Prescribing with Wisdom: Chinese Medicinal Herbs During Pregnancy

Dr. Helena Zhang is a true pioneer in the world of Traditional Chinese Medicine and women's health. She has over 25 years of experience as a practitioner and professor of acupuncture, herbal medicine, and qi gong. Her dedication to assisting women throughout their entire reproductive journey, from enhancing fertility to supporting pregnancy, postpartum, and breastfeeding, has earned her a well-deserved reputation in the field.

As the founder of the Jade Goddess Method, Dr. Zhang has developed a unique approach to women's health that combines movement, meditation, and medicated diet. Her holistic and nurturing approach has touched the lives of countless women, guiding them through the various stages of motherhood with care and expertise.

The following has been edited for length and clarity.

Q: A lot of students and new practitioners can feel hesitant when it comes to prescribing herbs for pregnant patients. How do you approach herbal prescriptions for patients during pregnancy?

A: The goal of herbal treatment is to be more fertile. And during pregnancy, at the first trimester, that’s usually when we use herbs to hold the fetus which means to help the fertilized embryo get more nutrients. That’s why we call it to “nourish the field”, to let the seed be grounded. And usually after the first trimester, we don’t really use herbs. We like to use acupuncture - less interference. During this time we encourage the proper use of food.

So, if we take a closer look at the first trimester, there are two fundamental problems for me. The first is to stabilize, to let the seed be grounded. We have to ask why the seed cannot be grounded. Maybe there is too much restlessness. It cannot be nourished by blood or there is too much heat in the blood. So that’s a seed problem.

The second reason is the field is not rich enough. Perfect seed, perfect embryo, but the seed cannot grow into a nice tree. This can explain why many fibroid patients cannot get pregnant. Fibroids may be absorbing the nutrients.

We use lots of holding herbs. Also, we are prescribing according to each person’s pattern. If the person has too much heat, then we are going to use Huang Qin to cool them down a little bit. If the person’s earth element is not strong enough, then we use Bai Zhu. If the person’s yang is not strong enough, we call it Kidney Yang Deficiency. At this moment, usually we like to use Suo Yang or we like to use Du Zhong. So, we have different choices of herbs that go in different directions. The fundamental importance is to have a good, accurate pattern identification.

Q: What are some of the most common patent formulas, if any, that you tend to use or recommend for pregnant patients?

A: From my point of view, we cannot really develop a patent herb or patent formula for a large population. It’s really case by case. Certain herbs are warming, certain herbs are cooling. If you don’t diagnose properly, the herbs cannot calm the fetus.

Okay, so calm the fetus itself means neutralizing the body’s constitution. There is no pattern. Yin is balanced and Yang is calm. In this case, the person is emotionally and physically very balanced and calm. If that’s not the case, we have to use herbs to try to neutralize the pattern.

You have to really have a proper diagnosis to understand what that means. Maybe books didn’t tell you why certain herbs can calm the fetus. From my point of view, when herbs can calm the fetus, it is because they can neutralize the pattern.

I usually don’t prescribe patent formulas during pregnancy or postpartum. That’s the moment I always ask my patients to invest in customized formulas, that is the best.

Q: When do you feel that herbs or formulas with pregnancy cautions or contraindications have benefits that outweigh the risks of taking them?

A: That’s really case by case. Let’s say that we have the famous formula called Gui Zhi Fu Ling Wan. From your book’s point of view it is cautioned for pregnancy. The interesting thing is that the formula was created for miscarriage. The problem is dosage and how often you take it. Zhongjing created this for ladies who started spotting at the first trimester. He used just a few pills. Very low dose to calm the fetus. There are lots of blood moving and invigorating herbs which are contraindicated for pregnancy. But he had this art. Can we do that, from my point of view? No. We don’t have this art. One day, if you have lots of experience, and you know your patient very well before pregnancy, then you can compare and you can play with that.

Gui Zhi Fu Ling Wan is a patent. It’s a capsule. It’s powder. We lost this part of practice. The pills. We know very well that to be fertile, moving blood is important. Blood needs to move. But as soon as the person is pregnant, moving blood is contraindicated. So that’s why, just like in Jade Goddess Qi Gong, Routine Two, it strongly promotes fertility. As soon as the person is pregnant, the movement becomes contraindicated. We have to treat the herbs exactly the same way.

We really need to understand that herbs can be dangerous. Don’t think herbs are safe because they are also very strong. If you already have heat symptoms and you continue to use warming herbs, then that can make things very dangerous. More restlessness. Right?

A common issue is nausea and vomiting. Usually, we encourage the person to not use herbs at this moment, or to only use Sheng Jiang, fresh ginger. But sometimes if the person’s vomiting gets too dangerous, she can find herself losing too many electrocytes, right? At this moment, we have to treat the patient with Ban Xia. Less is more. Don’t use too much. So, Ban Xia can be utilized. It’s already ginger processed Ban Xia. Ban Xia is toxic and always needs to be processed.

