CHAPTER 46 Abdominal Pain after Childbirth
Abdominal Pain after Childbirth includes abdominal or epigastric pain occurring soon after delivery.
Aetiology
Severe blood loss during childbirth
A profuse blood loss during delivery leads to Blood deficiency and to the Directing and Penetrating Vessels being Empty: the Uterus Vessel loses nourishment and lower abdominal pain develops. On the other hand, Blood deficiency leads to Qi deficiency; when Qi is deficient, it fails to move Blood properly, and this, in turn, leads to some Blood stasis.
Exposure to cold, irregular diet
Exposure to cold or excessive consumption of cold foods may create internal Cold which, in turn, leads to Blood stasis. Stagnant Blood leads to abdominal pain.
Emotional stress
Emotional stress after childbirth or an exacerbation of pre-existing emotional problems from the stress of delivery and puerperium leads to stagnation of Qi. In itself this may cause abdominal pain; in addition, it may lead to Blood stasis, which causes more, and worse, abdominal pain. Stagnation of Qi and Blood after delivery also leads to a total or partial retention of lochia which, in itself, is a further cause of abdominal pain.
Pathology
The pathology of Abdominal Pain after Childbirth is, as always, characterized by either a deficiency or an excess condition. The Golden Mirror of Medicine says:
Post-partum abdominal pain is caused by deficiency of Blood if there is heavy loss of blood; by stasis of Blood if lochiae are retained; by retention of Food if there is poor appetite, distension and fullness; and by invasion of Cold if pain is accompanied by a cold feeling.1
The Complete Works of Jing Yue says:
Deficiency and Excess should be differentiated in the treatment of post-partum abdominal pain. Pain from stasis of Blood is of the Excess type, while that due to deficiency of Blood is of the Deficient type. Pain accompanied by a feeling of distension or a sensation as if a stream of air was rushing upwards to the chest and hypochondrium, aggravated by pressure, is of the Excess type. To treat it, one must move Qi and disperse. Pain without distension or fullness and alleviated by pressure, warmth or eating, is of the Deficient type. One should not use herbs that expel pathogenic factors.2
Identification of patterns and treatment
The treatment principle must be based on a clear differentiation between Empty and Full types of pain: in case of deficiency, one needs to tonify Qi and nourish Blood and in case of Fullness one needs to invigorate Blood and eliminate stasis or dissolve accumulation of food. Bearing in mind what was discussed at the beginning of this section, one should not underestimate the possibility of stasis of Blood after delivery: often it is necessary to invigorate Blood to some extent even when the main treatment principle adopted is to nourish Blood.
Blood deficiency
Clinical manifestations
Dull abdominal pain after childbirth which is relieved by pressure and after eating, scanty, but continuous uterine bleeding which is pale in colour, dizziness, tiredness, blurred vision, constipation. Tongue: Pale and Thin. Pulse: Choppy.
Acupuncture
Ren-6 Qihai, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan. All with reinforcing method, moxa is applicable.
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