Trimesters:

Cooking Prenatal Qi

Holly Guzman, PCOM 2014

Basic Outline: (Presentation further includes Lecture, Cases, Demos)

Pregnant women prefer to have no pre-existing conditions and no health problems during the 9 months they
gestate their child. This is unrealistic, yet tends to be a source of worry. Any health issue may happen during
pregnancy, and many are specific to pregnancy. About a quarter of first pregnancies miscarry the 1st trimester.

First Trimester

Dos and Dont for the Newly Pregnant:

Weeks 1-13 (counted from LMP, i.e. week 2 is around ovulation)

Dont

Dos

Dont expose hands to cat litter box or gardens where cats may defecate. Toxoplasmosis
danger.
Dont take much Vit C. Although this is relative, higher doses first trimester are linked to
miscarriage. Be careful of rutin or mixed bioflavonoids that may be high in rutin.
Dont let your body fever or take hot baths. A core temperature rise of a few degrees can cause
developmental problems.
Dont worry about substances, like alcohol, having crossed into the baby prior to the baby
having a chord. Consuming alcohol in week 3 is not going to go to the babys liver.
Dont act like a stretching uterus and tummy will have the same stability that a non-pregnant
form has. The 4 following motions are associated with miscarriage:
o Dont pull upwards, like starting a pull chord motorboat, lawnmower or pulling large
weeds.
o Dont lug heavy bags, such as suitcases up the stairs
o Dont lift heavy objects down from a shelf over head
o Dont have pounding, such as running, abdominal percussion massage, or sexual
activity that persistently jostles the uterus. Heavy and rhythmic movement can be a
problem.
Situps can cause pulled abdominal muscles, usually not until in a later trimester, but it often
takes a while to break this habit:
o Dont do sit-ups, even to get out of bed, best to learn now how to roll to the side and
swing the legs down in order to get up.
Dont worry about prioritizing iron and calcium in the first trimester. They are often
constipating, cause nausea, and the fetus is too small to need large doses of this
supplementation. If they are digested well, it is fine to take them.
Dont take stimulant laxatives, the ones that cause peristalsis and cramping.
Do eat lots of small snacks, preventing an empty stomach. An empty stomach causes more
nausea, thus higher sickness in the morning, before eating.
Do keep in perspective that most morning sickness is from week 8 to week 12, just one month
long, peaking at week 10.
Do check if morning sickness is more settled with alkaline (crackers, kudzu), acidity
(grapefruit, umeboshi), warmth (ginger tea), or oxygen (get outside, walk).
Do take folic acid. Some women dont metabolize folic acid easily. To be sure, take it in a
completely available form, L-5-methytetrahydrofolate.
Folic acid is the foundation of pre-natal vitamins. It is important for perfect cell division. In
those women prone to division problems, 3-4 grams was the dosage per day shown to prevent
neural tube defect and spinal bifida as well as early developmental issues.
To test cell division capacity, the moms neutrophils can be checked to see if there is 100%
perfect division. If some % are hyper-segmented, (imperfect division), this reflects folic acid
insufficiency. The lab is called a Neutrophil hyper-segmentation test, with manual
differentiation.
For nausea, consider B-6, which helps the liver to keep up hormone metabolism
Do keep the bowels moving:
o Try foods including cooked dark leafy greens, acidophilus, fruits, oils, warm water as
tolerated.
o Early pregnancy hormones specifically interfere with peristalsis.
Weeks 4,8, and 12 it is common to spot, so use extra caution with peristalsis stimulation

Trimesters: Cooking Prenatal Qi

Holly Guzman, PCOM 2014

First Trimester

Dos and Dont for the Practitioner:

Herbs

Acupuncture

DO NOT:
Use herbs that
o have toxins (pennyroyal)
o blood breaking (e zhu, ze lan),
o break phlegm (zhe bei mu).
Do not clear more heat than the woman has excess
o For example, with more heat (such as acute hepatitis) more huang qin can
be used.
DO Consider:
Black haw, (Viburnum) for acute uterine cramping
Curing Pills after a meal to prevent vomiting
Ginseng if vomiting from severe stomach qi and yin deficiency
Collinsonia if supplementing for constipation
Miscarriage protection:
o Tai Shan Pan Shi San, Jiao Ai Tang
DO NOT:
Do Not use points that are counter-indicated for the patients condition.
o Do not disperse below the waist if the qi may come down too much (ie. ST
36, ST 40)
o Do not bring qi to the surface (ie TW 5, GB points) if the uterus may be
deprived of adequate qi flow
o Do not use points on the abdomen that are close to, or over stimulating to
the uterus,
o Do not disperse the lung qi (i.e. Lu 5)
o Do not loosen the sacrum or low back with local points

