Plasmacytoid mastitis, also known as acantholytic mastitis, chemical mastitis, occlusive mastitis, and ductal dilation of the breast, is a chronic benign disease of the breast with non-bacterial infection based on ductal dilation and plasma cell infiltration. It is characterized by non-cyclic breast pain, nipple discharge, subareolar masses, parareolar abscesses and areolar fistulas. Western medical treatment is mostly mastectomy or segmental mastectomy or ductal excision, which causes great physical and psychological trauma to the patient and has the concern of recurrence. We use a combination of internal and external Chinese medicine treatment, not only is the surgery simple, the scope of injury is small, less painful, less scarring, treatment is complete, but also can maintain the complete shape of the breast, maintain its normal physiological function, the patient is easy to accept. From August 1986 to September 1996, a total of 109 cases were admitted and treated, all of which achieved good results. I. Diagnostic criteria Most of the cases have congenital nipple depression deformity, with pimple-like or grease-like material or yellowish plasma fluid overflowing from the nipple hole; the onset is mostly seen in non-nursing coral or pregnant women aged 20 to 40 years old, or menopausal women. The lump is located in the areola at the beginning of the acute phase, with localized redness, swelling and tenderness, and enlarged ipsilateral axillary lymph nodes, but the systemic symptoms are mild. After anti-inflammatory treatment, the mass shrinks, forms a hard mass and adheres to the skin; after the abscess breaks down or after incision and drainage of the pus, the pus often contains powder-like material or plasma material with a small amount of purulent secretions, which does not close for a long time or heals and recurs, forming multiple fistulas leading to the nipple hole. Mammography, mammography, nipple smear and fine needle biopsy of breast lumps can be useful for diagnosis. General information Among 109 cases, 105 were female and 4 were male. The average age was 18-66 years old, 36.7 years old, and the average age of 4 males was 46.2 years old; 44 cases were aged 18-30 years old, 54 cases were aged 31-40 years old, 7 cases were aged 41-50 years old, 3 cases were aged 51-60 years old, and 1 case was aged 61 years or older, and 49.5% were aged 31-40 years old. The duration of the disease ranged from 10 days to 11 years, including 57 cases within 1 year, 43 cases from 1 to 5 years, 7 cases from 6 to 10 years, and 2 cases above 10 years. There were 6 cases with bilateral breast, and the rest were unilateral. Among the 105 female patients, 76 had complete or incomplete central nipple depression, 17 had nipple depression after the onset of the disease, 12 had no nipple depression or depression, and 9l had discharge from the nipple orifice. 1O9 patients, 97 had fistula wounds leading to the nipple orifice, 68 had fistula openings in the areola, and 4l had fistula openings in the breast. The fistula was opened in the areola in 68 cases and in the breast in 4l cases. In 67 cases, the largest number of surgical incisions or drains were made by Chinese and Western medicine, and the largest number of incisions were made eight times, but the incisions did not heal or recurred after years of treatment. Among them, 5 cases were diagnosed as breast cancer and proposed to be radical breast cancer surgery; 2 cases were diagnosed as breast tuberculosis; 15 cases were not treated for many times in outside hospitals and were proposed to be simple mastectomy. Treatment methods (a) Internal treatment method 1.heat in the liver, redness, swelling and pain in the nodules next to the areola, or pus in the end, accompanied by fever, headache, yellow greasy moss and slippery pulse. The treatment is to clear heat from the liver, invigorate blood and eliminate swelling. Commonly used are Chai Hu, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix Salviae Miltiorrhiza, Fructus tigrinus, Rhizoma Polygonatum, Dandelion, Melaleuca alternifolia, Radix et Rhizoma Polygonatum, Cincinnati, Herba Cistanches, etc. If the nipple overflow is watery, add raw rice kernel, zedoary, white fruit; if the overflow is bloody, add Xianhecao, Xie Cao, Sheng Diyu; if the area is red and swollen, add Yinhua, Half Branch Lotus, Deer Herb; if the pus is mature, add saponaria needle, cannon’s nail piece, raw rice kernel. 2.The remaining toxin is not cleared The abscess is self-collapsed or does not close for a long time after incision, and the pus is dripping and forming breast leakage, which is healed from time to time, with local stiff lumps. The treatment is to benefit the qi and Ying, and to clear the toxin. Commonly used are Astragalus membranaceus, Radix Codonopsis pilosulae, Rhizoma Atractylodis Macrocephalae, Poria, Radix Angelicae Sinensis, Radix Salviae Miltiorrhizae, Fructus Crataegus, Radix Paeoniae Alba, Rhizoma Paeoniae Alba, Dandelion, Radix et Rhizoma Tigrinus, Rhizoma Saponariae, Rhizoma Allium, Rhizoma Cornus. 