Polyhydramnios and Koi

Polyhydramnios is a condition of pregnancy in which a woman develops excessive amniotic fluid. Though this condition may be associated with maternal diabetes, Rh incompatibility, or congenital malformations, in 60% of cases, the cause is unknown from a western perspective. It is also unclear to what extent the polyhydramnios causes fetal abnormalities. It occurs in 1 out of every 150-280 pregnancies. Polyhydramnios predisposes a woman to abnormal fetal presentation, pre-term labor, dysfunctional labor, postpartum hemorrhage and cord prolapse upon rupture of the membranes. There is no western treatment for this condition other than resting. In extreme cases fluid may be drained via amniocentesis but the fluid may return quickly. 
In regard to polyhydramnios, my teacher, Dr. Qiu Xiao Mei writes “The category of the disorder in the traditional Chinese medical texts is “fetal water swelling and distention”. The cause and dynamic of this illness is most often Spleen and Kidney vacuity weakness, with water Qi not transforming. This results in the water pooling in the uterus. In my experience it is appropriate to adopt the principle of fortifying the Spleen, supplementing the Kidneys, disinhibiting water and dissipating swelling”. She offers very effective measures for treating this condition. If you are working with pregnant women, sooner or later someone with polyhydramnios will come into your clinic.  What a blessing!  This is because the methods below are very clear and effective for a dangerous condition that has no other treatment.

Below I have posted a variety of formulas from both Dr. Qiu and Dr. Xia Gui Cheng. Clinically I only have experience with Dr. Qiu’s methods. I have included some cases from Dr. Qiu and one from my own practice in which I utilized her methods. Of course, Dr. Qiu would be the first to say that the practitioner must not give herbal formulas symptomatically or by rote. Rather one must always base treatment on the differential diagnosis of the individual patient.

A pregnant woman’s belly should be taut and firm.  When there is an over abundance of amniotic fluid, the belly feels strange to the touch.  It feels like a water bed or water balloon.  If you should feel a belly like this, it is important to encourage your patient to be checked by her midwife or doctor.  Polyhydramnios can be associated with birth defects so it is also important to check for this.

Formulas

Carp and Radish Drink Li Yu Luo Bo Yin

Herbal Constituents:

Li Yu, Carp One fish (weighing about one Jin or one Pound, remove entrails and scales)

Luo Bo, Radix Raphani, Daikon 120 gm.

Method: Place the herbs in enough clear water to boil. Simmer until done. Drink the liquid as tea and eat the fish and radish. One dose is for one day. Take successively for one week and then use your discretion as to when to stop.

Function: Fortify the Spleen, disinhibit dampness, and scatter swelling

Principle Use: Excessive amniotic swelling and swelling in pregnancy.

Formulas Explanation: If during pregnancy the Spleen and Kidney are both vacuous, the Spleen vacuity leads to water damp failing to move and the Kidney vacuity leads to water Qi not transforming. Water damp accumulates internally. This is called “Fetal Water”. Carp and Radish Soup Li Yu Luo Bo Tang contains Radix Raphani Luo which disinhibits water and seeps out dampness. Caro Carpionis, Li Yu fortifies the Spleen and boosts the Kidney, disinhibits damp and scatters swelling. This prescription is simple yet has great effectiveness. Furthermore it is a marvelous food. It is worthwhile as a medicine because it doesn’t obstruct the fetal source and it reaches all the way to treat the pathogen.

San Yin Li Yu Tang (3 Reason Carp Soup)

Li Yu (carp 1 fish (1-2 lb)
Bai Zhu 6
Fu Ling 6
Dang Gui 4
Chao Bai Shao 6
Chen Pi 4.5
Sheng Jiang 3 pieces

Wu Pi Yin

Sheng Jiang Pi 9
Sang Bai Pi 9
Chen Pi 9
Da Fu Pi 9
Fu Ling Pi 9

Quan Sheng Bai Zhu San (Whole Life Atractylodes Powder)

Bai Zhu 30
Sheng Jiang Pi 3
Chen Pi 3
Da Fu Pi 6
Fu Ling Pi 6

San Dou Yin (3 Bean Drink)

Chi Xiao Dou 30
Lu Dou 15
Hei Dou 15
Gan Cao 3
Hong Zao 30

Dr. Xia’s Jia Jian Qian Jin Li Yu Tang

(1000 pieces of gold carp soup)(from Important Formulas Worth a Thousand Gold Pieces for Emergency) combined with Fang Ji Huang Qi Tang

Dang Gui 10
Bai Zhu 10
Bai Shao 10
Gou Qi Zi 10
Fu Ling 15
Fang Ji 10
Huang Qi 10
Li Yu 1 fish

 

Cases

Sharon’s Case

Main Complaint: C came to see me when she was 34 weeks pregnant. She had just been diagnosed by ultrasound with polyhydramnios. Much to her dismay, her midwife contraindicated her for home birth because of the risk factors associated with her condition. At the time of her first visit, C was 32 years old. This was her third pregnancy.

