The postpartum period is a magical time when after nine long months you are finally able to meet and hold your new baby! Around the world traditional cultures have special rites and rituals to help the new mother and baby to embark upon their life together, and many special foods for the mother to recuperate from the trials of birth, increase her breast milk, and help them both to thrive. Many traditional postpartum herbal soups and stews are very nutrient-dense, and are easily digested & assimilated. They are made in many traditional cultures to help women with postpartum healing; to recover their energy stores, increase milk production, balance their hormones, and prepare for the full-time job of taking care of their newborn.

Postpartum Resting Month
In Chinese culture, the 30 days immediately after a new baby is born is known as “sitting the month” (Zuò yuè zǐ - 坐月子), a post-partum resting time when mother and baby are nourished with warm healing foods to aid recovery and protected from any exposure to illness. Postpartum women were traditionally encouraged not only to stay at home indoors the whole month, but literally to spend the entire month in bed. Although this may seem extreme by modern standards, tens of millions of women in China today still choose to spend the month at home, and many of these even spend it in bed. This allows mothers to recuperate from their birth and avoid overexertion by not dealing with any household concerns or tending to visitors. The mother is simply supposed to rest, eat well, and enjoy her new baby.

The tradition of a postpartum resting period, or confinement, dates back more than 2,000 years ago to the Western Han Dynasty. Deemed a necessary postpartum ritual, it was believed that a month's confinement was essential to the mother's ability to stay healthy, and ease into the physical and mental/emotional demands of this new period of their lives. The main rules concerned keeping the mother and baby relaxed, secluded and protected from the outside world. Besides staying at home and in bed, the new mother is supposed to stay warm, especially keeping the ankles, wrists and necks covered, avoid eating cold foods or drinking cold liquids, and avoid drafts, all of which prevents wind from entering the body to cause illness. In ancient times she was prohibited from touching water and could drink only soup or wine. Then there are rules to prevent her from exerting herself, to prevent injuries or prolapse of the internal organs. These include no lifting (including carrying or bathing the baby) and going up or down stairs. She is also supposed to limit time sewing or reading books to protect the eyes and avoiding crying to conserve Body Fluids. Having sex is prohibited both to avoid exertion and because the Uterus is too open to damage by wind, cold, and other outside influences.

In the modern world many changes have been made to the postpartum month rituals, either to make the rules more bearable, or as concessions to modern life. These days women can enjoy the resting period without an excessive loss of freedom. For example, ritual dictums such as not bathing or washing the hair for 30 days to avoid wind entering the body are not as necessary now that we have indoor heating, a plentiful supply of hot water for baths or showers, and hair driers. Although not all modern women stay in the house the entire month or completely avoid touching water, most still follow the advice to bundle up and wear a hat, scarf and gloves when going out, drink warm water, and wear protective gloves when washing dishes.

TCM View of the Postpartum Woman
According to traditional Chinese medicine the postpartum period is defined as the first four months after childbirth, which includes the first month called "small full moon" following most of the same ideas as the traditional sitting month, and the last three months called "big full moon" during which time the mother transitions back to normal life with her newborn. Pregnancy drains the mother's Jing-essence in the creation of a baby, then childbirth strains the Qi and depletes Blood and Yin, and finally breastfeeding further depletes the mother's Blood in the creation of milk and the Qi needed to transform it. Therefore, after giving birth the mother has some degree of, and possibly significant, Blood, Yin/Body Fluid, Qi and Jing-essence deficiency. Additionally, her pores and interstices are considered to be relatively open, and her tendons and ligaments loose. Therefore, Chinese medicine agrees that women should avoid over-exertion postpartum to conserve Qi and Blood both for their recuperation and to ensure adequate breast milk, as well as to prevent muscle/tendon injuries and uterine or other organ prolapse. Although the traditional postpartum rule of staying home and in bed would prevent these issues, many modern practitioners feel staying in bed the whole time could lead to further muscular weakness and slow uterine recovery, and therefore advise moderate activity after the first day or two. Modifications to the rules of avoiding over-exertion still advise women to avoid any heavy work, including lifting heavy groceries, mopping the floor, excessive working out, etc.

