In Chinese medicine, treating pregnant women from fertilization to the successful birth of a healthy baby is an art form. It relates to the typical imbalances and different gestation phases through nutrition, acupuncture, herbs and touch therapy. The teachings of renowned doctor Sun Si Miao include among other things, nutritional recommendations and good habits to follow during each month of gestation. He also teaches about which organ and path feed the fetus, and provides insight to the delicate and subtle Chinese humor and manner of thought which are entwined in the ancient text.
Risk of miscarriage
Subclinical miscarriage defines a pregnancy which is lost before the fertilized egg cell attaches to the uterine wall or during the first two weeks after implantation. Clinical miscarriage defines a pregnancy which is lost after the HCG hormone is discovered in the blood and urine or after the pregnancy sac and fetal heart rate are discovered in an ultrasound. Many factors are at play in successfully maintaining a healthy pregnancy to term. The quality of the sperm and ovum of the future parents will greatly determine the embryo’s ability to survive.This quality depends on their age, habits, nutrition and general health.
Most miscarriages in the first trimester happen because of chromosomal abnormalities in the fetus, so abortion is how the female body prevents the development of a genetically defective fetus. It is impossible to prevent the miscarriage in this situation, despite efforts to save the pregnancy. When the fetus develops properly and a miscarriage occurs, the possible reasons are hormonal imbalance, immune system imbalance or emotional imbalance of the mother.
Nutrition in pregnancy
Nutrition during pregnancy is a busy topic, for obvious reasons: the woman’s altered sense of taste and smell, nausea and/or vomiting during the first trimester, heartburn, feeling internally hot, craving specific flavors, increased appetite to supply energy and the building blocks for the developing fetus, as well as emotional eating as a way for coping with the stress.
It is therefore important to find the right balance between the preferences, cravings and needs of the pregnant woman. Generally, no food is forbidden during pregnancy, but in some situations, it’s a good idea to talk about quantities and how much you should eat from a specific food.
For example, a typical desire for dry food, such as toasts, crackers and puffed rice cakes indicates there may be a deficiency in spleen function (Spleen Qi Deficiency), an organ that “loves” dryness and “hates” dampness; while the craving for cold cooling food, such as yogurt and fruit indicates the liver may be stagnant and overheated (Liver Qi Stagnation + Heat).When these two conditions occur simultaneously, we will use nutrition to strengthen Earth (spleen energy) and balance Wood(liver energy), first by eating cold grain salads and spelt flour or rye crackers, and gradually increasing the intake of cooked food to support spleen Qi along with green salads to balance the liver.
During pregnancy it’s important to maintain the delicate balance between the forces that support fetal growth in the womb, pelvic expansion and loosened tissues in lower body organs, with the forces that center the fetus and fight gravity’s pull while also contracting the cervix. Possible expressions of over-expansion during pregnancy are extreme weight gain, accumulated dampness in the lower body parts, edemas, bulgy and swollen blood vessels, effaced and/or partially dilated cervix, extreme weakness and a sensation of a downward pull. The forces of expansion and upkeepare somewhat affected by the latent power in food, a power directly expressed by the taste of food. Sweet taste encourages growth, expansion and laxation processes in the body, while salty taste promotes constriction and tightening. When laxation is excessive, it is advisable to minimize the intake of expanding foods, such as vegetables from the nightshade family of plants, tropical fruits and fruit juices, very sweet food and artificial sweeteners, soft and sweetened dairy products, sodas and beverages, alcohol, preservatives and food coloring. When a pregnant woman is excessively lax and prone to miscarriage, it is preferable to eat saltier food almost up until the pregnancy’s term.
Reasons for miscarriage
Chinese medicine relates clinically to a state of vaginal bleeding during pregnancy (Tai Lou) and a state of “restless embryo” (Tai Dong Bu An). In both conditions the fetus is still unharmed and the pregnancy can be saved.
