Acute mastitis is a common disease of the breast and belongs to the scope of “canker sores” in Chinese medicine. It is characterized by localized lumps in the breast, redness, swelling, heat, pain, and fever. The majority of cases occur during the postpartum period when breastfeeding is in progress, and are more common in primiparous women, usually 3-4 weeks after delivery. There are various names for canker sores depending on the cause and period of onset: those occurring during lactation are called external canker sores (also known as acute mastitis during lactation), those occurring during pregnancy are called internal canker sores (also known as acute mastitis during pregnancy), and those occurring during non-lactation and non-pregnancy are called non-lactating canker sores (also known as acute mastitis during non-pregnancy lactation). External canker sores are most common in clinical practice, accounting for about 95% of cases, while internal canker sores are less common and non-lactating canker sores are even less common.
The prevention and treatment of external canker sores is not only related to the recovery of the mother, but also to the growth and development of the baby, so it has received a lot of attention from doctors. Modern Chinese medicine has been studying this disease for more than 30 years and has accumulated a wealth of clinical experience, and the treatment of canker sores in Chinese medicine is both scientific and advanced, and its efficacy is now at the leading level.
1. Primary causes
Deficiency of positive qi: Women lose blood and qi after childbirth, which leads to deficiency of positive qi, and the couples are not dense, so the function of resisting external evil decreases, and external evil takes advantage of the deficiency to enter and cause the disease.
Internal injury of emotion and will: the nipple belongs to the liver meridian of the sympathetic yin, and the liver is responsible for draining and regulating milk secretion. When a woman gives birth to a new baby, she loses more qi and blood and cannot moisten the liver meridian, so the liver is not nourished and the discharge is not smooth.
Poor diet: The breast belongs to the Yang Ming stomach meridian, and the milk is made of qi and blood. After childbirth, a woman’s diet is not regular, and she deludedly uses thick and fatty tastes to supplement the spleen and stomach, which leads to the failure of the spleen and stomach to transport and transform, resulting in the accumulation of heat in the spleen and stomach, and stomach fire, which leads to the stagnation of qi and blood, the blockage of breast channels, and the congestion of damp heat and turbidity.
Fetal Qi: During pregnancy, the fetal Qi is strong, the chest is full of Qi, the Qi is not drained, and the evil heat is contained in the Yang Ming stomach meridian, resulting in swelling and internal blowing of canker sores.
2.Secondary causes
Milk accumulation: Milk accumulation is the most common cause. New mothers’ nipples are delicate and easily broken, or the nipples are congenitally deformed, which affects full breastfeeding, or improper breastfeeding methods, or more milk and less drinking, or improper weaning, can lead to the accumulation of milk and blockage of the milk complex into lumps, which can lead to canker sores due to heat and pus.
Invasion of external evil: the body is weak in the first birth, sweating and wind, or breastfeeding with the breast exposed, and the wind is attacked from outside; or the mouth of the breast is hot and sleeps with the milk, and the heat and poison in the mouth invades the breast hole; or the nipple is deformed, sunken or broken, and the poison is invaded from outside, which can make the breast lobe stagnant and blocked, turning heat into carbuncle.
3.Prompting factors
Emotional anger, cracked or broken nipples, sunken nipples, small nipples, stagnant milk and improper milking can trigger or aggravate the disease.
Western medicine believes that this disease is mostly due to postpartum resistance decline, nipple breakage, milk stagnation, bacteria along the lymphatic vessels, milk ducts invade the breast, secondary infection. The causative organism is mostly Staphylococcus aureus, followed by Staphylococcus albus and Escherichia coli.
4.Clinical manifestations
Most of the patients are lactating women, especially the new mothers who have not yet reached the full term.
(1) Initial: painful lump in the breast, skin color is not red or slightly red, skin is not hot or slightly hot, breast discharge is not smooth, feel nipple tingling when breastfeeding, may have nipple rupture erosion. It is accompanied by general discomfort, chills and fever.
(2) When septic: The affected breast lump gradually increases in size, with increased local pain, or a bird-pecking-like pain, skin color {red, skin burning. The lymph nodes in the ipsilateral axilla are enlarged and painful when pressed. By the tenth day or so of the red, swollen and hot breast pain, the central part of the lump gradually becomes softer, and there is a fluctuating feeling when pressed, and pus can be extracted by puncture. The systemic symptoms increase and the high fever does not subside.
(3) After ulceration or incision and drainage, the swelling and pain are reduced, the fever gradually subsides, and the sore gradually heals. If the pus does not flow smoothly and the swelling and pain do not subside, pockets of pus may form, or the pus may spread to other breast ligaments to form transcystic canker sores. If the sore does not close for a long time after ulceration and leaks milk or pus, it may form a milk leak.
5.Treatment
(1) Chinese medicine treatment is based on the principle of “draining the liver and Qi, clearing heat and detoxifying the toxin”.
