CHAPTER 5. Eastern approach to pregnancy
Introduction
Historically, the Chinese considered pregnancy to be an important time in any woman’s life. Because of alterations in Jing, Blood and Qi, they felt that it offered the possibility of positive change. At this time a woman’s health can be either strengthened or weakened.
Pre-conceptual health was considered to be fundamental. The quality of energy of both the mother and fetus is dependent on how the mother has looked after herself before the pregnancy, as well as the type of energy that she has inherited from her mother and father.
They also considered pregnancy to be an important time for the fetus and had a concept of ‘fetal’ education ( Tai Kyo). The mother needs to eat good foods and have a balanced emotional and physical lifestyle to support the fetus’s physical and emotional development. A calm atmosphere was generally emphasised, although if a woman wanted a boy she was advised to attend archery contests during certain months.
With much of Chinese medical theory, different and sometimes contradictory ideas are presented in different texts.
Some of the earliest texts (Huainanzi, 3rd century bc, translation by Major 1993) were written before the systematisation of the five elements, and therefore different resonances and correspondences are made between the elements and the organs. Some later texts, such as the Qipolun (11th century), emphasise the more esoteric aspects of pregnancy. Despite these differences the basic aspects of foetal development are quite consistent.
(Sandra Hill)
I have drawn upon various sources and linked this with my own knowledge. I have primarily included information which supports a relatively consistent model for the practitioner and so not all descriptions are included. I would suggest that the reader interested in a more detailed analysis of the classical texts look at the work of Elisabeth Rochat de la Vallée or Jean-Marc Eyssalet who both refer to the traditional texts. Many of these texts are only in Chinese or Japanese, but I have included the English references given by Rochat de la Vallée at the end of her text. I have also included some ideas from Jeffrey Yuen’s work which sometimes give a slightly different perspective.
Pregnancy was defined as 10 lunar months. Ten is a number which expresses the perfection of human nature and a unity for the Chinese (Suwen c. 100 bc). The natural duration for life is given as 100 years (10 × 10). Pregnancy is seen as being predominantly a time of Yin energy. In traditional Japan and China, indeed in many pre-industrial societies, pregnancy was a time when women were encouraged to take more care of themselves and would follow special diets and lifestyle changes.
5.1. General energy patterns for the mother
Pre-conception and fertility
The most important energy for supporting both fertility and pregnancy is Jing. Having a weak Jing would be considered to be one of the primary causes of infertility and miscarriage (Fu Qing Zhu and Tang Zong Hai). It is generally considered that the optimum time for conception is before 35 years of age. This represents five cycles of 7 years. Some writers think 21–29 years is the optimum time and others (Kawada 2006) consider 29–35 to be better because the mother is more emotionally mature. After 35 years the quality and amount of the mother’s Jing is declining. This affects both her ability to build the child and the child’s coding for its own growth. It does not mean all women over 35 have poor pregnancies and weak children but good pregnancy outcomes are dependent on a strong inherited Jing and healthy lifestyle.
GV, PV and CV are the basis for follicle maturation, ovulation and corpus lutuem development and are always involved with fertility. Anything, physical or emotional, which weakens the Uterus or the GV, PV and CV and Blood will reduce fertility, especially exposure to Cold. Excessive consumption of greasy foods and dairy products may lead to dampness in the lower burner which may prevent fertilisation. Liver Qi stagnation affects the CV and PV; this may correspond in western terms to tubal obstruction.
Miscarriage
The main cause of early miscarriage is also likely to be considered due to weakness of Kidney Jing which cannot support the growth and development of the fetus. This is linked with the quality of the DNA from a western viewpoint and corresponds to genetic factors being main causes of miscarriage. From a Chinese point of view the ‘DNA’ is not just about physical patterns passed through the generations but also about mental and emotional aspects.
Miscarriage can also be due to weakness in any of the energies which are needed to nourish the fetus. It may be due to weakness of Spleen or Girdle Vessel failing to hold the energy of the fertilised egg in the uterus. It can be linked in with dampness in the lower burner.
