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Disorders during Pregnancy

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Morning Sickness

Abdominal Pain

Abdominal Pain

Threatened Miscarriage

Anxiety

Edema

Dizziness – pre-eclampsia

Convulsions - eclampsia

Cough

Lin Syndrome

Difficult Labor

Disorders during pregnancy are related to Yin/Blood ↓ , Qi stagnation, or Phlegm/fluids.

   Yin/Blood ↓ - nourish SP, eliminate pathogenic factors.

   Qi stagnation – balance emotions.

   Phlegm/fluids – eliminate.

Pre-delivery most women have fire.  They need to do physical activity, but not too much.  Sex life should be balanced, care & less frequent encounters later in pregnancy.

All of the syndromes during pregnancy most likely were present to some degree before conception.

Morning Sickness

Diagnosis

Starts around 7^th week, may last until the 12^th week.  Certain smells, foods, thoughts can give a woman nausea.  Possible dizziness & loss of weight is when this condition should be treated.  A lot of blood in Chong Mai goes upward causing disharmony of the ST.

Pathogenesis Differentiation & Treatment

            1. ST Qi ↓ - weak SP/ST before pregnancy, may vomit clear dilute fluids, full Chong Mai makes it difficult to descend ST Qi,

                        Plus – SP/ST ↓ symptoms (nausea, no appetite)

                                  P/T – strengthen & descend ST Qi

                        Rx – Xiang Sha Liu Jun Zi Tang

            2. LR Qi stag. – may vomit bitter/acidic fluids, may be heat symptoms

                        Plus – LR Qi stag. symptoms (w or w/o heat)

                        P/T – soothe LR, clear LR Heat, harmonize ST Qi to descend

                        Rx – Su Ye Huang Lian Tang

            3. Phlegm stag. – may vomit phlegm & fluids, SP/ST ↓ = phlegm blocks ST Qi → upsurge of  Qi.  Shortness of breath, palpitations, chest distension.

                        P/T – eliminate phlegm, harmonize & descend ST Qi

                        Rx – Xiao Ban Xia Jia Fu Ling Tang

Abdominal Pain

Diagnosis

More significant low Jiao pain during pregnancy.

Etiology – Jing Luo stagnation in low Jiao areas (Ren, Du, & Chong).

Differentiate – acute severe low abdominal pain.

1. ectopic pregnancy

2. vaginal bleeding – starts dark like coffee

3. miscarriage – trauma, unhealthy fetus, pregnancy stops → contractions

4. threatened miscarriage – lay down & do nothing

5. PID

6. appendicitis

Pathogenesis Differentiation & Treatment

            1. Blood ↓ - caused by SP ↓ → can’t produce enough to fill Chong → dull pain, comes & goes

                        Plus – Blood ↓ symptoms (blurred vision, dizziness, pale tongue)

                        P/T – nourish Blood, calms fetus to relieve pain

                        Rx – Dang Gui Shao Yao San

            2. LR Qi stag. – abdominal/hypochondric distending pain

                        Plus – LR Qi stag. symptoms

                        P/T – soothe LR, promote Qi circulation, relieve pain

                        Rx – Xiao Yao San

            3. SP/KI Yang ↓ cold – cold pain in the low abdomen, cold body & limbs, poor appetite, loose stool

                        Plus – SP & KI Yang ↓ symptoms

                        P/T – warm Yang, disperse Yin cold, warm Uterus to relieve pain

                        Rx – Jiao Ai Tang

Threatened Miscarriage

Diagnosis

Anytime during pregnancy, start having spotting (small amount) that comes & goes, also may be low back ache, or low abdomen starts having sinking feeling or down pulling heavy sensation.  Amount of bleeding indicated severity.

Differentiate – women may have a pseudo period but keep the pregnancy (small amount of old blood – brown in color) w/o back pain or abdominal pain.

Pathogenesis Differentiation & Treatment

            1. KI ↓ - congenital or before pregnancy has KI ↓, start vaginal bleed small amount, pale red thin clear, ***sore low back – prolapse feeling in low abdomen, possible miscarriage before.

                        Plus – KI ↓ symptoms

                        P/T – strengthen KI, consolidate Qi, calm fetus

                        Rx – Shou Tai Wan

            2. Qi & Blood ↓ - pale dilute bleeding w/ sinking feeling in low Jiao (if SP ↓)

                        Plus – Qi & Blood ↓ symptoms

                        P/T – nourish Qi & Blood

                                              Rx – Tai Yuan Yin

          3. Blood Heat – overeat spicy hot food, or, LR Qi stag. → heat, or, Yin ↓ → heat, or, external Heat invasion.  All can push blood out of vessels.  Color fresh or dark red, thick.  Abdominal pain.

