bubble_chart Concept

Dysphoria during pregnancy refers to the state of a pregnant woman feeling anxious, restless, and depressed. It was anciently termed "dysphoria during pregnancy". Yixue Xinwu states: "The condition of dysphoria during pregnancy, if not properly managed, may lead to threatened abortion. Caution is advised." For instance, in the initial stage [first stage] of pregnancy, a slight feeling of feverishness is a common phenomenon and does not fall under the symptoms and signs of dysphoria during pregnancy.

The diagnosis of dysphoria during pregnancy must be based on "a pregnant woman having no other fever but feeling constantly troubled in heart." If the feverishness is due to other illnesses, then it should be considered separately.

bubble_chart Pattern Analysis

1. Yin Deficiency︰During the fifth or sixth month of pregnancy, the heart feels restless, with no peace in sitting or lying down. There may be vexing heat in the chest, palms, and soles, or afternoon tidal fever, dry throat and mouth, but no desire to drink much, and scanty yellow urine. The tongue texture is red, with thin yellow and dry coating or no coating, and the pulse is thin, rapid, and slippery. This condition often arises from pre-existing deficiency of yin blood, as the blood gathers in the uterus to nourish the fetus, further depleting yin blood. Yin deficiency leads to internal heat, and deficient heat disturbs mental activity, resulting in restlessness—this is a case of deficient heat. Common symptoms include vexing heat in the chest, palms, and soles, afternoon tidal fever, dry throat and mouth, but no desire to drink much. The treatment principle is to nourish yin, clear heat, relieve restlessness, and calm the spirit. The recommended formula is Ginseng Ophiopogon Tuber Powder.
2. Phlegm-fire︰Pregnant women experience palpitations, timidity, restlessness, heaviness of the head, vertigo, or fullness in the middle abdomen, sticky mouth, aversion to food, occasional nausea, vomiting of phlegm and saliva, yellow greasy tongue coating, and slippery pulse. This is mostly caused by internal retention of phlegm-fluid, excessive yang qi during pregnancy, and the interaction of phlegm-heat, which rushes upward to the heart. Symptoms include heaviness of the head, vertigo, irritability, chest tightness, vomiting, aversion to food, yellow greasy tongue coating, and slippery pulse. Taiping Shenghui Fang states in the "Treatises on Phlegm-Heat Formulas": "Phlegm-heat in the upper energizer causes dizziness, blurred vision, mental restlessness, and inability to eat." Shen's Nyuke Jiyao{|104|}·Dysphoria During Pregnancy{|105|} adds: "If caused by phlegm, the chest will inevitably feel full." Treatment should focus on clearing heat, resolving phlegm, relieving irritability, and calming the spirit. The recommended formula is Bamboo Juice Decoction with the addition of Fritillaria thunbergii and Tabasheer.
3. Liver Qi Depression︰Pregnancy for several months, feeling frightened and timid, restless and uneasy. Depression and irritability, distending pain in both flanks, frequent sighing. Tongue texture red with thin yellow coating and scant fluid, pulse wiry, slippery, and rapid. Mostly caused by anger and overthinking, liver depression qi stagnation, prolonged stagnation transforming into heat, wood fire flaring upward, disturbing the heart-mind, leading to restlessness—this is depressed heat. The key points of pattern identification are: the presence of liver qi stagnation signs, such as distending pain in both flanks, chest tightness, frequent sighing, depression and irritability, etc. From pulse manifestations, yin deficiency presents with a small and thin pulse; liver depression must show a wiry pulse. If accompanied by signs of yin deficiency such as a mirror-like tongue without coating or a peeling coating, it further aids in differentiation. The treatment principle is to soothe the liver and relieve depression, resolve stagnation and discharge heat. The recommended formula is Peripatetic Powder with modifications.

Regarding the condition of dysphoria during pregnancy, Li Taisu once clearly stated: "After conception, the blood becomes hot in the heart, and the heart qi is not clear, hence the person feels depressed, agitated, and restless. It is due to the pregnancy that one feels vexed, hence it is called dysphoria during pregnancy. It is not the child in the womb that is causing the vexation." The reasons for a pregnant woman's heat disturbing the heart spirit are none other than yin deficiency, phlegm fire, and liver depression. These should be differentiated based on clinical manifestations.

bubble_chart Documentation

1. Puji Fang．Pregnancy Various Phlegm Disorders: "For those experiencing pregnancy with symptoms of deficiency vexation and heat agitation, it is due to excessive yang qi, where heat energy acts alone, causing distress in the heart region, headache, red face, and yellow, astringent urine, and in severe cases, painful urination. The disease source also refers to this as dysphoria during pregnancy."
2. Also: "In the seventh or eighth month of pregnancy, injury from summerheat leads to dysphoria during pregnancy. Fetal qi disease pressing upwards causes throat obstruction, heart and abdominal distension and fullness pain, a sensation of sinking as if with dysentery, and each time one goes to the toilet, sitting for the duration of a meal, suddenly the qi descends, allowing for a single bowel movement. Common practice is to use dysentery medicine, not realizing the disease lies in fetal heat dysphoria during pregnancy. Use Minor Bupleurum Decoction with Coptis and Donkey-hide Gelatin pills."
3. Yixue Xinwu．Women's Disorders: "If there is spleen-stomach weakness with vomiting, reduced food intake, and heart vexation, use Six Gentlemen Decoction."
4. Zhangshi Yitong．Women's Disorders: "If during pregnancy there is restlessness, and the head and eyes feel heavy, it is due to heart and lung deficiency heat."