Birth/Post-Partum With CCM 1

Pregnancy, Birth & Post-partum with Classical Chinese Medicine

www.prodseminars,com 1



Pregnancy, Birth &

Post-partum with

Classical Chinese Medicine

Pregnancy, Birth &

Post-partum with

Classical Chinese Medicine

Genevieve Le GoffGenevieve Le Goff



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Pregnancy, Birth & Post-partum

with classical chinese

medicine



Shaoyin is the Emperor Fire



What you need

1. A solid understanding of classical physiology and classical physiology as it pertains to the peri-natal period

2. a good understanding of the mechanics of birth- not incompatible with classical, as this has been part of midwifery for millennia

3. knowledge of modern obstetrics and significance of diagnosis tests, etc.

4. a good heart

in this class we are doing #1, with #4.



Knowing our role:Midwives: specialists of normal pregnancy, birth and post-partum. Respectful of natural processes

We are pathologists

strength of prevention... must act on pulse

Nei Jing (chapter 2): The sages did not treat those already ill, but treated those not yet ill, they did not put in order what was already in disorder, but put in order what was not yet in disorder... now, when drugs are employed for therapy only after a disease has become fully developed, when restoring order is initiated only after disorder has fully developed, this is as if a well were dug when one is thirsty, and as if weapons were cast when the fight is on. Would this not be too late, too?

but we must restrain ourselves... less CAN be more... but not always.



Pregnancy in Classical TextsYi Zhou Shu "Lost Book of Zhou" (official historical record of the Western Zhou period 1046771 BCE). Earliest anecdotal evidence. Mentions the mother of the first emperor of the Western Zhou dynasty, who refused to look upon adverse colors, hear indecent sounds, or the utterance of any arrogant words, and because of this gave birth to a son who achieved great things.

Mawangdui: Tai Chan Shu (168 BC) - earliest text we have on the subject

10 lunar months development of the fetus and advice on food and lifestyle

Shang Han Za Bing Lun - by Zhang Zhong Jing (150219)

3 chapters on womens health, 2 of which cover pregnancy and post-partum



Wang Shuhe (180-270) - Mai Jing: several chapters on pregnancy.

Xu Zhi Cai Zhu Yue Yang Tai Fang (Xu Zhicais Month-By-Month Formulas for Nurturing the Fetus) - quoted in Sun Simiaos Bei Ji Qian Jin Yao Fang



What is classical?Han dynasty and before

Posterior physicians who followed that model of thought

Wang Shu He (180-270), wrote Pulse Classic Mai JingTao Hong Jing (456-536) ~ arranged and edited Shen Nong Ben Cao Jing and lost Tang Ye Jing

Xu Zhi Cai (493-572) ~ specialized in women and childrens healthSun Simiao (?-682) ~ compiled medical encyclopedia... and more, to Liu Yuan in the late Qing dynasty--> birthed Huai Xuan School via Zheng Qinan.



Based on understanding Yin & Yang, 5 Movements, 6 Conformations

Not Zang-Fu?

Nei Jing associations

emphasis on functional aspects vs. material



A anthropocentric/geocentric perspective



SouthSummer

Fire

NorthWinterWater

EastSpringWood

WestAutumnMetal

CenterEarth

wu xing - 5 Movements: yearly cycles, daily cycles, physiological cycles



HeavenYang

HumanityYang and Yin

EarthYin



Zheng Qinan- True Transmission of Chinese MedicinePrinciples - Scroll 1 (translation Yaron Seidman)

Kan trigram accounts for water, it belongs to Yin and isblood. True Yang resides within it. The middle line is heaven.Heaven one gives birth to water. In the human body it is thekidneys. A tiny bit of true Yang contained between the twoYin. It resides in the realm of Zhi Yin. It is the root and trueseed of human life. Various books call it True Yang.



Tai Yang

Tai Yin

Shao Yin

Shao Yang



Taiyang9am-3pm

Yangming3-9pm

Taiyin9pm-3am

Shaoyin11pm-5am

Jueyin1-9am

Shaoyang3-9am



Conformation Biao (manifestation) Zhong (middle) Ben (root)

Taiyang yang Shaoyin heat Cold

Yangming yang Taiyin damp Dry

Shaoyang yang Jueyin wind Ministerial Fire

Taiyin yin Yangming dry Damp

Shaoyin yin Taiyang cold Heat

Jueyin yin Shaoyang ministerial fire Wind



Taiyang and Shaoyin are both seen as their manifestation and their root. (Yang and Yin, cold and heat)

Shaoyang and Taiyin are seen as their root. (Ministerial fire, Damp)

Yangming and Jueyin are seen as their middle. (Damp, Ministerial fire)



Reaching Yin organs zhi yin: reaching Yin

Yangming

Taiyin

Shaoyin

Nei Jing: Spleen is the ultimate Yin organ

SuWen 6: The 3 yang conduits cannot lose each other.If they beat, but not at the surface, this is called one yang. [...] The 3 yin conduits cannot lose each other. If they beat, but not in the depth, this is called one yin. (Li and Kan trigrams)



:Ming is shining. From moon and window. (Shuowen Jiezi)

Jiong is a window opening onto beautiful bright light. Appearance and form. (Shuowen Jiezi)



Zao (dryness) is gan (dryness).

. Qian: coming out from the top. From yi (2nd heavenly stem). By yi, things reach.



Taiyin Shaoyin Jueyin



Flavors and cosmological

formula alchemy: an overview

Resonant versus functional flavor allocations



Nei Jing Su Wen chapter 22Zang Qi Fa Shi Lun

Discourse on how the qi in the Zang follow the patterns of the seasons

The Liver longs for dispersion;Quickly consume acrid to disperse it.Use acrid to supplement it, sour to drain it.[...]

The Heart longs for softness;Quickly consume salty to soften it.Use salty to supplement it, sweet to drain it.[...]



The Spleen longs for relaxation;Quickly consume sweet to relax it.Usebitter flavor to drain it and sweet to supplement it.[...]

The Lung longs for contraction;Quickly consume sour to contract it.Usesour to supplement it and acrid to drain it.[...]

