Cooperative Research Group of Moxibustion Version*
*Compiled by Jiangxi province
Moxibustion to Zhiyin points has been widely used to correct abnormal fetal position in China. A lot of clinical reports demonstrated that it was safe, simple and effective and patients were willing to undergo the treatment.
Clinical Investigations
Patients with various abnormalities in fetal position and 29 to 40 weeks pregnant were studied. The total number of cases undergoing moxibustion therapy was 2,069. Moxibustion was applied to Zhiyin points bilaterally. The heating was controlled so as not to produce burning pain. It was applied once a day for fifteen minutes.
The fetal position was corrected in 1,869 of 2,069 cases after moxibustion amounting to 90.3 per cent of the total. 86 per cent of the cases were corrected after one to four applications and the remaining 14 per cent were corrected after five to ten applications. In the 2,069 patients, 2,041 fetuses were in breech presentation (1841 corrected), and 28 were in acromion presentation (all corrected). The difference between the therapeutic effects in primiparae and in multiparae (up to para 6) was not significant.
The correction rate was higher in patients with an average tension of the abdominal wall than in those with high or low tension. The correction rate in patients 30 to 34 weeks pregnant was higher than in these with gestation above 34 weeks. Nevertheless, in 880 cases of the latter category the correction rate still approached 84.6 per cent.
In 1,794 of 1,869 cases with abnormal fetal position successfully corrected fetal movement could be felt when moxibustion was applied. 200 patients in whom fetal movement could not be felt were failures.
Of the 200 failures, the head of the fetus was fixed under the costal margin in 10 cases. The abdominal wall was rather tense in 65 cases. Among them the fetus had already partially entered the pelvis in 10 cases. These conditions were unfavorable for fetal version. In another 38 cases, the abdominal wall of the patient was lax. The abnormal position of the fetus easily recurred after version.
In order to check the effect of this method more strictly, 111 patients 30 to 38 weeks pregnant were admitted for further observation. In the first two days after admission no therapy was given so as to eliminate spontaneous version from the successful cases. In this period, the fetal position in 11 cases spontaneously returned to normal. It amounted to 9.9 per cent. In the remaining 100 cases no spontaneous version took place. Then moxibustion was applied to Zhiyin points once a day for nine days. In the course of therapy, the fetal position of 71 cases was corrected, the correction rate being 71 per cent. Of the 29 unsuccessful cases there were 7 cases in which the fetal position was corrected during moxibustion but the abnormal position recurred before discharge. It amounted to 24.1 per cent of the total unsuccessful cases. Of the above mentioned cases, 6 cases had tried the kneechest position and moxibustion therapy without success before admission. After admission moxibustion was successful in 5 of them. The conclusion drawn from the observations in this series was in agreement with that from prior observations. But the correction rate was somewhat lower in the present series. This may be due to differences in the criteria for case selection and evaluation between the out-patient department and the wards.
According to reports from foreign countries, the incidence of spontaneous cephalic version was 60 per cent, of which 90 per cent took place before the 34th week. As mentioned above, the correction rate with moxibustion was over 90 per cent. In patients with pregnancies over 34 weeks the correction rate still amounted to 84.6 per cent. The above facts demonstrated the practical significance of moxibustion in correcting abnormal fetal positions.
Experimental Observations
1. Among 41 patients with abnormal fetal position several physiological parameters have been recorded simultaneously. It was demonstrated that in the course of moxibustion, the respiratory activity of the patient did not change significantly. The blood vessels of the skin did not constrict but were rather in a constant state of dilatation. This was shown by the fact that the amplitude of the pulse wave in the plethysmogram increased and the skin temperature rose. The pulse rate did not increase. The systolic and diastolic pressure did not rise. The former even fall somewhat. The differential blood count did not change appreciably. Nevertheless the heart rate of the fetus increased. These results suggested that the sympathoadrenal system was not stimulated by moxibustion. The increase of fetal heart rate at this time might be due to other factors.
2. In 33 cases the alterations in endocrine activities have been investigated. It was found that before moxibustion, the value of urinary 17-hydroxy-corticosterone and 17-ketosteroid in the pregnant women was higher than that in the non-pregnant women. After moxibustion the value of these hormones in the pregnant women rose even higher. Pre- and post-moxibustion values of free plasma corticosterone have shown similar variations. These results suggested that moxibustion stimulated the hypophysial-adrenocortical system.
3. In 8 patients with fetus in breech presentation tracings of uterine contractions and fetal movements were recorded before and after moxibustion. It was observed that the increase in frequency and amplitude of these activities reached a peak one hour after moxibustion or during the night, and they returned to their previous levels on the next day. In patients in whom the abnormal position of the fetus was corrected after moxibustion, the reversion occurred automatically when these activities were near their peak. In four patients with dead fetus (3 in head presentation, 1 in breech presentation), no fetal movements were recorded in the tracing after moxibustion. The position of the fetus in these cases remained unchanged. It was suggested that the automatic version after moxibustion was related to the increased strength of uterine contractions and fetal movements.
4. Uterine activity was recorded in rabbits anesthetized with urethane. Moxibustion was applied bilaterally to points which corresponded to the Zhiyin points in human beings. This procedure induced an increase in the activity of the uterus.
5. Based on the facts described above, it was presumed that moxibustion applied to the "Zhiyin" points, by means of stimulating the secretion of the adrenal cortex, enhanced uterine activity. At the same time, fetal movement increased in strength (and consequently the heart rate of the fetus increased). These factors favored the automatic correction of the fetal position.
