Abnormal Fetal Position, Protracted

Labor, Insufficient Lactation, Acute

Infantile Convulsions

Prepared by: Sr. Mary Zhang

Date: Sep.1, 2017
1. Abnormal Fetal Position
This is considered abnormal when the fetus has not
turned downward in the womb after 30 weeks of
gestation.
It can occur in women with relaxed abdominal walls or
those who have been through labor previously.
EtiologyThis always involves the kidney, which is
associated with the uterus.
--If the woman is kidney deficiency by nature, or if
over indulgence in sex or heavy exertion injuries the
kidney, essence and blood can be damaged.
--If the essence and blood depleted, they will not be
available to nourish and enrich the uterus during the
later stages, and the fetus may be unable to turn and
drop normally.
Differentiation and Treatment
Pattern differentiation: The patient usually has no
obvious symptoms; diagnosis is confirmed only after
obstetric examination.
Treatment principles: Nourish the kidney and stabilize
the fetus.
Treatment methods: with the patient supine or seated
on a chair with good support, use moxa bilaterally with
a moxa stick once or twice a day at BL 67 (zhi yin) or SP
6 (san yin jiao) for 15~20 minutes until the fetus moves
into the normal position.
Formula:
BL 67 (zhi yin) or SP 6 (san yin jiao) no both side
Alternative therapies
Body acupuncture: at BL 67 (zhi yin) with
filiform needles and even stimulation.
Auricular acupuncture
Case Discussion
A 34-year-old, 8 months pregnant,
presented with malposition of the fetus.
She had a small tongue with a thin white
coating, slippery and weak pulse.
Ultrasound showed the fetus 'head to be
at the upper right abdomen.
2. Protracted Labor
This refers to labor that exceeds 24 hours.
Etiology and Pathogenesis: This can be caused by
deficiency or excess.
--The deficiency pattern can be due to the mother's
constitutional weakness, deficient health qi, qi
exhaustion from pushing too early during labor, or
premature rupture of the amniotic sac that causes the
loss of amniotic fluid and blood.
--The excess pattern can be the result of apprehension
during labor, over resting before delivery that impedes
qi and blood circulation, or invasion of pathogenic cold
that causes blood stasis and disturbs the movement of
qi.
Differentiation and Treatment
Pattern differentiation:
--Deficiency of qi and blood: weak labor pains,
distention, profuse pale red bleeding accompanied by
pallor, lassitude, palpitations, shortness of breath, pale
tongue, large and weak or deep and thread pulse.
--Qi and blood stasis: severe pain in the abdomen and
lower back and slight dark red bleeding accompanied
by a dark complexion, anxiety, occasional nausea, dark
red tongue, deep, excessive, and irregular pulse.
Treatment principles: Nourish qi and blood, dissolve
stasis, and unblock the collaterals.
Treatment methods: Use foot taiyin spleen and hand
yangming large intestine channel points. Reinforce for
deficiency and reduce for excess.
 Formula: LI 4 (he gu), SP 6(san yin jiao), BL 67 (zhi yin), Du yin
(EX-LE 11):
--for deficiency of qi and blood, add: ST 36(zu san li), KI 7 (fu liu);
--for qi and blood stagnation, add: LV3 (tai chong), GB 21 (jian
jing).
Explanation:
--LI 4 (yuan-source point): moves and rectifies qi, invigorate blood
and dissolves stasis;
--SP 6: moves and reinforces qi and invigorates and nourishes blood;
--BL 67 (jing-well point) + Du yin: promote delivery;
--ST 36: reinforces the spleen and stomach and generates qi and
blood;
-- KI 7: Reinforces the kidney to help uterine action during labor;
--LV 3 + GB 21: rectify qi and promote delivery.
 Points selection according to symptoms:
--for mental fatigue, add: RN 4 (guan yuan), RN 6(qi hai);
--for palpitations and shortness of breath, add: PC 6 (nei guan),
KI 3 (tai xi).
Alternative therapies

Moxibustion: RN 8 (shen qu)

Auricular acupuncture
Case Discussion
A 34-year-old female, in full term labor, had weak
uterine contractions, profuse pale red bleeding
accompanied by pallor, lassitude, palpitation, very low
energy, pale tongue, large and weak pulse.
3.Insufficient Lactation/Hypogalactia
Etiology and Pathogenesis: This can result from
either deficiency or excess.
--Deficiency: constitutional deficiency of spleen and
stomach can fail to transform nutrients that generate
qi and blood; this may be compounded by profuse blood
loss during delivery that leads to consumption of qi and
blood and failure to form milk.
--Excess: its usually caused by depression after
delivery, which produces liver qi stagnation that
obstructs milk flow.
 Differentiation and treatment:
Pattern differentiation:
--Qi and blood deficiency: insufficient, absent, or thin
milk after delivery, soft breasts without distention,
pallor, lusterless lip and nails, lassitude, palpitations,
poor appetite, loose stools, pale tongue, little coating,
deficient and thready pulse.
--Liver constraint and qi stagnation: obstructed milk
flow after labor, distention and pain in the breasts,
chest tightness, hypochondrial distention, mental
depression, epigastric distention, poor appetite, thin
white tongue coating wiry pulse.
Treatment principles: Fortify the spleen, reinforce qi,
soothe the liver, and resolve constraint.
 Treatment methods: Use foot yangming stomach and
foot jueyin liver channel points.
Formula:
RN 17 (dan zhong), ST 18 (ru gen), SI 1 (shao ze)
--For insufficient lactation due to qi and blood
deficient, add: BL 20 (pi shu), ST 36 (zu san li);
--For insufficient lactation due to liver constraint and
qi stagnation, add: LV 3 (tai chong), PC 6 (nei guan).
 Explanation:
--RN 17: regulates and rectifies qi and facilitates the flow of milk;
--ST 18: regulates and dredges channel qi to promote lactation;
--SI 1: an empirical point that promotes milk flow;
--BL 20 & ST 36: nourish blood and qi, fortify the spleen,
harmonize the stomach, and help restore the production of qi and
blood;
--LV 3 & PC 6: soothe the liver, regulate qi, ease the chest, and
dissipate masses.
Acupuncture techniques: use filiform needles; reinforce for the
deficiency and reduce for excess.
Points selection according to symptoms:
--for excessive blood loss, add: BL 18 (gan shu), BL 17 (ge shu);
--for chest and hypochondrial distension, add: LV 14 (qi men).
Alternative therapies

