Post Partum use of Sheng Hua Tang

Sheng Hua Tang is a formula designed by Fu Qing-Zhu in the 17th century.  It was first written about in his text Fu Qing-Zhu’s Gynecology (Fu Qing-Zhu Fu Ke) It is designed to treat women who are just post partum in order to transform blood stasis so that new blood can be generated.  This is one explanation given for the name of the formula “Generate and Transform Decoction”.  The name of the formula could also be translated as the “Giving Birth Decoction”.  This is possible because  the word for birth in Chinese is 生 Sheng and giving birth is sometimes referred to as the 大化 Da Hua or Great Transformation. (see Formulas and Strategies).  At any rate, this formula is truly excellent for post partum, post miscarriage and post termination patients.

In my own practice I have used Sheng Hua Tang more times than I can count.  I have found it very useful and helpful. I think of it as a formula that ensures that the uterus is clear, clean and warm after birth.  The healthy condition of the uterus after birth can help ensure good breast milk flow and help prevent post partum fever and depression.

Various doctors over time have created their own versions of Sheng Hua Tang.  Liu Feng-Wu created his Chan Hou Sheng Hua Tang Post Partum Generate and Transform Decoction and Dr. Xia Gui-Cheng created his own Jia Jian Sheng Hua Tang Sheng Hua Tang with Additions and Subtractions.

Below I have posted a translation of Dr. Xia Gui-Cheng’s writings on his understanding of Sheng Hua Tang.  He includes some very relevant research.  I especially like his explanation of how this formula treats the Spleen and Stomach in order to ensure the production of fresh blood.  He also goes into a great discussion of Pao Jiang.

Dr. Xia Gui-Cheng’s use of Modified Sheng Hua Tang

Jia Jian Sheng Hua Tang

Chao Dang Gui 12
Chuan Xiong 5
Tao Ren 9
Pao Jiang 3
Zhi Gan Cao 3
Shan Zha 10
Chao Jing Jie 6
Yi Mu Cao 15

Function:

Transform Stasis, Vitalize blood, warm the menses and stop pain

Application:

Lack of flow of the lochia or it flows but not smoothly, dripping without stopping or coming with clots with pain in the abdomen, purple spots on the tongue and a thin rough pulse.

Formula composition:

This formula is for postpartum lochia not flowing or ceaselessly flowing with lower abdominal cold pain due to blood stasis inwardly accumulating mixed with cold.  This is why it is necessary to vitalize blood and dispel stasis.  When this is done, there are really two reasons.  The first is that, by vitalizing the blood and transforming stasis, the expanded uterus to contract and to be restored to its original state.  This is the so-called “return to the past”.  The second is that by transforming stasis and dispelling the old, the new is generated.  This is the so-called “dispel the old to generate the new”.  This will result in the whole body recovering.  Moreover, this formula uses a large dose of Dang Gui as the principle herb to supplement and vitalize the blood, dispel stasis and generate the new.  Chuan Xiong vitalizes the blood and moves the Qi.  It is the Qi within the blood herb.  It assists the Dang Gui in contracting and aiding recovery of the uterus.  It is also a principle herb.  Tao Ren vitalizes the blood and dispels stasis.  By dispelling stasis the new is generated.  Tao Ren is an assistant.  Pao Jiang warms the channels and stops pain.  It also assists in generating the new.  Zhi Gan Cao harmonizes all of the herbs.  Gan Cao is honey fried and assists in warming the middle and is an envoy.  At present, I also add Jing Jie to course the Liver and resolve constraint. It assists the Gui and Xiong in contracting the uterus.  Shan Zha transforms stasis and generates the new. Yi Mu Cao is a principle herb regulating post partum.   All of the herbs work together as a formula to vitalize blood, transform stasis, contract the uterus, generate the new, warm the channels and stop pain.

Clinical application

  1. Postpartum abdominal pain: Postpartum scanty lochia, lower abdominal cold pain or relatively serious pain, low back soreness, pulse thin and wiry, tongue with purple sides and white sticky moss.  For this you can add 12 gm Yan Hu Suo.
  2. Retained placenta: Ceaseless flow of the lochia with scanty or profuse amount with purple red color and clots, back soreness with abdominal distention and a dark purple tongue.  The tongue may be yellow white and thick and sticky in the back.  For this, you can add 10 gm Chuan Niu Xi and 6 gm Hong Hua.
  3. Blood stasis type dysmenorrhea: Menstruation is late and the amount is scanty or profuse.  The color of the blood is purple red with clots, abdominal serious pain, cold feeling in the lower abdomen, pulse thin and wiry, tongue body with purple sides and purple stasis spots, thin pulse.  You can add 5 gm of Rou Gui and 10 gm of Yan Hu Suo.

