Abdominal Pain after Childbirth

CHAPTER 46 Abdominal Pain after Childbirth



AETIOLOGY 601

PATHOLOGY 601

IDENTIFICATION OF PATTERNS AND TREATMENT 602
Blood deficiency 602

Blood stasis 603

Retention of food 604

Ancient acupuncture prescriptions for post-partum abdominal pain 605

PROGNOSIS AND PREVENTION 605

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.



Irregular diet


Excessive consumption of greasy and sweet foods after childbirth may lead to retention of food and 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


Deficient Blood and Qi may cause abdominal pain of a deficient nature, i.e. quite mild, better with pressure and better after eating. Causes which are excess in nature include stagnation of Qi, stasis of Blood and retention of food: these cause a Full type of pain which is more intense, with a feeling of distension in the case of Qi stagnation and fixed, stabbing in the case of Blood stasis. Full-type pain is worse with pressure and worse after eating. It is also possible to have a mixed deficiency/excess condition since when Qi and Blood are deficient, they fail to move Blood properly and hence some stasis of Blood ensues.


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


When a woman has abdominal pain after childbirth, any question of infection must first be excluded. From a Chinese perspective, abdominal pain from infection would be accompanied by shivering, fever that rises continuously and discharge of lochia with a smell like rancid soya sauce.



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.


The patterns discussed are :


• Blood deficiency

• Blood stasis

• retention of food.


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.



Treatment principle


Tonify Qi, nourish Blood, stop pain.



Acupuncture


Ren-6 Qihai, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan. All with reinforcing method, moxa is applicable.




Explanation


– Ren-6 tonifies Qi in general and moves Qi in the abdomen.

– Ren-4 nourishes Blood and strengthens the Uterus.

– ST-36 and SP-6 tonify Qi and Blood.

– LIV-8 nourishes Liver-Blood.


Herbal treatment



a Prescription



– CHANG NING TANG

– Intestines Tranquillity Decoction


Explanation


– Dang Gui, E Jiao and Shu Di Huang nourish Blood.

– Ren Shen and Shan Yao tonify Qi and strengthen the Original Qi.

– Mai Men Dong nourishes Yin which helps to nourish Blood.

– Xu Duan tonifies Kidney-Yang and consolidates the Directing and Penetrating Vessels.

– Rou Gui promotes the generation of Qi and Blood.

– Gan Cao harmonizes.


Modifications


• If there is constipation, remove Rou Gui and add Rou Cong Rong Herba Cistanchis.

• If there is Cold and the patient has a strong preference for warm foods, add Xiao Hui Xiang Fructus Foeniculi

Related posts:

  1. Vaginal Itching (and Trichomonas and Candida Infections and Genital Eczema)
  2. Prolapse of the Uterus
  3. Acupuncture and Herbal Treatment in Midwifery
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Abdominal Pain after Childbirth

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