Plasmacytoid mastitis is called complex refractory plasmacytoid mastitis when multiple abscesses, multiple sinus tracts or fistulas, and acute and chronic inflammatory masses coexist, and is likened to a “rotten apple” or “tunnel war”. The condition is complex, the residual toxicity is difficult to clear, lingering or recurring, easily referred to as “persistent disease”, clinical treatment is quite difficult, patients are very painful, and long-term persistent. Difficulties in treatment: fistulae are formed after abscesses break down or incision and drainage, and pseudo-healing can be obtained through drainage and drug exchange treatment, but they are prone to recurrence. Due to the large change in breast shape caused by ductal resection or mastectomy, it is easy to recur, while simple mastectomy is too traumatic and causes a large physical and psychological burden to the patient, which is difficult for the patient to accept. The effect of antibiotic treatment is not significant, but easy to form “stiff lumps”, often more difficult to cure. The combination of external and internal treatment of Chinese medicine has achieved remarkable results in the treatment of complex refractory plasmacytoid mastitis. Based on the treatment principle of “expelling the evil without harming the righteousness and removing the decay to create new ones”, the main treatment is to drain the pus from the fire-needle cavity and to remove the decay and lift the pus with medicinal twisting and drainage. The treatment is complemented by the internal administration of Chinese herbal medicines to help eliminate the canker sores and to benefit the Qi and Ying. Advantages: less trauma, less bleeding, less change in breast shape, shorter treatment course, more precise efficacy and less recurrence. The location of the fire-needle branding site is chosen by taking the ultrasound image as the reference standard and selecting the lowest hanging position of the abscess. Because multiple abscess cavities coexist in patients with this disease, the most dominant abscess cavity should be selected, while the drainage port selected should take into account the drainage of the surrounding abscess cavities as much as possible. After puncture, the depth and extent of the pus cavity and the relationship between the sinus tracts or ducts can be probed with a silver ball probe, and on the day of puncture, the probe is guided to place a homemade pus-lifting drug twist in the main pus cavity or duct for drainage. On the next day, after probing the relationship between the pus cavity, sinus tracts or ducts with a probe, multiple pus-removing drug twists are inserted into the pus cavity, sinus tracts or fistulae that are opened in different directions as much as possible. The necrotic tissue of the pus cavity, sinus tract or fistula is thoroughly removed by scratching with a scraper and twisting with a cotton twist several times. The fistula should be lightly scraped with a spatula at the right time to help remove the rot and create new fistulae. If the fistula is connected to the papilla, dragline therapy is used. If the fistula is not clean, the fistula should be scraped with a spatula at the right time to help remove the rot and create a new one. When the cotton pad or butterfly gauze is pressurized, the pressure should be applied gradually from the top downward for those with long pipes greater than 5 cm, keeping the sore open for the time being in order to ensure unobstructed drainage if there is residual blood stasis and to prevent premature adhesion of the superficial part of the sore to cause poor healing. If there is no edema granulation, no necrotic fascia, no stasis of blood in the abscess cavity and canal, and the granulation on the sore surface is red and alive, and there is no abnormal echo on ultrasound and no abnormal blood count, the sore can be closed. Caution: 1. The fire needle puncture site should be chosen to avoid the areola as much as possible, and the puncture site should not be taken in the areola. 2. It is strictly forbidden to touch the skin, nipple or areola with the pus lifting strip. If there are edema buds, necrotic fascia and stasis in the sinus tract or fistula, and the tube is hard and painless and does not bleed, it can be called a “negative tube” and should not be closed, and the necrotic tissue should continue to be scraped with a scraper until there are no edema buds, no necrotic fascia and no stasis in the tube. If the duct is “positive duct” and the granulation in the duct is red and alive, painful to touch and bright red blood, the duct should be closed only when there is no abnormal echogenicity and no abnormal blood count on ultrasound examination. It is also common to see “half-negative, half-positive ducts” that are partially positive and partially negative, but the ducts should not be closed until they are all “positive”. 