by Raven Lang
Updated May, 2026
Hyperemesis gravidarum is a relatively rare condition (0.3% to 10.8% in less severe cases) that presents in pregnancy as violent and constant morning sickness with signs of dehydration and weight loss. In the USA, HG is the leading cause of hospitalization in early pregnancy and the second most common cause of pregnancy hospitalization overall. F1
Typically, morning sickness begins at 6 weeks and is rarely seen as an extreme condition. In morning sickness, acupuncture and careful meal planning with vitamin and herbal therapy can treat it easily, resulting in women being able to take in enough fluid and food that the symptoms are bothersome, but life goes on as relatively normal. Then, between 3 - 6 weeks after it begins, it disappears.
Hyperemesis gravidarum is different. The symptoms have a ferocity to them, and they do not stop after 6 weeks. Also, women cannot go about living a normal life, nor will TCM treatment be effective enough that they can consume adequate fluids and food. When an inexperienced practitioner sees this condition, there is a danger of mistaking it for morning sickness. This is because 1st trimester nausea and vomiting/N&V are generally expected and accepted, and for some women, the condition is worse than for others. When an acupuncture treatment for morning sickness does not last for at least 5 days, and instead symptoms return within 1–2 days, consider hyperemesis. Following are a few telltale signs that differentiate between morning sickness and hyperemesis:
- Morning sickness typically begins at 6 weeks and resolves at the latest by 12 weeks. Hyperemesis can begin as early as 4 weeks, and can last anywhere between 5 months to birth.
- TCM treatment for morning sickness that includes dietary suggestions, vitamin B6, herbs, and acupuncture works well, and the effects last approximately one full week. In hyperemesis, some women cannot even swallow the tiny meals recommended numerous times daily, nor can they take herbs or vitamins. Acupuncture, including gua-sha and bleeding, will only help for ½ day to 2 days, at most.
- In hyperemesis, besides severe N&V, there is an obvious increase of Heat, seen with signs such as dehydration, a shriveled tongue, significantly dry or “empty” skin, constipation, and weight loss. Depression and/or desperation can also accompany hyperemesis because there is no ability to lead a normal life. Also, the abdominal pain from continual vomiting can be severe. Morning sickness does not have these extremes.
Of course, in every disease there is a spectrum. When hyperemesis is not totally debilitating, frequent acupuncture treatments are advised. To lower costs and travel time, you can teach the gua-sha described below to the woman or a family member. This instruction can reduce the necessity for multiple treatments, as the disease lasts months, and often the gua-sha can lengthen the time between treatments. However, when hyperemesis is severe, without IV nutritional therapy and pharmaceuticals, it can be life threatening. The author Charlotte Bronte is believed to have died from hyperemesis.
I would like to share a severe hyperemesis case to point out when TCM practitioners must recognize our limits and know when to quickly refer to allopathic care. In the limited severe cases that I saw as a midwife and TCM practitioner, IV nutrition and IV hydration, along with antiemetic medication were necessary. The following case demonstrates how one needs to know one’s limits when presented with a severe case. It also elucidates the necessity of having colleagues in the western medical world that can be called upon at a moment’s notice to help our patients.
Paulette: A Case Study of Hyperemesis
A colleague with a patient suffering from morning sickness called me on a Sunday afternoon to ask if I would see her patient while she was going to be on a two-week vacation. I replied that she should tell her patient to give me a call and that I would come in early Tuesday, my first day of practice for the week. Beside the patient’s first name, the fact that it was a strong morning sickness case, that it was a first pregnancy, and that the woman was responding to the needles, no other information was given.
Later that afternoon I received a call from a woman whose voice I could barely decipher on the telephone. At first, I wondered if her strong accent was getting in the way of my understanding her, but after spending a few minutes on the phone, it became clear that she simply had no vocal strength and was, as a result, audibly imperceptible to me. Finally, in some exasperation, I asked if her partner or another person was with her and if so, could she please pass the phone to him or her. Within seconds I heard a clear loud booming voice and within the next two minutes I gave the person directions to my office and a time to meet me that coming Tuesday.
On Tuesday at the appointed time, a van pulled up in front of my office and stopped right in front of my door, as close as anyone ever did. A woman got out of the passenger side of the car, and hobbled, quite bent over, right into my office. Instead of stopping at the desk, which was at the entry by the door and was where I was sitting, she went to a bench about five feet away and collapsed onto it. In her hand she held a plastic bag and inside of it were some used tissues and a roll of toilet paper. The driver of the van had pulled away from the clinic’s entrance and gone to park. When I spoke to this woman, she answered me, and while I still could not clearly hear her, I recognized her as the patient my colleague had referred to me. This was Paulette.
