Morning sickness: Treatment with Chinese Medicine

The unfoldment of a pregnancy from conception to birth involves a myriad of miraculous, natural and normal physiological changes.  How a woman’s body adapts to these dramatic changes will predispose her to expressing symptoms commonly associated with pregnancy.

Along with breast distension and soreness, morning sickness is one of the most common and earliest physical symptoms of pregnancy.

Regarded as part of a normal pregnancy, around half to two thirds of all pregnant women will experience morning sickness to some degree, particularly in their first trimester.  Morning sickness typically begins around the fourth week of pregnancy and usually resolves by weeks 12-14.  In some cases it may continue until weeks 16-20, while some women may be troubled with it their entire pregnancy.

The severity of morning sickness differs between women and between pregnancies.  Women often complain of constant nausea, or waves of nausea that may or may not occur at regular times throughout the day.  Some women will occasionally vomit food, bile or phlegm and others will vomit excessively to the point of requiring medical re-hydration and nourishment in the form of intravenous fluids.

In most cases, morning sickness will not harm the mother or the unborn baby but it can be debilitating, restricting movement and affecting a woman’s capacity to work, care for other children and perform the normal activities of daily living – not to mention robbing her of the enjoyment of pregnancy.

Through this article we hope to explain the symptom of morning sickness from a Chinese Medicine perspective and offer information on how it might be used as a safe, effective, drug-free treatment option to treat morning sickness and prevent it from becoming serious enough to require medical intervention.

Chinese Medicine has a simple yet unique understanding of the causes of morning sickness.  This understanding evolved through the profound observation of nature, in the absence of modern biomedical science and technology.

The ancient Chinese observed that once a woman’s monthly period stopped as a result of pregnancy, the natural downward flow of menstruation ceased. The blood and energy normally expelled each month instead backed up in the uterus to provide the nourishing substrate for the growing foetus.

This excess energy and blood has the tendency to ‘rebel’ upwards and disrupt digestive function, producing the symptom of nausea and vomiting.  This phenomenon is known as ‘rebellious stomach energy’, and is also responsible for the symptom of breast distension, where nourishment ascends in the body as preparation for lactation several months away.

This theoretical understanding is really unimportant to most pregnant women experiencing morning sickness.  Usually all they are really interested in knowing is if Chinese Medicine is safe, and does it work.

A recent Australian study (Smith, Crowther & Beilby, 2002) concluded that acupuncture is a safe, effective treatment for women experiencing nausea and dry retching in early pregnancy.  The study found that acupuncture had no significant effect on the symptom of vomiting.

For best effect, women are advised to seek Chinese Medicine treatment sooner rather than later as once the pattern of morning sickness is established and embedded in the body’s responses it can be difficult to shift.

Early treatment saves women unnecessary distress associated with the symptoms and may be enough to avoid more aggressive conventional treatment further down the track.

During a full Chinese Medicine consultation women should expect their practitioner to take a comprehensive case history aimed at teasing out the characteristics of the presentation.

Enquiries might be made into which time of day the symptoms are worse or better, if eating improves or exacerbates the symptoms, if there is vomiting.

Questioning will also establish if there are any accompanying symptoms such as heartburn, food cravings, musculoskeletal neck and/or abdominal pain, and spasm from incessant retching.

Acting as a detective the answer to these questions directs the practitioner to construct an individualised course of treatment.  This might involve one or a combination of treatments including acupuncture, herbal medicine, acupressure and dietary advice.

Acupuncture

Acupuncture is typically attractive to pregnant women as a safe, drug free treatment option to treat morning sickness.

While a full Chinese Medicine approach combining a number of acupuncture points is the most effective way of treating morning sickness, some points, such as Pericardium 6 (PC6*) located on the inside of the wrist, are synonymous with treating nausea.  This point routinely appears as a single-point prescription for treating morning sickness.

In fact Sea-Bands designed to treat motion sickness double as an effective, non-invasive home treatment for the symptomatic relief of morning sickness.  Sea-Bands are comprised of an elastic strap with a plastic button which is able to be positioned over PC6 and left in place until symptoms ease.  They can be purchased from your local chemist.

Herbal treatment

It is our experience that Herbal Medicine is very effective in treating morning sickness.  Although in order to use herbal medicine a number of obstacles need to be overcome first.

Women are generally more reluctant to take herbs, especially in early pregnancy, for fear of harming their baby.

This concern is not necessary.

If prescribed by a registered Chinese Medicine professional, Chinese Herbal Medicine is perfectly safe for use during pregnancy.

Once comfortable with ingesting herbs the next challenge is in consuming them without vomiting.  It is therefore in women’s best interest to take herbs earlier in their pregnancy, hopefully before symptoms become too severe, and at times of the day when symptoms are generally less intense.

Practitioners tend to avoid using strong-flavoured, fragrant herbs when treating morning sickness as they can aggravate the pre-existing nausea and vomiting.

My preference is to use granulated herbs, pills or tinctures that do not require cooking and therefore don’t produce strong smells in the house during preparation.

By the time women present at clinic they have usually worked out what foods they can tolerate. Depending on the presentation, adjunctive dietary recommendations might also be given by the practitioner.

* Pericardium 6 is an acupuncture point located on the inside middle of the wrists approximately 3 finger widths (roughly equivalent to 2 cun, an ancient Chinese measurement) above the wrist crease.

What does the research say?

Smith C, Crowther C & Beilby J (2002) [1] conducted a single blind randomised controlled trial at the Women’s and Children’s Hospital in Adelaide, South Australia.

The study explored whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy.

593 volunteers less than 14 weeks’ pregnant with symptoms of nausea or vomiting were randomised into 4 groups.

The traditional acupuncture group received full TCM differential diagnosis and treatment, the formula acupuncture group received single point prescription, the third group sham acupuncture, and a control group received no treatment. Subjects were given weekly treatment for 4 weeks.

The study found that women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week than the control group.

Women who received formula acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared to the control group.

The sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the control group.

No differences in vomiting were found among the groups at any time.

The study concluded that acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy.

Data collected on perinatal outcomes, congenital abnormalities, pregnancy complications and newborn outcomes found that there were no significant differences between the study groups [2], leading the authors to conclude that no serious adverse effects arise from acupuncture during early pregnancy.

[1] Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early pregnancy: a randomised trial. Birth.2002Mar:29 (1):1-9

[2] Smith C, Crowther C, Beilby J Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Therapy Med. 2002 Jun; 10(2):78-83.