Post-Natal Depression

CHAPTER 45 Post-Natal Depression



AETIOLOGY 594

PATHOLOGY 594

IDENTIFICATION OF PATTERNS AND TREATMENT 595
Heart-Blood deficiency 595

Heart-Yin deficiency 597

Heart-Blood stasis 598

PROGNOSIS AND PREVENTION 600

WESTERN VIEW 600

Surprisingly, the condition of post-natal depression is not mentioned in modern Chinese books and the discussion of it in this chapter draws primarily on old gynecology and obstetrics books.


The pathology of post-natal depression in Chinese medicine revolves around Blood: the exertion and loss of blood occurring at childbirth induce a state of Blood deficiency; since the Heart houses the Mind and governs Blood, Heart-Blood becomes deficient, the Mind has no residence and it becomes depressed and anxious. This causes a state of depression, mild anxiety, insomnia and fatigue: on a mental level the mother feels unable to cope, she is tearful, she loses any libido and she may feel angry or guilty.


From Blood deficiency, other conditions may develop: after some time, and in women who have a predisposition to Yin deficiency, Blood deficiency may give rise to Yin deficiency and Empty-Heat. This would cause a more severe condition of depression with more intense anxiety, insomnia, mental restlessness and agitation.


Conditions of neurotic, obsessive, phobic or psychotic behaviour after childbirth are usually due to stagnant Blood harassing the Mind (rather than the more common Phlegm-Heat). In such cases, the woman is not only depressed but also confused, she may display obsessive behaviour or phobias and, in extreme cases, she may manifest psychotic behaviour. She may be aggressive and offensive, she may have hallucinations and delusions and she may display suicidal tendencies and even harbour destructive thoughts against her baby.


Of course, every woman suffering from post-natal depression will present with pre-existing disharmonies which will play a role in the pathology of this condition. For example, Phlegm is an important contributory factor as it obstructs the Mind.


In old China, there were various conditions describing the above situations. Chan Hou Wang Yan Wang Jian (image) means ‘absurd speaking and absurd seeing after childbirth’: this indicates a delusional state with incoherent speech and hallucinations.


Chan Hou Wang Yan Jian Gui Fa Kuang (image) means ‘absurd speaking, seeing ghosts and manic behaviour after childbirth’ and it indicates incoherent speech, visual and acoustic hallucination and hypomania. It was described by Wu Qian in his Golden Mirror of Medicine (1742).1


Chan Hou Xu Fan (image) means ‘mental restlessness after childbirth’ and it indicates a state of mental restlessness, insomnia and a feeling of heat in the evening, normally associated with Yin deficiency.


Chan Hou Jing Ji (image) means ‘palpitations and anxiety after childbirth’ and it indicates palpitations, anxiety and a flustered and confused state after childbirth, normally associated with Blood deficiency.


Chan Hou San Chong (image) means ‘three rebellions after childbirth’ and it indicates three conditions all resulting from retention of lochia and stasis of Blood in the Penetrating Vessel (Chong Mai), affecting the Heart (causing mental confusion, manic behaviour or depression, a feeling of oppression of the chest, mental restlessness and hysteria), the Lungs (breathlessness, cough, feeling of oppression of the chest) or the Stomach (a feeling of oppression of the epigastrium, nausea, vomiting, abdominal pain and fullness). It is worth noting that the Chinese word for ‘rebellious’ (chong) is the same as in Chong Mai (Penetrating Vessel).



Aetiology




Severe loss of blood during childbirth


Severe loss of blood during childbirth causes Blood deficiency; since the Heart houses the Mind and governs Blood, deficient Heart-Blood fails to house the Mind which becomes depressed and anxious. In women with a pre-existing deficiency of Blood, this situation may arise even if the blood loss during childbirth is not particularly heavy. Deficiency of Blood will cause depression, resulting in a case of Mind Weakened; if the deficiency of Blood gives rise also to anxiety and insomnia, it may result in Mind Weakened and Unsettled.2



Blood stasis after childbirth


Blood stasis after childbirth may occur in women who have a pre-existing state of stasis of Blood. Stagnant Blood rebels upwards in the Penetrating Vessel and harasses the Heart (though which the Penetrating Vessel flows): as the Heart governs Blood and houses the Mind, stagnant Blood harasses and obstructs the Mind. This is a case of Mind Unsettled and Obstructed.



Constitutional tendency to mental–emotional problems


A constitutional tendency to mental–emotional problems is often the basis for the development of mental problems after childbirth. The signs that may indicate such a tendency are:


• tongue with a deep Heart crack

• tongue that is ‘hammer-shaped’

• very Swollen tongue with a very sticky coating

• eyes lacking any lustre (i.e. eyes without shen).

Figure 45.1 illustrates the first and second types of tongue, i.e. one with a deep Heart crack and one that is hammer-shaped.


image

Figure 45.1 Tongue with deep Heart crack and hammer-shaped tongue.



