Lactation

==**Definition:** == Too much or too little milk production especially during nursing.
 * IBIS:**

==**Etiology:** == • lactation deficiency: Often due to a deficiency in prolactin. After birth, a prolactin deficiency may be the first indications of panhypopituitarism from pituitary destruction during the peripartum period (that is, Sheehan's syndrome). Prolactin stimulation tests are needed to discern if the prolactin levels are indeed low. Another cause of low lactation includes stopping breast-feeding for a time (due to mastitis, for example).

• lactation excess (galactorrhea): Breast secretion as a nonpuerperal or inappropriate phenomenon. However, the precise definition of the illness is not clearly defined in the literature. One quarter of women who have previously given birth can demonstrate lactation to some degree; this appears to be clinically unimportant. The secretion should be checked to ensure that it is milk and not another secretion that may signal serious breast pathology. Unfortunately there is no sure connection between hyperprolactinemia and galactorrhea; in many patients with high prolactin levels, lactation may not occur. And in patients with galactorrhea, the levels of prolactin may be low (for example, in the wet-nurse phenomenon where repeated stimulation of the breasts in a women who has been previously pregnant will cause lactation without a surge in prolactin levels). However, the drug bromocriptine, which causes prolactin levels to be suppressed, decreases galactorrhea (even in women who have low prolactin levels to begin with), so there must be some relationship to the ailment and the hormone, although at this time it is unclear.


==**Nutrition:** == therapeutic foods: » Insufficient lactation: • foods rich in Vitamins A, C, E, B-complex, Iron, and Magnesium • apricots, asparagus, green beans, carrots, sweet potatoes, peas, pecans, leafy greens, parsley, watercress, beet tops, dandelion greens (Weed, p. 85)

specific remedies: » Insufficient lactation: • 4 oz. barley shoots. Boil them in 1 pt. water until reduced by half. Drink the liquid but do not eat the shoots. (Butt and Bloomfield, p. 145) • 1 lb. papaya, 8 oz. fish. Boil in 3 pts. water until reduced by half. Eat and drink the results. (Butt and Bloomfield, p. 145) • eat foods from the carrot family: carrots, fennel, dill, caraway, carrot juice (one pint per day) • mix 1 tbsp. brewer's yeast, 1 tbsp. honey, and 1 tbsp. ground pecans or blanched almonds (not roasted) together and eat two to three times daily (Shefi) • increase water and liquid intake • boil 150 g bean curd with 50 g brown sugar in 3 cups water, add 50 ml rice wine when sugar dissolves. Drink all at once, once per day for 5 days. (Lu, p. 152) • crush river crab, boil it with 60 ml rice wine. Eat in 1 day (Lu, p. 152) • prepare 30 g lily flowers and 60 g lean pork as in normal cooking; steam the 2 ingredients over high heat until the pork is well done. Eat the whole thing. (Lu, p. 152) • simmer 500 g papaya with 500 ml rice vinegar and 30 g fresh ginger over low heat for 40 minutes. Drink as tea twice daily, 1 small glass each time. (Lu, p. 152) • eat cracked wheat and brown rice (Lu, p. 153) • boil 10 g anise seed in water to make a soup; add some wine (Lu, p. 153) • soak 1/2 cup pearled barley in 3 cups cold water overnight. Strain out barley and heat 1-2 cups barley water to boiling, then pour 1 cup boiling barley water over 1 tsp. fennel seeds and steep 10-15 minutes (Weed, p. 85) • take 1-3 fresh figs or 30 g dried fruit, 60 g lean pork and 2 red Chinese dates. Add water, steam and pulp, then eat daily. ((Yin-fang and Cheng-jun, p. 21) • take 15 g of dried mandarin orange seeds and crush them, add 30 g of rice wine and water, steam and serve twice daily (Yin-fang and Cheng-jun, p. 59) • take 60-90 g of shelled peanuts and 250 g of pork, add water and boil until tender. Serve per day for 5 days (Yin-fang and Cheng-jun, p. 97) • mix 30 g of fresh pumpkin seed with 18 g dried. Add 30 g sugar and a little eater, grind into a paste. Eat twice daily for 3-5 days (Yin-fang and Cheng-jun, p. 101)

