Volume 10, Number 1 | Spring 2015

Clinical Report 1 (Acupuncture)
A Case of Acupuncture and Moxibustion Treatment for
Insufficient Lactation Following Premature Birthadministration of acupuncture and moxibustion
treatment made breast-rearing possible.

Naoko Maeda
1) Ayumi Acupuncture and Moxibustion Clinic2) Ayumi Midwifery Clinic3) Dept. of Health Sciences, National University
Corporation of Tsukuba University of Technology【Case】
1. Profile
The patient was a 37-year old woman, height
159cm, weight 59kg, wishing mainly to improve theinsufficient lactation after the birth of the second
child.

【Introduction】
Obstetrics and pediatrics in Japan promote

Asthmaandbuckwheatallergywerecomplications. The asthma the patient had beenissuffering from during her childhood had been

defined as the promotion of infant growth throughalleviated, but recurred after the birth of her firstbreast-feeding with breast milk (the mother feeds

child

the infant directly from her own breast). Even if

inhalation twice daily of Pulmicort. The family

only a small amount of breast milk is fed to thehistory shows that her father had hypertension andinfant, one can speak in this case of breast-rearing,her mother arrhythmia.

breast-feedingininfancy.

"Breast-rearing"

and

can

currentlybecontrolled

with

but ideally the proportion of breast milk should be

Following the 20th gestational week the patient

increased. On the other hand, "maternal feeding"took tocolytic agents 4 times a day and rested atrefers to feeding breast milk to provide nutrition

home, but on the third day of the 35th week her

where administering mother's milk in other ways

waters broke and on the 5th day of the 35th week she

than direct breast-feeding also covers the definition

gave birth to a 2210-g boy through vaginal delivery.

of maternal feeding. This feeding form is called

Both mother and child were later discharged after"maternal feeding" when the proportion of mother's

the usual length of hospitalization.

milk is higher than 80%, while at a proportion ofless than 20% it is called "artificial (bottle) feeding"and the range from 20% to 80% is labeled "mixed

2. Postpartum course
Since

directbreast-feeding

immediately

feeding". Accordingly, even if artificial feeding the

postpartum was not possible as shown in Figure 1,

proportion of mother's milk which is less than 20%

she received breast-feeding instructions 30 days

still constitutes breast-rearing1).

after delivery from the practicing midwife S and

Yet, while in the "Investigation of infant feeding

thus became able to directly breast-feed by the 42nd(2005)" conducted every 10 years by the Ministry of

day after delivery. Also, because of insufficient

Health, Labor and Welfare2) 96% of the pregnant

lactation the patient received by the 61st day a

women responded during pregnancy, that theybreast massage from the practicing midwife S, butwould like to provide maternal feeding, threesince this did not promote lactation as expected, shemonths after delivery 20% of the mothers did not

visited this clinic by the 81st day after delivery,breast-feed. Further, if the infant's suckling power

asking to promote lactation because she strongly

is weak because of premature birth, making oral

wished to provide maternal feeding.

feeding impossible, breast-rearing will become
3. Present status

difficult.
Here I will report in a case insufficient lactation
following
14

prematurebirth,

wherethe

The mother's abdomen on the whole lacked
strength, in particular the area around CV4

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 10, Number 1 | Spring 2015

appeared to be concavity, but the adequate tensionof the mother's breasts and engorgement of blood

5. EvaluationIevaluatedthefollowingparameter:(1)

vessels was not observed. Moreover, excessive

concavity around CV4 and general abdominal

tension of the neck and back muscles was observed.

tension as body surface findings, (2) improvement of

The infant on the other hand gained about 10g bodyshoulder and back muscle tension, and (3) the

weight during the week prior to the clinic visit anddevelopment of an appropriate tension of the

drank about 280ml of powdered milk, divided into 7

breasts and engorgement of the blood vessels, set

portions over the day. On an acupuncture andthe weight gain of an average infant of 25-30 g/day

moxibustion examination I judged the condition of

as a target, and (4) decreased in the amount of

the mother being a deficiency pattern and recovery

powdered milk. Further, I had the patient weigh theafter childbirth being doing poorly. Also, the weight

infant's body weight at home and report back, upongain of the infant appeared to be insufficient. The

which the amount of powdered milk was decreased

amount of powdered milk for an infant of the given

over several steps.

age of the moon of the first visit would have been
720-960ml, so that I judged the feeding to be mixed
feeding with a ratio of 29.2%-38.9% of powdered【Results】(Figure 2)
The acupuncture and moxibustion treatment
was performed a total of 5 times. Treatment intervalmilk.

was 3 days between the first and second session andafter that once a week.

