Chinese Med Treatment of Post-Partum Depression and Anxiety Disorder

Chinese Medicine Treatment of Post-Partum Depression and Anxiety Disorder
with Case Study

In treatment of Psycho-Emotional disorders, Chinese Medicine always observes the actual physical or "somatic" manifestations that patients describe, as well as the disruptions of thoughts, cognition, and behaviors.

In the case of Anxiety disorder we ask, "What does it feel like in the center of the chest? What does it feel like in the neck and shoulders? What does it feel like in the pit of the stomach? What does it feel like in the intestines? What does it feel like in the head?

What is great about anxiety in a way, is that the red flags of the disease are "in your face." Shortness of breath, or abnormal heart beat, for example. Whereas with depression, physical symptoms may be more hidden, and the issue is more feelings (sadness, apathy,)then sensations.

In fact, part of the way one cures anxiety, is to learn how to pay attention to these physical symptoms that operate on a very primitive level; before you know you are anxious about something, your body is already manifesting symptoms.

A fluttering sensation in the chest. Tension in the facial muscles. A tight brow, temples, jaw, mouth. Shortness of Breath. Nausea. Diarrhea. Chills. Tingling in the skin. Restlessness at night, tossing and turning. Inability to get comfortable. Palpitations. Sudden hard heart beat. Insomnia. Worry. Obsessive Thinking.

In each case, with each of these symptoms, Chinese medicine describes a disruption of Qi flow. Lung Qi must go down. In shortness of breath, whether due to asthma or anxiety, the Lung's Qi is blocked. In the case of nausea the same rule applies. Stomach Qi must go downward, in nausea it rebels, and goes up.

Normally, when we are healthy and energetic, we have a balance between upward and downward movements of qi, as well as inward and outward. The Zheng, or "Upright Qi" keeps our organs in place (when it fails we are prone to organ prolapse), and provides our foundational energy for work and play. When there is abnormal fatigue due to illness, mental or physical, often the upright Qi is damaged.

The key in treating Anxiety, and other Mental-Emotional issues with acupuncture, is recognizing which organs Qi has been damaged, and in which way. In addition Qi rebelling, it can also be in a weakened state, it can be stagnated, it can be obstructed by blood stasis or by phlegm stagnation. There can be profound damage to the yin, yang, Qi, or Blood of one organ, like the "Spleen" whose Qi is integral to the manufacture of blood, and this may lead to Heart Blood Vacuity.

Now this Spleen deficiency can be from poor diet, but it is most often the result of excess worry. So in this case your choice of locations for the needle placement will involve points (I don't like this word, since they are not points, but depressions in the fascia or bones...indeed, the Chinese character contains the radical for a cave) that "Calm the Mind and Relieve Worry, that Nourish or Unblock the Spleen Qi, and Open the Heart Qi."

Chinese medicine, Chinese Herbal Medicine in particular, does a very good job describing various predictable patterns for each disease that has been studied over at least 3 millennia. (The first known Chinese medical texts are from around 500 BCE, but even these refer to "the ancients" and existing medical practices.

The key in herbal medicine is to identify the pattern that the patient is manifesting, and then give the herbal formula that matches it. An important factor for the practitioner is experience. Rarely do people match the textbook cases we learn in school, they are more like templates, and the problem is different patterns have overlapping symptoms, such as insomnia, or fatigue; so you must listen carefully to the pulse, look carefully at the face and tongue, be sensitive to the person's energy, and look for the cardinal symptoms that, combined with a tongue and pulse diagnosis, direct you to the prescription that most concurs.

A Case Study of Post-partum Depression with Anxiety

Claudia L. (not her real name) came in to see me, complaining of disabling post-partum depression and anxiety, with overwhelming feelings of apathy and sadness, to the point where she was having trouble doing a good job caring for herself and her baby. She was very restless and worried, but could not identify "anything to be worried about." She said she loves her husband and feels he loves her. She loves her baby, and has no financial worries, as her husband has an excellent job and also comes from a wealthy family. But she described "not feeling like myself...as if I were watching my life from outside myself, as if I were another person watching me."

Her other symptoms were irritability, severe fatigue, nervousness, difficulty concentrating, insomnia, and numbness and tingling in her legs, especially the left, that no M.D. could explain, after a gamut of neurological and other tests. She also felt dizzy on occasion, had headaches, and not much appetite.

Aside from her weak appetite, Claudia's digestion was normal, however her elimination was not; since the pregnancy she was having 3-4 soft to loose bowel movements per day.