I took her weak hands into mine for a few moments to make contact, introduced myself, and remarked on how her condition appeared excessive. Then I handed her my two-sheet intake form that I had prepared for her, but it was apparent she was not going to be able to fill them out, so I asked her to just fill in her name, age, phone number, and sign the paper at the bottom of the second page, which stated that she was giving me permission to treat her. She took the clipboard from me and made a mark on the spot for her signature. After that she gestured that her husband, who had just entered the clinic, would fill out her name and contact information. I introduced myself to him and handed him the clipboard, asking for those few facts. I then said to them both that it was alarming to see the level of discomfort and weakness that I saw before me, and that I was going to take Paulette into a room and put her in a comfortable chair or on a treatment table and do what I could for her. I then looked at her partner and said that it was fine for him to accompany us, if that was okay with Paulette. He immediately declined the invitation to join us, saying that he would prefer to return when the treatment was over, as he had numerous tasks to accomplish during this “free” time. Within another few minutes Paulette and I were in the treatment room in an otherwise empty clinic. She didn’t think she could get on the treatment table, so she sat on the comfy chair that I used for labor induction. Since her voice was barely audible, I pulled up my chair within inches of hers and asked a series of questions. She was bent over, looked green, deeply dry, and astonishingly weak, so I got right to the point.
- “How far along in your pregnancy are you?” She whispered, “Almost eleven weeks.”
- “Are you vomiting daily?” “Twenty-five to thirty times a day.”
- “How long has this been going on?” “Six weeks”
- “Are you able to eat anything?” “No.”
- “Can you drink any water?” “Just sips.”
- “When was your last bowel movement?” “One week ago, today”.
- “Are you passing waters?” “Only a little bit”.
- “How much is a little bit in one day?” “A few teaspoons”.
- “What color is it”? Paulette looked around the room and pointed to the bright orange of a Tibetan prayer flag hanging from the ceiling.
- “Can I see your tongue?” She stuck it out and it was deeply shriveled, dry, and nearly cadmium red in the center, with purple edges. I audibly gasped.
- “How much weight have you lost?” “25 pounds”.
- “Are you in the care of a physician or midwife?” “Yes”.
- “Who are you working with”? She gave me the name of a local obstetrician.
- “When did he last see you?” “Last Thursday at 4”.
- “What did he say about your condition?” “To return in one month”.
I sighed and asked if her acupuncturist was bleeding the back of her neck and if it was helping. She replied that it was of tremendous help, but the relief curbed the vomiting for only a day, and sometimes less. I then asked for her permission to call another obstetrician to see Paulette immediately, as I believed she needed to be in hospital receiving nutritional therapy and hydration. Her eyes widened, a smile came over her lips, and she said that she would very much like that and that she would be happy to have another doctor, as she did not know the doctors in this area and felt no rapport with the obstetrician she was seeing. I then proceeded to begin treatment by using a combination of gua-sha and bleeding. For cases such as these, this combination gives the best and most immediate relief and allows enough comfort to then give a needle pattern that can be retained for an hour, if possible.
The gua-sha is the first step and begins at the base of the posterior scalp along the Du Mai, beginning at Feng Fu/Wind’s Palace/Du 16 and continuing down the neck and into the upper Shu points along the Du and Bladder channels. As long as the skin turns an almost immediate red to burgundy from the friction of the gua-sha, keep going. Often by time you reach UB 20-21, the color response from the gua-sha significantly diminishes or stops. At that time, or whenever you see there is no longer an immediate color from the friction, you can stop. It is important to use unscented oil with the gua-sha, as a scented one can cause immediate and negative reactions. My favorite tool for gua-sha is the porcelain soup spoon found in most Chinese restaurants. It is important to use a porcelain spoon and not a plastic one, as the plastic ones cause too much discomfort.
The next step is to bleed the back of neck with a lancet, 1 - 2 cun below Ya Men/Gate of Muteness/Du 15. The two Du Mai points Ya Men/Du 15 and Feng Fu/Du 16, which have been addressed by the gua-sha, function to clear the brain. There is a Master Tung point, Zong Shu/All Pivot/1010.07, located in that same area, that also clears the brain. When Zong Shu is bled, it treats N&V from chemotherapy, motion sickness, Wind, and Heat. My teacher, Dr. Miriam Lee, who practiced Master Tung acupuncture, instructed me to bleed the area just below the posterior hairline and along the Du Mai for N&V of pregnancy, saying she preferred this location because it is easier to see, bleed, and clean than Zong Zhu, which is located on the scalp. She told me that due to the influence of high levels of pregnancy hormones*, the leading causes for morning sickness and hyperemesis, an imbalance in the brain occurs, and the gua-sha and bleeding of that area sends clear oxygenated blood to the brain, easing symptoms. And they do! The first time I saw this technique for N&V in pregnancy, it gave immediate relief. Very quickly I learned that when used for morning sickness, its effect can last a full week, or 4-5 days in strong cases. When used for hyperemesis, it can give relief for ½ - 1 day for severe cases, and 2 days at most for less severe cases.
