Principles And Treatments Of Chinese Medicine During Pregnancy – part one

By: Keren Zelicha

Treatment during pregnancy evokes numerous feelings for us as acupuncturists.  On the one hand, there is a strong feeling of joy and a desire to support and help the patient who is relying on our skills, but on the other hand, this is accompanied by concerns and dilemmas how to choose the best method of treatment and the clinical approach during pregnancy.  We’re all familiar with the Latin expression, primum non nocere, “First, do no harm.”  Our entire education is based on this principle.  Therefore, this dualism has been with us for years, the excitement and joy of providing help alongside the concern.  But this feeling can fuel the true need to learn, to delve into the subject and gain experience in the field.

I would like to shed some light for all Chinese medicine practitioners and present a two-part article in which I will deal with the period of pregnancy.

In part one we will start from the physiological process in order to understand the energy dynamics and involvement of the organs throughout all three trimesters of pregnancy.  We will continue in part two by looking backwards in time to the period of Zhang Zhong Jing, to the chapter dealing with pregnancy from his book Jin Gui Yao Lue. This chapter will help us analyze a number of central formulas which will clarify us what strategies and clinical approach we should emphasize during our treatment of pregnant women.  This will allow us to get a broad picture of the options available when treating pregnant women.

What happens during pregnancy according to Chinese medicine?

The fetus is created in the uterus after the connection of the essence (Jing) of the man and the woman.  The fetus receives nourishment from the kidney Jing through the Bao Luo channel. Additionally, heart blood nourishes the fetus through the Bao Mai channel or the Chong Mai meridian.  Support for pregnancy and the fetus is carried out through post-natal spleen-stomach qi.  The spleen aids in strengthening and holding the fetus & the uterus. Together with the Ren Mai they support fetal nourishment and growth.  Over the course of pregnancy, spleen deficiency could lead to dampness and to signs of edema in the legs, fluids and tingling in the shoulders and arms. One of the organs needed to maintain the movement and nourishment of the placenta is the liver.  The liver flows through the lower Jiao and influence the genital area.  It is connected to the uterus since it stores blood and is responsible for freeing the movement of the blood toward the endometrial lining and creating the placenta together with Chong Mai.  As the fetus develops, it can interfere the flow of qi within the mother due to the its size, mainly in the second and third trimesters, and lead to liver qi stagnation.  When the qi stagnates, lower back pain, symphysiolysis, varicose veins, or gestational hypertension may appear.

According to Chinese medicine, pregnancy continues for ten months. This idea of development of the pregnancy for ten months appears for the first time in the 2^nd century BCE in the ancient book Huai Nan Zi.  During that period, parallels were drawn between the human being, the cosmos, and the ten stems – orbits of the moon.  During this historical period, the human being was considered the highest form of life, similar to the number ten （ 十）, which represents excellence. The number ten has a high hierarchy since the process of transitioning from the number one to nine are fulfilled within it.  Therefore, ten months of pregnancy corresponds the idea of a perfect process of the evolution of life and man as a super entity in the world.

Chao Yuan Fang and Sun Si Miao, recalled that in each month of pregnancy, a particular meridian or organ must be nourished and is correspondingly forbidden for acupuncture.  Each month is characterized by the control of a particular organ according to the following order: liver, gallbladder, heart, triple warmer, spleen, stomach, lungs, colon, kidneys, and urinary bladder.

The three trimesters of pregnancy according to Chinese Medicine

The first trimester of pregnancy:

During the First Trimester of pregnancy, after conception there is a convergence of blood in the uterus, most of the woman’s qi and the blood flow toward the fetus and nourish it.  Therefore, fatigue and bowel irregularity can be observed.  Additionally, weakness or dizziness could appear since the movement of the blood is inward toward the uterus rather than toward the rest of the body and the digestive system.

The first month represents the stage at which the liver initiates and controls the creation and development of the fetus.  From a western medicine point of view, the first four weeks of embryo development are controlled by the blood:

• The endometrial lining thickens in order to provide nourishment for the fetus.
• The flow and distribution of blood and qi are very important and influence the embryo’s ability to implant and develop.
• Additionally, the quality of the blood is important and is depended on the Tai Yin -Spleen system.

