CHAPTER 52 Joint Pain after Childbirth
Joint Pain after Childbirth includes pain, ache, soreness, numbness or feeling of heaviness in the joints, back or knees after childbirth. It pertains to the broad disease category of Painful Obstruction Syndrome but it has specific characteristics and pathology when it occurs after childbirth.
Aetiology
Severe blood loss during labour
Profuse blood loss during labour leads to severe Blood deficiency after childbirth: the deficient Blood fails to nourish the channels and the sinews and this causes a dull ache of a deficient nature.
Invasion of external Wind
External Wind may invade the channels and settle in the joints causing Painful Obstruction Syndrome: a woman is more prone to such invasions after childbirth because the channels are in a weakened state due to Blood deficiency and the space between the skin and muscles is Empty due to Qi deficiency. Wind usually combines with either Cold or Dampness or both to cause joint pain. If Wind predominates, the ache will move from joint to joint. If Cold predominates, there is intense pain, and if Dampness predominates, there is numbness, tingling and a feeling of heaviness of the limbs.
Emotional problems
Emotional problems such as irritation, worry, frustration and resentment cause stagnation of Qi which, after childbirth, may easily lead to Blood stasis. Blood stagnating in the channels, especially in the joints, causes joint pain of a stabbing nature.
Weak body condition
If a woman suffers from a pre-existing weakness of the Kidneys and Liver, this will be exacerbated after childbirth. The Kidneys influence the bones and the Liver the sinews, and these two tissues will lack nourishment: this will cause a dull pain of a deficient nature in the joints and especially in the lower back and knees.
Pathology
The pathology of Joint Pain after Childbirth can be differentiated according to whether it is of an external or internal origin. When joint pain after childbirth is due to invasion of Wind, it is of external nature and its pathology is essentially the same as that of Painful Obstruction Syndrome.
In the other cases of Blood deficiency and deficiency of Liver and Kidneys, the joint pain is caused by malnourishment of the channels, sinews and bones. Blood stasis, caused by stagnation of Qi and Blood in the channels, is always painful; the principle is that ‘obstruction causes pain’.
From the point of view of deficiency/excess, the pain from invasion of Wind and from Blood stasis is of an excess nature, that from Blood deficiency and from Liver and Kidney deficiency is of a deficient nature. Pain of an excess nature is severe and stabbing if caused by Blood stasis; intense, fixed in one joint and cramping if caused by Cold; dull and with a feeling of heaviness if caused by Dampness; and dull and wandering from joint to joint if caused by Wind; it tends to improve with activity. Pain of a deficient nature is more like a dull ache and it improves with rest.
Identification of patterns and treatment
The treatment principle must be clearly differentiated according to the pathology. In deficiency cases, the primary aim is to nourish Blood, tonify Liver and Kidneys and benefit sinews and bones; the secondary aim is to expel Wind, scatter Cold and resolve Dampness. In excess cases, the primary aim is to expel Wind, scatter Cold and resolve Dampness; the secondary aim is to nourish Blood. Even if the joint pain is from external Wind, it is important to nourish Blood after childbirth, because the deficiency of Blood renders the woman prone to invasions of Wind and because nourishing Blood helps to expel Wind from the channels. In cases of Blood stasis, the main treatment principle is to invigorate Blood and eliminate stasis.
Blood deficiency
Clinical manifestations
Dull ache in the joints after childbirth, numbness and tingling of limbs, dull complexion, dizziness, insomnia, blurred vision, tiredness. Tongue: Pale and Thin. Pulse: Choppy.
Treatment principle
Nourish Blood, tonify Qi, warm the channels, remove obstructions from the Connecting channels.
Acupuncture
ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, G.B.-34 Yanglingquan, L.I.-11 Quchi, T.B.-5 Waiguan, Ren-4 Guanyuan, BL-11 Dashu, BL-17 Geshu, BL-20 Pishu, BL-23 Shenshu. All with reinforcing method except for T.B.-5 which should be needled with even method. Moxa is applicable.
Herbal treatment
Prescription
Explanation
Three Treasures remedy
This remedy nourishes Blood and expels Wind-Dampness from the channels: it was formulated specifically for cases of Wind-Dampness in the joints occurring against a background of Blood deficiency.
Blood deficiency
Clinical manifestations
Dull ache in the joints after childbirth, numbness and tingling of limbs, dull complexion, dizziness, insomnia, blurred vision, tiredness. Tongue: Pale and Thin. Pulse: Choppy.
Treatment principle
Nourish Blood, tonify Qi, warm the channels, remove obstructions from the Connecting channels.
Acupuncture
ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, G.B.-34 Yanglingquan, L.I.-11 Quchi, T.B.-5 Waiguan, Ren-4 Guanyuan, BL-11 Dashu, BL-17 Geshu, BL-20 Pishu, BL-23 Shenshu. All with reinforcing method except for T.B.-5 which should be needled with even method. Moxa is applicable.
Invasion of Wind
Clinical manifestations
Pain in the joints with sudden onset, contractions of joints, pain relieved by movement. If Cold predominates, the pain is fixed in a joint, intense and ameliorated by the application of heat. If Wind predominates, the pain wanders from joint to joint. If Dampness predominates, the ache is dull and accompanied by a feeling of heaviness and tingling, and the joints are swollen. Tongue: no change. Pulse: no change.