The energetics of conception
The eastern view of conception includes a philosophy on the purpose of manifesting as an individual and the destiny of that individual. Much of this aspect of Chinese medicine was either recorded in the oral traditions or lost during the Maoist Cultural Revolution but there are some references to it in the Neijing, Ling Shu and Dang Zhunyi, and Lonny Jarrett writes about it in Nourishing Destiny (Jarrett 1998).
Conception is the moment of destiny; the initial movement from the Tao, the one, undifferentiated, formless energy, to move into differentiation and form making the first step on the journey of forming an individual energy. The Jing of the two parents and the Blood of the mother unite and determine the energetic quality of the rest of the pregnancy (Ling Shu, c. 100 bc, Ch. 30).
Jeffrey Yuen (2005: 17) and others talk about the five elements flowing in reverse prenatally, reflecting the fact that prenatal life is like a mirror of our soul, showing where we come from. This movement therefore begins with Water and ends with Wood. As Water moves into form it passes through Metal. Most authors agree that the Soul is captured by the Po of the mother, which is stored in the Lungs. Po is the Corporeal Soul, that aspect of the soul which is expressed through the body. The quality of the mother’s Lungs in drawing energy into the body mirrors the importance of the health of the mother’s basic Qi, drawn into her body through the breath and expressed in her physical form.
Other energies present are the Yuan Qi. This is the representation of Heaven and Earth imprinted onto Jing at the time of conception, the Qi of the Universe, primordial Yin and Yang. Yin and Yang Qi energies are also present, the cultural and historical period, season, time of day in which a fetus is conceived. This is the basis of Chinese Nine Star Qi theory and astrology, and indeed of western astrology.
At the moment of conception the Jing (Earth) and the Shen (Heaven) mingle at the point of Ming Men ‘gate of destiny’. (GV 4)
Mingmen contains and focuses the infusion of our inheritance of primordial Yin and Yang (the Yuan Qi) which at our core joins each of us to the primordial Dao.
The interaction of this authentic water and fire conforms to the deep inner nature of each individual. The authentic self
The inherited constitution intermingles with the acquired constitution and the Shen is interacting with the Jing. During pregnancy the Yuan Qi guides the differentiation of the embryo and fetus. During life it is the inner fire which fuels developmental processes such as making blood, the growth of bones, emotional and psychic development and the ascent of spirit.
Shen is our purpose in life that provides us with the capacity to return to original nature by focusing ourintention inwardly toward the Jing. The heavenly aspect of inborn nature is Shen, the earthly aspect is Jing. Humans must establish their Zhi (human will) as a conduit for Shen (heaven) to interact with Jing (earth).
(Jarrett 1998: 59)
5.2. Main energy changes and patterns during pregnancy for the mother
To support the growth of the fetus, there is a change in the flow of energies in the mother’s body. The mother needs to have enough Jing, Qi and Blood to nourish the fetus and they need to be able to flow freely to the Uterus.
Although the fetus is drawing on the mother’s energies, pregnancy need not necessarily weaken a woman. The mother’s body is designed to be able to pass Jing on to her fetus, to be able to reproduce. Indeed for some women, the activation of these functions can strengthen and stimulate her body; for some women pregnancy is one of the healthiest, happiest times of her life. However, if any of the energies are insufficient, problems may arise with the growth and development of the fetus and the successful completion of gestation. The mother may also become weakened through the pregnancy.
The main focus of work is to maintain the best, most balanced production and flow of Qi, Blood and Essence.
Yin and Yang aspects of pregnancy
Pregnancy as a state of Yin/Water
At conception, Yang is the sperm which provides the spark of energy to begin the process of transforming the Yin egg into the embryo. The development of the being takes place in the watery environment of the womb–Yin energy in relation to conception and birth. The cessation of menstruation means that more Blood energy is available, mirroring what we know physiologically about the maternal increase in blood volume. Blood energy and body fluids are part of Yin fluids. The fetus is nourished, especially in the first trimester, by the mother’s Jing, which is stored in her Kidneys.
Yang aspects of pregnancy
Yin cannot exist without Yang. The absence of periods leads to an accumulation of Fire heat in the body and heat needs to be supplied to the fetus. This is how the Chinese viewed the rise in core body temperature in pregnancy.
During pregnancy there are more of all energies, Yang included.
