Breast Milk not Flowing (and Acute Mastitis)

CHAPTER 53 Breast Milk not Flowing (and Acute Mastitis)

AETIOLOGY 657
PATHOLOGY 657
IDENTIFICATION OF PATTERNS AND TREATMENT 658
Qi and Blood deficiency 658
Liver-Qi stagnation 660
Ancient acupuncture prescriptions for lack of milk 663
PROGNOSIS AND PREVENTION 663
WESTERN VIEW 663
APPENDIX: ACUTE MASTITIS 664
TREATMENT 665

This condition consists of scanty or absent breast milk after childbirth. I have preferred the term ‘Breast Milk not Flowing’ to ‘Insufficient Lactation’ or ‘Agalactia’ because the last two terms both imply a deficiency, a lack of a vital substance; lack of breast milk, however, may be due not to a deficiency of milk but to an obstruction or stagnation that prevents the flow of milk.

Aetiology

Severe blood loss during labour, long labour

Profuse blood loss during labour leads to deficiency of Blood: since Blood is the source of breast milk, deficient lactation results. A long and difficult labour leads to depletion of Qi and this may result in insufficient lactation when there is not enough Qi to express the breast milk.

Emotional problems

Emotional problems such as worry, anger, frustration or resentment cause stagnation of Liver-Qi: the Liver influences the breast and controls the nipple, and stagnant Qi obstructs the Connecting channels of the breast so that the breast milk cannot flow.

Pathology

The pathology of insufficient or absent lactation can be clearly differentiated between deficiency and excess: breast milk may be deficient because its source, Blood, is deficient; or there may be enough milk but it does not flow properly due to stagnation of Qi in the breast. Fu Qing Zhu places a special emphasis on distinguishing between the two main causes of insufficient lactation: a deficiency of Qi and Blood; or stagnation of Qi in the breast. He also places special emphasis on the role of Qi in lactation.

To transform breast milk from Blood needs Qi’s action and to express it needs Qi’s power. This situation could be compared with that of water being pumped out of a reservoir: there may be plenty of water (breast milk) in the reservoir, but if the pump (Qi) is inefficient, the water will not flow.

Fu Qing Zhu says:

Breast milk is a product of the transformation of Qi and Blood. Milk cannot be generated without Blood, but it also cannot be generated without Qi … without Qi, breast milk cannot be transformed, without Blood it cannot be generated. Of the two, Blood is transformed into breast milk … In a woman after childbirth, Blood is exhausted … how can it be transformed into breast milk? It is due to the strength of Qi if Blood is transported and transformed into breast milk … if Qi is flourishing, milk is also flourishing, if Qi is depleted, milk is depleted.1

Breast milk is a product deriving from the transformation of menstrual Blood by the Directing and Penetrating Vessels (Ren and Chong Mai): these two vessels are the source of menstrual blood below, and of breast milk above. Zhang Jing Yue says in his Complete Works of Jing Yue (1624):

Breast milk is a product of the transformation of the Qi and Blood of the Directing and Penetrating Vessels: downward movement of Qi and Blood produces the menses while upward movement produces milk. When there is insufficient lactation after childbirth, it is due to Qi and Blood deficiency … which is due to the depletion of the Directing and Penetrating Vessels.2

The Stomach channel also plays a role in lactation as it controls the breast as a whole, while the Liver channel controls the nipple. Fu Qing Zhu says: “Breast milk is transformed from Yang Ming [channel] which pertains to Earth.”3

While the main Empty cause of insufficient lactation is deficiency of Qi and Blood, the main Full cause of insufficient lactation is stagnation of Liver-Qi. As mentioned above, the Liver controls the nipple and it easily overacts on the Bright-Yang Channels (Wood overacting on Earth). Lactation relies on the power of Qi to transform Blood into milk and to express the milk properly. When Liver-Qi stagnates, it may hinder the flow of Stomach-Qi in the breast and create stagnation there with symptoms of distension, pain and milk not flowing.

