Contraindicated points during pregnancy

August 15, 2002

What about from a legal/perceived liability point of view. If, say, a woman were to spontaneously abort after 'tonifying' he gu or 'sedating' san yin jiao even when appropriate, couldn't this put the practitioner into a hairy position trying to explain why he/she used points that are 'contraindicated' in virtually every modern text? This would apply to the use of blood-invigorating herbs during pregnancy, as well?

-

rey tiquia

Cc: hrv

Saturday, August 31, 2002 6:21 AM

Contraindicated points during pregnancy

August 31,2002 8:20 pmMelbourne AustraliaDear Geoff,Thanks for your question. You do not have to apologize for posting the querry to this list for the way I see it the acupuncture body of knowledge 'embraces' herbal medicine and vice-versa. I think it is time to re-visit the status of contraindicated points in acupuncture. The issue has been murky over the years because of confusion over exactly what conditions or clinical patterns a prescription of acupuncture points are clinically 'indicated for' and what conditions their use should be 'contraindicated' against. In addition, this has been compounded by the fact that on the one hand while acupuncture has been used for pregnancy related conditions like morning sickness, it has been used in the distant past for terminating pregnancy. On the first question of 'indications for the deployment of acupuncture point prescriptions , I think we can all agree that the choice of acupuncture points is contingent upon the presenting signs and symptoms i.e. clinical pattern of a patient. And to establish this we collect data on the patient's condition using the Four Examination Techniques and then 'sort out' these data using the Jing-luo and Zang Fu conceptual templates . As for the question of contraindicated points for acupuncture, I would bring the "virtuoso acupuncturists" Zhao Ji An (l877-1938) "back to life" (through his writings) to answer it. He said: " Tonifying He gu (LI 4) , sedating san yin jiao (Sp 6) were methods used by the ancient practitioners to terminate pregnancy (xia tai zhi fa). However, just by tonifying He gu and sedating san yin jiao does not necessarily lead to aborting the foetus (luo tai) .If the patient is pregnant (you tai) and she is yang deficient due to a buoyant 'cold' zhen han yang xu, tonifying he gu will not only tonify the (deficient ) yang, but also it can calm the foetus (an tai). So , where lies the harm in giving acupuncture ? In the other case, a pregnant woman suffered from swollen legs and painful feet (tui zhong zu tong) sedating san yin jiao will not only make the swelling subside and stop the pain in the feet, but also , with the swelling and pain gone the foetus will be in a more stable condition. So, where lies the harm in giving acupuncture ? ... We can then see just tonifying and sedating does not lead to something harmful. However, once enough tonification is done, then take out the needles. We should never over tonify. When enough sedation is done, we should stop. We should not over sedate. These may de-stablize the foetus." [ Zhao Jin An l986. The Knack of Acupuncture and The Ten Methods of Massage Zhen jiu yao jue yu an mo shi fa . TCM Ancient Classics Publishing House. Beijing. pp.220-221] These are conclusionary comments (which I translated ) made by Zhao Ji An based on three cases of pregnant women receiving acupuncture for three different conditions . I have used some of the above acupuncture points on patients suffering from morning sickness or ren chen zhong e (even with patients who are having acupuncture for the first time) and have found acupuncture to be 'harmless' . The important thing is to explain calmly to an apprehensive patient what the whole process is all about (especially the phenomena of de Qi) and be 'caring' and 'light handed' with the needling. Regards,Rey TiquiaPhd CandidateDept. of History and PHilosophy of ScienceThe University of MelbourneParkvilleVictoriaAustralia >"Geoffrey Hudson, L.Ac." <list>> Contraindicated points during pregnancy>Thu, Aug 29, 2002, 5:10 PM>> My apologies for the off-topic post to a herbal list... > > I was reading the note below, and it reminded me to ask in the group> here - is there any 'definative' list of contraindicated points during> pregnancy? I've seen Sp 6, LI 4, GB21, sometimes St 36, lower back or> lower abdominal points on some lists, not on others... And then, more> often than not, 'contraindicated' points are often done in some cases> anyways. For instance, if you read some of the 'daoist' acupuncture> contraindicated point lists (wrong points at the wrong time), you start> to think that all points are contraindicated at all times. I want to be> safe, but then I also know that some of the contraindicated points may> not be that risky. I was wondering if anyone here has a good level of> experience with pregnant patients might like to share any info on this> subject. And, for that matter, any herbal lists as well? > > I'm stretching... But I believe there was a line in the Nei Jing where> Huang Di asked Qi Bo what to do when a pregnant patient needed a toxic> substance to treat a pathogen - Qi Bo answered 'if you need the> substance, then use it. No harm will come to the baby'. That may be> totally wrong, but I'm wondering if the same logic applies here.> > Geoff> >> __________>> >> Message: 16>> Wed, 28 Aug 2002 16:18:20 -0000>> "kampo36" <kampo36>> Re: ACUPRESURA>> >> Marco,>> >> ¡ay que chévere!>> >> Nicely done, very clearly written (even i could understand it). I'm >> not sure if you will include diagrams for the point location, but the >> descriptions were pretty clear so you might not even need to. I >> liked the way you incorporated emotional and spiritual effects of qi >> depression along with the usual physical description, and >> incorporated meditation and diet into the material as well. The >> description of the techniques would seem to require some >> demonstration or at least illustrations, that was the only part that >> seemed unclear to me.>> >> a few comments:>> UB54 is now generally known as UB40, the order of the points on the >> Foot Taiyang Bladder channel has been altered from earlier texts. >> This makes little difference unless you are trying to communicate >> with acupuncturists from outside of Asia who learned TCM in the last >> 10 or so years.>> >> Points to avoid in pregnancy differ according to different sources. >> Some sources mention GB21 as a point to avoid, as strong stimulation >> there seems to have a strong effect on the uterus. >> >> One point you might want to include is P6, which is easy to locate >> once you've found T5 (en el lado opuesto), and is very effective for >> nausea and generally thought of as safe in pregnancy. It is also >> effective for insomnia, desmayo, cardiac and digestive problems. If >> you wanted to make an even dozen points, I'd say why not throw in >> Liv3... ;o)>> >> Where did you get the point selection for MS?>> >> Thanks for sharing this, I really enjoyed reading it.>> >> take care,>> robert hayden> > > >

