In many extended families there is a ready-made menu for the postpartum "confinement" period (ở cữ), handed down from one birth to the next. Black silkie chicken stewed with herbs, braised pork hock, pork stir-fried with ginger and plenty of black pepper, rice cooked very soft, and drinking water that is always hot. Vegetables are boiled until very soft or cut out altogether, and fruit is saved until the month is over. The cook rarely asks how the new mother is feeling, because this menu has already fed several rounds of new mothers in the family.
Some mothers eat this way for the whole month and come out with rosy skin and their strength back. Others, by the second week, already have constipation, mouth ulcers, night sweats that soak the back of their shirt, and lochia (postpartum vaginal discharge) that still has not cleared. The family then assumes she has not been built up enough, so the next day’s soup is made even richer.
The books do not say every mother must eat warm
Every family has heard that "after birth you should eat warm". Xia Guicheng, in his book on gynecology in Chinese medicine, notes that earlier physicians held that "after birth one should warm and tonify" (温补 / 溫補, wēn bǔ), meaning building the mother up with warm, hot foods. In the very same passage he goes on. A person with qi deficiency (lacking qi: often tired, short of breath) and a weak Spleen (poor digestion) should be warmed and tonified. A person with blood deficiency whose yin (the body’s fluids, its cool and moistening part) has already been damaged should be cleared and nourished, that is, fed with things that are cool and moistening. And if, after birth, the mother has been built up inappropriately so that damp-heat (dampness and heat) is brewing inside, "then one cannot avoid clearing heat", meaning cooling is a must. He sums it up in one short line: "do not forget that she has just given birth, and do not be bound by the fact that she has just given birth". In other words, always remember the mother has just given birth, but do not let that make you rigid and insist that every mother eat the same way.
The three groups below are our own arrangement, drawn from many passages in the books, and which foods suit which mother is how the clinic understands and applies the books’ words. A mother with blood deficiency, which often comes with qi deficiency as well, is nourished with sweet, warm, soft foods; but when blood loss has gone so far that it drains the yin and produces heat inside, the food needs to be cool and moistening, and that is the "heat inside" group in the section below. In the part on treatment with medicine, Xia Guicheng reminds readers several times not to be bound by the idea that after birth everything should be warm, when the mother has an infection, a fever from blood deficiency with flaring fire (lack of blood producing heat that rises), or prolonged lochia. That is about prescribing, but it is enough to show that the book does not treat warmth as a rigid rule.
The classical Vietnamese physician Hai Thuong Lan Ong also writes in both directions, in his book Phu dao xan nhien (妇道灿然 / 婦道燦然, Women’s Medicine Made Clear). The old books took tonifying people with deficiency-cold (both depleted and cold) as the main treatment for postpartum illness. But if a mother is strong, had an easy birth, eats well and her lochia flows steadily, do not assume that everyone who has given birth is deficient and tonify at random; tonifying the wrong person only adds new illness. He advises that after birth, even without illness, the mother should rest, have her Spleen and Stomach cared for, and eat good food. At this point the Spleen and Stomach are still weak and digest poorly, so she should not eat too much; in the first few days she eats thin rice porridge, then gradually more, and never eats until overfull. Damage to the Spleen and Stomach from eating without moderation after birth is even given its own entry as an illness in Fù Qīngzhǔ Nǚ Kē (傅青主女科, Fu Qingzhu’s Gynecology), in the section Shēng huà biān.
Eating according to your type is clinical experience recorded in the books of traditional medicine, and we have not found any trial that had postpartum mothers eat according to their type and then measured the results. One study in Taiwan followed mothers from pregnancy until six months after birth. Their constitution changed from stage to stage; by six months, the yang-deficient type (lacking warmth, often cold) had nearly returned to how it was before pregnancy, while the yin-deficient type (lacking cool moisture, often hot inside) and the phlegm-dampness with blood stasis type (dampness and stale blood pooled inside) had not (Kuo 2015). So a mother’s type should be looked at again after each stage, rather than sorted once and followed forever.