If there is insufficient Yin, then there can be too much Yang. Excess Yang energy tends to rise. This can be the energetics behind migraine and even pre-eclampsia.
Changes in Qi, Blood and Jing
Jing
On one level Jing represents the huge hormonal changes the mother undergoes. These changes are most marked in the first trimester both energetically and physically. On another level it is about how the early stages of growth and development unfold for the fetus. It is of particular importance in the first trimester as the organ systems are being formed.
It relates mostly to the energy of the Kidneys, which store the Essence, and the Extraordinary Vessels of Governing Vessel, Conception Vessel, Penetrating Vessel, Girdle Vessel, Yin and Yang Heel and Linking, which circulate the Essence. It also relates to the Kidney–Uterus meridian which is responsible for the flow of Essence to the Uterus.
It is not possible to increase the amount of Essence which someone has, but it is possible to balance how it is moved around the body through working these meridians, especially in making sure that it gets to the fetus as well as the mother. The quality of Essence is affected by its interaction with the energy of food, processed mainly by Stomach and Spleen. Work with these meridians will be important, as will attention to proper diet and physical nourishment.
Stress and overwork particularly affect the Essence.
Flow and production of Qi: CV, GV and the 12 meridians
In the first trimester there are subtle changes in Qi flow in the body as Qi needs to be directed to the Uterus to nourish the placenta and the fetus but the fetus is still physically minute.
As the pregnancy progresses the fetus essentially blocks the flow of Qi in the mother’s abdomen, which affects Qi flow through the rest of the body. Furthermore the fetus is increasingly drawing upon the mother’s Qi to support its own growth and development.
The Conception Vessel and Governing Vessel are the regulators of Yin and Yang Qi in the body, especially in times of change, but ultimately all the 12 meridians are affected in different ways as they circulate different types of Qi, all of which are important for the fetus.
As the fetus grows, the abdomen distends and pressure is put on the abdominal organs and meridians, especially Heart–Uterus, Penetrating Vessel and Conception Vessel. The development of the linea nigra indicates some women’s response to the changes in the Conception Vessel. Both Qi and Body fluids find it more difficult to flow up and down the body. Energy is blocked in the Three Burners as the fetus prevents energy from moving between them. Blocked energy in the middle burner affects digestion. Energy flow into the upper burner also becomes blocked, affecting the flow into the arms and chest, influencing energy flow to the Heart and Lung. Blocked energy in the lower burner affects Bladder and Kidney and the flow of energy down to the mother’s legs, blocking especially the Yin meridians of Spleen, Liver and Kidney.
The increasing weight of the fetus tends to place strain on the back creating lordosis and affecting the flow of the Governing Vessel.
Flow and production of Blood
The extra Blood in the body tends not to be held in the uterus in the first trimester as the tiny embryo does not need it and so it may rise up the mother’s torso causing feelings of heat and Fire. This may cause morning sickness, breast fullness and emotional unsettledness. From the second trimester the fetus needs more blood and the placenta regulates hormones and blood flow to the fetus and feelings of heat settle at that time; the Penetrating Vessel energy becomes more settled.
After conception, Blood is gradually being transformed to Milk, in preparation for breastfeeding, and some of this Blood transfers its location from the lower to the upper burner. This will also contribute to morning sickness and the general feeling of heat above and distension of the breasts.
By the third trimester, the fetus needs a lot of Blood to support the rapid weight gain and laying down of fat. The mother may tend to be anaemic. The mother is not really suffering from typical Blood deficiency as overall there is still more Blood in the system. However, the composition of Blood has changed due to the ‘addition’ of Jing through menstrual Blood and the transformation into Milk.
The Penetrating Vessel is the Sea of Blood. Other important meridians are the Spleen which produces the Blood energy, the Liver which stores the Blood energy, and the Heart which rules the Blood energy. Heart–Uterus sends Blood energy and emotional energy to the Uterus.
Maternal changes in the different trimesters – five elements, 10 lunar months and dominant meridians
Over the centuries theories have developed referring to patterns of a dominant organ/meridian energy in the mother which nourishes the fetus during the different months (Ling Shu quoted in Eyssalet 1990; Zhubing Yuanhou Lun quoted in Rochat de la Vallée 2007). Some schools say that the dominant meridian for the mother in the month should not be worked (Eyssalet 1990, Maciocia 1998: 28). However, most therapists today would not avoid using the meridians. Indeed by understanding which meridian is nourishing the fetus during any month, it may be helpful to work that meridian in the mother with the focus on supporting the energy flow to the fetus. Zhubing describes points on the meridians to work.
