Postnatal Depression – A Chinese Medicine Perspective

Community of women administering postnatal care to new mother

The treatment of postnatal depression (PND) not only raises a lot of questions, but in our Western society it’s a hot topic that also manages to raise quite a few eyebrows. Despite the fact that mothering is a major transition in any woman’s life – whether she be a first timer or otherwise – and that the process of labour can be, and in our society quite often is traumatic, the stigma attached to PND remains. After all, a mother should be ‘happy’ after the birth of her child, shouldn’t she? Not necessarily, and especially not if the strain of pregnancy and birth has left her body out of whack. It’s of some consolation then that the treatment of postnatal syndromes related to our modern day understanding of PND, have been discussed in the Chinese Medical (CM) literature for half a millennium at least. 

According to an interesting article by Steve Clavey (Melbourne based CM practitioner and writer), the Ji Yin Gang Mu or the Compendium of Benefits to Women (1620), a leading CM text on the subject of gynaecology, there exist three core traditions for treating postpartum emotional disturbances that can be equated to PND.

Depending on the presenting signs and symptoms, these three approaches focus on:

1.      Purging of residual toxic Blood (bai xue) after birth

2.      Replenishment of Blood, which can become deficient due to the trauma of birth (regardless of how much blood is lost)  

3.      Scattering of internal ‘wind’ (an ancient CM descriptor recognised by a discreet set of signs and symptoms) that stirs when the Blood is deficient 

When considering PND then, CM treatment principles always involve some level of intervention to restore the proper functioning of the Blood. I capitalise Blood in this context, because we need to keep in mind that the CM concept of Blood is not exactly synonymous to our Western understanding of what blood is, how it’s manufactured in the body, what its function is, or most importantly, how it relates to consciousness and mental activity. It’s similar, and the CM understanding certainly involves the Western medical concept, and then some.

Of particular interest in the case of PND and other depressive disorders, is the fact that in CM terms, Blood is considered to be the material basis for mental activity. It is said that an ample supply of Blood is needed by the body in order to maintain a sharp consciousness and a robust spirit. A classical understanding supposes: ‘Qi and Blood are the foundation for human mental activities’, and, ‘harmonious circulation of Blood ensures a vigorous spirit’. It is understood, therefore, that an insufficiency of Blood, as brought on by the loss of blood during the birth process, or the deficiency left over from the exertion of labour, can naturally lead to postnatal mental disturbances. Treatment involves a combination of Chinese herbal remedies and acupuncture.

It’s interesting to note that in Asian cultures much emphasis is put on the postnatal resting  period. Due to their traditional understanding of how childbirth depletes the mother’s Blood and Qi, leading to deficiencies, respite and recuperation are encouraged for the first month postpartum. This time is referred to as the ‘sitting or settling month’, a time where new mothers are urged to stay at home as much as possible and avoid exposure to cold, wind and draughts. It is a nurturing time where rest and care of the baby is emphasised, and work, including housework, is discouraged. It is considered a ‘cold’ time for the mother’s body, due to the depletion of Blood. Warming foods are therefore encouraged and cold foods, such as raw food, restrained in order to restore balance to the mother’s recovering body. Hot beverages, soups, ginger concoctions and high protein intake are encouraged to generate warmth and replenish the system. In this way, many postpartum complications, such as PND, are avoided.

Black chicken stock, available at your friendly Asian grocer is the broth of choice for mother’s recuperating after childbirth. It can be purchased as stock cubes and prepared easily at home, and taken as a restorative hot beverage. For the more adventurous, here is a wonderful recipe I found on another interesting blog. It makes for informative reading too, and explains the healing properties of chicken broth and bone broths in general. I hope you will check it out at http://prettyinprimal.blogspot.com.au/2011/01/black-chicken-broth-and-soup.html

Protect University Education in Natural Medicine

If you live in Australia, you may be aware of the current push by a group of misinformed medical/scientific experts who are lobbying government and universities to axe natural/traditional medicine courses, including Chinese medicine studies, at our universities. If you care about maintaining the integrity of Natural Medicine education in our country I urge you join me in signing this petition at change.org http://www.change.org/petitions/protect-university-education-in-natural-medicine

