TCM Herbal Treatment for Vaginitis with Case Study

Vaginitis—regardless of the cause—is one of the last things any woman wants to deal with.

Traditional Chinese Medicine (TCM) offers a natural, holistic, and potentially safe approach to this common condition, which affects 23-29% of the female population worldwide. While the exact mechanisms of predisposition remain unclear in Western medicine, infectious vaginitis is most commonly caused by bacterial vaginosis (BV), vulvovaginal candidiasis (yeast infections), and trichomoniasis. These infections lead to vaginal dysbiosis, increasing susceptibility to complications such as sexually transmitted infections (STIs) and pelvic inflammatory disease (PID). Additionally, noninfectious vaginitis can arise from allergies, hormonal changes, or other irritants. Due to overlapping symptoms, misdiagnosis is frequent.

Interestingly, the principles of Chinese herbal medicine allow for a holistic approach that can be applied not only to BV but also to STIs and PID, addressing underlying imbalances rather than just treating symptoms.

This article focuses specifically on bacterial vaginosis (BV), as it is the most common form of vaginitis and a condition frequently seen in my private practice. While exploring the pathology of other causes of vaginitis, I will also discuss the most widely available treatment options, including allopathic medicine, naturopathic approaches, and Traditional Chinese Medicine (TCM). Finally, I will share a case study from my practice detailing the herbal formula prescribed to a patient who recently sought my help.

This article is a long read, you can jump ahead by clicking on the title that you are interested in directly.

1. What is Vaginitis and its Clinical presentation
2. Western medicine’s treatment
3. Bonus: Naturopathic medicine approach for Vaginitis
4. Can Chinese medicine treat Vaginitis?
5. A real case of TCM Treatment of Bacterial Vaginosis in Toronto

1. The Clinical Presentation of Vaginitis: Symptoms

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. There are several different types of Vaginitis, and their symptoms vary depending on what are the underlying causes.

Bacterial Vaginosis

Symptoms:

• Thin, watery vaginal discharge, often gray or white
• Strong fishy odor, especially after intercourse
• Mild vaginal irritation or discomfort (less common)
• No significant vaginal itching or burning
• No inflammation or redness (typically)

Clinical Findings:

• pH > 4.5 (alkaline environment)
• Positive “whiff test” (fishy odor when potassium hydroxide is added to a vaginal sample)
• Clue cells on microscopy (vaginal epithelial cells coated with bacteria)
• Absence of lactobacilli dominance in vaginal flora
• Minimal or no inflammation of the vaginal walls

Vulvovaginal Candidiasis (Yeast Infection)

Symptoms:

• Thick, white, clumpy vaginal discharge (“cottage cheese-like”)
• Intense vaginal and vulvar itching
• Burning sensation, especially during urination or intercourse
• Redness and swelling of the vulva
• Soreness or discomfort in the vaginal area

Clinical Findings:

• pH ≤ 4.5 (normal or slightly acidic environment)
• Budding yeast or pseudohyphae seen on microscopy (wet mount or KOH prep)
• Erythema (redness) and edema (swelling) of the vaginal walls and vulva
• Excoriations (scratches) or fissures due to intense itching

Trichomoniasis

Symptoms:

• Frothy, yellow-green vaginal discharge with a strong, unpleasant odor
• Vaginal itching, irritation, or burning
• Pain during urination (dysuria)
• Pain or discomfort during intercourse (dyspareunia)
• Lower abdominal discomfort (less common)
• Vulvar redness, swelling, and irritation

Clinical Findings:

• pH > 4.5 (more alkaline vaginal environment)
• Strawberry cervix (colpitis macularis): Small red pinpoint hemorrhages on the cervix
• Frothy, greenish-yellow vaginal discharge seen on examination
• Wet mount microscopy: Motile trichomonads (pear-shaped, flagellated protozoa) observed
• Positive whiff test (less common) when potassium hydroxide (KOH) is added to a sample
• Increased white blood cells (WBCs) in vaginal secretions

Atrophic Vaginitis

Atrophic vaginitis, also known as genitourinary syndrome of menopause (GSM), is a condition caused by estrogen deficiency, leading to thinning, dryness, and inflammation of the vaginal and vulvar tissues. It most commonly affects postmenopausal women, but it can also occur in breastfeeding women, those on anti-estrogen therapies, or individuals with ovarian insufficiency.

