Treatment to Regulate Menstruation and Promote Fertility, Part 1

By John Chen, PhD, PharmD, OMD, LAc

Infertility is defined as failure to become pregnant after several years of regular sexual activity during ovulation. Infertility afflicts more than 6 million American couples, of which approximately 40 percent is attributed to male and 60 percent to female partners.

For females, there are many reasons that contribute to infertility, including but not limited to: ovulatory failure or defect, blocked fallopian tubes, endometriosis, uterine fibroids, polyps, pelvic adhesions, pelvic inflammatory diseases, chlamydia, hormonal imbalance, age (especially those older than 34) and psychological issues. Often, more than one cause contributes to infertility.

According to traditional Chinese medicine, treatment of female infertility must focus on regulating menses. Essential keys in becoming pregnant include a healthy menstrual cycle along with strong kidney qi , an abundance of blood in the chong (thoroughfare) channel and an unblocked ren (conception) channel.

Menstrual Phase

In this phase, it's important to regulate the menses and ensure proper shedding of the uterine lining. Qi and blood-moving herbs are utilized to clear and prevent any stagnation in the lower jiao .

Herbal treatment

bai shao (Radix paeoniae alba)chi shao (Radix paeoniae rubrae) chong wei zi (Semen leonuri)chuan xiong (Rhizoma ligustici chuanxiong)dang gui (Radicis angelicae sinensis) fu ling (Poria) xiang fu (Rhizoma cyperi) ze lan (Herba lycopi)

These herbs are mild so as to regulate the menstrual flow and promote healthy shedding of endometrial tissue. Dang gui (Radicis angelicae sinensis) tonifies and moves blood. Chong wei zi (Semen leonuri) promotes blood circulation and regulates menstruation. When combined with dang gui (Radicis angelicae sinensis), they treat various types of gynecological disorders ranging from irregular menstruation, dysmenorrheal and amenorrhea, to postpartum abdominal pain. Ze lan (Herba lycopi) moves blood to dispel clots. It also works with fu ling (Poria) to reduce water retention and edema associated with menstruation. Chi shao (Radix paeoniae rubrae) and chuan xiong (Rhizoma ligustici chuanxiong) treat a wide variety of gynecological disorders by relieving pain. Xiang fu (Rhizoma cyperi) enters the liver and regulates qi to relieve bloating and emotional imbalances during the menstrual period. Bai shao (Radix paeoniae alba) nourishes blood, softens the liver and has an anti-spasmodic effect to relax the uterus and relieve pain.

From the Western medicine perspective, these herbs have marked influence to regulate menstruation. According to several studies, dang gui (Radicis angelicae sinensis) has both stimulating and inhibiting effects on the uterus, thereby exhibiting an overall regulatory effect on menstruation.1 Furthermore, dang gui (Radicis angelicae sinensis) in essential oil form was effective in relieving menstrual pain, with a 76.79 percent rate of effectiveness among 112 patients.2 The mechanism of this action is attributed in part to the analgesic and the anti-inflammatory effect of the herb, which has been cited to be similar or stronger than acetylsalicylic acid.3 Many other herbs are used in this formula to treat menstruation-related symptoms. For example, xiang fu (Rhizoma cyperi) has an inhibitory effect on the uterus to relax the muscles and relieve pain.4 Bai shao (Radix paeoniae alba) and chi shao (Radix paeoniae rubrae) have an anti-spasmodic effect to alleviate spasms and cramps.5,6 Xiang fu (Rhizoma cyperi) and bai shao (Radix paeoniae alba) have analgesic effects.7,8 Chi shao (Radix paeoniae rubrae) and chuan xiong (Rhizoma ligustici chuanxiong) have anti-platelet effects to reduce clotting and pain.9,10 Chuan xiong (Rhizoma ligustici chuanxiong ) and xiang fu (Rhizoma cyperi) have sedative effects to relieve stress, anxiety and general discomfort.11,12 Lastly, fu ling (Poria) has diuretic effects, reducing water accumulation and treating edema.13,14

Follicular Phase (The week following the last day of menstruation)

During this phase, the key strategy is to tonify the kidney yin , jing (essence) and blood, which are depleted. This stage is essential in fortifying the body to ensure healthy conception.

