Chinese Herbs for Lactation

Recently a practitioner posted a query on our Chinese medicine egroup wondering about a patient who suffered from insufficient lactation. It gave me the idea to post some interesting and very helpful material for this type of thing. Anyone working with women during pregnancy and through the postpartum time will come up on nursing issues and Chinese herbal medicine has so much to offer. I myself had insufficient lactation some 21 years ago and made myself some Pig’s Trotter Soup (see below) and experienced first hand the way it worked instantaneously.

In the Graduate Mentorship Program we spend a 3 full days on treating women during pregnancy and postpartum and some of the principles taught in this program are illustrated below. I’d like to mention these before going into the case studies:

When seeing women during the postpartum time, there are several checks that need to be done along with your regular intake and diagnosis. All of the issues you check for have an influence on the breast milk.

The first thing you check for is the woman’s appetite and thirst. If the woman has a poor appetite, it will be difficult for her to transform her foods and fluids into breast milk. In addition, if she is not thirsty, she will not take in enough fluids to produce milk. One must get to the root of why she has a poor appetite or lack of thirst.

The second check is her bowels. It is quite common for a woman to become constipated after giving birth. Yang Ming is the Dry Metal of the West. This means that the stomach and large intestine can tend to become pathologically dry. If this happens, not only might the stool stop, but the fluids to create breast milk can get dried up as well. In addition, constipation itself, even if not caused initially by dryness, can create dryness. When thinking about insufficient lactation, it is vitally important to ask about the bowel movements.
The third and final check is regarding the lochia. The lochia is the residual material left in the uterus after giving birth. There is some bleeding after birth that can continue for up to 3 weeks. If that bleeding becomes profuse or lasts too long, the can drain the vital fluids from the breasts.  Of course pathological lochia bleeding is an issue unto itself that deserves its own chapter in a book.  There are a variety of causes and methods for working with this that vary from the usual methods for stopping bleeding because of some of the special characteristics of the postpartum time.  

In one of the cases below, we can see that Dr. He Shao-Shan had to deal with the 45 day lochia bleeding and the constipation his patient suffered from before he could address the insufficient lactation directly.

So on with these 4 case studies which each show a slightly different angle on the issue of insufficient laceration.  I especially like Dr. Zhu’s ideas regarding food therapy.  Enjoy!

Postpartum insufficient lactation
(from 何少山: 医论医案经验集 Dr. He Shao-Shan’s Gathered Medical Discussions and Cases from Experience, 2007 )

Breast milk is transformed from Jing and blood.  In the Jing Yue Quan Shu it says, “Women’s breast milk is transformed from the blood and qi of the Chong and Ren vessels.  When it goes down, this is the menstruation.  When it goes up, this is the breast milk.”  Chen Su-An’s Correcting and Explaining Gynecology writes “When there is scanty breast milk, this is always due to deficiency of the spleen and stomach with insufficient intake of food and drink.  This will lead to insufficient lactation.  Recovery will ensue when the stomach Qi is greatly supplemented.  When the stomach flourishes, the Jing and Qi of water and grains generate new blood.  When the blood is full bodied, the breast milk is naturally sufficient.

Case 1
Ms. Dong, age 29

Ms. Dong was a staff member at the general party committee’s central office.  She came for her first visit on September 4, 1999.  She was 18 days postpartum and her breast milk was very scant.  She gave birth on August 20 at the labor and delivery department of our hospital.  After she gave birth her breast milk was scanty and her breasts were empty and slack without any distention or fullness.  She experienced palpitations, shortness of breath and weakness.  Her lochia had not stopped flowing and it was a pale color.  There was no abdominal pain.  Her stool was scanty.  Her complexion was sallow and her tongue body was pale with thin moss.  Her pulse was thin and weak.  This was postpartum Qi and blood deficiency weakness.  There was insufficiency of the source of the breast milk.  It was necessary to supplement Qi and nourish blood, open through the Luo vessels and hasten lactation.

