Philip A.M. Rogers MRCVS

AP and the Urogenital / Adrenal System


Aleksandrina_EV; Zharkin AF; Gavrilova AS (1992) [The AP prevention of anomalies in labour strength in pregnant women of a risk group]. Akush Ginekol (Mosk), 8-12 22-24. AP was carried out for 3-6 d in the course of preparation to labour of 80 pregnant women at risk of developing abnormalities of parturition. Points on the LU, KI, ST and CV Channels, and Ear- points were used. AP enhanced mainly the cholinergic-type activities of the ANS. Women who had received AP before the birth had a more normal course of spontaneous labour and significantly less blood loss than those who had not received AP.

Arkatov_VA; Zverev VV; Volkovinskii KE (1992) [The effect of tramal and APA on labour pain and the psychoemotional status of the parturient]. Anesteziol Reanimatol Mar-Apr 2:31-33. The changes in psychoemotional status, and the intensity and structure of parturition-pain, were studied in 65 women with reference to the use of concomitant correcting therapy during various types of analgesia. 44 women comprised a control group. APA was optimal during delivery without any correcting therapy, while tramal (at a dose of 1.43+0.06 mg/kg) was optimal during "programmed" delivery.

Beal_MW2 (1992) AP and related treatment modalities: 2: Applications to antepartal and intrapartal care. J Nurse Midwifery Jul-Aug 37(4):260-268. Yale Univ Sch of Nursing, New Haven, CT 06536-0740. The application of AP, moxibustion, acupressure, and shiatsu to antepartal and intrapartal care are discussed. Information on therapeutic interventions as described in textbooks is presented and compared with specific treatments evaluated in research studies. Specific clinical indications addressed include nausea during pregnancy, repositioning of the fetus in breech position, stimulation of contractions and true labour, and pain relief in labour. Qualifications for practitioners and recommendations for certified nurse-midwives caring for clients seeking referral for these services are discussed.

Berks_A (1996) AP in Labour and Delivery. Adapted from WWW. [After an uncomplicated delivery, Alex and Denise's son Noah Loren was born on 20 Aug 1996. For information on how to order Bob Flaws' books, please see the Blue Poppy Press page at the Book Farm: WebMaster].

The use of TCM in labour and delivery can be understand in many ways. Like all activities of life, labour induces a shift in the directionality of the Qi. This may be more important to understand than simple point prescriptions; once one understands the nature of Qi and the points, it is a simple and creative process to choose effective AP points.

For the pregnancy, mother has been holding the fetus in and up with her SP-Qi. All the other Zang-Fu Qi has had to spread and regulate and consolidate evenly. During labour, the Qi must go down and out. Both psychological and physical factors can slow or block this. Bob Flaws in his book "Path of Pregnancy Vol 1", lists 3 causes of delayed labour: Qi-Xue-Xu, Qi-Xue-Stasis, and Middle Jiao Qi-Xu. All three cause insufficient Qi and/or Xue to move the fetus down and out the birth canal.

The easiest of these to treat is Qi-Xue-Stasis. If the mother-to be can relax and get the uterus to relax labour will not be far behind. This can be done with many different therapeutic activities: stimulate the uterus with belly massage, have an orgasm, relax and visualize the uterus contracting. Bob Flaws quotes Wan Mi-Zhai (p169): "If labour goes on for >1 day, the woman is preoccupied with family and personal affairs and still has an appetite this is due to astringing of the uterus. But if the woman's labour goes on for >1 day, all the woman's affairs are settled and her appetite diminished, this is insufficiency of middle Qi not able to transport the and move the fetus".

Yin Channel Qi rises. Yang Channel Qi descends. Therefore, moxa or acupressure down the Yang Channels will assist downward movement of Qi. This principle is also applied in home remedies to bring on labour such as castor oil, a stimulating purgative and a favourite of Edgar Cayce. See Childbearing Year by Susan Weed (p60).

Specific AP points that descend include: LI04, SP06, GB21. LI04 is LI Yuan point; SP06 is the "3 Yin Crossing" point of the Foot Yin Channels. LI04 and SP06 are important points to circulate Qi-Xue and induce downward movement and labour. GB21 also descends (see Oriental Med J Spring, 1996 p6). These points can be combined with TH06 and LV03. Bob Flaws recommends not to retain the needles.

ST36 (ST He-Sea, Earth, Hour and Uniting point) combines with SP06 invigorates SP and ST, produces Qi-Xue and induces labour. These points can be needled, pressed, or warmed with moxa.

Bob Flaws in "the Path of Pregnancy Vol 1" lists other possible point combinations: LI04, SP06, BL67, Du Yin (Extra point, on the plantar surface of the centre of the proximal phalangeal joint of the second toe). Needle the first tow points and moxa the second 2. Another combination is: LI04, SP06, BL30 and Cuo Chan Xue (Hastening Birth point), an Extra point, 3 cun lateral to CV04. Needle 5 fen in depth. In pronounced back labour pain in the sacrum, needle Ba Liao (BL31-34) transversely. Tape the needles in place flush with the skin and use EAP.

Potential labour problems can be greatly aided by the use of herbs and an appropriate activity before labour to drain (disperse) Shi (Excess) or tonify (nourish) Xu (Weakness). However, AP also can act quickly on Qi-Stasis and Xue Stasis. For further discussion please read Bob Flaws Path of Pregnancy Vol 1.