Symptoms:

• Vaginal dryness
• Itching
• Burning
• Irritation
• Many also report pain during intercourse (dyspareunia)
• Postcoital spotting
• Urinary urgency
• Recurrent urinary tract infections (UTIs)
• Discomfort during urination (dysuria)

Clinical Findings:

• On clinical examination, the vaginal mucosa appears pale, thin, and dry, sometimes with small petechiae (red pinpoint spots).
• A hormone test can indicate low hormone levels, but this is not necessary.

Inflammatory Vaginitis

Inflammatory vaginitis (Desquamative Inflammatory Vaginitis, or DIV) is a chronic, non-infectious vaginal inflammation often associated with hormonal imbalances or immune dysfunction. It is characterized by persistent vaginal discomfort, yellow-green purulent discharge, and vaginal inflammation that does not respond to standard antibiotic or antifungal treatments. Many cases are linked to low estrogen levels, autoimmune conditions, or dysbiosis (disruption of the vaginal microbiome).

Symptoms:

• Chronic vaginal irritation
• Burning
• Dyspareunia (pain during intercourse)
• Persistent, abnormal discharge
• Unlike bacterial vaginosis, inflammatory vaginitis often presents with vaginal soreness and redness.
• Women may experience pain with urination due to irritation of the vaginal tissues.

Clinical Findings:

• Vaginal walls appear inflamed, with erythema and discharge.
• Microscopic examination reveals increased white blood cells (WBCs) but no dominant pathogenic bacteria.
• Vaginal pH is elevated (>4.5), and there is often a lack of Lactobacillus in the vaginal flora.

Allergic and Irritant Vaginitis

Irritant and allergic vaginitis are both non-infectious forms of vaginal inflammation caused by external substances that trigger irritation or an immune response. While irritant vaginitis results from direct chemical or physical irritation, allergic vaginitis is a hypersensitivity reaction to an allergen. The symptoms and treatment approaches for both conditions are similar, making them useful to discuss together.

Symptoms:

• Burning
• Itching
• Swelling
• Redness of the vaginal and vulvar area.
• Symptoms often develop shortly after exposure to the offending substance, which may include scented soaps, feminine hygiene products, douches, spermicides, lubricants, latex condoms, or certain medications.
• Unlike infections, these types of vaginitis do not produce a foul-smelling discharge.
• If the discharge is present, it is usually clear or slightly white.
• Pain during urination (dysuria) and discomfort during intercourse (dyspareunia) are also common complaints.

Clinical Findings:

• The vaginal and vulvar tissues may appear red, swollen, and irritated.
• In severe allergic reactions, small vesicles (fluid-filled blisters) or excoriations (scratch marks) from intense itching may be present.
• Vaginal pH typically remains normal (3.8–4.5) unless secondary bacterial overgrowth occurs.
• Microscopy does not reveal any infectious organisms, but allergic vaginitis may show elevated eosinophils (immune cells involved in allergic reactions).

2. The Treatment of Vaginosis With Allopathic Medicine

Bacterial Vaginosis (BV) – Treated with Antibiotics

BV is caused by an overgrowth of anaerobic bacteria, leading to an imbalance in the vaginal flora. The treatment involves antibiotics, which target and eliminate the harmful bacteria while allowing the normal Lactobacillus population to restore balance.

• Metronidazole (Flagyl) (Oral & Gel): Antibiotic (Nitroimidazole class) that kills anaerobic bacteria
• Clindamycin (Cream & Oral): Antibiotic (Lincosamide class) that stops bacterial growth
• Tinidazole & Secnidazole: Antibiotics similar to Metronidazole but with longer action

Vulvovaginal Candidiasis (Yeast Infection) – Treated with Antifungals

Yeast infections are caused by an overgrowth of Candida species (mainly Candida albicans). The treatment involves antifungal medications, which disrupt the fungal cell membrane, leading to the yeast’s death.

• Fluconazole (Diflucan) (Oral): Antifungal (Triazole class) that inhibits fungal growth
• Clotrimazole and others (Topical Creams & Suppositories): Antifungals (Azole class) that block fungal cell membrane production

Trichomoniasis – Treated with Antiprotozoal Antibiotics

Trichomoniasis is a sexually transmitted infection (STI) caused by the protozoan parasite Trichomonas vaginalis. It requires antiprotozoal antibiotics, which specifically target and destroy the parasite.