As she was breast feeding, her periods had not yet returned. Her baby was 11 months old.

Pulse

When feeling this woman's pulse, it was what we call "empty", that is a kind of hollow feeling, and it was weak, which means not much force. It was also unexpectedly thin, given her body structure.

Tonge Diagnosis

Claudia's tongue was rather pale, in spite of not being anemic. In addition there were deep cracks in the center of her tongue. She had a normal looking, thin white coat on her tongue, although it was a very slightly greasy looking. (Kind of as if tamped down, rather than light and delicate, which is normal)

Discussion of Case


The first thing I did, after noticing Claudia's worried look and soft, choppy voice was to ask her about the circumstances of her pregnancy and labor. Here is where the plot immediately thickened.

Claudia is a college graduate from Costa Rica. She met her husband when he was in Costa Rica surfing; they fell in love, and after a fairly short courtship, she left her very close-knit, warm, loving, but "crazy" family...the type where a daughter speaks to her mom daily, and visits are often and full of people, but also where the Anglo concept of boundries is non-existent ...as well as her country and her job to come here and live with her husband, whose family, of Anglo-Saxon origin, was the polar opposite emotionally.

On top of things, it was clear that the husband's mother seemed to look down on her because she is from Latin America, with dark skin and mestizo features.
As well, Claudia left her job, and because she is only partially fluent, she did not start working here, but became a homemaker. In fact, it turned out the husband would rather she not work.

At the time of her pregnancy, which was quick upon arrival in San Diego, Claudia had not made any significant friends. Her pregnancy was uneventful, and the actual labor was easy. But what came next in her story struck me as one of the hearts of the case.

Claudia is very proud of being Costa Rican, and in her own way looks down on Latinos from some other countries, like Mexico. Racism is all over the world. So, ironically, it was very hard for her that everyone in the hospital assumed she was Mexican, and behaved in what she took to be a patronizing or condescending way, as if she were from a poor uneducated family, which she was not.

To make matters worse, for various reasons, no one from her family was able to come up for the birth, and very shortly after the baby arrived, the female relatives from her husband were all crowded around the baby, which they had actually taken out of her arms. She described them in a circle, away from the bed, her husband included, ignoring her, " as if I were not even there."

It was at this very moment that the depression hit her. A wave of sadness, and profound loneliness.

Now, one might rightly observe, that given the identical circumstance, another woman might not have been moved by sadness and loneliness. Exactly right.
What we frequently have with many many diseases, is a combination of character type and life experience that creates susceptibility, that then manifests when there is a perfect storm of circumstance. Add in errors in diet and lifestyle, (and here lifestyle includes many things, from lack of exercise to lack of mental cultivation (by this I mean a regular practice of deep relaxation, meditation, and even self-examination, essentially the inability to experience silence and stillness and inner peace.), bingo, you have a disease.

So, as it turns out, Claudia has been a worrier her entire life. (This I could have told her from the cracks in the center of her tongue). Her willingness to leave Costa Rica so easily, was in part a measure of how things were not working for her there. Claudia had been a party girl and had had trouble with drugs and alcohol.

Chinese Medical Pattern


Excessive worry or obsessiveness , and even just the kind of excessive thinking one must do when one is a full-time student, weaken the Spleen Qi. The Spleen Qi has many jobs, transformation of foods and liquids, transportation of the Gu Qi from said foods and liquids, and nourishing the heart.

So the first cause of Claudia's problem is her pre-existing tendency to anxiety and over-thinking which damaged the Spleen Qi. Her lifelong worry was so severe it had consumed the Yin, leaving cracks in the center of the tongue. I am yet to see cracks like that in someone who is not an abnormal worrier. When the Spleen Qi is damaged, "blood" weakness follows, and the Heart Qi and Blood become empty, which means, "not enough of what should be there.".

When the Spleen Qi is weak, there is fatigue. When the heart Qi and Blood are weak there will be insomnia. But more importantly, when the blood is weak, one becomes uncomfortable in one's own skin, and restless. People who are Spleen and Heart Qi and Blood empty, are often one or all of the following: meek, irritable, forgetful, insecure. They may even develop feelings of depersonalization, which Claudia described, "not feeling like me." They are susceptible to what anxiety disorders, OCD, and reactive depression.

When Claudia described the situation at the birthing wing of the hospital, both the treatment, or perceived treatment by staff, as well as being alone and ignored immediately after the birth, and most importantly, the degree to which this affected her, the deep sense of abandonment, this immediately confirmed what both her pulse and tongue presentation, and many of her symptoms already suggested: a profound Heart Blood Vacuity or Emptiness, along with a Spleen Qi Vacuity.

