No. 80 January 2011 Herbs for the Treatment of Dysfunctional Uterine Bleeding Shepherd’s Purse Capsella bursa-pastoris herb is antihaemorrhagic and astringent, and is traditionally used to treat chronic menorrhagia and uterine haemorrhage.1,2 European herbalists regarded Shepherd's Purse as useful for heavy bleeding associated with fibroids.3,4 In the late 19th century, and during World War I in Europe, Shepherd's Purse was commonly used as a substitute for ergot in uterine bleeding.5-7 (Ergot is the product of a fungus (Claviceps purpurea) that grows on grain, especially rye. By the end of the 19th century, ergot was a standard drug used to induce contractions during labour. It was also used to treat postpartum haemorrhage.8) Ethanol extracts of Shepherd's Purse were also found to have a haemostatic action in a clinical setting in Japan.9,10 Dong Quai Angelica polymorpha (A. sinensis) root is well known in traditional Chinese medicine (TCM) as the premier herb in gynaecology.11-13 It tonifies and invigorates the blood, regulates menstruation, alleviates pain and relaxes the bowels.11,14 In this tradition, it is used to treat menstrual disorders including irregular menstruation, amenorrhoea and dysmenorrhoea; anaemia, abdominal pain, constipation, traumatic injury and boils.11 Use of Dong Quai for conditions of blood stasis,11 suggest it could be beneficial for endometriosis. In addition to many of these applications, Dong Quai is used traditionally in Vietnam for debility, fatigue, colic and headache.15 In the late 1800s Dong Quai was introduced into western medicine.16 A survey of practitioners, mainly of the western herbal tradition, was conducted by the American Herbalists Guild in 2002. An overwhelming majority of respondents used Dong Quai for indications consistent with TCM and focusing on gynaecological imbalances including endometriosis, fibroids, infertility, dysmenorrhoea, ovarian cysts, menopause and premenstrual tension.17 Not for Public Distribution. For Education of Health Care Professionals Only. In a clinical study, Dong Quai fluid extract was used for the treatment of dysmenorrhoea in nulliparous women, and for severe bleeding in multiparous women. Administration of fluid extract for 1 week before menstruation was effective in decreasing menstrual pain and chronic endometritis (inflammation of the endometrium).18 The beneficial effect of Dong Quai in relieving dysmenorrhoea may be associated with its uterine antispasmodic activity.17 False Unicorn Root Chamaelirium luteum (known previously as Helonias luteum, H. lutea) is native to North America. Indigenous Americans used the root and rhizome to stop miscarriage and relieve cough.19 It became official in the National Formulary (of the United States) in 1916.20 False Unicorn Root was found by the Eclectic physicians to be useful to improve the tone of the reproductive organs, especially when associated with colic and lumbar pain.2,19 It has also been used traditionally for dysmenorrhoea, amenorrhoea, leucorrhoea, prolapse with disordered menstruation and to improve libido.1,2,21 False Unicorn Root is regarded primarily as a uterine tonic,1,2 although also with action on the ovaries,22 and hence is used in pelvic inflammation and to improve fertility.22,23 Contemporary herbalists also recommend False Unicorn Root for hormonal problems of menopause.23 White Peony The white-coloured and peeled root of Paeonia lactiflora (White Peony) is used in traditional Chinese medicine (TCM) for the treatment of irregular menstruation, menorrhagia, uterine haemorrhage, amenorrhoea, dysmenorrhoea, vaginal discharge and night sweats. It relieves pain and spasm of the abdomen and limbs.11,14,24-26 Like Dong Quai, it is a herb that nourishes the blood (blood tonic),11,25 and is used for anaemia, particularly associated with menstrual disturbances.14,24 In experimental studies, oral administration of Paeonia lactiflora root decoction demonstrated antispasmodic activity in the ileum and uterus.27 Relief of uterine spasm 1 would be beneficial in treatment of endometriosis and dysmenorrhoea. Synergistic Formulation These herbs would complement each other in a very potent formulation with the following actions: • antihaemorrhagic, astringent, • uterine and ovarian tonic, • menstruation regulating, • blood building (blood tonic), • antispasmodic. Indications • • • Menorrhagia, dysfunctional uterine bleeding (including that caused by the presence of fibroids), breakthrough bleeding at ovulation. Relief of the symptoms of uterine prolapse and/or poor pelvic tone (including incontinence). Dysmenorrhoea, endometriosis. Are Used in Medicine. First published 1892, reprinted Dover Publications, New York, 1974. 