• Metronidazole (Flagyl) & Tinidazole: Antiprotozoal Antibiotics (Nitroimidazole class) that kill the parasite by damaging its DNA

Each of these treatments is pathogen-specific, meaning they target the underlying cause of the infection rather than just relieving symptoms.

Treatment for Non-infectious Causes With Allopathic Medicine

Atrophic Vaginitis Treatment
The first-line treatment for atrophic vaginitis is topical estrogen therapy, available in the form of creams (estradiol, conjugated estrogen), vaginal tablets, or vaginal rings, which directly replenish estrogen levels in the vaginal tissues. For women with systemic menopausal symptoms, oral or transdermal systemic hormone replacement therapy (HRT) may be considered. Non-hormonal options include vaginal moisturizers (used regularly to maintain hydration) and lubricants (to reduce discomfort during intercourse). In cases of severe irritation or discomfort, low-dose vaginal DHEA or selective estrogen receptor modulators (SERMs) such as ospemifene may be prescribed.

Inflammatory Vaginitis Treatment
Treatment typically includes topical or intravaginal corticosteroids (e.g., hydrocortisone) to reduce inflammation, clindamycin cream if secondary bacterial overgrowth is present, and vaginal estrogen therapy in cases associated with estrogen deficiency.

Allergic and Irritant Treatment
Treatment focuses on identifying and eliminating the irritant or allergen to prevent recurrence. In moderate to severe cases, topical corticosteroids or oral antihistamines may be prescribed to reduce inflammation and itching. If a latex allergy is suspected, switching to non-latex condoms is recommended.

3. Bonus: The Treatment of BV With Naturopathic Medicine

(Special thanks to my dear colleague, Leeza Lapshina, 3an excellent Toronto Naturopathic Doctor-to-be, for providing a thorough naturopathic approach to managing bacterial vaginosis for patients. Her valuable insights and contributions greatly enriched this article. Visit her website: www.thewellnaut.com to learn more about her work.)

Naturopathic medicine shares treatment principles with both allopathic and Chinese medicine, approaching infectious vaginitis in a stepwise manner.

Step 1: Eradication of Pathogenic Organisms: The first step typically focuses on eliminating the pathogenic organism using natural antimicrobial compounds to which the pathogen is sensitive. This approach is similar to allopathic medicine, which aims for specificity in targeting microorganisms.
For bacterial infections (such as BV), commonly used natural antimicrobials include:

• Thyme
• Oregano
• Zataria multiflora
• Tea tree oil
• Garlic

For Candida (yeast infections), effective natural antifungals include:

• Propolis
• Boric acid
• Tea tree oil
• Pau d’Arco

Step 2: Repopulating & Healing the Vaginal Microbiome

Once the pathogen has been addressed, the next phase of naturopathic treatment focuses on restoring balance and reducing inflammation rather than targeting a specific organism. This approach is less specific to the original pathogen and aligns with Chinese medicine principles, which emphasize rebalancing the body and supporting the overall health of tissues rather than simply eradicating an infection.

By introducing probiotics, this step helps repopulate beneficial vaginal flora, restore the natural pH, and create an environment that discourages the overgrowth of harmful bacteria or fungi. Additionally, by reducing inflammation in the vaginal canal, it improves tissue resilience and lowers the risk of recurrence, mirroring the Chinese medicine approach of strengthening the body’s internal balance rather than focusing solely on pathogen elimination.

To further support vaginal health, naturopathic treatments often include dietary and lifestyle changes, such as improving blood flow to tissues through exercise and reducing blood sugar levels to inhibit microbial overgrowth. This is often achieved by adopting appropriate dietary changes. By combining natural antimicrobials, microbiome restoration, and lifestyle changes, naturopathic medicine provides a holistic, integrative approach to vaginal health and infection prevention.

Treatment of non-infectious causes

Naturopathic medicine focuses on addressing the root cause of atrophic and inflammatory vaginitis by restoring hormonal balance, reducing inflammation, and supporting tissue healing. If hormonal imbalance is a factor, treatment may include botanical phytoestrogens (such as flaxseed and red clover), hormone-balancing herbs like chaste tree (Vitex), seed cycling, and dietary modifications to support estrogen metabolism. Immune modulation and Inflammation Management are key goals, achieved through Acupuncture, anti-inflammatory herbs (turmeric, licorice, calendula), probiotics to restore the vaginal microbiome, and a nutrient-rich diet low in processed foods and sugars. Topical applications such as poultices or vaginal suppositories with licorice, calendula, witch hazel, marshmallow root, and coconut oil can help soothe irritation and promote mucosal healing. Additionally, pelvic floor therapy, castor oil packs, and lifestyle changes—such as avoiding synthetic hygiene products and improving circulation through movement—can further support vaginal health and symptom resolution.