4. Acupuncture and moxibustion treatment
The acupuncture and moxibustion treatment

At the first visit the same amount of powdered

had the goal to improve the deficiency pattern of themilk of 280ml was used and the number of feedings

mother, in other words recover from the fatigue ofper day decrease by 2 times from the 7 times.

delivery and increase the amount of lactation.

Since at the second visit (3 days after the first

Based on the examination of the mother and thevisit) still neither an appropriate tension of thecondition of her breasts the amount of powderedbreasts and engorgement of the blood vessels nor

milk was decreased over several steps. At first visit

any other changes in physical condition wereI treated the stiffness of neck, shoulder and backobserved, I repeated the same treatment given

muscles, using KI4, KI7, KI9, HT3, PC4, SP4, SP7,

during the first session. From the second session theinserting needles to a depth of about 5 mm andpatient realized an until that point not present

retaining them there for about 12 minutes. I used

increase in lactation resulting in permeation of

40-mm stainless steel needles with a diameter ofbreast milk into her underwear and a daily weight

0.16mm (Seirin product). To improve the concavity

increase of the infant of 35g. For those reasons thearound CV4, the lack of abdominal tension anddaily amount of powdered milk was decreased 7

promote lactation I applied moxa sticks at KI3, SP6days after the first visit to 200ml administered inand CV17 until the lack of abdominal tension andsitting. Following the 13th day after the first visit,

concavity around CV17 had disappeared. I used the

however,moxa

sticks)"administered per day was returned to 280ml,

manufactured by Senefa. Also, I instructed the

because the weight gain of the infant later fell shortpatient to apply these moxa sticks as self-care atof the expectations.

sticks"SennenQ

Bokyu

(moxa

home once or twice daily for about 5 minutes at KI3,
SP6 and CV17.

theamountofpowderedmilk

On the fourth visit (17 days after the first visit)
the concavity around CV4 had decreased in depth

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 10, Number 1 | Spring 2015

and both a general increase in abdominal tension

highest immediately after delivery and gradually

and an appropriate tension of the breasts anddecreases after that, but each time the nipples areengorgement of the blood vessels were observed. Yet,stimulated temporarily increases again, resulting inbecause these improvements were still insufficient,thethe same treatment administered during the firstsuckling by the ninth day postpartum independent

session was continued. Also, the mother hadof the prolactin or oxytocin concentration. After aobserved her child without administering powdered

3-month postpartum period the prolactin value

milk, but since the infant's weight decreased, shesettles to the same level as in non-lactating womenadministered 21 days after the first visit 160ml ofand even after suckling increases are no longer

powdered milk per day.

observed. Promotion of sufficient lactation requires

establishmentofperiodiclactation

upon

By the fifth session (24 days after the first visit)

adequate sleep, avoidance of mental stress and thethe concavity around CV4 had disappeared, theperformance of breast massage." On the other hand,abdominal wall showed elasticity, the breast an

the Ministry of Health, Labor and Welfare reported

appropriate tension and engorgement of the blood"Examination of fluctuations in the proportion ofvessels. For this reason the treatment in this clinic

infant feeding methods (Figure 3) shows, that 1

was terminated and the patient instructed tomonth postpartum 42.5% used maternal feeding,continue the self-moxibustion at home. Even after

52.5% mixed milk feeding and 5.1% artificial

the end of the acupuncture and moxibustion

feeding. Three months postpartum the ratio oftreatment the patient reported the body weight ofmaternal feeding had decreased by 4.4% to 38.0%,

the infant and continued to adjust the amount ofwhile the ratio of mixed milk feeding had fallen bypowdered milk.