The Kidney longs for hardness;Quickly consume bitter to harden it.Usebitter to supplement it and salty to drain it.



Su Wen 5:Yin Yang Ying Xiang Da Lun

Qi and flavor:Acrid and sweet are effused and disperse Yang,Sour and bitter cause gushing and outflow and are Yin.



Shen Nong Ben Cao Jing - origins unclear

365 entries, later doubled by Tao Hong Jing (451-536)

3 classes of herbs: superior, middle level, inferior



Tang Ye Jing Fa - Yi Yin Tang Ye originally, quoted in Tao Hong Jings Secret Instructions for Assisting the Body: Essential Methods for the application of drugs to the Zang Fu.

Origins also unclear - earliest mention is in the Book of Han and by Huang Fumi (late Han) in his Huang Di Zhen Jiu jia Yi Jing - but attributed to Yi Yin (1648-1549 BCE), a cooking slave who helped his master Tang of Shang overthrow the Xia dynasty in 1600, so instating the Shang dynasty. He held office at the court until his death. He was famous for his knowledge, political know-how, cultivation, and use of flavors.

Presents formulae in relation to the 5 Movements and directions.

Lists the canon of core herbal methods.

inspired Zhang Zhong Jing as some SHZBL formula are directly from the TYJ.



Tang Ye Jing

All acrid flavor belongs to wood, of which Cinnamon is sovereign, Pepper is fire, Ginger is earth, Xi Xin in metal, Fu Zi is water.

All salty flavor belongs to fire, of which Xuan Fu Hua is sovereign, Da Huang is wood, Ze Xie is earth, Hou Po is metal, Xiao Shi is water.

All sweet flavor belongs to earth, of which Ren Shen is sovereign, Gan Cao is wood, Da Zao is fire, Mai Dong is metal, Fu Ling is water.



[]

All sour flavor belongs to metal, of which Wu Wei Zi is sovereign, Zhi Shi is wood, [Dou] Chi is fire, Shao Yao is earth, Shu Yu [now called Shan Yao] is water.

All bitter flavor belongs to water, of which Di Huang is sovereign, Huang Qin is wood, Huang Lian is Fire, Bai Zhu is earth, Zhu Ye is metal

These 25 flavors become the essence of all medicine, many treat the 5 zang and 6 fu, internal damage and various diseases; a scholar thus accepts [this as] a profound covenant.



Tai Chan Shu Earliest text devoted to this subject - Mawangdui 168BC

beginning Han dynasty, still some malleability in 5 Movements) theory --> use of a 6th element: Stone

text was copied in Ishimpo (Japanese text, 10th century) also quoted in Xu Zhi Cais Month-By-Month Formulas for Nurturing the Fetus (Xu Zhi Cai Zhu Yue Yang Tai Fang ), itself quoted in Sun Simiaos (?-682 AD) Bei Ji Qian Jin Yao Fang .

in this version Xu Zhi Cai added 2 formulae for each month, one for the mother in case of (threatened) miscarriage, and one in case of damage to the fetus - composition reflects what physiology should be.

The 10 lunar months of gestation



Fetal development along the 6 conformations and 5 movements

Describes 10 lunar months of gestation as a microcosm of creation.

This book is about how life cycles, and how different lives cycling intersect one another through procreation.



For us, starts at: Yin and Yang unite = conception. See first month description.

when we count the months, we count from conception, not from the first day of the last menstrual period.

Both mother and babys gestation start at Jueyin, but are on different cycles

Mother is on her own, slower cycle from Shaoyin conception to Taiyang separation at birth

Baby undergoes a whole cycle from Shaoyin conception all the way around the circle back to Shaoyin.



Month 1:The first month of pregnancy is called beginning embryo. [The mother] should eat and drink exquisite and thoroughly cooked things and fancy sour broths. She should be mounted [in sexual intercourse]. She should eat barley, but may not eat rancid or acrid things.This is what is called perfectly correct.

In the 1rst month of pregnancy, the foot jueyin channel nourishes [the fetus]. You must not needle or burn moxa on this channel.The foot jueyin is associated with the liver, which governs the sinews and blood.

[...] In the 1rst month of pregnancy, yin and yang have newly combined to constitute the fetus.

Xu Zhi Cais Month by Month Prescriptions for Nurturing the Fetus/Tai Chan Shu

Translation Sabine Wilms, Ph.D.



Jueyin = Yang within Yin.

Sour flavor moderates outward growth of Wood, which is the ascent of Yang // conversely acrid is prohibited because it does encourage movement up and out.

Yin and Yang have newly combined

importance of sleep (Shaoyin North)

fear/alarm also are emotions which move Qi outward from Center --> loss



Month 2:

The 2nd month of pregnancy is called beginning paste. [The mother] must not eat acrid or foul-smelling food. Her dwellings must be in a quiet location and in the case of a male child, she must avoid taxation. All the myriad joints are painful. This is the fetus beginning to bind.

In the second month of pregnancy, the foot shaoyang vessel nourishes [the fetus]. You must not needle or burn moxa on this channel. The foot shaoyang is associated with the gallbladder, which governs essence.



Shaoyang = yin within yang

acrid flavor still prohibited; alarm also

in shaoyang yang begins its ascent and begins to be utilized to create form... therefore must be preserved so that the childs essence can be as full as possible

a male child uses more Yang than a female child



Month 3:

The 3rd month of pregnancy is called beginning fetus. During this time period, it does not yet have a fixed form and is transformed by [the mothers] seeing things.

[...]

This is what is called internally responding to external images.

In the 3rd month of pregnancy, the hand heart governing vessel nourishes [the fetus], and you should not needle or burn moxa on this channel. The hand heart governor is associated with the heart. Avoid feelings of sorrow and grief, thought and preoccupation, fright and commotion.

In the 3rd month of pregnancy, the shape is being stabilized.



Relationship between heart shaoyin and form (xing)

: Heart: Heart is the human heart, earth storage; in the body it is the center. Appearance and form. Wise men say it accomplishes fire storage. (Shuowen Jiezi)

orifices are our interface with the world; recharge and discharge.



