Acupuncture Gynecology Dong

 

Acupuncture in Gynecology and Obstetrics

Dr Hongguang Dong Geneva Gen eva Uni Univer versity sity Hos Hospit pital, al, Switzerl Switzerland and

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Physiological and pathological characteristics of women •

Physiology: Menstruation, Menstruati on, pregnancy, delivery and childfeeding

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pathology disorders of menstruation, leucorrhoea (excessive vaginal discharge), pregnancy and delivery

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Base of Reproduction •

Bao Gong -Uterus

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Tian Gui Qi and Blood: Material Base Zang Fu: Source of Qi and Blood Extraordinary Vessels

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Qi, Blood, Zang Fu, Meridians and their relation with physiological activities of women

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Bao Gong –   – Uterus: Extraordinary Gong – Uterus: •

Uterus: Zi bao, Nu zi Uterus: Zi zi bao, Zi zang, zang, Zi chu,  Zi Gong 

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Position :

 –  Between guan yuan (Ren 4) and qihai  –  Lower Field of

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(Ren 6)

Elixir ( Dan Tian «Ren 5»)

zhang jing yue (1563-1640)

Linked with kidney via a channel called Uterus channel Bao channel Bao luo linked with heart via a channel called Uterus vessel  Bao mai 

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Bao Gong – Uterus: Extraordinary Function:

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A Installing: store essence and blood for menstruation and conc nceeiv iviing fet etu us, li like Zang   Zang o orga gans ns:: five za zang ng or orga gan ns aree sol ar solid id,, ins insta tall llin ing g bu butt not not di disc scha harg rgin ing g (e (ess ssen ence ce,, bloo blood) d)

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B Ex Excr cret etio ion: n: di disc scha harg rgee of me mens nstr trua uati tion on or de deli live verr ba baby by similar   Fu  Fu orga or gans ns: son ix tent funtor fu orga are ar e stal hoalli holl llow ow, disc di scha harg rgei eing ng thei th eir r: csix onte bgans but utns not not inst in ling ng.,.

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Physiology of menstruation in TCM The first chapter of Huang Di Nei Jing In general, the reproductive physiology physiology of woman is such that that at seven seven of of age her her kidney kidney beco become me full,... full,...;; at 14 years years the the Tian Tian gui gui come comess into into play, play, Ren mai circulat circ ulating ing strongly strongly (open) (open),, Chong mai is flourish flourishing, ing, the menses arrives and in regular interval, thus the conception is possible;…

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Tian Gui 

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Fu qing zhu (qing): menstrual blood, blood, not blood but Tian gui, which originate from the kidney yin with the participation of heart, spleen and liver.

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Xie ZF : Sex-stimulating essence of both sexes. (Xie ZF, In: Classified Dictionary of sexes. TCM)

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Tan Gui jiebin: yin qi, qi, Tian yi zhi yin qi •  Zhang jiebin: shi (ming): yin Jing, Jing, produce by kidney, •  Ma Gui:10th stem, pertain to water, is accumulation of congenital essence. Xue: congenital water, water, Xian Tian zhen •  Xue Xue: shui

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Functions of kidney •

Stores the essence of life, either inborn or acquired.

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In charge of reproduction, growth and development; Control Bones, fill up the brain, produce Marrow; Helps He lps the the ‘lun ‘lung’ g’ to inha inhale le air; air;

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Kidney refers to Western medicine •

Reproductive system

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Urogenital system Endocrine system Part of the immune system the higher nervous system

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Physiological activities of women with Zang Fu Kidney

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Store essence-material essence-material basis for formation of menstrual blood ;

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Formation of Tian Gui

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Physiological activities of women with Zang Fu Liver store the blood, ensures the smooth flow of qi. blood deficient  deficient : scanty periods, later periods or •  Liver blood amenorrhea.

qi regular the cycle and blood volume •  Liver qi regular •  Liver qi stagnation stagnation:: irregular menses; premenstrual syndrome; dysmenorrhea, amenorrhea.

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Physiological activities of  of women women with Zang Fu Spleen Produces Gu qi (Food (Food qi ) which is the basis for form fo rmat atio ion n of bloo blood, d, co cont ntro rols ls bl bloo ood. d.