The treatment described above involves the art of touch. Certainly, spooning the back of the neck and the upper Shu points with vigor is an aggressive form of touch. So, as you do this, check in with the woman and see how she is doing. Since many women feel instantly better from this simple procedure, don’t be timid. If your vigor is too much, your patient will tell you, and then it is best to let her be your guide. After the bleeding, most women feel the nausea is gone or at least greatly diminished. All this “touch” is strong, yet most women learn to appreciate it, due to its immediate effect. If a woman cannot handle its vigor, then either be gentler or limit yourself to the bleeding only, as it is the bleeding which gives the greatest relief for this condition.
Returning to Paulette, whose hair I had clipped up for neck access and whom I had placed in an upright chair to more easily perform these two tasks, when I was done with these first two steps, she sat up straighter and was then able to get herself on the treatment table and lie down on it.
The final step in the acupuncture treatment is to choose the needle pattern. I chose the pattern of the Chong Mai using the opening point Gong Sun/Prince’s Grandson/Sp 4 on her right foot. Added Zhong Wan/Middle Platform/CV 12, Xian Gu/Deep Valley/St 43 and Nei Ting/Inner Courtyard/St 44 on her most tender foot and closed the Chong Mai with Nei Guan/Inner Gate/PC6 on her left arm. The points Xian Gu and Nei Ting require strong stimulation and are used together to treat the abdominal pain from frequent vomiting. Nei Ting also treats Stomach Heat.
By the time the needles were in place, Paulette’s nausea had passed, and she was able to release her hold of the plastic bag, rest, and even nap. During her rest I made a call to an obstetrician whom I rely upon when I see conditions that require immediate allopathic care. Fortunately, the phone at the doctor’s office was answered and I gave a minute or two sketch of Paulette’s condition, saying that I felt she needed to be admitted to hospital right away. I was put on hold for just a few minutes and then told to “Send the patient over as soon as she was done with the treatment.”
A few hours later, I received a message from the obstetrician’s office that Paulette had been admitted to hospital and was given her room number. The following morning, I called Paulette. A strong, high-pitched voice with an accent answered the phone, and while I was completely surprised at the voice volume and its Qi, I realized immediately that it was Paulette. It seemed beyond credibility. She sounded nothing like the person I had sent to the obstetrician less than 24 hours before. Her voice alone answered most of what I needed to know, and with a smile on my face, I asked her what had happened since her arrival at the hospital.
Paulette was put on IV fluids, IV nutrition, and given an antiemetic suppository. In less than 24 hours I remarked that she sounded like a different person, and she happily replied that she felt like one. She remained in hospital for one full week, receiving continual care, and returning home on the 8th day. She still had some mild N&V and remained on the antiemetic. Hyperemesis gravidarum, in the severity of Paulette’s case, was a life-threatening condition that needed to be treated with IVs of fluid and nutrition, and medication. Needles can be a helpful adjunct therapy, but for cases like hers, they cannot and should not be seen as the only therapy, as they are not effective enough to keep a condition this severe from rendering a woman practically voiceless and lifeless. Prescribing herbs is out of the question, although a homeopathic prescription can be given. Prior to IV therapy and medication, many unlucky women with this disease deteriorated into dire physical conditions that seriously affected them, their fetuses, and sometimes resulted in death.
After Paulette was discharged from hospital, I treated her one more time with acupuncture, witnessing a far stronger woman whose eyes had Shen, pulse volume had filled, tongue had filled with fluid and lost the deep red center and edges, and who stood up straight when walking. When my colleague returned from holiday, Paulette returned to her continued care, while also remaining on antiemetic medication till the day she birthed. After receiving lifesaving fluid and nutrition, the combination of allopathic care and acupuncture worked well enough that she never had to return to hospital or have another IV. The nausea of pregnancy as well as some of the vomiting accompanied her till the last day of her pregnancy, but it remained under control, and she was able to eat, drink, gain weight, and have a relatively normal pregnancy. After birth, her symptoms stopped. Paulette birthed a healthy full-term baby and recovered remarkably well in her post-partum.
Paulette’s case provides an example of how beautifully two models of medicine work together, and how vital it is to develop relationships with doctors who have hospital privileges. Knowing you have someone on board that you can turn to in situations where you need help and need it fast, provides the best possible care for your patients, and peace of mind for yourself.
*The influential hormones that play a prominent role in morning sickness and hyperemesis are:
- GDF15/Growth Differentiation Factor 15 is produced by the feto-placental unit, and once it circulates in the maternal blood system, acts on the brainstem, the primary driver of nausea and vomiting in pregnancy. Apart from gestation, GDF15 is otherwise known as a stress hormone. F2
- hCG/Human Chorionic Gonadotropin is another key placental hormone that is strongly correlated with symptoms of morning sickness and hyperemesis gravidarum. It is the essential hormone responsible for maintaining early pregnancy.
- Estrogen and progesterone in high levels are associated with severe N&V.
- Thyroid hormones respond to high levels of hCG and can contribute to symptoms.
Footnotes
- NIH. C Liu, Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum 2022
- M. Feizo, et al. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. 12/13/2023
