Postpartum+Depression

Postpartum depression, also called "baby blues" refers to depression experienced in the postpartum period. such depression may occur within 24 hours of delivery. It is usually limited in duration (36-48 hours) and is very common. This type of depression may require treatment if it lasts more than 72 hours or is associated with lack of interest in the infant, suicidal or homicidal thoughts, hallucinations, or psychotic behavior.

Relevant TCM Diseases: //Chan Nou Jing Ji// refers to postpartum fright and anxiety w/ palpitations. //Chan Hou Huang Hu// means one that is abstracted from their surroundings as if in a trance postpartum.

Differential Diagnosis: Medical Disorders: A. Delirium B. Multiple Sclerosis (MS) C. Systemic Lupus Erythematosus D. Hyperthyroidism or hypothyroidism E. Other endocrinological diseases Effects of Substances: A. Chronic abuse of Alcohol or illicit substances B. Medication side effects Psychiatric Disorders: A. Schizophrenia and other psychotic disorders B. Obsessive-Compulsive Disorder (OCD) C. Anxiety Disorders

TCM Etiology and Pathogenesis: “Most postpartum mental-emotional disorders are rooted in vacuity. Due to excessive blood and fluid loss during delivey and consumption of blood and fluids due to breast-feeding, heart qi & blood may become vacuous and weak.. Since heart qi and blood is rooted in the spleen, heart vacuity is typically complicated by spleen vacuity... because spleen qi and kidney yang are mutually rooted, spleen qi vacuity may also invoke kidney yang vacuity.. In addition, it is possible to have completely replete postpartum disease mechanisms of essence spirit disorders. If spoilt blood (i.e. static blood) is retained after delivery and penetrates upward, it may disturb the heart spirit.”1

TCM Pattern Differentiation: Heart Qi Vacuity Weakness Pattern 1 Postpartum palpitations, nervous anxiety, vertigo, dizziness, impaired memory, deranged speech, spontameous perspiration, vexation & agitation, insomnia, pale white or sallow yellow complexion. [Ren Shen (6g.), Bai Zhu (9g.), Long Yan Rou (9g.), Yuan Zhi (6g.), Fu Shen (12g.), Mu Xiang (6-9g.), Huang Qi (9-18g.), Dang Gui (9g), Gan Cao (6-9g.), Zao Ren (12g.), Mai Men Dong (12g.), Wu Wei Zi (9g.), Mu Li (12g.), Long Chi (12g.)]
 * Tongue:** pale and dry
 * Pulse:** bowstring, fine
 * Treatment Principles:** Boost qi, nourish blood, quiet the spirit, tranquilize palpitations
 * Acupuncture Treatment:** Tonify: BL-15, BL-17, BL-20, HT-7, ST-36; Drain: GV-20, Yintang
 * Herbal Treatment:** //Gui Pi Tang Jia Wei//1

Blood Stasis Penetrating the Heart Pattern 1 Postpartum palpitations, uncalm sitting & sleeping, lochia not discharged, sometimes appears on the verge of mania. If extreme, there may be visual & auditory hallucinations, deranged speech and acting as if possessed. In addition there is loss of sleep, lower abdominal distention & pain, purple and dark complexion, deep red lips [Chuan Xiong (15g.), Sheng Di Huang (12g.), Bai Shao (9g.), Niu Xi (9g.), Pu Huang (9g.), Wu Ling Zhi (9g.)]
 * Tongue:** static spots or macules
 * Pulse:** bowstring, choppy and forceful
 * Treatment Principles:** Free the flow of the channels, quicken the network vessels
 * Acupuncture Treatment:** SP-10, SP-6, LR-3, LI-4, CV-6, CV-4. Draining technique.
 * Herbal Treatment:** //Jia Wei Chuan Xiong San//1

Yin Vacuity-Fire Effulgence Pattern 1 Postpartum heart vexation, restlessness, dizziness, tinnitus, impaired memory, insomnia, palpitations, night sweats, 5-palm heat, tidal heat, flushed red cheeks, dry mouth without thirst, weak low back & knees [Ren Shen (6g.), Dang Gui (9g.), Shu Di Huang (12g.), Tian Mai Dong (12g.), Rou Gui (3g.), Bai Shao (9g.), Mai Men Dong (12g.), Zhu Ru (9g.), Zhi Mu (9g.)] Injury of stomach and intestinal fluids w/ contipation & thirst: Use //Zeng Ye Cheng Qi Tang Jia Wei//: [Xuan Shen (15g.), Long Gu (15g.), Mu Li (15g.), Mai Men Dong (12g.), Sheng Di Huang (12-24g.), Da Huang (9g.), Mang Xiao (4.5g.)]
 * Tongue:** red tongue; scanty dry coat
 * Pulse:** bowstring, fine, rapid
 * Treatment Principles:** Nourish yin & clear heat, quiet the spirit, tranquilize palpitations
 * Acupuncture Treatment:** BL-15, BL-23, HT-7, HT-6, PC-7, KI-3, SP-6, GV-20, Yintang. Even technique.
 * Herbal Treatment:** //Ren Shen Dang Gui Tang Jia Wei//1
 * Modifications:**

Righteous Vacuity With Contraction of Evils Pattern 1 Dizziness, headache, aggitation & restlessness, heart palpitations, fearful throbbing, heart vexation, insomnia, profuse dreams, if severe, chaotic & confused thinking, possible tics and spasms or convulsions, alternating faver & chills [Long Gu (12-15g.), Mu Li (12-15g.), Chai Hu (9g.), Dang Shen (9-18g.), Huang Qin (9g.), Ban Xia (9g.), Dang Gui (9g.), Bai Shao (9-18g.), Shu Di Huang (9-12g.), Chuan Xiong (6-9g.), Gan Cao (6g.), Sheng Jiang (2 slices), Da Zao (3 pcs.)]
 * Tongue:** pale possibly puffy tongue; white coat
 * Pulse:** faint, forceless
 * Treatment Principles:** Course wind & dispel evils, harmonize the qi & blood, quiet the spirit
 * Acupuncture Treatment:** GB-20, GV-16, BL-12, TW-5, LI-4, GV-20, Yintang. Draining technique.
 * Herbal Treatment:** //Xiao Chai Hu Tang He Si Wu Tang Jia Wei//1