insufficient lactation, hypogalactia

Multicentral randomized controlled studies on acupuncture at Shaoze (SI 1) for treatment of postpartum hypolactation, 2007

Wang HC, An JM, Han Y, Huang LN, Zhao JW, Wei LX, Dong L, Zhai GR, Li XP, Yang AJ, Gu M.
Zhongguo Zhen Jiu.

Abstract
OBJECTIVE:
To explore effect of acupuncture at Shaoze (SI 1) for treatment of postpartum hypolactation.

METHODS:
Multicentral randomized controlled and single blind clinical trial was adopted, and 276 cases were divided into a treatment group and a control group, 138 cases in each group. The treatment group were treated with electroacupuncture (EA) at Shaoze (SI 1) and the control group with EA at Shangyang (LI 1). After treatment of 2 courses, the therapeutic effects and changes of cumulative score of TCM symptoms, mammary filling degree, lactation amount, prolactin level were evaluated and investigated.

RESULTS:
The cured and markedly effective rate was 97.8% in the treatment group and 24.3% in the control group with a significant difference between the two groups (P < 0.05). The treatment group in improvement of the cumulative score of TCM symptoms and the mammary filling degree, and increasing the lactation amount and the prolactin level were better than the control group (P < 0.01).

CONCLUSION:
Acupuncture at Shaoze (SI 1) has obvious therapeutic effect on hypolactation.

-> 원문 못 찾음.

Clinical Observation on the Treatment of Post-cesarean Hypogalactia by Auricular Points Sticking-Pressing, 2009

ZHOU Hai-yan (周海燕), LI Li (李 力), LI Dan (李 丹), LI Xia (李 霞), MENG Hong-juan (孟红娟), GAO Xue-mei (高雪梅), JIANG Hui-jun (姜慧君), CAO Li-rong (曹丽蓉), and ZHU Yi-ling (朱一麟)
Chin J Integr Med

ABSTRACT
Objective: To explore the effect of auricular points sticking-pressing (APSP) in treating postcesarean hypogalactia (PCH).

Methods: A randomized, controlled, single-blinded clinical trial on 116 patients with PCH was carried out. They were equally assigned to the treatment group and the control group. The treatment group received APSP, with the pellets pressed for 4 times daily, while the control group was only asked to do lactation to meet infant demand. The therapeutic effifi cacy and the changes in scores of traditional Chinese medicine (TCM) syndrome, volume of milk secretion, supplementary feeding and serum level of prolactin (PRL) in the two groups were estimated and compared after the patients had been treated for 5 days.

Results: The cured and markedly effective rate in the treatment group was 89.7%, which was signififi cantly higher than that in the control group (27.6%, <0 .05=".05" 0.2527="0.2527" 95="95" and="and" ci="ci" decrease="decrease" elevation="elevation" feeding="feeding" improvement="improvement" in="in" increase="increase" level="level" milking="milking" of="of" p="p" prl="prl" revealed="revealed" supplementary="supplementary" syndrome="syndrome" tcm="tcm" the="the" volume="volume">the treatment group were all superior to those in the control group, showing statistical signififi cance ( <0 .01=".01" p="p">
Conclusion: APSP shows an apparent effifi cacy in treating PCH and is worthy of application in clinical practice.

변증기준
(1) Qi-blood deficiency type(QBD):
little or even none of milk secretion,
thin milk,
soft mammary gland with no distending sensation,
lusterless complexion,
listlessness,
poor appetite,
pale tongue with thin-white coating,
fine-weak pulse;
(2) Gan (肝)-qi stagnancy type (GQS):
little or even none of milk secretion,
slimy milk,
distention and painful mammary gland,
dysthymia,
distending pain in the chest and hypochondriac region,
poor appetite,
dark-red tongue or with reddened tip and margin, thin-yellow coating,
wiry thready or wiry quick pulse

The severity of hypogalactia
(1) mild: volume of milk secreted met 2/3 of infants' requirement;
(2) moderate: up to 1/3;
(3) severe: almost no milk secretion, unable to lactate

주이혈점
유방점, 내분비점
  기혈부족시 비점, 위점
간기울결시 간점, 신문점

Vaccaria seeds were stuck and fi xed on the sensitive auricular points detected by a metal probe with zinc paste in 0.6 cm× 0.6 cm, with each pressed
individually for 1 min to induce stimulus until patients felt endurable heat and distending pain on auricles, and the pressing repeated for 4 times every day.
The pressing was performed once a day, beginning from the first day after cesarean, for 5 days in total. Meanwhile, the patients were encouraged to do breast feeding for no less than 8 times every day.

-> 이침이 PRL 수치를 증가시켜 모유량을 증가시킨다고 봄.

Galactorrhoea Following Acupuncture, 2012

Chris Jenner, Jacqueline Filshie.

일측 유방절제술을 받은 41세 여성에서 통증 치료 목적으로 받은 침 치료 중 건측에서 galactorrhea 발생함.

She was given paravertebral acupuncture at C7, T1, T2 and T4, which included the intercostobrachial nerve distribution, and trigger points in infraspinatus and the  suprascapular region were needled. The lymphoedematous right arm was avoided. Points on the left arm were treated; these included the traditional acupuncture point LI4.

호르몬 검사는 하지 않음.