11.5% to 41.0%. However, the ratio of artificial

The amount of powdered milk per day was 38

feeding had increased by 15.9% to 21.0%. This

days after the first visit 160ml and the infant gained

indicates insufficient lactation and an increase ofabout 25g weight per day. When the amount ofmothers not feeding the infants with mother's milk.

powdered milk used per day was 140 ml the weight

It also reveals that during pregnancy mothers may

gain of the infant dropped to 18.6g, so that 52 days

wish to breast-feed their children, but during theafter the first visit the amount of powdered milk per

lactation period this may in reality not work out so

day was returned to 160ml. The weight gain of thewell.

infant stabilized as a result of feeding 160ml of

In this case the patient took tocolytic agents

powdered milk per day. I concluded that the motherduring the pregnancy, but based on the prematurewasmanagement

delivery I surmise that her body was not ready to

independently and we agreed to terminate themaintain the pregnancy until full term (from thetreatment, but she would continue to feed the infant

37th GW to less than the 42nd GW). Also, the first

powdered milk once a day.

visit for acupuncture and moxibustion treatment

capableofcontinuingthewas on the 81st day after delivery and the treatment
was completed on day 103 after delivery. The【Discussion】
Lactogenesis and lactatin are according tocondition of mother and breasts, the time of"Standard Science of Obstetrics and Gynecology"3) alactation onset had already reached the stage ofprocesses where "postpartum stimulation of the

non-lactating women, so that it can be anticipatednipples by suckling releases prolactin, which thenthat without treatment she would gradually havepromotes lactation. The prolactin secretion isswitched to artificial nutrition.

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 10, Number 1 | Spring 2015

Searching for reports about insufficient lactation

the mother. With the convalescence of the motherin magazines about Chinese medicine I found onlyand disappearance of the depression at CV17 the

one

while

mother started to provide maternal feeding and an

hospitalized after full-term delivery by Fujiwara etappropriate tension of the breasts and engorgemental.4).

of the blood vessels were observed. The acupuncturereportabout

supporting

lactation

Causes for insufficient lactation include (1)and moxibustion treatment promoted lactation in

decreased lactation volume because of low milkspite of the prolactin dropping to a level similar to

production, (2) sufficient production, but problems

thatwith the milk discharge, (3) poor holding of the baby,

improvement of the postpartum exhaustion of the(4) the infant cannot take hold of the nipple because

mother the treatment thus conceivably led toof inverted nipples, or (5) there is a problem of how

maternal feeding.

of

non-lactating

women.

Achieving

the infant suckles5). In the present case (1), (4) and

The first author has a license as a midwife and(5) conceivably could have caused the insufficientas such examined the condition of the mother andlactation. Again, (6) decreased suckling drive, (7)her breasts, adjusting the amount of powdered milk

suckling difficulties and (8) exhaustion of theseveral times, but as Figure 2 shows, the infant did

motherdirectnot reach the target weight gain line. Adjustment ofbreast-feeding. Suckling difficulties include (a)the amount of powdered mild, not only in thismalformation

flat,

particular case, may determine, whether thehypertrophic hypotrophic), (b) anomalies of theinfant's weight gain will reach the expected level orbreasts (breast tension, secretion), (c) medical

not. Yano recommends that pregnant women should

conditions like cleft-palate), (d) functional factors

receive appropriate guidance from a midwife

like immature infant, low-birth-weight newborn

already during pregnancy. He recommends that theand (e) medical factors8). The items (6), (8) and a., b.

guidance by the midwife should be continued

and d. applied in the present case.

