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Postpartum Disorders

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Postpartum Dizziness

Postpartum Convulsions

Postpartum Abdominal Pain

Lochia (prolonged)– E Lu (Bu Jing)

Postpartum Constipation

Postpartum Fever

Postpartum Irregular Urination

Postpartum Sweating

Postpartum Body Pain

Diagnosis & Differentiation

After delivery a mother will have lost much of her Qi and Blood giving rise to ↓ or stagnation.  The woman in this state can easily be attacked by exterior pathogens, especially Cold.  If there is Blood Stasis it can easily attack the HT/LU/ST due to the Cold blood rising up.                             

HT – confused irritable

                                    LU – asthma, dyspnea, cough, fullness in chest

                                    ST – fullness in abdomen, nauseous, vomiting, no appetite

Classical Three Diseases during Post Deliver – San Bing

1.   Convulsion

2.   Fainting - Dizziness

3.   Constipation

Three Emergency’s during Post Delivery – San Ji

1.       Vomiting

2.       Severe Sweating

3.       Diarrhea

Postpartum Dizziness

Diagnosis

Dizziness or blurred vision directly after delivery and can be accompanied with vomiting. 

Differentiate

1.       epilepsy – will have epileptic history before pregnancy, will have sounds coming from throat and uncontrolled saliva from mouth.

2.       convulsions – increased B.P. with edema during pregnancy

Pathogenesis Differentiation & Treatment

1.       Qi Collapsed with ↓– severe bleeding during labour, thin blood.  dizziness with blurred vision and possibly fainting, feeling ‘not right’ in chest

Plus -  Qi deficient symptoms

P/T -  Nourish & consolidate Qi

Rx – Du Shen Tang (+) Huang Qi & Dang Gui in milder cases

2.       Blood Stagnation – minimal or no discharge after delivery, lower jiao pain, dizziness with fainting

Plus – blood stagnation symptoms

P/T – nourish blood to remove blood stagnation

Rx – Duo Ming San (severe stasis)

        Sheng Hua Tang (used normally for 2-3 days)

Postpartum Convulsions

Diagnosis

Post delivery patient suddenly spasms – all 4 limbs spasm along with clenched Jaw.  Convulsions are related with wind and may be caused by external pathogenic factors or caused by yin/Blood ↓      

Pathogenesis Differentiation & Treatment

1.       Yin & Blood ↓  – history of loosing excess amount of blood prior to delivery,  possible convulsions prior to delivery as well

Plus – yin deficient and blood deficient symptoms

P/T – nourish yin & blood to extinguish wind

Rx – Da Ding Feng Zhu  or  San Jia Fu Mai Tang

2.       External Toxic Pathogenic Invasion – directly after birth patient feels cold and has a fever with seizure symptoms

P/T – detoxify, expel wind, regulate blood to relieve convulsions

Rx – Cuo Feng San  OR  Zhi Jing San

Postpartum Abdominal Pain

Diagnosis

Lower abdominal pain after delivery is normal, but should also decline quite quickly.  If it remains quite significant or gets worse, treatment should be administered.  These patterns relate to mostly Blood ↓ & Qi stagnation.  In general the woman already had Qi/Blood ↓.  After giving birth a lot of blood is sometimes lost, this empties the Chong Mai, which can lead to Blood Stasis.  Within 3-4 days after giving birth the low Jiao pain starts, or when breastfeeding commences (Chong Mai brings blood upward creating more of a Blood ↓ in the abdomen).  The pain is intermittent but quite significant. 

Main Causes:

1. Blood ↓ → Blood Stasis (primary cause)
2. LR Qi stagnation → Blood Stasis
3. External Cold invasion → Blood Stasis

Differentiate – food stagnation/poor diet, which is more in the epigastric region & is diet related.  External Toxic Heat invasion (infection) should be accompanied by aversion to cold & fever, & the vaginal discharge (Lochia) starts to have bad odor.

Pathogenesis Differentiation & Treatment

            1. Blood ↓ - within 3-4 days there will be a dull pain in the low Jiao, pressure relieves pain, Lochia is scanty & pale, dry stool

                        Plus – Blood ↓ symptoms  T- pale thin  P- weak thin

                        P/T – nourish Qi & Blood

                        Rx – Chang Ning Tang

            2. Blood Stasis – severe pain, dislike pressure to the region, heat eases the pain, scanty Lochia that is dark purple w/ large clots & flows intermittently, may also have abdominal distension.

