SUMMARY: 70 patients diagnosed with hyperemesis gravidarum were randomly divided into control group (35 subjects) and treatment group (35 subjects). All subjects met the diagnostic criteria of hyperemesis gravidarum according to “Obstetrics and Gynecology” and the Traditional Chinese Medicine (TCM) diagnosis of pernicious vomiting during pregnancy due to Spleen and Stomach Deficiency according to “Gynecology in Traditional Chinese Medicine”. Inclusion criteria: ① meet the diagnostic criteria of hyperemesis gravidarum; ② normal pregnancy and hydatidiform moles ruled out by ultrasound; ③ moderate to severe hyperemesis gravidarum, defined by pregnancy-unique quantification of emesis (PUQE) ≥ 7 points ④ consent to join the study and informed consent signed. Exclusion criteria: ① patients with gastrointestinal, urinary, reproductive, neurologic or metabolic diseases; ② patients with other pregnancy-related diseases, such as acute fatty liver and preeclampsia. There was no significant difference in age, gestational age, course of disease, and order of pregnancy (P>0.05), and the two groups were statistically comparable. In the control group, subjects received routine treatment, including: temporary fasting or restricted liquid diet. According to the individual needs, about 3000 mL of liquid supplement was given per day, such as 250 mL intravenous (IV) compound amino acid, 500 to 1,000 mL IV compound sodium chloride, 5% IV dextrose saline, 10% IV dextrose, or 200 mg of vitamin B6 and 2 g of IV vitamin C. In addition to the routine treatment, subjects in the treatment group also received Modified Sangen Heqi Decoction （三梗和氣湯加味）with Baixiao moxibustion (百笑灸). The ingredients of Modified Sangen Heqi Decoction includes: Zi Su Geng 6g (紫蘇梗Perillae frutescens Britton), Huo Xiang Geng 6g (藿香梗Herba Pogostemonis) , Cang Zhu 9g (蒼术Rhizoma Atractylodis), Hou Po 9g (厚朴Cortex Magnoliae Officinalis), Jie Geng 6g (桔梗Radix Platycodi), Chen Pi 5g (陳皮Pericarpium Citri Reticulatae), Sha Ren 5g (砂仁Fructus Amomi), Zi Ke 5g (枳壳Fructus Aurantii), Huang Lian 6g (黄連Rhizoma Coptidis), Gan Cao 5g (甘草Radix Glycyrrhizae), and Lu Gen 30g (蘆根Rhizoma Phargmitis ). Additional herbs can be added according to the individual needs for each patient. Subjects received one decoction in two-divided dose per day, one in the morning and one in the evening. Subjects in the treatment group also received Baixiao moxibustion treatment at the following acupoints: REN 8 (神闕 Shen Que)、REN 12 (中脘 Zhong Wen)、PC 6 (內關 Nei Guan) and ST 36 (足三里 Zu San Li); the treatment was performed once a day and 30 minutes each time. A course of treatment consists of seven days, and most patients receive 1 -2 courses of treatment. To evaluate the efficacy, Traditional Chinese Medicine Syndrome Score Scale (TCMSSS), quality of life for nausea and vomiting during pregnancy (NVPQOL), and urine ketone were monitored.
Table 1. Comparison of Traditional Chinese Medicine Syndrome Score Scale
between Treatment and Control Group (
According to the results, the treatment group showed a more significant improvement in TCMSSS and NVPQOL scores (P<0.05). Compared to the control group, subjects in the treatment group also showed a more significant reduction in the frequency of nausea and vomiting (4.38 ± 1.06x/day in the control group vs. 3.56 ± 0.90x/week in the treatment group). In addition, urine ketone returned to normal significantly sooner in the treatment group (P<0.05). The results indicate that adding Modified Sangen Heqi Decoction with Baixiao Moxibustion to routine treatment can significantly improve the signs and symptoms, quality of life and laboratory marker for patients suffering from hyperemesis gravidarum.
Li Yuqing, et al. Fujian Journal of TCM. 2020. 51 (5): 38-40