After the fetus is delivered, the static blood and turbid fluid remaining in the uterus with appendages, or only a small amount being discharged, is called postpartum lochiostasis, or lochia not flowing.

This condition, Jingxiao Chanbao refers to as "residual blood not completely discharged after childbirth"; "Shen's Nyuke Jiyao Annotation" calls it "lochia not coming"; Fuke Yuchi refers to it as "lochia stagnation."

Postpartum lochiostasis retained in the body can lead to the critical condition of "three impacts" and should not be taken lightly.

bubble_chart Pattern Analysis

1. Qi Stagnation︰Postpartum lochiostasis, or difficulty in discharge, manifests as lower abdominal distension and pain, chest and hypochondriac distension, epigastric stuffiness with poor appetite, a normal tongue, and a deep, wiry pulse. Qi stagnation postpartum lochiostasis often results from emotional distress or excessive anxiety during childbirth, leading to impaired qi movement. Qi stagnation then causes blood stasis, preventing the discharge of lochia, characterized by lower abdominal distension and pain as well as chest and hypochondriac distension. Treatment should focus on regulating qi and activating blood circulation, using modified Xiang Ai Xiong Gui Yin.
2. Blood Stasis︰Postpartum lochia is scanty, dark purple in color, mixed with blood clots, abdominal pain with tenderness, or palpable masses at the painful area, purple tongue texture, thin white coating, and deep thin or deep choppy pulse. Blood stasis postpartum lochiostasis is caused by retained lochia and stasis obstructing the uterus with appendages, hence its characteristics include lower abdominal pain with tenderness or palpable masses. Treatment should focus on invigorating blood and resolving stasis, and the formula Generation and Transformation Decoction can be modified for use.
3. Cold Congealing︰Postpartum lochiostasis, lower abdominal cold pain, preference for heat application, cold limbs, pale lips, neutral taste in mouth, pale tongue with white coating, deep and slow pulse. The binding of wind-cold pathogens in the blood aspect leads to stagnation of lochia in the uterus, hence dominated by cold manifestations. The key diagnostic points are lower abdominal cold pain relieved by warmth, fear of cold with cold limbs, and slow pulse. Treatment focuses on {|###|}warming the meridians and dissipating cold{|###|}, but should be tailored according to accompanying symptoms. For cases with aversion to cold with fever and other exterior patterns, use Five Accumulations Powder to expel pathogens from the exterior; if accompanied by abdominal pain and vomiting or cough with counterflow, use Major Meridian-Warming Decoction to disperse; for lower abdominal cold pain, use Xianggui Powder to warm; for cold limbs, pale lips, and neutral taste in mouth, those with excess patterns should use Lesser Abdomen Stasis-Expelling Decoction to warm and promote movement, while those with deficiency patterns should use {|108|}Angelica, Fresh Ginger and Mutton Decoction{|109|} to warm and supplement.
4. Deficiency of Both Qi and Blood︰Postpartum lochia stops suddenly after discharge, with a sensation of lower abdominal fullness but no pain, accompanied by dizziness, tinnitus, palpitations, shortness of breath, mental fatigue, and lethargy. The tongue is pale with a white coating, and the pulse is weak and thin. This is often due to constitutional weakness and insufficiency of qi and blood, or prolonged labor and difficult delivery depleting qi and blood, leading to qi deficiency and insufficient blood, resulting in no blood to discharge. The key diagnostic points are mild lower abdominal fullness without pain, along with dizziness, tinnitus, palpitations, shortness of breath, mental fatigue, limb weakness, a pale tongue, and a thin, weak pulse. Treatment should focus on tonifying qi and blood. For mild cases, use Sage Cure Decoction; for severe cases, use Ten Major Tonics Decoction or Returning to Spleen Decoction. If the deficiency cannot tolerate strong tonification, it is advisable to take the medication in small, frequent doses.

bubble_chart Documentation

1. Mingyi Lei'an．Postpartum．Hua Bo-ren Case》 records: "A postpartum woman had lochia retention, umbilical abdominal pain, headache, and chills with fever. Everyone thought it was due to cold exposure, so they treated her with ginger and aconite, which only made her fever worse, and she developed convulsions in her hands and feet. The convulsions started after taking the ginger and aconite, caused by the dry formula agitating the blood and generating wind, leading to delirium and eye twitching. Her pulse was wiry and rapid. Her face was red, her eyes closed, and she mumbled incoherently. Her tongue was black like soot, dry without moisture, and her chest and abdomen were too tender to touch. The dry formula had agitated her blood, causing internal heat and wind, and blood stasis leading to pain. Such cases require careful consideration. If it were due to deficiency cold, wouldn't her hands and feet be cold? Moreover, with a black tongue and unbearable abdominal tenderness within three to four days, and a rapid, surging pulse? It was said: This is postpartum heat entering the uterus, thus generating wind. First, clear heat and reduce fire, treat wind and cool the blood. After two doses, she felt much better. Then, with amber and cow-bezoar, she regained some consciousness. Later, using Zhang Cong-zheng's Sanhe Powder to move blood and break blood stasis, after three to four doses, the lochia flowed heavily as at the beginning. By then, it had been ten days since delivery, and all symptoms subsided."