Acupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sections

Effects of traditional Chinese medicine-assisted intervention on improving postpartum lactation: A systematic review and meta-analysis

Importance

Breast milk is the safest food for infants and has many psychological and physical benefits for infants and mothers. However, problems encountered during the breastfeeding process can reduce postpartum women's willingness to breastfeed. Lactation and engorgement may be improved through Traditional Chinese Medicine auxiliary therapy. However, the overall efficacy of various Traditional Chinese Medicine auxiliary therapies and the relevant meridians and acupuncture points for treating breast milk deficiency remain unclear.

Objective

To investigate Traditional Chinese Medicine auxiliary therapy's effectiveness and acupoints for postpartum women who experience problems during the breastfeeding process.

Methods

Data were sourced from Embase, Web of Science, CINAHL, Cochrane, CNKI, PubMed, and the Airiti Library Central Register of Controlled Trials and Clinical Trials from the database inception to October 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Main outcome measures

The primary outcomes were overall efficiency, prolactin level, milk volume, and breast engorgement in postpartum women with lactation deficiency after-assisted therapies and the correlation between meridian points and milk secretion.

Results

A total of 1,516 studies were initially identified, and 357 articles were assessed. In the final analysis, 20 studies were included, covering various Traditional Chinese Medicine therapies (acupuncture, acupressure, scrapping, moxibustion cupping, etc.) to stimulate relative acupoints without any acupoint stimulation. The overall efficiency (odds ratio [OR] = 14.17, 95% confidence interval [CI] = 6.49 to 30.92), prolactin level (standardized mean difference [SMD] = 0.36, 95% CI = 0.074 to 0.64), improvement of milk volume (SMD = 0.94, 95% CI = 0.59 to 1.29), reduction of engorgement level (OR= 18, 95% CI = 8.34 to 38.82) demonstrated that Traditional Chinese Medicine therapies can effectively improve lactation and breast fullness, thereby helping patients with breast milk deficiency. The most common acupuncture points used to treat agalactia were classified as the Stomach Meridian, Small Intestine Meridian, and Conception Vessel, with the common acupoints CV17: Danzhong, ST18: Rugen, SI1: Shaoze, ST36: Zusanli, and ST16: Yingchuang.

Conclusion

Adjuvant Traditional Chinese Medicine therapy can improve lactation and breast engorgement, thereby increasing the willingness to breastfeed. Clinical Finding: 1. The best time for Traditional Chinese Medicine acupoint intervention for breast deficiency treatment is within 24 h 2. The most effective acupuncture points for improving milk deficiency and bloating pain are ST18: Rugen, ST16: Yingchuang, ST36: Zusanli, SI1: Shaoze, CV17: Danzhong. 3. Traditional Chinese Medicine is non-invasive and effective techniques such as scraping, cupping, acupressure and ear peas. 4. Traditional Chinese Medicine can be combined with other different acupuncture points according to the different constitutions of post-partum women. Breast acupressure, ear acupuncture, scrapping, cupping, and moxibustion are noninvasive treatments that can effectively help patients during lactation, and their clinical practice should be considered and widely promoted.

Evidence of the acupuncture points stimulation for the treatment of hypogalactia: A systematic review and meta-analysis

OBJECTIVE

To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity.

METHOD

Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis.

RESULTS

A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001).

CONCLUSION

The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

Effects of Acupressure on Lactation: An Integrated Review

PURPOSE

To assess the effects of acupressure on lactation.

METHODS

A literature search was conducted via Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed using keyword search terms acupuncture, Tuina and breastfeeding, human lactation or human milk and excluded auricular. Inclusion criteria were articles in English with no restriction on publication date. We included acupuncture as well as acupressure to ensure that relevant articles were not missed.

RESULTS

After duplicates were removed, our initial search yielded 217 articles. Using the PRISMA checklist (Liberati et al., 2009), six articles met inclusion criteria (five research studies, one case study). Preliminary evidence suggests acupressure offers a promising and inexpensive method of enhancing secretory activation following cesarean and vaginal term and late preterm births, specifically when performed at acupoints CV 17, ST 18, and SI 1.

CLINICAL IMPLICATIONS

Human milk is the optimal source of infant nutrition. Concern of low milk supply is most often cited as the cause for early supplementation with formula as well as early cessation of breastfeeding. Acupressure may be helpful in improving milk supply in early postpartum, but more research on acupressure and lactation is warranted.

Stimulation of Lactation Using Acupuncture: A Case Study

INTRODUCTION

Breastfeeding is a recognized preferred method of infant feeding; however, for many women, difficulties in breastfeeding result in termination before the recommended period of time. Acupuncture is suggested to be a promising option to treat lactation insufficiency and enhance the production of maternal milk.

MAIN ISSUE

We have reported the case of a woman with lactation insufficiency due to Caesarean section and congenital unilateral invaginated nipple. Milk production started on the 3rd day following delivery. The newborn was not provided with any food or fluids other than mother's milk. At 5 days of life, the newborn required long feeding periods and lost 4% of his birth weight, with the participant reporting lactation insufficiency described by the perception of inadequate milk production.

