Written by John Immel, IntroductionThe breasts secrete milk for the feeding of a newborn baby. In this paper I will discuss the Western medical anatomy, physiology, and pathologies and difficulties of breastfeeding. Then a presentation of the Ayurvedic approach and comparison of the two systems will follow. In general, where the Western model focuses on specific anatomical pathways, correct breastfeeding technique, nutritional requirements, and pathogens, Ayurveda focuses on quality of milk, its effects on the baby, and correcting infection through regulating the blood. In many cases, Ayurvedic treatments are preventative, relating to a number of pathologies instead of a single one. However, both systems agree that diet plays a large role in health of mom and baby while breastfeeding.Table of Contents
Anatomy and Physiology of Breast TissueThe breast sits over the chest wall and pectoral muscles and contains fatty and connective tissues, exocrine glands called mammary glands, an areola and nipple. The shape and structural integrity of the breast are maintained by ligaments attached to the chest wall. Milk is produced in small clusters of cells called alveoli. These alveoli form groups called lobules. Each lobule has a lactiferous duct leading to the nipple. Muscle tissue surrounding the alveoli can contract, pushing milk into the lactiferous duct and into widened areas called sinuses along the duct that collect the milk. A "simple mammary gland" is all the milk-secreting tissues of a single duct. A "complex mammary gland" is all the simple mammary glands (usually 10-20) that have their openings in a single nipple. The network formed by the ducts is complex like the tangled roots of a tree. Two-thirds of the functional milk producing tissue is found within 30mm of the base of the nipple. The connective and fatty tissues of the breast support and protect the milk producing areas.The areola is the dark skin surrounding the nipple. On the surface of the areola are several raised sebaceous sweat glands called Montgomery glands. They produce a natural oil which cleans, lubricates, and protects the nipple during pregnancy and breastfeeding. The oil also contains enzymes that kill bacteria. Hormones Affecting Lactation A number of hormones affect the development of the breast from birth through pregnancy and lactation, including progesterone, estrogen, prolactin, and oxytocin. The presence of progesterone during pregnancy causes further development of the breasts including growth of the areola, breast size and the formation of many more lobules. Progesterone stimulates the development of true alveoli from post-pubescent precursors and a richer blood flow to the breast. By the sixth month of pregnancy the breasts are capable of producing milk. Estrogen stimulates the growth of the ducts.Prolactin is a hormone that causes the alveoli to take nutrients from the blood stream and make milk. Oxytocin is a hormone that causes the milk to eject from the alveoli into the ducts and out the nipple (a process called the let-down reflex). The level of prolactin increases during pregnancy, causing mammary glands to grow and produce milk. But ejection of milk is inhibited by progesterone. Prolactin is secreted by the anterior pituitary under regulation from the hypothalamus. Prolactin is also produced in the breast and the uterine lining during pregnancy. Before childbirth levels of prolactin are regulated by the anterior pituitary. After childbirth prolactin levels are maintained by stimulation from the baby sucking on the nipple. When the breast is stimulated, nerve fibers in the nipple signal the hypothalamus and prolactin levels rise, peak in 45 minutes and return to pre-breastfeeding levels 45 minutes later. Until there is the next let-down reflex, the newly created milk will not be released. Thus, release of prolactin helps prepare breast for the next feed. Oxytocin is made in the hypothalamus and stored in the posterior pituitary. It is released from the pituitary by nerve stimulation from the hypothalamus. Since the release of oxytocin is controlled by the nervous system, the brain plays a large role and oxytocin levels are highly influenced by emotions. Ayurvedically, this implies that oxytocin is highly affected by Vata dosha, a theory we will return to later in the paper, In general, the release of oxytocin is stimulated by touch, hugging, and orgasm in both males and females. Oxytocin is involved in social recognition, bonding, and the formation of trust and generosity between people. Sometimes oxytocin is referred to as the "tend and befriend" hormone. Suckling stimulates nerve endings in the nipple and areola signaling the pituitary to release oxytocin. Oxytocin causes the let-down reflex by stimulating muscles cells around the alveoli to contract and eject milk into the ducts. The release of oxytocin also causes the uterus to contract, facilitating labor and helping the uterus return to normal size after pregnancy. Some emmenogogues and abortifacients (drugs that stimulate menstruation and abortion respectively) work by stimulating release of oxytocin. Thus, the same drug used as an abortifacient to induce labor can be used as a galactagogue (substances that stimulate milk secretion or production) after childbirth. The let-down reflex can be inconsistent in the beginning. It can be stimulated by the thought of breastfeeding or the sound of another baby crying. Sexual stimulation or orgasm can also cause a let-down reflex. Or, while the baby is feeding, milk may also drip from the opposite breast. Often, the inconsistencies settle down within two weeks of feeding. There can be many let-downs during a feeding. Whenever a let-down happens, the mother may feel a tingling or a full sensation in the breast or uterine cramping. The mother may also feel thirsty. Lactation Near the end of pregnancy around the time of parturition (presumably due to rising levels of prolactin), a woman's breasts enter lactogenesis stage I, producing colostrum, a thick yellowish fluid. True lactation does not begin until progesterone and estrogen levels drop after baby is born. When progesterone and estrogen levels drop in the presence of prolactin, about 30-40 hours after birth, the breast enters lactogenesis stage II. It begins producing copious amount of milk. The mother does not experience this milk "coming in" until 50-73hrs after birth when the breasts feel full. The milk produced during this phase is called "mature milk" as opposed to the colostrum.While the endocrine system controls milk production during pregnancy and the first few days after birth, control becomes more localized and demand-based once milk supply is more firmly established. This phase is called lactogenesis stage III, characterized by the supply and demand process. The breast continues to produce milk as long as it is emptied. The more nursing, the more milk produced. Many other hormones, such as follicle stimulating hormone (FSH), luteinizing hormone (LH) and human placental lactogen (HPL) also play roles in milk production. Weaning refers to the gradual process of substituting solid foods for breast milk until the baby is no longer breastfeeding. The World Health Organization recommends gradual weaning starting at six months. Within two weeks of no breast stimulation lactation ceases and prolactin levels drop. Composition of Breast Milk The colostrum is the first milk a breastfed baby receives. It is a thick, yellowish fluid that is highly concentrated, containing carbohydrates, proteins, and fats. It is also high in white blood cells and antibodies that build the baby's immunity and prevent food allergies. Colostrum has a mild laxative effect, expelling the meconium (tarry poop accumulated in the baby's GI tract during the pregnancy) and