Fever after Childbirth

CHAPTER 51 Fever after Childbirth



AETIOLOGY AND PATHOLOGY 639

IDENTIFICATION OF PATTERNS AND TREATMENT 640
Invasion of external toxins 640

Invasion of external Wind 643

Blood deficiency 645

Blood stasis 646

Steaming breast 647

Retention of food 648

PROGNOSIS AND PREVENTION 649

WESTERN VIEW 649

Fever after Childbirth may consist in a fever that is continuous but relatively low or in one that is sudden and high. If a slight temperature appears 1 or 2 days after childbirth and there are no other symptoms, it may not indicate any specific pathology but simply a temporary imbalance between Nutritive and Defensive Qi resulting from the strain of labour; this will not require treatment. A slight fever that appears 3 or 4 days after childbirth and in between breastfeeding sessions is called zheng ru, meaning ‘steaming breast’, and is not pathological: this will disappear after a few days.


Thus, Fever after Childbirth can be defined as a temperature of at least 38°C (100°F) that is persistent, that does not abate on its own and that is accompanied by other symptoms and signs.



Aetiology and pathology


After childbirth, the Upright Qi (Zheng Qi) is weakened, the Nutritive (Ying) and Defensive (Wei) Qi are out of balance with each other and the mother is therefore prone to invasions of Exterior pathogenic factors which may cause a fever. Internal factors such as deficiency of Blood or Yin may also cause a fever.




Invasion of external toxins


After childbirth the Upright Qi is weakened, resistance to disease is lowered, the Blood is exhausted and the blood vessels and channels are Empty and therefore prone to being invaded by external toxins. This concept corresponds to bacterial infections of the genital tract after childbirth. The fever is caused by the reaction of the Upright Qi against the external toxins. In the old times in China, this was a very frequent occurrence after childbirth due to poor hygienic procedures during and after labour.



External invasion of Wind-Heat


After childbirth the body’s Qi is weakened, the Nutritive and Defensive Qi are out of balance and the body is easily invaded by external Wind: the fight between the Upright Qi and the external Wind on the Exterior of the body causes a fever.



Severe blood loss during labour


Severe blood loss during labour causes exhaustion of Blood and/or Yin, Yang floats upwards and causes a fever: this is a fever of internal origin and is quite different in nature from the previous two. In the previous two cases the fever is due to the struggle between the Upright Qi and external pathogenic factors; in the case of Blood/Yin deficiency, fever is caused by the floating upwards of Yang and it is a sign of weakness.



Surgery, emotional problems


Caesarian birth may cause stasis of Blood. Emotional problems before or after childbirth may cause stagnation of Qi which also leads to Blood stasis. If stagnant Blood generates Heat, this may cause a fever of internal origin.



Retention of food


A woman needs to eat nourishing and Blood-forming food after childbirth, but it should also be easily digestible because Spleen-Qi is weakened by the strain of labour. Eating too much after childbirth may therefore lead to retention of food: when food stagnates in the Stomach and Intestines, it gives rise to Heat and may cause a fever. This process, common in children, is usually rare in adults, except in women after childbirth due to the weakened state of their digestive system.


When confronted with a feverish woman after childbirth, the first thing to establish is whether the fever is of external or internal origin. External fevers are due to invasion of either ‘toxins’ (corresponding to bacterial infections in Western medicine) or external Wind: in such cases, fever is due to the struggle between the Upright Qi and the pathogenic factors and it is a sign that the body is reacting. Of these two cases, invasion by external toxins is much more serious than that from external Wind.


In internal fevers, the fever is the end result of a pathological process and it does not indicate that the body is reacting to any pathogenic factor. For example, fever from Blood/Yin deficiency is due to Yang floating to the surface and to its ‘detachment’ from Yin: this is a sign of weakness, not a sign of reaction of the persons’s Upright Qi.


As for diagnosis, this must be based on the degree and timing of the fever, the character and appearance of the lochial discharge, the presence or absence of abdominal pain, headache or bodyaches, any breast pathology, the tongue and the pulse. Thus, a fever of external origin is accompanied by shivers: if it is from external toxins, the fever may be high and the lochial discharge foul-smelling; if from invasion of external Wind, the fever will be low and accompanied by bodyaches, headache and stiff neck.