Possible reasons for miscarriage:
Kidney Yang Deficiency which is expressed by impaired Chong Mai and Ren Mai:
A Kidney Yang Deficiency diagnosis is a common cause of subclinical miscarriage, i.e. before implantation or during early pregnancy. Symptoms in this condition include spotting or vaginal bleeding, lower back pain, painful legs, frequent urination, pale tongue, and pulse diagnosis will indicate a weak and soft pulse of the Kidney position.There may be a hormonal link to corpus luteumfailure and to low levels of progesterone.
This condition can be diagnosed through facial diagnosis: dark or blue coloration around point BL-1, hinting to cold ovaries; darkened or swollen lower eyelids, reflect the condition of the kidneys; darkened skin around the mouth, reflects the state of the liver; general aversion to cold, cold abdomen and cold feet.When the woman feels uncomfortably cold, treatment should focus on keeping the feet warm by bathing them in warm water and wearing thick socks, and maintaining the temperature of the womb by wrapping a woolen scarf around the waist area (imitating the Japanese haramaki, a thick “belly band” for the Ming-men area).Duringthe summer, it isn’t rare to see a pregnant woman dressed in sandals and a waist-length shirt which leaves the lower abdomen and back exposed, and yet, despite the hot weather, her feet are frozen and her abdomen feels cold to the touch). Despite the heat outside, there is lack in internal Yang, therefore warming is essential.
Formation of life on Earth is dependent upon heat (Yang) and dampness (Yin). The lining of the uterus enables the growth and development of the embryo when appropriate conditions of heat and blood flow are present.After the egg cell is implanted in the uterine wall, progesterone secretion from the corpus luteum is responsible for feeding the developing embryo via the uterine wall and for raising the mother’s temperature. In early pregnancy, the progesterone and heat will cause uterine lining adherence in order to hold the fetus in place. It is therefore clear that heat – physical heat, nutritional heat and most importantly, mental heat – is essential for successful egg cell implantation as well as for the entire pregnancy.
When Kidney Yang Deficiency is diagnosed in a pregnant woman with risk of miscarriage, nutritional therapy becomes highly significant and a priority, especially when the woman’s nutrition is based on cold food which in itself negatively affects Yang.One of the possible reasons for craving cold cooling food, as you may recall above, is the condition of Liver Qi Stagnation + Heat. Cold nutrition alleviates heat in the liver but doesn’t necessarily solve the stagnation, particularly when the diet is based on dairy products.Additionally, the cold gets in the way of the body’s efforts to maintain a proper level of heat in the lower body, for the development of the fetus.
To treat this condition we will choose food that strengthens Yang andcontributes to the body’s heat and helps strengthen the lining of the uterus around the embryo to prevent miscarriage. Food should be cooked for at least 40 minutes, to imbue the heat from cooking into the food and more oil and salt should be used.Eating salty food will provide the kidneys with the nutrition they need to increase inner fire and physical heat.
Sweet rice – is a type of brown rice. It’s warmer and stickier than round rice. It easily collects and absorbs and is ideal for Kidney Yang Deficiency condition with signs of seepage but without signs of dampness (spontaneous cold sweat, diarrhea, increased and urgent urination, weakness in the limbs).The rice can be toasted before cooking to reinforce its absorption and contraction effects.
Buckwheat – a heating and drying grain, with adsorption, drying and strengthening qualities. Buckwheat is suitable for the condition of Kidney Yang Deficiency with signs of accumulated dampness and fluids, swollen ankles (edema), heaviness, weakness and cold.Buckwheat contains rutin, a flavonoid that strengthens the lining of blood vessels and prevents bleeding. It’s effective when there is risk of miscarriage with gestational diabetes in the background or initial hypothyroidism with Kidney Yang Deficiency in the background and signs of excessive dampness and cold.
Adzuki beans –sweet and sour taste with a drying effect, prevent blood accumulation in the lower body parts, stop bleeding and support the activity of the adrenal gland. For Kidney Yang Deficiency with swelling, edemas and bleeding from the uterus, it is recommended to toast the adzuki beans and grind to powder.Sprinkle the powder over food as a spice or drink it as a concentrate in a glass of water. Also effective with diagnosis of gestational diabetes with signs dampness and cold, and is a good source of iron and treats anemia.