                                   Plus – Heat signs in whole body.

                 P/T – clear heat, cool blood, nourish blood to calm fetus

                                              Rx – Bao Yin Jian 

          4. Blood Stasis from Trauma – some type of injury, stagnation or disharmony of Qi/Blood, low back ache then sinking feeling in low abdomen, may have vaginal bleeding.

                  P/T – nourish Qi/Blood, harmonize blood to calm fetus.

                                        Rx – Gui Zhi Fu Ling Wan

          5. Toxicity – eat or take something Ø, injures Qi/Blood & fetus, poisoning symptoms then vaginal bleeding.

                                       P/T – detoxify, calm fetus

                                               Rx – E Jiao San

Anxiety

Diagnosis

Depressed, irritable, shocked easily – fear/timid, stressed out

Etiology

Primary cause is heat attacking the HT.  ↑ or ↓ complicated w/ Phlegm

Pathogenesis Differentiation and Treatment

1. Yin ↓ w/ hyperactive HT Fire – blood goes to low Jiao, if person already has blood & or Yin ↓ → HT Fire, irritability, restless

Plus - Yin ↓ symptoms (dry throat, dysphoria, night sweat)

                        P/T - Nourish Yin clear the heat to calm the mind

                        Rx - Ren Shen Mai Dong San

2. Phlegm-Heat - Phlegm accumulation in the chest prior to pregnancy, blood in low Jiao – Heat in upper Jiao, Heat and phlegm attack the HT, fullness &  irritability in the chest, dysphoria

                        Plus - Phlegm symptoms (dizzy, chest fullness, nausea)

                        P/T - Eliminate phlegm and clear heat to calm the mind

                        Rx - -Bei Mu Gua Lou San

3. LR Heat - emotional stress cause Qi stag. which turns into Heat, Heat attacks the HT,  very irritable

Plus - LR Fire symptoms (bitter taste, hypochondriac pain, dizziness, blurred vision, headaches, red complexion)

                                 P/T - Soothe LR to relieve anxiety

                        Rx - Dan Zhu Xiao Yao San

Edema

Diagnosis

  -Occurs Mid-Late Pregnancy

  -Starts at the limbs or eyes(water retention)

  -Edema normally surrounds the ankle area and then gradually rises up to the limbs

  -Hidden edema (weight suddenly increases, feel full & heavy)

  -Check urine test for proteins etc.

Differentiate  -after 30 weeks slight swelling on the feet is normal (edema disappears after sleep)

   -Nephritis - History of Kidney disorders - normally starts from the ankle and goes down

Pathogenesis Differentiation & Treatment

1. SP Yang ↓ - edema during late pregnancy (after 24 weeks), skin is yellowish

                        Plus – SP ↓ symptoms (heaviness, tired, tasteless mouth, poor appetite, may have cold signs)

                   P/T - strengthen SP to induce diuresis to treat edema

                        Rx - Bai Zhu San + Sha Ren (calm fetus)

2. KI  Yang ↓ - KI ↓ before pregnancy- gets worse after conception, KI Yang cannot properly transform water causing edema, lower limb edema, Edema is really soft (↓ type), Skin is dull a dull color, cold body and limbs, lower back weakness, palpitation, shortness of breath  T- pale w/ white moist coat  P- deep thin pulse

                        P/T - Strengthen KI Yang to invigorate KI function to steam & transform

                        Rx - Jing Gui Shen Qi Wan or Zhen Wu Tang

3. Qi stagnation –emotional stress and the fetus growth blocks the Qi circulation,

emotions (sadness) impairs LU Qi function, cannot disperse and descend properly, normal skin, fullness & distending pain in the chest, poor appetite

                          P/T - regulate the Qi to transform the Damp

                        Rx - Tian Xian Teng Tang + Si Ling San

**Must add herbs to calm the fetus: Sha Ren, Zi Su Ye, Bai Zhu

Dizziness – pre-eclampsia

Diagnosis

   Hypertension

   Mid to late stage of pregnancy

   Dizzy, Blurred vision

   If not treated edema and scanty urine will become apparent

   Dizziness complicated with headache, blurred vision, tinnitus, fullness in the chest, nausea, vomiting, Edema, scanty urine, BP is higher then their normal mmHg.

