CLINICAL EFFECT AND THE MECHANISM OF VERSION BY MOXIBUSTION

Cooperative Research Group of Moxibustion Version, Jiangxi

1. In 505 cases of 28-34 weeks pregnant women with breech position of fetus, 241 cases were treated by moxibustion at "Zhiyin" points for 7 days. In 195 cases, the abnormal position of fetus have been corrected and the successful rate was 80.91%. But in untreated control group (264 cases), only 130 cases have been turned to normal position spontaneously during the same period. The spontaneous version rate was 49.24%. There was a significant difference between the two groups (P<0.05). In 195 cases of moxibustion group in which abnormal fetal position had been corrected, 16 cases of them were returned to breech position again, whereas in 130 cases of control group whose abnormal position of fetus spontaneously corrected, 22 cases of them returned to breech position. The recorrent rate was significantly different between the two groups (p<0.05). In 36 cases of recurrence, 33 cases were recorrected by further treating with moxibustion. In the control group, the abnormal fetal position in 106 out of 123 cases without spontaneous version were corrected after treatment with moxibustion. The total successful rate of the treatment in the cases described above amounted to 86.88%. For the cases treated with moxibustion, the mortality of the fetus in the perinatal period, the incidence of the neck wound by the umbilical cord and the stillbirth rate of delivery were lower than those reported in the literatures concerned.

2. In 566 women of 28-56 weeks pregnancy with breech position of fetus, some factors which influenced the effect of moxibustion were investigated. It was found that the room temperature during the treatment significantly influenced the therapeutic effect. If the treatment was performed under the temperature lower than 10°C, the successful rate was 60.78%, when higher than ll^C, it was 84.42%. There was a significant difference between them. It was suggested that the thermal effect was related to the therapeutic effect of moxibustion.

3. During the treatment, some physiological changes of pregnant women were examined. The results obtained shown that after moxibustion the white blood cell count and differential count had not changed, pulse rate had not increased, blood pressure had not raised but sometimes fell slightly. It was interested that the pulse rate of fetus was increased significantly after moxibustion. Free cortisol levels in peripheral plasma was significantly increased after moxibustion. But the free cortisol contained in amniotic fluid was not elevated. This indicated that the elevated cortisol in plasma comes from the maternal adrenal cortex. The PGs contained in plasma was determined by RIA. It was found that the content of PGE was decreased significantly. It fell from 2032±95 pg/ml before moxibustion to 1397±122 pg/ml after moxibustion. But the content of PGF had not changed. So that the ratio of PGF/PGE was elevated from 1.08±0.06 before moxibustion to 7.70±0.16 after moxibustion. It was suggested that the elevation of the content of cortisol and the ratio of PGF/PGE in plasma might increase the uterine tension and promote its contraction, thereby the fetal movement was enhanced and the version was facilitated.

4. The types based on differentiation of symptoms and signs were determined by the diagnostic method of traditional Chinese medicine in 1103 cases of 28-34 weeks pregnant women. It was found that, in 612 cases with normal fetal position, 217 cases might be classified into the type in which both the Qi (vital energy) and Yin were deficient. They amounted to 35.46 %. 217 cases out of 491 cases with abnormal fetal position might also be classified into this type (44.20%). It was presumed that during the development of fetus, about more than 1/3 of pregnant women had lost Qi and damaged Yin in some degree. Moreover, in the group of pregnant women with abnormal fetal position, 138 cases might be classified into the type of Yang deficiency. It amounted to 28.11% and was more than that of normal fetal position group (70 cases, 11.44%). There was a statistical difference between the two groups. Therefore, it was suggested that the Yang deficiency might be of some significances in the pathological process of formation and the development of abnormal fetal position.

The cortisol level in plasma was remarkably different in various types of the groups with normal or abnormal fetal position. In pregnant women with Yang deficiency, the cortisol levels were lower, whereas in Yin deficiency they were higher. But after moxibustion, the cortisol levels were increased significantly in the two groups. The clinical therapeutic effect for version of moxibustion in Yang deficiency type was 85.44%, significantly higher than that in the Yin deficiency type or in the type with deficiency of both Qi and Yin.

Based on the facts described above, it was proposed that the effects of moxibustion to Zhiyin points for version might be related to its effects of warming and recuperating Kidney-Yang and regulating the function of Kidney, thereby stimulating the movement of uterus and fetus. This consisted with the changes of cortisol content and PGs level determined in the plasma.