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Spleen qi controlling blood in the vessel (if Spleen qi is is deficient, deficient, blood spill out the the vessels, vessels, resulting hemorrhages).

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Spleen qi keep keep uterus uterus in place, place, deficient of spleen spleen qi cause prolapse.

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Physiological activities of  of women women with Zang Fu and Extraordinary vessel Heart governs the blood Lung contributed to produce blood Chong mai Sea of the blood Ren mai Du mai 31/01/04

Sea of yin meridians Sea of yang meridians AGMA

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Extraordinary meridian •

Du Mai

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Ren Mai Chong Mai The same source Huiyin (Ren-1) (Three branches of one vessel)

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Four phases of the menstrual cycle •

Menstrual phase: Blood moving, required free flow of liver qi and blood ( move blood if period scanty, decrease bleeding if it heavy)

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Post-menstrual phase: phase:  blood and yin relatively empty, empty, Ren and Chong mai depleted. (Nourishing blood and yin «liver and kidney»)

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Mid-cycle phase: phase:  blood and yin fill up in Ren Ren and Chong mai (promote

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Pre-menstrual phase: Yang qi rises and liver qi moves in prepare for the

ovulation by nourishing the essence «kidney-Yang»)

 period (Tonify yang qi if it deficient, move move live-qi if it it stagnant

Giovanni Maciocia . Obstet & Gyne in Chinese medicine

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Xue - Blood The concept of blood in TCM is not completely the same as it is in Western medicine does. Blood is a vital nutrient substance in the body. It is formed from the combination of essence of food, which derived via digestion and absorption by spleen and stomach, and fluids containing nutrients. Kidney also contributes to the formation of blood as kidney storing essence that produces bone marrow. After being formed, blood circulates in the vessels throughout the body, promoted by the heart with the help of lung, controlled by the spleen which keeps blood flowing within the vessels and regulated by the liver as a reserve.

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Blood is essential essence The nature of women are belong to yin and Blood is essential to women. Menstruation is transformed from blood; fetus depends on blood to nourish and milk relies on blood to produce. Blood is easy to be consumed by the menstruation, pregnancy, labour and lactation, eventually leading to relative hyperactivity hyperacti vity of qi qi due to defici deficiency ency of of blood. blood. “lin “l ing g shu: shu: wu yi yin n wu wu we wei: i: wo woma man n is is bor born n con const stit itut utio iona nalllly y , excessive exce ssive in qi qi and insu insufficie fficient nt in in the the blood blood,, as in women’s women’s life there are many occasion to lose blood.”

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Types of Qi and their origins Lungs  process air 

Spleen  process  food 

Ying Qi  Nutritive Qi 

Kong Qi  Air Qi 

Zong Qi Gathering 

Zheng Qi  Normal 

Zang Fu Zhi Qi

Qi 

Qi 

Organ Qi 

Gu Qi

Wei Qi  Defensive Qi 

Grain Qi  Yuan Qi Original  Qi 

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Pathological characteristics Cause disease

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Six Si x ex exog ogen enou ouss pa path thog ogen enic ic fa fato tors rs

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Improp Impr oper er di diet et Overstrain

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Excessive Excess ive sexual sexual int interc ercour ourse se Incised wound and wound due to insects and animal attack 

Seve Se ven n em emti tion onss

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Pathological characteristics Pathogenesis

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Dysfunction of Zangfu Disorder of qi and blood Impairment of the Chong, Ren, Du and Dai Mai

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Infertility Thee st stan anda dard rd me medi diccal def efin init itio ion n of in infe fert rtil ilit ity y is th thee in inaabi bili lity ty  – Th of a cou coupl plee to con conce ceiv ivee af afte terr 12 mon month thss of int inter erco cour urse se wit witho hout ut the use of cont contrac racept eption ion..

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Ovulation induction •

Stener-Victorin Stener-Vic torin et al: Effec Effects ts of ElectroElectro-acupu acupunctu ncture re on anovula anovulation tion in women women with polycystic ovary syndrome. Actaa Obs Act Obstet tet Gen Genera erall Scand. Scand. 2000 2000 Mar;79 Mar;79(3) (3):18 :180-8 0-8..