From my point of view, if a practitioner really wants to use herbs to help pregnant patients, the knowledge needs to be advanced. Not only academic knowledge, but also advanced knowledge through practice, knowledge of experience. If the book tells you that you cannot use certain herbs, you have to understand why you cannot use that, like in the case of Ban Xia.

Q: When treating patients during pregnancy, are you typically treating common symptoms like nausea, heartburn, fatigue, high blood pressure, gestational diabetes, etc., or do you find that your patients present with more complex concerns?

A: Oh, we have everything during pregnancy. It’s just internal medicine. Pregnancy makes us very cautious. You have to really consider everything together because it’s very complex. The patient can develop an infection, a common cold, diarrhea, constipation, etc.

I had a patient who just had constant UTIs with itchiness and yellow discharge during the whole pregnancy. At this moment, what can you do? This constant infection can affect the baby, too. She didn’t take any antibiotics, which was her choice. She said that she used antibiotics, but it didn’t work. She was helped by the herbs. She had a healthy baby. So, everything can happen. Don’t think that pregnancy is just pregnancy.

Q: What do you see as the underlying cause for hyperemesis during pregnancy?

A: Sometimes it comes from a physical issue on the back, Du-9 area, and it is better to treat with needles. That’s why you cannot just use herbs. I always combine it with acupuncture. Also, food. Food for me is primary because that’s what she’s eating every day.

Sometimes it can be fear. First trimester is not going to last forever. Lots of inexperienced first time moms, as soon as they have something, they think that’s going to last forever. Fear and anxiety are a lot for pregnant patients. The whole energy is fear, acceptance in life, sacrifice. That’s the moment you grow.

Q: You prefer to use dietary changes to help a patient, especially in pregnancy, before jumping to herbs. This is part of the Jade Woman Medicated Diet method you founded. Do you have common foods that you’re recommending frequently to pregnant patients?

A: It’s always going to be based on the pattern.

Generally, we need to eat good protein. The western culture likes to eat lots of carbohydrates. Lots of pasta, bread, and rice which can make the baby grow. Maybe the size is big, but not really in a good, healthy way. So, lots of good protein at this moment is very important. Lots of fiber is important, too. The uterus is taking up the space of the large intestines, and increasing the pressure. That’s why constipation can become a common issue.

Carbohydrates and sugars create too much heat. They nourish bacteria. It’s very easy to grow a yeast infection or bacterial infection. That’s because of the excessive sugar, which is bad sugar. So berries and apples are best at this moment. Tropical fruit is case by case. Fruit like papaya, it’s very good for estrogen. But if the person already has estrogen dominance maybe it is better to avoid papaya.

Papaya is a wonderful thing for postpartum, though. It helps to produce more milk. In a good way, a delicious way. That’s the beauty of a medicated diet. People think a medicated diet is awful, or not tasty. Actually, no, I think it’s great. We have a tradition to mix food and disease prevention together, but modern people don’t think about that anymore. They’ve lost this knowledge. Still, sometimes we have to use herbs.

Q: Any final thoughts or strategies on using herbs during pregnancy, or even during the postpartum phase?

A: A few days or hours before labor, I encourage the patient to take ginseng to tonify and optimize energy to push. Recommend this according to their body constitution. American ginseng is cooling and nourishing, and ginseng is stronger. Be careful with a person who already has high blood pressure. That makes American ginseng better. They can drink it as tea or even just chew on it.

For postpartum there are two things you need to consider. First is depression which is normal. Why depression? The lady has been pregnant for nine months and there’s something inside emotionally, sentimentally, blood flow, everything. She felt that presence of life and suddenly it’s gone. This physical emptiness can manifest as emotional emptiness. There is also a loss of blood and fluid during labor. In my practice, I don’t replenish immediately. After labor, you are not sure if there is residual tissue in the uterus. You have to make herbs that promote blood flow as the chief. It doesn’t mean you cannot nourish, but don’t make nourishing herbs the chief. Usually I like to use three weeks to one month, make sure everything is out, and then we start to replenish.

Also, many ladies, they want to breastfeed. Of course, some ladies, they don’t want to breastfeed. If they don’t want to breastfeed, you can use herbs to stop the milk production. If they want to breastfeed, at this moment in your herbal treatment, add promoting milk duct herbs. Interaction is very important because baby gets the herbs, too. So you have to be very cautious of the herbs. Toxic herb is a no, for sure. But bitter herbs, sometimes. From my point of view, that is good for the baby. I always think that if the baby starts her life or his life with bitter taste, they will not be picky in the future because everything in the future will be sweet.

I think that Chinese medicine should be the primary care for postpartum. We can combine herbs and food together, and I think that is the best care for postpartum.

Dr. Helena Zhang’s practice and Jade Goddess Method can be found at drhelenazhang.com .