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bubble_chart Concept

The condition where breast milk 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 and full breasts with 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 Common Symptoms and Signs

1. Qi deficiency milk fistula disease: Milk flows out continuously throughout the day, with a small amount and thin quality, and the breasts are soft without a feeling of fullness. The face is pale, the skin is not moist, there is palpitation and shortness of breath, and mental fatigue and weakness. The tongue is pale, and the pulse is thin and weak.
2. Liver depression milk fistula disease: Milk continuously flows out on its own, with a small amount and thick quality, and the breasts are hard and painful. There is mental depression, irritability, or epigastric distension and poor appetite. The tongue is normal or slightly dark red, and the pulse is wiry and choppy.
3. Liver heat milk fistula disease: Milk flows out continuously, with a relatively large amount and thick quality, and there may be breast distension and pain. There is a bitter taste in the mouth, dry throat, irritability, excessive dreams, head distension, dizziness, constipation, and yellow urine. The tongue is red with thin yellow coating, and the pulse is wiry and rapid or thin and rapid.

bubble_chart Differential Analysis

1. Qi deficiency milk fistula disease and liver depression milk fistula disease: The former is a deficiency condition, while the latter is an excess condition. The deficiency condition is caused by postpartum malnutrition or excessive blood loss, leading to qi and blood deficiency, and stomach qi not being firm, resulting in loss of control function. The excess condition is mostly caused by anger damaging the liver, liver qi transversely invading the stomach, and stomach qi not being firm, leading to loss of containment. The key points of differentiation are: for the deficiency condition, the breasts are soft, the milk is thin and sparse, the amount is small, and there are signs of qi and blood deficiency (such as pale complexion, palpitation, shortness of breath, pale tongue, and thin weak pulse). For the excess condition, the breasts are hard and distended, the milk is thick and abundant, and there must be signs of both form and qi being excess (such as strong constitution, mental depression, irritability, normal or slightly dark red tongue, and wiry choppy pulse). The treatment principle should follow "treating deficiency with tonification, and excess with purgation". For deficiency pattern, tonifying and replenishing qi and blood, with containment, using the tonifying qi milk-retaining decoction; for excess pattern, soothing the liver and nourishing blood, using the liver-soothing milk-retaining decoction.
2. Liver heat milk fistula disease and liver depression milk fistula disease: Although both have signs of "depression" (such as breast distension and pain, irritability), they are quite similar. However, liver depression milk fistula disease does not have signs of "heat" (such as a large amount of milk fistula discharge, bitter taste in the mouth, dry throat, and rapid pulse), but instead presents a series of signs of qi depression and meridian obstruction (such as less milk fistula discharge, mental depression, irritability). Liver heat milk fistula disease is caused by anger damaging the liver, leading to excessive liver fire and overactive dispersion, forcing milk to overflow. It manifests as milk fistula disease accompanied by internal heat excess pattern. The key points for differentiation are: thick and abundant milk, or breast distension and pain (but soft to touch), bitter taste in the mouth, dry throat, irritability, dream-disturbed sleep, head distension, dizziness, red tongue with yellow coating, and thin rapid pulse. Treatment involves soothing the liver and relieving depression, clearing heat and stopping fistula discharge, commonly using Peony and Gardenia Peripatetic Powder with Luffa Vegetable Sponge. If there are signs of yin deficiency, then use Zishen Qinggan Yin.

Milk is transformed from blood and relies on qi for movement and regulation, so the amount and discharge of milk are closely related to the body's blood and qi. However, the breasts belong to the stomach, and the nipples belong to the liver. When liver qi is smooth and stomach qi is strong, milk storage and discharge are timely. Therefore, milk storage and discharge are also influenced by the functions of the liver and stomach. Postpartum blood and qi deficiency, or anger damaging the liver leading to liver fire excess and overactive dispersion, can all cause milk fistula disease. In addition to pattern differentiation and treatment, it is advisable to include blood-nourishing, yin-enriching, and astringent ingredients. Attention should also be paid to dietary regulation and maintaining a relaxed mood.

bubble_chart Literary Supplement

1. Nyuke Jinglun．The Complete Collection on 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 is often not viable. If postpartum overexertion causes a surge of milk, this is due to yang qi deficiency and collapse, and should be treated with Duzhen Tang to tonify it."