Uterinetonic — Uterinetonic Emmenagogue
Chamaelirium luteum Uterinetonic — Uterinetonic Hormonebalancer,uterinetonic
Dioscorea villosa — — Spasmolytic Hormonebalancer
Lamium album Anti-hemorrhagic
Leonurus cardiaca Cardiotonic, Emmenagogue Uterineamphoteric Uterineamphoteric
Mentha pulegium Emmenagogue Emmenagogue Emmenagogue Emmenagogue
Mitchella repens Antihemorrhagic Uterine tonic, hormone balancer
Paeonia lactiora Hormonebalancer Hormonebalancer, —
spasmolytic (P. brownii)
Pulsatilla vulgaris Anodyne Sedative (P. occidentalis)
Rubus idaeus Uterine tonic Antihemorrhagic Uterine tonic Uterine tonic
Ruta graveolens Emmenagogue — —
Salvia ocinalis Emmenagogue Anti-hemorrhagic — Antilactation
Tanacetum parthenium Anodyne — Emmenagogue,
Trillium erectum Antihemorrhagic Antihemorrhagic
(T. ovatum)
Viburnum prunifolium Spasmolytic Spasmolytic (V. edule) Spasmolytic (V. opulus) Spasmolytic
Vitex agnus-castus Hormonebalancer — Hormonebalancer Hormonebalancer
—, indicates that herb was not discussed.
15_3ACT.indd 131 5/29/09 4:23:24 PM
preliminary clinical trial using a complex formula (including
Silybum marianum [milk thistle] seed, Taraxacum officinale
[dandelion] root, and Cynara scolymus [artichoke] leaf, three
liver tonics) showed that these herbs could have effects on
follicular metabolism of androgens.
More research is need-
ed, but there may be some validity to using these herbs for
women with hormonal issues.
Herbs for Symptom Management
Frequently, while working on the hormonal or other bases
of female reproductive problems, it is necessary to reduce ex-
cessive bleeding, stimulate bleeding when little or none is oc-
curring, manage pain, or otherwise handle symptoms. While
these outcomes should not be the only objectives of treatment,
they can be very important.
ere are two classes of herbs that can help reduce excessive
bleeding, spotting, or midcycle bleeding (see Table 2). e as-
tringents contain tannins, and although they are not generally
believed to be systemically absorbed to any significant extent,
are still often effective for controlling excessive vaginal bleeding.
Perhaps one of the most famous among herbs specific to the
female reproductive tract would be the Trillium genus, although
these herbs are slow-growing, and their forest habitats are threat-
ened, so the much more sustainable Rubus spp. or Alchemilla spp.
should generally be used instead. One European trial suggested
that Alchemilla can be effective for addressing menorrhagia.
Nontannin-containing styptic herbs that can also reduce
excessive bleeding include Capsella bursa-pastoris (shepherd’s
purse) herb and Panax notoginseng (tienchi ginseng) root.
Punica granatum (pomegranate).
Table 4. Dr. Selena Heron’s Base Biphasic Formulas*
Follicular Base Formula
Latin name Part Form Proportion
Chamaelirium luteum Root Tincture 15%–30%
Medicago sativa Herb Glycerite 15%–30%
Angelica sinensis Decoctedroot Tincture 5%–15%
Actaea racemosa Root Tincture 5%–15%
Glycyrrhiza glabra Root Fluidextract 5%–15%
Mitchella repens Leafandfruit Tincture 5%–15%
Taraxacum ocinale Root Tinctureorglycerite 5%–15%
Vitex agnus-castus Fruit Tincture 5%–15%
Luteal Base Formula
Latin name Part Form Proportion
Taraxacum ocinale Root Glycerite 15%–25%
Smilax ornate Root Tincture 5%–15%
Alchemilla mollis Leaf Tincture 5%–15%
Silybum marianum Seed Tincture 5%–15%
Dioscorea villosa Root Tincture 5%–15%
Mitchella repens Leafandfruit Tincture 5%–15%
Viburnum prunifolium Bark Tincture 5%–15%
Vitex agnus-csatus Fruit Tincture 5%–15%
Eleutherococcus senticosus Root Tinctureoruidextract 5%–15%
the specic patient.
