Guest guest Posted October 17, 2007 Report Share Posted October 17, 2007 Hi all - I've been a lurker for a while, so forgive the sudden urgent post. I'm new into practice and unsure of how to approach the following situation: I've been treating a 42 y.o. woman for fertility with acu/herbs for a little over a month. She's a gynecologist, so she knows much more than I do about the western end of things. She completed her first IVF about 4 weeks ago, the egg was fertilized successfully, and she held it for about a week before miscarrying, now 4 weeks later, at ovulation, she is bleeding a little bit and is VERY concerned that the herbs I'm giving her are influencing her hormone levels leading to the mid-cycle bleeding. I known that beginning estrogen or birth-control pills can lead to mid-cycle bleeding, so I'm afraid that some of the herbs I'm giving her may have an estrogenic effect. Her cycle is 26-28 days long, bleeds for 3-4 days, fresh red blood, no clots or pain. Sleep good, but she is very high strung and anxious. T- puffy, sl. red, thin coat P-soft, xu kidney pulse. Dx - Ki Yin Xu, Sp Qi Xu Formula: Ding Jing Fang Jia Jian Dang Gui, Bai Shao, Shu Di, Chai Hu, Shan Yao, Fu Ling, Tu Si Zi, Dang Shen, Ba Ji Tian, Suan Zao Ren, Yuan Zhi, ZGC I'm particularly wondering about any of these herbs having estrogenic effects specifically or any other feedback any of you may have. And if they do, is that necessarily bad? Thanks in advance -- Sean Michael Hall, L.Ac. On Point Acupuncture 2346 Stuart St. Berkeley, CA www.onpointacu.com (510) 705-8755 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2007 Report Share Posted October 17, 2007 Additionally, she (my fertility patient, the gynecologist) has asked me for a list of herbs and the known constituents of each herb so that she can analyze them and determine if they have estrogenic qualities!!! , " sean_michael_hall " <seanmichaelhall wrote: > > Hi all - > > I've been a lurker for a while, so forgive the sudden urgent post. > I'm new into practice and unsure of how to approach the following > situation: > > I've been treating a 42 y.o. woman for fertility with acu/herbs for a > little over a month. She's a gynecologist, so she knows much more > than I do about the western end of things. She completed her first > IVF about 4 weeks ago, the egg was fertilized successfully, and she > held it for about a week before miscarrying, now 4 weeks later, at > ovulation, she is bleeding a little bit and is VERY concerned that the > herbs I'm giving her are influencing her hormone levels leading to the > mid-cycle bleeding. I known that beginning estrogen or birth-control > pills can lead to mid-cycle bleeding, so I'm afraid that some of the > herbs I'm giving her may have an estrogenic effect. > > Her cycle is 26-28 days long, bleeds for 3-4 days, fresh red blood, no > clots or pain. Sleep good, but she is very high strung and anxious. > T- puffy, sl. red, thin coat P-soft, xu kidney pulse. > Dx - Ki Yin Xu, Sp Qi Xu > > Formula: Ding Jing Fang Jia Jian > Dang Gui, Bai Shao, Shu Di, Chai Hu, Shan Yao, Fu Ling, Tu Si Zi, Dang > Shen, Ba Ji Tian, Suan Zao Ren, Yuan Zhi, ZGC > > I'm particularly wondering about any of these herbs having estrogenic > effects specifically or any other feedback any of you may have. And if > they do, is that necessarily bad? Thanks in advance > > -- > Sean Michael Hall, L.Ac. > On Point Acupuncture > 2346 Stuart St. > Berkeley, CA > www.onpointacu.com > (510) 705-8755 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2007 Report Share Posted October 18, 2007 On 10/17/07, sean_michael_hall <seanmichaelhall wrote: > > I'm particularly wondering about any of these herbs having estrogenic > effects specifically or any other feedback any of you may have. And if > they do, is that necessarily bad? Thanks in advance > Sometimes people feel better knowing what's going on rather than not knowing, obviously. In many cases, a Western explanation helps, even while you're busy nourishing the Kidney yin or Spleen qi, but people can also respond well to knowing what's going on from the TCM perspective, and while you may not be able to speak with her on that biomedical level, you can most certainly remain in your court and speak from the TCM position. I think that the " very high strung and anxious " part of your assessment is particularly important here. This is what you're dealing with right now, not her Chong and Ren mai functions. So the immediate treatment principle is to calm her shen (and of course question your own herb choices at the same time.) If your patient also bruises easily, you may be able to suggest to her that her spotting between periods is just another expression of weakened capillary integrity (Spleen qi not holding), and that dang gui, shan yao, fu ling, dang shen, and zhi gan cao can help to strengthen those structures to prevent inappropriate bleeding from any part of her body (including vaginal and/or subcutaneous bruising.) If the spotting can better be traced back to Kidney yin deficiency heat, if you can find other symptoms of heat, you may be able to describe how heat can appear at different levels or structures. If it enters the blood, spotting can ensue as the blood " boils out of the vessels " . Your formula is on the warm side, so you might want to look at that and decide if in fact, you are warming things up and perhaps need to balance things out with some cooling herbs such as sheng di huang, bai mao gen, and mu dan pi. As for directly answering your questions as to which of these herbs act like estrogen, I think that you'll have to visit PubMed