Study on clinical efficacy of needling Danzhong(CV 17) in treating postpartum hypogalactia. 2008

JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE
Tao Huang, Bao-ying Chen, Jun-qin He, Jian Bai, Mei Gu, Hong-tao Cao, Mei-jie He, Xin Li, Jing-wei Jiang and Gui-rong Zhai, et al.

Abstract

Objective  

To investigate the clinical efficacy of needling Danzhong(CV 17) in the treatment of postpartum hypogalactia and provide clinical evidence for indications of the point.

Methods  

A multi-centre single-blind randomized controlled trial was carried out. (276명)Two hundred and seventy-six puerperal women with postpartum hypogalactia were randomly allocated into acupuncture group and herb group, and respectively treated for three consecutive days(3일 동안 치료). The degree of mammary fullness, the amount of milk secreted, prolactin, baby weight, the frequency and volume of artificial feeding, the number of infant urination events, and the duration of baby crying were observed. The clinical curative effects on postpartum hypogalactia were compared.

Results  

Hypogalactia was effectively treated in both acupuncture and herb groups. There were statistically significant differences in degree of mammary fullness, amount of milk secreted, baby weight, the frequency and amount of artificial feeding, and the number of infant urination events between pretreatment and post-treatment, but no difference between the two groups. There was no significant difference in prolactin in the acupuncture group and there was a difference in prolactin in the herb group between pretreatment and posttreatment.

Conclusion  

Needling Danzhong(CV 17) can effectively promote lactation.

Xiong-gui-tiao-xue-yin (Kyuki-chouketsu-in), a Traditional Herbal Medicine, Stimulates Lactation with Increase in Secretion of Prolactin but not Oxytocin in the Postpartum Period, 2007

The American Journal of Chinese Medicine
Takahisa Ushiroyama

Abstract: The aim of the present investigation was to evaluate the clinical efficacy of Xionggui-tiao-xue-yin, a traditional Japanese herbal medicine, in stimulating lactation in the postpartum period. We enrolled 82 women who had a normal delivery in Osaka Medical College Hospital, and randomly assigned them to the following two groups: a group of 41 women who received Xiong-gui-tiao-xue-yin at a dose of 6.0 g/day (Group X), and a group of 41 women who received ergometrine (methylergometrine maleate) at a dose of 0.375 mg/day (Group E). Volume of lactation was determined daily until Day 6 postpartum. Plasma prolactin and oxytocin concentration were measured at Days 1 and 6 postpartum. The results showed that volume of lactation was significantly higher in Group X than in Group E at Days 4 (p = 0.042), 5 (p = 0.038), and 6 (p = 0.046). Significant differences between Groups X and E were noted in plasma prolactin concentration at Days 1 (157.9 ±  78.2 ng/ml and 129.1 ± 64.8 ng/ml; p = 0.037) and 6 (167.5 ± 95.4 ng/ml and 117.1 ± 53.6 ng/ml; p = 0.0042) postpartum. On the other hand, at Day 1, oxytocin concentration was significantly higher in Group E than in Group X (p = 0.0024). No adverse effects were observed in this study. 

The results of our study demonstrate the beneficial effects of Xiong-gui-tiao-xue-yin on lactation, with increase in prolactin level without increase in oxytocin level in the postpartum period. Therefore, Xiong-gui-tiao-xue-yin can be expected to improve lactation in women in the postpartum period. Further detailed bio-pharmacological studies and clinical trials to investigate the properties of this drug are warranted. 

가열식 화침

가열식 화침요법은 오승규 원장이 기존의 온침요법을 변형 개발하여, 인대, 건질환에 대해 사용됨.

<신용승, 화침요법에 관한 문헌적 고찰, 2003>

손상된 인대의 회복에 대한 온침의 효과, 2006

허동석

우측 뒷발 족관절 염좌를 유발한 쥐들을 4주와 8주 후 각각에 대하여 매주 1회 6주간 환측 족관절 전외측 부위에 온침을 시행함.
인대조직을 박리하여 western blotting and immunofluorescence, RT-PCR에 의하여 단백을 분석하기 위해 사용함. Hoechst 염색법은 각 세포수를 측정하고, Masson's trichrome 염색법은 콜라겐 섬유를 시각화 하는데 사용함.

섬유아세포 핵의 수 증가.
type III 콜라겐 mRNA와 단백질 발현 증가.
콜라겐 섬유의 시각적 강도 증가.
건에서도 유의성 있는 회복 정도를 보였으나, 인대에 비해 그 변화폭이 적어 건보다는 인대에 더욱 효과적으로 보임.

No injury 군(n=6)
only injury 군(n=6)
prolotherapy 군(n=14)
 0.1ml(12.5% 포도당 용액)

warming acupuncture(n=20)

내측 측부인대 손상 환자의 가열식 화침 치험 1례, 2009

고경모, 김재수, 이봉효, 정태영, 임성철, 이경민

大邱韓醫大學校 濟韓東醫學術院

여자 77세. 좌측 슬부동통 호소. 퇴행성 관절염 치료 당시로부터 10년전 진단.
초진 당시 내측 측부인대 부위 자발통, 압통, 부종, 열감, 내슬안 부위 동통, 보행시 통증 악화, 관절 불안정성 보임.