Clinical Experience:

Generating and transforming relates to the post-heaven Spleen and Stomach because the Spleen and Stomach are the source of generation and transformation.  All through the ages, formulas such as Si Jun Zi Tang, Liu Jun Zi Tang, Xiang Xia Liu Jun Zi Tang, Gui Pi Tang, Bu Zhong Yi Qi Tang, Shen Qi Tang and Dang Gui Bu Xue Tang have been the principle formulas for assisting Spleen and Stomach, which are the source of the generation and transformation.  I’ve observed that the generation and transformation function of the Spleen and Stomach lies in the up bearing and down bearing coordination in the clinic for a long period of time.  The food and fluids enter the Stomach where they are received and digested into the Jin and Ye and the minute essences.  The so-called clear essences are separated out.  This depends on the Spleen up bearing, transporting to the Heart and Lungs, transforming the food stuffs into Ying and Wai and Qi and blood, which flow into the blood vessels, which nourish the whole body.  The turbid wastes rely on the down bearing of the Stomach and are transported downward to the large and small intestines where it is discharged out of the body.  The up bearing the clear and down bearing the turbid are related to the Qi level.  Formulas such as Si Jun Zi Tang help from the Qi level.  However, the Qi and blood are in a close relationship.  When the blood is stagnant the Qi is effected.  The Qi will not flow and this certainly influences the up bearing and down bearing of the Spleen and Stomach.  Promoting up bearing and down bearing from the blood level assists this function in the Spleen and Stomach.  In Jia Wei Sheng Hua Tang Chuan Xiong and Jing Jie up bear and so the assist the Spleen’s up bearing the clear.  Dang Gui, Tao Ren, Shan Zha and Yi Mu Cao down bear and assist the Stomach in down bearing the turbid.  The assistants Pao Jiang and Gan Cao warm the middle, boosting the Spleen and Stomach.  Only then will the up bearing and down bearing of the Spleen and Stomach be promoted from the blood level and the post-heaven generation and transformation will flourish.  In addition, Dang Gui vitalizes and nourishes the blood.

 

In regard to the clinical application of Sheng Hua Tang , Liu Feng-Wu writes

“In terms of the production of blood one should not only think of the substantial aspects.  One should also think of the functional aspects.  When we look at the source of production, there are the two aspects of receiving the Qi and fetching the juice.  The Qi and juice together cause the liquid to become red and only then is there blood.  In order for blood to function it must always circulate.  If the movement of the blood becomes slow, ceases, becomes stagnant or even congealed, gathered or dead, it cannot function as blood.  Therefore, in terms of blood deficiency, one should differentiate between the lack of the blood’s material substance and a obstruction of its functional aspects.  The goal of vitalizing the blood is to promote the circulation of the fluid.  Only then can the vessel pathways be abundantly full.  The blood function is the foundation of its material substance.  Promoting the circulation of blood and strengthening the functional aspects obtains the goal of nourishing the blood”.

Pao Jiang

Pao Jiang is bitter, pungent and warm.  It enters the Liver and Spleen channels.  It is able to warm the channels, stop bleeding and stop diarrhea.  It is used in deficiency cold type bleeding presentations.  Spleen and Stomach deficiency cold, Stomach and abdominal cold pain, vomiting, watery diarrhea and chronic diarrhea.

“Gan Jiang is pungent.  After applying fire it becomes slightly bitter.  This is why it stops but does not stay”

“Pao Jiang is bitter and pungent and warm.  It enters the Lung, Spleen and Liver channel.  When Pao Jiang is blackened, its flavor changes from pungent and hot to bitter and warm and its scattering nature is removed.  Because of this, Pao Jiang guards steadfastly.  It enters the Liver channel and the blood level.  It warms the Liver’s root and deficiency causing cold and in this way it warms and nourishes the Liver channel.  It causes deficiency heat to retreat.  Add 2-3 pieces to Xiao Yao San to treat blood deficiency fever with sweating.  It is also able to warm the Spleen channel, treating chronic diarrhea.  When there is blood in the stool with Yin deficiency, it will assist the Yin herbs by guiding the blood upward and thereby the bleeding will stop on its own.  The Liver stores the blood and when there is profuse bleeding this causes Liver deficiency fever to suddenly express.  Use 2-3 fen to warm the Liver Zang and the exterior heat will spontaneously resolve.”