MANAGEMENT

Despite the implementation of conventional measures to improve lactation, the difficulties in breastfeeding persisted. Acupuncture was tried on Day 6 of life, and enhanced milk production was observed, which could be measured as the volume of residual milk extracted using the breast pump each time after the newborn achieved satiety. After acupuncture treatment there was an augmentation of maternal milk production from both breasts and successful lactation.

CONCLUSION

This case study provides information that might be useful for prospective investigation of acupuncture's efficacy in women with lactation insufficiency.

Integrated breast massage versus traditional breast massage for treatment of plugged milk duct in lactating women: a randomized controlled trial

Background

Plugged milk duct during lactation is a common problem in breastfeeding. Traditional breast massage (TBM) has been performed in Thailand with reasonable outcomes, but several follow-up sessions are often required. A new massage technique, the integrated breast massage (IBM), was subsequently developed. This study aimed to compare resolution time, reduction in mass size, and pain score after breast massage between the IBM and TBM techniques.

Methods

This randomized controlled trial was conducted at the Lactation Clinic of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during February 2019-July 2020. Women presenting with acute plugged milk duct were enrolled and randomly allocated to the IBM or TBM/control groups. Mass size in square centimeters (cm²) was calculated by multiplying the perpendicular axes of the mass. Pain score was self-scored by participants using a numerical rating scale. Median time (95% confidence interval [CI]) to resolution of plugged milk duct was derived using Kaplan–Meier survival analysis. Intention-to-treat analysis was performed.

Results

Eighty-four women (42 per group) were included. All enrolled study participants completed the study and were included in the final analysis. Twenty-six (61.9%) and 25 (59.5%) participants from IBM and TBM, respectively, had mass diameter > 5 cm. The median (interquartile range [IQR]) mass size was 30 (20–48) and 20 (12–14) cm² in IBM and TBM (p = 0.05), respectively. The median (95% CI) time to resolution of plugged duct was 0 (not available) and 1 (0.47–1.53) day in IBM and TBM, respectively (p < 0.01). After the first breast massage, the median (IQR) size of mass reduction was 30 (20–48) and 10 (10–26) cm² in IBM and TBM, respectively (p = 0.01). The median (IQR) reduction in pain score was 8 (7–8) and 6 (4–7) in IBM and TBM, respectively (p = 0.01). No participants developed skin bruising or hematoma after breast massage.

Conclusions

The IBM technique resolved plugged milk duct significantly faster, with significantly less pain, and with significantly greater reduction in mass size after the first massage compared to TBM.

Trial registration

Retrospectively registered in the Thai Clinical Trials Registry on 25 September 2019 (TCTR20190925001).

Pharmacokinetic study of clarithromycin in human breast milk by UPLC-MS/MS

This study aimed to develop a validated UPLC-MS/MS method for pharmacokinetic analysis of clarithromycin in human breast milk. For sample preparation, proteins precipitated with methanol and azithromycin were used as internal standards. Clarithromycin and azithromycin detection was achieved using electrospray ionization in positive mode. The chromatographic separation time was 5 min. The lower limit of quantification was 50 ng/mL. The calibration curve of clarithromycin was 50-4000 ng/mL, with a correlation coefficient> 0.99. The method was successfully applied to determine clarithromycin levels in breast milk obtained from a lactating mother after oral administration of a single tablet containing 500 mg of clarithromycin. The maximum human breast milk concentration (C_max) was 3660 ng/mL, the time to reach the maximum concentration (t_max) was 2.5 h, and the area under curve (AUC_0-24) was 18450 ng h/mL. The present study provides a novel UPLC-MS/MS method for pharmacokinetic analysis of clarithromycin in breast milk.

A comparative study of bilateral and unilateral early sucking within 2 hours of delivery on lactation

OBJECTIVE

This study explored and analyzed the effects of bilateral and unilateral early sucking within 2 h after delivery on lactation.

METHODS

From August 2019 to August 2020, 392 primiparas with full-term, singleton, natural delivery, and normal breast conditions were submitted to the Obstetrics Department of our hospital and were enrolled as the research subjects. The subjects were randomly divided into an experimental group and a control group, with 196 in each group. Both groups implemented early sucking with the assistance of a midwife within 2 h after delivery. The experimental group conducted bilateral breast sucking and the control group received unilateral sucking. The onset time of colostrum, the lactation volume, and the prolactin levels at 6 h, 24 h, 48 h, and 72 h after delivery, including neonatal urination and incidence of complications were compared between the two groups.

RESULTS

The onset time of colostrum in the experimental group was much earlier than that in the control group with a statistically significant difference (P<0.05). The postpartum filling time of the experimental group was shorter than that of the control group, with a statistically significant difference (P<0.05). There was a statistically insignificant difference in the distribution of lactation yield between the two groups at 6 h of postpartum (P>0.05). The lactation yield distribution in the experimental group at 24 h, 48 h, and 72 h was critically superior to that in control group, with statistically significant difference (P<0.05). The degree of prolactin in the experimental group was higher than that in the control group (P<0.05). There was no significant difference in urination frequency and the incidence of complications between the two groups of neonates at 24 h, 48 h, and 72 h (P>0.05).