치료방법
측부인대 기시부위는 관절면과 평행하게 선을 긋고 4개 침시술, 그 상방으로 3개의 침 시술을 한다.
종지 부위를 관절면과 수평으로 표시하고 4개 침시술, 하방으로 3개의 침 시술을 한다.
0.7mm * 10cm 침 사용.
가스 토치를 사용하여 피부로부터 2cm 가량 떨어진 지점을 가열하며 각 침체 당 약 30초 가량이 필요하다.
가열 과정은 2회 이상 반복하지 않는다.
가열시 따끔하거나 뜨겁다는 느낌을 호소하면 해당 침체의 가열을 중지하고 그 옆의 침체를 가열한다.
2일 간격으로 3회 시술함.

일주일 입원동안 가열식 화침, 한약치료, 물리치료 모두 적용됨. VAS 5로 감소되었다고 보고함.

가열식 화침을 이용한 외상성 내측측부인대 손상 치험 5례, 2010

이광호, 유영진, 선승호, 권기록

大韓鍼灸學會誌

외상에 의한 슬관절 통증 호소하는 환자 중 valgus stress test 양성, tenderness 양성 환자 5명

0.40mm * 40mm 침을 사용하여 0.8-1.0cm 간격으로 침을 자입하여 환자마다 15~20개의 침을 사용
침첨이 골막에 닿도록 자입함
가열 전 주변 부위가 화상 입지 않도록 반창고로 보호한 후 피부에서 1.3~1.5cm 떨어진 지점의 침체를 가열하고, 침체를 번갈아 가열하되, 각각 2-3회 정도 가열함

가열식 화침 이외에 다른 치료는 병행하지 않음.

요통에 대한 추나요법과 가열식 화침 병행 치료의 효과, 2011

장동호, 배우열, 정종훈, 이인선

韓方再活醫學科學會誌




3회 이상의 시술을 받은 43명(실험군 20명， 대조군 23명)을 대상
실험군 - 장골 후방회전변위 교정법과 천장관절 가열식 화침 요법을 병행
대조군 - 장골 후방회전변위 교정법으로만 치료

실험군으로 분류된 20명의 환자에게는 일반적인 침치료를 먼저 시행한 후, 장골 후방회전변위 교정법과 천장관절 가열식 화침 시술을 하였다.
하지길이 비교를 통하여 장골 후방회전변위, 장골 후방회전 & 천골 측굴변위로 나누어 교정법을 시행하였고,
교정 이후 양측의 하지길이가 일치된 상황에서 천장관절에 0.50x60mm의 1회용 호침을 후상장골극 내측 20 mm 및 하부 10 mm 정도에 35mm의 심도로 환자가 뻐근한 느낌을 호소할 때 까지 자침한 이후
피부에서 10mm 떨어진 침체 부위를 가스라이터를 이용하여 열을 가하여 환자가 뜨겁거나 따끔거림을 호소하거나, 침 주위의 피부에 수포가 보이면 가열을 중단하고 5~6초 경과 후에 열감이 소설됨을 확인하고 재차 가열하여 총 3회 정도 가열하였다.
치료는 3일에 1회씩 시행하여 주 2회 치료하였다.

대조군은 23명의 환자를 대상으로 일반적으로 사용하는 체침 치료를 하였다. 침치료 방법은 실험군과 동일.
장골 후방회전변위 교정법도 동일하게 시행하였다.
대조군 역시 다른 치료법은 본 연구의 치료효과 검증을 위하여 배제하였다.

슬개건 및 후방십자인대 손상을 동반한 슬내장증 환자에 대한 치험 1례 - 가열식 화침 치료 및 운동 치료를 중심으로 -, 2011

김민철, 주원상, 박가영, 박은영, 박진수, 김에스더, 김성호

韓方再活醫學科學會誌

교통사고로 인한 슬개건 및 후방 십자인대 손상을 동반한 슬내장증 호소하는 남성 22세.
MRI 상 R/O) partial tear of prox. PCL, Lt.
post. drawer test 양성

환자를 앙와굴슬위를 취하게 한 후 슬개골(patella) 하연으로 촉진을 통하여 병소의 위치를 확인하고 표시를 하였다.
시술 전 해당부위를 소독한 후 표시 된 부위에 0.40x40 mm 1회용 호침을 사용하였으며，
1 回/7-10 日(총 3회) 시술로
침 배열 간격은 0.8-1.0 cm로 하였고
자침 후 10분간 유침 하였으며,
자침 심도 는 0.8-1.2 cm로 하였다.
가열 시간은 10-15초로 자침 부위에서 약 1.3-1.5 cm 떨어진 부위의 침체를 3회씩 가열하였으며
가열 도구는 byte GAS IRON(KT-2001, Kovea Ltd., Korea) 을 이용하였다
가열 전후로 환부를 소독 및 보호하였다，

3회의 가열식 화침 시술
4주가 매일 정경침 시술
한방물리요법 시행
안정가료(1주)-체중 부하운동(2주)-능동운동, 수동운동, 등척성 저항운동, 등장성 운동(3주 이후) 시행
한약 투여

하슬개건에만 가열식 화침을 적용한 것으로 보임.

표시한 부분은 가열식 화침 시술일

가열식 화침(火鍼)을 이용한 방아쇠수지 치험 2례, 2011

이철휘, 박민규, 강일아, 신민근, 서상경, 윤광식, 이창희, 이재민

大韓鍼灸學會誌

침은 0.40 * 40mm 호침 사용

자침 부위는 palmar lig. of MCP jt. 주위 압통, 경결처 4군데 선혈.

침첨이 골막에 닿도록 자침한 후 침체 가열. 1회 열자극.