3.Phlegm stagnation type The wound is healed, but local hard lumps remain. The treatment is to dredge the liver and invigorate the blood, soften the hard lumps and disperse the knots. Commonly used are Chai Hu, Radix Angelicae Sinensis, Radix Paeoniae Alba, Salviae Miltiorrhizae, Peach kernel, Raw Hawthorn, Dandelion, Cichlidium, Whole Gourd Atrophy, Eleuthero, Xia Ku Cao, Artemisia, Ginger, Astragalus, Atractylodes, Poria, etc. (II) External treatment 1, the mass at the beginning of the available gold yellow cream external, daily change 1 time; abscess into under local anesthesia into the abscess incision and drainage, postoperative wounds with medicinal thread dipped in eight two Dan drainage, red oil cream cover paste, daily change 1 time. 2, has formed a fistula, after the acute inflammation subsides, available incision method, hanging method, dragging method, nipple splitting method, nipple orthopedic method, pad brocade bandage method, the removal of corruption and muscle method, specific operations and topical drugs are as follows: (1) incision method: applicable to shallow fistula. Under routine disinfection and anesthesia (local anesthesia for simple fistulas and epidural anesthesia for complex fistulas), the tube is cut open with scissors under the guidance of a silver bulb probe; complex fistulas with multiple external openings and cavities need to be cut open to expose the trauma. After the incision, the degenerated and necrotic adipose tissue is scratched with a spatula. (2) Hanging wire method: Applicable to deeper fistulas. Under conventional disinfection and anesthesia, a silver wire ball probe is gently inserted through the ulcer and threaded through the papillary orifice, then a silk or rubber band is tied to the end of the silver wire ball, then the silver wire is withdrawn from the ulcer and the superficial skin at the end of the papillary orifice is cut, the silk or rubber band is tightened, the silk is tied and fixed, and should be tightened day by day to produce chronic cutting of the fistula until the skin between the ulcer and the papillary orifice is completely until the skin between the ulcerated end and the nipple hole is completely hung open. (3) The dragline method is used for multiple fistulas. Under conventional disinfection and anesthesia, after probing with a silver bulb probe, 4 to 6 strands of No. 4 silk thread are run through the fistula lumen, and Jiu Yi Dan is applied to the silk thread daily, and the thread is dragged back and forth several times so that Jiu Yi Dan is dragged into the tube, and the thread is removed after 10 to 14 days, and the tube lumen is healed by adding cotton bandage for 7 to 10 days. (4) Nipple splitting method Applicable to fistulas leading to the nipple hole. Under routine disinfection and anesthesia, a silver wire ball probe is used to probe from the ulcerated mouth in the direction of the invaginated nipple, straight to the blind end of the atresia on the orifice, and the blind end of the nipple is seen to be lifted up, or sebum-like secretions are ejected, and after the probe is ejected from the nipple orifice, the skin and nipple are cut along the probe, and the fistula wall is scratched and scraped, and the medicine is changed daily until the wound is healed, and the two flaps of the split orifice are brought together before the near healing, so that the nipple remains intact Healing. (5) Nipple orthopedic method For fistulas with nipple depression or invagination, the nipple is pulled up after the fistula is incised on the basis of the above procedure, the nipple and subareolar tissue are separated with scissors to protect the milk duct, the muscle fibers causing the depression are cut, the excess skin is excised, the nipple is sutured outward in a misaligned interval to make the nipple protrude, and the stitches are removed after 5-7 days when the nipple no longer retracts, and the wound is opened for dressing. (6) Exorcism and muscle growth method After the ducts are cut and hung open, they must be changed daily. At the beginning of 5-7 days, the wound was filled with eighty-two Dan cotton to corrode the wall of the duct and covered with red oil paste gauze. After the change to the use of nine a Dan to mention the pus method of corruption, pulling out the poison to produce muscle. When the rot is removed from the newborn, the wound is closed with muscle growth and muscle growth until the wound is healed. (7) pad cotton bandage method: applicable to deep fistulas, cavities. After using the pus lifting method, the traumatic surface pus is reduced, the secretion becomes pure and clear, no pus rot filth, pus smear culture suggests no bacterial growth, the cotton pad can be used to press the cavity, and then give pressure bandage, so that the affected area breast pressure tight, change medicine once a day to promote the cavity wall adhesion, closure. 7 to 10 days after the cavity closure, continue to pad cotton pressure bandage for 10 to 14 days to consolidate the efficacy and avoid recurrence. 