Medicating the Milk Method

Eight aromatic and digestive drugs — ginseng, costus root, agastache, aquilaria, tangerine peel, medicated leaven, malt and clove — decocted with ginger, perilla and jujube, and then given **to the wet nurse rather than to the child.** The procedure is set out with unusual care: she takes it after eating, having first emptied her breasts completely so that the milk the child gets is new milk; she lies on her back a short while; then the child is put to the breast for a few mouthfuls only and is not allowed to feed to satiety. This is the one leaf in the section whose pharmacokinetic idea is sound. Drugs do pass into breast milk. Most small, lipophilic, weakly basic, poorly protein-bound molecules diffuse from maternal plasma into milk, and the relative infant dose is a real and measurable quantity that modern lactation pharmacology calculates drug by drug. Emptying the breast first and timing the feed to the maternal dose is, in principle, exactly the right manipulation: it is the same reasoning that underlies modern advice about timing a feed relative to a mother's medication. The practitioner here has worked out, without any theory of absorption or distribution, that what the mother swallows reaches the child, that the amount depends on when the child feeds, and that the transfer can be managed. What is wrong is the quantity and the drugs. Transfer into milk is low and highly variable — for most drugs the relative infant dose is a few per cent of the maternal dose, and for many it is a fraction of a per cent — so a few mouthfuls of milk after one packet of a mild aromatic decoction delivers something close to nothing. That is also the safety of the method: nothing in this particular formula is toxic, and nothing in it will reach the child in a quantity that matters either way. Where the route becomes dangerous is when the tradition uses it, as it elsewhere does, to pass a mineral or a venom to an infant through the milk — which is the same mechanism by which a nursing mother's mercury or lead reaches her baby. And the child is still the 慢驚風 child. A few mouthfuls of medicated milk, with the instruction 不可過飽 that he must not feed to his fill, is the opposite of what he needs, which is volume; see the note on `baekchul-san-soa`. The confident last line — 如此調理無不愈者, a child managed this way is never not cured — is the chapter at its least reliable, written about a condition whose mortality was high. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.