20 Vogel VJ. American Indian Medicine. University of Oklahoma Press, Norman, 1970. 21 Ellingwood F, Lloyd JU. American Materia Medica, Therapeutics and Pharmacognosy, 11th Edn. Eclectic Medical Publications, Portland, 1983. 22 Lyle TJ. Physio-Medical Therapeutics, Materia Medica and Pharmacy, 1897, reprinted National Association of Medical Herbalists of Great Britain, London, 1932. 23 Mills SY. The Essential Book of Herbal Medicine. Penguin Arkana (Penguin), London, 1991. 24 World Health Organization. Medicinal Plants in China. WHO Regional Office for the Western Pacific, Manilla, 1989. 25 Zheng G, Zhang C. Concise Chinese Materia Medica. The Series of Traditional Chinese Medicine for Foreign Readers. Shandong Science and Technology Press, Jinan, 1997. 26 Kong YC et al. J Ethnopharmacol 1986; 15: 1 27 Wagner H and Farnsworth NR (eds). Economic and Medicinal Plant Research, Vol 1. Academic Press, London, 1985. Author: Michelle Morgan © Copyright 2011 MediHerb. Cautions and Contraindications Not to be used during the first trimester of pregnancy. Shepherd's Purse should be avoided if possible by lactating women or used with caution. Dong Quai should be used cautiously in those with diarrhoea and avoided in those with acute viral infections. Further clinical research is required, but it is possible that Dong Quai may interact with warfarin. REFERENCES 1 British Herbal Medicine Association’s Scientific Committee. British Herbal Pharmacopoeia. BHMA, Bournemouth, 1983. 2 Felter HW, Lloyd JU. King’s American Dispensatory. 18th Edn, 3rd revision. First published 1905, reprinted Eclectic Medical Publications, Portland, 1983. 3 Leclerc H. Précis de Phytothérapie, 5th Edn. Masson, Paris, 1983. 4 Weiss RF. Herbal Medicine, translated by Meuss AR from the 6th German Edn of Lehrbuch der Phytotherapie. Gothenburg, AB Arcanum, Sweden, 1988. 5 Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis. Medpharm Scientific Publishers, Stuttgart, 1994. 6 Grieve M. A Modern Herbal. Dover Publications, New York, 1971. 7 Maisch JM. American Journal of Pharmacy Vol 16 No. 7, July 1888. 8 De Costa C. Lancet 2002; 359: 1768 9 Kuroda K, Kaku T. Life Sci 1969; 8: 151 10 Kuroda K, Takagi K. Arch Int Pharmacodyn 1969; 178: 382 11 Bensky D, Clavey S, Stoger E. Chinese Herbal Medicine: Materia Medica, 3rd Edn. Eastland Press, Seattle, 2004. 12 Yang SZ (translator). The Divine Farmer’s Material Medica. A Translation of the Shen Nong Ben Cao Jing. Blue Poppy Press, Boulder, 1998. 13 Liu F, Mau LY. Chinese Medical Terminology. The Commercial Press Ltd, Hong Kong, 1980. 14 Pharmacopoeia Commission of the People’s Republic of China. Pharmacopoeia of the People’s Republic of China, English Edn. Chemical Industry Press, Beijing, 1997. 15 World Health Organization. Medicinal Plants in Viet Nam. WHO Regional Office for the Western Pacific, Manilla, 1990. 16 McKenna DJ, Jones K, Hughes K et al. Botanical Medicines: The Desk Reference for Major Herbal Supplements, 2nd Edn. New York, Haworth Herbal Press, 2002. 17 American Herbal Pharmacopoeia. Dang Gui Root – Angelica sinensis: Standards of Analysis, Quality Control, and Therapeutics. American Herbal Pharmacopoeia, Santa Cruz, 2003. 18 World Health Organization. WHO Monographs on Selected Medicinal Plants, Vol 2. WHO, Geneva, 2001. 19 Millspaugh CF. American Medicinal Plants: An Illustrated and Descriptive Guide to Plants Indigenous to and Naturalized in the United States Which Not for Public Distribution. For Education of Health Care Professionals Only. 2