Month 4:

In the 4th month of pregnancy, [the fetus] begins to receive the essence of water and uses it to develop blood and the vessels.

[The pregnant woman] should eat meals of glutinous and non-glutinous rice and should drink broths made from fish and wild goose.

This is what is called making blood and qi exuberant so that they will penetrate in the ears and eyes and flow in the channels and network vessels.[...]

During the 4th month, the childs 6 bowels (fu) [should be allowed to] develop smoothly. the woman must quiet her body, harmonize her heart and will, and moderate her drink and food.



Month 5

In the 5th month of pregnancy, [the fetus] begins to receive the essence of fire and uses it to develop its qi. [...]

In the morning, she must inhale the rays from Heaven in order to avert cold disaster.

[The pregnant woman] should eat meals of glutinous rice and wheat and should drink beef and sheep or goats meat broth, combined with wu zhu yu and balanced in the 5 flavors.

This is what is called nurturing qi to stabilize the 5 viscera.



In the 5th month of pregnancy, the foot taiyin vessel nourishes [the fetus], and you must not needle or burn moxa on this channel. The foot taiyin is associated with the spleen.

During the 5th month, the childs four limbs are all being developed. [...]



Month 6:

In the 6th month of pregnancy, [the fetus] begins to receive the essence of metal and uses it to develop its sinews.

[The pregnant womans] body tends to feel slightly taxed. Do not retreat to quiet places, but roam outside in the wild; often watch running dogs and galloping horses.

[...].

This is what is called forming the interstices and stitching together the sinews to nourish their strength and harden the back and spinal column.



In the 6th month of pregnancy, the foot yangming channel nourishes [the fetus] and you must not needle or burn moxa on this channel. The foot yangming is associated with the stomach and governs mouth and eyes.

During the 6th month, the childs mouth and eyes are developing. Balance the five flavors and eat sweets and delicacies, but do not overeat.



Month 7:

In the 7th month of pregnancy, [the fetus] begins to receive the essence of Wood and uses it to develop its bones.

Tax the body and shake the limbs, do not let it be solid and motionless, move around and bend and stretch, all in order to make the blood and qi flow.

[...]

This is what is called nourishing the bones and hardening the teeth.



In the 7th month of pregnancy, the hand taiyin vessel nourishes [the fetus], and you must not needle or burn moxa on this channel. The hand taiyin is associated with the lung and governs the skin and hair.

During the 7th month, the childs skin and hair are already developed. Do not speak loudly, do not wail or cry, do not wear thin clothes, do not bathe, and do not consume cold drinks.



Month 8:

In the 8th month of pregnancy, [the fetus] begins to receive the essence of earth and uses it to develop the inner and outer layers of the skin.

Harmonize the heart and quiet the breathing, avoid any causes of extreme qi damage.

This is what is called sealing the interstices while enhancing the sheen of the facial complexion.

In the 8th month of pregnancy, the hand yangming vessel nourishes [the fetus], and you must not needle or burn moxa on this channel. the hand yangming is associated with the large intestine and governs the nine orifices. [...]



Month 9:

In the 9th month of pregnancy, [the fetus] begins to receive the essence of stone and uses it to develop its body hair.

Of the six bowels and hundred joints, all are completed and prepared. Allow [the mother] to drink sweet wine and eat sweets, and to loosen her girdle and act aloof. Wait on her.

[...]

In the 9th month of pregnancy, the foot shaoyin vessel nourishes [the fetus] and you must not needle or burn moxa on this channel. The foot shaoyin is associated with the kidney, which controls childbearing. [...]



Month 10:

In the 10th month of pregnancy, the 5 viscera are all completed, the 6 bowels are equally connected, and [the fetus] has absorbed the qi of heaven and earth in the cinnabar field, thereby allowing for the completion of all the joints and the human spirit. it merely awaits the time and then is born.



Beginning embryoBeginning pasteBeginning fetusReceives WaterReceives Fire

Receives MetalReceives WoodReceives EarthReceives Stone



Foot jueyin (liver)Foot shaoyang (gall bladder)Hand heart-governor (heart)Hand shaoyang (san jiao)

Foot taiyin (spleen)Foot yangming (stomach)

Hand taiyin (lung)Hand yangming (large intestine)

Foot shaoyin (kidney)



Wang Shuhe - Mai Jingbook 9, chapter 2

During a womans first month of pregnancy, the fetus is nourished by the foot jueyin vessel. During the second month, it is nourished by the foot shaoyang vessel. During the third month, it is nourished by the hand heart-governor vessel. During the fourth month, it is nourished by the hand shaoyang vessel. During the fifth month, it is nourished by the foot taiyin vessel. During the sixth month, it is nourished by the foot yang ming vessel. During the seventh month, it is nourished by the hand taiyin vessel. During the eighth month, it is nourished by the hand yangming vessel. During the ninth month, it is nourished by the foot shaoyin vessel. During the tenth month, it is nourished by the foot taiyang vessel.



not just rolling!JGYL 20-1: The pulse of a woman is moderate, but he pulse at the cubit is slender and weak. She is also thirsty and has no appetite. No fever or chill is observed. This indicates a pregnancy.

Mai Jing book 9, chap. 1: It is said in the classic that beating yin and distinct yang tells [the mother] carries a baby. This shows harmonious blood and qi and that yang has donated and yin is transforming. On examination, if the hand shaoyin pulse stirs in a big way, pregnancy is determined. The shaoyin is the pulse of the heart. the heart governs the blood vessels. In addition, the kidneys are named the uterine gate and infants door. The pulse in the chi is that of the kidneys. If the pulse in the chi does not expire under pressure, this should indicate a pregnancy. If the pulse remains quite the same in the superficial and deep levels in the three positions, not yielding to pressure, there is pregnancy.

