Articles - Post-Natal Depression

Strangely enough, 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 gynaecology and obstetrics books.

Post-natal depression is usually explained in Chinese medicine in terms of 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 deficiency, 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 or even schizophrenic 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.

In old China, there were various conditions describing the above situations. Chan Hou Wang Yan Wang Jian 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 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).

Chan Hou Xu Fan 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 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 means "three rebellions after childbirth" and it indicates three conditions all resulting from retention of lochia and stasis of Blood in the Penetrating Vessel, 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).

AETIOLOGY AND PATHOLOGY

1) EXCESSIVE LOSS OF BLOOD DURING CHILDBIRTH

Excessive 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 occur frequently, especially 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.

3) 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 glitter (i.e. eyes without shen).

Fig. 1. Heart crack.
Fig. 2. Hammer-shaped tongue.

Figures 1 and 2 illustrate the first and second types of tongue, i.e. one with a deep Heart crack and one that is hammer-shaped.

Thus, 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.

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, in post-natal psychosis, to calm the Mind, invigorate Blood, eliminate stasis and open the Mind’s orifices. Psychotic, manic or schizophrenic behaviours are all manifestations of obstruction of the Mind and one must therefore open the Mind’s orifices with herbs such as Shi Chang Pu Rhizoma Acori graminei, Hu Po Succinum, Yu Jin Tuber Curcumae, He Huan Pi Cortex Albizziae julibrissin, and Yuan Zhi Radix Polygalae tenuifoliae. 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.

DIFFERENTIATION AND TREATMENT

The patterns discussed are three:

  • Heart-Blood deficiency
  • Heart-Yin deficiency
  • Heart-Blood stasis

1) 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.

Herbal treatment

a) Prescription

FU SHEN SAN

Poria Powder

Ren Shen Radix Ginseng 6g
Huang Qi
Radix Astragali membranacei 6g
Shu Di Huang
Radix Rehmanniae glutinosae praeparata 6g
Bai Shao
Radix Paeoniae lactiflorae 6g
Dang Gui
Radix Angelicae sinensis 6g
Huai Niu Xi
Radix Achyranthis bidentatae 6g
Rou Gui
Cortex Cinnamomi cassiae 1.5g
Fu Shen
Sclerotium Poriae cocos pararadicis 9g
Hu Po
Succinum 1.5g (as a powder)
Long Chi
Dens Draconis 15g

Explanation

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

b) Prescription

GUI PI TANG Variation

Tonifying the Spleen Decoction

Ren Shen Radix Ginseng 6g (or Dang Shen Radix Codonopsis pilosulae 12g)
Huang Qi
Radix Astragali membranacei 15g
Bai Zhu
Rhizoma Atractylodis macrocephalae 12g
Dang Gui
Radix Angelicae sinensis 6g
Fu Shen
Sclerotium Poriae cocos pararadicis 9g
Suan Zao Ren
Semen Ziziphi spinosae 9g
Long Yan Rou
Arillus Euphoriae longanae 12g
Yuan Zhi
Radix Polygalae tenuifoliae 9g
Mu Xiang
Radix Aucklandiae lappae 3g
Zhi Gan Cao
Radix Glycyrrhizae uralensis praeparata 4g
Sheng Jiang
Rhizoma Zingiberis officinalis recens 3 slices
Hong Zao
Fructus Ziziphi jujubae 5 dates
Long Chi
Dens Draconis 12g

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.

Long Chi has been added to calm the Mind.

Three Treasures remedy

CALM THE SPIRIT

Ren Shen Radix Ginseng
Huang Qi
Radix Astragali membranacei
Bai Zhu
Rhizoma Atractylodis macrocephalae
Dang Gui
Radix Angelicae sinensis
Fu Shen
Sclerotium Poriae cocos pararadicis
Suan Zao Ren
Semen Ziziphi spinosae
Long Yan Rou
Arillus Euphoriae longanae
Yuan Zhi
Radix Polygalae tenuifoliae
Mu Xiang
Radix Aucklandiae lappae
Zhi Gan Cao
Radix Glycyrrhizae uralensis praeparata
Hong Zao
Fructus Ziziphi jujubae
Bai Zi Ren
Semen Biotae orientalis
He Huan Pi
Cortex Albizziae julibrissin
Shi Chang Pu
Rhizoma Acori graminei
Bai He
Bulbus Lilii

Explanation

This remedy is a variation of the formula Gui Pi Tang Tonifying the Spleen Decoction which tonifies Heart- and Spleen-Qi and Heart- and Spleen-Blood. The tongue presentation appropriate to this remedy is a Pale and Thin body.

