Chinese herbal medicine in pregnancy
On this page
- Overview
- What can Chinese herbs treat in pregnancy?
- Threatened miscarriage and pregnancy support
- Morning sickness and nausea
- Fatigue, anaemia and blood deficiency
- Anxiety, insomnia and mood
- Foetal growth and development
- Are Chinese herbs safe in pregnancy?
- How are herbs prescribed in pregnancy?
- The TCM understanding of pregnancy
- Frequently asked questions
- References
1. Overview
Chinese herbal medicine has been used throughout pregnancy for thousands of years in China and across East Asia. It offers a powerful complement to pregnancy acupuncture, addressing conditions that are difficult to treat with conventional medication — many of which are contraindicated in pregnancy — and supporting the health of both the mother and the developing baby.
In the UK, access to pharmaceutical treatment during pregnancy is limited by legitimate concerns about foetal safety. Acupuncture and Chinese herbal medicine fill a significant gap, providing effective options for nausea, fatigue, threatened miscarriage, anxiety, insomnia, digestive complaints, anaemia, poor foetal growth and other common pregnancy-related conditions.
I am Dr (TCM) Attilio D'Alberto, a qualified Chinese herbalist and member of the Register of Chinese Herbal Medicine (RCHM), practising at my Wokingham, Berkshire clinic. I have extensive experience prescribing Chinese herbal medicine safely throughout pregnancy, combining it with acupuncture and individualised dietary advice as part of a whole-person approach to maternity care. I am the author of My Pregnancy Guide.
The key principle that makes pregnancy herbal prescribing safe is expert individualisation. Herbs that are entirely appropriate outside pregnancy may require modification or omission during it; equally, certain herbs with specific applications in pregnancy should only be used by a qualified herbalist who understands the context. I always recommend obtaining herbal treatment from a qualified practitioner rather than purchasing over-the-counter herbal supplements, which cannot be individually tailored or professionally monitored.
2. What can Chinese herbs treat in pregnancy?
The conditions I most commonly treat with Chinese herbal medicine during pregnancy are:
- Threatened miscarriage and pregnancy support — the most important and evidence-rich application of herbal medicine in pregnancy, particularly for women with a history of miscarriage, those who conceived through IVF, or those with conditions such as low AMH or antiphospholipid syndrome
- Morning sickness and nausea — especially moderate-to-severe nausea that is not adequately controlled by acupressure or dietary measures alone
- Fatigue, anaemia and blood deficiency — very common in pregnancy, particularly in the first and third trimesters; herbal medicine restores blood and qi significantly faster than dietary changes alone
- Anxiety, insomnia and mood disturbance — herbal formulae that calm the Heart and nourish the Shen (spirit) are safe and effective throughout pregnancy
- Foetal growth support — where growth scans show the baby is smaller than expected, herbal medicine that nourishes the blood and strengthens the Kidney can support optimal foetal development
- Heartburn and digestive complaints — extremely common in pregnancy; herbal medicine regulates Stomach qi and reduces reflux without systemic side effects
- Urinary tract infections — recurrent UTIs are more common in pregnancy; herbs that clear damp-heat from the lower jiao support immune function and reduce recurrence
- Constipation — very common from early pregnancy; gentle herb formulae that moisten the intestines and move qi are safe and effective
- Oedema — swelling of the ankles and legs in pregnancy; herbs that strengthen the Spleen and resolve dampness can significantly reduce fluid retention
- Haemorrhoids — common in the second and third trimesters; herbs that cool the blood and reduce swelling provide effective relief
- Headaches and migraines — where conventional treatments are contraindicated, herbs that move qi and blood provide safe pain relief
- Hypertension in pregnancy — as an adjunct to conventional monitoring and management, herbs that calm Liver yang and regulate blood pressure can be used with care
- Transition to the postnatal period — see postnatal acupuncture and Chinese herbs
3. Threatened miscarriage and pregnancy support
Threatened miscarriage — defined by vaginal bleeding, cramping or both in early pregnancy with a viable foetus on ultrasound — occurs in approximately 20–25% of all confirmed pregnancies. About half of these will ultimately result in pregnancy loss. Western medicine offers limited effective treatment: progesterone supplementation is the main option and its evidence base is modest. Chinese herbal medicine has a centuries-long clinical tradition for this indication and a now substantial research evidence base.
The most widely studied formula for threatened miscarriage is Shou Tai Wan (Foetus Longevity Pill), a classical formula attributed to the 19th-century physician Zhang Xichun. It contains Tu Si Zi (cuscuta seed), Sang Ji Sheng (loranthus), and Xu Duan (dipsacus) — herbs that nourish Kidney essence, consolidate the Chong and Ren channels, and stabilise the pregnancy. Modern formulations of this and related formulae such as Shou Tai Tang (Shoutai Decoction), Gushen Antai Pills and Zishen Yutai Pills are the most studied interventions in the clinical literature.