All this emphasizes the liver’s responsibility of releasing blood when needed and keeping a free flow of qi and blood in order to nourish the pregnancy.

In the second month, the gallbladder is characterized by the ability to regulate qi and enable fetal nourishment.  The fourth to the eighth weeks of pregnancy are under the control of qi.  There is a need of qi in order to nourish the fetus and cause blood movement inside the placenta.  This process makes the first heartbeats possible.  The qi and Yang of the body also accumulate in the uterus, therefore, qi does not reach up to the head. This physiological situation could lead to weakness, dizziness, difficulty in concentration and confusion.  A problem in the flow of qi will be characterized by interference with the flow of Chong and a rebelling stomach qi manifesting as nausea.  During these weeks, the middle Jiao has difficulty creating qi, fluids, and blood.  Therefore, in the second month, fatigue and nausea continue.  At this stage, balancing qi and blood is very important and at the same time, we can say that this goal can be reached by balancing the spleen-liver organs.

The third month is controlled by the heart, providing the final element in recognizing the emotions and the connection of the mother and fetus.  This period also completes the entry of the soul into the blood and the establishment of the fetus within the uterus – miscarriages sometimes occur here between weeks 8 and 10, as if the “Shen” has decided not to continue its entry into the world.

The second trimester of pregnancy:

During the Second Trimester of pregnancy, the accumulation of blood in the uterus is released. The basic systems of the fetus have been created and from this stage on, there is hyperplasia – primarily growth and development of the basic systems.  To accomplish this, the trimester is controlled by the stomach, spleen and Triple warmer.  The triple warmer regulates the flow of the three Jiaos within the fetus, allowing distribution of blood, qi and fluids.  The ministerial fire is important here in order to regulate the triple heater’s functions.  Fluids arrive to the kidneys and bladders and the fetus begins to urinate and to create amniotic fluid.  The spleen and stomach allow the muscles of the fetus to grow. The intensity and strength of the spleen-stomach system improves the mother’s vitality so she has less nausea and her quality of life is getting better.

The third trimester of pregnancy:

Towards the Third Trimester of pregnancy, heaviness begins to be felt, the Ren and Dai channels are stretched, and reach their maximum ability to hold the uterus.  Therefore, heaviness or structural problems could appear and influence the movement and circulation of qi, blood, and fluids.  This imbalance between blood, qi, or fluids could lead to gestational diabetes, hypertension, and low or excess amniotic fluid.

From a physiological perspective, the stages of pregnancy and its development are dependent on the relationships between yang and yin, qi and blood.  The spleen and liver organs are both responsible for creating and functioning of these basic elements. Therefore, it is of great importance to maintain their vitality and assess their functionality throughout the three trimesters.

What about the Kidneys during pregnancy?

You are probably wondering why I did not mention the kidneys and their role in pregnancy?

In my humble opinion, the significance of the kidneys is mainly in the area of the essence (Jing) in order to create life and preserve it.  In other words, the kidneys are directly connected to the fetus itself and its quality.  They allow the full accomplishment of the fetus by connecting heavenly qi and earth energy through the physiological intermediary of the mother.  In this way, a perfect fetus can be developed, so that in its future life it can become an independent person, breathing, eating and warming its own Jing and qi.  hence, the kidneys not only influence the fetus in- utero, but also continue to work throughout the person’s life until the very end.

The involvement of the Jing- essence of the kidneys is recalled in the book Zhu Bing Yuan Hou Lun within the context of fetal development in accordance with the months of pregnancy.  The reference to the Jing- essence is mentioned within the first month, the fourth, and the ninth:

The first month of pregnancy is called the beginning of the form. [The woman] must nourish herself with essences and cooked foods…

The essence here refers to the best possible quality of nutrients and food in order to create a foundation for nourishing blood.  A woman needs to preserve a balance between the blood and qi in order to avoid disease later on.  A good quality of essence will allow her to replenish and support blood and essential body fluids for maintaining and feeding the fetus.

