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 Breast Disorders

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Lumps – Ru Bi

Breast Tenderness

Breast Discharge

Lack of Breast Milk

Mastitis

Breasts are for beauty

Breasts nourish baby

Breasts are emotional centers

Stimulation of nipples initiates uterine contractions

TCM – Breast physiology

1. First related to ST (SP) Jing

2. Secondly related to LR Jing (circles nipple)

3. Thirdly related to KI Jing (controls reproduction)

4. Chong & Ren both originate from reproductive areas & go to chest

TCM – Breast Pathology

May be invaded from external or have internal organ disharmony of Qi & blood

1. LR Qi stagnation (most common)

2. Qi & blood ↓ - see from appearance, lack of milk

3. Heat (LR ST) – leakage, bleeding, mastitis

4. Phlegm & Qi stagnation – lumps

5. LR KI ↓ - lack of milk, PMS, cysts

Diagnosis

Quantity & Quality of milk, ↑ or ↓ , color of milk, normally there should be no leakage, shape of breast (large = problems, small = problems), areola color/shape/size – when get dark = pregnant (very dark = boy, slightly dark = girl), areola turns orangey pale w/ undefined edge &/or inverted nipple may mean tumor, cancer will have a fixed bumpy edged lump w/ above areola signs, cysts have a clear edge and are moveable.

Principle of Treatment

Internal → treating Qi (nourish & move)

Soothe LR, nourish Qi & blood, clear Heat/detoxify, dissolve hardness, nourish LR KI

External

Lumps – Ru Bi

Diagnosis

Discovery of lump(s) in breast(s) that are of different size, amount or shape than normal. Can have pain or no pain, can change in size w/ cycle & emotions (luteal phase = larger, follicular phase = smaller).  Patient should get mammogram, if lump is malignant it will be hard, fixed, & feel like cauliflower, there may be an inverted nipple (significantly inverted- including areola), the edge of areola may not be distinct (fades to pale orangey), pink fluids may leak, check lymph nodes (axillary, 52-53 nodes).

Etiology

Primary cause is LR Qi stagnation (emotional, worry a lot, depressed, sad, generally more on the down side of emotions)

            1. Both LR & ST Qi stagnation → Blood Stasis or Phlegm stagnation.

            2. Qi & Phlegm stagnation → SP ST ↑ or ↓ → Dampness → Phlegm

                        or/, KI Yang ↓ → fluid metabolism ↓ → Phlegm

                        or/, LR Qi stagnation → SP ↓ → Phlegm

            3. KI Essence ↓ → blood ↓ → LR blood ↓ → can’t soothe Qi flow → Phlegm

                        or/, Chong & Ren are empty → external pathogenic invasion → Phlegm

Pathogenesis Differentiation & Treatment

LR Qi stagnation

can start in puberty, can change size with cycle &/or emotions, accompanied by pre-menstrual breast distension, dysmenorrhea, & infertility.

                        Plus – LR Qi stagnation symptoms (see Appendix 1)

                        P/T – soothe LR, regulate Qi, promote circulation to dissolve lumps

                        Rx – Xiao Yao San + Yu Jin, Ju He, Xia Ku Cao (dissolve hardness)

Phlegm & Qi stagnation

soft lumps like a hard boiled egg (smooth), no significant pain, does not necessarily change with cycle, usually in younger women, dizziness, nausea

                        Plus – Phlegm symptoms (see Appendix 1)

                        P/T – soothe LR, invigorate SP, eliminate Phlegm

                        Rx – Xiao Yao San + Hai Zao Yu Hu Tang

      or  Gua Lou Xie Bai Ban Xia Tang

KI ↓ w/ LR Qi stagnation

chronic, small sand/bean plentiful lumps, irregular menses, infertility, dark eye circles, weak back/knees

                        Plus – KI ↓ symptoms (see Appendix 1))

                        P/T – nourish KI, soothe LR to regulate Jing Luo to dissolve lumps

                        Rx – Ding Jing Tang + dissolve hardness herbs (as above)

Breast Tenderness

Diagnosis

Around period breasts (KI) feel tender, sore, distended, or have itchy pain in the nipples (LR)

Etiology

1. LR Qi stagnation – LR effects nipple – if the LR attacks the ST the breasts are effected.  Qi is not able to flow smoothly.

2. LR KI Yin ↓ - breasts are effected during menses, blood is ↓ - collaterals then lack nourishment & this leads to stag.

Differentiation

   Tumor – generally has inverted nipple, breast skin looks like an orange peel, Areola border is not clear.

   Cyst – can be big or small – change w/ cycle hormone levels, can have many, they are fluid filled sacs.

Pathogenesis Differentiation & Treatment

LR Qi stagnation

pre-menstrual tenderness, itchy, distended

                        Plus – LR Qi stag. symptoms (see Appendix 1)

                               P/T – soothe LR to relieve stagnation

                           Rx – Chai Hu Shu Gan San  or  Xiao Yao San

LR KI Yin ↓

tenderness in last few days of bleeding

                        Plus – LR KI Yin ↓ Heat symptoms (see Appendix 1)

                                          P/T – nourish LR KI Yin

                            Rx – Yi Guan Jian  or  Zi Shui Qing Gan Yin

Breast Discharge

Diagnosis

Abnormal fluid discharge from nipple, may have slight distension.  slight discharge during late pregnancy & after delivery is normal, although any other time or large amounts should be treated.

