Persistent Lochial Discharge (and Retention of Lochia)

CHAPTER 47 Persistent Lochial Discharge (and Retention of Lochia)



AETIOLOGY 607

PATHOLOGY 607

IDENTIFICATION OF PATTERNS AND TREATMENT 608
Qi deficiency 608

Blood stasis 609

Blood-Heat 610

Ancient acupuncture prescriptions for Persistent Lochial Discharge 612

PROGNOSIS AND PREVENTION 612

WESTERN VIEW 612

APPENDIX: RETENTION OF LOCHIA 612

AETIOLOGY AND PATHOLOGY 612

IDENTIFICATION OF PATTERNS AND TREATMENT 612
Qi and Blood stagnation 612

Stagnation of Cold and stasis of Blood 613

Ancient acupuncture prescriptions for retention of lochia 614

Persistent Lochial Discharge consists in a lochial discharge that goes on for longer than normal and continues to be red in colour rather than changing to a yellowish, serous discharge. Lochia refers to the bloody discharge coming from the placental site. The normal time of lochial discharge is about 3 weeks. As for the nature of lochia, see Western View towards the end of this chapter.



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.


The patterns discussed are:


• Qi deficiency

• Blood stasis

• Blood-Heat.


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.



Treatment principle


Tonify Qi, gather Blood.



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.




Explanation


– Ren-12, Ren-6, ST-36, SP-6 and BL-20 tonify Spleen-Qi.

– Du-20 raises Qi to stop bleeding.

– Ren-4 nourishes Blood, strengthens the Uterus and tonifies the Directing and Penetrating Vessels.

– BL-23 strengthens the Directing and Penetrating Vessels.

– SP-1, with moxa cones, stops uterine bleeding.


Herbal treatment



a. Prescription



– BU ZHONG YI QI TANG Variation

– Tonifying the Centre and Benefiting Qi Decoction Variation


Explanation

This formula, already explained, tonifies and raises Qi and stops bleeding from Qi deficiency.


– Lu Jiao Jiao was added to tonify the Governing, Directing and Penetrating Vessels and stop bleeding.

– Ai Ye was added to warm the Uterus and stop bleeding.


Modifications


• If there are cold limbs and abdominal pain, add Gui Zhi Ramulus Cinnamomi, Pao Jiang Rhizoma Zingiberis preparatum (toasted) and Bu Gu Zhi Fructus Psoraleae.

• If there are clots in the lochia and abdominal pain, add Wu Zei Gu Endoconcha Sepiae and Yi Mu Cao Herba Leonuri.

• If there is dizziness, blurred vision and palpitation, add Bai Shao Radix Paeoniae alba and Long Yan Rou Arillus Longan.

• If there is backache and the limbs are weak, add Xu Duan Radix Dipsaci and Du Zhong Cortex Eucommiae.

• If there is a dry mouth and the tongue has no coating, add Mai Men Dong Radix Ophiopogonis, Shi Hu Herba Dendrobii and Yu Zhu Rhizoma Polygonati odorati.


b. Prescription



– SHI QUAN DA BU TANG Variation

– Ten Complete Great Tonification Decoction Variation


Explanation

The first 10 herbs constitute the formula Shi Quan Da Bu Tang which tonifies Qi, warms Yang and nourishes Blood.


– E Jiao nourishes Blood and stops bleeding.

– Xu Duan consolidates the Governing and Directing Vessels and stops bleeding.


Three Treasures remedies



– TONIFY QI AND EASE THE MUSCLES

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.


– CALM THE SHEN

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.



Summary



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.



Treatment principle

Tonify Qi, gather Blood.



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


Prescriptions



• BU ZHONG YI QI TANG Variation Tonifying the Centre and Benefiting Qi Decoction Variation

• SHI QUAN DA BU TANG Variation Ten Complete Great Tonification Decoction Variation


Three Treasures remedies


• TONIFY QI AND EASE THE MUSCLES

• CALM THE SHEN


Blood stasis



Clinical manifestations


Persistent lochial discharge that is dark, scanty and with clots, abdominal pain that is relieved by the passing of clots. Tongue: Purple. Pulse: Wiry.



Treatment principle


Invigorate Blood, eliminate stasis, stop bleeding.



Acupuncture

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 Persistent Lochial Discharge (and Retention of Lochia)

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