Oriental Medicine Treatment of Postpartum Abdominal Pain
Chief Complaint: postpartum lower abdominal pain.
Medical History: Aside from the main complaint, the patient says she is “otherwise healthy.” Normally, she eats two meals per day and snacks as she becomes hungry throughout the day—though sometimes she does not feel hungry enough to snack and simply eats two meals per day.
Food is a “low priority” in her daily schedule, particularly, she says, now after the baby’s birth. Her husband, who loves to cook, does most of the cooking. Her digestion is fine: no gas or bloating. Her stools are formed and once per day. In general, she tends towards constipation. Her urination is fine. She eats dairy, grains, vegetables and meat. She does not have a sweet tooth nor eat very much “fast food.”
She occasionally gets parietal and occipital headaches and at certain times of the year feels depressed but is too sensitive to pharmaceuticals to take any medication. She has been in the past but is not now in counseling.
Questioning exam: Physically, the patient presents as 5’8″ tall with a weight of 150 lb. Her eyes are clear regarding Shen but she rubs them often and her vision is blurry. Her complexion is pale. She is not sweating. Though 98.7 degrees F., she says her body temperature feels cool (she always wears sweaters) and is cold at the extremities and in the abdomen. Her energy level is normally 8/10 but since the babies birth it is a 3/10.
Her sleep before the baby was eight hours per night. Since the baby’s birth she sleeps in two-to-three hour stretches and does not wake feeling rested. She estimates she gets six hours of sleep per day. Due to work and caring for her other children, she does not rest in the afternoon. Emotionally she feels alternately weepy and angry as a result of the sleep deprivation. Her two older boys, age 11 and 12, and her husband help with the baby and housework so, overall, she feels she has support.
Her menarche was at age 12 years. She has had two pregnancies and two births. The babies were Cesarean section, due to the first boys (first boy was 9lbs, head caught in birth canal) long and difficult attempted vaginal delivery. Her menses is every 28 days with 3-4 days of bleeding. There is no menstrual pain or other adverse symptomology, except when she is under stress.
Pulse exam: The postpartum abdominal pain responds favorably to pressure and warmth. Palpation shows a yielding, soft, cold abdomen with a fine bluish discoloration running from the pubic bone to the umbilicus.
The pulse is deep, wiry, and forceless.
Tongue exam: Her tongue body is pale. The tongue coating is thin and white with white prickles. There is a midline crack from the Lower to the Middle Jiao.
The pain is called Chan Hou Fu Tong or postpartum abdominal pain. It is also sometimes referred to as baby pillow pain, “Er Zhen Tong.” In the 8 principle analysis the patient is:
There are no signs of dampness.
Theoretically, the birthing process may damage a woman’s body fluids, blood and original qi. Difficult labor, excessive bleeding, internal wounds, and poor delivery conditions cause this problem. Also, the Chong and Ren channels may be damaged. Here, blood is the Chinese term for dense, material Qi. According to Maciocia (see Bibliography): Blood is inseparable form Qi itself, Qi infuses life into blood; without Qi, Blood would be an inert fluid.
In summary, wounds, damage, and hemorrhaging during the birthing process may injure a woman’s body fluids, blood and original qi. Thus the body’s powers of resistance is weakened allowing a cold invasion into the damaged area.
Blood deficiency results from birthing process. The cold is lodged in the blood level and obstructs the qi and blood. The pulse is weak due to lack of circulating qi and wiry due to pain from obstructing cold.
Blood deficiency allowing cold to invade the channels, including the Chong and Ren, and the Blood House (uterus). Pain in the Blood House due to cold obstruction.
Treatment Principle: Treatment Principle
Tonify qi and blood, expel cold, warm the interior, and alleviate pain.
Point Prescription: Acupuncture
St36, Sp10, and Liv8 all with moxa to tonify qi and blood and warm the interior. Du 20 to lift central qi. Apply salt to the umbilicus and do warming moxa to warm the interior. LI 4 to alleviate pain and expel cold. P6 Sp4 to treat ren and chong.
Herbal Formula: Food Therapy
The following formula is an example of “food as medicine.” Hence it is not appropriate for acute cases but only mild ones which tolerate a slower, more gradual change. With food medicines the body is rebalanced more slowly than with herbal medicines. This is ideally suited to the postpartum patient. Because she is sensitive to pharmaceuticals, she may show sensitivity to the Dang Gui. She has eaten mutton and ginger before with no ill effects. In consideration of the breast-feeding, the patient will be reassessed after a meal to make sure the babies feeding was not interrupted by the strong taste of the stew.
Since the time frame of the birth is December a tonifying medicinal diet is also harmonious with the seasons.
Dang Gui Sheng Jiang Yang Rou Tang or Mutton Stew with Tangkei and Fresh Ginger was published in the “Jin Gui Yao Lue” or “Essentials from the Golden Cabinet.” It is composed of:
Radix Angelicae Sinensis (Dang Gui) 9grams
Rhizoma Zingiberis Officinalis Recens (Sheng Jiang) 15grams
Mutton (Yang Rou) 48grams
Add the three ingredients together in a cooking pot. Add eight cups of water and simmer as a stew until the water is reduced to three cups of liquid.
This notable recipe was recorded by Zhang Zhongjing during the East Han dynasty in his book “Treatises on Febrile and Miscellaneous Diseases.”
From Bensky (1), “The actions are to warm the interior, nourish the blood and alleviate pain.” Warming the interior includes warming the channels, and according to the source text, the amount of Radix Angelica Sinensis (Dang Gui) can be increased to 48 grams in order to promote additional warmth. The foods also build qi.
Indications for the combination are postpartum abdominal pain, dysmenorrhea, amenorrhea, fibroids, cold abdominal pain, hernial pain, hypochondriac pain (especially if the patient has to stretch the ribcage to alleviate pain), liver channel pain, and middle or lower burner damp causing leukorrhea.
In general, Dang Gui goes to the lower burner and Sheng Jiang affects the middle.
The combination of the three foods is hot in nature, so it is contraindicated in yin deficient patients with heat signs like five-palm heat and nightsweats. Also the blood tonification must be cautionary for bloating, gas and diarrhea due to internal heat disorders or dampness obstructing. Care should be taken using this medicinal food with all heat signs, including Lung heat and Stomach heat with belching or vomiting.
Bensky, Dan and Barolet, Randall, “Chinese Herbal Medicine Formulas and Strategies,” Eastland Press, Seattle, 1990.
Lifestyle Prescription: The patient is advised to stay warm, rest to preserve qi, and avoid cold foods like ice cream. The patient borrowed a heat lamp to use as she napped or lay in bed.
Results: The patient resolved the cold pain gradually over the next few months. Her qi resumed its normal levels and she felt her resiliency return.
Synopsis: Heat is necessary for postpartum conditions. Had the patient come in immediately after the birth I would have advised ten days of one hour per day of indirect moxa to close the meridians and tonify the uterus and body in general.