Pao Jiang is bitter with great heat.  It causes the Yang to be generated and the Yin to retreat.  When there is vomiting of blood or nose bleed, it is suitable to use if there is Yin without Yang.  Do not use if there is Yin deficiency with fire and avoid it for pregnant women”.

Modern pharmacology considers Pao Jiang to be good for stomach ulcers and for stopping bleeding.  In Sheng Hua Tang, it warms and regulates the Spleen and Stomach and controls bleeding with the intention of returning the correct, generating and transforming.

Clinical verification

59 cases of postpartum uterus not returning to normal and 41 cases of postpartum contraction pain.  1 package of Sheng Hua Tang plus 1.5 gm of Hong Hua was given for 2-3 days.  Another 50 cases of uterus not returning to normal were given ergot alkali to compare.  The results with this formula were relatively good.

For retained placenta Sheng Hua Tang formula was used without Gan Cao.  Wei Jiang was substituted for Pao Jiang and Yi Mu Cao and Hong Hua were added.  22 cases were treated after a late abortion in which there was retained placenta.  After treatment each case manifested with the retained placenta discharging.  Bleeding and abdominal pain also stopped.

60 women were given 3 packages of Sheng Hua Tang as part of standard care.  60 women were not given the formula as a comparison group.  The following were checked after birth: the uterus returning to normal, the lochia flow being normal, post partum uterine contraction pain, sufficiency of breast milk and incidence of postpartum infections.  In the Sheng Hua Tang group there were incidences of problem in 35% of the women while in the control group there were problems in 51.5%.  The incidence of contraction pain between the groups was similar so if you remove this incidence, the incidence rate in the Sheng Hua Tang group was 10% while it was 28.3% in the control group.  This shows that Sheng Hua Tang is an effective formula for postpartum women.  Among the symptoms that manifested it became clear that Sheng Hua Tang is good for reducing infections and in promoting breast milk in post partum women.

Case Example

I treated a woman named Zhang who was 35.  She was 2 months postpartum with a poor appetite and mental weakness.  Her bowels were sometimes dry and sometimes sticky though it was mainly dry.  She would go 2-3 days with just one BM.  Her tongue moss was slightly sticky.  The tongue body was purple and dark.  Her pulse was thin and wiry.  She had been given Gui Shao Liu Jun Tang, Shen Ling Bai Zhu San for treatment without effect.  I considered this over and over and finally thought that I could not but give her Jia Jian Sheng Hua Tang with Chen Pi, Chao Gu Ya.  I gave her 7 packages.  Afterwards her appetite suddenly came back and her spirit also revived.  I gave her 7 more packages and she recovered.

Here is a link for a short video on Sheng Hua Tang

This entry was posted in Classic Formulas, Experiential Formulas, Famous Doctors, Obstetrics, Xia Guisheng. Bookmark the permalink.

6 Responses to Post Partum use of Sheng Hua Tang

  1. Karla Renaud says:

    Thanks, this is very interesting to see the modifications for slightly different situations postpartum.
    Can you speak to whether you have used SHT for women after miscarriage and what are your thoughts on that usage?
    I’ve used it for a couple women who allowed themselves to go through a natural miscarriage (one found out after 12 week ultrasound saw no fetal heartbeat, another suddenly started miscarrying), instead of an immediate D&C, but after she slowly passed what midwife and OBGYN thought was all the fetal & placental tissue, they each kept bleeding sometimes with clots, much longer than she should have. I didn’t want her to develop infection and fever from retained tissue, so used regular sheng hua tang since it seemed similar situation to retained placenta and persistent lochia bleeding. It worked, but would there have been something better to use in the situation after end of 1st trimester miscarriage vs live birth? (article above mentions modified SHT use for late abortion, but however late that means… ) I also wonder why they felt the need to modify as mentioned for retained placenta situation- remove gan cao, sub wei jiang, add hong hua and yi mu cao. Any thoughts?

  2. Steve Clavey says:

    Hi Karla,

    Sheng Hua Tang would be fine after miscarriage, early or late, in my experience. You only need to adjust it if the individual patient needs something specific, although I do think Yi Mu Cao is an excellent addition to this formula and confess that most often I will add this 12-15g.