» Congested lactation: • boil in 3 pt. water until reduced by half: 1 lb. carp, 4 oz. rice. Eat and drink half this amount twice daily (Butt and Bloomfield, 1985, p. 145) • boil in 1 pt. rice wine: 8 oz. lightly fried shrimps. Eat and drink 6 oz. twice daily Continue for 3 to 4 days (Butt and Bloomfield, 1985, p. 145)

specific remedies: » Excess lactation: • drink sage tea, 1 cup 6-8 times in one day to stop lactation or one cup twice daily to decrease milk (Shefi) • fry 120 g malt over low heat for a few seconds; add 750 ml water and bring it to a boil and cook until the malt is fully cooked; add 30 g brown sugar. Drink as soup once per day for 5-7 days (Lu, p. 152)

avoid: • coffee, caffeine

==**Botanicals** == • Atropa belladonna (toxic): local inflammations and swellings such as mastitis and engorgement, apply liniments or plasters topically taking care to wash thoroughly from breasts before nursing. For an anti-galactagogue effect when weaning or when mastitis threatens, place 5-10 drops in 4 oz. water and take 1 tsp. doses every few hours (Felter, pp. 239-240) • Borago officinalis: infusion of flowers and leaves, drink freely to promote nursing (Weed, p. 85; Mitchell, p. 85) • Cinnamomum camphora: suppresses milk production when used internally or topically on breasts (Felter, p. 266) • Cnicus benedictus: 10-20 drops tincture of leaf promotes milk production (Weed, p. 85) • Foeniculum vulgare: contains phytosterols that promote lactation. Bruise or crush the whole seeds (Anderson Geller; Mitchell, p. 34) • Humulus lupulus: infusions, tinctures, and even good-quality dark beer promote lactation, especially in women for whom tension or anxiety impairs milk letdown (Stansbury) • Leonurus cardiaca: a general women's herb, galactagogue (Heron) • Pimpinella anisum: contains phytosterols that promote lactation. Bruise or crush the whole seeds (Anderson Geller) • Physostigma venenosum (toxic): increases mammary gland secretions (Felter, p. 533) • Pilocarpus jaborandi (toxic): increases milk supply when deficient (Felter, pp. 539-546) • Salvia officinalis: dries up milk when weaning a child or lactation is excessive (Felter, p. 614)

==**Chinese Formulae** == » galactorrhea: incessant flow of milk: • Tang Kuei and Ginseng Eight C. (Ba Zhen Tang) minus cnidium (chuan xiong) plus astragalus (huang qi), schizandra (wu wei zi) and euryale (qian shi) (Bensky and Barolet, p. 259)

» insufficient lactation: • Dandelion C.: Lactagogue Formula: Xue Xu (Blood Deficiency) (Hsu, 1980, p. 582) • Pueraria F. (Ge Gen Tang): Lactagogue Formula (Flaws, p. 56-7, Hsu, 1980, p. 51; Yeung, p. 105; Dharmananda, 1986, p. 125; Bensky and Barolet, p. 51) • Tang Kuei Four C. (Si Wu Tang): Liver Xue Xu (Blood Deficiency): dizziness, blurry vision, lusterless complexion and nails, pale tongue (Hsu, 1980, p. 433; Yeung, p. 220; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 248) • Ginseng and Astragalus F. (Bu Zhong Yi Qi Tang) (Central Qi Pills) (patent): Spleen Qi Xu (Deficiency) with Spleen Qi Sinking: spontaneous sweating, aversion to cold, weak limbs, loose stools (Ginseng: Hsu, 1980, p. 255; Yeung, p. 51; Dharmananda, 1986, p. 186; Bensky and Barolet, p. 241; Bu Zhong: Fratkin, p. 171) • Tang Kuei and Peony F. (Dang Gui Shao Yao San): Liver Invading Spleen due to Liver Xue Xu (Blood Deficiency) (Flaws, p. 56, Hsu, 1980, p. 585; Yeung, p. 77; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 251) • Ginseng and Zizyphus F. (Tian Wang Bu Xin Dan): Heart Yin Xu (Deficiency) with Kidney Yin Xu (Deficiency): irritability, palpitations with anxiety, insomnia, inability to concentrate, dry stools, red tongue, may be night sweats (Flaws, p. 56, Hsu, 1980, p. 270; Yeung, p. 231; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 378)

