CHAPTER 34 Anxiety During Pregnancy
Anxiety in pregnancy is called zi fan (
) which literally means ‘child mental restlessness’, intending by that ‘mental restlessness of pregnancy’. There is no discussion of such a problem in Western medicine and, for this reason, there will be no Western differentiation at the end of this chapter.
Aetiology
Overwork, Yin-deficient constitution
If a woman overworks during pregnancy, this will aggravate a pre-existing condition of Yin deficiency because Blood, Essence and Yin are already taxed during pregnancy to nourish the fetus. Yin deficiency leads to Empty-Heat which harasses the Heart and Mind.
Emotional problems, irregular diet
Emotional problems such as worry, anger, resentment and frustration often lead to stagnation of Qi: stagnant Qi, after some time, may turn into Fire which harasses the Mind. Fire may also derive from a dietary irregularity, especially the excessive consumption of hot, pungent foods. Excessive consumption of greasy and dairy foods leads to the formation of Phlegm which may combine with Fire to both harass and cloud the Mind.
Pathology
The pathology of anxiety in pregnancy essentially is related only to Heat in three variations: Full-Heat, Empty-Heat and Phlegm-Heat. However, apart from the above pathogenic factors, there may be another element: Qi rebelling in the Penetrating Vessel. Pregnancy leads to a disharmony of the Penetrating Vessel very easily and many minor symptoms of pregnancy can be so explained. Because in pregnancy some Blood and Essence in the mother’s Penetrating Vessel are diverted to nourishing the fetus, there is a deficiency below in the Penetrating Vessel and a stagnation above with Qi rebelling upwards. One of the main symptoms of Qi rebelling upwards in the Penetrating Vessel is what is called li ji which may be explained in different ways (see Ch. 7). One of its meanings is a feeling of anxiety, which, on a physical level, is experienced especially in the chest and throat.
Identification of patterns and treatment
Heart-Blood deficiency
Clinical manifestations
Palpitations, anxiety, dizziness, pale face, insomnia, poor memory, tiredness. Tongue: Pale and Thin. Pulse: Choppy or Fine.
Acupuncture
HE-7 Shenmen, Ren-14 Juque, ST-36 Zusanli, KI-3 Taixi. All with reinforcing method. Moxa may be used.
Herbal treatment
Three Treasures remedy
This remedy is a variation of Gui Pi Tang for anxiety from Heart-Blood deficiency.
Lung- and Heart-Qi stagnation
Clinical manifestations
Palpitations, anxiety, a feeling of distension or oppression of the chest, depression, a slight feeling of a lump in the throat, slight shortness of breath, sighing, sadness, chest and upper epigastric distension, slightly purple lips, pale complexion. Tongue: normal coloured or slightly Pale Purple on the sides in the chest area. Pulse: Empty but very slightly Overflowing on both Front positions.
Acupuncture
HE-5 Tongli, HE-7 Shenmen, P-6 Neiguan, Ren-15 Jiuwei, Ren-17 Shanzhong, LU-7 Lieque, ST-40 Fenglong. Even method.
Herbal treatment
Three Treasures remedy
This remedy is a variation of Bam Xia Hou Po Tang.
Lung- and Heart-Qi stagnation
Clinical manifestations
Palpitations, anxiety, a feeling of distension or oppression of the chest, depression, a slight feeling of a lump in the throat, slight shortness of breath, sighing, sadness, chest and upper epigastric distension, slightly purple lips, pale complexion. Tongue: normal coloured or slightly Pale Purple on the sides in the chest area. Pulse: Empty but very slightly Overflowing on both Front positions.
Liver-Qi stagnation
Clinical manifestations
Anxiety, irritability, worry, epigastric and abdominal distension. Tongue: normal or slightly Red on the sides. Pulse: Wiry.
Acupuncture
P-6 Neiguan, T.B.-6 Zhigou, Du-24 Shenting, G.B.-13 Benshen, LIV-3 Taichong. All reducing or even method.
Herbal treatment
Three Treasures remedy
Liver-Fire
Clinical manifestations
Anxiety, mental restlessness, irritability, propensity to outburst of anger, a dry mouth, thirst, blood-shot eyes, dark urine, constipation, dizziness, tinnitus, dream- disturbed sleep. Tongue: Red body with redder sides, dry, yellow coating. Pulse: Wiry and Rapid.
Acupuncture
LIV-2 Xingjian, LIV-3 Taichong, BL-18 Ganshu, Du-18 Qiangjian, Du-24 Shenting, G.B.-13 Benshen, G.B.-15 Toulinqi, HE-7 Shenmen, P-7 Daling, LU-3 Tianfu. LIV-2, LIV-3 and G.B.-15 with reducing method, all the other points with even method.
Explanation
Herbal treatment
Prescription
Three Treasures remedy
This remedy is a variation of Long Dan Xie Gan Tang that drains Liver-Fire, resolves Phlegm, calms the Mind and settles the Ethereal Soul. The tongue presentation appropriate to this remedy is a Red and Swollen body, with redder sides and a sticky, yellow coating.
Liver-Fire
Clinical manifestations
Anxiety, mental restlessness, irritability, propensity to outburst of anger, a dry mouth, thirst, blood-shot eyes, dark urine, constipation, dizziness, tinnitus, dream-disturbed sleep. Tongue: Red body with redder sides, dry, yellow coating. Pulse: Wiry and Rapid.
