What are postpartum disorders? Postpartum disorders refer to conditions that occur in women from immediately after childbirth through the postpartum period and are related to childbirth or the postpartum recovery process. There are many common postpartum conditions seen in clinical practice, such as postpartum abdominal pain, spontaneous sweating, night sweats, postpartum spasms, postpartum fainting due to blood loss, prolonged lochia, postpartum fever, constipation, urinary abnormalities, body aches, lack of milk, and spontaneous lactation.
The main causes of these postpartum symptoms are:
① loss of blood and depletion of body fluids;
② internal obstruction by blood stasis;
③ external invasion by the Six Excesses or damage caused by improper diet or excessive physical exertion.
Because both qi and blood are depleted after childbirth, vital energy is impaired, and resistance is weakened—as the saying goes, “after childbirth, all the joints are depleted”—even the slightest exposure to pathogenic factors or carelessness in daily life can lead to the onset of one of these conditions. Here, we will focus on postpartum spontaneous sweating, night sweats, postpartum abdominal pain, persistent lochia, and postpartum body pain.
I. Postpartum Spontaneous Sweating and Night Sweats
This condition is one of the postpartum disorders and is a common postpartum ailment. It results from relative deficiency of qi and blood after childbirth, which causes the pores to become loose. It manifests as excessive sweating during meals or sleep; however, in most postpartum women, it resolves on its own within a few days and does not require treatment. If sweating occurs with physical activity and persists without ceasing, it is termed “postpartum spontaneous sweating.” If sweating occurs during sleep, soaking the clothing and, in severe cases, the bedding, but stops upon waking, it is termed “postpartum night sweats,” and treatment is indicated.
Etiology and Pathogenesis of Postpartum Spontaneous Sweating and Night Sweats
Qi Deficiency-Induced Spontaneous Sweating: The mother has a constitutionally weak constitution; further depletion of qi and blood during childbirth exacerbates this qi deficiency. As a result, the defensive yang is compromised and the skin pores are not properly sealed, leading to sweating during the day—which is particularly severe with physical activity—that is unrelenting and persists for an extended period.
Yin Deficiency Night Sweats: Due to the mother’s pre-existing deficiency of nutritive blood, compounded by blood loss during childbirth, the nutritive yin is depleted. This yin deficiency generates internal heat, forcing sweat outward, resulting in sweating during sleep that ceases upon waking.
Traditional Chinese Medicine Differential Diagnosis and Treatment: This condition emphasizes deficiency, but is further categorized into qi deficiency and yin deficiency; therefore, treatment methods differ accordingly.
Postpartum Spontaneous Sweating Due to Qi Deficiency: Caused by blood loss during childbirth, which depletes Qi along with the blood, leading to an inability of the Defensive Yang to consolidate the exterior. Patients present with profuse, uncontrollable postpartum sweating that worsens with movement, or spontaneous sweating accompanied by aversion to wind. Additionally, due to Qi deficiency, patients exhibit a pale complexion, shortness of breath, a weak voice, fatigue and weakness, a pale tongue with a thin coating, and a weak pulse. The treatment principle is to tonify Qi and consolidate the exterior, harmonize the Nutritive Blood, and stop sweating. Huangqi Decoction may be used for treatment.
Postpartum Night Sweats Due to Yin Deficiency: Childbirth causes blood loss, depleting the Nourishing Yin. Yin deficiency generates internal heat, which forces the body to sweat. Consequently, patients experience sweating during sleep after childbirth, which stops upon waking as Yang Qi protects the exterior; Furthermore, due to yin deficiency causing yang to rise to the upper body, the patient may exhibit a flushed complexion, dizziness, tinnitus, dry mouth and throat, thirst without a desire to drink, or heat in the palms and soles—which is more severe in the afternoon—and may be accompanied by soreness in the lower back and knees. The tongue is pale red or dark red, with little or no coating, and the pulse is fine, rapid, and weak. The treatment principle should be to nourish Yin, tonify Qi, generate body fluids, and curb sweating; Shengmai San with the addition of Floating Wheat and Calcined Oyster Shell may be used for treatment.
II. Postpartum Abdominal Pain
Postpartum abdominal pain, characterized primarily by pain in the lower abdomen, is caused by impaired circulation of Qi and blood, resulting in blood stasis in the lower abdomen that cannot flow freely—and where there is no free flow, there is pain. This is a common symptom following childbirth.
Etiology and Pathogenesis of Postpartum Abdominal Pain: The causes of impaired qi and blood circulation include blood deficiency and blood stasis.
① Abdominal pain due to blood deficiency: Resulting from postpartum blood depletion or excessive blood loss, which leads to deficiency in the Chong and Ren meridians, inadequate nourishment of the uterine vessels, and insufficient qi to propel blood circulation, causing sluggish blood flow and pain.