Case history

A 35-year-old woman had been suffering from depression and insomnia since the birth of her first child 2 years previously. She felt very depressed, had negative thoughts and found everything an effort. In addition, she slept badly, with nightmares, and woke up frequently during the night; she also experienced a floating sensation just as she was about to fall asleep. On interrogation, it transpired that she also suffered from poor memory, tingling of the limbs, palpitations, a feeling of heat at night, night-sweating, dry eyes, and a dry mouth and throat at night. Her periods were regular but rather scanty, lasting only 3 days. Her tongue was Thin, with a shallow Heart crack, and had generally a normal colour except for being Red on the tip. Her pulse was Fine.

Diagnosis

This is a clear case of Liver- and Heart-Blood and Liver-Yin deficiency. The symptoms of Liver-Blood deficiency are: depression, insomnia, tingling of limbs, poor memory, scanty periods, Thin tongue and Fine pulse. The symptoms of Liver-Yin deficiency are: feeling of heat at night, night-sweating, dry mouth and throat at night, a floating feeling just before falling asleep, nightmares and dry eyes. Although the tongue does not show any Yin deficiency, this simply means that the Yin deficiency is of recent date and not yet severe enough to show on the tongue. The deficient Liver-Blood and Liver-Yin fail to root the Ethereal Soul at night, hence the insomnia and nightmares; the floating sensation just before falling asleep indicates Liver-Yin deficiency. The wandering of the Ethereal Soul which results from the deficiency of Liver-Blood and Liver-Yin also induces a state of aimlessness, depression and despair. Apart from the patterns of Liver-Blood and Liver-Yin deficiency, there is also some Heart-Blood deficiency evidenced by the palpitations. The tip of the tongue is Red from some Empty Heat arising from the Yin deficiency and affecting the Heart. The midline Heart crack indicates a constitutional tendency to Heart patterns and emotional problems. However, this Heart pathology is secondary to that of the Liver.

Treatment principle

The treatment principle adopted was to nourish Liver-Blood and Liver-Yin, nourish Heart-Blood, calm the Mind and settle the Ethereal Soul. This patient was treated with both acupuncture and herbs.

Acupuncture

The main points used were selected from the following:

Ren-4 Guanyuan to nourish Blood and Yin.

Ren-15 Jiuwei to calm the Mind.

ST-36 Zusanli, SP-6 Sanyinjiao and LIV-8 Ququan to nourish Liver-Blood.

Herbal treatment

The herbal formula used was a variation of Yi Guan Jian One Linking Decoction which nourishes Liver-Yin:

Dang Gui Radix Angelicae sinensis 6g
Bai Shao
Radix Paeoniae lactiflorae
9g
Shu Di Huang
Radix Rehmanniae glutinosae praeparata
6g
Mai Men Dong
Tuber Ophiopogonis japonici
6g
Wu Wei Zi
Fructus Schisandrae chinensis
3g
Shan Zhu Yu
Fructus Corni officinalis
4g
Ye Jiao Teng
Caulis Polygoni multiflori
6g
Shou Wu
Radix Polygoni multiflori
6g
Long Yan Rou
Arillus Euphoriae longanae
6g
Bai Zi Ren
Semen Biotae orientalis
6g
Gou Qi Zi
Fructus Lycii chinensis
6g
Han Lian Cao
Herba Ecliptae prostratae
4g
Chuan Lian Zi
Fructus Meliae toosendan 3g

Explanation

Dang Gui, Bai Shao, Shu Di Huang, Shou Wu and Gou Qi Zi nourish Liver-Blood. Bai Shao is astringent and roots the Ethereal Soul in the Liver. Gou Qi Zi also nourishes Liver-Yin.

Mai Men Dong, Shan Zhu Yu and Wu Wei Zi nourish Yin. Wu Wei Zi and Shan Zhu Yu are also astringent and therefore help to root the Ethereal Soul in the Liver. Wu Wei Zi also calms the Mind.