Why This Is Important
University education currently provides one important source of training for Complementary and Alternative Medicine practitioners. These courses are renowned for their ability to create research literate practitioners who are able to provide high quality evidence-based therapies to the public and therefore work effectively in the health field. They also encourage students with an interest in research to continue along that path, adding a unique viewpoint to the scientific community and enhancing the development of the knowledge base. In addition, University education adds to the ability of Complementary and Alternative Medicine to continue its vital role in contributing to the improvement of local and global health outcomes in an integrated manner. While we highly respect the scientific abilities of the leading members of Friends of Science in Medicine and their right to contribute to healthy debate, we feel they are misinformed about the nature of university studies in Complementary and Alternative Medicine. As such, we are concerned at their request to disband these courses. We ask that the Vice-Chancellors make a public statement pledging to protect the high quality and science based courses in Complementary and Alternative Medicine that they currently offer.

Petition Updates (posted by Rachel McDonald Petition Organiser)

Petition mention in The Australian
Thank you to Stephen Matchett and The Australian for drawing attention to this petition. The article is entitled "Push to keep alternative medicine in universities" and was published online on Feb 2nd 2012.

Why is this a time sensitive issue?
It has come to my attention that people aren't sure why I am targeting the university. There is a meeting of Vice-Chancellors to discuss these courses being held in March. FSM want them to change the courses at that meeting. We need the Vice-Chancellors to publicly pledge to protect our courses before they go into it
"The groundswell of protest from medical professionals comes after a decision in Britain that means from this year it will no longer be possible to receive a degree from a publicly-funded university in areas of alternative medicine, including homeopathy and naturopathy
Australia's vice-chancellors will meet in March and Professor Dwyer said his group was aiming to get a commitment from them to endorse health courses only with evidence-based science"
From Sydney Morning Herald

Support is Growing
I am grateful to Professor Kerryn Phelps and Senator Hanson-Young for supporting my petition via twitter. We're growing quickly, however we still need more help. Please keep the momentum going and keep an eye out for responses. Thanks

Thank you for helping us protect Natural Medicine education in Australia … Rosana

Rosana Bouzas Member Australian Traditional Medicine Society: 26167

Free Pulse & Tongue Diagnosis

As of next week, I will be offering Free Tongue & Pulse Diagnosis sessions during the whole month of February, at Newtown.

This is a quick, hassle free examination central to Chinese medicine. Pulse and tongue qualities uncover valuable clinical information used for identifying conditions and treatment planning. Take this opportunity to meet me, if you haven’t already, and find out what acupuncture can do for you.

@Nature’s Energy (former Crystals & Beyond) 207 King St Newtown … (02) 9555 5533

Enter the Dragon … Happy Chinese New Year! So what’s in store?

Thanks to the Maya and their cryptic little calendar, 2012 is set to become one of the most speculative years in recent history. But what to make of such conspiracy and intrigue? Is the end of the world really nigh? Will aliens finally invade the earth? Are solar flares about to take us all out? Or will humanity step into a higher consciousness and save itself, from itself, at the last? Never mind those pesky aliens, it’s us we need to worry about!

Seriously, though, it’s hard to say with any degree of certainty what 2012 will eventually bring about (read on – you’ll soon understand why) but one thing’s for sure … as the Waning Crescent Moon gives way to the New Moon on January 23, more than one quarter of the folk worldwide will be celebrating in spades – Enter the Year of the Yang Water Dragon!

The Chinese aren’t too worried about the so called ‘end’ of the Mayan calendar, you see, because just like the Maya, the Chinese perceive time as cyclical rather than linear. To them the ‘end’ is no more than a new ‘beginning’, a fresh start. So what’s in store for the Year of the Yang Water Dragon? Glad you asked. Because despite uncertainty, and there’ll be plenty of that, here comes a year lugging a bag full of goodies for all of us J

For starters, this is a year of finding support in the unlikeliest of places. Why? Because Water is the ruling element, and if you take into account that roughly 70% of the world’s surface is H2O, and that we, ourselves, are no more than a bunch of water babies, you’ll soon get the correlation: the basic energetics of the Year are in harmony with the planet and everything on it, including us. Despite the Dragon’s natural independence and tendency for flying solo, the Water influence suggests that coordination, synchronisation, concord, unity, and solidarity are key elements for a good year. The Dragon energy, which verges on egotistical, is likewise dampened by Water. Therefore agreements, settlements and treaties become more likely. This makes for a year where deals are made and pacts are struck. To benefit from this dynamic, it’s wise to be open to negotiation and cooperation. Don’t be afraid of compromise. It’s a good year for collaboration and team work of all kinds.

