Insights from Ye Tianshi on Treating Postpartum Disorders: From Classic Medical Cases to Modern Inspirations
—— Also Discussing the Clinical Application of “Simultaneous Nourishment and Regulation” and “Harmonizing the Extraordinary Meridians”
The Essence of Ye Tianshi’s Thoughts on Diagnosing and Treating Postpartum Disorders
Ye Tianshi’s approach to treating postpartum disorders is deeply rooted in the principles of the “Jin Kui Yao Lue” regarding the “Three Postpartum Diseases” (spasms, stagnation, and constipation). He innovatively integrates the theory of extraordinary meridians, proposing two core principles:
“Do not be confined to postpartum, nor forget postpartum”
– Postpartum often presents with deficiency, but stasis and phlegm-dampness as real pathogens often persist, requiring a balance of “having issues without losing vitality”;
– Avoid using only warming tonics; advocate for “treating the disease while addressing the deficiency, with a gradual approach being preferable”.
“The Chong and Ren meridians must differentiate between deficiency and excess”
– For deficiency in the extraordinary meridians (e.g., lumbar pain), use Lu Jiao Shuang (Deer Antler Velvet) and Zi Shi Ying (Amethyst) for nourishment;
– For obstruction in the extraordinary meridians (e.g., painful lochia), use Hu Po (Amber) and Chong Wei Zi (Cang Zhu) to open the channels.
Analysis of Four Common Postpartum Pathologies and Treatment Methods
Lochia Stagnation: Nourish while promoting, valuing harmony
– Typical medical case: Qin’s case (postpartum chest tightness and abdominal pain)
– Treatment characteristics:
– Stir-fried Hawthorn combined with children’s urine → resolves stasis without harming yin;
– Yi Mu Cao (Motherwort) decoction instead of water → specifically enters the uterus, promotes water metabolism and resolves stasis.
– Modern inspiration:
– Incomplete uterine recovery postpartum: Yi Mu Cao granules + Sheng Hua Tang (Birth-Transforming Decoction) adjusted;
– Early acute mastitis: Yu Jin (Curcuma) combined with Pu Gong Ying (Dandelion) to soothe the liver and promote lactation.
Deficiency with Stasis: Simultaneous attack and nourishment, combining movement and rest
– Typical medical case: Cheng’s case (postpartum deficiency with pain)
– Treatment characteristics:
– Sheng Di Huang (Rehmannia) combined with Sheng Jiang (Ginger) → nourishes yin without hindering the spleen, while the spicy nature aids blood circulation;
– Hu Po (Amber) powder taken orally → resolves stasis and calms the spirit, especially suitable for insomnia with stasis pain.
– Modern inspiration:
– Post-cesarean intestinal adhesions: Tao Hong Si Wu Tang (Peach Blossom Decoction) plus Hong Teng (Sargentodoxa) and Bai Jiang Cao (Patrinia);
– Postpartum depression with bodily pain: 3g of Hu Po powder taken orally + Gan Mai Da Zao Tang (Licorice and Jujube Decoction).
Stagnation and Shen Disturbance: Calm the reverse and stabilize the collapse, harmonizing yin and yang
– Typical medical case: Tang’s case, Wu’s case (postpartum delirium)
– Treatment characteristics:
– Jiu Ni Tang (Rescue Reversal Decoction) (Long Mu, Mu Li, Gui Zhi, Gan Cao) → restrains sweating and supports yang, preventing seizures;
– Zi Shi Ying decoction → warms the extraordinary meridians, calms the upward reversal of qi.
– Modern inspiration:
– Postpartum thyroiditis during hyperthyroid phase: 30g of Sheng Mu Li (Raw Oyster Shell) + 15g of Xia Ku Cao (Selfheal);
– Peripartum cardiomyopathy with palpitations: Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig, Licorice, Dragon Bone, Oyster Shell Decoction) combined with Sheng Mai San (Generate Pulse Powder).
Injury to the Extraordinary Meridians: Fill and moisten, overcoming rigidity with softness
– Typical medical case: A certain case (lochia with lumbar pain)
– Treatment characteristics:
– Zhi He Shou Wu (Processed Fo-Ti) combined with Chuan Duan (Break Stone) → tonifies liver and kidney, strengthens the Ren and Du meridians;
– Ze Lan (Lycopus) combined with Charred Hawthorn → dispels stasis and generates new blood, stops bleeding without retaining pathogens.