Differentiate - primary high blood pressure, patient had a history of high blood pressure

Pathogenesis Differentiation & Treatment

1.Yin ↓ w/ hyperactive LR Yang - dizziness, blurred vision, tinnitus, poor sleep, red complexion

                        T- red  P- thin rapid

                        P/T - nourish the Yin, calm the Yang

                        Rx - Qi Ju Di Huang Wan

2. SP ↓ w/ hyperactive LR Yang - SP cannot properly transform Damp which creates Phlegm & so it can’t produce enough blood causing LR blood ↓ → LR Yang  rises

                        Plus – LR Yang rise & SP ↓ symptoms (heaviness, cloudy head, facial edema, poor appetite, loose stool)  T- thick greasy coat  P-wiry, slippery

                        P/T - strengthen SP to transform Damp, calm the LR to relieve dizziness

                        Rx - Bai Zhu San + Shi Jue Ming, Gou Teng (calm LR)

Convulsions - eclampsia

Diagnosis

Late pregnancy to pre/during/post delivery patient suddenly loses consciousness, the limbs may spasm → tetanus, eyes roll back, then wake after seizure.

Stages of Convulsion

-Severe headache, nausea, convulsions (eyes become fixed, spasm of arms, clenched teeth, facial twitch, whole body spasm, pale purple complexion, temporary breathing stoppage, saliva drips from mouth → seizure lasts between 30sec-2min → muscles relax, exhaling sound (if very severe patient will become unconsciousness after convulsion).  Zombie like state after.  Urine tests show ↑ protein &/or blood cells.

Pathogenesis Differentiation & Treatment

1. LR Wind - Yin ↓ creates hyperactive LR Yang which produces Wind, late stage of pregnancy patient goes into convulsion

                        Plus – LR Yang/Fire symptoms (red complexion, irritable, headache, bitter taste, headaches, sore dry eyes)

                        P/T - calm the LR Wind

                        Rx - Tian Ma Gou Teng Yin

2. Phlegm-Fire - due to pre-existing Phlegm with Yin ↓  Heat + Phlegm attacks the clear cavity (Head - Qing Qiao) which induces the convulsions, very late stage (during delivery) patient suddenly losses consciousness, prior to attack patient becomes dizzy, gets a headache, has rough breathing

T- yellow greasy coat  P- slippery wiry

P/T - clear Heat, eliminate Phlegm to open the cavity

Rx - Niu Huang Qing Xin Wan or An Gong Niu Huang Wan

Cough

Diagnosis

Anytime during pregnancy where there is a remittent, constant cough.  The cough will add extra pressure on the lower abdomen which may cause miscarriage.

Pathogenesis Differentiation & Treatment

1.      LU Yin ↓ – ↓ LU Yin cough due to ↓ Fire

Plus – Yin ↓ symptoms

P/T – nourish lung yin to clear deficient heat and relieve cough

Rx – Bai He Gu Jin Tang – (-) Dan Gui  (+) nourish lung yin herbs

2.      LU Phlegm Fire – Excess heat in the LU accompanied with phlegm

Plus – LU Heat and Phlegm symptoms

P/T – Clear LU heat & eliminate phlegm to relieve cough

Rx – Qing Jin Hua Tan Tang

Lin Syndrome

Diagnosis

Painful, urgent, frequent urination due to both ↑ & ↓ Heat.  The KI is unable to support the bladder creating ↓ Heat.

Pathogenesis Differentiation & Treatment

1.      ↑ HT Fire moves to SI – Painful, urgent, frequent urination

Plus – canker sores due to HT fire

P/T – Clear HT Fire

Rx – Dao Chi San

2.      Damp Heat in Lower Jiao – Painful, urgent, frequent urination with more of a burning pain than HT fire.

Plus – damp heat symptoms

P/T – clear Damp/Heat, induce diuresis

Rx – Jia Wei Wu Lin San

3.  Yin ↓ – chronic painful, urgent frequent urination,

Plus – emaciation, insomnia, palpitation, dry stools

P/T – nourish Yin, induce diuresis

Rx – Zhi Bai Di Huang Wan

Difficult Labor

Diagnosis

If women are ↓ in Qi/Blood or have Qi/Blood stagnation then difficult labor will occur.

Differentiate - Pre-Delivery – contractions MAY be present, will be dilated less than 8-10cm

Pathogenesis Differentiation & Treatment

1.      Qi/Blood ↓ – only mild contraction pain and lower back pain (usually very painful) short contractions with long remission between them.

Plus – general Qi & Blood deficient symptoms

P/T – Nourish Qi & Blood

Rx – Nan Chan Tang

2.      Qi/Blood Stagnation – excessive condition, strong pain during regular contractions with a long duration, small amount of dark blood.

Plus – general Qi & Blood Stagnation symptoms.

P/T – regulate Qi & Blood to dissolve stasis

RX – Chui Sheng Yin

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