74세 여성, 우측 4th MCP 관절부위 통증, 방아쇠 현상

12일간 매일 시술함

이후 외래 진료 중 7회 시술하여 양호한 결과(tanaka score 0)를 얻음

52세 남성, 좌측 3rd MCP 관절부위 통증, 방아쇠 현상

약 2달동안 화침치료 16회 시술 후 양호한 결과(tanaka score 2)를 얻음

전열침

전열침

溫鍵이나 뜸을 이용한 열자극 치료가 인대나 건 병변에 효과가 있는 것을 착안하여 스테인리스 침을 자침한 후 침체를 직접 가열하여 병소에 열자극을 전달하는 방법이다.
뜸보다 심부조직에 열자극을 가할 수 있고 溫鍵보다 높은 온도로 자극하고 가열하는 화력의 세기로 침체의 온도를 조절할 수 있다.

전열침은 화침요법과 온침요법을 결합한 것으로 치밀결합조직의 심부 병소에 침을 자입한 후 가열하는 치료법

섬유-골막 연접부는 침끝이 골막에 닿도록, 근-건 연접부 병변은 침 끝이 건조직의 60-70%를 관통할 정도로 자입하며, 이후 침체를 가열하는 방법이다.(오승규, 심부 가열침을 이용한 인대, 건 손상의 치료, 2009)

온침은 발목의 손상 인대 조직에서 type III 콜라겐 mRNA와 단백질의 발현 증가 및 콜라겐 섬유를 증가시키는 등 손상인대 회복에 유효함을 보였다.(Dong-Seok Heo, Effects of warming acupuncture on ligament recovery in injury-induced rats, 2006)

전열침을 적용한 산후 요통환자 치험 3례, 2012

임광묵, 위대용, 고연석, 이은희, 반지혜, 이아영

척추신경추나학회지

산후 골반통 - 척추 전만의 증가, 인대의 이완, 천장관절의 상방활주

산후 요통을 호소하며 입원한 환자 3례.

복와위로 요천추부 후면을 촉진을 통하여 압통을 호소하는 병소의 위치를 확인하고 0.40*60mm의 호침으로 15~20초, 2-3회 가열. 가열 방향은 체표면에서 30도 위를 향하도록 하였으며, 화상 등의 부작용을 방지하기 위하여 환부를 소독 및 보호함. 3일에 1회 시술.

전열침요법 외에 침치료, 약물치료, 물리치료 병행함.

평가척도는 SF-MPQ, VAS, ODI 를 사용하여 감소의 여부를 확인함.

전열침(가칭)이 급성 족관절 염좌로 인한 전거비 인대 손상에 미치는 임상적 효과, 2009

안순선, 장효길, 허동석

한방재활의학과학회


전거비 인대 2도 손상 환자군 79명.

0.25 mmx40 mm 호침 사용.
볼펜으로 섬유-골막 연접부에서부터 인대 부분을 압박하여 심한 통증이나 jump sign이 나타나는 곳을 표시한 후 골막에 닿을 때까지 자침하였다.
자침시 환자가 짜릿한 느낌이나 통증을 호소하면 이를 피하여 다시 자침하여 말초신경이나 혈관에 자침하는 것을 피하였다.
피부에 1 cm 떨어진 침체 부위를 가스라이터로 5~7초 정도 가열하며 환자가 뜨겁거나 따끔거림을 호소하면 1초 후 가열을 중단하였다. 침체를 가열할 때 불꽃이 피부를 향하여 화장을 입는 것을 방지하기 위해 자체 제작한 방열판(60 mmx90 mm, 열경화성 수지)을 사용하였다.
치료 후 화상 방지 를 위해 silver sulfadiazine 10 mg 성분의 연고로 처치하였으며 치료 기간은 주 1회를 원칙으로 하였다.

pressure algometer(AT-1114, J.TECH，USA)를 이용하여 pain threshold를 측정하였다.

전열침 요법이 pain threshold 및 VAS score 상에서 일반적언 2도 염좌의 치료기간보다 짧은 기간내에 효과를나타낸 것은 족관절 염좌의 조기치료를 가능하게 하여 치료 기간의 단축 및 만성불안정성을 조기에 막을 수 있다는 장점을 보여주는 것이라 하겠다.

전열침은 급 만성 족관절 2도 염좌에 효과가 있으며 이환 기간에 관계없이 치료 횟수에 대하여 유효하다고 사료된다.

전열침이 장요인대 염좌로 인한 요통에 미치는 임상적 효과, 2010

장효길, 안순선, 허동석, 홍권의

한방재활의학과학회

요통을 주소로 내원한 환자 중 8명(방사선 검사 상 요추부의 염좌 진단을 받았으며, 이학적 검사 상 belt test, goldthwait's test의 양성 소견을 나타내는 자)

양측의 관원수에 0.30mm * 75mm 일회용 스테인레스 호침으로 환자의 체격에 따라 2-3개를 40-50mm의 심도로 환자가 뻐근한 느낌을 호소할 때까지 자침하였다.
자침 시 환자가 찌릿한 느낌이나 통증으로 호소하면 이를 피하여 다시 자침하여 말초신경이나 혈관에 자침하는 것을 피하였다.
자침 후 1cm 떨어진 침체 부위를 가스라이터를 이용하여 열을 가하여 환자가 뜨겁거나 따끔거림을 호소하거나, 침 주위의 피부에 수포가 보이면 1초 후 가열을 중단하고 2-3초 정도 경과 후 다시 한 번 더 5-7초 정도 가열하였다. 침체를 가열할 때 불꽃이 피부를 향하여 화상이 입는 것을 방지하기 위해 자체 제작한 방열판(60mm*90mm, 열경화성 수지)을 사용하였고, 치료 후 화상 방지를 위해 silver sulfadiazine 10mg 성분의 연고로 후처치하였고 7일 간격으로 주 1회 치료하였다.

