Postpartum Uterine Bleeding

SYMPTOMS AND SIGNS: Normally, there is uterine bleeding at postpartum period which lasts about three weeks. If the bleeding does not stop in about three weeks, and are accompanied with other symptoms, such as fatigue, shortness of breath, lower fever, or lower abdominal pain, then it is due to certain pathogenic factors. One will show a pale or red tongue, weak or rapid pulse. 

ETIOLOGY AND PATHOLOGY: Postpartum uterine bleeding is due to abnormal Qi and blood circulations of Chong and Ren channels. The channel of Chong is supposed to be the sea of blood, Ren channel controls the pregnancy. After the baby is born, there is Qi or blood deficiency, or certain damage of internal organs, which will cause the deficiency or dysfunctions of Chong and Ren channels. The most commonly seen etiological factors are the following: 

  1. Qi Deficiency due to weak body, or postpartum hemorrhage, or overworking at postpartum period: this will lead to the deficiency of Chong and Ren channels and loss of their functions of holding blood.
  2. Blood heat due to Yin deficient body type, or postpartum hemorrhage, or over consuming by hot tonics or affected by exogenous heat factor, or depressed liver Qi changed into interior heat: this interior heat will disturb the blood circulation of Chong and Ren channels and will cause the uterine bleeding.
  3. Blood stasis causes the abnormal circulation of Chong and Ren channels.

DIFFERENTIATIONS: 

1. Qi Deficiency Type:

Indications: Postpartum uterine bleeding lasting more than a month with large amounts, and light red color, no odor, empty and dropping feeling atlowerabdom n, shortness of breath, dislikes talking, pale complexion and tongue, weak and slow pulse. 

Treatment & Formulas: Tonify Qi to hold blood. 

Products:

    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225): This is a typical Qi tonic herbal formula which helps ascend the Qi so as to hold blood. 
    • Shi Quan Da Bu Tang (Ginseng and Tang -keui Ten Combination, Item No. 2015): This is a tonic for both Qi and blood. 

2. Blood heat Type:

Indications: Postpartum uterine bleeding lasts more than the normal period with large amounts, dark red color, sticky in quality, strong odor, flushed complexion, dry mouth and throat, thirsty, red tongue, thready, weak and rapid pulse. 

Treatment & Formulas: Clear heat, tonify Yin so to stop the bleeding. 

Products:

    • Wen Qing Yin (Tang-kuei and Gardenia Combination, Item No. 2226): This is a very good formula for uterine bleeding due to interior heat and Yin deficiency. 
    • Jia Wei Xiao Yao San (Bupleurum and Paeonia Formula, Item No. 2068): It treats the interior heat due to the depressed liver Qi changed into the deficient fire.
    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No. 2123): It treats the blood heat due to the kidney Yin deficiency. It tonifies the kidney Yin and clears the deficient interior fire. 

3. Blood Stasis Type:

Indications: Postpartum uterine bleeding, scanty amount, deep dark in odor, or clots, lower abdominal pain, refusal to press, dear purplish tongue, or with peteachia, wiry and uneven pulse or deep and strong pulse. 

Treatment & Formulas: Eliminate the blood stasis by promoting the blood circulation. 

Products:

    • Sheng Hua Tang (Tang -kuei and Ginger Sheng Hua Tang (Tang -kuei and Ginger Combination, Item No. 2077): This is a typical formula for postpartum bleeding due to blood stasis plus the blood deficiency. 
    • Xiong Gui Jiao Ai Tang (Tang -kuei and Gelatin Combination, Item No. 2100): This is a very popular formula used for bleeding of uterine, or prevention of habitual abortion by tonifying and warming the blood to stop bleeding. 

Comment:

The single herb Yi Mu Cao (Leonuri Herba, Item No. 1400) is often used during postpartum because of its functions as blood tonic and regulating.


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