Thoughts on the Diagnosis and Treatment of Postpartum Rheumatism

Binlong WU, Lamei ZHOU

Department of Rheumatology, Wuxi Traditional Chinese Medicine Hospital, Wuxi 214001, China

Abstract Postpartum rheumatism belongs to the deficiency in origin and excess in superficiality. The dual deficiency of qi and blood is the main pathological basis of postpartum rheumatism. External pathogen, depression, and blood stasis are important pathogenic factors for postpartum rheumatism. Syndrome differentiation mainly includes deficiency-excess pattern identification. In terms of the treatment, it is necessary to take deficiency and depression as guiding principle. Besides, it is necessary to combine wind-cold-dampness or stasis evil of patients to take different treatment methods.

Key words Postpartum rheumatism, Postpartum impediment, TCM therapy

1 Introduction

Postpartum rheumatism, also called postpartum impediment, generally refers to the clinical symptoms of women’s limbs, joints, muscle pain, numbness, soreness, fear of cold, and fear of wind within 100 d after childbirth[1]. For postpartum rheumatism, there is no corresponding disease in western medicine. It covers many kinds of diseases and may be associated with depression, anxiety, fibromyalgia syndrome and some rheumatic immune diseases after childbirth[2]. Through review of the related literature, combined with our experience in the treatment, we had some thoughts about the diagnosis and treatment of postpartum rheumatism.

2 Causes and pathogenesis

2.1 Main pathological basis: dual deficiency of qi and blood

The blood of women is the root of innate endowment and qi is the essence. Blood is easy to become deficient after childbirth. There are four reasons for easy deficiency of qi and blood. (i) During pregnancy, both qi and blood are needed to nourish the fetus. (ii) During the childbirth, women will consume a lot of blood, and if they suffer from postpartum hemorrhage, it will damage the qi and blood. This is so called "original qi is damaged and dual deficiency of qi and blood after childbirth"[3]. (iii) Breast milk is needed after childbirth to raise infants, milk is transformed by qi and blood, so qi and blood are vulnerable to be consumed. (iv) Feeding infant after childbirth often needs staying up late, which will damage the qi and blood. Joint action of these factors leads to easy deficiency of qi and blood in collateral vessels, accordingly leading to pain and stiffness.

2.2 Major pathogenic factors for postpartum rheumatism: external pathogen, depression, and blood stasis

2.2.1External pathogen. External pathogen mainly refers to wind, cold, and dampness. After childbirth, if the healthy qi is deficient, adjustment is improper, and clothes are reduced or increased not properly, staying in cold air and wind for a long time, or living in damp room, all these will lead to invasion of evil qi, then qi deficiency is inevitable. With the invasion of the external pathogen, evil wind, cold and damp qi will flow into muscle surface and joint meridian, both qi and blood movement will become stagnant, leading to obstruction of qi and blood, accordingly resulting in the postpartum rheumatism. The major factor is dampness evil because the dampness easily leads to the recurrence of the disease. The reasons for dampness are as follows. On the one hand, after childbirth, it is easy to sweat. If the women just take shower after sweating, the water will stop on the skin and get sick. On the other hand, after childbirth, the diet often contains much fat and sugar, which are easy to damage the spleen and stomach, loss of transport and transformation will inevitably lead to dampness accumulation.

2.2.2Depression. Depression refers to gloominess in mood. On the one hand, women are easily to have psychological gap and easily lead to emotional distress due to physical and life changes after childbirth. On the other hand, after childbirth, blood deficiency leads to liver blood deficiency, liver qi will fail to be regulated, accordingly the depression of qi and blood leads to the occurrence of the disease.

2.2.3Blood stasis. The occurrence of blood stasis is due to deficiency in qi and blood, which leads to failure to promote movement of qi and blood. As stated inFuQingzhu’sObstetricsandGynecology, after childbirth, qi is weak and will be obstructed in meridians and collaterals[4]. On the other hand, residual lochia after childbirth often leads to blood stasis obstructed in meridians and collaterals, consequently stagnant movement of qi and blood leads to the postpartum rheumatism.

3 Main points of pattern identification

For pattern identification of the postpartum rheumatism, it is mainly deficiency in origin and excess in superficiality. Deficiency is the root of disease, and excess is the cause of the disease. Deficiency mainly refers to qi and blood deficiency. Dual deficiency of qi and blood is manifested as pain. The pain site is not fixed, and slight movement will lead to fatigue. Qi deficiency is mainly manifested as sweating. After sweating, women will fear cold. At the same time, qi is weak and fatigue appears. Blood deficiency is often manifested as muscle cramps, numbness of hands and feet, dizziness,etc.External wind pathogen will lead to scurrying pain, fear of cold, or sweating. Cold pathogen is manifested as relatively fixed pain, no sweating, and fond of warmth. Damp pathogen is mainly manifested as swelling and heaviness of the limbs. Depression is often manifested as joylessness, anxiety, or capriciousness, and fullness in the chest and hypochondrium. Blood stasis is often manifested as fixed pain, serious in night, dry mouth, and thirst without desire to drink, squamous and dry skin, or accompanied with residual lochia, and dark purple tongue.

4 Clinical application

Postpartum rheumatism belongs to the deficiency in origin and excess in superficiality. Its treatment should not adhere rigidly to the principle of postpartum but not forgetting postpartum. Although reinforcing the deficiency is the principle, clinically there are many cases of coexistence of deficiency and excess. Deficiency, depression, evil pathogen and blood stasis mutually interact with each other and mutually are causes and effects[5-6]. In clinical practice, we take the deficiency and depression as treatment principle, and identify if the patients have wind, cold or blood stasis symptoms, and then take different treatment methods.

If the deficiency in origin is the main syndrome, prescriptions such as Huangqi Guizhi Wuwu Decoction and Guizhi Xinjia Decoction are used. If patients accompanied with cold pathogen, Yupingfeng Powder is used. If accompanied with damp pathogen, Fangji Huangqi Decoction or Juanbi Decoction can be used. If accompanied with blood stasis, Buyang Huanwu Decoction is used.

If the depression is the main syndrome, Xiaochaohu Decoction or Xiaoyao Powder can be used. In case of accompanied with cold pathogen, Chaihu Guizhi Decoction can be used. If accompanied with damp pathogen, Xiaochaihu Decoction and Danggui Shaoyao Powder can be used. If accompanied with blood stasis, Shentong Zhuyu Decoction can be used. In summary, it is necessary to treat postpartum rheumatism in accordance with the actual syndrome. Using such method, it is easy to grasp the treatment principle and obtain desirable effect.