Salmon– strengthens Yang and is recommended for weakness, fatigue and anemia. It is advisable to prepare broth from salmon head.
Spleen Qi Deficiency expressed by Qiand blood weakness
Spleen Qi Deficiency is a common reason for clinical miscarriage in the first trimester. The symptoms in this condition include abdominal strain accompanied by a feeling of a downward pull of the stomach and lower back, fatigue, paleness, blood spotting and possibly palpitations. The pulse is thin and weak and the tongue is swollen and/or pale. Blood test hemoglobin level is low and the cervix may be effaced or dilatedin a gynecological examination. In this case the cervix is often stitched in order to keep it closed until the pregnancy reaches its term.
This syndrome can be confirmed through facial diagnosis, when the upper eyelids and/or temples are darker, or paler and bluish in color which reflects a weakened spleen/pancreas.
It’s natural to feel fatigue or tired in the first trimester and sometimes during the entire pregnancy, and it is also common to find physiological anemia in the blood. The woman’s Qi and blood energies are focused on feeding the growing baby’s needs above the mother’s needs.Fatigue and weakness are natural at this stage and should help the mother slow down and adapt to her new condition. Long hours at work, stress, strain and worries, ambition, lack in sleep, intensive physical activity, raising older children, cleaning the house and irregularcold (not cooked) food will deplete the mother’s resources faster than an avalanche, leading to Spleen Qi Deficiency and may even cause fetal distress. During pregnancy, a woman may want to slow down a notch, not work late, sleep early, not over-do it with physical activity and focus more of her attention on the process occurring in her uterusand body. For this condition, choose foods and a cooking style that will reinforce the element of Earth and the spleen. To strengthen the Earth element, drinks should be hot and food should be cooked and eaten warm, without salads or cold food. Grains are the main food group for strengthening the Earth element. It’s important to eat small organized meals that include grains throughout the day. A small amount of grains “cooking” in the stomach during the day provide strength, stability and security. In extremely harsh situations of weakened Earth element, nutrition should begin with rice congee (porridge) made from 1 cup grains and 6-8 cups water, slowly cooked for several hours. Whendigestion is very weak, it is recommended to cook white or brown rice congee, and then strain it through a cheese cloth to receive a creamy rice dish. Food should be slightly sweet and of earthy colors, round orange vegetables like pumpkin and carrots, and preferably cooked in crockery over medium heat.
Spleen Yang Deficiency and Kidney Yang Deficiency diagnoses are similar and will often occur simultaneously to some degree. Therefore, the above nutritional recommendations for Kidney Yang Deficiency are closely suitable for treating Spleen Yang Deficiency, although a call should be made as to which of the conditions is more prominent, and the more relevant advice should be emphasized.
Millet – expresses the Earth element in its round shape, yellow color, sweet/bitter/salty taste and drying quality. Millet solidifies and concentrates the element of Earth, its drying and warming qualities improve the spleen’s transformation and transportation functions. The contracting and absorbing qualities of millet are used for pregnancy maintenance in edematous women with a tendency for recurrent miscarriages with uterine bleeding or premature water breaking, as well as for conditions of excessive amniotic fluid or fetal hydrocephalus.
Galangal (Hulinjan Root)– is a plant in the ginger family which is commonly used in Thai and Indonesian cuisine as a spice. It also appears in the internally warming group (Gao Liang Jiang) in Chinese medicinal herbsliterature. The galangal is spicy, with a warming effect on the spleen and stomach and it also warms the uterus. Galangal is effective for bothKidney & Spleen Yang Deficiencyconditions accompanied by chills, stomach and lower back pain and diarrhea. Galangal can be purchased as dried slices which can be added when cooking soup or porridge, or grated over food or brewed as tea.
