Virgin Milk and Lactation in Chinese Medicine
Originally published on August 13, 2022.
This past week, I have been following a conversation on the OBAA members forum on “Lactation Insufficiency.” The practitioner who had created the original post noted that she had seen an increase in consultation requests because of the infant formula shortage in the US. In a funny coincidence, I have had a blog of my own floating around in my brain with the juicy title “Virgin Milk,” which just hadn’t gotten anywhere because I got a new stand-up paddle board and have been distracted by the gorgeous summer weather and some visitors. The final straw of the camel’s back about this topic, or third leg of the milking stool, so to speak, came a couple of days ago when somebody contacted me about presenting at a conference on the role of the heart in fertility. Be forewarned: This blog is quite long because it covers my four favorite subjects, namely goats, fertility, maternal health, and the heart.
Introduction: The Tiny Tool Chest of Biomedicine
Let us start with the basics: What is breast milk, where does it come from, and what mechanisms are involved in making it flow? Last but not least, and of significance to our understanding of lactation, what about inducing lactation in non-pregnant mammals? I don’t work, research, or think in the dominant modern biomedical paradigm, but its tools for establishing and promoting a healthy and abundant flow of breast milk in humans sure seem pretty limited, involving the localized health of the breast and nipple area and otherwise mostly focused on hormonal supplementation. Information on inducing lactation in non-pregnant people is interesting to me in this regard, because it provides insights into the way biomedical experts think about lactation: The standard protocol involves giving a combination of hormones (estrogen and progesterone to mimic the effects of a pregnancy) and then regular application of an electric breast milk pump, as often as every 3 hours, to stimulate the production and release of prolactin. So basically, the biomedical tool chest consists of a combination of hormones with breast and nipple massage. This same formula is, by the way, also replicated in research on inducing lactation in livestock, but with the significant addition of farming advice that I outline below. The cynic in me is tempted to explain this dearth of helpful information as the result of research funding, since baby formula manufacturers have much deeper pockets than advocates of natural breastfeeding, where no profit is to be made in a capitalist healthcare system. In sharp contrast to this situation, traditional Chinese medicine provides an abundance of practical and easily applicable guidance, both in terms of diagnosis and treatment. In my humble opinion, postpartum recovery and lactation are two hugely underutilized areas of specialization in traditional Chinese medicine, as practiced in the West, with great untapped potential. Before we look at that area, though, I want to draw your attention to a third, less obvious source of information: the management of dairy-producing livestock, primarily cows and goats.
Lessons from Lactating Livestock
I hope you bear with me here, instead of leaving in a huff and a puff because you got offended that I juxtapose lactating humans with lactating livestock. Please hear me out and allow me, in the concluding section of this post, to demonstrate why and how I think this highly practical information can be useful.
For fairly obvious reasons related to the financial significance of maximizing milk production in profit-oriented commercial agriculture, we find a wealth of theoretical and practical information on this topic, which is surprisingly consistent whether we consult well-funded agricultural extension offices or hippie homesteading websites. Discussions tend to include the following factors:
The importance of “peak milk yields,” which refers to the early period of lactation soon after freshening or, in human terms, the period of postpartum recovery, as the most consequential factor to affect lactation for the remainder of the reproductive cycle;
The need to ensure the animal’s comfort by encouraging exercise, providing space and rest, and avoiding environmental stresses like overcrowding or temperature extremes;
The significance of maintaining an ideal body condition throughout the entire reproductive cycle starting from the time prior to fertilization, throughout the pregnancy, and through the postpartum period, by means of a healthy balanced diet with ample fluids, calcium and protein, forage, and minerals, and neither underfeeding nor overfeeding (esp. too much starch, fat, and carbohydrates);
The prevention of nutritional deficiencies by means of supplementation (my absolute favorite being kelp and Redmond Mineral Salts);
The significance of a healthy digestion resulting in a good appetite (more on that below);
The proactive prevention, diagnosis, and treatment of potential pathogenic factors, most notably infections like mastitis;
The elimination of toxins, from stray voltage to moldy hay, toxic weeds, pesticidees, or fluoride;
The creation and consistent application of a good milking routine and frequency, in order to avoid damage to breasts and nipples, actively address any discomfort around milking, and promote a healthy let-down by eliminating psychological stresses and trauma;
The importance of starting the animal off with a healthy “dry” period before insemination, to prevent infections and other illnesses down the road, especially in the vulnerable postpartum period.