also clearing excess bilirubin from the system which helps to prevent jaundice. Colostrum is easy to digest. The low volume is easily accommodated by the baby's small digestive tract. A newborn's digestive tract is very permeable; colostrum helps to coat and seal the digestive tract and prevent germs and foreign particles from invading.The properties of mature breast milk are not entirely understood. The first milk that comes out of the breast during a feeding, called the foremilk, is watery, low in fats and carbohydrates. The hindmilk is creamier. Some have speculated that the foremilk is to satisfy thirst and the hindmilk nutrition. Generally, the ratio of water to fat fluctuates depending upon the mother's diet. Human milk is noticeably thinner and sweeter than cow's milk. It contains much less protein. Nutrient content is relatively consistent at 0.8-0.9% protein; 3-5% fat, 6.9-7.2% carbs, 0.2% ash (minerals). The carbohydrates are mostly lactose and sugars similar to lactose. Proteins include casein, alpha lactalbumin, lactoferrin, IgA, lysozyme, and albumin. Breast milk contains 10mg of calcium in every ounce. Breast milk also contains urea, uric acid, creatinine, amino acids, and nucleotides. Interestingly, it also contains ethnocannabinoid, the neurotransmitter released by marijuana. Breast milk contains a number of substances such as antibodies that make it antimicrobial and antifungal (https://www.latrobe.edu.au/microbiology/table1.html). Generally a nursing mother produces 23-27 ounces of milk per day. The milk contains roughly a thousand calories. Additionally, production of the milk requires approximately 500 calories. Milk production represents 25% of the mother's metabolic activity, 5% more than the brain. For this reason, during lactation, mothers may notice that the breasts generate a large amount of heat. Mothers should supplement their diet with calcium, folic acid, zinc, and a number of other vitamins and minerals found in breast milk. A woman who does not feed herself correctly will deplete her own bodily tissues of these vitamins and minerals instead of the baby's. Water intake should be increased by an entire quart per day. The mother should also be careful not to lose weight too quickly because release of toxins stored in fat can harm the baby. She should also avoid drugs, alcohol, and check with a healthcare provider before taking any medications. Breast Feeding Techniques & ChallengesWe'll address breast feeding techniques and challenges first since it is the most common etiological factor of the pathologies in this paper. Breastfeeding techniques and challenges include proper positioning of the baby, latching on, emptying the breasts, timing of feedings, pressure on the duct, and washing/cleaning the breast.The true measure of breastfeeding technique is effectiveness and level of comfort. If the baby is transferring milk, gaining weight, and breastfeeding is comfortable, then the technique is good. The two basic steps are correct positioning of the baby and correct latching technique. Latching refers to the baby's proper hold onto the breast with the mouth. Pain, inadequate transfer and emptying of milk can be due to poor positioning and latching technique. Or, it could be due to some of the challenges / pathologies reviewed below. Positioning and Latching For correct positioning and latching, the mother should sit comfortably with a straight back and the lap should be flat using a pillow to support the baby. She should tuck the baby's bottom in her elbow. With the same arm she should hold the baby's head behind the neck and shoulders with her hand. Starting with the baby's nose pointed opposite the nipple, she should tilt baby's head back. Then, she should move the baby's mouth/upper lip gently across the nipple until the baby's mouth opens really wide. Bring the baby's lower chin / lip towards the breast first. The baby's chin should be in close contact with the breast. The baby should be able to breathe easily (through nose). The mother should feel the baby has a big mouthful of breast. The mother may need to support her breast with the opposite hand.Various options from the sitting position include carrying the baby in a sling so that mother can continue with daily tasks. Or, lying down may be good for night feeds or mothers who have had a cesarean section. Here, the mother and baby can lie on their sides. An inverted or flattened nipple can be gently massaged to bring out the nipple. There are several signs of a proper latch on. One should be able to see the baby's lips, indicating that they are turned outward. There should be a tight seal between the baby's mouth and areola. Much of the areola should be inside his mouth. The baby's tongue should be between the lower gum and the breast, forming a trough around the nipple and cushioning the jaw. The baby's ears should be wiggling as he sucks and swallows due to movement of the jaw. One should hear the baby swallowing. Milk should not leak much from the baby's mouth. One shouldn't hear clicking sounds. The mother should keep in mind it often takes mother and baby two weeks to figure out a proper latch-on. Other difficulties with latch-on could be due to anatomical problems such as tongue tie. In that case, the flip of skin beneath the tongue called the frenulum is too short, preventing proper latching. Tongue tie is addressed with minor surgery. New babies may have trouble due to nipple confusion. As the mechanics of suckling from a bottle, pacifier, and breast are slightly different, new babies can get confused until they have more experience. For example, the baby may lift his tongue during breastfeeding instead of dropping it. As it is easier to prevent nipple confusion than correct it, babies should not be given bottles and pacifiers during the first three or four weeks while they are perfecting their breastfeeding skills. If trying to reacquaint the baby with the breast, start when the baby is calm, not ravenous. Stimulate the let-down reflex ahead of time for instant gratification of baby. You can also use an eyedropper or feeding syringe to drip milk into baby's mouth as she latches on. Nipple shields are a thin sheet of silicon with holes that cover the nipple during nursing. The baby sucks on the shield instead of the nipple directly. Nipple shields can be useful to protect a sore nipple while it is healing. But they can also lead to nipple confusion and inadequate transfer of milk. Since the breast is stimulated differently, it can also lead to low milk supply. Emptying the Breasts and Timing Many pathologies can be avoided by ensuring adequate flow of milk and flushing of the breast. Breasts should be completely emptied each feeding and alternate breasts should be used every feeding. Proper emptying of the breasts prevents engorgement, low supply, blocked ducts, inflammation, infection, and ensures the baby is getting enough food. Inadequate emptying is often caused by busy moms skipping feedings, nipple pain or other discomfort, the baby's teething, nipple confusion, the baby sleeping, and introduction to solid foods.Mother should feed 'on demand' whenever the baby is hungry instead of scheduling feedings. This helps milk supply to adjust naturally to the exact amount needed by the baby. If the baby is unable to nurse, supply can be maintained by manually expressing the milk with a pump or by using the hand. There are a number of websites giving detailed instructions on how to properly pump the breast with the hand (example: the Marmet technique). One can find out if the baby transferring enough milk by counting the baby's wet diapers. There should be around six in a day. The baby's weight should also be checked every two weeks to see if the baby is growing properly. The baby's stools