So in a way, this case was quite easy. The very pale tongue and empty thin pulse both confirm blood vacuity. While many of her symptoms alone or in different combinations in a different case ( fatigue, restlessness, irritablity, numbness and tingling in the limbs, etc;) could be attributed to other patterns of disharmony, together, in the context of her story, her tongue and pulse, and even her weak, choppy voice all confirmed an underlying dual pattern of Spleen Qi and Heart Blood Vacuity. And, luckily, there is only one Herbal Prescription to treat this pattern, and I happened to know, luckily, from an earlier patient who had actually come in wanting acupuncture for post-partum depression with a copy of an article on the use of this prescription in China for it, that this was the perfect choice.

Discussion of Prescription

This formula, Gui Pi Tang, (Ginseng and Longan Formula) was first described by Dr. Yan Yong-Huo in " Prescriptions Beneficial to Life" in 1253 C.E., during the Song Dynasty, for "too much thought and worry..." Dr. Yan places this formula in his text under the discussion of forgetfulness due to conditions other than aging, and emphasizes its importance for memory.

In the Ming Dynasty text, "Complete Works of Jing-Yue", Dr. Zhang Jie-Bin adds to Dr. Yan's discussion, and describes its use in conditions of anxiety connected to repressed feelings, denial and suppression. In Claudia's case, we see that she reports being very worried, but "having nothing to worry about."

Well I know from experience, that, aside from the natural human tendency to experience fear of death and dying (see the fight or flight response), which we normally don't think about, this patient actually has a lot to worry about.

Also, she reported feeling that her husband loves her, but also reported that he was working long long hours, and not having much time for her and the baby.
On top of that there is the husbands emotionally cold family, especially the mother-in-law, who look down on her.

Even for someone with good self esteem and strong "Spleen Qi and Heart Blood" this would be a challenge. But when the Spleen Qi and Heart blood are empty, one lacks presence and power, and finds it difficult to manifest one's own sense of meaning. Someone without these deficiencies is not so vulnerable to being abandoned and/or bullied.

I gave Claudia this formula, as well as a very gentle and supportive acupuncture treatment. Acupuncture is really excellent for moving the Qi. That is exactly what it does. So it is really good when we are stuck in a pattern, especially if we are ready to step off that square and move into something different or new.
Claudia started feeling better quite rapidly. At the second visit one week later her appetite had improved, and naturally as a result her energy was getting better. She described feeling a little more "herself." I took advantage of this greater stability to recommend working with a psychologist who could help work on the preexisting emotional issues, as well as a way to improve her present circumstances relating to family and work.

Claudia resisted going to a psychologist at first, describing feeling stigmatized by it. But eventually she did, and then she and her husband went together, when it became clear that one of the issues making her anxious was her perception of him being more loyal to his family than to her. Again, this is something, because of her Spleen Qi and Heart Blood Vacuity, that she needed an ally, or mediator, to help her recognize. She could not "fight" with her husband about this, or even discuss it with him on her own.

Finally, I was able to give Claudia lessons in Mindfulness Meditation, which I find really vital for the treatment of Anxiety and Depression. Breathing exercises are excellent, too, but the great thing about the practice of Mindfulness Meditation is that it allows you to develop a tool for creating a safe place in which any and all of one's thoughts, feelings, sensations, memories, dreams, reflections, attitudes, ideas, can be experienced and processed softly, gently, without judgment and without repression.

It is a way in which you actually process these things, and move out of the past and future into the present. Mindfulness meditation is very easy to practice, and I believe I can teach it to anyone. You just have to be willing to try. And it feels so good once you do it. All those things weighing you down become lighter, the things worrying you and spinning round and round and round in your head slow down and become dis-empowered. Will is one of the things developed.

Over the course of 6 months, getting a total of 8 acupuncture treatments, and taking the Gui Pi Tang, along with a Cordyceps Sinensis /Reishi Mushroom blend, consistently, Claudia reported feeling 80% better. Two years later I heard from her and she had had a second child and was doing fine internally. She had continued to work with the Psychologist for about a year and a half, during which time she had learned how to negotiate things like more frequent visits home, more visits of her mother and sister to San Diego, while taking on a part time job which got her out of the house on a regular basis doing something nourishing for herself.



Ayurveda, Acupuncture, and Chinese Medicine in San Diegohttp://www.bodymindwellnesscenter.com

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