Morning sickness is one of the most common symptoms during early pregnancy, typically occurring between weeks one to sixteen of the pregnancy. Though it is usually worst in the morning, nausea and vomiting may occur at any time of the day. Occasionally the nausea and vomiting is severe enough to produce weight loss, dehydration, electrolyte and acid-base disturbances, starvation ketosis or transient hepatic dysfunction in which case morning sickness changes to a more severe condition termed hyperemesis gravidarum.
What Causes Morning Sickness?
Simply, no one really knows. Hyperemesis gravidarum may be due to high or rapidly rising serum levels of chorionic Gonadotropins, estrogens, or both. Otherwise there might be a Thiamine or vitamin B1 deficiency which presents along with central nervous system impairment with symptoms such as confusion, visual disturbances, ataxia, and nystagmus. If left untreated it can lead to blindness, convulsion and coma. A vitamin K deficiency can also lead to hyperemesis gravidarum along with other symptoms such as epistaxis, increased plasma zinc levels and decreased copper levels (magnesium level remain unchanged).
According to Chinese Medicine, morning sickness is generally due to rebellious Chong Qi and failure of the Stomach to descend. This can be due to Spleen-Stomach deficiency or Liver fire due to restlessness or susceptibility to rage that attacks the Stomach through the Chong meridian. According to Maciocia and Sun Si Miao, the Heart can also play a role in morning sickness. Since the nature of the Heart Qi is to descend, if it does not do so it can lead to nausea and vomiting. Zhu Dan Xi also describes that there can be a disharmony between the Blood and Essence in the Chong Channel which results in Qi rebelling upwards.
How Does Western Medicine Treat Morning Sickness?
When morning sickness is not as severe, eating small and frequent meals is advised and staying away from any aggravating smells. When vomiting is prolonged or severe, treatment with vitamin B6 is often effective and can be supplemented with doxylamine. In case these fail, intravenous crystalloid solution is administered to help combat dehydration, ketonemia, electrolyte deficiencies and acid-base imbalances. Typically 100mg of Thiamine is added to the first liter.
How Does Chinese Medicine Treat Morning Sickness?
Chinese Medicine treats disease based on differentiation. Though Maciocia gives more including Heart Qi deficiency and Heart fire, they are more common later during pregnancy. Here are the most common types:
|Differentiation||Spleen-Stomach Deficiency||Liver-Stomach Disharmony||Phlegm Obstruction||Qi & Yin Fluid Deficiency|
|Type of Vomiting||Early pregnancy nausea-vomiting||Vomiting acidic or bitter fluid||Vomiting of phlegm or saliva||Severe vomiting|
|Other Signs||Feeling of fullness, anorexia, dizzy, lassitude, somnolence, light red tongue, white coating, weak pulse||Chest or ribside oppression, belching, sighing, dizzy, bitter taste in mouth, dry throat, thirst that prefers cold, constipation, dark urine, red tongue, yellow dry coating, taut, slippery and rapid pulse||Chest fullness, anorexia, flat taste in mouth, dizzy, palpitations, shortness of breath, light red and swollen tongue, white greasy coating, slippery pulse.||Difficulty eating, weight loss, fatigue, spiritlessness, dry mouth, decreased urination, constipation, red tongue, no coating, thready rapid pulse|
|Acupuncture||PC 6, RN 12, ST 36||PC 6, RN 17,LV3||PC 6, ST 40||PC 6, UB 20, UB 21, RN 12, ST 36, SP 6|
|Herbs||Modified Xiang Sha Liu Jun Zi Tang||Modified Jia Wei Wen Dan Tang||Modified Xiao Ban Xia jia Fu Ling Tang||Sheng Mai Yin & Zeng Ye Tang|
Herbs such as Ban Xia have the ability to the vomiting center to relieve vomiting. Zhu Ru has a bacteriostatic effect on staphylococcus albus, bacillus coli and typhoid bacillus. Huo Xiang contains volatile oils which have the effect of expanding the micrangium, promoting gastric secretions and relieving spasms of the stomach and intestines.
Common Acupuncture Points
It should be noted that points above the umbilicus can be used in the first three months but not after. Thanks to Maciocia for the image.
- Stomach Channel: ST 19, ST 20, ST 21
- Kidney Channel: KI 20, KI 21
- Ren Channel: RN 10, RN 11, RN 12, RN 13, RN 14
- Distal Points: PC 6, SP 4, ST 34, ST 36, ST 40, UB 20, UB 21
Western and Chinese medicine integrated treatments work very well together.
Caroline Prodoehl, D.Ac
Maciocia, Giovanni, 2011. Obstetrics and Gynecology in Chinese Medicine, 2nd Ed. Churchill Livingstone, Philadelphia, PA.
Wang, Yuxiang (2010). Integrated Gynecology Course Notes. Toronto School of Traditional Chinese Medicine.