15_3ACT.indd 132 5/29/09 4:23:25 PM
Again, these herbs have rich historical traditions for use but
have been poorly researched.
Tienchi ginseng was shown to
be antihemorrhagic when it was applied topically in at least
one clinical trial.
When insufficient menstruation occurs, emmenagogues are
used. ese are potentially abortifacient and should be used
cautiously as a result. Again, very little information is available
about how these herbs work, and their use is based on histori-
cal herbal medicine. If they do not work at usual doses, then
higher doses are not recommended because they have some
potential to result in excessive uterine bleeding.
For addressing uterine spasms or dysmenorrhea, herbal spas-
molytics are often effective. Dioscorea villosa (wild yam) root,
now widely though inaccurately believed to have progesteronic
or androgenic effects, is actually primarily an excellent uter-
ine relaxer. In fact, none of the studies on this herb exploring
progesteronic or androgenic effects have produced any support
for this concept,
and it seems to have come from a mis-
understanding that, industrially, the saponins in wild yam can
be converted to steroid hormones. However, the human body
is simply not able to do the same thing. Several other herbs are
listed in Herbs by eir Primary Actions.
is article has provided basic information for practitioners
so they can implement multiphasic prescribing of herbs more
widely. e Western and Eastern traditions of doing so coin-
cide and suggest that there is significant power in this approach.
Refinement of which herbs are used at what points during the
cycle is urgently needed, along with better understanding of
how the herbs work, so that they can be targeted more se-
lectively. Hormone-balancing herbs, tonifying and supporting
herbs, and symptom-managing herbs should all be utilized in
individualized formulas for treating menstruating women with
apparent hormonal imbalances. n
Conict-of-Interest Disclaimer
Dr. Yarnell is part owner of Heron Botanicals in Poulsbo,
Washington (the company founded by Dr. Heron, based on
her personal dispensary), which sells many of the products
mentioned in this article. ese products are also readily avail-
able from other sources.
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Eric Yarnell, N.D., is president of the Botanical Medicine Academy, a specialty
board for using medicinal herbs, and is a faculty member at Bastyr University
in Kenmore, Washington. Kathy Abascal, B.S., J.D., R.H. (AHG), is executive
director of the Botanical Medicine Academy in Vashon, Washington.
To order reprints of this article, e-mail Karen Ballen at:
or call (914) 740-2100.
15_3ACT.indd 134 5/29/09 4:23:27 PM
... Alchemilla L. genus (Rosaceae) represented by nearly 100 species all around the world [1] has medicinal properties in traditional medicine worldwide such as antiinflammatory, antiseptic, sedative, haemostatic, wound healing, expectorant, diuretic, astringent and, furthermore, is used for the treatment of atherosclerosis, diabetes [2,3] and against menorrhagia [4]. In Bulgarian folk medicine Alchemilla species are used against acute diarrhoea, dysmenorrhoea and menorrhagia; on the other hand, in Turkish folk medicine they are used as diuretic, laxative, tonic and for wound healing [5][6][7][8][9]. ...
... Decoction prepared from Alchemilla arvensis (L.) Scop. is used as diuretics [27]. It was reported that tincture prepared using leaves of Alchemilla mollis (Buser) Rothm. is also used against menorrhagia [4]. ...
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The aim of the present study is to evaluate the treatment potential of Alchemilla mollis (Buser) Rothm. and Alchemilla persica Rothm. in the experimentally induced endometriosis model in rats. Endometriosis was surgically induced in rats by autotransplanting endometrial tissue to abdominal wall. Thirty-six rats were randomly divided into six groups. The groups were orally treated with the methanol:water (80:20) extracts of aerial parts and roots of A. mollis and A. persica. Buserelin acetate (20 mg) was used as the reference drug. The phytochemical contents of the most active extracts were determined by high performance liquid chromatography. The cystic formation was determined to be significantly decreased with the aerial part extract of A. mollis. A reduction in the endometrioma was also determined for the aerial part extract of A. persica group. However, significant reduction on the levels of cytokine were recorded for the A. mollis aerial part extract group. Therefore, the phytochemical contents of the aerial part extracts of A. mollis. and A. persica were analyzed. The results of the present study revealed that the aerial part extracts of A. mollis and A. persica could be beneficial in the treatment of endometriosis.