Long Yang Rou, Ye Jiao Teng and Bai Zi Ren nourish Blood, calm the Mind, promote sleep and settle the Ethereal Soul.

Han Lian Cao clears Empty Heat arising from Liver-Yin deficiency.

Chuan Lian Zi moves Liver-Qi and counterbalances the cloying effect of the Blood and Yin tonics: it is also one of the few herbs that move Liver-Qi without injuring Yin.

After 6 months of treatment along the above lines, this patient’s mood returned to normal, her depression lifted and her sleep became much deeper.

2) HEART-YIN DEFICIENCY

Clinical manifestations

Post-natal depression, insomnia (waking up frequently during the night), mental restlessness, a feeling of guilt, exhaustion, scanty breast milk, palpitations, loss of libido, a feeling of heat in the evening, night-sweating. Tongue: Red without coating, with a Heart crack. Pulse: Floating-Empty.

Treatment principle

Nourish Yin, tonify the Heart, calm the Mind.

Acupuncture

HE-7 Shenmen, HE-5 Tongli, P-7 Daling, Ren-14 Juque, Ren-15 Jiuwei, Du-19 Houding, Du-24 Shenting, Ren-4 Guanyuan, LIV-8 Ququan, SP-6 Sanyinjiao. All with reinforcing method, except for the point on the head which should be needled with even method. No moxa.

Herbal treatment

a) Prescription

REN SHEN DANG GUI TANG

Ginseng-Angelica Decoction

Ren Shen Radix Ginseng 6g
Dang Gui
Radix Angelicae sinensis 9
Mai Men Dong Tuber Ophiopogonis japonici 6g
Bai Shao
Radix Paeoniae lactiflorae 9g
Shu Di Huang
Radix Rehmanniae glutinosae praeparata 6g
Rou Gui
Cortex Cinnamomi cassiae 1.5g

Explanation

This formula is also recommended by Wu Qian in his "Golden Mirror of Medicine".

b) Prescription

TIAN WANG BU XIN DAN

Heavenly Emperor Tonifying the Heart Pill

Sheng Di Huang Radix Rehmanniae glutinosae 12g
Xuan Shen
Radix Scrophulariae ningpoensis 6g
Mai Men Dong
Tuber Ophiopogonis japonici 6g
Tian Men Dong
Tuber Asparagi cochinchinensis 6g
Ren Shen
Radix Ginseng 6g
Fu Ling
Sclerotium Poriae cocos 6g
Wu Wei Zi
Fructus Schisandrae chinensis 6g
Dang Gui
Radix Angelicae sinensis 6g
Dan Shen
Radix Salviae miltiorrhizae 6g
Bai Zi Ren
Semen Biotae orientalis 6g
Suan Zao Ren
Semen Ziziphi spinosae 6g
Yuan Zhi
Radix Polygalae tenuifoliae 6g
Jie Geng
Radix Platycodi grandiflori 3g

Explanation

This formula, already explained, is used if, in addition to Heart-Yin deficiency, there is also Kidney-Yin deficiency. It nourishes Blood and Heart- and Kidney-Yin, calms the Mind and clears Empty Heat.

c) Prescription

AN XIN TANG

Calming the Heart Decoction

Dang Gui Radix Angelicae sinensis 60g
Chuan Xiong
Radix Ligustici Chuanxiong 30g
Sheng Di Huang
Radix Rehmanniae glutinosae 15g
Mu Dan Pi
Cortex Moutan radicis 15g
Pu Huang
Pollen Typhae 6g
He Ye
Folium Nelumbinis nuciferae 1 leaf

Explanation

This formula from "Fu Qing Zhu's Gynaecology" is for depression and psychotic behaviours after childbirth caused by Blood deficiency with Empty Heat harassing the Heart.