postpartum and a combination with acupuncture

may

be
of

factorsthe

impeding

nipples(sunken,Tatsunami et al. reported about the effects ofand moxibustion treatment would be desirable5). As

combined Ringheaded thumbtack needles andYano already pointed out, cooperation with thebreast massage6), while Fujiki et al. reported about

midwifethe effects on lactation in a SSP treatment grouptreatment results in a still more appropriatecompared with an untreated group7), where either oftreatment. Moreover, receiving acupuncture andthese reports had been limited to a period of one

moxibustion treatment already during pregnancy

month from immediately after delivery. Yano usedhelps to prepare the expecting mother's body andthe following acupoints GV20, LU1, LU2, CV6,

may guide the women towards a normal delivery. A

CV12, CV17, ST18, ST36, SP6, LR3, SI11, BL17,

normal delivery reduces the physical burden andduringacupunctureandmoxibustion

Tatsunami et al. used LU1, CV17,

leads to a good start of the child rearing. Reducing

while Fujiki et al. listed LU1, ST18,

the physical burden associated with pregnancy,

BL18,

BL205),

ST36

etc.6),

CV17, SI11, GV12, LU107). Common acupoints aredelivery,childrearingbyacupunctureand

LU1 and CV17, but the reports did not detail themoxibustion treatment helps mothers to enjoy

reactions at the acupoints. In my case, however, I

childcare and the author would like to recommend

chose and treated CV17, because I felt a depression

using acupuncture and moxibustion treatment forthere (state of deficiency) upon palpation and also

many pregnant women.

treated this point for postpartum convalescence of

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 10, Number 1 | Spring 2015

4. Yoko Fujiwara, Keiko Tori, Chikako Hisatomi,【Conclusion】
In a woman with insufficient lactation after giving

Akiko Uchino, Minoru Uchino: About support forprematurely birth in the 35th GW 5 acupuncture

early phase hypolactation. Journal of the Sagaand moxibustion treatments starting on the 81st day

Department of the Japan Society of Maternal

after delivery and reduction in the amount of

Health, 15(1), 25-27 2012

powdered milk made maternal feeding possible.

5. "Ladies Acupuncture and Moxibustion", Tadashi
Yano, Ishiyaku Pub,Inc., 251-257, 2006
6. Takako

References
1. Toshiaki Shimizu: The definition of maternal
feeding. Nutrition Committee – Report by the
newborn committee about the breast milk

Investigationof

Tadashi

Tsubo

Yano,

(acupoint)

ettreatment to promote lactation and its effects, Japan
Society of Maternal Health, 38:396-402, 1997
7. Akira Fujiki, et al.:. SSP treatment for patientswithSociety, 115(8):1364-1367, 2011

medicine and the pain clinic, 15:1013, 1985

3. "Standard Science of Obstetrics and Gynecology".
Takashi Okai, Takuya Ayabe, Igaku Shoin, 2011al.:,stimulation

promotion project. Journal of the Japan Pediatric
2. http://www.mhlw.go.jp/houdou/2006/06/h0629-1.html

18

Tatsunami,

postpartum

8. "Nursing
Matsubara,forhypolactation,

Maternal

MinakoFeeding",

Yamanishi,

SHUPPAN, Publishers Co., Ltd., 2003

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Oriental
Manami
MEDICUS

Volume 10, Number 1 | Spring 2015

Body weight and amount of powdered milk from delivery until visit in thisWeight(g)Amount of milk/day(ml)30 days after delivery,
consultation with midwife

42 days after delivery,
direct breast-feeding
becomes possible

Powderedmilk

WeightFirst visit

Weight gain curvewhen weight gain

61 days after delivery,is 1 kg/monthconsultation with midwife

No. of days
after delivery

Figure 1

Present illness

Weight gain after support and amount of powdered milk per day
Weight(g)Amount of milk/day(ml)Powderedmilk

Moxibustion
at home

WeightAvg. weight gain

Targetweight gain
Acupuncture &Moxibustion treatment (5)Acupuncture &Moxibustion treatment (4)Acupuncture &Moxibustion treatment (3)Acupuncture &Moxibustion treatment (2)Acupuncture &Moxibustion treatment (1)27g/day
18.6g/day
25g/day

35g/day

10g/day

Decrease
No. of days
after elivery

No. of days

Figure 2 Course

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Volume 10, Number 1 | Spring 2015

Fluctuations feeding methods
One monthafter delivery

Maternal feeding 42.5%

Mixed feeding 52.5%

Artificial feeding 5.1%

Three months
after delivery

Source: Ministry of Health, Labor and Welfare "Investigation of infant feeding in 2005"
Figure 320

Fluctuations in infant feeding methods

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)