History: 2 years before this pregnancy, while traveling, C’s digestion became very irregular. At that time she experienced severe bloating, gas and loose stool. She described her energy at that time as low and “muzzy” and worse in the morning. She was diagnosed by a variety of practitioners with the following conditions:
 Candida, for which she went on a yeast free diet and then a macrobiotic diet 
Irritable bowel syndrome, for which she was given a homeopathic remedy.
 Parasites for which she took Flagyl
. She also tried grapefruit seed extract, ginger and garlic.
 In spite of the treatments, her symptoms continued to varying degrees to the present time. In the second month of her pregnancy she said her “system crashed”. In addition to the above symptoms, she also experienced stomach pain and soreness, increased intensity of bloating with the sensation that her belly was distended and large like a water bed, frequent urination constant nasal congestion and a phlegmy cough. Emotionally she felt depressed, vulnerable and felt that she’d “lost her connection with herself”. Her previous pregnancies she described as wonderful and she was very distressed to feel so lost with this one. C had a history of heavy menstruation with clots. She bled profusely for 5 hours like a hemorrhage. 
Other than this she had been very healthy her whole life. As a dancer, she enjoyed her body’s strength.

Pulse exam showed strong, slippery radial pulses
.  Tongue exam showed a reddish tongue body with red dots. The tongue shape was puffy with scalloped edges. The tongue moss was thick and greasy toward the rear of the tongue.

Differential Diagnosis: Spleen Qi deficiency with an accumulation of dampness in the middle warmer. Qi depression due to dampness leading to depressive heat. 
Diagnosis Explanation: I knew that C had Spleen Qi deficiency because of her scalloped tongue. This helped explain her propensity for digestive disturbance and loose stool. I also knew she had damp accumulation because her fatigue was worse in the morning, accompanied by a “muzzy feeling”, she had water swelling and her tongue body was puffy with greasy moss in the rear section. The damp in her middle warmer was being transmitted to her Lungs causing her nasal congestion and phlegmy cough. The damp accumulation most likely came from both the Spleen Qi deficiency and eating a damp pathogen while traveling. Damp easily obstructs the Qi mechanism. I knew C’s Qi mechanism was disrupted because of the distention, pain and bloating she experienced. The depressive heat in her body was evidenced by her red tongue with the red spots. 
Treatment Principle: Strengthen the Spleen Qi, transform dampness, regulate the Qi of the middle warmer and clear depressive heat. All the while I had to support the pregnancy and protect the baby.
Treatment: For treatment I recommended my teacher’s experiential prescription Carp and Radish Soup, Li Yu Luo Bo Tang.

Also based on Dr. Qiu’s experience with polyhydramnios, I gave C a week’s worth of the following prescription (note that the dosages given are for one week’s worth of herbs)

Da Fu Pi Pericarpium Arecae Catechu 27 gm.

Chen Pi Pericarpium Citri Reticulatae 18 gm.

Su Geng Caulis Perillae 15 gm.

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae(Dry-fried)45 gm.

Hai Er Shen Radix Pseudostellariea Heterophyllae 45 gm.

Fu Ling Sclerotium Poria Cocos 27 gm.

Di Gu Pi Cortex Lycii Radicis 27 gm

.
Lu Dou Semen Phaseoli Radiati (mung bean) 27 gm.

Huang Qin Radix Scutellariae Baicalensis 36 gm.

Huai Shan Yao Radix Dioscoreae Oppositae 27 gm.

Chao Bian Dou Semen Dolichoris Lablab(Dry-fried) 27 gm.

Zhi Gan Cao Radix Glycyrrhizae Uralensis (Honey-fried) 9 gm.

Chi Xiao Dou Semen Phaseoli Calcarati (aduki bean) 36 gm.