A 2021 Cochrane systematic review of 44 randomised controlled trials involving 5,100 women found that Chinese herbal medicine combined with western medicine was more effective than western medicine alone for continuing pregnancy beyond 28 weeks of gestation (average RR 1.28; 95% CI 1.18–1.38; five trials, 550 women). Combined treatment was also more effective than western medicine alone at preventing inevitable miscarriage so that the pregnancy continued immediately after treatment.
An updated 2023 systematic review and meta-analysis published in Frontiers in Pharmacology (Xie et al.), analysing 57 randomised controlled trials, confirmed that Chinese herbal medicine showed a significant effect on continuation of pregnancy after treatment and improved outcomes past 28 weeks. Crucially, the review found no increased risk of adverse events in either the mother or the newborn with combined Chinese herbal and western medicine treatment compared with western medicine alone.
Beyond formally diagnosed threatened miscarriage, I recommend Chinese herbal pregnancy support for women who:
- Have a history of one or more previous miscarriages
- Conceived through IVF, ICSI, frozen embryo transfer or donor egg/embryo
- Have conditions associated with higher pregnancy risk, including PCOS, low AMH, antiphospholipid syndrome, thyroid disorders or uterine anomalies
- Are over 40
- Have a history of repeated IVF failure
- Are experiencing symptoms of pregnancy instability — bleeding, spotting, cramping or a slow rise in hCG — even without formal threatened miscarriage diagnosis
For these women, I recommend beginning herbal treatment as soon as pregnancy is confirmed and continuing through the first trimester and to at least 20 weeks, in combination with weekly acupuncture.
4. Morning sickness and nausea
Around 70% of pregnant women experience nausea and vomiting in pregnancy, most acutely in weeks 6–12. For most women this resolves by the end of the first trimester; for some, particularly those with a weaker Stomach qi constitution or significant emotional stress, it persists longer and can significantly impair daily functioning and nutritional intake.
In TCM, nausea in pregnancy is understood as Stomach qi counterflow — the normal downward-moving direction of Stomach qi is reversed, causing nausea, acid reflux, belching and vomiting. The most common patterns are Stomach and Spleen deficiency (weak digestive function failing under the additional demands of pregnancy), Liver qi invading the Stomach (stress and emotional tension disrupting the digestive system), or phlegm-fluid accumulation.
Herbal formulae commonly used for pregnancy nausea include:
- Xiao Ban Xia Jia Fu Ling Tang — a classical formula that descends Stomach qi, resolves phlegm and relieves nausea; Ban Xia (pinellia) is modified to its processed form (Fa Ban Xia) for pregnancy use
- Ju Pi Zhu Ru Tang — harmonises the Stomach, clears heat and descends rebellious qi; effective where nausea is accompanied by a feeling of heat
- Xiang Sha Liu Jun Zi Tang modifications — strengthens the Spleen and Stomach, resolves dampness and moves qi where Spleen deficiency is the primary pattern
Chinese herbs are particularly valuable for women whose nausea is severe or persistent and who are unable to eat normally, as improving digestive function supports both maternal and foetal nutrition through this critical period. Treatment is combined with dietary advice — small, frequent, warming meals; avoidance of raw and cold foods; ginger tea — and acupuncture at PC6 and related points. Read more: Morning sickness ›
5. Fatigue, anaemia and blood deficiency
Fatigue is one of the most common and most disabling symptoms of pregnancy, particularly in the first and third trimesters. It is driven by the enormous physiological demands of growing a placenta and baby — demands that in TCM terms translate directly into blood deficiency, as the mother's blood is redirected to nourish the foetus.
Pregnancy increases a woman's blood volume by up to 50%, and the increased demand for iron frequently exceeds dietary supply, resulting in iron deficiency anaemia — which affects approximately 40% of pregnant women globally. Western treatment is iron supplementation, which is often poorly tolerated (causing constipation, nausea and stomach pain) and has limited bioavailability.