As far back as the Huang Di Nei Jing (the most celebrated ancient Chinese medicine book published in approximately 2600 B.C.), Chinese medicine has regarded each menstrual cycle, then pregnancy & the postpartum period, and finally menopause, as three moments of opportunity in a women's life to strongly influence her Jing-essence and therefore the entire quality, and even the length, of her life. These are the times when she can either preserve/increase or deplete her Jing-essence and therefore significantly improve or damage her long-term health. The recent trend towards women saving their placenta to make soup or prepared capsules stems from ancient observations of mammals eating the placenta of their young after childbirth and is echoed in Chinese medicine's use of Zi He Che/human placenta (in China pig, cow or sheep placenta is used as well) first mentioned in the Ben Cao Shi Yi/Omissions from the Classic of the Materia Medica in 741 A.D. In modern times it is often used to boost postpartum recovery of Qi, Blood and Jing-essence and promote lactation. However, although insufficient lactation is a classical indication, postpartum recovery was not a traditional Chinese medical use for the very strong tonic Zi He Che, and there is some debate as to whether it is appropriate for every new mother.

Famous Chinese medicine gynecologist Fu Qingzhu wrote that Zhu Danxi, founder of the School of Enriching Yin, advocated for strongly supplementing Qi and Blood during the postpartum month and treating other conditions only secondarily, which Fu Qingzhu proclaimed as the guiding principle that should underlie the treatment of all postpartum disorders. According to him, all TCM diagnoses for post-partum women should take this notion into account as a vital part of the woman's terrain, even in cases of Qi or Blood stagnation, heat, damp-heat, etc.

TCM View of Postpartum Illness
The most feared agents of postpartum illness are wind, known to bring in the "100 illnesses," and cold, which can easily damage the body. In the short term, wind and cold can enter through the mother's open pores and invade the relatively empty channels, potentially causing a severe cold or flu when the mother's defenses are weak. Not only can wind and cold cause illness or delay postpartum healing, but cause future and possibly chronic health issues by lodging in the body, such as lodging in the head or joints leading to arthritis, chronic headaches or eye disorders.

The "empty" womb after birth is seen as particularly vulnerable to being harmed by cold. Fu Qingzhu warns about how vulnerable women are to invasion by wind and cold in the Uterus during their menses, which is equally valid after childbirth, miscarriage or abortion:

"The liver which stores blood belongs to wood. It hates wind and cold most of all. In the course of menstruation, women's cou li (or interstices) are wide open. When this is invaded by wind and cold, liver qi stagnates and the passages of the menses become obstructed."

If cold lodges in the Uterus it can cause blood clots, menstrual problems or even future infertility.

Therefore, Chinese medicine would advise modern women who choose to bathe or wash their hair to take a very warm (but not so hot they sweat) bath with slices of ginger in the water to warm it to prevent wind invasion, and to completely dry their hair before leaving the bathroom. Wet hair against the back of the neck is seen as a perfect invitation to wind and cold, and to cause headaches later in life. Thus, the Chinese medical viewpoint aligns with the traditional cultural view that the post-partum resting period should emphasize a warm, protected environment, and warm nourishing foods.

Postpartum Month Diet
The mother's diet is considered to be one of the most important aspects to speed healing and recovery during this month of rest. Even Chinese women who do not follow many of the other postpartum traditions tend to follow these. Foods highlight herbal soups, bone broths and congees, with pork, chicken, eggs, organ meats and fish. Some of the advice is contradictory, however. For example, while many believe that chicken and tonic herb soup is vital during the whole month, others say that chicken meat should be avoided initially due to hot natured chicken's potential to bring in wind (think of a chicken's jerky head movements) and should be given only once the first two weeks of the postpartum month is over.