... Folk medicine also uses it to treat excessive menstruation and wounds. [22][23][24] A. mollis naturally occurs across Turkey, mostly in northern and northern-eastern Anatolia. [25] The Alchemilla mollis The hepatoprotective efficacy of Rothm aerial component and root methanolic-water extracts on carbon tetrachloride caused hepatotoxicity and the hypoglycemic activity on alloxan-induced diabetic mice were assessed. ...
... Similar results were reported for closely related species of Alchemilla abyssinica by different investigators. Alchemilla vulgaris is claimed to have spasmolytic effect [18]. Ivancheva and co-workers [19] also reported, the infusion of Alchimella vulgaris is used as antidiarrheal agent. ...
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Background: Alchemilla abyssinica is a plant widely used in traditional medicine. Its wide use among the community plus already established scientific evidences for medicinal values of other Alchemilla species provided good ground for this investigation. Methods: In this research, CHCl 3 /EtoAc 1:1 extract of dried aerial parts of Alchemilla abyssinica, methanolic extract of the CHCl 3 / EtoAc residue and fractions of the methanolic extract were tested on isolated guinea-pig ileum (GPI) for possible presence of spasmogenic or spasmolytic effects. Concentrations of each extract and fraction ranging from 20-600 μg/ml final organ bath concentration were tested. The effects of these test samples on the basal rhythmic contractions of the GPI as well as on its contraction elicited using the agonist, histamine, were determined. The antagonist, Papaverine, was also used as a control smooth muscle relaxant. Results: While the CHCl 3 /EtoAc 1:1 extract showed neither spasmogenic nor spasmolytic result, the methanolic extract showed marked spasmolytic effect. This methanolic extract was fractionated using column chromatography and the fraction eluted using Hexane/EtoAc 1:2 gave greatest spasmolytic result. This fraction produced significant (P<0.05) dose-dependent spasmolytic effects on the agonist induced contractions of the GPI to 95.7% at 20 μg/ml, 43.6% at 70 μg/ml and 14.2% at 120 μg/ml in the organ bath. Conclusions: The results of the present study showed that Alchemilla abyssinica possesses spasmolytic property. The oral acute toxicity study showed Alchemilla abyssinica exhibited no toxicity up to doses of 1,000 mg/kg body weight in Swiss albino mice. Further chemical work to identify the compound(s) responsible for the activity is recommended.
... "Herba Alchemillae", a commercial drug containing A. mollis extract, has astringent, diuretic, and antispasmodic effects; it is also used as a medicine for the treatment of wounds and the treatment of excessive menstruation in folk medicine. [51][52][53] A. mollis grows naturally and widely in Turkey, especially in north and north-eastern Anatolia. 54 Alchemilla mollis Rothm aerial part and root methanolic-water extracts were evaluated for their hepatoprotective activity on carbon tetrachloride induced hepatotoxicity and hypoglycemic activity on alloxan-induced diabetic mice. ...
... Species of Alchemilla have been reported for the treatment of dysmenorrhea, gastrointestinal disorders, inflammation of the mouth and throat, eczema and skin rashes (Kupeli Akkol et al., 2015). Alchemilla mollis is traditionally used for the treatment of wounds and excessive menstruation (Makau et al., 2013;Trendafilova et al., 2011;Yarnel and Abascal, 2009). In addition, A. mollis has been reported for the antiviral, astringent, diuretic, antispasmodic and anti-oxidant activities due to the presence of phenolic content such as tannins and flavonoids (Makau et al., 2013;Trendafilova et al., 2011). ...
