Acupuncture for Postpartum Depression with Anxiety: A Case Study
What Acupuncture for Postpartum Depression Does Versus What Chinese Herbs Can Do
Acupuncture Unblocks the Stuck Qi of Depression.
Stuck Qi is at the root of any kind of depression. When we are healthy and happy and free of physical pain, our Qi circulates freely and all of our internal organs and tissues are nourished. But the moment you experience a strong negative emotion, your Qi is affected. It either moves too fast or too slow. Fight, flight, freeze.
Over the course of life there are minor harmless versions of this. You don’t get the raise you were hoping for, or you mother won’t get you the ice cream you want, you feel sad, you feel angry, you feel scared, and you pass through that with a little bit of time.
But! If your whole childhood was spent being gaslighted by your mother, or abused by your father, or you were in a war, recurrent or overwhelming fight, flight, freeze sets you up to be easily triggered by future events, IF you do not recognize and deal with the problem. What you experience in your body at this point is Stuck Qi.
This is why I use Acupuncture for Postpartum depression as the core of my treatment, and supplement it with herbs.
What is the Stuck Qi of Depression
The very word “depression” suggests stagnancy…What is a depression in nature? A low point on the land, either a rut in the road, or a low valley. It can be a place where the wagon gets stuck.
And don’t we use the words low, rut, stuck, and depressed to describe when we feel sad, blue, helpless, hopeless, depressed. So Chinese Medicine understood the energetic and visceral nature of emotional disorders. And understood that while anxiety requires calming, depression requires unblocking of stagnancy.
We use acupuncture and herbs to get the nervous system energy, what Chinese Medicine calls Qi, that is damaged in the case of postpartum depression, circulating again. This is also the case with shock, or when treating PTSD or chronicPTSD.
Its also true that if acupuncture does one thing, it “moves the Qi.” That is why there are so many acupuncture points that are forbidden during pregnancy. Because they have a strong effect on “opening the flow of Qi” in the pelvic floor downward. And its exactly why we use those very same acupuncture points for cervical ripening and to induce labor.
Chinese Herbs Can Strongly Nourish the Blood
Now, if the stagnation is due to a weakness, a vacuity, for example, what we call Blood Vacuity, then thats where herbs come in. Herbs, like quality food, can nourish the Qi and Blood, as well unblock their stagnancy?
Blood Vacuity and Exhaustion
When a normal person is exhausted, and famished, and they eat a good meal, their energy improves. Women with post partum depression ARE exhausted. They have the perfect storm of mental and physical exhaustion. Sleep deprivation is a method of torture. When you drink Chinese herbs for post partum depression, they are super nourishing. The are like a medical meal that restores what has been lost both emotionally and physically.
When to Nourish Qi and Blood
Blood Vacuity is common during the bleeding phase of the menstrual cycle, and also immediately after child birth. Besides the actual loss of blood that may take place during birth, the birth process itself, especially if extended, can be exhasting beyond what those of us who have not been thru it can only imagine. So blood vacuity is associated with fatigue and things that cause fatigue. Professional long distance runners often develop blood vacuity.
In China its standard historical practice to give women “tonic” herbs to nourish the blood and Yang after at menarche to help prepare the body for menses, and after childbirth, to help the body recover. Yang tonics are super stregnthening and warming, like Cinnamon Bark and Epimedii. Whereas Blood tonics like Dang Gui and He Shou Wu are profoundly nourish to mind and body at deep physical and emotional levels.
So any thing that leads to Blood exhaustion, overwork, extended labor, childbirth itself, is treated with Blood tonic herbs, often cooked with red meat. This is because, ethics or ecology aside, now, red meat is super concentrated B vitamins, Iron, and Protein, so, cooked as soup with herbs packs a powerful tonic punch. Think: Bone Broth.
Depression and Blood Stagnation
What is an example of Blood Stasis or Stagnation? A bruise. A better example are menstural pains during the bleeding, especially when better after passing a clot. Another example is that pain we feel when heartbroken, whether from suffering loss of a loved one or the loss of betrayal.. So Blood stasis involves fixed pain, whether emotional or physical.. But needles can do only one thing, unblock stuck Qi.
Now when you use Acupuncture for Post-Partum depression, and unblock stuck Qi, that can restore internal mechanisms of nourishment. So acupuncture CAN have a building effect, but its indirect. The best thing is tonic herbs, right away.