4. The flap should be scraped to remove the necrotic tissue such as edematous granulation of the sore skin, so that it becomes a positive flap with a red and active sore surface, a thin and red flap, and a bright red blood color before it can be closed. In complex refractory plasmacytoid mastitis, the treatment is mainly external treatment, supplemented by internal treatment. During the period of elimination and drainage, the internal treatment is based on the method of “removing toxins and eliminating carbuncles”. Basic prescription: Andrographis paniculata 10g (first decoction), Soapberry 30g, Dandelion 15g, Radix Platycodon 10g, Silphium 10g, Leucospermum 10g, Yujin 10g, Qingpi 15g, Wang Bu Liu Xing 15g, Quan Gua Bin 20g, Burdock 15g, Zhe Bei 15g. Addition and subtraction: For constipation, add Chuan Pu 15g, Hovenia 15g, Lycopodium 15g; for hard lumps, add Curcuma 15g, raw If the lump is tough and hard, add 15g of Curcuma longa, 30g of raw oyster (first decoction), 10g of silkworm, 5g of scorpion; if thirsty, add 15g of rhizome, 15g of smallpox powder. During the period of closure, the internal treatment is always based on the method of “strengthening the spleen, benefiting qi and harmonizing ying”: for the evidence of weakness of spleen and stomach, add and reduce Ginseng and Baijushan; for the evidence of spleen deficiency and dampness, add and reduce Xiang Sha Liu Jun Tang or Ping Gastric San; for the evidence of spleen deficiency and dampness obstruction, add and reduce Si Jun Zi Tang and San Ren Tang. For the evidence of spleen deficiency with dampness and internal heat, Si Jun Zi Tang combined with Yin Chen Artemisia Tang, plus or minus. The majority of patients with complex refractory plasmacytoid mastitis can be cured by the above-mentioned comprehensive treatment combining external and internal treatment, but in clinical practice, due to individual differences, some patients are particularly afraid of pain and have difficulty in adhering to frequent decay removal and debridement treatment, so the surgical method of one-time removal of lesions under anesthesia and analgesia is a helpless choice. The advantages of the surgical debridement method are pain relief and shortening the course of the disease. The disadvantages are that it may lead to changes in breast appearance, surgical scarring, certain risks associated with anesthesia and surgery, and higher treatment costs. The principle of surgical treatment is that the lesion must be removed completely and adequately, especially in the large subareolar duct, otherwise it is very easy to recur. Since 2004, our department has been treating plasmacytoid mastitis with wide excision of the lesion plus mammaplasty, which not only solves the problem of recurrence, but also ensures a certain breast shape, and has gained some valuable experience, which is described as follows: 1. If chronic inflammation is acute, the local skin is flushed, the skin temperature is high, and there is more pus exuding from the trauma, or if breast milk overflow is obvious during lactation, surgery is not recommended. Treatment is local drainage with pus lifting strips, external application of Jin Huang San and Tu Huang Lian liquid, together with Tori anti-pus herbal soup; those with overflowing breast are first given back to the breast, and in clinical practice, a decoction of 60g of Hawthorn, 60g of malt and 60g of grain bud is commonly used, and if necessary, 2.5mg of bromelain stop tablets are taken once a day. 2. Pre-operative ultrasound localization, marking the scope and location of the lesion. The scope of excision must reach the normal glandular tissue, along the pus cavity around 0.5cm ~ 1.0cm normal glandular excision, if there is necrosis, septic tissue residue, it will be a hidden recurrence. If there is a pimple-like discharge from the dominant duct behind the nipple, it should also be removed together; 3. If there is no drainage, the exudate will flow out from the wound, resulting in a non-healing wound. 5. Intraoperative hemostasis should be complete: because of the chronic inflammatory tissue is brittle, rich in blood flow, the trauma surface bleeds a lot, when cutting tissue electric knife should be adjusted to “mixed cut” mode, generally when cutting to the normal gland, the trauma surface bleeds less, bleeding points with electrocoagulation to stop bleeding.