Women's Treasure remedy

HEAVENLY EMPRESS

Sheng Di Huang Radix Rehmanniae glutinosae
Xuan Shen
Radix Scrophulariae ningpoensis
Mai Men Dong
Tuber Ophiopogonis japonici
Tian Men Dong
Tuber Asparagi cochinchinensis
Gui Ban Jiao
Colla Plastri testudinis
Ren Shen
Radix Ginseng
Fu Ling
Sclerotium Poriae cocos
Wu Wei Zi
Fructus Schisandrae chinensis
Dang Gui
Radix Angelicae sinensis
Dan Shen
Radix Salviae miltiorrhizae
Bai Zi Ren
Semen Biotae orientalis
Suan Zao Ren
Semen Ziziphi spinosae
Yuan Zhi
Radix Polygalae tenuifoliae
Jie Geng
Radix Platycodi grandiflori
Qin Jiao
Radix Gentianae macrophyllae
Qing Hao
Herba Artemisiae apiaceae
Di Gu Pi
Cortex Lycii radicis
Mu Dan Pi
Cortex Moutan radicis
Mu Li
Concha Ostreae
Gou Qi Zi
Fructus Lycii chinensis

Explanation

This remedy is a variation of the formula Tian Wang Bu Xin Dan Heavenly Emperor Tonifying the Heart Pill which nourishes Heart- and Kidney-Yin, clears Heart Empty Heat and calms the Mind.

3) HEART-BLOOD STASIS

Clinical manifestations

Post-natal depression, manic behaviour, scolding people, aggressive behaviour, delusions, hallucinations, suicidal, destructive thoughts, lack of bonding with the baby. Tongue: Purple. Pulse: Wiry, Rapid.

Treatment principle

Invigorate Blood, eliminate stasis, subdue rebellious Qi in the Penetrating Vessel, calm the Mind, open the Mind’s orifices.

Acupuncture

P-7 Daling, G.B.-17 Zhengying, G.B.-18 Chengling, Du-24 Shenting, Ren-14 Juque, BL-15 Xinshu, SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), KI-1 Yongquan, LIV-3 Taichong, BL-17 Geshu, SP-10 Xuehai. All with reducing method.

Herbal treatment

a) Prescription

XIAO TIAO JING TANG

Small Regulating the Menses Decoction

Bai Shao Radix Paeoniae lactiflorae 3g
Dang Gui
Radix Angelicae sinensis
3g
Mo Yao
Myrrha
3g
Hu Po
Succinum
3g
Rou Gui
Cortex Cinnamomi cassiae
3g
Xi Xin
Herba Asari cum radice
1.5g
She Xiang
Secretio Moschus moschiferi 1.5g

Explanation

This formula from the "Golden Mirror of Medicine" is for Blood which is both deficient and rebelling upwards to harass the Heart causing post-natal psychosis.

b) Prescription

SHA XIANG SAN

Cinnabaris-Musk Powder

Ren Shen Radix Ginseng 6g
Huang Qi
Radix Astragali membranacei
6g
Shan Yao
Radix Dioscoreae oppositae
6g
Fu Ling
Sclerotium Poriae cocos
6g
Yuan Zhi
Radix Polygalae tenuifoliae
6g
Zhu Sha
Cinnabaris
1.5g
Fu Shen
Sclerotium Poriae cocos pararadicis
6g
Gan Cao
Radix Glycyrrhizae uralensis
3g
Jie Geng
Radix Platycodi grandiflori
3g
Mu Xiang
Radix Aucklandiae lappae
3g
She Xiang
Secretio Moschus moschiferi 1.5g

Explanation

This formula is also from the "Golden Mirror of Medicine" and is specific for post-natal psychosis. What we now call psychosis was described as "seeing ghosts and incoherent speech" in the original text.

The use of Zhu Sha is now illegal and we should therefore replace it with Long Chi Dens Draconis 12g.

Three Treasures remedy

RED STIRRING

Dang Gui Radix Angelicae sinensis
Sheng Di Huang
Radix Rehmanniae glutinosae
Chuan Xiong
Radix Ligustici Chuanxiong
Chi Shao
Radix Paeoniae rubrae
Tao Ren
Semen Persicae
Hong Hua
Flos Carthami tinctorii
Chai Hu
Radix Bupleuri
Zhi Ke
Fructus Citri aurantii
Niu Xi
Radix Achyranthis bidentatae seu Cyathulae
Jie Geng
Radix Platycodi grandiflori
Gan Cao
Radix Glycyrrhizae uralensis
Dan Shen
Radix Salviae miltiorrhizae
Yuan Zhi
Radix Polygalae tenuifoliae
Yu Jin
Tuber Curcumae
He Huan Pi
Cortex Albizziae julibrissin

Explanation

This remedy is a variation of the formula Xue Fu Zhu Yu Tang Blood-Mansion Eliminating Stasis Decoction which invigorates Blood and eliminates stasis in the Upper Burner. The remedy has been modified from the original formula with the addition of herbs that calm the Mind and open the Mind’s orifices. The tongue presentation appropriate to this remedy is a Purple body.

