CHAPTER 47 Persistent Lochial Discharge (and Retention of Lochia)
Aetiology
Excessive strain during delivery, long labour
A long labour severely depletes Qi. When Qi is deficient, it fails to gather Blood which may leak out causing lochial bleeding with pale blood.
Invasion of cold
Invasion of Cold during or after delivery affects the blood vessels and the Uterus: Cold slows down the circulation of Blood and may cause stasis of Blood. Stagnant Blood obstructs the blood vessels and the Uterus so that newly generated Blood has nowhere to go and bleeding results.
Severe loss of blood during childbirth
Severe loss of blood during childbirth injures Blood and Yin: in women with a pre-existing condition of Yin deficiency, this leads to severe Yin deficiency with Empty-Heat. Heat enters the Blood portion and makes the Blood reckless causing it to spill out of the blood vessels.
Pathology
The pathology of Persistent Lochial Discharge consists in three possible conditions: Qi deficiency, Blood stasis or Blood-Heat. When Qi is deficient, it fails to hold Blood and bleeding results: in this case, the blood discharged will be pale. When Blood stagnates, the blood vessels and the uterus are obstructed by stagnant Blood; as newly generated Blood has nowhere to go, it leaks out. In this case, the lochial discharge is dark and with clots. When Heat invades the Blood portion, it makes Blood reckless so that it pushes out of the blood vessels, causing bleeding: in this case, the lochial discharge will be bright red or dark red.
The condition of Persistent Lochial Discharge should be differentiated from that of Fever after Childbirth. If the lochial discharge has an offensive odour (which the Chinese describe as that of rancid soya sauce) and the woman runs a temperature, this indicates an infection and, in Chinese medicine, falls under the category of Fever after Childbirth (see Chapter 51). Thus, Persistent Lochial Discharge assumes that there is no infection and the lochia does not have an offensive odour. However, please note that absence of odour does not necessarily mean that there is no infection, as virulent infection with haemolytic streptococci is not accompanied by an offensive smell. Thus, the most important distinguishing sign of a post-partum infection is fever.
Identification of patterns and treatment
The amount, colour, density and smell of the lochia should be analysed carefully to distinguish deficiency from excess and Heat from Cold. Thus, red, profuse, dilute, non-smelling lochia indicates Qi deficiency. Dark, dense lochia with a foul smell indicates Blood-Heat. Purplish lochia with clots denotes Blood stasis.
The treatment principles are therefore to tonify Qi, invigorate Blood or cool Blood. When tonifying with herbs, one must be careful not to overtonify as this may create stagnation. When invigorating Blood, do not use strong herbs that ‘break’ Blood as these may deplete Blood. One should try to use herbs that simultaneously gather Blood and stop bleeding, or herbs that cool Blood and stop bleeding. Also, when invigorating Blood, one should usually use one or two tonic herbs so that the Upright Qi is not damaged and the Directing and Penetrating Vessels may be tonified to carry out their normal function of expelling lochia.
Qi deficiency
Clinical manifestations
Persistent lochial discharge that is red, profuse, dilute and without odour, dizziness, exhaustion, breathlessness, sweating, a dislike of speaking, a feeling of bearing-down in the abdomen. Tongue: Pale. Pulse: Weak.
Acupuncture
Ren-12 Zhongwan, Ren-6 Qihai, Du-20 Baihui, ST-36 Zusanli, SP-6 Sanyinjiao, Ren-4 Guanyuan, BL-20 Pishu, BL-23 Shenshu, SP-1 Yinbai. All with reinforcing method; moxa is applicable.
Herbal treatment
a. Prescription
Explanation
This formula, already explained, tonifies and raises Qi and stops bleeding from Qi deficiency.
Modifications
Three Treasures remedies
This remedy is a variation of the formula Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction which tonifies and raises Qi. The tongue presentation appropriate to this remedy is a Pale body with a sticky coating.
This remedy is a variation of the formula Gui Pi Tang Tonifying the Spleen Decoction which tonifies Heart- and Spleen-Qi, nourishes Heart- and Spleen-Blood and calms the Mind. One of its uses is to stop bleeding from Qi deficiency. The tongue presentation appropriate to this remedy is a Pale and Thin body.
Qi deficiency
Clinical manifestations
Persistent lochial discharge that is red, profuse, dilute and without odour, dizziness, exhaustion, breathlessness, sweating, a dislike of speaking, a feeling of bearing-down in the abdomen. Tongue: Pale. Pulse: Weak.
Acupuncture
Ren-12 Zhongwan, Ren-6 Qihai, Du-20 Baihui, ST-36 Zusanli, SP-6 Sanyinjiao, Ren-4 Guanyuan, BL-20 Pishu, BL-23 Shenshu, SP-1 Yinbai. All with reinforcing method; moxa is applicable.
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