Auricular acupuncture
Dermal needling
Case discussion

a 34-year-old female, was complaining of thin milk

after delivery. She had a heavy bleeding around
delivery time. She looks pale, lusterless lips and nails,
palpitations, poor appetite, pale tongue, weak pulse.
4. Acute Infantile Convulsions
(Jing jue or chou feng)

This manifest as spamming limbs, locked jaw, arched

back rigidity, and even loss of consciousness.
--Acute infantile convulsions: sudden onset, excess
syndrome (will be discussed here); Most convulsions are
due to excess.
--Chronic infantile convulsions: slow onset, deficiency
syndrome.
--Age: 1~5 year old or younger
 Etiology and Pathogenesis: Qi and blood are deficient
because of the zang-fu organs of the young are
undeveloped. If this a compounded by:
--External invasion (seasonal pathogen): which causes
internal stagnation of excess heat, the resulting liver
wind will cause acute convulsion;
--Phlegm heat: improper diet impairs stomach and
spleen and lead to damp accumulates as phlegm,
internal phlegm turbidity that gives rise to internal
heat and generates wind;
--Sudden fright: disturbs the flow of qi.
Differentiation and Treatment
Pattern differentiation: Before acute infantile
convulsions occur, there are symptoms such as high fever,
red complexion, shaking of the head and tongue, chewing,
easy awakening from sleep, unruly movement of hands
and fear, irritability. These are followed by coma, the eyes
looking straight ahead, locked jaw, arched-back rigidity,
and spamming limbs.
--External invasion: accompanied by fever, headache,
cough, red throat, nausea and vomiting, thirst, irritability,
thin yellow tongue coating, floating and rapid pulse;
-- Phlegm heat: accompanied by fever, vomiting,
abdominal distention and pain, constipation, phlegmatic
sound in throat, loss of vitality, slightly yellow and thick
greasy tongue coating, rapid pulse;
--Fright: accompanied by emaciation, cold limbs, restless
sleep or somnolence, crying, thin tongue and dark purple
finger venules, and deep pulse.
 Treatment principles: Open orifices, extinguish wind,
eliminate phlegm, and relieve convulsions.
Treatment methods: use du mai and foot jueyin liver
channel points.
Formula:
--DU 26 (shui gou), DU 14 (da zhui), LI 4 (he gu)
--LV 3 (tai chong), shi xuan (EX-UE 11), GB 34 (yang
ling quan).
* For convulsion due to external pathogenic invasion,
add: LI 11 (qu chi);
* For convulsion due to phlegm heat, add: RN 12 (zhong
wan), ST 40 (feng long), HT 7 (shen men);
* For convulsion due to fright, add: yin tang (EX-HN 3),
HT 7 (shen men), KI 1 (young quan).
 Explanation:
-- DU 26: induces resuscitation and opens the orifices;
assist the resuscitory effect of DU 26 by pricking shi
xuan to bleed;
--DU 14 (the intersecting point of du mai and all the
yang channels): clears pathogenic heat;
--LV 3 (the yuan-source point): clears liver fire and
extinguishes liver wind;
--LI 4: strengthens the effects of the other acupoints;
--GB 34 (the influential point of the sinews): relaxes
the sinews and stops convulsions;
--LI 11 (he-sea point): clears heat and eliminates
invasive pathogens;
--RN 12 & ST 40: eliminate phlegm and open the
orifices in phlegm-heat convulsions;
--KI 1, yin tang, & HT 7: calm fright and tranquilize the
mind, extinguish wind, and stop convulsions.
Alternative therapies

Auricular acupuncture
Acupuncture and Bleeding:
--shi xuan (EX-UE 11), DU 26 (shui gou)
--LI 4 (he gu), LV 3 (tai chong)
* Prick shi xuan and DU 26; needle LI 4 and LV 3,
withdrawing after twirling and thrusting for a moment,
then bleed by pinching and squeezing.
 Acupuncture techniques:
Use filiform needles with reduction or bleed with
three-edged needles.
Points selection according to symptoms:
--for eyes rolled upward, use: DU 24 (shen ting), DU 8
(jin suo);
--for continuous convulsions, add: DU 22 (xin hui), SJ 9
(lu xi).
Case Discussion
a 3-year-old boy presented with high
fever and recurrent convulsions. He
got cold for one day, then followed by
high fever, red complexation,
irritability, and then the eyes looking
straight ahead, locked jaw; and
accompanied by cough, red throat,
vomiting, yellow tongue coating,
floating pulse.