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Stener-Victorin et al. Effects of electro-acupunctur electro-acupuncturee on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Repro Reprod. d. 2000 2000 Nov;6 Nov;63(5):1 3(5):1497-5 497-503 03

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Chen BY. Acupuncture normalises dysfunction of hypothalamic-pituitaryovarian axis. Acup Ac upun unct ct El Elec ectr trot othe herr Re Ress 19 1997 97;2 ;22( 2(2) 2):9 :977-10 108 8

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Ovulation induction

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Chen BY, Yu J. Relationship between blood radioimmunoreactive  beta-endorphin and hand skin skin temperature, during the electroacupunctu acupun cture re ind induct uction ion of ovu ovulat lation ion.. 1991;16(1-2):1-5.

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Acupun Acu punct ct Ele Electr ctroth other er Res Res..

Yu J et al: Changes in serum FSH, LH and ovarian follicular growth growt h during Electroa Electroacupu cupunctur ncturee for induction induction of ovulation. ovulation. Zho Zh ong Xi Yi Jie He Za Za Zh Zhii 19 1989 89 Apr pr;9 ;9(4 (4): ):1 199 99-2 -20 02, 19 195

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Infertility •

Stener-Victorin E: Reduction of blood flow impedance in the uterine arteries arteries of  infertile women with Electro-acupuncture Electro-acupuncture.. Hum Reprod 1996 Jun;11 Jun;11(6):13 (6):1314-7 14-7

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Gerhard I et al: Auricular acupuncture in the treatment of female infertility. Gyneco Gyn ecoll Endo Endocri crinol nol 199 1992 2 Sep Sep;6( ;6(3): 3):171 171-81 -81

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Analgesia in IVF

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Stener Ste ner-Vi -Victo ctorin rin et al: A prospe prospecti ctive ve random randomize ized d study study of electro electro-acupuncture acupunctu re versus versus alfentanil alfentanil as anaesthe anaesthesia sia during during oocyte aspiration in in-vitro fertilisation. LI4 TE5 ST29 GV 20 ST 36

 Hum Reprod 1999 Oct;14(10):2480-4

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Influence of acupuncture on the pregnancy rate in IVF 160 pa parrtic iciipa pan nts wer eree di div vid ided ed int nto o two gr gro oup ups, s, eac ach h recei re ceivin ving g a sta standa ndard rd inin-vit vitro ro pro proced cedur uree (I (IVF) VF)..

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(IVF (I VF)) On Only ly 26 26.3 .3% %

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Paulus Paul us W et al, al,.. in pati patien ents ts who who un unde derg rgo o as assi sist sted ed re repr prod oduc ucti tion on therapy. thera py. Fertil Fertil Steril Steril.. 2002 Apr;7 Apr;77(4): 7(4):721-4 721-4..

IVF pl plus us Ac Acup upun unct ctur uree 42. 42.5% 5%

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Influence of acupuncture on the pregnancy rate in IVF Pre-trans Pre-tr ansfe ferr poi points nts:: PC 6, Sp-8 Sp-8 Dij Diji, i, Liv Liv 3, GV20 GV20 Bai Baihui hui,, SP29 guilai Post –tra –transfe nsfer: r: ST 36, SP 6, 6, SP10, Li4-i Li4-inhib nhibitin iting g uterus uterus motility Auricular: 55-Shen men, 58-Zigong, 22 Neifenmi,, 34 Naodian  Neifenmi

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Reviews: Acupuncture in infertility Modification of semen quality (low sperm count and poor motility)

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Crimmel Crimm el AS, J Androl. Androl. 2001 2001 Mar-Apr;22 Mar-Apr;22(2):17 (2):173-82. 3-82. Review Review

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Siterman Arch Androl Siterman Androl.. 1997 Sep-Oct Sep-Oct;39(2 ;39(2):155):155-61. 61. Urolog Uro logee A. 1984 Nov;23 Nov;23(6) (6):32 :329-3 9-33. 3.

