Patient's question:
Medical Description: Abdominal pain after cesarean section for more than 40 days.History of Treatment and Effect: Ultrasound findings: Uterus: Position (posterior). Transverse diameter 52mm, anteroposterior diameter 40mm, left-right diameter 44mm. Endometrial line clear, thickness 5mm. Adnexa: Left ovary 4017mm; right ovary 4321mm. A 20mm fluid mass is observed posterior to the uterus. Ultrasound suggests: Pelvic effusion.
Help Needed: I want to know the current situation.
Doctor's answer:
1. Traditional Chinese Medicine TreatmentChronic pelvic inflammatory disease is predominantly of the damp-heat type, with the treatment principle focusing on clearing heat and draining dampness, as well as promoting blood circulation and resolving stasis. The herbal formula includes: Salvia miltiorrhiza 18g, Paeonia rubra 15g, Aquilaria agallocha 12g, Persicae Semen 9g, Lonicera japonica 30g, Taraxacum mongolicum 30g, Poria 12g, Moutan Cortex 9g, and Rehmannia glutinosa 9g. When the pain is severe, Corydalis tetrandra 9g is added. Some patients may have a cold congealing and qi stagnation type, with the treatment principle being to warm the meridians, dispel cold, and promote qi circulation and blood flow. The modified Guizhi Fuling Decoction is commonly used. For qi deficiency, Astragalus membranaceus 15g, Atractylodes macrocephala 9g, and Codonopsis pilosula 15g are added.
2. Other Medications
When using anti-inflammatory drugs, α-chymotrypsin 5mg or hyaluronidase 1500U can also be administered intramuscularly, once every other day, with 5–10 doses constituting a course to facilitate adhesion resolution and inflammation absorption. If individual patients develop local or systemic allergic reactions, the medication should be discontinued. In certain cases, antibiotics may be used in conjunction with dexamethasone. Dexamethasone 0.75mg is taken orally three times daily. When discontinuing the medication, it is important to gradually reduce the dose.