Mastopathy, called “mastopathy” in Chinese medicine, is a benign hyperplastic disease of the breast tissue that is neither inflammatory nor tumorigenic. Its incidence accounts for 40% of women of childbearing age and 75% of all breast diseases, and is the most common breast disease. With the changes in the social and natural environment, the accelerated pace of life, the increased awareness of competition and the change in dietary structure, the incidence of mastopathy has been on the rise year by year. Women with high socioeconomic status, high education level, early menarche, low birth status, older first pregnancy and late menopause are the high incidence of this disease. The main manifestations are breast pain and breast lumps, which tend to change with menstrual cycle or emotional changes.
Etiology and pathogenesis
1.Primary causes
Emotional and moral injury: People have emotional changes of joy, anger, sadness, thought, grief, fear, and fright, but if they are within the normal limits of physiological tolerance, they will not cause disease and are not called emotional and moral injury. If a person suffers from mental stimulation for a long period of time or is suddenly subjected to severe mental stimulation, which exceeds the range that the individual’s physiology can regulate, it can cause disease. Among breast diseases, breast enlargement disease is a typical disease of the emotions. In modern society, women, like men, bear the burden of society and family responsibilities, and the burden they have to bear is not light, coupled with the monthly menstrual flow, emotional fluctuations. The liver is endowed with the nature of the general, the body of Yin and Yang, a little emotional disorder, the liver Qi from the depression in the meridian, resulting in the irregularity of drainage, the light breast swelling and pain, the heavy invisible Qi stagnation into a tangible knot and the development of the disease.
Labor weariness internal injury: due to excessive work, especially overage in the workplace and a longer period of physical exertion, self-imposed pressure, as well as the social environment, living habits, psychological, physiological factors, resulting in excessive exertion, depletion of vital energy, damage to the kidneys and spleen and stomach, weakness of the spleen and stomach coupled with the deficiency of kidney qi, can not be instilled to nourish the flushing, the flushing of the disorder and the disease.
Diet: In recent years, the number of post-menopausal women suffering from mastopathy has increased, which is related to today’s diet intake of too much fat, sweet and thick products, too many nutrients, growth factors, estrogen, etc. The spleen and stomach are the backbone of the day, the spleen and stomach by the Sheng water and grain, to produce the nutrients needed by the body, irrigate the five organs and six bowels, to maintain the normal physiological functions of the body. If the diet is not moderate, overeating, or greedy for cold and cold, damage to the spleen and stomach, resulting in spleen weakness and stomach weakness, the inability to promote the normal operation of the body, the poor flow of Qi and blood, resulting in gas stagnation, blood stasis, phlegm coagulation and other pathological products, these pathological products stagnate in the breast local, can lead to this disease.
2.Secondary causes
Phlegm: If the congenital deficiency, weakness of the spleen and stomach, or greed for cold and cold, overeating and overeating, damage the spleen and stomach, spleen loss of health, then the clear yang does not rise, turbid yin does not descend, stay in the middle jiao, dampness and phlegm; liver is the main drainage, liver qi is in line with the qi, can promote the smooth distribution of fluid throughout the body, liver loss of drainage, qi stagnation, fluid stays in the body, liver depression into fire, refining fluid into phlegm, phlegm knots in the breast and become breast fetish.
Qi stagnation: External evil, internal injury or phlegm stagnation leads to poor flow of Qi, which is depressed in the body and cannot be released. The liver is the master of draining and regulating the qi flow, and affects the smooth flow of the two channels, so the liver is depressed and the qi is stagnant, then the function of spreading the fluid around the body is not in order and mastopathy is formed. Qi stagnation is blood stasis, phlegm and stasis of the same origin, the two cross knots are not dispersed more likely to form lumps.
3.Prompting factors
Excessive exertion, excessive emotions can trigger or aggravate the disease.
The occurrence of masturbation can be caused by a single internal organs, or by multiple internal organs. In the clinical evidence, liver qi stagnation caused by depression alone, spleen failure, phlegm and dampness are mostly seen in young women; compound factors cause the disease, mostly due to liver and kidney deficiencies, dysregulation of the flush, mostly seen in middle-aged and post-middle-aged women.
Clinical manifestations
1. Pain: Breast pain is mainly swelling pain, which may include stabbing and pulling pain. The pain often intensifies before menstruation and decreases after menstruation, or the pain changes with mood swings, and the pain is untouchable in severe cases, and there is also breast pain when walking or moving, which affects work and life in heavy cases.
2.Lumps: Breast lumps can occur in one or both breasts, mostly in the outer upper quadrant of the breast. The masses have a medium or hard texture, smooth or granular surface, good mobility, and are mostly accompanied by pressure pain. The size of the masses varies, usually 1 to 2 cm in diameter, and the larger ones can exceed 3 cm. The shape of the lumps can be lumpy, nodular, diffuse, striated, mixed, etc.
3. Breast lumps may increase in size and harden before menstruation, and slightly decrease in size and softness after menstruation. Individual patients may also have nipple discharge, which is white or yellowish green, or plasma-like.
4. Breast pain and breast lumps may appear simultaneously or sequentially, or pain may be the main cause, or lumps may be the main cause. Patients are often accompanied by menstrual disorders and irritability.
