Canker sores are acute purulent diseases that occur in the breast. It is characterized by painful lumps and swelling in the breast, with generalized fever and thick pus after ulceration. It is often seen in lactating women, especially in primiparous women who are not yet full term. This disease is equivalent to acute mastitis in Western medicine.
[Etiology]
Stagnation of liver and qi, internal injury of emotion and will, which leads to lumpy milk; stagnation of heat for a long time, which leads to pus when the heat is stronger than the flesh; stagnation of stomach heat, which leads to blockage of milk channels and canker sores due to eating fatty, sweet and thick food after childbirth; stagnation of milk, broken or sunken nipples, which affects breastfeeding and leads to poor discharge of milk, or the accumulation of residual milk that cannot be sucked up by the baby, which leads to stagnation of milk and becomes canker sores due to heat over time.
[Diagnosis]
It is most common in nursing women who have not yet reached the full term after delivery, especially in those with broken nipples or stagnant milk.
The patient feels painful swelling of the affected breast and a hard lump (or no hard lump), mostly in the lower outer quadrant of the breast, with poor milk drainage; accompanied by systemic symptoms such as fever, chills, headache and bone pain, and loss of appetite. After treatment, if the fever and chills subside and the swelling and pain decrease within 2-3 days, the disease will be cured.
Pus-forming stage: the above-mentioned symptoms are aggravated, the hard lump gradually increases, followed by redness and burning of the skin, pulsating pain, pressure pain, swollen lymph nodes in the axilla on the affected side, and high fever that does not subside, which is a sign of suppuration. If the center of the hard mass is gradually soft and there is a fluctuating feeling when pressing it, it indicates that the abscess has been cooked. However, the fluctuating sensation of deep abscess is not obvious, and puncture is needed to determine it.
Fulminant stage: After natural breakage or incision and drainage of pus, the swelling and pain will generally be reduced, and the fever and chills will gradually subside and heal. If the pus does not flow smoothly, the swelling and heat do not subside, the pain does not subside, and the fever does not subside, pockets of pus may form, or the pus may spread to other breast sacs (glandular lobes), forming “transcystic canker sores”, or sepsis may develop. If the milk overflows from the sore and is not cured for a long time, it may form a milk leak.
[Differential diagnosis]
Plasmacytoid mastitis occurs most often in non-lactating women, but can also occur during lactation. The lump is located in the areola and is associated with sunken and indented nipples, red and swollen areola skin, itching or burning sensation, and later becomes painful. The nipple overflows with reddish-brown, green or black fluid, and soft nodules with indistinct margins can be found in the subareolar area, or occasionally hard nodules.
[Treatment]
Massage: In cases of canker sores with localized swelling and pain and obvious stasis of milk, breast massage is feasible. First apply hot compress, then apply a little lubricant to the affected breast, gently pull the nipple several times, then hold up the affected breast with the palm of one hand, and gently push the fingers of the other hand together from the base edge of the breast to the nipple to squeeze out the stagnant milk gradually.
Second, the depressed breast period with gold cream or yulu cream compress; or with fresh wild chrysanthemum, fresh dandelion, fresh dicotyledonous grass, cactus (remove the thorns), etc. washed and pounded external compress; or with 20% mannitol solution wet compress; or with rhubarb, mannitol, each equal parts of the research powder, the appropriate amount of Vaseline dressing.
Third, the pus-forming stage of local press with a sense of fluctuation or by puncture to extract pus pus, should be timely incision and drainage. Generally, a radial incision in the direction of the nipple is used, and the location of the incision is chosen at a slightly lower part of the abscess, but it is necessary to avoid surgical damage to the breast complex to form a breast leak. In the case of superficial abscesses in the areola, abscesses behind the breast or abscesses around the breast, an arc-shaped incision can be made at the edge of the areola or around the breast. If the abscess cavity is large, counter-oral drainage can be made at the lowest part of the abscess cavity if necessary. If the abscess is small and shallow, needle aspiration can be used to extract the pus.
If the pus is exhausted, the pus cavity can be pressurized with cotton pads so that the pus will not be retained; if there is overflow of milk from the sore, the affected side can be tightened with cotton pads to drain the milk and promote healing; if it becomes a transcystic canker sore, another opening can be made at the point where the lump should be pressed; if it forms a sinus tract in the breast, a sinus tract can be made. If a sinus tract is formed in the breast, insert a five-five dan medicine twist into the sinus tract to the depth of the pus cavity to corrode the wall of the canal, and then use a nine-one dan medicine thread until the pus is reduced and the pus is purified.