Herbal treatment

bai zhu (Rhizoma atractylodis macrocephalae) chong wei zi (Semen leonuri) chuan xiong (Rhizoma ligustici chuanxiong) dang gui (Radicis angelicae sinensis) E jiao (Colla corii asini)fu ling (Poria) gou qi zi (Fructus lycii) huai niu xi (Radix achyranthis bidentatae) lu jiao shuang (Cornu cervi degelatinatium) mu dan pi (Cortex moutan) nu zhen zi (Fructus ligustri lucidi) shan yao (Rhizoma dioscoreae) shan zhu yu (Fructus corni) shu di huang (Radix rehmanniae preparata) tu si zi (Semen cuscutae) wu wei zi (Fructus schisandrae chinensis) ze xie (Rhizoma alismatis)

These herbs tonify blood, nourish yin and replenish jing. Mild qi - and blood-moving herbs also are used to prevent stagnation as a result of the rich tonics. In this formula, dang gui (Radicis angelicae sinensis), shu di huang (Radix rehmanniae preparata) and E jiao (Colla corii asini) are among the most effective blood-tonifying herbs to replenish what was lost through menstruation. Bai zhu (Rhizoma atractylodis macrocephalae), fu ling (Poria) and shan yao (Rhizoma dioscoreae) strengthen the spleen. A healthy spleen is essential in the production of blood and extraction of postnatal qi from food. Shan zhu yu (Fructus corni), nu zhen zi (Fructus ligustri lucidi) and gou qi zi (Fructus lycii) nourish the kidney yin and jing. Tu si zi (Semen cuscutae) and lu jiao shuang (Cornu cervi degelatinatium) are two mild yang-tonic herbs to support the kidney yang.

Without yang tonics, yin tonics cannot achieve their maximum effect. Wu wei zi (Fructus schisandrae chinensis) is an astringent herb added to consolidate, bind and prevent the leakage of jing. Ze xie (Rhizoma alismatis) is used to offset the stagnating nature of shu di huang (Radix rehmanniae preparata). Chuan xiong (Rhizoma ligustici chuanxiong), mu dan pi (Cortex moutan) and chong wei zi (Semen leonuri) are mild blood-moving herbs used to ensure that the tonics do not become stagnant. Huai niu xi (Radix achyranthis bidentatae) guides the effect of the herbs to the lower jiao, namely the kidney. In summary, this formula successfully tonifies the body to ensure healthy conception by using herbs that supplement the kidney yin, jing and blood.

From the Western medicine perspective, these herbs facilitate and restore normal health and well-being after menstruation. This formula contains herbs with regulatory effects to promote normal menstruation, hematological effects to promote production of white and red blood cells and adaptogenic effects to address mental and physical stresses associated with menstruation. According to several studies, administration of dang gui (Radicis angelicae sinensis) is associated with both stimulating and inhibiting effects on the uterus, thereby exhibiting an overall regulatory effect.15 Because of this regulatory effect, dang gui (Radicis angelicae sinensis) is beneficial and can be used before, during and after menstruation. Since most women have pronounced weakness and deficiencies after their menstruation, many herbs in this formula promote the production of various types of blood cells. According to one study, gou qi zi (Fructus lycii) has a marked hematopoietic effect to increase the production of red blood cells and white blood cells.16 According to another study, administration of E jiao (Colla corii asini) has a marked hematopoietic effect to increase the production of red blood cells and white blood cells,17 and its use has been shown to effectively treat leukopenia and anemia.18

Furthermore, bai zhu (Rhizoma atractylodis macrocephalae) has an immunostimulant effect by increasing the activity of macrophages and the reticuloendothelial system. It also increases the number of white blood cells, lymphocytes and IgG.19,20 Wu wei zi (Fructus schisandrae chinensis) has an immunostimulant effect to heighten non-specific immunity.21 Lastly, gou qi zi (Fructus lycii) has an immunostimulant effect to increase non-specific immunity and the phagocytic activity of macrophages and the total number of T cells.22 As stated above, this formula contains herbs with an adaptogenic effect to help the body cope with mental and physical stress during and after menstruation. Examples of these herbs include bai zhu (Rhizoma atractylodis macrocephalae) and tu si zi (Semen cuscutae).23,24