I gave her 3 packages of the following formula:

After taking the 3 packages, this patient’s breasts began to feel distended and her breast milk slightly increased and her other symptoms cleared.

DISCUSSION

When there is postpartum Qi and blood deficiency and weakness with insufficient lactation one should strongly supplement.  Dr. He Shao-shan liked to use Dang Gui Bu Xue Tang with a large amount of Huang Qi to greatly supplement the Qi of the spleen and lung.  This is combined with Dang Gui to harmonize and nourish the blood.  When the Qi flourished the blood is generated.  The flavor and Qi of Dang Gui is thick and it is Yin within Yin and therefore it is able to enrich Yin and nourish blood.  Huang Qi is an herb to supplement Qi.  In the original formula 30 grams were used.  5 times as much Huang Qi is used compared to the Dang Gui, which was recommended to be 6 grams.  But, given the low proportion of Dang Gui, how could this be a decoction for supplementing blood?  Blood has form and is generated from the formless Qi.  One must increase the herbs that have form. When Dang Gui leads then the source will generate blood.  The classics say, “Yang generates and Yin grows.” This case illustrates the meaning of this.

He Shao-shan uses a large amount, 60 grams, of Huang Qi.  He adds Shu Di Huang to enrich Yin and nourish blood and Wang Bu Liu Xing, Tong Cao and Zhi Shan Jia Pian to open through the luo vessels of the breast.  Here the Qi and blood are both supplemented and nourished so there is no need to worry about the amount of breast milk.

Case 2
Ms. Bi, age 33.

This patient came for her first visit on March 27, 2000.  She had given birth 2 ½ months previously though her lochia had not cleared.  A bimanual exam showed that her uterus had returned to its normal size.  The blood color was dark brown or pale and her breast milk was scanty.  It was necessary to nourish blood and consolidate the Chong, transform stasis and generate the new.  I gave her 5 packages of the following formula:

Second visit: April 3, 2000.

After taking the Sheng Hua Tang with Huang Qi the bleeding cleared.  Her bowels were difficult and her milk was scanty.  I continued with the same principle and gave her 10 packages of the following formula:

I saw Ms. Bi again on April 17, 2000.  On the 6^th of April she bled a moderate amount.  After 9 days it stopped.  I diagnosed this as menstruation.  She felt back soreness, her breast milk was still scanty but her bowels were moving smoothly.  Her tongue was red and slightly crimson.  Her pulse was thin and rapid. I again decided to nourish her blood and consolidate the chong.  I gave her 10 packages of the following formula:

Her next visit was on May 8^th, 2000.  Her postpartum illness was better.  Only the symptom related to her breast milk remained. I gave her 14 bags of modified Dang Gui Bu Xue Tang:

After the last herbs her breast milk increased and her bowels were fine.  When she over worked her back would become sore but over all the formula had been effective.  Going forward I gave her the following formula to consolidate the result.

DISCUSSION

In this case of insufficient lactation there was lochia bleeding accompanying the main complaint.  Nourishing the blood and consolidating the chong vessel, transforming stasis and generating the new, attained the desired result for the insufficient and difficult flow.  After the lochia had cleared, Dr. He Shao-shan used a large dose of Huang Qi and Dang Gui for a relatively long period of time and this was effective.

Case 3
Ms. Su, age 26, Bank worker

This patient came for her first visit on October 31, 1997.  She was postpartum 20 days.  Both of her breasts had been distended and painful for 5 days.  She had given birth on October 11 and her breast milk did not flow smoothly right away. In the last 5 days, the pain and distention developed.  The left side was extreme and was very painful when touched.  There was also a hard knot. On this day she had developed fever and chills.  Her bowels were dry and her lochia had cleared.  Her tongue was red with thin yellow moss at the root.  Her pulse was thin and rapid.  This was stagnation and blockage of the Qi mechanism.  The Luo vessels of the breast were blocked.  This congestion had developed into heat.  It was necessary to regulate the Qi and open through the Luo vessels.  At the same time I needed to clear heat and scatter nodulation.  I have her 5 packs of the following formula.