[Other treatments]
Acupuncture and moxibustion: take shoulder well, danzhong, sansanli, liege and diaphragm points, and use the acupuncture and diarrhea method, keeping the needles for 15-30 minutes, once a day.
[Prevention and Regimen]
1, after 5 months of pregnancy, often scrub the nipples with warm water or 75% alcohol; pregnant women with nipple invagination, should often squeeze and lift to correct, available small wine cups to tap and suck.
2, the mother should be instructed to breastfeed reasonably, to develop the habit of regular breastfeeding, to keep the milk discharge smooth; too much milk, the use of breast pump to suck out the milk to empty, to prevent stagnant milk.
3, keep the nipples clean, such as nipple cracking, abrasions should be promptly treated.
4, pay attention to the baby’s oral cleanliness, do not let the baby sleep with the nipple in his mouth.
5. The mother should keep her spirit relaxed and avoid excessive emotions, and should gradually reduce the number of breastfeeding sessions before weaning.
[Identification and treatment]
(A) Painful swelling of the breast with or without lumps, unchanged or slightly red skin color, poor milk drainage; accompanied by fever, headache, thirst, constipation; light red or red tongue, thin yellow fur, floating or string pulse.
Analysis: internal injury of emotion and will, liver qi stagnation, depression and heat, combined with postpartum wanton eating of thick flavors, heat accumulation in the stomach, resulting in heat in the liver and stomach, stagnation of qi and blood, blockage of breast channels, pain if not pass, so the breast swelling and pain with lumps; internal heat, so the skin of the affected side of the breast is slightly red; internal heat, positive and evil competition, loss of harmony between the Ying and Wei, so vicious chills and fever, headache and bone pain; heat in the stomach, so thirst, constipation, red tongue with thin yellow moss; string pulse belongs to the liver, thin yellow pulse. Numerical pulse is heat.
Treatment: Drain the liver and clear the stomach, promote lactation and eliminate swelling.
Remedy: Guahuabu burdock soup with addition and subtraction. If the milk is too congested, add Wang Bu Liu Xing, Lu Lu Tong, and Le Liu to clear the milk; if the milk is congested after weaning, add Sheng Shan Zha and Sheng Ma Sha to return the milk; if the postpartum dew is not yet complete, add Gui Wei, Chuan Xiong, and Yi Mu Cao to remove stasis; if the breast lumps are obvious, add Angelica Sinensis, Red Peony, and Tao Ren to invigorate the blood and remove stasis; if the stool is constipated, add Sheng Da Huang and Huo Ma Ren to relax the stool.
(2) The lump with heat toxicity gradually increases in size, the skin is red, burning, painful like chicken pecking, the center of the lump is gradually softening, with a feeling of fingertips; it may be accompanied by strong heat, thirst for cold, red face and eyes, restlessness, constipation, short red urine; the tongue is red, the coating is yellow and dry, and the pulse is counted or slippery.
Analysis: Heat in the liver and stomach, heat and toxin, blockage of breast channels, stagnation of Qi and blood, so the breast lump gradually increases in size, with localized heat, pain and burning; when heat is strong, flesh rots into pus, so the lump becomes soft in the center and feels like a finger when pressed; fire and heat inflammation, so the face is red and the eyes are red; heat disturbs the mind, so irritability and restlessness; fire and heat injures yin, so fluid is depleted, so the urine is short and red; fluid injury leads to water for self-help, so thirst and drinking cold; intestinal heat and fluid deficiency, so the stool is dry; the tongue is red, the fur is yellow, and the pulse is slippery. The red tongue, yellow fur and number of pulse are all heat signs.
Treatment: Clearing heat and detoxifying the toxin, and promoting toxicity to penetrate pus.
Prescription: Add flavor to penetrate pus. In case of severe heat, add raw gypsum, Zhi Mu, Jin Yin Hua and Dandelion to clear heat and detoxify.
(3) The swelling and pain of the breast is relieved after the ulceration, but the sore is constantly filled with pus, the pus is thin, the healing is slow, or the milk overflows from the sore to form a milk leak; the face is less florid, the body is weak, the head is dizzy, or the low fever does not subside, and the appetite is weak; the tongue is pale, the fur is thin, and the pulse is weak and feeble.
Analysis: After the pus is broken, the pus and toxin will be drained and the swelling and pain will be reduced; however, if the body is deficient, even though the pus and toxin are drained after the ulcer, the Qi and blood are deficient, so the mouth will be closed slowly; the weakness of Qi and blood can be seen as less color, general weakness, dizziness and dizziness; the pale tongue, thin coating and weak pulse are signs of Qi and blood deficiency.
Treatment: Benefit Qi, harmonize Ying, and restrain toxins.
Radicals: Tori Disinfection San plus or minus.