3, the wound healing, local residual stiffness block, sub-charge and cream external application, daily change of medicine once. V. Treatment results (a) efficacy criteria Healing: the mass disappears, the fistula disappears completely, the fistula is completely closed, there is no local pain and pressure, no discharge from the nipple hole, and the retracted nipple returns to normal. Improvement: the lump is reduced, the fistula is nearly healed, the local redness and pain disappears, the nipple discharge is significantly reduced, and the retracted nipple is partially restored. Ineffective: no significant improvement before and after treatment. (B) Efficacy analysis: Among the 109 patients, 105 cases were cured, accounting for 94.5%; 4 cases were improved, accounting for 5.5% (3 cases were discharged automatically; 1 case was discharged at the end of the lump and was transferred to outpatient clinic for further treatment). During the treatment, 106 cases were treated by incision method, 16 cases were treated by hanging method, 33 cases were treated by dragging method, 97 cases were treated by nipple splitting method, 15 cases were treated by nipple correction method, 98 cases were treated by padded cotton bandage method (there were more than one method for one person), and the course of treatment ranged from 18 to 138 days, with an average of 48 days. (a) Plasmacytoid mastitis is equivalent to “acne mammary epilepsy” in Chinese medicine, which is similar to this disease in the literature of Chinese medicine. The accumulation and overflow of lipid-like secretions and their decomposition products in the ducts and the chemical inflammation of the duct walls and the tissues surrounding the ducts are the main causes of the local symptoms. According to Chinese medicine, the nipple belongs to the liver and the breast belongs to the stomach. Patients with this disease have sunken nipple deformities, and due to liver Qi stagnation, Ying Qi does not follow, Qi stagnation and blood stasis, and the lumps are formed; the stagnation turns into heat, and the abscess breaks into an abscess due to steam and flesh rot. Treatment is mostly based on draining the liver and clearing heat, invigorating blood and eliminating swelling to promote dissipation of the mass, prevent expansion and aggravation of the lesion, and create favorable conditions for surgery. The treatment is often used to clear the liver, activate blood, soften the hardness and eliminate swelling, such as Chai Hu, Chen Pi, August Zha, Radix Angelicae Sinensis, Radix Paeoniae Alba, Danshen, Peach kernel, etc.; to clear the milk channels and promote the smooth drainage of milk ducts, such as Lonicera japonica, Liuxingzi, Lutong, Silphium, etc.; to tonify the kidneys and regulate flushing, adjust hormone secretion, and have a curative effect on inhibiting ductal epithelial secretion and ductal dilation, such as Xian Lingma, Cistanches, Bacopa monniera, Cornu Cervi Pantotrichum, etc.; Dandelion, Tiger Balm, White Flowered Serpent’s Tongue, Deer Containing Herb, Scutellariae, Half Branch Lotus, Yin Yin, etc. The abscess period is mostly accompanied by bacterial infection, additional heat-clearing and detoxifying drugs must be used, and can be combined with Chinese medicine preparations such as Shuang Huang Lian and Qing Kai Ling intravenous drip; the fistula period should be used to benefit the Qi and nourish the blood, and can be combined with Chinese medicine preparations such as Huang Qi and Dan Shen intravenous drip, in order to help the toxin to penetrate the evil, to promote early convergence of the wound, to avoid recurrence; the residual stiff lumps in the prescription should be used to resolve blood stasis and soften the hard knots, together with Chinese medicine preparations such as Huang Qi, Dan Shen and Pulsatilla (2) “Surgical method (2) “In surgery, external treatment is the most important”. The main reason for this is the surgical treatment and drug exchange. The key to surgical treatment is to explore the ducts carefully, patiently and gently, avoiding violent and rough movements to prevent the formation of false channels; fistulas and dilated milk ducts leading to the nipple hole must be incised, all necrotic cavities from superficial to deep lesions are incised, and degenerated necrotic tissue is removed. After surgery, the dressing must be changed daily, and the trauma must be filled with red ointment gauze with emphasis on uniformity. In the early stage, the dressing should be tight, so that the trauma is completely cleared of pus and rot and no foci remain; in the middle stage, it should neither be too tight nor too loose, so that the trauma buds can grow from the base and do not make the bridge heal; in the late stage, it should be loose, so that the trauma can heal quickly. (c) Nipple indentation is the key to the occurrence and recurrence of the disease after healing. After surgical treatment such as nipple splitting, the nipple is more concave and the milk ducts under the nipple are still distorted, adherent and obstructed, so the nipple concavity must be corrected at the time of surgery and attention must be paid to making the nipple turn out when changing medicine to avoid recurrence. (d) The disease has a certain possibility of carcinoma, and pathological examination should be performed first for suspected carcinoma to avoid misdiagnosis and radical surgery, or negligent omission and delay of the disease. The pathological changes of this disease are easily confused with tuberculosis and must be differentiated from it.