In addition, shan yao (Rhizoma dioscoreae) has a stimulating effect on the gastrointestinal tract to promote normal digestion and absorption of nutrients.25 Chuan xiong (Rhizoma ligustici chuanxiong) and mu dan pi (Cortex moutan) stimulate blood circulation and promote delivery of oxygen and essential nutrients to various parts of the body.26,27 Wu wei zi (Fructus schisandrae chinensis) stimulates the central nervous system and increases mental alertness, improves work efficiency and quickens reflexes.28 Fu ling (Poria) and ze xie (Rhizoma alismatis) have diuretic effects, drain water and treat edema frequently associated with menstruation.29,30

References

1. Zhong Yao Xue (Chinese Herbology), 1998; 815:823. 2. Lan Zhou Yi Xue Yuan Xue Bao (Journal of Lanzhou University of Medicine), 1988; 1:36. 3. Yao Xue Za Zhi (Journal of Medicinals), 1971; (91):1098.

4. Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1935; 12:1351. 5. Zhong Cheng Yao Yan Jiu (Research of Chinese Patent Medicine), 1980; 1:32. 6. Zhong Yi Za Zhi (Journal of Chinese Medicine), 1985; 6:50. 7. Gui Yang Yi Xue Yuan Xue Bao (Journal of Guiyang Medical University), 1959;113. 8. Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1983;

4:14. 9. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1984;

4(12):745. 10. Hua Xi Yi Xue Za Zhi (Huaxi Medical Journal), 1993; 8(3):170. 11. Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983:123. 12. Zhong Guo Yao Ke Da Xue Xue Bao (Journal of University of Chinese Herbology), 1989; 20(1):48. 13. Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and

Pharmacology of Common Chinese Drugs), 1994; 1383:1391. 14. Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1986;

8:25. 15. Zhong Yao Xue (Chinese Herbology), 1998: 815-230. 16. Zhong Yao Xue (Chinese Herbology), 1998: 860-2. 17. Zhong Cheng Yao Yan Jiu (Research of Chinese Patent Medicine), 1981; (5):31. 18. Shan Dong Yi Yao Gong Ye (Shandong Pharmaceutical Industry), 1986; 3:21. 19. Jun Shi Yi Xue Jian Xun ( Military Medicine Notes ), 1977; 2:5 20. Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1979; 6:60. 21. Zhong Yao Xue (Chinese Herbology), 1998: 878-881. 22. Zhong Cao Yao (Chinese Herbal Medicine), 19(7):25. 23. Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1974; 8:13. 24. Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and

Pharmacology of Common Chinese Drugs), 1994: 1563-4. 25. Zhi Wu Zi Yuan Yu Huan Jing (Source and Environment of Plants), 1992; 1(2):10. 26. Zhong Yao Xue (Chinese Herbology) , 1989; 535:539. 27. Guo Wai Yi Xue Zhong Yi Zhong Yao Fen Ce (Monograph of Chinese Herbology from Foreign

Medicine), 1983; (3):5,1984;(5):54. 28. Zhong Yao Xue (Chinese Herbology), 1998; 878:881. 29. Sheng Yao Xue Za Zhi (Journal of Raw Herbology), 1982; 36(2):150. 30. Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and

Pharmacology of Common Chinese Drugs), 1994; 1383:1391.

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Treatment to Regulate Menstruation and Promote Fertility, Part 2

By John Chen, PhD, PharmD, OMD, LAc

Editor's Note: Part one of this article ran in the May 2008 issue.

Ovulatory Phase

The primary treatment plan during this phase is to help the eggs mature and promote ovulation.

Kidney yang tonic herbs have the effect to enhance the surge of luteinizing hormone, which then stimulates ovulation. Herbs should be taken three days before and three days after ovulation.