                        Plus – T- dark  P- wiry uneven

                        P/T – promote blood circulation, remove Blood Stasis, (expel cold)

                        Rx – Sheng Hua Tang

                                    - if Qi stagnation add wu yao, zhi shi, zhi ke (qiao), lian hu suo

                                    - if severe Heat add Chen Qi Tang

Lochia (prolonged)– E Lu (Bu Jing)

Diagnosis

After 3 weeks Lochia should be finished, if it is not, treatment should be administered.  If amount is too large, color & density have changed, or a bad odor has appeared, the situation should also be looked after.  This syndrome may be accompanied by low Jiao pain, & infection w/ fever.  Weakness or retroflexion of the Uterus may also predisposition a woman to this problem. 

Etiology

The Chong & Ren Mai are not functioning right, which may create trouble moving the blood out of the Uterus & up to the breasts to produce milk.

            1. Qi ↓ - (SP), general SP Qi ↓, difficult labour → SP Qi sinking – can’t consolidate the blood → prolonged or ↑ Lochia.

            2.  Heat in the Blood – Yin ↓ before birth → after birth Yin becomes more ↓ →

 ↓ Heat in the Blood, or, emotions cause LR Qi stagnation → Heat in the Blood, or, Diet of hot spicy food → Heat in Blood.

            3. Blood Stasis – cold invasion &/or Blood ↓ &/or Qi stagnation, &/or already have Blood Stasis in the Uterus, &/or, placental retention → stagnation in Chong & Ren → new blood can’t enter Chong & Ren → prolonged Lochia.

Pathogenesis Differentiation & Treatment

            1. Qi ↓ - prolonged pale Lochia in large amounts, no odor, empty feeling in the low Jiao (SP sinking)

                        Plus – general Qi ↓ symptoms

                        P/T – nourish Qi, ascend mid Jiao Qi, consolidate blood

                        Rx – Bu Zhong Yi Qi Tang + Ai Ye Tan (mugwort stop bleeding)

            2. Heat in the Blood – prolonged Lochia, large amount, red thick sticky, may have strong odor

                        Plus – Heat symptoms (thirst, red tongue & face, etc.)

                        P/T – nourish Yin, clear Heat, stop bleeding

                        Rx – Bao Yin Jiao + Er Zhi Wan

            3. Blood Stasis – prolonged Lochia, starts & stops flowing (stagnation), sometimes more/less, dark purple w/ big clots, pain in low Jiao subsides after clots are passed.

                        Plus -  T- purple  P- wiry uneven

                        P/T – promote blood circulation – remove Blood Stasis

                        Rx – Sheng Hua Tang

Postpartum Constipation

Diagnosis

This is a very common condition, after delivery the woman will have difficulty with bowel movements.  They may be infrequent, with dry stool & pain upon defecation. 

The primary cause is Blood ↓ (this is always present), it may have existed prior to delivery, or manifested from blood loss during delivery.  Yin ↓ Heat that may have existed prior to delivery, or have been brought on by ↑ labour sweat.  Qi ↓ may also be the cause of constipation (characterized by lack of energy to push stool out) & have been preexisting or manifested from consumption during labour.  Also be sure to check for anal injury.

   If the woman eats regularly, has no abdominal pain, & no nausea, the diagnosis is constipation.

***Do not use Bitter Cold downward draining herbs.

Pathogenesis Differentiation & Treatment

          1. Blood ↓ - rabbit stool (dry dark hard bits), dull pale skin

          Plus – Blood ↓ symptoms (blurred vision, dizziness, numb limbs, pale)

                                    T- pale  P- weak thin (uneven)

                                  P/T – nourish blood, lube bowels

                     Rx – Si Wu Tang + Wu Ren Wan  or  Run Chang Wan

          2. Qi ↓ (& Blood ↓)- desire to have bowel movement but no energy to push out, when try they sweat & get short of breath, slightly dry stool.

                 Plus – Qi ↓ symptoms (fatigue, weak voice, low immune system)

                                T- may be normal or pale  P- empty

                               P/T – nourish Qi & Blood, lube bowels

                                             Rx – Run Zao Tang

          3. Yin ↓ Heat (& Blood ↓)- Blood ↓ w/ dry symptoms – thirst, low fever, dry stool

                Plus – Yin ↓ Heat symptoms (night sweat, restless, anxiety)

                      T- red w/ scanty coat or thin yellow  P- thin rapid

                         P/T – clear ↓ Heat, nourish Blood, lube bowels

                             Rx – Ma Zi Ren Wan + Yin & Blood tonics

          4. Overeating – over-consumption of hot spicy foods can cause constipation (diet should be changed)

                                              Rx – Bao He Wan

Postpartum Fever

Diagnosis

High or low fever &/or chills, aversion to cold after delivery.  It is normal to have very mild fever for 1-2 days after giving birth, but when this persists it should be treated.