Pale mothers who often feel dizzy: build up gently, keep it soft
Mothers with blood deficiency often have a pale or dull complexion. They feel dizzy or see spots when standing up or sitting down, often have palpitations, and sleep little. The lower belly has a dull ache that feels better when rubbed or pressed, and they are sometimes constipated. When qi is deficient too, the mother is tired, short of breath, reluctant to talk, and sweats with the slightest movement.
Xia Guicheng writes simply that for blood deficiency, sweet, warm foods that nourish the blood come first. For mothers with qi and blood deficiency who have body aches after birth, he advises eating red dates (Da zao, Ziziphus jujuba fruit), longan (Long yan rou, Dimocarpus longan aril), fresh ginger (Sheng jiang, Zingiber officinale rhizome, fresh) and goat meat, along with a few herbs, to support the medicine. Mothers with this pattern therefore do well with foods that are sweet, warm, cooked soft and easy to digest.
What the books stress most of all is not to pile on rich foods while the stomach cannot yet digest them. Hai Thuong writes that a person whose Spleen and Stomach are weak, with no fire inside, should eat plain rice porridge first and only gradually add a little goat meat or pork trotters; eating meat too early brings fullness and stagnation, belly pain and diarrhea. Xia Guicheng’s book also notes that with deficiency-type belly pain, the Spleen and Stomach need even more care. If a mother has no appetite yet and food sits a long time before it digests, move up gradually from porridge to soft stews, and do not push her to eat until full so she will recover faster.
Mothers with a cold pattern: eat warm, eat cooked
The lower belly aches with a cold kind of pain that eases with a warm compress. The mother dislikes cold, has cold hands and feet and a pale, bluish face. Her lochia is scant, purple and has clots.
The advice to eat warm suits this pattern best. The Jīn Guì Yào Lüè (金匮要略 / 金匱要略, Synopsis of the Golden Chamber) has a dish of goat meat cooked with Dang gui (Angelica sinensis root) and fresh ginger for mothers with a dull, cold ache in the belly after birth, and both Hai Thuong and Xia Guicheng copy it. Slices of fresh ginger in a pot of soup or meat as a seasoning also suit mothers with deficiency-cold, in the same spirit.
The advice to avoid raw and cold food goes back to the Tang dynasty. The physician Meng Shen already advised avoiding raw and cold food after birth, and he is quoted in the Běn Cǎo Gāng Mù (本草纲目 / 本草綱目, Compendium of Materia Medica). Hai Thuong reminds mothers not to give in to cold food even in summer, and the book Bǎo Chǎn (保产 / 保產, Safeguarding Childbirth), which he copied out, says that eating food that has gone cold before the first month after birth is over can cause blood stagnation, dysentery or diarrhea. The books only advise avoiding raw and cold food, so for mothers with a cold pattern we advise drinking warm, eating food that is cooked, cooking vegetables too, and eating them while still hot.
Warmth has its limits too. On medicines, Fu Qingzhu’s book (the Shēng huà biān section) warns that medicine that is too cold makes the blood stagnate, while medicine that is too hot, such as Rou gui (Cinnamomum cassia bark) and Fu zi (Aconitum carmichaelii lateral root, processed), can cause heavy bleeding. Meals should follow the same spirit. A mother with a cold pattern needs warm dishes, but spicy, hot food does not need to be in every meal.
Mothers with heat inside need lighter food
"Heat inside" is how families usually put it. The books split it into several kinds, each with its own signs:
- Yin deficiency: sweating during sleep that stops on waking; a flushed red face, ringing in the ears; dry mouth and throat; hot palms and soles; a low fever in the afternoon, restlessness and trouble sleeping, constipation;
- Blood heat: lochia that goes on past the expected time, heavy, red, thick and sometimes foul-smelling; dry mouth, red face;
- Damp-heat: a dry or bitter, sticky mouth; a yellow, greasy tongue coating; burning, painful urination; yellow, sticky sweat.