==**Acupuncture** == after assessing the person and palpating, consider these patterns: » deficient lactation: Xu (Deficiency) of Qi and Xue (Blood); Yin Xu (Deficiency); Qi Stagnation and Xue Yu (Blood Stasis); Liver Qi Stagnation; Shi (Excess) of the Chong Mai (Penetrating Vessel) » excess lactation: Qi Xu (Deficiency); Heat in the Xue (Blood); Xu (Deficiency) of the Chong Mai (Penetrating Vessel)

» illustrative combinations for deficient lactation: • TW-6, St-36, CV-17 and St-18 for insufficient lactation (Shanghai, p. 236) • GV-14, CV-4, CV-6, CV-12, UB-23, LI-4 and St-36 for agalactia (Liu, p. 404) • SI-1, UB-18, UB-17 and SI-11 (+) for agalactia due to Xu (Deficiency) of Qi and Xue (Blood) (Flaws, 1983, p. 56) • St-18, PC-6, CV-17 and Lv-14 (-) for agalactia due to Stagnation of Qi and Xue (Blood) (Flaws, 1983, p. 56) • SI-1, Ht-1, CV-17 and St-18; GB-41 and CV-3 for insufficient lactation (Mann, p. 153) • CV-17 (D) and SI-1 (can also add: LI-4, St-36 and Sp-6) for insufficient lactation as part of Xue Xu (Blood Deficiency) due to excessive blood loss during childbirth (Mann, p. 153) • CV-17 (D), SI-1 and GB-21 (can also add: Lu-7) for insufficient lactation with "Qi Mai blocked and Cold" (Mann, p. 153) • CV-17, St-18 and SI-1 (also consider: UB-18, UB-20 and St-36) for insufficient lactation (Shanghai, p. 678) • Sp-4 and PC-6 open the Chong Mai (Penetrating Vessel) for which deficient lactation is a symptom of Shi (Excess) • CV-17 (D) with GB-21, SI-1, LI-4 and Sp-6 for agalactia (Flaws, 1983, p. 57) • SI-1, SI-2, LI-4 and CV-17 (+) for agalactia (Flaws, 1983, p. 57) • CV-17 and St-18 (ind. D for 10-20 minutes); Ht-1, SI-1 and St-26 (mild +), treating 1-2 times daily, for agalactia (Flaws, 1983, p. 57) • CV-17, St-18, SI-11 and SI-1 for insufficient lactation or mastitis (Shanghai, p. 199) • Lu-10 and SI-1 remove Obstruction of the breast; benefit scanty lactation due to Obstruction (Flaws, 1989, p. 80) • direct moxa on CV-17 and SI-1 for lack of milk (Shanghai, p. 678) • St-18, St-1 and CV-17 promotes milk secretion (Finkelstein, p. 15) • CV-17, SI-1 and St-36 increase oxytocin and lactase levels in body to promote lactation (Finkelstein, p. 91) • St-18 and St-16 (-) disperse local Stagnation in breast; promote flow of milk

» illustrative combinations for lactation: • Lu-1 and St-38 (-) for galactorrhea (Flaws, 1983, p. 57)