Are you still with me? And can you see where I am going with this, especially when you compare it to the bare-bone two-pronged approach of hormones and breast pump application with which human mammals are treated in our current biomedical system?
Having observed and lovingly accompanied dozens of goat ladies through their reproductive cycles as a goat farmer myself, I can assure you that all the factors mentioned in this long list are in fact decisive and significant and make a real, measurable difference. And in contrast to providers of healthcare to lactating humans, caring farmers do measure milk yield, taste the milk, test for mastitis, massage the udder and stroke the abdomen, and observe and carefully adjust feed and fluid intake on a daily or twice-daily basis (!). In addition, goats tend to be bred every year in commercial operations, and a single farmer is usually in charge of the animal throughout her entire reproductive cycle, from birth through puberty at about 5 months to the first freshening (after five months of pregnancy) and multiple yearly reproductive cycles, before the nanny should get to retire at around 10 years of age. Do you see now how much direct and hands-on experience a caring farmer or committed researcher can collect over just a few years in this scenario?
My Personal Goatherd Experiences
I personally have three particularly relevant experiences and lessons to share with you:
1. A Traumatized Teenager
The only goat I have ever had to put down during kidding was a rescue goat that was dropped off at my place in New Mexico ready to go into labor, totally traumatized, a youngster still who had just witnessed her mom being killed in a mountain lion attack. I wish people were more careful about breeding goats too young and protecting them from predators! These are painful lessons that can pretty easily be avoided. The goat in this story was clearly too young and the baby too large, and there was no physical way to get the baby out. My neighbor and I tried for a whole night, without success, even long after the baby had died. This was in rural New Mexico with no livestock vet around, and eventually we looked at each other and decided to put the poor goat out of her misery. In real farming, life and death are constant companions and you quickly learn that you can’t have one without the other.
2. Mastitis, Malnutrition, and the Importance of Diet
As some of you may remember from a previous blog (https://www.happygoatproductions.com/blog/2020/8/22/crying-over-spilled-milk), roughly two years ago I rescued a very sick malnourished traumatized goat with horrible mastitis who was on her way to get euthanized by the vet. I took “April” in because it was the first year of Covid, I needed a recipient for my love when my daughter and parents were far away, and I just had this sense that she wasn’t ready to leave this life. The renamed “Lady Yang Xiaomei” and I have been in love with each other ever since in a way that I have never loved another goat. I treated her for months with twice daily hour-long udder and whole-body massages, moxibustion, Chinese and Western herbs, long walks in the forest, and a huge smorgasbord of ever-changing foods and supplements, from which she picked carefully and wisely with tiny little nibbles that slowly, ever so slowly, grew more enthusiastic. Her sometimes surprising choices included citrus rind, ginger, garlic, turmeric, motherwort, mugwort, mint, sage, oregano, comfrey, lemon balm, and anything else growing in my herb garden, foliage from raspberries, blackberries, huckleberries, elderberries, salal, nettles, wild currants, ivy, and other trees and shrubs and vines growing in my woods, kelp and eelgrass from the beach, mineral mixes, grape leaves, apples, and over time hundreds of pounds of carrots that my neighbor picked up on the mainland in huge 25-lb bags. She also loved eating flowers (dandelion, rose, dried hibiscus, butterfly bush, and daisies), probably because she needed her spirit lifted and heart nourished. When given the opportunity, goats are incredibly wise and intentional in their food choices, and I learn about food as medicine every time I take them out grazing. Of course Lady Yang also received the usual sunflower-alfalfa pellet-grain mix and orchard grass and alfalfa hay. Basically I threw the kitchen sink and then some at her, and she pulled through for us! Who knows how much of it was the diet, or the supplements, or my loving physical touch and gentle calm caring.
Ever since, she been consistently producing at least 1-2 quarts a day for me, even though I have never pushed her to increase her milk production, haven’t bred her again, and actually have always tried to steer her to feed her own body first (I have my subtle ways there) rather than producing milk. To this day, she refuses to leave the milking stand after I finish milking her if I don’t give her that daily massage routine that we both love so much, from her tender cheeks to the special soft spot between her ears to her tense neck muscles down her still a bit too bony spine, over her soft abdomen and still irregular udder to the finishing kiss on her nose, which is obviously my favorite part. I have never had a goat express physical affection like this before and get reminded every day of the healing power of touch, which obviously is a two-way street, and the strength of our heart-to-heart connection. And just this spring, after almost 2 years of special treatment, I finally feel like she has fully come back to all her glory with a shiny coat, sparkling shén spirit in her eyes, joyful prancing and much greater all-around calmness, and very solid appetite.