Xia Guicheng notes that one cause of prolonged lochia is eating too much spicy, hot food after birth, which drains the yin, creates deficiency heat and pushes the blood out. Prolonged lochia has many other causes, so the mother still needs an examination; changing the menu alone is not enough.
He warns about overdoing the building-up in many places. Eating too much rich, sweet, spicy and hot food creates damp-heat, and some mothers get painful urination. Mothers with prolonged lochia are told to avoid rich, sweet, strongly flavored food and "heavily tonifying foods". He also records that sweating of the damp-heat kind is partly due to building up the mother in the wrong way.
The book even describes a case of exactly this. A mother had night sweats for more than two months after birth, and had long had yellow, sticky vaginal discharge. Feeling weak, she drank soup of Huang qi (Astragalus membranaceus root) cooked with red dates again and again. Xia Guicheng judged that this tonic was "constantly feeding turbid dampness" (湿浊 / 濕濁, shī zhuó), that is, it kept adding to the murky dampness pooled in her body and made the damp-heat worse; the illness also had roots in her existing dampness and an unsuitable diet. She was treated with medicine to nourish yin, clear heat, strengthen the Spleen and drain dampness, and recovered.
For mothers who are constipated from eating a lot of spicy, hot and fried food, Xia Guicheng recommends changing eating habits: more green vegetables such as celery and spinach, more bananas and apples, enough water, and no spicy, hot food; skipping meals out of fear of having a bowel movement does not help. Mothers who sweat a lot are told to avoid black pepper, ginger, scallions and garlic and, except in a few serious cases decided by the physician, not to have scalding-hot food or drinks. In short, a mother with heat inside needs light food that is cool and moistening, still cooked.
The pot of mugwort water often boiled for new mothers needs the same thinking. The lương y (traditional medicine practitioner) Nguyen Huu Duc, in his lecture notes on Vietnamese medicinal herbs, says mugwort (Ai ye, Artemisia vulgaris / Artemisia argyi leaf) should not be used when a person is running hot, sweating from the head, or constipated from a lack of body fluids (the liquids and moisture in the body).
When a mother is cold outside and hot inside
Some mothers do not fit neatly into one pattern. Hai Thuong writes that after birth, yang deficiency brings cold on the outside and yin deficiency brings heat on the inside; heavy blood loss leads to blood deficiency, fire stirs, and the mother becomes restless and feverish. Xia Guicheng’s book describes mothers with a fever from blood deficiency who still dislike cold and like warmth, yet whose face is red as if brushed with rouge.
One common picture is a mother with cold hands and feet who dislikes wind, yet has a dry mouth, mouth ulcers and constipation. Eating very hot food to fight the cold may make the heat inside flare up more. Eating cooling food to bring the heat down may make the cold belly feel worse. Neutral foods (neither hot nor cold) or mildly warm, easily digested dishes usually push the body less toward either heat or cold, but a mixed pattern is all the more reason to have a physician take a look first.
Who should cut back on ginger, black pepper and spicy, hot food
Ginger is in almost every confinement dish. Hai Thuong, in Duoc pham vung yeu (药品汇要 / 藥品彙要, Essentials of Materia Medica), praises fresh ginger after birth for breaking up blood stasis, then in the same entry warns that it should not be used by people with yin deficiency and exuberant fire, people who are sweating, or people with belly pain from heat. The Chinese Materia Medica textbook (中药学 / 中藥學, Zhōng Yào Xué) now used in China says the same: fresh ginger "assists fire and injures yin" (助火伤阴 / 助火傷陰, zhù huǒ shāng yīn), meaning it adds heat and drains the yin, so people with exuberant heat (running very hot) and people with yin deficiency and internal heat (lacking yin, producing heat inside) should avoid it.
Li Shizhen, in the Běn Cǎo Gāng Mù, writes that eating ginger for a long time builds up heat; people with hemorrhoids who eat a lot of it along with alcohol will have a quick flare-up, and people with boils who eat a lot will get worse.
