bubble_chart Concept

Placenta, also known as placenta, is the afterbirth. When the placenta cannot be delivered for a long time after the fetus is delivered, it is called retention of placenta, also known as "retained placenta."

bubble_chart Pattern Analysis

1. Qi Deficiency︰Postpartum placenta retention, slight lower abdominal distension, palpable mass upon pressure. Lochia is profuse and pale in color, complexion pale, preference for warmth and fear of cold, flusteredness and shortness of breath, or even dysphoria, dizziness, spontaneous sweating, lips and fingers either dull or cyanotic. Tongue pale with thin coating, pulse weak. Mostly caused by the mother's inherent weakness, insufficient original qi, or prolonged labor, excessive exertion, leading to dual deficiency of qi and blood after childbirth, resulting in inability to expel the placenta. Symptoms include retention of placenta, slight lower abdominal distension, painless upon pressure, profuse lochia, pale complexion, preference for warmth and fear of cold, flusteredness and shortness of breath, spontaneous sweating, pale tongue texture with thin white coating, floating and weak pulse, etc. Treatment should focus on tonifying qi and contracting the uterus, using Middle-Tonifying Qi-Replenishing Decoction with motherwort herb; if excessive blood loss leads to dual deficiency of qi and blood, Eight Precious Ingredients Decoction with motherwort herb can be used.
2. Blood Stasis︰Postpartum retention of the placenta, lower abdominal pain, hardness with a palpable mass and tenderness, scanty lochia. Dark purple complexion, subjective abdominal distension and fullness, rushing up to the chest. Purple tongue texture, thready and choppy pulse. This is due to lochia flowing into the placenta, causing distension and stagnation preventing expulsion. The differences between the two syndromes are: (1) Lower abdominal distension and fullness with pain, or rushing up to the chest. (2) Dark purple complexion, purple tongue, thready and choppy pulse. Treatment should focus on expelling stasis and contracting the uterus, using Achyranthes Root Powder minus Moutan Bark, plus Motherwort Herb and Submature Bitter Orange.
3. Cold Congealing︰Postpartum placenta retention, lower abdomen cold pain with tenderness, scanty lochia that is pale or dark in color. Complexion is bluish-white, with restlessness and irritability. Tongue texture is pale with thin white coating, pulse is deep-slow or tight. This is caused by external cold invading the deficient body and transmitting to the blood aspect, leading to stagnation of qi and blood, preventing the placenta from being expelled promptly; lower abdomen cold pain, or nausea during pain; bluish-white complexion, pale tongue, deep-slow or tight pulse. Treatment should focus on warming the meridians and dissipating cold. The recommended formula is Black Miraculous Powder with stir-fried black soybean removed, and Achyranthes Root and Submature Bitter Orange added.

Postpartum retention of the placenta is most commonly seen in clinical practice as two patterns: qi deficiency and cold congealing, with the blood stasis type being the most severe. The "Collection on Delivery and Infant Feeding" states: "After the mother gives birth, blood flows into the placenta, causing it to swell with blood, thus preventing it from being expelled. If treatment is delayed, the swelling will fill the abdomen, rising to the chest and heart, causing pain and difficulty breathing, making it difficult to treat." Since the adoption of modern delivery methods, this condition has become rare.

bubble_chart Documentation

1. Jingyue Quanshu- Women's Regulations: " When lochia flows into the uterine sac, causing distension and retention, it is because after the fetus leaves the womb, the ligaments must descend. Thus, the sac in the abdomen takes the shape of an upturned leaf, which pools blood and obstructs its discharge. Experienced midwives often recognize this—they press the base of the sac with their fingers to disperse the blood, or they lift a corner of the upper opening to allow the lochia to drain, after which the empty sac will naturally detach. ... If blood seeps into the sac and stagnates over time, causing distension, pain, breathlessness, or urgency, mere blood-dispelling methods will not suffice. Quickly administer Duoming Dan (Life-Saving Pill) or Sudden Smile Powder mixed with heated wine to disperse the blood and relieve distension, allowing the sac to descend. For cases complicated by qi and blood deficiency, Yangjin Decoction is the best choice."