CONCLUSION

The effect of bilateral early lactation within 2 h after delivery is superior to that of unilateral early lactation, which is worthy of clinical application.

The effect of dance-based mind-motor activities on the quality of life in the patients recovering from COVID-19: A protocol for systematic review and meta-analysis

BACKGROUND

Since the outbreak of coronavirus disease 2019 (COVID-19), with the improvement of diagnosis and treatment level in various countries, more and more patients have been discharged after systematic treatment. In order to effectively promote the overall recovery of patients' physical and mental function and quality of life (QOL), the focus of clinical work should be gradually shifted to rehabilitation treatment. Dance-based mind-motor activities were defined as coordinated upright mind-motor movements that emphasize dynamic balance, structured through music or an inner rhythm (e.g., breathing) and distinctive instructions or choreography, and that involve social interaction. It has positive effects on motor function, lung function, psychological mood and other aspects, so it can be used as a safe alternative therapy for patients recovering from COVID-19. At present, there are no relevant articles for systematic review.

METHODS

From its inception until March 2021, we will conduct a comprehensive electronic search, including Cochrane Library, MEDLINE, PubMed, Springer, EMBASE, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Wan-fang database. Two independent researchers will conduct article retrieval, screening, quality assessment, and data analysis through the Review Manager (V. 5.3.5).

RESULTS

The results of this study will evaluate the effectiveness and safety of dance-based mind-motor activities for the improvement of QOL in COVID-19 patients during the recovery period.

CONCLUSION

The conclusion of the study will provide an evidence to judge whether dance-based mind-motor activities is effective and safe for COVID-19 in recovery period.

ETHICS AND DISSEMINATION

This protocol will not evaluate individual patient information or infringe patient rights and therefore does not require ethical approval.

PROSPERO REGISTRATION NUMBER

CRD42021232995.

The Acceptability, Feasibility, and Effectiveness of Breast Massage Combined with Acupoint Stimulation to Promote the Volume of Human Milk in Mothers with Preterm Infants: A Pilot Study

Background. Preterm infant mothers have always encountered difficulties in human milk production. For this reason, an intervention of breast massage combined with acupoint stimulation was designed to increase the production. Purpose. Through a pilot randomized trial, we assessed the acceptability, feasibility, and effectiveness of breast massage combined with acupoint stimulation and the study procedures. Methods. 40 participants of preterm infants born at less than 34 weeks of gestation were randomly allocated to the CG (control group) or the EG (group with breast massage combined with acupoint stimulation). Data related to the acceptability, feasibility, and effectiveness of the intervention and research procedures were collected and analysed. Results. The daily volume progressively increased each day in the first 7 days in both groups and a significant difference was observed between the groups ( $P$  < 0.001). The initiation time of lactogenesis stage II was 50.06 ± 6.78 (40.00–64.00) hours in the EG and 66.18 ± 14.64 (48.00–96.00) hours in the CG, where a significant difference was detected ( $P$  < 0.05). The mean score of satisfaction with the intervention in the EG was 4.56 ± 0.32 (4.0–5.0), while the retention rates were 82.5% and 85.5% (17/20) in the CG, and 80% (16/20) in the EG. Conclusion. This pilot study was oriented towards the effectiveness of breast massage combined with acupuncture stimulation for the increase of human milk production in the participants. The intervention was accepted well and the study process was reasonable. A large-scale RCT will be able to determine the beneficial effects of this intervention on human milk production.

The efficacy of Tuina for asthma: A protocol for a systematic review and meta-analysis

BACKGROUND

Asthma is one of the most common chronic diseases in the world, with ∼100 million asthma patients worldwide. China has become one of the countries with the highest asthma death rate in the world. Asthma is a chronic airway inflammatory disease. Patients with this disease may have symptoms such as cough, wheezing, and difficulty breathing. For many years, Western medicine has mainly used anti-inflammatory, anti-bronchial spasm, asthma, cough, and oxygen to treat this disease, but the effect is not good. Tuina is a common treatment for asthma in China. But at present, there is no systematic evaluation report on its therapeutic effectiveness and safety. This protocol aims to reveal the efficacy and safety of Tuina for treating asthma.

METHODS

The following databases will be searched by electronic methods: PubMed, EBASE, WHO International Clinical Trials Registry Platform, Embase, the Chinese Biomedical Literature Database (CBM), Wan-fang Data (WANFANG), the China National Knowledge Infrastructure (CNKI), and other sources from inception to November 2020. Bias risk, subgroup analysis, data synthesis, and meta-analyses will be assessed with RevMan V.5.3 software if the data is met inclusion conditions.

RESULTS

This study will present a quality evidence of Tuina for the treatment of astma patients.

CONCLUSION

The systematic review will present reliable evidence to judge whether or not Tuina is a safe and effective intervention for asthma patients. International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) registration number: INPLASY2020110100.