From the passages above, the clinic has put together a list of mothers who should cut back on ginger, black pepper, chili and spicy, hot food. The two items on hemorrhoids and boils rest on Li Shizhen’s words, which apply to everyone in general and were not written specifically for the postpartum period.
- Mothers who are bleeding heavily or have prolonged lochia, because Fu Qingzhu’s book, in its entry on postpartum hemorrhage, advises avoiding hot things such as black pepper and ginger, along with raw, cold food;
- Mothers with heat inside, a dry mouth, a flushed face, hot palms and soles;
- Mothers who are constipated;
- Mothers who sweat a lot;
- Mothers with hemorrhoids;
- Mothers with acne breakouts or boils.
Hai Thuong wraps this idea into his verse Ve sinh yeu quyet (卫生要诀 / 衛生要訣, Essential Verses on Keeping Well), after listing ginger, garlic, Chinese onion and scallions: "Spices in moderation are fine / But those with dryness-heat, remember to avoid them."
The clinic draws a line between ginger sliced into a pot of meat as a seasoning and strong ginger water or ginger wine drunk like medicine. Drinking ginger like medicine calls for looking at the mother’s type, and mothers with heat inside or heavy bleeding should cut back. In medicine, fresh ginger, dried ginger (Gan jiang, Zingiber officinale rhizome, dried) and charred ginger (Jiang tan, Zingiber officinale rhizome, charred) are each used differently too.
Breastfeeding mothers often ask whether ginger passes to the baby. LactMed, the U.S. National Library of Medicine’s database on drugs and breast milk, says ginger used as a seasoning is considered safe, including while breastfeeding; data on safety for mother and baby are still very limited, and the evidence that it increases milk supply is weak. LactMed also notes that ginger may raise the risk of bleeding in people taking blood thinners such as warfarin, so mothers on blood thinners should ask their doctor before taking ginger like medicine. LactMed considers turmeric used as food to be safe, but there is no basis yet for the idea that turmeric helps milk supply. With black pepper eaten in normal amounts, very little of its hot compound, piperine, gets into breast milk.
In the old books, alcohol is used as a medicine to move the blood, yet they still warn that people who are depleted should not drink much and should not drink right after giving birth. When a mother is breastfeeding, the alcohol level in her milk follows the alcohol level in her blood (LactMed); the clinic’s series on nutrition while breastfeeding covers this in detail.
Vegetables and fruit during the confinement month
Avoiding raw, cold food is easily taken to mean avoiding fruit and vegetables altogether. One survey that asked 2,100 mothers in Hubei (China) found that during the confinement month, nearly 8 in 10 mothers ate no fruit and nearly 1 in 5 ate no vegetables (Liu 2006). In the same data set, mothers who ate leafy greens and varied their meals often had fewer problems around the anus, although this only shows the two things going together, not that eating vegetables is the cause (Mao 2016). In six Chinese cities, another study found diet quality was best in the first month compared with later stages, but most mothers ate too few vegetables, fruits and dairy and too much grain and meat (Jiang 2023); in other words, the diet was more unbalanced than insufficient.
Cooked vegetables and fruit eaten warm are not the same as the raw, cold food the books advise avoiding. So mothers with a cold pattern, a weak Spleen and Stomach, or a tendency to loose stools should eat vegetables cooked and still hot, and not eat fruit straight out of the fridge. Mothers who are constipated or have heat inside should eat more green vegetables, bananas and apples, as Xia Guicheng advises. In a trial also in Hubei, mothers who received advice on diet and daily habits after birth ate more fruit and vegetables and had less constipation, most clearly in the cities (Liu 2009); the program covered many things, so the part due to diet could not be separated out.
When the food still does not seem to suit you
The Bǎo Chǎn text that Hai Thuong copied notes that eating hot food after birth can cause tiredness, night sweats and "a smoldering heat inside the bones". However, tiredness and sweating have many other causes. Lack of sleep alone, staying up at night to breastfeed, is enough to leave a mother tired, unable to concentrate and irritable, so not everything can be blamed on her meals.