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p class="Abstract">Wound occurs due to disruption of soft tissues that results from injury. Recently many medicinal plants have been demonstrated for wound healing potential through in vivo and in vitro preclinical models and their mechanisms of wound healing has also been reported. Medicinal plants have been reported to show wound healing potential via angiogenesis, activation of NF-κB, favoring pro-inflammatory cytokines, increased expression of inducible nitric oxide synthase (iNOS) and alpha 1 type 1 collagen, and anti-oxidant activity. Thus, in this review, an attempt was made to give an insight into the recently reported medicinal plants with wound healing mechanisms which could be beneficial in therapeutic practice and development of new wound healing drugs for human use.</p
... Alchemilla mollis (Buser) Rothm, from the genus Alchemilla, is also used in traditional European medicine. "Herba Alchemillae", a commercial drug containing A. mollis extract, has astringent, diuretic, and antispasmodic effects; it is also used as a medicine for the treatment of wounds and the treatment of excessive menstruation in folk medicine [7][8][9]. A. mollis grows naturally and widely in Turkey, especially in north and north-eastern Anatolia [10]. In Turkish folk medicine, species of Alchemilla are known locally as, fındık otu or aslan pençesi. ...
... As women approach perimenopause, they often begin to develop cycle irregularities that benefit greatly from multiphasic formulations as described in the current authors' earlier article on this subject. 2 As time progresses, the progesterone phase of a woman's menstrual cycle becomes increasingly erratic and disorganized. These hormonal changes cause a variety of symptoms but night sweats are not a common symptom in this early perimenopausal stage. ...
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Herbal treatments can help quiet perimenopausal symptoms, such as night sweats, successfully. However, given the prevalence of xenoestrogens and their increased effects in menopausal women, treatment of night sweats also should include a nutritional component and adaptogens to help women cope with the hormonal changes that are experienced. Actaea racemosa (also known as Cimicifuga racemosa, black cohosh) root, Angelica sinensis (dong quai) root, Verbena spp. (vervain) herb, Melissa officinalis (lemon balm) herb, Salvia spp. (sage) herb, Lycopus spp. (bugleweed) herb, Schisandra chinensis (schisandra) berry, Withania somnifera (ashwagandha) root, Panax quinquefolius (American ginseng) root, and Astragalus membranaceus (astragalus) root all have roles to play in the treatment of perimenopausal night sweats.
... There is a tradition within Western herbalism called multiphasic prescribing for menstruating women that mirrors this approach. 40 There are studies, however, that do examine the influence of acupuncture on different aspects of the ...
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Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years. This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health. A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary. For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed. There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women's health.
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p class="Abstract"> Alchemilla mollis , is used in traditional medicine for the treatment of wounds and excessive menstruation. Aqueous methanol extracts of A. mollis and A. persica were evaluated for wound healing acivity by using linear incision and circular excision wound models along with hydroxyproline estimation and histopathological analysis. Anti-inflammatory effect was determined according to Whittle method. The extracts prepared from the aerial parts of A. mollis and A. persica exerted significant wound healing activity with the tensile strength values of 39.3% and 33.3%, respectively, and with the contraction values of 51.4% and 43.5%, respectively. Hydroxyproline estimation and histopathological analysis also confirmed the results. The extracts of A. mollis and A. persica showed significant anti-inflammatory activity with the values of 30.6% and 26.6% respectively. These results showed that A. mollis and A. persica possess significant wound healing and anti-inflammatory activities. Video Clip Circular excision wound model : 2 min </p
As part of the development of an acupuncture protocol for a randomised controlled trial (RCT) to enhance female fertility, experienced practitioners were interviewed to explore what factors they considered to be important components to their acupuncture practice with women with fertility problems. The interviews were wide-ranging and an analysis of the discussion generated a series of questions that were then put to a broader focus group of experts in the field. The extracts of the interviews presented here also raise other issues about how acupuncture is practised and the implications of this for acupuncturists - such as the complexity of the acupuncture therapeutic engagement, the specialist knowledge necessary for work in fertility, and the self-nurturing required by the acupuncturist to sustain practice. More exploration into the nature of acupuncture practice requires increased use of qualitative research methods.