Chinese Herbs Are Natural Drugs that Work Togethe with Acupuncture for Postpartum Depression
But Chinese Herbs are natural drugs that treat the unique case of post-partum depression. What is unique here is the massive hormonal changes that occur during pregnancy, the “fetal toxins” that the mother’s body has to process for 9 months, especiall the 2nd and 3rd trimester
A Case Study of Acupuncture for Post Partum Depression Combined with Chinese Herbs and Mindfulness
The Patient and her Postpartum Depression: Signs and Symptoms
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.
- She described having trouble “doing a good job caring for herself and her baby.”
- Claudia was very restless and worried, but said, “I dont have anything to be worried about.”
- She said she loves her husband and feels he loves her.
- Also that 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.”
Emotional and Neurological Symptoms
- severe fatigue,
- 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.
Since the end of 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.
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’s muscular structure. All of this pointed clearly to a Blood Vacuity 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)
Here the tongue confirmed the Blood Vacuity diagnosis, because it is pale. Almost all anemics will have a frank pales tongue, but not all pale tongues and blood vacuity are anemia! But ALL pale tongues show Blood Vacuity due to some reason, and the reason CAN be emotional.
Discussion of a Case Involving Disempowerment and Isolation
Before we can decide how to use Acupuncture for postpartum depression, we have to decide on Claudia’s pattern. This involves observing signs and symptoms, but also the history of the disorder..Clearly from the tongue and pulse she suffers from Blood Vacuity. The crack down the center of her tongue tells us Heart Blood Vacuity. From her symptoms we know there is a lot of Anxiety/Fear, and, that there is also Frustration and Anger, though in her disempowered social position, it is mainly manifesting passively, as irritibility.
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.
Taking the History:
Claudia is a college graduate from Latin America. She met her husband when he was in her country on vacation. 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, in her own words, ” the Anglo concept of boundries is non-existent.”
Family/Culture of Origin Differences
To complicate matters, not only did Claudia leave her beloved country and her job that she liked, and her mother and family to come here and live with her husband, but HIS family, of Anglo-Saxon origin, was the polar opposite emotionally, ergo very boundried, to the point of coldness.
On top of things, it was clear that the husband’s wealthy mother seemed to look down on her because she is from Latin America, with dark skin and mestizo features. The key point is, its how Claudia felt, and from the evidences she gave, sounded accurate.
Loss and Isolation
Not only did Claudia leave her job that she liked, but, because she is only partially fluent in English, she did not start working here, but became a homemaker. In fact, it turned out her husband would rather she not work, but be a stay at home wife. Its also true that Claudia became pregnant quickly.
As Claudia’s pregnancy was soon upon arrival in San Diego, Claudia also found herself without any significant friends. Her social life revolved around her husband. As it turns out, Claudia’s pregnancy was uneventful, and her labor easy. So at this point in the story, there are zero apparant physical reasons for the post partum depression. Mind you, too, that by the time she came to see me, 11 months since the birth of her daughter, the Western Medicine docs said, “there is nothing wrong with you.” Did they refer her to a therapist specializing in post-partum depression?
What Came Next Explained Alot
But what came next in her story struck me as one of the hearts of the case.
Claudia is very proud of being from one of the more advanced and successful countries in Latin America, and in her own way looks down on Latinos from some neighboring countries with larger problems. 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.
The Moment the Depression Came Over Her Like a Wave
To make matters worse, for various reasons, no one from her family was able to come up for the birth.
Key Point: Claudia described being in the recovery room very shortly after delivery–
“the female relatives from my husband’s family were all crowded around the baby, which they had actually taken out of my arms. They were all in a circle, away from my bed, my husband included, ignoring me, as if I were not even there.”
It was at this very moment that the depression hit her. A wave of sadness, a wave of loneliness.
Now, its possible, that given the identical circumstance, a less disempowerd woman might not have been moved by sadness and loneliness, and might have in that moment stood up for her rights. But we know from her tongue diagnosis that this is a delicate sensitive person who will always be prone to emotional disorders.
The Perfect Storm of BodyMind Type with Unfortunate Experience
What we frequently have with many disorders, 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.
A Worrier and Party Girl
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 her homeland 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. Coming to USA and marrying this fella, was an escape, and escape to a new world cuts two ways. Moving, moving to a foriegn country, getting pregant, having a baby, each of these is a big change…
Chinese Medical Pattern: Heart and Spleen Qi Vacuity with Liver Depression Qi Stagnation
Before we can do acupuncture for postpartum depression we need to know where to start. We need to treat the cause and not just the symptoms. Ditto our herbs.