August 31, 2002

August 31,2002 8:20 pm

Melbourne Australia

Dear Geoff,

Thanks for your question. You do not have to apologize for posting the querry to this list for the way I see it the acupuncture body of knowledge 'embraces' herbal medicine and vice-versa.

I think it is time to re-visit the status of contraindicated points in acupuncture. The issue has been murky over the years because of confusion over exactly what conditions or clinical patterns a prescription of acupuncture points are clinically 'indicated for' and what conditions their use should be 'contraindicated' against. In addition, this has been compounded by the fact that on the one hand while acupuncture has been used for pregnancy related conditions like morning sickness, it has been used in the distant past for terminating pregnancy.

On the first question of 'indications for the deployment of acupuncture point prescriptions , I think we can all agree that the choice of acupuncture points is contingent upon the presenting signs and symptoms i.e. clinical pattern of a patient. And to establish this we collect data on the patient's condition using the Four Examination Techniques and then 'sort out' these data using the Jing-luo and Zang Fu conceptual templates .

As for the question of contraindicated points for acupuncture, I would bring the " virtuoso acupuncturists " Zhao Ji An (l877-1938) " back to life " (through his writings) to answer it. He said:

" Tonifying He gu (LI 4) , sedating san yin jiao (Sp 6) were methods used by the ancient

practitioners to terminate pregnancy (xia tai zhi fa). However, just by

tonifying He gu and sedating san yin jiao does not necessarily lead to

aborting the foetus (luo tai) .If the patient is pregnant (you tai) and she

is yang deficient due to a buoyant 'cold' zhen han yang xu, tonifying he gu

will not only tonify the (deficient ) yang, but also it can calm the foetus (an tai).

So , where lies the harm in giving acupuncture ? In the other case, a

pregnant woman suffered from swollen legs and painful feet (tui zhong zu tong)

sedating san yin jiao will not only make the swelling subside and stop the pain

in the feet, but also , with the swelling and pain gone the foetus will be in a more

stable condition. So, where lies the harm in giving acupuncture ? ... We can then see

just tonifying and sedating does not lead to something harmful. However, once

enough tonification is done, then take out the needles. We should never over

tonify. When enough sedation is done, we should stop. We should not over sedate.

These may de-stablize the foetus. " [ Zhao Jin An l986. The Knack of Acupuncture and The

Ten Methods of Massage Zhen jiu yao jue yu an mo shi fa . TCM Ancient Classics

Publishing House. Beijing. pp.220-221]

These are conclusionary comments (which I translated ) made by Zhao Ji An based on three cases of pregnant women receiving acupuncture for three different conditions .

I have used some of the above acupuncture points on patients suffering from morning sickness or ren chen zhong e (even with patients who are having acupuncture for the first time) and have found acupuncture to be 'harmless' . The important thing is to explain calmly to an apprehensive patient what the whole process is all about (especially the phenomena of de Qi) and be 'caring' and 'light handed' with the needling.