should be well formed or loose, not dry (which could indicate dehydration). Cleaning the Breast Breasts should not be cleaned with soap because it is too drying for sensitive nipple tissue. Instead, they should be rinsed. Natural oils released from Montgomery glands on the areola protect the areola from drying out and contain antimicrobial elements that prevent infection.Pathologies and Difficulties in Breast FeedingPathologies of the breast and difficulties of breast feeding fall under several general categories. These include pain or soreness while breastfeeding, nipple and other topical disorders, breast engorgement, plugged ducts, breast infection, and low supply of milk. Broadly, treatment involves ensuring proper breast feeding technique, continued nursing of the baby to flush the system, and avoidance of soaps or other drying elements topically. A lactation consultant is recommended to ensure proper technique in all pathologies.Pain and Soreness of Nipples The best treatment for sore nipples is prevention. Most nipple soreness can be prevented with proper latch-on technique. However, a new onset of pain after painless breastfeeding for several weeks could be due to thrush, a fungal infection of Candida albicans (yeast).In proper latch-on, the mother can check to see that the lower lip is protruded outward and fix it with the finger. Sore nipples can also result from the baby's repeated attempts to latch-on. Usually pain is greatest when the baby first latches on and tends to subside during the feeding. In that case, encourage a let-down response by expressing some milk before the baby begins to nurse; that will prevent the baby from trying too hard. Hungrier babies tend to nurse harder. Frequent feedings and listening for signs of hunger can help avoid excess hunger. Nurse on the least sore side first. This way, the baby will be less aggressive by the time he gets to the painful breast. Change positions every feeding so that baby's gums massage different area of the breast. Soreness on the underside of the breast indicates that too much of the top of the areola is in the baby's mouth or that lips are tucked in. Soreness on the top of the breast can indicate that the baby is raising up the back of the tongue while nursing. Soreness at the tip of the nipple can indicate the nipple is off center in the baby's mouth. The wrong breast pump can also damage sensitive nipple tissue. In that case, empty the breast by hand. Nipple confusion could also be the cause of sore nipples. If the baby applies the techniques he learns sucking from the bottle to the breast, the tongue and gums will traumatize the nipple. The nipple should be far back in the baby's mouth where it is less likely to get sore or come into contact with the gums. Several minutes after the baby is finished feeding, the nipples may suddenly turn white. This condition is called "blanched nipples." In that case the nipples will feel like they are burning. They should return to normal color several minutes after blanching, but the condition may repeat again. The cause seems to be vasospasms (spasms of sphincter muscles regulating capillary blood flow) as in Raynaud's syndrome. Whatever causes pain during breastfeeding can also cause vasospasm. In that case proper latch-on technique is the best prevention. Dry warming of the nipple after nursing also helps to reduce spasms. Cracked nipples are a more severe complication of improper latching. Cracked nipples can also be a sign of yeast infections. The severe dry skin of eczema can result from allergies to clothing washed with certain laundry detergents or if the baby has food particles in the mouth while nursing. To avoid dryness or cracking use only water to clean the breasts; soaps and lotions can remove the protective oil from the Montgomery glands. Since breast milk is antimicrobial, the best way to prevent cracks from getting infected is to rub a bit of breast milk over the nipples after each feeding and let them air dry. Although some bleeding in the first few days after breastfeeding is normal, reflecting increased blood flow to the breast, cracked nipples can also bleed as the condition worsens. While the nipple is healing, sometimes cessation of breast feeding is necessary. The mother and baby will have to explore alternative feeding methods such as bottle feeding, nipple shields or finger feeding. The breast will have to be pumped to ensure continued supply. When pumping is too painful, hand expressing the milk is recommended. As these techniques could cause nipple confusion and low supply of milk, take precautions. Medical grade lanolin, an ointment, can help with deep cracks and bleeding. Tea bags on the nipples also act as an astringent and hemostatic. To encourage healing of the nipple, expose the nipple to air as much as possible. Nursing pads tend to get damp; they should be changed often to keep the nipple dry. Dipping the breasts in a saline solution can help, followed by lubricating the nipple with some expressed milk as mentioned above. Milk Blisters Milk blisters, sometimes called nipple blisters or blebs, happen when skin grows over a pore of a duct in the nipple. The milk blister shows up as a clear yellowish or white dot, with pain experienced just behind the blister. The blister typically bulges outward if the breast is compressed. Milk blisters can be persistent lasting several weeks and painful.Milk blisters are thought to be caused by the epidermis sealing over the pore and triggering an inflammatory response. Oversupply, pressure on that area of the breast, improper latch and friction, and any of the causes of a clogged duct (discussed below) can also cause a milk blister. Yeast infections can also cause milk blisters. Milk blisters are not the same as blood blisters, which are red and due to friction caused by the baby's improper suckling or a badly fitting nipple shield or breast pump. To treat a milk blister, soak the affected area in Epsom salts and then apply moist heat before nursing to open the milk ducts. Clear the skin from the duct using fingernails or a sterile syringe (see a healthcare provider for a sterile way to open the blister). Remove any remaining excess skin. Follow the same techniques as healing cracked nipples. As in clogged ducts, nursing or pumping with a hospital grade pump will help remove any congealed milk in the duct. Or, one can hand express to hopefully remove any congealed milk in the duct. One should continue the treatments for several days until the duct stays clear. Breast Engorgement When the supply of milk is greater than infant demand, the breasts can become engorged. Breast engorgement typically happens when milk first "comes in" a few days after birth. When feedings are skipped or there is an interruption in the normal routine, the mother might not be able to nurse or pump as much as usual. The breasts can become engorged anytime the mother suddenly stops breastfeeding, when demand from the baby decreases as solid foods are introduced, and during weaning.The symptoms of breast engorgement are swollen, firm and painful breasts. The nipples will be flattened out, the areola will be hard, and the baby may have a difficult time latching on. Lymph nodes in the armpits might be tender and slightly swollen. Severe engorgement can lead to mastitis, or infections in the breast. The treatment of breast engorgement is to keep the milk moving by nursing or expressing milk frequently. A hard areola and flattened nipples can make it difficult for the baby to latch on. In that case the areola can be softened by applying heat and massaging gently. Some milk should be let out before feeding the baby. Alternatively, multiple-holed breast shells worn before feedings will help draw out the nipple. The mother should avoid