Explanation of treatment: Within the above prescription, Bai Zhu, Huang Qin and Zi Su Geng all calm the fetus. Bai Zhu, Shan Yao, Tai Zi Shen and Zhi Gan Cao all strengthen the Spleen Qi. The beans, Bian Dou, Chi Xiao Dou and Lu Dou, as well as the Fu Ling, are all chalky and absorbent and help drain dampness through urination as well as helping Spleen absorb pathological fluids through the digestion. Da Fu Pi and Zi Su Geng regulate the Qi mechanism. Da Fu Pi and Di Gu Pi, as outer peels, also help drain dampness through the urination. Huang Qin, Di Gu Pi, Lu Dou and Chi Xiao Dou all help clear heat. All together this formula matches the treatment principle above.

Treatment Outcome: C drank her herbal decoction twice a day and had a bowl of Carp and Radish soup every day, eating both the fish and the radish. Within a week, C began to feel much better. The bloating, distention and pain were significantly reduced and her bowel movements became formed. Her spirit was hopeful and more connected. Her cough and stuffy nose was completely resolved. I continued the same treatment with minor adjustments. Within three weeks, the previous diagnosis of polyhydramnios was withdrawn after an ultrasound revealed her fluid to be within the normal range. C went on to have a successful home birth at full term. She and her new son were both healthy after the birth.

Dr. Qiu’s Cases

Case 1

Ms. Hu, a twenty nine year old teacher came for her first visit on October 10, 1973. She was four and a half months pregnant. Her abdomen increased in size relatively quickly and is not consistent with her month of pregnancy. An ultrasound examination showed that she had “excessive amniotic fluid”. Ms. Hu’s subjective experience was that her abdomen felt distended and oppressed, her appetite was poor and her urination was scanty. Her pulse was thin and slippery and her tongue body was red and moist. In this case, the Spleen, being vacuous, lost its movement which caused the Qi to stagnate and for the water to pool up. In this way, the fetal water became over abundant. For treatment I used a modified version of Wu Pi Yin Five Peel Drink. I gave her five packages of the following prescription. (Note that in these cases, these dosages are for one day’s worth of herbs)

Tian Xian Teng Caulis Aristolochiae 9 gm.

Da Fu Pi Pericarpium Arecae Catechu 9 gm.

Chen Pi Pericarpium Citri Reticulatae 4 gm.

Su Geng Caulis Perillae 2.4 gm.

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae(Dry-fried) 9 gm.

Sang Bai Pi Cortex Mori Albae Radicis 9 gm.

Ze Xie Rhizoma Alismatis Orientalis 9 gm.

Hai Er Shen Radix Pseudostellariea Heterophyllae 30 gm.

Fu Ling Pi Cortex Poria Cocos 30 gm.

Di Gu Pi Cortex Lycii Radicis 15 gm.

Huang Qin Radix Scutellariae Baicalensis 9 gm.

Zhu Ma Gen Radix Boehmeriae 15 gm.

Second Visit: October 15, 1973. After the herbs, Ms. Hu’s urination became clear and more profuse. Her abdomen was slightly smaller. Her pulse was wiry and slippery and her tongue was red. I continued along the same lines with some additions and subtractions, giving her seven packages of the following prescription:

Hai Er Shen Radix Pseudostellariea Heterophyllae 30 gm.

Sang Bai Pi Cortex Mori Albae Radicis 9 gm.

Huang Qin Radix Scutellariae Baicalensis 9 gm.

Zhu Ma Gen Radix Boehmeriae 15 gm.

Da Fu Pi Pericarpium Arecae Catechu 9 gm.

Tian Xian Teng Caulis Aristolochiae 9 gm.

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae (Dry-fried) 9 gm.

Chen Pi Pericarpium Citri Reticulatae 4 gm.

Di Gu Pi Cortex Lycii Radicis 12 gm.

Su Geng Caulis Perillae 2.4 gm.

Hong Zao Fructus Zizyphi Jujubae 15 gm.

Third Visit: November 3, 1973. Ms. Hu’s urination was still profuse and without discomfort. Her pulse and tongue were as before. For treatment I used Three Bean Drink San Dou Yin and Carp Soup Li Yu Tang. I gave her ten packages of the following prescription:

Chi Xiao Dou Semen Phaseoli Calcarati 30 gm.

Lu Dou Semen Phaseoli Radiati 15 gm.

Hei Dou Semen Glycines Atrum 15 gm.