I gave her 500 grams of Pu Gong Ying to boil and apply externally and urged her to continue nursing.

After 5 packages her fever receded and the abscess on her breast had gradually diminished.  Her breasts were still distended and the breast milk was still not flowing easily.  I continued with the same ideas, giving her 5 packages of the following formula:

After the above herbs, her breast milk flowed smoothly.  I gave her 5 more packages and she was cured.

Discussion:

Although the cause of breast abscess can be due to Liver constraint transforming to fire, there are other causes and these are not all the same.  There is stomach heat and congestion, nipple damage, infectuous toxin, lowered resistance or contracting external influences.  However the cause can be summed up as Yang heat illness of the breast.  When the breast is red and swollen with fire toxin, hardening and pain that is intensified by touch.  This is a problem of stasis and knotting.  The treatment is basically the method of clearly heat, resolving toxin and transforming stasis.  For this I used Pu Gong Ying, Jin Yin Hua and Lian Qiao to clear heat and resolve toxin.  Xia Ku Cao and Xiang Bei Mu and Zao Jiao Ci soften hardness and scatter nodulation.  Chuan Shan Jia is effective for dispersing.  It’s nature moves and scatters and is effective for opening through and descending the breast milk.  When these herbs are combined with Wang Bu Liu Xing, Lou Lu and Lu Lu Tong.  These herbs are able to vitalize the blood, scattering stasis, opening and moving the channels and Luo vessels.  Breast pain is basically a local illness however, there is a close relationship between the foot Jue Yin Liver channel and the foot Yang Ming stomach channel.  The Liver stores the blood and is responsible for the Qi mechanism of the whole body.  The stomach is the sea of the 5 Zang and 6 Fu organs.  The 5 Zang and 6 Fu organs are all subservient to the Qi of the Stomach.  Because of this, when there is breast pain it is not only steaming heat in the breast.  There are also whole body symptoms of fever, aversion to cold.  When treating breast abscess, the whole picture must be seen with careful attention to differentiating the presentation and treating.  One must focus on the particular circumstances surrounding the local problem.  Dr. He Shao-Shan uses a variety of external methods.  When the breast was red and swollen, he often uses Pu Gong Ying as an external wash.  If the knotted lump is difficult to disperse, Dr. He often adds Pi Xiao (Glauber’s Salt) as an external method.  Internal and external methods are used together and the treatment is effective.

Case 4 by Dr. Zhu Xiao-Nan
Ms. Wang, age 27, married, peasant

In September of 1959 Ms. Wang gave birth to her third child.  45 days after this she developed dizziness, back soreness, chest and abdominal distention and her breast milk was insufficient.  The result was that the baby cried noisily and the mother became extremely depressed.  At that point she came in for a visit.

Check up on October 22.  She had insufficient breast fluid, her complexion was dark and yellow, weariness of spirit and dizziness.  Her pulse was thin and weak while her tongue body was pale with thin white moss.  This was Qi and blood deficiency and weakness.  The source of the breast milk was deficient and depleted.  The treatment focused on fortifying the spleen and boosting the blood while filling and nourishing the breast milk.