장요인대 염좌로 인한 요통환자의 전열침을 통한 호전은 요추와 천골, 천골과 장골, 추체와 추체간의 안정성을 정상으로 유지하여 관절의 과가동성을 방지함으로써 통증의 경감을 가져온다고 생각된다.

요추에서 주로 문제를 일으키는 인대들로는 극간인대, 장요인대, 천장인대, 천극인대, 천결절인대, 천미인대 등의 척추 뒤쪽의 인대와 골반의 인대, 그리고 고관절과 기타 하지의 큰 관절 주변의 인대들이다.(George Stuart Hackett, 프로로테라피를 이용한 인대와 건의 이완에 대한 치료, 2004)
장요인대가 만성 요통의 중요한 원인이 될 수 있다.(Sims JA, The role of the iliolumbar ligament in low back pain, 1996)
제5요추-제1천추 접합부의 굴곡시에 장요인대의 후방섬유는 요-천추의 전방굴곡을, 전방섬유는 외측굴곡을 조절한다.(leong JC, The biomechanical functions of the iliolumbar ligament in maintaining stability of the lumbosacral junction, 1987)
장요인대가 요-천추부에서 회전력에 대한 안정성을 제공한다.(Chow DH, Torsional stability of the lumbosacral junction, significance of the iliolumbar ligament, 1989)
양측의 장요인대를 제거한 뒤 운동범위의 증가를 확인하여 요천추부의 안정성은 편측 인대만으로는 제공되지 못한다.(Yamamoto, The role of the iliolumbar ligament in the lumbosacral junction, 1990)

전열침(傳熱鍼)과 일반 침의 병행치료가 발목 염좌로 인한 외측인대 2도 손상에 미치는 임상적 효과,2011

장선정, 장효길, 허동석

한방재활의학과학회

외측인대 2도 손상 환자군 67명

침은 0.25 mmx40 mm
볼펜으로 섬유-골막 연접부에서부터 인대 부분을 압박하여 심한 통증이나 jump sign이 나타나는 곳을 표시 한 후 골막에 닿을 때까지 자침하였다.자침 시 환자가 찌릿한 느낌이나 통증을 호소하면 이를 피하여 다시 자침하여 말초신경이나 혈관에 자침하는 것을 피하였다.
pressure algometer(AT-1114, J.TECH, USA)를 이용하여 pain threshold를 측정하였다. 대상 환자가 누운 상태에서 시술자가 손상 인대의 최압통점 부위에 pressure algometer를 1kg/sec의 속도로 피부와 수직방향으로 압력을 가하여, 환자가 통증을 느끼는 시점에서 통증을 호소하거나 '아'라고 말할 때의 pressure algometer의 수치를 kgf단위로 측정하여 3회 측정한 후 평균 수치를 반영하였다.

통증 감소 효과를 보임. 통계적 방법은 잘못 적용되어 볼 필요 없음.

전열침(傳熱鍼)이 급·만성 족관절 염좌로 인한 전거비 인대 손상에 미치는 임상적 효과, 2011

장효길, 허동석

한방재활의학과학회


전거비 인대 2도 손상 환자군 79명

침은 0.25 mm x 40 mm stainless steel 멸균호침
기타는 위의 논문과 동일

전열침(傳熱鍼)이 급성 족관절 염좌로 인한 전거비·종비 인대 손상에 미치는 임상적 효과, 2010

안순선, 허동석

한방재활의학과학회

CFL 손상 12명(2차 치료 5명), ATFL 손상 16명(2차 치료 6명)

나머지는 상동

유방울혈

Treatments for breast engorgement during lactation (Review), 2010

Mangesi L, Dowswell T

Main results

We included eight studies with 744 women. Trials examined a range of different treatments for breast engorgement: acupuncture (two studies), cabbage leaves (two studies), cold gel packs (one study), pharmacological treatments (two studies) and ultrasound (one study). For several interventions (ultrasound, cabbage leaves, and oxytocin) there was no statistically significant evidence that interventions were associated with amore rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. There was evidence from one study that, compared with women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days following treatment, although there was no evidence of a difference between groups by six days, and the study did not have sufficient power to detect meaningful differences for other outcomes (such as breast abscess). A study examining protease complex reported findings favouring intervention groups although it is more than 40 years since the study was carried out, and we are not aware that this preparation is used in current practice. A study looking at cold packs suggested that the application of cold does not cause harm, and may be associated with improvements in symptoms, although differences between control and intervention groups at baseline mean that results are difficult to interpret.