PROGNOSIS AND PREVENTION

Post-natal depression responds very well to treatment with acupuncture and Chinese herbs and the overwhelming majority of cases can be helped in a relatively short period of time, perhaps a few months. The pattern from Blood deficiency is easier to treat than that from Yin deficiency. Post-natal psychosis is much more difficult to treat and, in severe cases, Chinese treatment may have to be combined with Western medication, especially if the mother is suicidal or destructive towards the baby.

In any case, the signs that point to a poor prognosis are:

  • red tongue with a redder tip and a very deep Heart crack
  • extremely Swollen tongue with sticky coating
  • tongue that has a very marked hammer shape (see Fig. 45.1 above)
  • eyes that lack any shen (glitter, shine) and therefore look extremely dull
  • uncontrolled look of the eyes, meaning that the eyes are staring, or fixed, or moving too much, or with the white of the eye showing all round.

REPLY TO COMMENTS

The chapter on post-natal depression in my book "Obstetrics and Gynaecology in Chinese Medicine", from which this article is taken, has been commented upon by some authors.

In reply, I would like to say first of all that, as this subject is not discussed in modern Chinese books, I have followed only classical texts and primarily Wu Qian’s "Golden Mirror of Medicine" (Yi Zong Jin Jian, 1742). The patterns that I present are those I found in this text: I did not find other patterns discussed in the context of post-natal depression. Of course, it may well be that the chapter on post-natal depression suffers from omissions especially since it is the first to appear in English on this subject.

One comment was that the patterns presented are not enough and that there are other patterns which cause depression. I think these comments are based on a basic misunderstanding and confusion between depression in general and post-natal depression. Post-natal depression is, by definition, depression starting soon after childbirth in a previously mentally-healthy woman: if the woman was already suffering from depression before pregnancy and childbirth, then it is not post-natal depression. The pathology of post-natal problems is strongly dominated by a Blood pathology as it is in many other post-natal problems, e.g. joint pains after childbirth, post-natal abdominal pain, etc. Thus, it is not surprising that the Golden Mirror of Medicine discusses the above Blood patterns in post-natal depression.

Some authors have commented on Phlegm as a pattern in post-natal depression: this cannot be for the reason mentioned above. Post-natal depression develops fairly soon after childbirth in a previously mentally-healthy woman: Phlegm is a complex pathogenic factor that is the result of a long-standing disharmony and takes a long time to form. Thus, it cannot be a pattern causing post-natal depression because it cannot be formed so quickly after childbirth.

Other authors mention Liver-Qi stagnation as a pattern in post-natal depression because the mother is subject to so much stress soon after childbirth. This is a basic misunderstanding of the diagnosis of patterns: a pattern is diagnosed not from the aetiology but from the clinical manifestations. In other words, we can diagnose that a patient suffers from Liver-Qi stagnation if he or she presents with the symptoms and signs of Qi stagnation, not on the basis of an observation of the patient’s life events. The fact that the mother is subject to considerable stress after childbirth does not necessarily imply that she suffers from Liver-Qi stagnation: the same stress may cause many other patterns, e.g. Heart-Blood deficiency, Heart-Blood stasis, etc.

Of course, that is not to say that in practice the patterns appearing in post-natal depression are simply those indicated in the above article as every woman will have pre-existing disharmonies which will change the clinical picture: but this applies to any disease, not just post-natal depression. Thus, it may well be that a woman suffering from post-natal depression may suffer from Phlegm or Qi stagnation in addition to the Blood patterns discussed above, but these will be pre-existing patterns.

Some authors assert that there cannot be mental depression without Liver-Qi stagnation: this is patently absurd as many other (including purely Deficient) patterns (e.g. Heart-Blood deficiency, Kidney-Yang deficiency) may cause mental depression as one can verify in any modern or ancient Chinese medicine book. Perhaps this misunderstanding arises from the Chinese word yu which is used both to indicate depression and Qi stagnation: another good reason for translating it as "stagnation" (rather than depression) when it is in the context of Liver patterns.

Copyright (c) Giovanni Maciocia 2000