1.What is gynecomastia? Although male breast diseases are rare, various female breast diseases can occur in men, and the incidence is increasing year by year. It has been reported that gynecomastia accounts for about 90% or more of male breast diseases. 30% of middle-aged adult males have palpable breast tissue, and by the age of 70 or older, more than 30% can have palpable breast tissue. Gynecomastia is the abnormal development or hyperplasia of the tissue and fat surrounding the male breast ducts, which may be associated with increased estrogen or decreased androgens. Gynecomastia is characterized by unilateral or bilateral breast enlargement in men, with a disc-shaped mobile lump under the areola and painful breast swelling. Gynecomastia seriously affects the psychological state of the patient, leading to low self-esteem, interpersonal difficulties and many other psychological hazards. 2. What are the causes of gynecomastia? Modern medicine believes that gynecomastia is mainly caused by a decrease in the level of androgens in the body and an absolute or relative increase in estrogen, or an increase in the sensitivity of breast tissue to it, which may induce breast enlargement. The etiology is physiological, pathological, idiopathic and pharmacological, and is generally caused by a decrease in the androgen/estrogen ratio. In Chinese medicine, this disease is called “breast scrofula”, and it is believed that men’s nipples belong to the liver, and the liver likes to be organized and depressed, so it should not be violent and angry. If you are depressed and irritable, your liver will lose its circulation and control, and then your qi will stagnate and blood will stasis, and if your spleen is not healthy, phlegm will grow. Once the gland enlarges for more than a certain period of time (usually 12 months), the gland will undergo interstitial vitreous transformation and tissue fibrosis, resulting in a serious decrease in responsiveness to drugs. After the etiology is clearly defined, pharmacological treatment, such as estrogen receptor inhibitors, androgens or Chinese herbal medicine, is feasible. When drug treatment is not effective and affects the patient’s life, psychology or appearance, surgical treatment can be chosen. At present, Western medical treatment mainly adopts surgery or hormone therapy, but there are many adverse reactions and high recurrence rate. The treatment advocates symptomatic treatment, using testosterone, clomiphene, and also with chorionic gonadotropin treatment. However, the efficacy is not very satisfactory, and it is easy to relapse after stopping the drug. In recent years, with the improvement of people’s living standard, the incidence and consultation rate of this disease has a tendency to increase significantly. Patients not only require cure of the disease itself, but also higher quality of life such as aesthetic appearance, which poses a new challenge to doctors for proper diagnosis and treatment. Chinese medicine treatment should be based on draining the liver and relieving depression, resolving phlegm and dispersing nodules. Commonly used to de-stress the liver, dissolve phlegm and disperse nodules, activate blood circulation and relieve pain to treat breast enlargement, breast swelling and pain caused by liver stagnation, phlegm and stagnation. 4. Precautions (1) Breast development during puberty needs to be distinguished from physiological breast enlargement, such as that occurring during puberty. Because the endocrine function is gradually active at this stage, the testes produce a large amount of androgens while estrogen production increases, and the sensitivity of breast tissue to estrogen increases, which stimulates hyperplasia and hypertrophy of breast tissue. It can occur unilaterally or bilaterally at the same time, mostly as a limited hyperplasia, often forming a disk-shaped hard lump or nodule under the areola, about 2-3 cm in diameter with clear edges, which can be freely pushed during examination. The enlarged breast may be distended, mildly painful to touch, and may even have a milk-like discharge. This kind of physiological breast enlargement is not harmful to health and is usually transient, so there is no need for treatment. (2) Prevention of breast cancer There is a possibility of cancer due to prolonged high estrogen stimulation, so clinical attention should be paid to differentiate it from breast cancer. Very few of the male breast lumps are malignant tumors, and old age is a cancer-prone period. If the breast development does not subside, drug treatment is feasible. If drug treatment is ineffective, accompanied by pain and affecting the aesthetics, surgery can be considered, and the timing of surgery should be chosen to strictly grasp the indications.