Fevers from internal origin occur without shivers. If the fever is caused by stasis of Blood, the lochial discharge will be scanty with clots, or may not occur at all, and there will be abdominal pain. If the fever derives from Blood/Yin deficiency with Yang floating, it will be accompanied by prostration, exhaustion, sweating and dizziness.



Clinical Note



• Shivers, aversion to cold, low fever, bodyaches, headache, stiff neck: fever from external invasion of Wind

• Shivers, aversion to cold, high fever, foul-smelling lochial discharge: fever from external toxins

• Scanty lochial discharge, clots, abdominal pain: fever from Blood stasis

• Prostration, exhaustion, night sweating, dizziness: fever from Yin deficiency


Identification of patterns and treatment


The treatment principle depends entirely on the origin of the fever: in external fevers one must clear Heat or Wind-Heat, release the Exterior and harmonize the Nutritive and Defensive Qi. In internal fevers, one must clear Heat, and invigorate Blood or nourish Blood and Yin.


The patterns discussed are:


• invasion of external toxins

• invasion of external Wind

• Blood deficiency

• Blood stasis

• steaming breast

• retention of food.


Invasion of external toxins



Clinical manifestations


High fever after childbirth, hypogastric pain which is worse with pressure, scanty lochial discharge that is dark purple and smelling like soya sauce, mental restlessness, agitation, thirst, in severe cases delirium or even convulsions, scanty, dark urine, constipation. Tongue: Red with Red points and a thick, sticky, yellow coating. Pulse: Slippery, Overflowing, Rapid.



Treatment principle


Clear Heat, drain Fire, resolve Toxin, cool Blood, invigorate Blood, eliminate stasis.



Acupuncture


L.I.-11 Quchi, P-3 Quze, KI-2 Rangu, LIV-3 Taichong, SP-9 Yinlingquan, Du-14 Dazhui. All with reducing method, no moxa.




Explanation


– L.I.-11 clears Heat and resolves Toxin.

– P-3 cools Blood.

– KI-2 and LIV-3, in combination, cool Blood. LIV-3 also invigorates Blood.

– SP-9 helps to resolve Toxin.

– Du-14 clears Heat.


Herbal treatment



a Prescription



– WU WEI XIAO DU YIN and SHI XIAO SAN

– Five Ingredient Dissolving Toxin Decoction and Breaking into a Smile Powder


Explanation

The first five ingredients constitute the formula Wu Wei Xiao Du Yin, with all its ingredients resolving Toxic-Heat.


– Pu Huang and Wu Ling Zhi invigorate Blood and eliminate stasis.


b Prescription



– JIE DU HUO XUE TANG Variation

– Expelling Toxin Invigorating Blood Decoction Variation


Explanation

The first eleven herbs constitute the formula Jie Du Huo Xue Tang which resolves Toxic-Heat and invigorates and cools Blood.


– Lian Qiao, Ge Gen, Chai Hu and Gan Cao clear Heat and resolve Toxic-Heat.

– Sheng Di Huang, Chi Shao and Dang Gui cool and harmonize Blood.

– Hong Hua and Tao Ren invigorate Blood and eliminate stasis.

– Zhi Ke moves Qi to help to invigorate Blood.

– Bai Shao pacifies the Liver and harmonizes Blood. Together with Gan Cao it also stops pain and moderates urgency.

– Jin Yin Hua has been added to resolve Toxic-Heat.

Compared with the previous formula, the present one has a stronger action in cooling Blood and clearing Empty-Heat: it is therefore suitable if the tongue coating is beginning to fall off and the tongue body is becoming peeled.



c Prescription



– DA HUANG MU DAN TANG Variation

– Rheum-Moutan Decoction Variation


Explanation

The first five herbs constitute the formula Da Huang Mu Dan Tang which resolves Toxic-Heat and cools Blood. Taken from the Discussion of Cold-induced Diseases, it is specific for intestinal abscess with high fever. It is therefore well suited to treat high fever after childbirth deriving from a genital infection. The tongue presentation appropriate to this formula is a Red body with Red points with a thick, yellow coating.