Acupuncture to treat breast engorgement: two studies with 293 women

Primary and secondary outcomes
Two studies examined the effects of acupuncture on breast engorgement(Kvist 2004; Kvist 2007). In both studies there were three treatment groups: advice and usual care (which might include the use of oxytocin nasal spray at the discretion of the midwife); advice and acupuncture (excluding the SP6 acu-point); and advice and acupuncture including the SP6 point. Results for resolution of symptoms were very similar for women in the two acupuncture groups in the Kvist 2007 study, and we have combined them in the data tables. 
We were not able to include data from the Kvist 2004 study in analyses because results were not set out separately for the three randomised groups in the published report and were not available from the author.
Neither study provided information on the review’s primary outcomes(cessation of breastfeeding and mastitis). The number of women prescribed antibiotics may represent a proxy measure of mastitis; results from Kvist 2007 show that, while women in the acupuncture group were less likely to be prescribed antibiotics, the difference between the acupuncture and control group was not statistically significant.
The number of women with breast abscess was reported in Kvist 2007; women in the acupuncture group were less likely to have abscess compared to women receiving routine care, but the difference between groups did not reach statistical significance (risk ratio (RR) 0.20. 95% confidence interval (CI) 0.04 to 1.01, P =0.05).

Non pre-specified outcomes
The amount of time taken for symptoms to resolve was reported by Kvist 2007. Findings favoured the acupuncture group, with fewer women having symptoms at three, four, and five days after commencement of treatment; at four and five days the differences between groups reached statistical significance (RR 0.82, 95% CI 0.69 to 0.96) and (RR 0.84, 95% CI 0.70 to 0.99) respectively. The difference between groups for the numbers of women with symptoms lasting more than six days was not statistically significant.
In the Kvist 2004 study it was reported that at three days after the start of treatment there were no significant differences between groups for severity of symptoms or for satisfaction with breastfeeding.

Cabbage leaves to treat breast engorgement: two studies with 62 women

Primary and secondary outcomes
Two studies by the same author examined cabbage leaves to reduce symptoms of breast engorgement, and collected information on pre- and post-treatment pain scores in randomised groups. In both studies breasts rather than women were randomised, and results were not reported in a way that allowed us to enter data into RevMan 2008. In a study comparing cabbage leaves and gel packs (Roberts 1995a) it was reported that women in both groups had reductions in pain scores following treatment, but that there were no significant differences between groups (data not shown). In a second study comparing chilled versus room temperature cabbage leaves, again authors reported that both groups had less pain following treatment, but that there was no difference between the randomised groups for post-treatment pain scores (Roberts 1995)(data not shown).

Cold packs for breast engorgement: one study with 88 women

Primary and secondary outcomes
In a non-blinded study women who had had caesarean deliveries and who developed symptoms of breast engorgement were randomised to treatment and control groups (breast-shaped cold packs worn in a halter versus routine care) (Robson 1990). Women in the intervention group seemed to experience a reduction in pain intensity at post-test. The author reported a decrease in mean pain intensity score from 1.84 (standard deviation (SD) 0.65) to 1.23 (SD 0.68) compared with an increase in the control group from 1.50 (SD 0.71) to 1.79 (SD 0.72). However, the differences between groups at baseline, and the failure to observe randomisation(women with “heightened distress” were moved into the control group), make results difficult to interpret.

Agreements and disagreements with other studies or reviews

Clinical practice guidelines in the UK (NICE 2006) broadly agree with this review concluding that cabbage leaves and cold packs may be helpful for symptom relief, but that evidence on the effectiveness of these interventions is not strong. In the absence of evidence from trials the guidelines recommend breast massage,
continued breastfeeding and analgesia for symptom relief.

A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation, 2007

Linda J. Kvist, MScN, RM, RGN (Care Development Manager and Postgraduate Student), Marie Louise Hall-Lord, PhD, RN (Associate Professor), Hakan Rydhstroem, PhD, MD (Associate Professor), Bodil Wilde Larsson, PhD, RN (Professor)

to further compare acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation

The hypothesis tested is that acupuncture treatment will hasten recovery from inflammatory symptoms of the breast during lactation.

group 1: essential care and the use of oxytocin spray as deemed necessary by the midwife;
group 2: essential care and treatment by acupuncture needles placed at HT 3 and GB 21;
group 3: essential care and treatment by acupuncture needles placed at HT 3, GB 21 and SP 6.

To help standardise treatments, the midwives were asked to adhere to the following instructions. It was essential that all the participants expressed the sensation of De Qi. If the sensation occurred directly after insertion of the needle, no further manipulation should be carried out. If De Qi did not occur spontaneously, the point should be stimulated by rotation of the needles clockwise to 180° for 30 seconds. This was to be repeated as necessary after 15 mins. Re-positioning of the needle should be carried out if De Qi still did not occur. All treatments were to be terminated after a maximum of 30 mins. A battery-driven acupuncture point localiser was used in conjunction with manual palpation of the points. Marco Polo stainless steel needles with copper handles, gauge 0.25 mm and length 25 mm were used. Insertion was made between 3–5 mm depths, depending on the individual's amount of subcutaneous fat. Needles of gauge 0.2 mm and length 13 mm were available for use for mothers with very little subcutaneous fat. The midwives were at liberty to give daily acupuncture treatments for as long as they and the mothers deemed this necessary.

항생제 처방 비율이 통계적으로 유의성은 없게 나왔으나 의미 있는 감소를 보임.

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment, 2008

Linda J Kvist, Bodil Wilde Larsson, Marie Louise Hall-Lord, Anita Steen and Claes Schalén

Abstract
Background: The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.

Methods: In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical  statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.

Results: Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 10^7 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).

Conclusion:  Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.


세균 수, 종류와
1) 유선염의 증상,
2) 항생제 처방 유무,
3) 농양의 유무,
4) 증상의 재발 정도
와는 관계없음.