In over 20 years of working with pregnant women, I have not specifically avoided working any of the meridians. Indeed I have often worked meridians which correspond to the month, to no ill effect. The schema can, however, provide a useful way of understanding which energies in the mother may tend to go out of balance at particular stages of pregnancy and indeed sometimes it is useful to work with the energies of the dominant meridian in order to support the mother (Suzanne Yates).
The Huainanzi text became the basis of many later descriptions, one of the most well known being the Zhubing Yuanhou Lun (6th century CE). This text gives a detailed account of the changes within both the mother and foetus during the 10 months of pregnancy, presenting the dominant meridian in the mother, the kind of food she should eat, the behaviour she should adopt. Within the mother the meridians are given in order as: liver, gall bladder, pericardium, triple heater, spleen, stomach, lungs, large intestine and kidney; the functions of these meridians as governing the development of blood, essences, vital spirits, the six fu, the four limbs, the mouth and eyes, skin and body hair, the nine orifices and the vital circulation within the foetus.
(Sandra Hill)
Dominant meridians for each month of the 10 lunar months of pregnancy are:
1. Liver (LV).
2. Gall Bladder (GV).
3. Pericardium (HC/HP).
4. Triple Heater (TH).
5. Spleen (SP).
6. Stomach (ST).
7. Lungs (LU).
8. Large Intestine (LI).
9. Kidney (KD).
10. Bladder (BL).
Energies of the different trimesters
Conception: Water > Metal
First trimester: Earth – months 1–3
The fertilised egg embeds in the wall of the uterus (Earth), putting down roots and beginning to grow and develop.
Common symptoms for the mother in the first trimester are of Spleen and Stomach not being harmonised (e.g. bloating, nausea, sickness, emotional ungrounding).
Changes in Blood predominate here and this aspect represents close links with the Earth and the energy of nourishment. Blood is no longer lost each month. A woman needs to keep a good balance of energy between her Qi and Blood and it is important that she has good-quality food to nourish her. There is a need to increase stores of Blood, and this is done through the Liver.
Dominant meridians
• First month – Liver. This represents the beginnings of creation. Blood gathers in the Uterus. Sun SiMiao (Rochat de la Vallée 2007) says that in the first month the mother should not move too much as Blood will go to the muscles rather than be gathered in the Uterus. He suggests that it is better to be quiet and rest.
• Second month – Gall Bladder. This represents the movement of Blood as it gathers more strongly in the Uterus.
• Third month – Heart Protector. This completes the action of enriching the Blood with the Spirit. It is at this point the fetus is considered to exist.
Second trimester: Fire – months 4–6
The mother begins to develop more of an emotional connection with the fetus as she feels movements. Fetal education begins. During the fifth month the fetus receives the Essences of Fire. Physically the changes in the Blood will support the continued growth of the fetus.
Often the mother feels more at ease and settled both physically and emotionally. The texts now recommend that she moves and spends time outside.
Dominant meridians
The dominant organs here are those connected with the continued growth and development of the fetus.
• Fourth month – Triple Heater. This continues the process of Blood moving through the body and the blood and blood vessels. It is also about the movement of water, fluids and Qi through the body.
• Fifth month – Spleen. The mother’s Blood nourishes the growing fetus as it lays down more fat.
• Sixth month – Stomach. Continues the giving of nourishment to fetus as well as defensive Qi. However, it was considered important in this month that the mother should not eat too much food. This is often the month that the mother may begin to experience heartburn and needs to start to eat smaller amounts of food, maybe at more frequent intervals through the day.
Third trimester: Wood – months 7–10
If the mother continues to exercise and move physically, then the free flow of Wood energy prepares her for the physicality of birth and caring for a new baby. If she rests too much, then frustration, worry and feelings of control may build up and she may find birth difficult, both physically and emotionally.