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Introduction: Isoflavones are hypothesized to protect against breast cancer, but it is not clear whether they act as oestrogens or anti-oestrogens in breast tissue. Our aim was to determine the effects of taking a red clover-derived isoflavone supplement daily for 1 year on mammographic breast density. Effects on oestradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), lymphocyte tyrosine kinase activity and menopausal symptoms were also assessed. Methods: A total of 205 women (age range 49-65 years) with Wolfe P2 or DY mammographic breast patterns were randomly assigned to receive either a red clover-derived isoflavone tablet (26 mg biochanin A, 16 mg formononetin, 1 mg genistein and 0.5 mg daidzein) or placebo. Change in mammographic breast density, serum oestradiol, FSH, LH, menopausal symptoms and lymphocyte tyrosine kinase activity from baseline to 12 months were assessed.
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Nuclear receptors function as ligand-regulated transcription factors and modulate the expression of sets of genes in response to varying concentrations of ligands. The ligand modulators can be endogenous metabolites that function as hormones, or they can be exogenous substances, such as pharmaceutical agents or environmental substances of natural or man-made origin, which in some cases can cause endocrine disruption. Ligands modulate nuclear receptor activity by binding to their ligand-binding domains and stabilizing conformations that lead either to transcriptional activation or repression. The ligand-binding pocket is somewhat flexible, and binding affinities can be measured over a 10-million-fold range (i.e., with equilibrium dissociation constant values ranging from ca. 0.01 nM to 100 muM). Thus, it is not surprising that by binding a large variety of structures, some nuclear receptors can appear to be promiscuous; however, when affinity is considered, the binding patterns are more restricted. The spectrum of ligands that bind to the estrogen receptor has been most thoroughly investigated. Those from natural sources include natural products in food, such as soy isoflavones and whole grain lignans, as well as microbial products and components from wood. Aside from pharmaceuticals, man-made estrogen ligands can be found in industrial products, such as alkyl phenols from nonionic detergents, bisphenols from plastics, indicator dye impurities, polymer chemicals, and chlorinated aromatics and pesticides. Exogenous ligands are also known for the androgen and progesterone receptors. While it is possible that endocrine disruption can result from exogenous chemicals acting directly as ligands for the nuclear receptors, endocrine disruption needs to be considered in the broader context; thus, compounds also need to be assessed for their effects at other levels, such as on endogenous hormone production, transport, metabolism, and clearance, and at points in signal transduction cascades that are beyond the ligand-receptor interaction.
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Based on the epidemiological evidence for a relationship between consumption of certain foods and decreased cancer incidence in humans, an assay was developed to screen and fractionate plant extracts for chemopreventive potential. This assay measures effects on the metabolism of [3H]benzo(a)pyrene [B(a)P] in hamster embryo cell cultures. Screening of several plant extracts has generated a number of activity leads. The 95% ethyl alcohol extract of one of these actives, Trifolium pratense L. Leguminosae, red clover, significantly inhibited the metabolism of B(a)P and decreased the level of binding of B(a)P to DNA by 30 to 40%. Using activity-directed fractionation by solvent partitioning and then silica gel chromatography, a major active compound was isolated and identified as the isoflavone, biochanin A. The pure compound decreased the metabolism of B(a)P by 54% in comparison to control cultures and decreased B(a)P-DNA binding by 37 to 50% at a dose of 25 micrograms/ml. These studies demonstrate that the hydrocarbon metabolism assay can detect and guide the fractionation of potential anticarcinogens from plants. The ability of the isoflavone biochanin A to inhibit carcinogen activation in cells in culture suggests that in vivo studies of this compound as a potential chemopreventive agent are warranted.
In order to evaluate the role of androgens in the pathogenesis of acne, the efficacy of Shakuyaku-Kanzo-To (SK) in the treatment of acne was evaluated in 29 women with acne. SK (7.5 g/day) were administered daily for 12 weeks to 29 acne patients. Serum levels of testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S) and sex hormone binding globulin (SHBG) were measured by RIA during the mid follicular phase. While taking SK, serum FT levels were significantly lower than those in the basal levels. The other hormone levels showed no significantly differences between the basal and the treatment levels. SK was significantly effective in reducing the numbers of comedones. 18 of the 29 patients had a good response. These results suggest that SK is effective in the treatment of acne vulgaris in accordance with reducing the serum FT levels.
