bubble_chart Concept

Postpartum milk that flows out naturally without the baby sucking is called milk fistula disease, commonly known as "fistula disease milk." If the postpartum woman has a strong constitution, with full breasts and milk overflow, it is due to vigorous qi and blood, and abundant milk, which is not a pathological condition and does not require treatment.

bubble_chart Pattern Analysis

1. Qi Deficiency︰Milk flows continuously throughout the day due to fistula disease, with a small amount and thin quality, and the breasts are soft without a sense of fullness. The complexion is pale, the skin lacks moisture, and there is flusteredness, shortness of breath, mental fatigue, and lack of strength. The tongue is pale, and the pulse is thin and weak. This belongs to deficiency. It is caused by postpartum malnutrition or excessive blood loss, leading to qi and blood deficiency and weakness, stomach qi failing to consolidate, and loss of control function. The key points of differentiation are: soft breasts, thin and sparse milk in small amounts, along with signs of dual deficiency of qi and blood (such as pale complexion, flusteredness, shortness of breath, pale tongue, and thin, weak pulse). The treatment should focus on tonifying and replenishing qi and blood, supplemented with consolidation. The recommended formula is the Qi-Tonifying Milk-Retaining Decoction.
2. Liver Qi Depression︰Milk continuously leaks out spontaneously due to fistula disease, with a small amount and thick consistency. Both breasts are distended, hard, and painful. The patient experiences mental depression, irritability, and a tendency to anger, or may have epigastric distension and reduced appetite. The tongue texture is normal or slightly dark red, and the pulse is wiry and rough. This condition is classified as excess. It is often caused by anger damaging the liver, leading to rebellious liver qi invading the stomach and resulting in the stomach qi failing to secure and control. The key diagnostic points include: distended and hard breasts, thick and abundant milk, and clear signs of both physical and qi excess (such as a robust constitution, mental depression, irritability, a tendency to anger, a normal or slightly dark red tongue texture, and a wiry, rough pulse). There are no signs of "heat" (such as a large amount of milk leakage due to fistula disease, a bitter taste in the mouth, dry throat, or rapid pulse), but rather a presentation of qi depression and obstruction of the collaterals (such as distended and hard breasts with only a small amount of leakage, mental depression, irritability, and a tendency to anger). The treatment principle is to soothe the liver and nourish blood, using the Tong Gan Shou Ru Tang formula.
3. Liver Heat︰The milk flows continuously in large amounts, with a thick texture, and may be accompanied by breast {|###|}distending pain{|###|}. There is a {|###|}bitter taste in the mouth{|###|}, dry throat, irritability, and {|###|}dreamfulness{|###|} with scattered thoughts. Other symptoms include head distension, {|###|}dizzy vision{|###|}, {|###|}constipation{|###|}, and yellow urine. The tongue is red with thin yellow coating, and the pulse is wiry and rapid or thin and rapid. This condition arises from {|###|}anger damaging the liver{|###|}, leading to excessive {|###|}liver fire{|###|} and overactive dispersion, which forces the milk to overflow. The manifestations include spontaneous milk discharge from a {|###|}fistula disease{|###|} accompanied by internal heat excess pattern. The key diagnostic points are: thick and abundant milk flow, or breast {|###|}distending pain{|###|} (though the breasts feel soft upon touch), {|###|}bitter taste in the mouth{|###|}, dry throat, irritability, {|###|}dreamfulness{|###|} with scattered thoughts, head distension, {|###|}dizzy vision{|###|}, red tongue with yellow coating, and a thin, rapid pulse. The treatment focuses on {|###|}soothing the liver and relieving depression{|###|}, clearing heat, and stopping {|###|}fistula disease{|###|}. The commonly used formula is Peony and Gardenia Peripatetic Powder with the addition of Luffa Vegetable Sponge. For cases with accompanying {|###|}yin deficiency{|###|} symptoms, the Nourish Kidney and Clear Liver Decoction is used.

Milk is transformed from blood and relies on qi for its movement and regulation. Therefore, the quantity and discharge of milk are closely related to the blood and qi of the human body. However, the breasts belong to the stomach, and the nipples belong to the liver. When liver qi flows smoothly and stomach qi is strong, the storage and discharge of milk occur at appropriate times. Thus, the storage and discharge of milk are also influenced by the functions of the liver and stomach. Postpartum blood and qi deficiency can lead to a lack of control; or depression and anger damaging the liver, causing the liver to invade the stomach and weaken stomach qi; or anger damaging the liver, leading to excessive liver fire and overactive dispersion, all of which can cause spontaneous milk discharge or fistula disease. In addition to pattern identification and treatment with appropriate medications, it is advisable to incorporate blood-nourishing, yin-enriching, and astringent substances. Attention should also be paid to dietary regulation and maintaining a relaxed and cheerful mood.

bubble_chart Documentation

1. Nyuke Jinglun．The Complete Guide to Postpartum Conditions states: "Postpartum spontaneous lactation is due to stomach qi deficiency and should be treated with tonics to stop it. If lactation occurs before childbirth, it is called lactorrhea, and the child born is often not viable. If after childbirth, due to excessive labor, milk gushes forth, this is due to yang qi deficiency and collapse, and should be treated with Ginseng Decoction to tonify it."