The first week of the postpartum month emphasizes herbal soups and food to both strengthen Blood and invigorate the Blood, in order to completely shed the old Blood from the Uterus (lochia), and gentle detoxification to cleanse the Uterus of "fetal toxins" developed during pregnancy. The second week uses bone soups and herbs to tonify the Blood, and strongly tonify Qi to tonify Blood, to heal the perineum and lift the organs back into their proper places, and herbs to strengthen the Kidney and lower back. The third and fourth weeks focus on tonifying Blood & Yin, building a strong milk supply, and recipes using vinegar and other astringent herbs to help stop the leakage of fluids - night sweats, any continuing spotting, etc.

Although in Chinese medicine the ideal diet should vary based upon on an individual's TCM diagnosis, most postpartum soups focus on warming the body, tonifying the Qi and Blood lost during the delivery and to encourage healthy lactation. For some women with heat in the Blood or damp-heat for instance, the diet should be adjusted to balance out the excessively warming and tonic soups with gentle heat or damp-heat clearing herbs and vegetables, and reducing or eliminating the use of ginger and wine.

Tonic Pork, Shan Yao & Long Yan Rou Soup Recipe
(modified Qīng zhū gǔ tang - 清豬骨湯)

This mildly sweet pork and herb soup is perfect for the second week after birth when there is a focus on gently building Qi and Blood, nourishing Jing-essence, strengthening the Spleen, and restoring and holding the organs in their proper place. Cooking the broth with bone-in pork also increases the ability to deeply nourish the body by supplementing the Jing-essence and marrow. Although fruits and vegetables are traditionally considered to be too cold/cooling/clearing for the postpartum period, most modern practitioners feel that tonifying root vegetables such as yams and beets can be eaten right away. Nutrient-dense root vegetables such as the turnips, parsnips, and sweet potatoes in this recipe absorb lots of vital vitamins and minerals from the soil as they grow, are high in antioxidants, and contain lots of fiber. These root vegetables also strengthen digestion; they benefit the Stomach and Spleen and increase the ability to digest food and absorb nutrients.

Shan Yao is a gentle nourishing digestive tonic; it tonifies the Spleen, Lung and Kidney, both Qi and Yin, without being heavy or cloying. It also stabilizes and binds the Jing-essence and due to its mild astringing quality, can gently build up post-natal Jing-essence over time. Long Yan Rou nourishes the Blood, tonifies Qi and calms the Shen, benefiting both Heart and Spleen, promoting good sleep and higher energy levels. Dang Shen and Huang Qi combine to strongly tonify the Spleen and Lung Qi, and directly (Huang Qi) or indirectly (Dang Shen) tonify the Blood. Dang Shen indirectly benefits the supply of Body Fluids to balance Huang Qi, which is slightly drying. Huang Qi also strengthens the Wei-qi and stabilizes the exterior to prevent wind invasion, raises the Yang Qi to pull the organs back into their proper place after birth and prevent Qi deficient prolapse, aided by Dang Shen. Gou Qi Zi is a strong but well-balanced tonic; it tonifies Liver Blood, benefits the Jing-essence and brightens the eyes, nourishes Lung and Kidney Yin, and mildly tonifies Kidney Yang. Sheng Jiang warms the middle jiao and strengthens digestion, transforms phlegm, and resolves toxicity.

Makes 8 cups

Ingredients:
• 2.5 lbs. bone-in pork shank* (or other cut of bone-in pork, preferably pastured, organic pork)
• 40g Shan yao/Chinese wild yam
• 40g Long yan rou/Longan fruit
• 30g Dang shen/Codonopsis root
• 20g Huang qi/Astragalus root
• 20g Gou qi zi/Go-ji or wolfberries
• 8 slices Sheng jiang/fresh ginger (can omit if the mother has heat or damp-heat)
• 1 turnip, sliced into bite-sized pieces
• 1 parsnip, sliced into bite-sized pieces
• 1 sweet potato, sliced into bite-sized pieces
• 2 Tbsp sea salt
• 8-10 cups of fresh cold water
• 4-8 eggs, hardboiled and deshelled
*This recipe calls for 2 lbs of pork and ½ lb. of bones, which can easily be from 2.5 lbs of bone-in pork shank or other bone-in cut to combine meat and bones, or separately as 2 lbs. pork meat and ½ lb. of bones.