Regards,

Rey Tiquia

Phd Candidate

Dept. of History and PHilosophy of Science

The University of Melbourne

Parkville

Victoria

Australia

> " Geoffrey Hudson, L.Ac. " <list

>

> Contraindicated points during pregnancy

>Thu, Aug 29, 2002, 5:10 PM

>

> My apologies for the off-topic post to a herbal list...

>

> I was reading the note below, and it reminded me to ask in the group

> here - is there any 'definative' list of contraindicated points during

> pregnancy? I've seen Sp 6, LI 4, GB21, sometimes St 36, lower back or

> lower abdominal points on some lists, not on others... And then, more

> often than not, 'contraindicated' points are often done in some cases

> anyways. For instance, if you read some of the 'daoist' acupuncture

> contraindicated point lists (wrong points at the wrong time), you start

> to think that all points are contraindicated at all times. I want to be

> safe, but then I also know that some of the contraindicated points may

> not be that risky. I was wondering if anyone here has a good level of

> experience with pregnant patients might like to share any info on this

> subject. And, for that matter, any herbal lists as well?

>

> I'm stretching... But I believe there was a line in the Nei Jing where

> Huang Di asked Qi Bo what to do when a pregnant patient needed a toxic

> substance to treat a pathogen - Qi Bo answered 'if you need the

> substance, then use it. No harm will come to the baby'. That may be

> totally wrong, but I'm wondering if the same logic applies here.

>

> Geoff

>

>> __________

>>

>> Message: 16

>> Wed, 28 Aug 2002 16:18:20 -0000

>> " kampo36 " <kampo36

>> Re: ACUPRESURA

>>

>> Marco,

>>

>> ¡ay que chévere!

>>

>> Nicely done, very clearly written (even i could understand it). I'm

>> not sure if you will include diagrams for the point location, but the

>> descriptions were pretty clear so you might not even need to. I

>> liked the way you incorporated emotional and spiritual effects of qi

>> depression along with the usual physical description, and

>> incorporated meditation and diet into the material as well. The

>> description of the techniques would seem to require some

>> demonstration or at least illustrations, that was the only part that

>> seemed unclear to me.

>>

>> a few comments:

>> UB54 is now generally known as UB40, the order of the points on the

>> Foot Taiyang Bladder channel has been altered from earlier texts.

>> This makes little difference unless you are trying to communicate

>> with acupuncturists from outside of Asia who learned TCM in the last

>> 10 or so years.

>>

>> Points to avoid in pregnancy differ according to different sources.

>> Some sources mention GB21 as a point to avoid, as strong stimulation

>> there seems to have a strong effect on the uterus.

>>

>> One point you might want to include is P6, which is easy to locate

>> once you've found T5 (en el lado opuesto), and is very effective for

>> nausea and generally thought of as safe in pregnancy. It is also

>> effective for insomnia, desmayo, cardiac and digestive problems. If

>> you wanted to make an even dozen points, I'd say why not throw in

>> Liv3... ;o)

>>

>> Where did you get the point selection for MS?

>>

>> Thanks for sharing this, I really enjoyed reading it.

>>

>> take care,

>> robert hayden

>

August 31, 2002

Rey can you email me the article you posted at alonmarcus as I could not get into

Thanks

alon

September 2, 2002

Dear Mr. Wasserman,

Your question is very timely indeed for here in Australia , parliament is considering a bill to cap medical indemnity compensation in the light of the public liability insurance crisis.

First of all, the text in question is in a termporal sense a 'modern' text.

Second, the text cited are conclusions from three clinical case studies involving the proceedure of using acupuncture points supposedly 'contraindicated' for use for pregnant women.

Thridly, I cited this text precisely to debate the whole issue of 'contraindication' and 'indication' of the use of acupuncture points vis-a-vis clinical conditions involving pregnant women. As stated in my original post, the issue currently is still very " murky " . Through open debate, related issues can be professionally and openly discussed . If the discussion could not settle the matter, then this could open avenues for future research. It is a question of finding out the 'practical science' behind this complex phenomenon.

If anything the publication of this text can only shed light to the " hairy situation " that is keeping everyone in the dark.

Regards,

Rey Tiquia

Chairperson

Alliance of Association of Australia

----------

" Wasserman " <danjan18

Re: Contraindicated points during pregnancy

Fri, Aug 16, 2002, 3:07 AM

What about from a legal/perceived liability point of view. If, say, a woman were to spontaneously abort after 'tonifying' he gu or 'sedating' san yin jiao even when appropriate, couldn't this put the practitioner into a hairy position trying to explain why he/she used points that are 'contraindicated' in virtually every modern text? This would apply to the use of blood-invigorating herbs during pregnancy, as well?

-

rey tiquia <rey

Cc: hrv <hrv