Heat in the Blood and/or blood stagnation
The most common cause of heat in the blood and risk of miscarriage are Kidney Yin Deficiency and empty heat that dries the blood and endometrium and may cause blood stagnation in the womb and uterine bleeding. Kidney Yin Deficiency is more common in women nearing 40 and expresses the body’s dwindling resources over the years, as a result of an exhausting lifestyle, hard work and stress, without enough time allocated for rest, nutrition and the recovery of body and mind. Other reasons for heat in the blood areLiver Fire which harms the endometrium and destabilizes the Qi of the heart. Liver Fire can develop due to underlying uncontrolled anger, alcohol consumption, smoking, using drugs and very warming and stagnating nutrition that includes many spices, spicy-hot fried food, low quality oils, barbecued meats, using too much salt, over consumption of cheeses and creams, eggs, nuts and nut butters (peanut butter, sesame paste) while at the same time not consuming enough vegetables and fluids.
Symptoms include uterine bleeding (the blood is fresh and red), feeling hot and restless, thirsty, constipated with hard dry stools, sparse and dark urine, fast and shallow heartbeat and a red tongue. Facial diagnosis may show cracks and red coloration between the eyebrows (liver); reddish/purple capillaries may appear in the lower eyelid area (kidneys), the internal nostril lining (womb and endometrium) and the chin (womb and cervix).
Nutritional therapy should include food that will help cool the blood, move it when stagnant, feed Yin and calm the heart and mind. Cooking methods for this purpose are short, by steaming or cooking in boiling water for 15 minutes. Grains should be soakedin water before cooking, legumes should be sprouted and veggies should be a key ingredient in the diet. It’s good to remember that for a pregnancy to survive it requires proper physiological heat, which is why proper cooling is necessary as is a change in the therapeutic strategy at the right time.
Black beans – cooling effect, sweet tasting, providenourishment to Kidney Yin and body fluids.Black beans have an absorbing quality and an inner pull effect; they stop uterine bleeding in a state of Kidney Yin Deficiency and empty heat which are concomitant to lower back and knee pain, nose bleeds, hemorrhoids and loss of voice.To feed Kidney Yin, it is advisable to prepare a black beans drink from one cup of beans cooked in five cups of water for one hour. Drink half a cup of the cooking water half an hour before eating.
Spinach – sweet tasting with a cooling and dampening effect. Suitable for blood heat due to Kidney Yin Deficiency and signs of dryness such as thirst, nose bleeds, constipation and hard dry stools, difficulty passing urine and gestational diabetes due to Yin deficiency. Spinach stops bleeding, cleanses the blood from heat and works to reduce blood acidity due to excessive consumption of animal protein. When prone to over coagulation or when taking blood thinning drugs, spinach is not recommended because of its high vitamin K content.
Eggplant – a member of the nightshade family. Has a cooling and drying effect, tastes sweet, astringent and bitter. Effective when there is blood heat and blood stagnation due to Liver Fire, cools the blood and prevents blood stagnation in the lower body and especially in the uterus.Eggplant decreases the chance of blood clots, and is more suitable for treatment when the pregnant woman has a craving for eggplants.
Saffron – known as Hong Hua in Chinese medicine herbology, it is slightly warming,spicy and affects the heart and liver. At a high dose, it moves stagnated blood in the uterus.At a low dose, as is popular in nutrition, it gently movesthe blood without drying or harming Yin.Saffron has a positive relaxing effect on the mind.
When there is risk of miscarriage, most Chinese medicine therapists (rightfully) choose medicinal herbs and acupuncture as treatment. However, nutritional therapy is prepotent and often has a surprisingly fast effect. In contrast to medicinal herbs and acupuncture, nutrition acts as a safety net, providing support with every bite throughout the day.Nutritional therapy is especially significant when the woman’s diet is part of the root cause of the situation.
The treatment ideas described in this article provide a glimpse into the world of nutritional therapy according to Chinese medicine but they are not offered as medical recommendations and they must not be leaned upon as a source of complete information for treating the risk of miscarriage.
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- Jane Lyttleton, Treatment of Infertility with Chinese Medicine, Churchill Livingstone, 277-298
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- MichioKushi, How to See Your Health: Book of Oriental Diagnosis, Japan Publications, 31
- Giovanni Maciocia, Obstetrics and Gynecology in Chinese Medicine, Churchill Livingstone, 473-482
 Ovarian tissue which is formed from the residue of the ovulating follicle and is responsible for progesterone secretion