2 2 cases of post dialation and curretage abdominal pain : 44 1974 4 6 Case 1: Zhang Mou, female, 44yo, outpatient basic

ic history. First visit 4/6/1974, :2 l CC: 2 days after D&C procedure, patient experienced intense abdominal pain for 1 day. :4 4 Current medical presentation: on 4/4 underwent D&C due to a partial abortion. 5 , After 5 days and nights, suddenly there was lower abdominal pain, as well as low back pain. , She previously took a painkiller and tetracycline, the pain did not decrease, the low back and abdomen were aching, the lochia was very little, there was dizziness and decreased food intake, leg weakness, cold sweating with the pain, and her face was pale. :: Tongue: tongue body was dusky and pale. Pulse: wiry and slow. : Basis of medical diagnosis: 1. post partial abortion procedure. 2. abdominal pain following D&C needs investigation. : TCM doctor's diagnosis : Blood stasis collected interiorly, concurrently affected by cold. : Treatment: Invogorate blood to transform stasis, nourish blood and warm the uterus. : Formula dang gui 3 qian, chaun xiong 1 qian, hong hua 1 qian, yi mu cao 1 qian, ze ln qian, tao ran 5 fen, zhi gan cao 5 fen, pao jiang 5 fen, nan shan zhi 2 qian, pu huang 3 qian, wu ling zhi 3 qian : 4 8 2 , ()2 Treatment course: 4/8, after 2 bags of the above formula, the abdominal pain eased, discharged two black blood clots, the lower abdomen still had a feeling of being weighed down, bowel movements were scarce and watery, and there were

two bowel movements per day. 3 From the previous formula, pao jiang was removed and 2 qian gan jiang, 3 qian of bai zhu were added, and [the patient] was given another 3 bags 4 13 4/13, Following the administration of herbs the lochia cleared, the lower abdomen was not painful, bowel movements regulated, and the symptoms alleviated. : 41 Case 2: Li Cai, female, 41yo, Waiyuan consultation case history 1975 4 22 Consultation date 4/22/1975. :1 Chief complaint: Following an abortion, the lower abdomen was suddenly severly painful for one week. :1974 4 18 Current symptoms: Early in her pregnancy there were complications from rheumatic heart disease, on 4/18/1975 , she underwent an induced abortion procedure. Because of the surgery, she went into shock and was hospitalized for observation. (37.3 .., 38. 2"<:: ) , 2 () After the procedure she had a fever (37.3-38.2 degrees C), bowel movements were dry, she had dizziness and decreased appetite, abdominal pain, vaginal bleeding, for nearly two days the bleeding increased (it was the same amount as her menstrual ow), it was red and had clots, the lower abdomen had sudden severe pain, and the pain was xed in location. :37.3"<:: 80 /l 110/70 On exam: Temperature 37.3, heart rate 80BPM, facial color is normal, throat is bloodshot (google says throat congestion), (something about a heart murmur), soft abdomen, clear lower abdominal pain with pressure, BP110/70 (google says mm soft column?) 4 20 7 I ~400/61% 4/20 blood leukocytes 7 I-400 cubic mm, neutrophils 61% :: Tongue: tongue body is dusky, coat is yellow and greasy. pulse: wiry and slippery. ; Western dx: spontaneous post uterine abdominal pain of unknown origin. (unknown? she underwent a D&C!!) 2. Rheumatic heart disease. : TCM dx: interior blood stasis binding, damp heat pouring downward

: Tx strategy: clear heat and drain damp, invigorate the blood to transform stasis. : Formula qu mai 4 qian, mu tong 1 qian, che qian zi 3 qian, hua shi 5 qian, da huang one qian, bai jiang cao ve qian, pu gong ying 5 qian, yan hu suo 3 qian, wu ling zhi 3 qian, pu huang 3 qian, mo yao 2qian, tao ran 5 fen, yi mu cao 1 qian :4 29 3 Course of treatment:4/29, took (more than?) 3 doses, dispelled a membranous thing (?) and a clot as well as small blood clots. Afterward the bleeding decreased, the abdominal pain eased, and the body temperature normalized. 5 2 :430 3 52 She continued with the above dose. 5/2 subsequent medical visit: After the above formula, from 4/30 onward the bleeding stopped, the abdominal pain ceased, and the body temperature was normal for the last 3 days, on 5/2 she was released from the hospital. (Commentary) Abortion and post-partum abdominal pain, in most cases is caused by placental tissue that remains in the womb, or there is infection following the procedure. :: Dr. Liu believes: This condition is more often seen in the following three situations: : 1. The blood stasis has collected interiorly: Part of the embryological tissue was not eliminated, or following the procedure the blood ow was poor, in TCM this is known as blood stasis settling in the uterus, therefore there is pain. In this condition you see xed pain that resists pressure, vaginal bleeding, dark purple complexion, sometimes accompanied by lower back pain. One should treat this by means of invigorating the blood and transforming stasis, many choose Sheng Hua Tang with modication. : 2. Cold lodged in the uterus: during the process of surgery the patient catches cold, in most cases there you will see gripping pain in the lower abdomen, chills, a

pale complexion, pulse is wiry and tight. One should treat this by warming the uterus to dispel the cold, many use Wen Jing Tang with modication. : , 3. Blood stasis collecting internally together with damp heat: In addition to abdominal pain that refuses pressure of the interior blood stasis type, one would also see symptoms on the exterior. Concurrently there are signs of damp heat, often accompanied by heat effusion, uterine bleeding, red face, abdominal pain that refuses pressure, tongue body is dusky, with a yellow coat, the pulse is wiry and slippery. Treat this with Ba Zheng San, consider adding medicinals from the category of clearing heat and resolving toxicity, and invigorating blood to transform stasis. In the rst example, post D&C, the bleeding was not much, there was severe lower abdominal pain, low back pain, connected to interior blood stasis. . , , The complexion was pale and there was twisting pain in the abdomen due to blood deciency and cold. Due to the post-abortion D&C, qi and blood deciency failing ensues, and therefore there is dizziness rising, poor food intake, leg weakness with diminished force. The dusky tongue is from blood deciency and blood stasis. The wiry pulse indicates pain, slowness indicates deciency. These symptoms belong to blood stasis solidifying, blood deciency affected by cold. Therefore treat the earth by the method of invigorating blood and transforming stasis, nourishing blood and warming the channels. Use Chan Hou Sheng Hua Tang to treat this efffectively. In case 2, the procedure was complicated by shock, there was severe postoperative abdominal pain, persistant vaginal bleeding, the tongue was inclined toward duskiness, these symptoms are due to interior blood stasis. The slight fever, yellow greasy tongue fur, and the wiry slippery pulse, are all signs of damp heat. There are symptoms of interior blood stasis binding, and damp heat pouring downward. Therefore, use Ba Zheng San with modication.

Use this primarily from the category to clear heat and drain dampness, and secondarily to assist in invigorating blood to transform stasis. After taking the medicinals, there was a membranous discharge, the abdominal pain was eased, the vaginal bleeding ceased, avoiding pain during a second D&C (?). The above are two similar cases of post D&C abdominal pain, the fundamental pathology of both being blood stasis collecting interiorly. . Yet the rst example is one of simultaneous deciency cold, and the second example is one of simultaneous damp heat, and these should serve as a detailed differential diagnosis.