Pulses in pregnancy



Mai Jing book 9, chap.1: In the initial stage of pregnancy, the pulse is slightly small in the cun, beating 5 times for one respiration. In the third month, the pulse is rapid in the chi. If the pulse is slippery and racing but scattered under heavy pressure of the fingers, the fetus in in the third month.If the pulse is not scattered under heavy pressure of the fingers and it is racing but not slippery, the fetus is in its fifth month. When a woman is in the fourth month of pregnancy, the method of determining the sex is that a racing pulse on the left hand tells a male, while a racing pulse on the right tells a female. If the pulse is racing on both hands, this tells that two babies will be born.



our archenemy: the weak pulse!!!Mai Jing, book 9, chap.2: In the seventh month of pregnancy, if the woman has a replete, large, firm, and strong pulse, this shows life. If she has a deep, thin pulse, this shows death. In the eighth month of pregnancy, if the woman has a replete, large, firm, strong, bowstring, and tight pulse, this shows life. If she has a deep and thin pulse, this shows death.



Pathology



MiscarriageHabitual: best is prevention - strengthen the Root before pregnancy

Shaoyin/Jueyin usually must be strengthened

diet

lifestyle

emotions



Threatened or in process

Jueyin blood dryness or insufficiency:

some of the treatment are the same. This is because the root of the disorder is the same

example: Gui Zhi Fu Ling Wan is used both to prevent and complete miscarriage.



JGYL 20-2: A woman who originally suffered from zheng disease ceases menstruating for a period of less than 3 months, but continues to suffer from mild chronic vaginal discharges. [...] In cases where menstruation ceases for 3 months and is followed by mild chronic bloody vaginal discharge, blood stasis will result. Bloody discharge does not cease because zheng has not yet subsided. Stasis should be removed with GZFLW.

only prevents miscarriage if history of mass; otherwise helps complete.

Caution: Do not use to induce labor as it can cause excessive bleeding!

Guizhi Fuling Wan:Gui ZhiFu LingMu Dan PiTao RenFu Ling



Xiong Gui Jiao Ai Tang:

JGYL 20-4: XGJAT can be prescribed in the following cases: mild chronic bloody vaginal discharge; mild chronic bloody vaginal discharge after miscarriage, and mild chronic bloody vaginal discharge with abdominal pain resulting from retarded growth of the fetus.

emphasis is more on nourishing the blood and warming jueyin; resolves blood stasis by push and pull approach.

Chuan Xiong 6gZhi Gan Cao 6gAi Ye 9gDang Gui 9gBai Shao 12gSheng Di Huang 18gE Jiao 6g



Shaoyin insufficiency:

common in long term fertility patients - may need to continue Si Ni Fa into the beginning of pregnancy - only do this if you are properly trained to do so! and if you have pure, steamed fu zi.

JGYL 20-3: During the 6th and 7th month of pregnancy, the patient has fever and the pulse is tight. The abdomen is distended, and this becomes aggravated. She has abdominal pains and a feeling of cold, as if the abdomen were being fanned. [ note: in fukushin a cold abdomen is a fu zi indication ] This indicates the opening of the uterus. Fu Zi Tang should be adopted to warm the uterus.

Fu Zi TangFu Zi 2 pieces (60g)Fu Ling 9gBai Shao 9gBai Zhu 12gRen Shen 6g (Dang Shen)



Mai Jing, book 9, chapter 2: In the 6th or 7th month of pregnancy, the woman may have a tight pulse, suffering from fever, the fetus out-reaching in the abdomen, and abdominal pain and aversion to cold. This cold is as if the lower abdomen were being fanned. What accounts for this is the opening of the uterus. It is necessary to warm the uterus with Fu Zi Tang.

ONLY FOR EMERGENCIES

ONLY IF YOU ARE VERY FAMILIAR WITH THE USE OF FU ZI METHOD

ONLY IF YOU HAVE GOOD FU ZI ( PURE STEAMED)

ONLY SHORT TERM (1 dose)



Shaoyang problem:

JGYL 20-5: Dang Gui Shao Yao San can be prescribed for pregnant women with chronic abdominal pain and contractions.

Contractions are shaoyang (alternating). Ministerial Fire is manifesting as Shaoyang symptoms in Jueyin uterus.

Both Shaoyang and Jueyin manifest through Ministerial Fire (root of Shaoyang and center of Jueyin)

Dang Gui Shao Yao SanDang Gui 9gBai Shao 48gFu Ling 12gBai Zhu 12gZe Xie 24gGrind into powder and take 1 fangcunbi with wine, 3 times per day.



SNBCJ: Shao Yao is bitter. It mainly treats evil qi and abdominal pain, eliminates blood impediment, breaks hard gatherings and cold and heat mounting conglomerations, relieves pain, disinhibits urination, and boosts the qi. It grows in rivers and valleys.

Bai Shao restrains wood and relaxes it so the muscles of the uterus (Earth) can relax)

SNBCJ: Ze Xie is sweet and cold. It mainly treats wind, cold damp impediment and difficult lactation. It disperses water, nourishes the 5 zang, boosts the qi and strength, and makes one fat and strong. Protracted taking may sharpen the ears and eyes, make one free from hunger, prolong life, make the body light, render the face brilliant, and enable one to walk over water.



Usually rooted in deficiency (excess is rare in pregnancy) -->nausea usually better after eating, worse before breakfast when stomach is empty.

Spleen-friendly diet: small, frequent meals, warm.

JGYL 20-6: A pregnant woman is suffering from repeated nausea and vomiting. Ganjiang Renshen Banxia Wan can be adopted.

Sheng Jiang is what makes Ban Xia safe - never do without it!

Morning sickness

Gan Jiang Ren Shen Ban Xia WanGan Jiang 3gRen Shen 3g (Dang Shen)Ban Xia 6gPound the herbs into a powder and mix with fresh ginger juice. Form pills the size of firmiana seeds. Take 10 pills, 3 times per day.



Can also use Xiao Ban Xia Tang ( Ban Xia 12g, Sheng Jiang 24g) for short term if more severe... Xiao Ban Xia jia Fu Ling Tang if accompanied by dizziness.

Very severe: can do Da Ban Xia Tang ( Ban Xia 24g, Honey 12g, Ren Shen 9g) for the short term, but MUST add Sheng Jiang (and reduce Ban Xia).

because this is often rooted in deficiency it is good to use a nourishing formula as well.

