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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Chinese Medicine for Third Stage

Nowhere is the importance of using a bit of differentiation more important than in the use of herbs for pph. Western herbology is just not enough. You can blame pph on uterine atony, retained placenta, placental fragments, but you cannot apply herbal remedies across the board for all of these. It just doesn't make sense. Should an atonic uterus be treated the same as a pph from retained placenta?

Chinese medicine(TCM), for all its weird language, has the advantage of more carefully discriminating the cause of pph. However, the language is not the language of western medicine (i.e. anatomical). It has to do with differentiation in TCM. The differentiation centers around the nature of the bleeding you see.

Pph has three distinct variations.

1) Profuse bright red or thick bright red bleeding This kind of bleed is caused by something called blood heat. Blood heat causes the blood to become recklessly marauding and overflow the vessels, just like a boiling pot overflows. Other symptoms would include: red face, sensation of heat, thirst, red tongue body with a yellowish coating and a rapid (over 90bpm) full pulse. When I see someone in pregnancy that has heartburn, rapid pulse, insomnia, an increased pulse upon taking any hot drinks, thirst for cold, red tongue etc., I always treat them for heat in order to prevent hemorrhage.

Herbs: NEVER CAYENNE, it's too hot. That's why it should never be used for hemorrhage, unless you are clearly differentiating and you know there is not heat. The best thing to use in this case is an acupuncture technique (see separate post) to bleed Spleen 1. Herbs of choice: motherwort (Leonurus cardiaca). Motherwort is mostly used for stasis, but it is also cooling and astringent, so it is the one you would possible carry that will work. Another would be blue cohosh (Caulophyllum thalictroides). In the Western world, blue cohosh is an oxytocic, in TCM terms, it clears wind-heat, so what you'd use it for is it's ability to be cooling.

2) Dark red clotty bleeding with or without abdominal pain This is bleeding due to blood stasis. Stasis in the channels and network vessels does not allow the normal flow of blood (hence the pain), and causes the blood to flow out of the channel in a hemorrhage. You must remove the stasis to cure the bleed. Other symptoms: notably, pain, dark coloring under the eyes, purplish hue to the tongue body, and a wiry or choppy pulse--something you probably can't differentiate without training or a long winded episode from me on pulse diagnosis. Rely on the clots and pain as your differentiating symptoms.

Herb of choice: motherwort (Leonurus cardiaca) --you knew I was going to say that, didn't you? If you had it, you could also use cattail pollen (Typha angustifolia), safflower (Carthamis tinctorius), and peach pit (Prunus persica), but neither you, nor I are likely to have those on hand for emergency use. The Chinese patent Yun Nan Bai (Pai) Yao is made of an herb called pseudoginseng (Panax notoginseng). This has the benefit of stopping bleeding as well as moving stasis, and is packaged as a powder or capsules. The powder and capsules come with a little red pill. This pill is only used for emergency treatment of shock, so disregard it in most cases. It won't help stop the bleed, only shock. For a bleed, take 4 capsules immediately. They are a bit slower acting than the motherwort.

3) Pale or watery, profuse light red thin bleeding This is usually the cause of delayed hemorrhages, or the bleed that accumulates in the first hours postpartum. It is caused by qi deficiency, meaning that there isn't enough "energy" to keep the blood in circulation. A variation of this would be a bleed with a prolapse. Qi is responsible for "lifting and holding" the organs in place and the blood within the vessels, so when it is weak, they fall, as does the blood. This is where you'd see marked uterine atony. Other symptoms include: pallor, sweating, weakness, feeble voice, pale tongue body and weak and thready pulse.

The herbs of choice here are those that strongly tonify qi, and some contractants. I use Chinese ginseng (Panax ginseng). I have a few roots I boil into a tea before each delivery, and nearly everyone gets some. It's a great restorative as well as treating pph. Also, I use cottonroot bark (Gossypium herbaceum), which has no history or description in TCM, but I find it the most reliable herbal uterine contractant. Red Raspberry (Rubus ideaus) is best used as a preventative; I haven't found it miraculous in stopping a bleed. This is the one situation where cayenne probably got its reputation for working on pph. For someone who is so weak, the cayenne would strongly warm the interior, and since warm is yang, and yang refers to function, it could be this increased yang that urges the uterus to function properly. More often than not, what you see in 20 minutes with cayenne is a renewed bleeding, because it is too hot (adds blood heat).

My protocols on pph involve: getting placenta out if in, nipple stim, checking bladder status, acupuncture on Spleen 1, use of herbs as above , bimanual compression, and use of antihemorrhagics, usually in that order.