Antibiotics for mastitis in breastfeeding women, 2009

Shayesteh Jahanfar, Chirk-Jenn Ng, Cheong Lieng Teng

One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation.
Older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic.

Interventions for preventing mastitis after childbirth, 2010

Maree A Crepinsek, Linda Crowe, Keryl Michener, Neil A Smart

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2009), CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to November 2009), EMBASE (1974 to November 2009), CINAHL (1981 to November 2009), MIDIRS (1971 to November 2009), IPA (1970 to November 2009), AMED (1985 to November 2009) and LILACS (1982 to November 2009).

We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti-secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial).

Occurrence of lactational mastitis and medical management: A prospective cohort study in Glasgow, 2008

Jane A Scott, Michele Robertson, Julie Fitzpatrick, Christopher Knight and Sally Mulholland.

A longitudinal study of 420 breastfeeding women was undertaken in Glasgow in 2004/05.

In total,
74 women (18%) experienced at least one episode of mastitis.
More than one half of initial episodes (53%) occurred within the first four weeks postpartum.
One in ten women (6/57) were inappropriately advised to either stop breastfeeding from the affected breast or to discontinue breastfeeding altogether.

Breast Milk Jaundice and Maternal Diet with Chinese Herbal Medicines

Evidence-Based Complementary and Alternative Medicine
Volume 2012, Article ID 150120, 6 pages

Yi-HaoWeng,1 Ya-Wen Chiu,2, 3 and Shao-Wen Cheng1


Our objective was to identify the association between maternal diet with Chinese herbal medicines and prolonged jaundice of breast-fed infants. Healthy infants at 25 to 45 days of age were eligible for enrollment into this prospective study. Jaundice was defined as a transcutaneous bilirubin (TcB) value ≥ 5mg/dL. A questionnaire survey asking feeding type, stool pattern, and maternal diet was conducted at the time of TcB measurement. A total of 1148 infants were enrolled, including 151 formula-fed, 436 combination-fed, and 561 breast-fed infants. The incidences of jaundice were 4.0% in formula-fed infants, 15.1% in combinationfed infants, and 39.8% in breast-fed infants (P < 0.001). In addition, jaundice was noted in 37.1% of preterm infants and 25.0% of term infants (P < 0.001). Furthermore, jaundice was more common in breast-fed infants whose mothers did not consume the traditional Chinese herbal medicines than in breast-fed infants whose mothers did consume such medicines (P < 0.001). 


In conclusion, this cohort study has identified late-preterm birth and breast feeding as the contributory factors for prolonged jaundice of apparently well infants. The data indicate that postpartum diet with Chinese herbal medicines is associated with breast milk jaundice.

late-preterm infant & breast-feeding 군일수록 황달 유병율 높음.

 

완전모유수유군의 상대위험도 19.881, 혼합수유군 4.539, 조산군 1.998 순으로 나타남. 

한약 복용군에서 황달 유병율의 유의성 있는 감소 및 대변 횟수의 적정성을 보이고 있음.

(후기)모유 황달과 관련하여 요인을 분석한 논문.
조산, 완전 모유수유아들에게 황달 비율이 높음.
한약 복용군(생화탕, 사물탕, 두충. 기타 한약은 조사되지 않음.)의 infant에서 황달 비율이 유의성있게 낮음.

1. 모체의 식이 상태에 따라 모유 성분의 변화가 있다.
   (changes in maternal diet can affect the composition of breast milk)
2. 성분이 확인되지 않았지만, 한약 복용은 모체와 신생아에게 모두 도움이 될 수 있다. 
   (our results indicate that a combination of chinese medicines with a traditional chinese maternal diet may decrease the development of prolonged jaundice.)
3. 산모가 감초를 복용함으로써 빌리루빈 청소율을 높인다는 보고.
(Traditional Chinese medicine and treatment of neonatal jaundice, 1996 -> 인진, 대황, 감초, 황금, 황련)
(Neonatal jaundice--traditional Chinese medicine approach, 2001 -> 비슷한 내용)
4. 모유는 빌리루빈의 재흡수를 촉진하며, 장간순환하는 빌리루빈 양이 증가하면서 황달이 연장됨.
(Enterohepatic circulation of nonconjugated bilirubin in rats fed with human milk, 1990)

Efficacy of Acupressure on Breast Engorgement during Breast--feeding in Postpartum Mothers