② Abdominal pain due to blood stasis: Due to postpartum weakness of vital energy and careless daily habits, cold pathogens take advantage of this vulnerability to invade the uterine meridians. The blood congeals due to the cold, or emotional distress leads to stagnation of liver qi, disrupting its normal dispersing function. As a result, qi circulation is impaired, blood stasis accumulates internally, and the mother’s lochia fails to be expelled as it should, thus causing abdominal pain.
Traditional Chinese Medicine Differential Diagnosis and Treatment: Postpartum abdominal pain is classified into blood deficiency and blood stasis. Abdominal Pain Due to Blood Deficiency: This results from significant blood loss after childbirth, leading to emptiness in the meridians and weakened circulation. Consequently, the Chong and Ren meridians are inadequately nourished, and there is a deficiency of qi and blood, essence, and body fluids. Patients typically present with a dull, aching pain in the lower abdomen that is relieved by pressure, pale-colored lochia in small quantities, accompanied by dizziness, tinnitus, and dry stools. The tongue is pale red with a thin coating, and the pulse is weak and fine. The treatment principle should be to tonify blood and qi; the formula Changning Decoction with appropriate modifications may be used. If blood deficiency is complicated by cold—manifesting as abdominal pain relieved by warmth, cold hands and feet, a pale-blue complexion, and a fine, slow pulse—treatment should focus on nourishing blood and dispelling cold; the formula Danggui Jianzhong Decoction is recommended. Abdominal Pain Due to Blood Stasis: Caused by the invasion of cold pathogens, which cause blood to congeal due to cold, or by liver qi stagnation, which impedes blood circulation, leading to the retention of blood stasis and obstruction of flow. Consequently, patients present with postpartum lower abdominal pain that is tender to pressure or slightly relieved by warmth, scanty lochia that is dark purple in color and contains clots, and may be accompanied by distending pain in the chest and flanks, a pale-blue complexion, cold extremities, a dark tongue, a white, slippery coating, and a deep, tight, or string-like, rough pulse. The treatment principle should be to activate blood circulation and remove blood stasis, dispel cold, and relieve pain; Shenghua Decoction with the addition of Motherwort (Yimucao) and other herbs may be used. If the patient experiences severe lower abdominal distension rather than pain after childbirth, with marked fullness and distension in the chest and flanks, this indicates a pattern of qi stagnation and blood stasis; in this case, add Fructus Aurantii Immaturus (Zhike), Wuyao, and Guangmuxiang to the above formula to regulate qi, resolve stagnation, and relieve distension.
III. Persistent Postpartum Lochia
Lochia refers to the red fluid discharged from the vagina after childbirth, which contains blood, necrotic decidual tissue, bacteria, and mucus. Initially, for the first 3–4 days, lochia is slightly heavier, reddish in color, and odorless; it gradually lightens thereafter, turning white after 10 days. Under normal circumstances, lochia is typically completely expelled within 20 days. If lochia persists for more than 20 days after childbirth and continues to trickle, it is termed “persistent lochia” and requires treatment.
Etiology and Pathogenesis: The mechanism underlying persistent postpartum lochia is primarily attributed to disorders of the Chong and Ren meridians and abnormalities in the circulation of qi and blood. Since the Chong meridian is the “Sea of Blood” and the Ren meridian governs the uterus, lochia is derived from blood, which originates from the zang-fu organs and flows into the Chong and Ren meridians. If the zang-fu organs are diseased or the Chong and Ren meridians are weakened, this can lead to the condition of persistent postpartum lochia. The causes include qi deficiency, blood heat, and blood stasis.
Qi Deficiency Type: A constitutionally weak constitution with insufficient vital energy; blood loss and qi depletion during childbirth further deplete vital energy; or premature postpartum exertion that exhausts the spleen, causing qi to sink downward, resulting in instability of the Chong and Ren meridians and impaired blood retention, thus leading to persistent lochia.
Blood-Heat Type: ① A pre-existing condition of yin deficiency, compounded by blood loss during childbirth, leading to further depletion of yin fluids and damage to nourishing yin, which in turn generates internal heat due to yin deficiency. ② Excessive consumption of pungent, hot, warm, or drying foods after childbirth. ③ Exposure to heat pathogens; or liver qi stagnation transforming into heat. In all these cases, heat disturbs the Chong and Ren meridians, forcing blood downward, and can lead to persistent lochia. Blood Stasis Pattern: After childbirth, the uterine meridians are depleted; cold pathogens take advantage of this vulnerability to invade the uterus, intermingling with the blood to cause stagnation and congestion. Stagnant blood obstructs the internal channels, or retained placental tissue affects the Chong and Ren meridians, preventing blood from returning to its proper channels, resulting in prolonged lochia that fails to clear.