Directions:
1. Rinse the herbs and let them soak in a bowl of fresh water for at least 20 minutes.
2. Rinse and pat dry the pork shank, then coat all sides of pork (and bones if not bone-in) with sea salt or other quality salt (but not table salt, which contains “flow-agents” and other chemicals). According to Chinese medicine dietary guidelines, marinating the pork in salt releases any fire toxins from the bones. Salting the meat also heightens its flavor and most of the salt is washed off by the subsequent blanching.
3. Quickly boil pork for 3-5 minutes in a separate pot of water to blanch it.
4. Drain pork and set aside.
5. Rinse, peel and slice the turnip, parsnip and sweet potato.
6. Bring 8-10 cups of fresh cold water to a boil in a large stockpot on high heat.
7. Once the water boils, add the herbs, pork, and sea salt to the pot and put a cover on.
8. Lower the heat to a medium and keep at a low boil with a cover on for 1 hour, then add the vegetables. Continue at a low boil.
9. In the meantime, place 4-8 eggs in a separate pot in a single layer and cover with at least an inch or two of fresh cold water. Heat on high to a full rolling boil, then turn off the burner, keep the covered pot on the burner and let sit for 10-12 minutes. Then strain and rinse with lots of cold water. Peel.
10. Once the pork soup has been boiling for 1.5 to 2 hours, taste broth for flavor, adjust as needed. Add whole hard-boiled eggs and allow to simmer in the soup for another few minutes.

Serve and enjoy!

References:
1. “Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC19130...
2. “Doing the Month - Behind the Door of Chinese Postnatal Confinement”: https://www.chinasimplified.com/2014/10/21/doing-t...
3. Fu Qing-zhu's Gynecology, translated by Yang Shou-zhong & Liu Da-wei, Blue Poppy Press, Boulder, CO 2007.
4. The Essential Guide to Acupuncture in Pregnancy & Childbirth, Debra Betts, Journal of Chinese Medicine, Ltd., Hove, England, 2006.
5. Handbook of Obstetrics & Gynecology in Chinese Medicine; an integrated approach, Yu Jin, M.D., translated by Chris Hakim, Eastland Press, Seattle, WA, 1998.
6. Mama Tong - local Chinese herbal soup company specializing in soups and broths for new mamas and everyone committed to nourishing delicious food! https://mamatongsoup.com/
7. The Chinese Soup Lady - a treasure trove of traditional Chinese herb soups, including many postpartum ones: http://www.thechinesesouplady.com/confinement-soup...
8. Study: A Comparison of Practices During the Confinement Period among Chinese, Malay, and Indian Mothers in Singapore: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC49923...
9. Study: The Association between Traditional Chinese Dietary and Herbal Therapies and Uterine Involution in Postpartum Women: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC30927...
10. “I tried the Chinese practice of ‘sitting the month’ after childbirth,” Leslie Hsu Oh, from The Washington Post, January 8, 2017. https://www.washingtonpost.com/national…
11. NPR: “For Chinese Moms, Birth Means 30 Days In Pajamas”: https://www.npr.org/2011/07/20/138536998/for-chine...

Laura Stropes, L.Ac. is a licensed practitioner of traditional Chinese medicine, with a great love of Chinese herbology. She has been practicing in the San Francisco Bay Area since 1998. She specializes in Chinese internal medicine, with a strong focus in TCM gynecology, fertility and pregnancy. She can be reached at: 510-326-9597 and laura@laurastropes.com.