DO Consider:
Tonifying: Tiger warmer, gentle heat on St qi line, P6, Sp 6.
Gua Sha GV 16 for nausea as this is the location of the brain center for hiccupping
and vomiting (medulla oblongata).
Needles:
o To help hold in the baby: GV 20, Lu 7 against the channel flow
o Morning Sickness: KMS Style:
With a pancreatic hara (lateral tension CV 12 to St 21) use SP 5 &
Sugar points at T11-12 region and:
If K2 pp (pressure pain): K7 and K10
If no pp at K2, use K6 and K27
With a history of over reaction to birth control pills, or Pitosin
usage, use SI 3, SI 13, Bl 2

Trimesters: Cooking Prenatal Qi

Holly Guzman, PCOM 2014

2nd trimester is a time to add in broader food, more calories, more minerals and vitamins!
Many tests will be pushed: 12 week Maternit21, 19 week ultrasound, glucose tolerance, alpha fetoprotein.
Know BP.
Baby shows by 5 months.

Second Trimester

Dos and Dont for the Pregnant Woman:

Weeks 14-27, 4-6 months

Dont

Dos

Do not take over 5000 IUs of Vit A. This number keeps lowering, as it used to be 8000. Dosage
cut off needs to be ok for the weakest of livers in the weakest of babies.
Do not drink lots of Orange Juice. Julian Scott is convinced over usage adds to acidity and
neurological unrest in the fetus, and is linked to fussy, difficult children.
Do not allow the picky stomach of the first trimester to lead to leeway on sweets.
Do: CALCIUM: RDA is 1500 mg per day in pregnancy (2000mg per day nursing)
o Building a whole baby skeleton takes lots of calcium. The baby will draw from
whatever is available, if it doesnt get what it needs from the mothers diet, it will draw
the minerals from her bones. Thus the saying Have a baby, loose a tooth
o Calcium supplements tend to have a high dosage of large pills. The more compact, the
less digestible.
o Calcium needs stomach acid to be broken down, harder more compact pills or weaker
stomach acid present a problem. This relates to why adding vinegar to bone broth
soup dissolves more minerals into the broth. Check if the calcium pill dissolves in
white vinegar in 20 minutes. If not, it may be passing through the digestive system
whole, or partly un-absorbed.
o Try and meet some meet calcium requirements through diet.
o Check for high calcium sources.
300 mg calcium per cup of milk
500+ in a cup of Ricotta cheese
360 in a cup cooked collards
300 in 2 T. blackstrap molasses (also very high in iron)
Calcium in mgs per 3 oz serving:
354 sardines
109 tofu
254 in almonds
405 in sesame seed meal. Etc.
Do: MAGNESIUM:
o Good to take with calcium to make it less constipating,
o Helps build bones.
o Helps cramping muscles
o Calms the nervous system.
o Comes in many forms, which can be more and less laxative.
o Dosage usually at half the amount as the calcium.
Do: PROTEIN:
o Exact amounts is a source of controversy.
o High protein, low sugar diets protect from pre-eclampsia.
o Protein is the fuel for growing.
Do: FISH OILS:
o Highly correlated with superior neurological development
o Pregnant and lactating women supplementing DHA, 300mg a day, linked to higher
brain, cognition, emotional, & motor skills in infants.
o
Do: VIT E:
o Helpful to keep veins from becoming varicose.
o Important in pregnancies when mother is over 30 (most these days).
o Use a mixed tocopherol, about 400 IU a day.
Okay to use higher C or rutin this trimester only.

Trimesters: Cooking Prenatal Qi

Holly Guzman, PCOM 2014

Do: IRON:
o Watch moms hematocrit, and raise it up past 35 with iron if possible.
o Iron best absorbed with more stomach acid, take with acidic food or protein to
activate acid.
o Take in multiple smaller doses or time released.
o Chlorophyll of plants similar to blood, try chlorella or spirulina.
o Anemia causes SOB, tiredness, easier to bruise and to bleed excessively during
birthing.
o Babys liver will begin to draw and store its own iron (reserved for the months when
its diet is only milk, but it is gaining blood volume and needs spare iron). The babys
iron requirements often result in a drop in the moms hematocrit in the 7th month.
Anticipate, and increase blood building before this happens.