Traditional Chinese Medicine Differential Diagnosis and Treatment: The differential diagnosis of this condition should be based on the color, volume, consistency, and odor of the lochia to distinguish between deficiency, excess, cold, and heat patterns. If the lochia is pale red in color, abundant in volume, thin in consistency, and odorless, it is typically indicative of qi deficiency; if the lochia is red or purple in color, relatively abundant in volume, viscous in consistency, and has a fishy odor, it is typically indicative of blood heat; if the lochia is purplish-black in color with blood clots and scant in volume, it is indicative of blood stasis.
Persistent lochia due to qi deficiency: Because qi deficiency causes the uterus to lose its ability to retain, yang qi is deficient, blood lacks warmth and nourishment, and qi sinks downward, the patient presents with prolonged, excessive postpartum lochia that is pale in color, thin in consistency, and odorless, accompanied by a sensation of emptiness and heaviness in the lower abdomen, fatigue and reluctance to speak, a pale complexion, a pale-red or pale and swollen tongue with a thin white coating, and a fine, weak, or fine and slow pulse. The treatment principle is to tonify qi and consolidate blood. The formula Bu Zhong Yi Qi Tang, augmented with deer antler gelatin or donkey-hide gelatin and charred mugwort leaves, may be used.
Blood-Heat Pattern of Prolonged Lochia: Due to the depletion of yin fluids after childbirth, yin deficiency gives rise to internal heat. This heat disturbs the Chong and Ren meridians, forcing blood downward, or ascends to disturb the body, or damages yin fluids. Consequently, the patient presents with prolonged lochia that does not cease, characterized by a heavy flow, deep red color, and viscous consistency. The tongue is red, and the pulse is deficient, fine, and rapid. The treatment principle is to nourish yin, clear heat, and stop bleeding. Treatment may involve Baoyin Decoction supplemented with ejiao and Eclipta prostrata. If a concurrent infection is present, resulting in purulent vaginal discharge with a foul odor, the formula should be supplemented with honeysuckle, red vine, dandelion, and Patrinia scabiosa. If the persistent lochia is due to liver qi stagnation transforming into heat, presenting with distending pain in the flanks, restlessness, a yellow tongue coating, and a string-like, rapid pulse, treatment should focus on soothing the liver, resolving stagnation, clearing heat, and cooling the blood. Treatment may involve Dan Zhi Xiao Yao San supplemented with Sheng Di Huang, Huanliancao, and Rubia root.
Persistent lochia due to blood stasis: Cold causes blood to congeal, leading to stasis that blocks the uterine vessels and accumulates internally. Typical manifestations include postpartum lochia that is scanty, flows sluggishly, and is irregular; the discharge is dark purple with blood clots; the lower abdomen is painful and tender to pressure, with palpable clots on examination. This may be accompanied by distending pain in the chest and abdomen, a dark purple tongue (or petechiae along the tongue margins), and a wiry, choppy, or deep, full, and forceful pulse. The supports principle is to promote blood circulation and resolve stasis; Shenghua Decoction combined with stir-fried Polygonum aviculare (Polygonum aviculare L., common name: flatstem knotweed) and Leonurus japonicus (Leonurus japonicus Houtt., common name: motherwort) yields good results.
If the patient presents with qi deficiency complicated by blood stasis, accompanied by a sensation of emptiness and heaviness in the lower abdomen, add Astragalus and Codonopsis to the above formula; if accompanied by infection, add herbs to clear heat and eliminate toxins, but avoid bitter-cold herbs as they may be detrimental to the patient; if necessary, add dandelion for treatment.
IV. Postpartum Body Pain
Symptoms such as aching, numbness, and heaviness in the limbs or joints that occur during the postpartum recovery period are referred to as “postpartum body pain,” “postpartum joint pain,” or “postpartum gout.” This is a common condition among women after childbirth and requires active treatment; otherwise, symptoms may persist for a long time and, in severe cases, may interfere with studies or work.
Etiology and Pathogenesis of Postpartum Body Pain: The pathogenesis of this condition primarily stems from postpartum blood deficiency, leading to inadequate nourishment of the meridians; or from a deficiency of both qi and blood after childbirth, allowing external pathogenic factors such as wind, cold, and dampness to invade the body and obstruct the circulation of qi and blood; it may also result from kidney deficiency causing inadequate nourishment of the uterine meridians.
Blood Deficiency: Excessive blood loss during childbirth leads to depletion of the limbs and bones, resulting in inadequate nourishment of the tendons, vessels, and joints, which in turn causes aching, numbness, and other symptoms in the limbs or joints.