Gui Zhi Tang, Xiao Jian Zhong Tang, Huang Qi Jian Zhong Tang, Dang Gui Huang Qi Jian Zhong Tang...

if cold in the area of Ren 12, or loose stools... Li Zhong Wan.



TYJ: Xiao Bu Pi Tang (Minor spleen supplementing decoction) ~ Formula that treats non-transformation of food, occasional spontaneous vomiting or diarrhea, incessant vomiting and diarrhea, and suffering from hunger in the heart [region]. There may be glomus below the heart, the pulse in faint and forceless, there is generalized heaviness, wilting of the legs, and frequent cramps.

Prevention lies in a harmonious physiology

RenshenZhi Gan CaoGan Jiang

each 3 liangBai Zhu

1 liang



JGYL 20-1: The pulse of a woman is moderate, but the pulse at the chi is slender and weak. She is also thirsty and has no appetite. No fever or chill is observed. This indicates a pregnancy. Gui Zhi Tang can be adopted.[...] In case of improper treatment, syndrome will appear with complications of vomiting and diarrhea at the end of the first month. At this point, Gui Zhi Tang is no longer appropriate.



originates in the right side of the circle, even where blood is deficient...

is (mouth) yangming orifice with l going through it = ability to absorb life

Usually a Jian Zhong Tang family formula: construct the middle, the . Can use safely throughout pregnancy. Benign.

NO Fu Zi method during pregnancy unless emergency and no other recourse. other methods can treat shaoyin water if needed (see treatment of edema, pre-eclampsia)

Fatigue/Xu lao bing



Xiao Jian Zhong Tang

Gui Zhi 9gBai Shao 18gSheng Jiang 9gDa Zao 12 piecesZhi Gan Cao 6gYi Tang 12g

Huang Qi Jian Zhong Tang

Gui Zhi 9gBai Shao 18gSheng Jiang 9gDa Zao 12 piecesZhi Gan Cao 6gYi Tang 12gHuang Qi 4.5g

Dang Gui Jian Zhong Tang

Gui Zhi 9gBai Shao 18gSheng Jiang 9gDa Zao 12 piecesZhi Gan Cao 6gYi Tang 12gDang Gui 6g



Cold damage/ Gan MaoCold is not just an external influence, but also equates to North, and Shaoyin.

A Taiyang injury affects Shaoyin and prevents the whole physiological cycle from happening

Must support the root (original SHL Gui Zhi Tang and Ma Huang Tang contained Fu Zi... use the IDEA... dont repeat the recipe blindly but think and adapt!)Gui Zhi Tang fine, jia Hou Po/Xing Ren fine too if needed short termXiao Chai Hu tang fine

Safety is TIMELINESS and DOSAGE. (How many degrees am I shifting?)



OligohydramniosFluids are not enough--> must increase rain, condensing power of Metal.

Use sour+ sweet to generate fluids

Have Mom drink a lot of lukewarm fluids, broths, etc...

leads to and presents with concurrent jueyin blood deficiency or dryness... must be treated too ( E Jiao, Sheng Di, etc...) as is associated with poor nourishment of fetus.

Sheng Mai San

Wu Wei Zi 24gMai Men Dong 24gRen Shen 12g (Dang Shen)



TYJ: Da Bu Pi Tang ( Major Spleen Supplementing formula) ~ Formula that treats great exhaustion of spleen qi, [characterized by] non-transformation of food, retching, vomiting, and diarrhea. The patient is desiccated and emaciated like brushwood, unable to move and turn when standing up, has a bitter and dry mouth, is thirsty, sweats, breathes rapidly, and the pulse is faint or occasionally faint.

Ren ShenZhi Gan Cao each 1 liangGan Jiang 3 liangBai ZhuMai Men DongWu Wei ZiXuan Fu Hua

(one prescription writes Mu Dan Pi, it is suitable to follow this; each 1 liang)

Use 1 dou of water and boil these 7 flavors down to 4 sheng. Take warm in 4 doses, 3 during the day and 1 at night.



Polyhydramnios

Baby has too much water to float in - danger of cord entanglement, malpresentation, cord compression/prolapse during birth

Fluid metabolism problem

was there a cold injury, leading to Wu Ling San condition?if not (most likely), Taiyin/Shaoyin problem --> must use Bai Zhu/Fu Ling method (Zhen Wu Tang not appropriate because of pregnancy... use gentle, long term)



Ren Shen Tang plus Fu Ling

Ren Shen Gan JiangBai ZhuZhi Gan CaoFu Ling

Li Yu Tang (Bei Ji Qian Jin Yao Fang)

Li Yu (carp) 96gBai Zhu 15gSheng Jiang 9gBai Shao 9gDang Gui 9gFu Ling 12g

JGYL 20-8: A pregnant woman is suffering fluid retention syndrome with symptoms of heaviness of movement, dysuria, aversion to cold and vertigo which is aggravated when the patient stands up. In such cases, Kui Zi Tang can be prescribed.

Kui Zi TangKui Zi 48gFu Ling 9g



Failure to thrive

Look for reasons:

Diet insufficient? sleep? rest? think of this first!!!

Yangming/taiyin function insufficient?

Root/Shaoyin problem?

Jueyin dryness or placental insufficiency?



Taiyin/ Shaoyin problem: in pregnancy the treatment is the same as we cant use Si Ni Fa: XJZT, HQ/DGJZT, LZW etc...

Jueyin: can be a problem with the richness of blood, or its viscosity/dryness... these are very close.

must support the right side of the circle as above, to support the production of blood...

must also gently reliquify blood (NO harsh blood movers which are completely contraindicated!) ( chuan xiong, dang gui, bai shao, with a lot of caution wu zhu yu, xi xin etc..) - must balance out this outward movement with...

moisturizing herbs that restrain the movement of Jueyin (e jiao, sheng di huang, da zao...)



filtration problem

in addition to standard treatment of jueyin, must use acrid herbs to penetrate through: wu zhu yu, xi xin, chuan xiong, ze xie, mu tong WJT modifications, DGSNT modifications... most of them controversial and poisonous... only use as last resort with informed consent of all parties.

often with intractable jueyin cold.case study: twins, one with an inadequate placenta stopped growing.