4. Chinese Medicine Treatment of Bacterial Vaginosis

Underlying factors – What do Chinese medicine think about BV and Vaginitis in general?

Three common pathological patterns identified in Chinese medicine assessment for BV are blood stagnation, dampness, and heat.

The Blood Stagnation pattern is commonly observed in gynecological conditions, including BV. This is because the female reproductive system is highly complex in structure, and the monthly menstrual cycle makes it more prone to blood circulation issues. Healthy blood circulation is essential in ensuring that cells can perform their functions and prevent bacterial adhesions.

In Kampo Medicine, we use unique assessment methods to determine whether blood circulation dysfunction is involved. You can find detailed information in my other article, ‘Oketsu’

Heat: In Chinese medicine, inflammation is often referred to as heat because the corresponding symptoms include redness, fever, swelling, and pain. While bacterial vaginosis (BV) is often not characterized by noticeable clinical inflammation, research shows a link between BV and inflammatory response at the cellular level, meaning that even though symptoms like redness or swelling might not be present, the body is still mounting an immune response to the altered vaginal microbiota associated with BV; this inflammatory response can potentially contribute to complications like increased risk of sexually transmitted infections (STIs) or pelvic inflammatory disease (PID) if left untreated.

In Traditional Chinese Medicine, Dampness is a pathological condition characterized by stagnation of fluids, heaviness, swelling, and turbidity, often leading to excess discharge, odor, and persistent infections. Bacterial vaginosis (BV), from a TCM perspective, is primarily associated with Dampness accumulation, often combined with Heat and Stagnation, disrupting the body’s natural balance.

An experienced Chinese medicine practitioner conducts a thorough assessment, which includes pulse, tongue, and abdominal examinations. Based on both Western and Eastern clinical presentations, they create a personalized treatment plan using a combination of herbal formulas and/or acupuncture to address the underlying imbalances.

The advantage of Chinese herbal medicine in BV treatment

Many herbs that Chinese medicine uses have both antimicrobial and anti-inflammatory effects. Which largely expands the range of therapeutic EFFECTS compared to Standard Allopathic treatment of antibiotics.

The flexibility of herbal formulas allows Chinese medicine practitioners to proactively use herbs to reduce the risk of BV, increasing susceptibility to conditions such as STIs, PID, and other complications.

Such a complex treatment can be achieved with minimal side effects due to its holistic nature, which not only targets pathological factors but also preserves and restores the body’s normal functions.

How do Chinese medicine practitioners use herbs and acupuncture to treat Vaginitis?

A detailed and proper consultation and assessment form the foundation of a successful treatment. As mentioned earlier, once the practitioner identifies the underlying patterns, they can tailor an herbal formula and acupuncture point selection to effectively address the issue.

For example:

• To resolve dampness, commonly used herbs include Bai Zhu (Atractylodes), Ze Xie (Alisma), and Fu Ling (Poria).
• To clear heat, I often use Huang Bai (Phellodendron), Bai Tou Weng (Pulsatilla), and Huang Qin (Scutellaria).
• To eliminate toxicity, frequently used herbs include Yin Hua (Lonicera), Tu Fu Ling (Smilax), and others.

How do Chinese medicine practitioners use herbs and acupuncture to treat Vaginitis?

As one of the main modalities in Chinese medicine, Acupuncture can help women with vaginitis by improving circulation, reducing inflammation, and regulating immune function. Common points for acupuncturists to use to treat BV and other reproductive conditions are SP9 (Spleen 9), LI11 (Large Intestine 11), and GB34 (Gallbladder 34), among other points according to each individual condition. For example, in Chinese medicine, the genital organs are managed by the Liver, therefore, many points on the Liver meridian, such as Lv3, and Lv 5, are often selected to treat Bacterial Vaginosis.

5. A Case of Bacterial Vaginosis in Toronto by Tcm

Recently, a woman of reproductive age came to me seeking treatment for bacterial vaginosis (BV). This case is still in progress, but we have already seen positive signs shortly after beginning treatment.