Pathology


The pathology of post-natal depression is centred around Blood: it is due either to a Blood deficiency, or to a Blood deficiency turning into Yin deficiency, or to Blood stasis. The principal organ involved is always the Heart: Heart-Blood deficiency, Heart-Yin deficiency or Heart-Blood stasis respectively. However, other organs are involved too: a state of Heart-Blood deficiency after childbirth nearly always involves Liver-Blood deficiency; a state of Heart-Yin deficiency is frequently associated with Liver- and/or Kidney-Yin deficiency; and a state of Heart-Blood stasis is nearly always associated with Liver-Blood stasis within the Penetrating Vessel.


Moreover, Blood deficiency and Blood stasis affect not only the Heart (and therefore the Mind) but also the Liver and therefore the Ethereal Soul (Hun). A deficiency of Blood may induce a state of rootlessness and excessive movement of the Ethereal Soul which causes anxiety. On the other hand, if the Blood deficiency is associated with a Qi deficiency, the movement of the Ethereal Soul is impaired and this results in depression.


The main treatment principles adopted in post-natal depression from deficiency of Blood or Yin are therefore to nourish Blood or Yin and calm the Mind and the Ethereal Soul, and, in post-natal psychosis, to calm the Mind and the Ethereal Soul, invigorate Blood, eliminate stasis and open the Mind’s orifices.


Psychotic and manic behaviours are manifestations of obstruction of the Mind and one must therefore open the Mind’s orifices with herbs such as Shi Chang Pu Rhizoma Acori tatarinowii, Hu Po Succinum, Yu Jin Radix Curcumae, He Huan Pi Cortex Albiziae and Yuan Zhi Radix Polygalae. Acupuncture points that open the Mind’s orifices include: P-5 Jianshi, Du-20 Baihui, Du-26 Renzhong, ST-40 Fenglong, ST-25 Tianshu, all the Well points, G.B.-17 Zhengying, G.B.-18 Chengling, Du-19 Houding, G.B.-13 Benshen, SP-1 Yinbai and Du-18 Qiangjian.



Identification of patterns and treatment


The patterns discussed are :


• Heart-Blood deficiency

• Heart-Yin deficiency

• Heart-Blood stasis.


Heart-Blood deficiency



Clinical manifestations


Post-natal depression, fatigue, mild anxiety, insomnia, tearfulness, a feeling of guilt, loss of libido, poor memory, palpitations. Tongue: Pale and Thin. Pulse: Choppy and Weak on the left side, especially on the Middle and Front positions.



Treatment principle


Nourish Blood, strengthen the Heart, lift mood.



Acupuncture


HE-5 Tongli, HE-7 Shenmen, Ren-14 Juque, Ren-15 Jiuwei, BL-15 Xinshu, LIV-8 Ququan, Du-20 Baihui, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, Du-19 Houding, P-6 Neiguan. All with reinforcing method, except Du-19 which should be needled with even method. Moxa is applicable.




Explanation


– HE-5 and BL-15 tonify Heart-Qi.

– HE-7, Ren-14 and Ren-15 nourish the Heart and calm the Mind.

– Du-20 lifts mood and relieves depression.

– LIV-8 nourishes Liver-Blood.

– Ren-4, with moxa cones, nourishes Blood and strengthens the Uterus.

– ST-36 and SP-6 nourish Blood. They are particularly effective with warming needle.

– Du-19 calms the Mind: it is particularly effective combined with Ren-15.

– P-6 calms the Mind and lifts mood.


Herbal treatment



a Prescription



– FU SHEN SAN

– Poria Powder


Explanation


– Wu Qian in his Golden Mirror of Medicine (1742) recommends this formula for palpitations, anxiety and confused behaviour after childbirth.3 The term I have translated as ‘confused behaviour’ is huang hu, which means ‘absent-minded’ or ‘as if in a trance’.

– Ren Shen and Huang Qi tonify Qi and strengthen the Original Qi.

– Shu Di Huang, Bai Shao, Dang Gui and Huai Niu Xi nourish Blood.

– Rou Gui warms the Interior. It also enters the Heart and encourages the generation of Qi and Blood.

– Fu Shen, Hu Po and Long Chi calm the Mind.


b Prescription



– GUI PI TANG Variation

– Tonifying the Spleen Decoction Variation


Explanation

The formula Gui Pi Tang, already explained, tonifies Spleen-Qi and Heart-Blood and calms the Mind: it is ideally suited to treat post-natal depression and insomnia. This formula is also recommended by Wu Qian in his Golden Mirror of Medicine for post-natal depression from worry, pensiveness and sadness.4


– Long Chi has been added to calm the Mind and settle the Ethereal Soul.

Related posts:

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  2. Abdominal Pain after Childbirth
  3. Acupuncture and Herbal Treatment in Midwifery
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Post-Natal Depression

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