bottles, pacifiers and nipple shields during this period to avoid nipple confusion. Breasts should be emptied with each feeding. Feeding 'on demand' whenever the baby is hungry to helps milk supply adjust naturally to exact amount needed. Ibuprofen can help reduce pain and swelling. Applying ice or cold compress after nursing will also relieve pain and swelling. The supportive nursing bra should not be too tight. If baby can't feed at all, the breasts should be emptied with a pump or manually to express the milk. If not breastfeeding, the mother should avoid stimulating the nipple because it could result in release of prolactin and increase supply to the breast. Alternatively, cabbage leaves placed directly on the breast are soothing and reduce supply if oversupply is the root cause of the problem. Plugged Ducts A plugged milk duct is a lactiferous duct that is clogged, and the flow is milk is interrupted. The pore may be clogged due to a milk blister but obstruction can occur anywhere in the ductal system. A plugged duct usually occurs gradually and affects only one breast. Breast engorgement, inadequate milk removal, and any kind of milk stasis can lead to plugged milk ducts. Incorrect feeding position might cause unequal emptying of the sinuses. Fingers, tight clothing, prone sleeping position, and carrying something heavy close to the breast can put pressure on the milk ducts, restricting the flow and leading to stagnation and plugged ducts.Whereas breast engorgement affects the entire breast, with a plugged duct the breast will show a hard lump or wedge shaped area of engorgement. It may be slightly red, tender, hot, and swollen. Let-down can be painful. After the breasts are emptied, the area will naturally be less engorged and less painful. There is a slight possibility of a low grade fever if the plugged duct is infected. Milk supply might be lower. As the plug releases, the mom may experience strings or grains of thickened and fatty looking milk. The color can be greenish or brownish but poses no threat to the baby. More frequent nursing, especially of the affected side, relieves the condition. If the obstruction occurs at the surface it can often be gently scraped away with a fingernail. Analgesics can temporarily help with pain. Application of moist heat will encourage the sinus to open and circulation in the area. Symptoms should be relieved within twenty four hours to avoid complications such as mastitis (discussed below). In some cases the plug can be reabsorbed by maternal tissues or dissolve on its own. Puerperal Mastitis Mastitis is any inflammation of the mammary glands. Some cases of mastitis are infectious. Breast engorgement is often considered to be a light case of mastitis. Mastitis can be classified by several types: milk stasis, non-infectious, infectious, or abscess. The most common infectious agents can be Staphylococcus aureus, Streptococcus spp., and gram negative bacilli such as Escherichia coli. However, these organisms are present in the normal breast flora and not necessarily indicative of root cause.Mastitis is caused by the same etiology and risk factors as breast engorgement and plugged ducts, although the symptoms are generally more severe. Mastitis can also be triggered by engorgement, a plugged duct, oversupply, irregular feeding schedule, and infection. It is most common in the first 2-3 weeks of breastfeeding. Symptoms usually appear abruptly and affect only one breast. Repeated mastitis often occurs during weaning before hormone levels have settled. Hyperprolactinemia (high levels of prolactin in the blood), diabetes mellitus, and low thyroid function can also cause mastitis, as well as a number of other factors unrelated to pregnancy (such as pierced nipples). Infection can also be due to stress, fatigue, anemia or low immunity. Twenty percent of women have mastitis or engorgement during breastfeeding but only one in twenty (5%) get infected. Breast abscess is a potential complication. Mastitis occurs much less frequently in non-Western countries where breastfeeding is more frequent and normal. The cardinal signs of mastitis are local pain, redness, swelling and warmth: the same symptoms as breast engorgement. In later stages, fever and flu-like symptoms can develop. There may be red streaks extending out from the affected area. Milk from the affected breast can be considerably saltier than normal, and it can be clumpy, stringy, and coagulated. The milk can be mixed with blood, pus or mucus. The treatment for mastitis is much the same as the treatment for a plugged duct or breast engorgement. Continued nursing is the most effective way to reduce symptoms and stasis of milk. Abrupt weaning can make symptoms more severe. Since symptoms can rapidly progress to infection, attempt should be made to relieve them within the first 12-24 hours. The mother should not quit nursing. Instead, completely empty the breast at every feeding. The use of cold compresses in severe mastitis can reduce inflammation but the use of warm compresses in lighter cases can help open up the milk ducts and move stasis. Alternating hot and cold compress can also be effective in flushing out clogged ducts. Drinking an adequate supply of fluids encourages flow. If weaning, medications that reduce prolactin levels or herbs like common sage can help dry up the milk supply. Treatment with antibiotics has limited effect in cases of infection; resting is more effective to rebuild immunity if fever or other signs of infection are present. However, the mother should see a doctor if symptoms last longer than 12-24 hrs. Ninety percent of breast abscesses can be managed by repeated aspirations rather than formal surgery. Thrush Candida albicans (thrush or yeast) is a fungus that occurs naturally in the mucous membranes and the skin. Postpartum, thrush usually refers to a yeast infection in the baby's mouth that can spread to the mother's nipple, making them red and very sore. Yeast thrives on sugar. Thrush is very common during pregnancy because higher levels of estrogen increase sugar levels in the blood. The baby may then contract yeast during passage through the birth canal. Cracked nipples can become infected and then infect the baby. There are many other ways that baby and mother contract the yeast and spread the infection to one another; for example, environmental contact with yeast or consumption of yeast beers.Most thrush symptoms appear two to four weeks after birth. Infections are common and painful but rarely serious. Antiobiotics should be avoided because killing off the good bacteria that keep yeast from multiplying too rapidly in the body, they leave the body vulnerable to yeast infections. The cardinal signs of thrush are white spots in the baby's mouth or small red or white patches on the nipple. The baby's bottom can be red and tender. Nipples may be red or purple, extremely painful, and sensitive to light touch or a hot shower, which increases the symptoms of inflammation. The nipples may look puffy, scaly, flaky, weepy or have tiny blisters. Suckling may be uncomfortable for baby and mother and can interrupt nursing. Pain also inhibits the let-down reflex and can lead to reduced milk supply. Yeast infections can lead to plugged ducts and mastitis. Vaginal yeast infection can produce a thick, white discharge with redness, itching and burning in the mother. Whereas pain usually decreases after feeding in cases of engorgement or clogged ducts, in yeast infections of the nipple pain lasts throughout the feeding and continues after feeding. Pain may radiate into the mother's arm and back. Pain that begins unexpectedly after a period of pain-free nursing can indicate yeast infection. Even if only one has symptoms, both the baby and the mother should be treated. Occasionally