Chinese herbal medicine addresses blood deficiency from two directions: directly nourishing blood and yin, and strengthening the Spleen (the organ responsible in TCM for producing blood from food) to improve the body's own blood-producing capacity. Key blood-nourishing herbs used in pregnancy include:
- Dang Gui (Chinese angelica root) — nourishes and moves blood; used in pregnancy at lower doses and in appropriate formula context where blood deficiency with mild stagnation is present
- Shu Di Huang (prepared rehmannia) — deeply nourishes Kidney yin and essence, supporting blood production; used where yin deficiency accompanies blood deficiency
- Bai Shao (white peony root) — nourishes blood and yin, calms Liver yang, relieves cramping and pain; very safe throughout pregnancy
- Huang Qi (astragalus root) — strengthens the Spleen qi that produces blood from food; improves energy, immune function and resistance to infection
The standard formula Si Wu Tang (Four Substance Decoction) — containing dang gui, shu di huang, bai shao and chuan xiong — is the foundational blood-nourishing formula of Chinese medicine. It is modified for pregnancy by adjusting the proportions and adding specific herbs appropriate to the individual's full pattern.
6. Anxiety, insomnia and mood
Anxiety is extremely common in pregnancy, particularly for women who have experienced a difficult fertility journey, previous miscarriage, IVF or other losses. The anxiety of early pregnancy — before scans confirm all is well — is often intense, and can persist throughout the pregnancy and into the postnatal period. Insomnia is closely related, driven by anxiety, physical discomfort, hormonal changes and the increased frequency of urination at night.
In TCM, anxiety and insomnia in pregnancy are typically understood as disturbance of the Heart Shen (spirit), often arising from blood deficiency (the Heart is nourished by blood — when blood is insufficient, the Heart is not rooted and the spirit becomes agitated) or from Liver qi stagnation (particularly in women who are holding a great deal of tension and emotional suppression).
Herbal formulae used for anxiety and insomnia in pregnancy include:
- Gan Mai Da Zao Tang — a gentle classical formula consisting of only three ingredients (licorice root, wheat grain and jujube dates); calms the Heart, nourishes the spirit and relieves emotional volatility; widely used in pregnancy for its safety and effectiveness
- Gui Pi Tang modifications — strengthens Spleen and Heart, nourishes blood and calms the spirit; used for insomnia, anxiety, palpitations and poor memory arising from Spleen and Heart blood deficiency
- Suan Zao Ren Tang modifications — nourishes blood, clears deficiency heat and calms the mind; used for insomnia with vivid dreaming, night sweats and difficulty falling asleep
These formulae are among the safest in the Chinese medicine pharmacopoeia for pregnancy use. They are free of herbs with descending or blood-moving actions that would require caution, and they address the root imbalance rather than simply sedating the symptom. When combined with acupuncture, results are often significantly faster than with herbs alone.
7. Foetal growth and development
Foetal growth restriction (FGR) — where growth measurements fall below the tenth percentile for gestational age — affects approximately 8–10% of pregnancies and is one of the key risk factors for adverse perinatal outcomes. In western medicine, management is primarily monitoring with the aim of timing delivery appropriately; there is no pharmaceutical intervention that reliably improves foetal growth.
In TCM, poor foetal growth is understood as insufficient nourishment reaching the foetus — typically from blood deficiency, Kidney deficiency (jing not supporting foetal development), or poor Spleen function failing to transform food into blood and qi. Treatment focuses on nourishing the blood and Kidney, strengthening the Spleen and improving the circulation of qi and blood to the uterus and placenta.
Herbal treatment for poor foetal growth typically combines classical blood-nourishing formulae with Kidney-tonifying herbs (tu si zi, sang ji sheng, shu di huang), alongside dietary and lifestyle advice. Treatment should always be conducted in close collaboration with the obstetric team monitoring the pregnancy.
8. Are Chinese herbs safe in pregnancy?
Chinese herbal medicine is safe in pregnancy when prescribed by a qualified, experienced herbalist who understands the specific requirements of pregnancy prescribing. This is an important qualification — not all herbs used in general TCM practice are appropriate in pregnancy, and some require modification or avoidance.
Herbs that are routinely avoided or modified in pregnancy include those with strongly moving, descending or blood-breaking actions — properties that could stimulate uterine contractions or cause bleeding. These include large doses of dang gui, chuan xiong, hong hua (safflower), tao ren (peach kernel), and others. A qualified herbalist knows which herbs fall into this category and formulates accordingly.
The herbs that are specifically recommended in classical TCM pregnancy texts — such as those in the Shou Tai Wan family, the blood-nourishing formulae and the spirit-calming formulae — have been used throughout pregnancy for centuries and have a well-established safety profile. The 2023 systematic review by Xie et al. (57 RCTs) found no increased risk of adverse events in the mother or newborn from Chinese herbal medicine treatment during pregnancy for threatened miscarriage.
I am a member of the Register of Chinese Herbal Medicine (RCHM), which requires adherence to strict professional standards and continuing education in safe prescribing. All herbs I prescribe come from Sun Ten (Taiwan), a pharmaceutical-grade manufacturer meeting rigorous quality and heavy metal testing standards. Read more about the safety of Chinese herbal medicine ›
9. How are herbs prescribed in pregnancy?
Chinese herbal medicine in pregnancy is always prescribed individually, based on a full assessment of the mother's TCM pattern — her constitution, symptoms, tongue and pulse findings, and the specific demands of her stage of pregnancy. No two prescriptions are exactly alike.