or get that thick (Japanese?) book called something like " Chemical Constituents of Chinese Herbs " . I don't know if it will help you at all, and perhaps the best thing would be to simply let her go online and track down that information. You know, the most difficult condition to treat is anxiety. Not because the problem is symptom is difficult to resolve, but because the patients are flighty and noncompliant. They're good for about a week, but then they get (you guessed it) anxious about the formula and stop taking it. So good luck on this one. -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2007 Report Share Posted October 18, 2007 Sean, If whe is diligent, she will find that some of the herbs have estrogenic properties. However, the influence of the herbs' estrogenic effects is largely influenced by dosage. In all likelihood, the bleeding she is experiencing is the the result of the residual effects of the fertility drugs she took and/or her recent miscarriage. It should staighten out after a cycle or two. If she is realy concerned about the herbs, encourage her to lay off of them until she has had time to research their effects and until the bleeding has subsided. Also, you might have her check with her IVF doctor to see if this may be a common side-effect of the Follicle Stimulating medications or progesterone injections. David Karchmer , " sean_michael_hall " <seanmichaelhall wrote: > > Additionally, she (my fertility patient, the gynecologist) has asked > me for a list of herbs and the known constituents of each herb so that > she can analyze them and determine if they have estrogenic qualities!!! > > , " sean_michael_hall " > <seanmichaelhall@> wrote: > > > > Hi all - > > > > I've been a lurker for a while, so forgive the sudden urgent post. > > I'm new into practice and unsure of how to approach the following > > situation: > > > > I've been treating a 42 y.o. woman for fertility with acu/herbs for a > > little over a month. She's a gynecologist, so she knows much more > > than I do about the western end of things. She completed her first > > IVF about 4 weeks ago, the egg was fertilized successfully, and she > > held it for about a week before miscarrying, now 4 weeks later, at > > ovulation, she is bleeding a little bit and is VERY concerned that the > > herbs I'm giving her are influencing her hormone levels leading to the > > mid-cycle bleeding. I known that beginning estrogen or birth- control > > pills can lead to mid-cycle bleeding, so I'm afraid that some of the > > herbs I'm giving her may have an estrogenic effect. > > > > Her cycle is 26-28 days long, bleeds for 3-4 days, fresh red blood, no > > clots or pain. Sleep good, but she is very high strung and anxious. > > T- puffy, sl. red, thin coat P-soft, xu kidney pulse. > > Dx - Ki Yin Xu, Sp Qi Xu > > > > Formula: Ding Jing Fang Jia Jian > > Dang Gui, Bai Shao, Shu Di, Chai Hu, Shan Yao, Fu Ling, Tu Si Zi, Dang > > Shen, Ba Ji Tian, Suan Zao Ren, Yuan Zhi, ZGC > > > > I'm particularly wondering about any of these herbs having estrogenic > > effects specifically or any other feedback any of you may have. And if > > they do, is that necessarily bad? Thanks in advance > > > > -- > > Sean Michael Hall, L.Ac. > > On Point Acupuncture > > 2346 Stuart St. > > Berkeley, CA > > www.onpointacu.com > > (510) 705-8755 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2007 Report Share Posted October 19, 2007 Thanks so much Al and David for your responses. I posted my message feeling very anxious about seeing my patient the next morning and your responses were very helpful. Here's the update for those interested. Since she is a gynecologist, she checks her FSH, estrogen, LH, etc. constantly it seems. For the past week or two she says her estrogen levels were higher than normal, which at first she was pleased with. Around mid-cycle her FSH levels were fine and ultrasound showed that two nice follicles had developed. Unfortunately, there was no LH surge, hence no ovulation. Her theory is that one of the follicles hemorrhaged and now she's shedding her endometrial lining mid-cycle. (very profuse bleeding). I photocopied the relevant monographs from Chen's book and rx that she lay off the herbs until the bleeding stops and she's had a chance to research the herbs (as you've suggested David). Luckily for me, she admitted that there are many other potential reasons she's bleeding now, only one of which is higher estrogen levels. BTW - I agree with you Al, that the focus of my therapy for now, in addition to nourishing Kidney Yin and Sp Qi, should be calming spirit. I think success there will positively affect everything else. Thanks again, Sean , " thecornerstoneclinic " <thecornerstoneclinic wrote: > > Sean, > > If whe is diligent, she will find that some of the herbs have > estrogenic properties. However, the influence of the herbs' > estrogenic effects is largely influenced by dosage. > > In all likelihood, the bleeding she is experiencing is the the > result of the residual effects of the fertility drugs she took > and/or her recent miscarriage. > > It should staighten out after a cycle or two. If she is realy > concerned about the herbs, encourage her to lay off of them until > she has had time to research their effects and until the bleeding > has subsided. Also, you might have her check with her IVF doctor to > see if this may be a common side-effect of the Follicle Stimulating > medications or progesterone injections. > > David Karchmer > > > Quote Link to comment Share on other sites More sharing options...
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