The Dragon is considered an impenetrable creature by the Chinese. It moves in such a way that it’s impossible to see its head and tail at the same time, and as a result, it’s deemed to be unpredictable and shrewd. Its ambiguous colour is also significant, and lends it a mysterious quality. So we can expect the year to usher in the strength to resist destruction (so much for Armageddon), and to carry a degree of volatility and spontaneity. Astuteness and insight will be on the increase, as will eccentricity and peculiarity of all kinds. Things happening outside the norm are set to thrive. So if you want to prosper in the Year of the Dragon: think outside the square, expect the unexpected, keep your wits about you, and know that the unfathomable strength of the Dragon is yours for the taking.

What’s more, the Year of the Dragon highlights the Four Benedictions of the East: wealth, virtue, harmony and longevity. Resources and accumulation will feature highly this year, so watch the Dragon tendency to overspend and take care with high risk investment. The focus should be on building up, growth and increase. It’s a thriving year, and new business ventures with a focus on innovation and/or cooperation will benefit from this influence. But competition will be tough, as the energy of the Dragon drives ambitions and stirs desires. New marriages and relationships should fare well this year, but longstanding unions will be challenged to grow or perish. Infidelity and trust issues will come to the fore, as integrity, honesty and honour are put under the spotlight.

Interestingly, the East is set for expansion this year. Especially the Far East and South-East Asia will undergo a period of progress. On a local scale, Australia’s Eastern seaboard should also benefit from this energy, and in Sydney we will see an increase in development in the Eastern suburbs. On the home front, it’s beneficial to display a figurine of a Dragon on the east side of your office or workspace, especially one made of crystal, wood or earthenware. Avoid metal because its energy will negate the power of the Dragon.  Hanging a picture of a Dragon on the eastern wall works just as well, but be especially mindful of not placing the creature in your bedroom.

It’s little wonder that the Emperors of old chose to associate themselves with the symbol of the Dragon, which is still considered exceptionally lucky today. Those born under the sign are said to be blessed, so a watch for a boom in Asian birth rates this year. After all, who wouldn’t want their child favoured by the Dragon’s Cosmic Breath?

Good luck in 2012!



Preventive Acupuncture … What is it?

Ancient Chinese Medicine practitioners stressed that it was wiser to treat the healthy, and in the process prevent disease, than to treat the sick only after illness had taken hold. In my previous post I explained this more fully, and I also described how I came to learn the value of that philosophy in person. Now if you read that post, you may have gathered that as an acupuncturist, the focus of my clinical work is Prevention. And you’d be right. My business card makes that very point: Prevention is Better than Cure … because I believe in that age old common sense approach wholeheartedly. However, if by chance, you came to the conclusion that I don’t, won’t or only reluctantly treat existing complaints – you’d be mistaken. Why? Well for starters, it has nothing to do with my bottom line.

The way I practice preventive acupuncture is in stages. I stress the I factor here, simply because not all acupuncturists practice in the same way. There are as many ways to practice the art as there are practitioners out there, and if you’ve ever tried acupuncture or other natural therapies with more than one health worker, you would have noticed this for yourself. So, the way I practice preventive acupuncture is in a four-fold manner. Let me explain.