Fu Qing Zhu emphasizes the role of stagnant Liver-Qi in hindering Stomach-Qi in the breast and it is significant that Dr Fu mentions “stagnation in the Bright Yang [Yang Ming]” rather than Liver-Qi stagnation. He says:

Distension, fullness and pain in the breast show that [the breast] would like to transform the milk but cannot do so, what else beside stagnant Qi could cause this? The stagnation in Bright Yang is due to shame and resentment.4

Thus, Fu Qing Zhu clearly identifies emotional problems as the chief cause of stagnation of Liver-Qi. The Literati’s Care of their Parents (Ru Men Shi Qin) by Zhang Zi He (1156–1228) also says: “Crying, weeping, sadness, anger, depression, may all cause the breast vessels not to flow.”5

Thus, we can also see the pathology of Breast Milk not Flowing in terms of Qi and Blood, with the former either deficient or stagnant and the latter only deficient (see Figure 53.1).

image

Figure 53.1 Pathology of Breast Milk not Flowing.

In terms of differential diagnosis, Breast Milk not Flowing should be distinguished from Breast Carbuncle (Ru Yong) which is also characterized by insufficient lactation but, in addition, by systemic signs such as shivers, fever, joint pain and a feeling of oppression of the chest: Breast Carbuncle corresponds to acute mastitis in Western medicine.

Identification of patterns and treatment

The patterns discussed are:

• Qi and Blood deficiency
• Liver-Qi stagnation.

Qi and Blood deficiency

Clinical manifestations

Insufficient or absent lactation after childbirth, watery milk, no feeling of distension of the breasts, sallow complexion, dry skin, poor appetite, tiredness. Tongue: Pale. Pulse: Choppy.

Treatment principle

Tonify Qi and Blood primarily: secondarily, remove obstructions from the breast Connecting channels.

Acupuncture

ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, G.B.-41 Zulinqi, ST-18 Rugen, ST-12 Quepen, Ren-4 Guanyuan, BL-20 Pishu, BL-23 Shenshu, S.I.-1 Shaoze, Ren-17 Shanzhong. All with reinforcing method. Moxa may be used.

Explanation

– ST-36 and SP-6 tonify Qi and Blood. They are especially effective with warming needle.
– LIV-8 nourishes Liver-Blood.
– G.B.-41 removes obstructions from the breast Connecting channels.
– ST-18 is a local point for the breast.
– ST-12 influences the breasts and stimulates the descending of Stomach-Qi and the flow of milk.
– Ren-4 nourishes Blood.
– S.I.-1 is an empirical point for insufficient lactation.
– BL-20 and BL-23 tonify Qi and Blood.
– Ren-17 tonifies Qi in the chest which is necessary to express milk.

Herbal treatment

a. Prescription

– TONG RU DAN
– Penetrating the Breast Special Pill
Explanation

– Ren Shen and Huang Qi tonify Qi. As explained above, Qi is necessary to express milk.
– Dang Gui and Mai Men Dong nourish Blood and promote fluids. This is necessary because Blood is the source of milk.
– Mu Tong removes obstructions from the breast Connecting channels.
– Jie Geng acts as a messenger to direct the herbs to the Upper Burner.
– Pig’s trotter is a folk remedy to promote the production of breast milk. Traditionally in China the ‘seven-star pig’s trotter’ is used, which indicates a particularly fat pig.

This formula is from Fu Qing Zhu’s Gynaecology and the dosages indicated above are those from the source text. They are interesting because of the very high quantities of the Qi and Blood tonics and the minute quantities of Mu Tong and Jie Geng.

Modifications

• If there is a very dull complexion, dry skin, depression, exhaustion, and palpitations, add Shu Di Huang Radix Rehmanniae preparata, Bai Shao Radix Paeoniae alba, Chuan Xiong Rhizoma Chuanxiong and Shou Wu Radix Polygoni multiflori preparata.
• If there is dizziness, palpitations, five-palm heat, dry mouth and throat, a feeling of heat in the afternoon, dry stools and a Red tongue without coating, add Sheng Di Huang Radix Rehmanniae, Tian Hua Fen Radix Trichosanthis and Zhi Mu Rhizoma Anemarrhenae.
• If there is poor appetite and loose stools, add Shan Yao Radix Dioscoreae and Bian Dou Semen Lablab album.
• If there is some Qi stagnation, add Chai Hu Radix Bupleuri and Fo Shou Fructus Citri sarcodactylis.

b. Prescription

– EMPIRICAL PRESCRIPTION from Dr Cong Chun Yu
Explanation

This formula is used if there is a condition of mixed deficiency and excess, with deficiency of Qi and Blood and some stasis of Blood, Heat and Phlegm in the breasts. Thus, in such a case, although the main problem is a deficiency of Qi and Blood, the breasts would be swollen, hot and tender. The tongue presentation appropriate to this formula is a Pale body but with slightly Red sides and Swollen with a sticky coating.

