bubble_chart Concept

Massive bleeding from the anus after the delivery of the placenta is called postpartum metrorrhagia. This condition is commonly seen within two hours after delivery. If there is a significant loss of blood in a short period, "postpartum dizziness due to hemorrhage" may occur (i.e., dizziness, blurred vision, cold reversal of hands and feet, unconsciousness, etc.). This is a critical symptom and sign of postpartum disease and must be given sufficient attention.

Postpartum hemorrhage caused by retained placenta, placental remnants, or injury to the soft birth canal is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Qi Deficiency︰Shortly after the delivery of the placenta, there is a sudden profuse bleeding from the birth canal like a collapse, without abdominal pain, dizziness, blurred vision, pale complexion, palpitation, shortness of breath and inability to speak, cold limbs with sweating, or blurred vision in both eyes, pale tongue texture, weak and rapid or faint and thin pulse, and abdominal palpation revealing a soft and enlarged uterus. This is mostly due to the mother's inherent weakness, prolonged labor, or excessive fatigue during childbirth, leading to qi deficiency and inability to control blood. The clinical characteristics are: bleeding mostly occurs after the delivery of the placenta, presenting in paroxysms. Due to uterine relaxation during bleeding, sometimes the blood does not flow outward but accumulates in the uterine cavity. At this time, the uterine volume continues to increase and becomes soft. If the uterus is pressed, a large amount of blood clots will be discharged from the vagina. The tongue texture is pale, the pulse is weak and rapid, and abdominal palpation reveals poor uterine contraction, softness, and enlargement. Treatment should focus on tonifying qi and controlling blood, and emergency administration of Duzhong Decoction is recommended. If symptoms include profuse sticky cold sweat, dysphoria and restlessness, rapid breathing, reversal cold of limbs, and a faint pulse on the verge of disappearing, emergency administration of Ginseng and Aconite Decoction with child's urine should be given. For milder cases, a drastic tonification of original qi can be achieved by administering the tonifying qi and rescuing collapse decoction to stop bleeding and stabilize collapse.
2. Blood Stasis︰After the placenta is delivered, there is heavy vaginal bleeding with blood clots, paroxysmal lower abdominal pain that resists pressure, a pale tongue texture or with ecchymosis, a thin and rapid or deep and choppy pulse, and a hard mass felt upon pressing the lower abdomen. This is mostly due to static blood retention in the uterine cavity, preventing new blood from following meridian tropism. The clinical manifestations include: heavy postpartum anal and vaginal bleeding, intermittent passage of blood clots, paroxysmal lower abdominal pain that resists pressure, and even epigastric distress and fullness. Severe abdominal pain may lead to unconsciousness, with a mostly thin and rapid pulse, and a hard mass in the lower abdomen. Treatment should focus on resolving stasis to stop bleeding, supplemented by tonifying qi. The recommended formula is the modified Sudden Smile Powder with Sanqi powder added.

This condition has two types: deficiency and excess. Deficiency is characterized by qi deficiency, heavy uterine bleeding, a weak and rapid pulse, and a soft uterus. Excess is characterized by blood stasis, less uterine bleeding that is persistent, sometimes with large blood clots, and a hard uterus. Postpartum metrorrhagia is a critical condition that requires active emergency treatment. Blood transfusion and fluid replacement may be necessary, along with treatment based on the specific condition. Once the bleeding stops, tonifying and replenishing qi and blood should be done to restore the source.

bubble_chart Documentation

1. Yizong Jinjian Gynecology Essentials．Postpartum Section: "Postpartum anus bleeding has already caused blood loss, and if further complicated by metrorrhagia, it indicates blood desertion disease with qi sinking, which is a serious condition and should be treated with drastic tonification. It is advisable to use Ten Major Tonics Decoction with Donkey-hide Gelatin, Cimicifuga Rhizome, Dipsacus, Zao Ren, Cornus, and Blast-Fried Ginger charcoal to elevate and tonify the collapse. If it is due to sudden anger damaging the liver and causing reckless blood flow, it is advisable to use Peripatetic Powder with black gardenia, Unprocessed Rehmannia Root, and lalang grass rhizome to clear it. If it is due to internal blood stasis, there will likely be abdominal distension and fullness with pain, and it is appropriate to use finger citron powder and Sudden Smile Powder to tonify and expel it."