the sexual partner of the mother may also need to be treated. Breast milk is antibiotic; therefore continued nursing helps clear up infection in baby and mother. The nipple should be numbed before nursing with a cold ice pack. Consumption of foods with a high sugar content should be decreased and fermented foods like beer and bread have yeast in them and should be avoided. Supplementation with probiotics can help restore the natural bacterial flora that fight the yeast. After nursing the nipple should be rinsed in a vinegar water solution (1tbsp:1c), and then a topical antifungal cream appropriate for the breast should be applied. If using a cream, nipples should be washed before nursing. Gentian violet was recommended on several websites as treatment for yeast. Standard treatments for diaper rash and yeast infections should be followed (beyond the scope of this paper). Oral medication may be given if the problem cannot be cleared topically. Persistence in treatment is best because yeast infections, once established, are difficult to get rid of. Anything that goes into the baby's mouth should be boiled. Bras should be soaked in hot soap water and rinsed well. Hands should be washed before each feeding. Condoms should be used during sex and the partners mouth kept away from the breast. Topical creams are often prescribed for mother's nipple and baby's bottom. The breast and baby's bottom should be exposed to air and sunlight. The breasts should be air dried after each feeding. Hyperlactation Hyperlactation is when the body produces too much milk which either leaks or comes out fast or forcibly. Hyperlactation is sometimes called hyper-letdown reflex but that name isn't accurate because it implies the problem is in the letdown reflex rather than overabundant supply. Hyperlactation can cause engorgement if the breasts are not emptied.The cause can be excess release of prolactin. Prolactin secretion increases if there is excess pumping or stimulation of nipples between feedings. Hormonal imbalances, pituitary tumors and medications can also raise milk production. Hyperlactation occurs more often in women with a larger number of alveoli in the breast. Generally, hyperlactation is not a big problem, merely causing some discomfort for the baby while feeding. The baby may pull away, gag, or choke after the initial squirt of milk because they can't swallow fast enough. Breasts may leak between feedings. The baby may also clamp down on the nipple to slow the flow. The baby may spit up often or tend to be very gassy. Generally, these symptoms start 3-6 weeks after delivery. If the cause is excess stimulation, find ways to avoid the cause (example pumping, stimulation of nipple between feedings). Supply normally corrects itself with on-demand feeding. Expressing a bit of milk before feeding the baby prevents overwhelming him with excess pressure. The mother may lie back with the baby on top so gravity will slow down the release of the milk into the baby's mouth. The body can be tricked into thinking it is weaning through fewer or shorter feeding times. Reducing the amount of milk that comes out in a single feeding signals the body to produce less milk. The mother should use only one breast for 2-4 feedings, expressing a bit of milk from the other breast to relieve pressure. The supply should react within 24-48 hours but it can take as long as a week to see improvement. The baby should be burped frequently to prevent gas and fussiness. Babies nursed when they are sleepy will nurse less vigorously. Applying cool compresses to the breast will discourage blood flow and slow production. Cabbage compress, sage, or other herbs can help reduce milk supply. There are also Western medicines that reduce supply of milk by inhibiting prolactin. Low Milk Supply Often mothers think they have a low supply of milk when they do not. In fact, on all of the website I researched I could not find one that listed signs and symptoms of actual low supply. If the baby is gaining weight and there are plenty of wet diapers, then supply is most likely fine. It is normal for the breasts to feel less empty after the first 6-12 weeks when milk supply is well coordinated to demands from the baby. The mother may also stop feeling the let-down reflex even though supply is normal.Milk production is a supply and demand process; the more you nurse the more you produce. Anything that reduces the proper transfer of the milk (such as poor latching technique or nipple confusion) can lead to reduced supply. An irregular feeding schedule, not nursing or pumping enough can reduce the supply. Introduction of solid foods can also lead to reduced demand. Nipple shields may not stimulate the release of prolactin as well as direct sucking from the nipple. Certain medications and birth control pills can interfere with lactation by increasing progesterone or estrogen levels. Low milk supply is rarely due to physical inability to produce milk, but some examples include maternal endocrine disorders, illness, dehydration and malnutrition of the mother. A poor milk ejection reflex can seem like low milk supply. Poor ejection reflex can be due to sore or cracked nipples, separation from the infant, a history of breast surgery, or tissue damage from prior breast trauma. The mother's emotions, such as stress, fear, anger or anxiety, can cause difficulties with breastfeeding. If a mother has trouble breastfeeding, different methods of assisting the milk ejection reflex may help. The mother should rest and relax before nursing so that emotions will not interfere with the let-down reflex. The mother should feed in a familiar and comfortable location, massage the breast or back, or warm the breast with a cloth or shower. Nursing on demand is the best way to regulate supply. Emptying the breast frequently and thoroughly encourages faster milk production. Use of massage towards the end of the feeding better empties the breast and opens up the ducts. Breasts should be pumped or nursed more frequently. The mother should wait until the baby is finished emptying the breast before switching sides. Breasts should be pumped after nursing if the baby does not adequately empty both breasts. Certain medications and herbs such as fenugreek can increase milk production. Ayurvedic Approach to BreastfeedingFor this paper I reviewed sections from Charaka Samhita, Susruta, and Kasyapa Samhita. Astanga Hridayam contains a nice section on lactation but I did not have time to review it in this paper. Much of the Western anatomy, physiology, pathology, and treatment do not exactly correspond to those in ancient texts. Where references to the ancient text are not included in any of the following paragraphs it implies I am using my own intuition to fill in the gaps. Many of the texts gave long lists of herbs as treatments. In researching this paper I researched each of the individual herbs and tried to create a therapeutic strategy which, because of my lack of clinical experience, is at best a guess of their actual intention, including the assumption that a therapeutic strategy exists in each case.The ancient texts are translated with the word wet-nurse instead of mother presumably to account for the possibility that the baby is nursed by someone other than the mother. However, the texts do not say whether wet-nurse excludes the mother and do not discourage mothers from breastfeeding their own children. Anatomy and Physiology Breast milk is the upadhatu (superior byproduct) of rasa. The sweet essence of rasa dhatu that is drawn from the digested food courses through the whole body and ultimately becomes concentrated in the breast of a mother is called milk. (Su Ni 10.20) Milk is essentially Kapha in nature. The process of lactation is governed by stanya vaha srotas, the milk