Herbal Treatment

ba ji tian (Radix rorindae officinalis)bai shao (Radix paeoniae alba)dang gui (Radicis angelicae sinensis) gou qi zi (Fructus lycii) lu jiao shuang (Cornu cervi degelatinatium) shan zhu yu (Fructus corni) shu di huang (Radix rehmanniae preparata) suo yang (Herba cynomorii) tu si zi (Semen cuscutae) xiao hui xiang (Fructus foeniculi) xu duan (Radix dipsaci) yi mu cao (Herba leonuri) yin yang huo (Herba epimedii)

The ovulatory stage is when kidney yin is turning into yang and ovulation occurs with a peak in temperature. To facilitate ovulation, mild blood-moving herbs also are added. Suo yang (Herba cynomorii) traditionally is used for infertility, low libido, lack of kidney jing (essence) and other kidney yang deficiency conditions. It is used with yin yang huo (Herba epimedii), lu jiao shuang (Cornu cervi degelatinatium), xu duan (Radix dipsaci) and ba ji tian (Radix rorindae officinalis) to boost the yang and promote ovulation.

Tu si zi (Semen cuscutae) tonifies both kidney yin and yang and is an essential herb for treating infertility. Xiao hui xiang (Fructus foeniculi) warms the kidney and the womb in preparation for pregnancy. Shu di huang (Radix rehmanniae preparata), gou qi zi (Fructus lycii), bai shao (Radix paeoniae alba) and shan zhu yu (Fructus corni) support the kidney yin for two purposes. They enhance

the effects of the yang tonics (kidney yin and yang should always be tonified together for maximum effect) and prevent the yang tonics from creating deficiency in kidney fire. Yang tonics promote the release of the egg. Dang gui (Radicis angelicae sinensis) tonifies blood, and yi mu cao (Herba leonuri) moves the blood. This increases blood supply to the ovaries to induce contraction of the muscles pulling the ovaries closer to the fallopian tubes, thus facilitating the movement of the egg into the fallopian tube.

Administration of dang gui (Radicis angelicae sinensis) is associated with both stimulating and inhibiting effects on the uterus, thereby regulating menstruation.31 Because of this effect, dang gui (Radicis angelicae sinensis) is beneficial and can be used before, during and after menstruation. To regulate ovulation, many herbs are used to promote the production and secretion of various hormones. For example, use of shu di huang (Radix rehmanniae preparata) has a marked stimulating effect on the endocrine system, with the mechanism of action attributed to inhibiting negative feedback signals to the pituitary gland.32

According to another study, administration of ba ji tian (Radix rorindae officinalis) also stimulates the endocrine system and increases the production and release of hormones.33 Most importantly, use of yin yang huo (Herba epimedii) stimulates the endocrine system by increasing production and secretion of endogenous hormones such as corticosterone, cortisol and testosterone.34 Finally, this formula uses many herbs to facilitate and enhance the overall effect of therapy. Gou qi zi (Fructus lycii) and yi mu cao (Herba leonuri) both stimulate the reproductive organs (namely the uterus) to prepare for conception.35,36

Luteal Phase (week before menstruation onset)

The focus during this phase is to regulate liver qi, treat any possible premenstrual syndrome and ensure proper flow of qi and blood in the liver, chong (thoroughfare) and ren (conception) channels. When patients are more relaxed, conception is more likely to happen.

Herbal Treatment

bai shao (Radix paeoniae alba)bai zhu (Rhizoma atractylodis macrocephalae) chai hu (Radix bupleuri) chuan niu xi (Radix cyathulae) chuan xiong (Rhizoma ligustici chuanxiong) dang gui (Radicis angelicae sinensis) fu ling (Poria) gan cao (Radix glycyrrhizae) he huan pi (Cortex albiziae) ju he (Semen citri rubrum) lu lu tong (Fructus liquidambaris) xiang fu (Rhizoma cyperi) yi mu cao (Herba leonuri) yu jin (Radix curcumae)

Regulating liver qi is the most important treatment strategy during this stage. Liver qi stagnation is characterized by irregular menstruation, abdominal bloating, irritability, emotional instability, short temper and breast distension. This formula is designed to relieve PMS, release tension and stagnation, and prepare the uterus for proper shedding the following week.