The clomiphene treatment and the combination treatment with clomiphene citrate and Toki-shakuyaku-san, which is a traditional Chinese herbal medicine, were applied for 93 patients with ovulatory disturbances. The clomiphene treatment restored ovulation in 45 of 52 patients (86.5%) and 11 patients (21.2%) became pregnant, and the combination treatment induced ovulation in 36 of 41 patients (87.8%) and 14 patients (34.l%) conceived. The duration of treatment till the first ovulated cycle was not significantly differ in two groups, however the first pregnant cycle with combination treatment was significantly (p < 0.05) earlier than that of clomiphene cycle. Both patients with clomiphene treatment and combination treatment showed significant (p < 0.01) increase in the serum level of estradiol in the preovulatory phase and of progesterone in the mid-luteal phase, but the serum level of progesterone and the ratio of progesterone/estradiol in the preovulatory phase with combination treatment was significantly (p < 0.05) lower than that with clomiphene treatment. These results indicate that the combination treatment is effective for treatment of patients who have not become pregnant with clomiphene treatment, and suggests that Toki-shakuyaku-san may be effective by improvement of ratio of estrogen and progesterone secretion.
In this study, we attempted to identify the mechanisms of paeoniflorin on antinociceptive effects in mice. Paeoniflorin (48, 96, 240, 480 μg, i.c.v.) showed dose-related antinociception both on the early and late phases of formalin test in mice. Moreover, paeoniflorin (48 μg, i.c.v.) could potentiate the antinociception of morphrine (0.5, 1.0 mg/kg, s.c.) in the formalin test. However, the antinociceptive effects of paeoniflorin were not potentiated by l-arginine (600 mg/kg, i.p.) or antagonized by β-funaltrexamine (β-FNA) (10 μg, i.c.v.), ICI-174,864 (1 μg, i.c.v.) and ryanodine (10 ng, i.c.v.) on both the early and late phases of formalin test. l-NAME (75 mg/kg, i.p.) could reverse the effect of paeoniflorin on the late phase of formalin test. Naloxone (1 mg/kg, i.p.) and nor-binaltorphimine (nor-BNI) (1 μg, i.c.v.) could block the paeoniflorin-induced antinociception on the early phase of formalin test. These results suggested that the central antinociceptive effects of paeoniflorin on formalin test in mice were mediated by the activation of κ-opioid receptor and not related to the increase of intracellular calcium.
Cimicifuga racemosa (L.) Nutt. (syn. Actaea racemosa L., black cohosh) is used to relieve menopausal hot flashes, although clinical studies have provided conflicting data, and the active constituent(s) and mechanism(s) of action remain unknown. Because serotonergic receptors and transporters are involved with thermoregulation, black cohosh and its phytoconstituents were evaluated for serotonergic activity using 5-HT7 receptor binding, cAMP induction, and serotonin selective re-uptake inhibitor (SSRI) assays. Crude extracts displayed 5-HT7 receptor binding activity and induced cAMP production. Fractionation of the methanol extract led to isolation of phenolic acids and identification of N(omega)-methylserotonin by LC-MS/MS. Cimicifuga triterpenoids and phenolic acids bound weakly to the 5-HT7 receptor with no cAMP or SSRI activity. In contrast, N(omega)-methylserotonin showed 5-HT7 receptor binding (IC50 = 23 pM), induced cAMP (EC50 = 22 nM), and blocked serotonin re-uptake (IC50 = 490 nM). These data suggest N(omega)-methylserotonin may be responsible for the serotonergic activity of black cohosh.
The Chinese people discovered Dong Quai and used it as a tonic and spice. Women especially have used Dong Quai to protect their health, generation after generation. This paper reviews the pharmacological effect, toxicity and dosage formula of Dong Quai, based on the modern concept.