In the fourth month of pregnancy, [the fetus] begins to receive the essences of water to form the blood circulation…

The fourth month of pregnancy is controlled by the triple burner. The fetus Zang Fu organs continue their formation and require the Jing- essence of the water in order to form blood circulation.  The triple burner belongs to the Shao-Yang and its ability to distribute Jing- essence depends on the vitality of the ministerial fire. Free passages allow the distribution of qi & Jing- essence to the 5 Zang organs and will support blood creation and circulation.  This is an active action during pregnancy which requires qi and yang.  This period during pregnancy (the fourth month), manifests by a prosperity of qi and blood. Therefore, the triple burner which is responsible for the free passages and the transformation inside the body, must regulate the movement and flow of qi- blood, yin- yang & Jing substances. This way it allows the development of life.

In the ninth month of pregnancy [the fetus] begins to receive the essences of the stone to form the skin and body hair, the six Fu and the one hundred joints all is completed.

In the ninth month, the fetus receives “stone” essence.  The choice of the word stone directs us to a concentrated mineral and the significance of the concentrated Jing- essence. If the Jing- essence is of high quality, it is full of possibilities and is able to flow.  Stone is a visual material which possesses a clear shape, just as in the ninth month, the fetus is already complete.  Its shape is visible to the eye and all its organs are complete. The skin forms the outer border of the body, this is the place of transition between outside and inside. The six fu organs are also a type of transitional place within the body for food. The joints allow movement and transition between body parts.  Not only the overall shape of the body is perfect, but rather, also the transitional regions between internal and external which are necessary for the baby and its ability to move – they are all fully-built and complete.

“Stone” belongs to the kidneys, which are responsible for the ninth month.  The kidneys represent a source of prenatal qi and mystery.  They are expressed at the end of the process of creating the fetus in order to reflect the continuity of the progressive development of life from its hidden mysterious origin to its complete achievement. It is this Jing- stone nature which is related to the kidneys and linked to the continuity and unceasing flowing of life.

Acupuncture preparation for birth- Pre- labor routine

Before birth, the woman requires physical and emotional power and vitality in order to give birth to the fetus.  The closer we get to the time of birth, the more we feel the increase of qi and blood in the pulse.  The pulse strength mainly in the kidney position, increases towards birth. This is a positive and a vital sign that give the birthing woman the strength to head out onto the journey of birth.  Apart from the qi intensity and the physical ability required during the birth process, there is also a need for mental flexibility.  This flexibility depends on the qi circulation and the nourishment of Heart blood in order to calm the “Shen”. It is recommended to have a relaxed and adaptive state of mind in order to overcome all the changes that might occur during labor such as the style of birth.  Additionally, a woman with mental and intellectual stability can more easily converge, focus, relax and get over her fear of birth process.  Thus, the movement and initiation of the birth process will be created out of relaxation and acceptance. The ability to reach the due date will a calm mind, require a strong “earth” an abundant spleen qi that is able to control thoughts, able to support the heart blood and relax the “shen”. The ability to be flexible and not to stay in a pattern of “the ideal way of delivery” requires the liver to release the blood correctly and not to stagnate. If the Lung- metal element will be too strong it will overcome wood and mental or physiological obstruction might occur.

Conclusion:

From this overview of these physiological processes, we learn that the spleen-stomach systems together with the liver system form an important basic anchor during each one of the stages of pregnancy. The communication between wood and earth contribute the balance of the pregnant woman’s health and function.

The interactions between wood and earth are important for correct physiology during pregnancy since they:

1. Form the basis for the production and circulation of qi and blood
2. Influence the implantation of the fetus and its development throughout all trimesters
3. Prevent symptoms of pain, accumulation of fluids and in extreme cases, prevent gestational diabetes or hypertension
4. Influence the woman’s mood before birth. Especially her confidence and mental flexibility needed in order to prepare for childbirth

Bibliography:

1. Pregnancy and gestation in Chinese classical text: Elisabeth Rochat De La Vallee

Related articles:

Principles And Treatments Of Chinese Medicine During Pregnancy – part two

Read more about Acupuncture or acupressure for induction of labor from the Cochrane database here