Etiology

Mainly LR Jing & ST Fu

          1. LR Qi stagnation → Heat – push fluids out, if injury to vessels has occurred the fluid may be pinkish (blood).

          2. ST Qi ↓ - milk comes from SP ST T&T, ST Jing goes to nipple – Qi can’t keep fluids in.

Principle of Treatment

LR Heat → clear Heat soothe LR

ST Qi ↓ → strengthen SP ST Qi

Pathogenesis Differentiation & Treatment

LR Qi stagnation → Heat

discharge is pale yellow & thick, may feel hot accompanied with distension of breast, may have slow growth of fetus.

                        Plus – LR Qi stagnation symptoms (see Appendix 1)

                      P/T – soothe LR, purge Fire, stop breast discharge

                                       Rx – Dan Zhi Xiao Yao San

ST Qi ↓

discharge is thin, large amount, breasts are soft, may have slow growing fetus.

                        Plus – SP ST Qi ↓ symptoms (see Appendix 1)

                       P/T – nourish mid Jiao Qi to consolidate breasts

                           Rx – Bu Zhong Yi Qi Tang  or  Ba Zhen Tang

Lack of Breast Milk

Diagnosis

Within 12 hours colostrums should come, it is pale yellow & thick.  If very little appears or none comes this poses a problem that needs treatment.  This problem may also manifest as small amounts of milk produced throughout breastfeeding months.  Enough milk depends on the baby’ needs.

Pathogenesis Differentiation & Treatment

Qi & Blood ↓

loss of blood & Qi during delivery, ↓ constitution, or too young or old, may all result in not enough milk.  Breasts are soft, never get engorged, milk is thin & watery.  These women may have large amounts of lochia postpartum.

                        Plus – Qi & Blood ↓ symptoms (see Appendix 1)

                        P/T – nourish Qi & Blood to increase milk production

                        Rx – Tong Ru Dan  or  Zhu Ti Tang (Ba Zhen Tang w/ Huang Qi & pig leg)

LR Qi stagnation

emotional stress injures milk production, breast distension, hard breasts, pain

                        Plus – LR Qi stagnation symptoms (see Appendix 1)

                        P/T – soothe LR

                        Rx – Xia Ru Yong Quan + Wang Bu Liu Xing & Chuan Shan Jia

Phlegm & Qi stagnation

not necessarily emotional, may enlarge but breasts stay soft & fatty with no milk, may be overweight, may have lack of milk glands.

                        P/T – strengthen SP, eliminate Phlegm

                        Rx – Lou Lu San (classic)

                                    + SP tonics (Huang Qi, Bai Zhu)

                                                + Phlegm herbs (Ban Xia, Gua Lou, Bei Mu)

                                                + Blood tonics

Mastitis

Diagnosis

Acute infection of breast (abscess).  Distended breast, painful, swollen w/lumps.  If caught early can be massaged out, treated with warm moist herbal washes & compresses.  If left untreated or unnoticed may manifest with flu like symptoms (toxic Heat).  As it grows & fills with pus it can get very painful & lead to forming an abscess.  This is when it will get red & hot.  Internal blockages are deeper & generally can’t be seen on the surface, grow slower, are harder to detect, & are tougher to move or break-up.  The major cause is during breastfeeding the milk stagnates (from irregular feeding, not enough stimulation, etc.), this results in blocked duct(s) & creates the infection.

Etiology

2 types → late pregnancy & postpartum

Postpartum

            1. LR Qi stagnation w/ ST Heat – emotional stagnation, eat too rich/hot food → ST Heat → Qi stagnation & Heat turns milk into blockage → infection.

            2. Toxic Heat invasion – at beginning of breastfeeding nipple is not tough, it cracks & milk stagnates in the crack leading to infection.  If nipple is too small the baby will suck with great force & may injure the nipple, it then gets invaded from the exterior. 

            3. All 10 fingertips go to HT & nipple, sores on fingers cause pain → mother breastfeeds less → milk stagnates & toxic Heat invades (forms).

            4. When it is time to stop feeding, or too much milk is being produces this may lead to retention → stagnation → Heat → infection.

Late Pregnancy

            1. Internal – all Essence goes to low Jiao for fetal growth, then anything that may cause Heat (woman is already Fire at this time) → the Heat follows the Chong Mai & goes into breast creating the infection.  i.e. Yangming Heat

Pathogenesis Differentiation & Treatment

Postpartum

Early stage → remove blockage, open Jing, dissolve.

LR Qi stagnation → ST Heat

milk secretion is not smooth, emotional stress, diet, start w/ hard lump → breast engorgement, may get flu like symptoms → LR ST Heat

P/T – soothe LR, clear ST Heat, promote milk secretion & dissolve hardness

                        Rx – Gua Lou Niu Bang Zi Tang

                                    + clear Heat herbs (Pu Gong Ying, Zao Jiao Cao)

External treatment – massage (from base to nipple)

                               - Heat w/ moist herbal compresses (Pu Gong Ying)

Late stage

Toxic Heat

hard lump, red with Heat on skin, high-fever, may feel pulse on lump, lump may also have a soft center (pus)

                        Plus – Heat symptoms (see Appendix 1)

                        P/T – strengthen Wei Qi to discharge pus

                        Rx – Tou Li Xiao Du San  or  Xian Fang Huo Ming Yin

Late Pregnancy (7,8,9 months)

Internal

starts with feel deep hard lump(s) → skin gets red hot & painful, fever & flu symptoms may appear, takes longer to manifest i.e. 1 month.

                        P/T – soothe LR, clear ST Heat, calm fetus

                        Rx – Xiao Yao San  + Pu Gong Ying & Gua Lou, Su Geng

Additional information:

1. After 6-7 months the woman should soothe & massage breasts with warm cloths.
2. Treat cracks with sesame oil or oil extracted from hard boiled egg yolk baked on wax paper.
3. Ween baby slowly to help reduce the production of milk.

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