– Da Huang and Mang Xiao drain Fire, resolve Toxic-Heat and invigorate Blood.

– Mu Dan Pi and Tao Ren invigorate and cool Blood.

– Dong Gua Ren drains Damp-Heat and helps to resolve Toxic-Heat

– Bai Jiang Cao and Hong Teng resolve Toxic-Heat.

– Yi Yi Ren drains Damp-Heat and resolves Toxic-Heat.

Compared with the previous two formulae, the present one is for a severe condition of genital infection after childbirth with a dark Red tongue and an Overflowing, Rapid pulse. It may be considered a variation of the prescription Tao He Cheng Qi Tang Persica Conducting Qi Decoction which is for Fire at the Qi level (within the Identification of Patterns according to the Four Levels) with stasis of Blood.



Modifications


• If there are symptoms of Heat at the Qi level (Bright-Yang Channel pattern), such as profuse sweating, intense thirst, Big pulse and high fever, add Shi Gao Gypsum, Zhi Mu Rhizoma Anemarrhenae and Tian Hua Fen Radix Trichosanthis.

• If there are symptoms of Fire at the Qi level (Bright-Yang Organ pattern), such as constipation and abdominal fullness and pain, add (or increase) Da Huang Radix et Rhizoma Rhei and Mang Xiao Sulfas Natrii.

• If there are symptoms of Dampness, add (or increase) Yin Chen Hao Herba Artemisiae scopariae and Yi Yi Ren Semen Coicis.

• If there are symptoms of Blood-Heat such as maculae and a Red tongue without coating, add or increase Mu Dan Pi Cortex Moutan, Chi Shao Radix Paeoniae rubra, Sheng Di Huang Radix Rehmanniae and Xuan Shen Radix Scrophulariae.

Table 51.1 compares and contrasts the above three formulae.



Table 51.1 Comparison of three formulae for Fever after Childbirth from invasion of toxins

image

As can be seen from reading the modifications listed above, this pattern can be analysed in the light of the Identification of Patterns according to the Four Levels. In most cases, the pattern will be Heat at the Qi level which can manifest itself in two ways, i.e. Stomach-Heat (identical with the Bright-Yang Channel pattern in the Identification of Patterns according to the Six Stages) or Intestines Dry-Heat (identical with the Bright-Yang Organ pattern in that Identification).


The Qi level is characterized by strong Heat but also by the reaction of the body against infection, hence the fever. A condition at the Qi level is never life-threatening. The treatment principle at the Qi level differs according to whether there is Heat (as in Stomach-Heat) or Fire (as in Dry-Heat in Stomach and Intestines): in the former case, one must clear Stomach-Heat with cold, pungent herbs (such as Shi Gao Gypsum) to push it outwards; in the latter case, one must drain Fire by using bitter, cold herbs (such as Da Huang Radix et Rhizoma Rhei) that drain it downwards by purgation.


At the Nutritive Qi level, the Heat penetrates deeper into the Interior and it burns the body fluids giving rise to some Yin deficiency. At the Blood level, the Heat is at its deepest; in the Blood portion, the Yin is injured and internal Wind may develop. The Nutritive Qi and Blood levels are similar in character but the Blood level is typically characterized by mental confusion, bleeding and maculae. The treatment principle at the Nutritive Qi level is to clear Ying and nourish Yin; at the Blood level, it is to clear Empty-Heat, cool Blood, nourish Yin, stop bleeding and extinguish Wind if necessary. Contrary to the Qi level, a condition at the Nutritive Qi and Blood level may be life-threatening. Apart from the symptoms, the tongue is important in identifying the level: at the Qi level, the tongue is Red, with Red points and with a thick, dry, dark yellow or brown coating; at the Nutritive Qi level and the Blood level, it begins to lose its coating and becomes dark Red with Red points and dry.


Table 51.2 will clarify the symptoms and formulae applicable at each level.



Table 51.2 Symptoms and formulae for Qi, Nutritive Qi and Blood levels of the Four Levels

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

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Fever after Childbirth

Full access? Get Clinical Tree
Get Clinical Tree app for offline access