Mastodynia, or simple mammary epithelial hyperplasia, is an early stage of mastodynia, which is a physiological change of breast tissue hyperplasia and poor replenishment caused by endocrine imbalance, and the clinical manifestations are mainly periodic breast swelling and pain and breast lumps. Most scholars believe that this disease is related to mental factors and endocrine disorders. Long-term mental stress, fatigue, emotional depression and other factors can act on the thalamus-pituitary-ovarian axis, causing abnormalities in the regulation of the thalamus and ovaries, resulting in endocrine disorders and imbalance in the ratio of estrogen and progesterone, leading to different degrees of hyperplasia of the ductal epithelium and mesenchymal fibrous tissue of the breast, and a series of clinical symptoms. There is no mass formation in the mammary gland as seen by the naked eye, and the hyperplastic lesions are generally dense, with small grayish translucent particles visible on the cut surface. The main microscopic lesions are hyperplasia and detachment of the terminal milk ducts and alveolar epithelium, resulting in painful swelling of the milk ducts. There is also hyperplasia of the fibrous tissue surrounding the milk ducts and alveoli, which may be infiltrated with lymphocytes. Clinical manifestations: The disease occurs in middle-aged women and is mainly characterized by periodic breast swelling and pain and lumps. (1) Breast swelling and pain: Breast swelling and pain usually appear about 1 week before menstruation and gradually worsen, and after menstruation, it is relieved to disappear, and is cyclical. There are also a few patients with irregular pain. The pain is mostly intermittent, diffuse dull pain or limited stabbing pain, mostly located in the upper outer part of the breast, unilateral or bilateral, with bilateral pain being more common. There may be tenderness or pressure pain. The pain may radiate to the ipsilateral axilla, upper limbs, and back of the shoulder. Patients tend to have irregular menstruation, short periods and low menstrual volume. The pain mostly appears or worsens under mood swings, worry and exertion. (2) Breast lumps: There is no specific change in breast shape, and granular nodules within the lamellar thickened glands are mostly palpable in the breast, but no specific lumps can be palpated. The lumps are more common in the upper outer quadrant and are obvious in the premenstrual period, but shrink to disappear after the onset of menstruation. Diagnosis and differential diagnosis: (1) Periodic pain, tenderness and granular nodules in the breast area are the main clinical manifestations of this disease. (2) Physical examination. (1) Ultrasound examination: The breast hyperplasia or mammary lesion area is mainly a heterogeneous hypoechoic area under ultrasound as well as an echogenic area in the cystic area, with no obvious mass shadow. 2. Mammography: Mammography of breast pain often has no obvious changes. In the adenopathy and cystic hyperplasia stages, the hyperplastic breast tissue shows an increased density shadow with indistinctly delineated cotton wool or hairy glass-like changes at the edges. In the presence of cysts, round translucent shadows in irregular enhancement shadows are seen. 3. Breast MRI examination. 4. Excisional or excisional biopsy. Treatment: The disease is a physiological benign lesion and is self-limiting, and generally does not require any treatment. For those with severe pain, drug therapy can be considered. (1) Chinese herbal medicine: Chinese medicine is unique in the treatment of mastocytosis and is now the main method of treatment. According to the theory of Chinese medicine, this disease belongs to the breast “fetish”, which is caused by depression and anger to the liver, thoughts to the spleen, qi stagnation and blood stasis, phlegm coagulation into nuclei and cause lumps. Therefore, the treatment mostly uses Chinese herbal medicines or Chinese patent medicines, such as: breast fetish elimination tablets, breast health tablets, breast lump elimination, etc.. The herbal formula can be tried as follows: Chai Hu 9g, Angelica Sinensis 12g, Bai Shao 12g, Xiang Shen 9g, Qing Chen Pi (each) 6g, Fu Ling 12g, Han Xia 9g, Quan Gua Pao 12g, Roasted Milk Myrrh (each) 4.5g, Sheng Gan Cao 3g. 12g of Atractylodes Macrocephalae is added for loose stools, 9g of Golden Bell Seeds and 9g of Yan Hu for very painful breasts. 15g of Yimou Cao is added for low menstrual flow, 12g of Walnuts and 9g of Ze Lan for very painful periods. (2) Iodine preparation treatment: A small amount of iodine acts on the anterior pituitary gland to produce luteinizing hormone, reduce the level of estrogen in the body, relieve its stimulating effect on the mammary glands, restore the normal function of the ovaries, and improve the patient’s breast pain symptoms. Dosage: 5% potassium iodide 10ml, 3 times/d, orally. The duration of this treatment should not be too long, so as not to cause hormonal disorders in the body, and may also affect the function of the thyroid gland. (3) Hormone therapy: In the past, endocrine drugs were mostly used to treat mastocytosis. Although the effect of hormone therapy may be better at the beginning, the use of hormone therapy may be overkill and aggravate the endocrine imbalance due to the endocrine hormone disorder in mastocytosis patients themselves, and may have adverse effects on other organs and systems, so it is not used as routine treatment now. The following are only the more commonly used drugs: 1. Danazol: also known as ethinyltestosterol, a derivative of 17d-ethinyltestosterol, can act on the lower thalamus, pituitary gland and ovaries, inhibit ovarian function, reduce the secretion of oogenic hormone (FSH) and luteinizing hormone (LH), and reduce the level of serum lactogen (PRL). Dosage: 100-200mg per dose, orally, 1 time/d. Use for 2-3 months. Adverse effects include weight gain, acne, hirsutism and menstrual disorders. 2. Tamoxifen (triamcinolone): It is an estrogen-like drug that competitively binds to estrogen receptors to block estrogenic effects. Dosage: It can be administered on a cyclic basis, starting with oral tamoxifen 2-5 days after menstruation, 10mg each time, 1 time/d, for 15-20 days, until 1 day before menstruation. The adverse effects of tamoxifen are menstrual disorders, abnormal leucorrhea, and may increase the risk of endometrial cancer. Bromocriptine: Bromocriptine is a long-acting activator of dopamine receptors, which directly inhibits the synthesis and release of prolactin from lactating cells by acting on the dopamine receptors of pituitary lactating cells and releasing dopamine. Dosage: The drug is administered cyclically, starting with 1.25 mg daily on the 14th day of PMS and increasing by 1.25 mg daily until the dose reaches 2.5 mg twice daily, and at this dose until menstruation. Adverse effects of this drug include nausea, dizziness and other symptoms, as well as lowering blood pressure, which should be noted. Finally, breast pain is a self-limiting disease, which may heal on its own through the physiological process of pregnancy and breastfeeding, and has a good prognosis itself. The relationship between mastocytosis and breast cancer is not conclusive, but mastocytosis generally has no risk of cancer. Patients with mastocytosis should avoid spicy and irritating foods and prefer a low-fat and vitamin-rich diet. Live a regular life and combine work and rest. Keep your mood relaxed, reduce stress, and be less angry. Avoid abortion as much as possible. Learn breast self-examination and do regular review.