Empty-Heat from Yin deficiency
Clinical manifestations
Anxiety, mental restlessness, feeling fidgety especially in the evening, inability to lie down, palpitations, dry mouth and throat, feeling of heat in the evening, malar flush, night sweating. Tongue: Red without coating. Pulse: Floating-Empty and Rapid.
Acupuncture
SP-1 Yinbai, KI-2 Rangu, KI-3 Taixi, KI-6 Zhaohai, KI-9 Zhubin, HE-7 Shenmen, HE-6 Yinxi, P-7 Daling, Ren-15 Jiuwei, SP-4 Gongsun (on the right) and P-6 Neiguan (on the left). KI-3, KI-6 and KI-9 with reinforcing method; all the others with even method.
Explanation
Herbal treatment
b Prescription
Explanation
The difference between this formula and the previous one is that this formula nourishes more Heart-Yin while the previous one nourishes both Heart- and Kidney-Yin.
Women’s Treasure remedy
This remedy is a variation of the formula Tian Wang Bu Xin Dan Heavenly Emperor Tonifying the Heart Pill: it nourishes Heart- and Kidney-Yin, clears Heart Empty-Heat and calms the Mind. The tongue presentation appropriate to this remedy is a Red body without coating, with a redder tip, and with a central Heart crack.
Empty-Heat from Yin deficiency
Clinical manifestations
Anxiety, mental restlessness, feeling fidgety especially in the evening, inability to lie down, palpitations, dry mouth and throat, feeling of heat in the evening, malar flush, night sweating. Tongue: Red without coating. Pulse: Floating-Empty and Rapid.
Acupuncture
SP-1 Yinbai, KI-2 Rangu, KI-3 Taixi, KI-6 Zhaohai, KI-9 Zhubin, HE-7 Shenmen, HE-6 Yinxi, P-7 Daling, Ren-15 Jiuwei, SP-4 Gongsun (on the right) and P-6 Neiguan (on the left). KI-3, KI-6 and KI-9 with reinforcing method; all the others with even method.
Phlegm-Fire harassing the Mind
Clinical manifestations
Mental restlessness, agitation, phobias, anxiety, irritability, a feeling of oppression of the chest, dizziness, palpitation, nausea. Tongue: Red, Swollen and with a sticky, yellow coating. Pulse: Slippery and Rapid.
Treatment principle
Drain Fire, resolve Phlegm, calm the Mind, open the Mind’s orifices, calm the fetus.
Acupuncture
LIV-2 Xingjian, L.I.-11 Quchi, Ren-12 Zhongwan (if within the first three months of pregnancy), ST-40 Fenglong, SP-9 Yinlingquan, Ren-15 Jiuwei, ST-8 Touwei, G.B.-17 Zhengying and G.B.-18 Chengling. All with reducing method except for Ren-12 which should be needled with reinforcing method.
Herbal treatment
Prescription
Three Treasures remedy
This remedy is a variation of the formula Wen Dan Tang Warming the Gall Bladder Decoction and it resolves Phlegm-Heat, calms the Mind and settles the Corporeal Soul. It is indicates when the Heart and Lungs are obstructed by Phlegm-Heat, caused by longstanding worry, grief or sadness.
Phlegm-Fire harassing the Mind
Clinical manifestations
Mental restlessness, agitation, phobias, anxiety, irritability, a feeling of oppression of the chest, dizziness, palpitation, nausea. Tongue: Red, Swollen and with a sticky, yellow coating. Pulse: Slippery and Rapid.
Treatment principle
Drain Fire, resolve Phlegm, calm the Mind, open the Mind’s orifices, calm the fetus.
Acupuncture
LIV-2 Xingjian, L.I.-11 Quchi, Ren-12 Zhongwan (if within the first three months of pregnancy), ST-40 Fenglong, SP-9 Yinlingquan, Ren-15 Jiuwei, ST-8 Touwei, G.B.-17 Zhengying and G.B.-18 Chengling. All with reducing method except for Ren-12 which should be needled with reinforcing method.
Prognosis and prevention
Both acupuncture and Chinese herbs are excellent to deal with anxiety during pregnancy. Acupuncture is probably to be preferred because, especially in the first 3 months of pregnancy, it is better to avoid prescribing herbs. Because it does not introduce any substance into the body, acupuncture is ideally suited to treat anxiety during pregnancy.
Since, in addition to Heat, this problem is also closely related to a disharmony of the Penetrating Vessel, acupuncture can regulate and harmonize this vessel directly and effectively. Epigastric points on the Penetrating Vessel such as KI-21 Youmen and KI-20 Tonggu would be particularly useful as they subdue rebellious Qi of this vessel and calm the Mind.
Depending on the severity of the condition, just a few sessions may suffice or it may be that the woman needs to be treated throughout her pregnancy. The pattern from Phlegm-Fire is more difficult to treat than the one from Empty-Heat, because Phlegm is hard to resolve and also obstructs the Mind’s orifices. Obstruction of the Mind, as happens with Phlegm, is more difficult to treat than unsettling of the Mind from Empty-Heat or Heat.
), People’s Health Publishing House, Beijing, pp 26–27. An Explanation of Acupuncture Points was first published in 1654..