carrying channels. The alveoli are the mula (root), the ducts are the marga (passage), and the nipple is the mukha (opening) of stanya vaha srotas. The areola is a mula of artava vaha srotas (female reproductive carrying channels). The lymphatic system of the breast is governed by rasa, the blood supply by rakta, and the fatty tissue by meda dhatu.Breast milk is like semen in the man. Both are the essence of digested food. Both are stimulated by sight, touch, and memory. They are the result of strong and unclouded affection. Constant love is the cause of secretion of milk from the breast. (Su Ni 10.21-25) The milk carrying ducts are closed in a woman until she has children; the doshas do not descend through them and none of these pathologies apply. Only women who have had children suffer from these diseases. (Su Ni 10.17-19) Breast growth and development is governed by the endocrine system and thus primarily Vata dosha, majja dhatu and tejas. As breast milk is an upadhatu of rasa, the quality of breast milk is governed by the quality of ahara rasa (undigested microchyle which is also immature rasa dhatu) and rasa dhatu agni. Release of oxytocin and prolactin is controlled by nervous system and thus lactation and the let-down reflex are governed by Vata dosha, specifically prana and apana vayus. To understand the link with apana we have to remember that apana's function is to hold or retain until the proper time of release. Thus the let-down reflex is regulated by sukshma apana or the subtle apana throughout the body (as opposed to the grosser apana of the colon). Colostrum and breast milk is high in immune factors (one aspect of ojas). The ancient classics talk very little about breastfeeding technique. Description of Optimal Breasts, Milk, and Wet Nurse "Breasts should not be situated at a very high level in the chest. They should not hang very loose. They should neither be very lean nor plump. They should be attached with a nipple of proportionate size. The child should find it easy to suckle them." (C.S.Sa 8.53)Breast milk should have a natural color (grayish tint), taste (sweet), and touch (natural touch is unexplained in the texts). If breast milk has normal qualities, when poured over a pot of water it gets mixed up with the water (C.S.Sa 8.54-55) without giving rise to froths or shreds (Su Sa 10.31). Pure breast milk provides nourishment and maintains good health of the child. Milk should be copious. Otherwise the breast milk is vitiated (C.S.Sa 8.54-55). The features or pure breast milk are proper development of strength, body-parts and longevity of fetus, as well as a disease and trouble free child and wet nurse (Ka.S.Su 19.26). Good quality breast milk is maintained through congenial diet, and when the wet nurse is taken care of and nourished by others (Ka.S.Su 19.42). The wet nurse should keep a predominance of Vata and Pitta, a strong digestive fire, regular menstruation, and equilibrium of all three dosas (Ka.S.Ci 18.5-6). Alkalies (alkaline or caustic medications and preparations) should not be used; they destroy the progeny (Ka.S.Ci 18.10). The wet nurse should be from the same caste as the mother, neither too young nor old, free from diseases, and clean. Her breasts and milk should be excellent and she should have plenty of milk. She should have living children and affection for children (C.S.Sa 8.52). The wet nurse should not be too hungry, aggrieved, fatigued, too thin, too corpulent, or a pregnant woman. Nor of amla Pitta (sour Pitta leading to loose stools or acid indigestion, etc.), one with unhealthy diet or lifestyle, whose dhatus are vitiated, or before medicine taken has been fully digested in the nurse, or one with deranged dosha or mala. (Su Sa 10.31) She should be of middle stature, sound health, and good character. Her skin should be healthy unmarked by moles or stains (Su Sa 10.25). The child drinking milk that is sweet will have excessive urine and feces while astringent milks cause retention of urine and feces. Oil colored milk will give the child good strength. He will become rich if he drinks ghrta colored milk. The child will be famous and attains all qualities of pure milk if the milk is smoke colored (Ka.S.Su 19.3-4.1). The child consuming the breast milk of a wet nurse having Pitta and Vata prakruti, salty breast milk, multiparity, or consuming milk vitiated by the doshas becomes lame, idiot, and dumb. (Ka.S.Ci 17.5) The wet nurse should be treated to massage, unguents, bath, white garments, clean or pure food (Ka.S.Ci 18.11-12).Obesity of the wet nurse should be treated with rakta moksha (blood letting), basti (enema) and virechana (purgation). This will decrease fat, open the srotas and increase the proper flow of rasa (Ka.S.Ci 18.13-14.1). An emaciated or amenorrheal wet nurse gets cured by bruhana (anabolic drugs) (Ka.S.Ci 18.14.2). To feed the child, the wet nurse should check the quality of the milk, then bathe, use oils on the body, and wear white cloth. She should take medicines that are alteratives (cleaning rakta such as Amalaki and Guduchi), spiritually cleansing or that have a positive effect on the nervous system (such as brahmi), purgatives such as haritaki, and herbs that are nourishing to the fetus. Charaka gives a long list of herbs in each section which can be reviewed following the references in each paragraph. (C.S.Sa 8.58) The child should burp up some of the milk after sucking. Comparison of Western and Ayurvedic Pathologies Since Ayurveda does not classify diseases the same way as the Western model, I will present a short comparison of general pathologies before specifically presenting each pathology in detail.Generally, pathologies and poor quality breast milk are due to ama in rasa dhatu clogging the channels. Poor diet and lifestyle vitiate agni and create poor rasa dhatu and ama. The Kapha qualities of milk easily become vitiated. The sticky, slimy qualities of ama clog the ducts and cause infection. Clogged ducts are considered to be sanga (stagnation) of stanya vaha srotas. Treatment is to burn the ama (pachana), open the channels, and use herbs that clean breast milk (stanya shodhana). Quality of rasa dhatu may be assessed by the quality of complexion of the skin. Pathologies can also be caused by vitiated doshas lodging in the breast tissue. If Kapha invades the breast tissue it causes engorged breast, oversupply, milk blisters, or clogged ducts. If Kapha pushes Pitta it can create septic mastitis (Pittaja nadi vrana) or yeast infection (Pittaja vidradhi). General treatment is both topical and internal, designed to bring the vitiated doshas back to the GI tract and eliminate them using pancha karma, particularly emesis. If oversupply is the issue, it is stanya vaha sroto atipravrutti (atipravrutti = excess flow). In that case herbs that inhibit lactation will help. The areola of the nipple is related to artava vaha srotas, which is vulnerable to emotional trauma and nervous system disorders that can inhibit the let-down reflex. The treatment of inhibited let-down reflex is to ground Vata and take galactagogues. If stress affects the nursing relationship, it is due to high Vata. The rough quality of Vata also creates painful, cracked or bleeding nipples, and/or blood blisters. Caution in treatment is advised because all topical and internal medicines find their way into the breast milk. In general, internal medicines are preferred because they are processed by jathara agni (main agni of the GI tract) which is stronger than bhrajaka agni (agni of the skin that processes topical medications). After any applications of topical medicines, before breastfeeding the breast should be completely emptied after the medicine has been absorbed and digested (the signs of properly digested medicines are not given, I would