Postpartum edema refers to the swelling of the face or limbs in women after childbirth. There are also cases where pregnancy edema persists into the postpartum period due to inadequate treatment.

Postpartum edema, due to the physiological characteristics of women, has a slightly different mechanism of disease and treatment compared to internal medicine Zabing edema, hence it is discussed in a separate section.

bubble_chart Pattern Analysis

1. Qi Deficiency with Blood Depletion︰Generalized edema, complexion shallow yellow, pale lips, pale nails, dizziness and blurred vision, palpitation and shortness of breath, mental fatigue and lack of strength. The tongue is pale with thin white coating, and the pulse is thin, weak, and feeble. Mostly caused by excessive loss of blood during childbirth and depletion of healthy qi. Its clinical characteristics are: in addition to generalized edema, the patient must exhibit complexion shallow yellow, pale nails, palpitation and shortness of breath, dizziness and blurred vision, and other signs of dual deficiency of qi and blood. The treatment should focus on tonifying qi and tonifying blood, supplemented by unblocking water and dispersing edema. The prescription used is Eight Precious Ingredients Decoction with the addition of Cinnamon Twig, motherwort herb, and others.
2. Qi Stagnation and Blood Stasis︰Swelling first appears in the feet, gradually extending to the legs and abdomen, with distension and oppression in the chest and epigastrium, a depressed mental state, lower abdominal pain that refuses pressure, scant lochia that is dark red in color. The tongue is purplish-dark with thin white fur, and the pulse is deep and rough. This is often caused by frequent melancholy, obstructed qi movement, and static blood retention.
3. Spleen Deficiency︰Facial and limb edema, pale yellow skin tone, mental fatigue and lack of strength, cold limbs, bland taste in the mouth, poor appetite, abdominal distension and fullness with loose stools, swollen tongue with tooth marks, thin white moist tongue coating, slow slippery and weak pulse. Mostly due to habitual spleen qi deficiency, or excessive consumption of raw and cold foods injuring spleen yang, leading to impaired transportation and transformation, and retention of water-dampness. Alternatively, it may result from neglected treatment of pregnancy edema, causing lingering water-dampness. The main manifestations include edema of the face, hands, feet, or limbs, along with anorexia and abdominal distension and fullness. Treatment should focus on fortifying the spleen and disinhibiting water. The recommended formula is Spleen-Strengthening Decoction combined with White Atractylodes Powder with modifications.
4. Kidney Deficiency︰Generalized edema, especially severe below the waist, pitting on pressure, dull complexion, palpitation with shortness of breath, reversal cold of the limbs, lumbago with leg weakness. The tongue is pale with white, moist fur; the pulse is deep and slow. This is mostly caused by habitual kidney deficiency, postpartum kidney qi debility failing to warm and transform water humor, or preexisting kidney deficiency edema that was not treated during childbirth. As stated in Nyuke Jiyao Commentary·Edema in Pregnancy: "Edema during pregnancy arises because true yin gathers to nourish the fetus, while kidney yang qi cannot spread and distribute, causing uncontrollable flooding of the water passage." Its clinical characteristics are: edema particularly severe below the waist, accompanied by symptoms such as dull complexion, lumbago with leg soreness. The treatment principle should focus on warming the kidney and disinhibiting water. The formula used is True Warrior Decoction combined with Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction with modifications.
5. Dampness-heat︰Swelling in the lower limbs, heavy body and fatigue, chest tightness and epigastric distension, dark urine, frequent and painful urination, anorexia, soreness and distension in the waist. Yellow and greasy tongue coating, soggy and slippery pulse. Often caused by inherent dampness-heat excess compounded by exposure to dampness-heat pathogens, which accumulate in the lower energizer and lead to illness. The clinical features are: in cases of qi stagnation and blood stasis, swelling first appears in the feet and gradually extends to the legs and abdomen, accompanied by symptoms of liver qi depression and static blood retention; in cases of dampness-heat pouring downward, manifestations include heavy body and fatigue, dark urine, frequent urination, painful urination, etc. The treatment principles are: for qi stagnation and blood stasis, regulate qi and resolve stasis, using modified Minor Channel-Regulating Powder; for dampness-heat pouring downward, clear heat and drain dampness to reduce swelling, using modified Eight-Ingredient Rectification Powder or Angelica Pain-Relieving Decoction.

bubble_chart Documentation

1. 《Shen's Nyuke Jiyao Annotation, Section 27. Edema: "Postpartum edema, first distinguish between water pestilent qi disease, water disease skin thin white and shiny, like wrapped in water. Qi disease skin thick color unchanged. The classic says: The kidney is the gate of the stomach. If the gate is not functioning well, water accumulates and causes illness, as postpartum kidney qi is inevitably damaged, the stomach's yang is weak, unable to distribute body fluids, dredging and regulating water passage, this is the reason for water accumulation, suitable kidney qi soup pills, this syndrome skin thin white can be proven. The body's nutrient-defense qi, when flowing smoothly is balanced, when stagnant causes swelling, stubborn phlegm static blood, all can block the qi passage causing swelling, this syndrome skin thick color unchanged, with a wiry pulse is phlegm; a thin or hollow pulse is blood aspect pattern, differentiate treatment and use medicine accordingly. There is also a type of blood deficiency leading to qi stagnation, the swelling is not severe, color slightly yellowish, suitable to use Angelica Sinensis as the main ingredient, supplemented by White Atractylodes Rhizome, Dried Tangerine Peel, Poria, and the like.