3. Udder Health and Inducing Flow
As a final note, Lady Yang Xiaomei is even back to having two working teats and a reasonably balanced udder! Because of her awful state of malnutrition, I had originally tried to dry her off two years ago but was too worried about the mastitis and painful swelling to stop milking completely. So while one side of the udder had gone dry, she ended up producing far too much milk on the other side, and this imbalance was an injury waiting to happen. To address this issue, I slowly and patiently worked my magic to restore some milk flow to the “dead” teat, going from a few drops per milking session over a period of months to a couple of cups a day and a semblance of balance. She’s been going strong on both udders ever sides.
This success with restoring flow in Lady Yang’s dry teat caused me to start a fun experiment a few weeks ago with my other goat, Miss Marisol Unicorn, the obnoxious rowdy teenager in the barn. Her physical beauty and intelligence allow her to get away with a lot, but this spring I decided it was time for her to own her keep. Plus she has been getting a bit chubby and I just haven’t been able to find a worthy partner for this princess among the local inbred hoodlums. So I decided one day, when I already had her on the milking stand to trim her hooves, to just squeeze those teats and see what might happen. A few drops… the next day, a few more… the next day, half a tea spoon…and from there, with persistence, patience, and determination, I have managed to increase her milk production a bit every day, by means of nothing but my bare hands, to almost two cups a day now and still growing. And this is how I ended up with the miracle of “virgin milk”! Check back in a month and I shall let you know what happened but at this point, I think it’s been worth it, plus it’s a great excuse to cuddle with Marisol...
A Note of Caution
Before we now return to lactation in humans and explore the potential application of these lessons to human mammals, however, I would like to insert a note of caution: We must keep in mind that these two goats in my care have been bred intentionally for literally hundreds of generations for the sole purpose of being highly producing dairy goats. If one were to repeat this experiment with Boer goats (which are bred for meat production), for example, or even with some of the scrawnier goats I used to raise in New Mexico, the outcome would be very different, and it would be much more challenging. It is important for me here not to minimize the difficulty of inducing, establishing, and stabilizing lactation in humans. When I was breastfeeding my own daughter a couple of decades ago, I had two close friends unsuccessfully try to breastfeed their own newborn babies. How I wish I had known then what I know now, or that I could have directed them to a wise Chinese medicine practitioner to support them in their struggles! One had adopted her baby and dreamed of inducing the flow of breast milk even without ever having been pregnant to feed her precious son. As I think so often and with so many of my friends and neighbors, Chinese medicine could have helped her in so many ways, both with herbs and with acupuncture. But as a first-time mother without any additional support around breastfeeding, she eventually had to give up. The other had gone through an extremely traumatic birth and postpartum experience: Her baby had been born not, as planned, at home but prematurely and with severe birth defects in the hospital, which required a series of highly invasive risky surgeries over the next few months. To make matters worse, the hospital administration had prohibited the parents from taking their son home with them when his condition became stable enough because they lacked running water and electricity, even threatening at one point to take the baby away. Needless to say, my friend had experienced a total heart shock. Being blessed with an abundant milk flow myself, I remember hooking myself up, like a cow, to one of the milk machines in that awful sterile hospital room that really did feel like the milking parlor of a dairy farm, to share my own milk with her baby several times a week. I cannot imagine trying to establish a milk flow in that environment, with that trauma happening right there, while she was still recovering physically and mentally from her own excruciating experience of giving birth and dealing with the horrific aftermath of almost losing her precious newborn baby.
So every story is different, and perhaps the biggest lesson here is that humans (and other mammals) are not machines with switches that can be turned on or off, and that physical health, or what Chinese medicine might refer to as 形 xíng (lit. “form”) is only one aspect of what allows a human to function in the tender balance of Yīn and Yáng, Qì and blood, yíng 營 Provisioning and wèi 衛 Defense, xū 虛 vacuity/deficiency and shí 實 excess/repletion.
Chinese Medicine on Lactation
And now, at long last, let us look at Chinese medicine for guidance on lactation. I want to give us some classical quotes to contemplate, from a wide range of sources and presenting multiple perspectives and potential angles from which to think about lactation issues. Some of the following quotes just discuss menstruation and blood, instead of lactation specifically, but since breast milk is nothing but a transformation of menstrual blood, much of the information on menstruation is also relevant for lactation.