In old Chinese traditions, during the last 3 months of pregnancy (Eyssalet 1990, quoting Lin Shu J in ch. 10, article 2) the mother would be in a separate room so that she did not have contact with the father. This was to bring about a more feminine contact and bond between mother and fetus and in preparation for birth and for breastfeeding. The husband would be purifying himself through abstinence in preparation for meeting his child.
• Seventh month – Lungs (Metal). Nourish the Wood of the fetus. Lungs affect the exteriorisation of the energy.
• Eight month – Large Intestine. The Yang of Metal is fixing limits. Breathing of the mother is considered especially important during these last months. Her skin is lustrous.
• Ninth month – Kidney energy supports the fetus for the completion of the ancestral plan.
• Tenth month – Bladder. The Yang aspect of Water, preparing for birth moving into the Yang energy of Wood for birth.
5.3. Energy patterns for the fetus
For the Chinese, at birth we are already 1 year old. This may even represent the idea that the spirit of the fetus is present in the few months before conception.
There are theories about the development of the meridians in the fetus and what is happening at each month (Matsumoto & Birch 1988: 153–156). The most important energy shift is along the midline of the body – the development of the Extraordinary Vessels, which is discussed on p. 123.
In eastern philosophy, by contrast with western where it is now known that the fetus is mostly developed in the first few months, the fetus develops more gradually as the pregnancy progresses and different aspects of the soul come into the body.
Mother and child interactions: fetal education
Fetal education ( Tai Kyo) begins from the third month when the fetus is formed: ‘The beginning of the person is the beginning of the heart/mind and the ability to receive influences at the mental level. So what the mother thinks and sees can influence the formation of the child’s mind’ (Rochat de la Vallée 2007: 48). One writer, Chao Shi Lin, (quoted in Essaylet) provides a prescription of each month such as:
if you want a boy take a bow and arrows
if you want a girl wear round Jade
if you want a beautiful infant wear white jade and admire peacocks (paon)
Other writers and other descriptions are elaborated in the texts.
Music was considered especially important for developing the heart and Shen of the fetus. Good-quality food was considered important for strengthening the Jing of the fetus and in the Zhubing Yuanhou Lun (quoted in Essaylet) specific foods are suggested for each month of pregnancy.
There was, however, also the idea that the child is able to separate from the mother and have his/her own individual characteristics. Eyssalet links this with the idea of the earthly spirits, the Gui as opposed to the heavenly spirits of the Shen (Eyssalet 1990: 214). The Gui are points linked more with the separation of a separate and distinct energy of the fetus. Points linked with the Gui are: LI 1, LI 10, LI 11, Lung 5, Lung 9, Lung 10, ST 36, ST 6, SP 1, HC 5, HC 7, GV 22, GV 23, GV 26, GV 16, BL 62, CV 24. We could consider using these points with a focus on connecting with the individual nature of the fetus.
Yin and Yang in the developing fetus
There can be imbalances of Yin or Yang in the developing fetus. Congenital defects can be seen as too much consolidation of Yin without the ability to disseminate Yang. CV is in state of excess and GV is in state of deficiency. This can be seen in cases of dwarfism, Down’s syndrome, mental retardation, or where the body is truncated with the head close to the shoulders and lots of padding around the neck. The legs and hands are sometimes clubbed. All this represents excessive Yin.
Too much Yang would be infantile seizures and convulsions, or heat presiding over damp.
Changes in Qi, Blood and Jing
Jing
This is the essential building block which forms the fetus, as the Jing of the mother and father unite. It is the DNA, the ancestral blueprint. The mother’s Jing continues to nourish the fetus during gestation.
Qi
The Qi in the fetus is not said to flow independently as the source for the Qi (Air and Food) comes via the mother. Once the egg is fertilised Qi starts to flow. As the egg develops so too does Qi. There are references to Qi flowing through the meridians, which are developing during each lunar month of gestation. Qi can be said to flow with Blood – Qi is mediated by Blood as it comes to the fetus via the placenta.
The source of Qi is considered to be the Ming Men and Qi first flows along the axis of the CV and GV, which regulate Yin and Yang Qi and PV which regulates Blood. As the limbs develop and the meridians therefore form, then Qi starts to flow out from this mid-line. This fits in with the idea of the Extraordinary Vessels being older energies and the 12 meridians being more recent.