Ms. Wang’s next visit was on October 26^th and after taking the enriching and nourishing herbs her breast milk had increased.  There had also been a change for the better with the dizziness and chest oppression.  She still had back soreness and weak limbs and her bowel movements were not good.  This was dual deficiency of the Liver and Kidney with scanty blood and intestinal dryness.  My treatment focused on consolidating the Kidneys, nourishing the blood, opening through the breasts and moistening the intestine.  I gave her the following prescription:

Discussion:

There is often insufficiency of breast milk in women who suffer from Qi and blood weakness and depletion.  In the Fu Ren Liang Fang (Wonderful Prescriptions for Women) is says, When a woman’s breast milk does not move the is due to Qi and blood weakness and depletion.” The breast fluid is generated from the transformed blood.  Blood deficiency causes the source of the breast milk to be diminished so that there is not enough milk.  This is definitely the principle behind this problem.  If one simply gives herbs to open through and course in order to create a flow in the breasts, this will definitely be ineffective.  One must regulate and nourish the Qi within the blood with one or two flavors to move and open through the breasts.  Then the effect will be good.  The formula for this case is based on Huang Qi Ba Wu Tang.  This formula is from the Yi Lue Liu Shu (6 Texts of Medical Summary) and it includes Shu di, Huang Qi, Bai Zhu, Fu Ling, Dang Gui, Chuan Xiong, Bai Shao and Zhi Cao.  Gui, Shao and Xiong supplement blood, nourish blood and vitalize blood while Huang Qi supplements Qi.  Zhu, Chen and Ling fortify the Spleen and Stomach so that the source of the Qi and blood is filled.  Yu Jin opens and relaxes the center while resolving oppression.  Zhi Qiao moves the Qi and dispels distention.  Lu Lu Tong and Tong Cao are moderate and harmonizing opening through herbs.  There was a clear result after taking the herbs.  At the second visit, in order to regulate and supplement the root, I added Si Gua Luo to help the movement in the breast.  When the Qi and blood were sufficient the source of transformation could generate and so the breast milk was spontaneously generated.  It was not necessary to rely on opening through the breast herbs to be effective.

When insufficient lactation is due to deficiency, in addition to the herbal formula, on can use food as a treatment.  This way the treatment is supported from the sidelines.  One can use Zhu Ti Jian Tang (Pig’s Trotters Soup) or drink a lot of Chi Dou Tang (Red Bean Soup).  Another simple method that is effective is to drink a lot of Mi Tang (Rice or Millet Gruel).  When cooking rice or gruel, After boiling there is a thick or frothy substance that forms on the surface.  When this rises, it should be taken as if it was tea.  This will harmonize the stomach and generate fluid.  It has the function of filling and nourishing the breast fluid.  This method is not only beneficial, but it is also inexpensive.  It deserves to be popularized. 

When insufficient lactation is due to deficiency, generally the whole body is weak and depleted.  The milk is scantly but the breasts also lack distention.  There are types of scanty breast milk that are excess in which the body is robust.  This occurs when there is constraint and stasis with knotting.  In this case the breast milk comes out scanty but the breasts are distended and painful.  The treatment here should regulate the Qi and open through the breast.  One can use Tong Quan San (Bubbling Spring Powder), which is from the Yi Zong Jin Jian- Fu Ke Xin Fan Yao Jue (Golden Mirror of the Medical Tradition – Secret Teaching for Women).  This formula includes Wang Bu Liu Xing, Bai Ding Xiang, Lou Lu, Tian Hua Fen and Jiang Can.  You can add herbs such as Xiang Fu, Sha Ren, Zhi Qiao and He Huan Pi.

Okay, finally a recipe for Pig’s Trotter Soup.  It is actually yummy and it is not hard to find Pig’s Feet at a large grocery store.  Just go to the meat department and ask.  They are not usually out in the case.

Introduction

Don’t be put off by the thought of trotters! Pig’s feet are simmered long and low to draw out their naturally occurring gelatin and calcium, creating a thick, rich soup that is low in fat and high in flavor and body. Add diced chicken for protein, or serve over egg noodles, potatoes, or with a thick slice of really good bread.

Ingredients

Chicken, turkey or vegetable stock (homemade is best); at least a quart and a half of fresh cold water; garlic; celery; carrots; onion; 3 pig’s feet cut into 2-inch by 2-inch pieces (readily available at most butcher counters, especially in more ethnic supermarkets)

Directions