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Postpartum lactation is very little or absent, known as agalactia, also referred to as "agalactia." This condition not only occurs postpartum but can also appear throughout the entire lactation period. Agalactia that occurs during lactation due to another pregnancy, or congenital absence of milk in women, should not be considered as agalactia and therefore falls outside the scope of this discussion.

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1. Deficiency of Both Qi and Blood︰Postpartum agalactia or very little milk, breasts without distending pain; pale and sallow complexion, dry skin, poor appetite, loose stools, fear of cold, mental fatigue; dizziness, tinnitus, palpitations, shortness of breath, sore lower back and weak legs, or frequent urination and dry stools; pale tongue with scant coating, weak and thin pulse. The mother has inherent spleen and stomach deficiency, insufficient transformation of qi and blood, leading to reduced milk secretion, or excessive blood loss during childbirth, qi depletion following blood loss, which can also affect milk production, resulting in agalactia. There are also cases where excessive childbirth and lactation lead to extreme depletion of qi, blood, and body fluids, emaciation, and exhaustion of yin nutrients, causing agalactia. The clinical features of this syndrome are: agalactia, absence of breast distending pain, and systemic signs of qi and blood depletion. Treatment focuses on tonifying the middle and replenishing qi, supplemented by promoting lactation, using the Tong Ru Dan formula.
2. Liver Qi Depression︰Postpartum lactation suddenly ceases, with breast distension, dullness, and mild pain; mental depression, chest and hypochondriac discomfort, epigastric distension, and reduced appetite; {|###|}normal tongue texture, thin yellow coating, and deep wiry pulse. Mostly caused by postpartum emotional depression, {|###|}liver failing to act freely, qi movement stagnation, leading to mammary duct obstruction. Rumen Shiqin states in "Discussion on Lactation Cessation": "Or due to crying, grief, anger, depression, or knotting, qi overflows and becomes blocked, resulting in the lactation vessels failing to function." The disease affects the qi aspect. Treatment should focus on {|###|}soothing liver and regulating qi to promote lactation. The recommended formula is Liver-Warming Decoction supplemented with {|###|}fistula disease reed, Ricepaperplant Pith, mongolian snakegourd root, and Cowherb Seed.
3. Blood Stasis and Vessel Obstruction︰Postpartum agalactia or complete absence of milk, with hard and painful breasts that resist pressure; chest tightness and belching, possibly accompanied by slight abdominal distension and fullness, scanty lochia that is dark with clots; slightly bluish complexion, slightly cyanotic tongue, and deep, rough pulse. This is often due to postpartum qi and blood stasis obstruction, leading to meridian stagnation and hindering milk production, hence agalactia. The pathology lies in the blood aspect. Treatment should focus on invigorating blood and resolving stasis to promote lactation, using Generation and Transformation Decoction combined with Yongquan Powder, with appropriate additions such as Akebia Stem and Squama Manitis.

In clinical practice, distinguishing between deficiency and excess is crucial for agalactia. Generally, the presence or absence of distending pain in the breasts is a key diagnostic criterion. If the breasts are soft and without distending pain, it is often due to deficiency of both qi and blood. If the breasts are hard, painful, and tender to touch, or accompanied by fever, it is usually due to stagnation of qi and blood. The former is often accompanied by systemic symptoms of qi and blood deficiency, while the latter typically presents with clinical manifestations of qi and blood stagnation. Treatment should follow the principle of "tonifying deficiency and dispersing excess." If combined with acupuncture, the therapeutic effect can be enhanced.

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1. Nyuke Jinglun. The Complete Guide to Postpartum Conditions states: "A woman's breast milk is transformed from qi and blood. The lack of milk flow is caused by qi and blood deficiency, leading to weak and imbalanced meridians. Some say that postpartum women must have milk; even if the breasts are swollen, it is due to wind-heat in young women who have just given birth for the first time. They need to take clearing and diuretic medicine to promote milk flow. If a woman has given birth multiple times and has no milk, it is due to fluid exhaustion, and she must take nourishing medicine to assist. If there is some milk but not much, she should take medicine to regulate the meridians and still use soups to induce lactation. This is because a woman's milk relies on the thoroughfare vessel and the stomach meridian. Some women who have given birth multiple times often have abundant milk, which is due to their strong qi and blood. If a woman has a pre-existing condition in the thoroughfare and conception vessels, her milk will be scant and yellowish, and her child will be weak and prone to illness."