There is also the idea of Yuan Qi guiding the differentiation of the embryo and fetus fuelling developmental processes such as making blood, the growth of bones, emotional and psychic development.
Blood
The nourishing quality of Blood is important for the fetus. The fetus receives nourishment directly through the Blood which is flowing into it via the placenta and thus the PV of the mother is important. As the fetus grows and lays down fat it starts to need more Blood, so that by the end of the pregnancy this is one of the main energies which is nourishing it.
Embryological development
One interesting view of fetal development put forward by Michio Kushi (1979) is viewing fetal development as mirroring the whole period of human evolution (the human being as the microcosm of the universe, which is the macrocosm) from our time in water to the time of volcanic shifts and eruptions, through to the evolution of reptilian and mammalian life on earth. The total period of 280 days of pregnancy represents a repetition of the evolutional process of biological life in the ocean of the earth until the time of the rise of land upon the surface of the water. It repeats at least 2.8 billion or nearly 3 billion biological years. The ancients therefore considered that the average speed of growth is 10 million biological years per 24 hours.
This means each day of life in utero represents a considerable amount of human evolution and this was why the Chinese felt that the influences upon the fetus in the womb in pregnancy had such a profound effect.
The Chinese texts detail many aspects of fetal development. Rochat de la Vallée says that the
building starts with the most internal composition, the water, the ability to take a form, the five zang and the five constituent parts of the body and then moves from the depths outwards to the surface and the nine orifices (Guanzi Ch 39 and Lingshu Ch 10) … The sense organs … are able to perceive not only big and obvious things but also that which is not seen or heard directly. The production of a human being implies a destiny not just to comprehend the obvious, but to use the fullness of blood and qi and spirits and all the sensory faculties to go further than what is easily perceptible. The heart or mind can be used to think about what is really important in life and what is the subtle mystery of life.
(Rochat de la Vallée 2007: 14, 15)
And Sandra Hill says:
The earliest text on the development of the foetus is found inChapter 7of the Huainanzi, a compilation of Daoist philosophical writings from the 3rd century bce.Chapter 7is called Jing Shen, vital spirit, or essence spirit; the development of the foetus follows directly after a well known quotation from the Dao De Jing – the Dao gives rise to the one, the one gives rise to the two, the two give rise to the ten thousand beings …
At 1 month it is a bulge; at 2 months it is a paste; at 3 months it is foetus; at 4 months it has flesh; at 5 months it has sinews; at 6 months it has bones; at 7 months it is complete; at 8 months it moves; at 9 months it quickens; at 10 months it is born.
In other texts, the development of the foetus is expressed as in the first month, the beginning of form; the second, the beginning of the rich paste; the third, the beginning of the foetus; and at the fourth month there is a change from the Huainanzi text to present a rotation of the elements through water, fire, metal, wood and earth, and ending in the tenth month with stone.
(Sandra Hill)
Summary of changes (Eyssalet 1990)
Jean-Marc Eyssalet summarises the changes for the fetus presented in eight traditional texts (Hua Tai Jing Zhong Ji Jing (A); Chao Shi (B); Wu Zang Lun (C); Lu Xin Jing (D); Qian Jin Lin (E); Yi Jing Mi Lu de Hua Tuo (F); Huai Nan Zi (G); Rgyud Bzi du Thibet (H)).
I have selected some of the most important to give an idea. (For the full table see Eyssalet 1990: 169–173.)
Month 1 – takes the breath (A), blood and sperm fix (D).
Month 2 – seizes the Ling (A).
Month 3 – contains changes (A) (D) Yang spirit gives the three Hun.
Month 4 – fixes the vital principle: Jing (A), takes on corporeal form (C), takes on the Yin and the seven Po (D).
Month 5 – takes on the substance of the head (A), tendons and bones formed (C), five movements of the subtle organs (D).
Month 6 – hair and skin formed (C), six rules (Lu) fix and bones and tendons (E) (G).
Month 7 – Shen covers everything (A), the Hun start beating (C), the vital principle opens the main orifices and communicates with a clear light (D), the being is formed (G).
Month 8 – takes possession of individual spirit.
Month 9 – takes the voice (A), turns the body three times (C).
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