*Compiled by Jiangxi province
Moxibustion to Zhiyin points has been widely used to correct abnormal fetal position in China. A lot of clinical reports demonstrated that it was safe, simple and effective and patients were willing to undergo the treatment.
Clinical Investigations
Patients with various abnormalities in fetal position and 29 to 40 weeks pregnant were studied. The total number of cases undergoing moxibustion therapy was 2,069. Moxibustion was applied to Zhiyin points bilaterally. The heating was controlled so as not to produce burning pain. It was applied once a day for fifteen minutes.
The fetal position was corrected in 1,869 of 2,069 cases after moxibustion amounting to 90.3 per cent of the total. 86 per cent of the cases were corrected after one to four applications and the remaining 14 per cent were corrected after five to ten applications. In the 2,069 patients, 2,041 fetuses were in breech presentation (1841 corrected), and 28 were in acromion presentation (all corrected). The difference between the therapeutic effects in primiparae and in multiparae (up to para 6) was not significant.
The correction rate was higher in patients with an average tension of the abdominal wall than in those with high or low tension. The correction rate in patients 30 to 34 weeks pregnant was higher than in these with gestation above 34 weeks. Nevertheless, in 880 cases of the latter category the correction rate still approached 84.6 per cent.
In 1,794 of 1,869 cases with abnormal fetal position successfully corrected fetal movement could be felt when moxibustion was applied. 200 patients in whom fetal movement could not be felt were failures.
Of the 200 failures, the head of the fetus was fixed under the costal margin in 10 cases. The abdominal wall was rather tense in 65 cases. Among them the fetus had already partially entered the pelvis in 10 cases. These conditions were unfavorable for fetal version. In another 38 cases, the abdominal wall of the patient was lax. The abnormal position of the fetus easily recurred after version.
In order to check the effect of this method more strictly, 111 patients 30 to 38 weeks pregnant were admitted for further observation. In the first two days after admission no therapy was given so as to eliminate spontaneous version from the successful cases. In this period, the fetal position in 11 cases spontaneously returned to normal. It amounted to 9.9 per cent. In the remaining 100 cases no spontaneous version took place. Then moxibustion was applied to Zhiyin points once a day for nine days. In the course of therapy, the fetal position of 71 cases was corrected, the correction rate being 71 per cent. Of the 29 unsuccessful cases there were 7 cases in which the fetal position was corrected during moxibustion but the abnormal position recurred before discharge. It amounted to 24.1 per cent of the total unsuccessful cases. Of the above mentioned cases, 6 cases had tried the kneechest position and moxibustion therapy without success before admission. After admission moxibustion was successful in 5 of them. The conclusion drawn from the observations in this series was in agreement with that from prior observations. But the correction rate was somewhat lower in the present series. This may be due to differences in the criteria for case selection and evaluation between the out-patient department and the wards.
According to reports from foreign countries, the incidence of spontaneous cephalic version was 60 per cent, of which 90 per cent took place before the 34th week. As mentioned above, the correction rate with moxibustion was over 90 per cent. In patients with pregnancies over 34 weeks the correction rate still amounted to 84.6 per cent. The above facts demonstrated the practical significance of moxibustion in correcting abnormal fetal positions.
Experimental Observations
1. Among 41 patients with abnormal fetal position several physiological parameters have been recorded simultaneously. It was demonstrated that in the course of moxibustion, the respiratory activity of the patient did not change significantly. The blood vessels of the skin did not constrict but were rather in a constant state of dilatation. This was shown by the fact that the amplitude of the pulse wave in the plethysmogram increased and the skin temperature rose. The pulse rate did not increase. The systolic and diastolic pressure did not rise. The former even fall somewhat. The differential blood count did not change appreciably. Nevertheless the heart rate of the fetus increased. These results suggested that the sympathoadrenal system was not stimulated by moxibustion. The increase of fetal heart rate at this time might be due to other factors.
2. In 33 cases the alterations in endocrine activities have been investigated. It was found that before moxibustion, the value of urinary 17-hydroxy-corticosterone and 17-ketosteroid in the pregnant women was higher than that in the non-pregnant women. After moxibustion the value of these hormones in the pregnant women rose even higher. Pre- and post-moxibustion values of free plasma corticosterone have shown similar variations. These results suggested that moxibustion stimulated the hypophysial-adrenocortical system.
3. In 8 patients with fetus in breech presentation tracings of uterine contractions and fetal movements were recorded before and after moxibustion. It was observed that the increase in frequency and amplitude of these activities reached a peak one hour after moxibustion or during the night, and they returned to their previous levels on the next day. In patients in whom the abnormal position of the fetus was corrected after moxibustion, the reversion occurred automatically when these activities were near their peak. In four patients with dead fetus (3 in head presentation, 1 in breech presentation), no fetal movements were recorded in the tracing after moxibustion. The position of the fetus in these cases remained unchanged. It was suggested that the automatic version after moxibustion was related to the increased strength of uterine contractions and fetal movements.
4. Uterine activity was recorded in rabbits anesthetized with urethane. Moxibustion was applied bilaterally to points which corresponded to the Zhiyin points in human beings. This procedure induced an increase in the activity of the uterus.
5. Based on the facts described above, it was presumed that moxibustion applied to the "Zhiyin" points, by means of stimulating the secretion of the adrenal cortex, enhanced uterine activity. At the same time, fetal movement increased in strength (and consequently the heart rate of the fetus increased). These factors favored the automatic correction of the fetal position.
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