To continue on the theme of birthing, I was recently editing video from the last Graduate Mentorship Program. The video I am currently working on is from the part of the program on pregnancy and labor. I was reminded about Dr. Qiu Xiao-mei’s use of the “finger pulse” as a diagnostic tool during labor. It can give the doctor a reading on the woman’s readiness to give birth, the dilation of the cervix and the strength behind the contractions. I have translated and read case studies in which the finger pulse is used but I had never read anything in particular about it’s meaning or how to do it. I decided to do a bit of a query to some knowledgable friends of mine. I got a lengthy reply from Steven Clavey. He sent me a descriptive passage in Chinese that I translated this morning as well as a diagram and a few words of his own. I’ve included all this here and have also added a couple of cases of Dr. Qiu Xiao-mei to illustrate her use of the finger pulse. In the first case the finger pulse was weak and this indicated to Dr. Qiu that a strong tonification method was necessary. In the second case, the finger pulse was strong but did not extend to the finger tip. This indicated a case of stagnation and so strong abducting herbs were given.
It is interesting to note the use of Quinine as an agent to induce labor. Because quinine has this effect, it cannot be used to treat malaria in pregnant women. There are many writings about how to treat women who contract malaria during pregnancy with Chinese herbs because quinine is contraindicated.
So here it is….
About the finger pulse
(my direct translation) The middle finger has three joints. This can be divided into 7 sections. The first finger joint has 1 section. The second finger joint has the 2nd and 3rd sections. The third finger joint has the 4th, 5th, 6th and 7th sections. When checking, the woman should be supine with the hand stretched out flat. The doctor uses her thumb and two eating fingers curved to form a hoop and grasps the middle finger. To do the exam, at the beginning of each contraction move from the first finger joint toward the fingertip. When the finger vessel pulsing feels strong and forceful in a throbbing manner, this is normal. The arm of the woman in labor should be laying stretched out comfortably with the palm up. There should be nothing to obstruct the circulation of blood. The finger pressure should not have too much tension. If there is too much tension you may get confused by your own finger pulse. If you don’t feel this sufficiently on either side of the middle finger, you can seek it more toward the back of the hand or toward the palm side. Generally it is easiest to feel on the middle finger. The pulsing is most clear from the time a contraction begins to the time it ends so this is the standard time during which it should be checked.
When labor first begins, the contractions are relatively light and the time between contractions is relatively long. The pulse beats at the first and second section. During the first stage of birth in which labor is progressing and the cervix gradually opens, the finger pulse also moves toward the fingertip. From the time that the cervix is open 6-7 centimeters until it is completely open, the finger pulse progressively reaches section 5, 6 and 7 and the finger pulse shows clear strength.
During the second stage of labor in which the baby is ready to come out, the woman begins to hold her breath to increase abdominal pressure and the finger pulse comes with even more force. This force continues until the placenta is discharged.
Steve Clavey wrote:
First mention I know of for the finger pulse is in Zhang Jing-Yue’s Fu Ren Gui (Standards for Gyne). I have not used it myself, but I might start trying it!
“Basically you feel along the side of the middle finger with your thumb and forefinger, applying even pressure, not too tight, and see if you can feel a pulse. It isn’t always right in the middle of the side of the finger, it might be more toward the palm or the back of the hand. The higher up the finger the more pregnant. Closer to the top it starts to show the degree of cervix opening; when the pulse reaches the tip she is ready to go! The pulse will be most obvious during contractions, so that’s a good time to use this to check cervical opening.
If these pulses exist clearly, but suddenly stop, the baby may have died (although I’d be cautious of suddenly annoucing this out of the blue!)”.
Case One: Shen Miao Fou Shou San
Ms. Xie entered the hospital on November 24, 1960. She was pregnant with her first child and her expected date of delivery of October 26. She was post-term and this is why she was hospitalized. On the second day of her hospitalization she was given quinine to induce labor but after two days she had not manifested any clear signs of labor so, in addition, I gave her Chinese herbs to hasten labor. Her pulse was thin, soggy and slippery. The throbbing of her finger pulse lacked strength and wasn’t extending beyond the fingertip. The body of her tongue was pale red. I used the perscription Shen Miao Fo Shou San Miraculous Spirit of the Buddha’s Palm Powder, With the addition of the following herbs:
DangShen Radix Codonopsitis Pilosulae l0qm.
HuangQi Radix Astragali Membranei 12gm.
YiMuCao Herba Leonuri Heterophylli 9gm.
After these herbs, that evening, the contractions began. The sequence of the delivery went smoothly, she gave birth naturally.