Gan Cao Radix Glycyrrhizae Uralensis 3 gm.

Hong Zao Fructus Zizyphi Jujubae 30 gm.

As for the Carp Soup Li Yu Tang I instructed her to cook one fish, weighing one Jin, cutting of the head and tail, in a soup with Luo Bo Radix Raphani and to drink it in place of her daily tea.

Forth Visit: December 22, 1973. A check up revealed that Ms. Hu’s abdomen had increased appropriately to her month in pregnancy. I discontinued the herbs though kept her under observation. After a full term, she gave birth and the baby was without irregularity.

Case 2

Ms. Shan, a twenty four year old woman, came for her first visit on March 12, 1948. She was seven months pregnant. Her abdomen was especially large and her urination was scanty. She also felt chest oppression, panting upon movement and low back soreness. Her pulse was slippery and her tongue moss was thin white. This was a case of fetal water swelling and fullness due to Spleen movement loosing its fortification resulting in water pooling in the uterus. For treatment I used San Yin Li Yu Tang Three Reason Carp Soup with added flavors. I gave her five packages of the following prescription:

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae (Dry-fried) 9 gm.

Fu Ling Sclerotium Poriae Cocos Pararadicis 15 gm

Chao Dang Gui Radix Angelica Sinensis (Dry-fried) 9 gm.

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Chen Pi Pericarpium Citri Reticulatae 4.5 gm.

Sheng Jiang Rhizoma Zingiberis Officinallis 3 pieces

As for the Carp Soup Li Yu Tang I instructed her to boil one fish, weighing one Jin, making a clear broth. I had her drink a cup and a half with her herbs on an empty stomach.

Second Visit: After taking the Three Reason Carp Soup San Yin Li Yu Tang Ms. Shan’s urination increased and the amniotic fluid decreased. The size of her abdomen was slightly contracted. The rebellious Qi was also less. Her pulse and tongue were as before. I gave her three packages of the original prescription and instructed her to take one package on intermittent days.

Third Visit: All of Ms. Shan’s symptoms had been eliminated. I urged her to boil a Carp, weighing one Jin, with Luo Bo Radix Raphani and drink the broth every day, not on a fixed schedule, for four days. After a normal delivery of a single child, the baby was without abnormalities.

Case 3

Ms. Yang was thirty-one years old when she came for her first visit on May 10, 1979. She was early in her pregnancy, just two months along and had suffered from relatively acute vomiting, dizziness, chest oppression, poor appetite and back soreness as if her back was broken. She had been pregnant two times in the past and both times suffered from excessive amniotic fluid. The first child died at seven months of pregnancy and the second child died at five months of pregnancy. Her pulse was thin and relaxed and her tongue moss was thin white. Both the Spleen and Kidneys were vacuous and the fetal Qi was not harmonized. It was essential, in this case to guard against the water Qi not transforming and then having the disorder of over abundant amniotic fluid. For treatment it was appropriate to supplement and boost the Spleen and Kidneys, rectify the Qi and calm the fetus. This approach was assisted by harmonizing the Stomach and stopping vomiting. I gave her five packages of the following prescription:

Hai Er Shen Radix Pseudostellariea Heterophyllae 30 gm.

Lu E Mei Fructus Mume 4.5 gm.
Chao

Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Huai Shan Yao Radix Dioscoreae Oppositae 12 gm.

Bian Dou Semen Dolichoris Lablab 9 gm.

Shu Di Huang Radix Rehmanniae Glutinosae Conquitae (Prepared) 15 gm.

Fu Ling Sclerotium Poriae Cocos Pararadicis 9 gm.
Chao

Bai Zhu Rhizoma Atractylodis Macrodephalae (Dry-fried) 9 gm.

Ju Hong Pars Rubra Epicarpii Citri Erythrocarpae 4.5 gm.

Chen Shan Yu Rou Fructus Corni Officinalis 9 gm

.
Dan Zhu Ru Caulis Bambusae in Taeniis 9 gm.

Zhi Ji Nei Jin Endothelium Corneum Gigeriae Galli (Honey-fried) 9 gm.

Hong Zao Fructus Zizyphi Jujubae 12 gm.

Second Visit: May 29, 1979. Ms. Yang’s back soreness had decreased and the vomiting had stopped. She still had an aversion to food. Her pulse was thin and slippery and her tongue moss was thin white. My treatment plan was to fortify her Spleen and harmonize her Stomach, rectify her Qi and calm the fetus. I have her seven packages of the following prescription:

Chao Dang Shen Radix Codonopsitis Pilosulae 9 gm.