The Spleen’s Qi
Excessive worry or obsessiveness weaken the Spleen Qi. The Spleen Qi has many jobs, chief of which is the break down and transport of the essence of foods and liquids, to the cells. This is the blood that is said to nourish the heart. Here heart means something between physical and mental. It describes what happened to that man in the film who eats junk food for a month and gets depressed.
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.”.
Blood Vacuity or Stasis Is Invovled in All Psychological or Emotional Disorders
When the Spleen Qi is weak, there is fatigue, and as the Spleen Qi makes the blood, the blood becomes empthy. 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, we only know how she perceived it. Its not hard to imagine, frankly, but the more important piece is what her nervous system does with that information. What vital is the degree to which this affected her, her susceptibility to a deep sense of abandonment, this confirms what both her pulse and tongue presentation, ans symptoms already suggested: a profound Heart Blood Vacuity or Emptiness, along with a Spleen Qi Vacuity. Someone with abandonment issues will always have Heart Blood Vacuity. The vessel that should have been filled, was not.
Gui Pi Tang: Decoction to Strenghten the Spleen and Stomach
This is a fabulous formula for emotional issues and insomnia involving Blood Vacuity. So in a way, this case was easy. The very pale tongue and empty thin pulse both confirm blood vacuity. Many of her symptoms–fatigue, restlessness, diarrhea, apathy, numbness and tingling in the limbs, even her weak and choppy voice–all confirmed an underlying dual pattern of Spleen Qi and Heart Blood Vacuity.
One of the key symptoms of Spllen Qi Vacuity here is the diarrhea. And people with high levels of anxiety will often get recurring diarrhea, as the flight part of the nervous system causes the bowel to empty rapidly.
Luckily, there is only one major Herbal Prescription to treat this pattern, and I happened to know, luckily, from an earlier patient who had actually come in wanting acupuncture for postpartum 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) dates back to 1253 C.E., and was used 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. This is why over time it had become a favorite formula for students, whose job it is to “think too much” and often worry a lot over grades and success.
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.”
The Ancient Chinese Acupuncture Herbalists and Modern Psychology
Isn’t this interesting that back in the 1600’s, long before Freud, that the Chinese doctors who used acupuncture to treat postpartum depression and also used herbs, described the damage done by repressing feelings and practising denial of feelings!
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. People with strong Spleen and Heart Qi though, are like Generals, Warrrors, they dont get pushed over or back easily. 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.
Acupuncture for Postpartum Depression–Claudia’s Treatment
I gave Claudia this herbal formula from day one. I also gave her 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.
Which Channels to Needle?
I chose points on the Spleen, Stomach, Liver and Heart channels. These were points to unblock stagnation in all of those channels, but especially the Liver and Heart, which are organs “of blood.” For these channels I chose “Yin” points at the elbows and knees, and on the Yin side or inside of the limbs. These have an intensely calming effect.
On the Spleen and Stomach channels I add moxabustion to some of the acupuncture. Moxabustion, like herbs, can add energy to the body. This is to stregnthen….Finally I also did moxabustion of Pericardium 6. This is a great acupuncture point for postpartum and other depression with anxiety. Its Chinese name is Nei Guan, or Inner Gate. Here the Gate is to the Heart. We can nourish the heart and releive anxiety with the nourishing warmth and Qi moving effect of moxabustion
Logic of the acupuncture treatment for postpartum depression
The Spleen and Stomach channels points were to stimulate the Spleen Qi to make healthier blood. Moxabustion was added to pour Qi directly into the Earth Point (Zu San Li) of the Stomach channel. This as complimented by the same at San Ying Jiao on the Spleen, to strongly nourish Blood and Qi.
Points on the Liver and Heart channels were chosen to release Liver Depression Qi Stagnation that manifests as irritablity and sensitivity due to the natural heat caused by Qi stasis in the Liver . The heart channel points chosen were to calm the Shen or Heart or Consciousness
Claudia started feeling better quite rapidly. At the second visit (after one week) 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.
Mindfulness Meditation to the Rescue!
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, (to further consolidate the stregnthening of her Blood, Ying, and Yang), 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 that gave her more autonomy and self nourishment.