Differential diagnosis of mastopathy and breast cancer
Both of them can be seen as breast lumps, but the texture of breast lumps in mastocytosis is usually soft or medium hard, and the lumps are mostly bilateral and multiple, vary in size, and can be nodular, lumpy or granular, with good mobility and no adhesion to skin and surrounding tissues.
Breast lumps are usually hard, some are as hard as stone, most of them are unilateral, round, oval or irregular in shape, and can grow to a large size, with poor mobility and easy adhesion to the skin and surrounding tissues. In addition, on the mammogram of breast, breast cancer often appears as lump shadow, tiny calcified dots, abnormal vascular shadow and burr, which can also help in the diagnosis. Mass needle aspiration of breast cancer can find heterogeneous cells. The final diagnosis needs to be based on the histopathological examination results.
Treatment
1.Treatment by holistic diagnosis
Chinese medicine focuses on treating the root of the disease. The root of breast enlargement disease is liver, spleen, kidney and punching.
(1) For patients who are emotionally depressed, irritable and under stress at work, they belong to the liver-depressed and qi-stagnant type, and should be treated from the liver.
(2) For patients with high work and life stress, long-term physical exertion, easy fatigue, liver depression and spleen, spleen deficiency and phlegm, phlegm and phlegm stagnation, stagnation in the breast lobe, the patient should be classified as spleen deficiency and phlegm stagnation type, the treatment should start from the spleen, the treatment is based on strengthening the spleen and resolving phlegm, the formula is Xiang Sha Liu Jun Zi Tang, Ginseng Ling Bai Zhu San plus or minus.
(3) For menstrual irregularities, premenstrual breast swelling and lumpiness aggravated, back pain or pain in the abdomen before menstruation, and emotional discomfort, it is classified as the type of dysregulation of the flushing and the deficiency of the liver and kidney.
In clinical practice, there are often mixed types of liver, spleen and kidney, so the three methods should be used together. In the identification treatment, the treatment of liver, spleen and kidney (Chong Ren) should be focused on each other, in order to cope with the clinical complexity and changes.
2.Local evidence-based treatment
Mastocytosis should also pay attention to the identification and treatment of local symptoms and signs.
(1) For those with local pain and tenderness without lumps, they are invisible and have qi stagnation, and it is proposed to use Chinese herbal medicines to relax the liver and regulate qi, such as Chai Hu, Yu Jin, Xiang Fu, Yan Hu Suo, and Fo Shi.
(2) For those with localized lumps, they are tangible and are formed by qi stagnation for a long time. Those with soft and tough feeling on palpation are mostly cystic hyperplasia of the breast, while those with hard and tough texture are mostly fibrotic hyperplasia or fibromatosis, and should be treated with herbs to invigorate blood circulation and remove blood stasis, soften and disperse knots, such as Salvia miltiorrhiza, Panax ginseng, Paeonia lactiflora, Peach kernel, Motherwort, Elephant’s mantle, Sea fushion, Calcined oyster, etc.
(3) For those with nipple overflow, treatment should be identified on the basis of identification of evidence and disease.
(4) For patients with mastocytosis accompanied by uterine fibroids and ovarian cysts, additional products can be used to regulate qi and invigorate blood circulation, soften hardness and disperse knots, such as cumin, golden belladonna, danggui tail, wang bu liuxing, curcuma longa, tu fu ling, cuscuta, etc.
3.External treatment
The external treatment for this disease includes: Chinese herbal patching method, Chinese herbal ironing method, drug breast mask, local fumigation, iontophoresis, etc.
4.Food therapy formula: Here we recommend some food therapy formula for the treatment of mastocytosis for reference.
(1) boiled eggs with mugwort leaves
Main ingredients: 150 grams of mugwort leaves, 2 eggs.
Preparation: Boil together.
Serving method: Discard the soup and eat the eggs.
Effects: Relieves liver and Qi, resolves phlegm and softens firmness. Suitable for liver depression and phlegm coagulation type breast enlargement.
(2) green skin two flowers tea
Ingredients: chrysanthemum, rose, 10 grams each, 6 grams of green peel.
Preparation: the above medicine brewed with boiling water.
Dosage: drink as tea.
Effects: Clearing heat and dissipating nodules, suitable for breast enlargement.
(3) Wang Bu Liu Xing lean meat soup
Ingredients: 250 grams of lean pork, 12 grams of Wang Bu Liuxiang, 30 grams of astragalus.
Method: 3 materials washed, put together in a pot, add water to the appropriate amount, boil over high heat, change the fire to low boil 1 to 2 hours, seasoning for use.
Serving method: eat with meals.
Effects: Tonifies the qi, strengthens the spleen and promotes lactation. It is suitable for those who have breast enlargement due to physical deficiency.
Prevention and care
1, mastopathy patients pay attention to maintain a good attitude of openness and cheerfulness, to resist the negative emotions of tension and anxiety.
2, pay attention to maintain a combination of work and rest, work in an orderly manner, timely relief of work tension, overdraft, pressure state.
3, pay attention to maintain a pleasant and harmonious living environment, healthy dietary hygiene habits, should be appropriate to control the intake of fatty foods.
4, timely treatment of menstrual disorders, uterine fibroids, ovarian cysts and other gynecological disorders and other endocrine diseases.
5, postmenopausal women with incomplete breast degeneration and hyperplasia coexist, prone to abnormal hyperplasia and cancer, need to strengthen the examination, follow-up observation, be alert to cancer.