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae (Dry-fried) 9 gm.

Hong Zao Fructus Zizyphi Jujubae 4.5 gm.

Fu Ling Sclerotium Poriae Cocos Pararadicis 9 gm.

Ze Xie Rhizoma Alismatis Orientalis 9 gm

Lu E Mei Fructus Mume 4.5 gm.

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Zhi Ji Nei Jin Endothelium Corneum Gigeriae Galli (Honey-fried) 9 gm.

Huang Qin Radix Scutellariae Baicalensis 9 gm.

Su Geng Caulis Perillae 9 gm.

Third Visit: June 27, 1979. Ms. Yang was more than three months along at the time of this visit. Her pulse was thin and slippery and her tongue moss was thin. It was essential to avoid swelling and fullness of the amniotic fluid so I again fortified her Spleen, harmonized her Stomach and disinhibited water. I gave her five packages of the following prescription:

Fu Ling Sclerotium Poriae Cocos Pararadicis 9 gm.

Di Gu Pi Cortex Lycii Radicis 9 gm.

Lu E Mei Fructus Mume 4.5 gm.

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae (Dry-fried) 9 gm.

Chen Pi Pericarpium Citri Reticulatae 4.5 gm.

Su Geng Caulis Perillae 6 gm.

Sang Bai Pi Cortex Mori Albae Radicis 9 gm.

Huang Qin Radix Scutellariae Baicalensis 9 gm.

Hai Er Shen Radix Pseudostellariea Heterophyllae 15 gm.

Forth Visit: July 2, 1979. Ms. Yang’s fetus was restless. Both of her pulses were wiry and slippery. The body of her tongue tended to red. For treatment I used Three Bean Drink San Dou Yin with added flavors.

Chao Bian Dou Semen Dolichoris Lablab (Dry-fried) 9 gm.

Lu Dou Semen Phaseoli Radiati 12 gm.

Hei Dou Semen Glycines Atrum 12 gm.

Bai Zhu Rhizoma Atractylodis Macrodephalae 9 gm.

Sang Ji Sheng Ramulus Sangjisheng 9 gm.

Fu Ling Sclerotium Poriae Cocos Pararadicis 15 gm.

Bei Sha Shen Radix Adenophorae seu Glehniae 9 gm.

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Huai Shan Yao Radix Dioscoreae Oppositae 12 gm.

Zhi Gan Cao Radix Glycyrrhizae Uralensis (Honey-fried) 3 gm.

Fifth Visit: September 17, 1979. By this visit, Ms. Yang was already more than six months pregnant. She could feel her baby move. Her pulse was thin and slippery and the moss on her tongue was thin. I continued to fortify her Spleen and calm the fetus and gave her seven packages of the following prescription:

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae (Dry-fried) 9 gm.

Hai Er Shen Radix Pseudostellariea Heterophyllae 15 gm.

Chen Pi Pericarpium Citri Reticulatae 4.5 gm.

Fu Ling Sclerotium Poriae Cocos Pararadicis 12 gm.

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 15 gm.

Su Geng Caulis Perillae 4.5 gm.

Chao Bian Dou Semen Dolichoris Lablab (Dry-fried) 12 gm.

Huai Shan Yao Radix Dioscoreae Oppositae 12 gm.

Zhi Gan Cao Radix Glycyrrhizae Uralensis (Honey-fried) 3 gm.

Hong Zao Fructus Zizyphi Jujubae 15 gm.

Case 4

Ms. Yang was thirty-two and three months pregnant when she came for her first visit on July 2, 1979. She had been pregnant two times before and suffered from excessive amniotic fluid. Both pregnancy resulted in fetal death. Both of her pulses were wire and slippery and her tongue was crimson. For treatment I used a modified version of San Dou Yin Three Bean Drink and gave her seven packages of the following prescription:

Chao Bian Dou Semen Dolichoris Lablab (Dry-fried) 12 gm.

Lu Dou Semen Phaseoli Radiati 12 gm.

Hei Dou Semen Glycines Atrum 12 gm.

Bai Zi Ren Semen Biotae 9 gm.

Huang Qin Radix Scutellariae Baicalensis 12 gm.

Fu Ling Sclerotium Poriae Cocos Pararadicis 12 gm.