– Dang Gui and Huang Qi tonify Blood and Qi respectively; the high dosage indicates that this is the primary aim of the formula.
– Lou Lu resolves Toxic-Heat and promotes lactation.
– Dong Kui Zi drains Dampness and promotes lactation.
– Wang Bu Liu Xing and Chuan Xiong invigorate Blood and eliminate stasis.
– Gua Lou resolves Phlegm and affects the breasts.
– Tian Hua Fen and Bai Shao promote fluids and nourish Blood.
– Tong Cao and Mu Tong remove obstructions from the breast Connecting channels.

c. Prescription

– SI WU TANG Variation
– Four Substances Decoction Variation
Explanation

This variation is recommended by Wu Qian, author of the Golden Mirror of Medicine (1742).6

The first four herbs constitute the formula Si Wu Tang which nourishes Blood.

– Tian Hua Fen promotes the generation of fluids and stimulates lactation.
– Wang Bu Liu Xing invigorates Blood and stimulates lactation.
– Mu Tong removes obstructions from the Connecting channels and stimulates lactation. Please note that this herb cannot be used and it should be replaced with Tong Cao Medulla Tetrapanacis.
– Pig’s trotter stimulates lactation.

Folk remedies

– Soup made with two pig’s trotters, salt and Tong Cao Medulla Tetrapanacis 5 g.
– Carp soup with spring onions, ginger, salt and Tong Cao Medulla Tetrapanacis 5 g.
– Eating Day Lily vegetables (Hemerocallis fulva) is beneficial in general after childbirth and promotes lactation.

Women’s Treasure remedy

– PRECIOUS SEA

This remedy tonifies Qi and nourishes Blood. The tongue presentation appropriate to this remedy is a Pale and Thin body.

Summary

Qi and Blood deficiency
Clinical manifestations

Insufficient or absent lactation after childbirth, watery milk, no feeling of distension of the breasts, sallow complexion, dry skin, poor appetite, tiredness. Tongue: Pale. Pulse: Choppy.

Treatment principle

Tonify Qi and Blood primarily: secondarily, remove obstructions from the breast Connecting channels.

Acupuncture

ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, G.B.-41 Zulinqi, ST-18 Rugen, ST-12 Quepen, Ren-4 Guanyuan, BL-20 Pishu, BL-23 Shenshu, S.I.-1 Shaoze, Ren-17 Shanzhong. All with reinforcing method. Moxa may be used.

Herbal treatment

Prescriptions

• TONG RU DAN Penetrating the Breast Special Pill
• EMPIRICAL PRESCRIPTION from Dr Cong Chun Yu
• SI WU TANG Variation Four Substances Decoction Variation
Women’s Treasure remedy

• PRECIOUS SEA

Liver-Qi stagnation

Clinical manifestations

Absent or scanty lactation, distension, hardness and pain of breasts, hypochondrial distension, irritability, epigastric distension. Tongue: slightly Red on the sides. Pulse: Wiry.

Treatment principle

Pacify the Liver, eliminate stagnation, move Qi, remove obstructions from the breast Connecting channels, promote lactation.

Acupuncture

T.B.-6 Zhigou, G.B.-41 Zulinqi, ST-18 Rugen, SP-4 Gongsun (on the right) and P-6 Neiguan (on the left), G.B.-34 Yanglingquan, LIV-3 Taichong, Ren-17 Shanzhong, S.I.-1 Shaoze, T.B.-3 Zhongzhu, BL-51 Huangmen, LU-9 Taiyuan, LIV-4 Zhongfeng, G.B.-21 Jianjing. All with reducing or even method.

Explanation

– T.B.-6 moves Qi and affects the sides of the breasts.
– G.B.-41 removes obstructions from the breast Connecting channels.
– ST-18 is a local point for the breast.
– SP-4 and P-6 subdue rebellious Qi in the Penetrating Vessel and pacify the Liver. The Penetrating Vessel flows over the breasts.
– G.B.-34 and LIV-3 move Qi, eliminate stagnation and pacify the Liver.
– Ren-17 moves Qi in the chest.
– S.I.-1 is an empirical point to promote lactation.
– T.B.-3 moves Qi and removes obstructions from the Upper Burner.

Related posts:

  1. Vaginal Itching (and Trichomonas and Candida Infections and Genital Eczema)
  2. Abdominal Pain after Childbirth
  3. Habitual Miscarriage
  4. Endometriosis

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Breast Milk not Flowing (and Acute Mastitis)

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