When a patient consults with me, the first question I ask is: ‘How can I help you?’ A no brainer, right? Well, not quite. The reason I ask this question is to quickly ascertain what stage of preventive acupuncture I need to apply with this particular patient at this particular time. It’s important for me to establish this right away, because to a great extent, it determines which diagnostic methods I use from that point onwards, which differentiation model to choose, what treatment protocol to follow, what acupuncture prescription to write, and what other techniques, such as warming, cupping, etc I will apply. All this after the first question, you may ask. That’s exactly right, because I know the answer to ‘How can I help you?’ will invariably involve one of four responses:

1.      First Stage Prevention: The answer here will go something like this – ‘I’m not sure how you can help me, or if you can help me, because apparently there’s nothing really wrong with me. I just don’t feel well but my doctor can’t pinpoint it. Sometimes I get headaches/aches and pains/I feel sluggish/I don’t sleep real well/I feel tired/stressed/foggy/ etc. I’m sure there’s something wrong with me but my bloods/pressure/function tests/scans/ etc don’t show anything abnormal.’

Or sometimes … ‘I’ve come to see you because I’ve never had acupuncture, I’ve  wanted to try it for a long time but didn’t know how to go about it until so and so recommended you/I saw your ad/read your blog/ etc.’

2.      Second Stage Prevention: This answer will be along these line – ‘I always get a migraine just before/during/after my period and I’m sick of it/ I used to be a professional dancer. I still like to keep in shape but I get these pains down the sides of my legs when I stretch. The physio reckons it’s sciatica, what do you reckon?/ Every now and then I break out in an itchy rash. My doc says it’s urticaria and now wants me to use a corticosteroid lotion, but I don’t want to cause I hear it stains the skin/ I’m on my third course of antibiotics for a dry cough that just won’t go away/I’m a sinus sufferer. I usually manage it ok, but I just want to get rid of it altogether, is there a cure?/ etc.’

3.      Third Stage Prevention: This answers sounds a bit like this – ‘I’ve recently been diagnosed with heart disease and my wife told me to come here. I actually feel fine/ I’m going through menopause and I think I might be depressed/ I’ve got RSI. I think it’s getting worse but I’m allergic to anti inflammatories / There’s something wrong in my uterus, my periods are getting really strange/etc.’

 Or … ‘I fell and twisted my ankle/ I passed gallstones/ I can’t get pregnant/ etc.’

4.      Fourth Stage Prevention: Finally, this answer – ‘I have rheumatoid arthritis/I’ve been an asthmatic since I was a small child/I’m a diabetic/ I have chronic fatigue syndrome/I have crohn’s disease/I have lupus/ etc.’

Notice the difference between the answers and you’ll get an idea of how I practice. Treatment strategies for first stage patients involve preventing the onset of disease generally. These patients are not sick, but they may still want to feel better, physically, mentally, emotionally, etc. I enjoy treating these patients because I can do things with them that I can’t do with the others, at least not initially, and these patients allow me to delve into the more esoteric acupuncture practices which I really dig.

Care for second stage patients is more about preventing the recurrence of some particular ailment. These patients are more able to define what is wrong with them, and are either seeking help for the first time, or (the more likely scenario) have done the health rounds already and have come to see me as a kind of last resort. Treatment here needs to first address the condition until the signs and symptoms improve and then move onto prevention of recurrence, which also eventually involves stage one, preventing the onset of disease generally, that is, preventing other diseases.

I find third stage patients the most challenging, but don’t get me wrong, I enjoy a challenge. At this stage the main treatment outcome involves preventing further damage and/or preventing the condition from getting any worse. Sporting injuries and many long term musculoskeletal disorders fall into this category, so do some types of chronic diseases, though chronic illness tends to fall mainly into fourth stage. It’s important at this stage (as in all stages, but more so here) to look at lifestyle factors and modify what can be changed, for example diet, smoking, alcohol intake, etc. Most of the patients I see fall into this category and my intention is always to move them up to second stage (managing and eventually preventing recurrence). Once this is established we can look at progressing to first stage.

Finally, there is fourth stage, or managing chronic illness and persistently recurring disorders, often of the type that are characterised by acute onsets with periods of remission. These complaints, often called syndromes because of the complex nature of the pathophysiology, are very difficult to treat successfully. Often these patients are well aware of that fact and are simply looking for ways to better manage their conditions. Treatment here is aimed at addressing the acute onsets, when they occur, and working preventatively during times of remission. Because of the multi-layered nature of these conditions, which often involve systemic or all body processes, it’s difficult to move these patients up the preventive ladder. That is, move away from managing their condition to preventing further damage or a worsening of symptoms with the next recurrence. It can be done, but moving any further up is difficult, although the prevention of many complicating factors can be achieved.