Sheng Bai Zhu Rhizoma Atractylodis Macrodephalae (Fresh) 9 gm.

Second Visit: July 30, 1979. Ms. Yang was more than four months pregnant at the time of this visit and her lower abdomen had a bearing down sensation. Both of her pulses were wiry and slippery and her tongue was crimson with thin moss. Wanting to avoid another pregnancy with excessive amniotic fluid I again gave her a modified version of San Dou Yin Three Bean Drink and gave her seven packages of the following prescription:

Lu Dou Semen Phaseoli Radiati 12 gm.

Hei Dou Semen Glycines Atrum 12 gm.

Huang Qin Radix Scutellariae Baicalensis 9 gm.

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Chao Bai Zhu Rhizoma Atractylodis Macrodephalae(Dry-fried) 9 gm.

Fu Ling Pi Cortex Poria Cocos 30 gm.

Chao Bian Dou Semen Dolichoris Lablab (Dry-fried) 12 gm.

Su Geng Caulis Perillae 2.4 gm.

Qing Pi Pericarpium Citri Reticulatae Viride 4.5 gm.

Third Visit: August 20, 1979. Five months pregnant at this point, Ms. Yang felt that the fetus was restless. The fetal heartbeat was relatively faint. My treatment was designed to fortify and move. I gave her three packages of the following prescription:

Bai Zhu Rhizoma Atractylodis Macrodephalae 9 gm.

Bai Fu Ling Sclerotium Poriae Cocos Pararadicis 15 gm.

Huai Shan Yao Radix Dioscoreae Oppositae 12 gm.

Bai Bian Dou Semen Dolichoris Lablab 12 gm

Hai Er Shen Radix Pseudostellariea Heterophyllae 9 gm.

Sang Ji Sheng Ramulus Sangjisheng 9 gm

Chao Bai Shao Radix Paeoniae Lactiflorae (Dry-fried) 9 gm.

Zhi Gan Cao Radix Glycyrrhizae Uralensis (Honey-fried) 3 gm.

Bei Sha Shen Radix Adenophorae seu Glehniae 9 gm.

Case 5

Ms. Zuo, a twenty eight year old teacher came for her first visit in September of 1950.
She was seven months pregnant and suffered from chest oppression which was worse with eating. Her urination was scanty. Her pulses were thin and slippery and the moss on her tongue was thin and the body of it was moist. Her gynecology exam showed that her uterus was the size of a full term pregnancy. The fetal heartbeat and position were unclear. Her diagnosis was excessive amniotic fluid disorder in the seventh month of pregnancy. I urged her to use my proven prescription Li Yu Luo Bo Yin Carp and Radish Drink .

Second Visit: She drank ten packages the above prescription, which increased her urination and calmed the fetus. Her pulse and tongue were as before. I gave her Si Jun Zi Tang Four Gentleman Soup and urged her to take one package each day for a long period of time. After full term she gave birth to a daughter weighing 3500 grams.

Commentary: 
Excessive amniotic fluid is a commonly seen disorder in the obstetric department and is a considerable risk for both the mother and the child. The category of the disorder in the traditional Chinese medical texts is “fetal water swelling and distention”. The cause and dynamic of this illness is most often Spleen and Kidney vacuity weakness with water Qi not transforming. This results in the water pooling in the uterus. In my experience it is appropriate to adopt the principle of fortifying the Spleen, supplementing the Kidneys, disinhibiting water and dissipating swelling. The prescriptions I commonly use as principle prescriptions are Quan Sheng Bai Zhu San Whole Life Atractyloes Powder, Bian Que San Dou San Hyacinth Magpie Three Bean Powder, or San Yin Li Yu Tang Three Reasons Carp Soup . For a lighter treatment, using Wu Pi Yin Five Peel Drink or Li Yu Luo Bo Yin Carp and Radish Drink in place of daily tea or beverage is also good. 
In the first example, the size of the patient’s belly was bigger than was appropriate for the number of months she was pregnant. She felt abdominal distention, poor appetite and scanty urination. Her differential diagnosis was Spleen vacuity and water pooling leading to over abundant amniotic fluid. The prescription used Hai Er Shen and Bai Zhu to fortify the Spleen and boost the Qi. The five peels, Tian Xian Teng and Ze Xie disinhibited the water and dissipated swelling. I also added Su Geng, Huang Qin and Zhu Ma Gen to rectify Qi and clear heat in order to calm the fetus. On the second visit I used a modified version of the original method and her symptoms had basically disappeared. On the third visit I gave her San Dou San Three Bean Powder, and Li Yu Luo Bo Yin Carp and Radish Drink to take as a food and drink treatment, in order to consolidate the effect. 
In the second example the patient suffered from heavy fetal water disorder and I used San Yin Li Yu Tang Three Reasons Carp Soup and the effectiveness was especially good. According to the San Yin Fang Three Yin Formulary “Li Yu Tang Carp Soup treats large abdomen in pregnant women and water qi in the fetal residence”. In my experience, this prescription is reliably effective for the treatment of excessive amniotic fluid. 
In example three, the patient had lost her babies twice due to excessive amniotic fluid. Her visit to me related to her third baby. She was more than two months pregnant. Though there was no clear manifestation of excessive amniotic fluid, the malign obstruction was relatively extreme and she was heading toward illness. Treatment had to be given to guard against further pathology and so I fortified her Spleen, harmonized her Stomach, move water, rectify her Qi and calm the fetus. After the treatment she didn’t tread in the same old rut. 
In example five the patient benefited from my proven prescription Li Yu Luo Bo Yin Carp and Radish Drink and had a smooth delivery at full term.