» related combinations: • St-30, GB-22 <-> Sp-21 area and SI-11 are "essential" points for treating breast problems; St-15 <-> St-16 area along with PC-6 and Sp-4, to effect the Chong Mai (Penetrating Vessel), are secondary points; palpation, of course confirms the points' appropriateness (Matsumoto) • SI-1 and tai yang for swollen breasts (Shanghai, p. 241)

==**Homeopathy** == • Borax: milk too thick and tastes bad so child will not nurse • Calcarea carbonica: to increase milk supply • Calcarea phosphorica: child refuses milk because tastes salty • Chionanthus virginica: to stop milk supply • Lac caninum: milk too profuse • Lactuca virosa: to increase milk supply • Lac vaccinum defloratum: for reducing milk supply • Phytolacca: inflammation: milk becomes stringy and hangs from nipple; milk coagulated; scanty, thick, unhealthy and dries up soon • Pulsatilla: to stop flow after child weaned • Sabal serrulata: to produce a milk supply • Secale cornutum: suppression or non-appearance of milk after delivery • Sticta pulmonaria: scanty milk; annoyed because of lack of milk • Urtica urens: decreased secretion with swelling of breasts; dries up milk in women who are weaning

==**Subtle Support** == • notes: A, C, C#, G, G#

• chords: A Major, C Major (Gimbel, p. 116)


==**Mind/Body** == • Breasts represent mothering and nurturing. (Hay, 1984, p. 157) • If the infant is not nursed, then the mother is on some level unwilling to feed and protect it, to intervene personally on behalf of the child. In mothers who cannot give milk this problem is more deeply repressed than in those who simply do not want to feed their children and are quite open about it. (Dethlefsen, p. 190)

Chinese psychophysiology: • Stomach ~ Wei is the Sea of Nourishment and origin of all fluids; transforms and digests food so that the Spleen can separate the distilled food essences; with the Spleen, is the root of post-natal Qi; and as Earth, relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, and nurturance. » Weakness, dysfunction, and illness associated with worry, anxiety, and overthinking. » Stomach Xu (Deficiency) signs include slow digestion; vomiting after meals; painful eyebrows; emotionality; teariness; sadness; cold feet (Seem, p. 28); cold and shivering in the abdominal area; abdomen swollen and full; gastritis; loss of appetite; diarrhea; nausea; and leg weakness. » Mental signs of Stomach channel disorders include depression, death wishes, instability, suicidal tendencies, mentally overwrought, doubt, suspicions, tendency to mania, and slowness at assimilating ideas. (Seem, p. 27)

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Spleen Xu (Deficiency) increases the susceptibility to "invasion" by the Liver. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis). » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu (Blood Stasis) often begins with Qi Stagnation.

==**Integrative Therapies** == Breast milk contains most of the nutrients that a growing baby needs. It also contains powerful antibodies that help the nursing infant fight infection and allergies.

Hormonal secretions during pregnancy stimulate the production of milk in the breasts. Nursing further stimulates milk production and ejection. The more the baby suckles at the breast, the more milk is produced. Therefore, if you nurse the baby when it is hungry for at least 10 minutes at each breast, rather than putting it on a schedule, the flow of milk will increase. Infants will typically want to nurse about 8 to 18 times per day. A baby who is getting an adequate milk supply has at least 6 to 8 wet diapers each day.

Decrease in milk production is often due to a rigid feeding schedule. Many women also find that their milk supply decreases if they fail to get enough rest or if they are under stress. In addition, poor nutrition on the part of the breastfeeding woman often leads to a lessened milk supply.

Check with your physician before taking any drugs or medication. Most medications will be transmitted to the baby through the breast milk in varying degrees of concentration.