Exogenous Wind-Cold: Due to postpartum deficiency of both qi and blood, the ying and wei qi become imbalanced, and the skin and pores lose their tightness. If daily routines are not managed with care, pathogenic factors such as wind, cold, and dampness can take advantage of this vulnerability to invade the body, stagnating in the meridians and joints. This obstructs the circulation of qi and blood, leading to blood stasis and the onset of this condition.
Kidney Deficiency: In individuals with a constitutional kidney deficiency, childbirth can injure the internal organs, resulting in deficiency of both qi and blood and inadequate nourishment of the uterine meridians. In women, the lower back is associated with the kidneys, to which the uterine meridians are connected. Excessive blood loss leads to deficiency in the uterine meridians and kidney qi, resulting in symptoms such as lower back soreness and weak knees.
Traditional Chinese Medicine Differential Diagnosis and Treatment of Postpartum Body Pain: The treatment of postpartum body pain differs from that of general rheumatic body pain. Due to the postpartum deficiency of both qi and blood, even when accompanied by external pathogens, treatment should primarily focus on regulating qi and blood, with a slight emphasis on dispersing the meridians; however, potent wind-dispelling herbs should not be administered.
Blood Deficiency Type: Due to postpartum blood deficiency, the tendons and vessels are deprived of nourishment. Since blood deficiency prevents the blood from ascending to nourish the heart, postpartum patients may present with generalized joint pain, aching and numbness in the limbs, dizziness, and palpitations. The tongue appears pale red with little coating, and the pulse is fine and weak. The treatment principle should be to nourish the blood, tonify qi, warm the meridians, and unblock the collaterals. Treatment may involve the Huangqi Guizhi Wuwu Decoction with the addition of Angelica sinensis and Milettia reticulata.
Wind-Cold Exogenous Pathogen Pattern: Due to postpartum physical weakness, exogenous pathogenic factors such as wind, cold, and dampness can invade the body. These pathogenic factors stagnate in the meridians, obstructing the flow of qi and blood; obstruction leads to pain. Consequently, patients may present with generalized joint pain, difficulty in flexing and extending the limbs, pain that shifts location, severe pain resembling a piercing sensation, or swelling, numbness, and heaviness in the limbs, making walking difficult, with relief upon exposure to warmth. The tongue is pale in color with a thin white coating, and the pulse is fine and slow. The treatment principle should be to nourish the blood, dispel wind, disperse cold, and eliminate dampness. Duhuo Jisheng Decoction may be used for treatment, with modifications made according to the specific symptoms.
Kidney Deficiency Type: Due to a constitutional deficiency of kidney qi, compounded by postpartum deficiency of both essence and blood, the uterine meridians become undernourished. Consequently, patients present with postpartum soreness in the lower back and legs, weakness in the legs and feet, possibly accompanied by pain in both heels or increased nocturnal urination. The tongue is pale red with a thin white coating, and the pulse is deep, fine, and weak. The treatment principle is to tonify the kidneys, strengthen the lower back, and fortify the tendons and bones. Using the Yangrong Zhuoshen Decoction with added Rehmannia glutinosa, among other herbs, can yield good results.
If postpartum blood stasis obstructs the meridians, resulting in joint stiffness, the patient may suffer from postpartum body pain, difficulty in flexing and extending the limb joints, or abdominal pain accompanied by poor lochia discharge. The tongue appears dark purple or has petechiae due to stasis, and the pulse is deep and hesitant. The supports principle is to promote blood circulation, expel wind, unblock the meridians, and helps with occasional pain; the “Shentong Zhuyu Decoction” may be used for supports.
Prevention of Postpartum Disorders
(1) Since postpartum disorders are caused by deficiency of qi and blood, blood stasis, or external pathogens invading a weakened constitution, bed rest and avoiding excessive exertion too soon are crucial;
(2) Avoid excessive consumption of pungent, heating, or spicy foods; instead, opt for light, nutrient-rich meals;
(3) Pay attention to emotional well-being. As the ancient Chinese said, “All diseases arise from qi.” It is essential to avoid getting angry after childbirth to prevent the onset of postpartum disorders;
(4) Abstain from sexual intercourse: Refrain from sexual activity for a short period after childbirth to prevent depletion of essence and blood and to avoid infection;
(5) Avoid exposure to wind and cold: Because the body is weak after childbirth, it is susceptible to invasion by external pathogens;
(6) Maintain good hygiene of the vulva and breasts;
(7) If you experience any unusual symptoms, seek medical examination and treatment promptly; do not delay;
(8) Take Chinese herbal medicines that tonify qi and nourish blood, as they serve both preventive and therapeutic purposes.