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2 Responses to Polyhydramnios and Koi

  1. Raven Lang says:

    sharon,
    these examples are fabulous. over the top. thank you for them. i also learned about the carp soup from my teacher Dr. Susan Chen, and have used it, although finding carp is not easy in many communities without asian markets.

    before i studied TCM, i had two severe cases of polyhydramnios. the first one was in the mid 70’s when i was a midwife. in both situations i consulted obstetricians, and in the first case consulted two of them. first OB didn’t see any problem (nor did the second). this was before the common use of ultrasound, although this woman had a local U/S from our back-up doc, and then, when i felt the info wasn’t good enough, she went to stanford (an hours drive from her home) and the US showed no abnormalities plus all her obstetrical signs were normal. i remember calling the OB at stanford and he encouraged me to relax, as she just was making too many fluids, but nothing pathological was taking place. still, for me the fetus was extremely difficult to palpate position d/t the excess waters, and fetal heart tones were next to impossible to hear without the doppler, which had yet to come into common use and which i didn’t own. at any rate, with two physicians saying all was well, we delivered her at home with me making her a deal that i wouldn’t try listening for fht’s b/c they were never available, and it was the only fetal death i ever attended. as it turned out from the autopsy, the baby was highly macerated, and the guess was that the death took place some 70 hours before birth.

    the second case was seen in 87, after i had become a TCM practitioner and learned about how to treat conditions in ways western medicine did not know about or understand. the woman came at 7 months or so b/c of rib pain, as the uterus was so big it was stretching her ribcage. when i did abdominal palpation, her skin was so shiny that i could almost see my reflection in it. of course, the fetus was impossible to palpate. i urged her to see an OB, as she was working with a midwife, telling her that the amount of waters (which by the way were causing her skin great itching) seemed to me a red flag, and that she should receive an U/S to learn of or rule out any problems. i treated her for her rib pain, and she left rib pain free. however, she was a bit angry that i had overstepped my boundaries by cautioning her, as she came to me for pain and pain alone. since her midwife had been the one to refer her to me, i called her and told her of my alarm, urging her to accompany the woman to our local OB who loves to give U/S’s. anyway, she went the following day and learned that the baby had gross anomalies, as his spleen and liver were above the diaphragm. he was delivered by c/s early and within hours or days given surgery. when he was one year old i learned that he had survived the surgery well and thankfully was normal in every department of growth.

    the other cases i have seen since becoming an acupuncturist have not been severe polyhydramnios, but just hydramnios which proved to be difficult and uncomfortable for the mother. all have been dealt with by using needles and herbs and have all resolved as yours did, although i do not have the herbal knowledge that you have, so my formulas have been less tailored and less complex. one more thing: i often see this condition along with other problems seen in pregnancy, such as hypertension, a hx of juvenile diabetes in the mother, or PID. occasionally it shows up with general edema of the mother, with her coming for tx d/t carpel tunnel of swollen feet.

    anyway, thanks for these cases. i am storing them for future use, should i ever need to see them again, if i were even ten years younger, i’d go to your school and take your class in OB. you have so much to give. these new practitioners are lucky to have you as their treasure.

  2. Sharon says:

    Thanks Raven! It is great to have your experience here.

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