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Acupuncture Today
January, 2007, Vol. 08, Issue 01
 
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A Clinical Approach to Preventing Miscarriage

By Gary Wagman, LAc

The monthly cycle is the body's reflection of the ebb and flow of yin and yang. Yin dominates the first half of the cycle and yang dominates the second half. Yin represents the luteal or estrogen-controlled phase of the monthly cycle, while yang represents the follicle or progesterone-controlled phase.

Miscarriage is a result of an imbalance between yin and yang. If this imbalance is addressed before pregnancy, the chances of having a healthy fetus are much higher. Regulating the menstrual cycle will not only help prevent miscarriage, as the menstrual cycle is a direct reflection of a woman's health. Regulating the menstrual cycle also can help promote a woman's general well-being. This article will attempt to provide general insight into the treatment of miscarriage, both before and after pregnancy begins.

In order to effectively determine the ebb and flow of yin and yang during the cycle, the basal body temperature (BBT) should be taken daily for a period of one month. This method is a very efficient diagnostic technique that easily can coincide with traditional Oriental medical diagnosis. For example, if the body temperature during ovulation does not rise significantly, there may be a yin (cold) excess manifestation. Depending on the individual's situation, treatment can be carried out in various ways. In this case, yin excess could be a result of blockage or dampness. Chances are that higher than normal blood estrogen levels will be present. Factors such as ovarian cyst, endometriosis or fibroid obstruction should be ruled out. Treatment should be based on assisting the body's yang function by using warm and/or blood-activating herbs. If ovulation occurs before day 12 of the cycle and there is elevated body temperature, yin-tonifying, heat-clearing and/or blood-nourishing herbs can be prescribed. The need for such treatment is based on the concept that yang excess causes the cycle to shorten due to internal body heat.

As mentioned before, miscarriage might be a result of internal yin or yang imbalance. This imbalance might be due to inherent or acquired physical or spiritual tendencies. Anger during pregnancy, for example, gives rise to internal heat. This can be compared to heavy wind that shakes and blows the branches off of a tree. When miscarriage is a result of deficiency, it can be compared to the drying up of a tree branch, which causes the young sprouts to fall (yin deficiency/yang excess). A cycle affected by a yin excess condition can be compared to overwatering a plant, causing it to rot away (yin excess/yang deficiency).

The second month of pregnancy is marked by the initiation of the "xiang hua" (abundant fire) stage. During this state of pregnancy, miscarriage most frequently occurs. Qin zhu tang (Scutelleriae and Actractylodis decoction) is an efficient remedy for miscarriage that habitually occurs around this time. This formula, which combines huang qin 12 g (Scutellariae radix) and bai zhu 6 g (Actractylodis macrocephalae radix), helps prevent miscarriage due to excess yang heat. It also helps calm the fetus and reduce heat, swelling and dampness, even when threatened miscarriage is not apparent. Heat during pregnancy most likely is to be a direct result of dampness accumulation due to spleen qi deficiency. This is a condition that commonly occurs from the beginning stages of pregnancy due to excess taxation of the digestive system. This situation often is accompanied by deficiency of yin and blood. If there is concurrent yin and blood deficiency, ba wei tang (eight-ingredient pill) can be added to the above prescription.

Bleeding during pregnancy also might indicate possible future miscarriage. The two types of pregnancy bleeding are tai dong (excess fetal movement) and tai ru (fetal leakage). Tai ru refers to the symptom of vaginal bleeding in small and sporadic amounts during pregnancy. Heat accumulation and qi deficiency are both causes for this condition. Tai ru also might be a result of excess sexual intercourse during pregnancy. Tai dong is characterized by bleeding, accompanied by pain. Pain is the symptom which differentiates tai dong from tai ru.