Placental insufficiency



Other placental problemsPlacental Previa:

Root is not strong enough

HQJZT early on

Subchorionic bleeding

LZW/RST

XGJAT

etc.



late pregnancy



Fatigue

Common right before birth

9th lunar month: fetus is nourished by Shaoyin kidney. Xu Zhi Cais formula contains FZ

Must rest a lot

Worst possible prognosis for birth is a weak pulse - it takes a lot of energy to make contractions to birth the baby and to stop the bleeding after the placenta has been expelled.



Pre-eclampsia

DX:

High blood pressure

Edema

Proteinuria

Headache

Nausea



Edema/Proteinuria: Shaoyin Water metabolism problem

Dizziness/ redness of face maybe: NOT excess... NOT Yin Xu... this is Yang Xu with Yin galloping upward with the Yang that has lost its root ( Zheng Qinan case study)

Normally in this situation we would use Zhen Wu Tang or a similar formula... but here we cant because of the pregnancy (although Xu Zhi Cai recommends this type of method)

we can use Ling Gui Zhu Gan Tang and/or the Xuan Fu Hua method... but first a bit of background on this...



Zheng Qinan (translation Yaron Seidman): True Yang appear under the following names: minister fire, gate of life fire, dragons thunder fire, rootless fire, Yin fire and empty fire. When it is diseased it comes under the following descriptions: Yuan (original) Qi does not receive, original Yang scatters outwards, true fire ascends upwards, Kidney Qi does not receive, Qi does not return to its origin, solitary Yang surface upwards, empty fire rushes upwards etc all sorts of names all describing the one Yang in the middle of Kan trigram. The origin of this one Yang has transformed from the pre-heaven of Qian metal. Therefore it has the name dragon. One Yang lands in the midst of the two Yin and transform into water. It establishes the extreme range of water (Yang is then the root of water).



Water quality is to flow downward, and this is Kans fixed position in the post-heaven arrangement. It is an unchangeable principle. One should know that the dragon at this time is the new born dragon (dragon means the one Yang in the middle of Kan). It is unable to soar to excite the clouds and scatter the rain. It can only dive into the abyss where water becomes its residence. With waters nature it succeeds in becoming peaceful in this lower position and it bows its head underneath. With diseases where, for example, empty fire rushes upwards, it clearly binds with the surging water (water is Yin). If the water surges one fraction, the dragon surges as well one fraction (dragon is fire). If the water is higher one foot then the dragon is higher one foot as well. The dragon is roaming because the water is surging. It is not that the dragon fails to dive and acts contrary to its normal state.



Therefore the classic states: When the Yin surges the Yang must decline. One can realize that by the application of medicinals one must support the Yang and restrain the Yin. And so as soon as the town doctor see an empty fire rushes upwards, he doesnt even inspect the vital why and wherefore. He opens his mouth and say nourish the Yin and descend fire. He self proclaims to have grasped the problem and not even think of the principle where when Yin surges (Yin surges means that kidney water is exuberant) Yang is deficient (Yang deficient means that the emperor fire is weak). And so he doesnt support the Yang and to the contrary nourish the Yin even more. It is truly not less then adding frost to a snowfield. Isnt this the common hand of medicine? Whenever I see a disease such as empty fire rushes upwards where the patient loves to drink warm liquids and cant stomach anything cold, it is self evident that nourishing the Yin is a mistake.



Also when I say that cinnamon and aconite cause the fire to return to its origin, no one knows the meaning of it. They dont know that cinnamon, aconite and dry ginger are a pure ball of raging fire. When fire is vigorous then Yin disappears on its own. It is like the strong sun that scatters the clouds until they disappear. Moreover the power of cinnamon and aconite can supplement the Yang in Kan and Li.Their character is extremely upright and unyielding. They can erase completely the Yin Qi that overstepped its authority. When Yin Qi is completely erased[7] then the great space opens up a wide corridor. Above and below establish peace naturally and without unilateral flourishing. How can this not be seen as truly leading fire back into its origin! All through history commentators didnt search out the reality under the surface where one Yang is being submerged in the water. This caused later students ignorance with having nothing to depend on. Countless people died under nourishing Yin and descending fire. Truly it is a corrupt practice through the ages and a great regret to the school of medicine.



Fire herb of the Fire class in the TYJFlower has levity, parallels the acridity of FZ - yet has downward directionalitySBCJ: XFH is sweet and warm. it boosts Qi and removes black patches from the face, thus rendering the facial complexion attractive.

Xuan Fu Hua



Ling Gui Zhu Gan Tang:Fu Ling 12gBai Zhu 6gGui Zhi 9gZhi Gan Cao 9g

(+ Xuan Fu Hua 9g)

Fu Ling Xuan Fu Hua Tang (Sun Simiao):Fu Ling 12gBai Zhu 12gHuang Qin 9gXuan Fu Hua 6gXing Ren 9g

Differential diagnosis:For Yin overtaking Yang: LGZGT + XFHYin galloping upward with Yang (ministerial Fire lost its root AND Yin has overtaken Yang): FLXFHTThis can eliminate proteinuria, curb high blood pressure and buy more time for babys development. The mother MUST be closely monitored by midwife or MD.

Edema can be treated this way as well. Always remember edema is a sign of Shaoyin/Taiyin weakness, and treat accordingly to prolong life!



Su Wen 18: When the face is swollen, that is called wind. When the feet and shins are swollen, that is called water.



Malpresentation of the fetus

NOT pathological until 35 weeks (Western medicine count)!Babies can move freely in the water until week 35; then they get too big and dont have enough room to do so.

Most babies go head down spontaneously by that time.

Mawangdui text: this time (35wks Western= 33wks CCM, 4 wks per lunar month) corresponds to the element of Stone , and Shaoyin kidney, which comes right after the element of Metal (Yangming large intestine)Presentation is a function of yangs ability to submerge into Yin, downward directionality.

UB 67 Zhi Yin Reaching Yin



What conditions are we looking for for an easy, timely birth?