To begin with, we all know the basic Chinese medicine theory that the liver stores the blood while the heart is in charge of the 脈 mài, which we can read as “vessels” and/or as “flow in the vessels.” Here is a rich commentary from the late Míng (17th c.) period on Sùwèn 5, the chapter in the Yellow Emperor’s Inner Classic that I translated in my book Humming with Elephants. It offers us much food for thought on the balance of Yīn and Yáng obviously, but also on the interaction of the liver and heart and blood and Qi and on the role of the emotions for a healthy menstruation, pregnancy, and lactation:
“Qì is Yáng, Blood is Yīn. The Liver stores the Blood, and the Heart stores the Shén. Fulminant Anger results in counter-current flow of Liver Qì and then in chaos in the Blood. Hence it injures Yīn. Fulminant happiness results in laxness of the Heart Qì, and in the escape of the Shén. Hence it injures Yáng.” (Zhāng Jièbīn, commentary on Sùwèn 5, the “Great Treatise on the Resonant Manifestations of Yīn and Yáng)
Next, let me briefly summarize one of the earliest presentations of female menstrual pathology, which comes from the Zhūbìng yuánhòu lùn 《諸病源候論》 (“On the origins and symptoms of the various diseases”) from the early seventh century: Excessive taxation damage injures the blood in the channels, which causes vacuity in the body and allows for the contraction of wind and/or cold. These enter the uterine network vessels and strike the place where the blood is “completed” 成. The Chōngmài and Rènmài are the “sea of the channels and network vessels,” and when the Rènmài is diseased, a woman suffers from so-called dàixià 帶下, literally “below the belt” but often used in the more specific meaning of vaginal discharge. Additionally, the two key channels involved in women’s reproduction are the Hand Tàiyáng Small Intestine Channel, and the Hand Shàoyīn Heart Channel. The heart is a zàng organ and in charge of the interior, while the small intestine is a fǔ organ and in charge of the exterior. The blood in these two channels in women makes breast milk above and menstrual fluids below, in a process controlled by the Chōngmài and Rènmài. These two extraordinary vessels start inside the uterus and when “Yīn and Yáng are excessive,” this situation damages the uterine network vessels. Wind evil seizes the resulting vacuity and enters the womb, injuring the Chōng and Rèn vessels and damaging the blood in the Tàiyáng and Shàoyīn channels. This causes filthy fluids in the space of the uterine network vessels to combine with blood and descend together, which is what is referred to as dàixià or, in modern English, vaginal discharge. When cold, it is mostly white; when hot, it is mostly red. In entry after entry, this text describes the following constellation of causes for women’s diseases: Childbirth results in taxation, which causes damage to Qì and blood and to the Chōng and Rèn vessels. Due to this physical depletion, women are more susceptible to invasion from wind and/or cold, which lodge in the uterus and make the blood congeal, in the case of cold, or injure the channels and hence the movement of blood, in the case of wind. Either or both of these factors together affect the flow of female blood as menstrual fluid, nourishment to the fetus during pregnancy, and breast milk.
The following quote summarizes women’s physiology and menstrual pathology in a very similar way, tugged away in an explanation on impeded menstrual flow, which is full of information that we can easily apply to lactation as well. This quotation comes from Qí Zhòngfǔ’s 齊仲甫 Nǚkē bǎiwèn 《女科百問》 (“Hundred Questions on Gynecology”), a text that was originally published in 1220 CE and that I have translated and and published in my book Channeling the Moon.
“There are four channels that host women’s menstrual fluids: The first two are the Chōngmài and Rènmài, and the second two are the Hand Tàiyáng and Shàoyīn Channels.
Now, the Chōngmài is the Sea of Blood, and the Rènmài is in charge of the uterus and fetus. These two provide support for each other, and therefore allow the woman to bear children.
The Hand Tàiyáng is the channel of the small intestine, which is a fǔ organ and thus in charge of the exterior, belonging to Yáng. The Hand Shàoyīn is the channel of the heart, which is a zàng organ and thus in charge of the interior, belonging to Yīn. These two channels affect the breast milk above and the menstrual fluids below.