Second Trimester

Clinical Recommendations for the Practitioner:

Herbs

Acupuncture

Clinical Info:

Good time to do constitutional formulas. Tonify blood, yin, yang, qi, kidneys, spleen, etc.
Tinctures are the cleanest for heavy metals and you can burn off the alcohol.
Quiet Contemplative by Kan an excellent pregnancy tonic. [Liu Wei with added tu su zi,
(cuscuta) han lian cao, (eclipta), sang shen zi,(mulberry) gou ji zi ( lycium) all used in
general to help in pregnancy].
Bu Zhong Yi Qi Tang: Used to raise up spleen qi. Low placentas can migrate up.
Liver Clearing Herbs: Dandelion, burdock, milk thistle. For skin irritations and also
useful to control fibroids.
Eulethero (Siberian Ginseng) used to protect from exposure to radiation and stress.
Bai he (lily bulb) and Mai men dong (ophiopogon) used to help lung yin, offset skin and
allergic tendencies in the newborn.
5th and 7th month use Kidney 9 (or whole yin wei meridian treatment), as the guest host
point calms a restless fetus, enhances good clear skin for the child, and harmonizes the
relations between the mother and child.
Constitutional acupuncture, remembering that the pregnancy changes lots of reactions,
you do not know if this person will respond in the same ways as prior to pregnancy.
Watch for classic timing of symptoms:
o 17 weeks: tendency for nasal mucous membrane to swell, allergies, and
nosebleeds.
o For sinus infections, use aromatic sinus ointments (Vics variations) to keep nose
draining. Use local sinus points with fine needles.
o 18 weeks and on, many types of skin irritations can occur:
Prick tip of ear to release heat.
Use Spring Wind Burn Ointment.
Use liver clearing support herbs (see herbs section above).
Dry brush the bottom of the feet.
Pelvic instability and pain: self help book: Relieving Pelvic Pain During and After
Pregnancy by Cecile Rost
UTIs often go undetected. A little frequency and urgency can be the only signs.
Yeast Infections common. High estrogen raises pH vaginally and is conducive.
Gender Assessment by Pulse Evaluation possible after 13 weeks.
o Classical Chinese idea that if the Kidney yin pulse, (proximal left pulse), was
strong enough to engender a strong heart pulse by this week, then the child would
be a boy.
o Alternately: Strength of right kidney yang to left kidney yin, or relation of whole
left pulse to the whole right pulse.

Trimesters: Cooking Prenatal Qi

Holly Guzman, PCOM 2014

Third Trimester
Weeks 28-40, 7-9 months
The baby fully formed, some children born anytime in the last trimester survive. Every
Overview

Clinical Info:

week inside increases vitality.