If a woman has cycled on time with nature and the pulse is harmonious, the birth should be on time.

Labor belongs to Shaoyang (alternating contractions). Before labor and during, the pulse should be wiry... its a sign that Jueyin uterus is being affected by its center Ministerial Fire.

DO NOT SUPPRESS the wiriness of the pulse

Again our archenemy is the weak pulse ( post-dates, hemorrhage...)... if we are in a Yin conformation there is not enough yang to manifest Shaoyang alternance of contractions.

Wood: strong, steady, gentle growth. If there is strong emotional distress, maybe relax and slow down Wood so the mother doesnt waste her Yang by discharging emotions... Otherwise, leave it be and STRENGTHEN THE ROOT.



Easiest position is LOA: Left Occiput Anterior



Post dates/overdue labor

Think of the Tai Ji circle and what might weaken the Root, or obstruct the return of the Yang to Yin.

Yangming not descending: easy... just unblock the Yangming/Jueyin axisconstipation, nausea, etc...

Da Huang, Hou Po, Zhi Zhi... much better than castor oil



Weak pulse: difficult... must play a game with time, strengthen as quickly as possible (rest, herbs), then if nothing happens try purging if the stools are solid (emergency medicine). NOTES:

purging will NOT work if the stools are loose already... Yangming is already too open and this would only further exhaust the mother.

beware of Blue Cohosh (speeds up BPM in mother and baby)beware of blood movers... they may start labor but you may have a hemorrhage on your hands during delivery



Wang Shuhe, Mai Jing book9, chapter 2: For a pregnant woman, it is appropriate to take Dang Gui San since this will bring to pass a smooth delivery without any trouble.



Stalled laborThe principles are the same as for labor induction. Tell the midwives to call you early on, as exhaustion and the weakening of the pulse are determining factors.

If there is time cook herbs right away, put them on the stove before you needle.

Must be diligent and wiling to stay a long time, in odd places and positions, and keep stimulating by hand/heart. Keep your sense of humor.

Sp.6 goes to the uterine muscles. Needles in Sp. 6 get very tight and hard to stimulate starting just before and during contractions. This way you can tell if a contraction is coming even before the monitor can!

... if tofu needle on Sp. 6... bad prognosis: need more Qi/Yang... if the midwifes timeline allows safety-wise, have the woman rest and then try again.

U.B. 60 goes to the cervix and helps it open

If upward Qi counterflow: St.44, G.B. 21, L.I. 4, Liv. 3, G.B. 42...



Leave when the contractions are regular for at least 30 minutes...

Do not overstay your welcome (chances are you are not part of their birth plan...)Do your work, then retire Lao Zi

Retained placenta: same treatment principles.



A is born!



Out of our scope of practice and our ability for the most part.

BEST IS PREVENTION by making the Root strong before and during the pregnancy.

This is a function of the strength of uterine contractions (see picture). Pitocin, methergine injection immediately; nursing/ nipple stimulationif had to, could do Si Ni Tang (FZ unification warm root, GJ stop bleeding)

Bleeding can also be caused by an incomplete placenta (midwifes job)For chronic bleeding after birth we need to treat Jueyin as well.

Post-partum hemorrhage



This is how bleeding stops after birth... strong contractions take energy--> we need strong Yang!



A very healthy placenta!



post-partum



Expelling lochia (old, dry blood)

can prevent many menstrual and menopausal problems (dysmenorrhea, hot flashes...)

Establishing plentiful lactation

a function of plentiful blood

Recovering

tied to the above two points: must eliminate stasis and engender new Blood.



Sun Simiao, BJQJYF Volume 3, chapter 1 (translation Sabine Wilms)

In all cases, it is not only during delivery that women must worry. When they arrive at the postpartum stage, they must exercise particular caution. This is where the greatest threat to their lives is found. [...] At the time of violation [of prohibitions], [the disease] might be as tiny as autumn down. But the contracted illness will be larger than Mt. Song or Mt. Dai.

Why is this so? Post-partum illnesses are more difficult to treat than others. After women have completed a delivery, their 5 zang suffer from vacuity emaciation. You may only use supporting and supplementing and must not use shifting and draining.

[...] if a violation has occurred, it is inevitable that her body will become rigid and arched backwards, resembling opisthotonos. this condition is called childbed wind.



For students of this text, it is of utmost importance that you familiarize yourselves with this [section of] prescriptions thoroughly. You must not equate these with ordinary prescriptions! It is particularly prohibited to use the privy to empty her bowels. She should do it inside on a chamber pot.

In all cases, she may only engage in sexual intercourse after the full 100 days are over. otherwise, [she will suffer from] vacuity detriment for the rest of her life and the myriad illnesses will flourish and grow. Beware of this!

In all cases, whenever women suffer from wind qi and vacuity cold below the navel, there is no other reason for this than she has engaged in sexual intercourse too soon.



In all cases, for the duration of the first 7 days after delivery, the malign blood is not yet eliminated completely and she may not take any decoctions. Wait until the lumps below her navel have dissipated and only then introduce Sheep or Goats Meat Decoction.

In cases of severe and sharp pain, this rule does not apply. After the vicissitudes of the first 2 or 3 days, she may take Ze Lan Wan. It is excellent if she waits until the end of the month before she stops taking the pills. Otherwise, she will not be able to recover from vacuity detriment.

In cases of extreme emaciation that she is unable to recover from, she should take Wu Shi Ze Lan Wan [lost].

In all cases, women absolutely must take Ze Lan Wan during the lying-in period as a supplement. As for taking it, as a rule it must be outside the first 7 days. They may not take it earlier!



Ze Lan Tang: (BJQJYF Volume 3, chapter 5)

Ze Lan 6gDang Gui 6gSheng Di Huang 6gGan Cao 4.5gSheng Jiang 9gShao Yao 3gDa Zao 10 pieces

SNBCJ: Ze Lan (Herba Lycopi) is sour. It is nontoxic, treating mainly breast-feeding women, nosebleed, illnesses following wind stroke, enlarged abdomen with water swelling, puffy swelling of the trunk, face, and limbs, water inside the bone joints, incised wounds, welling abscesses and swellings, sores, and suppuration. Its other name is Hu Lan (Tiger Orchid). Another name is Long Zao (Dragon Date). It grows by the side of pools.



