Chiu 2010.

Methods	Randomised controlled trial. Computer‐generated block randomisation list, with block sizes of 4 and 8, used to ensure even distribution of participants (30 in each group).
Participants	60 breastfeeding women recruited from a medical centre in central Taiwan. Inclusion criteria: a) breast engorgement (diagnosed as having hot, painful, hard breasts; non‐flow of milk; abnormal thirst levels; and breast tenderness); b) no high‐risk complications both before or following childbirth (˝high risk˝ not defined); and c) willingness to participate.
Interventions	Intervention group (27 participants): short and soft Gua‐Sha scraping therapy was applied to acupoints ST16, ST18 and SP17, in the direction of the nipples. In addition, scraping therapy was applied between the engorged breasts to acupoints CV17. Each position was lightly scraped 7 times in 2 cycles before the next breastfeed. Intervention time was 2 +/‐ 0.5 min. Control group (27 participants): small towels were immersed in hot water, of 43 ± 2 °C, and then applied to the breasts. This was followed by massage, done using the index and middle fingers in a spiral motion towards the nipples. Intervention time in the control group was 20 ± 2 min.
Outcomes	Breast engorgement symptoms based on SBES measured at 5 min and 30 min post‐treatment. SBES addresses pain, engorgement and discomfort, measured with a visual analogue scale (0 to 10). Breast and body temperatures (measured with digital infrared thermal imaging system) and vital signs (BP) were recorded at 5 min and 30 min post‐treatment.
Notes	The standard deviation of changes from baseline was missing for all variables so we used a correlation coefficient of 0.80 to impute the change‐from‐baseline standard deviation according to the formula provided in the Cochrane Handbook for Systematic Reviews of Interventions (Ch. 16.1.3.2). Mild skin redness and elevation was noted in the intervention group but no discomfort was expressed by study participants.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	˝Computer‐ generated block randomisation list.˝
Allocation concealment (selection bias)	Unclear risk	Not reported. Author contacted, additional information not provided.
Blinding (performance bias and detection bias) Women	High risk	˝Open trial, i.e., all participants knew to which group they had been assigned.˝
Blinding (performance bias and detection bias) Clinical staff	High risk	˝Open trial˝; ˝the primary investigator handled all interventions.˝
Blinding of outcome assessment (detection bias)	Low risk	˝All data were collected by a nurse who was blinded to patient group assignments.˝
Incomplete outcome data (attrition bias) All outcomes	Low risk	Author contacted to clarify inclusions/exclusions: 60 participants initially recruited of which 30 in the experimental group and 30 in the control group. 6 women were ˝removed˝ from the study due to: fever (n = 2), early discharge (n = 2) and fatigue (n = 2). Final number of participants: 54 (27 in each group). Hence, attrition appears balanced in number and reason across groups.
Selective reporting (reporting bias)	Low risk	BP results not reported, but least relevant to study objectives.
Other bias	Low risk	˝The groups showed no statistically significant differences in any variables except for age. No significant differences were found between groups in terms of pretest variables.˝