These stages are not set in stone, however, the margins can blur and there can be significant overlap. This is simply the working model I use to determine how to best assist my patients at any given time.

If you’re interested in acupuncture and want to learn what a consultation at any of these stages looks like, join me again as I explore this further and also take a closer look at what well-ness is. Tips and hints for self-help also coming up …

Four Years on a Bed of Spikes or How I Learnt about Preventive Health Care …

I spent a prickly four years at uni, and I mean that literally. Imagine this: a room crammed with acupuncture students (read enthusiastic amateurs) practicing their new found skill on each other. Ouch! I was needled (read stabbed), pierced, stuck, speared, slashed, gored, and gouged on a daily basis. We were rehearsing the ‘gentle’ art of acupuncture, and we were violently passionate about it. We held those fine little needles in our rough little hands and went for it no holds barred. Right under the noses of our instructors, mind you, who looked on bemused by our incompetence and could do little more than rescue the bleeders. But did we eventually learn the subtle techniques of acupuncture needling? Oh yes, we did! And something quite extraordinary happened to us over those four excruciating years … we rarely, if ever, got sick J In its essence, you see, Chinese Medicine is preventive health care at its finest. It was an agonising lesson to learn, but one definitely worth the pain.

The following quote from the Yellow Emperor's Inner Canon (Huangdi Neijing), an ancient Chinese medical text, illustrates just how much Chinese Medicine has traditionally valued preventive health care over curative and palliative interventions: “The sages of antiquity did not treat those who were already sick, but those who were not sick ... When a disease has already broken out and is only then treated, would that not be just as late as to wait for thirst before digging a well, or to wait to go into battle before casting weapons?” By and large, traditional Chinese doctors were retained to keep the townsfolk from getting ill. Sick folk can’t support a doctor as well as healthy folk, you see, so it made a great deal of sense for the doc to keep his patrons healthy. To be the Emperor's personal physician, however, was the ultimate honour. But woe betide he who allowed the sovereign to get sick. In imperial China, a physician’s skill in the art of preventive measures could literally save his own skin!

But back to the future: Now let’s contrast these ideas to our current concept of medical care. Health care in this day and age is mostly curative, that is, a restoration from illness to health. Just a cursory glance through the window of your friendly, local doc’s waiting room will highlight this. It’s packed full of coughing, limping, teary eyed, downcast figures just waiting patiently for their turn. We’ve all been there. And as for the Emergency Room or waiting lists of your local hospital, forget it, you don’t want to go there! Quite literally, if no one ever got sick, our health care industry would be mostly redundant.

Sure, our Western medical system also takes preventive measures of sorts, immunisation regimes, for example, are a case in point. So is early screening and the spate of blood testing that goes on nowadays. Public health measures to raise awareness of healthier lifestyle choices are also ongoing. There’s the stop smoking campaigns, the promotion of regular exercise as a means of keeping fit, and the call for weight management to prevent many of our, so called, lifestyle diseases. Birth control, come to think of it, is another form of medical prevention, as is the enforced fluorination of our drinking water to prevent tooth decay. But on the whole, our modern medical model remains mostly curative and palliative. We’ve become quite adept at managing chronic illness and helping people to quietly pass away.

Don’t get me wrong, there’s nothing unethical about helping folk cope with crippling illness and imminent death. There’s a whole lot of good in our medical model, too. In the realms of emergency intervention and life saving operative techniques, Western medicine has no rivals. My own daughter, at the tender age of 13, recently underwent radical spinal surgery to correct a gross structural scoliosis. Had it not been for that intervention, she would have certainly suffered a lifetime of incapacitating disability. No siree, there’s definitely a brave new world of technological advancement out there in the heroic field of modern medicine, that I neither mean to refute or undermine. Trust me.

