From ancient times, the Emperor Fu Xi, when determining the position of human beings within the universe, decided that the human being is in the center. From that place, between Heaven and Earth, the human being has the function of working and producing, being the living incarnation of the Fifth Station.
The most-sublime thing that we can produce as a species is another human being; however, in the process of birth, a woman can be left with a Deficiency of Yang, Jin Ye, or Xue that delays the production of colostrum and/or breast milk, or even blocks breastfeeding. In this case, the secretory function is affected because the woman does not produce breast milk.
To solve this health problem, we use the treatment method of the Imperial Vietnamese Medicine, known as Tree of Life.
We tonify the Jing and Qi roots, through the points CV 3, CV 4, CV 6, and CV 17. This allows a patient to recover the Jing she has lost in childbirth and to stimulate her Qi. We stimulate the production of substances with the right point ST 36, and by rotating the needle clockwise. Superficial puncture, at a depth of 2 mm, is performed on all acupuncture points.
Moxibustion is applied to all the points, keeping the moxa on until the patient feels that she is going to sustain a burn.
With this protocol, we are able to recover the patient's Qi, strengthen the Jing, and help her recuperate from childbirth. A single session is enough to activate milk production.
Chicken soup is recommended as food, to replenish the patient's liquids and tone up her Spleen. It is very important to keep the patient well-hydrated orally or intravenously. This not only helps to replenish all the liquids lost in the delivery but also prevents postpartum depression.
Address correspondence to:
Felipe Abreu Márquez, MD
Institute for Latin America
Urbanización Entre Ríos
Calle Sexta Manzana L1 Solar 14,
Parroquia la Puntilla Samborondón,
Province of Guayas 092301
Ecuador
E-mail: hoathienecuador@gmail.com
During lactation, when maternal milk is very sparse or totally absent—known as “lack of milk”—it is also called “insufficient milk” or “Stagnant milk.” According to Traditional Chinese Medicine (TCM), the etiology and pathogenesis are an insufficient milk source, or no milk available, or blockage of milk.1
Syndrome Differentiation in TCM
In patients with Qi and Blood Weakness, the clinical manifestations are lack of milk or thin milk, soft breasts without distension, lower energy, a poor complexion, a light tongue with a thin white coating, and a weak pulse. For patients with Liver Depression and Qi Stagnation, the clinical manifestations are lack of milk or thick milk, breast distension and pain, breast complaints of fullness and pain, depression, loss of appetite, a normal tongue with a thin yellow coating, and stringy and rapid pulse. Patients with Qi and Blood Weakness syndrome should be treated by tonifying Qi and nourishing Blood and promoting milk. Patients with Liver Qi Stagnation should be treated by dispersing the Stagnated Liver Qi to relieve their depression and dredging collateral to promote lactation.
TCM Herbal Prescriptions
Tong Ru Dan2 is given to patients with Qi and Blood Weakness and is composed of ginseng (Panax spp.), astragalus (Astragalus membranaceus), dong quai (Angelica sinensis), mai dong (Ophiopogonis spp. ) radix, mu-tong (Caulis akebiae), balloon flower (Platycodon grandiflorum), and pig trotters. For patients who consume less food and who have loose stools, we would add fried bai zhu (Atractylodes macrocephala), poria (Poria cocos), and fried hyacinthbean (Lablab purpureus). For patients with dizziness and palpitations, we would add Donkey-hide Glue (Colla Corii Asini), Chinese peony (Paeoniae alba) radix, and he shou wu (Polygonum multiflorum).
Xia Ru Yong Quan San3 is given to patients with Stagnation of Liver Qi and is composed of sickle-leaved radix bupleuri (Bupleurum falcatum), Green Tangerine Peel (Pericarpium Citri Reticulatae Viride), dang gui (Angelica sinensis), Chinese peony (Paeoniae alba), chuan xiong (Ligusticum wallichii), Chinese foxglove (Rehmanniae recen) radix, gourd (Trichosanthes spp.) root, Dahurian angelica (Angelica dahurica), Chinese pangolin (Manis pentadactyla), cowherb (Vaccaria spp.) seed, uniflower swisscentaury root (Radix rhapontici), rice-paper pith (Tetrapanax papyriferus), balloon flower (Platycodon grandiflorum), and licorice (Glycyrrhiza glabra). For patients with breast distension we would add tangerine pith (Citrus reticulata Blanco), towel gourd sponge (Spongiforma squarepantsil), and Nutgrass Galingale Rhizome (Cyperus rotundus). For patients with hard and painful breasts and/or with local heat sensations and lumps in the breasts, we would add dandelion (Taraxicum officinale), self-heal (Prunella vulgaris), Red Paeony Root (Radix Paeoniae Rubra), and liquidambar formosana hance (Fructus Lipuidambaris Liquidambar).