Chia-hui Chen


　Background and purpose: The World Health Organization (WHO) recommends that breastfeeding is the best ideal method to provide newborns with nutrients. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods for up to two years of age or beyond. There are many advantages of breastfeeding. However, the pain caused by breast engorgement is one of the reasons women discontinue breastfeeding. The general management of breast engorgement is to encourage early breastfeeding and increase breastfeeding frequency. However, non-rooming-in mothers are unable to relieve breast engorgement due to low suction frequency. The pain caused by breast engorgement discourages mothers to keep breastfeeding. Acupressure has the effect of removing obstructions from meridians to facilitate breast milk ejection, and reduce pain caused by breast engorgement. The purpose of this study is to determine the effect of acupressure to relieve breast engorgement.
　
　　Methods: A randomized controlled trial was conducted on 60 postpartum non-rooming-in women in a postpartum care center at a Chiayi regional teaching hospital. Participants had been randomized equally to experimental and controlled group (each group had 30 persons). The member of each group signed the different kind of agreement to make sure they didin’t know another intervention ,to avoid placebo effect .In the experimental group, the women received acupressure and hand expression of breast milk daily for 3 days. The acupoints were 屋翳 (Wu-Yi, ST15) , 膺窗 (Ying-Chuang, ST16) , 乳根 (Ru-Gen, ST17) and 膻中 (Dan-Zhong, CV17). In the control group, the women proceeded with only hand expression of breast milk. The assessment of the subjects included recording their basic characteristics, completion of a subjective breast engorgement scale, and physiological measurements. Interventions was performed by the same researcher with the same approach and strength. Another nurse help the participants to fill the engorgement symptoms rating scale. All data collected were analyzed with Microsoft Excel 2007 and SPSS Version 18. Paired-samples t-test, independent t-test and Chi-Square test were used to evaluate differences in basic characteristics and outcome indicators. Generalized estimating equation (GEE) models were used to determine relationships between breast engorgement and basic characteristics. Data were again collected one month after intervention, and were subjected to Fisher’s exact test analysis.
　
　　Results: The basic characteristics of subjects in the two groups were homogeneous. In both groups, there were significant statistical differences (P < 0.001) in the extent of breast engorgement, subjective breast pain, and subjective breast discomfort at 5 minutes and 30 minutes after intervention on the 1st, 2nd and 3rd day postpartum. Comparisons between the experimental group and the control group showed significant improvements (P < 0.001) in all outcome indicators. After including the basic characteristics of subjects into the analysis, no significant changes in the results were found. Furthermore, results obtained from the data collected one month after intervention showed that subjects in the experimental group experienced no breast pain. In contrast, 39.3% of subjects in the control group experienced intermittent breast pain. Moreover, 3.3% and 53.6% of subjects in the experimental group and control group, respectively, experienced localized breast engorgement.
　
　　Conclusion: Acupressure had significant effects in reducing breast engorgement. It should be promoted to help lactating women to breastfeed successfully. The results of the present study can be used as a reference for postpartum breast engorgement care.

원본 못 구함.

지압 시간, 빈도에 대한 정보를 얻을 수 없음.

산후신통 중 요통, 골반통 검사법의 민감도 특이도

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review

Daniela Aldabe • Stephan Milosavljevic • Melanie Dawn Bussey

1) 임신 중 SIJ의 불균형

2) 근피로도가 높아져서 동원율이 높음

3) 보행시 체간부 회전율이 높아짐

4) P4 test, ASLR test가 효용성이 높다.

 ASLR test - 체간에서 다리로의 부하 전이를 평가하는 골반 기능 평가 방법

                - pos : 골반대의 불균형 의미

 P4 test - 임신 중, 산후 골반통을 평가하는 민감도, 특이도가 높은 검사 방법

  이 두 검사는 LBP, 부인과적 증상과 산후 골반통을 감별하는데 도움이 된다.

The posterior pelvic pain provocation test in pregnant women (1994)

 P4 test(posterior pelvic pain provocating test)

 - 임산부의 요통과 골반통을 감별하는 간단한 검사법

 - 민감도 : 81%, 특이도 80% 보고.

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain(2000)

15가지 검사법을 적용해서 민감도와 특이도를 검사해 보았을 때, P4 test가 골반대(SIJ 포함) 병변에서는 가장 효율적.

최소 84% 이상의 민감도, 98%의 특이도를 보임.

기타

The long dorsal sacroiliac ligament pain test도 제안이 되었으나, palpation test이므로 연습이 조금 필요할 듯 하다. 

임산부의 골반은 ant. tilt로 LDL 의 장력이 최대가 되므로 이 부위의 신장성 통증은 당연히 따라다니는 부분이다.

Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial

Abstract

Background

Zingiber officinale R. rhizome (ginger) is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases. The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea.

Method

This was a randomized, controlled trial. The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea. The students were all residents of the dormitories of Shahed University. They were randomly assigned into two equal groups, one for ginger and the other for placebo in two different treatment protocols with monthly intervals. The ginger and placebo groups in both protocols received 500 mg capsules of ginger root powder or placebo three times a day. In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period. In the second protocol ginger and placebo were given only for the first three days of the menstrual period. Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale.

Results

There was no difference in the baseline characteristics of the two groups (placebo n = 46, ginger n = 56). The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one (P = 0.015) and protocol two (P = 0.029). There was also significant difference in duration of pain between the two groups for protocol one (P = 0.017) but not for protocol two (P = 0.210).

Conclusion

Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically
significant effect on relieving intensity and duration of pain.

생강 1500mg로 원발성 생리통을 갖고 있는 가임기 여성(이란, 대학생)에게 월경 예정일 2일전부터 5일동안 투여한 결과 유의성 있는 통증 강도 및 기간의 감소가 관찰되었음.

이전 보고에서 생강의 항염증 효과(COX, LOX의 억제를 통한 LT, PG의 합성 억제)가 알려져 원발성 생리통에서도 같은 기전으로 작용한 것으로 보임.

이번 연구에서 유효 성분인 gingerol, shogaol의 함량이 조사되지 않음.


최근 보고(조직배양생강과 한국재래종 생강의 유효성분 비교, 조만현 외, 한국자원식물학회, 2011년)에서 6-gingerol 의 함량이 종류에 따라 차이가 있지만 0.1~0.3%(최고 75~80% EtOH 추출 상 0.6%)로 보고되는 바, 추정을 하면 3mg/day의 gingerol 정도로 추정할 수 있으나 확실하지는 않다.