JGYL 21-1:

Question: Convulsive disease, syncope and constipation are the 3 principal postpartum diseases. Can the Master explain them?

Master: After delivery, a woman will suffer blood deficiency. She will perspire a lot and is therefore easily affected by pathogenic wind. Convulsive disease is a common ailment. Loss of blood and perspiration will allow in the pathogenic cold, resulting in syncope. Loss of body fluid will bring dryness, eventually resulting in constipation. Symptoms and signs of syncope in women after delivery include weak pulse, nausea and anorexia, constipation, sweat appearing only on the forehead. Pathology of the syndrome results from deficiency in the blood. Before the syncope subsides, profuse perspiration will appear. When the blood is deficient, coldness in the extremities will occur and the solitary Yang will ascend, causing perspiration. This will bring the Yin and Yang into harmony. Syndrome of constipation, nausea and anorexia can be treated with Xiao Chai Hu Tang.



Wang Shuhe, Mai Jing Book 9, chapter 3 (quoting JGYL 21-7): If a woman is hit by wind during labor, (wind evils) may remain unresolved for tens of days, giving rise to slight headache, aversion to cold, occasional fever, tightness below the heart, dry retching, and (spontaneous) sweating. Even though (the disease) has persisted for a long time, so long as the manifestations indicating Yang Dan (Dawn the Yang) stay, one may administer Yang Dan tang. This formula is contained in the Shang Han Lun. Yang Dan is nothing but Gui Zhi Tang (Cinnamon Twig Decoction).



JGYL 21-2: After the syndrome [wind strike] subsides, the patient has a good appetite. 7 or 8 days later, fever recurs. This is a case of stomach excess. Da Cheng Qi Tang should be adopted.

JGYL 21-3: Postpartum chronic abdominal pain and contraction can be treated with Dang Gui Sheng Jiang Yang Rou Tang. This decoction is also effective for abdominal pain caused by cold and consumptive diseases.

Dang Gui Sheng Jiang Yang Rou Tang:Dang Gui 9gSheng Jiang 15gMutton 48g



JGYL 21-4: Zhi Shi Shai Yao San can be adopted in cases of postpartum abdominal pain with restlessness and a sensation of fullness that makes it difficult for the patient to lie quietly in bed.

JGYL 21-5: Postpartum pain should be treated with Zhi Shi Shao Yao San. If the syndrome does not subside, it is a case caused by blood stasis in the region below the umbilicus. Xia Yu Xue Tang should be adopted. This formula is also effective for treating menstrual disorders.

Zhi Shi Shao Yao San:Zhi ShiShao YaoGrind equal amounts into powder. take 1 fangcunbi per dose 3 times per day. [...] Medicine should be taken together with barley porridge

Xia Yu Xue Tang:Da Huang 6gTao Ren 20 piecesTu Bie Chong 20 pieces



JGYL Chapter 21 appendix: Neibu Dang Gui Jian Zhong Tang is effective in treating post-partum weakness and deficiency accompanied by acute pain in the abdomen and dyspnea, dragging pain in the waist and back, and anorexia. In the first month after delivery, 4 or 5 doses will help restore the patients health. {...} if the patient is extremely weak, add 6 liang (18g) Yi Tang. {...} If the patient has suffered a great loss of blood, add 18g Di Huang and 6g E Jiao, the latter being added when the decoction is prepared. If Dang Gui is not available, Chuan Xiong can be used, and Sheng Jiang can be replaced by Gan Jiang.

Neibu Dang Gui Jian Zhong Tang:Dang Gui 12gGui Zhi 9gBai Shao 18gSheng Jiang 9gDa Zao 12 piecesZhi Gan Cao 6g



Jueyin/YangMing axis: Jueyin nipple/blood to babys Yangming orifice, perpetuating life!

If the blood is not dry and is abundant there will be an abundance of milk too. Therefore the things we just mentioned are first and foremost.If the milk flow is however obstructed, it needs to be freed with acrid or moving herbs: tong cao, xi xin, dang gui...

all classical texts include herbs that counter Yangming dryness (if there is dryness the blood cannot flow): gua lou gen (=tian hua fen), mai men dong, lou lu, lu gen, dan zhu ye...

shi zhong ru (stalactite - stone that brings together milk/breast) -shaped like a dripping breast.

Lactation:



Shi Zhong Ru Tang: (BJQJYF volume 2, chapter 9)Shi Zhong Ru 6 zhuBai Shi Zhi (kaolin) 6 zhuTong Cao 12 zhuJie Geng o.5 liangXiao Shi (niter) 6g

Mai Men Dong San (BJQJYF volume 2, chapter 9)Mai Men Dong Shi Zhong RuTong CaoLi Shi (fibrous gypsum)Dang Gui Si Ni Tang (SHL- Jueyin chapter)Gui Zhi 9gDang gui 9gBai Shao 9gXi Xin 6gZhi Gan Cao 6gDa Zao 25 piecesMu Tong/Tong Cao 6g



Formula for absence of breast milk, BJQJYF volume 2, chapter 9:Shi Zhong Ru 12gGan Cao 6gLou Lu 9gTong Cao 15gGua Lou Gen 15g

Regulating the Jueyin/Yangming axis in the mother can help colic in a newborn.

Case study: Difficult lactation, cold blanched nipples, colicky baby with vry cold abdomen: DGSNT



Su Wen 13:Qi Bo: The utmost principle in treatment lies with the oneness.Huang Di: What is that to say, the oneness?Qi Bo: There is oneness, and therefore one gets it.Huang Di: How?Qi Bo: Close the doors and shut the windows,tie yourself to the patient,

repeatedly inquire about [her] feelings,adapt to her sentiments.

If one gets a hold of the spirit,the [patient] will prosper;if the spirit is lost,[the patient] perishes.

Huang Di: Good!



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Birth/Post-Partum With CCM 1