Acupuncture Therapy
The main points used are Danzhong (RN 17), Rugen (ST 18), and Shaoze (SI 1).
For patients with Qi and Blood Weakness, we would add Zhongwan (RN 12), Guanyuan (RN 4), Zusanli (ST 36), Sanyinjiao (SP 6), Gongsun (SP 4), and Hegu (LI 4). For patients with Liver Qi Stagnation, we would add Qimen (LA 14), Taichong (LR 3), Neiguan (PC 6), and Shenmen (HT 7).
Treatment protocol involves oblique insertion of the needles at RN 17, ST 18, and LA14; sparrow-peck moxibustion or point-thorn bloodletting at SI 1; and perpendicular insertions of needles at other acupoints. The invigoration method is used for patients with Qi and Blood Weakness. The reducing method is used for patients with Liver Stagnation and Qi Stagnation. The needles are retained for 15–20 minutes after De Qi. Treatment is given once per day, and then interval treatments are provided or the treatment is ended, according to the lactation produced.
Massage Therapy
This approach uses a kneading- or holding-massage method at RN 17, ST 18, Ruzhong (ST 17), and around the breast for 15–20 minutes. Local acid dilation and heat are also appropriate. After massage is completed, we would clean the breast and nipple immediately. This treatment is given 1–2 times per day. For the lactation Stasis that leads to agglomerate pain, local hot compresses can be used. We would then rub the agglomerated place till the agglomerate became soft.
Auricular Therapy
We would needle each point for 2–3 minutes until a warm sensation is felt in the ear. Treatment is given once every 2–3 days, alternating the left and right ears.
The main points used are Endocrine (CO 18), Chest (AH 10), and Ruxian (AH 11).
For a patient with Qi and Blood Weakness syndrome, we would add Stomach (CO 4), Spleen (CO 13), Heart (CO 15), and Kidney (CO 10) auricular points.-For a patient with Liver Stagnation and Qi Stagnation syndrome, we would add Liver (CO 12), Shen Men (TF 4), Gallbladder (CO 11), and Triple Energy (CO 17) auricular points.
Moxibustion Therapy
The main points used are Zigong (EX-CA 1), Zhongji (RN 3), and Guanyuan (RN 4). We would use mild moxibustion beginning 12 hours after delivery, at 20 minute each time, twice per day, for 3 days consecutively.
Diet Therapy
The patient would be instructed to stew 2 pig trotters and 24 g of T. papyriferus together, discard the T. papyriferus, eat the pig trotters, and drink the soup. Alternatively, a patient could stew 30 g of A. membranaceus radix, 9 g of A. sinensis, and 2 pig trotters together, then discard the A. membranaceus radix and A. sinensis, eat the pig trotters, and drink the soup. This preparation should be made and consumed by the patient once per day, consecutively, for 3–7 days.
Typical Case
A 24-year-old female had insufficient lactation for 2 months after delivery. She needed to add supplemental milk to feed her baby. She had hard and painful breasts, a depressed mood, poor sleep, a loss of appetite, a red tongue with a yellow coat, and stringy and rapid pulse.
Acupoints selection
The points chosen were RN 17, bilateral ST 18, bilateral SI 1, bilateral LA 14, bilateral Taichong (LR 3), bilateral PC 6, and bilateral HT 7.
Methods used
We performed oblique insertions of needles on RN 17, ST 18, and LA 14 at a 15° angle, shallow insertion of a needle on SI 1, and perpendicular insertions of needles on the other acupoints. These needles were retained for 20 minutes after De Qi, once per day.
Dietary Therapy
The patient was instructed to prepare the mixture of pig trotters and rice-paper pith (Tetrapanax papyriferus) and consume that for 5 days. Her lactation increased significantly, and she did not need to supplement any milk to feed her baby.