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Crimmel AS et al: Withered Crimmel Withered Yang: Yang: a review of traditiona traditionall Chinese Chinese medical treatment of male infertility and erectile dysfunction

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J Androl Androl 200 2001 1 Mar-Apr; Mar-Apr;22( 22(2): 2):173 173-82 -82

Siterm Sit erman an SAn SAndro drolog logia. ia. 2000 2000 Jan; Jan;

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Anti-emetic • •

Preoperation: Preoperati on: Kota Kotani ni N et al. Preop Preoperati erative ve intra intraderma dermall acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirem analgesic requirement, ent, and sympathoa sympathoadrena drenall resp responses onses Anaest Ana esthes hesia: ia: Som Somri ri M et al. Acu Acupun punctu cture re ver versus sus ond ondans ansetr etron on in the prevention of postoperative vomiting. A study of children undergoing dental surgery. Anaesthesia 2001 Oct;56(10):927-32

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Anti-emetic •

Pregnancy: Knight B et al. Effect of acupuncture on nausea of  pregnancy: a randomised, randomised, controlled trial. Obst Ob stet et Gy Gyne neco coll 20 2001 01 Fe Feb; b;97 97(2 (2): ):18 1844-8 8

Chemotherapy-i Chemother apy-induc nduced ed neme nemesis: sis: Shen J et al. Elect Electroac roacupunc upuncture ture for control control of myel myeloabla oablative tive chem chemother otherapy-i apy-induc nduced ed emesis: emesis: A randomised controlled trial JAMA2000 Dec 6;284(21):2755-61

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Breech Presentation

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Overview Breech presentation Epidemiology: Epidemiolo gy: incidence of breech presentation •

Week 30 gestation: 25% of all pregnancies Most undergo spontaneous version at 32-34 weeks

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Term: 3-4% of all pregnancies

Types

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Frank Breech (45-50%) : Hips flexed ; Knees extended Complete Breech (10-15%); Hips flexed; Knees flexed f lexed Footling Breech or Incomplete Breech (35-45%);One or both thighs extended

External cephalic External cephalic version version :Suc :Success cess rate is around around 50% 50% 70% 70% 31/01/04

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BL--67 Zhiyin Moxibustion BL BL-67 :

• Op Opti tima mall tim time: e: at th thee be begi gini ning ng of 34 34th th.. Unti Untill ll 37 37th th ge gest stat atio ion n Techni hnique que:: Moxibut Moxibution ion at BL-6 BL-67, 7, 15-20m 15-20min in/d /d for 10 days days • Tec « Huo zu qi dao, sh shi neng qiu yu »-Golden mi mirror of medicine

• Scar moxa is the best ???

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Mechanism Moxa on BL-67

Increa Inc reased sed pla placen cental tal E2

adrenocorti adreno cortical cal stim stimulati ulation on

Change Cha nge in pro prosta stagla glandi ndin n levels

Increased myometrial sensitivity

Increased myometrial contractility

Incr In creease sed d fe fettal he heaart ra ratte an and in inccre reas aseed fe feta tall acti tiv vit ity y

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Literature reviews: acu-moxi-BP •

Cardini F et al Moxibustion for correction of breech presentation: a randomised controlled trial. week k of ges gestati tation on Subjec Sub jects:2 ts:260 60 of Pri Primig migrav ravida idas. s. Tre Treatm atment ent:: mox moxibu ibusti stion on at the 33t 33th h wee Resu Re sult: lt: the the 35 35th th wee week k of gest gestat ation ion,, 98 (75 (75.4 .4%) %) vs 62 62 (47. (47.7% 7%))

JAMA 1998 Nov 11;280(18):1580-4

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Neri I et al No Neri Nonn-st stre ress ss te test st ch chan ange gess du duri ring ng ac acup upun unct ctur uree pl plus us mo moxi xibu bust stio ion n on BL67 BL67 point point in breech breech pres presenta entatio tion n J Soc Gynecol Gynecol Invest Investig. ig. 2002 2002 May-Jun; May-Jun; 9(3): 9(3): 158-62