Case Study: A low abdominal pain is caused by an accidental extension of the operative incision after a cesarean
Ms. H. D. is 29 years old teacher who has been suffering from a constant pain in the low abdomen for two months after a cesarean. Until the end of her first pregnancy, she is done a cesarean due the head of the fetus hasn’t dropped into her pelvis until the labor arrives which is caused by a too narrow of her pelvis which can’t bear the bigger fetus through.
She experiences a good operation and gains a health baby girl.
Because she is breastfeeding and doing many house works when she is discharged from the hospital, she starts to feel a pain at the right low abdomen which is a constant dull aching in a week after her operation. It may be caused by her moving too early. She manifests poor appetite and regular bowel movement. GP gives her Co-codamol which makes her constipation, so she visits me for TCM treatment.
Dr Jiang’s examination on her when she first visits is that:
There is a soft abdomen with a pressing pain limited at the right low abdomen where lies at the right low part of the scar of cesarean and no rebounding pain and muscular tension are found. There is a minor discomfort in the left low abdomen with some distension and gurgling sound in the intestines.
Light red tongue with less white coating and wiry pulse are recognized.
The diagnosis of CWM to her is that: 1 An accident extension of operative incision after a cesarean 2 A minor local peritonitis
The Identification of patterns to her is that:
The accumulation of dampness-heat with blood stasis obstructs in the abdominal Qi, respondent to spleen and large intestine.
The treating principle is to remove the dampness and clear the heat and to dredge the abdominal Qi by expelling the stasis.
Treatment is given as below:
Baihui(Du20), Tianshu(St25), Zusanli(St36), Neiting(St44), Yanglingquan(Gb34), Zulinqi(Gb41), Waiguan(Sj5), Yinlingquan(Sp9), Sanyinjiao(Sp6)
The herbal medicine: The typical main formula is based on Lanweiqinghua Tang and variation which is prescribed as below: Chaihu10, Yinchen10, Chuanlingzi10, Mudanpi10, Jinyinhua15, Pugongying10, Zhiqiao10, Houpo10, Yanhu10, Dahuang10 (later), Chishao10, Gancao5. Above herbs are decocted as a juice which is taken twice daily.
After a week, she has a regular below movement, remarkable reduced pain at the right low abdomen and calmed sleep. So another course of acupuncture and same prescription are given, and then she is adjusted to patent herbs and acupuncture weekly:
Dachaihu Tang Wan15pills, twice daily Jiaweixiaoyao Wan 1pill, twice daily
After 4 weeks, she has healed completely. She keeps her breastfeeding, free abdominal pain, regular bowel movement, good sleep and full of energy; and turns to gain a part-time work.