She is no longer considered IUGR!

^{This is post #7 in the WPC blog.  Click here to visit the blog homepage.}

The White Pine Circle Women's Great Turnings course starts in less than a week. In my clinical practice, I use the principles and methods we teach in the program daily. Below is a current case of a woman who came to me a month ago with a diagnosis of IUGR, Intrauterine Growth Restriction. 

I've only seen Sera (made up name) three times and will see her for the fourth time later today. I've read material on how to treat IUGR with lists of herbal formulas that primarily increase the mother's nourishment. This case shows how our results can be remarkably rapid when we treat the presenting pattern rather than focusing on the disease. I hope this case inspires people to join our course! 

• Sera, age 28, came in at 34 weeks for IUGR. Her due date is 9/27/24 
• At 21 weeks, her baby was in the 40^th %, but at 32 weeks, she was in the 5^th %. The ob-gyns wanted to induce if this did not improve in the next two weeks. The ultrasound of the placenta showed no abnormalities. 
• Sera's menstruation returned eight weeks after delivery. This pregnancy came 17 months after her first baby—family bed and on-demand nursing. 
• Sera's feet get very hot at night, so her thyroid was checked, but it was only slightly abnormal. The hot feet disturb her sleep. Generally, she feels hot. She can also feel alternating hot and cold. She is thirsty with incomplete and frequent urination. Night urine 2-3X. She feels easily overstimulated by noise. 
• Her baby is very active compared to her first child, sometimes with painful kicking. 
• She thinks she breaths through her mouth at night, and in general, I observed. 

Tongue slightly lavender

Pulses: Left side thin and wiry, Right Guan and Chi wiry

I checked her blood work, hemoglobin, and hematocrit, comparing her early pregnancy results with more recent results. I have learned from midwives and many cases in my practice that high or rising levels of hemoglobin and hematocrit are the best pre-symptomatic early indicators of pre-eclampsia. Reading these results is an essential skill students learn in the Women's Great Turnings course. High levels indicate systemic blood stasis, meaning that the woman's blood is generally too thick and not sufficiently dilute. This diagnostic is one of the very few times I will come to a Chinese medical conclusion based on a Western medical lab result. As pregnancy progresses, the levels should go down to represent the healthy natural dilution of the blood. 

According to her bloodwork, Sera's hematocrit and hemoglobin were high at the start of her pregnancy. Though these levels had decreased some, the descent was inadequate for a healthy pregnancy. Below is a chart of Sera's results and a chart to show what healthy levels should be in later pregnancy. 

I diagnosed Sera as follows: 

Systemic blood stasis with blood failing to nourish the womb and fetus

Damp accumulation in the lower Jiao

Dispersion thirst

I based this diagnosis on the blood work and the following evaluation of her signs and symptoms. This process helps me see what is happening without jumping to diagnostic conclusions. 

I saw a pattern that is all too common in pregnancy. Sera's water metabolism was unregulated. Instead of being absorbed into her blood, water was pouring through her. Her thirst, combined with frequent urination and dampness in the lower Jiao, is called dispersion thirst. Dispersion thirst is caused when water is not absorbed into the body and blood. This causes the blood to thicken. Placental function depends on healthy blood and blood that dilutes in later pregnancy. Though it had not shown on the ultra-sound, Sera's placenta was not functioning to nourish her baby properly. 

Sera also felt hot and had hot feet. I was unsure how much of this heat was due to excess from a blocked pivot and how much was due to the deficiency of blood (systemic blood stasis is a form of blood deficiency as there is not enough healthy blood). I used herbs to work with both. 

In addition to herbs and acupuncture, I instructed Sera to tape her mouth at night (see my breathing class in the WPC) to reduce the frequent night urination. 

The formula that matched Sera's pattern integrated three Jin Gui Yao Lue formulas: Dang Gui Shao Yao San, Dang Gui San, and Bai Zhu San

Raw Powder @ 9 gm/day to be soaked in a thermos of boiling water overnight. 

Dang Gui 12
Bai Shao 18
Chuan Xiong 9
Fu Ling 12
Bai Zhu 18
Ze Xie 9

Mu Li 9
Huang Qin 12

A week later, Sera reported that, according to an ultrasound, the baby had grown by a pound. The fetal movement was less active at night, and there had been no painful kicks. Noise was less bothersome, the thirst was less, and the urine was a bit more complete. Night urine was the same. She had difficulty keeping the tape on her mouth. 

Next visit: She didn't have another scan but could tell the baby was growing. Urine and thirst better. Sera was doing better keeping the tape on her mouth at night. She had stopped mouth breathing during the day. 

This week, I got the following email from Sera after a prenatal visit at 36.5 weeks: 

"Excellent news from our scan today; she gained a pound and a half in the last two weeks and is up to the 24%, so she is no longer considered IUGR."

The removal of the IUGR diagnosis means that Sera can go to term with no induction. 

Formula explanation: 

Dang Gui Shao Yao San regulates the blood/water ratio. The Dang Gui, Bai Shao, and Chuan Xiong harmonize blood (which means it increases the fluid aspect of blood and liquifies viscous blood). Bai Zhu, Fu Ling, and Ze Xie bank up Soil to absorb and drain water more efficiently. Altogether, this formula helps water come back into the blood. Often, one sees edema, but in this case, the fluid is being lost. Either way, the formula works. By adding Huang Qin to this formula, I have integrated Dang Gui San. Huang Qin unblocks the Shaoyang pivot to relieve heat, mainly when the heat is affecting the blood. Adding Mu Li, I am integrating most of Bai Zhu San, which is Zhang Zhong Jing's formula for "nourishing the fetus in pregnancy." Mu Li cools deficient heat, and its salty coolness helps liquefy blood thickened by heat. This was how I covered both bases of excess and deficient heat. 

Sera came to me at week 34 as she was headed toward an induction. This case shows how quickly the herbs can work when the diagnosis is accurate and the formula follows the pattern. 

Sharon