Shen Miao Fo Shou San Miraculous Spirit of the Buddha’s Palm Powder, is also called Xiong Gui Tang, Ligusticum and Angelica Soup(with the two ingredients Chuan Xiong Radix Ligustici Chuanxiong and Dang Gui Radlix Angelica Sinensis). Chuan Xiong and Dang Gui are both principle herbs for treating the Blood level. Dang Gui is sweet and so it supplements. It is pungent and so it dissipates. Its bitterness drains and its warmth penetrates. It is both able to supplement Blood and quicken Blood. Chuan Xiong is pungent, warm fragrant and piercing. It moves but doesn’t stay and it treats the Qi within the Blood. It has the function of quickening the Blood and moving the Qi. It supplements while penetrating through, opens while closing. In regard to hastening birth, it is the most reliable, having a fast acting and victorious effect.
In addition, Dang Shen Radix Codonopsitis Pilosulae and Huang Qi Radix A$tragali Membranacei are added to supplement Qi. Yi Mu Cao Herba Leonuri Heterophylli is given to activate uterine contractions, boost the mother and calm the child.
Ms. Zheng was age 40 when she entered the out patient ward for a consultation. She was admitted into the hospital, pregnant nine months with her ninth child. She had been passing water for eight hours and had developed abdominal pain characteristic of labor for a period of four hours. The check up showed her blood pressure to be 130/ 80 mm mercury. Her heart and lung were normal. The fundus of her uterus was four-finger below her xiphoid. The baby presented cephalic and left anterior occipital. The fetal heart rate was 140/minute. Contractions were irregular. An anal exam revealed that the amniotic sack had been broken. Her cervix was dilated two fingers. The western diagnosis was “full term pregnancy with premature rupture of membranes”. Because of this they gave her antibiotics to prevent an infection. She was simultaneously gave her quinine and pituitrin in an intravenous drip to hasten labor. All of these methods were ineffectual. The membrane had been ruptured already for ten days and her temperature was over 38 degrees centigrade. Her blood chemistry exam showed that the total leukocyte count was 2400/ cubic mm. Neutrophils were 85 %. Ms. Zheng’s amniotic fluid was murky and her facial color was dull white and clear. She experienced chest oppression and distention. In spite of the abdominal pain, the fetus did not descend. Her pulse was deep, wiry and slippery. Her finger was throbbing distinctly and with strength but only to between the first and second finger joint. The body of her tongue was dark red. I gave her two packages of Tuo Hua Jian Cast Off the Flower Drink:
|Dang Gui||Radix Angelica Saneness||9gm.|
|Chuan Xiong||Radix Ligustici Chuanxiong||6gm.|
|Rou Gui Wei||Cortex Cinnamomi Cassiae||3gm.|
|Niu Xi||Radix Cyathulae Officina1is||12gm.|
|Che Qian Zi||Semen Plantaginis||9gm.|
|Hong Hua||FIos Carthami Tinctorrii||9gm.|
|Yi Mu Cao||Herba Leonuri Heterophlli||9gm.|
|Gui Ban||Plastrum Testudinis||12gm.|
|Huang Qin||Radix Scutellariae Baicalensis||6gm.|
|Ren Dong Teng||Ramulus Lonicera Japonica||12 gm.|
|Lian Qiao||Fructus Forsythiae Suspensae||9 gm.|
After two packages, Ms. Zheng’s contractions increased and became regular and stronger. On the afternoon of July 2 she smoothly completed childbirth. After the birth, her condition was good.
Discussion: This example of Blood vacuity relates to many deliveries. The Qi mechanism has become stagnant and depressed. The amniotic sack broke early and the amniotic fluid was dry and obstructed and hence unable to move the fetus downward. Since this problem came with an infectious fever, she was no longer a candidate for a cesarean section. Her only possible course was to conclude the birth process right away in order to save her life. In this situation I imitated Zhang Jing Yue by using the method exemplified by his prescription Cui Sheng Tuo Jian Hastening Life Cast Off the Flower Drink. This prescription contains Dang Gui Radix Angelica Sinensis, Chuan Xiong Radix ligustici Chuanxiong, and Hong Hua FIos Carthami Tinctorrii to nourish the Blood, quicken the Blood and dispel stasis. Niu Xi Radix Cyathulae moves the Blood and induces all the herbs to move downward. Che Qian Zi Semen Plantaginis is slippery and penetrates through stasis. Rou Gui Cortex Cinnamomi Cassiae is pungent and warm and penetrates through to guide the Qi into the Blood. There is also Yi Mu Cao Herba Leonuni Heterophylli and Gui Ban Plastrum Testudinis, which hasten birth and open the joining bone. Huang Qin Radix Scutellariae Baicalensis, Ren Dong Teng Ramus Lonicerae and Lian Qiao Fructus Forsythiae are important for clearing hear and resolving toxin. In this way the herbs mutually support and reinforce each other. By increasing Qi and Blood there could be disinhibited, which is why the fetus moved down. The mother and child were safe and childbirth was smooth.