imagine at least several hours are needed). Ayurvedic Pathologies of LactationOld folklore states that ingestion of small hard pieces of anything (dust, hair, nails, etc.), called vajra, get stuck in the stanya vaha srotas in the lactating mother causing any of the pathologies related to plugged ducts. Treatment is to open the channels (through application of heat, etc.). Topics related to lactation include stanya shodhana (cleansing of vitiated breast milk), stanya samjana (increasing the supply of breast milk) and stanya roga (morbidities of the breast).Stanya Shodhana Breast Milk Cleansing Impure breast milk can lead to milk stasis and related pathologies of the breast (plugged ducts, etc.), infection of the breast (thrush, mastitis), and can also affect the child causing undernourishment, digestive problems, or other diseases. According to Charaka, there are eight vitiations of milk discoloration, bad smell, bad taste, sliminess, foaminess, lack of unctuousness, heaviness, and over-unctuousness. (C.S.Su 19.4.3) The breast milk gets vitiated by the emotional state, constitution of the wet nurse, and the deranged doshas. An external blow can also vitiate the breast milk. (Ka.S.Su 19.1-2)The breasts are especially vulnerable to poor lifestyle and diet which provoke Kapha. Anything that causes ama or vitiates rasa, rakta or ambu vaha srotas causes vitiation of breast milk. For example sour, saline, pungent, and alkaline food vitiate rasa and rakta dhatu. Food that causes obstruction of the channels (generally heavy and Kapha provoking) can lead to plugged ducts and milk stasis. Sleeping during the day after eating foods such as rice pudding or jaggary can provoke Kapha. Lack of exercise increases ama. Excessive emaciation due to chronic diseases can deplete rasa dhatu. Rasa dhatu is also affected by emotions. Mental trauma, physical pain, and remaining awake at night with worry can vitiate rasa dhatu and consequently the breast milk (C.S.Ci 30.232-236). Stanya Shodhana - Signs and Symptoms of Vitiated Breast Milk Vata type milk is astringent and floats on water. (Su Sa 10.31) It is blackish or reddish in color, clear, absent of any smell, not unctuous, liquid, frothy, light, not satisfying, and causes emaciation and Vata diseases. (C.S.Sa 8.54-55)Vata vitiated milk is caused by a Vata provoking diet with food that lacks unctuousness. When the vayu reaches the breasts it afflicts the taste of the breast milk. Aggravated vayu churns up the milk inside the breasts and make it a mass of frothy substance. As a result, milk flows out of the breast with difficulty. By taking this polluted milk, the child's voice becomes weak and he suffers from stasis of stool, urine and flatus. He gets Vata type of head diseases and pinasa (runny nose). The aggravated vayu dries up the unctuousness of the milk and the child gets reduced of his strength and unctuousness. (C.S.Ci 30.238) Pitta vitiated milk tastes acidic, pungent, and has a yellow hue if left to float on water. The aftertaste is bitter, sour, and pungent. It has a smell like that of a dead body or blood. It is excessively hot and causes Pitta diseases. (C.S.Sa 8.54-55) Pitta vitiated milk is caused by a Pitta provoking diet with ingredients that are hot, etc. afflicting the breasts of the woman (C.S.Ci 30.243-245). As a result, the milk becomes blackish, bluish, coppery, or yellowish and floats on water (Su Sa 10.31). The Pitta causes a foul smell in the breast milk, and the child taking this milk gets anemia and jaundice. There will be discoloration of his body, perspiration, morbid thirst and diarrhea. The baby's body remains warm constantly and the baby does not like to breast feed. (C.S.Ci 30.243-245) When Kapha is high the breast milk becomes thick, slimy, thready, and sinks (Su Sa 10.31). The milk is exceedingly white in color; excessively sweet in taste and has a saline after-taste. It has the smell of ghee, oil, muscle, fat and bone marrow. (C.S.Ci 30.243-245) The unctuous quality of Kapha makes Kapha vitiated breast milk excessively unctuous. When Kapha is heavy the milk becomes heavy. Kapha vitiated milk is caused by a Kapha provoking diet and lifestyle. The child suffers from vomiting, griping, pain, and excessive salivation. The channels in his body are constantly smeared with Kapha. The child is sleepy, fatigued, and inactive. He suffers from Kapha type diseases such as swasa (dyspnea), cough, dribbling of saliva and tamaka (asthma). The child suffers from excessive salivation, swelling of the face, and dull eyes. The child also suffers from heart diseases and others (C.S.Ci 30.246-250). Stanya Shodhana - Treatment of Vitiated Breast Milk In cases of deficiency due to Vata, build rasa dhatu with ojas building foods taking precautions not to provoke Kapha. Otherwise, generally, herbs and treatments that clean and burn ama from rasa dhatu or the lymphatic system are best for helping to purify the breast milk. Alteratives help clean the blood of any impurities. Additionally, the wet nurse should take cleansing measures (Ka.S.Su 19.4.2). She should use pachana type drugs (drugs that burn ama), emesis to clear excess Kapha and then purgation to clear ama. Galactagogues flush the system. Special herbs that purify the milk are called stanya shodhana. For this, Charaka recommends amalaki, kutki, ginger and Guduchi among others. One should give medicines with honey in vitiation of Kapha, otherwise give with ghee (Ka.S.Su 19.12-14). Use drugs and foods with bitter, astringent, pungent (without provoking Pitta) and sweet tastes to purify breast milk (C.S.Sa 8.56).For emesis the doctor should administer vaca, yasti madhu, madana phala and decoction of neem as well as patola mixed with salt. Then the patient should follow a rehabilitating diet followed by purgation with paste of trivrt or abhaya mixed with a decoction of triphala or honey or haritaki with cow's urine. (C.S.Ci 30.251) General stanya shodhana foods and drinks include rice, barley, and bamboo shoots with fat. Vegetable soups which are light for digestion will increase agni (thereby digesting ama and pacifying Kapha). These soups should be boiled with neem, kulaka (karavellaka), amalaki, ginger, black pepper, pippali and rock salt for purification of the breast milk (C.S.Ci 30.257-260). Charaka gives specific recipes for correcting distaste of breast milk in general and in eight specific types of distaste. Generally, paste of panca kola (pippali, pippali mula, cavya, citraka, nagara) and kulattha should be applied over breasts. After it has dried, the breasts should be washed and the accumulated milk squeezed out (C.S.Ci 30.263-264). Stanya Shodhana - Treatment of Thrush If the doshas have vitiated the breast milk, stomatitis (presumably including thrush) develops in the mouth of child. Forced milking will bring relief to the wet nurse and child. She should be given medicines to cleanse the vitiated milk (Ka.S.Si 3.6-14).Stanya Samjanana Increasing Milk Flow Anger, grief, other emotions, and absence of natural affection for the child cause the milk to dry up (Su Sa 10.30) due to Vata vitiation in majja dhatu. The treatment is to restore equanimity and care free living, and to use galactagogues. Generally, galactagogues are aphrodisiacs, nourish reproductive tissue, and are unctuous, anabolic, demulcent, sweet, heavy, or oily. They tend to have a sweet vipak. Generally medicines that increase sperm also increase milk production.Some galactagogues work by stimulating the let-down reflex via oxytocin (vacha). Vacha plus saffron and pippali can be used as a galactagogue in post partum. Since mammary glands are modified sweat glands, diaphoretics (promoting sweat) should increase milk production. Charaka lists lemongrass as an example. In general, shatavari, vidari, and fennel are