Tai dong is a result of qi stagnation rather than qi deficiency. In order to treat tai ru, the practitioner should focus on reducing heat and tonifying qi. Zhi ke tang (Citri aurantii decoction), which combines bai zhu 14 g (Actractylodis machrocephalae), zhi ke 7 g (Citri aurantii) and huang qin 7 g (skullcap root), is helpful for treating tai ru syndrome. The treatment of tai dong involves moving the qi. Qi stagnation might occur as a result of the mother's emotional state as well. For example, stress causing liver qi stagnation. Liver stagnation also causes the fetus to become agitated, causing it to become restless giving rise to the term excess fetal movement.

Shao jiao ai tang (minor Corii asini and artemesia decoction) is helpful for the treatment of tai dong syndrome. This combines er jiao 8 g (Corii asini) and ai ye 16 g (Artemesia argyi).

Careful consideration should be made before the treatment of tai ru or tai dong. Symptoms of vaginal bleeding might occur sporadically during pregnancy. It's only when the situation becomes more pronounced should action be taken. This precaution holds true to all forms of medical intervention during pregnancy. If the practitioner bases his or her decisions on hasty judgment, the delicate fetus might be at risk.

The source of vaginal bleeding during pregnancy should be clearly differentiated. If blood is mixed with urine, it most likely will be emanating from the urinary bladder. Bleeding occurring in both tai dong and tai ru occurs directly from the uterus and is a result of chong and ren mai malfunction. The flow of blood in these cases will not be mixed with urine. In the clinical setting, some women might complain of monthly bleeding (coinciding with their monthly cycle) even after knowledge of being pregnant. This is due to an abundance of qi and blood in the meridians. If the pregnant mother is in good health and there are no accompanying symptoms, she should be encouraged and told not to worry. It's important, however, that an obstetrician is consulted in order to confirm whether she is, indeed, pregnant.

As previously mentioned, the emotional state of the pregnant women has a direct effect on the health of the fetus. If the mother's emotional state affects the fetus resulting in tai dong, it's necessary to focus treatment on her spiritual well-being. If the fetus lacks good health and affects the health of its mother, the method of calming the fetus should be administered. The above mentioned formula, qin zhu tang, is helpful in such cases. If the pregnant mother is plagued by internal disease or is overworked, her lower abdomen might feel like it's pulling downward. If this situation is severe enough, the uterus might even escape and sink downward. In this case, the use of bu zhong yi qi tang (tonify the middle and augment the qi decoction) is appropriate, consisting of the following ingredients:

  • huang qi 6 g (Astragali membranacei radix);
  • ren shen 4 g (Ginseng radix);
  • bai zhu 4 g (Actractylodis macrocephalae radix);
  • gan cao 4 g (Glycyrrhizae uralensis radix);
  • dang gui 2 g (Angelicae sinensis radix);
  • chen pi 2 g (Citri reticulatae, Pericarpium);
  • sheng ma 1.2 g (Cimicifugae radix); and
  • chai hu 1.29 g (Bupleuri radix).

The dosage of each herb in the above-mentioned formulae is carefully considered due to the fragility of the fetus. Naturally, according to the individual, dosages will vary slightly. However, caution should be made against prescribing excess amounts of each herb. Each formula mentioned in this article corresponds with single doses. Therefore, if two dosages were taken per day, the amount of each herb would be doubled and cooked accordingly.

No matter what the etiology might be, treatment of miscarriage essentially is about establishing biological harmony. Both spiritual and physiological factors always should be taken into consideration. The human body, just like all other phenomenon in nature, has its cyclical patterns according to the day, month and season. Only when our body's internal cycles are adjusted to the cycles occurring in nature can it function effectively. Whether it be herbs, acupuncture, diet, exercise and/or counseling, the objective always is the same. When such factors are taken into consideration, miscarriage can be treated with great efficiency.


Gary Wagman graduated from Emperor's College of Oriental Medicine and studied Sasang medicine in Korea at Daejeon University. He currently works full time at Harmony Acupuncture and Herbs in West Linn, Ore.


 

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