In my limited experience, having recently witnessed the birth of my son Noah, labour is aided by a clear plan of action, focused breathing, a synchronized supportive set of people at the birth and an emotionally clear labouring woman. Strong physical fitness also helps. The acupressure that I was able to apply to her back, helped a great deal in preventing her use of medication.

The "Bradley Way" is an enjoyable book on Natural childbirth. Though stern in its approach to delivery without Med intervention. It had the best advice to the woman in labour and how the father should approach the situation as a birth coach.

Cardini_F; Basevi V; Valentini A; Martellato A (1991) Moxibustion and breech presentation: preliminary results. AJCM 19(2):105-114. Div of Obstetrics and Gynecol, Zevio Hospital, Verona, Italy. Moxibustion at BL67 is an ancient method of obtaining the version of abnormal presentation of the fetus during the last 3 mo of pregnancy. The authors reviewed the Chinese references on this subject and stressed the importance of parity and gestational age in testing the efficacy of this therapy. Preliminary results are described and compared with those reported in Chinese articles. Success rates in version by moxibustion versus spontaneous version are also compared.

Cardini_F; Marcolongo A (1993) Moxibustion to correct breech presentation: a clinical study with retrospective control. AJCM 21(2):133-138. Dept of Obstetrics and Gynecol, Policlinico Borgo Roma, Verona, Italy. In this study we treated a group of women during pregnancy by moxibustion on point BL67, to obtain inversion of fetuses in breech presentation. Comparison is made with a control group drawn retrospectively from clinical files at a regional hospital. The aim of the study is to identify the ideal population (in terms of parity and gestational age) to be included in a randomized controlled trial.

Donchenko_VS; Kiverov SV; Lants GI; Uramaev FR; Samoilov VA (1991) [Pharmacological stimulation of AP points for analgesia in patients with gynaecologic diseases in the postoperative period]. Akush Ginekol Mosk May 5:69-70.

Engel_K; Gerke-Engel G; Gerhard I; Bastert G (1992) [Fetomaternal macrotransfusion after successful internal version from breech presentation by moxibustion]. Geburtshilfe Frauenheilkd Apr 52(4):241-243. Universitäts-Frauenklinik Heidelberg, Germany. In a primigravida with a fundal/anterior wall placenta, a successful cephalic version was noted at 39 wk after repeated moxibustion of the BL67. Since routine foetal heart rate monitoring showed a sinusoidal pattern with severe decelerations, immediate Caesarean section was performed. Foetomaternal macrotransfusion of circa 300 ml of blood was found. In view of this complication, possible risks of the method are discussed. Moxibustion does not seem to be suitable as self-therapy without close medical follow-up.

Frygner_K (1994) [AP during childbirth]. Jordmorbladet 5:20-21. In Norwegian.

Lyrenõs_S; Lutsch H; Hetta J; Nyberg F; Willdeck-Lundh G; Lindberg B (1990) AP before delivery: effect on pain perception and the need for analgesics. Gynecol Obstet Invest 29(2):118-124. Dept of Obstetrics and Gynecol, Uppsala Univ, Sweden. Pain experience and the amount of analgesics needed during labour were studied in 32 primiparous women who had received repeated treatment with AP (AP) during the month prepartum and in 16 nontreated primiparous women. The women's psychological profiles were evaluated by a psychiatric interview at wk 38 of pregnancy. Treatment with AP did not reduce the need for analgesics in labour. During labour, all women experienced successively rising pain irrespective of whether or not they had been treated with AP before labour or delivered under local anaesthesia. Experience of pain was not reduced in subjective assessments in women treated with AP. There was a strong correlation between assessments of pain made during labour and 6 mo after delivery. In the group that did not receive AP, CSF dynorphin A was significantly lower in parturients who chose epidural anaesthesia.

Ma_H; Jiang E; Zhao X (1992) [The effect of AP on the level of Substance-P in serum of gravida during delivery]. Jinzhou Med Coll, Liaoning. Chen Tzu Yen Chiu 17(1):65-66. We determined the level of Substance-P in the serum of 56 gravida with RIA before and after AP during the active period of the delivery. The result suggested that the AP may be decline the level of Substance-P in the serum of the gravida, so that played role of analgesic effects.

Martensson_L; Lundqvist E (1993) [AP during pregnancy and delivery: a midwife's concern (letter)]. Jordemodern May 106(5):162-163.

Nilsson_M (1993) [AP for analgesia during childbirth]. Jordemodern Jul_Aug 106(7-8):246-267.

Tremeau_ML; Fontanie-Ravier P; Teurnier F; Demouzon J (1992) Protocol of cervical maturation by AP. J de Gynecologie, Obstetrique et Biologie de la Reproduction 21(4):375-380. INSERM, UnitÚ 292, Le Kremlin-BicÛtre, France. 98 patients were assigned to 3 groups: 1=Control; 2=Placebo; 3=AP treatment. It was possible to improve cervical maturation if AP sessions were given at the start of the 9th mo. Bishop-scores in the 3 groups after 10 d interval show that there was a significant progression of 2.61 points in the AP-Group, compared with only 0.89 and 1.08 in the placebo and control groups.

Yelland_S (1995) Using AP in midwifery care. Mod Midwife Jan 5(1):8-11. AP is based on the theories of TCM. These have little in common with the western models of anatomy or the processes of health and disease. However, it appears that in many cases AP is clinically effective (greater than placebo). Many women look to alternative therapies during pregnancy and childbirth. AP is safe, cheap and works clinically. AP is therefore a valuable holistic skill to add to the midwife's repertoire. Both research and a system of training are required if AP is to play its full part in midwifery care.