Herbs are prescribed as pharmaceutical-grade granules from Sun Ten, taken dissolved in warm or hot water twice daily. This is the form most suited to pregnancy: granules are convenient, easy to prepare, precisely dosed, and free from the alcohol preservatives sometimes found in liquid herbal extracts.
Prescriptions are reviewed and adjusted as the pregnancy progresses. The treatment priorities in the first trimester — primarily stabilising the pregnancy and addressing nausea — are different from those of the second trimester (building blood, supporting the baby's growth, managing musculoskeletal complaints) and third trimester (building maternal reserves for birth, preparing for delivery, addressing late-pregnancy symptoms). A good pregnancy herbal prescription evolves with the pregnancy.
Herbal consultations are available in person at my Wokingham clinic and online via Zoom for patients throughout the UK and internationally, with herbs posted directly to you.
10. The TCM understanding of pregnancy
In traditional Chinese medicine, pregnancy is a state in which the Chong and Ren channels — the two most important channels for women's reproductive health — are directed inward to nourish the growing foetus. The mother's blood is the primary substance of nourishment: it forms the placenta, feeds the developing baby and sustains the uterine environment throughout gestation.
The Kidney system in TCM governs reproduction and stores the jing (constitutional essence) that forms the foundation of the baby's development. Both parents' Kidney jing contributes to the baby's constitutional strength. During pregnancy, supporting the mother's Kidney yin and yang, and conserving jing, helps to sustain healthy foetal development and reduces the risk of complications associated with Kidney deficiency: threatened miscarriage, foetal growth restriction, premature birth and poor foetal development.
The Spleen system is responsible for transforming food into blood and qi. A strong Spleen is essential in pregnancy because the demands for blood are so much greater than normal. When the Spleen is weak — which can be caused by poor diet, overwork, excessive worry or a constitutionally weak digestive system — blood production is insufficient to nourish both the mother and the baby adequately, resulting in fatigue, anaemia, nausea, oedema and poor foetal growth.
Chinese herbal prescribing in pregnancy is oriented around these three systems — nourishing blood, supporting the Kidney and strengthening the Spleen — with the specific formulation determined by which systems are most depleted in the individual patient.
11. Frequently asked questions
Can I take Chinese herbs if I am also taking progesterone or other prescribed pregnancy medication?
In most cases, yes. Chinese herbal medicine does not interact adversely with progesterone supplements, aspirin (used in antiphospholipid syndrome), thyroid medication or other commonly prescribed pregnancy drugs. Please inform me of all medications you are taking so I can formulate the prescription appropriately and advise on timing of doses.
Can I take Chinese herbs in the first trimester?
Yes — with the important caveat that prescription must be by a qualified, experienced herbalist who knows which herbs to include and which to avoid in the first trimester. The first trimester is actually the most important time for herbal pregnancy support, particularly for women with a history of miscarriage or who have conceived through IVF. The Shou Tai Wan family of formulae is specifically designed for first-trimester use.
Can I combine Chinese herbs with acupuncture in pregnancy?
Yes, and in most cases this combination produces better outcomes than either treatment alone. Acupuncture addresses immediate symptoms and supports hormonal and nervous system balance during treatment sessions; Chinese herbal medicine provides continuous daily support between sessions and addresses deeper constitutional deficiencies. Together they are the most comprehensive and effective form of TCM pregnancy care.
Should I tell my midwife or obstetrician I am taking Chinese herbs?
Yes. I always recommend informing your midwifery or obstetric team that you are receiving Chinese herbal medicine, particularly if you are under consultant care. In most cases there will be no concerns. If your consultant has specific questions about the herbs I am prescribing, I am happy to correspond directly with them or provide information about the formulation.
Can Chinese herbs help if I have had multiple miscarriages?
Yes. Recurrent miscarriage is one of the conditions where Chinese herbal medicine is most valuable, both for investigating the TCM pattern that may be contributing to the losses, and for supporting the next pregnancy from the outset. Treatment ideally begins before the next conception attempt, so that the underlying pattern can be treated and the constitutional weakness addressed before the pregnancy begins. Read more about treatment for recurrent miscarriage ›
Where is your clinic?
I practise at Wokingham Therapy Clinic, 49 Denmark Street, Wokingham, Berkshire, RG40 2AY. I also offer online herbal consultations via Zoom for patients throughout the UK and internationally, with herbs posted directly to you. View treatment prices ›