popular galactagogues. Sweet cereals and drinks are also galactagogues. Susruta recommends rice, barley and wheat (Su Sa 10.30). Liquid, sour, and salty substances, including medicated wines are galactagogues (C.S.Sa 8.57). Meat soups, garlic, onion, sleeping and pleasure, and avoidance of anger, journey, fear, grief, and exercise all increase the milk. (Ka.S.Su 19.19-25). If the mother takes milk treated with aphrodisiac medicines it increases breast milk. Ghee and oil are galactagogues. Enemas are galactagogues because they pacify apana vayu and problems with the let-down reflex. Kashyapa Samhita also recommends hing, an initially surprising choice because hing vitiates the blood (rasa/rakta). Gogte writes that hing is aphrodisiac by ushna (hot) and tikshna (sharp) qualities. It cleans the uterus in postpartum conditions and builds agni but also vitiates the blood. (Ka.S.Su 19.10-11). Thus perhaps hing is suitable only in Vata or Kapha vikruti. For nourishing reproductive tissues, cleansing the breast milk, and increasing the flow of milk Sebastian Pole recommends shatavari, fennel, ajmoda, ajwain, turmeric, bala, licorice, almonds, and ghee which all help to increase the quantity and quality. Several of these drugs are blood thinners and vasodilators that can increase circulation and blood flow to the breast, opening the channels. Those that reduce inflammation could increase supply by reducing pressure on the channels. Stanya Roga Disorders of the breast Stanya roga means disorders of the breast including mastitis both septic and aseptic, and breast abscesses. Stanya roga can be a complication of breast milk vitiation (requiring stanya shodhana), particularly if ama clogs the channels and they become inflamed or infected. In Kashyapa Samhita, stanya roga is called stanya kilaka.Dosha lodged in the breast vitiates the local flesh and blood (Su Ni 29-30). The pus of an abscess or swelling burrows into the affected part if a person neglects it in its fully suppurated stage. An abscess or swelling burrowed deeply in the tissue is called called nadi vrana owing to the large number of recesses or cavities inside (Susruta, NI, 10.9-10). According to Susruta, there are as many types of stanya roga as there are nadi vrana: Vataja, Pittaja, Kaphaja, tridoshaja, and salyaja (due foreign body). Vataja type is rough, short mouthed (?), with aching pain in its inside. Frothy secretions are worse at night. Pittaja type is accompanied by thirst, lassitude, heat, piercing pain, fever from beginning, and exudes large quantity of hot, yellow colored secretion greater by day. Kaphaja type is hard, itching, numbed or with slight pain. It secretes copious thick, slimy, white colored pus that is greater at night. Tridoshaja type is attended with fever, burning sensation, difficulty breathing, dryness of the mouth, and syncope. It is dreadful and fatal. Salyaja type is caused by a foreign body (dirt, bone, splinter, etc.). It tends to burst open the skin along channel of insertion. There is constant pain, sudden and rapid exudate of hot, blood tinged frothy secretion like clear churned curd (Su. Ni., 10.11-16). The general symptoms of stanya roga are indigestion, uneasiness, lassitude, causeless pain, anorexia, arthralgia, body ache, headache, inflammation of eyes, stiffness of body parts, moistening of Kapha, fever, thirst, diarrhea, retention of urine, stiffness and discharge from breasts. There can be a network of veins around the breasts along with inflammation, pain, sickness, burning sensation and tenderness (Ka.S.Su 19.32-35). Pitta suppurates and ruptures earlier. Kapha troubles for a longer period. Vata increases very fast. (Ka.S.Su 19.36) Treatment of Stanya Roga If the cause is milk stasis or clogged channels it can be treated by medicines and therapies that open and lubricate the channels including pungent herbs, ghee and treatments for stanya shodhana. Continued suckling of the child or milking of the blocked area causes the clogged particles (vajra) to come out quickly with milk and blood (Ka.S.Su 19.37-38). Drinking of ghrta causes the channels to become soft and the vajra (hard particles blocking channels) to come out. Methodical squeezing and moistening, cold fomentation by trickling, anointing, and purgatives help dislodge milk stasis. As a last resort, an abscess should be drained by incision, taking care to avoid the milk carrying channels, nipple, and areola (Ka.S.Su 19.39-41).Galactagogues, blood thinners and any drug that increases flow can help expel the clog. If there is any inflammation, analgesics and drugs to reduce Pitta should be administered. Massage clears obstructions. Leeches both thin the blood and remove vitiated dosha locally. Vacha clears obstruction caused by Kapha. Perhaps drugs that dissolve calculi and that are diuretics can also help open the channels. Sebastian Pole recommends topical turmeric, aloe vera, and neem cream but caution is advised with any topical treatment because the medicines will enter the breast milk directly. After intake or application of medicine, wait for complete digestion of the medicines (presumably at least two hours until the stomach is empty and light, but this can mean up to six hours). Then completely empty the breast to flush the medicines if they are contraindicated for a growing child. Topical treatments are contraindicated in Susruta. According to Susruta, stanya roga is corrected with an eye to the dosha involved. He uses internal medications only, and specifically advises against use of poultices. Since breast tissue is extremely soft and fleshy, Sushruta advises against tight bandaging. (Su. Ci. 17.42-44) In the case of inflammatory swellings, he uses treatment for vidradhi. Vidradhi is a topical abscess as in a yeast infection. In the unsuppurated stage, vidradhi is cured using the sixty curative measures of ulcers starting with apatarpana. Vidradhi is a large chapter beyond the scope of this paper but treatment of ulcers and swellings is a prerequisite to treatment of yeast infections (Su. Ci. 16.2). Sebastian Pole, however, suggests neem and turmeric poultices for their antimicrobial and antifungal properties. READ MORE ON THIS TOPIC
BROWSE SIMILAR ARTICLES BY TOPICMy Saved Articles | Most Popular About the Author John Immel, the founder of Joyful Belly, teaches people how to have a healthy diet and lifestyle with Ayurveda biocharacteristics. His approach to Ayurveda is clinical, yet exudes an ease which many find enjoyable and insightful. John also directs Joyful Belly's School of Ayurveda, offering professional clinical training in Ayurveda for over 15 years.John's interest in Ayurveda and specialization in digestive tract pathology was inspired by a complex digestive disorder acquired from years of international travel, as well as public service work in South Asia. John's commitment to the detailed study of digestive disorders reflects his zeal to get down to the roots of the problem. His hope and belief in the capacity of each & every client to improve their quality of life is nothing short of a personal passion. John's creativity in the kitchen and delight in cooking for others comes from his family oriented upbringing. In addition to his certification in Ayurveda, John holds a bachelor's degree in mathematics from Harvard University. John enjoys sharing Ayurveda within the context of his Catholic roots, and finds Ayurveda gives him an opportunity to participate in the healing mission of the Church. Jesus expressed God's love by feeding and healing the sick. That kindness is the fundamental ministry of Ayurveda as well. Outside of work, John enjoys spending time with his wife and 6 kids, and pursuing his love of theology, philosophy, and language. STUDY AYURVEDA
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