– Modern inspiration:
– Postpartum sacroiliac joint inflammation: Du Huo Ji Sheng Tang (Angelica and Pubescent Angelica Decoction) plus Lu Jiao Shuang (Deer Antler Velvet);
– Pelvic floor muscle relaxation: 60g of Huang Qi (Astragalus) + 30g of Zhi Shi (Bitter Orange) to lift and stabilize.
Clinical Insights and Innovations in Medication
From “Children’s Urine Oral Administration” to Biologic Agent Thinking
Ye Tianshi used children’s urine (now can be replaced with Ren Zhong Bai) to guide medication into the blood, and modern research confirms its content of urokinase can promote fibrinolysis. Clinical references:
– Elevated D-dimer postpartum: 1.5g of water leech powder taken orally + 30g of Yi Mu Cao;
– Foul lochia (infection tendency): Jin Yin Hua (Honeysuckle) decoction with Yun Nan Bai Yao (Yunnan Baiyao).
From “Hua Sheng Dan” to Targeted Channel Opening Concepts
Vinegar-cooked Da Huang (Rhubarb) “enters the affected area without harming the healthy area,” suggesting:
– Poor healing of uterine incision: vinegar-prepared Da Huang applied externally to the lower abdomen;
– Postpartum masses (recurrence of uterine fibroids): Gui Zhi Fu Ling Wan (Cinnamon and Poria Pill) plus vinegar-prepared Bie Jia (Soft-shelled Turtle Shell).
From “Extraordinary Meridian Treatment” to Fascia Chain Theory
Deficiency in the Du and Ren meridians causing lumbar pain ≈ imbalance in the erector spinae-lumbar fascia chain, can:
– Use floating needles to disperse the eight sacral points + moxibustion at Ming Men (Gate of Life);
– Acupuncture at Hou Xi (Back Stream) (to open the Du meridian) combined with Zu Lin Qi (Foot-Lin-qi) (meeting point of the Ren meridian).
Modern Changes in Postpartum Women’s Constitution and Countermeasures
Air conditioning and cold drinks causing “cold and stasis intermingled”
– Symptoms: dark lochia with blood clots, cold pain in the lower abdomen.
– Treatment: Moxibustion at Shen Que (Spirit Gate) + Shao Fu Zhu Yu Tang (Lower Abdomen Stasis-Removing Decoction).
Excessive supplementation causing “phlegm-heat obstruction”
– Symptoms: thick and difficult-to-express breast milk, thick greasy tongue coating.
– Treatment: 15g of Gua Lou Pi (Trichosanthes Fruit Peel) + 10g of Lou Lu (Luffa) + 20g of Si Gua Luo (Silk Gourd Fiber).
Anxiety and insomnia causing “heart and kidney not communicating”
– Symptoms: restless sleep at night, night sweats, palpitations.
– Treatment: 3g of Huang Lian (Coptis) + 1g of Rou Gui (Cinnamon) (Jiao Tai Wan) + auricular acupressure at Shen Men (Spirit Gate).
Case Sharing: Record of Diagnosis and Treatment of Postpartum Body Pain
Patient, 32 years old, 45 days postpartum, experiencing cold pain in all joints, lochia not yet cleared, pale tongue with white coating, deep and thin pulse.
– Diagnosis: Blood deficiency with cold congealing, extraordinary meridians lacking nourishment
– Prescription:
– 15g of Dang Gui (Angelica) 10g of Gui Zhi (Cinnamon) 20g of Bai Shao (White Peony) 3g of Xi Xin (Asarum)
– 15g of Lu Jiao Shuang (Deer Antler Velvet) 30g of Ji Xue Teng (Spatholobus) 5 slices of Sheng Jiang (Ginger) 5 pieces of Da Zao (Jujube)
– External use: Wu Zhu Yu (Evodia) coarse salt bag for hot compress on the lumbar region
– Efficacy: Pain reduced after 5 doses, continued with 7 doses to clear lochia, joints warmed.
Conclusion
Ye Tianshi’s treatment of postpartum disorders is akin to “Tai Chi Push Hands,” seeking balance between nourishment and promotion, and finding opportunities within the extraordinary meridians’ qi and blood. Modern clinical practice facing “confinement diseases” must not only inherit the ancient wisdom of “harmonizing qi and blood” but also innovate such as:
– Combining Sheng Hua Tang with pelvic floor rehabilitation training;
– Using floating needles to release postpartum lumbar fascia chains;
– Replacing some sedative medications with emotional guidance.
Remember: Postpartum is not solely a deficiency syndrome; stasis, stagnation, cold, and heat can all be problematic. Only by observing the pulse and symptoms can one understand the underlying issues, thus honoring Ye’s true meaning of “the physician’s intent.”