At the initial stage, the main manifestation is milk stagnation and internal heat toxicity. The treatment is based on draining the liver and clearing heat, promoting lactation and reducing swelling.
For lactation, add Andrographis paniculata, Mouton, Wang Bu Liu Xing; for qi stagnation, add orange leaf and neem; for fever, add raw gypsum and reuse scutellaria; for swelling and pain, add frankincense, myrrh and red peony; for milk return, add jiao hawthorn and jiao malt. At the same time, apply Jinhuang Paste and Yulu Paste externally. For those who have poor milk discharge, breast massage can be performed regularly.
Pus-forming stage: If an abscess has formed, it should be excised and drained in time. After incision and drainage of pus, local use of “eight two Dan” or “nine one Dan” to raise pus and detoxification, and use “red oil cream” gauze to apply externally. If there are pockets of pus, it can be treated by cotton pad method, that is, a cotton pad is placed under the pus cavity and pressure bandage is applied so that the pus will not be retained.
If local sinus tracts are formed in the breast, “Wu Wu Dan” can be inserted into the sinus tracts to corrode the walls of the tracts, and after the pus disappears, “Sheng Yu San” can be given to promote the healing of the sinus tracts. In addition to local treatment, appropriate internal medication can be given to promote the drainage of pus, support the righteousness and accelerate the healing of the sore.
(2) Western medicine treatment
Western medicine treatment can be oral or injectable antibiotics, especially for serious infections, when local and systemic symptoms are obvious, effective antibiotics should be applied early and in sufficient quantity. At present, all kinds of antibiotics are constantly updated, but for acute mastitis, common penicillin is still extremely effective, so we suggest that as long as there is no allergy, antibiotics are preferable to penicillin, with intravenous injection effect.
It should be noted that it is best not to treat with antibiotics alone and not to receive Chinese herbal medicine for the sake of saving time. The use of antibiotics alone can sometimes make the acute inflammation of the breast prolonged and difficult to heal, forming a stiff lump. Since Chinese herbal medicine has obvious advantages in treating this disease, Chinese herbal medicine should be used as the main treatment, and appropriate antibiotics should be given at the right time, and good clinical results will be achieved.
(3) External treatment
①Ruyi Jinhuang San is made into a paste with vinegar or white wine and applied locally to the lesion.
②Fresh dandelion 60-120g, onion 30-60g, pounded into a paste, applied to the affected area, tied with bandage or triangular towel, change the medicine once a day.
(3) Three yellow ointment applied externally: Three yellow ointment, i.e., equal parts of Phellodendron, Rhubarb and Scutellaria, is grinded into a fine surface and mixed into a paste with cool boiled water, honey or equal amount of petroleum jelly.
(4) Other therapies: massage, acupuncture, moxibustion, compress, acupoint injection method, nose plugging method, pinching and squeezing method, medicinal bath therapy, etc.
(5) Treatment of mastitis food therapy recipes: Here are some recommended mastitis food therapy recipes for reference.
Loofah white wine drink
Ingredients: 20 grams of loofah (dried), 40 ml of white wine.
The medicinal value of the main ingredients.
Loofah: sweet in taste, flat and slightly cool in nature. It has the effect of diarrhea and thirst, clearing heat and cooling blood to detoxify, dispelling wind and phlegm, relieving cough and asthma, opening the meridians, moving blood vessels, reducing swelling, and lowering breast milk.
White wine: bitter, pungent, warm in nature. It has the efficacy of promoting the circulation of Qi, relaxing the tendons and activating the collaterals, drinking less and refreshing, warming the stomach and dispelling cold, relieving pain and acting as a medicinal guide.
Method: Put the dried loofah into a bowl, burn it into charcoal powder with a sesame pole fire, add 40 ml of white wine and stir well.
Dosage: Once a day for 3 times.
Efficacy: This product has the efficacy of opening the meridians, clearing heat, resolving phlegm, dispersing depression and moving stagnation, and is suitable for people with early mastitis.
Dandelion porridge
Main ingredients: 90 grams of dandelion (50 grams of dried product), 100 grams of round-grained rice.
Supplementary ingredients: appropriate amount of water, appropriate amount of sugar.
Medicinal value of the main ingredients.
Dandelion: bitter, sweet and cold in nature. It has the effect of clearing heat and detoxifying, dispersing knots and eliminating swelling.
Japonica rice: sweet in taste and flat in nature. It has the effect of tonifying the middle, strengthening the spleen and stomach, nourishing the essence and eliminating boredom, strengthening the muscles and bones, and stopping thirst and diarrhea.
Method of preparation.
First, dandelion washed and chopped, put into a casserole with an appropriate amount of water and boil for 30 minutes to remove the dregs and leave the juice for use.
Then wash the japonica rice into the casserole, and cook with the liquid until the porridge, add some sugar to taste.
Dosage: Take one dose daily, once in the morning and once in the evening, for 5 days.
Efficacy: This product has the effect of clearing heat and detoxification and reducing swelling, suitable for people with mastitis and abscess formation period.