I’m simply saying there’s also another way, and prevention is better than cure, hands down. For those of us who have not yet succumbed to the wrath of our lifestyles, and are not suffering with ailments, like my daughter, that need swift, specialised adjustment, there is certainly help at hand. We can take good, natural measures today to prevent illness tomorrow, and in doing so, eliminate all of those niggly health complaints we hardly have words for: sluggishness, heaviness, fogginess, stiffness, aches and pains, mild anxieties and stress, fullness, insomnia, and just plain feeling out of sorts, felling a lack of well-ness. I learnt that the hard way!

I exaggerate of course. In reality, I discovered acupuncture as a preventive tool in the most harmless of ways. Our class was full of camaraderie and fellowship. We learnt together. No measly needle stick injury could stop the likes of us. Especially not when a couple of years down the track we all started to look around us and actually notice none of us ever got ill. Not really. No unexplained absences, bar a couple of pregnancies. No sniffly kid in the corner. No mysterious aches and pains. Our teachers never told us to expect this, we eventually figured it out for ourselves. How clever of them …

In my next few posts I will try to explain how acupuncture works to prevent disease and rid you of all those minor, hard to pin and eliminate health complaints that keep you feeling unwell. If you have an interest in remaining healthy or just plain want to feel better … watch this space!

In response: Kidney function and Irritable Bowel Syndrome (IBS)

Hi and a big thanks to everyone who’s checked out my blog. I’ve had a great response to my first post from patients, family and friends. With respect to that, I’ve had a number of questions concerning the Kidney’s relation to bowel function, and I’d like to respond before moving onto the next topic.

Before I get into it, I need to clarify that the Kidney of CM is not synonymous with our Western idea of the kidneys. In an anatomical sense, yes, they are one and the same, but as far as function is concerned the Kidneys of CM have a wider scope of influence in the body. In addition to the many physiological functions of the Kidney, there are the energetic functions to consider as well. I’m not going to go any further into that for now, as it would take us away from the topic of this post, except to reiterate that when a CM practitioner refers to Kidney in CM jargon, they are usually referring to the organ network, including the channel and all its interrelated parts. I always use capital letters to differentiate between the CM organs and our Western understanding of these, and when I speak about Kidney in CM terms I use the singular, as is used in CM, and I use the plural kidneys, when speaking in Western terms.

But back to topic: I chose to point out how CM jargon can be incomprehensible to patients by referring to a case of irritable bowel syndrome (IBS) characterised by what the Chinese refer to as: ‘cock’s crow diarrhoea’ or chronic (long term), loose bowel movements in the morning. In CM, as in Western medicine, diarrhoea is usually due to disorders of the small and large intestines, the stomach, and in CM also the Spleen (once again not synonymous to our understanding of the spleen as such), and is clinically distinguished into acute and chronic types.

In CM theory, the Stomach dominates receiving food and water and the Spleen dominates what is termed: Transportation and Transformation of food and water into the ‘essence of food and water’. When the Stomach and Spleen are diseased, normal digestion and absorption of food and water is disturbed, resulting in a mix of ‘essence’ with waste products passed through the large intestine as diarrhoea. In CM, the Spleen Yang (functional aspect of the organ) is closely related to the Kidney Yang, because the Kidney is the source of all Yang. This is one of the many energetic functions of the Kidney, it provides the body with its capacity to function optimally.

So let’s look again at our case. The complete sign and symptom picture was as follows: Lower abdominal pain, borborygmi (stomach noises) and loose stools in the morning, all relieved after bowel movement and aggravated by cold. All signs of under functioning  Kidney Yang. A cold, distended abdomen, plus cold legs and feet were also present, as was a pale tongue with a white coat, and a deep, forceless pulse. All further signs of Yang deficiency, this time of the Spleen and Stomach, that is, Kidney Yang not supporting Spleen Yang function. You will have noticed that Yang deficiency is characterised by a lack of warmth. Providing warmth, proper movement and function being a major task of the Yang energy of the body.

Treatment strategies in CM always aim to correct the ‘root’ or cause of a presentation, and not merely resolve the ‘branches’ or signs and symptoms. That’s why invigorating the Kidney Yang with tonification methods and adding warming techniques through moxibustion became important in this case.