Perhaps taxation has damaged the Qì and blood, causing generalized vacuity and allowing for the contraction of wind-cold. Wind-cold has intruded into the channels and network vessels where it is assaulting the blood and Qì. Because blood that has contracted cold becomes congested and stagnant, this prevents the menstrual fluids from flowing freely and smoothly.” (Hundred Questions on Gynecology, in discussing menstrual fluids arriving on time but not flowing freely)
Looking at lactation specifically, we additionally need to take into consideration the direct effects of labor and delivery on the woman’s body. In general, childbirth has grave potential to damage and exhaust the blood in the vessels and the Qi. As we read above, the blood and vessels are associated with the heart, so it is not just that the state of the heart affects the blood flow, but also in reverse that damage to the blood, which certainly occurs during childbirth, affects the heart! This can then manifest in such symptoms as mania, Shén disturbance, heart vexation, insomnia, fainting etc. For the discerning practitioner, it is essential in the diagnostic process to recognize when these signs are not due to external wind but rather to the aftereffect of birth, since treatment will obviously look very different. To make matters worse, rotten postpartum blood may accumulate, pushing against the heart and blocking its orifices, causing mental confusion and similar symptoms, or flowing into the extremities. In that case, the patient may appear to suffer from water swelling, but instead of treating them as such, the practitioner will have to focus on dispersing postpartum stale blood. Similarly, symptoms like pain, vomiting, shortness of breath, and constipation after childbirth are likely not due to the invasion of external pathogens but to blood stagnation, especially in the space between the channels and flesh, and lack of fluids, causing tension in the sinews, stiff joints and lower back, headaches etc.
Compounding the immediate effects of childbirth, the resulting extreme vacuity, exhaustion, and openness after birth make it easy for pathogens to sneak in. As Chinese medicine sources, from the distant classics to contemporary popular websites, warn with great urgency, it is essential that women are carefully nurtured and protected during the vulnerable postpartum period, which is what the practice of “doing” or “sitting out the month” (zuò yuèzi 坐/做月子) is all about! While we can read these rules, prohibitions, recipes, and recommendations as a long list of restrictive and patronizing taboos that drastically limit a new mother’s freedom to move and act, we can also see it an expression of tender loving care for the new mother and her baby, by protecting them from outside harm (cold, wind, evil Qì), perhaps similar to the Western tradition of “confinement.”
In stark contrast to the casual treatment of postpartum women in our current biomedical culture, in the Chinese tradition, special meals and pampering practices aim to replenish her after the depletion, exhaustion, and loss of blood and Qì that she experienced during labor and birth (and pregnancy and lactation). Rest and recuperation are emphasized to help her recover from the physical and emotional trauma of birth, which, by the way, also applies to women who experienced a miscarriage or abortion. Proper postpartum care aims to restore the healthy flow of Qì and blood, and to harmonize yíng (provisioning) and wèi (defense). In this context, it is easy to see how the absence of such practices could have the opposite effect by not allowing the woman to recover from childbirth and replenish her depleted blood and Qì, with obvious consequences for the production, quality and quantity, and flow of breast milk.
Concretely addressing issues with the flow of breast milk, the thirteenth-century text Fùrén dàquán liángfāng 《婦人大全良方》 (“Excellent comprehensive formulas for women”) posits three primary scenarios for lactation problems in the introductory essay: When the breasts are extended and full after birth in a young mother, this indicates the presence of wind heat, which must be treated with clearing and disinhibiting medicinals to make the milk flow. An absence of breast milk in women who are exhausted from too many births indicates a total exhaustion of fluids, which must be addressed with moistening and enriching medicinals to move the milk. And lastly, if there is milk but just not enough, you must give medicinals to promote free menstrual flow in order to move the milk, accompanied by rich broths. The 15 formulas that follow the introductory essay address all of these possibilities, and more. It is my hope that this blog has given you at least a starting point from which to think about lactation issues, by presenting you with some possible angles for your diagnostic detective work and resulting options for treatment.
To end on a positive note, I offer you a final perspective that is admittedly pretty far out there but paints a beautiful image of healthy physiological functioning. The following quote comes from my book Twelve Characters: A Transmission of Wang Fengyi’s Teachings:
“The internal Five Element cycle of mutual generation begins with Fire. The Heart is associated with Fire, and when heart fire descends, it causes a sense of deep calm in the Heart, like the sun that illuminates all things in the world equally. As the result, the qi of Earth rises and unites with the qi of Heaven. This is Fire engendering Earth.
The yang qi of Earth rising and turning into fluids, which are then able to moisten Lung Metal, this is Earth engendering Metal. Lung qi being clear and hence allowing qi and blood to transform into yang Water, which is precisely Kidney Water, this is Metal engendering Water. The brimming fullness of Kidney Water and complete accumulation of the original essence allows Liver qi to course freely. This is Water engendering Wood. When Wood receives moistening from Water, Liver qi becomes calm and harmonious and Heart Fire naturally descends. This is Wood engendering Fire.
As the Five Elements move through this cycle, the hundred diseases are naturally prevented from arising.”