BV Patient M: Background and Symptoms

Patient M is a 24-year-old female who has been struggling with BV for the past 18 months. She had undergone multiple rounds of oral antibiotics and was regularly using intravaginal gels to manage her symptoms. Despite continuous treatment, her symptoms remained unchanged, leading to frustration and distress.

Her primary symptoms included:

• Persistent bad vaginal odor. This is the most bothersome symptom because she can smell it all the time, making her feel very uncomfortable while she is at work, going out, and when going to the gym.
• Abnormal discharge (sometimes thick and clumpy, other times loose)
• Vaginal dryness, requiring lubricants to avoid pain during intercourse, which greatly affected her quality of life

Aside from BV, her general health was otherwise good.

TCM Clinical Findings

Upon TCM physical assessment, her pulse and abdominal examination (Fukushin) were negative, and the only positive finding was that her tongue had a white thick coating. Her tongue presentation indicated “dampness”. In Chinese herbology, dampness is the primary cause of a dysregulated microbiome environment. Chinese practitioners don’t have a need to differentiate the location of microbial dysbiosis, be it the vaginal canal or Digestive tract. The treatment principle and the herbs used are mostly the same.

TCM Bacterial Vaginosis Treatment Toronto

Treatment Approach: After a thorough consultation and assessment, I formulated a custom herbal prescription for her to take twice daily. At the same time, I advised her to discontinue both oral and intravaginal antibiotic treatments.

Initial Results: After just one week of taking the herbal formula, all of her symptoms improved simultaneously—something that had not occurred at any point during her year and a half of Western medical treatment. She was hopeful, and both of us were very pleased with her progress.

Additionally, I observed that her tongue coating was noticeably reduced compared to her initial visit, which may indicate an improvement in her bacterial environment.

Below, I will outline the ingredients of the herbal formula, grouped by their primary therapeutic effects.

The Chinese medicine formula that turns BV around in two weeks

One week after the second visit, I received a text message from M, the same one shared at the beginning of this article. Now, I am going to reveal the principles behind the effectiveness of Chinese medicine.

However, I want to emphasize that this herbal formula was specifically designed for Patient M and tailored to her individual condition. It may not be suitable for others, as each person’s body and symptoms require a unique approach. Many of these herbs have potent effects and, if not used correctly, can lead to unintended consequences.

This is not medical advice or a treatment recommendation. I strongly urge anyone considering herbal medicine to consult a qualified healthcare provider or a licensed Chinese medicine practitioner before using any herbal remedies. I am not responsible for any outcomes resulting from the use of this formula without proper professional guidance.

If you choose to use this formula, please do so with caution and under the supervision of a knowledgeable practitioner.

The Bacterial Vaginosis Formula:

• Tu Fu Ling, Jin Yin Hua, Huang Lian (For Toxicity)
• Huang Qin, Huang Lian, Zhi Zi, Huang Bai (For Heat)
• Bai Zhu, Fu Ling, Huang Bai (For Dampness)
• Chai Hu, Dang Gui, Shao Yao, Mu Dan Pi, Chuan Xiong (For Blood)

Unlike synthetic, single-structured drugs, natural herbs contain multiple active compounds, allowing them to exert a broad range of therapeutic effects on the body. While I have grouped them by their primary actions, in reality, their effects blend and interact synergistically within the body.

Chinese medicine has been systematically practiced for thousands of years, leaving us with a vast knowledge base on treating many diseases that humans have faced throughout history. Today, as Western medicine struggles to safely and effectively address chronic illnesses, Chinese medicine can play a valuable role in supporting health and resilience throughout life.

For Patient M, the treatment is still in its early stages, but there is hope that she will fully recover from BV and regain a normal quality of life. This is just one of many cases where I have used Chinese medicine to help patients improve their well-being, enhance resilience, and overcome persistent health challenges.

Conclusion

This article explored vaginitis, with a primary focus on bacterial vaginosis (BV)—the most common form and a condition frequently seen in my practice. BV can be persistent and frustrating, but Traditional Chinese Medicine (TCM) offers a holistic, natural approach that addresses the underlying imbalances contributing to this condition.

If you are struggling with bacterial vaginosis or any other form of vaginitis, I invite you to explore Chinese medicine as a treatment option. Whether you’re in Toronto or anywhere in the world, I provide customized herbal formulas tailored to your individual needs and can arrange international shipping.

For consultations or inquiries, feel free to reach out through my website or contact me directly—I’d be happy to help.