Etiology

          1. Toxic pathogenic invasion (infection)- unclean delivery environment, open to invasion → enters meridians → fever (body trying to get rid of infection).

          2. Blood Stasis- Lochia does not flow smoothly → stagnation in Ying & Xue levels → blocks Qi circulation → Heat/fever (Ying Xue disharmony)

          3. External Pathogenic invasion- Wei Qi is weak (immune system), catch common cold/flu (Wind/Cold or Wind/Heat) → fever & possible chills (Ying Xue disharmony)

          4. Blood ↓ - Yang Qi floats on surface → fever

Differentiate – dysentry (w/ fever), malarial diseases (w/ fever)

Pathogenesis Differentiation & Treatment

          1. Toxic Heat invasion (infection)- aversion to cold → high fever, pain in low Jiao, Lochia has strong odor & is dark brown (amount varies)

               Plus – Heat symptoms (thirst, dysphoria, scanty dark urine, dry stool)

                               T- red w/ yellow coat  P- rapid forceful

              P/T – clear Heat, detoxify, cool Blood, promote Blood circulation

               Rx – Jie Du Huo Xue Tang  (jin yin hua, lian qiao, pu gong ying)

          2. Blood Stasis – aversion to cold & high fever, scanty Lochia (lumpy dark purple), severe low Jiao pain.

                                        Plus – T- purple  P- uneven

                  P/T – promote Blood circulation, remove Stasis, clear Heat

                    Rx – Shen Hua Tang + clear heat (same herbs as above)

          3. External Pathogenic invasion – NO abdominal pain, aversion to cold w/ fever or alternating fever & chills, Lochia is normal

             Plus – superficial symptoms (headache, body ache, sneeze, runny nose)

                                 P- floating  T- normal or slightly red

                                    P/T – nourish Blood, expel Wind

                                        Rx – Jing Feng Si Wu Tang

          4. Blood ↓ - loss of Blood during delivery → ↓ fever, lasts for more than 2 days, spontaneous sweats, Lochia is scanty pale & thin, dull low Jiao pain

                           Plus – Blood ↓ symptoms (pale nails/hair, poor memory/concentration)

                                    T- pale  P- weak rapid (uneven)

                              P/T – nourish Blood & Yin to clear ↓ Heat

                                    Rx – Di Gu Pi Tang  (not cloying)

Postpartum Irregular Urination

Diagnosis

May have Lin, retention of urine (long bi), ↑ in frequency (up to 20 times/day), incontinence, or any irregularity of urinary function.  May also have blood in urine.

Etiology – mainly BL disorder (w/ LU KI then SP)

          1. Qi ↓ - already have Qi ↓ (LU SP), during delivery consume more Qi → after have poor diet & rest → can’t regulate & transform water & water passages.

          2. KI ↓ - already have KI ↓ → after delivery become more Yang ↓, can’t transform Yin properly → urinary problems.

            - or Yin ↓ - Yang has nothing to transform → urinary problems.

          3. Damp/Heat – external or internal Damp/Heat accumulates in the BL → urinary problems.

          4. BL injury – from labour or instruments.

Differentiate – has the Bladder been injured.

Pathogenesis Differentiation & Treatment

          1. Qi ↓ - retention of urine w/ low Jiao fullness, frequent urination, incontinence.

                        Plus – Qi ↓ symptoms  (pale, fatigue, weakness)

                                 P/T – nourish Qi to transform fluids

                      Rx – Bu Zhong Yi Qi Tang  (if retention add fu ling)

          2. KI ↓ - urine problems similar to above but may also experience enuresis.

               Plus – KI ↓ symptoms  (low back/knee weakness, Yang- cold  Yin- night sweats, dizziness)

                               P/T – nourish KI Qi to transform urine

                               Rx – retention – Ji Sheng Shen Qi Wan

                                      incontinence – Sang Piao Xiao San

          3. Damp/Heat accumulation – possibly labour wounds not healing properly, an infection, Lin symptoms (frequency, burning, difficulty, pain) or retention of urine, scanty dark yellow urine

            Plus – Damp/Heat symptoms (chest fullness, nausea, unfinished feeling after bowel movement)  T- red w/ yellow greasy root  P- rapid soft

                                  P/T – induce diuresis, clear Heat

                                Rx – Jia Wei Wu Lin San + yi mu cao

          4. Bladder trauma – long difficult labour (i.e. retroflexion of uterus), epiziotomy, or any other damage to area, causes incontinence, urine may contain blood.

