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The condition of having very little or no postpartum lactation is called agalactia, also referred to as "agalactia." This condition not only occurs postpartum but can also appear throughout the entire lactation period. Agalactia due to a subsequent pregnancy during the lactation period, or congenital absence of lactation in women, should not be considered as agalactia and thus are not within the scope of this discussion.

bubble_chart Common Symptoms and Signs

1. Qi and Blood Deficiency Agalactia: Postpartum agalactia or very little lactation, with no breast distension or pain; pale and sallow complexion, dry skin, poor appetite, loose stools, aversion to cold, fatigue; dizziness, tinnitus, palpitations, shortness of breath, sore lower back and weak legs, or frequent urination and dry stools; pale tongue with little coating, weak and thin pulse.
2. Liver Depression Qi Stagnation Agalactia: Sudden cessation of lactation postpartum, with breast distension and slight pain; mental depression, discomfort in the chest and hypochondrium, epigastric distension, reduced appetite; normal tongue with thin yellow coating, deep and wiry pulse.
3. Blood Vessel Obstruction Agalactia: Postpartum agalactia or complete absence of lactation, with hard and painful breasts that resist pressure; chest tightness, belching, or accompanied by slight abdominal distension and pain, scanty lochia with dark color and clots; slightly bluish complexion, slightly bluish tongue, deep and choppy pulse.

bubble_chart Differential Analysis

1. Qi and Blood Deficiency Agalactia: The woman has a weak spleen and stomach, insufficient production of qi and blood, leading to reduced lactation, or excessive blood loss during childbirth, qi depletion following blood loss, which can also affect the production of lactation, causing agalactia. There are also cases where excessive lactation leads to extreme deficiency of qi, blood, and body fluids, resulting in emaciation and depletion of yin, leading to no lactation. The clinical features of this syndrome are: agalactia, no breast distension or pain, with systemic symptoms of qi and blood depletion. Treatment focuses on tonifying the middle and replenishing qi, supplemented by promoting lactation, using the formula Tong Ru Dan.
2. Liver depression qi stagnation agalactia and blood vessel obstruction agalactia are both excess pattern. Liver depression qi stagnation agalactia is often caused by postpartum emotional depression, the liver failing to act freely, obstructed qi movement, and stagnation of the milk ducts. Rumen Shiqin stated in "On the Failure of Milk Production": "It may be due to crying, grief, anger, depression, or knotting, leading to qi overflow and blockage, resulting in the failure of milk flow." Blood vessel obstruction agalactia is often caused by postpartum qi and blood stasis, meridian obstruction, and hindrance of milk production, thus leading to agalactia. The former is mostly caused by mental stimulation such as the seven emotions, affecting the qi aspect; the latter is caused by qi and blood stasis, affecting the blood aspect. One is due to obstructed qi movement and stagnation of the milk ducts; the other is due to blood vessel obstruction and hindrance of milk production. In the former, the breasts are more swollen than painful; in the latter, the breasts are hard, painful, and tender to touch. The former is accompanied by symptoms of liver depression qi stagnation (such as mental depression, discomfort in the chest and hypochondrium, etc.); the latter is accompanied by symptoms of blood stasis (such as lower abdominal pain, lochia with clots, slightly purple complexion, bluish tongue, etc.). For liver depression qi stagnation agalactia, treatment should focus on soothing the liver and regulating qi to promote lactation, using Liver-Warming Decoction with the addition of Uniflower Swissentaury Root, Ricepaperplant Pith, Mongolian Snakegourd Root, and Cowherb Seed. For blood vessel obstruction agalactia, treatment should focus on invigorating blood and resolving stasis to promote lactation, using Generation and Transformation Decoction combined with Yongquan Powder, with the addition of Akebia Stem and Squama Manitis as appropriate.

In clinical practice, distinguishing between deficiency and excess is crucial for agalactia. Generally, the presence or absence of breast distension and pain is a key diagnostic criterion. If the breasts are soft and not distended or painful, it is mostly due to qi and blood deficiency; if the breasts are hard, painful, and tender to touch, or accompanied by fever, it is mostly due to qi and blood stagnation. The former is often accompanied by systemic symptoms of qi and blood deficiency, while the latter is often accompanied by clinical manifestations of qi and blood stagnation. Treatment should follow the principle of "tonifying deficiency and dispersing excess." If combined with acupuncture, the effect will be even better.

bubble_chart Literary Supplement

1. Nyuke Jinglun．The Complete Guide to Postpartum Conditions states: "A woman's breast milk is transformed from qi and blood. The lack of milk flow is caused by weak qi and blood deficiency, leading to disharmony in the meridians. It is said that postpartum women must have milk; if the breasts are swollen but milk is not produced, this is due to wind-heat in young women who have just given birth for the first time. They need to take clearing and purging medicine to promote milk flow. If a woman has given birth multiple times and still has no milk, it is due to fluid exhaustion, and she needs to take nourishing and tonifying medicine to assist. If there is some milk but not much, she needs to take medicine to regulate the meridians, and also use soups to guide it. This is because a woman's milk relies on the thoroughfare vessel and the stomach meridian. Some women who have given birth multiple times still have abundant milk, which is due to their strong qi and blood. If a woman has a pre-existing condition in the thoroughfare and conception vessels, her milk will be scant and yellow, and her children will be weak and prone to illness."