If there is a history of early labor, or the cervix is considered loose, use acupuncture and
herbs to support the qi.
Week 35 is especially vulnerable to early delivery.
The longer the gestation, the bigger the baby, the heavier the load.
All of the mothers organs are working harder to support both lives.
o Heart: The moms heart rate is faster
o Lungs: Mom is short of breath.
o Stomach: Her stomach has less room and more heartburn.
o Kidneys: If her kidneys get past their capacity, this will result in pre-eclampsia.
o Spleen/Pancreas: Past capacity will result in gestational diabetes.
Early Labor
o Black Haw,(viburnum) can stop the acute contractions that lead to early labor.
o Constitutionally: Bu Zhong Yi Qi Tang, Ba Zhen Yi Mu Wan, Shou Tai Wan (Fetus
Longevity Pills).
o SP 4 can stop the acute contractions that lead to early labor
Supporting Muscles & SP Qi
o Tonify: GV 20, Lu 7, moxa or tiger warmer St 36, tiger warmer tonify Sp 6, K3, Bl 23.
o KMS:
Visceroptosis: See Kiiko Matsumoto Clinical Strategies Volume 1, Pg 215-220.
Hemorrhoids: Use local moxa stick with the mom positioned so her butt is raised.
BP concerns:
o A 10 hg rise in the diastolic (bottom number) from a baseline 2nd trimester diastolic
is significant cause for pre-eclampsia concern.
o Use a proactive herbal formula to help the kidneys if you see this BP change or other
early signs.
o Early signs are also protein in the urine and excessive swelling.
o Change to a high protein (eggs are known to be especially helpful) and low glycemic
index diet.
o Use a BP herb formula assertively. (long gu, e jiao, tian ma, gou teng, shi jue ming,
sang ji sheng, mu li, bai shao, gui ban, fu ling, gou ji zi. )
Gestational Diabetes concerns:
o Insulin may be given to mothers with gestational diabetes if their morning fasting
blood sugar is over 105.
o Home kits are easily available to check blood sugar.
o Treatments for blood sugar can include:
Herbal formulas for the spleen, (6 gentleman, Gui Pi Tang)
Acupuncture (tonify the SP and KMS sugar points T11 and T12 jia ji)
Diet (high protein, including protein powder or Greek yogurt late at night,
low glycemic, insulin enhancers like huckleberries, Jerusalem artichokes) to
prevent the risks of gestational diabetes.
Strep B vaginal growth prior to a vaginal delivery: Treat & Retest
o Take Usnea orally.
o Acidophilus/bifidus orally, and a gentle splash vaginally to change the ecosystem.
o Consider usnea suppositories made in cocoa butter.
Vaginal Herpes:
o Consider a moderate dose of Long Dan Xie Gan, calibrated to the amount of heat the
mom has excess and can be reduced.
o Okay to take some Lysine. Stay away from high Arginine sources including peanuts,
nuts, corn, chocolate.
o Must be without vaginal lesions to deliver vaginally. Can cover lesions other places.

Trimesters: Cooking Prenatal Qi

Holly Guzman, PCOM 2014

Mouth Health: Placentas have bacteria in them that most resemble oral bacteria, and are
passed to the baby. Placenta bacteria differs if baby born before 37 weeks. Gum disease
and pre-term birth well known correlation. Keep up with oral health!

LAST MONTH
Dont

LAST MONTH (9)

o Do not supplement with high Vit C. The risks associated with early miscarriage are
over. The issue is high levels in pregnancy changing to a rapid reduction of vitamin C
in the babys blood after birth. The contrast can cause scurvy symptoms in the
newborn.
o Do not swim and miss if the amniotic water breaks, as the mom would not be aware.
LAST MONTH (9)
Dos
o Do: Add the essential fatty acid GLA. Not in fish oil.
Good sources EPO or borage seed, or freshly cracked, not heated nuts, such as
walnuts bought in the shell.
GLA plays a role in keeping down excess swelling in the mom, esp. in hands that
feel like carpal tunnel.
Externally used in Western medicine to ripen the cervix.
Orally only the last month.
If GLA is high in mothers milk , protects from eczema and ear infections.
o Do reduce calcium in last month.
A larger, harder head does not help with an ideal birth for the mom and baby.
The newborn baby has plenty of additional skull growth on its exclusive milk
diet.
Mexican folk medicine restricts cheese in the last month.
o Do keep the buttocks, hands and feet warm, keep on clothing and no sitting on cold.
o Is the babys head down? If not, be sure to warm up moms sacrum and buttocks, and
keep them warm. Adjust the qi lower.
To prepare for an easy birth:
Birth
o Japanese tradition is no sweets for 3 weeks prior to due date. On due date, resume a
Preparation
little sweet. Sweet causes contraction, and sweet can help with the labor marathon.
Acupuncture: Relax and soften all tense birthing muscles by needling them. L2, L3,
piriformis, spinus erectus, gelatinous nodules around the sacrum. Needle into the liao
points with the mom sitting upright on a stool, to lift, thin and soften the cervix.
If the baby is overdue, use pulse diagnosis to find which blockages to treat.
Overdue
Liver pulse and tendons too tight? LV 3, LV 9. Look for a pulse change & the LV meridian
softening.
Lung pulse not dispersing, still forcefully rising & holding things up and attached? Lu 5
Kidney yang pulse too deficient? Get the mom to truly rest, moxa Bl 23.
Heart pulse not peaceful? Ear shen men. Tiger warmer T4, T5 jia ji. What is she most
anxious about? Ask and treat.
Spleen pulse too slippery, relaxed and comfortable, parked in being pregnant? strong
stimulus to move qi in ba liao pts.
Chinese gma says: New mom mustnt put her hands in cold water after the birth.