Acupuncture
LIV-8 Ququan, G.B.-34 Yanglingquan, ST-36 Zusanli, SP-6 Sanyinjiao, Ren-4 Guanyuan, BL-11 Dashu, Du-14 Dazhui, BL-12 Fengmen, T.B.-5 Waiguan, ST-43 Xiangu, BL-17 Geshu, SP-9 Yinlingquan, Ren-12 Zhongwan, Ren-6 Qihai. The points to nourish Blood with reinforcing method and those to expel Wind, Scatter Cold and resolve Dampness with reducing method.
Herbal treatment
Prescription
Explanation
This prescription is warm in nature and it is more suitable if there is Cold in the joints and the tongue is Pale.
Three Treasures remedy
This remedy is a variation of Du Huo Ji Sheng Tang above.
Invasion of Wind
Clinical manifestations
Pain in the joints with sudden onset, contractions of joints, pain relieved by movement. If Cold predominates, the pain is fixed in a joint, intense and ameliorated by the application of heat. If Wind predominates, the pain wanders from joint to joint. If Dampness predominates, the ache is dull and accompanied by a feeling of heaviness and tingling, and the joints are swollen. Tongue: no change. Pulse: no change.
Acupuncture
LIV-8 Ququan, G.B.-34 Yanglingquan, ST-36 Zusanli, SP-6 Sanyinjiao, Ren-4 Guanyuan, BL-11 Dashu, Du-14 Dazhui, BL-12 Fengmen, T.B.-5 Waiguan, ST-43 Xiangu, BL-17 Geshu, SP-9 Yinlingquan, Ren-12 Zhongwan, Ren-6 Qihai. The points to nourish Blood with reinforcing method and those to expel Wind, Scatter Cold and resolve Dampness with reducing method.
Blood stasis
Clinical manifestations
Severe joint pain after childbirth, stiffness of joints, contraction of limbs, abdominal pain, scanty lochial discharge, dark complexion. Tongue: Purple. Pulse: Wiry or Firm.
Acupuncture
L.I.-11 Quchi, SP-10 Xuehai, BL-17 Geshu, SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), SP-6 Sanyinjiao, Du-8 Jinsuo, Ren-6 Qihai, T.B.-5 Waiguan, T.B.-6 Zhigou. All with reducing or even method.
Herbal treatment
Prescription
Explanation
Blood stasis
Severe joint pain after childbirth, stiffness of joints, contraction of limbs, abdominal pain, scanty lochial discharge, dark complexion. Tongue: Purple. Pulse: Wiry or Firm.
Liver-Blood and Kidney-Yang deficiency
Clinical manifestations
Dull joint-ache after childbirth especially in the knees and lower back, tiredness, dizziness, tinnitus, backache. Tongue: Pale and wet. Pulse: Deep, Weak.
Treatment principle
Tonify the Liver and Kidneys, remove obstructions from the Connecting channels, warm the channels and stop pain.
Acupuncture
BL-23 Shenshu, BL-18 Ganshu, Ren-4 Guanyuan, LIV-8 Ququan, KI-10 Yingu, LIV-7 Xiguan, G.B.-34 Yanglingquan, KI-3 Taixi, G.B.-39 Xuanzhong. All with reinforcing method; moxa is applicable.
Herbal treatment
a Prescription
Three Treasures remedy
This remedy nourishes Liver- and Kidney-Yin and benefits sinews and bones. The tongue presentation appropriate to this remedy is a Red body without coating.
Liver-Blood and Kidney-Yang deficiency
Clinical manifestations
Dull joint-ache after childbirth especially in the knees and lower back, tiredness, dizziness, tinnitus, backache. Tongue: Pale and wet. Pulse: Deep, Weak.
Treatment principle
Tonify the Liver and Kidneys, remove obstructions from the Connecting channels, warm the channels and stop pain.
Acupuncture
BL-23 Shenshu, BL-18 Ganshu, Ren-4 Guanyuan, LIV-8 Ququan, KI-10 Yingu, LIV-7 Xiguan, G.B.-34 Yanglingquan, KI-3 Taixi, G.B.-39 Xuanzhong. All with reinforcing method; moxa is applicable.
Prognosis and prevention
Joint Pain after Childbirth reacts well to treatment with both acupuncture and herbs, but it may take some weeks to achieve an improvement. The sooner after childbirth the treatment is started, the better the results. The easiest pattern to treat is the one from Blood deficiency and the most difficult that from Blood stasis. Acupuncture is particularly useful in the treatment of this condition because it can treat the affected joints directly.
As for prevention, it is very important for women to take extra care after childbirth and not be exposed to Cold, Wind or Dampness. They should also take enough rest so that Qi and Blood can recover from the strains of labour.
), Ancient Chinese Medicine Texts Publishing House, Beijing, p. 24. Chen’s book, written during the Qing dynasty (1644–1911), was entitled Secret Gynaecological Prescriptions (Fu Ke Mi Fang) and published in 1729..