Chai hu (Radix bupleuri) and xiang fu (Rhizoma cyperi) smooth the liver qi and disperse qi stagnation. He huan pi (Cortex albiziae) relieves liver qi stagnation and reduces anxiety and irritability. Dang gui (Radicis angelicae sinensis) tonifies blood and relieves pain. Bai shao (Radix paeoniae alba) nourishes

the blood to soften the liver and relieve distention and pain. Bai zhu (Rhizoma atractylodis macrocephalae) and fu ling (Poria) tonify the spleen and dispel dampness to facilitate the transportation and transformation of nutrients. Gan cao (Radix glycyrrhizae) supplements qi and helps bai shao (Radix paeoniae alba) soften the liver to relieve pain. Yu jin (Radix curcumae), chuan xiong (Rhizoma ligustici chuanxiong), lu lu tong (Fructus liquidambaris) and yi mu cao (Herba leonuri) break blood stasis in the lower jiao and help it to ensure proper shedding of the endometrial lining during the period. Chuan niu xi (Radix cyathulae) and ju he (Semen citri rubrum) are channel-guiding herbs that help direct the effect of the formula to the lower jiao.

Administration of dang gui (Radicis angelicae sinensis) has both stimulating and inhibiting effects on the uterus, thereby exhibiting an overall regulatory effect on menstruation.37 Furthermore, use of dang gui (Radicis angelicae sinensis) in essential oils form was effective in relieving menstrual pain, with a 76.8 percent rate of effectiveness among 112 patients.38 This action is attributed in part to the herb's analgesic and anti-inflammatory effects, which are similar to or stronger than acetylsalicylic acid.39

Herbs with analgesic effect to relieve pain include xiang fu (Rhizoma cyperi),40 gan cao (Radix glycyrrhizae),41 chai hu (Radix bupleuri),42 and bai shao (Radix paeoniae alba).43 Herbs with anti-inflammatory effects to reduce swelling and inflammation include gan cao (Radix glycyrrhizae),44 chai hu (Radix bupleuri)45 and bai shao (Radix paeoniae alba)46 Herbs with muscle-relaxant effects to relieve spasms and cramps include bai shao (Radix paeoniae alba) and gan cao (Radix glycyrrhizae).47,48 In addition, fu ling (Poria) is added for its mild sedative effect to relieve the general pain and discomfort associated with PMS.49

Yi mu cao (Herba leonuri) has been used specifically to treat irregular menstruation and hypermenorrhea.50 Furthermore, this formula uses many herbs to treat menstruation-related complications. For example, fu ling (Poria) and bai zhu (Rhizoma atractylodis macrocephalae) have diuretic effects, and are used to drain water accumulation and treat edema.51-53 Chuan xiong (Rhizoma ligustici chuanxiong), yi mu cao (Herba leonuri) and bai zhu (Rhizoma atractylodis macrocephalae) have anti-platelet effects, and are used to prevent clotting and pain before and during menstruation.54-

56 Finally, yi mu cao (Herba leonuri) has a stimulating effect, while xiang fu (Rhizoma cyperi) has an inhibiting effect on the uterus. The regulatory effects of these two herbs ensure proper and smooth transition throughout changes in the menstrual cycle.57,58

Nutrition

Foods that are cold or sour (all citrus) should be avoided one week before and during menstruation, as they create stagnation and cause pain. More nuts and seeds should be eaten. Avoid overly spicy and pungent foods, as they may cause excessive bleeding. Decrease processed food and increase organic food. Avoid alcohol, coffee and cigarettes.

Lifestyle Instructions

Because there is only one window of opportunity to become pregnant each month, it is important to be patient and to give the herbs enough time to bring the body back to balance. Try not to feel anxious, nervous, depressed or worried. Engage in yoga, meditation, Tai chi chuan or other activities that help with relaxation and focus on something other than constantly thinking about trying to become pregnant. A positive attitude and low stress level can contribute greatly to a successful pregnancy.