If a mother stays tired for a long time, she should see a doctor and have tests first, before thinking about building her up. Herbal decoctions while breastfeeding and foods to boost milk supply are covered in other articles in this series.
If a mother is bleeding heavily, has a fever, or her lochia smells foul, she should see a doctor right away, not wait for a change of menu. Signs that need prompt medical care are covered separately in the article "Warning signs after birth that need care right away".
Whoever does the cooking can help with one small thing. For a few days, write down what the mother eats at each meal and how she feels afterward, then bring that note along when taking her to the doctor. The doctor will use it, together with the mother, to choose which foods to add and which to cut back on for now.
Some mothers change their meals according to the note, yet still feel full and digest slowly. Then the reason the stomach still cannot cope sometimes lies outside the soup pot. Walther’s Applied Kinesiology (AK) textbook gives digestive disorders as an example of a condition that keeps dragging on because of emotional stress, and reminds examiners not to overlook the emotional side (Walther 2000, p. 433). At the clinic, the doctor asks the mother to think about whatever is weighing on her mind, then tests her muscle strength by hand. If the muscle weakens, the doctor lightly places fingertips on the two bumps of her forehead while she keeps thinking about it. AK works alongside the pulse, the tongue and the meal notes; it does not replace a medical diagnosis.
References
Sources in Vietnamese
- Nguyễn Hữu Đức. Bài giảng Nam dược. Phần 2, tr. 113.
- Hạ Quế Thành. Thực dụng Trung y phụ khoa học (bản dịch tiếng Việt của BS. Tâm). Tr. 110, 441–442, 448, 450–452, 454, 456, 458–464, 469, 472.
- Hải Thượng Lãn Ông. Hải Thượng y tông tâm lĩnh. Hà Nội: NXB Y học. Tập 1, tr. PDF 874, 875, 879, 882, 946, 1097; tập 2, tr. PDF 444.
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Sources in English
- Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/. Entries: Ginger (PMID 30000845); Turmeric (PMID 30000906); Black Pepper (PMID 35349239); Alcohol (PMID 30000529).
- Jiang J, Huang J, Su Y, Wang Y. 2023. Applying the Adjusted Chinese Dietary Balance Index-16 to Assess the Dietary Quality of Chinese Postpartum Lactating Mothers. Nutrients. 15(21). doi:10.3390/nu15214499. PMID: 37960152.
- Kuo SH, Wang HL, Lee TC, Chan TF, Chou FH, Chen LM, et al. 2015. Traditional Chinese medicine perspective on constitution transformations in perinatal women: A prospective longitudinal study. Women Birth. 28(2):106-11. doi:10.1016/j.wombi.2015.01.002. PMID: 25636899.
- Liu N, Mao L, Sun X, Liu L, Chen B, Ding Q. 2006. Postpartum practices of puerperal women and their influencing factors in three regions of Hubei, China. BMC Public Health. 6:274. doi:10.1186/1471-2458-6-274. PMID: 17087836.
- Liu N, Mao L, Sun X, Liu L, Yao P, Chen B. 2009. The effect of health and nutrition education intervention on women’s postpartum beliefs and practices: a randomized controlled trial. BMC Public Health. 9:45. doi:10.1186/1471-2458-9-45. PMID: 19183504.
- Mao L, Ma L, Liu N, Chen B, Lu Q, Ying C, et al. 2016. Self-reported health problems related to traditional dietary practices in postpartum women from urban, suburban and rural areas of Hubei province, China: the ‘zuò yuèzi’. Asia Pac J Clin Nutr. 25(1):158-64. doi:10.6133/apjcn.2016.25.2.03. PMID: 26965775.
- Walther DS. 2000. Applied Kinesiology: Synopsis. 2nd ed. Pueblo (CO): Systems DC. p. 433.
Sources in Chinese
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