Mei Li, BS and
Xiaomei Wang, MD, PhD
Shanghai University of Traditional Chinese Medicine
Shanghai, China
Address correspondence to:
Xiaomei Wang, MD, PhD
Shanghai University of Traditional Chinese Medicine
650 South Wanping Road
Xuhui District, Shanghai 200030
China
E-mail: wxm123@vip.sina.com
Breast milk plays a very important role in the development of the neonate and is the main source of exclusive nutrition for the neonate, especially in the first 6 months. Breast milk also has many benefits for the mother, including a lower incidence of breast cancer, heart attack, type 2 diabetes, and metabolic syndrome diseases. Benefits of breastfeeding for the baby include higher intelligence quotient and reduced gastrointestinal and respiratory diseases.1–3 Promoting breastfeeding of mothers is one of the main goals set by the World Health Organization.4
In Iran, most of the hospitals are child-friendly centers and teach mothers the necessary training for successful breastfeeding. Unfortunately, despite the efforts made in this field, many mothers still cannot breastfeed their babies successfully, which frustrates the mothers. Studies have shown that several factors play roles in inadequate breastfeeding, including nutritional, environmental, biologic, social, and psychologic factors. According to studies, one of the factors in inadequate breastfeeding is the lack of sufficient milk production.5
In Iran, several pharmacologic and nonpharmacologic methods are used to help mothers produce more milk. Pharmacologic interventions include the use of drugs such as metoclopramide, carbamazepine, and domperidone, which also have side-effects. Therefore, in addition to these drug methods, use complementary and alternative medicine methods are usually tried.
In Iran, several herbal medicines have been used to increase milk production, including dill (Anethum graveolens), celery, Apium graveolens), cumin (Cuminum cyminum), carrot (Daucus carota), parsley (Petroselinum crispum), lettuce (Lactuca sativa), and fennel (Foeniculum vulgare),2 One of the herbal medicines used in Iran to increase milk, is a milk-producing preparation that contains an alcoholic extract of 6 milk-enhancing plants, including F. vulgare, anix (Pimpinella anisum), C. cyminum, A. graveolens, P. Crispum, and black seed (Nigella sativa). In addition, an aqueous extract of one of these plants—such as C. cyminum and F. vulgare alone—is also used to increase breastfeeding. F. vulgare has been used in traditional medicine for thousands of years in East Asia, India and China to treat various ailments. Studies in Iran have shown that F. vulgare increases serum prolactin levels in lactating mothers significantly and thus increases milk production.6
In addition to the above herbal medicines, acupressure on SI 1, LI 4, and GB 21 acupoints is also performed in some centers and hospitals in Iran. Acupressure is a subset of acupuncture and a branch of Traditional Chinese Medicine in which pressure is applied on acupoints to relieve specific symptoms and diseases. According to the World Health Organisation, acupuncture and acupuncture may be used to treat and relieve many symptoms and diseases in individuals.7–12 Unfortunately, widespread use of acupressure is not common in Iran at the moment, and more research is needed on this discipline.
Confirmation Statement
All authors confirm that their research is supported by Guilan University of Medical Sciences.
Latif Panahi, RN, and Somaye Pouy, RN, PhD
School of Nursing and Midwifery
Guilan University of Medical Sciences
Rasht, Guilan, Iran
Address correspondence to:
Latif Panahi, RN
School of Nursing and Midwifery
Guilan University of Medical Sciences
Rasht, Guilan 4144643199
Iran
E-mail: Latif_p2020@yahoo.com
Medical Acupuncture is pleased to continue this regular feature, Clinical Pearls, which we have found to be very useful for, and practical to, the readership, and very popular. All of us are confronted with clinical challenges, especially when dealing with therapeutic strategies. We hope this ongoing collection of Clinical Pearls will be easily accessible and ready to put into action for the benefit of our patients, and even ourselves. How often do we ask our colleagues: “How do you treat… ?” This time, we posed the question: “How do you treat reduced lactation in nursing mothers in your practice?” Herein lie your contributions. We trust that our readership will continue to participate in this section by either asking the questions or supplying the “Pearls.” If you have a “question” you would like to see answered, please send it to our managing editor, Yael Ben-Porat, at: yaelbenporat@me.com We encourage and welcome your input and participation. Please address your answers to “Pearls” to our managing editor, Yael Ben-Porat, at: yaelbenporat@me.com
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