    I don’t see any logical reason for the researchers to omit Gan Cao in cases of retained placenta (but there is a lot I don’t know, so I would be happy to learn) and often these alterations go unexplained in herbal formula research, coming down (I believe) in the end to an individual preference. Similarly with Wei Jiang (baked ginger) instead of Pao Jiang — it could be as simple a reason as the dispensary they used did not carry Pao Jiang.

    Btw, ultrasounds showing no heartbeat can be unreliable occasionally. I try to insist on a second scan from another clinic 10+days later to confirm, although some women find that hard to deal with: “I just want it out!”

    Steve

  3. Hi Karla and Steve,

    I’ve primarily used Liu Feng-Wu’s modification of Sheng Hua Tang over the years. He adds small amounts of herbs such as Yi Mu Cao, Hong Hua, Tao Ren, Ze Lan and Shan Zha. If there is pain he adds Wu Ling Zhi and Pu Huang. He has a great discussion on the use of small amounts of blood vitalizing herbs to tonify the blood – how improving the movement of the blood improves its quality and is there-by tonifying. I use these ideas in my practice a lot. In other material by Dr. Xia I have read, he echos this idea and also the idea that moderate doses of these herbs quicken the blood and dispel stasis and large doses crack stasis. In other words, for retained placenta, moderate to larger doses would be used.

    Liu Feng-wu has written up a number of case studies that range from post birth to post miscarriage to post termination. I don’t consider how long the woman was pregnant or how the pregnancy ended. All of these situations can benefit from Sheng Hua Tang.

    Although Sheng Hua Tang can be used to discharge left over tissue that has not come out, is not the appropriate formula to dispel a fetus that has not come out whether the expired fetus is 6 weeks or 6 months.

    I can understand replacing the pao jiang with wei jiang when there is retained placenta. As Dr. Xia says, Gan Jiang stops but does not stay. He does not mention here that Sheng Jiang moves and does not stay and more importantly that Pao Jiang stops and stays. Dr. Xia writes “When Pao Jiang is blackened, its flavor changes from pungent and hot to bitter and warm and its scattering nature is removed. Because of this, Pao Jiang guards steadfastly”. Pao Jiang is carbonized and therefore styptic. Notice above that Dr. Xia mentions it for stopping sweating and diarrhea too. So, with retained placenta, it seems that Dr. Xia wants to make sure the formula is more dispelling. I would put the Pao Jiang back in as soon as the placenta let go and came out.

    How interesting about the heart beat! We should really take heed. This makes me think of the case study here:
    http://whitepinehealingarts.org/topicsblog/?p=511
    in which Dr. Zhu encourages us to not be hasty with a diagnosis of expired fetus and teaches us how to determine the presence of life…

  4. Eran Even says:

    Hey Sharon,

    Fantastic case, and super translation!

    I have personally (unfortunately) used SHT numerous times for miscarriages, usually around the 10-14 week mark. I haven’t used it unmodified and usually gravitate towards something similar to what Liu Feng-Wu would do, i.e with the San Leng, Tao Ren, Hong Hua, etc…..Usually with the cases I have seen up here, woman will get a prescription for misoprostol, try it for a couple days, and after little to no help, come see me for herbs. I can understand (personally) the intense loss felt with a miscarriage, and it is completely understandable that a woman would ‘want it out’ to begin the grieving process. For the most part SHT modified has done the trick, pretty quickly.
    Definitely interesting about the heart beat. I hate to think now if any of these woman had been misdiagnosed.

    Eran

  5. Steve Clavey says:

    Good call Sharon on the Pao Jiang Wei Jiang difference! I should re-read the Materia Medica as I had forgotten that …

    Eran
    >I hate to think now if any of these woman had been misdiagnosed.
    Yes, that’s why it is a delicate decision about when to discuss this with a pregnant (or recently pregnant) woman … too early and it may be seen as negative, but too late and they may have made a decision that they might not have made with a bit more information. Of course at that point you can’t say “Well maybe that was a mistake, your baby might still have been ok.” (shudder)
    I have not looked at any statistics, btw, on false negatives in ultrasounds, I am only going from what my patients have told me, so it is anecdotal. I just know that I try to insist on two scans with a week or more in between.

  6. susan minich cnm msn msom lac says:

    anyone have experience with a post-partum pt who has a 1st degree cystocele- use of herbs thanks

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