Clinical Notes

There are many causes of infertility, all with a corresponding TCM diagnosis. For example, an inability to ovulate often indicates kidney yang deficiency, while tubal obstruction means qi, blood or phlegm stagnation. A specific diagnosis is necessary in selecting the right herbal formula for the patient.

One course of treatment is three months. Efficacy ranges from one to three courses. The couple should not try excessively to become pregnant during the first month of herbal treatment. The liver qi should be relaxed. Proper preconception care enables the body to be at optimal health and is extremely important to ensure healthy conception and pregnancy.

In cases in which the period is irregular and there is no clear distinction of the phases, treat the underlying cause first by using a supplementary formula. When a pattern establishes, use the herbal formulas accordingly. Women who were on oral contraceptives previously may not become pregnant as quickly, because the body needs a period of time to readjust and begin to secrete hormones regularly without the interference of contraceptives. Herbs will help speed up this process.

Cautions

Women who take these fertility formulas may experience more bleeding during their period, which is normal. These formulas are designed to treat infertility. They do not offer any protection against sexually transmitted diseases. These herbs are ineffective for infertility caused by immune dysfunction.

Female infertility is a complicated disorder that has numerous causes. In Western medicine, those with disorders such as irregular or absence of ovulation usually are treated with the drug Clomid (clomiphene), which has side effects such as hot flashes, abdominal swelling, breast tenderness, nausea, vision disturbance and headaches. Those with problems with the fallopian tubes or cervix are treated with physical interventions, such as surgery, intrauterine insemination and in vitro fertilization. Although these methods are effective, they are more invasive, expensive and risky.

Continuous and persistent use of these four fertility formulas will regulate menstruation, balance hormones, and strengthen the underlying condition. Not only will they significantly improve the possibility of successful fertilization, but they also will increase the probability of a smooth pregnancy with minimal complications.

References 31. Zhong Yao Xue (Chinese Herbology), 1998;815:823.32. Zhong Yao Xue (Chinese Herbology), 1998;156:158. 33. Guo Wai Yi Xue Zhong Yi Zhong Yao Fen Ce (Monograph of Chinese Herbology From Foreign Medicine), 1990; 12(6):48.34. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1989; 9(12):737-8,710.35. Zhong Yao Xue (Chinese Herbology), 1998;860:862. 36. Zhong Yao Yan Jiu (Research of Chinese Herbology), 1979;581. 37. Zhong Yao Xue (Chinese Herbology), 1998;815:823. 38. Lan Zhou Yi Xue Yuan Xue Bao (Journal of Lanzhou University of Medicine), 1988;1:36. 39. Yao Xue Za Zhi (Journal of Medicinals), 1971;(91):1098. 40. Gui Yang Yi Xue Yuan Xue Bao (Journal of Guiyang Medical University), 1959;113. 41. Zhong Yao Xue (Chinese Herbology), 1998;759:765.42. Shen Yang Yi Xue Yuan Xue Bao (Journal of Shenyang University of Medicine), 1984;1(3):214. 43. Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1983;4:14. 44. Zhong Cao Yao (Chinese Herbal Medicine), 1991;22(10):452. 45. Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983; 888. 46. Zhong Yao Zhi (Chinese Herbology Journal), 1993;183. 47. Zhong Yi Za Zhi (Journal of Chinese Medicine), 1985;6:50. 48. Hu Nan Zhong Yi (Hunan Journal of Traditional Chinese Medicine), 1989;2:7.49. Zhong Yao Da Ci Dian (Dictionary of Chinese Herbs), 1977;1596. 50. Zhong Hua Fu Chan Ke Za Zhi (Chinese Journal of OB/GYN), 1958;1:1. 51. Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and

Pharmacology of Common Chinese Drugs), 1994;1383:1391. 52. Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1986;8:25. 53. Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1961;47(1):7. 54. Hua Xi Yi Xue Za Zhi (Huaxi Medical Journal), 1993;8(3):170. 55. Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1986;6(1):39. 56. Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994;739:742. 57. Zhong Yao Yan Jiu (Research of Chinese Herbology), 1979;581.58. Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1935;12:1351.

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