          Plus – fatigue, uncomfortable, dribbling  T- pale, white coat  P- thin rapid

                         P/T – nourish Qi & Blood, consolidate bladder

Postpartum Sweating

Diagnosis

Nighttime or daytime spontaneous sweating.  It is normal to sweat the first 1-2 days but if this persists it is abnormal.  The amount is quite significant & may be non-stop (can be on whole body or just the head).

Etiology – Qi & Blood ↓ (Yin ↓)

Spontaneous sweating → Qi ↓ , can’t consolidate Wei (this can injure fluids more, causing constipation, if severe may cause muscle spasm, or have Yang collapse (shock – oily cold sweat)

Night sweats → Yin ↓ (Blood ↓)  wake w/ bed soaked

Differentiate – summer-heat stroke (sweat w/ possible delerium)

Pathogenesis Differentiation & Treatment   (must harmonize Ying & Wei)

          1. Qi ↓ - spontaneous sweating for many days after giving birth, sweat after very little exertion, large amounts of sweat, may occur only on the head (Yin ↓ → Yang rises), may be low on breastmilk

              Plus – Qi ↓ symptoms (fatigue, weakness, pale face)   T- pale  P- weak

                            P/T – nourish Qi & Yin to consolidate Wei

                 Rx – Huang Qi Tang or Yu Ping Feng San or Ma Huang Tang

          2. Yin ↓ - night sweats

              Plus – whole body Yin & Blood ↓ symptoms (hot flashes, pale tongue nails, dry hair & skin, thin weak person)  T- red w/ scanty coat  P- thin rapid

            P/T – nourish Yin & Qi to promote production of Body fluids & consolidate superficial.

                               Rx – Sheng Mai San + Yu Ping Feng San

Postpartum Body Pain

Diagnosis

Aches, stiffness, numbness, heaviness, or any type of pain in the limbs or joints.  TCM considers this a Wind condition.  Within 3 months after birth body has significant pains, if left untreated may become chronic.  More common in winter or spring & in cold climates.  It has an acute onset (Wind), sciatica is the most common complaint.

Etiology

Qi & Blood ↓ , exterior Wind Cold Damp invades the collaterals then meridians & causes stagnation → Pain.

Pathogenesis Differentiation & Treatment

          1. Blood ↓ - before delivery then lose more during birth, meridians are empty → easy to get stagnated or be invaded by pathogens.  Joints ache in the whole body, pain & numbness, may also be a lack of milk.

                   Plus – Blood ↓ symptoms  T- pale, white coat  P- weak

            P/T – nourish Blood & Qi to warm meridians to open & relieve pain

                                 Rx – Huang Qu Gui Zhi Wu Wu Tang

          2. Wind/Cold invasion – catch cold (weak Wei Qi/immune system), starts w/ superficial symptoms then whole body pain & joint stiffness, sciatica, wandering pains, & swollen heavy joints.

                P/T – nourish Blood to expel Wind & Cold, eliminate Damp

                                       Rx – Du Huo Ji Sheng Tang

KI ↓ 

has KI ↓ before delivery then during labour KI gets injured more → Pain in low back/knees/heels, dark circles around eyes, dizziness, tinnitus, nocturnal enuresis, T- may be pale  P- deep thin

                               Plus – KI ↓ symptoms (see Appendix 1)

                  P/T – nourish KI & Blood to strengthen bones & tendons

                Rx – Yang Ying Zhuang Shen Tang + expel wind/damp herbs

Blood Stasis

loss of blood during delivery, external Cold blocks meridians, scanty Lochia (old blood retained), catch Ǿ Heat pathogen (injure Ying & Xue) → all can lead to Blood Stasis → pain in the lower limbs, numbness, heaviness, Heat → causes redness (pain may start after fever, this resembles Rheumatoid arthritis), P- uneven wiry

                         Plus – Blood Stasis symptoms (see Appendix 1)

                P/T – nourish Blood, promote circulation, remove stasis to relieve pain

                                      Rx – Shen Tong Zhu Yu Tang

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