THE PROPER DIET FOR NURSING WILL INCLUDE: 1. Maintaining an overall healthy diet. Eat daily servings of vegetables, whole grains, fresh fruit, and proteins with a minimum of animal fat. For more information, refer to the article on healthy diet. 2. Add plenty of calcium-rich foods to the diet. Eat 2 or more servings of the following daily: 4 ounces of nuts, 1 ounce of dried seaweed, 1 cup of cooked greens, 8 ounces of fish, or 2 tablespoons of molasses. Other good sources of calcium include goat milk, salmon, sardines, mackerel, and sesame seeds. 3. Be sure to get enough protein. The number of grams of protein you need to eat daily is equal to about 2/3 of your weight in pounds. Include beans, nuts, and seeds as high-quality sources of protein in the diet. 4. To increase the B vitamins in the diet, take 3 to 6 heaping tablespoons of nutritional yeast throughout the day with meals or blended with milk or juice. 5. Calf liver or liquid extracts of liver help supply the higher than usual requirements for B vitamins and vitamin A. Consult the product label for daily dosage if commercial extracts are used. To avoid taking in too much vitamin A, care must be taken not to consume more liver than the equivalent of 1/4 pound per day. 6. Eat plenty of leafy green vegetables, especially beet greens, kale, collards, turnip tops, and dandelion greens. 7. Supplement liquid intake with barley water. It is prepared by boiling 1/2 cup pearl barley in 3 cups of water for 25 minutes. Strain it and add 1 teaspoon of Fennel seeds per cup of liquid. Fennel tends to increase breast milk production. 8. Wheat germ – Up to 1/2 cup per day. 9. Consumption of caffeine by nursing mothers has been related to fussiness and colic in infants. Decrease or eliminate consumption of caffeine, found mostly in sodas, coffee, black tea, chocolate, and some over-the-counter medications.

THE FOLLOWING SUPPLEMENTS CAN BE TAKEN WHILE NURSING: 1. Vitamin C – 1,000 milligrams twice per day. 2. A multivitamin and mineral supplement – taken daily. Prenatal vitamins are fine to use. Consult the product label for dosage information. 3. Iron – 30 milligrams, 3 times per day. 4. Do not take vitamin B6 supplements, as they may contribute to lowered milk production.

HERBS CAN BE USED TO HELP INCREASE THE MILK SUPPLY: 1. Galega or Goat's Rue – 1 tablespoon of the herb in 1 cup of boiling water. Steep for 5 minutes. Take 3 cups of the tea daily. 2. Blessed Thistle Leaf – 20 drops of the tincture, which is liquid herbal extract, 2 to 4 times per day. 3. Borage Leaf – 1 ounce of the dried leaves in a quart of boiling water. Steep for 30 minutes. One half cupful is taken before or during each nursing session. 5. Including lots of fresh parsley and watercress in the diet is also helpful in sustaining lactation. 6. Hops flowers are excellent for the relaxation of the mother as well as to increase the flow of milk. However, the tea is extremely bitter. Alcohol-free beer made without chemical additives is another way to consume hops. 7. An ample intake of liquid is required to maintain a plentiful flow of milk. A nursing mother should drink 8 to 12 cups of liquids per day. Mineral-rich herb teas such as Raspberry leaf, Nettles, Alfalfa, or Red Clover are recommended. To make a cup of tea, add 1 cup of boiling water to 1 tablespoon of the dried herb. Let the tea sit covered for 3 to 5 minutes.

AS ADDITIONAL MEASURES: • Eliminate or cut down on smoking. Heavy smoking reduces milk production, reduces the already small vitamin C content of milk, and increases the possibility that the infant will suffer from colic, nausea or vomiting. • Eliminate consumption of alcohol to avoid possible harmful effects on the baby, since the alcohol content of breast milk rises at about the same rate as the alcohol content in the blood.

FOR THE BABY: 1. After 6 months, the stored iron that the baby has is depleted. Since breast milk contains relatively small quantities of iron, the infant's diet can be supplemented with liquid iron. See the product label for dosage information. 2. Breast milk is low in vitamin D. Expose the baby to the sun daily if the weather permits. However, be careful not to let the baby become chilled.